Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareFunctional Status and Quality of Life of Judokas Due to Knee Injury English0105Deptee WarikooEnglish Harshita RaghuEnglish Lovish GuptaEnglishIntroduction: Judo, is a primarily a sport. The objective is to master the opponent. This is mainly done by applying pressure to arm joints or to the neck to cause the opponent to yield. This format of play leads to a ligament tear due to a direct blow to the knee, either from a fellow athlete or the judo mats. Injuries mainly occur due to a poorly executed throw or bad falling technique. The knee usually buckles and pain is severe. This knee injury affects the players badly. Objectives: To find the percentage of knee injury and affection on functional status and quality of life of judokas. Methods: Based on inclusion and exclusion criteria 100 subjects were enrolled for the study of purposive sampling. Judokas filled the set of questionnaire about knee injury and osteoarthritis outcome score. Results: Data was meaningfully assorted through calculation of mean, median and standard deviation. Value of mean is 55.48, median is 56 and standard deviation is 26.976. Conclusion: The conclusion of the study is that 51% of the players have mild effect on their functional status and quality of life due to knee injury during their practice session followed by moderate 45% and only 4% of population has severe effect on their functional status and quality of life during and after their practice sessions. EnglishFunctional status, Quality of life, Disability, Physiotherapy, Practice session and Judokas.INTRODUCTION According to Burdick D1 Judo, Japanese j?d?, is a system of unarmed combat, now primarily a sport. Techniques are generally intended to turn an opponent’s force to one’s own advantage rather than to oppose it directly. Judo is a highly technical sport based on the principle of “maximum efficiency with minimum effort". A judo fight starts with the opponents both standing, attempting to throw each other off balance. After a throw, judokas transition to ground-fighting, the so-called “ne-waza” .2 Judo was appointed as a sport that has a prominent relative risk of injury compared to other sports as stated by Parkkari J et al.3 According to Buschbacher RM et al.3, it is plausible to reason that more training should correlate with lower injury incidence. A recent study of karate injuries found that injury incidence increased with competitor rank, and with the number of years practicing, as stated by Destombe C et al.4 In two studies on the Korean In olympic team judokas, the knee was frequently injured,5 with 20% of the injuries occurring in the trunk, especially in the lumbar and thoracic spine. According to Witkowski et al. the injuries occurred mainly during training, not during competition. They found that 30% of the injuries occurred in the lower limbs (most at the knee), and 20.7% of injuries in the trunk and shoulder combined. Cynarski WJ7 stated that Judo injuries mostly affect body extremities, especially the knee (up to 28%), shoulder (up to 22%) and hand/?ngers (up to 30%). There is a high prevalence of anterior cruciate ligament injuries (ACL) in judokas has been reported, and there has been very little research concerning events preceding the injury as stated by the KoshidaSet al.8. The need of the study is to check how functional status and quality of life are affected by a knee injury during regular training. METHODOLOGY Study design: The study was Survey in nature. Sampling Technique: The subjects were selected by purposive sampling. Sample size: 100 subjects Source of data:  Sports clubs of Dehradun ELIGIBILITY Inclusion criteria Age group between 10-30 years. Both males and females. Had a knee injury within past year. Subjects are taken from Sports clubs of Dehradun Subjects who are taking training for at least three months. Exclusion criteria: Fracture of lower limb. Recent surgical procedure. Any neurological disorder like stroke, head injury. Subjects who are beginners are excluded. PROCEDURE On the basis of Inclusion and Exclusion criteria subjects filled a Knee injury and osteoarthritis outcome score (KOOS)7 questionnaire about knee injury, which included the content about lifestyle after a knee injury, amount of pain, problems in daily life, questions on crackle, swelling, catch, stiffness and range of motion and pivoting of knees. RESULTS Descriptive analysis and mean is applied to find the frequency of Functional Status and Quality of Life of Judokas due to knee injury. The results showed that out of 100 subjects 4 were severely disabled, 45 were moderately disabled and 51 were mildly disabled. First 5 questions of the questionnaire asked about the symptoms of a knee injury. The first set of questions were asked about symptoms during the last week. 44% of population had swelling rarely followed by sometimes (29%), never (18%), often (8%) and always (1%). 43% of the population reported grinding feel and hear a clicking or other types of noise when their knee moved rarely followed by sometimes (25%), often (2%) and never (30%). 57% of the population never felt their knee catch or hang up while moving followed by rarely (32%), sometimes (9%). In the second set of questions, population was asked about stiffness in their knee. 42% of the population reported mild joint stiffness after wakening in the morning followed by moderate (23%), severe (7%), extreme (1%) and none (27%). 47% of the population had mild knee stiffness after sitting, lying or resting later in the day followed by moderate (29%), severe (8%) and none (22%). Next set of questions was related to pain, 41% of the population experienced moderate knee pain followed by severe (31%), mild (12%) and none (16%). The amount of pain experienced in the last week during the following activities was asked. 45% of the population experienced mild knee pain during twisting/pivoting on their knee followed by moderate (30%), severe (8%) and none (17%).  43% of the population experienced mild knee pain while straightening knee fully followed by moderate (53%), severe (8%), extreme (2%) and none (14%). 47% of the population experienced mild knee pain while bending their knee fully followed by moderate (29%), severe (12%), extreme (1%) and none (11%). 59% of the population experienced mild knee pain while walking on flat surface followed by moderate (25%),  severe (6%) and none (10%). 41% of the population experienced mild knee pain while going up and down stairs followed by moderate (38%), severe (8%), extreme (4%) and none (9%). 73% of the population experienced mild knee pain while in bed followed by moderate (14%), severe (4%), extreme (1%) and none (9%). 66% of the population experienced mild knee pain while sitting or lying followed by moderate (18%), severe (7%) and none (9%). 44% of the population experienced mild knee pain while standing upright followed by moderate (35%), severe (5%), extreme (4%) and none (12%). 44% of the population experienced moderate difficulty while descending stairs followed by mild (36%), severe (9%), extreme (2%) and none (9%). 46% of the population experienced moderate difficulty while ascending stairs followed by mild (35%),  severe (6%), extreme (4%) and none (9%). 37% of the population experienced moderate difficulty while bending to the floor to pick up an object followed by mild (36%), severe (8%), extreme (1%) and none (8%). 32% of the population experienced mild difficulty while putting on socks followed by moderate (9%), severe (2%) and none (57%). 46% of the population experienced moderate difficulty while lying in bed and turning over or maintaining knee position followed by mild (37%), extreme (5%), severe(3%) and none (9%). 52% of the population experienced moderate difficulty while getting in/out of the bath, followed by mild (31%), severe (7%), extreme (2%) and none (8%). 64% of the population experienced mild difficulty while getting on/off toilet followed by moderate (21%), severe (6%) and none (9%). The difficulty may differ due to the different toilet styles (like Indian or western) used by players. 45% of the population experienced mild difficulty while doing heavy domestic duties like moving heavy boxes, etc. followed by moderate (30%), severe (8%) and none (17%). 43% of the population experienced mild difficulty while doing light domestic duties like cooking, etc. f and what degree of difficulty they had experienced during last week due to their knee. 47% of the players experienced mild difficulty while squatting followed by moderate (29%), severe (12%), extreme (1%)  and none (11%) during their last week practice session. 59% of the population experienced mild difficulty while running followed by moderate (25%), severe (6%) and none (10%). 41% of the population felt difficulty while jumping followed by moderate (38%), severe (8%), extreme (4%) and none (9%). 44% of the players experienced mild difficulty while twisting/ pivoting on their knee during their practice followed by moderate (35%), severe (5%), extreme (4%) and none (12%). 44% of the players experienced moderate difficulty while kneeling followed by mild (36%), severe (9%), extreme (2%) and none (9%).   Last set of questions were based on quality of life affected due to knee. 46% of the population were moderately aware of their knee problems followed by mild (35%), severe (6%), extreme (4%), and none (9%). 46% population had moderately modified their lifestyle to avoid potentially damaging activities to their knee followed by mildly (37%), extremely (5%), severely (3%) and none (9%). 52% of the population was moderately troubled with lack of confidence in their knee followed by mildly (31%), severely (7%), extremely (2%) and none (8%). In general, 47% of the population had moderate difficulty with their knee followed by mild (36%), severe (8%), extreme (1%) and none (8%). DISCUSSION The study aimed to know how knee injuries affect the functional status and quality of life in Judokas. According to Adams8, a judo practitioner is called a judoka. The result of the present study depicted that51% of the players had mild effect on their functional status and quality of life due to knee injury during their practice session followed by a moderate 45% and only 4% of population. In the study the number of male judokas was 52% and female judokas were 48% and with age of 10-15 years were 40%, 16-20 were 29%, 21-25 were 20% and 26-30 years was 11%. The subjects reported rare to mild swelling with 43% of population reported grinding feel and hear clicking or other types of noise when their knee moved. 42% of population reported mild joint stiffness with, 41% of the population experiencing moderate and 31% severe knee pain. The whole symptoms may arise because of improper training sessions and techniques. In a study conducted by Brostinni9, They presented a relationship with the knee injuries, in the majority in the UK situation. The author also suggested that the relationship of the training injuries is very concerning, mainly due to the evidence that the major part of the reports occurred whenever a heavier opponent participated, and that is a quite common situation in the training. Another study by Hirokazu Kobayashi et al.10 suggested the common mechanisms of anterior cruciate ligament injuries in judo: a retrospective analysis and concluded that Grip style may be associated with Anterior cruciate ligament injury occurrence in judo. In addition, direct contact due to the opponent's attack may be a common mechanism for Anterior cruciate ligament injuries in judo. The study depicted that previous knee injury does have an impact on function, daily living, recreational activities and degree of difficulty. It proves that there is severe effect on functional status and quality of life due to knee injury of Judokas during their practice sessions. This may be because of improper techniques and lack of physiotherapy services in sports academies. The flooring of the academies is also cemented and not proper which may be the important factor affecting the knee joints and performance of players. Main problem with the players occurred while performing sports activities. So, knowledge of precise and particular techniques is very important as suggested by Pocepco E et al.11 comprehensive knowledge about the risk of injury during sport activity and related risk factors represents an essential basis to develop effective strategies for injury prevention. Thus, the introduction of an ongoing injury surveillance system in judo is of utmost importance. Another study conducted in Russia by Osipov A et al.12 suggests that a qualified trainer should establish a high-quality interaction with the athletes, in close interpersonal relationships and moral authority. Another study conducted in Athens by Callister R et al.13 described that training is performed as overtraining and some aspects of performance were adversely affected as the consequence.  This study helps to aware physiotherapists as well as judokas towards the prevalence of knee injuries, so further refining of treatment protocols and techniques used in judo can be done. These also aware judokas about physiotherapy profession and the physiotherapists will help them to use the proper technique efficiently in their training to prevent further injuries. The future scope of the study can be done by taking into consideration of following aspects: Large sample size. Differentiating the judokas based on their belts. Years of practice. CONCLUSION The conclusion of the study is that 51% of the players have mild effect on their functional status and quality of life due to knee injury during their practice session followed by moderate 45% and only 4% of population has severe effect on their functional status and quality of life during and after their practice sessions. ACKNOWLEDGEMENT We thank all our subjects for their cooperation and interest in the study. We thank Dolphin PG Institute of Biomedical and Natural Sciences for cooperation and motivation. SOURCE OF FUNDING Self CONFLICT OF INTEREST The authors declare no potential conflicts of interest with respect to research, authorship and/or publication of this article. AUTHORS’ CONTRIBUTION: Dr Deptee Warikoo: Investigation, Manuscript writing. Dr Harshita Raghu: Data Collection Dr Lovish Gupta: Data collection Englishhttp://ijcrr.com/abstract.php?article_id=4422http://ijcrr.com/article_html.php?did=4422 Dakin BJ. Encyclopedia Britannica. 2018. Wieslaw B, Smolders P, Rydzik L, Bikos G, Mauffulli N, Malliaropoulos Net al. Judo Injuries Frequency in Europe’s Top-Level Competitions in the Period 2005–2020. J. Clin. Med. 2021, 10, 852. Parkkari J, Kannus P, Natri A, Lapinleimu I, Palvanen M. IJSM .2004; 25:209-216. Destombe C. Revue Du Rhumatisme: Incidence and nature of karate injuries. Joint Bone Spine.2006;73(2):182–188. Kim, K.-S.; Park, K.J.; Lee, J.; Kang, B.Y. Injuries in national Olympic level judo athletes: An epidemiological study. Br. J. Sports Med. 2015, 49, 1144–1150  Witkowski, K.; Maslinski, J.; Szalek, M.; Cieslinski, W.; Migasiewicz, J. Risk related to passion–Comparative analysis of traumas on the example of judo and wrestling. Arch. Budo Arch. Budo 2015, 11, 411–415 Salavati M, Akhbari B, Mohammadi F, Mazaheri M, Khorrami M. Knee injury and Osteoarthritis Outcome Score (KOOS); reliability and validity in competitive athletes after anterior cruciate ligament reconstruction. Osteoarthritis and Cartilage. 2011;19, 406-410. Adams, Neil, Armlocks, Judo Masterclass Techniques, London: Ippon Books: 1991. Barsottini D, Guimarães A.E and De Morais.P. Relationship between techniques and injuries among judo practitioners. 2006. Rev Bras Med Esporte _ Vol. 12, Nº 1 – Jan/Fev Hirokazu K, Tomonao K, Sentaro K, Koji M, TsuruoO, Takuya S et al. Mechanisms of the Anterior Cruciate Ligament Injury in Sports Activities: A Twenty-Year Clinical Research of 1,700. Journal of Sports Science & Medicine. December 2010;1;9(4):669-75 Elena P, Gerhard R, Nemanja S, Stanislaw S, Fabricio BDV, Carlos G-G et al. Injuries in judo: a systematic literature review including suggestions for prevention.Br J Sports Med 2013; 47: 1139–1143. Osipov A, Kudryavstev M, Salyamova P, Sherzanova Z, Struchkov V, Glinchikova L et al. Comparative Analysis of the scientific views of Russian and foreign scientists on the problem of training skilled judo wrestlers. 