Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30HealthcareREFLECTIONS OF MEDICAL STUDENTS ON CADAVERIC DISSECTION IN PRESENT SCENARIO English0105Anita RaniEnglish Jyoti ChopraEnglish Archana RaniEnglish Rakesh Kumar VermaEnglish Arvind Kumar PankajEnglishObjective: Continuation of cadaveric dissection in era of computer assisted learning is losing its charm in many medical schools worldwide. For the past few years, we were observing that our undergraduates were not able to complete the whole body dissection in time. Therefore, we planned to substitute dissection with demonstration of carefully dissected parts (prosections). The views of students were taken regarding dissection and demonstration of prosections for learning anatomy. Methods: A questionnaire regarding perception of human cadaveric dissection, preference towards demonstration of prosections for anatomy learning and problems encountered during dissection was distributed to the first year MBBS students (n=243) immediately after completion of first professional examination. Results: Majority (78%) of students were in favor of performing dissection but only 45% students performed dissection when the chance was given to them. 49% students did not dissect all the allotted regions while 6% students never attempted for dissection. 21% students were not able to complete the given dissection task. Prosection alone was least preferred whereas 50% students voted for both activities. 33% expressed that dissection alone is sufficient. Students felt that cadaveric dissection helped them in understanding of the subject. They also expressed that shortage of time, mass bunking, lack of supervision by teachers, excessive fat, lack of prior knowledge and irritating formalin fumes are some difficulties which they face while performing dissection. Conclusion: Dissection should continue to be a cornerstone in learning gross anatomy but only after reframing objectives which are realistic and achievable in given time frame. Prosected parts should be used as an adjunct for teaching and learning in anatomy. EnglishCadaver, Dissection, Prosection, Medical studentINTRODUCTION Anatomy teaching in medical schools has been traditionally based around the use of human cadaveric specimens.1 No doubt cadaveric dissection facilitates learning of three dimensional structure of human body through self-discovery and observation, but at the same time it is expensive, time consuming and potentially hazardous. Problems related to the use of human cadaver, teaching methods, resources and time constraints has forced many schools to introduce a shift towards greater use of alternative modalities of teaching gross-anatomy involving cadaveric plastination, non-cadaveric models and computer-based imaging.2 For the last 3-4 years, we are providing two cadavers for dissection to each batch (total 8), of 32 MBBS students. Each student gets a chance to dissect some part of every region in rotation. After completion of every region, for revision, prosected specimens are shown to students. In both formative and summative assessments, viva-voce is based on identification of structures on prosected parts. Dissection skill is not assessed at any stage of evaluation. Due to time crunch most of the time dissection task allotted to undergraduates remains uncompleted. This observation led us to think for revising our curriculum. We planned to replace dissection activity with demonstration of prosected specimen. As suggested by Nagar et al. (2012), that opinion of the students need should be heard in deciding curriculum, we interrogated our students to give their perception of significance of dissection activity and related problems.3 METHODS A questionnaire regarding perception of human cadaveric dissection, preference towards demonstration of prosections for anatomy learning and problems encountered during dissection was distributed to the first year MBBS students (n=243) immediately after completion of first professional examination. Students views were recorded and statistically analyzed. Study was approved by the institutional ethical review committee and after explaining the purpose of study consent was taken by students before distribution of questionnaire. RESULTS Majority of students (78%) liked to perform dissection and suggested it to be a compulsory activity, but only 45%students performed dissection when the chance was given to them. Nearly half of the students (49%) accepted that they did not dissect all the allotted regions while 6% students never attempted for dissection. 67% students were able to complete given assignments in stipulated time while 21% were not. Given choice between prosections or dissection, prosection alone was least preferred whereas 50% students voted for both activities as teaching modality and 33% expressed that dissection alone is sufficient (Table 1). Table1: Responses of students for their dissection and prosection choices Question Response in % Yes No Sometimes Not Responded Should dissection be mandatory? 78 5 - 17 Did they perform dissection? 45 6 49 - Whenever had chance to dissect, able to successfully complete the task 67 21 2 10 Only dissection is sufficient for learning Anatomy 33 52 - 15 Only demonstration of prosected part is sufficient for learning Anatomy 2 83 - 15 Both prosection and dissection are required 50 35 - 15                             Students were asked to express their views regarding role of dissection in learning anatomy and problems encountered during dissection. Majority (80%) of students opined that dissection helps in providing three dimensional understanding of structures while many (73%) correlated it with better retention. Few (45%) also accepted its benefit in making anatomy fascinating and 30% responded that it helps in explaining cross sections in a better way (Table 2). Students quoted many problems associated with task of performing dissection (Table 3). Answers were interpreted and categorized into seven areas of difficulty. Majority (83%) reflected the crunch of time as biggest threat while a minority also expressed the problem of language as one of the barrier in receiving maximum benefit of dissection. Table 2: Students views on "how dissection helps in learning anatomy" S. No. Views Response 1. Seeing in 3-D, helps in better understanding of inter-relations of structures 80% 2. Better retention of facts and relations 73% 3. Makes the subject interesting and fascinating 45% 4. Helps in explaining the cross sectional anatomy 30% Table 3: Causes for not completing the task/ difficulties faced during dissection S. No. Problems encountered in doing complete dissection Response 1. Time constraints (shortage of time) 83% 2. Mass bunking of classes 20% 3. Lack of proper guidance 43% 4. Lack of proper knowledge of the part to be dissected 52% 5. Lack of confidence (need practice) 51% 6. Troublesome dissection due to excessive fat 21% 7. Non conducive environment of Dissection Hall 10% 8. Language problems 9% DISCUSSION Reduced contact hours in anatomy and introduction of other areas like imaging, developmental, microscopic, living anatomy etc. has forced us to cut short gross anatomical details from curriculum. Despite of the fact that complete dissection of human body by undergraduates is facing several practical difficulties, our students gave a positive feedback for continuing dissection. Dissection has been recognized as the most universal instrument, which is strongly supported and preferred over other methods for professional training and skill development in becoming medical doctors.4-7 Majority of students (78%) appreciated the role of touch mediated perception of body and its positive role in understanding human structure and therefore promoted dissection (Table 1). Cadaveric dissection allows students grasp the three dimensional anatomy and concept of biological variability.8 Dissection is also favored because apart from imparting anatomical knowledge it also offers positive learning opportunities to enhance the skills and attitudes of future doctors like teamwork, respect for the body, familiarization of the body, application of practical skills, integration of theory and practice, preparation for clinical work and appreciation of the status of dissection within the history of medicine.9 The value of dissection is well recognized by several institutes around the world who reversed their decision to close the cadaveric labs in anatomy and restarted dissection with modifications.10 One may argue, if, so than why 55% students did not take the advantage of performing dissection. Different visual and kinesthetic styles of learning among students may help in understanding such discrepancy.11 Apart from this, we also know that assessment drives learning and because dissection skills are not evaluated at any step of assessment i.e. formative or summative in our setup, so students, though accepted the significance of it but did not exhibit their interest in performing it. However studies suggest that the students who had a cadaver dissection-based learning did better in all aspects of the exams.12 But some have quoted that students who perform dissection daily, perform better only in practical examinations.13 While, interrogating for the causes of non-completion of dissection, apart from time constraint, a list of other problems was also expressed by students (Table 3). Time factor was one of those troubles which was on the top of the list. Not only the task was time consuming but mass bunking by students also added to the crunch of time. As students got less chance to dissect, lack of practice and confidence added up to grave the problems and hence the learning objective was not achieved. Any educational activity, even of highest importance, if uncompleted within stipulated time cannot serve its purpose. According to Woolf (1999), curriculum can only be effective if SMART objectives are set. SMART objectives are those that are Specific, Measurable, Achievable, Realistic, and within a Timescale.14 During last few years, we were observing that cadaveric dissection assignments were incomplete most of the time and same was reflected by students in the present study so it is a high time to reconsider the dissection activity for learning gross anatomy.15 Lawrence and William (2006) suggested several redesigned shortened dissection courses in consultation with clinicians to transform traditional dissection courses rather than avoiding them. While redesigning the anatomy curriculum one should ensure that dissection remains a part of learning methodology.10 Unavailability of trained teachers during dissection hours to guide undergraduates was also among the highlights. To develop autonomy and competence in any skill, a healthy interaction between trainee and supervisor is necessary. As first year students are not much confident in performing dissection, their need of trained and skilled teachers during the whole period of dissection cannot be overlooked. Many researchers also stated that a good number of students expressed their learning difficulties, while performing dissection.16-18 Though, these students were not of low intelligence but they needed psychological and practical support, which can be provided by experienced and trained teacher. Problem of lack of guidance during dissection can be solved to a certain extent by putting projection screens in Dissection Hall to display dissection procedures and various steps. A proper Post-Graduate program in Anatomy is also demand of hour, as some gap between trainee and trainer can thus be narrowed down. And last but not the least, experienced faculty should continue to be among young students to share knowledge, despite of their busy schedule of administrative responsibilities. Students also admitted that sometimes they did not read the subject and come unprepared, so due to lack of proper knowledge they were unable to complete the assigned task. Few students experienced language problem. As the medium of instruction/teaching is mostly English in medical schools, the students from rural background face difficulty in understanding subject. To alleviate this problem MCI, in its 2015 vision, has suggested starting of foundation course, in which