Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Warning: Cannot modify header information - headers already sent by (output started at /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php:195) in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 234
Warning: SimpleXMLElement::asXML(): xmlEscapeEntities : char out of range in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 235
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareThe Role of Iron Profile in the Differential Diagnosis of Microcytic Hypochromic Anemia in King Abdulaziz Medical City
English0105Mohieldin ElsayidEnglish Rasha Mohammad Al-ghamdiEnglish Atheer Mubarak Al-ghamdiEnglish Naif M. AlhawitiEnglish Alotibi R SEnglish Ghadeer Nabeel MugladEnglish Amir AbushoukEnglish Mohamed E. AhmedEnglish Naif S. SannanEnglishIntroduction: Anemia is an abnormal decrease in red blood cells (RBCs) and is classified as; macrocytic, normocytic or microcytic. Iron profiling along with complete blood counting (CBC) is performed to diagnose microcytic hypochromic anemia (MCA). Aims: To evaluate the role of iron profile in differentiating MHA. Methodology: A retrospective chart-review study was conducted in 2019 on anemic patients attending King Abdulaziz Medical City. Values from CBC and iron profiling tests were collected. Results: 219 patients with MHA, 164 females and 55 males, were identified. Female patients were 74.9% of all cases, and adults were the most affected. Values of CBC parameters including hemoglobin, RBCs, packed cells volume (hematocrit), mean cell volume and mean cell hemoglobin were significantly lower in cases than in controls (pEnglishAnemia, Microcytic Hypochromic anemia, Thalassemia, Iron deficiency anemia, Anemia of chronic disease, Sideroblastic anemia, Complete blood count (CBC), Iron Profile testIntroduction:
Anemia is a very common condition and defined as an abnormal decrease in the total red blood cells (RBCs).1 According to the world health organization, anemia affects 24.8% of the human population.2,3 A recent study conducted on pregnant women indicated that 41.8% are affected.2According to a study conducted in Ethiopia, 11.5 percent of pregnant women were affected.4Another study of 1573 men, women, and children found that 13% of men and nearly half of women and children had iron deficiency.5Furthermore, a number of studies support the high prevalence of anemia.6,7,8,9
Anemia has several types and can be classified according to RBCs’ morphology into three major classes.2,10,11,12 Macrocytic anemia (large RBCs), normocytic anemia (normal RBCs size), and microcytic anemia (small RBCs).12Microcytic anemia is subdivided into hypochromic, normochromic, and hyperchromic in respect to the hemoglobin amount in the RBCs.Hemoglobin is a protein with four peptides responsible for RBCs redness and gas transportation, and it has iron as one of its important components.2,12Generally, anemia is a consequence of iron deficiency which leads to a decrease in hemoglobin production; however, pathogenesis may differ in some microcytic hypochromic anemia.1,12Thalassemia, for example, is a type of microcytic hypochromic anemia that is due to genetic mutation, while sideroblastic anemia is acquired.10,12
Iron profile test and complete blood count(CBC) are performed to diagnose anemia.11,12,13Iron profile test was composed of serum iron test, total iron-binding capacity test (TIBC), serum ferritin test, and transferrin saturation test.14 CBC contains several tests that are essential to determine cells morphology and pigmentation that are used to identify the anemia type, whether it is hypochromic or not, and whether it is microcytic or not.3,11,12,14 Bone marrow examination and molecular tests are able to differentiate microcytic hypochromic anemias.6,11,12In addition, a study used a soluble transferrin receptor (sol TFR) test to diagnose anemia in patients with systemic lupus erythematosus, which showed better detection of iron deficiency anemia compared to the iron profile test, and different studies have shown that CBC is essential in diagnosis and differentiation of anemias.6,7,13,15, 16
This study aims to evaluate the role of iron profile in the differential diagnosis of microcytic hypochromic anemias.
Materials and Methods:
This is a retrospective chart review study conducted in anemic patients seeking consultation in King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia. The study included 219 patients diagnosed with microcytic hypochromic anemia, (55 males and 164 females) in different age groups: 9 infants; 10 children; 9 teens; 148 adults; and 46 elderly. Results of CBC, red blood cell morphology, iron profile tests, demographic and clinical data were collected from the KAMC medical records after approval by the Institutional Review Board (IRB# SP19/327/J) at the King Abdullah International Medical Research Centre following the declaration of Helsinki.
Data Management and Analysis Plan:
The data was collected in an excel sheet and entered into SPSS software (version 20). A backup soft copy version, as well as hard copy print, were dated, saved, and secured after each data entry. Categorical variables were presented in frequency and percentage distribution, while continuous variables were described by the mean and standard deviation (SD). Independent samples t-test and analysis of variance were conducted to examine significant differences between study variables; results with p-value less than or equal to 0.05 were set to be significant.
Results:
Among the cases, 74.9% out of 219 were females, compared to 76% females out of 50 control individuals. Infants, children, teens, adults and elderly accounted for 2.8%, 4.7%, 4.1%, 67.6%, 21% of the cases, respectively, with the highest percentage in adults. The Hb, RBC, PCV, MCV and MCH values were significantly lower in cases compared to controls (pEnglishhttp://ijcrr.com/abstract.php?article_id=4440http://ijcrr.com/article_html.php?did=4440
Lanier JB, Park JJ, Callahan RC. Anemia in older adults. Am Fam Physician. 2018 Oct 1; 98(7):437-42.
Liyew AM, Tesema GA, Alamneh TS, Worku MG, Teshale AB, Alem AZ, et al. Prevalence and determinants of anemia among pregnant women in East Africa; A multi-level analysis of recent Demographic and Health Surveys. PloS one. 2021 Apr 27; 16(4):e0250560.
World Health Organization: health topics on Anemia which is available at http://www.who.int/topics/anaemia/en/.
Kumera G, Haile K, Abebe N, Marie T, Eshete T. Anemia and its association with coffee consumption and hookworm infection among pregnant women attending antenatal care at Debre Markos Referral Hospital, Northwest Ethiopia. PloS one. 2018 Nov 8; 13(11):e0206880.
Asobayire FS, Adou P, Davidsson L, Cook JD, Hurrell RF. Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections: a study in Cote d'Ivoire. Am J Clin Nutr. 2001 Dec 1; 74(6):776-82.
Cascio MJ, DeLoughery TG. Anemia: evaluation and diagnostic tests. Med Clin. 2017 Mar 1; 101(2):263-84.
Mittal S, Agarwal P, Wakhlu A, Kumar A, Mehrotra R, Mittal S. Anaemia in systemic lupus erythematosus based on iron studies and soluble transferrin receptor levels. J Clin Diagn Res: JCDR. 2016 Jun; 10(6):EC08.
Esen UI. Iron deficiency anemia in pregnancy: The role of parenteral iron. J Obstet Gynaecol. 2017 Jan 2; 37(1):15-8.
Gwetu TP, Chhagan MK, Taylor M, Kauchali S, Craib M. Anaemia control and the interpretation of biochemical tests for iron status in children. BMC research notes. 2017 Dec; 10(1):1-9.
Jansen V. Diagnosis of anemia—A synoptic overview and practical approach. Transfus Apher Sci. 2019 Aug 1; 58(4):375-85.
Zanetti R, Feldman B, Porea T. Microcytic Anemia. Pediatr Rev. 2021 Jan; 42(1):41-3.
Ganz T. Anemia of inflammation. N Engl J Med. 2019 Sep 19; 381(12):1148-57.
Buttarello M. Laboratory diagnosis of anemia: are the old and new red cell parameters useful in classification and treatment, how?. Int J Lab Hematol. 2016 May; 38:123-32.
Kelly AU, McSorley ST, Patel P, Talwar D. Interpreting iron studies. BMJ. 2017 Jun 15; 357.
Wici?ski M, Liczner G, Cadelski K, Ko?nierzak T, Nowaczewska M, Malinowski B. Anemia of Chronic Diseases: Wider Diagnostics—Better Treatment?. Nutrients. 2020 Jun; 12(6):1784.
Ianni CM, McDowall MP, Zuska IA. Differential Diagnosis of Low Hemoglobin. Dimens Crit Care Nurs. 2021 Jul 1; 40(4):204-9.
Harmening DM. Clinical Hematology and Fundamentals of Hemostasis. 5th. Philadelphia, PA, USA: FA Davis Company. 2009.
Camaschella C, Nai A, Silvestri L. Iron metabolism and iron disorders revisited in the hepcidin era. haematol. 2020 Feb; 105(2):260.
Rathnayake G, Badrick T. Is total iron-binding capacity (TIBC) calculation correct? Pathology. 2019 Jun 1; 51(4):451-2.
Perry M. Anaemia in primary care: iron deficiency and anaemia of chronic disease. J Nurs Pract. 2021 Sep 2; 32(9):358-62.
Xu Y, Alfaro-Magallanes VM, Babitt JL. Physiological and pathophysiological mechanisms of hepcidin regulation: clinical implications for iron disorders. Br J Haematol. 2021 Jun; 193(5):882-93.
Abu-Shaheen A, Heena H, Nofal A, Abdelmoety DA, Almatary A, Alsheef M, et al. Epidemiology of Thalassemia in Gulf Cooperation Council Countries: A Systematic Review. Biomed Res Int. 2020 Oct 29; 2020.
Wang YP, Chang JY, Wu YC, Cheng SJ, Chen HM, Sun A. Oral manifestations and blood profile in patients with thalassemia trait. J Formos Med Assoc. 2013 Dec 1; 112(12):761-5.
Taher AT, Porter JB, Viprakasit V, Kattamis A, Chuncharunee S, Sutcharitchan P, et al. Approaching low liver iron burden in chelated patients with non-transfusion dependent thalassemia: the safety profile of deferasirox. Eur J Haematol. 2014 Jun; 92(6):521-6.
Abu-Zeinah G, DeSancho MT. Understanding Sideroblastic Anemia: An Overview of Genetics, Epidemiology, Pathophysiology and Current Therapeutic Options. J Blood Med. 2020; 11:305.
del Rey M, Benito R, Fontanillo C, Campos-Laborie FJ, Janusz K, Velasco-Hernández T, et al. Deregulation of genes related to iron and mitochondrial metabolism in refractory anemia with ring sideroblasts. PLoS One. 2015 May 8; 10(5):e0126555.
Martínez-Sánchez LM, Palacio SC. Sideroblastic anemia, a rare disease of multiple causes. Rev Cubana Hematol Inmunol Hemoter. 2020; 36(3).
Abioye AI, Aboud S, Premji Z, Etheredge AJ, Gunaratna NS, Sudfeld CR, et al. Hemoglobin and hepcidin have good validity and utility for diagnosing iron deficiency anemia among pregnant women. Eur J Clin Nutr. 2020 May; 74(5):708-19.
Mansour D, Hofmann A, Gemzell-Danielsson K. A review of clinical guidelines on the management of iron deficiency and iron-deficiency anemia in women with heavy menstrual bleeding. Adv Ther. 2021 Jan; 38(1):201-25.
Chueh HW, Jung HL, Shim YJ, Choi HS, Han JY. High anemia prevalence in Korean older adults, an advent healthcare problem: 2007–2016 KNHANES. BMC Geriatr. 2020 Dec; 20(1):1-9.157.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareImpact of Smartphone Usage on Quality of Treatment Provided by the Physiotherapists and the Physiotherapy Interns in Out Patient Department
English0615Kangkana GoswamiEnglish Nagaraj SibbalaEnglishIntroduction: Smartphones have become an essential part of our lives. There is anecdotal evidence that health professionals are increasingly using Smartphones during their work. Smartphone use in healthcare work settings presents both opportunities and challenges. Using smartphones during clinical practice causes lack of attention, diminished capacity to remember important information, and a decrement in performance which might impact the quality of treatment provided. Aims: The objective of the study is to determine the impact of smartphone usage on the quality of treatment provided by the physiotherapists and the physiotherapy interns during the treatment sessions in OPD’s. Methodology: A descriptive design with convenience sampling and a self-designed questionnaire with close-ended questions were used to survey 120 PTs and PT interns working in various healthcare sectors. The questionnaire was based on various validated instruments for assessing the frequency and purpose, perception and opinion regarding the usage of smartphones during treatment. Results: In the present study, the statistical analysis showed that there is a significant difference in the frequency and purpose of smartphone usage during treatment among the groups with p valueEnglishSmartphone, Health care, Physiotherapists, Health professionals, Distraction, Interruption, Workplace, Health consequences, Mobile phone dependenceIntroduction:
Smartphones have become inextricably linked to our daily lives. Smartphones are preferred by users due to their accessibility, utility, multitasking, and mobility. They are now more than just a means of communication among persons because they allow us to use various programs to access the internet, banking services, entertainment, and social networks.
Smartphones are preferred by users due to their accessibility, utility, multitasking, and mobility. According to a survey, people spend 3 to 5 hours per day on their smartphones and touch them 2617 times each day on average. Many people believe that this technology will have a large positive impact in the healthcare field. As a result, they can assist healthcare practitioners in a variety of ways. Smartphones provide clinicians with internet access for medication references and professional guidelines, as well as the ability to utilize them as bedside medical calculators. Sharing a range of images, such as x-rays, ultrasound, Computed Tomography/Magnetic Resonance Imaging scans, and photos displaying a patient's wounds or condition, using instant messaging could increase communication between practitioners.1-3 However, data on the detrimental physical and psychological implications of excessive usage of mobile phones is already starting to emerge.3Smartphones are thought to cause in attentional blindness and inattentiveness in users. Smartphone distraction has also been linked to attentional impulsivity, which is reinforced by rewarding persistent checking behaviors. The degree to which a person multitasks media is connected to attentional impulsiveness. Multitasking not only lengthens the time it takes to finish a task, but it also causes shallow thinking to take precedence over deep, thoughtful reflection and analysis 4-6
. The use of a smartphone for extended periods of time, as well as repeated movements of the upper extremities in an unnatural posture, have been demonstrated to be the leading causes of musculoskeletal issues. The muscular and nerve tissue in the hand may be severely impacted by the prolonged changed static posture and repetitive use of the wrist and thumb during smartphone operation. Excessive repetitive or static wrist and thumb movements when using a smartphone might raise joint strain, increase carpal tunnel pressure, and reduce the available room for the median nerve to move. As a result, acute trauma occurs, causing the median nerve and muscle tendon to expand.7
In situations where such disruptions should be avoided, physicians in hospitals are unnecessarily interrupted by cell phones. Using a smartphone in a healthcare context could jeopardise a patient's privacy, which is known because it is a person's right to govern, utilize, and share their health-related data and confidentially. Some even believe it is impolite to use a smartphone in front of a patient. 10 Patients have an unfavourable opinion of resident doctors who take up phone calls, check or compose messages while interacting with patients or observing a treatment. According to a study in house staff, smartphones can undermine interprofessional behaviour because they prefer texting to direct communication with nurses, which leads to unprofessional behavior8-11
Increased smartphone use has also been linked to mental health issues12Smartphones have also been labelled as possibly addicting and detrimental to people's work and personal lives. Individuals are exhibiting addicted behavior towards smartphone usage, according to existing literature, resulting in serious negative emotional and societal consequences. In adults and adolescents, a poor ability to regulate emotional responses to bad experiences appears to be linked to more problematic smartphone use.13 People who are stressed are more prone to smartphone addiction and are more likely to engage in addictive behaviour to reduce stress. Smartphone addicts also had poor communication skills, according to the study. Self-control is a key component of smartphone addiction, and it's closely linked to the compulsive usage of social media sites like Facebook. As a result, people should find a means to improve their self-discipline and detect and manage inappropriate behaviour.14
Internal thoughts or external cues appear to activate smartphone use distraction, which may be fueled by online vigilance—a persistent obsession with online information that leads to salience monitoring and encouraging cravings to check. As a result, habitual behaviour develops. 22 They create tolerance, which means that users feel compelled to spend more time on their phones in order to be satisfied, and they encourage constant, compulsive checking habits. The term 'nomophobia' was coined to describe an uncontrolled dread of leaving home without a mobile phone, which manifests as anxiety, emotional instability, hostility, and difficulties concentrating.
15
Although smartphones provide considerable convenience in our daily lives, their continual use may interfere with work. Physical therapists conduct intricate duties that frequently necessitate their complete attention. As a result, dividing attention between one or more tasks may result in a drop in performance, which could lead to clinical errors. If the therapist is preoccupied, the treatment will take longer to complete. It's also worth noting that a smartphone or other technology interrupting a physical therapist's primary duty creates a communication barrier between the patient and the therapist. Communication is critical for a physiotherapist to gain a better knowledge and diagnosis of the patient's condition.
OBJECTIVES
To determine the impact of smartphone usage on quality of treatment provided by the physiotherapists and the physiotherapy interns between the treatment sessions in OPD’s.
METHODOLOGY
Source of data:
Physiotherapists and physiotherapy interns in and around Bangalore.
Method of collection of data
Population : Physiotherapists and physical therapy interns
Sample design : Convenience Sampling
Samplesize : 120
Type of study : Descriptive study
Duration : 6months
Materials required : Questionnaire
Inclusion criteria:
Certified Physiotherapists
Physiotherapy interns
Age ranging from 22 to 35years
Both gender
Subjects who know local language/English for communication
Exclusion Criteria:
Non- co-operating physiotherapists and physiotherapy interns.
Subjects who cannot comprehend/complete the Questionnaire
Methodology:
Subjects who fulfill the inclusion criteria were included in the study. A prior informed consent was taken from the participants and permission was obtained from the institution’s ethical committee.
Institutional Ethical Committee Padmashree Institute of Physiotherapy vide Ref No: PIP/EC/
10-6/03-2020 dated 10.03.2020 has reviewed the research proposal and certifies that research proposal is ethically satisfactory. Ref: Ethical Guidelines for biomedical research on Human subjects – ICMR New Delhi 2000.
RESULTS
Table 1 shows the age distribution of physiotherapists and physiotherapy interns using Chi-Square test. Among 120 subjects, the number of physiotherapists were 72 (60%) and number of physiotherapy interns were 48(40%) with 18(25%) physiotherapists and 97.9% (97.9%) physiotherapy interns below 25 years, 38(52.3%) physiotherapists and 1(2.1%) physiotherapy interns between 25-30 years, 11(22.2%) physiotherapists and 0 physiotherapy intern above 30 years. The Chi-Square value was 24.848 and p-value was P0.05. Therefore, it was concluded that there was no significant difference between registrations for practice over the groups. The following pie diagrams showed the distribution of physiotherapists and physiotherapy interns according to their registration for practice.
Table 4 presents the distribution of physiotherapists at physiotherapy interns according to the type of work using Chi-Square test. In the study, 4(5.6%) physiotherapists work exclusively in the public healthcare setting, while 46(63.9%) physiotherapists work in private healthcare setting, rest 22(30.5%) physiotherapists work in a combination of public health and non-public health care settings. Similarly, 8(16.7%) physiotherapy interns were working in public health care setting, 30(62.5%) physiotherapy interns were working in private health care setting and 10(20.8%) were working in a combination of public health and non-public healthcare setting. Their Chi-Square value was 4.585 with p>0.05. Therefore there was no significant difference in type of work between the groups.
Table 5 presents the distribution of physiotherapists and physiotherapy interns according to hours engaged in their physiotherapy practice per week using Chi-Square test. 20(27.8%) physiotherapists and 4(8.3%) physiotherapy interns were engaged less than 30 hours of clinical practice per week. 21(29.2%) physiotherapists and 20(41.7%) physiotherapy interns work between 30-40 hours per week and 31(43.1%) physiotherapists and 24(50.0%) physiotherapy interns works more than 40 hours per week. The Chi-Square value was 7.065 with PEnglishhttp://ijcrr.com/abstract.php?article_id=4441http://ijcrr.com/article_html.php?did=4441
Fitz N, Kushlev K, Jagannathan R, Lewis T, Paliwal D, Ariely D. Batching smartphone notifications can improve well-being. Computers in Human Behavior. 2019 Dec 1;101:84-94.