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareSmart SOP’s Surveillance System using Deep Neural Network English0611Chaman LalEnglish Zahid AliEnglish Shagufta AftabEnglish Suresh Kumar BeejalEnglish Mehwish ShaikhEnglish Ambreen FatimaEnglishThe global pandemic Corona virus sickness 2019 had a devastating impact on the world, according to statistics received by the World Health Organization. A study shows that about 33 million people are affected by the virus and more than 1 million deaths are reported worldwide. Currently, there are no specific vaccines or treatments for COVID-19. Now, WHO recommends that wearing a mask and following the SOP’s can help us in preventing the spread of the virus. There are only few studies about face mask detection based on image analysis. To create a safe environment in public places, educational institutions, & shopping malls we are proposed an effective idea based on computer vision and AI which is focused on real-time automated monitoring through the camera to detect people whether they are wearing a mask or not, also checks body temperature by the sensor-based model. In this proposed system modern deep learning algorithms have been mixed with different techniques to detect the unmasked faces and temperature and generate warning alerts by capturing images of the people not wearing masks and if the person has temperature, then it will also generate an alert of having temperature. This system favors society in preventing the spread of the virus as it has already infected 33 million people worldwide. The goal is to evaluate the face detection through image processing to prevent society from the spread of global pandemic disease and pollution. EnglishINTRODUCTION The spread of COVID-19 has created global health crises. In December 2019, before the coronavirus was proclaimed a global pandemic, a new infectious respiratory disease arose in Wuhan, China, infecting thousands of people and resulting in 170 recorded deaths. The disease was dubbed COVID-19 by the 1World Health Organization (Coronavirus disease 2019). Coronavirus expanded fast over the world, posing major health, economic, environmental, and social issues to the entire world population. As a result, an increasing number of people are concerned about their health, and governments regard public health to be a major priority1 People should use masks to reduce the risk of virus transmission and keep social space between persons to prevent the infection from spreading, according to the WHO. The identification of face masks and temperature has become a computer vision challenge to aid society. This model explains how to prevent the virus from spreading by detecting a person's temperature and whether they are wearing8 a mask in public settings in real-time. It’s a real-time temperature measurement, and the flow of people can pass through quickly to avoid staying long and reduce the risk of cross-infection. The model is a combination of a lightweight neural network, and computer vision with the transfer of learning techniques to detect the unmasked faces and temperature through image processing by real-time monitoring of the people. Since the data set to detect the mask can be harder to extract, we use transfer2,9,10 learning techniques. Using Open-CV helps in deep learning the model3,7,11 and helps to meet the real-time requirements so if any person is detected with temperature or not following the SOP’s i.e., not wearing a mask, it takes a picture of the person not wearing the mask and send violation alert or notification will be sent to the system to take necessary actions. BACKGROUND As the global pandemic has infected over millions of people and caused more than 1 million deaths are reported worldwide and no proper solution has been discovered to stop the spread of the coronavirus. The COVID-19 virus is primarily transmitted through droplets of saliva or nasal discharge when an infected person coughs or sneezes, thus respiratory14 etiquette is very important (for example, by coughing into a flexed elbow). There are no COVID-19 vaccinations or therapies available currently. However, numerous clinical trials testing potential therapies are currently underway. As clinical findings become available, WHO will continue to offer updated information5. Now, WHO recommends that people should take safety measures and should follow the SOP’s and wear masks to prevent the spread of the virus4,6. A significant indication of COVID-19 infection is a rise in body temperature. Thermal screening is now carried out with handheld contact-free thermometers, which necessitates health personnel approaching the individual being checked, placing them at risk of infection. It's also nearly impossible to take the temperature15,16 of every single person in a public place. To overcome this problem, we proposed a computer vision approach to help society in maintaining the environment12,13 in which SOP’s are followed strictly. We proposed a computer vision system model which is supposed to check the temperature of people and whether people are wearing masks or not by real-time monitoring of the people and if someone is captured not wearing mask or if they have body temperature then it will notify the authorities by sending them the warning alerts with captured images. It will help society in preventing the spread of the virus in public places. RELATED WORK Neural networks (NNs) are compositional models with more generic nodes and less interpretability than the previous models. The most well-known use of Convolutional NNs20,23. These models, in the form of DNNs, did not emerge as extremely successful on large-scale picture classification tasks until recently19. However, their detecting potential is restricted. Using multi-layer Convolutional NNs, scene parsing has been attempted as a more detailed kind of detection21. DNNs have been used to solve the problem of medical image segmentation18,22, which has a similar high-level purpose but uses a much smaller network with different features, loss function, and lacks apparatus to distinguish between multiple instances of the same class, is perhaps the most similar method to ours. We perform object box extraction after regressing to object masks over many sizes and huge image boxes. The acquired boxes are fine-tuned by repeating the technique on the subpictures, which are cropped using the current object boxes. We just show the whole object mask for clarity, but we use all object masks. CONVOLUTIONAL NEURAL NETWORK CNN's are a sort of feed-forward neural network with many layers. Convolutional neural networks have layers with small neuron collections that each observe a small piece of an image. The results from all the collections in a layer partially overlap to provide the overall visual picture. Each filter takes a set of inputs, conducts convolution, and optionally adds non-linearity to the mix17. In picture and facial recognition, the most widely used algorithm is CNN. CNN is a sort of artificial neural network that extracts features from input data using convolutional neural networks to enhance the number of features. DEEP NEURAL NETWORK Image recognition is a specialty of deep25 neural networks (DNNs). The purpose of neural networks, which are computer systems that identify patterns, is pattern recognition. The name comes from the fact that their design is based on the structure of the human brain. In this system, there are three types of layers: input, hidden layers, and output. The input layer receives a signal, the hidden layer processes it, and the output layer produces a decision or forecast based on the input data. The network's layers are made up of interconnected nodes (artificial neurons) that execute calculations. Neural networks extract features directly from the data with which they are trained, removing the need for experts to manually extract them. OBJECT DETECTION Object detection, a subset of computer vision, is an automated approach for finding interesting objects in a picture in relation to the background. [Fig: 1] shows two images with foreground objects. The convolutional DNN established by is the foundation of our network. It has a total of seven layers, the first five of which are convolutional and the latter two of which are fully linked. As a non-linear transformation, each layer employs a corrected linear unit. In addition, max pooling21 is present in three of the convolutional layers. We suggest the reader to for more information. TENSORFLOW BASED DETETCTION The human visual system is fast and accurate, and it can execute complicated tasks like identifying many items at once, so humans can detect and identify an object in real-time. Because of the availability of massive datasets and machine learning methods, computers can now detect and classify multiple images with high accuracy, just like humans. Google Brain TensorFlow is an open-source toolkit for numerical computing and large-scale machine learning that makes it easier to gather data, train models, serve predictions, and refine future outcomes. TensorFlow is a software that mixes Machine Learning and Deep Learning models and algorithms. The steps for detecting objects in real-time are very similar to those described before. All we need now is an additional dependent, which is Open CV. e. DETECTION BASED ON DNN As illustrated in [fig. 2], the basis of our technique is a DNN-based regression towards an object mask. We may create masks for the entire object as well as parts of it using this regression model. We can get masks of many objects in a picture using a single DNN regression [fig. 2]. We use the DNN localizer on a small selection of huge sub-windows to improve the precision of the localization even more. system requirement TENSORFLOW: Tensor flow is a free software package that may be used for a range of data flow and differentiable programming tasks. It's a symbolic math library that's also used in machine learning applications like neural networks. It's used by Google for both research and manufacturing. TensorFlow was built by the Google Brain team for internal use. On November 9, 2015, it was made available under the Apache License 2.0. TensorFlow's architecture enables computation to be distributed over a range of platforms. b. OPEN CV Open CV is a collection of programming functions geared primarily at real-time computer vision. Willow Garage now supports it, which was originally built by Intel. The library is cross-platform and free to use, thanks to the open-source BSD license. c.MT CNN Multi-Task Cascaded Neural Network (MTCNN) Fig. 4 is an acronym for Multi-Task Cascaded Neural Network. A convolutional neural network is a type of neural network that recognizes faces and facial landmarks in images. It consists of three neural networks coupled in a cascade. d.KERAS Keras is a neural network library written in Python. As a foundation, it can be built atop TensorFlow, Microsoft Cognitive Toolkit, Theano, or PlaidML. It's user-friendly, modular, and expandable, to facilitate deep neural network research quickly. e.LINUX Compared to other operating systems, Linux is more stable and secure (OS). Linux and Unix-based operating systems have fewer security vulnerabilities since the code is regularly checked by many developers. Its source code is also available to anyone. f.PI INTERFACING CAMERA The Pi 4 can be used for a vast array of image recognition tasks, and the creators of the device seem to have recognized. g.LCD DISPLAY LCD display will be used to display pictures of person wearing masks or not wearing masks which are detected by the system. Also, it will help in displaying messages like when it detected an unmasked face. h.SENSOR FOR TEMPERATURE DETECTION. The sensor will be needed to measure temperature24 on real time in [fig. 3]. METHODOLOGY Using Deep Learning algorithms, it was possible to detect temperature and unmasked faces. Our project is divided into two phases: training the model by giving data set and implementing the detection system based on image processing. For this purpose, we divide it into different phases mentioned below: a.DATA COLLECTION In phase 1 we will collect the data set that will help us in training the model that how the system detects if the person is wearing mask and following SOP’s or not. For this purpose, we will take different pictures of people wearing masks and not wearing masks to train the model on what measures the system will identify who is wearing masks or who is not wearing mask in public places. Some examples are shown in figure below with masks, without masks, hand masks, with or without masks in one frame and confusing images without masks.5,6 Also, we will give data set to recognize the body temperature automatically by sensor.15,16 b.MODEL TRAINING Due to limited size of data set of face mask it is difficult for learning algorithms to learn better features. Our proposed system uses transfer learning techniques to train the system model [fig. 4] that on what measures will it detect the temperature and checks if the person is wearing mask or not. The data set is loaded into the project directory, and the algorithm is trained using photographs of people wearing masks, without masks, and images that are perplexing14 without masks. All the images and data set for thermal screening of body temperature from phase 1 creates a baseline for our project it will help the algorithms to learn objects which shows that transfer learning can increase the face detection performance by 3 to 4% and enhance the accuracy level. The model is trained by using TensorFlow for better image processing compiled with MTCNN algorithm which improves the accuracy level by 99.99%. c.MODEL IMPLEMENTATION After training the model we must implement the algorithm-based system i.e., MT CNN algorithm with the camera to automatically track the public areas to prevent the spread of COVID-19. The camera will help the trained model to detect on real-time in public places if a person is not wearing masks or have temperature. The system will also help in maintaining a hygienic environment in public places. Also, it improves the accuracy level by 99.99%. d.MODEL TESTING Once the model is completely trained and is given all the data set to measures the detection of people not wearing mask, we check the accuracy level of the model based on the data set given to it by showing the bounding box with green colour. If the person in the bounding box is not wearing a mask or the mask is not visible to the camera or if the person is having temperature15,16 it will change it colour into red and capture its image and will generates a warning and send alert to monitoring authorities with face image. To begin, a CNN technique7 is utilized to create a huge number of bounding boxes that span the entire image5,6 (that is, an object localization component). Then, for each of the bounding boxes, visual features are extracted. The system accuracy level is approximately 99.99%. We can see how the model identify the images with and without masks with red and green boundary boxes. The red box will appear when the camera captures any faces without mask and temperature body then it will generate alerts and notify the authorities otherwise the boundary box will be green showing that people are wearing masks. RESULT AND ANALYSIS In all the images we include in the data set we have given some images of people wearing masks, some not wearing masks and some confusing images and some techniques on how to measure the temperature of the body. The data set was used to train the model which gives the accuracy of 99.99% 8,9,13. When the model is completely trained by implementing the deep learning algorithms, it will help the society in maintaining the SOP's in public areas when the camera monitors any person in the boundary box without mask or have temperature it will automatically generate warning alerts and send the notification to the monitoring authority with the face image that violates the rule or have body temperature. Resulting in an environment where we can prevent the spread of this global pandemic coronavirus and polluted environment. The above pictures are showing the results of a person who is captured by the system not wearing mask and at the same time it is showing the results with a message "Please wear mask to defeat corona" in a green boundary box. Below has one more person detected not wearing mask. As in this pic, we can see the system does not recognize the name of the person it is because we have not feed its data in the system, but it can still detect the not wear mask [fig. 5] and wear mask [fig. 6] faces. The proposed system can detect the temperature and unmasked faces by real-time monitoring of the people using image processing and data entry. The system is user-friendly; we can get the data of captured images easily. The system monitors the people in the boundary box and if it detects a person having a temperature or without mask it will change the color of the boundary box into red. The system keeps the detected picture in the database for future use. The system will notify the authorities if it detects temperature or unmasked faces by capturing their pictures automatically. Data entry and image processing of large data set can improve the accuracy level of the system. This system with more modification will help the society in future. The system has accuracy level of 99.99%. CONCLUSION The proposed system will contribute to the healthcare sectors through which we can help society in preventing the spread of the pandemic virus COVID-19 even after the vaccine is invented. Detection of temperature and unmasked faces by image processing and data entry, which can contribute to public healthcare. The architecture is based on the two main phases which are training face mask and temperature detector and implementing the face mask and temperature detector. To extract large data set, we used transfer learning technique to train the model. If someone is captured not wearing mask it will automatically generates warning alerts with image of the person to take necessary actions to maintain the SOP’s based environment and to prevent the spread of the coronavirus. On training the model, we got an accuracy of 90%. As a result, it may be used to measure temperature and monitor uncovered faces in crowded places such as train stations, bus stops, markets, streets, mall entrances, schools, and colleges. ACKNOWLEDGEMENT: The researchers whose works are cited and listed in this paper's references have been of tremendous assistance to us. The laboratory facility for the analysis deserves special mention. The authors express their gratitude to individuals who contributed to the study's improvement for being patient. Source of Funding: Nil Conflict of Interest: None Author’s contribution: Chaman Lal: writing of final drafts and data collection. Zahid Ali: Manuscript Final Editing Shagufta Aftab: writing of first draft. Suresh Kumar B: Manuscript Editing. Mehwish Shaikh: Editing of first draft. Ambreen Fatima: writing of second draft. Englishhttp://ijcrr.com/abstract.php?article_id=4423http://ijcrr.com/article_html.php?did=4423[1]       Covid CD, Team R, Covid CD, Team R, COVID C, Team R, Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T. Coronavirus disease 2019 in children—United States, February 12–April 2, 2020. Morbidity and Mortality Weekly Report. 