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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareFamily Functionality in Tuberculosis Patients Tended in Health Facility of Los Olivos, 2019
English0106Choqui-Collahua NicoleEnglish Ramirez-Aguilar GroverEnglish Meneses-Claudio BrianEnglish Matta-Solis HernanEnglishEnglish Family, Family Functionality, Health Center, Survey, Treatment, TuberculosisIntroduction
Family functionality is the establishment of bonds and affective ties.1 The family as a nucleus experiences numerous situations, which can unbalance and cause the breakdown of its integrity, if they do not find a solution so, it can trigger a crisis.
According to the World Health Organization (WHO), tuberculosis (TB) is one of the 10 leading causes of death in the world. In 2018, 10 million people became ill with TB, of which 1.5 million died from the disease.2 It is considered a highly contagious and even lethal disease if the family does not propose preventive and promotional measures, going to the nearest Health Center.
According to the Pan American Health Organization (PAHO), in its 2017 report, it indicates that Peru is the second country with the highest TB burden, being the Lima and Callao departments where 64% of the cases are concentrated respectively.3,4
According to the Ministerio de Salud (MINSA), in its 2016 report, a total of 30.260 positive symptoms were recorded between the ranges 30 - 59 years old.5
The spread of tuberculosis is through expectoration, maintaining a dialogue from an infected person to a healthy person, by which the bacillary concentration is transported through the respiratory tract, reaching the lungs, in 79 to 87% and even locating in other body parts. The causes of tuberculosis are an intense cough that lasts 2 weeks, weakness when carrying out daily activities, become fatigued quickly, fever, night sweats.6,7
Patient with tuberculosis complies with protocols assigned by the health personnel, where it attends its treatments, one of the factors for which it is vulnerable falls to the psychological aspect with 32.9%, triggering in some cases the stigmatization of the patient at home with 8.5%, often causing internal discomfort, falling into initial stages of depression, loneliness and sadness.8
It presents research collected to reduce 90% of deaths from TB and 80% of the incidence of this disease compared to 2015, it is necessary to improve the provision of personnel and apply other strategies such as increasing the number of agent’s community. Concluding that although the health services of DIRESA Callao have adequate infrastructure, there are serious limitations in personnel and the information system, regarding the management of TB cases at the first level of care.9
The authors present different studies at the Latin American level, one of them Cuba, they show that the patient who lives in nuclear family groups approximates a higher percentage of complying with their pharmacological treatment, which is complemented by the research study carried out in 68 families who represents 35% of the total, who comply with the health treatment.10
The objective of the study is to determine the family functionality in people affected by tuberculosis in Health Facility, belonging to the Los Olivos district, which it will allow providing relevant and important data about the role played by the family environment in their progressive recovery of the patient with tuberculosis.
The study applied the data collection instrument Family Functioning Assessment Scale (FFAS) was created by David H. Olson, which has been useful to assess family functionality in families of tuberculosis patients from the district of Los Olivos.
The data collection processing was done through the survey of patients affected with tuberculosis, the data to be entered were performed in a data matrix that was designed in the statistical program SPSS (Statistical Package for the Social Sciences) in version 23.0, which it allowed a better data processing for the realization of statistical tables and graphs, later they are described and interpreted in results and discussions, respectively.
The research work is structured as follows: In section II, the development of the data collection processing of tuberculosis patients will be presented and the guidelines to be considered so that they are within the research work. In section III, the results will show the family functionality of the patients treated in the Health establishments of Los Olivos, according to the specified dimensions of the variables measurement instruments. In section IV, it presents the research work discussions, in section V, the conclusions and in section VI the recommendations as well as the future work that is intended to be achieved with the research work.
Methodology
In this part, the type and design of the research will be evidenced, as well as the population and sample that will be carried out in the research work, in addition to the inclusion and exclusion criteria, and finally, the data collection technique and instrument.
Research Type and Design
The present research work is non-experimental, descriptive with a quantitative approach, it is a cross-sectional correlational investigation.
Population and Sample
The population will be made up of 192 families from the Los Olivos Health Establishments, which have relatives with tuberculosis.
Inclusion Criteria
People over 18 years old who have a diagnosis of tuberculosis.
People with a diagnosis of tuberculosis undergo treatment in the centres of health establishments.
People with a diagnosis of Extra-pulmonary, sensitive, multidrug-resistant, and extremely resistant tuberculosis who are registered in health establishments.
People who have lived in the jurisdiction of Los Olivos district for 4-6 months.
People affected by tuberculosis who wishes to participate and signs the informed consent.
Exclusion Criteria
People under 18 years old who have a diagnosis of tuberculosis.
The person with tuberculosis does not present alterations in their physical and/or mental capacity.
People who have not lived in the jurisdiction of Los Olivos district for 4-6 months.
People affected by tuberculosis who do not wish to participate or sign the informed consent called “CARTA N°011-2019-EPENF-UCH”.
Technique and Instrument
The technique that was used is the survey, through the questionnaire or data collection instrument on Family Functionality, which aims to measure Family Functionality in patients with tuberculosis treated in Health establishments in the Los Olivos District.
The FACES IV Family Functionality scale was created by David H. Olson, in 1991, its application is given individually, with an approximate duration of 15 minutes, it is aimed at people who are older than 18 years old. The Family Functionality Scale in its definitive version is composed of 42 items, distributed in 2 dimensions: Cohesion consisting of 3 sub-dimensions: Unbound, Balanced Cohesion, and entangled, consisting of 7 items each. The flexibility that groups 3 sub-dimensions: Rigid, Balanced Flexibility, Chaotic, which consist of 7 items each; it also consists of 5 response alternatives, from "very disagree", "generally disagree", "undecided", "generally agree" and "totally agree"11.
Place and Application of the Instrument
The survey carried out to measure Family Functionality in patients with Tuberculosis was carried out in health establishments in the Los Olivos District.
The survey was carried out in morning shifts, the questionnaire was carried out to the patients with an average time of 15 minutes to each selected (those who have more than 18 years old, according to the inclusion criteria) in the research work, it was concluded with regular satisfaction at the time of collecting the surveys, since, at the time of the interview with the patients, many were suspicious of providing their data, and refused to participate in the research work.
In Figure 1, the arrival of the patients is expected to comply with their respective treatment and at the same time survey with prior consent, on Family Functionality in patients with tuberculosis of the Juan Pablo II Health establishment, belonging to the Los Olivos District.
In Figure 2, the medical records and the first and second choice pharmacological treatments of patients with Multidrug-resistant Pulmonary Tuberculosis can be visualized.
Therefore, it is important to emphasize the presence of health professionals, which is of important mental health, the type of diet they follow according to the protocol, in order soon, to meet the objective of their restoration, the well-being of the patient and return to work activities.
Result
A summary table of the surveys carried out following the guidelines corresponding to the research work will be shown below:
In Figure 3, it can observe family functionality in its cohesion dimension, where 99 (52%) are very connected, 42 (22%) are connected, 35 (18%) are tangled, 11 (6%) are not very connected and 5 (3%) are unbound.
In Figure 4, it can observe family functionality is in its flexibility dimension, where 136 (71%) are flexible, 45 (23%) are not very flexible, 10 (5%) are very flexible and 1 (1%) is rigid.
In Figure 5, it can observe family functionality in its communication dimension, where the high level prevailed with 95 (49%) patients.
In Figure 6, it can observe family functionality in its satisfaction dimension, where the low level prevailed with 67 (35%) patients.
The management of the situations mentioned above can favour the incidence of tuberculosis in patients treated in the different First Level Health Establishments, which not only requires greater efforts in terms of economic, human, organizational, and operational resources.
Despite the constancy on the part of health personnel in different areas, our research shows that Family Health still needs to be addressed in its entirety, starting with working clearly with the family because this is vitally important support, due to person who has tuberculosis at all levels can achieve the completion of treatment and a speedy recovery.
Discussion
In the present study, the topic of Family Functionality is raised, in the established dimensions, assessing the operation of families in people with tuberculosis assisted in the Los Olivos Health Establishments.
Applying the FACE IV Questionnaire, the Family Functionality variable was measured, being useful as a relational diagnosis and focused on the family system, in its three dimensions: Cohesion, Flexibility and Communication12.
Regarding its Family Cohesion dimension, in people affected by tuberculosis assisted in Health Establishments in Los Olivos, the very connected Family Functionality predominated, followed by connected, tangled, not very connected and unbound, are those that determine in a general way.
For this it is important that, during the treatment stage of the disease in the patient, to adapt to this new situation, the family sets in motion self-regulation mechanisms that allow it to continue to function, in such a way that changes are generated in the family interactions leading to a balance or imbalance, putting the well-being and management of the sick patient at risk, as well as the functionality of the family system13. The results of Jiménez L, Lorence B and collaborators, concluded that its Family Cohesion dimension presented a good cohesion with 50%, compared to Table 1, where it shows 52%, a good connection of support and decisions throughout the family group12.
Regarding Family Functionality according to the Family Flexibility dimension, in people with tuberculosis, flexibility prevailed, followed by not very flexible and very flexible, this dimension refers to the roles shared by each family member.
Different studies were obtained from Spleen J, Spleen O and collaborators, who mention in their study that the dimensions of Family Flexibility showed good flexibility with 55%, representing docile flexible families14.
Regarding Family Functionality in its Family Communication dimension, in patients with tuberculosis, high levels prevailed followed by moderate levels, very high levels, very low levels and low levels. This dimension refers to the fact that there is communication in the family environment where they interact assertively.
Good communication is essential in the family environment, which leads to multiple benefits and can even achieve good relationship stability among their family group. According to studies by Julca F, Melgar C, in their research, they coincide with the fact that the family establishes continuous communication with the patient.15
Regarding Family Functionality in its Family Satisfaction dimension, in patients with tuberculosis in Los Olivos Health Establishments, low-level Family Functionality prevailed, followed by moderate level, very low level and very high-level Family Functionality.
According to the results reflected, it was low, because both the affected person as well as the family environment undergo changes in the emotional, from the patient in transmitting the disease to others, and in the family participants in being protected with biosecurity material at the time to establish a dialogue.16
Conclusions
Numerous preventive programs in Health Establishments at all levels are generally focused on avoiding infectious and chronic diseases, without considering mental health.
The frequency of family support in the patients with tuberculosis analyzed indicates that in our environment mental disorders can become a public health problem, since it is a condition that can be treated and, when recognized, it is possible to increase and raise awareness of family support and prevent new episodes of the disease.
Therefore, preventive, and promotional measures should be included in the first level of medical care to provide psychological support to relatives and patients diagnosed with tuberculosis; This is important if they come from extended families, as this can help reduce the prevalence of depression in these patients. In addition, if severe depression or persistent problems are found in the relationship between family members, the patient and their relatives should be referred to a systematic family therapist.
Recommendations
Compare the results with the leadership of the various Health Establishments of the First Level of Attention of the Los Olivos District, considering and guiding the interdisciplinary and interdepartmental work, through strategies. In this field, nursing will direct and strengthen the care of affected patients and families, thus promoting the implementation of community and family health plans and reducing the lack of family support.
Implementation in first-level care facilities in the Los Olivos district with programs of sessions aimed at patients and families who were at high risk, being a vulnerable population.
To form family support groups for tuberculosis patients to achieve greater success in adherence to drug treatment. Also, we want to make consent to a family with the treat and care of a tuberculosis patient.
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. Also, the help of the Universidad de Ciencias y Humanidades for the advice and payment of the research work.
Conflict of Interest
The authors declare that they have no conflict of interest.
Source of Funding
The research work did not receive any monetary funds to carry it out.
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16. Alcívar L, Arteaga M, Cando M, Vinces T. Factors that influence the presence of tuberculosis. Revista Científica Dominio de las Ciencias; 2018; 4(4): 69-97. Available from: https://dialnet.unirioja.es/servlet/articulo?codigo=6657248
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareImmuno-Metabolic Aspects of Pathological Processes
English0713Zemskov Vladimir MEnglish Zemskov Andrey MEnglish Pronko Konstantin NEnglish Neymann VictoriaEnglish Demidova Valentina SEnglish Zemskova Veronika AEnglish Barsukov Alexander AEnglish Kozlova Maria NEnglish Shishkina Nadezhda SEnglish Revishvili AmiraEnglishEnglishMetabolic syndrome, Modulators, Antioxidants, Laboratory markers, Immuno-metabolic disorders, Targeted correctionINTRODUCTION
Immuno-metabolic disorders are a probable universal element of the pathogenesis of a wide range of diseases. It seems relevant to study these mechanisms and the possibilities of their targeted correction.1
FUNCTIONAL RELATIONSHIP OF IMMUNO-METABOLIC MECHANISMS
Nucleic acid exchange
Its state is a marker of the severity of pathological processes and regulation of immune reactivity.2 So, in the acute period of nonspecific bronchopulmonary diseases in patients, accumulation occurs in the blood, and in lymphocytes, the synthesis of nucleic acids (NA) is stimulated with a decrease in parameter values ??in the stage of remission and after effective therapy. An indirect confirmation of the stated pattern is the fact of an increase in urinary excretion of the components of NA guanine, uracil, cytidine, and thymine in children during the period of asthma attacks in the relatively calm period of bronchial asthma. In patients with the absence of normalization of nucleic acid metabolism, there was no clear recovery, and chronicity of the pathology was noted. A significant inverse correlation was found between the content of plasma RNA and "zero" lymphocytes with bronchial asthma, chronic pneumonia, and a direct correlation with mature T and B cells.3Perhaps RNA is one of the factors limiting the maturation of lymphocytes. A possible secondary messenger between NA and immune reactivity is the cyclic nucleotide system cAMP/cGMP.4
In patients with peptic ulcer disease and nonspecific inflammatory lung diseases, a direct correlation was established between the content of serum RNA with the level of T-cells and an inverse relationship with immature “zero” lymphocytes. Violation of RNA metabolism was closely related to the content of cAMP in the mucosa. In the case of gastric ulcer and to a lesser extent in the case of duodenal ulcer, the amount of cAMP in the mucosal area remote from the defect was overstated, and in the case of peptic ulcer of the anastomosis, it was reduced. In the area of ??direct injury, the amount of cAMP in the tissue was reduced.3,5 A direct correlation was established.6,7 between the content of the total pool of nucleic acids (DNA+RNA) in the blood serum in acute dysentery in proportion to its severity.
The role of low molecular weight ribonucleotides
In infection and immunity
The accumulation of RNA in the body in the initial period of the development of the infectious process stimulates the reproduction of microorganisms of various taxonomic groups, the selection of virulent clones, the production of exotoxins, which causes the potentiation of the infection.2,3,8 Later, the same factor causes an increase in antigenicity, immunogenicity, antibiotic sensitivity bacteria. To this should be added the activation of the mobility, absorption, and metabolic capacity of macrophages, the production of humoral defence factors, quantitative and functional characteristics of populations of lymphocytes, differentiation, cooperation of T- and B-lymphocytes, which provides an increase in the body's resistance.
Nucleic acids and, above all, RNA, replenish the fund of substances necessary for the normal functioning of the body. ATP is a source of energy, cytosine nucleotides are involved in the synthesis of lipids, uridine, and guanine nucleotides in the exchange of polysaccharides, and the latter is also involved in the synthesis of proteins. There is an indirect, mediated pathway of RNA action on cells through the system of cyclic nucleotides.
Metabolic immunomodulation
Antioxidant protection
It is carried out by a system of high-molecular enzymes (superoxide dismutase (SOD), catalase, glutathione peroxidase, glutathione reductase), and low-molecular bio-antioxidants proteins containing metals with variable valence (transferrin, ferritin, ceruloplasmin-CP). The second non-enzymatic group of AOD is made up of carotenoids (β-carotene, retinol), α-tocopherols, polyunsaturated phospholipids, ascorbic acid, glutathione, some amino acids, urea, uric acid, and selenium compounds. High-molecular antioxidants are associated with various cellular structures, while low-molecular antioxidants are relatively freely distributed between cells, intercellular fluids, and blood. A decrease in the antioxidant potential is accompanied by the need to replenish the pool of low molecular weight metabolites by their exogenous introduction into the body.9
Free radical oxidation processes lipids and proteins
They are central to cell metabolism. The products of this process are a source of energy, plastic material for the creation and renewal of cellular structures, are directly involved in the metabolism of carbohydrates, lipids, proteins, nucleic acids, the biosynthesis of prostaglandins, and catecholamines, and regulate the permeability of biological membranes.10FRO reactions are an indicator of resistance stationary mode of biochemical transformations in the body, regulating its adaptive capabilities. The main laboratory parameters of FRO are malondialdehyde (MDA), diene conjugates (DC), ketodienes (KD), bityrosine cross-links (BC), Schiff bases (SB).
Therapeutic metabolic modulation
Immunodeficiency states are realized through targeted stimulation of the AOS (antioxidant system). The most widely used antioxidant drugs are energizers riboflavin and nicotinamide, free fatty acids, pantothenate and carnitine, glycolysis activators thiamine, riboxin, beta-oxidation stimulants biotin, thiamine, lipoate, antioxidants β-carotene, retinol, α-tocopherol, ascorbic acid, ubiquinone, polyunsaturated phospholipids, hepato-protectors essential, carsil, lipostabil, phosphoglyph, medicinal enzymes trypsin and other proteolytic drugs.9
Immuno-metabolic associations
The correlation dependence of metabolic parameters on the indices of the T-link of immunity was revealed, and positive correlations undoubtedly prevailed over negative ones. The level of total T-lymphocytes had a positive relationship with thymol "test", blood amylase, cholesterol, prothrombin, the antioxidant activity of blood plasma (AOA), the activity of superoxide dismutase, and negative with ALAT (alanine- aminotransferase). All three types of regulatory cells had a negative significant association with ALAT. The absorption capacity of leukocytes, assessed by the phagocytic index (PI) and phagocytic number (PN), was under the "negative control" of prothrombin, ALAT, thymol "test", free and bound bilirubin, and under the "positive control" of cholesterol. Prothrombin was negatively associated with the metabolic activity of neutrophils, and total bilirubin, ASAT (aspartate aminotransferase), and total protein were positively "dependent" on them .11
The coordinated dynamics of key tests of the formula of immune system disorders with metabolic parameters in patients with proinflammatory diseases is of theoretical importance.12In pyoderma, the formula CIC3+NKc3+IL63+ (deciphering the designations of the formulas in the text and the table) with the total antioxidant blood activity (AOA), total thiols, SB, CP, with pyelonephritis of the formula B3+MVM3+NBTsp2- with vitamin E (VE), SOD, respectively, with chronic adnexitis T3+IgM3+IL63+ with SB, CP, KD, and in chronic cystitis of the formula Tc3+IgA2-IL63+ with DC, BE, BC. These regularities changed after the correction.
Pathogenesis of metabolic syndrome (MS)
The pathogenesis of MS is based on insulin resistance, which entails hyperinsulinism. There is evidence that it is visceral obesity, an increase in the activity of many counterinsular hormones (insulin antagonists) that provoke and maintain insulin resistance. As indicated by Talantov et al. and Shevchuk (cited from 13), patients with MS have decreased levels of TSH (thyroid-stimulating hormone), thyroid hormones T3 and T4, STH (somatotropic hormone) with a simultaneous increase in ACTH (adrenocorticotropic hormone) levels, cortisol, aldosterone. Analysis of the state of the immune system in patients MS without concomitant chronic infections and thyroid pathology disorders of the immune system were revealed in a decrease in the number of T-lymphocytes and dysimmuno-globulinemia, with this pathology there is an inversion of the immune status with a deficiency of T-suppressors, T-helpers, NK-cells. Autoimmune thyroiditis was detected in 54%, chronic infectious diseases in 58.3%, their combination in 29.2%.13
There is a frequent combination of diabetes mellitus with thyroid pathology, which may also indicate the interest of the immune system in the latter. 14
Ischemic and hemorrhagic strokes, burdened
With metabolic syndrome
The layering of this pathology on various diseases causes a probable, but insufficiently studied, change in the homeostasis of the body. It was found that patients with similar processes develop a qualitatively similar, quantitatively more pronounced reaction in hemorrhagic stroke in the form of an imbalance of the primary and secondary products of free radical oxidation of lipids and proteins, preferential activation of enzymatic and non-enzymatic mechanisms of the antioxidant system against the background of accumulation of pro-inflammatory cytokines.15
Ischemic heart disease, aggravated
Metabolic syndrome
This complication causes pathological stimulation of carbohydrate and lipid components of the antioxidant system, cytokine, endocrine, and other indicators - glucose, insulin, glycosylated haemoglobin, HOMA-IR, IL-1β, IL8, thyroglobulin, γ-interferon (γ-IFN).11
The functional unity of the central nervous system,
Endocrine and immune regulatory systems
The ability of various parts of the brain to regulate the severity of immune reactions, innervation of the central and peripheral organs of the immune system, and conditioned reflex and intellectual modification of its functions was established. As well as the production of various regulatory peptide hormones by the organs of the immunocompetent sphere, and the CNS of mediators of the immune system, the “endocrine-like” effect of cytokines with the reproduction of endocrine function and the presence of common receptors in nerve and immunocompetent cells, stimulating and suppressive immunotropic potencies of hormones. It is essential that the restoration of disorders of one system - the immune, is accompanied by changes at the level of the organism, causing modifications in the endocrine status, metabolic parameters, the nervous system. 16, 17, 18, 19
RELATIONSHIP OF IMMUNO-METABOLIC DISORDERS
WITH CLINICAL COURSE OF DISEASES
Severe asphyxia in newborns
In these sick children, a significant negative relationship was found between the levels of CD3, CD4, CD8, CD95 lymphocytes and the degree of anti-infectious resistance. At the same time, the concentration of IgA in the umbilical cord blood correlated with the formation of atopic dermatitis (AD) in the child, anaemias, CD56 lymphocytes with intestinal dysbiosis, urinary tract infection, vulvovaginitis.20The correlation analysis revealed a negative dependence of the NBTac of neutrophils in the umbilical cord blood and oligohydramnios, CD4 levels on days 4-5, and polyhydramnios, vaginal candidiasis in the mother during pregnancy, endometritis, and the content of CD95 lymphocytes and gestosis. A positive relationship was found in the value of PN with a long anhydrous gap in the mother and the number of CD56 lymphocytes on days 4-5 with perinatal damage to the central nervous system of the child.
The role of metabolic processes in the
Genesis of diseases
Evidence of their participation in pathology is the accumulation of low molecular weight nucleic acids in thyrotoxicosis, primary rheumatic heart disease, infiltrative tuberculosis, dysentery, poisoning, radiation damage, and a decrease in rheumatoid arthritis, obstructive jaundice, infectious hepatitis, diabetes mellitus, peptic ulcer of the gastrointestinal tract and alcohol intoxication.21 At the same time, clinical models of eight variants of cerebrovascular diseases have shown the involvement of lipid peroxidation and antioxidant system factors in key immune mechanisms of metabolic reactions as the severity of the pathological process increases.5, 12
CORRECTION OF IMMUNO-METABOLIC DISORDERS
Metabolic effects of immuno-modulators
Poly- and lipopolysaccharides
Thus, the metabolic action of this group of drugs is expressed in the intensification of protein synthesis, activation of the "adenylate cyclase - cAMP" system, various enzyme systems, and the inclusion of 3H-thymidine into the spleen cells.22
Prodigiosan
Under its influence, 23 the activity of glycolytic dehydrogenases was significantly stimulated (cytoplasmic α-GPDG [α-glycerophosphate dehydrogenase] and LDG [lactate dehydrogenase]), the activity of the key enzyme hexose monophosphate shunt (G-6-PDG). The general effect of prodigiosin on the body was expressed in the mobilization of the hormonal system "pituitary-adrenal cortex", activation of lymphoid cells, macrophages, plasmocytes, synthesizing immunoglobulins.
Synthetic modulators
Synthetic double-stranded RNA poly I: C,
poly-A: U, poly G: C
They increased the incorporation of 3H-thymidine into lymphoid and other cells, stimulated the formation of adenylate cyclase, cAMP, and had colossal immunomodulatory activity.24
Thymusderivatives, myelo peptides
Potentiated the synthesis of protein and nucleic acids in various cells.25, 26 The former proved to be additionally powerful regulators of lipid metabolism, reduced blood glucose levels, and normalized liver function indices. In patients with superficial vasculitis, thymomimetics determined from the level of traditional treatment the normalization of tryptophan in the blood, and in the urine of cystic acid, taurine, glutamic acid, proline, glycine, alanine, a-aminobutyric acid, cystine, lysine, 1-methylhistidine, arginine, 2- methylhistidine, the number of amino acids. Among other changes in the biochemical parameters of blood, taktivin caused a decrease to the norm of the initially increased level of glucose, alkaline phosphatase, ASAT, ALAT, cholesterol, triglycerides, LDG, calcium, and an increase to the norm of creatinine, total bilirubin, albumin, iron, creatinine phosphokinase, a total of 13 parameters. In the urine, there was an increase in the reduced content of creatinine and a decrease in sodium.
Sodiumnucleinate
Its effect on cell metabolism turned out to be very broad.2 In the spleen lymphocytes, the synthesis of RNA, DNA, the protein was stimulated, ATP and ADP accumulated, monoamine oxidase, α-GPDG were activated, the biosynthesis of mitochondrial, nuclear, cytoplasmic RNA increased in the liver, the activity of tryptophanpyrrolase increased. In the granulocytes of healthy individuals, oxygen consumption increased, and the rate of glycolysis decreased.
The differentiated effect of monoribo-nucleotides on lymphocyte receptors has been established. AMP had the highest activity, minimal GMP, the combination of complementary GMP+CMP was also highly active, with minimal changes on T-helper and T-suppressor. 27
In patients with acute dysentery CMP and UMP stimulate the formation of antibody-forming cells by 9-19 times, and AMP decreases them by 10 times. AMP inhibited antigen-specific responses and increased delayed-type hypersensitivity.27
Immuno modulatory effects of metabolic
A wide panel of combined studies was performed on various clinical models of proinflammatory diseases (PID). They consisted of exacerbation of deep pyoderma (EDP) and chronic pyelonephritis (ECPN), ECPN + urolithiasis disease (ULD), purulent soft tissue infection (PSTI)+AD, +true eczema (TE), acute salping-oophoritis (ASO), and exacerbation of chronic salping-oophoritis (ECSO), ECSO+bacterial vaginosis (BV), urogenital chlamydia, nonspecific inflammatory diseases of the lungs, which included mixed, exogenous and endogenous bronchial asthma (mBA, exBA, enBA), chronic obstructive lung disease (COLD), mBA+COLD, mBA+AD. The effect of the "traditional" treatment of diseases and its combination with the antioxidant hypoxene, immunotropic drugs with antihypoxic, antitoxic, metabolic, haemo-stimulating, immunological properties, cygapan metabolic (food supplement containing 63 micro-and macroelements, amino acids, vitamins) was studied, tycveolum (realizing hepatoprotective, regenerative, immunostimulating, anti-inflammatory effects), limontar (a preparation of citric and succinic acids, which are stimulators of nucleic acid metabolism and redox processes) and metabolites of nucleic acid origin with sodium nucleinate, derinate (officinal drug, high molecular weight DNA), isoprenaline on immune, haematological, biochemical, bacteriological and clinical parameters. 28,29,30
In patients by the rank method (used to compare the effectiveness of immuno corrections, when immune markers in patients receiving drugs, the greatest changes are measured by rank 1, then by rank 2, etc., and the minimum sum of ranks reflects the maximum effect of the action), the normalizing the effect of antioxidants and metabolites on grouped (divided into groups) laboratory parameters, built the final rating algorithm of complex treatment (determined by the degree of immune disorders of the indicators, which are arranged in the order of decreasing significant deficiency from the specified values), identified the key targets of the drug action on the immune system (see the table for the ITF decoding) with an indication of the order of the parameters in the formulas, vectors and the degree of their dynamics from the initial level.30
Hypoxene (Hp)
Patients Hp causes an ambiguous positive effect on the studied parameters of patients suffering from various PID. Thus, the predominant normalization of immune parameters was achieved in patients with ACPN, PIST+TE, haematological parameters with?DP, ECPN, ECPN+ULD, PIST+AD, bacteriological parameters with PIST+AD, clinical patients with ECPN, PIST+AD. In total, an increase in the final effectiveness of complex treatment due to hypoxene was shown in five cases out of seven (EDP, ECPN, ECPN+ ULD, PIST+AD, PIST+TE). With mBA, the antioxidant increased the final efficacy of the complex treatment.
When determining the spectrum of targets of hypoxene in the immune system in patients with six types of bronchopulmonary diseases, leukocytes, lymphocytes, Th, NK, Ig of three classes, PI, IL4 concentration with a stimulating vector turned out to be key.
In patients with nonspecific inflammatory lung diseases, a high immuno-clinical effect of sodium nucleinate has been shown.3 The maximum normalizing effect of the modulator in patients with mBA, ecBA, mBA+AD, enBA, COLD, mBA+ COLD was found in biochemical, immune and clinical action, which included markers of T cells, their regulatory subpopulations, B-lymphocytes, IgA and M, CEC, absorption and metabolic activity of neutrophils, cytokines. In principle, positive clinical and laboratory results were obtained in patients with ECPN, PIST, and DP using the nucleic acid modulators ridostin, derinat, and isoquinoline.
Thus, various metabolites and antioxidants against the background of traditional treatment of proinflammatory and nonspecific bronchopulmonary diseases in most cases significantly increase the final clinical and laboratory effectiveness of complex effects on patients and fundamentally change the sets of signal markers in the formulas of targets for immunoprotection of drugs.
Comparative effectiveness of immunomodulatory and immuno-metabolic therapy of diseases
On clinical models of PID (pyoderma, pyelonephritis, adnexitis), we studied the effect of the Gl modulator and its combination with the antioxidant hypoxemia (Gl + Hp) on the grouped clinical, laboratory, and signalling immuno-metabolic parameters.31 The data obtained are summarized in Table.1.
Legend: G, I, M, C, B – haematological, immune, metabolic, clinical, bacteriological indicators, * reliability of differences, withP< 0.05, ITFown, MTFown - immunoprotection and metabolic target formulas regarding basic treatment; own - own effect of some modulators, Ma - CD95+ lymphocytes, Ct - common thiols, the rest see the text.
The data in the table indicate that in patients with deep pyoderma, immunotherapy with Galavit relative to traditional treatment led to the normalization of three groups of markers - haematological, metabolic, and clinical, with four CPNs - G, I, M, C, with CA of one haematological one. The combination of Gl with Hp led to a modification and an increase in the clinical and laboratory effect.
Specifically, in DP, galavit provided a decrease in the level of pro-inflammatory TNF, total lymphocytes and lymphocytes with apoptosis receptor expression, hyperimmunoglobulinemia M, in CPN - IL4, phagocytic index, and T-regulators turned out to be signalling targets, and in CA, thymus-dependent NK, CIC, IgM turned out to be supporting markers. When using a combination of Gl+Hp in patients with DP, CPN, CA, typical ITFown were accordingly modified (NKc3+PI2+IL83+, which affected cytotoxic natural killers, phagocytic index and interleukin-8), in CPN, respectively, Th3+IL83+B3+ that affected T-helpers, IL8 and B-lymphocytes, with CA, respectively, IgM2+Tc3+NKc3+, which affected immune globulins M, T-cytotoxic lymphocytes and cytotoxic NK cells).32Thus, in patients with DP, the composition of ITFown during galavit was expressed in AOA2+MDA1+Ct1- and, in the case of a combination of Gl+Hp, in turn, MDA2-SOD2+VE1+.
Discussion: The article describes the problem of immuno-metabolic aspects of pathological processes, which is practically new for clinical immunology, and its formulation and consideration mainly belongs to the authors of this article. In fact, for the first time, the relationship between immune-metabolic mechanisms in the implementation of immune responses is discussed. The greatest importance is attached to the state of nucleic acid metabolism as a marker of the severity of immunopathology and a regulator of immune reactivity. His condition turned out to be key in the development of immuno-associated diseases, infectious pathology and substantiated new approaches for nucleic acid replacement immunotherapy. The most important role of the antioxidant defence system, free-radical oxidation of lipids and proteins was shown, which made it possible for the first time to propose therapeutic metabolic modulation. New information is presented on the currently intensively studied metabolic syndrome, its effect on patient homeostasis. A large body of information with the discussion of new aspects covers various pathologies, including diabetes, cardiovascular diseases, psoriasis, the relationship of immuno-metabolic disorders with the clinical course of various infectious and non-infectious diseases, correction of developing disorders by various immunotropics and, which is especially important, novelty drugs is postulated low molecular weight RNA. In this area, serious research has been done and excellent clinical results have been obtained. As a result, the discussion of new aspects of immuno-metabolic associations led to the creation of a new direction in clinical immunology - immunomodulatory metabolism therapy and new approaches to correcting immune and metabolic disorders in the body with a wide range of pathology.
CONCLUSIONEnglishhttp://ijcrr.com/abstract.php?article_id=4199http://ijcrr.com/article_html.php?did=41991. Chereshnev VA, Shmagel KV. Immunology: a Textbook for Students Edu-cational Institutions of Higher Professional Education. Moscow. Publishing
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2. Zemskov VM, Neymann VV, Pronko KN, Zemskov AM. Globalrole of Low molecular weight nucleic acids in biological systems. Glob J Med Res: C Microbio Path. 2020; 20(2): 5-10.
3. Zemskov VM, Zemskov AM. Immunomodulating effects of a low molecular weight RNA. Soviet Medical Reviews/Section D. Immunology.
Reviews, ed. by R.V. Petrov, v. 3, Part 3. Harwood Academic Publishers. Churchill-London-Paris-New York-Melbourne 1992a: 113p.
4. Zemskov A, Zemskov M, Zoloedov V. Immunology of chronic obstructive pulmonary diseases. Academic Publishing Deutschland: LAP
LAMBERT 2016: 676?.
5. Zemskov A, Zemskova V, Berezhnova T. Metabolic immunity. Metabolic disorders, diagnosis, correction, immunotherapy.LAMBERT Academic
Publishing2020a:385p.
6. Zemskov MV, Pritulina YuG.The effect of NaRNA on shigella-infected mice. J Microbiol. 1978;6: 100- 102.
7. Zemskov AM, Zemskov VM. 1992. Acute shigellosis. A new concept on the role of nucleic acids in infection and immunity. Voronezh. Publishing
House: Voronezh University. 1992;b: 134p.
8. Zemskov VM. On the role of nucleic acids in infection and immunity. J Microbiol. 1970b; 12: 65-70.
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10. Lutskiy MA, Zemskov AM.Oxidative stress in the pathogenesis of stroke and demyelinating diseases of the nervous system.Voronezh. Publishing
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareManagement of Diabetic Peripheral Neuropathy Using Ayurvedic Protocol: A Case Report
English1418Naduvathu Vasudevan AnjalyEnglish Mund Jaya SankarEnglish Mishra Rattna PravaEnglishIntroduction: Diabetic peripheral neuropathy is the most common complication of diabetes, and can occur in all diabetics regardless of the type. Its diagnosis is clinical, with suggestive history and neurologic examination. Altering the natural history and administering symptomatic treatments are the hallmark of management, but many systems of medicine tried to target multiple pathways have not shown promising results. Hence, options in Ayurveda may be sought.