Johnson AC, El Hajj SC, Perret JN, Caffery TS, Jones GN, Musso MW. Smartphones in medicine: emerging practices in an academic medical center. JMS. 2015 Jan;39(1):1-6.
Aggarwal M, Grover S, Basu D. Mobile phone use by resident doctors: Tendency to addiction-like behaviour. G J P. 2012;15(2):50-.
Throuvala MA, Griffiths MD, Rennoldson M, Kuss DJ. Mind over matter: testing the efficacy of an online randomized controlled trial to reduce distraction from smartphone use. IJERPH 2020 Jan;17(13):4842.
Uncapher MR, Thieu KM, Wagner AD. Media multitasking and memory: Differences in working memory and long-term memory. Psychonomic bulletin & review. 2016 Apr;23(2):483-90.
Rosen LD, Carrier LM, Cheever NA. Facebook and texting made me do it: Media-induced task-switching while studying. Computers in Human Behavior. 2013 May 1;29(3):948-58.
Eitivipart AC, Viriyarojanakul S, Redhead L. Musculoskeletal disorder and pain associated with smartphone use: A systematic review of biomechanical evidence. HKP Journal. 2018 Dec 14;38(02):77-90.
Solvoll T, Scholl J, Hartvigsen G. Physicians interrupted by mobile devices in hospitals: understanding the interaction between devices, roles, and duties. J Med Internet Res. 2013 Mar 7;15(3):e2473.
Zarandona J, With a smartphone in one's pocket: A descriptive cross-sectional study on smartphone use, distraction and restriction policies in nursing students. Nurse education today. 2019 Nov 1;82:67-73.
Wu R, Rossos P, Quan S, Reeves S, Lo V, Wong B, Cheung M, Morra D. An evaluation of the use of smartphones to communicate between clinicians: a mixed-methods study. J Med Internet Res. 2011 Aug 29;13(3):e1655.
Katz-Sidlow RJ, Ludwig A, Miller S, Sidlow R. Smartphone use during inpatient attending rounds: prevalence, patterns and potential for distraction. JHM. 2012 Oct;7(8):595-9.
Lee KE, Dependency on smartphone use and its association with anxiety in Korea. Public health reports. 2016 May;131(3):411-9.
Horwood S, Anglim J, Tooley G. Type D personality and the Five-Factor Model: A facet-level analysis. Personality and Individual Differences. 2015 Sep 1;83:50-4.
Sok SR, Seong MH, Ryu MH. Differences of self-control, daily life stress, and communication skills between smartphone addiction risk group and general group in Korean nursing students. Psychiatric Quarterly. 2019 Mar;90(1):1-9.
Aguilera-Manrique G, The relationship between nomophobia and the distraction associated with smartphone use among nursing students in their clinical practicum. PloS one. 2018 Aug 27;13(8):e0202953.
Oulasvirta A, Rattenbury T, Ma L, Raita E. Habits make smartphone use more pervasive. Personal and Ubiquitous computing. 2012 Jan;16(1):105-14.
Gill PS, Kamath A, Gill TS. Distraction: an assessment of smartphone usage in health care work settings. Risk management and healthcare policy. 2012;5:105.
Bientzle M, Restle A, Kimmerle J. Perception of Purposeful and Recreational Smartphone Use in Physiotherapy: Randomized Controlled Trial. J Med Internet Res 2021 Apr 21;9(4):e25717.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcarePreliminary Study on the Composition of Nanoparticles for the Treatment of Peptic Ulcer
English1625Shubhrajit MantryEnglish Sahil ShaikhEnglish Shubham ShindeEnglish Shital BidkarEnglish Ganesh DamaEnglishOne of the most frequent gastrointestinal issues is a gastric ulcer. Throughout their lives, peptic ulcer disease affects more than 10% of the adult population in Western countries. The pathogenesis of peptic ulcer disease is based on an imbalance between mucosal defense factors (bicarbonate, mucin, prostaglandin, nitric oxide, and other peptides and growth factors) and hazardous chemicals (acid and pepsin). Certain acid-related illnesses can be addressed and prevented by lowering gastric acidity or improving mucosal protection. In the treatment of stomach ulcers, nanoparticles are being developed for antiulcer drug delivery. Other treatments, such as nanotechnology, are gaining prominence as a result of the challenges in treating peptic ulcers. Different types of nanoparticles have strong antibacterial properties, polymeric nanoparticles have advantages in drug delivery and drug protection and membrane-coated nanoparticles have prominent properties of indirect targeting, demonstrating the importance of nanotechnology in the development of new peptic ulcer treatments. The pharmacokinetic performance and ulcer healing response of an antiulcer medicine in the form of nanoparticles were evaluated in Wistar rats with produced ulcers during characterization. The size distribution of the drug-filled particles was limited, with a size of approximately 200 nm.
EnglishProton Pump Inhibitor, Peptic Ulcers Disease, Gastro-intestinal track, Nanoparticles, Nonsteroidal Anti-inflammatory Drug, Nano- MaterialsIntroduction
Acids and pepsin cause ulcers on the lining of the duodenum and stomach, causing peptic ulcers (PUD). PUD is caused by an imbalance between protective factors such as prostaglandins, blood flow, and cell regeneration and aggressive factors such as alcohol abuse, smoking, Helicobacter pylori colonization, and the use of nonsteroidal anti-inflammatory drugs.1
Peptic ulcer (PUD) is a term used to describe a wound in the gastrointestinal tract (GIT) that reaches the inner, submucosal, and possibly outer muscle layers, causing perforation and death. Organ wall lead. The disease affects a significant portion of the world's population and increases public health costs. Ulcers are a common condition that affects people around the world. Symptomatic treatment of ulcers hurts health due to unpleasant side effects. Many herbs and secondary metabolites are currently used to treat ulcers.2
Traditional oral treatments are well known. However, drug degradation in the gastrointestinal environment, reduced oral bioavailability and lack of drug delivery to the target site can reduce the effectiveness of this treatment. After this approach, it becomes attractive to use tactics to improve the effectiveness of these traditional medicines.1 For better effect, the particle size of the formulation in the nanometer range is preferred for high penetration efficiency. Therefore, the composite material is prioritized over the nanoparticles formed. Nanomaterials are gaining importance in innovation due to their adjustable physical, chemical, and biological properties, and their superior performance compared to bulk materials. The size, composition, shape, and origin of nanomaterials are all factors that need to be considered.3
Role of nanoparticles in peptic ulcer-
Nanoscale devices less than 50 nanometresin diameter can easily penetrate most cells, while devices less than 20 nanometresin diameter can easily exit the blood arteries as they circulate through the body. Due to their small size, nanoscale devices can easily interact with biomolecules both on the surface and inside the cell. As a result, it is made of high molecular weight nanoparticles that can be used to treat ulcers.4The production of high molecular weight nanoparticles by high-speed homogenizer and ultrasonic technology increases the solubility and absorption of the drug, increasing its availability at the action site and the therapeutic index.5In peptic ulcers, sucralfate is a topically active chemical that combines with hydrochloric acid in the stomach in an acidic environment to produce a pasty, viscous crosslinker capable of serving as an acid buffer for up to 6 to 8 hours after a single dose in an acidic environment6. This project creates polymeric nanoparticles, reducing the available particle size and increasing treatment efficiency7. Due to the formation of a polymeric coating, the absorption rate is also increased in the stomach and intestine.8 Using an ultrasonic homogenizer is very efficient in reducing soft and hard particles. Homogeneity is based on cavitation9. When a liquid undergoes intensive sonication, the sound waves propagate through the liquid, causing alternating high-pressure and low-pressure cycles (approximately 20,000 cycles/sec).10
The epithelium of the small and large intestines is in intimate contact with ingested material to absorb nutrients. Disaccharides, peptides, fatty acids, and monoglycerides are produced in the small intestine, then converted and absorbed in the villi. Due to electrostatic repulsion and trapping means, charged particles such as carboxylate polystyrene nanoparticles or those made from positively charged polymers have limited oral bioavailability 11. The smaller the diameter of the particles, the faster they can pass through the mucus and reach the colon cells; a Diameter of 14 nm penetrates in 2 min, the diameter of 415 nm penetrates in 4 min. particles look 30 min while 1000 nm particles cannot shift this barrier.12
Ulcer Anatomy & Pathophysiology-
An ulcer is a continuous rupture of the covering epithelium, whether it is the skin or the mucosa, due to molecular death. An ulcer is a rupture or rupture of the inner lining of the body that prevents a membrane-bound organ from continuing to function normally. An imbalance between protective and destructive factors in the gastrointestinal tract lining causes peptic ulcer disease. duodenum (PUD). Risk factors for PUD include H. pylori infection, NSAID use, first-degree relative with PUD, migration from developed countries, and African-American/Hispanic ethnicity. A mucosal defect extending to the muscular mucosa is common with peptic ulcers. The inner layers are susceptible to acid when the mucous membrane that protects the surface is damaged. The ability of mucosal cells to release bicarbonate is also impaired. H. pylori is known to localize and inflame the gastric mucosa. H. pylori also inhibits bicarbonate release, promotes metabolism, and increases gastric acidity.12
Preliminary test for peptic ulcer-
Stool monoclonal antigen tests-
When using a laboratory-certified monoclonal test, fecal antigen screening uses a monoclonal antibody that is as accurate as of the urea breath test 16. The urea breath test is more expensive and requires more equipment. Similar to how a urea breath test only detects an existing infection, a stool antigen test can be used as a curative test. PPIs should avoid for two weeks before testing, but stool antigen testing is not as affected as urea breath tests using PPIs. 17
Mechanism of Action of drug -
Finally, PPIs work by reducing gastric acid secretion. These drugs are absorbed near the small intestine and then released into the circulation, where they affect the stomach’s parietal cells.18 The enzyme H+/K+ ATPase, or proton pump, is found in parietal cells and is blocked by PPIs. The penultimate stage in gastric acid secretion is this enzyme. PPIs are active precursors in the acid-secreting tubules of parietal cells only after acid-catalyzed cleavage. PPIs are broken down by the liver enzyme P450.19 Though there are slight differences in which the P450 enzyme predominates in breaking down some PPIs, CYP2C19 is the most common.14Understanding how PPIs are metabolized can help us understand why certain PPIs work better for some people than others. For example, people of Asian descent have higher bioavailability of PPIs and should start at a lower dose. The bioavailability of PPIs increases with age. Therefore, the dosage in the elderly should be checked frequently and changed as necessary. PPIs are the most effective drugs to reduce acid production in the stomach.15
Figure. 3 - Schematic representation of the major pathophysiological mechanisms involved in the pathogenesis of peptic ulcer disease and the sites of action of the most commonly used pharmacological treatment options for peptic ulcer disease. CCK2 = cholecystokinin receptor; PGE2 = prostaglandin E2; PGI2 = prostaglandin I2; EP3 = prostaglandin E3 receptor; HIST = histamine. 21
Role of additives for nanoparticles drug targeting-
Organic Solvent-
Organic solvents recognized as neurotoxins include hexane, tetrachlorethylene, and toluene. Fatty and aromatic hydrocarbons, amines, esters, ethers, ketones, and nitrated or chlorinated hydrocarbons are all examples of organic solvents.16
Polymer-
Allows the modification of ligand surfaces for stealth and drug delivery, ensuring the stability of labile molecules. e.g. Gelatine, lecithin, albumin17.
Surfactant-
Surfactants reduce the average particle size by changing the surface energy of the particles. As a result, the surface tension decreases, and the Kelvin barrier changes, allowing more particles to avoid agglomeration18.
Aq. Solvent-
The aq. Solvents are used to dissolve the surfactant and form a solution19.
Production technique used in particles –
Solvent Evaporation Method –
Solvent evaporation was the original approach to producing macromolecular NPs from a prefabricated polymer. The production of an oil-in-water (o/e) emulsion is required for this process, which leads to the synthesis of nanoparticles 25. The whole process is described, to begin with, an organic phase is produced using a polar organic solvent, in which the polymer is dissolved and the active ingredient (eg a drug) is decomposed. canopy. Both chloroform and dichloromethane have been used extensively in the past, but more often in the past. Due to their toxicity, they have been replaced by ethyl acetate, which is more toxic and therefore more suitable for biomedical applications 20. Aqueous phases containing surfactants (eg polyvinyl acetate; PVA) were also frequently produced. The organic solution is emulsified in the aqueous phase with a detergent and processed into a nanodroplet dispersion using high-speed homogenization or ultrasonic waves. Evaporation of the polymeric solvent that can diffuse into the continuous phase of the emulsion results in a suspension of NP. The solvent is expelled either by continuous magnetic stirrer at room temperature (for more polar solvents) or constant depressurization (as for dichloromethane and chloroform). The cured nanoparticles can then be washed and collected by centrifugation, and after the solvent has evaporated, they can be lyophilized for long-term storage21.
Emulsions - Diffusion Method-
This is due to Leroux et al. The patented approach is a modified version of the salting-out process. The polymer was dissolved in a water-miscible solvent (propylene carbonate, benzyl alcohol) and then the solution was saturated with water 28. The solvent phase saturated with polymer water is emulsified into an aqueous solution containing stabilizers29. Then the solvent is removed by evaporation or filtration 30. The advantages of this approach are excellent encapsulation efficiency (typically 70%), minimal homogenization requirements, high batch-to-batch reproducibility, easy scaling, simplicity, and limited size distribution31. The leakage of water-soluble drugs into the saturated aqueous outer phase during emulsification reduces encapsulation efficiency, which is a drawback of this approach 32.
Characterization of nanoparticles-
Morphology-
Scanning and transmission electron microscopes (SEM and TEM) are widely used to learn more about the shape and size of polymer NPs. To analyse the morphology of NP, NP is often used in combination with cryofracture technology. Electron microscopy (TEM) is often used to distinguish between nanocapsules and nanospheres and to measure the wall thickness of nano-capsules. Nanospheres have a spherical, solid polymer structure, while nano-capsules have an oily core surrounded by a thin polymer shell (about 5 nm). Atomic force microscopy is another approach that has been used to analyse the surface morphology of macromolecular NPs (AFMs)33.
Particle size and size distribution-
Microspheres were suspended in liquid paraffin and observed with an optical microscope. The size distribution of the microsphere was investigated using laser diffraction technology (Malvern Instruments Ltd., Malvern, UK). Average particle size was calculated and reported in micro-meters using cyclohexane as a dispersant 34.
The yield of Nanoparticles-
The total weight of the nanoparticles produced was compared to the total weight of the copolymer and the drug to calculate the nanoparticle yield. 35
Entrapment efficiency-
The nanoparticles were separated from the dispersion by centrifugation at 22,000 rpm for 25 min. The supernatant obtained after centrifugation was appropriately diluted and analysed for free diazepam by UV-Visible spectrophotometer at specific nanometres. The trap effectiveness percentage is calculated as follows 36
Drug Content analysis-
Properly weigh 10 mg of microspheres into a clean 100 ml volumetric flask, dissolve in approximately 2 ml of acetone, adjust the volume with a pH 7.4 buffer, then increase the volume with a pH 7.4 buffer for marking. Rice field. completely. After filtration and dilution, samples were analysed spectrophotometrically to estimate drug concentrations in microspheres. The drug content of each sample was averaged in three separate tests. The containment efficiency of microspheres was estimated by dividing the actual drug content by the theoretical drug content of microspheres 37
Stability of Nanoparticles-
The storage of optimal formulations at 4°C 1°C and 30°C 2°C in a stabilization chamber for 90 days determines the stability of the resulting nanoparticles. Samples were examined for drug content, drug release rate (t50%), and any changes in appearance after some time, such as 0, 1, 2, and 3 months 38
Drug-Excipients Compatibility Studies-
Excipients are essential components of almost all pharmaceutical dosage forms, so it is essential to investigate any physical or chemical interactions between the drug and the excipients, as excipients can change in drug bioavailability and stability. To create a product that is stable, effective, attractive, easy to use, and safe, drugs and excipients must be compatible. Compatibility studies are especially important if the excipients are new and have never been used in formulations containing the active ingredient. To test drug compatibility with different excipients used, DSC and FTIR techniques have been widely used 39
Pharmacokinetic study-
We generated three groups of four Wistar rats (250-300 g) with ulcers. Drugs with NaHCO3 solution (5 mg/kg) or drug formulation (5 mg/kg) were administered to Wistar rats. Blood samples were obtained from the tail vein of each rat before drug treatment and at levels of 0.5, 1, 1.5, 2, 3, 4, 5, 6, 8, 10, 12, and 24 h after dosing. The supernatant was collected after centrifugation of the blood sample at 12,000 rpm for 10 min at 4 °C. Using acetonitrile and centrifugation, the drug formulation of each sample was extracted. The supernatant was collected, dried, and reconstituted using the mobile phase for HPLC analysis. The number of drug formulations that can be recovered from serum samples has been calculated. Using a non-inhibitory pharmacokinetic analysis model, pharmacokinetic parameters were calculated.40
Pharmacodynamic study-
Wistar rats with ulcer-induced ulcers were divided into four groups (n = 4) and received saline (control group), drug solution, or capsule containing the drug formulation. For 7 days, the formulations were administered orally once daily. After 24 h, the mice were dead. The stomach was sectioned along the greatest curvature and its mucosal surface was cleaned with saline solution 40. The total mucosal area and ulcerated area were measured using Axio Vision software after imaging the gastric mucosa. The equation used to determine ulcer index (IU)
Biodistribution of nanoparticles in stomach tissue-
Male Wistar rats weighing 250-300 gms were used in this investigation, and they were obtained from the local Laboratory Animal Center. All animal experiments followed the National Institutes of Health Guidelines for the Care and Use of Laboratory Animals, and all procedures were reviewed by the Animal Research Ethics Board. During the night, the rats were fasted but were given free water. Oral doses of 100% ethanol (5 ml/kg) cause gastric ulcers. The ulcer-induced mice were divided into three groups, with four mice each (one control and two treatment groups). The treatment groups received ready-to-use drugs, while the control groups received only physiological saline. Formulas were used orally 1 h after ethanol administration40 Four after receiving the dose, the rats were slaughtered. The stomach is opened longitudinally and saline solution is rubbed. Stomach tissue was divided into ulcerated and non-ulcerative sections, and freshly removed tissue was frozen using Tissue Tek. A CM3050 S cryostat was used to segment the molded tissue sample, which was then examined under a fluorescence microscope with an integrated digital microscopy system.41 Hematoxylin and eosin were also stained with hematoxylin and eosin to show healthy and ulcerated tissue morphology. The total mucosal area and ulcerated area were measured using Axio Vision software for quantitative determination. Ulcerated and non-ulcerative tissues were lyophilized separately in the dark. Each tissue sample was sonicated for 15 min after immersion in acetone. The supernatant was obtained after centrifugation of those tissue samples for 5 min at 2000 pm. Three times the extraction process was performed. Finally, the supernatant was diluted with acetone and examined with a fluorescence spectrometer at 430 nm and 490 nm. The absorption ratio of nanoparticles per cm2 of gastric tissue, whether ulcerated or not, was used to calculate the absorption of nanoparticles. 42
Discussion-
According to evaluations of multiple papers, reducing the particle size of the dosage form increases porosity and permeability, which increases bioavailability and therapeutic efficacy, and this phenomenon is useful for treating peptic ulcers. Proton pump inhibitors are the best category of the drug in polymeric nanoparticle form, according to the review, and produce better results than other drug categories. When standard dose forms are compared to novel drug delivery systems (NDDS) dosage forms, we discover that NDDS is more effective and patient compliance is higher.
Conclusion-
We can treat PU with high drug potency, bioavailability and efficacy by using formulations containing NPs, resulting in reduced dosing frequency. A lot of research has been done to better understand how nanoparticles heal peptic ulcers, but one of the 4,444 hardest parts of characterizing is their microscopic size. The charge carriers are about 200 nm in size and narrow in size distribution. Nano-sized devices with a diameter of fewer than 50 nanometres can easily enter most cells, while those with a diameter of fewer than 20 nanometres can easily exit blood arteries as they travel. in the body. Nanoscale devices can easily interact with biomolecules both on the surface and inside cells due to their small size.