2020 Apr 10;69(14):422. [2]       Hadayer A, Zahavi A, Livny E, Gal-Or O, Gershoni A, Mimouni K, Ehrlich R. Patients wearing face masks during intravitreal injections may be at a higher risk of endophthalmitis. Retina. 2020 Sep 1;40(9):1651-6. [3]       Zhao F, Li J, Zhang L, Li Z, Na SG. Multi-view face recognition using deep neural networks. Future Generation Computer Systems. 2020 Oct 1; 111:375-80. [4]       Laine S, Karras T, Aila T, Herva A, Saito S, Yu R, Li H, Lehtinen J. Production-level facial performance capture using deep convolutional neural networks. In Proceedings of the ACM SIGGRAPH/Eurographics symposium on computer animation 2017 Jul 28 (pp. 1-10). [5]       Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. Journal of travel medicine. 2020 Mar 13. [6]       Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. The Lancet Respiratory Medicine. 2020 May 1;8(5):434-6. [7]       Kumar A, Kaur A, Kumar M. Face detection techniques: a review. Artificial Intelligence Review. 2019 Aug;52(2):927-48. [8]       Liu L, Ouyang W, Wang X, Fieguth P, Chen J, Liu X, Pietikäinen M. Deep learning for generic object detection: A survey. International journal of computer vision. 2020 Feb;128(2):261-318. [9]       Wang Z, Wang G, Huang B, Xiong Z, Hong Q, Wu H, Yi P, Jiang K, Wang N, Pei Y, Chen H. Masked face recognition dataset and application. arXiv preprint arXiv:2003.09093. 2020 Mar 20. [10]     Liu W, Wang Z, Liu X, Zeng N, Liu Y, Alsaadi FE. A survey of deep neural network architectures and their applications. Neurocomputing. 2017 Apr 19; 234:11-26. [11]     Matrajt L, Leung T. Evaluating the effectiveness of social distancing interventions to delay or flatten the epidemic curve of coronavirus disease. Emerging infectious diseases. 2020 Aug;26(8):1740. [12]     Khandelwal P, Khandelwal A, Agarwal S, Thomas D, Xavier N, Raghuraman A. Using computer vision to enhance safety of workforce in manufacturing in a post covid world. arXiv preprint arXiv:2005.05287. 2020 May 11. [13]     Ristea NC, Ionescu RT. Are you wearing a mask? Improving mask detection from speech using augmentation by cycle consistent gains. arXiv preprint arXiv:2006.10147. 2020 Jun 17. [14]     Yadav S. Deep learning-based safe social distancing and face mask detection in public areas for covid-19 safety guidelines adherence. International Journal for Research in Applied Science and Engineering Technology. 2020 Jul;8(7):1368-75. [15]     Lal C, Ahmed A, Siyal R, Beejal SK, Aftab S, Hussain A. Text Clustering using K-MEAN. International Journal. 2021 Jul;10(4). [16]     Livanos NA, Hammal S, Nikolopoulos CD, Baklezos AT, Capsalis CN, Koulouras GE, Charamis PI, Vardiambasis IO, Nassiopoulos A, Kostopoulos SA, Asvestas PA. Design and interdisciplinary simulations of a hand-held device for internal-body temperature sensing using microwave radiometry. IEEE Sensors Journal. 2018 Jan 9;18(6):2421-33. [17]     Uçar A, Demir Y, Güzeli? C. Object recognition and detection with deep learning for autonomous driving applications. Simulation. 2017 Sep;93(9):759-69. [18]     Schulz H, Behnke S. Object-class segmentation using deep convolutional neural networks. In Proceedings of the DAGM Workshop on New Challenges in Neural Computation 2011 Aug 30 (pp. 58-61). [19]     Krizhevsky A, Sutskever I, Hinton GE. Imagenet classification with deep convolutional neural networks. Advances in neural information processing systems. 2012;25. [20]     LeCun Y, Bengio Y. Convolutional networks for images, speech, and time series. The handbook of brain theory and neural networks. 1995 Apr;3361(10):1995. [21]     Farabet C, Couprie C, Najman L, LeCun Y. Learning hierarchical features for scene labeling. IEEE transactions on pattern analysis and machine intelligence. 2012 Oct 24;35(8):1915-29. [22]     Ciresan D, Giusti A, Gambardella L, Schmidhuber J. Deep neural networks segment neuronal membranes in electron microscopy images. Advances in neural information processing systems. 2012;25. [23]     Song C, Zeng P, Wang Z, Zhao H, Yu H. Wearable continuous body temperature measurement using multiple artificial neural networks. IEEE Transactions on Industrial Informatics. 2018 Jan 15;14(10):4395-406. [24]     Shagufta A, Chaman L, Suresh Kumar B, Ambreen F. Raspberry Pi (Python AI) for Plant Disease Detection. Int J Cur Res Rev. 14(3), February 2022, 36-42, http://dx.doi.org/10.31782/IJCRR.2022.14307. [25]     Tharun Pranav S V, Anand J. Detection of COVID-19 from Chest X-ray Images using Concatenated Deep Learning Neural Networks. Int J Cur Res Rev. 14(3), February 2022, 53-59, http://dx.doi.org/10.31782/IJCRR.2022.14310.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcarePostnatal Growth of Intrauterine Growth Restricted Newborns English1216Khayer MAEnglish Dey SKEnglish Akhter SEnglish Malek AEnglish Binte SEnglishIntroduction: Intrauterine growth restriction plays a significant role in short and long term adverse outcome. It is reflected in the relatively high incidence of neurodevelopmental impairment and somatic growth failure. Growth in the first year of life gets an opportunity to recover its growth deficit of intrauterine life and to catch up with its normal birth weight siblings Objective of the Study: To assess the postnatal growth of intrauterine growth-restricted newborns at 3, 6 and 9 months of age. Methodology: A Prognostic cohort study was conducted at the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh from 1st April 2017 to 20th September 2018. It involved monitoring of 31 intrauterine growth-restricted newborns and 39 normal birth weight neonates over a period of 9 months. Follow up were done at 3, 6 and 9 month of age. At every visit weight, length, occipitofrontal circumference and chest circumference were measured. Data was analyzed using SPSS 20 and plotted in tables and graphs. Data imputation was done for the missing data. Multiple regression analysis was done for confounder of growth when data was statistically significant. Results: Mean birth weight was 1748 ±437.09 g and 2893.54±467.07g, birth length 44 ±4.2439 cm and 49.26±1.634cm, birth occipitofrontal circumference 30.76 ±2.380 cm and 34.35±1.083cm, birth chest circumference 24.39 ±1.940 cm and 29.15±2.933cm in IUGR and control group respectively which was statistically significant. There were catch-up weight gain in 3, 6 and 9 months of age in IUGR group but it was less than the normal birth weight group during the followed-up period. During the follow-up period, cacth up growth in length was achieved in first 9 months of age. During the first 3 months there were no catch-up growth in IUGR babies head circumference but it increases in normal rates. Mean chest circumference values at 3 months were statistically significant and after multiple regression analysis, it is significant for birth length. In general, IUGR babies when compared with the control group remained small in all the four growth parameters but it had catch-up growth in first 9 months of age. Conclusion: During the follow-up period, a catch-up of growth was achieved regarding weight, length, OFC and chest circumference but the growth parameters were lower than the appropriate for gestational age birth weight newborns. English Postnatal Growth, Intrauterine Growth, Restricted Newborns, Normal birth weight, Retardation, Circumference. Introduction Intrauterine growth retardation, the terminology for infants whose birth weight is below 10th percentile for gestational age occurs in 3% to 10% of all pregnancies.1-3 Newborns whose head circumference (HC), length and weight (Wt) are all proportionately reduced < 10 percentile for gestational age are considered to be symmetrical IUGR.2 When newborns weight is reduced out of proportion to length and head circumference are considered as asymmetrical IUGR.2 Growth in the first year of life is crucial not just for the time being but it has a lifelong implication for IUGR infant because it gets an opportunity to recover its growth deficit of intrauterine life in this period and to catch up with its normal birth weight siblings. In IUGR babies, especially preterm babies and those without congenital anomalies, the growth is very fast in first year of life.4 When adequately fed, they do not lose weight and start gaining weight after 2 to 3 days of age. Their initial weight gain is rapid which subsequently slows down after three months of age.5  It has been shown that bodyweight of small for gestational age infant at 2 years of age is about 10% lower as compared to appropriate for gestational age of identical maturity.5,6 Such low birth weight survivors demonstrate significant growth retardation as reflected by body weight, length, chest circumference, in comparison to normal weight peers7. These children with poor growth have high rate of mortality and morbidity and they suffer from motor and developmental delay.8,9 Infrequently infants with IUGR grow poorly and do not demonstrate catch-up growth and these infants may benefit from recombinant human growth hormone therapy beginning at 4 years of age.9 The clinical consequences may not be apparent until later in development; therefore, it is crucial to follow-up these infants. There is a paucity of studies regarding growth and development of IUGR babies in Bangladesh. So the objective of this study was to assess the postnatal growth of intrauterine growth-restricted newborns. Materials and Methods  This Prognostic cohort study was conducted from 1st April 2017 to 20th September 2018 in the department of neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Prior approval from Institutional Review Board (IRB) was taken for this research work. All IUGR (weight Englishhttp://ijcrr.com/abstract.php?article_id=4424http://ijcrr.com/article_html.php?did=4424 Lee PA, Chernausek SD, Hokken-Koelega AC, Czernichow P; International Small for Gestational Age Advisory Board. International Small for Gestational Age Advisory Board consensus development conference statement: management of short children born small for gestational age. Pediatrics. 2003: April 24-October 1, 2001. 111(6 Pt 1):1253-1261. Gomella, T. L., Cunningham, M. D., Eyal, F. G., Tuttle, D. Management, procedures, on-call problems, diseases, and drugs. Neonatology: (2013).  Gibson, AT, Carney, S, Cavazzoni, E, Wales, JKH. Neonatal and postnatal growth..Horm Res. 2000; vol.53, pp: 42-49. Madhur, B, Rupali, B. Physical growth of LBW babies in first six month of life longitudinal study in a rural block of Assam. Natl J Community Med. 2014; Vol.5, issue 4, pp: 397-400. Meharban, S. Care of the newborn eight edition. CBS publishers and distributors, New Delhi, India. 2015 Gerdes M, Bernbaum J. Follow-up care of the low birth weight infant..Indian J Pediatr. 1998; vol. 65, pp: 829-39. Bhargava, S K, Kumari, S, Choudhury, P,  Bhutani, R, Sachdev, H P S. A Longitudinal study of physical growth of small for date infants from birth to six years.  Nutr Res. 1985; vol. 5, pp: 707-713. Grantham-McGregor, SM. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007; vol. 369, pp: 60-70 Kliegman, RM, Stanton, BF, St. Geme, JW, Schor, NF. Nelson Textbook of Pediatrics, first South Asia edition. Elsevier. 2015 Bhatia, BD, Agarwal, KN, Jain, NP, Bhargava, V. Growth pattern of Intrauterine Growth Retarded Babies in First Nine Months of Life. Acta Paediatr. 1984; vol. 73, pp:  189-196. Aviva Fattal V, Hagit TA, Yael, L, Ronny, G, Rina, E, Shaul, H. Growth Patterns in Children with Intrauterine Growth Retardation and Their Correlation to Neurocognitive Development. J Child Neurol. 2009; vol.24, pp: 846. Holmes, GE, Miller, HC, Hassanein, K, Lansky, SB, Goggin, GE. Postnatal somatic growth in infants with atypical fetal growth patterns. Am j Dis. Child. 1970; vol.131, pp: 1078-83. Jose, V, Velizan, J, Smeriglio, V. Postnatal experiences of intrauterine growth retarded infants’, Intrauterine growth retarded workshop series. Lancet Glob Health. 1989; vol. 18, pp: e681-691. Santosh, K, Sudarshan, K, Panna, C, Rita, B, Sachdev, HPS. A longitudinal study of physical growth of small for date infants from birth to six years. www.academia.edu. 2012. Srivatava, AK, Agarwal, VK, Gupta, SK, Mehrotra, SN. A longitudinal study of Physical growth and morbidity pattern of small for date babies from birth to six months of life. Indian J. Pediatr.. 1978; vol. 45, pp: 1-10. Low, JA, Galbraith, RS, Muir, D, Killen, H, Karchmar, J, Campbell, D. Intrauterine growth retardation: A preliminary report of long term morbidity. Am. J. Obstet. Gynecol. 1978; vol. 130, pp: 534. Karlberg, J, Albertsson-Wikland, K. Growth in the full term small for gestational age infants: from birth to final height. Pediatr Res. 1995; vol. 38, pp: 733-739.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareAwareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study English1723Prabhu AEnglish Jathanna JSEnglish Naik PEnglish Reddy RBEnglishPurpose: To develop and validate the questionnaire and to translate it to the local vernacular language, Kannada. To assess the level of awareness and knowledge about common eye conditions among the ASHA workers in the rural communities of Udupi district. Materials & Methods: A cross-sectional observational study was conducted on32 ASHA (Accredited Social Health Care Activists) workers of age ranging from 32-48 years (SD + 3 years) from January 2019 to April 2019. This study was presented and approved by the Institutional Research Board, (Manipal College of Health Professions) and written consents were taken from the subjects. A validated questionnaire was used in this process. Beforehand this questionnaire was developed from the conclusion of a structured focus group discussion comprised of vision science experts. The phase and content validation proceeded. This validated questionnaire was used to elicit the responses from the ASHA workers of Udupi district, India. This structured questionnaire consisted of questions from refractive errors, cataract, diabetic retinopathy, glaucoma, pink eye or madras eye, common style and retinopathy of prematurity. Responses were analysed by calculating the percentage. Having heard of the eye disease in question was defined as ‘‘awareness’’ and having some understanding of the eye disease was defined as ‘‘knowledge’’. Results: A total of 32 ASHA workers from the Udupi district were included in the study with a mean age of 40±5 years. The awareness about myopia was 100% (32), hyperopia 87.50% (28), presbyopia 28.12% (9), cataract 96.87% (31), diabetic retinopathy 100% (32), glaucoma 71.87% (23), pink eye or madras eye 71.87% (23), common style 18.75% (6) and retinopathy of prematurity 40.62% (13). Conclusion: The results indicate that the study population had a high level of awareness about eye diseases, but their knowledge of the diseases was still limited. Very less awareness about common style, presbyopia, and retinopathy of prematurity. ASHA workers require a lot more awareness and knowledge about common eye diseases which can be improved by conducting health care programs and giving them training. EnglishRefractive errors, Diabetic retinopathy, Glaucoma, Presbyopiahttp://ijcrr.com/abstract.php?article_id=4425http://ijcrr.com/article_html.php?did=4425