Case Report: A 49-year-old female patient who presented with numbness over her lower limbs associated with tingling sensation since the past year and who was diagnosed case of diabetic peripheral neuropathy is presented here. She underwent an inpatient treatment protocol, which included oral medicines and external therapies.
Results: Michigan Neuropathy Screening Assessment showed a 50% improvement in the history questionnaire and 80 % improvement in physical examination. In the biothesiometry readings, there was an improvement in vibratory perception by 25 % and 50% in right and left leg respectively.
Conclusion: This case illustrates the potential of an Ayurvedic treatment protocol to manage peripheral diabetic neuropathy.
EnglishAyurveda, Case Report, Diabetic neuropathy, Holistic approach, Prameha, Raktavrita vatamIntroduction
Neuropathies are common in diabetics1 and may result in serious consequences including foot ulcers, amputations, silent myocardial infarctions, and premature death.2 Diabetic peripheral neuropathy primarily involves the distal portion of the longer myelinated and un-myelinated sensory axons, with sparing of motor axons.3 Symptoms encompass numbness, tingling, burning sensation, a sensation of shooting and cutting pain, walking on cotton wool or glass shards, and feeling of either heat or cold. Conservative management in peripheral diabetic neuropathy aims at symptom relief. The efficacy of an Ayurvedic treatment protocol to manage peripheral diabetic neuropathy in a 49-year-old female with gestational diabetes is presented here. The report adheres to the Case Report (CARE) Guidelines to ensure efficacy and transparency in reporting.4 Institutional ethics committee clearance was not required; however, written informed consent was obtained from the patient before writing her case.
Case Report
In 2015, the patient started experiencing occasional pricking pain in the plantar aspect of both feet. She initially ignored it, but the condition gradually worsened to the point where she started having severe burning sensations, numbness, and tingling sensations. She consulted her allopathic diabetologist for the above and he diagnosed it as Diabetic peripheral neuropathy and prescribed Remylin D tablets. She developed altered sensations in both feet four months ago. She approached Sreedhareeyam Eye Hospital for management of glaucoma, which was diagnosed three months previously, and was offered treatment for both glaucoma and peripheral diabetic neuropathy. She had developed gestational diabetes during her second pregnancy 20 years before. She has been using insulin for ten years (30 units in the morning and 10 in the evening). Her father is a known case of diabetes mellitus. Bowel, appetite, micturition, and sleep were normal. Cardiovascular, gastrointestinal, and central nervous systems; and all vital signs were normal.
The examination demonstrated feet devoid of deformities, dry skin, callus, infections, and fissures; absence of ulceration, decreased ankle reflexes, absent vibration perceptions at the great toes. Monofilament examination is a noninvasive examination to test the sensitivity to touch. It is measured by using a thin strand of nylon, which is applied perpendicular to skin in 10 areas of each foot. Biothesiometry, done on six specific areas of both heels, viz., big toe, anterior lateral eminences of the sole on both sides, anterior longitudinal sulcus, plantar region, and heel, demonstrated severe loss of vibratory perception, the mean being 28 volts and 34 volts in right and left foot respectively. Laboratory investigations showed an HbA1c of 6.4%, fasting blood glucose level of 174mg/dL, and post-prandial blood glucose level of 291mg/dL.
The Ayurvedic assessment demonstrated that the patient was MadhyamaVaya (middle age), Kapha-Vata Prakriti (somatic constitution of Kapha and Vata), and Madhyama (moderate) Samhanana (compactness of body parts), Pramana (measurement), Sattva (psyche), Satmya (habituation), Ahara Sakti (digestion), and Vyayama Sakti (exercise capacity). The disease was explored along the lines of Prameha Upadrava (complications of diabetes mellitus) based on her symptoms.
A COVID-19 reverse-transcription polymerase chain reaction (RTPCR) test done before IP admission turned out to be negative. Her course of inpatient Ayurvedic treatment comprised of oral medicines (Table 1) and external therapies (Table 2). Pancakarma (bio-purification) was not attempted due to the severity of the case. She was also placed on a strict dietary regime amounting to a total calorie intake of 1600 Kcal/day, which included regular mild-to-moderate exercise and intake of leafy vegetables, pulses, skimmed milk, and other healthy items; and abstinence from sweet, deep-fried, and starchy foods and products prepared from refined grains. Insulin administration as per dose and time was also adhered to.
Assessment before and after treatments was done with the Michigan Neuropathy Screening Instrument (MNIS), 5 biothesiometry readings, and laboratory investigations. Improvements in MNSI scores were noted. (Table 3) Biothesiometry readings improved to a stage where a moderate loss of vibratory perception was observed (20.6 and 22.5 volts in right and left foot respectively). (Table 4) FBS taken on October 13th, 2020 showed improvement to 144mg/dL. FBS and PPBS taken on 25th October, 2020 improved to 140mg/dL and 207mg/dL respectively.
Diabetic Powder* (2 tablespoons boiled in 1L of water and taken intermittently after filtering), PrabhanjanaVimardanaTailaand Sahacaradi Taila (application 1/2 hour before bath), Varanadi Kvatha and Indukanta Kvatha (10mL of each decoction boiled in 45mL boiled and cooled water and taken twice a day before food), Dhanvantara Gutika (1 tablet powdered and added to the decoctions), and VaraChurna (1 teaspoon of powder with hot water 1/2 hour after dinner) were prescribed at discharge, along with instructions to adhere to a strict diabetic diet and perform regular mild-to-moderate exercise daily.
All medicines were manufactured at Sreedhareeyam Farmherbs India, Pvt. Ltd., the hospital’s GMP-certified manufacturing unit.
Discussion
Diabetes mellitus is considered as Prameha as per Ayurveda, and is placed among the eight dreadful conditions (Ashta Mahagada), viz., Vatavyadhi (neurological diseases), Asmari (renal calculus), Kushta(obstinate skin disorders), Meha (obstinate urinary disorders including diabetes mellitus), Udara(abdominal enlargement), Bhagandara (fistula-in-ano), Arsas (haemorrhoids), and Grahani (irritable bowel).6 All varieties of Meha, if untreated, progress to Madhumeha, which is Asadhya (incurable).
The probable Nidanas observed in this patient were overindulgence in foods that were Guru (heavy), Snigdha (unctuous), Sita (cold), and Picchila (slimy) by nature. These resulted in Dhatvagnimandya (impaired digestion at the level of the tissues), which in turn lead to the production of Ama (undigested, toxic waste). The weakened Agni was not able to produce proper Anna Rasa (the essence of food). Dhatvagnimandya of Medas (adipose tissue) failed nourishment of the other Dhatus, viz., Asthi (bone), Majja (marrow), and Sukra (seminal fluid), resulting in their Kshaya (decrease). This Kshaya was manifested in the form of neuropathy and other consequences of diabetes mellitus.
The Rukshata (dryness) in the patient’s body as a result of increased Vata caused a failed vasodilator mechanism that altered the functions of endoneural and epineural blood vessels. Sensory disturbances in this patient were caused by affected Rakta Dhatu (blood tissue), It also resulted in Dhamani Praticaya (hardening of vessels), a Nanatmaja Vikara of Kapha, as evidenced by microangiopathy.
Pricking pain in this patient was significant of Sucibhiriva Tudyate (feeling of pins and needles), which is a Lakshana of Sonitavrta Vata described by Acarya Susruta7 and Majjavrta Vata described by Acarya Caraka.8 Tingling sensation is indicative of Cumcumayana, a feature of Sonitavrta Vata told by Acarya Susruta; Harsha Lomaharsha, a feature of Tvaggata Vata as per Susruta and Pittavrta Samana Vata told by Caraka. The burning sensation is indicative of Daha, a Purvarupaand Upadrava of Prameha told in Caraka SamhitaNidanaSthana; Vidaha, a NanatmajaVikara told by Caraka; Plosha, a NanatmajaVikaraof Pitta explained by AshtangaSangraha; and Pariplosha, a Lakshanaof KaphaKshaya and RaktaMedogata Pitta as per AshtangaSangraha, and a Upadrava of Pittaja Prameha as per Susruta. The numbness was indicative of Supti, a Purvarupaof Prameha as per Caraka Samhita Nidana Sthana. Abnormal perceptions of pain were indicative of Toda, a Lakshana ofVyanavrtaPrana told by Caraka; Sula, a Lakshanaof Prameha Upadrava told by Susruta Samhita Nidana Sthana; and Bheda, a NanatmajaVikaraof Vata.
Based on the above, the treatment protocol was adopted to reduce Prameha and to nourish the nerves. The common properties of the oral medications are Kapha-Vata Samana (pacifying Kapha and Vata), Dipana (appetizing). Pacana (digestive), SrotoSodhana(channel-cleansing), and Lekhana (scarifying). Excess Snigdha(unctuous), Manda (slow), and Picchila(slimy) qualities were avoided as the Kapha Dosha was pathologically active. The medicines possess antioxidant, antibacterial, and anti-diabetic properties, which helped to re-establish homeostasis and metabolism, and supply nutrition to the nerves.
The external therapies were aimed at normalizing Vata. Patra Pinda Sveda enhanced vasodilation and promote the activity of the parasympathetic nervous system by its Ushna (hot) property. The Sukshma (minute) and Sara (fluid) properties enabled dislodging of the adherent Doshas and expelling through the pores of the skin as sweat. The use of Saindhavaand JambiraSvarasa enhanced its absorption into the skin and propelled it to dislodge adherent Doshas. Abhyanga further enhanced vasodilation and transport of nutrients by its application of pressure and motion. The medicines used for Abhyangawere Vataharaby nature. Sashtika Sali Pinda Sveda not only stimulated Vata but also nourished the nervous system. The combined effects of the external therapies enhanced nervous activity, stimulated the peripheral nervous system, and enhanced sensitivity, as documented in the biothesiometry readings.
The strict dietary regime was to lower serum glucose, minimize carbohydrates, and restore metabolism. Equal and spaced portions from each of the main food groups were essential to balance the amounts of carbohydrates, vitamins, minerals, and nutrients.
Conclusion
A concerted effort by the oral medicines, external therapies, and dietary regime yielded positive results in the patient. At the time of discharge, biothesiometry readings improved and the MNIS showed more positive results. Management of Meha may always be a challenge, but concerted efforts by the physician, medicine, attendants, and physicians, the four limbs of treatment, result in positive outcomes. The results obtained in this report may be analyzed and validated by large-scale sample trials.
Acknowledgement:
The authors thank Sreedhareeyam Ayurvedic Eye Hospital and Research Center, and Sreedhareeyam Farmherbs India Pvt. Ltd., for their help in preparing this case report. The authors acknowledge the immense help received from the scholars whose articles are cited and included in references to this manuscript. The authors are also grateful to the authors/editors/publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed.
Source of Funding:
No financial interests (stocks, patents, employment, honoraria, or royalties) or nonfinancial relationships (political, personal, or professional) that may be interpreted as influential toward the content of this manuscript are declared as well.
Conflict of Interest: None declared.
Authors’ Contribution:
Anjaly Naduvathu Vasudevan collected and analyzed the data and prepared the report.
Jaya Sankar Mundanalyzed the data and reviewed the article.
RatnaPravaMisraanalyzed the data and reviewed the article.
Annexure: The Michigan Neuropathy Screening Instrument
Part A: History (to be completed by the patient of diabetes)
Please take a few minutes to answer the following questions about the feeling in your legs and feet. Check ‘yes’ or ‘no’ based on how you feel. Thank you.
Englishhttp://ijcrr.com/abstract.php?article_id=4200http://ijcrr.com/article_html.php?did=4200
Dyck PJ, Kratz KM, Karnes JL(1993) The prevalence by staged severity of various types of diabetic neuropathy, retinopathy and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurol. 43: 817-824
Boulton AJ, Vinik AI, Arezzo JC (2005) Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 28: 956-962
Malik RA, Tesfaye S, Newrick PG (2005) Sural nerve pathology in diabetic patients with minimal but progressive neuropathy. Diabetol. 48: 578-585
Gagnier J, Kienle G, Altman DG, Moher D, Sox H, Riley DS, CARE group, The CARE guidelines: Consensus-based clinical case-reporting guideline development. Global Advances in Health Med. 2013; 2(5):38-43
Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994;17:1281-89
Murthy KRS, editor, (2nded.). Ashtanga Samgraha of Vagbhata, NidanaSthana;Atisara-GrahanidoshaNidana: Chapter 8, Verse 33. Varanasi: Chaukhambha Sanskrit Series Office, 1999; 197.
Sharma PV, editor, (1sted.).Susruta Samhita: With English Translation of Text and Dalhana’s Commentary along with Critical Notes, Vol. II, Nidana Sthana: VatavyadhiNadana, Chapter 1, Verse 33. Varanasi: ChaukhambhaVishwabharati, Reprint 2005; 9.
Sharma RK, Dash B, (1sted.). Caraka Samhita: Text with English Translation and Critical Exposition based on Cakrapanidatta’s Ayurveda Dipika: Vol. 5, Cikitsa Sthana, Vatavyadhi Cikitsa, Chapter 28, Verse 67, Varanasi: Chaukhambha Vishwabharati, Reprint 2013; 39 .
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareMorphologic and Morphometric Analysis of External Ear: A Preliminary Study on Monozygotic Twins for Personal Identification
English1926Baroniya YashEnglish Das TanurupEnglish Harshey AbhimanyuEnglish Srivastava AnkitEnglishEnglish External ear, Monozygotic twins, Morphological features, Morphometric variation, Criminal investigation Personal identificationIntroduction
Twins and issues inextricably related to them are consistently capturing severe attention towards the scientific research community from the last century. In the late 19th century J Matthews, a Scottish obstetrician first recognized two specific types of twins. But, Francis Galton was the first person to coin the distinct possibility of applying twins for the comparison of hereditary and environmental contributions.1,2 Twins are typically classified into two specific categories i.e., monozygotic (Identical: naturally divided from a single fertilized egg) and dizygotic (Fraternal: formed by two independently fertilized eggs by two different sperms).2,3 Monozygotic twins are virtually identical because they universally share the same chromosomal sequence4 except for very few rare mutations.5 Individualization of monozygotic twins without modern genetic sequencing techniques in common remain a critical task as they naturally possess almost identical phenotypic appearance.6,7 They easily hide or swap their distinctive identity by exploiting the key advantage of striking similarity to voluntarily commit crimes. The distinct population of monozygotic twins is gradually increasing around the globe and including India in the last few decades. In 2013, a high frequency of twins was observed during a health camp in Kodinhi, a village in Kerala, by the members of Yenepoya Dental College, Mangalore, Karnataka. A further survey revealed that there was a ratio of 35 twins out of every 1,000 individuals.3 Personal identification plays a vital role in the field of forensic sciences. The modern Biometric system is most reliable to positively establish the personal identity based on the morphological and behavioural characteristics of an individual.8,9 Ear biometrics is undoubtedly an emerging technique in the field of personal identification. The science of human identification from ear impressions or prints is called Forensic Otoscopy.10 It possesses several overwhelming advantages as a biometric feature due to its stability (mostly invariable during various facial expressions and poses) and peculiar structure. The remarkable peculiarity of the external ear comprises several anatomical features i.e., auricle shape, earlobe shape (Lobule), attachment of the earlobe (Lobule), helix shape and tragus shape.10,11 Figure 1 demonstrates the various morphological characteristics of the ear. The oily and waxy surface of the external ear (Pinna or auricle) is responsible for the Ear prints on a contrasting surface.10,11 Ear prints are found in cases where a criminal try to overhear the private conversation behind the other side of the door or window.10 The first direct involvement of the ear in a forensic issue dated in 1910. In that case, the distinctive identity of a prisoner was scientifically proved with the help of the remarkable peculiarity of his ear.11 It can also be a vital feature for personal identification in the case of the mutilated body or in a circumstance where the alleged suspect has gone through plastic surgery. In recent years, crimes often been recorded in overhead CCTV cameras. A considerable chance of excellent visibility of a person’s pinna in raw CCTV footage can be properly investigated and identified with a forensic expert.10 In previous studies on ear patterns or prints, researchers proved its uniqueness in every person and no two individuals can have the same set of morphological characteristics on the external ear.10-19 Preliminary research was also conducted on the variations of external ear prints of monozygotic twins.20 But, no studies are present on the morphologic and morphometric similarities and dissimilarities of identical twins’ external ears. A present study is a preliminary approach aimed at the comprehensive examination of the morphological features and differences of external ears among monozygotic twins.
Methodology
The present study has been conducted to carefully analyse the morphology and morphometry of the external ear of monozygotic twins. A total of 37 pairs (74 subjects) of monozygotic twins aged between 5 to 40 years was examined in this study. All the samples were randomly collected from three different regions of central India i.e., Jhansi, Bhopal, and Shivpuri. A valid written informed consent was obtained from the parents of the subjects under the age of 18 years as well as from the adult subjects before the study. All the subjects were properly informed about the specific purpose and fundamental nature of the experiment.
Image acquisition
Female subjects were asked to remove jewellery from their ear and tie up their hairs before the image acquisition. All the images were captured through ‘NIKON COOLPIX L 21’ in a stationary position from 1 meter with the head in Frankfurt Horizontal Plane (A parallel line joining the orbitale and tragion). The maximum vertical length and maximum horizontal width (figure 2a) were recorded by Vernier Calliper (figure 2b). Figure 3a and 3b show the right ears of two individuals of a twin pair.
Data interpretation and statistical analysis
Five features i.e., ear length, ear width, lobular attachment, the shape of auricle and shape of lobule were observed and recorded. Images were categorized based on the shape of the auricle, lobule of ear and attachment of lobule. Based on auricle, shape ear is classified into four categories described in table 1. Four types of lobules are present in the human ear i.e., Arched, Round, Triangular and Rectangular. The correlation coefficient (R) was calculated between the following quantitative features:
1. Between the lengths of the right ears of the two individuals of twin pairs.
2. Between the breadths of the right ears of the two individuals of twin pairs.
3. Between the lengths of the left ears of the two individuals of twin pairs.
4. Between the breadths of left ears of the two individuals of twin pairs.
5. Between the lengths of the right and left ears of the same individual.
6. Between the breadth of right and left ears of the same individual.
The length and breadth of each ear were plotted in an X-Y plane to find out the corresponding two-dimensional vector. The two-dimensional vector of the same ear (right vs right and left vs left) from the two individuals of a twin pair was compared by finding the Euclidean distance between them.
Results
The present study was carefully conducted to study the morphological and morphometric features of the external ear of monozygotic twins. The study shows that all the selected morphological features were the same in a twin pair. Figures 4.a and 4.b show the right ear of two individuals of a twin pair. Although the length and breadth of each ear slightly differ between the individuals of a twin pair.
The distribution of auricle shape among all the twin pairs shows that the oval-shaped ear is the most frequent with 43.24% and the round-shaped ear is the least frequent with 10.81%. Table 2 and figure 4. demonstrate the frequency distribution of all the auricle shapes. Figure 5. a to 5.d shows the different auricle shapes found on the present samples of monozygotic twins. Arch-shaped ear lobule has the highest frequency of 45.94% among all the twin pairs and a triangular lobule has the lowest frequency of 8.10%. Table 3 and figure 4. b demonstrate the frequency of all the ear lobule shapes. The attached ear lobule is more frequent than the free lobule among the twin pairs. Table 4 and figure 4. c demonstrate the distribution of the attached and free lobule percentage among the twins.
The calculated ‘R’ values between the length of right ears of twin pairs and breadth of right ears of twin pairs were 0.99 and 0.95 respectively. The calculated ‘R’ values between the length of left ears of twin pairs and breadth of left ears of twin pairs were 0.98 and 0.95 respectively. The calculated ‘R-value between the length of the right and left ears of an individual was 0.99. The calculated ‘R-value between the breadth of the right and left ears of an individual was 0.97. A positive Euclidean distance was found between the same ears of every twin pair under the study. Table 5 shows all the Euclidean distances between the vector values of right and left ears in all the twin pairs. Figures 6.a and 6b show the euclidean distances between the right ears and left ears of twin pair 2 respectively. The lowest and highest Euclidean distances between the vector values of the left ear among all the twin pairs are 0.1 and 0.36056 respectively. The average Euclidean distances between the vector values of the right ears and vector values of left ears among all the twin pairs are 0.19674 and 0.22868 respectively.
Discussion
The obtained results of the present study show that morphological characteristics of the external ear are identical between the individuals of a twin pair. The appropriate size of each ear is marginally different to every individual of a twin pair which is proof of the uniqueness. Several previous studies indicated the differences between structure and morphological characters of the ear between individuals for forensic purposes.21-24
The present study shows that 43.24% of twin pairs have an oval-shaped auricle. The oval shape is found to be the most frequent among all. Similar results were properly obtained in the comprehensive studies by Krishan et al. (36%— 40% in males and 39— 46% in females) 10, Iannarelli (40-46%) 25 and Singh and Purkait (47-52%).24 Van der Lugt 26 found 68.75 and 65% oval shape in Dutch males and American males. Yadav et al. 27 equally determined a similar frequency of oval shapes (61.33%) in a North Indian population. Round-shaped ears found in 10.81% of twin pairs in the present study. Krishan et al. 10 found 18 - 20% and 15 – 18.4% round-shaped ears in males and females of Himachal Pradesh, India respectively. Singh and Purkait 24 found a 23-59% round ear in the central Indian population, and Van der Lugt 26 found a round-shaped ear in 3% Dutch males and 2% American males. Yadav et al. 27 observed 14.66% round ear in a North Indian population. The rectangular auricle is present in 24.32% of twins in the present study. Krishan et al. 10 observed a dissimilar frequency of rectangular auricle (2– 8.9% in males and 7– 9.2% in females) in his similar study to the study on Dutch males 26 (9.1%). On the contrary, only 3% of Americans invariably showed rectangular auricle shape 26. Yadav et al. 27 observed a 12.66% rectangular ear in his study. 21.62% among all the twin pairs have a triangular auricle. Krishan et al. 10 found less percentage of the triangular auricle in their study (6 – 8.9% in males and 10 – 12.9% in females). Only 8.33% of triangular ears were observed in the study of Yadav et al 27.
Arch shaped lobule is the most frequent with 45.94% and a triangular lobule is the least frequent with 8.10% in the present study. Krishan et al. 10 also found arched shaped lobule as the most frequent with 61-74.4% in males and 59-72.4% in females. The frequency of triangular shape shows a similar percentage in the study of Krishan et al. 10 with 5-8.9% in males and 5-10.4% in females. In the study of Yadav et al. 27 round-shaped lobules were most frequent (43%) and a triangular lobule was least frequent (4.33%). Lobule attachment is categorized as attached and free. The attached lobule is more frequent (56.75%) than the detached lobule (43.25%) among twin pairs. Krishan et al. 10 classified lobule attachment in three categories i.e., attached, partially attached and free. They found 45-53.3% attached and 9-41.1% free lobule in males and 49-56.3% attached and 8-33.3% free lobule in females.10 Singh and Purkait 24 found only 19-24% attached and 53.71-62% free ear lobule in the Central Indian population, which is similar to the present study. Farkas 28 observed only 2-3% attached ear lobule in the American Population. Gable 29 found a relatively similar percentage of attached earlobe (25-40%) in American Whites and Dunkers in comparison to the present study. Bhowmik 30 found 77-78% free lobule in Brahmin and Muslim males. Table 6 summarizes the frequency of morphological characters of previous studies and the present study. Yadav et al. observed free ear lobule (65.66%) more frequent than the attached ones (34.33%).
The correlation between the length of the same ear and breadth of the same ear in twin pairs and length of the opposite ear in every individual from all the twin pairs were calculated to find out the interrelation between the ear morphometries of monozygotic twins. The results indicated an exceptionally positive correlation between all the selected parameters (0.99-0.97). Taura et al. 31 found a moderate positive correlation between the right ear length and left ear length (0.89) and right ear width and left ear width (0.72). In the present study, Euclidean distances between the two-dimensional vectors of the same ear in two individuals of a twin pair were used to find out any possible quantitative variability between them. The positive Euclidean distances between the same ears of every twin pair constitute empirical proof of the difference between them. The vectors were generated from the values of length and breadth. Purkait and Singh 8 performed a similar analytical procedure in their study based on Euclidean distances between multiple vectors generated from the distances between different landmarks on the external ear.
Conclusion
The present study represents an attempt to analyze the morphology of the external ear of identical twin pairs and find out the differences between them. The study satisfactorily concludes that both the individuals of an identical twin pair share the consistent morphological feature on the external ear, but the size of each ear has a minor difference. The frequency distribution of different features shows similarity with the results of a few previous studies on different Indian and world populations. The oval-shaped auricle is the most frequent and the round-shaped is the least frequent among all the twin pairs under the present study. The study also revealed the highest frequency of arched type ear lobule and lowest frequency of triangular ear lobule among all twin pairs. The attached ear lobe is more common than the free ear lobe in all the twin pairs. The specific Statistical results showed that the length of the same ear in a twin pair is more correlated than their breadths. The correlation between the length and breadth of the right and left ear of each individual in a twin pair is also highly correlated. The difference of size between the same ears of two individuals in a twin pair was established by Euclidean distance. A certain distance was noted between the two-dimensional vectors of the same ear in both individuals of every twin pair. This study will help to distinguish between monozygotic twins based on their morphometric differences. The present study is a preliminary experimental approach towards the comparison of monozygotic twins’ ears that consists of limited morphological and morphometric features. Further expansion of the study is under progress in the laboratory of our institute and the results of the experiments will be communicated soon.
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
Funding
No funding was received for this work.
Conflict of Interest
The authors declare no conflict of interest.
Authors Contribution
Yash Baroniya: Conceptualization, performed experiments and wrote the draft of the manuscript.
Taurus Das: Analyzed the data and wrote the draft of the manuscript.
Abhimanyu Harshey: wrote the draft of the manuscript.
Dr. Ankit Srivastava: Conceptualization, edited the draft manuscript.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareHigh-Risk Pathological Features in Robotic-Assisted Laparoscopic Radical Prostatectomy Specimens
English2733Anuradha SekaranEnglish Harika MethukuEnglish C. MallikarjunEnglish Purna Chandra ReddyEnglish Narrendran APEnglish Rajesh Kumar Reddy AdapalaEnglishEnglish Prostate carcinoma, Robotic-assisted laparoscopic radical prostatectomy, Positive surgical margins, Extraprostatic extension, Seminal vesical invasion, Biochemical recurre
INTRODUCTION:
Prostate carcinoma is the most common cancer in men. A common treatment modality is a radical prostatectomy. After radical prostatectomy, patients with high-risk pathological features have an increased risk of developing biochemical recurrence in the future. Any inaccurate risk assessment in prostate carcinoma is likely to result in improper treatment. It can lead to indiscriminate administration of androgen deprivation therapy or unnecessary exclusion of cases from the same. Histopathological features provide indicators of PSA recurrence-free survival. The high-risk pathological factors include grade group, positive surgical margins, EPE, lymph node metastasis, seminal vesicle invasion (SVI) and higher grade of disease. After radical prostatectomy, the probability of disease-free survival at 5 years is around 80% for tumours with negative margins, whereas it is only 58% to 64% for tumours with positive margins1. EPE and lymph node metastasis are important factors that correlate with biochemical recurrence and disease-free survival. SVI is also a predictive pathological factor of local recurrence and distant metastases2. Radical Prostatectomy can be performed either through retropubic, laparoscopic or robotic-assisted laparoscopic techniques. With the introduction of advanced robotic devices such as the Da Vinci Surgical System, RALRP has been widely accepted as a new gold standard in the treatment of prostate cancer3. Advantages of RALRP over RRP are minimally invasive procedure, high precision, greater 3-dimensional visualization of the surgical area, better functional and oncologic outcomes with less operative blood loss, higher continence and potency rates. RALRP shows a lower positive surgical margin rate and maintenance of larger amounts of residual surface adipose tissue in RALRP specimens3. Maintained larger amounts of residual surface adipose tissue indicates better-preserved prostate capsules and diagnosis of EPE also depends on the presence of surface adipose tissue, RALRP usually provides better specimens for accurate pathologic staging than RRP3. The probability of disease-free survival depends on accurate pathologic assessment which is therefore very important.
OBJECTIVE:
Prediction of oncological outcomes with an emphasis on high-risk pathological factors including biochemical recurrence in post-RALRP patients.
MATERIALS AND METHODS:
We retrospectively reviewed 88 patients who had undergone RALRP over 3 years. Prostatectomy and lymph node excision specimens were examined by the pathologists according
to standard protocols. These specimens received were oriented, and inked with different colours on apex, base, anterior, posterior, right and left sides. The vas resection margins were sampled and the seminal vesicles were cut close to the prostate. The apex and base are cut perpendicular to the urethra and then sectioned sagitally. The remaining prostate was sliced into 4 mm sections (figure 8). Tumours were graded and grouped according to the revised Gleason score as per the 2016 World Health Organization (WHO) classification of Tumours of the urinary system and male genital organs. The pathologic staging was done according to the 2018 pTNM classification.
Parameters analysed in the present study are the age of the patient, preoperative and post-operative serum Prostate Specific Antigen (PSA), Gleason score in preoperative Transrectal ultrasound-guided biopsy (TRUS) or Transurethral resection of the prostate (TURP), Gleason score in radical prostatectomy specimen, extraprostatic extension (EPE), lymphovascular invasion(LVI), Seminal vesicle invasion (SVI), positive surgical margins (PSM) and pelvic lymph node dissection. Prospectively, post-operative PSA levels at the last follow up visit were noted.
RESULTS:
Preoperative characteristics of patients undergone RALRP are shown in table 1.
The final report was signed out after being reviewed by two pathology consultants
Patients ages ranged between 51 to 83 years. Preoperative PSA was available in 83 patients which ranged between 5.24 to >100 ng/mL with a mean of 18.5ng/mL. Preoperative Gleason scores were available in 83 out of 88 patients. 31%, 55%, 13% of patients had preoperative Gleason pattern 6,7, 8-10 respectively.
Final Gleason score in radical prostatectomy – Gleason score 6 in 10% of patients, Gleason score 7 in 74 % of patients, Gleason score 8-10 in 16% of patients. The discordance between initial core needle biopsy GS and RALRP GS was observed to be ~4.8 % in the current study (calculated using paired Student t-test).
Any poorly differentiated foci on both biopsies and prostatectomy specimens were confirmed by immunostaining with alpha-methyl acyl-CoA racemase(AMACR) as and when required.
Extraprostatic extension is seen in 28% of patients. LVI is seen in 12% of patients. Seminal vesicle invasion is seen in 20% of patients. Surgical margin apex was involved in one patient. The surgical margin base and anterior were uninvolved in all patients. The surgical posterior margin was involved in one patient. The surgical right lateral margin was involved in 5 out of 88 patients. The surgical left lateral margin was involved in one patient. Bladder neck margin was involved in one patient. Pelvic lymph node dissection was done in 37% (33 out of 88) patients out of which lymph node metastasis was found in 6 out of 33 patients. Final pathologic stage classification of T2 in 67 % patients, T3a in 13% patients, T3b in 20% patients.
To analyse the frequency of biochemical recurrence, patients were followed –up with postoperative serum PSA determinations. The values were analysed in 44 out of 88 patients, with the cut-off value being less than or equal to 0.2ng/ml. Around 62% of patients were found to have values less than 0.2ng/ml and the remaining (38%) had more than 0.2ng/ml.
DISCUSSION:
RALRP has changed the treatment of prostate cancer with marked improvement in functional outcome and reduced technical limitations4. India saw exceptional growth in robotic surgery from 2006 onwards. There are currently 66 centres and 71 robotic installations as of July 2019, with more than 500 trained robotic surgeons in our country. The trend suggests that the rise of robotic surgery in India has been, and is going to be a rapid and huge one. Different surgical procedures have varying incidences of positive surgical margins which play an important role in the evaluation of oncologic outcomes. Capsular incision during surgery indicates damage to the prostate capsule and may contribute to a positive surgical margin if the tumour is present at the site of the capsular incision. The presence of residual surface adipose tissue suggests an undamaged prostate capsule. Rajan et al. showed that preoperative PSA, GS, clinical T stage, pT stage, and >3mm multifocal PSMs were predictive factors of Biochemical recurrence (BCR)5. Preoperative serum PSA levels also affect BCR6. Therefore this study is to scrutinize RALRPand its outcomes on positive surgical margin status, EPE and other histologic variables which define patient outcomes.
GLEASON SCORE:
Appropriate treatment modalities for prostate cancer are mainly based on pathologic information obtained from needle biopsies, that should correlate with that obtained from Radical prostatectomies. GS is associated with tumour prognosis and the new WHO grading system is composed of five prognostic grades. Inconsistency rates of Gleason score between needle biopsy and radical prostatectomy were around 23% to 56%7. Increasing the number of needle biopsies strengthens the accuracy of GS for accurate prediction of final cancer grade. The other reasons for GS discrepancies comprise grading errors by pathologists, borderline grades, sampling errors and the fact that prostate cancer is multifocal, with a heterogeneous population of tumour cells. This may result in inadequate sampling and that is over-represented with high-grade disease or, conversely, over-represented with the low-grade disease compared with histological grade in the resected prostate. In our study, discordant states were only around ~4.8%. Examples of fewGleason patterns are shown in Figures 5,6 and 7.
POSITIVE SURGICAL MARGIN IN RALRP:
The Independent predictive factor of biochemical recurrence, local recurrence and development of distant metastasis is found to be PSM after RP8. Figure 4 depicts a positive surgical margin. Factors such as cancer volume, surgical technique, artefacts, experience and pathological evaluation affect surgical margins6. Also, the rate of PSMs significantly increased with
Preoperative PSA, Pathological tumour stage and grade6. Coelho et al. compared the data from 11 published studies of RALRP (8,472 cases) in high-volume centres which showed weighted mean positive surgical margin rates of 13.6% which was lower compared to RRP specimens where PSM of 24% was observed 8,3. When Coelho et al. compared PSM rates in different T stages PSM rates for pT2 tumours were also lowest (9.6% for RARP) when compared to PSM rates in RRP and laparoscopic radical prostatectomy(LRP)8. A study done by Henghonget al. noted that the positive surgical margin rate in RALRP group was 28.6% which was comparable with the published data (9.3-33.3%)3. However all of the reports cited above were non-randomized studies, so definitive conclusions cannot be reached8. PSM in our study was 11.3 % which was comparable to the above-mentioned studies.