Acknowledgment-
The authors express their sincere gratitude to Sharad Chandra Pawar College of Pharmacy, College of Pharmacy, Our, University Libraries, and all other sources for their cooperation and advice in writing this review.
Source of Funding-
Self-Finance
Conflict of Interest: Nil
Author Contribution-
All authors contributed equally towards the data collection, data analysis & compilations.
Englishhttp://ijcrr.com/abstract.php?article_id=4442http://ijcrr.com/article_html.php?did=4442[1] Spósito L, Fortunato GC, Furquiim de CamargoBA, Dos Santos MA, de Souza PMC, Meneguin AB, et al. Exploiting drug delivery systems for an oral route in the peptic ulcer disease treatment,” J. Drug Target., vol. 0, no. 0, pp. 1–19, 2021, doi: 10.1080/1061186X.2021.1904249.
[2] Singh AK, Singh SK, Singh PP, Srivastava AK, Pandey KD, Kumar A, et al. “Biotechnological aspects of plants metabolites in the treatment of ulcer: A new perspective,” Biotechnol. Reports, vol. 18, p. e00256, 2018, doi: 10.1016/j.btre.2018.e00256.
[3] Chaubey P, Mishra B, “Mannose-conjugated chitosan nanoparticles loaded with rifampicin for the treatment of visceral leishmaniasis,” Carbohydr. Polym., vol. 101, no. 1, pp. 1101–1108, 2014, doi: 10.1016/j.carbpol.2013.10.044.
[4] El-Bialy T, Nanotechnology in Orthodontics-2: Facts and Possible Future Applications. Elsevier Inc., 2012.
[5] Guardia P, Batle-Brugal B, Roca AG, Iglesias O, Morales MP, Serna CJ et al., “Surfactant effects in magnetite nanoparticles of controlled size,” J. Magn. Magn. Mater., vol. 316, no. 2 SPEC. ISS., pp. 756–759, 2007, doi: 10.1016/j.jmmm.2007.03.085.
[6] Lv Q, Zhang B, Xing X, Zhao Y, Cai R, Wang W et al., “Biosynthesis of copper nanoparticles using Shewanella lochia PV-4 with antibacterial activity: Novel approach and mechanisms investigation,” J. Hazard. Mater., vol. 347, no. 2010, pp. 141–149, 2018, doi: 10.1016/j.jhazmat.2017.12.070.
[7] Wang Y, Li P, Tran TTD, Zhang J, Kong L. “Manufacturing techniques and surface engineering of polymer-based nanoparticles for targeted drug delivery to cancer,” Nanomaterials, vol. 6, no. 2, 2016, doi: 10.3390/nano6020026.
[8] Zielinska A, Carreiro F, Oliveira AM, Neves A, Pires B, Nagaswamy Venkatesh D, et al. “Polymeric Nanoparticles: Production, Characterization, Toxicology and Ecotoxicology,” Molecules, vol. 25, no. 16, 2020, doi: 10.3390/molecules25163731.
[9] Kang Y, Huang Y, Yang R, Zhang C. “Synthesis and properties of core-shell structured Fe(CO)5/SiO2 composites,” J. Magn. Magn. Mater., vol. 399, pp. 149–154, 2016, doi: 10.1016/j.jmmm.2015.09.061.
[10] Nassif M, Elaskary FS. “Nanotechnology and Nanoparticles in Contemporary Dental Adhesives,” Nanobiomaterials Clin. Dent., pp. 131–164, 2012, doi: 10.1016/B978-1-4557-3127-5.00007-6.
[11] Brooks FP, "The pathophysiology of peptic ulcer disease," Dig. Dis. Sci., vol. 30, no. 11 Supplement, pp. 15–29, 1985, doi: 10.1007/BF01309381.
[12] Hasnath Siddique DRA, “Prevalence of Peptic Ulcer Disease among the Patients with Abdominal Pain Attending the Department Of Medicine in Dhaka Medical College Hospital, Banglades et. al, ” IOSR J. Dent. Med. Sci., vol. 13, no. 1, pp. 05–20, 2014, doi: 10.9790/0853-13190520.
[13] Kron J,“Peptic ulcer disease,” J. Complement. Med., vol. 7, no. 1, pp. 12–19, 2008, doi: 10.1300/j100v01n03_04.
[14] Ivanova N, Gugleva V, Dobreva M, Pehlivanov I, Stefanov S, Andonova V, et al. Pathophysiology of Gastric Ulcer Development and Healing: Molecular Mechanisms and Novel Therapeutic Options," Intech, vol. I, no. tourism, pp. 114–142, 2016.
[15] Snowden FM, "Emerging and reemerging diseases: a historical perspective. (Special Issue: Immunology of emerging infections.)," Immunol. Rev., vol. 225, pp. 9–26, 2008.
[16] Low VHS. “Peptic ulcer disease,” Abdom. Imaging, vol. 9783642133, pp. 383–390, 2013, doi: 10.1007/978-3-642-13327-5_18.
[17] Fisher J, Gitu AC. Diagnosis and treatment of peptic ulcer disease and H. pylori infection," Am. Fam. Physician, vol. 91, no. 4, pp. 236–242, 2015.
[18] Moayyedi P, Talley NJ, Fennerty MB, Vakil N, et al., “Can the clinical history distinguish between organic and functional dyspepsia?” J. Am. Med. Assoc., vol. 295, no. 13, pp. 1566–1576, 2006, doi: 10.1001/jama.295.13.1566.
[19] A. T. Chatila, M. Bilal, and P. Guturu, et al., “Evaluation and management of acute pancreatitis,” World J. Clin. Cases, vol. 7, no. 9, pp. 1006–1020, 2019, doi: 10.12998/wjcc.v7.i9.1006.
[20] Gomes CA, Junior CS, Di Saverio S, Gomes CC, Sartelli M, Kelly MD et al. “Acute calculous cholecystitis: Review of current best practices,” World J. Gastrointest. Surg., vol. 9, no. 5, p. 118, 2017, doi: 10.4240/wjgs.v9.i5.118.
[21] G. R. Lichtenstein,Proton pump inhibitors,” Gastroenterol. Hepatol., vol. 14, no. 3, p. 135, 2018.
[22] El Rouby N, Lima JJ, Johnson JA, et al. “Proton pump inhibitors: from CYP2C19 pharmacogenetics to precision medicine,” Expert Opin. Drug Metab. Toxicol., vol. 14, no. 4, pp. 447–460, 2018, doi: 10.1080/17425255.2018.1461835.
[23] Taheri PA, Mahdianzadeh F, Shariat M, Sadeghi M. “Combined therapy in gastroesophageal reflux disease of term neonates resistant to conservative therapy and monotherapy: A clinical trial,” J. Pediatr. Neonatal Individ. Med., vol. 7, no. 2, pp. 1–8, 2018, doi: 10.7363/070201.
[24] E. E. Guidelines “Entitlement Eligibility Guidelines Peptic Ulcer Disease,” no. February 2005.
[25] Boselli l, Lopez H, Zhang W, Cai Q, Giannone VA, Li J et al., “Classification and biological identity of complex nano shapes,” Commun. Mater., vol. 1, no. 1, pp. 1–12, 2020, doi: 10.1038/s43246-020-0033-2.
[26] Smitha KT, Nisha N, Maya S, Biswas R, Jayakumar R. “Delivery of rifampicin-chitin nanoparticles into the intracellular compartment of polymorphonuclear leukocytes,” Int. J. Biol. Macromol., vol. 74, pp. 36–43, 2015, doi: 10.1016/j.ijbiomac.2014.11.006.
[27] Tiwari AD, Mishra AK, Mishra SB, Kuvarega AT, Mamba BB. “Stabilisation of silver and copper nanoparticles in a chemically modified chitosan matrix,” Carbohydr. Polym., vol. 92, no. 2, pp. 1402–1407, 2013, doi: 10.1016/j.carbpol.2012.10.008.
[28] Yadi M, Mostafavi E, Saleh B, Davaran S, Aliyeva I, Khalilov R, et al. “Current developments in green synthesis of metallic nanoparticles using plant extracts: a review,” Artif. Cells, Nanomedicine Biotechnol., vol. 46, no. sup3, pp. S336–S343, 2018, doi: 10.1080/21691401.2018.1492931.
[29] Bohrey S, Chourasiya V, Pandey A. “Polymeric nanoparticles containing diazepam: Preparation, optimization, characterization, in-vitro drug release and release kinetic study,” Nano Converg., vol. 3, no. 1, pp. 3–9, 2016, doi: 10.1186/s40580-016-0061-2.
[30] Arnaud Mayence.Design and characterization of nanoparticles and their assemblies. 2016.
[31] Pal SL, Jana U, Manna PK, Mohanta GP, Manavalan R. “Nanoparticle: An overview of preparation and characterization,” J. Appl. Pharm. Sci., vol. 1, no. 6, pp. 228–234, 2011.
[32] Lohat SK, Kumar S, Gaba P. “An Overview: Preparation Characterization and Applications of Nanoparticles,” J. Drug Deliv. Ther., vol. 10, no. 6-s, pp. 159–167, 2020, doi: 10.22270/jddt.v10i6-s.4398.
[33] Krukemeyer MG, Kren V, Huebner F, Wagner W, Resch R. “History and Possible Uses of Nanomedicine Based on Nanoparticles and Nanotechnological Progress,” J. Nanomed. Nanotechnol., vol. 06, no. 06, 2015, doi: 10.4172/2157-7439.1000336.
[34] Harrison ME, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Cash BD et al., “The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction,” Gastrointest. Endosc., vol. 71, no. 4, pp. 669–679, 2010, doi: 10.1016/j.gie.2009.11.027.
[35] Betala S, Varma MM, Abbulu K.Formulation and Evaluation of Sustained Release Microspheres of Metoprolol,” Int. Res. J. Pharm., vol. 8, no. 11, pp. 103–108, 2017, doi: 10.7897/2230-8407.0811226.
[36] Tiruwa R. “A review on nanoparticles – preparation and evaluation parameters,” Indian J. Pharm. Biol. Res., vol. 4, no. 2, pp. 27–31, 2016, doi: 10.30750/ijpbr.4.2.4.
[37] Datta N, Pal M, Roy U, Mitra R, Pradhan A. “WJPR,” Infection, vol. 13, no. 10, p. 15, 2014, doi: 10.20959/wjpr201810-12383.
[38] Ito Y, Arai H,Uchino K, Iwasaki K,Shibata N, Takada K, et al., “Effect of adsorbents on the absorption of lansoprazole with surfactant,” Int. J. Pharm., vol. 289, no. 1–2, pp. 69–77, 2005, doi: 10.1016/j.ijpharm.2004.10.010.
[39] Alai M.“Application of nanoparticles for oral delivery of acid-labile lansoprazole in the treatment of gastric ulcer: In vitro and in vivo evaluations,” Int. J. Nanomedicine, vol. 10, no. 2, pp. 4029–4041, 2015, doi: 10.2147/IJN.S82366.
[40] Payab S, Davaran S, Tanhaei A, Fayyazi B, Jahangiri A, Farzaneh A et al. “Triamcinolone acetonide-Eudragit® RS100 nanofibers and nanobeads: Morphological and physicochemical characterization,” Artif. Cells, Nanomedicine Biotechnol., vol. 44, no. 1, pp. 362–369, 2016, doi: 10.3109/21691401.2014.953250.
[41] Kuna L, Jakab J, Smolic R, Raguz-Lucic N, Vcev A, Smolic M, et al., “Peptic ulcer disease: A brief review of conventional therapy and herbal treatment options,” J. Clin. Med., vol. 8, no. 2, 2019, doi: 10.3390/jcm8020179.
[42] Comoglu T, Gonul N, Dogan A, Basci N. “Development and in vitro evaluation of pantoprazole-loaded microspheres,” Drug Deliv., vol. 15, no. 5, pp. 295–302, 2008, doi: 10.1080/10717540802006864.
[43] Hoa LTM, Chi NT,Nguyen LH, Chien DM. “Preparation and characterization of nanoparticles containing ketoprofen and acrylic polymers prepared by emulsion solvent evaporation method,” J. Exp. Nanosci., vol. 7, no. 2, pp. 189–197, 2012, doi: 10.1080/17458080.2010.515247.
[44] Hoa LTM, Chi NT, Triet NM, Nhan LNT, Chien DM. “Preparation of drug nanoparticles by an emulsion evaporation method,” J. Phys. Conf. Ser., vol. 187, pp. 1–4, 2009, doi: 10.1088/1742-6596/187/1/012047.
[45] Poovi G. “Preparation and characterization of Rapaglinide Loaded Chitosan Polymeric Nanoparticles,” IEEE Nanotechnol. Mag., vol. 5, no. 1, p. 3, 2011, doi: 10.1109/MNANO.2010.939835.
[46] Ghaderi S, Ghanbarzadeh S, Hamishehkar H "Evaluation of different methods for preparing nanoparticle-containing gamma oryzanol for potential use in food fortification," Pharm. Sci., vol. 20, no. 4, pp. 130–134, 2015, doi: 10.5681/PS.2015.001.
[47] Guo S, Liang Y, Liu L, Yin M, Wang A, Sun K et al. “Research on the fate of polymeric nanoparticles in the process of the intestinal absorption based on model nanoparticles with various characteristics: size, surface charge and pro-hydrophobics,” J. Nanobiotechnology, vol. 19, no. 1, pp. 1–21, 2021, doi: 10.1186/s12951-021-00770-2.
[48] Osorio R, Alfonso-Rodríguez CA, Medina-Castillo AL, Alaminos M,Toledano M. “Bioactive polymeric nanoparticles for periodontal therapy,” PLoS One, vol. 11, no. 11, pp. 1–18, 2016, doi: 10.1371/journal.pone.0166217.
[49] Hussain M.“Formulation and evaluation of Ethambutol polymeric Nanoparticles,” Int. J. Appl. Pharm., vol. 12, no. 4, pp. 207–217, 2020.
[50] Nagarajan E, Shanmugasundaram P, Ravichandiran V, Vijayalakshmi A, Senthilnathan B, Masilamani K, et al. “Development and evaluation of chitosan-based polymeric nanoparticles of an antiulcer drug Lansoprazole,” J. Appl. Pharm. Sci., vol. 5, no. 4, pp. 20–25, 2015, doi: 10.7324/JAPS.2015.50404.
[51] Kaushik A, Sharma HK.“FORMULATION AND EVALUATION OF CETUXIMAB LOADED POLYMERIC NANOPARTICLES,” IJPSR, vol. 10, no. 1, pp. 1–23, 2016, doi: 10.13040/IJPSR.0975-8232.10(1).266-71.
[52] Rodrigues DF, Do Couto RO, Sinisterra RD, de Jensen CE. “Novel eudragit-based polymeric nanoparticles for sustained release of simvastatin,” Brazilian J. Pharm. Sci., vol. 56, pp. 1–12, 2020, doi: 10.1590/s2175-97902019000418363.
[53] Tavares EJM, De Araújo DR, Fraceto LF. “Ivermectin-loaded polymeric nanoparticles: Screening the effects of polymers, methods, and the usefulness of mathematical models,” J. Nanosci. Nanotechnol., vol. 17, no. 6, pp. 4218–4234, 2017, doi: 10.1166/jnn.2017.13111.
[54] El Hady WEA, Mohamed EA, El-Aazeem Soliman OA,El-Sabbagh HM. “In vitro-in vivo evaluation of chitosan-PLGA nanoparticles for potentiated gastric retention and anti-ulcer activity of diosmin,” Int. J. Nanomedicine, vol. 14, pp. 7191–7213, 2019, doi: 10.2147/IJN.S213836.
[55] Safarov T, Kiran B, Bagirova M, Allahverdiyev AM, Abamor ES. “An overview of nanotechnology-based treatment approaches against Helicobacter Pylori,” Expert Rev. Anti. Infect. Ther., vol. 17, no. 10, pp. 829–840, 2019, doi: 10.1080/14787210.2019.1677464.
[56] Jain AK, Jain SK. “Development and characterization of nanolipobeads-based dual drug delivery system for H. Pylori targeting,” vol. 2330, no. 6, pp. 593–603, 2013, doi: 10.3109/1061186X.2013.784978.
[57] Ramesh KD, Amol K, Jaydeep P.“Formulation and in-vitro Evaluation of floating tablets of Antibiotics used in the treatment of Peptic ulcer,” vol. 11, no. 1, pp. 1–7, 2021, doi: 10.5958/2231-5713.2021.00004.0.
[58] Kumar PR, Doddayya H, Reddy SR. “Design and evaluation studies on novel floating tablets for peptic ulcer treatment,” J. Adv. Pharm. Educ. Res. 2, vol. 176, no. 2, pp. 159–176, 2011.
[59] Jain S, Jain N, Kor ML, Kumar UK, Jain AK. “Development and optimization of mucoadhesive microballons of nizatidine for management of peptic ulcer,” Pharm. Sci. Dev. Res., vol. 6, pp. 21–29, 2020.
[60] Strasser M, Noriega P, Löbenberg R, Bou-Chacra N, Bacchi EM. “Antiulcerogenic potential activity of free and nanoencapsulation Passiflora serratodigitata L. extracts,” Biomed Res. Int., vol. 2014, 2014, doi: 10.1155/2014/434067.
[61] Patel DJ, Patel JK. “Design and Evaluation of Famotidine Mucoadhesive Nanoparticles for Aspirin Induced Ulcer Treatment,” no. June 2014, 2013, doi: 10.1590/S1516-89132013000200007.
[62] Gupta R, Prajapati SK, Pattnaik S, Bhardwaj P. “Formulation and evaluation of novel stomach specific floating microspheres bearing famotidine for treatment of gastric ulcer and their radiographic study,” Asian Pac. J. Trop. Biomed., vol. 4, no. 9, pp. 729–735, 2014, doi: 10.12980/APJTB.4.201414B73.
[63] Radwan MF, El-moselhy MA, Alarif WM, Orif M, Alruwaili NK, Alhakamy NA. “Optimization of Thymoquinone-Loaded Self-Nanoemulsion for Management of Indomethacin-Induced Ulcer,” Dose-Response An Int. Journal, vol. 1, no. June, pp. 1–9, 2021, doi: 10.1177/15593258211013655.
[64] H. Journals, Formulation and Evaluation of Novel Drug Delivery System for Treatment of Peptic Ulcer,” no. 1, 2017.
[65] Bangun H. “Anti-ulcer effect of gastroretentive Drug Delivery system of Alginate Beads Containing Turmeric Extract Solid Dispersion,” Mathcad J Med Sci, vol. 05, no. Jan, pp. 19–27, 2021.
[66] Chaudhary R, Basavaraj BV, Bharath S, Deveswaran R. "Extended-Release Gastro Retentive Mucoadhesive Bilayer Tablet of an Anti-Ulcer Drug," MSRUAS-SASTech Journal, vol. 15, no. 1, pp. 41–44.
[67] Mahurkar N, Sayeed SM.“Synergistic Antiulcer Effect of Melatonin and Esomeprazole Combination in Pylorus Ligation, Ethanol, Aspirin-induced Peptic Ulcers,” Asian J. Pharm. Res., vol. 5, no. 1, pp. 10–14, 2015, doi: 10.5958/2231-5691.2015.00002.7.