English language course is incorporated for those who wish to study. In many of the previous studies, students reaction towards cadaveric dissection has been associated with adverse emotional reactions and mixed feelings but none of our student in the present study quoted any anxiety, fear or emotional problems.2,19 Also very few of our students expressed the inability to perform dissection due to irritating formalin fuels. Probably, as the study was conducted at the end of first year, may be by this time they were acclimatized to the dissection hall environment and did not appreciate the above factor as one of the major problem. Several studies, based on students feedback and assessments suggested the use of carefully prosected parts for learning gross anatomy, as a replacement of dissection, for first year medical schools.20,21 Those who favor prosection based curricula opined that one should start with visually simplified fundamental lines and symmetrical patterns and build up to the more complex organization in order to facilitate learning of spatial relationships. This theory can be best practiced in anatomy by studying carefully crafted prosections. During dissection one begins with complex structure and reduces it in the process, and hence defeats the law of learning. Student learning is not dependent on performance of a full dissection. It is the sum of instructions, involvement, interaction, self-assessment and testing of one's newly acquired knowledge. If simplified, educationists feel that student may obtain a multisensory experience and learn structures and relationships from an interactive exploration of carefully prepared prosected cadavers.22 If we analyze impact of performing dissection during first year of medical training on practice, an observational study predicted that performing dissection does not have much influence on the performance of medical students.23 This prompted us to think over for replacing dissection with prosected part demonstration, but majority of our students did not favor it. 50% students felt the need of both, dissection as well as prosection, suggesting that a single tool is not sufficient. Dissection and prosection both should be continued. As effective time for performing dissection is actually less, stress should be on essential anatomy only.Post graduates in anatomy and other surgical specialties should be actively involved in fine dissection and preparation of prosected specimen. To sum up, the study suggested that though dissection is a time consuming process and the students were not able to complete it in stipulated time but it should not be completely replaced by prosection. Based on the feedback an effort was made to reframe the dissection schedule of undergraduates for future batches. CONCLUSION Dissection should continue to be a cornerstone in learning gross anatomy but only after reframing objectives which are realistic and achievable in given time frame. Prosected parts should be used as an adjunct for teaching and learning in anatomy. ACKNOWLEDGEMENTS I express my gratitude to the staff of the Department of Anatomy for assistance in providing infrastructure facilities and necessary help. Authors are also thankful to the first year MBBS students for sharing their views regarding dissection and prosection. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Source of Funding: Nil Conflict of interest: All authors have none to declare. Englishhttp://ijcrr.com/abstract.php?article_id=134http://ijcrr.com/article_html.php?did=134  Cahill KC, Ettarh RR. Attitudes to anatomy dissection in an Irish medical school. ClinAnat. 2009; 22(3):386-391. Mulu A, Tegabu D. Medical Students' Attitudinal Changes towards Cadaver Dissection: A Longitudinal Study. Ethiopian Journal of Health Sciences. 2012; 22:51-58. Nagar SK, Malukar O, Kubavat D, Prajapati V, Ganatra D, Rathwa A. Students perception on anatomy teaching methodologies. National Journal of Medical Research. 2012; 2(1): 111-112. Azer SA, Ezinberg N. Do we need dissection in an integrated problem-based learning medical course? Perceptions of first and second year students. Surg Radiol Anat. 2007; 29(2):173-180. Iqbal K. Impact of dissection; under and postgraduate study in medical colleges. Professional Medical Journal. 2010; 17(3): 490-492. Rajkumari A, Singh YI. Body donation and its relevance in anatomy learning: A review. J AnatSoc India. 2007; 56(1):44-47. McLachlan JC, Bligh J, Bradley P, Searle J. Teaching anatomy without cadavers. Med Edu. 2004; 38(4): 418-424. Winkelmann A. Anatomical dissection as a teaching method in medical school: a review of the evidence. Med Edu. 2007; 41(1):15-22. Heidi KL. Perceptions of dissection by students in one medical school: beyond learning about anatomy: A qualitative study. Med Edu. 2005; 39(3):318-325. Lawrence JR, William BS. Should we continue teaching anatomy by dissection when? The Anatomical record. 2006; 289B: 215-218. Johnson M. Evaluation of Learning Style for First Year Medical Students. International Journal for the Scholarship of Teaching and Learning. 2009; 3(1):1-17. Godson EA, Anthony IU. Impact of the use of cadaver on student's ability to pass anatomy examination. Anatomy. 2010; 4: 28-34. Chika N, Nirusha L, Wojciech P. Assessing the quality of dissection: A method for improving anatomy knowledge of first year medical students. The FASEB Journal. 2013; 27:318-26. Woolf F. Partnerships for learning: a guide to evaluating arts education projects. London, Regional Arts Boards and the Arts Council of England. 1999. Hughes P, Ed Ferrett. Introduction to Health and Safety in Construction. 4th ed. New York, Routledge, 2011;pp 162. Burgess A and George RS. Elective anatomy by whole body dissection course: what motivates students? BMC Medical Education 2014, 14:272. Jayanthi A, Sajna MV, Benjamin B. Students perception of teaching learning method in dissection and histology lab. IOSR Journal of Dental and Medical Sciences. 2014; 13(11): 24-28. Rowland A, Abbott S, Bevere G, Christopher MR. Medical students perceptions and understanding of their specific learning difficulties. International Journal of Medical Education. 2013; 4: 200-206. Agnihotri G, Sago MG. Reaction of first year medical students to the dissection hall experience. NJIRM 2010;1(4): 4-9. Collins JP. Modern approaches to teaching and learning anatomy. Brit Med Journal. 2008; 337: 1310. Dinsmore CE, Daugherty S, Zeitz HJ. Teaching and learning gross anatomy. Clin Anat. 1999; 12: 110-114. Topp KS. Prosection vs. Dissection, the Debate Continues: Rebuttal to Granger. The Anat Rec. 2004; 281:12-14. Jones LS, Paulman LE, Thadani R, Terracio L. Medical student dissection of cadavers improves performance on practical exams but not on the NBME Anatomy subject exam. Med. Educ. Online. 2001;6(2).

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30HealthcareA STUDY ON THE PREVALENCE OF NUTRITIONAL PROBLEMS OF SCHOOL GOING ADOLESCENT GIRLS OF KASHMIR VALLEY WITH SPECIAL FOCUS ON ANEMIA English0612Darakshan AliEnglish Anjum FaziliEnglish Rohul Jabeen ShahEnglish Mir Mohammad RafiqEnglishBackground: In India adolescents constitute about 22.8% of total population forming a significant proportion of the population [3].Nutrition is an important area of concern in adolescent health especially in girls. Improper nutrition in girls has been shown to lead to adverse intergenerational effects. Aims and Objectives: To identify the nutritional problems of school going adolescent girls of Kashmir Valley and to study the factors associated with anemia in these girls. Methodology: A cross sectional study design was adopted and the study was conducted in randomly selected schools in three districts of Kashmir Valley. A total of 428 girls in the age group of 12 to 18 years were included in the study. Data was collected using a pre-tested and pre-structured questionnaire which included assessment of the dietary habits, anthropometric measurements and general physical examination of the study population. Hb estimation of a subset of the study population was also done. Data was analyzed using SPSS 20.0. Results: It was seen that anemia was the most common nutritional problem in the adolescent girls seen in 53.30% of them followed by thinness in 35.70% of them [7] Other problems seen were overweight, obesity and thyromegaly. Conclusion: Thus it is concluded from this study that a considerable proportion of adolescent girls suffered from nutritional problems which need to be addressed in order to improve the overall health status of these girls. EnglishAdolescents, Nutrition, Thinness, Overweight, AnemiaINTRODUCTION The term "adolescence" is derived from the Latin word "ADOLESCERE" meaning "TO GROW" or "TO MATURE". WHO defines adolescence as the segment of life between the ages of 10 to 19 years. Adolescence is one window of opportunity which can be used effectively to inculcate good practices in individuals and hence in community [1]. Adolescents constitute about 20% of the total world population [2]. In India adolescents constitute about 22.8% of total population which in absolute numbers is approximately 273 million forming a significant proportion of the population[3].The importance of adolescents lies in the fact that they are going to be the adults of tomorrow and the future development of a nation rests in large part on the prospect of having adults who are educated, healthy and economically productive[2]. Nutrition is of importance especially in adolescent girls where malnutrition, anemia and stunting could have adverse intergenerational effects. Micronutrient deficiency is also seen in a significant number of adolescents. There is also increasing evidence that overweight and obesity is confined not only to adults but also being reported among the children and adolescents perhaps due to changing lifestyles. In order to deliver health care services to adolescents it is important to know what the health problems and needs of these adolescents are. Our study aims to help planners and policy makers to provide services relevant to the needs of adolescents. MATERIAL AND METHODS OBJECTIVES To identify various nutritional problems of school going adolescent girls of Kashmir Valley. To identify various factors associated with anemia in these girls. To recommend measures for prevention and control of anemia. METHODOLOGY A cross sectional study design and multistage random sampling technique was used and the study was conducted in 18 Girls schools selected randomly from three districts of Kashmir Valley. The calculation of required sample size was carried out using prevalence (p) as 50% and an allowable error of 5% and using the formula:                                n= Z2p(1-p)/e2 n= estimated sample size p= expected prevalence Z= statistic for 95% level of confidence (1.96) e= allowable error Thus the sample size was 422 including a 10% for non-responders. To round off, a sample size of 450 was taken (including a margin of 10% for non-response rate)[7]. One district was selected from each of the three geographical regions of Kashmir valley. Since the enrolment ratio of school going adolescent girls in the age group of 12-18 years in urban and rural areas of Kashmir Valley is 1.07:1 [4], the calculated sample size was divided in the ratio of 1.07:1 between the selected urban and rural districts of Kashmir[7]. The study was conducted in a total of 18 schools. The number of students to be taken from each school and class was calculated on the basis of Probability Proportional to Size (PPS) technique. Adolescent girls aged 12-18 years who gave consent/whose parents gave consent to be a part of this study was included in the study[7]. ETHICAL ISSUES:                                Ethical clearance was sought from the Institutional Ethics Committee. Besides this, proper permission was taken from Director School Education, Kashmir and concerned Chief Educational Officers of all the three districts as well as from the school authorities. Informed consent was taken from parents of the students. Consent was taken from the student as well. Confidentiality was maintained at all times and girls in need of medical attention were appropriately referred[7]. TOOLS FOR DATA COLLECTION: Data was collected using a pre tested and pre structured proforma which included questions on social and demographic particulars and questions on diet and physical activity and a thorough clinical examination and anthropometry was also done. The study population was categorized as thin, overweight and obese on the basis of BMI for age as per WHO growth reference values[5] and they were also categorized on the basis of Waist-hip ratio[6] as overweight and obese. Micronutrient deficiencies included anemia which was assessed clinically and using laboratory investigation (Hb estimation) of a subset of the study population. Assessment of Iodine deficiency was done clinically based on the presence of thyromegaly. Hemoglobin estimation was done on 50% of the study population which were selected by systematic random sampling. DATA ANALYSIS: Data was analyzed using SPSS version 20.00. A p value of ≤ 0.05 has been considered significant. RESULTS Table 1depicts the socio-demographic profile of the study population. It was observed that 48.40% of the adolescents belonged to a rural area while as 51.60% belonged to urban background. 