PSM for organ-confined disease (pT2) varies from 4.5 to 10.6%, whereas the same for pT3 disease ranges from 20 to 47%9. In our study, the PSM for cases with pT2 and pT3 were 10.5% and 10% respectively.
Few studies showed that PSM at apex reduced in RALRP when compared to RRP due to improved visualization of apex10, however other studies showed no statistical difference between different PSM sites in RALRP vs RRP11. In our study, posterior and lateral margins are more involved than apex which was comparable to few other studies in literature10. In the study of 500 cases done by Patel et al. apex was involved in 8.5% of all patients with positive surgical margin and posterolateral was involved in 56% whereas those rates are 10% and 80% in our study respectively10.
EPE IN RALRP:
EPE in simpler terms is defined as the presence of a tumour beyond the confines of the prostate gland (figure 1). Identifying boundaries of the prostate gland is difficult at times especially when the desmoplastic reaction is induced by a tumour at the periphery and also due to the fact prostate lacks a true histological capsule12. Hence Diagnostic criteria for EPE will vary with different regions and also diagnosis of EPE can be made in several different situations12.EPE is a well-established adverse prognostic factor of prostatic carcinoma12. Over some time, it was observed that about 50% of patients with EPE did not show 10-year tumour progression, hence studies have been done to quantify EPE in a manner by which it can predict tumour progression12. In our study, EPE was found in 28 % of patients.
LYMPH NODE DISSECTION AND METASTASIS:
In intermediate and high-risk localized prostate cancer, pelvic lymph node dissection(PLND) is performed along with radical prostatectomy13. Improvement of cancer-specific survival is noted with excision of at least 4 lymph nodes as demonstrated by the Surveillance Epidemiology and End Results (SEER) database study13. With the increase in the number of lymph nodes removed during Radical prostatectomy (RP) and PLND, improvement in cancer-specific survival was noted in a study done by Abdollah et al13. Several lymph nodes dissected are more in RALRP than RRP as more meticulous dissection with the help of 3D vision and less intraoperative blood loss14. In the study of 100 patients who had undergone extended pelvic lymphadenectomy by Batra et al., 17% were detected with lymph node?positive disease13. This finding is comparable to findings in our study. In our study out of 33 patients who had undergone lymphadenectomy 18% of patients had lymph node positive disease. Extended PLND was an independent prognostic factor for biochemical progression?free survival when adjusted for other clinical and pathologic features13.
The preoperative clinical stage was found to be the only significant criteria for pelvic lymph node involvement in the study done by Batra et al.13Lymphnode with tumour deposit is depicted in figure 2.
SEMINAL VESICLE INVASION (SVI):
SVI is defined as a tumour invading the muscular wall of seminal vesicles (figure 3). In patients, without lymph node metastasis SVI route is not of prognostic importance15. Despite earlier detection and stage migration in the PSA era, the SVI rate decreased from >10% to 6% of all RP specimens15. SVI is a poor prognostic indicator despite lower PSM rate, lymph node-positive rate, frequency of T3b disease and is believed to be associated with occult micrometastatic disease, earlier biochemical recurrence and disease progression15. Advanced clinical stage, intermediate or high-risk Gleason score at pathological evaluation and positive surgical margins predict biochemical recurrence15. In our study, SVI is seen in 20% of the patients.
POST-OPERATIVE PSA VALUES AND ASSOCIATION WITH BCR:
The most appropriate definition of BCR after a RALRP is uncertain. In general, PSA should reach undetectable levels within 4 weeks after surgery. However, a detectable PSA level after this time does not necessarily represent a clinically significant recurrent disease. Some patients with detectable PSA levels do not progress because of the presence of a benign prostate gland at the margin of resection or from a dormant residual focus of prostate cancer at a local or distant site16.
Like that reported by others, 17BCR is defined by single post-op PSA value of less than or equal to0.2ng/ml. This shows that RALRP confers effective BCR control, however, long-term oncological safety still needs to be established.
LIMITATIONS:
We were able to analyze the postoperative PSA values of only 50% of patients (44/88) since the remaining did not present themselves for follow-up. And the comparison between RRP and RALRP was not done.
CONCLUSION:
In summary, the risk assessment of disease recurrence and progression after prostatectomy is based on specific serological and histopathological findings. These findings should be analysed precisely for the optimal administration of adjuvant therapy and follow-up. Among surgical options, RALRP has evolved as the most promising treatment modality for prostatic carcinoma. It has advantages such as high lymph node yield, better visualization of apex, less PSM rate and therefore may have good long term oncologic outcomes.
ACKNOWLEDGEMENTS:
The authors would like to thank the technical staff of AIGHospitals and Consultants of AINU Hospitals for providing material for publication and Dr Juhi Khanna for her help in drafting of the manuscript.
DECLARATIONS:
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
Author’s contribution statement:
Dr AnuradhaSekaran – Conception of study, data analysis, interpretation and critical revision
Dr Harika Methuku – Data collection, Analysis and Interpretation
Dr Mallikarjuna C – Conception of study and revision of the manuscript
Dr Purna Chandra Reddy K– Manuscript revision
Dr Narendra A.P – Data analysis
Dr Rajesh Kumar Reddy Adapala - Critical revision
Englishhttp://ijcrr.com/abstract.php?article_id=4202http://ijcrr.com/article_html.php?did=4202
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcarePattern of the Angle between Axial and Digital Triradius of the Dermatoglyphic Trait Among Type Two Diabetes Mellitus Patients in the Eastern Region of India: A Case-Control Study
English3438Sarkar SatabdiEnglish Sarkar TanmayEnglish Basak SamanwitaEnglish Sarkar ArpitaEnglish Saha Pallab KumarEnglish Kundu BananiEnglishEnglishDermatoglyphics study, Axial triradius, Digital triradius, ATD angle, Type two diabetes mellitus, Ink methodINTRODUCTION:
Dermatoglyphics is the study of the epidermal ridge pattern of the skin of the fingers, palms, toes, and soles. These features are produced under genetic control but may be affected by environmental factors during early intrauterine life. Harold Cummins illustrated the term ‘Dermatoglyphics’ in 1926 (Greek derma-skin, Greek Glyphein- to carve).1
The epidermal ridge patterns once established do not change after 21 weeks of intrauterine life. The specific features of dermatoglyphic traits were ascertained to be inherited as dominant, incompletely dominant recessive, a single gene, or polygenic with complete or incomplete penetrance.2 It is also considered as a variable expression of genes. The large number of chromosomal and developmental defects like mongolism, Turner’s syndrome, cardiovascular disease, bronchial asthma, schizophrenia, and hypertension had shown an association with dermatoglyphic feature changes.3,4,5,6 The epidermal ridge pattern analysis in the dermatoglyphic study can be considered as a diagnostic as well as screening tool as it is based on genetic background, easily accomplished task, and cost-effective.
Diabetes mellitus (DM), a non-communicable disease poses a significant public health problem in India and is one of the most studied metabolic diseases in the world. The occurrence of type two diabetes mellitus has strong interaction between genetic and environmental factors. Family history is a strong risk factor and it indicates genetic predisposition.7 As epidermal ridge patterns are genetically determined, the dermatoglyphic prints represent a non-invasive anatomical marker of type two diabetes mellitus. Thus, it will help in early detection. Early treatment of the disease cause delaying in the development of microvascular and macrovascular complications.
So far, very little information is obtained about the dermatoglyphic features of type 2 DM patients in many regions of India. From the eastern part of India, the data on the angle between axial and digital triradius (atd angle) of dermatoglyphic study of type 2 DM patients is insubstantial, though the disease burden is gradually increasing in comparison to the many other regions of India.8 Hence the purpose of our study was to collect and analyze the data of atd angle in type two DM patients and compared that data with non-diabetic patients (controls) and tried to reach conclusions that those data can be useful as a screening tool in the diagnosis of type 2 DM.
MATERIALS AND METHODS:
The study was conducted after taking permission from the institutional ethical committee and review Board. The study was conducted on 200 (100 male and 100 female) clinically diagnosed type two DM patients (confirmed by fasting blood glucose more than 126 mg/dl and post-prandial blood glucose equal to or more than 200 mg %)9, of the age group of 40-60 years who attended the OPD between January 2011 to August 2012. 200 sex-matched controls of same age group and the same demographic profile were selected among the staff members, the paramedical staff, and accompanier of non-diabetic patients (those who did not have any symptoms which were related to type 2 DM and random blood sugar level is Englishhttp://ijcrr.com/abstract.php?article_id=4203http://ijcrr.com/article_html.php?did=42031. Cummins H, Midlo, C. Palmar and plantar epidermal ridge configurations (dermatoglyphics) in European Americans. Am. J. Phy. Anthropol1926; 9: 471-502
2. Meier RJ. Anthropological Dermatoglyphics: A Review. Yearbook of Physical Anthropology 1980; 23:147-178
3. Blanka S, Milton A. Dermatoglyphics in medical disorders. New York: Heidelberg Berlin: Springer – Verlag1976.
4. Rashad MN, Mi MP. Dermatoglyphic traits in patients with cardiovascular disorders. Am J Phy Anthropol. 1975;42(2):281-3
5. Pakhale S V, BoroleS B, Doshi M A, More P V. Study of the fingertip pattern as a tool for the identification of the dermatoglyphic trait in bronchial asthma. JCDR2012;6(8): 1397–1400
6. Hirmath R, Nuchhi A, Gosavi A, Mugadlimath A . Comparative Study of Dermatoglyphic Patterns of Schizophrenic Patients with Control Population Int J of Anat Rad and Sur 2017;6(4):26-30
7. Verbov J. Clinical significance and genetics of epidermal ridges-a review of dermatoglyphics. J Invest Dermatol 1970; 54:261-271.
8. Pradhan R, Kumar D B, Mitra A. Some Salient Points in Type 2 Diabetes Prevalence in Rural Bengal, Studies on Ethno-Medicine 2009; 3:2: 127-131
9. Kasper DL. Harrison's principles of the internal medicine.19th edition. New York.McGraw Hill Education Medical2015; 2:2399-2400
10. Singh IP and Bhasin MK. Dermatoglyphics. A manual of biological anthropology. New Delhi.Kamla-Raj Enterprises2004: 317-84
11. Oladipo G, Ogunnowo B. M. Dermatoglyphic patterns in diabetes mellitus in a southeastern Nigerian population. Afr. J. of Appl.Zool& Environ. Biol 2004; 6: 6-8.
12. Rajnigandha V, Mangala P, Latha P, Vasudha S. Thedigito-palmar complex in non-insulin-dependent diabetes mellitus. Turk. J. Med. Sci 2006;36(6):353-55.
13. Padmini MP, Rao NB, MalleswariB. The Study of Dermatoglyphics in Diabetics of North Coastal Andhra Pradesh Population, Ind J. Fundamental. Appl. Life Sci 2011; 1: 75-80.
14. Sharma MK, Sharma H . Dermatoglyphics: A diagnostic tool to predict diabetes. J. Clin. Diagnostic Res 2012; 6(3): 327-332.
15. Eberechi D, Gabriel O, Peter D. A comparative study of the digital pattern, position of triradii, b-c and a-d palmar distances of diabetic subjects and essential hypertensive individuals in river state.Int. J. Adv.Biotechnol. Res 2012; 3(2): 615-620
16. Trivedi P, Singel T, Kukadiya U, Satapara V, Raghava J, Patel M, et al. Correlation of atd angle with NonInsulin Dependent Diabetes Mellitus in Gujarati population. J. Res. Med. Dent. Sci 2012; 2(2): 47-51.
17. Pathan FJ, Hashmi RN. Variations of Dermatoglyphics Features in Non-Insulin Dependent Diabetes Mellitus. Int J Recent Trends Sci Technol. 2013; 8(1): 16-19.
18. Rakate NS, Zambare BR.Comparative study of the dermatoglyphic patterns in type II diabetes mellitus patients with non-diabetics.Int J Med Res Health Sci 2013;2(4): 955-959
19. Srivastava S, Rajasekar S. Comparison of Digital and Palmar Dermatoglyphics Patterns in Diabetic and Non-Diabetic individuals. IOSR-JDMS 2014; 13:93-95.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9Healthcare" Myotonic Myopathy - A Case Report "
English3941Kakkad A.English Ramanandi V.English Desai A.EnglishBackground: Myotonia is a quite rare condition. The involvement of multiple systems makes the management of conditions difficult. The role of physiotherapy for such a rare condition is unexplored. Objective: The objective of this case study is to be clearer about the role of physiotherapy in the treatment of Myotonic-myopathy. Discussion: In this case report, the disease and its medical and physiotherapy management are discussed in brief. Conclusion: Patients suffering from myotonic myopathy can be benefited from a holistic approach with the combination of medicine and physiotherapy.
English Myotonia, Myopathy, Myotonic Myopathy, Muscle Relaxation Difficulty, Quality of life, PhysiotherapyIntroduction
It is a rare genetic multi-system disorder of late childhood or adult-onset characterized by mild myotonia, muscle weakness, and rarely cardiac conduction disorders.1 Myotonic Dystrophy (DM) is a type of muscular dystrophy that can affect skeletal muscles and other viscera in the human body. “Myotonia can be defined as an inability to relax muscles at will.” The term “muscular dystrophy” denotes progressive degeneration of muscles, with weakness and atrophy of the muscle. Myotonic dystrophy is often written as “DM” due to the Greek name, dystrophia myotonica. Steinert disease is another name occasionally used for this.2 Other synonyms are Curschmann-Batten-Steinert syndrome, Myotonia Atrophica, Myotonic Muscular Dystrophy, Proximal Myotonic Myopathy, Ricker Syndrome. It refers to two rare genetic disorders of muscle that affect multiple systems of the body. There are two main types.DM type 1 (DM1) is classified as mild DM1, classic DM1 as well as congenital DM1. Mild DM1 is identified by clouding of the eyes lenses (cataracts) and maintained muscle contractions (myotonia), where the muscle does not relax after contraction. Classic DM1 is identified by weakness and wasting of muscle (atrophy), myotonia, early onset of cataracts (before 50 years of age), and heart conduction abnormalities of electrical impulses. Congenital DM1 is identified by the weakness of muscle (hypotonia), difficulty in breathing, disability, and early chances of death. DM type 2 (DM2) manifests similar clinical features to DM1, but it is noted generally a less severe form of disorder and does not produce congenital disease. DM1 is due to a change in the DMPK gene. DM2 is due to a change in the CNBP gene. All these changes are in an autosomal dominant manner.3 There is currently no cure for myotonic dystrophy, there are ways to help manage the condition.4 It is characterized by myotonia, progressive muscle weakness, cataracts, and cardiac abnormalities as well as frontal balding and gonadal insufficiency in males. The primary genetic abnormality responsible for myotonic dystrophy has been identified as an expanded trinucleotide repeat (CTG) in the DM gene on chromosome 19.5 The progression of DM is variable among different individuals, but generally, symptoms progress low. Life span is reduced in patients having congenital DM1 and is likely reduced in patients having childhood DM1 and classic (adult-onset) DM1.6 It is an autosomal dominant inherited disorder.7
Case Report
Permission was taken from the head of the institution. Here reported case is of 18 years old male suffering from myotonic myopathy. At the age of 16 years, the patient had started feeling difficulty in walking and difficulty standing from cross leg sitting from the floor. During investigations, Creatine Phosphokinase level was found high i.e. 1084 U/L. Motor and Sensory nerve conduction studies were found normal. Electromyography revealed small amplitude, short duration, and polyphasic Motor Unit Action Potentials for all muscles when voluntary activity was recorded along with the presence of full and early recruitment with submaximal exercises and interference pattern was recorded suggestive of myotonic discharge. Pulmonary Function Test demonstrated severe restriction at the age of 17 years. 2DEcho was found with a normal Left Ventricular Ejection Fraction. The patient was given medicines as a supportive treatment only. Medicines used were Tab. Bonwell (Calcium Carbonate + Vitamin D3 1000 IU) and Tab. Evion (Vitamin E) 200 mg and also multivitamins occasionally.
Physiotherapy assessment demonstrated an absence of all the jerks in presence of normal tone and normal sensations. Muscle power assessed by Modified Medical Research Council grading was reduced in all the muscles of limbs and trunk. Physiotherapy treatment is directed towards developing good strength in all four limbs and trunks, functional balance, and gait training with more focus on functional rehabilitation as shown in Figure 1. The patient is currently under a strengthening regimen for all four limbs and functional training for activities of daily living. The patient is currently doing all his daily living activities along with continuing his job and can deal with his personal and social responsibilities well. Improvement in cardiopulmonary endurance is a long-term goal for maintaining a longer and quality life for the patient.
Discussion
The patient represents a rare case of myotonic myopathy. The patient is selected for the study as proper medical management along with appropriate physiotherapy showed improvement in the patient’s quality of life by increasing muscle strength. There are very few researches available for the role of physiotherapy in myotonic myopathy so more numbers of researches are needed to be done for long-term duration. This can also help for creating awareness about changing the common belief that for this type of patient, only maintenance of condition and preventing complication is not sufficient. This type of patient can be given improved strength, endurance, and quality of life even though the condition itself is not curable. There is no current evidence-based standard of care for patients with myotonic myopathy and no research was found.7
Conclusion:
From the present case study, it is concluded that patients suffering from myotonic myopathy can be benefited from a holistic approach with a combination of medicine and physiotherapy. The patient’s functional independence and quality of life can be improved by physiotherapy intervention. Future research is required for more pieces of evidence of physiotherapy in the treatment of Myotonic Myopathy.
Declaration by Patient:
Informed written consent was signed by the patient.
Financial Support & Sponsorship:
Nil
Conflict of Interest:
None
Acknowledgement:
We would like to thank the Management of SPB Physiotherapy College, Surat for allowing us this research and Staff members for supporting this research.
Author’s contribution:
The first & second authors assessed and treated discussed the case and the third author reviewed the same.
Source of Funding:
Nil
Englishhttp://ijcrr.com/abstract.php?article_id=4204http://ijcrr.com/article_html.php?did=4204References
Reserved I. Orphanet: Proximal myotonic myopathy [Internet]. Orpha.net. 2020 [cited 6 April 2020]. Available from: https://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=EN&Expert=606
Diseases - Myotonic Dystrophy DM - Top Level | Muscular Dystrophy Association [Internet]. Muscular Dystrophy Association. 2020 [cited 6 April 2020]. Available from: https://www.mda.org/disease/myotonic-dystrophy
Myotonic Dystrophy - NORD (National Organization for Rare Disorders) [Internet]. NORD (National Organization for Rare Disorders). 2020 [cited 6 April 2020]. Available from: https://rarediseases.org/rare-diseases/dystrophy-myotonic/
The myotonic dystrophies - Muscular Dystrophy UK [Internet]. Musculardystrophyuk.org. 2020 [cited 6 April 2020]. Available from:https://www.musculardystrophyuk.org/about-muscle-wasting-conditions/myotonic-dystrophy/myotonic-dystrophy-factsheet/
Stephan E. et. al. Proximal Myotonic Myopathy: Clinical, Neuropathologic, and Molecular Genetic Features. ACLSS. 2001;31(2):140-146
Diseases - Myotonic Dystrophy DM - Top Level | Muscular Dystrophy Association [Internet]. Muscular Dystrophy Association. 2020 [cited 6 April 2020]. Available from: https://www.mda.org/disease/myotonic-dystrophy
Schulte-Mattler W, Zierz S, Eger K. Proximalemyotone. Myopathie (PROMM). Der Nervenarzt. 1997;68(10):839-844.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareA Study of Cardiac Autonomic Neuropathy Among Type-II Diabetic Patients
English4247Surendra B.V.English Muthiah N.S.English Sailaja M.V.English Prabhu K.EnglishEnglishCardiac Autonomic Neuropathy (CAN), Diabetes Mellitus, Ewings test, Risk factors, Prevalence, Cardiac autonomic function tests (CAFT)
INTRODUCTION:
Diabetes is a metabolic disorder characterized by hyperglycemia that occurs either due to decreased insulin level or insulin resistance Diabetic Autonomic Neuropathy1 can involve the entire autonomic nervous system (ANS). It is manifested by dysfunction 2 of one or more organ systems.(e.g.,cardiovascular, gastrointestinal, genitourinary,sudomotor,or ocular) CardiacAutonomicNeuropathy (CAN) is a serious complication of Diabetes Mellitus (DM) that is among the least recognized and understood. Not only does it affect the survival and quality of life in diabetics 3-5 it is also a major source of increased cost in diabetic care. Currently, a consensus exists that CAN is an independent risk factor for cardiovascular events 6, Its high mortality rate is related to cardiac arrhythmias, silent myocardial ischemia, sudden death, perioperative cardiovascular, and cardiorespiratory instability.7 the autonomic fibres innervating heart and blood vessels are affected in CAN and causes disturbances in cardiovascular dynamics 8 and anatomy9 It is recommended by several professional bodies,10-12 to perform a subclinical assessment of CAN by utilizing CARTs as soon as T2DM is diagnosed. Ewing’s CARTs are considered as Gold standard in CAN, therefore, consistently been used for its subclinical assessment.13,14 Hyperglycemia, obesity, dyslipidemia, hypertension, and smoking which are the modifiable risk factors are among the proposed risk factors for Cardiac autonomic neuropathy 15,16–20No clear evidence supports glucose-lowering intervention to prevent CAN in type 2 diabetes 21. On the other hand in the steno-2 trial, multifactorial therapy decreased the development of CAN up to 68%.22
The present study was planned to find out the prevalence of Cardiac autonomic neuropathy and the risk factors associated with CAN among type-II Diabetes Mellitus participants in a tertiary care hospital.
Material and methods:
This cross-sectional study was conducted at the department of General medicine OPD, Viswabharathi medical college from December 2019 to November 2020. 273 type-II Type-II DM patients with ≥ 3years of the duration of both sexes aged between 35-80 years were selected for this study by purposive sampling technique. Participants with other diseases associated with the autonomic nervous system, Patients on drugs like sympathomimetics, and antiarrhythmics, patients with underlying cardiac illness, and uncooperative and physically disabled patients were excluded from this study.
This study was approved by the Institutional Ethics Committee having approval number VMC/IEC/2/2018 and an informed consent form was obtained from the study participants.
Study protocol:
A questionnaire That included socio-demographic details such as age, sex; anthropometric details such as height, weight; duration of diabetes, smoking & Hypertension history was administered to each patient.
clinical and laboratory parameters such as BMI, Blood pressure, HbA1c, serum cholesterol, serum triglycerides were collected from each patient
BMI: by dividing weight in kilograms by the square of height in meters BMI was calculated.
Blood pressure was measured with a standard mercury manometer and if their blood pressure values were >140/90 mmHg or they were taking any antihypertensive drugs were considered to have arterial hypertension
after an overnight fasting Venous blood was drawn in the morning. using the automatic analyzer. Serum cholesterol and serum triglycerides Were measured and Glycosylated haemoglobin (HbA1c) was measured by high-performance liquid chromatography.
Ewings Cardiovascular Reflex Tests (CRT): All the patients selected for the study underwent Cardiovascular Reflex Tests (CRT) for evaluation of cardiac autonomic neuropathy. Standard 12 lead ECG was taken and heart rate was measured by continuous ECG recording using lead II.
Instruments: 1. ECG instrument (CONTEC ECG300G) with a paper speed of 25mm/sec
2. Diamond Sphygmomanometer BP instrument
All five Ewing`s tests were performed as following for the detection of DCAN (diabetic cardiac autonomic neuropathy):
I. Tests for assessing parasympathetic function
1) Heart rate response to deep breathing test:
2) Heart rate response to Valsalva maneuver
3) Heart rate response to standing
II.. Tests for assessing sympathetic function:
1) Blood pressure response to sustained handgrip
2) Bloodpressureresponsetostanding
The results were then categorized into one of the four groups
Normal
Early CAN - One of three parasympathetic tests abnormal or two borderline
Definite CAN- Two parasympathetic tests abnormal
Severe CAN- Two parasympathetic tests abnormal + one or both sympathetic tests abnormal
Statistical Analysis: Data analysis was done by using Software Package of Social Sciences (SPSS) trial version 16. Continuous data were analysed by using the Student unpaired t-test. The association of risk factors with the prevalence of CAN was analysed by using the Pearsons chi square test. The accepted level of significance was set below 0.05 (PEnglishhttp://ijcrr.com/abstract.php?article_id=4205http://ijcrr.com/article_html.php?did=4205
Sarah Wild, Gojka Roglic, Anders Green, Richard Sicree, Hilary King. Global Prevalence of diabetes: estimates for 2000 and projections for 2030. Deathcare 2004;27(5):1047–1053.
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Aaron I Vinik, Raelene E Maser, Braxton D Mitchell, Roy Freeman. Diabetic autonomic neuropathy. Deathcare. 2003;26(5):1553–1579.
Maser RE, Mitchell BD, Vinik AI. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes. A meta-analysis. Deathcare. 2003;26(6):1895-1901.
Vinik K, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007; 115(3):387-397
Maser RE, Lenhard MJ, Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab. 2005;90(10):5896–5903,.
Maser RE, Mitchell BD, Vinik AI, Freeman RD. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes a meta-analysis. Deathcare 2003;26(6):1895–1901.
Kimura M, Toyoda M, Ono M, Saito N, Kaneyama N, Miyauchi M, et al. Detection of autonomic nervous system abnormalities in diabetic patients by 24?hour ambulatory blood pressure monitoring. Tokai J Exp Clin Med. 2018;43(3):97–102.
Hjortkjaer HO, Jensen, Halsted J, MogensenUM, Corinth, Rossing P, et al. Left ventricular remodelling and cardiac chamber sizes in long term, normal albumin uric type1 diabetes patients with and without cardiovascular autonomic neuropathy. J Diabetes Complications. 2019;33(2):171–177.
Andrew JM. Boulton, Arthur I. Vinik, Joseph C. Arezzo, Vera Bril, eval. Feldman, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Deathcare. 2005; 28(4):956–962.
Spallone V, Bellavere F, Scionti L, Maule S, Quadri R, Bax G, et al. Recommendations for the use of cardiovascular tests in diagnosing diabetic autonomic neuropathy. Nutr Metab Cardiovasc Dis. 2011;21(1):69–78.
Vincenza Spallone, Dan Ziegler, Roy Freeman, Luciano Bernardi, Simona Frontoni, Rodica Pop-Busui, et al. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27(7):639–653
Maser RE, Mitchell BD, Vinik AI, Roy Freeman. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes a meta-analysis. Deathcare. 2003;26(6):1895–1901.
Jae-Seung Yun, Ji-Hyun Kim, Ki-Ho Song, Yu-Bae Ahn, Kun-Ho Yoon, Ki-Dong Yoo, et al. Cardiovascular autonomic dysfunction predicts severe hypoglycemia in patients with type 2 diabetes: a 10- year follow-up study. Deathcare. 2014;37(1):235–241.
Rodica Pop-Busui, Andrew J.M. Boulton, Eva L. Feldman, Vera Bril, Roy Freeman, Riyaz A. Malik, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Deathcare. 2017;40(1):136–154
Ayad F, Belhadj M, Pariés J, Attali JR, Valensi P. Association between cardiac autonomic neuropathy and hypertension and its potential influence on diabetic complications. Diabet Med 2010;27(7):804–811
Andrew Moran, Walter Palmas, Lesley Field, Jyoti Bhattarai, Joseph E Schwartz, Ruth S Weinstock et al. Cardiovascular autonomic neuropathy is associated with microalbuminuria in older patients with type 2 diabetes. Deathcare. 2004;27(4):972–977
Maser RE, Lenhard MJ. An overview of the effect of weight loss on cardiovascular autonomic function. Curr Diabetes Rev. 2007;3(3):204–211
Voulgari C, Pallas M, Kokkinos A, Ariana V, Katsilambros N, Tentolouris N, The association between cardiac autonomic neuropathy with metabolic and other factors in subjects with type 1 and type 2 diabetes. J Diabetes Complications. 2011;25(3):159–167
Serhiyenko VA, Serhiyenko AA, Cardiac autonomic neuropathy: risk factors, diagnosis and treatment. World J Diabetes. 2018;9(1):1–24
William Duckworth, Carlos Abraira, Thomas Moritz, Domenic Reda, Nicholas Emanuele, Peter D Reaven, et al. VADT Investigators, Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–139
Gaede P, Vedel P, Parving HH, Pedersen O, Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomized study. Lancet. 1999;353(9153):617–622
Jesper FR, Knud Y, Elisabeth G, Poul E J, Hans H L, Ebbe E, et al, Cardiovascular Autonomic Neuropathy Is Associated With Macrovascular Risk Factors in Type 2 Diabetes: New Technology Used for Routine Large-Scale Screening Adds New Insight. J Diabetes Sci Technol. 2014;8(4): 874–880
Gupta S, Gupta N. The Prevalence of Cardiac Autonomic Neuropathy in Type 2 Diabetes Mellitus. JMSCR. 2017;5(7):24635-39
Barthwal SP, Agarwal R, Khanna D, Kumar P. QTC prolongation in diabetes mellitus- an indicator of cardiac autonomic neuropathy. J App Pharm Int. 1997;(45):15–17.
Mathur CP, Gupta.QTC prolongation in diabetes mellitus-an indicator of cardiac autonomic neuropathy.JIM. 2006;7(2):130–162.
Pappachan J, Sebastian J, Bino B, Jayaprakash K, Vijayakumar K, Sujatha P, et al. Cardiac autonomic neuropathy in diabetes mellitus: prevalence, risk factors and utility of corrected QT interval in the ECG for its diagnosis. Postgrad Med J. 2008; 84(990): 205–210.
Refaie W. Assessment of cardiac autonomic neuropathy in long-standing type 2 diabetic women. EHJ. 2014; 66(1): 63–69.
Sukla P, Shrivastava SR, Shrivastava P S, Rao NL. Assessment of the cardiac autonomic neuropathy among the known diabetics and age-matched controls using non-invasive cardiovascular reflex tests in a South-Indian population: A case-control study. Avicenna J Med. 2016; 6(3): 81-85.
Haji KK, Shuaib A, Imran AS, Fatima Q. Cardiac AutonomicNeuropathy in Type-1 Diabetes Mellitus Patients and its Association with the duration of Disease and Glycemic Control. J Coll Physicians Surg Pak. 2009; 19(4): 232–235.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareComparative Evaluation of Four Different Anterior Reference Points & Their Effect on the Protrusive Condylar Guidance Angle Obtained in Semi Adjustable Articulator
English4852Bora NeelamEnglish Jagtap AmitEnglish Dange BhagyashreeEnglish Bulbule NileshEnglish Gandage DhananjayEnglish Swarup SiddharthEnglishEnglishAnterior point of reference, Orientation jaw relation, Articulator, Lateral cephalograms, Orbitale, Orbitale minus 7 mmINTRODUCTION
The form, function, & patho-function of the dynamic masticatory system comprises one of the most fascinating, basic, and important areas of study in dentistry.1 No speciality in dentistry can be effectively practised at the highest level of competence without an understanding of how the teeth relate to the rest of the masticatory system, including the temporomandibular joints. It is correctly said that dentists who ignore the relationship of the occlusion to the position and condition of the temporomandibular joints can only guess at diagnosing a myriad of problems that are seen in every general practice.2
The use of 2 posterior points and an anterior point of reference for orienting a maxillary cast to an articulator has long been advocated.3 Anterior reference point is any point located on the midface that, together with two posterior reference points, establishes a reference plane.4 Different anterior points of reference for different articulators have been proposed which include the orbitale, orbitale minus 7 mm, nasion, ala of the nose, superior annular notch and inferior annular notch on the incisal guide pin of the Hanau wide vue articulator. Out of these points, the orbitale, orbitale minus 7 mm, superior annular notch & inferior annular notch on the incisal guide pin of the articulator are used in this study as anterior points of reference for Hanau Wide Vue articulators. A variation in the supero-inferior position of casts on the articulator can alter the protrusive condylar guidance making the reliability of these anterior reference points questionable.
With this background of uncertainty, a study was planned to evaluate four different anterior reference points and their effect on the protrusive condylar guidance angle obtained in semi adjustable articulator.
METHODOLOGY
Twenty Students from Dr. D.Y Patil Dental College and Hospital, Pimpri were selected for the study. Irreversible hydrocolloid impressions were made for the maxillary & mandibular arch. One set of the stone cast (maxillary & mandibular) was obtained for each student after making the impressions. Bases were poured for the casts & then a spilt cast was made for the maxillary cast.
Four different anterior reference points were selected for mounting the casts on a Hanau Wide Vue articulator. The orbitale of the patient, orbitale minus 7 on the patient, superior annular notch on the incisal guide pin of the articulator (37 mm below the orbital plane), the inferior annular notch on the incisal guide pin of the articulator (54 mm below the orbital plane) were the anterior reference points used in the study. The maxillary teeth impression was recorded on the bite fork with impression compound.
The first anterior point of reference was selected as orbitale. The position of the orbitale was confirmed, which is located on the notch present in the lower rim of the orbit in line with the pupil of the eye & was marked with an indelible pencil.5 (Fig.1) This marking was used as the anterior point of reference for the facebow transfer using a facebow (Hanau spring Bow, Teledyne Water Pik, Fort Collins, Colorado, USA). The external auditory meatus was used as posterior determinants for recording the orientation of the maxilla to the cranium. The facebow record was made followed by transfer of the facebow record onto the Hanau Wide Vue semi-adjustable articulator and indirect mounting of the maxillary cast was done.6 Then the mandibular cast was mounted in maximum intercuspation with the maxillary cast.7
After completion of mounting a pencil mark was made on the buccal cusp tip of the maxillary 1st premolar on both sides of the cast. Another marking was made 6 mm distal to the previous mark on the mandibular tooth on both sides of the cast. Then, the centric locks were opened & the mandibular cast was protruded so that the two lines marked previously coincided. An anterior jig was then fabricated with an impression compound with the mandibular protrusion of 6 mm. This jig was then placed intraorally & checked. This was done to keep a constant of 6 mm protrusion for all the subjects.
Three sets of protrusive interocclusal records were made intraorally using Addition silicone bite registration material with the jig placed between the anterior teeth. The protrusive bite records were used to program the articulator.8 Then the average of the three readings was calculated for both the right & left sides. The condylar guidance angle was tabulated for both the right & left sides.
The casts were then demounted and used again for the mounting with the second anterior point of reference. A second mark was made 7 mm below the orbital marking and was used for the second facebow transfer. (Fig. 2)
Then the casts were mounted similarly as done previously for orbitale as the anterior point of reference. Programming of the articulator was done & the condylar guidance angles were tabulated for both sides.