[68] Bhalekar MR, Kadam NM, Patil NH, Gawale NS, Madgulkar A.Novel ion-exchange resin-based combination drug-delivery system for treatment of gastroesophageal reflux diseases, Braz J. Pharm Sci. 46 (2) June 2010
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareRecent Insight and the Utility of Proniosom for the Treatment of Acne Vulgaris
English2630Shubhrajit MantryEnglish Siddhi PanhaleEnglish Alim MominEnglish Sahil ShaikhEnglish Ganesh DamaEnglishThe dispersion of niosomes and liposomes are at significant risk of aggregation, fusion and encapsulated drug discharge. The proniosomal could be a dry granular substance that dissolves in water to generate a noisome suspension. Proniosomes offer an advantage over niosomes due to the reduction of physical instability issues such as agglomeration, amalgamation, and discharge or reactivity of the encapsulated medication. It is simple to carry, distribute, store, handle, and dose. Proniosome show equal or larger effectiveness in drug unhitch performance once placed next with developed typical niosomes. The most effective challenge with topical drug delivery is the differing types of nature of skin that restrict the entry of most medication. The proteasomes acted as a consequence of the most effective vesicles in dermal drug delivery due to their nanometer size, stability, and their elastic nature. They acted as a drug applicator to deliver entrapped drug molecules into or across the skin and, due to individual supermolecule elements, to inflated penetration into the horny layer and so the alteration of the physical object supermolecule lamellae within the layer of skin. Suspension technique, slow spray coating technique & Coacervation half separation technique unit the methodologies that unit accustomed formulate proniosome.
EnglishAcne vulgaris, Antiacne activity, Transdermal route, Proniosomal gel, Niosomes, SkinINTRODUCTION
The main issue with topical drug administration is the skin's barrier nature, which prevents most medicines from entering. The proniosomes acted because the best vesicles in dermal drug delivery because of their micro-millimeter size and their elastic nature.1 They acted as a drug applicator to deliver entrapped drug molecules into or across the skin and, thanks to the individual lipid parts, increased penetration into the stratum and, later, the alteration of the animate thing lipid lamellae among the skin layer. Most parts of proniosomes square measure a surface-active agent, membrane stabilizer, and carrier. Carriers allow the flexibleness within the magnitude relation of surface-active agent and different parts incorporated. They increase the extent and enhance economical loading e.g., sorbitol, mannitol, glucose, lactose. However, owing to its low bioavailability, it has a limited market presence. The stratum route is conventionally used because it is agreeable and safe, and it has more advantages than the traditional indeterminate quantity type, such as GI conflict, variable GI immersion, enhanced bioavailability, reduced frequency of administration, and improved patient adherence. Niosomes, or nonionic surface-active agent vesicles, are tiny lamellar structures formed by combining nonionic surface-active agent, cholesterin, and diacetyl phosphoric acid with the intention of future interaction in binary compound media. Throughout dispersion, each niosomes and liposome square measure at high risk of agglomeration, fusion, and run of encapsulated drug. A promising product, known as the proniosome, might be a dry granular substance that dissolves in water to form a noisome solution. Proniosomes provide several advantages over niosomes, including the reduction of physical instability issues such as aggregation, fusion, and run, as well as the chemical reaction of encapsulated drugs. It also allows for simple transport, distribution, storing conditions, and an unlimited amount. Proniosomes have shown similar or higher efficacy in drug unleash performance than regular niosomes. Proniosomes often contain non-polar surfactants such as span 20, 40, 60, 80, and 85, tween 20, 40, 60, 80, emulsifier, alcohol (ethanol, methanol, and isopropyl alcohol), and chloroform. The majority of surface-active agents that are used to make non-ionic surface-active agent vesicles have a solubility of coffee binary compound. However, in the presence of cholesterin, freely soluble non-polar surfactants such as tween will type the micelles on association.2
a) Cholesterol content in proniosomal formulations could affect vesicle stability and pore size.
b) Sterol-containing formulations improve drug defense potency as compared to formulations that only contain emulsifiers.
c) The use of an emulsifier in a composition necessitates particular handling during formulation and storage, making the product less stable and expensive.3
Acne vulgaris-
Skin inflammation is an ongoing disruption of the oil gland vesicle that affects the first half of a person's life. Acne causes a sort of lesions. It should leave scars once regression and it's outlined by the alteration of intervals of exacerbation and stability.4 Spontaneous regression generally happens once age twenty, however, some sufferers could preserve suffering at some stage in adult life. The foremost common drug won’t to the treatment for acne in an exceeding style of the stratum. The rationale for mistreatment gel formulation they're typically additional active and stable and water-based gel is less botheration, therefore it's most well-liked than lotions.5
Causes-
1. Excess production of sebum (oil) from the sebaceous gland.
2. Bacteria
3. Hormonal imbalance
4. Dead skin cells
5. Ingrown hairs.6
MATERIALS OF PRONIOSOMES-
Surfactant-
Surfactants are surface-active organic molecules that are naturally amphiphilic. They must perform a variety of tasks, including solubilizing agents, wetting agents, emulsifying agents, and porousness enhancers. The HLB value of a wetting agent is important for the vesicle's dominant drug defense. Because deliquescent oleophilic balance is a compatible predictor of a wetting agent's potential to generate vesicles, hlb varieties four to eight were found to be balanced with vesicle production.7
Carrier-
The carrier used in the preparation of proniosomes allows for flexibility in the quantitative relationship of wetter and other included materials. Additionally to the current, it will increase the expanse and therefore economic loading. The carriers must be secure and non-toxic, free-flowing, have a low solubility in the loaded mixture resolution, and have a high water solubility for simple associations. The most often used carriers are mentioned as follow.
Malodextrin
Sorbitol
Spray-dried lactose.
Glucose monohydrate.
Lactose monohydrate.
Sucrose stearate.7
Solvent and Aqueous Phase-
Alcohol significantly impacts drug permeation rate and vesicle size in proniosomes. The size of vesicles generated from various alcohols varies, and they are arranged in the following order:
Ethanol > propanol > Butanol > isopropanol.
The aqueous phase in the preparation of proniosomes is phosphate buffer 7.4, 0.1 percent glycerol, and hot water.7
Lecithin- They are typically named looking on their supply of origin like soy phospholipid from soybeans and egg phospholipid from ingredient phosphatidyl B is such a significant part of phospholipid. Within the sac system, it acts as a variety of vital roles like:
A) It plays role as a permeation enhancer.
B) Prevents the escape of drugs.
C) increased the % drug defense thanks to high phase transition temperature soy phospholipid forms the vesicles of more in comparison to egg phospholipid whereas once we compared these 2 on the idea of the penetration capacity soy phospholipid could be a higher candidate to pick because it contains unsaturated carboxylic acid, oleic and linoleic acid, linoleic acid, polyunsaturated carboxylic acid} where also the egg phospholipid contains the saturated fatty acid.8
Cholesterol is a natural steroid that is employed as a membrane addition. Steroid’s area unit vital parts of a semipermeable membrane and the presence in membrane bring regarding significant changes concerning bilayer stability, thinness, and porosity. It avoids aggregation by including molecules that stabilize the system and prevent mixture formation due to repulsive steric or static forces. The sterol {content increase there's a vital big major increase in demurrer potency (%) however when an explicit limit additional sterol increase leads to a significant decrease in demurrer potency. The increase in demurrer potency indicates that sterol serves as a "vesicular cement" within the molecular cavity of the wetter bilayer, preventing the gel-to-sol transition and resulting in fewer leak vesicles. Therefore, an increase within the rigidity decreases the porosity of the entrapped drug and thence improves the demurrer potency. However, once sterol quantity was enhanced when an explicit limit, the other result occurred. The explanation behind shriveled demurrer potency could also be thanks to the explanation that a sterol molecule can contend with drug for house among the bilayer, take away drug from bilayer, and additionally to the current can disrupt the sac membrane structure.8
METHODS OF PREPARATION
Proniosomes prepared by three methods:
Slurry method-
Proniosomes are made by mixing the carrier with the entire wetting agent solution in a spherical flat-bottom flask attached to a rotating flash evaporator and vacuuming the mixture to create a dry, free-flowing molecule in powdered form. Finally, formulation should be kept in a firmly sealed instrument and refrigerated in a lightweight container. The time required to produce proniosomes is independent of quantitative relationship between wetting agent response and applicating material and appears to be steady. This approach is advantageous because it protects the active ingredients and surfactants from reactivity and oxidation due to the homogeneous coating on the carrier. On the side of that, the upper expanse ends up in an agent wetting agent and coating, which makes the rehydration method a lot of economical.9
Slow Spray Coating Method-
Proniosomes are made by spraying an organic solvent with a wetting agent onto an applicator and then evaporating of solvent. Because the carrier is solubilized in the organic solvent, this procedure must be repeated until the desired level of wetting agent loading is achieved. The wetting agent layer on carrier is extremely thin, allowing multilamellar vesicles to form the carrier dissolves. The niosomes that result have a consistent size saperation, similar to those produced by traditional techniques. The most significant benefit of this technology is that it provides a means for formulating hydrophobic medications in a high lipid suspension with or without the drawbacks of suspension instability or active ingredient subject to a chemical reaction. Because sorbitol carrier is soluble in solvent used for deposit wetting agent, this process was resulted to be time-consuming. It's also been discovered to obstruct the encapsulation of bound medications.9
Co-acervation - Phase Separation Method:
Proniosomal gels are ready by this technique that includes wetter, lipoid, and drug during a wide-mouthed glass ampule alongside a touch of alcohol on it. Warm the combination in a water tub at 60-70°C for 5 minutes, or until the wetter mixture is completely dissolved. Then the binary compound part is added to on top of the ampule and warm still a transparent answer is created that is then born again into the proniosomal gel on cooling.10
CHARACTERIZATION-
Determination of in-vitroAnti-acne activity-
Collection of bacterial strains- Aerobic bacteria: Staphylococcus epidermidis and anaerobic bacteria: P. the Microbial Type Culture Collection Centre provided the Acnes.11
Growth condition, culture medium- Fresh cultures of aerobic and anaerobic bacterias isolates were suspended in nutrient broth media and incubated. S. epidermidis is cultured in Mueller-Hinton (MH) agar medium and incubate for 24 hrs. at 37°C in aerobic conditions, and P. acnes are cultured in brain heart infusion (BHI) agar medium and incubated anaerobically with 1% glucose at 37°C for 48 hrs.12
Collection of fungal strain-
Growth conditions, inoculum preparation- The strain was grown on the potato dextrose broth (PDB) or potato dextrose agar (PDA) media follows incubation at 30°C in aerobic conditions during 2-7 days. 13
EVALUATION
Measurement of vesicle size and size distribution
The vesicle dispersions were diluted a hundred times within the same medium used for his or her preparation. Vesicle size was measured on a particle size instrument. The equipment consists of a He-Ne shaft of 632.8 nm centered with a minimum power of 5mW employing a Fourier lens to a degree at the center of multi-component detector and a little volume sample jailhouse (Su cell). The Microbial Type of Culture Collection Centre provided the Acnes. Hu C and Rhodes in 1999 according to that the common particle size of proniosomes derived niosomes is {approximately about close to just regarding some roughly more or less around or so} roughly whereas that of standard niosomes.15
Particle surface and shape morphological characteristic
The particle size of proniosomes is an incredibly necessary characteristic. Scanning microscopy was used to investigate the surface morphology (roundness, smoothness, and aggregation formation) and thus the size distribution of proniosomes (SEM). Proniosomes were soaked in water and applied on aluminum stubs with double-sided tape. The aluminum stub was placed within the chamber of a scanning negatron.15
Measurement of particle charge
Zeta potential analysis is finished for determinative the mixture properties of the ready formulations. The appropriately diluted proniosomes derived noisome dispersion was resolute victimization letter potential instrument supported activity lightweight Scattering and optical device Christian Johann Doppler Velocimetry technique. The temperature was set at 25°C. Vesicles and their dreadful letter directly from the measurement. Potential values with a variance of five measurements were obtained.16
Rate of hydration (spontaneity)
This technique contains a variety of tiny qualitative analysis tubes. During which one milliliter of dissolution medium and proniosomes square measure placed. From this technique direct dilution of proniosomes is feasible.16
Drug content
Drug content uniformity of proniosomal gel is resolute by analyzing the drug concentration. From the four completely different points of sample square measure taken. Then samples were dissolved in phosphate solution (pH 6) and stir it to dissolve the vesicles. The presence of drug contents was resolute in the victimization of the U.V photometer at a selected wavelength.17
Stability of proniosomes
The stability testing of proniosomes is vital to work out the action of a drug from vesicles. In this method, samples were sealed in twenty-milliliter glass vials and kept at refrigeration temperature (4°C - 8°C) and 30°C for ninety days. When ninety days, the association step was meted out, and in addition, because the mean of particle size and denial efficiency of every sample was resolute the results in square measure compared with freshly ready proniosomes-derived noisome.17
pH
A digital pH meter was used to determine pH of proniosomal dispersion. Associate accurately weighed quantity of gel was spread in exceedingly refined water. Then calibrate the pH of proniosomes before use with a customary solution later which provides the pH of the gel.18
Viscosity
Viscosity was measured by employing a measuring system. In this, the associate accurately weighed the quantity of the gel was taken into a beaker, consistency was measured by rotating the spindle in an exceeding beaker.18
Discussion: According to evaluation of various paper the Proniosom are the best drug delivery system for the easy penetration of skin due to there smaller particle size and it gives a soothing and cooling effect to the skin and having less adverse effect.
CONCLUSION-
The dermal route is employed for local action only to treat different types of skin diseases such as acne vulgaris. This route can avoid systemic effects and therefore offers fewer side effects. On other hand, through transdermal delivery, we can deliver drugs for systemic action. But in both the dermal and transdermal delivery of drug, the skin prevents the penetration of drugs. The vesicular drug delivery can be utilized to overcome the problem. The objective of this project is to use proniosomes to target Anti-acne activity & improve stability of anti-acne drugs while administration. Proniosomal gel formulation is better comfortable, majorly used in drug targeting for controlled, sustained release of the drugs (hydrophobic and hydrophilic). Because it has the most desirable skin penetration and entrapment efficiency. They have good physicochemical properties while industrial manufacturing, handling, and storage. Overall, proniosomes are a very effective vesicular drug delivering system for various therapeutically active drugs. And they provide more satisfactory treatment than conventional drug delivery systems.
ACKNOWLEDGMENT
The authors express their heartfelt gratitude to Sharadchandra Pawar College of Pharmacy, Dumbarwadi, Otur, the college library, and all other sources for their cooperation and guidance in writing this review article.
Source Of Funding : There is no any source of funding for my review study.
Conflict of Interest: There are no conflicts of interest and disclosures regarding the manuscript.
Author’ Contribution: The concept and Design of the study were done by Siddhi Panhale, Shubhrajit
Mantry. Data acquisition and analysis were done by Siddhi Panhale. Manuscript preparation, editing done by Siddhi Panhale.
Englishhttp://ijcrr.com/abstract.php?article_id=4443http://ijcrr.com/article_html.php?did=44431. Hu C, Rhodes DG. Proniosomes: a novel drug carrier preparation. Int. J. Pharm. 1999 Aug 5;185(1):23-35.
2. Vora B, Khopade AJ, Jain NK. Proniosome-based transdermal delivery of levonorgestrel for effective contraception. J Control Release. 1998 Jul 31;54(2):149-65.
3. Namdeo. A. Niosomes as drug carriers. Indian J pharm.sci 1996;58(2):41–6.
4. Chien YW, Valia KH. Development of a dynamic skin permeation system for long-term permeation studies. Drug Development and Industrial Pharmacy. 1984 Jan 1;10(4):575-99.
5. Touitou E, Dayan N, Bergelson L, Godin B, Eliaz M. Ethosomes—novel vesicular carriers for enhanced delivery: characterization and skin penetration properties. J Control Release. 2000 Apr 3;65(3):403-18.
6. Tripathi KD. Essentials of medical pharmacology. JP Medical Ltd; 2013 Sep 30.
7. Indira U, Uma Shankar MS. Proniosomes as a drug carrier: A review. Int J Pharm Sci Res. 2012;3(12):4617-25.
8. Rahimi F, Bahramgur M, Amoabediny G, Bagheri Pebdeni A, Ebrahimi Hosseinzade B, Amoabediny Z. Synthesis and optimization of an effective dose of niosomal amikacin for antibacterial activity on Pseudomonas aeruginosa. Daneshvar Medicine. 2022 Feb 20;29(6):86-100.
9. Tanwar H, Sachdeva R. Transdermal drug delivery system: A review. Int J Pharm Sci Res. 2016 Jun 1;7(6):2274.
10. Upadhye S, Rafik IN. Proniosomes: A novel vesicular drug delivery system. Am. J. PharmTech res. 2020;10(2):260-73.
11. Al Sabaa H, Mady FM, Hussein AK, Abdel-Wahab HM, Ragaie MH. Dapsone in topical niosomes for treatment of acne vulgaris. Afr. J. Pharmacy Pharmacol. 2018 May 22;12(18):221-30.
12. Pate M, Jain S. AN INCLUSIVE REVIEW ON NOVEL DRUG DELIVERY STRATEGIES FOR AN EFFECTUAL DELIVERY OF BIO-ACTIVE DRUG MOLECULES IN THE TREATMENT OF ACNE. J. Adv. Sci. Res. 2021 Jan 2;11.
13. Al Sabaa H, Mady FM, Hussein AK, Abdel-Wahab HM, Ragaie MH. Dapsone in topical niosomes for treatment of acne vulgaris. Afr. J. Pharmacy Pharmacol. 2018 May 22;12(18):221-30.
14. Suva MA, Patel AM, Sharma N, Bhattacharya C, Mangi RK. A brief review on acne vulgaris: pathogenesis, diagnosis and treatment. Research & Reviews: Journal of Pharmacology. 2014;4(3):1-2.
15. Radha GV, Rani TS, Sarvani B. A review on proniosomal drug delivery system for targeted drug action. Journal of basic and clinical pharmacy (JBCP). 2013 Mar;4(2):42.
16. Suryawanshi SS, Patil PP, Gaikwad RG, Mali SS, Pol SL. PRONIOSOMES: MODERN DRUG DELIVERY SYSTEM
17. Sachan A, Kumar S, Dwivedi T. A Review on Proniosome: As a Drug Carrier. Available online www.jocpr.com J. chem. pharm. res.[Internet] 2021(7):1–07.
18. Venkatesh DN, Priyanka VS, Tulasi K, Kalyani K, Ali SA, Jilakara H. Proniosomes: A superior drug delivery system. Int J Pharm Sci Drug Res. 2014;6(3):178-82.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareTo Compare the Effect of Lumbar Stabilization Exercise and Conservative Treatment in Lowback Pain for Healthcare Professionals
English3639K. KotteeswaranEnglish S. Sahiya AnjumEnglish M. AkshayaEnglish S. Santhana LakshmiEnglishIntroduction: Lumbar stabilization exercise provides greater support to spine and helps in preventing low back pain. Lumbar stabilization exercise includes pelvic tilting, Knee to chest position, lumbar rotation stretch, transverse abdominis tuck, hip bridging exercises. Aim: The aim of the study is to determine the effectiveness of lumbar stabilization exercises and conservative treatment in low back pain for health care professionals. Method: 30 subjects were selected based on the inclusion and exclusion criteria. Group A consisted of 15 subjects were given lumbar stabilization exercise with interferential therapy. Group B Consists of 15 subjects were given conservative treatment with interferential therapy. The outcome factor used is NPRS (Numerical pain rating scale) and Modified Oswestry low back pain disability Questionnaire. The collected data was tabulated & analyzed using descriptive & inferential statistics. Result: paired t-test revealed that the mean are statistically significant between pre-test and post-test in lunbar stabilization group with pEnglish Low back pain, Lumbar stabilization exercises, Health care professionals, Interferential therapy, Oswestry low back pain disability Questionnaire, lumbar stabilityINTRODUCTION:
Health care professionals are all people engaged in actions whose primary intent is to enhance health, they are the one who study, diagnose, prevent and treat human illness, injury and other physical and mental impairments. The types of hazards which are faced by healthcare professionals are a physical hazard, chemical, biological, radiation, stress, stalking by patients and violence, they are at a high risk of musculoskeletal disorders due to patient handling.1 Low back pain is one of the most common work-related musculoskeletal disorders among health care professionals. Work-related low back pain(LBP)causes disability which affects their activities of daily living and work productivity. The main risk factors of LBP are bad postures, bending, twisting and frequent lifting,2 awkward posture, repetitive work, manual handling of loads, poor ergonomic conditions and particular incorrect lifting factors are also causes a broad range of musculoskeletal disorders, particularly low back pain.3Physicians, dentists, nurses, physiotherapists, and other healthcare professionals face repetitive trauma and incessant strains in their routine patient care activities which paving the way to chronic illness and musculoskeletal injuries.4 The main biomechanical risk factor in workplace is Awkward postures (bending, twisting, reaching overhead, kneeling, squatting, pinch grips) of health care professionals while performing physical task causes biomechanical stress (compressive stress) to the joints and surrounding soft tissues causing low back pain. The compressive stress is created on posterior elements due to abnormal exaggeration of lumbar curve which weakens the abdominal muscles and causes low back pain.5Various exercises such as lumbar stabilization exercise, motor control exercises, core strengthening exercises, lumbar flexion exercises, walking exercises, and bracing exercises have been proposed to reduce chronic low back pain. This Exercise can improve back extension strength, mobility, endurance, and functional disability.6 Lumbar stabilization is an active form of exercise which is designed to strengthen the muscles to support the spine and help prevent lower back pain. In specific stabilization exercises lead to changes in motor programming of the automatic feed-forward recruitment of deep core muscles.