37.90% study population was in the age group of 12-14 years and 62.10% were in the age group of 15-18 years. It was observed that almost all i.e. 95.80% participants were Muslims. (70.10%) participants came from nuclear families and 128 (29.90% ) came from joint families. It was seen that 48.40% participants had illiterate mothers and 51.60% had literate mothers and 79.2%had mothers who were homemakers and 20.80% had working mothers [7]. Table 2 depicts the distribution of study population on the basis of their SES. SE classes I and II have been grouped together and considered as upper class, SE class III considered as middle class and SE classes IV and V together considered as lower SE class. It was observed that 45.56% of the study population belonged to lower SE class followed by 37.62% belonged to middle class and 16.82% belonged to upper SE class [7]. Table 3 depicts the prevalence of various nutritional problems in the study population. Most common nutritional problem encountered was anemia seen in 53.30% of the adolescent girls. Table 4:  This table depicts the age wise distribution of study population by their mean Hb level (81). The mean Hb level of the study population was 11.34+1.66g% . The overall prevalence of anemia was 53.3% , with highest prevalence seen at 15 years of age (70.6% %) and lowest at 16 years of age (34.3%). Table 5: Out of the 114 anemics detected, 25 (21.93% ) were mildly anemic and 89 (78.07% ) had moderate anemia. However none of the adolescent girls was severely anemic. Table 6 depicts the relation between Hb level and sociodemographic variables of the study population. It was seen that the prevalence of anemia in the study population in the age group 12-14 years was significantly higher than in 15-18 years of age group (p=0.021). Also the prevalence of anemia in upper SE class was significantly higher than that in middle class (p =0.018). The prevalence of anemia among study participants from rural background was significantly higher than those from urban background (p = 0.018). Also the prevalence of anemia was significantly higher in study population whose mothers were illiterate than those with literate mothers (p==0.003). Table 7: On binary logistic regression analysis (multivariate analysis) the prevalence of anemia correlated strongly with Age, SES and  residence of the adolescent. Table 8 depicts the relationship of prevalence of anemia in study population with age at menarche. The association was not statistically significant (p 0.729). Table 9 depicts the relation of anemia with heavy menstrual periods. The association of the prevalence of anemia and heavy menstrual periods was not statistically significant. Discussion The present study revealed that overall prevalence of thinness in the study population was 35.70% [7].  Anand K. et al observed almost a similar prevalence (30.1% ) of thinness in north Indian rural school going girls near Delhi [2]. A higher prevalence of thinness among adolescent girls was observed by Wasnik V et al in Andhra Pradesh (56.4% ) [8]. The prevalence of over-weight in the present study was 7.20 as per BMI for age[7]. Omobuwa O et al in their study on in- school adolescents in Nigeria found that 7.6% of them were overweight or obese which was similar to the results of our study [9]. Also, Van-Niekerk S M et al in their study on adolescent school children in Cape Town, South Africa reported that 7.7% adolescent girls were overweight based on BMI for age [10]. In the present study a total of 33(7.71% ) adolescents had a waist hip ratio of < 0.80[7] while as in a study conducted by Kumar CM et al in Andhra Pradesh 35% adolescent girls had a waist hip ratio of > 0.80 which is much higher than the present study [11]. In our study the overall prevalence of anemia was 53.3%. Out of the 114 anemic adolescents detected 21.93% were mildly anemic and 78.07% were moderately anemic. However, none of the adolescent girls was severely anemic. A similar prevalence of anemia(55.5% ) among adolescent girls was reported by Muzammil K et al in Dehradun[12] and(59.8% ) by Kaur S et al in Wardha[13]. However a higher prevalence(83.3% ) was reported by Dixit S et al in Lucknow[14] and Premlatha T et al in Tamil Nadu[15] who reported a prevalence of 78.75% with varying degrees ranging from mild, moderate and severe which were 37.5% , 35% and 6% respectively . The present study revealed that the prevalence of anemia in the study population in the age group 12-14 years was significantly higher (63.10% ) than in 15-18 years of age group (46.90% ; p=0.021). A higher prevalence of anemia in the lower age group may be attributed to higher prevalence of menorrhagia (puberty me%norrhagia) at the time around menarche. A similar higher prevalence of anemia in 10-14 yr age group (60.71% )than 15-19 yr age group (57.44% ) was also reported by  Dutt R et al in Maharashtra[16] and Rajaratnam J et al in Tamil Nadu (46.5% in 13-14 years age group and 44.05% in 15-19 years age group)[17]. In the present study the prevalence of anemia was significantly higher in upper SE class (66.70%) followed by lower class (60.40%) and middle class (39.20%, p= 0.006). A higher prevalence of anemia in the higher SE status may be attributed to the fact that adolescents from higher SE classes are more conscious of their body image and thus resort to practices like dieting which might lead to a deficiency of various macro and micronutrients including Iron leading to anemia. However, in contradiction to our study, Siddharam SM et al reported a higher prevalence of anemia in lower SE strata (29.61% in SE class IV and V) in Hassan district, Karnataka[18]. Similarly Gawarika R et al found the overall percent prevalence of anaemia among the adolescent girls of weaker economic group in Madhya Pradesh as 96.5% and among girls of middle or higher middle income group as 65.18 %[19]. Only 3.97% of our study participants in this study showed palpable thyromegaly.Rest of the study participants (96.02%) did not have any thyromegaly. A similar prevalence of thyromegaly (5.12%) in female adolescents in West Bengal was reported by Haldar A et al[20].   Conclusion It is concluded from our study that a considerable number of adolescent girls suffered from various nutritional problems. The common nutritional problems observed in these girls were anemia, thinness, overweight and obesity.   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. Recommendations Based on the results of our study the following recommendations are put forth: Since anemia was the most common nutritional problem seen in these adolescent girls, generating awareness among mothers on iron rich foods and their importance will be helpful in overcoming this problem. Undernutrition in the form of thinness was also seen in a considerable proportion of adolescent girls. In this regard, parents as well as teachers should be sensitized on under nutrition and the role of healthy diet [7]. Over nutrition in the form of overweight and  obesity was also seen in some of these girls. So, parents need to be educated about the importance of healthy eating habits and regular physical activity[7]. Volunteers from among the school girls can be trained as peer educators who can in turn educate other girls regarding various aspects of nutrition. Operational research and behavioural studies for finding new and innovative ways with which to approach the nutrition problems during adolescence should be conducted on a large scale. Policymakers should be informed about the needs of young people and advocate for need based policy and program changes. Already existing Adolescent health programmes need to be monitored and evaluated to document evidence on effective implementation.     Englishhttp://ijcrr.com/abstract.php?article_id=135http://ijcrr.com/article_html.php?did=1351. Lal S, Adarsh, Pankaj. Textbook of Community Medicine. 3rd ed. New Delhi: CBS Publishers; 2013. p.155-6.  2. Anand K, Kant S, Kapoor SK. Nutritional status of adolescent school children in rural north India. Indian J paediatr.1999; 36: p.810-16. 3. WHO Nutrition in adolescents-Issues and challenges for the health sector. 2005. p.1. 4. International Institute for Population Sciences (IIPS), 2010. District Level Household and Facility Survey (DLHS-3 India). 2007-08; p.41. Accessed on 20th Feb, 2015. 5. www.who.int. 2014; Available from: http://www.who.int/ growth_ref/who2007_bmi_for_age/en/. Accessed on 10th Oct, 2014. 6. Kaur S, Walia I. Body mass index, waist circumference and waist hip ratio among nursing students. Nursing and Midwifery Research Journal. April 2007; 3(2): p.84-90.  7. Darakshan A, Shah RJ, Fazili AB, Rafiq MM, Mushtaq B,Iqbal QM, Dar SY. A study on the prevalence of thinness and obesity in school going adolescent girls of Kashmir Valley. IJCMPH. July 2016; 3(7): p.1884-93 8. Wasnik V, Rao BS, Rao D. A study of health status of early adolescent girls residing in social welfare hostels in Vizianagaram district of AP, India. IJCRIMPH. 2012; 4(1): p.72-83. 9. Omobuwa O, Alebiosu CO, Olajide FO, Adebimpe WO. Assessment of nutritional status of in school adolescents in Ibadan, Nigeria. SAFP. 2014; 56(4): p.246-50. 10. Van Niekerk SM, Grimmer K, Louw Q. The prevalence of underweight, overweight and obesity in a multiracial group of urban adolescent school children in the Cape Metropole area of Cape Town. S Afr J Clin Nutr. 2014; 27(1): p.18-24. 11. Kumar CM, Babu CS. Reproductive health problems of adolescent girls between 15 and 19 in Andhra Pradesh. Pak Peds J. 2012; 36(4): p.225-34. 12. Muzammil K, Kishore S, Semwal J. Common nutritional deficiencies of adolescents in Dehradun. Indian J. Sci. Res. 2010; 1(1): p.77-80. 13. Kaur S, Deshmukh PR, Garg BS.Epidemiological correlates of nutritional anemia in adolescent girls of rural Wardha. IJCM. October-December 2006; 31(4): p.255-8. 14. Dixit S, Kant S, Agarwal GG, Singh JV. A community based study on prevalence of anemia among adolescent girls and its association with iron intake and their correlates. Indian J Prev Soc Med. 2011; 24(4): p.393-8. 15. Premlatha T, Valarmathi S, Srijayanth P, Sundar JS, Kalpana S. 