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcarePreoperative Anxiety in Cardiac Surgery Patients English2431Adhyapak SadhanaEnglishIntroduction: People with high level of anxiety experience significant distress & impairment in interpersonal as well as social functioning. There are many medical conditions where patients develop high levels of anxiety. Anxiety with surgery is associated with autonomic changes, supplementary doses of anesthetic drugs, increased level of postoperative pain & more chances of postoperative nausea & vomiting. To prevent & treat anxiety effectively, one must assess level of anxiety accurately. A nurse can assess anxiety & reduce it to a manageable & comfortable level. Aims: A study was conducted to anticipate preoperative anxiety among patients undergoing cardiac surgeries & to identify dimensions of anxiety. Methodology: A quantitative approach was used for this cross-sectional study. Content validity of the tool was done&reliability was calculated using Karl Pearson’s coefficient of correlation. The sample was calculated by 80 % confidence level with 5% error. Total sample was 80 patients admitted in cardiothoracic ward. Samples were selected by convenient sample technique. Anxiety level was identified with the help of Amsterdam Preoperative Anxiety & Information Scale. Along with anxiety level, researcher also tried to find the possible causes of anxiety. Result: Descriptive data was analyzed & association between variables was identified. 82.5% of patients were males & 17.5 % were females. Most of them i.e., 86.3 % underwent coronary artery bypass graft (CABG) & 13.8% underwent valvular surgeries. It was seen that 16.3% of patients had high level of anxiety related to anesthesia, 27.5% of patients had high level of anxiety related to surgery & overall high anxiety level was seen in 21.3% of patients. The association was seen with gender, previous experience of surgery & duration of hospitalization. Most common causes of anxiety identified were worried about postoperative pain & family concern. Conclusion: Nurses can identify triggers of anxiety, recognize the symptoms of onset of anxiety & intervene before patient reaches to panic stage. English Preoperative, Anxiety, Cardiac surgery, Coronary artery, Valvular surgery, Bypass graftIntroduction Anxiety is a strong concern for something happening. Many times, anxiety disturbs activities of daily living. People with a high level of anxiety experience significant distress & impairment in interpersonal as well as social functioning. There are many medical conditions where patients develop high levels of anxiety. Anxiety with surgery is associated with autonomic changes, supplementary doses of anesthetic drugs, increased level of postoperative pain & more chances of postoperative nausea & vomiting. A cohort study was conducted & Amsterdam Preoperative Anxiety & Information Scale was used to assess anxiety. The various sources of anxiety were related to anesthesia, surgery & other related factors. Anxiety scores were seen on the higher side with higher education & patients undergoing general anesthesia. The association was also seen with female gender. 1 Leopold Eberhart et al analyzed anxiety in preoperative period & also found predictors of anxiety. It was a cross-sectional study where anxiety was assessed with the help of Amsterdam Preoperative Anxiety & Information Scale. 40.5% patients showed high level of anxiety & total preoperative anxiety score was 9.9. Main concern for fear was mistaken by the anesthetist, as fatigue & drowsiness. It was seen that gender, positive & negative anesthesia experience predicted anxiety subscales.2 Ghogiang Gu3 determined the relationship between coronary surgeries & symptoms of anxiety & depression in coronary heart disease patients. Patients were asked to complete the Hospital Anxiety & Depression Scale & separate questionnaire before & after surgery. Coronary surgeries were found to be significantly associated with symptoms of anxiety & depression. It was also seen that symptoms related to anxiety increased one day before & after surgery. According to Sigdel S4 One of the main risk factors for the development of anxiety is the presence of cardiac disease & surgery. Total 140 patients were investigated with the help of the State-Trait Anxiety Inventory (STAI)& preoperative anxiety was seen in 58.5% of patients. Female gender & previous anesthesia exposure were identified as risk factors. Cardiovascular disease is associated with increased risk of morbidity in the short & long term. One of the major treatments for cardiovascular disease is surgery. Today there are various surgical options available for patients to relieve cardiac symptoms & improve quality of life. But during any form of treatment, patient-reported outcome is the most important aspect.5 Under patient-reported outcomes, patient himself/herself assesses the various physical & psychological symptoms. Anxiety is one of the important reactions noted in patients waiting for surgeries. Increased level of anxiety is associated with negative consequences of postoperative outcome & rehabilitative process.6 To prevent & treat anxiety effectively, one must assess level of anxiety accurately. Nurse can assess anxiety & reduce it to a manageable & comfortable level. The nurses’ goal is to assist patients with anxiety to develop adaptive coping strategies. Jose Prado7 Olivares et al. assessed level of anxiety using State-Trait Anxiety Inventory in patients undergoing cardiac surgeries. Coronary artery bypass graft (CABG) was performed on 47% of patients & valvular surgeries were performed on 26.7% of patients. Total 60 samples were included in the study. Moderate to high level of anxiety was seen in 80% of patients. First surgical intervention was found to be related with level of anxiety. It was concluded that patients undergoing cardiac surgeries should be given well-framed program through individualized education. Similarly, Jitendra Jeenger et al.8 found the prevalence of depression & anxiety after first myocardial attack. 60 cases of diagnosed acute myocardial infarction were compared with 60 healthy individuals. Patients with myocardial infarction were seen to be enduring from depression and anxiety symptoms. 40% of myocardial infarction patients showed depressive episodes & 35% showed anxiety symptoms. Objectives The main objectives of the study were to assess preoperative anxiety among patients undergoing cardiac surgery, to identify the association between preoperative anxiety & demographic variables & to find possible causes of preoperative anxiety. Methodology Research design A quantitative approach was used for this cross-sectional study. The study population was patients admitted for cardiac surgeries i.e., coronary artery bypass graft & valvular surgeries. Sample was calculated by 80 % confidence level with 5% error. Total sample was 80 patients admitted in cardiothoracic ward. Samples were selected by convenient sample technique. Development of tool Tool included three sections. Section I included demographic details like age, gender, education, occupation, marital status, type of family, BMI, previous experience of surgery & type of surgery. Section II was Amsterdam Preoperative Anxiety & Information Scale (APAIS) to assess level of anxiety. Boker A9 et al. evaluated different scales of anxiety i.e., state-trait anxiety inventory, Amsterdam Preoperative Anxiety & Information Scale & Visual analogue scale. It was seen that it was an advantage to use APAIS as patients could easily answer the questions. Consistent correlation of APAIS was seen with other anxiety scales. So, the investigator decided to use this scale. Amsterdam Preoperative Anxiety & Information Scale consists of 6 questions with a Likert scale ranging from 1 (not at all) to 5 (extremely). Out of these four questions show level of anxiety & two questions identify patient’s need for information. Researcher identified anxiety related to anesthesia, anxiety related to surgery, total anxiety & patient’s need for information. Researcher decided the scoring system to divide anxiety in mild, moderate & severe levels. Section III was a self-administered questionnaire. This included 10 yes/ no type questions related to possible causes of preoperative anxiety. All the questions were easily understood & readily answered by the sample. Ethical consideration The researcher got approval from the institutional research & recognition committee & institutional ethical committee. Written informed consent was taken from each sample before data collection. Validity & reliability Content validity was done from 12 experts of related field. Reliability was done using the test-retest method. The formula used was Karl Pearson’s coefficient of correlation. It was found to be 0.99. So, the tool was considered reliable & was retained. A pilot study was done on 10 samples to assess the feasibility of the study. It was done in the month of December 2020. Data collection Data was collected from January 2021 to June 2021. It was a private charitable hospital from Pune. Data was collected on the day of surgery prior to surgery. Patients took approximately 10 minutes to answer the questions. They completed it in the wards before they were shifted to the operation theatre. Inclusion & exclusion criteria Patients admitted only for coronary artery bypass graft & valvular surgeries were included & patients undergone emergency surgeries were excluded from the study. It was assumed that patients waiting for cardiac surgeries present high levels of anxiety & assessment of preoperative anxiety have better postoperative outcomes. Results Section I Above table indicates that 5% of the patients undergoing cardiac surgery were in the age group of 31-45 years, 80% of them were in 46-60 years and 15% of them were above 60 years. 82.5% of them were males and 17.5% of them were females. 21.3% of them had primary education, 40% of them had secondary education and 38.8% of them were educated up to graduation and above.26.3% of them were working in private sector, 10% of them were from government sector, 18.8% of them had business, 16.3% of them were farmers/laborers, 20% of them were retired and 8.8% of them were houseworkers.91.3% of them were married, 1.3% of them were unmarried, 2.5% of them were divorced and 5% of them were widow.37.5% of them were from nuclear family and 62.5% of them were from joint family. Fig 1 shows that 6.3% of them were admitted in the hospital for 1 day before surgery, 28.8% of them were admitted for 2 days before surgery, 36.3% of them 3 days before surgery and 28.8% of them for more than 3 days before surgery. Table No 2 shows that 20% of them had history of chronic illness, 31.3% of them had history of previous surgery & 17.5% of them used substance. It is also seen that 86.3% of them underwent CABG and 3.8% of them had valvular surgery. Section II - It deals with analysis of data related to preoperative anxiety among patients undergoing cardiac surgery. Table No 3 suggests that 40% of the patients had mild preoperative anxiety related to anaesthesia, 43.8% of them had moderate preoperative anxiety and 16.3% of them had high preoperative anxiety related to anaesthesia. 18.8% of the patients had mild preoperative anxiety related to surgery, 53.8% of them had moderate preoperative anxiety and 27.5% of them had high preoperative anxiety related to surgery. 20% of the patients had mild overall preoperative anxiety, 57.5% of them had moderate overall preoperative anxiety and 21.3% of them had severe overall preoperative anxiety. 25% of them did not require information, 45% of them needed litter information and 31.3% of them needed more information. Section III Analysis of data related to association between preoperative anxiety & demographic variables. Table No 4 indicates that Since p-values corresponding to gender, education, occupation, family type, BMI, previous surgery, and duration of hospital stay before surgery were small (less than 0.05), the demographic variables gender, education, occupation, family type, BMI, previous surgery and duration of hospital stay before surgery were found to have significant association with the preoperative anxiety among patients undergoing cardiac surgery. Fig 2 shows that 66.3% of the patients undergoing cardiac surgery were worried about post-operative pain. 36.3% of them were anxious about pain during surgical pain. 2.5% of them were afraid of unknown. 30% of them anxious about the improvement after surgery. None of them were anxious about post-operative nausea and vomiting. 21.3% of them were anxious about the complications. 2.5% of them were anxious about the loss of job. 62.5% of them were anxious about the family concern. 23.8% of them were worried about economic conditions. Discussion Mehdi F et al.10 evaluated preoperative anxiety & susceptible components in cardiac surgery patients. Patients between the age group of 18-65 were assessed for anxiety & association was found with various demographic variables. Females & patients with opioid addiction exhibited high level of anxiety (pEnglishhttp://ijcrr.com/abstract.php?article_id=4426http://ijcrr.com/article_html.php?did=4426 Celik F., Edipoglu I.S. Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur J Med Res 23, 41 (2018). https://doi.org/10.1186/s40001-018-0339-4 Eberhart L., Aust H., Schuster M. Preoperative anxiety in adults - a cross-sectional study on specific fears and risk factors. BMC Psychiatry 20, 140 (2020). https://doi.org/10.1186/s12888-020-02552-w Gu G, Zhou Y, Zhang Y, Cui W. Increased prevalence of anxiety and depression symptoms in patients with coronary artery disease before and after percutaneous coronary intervention treatment. BMC Psychiatry. 2016 Jul 22;16:259. doi: 10.1186/s12888-016-0972-9. PMID: 27450548; PMCID: PMC4957885. Sigdel S, Ozaki A, Basnet M, Kobashi Y, Pradhan B, Higuchi A, Uprety A. Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study. Medicine (Baltimore). 2020 Feb;99(9):e19302. doi: 10.1097/MD.0000000000019302. PMID: 32118748; PMCID: PMC7478669. Adam J Z , “Measures of Preoperative Anxiety”, Aanesthesiology Intensive Therapy, 2019; 51(1):64:69 doi:10.5603/AIT.2019.0013 https://pdfs.semanticscholar.org/8bed/773045cee544a29d69a0691226c3899ad8bb.pdf Jose PO & Elena CS, “Preoperative anxiety in patients undergoing cardiac surgery”, Diseases, 2019 Jun; 7(2): 46 doi: 10.3390/diseases7020046 Jeenger J, Wadhwa S, Mathur DM, “Prevalence of depression & anxiety symptoms in first attack myocardial infarction patients of Mewar region: A cross sectional study”, Int J Cur Res Rev, volume 6 (07), April 2014, pg no 79-85 Boker A., Brownell L. Donen N, “The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety”, Can J Anesth 49, 792–798 (2002). https://doi.org/10.1007/BF03017410 Fathi M, Alavi SM, Joudi M, Joudi M, Mahdikhani H, Ferasatkish R et al.  “Preoperative anxiety in candidates for heart surgery”, Iran J Psychiatry Behav Sci, 2014, 8(2), 90-96 Ramesh C, Baby S. Nayak, Pai VB, George A, George LS, Devi ES, Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study, Int. J. Afr. Nurs. Sci., Volume 7, 2017, Pages 31-36, ISSN 2214-1391, https://doi.org/10.1016/j.ijans.2017.06.003. Hernández-Palazón J, Fuentes-García D, Falcón-Araña L, Roca-Calvo MJ, Burguillos-López S, Doménech-Asensi P, Jara-Rubio R. Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):236-244. doi: 10.1053/j.jvca.2017.04.044. Epub 2017 Apr 26. PMID: 28803768, pg no 236-244.  Gangadharan P, Assiri R A M, Assiri F A A, “Evaluating the level of anxiety among pre-operative patients before elective surgery”, Int J Cur Res Rev, volume 6, issue 22, November 2014, pg no 37-41 Rosiek A, Kornatowski T, Rosiek-Kryszewska A, Leksowski L, Leksowski K, “Evaluation of stress intensity & anxiety level in preoperative period of cardiac patients”, BioMed Res. Int., vol 2016, article ID 1248396, 8 pages, 2016. https://doi.org/10.1155/2016/1248396 Bedaso A., Ayalew M. Preoperative anxiety among adult patients undergoing elective surgery: a prospective survey at a general hospital in Ethiopia. Patient Saf Surg 13, 18 (2019). https://doi.org/10.1186/s13037-019-0198-0 Takenak S,, “Preoperative anxiety & intraoperative nociception in patients undergoing thoracic surgery”, J. Surg. Res., 2020 May;249:13-17. doi: 10.1016/j.jss.2019.12.017.  Rodrigues HF, Furuya RK, Dantas RAS, Rodrigues AJ, Dessotte CAM, “Association of preoperative anxiety and depression symptoms with postoperative complications of cardiac surgeries.”, Rev Lat Am Enfermagem. 2018 Nov 29;26:e3107. doi: 10.1590/1518-8345.2784.3107. PMID: 30517589; PMCID: PMC6280174. Jaensson M., Dahlberg K., Nilsson U. Factors influencing day surgery patients’ quality of postoperative recovery and satisfaction with recovery: a narrative review. Perioper Med 8, 3 (2019). https://doi.org/10.1186/s13741-019-0115-1 Kalogianni A, Almpani P, Vastardis L, Baltopoulos G, Charitos C, Brokalaki H. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? Eur J Cardiovasc Nurs. 2016 Oct;15(6):447-58. doi: 10.1177/1474515115602678. Epub 2015 Aug 24. PMID: 26304701. Niknejad R, Mirmohammad-Sadeghi M, Akbari M, Ghadami A. “Effects of an orientation tour on preoperative anxiety in candidates for coronary artery bypass grafting: A randomized clinical trial.” ARYA Atheroscler. 2019 Jul;15(4):154-160. doi: 10.22122/arya.v15i4.1806. PMID: 31819748; PMCID: PMC6884734. Guo P, “Preoperative education interventions to reduce anxiety & improve recovery among cardiac surgery patients”, J. Clin. Nurs., 2015 Jan; 24(1-2):34-46 doi: 10.1111/jocn.12618. Pazar B, Iyigun E, “The effects of preoperative education of cardiac patients on haemodynamic parameters, comfort, anxiety and patient-ventilator synchrony: A randomised, controlled trial.” Intensive Crit Care Nurs. 2020 Jun;58:102799. doi: 10.1016/j.iccn.2020.102799. Epub 2020 Jan 25. PMID: 31987684. Asilioglu K, Celik SS, “The effect of preoperative education on anxiety of open cardiac surgery patients.” Patient Educ Couns. 2004 Apr;53(1):65-70. doi: 10.1016/S0738-3991(03)00117-4. PMID: 15062906 Mousavi M N, Zakerimoghadam M, Esmaeili M, Kazemnejad A. Effects of Nurse-Led Intervention on Patients&#39; Anxiety and Sleep Before Coronary Artery Bypass Grafting. Crit Care Nurs Q. 2018 Apr/Jun;41(2):161-169. doi: 10.1097/CNQ.0000000000000195. PMID: 29494371. Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database of Systematic Reviews 2013, Issue 6. Art No.:CD006908. DOI:10.1002/14651858.CD006908.pub2. Accessed 21 July 2021. Domar AD, Everett LL, Keller MG. Preoperative anxiety: is it a predictable entity? Anesthesia and Analgesia. 1989 Dec;69(6):763-767. Polit, Beck, “Nursing Research”, Lippincott William and Wilkins, 9th edition, 2012, pg no 50-55, 264