Pain and disability is decreased following the application of lumbar stabilization exercises. It also helps in improving neuromuscular control, quality of movements, coordination.7 Transverse abdominis muscle attached to the vertebra through thoracolumbar fascia helps in stiffening the spine by increasing intraabdominal pressure.8 This exercise can be performed by the isolated contraction of transverse abdominis and lumbar multifidus through an abdominal tuck in a quadruped position, sitting, supine and standing positions. Progression of these exercises are by placing additional loads on the spine through various upper extremities, lower extremities and trunk movement patterns. The goal is to recruit a variety of trunk muscles.9 The underlying concept of these exercise programs is the ability of the muscular system to help maintain a neutral position of the spine and to prevent excessive lumbar segment motion.10 Studies show that musculoskeletal disorders are some main causes for frequent sick leave, along with that psychological stress, exposure to different occupational hazards could also have an adverse effect on physical health and it will indirectly increase sick leave.11
The Oswestry Disability Index (ODI) is a quantitative outcome measure used for individuals with low back pain (LBP). The ODI is a self-administered questionnaire that contains 6 statements in 10 domains that are scored from 0-5. Scores are associated with the degree of disability ranging from minimal to bedbound. The ODI is a valid, reliable, and responsive condition-specific assessment tool that has withstood the test of time and scrutiny. So far, it has been used mostly in chronic and severely disabled populations but shows good indicators for the assessments of less severe complaints. Interpretability of the ODI is good. The ODI is an acceptable tool to measure disability caused by LBP and it is easy to administer, score, objectify patient’s complaints and monitor the effects of therapy.12
MATERIALS AND METHODS
The study was designed as a Quasi-experimental study. The study setting was the physiotherapy outpatient department, Saveetha Medical College and Hospital and this study was approved by the Institutional Scientific review board 007/01/2020. 30 subjects who were willing to participate were selected using a convenient sampling technique, based on inclusion and exclusion criteria. The subjects included are health care professionals such as duty nurses, and physiotherapists of both genders between the age group of 25-55years who have been suffering from chronic low back pain. In this study, we excluded conditions like Spinal fracture, Spondylolisthesis, Spinal stenosis, TB spine and other recent Spinal surgeries.
The safety and simplicity of the procedure were explained to the patient and written consent was obtained from the subject in their known language. The pre-test values were obtained using the Oswestry disability questionnaire. Oswestry disability questionnaire consists of 5 domains each question is scored on a scale of 0-5; with the first statement is 0 indicating the least amount of disability and the last statement is scored as 5 indicating most severe disability. The score of all questions was summed then multiplied by 2 to obtain the disability index. The subjects has been categorized into moderate disability, severe disability and crippled by using Oswestry Disability Questionnaire.
Subjects were categorized in two groups, Group A comprising of 15 subjects were treated with lumbar spine stabilization exercises including pelvic tilt, Knee to chest position, lumbar rotation stretch, hip bridging with an exercise ball. Group B comprising of 15 subjects were given conservative treatment like hamstring stretch, back extensor exercises, gluteal stretch, cat and camel position. Both the groups were treated with interferential therapy. The exercise were given for a period of 4 weeks. After the intervention, the post-test evaluation was taken as the same in pre-test. The values were tabulated and statistically analyzed.
STATISTICAL ANALYSIS:
The collected data were tabulated and analyzed using descriptive and interferential statistics. Paired t-test is used to analyze significance between pre and post test values. and an unpaired t-test was used to analyze the significance between the two groups. p value Englishhttp://ijcrr.com/abstract.php?article_id=4444http://ijcrr.com/article_html.php?did=4444
Mohanty A, Kabi A, Mohanty AP. Health problems in healthcare workers: A review. J Family Med Prim Care.2019;8(8):2568–2572.
Pakkir Mohamed SH, Al Amer HS. Prevalence of Work-Related Low Back Pain among Health Care Professionals in Tabuk, Saudi Arabia. Majmaah J Heal Sci.2019;7(1):52-65.
Mehrdad R, Shams-Hosseini NS, Aghdaei S, Yousefian M. Prevalence of Low Back Pain in Health Care Workers and Comparison with Other Occupational Categories in Iran: A Systematic Review. Iran J Med Sci.2016;41(6):467-478.
Koyuncu N, Karcioglu O. Musculoskeletal complaints in healthcare personnel in hospital An interdepartmental, cross-sectional comparison. Medicine.2018;97(40):1-6.
Trinkoff AM, Lipscomb JA, Geiger-Brown J, Storr CL, Brady BA. Perceived physical demands and reported musculoskeletal problems in registered nurses. Am J Prev Med. 2003;24(3):270-275.
Suh JH, Kim H, Jung GP, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain A randomized controlled trial. Medicine.2019; 98(26):1-9.
Hosseinifar M, Akbari M, Behtash H, Amiri M, Sarrafzadeh J. The Effects of Stabilization and Mckenzie Exercises on Transverse Abdominis and Multifidus Muscle Thickness, Pain, and Disability: A Randomized Controlled Trial in Non-Specific Chronic Low Back Pain. J. Phys. Ther.Sci.2013; 25(12) :1541-1545.
Barr KP, Griggs M, Cadby T: Lumbar stabilization: Core concepts and current literature, part 1. Am J Phys Med Rehabil.2005;84:473–480.
Rabin A, Shahua A, Pizem K, Dickstein R, Dar G. A Clinical Prediction Rule to Identify Patients With Low Back Pain Who Are Likely to Experience Short-Term Success Following Lumbar Stabilization Exercises: A Randomized Controlled Validation Study. J Orthop Sports Phys Ther.2014;44(1):6-18.
.Abass AO, Alli AR, Olagbegi OM, Chirstie CJ, Bolarinde SO. Effects of an eight-week lumbar stabilization exercise program on selected variables of patients with chronic low back pain. Bangladesh J Med Sci.2020;19(3):467-474.
Mollazadeh M, Saraei M, Mehrdad R, , Izadi N. Sickness absenteeism of Healthcare Workers in a Teaching Hospital. Hospital Practices and Research.2018;3(1):6-10
Vianin M. Psychometric properties and clinical usefulness of the Oswestry Disability Index. J Chiropr Med.2008;7(4):161–163.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareEfficacy of Oral Febuxostat drug for Slowing the Glomerular Filtrate Rate Decline in Patients With Chronic Kidney Disease and Asymptomatic Hyperuricemia: A 6-Month, Single-Blind, Randomized, Placebo-Controlled Trial
English3135Abdul Malik MujahidEnglish Muhammad Umar FarooqEnglish Rashid KarimEnglish Mehriq FatimaEnglishIntroduction: Hyperuricemia is considered a putative risk factor for the progression of renal disease and febuxostat is used as an additional therapy for the control of lowering eGFRin CKD 3 and 4 patients. Objective: To determine the effect of febuxostat on eGFR among patients with chronic renal failure and increased uric acid levels. Materials and Methods: A single-Blind, RCT was conducted at Mayo Hospital, Lahore from 1st February 2019 to 31st January 2020. 330 Patients who full filled the inclusion criteria were enrolled. After the approval from Ethical Committee, written informed consent was taken and they were randomly divided into 2 groups. Group A patients received febuxostat 40 mg daily and group B received a placebo with conventional therapy. Patients were evaluated for mean eGFR at the start, 3 and 6 months of treatment in both groups. Data was entered and analyzed in SPSS ver: 21. Mean and standard deviation were calculated for numerical variables. An Independent test was used to compare the means between the groups at baseline, 3 and 6 months with p < .05 as statistical significant. Results: In this study, efficacy was determined in terms of retardation in eGFR decline. At baseline and at 3rd month, no significant difference was found in eGFR in both groups however at 6th month mean eGFR was higher in Group A as compared to group B. Conclusion: The study concluded that febuxostat is more efficacious in the slowing of declining e-GFR in patients with CKD stage 3 and 4.
EnglishFebuxostat, CKD, Hyperuricemia, renal failure Grade 3 – 4, renal insufficiency, GFR, PlaceboIntroduction:
According to available research data, it is estimated that 13% of adult population is currently suffering from Chronic Kidney Disease (CKD), a value which is expected to increase in the future.1 The main causative factor for this disease is Diabetic nephropathy. Pakistan Economic Survey 2005-06 declares a total of 21 million people suffering from CKD stage 3 or 4.2,3 Definition of Chronic renal failure by the National Kidney Foundation is a decrease in glomerular filtration rate (GFR) to Englishhttp://ijcrr.com/abstract.php?article_id=4445http://ijcrr.com/article_html.php?did=4445
Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. Jama. 2007;298(17):2038-47.
Saran R, Robinson B, Abbott KC, Agodoa LY, Albertus P, Ayanian J, et al. US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. American Journal of Kidney Diseases (AJKD). 2017;69(3):A7-A8.
Kazmi W, Shahid K, Yousuf A, Osmani A, Marmoos T, Warsi F, et al. A higher than expected prevalence of Chronic Kidney Disease in Pakistan. J Am SocNephrol. 2007;18:540.
Eknoyan G, Levin NW. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
Jafar TH. The growing burden of chronic kidney disease in Pakistan. N Engl J Med. 2006;354(10):995-7.
Tanaka K, Hara S, Kushiyama A, Ubara Y, Yoshida Y, Mizuiri S, et al. Risk of macrovascular disease stratified by stage of chronic kidney disease in type 2 diabetic patients: critical level of the estimated glomerular filtration rate and the significance of hyperuricemia. Clinical and experimental nephrology. 2011; 15(3):391-7.
Satirapoj B, Supasyndh O, Nata N, Phulsuksombuti D, Utennam D, Kanjanakul I, et al. High levels of uric acid correlate with decline of glomerular filtration rate in chronic kidney disease. J Med Assoc Thai. 2010;93(6):S65-S70.
Ben-Dov IZ, Kark JD. Serum uric acid is a GFR-independent long-term predictor of acute and chronic renal insufficiency: the Jerusalem Lipid Research Clinic cohort study. Nephrology Dialysis Transplantation. 2011;26(8):2558-66.
Takano Y, Hase-Aoki K, Horiuchi H, Zhao L, Kasahara Y, Kondo S, et al. Selectivity of febuxostat, a novel non-purine inhibitor of xanthine oxidase/xanthine dehydrogenase. Life sciences. 2005;76(16):1835-47.
Tatsuo H, Iwao O. A repeated oral administration study of febuxostat (TMX-67), a non-purine-selective inhibitor of xanthine oxidase, in patients with impaired renal function in Japan: pharmacokinetic and pharmacodynamic study. JCR: Journal of Clinical Rheumatology. 2011;17(4):S27-S34.
Horikoshi R, Akimoto T, Inoue M, Morishita Y, Kusano E. Febuxostat for hyperuricemia: experience with patients on chronic hemodialysis treatment. Clinical and experimental nephrology. 2013;17(1):149.
Sircar D, Chatterjee S, Waikhom R, Golay V, Raychaudhury A, Chatterjee S, et al. Efficacy of febuxostat for slowing the GFR decline in patients with CKD and asymptomatic hyperuricemia: a 6-month, double-blind, randomized, placebo-controlled trial. American Journal of Kidney Diseases (AKJD). 2015;66(6):945-50.
Tanaka K, Nakayama M, Kanno M, Kimura H, Watanabe K, Tani Y, et al. Renoprotective effects of febuxostat in hyperuricemic patients with chronic kidney disease: a parallel-group, randomized, controlled trial. Clinical and experimental nephrology. 2015;19(6):1044-53.
Johnson RJ, Nakagawa T, Jalal D, Sánchez-Lozada LG, Kang D-H, Ritz EJNDT. Uric acid and chronic kidney disease: which is chasing which? 2013;28(9):2221-8.
Li L, Yang C, Zhao Y, Zeng X, Liu F, Fu PJ. Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?: A systematic review and meta-analysis based on observational cohort studies. 2014;15(1):122.
Bakan A, Oral A, Elcioglu OC, Takir M, Kostek O, Ozkok A, et al. Hyperuricemia is associated with progression of IgA nephropathy. 2015;47(4):673-8.
Maahs DM, Caramori L, Cherney DZ, Galecki AT, Gao C, Jalal D, et al. Uric acid lowering to prevent kidney function loss in diabetes: the preventing early renal function loss (PERL) allopurinol study. 2013;13(4):550-9.
Pasina L, Brucato A, Djade C, Di Corato P, Ghidoni S, Tettamanti M, et al. Inappropriate prescription of allopurinol and febuxostat and risk of adverse events in the elderly: results from the REPOSI registry. 2014;70(12):1495-503.
Becker MA, Schumacher HR, Espinoza LR, Wells AF, MacDonald P, Lloyd E, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. 2010;12(2):R63.
Omori H, Kawada N, Inoue K, Ueda Y, Yamamoto R, Matsui I, et al. Use of xanthine oxidase inhibitor febuxostat inhibits renal interstitial inflammation and fibrosis in unilateral ureteral obstructive nephropathy. 2012;16(4):549-56.
Sezai A, Soma M, Nakata K-I, Hata M, Yoshitake I, Wakui S, et al. Comparison of febuxostat and allopurinol for hyperuricemia in cardiac surgery patients (NU-FLASH Trial). 2013:CJ-13-0082.
Tanaka K, Nakayama M, Kanno M, Kimura H, Watanabe K, Tani Y, et al. Renoprotective effects of febuxostat in hyperuricemic patients with chronic kidney disease: a parallel-group, randomized, controlled trial. 2015;19(6):1044-53.
Lee J-W, Lee K-HJ, nephrology. Comparison of renoprotective effects of febuxostat and allopurinol in hyperuricemic patients with chronic kidney disease. 2019;51(3):467-73.
Sakai Y, Otsuka T, Ohno D, Murasawa T, Sato N, Tsuruoka S. Febuxostat for treating allopurinol-resistant hyperuricemia in patients with chronic kidney disease. 2014;36(2):225-31.
Tsuruta Y, Mochizuki T, Moriyama T, Itabashi M, Takei T, Tsuchiya K, et al. Switching from allopurinol to febuxostat for the treatment of hyperuricemia and renal function in patients with chronic kidney disease. 2014;33(11):1643-8.
Zeng XX, Tang Y, Hu K, Zhou X, Wang J, Zhu L, et al. Efficacy of febuxostat in hyperuricemic patients with mild-to-moderate chronic kidney disease: a meta-analysis of randomized clinical trials: A PRISMA-compliant article. 2018;97(13).
Ramirez MEG, Bargman JM. Treatment of asymptomatic hyperuricemia in chronic kidney disease: A new target in an old enemy–A review. 2017;8(5):551-4.
Eleftheriadis T, Golphinopoulos S, Pissas G, Stefanidis I. Asymptomatic hyperuricemia and chronic kidney disease: a narrative review of a treatment controversial. 2017;8(5):555-60.
Mazzali M, Hughes J, Kim Y-G, Jefferson JA, Kang D-H, Gordon KL, et al. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. 2001;38(5):1101-6.
Rao GN, Corson MA, Berk BC. Uric acid stimulates vascular smooth muscle cell proliferation by increasing platelet-derived growth factor A-chain expression. 1991;266(13):8604-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareSoil Microbiota and Its Plant Interactions
English4046Domenico PrisaEnglishMicrobial biodiversity comprises microorganisms belonging to all kingdoms: from prokaryotes (archaea and bacteria) to eukaryotes (fungi, microalgae, molds, yeasts and protists). Microorganisms make up a large part of the earth’s biomass, are extraordinarily diverse and are widespread in all habitats. More than two-thirds of the total biodiversity consists of bacteria, while archaea and eukaryotes occupy less than one-third. Microorganisms interact with each other and with the biotic and abiotic components of their environment, creating ecosystems in which there is a dynamic balance between the different components. The rhizosphere is the portion of soil surrounding the roots of plants, from which they absorb the essential nutrients and water they need to grow. In addition to the roots, there are further biotic components in the rhizosphere, such as symbiotic microorganisms, beneficial and pathogenic bacteria, and microscopic and macroscopic fungi. The aim of this review is to increase the knowledge about the interactions between plants and soil microorganisms.