The third & fourth anterior point of reference i.e. the superior annular notch on the incisal guide pin of the articulator & the inferior annular notch on the incisal guide pin of the articulator was used for mounting the maxillary cast. A facebow record was made without considering the anterior reference point on the patient. (Fig.3)
To locate the incisal edges of the maxillary casts at the level of superior & inferior markings on the incisal guide pin respectively, the facebow was adjusted by using an anterior elevator (no. 010358-000, Teledyne Water Pik, Fort Collins, Colorado, USA). The casts were mounted using the new facebow record. The maxillary cast was mounted followed by mounting of the mandibular cast as done previously. Programming of the articulator was done & the condylar guidance angles were tabulated for both the sides for both the superior & inferior annular notch as the anterior points of reference.
A radiographic marker was then placed in the same position on the patient’s face where the orbitale was marked for orbitale as the anterior point of reference. This was done to trace the same marking of orbitale on the lateral cephalogram as on the face. The two lateral cephalometric radiographs were made using a Broadbent cephalostat to standardize the head positions in the Department of Oral Medicine Diagnosis and Radiology. One lateral cephalometric radiograph was made in maximum intercuspation. The second lateral cephalometric radiograph was made in a protrusive position by placing the anterior jig intraorally.
The lateral cephalograms were then traced and superimposed. The following points were traced on each lateral cephalogram: sella, nasion, radiographic orbitale, porion.9 The condyle border was traced for both sides and their mean condyle border was marked. A posterior-most point was marked on the posterior slope of the condyle. Sella & nasion were connected & this line was used for overlapping the two lateral cephalograms. Frankfort horizontal plane was drawn by connecting the radiographic orbital & porion. By joining the posterior-most points on the posterior slope of the condyles in maximum intercuspation and the protrusive position, the protrusive condylar path was gained. The angle between the condylar path and the Frankfort horizontal plane was determined. (Fig.4)
METHOD OF DATA ANALYSIS:
The Paired ‘t’ test was used to analyse the values gained for protrusive condylar guidance in 4 different mountings and the radiographic tracings.
RESULTS:
Comparison of protrusive condylar guidance angle values obtained from 4 different anterior reference points and radiographic tracings. (Table 1)
DISCUSSION
In this study, four different anterior reference points were used i.e. Orbitale, orbitale minus 7 mm, Superior annular notch and inferior annular notch present on the incisal pin of the Hanau wide vue articular.
The values obtained for protrusive condylar guidance in 4 different mountings and the radiographic tracings were analysed using paired t-test & correlation test. The analysis of the data obtained from the study did not support the null hypothesis that all anterior points of reference register the same condylar guidance on both the articulators. The analysis showed that the four different anterior points of reference used in the study recorded different condylar guidance values.
The mean protrusive condylar guidance values registered for mountings with Orbitale as the first anterior point of reference was 35 ± 4.29 degrees, with Orbitale minus 7 mm as the second anterior point of reference was 26.72 ± 7.12 degrees, with the superior annular notch as the third anterior point of reference was 25.62 ± 5.95 degrees, with the inferior annular notch as the fourth anterior point of reference was 34.75 ± 5.05 degrees. The mean protrusive condylar guidance values registered radiographically was 35.5 ± 4.89 degrees.
The protrusive condylar guidance values registered for mountings with Orbitale minus 7 mm (p = 0.000) and superior annular notch (p = 0.000) as anterior points of reference were significantly different (p Englishhttp://ijcrr.com/abstract.php?article_id=4206http://ijcrr.com/article_html.php?did=4206
Koolstra, Harm J. Dynamics of the Human Masticatory System. Critical reviews in oral biology and medicine: an official publication of the American Association of Oral Biologists. 2002;13,366-76. DOI:10.1177/154411130201300406.
Dawson PE. Functional Occlusion: From TMJ to Smile Design. 2nd Edition. The United Kingdom, Elsevier Health Sci. 2006; ix-x.
Bailey JO Jr, Nowlin TP. Evaluation of the third point of reference for mounting maxillary casts on the Hanau articulator. J Prosthet Dent. 1984 Feb;51(2):199-201. doi: 10.1016/0022-3913(84)90260-9. PMID: 6583397.
The glossary of prosthodontic terms. J Prosthet Dent. 2005;94:10-92
Salzmann JA. Orthodontic practice and techniques. Philadelphia: JB Lippincott Co; 1957. p. 139.
Anderson JD. Biological & clinical considerations in making jaw relation records & transferring records from the patient to the articulator. Zarb Bolender. Prosthodontic treatment for edentulous patients.12th edition. St. Louis: Mosby; 2009. p. 268-97.
Shillingburg HT. Interocclusal records. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence Publications. 1997;35-45
Shillingburg HT. Articulation of casts. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence Publications. 1997;47-72
Gilboa I, CardCash HS, Kaffe I, Gross MD. Condylar guidance: correlation between articular morphology and panoramic radiographic images in dry human skulls. J Prosthet Dent. 2008 Jun;99(6):477-82. doi: 10.1016/S0022-3913(08)60112-2. PMID: 18514670.
Lauciello FR, Appelbaum M. Anatomic comparison to arbitrary reference notch on Hanau articulators. J Prosthet Dent. 1978 Dec;40(6):676-81. doi: 10.1016/0022-3913(78)90068-9. PMID: 281520.
Lawrence A, Weinberg A.B. An evaluation of the face bow mounting. J Prosthet Dent 1961;11(1):32-42. 10.1016/0022-3913(61)90107-X
Gonzalez JB, Kingery RH. Evaluation of plane of reference for orienting maxillary casts on articulators. J Am Dent Assoc. 1968;76:329-336.
Nooji D, Sajjan SM. The third point of reference and its effect on the protrusive condylar guidance angles obtained in the semi-adjustable articulator. J Indian Prosthodont Soc 2008;8:71-77.
Anusha CV, Singh AA, Sam G, Sangwan B, Shilpa M, Kamath AG. Evaluation of Two Facebow/Semi-adjustable Articulator Systems for Orienting Maxillary Cast on Articulators: A Pilot Study. J Contemp Dent Pract. 2016 Apr 1;17(4):327-30. doi: 10.5005/jp-journals-10024-1849. PMID: 27340168.
Shetty S, Shenoy KK, Sabu A. Evaluation of the accuracy of transfer of the maxillary occlusal cant of two articulators using two facebow/semi-adjustable articulator systems: An in vivo study. J Indian Prosthodont Soc. 2016 Jul-Sep;16(3):248-52. doi: 10.4103/0972-4052.176525. PMID: 27621543; PMCID: PMC5000565.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareHerbal Medicinal based Approach for Alzheimer Disease - A Mathematical Model
English5359Arora KomalEnglish Khurana PoojaEnglish Kumar DeepakEnglishIntroduction: Due to the cases of more than 1 million (in India) and more than 80 million (worldwide) of Alzheimer disease, there is an immediate need of finding a cure for Alzheimer. Alzheimer disease, a type of dementia, is a neurodegenerative, progressive disease that gives rise to troubles and issues related to cognitive functions. It is not a normal part of ageing; though the greatest known risk factor is increasing age. Aim: Many treatments and many medications have been found but their efficacy to reach Blood-Brain Barrier and rate of beta-amyloid clearance is very low. Moreover, drawbacks like cost, drug resistance and side effects bringing down their success rate. Methodology: Considering the problem, this entry focuses on the alternate ways (herbal medicine) for Alzheimer cure by generalizing the mathematical model to investigate the effect of selected medicinal plants on the levels of amyloid-beta peptides, the characteristic hallmark of Alzheimer. Results: We have analyzed the effect of active compounds of five potent medicinal plants at different dosages i.e. 250 mg/ day, 500 mg/day, 750 mg/day and 1000 mg/day concerning time and found Withania somnifera as the best plant amongst five as it showed an effective decline in the beta-amyloid levels at 500 mg/day. We have also examined the ADME ( Absorption, Distribution, Metabolism and Excretion) profile of the selected plants using the Swiss ADME server which revealed no violation of Lipinski’s rule. Conclusion: This model can act as a utility model for formulating herbal-based compounds that increase the rate of amyloid-beta clearance from the brain by inhibiting aggregation of amyloid-beta with least/no side effects.
EnglishAlzheimer disease, Amyloid-beta, Mathematical model, Herbal approach, Medicinal plant, DosageIntroduction
The brain, the central part of our body, controller of all the activities, is made of 100 billion nerves. All the nerves have their specialized functions to perform. Some are involved in thinking, behaviour and memory while others are involved in hearing, audition, gustation, vision and other activities forming a communicating network between different cells. Nerves that are involved in cognitive activities, when starts degenerate lead to the loss of memory. Deteriorative association between the brain cells which decrease the acetylcholine neurotransmitter is the main cause of memory loss, and leads to dementia.1Synapses (the connection between the different neurons), a major expressway or a site of communication for memories, emotions, sensations, thoughts, and movements permit information to pass via chemical pulses between different neurons.
Alzheimer’s disease (AD) is a neurodegenerative, inevitable, progressive disorder that affects memory, thinking behavior and other potential activities.2 Worldwide, more than 25 million people are suffering from dementia, which more of them are from AD. It has been estimated that approximately about 5 million fresh/ new cases happening each year and this figure is expected to become two-fold after every two decades (20 years).
The underlying and foremost step of the disease is to strike the brain’s memory centre leading to individuals of AD being more forgetful and distracted. The initial stage of AD is difficult to be diagnosed as its symptoms are noticeable usually at an advanced stage. The sequential cleavage of APP (Amyloid Precursor protein), results in the formation of peptide Amyloid-beta by beta-secretase followed by gamma-secretase. This is known as the Amyloidogenic pathway. The enzyme alpha-secretase competes with gamma-secretase to stop this amyloidogenic pathway. Competition of alpha-secretase with gamma-secretase is the non-amyloidogenic pathway.3,4 According to the amyloid cascade hypothesis, imbalances between the formation and removal of amyloid beta results in the dysfunction of neurons and ultimately cell death. Different forms of amyloid-beta in terms of structure can occur such as oligomeric, proto fibrillar, and fibrils.5Accumulation of deposits of beta-amyloid protein outside nerve cells results in the formation of hard plaque. Simultaneously, the accumulation of malformed versions of tau proteins inside the neurons results in the collapsing of neuron’s transport microtubules.6 As time passes, the functioning of neurons become less efficient or die, ultimately fail to communicate with one another causing the shrinkage of brain tissue. One’s judgment becomes awful as the disease spreads to the outer layer of the brain. Age and genetic factors are the known risks associated with Alzheimer. Other factors such as gender, awareness, previous head injury, family history, exposure to heavy metals, down’s syndrome contribute greatly to the development of AD. Individuals having down’s syndrome, after 40 years of age, develop almost the same neuropathological symptoms of AD and thus the strong evidence for the genetic premise of Alzheimer disorder.7 2-3% of early-onset AD cases are associated with the mutation caused on chromosome number 21 (the chromosome that encodes the amyloid-beta peptide precursor i.e. APP) whereas 70-80% of AD cases (early onset) are associated with the mutations in presenilin 1 (PS1) gene present on chromosome number 14 and 20-25% of the early cases are linked to the mutations in presenilin 2 (PS2) present on chromosome number 1. APP, PS1 and PS2 alter the processing mechanism of APP that leads to increased amyloid-beta production. APP cleavage by enzyme beta-secretase followed by cleavage by gamma-secretase results in the formation of amyloid-beta. Deposition of these amyloid-beta peptides is a first step in the aetiology and pathogenesis of Alzheimer disease followed by other characteristics of AD such as microtubule misfolding (neurofibrillary tangles), loss of synaptic connection, and dementia. Apo E gene encoded on chromosome number 19 increases the 50% risk of developing Alzheimer.
According to the computed value, it has been reported that around 5.4 million Americans are suffering from Alzheimer dementia in 2017 in which 5.3 million are having late-onset Alzheimer (65 years of age or more). It ranks fifth in terms of causing death.8
The main cause of Alzheimer is the deterioration and death of neurons that are responsible for thinking, learning and behaviour and as the neurons degenerate it affects the entire brain. It is differentiated from the normal brain as the accumulation of deposits of beta-amyloid plaques and neurofibrillary tangles causes shrinkage of the brain.9
There is a conformational change in the soluble beta monomers to form the beta-sheet rich misfolded structure and hence aggregates to form amyloid fibrils. Deposition of these fibrils outside the neurons, called senile plaques lead to neurodegeneration.9 Amyloid beta, a short peptide cleaved by enzymes β (beta) secretase and γ (gamma) secretase, is derived from the amyloid precursor protein (APP), a gene which is found on chromosome number 21q21.10 Around 40 and 42 peptides of amino acids (beta-amyloid 40 and beta-amyloid 42) are obtained by cleavage by β secretase and then γ secretase.
Tau, a protein associated with microtubules found in cell bodies and mainly in the axons of nerve cells in the CNS. Around 6 isoforms of human tau protein have been expressed by the phenomenon of alternate mRNA splicing from a single gene that contains 16 exons and is present on chromosome 17q21. Twisted fibres of the protein tau, called neurofibrillary tangles (intracytoplasmic structures) build up inside cells because collapsing of neuron’s transport microtubules.11
Also, a decrease in the levels of acetylcholine due to its breakdown by an enzyme called acetylcholinesterase results in memory loss and hence Alzheimer.
Thus, amyloid accumulation, microtubules misfolding, dysfunction of cholinergic mechanism, oxidative stresses are some of the factors involved in the pathophysiology of Alzheimer disease.10
The distinguishing features of the brain describing the characteristic change that arises due to AD usually happen around 20 years before the emergence of symptoms and therapeutic remedy can be identified and accomplished. The phase where the slightest or suggestive symptoms appears offers a likely possibility for curative intercession that can decelerate the progression of the disease. There are four stages in the progression of dementia (starting from cognitively normal to dementia). The stage Mild cognitive impairment (MCI) appears before AD and for the early detection of Alzheimer, the transformation of stage MCI to stage AD is of agreeable concern. Assessment of significant biomarkers can be overriding to early (preclinical) diagnosing, monitoring, treating, and continuing phases of AD analysis.11 However, there is a requirement for standardizing such biomarkers for accurate and early diagnose of AD. This includes amyloid-beta, tat and phosphorylated tau, glucose, Positron emission tomography (PET), Cerebrospinal fluid (CSF), Apo E and telomere length, Magnetic Resonance Imaging (MRI), RNA interference.12-17
Food and drugs administration (FDA) approved drugs to treat symptoms related to Alzheimer’s disease, that includes the class of drugs called “cholinesterase inhibitors”. The cholinesterase inhibitors halt the process of disintegration and breakdown of a chemical messenger in the brain that is important for learning and memory. Examples of such drugs are donepezil, galantamine and rivastigmine approved for the treatment of mild to moderate Alzheimer disease. Other classes of drugs include M drugs (Memantine, melatonin, minocycline, modafinil). Memantine is an uncompetitive NMDA (N-methyl-d-aspartic acid receptor antagonist) and is approved for the management of moderate-to-severe AD, Melatonin is a neuroprotector and antioxidant and anti-inflammatory in nature, Minocycline reduces neuroinflammation and CNS pathology and prevents cell death and Modafinil is a wake-promoting agent is approved for use in narcolepsy and obstructive sleep apnea. It improves global mental status, hippocampal neurogenesis, attention, and cognition. Amyloid-beta degrading enzymes such as an insulin-degrading enzyme, neprilysin, endothelin-converting enzyme decrease the levels of amyloid-beta is also one of the medications approved for Alzheimer treatment.18
Though numerous treatments and medications such as acetylcholinesterase inhibitors, M-drugs, amyloid degrading enzymes are already on the market, their results not indicating the complete clearance of amyloid-beta from the brain. Moreover, some of the downsides of these medications like toxicity, drug resistance, side effects, and cost urge the need to have a transition from these chemical medications towards the natural traditional medications in a form of herbal treatment. Plants are utilized as an essential source for various drugs in Indian medicinal history. The complete description of all the curative properties of the medicinal plants has been listed in Rigveda. After a while, various synthetic drugs developed and commenced which due to their drawbacks failed. Recently, the trend of using plants is again rising and is being utilized confidently.
Medicinal plants such as Curcuma longa, Withania somnifera, Bacopa monnieri, Centella Asiatica, Convolvulus pluricaulis have been reviewed, researched and documented to show potent responses in Alzheimer cure. These plants consist of active compounds like tannins, lignans, triterpenes, alkaloids, flavonoids, sterols and polyphenols and work by inhibiting fibrillation, relaxing CNS, promoting memory.19,20
Material and Methods
Mathematical model
Alzheimer, a neurodegenerative disorder, affects the thinking, memory, behaviour and other activities of an individual. In addition to the effect on an individual’s memory, it produces a considerable stretch to the society also and hence several medications like cholinesterase inhibitors, M drugs, NMDA antagonist, antioxidants, statins, PPAR gamma antagonist and some combinational approaches of these drugs were developed for the treatment of Alzheimer but despite all these treatments, condition of Alzheimer’s patients and hence its influence on society is not improved. Herbal therapy is an alternative for the drugs available in the market that failed due to their drawbacks.
Various mathematical models have been made representing the role of amyloid-beta aggregation, tau phosphorylation, microglia’s, astrocytes, macrophages, in the development and management of Alzheimer disease.32 Puri and Li describe the pathogenesis of Alzheimer in the form of a mathematical model.33 Also, the mathematical model symbolizing the death of neurons in Alzheimer has also been constructed.34
This mathematical model acts as a template to determine the dosage of active constituents of medicinal plants in lowering the levels of amyloid-beta in the brain and helps in their clearance.
The extracellular amyloid beta-peptide satisfies the following equation:
To investigate the effective dosage of medicinal plants to clear the amyloid-beta levels from the brain, extract of five plants have been analyzed in four different doses (250 mg/day, 500 mg/day, 750 mg/day and 1000 mg/day) for about 5 months.
The dosage equation is as follows:
Parametric description
Proteolytic degradation of APP by beta and gamma-secretase releasing Amyloid beta.
Release of amyloid-beta by activated astrocytes.
Reference density of the astrocyte cells in the brain.
Release of amyloid-beta by dendritic cells.
Reference density of the dendritic cells in the brain.
Clearance of amyloid-beta by microglia.
Clearance of amyloid-beta by amyloid-beta degrading enzymes.
H: Dosage quantity
k: Michael’s-Menten coefficient
2.2General solution of first-order differential equations-Euler’s Method.
The general case for the solution of a first-order differential equation can be computed numerically approximations. The differential equation is replaced with the following approximation
For sufficiently small. This can be arranged to
So given step size and initial condition.
2.3 ADME (Absorption, Distribution, Metabolism, Excretion) Profile analysis
The exploration of pharmacokinetics and physio-chemical characterization is an important step in the identification of any drug to cure the disease effectively. Here, we have used the swiss ADME server to investigate the drug-likeness properties of the plants selected for reducing the amyloid-beta concentration from the brain [35]. Various parameters like molecular weight, lipophilicity, water-solubility, gastrointestinal absorption, CYP inhibitors, bioavailability score have been calculated using swiss ADME and listed in table 2. Also, the violations of Lipinski’s rule (if any) have been reported.
Results and Discussions
Amyloid beta forms in the brain of every individual by the cleavage of APP by the action of enzyme beta-secretase followed by gamma-secretase. However, it excretes out of the brain, meaning the production and removal of amyloid-beta is a simultaneous process. The imbalances between the formation and removal of amyloid-beta from the brain lead to its accumulation.
The alternative for synthetic drugs is herbal medicine. Medicinal plants due to the presence of active constituents have potential in the treatment of various disorders. Active constituents such as curcumin, steroids, glycosides, anthocyanins, terpenoids, Asiatic acid, alkaloids have been reported and documented for the potent purpose of reducing beta-amyloid levels. To find an effective cure, it is very important to explore pharmacokinetics and physicochemical properties such as water solubility, gastrointestinal absorption, lipophilicity, bioavailability score and many more. The Lipinski’s rule is a standardized rule for drug development that determines the drug-likeness properties of a molecule and according to the rule drug molecule having MW > 500 g/mol, hydrogen-bond-donating atoms > 5, Hydrogen-bond-accepting atoms > 10, or log p > 5 is not considered as a good pharmaceutical agent in terms of oral activity. The natural molecules we have selected for the cure of Alzheimer showed good pharmacokinetics and Physico-chemical properties and no violation of Lipinski’s rule except for active compounds bacoside and asiaticoside present in Bacopa monniera and Centella Asiatica. In addition to this, the dosage of different plants has also been investigated at 250 mg/day, 500 mg/day, 750 mg/day and 1000 mg/day for five months where Curcuma longa showed the best results at 1000 mg/day dose, Bacapo monnieri at 750 mg/day, Convolvulus pluricaulis at 1000 mg/day dose, Withania somnifera at 500 mg/day, and Centella Asiatica at 750 mg/day; the results of which are interpreted well in the graphs viz Figure 2, 3, 4, 5, and 6. Our inference from the results implies that Withania somnifera is the best amongst five plants as it is effective in clearing amyloid-beta at a lower dose i.e., 500 mg/day as compared to others.
Conclusion
Due to the challenges faced by the pharmaceutical industries, the treatment of neurodegenerative diseases is becoming expensive, inefficient and riskier. This caused a transition from these chemical medications towards the natural traditional medications in a form of herbal treatment. Considering the effects of memory, thinking and other essential activities on Alzheimer’s patients and its stress to society, this research involves the formation of a mathematical model that acts as a template to represent the change in the levels of beta-amyloid protein (the defining feature of Alzheimer disease) upon intake of herbal formulation in form of active constituents present in the medicinal plant. The potential ability of plants in inhibiting fibrillation and hence reducing the amyloid-beta levels is due to the presence of active constituents like tannins, lignans, triterpenes, alkaloids, flavonoids, sterols and polyphenols. For different doses, the active component of the selected plant was analyzed where information from the graph reveals that all selected plants showed reduced amyloid beta levels, however, Withania somnifera showed the best results at a lower dose (50 mg/day) concerning time as compared to others. Also, the results of ADME analysis showed good bioavailability score, solubility, lipophilicity
Acknowledgement:
The authors thank the Dept. of Biotechnology, MRIIRS LAB to provide data sets on lifestyle disorders to provide facts that motivate authors to do research work.
Conflict of interests: The authors declare no conflict of interest, financial or otherwise.
Funding Agency: None
Contribution of Individual Authors
Arora K. developed the theoretical formalism, performed the analytic calculations and performed the numerical simulations. Both Khurana P. and Kumar D. authors contributed to the final version of the manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=4207http://ijcrr.com/article_html.php?did=4207
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareAssessment of Human Leukocyte Antigen (HLA)- DRB1 Alleles Associated with Susceptibility to Rheumatoid Arthritis: A Study on North-Eastern Indian Population
English6064Manoj Kr ChoudhuryEnglish Pankaj KakatiEnglish Dhritiman MisraEnglish Roonmoni DekaEnglish Chitralekha BaruahEnglishEnglishRheumatoid arthritis, Pathogenesis, Genotyping, Susceptible, ProtectionINTRODUCTION
Rheumatoid arthritis (RA) is a composite, chronic disease-causing inflammation of joints and surrounding tissues. It has a heterogeneous nature, where both genetic and environmental factors have crucial roles in pathogenesis.1 The prevalence of RA is 1% globally. Several risk factors such as ethnicity, gender, smoking, under-nutrition and host immunogenic factors are found to be associated with susceptibility to RA.2
A genetic contribution to the development of RA is estimated to attribute to about 30% - 50% of the disease risk. Based on the facts on risk rates it has been documented that there is a genetic
association of the disease among close relatives such as siblings, offspring and parents. The risk rate is found to be two to three per cent among 1st degree relatives.3
The strongest association has been reported with human leucocyte antigen (HLA) alleles, in particular with HLA-DRB1 alleles, Human leukocyte antigen (HLA) molecules play a key role in the immunogenicity by presenting endogenous and exogenous peptides to cd8+ and cd4+ T cells. A specific sequence, present within the peptide-binding cleft of HLA class II molecules (HLA-DR,-DP and –DQ), has been implicated in genetic susceptibility to RA.
Among the class II HLA genes, the HLA- DRB1 alleles encode a “shared epitope” a five amino acid sequence motif in residues 70-74 of the HLA-DRβ (beta) chain are found to be connected with the severity of RA.4 In some populations the DRB1*01 and DRB1*04 alleles have been reported to have a strong association with RA due to the presence of shared epitope but studies from the northeastern part of India regarding this association have not yet been documented. Ethnic differences both in terms of genetic association and prevalence of RA have been observed worldwide, for instance, about 5 to 6% of people from North American population groups get affected by RA, on the other hand, the rate of effectiveness is quite low in Caribbean people of Africa.5 The reason behind such inconsistencies may lie in both the genetic as well as on environmental aspects associated with the ethnic groups. Because of these inconsistencies in different geographical areas among different populations, it is necessary to conduct more studies in distinct geographical stretches to examine the factors contributing to disease occurrence and progression.5,6
From Northeastern India, only a handful of studies on the association of genetic factors related to RA have been conducted. A recent study states that TNF-α –308 variant GA genotype is higher in RA cases (46.03%) than in controls (25%). The presence of TNF-α –308 variant A allele is associated with an increased risk of RA susceptibility.6 Another study was done on the association of HLA-DRB1 snp genotypes with Rheumatoid arthritis in the northeast Indian population. It has been reported that HLA-DRB1 rs 660895 heterozygote AG genotype is associated with a reduced risk of RA compared to controls. Also, a significantly higher distribution of HLA-DRB1 rs 13192471 was observed in RA cases.7, 8, 9
Not a single study analyzing the frequency of DRB1 alleles associated with RA in this region has been reported so far, therefore the present study aims at accessing the HLA DRB1 alleles associated with susceptibility to RA among the population of North-eastern India.
MATERIALS AND METHODS
The study had been carried out in Gauhati Medical College & Hospital (GMCH) which is an advanced tertiary care government hospital situated in Guwahati, Assam. This hospital caters for a large number of patients from every nook and corner of the state as well as from almost all other states of North-eastern India. Ethical clearance vide letter no. MC/108/2012/9 had been obtained from the Institutional Ethical Committee (IEC) of GMCH before conducting the research.
Population Samples
A total of 150 cases, aged between 18 to 65 years, were enrolled. Enrollment was based on the fulfilment of standard American College of Rheumatology (ACR) / European League against Rheumatism (EULAR) 2010 criteria. All the parameters included in the criteria like morning stiffness, RF factor, number of short and long joints involved, ESR, ACCP were checked and documented after thorough clinical examination by a registered medical practitioner.
150 Healthy Controls of same age group free from autoimmune symptoms with normal ESR, CRP levels and no family history of RA were enrolled in the study.
All the RA patients and controls enrolled in the study were from the North-Eastern part of India. Prior Informed consent was taken from all subjects at the time of participation in the study.
DNA extraction and PCR of the HLA-DRB1
Genomic DNA was extracted from peripheral blood leucocytes by salting out a technique using ammonium acetate salts and stored at -20°C for further use in PCR. The purity and concentration of the extracted DNA samples were checked in a spectrophotometer (MultiscanGo) and all DNA samples had been found to have a purity ratio (260/280) between 1.8 to 1.9 and concentration between 300 to 500 ng per microliter. The HLA DRB1 alleles were evaluated in patients and controls by using sequence-specific priming techniques of PCR (SSP-PCR). Inno-Train genotyping kits were used for this purpose.
The PCR program was an initial denaturation at 96°C for 2 minutes, followed by denaturation of 10 cycles at 96°C for 15 seconds and annealing at 65°C for 1 minute, after that another 20 cycles of denaturation at 96°C for 15 seconds, then annealing at 61°C for 50 seconds and a final extension at 72°C for 30 seconds in a Gradient Thermal Cycler. PCR product evaluation was performed by agarose gel electrophoresis. The gel was prepared of 2% Agarose in 0.5x Tris-acetate EDTA (TAE) buffer. Ethidium bromide (EtBr) was added in the gel which acts as an intercalating agent. The sample loaded agarose gel was run in TAE buffer for 20 minutes in an electrophoretic assembly at 200 V. Documentation of the gel after electrophoresis was done in a Gel Documentation unit (GEL-Doc, Make- Biorad). Hit charts and Helmberg SCORE software were used to assess the HLA DRB1 Alleles.
Statistical Methods: Statistical analysis and results validation were performed by IBM SPSS ver. 25 software using Pearson’s Chi-square test formula. The significance was described in terms of the p-value. Results having a p-value < 0.05 was considered statistically significant.
RESULTS
From the demographic profile of the patients as demonstrated in Table 1 it was observed that the majority of the patients enrolled in the study were women.
The allelic distribution of HLA DRB gene among the patients and controls was evaluated and displayed in Table 2 and Figure 1.
From the univariate analysis, it had been noticed that the frequency of DRB1*10 was higher in the patient group (65.3%) compared to the control group (24%) (OR= 5.968, CI= 3.607 to 9.874, PEnglishhttp://ijcrr.com/abstract.php?article_id=4208http://ijcrr.com/article_html.php?did=42081. Klareskog L. Genes, environment and immunity in the development of rheumatoid arthritis. Eur J Clin Investig. May 2007;37:29-30.
2. Song Li, Yangsheng Yu, Yinshi Yue, Zhixin Zhang, Kaihong Su. Microbial Infection and Rheumatoid Arthritis. J Clin Cell Immunol. 2013. Dec;4(6):174.
3. Muazzam AG, Mansoor A, Ali L, Siddiqi S, Hameed A, et al. Association of HLA-DRB1 and -DQB1 alleles and haplotypes with rheumatoid arthritis in a Pakistani population. Arthritis Res Ther. 2013;15:R95.
4. Joseph Holoshitz. The Rheumatoid Arthritis HLA-DRB1 Shared Epitope. Curr Opin Rheumatol. 2010 May;22(3):293-298.
5. Peschken CA, Hitchon C, Robinson DB, Smolik I, Barnabe CR, et al. Rheumatoid Arthritis in a North American Native Population: Longitudinal Followup and Comparison with a White Population. J Rheumatol. 2010 Aug 1;37(8):1589-1595.
6. Das S, Baruah C, Saikia AK, Tiwari D, Bose S. Genetic and expression changes in TNF-α as a risk factor for rheumatoid arthritis pathogenesis in Northeast India. J Genet. 2019 Mar;98:3
7. Das S, Baruah C, Saikia AK, Bose S. Associative role of HLA-DRB1 SNP genotypes as risk factors for susceptibility and severity of rheumatoid arthritis: a North-east Indian population-based study. Int J Immunogenet. 2018 Feb;45(1):1-7.
8. Woude D, Duistermaat J, Toes RE, Huizinga TW, Thomson W, et al. Quantitative heritability of anti-citrullinated protein antibody-positive and anti-citrullinated protein antibody-negative rheumatoid arthritis. Arthritis Rheum 2009;60:916-923.
9. Drongelen V, Holoshitz J. HLA-disease associations in Rheumatoid Arthritis. Rheum Dis Clin North Am. 2017 Aug;43(3):363-376.
10. Matzaraki V, Kumar V, Wijmenga C, Zhernakova A. The MHC locus and genetic susceptibility to autoimmune and infectious diseases. Genome Biol. 2017;18:76.
11. Alamanos Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun Rev. 2005;4(3):130-136.
12. Bongi SM, Porfirio B, Rombola G, Palasciano A, Beneforti E, Bianucci G. Shared-epitope HLA-DRB1 alleles and sex ratio in Italian patients with rheumatoid arthritis. Joint Bone Spine. 2004;71:24-28.
13. Oka S, Furukawa H, Shimada K, Hashimoto A, Komiya A, et al. Association of HLA-DRB1 genotype with younger age onset and elder age-onset rheumatoid arthritis in Japanese populations. J Med. 2019;98:48.
14. Delgado AM, Anaya JM. Meta-analysis of HLA-DRB1 polymorphism in Latin American patients with rheumatoid arthritis. Autoimmun Rev. 2007;6:402-408.
15. Jun KR, Choi SE, Cha CH, Oh HB, Heo YS, et al. Meta-analysis of the association between HLA-DRB1 allele and rheumatoid arthritis susceptibility in Asian populations. J Korean Med Sci. 2007;22:973-980.
16. Jaini R, Kaur G, Mehra NK. Heterogeneity of HLA-DRB1*04 and its associated haplotypes in the North Indian population. Hum Immunol. 2002 Jan;63(1):24-29.
17. Sandoughi M, Fazaeli A, Bardestani G, Hashemi M. Frequency of HLA-DRB1 alleles in rheumatoid arthritis patients in Zahedan, Southeast Iran. Ann Saudi Med 2011;31(2):171-73.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareSynthesis and in vitro Antibacterial, Antitubercular and Cytotoxicity Evaluation of Lomefloxacin Derivatives
English6572Gurunani GulshanEnglish Agrawal KapilEnglish Walde SheelpriyaEnglish Ittadwar AbhayEnglishEnglish Antibacterial activity, Antitubercular activity, Fluoroquinolone, Lomefloxacin, N-piperazinyl quinolone, SynthesisIntroduction
Fluoroquinolones, a major class of antibiotics, are under clinical development. The antibacterial activity of Fluoroquinolones is due to the inhibition of bacterial enzymes; DNA-gyrase and topoisomerase IV. They have potent activity, rapid bactericidal effects, and a low prevalence of resistance development.1The fluoroquinolones exert certain adverse effects, have restricted activity against Grampositivepathogens and methicillin-resistant Staphylococcus aureus (MRSA).2Therefore, there is a need of synthesizing novel quinolones with better activity profile, pharmacokinetics, and acceptability, to overcome the limitations of existing drugs.3 Most of the quinolone antibacterial research has been focused on substitution at the C-7 as it is the most adaptable site for chemical change.C-7 position is an area that determines potency and target preference and also controls the pharmacokinetic properties of the drugs, with basic nitrogen.4-6The most commonly found substitution at the C-7 position is a five- or six-membered ring. For example, aminopyrrolidine substituent at C-7 in trovafloxacinandgemifloxacinandPiperazine substitution at the C-7 position in norfloxacin, ciprofloxacin, pefloxacin, pefloxacin, ofloxacin, amifloxacin, fleroxacin, lomefloxacin, sparfloxacin, difloxacin, enoxacin, enrofloxacin, levofloxacin, marbofloxacin, and orbifloxacin which has triggered a wide range of clinically useful fluoroquinolone antibacterial agents.7-17(Figure 1) The site near the C-7 substituent is regarded as the domain for drug–enzyme interaction and the cell permeability.18-21 The piperazine moiety of 7-piperazinyl quinolones possesses enough structural flexibility to allow product optimization. In the present study, we have aimed to achieve a better antimicrobial profile at a lower concentration, by preparing [(7-(4--(5-substituted-benzoylthio)-1,3,4-thiadiazol-2-yl)-3-methylpiperazine-1-yl)-1-ethyl-6,8-difluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid](5a to 5j) derivatives and have been evaluated for its in vitro anti-bacterial and anti-tubercular effect. (Figure 2).