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareKnowledge and Practices Regarding Standard Precautions for Infection Control Among Nurses Working at a Public, Tertiary Care Hospital Islamabad, Pakistan     English3239Ms. Samina YasmeenEnglish Tazeen Saeed AliEnglish Wardah KhalidEnglish Ms. Zohra KurjiEnglish Mr. Shair Muhammad HazaraEnglish Mr. Shahzad BashirEnglishIntroduction: To protect patients and healthcare providers from healthcare-associated infections (HAIs), standard precautions have been promoted universally. Nurses are the forefront force inpatient care; therefore, evidence-based and up-to-date knowledge and practices can play a vital role in helping nurses apply standard precautions (SPs). Methods: The analytical cross-sectional study design was used. Through purposive sampling, the data were collected from 320 nurses, via, a self-administered questionnaire, from April to May 2017, from a public tertiary level hospital in Islamabad. The validity and reliability of each section were established. Mean and standard deviation were computed for continuous variables’ whereas; frequencies with percentages were calculated for categorical variables. The Multiple linear regression was applied for inferential statistics, maintaining 95% CI for important associations. Results: Out of 320 participants, the mean age of the participants was 33.04 ± 6.65 years. More than half of the study participants (66.88%) were females’ whereas 33.13% were male nurses. The mean knowledge and practice were 19.6 ±3.3 and 13.00± 5.23, respectively, with a maximum score of 24 and 25. The results showed that the knowledge of the participants was better as compared to practices, though, in general knowledge they were reported as relatively deficient. Continuing training sessions on SPs revealed a significant 0.66 (95% C.I; 1.07, 3.67) relationship with the knowledge score in the final model. Practices were found to be better. Similarly, the Hep. B vaccinated nurses showed a positive impact of 1.49 (95% C.I; 0.07, 2.91) on the level of practices in MLR. Conclusion: The overall level of knowledge and practices among female nurses regarding standard precautions were inadequate. The study findings highlighted the need to continue intensive and in-service trainings sessions on SPs of infection control, using innovative approaches. English Infection Control, Knowledge, Attitudes, Practices, Nurses, Public Tertiary Care, HospitalINTRODUCTION Healthcare-associated infections (HAIs) are the most striking global health problem, leading to a significant burden among patients, healthcare systems, and health care providers (HCPs). HAIs refer to those infections which are acquired during the process of hospital care and are absent on admission.1,2,3 With regard to the patients, it claims that the rate of HAI is 25% to 40% high globally.[3]In developed countries, around 5% -10% admitted patients acquire HAIs at any given time in acute care hospitals, whereas, in developing countries, this risk is 2-20 times higher.3 Like, in Pakistan, around 1,170,561 are reported cases of HAIs annually (National Report on Right Diagnosis from Health Grades, 2014). In addition, research studies have reported that the incidence of HAIs is approximately 29.13%, as out of 333 patients admitted during the one year in tertiary care hospitals, 97 were affected with these infections.4 As far as the health systems are concerned, these infections cause unnecessary morbidity and mortality,3 and along with a poor supply of health services, these infections eventually lead to extra financial burdens for the health system.5 Such infections annually account for approximately 99,000 deaths in the United States hospitals and estimated 37,000 deaths in Europe.6  Meanwhile, HCPs are also at a great risk of acquiring infections during their practices. Unsafe practices by HCPs are a major problem; and nurses are particularly more vulnerable to infections while performing their duty, due to their frequent and direct contact with patients.7 Worldwide, the estimated sharp needle injuries resulted in 66,000 Hep B virus (HBV) infection, 16,000 Hep C viruses (HCV) infections, and more than one thousand Human Immunodeficiency Virus (HIV) infections among HCPs; this is the very high ratio.3 The CDC and WHO suggested that standard precautions (SPs) can help to prevent the spread of HAIs, thereby ensuring the occupational safety of health-care workers. SPs are the minimum practices that apply in all cases of patients, in any setting where healthcare is delivered, regardless of the patients’ diagnoses. These include regular hand washing; use of protective equipment, (PPE) like gloves, goggles, shoe cover, masks, and gowns to save oneself from the blood and body fluids of the patients; and accurate sharps’ disposal to control and prevent HAIs. Adherence to the suggested infection control practices helps in decreasing the infectious agents’ transmission in a hospital setting.8 Several studies in Pakistan have found that despite the development and availability of detailed guidelines for infection control, the rates of HAIs are still high and the practice levels to minimize the infection rates among nurses have been found to be low, especially in the public-sector hospitals of the country. The reason may be inadequate knowledge regarding SPs.9, 10, 11 However, these studies were not conducted exclusively on nurses and did not address all the components of SPs. The focus of this study is to evaluate all the elements of SPs with regard to nurses working in a public tertiary care hospital, where there is an obvious need for it. Therefore, this study has been conceptualized to assess the level of knowledge and practices regarding standard precautions among nurses working at a public tertiary care hospital in Islamabad, Pakistan. MATERIAL AND METHODS Study setting, sample size, and participant data This is an analytical cross-sectional study conducted at the premises of the Pakistan Institute of Medical Sciences, Islamabad (PIMS) in the period of one month from April 2017 to May 2017. The sample size was calculated using the online tool Open-Epi version 3 12  considering the prevalence of good knowledge ranged from 67%-80% 13, 14 and for good practice, it ranged between 46.1%-62% 13, 14, with confidence limits of 95%, and design effect of 01. The final sample size after adjusting the non-response rate (10%) was calculated in the range of 270-370. Hence, practically a sample of 320 was achieved within the specified period. The inclusion criteria for the study participants were male and female nurses with no upper age limit. Participants should have a minimum qualification, a diploma in nursing with minimum six months work experience in a public tertiary hospital. Similarly, nurses working at the managerial post and providing services in the out-patient departments were excluded from the study.  Study Tool, Validity, Reliability and Pilot Testing  A structured questionnaire adopted from one of the Chinese study15, but it&#39;s modified according to the local context. The permission to use this tool has been taken from the primary author. Content validity of the tool was done by a panel of six experts, including infection control specialist doctors and nurses, clinical faculty nurses, and a statistician. The relevancy and clarity were calculated at 0.70 and 0.90 respectively for Knowledge Section. Similarly, the deliberately calculated value for the practice section was calculated 0.84 and 0.72 against relevancy and clarity. Moreover, the reliability of the tool was calculated by used Cronbach&#39;s alpha and it was found 0.76 and 0.84, respectively, for both the knowledge and practice sections. Furthermore, a questionnaire was pre-tested on 20 nurses, in a nearby hospital that was similar to the study setting to assess its comprehension and language. Ethical Considerations Prior to the commencement of this study, formal ethical approval was obtained from the AKU-ERC (no. 4622-SON-ERC-17) also written permission was sought from the head of the PIMS hospital Islamabad. Since it was an interview-based study, there was no apparent harm or deception for the participants during the interview process. During data collection, privacy was maintained for all the participants, as they were interviewed in separate rooms. Sampling Technique The purposive sampling technique was applied for recruiting the participants. After filling the eligibility criteria duty nurses were approached in their respective departments. Data analysis and management In this present study, descriptive statistical analysis was used to interpret continuous variables as the mean ± standard deviation, and categorical variables as the count (percentage). A multiple Linear Regression test was used to analyze the effect of various factors on the knowledge and practice of nurses. The data was entered twice to minimize the chances of error. For any missing data or to prevent error, data was cross-checked while entering in STATA. Each questionnaire was checked by the principal investigator before entering data for any missing value. RESULTS This present study was performed on a total number of 320 nurses. Here, we could try to give an overview regarding the baseline socio-demographic characteristics of nurses such as; age, gender, marital status, professional qualification, work experience in years, work area, any training attended on standard precautions, number of training sessions attended by nurses during the last 1 year on standard precautions, and Hepatitis B vaccination status of nurses in Table 1. It indicated that the mean age of the study participants was 33.04 ± 6.65 years. More than half (66.88%) of the study participants were female, whereas 33.13% were male nurses. Amongst of these, 60.94% were married, while 39.06% were single. Respondents with Diploma holders in nursing and BSc Nurses made up the highest proportion of 59.38%. With regards to the total work experience, the majority (66.56%) of the participants had the experience of 1-10 years, 27.81% of 11-20 years, and only 5.63% had working experience of 21-30 years. Among nurses, the majority (28.44%) were working in the ICU/CCU, Burn and Hemodialysis units. Concerning the training attended during the last one year, more than half (77.19%) had never attended any training session, while 18.13% and 2.81% had attended one and two sessions, respectively. Only a few (1.88%) reported that they had attended 3-5 training sessions on SPs during the last one year. Regarding the refresher courses attended during the last one year, it was reported that around two thirds (74.69%) had never attended any refresher course, while 18.44% and 5.31% had participated in one and two courses, respectively, whereas 3-5 number of courses had been attended by only 1.56% of the nurses. Furthermore, the majority (91.88%) of the participants reported a need for continued trainings regarding SPs. Around 91.56% stated that they had SPs&#39; items available in their units, while 92.81% reported that they had easy access to a handwashing area in their departments. Moreover, 19.69% of nurses had not been vaccinated against hepatitis B. The mean knowledge score of the participants regarding SPs, was 19.6 ±3.31, while the mean practice score was 13.00± 5.23. (Table 2). For knowledge, simple linear regression showed that increasing age, female in gender, being married, having a diploma and BScN level of education, having experience of working areas like surgery, operating room, private block and isolation unit, receiving no training on SPs during the last one year, and attending any refresher course during last one year were negatively associated with the level of knowledge regarding SPs. However, attending training and refresher courses on SPs, and having attended more than two refresher courses during the last one year, expressing need for continuous training sessions, having access to handwashing areas, along with the availability of SPs’ items, and receiving Hep. B vaccination indicated a positive relationship with the level of knowledge in nurses. The detailed factors associated with the practice of standard precautions among nurses are presented in Table 3. For the final multiple linear regression model, the knowledge regarding SPs decreased in the female gender by -0.96 (95% C.I; -1.71, -.22), as compared to the male nurses. A better level of knowledge was seen among nurses working in the Pediatric and Gynecology departments by 1.30 (95% C.I; 0.26, 2.33). The need for continued training sessions on SPs revealed a significant 0.66 (95% C.I; 1.07, 3.67) relationship with the knowledge score. A positive relation of 2.37 (95% C.I; 1.50, 3.23) was seen on the knowledge score of nurses who received Hep. B vaccine (Table 4). The final model portrays 15.6% (Adjusted r2 =0.156) variability regarding knowledge. As for practice, the final model showed that it increased by 2.24 (95% C.I;0.53, 3.96) among participants who attended training sessions on SPs. Practices of nurses were positively related to increasing in the availability of SPs items and accessibility to a handwashing area in the departments by 2.09 (95% C.I; -0.01, 4.21) and 2.45 (95% C.I; 0.25, 4.66), respectively. The Hep. B vaccinated nurses showed a positive impact of 1.49 (95% C.I; 0.07, 2.91) on the level of practices as compared to non-vaccinated nurses against Hep B (Table 5). The final model depicts 0.068 % (Adjusted r2 =6.8) variability in practice. DISCUSSION The current study highlights the level of knowledge and practices regarding SPs among nurses working in a public-sector hospital in Islamabad, Pakistan. The findings of the current study were consistent with other national and international studies, showing that nurse’s knowledge and practices regarding SPs is one of the major challenges due to a number of reasons. In present study, the mean age of the study participants was 33.04 ± 6.65 years which is consistent with the findings reported in the previously published studies in neighboring countries, like Afghanistan, and in Vietnam. 