EnglishINTRODUCTION
Since ancient times, some farmers have marvelled at how forests and grasslands could grow and vegetate without any fertilisation. Through long studies and after a long time we have been able to understand how this could happen. Much of what seems supernatural happens through a huge underground network of fungi and micro-organisms which, by interacting continuously, transfers and distributes large quantities of vital plant components such as nitrogen, phosphorus, manganese, sulphur as well as carbohydrates produced by plants.1 Among the major players in this, are arbuscular mycorrhizae, symbiotic associations established between thousands of species of soil fungi and the roots of most terrestrial plants. Mycorrhizae are essentially filaments (hyphae) that support themselves on the roots of the host plant and permeate the surrounding soil, progressively probing it for nutrients.2 Their combined action with a specific associated microbiome can extract key nutrients from the soil, store large amounts of carbon from the soil, retain and distribute water, buffer acidity and alkalinity and improve soil structure like no other. Unfortunately, some agronomic practices contribute to tearing apart this underground network with extremely negative results.3 The distribution of this natural resource through deep tillage, forced cultivation, uncontrolled fertilisation and long resting periods has led to the need to use mineral substances, which are obtained with enormous expenditure of energy, depletion of natural resources and non-renewable fossil fuels.4 One of the synthesis products of arbuscular mycorrhizae is glomalin, a glycoprotein containing 30-40% carbon. Glomalin is produced in large quantities by arbuscular mycorrhizal fungi (AM). In soils, the amount of glomalin was found to be correlated with the main fertility parameters. Laboratory analyses have shown that glomalin has a high affinity for iron and a strong ability to bind to heavy metals.5 Under normal conditions, these elements are used by the associated plant for its metabolic functions, whereas in seriously contaminated soils, glomalin effectively sequesters the metals from the soil and then transfers them to the host plant if the latter is able to tolerate them: the higher the tolerance of the host plant, the greater the quantity of elements extracted.6 Metal immobilisation of a highly stable protein fraction such as glomalin may be of considerable significance in alleviating toxicity due to excess metals. The metal contained GSRP (Glomalin Related Soil Protein) may represent a system to avoid the loss of metals contained in the soil through leaching and their percolation into groundwater. Glomalin, thanks to its long persistence period in the soil, would act in this sense as a trap system capable of storing mineral nutrients and immobilising them. Glomalin is capable of creating aggregates by promoting flocculation and storing carbon in the protein and carbohydrate (glucose and sugars) subunits of the soil, preventing leaching. It has been discovered that the weight of glomalin is 2 to 24 times that of humic acids (the products of plant decomposition hitherto considered to be most responsible for storing carbon in the soil). Humic acids would contribute only 8% of the soil carbon.2
MICROBIAL BIOMASS
The term microbiome is often mistakenly used to refer to the set of microorganisms that inhabit a living being or part of it. However, the correct term to use here is 'microbiota'. Instead, the microbiome refers to the totality of the genetic make-up possessed by the microbiota, i.e. the set of their genes.7 Almost all of us have been used to associating microbes and bacteria with a negative image since childhood. The 'bad' microbes that cause disease and infection are only a small part of the hidden world around us. Microbes are everywhere and not only live in close contact with us, but are indispensable for our survival and for the life of our entire ecosystem.8 Preserving the life and diversity of microorganisms is just as important as combating the 'bad' ones, just think of the beneficial effects that taking probiotics (good microorganisms) can have on our health. This is why the use of substances that can harm this 'invisible' population is counterproductive. Several studies correlate the microbiome with the health status of the host, making microbiome analysis a new frontier not only in medicine, but also in agriculture.9 Microorganisms can boost the immune system and prevent diseases, determine the productivity of soils and crops and thus improve growing conditions (Figure 1). Knowing the micro-organisms that colonise different soils and the relationship between the microbiome and the environment, which is strongly involved in the fate of ecosystems, is crucial in the interaction between plants and the land. Recent studies show that a strong correlation exists between the microbiome of the land and the microbiome of plants, resulting in an impact on food. Also in the food sector, the microbiome plays an important role in various productions, such as fermented products.10 The microbial biomass represents a reserve of available nutrients, so soils with a high microbial mass have a higher capacity to make them available. Enzymatic activity is the ability of a soil to stimulate certain spontaneous biochemical reactions in the soil. Some reactions occur faster (e.g. urea degradation) if the catalysts are enzymatic. Intracellular and extracellular enzymes are present. Intracellular enzymes within microbial cells are responsible for normal metabolism, while extracellular enzymes make certain compounds available to organisms that are otherwise unusable.11 The majority of enzymes in the soil are microbial in origin, so enzyme activity is an indicator of the presence of microorganisms in the soil. Micro-organisms interact with soil surfaces, so the greater the specific surface area, the greater the presence of micro-organisms.12 In clay soils their presence is greater. Enzyme activity is also influenced by crop rotation (a maize-oats rotation results in an average presence and persistence 2/3 times higher than a single-crop maize rotation), tillage (less tillage, higher content) and pH. Among the enzymes, dehydrogenase is the one most involved in the early stages of organic matter degradation, its presence depending on the biological activity of microbial populations.13
BENEFICIAL MICROORGANISMS AND RHIZOSPHERE INTERACTION AND AGRONOMIC PRACTICES INTERFERENCE
Micro-organisms can adversely affect plant development without necessarily acting as plant pests.14 Their action can alter the water supply, the uptake of ions and substances useful for growth, altering root functionality and/or limiting the harmonious development of the plant (Table 1). The main mechanism of action of the specific micro-organisms that improve the rhizosphere is competition with the harmful strains in the soil, thus favouring the availability and uptake of nutrients.15The various classifications of microorganisms in the rhizosphere distinguish between "major pathogens" and "minor pathogens", with the former penetrating the plant and causing the most damage, and the latter including obligate and facultative parasites.16 Within the minor pathogens there are some, non-psraxic, growth-altering with their metabolites (DRMO Deleterious Rhizosphere Microorganisms), while others are parasites of plant tissue (Parasitising Minor Pathogens).17 The pathogenicity of DRMOs is not easy to prove, as their effect on plants is limited to a delay in root growth without any other distinctive symptoms. The hypotheses that DRMOs belong mainly to different families, including Enterobacteriaceae, Corynebacteriaceae, Pseudomonaceae and Bacillaceae, are fairly consistent but not fully clarified.18
MECHANISMS OF MICROORGANISM ACTIVITY
Microorganisms can interfere with plant growth through competition and interference with the microflora naturally present in the soil.19 Root growth, the length and number of root hairs and an efficient metabolism of the root cells are key aspects for an optimal uptake of water and less available ions in the soil such as P and K (Figure 2). There are micro-organisms that produce metabolites that hinder these processes and have a negative effect on plant growth.20 Others, such as Pseudomonas fluorescens, produce secondary metabolites such as growth-promoting substances and antibiotics. The action of metabolites can alter cell wall structure, cell permeability, polysaccharide and acid secretion and enzyme release, all of which interfere with physiological processes.21 We have to consider that for the plant the uptake of nutrients is an energy-intensive process and involves 60% of the root respiration under normal conditions.22 The increased availability or ease of uptake, assisted by specific micro-organisms, contributes to the availability of energy that the plant can use for other more useful metabolic activities (Table 2). Changing the composition of the microbiome also serves this purpose.23
ROOTS COLONISATION WITH PGPR (PLANT GROWTH-PROMOTING RHIZOBACTERIA)
The effectiveness of PGPR activity on stimulating plant growth depends mainly on the timely establishment and persistence of DRMOs.24 The greatest effectiveness is obtained by treating the seeds and tubers from which they will colonise the root systems (Figure 3). It has been noted that PGPRs introduced via this route remained during the growing season even though their numbers gradually decreased compared to the total (more stable) population of fluorescent Pseuodomonas.25Competition between micro-organisms increases as the overlap of their ecological niches increases. Some unfavourable environmental factors may reduce the effectiveness of PGPRs. The availability of Fe3+ is limited in alkaline and neutral soils and increases with increasing acidity. A higher activity of DRMOs and a lower suppressive activity of PGPRs on DRMOs could be expected as soil acidity increases.26 Some clay minerals appear to have a pronounced effect on siderophore-mediated microbial activity. For example, the presence or absence of certain clay minerals has been correlated with the suppressiveness of certain soil-borne diseases. The presence of illite inhibited the antagonistic activity of Pseudomonas fluorescens on root pathogens such as Thielaviopsis basicola, whereas this activity was favoured by vermiculite. The inhibition seems partly attributable to the interference of clay with the ferric nutrition of the fungi. The environment may also affect the rate of exudate emission by the roots and their composition.27
PHOSPHORUS AVAILABILITY AS A RESULT OF MICROBIAL ACTIVITY
Phosphorus is a poorly mobile element in the soil and highly insoluble in non-neutral soils. Phosphorus is an essential element for plant development and is present in fair quantities in soils throughout Europe. However, it is always added to fertilisation plans because it is scarcely available to plants.28 However, this route is not sustainable given the limited availability of mineral phosphorus (stocks are expected to run out by 2033), the very low yield (only 5% of the added P is assimilated by plants) and the negative impact (e.g. eutrophication of water). Given the type of soil on the European continent, new solutions are being developed that are both environmentally sustainable and economically advantageous.29 The forms in which it is found in the soil are mainly phosphates (Fe, Al and Ca) or as gradually mineralised organic phosphorus. The reaction of the soil strongly influences its bioavailability: at a pH of less than 6, ferric phosphate prevails, and at a pH of more than 7, calcium phosphate, all stable and insoluble forms.Micro-organisms act on the breakdown of phosphorus organic compounds and the organification of mineral phosphorus. Mycorrhizae play a key role in phosphorus uptake by acting as root extensions and having high uptake efficiency even in more stable forms. Inorganic phosphorus present in the soil is transformed into soluble and available phosphorus by certain bacteria such as Pseudomonas fluorescens, Bacillus amyloliquefaciens and Bacillus megaterium. These bacteria are naturally present in our soils, but as they are sensitive to pollution and over-fertilisation, their presence is low if not absent in highly polluted soils.30 A solution could therefore be to multiply them in the laboratory and inoculate specific microbial consortia for each plant, thus overcoming the problem of pollution and natural competitors. Organic phosphorus is made available to plants by enzymes (phytase and phosphatase) present in certain endomycorrhizal fungi. Endomycorrhizae live on the roots of plants and a symbiosis is established between them and the plant. Some of them are capable of supplying phosphorus and water to the roots and in return take up carbohydrate substances.31 There are endomycorrhizae that release phosphorus quickly, others that take a long time, others that are able to release phosphorus constantly and finally there are endomycorrhizae that do not interact with phosphorus at all. Combinations of different types of mycorrhizae are optimal as they result in immediate availability of phosphorus that remains constant over time. The endomycorrhizae generally used are Glomus intraradices, Glomus claroideum, Gigaspora margarita. The limit in the use of mycorrhizae is given by the quantity of phosphorus already present in the soil, in fact for the symbiosis to be established there must be a convenience on both sides. If the plant has sufficient phosphorus (a condition which rarely occurs) it has no need to enter into symbiosis with the fungus.32Actinomycetes are also present in the soil. They perform an activity of fundamental importance, as they preside over various operations such as: i) active participation in the decomposition of animal and plant tissues resistant to microbial attack; ii) they allow the formation of humus, through the conversion of organic residues into compounds typical of the organic fraction of the soil; (iii) regulate the microbiological balance of the soil through the production of antibiotics and probiotics (group B vitamins) that stimulate growth.33
AGRONOMIC PRACTICES EFFECT ON MICROBIAL ACTIVITY
The effects of micro-organisms, irrespective of the quantity present in a given soil, appear to be influenced by the agronomic practices carried out in that soil. Numerous studies and observations have suggested that microbial factors, more than the presence of normal pathogens, play a decisive role in, for example, plant yield. Among these factors, non-spore farming of harmful microorganisms can play a decisive role.34 The effect on yield reduction increases in some species (potato) as the cropping sequence is intensified, although the mechanism generating this effect is not yet fully understood. The effect is certainly related to host specificity as in crops other than potato (wheat, beet) the effects are less evident. One of the explanations may be that some harmful strains survive on the root residues of the crop, representing a potential inoculum for the colonization of subsequent crops. As the frequency of cultivation increases, the phenomenon widens. Another hypothesis is the accumulation of compounds that stimulate the production of toxic metabolites. In the case of cyanide, glycine could be its precursor, as well as some ferric metals. Glycine and, to a lesser extent, proline, increase cyanide production by some microbial strains and both are constituents of radical exudates.35 Studies have shown that glycine is resistant to microbial degradation and that proline and glycylglycine have a high affinity for certain clay minerals, remaining in the soil for a long time. One of the possible causes of the disease known as replant disease (the reduction in vigor and reseeding yield of the same species) is attributable to fluorescent and non-fluorescent strains of Pseudomonas. There is therefore evidence that part of the microflora present in the rhizosphere can adversely affect plant growth and development and that the activity of this microflora is influenced by agronomic practices.5 Frequent tillage, especially deep tillage, has deleterious effects on soil microflora. In general, symbiotic microorganisms such as Rhizobium, some actinomycetes, mycorrhizal fungi and saprophytes increase the availability of nutrients and/or growth-stimulating substances as well as suppress parasitic and non-parasitic pathogens.10The inoculation of micro-organisms specific to the colonization of the rhizosphere can lead to extremely positive effects.36The production of siderophores under Fe-limiting conditions is one of the effects observed. This results in strong competition with harmful microorganisms for Fe3+ ions in the rhizosphere. Siderophores are small molecules with a high affinity for iron and capable of effectively chelating it, generally produced by certain microorganisms, fungi and grasses. Siderophores are among the strongest Fe3+ chelating agents known.37 The growth-promoting effect attributed to the removal of Fe available to harmful micro-organisms (DRMO) has been demonstrated in various experimental studies. Siderophores chelate Fe3+ that is no longer available to DRMOs, leading to a decrease in growth and virulence.38,39
DISCUSSION
In recent years, agriculture has faced the challenge of economic and environmental sustainability, reducing fertilizer use while adopting strategies to increase water use efficiency. Many microorganisms or fungi can promote the plant's use of nutrients and water in the soil.7 There are numerous bacterial strains that promote root growth and are classified according to acting at the level of the rhizosphere and rhizoplane. Many studies carried out with growth-promoting bacteria (PGPR), which have given interesting results in a controlled environment or in vitro, have not been as effective in field crops in promoting plant growth. One of the problems encountered in the field with the use of microbial biostimulants is the use of live microbial mediums which make application by the farmer difficult.5 To overcome this problem, microbial biostimulants are formulated and encapsulated with calcium alginate, which facilitates the retention and release of PGPR bacteria into the soil after application. Microorganisms that stimulate plant growth and resistance include arbuscular mycorrhizal fungi (AMF). They are effective in nutrient uptake but also in improving tolerance to abiotic stresses. One of the key characteristics of AMF is that they can only survive in symbiosis with the roots of the host plant. The improved quality of the plant in the nursery phase also has an impact on its behaviour in the subsequent cultivation phase. MFAs ensure a symbiotic relationship with the host plant, which makes it possible to overcome transplant stress and reduce the acclimatization period.15
CONCLUSIONS
As is well known, fertility depends on the physical, chemical and biological properties of the soil. However, biological soil fertility is often forgotten and is much less studied than the others. It is linked to the activity of micro-organisms, on which the balance of nutrient cycles such as nitrogen, phosphorus and sulphur depend. It is, therefore, necessary to investigate a number of aspects related to plant growth promotion such as: (i) how the action of DRMO siderophores on plant growth and field yield occurs and takes place; (ii) whether siderophores of PGPRs are produced in the rhizosphere; (iii) whether it is possible to genetically manipulate siderophores to increase the effectiveness of PGPRs.
ACKNOWLEDGEMENT
The author would like to express his heartfelt gratitude to his colleagues at CREA Research Centre fr Vegetable and Ornamental Crops in Pescia and to all other sources for their cooperation and guidance in writing this article.
Source of Funding:
None
Conflict of Interest:
The author declares no conflict of interest.
Authors’ Contribution:
The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.
Englishhttp://ijcrr.com/abstract.php?article_id=4446http://ijcrr.com/article_html.php?did=4446
Schippers B. Biological control of pathogens with rhizobacteria. Phil. Trans Royal Soc. Lond. 1988; 283-293
Schippers B, Bakker AW, Bakker PAHM, van Peer R. Beneficial and deleterious effects of HCN-producing pseudomonads on rhizosphere interactions. Plant Soil 1990; 129:75-83
Schippers B, Bakker AW, Bakker PAHM. Interactions of deleterious and beneficial rhizosphere microorganisms and the effect of cropping practices. Ann. Rev. Phytopatol. 1987; 25:339-358
Schroth MN, Hancock JG. Disease suppressive soil and root colonizing bacteria. Science 1982; 216:1376-1381
Somers E, Vanderleyden J, Srinivasan M. Rhizosphere bacterial signaling: a love parade beneath our feet. Crit. Rev. Microbiol. 2004; 30: 205-240
Stroo HF, Elliott LF, Papendick RI. Growth, survival and toxin production of root-inhibitory pseudomonads on crop residues. Soil Biol. Biochem. 1988; 20:201-207
Abatenh E, Gizaw B, Tsegaye Z, Wassie M. The role of microorganisms in bioremediation- A review. OJEB. 2017; 2:038-046
Arora NK. Plant microbes symbiosis: Applied Facets. Springer India. 2015
Bashan Y. Inoculants of plant growth-promoting bacteria for use in agriculture. Biotechnology advances. 1998; 16(4):729-770
Bashan Y, de-Bashan LE, Prabhu SR, Hernandez JP. Advances in plant growth-promoting bacterial inoculant technology: formulations and practical perspectives (1998-2013). 2014; 378(1-2):1-33
Baudoin E, Benizri E, Guckert A. Impact of artificial root exudates on the bacterial community structure in bulk soil and maize rhizosphere. Soil Biology and Biochemistry. 2003; 35(9):1183-1192
Compant S, Samad A, Faist H, Sessitsch A. A review on the plant microbiome: Ecology, functions and emerging trends in microbial apllication. Journal of advanced research. 2019; 19:29-37
Delgado-Baquerizo M, Oliverio AM, Brewer TE, Benavant-Gonzalez A, Eldrige DJ, Bardgett RD, et al.. A global atlas of the dominant bacteria found in soil. Science. 2018; 359(6373): 320-325
Dennis PG, Miller AJ, Hirsch PR. Are root exudates more important than other sources of rhizodeposits in structuring rhizosphere bacterial communities? FEMS microbiology ecology. 2010; 72(3):313-327
Dous S, Wang S. Review of different microorganisms effect on humus formation. Journal of Jilim Agricultural University. 2011; 33(2):119-125
Foster RC. Microenvironments of soil microorganisms. Biology and fertility of soils. 1988; 6(3):189-203
Gamalero E, Lingua G, Berta G, Glick BR. The beneficial role of plant growth-promoting bacteria and arbuscular mycorrhizal fungi on plant responses to heavy metal stress. Can. J. Microbiol. 2009; 55(5): 501-514
Prisa D. Italian chabazitic-zeolitite and Effective microorganisms for the qualitative improvement of olive trees. Atti del Convegno di Calci (PI) 2017 Atti Soc. Tosc. Sci. Nat., Mem. 2018; 125:13-17
Prisa D, Sarrocco S, Forti M, Burchi G, Vannacci G. Endophytic ability of Trichoderma spp. as inoculants for ornamental plants innovative substrates. IOBC Bullettin. 2013;86: 169-174
Singh JS, Pandey VC, Singh DP. Efficient soil microorganisms: a new dimension for sustainable agriculture and environmental development. Agriculture, ecosystems & environment. 2011; 140(3-4): 339-353
Souza RD, Ambrosini A, Passaglia LM. Plant growth-promoting bacteria as inoculants in agricultural soils. Genetic and molecular biology. 1987; 38(4):401-419
Stevenson FJ. Humus chemistry: genesis, composition, reactions. John Wiley & Sons. 1994
Toju H, Peay KG, Yamamichi M, Narisawa K, Hiruma K, Naito K, Yoshida K. Core microbiomes for sustainable agroecosystems. Nature plants. 2018; 4(5):247
Prisa D. Rhizobacteria and zeolites for overcoming saline stress in the cultivation of succulent plants. The International Journal of Engineering and Science (IJES). 2019; 8(5I): 38-41
Curtis TP, Sloan WT. Exploring microbial diversity- A vast below. Science. 2005; 309:1331-1333
Ellingsoe P, Johnsen K. Influence of soil sample sizes on the assessment of bacterial community structure. Soil Biology and Biochemestry. 2002; 34(11):1701-1707
Malusà E, Pinzari F, Canfora L. Efficacy of biofertilizers: challenges to improve crop production: In Microbial inoculants in sustainable agricultural productivity. Springer, New Delhi. 2016; 17-40
Smith KA, Ball T, Conen F, Dobbie KE, Massheder J, Rey A. Exchange of greenhouse gases between soil and atmosphere: interactions of soil physical factors and biological processes. Eur. J. Soil Sci. 2018; 69(1):10-20
Prisa D. Optimised fertilisation with zeolitites containing Plant Growth Promoting Rhizobacteria (PGPR) in Ranunculus asiaticus. GSC Biological and Pharmaceutical Sciences. 2020; 10(01):096–102
Torsvik V, Ovreas L. Microbial diversity and function in soil: from genes to ecosystems. Current opinion in microbiology. 2002; 5(3):240-245
Alexander M. Introduction to soil Microbiology. John Wiley & Sons, New York. 1977
Briggs D, Walter SM. Plant Varation and evolution. Cambridge University Press. 1997
Iaccarino M. Microrganismi benefici per le piante. Idelson- Gnocchi. 2006
Prisa D. Gigaspora Margarita use to improve flower life in Notocactus and Gymnocalycium plants and roots protection against Fusarium sp. World Journal of Biology Pharmacy and Health Sciences(WJBPHS). 2020; 04(01), 051–058
Prisa D. Improvement Quality and Content of Pepper and Chilli Nitrates Influenced by the Effective Microorganisms. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS). 2019; 53(1): 176-181
Prisa D. Effect of Glomus mosseae inoculation on growth and flowering improvement of Chamaecereus sylvestrii and Mammillaria laui. World Journal of Advanced Research and Reviews(WJARR). 2019; 02(03):31-38.