Materials and Methods
Materials
All the chemicals, reagents, and solvents used in this research were bought from E Merck Ltd, Loba chemicals Ltd, Sigma-Aldrich Ltd., Spectrochem Ltd., Hi-media, and Rankem Chemicals Ltd. Mumbai, India. Solvents used were dried and purified as and when required. The melting points reported were uncorrected and were determined in open capillaries using Thiele's melting point apparatus and measured in (°C). The yields of synthesized compounds were mentioned in tables along with respective physical constants. The FT-IR spectra were obtained Shimadzu FTIR spectrophotometer and values were measured in cm−1(potassium bromide disks). 1HNMR and 13C NMR were recorded at 400MHz and 100MHz respectively on a Bruker AM spectrometer, IISc Bangalore, and chemical shifts are expressed as δ (ppm) with tetramethylsilane as an internal standard. The FAB / EIMS mass spectra were recorded on Autospec Mass spectrometer, IICT, Hyderabad.
Methods
General Procedure for Synthesis of 2(a–j) (Figure 3)
Synthesis of substituted/unsubstituted phenacyl bromide 2(a–j)
0.1 mol of substituted/un-substituted acetophenones 1(a–j) were taken in the two-necked round bottom flask, suitable anhydrous solvents (ether, acetone, methanol, chloroform) was added with anhydrous AlCl3. The reaction condition was kept up either in cold or at room temperature and bromine (0.09mol) was added with stirring. Mixtures 2(a–j) were acquired as colourless to brown to shining crystals. The product was washed twice with appropriate solvents and recrystallized from methanol to get lachrymatory crystals.22-23 Liquefying point ranges of 2a–j; R = H, Cl, Br, F, NO2, CH3, OCH3, NH2, OH, C6H5; 48-50°, 90–92°, 110–112°, 46-48, 96–98°, 52–54°, 72–74°, 80–84°, 102-104, 98-102 respectively (50–74 %).
General Procedure for Synthesis of3(a–j). (Figure 3)
Synthesis of 2-((amino-1,3,4-thiadiazol-2yl)thio)-1-(4-subst.) ethanone 3 (a–j).
The 2-amino-5- mercapto-1,3,4-thiadiazole (0.1mol) was suspended in 15 ml of water and 80% potassium hydroxide (0.1 mol) was added. This solution was de-colorized with activated charcoal, followed by the addition of 32 mL of ethanol and stirred rapidly with 2 (a–j) (0.1mol). The reaction mixture was cooled for 40 minutes and it added 200 mL of cold water. It is then filtered to obtain the solid product and washed with ether and water. The 3(a–j) were obtained (Scheme 1), with 54–68% yield and melting point (80–108oC). 24-25
General Procedure for Synthesis of4(a–j). (Figure 3)
Procedure for Synthesis of 2-((5-chloro-1, 3, 4-thiadiazol-2yl) thio)-1-(4-subs.)ethanone4 (a–j)
Triturated 2-((amino-1,3,4-thiadiazol-2yl) thio)-1-(4-subs.) ethanone 3(a–j) (30 mmol) with sodium nitrite (60 mmol). The triturate was introduced in the ice-cooled (0–5oC) mixture of 15 ml water and 30 ml concentrated HCl with stirring in the presence of copper powder. The product was refluxed for 1 hour at 750C and cool. Then the mixture was extracted thrice with dry chloroform (75 ml). The combined extracts of chloroform were washed with a sodium bicarbonate solution. Then the solution was dried over sodium sulphate followed by evaporation under reduced pressure. Finally, recrystallization of the product was done using ethanol to yield 2-((5-chloro-1, 3, 4-thiadiazol-2yl)thio)-1-(4-subst) ethanone 4 (a–j) (Scheme 1). The compound was purified by column chromatography with methanol: chloroform (1:9) as mobile phase26, m.p. 85–110oC (48–60%).
General Procedure for Synthesis of 5(a–j). (Figure 3)
Synthesis of 1-subst.-6-fluoro-8-subst.-7-(3-subst.-4-(5-subst.((2-oxo-2-(p-subst.)ethyl)thio)-1,3,4-thiadiazol-2-yl)piperazin-1-yl)-4-oxo-1,4-dihydroquinoline-3-carboxylic acid 5(a–j).
A combination of equimolar quantities of compound 2-((5-chloro-1, 3, 4-thiadiazol-2yl)thio)-1-(4-subs.)ethanone4(a–j) and piperazinyl fluoroquinolone (sparfloxacin), along with sodium-bicarbonate in 10 ml dimethyl-formamide was refluxed on an oil bath at 140–160oC for hrs. After cooling the reaction mixture, 10ml of cold water was added to it. The precipitated product was filtered and washed with water. The product was then subjected to recrystallization using a blend of dimethylformamide and water to yield (5a-j) compounds.27-28 (Scheme 1). The Physicochemical results are shown in (Table 1)
Antibacterial Activity
Preliminary in vitro antibacterial activity was employed by the broth micro-dilution technique. Antibacterial Activity was examined against two Gram-negative microorganisms, Pseudomonas aeruginosa and Escherichia coli, and two Gram-positive microorganisms, Staphylococcus aureus and Bacillus subtilis. The test compounds and reference drugs (Sparfloxacin and Rifampicin) were prepared in Mueller-Hinton agar medium by two-fold serial dilutions. The required concentrations of 0.5, 1.0, 2.5, 5.0, 7.5, 10.0, 12.5, 15.0, 17.5, and 20.0 µg/ml was obtain by Progressive double dilutions with agar. The Petri plates were inoculated with 1–5 × 104 colonies forming units (CFU/ml) and incubated at 370C for 18 hours.29The results are presented in (Table 2).
Anti-tubercular Activity
In vitro screening for anti-mycobacterial was performed by utilizing M. tuberculosis virulent H37Rv strain. The broth dilution assay for each drug for determination of MIC was determined by using the frozen culture of Middlebrook 7H9 broth supplemented with 10% ADC (albumin dextrose catalase) and 0.2% glycerol. It is used as inoculum with dilution in broth to 2 × 105CFU/ml. In the assay, for the accommodation of compounds U-tubes were used in 0.1, 0.5, 1.5, 2.5, 05, 7.5, 10, 12.5, 15, 17.5 and 20 mg/ml dilutions.30-31 The results are presented in (Table 2).
In-vitro cytotoxic study
Estimation of cell viability
Conversion of MTT [(3-(4,5-dimethyl thiazol-2-yl)-2,5-diphenyl tetrasodium bromide)] to dark blue formazan crystals due to the presence of living cells, was employed for estimation of cell viability. Colourimetric analysis was used for the estimation of MTT cleaved to the viable cells.The solution of compounds under investigation in DMSO was diluted to achieve test concentrations. The DMSO content was maintained below 0.1% in all the aliquots under investigation. The cultured Hep-G2 normal liver-cell lines were added in plates with 96 wells and then preserved with variable dilutions of investigational compounds in DMSO, at 37oC in a carbon dioxide incubator for four days. Further, the MTT reagent was instilled into the wells and incubated for four hours, and then the dark blue formazan developed was allowed to dissolve in DMSO and the colourimetric absorbance was read at 550 nm. The IC50value was estimated by graph plotted between percentage cells inhibited versus concentrations.32 The findings are provided in (Table 2).
Results
Spectral Data of synthesized compound
1-ethyl-6,8-difluoro-7-(3-methyl-4-(5-((2-oxo-2-phenylethyl)thio)-1,3,4-thiadiazol-2-yl)piperazin-1-yl)-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (5a)
IR (KBr) cm-1: 3422(carboxylic, O-H str.), 2943(Ar. C-H str.), 2856(Ali. CH2, C-H str.), 1716(carboxylic, C=O str.), 1642(ketonic, C=O str.), 1588(Imine, C=N str.), 1320(ethylic, C-H str.); 1H-NMR (DMSO-?6) ?ppm: 12.52(s, carboxylic, 1H, OH), 9.02(s, 1H, H2-quinoline), 7.56-7.94(m, 5H, Ar.), 7.58(s, 1H, H5-quinoline), 4.92(s, 2H, CH2), 4.64(q, 2H, NCH2CH3), 2.92-3.50(m, 7H, piperazinyl), 1.38(t, 3H, NCH2CH3), 1.29 (s, 3H, piperazinyl CH3).
7-(4-(5-((2-(4-chlorophenyl)-2-oxoethyl)thio)-1,3,4-thiadiazol-2-yl)-3-methylpiperazin-1-yl)-1-ethyl-6,8-difluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (5b)
IR (KBr) cm-1: 3445(carboxylic, O-H str.), 3005(Ar. C–H str.), 2852(Ali. CH2, C-H str.), 1725(carboxylic, C=O str.), 1656(ketonic, C=O str.), 1583(Imine, C=N str.), 1307(ethylic, C-H str.); 1H-NMR (DMSO-?6) ?ppm: 12.55(s, carboxylic, 1H, OH), 8.91(s, 1H, H2-quinoline), 7.60-7.92(m, 4H, Ar.), 7.42(s, 1H, H5-quinoline), 4.84(s, 2H, CH2), 4.57(q, 2H, NCH2CH3), 2.94-3.47(m, 7H, piperazinyl), 1.46(t, 3H, NCH2CH3), 1.33(s, 3H, piperazinyl CH3); 13C-NMR (DMSO-?6) ?ppm: 198, 180, 161, 158, 148, 144, 130, 118, 110, 68, 40, 18; MS: m/z = 619 [M+];CHN calcd;C27H24ClF2N5O4S2;C, 52.30; H, 3.90; N, 11.29; Found C, 52.34; H, 3.90; N, 11.30.
7-(4-(5-((2-(4-bromophenyl)-2-oxoethyl)thio)-1,3,4-thiadiazol-2-yl)-3-methylpiperazin-1-yl)-1-ethyl-6,8-difluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (5c)
IR (KBr) cm-1: 3444(carboxylic, O-H str.), 3009(Ar. C-H str.), 2850(Ali. CH2, C-H str.), 1728(carboxylic, C=O str.), 1625(ketonic, C=O str.), 1554(Imine, C=N str.), 1310(ethylic, C-H str.); 1H-NMR (DMSO-?6) ?ppm: 12.58(s, carboxylic, 1H, OH), 8.93(s, 1H, H2-quinoline), 7.61-7.94(m, 4H, Ar.), 7.44(s, 1H, H5-quinoline), 4.80(s, 2H, CH2), 4.59(q, 2H, NCH2CH3), 2.93-3.48(m, 7H, piperazinyl), 1.48(t, 3H, NCH2CH3), 1.31(s, 3H, piperazinyl, CH3); 13C-NMR (DMSO-?6) ?ppm: 199, 181, 165, 160, 149, 128, 120, 108, 70, 42, 17.
5.4 7-(4-(5-((2-(4-fluorophenyl)-2-oxoethyl)thio)-1,3,4-thiadiazol-2-yl)-3-methylpiperazin-1-yl)-1-ethyl-6,8-difluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (5d)
IR (KBr) cm-1: 3454(carboxylic, O-H str.), 2926(Ar. C-H str.), 2853(Ali. CH2, C-H str.), 1726(carboxylic, C=O str.), 1658(ketonic, C=O str.), 1584(Imine, C=N str.), 1327(ethylic, C-H str.); 1H-NMR (DMSO-?6) ?ppm: 12.68(s, carboxylic, 1H, OH), 8.94(s, 1H, H2-quinoline), 7.98-8.02(m, 4H, Ar.), 7.78(s, 1H, H5-quinoline), 4.59(s, 2H, CH2), 4.42(q, 2H, NCH2CH3), 2.50-3.50(m, 7H, piperazinyl), 1.48(t, 3H, NCH2CH3), 1.25(s, 3H, piperazinyl CH3); 13C-NMR(DMSO-?6) ?ppm: 197, 173, 148, 133, 117, 107, 98, 74, 48, 38, 37; MS: m/z = 602 [M+]; CHN calcd; C27H24F3N5O4S2; C, 53.72; H, 4.01; N, 11.60; Found C, 54.12; H, 3.98; N, 11.94.
7-(4-(5-((2-(4-nitrophenyl)-2-oxoethyl)thio)-1,3,4-thiadiazol-2-yl)-3-methylpiperazin-1-yl)-1-ethyl-6,8-difluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (5e)
IR (KBr) cm-1: 3441(s, carboxylic, O-H str.), 3006(Ar. C-H str.), 1374(Ali. CH2, C-H str.), 1728(carboxylic, C=O str.), 1624(ketonic, C=O str.), 1547(Imine, C=N str.), 1311(ethylic, C-H str.); 1H-NMR (DMSO-?6) ?ppm: 12.56(s, 1H, carboxylic, OH), 8.92(s, 1H, H2-quinoline), 7.74-7.92(m, 4H, Ar.), 7.47(s, 1H, H5-quinoline), 4.83(s, 2H, CH2), 4.65(q, 2H, NCH2CH3), 2.92-3.47(m, 7H, piperazinyl), 1.47(t, 3H, NCH2CH3), 1.38(s, 3H, piperazinyl CH3); 13C-NMR (DMSO-?6) ?ppm: 192, 183, 165, 155, 147, 138, 129, 113, 74, 47, 11; MS : m/z = 630 [M+];CHN calcd;C27H24F2N6O6S2;C, 51.42; H, 3.84; N, 13.33; Found C, 51.40; H, 3.85; N, 13.30.
1-ethyl-6,8-difluoro-7-(3-methyl-4-(5-((2-oxo-2-(p-tolyl)ethyl)thio)-1,3,4-thiadiazol-2-yl)piperazin-1-yl)-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (5f)
IR (KBr) cm-1: 3427(s, carboxylic, O-H str.), 2934(Ar. C-H str.), 2854(Ali. CH2, C-H str.), 1710(carboxylic, C=O str.), 1623(ketonic, C=O str.), 1576(Imine, C=N str.), 1298(ethylic, C-H str.); 1H-NMR (DMSO-?6) ?ppm: 12.06(s, 1H, carboxylic, OH), 8.84(s, 1H, H2-quinoline), 7.54-7.68(m, 4H, Ar.), 7.38(s, 1H, H5-quinoline), 4.64(s, 2H, CH2), 4.32(q, 2H, NCH2CH3), 2.83-3.27(m, 7H, piperazinyl), 2.37(s, 3H, tolyl), 1.32(t, 3H, NCH2CH3), 1.19(s, 3H, piperazinyl CH3); 13C- NMR (DMSO-?6) ?ppm: 188, 179, 158, 147, 135, 128, 116, 108, 68, 35, 16, 7.
7-(4-(5-((2-(4-methoxyphenyl)-2-oxoethyl)thio)-1,3,4-thiadiazol-2-yl)-3-methylpiperazin-1-yl)-1-ethyl-6,8-difluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (5g)
IR (KBr) cm-1: 3445(carboxylic, O-H str.), 3011(Ar. C-H str.), 2851(Ali. CH2, C-H str.), 1728(carboxylic, C=O str.), 1634(ketonic, C=O str.), 1581(Imine, C=N str.), 1310(ethylic, C-H str.); 1H-NMR (DMSO-?6) ?ppm: 12.83(s, carboxylic, 1H, OH), 9.04(s, 1H, H2-quinoline), 7.14-7.98(m, 4H, Ar.), 7.84(s, 1H, H5-quinoline), 4.71(s, 2H, CH2), 4.37(q, 2H, NCH2CH3), 3.83(s, 3H, methoxyl), 2.92-3.67(m, 7H, piperazinyl), 1.31(t, 3H, NCH2CH3), 1.11(s, 3H, piperazinyl CH3); 13C- NMR (DMSO-?6) ?ppm: 191, 184, 168, 156, 138, 129, 112, 108, 60, 38, 18, 11; MS: m/z = 617 [M+1];CHN calcd;C28H27F2N5O5S2;C, 54.62; H, 4.42; N, 11.38; Found C, 54.64; H, 4.40; N, 11.37.
7-(4-(5-((2-(4-aminophenyl)-2-oxoethyl)thio)-1,3,4-thiadiazol-2-yl)-3-methylpiperazin-1-yl)-1-ethyl-6,8-difluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (5h)
IR (KBr) cm-1: 3452(carboxylic, O-H str.), 3367(Ar. NH2, N-H str.), 3027(Ar. C-H str.), 2851(Ali. CH2, C-H str.), 1736(carboxylic, C=O str.), 1628(ketonic, C=O str.), 1580(Imine, C=N str.), 1327(ethylic, C-H str.); 1H-NMR (DMSO-?6) ?ppm: 12.88(s, carboxylic, 1H, OH), 9.12(s, 1H, H2-quinoline), 7.86(s, 1H, H5-quinoline), 6.83-7.72(m, 4H, Ar.), 6.31(s, 2H, Ar. NH2), 4.72(s, 2H, CH2), 4.32(q, 2H, NCH2CH3), 3.02-3.62(m, 7H, piperazinyl), 1.29(t, 3H, NCH2CH3), 1.14(s, 3H, piperazinyl CH3); 13C- NMR (DMSO-?6) ?ppm: 197, 187, 172, 151, 133, 123, 117, 107, 67, 35, 16; MS: m/z = 601 [M+1];CHN calcd;C27H26F2N6O4S2; C, 53.99; H, 4.36; N, 13.99; Found C, 54.02; H, 4.37; N, 13.98.
Englishhttp://ijcrr.com/abstract.php?article_id=4209http://ijcrr.com/article_html.php?did=4209
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Agrawal KM, Talele GS. Synthesis and antibacterial, antimycobacterial and docking studies of novel N-piperazinyl fluoroquinolones. Med.Chem Res. 2013; 22(2):818–31.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareStudy of Frequency of Iatrogenic Perforations by Group of Teeth and Localization Made by Bulgarian Students
English7377Dimitrova IvankaEnglish Angelova LiliyaEnglish Hristov KrasimirEnglishIntroduction: Iatrogenic perforation of the pulp chamber floor or the root is a major endodontic complication that may cause treatment failure. Aims: The objective of this study is to analyze the frequency of iatrogenic perforations made during endodontic treatment by last year dental students. Investigating the most affected groups of teeth, and the most common localization of the perforations will help to determine which steps of the endodontic procedure need an alternative approach in students’ training and will ultimately improve the education process. Methodology: The data were collected from patient records and obtained from clinical exams during the academic year 2016. The final data comprised 493 teeth. All perforations were confirmed clinically and on an x-ray. Clinical criteria included sudden bleeding or pain during instrumentation; the presence of blood on paper points, confirming perforation via apex locator. Results: 20 iatrogenic perforations were identified during the endodontic treatment of 493 teeth or 4,1% of all clinical cases. More perforations were made in upper posterior teeth (premolars and molars) -45% of all the perforations. The type of the tooth was found to be of no significance for the occurrence of perforation p> 0, 005. 11 teeth or 55% of all 20 perforations were apical, followed by perforations in the furcation area. There are no significant differences found in different types of localization of iatrogenic perforations. Conclusions: Analyzing the data from the current study allows us to establish the need to improve students’ practical skills in endodontic treatment of molars and to improve their training in using apex locators so there are fewer apical perforations
English Endodontic education, Root canal treatment, Iatrogenic perforation, Dental students, Epidemiology, Practical trainingIntroduction
Accidental perforation of the pulp chamber floor or the root is a major complication of endodontic treatment. Iatrogenic perforations may occur at any time in root canal treatment and may cause treatment failure. Early diagnosis, size, shape, location, type of perforation, the chosen treatment, the experience of the practitioner, the materials used for the obturation, and host response are the factors that affect perforation management and the prognosis of the tooth.1,2 Endodontic education must be sufficient and up to date so that graduating young dentists, lacking clinical experience still can perform at their best with minimal iatrogenic mistakes. We have to improve undergraduate programs, where it is possible to minimize circumstances like lack of theoretical knowledge and practical skills to affect the future performance of the dentist.3,4The frequency of iatrogenic perforations in different groups of teeth and regarding the location of the perforation is not studied well.5,6 The localization of the perforation and the type of teeth involved is crucial for the treatment outcome.
To find and analyze where learning difficulties may appear, and where the program fails to provide the necessary skills for students, iatrogenic perforations made by Bulgarian students were studied. Their cause, type, frequency, the most affected groups of teeth are the indicators that helped to define the existing problems. An epidemiological study on the technical characteristics of canal fillings in the Bulgarian population7showed a good treatment quality in only 29.6%of the cases studied, which justifies our efforts.
The objective of this study is to analyze the frequency of iatrogenic perforations made by last year students. Investigating the most affected groups of teeth, and the most common localization of the perforations will help to determine which steps of the endodontic procedure need an alternative approach in students’ training and will ultimately improve the education process.
Material and Methods
Dental medicine training in Bulgaria lasts six years. In the sixth year, students have to develop skills in the comprehensive treatment of patients, and endodontics is part of this curriculum. They perform their treatment under supervision, but the specialists supervising them do not approve every step of the process so that students have more autonomy and higher responsibility.
The data were collected from patient records and obtained from clinical exams during the academic year2016. 567 teeth were first included in the study. Case files with missing information and poor radiographs were excluded. The final data comprised 493 teeth and 854 root canals. All 144 last year students participated.
Intraoral radiographs were taken at the beginning, and after each treatment step: determining working length, canal obturation, and post-placement. X-rays with superimposition of anatomical structures, tooth structures, and root canal filling were not included in this research. Criteria for radiographic characteristics of proper endodontic treatment were matched to the European guidelines and other studies on root canal treatment, performed by dental students.4,8
The clinical and radiographical exams constitute the basis of iatrogenic perforation diagnosis.2
Clinical criteria include sudden bleeding or pain during instrumentation of the root canals; the presence of blood on paper points, confirming perforation via apex locator.
Radiographic criteria following the clinical exam: perforations were diagnosed via radiographic evidence of a file passing through the tooth structure and entering into the periodontal ligament or bone for perforations on the pulp chamber floor, lateral root perforations, and apical perforations. The presence of fresh bleeding in the canal or on the surface of files or paper points and lack of an apical stop are indicators of the perforation of the apical foramen. The penetration of the last file beyond the radiographic apex confirms the presence of this procedural accident.
All patients signed informed consent. The Ethics Commission for Research at the Medical University of Sofia (KENIUMUS)approved the study.
Two experienced researchers were calibrated to a high level of reproducibility with Kappa values of 80-90. They examined separately all radiographs with the aid of a double-magnifying glass. The results were compared and where differences occurred the examiners reached a consensus.
Statistical Methods:
The association between the groups was investigated using cross-tabulation. The differences between the groups were tested using Z-test with Bonferroni correction and were considered statistically significant when p0,005 (Table 2).
The highest reported per cent procedural error was for the group of upper molars (1.2%) compared to the overall prevalence of perforations (4.1%) (Table 3). The least affected by iatrogenic perforations in this study are upper and lower frontal teeth (Table 3).
In the academic year of 2016, 11 teeth or 55%of all 20 perforations were apical, followed by perforations in the furcation area(Table 4). There were no significant differences found in different types of localization of iatrogenic perforations: furcal, lateral, and apical.
Discussion
Students at the Faculty of Dental Medicine in Sofia Medical University study a two-year preclinical course that starts in their second year of training. During this training, they perform endodontic treatment on extracted teeth: 5anterior teeth, 2 premolars, 4 molars. The clinical program lasts 2 years and starts in the fourth year. It takes 4 terms; 60 hours of lectures, and 5 hours of clinical exercises per week. Students treat patients with pulpitis and periodontitis of single and multi-rooted teeth. In the dental training clinic, each stage of treatment is observed and approved by experienced teachers, specialists in endodontics.
Little information is available in the literature regarding the frequency of student’s made perforations by groups of teeth and localization.
Smadi et al.9 report the greatest incidence of perforation in upper posterior teeth. Our study confirmed these results with more than 1/2 of perforations occurring in the maxilla (11 out of total affected teeth20). Tsesis et al.10found in their study something different: there were significantly more identified perforations in mandibular molar teeth than in any other location (pEnglishhttp://ijcrr.com/abstract.php?article_id=4210http://ijcrr.com/article_html.php?did=42101. Hegde M, Varghese L, Malhotra S. Tooth Root Perforation Repair-A Review. Oral Health Dent Manag 2017;16(2):1-4
2. Tsesis I, Fuss Z. Diagnosis and treatment of accidental root perforations. Endod Topics 2006;13:95–107.
3. De Moor R, Hülsmann M, Kirkevang LL,Tanalp J, Whitworthet. Undergraduate curriculum guidelines for endodontology. Int Endod J 2013;46(12):1105–14.
4. Khabbaz M, Protogerou E, Douka E. Radiographic quality of root fillings performed by undergraduate students. Int Endod J2010;43(6):499–508.
5. Kouzmanova Y. Endodontic perforations – sealing ability of calcium silicate types of cement and prevention [dissertation]. Sofia: Medical Univ.; 2019.
6. McCabe PS. Avoiding perforations in endodontics. J Ir Dent Assoc 2006;52(3):139-48
7. Vangelov L, Stamatova I, Vladimirov S. Radiographic evaluation of the periapical status of endodontically treated teeth. Dental Medicina2008;90:17-23.
8. EleftheriadisGI, Lambrianidis TP. Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic. Int Endod J 2005;38(10):725–34.
9. Smadi L, Hammad M, El-Ma'aita A. Evaluation of the quality of root canal treatments performed by dental undergraduates: is there a need to review preclinical endodontic courses? Am Educ Res J 2015;3(12):1554-8.
10. Tsesis I, Rosenberg E, Faivishevsky V, Kfir A, Katz M, Rosen E. Prevalence and associated periodontal status of teeth with root perforation: aretrospective study of 2,002 patients’ medical records. J Endod 2010;36(5):797–800.
11. Cimilli H, Mumcu G, Cimilli T, Kartal N, Wasselink P. The correlation between root canal patterns and interorificial distance in mandibular first molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:e16–21.
12. Kartal N, Cimilli HK. The degrees and configurations of mesial canal curvatures of mandibular first molars. J Endod1997;23(6):358–62.
13. Ruddle C. Cleaning and shaping the root canal system. In: Cohen SBR, ed. Pathways of the Pulp. 8th ed. St. Louis, MO: C.V. Mosby; 2002. p. 231–93.
14. Garcia Filho PF, Letra A, Menezes R, Carmo AM. Danger zone in mandibular molars before instrumentation: an in vitro study. J Appl Oral Sci2003;11(4):324-6.
15. Balto H, Al Khalifah Sh, Al Mugairin S, Al Deeb M, Al-Madi E. Technical quality of root fillings performed by undergraduate students in Saudi Arabia. Int Endod J 2010;43(4):292-300.
16. AlRahabi MK. Evaluation of complications of root canal treatment performed by undergraduate dental students. Libyan J Med2017;12(1):1345582.
17. Haji-Hassani N, Bakhshi M, Shahabi S. Frequency of iatrogenic errors through root canal treatment procedure in 1335 charts of dental patients. J Int Oral Health 2015;7(Suppl 1):14?7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareEfficacy of Coronally Advanced Flap with and Without Augmentation in The Management of Gingival Recession: A Systematic Review
English7885Ambilwade Komal SEnglish Gopalakrishnan D.English Martande SantoshEnglish Deodhar Amol G.EnglishBackground and Objectives: An array of therapeutic options are available for the management of gingival recession by utilizing pedicle flap procedures or by free soft tissue graft procedures. Coronally Advanced flaps have been described to maintain the recipient site esthetics and to prevent the relapse of recession. Hence, a newer approach using Coronally Advanced Flap with or without adjunctive augmentation to gain more potential results for Gingival Recession. This study aimed to systematically gather and evaluate the efficacy of Coronally Advanced Flap technique Flap with or without adjunctive augmentation techniques in the treatment of gingival recession. Data Sources: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline for systematic reviews were used. A systematic search was conducted using MEDLINE, Cochrane Central Register of Controlled Trials, Google Scholar, Google, Clinical trials registry and manual search using D.Y. Patil Dental College library resources were searched up to and including 31st October 2019 to identify appropriate studies. All cross-reference lists of the selected studies were also screened. Results: After a literature search of 368 articles from PubMed, 8 articles were found relevant according to the inclusion criteria which evaluated the efficacy of Coronally advanced flap with or without adjunctive augmentation technique in the management of gingival recession defects, where Coronally Advanced Flap with Augmentation showed better results as compared to Coronally Advanced Flap alone. Conclusion: Coronally Advanced Flap Technique with the use of various augmentation is effective in the management of gingival recession
EnglishINTRODUCTION:
The fundamental goal of periodontal care is to improve oral health, by re-establishing the comfort, function and esthetics of natural teeth. It involves the treatment of gingival recession (GR), which is characterized by the exposure of the root surface caused by the displacement of the gingival margin apical to the cementoenamel junction (CEJ).1 To avoid GR progression and its functional and esthetics consequences, various surgical techniques have been proposed to achieve predictable root coverage. 2 The most common etiological factors include periodontal disease, aggressive tooth brushing, aberrant frenal attachment, and inflammation, improper flossing, incorrect occlusal relationships, and dominant roots.3 Numerous surgical approaches for the treatment of single Miller Class I and II gingival recession (GR) defects are documented in the literature.4 One of the most reliable techniques that result in the best long-term clinical outcome is the coronally advanced flap (CAF) procedure. This procedure may be used alone or in combination with connective tissue graft (CTG), barrier membrane, enamel matrix derivative, acellular dermal matrix, or platelet-rich plasma.5
A significant percentage of Gingival recession coverage has been showing by several preneoplastic techniques that include CAF Or CAF+CTG or different biomaterials. A study done by Jepsen, et al. showed increased mean root coverage, as well as higher predictability in achieving complete root coverage when compared to CAF alone.2 One of these substitutes is a xenogeneic collagen matrix (CMX) of porcine origin that has been successfully used to augment keratinized tissue 4 and is less invasive, time-consuming, and unlimited supply.6 The use of enamel matrix derivative proteins (EMD) in root coverage procedures has shown excellent clinical features as the improvement of the probability to achieve complete root coverage in localized Miller class I and II gingival recessions when compared to the CAF alone. Also, periodontal regeneration, as seen in histological studies in animals and humans with the formation of new bone, cementum, and the periodontal ligament is associated with EMD use.7 Based on these biomaterials characteristics, it could be hypothesized that the association of CM and EMD would increase the predictability of the treatment of gingival recession defects.6
The amnion and chorion are membranes that build the amniotic sac that surrounds and protects an embryo. It has biological properties that can modulate angiogenesis, reduce inflammation, diminish the occurrence of adhesions and scarring, and promote wound
healing.8 Applications of placental allograft include the treatment of corneal epithelial defects, chemical or thermal burns, neurotrophic corneal ulcers, glaucoma surgery, cicatricial pemphigoid or Stevens-Johnson syndrome, and the reconstruction of conjunctival and ocular surfaces.9 Placental membranes have recently been tried as a biomaterial for regenerative purposes. In periodontics, these membranes have also been used for the treatment of furcation defects, root coverage, and intrabody defects.
Systematic reviews aim to address these problems by identifying critically evaluating and integrating the finding of all relevant, high-quality individual studies addressing one or more research questions.
Thus, a systematic review summarizes the results of available carefully designed healthcare studies (Randomized Control Trials) and provides a high level of evidence on the effectiveness of healthcare interventions.
So far, no systematic review evaluating the efficacy of Coronally Advanced Flap alone and Coronally Advanced Flap with various Adjunctive like Connective Tissue Graft, Xenogenous Collagen Matrix, Enamel Matrix Derivative, Placental Membrane in the treatment of gingival recession defects has been performed. Hence, the study aims to gather and evaluate in a systematic manner available data on the efficacy of Coronally Advanced Flap with or without adjunctive augmentation techniques in the treatment of Gingival Recession
Material and Method
ELIGIBILITY CRITERIA
Inclusion Criteria :
Eligible studies included randomized clinical trials with essential data on Coronally Advanced Flap with and without Augmentation in Gingival Recession
Eligibility criteria were good health, any age groups and either sex, Gingival Recession subjects and Coronally Advanced Flap intervention with and without various Augmentation techniques.
Pubmed search which includes articles published from the earliest available data up to
31st November 2019.
Studies that include any two of the indices for the severity of Miller’s Class I, Millers Class II Gingival Recession, isolated Gingival recession.
Only papers written in English were accepted
Exclusion Criteria :
Reviews, case reports, abstracts, editorials, letters, and historical reviews and in vitro studies and unpublished, grey literature was not included in the search.
Studies include medically compromised patients, smokers, pregnant women
Studies that have used Multiple Gingival Recession.
Studies including animal models.
PICO
P - Participants: Gingival Recession patients
I - Intervention: Coronally Advanced Flap
C - Comparison: Coronally Advanced Flap + Connective Tissue Graft OR Coronally Advanced Flap + Platelet Rich Fibrin OR Coronally Advanced Flap + Enamel matrix Derivative OR Coronally Advanced Flap + collagen matrix, Coronally Advanced Flap + Placental Membrane.
O - Outcomes: Root Coverage.
S - Study designs: Randomized Clinical Trials.
A final of 8 articles have been used for detailed evaluation in this systematic review after assessment of the full text.
Results:- After a literature search of 368 articles from PubMed, 8 articles were found relevant according to the inclusion criteria which evaluated the efficacy of Coronally advanced flap with or without adjunctive augmentation technique in the management of gingival recession defects, where Coronally Advanced Flap with Augmentation showed better results as compared to Coronally Advanced Flap alone.
Discussion:-
The gingival recession has been associated with dentinal hypersensitivity, root caries and esthetic Compromise. Several grafts have been used in different clinical trials with different degrees of success. literature indicates that the subepithelial connective tissue graft is the most predictable root coverage surgical procedure, considered as a ‘gold standard’ technique, in which a bilaminar vascular environment is created to nourish the graft.1
To increase the efficacy of root coverage procedures, reduce the morbidity of the technique, and improve clinical outcomes, proposals have been made for the addition of biologic factors and membranes, such as enamel matrix derivative, platelet-rich plasma, platelet-rich fibrin, and collagen membranes. 8
A novel membrane that has been recently employed for guided tissue regeneration is the placental membrane. The placental allografts possess antibacterial and antimicrobial properties with immune privilege and are thus quite different from cadaveric allograft, xenograft, and alloplastic barrier membranes used in periodontal therapy.8 Coronally Advanced Flap procedure (CAF) has been tried with varying degrees of success to cover the recession defects. Histologically, this technique leads to the reformation of junctional epithelium and the connective tissue attachment with the minimal bone repair but is not stable over a long period, Thus, there has been a desire to find a substitute for the autogenous donor tissue. Recently, newer xenogenic collagen matrices have been developed, which have resulted in significant improvement in the clinical parameters.