14, 16 The study findings can be easily compared with the existing literature from Afghanistan and Vietnam as the descriptive results, especially age, are quite similar. The present study also observed that more than half of the participants working as bedside nurses were diploma holders in nursing. This reflects the fact that the majority of the nursing personnel have a basic qualification in nursing, which can impact the practices of SPs.17, 18 This finding can be explained in the Pakistani context by the fact that the nurses who get a higher qualification and more experience prefer to teach rather than work in clinical settings. Hence, this can be another reason why nurses have lower knowledge and poor practices regarding SPs, as in the diploma curriculum, proper attention is not given to teaching the infection control protocols. However, this study did not find any meaningful differences in the knowledge and practice of all nurses regarding SPs, regardless of the work experience and professional qualification. It was assumed that, therefore, lack of ongoing trainings/ educational programs in the public healthcare facilities in Pakistan, including trainings on SPs, might have resulted in these findings, and that years of experience also did not influence the knowledge scores. Similarly, for a professional qualification, it was assumed that insufficient focus on infection control measures, including SPs, during the diploma program could have resulted in showing no significant difference between knowledge and qualification; and between practice and professional qualification. These findings were in concordance with the existing study in Afghanistan and others.16, 19 However, the findings of the current study were different from a study that has reported a significant relation of knowledge with years of experience and professional qualification. That study showed a higher ratio for the younger population, where the majority of the participants had the higher qualifications, e.g., bachelor’s degree in nursing.20 Knowledge and Practices Regarding Standard Precautions The study findings that female nurses were less likely to have adequate knowledge with increasing with age was quite similar with one of the international study.16, but in contrary with the study results in Nigeria.21, which reported that females had better knowledge of SPs as compared to male health professionals. Moreover, in the current study, the significant association between the need for training sessions on SPs and the knowledge score well explains the phenomena of lack of training and workshops on infection control in public sector health facilities; a similar finding has been reported in the literature.15 However, in literature, great emphasis can be seen with regard to the improvement in knowledge and practices through the inclusion of SPs in medical education/trainings for all HCWs. 14 The findings of the present study demonstrate a relatively better knowledge among nurses in the Gynecology and Pediatric department in comparison with the rest of the working area. However, the current findings were opposite to an interventional study in a pediatric unit in Egypt, which showed deficient knowledge prior to intervention as compared to the post-intervention stage. In this study, the nurses who were vaccinated for Hep B had good knowledge of SPs as compared to those who were not vaccinated. The same finding is reported by a similar study in Afghanistan (16), but is contradictory to the findings reported in two studies reported in Nigeria.17, 22 Concerning the practices of SPs, the current study also demonstrated a relatively lower level of practices among nurses and this was similar to the findings reported in the literature in Afghanistan, Vietnam, and others.14, 16, 23 The study in China “Factors impacting compliance with SPs in nursing”, supported the current study finding that the nurses who had received trainings in the last one year showed good practices as compared to those who had not attended any training sessions ever, as they also reported that the nurses who had received trainings had better compliance in comparison to the nurses who had never attended any training session.[15] Other studies from Cypriot and Ethiopia also have similar findings.15, 24, 25. As far as the availability of SPs items, including accessibility to a handwashing area is concerned, the present study significantly revealed that practices were better in those areas where sufficient resources were provided and nurses had easy access to a handwashing area in their units. The findings are in concordance with previously published literature.15,16, 21 Additionally, the findings of the study, that nurses vaccinated against Hep B showed better practices in contrast to those who were not vaccinated are contradictory to a study done in North-eastern Nigeria about “Knowledge of Hep B vaccination among operation room staffs and their status”22 and the difference in the findings can be due to that the operating room nurses are even not allowed to enter in the work area without precautions. CONCLUSION Based on the current study findings, it can be inferred that the nurses in public hospitals have relatively inadequate knowledge and practices regarding standard precautions were towards lower side. These findings suggest that continuous education sessions, seminars, refresher courses, and workshops should be made mandatory for all health professionals in hospitals, particularly nurses, to encourage them to improve their practices based on improved knowledge. Acknowledgment: Exclusive thanks to the Aga khan university School of Nursing. My sincere gratitude to the thesis supervisor and committee members for their timely, constructive, and critical feedback at each step of the entire journey. I am thankful to the members of this article to help in manuscript writing and reviewing till to the publication. Source of Funding: None. Since, it a Master’s thesis as core step in successful graduation, no any additional funding source remained its part including any public, private or NGO, s. Conflict of interest: There is no any conflict of interest among members. Authors’ Contribution: SY, conceived idea of the research, design & editing of the manuscript TSA, WK, & ZK did design and statistical analysis SMH & SB did manuscript writing, critical review and final approval of the manuscript. Englishhttp://ijcrr.com/abstract.php?article_id=4427http://ijcrr.com/article_html.php?did=44271.     Nejad SB, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Org. 2011;89:757-65. 2.     Sandokji AM, Murshid KR, El-Badry AA, Al-Ali KH, Shalaby SA. Infectious Nosocomial Diarrhea in the Surgical Wards: Role of Parasites and Microbes Imply Stool Analysis “Arabic Abstracts”. J Taibah Univ Med Sci. 2009;1(4):A8. 3.     Organization WH. Report on the burden of endemic healthcare-associated infection worldwide. 2011. 4.     Shaikh JM, Devrajani BR, Shah S, Akhund T, Bibi I. Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital. J Ayub Med Coll Abbottabad. 2008;20(4):37-40. 5.     Petersen MH, Holm MO, Pedersen SS, Lassen AT, Pedersen C. Incidence and prevalence of hospital-acquired infections in a cohort of patients admitted to medical departments. Dan Med Bull. 2010;57(11):A4210. 6.     Getchell JP, Wroblewski KE, DeMaria Jr A, Bean CL, Parker MM, Pandori M, et al. Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morbidity and mortality weekly report. 2013;62(18):362. 7.     Maragos A, Maltezou HC, Raftopoulos V. Strategies to increase influenza vaccine uptake among health care workers in Greece. Scand J Infect Dis. 2009. 8.     Control CD, Prevention. Hepatitis C information for health professionals: statistics and surveillance. 2011. 9.     Janjua NZ, Razaq M, Chandir S, Rozi S, Mahmood B. Poor knowledge–predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan. BMC Infect Dis. 2007;7(1):1-11. 10.   Jawaid M, Iqbal M, Shahbaz S. Compliance with standard precautions: A long way ahead. Iran J Public Health. 2009;38(1):85-8. 11.   Siddique K, Mirza S, Tauqir SF, Anwar I, Malik AZ. Knowledge attitude and practices regarding needle stick injuries amongst healthcare providers. Pak J Surg. 2008;24(4):243-8. 12.   Dean A, Sullivan K, Soe M. OpenEpi: Open Source Epidemiologic Statistics for Public Health Accessed from https://www. openepi. com/Menu/OE_Menu. htm. Accessed; 2016. 13.   Alice TE, Akhere A, Ikponwonsa O, Grace E. Knowledge and practice of infection control among health workers in a tertiary hospital in Edo state, Nigeria. Direct Res J Health Pharm. 2013;1(2):20-7. 14.   Thu T, Anh N, Chau N, Hung N. Knowledge, attitude and practices regarding standard and isolation precautions among Vietnamese health care workers: a multicenter cross-sectional survey. Intern Med. 2012;2(4):115. 15.   Luo Y, He G-P, Zhou J-W, Luo Y. Factors impacting compliance with standard precautions in nursing, China. Int J Infect Dis. 2010;14(12):e1106-e14. 16.   Fayaz SH, Higuchi M, Hirosawa T, Sarker MAB, Djabbarova Z, Hamajima N. Knowledge and practice of universal precautions among health care workers in four national hospitals in Kabul, Afghanistan. J Infect Dev Ctries. 2014;8(04):535-42. 17.   Abubakar SM, Haruna H, Teryila KR, Hamina D, Ahmadu I, Babaji M, et al. Assessment of knowledge and practice of standard precautions among nurses working at Federal Medical Centre Gombe, Nigeria. Direct Res. J. Health Pharm. 2015;3(1):11. 18.   El-Sol A, Badawy A. The effect of a designed teaching module regarding prevention of central-line associated bloodstream infection on ICU nurses&#39; knowledge and practice. AJN Science. 2017;6(1):11-8. 19.   Bai HJ. Knowledge and Practice of Health Care Workers on Infection Control Measures. AJNER. 2015;5(4):518-22. 20.   Ayed A. Knowledge and practice of nursing staff towards infection control measures in the Palestinian hospitals. 2015. 21.   Abdulraheem I, Amodu M, Saka M, Bolarinwa O, Uthman M. Knowledge, awareness and compliance with standard precautions among health workers in north eastern Nigeria. 2012. 22.   Kesieme EB, Uwakwe K, Irekpita E, Dongo A, Bwala KJ, Alegbeleye BJ. Knowledge of hepatitis B vaccine among operating room personnel in Nigeria and their vaccination status. Hepatitis research and treatment. 2011;2011. 23.   Salehi AS, Garner P. Occupational injury history and universal precautions awareness: a survey in Kabul hospital staff. BMC Infect Dis. 2010;10(1):1-4. 24.   Efstathiou G, Papastavrou E, Raftopoulos V, Merkouris A. Compliance of Cypriot nurses with standard precautions to avoid exposure to pathogens. Nursing & health sciences. 2011;13(1):53-9. 25.   Haile TG, Engeda EH, Abdo AA. Compliance with standard precautions and associated factors among healthcare workers in Gondar University Comprehensive Specialized Hospital, Northwest Ethiopia. J Environ Public Health. 2017;2017.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareIn-Vivo Screening of Citrus Maxima Oil Against, Escherichia Coli Infection in Rabbits English4048Nisar AhmadEnglish Muhammad Shahab KhanEnglish Ashfaq AhmadEnglish Muhammad BilalEnglish Farooq Akbar KhanEnglishIntroduction: Escherichia coli is a Gram-negative facultatively anaerobic bacteria that cause serious damage in animals and humans by causing high morbidity and mortality. The increasing prevalence of antibiotic-resistant microorganisms has made it necessary to replace alternative sources of antibiotic products. There is a persistent need to recognize new and novel antimicrobial agents that would help in alleviating the problems of emerging resistant bacterial pathogens. Plant-derived natural products represent an attractive source of antimicrobial agents since they are natural and affordable, especially in rural societies in poor developing countries Objectives: The objective of the current research was to explore the antibacterial capabilities of the Citrus maxima oil against Escherichia coli infection in rabbits. The effect of oil on rabbits’ hematological parameters was also assessed. Methods: Rabbits were distributed into six groups, 1st group served as a negative control, 2nd group as a positive control, infected with E. coliat the dose rate of 2.0 x 1010 CFU without medication, group 3rd, 4thand 5th were infected with E. coli and supplemented with oil at different doses and 6th group was infected with E. coli and treated with Moxifloxacin HCL (standard drug) at the dose rate of 7mg/kg. The blood samples of tested animals were collected for the analysis of haematological parameters on different days of the experiments. Result: The results showed a significant increase in WBCs, MCV, HCT and neutrophils during infection. RBCs, MCH, MCHC, haemoglobin, lymphocytes and platelets count decreased during infection. The current study provides a scientific contextual for the significant use of Citrus maxima oil for the treatment of various pathological diseases. Conclusion: The obtained result gives an insight into the antibacterial capabilities of the Citrus maxima oil against Escherichia coli infection in rabbits. Citrus maxima oil exhibited variable, but remarkable antibacterial potential. These oils could be used as a source of antimicrobial agents in pharmaceutical industries. EnglishAntimicrobial, bacterial pathogens, Citrus maxima oil, Escherichia coli, Hematological parameters, Medicinal plant INTRODUCTION The increasing bacterial conflict to antibiotics has developed a growing APPREHENSION GLOBALLY.1 With the appearance and growth of microorganisms such as gram-negative (E.coli) bacteria which can cause serious infections.2 There are a number of drugs available to treat gram-positive bacteria, but less in number to treat gram-negative bacteria.3 In addition, high cost and adverse effects are commonly related to widespread synthetic antibiotics are a chief burning global issue in considering infectious diseases.4 Infectious diseases pose serious problems to health and they are the main cause of morbidity and mortality worldwide.5 The increasing prevalence of antibiotic-resistant microorganisms, has made it necessary to replace alternative sources of antibiotic products.6 Plant derived natural products represent an attractive source of antimicrobial agents since they are natural and affordable, especially in rural societies in poor developing countries.7 The literature survey revealed that the peel of Citrus maxima fruits is extremely thought to be a universal remedy within the flavoring drugs with various spectra of pharmacologic activity.8 Citrus maxima is the most extensively studied medicinal plant in recent literature. Citrus maxima is an edible fruit, its flesh is juicy, soft in texture and wealthy in nutrients and is endemic to tropical part of Asia.9E.coli is the most commonly found bacterium in the human intestinal tract. Under normal conditions, its presence is conducive to digestive processes. But when present in excess or in virulent form it causes diseases.10 E.coli, contaminate food and water supplies.11 Plants play an important role in human health because they produce a wide array of bioactive molecules which have medicinal values.12 Despite the efforts in producing the number of new antibiotics in the last three decades, resistance to these drugs by microorganisms has increased.13 The in-vitro anti-bacterial activities of three citrus Plants extracts, Citrus macrocarpa, Citrus Aurantium and Citrus maxima against S. aureus but not against E.coli.14 The oil of this fruit has been reported to possess some nutritive and medicinal potentials.15 Material and methods The main objective of the present study was to investigate the antibacterial activity of Citrus maxima oil against E. coli infection in rabbits.A total of 30 adult Rabbits of both genderswas used in the current study as experimental animals. Grouping of animals Rabbits having same weight were kept in the same group, thirty rabbits of both gender, which were randomly divided into six equal groups, 1stgroup (negative control), 2ndgroup infected with Escherichia coli orally at the dose rate of 2x1010 CFU (served as positive control) which did not receive any drug or essential oil as a treatment, 3rd group, infected with E. coli at the dose rate of 2x1010 CFU and was treated with Citrus maxima oil at a dose rate of 1ml, 4th group, infected with E. coli at the dose rate of 2x1010 CFU and was fed with Citrus maxima oil at a dose rate of 1.5ml, 5th group, infected with E.coli at the dose rate of 2x1010 CFU and fed with Citrus maxima oil at a dose rate of 2ml, 6th group was injected with E.coli at the dose rate of 2x1010 CFU and was fed with standard drug, (Moxifloxacin HCL). Chemicals and apparatus Citrus maxima oil and Moxifloxacin HCL were purchased from the local market of QissaKhwani Bazar, Peshawar, Pakistan. The equipment used in the current study were a Haematological analyzer and a Weight scale. Initiation of medication All groups of rabbits received a freshly cultured sample of E. coli (2x1010 CFU) orally except the control group. After administration of the bacteria, rabbits were checked for feed intake and other clinical signs. The responses of the rabbits to E. Coli bacteria were identified by the clinical signs like temperature, diarrhea, weight loss and reduced feed intake. Medication of infected rabbits After development of clinical signs, group 3rd, 4th and 5th were treated with Citrus maxima oil at a dose rate of 1ml, 1.5ml and 2ml, while group 6th was treated with standard drug, Moxifloxacin HCl. Phenobarbital sodium was used to anesthetize the rabbits for the collection of blood samples. Blood samples (about 3ml) were collected from all rabbits, at day zero, day three, day six and day nine of the experimental work for the analysis of different haematological parameters. Statistical analysis The data obtained from the study were analysed statistically, using the analysis of variance (ANOVA) and Tukey’s multiple comparison test were used to determine the differences between treatments. The mean and standard deviation (SD) were sorted out of each parameter, using, Graph pad prism software. RESULTS In the present study, rabbits were divided into different groups. 