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30HealthcareEVALUATION OF LIVER SPACE OCCUPYING LESIONS BY FINE NEEDLE ASPIRATION CYTOLOGY English1318Sameer B. DalsaniyaEnglish Majal G. ShahEnglish Trupti S. PatelEnglish Jahnavi S. GandhiEnglish Dhaval H. JetlyEnglish Priti P. TrivediEnglishObjective: To evaluate the different liver space occupying lesions diagnosed on FNAC presenting at our hospital and share our experience of Fine Needle Aspiration Cytology of liver lesions. Material and Method: Retrospective study of total of 400 cases of liver space occupying lesions was done at Gujarat Cancer and Research Institute, Ahmedabad during 6 months period (January 2015 to June 2015). Papanicolau (PAP) and May-Grunwald-Giemsa (MGG) stained smears were reviewed and analyzed. Inconclusive aspirations and inadequate aspirations were excluded from study. Results: 294 cases out of 400 cases - where FNA yielded adequate cellularity were analyzed. Age ranged from 1 to 80 years with male predominance. Out of 294 cases, 292 cases (99.32%) were diagnosed as neoplastic and 2 cases (0.68%) as non neoplastic lesions. Of total 292 cases, 66 cases (22.44%) were diagnosed as primary hepatic malignancies in which 7 cases (2.37%) were of Hepatoblastoma and 59 cases (20.07%) of Hepatocellular carcinoma. Metastatic tumor was the most common and constituted 226 cases (76.88%). Metastatic lesions were Adenocarcinoma (62.93%), Small cell carcinoma (7.15%), Squamous cell carcinoma (1.36%), Malignant Melanoma (1.36%), Neuroendocrine tumor (1.70%) and Medullary carcinoma (0.34%) in decreasing order of frequency. The two non neoplastic lesions were of Abscess formation (0.68%). Conclusion: Cytology is a first line of investigation in liver space occupying lesions as the procedure is minimally invasive, safe, simple, quick and cost effective. EnglishFine Needle Aspiration Cytology, Liver SOL, UltrasonographyINTRODUCTION Liver can be affected by a variety of diseases which can be metabolic, infectious or neoplastic. These diseases are suspected clinically and biochemically. Radiologically they present either as diffuse involvement or as focal lesions and also designated as Space Occupying Lesions (SOLs). Fine Needle Aspiration Cytology (FNAC) has been proven to be a very effective means of obtaining tissue from many different body sites – superficial as well as deep lesions for diagnosis. It was applied in liver as early as 1985. FNAC is a rapid, inexpensive and minimally invasive technique for diagnosis of liver SOLs without significant complications[1]. Ultrasonography (USG) or Computed Tomography (CT) – guided FNAC is an accurate method for arriving at a definite tissue diagnosis in focal liver lesions [2]. Occasional inflammatory lesions or diffuse liver diseases may mimic mass like lesions or appear as non homogenous regions on radiographs. Such lesions can also be well sampled by FNA to rule out neoplasm from differential diagnosis [3]. According to literature, the diagnostic accuracy of FNAC for liver lesion is greater than 85% and in malignant lesion its sensitivity is around 90% (67-100%) [4]. The aim of the present study was to evaluate the different liver SOLs diagnosed on FNAC presenting at our hospital and share our experience of FNAC of liver lesions. MATERIAL AND METHOD A retrospective study of 400 cases of liver SOLs who presented at Gujarat Cancer and Research Institute, Ahmedabad during a 6 months period (January 2015 to June 2015) was done. Clinical and Radiological details were obtained. USG or CT guided FNACs performed using 20/21-gauge disposable spinal needle, attached to a 10 ml disposable syringe in a liver space occupying lesions diagnosed clinically or radiologically with normal range of coagulation profile. The area was cleaned with the antiseptic and during suspended respiration; needle was introduced percutaneously in to the lesion evaluated by ultrasound guidance. One to three passes were done. At least six smears were made from aspirated material. Five smears were immediately fixed in 100% methanol for 15 minutes and then stained by Papanicolau (PAP) stain while one dry smear was stained by May-Grunwald-Giemsa (MGG) stain. 294 cases out of 400 cases - where FNA yielded adequate cellularity were selected for this study. Inconclusive aspirations - when smear had some cells, not sufficient enough for diagnosis and inadequate aspirations - when smear did not show any epithelial cells were excluded from the study. Lesions were categorized in to Non Neoplastic and Neoplastic lesions. Neoplastic lesions were further classified as Benign and Malignant. Malignant lesions further sub typed as primary and secondary (metastatic) tumors. Non Neoplastic lesions include inflammatory or infective lesions. RESULTS FNAC of total 400 cases of liver SOLs were studied. It was conclusive in 294 cases. The diagnostic yield was 73.5%. The patient’s age ranged from 1 to 80 years out of which 162 were male (55.10%) and 132 were female (44.90%). Table I show various cytological diagnoses in Liver SOLs – 294 cases. Table I : - Spectrum of FNAC findings in Liver SOLs   Diagnosis of FNAC No of cases Percentage A Neoplastic lesion 292 99.32% 1 Primary malignancy 66 22.44% a Hepatoblastoma 07 2.38% b Hepatocellular carcinoma 59 20.06% 2 Secondary malignancy 226 76.88% a Adenocarcinoma 185 62.93% b Small cell carcinoma 21 7.15% c Squamous cell carcinoma 04 1.36% d Melanoma 04 1.36% e Neuroendocrine tumor 05 1.70% f Spindle cell tumor 03 1.02% g Round cell tumor 03 1.02% h Medullary carcinoma 01 0.34% B Non neoplastic lesion 02 0.68% 1 Abscess 02 0.68% Out of 294 cases, 292 (99.32%) were malignant and 2 cases (0.68%) were of infective etiology – abscess formation. Of 292 malignant cases diagnosed, 66 (22.44%) were primary liver neoplasm and 226 (76.88%) were secondaries (metastasis). Benign hepatic lesions were not seen in our study. Out of 66 primary liver neoplasms, 7 cases were of hepatoblastoma and 59 cases were of Hepatocellular carcinoma. The most important cytomorphological features of primary tumors – HCC were cellularity, architectural patterns, cytological features of individual cell and background material. The main architectural pattern seen was broad trabeculae with transgressing blood vessels, cohesive clusters and endothelial wrapping and bare atypical nuclei in the background. The cytological features included were polygonal cells with centrally placed nuclei with high N:C ratio, single or multiple macronucleoli, abundant eosinophilic granular cytoplasm, intranuclear cytoplasmic inclusions and bile plugging (figure-1). Serum alphafetoprotein (S.AFP) level was raised in 41 cases and normal in 13 cases of HCC while in 5 cases S.AFP level was not done. The hepatoblastoma is a primary liver tumor in pediatric age group, consisting of small round to oval uniform sized cells. The cytoplasm was granular with indistinct borders. The nuclei have smooth nuclear membrane, chromatin was fine to coarsely granular and evenly distributed. Few cells had single nucleolus. The background was dirty with fragments of capillaries and plump spindle shaped endothelial cells (figure - 2). S.AFP levels were elevated in all the cases of hepatoblastoma. Metastatic tumor was the most common malignant hepatic lesion (226 cases- 76.88%). Metastatic adenocarcinoma was the commonest type (185 cases) followed by small cell carcinoma (21 cases), neuroendocrine tumor (5 cases), squamous cell carcinoma (4 cases), melanoma (4 cases), spindle cell tumor (3 cases), round cell tumor (3 cases) and medullary carcinoma (1 case). The commonest primary sites of adenocarcinoma were the lung, breast, GI tract, pancreas, ovary and gall bladder in decreasing order of frequency. The common cytological features of adenocarcinoma were high cellularity, columnar or cuboidal tumor cells with nuclear pleomorphism, high nuclear to cytolplasmic (N:C) ratio with central to eccentrically placed nucleus, fine dispersed to coarse chromatin and scanty to moderate, vacuolated or pale cytoplasm. Cells were arranged in glands, acinar or palisade like patterns; three dimensional clusters; or singly. Inflammation, necrosis and fibrosis were seen in some cases. Most of them showed benign hepatocytes in the background (figure - 3). In 167 cases (73.89%) out of 226 cases, the commonest primary site of adenocarcinoma was the lung, breast, GI tract, pancreas, ovary, gall bladder in decreasing order of frequency. Rest 59 cases (26.11%) presented as metastasis of unknown origin to liver. The small cell carcinoma showed small monomorphic cells with finely granular chromatin, inconspicuous or absent nucleoli and scanty cytoplasm. Nuclear moulding, smearing artifact along with apoptosis and mitosis were also seen (figure - 4). Neuroendocrine tumor revealed monomorphic, plasmacytoid cells in vascular pattern with salt and pepper chromatin, small nucleoli and abundant cytoplasm. Mitotic activity and necrosis were not evident (figure - 5). The squamous cell carcinoma showed squamoid tadpole like cells with irregular hyperchromatic nuclei and well defined, abundant, keratinized cytoplasm. The cells were present in the necrotic inflammatory background. Metastatic Melanoma showed dispersed large polygonal cells with centrally placed nuclei, macronucleoli, intranuclear cytoplasmic inclusions with presence of intracytoplasmic melanin pigments (figure - 6). Metastatic spindle cell tumor showed cohesive tissue fragments of spindle cells with mild atypia without necrosis and mitosis. These cases were known case of Gastro Intestinal Stromal Tumor (GIST) of small bowel. Metastatic round cell tumor (3 cases) showed discrete small round cells with high N:C ratio with features suggestive of NHL, Wilm’s tumor and Ewing’s Sarcoma respectively. One case of metastatic medullary carcinoma from thyroid was also seen during this study. Two Non Neoplastic lesions were of infective etiology showing numerous polymorphs, necrosis and debris. ZN stain and PAS stain were performed to rule out tuberculosis and fungal infection respectively. DISCUSSION Lundquist et al in 1971 first showed the utility of FNAC in diagnosing hepatic lesions [1]. Guided FNAC is a very useful procedure for the diagnosis of various Neoplastic and Non Neoplastic hepatic lesions. It is a minimal intervening procedure at low cost and without major complication. The only contraindications are marked hemorrhagic diathesis and suspected vascular lesions [5,6]. No complications were seen during our study. The diagnostic yield of our study was 73.5%; almost similar results were seen in the earlier studies [7,8,9]. For any SOL in liver the differential diagnosis includes inflammatory lesions, metastatic deposits and primary liver malignancy. The imaging techniques helps, but some overlap between the radiologic features of liver abscess, Hepatocellular carcinoma and metastasis are seen. Tumor either primary or secondary can undergo extreme necrosis and present radiologically as cavitary neoplasm mimicking abscess and similarly abscesses with accompanied proliferative reactive changes mimic neoplastic process radiologically. In this situation guided FNAC plays an important complementary role for the accurate cytological diagnosis of various liver lesions [10]. In focal liver lesions multiple aspirates can be done replacing core needle biopsy to a large extent [11]. It helps to categorize liver lesions into primary, metastatic or non neoplastic. With the use of cell blocks diagnostic accuracy is improved as it facilitates study of multiple sections, use of special stains and immunohistochemistry (IHC) [12]. Metastatic tumors were the most common (76.88%) among the malignant liver lesions. Our results are comparable with other studies such as, Dhameja et al [13], Rasania et al [9] and Ali SR et al [14] which showed 77.7%, 70.4% and 58% of metastatic tumors respectively among the total liver malignancies. However, study by Swamy et al [15] found primary malignancies more common than metastatic lesions. We studied and evaluated the different features in HCC as described by Ali et al [16] and Tao et al [17]. The cytomorphological features were cellular arrangement, cell size, N:C ratio, cohesiveness of cells, nuclear shape and size, location, multinucleation, prominent nucleolus, amount of cytoplasm, vacuolation, bile production and hyaline bodies. HCC was differentiated from other malignant and nonmalignant condition of liver by the different features collectively like cellularity, trabecular pattern, hyperchromasia, uniformly prominent nucleoli, multiple nucleoli and atypical naked nuclei. The most important and helpful cytological features were the trabecular pattern, irregular granular chromatin, prominent nucleoli and atypical striped nuclei [18]. The atypical naked nuclei were included as one of the important criteria for the diagnosis of HCC by Pedio et al [19] as these were rarely seen in benign and metastatic condition. Three criteria differentiate HCC from metastatic tumor; polygonal cells with centrally placed nuclei, malignant cells separated by sinusoidal capillaries and bile. Two additional criteria, namely endothelial cells surrounding tumor cell clusters and intranuclear inclusions were identified as being