The final goal of root coverage procedures is the complete coverage of the recession with pleasant esthetic outcomes (Cairo et al. 2009). Since root coverage can be achieved with different approaches, the selection of the proper treatment approach requires a decision-making process that keeps account several aspects, like the morphology of the recession and the neighbouring periodontal tissues, the clinical efficacy of the surgical procedure, its morbidity, the skill ability required for its application and the cost-benefit ratio
Strength and relevance of evidence:
The following 8 articles have been included in the systematic review, which has analysed the efficacy of Coronally Advanced Flap alone and Coronally Advanced Flap with various adjunctive to it for the treatment of Gingival Recession.
Cairo F et al.10 conducted a Randomized Controlled Trial (Table no. 1-8) on A total of 29 patients with one recession were enrolled; 15 patients were randomly assigned to CAF + CTG while 14 to CAF alone where he concluded No difference was detected in term of RecRed. CAF +CTG was associated with longer surgical time, the higher number of days with postoperative morbidity and the need for a greater number of analgesics than CAF alone. No difference for the final RES score was detected.
Kuis D et al.11 conducted a study(Table no. 1-8) on Thirty-seven patients with 114 bilateral, single Miller Class I and II GR defects were treated with CAF on one side of the mouth and CAF+CTG on the other side where Both surgical procedures (CAF and CAF+CTG) are effective in the treatment of single Miller Class I and II GR defects since both resulted in the reduction of REC and increase of KT. CAF+CTG provided a better long term clinical outcome than CAF alone.
Cairo F et al.12 conducted a study(Table no. 1-8) on 24 of the 29 patients from which 13 were treated with CAF + CTG and 11 with CAF with a follow up of 3-year follow-up. The blind and calibrated examiner measured the outcome that included complete root coverage (CRC), recession reduction (RecRed), Root coverage Esthetic Score (RES) and Keratinized Tissue (KT) Gain. Visual Analogue Scale (VAS) for evaluation of patients satisfaction. CAF + CTG resulted in better outcomes in terms of CRC than CAF alone 3 years later. In terms of RecRed, RES score and VAS values no difference was detected. Also, CAF + CTG was associated with higher KT gain than CAF.
Jepson K et al.2 conducted a study (Table no. 1-8) where there was a high correlation between 6 months and 3 years RC outcomes for both CAF procedures. Mean RC following CAF + CMX amounted to 89.9% after 6 months and 91.7% after 3 years (Pearson´s correlation: 0.91). The corresponding values for CAF were 83.7 % vs. 82.8 % (Pearson´s correlation: 0.94). Likewise, CRC was stable with 61/61 % for CAF + CMX and 39/39% for CAF after 6 months/3 years, respectively.
Sangiorgio P et al.6 conducted a study (Table no. 1-8) where obtained root coverage was 68.04 ± 24.11% for CAF; 87.20 ± 15.01% for CAF+CM; 88.77 ± 20.66% for CAF+EMD and 91.59 ± 11.08% for CAF+CM+EMD after 6 months, with the groups receiving biomaterials showing greater values. Complete root coverage for CAF+EMD was 70.59%, significantly superior to CAF alone (23.53%); CAF+CM (52.94%) and CAF+CM+EMD (51.47%). Keratinized tissue thickness gain was significant only in CM treated groups.
Santos R et al.13 conducted a study (Table no. 1-8) The impact of oral health on quality of life after 6 months was significant for CAF + CM, CAF + EMD and CAF +CM + EMD (p Englishhttp://ijcrr.com/abstract.php?article_id=4211http://ijcrr.com/article_html.php?did=4211
American Academy of Periodontology. Glossary of Periodontal Terms. J Periodontol. 2001; 4: 177–179.
Jepsen K, Stefanini M, Sanz M, Zucchelli G, Jepsen S. Long-Term Stability of Root Coverage by Coronally Advanced Flap Procedures. J Periodontol. 2017 Jul;88(7):626-633.
Richardson CR, Allen EP, Chambrone L, Langer B, McGuire MK, Zabalegui I et al. Periodontal Soft Tissue Root Coverage Procedures: Practical Applications From the AAP Regeneration Workshop. Clin Adv Periodontics. 2015 Feb;5(1):2-10. .
Oates TW, Robinson M, Gunsolley JC. Surgical therapies for the treatment of gingival recession. A systematic review. Ann Periodontol. 2003 Dec;8(1):303-20
da Silva RC, Joly JC, de Lima AF, Tatakis DN. Root coverage using the coronally positioned flap with or without a subepithelial connective tissue graft. J Periodontol. 2004 Mar;75(3):413-9
Sangiorgio JPM, Neves FLDS, Rocha Dos Santos M, França-Grohmann IL, Casarin RCV, Casati MZ et al. Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part I: Clinical Outcomes. J Periodontol. 2017 Dec;88(12):1309-1318.
McGuire MK, Scheyer ET, Schupbach P. A Prospective, Case-Controlled Study Evaluating the Use of Enamel Matrix Derivative on Human Buccal Recession Defects: A Human Histologic Examination. J Periodontol. 2016 Jun;87(6):645-53.
McGuire MK, Nunn M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: Comparison of clinical parameters. J Periodontol. 2003 Aug;74(8):1110-25.
Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol. 2002;29 Suppl 3:178-94; discussion 195-6.
Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Cincinelli S et al. Coronally advanced flap with and without connective tissue graft for the treatment of single maxillary gingival recession with loss of inter-dental attachment. A randomized controlled clinical trial. J Clin Periodontol. 2012 Aug;39(8):760-8.
Kuis D, Sciran I, Lajnert V, Snjaric D, Prpic J, Pezelj-Ribaric S et al. Coronally advanced flap alone or with connective tissue graft in the treatment of single gingival recession defects: a long-term randomized clinical trial. J Periodontol. 2013 Nov;84(11):1576-85.
Cairo F, Cortellini P, Tonetti M, Nieri M, Mervelt J, Pagavino G et al. Stability of root coverage outcomes at a single maxillary gingival recession with loss of interdental attachment: 3-year extension results from a randomized, controlled, clinical trial. J Clin Periodontol. 2015 Jun;42(6):575-81.
Rocha Dos Santos M, Sangiorgio JPM, Neves FLDS, França-Grohmann IL, Nociti FH Jr, Silverio Ruiz KG et al. Xenogenous Collagen Matrix and/or Enamel Matrix Derivative for Treatment of Localized Gingival Recessions: A Randomized Clinical Trial. Part II: Patient-Reported Outcomes. J Periodontol.2017 Dec.
George SG, Kanakamedala AK, Mahendra J, Kareem N, Mahendra L, Jerry JJ. Treatment of gingival recession using a coronally advanced flap procedure with or without placental membrane. J Investig Clin Dent. 2018 Aug;9(3):e12340.
Rasperini G, Acunzo R, Pellegrini G, Pagni G, Tonetti M, Pini Prato GP et al. Predictor factors for long-term outcomes stability of coronally advanced flap with or without connective tissue graft in the treatment of single maxillary gingival recessions: 9 years results of a randomized controlled clinical trial. J Clin Periodontol. 2018 Sep;45(9):1107-1117.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareTherapeutic and Antigenotoxic Effects of Lycopene in Managing OSMF - A randomized Placebo-Controlled Trial
English8691Madhu PAEnglish Suma GNEnglish Raghu DEnglish Manisha LEnglish Dayashankararao JKEnglish Puneet KEnglishIntroduction/Objective: Lycopene is effective in managing OSMF. Effect of Lycopene on reducing the Micronuclei frequency & correlation of Serum lycopene and BMCF has not been studied in OSMF. This study is designed to assess the effect of lycopene in reducing, clinical symptoms, as assessed by mouth opening (MO), Tongue protrusion (TP), Cheek flexibility (CF), Palpable fibrotic bands (FB), burning sensation (BS), and the genotoxicity in oral submucous fibrosis patients as assessed by buccal micro-nucleated cell frequency (BMCF). Methods: A randomized, placebo-controlled, triple blinded trial, of 3 months duration. Out of 40 OSMF patients reported during the study period, 36 OSMF patients aged between 17-70 years who fulfilled the inclusion criteria were randomly divided into two groups equally- Group 1 received lycopene 16 mg (Lycored ® 4mg 2 BID) per day, and Group 2 received placebo capsules (similar quantity). The outcomes MO, TP, CF, FB, BS, serum lycopene levels and BMCF were recorded at the baseline and the end of 3 months. Results: In Group 1 compared to Group 2 clinical signs and symptoms MO, TP, BS improved significantly. Serum lycopene levels improved and BMCF reduced significantly. BMCF showed a negative correlation with the serum lycopene levels. Conclusion: The results of the present randomized controlled study throw more light on the role of lycopene in combination with habit cessation in OSMF, both in the improvement of most of the clinical symptoms and as a potent antigenotoxic agent, by reducing BMCF.
EnglishMouth opening, Burning, Micronuclei, Oral submucous fibrosis, Lycopene, BMCF Introduction
OSMF a potentially malignant disorder (PMD) has a reported 7–13% malignant transformation.1Gutkha / areca nut chewing promotes gene damage, early detection of which may help prevent malignant transformation.2,3 MN assay is used as a marker of genotoxicity in oral PMD and malignancy. 2,4Management of OSMF aims to ameliorate the symptoms, and minimize the malignant transformation.5lycopene, a natural antioxidant is a useful therapeutic agent in OSMF.6Lycopene has antimutagenic and anti-mitogenic activity. It interferes with free radical chain reaction, cancer cell proliferation. Dietary supplement of lycopene has shown to improve serum lycopene and to reduce the BMCF in PMDs.7There are no controlled studies to demonstrate the therapeutic effect of lycopene on disease symptoms and antimutagenic effect on BMCF in OSMF. Hence, the present placebo-controlled study was designed to assess the efficacy of lycopene as a therapeutic and anti-genotoxic agent in OSMF as assessed by BMNC frequency.
Methods:
36 OSMF patients, aged 17-70 years, visiting the Oral Medicine and Radiology department, were enrolled once the inclusion and exclusion criteria were satisfied, using convenience sampling.
Diagnosis of oral submucous fibrosis was based on the classification criteria given by Pindborg JJ.8Inclusion criteria were that patients with a six-month-long habit of chewing areca nut or any other product of areca nut and those who were compliant in quitting the habit following counselling. Patients on antioxidant therapy in recent past six months or who had any other concurrent oral mucosal disease, (e.g., oral cancer, other pre-cancer like leukoplakia, lichen planus) a known history of systemic disease were excluded. Group 1 consisted of 3,6,9 patients in OSMF stage 1, 2, & 3 respectively, Group 2 consisted of 12, & 6 patients in Stage 2 & 3 respectively.
Informed consent of all the participants was obtained. Institutional Ethical Committee gave ethical clearance for the study.
Before the administration of therapy, all the participants were subjected to oral prophylaxis. At every visit, compliance in habit cessation was checked.
Study design:
A randomized, placebo-controlled, triple blinded trial of three months duration.
Randomization:
36 OSMF patients aged between 17-70 were randomly allocated to two groups equally (using a computer-generated allocation series, by Stat Trek's Random Number Generator). [Fig 1]
Blinding:
Patients, the investigator (who administered the drugs and measured the outcomes), and the data analyst (person who analyzed the data ) were blinded to which group the subject belonged. Allocation and coding were done by a trained clinician, who did not participate in the drug administration or outcome measurements.
Intervention:
Group 1 received lycopene, 16 mg (Lycored ® 4mg 2 BID p.o) per day, and Group 2 received placebo (similar quantity). LycoRed™ 4 mg soft gels & the placebo (manufactured by Jagsonpal Pharmaceuticals Ltd., New Delhi, India) were supplied as bottled LycoRed™ soft gel capsules. Placebo was also dispensed in identical packages. 60 capsules were dispensed at the beginning and every visit(fortnightly). The remaining number of capsules was counted for checking patient compliance. Side effects, if any, were recorded at each follow-up.
Coding:
The packaging bottles contained 60 capsules each. All 36 patients’ bottles were coded with the serial numbers, 1 to 36, 1-18 for lycopene, and 19-36 for placebo. Against each serial number, a code of 1 is written for lycopene and 2 for placebo and the patient's group allocation number. (Eg. Code 10(1,10,) is 10th patient in lycopene group, & 28 (2,10) is 10th patient in placebo group). Code was written on six bottles each to suffice for six visits. The codes were noted in a separate sheet against each patient and sealed and preserved for decoding later.
Outcome measurements:
Clinical, cytological and serum assessments were done at the baseline and the end of 3 months. Patients were recalled every 15 days to dispense the medicines, check for compliance and reassurance. Most of the recalls happened within +/-1 of the scheduled day. Clinical parameters recorded included maximum mouth opening, tongue protrusion, cheek flexibility, palpable fibrotic bands, and burning sensation. The distance between the mesio-incisal edges of the maxillary and mandibular right central incisors was measured using a Vernier calliper to record the mouth opening. The distance from the mesio-incisal angle of the upper central incisor to the tip of the extended tongue gave tongue protrusion measurements. The difference (V2 -V1) in the distance between the two points on a line from the right commissure of mouth to tragus was the Cheek flexibility. The first point was marked at the intersection of this line and the vertical line drawn from the pupil, and the second point was 1cm away toward the tragus. V1 is the distance between the points at rest, & V2 is when the patient fully blows his cheeks. The number of the fibrotic bands were recorded by palpation of buccal and labial mucosa. The burning sensation was scored on a Numeric Rating Scale (NRS). Based on the patient's response a marking from 0 to 100 was done, (Score 0: no pain; Score 100: severe pain).
Serum lycopene levels: 4ml fasting venous (from antecubital fossa) blood sample collected in sodium citrate vial, centrifuged for 10 min at 4000 rpm, to separate plasma. Plasma lycopene level was estimated through high-performance liquid chromatography (HPLC) under the chromatographic conditions, including a mobile phase of 47: 47: 06 (Acetonitrile: Methanol: Chloroform), the wavelength of 472 nm using Novak C16 column at a flow rate of 1.5 ml/litre.
BMCF: Scrapings from the middle of buccal mucosa on both sides with a sterile wooden spatula yielded the buccal cells and transferred to slide and fixed with 70% isopropyl alcohol spray. Smears stained using haematoxylin and eosin stain were viewed in a light microscope, screened under ×10 magnification, and the micronuclei were counted using ×40. (Figure. 3)
For Quantification, a total of 1000 cells with intact nuclei and cell boundaries were counted per smear, starting from the left corner using a zigzag method for screening the slides for the presence and number of BMCF as per Tolbert et al.9An oral pathologist and a postgraduate student who made the observations were blinded for the patient's study group. Evaluation for micronuclei was restricted to oral mucosa cells with intact nuclei.
Criteria for scoring included extrachromosomal cytoplasmic micronuclei of two to four picometers in diameter and had the same texture and intensity as the nucleus and were in the same focal plane as the nucleus.
Attrition:
There were two and four dropouts in Group I & 2, respectively. (Fig. 1) An intention to treat outcome analysis assuming the worst-case scenario was used to treat the uneven dropouts.
Statistical analysis:
SPSS Version 16.0 was used for the statistical analysis assuming a significance level of p Englishhttp://ijcrr.com/abstract.php?article_id=4212http://ijcrr.com/article_html.php?did=4212[1]. Sudarshan R, Rajeshwari G, Vijayabala G. Pathogenesis of Oral SubmucousFibrosis: The Past and Current Concepts. Int J Oral Pathol Med. 2012;3: 27-36.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcarePhytochemical Properties and Antimicrobial Activities of Some Important Medicinal Plants of Dhemaji District of Assam
English9298Konwar MayaEnglish Das PriyankaEnglish Sarma Manash PratimEnglish Bhagawati PrasenjitEnglishEnglish Phytochemicals, E. coli, OldenlandiacorymbosaL, Ipomoea aquatic Forssk, antimicrobial, AssamIntroduction:
Phytochemicals are chemicals that are present naturally in plants in the form of organic compounds. These phytochemicals synthesized in plant parts are used up by the local peoples for the healing of certain disorders1. Primary metabolites are essential for growth and development. Secondary metabolites produced by plants are often colourful and flavored compounds. In recent years, secondary plant metabolites i.e.phytochemicals have been extensively investigated as a source of medicinal agents2. It’s a standard process to look for the presence of newer drugs from natural products derived from plant species using pharmacological activity studies 3. These are synthesized in almost all parts of the plant like roots, tubers, stems, leaves, flowers, barks, fruits, seeds etc. These organic compounds provide definite physiological action on the human body and these bioactive substances include tannins, alkaloids, carbohydrates, terpenoids, steroids, flavonoids, coumarins, proteins and glycosides.
In the present work, phytochemical analysis and antimicrobial activity were carried out in ten plants i.e., Vitexnegundo, Oldenlandiacorymbosa, Centellaasiatica, Costusspeciosus, Ocimum sanctum, Pipernigrum, Mimusapudica, Phlogacanthusthyrsiflorus, Andrographispaniculataand Ipomoeaaquaticaof Dhemaji district of Assam. The scientific names, diagram, distribution, and medicinal properties of the studied plants has been tabulated below (Table 1)
Details of the studied plants:
Materials and methods:
Collection of Plants Sample-
Fresh plant parts of Vitexnegundo, Oldenlandiacorymbosa, Centellaasiatica, Costusspeciosus, Ocimum sanctum, Piper nigrum, Mimusapudica, Phlogacanthusthyrsiflorus, Andrographispaniculata, Ipomoeaaquatica were collected from different villages of Dhemaji district of Assam. The plant materials were identified using taxonomic tools. The plant materials were washed under running water, shaded and dried until all the water molecules evaporated and plants become well dried for grinding. After completion of the drying process, the plant materials were ground in a grinder and fine powder was transferred into the sealed container with properlabeling.50 grams of powder of plant sample was taken to extract with an adequate amount of ethanol (4:1) using soxhlet apparatus. The liquid part is stored at 40 C in a separate container.
Chemicals and reagents:
Distilled water, methanol, Di-ethyl ether hexane, Sodium phosphate buffer, DNS, Starch, DPPH, Ethanol, MH agar, Sodium acetate, sodium hydroxide, hydrogen peroxide, 95% ethanol, 1% lead acetate, hydrochloric acid, sulphuric acid, sodium carbonate, Chloroform [Jaldhara and Co.].
Glassware and plastic wares:
Beaker, conical flask, test tubes, measuring cylinder, Pipette, Petri dishes, test tube stand, plastic tray, micropipette tips.
Equipment:
Some of the equipment utilized for the study included-ANAMED Electronic Balance, spectrophotometer, pipettes, soxhlet apparatus, micropipettes, centrifuge, Hot plate water bath, Laminar air flow, -70C Temperature Freezer were the major equipment used in the study.
Preparation of plant extracts:
Water extract:
The water extraction was done using the standard method, where ground plant material of 5gm weighed was crushed in 100ml of sterile distilled water. The mixture was boiled at50-600C for 30 minutes on the water bath and it was filtered through what-man No.1 filter paper. Then the filtrate was centrifuged at 2500 rpm for 15 minutes. The extract was collected, labeled and stored in sterile bottles at50 C for further different experimental use.
Ethanol extract:
Ground samples (5gm) were extracted with 100 ml of 95% ethanol on a water bath at 700C for 2 hours. The extracted samples were centrifuged and the supernatant was transferred into 50 ml volumetric flask and adjust volume to 50 ml with 95% ethanol. The sample was stored at -40c.
Qualitative analysis of phytochemicals:
Chemical tests were carried by using aqueous and ethanol extracts to identify various phytochemicals using standard methods 4-7. The qualitative analysis for the extracts for the presence of chemical constituents was performed by various chemical tests like Steroids (Salkowski test), Terpenoids (Salkowski test), Flavonoids (Alkaline reagent test, sulfuric acid test, Lead acetate test), Tannins (Lead acetate test), Glycosides (Keller kiliani test), Coumarins (NaCl test).
Antimicrobial activity of plant extracts:
Antimicrobial tests using the leaf extracts of V.negundo, O.corymbosa, C.asiatica, C.speciosus, O. sanctum, P.nigrum, M.pudica, P.thyrsiflorus, A.paniculata, I.aquatic were carried out against the pure culture of Salmonellatyphi, Klebsiella species and Escherichia coli. Bacteria were cultured overnight at 370 C for 72 hours. The antibacterial activity of the leaf was determined using the good diffusion method. The bacterial strain was spreading on Muller Hinton Media with the help of the “L” rod. Wells (5mm diameter) were punched in the agar in the petri dish. Then the concentrated leaf extracts were added to the well. The plates were inoculated for 48 hours and the bacterial was assessed by measuring the diameter of the zone of inhibition in mm.
Results:
Phytochemical analysis:
The phytochemical characteristics of ten medicinal plants tested were summarized in the table-2. The results revealed the presence of medically active compounds in the ten plants studied. The leaves of V. negundo have positive results for the test flavonoid, tannin, glycosides, and coumarin. For O.corymbosa, we have found positive results for terpenoid, flavonoid, tannin, and coumarin. In the case of ofC.asiatica, we have found positive results for terpenoid, flavonoid, tannin, and coumarin.C.speciosus, showed a positive result for steroid, flavonoid, tannin, glycoside.O.sanctum, have positive results for tannin, glycoside, coumarin. P.nigrum has a positive result for the tested steroid, tannin, terpenoid, flavonoid, and glycoside. M.pudica have found positive result for steroid, flavonoid, tannin, coumarin, P, thyrsiflorus showed positive results for terpenoid, flavonoid, tannin and glycoside.A.paniculatatahave positive result for terpenoid, tannin, glycoside, a flavonoid. The plantI.aquaticashowed positive result for steroids, flavonoids and tannins.
Antimicrobial activity:
Antimicrobial activity for the leaves of V.negundo, O.corymbosa, C.asiatica, C.speciosus, O. sanctum, P. nigrum, M. pudica, P. thyrsiflorus, A. paniculata, I.aquatica against Salmonella typhi, E. coli and Klebsiella species are given below. (Table 3).
Discussion:
Analysis of plant extract revealed the presence of phytochemicals like steroids, terpinoids, flavonoids, tannins, glycosides, carbohydrates, proteins and amino acids. The important thing is that except for O. sanctum all plant samples contain one common and abundant secondary metabolite flavonoid. The literature survey of a previous study by Yadavet al. revealed the presence of phytochemicals in different solvents extracts and also find total phenolic and flavonoid contents of the selected medicinal plants8. Worked on phytochemical evaluation and determination of the antimicrobial activity of the plants like Ricinuscommunis (leaves, stem, roots), Ipomoea Aquatica(stem)had shown antimicrobial activity against E.coli. Xanthium strumarium (leaves, roots) andMenthapiperita(stem)had shown strong antimicrobial activity against Staphylococcus aureus9. Oldenlandiacorymbosa had not shown antimicrobial activity against Staphylococcus aureus and E. coli. In the current study leaves of Oldenlandiacorymbosa and Ipomoea Aquatica had shown antimicrobial activity. Previous work on the phytochemical analysis of four selected medicinal plants i.e., Trigonellafoenum –graecum, Syzgiumcumini, Terminalia chebula and Salvadorapersica revealed the presence of phytochemicals, flavonoid, Saponins and tannins10. In the present study of these plants also flavonoids and tannins are present in all of them exceptOcimum sanctum, which did not contain flavonoids. Previous work by Sharma et al. on five medicinal plants such as Tinosporacordifolia, Bryophyllumpinnatum, Terminalia belerica, Xanthium strumariumand Oldenlandiacorymbosarevealed that Glycosides were absent from the leaves of Tinosporacordifolia, steroids and terpenoids were absent in the leaves of Xanthium strumarium. Alkaloids were absent in the leaves of Terminalia bellerica and also in the leaves of Tinosporacordifolia11. Tannins bind to proline-rich protein and thereby interfere in the protein synthesis12. Hydroxylated phenolic substances, Flavonoids are manufacture by plants in response to microbial infections and they are effective antimicrobial substances against a wide range of microorganisms in vitro. Their activity is due to their ability to complex with extracellular and soluble protein and to complex with bacterial cell wall13. They are effective antioxidants and show strong anticancer activities also 14-16. Plant extracts were also containing saponins, which are known to produce inhibitory effects on inflammation17. Steroids have been reported to have antibacterial properties and they are very important compounds especially due to their relationship with compounds such as sex hormones18. Alkaloids have been associated with medicinal uses for centuries and one of their common biological properties is their cytotoxicity 19. Glycosides are known to lower blood pressure according to many reports20. The phenolic compounds are one of the largest and most ubiquitous groups of plant metabolites21.
Conclusion:
Medicinal plants have had a considerable global interest in recent years. The chosen ten medicinal plants are the source of the secondary metabolites i.e.steroids, terpenoids, flavonoids, tannins, glycosides and coumarins. Medicinal plants play an important role in treating various diseases. Due to the presence of secondary metabolites in medicinal plants they can activate in anti-diuretic, anti-inflammatory, anti-cancer, anti-malarial, anti-bacterial, anti-fungal, anti-diabetic and hepato-protective activity.
Nowadays, researchers can develop drugs from selected medicinal plants. But there are much more issues and challenges which have to be solved very effectively for these medicinal plants having antibacterial and phytochemical properties to promote them to the field of application. Since these medicinal plants are used by the traditional people for a long back so proper isolation, identification and mode of action of individual phenolic, as well as other biologically active compounds, would surely open the door for developing drugs from these plant resources. Finally, we will also have to give importance to the proper conservation of these medicinal plant species.
Acknowledgement:
The author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors were also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discusses.
Conflicts of interest: There is no conflict of interest.
Author’s Contribution
MK: Did the wet lab experiments
PD: Did the survey component
MPS: Designed the study
PB: Expertise in taxonomy and drafting the paper.
Financial Disclosure: None
Englishhttp://ijcrr.com/abstract.php?article_id=4213http://ijcrr.com/article_html.php?did=42131. Solomon CU, Arukwe UI, Onuoha I. Preliminary phytochemical screening of different solvent extracts of stem bark and roots of Dennetiatripetala G. Baker. Asian J Plant Sci2013;3(3):10-3.
2. Okoli RI, Turay AA, Mensah JK, Aigbe AO. Phytochemical and antimicrobial properties of four herbs from Edo State, Nigeria. Rep Opinion2009;1(5):67-73.
3. Charles A, Stanly AL, Joseph M, Ramani VA. GC-MS analysis of bioactive components on the bark extract of AlseodaphnesemecarpifoliaNees (Lauraceae). Asian J Plant Sci2011;1(4):25-32.
4. Kumar U, Kumar B, Bhandari A, Kumar Y. Phytochemical investigation and comparison of antimicrobial screening of clove and cardamom. Int J Pharm Sci Res2010;1(12):138-47.
5. Dhanasekaran M, Abraham GC, Mohan S. Preliminary phytochemical and histochemical investigation on Kigeliapinnata DC. Int J Pharm Sci Res2014;5(7):413-9.
6. Bargah RK. The preliminary test of phytochemical screening of crude ethanolic and aqueous extract of MoringapterygospermaGaertn. J PharmacognPhytochem2015;4(1):7-9.
7. Yadav M, Chatterji S, Gupta SK, Watal G. Preliminary phytochemical screening of six medicinal plants used in traditional medicine. Int J Pharm Sci Res 2014;6(5):539-42.
8. Yadav RNS, Agarwala M. Phytochemical analysis of some medicinal plants. J Phytol2011;3(12):10-14.
9. Bhattacharjee M, Devi J, Elanbam CD, Talukdar N, Kalita PP, Neog K, et al. Phytochemical analysis of traditional medicinal plants and their antimicrobial activity: An experience from northeast India. J Pharm Res 2016;1(1):1-7.
10. Bansode TS, Salalkar BK. Phytochemical analysis of some selected Indian medicinal plants. Int J Pharm Bio Sci 2015;6(1):550-6.
11. Sharma AK, Upadhyaya SK, Chauhan SK, Sharma S. Phytochemical analysis of some medicinal plants of district Saharanpur. Int J Pharm Chem 2017;7(3):54-7.
12. Shimada T. Salivary proteins as a defence against dietary tannins. JChemEcol2006;32(6):1149-63.
13. Cowan MM. Plant products as antimicrobial agents. Clin Microbiol Rev 1999;12(4):564-82.
14. Salah N, Miller NJ, Paganga G, Tijburg L, Bolwell GP, Rice-Evans C. Polyphenolic flavanols as scavengers of aqueous phase radicals and as chain-breaking antioxidants. Arch BiochemBiophys1995;322(2):339-46.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareSurvey on Evaluation of Awareness of Periodontal Health Among Subjects Undergoing Orthodontic Treatment and Trainee Orthodontists’
English99104Shahi Prashant KumarEnglish Shahi AnudeepikaEnglish Agrawal ParvEnglish Nanda MadhurimaEnglish Tiwari SakshiEnglish Singh AartikaEnglishIntroduction: The present study aims at surveying orthodontists and the patients undergoing orthodontic treatment to assess awareness about periodontal health care. The objectives were to assess the awareness about periodontal health care among orthodontists and to assess the patient’s perception regarding the importance of periodontal health in orthodontic treatment. Materials and Methods: 100 participants including 50 orthodontists and 50 orthodontic patients were included in the survey. The orthodontist included in the study were postgraduate trainee orthodontists in the second and final years of their courses and patients undergoing orthodontic treatment at least for 6 months. Dentists other than orthodontists, having orthodontic practices were excluded from the study. Patients who have started orthodontic treatment within 6 months and those who have completed were also excluded from the study. Results: The data were analyzed statistically using the Chi-square test.90% of orthodontists accepted the importance of oral hygiene and periodontists’ approval before orthodontic treatment; 30%were convinced enough for continuous monitoring of periodontal health by periodontists. However, 90% of patients concurred with the above. Also, above 80% of patients experienced difficulty in brushing due to braces and required modification in brushing technique. 34% gave importance to periodontal health over esthetics for seeking the orthodontic correction. Conclusion: Inadequate periodontal health care is either due to lack of knowledge or negligence by the doctors and patients themselves. So, to achieve an optimum and long term benefit, constant motivation of patients is required.
English Oral hygiene, Orthodontic correction, Orthodontists, Brushing, Periodontal health, AwarenessINTRODUCTION
Orthodontic treatment provides a promising result to the dentofacial complex and thereby has got vast acceptance in routine dental practice. Fixed appliance mechanotherapy improves the patients’ oral health and aesthetics and establishes good functional occlusion. It is seen that any deviation from an ideal arrangement and position of teeth, in the form of dental malocclusion (open bite/ deep bite/ cross-bite/ tooth rotation) is not a primary but an auxiliary factor that facilitates more dental plaque accumulation. By correcting the dentoalveolar complex, orthodontic procedures indirectly give positive effects on periodontal health and thereby increase the longevity of teeth.1 Importance of oral hygiene in orthodontic patients is always intensified to prevent any further periodontal disease and any iatrogenic damage. Fixed orthodontic appliances, such as orthodontic braces, arches and bands increase the number of retention places which makes plaque removal difficult.2,3 Self-cleaning is also more difficult because of the reduced effect of mechanical chewing and rinsing the food residues off by saliva. Active cooperation of orthodontic patients is essential over a prolonged treatment and involves keeping appointments and maintaining of an adequate level of oral hygiene and refraining from hard and sticky foods.2,4The choice of patients, education, and training about regular and correct oral hygiene, together with preventive and prophylactic measures contributes to the functional and aesthetic success of orthodontic therapy. Regular oral hygiene maintenance is of great importance for the preservation of gingival health until the completion of orthodontic therapy as well as post-orthodontically. Due to inadequacy of knowledge regarding gingival health, the majority of orthodontic patients do not maintain their oral hygiene adequately and thereby it remains one of the major reasons for non-compliance among the orthodontic patients.5So, to achieve optimum and long term benefits constant motivation of patients is required. Ortho-Perio relationship has always been two branches working in mutual benefit to the patients.
Worldwide Orthodontic treatment is practised, by Orthodontists and is making dentistry proud every day, by giving extraordinary profile changes to the patients. In contrast, as we say the base of a building should always be strong enough to bear the load, hence periodontal treatment has successfully proven itself, by providing strong bone support for any kind of dental treatment to commence. Bacterial pathogens have always played an important part in periodontal treatments. Problems of gingival recession, bone defects, and maintenance of oral hygiene are the major challenges faced by Periodontists.
Various programmes at school levels to international levels are being held, to educate society about the need for good oral hygiene. Since a patient will never know what is going inside the oral cavity, masses are being taught about the regular visits to the dentists for a dental check-up. As students or trainees, the dentists are bound to work in a symbiotic relationship, by referring and consulting every department, so that the treatment is appropriate and goes perfectly. The basics are being taught at the college level, but the point is how many of the daily practitioners are practicing it in their daily lives. None would be the answer. The survey has been conducted to evaluate and come to a conclusion, about the prevailing scenario. Brushing and the importance of oral hygiene if being taught to a patient at every orthodontic treatment visit, the results would be much more enhanced and the treatment would finish up much faster.
MATERIALS AND METHODS
The present survey was conducted by a simple random sampling method. Among 100 samples, 50 were orthodontic patients and 50 were postgraduate students in the branch of orthodontics. After taking the approval from the Institutional Ethics and Review Board, Kothiwal Dental College & Research Centre, two questionnaires, each comprising of a set of 10 questions (Annexure I & II) were filled by both orthodontists and orthodontic patients, separately designed for them. The identity of the participants was confidential.
Both open- and closed-ended questions were included in the questionnaire survey. To assess the awareness regarding oral hygiene and that brushing played an important role during orthodontic treatment, questions were given with answer choices that were easily understandable and brief in manner. The questionnaire was given to all the selected patients to complete the answers, with prior explanation to fill the questionnaire. One investigator was available while filling the questions, and participants were encouraged to approach the investigator for any clarification. All answers were kept confidential, and no individual patient was identified. Patients who completed a minimum of 6 months of orthodontic treatment were included in the survey.
The study was conducted from December 2016 to January 2017, with a questionnaire with open-and closed-ended questions, which onsistedof10questionsassessingtheawareness of gingival and oral health and the attitude of orthodontic correction-seeking individuals and orthodontists treating in Kothiwal dental college and research centre. The inclusion criteria were:
Patientstreatingfororthodonticmalocclusionmorethan6months.
Postgraduate trainee orthodontists in the second and final year of their courses.
Patients undergoing orthodontic treatment at least for 6 months.
Exclusion Criteria:
Dentists other than orthodontists, though they might be having orthodontic practices.
Patients who have started orthodontic treatment within 6 months.
Patients who have completed orthodontic treatment.
Ethical clearance was obtained from the Institutional Ethics and Review Board, Kothiwal Dental College & Research Centre, Moradabad. All answers were collected and recorded. All recorded data were statistically analyzed using SPSS version 15 data analyzer (IBM company, Armonk, NewYork). Chi-square test was done, and the level ofsignificancewaspEnglishhttp://ijcrr.com/abstract.php?article_id=4214http://ijcrr.com/article_html.php?did=4214
Bimstein E, Becker A. Malocclusion, orthodontic intervention, and gingival and periodontal health. Periodontal and Gingival Health and Diseases. London: Martin Dunitz Ltd; 2001; 250-90.