1st group was kept as a negative control, neither infected nor medicated, 2nd group served as a positive control which was infected, but not treated 3rd, 4th and 5th groups were treated with Citrus maxima oil at a dose rate of 1ml, 1.5ml, and 2mland group 6th was treated with standard drug (Moxifloxacin). Pre infection Blood samples was collected on day zero and the results of all the groups have been shown in: (Table 1). 1stGroup (negative control) About 3ml blood was collected from the animals. The TRBCs of negative control was 5. 73±0. 028x106/µl and hemoglobin value was 9. 52±0. 035%. The MCH, MCHC and MCV values were 21.49±0.134 Pg, 33.0±0.848 gm/dl and 50.7±0.070pg. The WBCs count was in the range of 5.72±0.035 x 103 /µl while lymphocytes count was 27±0.494%. The neutrophils, platelets count and HCT value were also in the normal reference range (60.5±0.707%, 530.5±0.035 x 103 /µl and 37.5±0.17%). 2nd group (positive control) The same amount of blood was also collected and were analysed for different parameters. The values of the RBCs and haemoglobin were 5.08±0.033x106/µl and 9.81±0.13%. Lymphocytes count was 28.3±0.31%. MCH and MCHC level were 19.7±0.41Pg and 30.5±0.16gm/dl. The MCV, WBCs and Neutrophils count were in the range of 50.6±0.12pg, 5.5±0.045x 103 /µland 62.6±0.25%. Platelets level was 528±0.11x 103 /µl and HCT value were 36.8±0.10%. 3rd Group three (low dose) Before infection the RBCs and hemoglobin value were in the range of 5.70±0.17x 106 /µl and 9.45±0.057%. The MCH value was 21.45±0.14pg and MCHCs value was 33.03±0.081gm/dl while MCV was in 50.76±0.072pg range. WBCs, lymphocytes and neutrophil count were 5.71±0.036x 103 /µl, 27.05±0.26% and 62.53±0.19%. HCT value was 37.46±0.92%, platelets count was 531.52±0.27x 103 /µl while RDWC level was 15.56±0.095%. 4thGroup (medium dose) RBC and haemoglobin of group 4th before infection were 5.73±0.23x 106 /µl and 9.52±0.27%. The concentration of MCH was 21.48±0.33pg while MCHC was 32.95±0.12gm/dl. The level of MCV and WBCs were in the range of 50.74±0.12pg and 5.71±0.076x 103 /µl. Lymphocytes, neutrophils and platelets count were 28.96±0.17%, 61.47±0.44% and 525.50±0.14x 103 /µl while HCT and RDWC values were in the range of 37.50±0.14%, and 15.60±0.26%. 5thGroup (high dose) The RBC count was 5.76±0.074x 106 /µl while hemoglobin value was 9.75±0.38%. The values of MCH, MCHC and MCV were 21.51±0.25pg, 32.95±0.25gm/dl and 50.69±0.16pg. WBCs count was 5.71±0.036x 103 /µl and lymphocytes count was 28.08±0.28% while the neutrophil count was 60.44±0.36%. Platelets, HCT and RDWC level were 530.54±0.087x 103 /µl, 37.53±0.15% and 15.57±0.21%. 6thGroup (standard drug) The RBCs and haemoglobin values were 5.78±0.77x 106 /µl and 9.81±0.084%. The concentration of MCH was 21.56±0.036pg and MCHC was 33.02±0.17gm/dl. MCV, WBCs and lymphocytes count were 50.72±0.34pg, 5.73±0.045x 103 /µl and 27.03±0.13% while neutrophil count was 61.52±0.27%. The platelets count was 524.53±0.053x 103 /µl, HCT value was 37.48±0.17%. During Infection The rabbits were infected with pathogenic E. coli at the dose rate 2x1010 CFU, except group 1st (control group). After causing infection, whole blood was collected from all the infected groups for analysis of haematological parameters (Table 2). 2nd group (positive control) The RBCs and haemoglobin count during infection were 3.47±0.042x 106 /µl and 6.82±0.042%. Neutrophils and Platelets count were 66.4±0.042% and 435±0.042x103/µl. The MCH value were20.53±0.042pg and the MCHC were 28.15±0.070gm/dl. The lymphocyte, WBCs and MCV count were 23.6±0.035%, 8.22±0.035x 103 /µl and 59.53±0.028pg. The HCT value was 41.62±0.028%. The level of RDWC was 15.42±0.10% during infection. 3rd Group (low dose) This group was also infected with E. coli, RBC count was 3.44±0.028x 106 /µl and haemoglobin value was 6.74±0.035%. The MCH and MCHC values were 20.50±0.035pg and 28.17±0.035gm/dl. The MCV, WBCS and lymphocytes count were 66.56±0.622pg, 8.17±0.014x 103 /µl and 25.62±0.042% while HCT value was 41.64±0.056%. The level of RDWC was 15.45±0.24%, the neutrophils and platelets count were 65.41±0.414 % 491.04±0.21x 103 /µl. 4th Group (medium dose) RBCs and haemoglobin count were 3.48±0.21x 106 /µl and 6.85±0.14%. The MCH value were 20.49±0.14pg and MCHC were 28.18±0.28 gm/dl. MCV, lymphocytes, WBCs count were 57.52±0.11pg, 24.64±0.49 %, 7.4±0.07x 103 /µl and HCT value was 42.66±0.056 %. Platelets and neutrophils count were 54.43.8±0.4, % 444.03±0.07x 103 /µl. The RDWC level was 15.45±0.24% during infection. 5th Group (high dose) RBCs count was 3.5±0.014x 106 /µl while haemoglobin value 6.90±0.14%. The values of MCH and MCHC were 20.52±0.14pg and 28.20±0.28 gm/dl. MCV, WBCs and lymphocytes count were 56.55±0.11pg, 8.33±0.070 x 103 /µl and 23.65±0.049%. Platelets and neutrophils count were 467.05±0.28x 103 /µl and 67.41±0.035%. The HCT value was 41.65±0.29 %. 6th Group (standard drug) In this group the RBCs and haemoglobin values were 3.51±0.014x 106 /µl and 6.98±0.070%. MCH value was 20.54±0.14pg and MCHC was 28.22±0.28gm/dl. The lymphocyte and MCV count were 21.66±0.084% and 55.2±0.11pg. During infection. Platelets and neutrophils count were 429.06±0.28x 103 /µl and 54.44±0.141%. During Treatment Total Red Blood Cells (TRBCs) At day six, the TRBCs count in negative control group was 5.73±0.028x 106 /µl, the positive control group was 4.54±0.028x 106 /µl. In groups, that were infected with E.coli and treated with C.maxima oil at the dose rate of 1ml/kg, 1.5ml/kg and 2ml/kg, the TRBCs counts were 6.26±0.028x 106 /µl, 5.40±0.042x 106 /µl and 4.04±0.028x 106 /µl. The group which was infected with E.coli and treated with standard drug (Moxifloxacin HCl), the RBCs count was 5.83±0.035x 106 /µl. A significant difference (PEnglishhttp://ijcrr.com/abstract.php?article_id=4428http://ijcrr.com/article_html.php?did=44281.         Huang X, Venet F, Wang YL, Lepape A, Yuan Z, Chen Y, et al. PD-1 expression by macrophages plays a pathologic role in altering microbial clearance and the innate inflammatory response to sepsis. Proc Natl Acad Sci. 2009 Apr 14;106(15):6303–8. 2.         Arshi N, Ahmed F, Kumar S, Anwar MS, Lu J, Koo BH, et al. Microwave assisted synthesis of gold nanoparticles and their antibacterial activity against Escherichia coli (E. coli). Curr Appl Phys. 2011 Jan;11(1):S360–3. 3.         Levy SB, Marshall B. Antibacterial resistance worldwide: causes, challenges and responses. Nat Med. 2004 Dec;10(S12):S122–9. 4.         Sharma P, Hussain N, Borah DJ, Das MR. Kinetics and Adsorption Behavior of the Methyl Blue at the Graphene Oxide/Reduced Graphene Oxide Nanosheet–Water Interface: A Comparative Study. J Chem Eng Data. 2013 Dec 12;58(12):3477–88. 5.         Foroughi A, Pournaghi P, Zhaleh M, Zangeneh A, Zangeneh M, Moradi R. Antibacterial Activity and Phytochemical Screening of Essential Oil of. 2016;8(11):5. 6.         Sharififar F, Ansari M, Eslaminejad T, Ohadi M, Mobarrez B, Raeiszadeh M, et al. Antimicrobial Potency of Plant Species: A Review. Eur J Med Plants. 2016 Jan 10;11(1):1–17. 7.         Ghosh A, Das SK. Coverage and connectivity issues in wireless sensor networks: A survey. Pervasive Mob Comput. 2008 Jun;4(3):303–34. 8.         Rodrigues AL, Becker J, de Souza Lima AO, Porto LM, Wittmann C. Systems metabolic engineering of Escherichia coli for gram scale production of the antitumor drug deoxyviolacein from glycerol: Deoxyviolacein production in engineered E. coli. Biotechnol Bioeng. 2014 Nov;111(11):2280–9. 9.         Ibrahim A, Rahnamayan S, Martin MV, Deb K. 3D-RadVis Antenna: Visualization and performance measure for many-objective optimization. Swarm Evol Comput. 2018 Apr;39:157–76. 10.       Qureshi N, Mishra S, Vyas A, Vyas H. Antibacterial Effects of Extracts of Selected Medicinal Plants in Combination with Honey. :10. 11.       Swimm AI, Kalman D. Cytosolic Extract Induces Tir Translocation and Pedestals in EPEC-Infected Red Blood Cells. Galan J, editor. PLoS Pathog. 2008 Jan 18;4(1):e4. 12.       Brownson RC, Baker EA, Deshpande AD, Gillespie KN. Evidence-based Public Health. Oxford University Press; 2017. 369 p. 13.       Muthuri SG, Venkatesan S, Myles PR, Leonardi-Bee J, Al Khuwaitir TSA, Al Mamun A, et al. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med. 2014 May;2(5):395–404. 14.       De Castro MEG, Dulay RMR, Enriquez MLD. Toxic and teratogenic effects of medicinal and culinary mushroom, termitomyces clypeatus, collected from the termite mound in Mt. Makiling Forest Reserve, Los Baños, Laguna, Philippines on Developing embryos of zebrafish (Danio rerio). Pharm Lett. 2016 Jan 1;8(5):237–42. 15.       Rodríguez-Fonseca B, Mohino E, Mechoso CR, Caminade C, Biasutti M, Gaetani M, et al. Variability and Predictability of West African Droughts: A Review on the Role of Sea Surface Temperature Anomalies. J Clim. 2015 May 15;28(10):4034–60.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareA Study to Compare the Effect of Conventional Knee Exercises & Macquarie Injury Management Group (Mimg) Protocol on Pain & Functional Mobility in Patients with Primary Osteoarthritis Knee- An Interventional Study English4954Yashasvi ShuklaEnglishIntroduction: Osteoarthritis is a disorder of the diarthrodial joint, a slow degenerative disease clinically characterized by pain, loss of range of motion. On x-ray seen as reduced joint space, formation of osteophytes and deformity. Manual therapy has been proved to be an effective treatment method in knee osteoarthritis (OA), but there is a need to investigate the effectiveness of MIMG manual therapy technique. There is limited evidence on the effect of MIMG protocol in knee OA. Aim: To find the effectiveness of MIMG protocol on pain and range of motion in knee osteoarthritis. Methodology- 38 subjects with the diagnosis of knee OA stage II and III on Kellegren Lawrence classification were recruited from Shree K.K. Sheth physiotherapy Centre, Rajkot, Gujarat. An interventional study was conducted on 38 subjects. Result: The outcome measures MIMG protocol is effective as conventional exercises in treating OA knee. Conclusion: MIMG can be suggested as one of the treatment protocols. EnglishPrimary OA knee, Macquarie Injury Management Group Protocol, Pain, Functional mobility, Joint disease, DegradatioINTRODUCTION Osteoarthritis (OA) is a degenerative joint disease and the most common form of chronic disorder of synovial joints1 in aging population.2 It is the most frequent joint disease with a prevalence of 22% to 39% in India.2 Knee Osteoarthrosis (OA) is one of the most prevalent musculoskeletal complaints worldwide, affecting 30–40% of the population by the age of 65 years. Primary osteoarthritis of the knee is associated in 90% of cases with varus deformity. Worldwide estimates indicate that 9.6% of men and 18% of women above 60 years of age have symptomatic OA2but knee involvement is seen equally in both genders from 55-64 years of age.4 The pathophysiology states that osteoarthritic changes are due to an imbalance between the degradation and synthesis process of the articular cartilage. The most widely used classification scheme for the diagnosis OA is based on the radiological appearance of the joint, which is known as Kellgren and Lawrence classification of Osteoarthritis. Grade I and II according to Kellgren-Lawrence Grading Scale4 or the participants fulfilling the following criteria of the American College of Rheumatology (ACR). (ACR): ACR clinical and radiological criteria: 1) Knee pain for most days of the prior month. 2) Osteophytes at joint margins on X-ray. 3) Synovial fluid typical of osteoarthritis (laboratory). 4)  Age 40 years. 5) Morning stiffness 30 min. 6) Crepitus on active joint motion. OA present if items 1, 2 or 1, 3, 5, 6 or 1, 4, 5, 6 are present.3 Radiographs add little to the accuracy of the clinical diagnosis. But in Osteoarthritis of the knee muscle strength and pain are more explanatory of functional loss than radiograph findings. According to a study done on by Roddy et al.,(2005), aerobic walking and quadriceps strengthening exercises helped patients to decrease pain and improve functional activities. However, there are few studies regarding the effects of exercise on postural stability and balance in OA patients.5 The Macquarie Injury Management Group (MIMG) knee protocol is a new technique in manual therapy developed by Dr. Henry Pollard, a practicing sports clinical scientist based in Sydney. MIMG knee protocol is an approach that includes two techniques myofascial mobilization and myofascial manipulation. It was introduced by the MIMG group, Australia. The techniques involved are the myofascial mobilization technique and myofascial manipulation technique.6 Short-wave diathermy (SWD) is a high-frequency current generated by an oscillator circuit that allows electrons to oscillate at a frequency of 27.12 MHz.7 Pain can be measured for severity on a visual analog scale. It is one of the most basic pain measurement tools. The reliability of VAS is 0.60 to 0.77 and validity is 0.64 to 0.84.8 The WOMAC is a disease-speci?c self-report multidimensional questionnaire assessing pain, stiffness, and physical functional disability. The original WOMAC is available in two formats, visual analog scales (VAS) and ?ve Likert boxes, with similar metric properties.9           MATERIALS AND METHODS Study design: An interventional study. Sampling technique: Purposive sampling and group allotment by random sampling Study setting: K.K Sheth Physiotherapy college. Sample size: Total 38 subjects (divided into 2 groups). Study population: males and females with OA knee.       Study duration: 6 sessions per week (two weeks). Method of data collection: A total 38 patients were selected for the study by giving consideration to inclusion and exclusion criteria. All the subjects were explained the purpose and the test procedures & written consent was obtained. Ethical clearance was given by the Saurashtra University panel, Rajkot, Gujarat, India. SELECTION CRITERIA: Inclusion criteria: age-40 to 70 years of age.5 Gender- both males and females. Subjects who are clinically diagnosed with primary OA knee according to American College of Rheumatology (ACR). Exclusion criteria:- Patients with history of hip and/or back injury and lower-limb joint replacement. Participants who had a joint replacement surgery, history of meniscal or other knee surgery in past 6 months. fractures at knee and hip joint, deformity at lower limb, osteoporosis, neurological deficits, systemic illness & metabolic disorder. Materials:      Pen. Paper. Treatment table. Record and data collection sheet. Consent form. Short wave diathermy (Electrowave 300) Measurement procedure The A and B group subjects took part in identical pre-and post-test protocols. Group A:  conventional Q-drills and short wave diathermy. (n=15) Group B: MIMG and short wave diathermy. (n=15) GROUP A- Conventional knee exercises. Static quadriceps.  last 15 degree knee extension. (figure 1)  high sitting knee extension. (figure 2) unilateral straight leg raising.10  10 repetitions of 5-second hold for each exercise. GROUP B- MAQUARIE INJURY MANAGEMENT GROUP PROTOCOL (MIMG)6 The intervention group received a MIMG (Macquarie Injury Management Group)    chiropractic knee protocol. It consists of a non-invasive myofascial mobilization procedure and an impulse thrust procedure performed on the symptomatic knee of participants. In cases where OA was bilateral; mobilization was performed on both knees. Myofascial mobilization technique:  The patient laid supine near the homolateral edge of the couch. The practitioner sat on the homolateral side of the couch with the cephalad thigh under the leg of the patient’s involved limb and superior to the patient’s knee. The patient’s lower hamstring area rested on the practitioner’s thigh with their knee able to rest in 900 of flexion. The practitioner had two choice of contacts:1) a pincer contact with the thumb and index either side of the medial and lateral superior poles of the patella. 