important secondary criteria for HCC [20]. Hepatoblastoma usually affects 3 years old or younger children and has markedly elevated S.AFP level as seen in our study. Hepatoblastoma is not associated with cirrhosis. On FNAC, a hepatoblastoma can resemble a normal liver if it exhibits a predominantly fetal type differentiation with trabecular pattern. If other epithelial components such as embryonal, small cell or macrotrabecular patterns are present, the tumor shows a more heterogenous population of variably sized cells with or without trabecular groups, suggesting diagnosis of hepatoblastoma. On cytology smears alone, abundant embryonal or small cell components may resemble other small-cell tumors of childhood, such as embryonal rhabdomyosarcoma, neuroblastoma, Ewing’s sarcoma, Wilm’s tumor and Lymphoma [4]. The macrotrabecular component can be more cytologically pleomorphic, mimicking HCC [1]. Metastatic Adenocarcinoma show variable differentiation. The cytoplasm differs markedly from that of hepatocytes. Necrosis, inflammation, mucin and columnar or cuboidal differentiation favours metastatic adenocarcinoma [9,10,15]. Metastatic Squamous cell carcinoma, usually from the lung, may not pose any diagnostic difficulty except for poorly differentiated tumors, in the absence of keratin and in the presence of marked necrosis and inflammation [9,10,15]. Metastatic Melanoma may present diagnostic difficulty with HCC, especially when the primary has not been discovered. Melanoma has several features in common with HCC, including polygonal cells with centrally placed nuclei, prominent nucleoli and intra nuclear cytoplasmic inclusions. Presence of coarse brown pigment of melanin has been considered an important diagnostic feature of melanoma. Even melanin pigment may resemble various liver cell pigments. Melanin may not be found in metastatic lesions. In such cases Immunohistochemistry for HMB-45, S-100 and cytokeratin is recommended [11]. Small/Intermediate round cell malignancies include neuroendocrine tumor, small cell carcinoma, lymphoma and round cell tumors. Most neuroendocrine tumors are from the gastrointestinal tract, pancreatico-biliary tract or lung. A primary hepatic neuroendocrine tumor is unusual. Small cell carcinoma usually arises from the lung. Lymphoma seldom present as primary neoplasm, although hepatic involvement is common in advanced disease. It can be mistaken for poorly differentiated carcinoma or HCC [10]. Hence, this study shows different neoplastic and non neoplastic lesions can be accurately diagnosed by guided FNAC as shown by other studies. CONCLUSION In the present setup from this study it is felt that USG guided FNAC is very useful in a diagnosis of different liver SOLs lesions as the procedure is simple, safe, quick, economical and accurate. It can segregate benign and malignant lesions and primary and secondary malignancies with accuracy. Early diagnosis decreases the length of stay in hospital and minimizes further ancillary investigations. Accurately sampled, well prepared and well stained cytological samples along with clinical and radiological correlation yield the best results. So, FNAC is a simple and effective tool in our hand. DECLARATION Prior Publication - NIL Support - NIL Ethical Clearance- Approved. Source of Funding – NA Conflict of Interest – NIL ABBREVIATION FNAC - Fine Needle Aspiration Cytology PAP - Papanicolau MGG - May-Grunwald-Giemsa SOL - Space Occupying Lesions USG - Ultrasonography CT - Computed Tomography S.AFP - Serum alphafetoprotein GIST - Gastro Intestinal Stromal Tumor NHL – Non Hodgkin Lymphoma ZN - Ziehl–Neelsen PAS - Periodic acid–Schiff IHC - ImmunoHistoChemistry HCC – HepatoCellular Carcinoma ACKNOWLEDGEMENTS Authors acknowledge the immense help received from the scholars whose article 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. Note: The present study was undertaken at tertiary care hospital of Gujarat to know the etiology of the various liver space occupying lesions by FNAC. In the present study, FNAC performed on the patient as routine diagnostic procedure which was with prior consent of the patients. Ethical committee clearance has not been required as confidentiality of patients’ details has not been published.                             Englishhttp://ijcrr.com/abstract.php?article_id=136http://ijcrr.com/article_html.php?did=136 Boer BD. Liver and spleen. In: Orell SR, Sterret GF, Whitaker D, editors. Fine Needle Aspiration Cytology. 5thed. New Delhi: Churchill Living Stone? 2005. p. 271-96. Das DK, Tripathi RP, Chachra KL, Sodhani P, Prakash S, Bhambhani S. Role of guided fine needle aspiration cytology in diagnosis and classification of liver malignancies. Trop Gastroenterol 1997;18:101-6. Tsui WM, Cheng F, Lee Y. Fine needle aspiration cytology of liver tumors. Ann Contemp Diagn Pathol 1998; 2:79-93. Pitman MB. Liver. In: Gray W, Kocjan G, editors. Diagnostic Cytopathology. 3rded. Philadelphia:Elsevir;2010. 287-317. Kyu FY, Chen WJ, Lu SN, Wang JH, Eng HL. Fine needle aspiration cytodignosis of liver tumors. ActaCytol 2004, 48:142-48. Whitlach S, Nuñez C, Pitlik DA. Fine needle aspiration biopsy of the liver. A study of 102 consecutive cases. ActaCytol 1984?28: 719-25. Ho CS, Mc. Loughlin MJ, Tao LC, Blendis L, Evans WK. Guided percutaneous fine needle biopsy of liver. Cancer 1981?47: 1781-85. Shah A, Jain GM. Fine needle aspiration cytology of liver- A study of 518 cases. J Cytol 2002?19:139-43. Rasania A, Pandey CL, Joshi N. Evaluation of FNAC in diagnosis of hepatic lesion. J Cytol 2007?24:51-54. Wee A, Nilsson B, Yap I, Chong SM. Aspiration cytology of liver abscess.With an emphasis on diagnostic pitfalls. ActaCytol 1995?39:453-62. Asghar F, Riaz S. Diagnostic accuracy of percutaneous cytodiagnosis of hepatic masses, by ultrasound guided fine needle aspiration cytology. Annals 2010?16:184-88. Ceyhan K, Kupana SA, Bektaº N, Coban S, Tuzun A, Cinar K, et al . The diagnostic value of on-site cytopathological evaluation and cell block preparation in fine needle aspiration cytology of Liver masses. Cytopathology 2006?17:267-74. Dhameja N, RaiVarnika, Singh R: Fine needle aspiration cytology of liver space occupying lesions – a study of 57 cases from a tertiary care centre. IJSR 2016; 5:287-91. Ali SR, Jayabackthan L, Rahim S, Sharel MB, Prasad K, Hegdekatte N. Role of fine needle aspiration cytology in the diagnosis of hepatic lesions. Muller J Med Sci Res 2015?6:125-28. Swamy MC, Arathi C, Kodandaswamy C. Value of ultrasonography-guided fine needle aspiration cytology in the investigative sequence of hepatic lesions with an empahasis on Hepatocellular carcinoma. J Cytol 2011?28:178-84. Ali MA, Akhtar M, Mattingly RC. Morphologic spectrum of Hepatocellular carcinoma in fine needle aspiration biopsies. Acta Cytol 1986?30:294­301. Tao LC, Donat EE, Ho CS, Mchoughlin MJ. Evans WK. Cytologic diagnosis of hepatocellular carcinoma by fine needle aspiration biopsy. Cancer 1984? 53:547­52. Cohen MB, Haber MM, Holly EA, Ahn DK, Bottles K, Stoloff AC. Cytologic criteria to distinguish hepatocellular carcinoma from nonneoplastic liver. Am J ClinPathol1991?95:125-30. Pedio G, Handolt U, Zobeli U, Gut D. Fine needle aspiration of the liver. Significance of hepatocytic naked nuclei in the diagnosis of hepatocellular carcinoma. ActaCytol 1988? 32: 437-42. Bottles K, Cohen MB, Holly EA, Chiu SH, Abele JS, Cello JP, et al. 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30HealthcareA STUDY ON VARIOUS DETERMINANTS OF MATERNAL MORBIDITY AMONGST MARRIED WOMEN IN REPRODUCTIVE AGE GROUP IN URBAN SLUMS OF JAMNAGAR, GUJARAT, INDIA English1925Neha A. PatelEnglish J. P. MehtaEnglish Sumit UnadkatEnglish Sudha B. YadavEnglishBackground: Maternal morbidities associated with antenatal, Intranatal and postnatal period are affecting the outcome of pregnancy. Amongst these morbidities, many are preventable. Various determinants which have effect on these morbidities can be utilized to improve maternal health as well as to reduce Maternal deaths. Government has many programs and policies to improve maternal health, but determinants like education of woman, socio economic status, cultural barriers, and women empowerment are regulating the health seeking behaviour of a woman. Current study was designed with an. Objective: To study various determinants affecting maternal morbidity in married women of reproductive age group. Materials and Methods: Cross sectional study was conducted in Jamnagar. 450 women were selected by 30 cluster sampling. Data analysis was done with Microsoft office Excel and SPSS 20.Chi square test was applied. Results: 302(67.11%) women suffered from any type of Maternal Morbidity during their pregnancy, childbirth or puerperium, 55.56% ,20.22 % and 24.44% women had antenatal, Intranatal and postnatal morbidities respectively. Conclusion: The study indicate that raising educational status of women, Proper Antenatal care, birth interval of >3 years, knowledge regarding danger signs of pregnancy; all of these determinants have a positive contribution in preventing Maternal Morbidity and Mortality. EnglishDeterminants, Hyperemesis Gravidarum, Maternal Morbidity, Meconium aspiration syndrome (MAS), Puerperal sepsis, Postpartum Haemorrhage (PPH), Premature rupture of Membrane(PRM)INTRODUCTION: Each year, more than a half million women lose their lives from complications arising before, during, or after childbirth. Almost all of these deaths occur in the developing world, and almost all of them are preventable. Pregnancy and childbirth related complications are among the leading cause of mortality and morbidity in women of reproductive age in developing countries. It has been estimated that for one maternal death at least 15 more suffer from severe morbidities. As such, about an optimistic 5-7 million women suffer a severely impaired quality of life as a result of short term or long term disability. (1) Obstetrics morbidity is classified as: Direct morbidity i.e. temporary ii. permanent Indirect morbidity Temporary: APH, PPH, Eclampsia, obstructed labour, rupture uterus, sepsis, ectopic pregnancy, etc Permanent: VVF, RVF, dyspareunia, Prolapse, secondary infertility, etc Indirect: malaria, hepatitis, TB, anaemia Maternal Mortality estimates are used to highlight the plight of pregnant women in less developed countries. However, Maternal Mortality is just the tip of the iceberg of the health problems of women. Many women do not die of causes related to pregnancy but suffer severe morbidities. In developing countries, pregnancy and childbirth related complications are the leading causes of disability among women aged 15-44. The world development report estimated that 18 percent of the burden of disease for these women is due to maternal causes. (2) Identifying the determinants of Maternal Morbidity and mortality is a valid scientific endeavour in its own right, but it is particularly relevant to any undertaking to improve maternal health. By understanding the determinants of ill-health and their inter-relationships, it is possible to develop treatments, seek preventive measures, target high-risk individuals and groups, and assess the health implications of changes in the biological, physical, or social environment. On the other hand, it is also important to recognize that identifying and intervening against specific determinants of maternal ill-health is not exclusively within the sphere of bio-medical expertise, and that a multidisciplinary approach to studying and resolving health problems is imperative. (3) Sixty-six percent of the women developed at least one complication during the index pregnancy and childbirth, the most common of which were prolonged labour, fever, bleeding, and pre-eclamptic toxaemia. Reporting of complications was found to be associated with women’s education, parity, and knowledge about obstetric complications. (4) METHODS A Cross sectional study was conducted in Urban slums of Jamnagar Municipal Corporation Area from August 2010 to December 2011. By using Cluster sampling technique 30 clusters were selected and 15 women from each cluster were interviewed who had delivered in last 1 year. The study was carried out by undertaking house to house visits of the area of each cluster. From a random direction in each cluster, study was started by asking the family if there was any woman who had delivered in last one year (1st September 2009 to 31st August 2010- women who delivered in that duration). Sample size is calculated by formula n= 4pq/l2, Where, n= required sample size p=proportion or prevalence of interest q=100-p l=allowable error (10 – 20%) An anticipated P value is taken as 50% as per WHO practical manual on sample size determination in health studies by Lwanga and Lemeshow. (5) p is taken as 50%, so as q=50%. If L=10%, Then, sample size would be….. n  = 4x50x50  = 400.            