Baheti MJ, Toshniwal NG. Survey on oral hygiene protocols among orthodontic correction-seeking individuals. J Educ Ethics Dent. 2015 Jan 1;5(1):8-13.
Krishnan V, Ambili R, Davidovitch Z, Murphy NC. Gingiva and orthodontic treatment. Semin Orthod. 2007;13(4):257-71.
Becker A, Shapira J, Chaushu S. Orthodontic treatment for disabled children - A survey of patient and appliance management. J Orthod. 2001 Mar;28(1):39-44.
Alstad S, Zachrisson BU. A longitudinal study of the periodontal condition associated with orthodontic treatment in adolescents. Am J Orthod. 1979 Sep 1;76(3):277-86.
Grzesik WJ, Narayanan AS. Cementum and periodontal wound healing and regeneration. CritRev Oral Biol Med. 2002 Nov;13(6):474-84.
Zachrisson SI, Zachrisson BU. Gingival condition associated with orthodontic treatment. Angle orthod. 1972 Jan 1;42(1):26-34.
Zachrisson BU, Zachrisson S. Gingival condition associated with partial orthodontic treatment. Acta Odontol Scand. 1972 Jan 1;30(1):127-36.
Boyd RL, Leggott PJ, Quinn RS, Eakle WS, Chambers D. Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissues versus those of adolescents. Am J Orthod Dentofac Orthop. 1989 Sep 1;96(3):191-8.
Elanchezhiyan S. R. Awareness on gingival health among orthodontic correction-seeking individuals. J Indian Acad Dent Spec Res. 2010;1(3):19-21.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareConcern, Awareness and Decision Towards Different Orthodontic Treatment Modalities - An Questionnaire Survey
English105111Navin N.English Prema A.English Saravana Kumar S.English Yamini J.English Sushmitha R. IyerEnglishAim: To describe and analyze the awareness, thoughts and values influencing patients decisions to undergo orthodontic treatment with the ultimate aim of getting a deeper insight into decision making and the need to undergo orthodontic treatment. Material and Methods: All outpatients of the orthodontic department were included in the study. The questionnaire was framed under three categories namely patients concerns for orthodontic treatment, patients knowledge or awareness of different orthodontic treatment modalities and patients preferences or decisions on various orthodontic appliances. Likert type scale for awareness was used to rate the awareness level. Participants were then asked to rank their most preferred orthodontic appliance option. Four listed options included (a. Metal bracket, b. Clear bracket, c. Lingual brackets and d. Clear aligners). Result: The factors affecting patient’s concern for orthodontic treatment are as follows: pain and discomfort, the appearance of braces, cost, changes in diet pattern, being teased by friends, neighbours, peer group etc., long treatment duration, skip work on the day of review, transportation for monthly review, uneasiness during smiling and speech. The mean awareness scale shows Metal braces to be highly recognized, followed by clear braces and lingual appliances while growth modification reported least appraised. Conclusion: The dentist must educate patients on new technologies available in the market which would address patients concerns about orthodontic treatment. Awareness should be created among all population groups on other orthodontic treatment modalities in particular growth modifiers.
EnglishOrthodontic Treatment, Concern, Awareness, Decision Making, Survey, QuestionaireINTRODUCTION
The modern era with emerging and enabling technologies have helped the orthodontic profession progress in various methods of treatment. The profession has seen transitions from traditional braces to self-ligating brackets, lingual braces, removable aligners, and much more advanced technology, which address patients concerns (in particular esthetic and comfort) and the need for a timely efficient care1,2.
Orthodontics deals with the diagnosis, prevention and correction of malocclusion. Malocclusion is not a disease itself, but rather a state of being different from societal norms, which may cause anxiety about one’s dentofacial appearance and functional problems3. Sari et al., 20054 have shown that high anxiety levels are seen in patients with malocclusion. The concern is a cognitive activity that accompanies anxiety about future events5.
Increased patient awareness on smile beauty and facial appearance are observed more frequently in daily clinical practice. In recent years there has been an increase in the number of patients-both adults and adolescents seeking orthodontic treatment in addition, patients' expectations on treatment outcomes continue to rise. A desire for more aesthetic materials has resulted in both smaller sized and 'tooth-coloured appliances.
Long treatment duration and non-aesthetic appearance of metal brackets are the main reasons discouraging adult patients to start orthodontic treatment6. Another important aspect of choosing a specific appliance option is its cost. The cost of treatment was reported to hinder their ability to meet their demanded treatment and fulfil their needs, and it was rated to be the most significant barrier to receiving dental services.
Hence, it is important to identify factors that may influence patients’ treatment uptake decisions. It is also unknown whether patients’ aware of orthodontic advancement which may be related to their treatment demands. Therefore, this study aimed to describe and analyze the awareness, thoughts and values influencing patients decisions to undergo orthodontic treatment with the ultimate aim of getting a deeper insight into decision making and the need to undergo orthodontic treatment.
MATERIALS AND METHODS
A cross-sectional epidemiological survey was conducted in the department of orthodontics and dentofacial orthopaedics approved by the institutional ethical committee(678/IHEC/12-19). All the outpatients for orthodontic consultation during the period from March 2019 to 2020 were included in the study. The patient's details like age, gender and educational level were collected. Both Verbal and written information about the study was given to all subjects and written concern was obtained from all the participants. All the participants were asked about their decision to undergo orthodontic treatment and the answers were registered (a. Yes b. No c. Not yet decided) before proceeding with the study questionnaire.
Study Design
A prestructured questionnaire (Fig. 1) was given to random 300 patients (179 girls and 121 boys) aged 18-30 years satisfying the inclusion criteria.
Inclusion criteria
Patients undergoing orthodontic consultation for the first time.
Patients between 18-30years old.
Patients with no history of orthodontic treatment.
Patients with no siblings who previously underwent orthodontic treatment.
The questionnaire was framed under three categories namely patients’ concern about orthodontic treatment, patients’ knowledge or awareness on different orthodontic treatment modalities and patients’ preference or decision on various orthodontic appliances. The concern for orthodontic treatment was gathered under the following 10 factors: 1. Pain and discomfort, 2. Change in food style, 3. The appearance of braces, 4. Transportation, 5. Being teased, 6. Cost,7. Avoiding smiling, 8. Long treatment duration,9. Speech problems, 10. Time off from work.
Ten orthodontic treatment options representing the major therapeutic modalities in daily practices to understand patients’ knowledge or awareness on different orthodontic treatment modalities were listed as 1. Space maintainer, 2. Arch Expander, 3. Growth modification devices, 4. Metal braces, 5. Clear braces(Ceramic), 6.Self Ligating Braces, 7. Lingual braces, 8.Clear Aligner, 9. Mini implant or Mini screw, 10.Combined orthodontics and surgical cases. Images for each orthodontic therapy was shown to patients like Nance holding appliance, Maxillary arch expander, Headgear, Twin block, Metal bracket, Ceramic bracket, Lingual bracket, Passive Self ligating bracket with opening a door, Clear aligner partially and completely inserted, a Mini implant placed for anterior retraction and a pre-and posttreatment extra-oral profile of a combined orthodontic and surgical case. Each image was re-sized to the same dimension with better quality images. A likert-type scale for awareness was used to rate the awareness level of each therapy. It has five categories as follows: (1) not at all aware, (2) slightly aware (3) somewhat aware, (4) moderately aware, and (5) extremely aware.
Participants were then asked to rank their most preferred orthodontic appliance option. Four listed options include (a.Metal bracket, b.Clear bracket, c.Lingual brackets and d.Clear aligners).
Statistical analysis
Statistical evaluation of the data was performed using the IBM SPSS statistics software. Chi-Squared test was used to detect statistically significant differences between Likert’s scale awareness means of the different ten orthodontic modalities with age, gender, level of education and between treatment decisions and Mean ranking of the selected four appliances were found and also a concern for orthodontic treatment according to age, sex and treatment demand was evaluated.
RESULTS
The distribution of patients according to sex, age and treatment decision is shown in table 1. Out of 300 participants, 47(15.67%) were postgraduates, 189(63%) were graduates, 59(19.67%) were educated to higher secondary level (Class 11-12), 5(1.67%) were educated to secondary level(Class 6-10) shown in Table 2. Around 236 participants(78.67%) agreed to undergo orthodontic treatment, whereas 33 participants(11%) do not want to undergo orthodontic treatment while 31participants(10.37%) had not yet decided whether to undergo orthodontic treatment.
Patients' concern for orthodontic treatment which was gathered under 10 factors mentioned are shown in figure 2. 89(29.67%) participants felt pain and discomfort as their major concern towards orthodontic treatment, 67(22.33%) participants worried about the appearance of braces,43(14.33%) participants felt cost as their major concern, 26(8.67%) participants were apprehensive about changes in diet pattern, 19(6.33%) participants expressed on being teased from friends, neighbour, peer group etc.,19(6.33%) participants felt that the time off from work on the day of the review was their concern, 15(5%) participants were disturbed about long treatment duration,8(2.67%) participants bothered about their transportation for monthly review, 7(2.33%) participants felt about uneasiness during smiling due to braces, 7(2.33%) participants were distressed that braces would affect their speech.
The mean awareness level of each appliance is shown in figure 3. Metal braces(3.96/5) was mostly recognized, similarly, clear braces and clear aligners were among the highly recognized with the mean awareness scale of about 3.18 and 2.92 out of 5 respectively followed by lingual bracket. while growth modification appliances(1.48/5) was as expected reported at least (table 3).
The mean ranking for each one of the four orthodontic appliances selected were shown in figure 4. The ceramic bracket was the most preferred treatment option(3.68/5) and the Lingual bracket was placed the least in the ranking(2.34/5)
In our study 72.7% of participants were inadequately aware and 27.3% of participants shows moderate awareness to different orthodontic treatment modalities..(Table 4)
Statistical differences between age and level of awareness were found. Participants with age group of 26-30years had more level of awareness when compared to the remaining age group(p=0.02).(Table 5). and there is a correlation between education and level of awareness with the postgraduates showing more awareness when compared to graduates, higher secondary, and secondary(p=0.000). No statistical differences were found between gender(p=0.193), treatment decision(p=0.366) and level of awareness.
Correlation was also found between concern and treatment decisions groups, the concern items “ Appearances of braces” and “ change in food style” were related to the treatment demand group ( p = 0.01, and p = 0.043, respectively). The most frequent concern item among patients who had not yet decided whether to undergo treatment or not and patients who don’t want treatment is about “cost” and “pain and discomfort” p = 0.002, p=0.005 respectively. There was no statistically significant difference in patients’ concerns about gender and age group (p > 0.05).
DISCUSSION
This survey among patients regarding orthodontic treatment proves to admit the fact that individual concern plays an important factor in making their decisions to undergo treatment. According to our results, future orthodontic patients had concerns mainly on “pain and discomfort”, “Appearances of braces”, “Cost”, and “Changes in food style”. These findings are similar to those studies by Bennett et al., 19977, Sayer and Newton et al., 20078 and Kazanci et al., 20169. In the present survey, postgraduates felt changes in food style as one of their concerns whereas most graduates and higher secondary and secondary participants felt cost as one of their concerns along with pain and appearance of braces. Almost 14.33% of participants had a concern about cost as hindering factor for them to undergo orthodontic treatment. a participant who had cost as their concern would certainly accept orthodontic treatment if there is a government-employed health care policy. But in the developing countries where patients cannot avail of insurance policy for orthodontic treatment, the concern of cost factor by patients should be dealt with separately. However, the majority of patients would spare cost factor when compared to other factors like pain and appearance of braces.
In our study, 29.67% of participants felt pain as the main concern in orthodontic treatment. Pain and discomfort are one of the most common and problematic sequelae of orthodontic treatment.10-12 According to the literature, 70-95% of orthodontic patients experience pain during orthodontic treatment.13, 14 According to Banerjee et al., 201815, pain is one of the major reasons for patient non-compliance and is a primary reason for missing appointments. To resolve this problem sufficient patient-orthodontist communication about pain management during orthodontic treatment may reduce their fear of pain and discomfort during orthodontic treatment and improve their quality of life and as well their treatment cooperation and satisfaction.
The highest awareness score among orthodontic devices listed was metal brackets (3.96 out of 5) followed by clear braces, clear aligners, lingual brackets (3.18,2.92 and 2.78 out of 5). On the other hand space maintainer, arch expander and growth modification appliances like facemask, headgear, twin block displayed the lowest level of awareness(1.68, 1.66 and 1.48 out of 5). Mane et al., 201816, found that people in rural areas have lack awareness of various techniques and advances in orthodontic treatment. Our result was also similar to the survey by Bindayel et al., 201817 where the level of awareness of the stainless steel brackets is high and the least awareness level was found in headgear and functional appliances. A study by Sruthi et al., 201818 found that participants knowledge on functional and myofunctional appliances was less and more awareness has to be created. This highlights the lack of specific knowledge on different orthodontic treatment modalities. Therefore a campaign is required to raise public awareness and improve knowledge on different orthodontic treatment modalities. Since growth modification appliance can be rendered only to younger age group population, general population or paediatric as well adult population seeking dental treatment should be educated on growth, modification procedures which can circumvent surgical procedures in future.
In our study, 22.33% of participants felt the appearance of braces as their concern in orthodontic treatment. This concern was about esthetics which attributes to the major requirement for modern society, which caused an increased demand for aesthetic treatment.19 In our study, the clear(Ceramic) bracket was the most preferred treatment option(3.68 out of 5)followed by a clear aligner (3.24 out of 5) whereas lingual braces were the least preferred treatment option(2.34 out of 5). This result was also similar to the study by Rosvall et al., 200920 and Bindayel et al., 201821. But the result was in contrast to a study by Ziuchkovski et al., 200822, where they noticed clear aligner and lingual appliances were the most attractive treatment. The metal bracket which was commonly used in orthodontic practice were considered unattractive while ceramic bracket and orthodontic clear aligners were considered better aesthetic options. According to Feu D et al., 201223, socioeconomic status and age play a major role in the decision of aesthetic orthodontic options. Patients with high socioeconomic status and ages between 17 and 26 years are willing to receive aesthetic appliances irrespective of the cost. It is important to include socioeconomic status as one of the factors affecting decision making, hence this study’s results cannot be indiscriminately applied to groups with socioeconomic differences and this was considered to be the drawback of this study.
CONCLUSION
The mean awareness scale shows Metal braces to be highly recognized, followed by clear braces and lingual appliances while growth modification reported least appraised.
The dentist has to educate patients on new technologies available in the market which would address patients concerns about orthodontic treatment. Awareness should be created among all population groups on other orthodontic treatment modalities in particular growth modifiers. which would intercept malocclusion at an earlier stage
Futuristic application of orthodontic treatment should be towards prevention and interception of malocclusion. Hence awareness of preventive and interceptive orthodontics should be created among the general public.
Conflict of interest: None
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.
Funding Agency: nil (self-funding)
Authors contribution:
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareReport on the Occurrence and Taxonomy of Dichothrix Zanardini Ex Bornet & Flahault 1886 and Fischerella (Bornet Et Flahault) Gomont 1895– Two Rarest Filamentous Cyanobacteria from West Bengal, India
English112115Chatterjee SudipEnglishObjective: The author intended to investigate the diversity of cyanobacteria which is considered to be omnipresent and at the same time examine the role of the taxa in the ecosystem at the site of occurrence. The work was also undertaken to describe the obtained taxa, following taxonomic processes. Methods: Random sampling was done from different locations of the district of Burdwan in West Bengal. Live samples, as well as soil from target sites, were collected and investigated following standard systematic protocols for cyanobacterial taxonomy. Results: In this present investigation the author reported the occurrence of two very rare and filamentous types of cyanobacteria [viz. Dichothrix & Fischerella] from different locations of said area. The detailed taxonomic analysis of each tax an along with scientific drawing will not only help in systematics but also will add to the distribution pattern of the concerned group across the world. Conclusion: The results of this investigation will add a definite and conclusive understanding on the existence of two rarest forms of filamentous cyanobacteria which were never known from this part of the world. The author also tried to investigate the role of these taxa on the ecosystem. Though present communication is mainly on the taxonomy of the obtained taxa.
English Cyanobacteria, Dichothrix, Fischerella, First-report, India, West BengalINTRODUCTION
To investigate the occurrence of Cyanobacteria 1, the present work was undertaken to evaluate the diversity and systematics of the concerned group. The organism belonging to the group phenotypically may be divided into two distinct forms – Coccoid & Filamentous 2. The investigation was undertaken on the said group for several reasons. The cyanobacteria for economic reasons, taxonomic reasons and from the evolutionary point of view is very important. In the present investigation, two such taxa were taken into consideration which is very interesting from the point of view of overall plant evolution. We all know that introduction of a branching pattern is considered as one of the advancements in the evolutionary line. The obtained taxa exhibit initiation of various branching patterns in their vegetative trichome structure.
Time-to-time several workers had tried to accumulate scattered data about Cyanobacteria from diversified habitats of different parts of this continent. But apart from the very extensive monographic study by very few workers like Desikachary (1959); Prasad and Srivastava (1992) on Andaman flora, no significant studies on the diversity of the concerned group has been done on Cyanobacteria particularly from this part of India. The author thus tried to examine different locations to study the occurrence of different forms of cyanobacteria.
Both the taxa obtained during this investigation points towards advancement by manifestation of branching in the thallus. Dichothrix 3 as a genus is not very common in occurrence worldwide. The Dichothrix is known to be represented by 44 species to date 4. The taxa of the concerned group are known to occur only as of the benthic form on other submerged plants or other algae, sometimes on rocks present at the bottom of the aquatic body. Many species are marine. In the present investigation, the author obtained two species, out of which one is the first report from India and another is the first report from the state.
The genus Fischerella 5 is also very rare in occurrence compared to other related taxa. The taxa are represented by 22 species worldwide to date4. The taxa are very interesting to the phycologists and microbiologists as it exhibits true branching pattern and at the same time dimorphic branching pattern. In the present investigation, the author obtained two species, out of which one is the first to report from India and another is the first report from the state.
The obtained result of this investigation will add a definite and conclusive understanding of the existence of two rarest forms of filamentous cyanobacteria which were never known from this part of the world. The author also tried to investigate the role of these taxa on the ecosystem. The systematic description of obtained taxa along with scientific drawings should be of great help in the identification of the said taxa by future workers. The author believes, evolutionary biologists and toxicologists will benefit immensely benefitted through the outcome of this investigation.
MATERIAL & METHOD
The samples were collected from different localities of the concerned district. While collecting the samples special attention was paid to the sewage canals and stagnant water bodies near rice fields and populated localities. The soil samples were also collected along with the algal samples following standard ecological techniques i.e. from 4-5 different points at the vicinity of the spots of interest, for limnological analysis.
The following map will provide an exact idea about the geographical position of the sampling site: -
the pH of the water bodies was measured using pH paper (Merck Universal indicator, range1-10). The temperature of the water and the surrounding atmosphere were recorded using an immersion thermometer. The phytosociological associations were also recorded in the field record databook for further analysis.
Samples were taken on thin slides for study and drawings were made using drawing prism under low power (15x ? 10x) and high power (15x ? 40x) observation mode. The magnification and the length and breadth of the required portions were taken using stage and ocular micrometres by standardization technique. Sometimes the oil immersion lens was also brought into use for better results.
For the study of life cycle patterns and other biochemical analyses, the collected live algal samples were cultured through standard techniques. The cleaned samples were introduced into Petri dishes [(90 ? 15) mm; Borosil] and culture tubes were properly sterilized by autoclaving them at 15-pound pressure for 15 minutes. The medium used was modified BG – 11[1] solidified by 3% agar. The cultures in the later stages were transferred to liquid culture (medium BG – 11) in polythene bags [(7 ? 5) inch – Autoclavable] for optimum proliferation.
As the materials were collected from water bodies and moist soil surfaces the available Nitrogen, Phosphorus & Organic carbon was also measured at the site of collection following standard protocol.
RESULT & DISCUSSION
DICHOTHRIX3.
Many sub-dichotomous falsely branched filaments together form a pulvinus, gelatinous thallus. Many trichomes at the base are present within a common sheath. Trichomes generally end in hair. Heterocysts were mostly basal but sometimes intercalary also.
Taxonomic Position: Cyanophyceae, Nostocales, Rivulariaceae.
Artificial Key to the species obtained during this investigation:
1 Trichome 6.5 – 7.5 µm wide and cells are always longer than broad………….....D. gypsophila
1 Trichome 11 – 12.5 µm wide and cells are broader than long……………….……. D. orsiniana
1. Dichothrixgypsophila3; (Fig. – 2; A)
The thallus is made up of pseudo dichotomously branched filaments. Filament sheathed, prostrate part and erect parts are morphologically dissimilar. Branching false with heterocysts at the base of the trichome. Cells are sub-spherical to cylindrical. Trichome 6.5μm – 7.5μm broad with sheath and gradually tapering from base to apex.
Habitat – Obtained from Galsi area [Sample No. SC – 101 and 103 (pH 7.5 & Temperature 25oC) dated 23/11/2020] on other aquatic plants and submerged plastic bags as the tuft of dark-green to yellowish-green algal mass.
Discussion about the taxa: -This is the first report of the taxon from this part of India. Since the first report by Bornen&Flahault 1886, the taxa retained its taxonomic identity and according to available reports it has never been assigned as different taxa by any other worker. Thus, it is easily understandable that the taxa possess a very stable structure and adapted to varied environmental conditions efficiently.
2. Dichothrixorsiniana3; (Fig. – 2; B)
The thallus is made up of profusely and falsely branched trichomes. Trichome made of sub-spherical cells with 11μm – 12.5μm thickness. Heterocysts terminal and basal trichome sheathed and sheath very thick with open at the apical portion.
Habitat – Obtained from Budbud area [Sample No. SC – 113 (pH 6.5 & Temperature 15oC) dated 23/12/2019] in a rice field as slimy green algal mass and from Durgapur area [Sample No. SC – 133 (pH 6.5 & Temperature 20oC) dated 05/02/2020] in a sewage canal carrying industrial wastewater. But in both cases, the alga was found to occur as benthic material on either submerged higher plant leaves or waste products dumped by a human.
Earlier reports from India: Bombay6; Sikkim7
Discussion about the taxa: - This is the first report of this taxon from West Bengal. Like many other taxa under the genus Dichothrix, this taxa also was able to sustain different environmental changes as evident from the consistency of morphological attributes throughout its existence on earth.
FISCHERELLA5
Filamentous, filaments branched. The filament is generally made up of a single row of cells but sometimes maybe bi- or tri-layered too. The cells of the prostate portion are spherical to sub-spherical in outline and the branches generally unilateral are made up of elongated cells. The sheath of the prostrate and the older portion of the filament is very thick, but the branches have a thin sheath. Heterocysts intercalary and present on both prostrate parts and branches.
Taxonomic Position: Cyanophyceae, Stigonematales, Fischerellaceae.
Artificial Key to the species obtained during this investigation:
1 Cell of the prostrate part of the trichome is 6 - 7 µm wide and branches gradually tapering…...
………………………………………………………………………………………… F. ambigua
1 Cell of the prostrate part of the trichome is 9.5 – 10.5 µm wide, branches uniformly broad…...
……………………………………………………...…………………………..…… F. muscicola
1. Fischerellaambigua5; (Fig. – 2; C)
Trichome branched, covered by a thick mucilaginous sheath. The cells of the prostrate part are bi-layered and that of the branch is uni-layered. Cells of the prostrate part are spherical in outline with 6μm - 7μm in diameter and that of the branches 3μm – 4.5μm broad. The cells of the branch are elongated and gradually taper towards the apex. Heterocysts intercalary and present on both prostrate and erect parts.
Habitat – Found to grow on the moist and clayed surface of the sewage canal in the Barakar area [Sample No. SC – 159 (pH 6.5 & Temperature 15oC) dated 16/12/2019] near a market area and from Katwa [Sample No. SC – 167 (pH 7.5 & Temperature 32oC) dated 22/08/2020] in rice field as the tuft of blue-green algal mass.
Discussion about the taxa: This is the first report of the taxon from India. It is presently considered a valid taxon from the taxonomical viewpoint. This taxon is often being confused with species of Scytonema and as it is very rare in occurrence it was never reported from India before this report, according to the available literature.
2. Fischerellamuscicola5; (Fig. – 2; D)
Trichome branched, branches arise from one side of the prostate part, branches dimorphic. Cells of the prostrate part are spherical with 9.5μm – 10.5μm in diameter. Cells of the erect part are elongated 6μm – 6.6μm broad. Trichome sheathed, the sheath was hyaline and thin. Heterocysts intercalary and present in both prostrate and erect parts.
Habitat – Obtained from Kalna area [Sample No. SC – 98 (pH 7.5 & Temperature 16oC) dated 28/11/2020] in a Chorchorus retting water body as green, thin film on the moist soil surface and from Galsi area [Sample No. SC – 101 & 105 (pH 7 & Temperature 25oC) dated 23/12/2020] amongst other semi-aquatic plants in a roadside canal.
Discussion about the taxa: Previously these taxa were reported from Faridpur, Bengal [Presently in Bangladesh]8 and Allahabad9. So though this taxon is very rare and restricted (habitat wise) in occurrence the author could not claim this report as first from India but it may easily be claimed as the first report from this part of India.
ACKNOWLEDGMENT
The contribution of Prof. J.P. Keshri of Phycology Section, Department of Botany, The University of Burdwan is respectfully acknowledged for his guidance and constant logistic support. The encouragement of Principal, Syamsundar College along with all other associated staff and colleagues of the colleges are duly acknowledged. The authors acknowledge the immense help received from the scholars whose articles were cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of Interest – NONE
Funding Information – Not Applicable
Author’s Contribution – The author solely performed all investigation and reporting work. For identification purpose literature by other workers were consulted and duly referred.
Englishhttp://ijcrr.com/abstract.php?article_id=4216http://ijcrr.com/article_html.php?did=4216
Stanier RY, Kunisawa R, Mandel M, CohenG.Purification and properties of unicellular blue-green algae. Bacteriol Rev 1971;35: 171-205.
Komárek J, Kaštovský J, Mareš J, Johansen JR. Taxonomic classification of cyano-prokaryotes using a polyphasic approach. Preslia 2014; 86: 295–335.
Bornet É, Flahault C. Revision des Nostocacéeshétérocystéescontenues dans les principauxherbiers de France. Ann Sci Nat Bot Septièmesérie1886; 3: 323-381.
Anagnostides K,Komárek J.Modern approach to the classification system of cyanophytes. Arch HydrobiolSuppl1985;80: 327 – 472.
Gomont M. Monographie des Oscillariées. Ann Sci Nat Bot Ser 1892; 16:198-246.
Komárek J, Hindák F. Taxonomic review of the natural population of the cyanophages from the gemphospaeric complex. Arch Hydrobiol 1988; 80:205- 225.
Bhakta S, Das SK,Adhikary SP.Freshwater Algae of Sikkim. J Indian Bot Soc 2010; 89 (1&2): 169-184.
Banerji JC. On algae found on soil samples from alluvial paddy field of Faridpur, Bengal. Sci & Cult 1935; 1: 298-299.
Gupta AB.The algal flora of some paddy fields and its importance in soil economy.J Res 1957; 11: 227- 240.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareTo Evaluate the Effect of Different Margin Designs on Marginal Accuracy and Fracture Resistance of Zirconia Core Restorations
English116123Milani NehaEnglish Jagtap AmitEnglish Attargekar VikasEnglish Athavale SmitaEnglish Dange BhagyashreeEnglish Gandage DhananjayEnglishIntroduction: The strength of all-ceramic restoration depends not only on the fracture resistance of the material but also on a suitable preparation design that provides adequate material thickness. Objective: The purpose of the study was to evaluate the property of fracture resistance and marginal accuracy of zirconia core restorations with two different margin designs. Methods: Two stainless steel dies, with deep chamfer and shoulder margin designs were fabricated. Impressions of the dies were made in polyvinylsiloxane material and poured in die stone followed by fabrication of zirconia copings using CAD/CAM technology. A stereomicroscope was used to evaluate the marginal accuracy before and after cementation. For testing fracture resistance, a universal testing machine was used. Results: Comparison of mean values of marginal accuracy before cementation for deep chamfer 11.41 ± 4.61µm and shoulder margin group 51.9 ± 13.1µm and after cementation for deep chamfer 40.38 ± 9.47 µm and shoulder margin groups 77.4 ± 14.3µm were calculated. The data for both the groups was statistically analyzed PEnglishDental ceramics, Deep chamfer, Fracture resistance, Marginal accuracy, Shoulder margin, ZirconiaIntroduction
The demand for tooth-colored restorations has surged by multitudes in the last decade.1Although a 94% success rate has been attributed to metal-ceramic restorations2 due to their conservative preparation and satisfactory aesthetics, concerns have been raised regarding their biocompatibility and optical properties.3 On the other hand, properties like biocompatibility, light absorption, light scattering behavior and relative affordability present a significant rationale for the use of all ceramics in dentistry.4 These materials can be defined by their inherent properties that form hard, stiff and brittle materials due to the nature of their inter-atomic bonding which is ionic and covalent.5
The all-ceramic restorations that were initially indicated exclusively in the aesthetic zone, are now also being used in the posterior regions owing to advancements in the material science & fabrication methodology of dental ceramics. Longitudinal clinical studies evaluating glass-ceramic crowns 6,7and those with a densely sintered alumina core8have shown similar results when compared to metal-ceramic crowns, but have shown higher failure rates in the posterior region, where these restorations are prone to brittle fracture.9 However, the use of toughened ceramics such as yttria-stabilized zirconia offers a more fracture-resistant application of all-ceramic crowns in the posterior region without compromising aesthetic qualities.10Zirconia is a crystalline dioxide of zirconium. Its mechanical properties are very similar to those of metals and its colour is like tooth colour.11
Zirconia ceramics have physical properties that can achieve twice the flexural strength and fracture toughness of densely sintered high purity alumina ceramics.11,12 The tetragonal crystals in the yttria-stabilized zirconium oxide ceramics are metastable and can be transformed into larger monoclinic crystals with the application of stress from cracks or flaws.13 This phenomenon is beneficial in hindering the crack growth and increasing fracture toughness; hence, it is referred to as transformation toughening.14
All-ceramic restorations must ensure requirements of fracture strength and precision for marginal accuracy to ensure their clinical success. Increased marginal discrepancies expose the luting agent to the oral environment leading to cement dissolution and microleakage.15 A weak cement seal permits the percolation of bacteria and causes inflammation of the vital pulp.16In-Vivo studies have correlated a large marginal discrepancy with a higher plaque index and compromised periodontal health.17-20
Since the preparation & fabrication of all-ceramic restorations are far more critical & technique sensitive as compared to metal-based restorations, adequate preparation guidelines are of paramount importance to ensure their success. The strength of an all-ceramic restoration depends not only on the fracture resistance of the material but also on a suitable preparation design that provides adequate material thickness.21 The most commonly used margin designs for all-ceramic restorations include chamfer, deep chamfer, chamfer with collar, round end shoulder & shoulder. The purpose of this study was to comparatively evaluate the effect of two margin designs deep chamfer and shoulder on the marginal accuracy & fracture resistance of zirconia core restorations.
Materials and Methods
The study was carried out using two machined standard stainless-steel dies with a height of 7mm and diameter of 5mm.22The marginal area of one machined die was prepared with a deep chamfer (Figure 1A) finish line (1mm depth) while the marginal area of the other die was prepared with a shoulder (Figure 1B) finish line (1mm depth). The convergence of the axial walls was kept at 10o. Four reference lines were scribed at the mid-point of each surface of the die (i.e.mid buccal, -distal, -lingual, -mesial) for evaluating the marginal accuracy. A custom tray for each die was fabricated for making the impression. Orientation grooves were machined on the base of the die to ensure the accurate fit of the custom tray (Figure 1C).Impression of each die was made using polyvinylsiloxane impression material (Dentsply AQUASIL; Monophase). An equal amount of base & catalyst paste was dispensed on a glass slab. Using a cement spatula, the two pastes were manipulated to achieve a uniform colour & consistency, after which it was carried onto the custom tray and an impression was made (Figure 1D and 1E). The impressions were poured in die stone (Kalabhai Ultrarock)following which zirconia copings (CDA ZIRCAM 5AXIS CAD/CAM) of 0.4mm thickness with 35μm cement space23 were fabricated on the stone dies, using CAD/CAM technology (Figure 2).
For evaluation of marginal accuracy before cementation, the fit of each coping was visually examined on the metal die before assessing the marginal accuracy. The marginal fit was evaluated by measuring the gap between the edge of the coping and the prepared steel die margin using a stereomicroscope (Wuzhou New Found Instrument Co. Ltd. China; Model: XTL 3400E) of 30X magnification Figure 3A and 3B. All the measurements were made perpendicular to the steel die axis.24At four different points (mid-buccal, mid-distal, mid-lingual, mid-mesial) the distance between the edge of the coping and the prepared steel die margin was measured using image analysis software.24 Three measurements were made at each of the four positions; a total of 12 measurements per coping was performed. The mean of 12 values indicated the mean marginal accuracy value for each coping.24
Before cementation, all the copings were thoroughly cleaned with distilled water and then air-dried. The copings were then luted to the master metal die with RelyX resin cement (3M ESPE) following the manufacturer’s recommendation. During the cementation procedure, the crowns were placed under the constant pressure of 10N for 1 minute to ensure complete and uniform seating and polymerized with light exposure of 30 seconds per crown.25After removing the excess cement and cleaning the restoration margin, post cementation marginal gap analysis was executed in the same manner as previously described in Figure 3Cand 3D.
For testing the property of fracture resistance, the cemented samples were loaded in distilled water at room temperature for 24hrs to mimic the hydrolytic effect of saliva on the ceramic.14Mechanical testing was done using a Universal Testing Machine26(Star Testing Systems, India Make, Software BasedModel no. MSTS 248). The samples were clamped in the holder of the machine and loaded vertically on the occlusal surface. As the position of the applied force has a significant influence on fracture strength results, the loading piston was positioned at the center of the occlusal surface.23 The load was applied along the long axis of each stainless-steel die with a crosshead speed of 3mm/min until fracture occurred. The fracture load data was automatically recorded using the software (Figure 4 A and B).
Method of data analysis
Statistical analysis was done by descriptive statistics as mean, SD, etc. Comparison of groups was done by applying Student’s ‘t’ test (unpaired) and inter-group comparison by Student’s t-test (paired). The level of significance (P) was calculated using SSPS Version 17.0 Software program.
Results
The following values were obtained for Marginal accuracy (deep chamfer and shoulder) using Image analysis software and fracture resistance (deep chamfer and shoulder) using a Universal testing machine as shown in Table 1 and 2.