Prisa D. Glomus mossae and Glomus intraradices in the rooting and essential oil production of aromatic succulent plants Plectranthus amboinicus. Science International. 2022; 34(1): 41-44
Prisa D. Effective Microorganisms Improve Growth and Minerals Content in the Medicinal Plant Bulbine frutescens. Indian Journal of Natural Sciences. 2022; 12(70): 37763-37770
Florenzano G. Elementi di microbiologia del terreno. Manuali di Agraria. Edizioni Reda.1972
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareA Study of Anatomical Variations of Extrahepatic Biliary System by Pre-operative Magnetic Resonance Cholangio-Pancreatography and that Encountered during Laparoscopic Cholecystectomy: A Prospective Observational Study
English4753Chhikara AmitEnglish Gupta AnurakshatEnglish Trehan VikramEnglish Mohan HariEnglishIntroduction: The variations in cystic duct anatomy are of considerable importance during surgical excision of the gallbladder (cholecystectomy). Preoperative MRCP assessment of possible anatomical variations helps the surgeon to formulate appropriate strategies and operative planning. Objective: To assess the usefulness of pre-operative MRCP assessment of anatomical variations of the extra-hepatic biliary tree in surgical planning and validate the MRCP findings with surgical findings. Material and Method: A total 120 patients of ultrasonography-proven gallstone disease were included in the study, further evaluated preoperatively by magnetic resonance cholangiopancreatography for delineation of extra-hepatic biliary anatomy and was compared with findings during Laparoscopic Cholecystectomy performed in the same patients. Seven patients had frozen Calot’s triangle per-operatively and were excluded from the study. Results: The majority of patients were in the age group of 51-60 years (28.4%) and females (85.84%). on MRCP, Posterior insertion of the Cystic duct was noted in 58.41% of patients, Lateral insertion in 35.39% of patients while on per-operatively Posterior insertion was noted in 50.44% and lateral insertion in 38.94 % patients. Most common intra-op complication was Bile spill in 19.4% of patients, a Stone spill in 9.7% patients and there was no bile duct injury noted. Conclusion: There is a definitive role of magnetic resonance cholangiopancreatography prior to laparoscopic cholecystectomy in gallstone disease for precisely delineating the extrahepatic biliary tree anatomy and predicting difficult surgery thus helping the surgeon to be prepared for the eventualities during surgery and to prevent biliary injury. However, still intra-op picture can vary and overall, there is a reduction in patient morbidity.
EnglishExtra-hepatic Biliary Anatomy, Pre-operative MRCP, Cystic duct insertion, Laparoscopic Cholecystectomy, Biliary injuryINTRODUCTION
The cystic duct drains the gallbladder into the common bile duct. In adults, it is usually between 2 and 4 cm long and has a luminal diameter of 2–3 mm.1 Cystic duct unite with the common hepatic duct in a variable fashion to form the common bile duct. Anatomic variants of the cystic duct insertion into the extrahepatic bile duct are:
(a) Right lateral insertion
(b) Anterior spiral insertion
(c) Posterior spiral insertion
(d) Low lateral insertion with a common sheath,
(e) Proximal insertion or low medial insertion.
The cystic duct joins the middle third of the combined lengths of the common hepatic and common bile ducts in most of the patients,2 but it may also drain by variable insertion into the distal common bile duct (CBD) usually joins the right lateral aspect by making oblique angle or run parallel with common hepatic duct in the free edge of the lesser omentum for a variable distance before merging.3 These variations of cystic duct anatomy are identified by preliminary cholangiogram of considerable importance to prevent biliary injury during cholecystectomy.
In adults, the common hepatic duct descends approximately 3 cm before being joined obliquely on its right by the cystic duct to form the common bile duct. In adults common bile duct divided into supraduodenal, gastroduodenal and pancreatic segments and is usually between 6 and 8 cm long and its luminal diameter, as measured by ultrasound, is no more than 7 mm.4 The supraduodenal segment of the common bile duct is the most accessible at surgery. Calot’s triangle, which is an isosceles triangle based on the common hepatic duct, with the cystic artery and cystic duct forming its sides.5 Understanding the variations in biliary and arterial anatomy as they relate to the triangle is of considerable importance during excision of the gallbladder in order to avoid injury to the common hepatic or common bile duct or right hepatic artery. 6,7 (Figure 1)
Extra-hepatic biliary system has wide anatomical variations which might have a detrimental role on the successful culmination of a Laparoscopic Cholecystectomy procedure. Although the incidence and frequency of these different anatomical variations vary substantially yet these anatomical variations from normal anatomy make the Laparoscopic Cholecystectomy procedure difficult and might result in biliary tract injury.7,8 Incidence of extra-hepatic biliary tree anatomical variations is seen less than 50%.9 Preoperative assessments of possible anatomical variations help the surgeon to formulate appropriate strategies and operative planning. Failure to recognize some of the clinically important variants may lead to complications. In recent years magnetic resonance cholangiopancreatography (MRCP) has come up as an optimal non-invasive imaging modality for the evaluation of anatomical variations of the extra-hepatic biliary tree. In the present study anatomical variations of the extrahepatic biliary system assessed by preoperative MRCP and that encountered during Laparoscopic Cholecystectomy
MATERIAL AND METHOD
Study type-This was a prospective observational study.
Study population- A total of 120 patients were included in the study.
Inclusion criteria- Patient aged 18 to 80 years of both sex, belonging to different socio-economic conditions and various geographical locations of India and who had ultrasonography proven symptomatic cholelithiasis were further evaluated preoperatively by magnetic resonance cholangiopancreatography for delineation of extra-hepatic biliary anatomy, underwent laparoscopic cholecystectomy.
Exclusion criteria- Patients who were unwilling to participate in the study, in which MRI was contraindicated, acute calculus cholecystitis, empyema gall bladder, pancreatitis and frozen Calot's triangle preoperatively were excluded from the study.
Place of study -This study was conducted at 7 Air Force Hospital Kanpur, India,
Duration of study- The study duration was from January 1, 2018, to December 31, 2018.
Objectives of study-
To find out by MRCP frequency and types of anatomical variations of the extra-hepatic biliary tree in patients supposed to undergo Laparoscopic Cholecystectomy.
To validate the MRCP findings with surgical findings.
To assess the usefulness of pre-operative MRCP assessment of anatomical variations of the extra-hepatic biliary tree in surgical planning.
Methodology: In the present study, 120 patients with ultrasonography-proven gallstone disease were further evaluated preoperatively by Magnetic Resonance Cholangiopancreatography using a Magnetic Resonance Image (MRI) unit on MRI scanner and images obtained by using Philips Achieva® 1.5 TESLA MRI. The MRCP images were evaluated by an experienced radiologist for the presence of different anatomical variations of the extra-hepatic biliary tree. Preoperative workup general blood picture, assessment of liver function test, renal function test and fitness for general anesthesia was done. Informed written consent was obtained from all the patients before the operative procedures. Participation in the study was entirely voluntary giving the patient right to withdraw from study whenever he/she wishes to do so.
This study was approved by the Institutional Ethical Committee (7AFH/24Apr/2018). Demographic information, personal and medical history was obtained. Preoperative MRCP for delineation of extra-hepatic biliary anatomy were noted. All the patients underwent Laparoscopic Cholecystectomy. Anatomic variations in extra-hepatic biliary tree were observed and recorded during the procedure. Seven patients had frozen Calot’s triangle per-operatively and were excluded from the study. Preoperative MRCP findings were compared with Laparoscopic Cholecystectomy findings in the same patients. Impact of MRCP assessment of extra-hepatic biliary tree variations was assessed with respect to reduction in intraoperative and postoperative complications.
Data Collection Method
The data was collected on a semi-structured questionnaire. Records of all the test reports are maintained. Observations were made under direct supervision. The data so collected were fed into the computer using MS Excel 2013 or compatible software.
STATISTICAL METHODS
The data was analyzed using Statistical Package for Social Sciences version 21.0 or above. Chi-square test, ANOVA and Independent Samples 't'-test was used for comparison of data. A p-value less than 0.05 was considered to indicate a statistically significant association. Sensitivity, Specificity, PPV, NPV and accuracy of MRCP were also assessed.
RESULTS
Age of the patients: Majority of patients were of age group 51-60 years (28.4%) followed by age groups 31-40 years and 41-50 years (20.3% each) and the mean age was 47.32±13.58 (Figure 2a).
Gender of patients: On the basis of their gender, the majority of patients were females (85.84%) followed by males (14.16%) (Figure2b).
Cystic duct and Common bile duct diameter: It was noted that mean cystic duct diameter in females was 1.60±0.79 mm and in males it was 1.35mm±0.44mm while mean CBD diameter in females was 5.88±1.67mm and in males it was 5.88±1.26mm (Table 1a, 1b).
Cystic duct insertion:
a) On MRCP: Posterior insertion was noted in 58.41% patients, lateral insertion in 35.39% patients, anterior insertion in 2.66% patients and medial insertion in 3.54% patients (Table 2a, Figure3).
b) On Per-operative: Posterior insertion was noted in 50.44% patients, lateral insertion in 38.94 % patients, anterior insertion in 9.74% patients and medial insertion in 0.88% patients (Table 2b, Figure 4).
MRCP was able to predict correct anatomical variation in 70 cases out of the 113 that were evaluated giving a rate of 61.94%. The errors in detection can be due to multiple causes like observer sensitivity, technical skill in image acquisition, stage of disease process leading to changes in nature of image and body characteristics of the patient. Each of these factors needs to be evaluated separately in future studies with larger sample size.
Table (Table 3a, 3b) analyses the usefulness of MRCP preoperatively to screen the cases planned for Laparoscopic Cholecystectomy. Considering Cystic duct insertion noted during preoperative MRCP and that noted intra-operatively, Lateral (a) and Posterior insertion(c) were the most common finding and considering these findings to be normal, Anterior (b) and Medial insertion(d) were considered as anatomical variation and the following results were obtained.
Intra-op complications: Most common intra-op complication was bile spill in 19.4% of patients, stone spill in 9.7% of patients and vascular injury (cystic artery) during dissection in 7.96% patients. No bile duct injury, trocar injury, bowel injury or port site bleeding was noted (Table 4).
Operative time: Time taken for performing laparoscopic cholecystectomy was less than 60 minutes in 82(72.56%) cases and more than 60 minutes of operative time in 31(27.43%) cases.
DISCUSSION
The frequency and types of extrahepatic biliary tree anatomical variations is quite high and owing to these variations, there is difficulty during operative procedures and often there is a high incidence of intra-operative and postoperative complications. In recent years, Magnetic Resonance Cholangiopancreatography (MRCP) has emerged as a useful modality to assess these variations non-invasively prior to surgery itself. The present study was conducted to assess the usefulness of pre-operative MRCP, assessment of frequency and types of anatomical variations of the extra-hepatic biliary tree in patients supposed to undergo Laparoscopic Cholecystectomy and compare with surgical findings.
In a study by Al Ghamdi A S et al. 10, the mean age was 41 years (range 10-100 years) in the age group 31-40 years while in the present study the mean age was 47 years (range 22-76) with the highest incidence was in 6th decade. The youngest male was 22 years old and the female 24 years. In a study by Sakorafas et al.11 female genders was associated with a higher prevalence, 16% compared to 9% for males. IJ Beckingham12 studied that the female gender carried twice the risk of gallstone disease as compared to men, which was especially prominent at young age, mainly because of hormonal factors. Present study results correlated with their findings with a female: male ratio of 6.06: 1 (97 females vs 16 males). In present study mean cystic duct diameter was 1.60 mm with a SD of 0.79mm in females and in males it was noted to be 1.35 mm with a SD of 0.44mm.No other study in the past has noted this particular parameter. This may be due to the non-availability of detailed MRCP findings or due to the non-availability of expertise. Kim H J et al.,13 in a study of normal structure, variations and anomalies of the pancreaticobiliary ducts found that the mean maximal and mid-portion diameters (mm) of the common bile duct were 6.4mm (1.8) and 5.5mm (1.7) respectively while dilated CBD was described to have an association with difficult surgery and conversion to open surgery by Liu et al.14 In present study, mean diameter of CBD in females was 5.88 mm with an SD of 1.67 mm and in males it was noted to be 5.88 mm with an SD of 1.26mm. In a study by Sarawagi R et al.,15 the accuracy of MRCP evaluated in the diagnosis of anatomic variants of biliary tree in 224 patients, MRCP demonstrated the cystic duct in 198 patients, including a low cystic duct insertion in 18 patients (9%) and a parallel course of the cystic and hepatic ducts in 7.5% patients. There were three common variants in the anatomy of the cystic duct region: low cystic duct insertion with distal third of the CBD (9%); medial insertion, where the cystic duct drains into the left side of CBD (10-17%); and a parallel course and less angular entry into CBD (1.5-25%). In the present study, patterns of cystic duct insertion noted during preoperative MRCP were lateral insertion in 35.40%, posterior insertion in 58.41%, anterior insertion in 2.65% and medial insertion in 3.54% of patients. When these patients were taken up for Laparoscopic Cholecystectomy, the intra-operative patterns of cystic duct insertion were found to be a lateral insertion in 38.93%, posterior insertion in 50.44%, anterior insertion in 9.73% and medial insertion in 0.88% patients. In this study it was tried to analyze the usefulness of MRCP preoperatively to assess the extrahepatic biliary tree anatomy for the case planned for Laparoscopic Cholecystectomy. To calculate the results, intraoperative findings have been used as Gold Standard. The sensitivity of MRCP was 97.12% with a 95% confidence interval (91.8%-99.4%). This implies that the sensitivity of MRCP was at least 91.8%, which was quite high and the chances of missing a case of anatomical variation were low, thus making MRCP a useful imaging modality for preoperative assessment of anatomical variations. The specificity was 44.4% with 95% confidence interval (13.7%-78%). The specificity was low which implies that there were fair chances of false-positive cases where MRCP highlights a variation, which actually was not present. However, this is clinically not very important as this would mean taking more precautions during surgery which is never a bad idea in such cases. I J Beckingham12 in his study found that biliary tree injury with laparoscopic cholecystectomy was 0.2 – 0.4 % as compared to 0.1% with open cholecystectomy while in the present study, there were no bile duct injuries. This may be attributed to the fact that centre has highly trained senior faculty and each patient had undergone extensive pre-operative evaluation which was far beyond the standard of care. Al Ghamdi A S et al.,10 in the study of 751 patients, the mean operative time was 65.52 minutes, seven patients (0.93%) converted to Open Cholecystectomy (OC) and mortalities of 02 patients (0.26%). In present study, the mean operative time was 54.13±25.71min and there was no conversion or mortality. In view of the smaller sample size in study group, the difference in mortality rates was also not statistically significant.
CONCLUSION
The present study attempts to determine the role of magnetic resonance imaging and magnetic resonance cholangiopancreatography prior to laparoscopic cholecystectomy in gallstone disease. However, laparoscopic cholecystectomy carries a higher risk of injury to biliary tree than conventional surgery. Significant number of these injuries is caused by variations in the biliary tree anatomy. By precisely delineating the biliary tree anatomy, magnetic resonance imaging and magnetic resonance cholangiopancreatography can assist the surgeons in predicting difficult surgery thus helping the surgeon to be prepared for the eventualities during surgery and to prevent biliary injury. However still intra-op picture can vary and overall, there is a reduction in patient morbidity.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. The authors also thank to all the participants who have participated in the study.
Source of Funding: NIL
Conflict of interest: NIL
Ethical committee clearance: IEC No. (7AFH/24Apr/2018).
Author’s contribution:
Study conception, Design of methodology & Intellectual content: Dr. Amit Chhikara,
Dr. Anurakshat Gupta
Acquisition, Analysis and Interpretation of data: Dr. Amit Chhikara, Dr. Hari Mohan.
Drafting, Review, Editing of the manuscript: Dr. Hari Mohan, Dr.Vikram Trehan.
Critical revision & Final approval: Dr.Anurakshat Gupta, Dr.Vikram Trehan.
Englishhttp://ijcrr.com/abstract.php?article_id=4447http://ijcrr.com/article_html.php?did=44471. Dasgupta, D, Stringer M D. Cystic duct and Heister’s ‘valves’. Clinical Anatomy. 2005 Mar;18(2):81-7.
2. Shaw M J, Dorsher P J , Vennes J A. Cystic Duct Anatomy: An Endoscopic Perspective. Am. J. Gastroenterol. 1993.;88(12):2102-6.
3. Lamah M, Karanjia N D, Dickson G H. Anatomical variations of the extrahepatic biliary tree: Review of the World literature. Clin. Anat. 2001 May; 14(3): 167-72.
4. Perret R S, Sloop G D, Borne J A. Common bile duct measurements in an elderly population. J. Ultrasound Med. 2000 Nov.19(11):727
5. Schwartz S I. Eponyms in Surgery and Anatomy of the Liver, Bile Ducts and Pancreas by Mark D. Stringer. Clin. Anat. 2010; 23(3):319.
6. Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman M M, Matsuno S et al. Laparoscopic cholecystectomy, Calot’s triangle, and variations in cystic arterial supply. Surgical Endoscopy. 2000; 14:141-44.
7. Talpur K A, Laghari A A, Yousfani S A, Malik A M, Memon A I, Khan S A. et al. Anatomical variations and congenital anomalies of extrahepatic biliary system encountered during laparoscopic cholecystectomy. J Pak Med Assoc. 2010 Feb; 60(2):89-93.
8. Boyden E A. The anatomy of the choledochoduodenal junction in man. Surg. Gynecol. Obstet. 957 Jun;104(6):641-52
9. Paul S, Jacinth S J, Muniappan V. Variations of the Extrahepatic Biliary Tract: Cadaveric Study. J. Dent. Sci.. 2013;10 (1):46
10. Al Ghamdi A S, Khamis H S, El Said RE, Khairy G A. Laparoscopic cholecystectomy: the outcome with minimal conversion rate: Experience in a district hospital. Saudi J. Gastroenterol. 2003; 9: 124–8.
11. Sakorafas GH, Milingos D, Peros G. Asymptomatic cholelithiasis: Is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig. Dis. Sci. 2007; 52:1313–1325.
12. Beckingham I J. Gallstone disease. Br. Med. J.2001;322.
13. Kim HJ et al . Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc. 2002 Jun; 55(7):889-96.
14. Liu C L, Fan S T, Lai E C S, Lo C M, Chu K. M. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch. Surg. 1996; 131: 98–101.
15. Sarawagi R, Sundar S, Gupta S K, Raghuwanshi S. Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications. Radilogy research and practice. 2016,
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareFungal Endocarditis in an Alport’s Syndrome Patient with Chronic Kidney Disease on Regular Hemodialysis
English5457Nithin BharadwajEnglish Chandra Shekara ReddyEnglish Arun SrinivasEnglish Siddarth Kumar ChawathEnglish Lakshminarayan AcharEnglishIntroduction: Fungal Endocarditis is rare and fatal. Most prevalent in immunosuppressed and Intravenous Drug Abusers. Candida and Aspergillus species are most common etiologic Fungi. Case presentation: A Seventeen-year-old male with known Hypertensive, Seizures and Alport Syndrome of Stage V Chronic Kidney Disease, admitted with history of fever and chills for 2weeks. On regular hemodialysis via right Internal Jugular Vein Permcath, inserted 6 months ago. Clinical examination was unremarkable except for tachycardia and hypotension. Serial blood cultures were negative for any growth. But 2D Echocardiography confirms the presence of mobile vegetative mass attached to the Tricuspid Valve (TV), which extends and then obstructs the Right Ventricular Outlet Tract (RVOT). With worsening symptoms and failed initial management, he was admitted first time and underwent removable of Permcath, TV Vegetectomyand then Pericardial patch augmentation of Septal Tricuspid Leaflet and Alferi type of TV repair. Both Permcath tip and excised mass were sent for Histopathological Examination (HPE), confirming Fungal infection with Magnusiomyces Capitatus, which belongs to Blastoschizomyces capitatus. Responds to Inj. LoposomalAmhotericin B and Voroconazole. But within few weeks, he developed Severe Tricuspid Regurgitation and Right heart failure with gross Ascitis. Then readmitted for a second time and underwent immediate symptomatic relief by Ascitic tapping followed by TV Replacement with 31 mm of St. JUDE Mechanical Valve. Perioperative management was challenging and stabilized gradually and involves a multispecialty team approach. Discussion: Fungal endocarditis is a serious condition. Combined aggressive Medical and Surgical therapy will have a better outcome
EnglishAntifungal Agents, Fungal Endocarditis, Right Heart Failure, Tricuspid Valve Replacement, Ascitic tapping, Multispecialty team approachIntroduction
Fungal endocarditis (FE) remains the rare most serious form of infective endocarditis, with a high mortality rate of about 50%.1,2,3 It is highly challenging to identify the source, establish a diagnosis and to apply specific treatment. This is because of the high mortality rate and complexity of FE will lead to lack of prospective randomized clinical trials for FE management.