5x5 Non-response rate/loss of sample = 10% of sample size So, total sample size comes out to be 440 for the study. To make round figure, 450 study subjects were chosen. A pretested semi-structured Performa was used to collect the data through oral questionnaire by visiting them at their home. Prior verbal consent was taken from study subjects. The data entry was done in Microsoft Office Excel 2007. Analysis was done by the use of Medcalc 10.4.8.0., SPSS version 20 and Microsoft office Excel 2007. Chi square test was applied to check the associations. Prior approval from ethical committee was taken. RESULTS The mean age of study subjects was 24.84 years. Amongst them 49% were 20-25 years old. 77.34% were Hindus while others were Muslims. 47.7% women were educated till primary. Only 5.11% were graduates. 72.45% women were from lower socio economic class according to Prasad’s classification. 99% women had taken antenatal visits.59.1% women had consumed IFA tablets for more than 100 days during their last pregnancy, while 96.9% women had received two doses of TT during antenatal period.61.77% women had knowledge regarding danger signs of pregnancy. The present study revealed that from all the women, 302(67.11%) women had suffered from any type of Maternal Morbidity during their pregnancy, childbirth or puerperium, while rest 148(32.89%) did not have any morbidity. (Fig.1)From the women, who had any kind of morbidity, 55.56% women had morbidity during their antenatal period, 20.22% women had morbidity during intranatal period and 24.44% women had morbidity during their post partum period. ( Fig.2) During the study, only few women had record regarding their blood investigation reports. From the hospital discharge cards or from case papers, only 130 women had record regarding Hb estimation. From these 130 women, more than three fourth women i.e. 107(82.30%) had Anaemia as they had Hb 11 gm%. Table 1 shows that from the women who had antenatal morbidity, majority had complaint of weakness (70.4%). Other morbidities found were Hyperemesis Gravidarum (25.2%), swelling of legs (25.2%), Hypertensive Disorder (Pregnancy Induced Hypertension) (14.4%), Bleeding P/V (11.6%), Headache (8.8%), blurring of vision (8.4%), Eclampsia (1.6%) and fever with vaginal discharge (6%).  (Insert table 1 here) Table 2 shows that from the women who had intrapartum morbidity, major cause found were Prolonged labour (34.6%), Premature Rupture Of Membrane (31.86%), Oligohydroamnios (18.68%), Malpresentation (12.08%) and Foetal distress (12.08%). Very few women had complaint of MAS (5.5%), Polyhydroamnios (3.3%) and Cord Prolapse (2.2%). 2 women suffered from Primary Post Partum Haemorrhage.(Insert Table 2 here) Table 3 shows that from the women who had post partum morbidities, common morbidities found were backache (22.72%), pain in stitches (18.18%), infection of stitches (13.63%), Mastitis (10%) and delayed milk output (9.1%). Post partum haemorrhage was found in 4 women, while only one woman had Septicaemia and one woman had Eclampsia. 13(2.89%) women had other problems like fever, diarrhoea, bleeding from tear etc.(Insert table 3 here) Over all medical complication during pregnancy were 7.78% amongst the women. Out of those who had medical complications, 34.28% women had Diarrhoea ,22.85% had Fever, 8.57% had Reproductive Track Infection,5.7% women had Malaria during pregnancy and 5.7% had Tuberculosis infection and was on AKT. One woman was having HIV infection. 20% women had other complication like Asthma, Jaundice, Rubella, Stone etc.  70(15.55%) women had complaint of backache, the reason could be less birth interval or anaemia in last pregnancy, 2.44% women had pain in stitches and 11(2.44%) women had complaint of weakness. One had problem of Fistula and one had complaint of Incontinence in presence. (Insert Table 4 here) This table shows that women, who had better knowledge regarding danger signs of pregnancy, had reported the Maternal Morbidity more than those who had no knowledge .i.e. 71.5% and 68.6% respectively. The difference is statistically highly significant.(pEnglishhttp://ijcrr.com/abstract.php?article_id=137http://ijcrr.com/article_html.php?did=1371. Dutta, D C. Textbook of Dutaa. 2004. 6th Edition. 2. G. Rama Padma. Maternal Morbidity in rural Andhra Pradesh. Hydrabad : s.n., nov. 2004, Vol. working paper no.63. 3. Oona M.R. and Wendy j. Graham. Measuring the determinants of Maternal Morbidity and Mortality: Defining the selected outcomes and determinants and demonstrating associate. . 23 Int J Cur Res Rev | Vol 8 • Issue 24 • December 2016 Patel et.al.: A study on various determinants of maternal morbidity amongst married women in reproductive age group in urban slums... 4. Shameem Ahmed. B Maternal morbidity in Rural Bangladesh: Where Do Women Go For Care? working paper no.113, s.l. : ICDDR, 1998. 5. Lwanga S.K. and Lemeshow S. Sample size determination in health studies. Geneva : WHO, A practical Manual, 1991. 6. Bhatiya J C. Levels and causes of maternal mortality in Southern India, Studies in Family Planning. 1993, Vols. 24, 310-318. 7. Walsh J A et al. Maternal and perinatal health problems in in: Jamison D. T and Mosley W.H eds. Evolving sector priorities in developing countries. Washington D.C. : The World Bank, 1989. 8. Koblinsky M A et al. Mother and more: a broader perspective on women’s health.in. s.l. : Westview press, Oxford, 1993. 9. Vijay M. Sarode. Does illiteracy influence pregnancy complications among women in the slums of Mumbai. may , s.l. : International Journal of Sociology and Anthropology, 2010, Vols. vol. 2(5) pp.82-94. 10. Agarwal and Sidhharth. Birth preparedness and complication readiness among slum women in Indore city. s.l. : Indian Journal of Community medicine, 2010. 11. National Family Health Survey III. 2005-2006. 12. S Sreelatha,Smt. Remadevi S, Dr. Leela Itty Amma,. assessing quality of antenatal care in Thiruvananthpuram. 2002. 13. Bang R A, Bang AT, Reddy MH, Deshmukh MD, Baitule SB, Filippi V Maternal morbidity during labour and the pueperium in rural homes and the need for medical attention: A prospective observational study in Gadchiroli.. Mar, Gadchiroli. : BJOG, 2004, Vols. 111(3):231-8. 14. Patra S.Singh B, Reddaiah VP. Maternal morbidity during postpartum period in a villae of North India: a prospective study s.l. : centre of community medicine,AIIMS, 2008, Vols. 0ct:38(4):204-8. 15. Bruce FC, Berg CJ,Hornbrook MC, WhitlockEP, Calaghaan WM,Gold R. Maternal Morbidity Rates in a managed care population. s.l. : Journal of Obstet Gynecol, 2008, Vols. 111: 1089- 1095. 16. Koki Gilberto Eppu. Determinants of Maternal Morbidity and Mortality,Turkana District- Kenya. s.l. : A theses submitted as partial fulfilment for the award of Master degree in International Health, August 2010. 17. Jean CF, Alex E, Rose O. provision and use of MAternal Health services among urban poor women in Kenya: What do we know and What can we do? s.l. : Journal of Urban health, May 2008, Vols. 85(3): 428-442. 18. Agustin, Conde-Agudelo and Jose M. Belizan. Maternal Morbidity and Mortality associated with Interpregnancy interval: cross sectional study.http://www.bmj.com/cgi/content/ full/321/7271/1255, s.l. : British Medical Journal, 2000, Vols. 321:1255-1259. 19. Datta K K et al. Morbidity pattern amongs rural pregnant women in Alwar,Rajasthan- a cohort study,health and population perspectives and issues.. 3,282-292, Alwar : s.n., 1980.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30HealthcareEVALUATION OF MERCURY (HG) AND ARSENIC (AS) RESIDUES IN ORGANS AND MUSCLES OF SLAUGHTERED PIGS AT NSUKKA SLAUGHTER HOUSE IN ENUGU STATE, NIGERIA English2632Felix Chidiebere ObiohaEnglish Lynda Onyinye ObodoechiEnglish Johnbosco Chinwuba UkohaEnglishAim: The aim of this study was to determine the presence and concentration of mercury (Hg) and arsenic (As) in organs and tissues of slaughtered pigs in Nsukka slaughter house. Methodology: From a total of 110 slaughtered pigs, liver, kidney and muscle samples of each pig were collected and analyzed for the detection of mercury and arsenic residue using Atomic Absorption Spectrophotometer. Results: A prevalence rate of 66.4% and 29.1% were recorded for mercury and arsenic respectively. The level of mean concentrations of arsenic in kidney, liver and muscle were 0.0016mg/kg, 0.0025mg/kg and 0.0012mg/kg respectively. While level of mean concentrations of mercury were 0.0009mg/kg, 0.0010mg/kg and 0.0006mg/kg in kidney, liver and muscle respectively. There was a significant difference (P< 0.05) in the concentration of arsenic and mercury in liver, kidney and muscle samples of the different age groups of the slaughtered pigs. Conclusion: The levels of mercury and arsenic in few samples that exceeded the provisional tolerable weekly intake (PTWI) may pose human health threat to pork consumers in the study area. EnglishArsenic, Heavy metal, Kidney, Mercury, ResiduesIntroduction Heavy metals are serious environmental pollutants and their uptake and accumulation in the ecosystem, beyond safe limits, would cause direct consequences to food chain and ultimately to man (Felix et al., 2016a). Heavy metals such as mercury, arsenic etc, are naturally occurring elements in the earth’s crust, and thus direct or indirect exposure to them from natural sources is inevitable especially for animals that are not intensively reared (Felix et al., 2016a). In animal tissues, metals may enter through animal feeds, green fodder, drinking water and pharmaceutical medicines etc. Other sources are accidental access to limed field, mineral supplements with high content of trace metal and licking of painted surfaced containing metallic pigments. The common source of arsenic is in fluid used for dipping and spraying of animal to control ecto-parasites. Industrial wastes and sewage water from the chloroalkali industry are a major source of mercury pollution.  