2) A reinforced web contact supporting the medial and lateral superior poles of the patella. The second position is recommended for those practitioners who have a hypermobile thumb. The patient was then instructed to begin actively extending their knee through the pain-free range of motion while the practitioner maintained contact at the patella. The force through the patella is in a plane applied at a tangent to the angle of the knee to avoid a compressive load. The patient extended the knee as far as possible in a pain-free manner from the initial starting position. The practitioner maintained contact at the patella during this movement. This was repeated upto 10 times. Myofascial manipulation technique: the patient laid supine and the therapist stood on the same side of the plinth with the patient’s leg grasped between the thighs to apply a distractive force to produce traction over the tibio-femoral joint. The practitioner contacted the knee with hands either side. Both thumbs contact on the tibial tuberosity and the fingers wrap around the knee to the distal end of the popliteal space. A thrust was then delivered, in the caudal direction in order to mobilize the joint in a near full extension position. Treatment given in both the groups: Both the groups were given shortwave diathermy for 15min.11 STATISTICAL ANALYSIS Statistical software:       All statistical analysis was done by SPSS statistics version 20.0 for windows software. Microsoft excel was used to calculate mean and Standard Deviation (SD), and to generate graphs and tables. Statistical test: Means and Standard Deviation (SD) were calculated as a measure of central tendency and measure of dispersion respectively. Within-group comparison of WOMAC and VAS value was analyzed by Wilcoxon signed-rank test and between-group comparison of WOMAC and VAS value was analyzed by Wilcoxon sum rank test or Mann-Whitney U test. Pretreatment and post-treatment data of active knee flexion-extension range of motion and visual analog scale was analyzed by Paired t-test and Wilcoxon signed-rank test respectively and comparison between two groups of active knee flexion-extension range of motion and visual analog scale was analyzed by unpaired t-test and Mann-Whitney U test (Wilcoxon sum rank test). Level of significance (p-value) was set to 0.05. RESULT Thirty eight subjects were randomly divided into two Groups:- Group A conventional Q-Drills treatment (n=19) and Group B MIMG protocol (n=19). Outcome measures WOMAC, ROM and VAS for pain were taken before and after the completion of twelve sessions of treatment (6 times/ week). The below findings suggest that there is a statistically significant difference for pre-treatment and post-treatment comparison for WOMAC in Group-A (Conventional Q-Drills) and Group-B (MIMG Protocol). There is a statistically significant difference in pre-treatment and post-treatment comparison of VAS in both groups. There is no significant difference for between-group comparisons of WOMAC & VAS. Hence, null hypothesis was accepted and the experimental hypothesis was rejected.            DISCUSSION In present study, when the values of pre-treatment and post-treatment VAS and WOMAC were analyzed, it was statistically significant in both the groups but when a comparison was done between them, both the techniques were equally effective in reducing pain and improving functional mobility. Conventional exercise therapy is regarded as the cornerstone of conservative management of the OA knee.2,3 Exercise regimens containing repetitive movements increase the ability of the person’s control over joint movements in all positions. Dynamic stability may help to control abnormal joint translation that occurs during daily movements. This shows as an improvement in WOMAC score. Knee-extension exercises provide additional vastus medialis obliques (VMO) activity and thus have a greater impact on strengthening the VMO. The VMO functions to control patella alignment by pulling the patella medially during extension and under normal knee function acts as a dynamic medial stabilizer of the patella once the knee reaches terminal extension12 and the final arc of 30 degrees of extension is suggested for strengthening the quadriceps.13 Debra Kushion et al.,(2012)performed a study to compare four common rehabilitation exercises: straight leg raise with neutral and externally rotated hip positions (SLRN, SLRER), and short arc quad with neutral and externally rotated hip positions (SAQN, SAQER) in subjects of  PFPS(patellofemoral pain syndrome)  for activating the vastus medialis oblique (VMO) and vastus lateralis (VL) and concluded that exercises including short arc quad knee extensions are more effective for both the VMO and VL activation than those incorporating straight leg raises.14 social interaction should have been included as well15 as a part of awareness about the condition and its degeneration. Vandana J. Rathod in 2011 stated that supervised exercises and home based exercises are effective in reducing pain and improving physical function in subjects with osteoarthritis of knee, when given with proper dosage.16 The other objective of this study was to find out the effectiveness of MIMG protocol. Gail Deyle(2000) concluded from their interventional study that a combination of manual therapy and supervised exercise is effective in improving walking distance, decreasing pain, dysfunction and stiffness in patients with OA knee.  The MIMG protocol used for the intervention consisted of a non-invasive myofascial mobilization procedure and an impulsive thrust procedure specific to the patello-femoral articulation. The patient is able to actively articulate through knee flexion and not excessively tighten the quadriceps to cause a vector that compresses the patella onto femur. The mobilization procedure stretches the joint capsule in a sagittal plane, gently mobilizes any restriction to normal movement within the limits of patient tolerance and likely loosens adhesions to the patello-femoral articulation. Together these effects allow the knee greater mobility with less effort, restriction and pain. The second part of the procedure utilizes a manual therapy procedure that is not under the voluntary control of the patient. It involves the application of longitudinal traction of the tibio-femoral joint in a manner designed to distract the knee and mobilize the joint in a near-full extension position. An impulsive type of thrust directed in a caudal direction is delivered to the knee of the patient. The object of this procedure is not to produce joint cavitation, more so to mobilize the joint. In cases of tibial rotational restriction, the pre manipulative setup could include a rotated tibia as a start point. The thrust component remains the same and is directed purely caudal in direction. Pollard H and Chiro Grad Dip et al. (2008) studied that the MIMG had benefits in a short term period on self-reported pain and knee function, their study used placebo effect of TENS where intensity was set at zero. CONCLUSION The result of the present study showed that patients belonging to both the groups that are conventional knee exercises and MIMG group had relief from pain and other symptoms, increase the activity of daily living and knee-related quality of life. Hence, concluded that both the techniques were effective for osteoarthritis of knee joint. It can be further recommended that both the techniques can be included together in OA treatment regime for better results for patients. ACKNOWLEDGEMENTS Author acknowledges extensive support received from the guide Dr. Sheetal Patel, associate professor at Shri K.K.Sheth Physiotherapy College, who thoroughly guided me throughout the research, scholars whose articles are cited and included in the references of this manuscript. The author also shows gratitude to authors/ editors/ publishers of all those articles, journals and books from where the literature for this research work has been reviewed and discussed. CONFLICT OF INTEREST There was no conflict of interest. SOURCE OF FUNDING Self-funded. Interpretation: The above table and graph shows mean and SD for group A and group B Mann Whitney U test was used for between-group comparison of WOMAC of Group A and Group B. Interpretation: The result shows no significant difference for WOMAC (Z=-2.647, p=0.008). Wilcoxon sign rank test was used for pre-treatment and post-treatment comparison of VAS of Group A and Group B. Mann Whitney U test was used for between group comparison of VAS of Group A and B. Interpretation: The above table and graph shows mean and SD of VAS of Group A and Group Interpretation: The above table shows mean and SD of VAS for both groups. Interpretation: The above table and graph shows mean and SD of VAS for both the groups. Englishhttp://ijcrr.com/abstract.php?article_id=4429http://ijcrr.com/article_html.php?did=4429 Mohan H (2005), textbook of pathology fifth edition. JAYPEE brothers’ medical publishers (p) ltd. Malgaonkar P, Kumar S, Babu V. Short term effect of mulligans mobilization versus kinesiotaping in knee pain and disability for OA knee. Int. J. Physiother. 2014; 1(4);233-240. Essential orthopedics, J Maheshwari 3rd edition; 2011; 278-285. Altman R. Alarcon G. Arthritis and rheumatism;1991;34;505-51 Kellgren JH, Lawrence JS. Osteoarthritis and disk degeneration in an urban population. Annals rheumatism;1958;17;388-97. Pollard H. 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Deyle GD, Henderson NE, Matekel RL. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med2000; 132(3):173–181. Moss P, Sluka K, Wright A. The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Man Ther 2007; 12: 109–18. Susan OS, Thomas S. Physical rehabilitation. Fifth edition. Philadelphia: FA Davis Company; 2007. Exercise interventions in Knee Osteoarthritis in Aging adults: A Systematic Review of Randomized Clinical Trials Ranveer Kumar Mahato, Int J Cur Res Rev | Vol 11 Issue 23  December 2019 Effect of supervised exercise program and home based exercise program in osteoarthritis of knee joint  Int J Cur Res Rev www.ijcrr.com Vol. 03 issue 01 Jan 2011

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareObserving the Outcome of Ureter Stones Expelled with Medical Expulsive Therapy: A Prospective Longitudinal Study English5558Saadat Hassan Shah HashmiEnglish Muhammad AmeenEnglish Ruqia TahirEnglish Kamran Munir BajwaEnglish Naeem Ahmed ButtEnglish Ayaz Ahmad KhanEnglishIntroduction: There are a lot of risks involved with the surgery which include postoperative complications such as ureteric damage and sepsis. With the rise in the need for an efficient cure for expelling ureter stones research is being done to study the effect of medical expulsive therapy on the expulsion of stones. Aim: The purpose of this study was to observe the outcome of ureter stones expelled with medical expulsive therapy Methodology: The study population consisted of a sample of 220 patients that had been diagnosed with Ureterolithiasis. This diagnosis was radiologically confirmed. Once the diagnosis was confirmed, the patients have prescribed medication for the medical expulsive therapy. The medication prescribed was tamsulosin which was to be taken daily over a period of six weeks. Follow-up checkups were used to gauge the pain severity and determine whether the drugs needed to be continued. Surgical intervention was required for patients who had a stone size greater than 10 millimeters. A prospective longitudinal study. This study was conducted at Benazir Bhutto Hospital Rawalpindi Pakistan, a period of six months from December 2020 to May 2021. Results: In a total of 220 patients, 173 (78.6 %) of the patients were male while the rest of the 47 patients (21.4%) were female. The mean age of the patients was 41 ± 4.3 years. The results showed that a total of 220 stones were found in the patients where 43 stones (19.5 %) were found in the upper ureter, 55 stones (25%) in the mid ureter and 122 stones (55.5%) in the lower ureter. A total of 40% of the patients passed their stones within the 12-weeks. A total of 14% of patients did not expel the stones through Medical expulsive therapy rather they required surgery to remove the stones. The results from the study showed that in cases of uncomplicated Ureterolithiasis, stones that had a size of up to 10 millimeters could be expelled easily through medical expulsive therapy. Conclusion: The study showed that only a small percentage of the patients with ureter stones required surgical intervention and vertical expulsive therapy proved to be an efficient way of expelling the stones up to ten millimeters. The trial could be continued from 6 to 12 weeks dependent on the movement of the stones through the ureter passage. EnglishRenal calculi, Ureter, Medical expulsive therapy, Patients, Surgical intervention, Techniqueshttp://ijcrr.com/abstract.php?article_id=4431http://ijcrr.com/article_html.php?did=4431

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareA Randomized Study to Compare the Efficacy of Lignocaine, Dexamethasone, Pethidine, and Placebo in the Prevention of Pain Caused by Propofol Injection English5962Ahmed Uddin SoomroEnglish Arif Iftikhar MallhiEnglish Aqil QayoomEnglish Mujeeb Ahmed KhanEnglish Imran HafeezEnglish Maqsood Ahmed SiddiquiEnglishIntroduction: Propofol is used in injectable form intravenously by anesthetists for the induction of anesthesia. It is the drug of choice in short or daycare surgical cases. The patients who experience pain, are also able to experience anxiety and fear. In the most severe cases, they can also face myocardial infarction and ischemia. Aim: A comparison of pain-alleviating effects of Lignocaine, Dexamethasone, Pethidine, and placebo in a patient caused by the administration of Propofol for the induction of anesthesia. Methodology: The study included 144 patients who had been given an injection of Propofol for the induction of anesthesia. The patients were divided into four groups as four types of drugs were administered. The allocation of the participants was done randomly. The age range of the patients was from 18-62 years. All the participants were undergoing upper abdominal surgery. After the administration of 25% Propofol, the patients were asked for their status of pain. A randomized controlled trial. This study was conducted at Chandka Medical College, SMBBMU Larkana, Pakistan from April 2020 to April 2021. Results: The drugs Lignocaine, Dexamethasone, and Pethidine reduced the pain caused by injection of Propofol as compared to the placebo. The pain score in these three drug groups was not significantly different. Also, the recall of pain in these groups was not significantly different. However, the difference between the placebo group and the remaining three groups was significant. Conclusion: Lignocaine, Dexamethasone, and Pethidine significantly reduce the pain caused by the Propofol injection as compared to a placebo. There is no significant difference between their efficacies. Nonetheless, the difference between the previously mentioned drugs and placebo is significant. EnglishLignocaine, Dexamethasone, Propofol, Pethidine, Anesthesia, Drawbackhttp://ijcrr.com/abstract.php?article_id=4432http://ijcrr.com/article_html.php?did=4432

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241EnglishN2022April5HealthcareSurgical Site Infection in Distal Femur Fractures Following Operative Treatment of Open Fracture: Incidence and Prognostic Risk Factors: A Cohort Study English6368Zahoor Illahi SoomroEnglish Abdul Rehman KhanEnglish Madan LalEnglish Niaz Hussain KeerioEnglish Syed Muhammad Khalid KarimEnglish Asfandyar KhanEnglish Syed Shahid NoorEnglishIntroduction: Bimodal distribution of Chinese adults reported an overall 8.7% of all femoral fractures were reported in recent years. The soft tissue dissection during surgery results in impairment in already damaged soft tissue. This impairment leads to postoperative complications. Aim: To determine the incidence and risk predictors of surgical site infections in distal femur fracture treated by open reduction and internal fixations. Methodology: We divided all recruited patients into two groups based on the occurrence of SSI. We classified patients with SSI in the case group and without SSI in the control group. Superficial SSI was defined as the infiltration on the skin or subcutaneous tissue of the operation site. The definition of the deep SSI was based on the satisfaction regarding deep fascia infection, persistent wound effusion, local abscess requiring focal debridement, and implant replacements. Wound exudates of all patients were sent for evaluation culture and sensitivity. A cohort study, This study was conducted at Peoples University of Medical & Health Sciences Nawabshah, Pakistan from December 2019 to December 2020. Results: We observed 22 cases of SSI with a median time duration of 14 ranging from 2 to 106 days. The majority of the SSI cases were reported during hospitalization (81.2%, 18/22). Furthermore, we observed 2.4% superficial SSI and 3.6% deep SSI with an overall prevalence of 6%. The average age of patients was reported as 53.7 ± 17.0 years with three median ages of groups (34, 51, and 68 years respectively). Conclusion: Our results revealed a high probability of SSI in open fractures, however, the prevalence was 6%. Independent risk factors like A/G levels may play a role as defensive factors. We recommend conducting case-control trials to check the validity of our results. EnglishDistal femur fractures, Surgical site infection, Open reduction, Internal fixations, Defensive factors, Bimodal distribution, populationhttp://ijcrr.com/abstract.php?article_id=4433http://ijcrr.com/article_html.php?did=4433