For marginal accuracy before cementation, the mean ± SD was 11.41 ± 4.61µm (deep chamfer) and 51.9 ± 13.1 µm (shoulder margin) as shown in Table 3. The marginal accuracy was better in the deep chamfer group as compared to the shoulder group.
The mean ± SD of marginal accuracy after cementation were 40.38 ± 9.47µm (deep chamfer) and 77.4 ± 14.3µm (shoulder margin) as shown in Table 4. The data were analysed for both the groups using a student t-test which showed a statistically significant difference (PEnglishhttp://ijcrr.com/abstract.php?article_id=4217http://ijcrr.com/article_html.php?did=42171. Stavridakis MM, Krejci I, Magne P. Immediate dentin sealing of only preparations: the thickness of pre-cured Dentin Bonding Agent and effect of surface cleaning. Oper Dent. 2005 Nov-Dec;30(6):747-57.
2. Walton TR. A 10-year longitudinal study of fixed prosthodontics: clinical characteristics and outcome of single-unit metal-ceramic crowns. Int J Prosthodont.1999 Nov-Dec;12(6):519-26.
3. Sadowsky SJ. An overview of treatment considerations for esthetic restorations: a review of the literature. J Prosthet Dent. 2006 Dec;96(6):433-42.
4. Kelly JR, Campbell SD, Bowen HK. Fracture-surface analysis of dental ceramics. J Prosthet Dent. 1989 Nov;62(5):536-41.
5. McLaren EA, Cao PT. Ceramics in Dentistry—Part I: Classes of Materials. Inside Dentistry 2009 Oct;5(9)94-103.
6. Fradeani M, Redemagni M. An 11-year clinical evaluation of leucite-reinforced glass-ceramic crowns: a retrospective study. Quintessence Int. 2002 Jul-Aug;33(7):503-10.
7. Malament KA, Socransky SS. Survival of Dicor glass-ceramic dental restorations over 14 years: Part I. Survival of Dicor complete coverage restorations and effect of internal surface acid etching, tooth position, gender, and age. J Prosthet Dent. 1999 Jan;81(1):23-32.
8. Odman P, Andersson B. Procera AllCeram crowns followed for 5 to 10.5 years: a prospective clinical study. Int J Prosthodont. 2001 Nov-Dec;14(6):504-9.
9. De Jager N, Pallav P, Feilzer AJ. The influence of design parameters on FEA-determined stress distribution in CAD-CAM produced all-ceramic dental crowns. Dent Mater. 2005 Mar;21(3):242-51.
10. Raigrodski AJ. Contemporary all-ceramic fixed partial dentures: a review. Dent Clin North Am. 2004 Apr;48(2):531-44.
11. Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Biomaterials 1999 Jan;20(1):1–25.
12. Cales B, Stefani Y, Lilley E. Long-term in vivo and in vitro ageing of a zirconia ceramic used in orthopaedic. J Biomed Mater Res. 1994 May;28(5):619-24.
13. Guazzato M, Albakry M, Ringer SP, Swain MV. Strength, fracture toughness and microstructure of a selection of all-ceramic materials. Part II. Zirconia-based dental ceramic materials. Dent Mater. 2004 Jun;20(5):449-456.
14. Zahran M, El-Mowafy O, Tam L, Watson PA, Finer Y. Fracture strength and fatigue resistance of all-ceramic molar crowns manufactured with CAD/CAM technology. J Prosthodont. 2008 Jul;17(5):370–377.
15. Jacobs MS, Windeler AS. An investigation of dental luting cement solubility as a function of the marginal gap. J ProsthetDent.1991 Mar;65(3):436-42.
16. Goldman M, Laosonthorn P, White RR. Microleakage—full crowns and the dental pulp. J Endod.1992 Oct;18(10):473-5.
17. Valderhaug J, Birkeland JM. Periodontal conditions in patients 5 years following insertion of fixed prostheses. The pocket depth and loss of attachment. J Oral Rehabil.1976 Jul;3(3):237-243.
18. Valderhaug J, Heloe LA. Oral hygiene in a group of supervised patients with fixed prostheses. J Periodontol. 1977 Apr;48(4):221-4.
19. Janenko C, Smales RJ. Anterior crowns and gingival health. Aust Dent J.1979 Aug;24(4):225-30.
20. Silness J. Periodontal conditions in patients treated with dental bridges. 3. The relationship between the location of the crown margin and the periodontal condition. J PeriodontalRes.1970;5(3):225-9.
21. Friedlander LD, Munoz CA, Goodacre CJ, Doyle MG, Moore BK. The effect of tooth preparation design on the breaking strength of Dicor crowns: Part I. Int J Prosthodont.1990 Mar-Apr;3(2):159-68.
22. Jalalian E, Rostami R, Atashkar B. Comparison of chamfer and deep chamfer preparation designs on the fracture resistance of zirconia core restorations. J Dent Res Dent Clin Dent Prospects. 2011;5(2):41-45.
23. Beuer F, Aggstaller H, Edelhoff D, Gernet W. Effect of preparation design on the fracture resistance of zirconia crown copings. Dent Mater J. 2008 May;27(3):362-7.
24. Subasi G, Ozturk N, Inan O, Bozogullari N. Evaluation of marginal fit of two all-ceramic copings with two finish lines. Eur J Dent. 2012;6(2):163-168.
25. Jung RE, Sailer I, Hämmerle CH, Attin T, Schmidlin P. In vitro colour changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent. 2007 Jun;27(3):251-7.
26. Jalalian E, Aletaha NS. The effect of two marginal designs (chamfer and shoulder) on the fracture resistance of all-ceramic restorations, Inceram: an in vitro study. J Prosthodont Res. 2011 Apr;55(2):121-5.
27. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications in fixed prosthodontics. J Prosthet Dent. 2003 Jul;90(1):31-41.
28. Webber B, McDonald A, Knowles J. An in vitro study of the compressive load at fracture of Procera AllCeram crowns with varying thickness of veneer porcelain. J Prosthet Dent. 2003 Feb;89(2):154-160.
29. Felton DA, Kanoy BE, Bayne SC, Wirthman GP. Effect of in vivo crown margin discrepancies on periodontal health. J Prosthet Dent. 1991 Mar;65(3):357-64.
30. Lui JL. The effect of firing shrinkage on the marginal fit of porcelain jacket crowns. Br Dent J.1980 Jul 15;149(2):43-5.
31. Groten M, Axmann D, Pröbster L, Weber H. Determination of the minimum number of marginal gap measurements required for practical in-vitro testing. J Prosthet Dent.2000 Jan;83(1):40-9.
32. Tao J, Han D. The effect of finish line curvature on marginal fit of all-ceramic CAD/CAM crowns and metal-ceramic crowns. Quintessence Int. 2009 Oct;40(9):745-52.
33. Beuer F, Aggstaller H, Richter J, Edelhoff D, Gernet W. Influence of preparation angle on the marginal and internal fit of CAD/CAM-fabricated zirconia crown copings. Quintessence Int. 2009 Mar;40(3):243-50.
34. Vigolo P, Fonzi F. An in vitro evaluation of the fit of zirconium-oxide-based ceramic four-unit fixed partial dentures, generated with three different CAD/CAM systems, before and after porcelain firing cycles and after glaze cycles. J Prosthodont. 2008 Dec;17(8):621-6.
35. Pera P, Gilodi S, Bassi F, Carossa S. In vitro marginal adaptation of alumina porcelain ceramic crowns. J Prosthet Dent. 1994 Dec;72(6):585-90.
36. Att W, Komine F, Gerds T, Strub JR. Marginal adaptation of three different zirconium dioxide three-unit fixed dental prostheses. J Prosthet Dent. 2009 Apr;101(4):239-47.
37. Bindl A, Mörmann WH. The marginal and internal fit of all-ceramic CAD/CAM crown-copings on chamfer preparations. J Oral Rehabil. 2005 Jun;32(6):441-7.
38.Hilgert E, Buso L, Neisser MP, Bottino MA. Evaluation of marginal adaptation of ceramic crowns depending on the marginal design and the addition of ceramic. Brazilian Journal of Oral Sciences. 2004;3(11):619-623.
39. Souza RO, Özcan M, Pavanelli CA, Buso L, Lombardo GH, Michida SM, Mesquita Am, Bottino MA. Marginal and internal discrepancies related to margin design of ceramic crowns fabricated by a CAD/CAM system. J Prosthodont. 2012 Feb;21(2):94-100.
40. Gavelis JR, Morency JD, Riley ED, Sozio RB. The effect of various finish line preparations on the marginal seal and occlusal seat of full crown preparations. J Prosthet Dent. 1981 Feb;45(2):138-45.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareLaparoscopic Cholecystectomy and Post-operative Pain Management Our Experience from Medical College Hospital
English124128Ovaise MalikEnglish Yaqoob HassanEnglish Ajaz Ahmad RatherEnglishAim: The study was aimed to compare the efficacy of Trans Abdominal Plane (TAP) block with port site infiltration on postoperative pain and analgesia requirement in patients undergoing laparoscopic cholecystectomy. Methods: The Prospective observational study was conducted at SKIMS Medical College Hospital over 1 year. A total of 112 subjects between 20 to 70 years of age with the American Society of Anaesthesiologists(ASA) physical status I/IIundergone laparoscopic cholecystectomy were included. The patients were divided into two groups using computer-generated random numbers; Group A included patients who received Ultrasound-guided bilateral subcostal transabdominal plane (TAP) block and Group B included patients who received port-site infiltration. The patients were assessed for pain in the first 24hours period using the Visual analogue pain scale (VAS) at 0,2,6,12 And 24hours. The data was collected and analyzed. Results: Among 112 patients who met the inclusion criteria, 37.5% were males with a male: female ratio of 0.6. The maximum number of patients were in the age group of 40-50years (41.05%) with the mean age in the TAP group 43.96 years and port-site infiltration group 44.74 years. There was no statical differences between the two groups and were comparable in gender, age and American society of anaesthesiology(ASA) physical status. At 24 hours, subjects with TAP blockhead had a mean VAS score less than the port site infiltration group (0.2 vs 0.4). The overall VAS Score was significantly lower in TAP block subjects (p-value of 0.0011). No significant statistical difference with regards to time to oral intake, ambulation after surgery and hospital discharge was found between the two groups of patients. All the patients did well and were fully satisfied. Conclusion: Ultrasound-guided TAP block is an effective, safe, efficient and satisfactory method of analgesia after laparoscopic cholecystectomy. Port-site infiltration also improves the postoperative outcome but is less efficient than TAP block in laparoscopic cholecystectomy.
EnglishAnalgesia, Laparoscopy, Cholecystectomy, Transverse abdominis plane block, Ultrasound, Post-operative painINTRODUCTION
Symptomatic cholelithiasis is one of the commonest disease processes treated by general surgeons. Regardless of underlying indications, laparoscopic surgery has become the procedure of choice for cholecystectomy. Laparoscopic cholecystectomy though being a minimally invasive procedure results in significant post-operative pain and therefore analgesia requirement.
Appropriate postoperative pain control is essential to relieve the patients from stress and suffering and to improve the overall postoperative status. Common methods of pain relief include Intravenous infusion of narcotics, epidural analgesia using local anaesthetics with or without narcotics, oral administration of narcotics and use of non-narcotic oral medication such as NSAIDs etc.1Effective management of postoperative pain helps in wound healing, early ambulation and mobilization, prevention of deep vein thrombosis and improve acute and long-term patient outcomes.
Use of long-acting local anaesthetics or placement of indwelling catheter provides long-term pain relief. Local infiltration of anaesthesia with lidocaine is suitable for minor superficial operations including the skin and subcutaneous tissue. Bupivacaine (0.5% or 0.25% with or without adrenaline) is the long-acting local anaesthetic agent. Although being slower in onset than lidocaine, the effectiveness is prolonged for up to 8 hours henceforth used for post-operative pain management.2TAP block under ultrasound guidance causing somatic anaesthesia of abdominal wall has become the common method of analgesia in case of any abdominal surgery. The anterolateral abdominal wall and parietal peritoneum are innervated by the upper (subcostal or intercostal plexus) and lower (in the vicinity of the deep circumflex iliac artery) TAPplexus formed by communication of intercostal, subcostal and L1 segmented nerves. Ultrasound-guided injection of local anaesthesia into the fascial plane between the internal oblique and transverse abdominus muscle allows a block of T6-L1 segmented nerves and excellent anaesthesia of the anterior abdominal wall.3 In literature, TAP-block has been found effective in general,4,5 urological,6 plastic,7,8gynecological,9,10,11 and colorectal surgeries,12for post-operative analgesia.Our study aimed to compare the efficacy of Trans Abdominal Plane (TAP) block with port-site infiltration on postoperative pain score and analgesic requirement in patients undergoing laparoscopic cholecystectomy.
Materials and Methods
The Prospective observational study was conducted at SKIMS Medical College and associate hospital over 1 year. The study included a total of 112 subjects. All our patients were evaluated starting from complete history taking and clinical examination in the pre-anaesthesia check-up room. The patients were subjected to routine investigations including Full blood count, liver and kidney function test, serum electrolytes, Hepatitis and viral serology, radiograph chest and abdominal ultrasonography. All the patients between 20 to 70 years of age with the American Society of Anaesthesiologists(ASA) physical status I/IIundergone laparoscopic cholecystectomy were included in our study. The patients with ASA grade > II, allergic subjects, patients with a history of opioid medication or addiction, patients with skin infections and dermatological problems and patients who received analgesic medication within 24 hours of procedure were excluded from the study. The informed written consent was taken from each subject after explaining the nature of anaesthesia and options of post-operative analgesia.
The patients were randomly divided into two groups before the procedure. Group A included 54 patients who received Ultrasound-guided bilateral subcostal TAP block [15ml of Bupivacaine 0.2% each side] and Group B included 58 patients who received port-site infiltration [5ml bupivacaine 0.2% each site]. All our patients received the same pre-anaesthesia medication in the recovery room and induction was done with propofol (1 to 1.5 mg/kg) and fentanyl (2 to 20 mcg/kg). Using video laryngoscopy, the patients were intubated with the properly sized cuffed endotracheal tube under the cover of short-acting muscle relaxants. Anaesthesia was maintained with a standard protocol regimen including oxygen, nitrous oxide and injectable muscle relaxants. Strict intra-operative monitoring of vitals was made throughout the procedure.
Intra-operatively each of our subjects received 1 g of paracetamol infusion and 75 mg of intravenous diclofenac. After the procedure, the patients were strictly monitored for vitals and post-operative pain in our High-dependency unit of the surgical ward. All our patients received 1g paracetamol 12hourly and intra-muscular Tramadol 100mg for break-through pain in the post-operative period. The patients were assessed for pain at 0,2,6,12 And 24hours using Visual Analogscale scores. The data was collected and analyzed.
Results
A total of 112 patients was studied including 37.5% males and 62.5% females with a male: female ratio of 0.6.Maximum number of patients were in age group of 40 to 50years (41.05%), followed by 30-40years (19.64%),50-60 years (19.04%),20-30years (12.5%) and 60-70 years (7.14%). The mean age in the TAP group was 43.96 years and in the port-site infiltration group 44.74 years. There was no statical differences between the two groups and were comparable in gender and other demographic characteristics.58 patients belonged to the American society of anaesthesiology physical status 1 and 54 patients to ASA11.No statistically significant difference was found between the groups concerning the ASA classification of patients.
Post-operatively patients were strictly monitored and pain and analgesic requirements were recorded. We use the Visual analogue scale (VAS) as a primary assessment of post-operative pain at each point in time.VAS scores are recorded on a10 cm horizontal line, anchored by word descriptors at each end that represents a continuum between ‘no pain’ and ‘severe pain’. The patient marks on the line the point that they feel represents their perception of pain and the VAS score is determined by measuring in millimetres from the left-hand end of the line to the point that the patient marks. On this VAS, 0 indicates no pain and 10 indicate very severe pain in the wound. This was recorded at 0,2,6,12, and 24 hours post-operatively [0= no pain;1-3=Mild pain;4-6= moderate to severe pain;7-9= very severe pain;10=worst pain possible]. The mean VAS score at 0-hour postoperative period was 1.8 in TAP group subjects while as it was 1.9 in the port-site infiltration group. At 24 hours patients with TAP block has a mean VAS score of less than port site infiltration group patients (0.2 vs 0.4). The overall VAS Score was significantly lower in TAP block subjects with a p-value of 0.0011.[Table 1].
All the subjects were encouraged for ambulation a few hours after the surgery.59.82% of our patients were fully ambulated and started oral feeds within 12 to 24 hours of surgery. However, time to oral intake and ambulation after surgery was statistically insignificant between the two groups of patients. [Table: 2]
The majority of our subjects (67.85%) were discharged within 36 hours after surgery. The difference between the two groups was statistically insignificant [Table 3].
None of our patients experiences any complications during the administration of anaesthetic drugs like intravascular or intraperitoneal injection, local bleeding or infection and anaesthetic overdosage. All our subjects were discharged within 48 hours of the post-operative period on oral paracetamol 650 mg 12hourly and attached to our outpatient department on weekly follow-up. All the patients did well and were fully satisfied.
Discussion
Post-operative pain is an unavoidable consequence of any surgical procedure. Since the advent of laparoscopy, about 90% of elective procedures and 70% of urgent cholecystectomies are being performed laparoscopically.13 Though being minimal invasive procedure with reduced surgical trauma response, patients of laparoscopic cholecystectomy experience significant postoperative pain.
The multipronged approach of opioids, peripheral nerve block and non-opioid analgesia should be incorporated for effective and satisfactory post-operative pain management in both laparoscopy and open procedures. Local anesthesia temporally blocks nerve conduction by binding to neuronal sodium channels and is used for short-term post-operative pain relief. Field block targets the small cutaneous sensory nerve fibres, used more commonly to achieve moderate sensory blockade for postoperative analgesia. Transabdominal plane block, adductor canal block, intercostal nerve block, and local infiltration of long-acting anaesthetic agents are procedures used for postoperative analgesia. This study was done to compare the efficacy of TAP block versus local infiltration of port sites in laparoscopic cholecystectomy.
A total of 112 patients was studied including 37.5% males and 62.5% females with a male: female ratio of 0.6.54 patients received TAP block and 58 received port-site infiltration. A maximum number of patients were in the age group of 40 to 50years (41.05%) with the mean age in the TAP group 43.96 years and the port-site infiltration group 44.74 years. 58 patients had American Society of anaesthesiology physical status-1 and 54 patients with American society of anaesthesiology-11.No statical differences between the two groups concerning age, gender and ASA physical status was noted. The findings are comparable with the study done by Suseela et al.14
We use the Visual analogue (VAS) score as a primary assessment of post-operative pain at each point in time. VAS pain score considered the gold standard of pain quantification,15is usually a horizontal line, 10 cm in length, anchored by word descriptors at each end. The VAS score is determined by measuring in millimetres from the left-hand end of the line to the point that the patient marks. On this VAS, 0 indicates no pain and 10 indicate very severe pain in the wound. The mean VAS score at 0-hour postoperative period was 1.8 in TAP group subjects while as it was 1.9 in the port-site infiltration group. At 24 hours patients with TAP block has a mean VAS Score of less than port site infiltration group patients (0.2 vs 0.4). The overall VAS Score was significantly lower in TAP block subjects than the local anesthesia infiltration group with a p-value of 0.0011. We found that TAP group subjects had lower mean pain scores as the time passes post-operatively. Local infiltration of anesthesia agents is short-acting with maximum effects at 1-hour post-surgery and the effect decreases to minimal by 8 hours and vanishes at 16 hours.16 While as TAP block, effects lasts longer than local infiltration. Ortiz and other researchers found that the efficacy of TAP is of prolonged duration than that of LAI and demonstrates its advantages gradually over time.17Literature has proven that TAP block turned out to be superior once compared with port-site infiltration and with epidural analgesia for different abdominal surgeries.17,18,19
All the subjects were encouraged for ambulate a few hours after the surgery.59.82% of our patients were fully ambulated and started orals feeds within 12 to 24 hours of surgery.67.85% of our subjects were discharged within 36 hours after surgery. We found no statistically significant difference between the two groups with regards to postoperative feeding and ambulation time and discharge from the hospital. All our subjects were discharged within 48 hours of the post-operative period on oral paracetamol 650 mg 12hourly and attached to our outpatient department weekly follow-up. The study done by De Oliveira et al. found that TAP block subjects with reduced pain decreased opioid consumption, and provided earlier discharge readiness as compared to placebo in laparoscopic surgery.20
None of our patients experiences any complications during the administration of anesthetic drugs like intravascular or intraperitoneal injection, local bleeding or infection and anesthetic overdosage. All the patients did well and were fully satisfied.
Conclusion
Post-operative pain control plays a significant role in the overall outcome after laparoscopic cholecystectomy. Ultrasound-guided TAP block is an effective, safe, efficient and satisfactory method of analgesia after laparoscopic cholecystectomy. Port-site infiltration also improves the post-operative outcome but is less efficient than TAP block in laparoscopic cholecystectomy.
Source of Funding ------NONE
Ethical Issue ------NONE
Conflict of Interest -------NONE
The authors have no other disclosure.
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.
Authors Contribution:
Authors 1,2 and 3 have a role in conception and designing, data collection, writing and critical review. We are taking responsibility for the authenticity and integrity of the research process.
Englishhttp://ijcrr.com/abstract.php?article_id=4218http://ijcrr.com/article_html.php?did=4218[1] Ashley SW, William GC, and Herbert C. Acs Surgery: Principles and Practice. Ontario: Decker Intellectual Properties, 2014. Print Chapter 5.
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[6]Skjelsager A, Ruhnau B, Kistorp TK, Kridina I, Hvarness H, Mathiesen O, et al.: Transversus abdominis plane block or subcutaneous wound infiltration after open radical prostatectomy: a randomized study. Acta Anaesthesiol Scand 2013, 57(4):502–508.
[7]Araco A, Pooney J, Araco F, Gravante G: Transversus abdominis plane block reduces the analgesic requirements after abdominoplasty with flank liposuction. Ann Plast Surg 2010, 65(4):385–388.
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[13] Duncan CB, Riall TS. Evidence-based current surgical practice: calculous gallbladder disease. J Gastrointest Surg. 2012 Nov;16(11):2011-25. doi: 10.1007/s11605-012-2024-1. Epub 2012 Sep 18. PMID: 22986769; PMCID: PMC3496004.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9HealthcareDevelopment, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and IT"s Degradation Products
English129137Ashish B RogeEnglish Sagar N FirkeEnglish Shrinivas K SarjeEnglish Mahavir H GhanteEnglish Giridhar R ShendarkarEnglish Nitin B GhiwareEnglishIntroduction: Efficacy and safety of drug therapy is directly related to the stability of active pharmaceutical ingredient (API) and drug product used. Forced degradation studies (also called stress testing) are performed for better understanding of API and drug product stability. Thus, stress testing is a prognostic research tool used to ascertain stability of drug molecules and provide support for developing a stability-indicating method. Aim: The research aim is Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and Its Degradation Products. Objective: The objective of the current study was to develop a validated specific stability-indicating reversed-phase liquid chromatographic method for the quantitative determination of Desloratadine HCl in bulk samples in the presence of degradation products. Method: Desloratadine HCL was subjected to variable pH, oxidative, dry heat and photolytic stress condition as per ICH guideline for the stability study. Stressed samples were further studied by the validated RP-HPLC method and also studied by GC-MS to characterize degradation products (Fig 15). Result: At oxidative stress, degradation products were generated and detected by GCMS. Slight degradation was observed in acidic and alkaline stress while no degradation was observed in other stress conditions. Separation of degradation products from pure drug was achieved on C18 column 5µ (4.6 X 250 mm) using the mobile phase consists a mixture of Orthophosphoric acid (0.1%V/V), Acetonitrile and Methanol (50:35:15 V/V/V). The detection was carried out at 242 nm. The proposed validated LC method was used to quantify the stressed test solutions in order to ascertain stability-indicating potential of the method. Conclusion: The established LC approach has been shown to be suitable for determining the quality of Desloratadine HCl from its dosage form and assessing its stability when required.
EnglishReversed-Phase Liquid Chromatographic Method, Validation, Stability study, Gas Chromatography and Mass Spectrometry (GCMS), Orthosphosphoric acidhttp://ijcrr.com/abstract.php?article_id=4384http://ijcrr.com/article_html.php?did=4384Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9Healthcare
Analyzing the Impact of Antenatal Depression on Birth Outcomes in Selected Tertiary Level Hospital
English138141Rajashri B. KaraleEnglish Shushma SheteEnglish Mahadeo ShindeEnglish
Introduction: Psychological problems are one of the primary concerns for pregnant women, and depression is the most prevalent mental health condition that a woman may experience during her pregnancy and the perinatal period anywhere in the world. Aims: The purpose of this research was to determine the correlation between the severity of depression experienced in the final trimester of pregnancy and the outcome of the pregnancy. Materials and Methods: The level of depression experienced during the third trimester was evaluated by means of descriptive research. Data were obtained from fifty pregnant mothers at Krishna Hospital in Karad, Maharashtra, using a straightforward random selection procedure in both the prenatal outpatient department and the postnatal ward. In order to obtain the responses, interviews were conducted with fifty pregnant women who were in their third trimester according to their EDD. The demographic information was gathered through the use of a structured questionnaire, and the level of depression was determined using the Hamilton Depression Rating Scale (HAM-D). The data were summarised and described using frequency, percentage, means, and standard deviation, and inferential statistics like the chi-square (2) test were used to determine whether or not there was a relationship between the variables. Result: The outcomes of the study indicate that a total of 9 mothers (18%) did not suffer from depression, 22 mothers (44%) did suffer from mild depression, 16 mothers (32%) did suffer from moderate depression, and 3 mothers (6%) did suffer from severe depression. It was found that there was a significant association between the level of depression and the type of delivery (p = 0.0141), that there was a significant association between the level of depression of the mother and the weight of the baby (p = 0.0149), but that there was no significant association between the weight of the baby and the type of delivery (p = 0.8765). Conclusion: The findings of the study indicated that pregnant women experience depression during their third trimester, which necessitates the quick attention of medical professionals so that the condition does not have an impact on the outcome of the pregnancy.
EnglishAntenatal Depression, Pregnancy Outcome, Tertiary level Hospital, Unfavourable, Depressive symptoms, Prevalencehttp://ijcrr.com/abstract.php?article_id=4651http://ijcrr.com/article_html.php?did=4651
1. Bowen A, Muhajarine N. Antenatal depression. Can. Nurse. (2006) 102:26–30.
2. Sheeba B, Nath A, Metgud CS, Krishna M, Venkatesh S, Vindhya J, Murthy GVS. Prenatal Depression and Its Associated Risk Factors Among Pregnant Women in Bangalore: A Hospital Based Prevalence Study. Front Public Health. 2019 May 3;7:108. doi: 10.3389/fpubh.2019.00108. PMID: 31131270; PMCID: PMC6509237.
3. Shruthi H, Keshava KP, Hulegar AA, Sandeep KR. Prevalence of antenatal depression and gender preference: a cross-sectional study among Mangalore population, Karnataka. India. J Pharm Biomed Sci. 2013;30:1011-4.
4. Ajinkya S, Jadhav PR, Srivastava NN. Depression during pregnancy: Prevalence and obstetric risk factors among pregnant women attending a tertiary care hospital in Navi Mumbai. Ind Psychiatry J . 2013 Jan;22(1):37.
5. Arora P, Aeri BT. Burden of antenatal depression and its risk factors in Indian settings: A systematic review. India J Med specialities. 2019 Apr 1;10(2):55.
6. Latendresse G, Wong B, Dyer J, Wilson B, Baksh L, Hogue C. Duration of maternal stress and depression: Predictors of newborn admission to neonatal intensive care unit and postpartum depression. Nursing Research. 2015 Sep 1;64(5):331-41.
7. Eastwood J, Felix A. Ogbo, Hendry A, Noble J, Page A. The Impact of Antenatal Depression on Perinatal Outcomes in Australian Women. PLoS one. 2017;2:1
8. Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best practice & research Clinical obstetrics & gynaecology. 2014 Jan 1;28(1):25-35.
9. Murtaja FF, Thabet AA. Anxiety and depression among pregnant women in the Gaza Strip. Psychol Cogn Sci Open J. 2017;3(4):137-44.
10. Saeed A, Raana T, Saeed AM, Humayun A. Effect of antenatal depression on maternal dietary intake and neonatal outcome: a prospective cohort. Nutr. J. 2015 Dec;15(1):1-9.
11. Fekadu Dadi A, Miller ER, Mwanri L. Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: a systematic review and meta-analysis. PloS one. 2020 Jan 10;15(1):e0227323.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9Healthcare
Assessing Nurses’ Knowledge and Attitudes Toward Pressure Ulcers in a Tertiary Care Setting
English142146Ujwala R MoreEnglish Mahadeo B ShindeEnglish
Introduction: Context and goals: “Constant attention by an experienced nurse may be just as crucial as a big operation performed by a surgeon.” 1 It is not uncommon for patients to develop pressure ulcers, which require correct guidelines and care from nurses. Because of this, it is important for nurses to be knowledgeable about healthy positions, specific protection, and the early recognition of symptoms, as well as other factors that can assist individuals in maintaining and promoting good health. Aims: To evaluate existing knowledge, as well as current, practises regarding the prevention of pressure ulcers. Methods: A research study using a cross-sectional design was carried out on one hundred registered nurses working in tertiary care facilities affiliated with Krishna Hospital and Medical Research Centre Karad. A questionnaire that the participants had to fill out on their own was used to evaluate their level of knowledge. Result: The findings show that the bulk of personnel, 83%, fall within the age range of 30 years, while the remaining 17% fall within the age category of 30 years or older. 62% of staff nurses possessed average levels of knowledge, 19% possessed good levels of knowledge, and 19% possessed poor levels of knowledge. Perspectives of the nursing staff with reference to pressure ulcers 40% staffs were neutral, 35% staffs disagreed and 25% staffs agreed. The purpose of this study was to investigate the knowledge and attitude of staff nurses regarding pressure ulcers. The findings suggest that in the future, there is a requirement for a systematic teaching programme in order to improve the knowledge of staff nurses. Conclusion: The prevention of pressure ulcers frequently requires the utilisation of low technology; nonetheless, careful attention is necessary in order to address the risk factor for pressure ulcers
EnglishAssess, Knowledge, Attitude, Pressure Ulcer, Pevention, Prolonged immobilityhttp://ijcrr.com/abstract.php?article_id=4652http://ijcrr.com/article_html.php?did=4652
1. Mitchell A. Adult pressure area care: preventing pressure ulcers. Br J Nurs. 2018 Oct 4;27(18):1050-2.
2. Baier RR, Gifford DR, Lyder CH, Schall MW, Funston-Dillon DL, Lewis JM, Ordin DL. Quality improvement for pressure ulcer care in the nursing home setting: the Northeast Pressure Ulcer Project. J Am Med Dir Assoc. 2003 Nov 1;4(6):291-301.
3. Berlowitz D, Bedford LC, Parker V, Niederhauser A, Silver J. Preventing pressure ulcer in hospitals a tool kit for improving quality of care, pressure injury prevention and management clinical guideline in Western Australia. Western Australia. 2013.
4. Examination PM. MEDICAL, SURGICAL, OBSTETRICAL.
5. Dilie A, Mengistu D. Assessment of nurses’ knowledge, attitude, and perceived barriers to expressed pressure ulcer prevention practice in Addis Ababa government hospitals, Addis Ababa, Ethiopia, 2015. Advances in Nursing. 2015 Dec 22;2015.
6. Dave K, Choudhary RD. Effectiveness of a pressure ulcer prevention package (PUPP) for patients admitted in intensive care units: an experimental study. Int. J. Adv. Nurs. Stud. 2020;8(4):273-8.5.
7. Gedamu H, Hailu M, Amano A. Prevalence and associated factors of pressure ulcer among hospitalized patients at Felegehiwot referral hospital, Bahir Dar, Ethiopia. Advances in Nursing. 2014 Dec 16;2014.
8. Qaddumi J, Khawaldeh A. Pressure ulcer prevention knowledge among Jordanian nurses: a cross-sectional study. BMC nursing. 2014 Dec;13(1):1-8.
9. Tubaishat A, Aljezawi M, Al Qadire M. Nurses’ attitudes and perceived barriers to pressure ulcer prevention in Jordan. J Wound Care. 2013 Sep;22(9):490-7.
10. Dilie A, Mengistu D. Assessment of nurses’ knowledge, attitude, and perceived barriers to expressed pressure ulcer prevention practice in Addis Ababa government hospitals, Addis Ababa, Ethiopia, 2015. Advances in Nursing. 2015 Dec 22;2015.
11. Islam S, Sae-Sia W, Khupantavee N. Knowledge, attitude, and practice on pressure ulcer prevention among nurses in Bangladesh.
12. Dilie A, Mengistu D. Assessment of nurses’ knowledge, attitude, and perceived barriers to expressed pressure ulcer prevention practice in Addis Ababa government hospitals, Addis Ababa, Ethiopia, 2015. Advances in Nursing. 2015 Dec 22;2015.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411321EnglishN2021November9Healthcare
A Study on Emotional Intelligence of School Teachers in Secunderabad
English147151G. MadhukarEnglish
Introduction: Emotional Intelligence is natural instinctive affection of mind. Thus, emotions are reactions consisting of psychological reactions, subjective cognitive states and expressive behaviors.Until recently we have been led to believe that only Intelligence Quotient (IQ) is related to one’s success.
Aim: The present study is aimed to find Emotional Intelligence of Primary school teachers of Secunderabad. Latest research shows that Emotional Intelligence is found to have greater influence on one’s success along with Intelligence Quotient Teacher’s especially need a good level of Emotional Intelligence as they influence the children’s affective domain along with cognitive domain. Since personality of the child is formed in the primary stage of children.
Objectives: To study the level of Emotional Intelligence among school teachers. To study the extent of difference in emotional intelligence among male and female teachers. To study the extent of difference in Emotional Intelligence among school teachers working under different managements.
Method: The survey was conducted on a sample of 30 primary school teachers of Government, Private and Private-aided schools, selected randomly.
Results: The result indicated that there is a significant difference in the Emotional Intelligence levels among female and male primary teachers of Government, Private and Private-aided schools.
Conclusion: Thus, it was concluded that gender influences the Emotional Intelligence of teachers whereas the type of management in which the teachers are working show no influence on the Emotional Quotient of the teachers.
EnglishEmotional Intelligence, Teachers, Influence, Education, School and Management, Emotional Quotienthttp://ijcrr.com/abstract.php?article_id=4677http://ijcrr.com/article_html.php?did=4677
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6. Penrose, A., Perry, C. & Ball, I. (2007). Emotional intelligence and teacher self efficacy: The contribution of teacher status and length of experience, issues in Educational Research, Vol- 17, Page No. 107-126.
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