Case Report
We report a case of Fungal Endocarditis in a Seventeen-year-old male patient. He suffers from Hypertension, Seizure disorder and Alzheimer’s Syndrome with Chronic Glomerulonephritis with Stage 5D chronic kidney disease. He inherited Alport’s Syndrome from his mother. She also had CKD, both were on regular hemodialysis. His female sibling was free from Alport’s Syndrome. Alport’s Syndrome - X-linked Genetic disorder mainly affects kidney. He undergoes hemodialysis via Permcath, which was placed 6 months ago at the Right Internal Jugular vein. He was admitted twice with the intractable clinical course for Fungal Endocarditis management and stays in the hospital for nearly about 92 days.
First Admission: He was clinically presented with a history of fever, chills and tachycardia. All of his investigations were unremarkable except-Anemia(5.5 gms/dl). Thrombocytopenia (17000 cells /cumm) and 2D Echocardiography confirms the presence of a mobile mass attached to the Tricuspid Valve (TV) leaflet as shown in Figure 1.
The presence of Fever with chills and tachycardia, rapid growth of mass and presence of indwelling catheter confirms Infective Vegetative mass and hence Intra Cardiac mass as the differential diagnosis was ruled out. Serial blood cultures were revealed no growth, probably because of prior of medications. He failed to respond initial use of broad-spectrum antibiotics and antifungal treatments on an outpatient basis. As constitutional symptoms persist and increased Right Ventricular Outlet Tract obstruction by TV vegetative mass, with no option left out relatives were counselled, consented and admitted for high-risk TV mass removal surgery. Prior to surgery, CT Thorax was done which showed an extension of TV mass as in Figure 2. Also, he receives Six units of Leucodepleted Packed Red Blood Cells and Four units of Single Donor Platelet during the periprocedural period for correction of Anemia and Thrombocytopenia. Immediately after admission, Permcath was removed as it may be the only source of infection. Then Left Femoral HD catheter was placed for regular in-hospital temporary hemodialysis. Under General Anesthesia with Cardio-Pulmonary Bypass and Mechanical Ventilation support, TV mass ( Size - 3 X 4 x 5 cms ) was removed by TV Vegetectomy and then Pericardial patch augmentation of Septal Tricuspid Leaflet and Alferi type Tricuspid Valve repair ( by TV edge to edge stich ) was done. Both Permcath tip and TV mass were sent for histopathological examination(HPE) analysis. Both confirms Fungal Endocarditis (Fungal IE) as shown in Figure 3 - Magnusiomyces Capitatus belongs to Blastoschizomycescapitatus. Figure 3 -also shows gross anatomy of the excised mass. Along with regular medications. he was treated with Inj. Loposomal Amhotericin B, Tab. Voriconazole and other supportive measures. Then gradually weaned from Mechanical Ventilation support and extubated. Before first discharge, temporary Left Femoral Hemodialysis catheter was removed and new Left Brachiocephalic Fiastulae was created for future permanent hemodialysis. Prior to first discharge 2D Echo shows Moderate TR as shown in Figure 4.
Second Admission: Within few weeks, he was readmitted with worsened breathing difficulty and gross ascites. 2D Echo shows Dilated RA, RV, Severe TR and RV dysfunction as in Figure 5. Immediately he underwent therapeutic Ascitic fluid aspiration and aspirated 3.5 liters of Ascitic fluid to get immediate symptomatic relief. As TV destruction continued, Tricuspid Regurgitation worsens and so Tricuspid Valve Repair (TVR) was advised. Again relatives were counseled, consented and admitted for high-risk 2nd Surgery. Again, under General Anesthesia with Cardio-Pulmonary Bypass and Mechanical Ventilation support - underwent successful TV Replacement surgery with 31 mm of St. JUDE Mechanical Valve. He had delayed the weaning process from Mechanical Ventilation support due to intractable Seizures, treated with IV Sodium Valproate. We also encountered and managed some of the other complications that include Valproate induced Pancreatitis - treated conservatively, Left Femoral Artery Pseudoaneurysm and Hematoma - managed with direct Thrombin injection and Pseudoaneurysmal repair & large Left thigh hematoma evacuation and also had anteriorly popped outed Sternal wire, which was later removed directly. He was then gradually stabilized. Throughout his hospitalizations, he underwent regular hemodialysis initially via a temporary Left Femoral Hemodialysis catheter and later with permanent Left Brachiocephalic Fiastulae. At 2nd discharge, 2D Echo has shown definitive improvement as shown in Figure 6 with mild TR and without RV dysfunction. Multi-Specialty consultations was done including Diet, Psychiatry and Genetic counseling. Plan for Renal Transplantation after stabilization at later date.
Discussion
Fungal endocarditis (FE) is fatal, usually being diagnosed postmortem.1 FE is most prevalent in patients who are immunocompromised, intravenous drug abusers, prolonged use of antibiotics, parenteral nutrition or any intracardiac devices.1,2 The diagnosis of FE is challenging due to its slow growth.1,2 Neither any specific tests nor any diagnostic criteria were available for Fungal IE.2
High mortality rate and complexity of FE may lead to lack of prospective randomized clinical trials for FE management.2 Current guidelines recommend initial or induction therapy with Amphotericin B (AMB) with or without Flucytosine combined with surgical removal of vegetations, followed by chronic suppressive therapy with oral fluconazole.1,2 Voriconazole is for both first-line for induction and long-term suppression therapy for treating Aspergillus endocarditis.2 Duration of antifungal therapy is usually 6-8 weeks depending upon clinical improvement.2 Combined treatment appears to be superior to monotherapy, before the onset of valve destruction, fatal embolic strokes or chordal rupture causing valvular insuffiency.1,4In the presence of Fungal Endocarditis, Indications and Timing of surgery is very important. Indications and Timing of Surgery in the presence of Fungal Endocarditis were listed in Table 1 - a Consensus on Surgical Treatment of Infective Endocarditis by American Association for Thoracic Surgery Guidelines.5
Conclusions
Fungal endocarditis(FE) is a serious health condition. Early diagnosis and intensive management are essential. Combined Medical and Surgical therapy will have better outcomes. Consensus on FE management is evolving.
Learning Points
Aggressive and early combined Medical and Surgical therapy for FE is essential.
A multi-Specialty approach is often required.
Dietary Consultation and Psychiatry Counselling are equally important.
Acknowledgments
We acknowledge the immense help received from the scholars whose articles are cited and included in the references of this manuscript. We are also grateful to the authors/editors/publishers of all those articles, journals and books from which the literature for this article has been reviewed and discussed.
Conflict of interest: No conflict of interest
Source of funding: None
Authors contribution:
Nithin Bharadwaj contributes to complete conceptualization and data collection, Chandra Shekara Reddy creates complete manuscript preparation and editing, Arun Srinivas as the corresponding author and provides complete guidance and proof correction of manuscript, Siddarth Kumar Chawath guides complete journal search and publication guidelines and Lakshminarayan Achar permits to access complete surgical notes and figures / photos.
Englishhttp://ijcrr.com/abstract.php?article_id=4448http://ijcrr.com/article_html.php?did=4448
Yuan SM. Fungal endocarditis. Braz. J. Cardiovasc. Surg. 31 (3) • May-Jun 2016 • https://doi.org/10.5935/1678-9741.20160026
Pasha AK, Lee JZ, Low SW, Desai H, Lee KS, Al Mohajer M. Fungal endocarditis: update on diagnosis and management. Am. J. Med. 2016 Oct 1;129(10):1037-43
Tacke D, Koehler P, Cornely OA. Fungal endocarditis. Current opinion in infectious diseases. 2013 Dec 1;26(6):501-7.
Pang PY, Sin YK, Lim CH, Tan TE, Lim SL, Chao VT, et al. Surgical management of infective endocarditis: an analysis of early and late outcomes. Eur J Cardiothorac Surg. 2015 May 1;47(5):826-32.
Writing C, Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary. J Thorac Cardiovasc Surg. 2017; 153:1241-58.
DOI: https://doi.org/10.1016/j.jtcvs.2016.09.093
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareRole of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding
English5863Vinita SarbhaiEnglish Ayushi SinhaEnglishIntroduction: Transvaginal Sonography has emerged as an important modality in investigating AUB, but it cannot diagnose endometrial pathology in absence of histopathology of the endometrium. The addition of Color doppler (CDTU) to TVS can help in diagnosis by evaluation of blood flow through vascular patterns and Uterine artery indices. Objective: To evaluate the role of Transvaginal Ultrasonography and Colour Doppler (CDTU) in abnormal uterine bleeding and correlate them with histopathological diagnosis. Methods: TVS and Colour Doppler were performed in 70 patients with AUB. TVS included evaluation of endometrium, size of the uterus, any uterine or adnexal pathology. The vascular pattern of Spiral arteries of the endometrium and uterine arteries was analyzed. Uterine artery indices (RI and PI) were calculated. 1.83 was taken as cut-off for PI and 0.81 was taken as cut-off for RI. The results were then compared with histopathology of the endometrium. Results: On TVS, the causes of AUB were Leiomyoma in 17.1%, polyp in 10%, PCOS in 8.5%, Adenomyosis in 5.7%, and Endometrial growth in 2.8%. 11 patients had suspected malignancy by uterine indices of RI (English Transvaginal-sonography, Colour Doppler, Abnormal Uterine Bleeding, Uterine artery indices, Endometrial Hyperplasia, Carcinoma Endometrium.INTRODUCTION:
Abnormal uterine bleeding (AUB) is one of the most common presentations in Gynae OPDs for patients of all age groups. AUB significantly affects health related quality of life, and therefore necessitates immediate attention. The management of AUB is complex without proper diagnosis. After detailed history and examination, further investigations are required for pointing out the cause of AUB. The most commonly done investigations include Trans Vaginal Ultrasound, Endometrial Aspiration, Endometrial Biopsy, Dilatation and curettage and office hysteroscopy.
In recent years, Trans Vaginal Ultrasound has emerged as an important modality in investigating AUB. TVS provides a high-resolution image of pelvic organs, rapid assessment of uterine and adnexal pathologies, and measurement of endometrial thickness and echogenicity of the endometrium. Addition of Colour doppler (CDTU) to TVS helps in evaluation of blood flow, by looking at vascular patterns and calculation of Uterine artery indices (Resistive index and Pulsatility index).
With this background, the present study was carried out with an aim to evaluate the role of Trans vaginal Ultrasonography and colour doppler in evaluation of abnormal uterine bleeding and correlating them with histopathological diagnosis.
METHODS
This study was carried out in a Tertiary care Hospital, Kasturba Hospital, New Delhi. 70 patients between 30-60 years of age with AUB attending the outpatient clinic were included after informed consent and due clearance from the ethical committee.
Patients with Pregnancy, Coagulation disorders, previously diagnosed genital tract malignancy, carcinoma breast and history of drug intake like tamoxifen were excluded from the study. A detailed history including menstrual pattern, irregularities, associated complaints, obstetric history, medical history, surgical and family history were taken. All the women were then clinically evaluated – general, systemic and gynaecological examinations with relevant blood investigations were carried out.
TVS was performed in all AUB patients. Endometrial thickness, echogenicity of endometrium, size of uterus, any uterine or adnexal pathology were observed and noted. The Power doppler gate was then activated for blood flow mapping of endometrium. Vascular pattern of Spiral arteries of endometrium, and uterine arteries was analysed. Uterine artery indices (RI and PI) were calculated(Fig2). On CDTU, 1.83 was taken as cut off for PI (1.83 was considered benign) and 0.81 was taken as cut off for RI (Englishhttp://ijcrr.com/abstract.php?article_id=4449http://ijcrr.com/article_html.php?did=4449
Fatima A, Dombale V. Morphological Spectrum of Endometrium in Dysfunctional Uterine Bleeding. Ind J of Path: Res and Pract. 2017;6(2 (Part-2):349-353.
DOI: http://dx.doi.org/10.21088/ijprp.2278.148X.6217.1
Jaiswar SP, Sachan R, Srivastava PK, Goel MM, Pandey M. A comparative diagnostic evaluation of hysteroscopy, transvaginal ultrasonography and histopathological examination in cases of abnormal uterine bleeding. J Obstet Gynecol India: 2006; 56(3): 240-243
Niknejadi M, Haghighi H, Ahmadi F, Niknejad F, Chehrazi M, Vosough A et al. Diagnostic Accuracy of Transvaginal Sonography in the Detection of Uterine Abnormalities in Infertile Women. Iranian Journal of Radiology. 2012;9(3):139-144.
Singh P. Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration. J Midlife Health. 2018 Jan-Mar; 9(1):32-35. DOI: http://dx.doi.org/10.4103/jmh.JMH_109_17.
Alcázar J, Galán M, Jurado M, López-Garc??a G. Intratumoral Blood Flow Analysis in Endometrial Carcinoma: Correlation with Tumor Characteristics and Risk for Recurrence. Gynecologic Oncology. 2002;84(2):258-262.
Choudhary J, Acharya V, Jain M. Evaluation of abnormal uterine bleeding with transvaginal sonography and hysteroscopy in perimenopausal women. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3607.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareFactors Influencing Antiepileptic Drug (AED) Nonadherence in a Tertiary Care Hospital: A Cross-Sectional Study
English6468Majid Ali KhandEnglish Shoaib AhmedEnglish SaifullahEnglish Lal ChandEnglish Muhammad Asif KhaskheliEnglishIntroduction: Epilepsy affects almost 50 to 70 million individuals worldwide, accounting for 0.75 percent of the worldwide illness burden. Every year, an approximately of 2.4 million individuals are afflicted with epilepsy. Due to a lack of accessibility and affordability of AEDs, up to three-quarters of patients with epilepsy in low-income nations are unable to receive the medication they require. Aim: To determine the factors influencing antiepileptic drug (AED) nonadherence in a tertiary care hospital. Methodology: According to the findings of a single-center, cross-sectional investigation, we did a subgroup assessment. Patients have to be at least 18 years old to participate. The Morisky Medication Adherence Scale, which has four items, was employed to assess compliance to AEDs. To forecast parameters linked to AED nonadherence, researchers employed multivariable logistic regression assessment. Results: This subgroup evaluation includes a total of 270 patients who met the eligibility criteria. Amongst the patients, 82 (31%) did not take their medication as prescribed. AED polytherapy, medication-linked negative events, and medication length beyond 3 years were three characteristics linked to poor adherence. Conclusion: Almost one-third of the participants did not take their medicine as prescribed. Noncompliance may be minimized if patients’ treatments are limited to monotherapy as much as feasible and patients are taught about the length of medication and potential side effects of AEDs.
EnglishEpilepsy, Antiepileptic dugs, Compliance, Poly therapy, Potential side effects, Morisky Medication Adherence Scalehttp://ijcrr.com/abstract.php?article_id=4508http://ijcrr.com/article_html.php?did=4508Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareCost-effectiveness and Clinical Outcomes of Early Tracheostomy in the Patients of Isolated Head Injury: A Retrospective Study
English6972Fahmida Arab MallahEnglish Syed Aamir ShahEnglish MuzamilEnglish Abdul Razaque MariEnglish Asim ShahzadEnglish Rayif Rashid KanthEnglishIntroduction: Early tracheostomy (ET) proved to be effective in the intensive care unit (ICU) in patients who face difficulty in weaning off of mechanical ventilators easily. Tracheostomy is a common procedure applied in mechanically ventilated patients. It aims at reduce of complications and improving of comfort of the patient. However, the benefits of the tracheostomy must be evaluated against the risks of the tracheostomy before its placement. Variables which are needed to be considered before performing a tracheostomy are the timing of the procedure, absence or presence of TBI, and severity of the injuries. Aim: To assess the cost-effectiveness and clinical outcomes of early tracheostomy in the patients of isolated head injury Methodology: A total of 212 patients were included in the study. All the patients had isolated severe traumatic brain injury (TBI) and required mechanical ventilation. Tracheostomy was done within seven days of retaining TBI. Prolonged endotracheal intubation (EI) was defined as intubation more than seven days after TBI. A total of 103 (48.58%) patients underwent early tracheostomy (ET). A total of 109 (51.42%) patients underwent prolonged (EI). The patients were assessed according to the occurrence of ventilator-associated pneumonia (VAP), Glasgow Outcome Score (GOS), and ICU stay. Results: The occurrence of VAP was 133 (62.74%) in the EI group which was higher compared to that of the ET group in which 79 (37.26%) had presented with VAP. The duration of need for a ventilator in the ET group was 10 days compared to 13 days of the prolonged EI group. Similarly, the need for ICU stay was 11 days in the ET group which was lesser than 13 days of the EI group. The complication rate in the ET group was 14% and in the EI group, it was 18%. The rate of mortality in the ET group was 7.77% and it was 16.51% in the EI group. The GCS of the ET group was better than the EI group. Moreover, the cost of the EI group was more than the ET group. Conclusion: ET reduces the total duration of ICU stay and ventilation in patients with severe TBI. The frequency of VAP is also lesser in the patients given ET. Hence, ET should be given in patients with severe head injuries that require prolonged support of mechanical ventilation.
EnglishMechanical ventilation, Early tracheostomy, Severe traumatic brain injury, Prolonged endotracheal intubation, EI group, ET grouphttp://ijcrr.com/abstract.php?article_id=4509http://ijcrr.com/article_html.php?did=4509Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241148EnglishN2022April19HealthcareEffect of Percutaneous Transvenous Mitral Commissurotomy in Severe Mitral Stenosis: A Cross-Sectional Study
English7375Muhammad RafiqueEnglish Abdul SalamEnglish Fazal ur RehmanEnglish Wajid HussainEnglish Waqar AzimEnglish Muhammad HashimEnglishIntroduction: The inflow obstruction from the left atrium to the left ventricle due to rheumatic involvement of apparatus is the main cause of Mitral stenosis. The patients with mitral valve involvement are found to have a combination of stenosis and regurgitation. Due to the thromboembolic phenomenon, left atrial dilatation and stasis predispose thrombus formation. So, even after percutaneous treatment, the elevated pressure in MS patients causes morbidity and mortality. Aim: To assess the effect of percutaneous transvenous mitral commissurotomy (PTMC) in reducing pulmonary hypertension in patients with severe mitral stenosis Methodology: A total of 134 patients were included in the study. All of them had severe mitral stenosis with elevated pressure of more than 55 mmHg. The age range of patients was between 16 to 62 years. These patients were assessed by echocardiography post-PTMC. Age, gender, and other demographic details were also noted. Results: Mean age of patients was 36.44±11.37 years. Hypertension was found in 49 patients, and diabetes in 48 patients. Mean baseline systolic pressure was found to be 73.62+9.10 mmHg and mean artery systolic pressure was 44.09±5.06 mmHg. After the commissurotomy, the pulmonary artery systolic pressure reduced from baseline by 38.90+5.20. In 125 patients the Transvenous mitral commissurotomy was effective and in 9 patients it was ineffective. Conclusion: This study was found to be successful because it had fewer patients with pulmonary hypertension after the completion of treatment. For the reduction in mean pulmonary artery, systolic pressure balloon valvotomy is a useful technique irrespective of age and gender.
EnglishPulmonary artery systolic pressure, Balloon valvotomy, Effectiveness, Transvenous mitral commissurotomy, Pulmonary hypertension, Thromboembolic Phenomenonhttp://ijcrr.com/abstract.php?article_id=4510http://ijcrr.com/article_html.php?did=4510