Arsenic is a metal that occurs at ultra trace levels. It has been suggested that this metal could play an essential role in humans because decreases in serum arsenic concentration have been correlated with injuries of the central nervous system, vascular disease and cancer (Smith et al., 2000; Pesch et al., 2002). Chronic arsenic toxicity is mostly manifested in weight loss, capricious appetite, conjunctively and mucosal erythematic lesion including mouth ulceration and reduced milk yield. Acute toxic effects include abdominal cramping, hyperesthesia in extremities, abdominal patellar reflexes and abdominal electrocardiogram (Pesch et al., 2002). The toxicity of mercury depends on its chemical form methyl mercury being the most hazardous metal and stable form of mercury that has been attributed to the suffering of most avian and mammalian predators at the top of contaminated tropics. Mercury has the ability to cross the blood brain barrier for example methyl-mercury causing toxicity of central nervous system in animals and as well as in humans (Mukesh et al., 2008). A well documented environmental disaster associated with mercury is the Minamata disease. Minamata disease is sometimes referred to as Chisso- Minamata disease. It is a neurological syndrome caused by severe mercury poisoning. Mercury has the ability to cross the blood brain barrier for example methyl-mercury causing toxicity of central nervous system in animals and as well as in humans. (Mukesh et al., 2008). The polluted meats from the edible animal products exposed to heavy metals in the environment are sold in the market for human consumption (Felix et al., 2016a). Despite the high concentrations of heavy metals in Enugu State, no studies have been conducted to determine metal contamination levels in pigs which scavenge freely in the area. The animals when exposed to toxic metals accumulate them in their organs such as liver and kidneys, which are considered delicacies in Nsukka. Meat produced from these animals is a rich and convenient source of nutrients such as proteins and micronutrients. It is therefore imperative that this study be carried out with the major aim to investigate the possible presence and prevalence of mercury and arsenic residues in organs and muscles of slaughtered pigs in the study area and also, to determine its level (concentration) in the tissues. Materials and methods Study Area The study was done in Nsukka slaughter house of Enugu State, South East Nigeria. Nsukka urban has a map coordinates of 6°51′24″N and 7°23′45″E. Nsukka has a total land area of about 17.5 sq mi (45.38 km2), and has an elevation of 1,810ft (522 m) with a population of 309, 633(NPC, 2006). Study Design The research work was a four month cross sectional survey and laboratory analysis of samples from slaughtered pigs, to determine the presence, prevalence and concentration of Mercury and Arsenic. This experiment was conducted with the permission of the Institution’s Ethics Committee. Sampling technique and Sample Collection One (Nsukka) out of the three agricultural zones in Enugu State was randomly selected. Stratified random sampling was used to select pigs from the slaughter house assigning them into female and male sex strata and systematic random sampling was used to select 1 in 3 pigs slaughtered, twice a week for four months. A total of 330 fresh samples of liver, kidney and muscle from 110 slaughtered pigs were collected between the months of June 2014 and September 2014. Age was determined using teeth eruption and wearing. About 50g each of liver and muscle samples and a whole kidney of each selected slaughter pig was packed in sterile polythene bags, labeled and sent to Veterinary Public Health and Preventive Medicine, University of Nigeria, Nsukka for freezing pending analysis. The frozen samples were transported in a cold chain to Springboard Research laboratory, Awka Anambra State, Nigeria, for chemical analysis. Information on the method of processing and the type of materials used was collected by observation and pictures were taken. Sample processing Digestion of Sample (Dry Digestion) Digestion of the sample was done using the method of Felix et al. (2016a). Liver, kidney and muscle samples were dried in the oven at 45o C. After drying, individual sample was crushed into fine powder using mortar and pestle, and 1.0g of the fine powdered sample was weighed into porcelain crucible and ignited in a muffle furnace at 500o C for 6 to 8 hours. The samples were then removed from the furnace and allowed to cool in desiccators, and weighed again. 5cm cube of 1M Trioxonitrate (V) acid (HNO3) solution was added to the left-over ash and evaporated to dryness on a hot plate and returned to the furnace for re-heating at 400o C for 15-20 minutes until perfect grayish-white ash was obtained. The samples were then allowed to cool in desiccators. 15ml (cm3) hydrochloric acid (HCL) was then added to the ash to dissolve it and the solution was filtered into 100 cm3 volumetric flask. The volume was made to 100cm3 with distilled water. Analysis Mercury and arsenic residues were tested using the digested samples of liver, kidney and muscle under specified condition using Atomic Absorption Spectrometer (AAS). The procedure was done according to the manufacturer (AA-6800, Shimadzu Atomic Absorption Spectrophotometer) (Szkoda and Zmudzki, 2005). Data Analysis and Presentation The data generated from the study were statistically analyzed using SPSS version 17. Analysis of variance and post hoc test were performed to determine if there is statistical significance difference in the mean concentrations of mercury and arsenic among various age groups Descriptive statistics was also used and data generated were converted to percentages and presented in tables. P < 0.05 was considered to be significant. RESULTS Prevalence of mercury residue in slaughtered pigs in Nsukka slaughter house Out of a total of 110 pigs sampled, 73 (66.4%) were positive while 37 (33.6%) were negative for mercury residue and from 330 organs sampled (110 each of liver, kidney and muscle from the 110 pigs), 177(53.6%) were positive for mercury residue (Table 1). Prevalence of Arsenic residue in slaughtered pigs in Nsukka slaughter house Out of a total of 110 pigs sampled, 32 (29.1%) were positive while 78 (70.9%) were negative for arsenic residue and from 330 organs sampled (110 each of liver, kidney and muscle from the 110 pigs), 55 (16.7%) were positive for arsenic residue (Table 2). Comparison of the number of positive samples and the mean Concentrations of Mercury and Arsenic in the different organs from different sources with their specific PTWI Table 3, arsenic recorded 0 (0%) of kidney, 3(2.73%) of the liver and 0(0%) of the muscle samples respectively which were above the PTWI of 0.015 mg/kg body weight (bw). Table 4 mercury recorded 1 (0.9%) of kidney, 0(0%) of the liver and 0(0%) of the muscle samples respectively which were above the PTWI of 0.005 mg/kg bw. Organ distributions of arsenic in slaughtered pigs In figure (fig.) 2, the presence of arsenic was recorded 22(20%) of liver, 19(17.3%) of kidney and 14(12.7%) of muscle samples. There is no significant difference between occurrence of arsenic and the organ types. Organ distributions of mercury in slaughtered pigs In fig. 3, the presence of arsenic was recorded 66(60%) of liver, 61(55.5%) of kidney and 50(45.5%) of muscle samples. There is significant difference between occurrence of mercury and the organ types. Age distribution of mercury and arsenic concentrations in Nsukka slaughter house The mean mercury concentrations in age range of slaughter pigs, 0 to 1 year were 0.0014mg/kg, 0.0014mg/kg, and 0.0008mg/kg in kidney, liver and muscle samples respectively (Table 5). In age range 2 to 3 years, the mercury concentrations of 0.0008mg/kg; 0.0009mg/kg and 0.0006mg/kg were recorded in kidney, liver and muscle respectively. The mean mercury concentrations in age range 4 to 5 years were 0.0007mg/kg, 0.0007mg/kg and 0.0004mg/kg in kidney, liver and muscle respectively. The mean mercury concentrations for the age range ≥ 6 years were 0.0004mg/kg, 0.0006mg/kg and 0.0002mg/kg in kidney, liver and muscle respectively. The mean arsenic concentrations in age range of slaughter pigs, 0 to 1 year were 0.0026mg/kg, 0.0041mg/kg, and 0.0023mg/kg in kidney, liver and muscle samples respectively (Table 5). In age range 2 to 3 years, the arsenic concentrations of 0.0011mg/kg; 0.0021mg/kg and 0.0010mg/kg were recorded in kidney, liver and muscle respectively. The mean arsenic concentrations in age range 4 to 5 years were 0.0016mg/kg, 0.0020mg/kg and 0.0008mg/kg in kidney, liver and muscle respectively. The mean arsenic concentrations for the age range ≥ 6 years were 0.0007mg/kg, 0.0008mg/kg and 0.0002mg/kg in kidney, liver and muscle respectively. However, for arsenic and mercury residues, the European Commission has not established statutory limits for meat products. Mercury levels in our samples were very low, about 1000-fold lower than allowed in fish (European Commission, 2011). The Joint FAO/WHO Expert Committee on Food Additives (JECFA) Provisional Tolerable Daily Intake (PTDI) for inorganic arsenic is 0.002 mg/kg bodyweight, equivalent to 0.12 mg/day for a 60kg adult. The JECFA Provisional Tolerable Daily Intake (PTDI) for inorganic arsenic is 0.002 mg/kg bodyweight, equivalent to 0.12 mg/day for a 60kg adult. PTWI for mercury is 0.005mg/kg bw and 0.0015mg/kg bw for arsenic. However, mean values for arsenic and mercury in all the organs and muscle samples were below the PTDI except in the age range 0 to 1 year (0026mg/kg, 0.0041mg/kg, and 0.0023mg/kg in kidney, liver and muscle respectively) and liver of age range 2 to 3 (0.0021mg/kg). Also, the mean values for mercury and arsenic in all the organs and muscle samples were below the PTWI except in few samples of the kidney and liver in Hg and As respectively, which was slightly higher but not statistically significant (pEnglishhttp://ijcrr.com/abstract.php?article_id=138http://ijcrr.com/article_html.php?did=138 Akoto O, Bortey-Sam N, Nakayama SMM, Ikenaka Y, Baidoo E, Yohannes YB, Mizukawa H, Ishizuka M. Distribution of Heavy Metals in Organs of Sheep and Goat Reared in Obuasi: A Gold Mining Town in Ghana. Int. J. Environ. Sci. Toxic 2014; 2(2):81-89 Anonymous. Mercury residues in the tissues of domestic pigs and feral animals in New Zealand. Surveillance 1989; 16(1)   Caggiano R, Macchiato MF, Ragosta M. Heavy metals in ryegrass species versus metal concentrations in atmospheric particulates in an industrial area of southern Italy. Environ Monit Assess 2004; 102(1-3): 67-84. European Commission (EC). Amending Regulation (EC) No 1881/2006 Setting Maximum Levels for Certain Contaminants in Foodstuffs. Commission Regulation No 420/2011 of 29 April 2011 OJ L 111/3 of 30 April 2011. Ekenma K, Anelon NJ, Ottah AA. Determination of the presence and concentration of heavy metal in cattle hides singed in Nsukka abattoir. J. Vet. Med. Anim. Health 2014;7:9-17. Felix OC, Ekene E, Johnbosco UC, Anelon NJ. Assessment of cadmium (Cd) residues in organs and muscles of slaughtered pigs at Nsukka and environs in Enugu State, Nigeria. J. Vet. Med. Anim. Health 2016a; 8(11): 199-206 Felix OC, John NA, Ekene EV. Assessment of lead (Pb) Residues in Organs and Muscles of Slaughtered Pigs at Nsukka and Environs in Enugu State, Nigeria. J Adv Vet Anim Res 2016b; Online First: 17 Nov. Mukesh KR, Puneet K, Manoj S, Anand S. Toxic effect of heavy metals in livestock  health. Vet. World 2008;1(1):28-30 National Population Commission (NPC). Census data. National Population Commission Nigeria.2006 Okoye CO, Ugwu JN. Impact of environmental cadmium, lead, copper and zinc on quality of goat meat in Nigeria. Bull. Chem. Soc. Ethiop 2010; 24(1):134. Oliver MA. Soil and human health: a review. Eur J Soil Sci 2007; 48: 573-92 Pesch B, Ranft U, Jakubis P, Nieuwenhuijsen MJ, Hergemoller A, Unfried K, Jakubis M, Miskovic P and Keegant T. Environmental arsenic exposure from a coal-burning power plant as a potential risk factor for nonmelanoma skin carcinoma: results from a case-control study in the district of Prievidza, Slovakia. Am. J. Epidemiol 2002;155: 798–809. Smith AH, Arroyo AP, Mazumder DN, Kosnett MJ, Hernandez AL, Beeris M, Smith M M and Moore LE. Arsenic induced skin lesions among Atacamano people in Northern Chile despite good nutrition and centuries of exposure. Environ. Hlth. Perspectives 2000;108: 617–620. Szkoda J O, Zmudzki J. Determination of lead and cadmium in biological material by graphite furnace atomic absorption spectrometry method. Bull. Vet. Inst. Pulawy 2005;49:89-9

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30HealthcareA COMPARATIVE STUDY OF MIGLITOL AND ACARBOSE ADD ON THERAPY INTENDED FOR BETTER GLYCAEMIC CONTROL IN TYPE 2 DIABETES MELLITUS English3340Lopamudra Dhar ChoudhuryEnglish Ranjan BasuEnglish Tanmay BiswasEnglish Apurba MukherjeeEnglish Anup Kumar DasEnglishObjectives: This study was done to find out the comparative efficacy of Miglitol and Acarbose as add on therapy in patients of type 2 Diabetes Mellitus. Methods: This is a prospective, randomized, patient controlled, open label comparative study involving Type 2 diabetes patients, aged between 35-70 years of either sex of hyperglycaemic with PPBS >180mg%, FBS 0.05 signifying Miglitol to be better than Acarbose in terms of glycaemic controlin type 2 D.M. Conclusions: Type 2 Diabetes forms a significant share of the Diabetic load in India where cereals in the form of carbohydrates form the staple diet of most Indians. Thus α glucosidase inhibitors like Miglitol and acarbose are sure to play an important role as an add on therapy when first line drugs like sulphonylurea and biguanides fail to control the hyperglycaemia and they have minimum adverse effects, with more or less similar efficacy with Miglitol being better than Acarbose.. EnglishType 2 Diabetes Mellitus, Hyperglycaemia, PPBS, HbA1c, Miglitol, AcarboseIntroduction Type 2 diabetes mellitus is a large and growing health problem and appears to be associated with urbanization, sedentary lifestyle and dietary habit. The world Health Organization (WHO) has estimated that the global prevalence of type 2 diabetes is increasing rapidly and India bears a sizeable burden of this epidemic. The term diabetes mellitus describes a metabolic disorder of multiple etiology, characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both1.Type 2 diabetes mellitus is a progressive disease and once diagnosed, the treatment pathway involves an increasingly complex combination of treatments as the disease worsens2. Therapy however should be individualized according to the degree of hyperglycaemia3. There are three modalities to Diabetes care. First is aimed at lifestyle modification including physical activity and dietary restrictions. Second involves use of drugs which increase insulin availability like sulphonylurea or insulin secretagogue Repaglinide. Third modality is use of agents that increase insulin sensitivity like Biguanides and Thiazolidinedione or drugs which reduce insulin requirement like α glucosidase inhibitors3. Compared with sulfonylurea, AGIs seem to be inferior with respect to glycemic control, but they reduce fasting and postprandial blood glucose as well as insulin levels4.  The primary objective in the management of type 2 diabetes is glycaemic control along with management or prevention of micro and macro vascular complications. Epidemiological evidence strongly implicates postprandial hyperglycaemia, but not fasting hyperglycaemia, as an important contributor associated with the development of macrovascular complication in type 2 DM5. Techniques that can improve postprandial control include lowering the carbohydrate, encouraging physical activity after meals, adding α glucosidase inhibitors with meals and using rapidly acting insulin analogues5,6. Alpha glucosidase inhibitors (acarbose, miglitol and voglibose) are agents which specifically target post prandial blood sugar level7.When administered along with the first bite of a carbohydrate rich diet, carbohydrate absorption is shifted more distally in the intestine, allowing the sluggish insulin secretory  dynamics of Type 2 diabetics to catch up with the carbohydrate absorption, thereby counteracting the post absorptive glucose rise8. These oral antidiabetic agents  also have action on the fasting blood glucose level, gastrointestinal hormones and body weight. Thus their efficacy and safety needs to be compared for  their therapeutic applications. Materials and Methods A prospective, randomized, patient controlled, open label comparative study was done on 50 Type 2 diabetes mellitus patients attending the Diabetic OPD at R.G.KAR Medical College and  Hospital starting from July, 2004 and completed with 18 months’ follow for each patient, up  till May, 2006. Type 2 diabetes patients, aged between 35-70 years, of either sex, hyperglycaemic with PPBS >180mg%, FBS Englishhttp://ijcrr.com/abstract.php?article_id=139http://ijcrr.com/article_html.php?did=139  Powers A,D’ Alessio D. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycaemia. In ,Laurence Brenton(ed).Goodman and Gillman’s The Pharmacological Basis of Therapeutics, 12th edition, USA, McGraw Hll Companies, 2011;p1238-73. Nathan DM, Buse JB, Davdson MB, et al. Medical management of hyperglycaemia in Type 2 diabetes. A consensus statement of American Diabetes Association and the European Association for study of Diabetes. Diabetes care 2009;32:193-203. Lesley J. Scott and Caroline M. Spencer; Miglitol a review of its therapeutic potential in Type 2 Diabetes Mellitus ; Drugs:2000 March 59(3);521-549  Rybka J, Goke B, Sissmann J; European Comparative Study of 2- α glucosidase     Inhibitors, Miglitol and Acarbose;                       Diabetes 1999 May:48 Suppl.1;101 Ceriello A, Colagiuri S,Gerich J, Tuomilehto J. Guideline for management of postmeal glucose.Nutr Metab Cardiovasc Dis                2008;18:S17-S33. Sudhir R, Mohan V. Postprandial hyperglycaemia in patients with Type 2 diabetes mellitus.Treat Endocrinol 2002;1:105-16. Monami M, Lamanna C, Marchionni N, Mannuci E, Comparison of different drugs as add on treatments to Metformin in Type 2 diabetes: A meta-analysis,Diabetes Res Clin Pract 2008;79:196-203. Scheen AJ.Is there a role for alpha-glucosidase inhibitors in the prevention of Type 2 diabetes mellitus? Drugs 2003;63:933-51. Scott LJ; Spencer CM; Miglitol: A Review of its Therapeutic Potential in Type 2 Diabetes Mellitus. Drugs, Vol 59, No, 3, March 2000, pp 521-549(29) Jean-Louis Chiasson, Lisa Naditch; The Synergistic Effect of Miglitol Plus Metformin Combination Therapy in the Treatment of Type 2 Diabetes.Diabetes Care June2001:24(6):989-994 Johnston PS, Coniff RF, et al; Effects of the Carbohydrate Inhibitor Miglitol in Sulfonylurea-treated NIIDM Patients. Diabetes Care January 1994 ; 17 (1):20-29 Bastyr EJ, III Stuart CA, Brodows RG, Schwartz S et al. Therapy focused on lowering postprandial glucose, not fasting glucose, may be superior for lowering HBA1c. Diabetes Care 2000; 23;1236-41. Jean-Pierre JE Sels,Maya SP Hujiberts, Bruce HR Wolffenbuttle; Miglitol, a new α-glucosidase inhibitor;Expert Opinion on Pharmacotherapy Nov1999:1:149-156 Kingma PJ et al; α glucosidase inhibition by Miglitol in NIDDM patients. Diabetes Care 1992 Apr;15:478-83 Johnston PS. Coniff RF. Hoogwer BJ et al. Effects of the carbohydrate inhibitor miglitol in sulfonylurea treated NIDDM patients.Diabetes Care 1994 Jan:17:20-9 Joubert PH,Ventor HL et al.The effect of Miglitol and Acarbose after an oral glucose load; a novel hypoglycaemic mechanism.Br J Clin Pharmacol 1990 Sep;30:391-6 Reuser AJ, Wisselaar HA et al; An evaluation of the potential side effects of alpha-glucosidase inhibitors used for the management of diabetes mellitus. Eur J Clin Invest 1994 Aug;24 Suppl3:19-24 Lee A et al; The effects of miglitol on glucagon like peptide-1 secretion and appetite sensations in obese type 2 diabetics. Diabetes Obes Metab. 2002 Sep;4(5):329-35 Lebovitz HE, Oral therapies for diabetic hyperglycaemia Endocrinal Metab Clin North Am 2001, 30.909-33 Peter S Johnston, Peter U Feig, Robert F Coniff, et al, Chronic treatment of African-American Type 2 Diabetic-Patients With α glucosidase inhibition. Diabetes Care March 1998;21(3):416-422 Fujimoto Y. Ohhira M. Miyokawa N, Kitamori S, Kohgo Y; Acarbose–induced hepaticinjury.Lancet1998, Jan31, 351 (9099) :340

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30General SciencesSTUDIES ON EFFECT OF CERTAIN ANTIBIOTICS ON CALLUS GROWTH IN TERMINALIA CHEBULA English4145P. RamanjaneyuluEnglish A. Vijaya Bhaskara RaoEnglishThe study was undertaken to identify suitable antibiotic and their required concentrations for enhancement of callus production and for further transformation studies. The effect of antibiotics such as carbenicillin, cefotaxime and streptomycin were studied on the callus growth of Terminalia chebula. Different antibiotics were added at different concentrations to the callus culture media and maintained up to 45 days. The experiments exhibited varied growth stimulation over controls. Cefotaxime and carbenicillin exhibited higher growth index when compared to control at different concentrations whereas streptomycin showed insignificant effect on growth index of Terminalia chebula callus culture. The results could be attributed to the plant hormone like chemical nature of cefotaxime and carbenicillin. However streptomycin did not exhibited higher callus production. Hence, it is concluded that the addition of antibiotics at optimum concentrations to the culture media could increase the growth of callus and the higher yield of callus. EnglishTerminalia chebula, Callus growth, Cefotaxime, Carbenicillin, Streptomycin Introduction Terminalia chebula is an important medicinal plant having various bioactive compounds such as alkaloids, tannins, flaovanoids, terpinoids (Rathinamurthy and Thilagavathi, 2014). And it is secondary food plant for wild silkworms. Since, Terminalia chebula had hard seed coat, heavy pest and disease infestation of seeds and low survival rate of stem cuttings, grafting and layering, it is the need of the hour to go for alternative methods of plant propagation. Unorganized cell mass and the development of callus is necessary for the development of transgenic plants. It is known that callus could be initiated by hormones such as cytokinins and auxin. Purohit et.al., (1995) exhibited high frequency of regenerative of callus, when supplemented with α-indole acetic acid (IAA) and kinetine (Kn). Antibiotics are used to suppress or to eliminate bacteria in Invitro plant tissue cultures. Furthermore antibiotics are being used to induce to calli, however a little is known about the mechanism of induction. Apart from controlling and removal of microbial contamination in plant tissue cultures (Pollock et.al., 1983) certain antibiotics exhibited growth stimulation in different plants. Carbenicillin and cefotaxime both belong to the β-lactam group, have minimal toxicity on most plants (Mathias and Boyed, 1986) and these antibiotics are widely used in agrobacterium mediated transformation. Streptomycin is an amino aminoglycoside antibiotic which inhibits peptide elongation and protein synthesis resulting in bactericidal activity (Biswas and Gorini, 1972).Hence the present study was carried out to develop callus production by addition of antibiotics to callus cultures of T. chebula from leaf explants to know the effect of different antibiotics on callus growth and development. Materials and Methods Plant material Terminalia chebula of the family Combretaceae was used as plant material collected from one year old T. chebula. The leaves were washed in water containing 5 ml laboline detergent and thoroughly rinsed in distilled water for 5-6 times. These were treated with 0.1% (w/v) Bavistan (fungicide) solution for 10 min, and rinsed for 5-6 times with sterile distilled water. The tender leaves of approximately 5 cm in length were cultured in 25x150 mm tubes containing 15ml of solid 0.9% (w/v) agar, MS media (Murashige and Skoog 1962). The basal medium was supplemented with 30 g/l sucrose and 2 mg/l 2-4-D to achieve callus. The pH of the medium was adjusted to 5.8 before autoclaving at 121ºC for 15 min. Collected explants such as in vitro leaves were used for callus initiation. Small piece of callus of known initial fresh weight 50±10 mg/l were kept on the medium containing Control 100,200,300,400,500,700mg/l of carbenicillin, cefotaxime and streptomycin for each experiment included eight replication for treatment. After 45 days of incubation the final fresh weights were measured to calculate the growth index (GI). Callus growth (GI) was represented according to the equation as described by (Dung et al., 1981). Growth index (GI) = Final callus fresh weight - Initial callus fresh weight X 100 Initial callus fresh weight   Antibiotic treatments of callus cultures carbenicillin, cefotaxime and streptomycin were dissolved in double distilled water (DDW), filtered-sterilized and added to the liquid medium after autoclaving all the above antibiotics were added to the callus culture medium at different concentrations i.e., 100 mg/l, 200 mg/l, 300mg/l, 400mg/l, 500mg/l 700mg/l. Control were maintained without antibiotics, the effects of antibiotics and the growth of callus on solid medium after 45 days. Duncan&#39;s Multiple Range Test(1955) was used to determine the statistically significance among control and antibiotic treated callus. All quantification measurements were expressed as mean ± SEM for each experiment 8 replications were cited. Results From the date presented in the Table 1 and Figure 1, it is observed that relative to growth index of callus in Terminalia chebula. After 45 days significantly increased on cefotaxime treatment. The increase in the callus growth index was highest at the concentration of 500 mg/l. However, at the concentration of 700 mg/L the growth index was less when compare to controls. The order of increase was 100Englishhttp://ijcrr.com/abstract.php?article_id=140http://ijcrr.com/article_html.php?did=140 Biswas, D. K., and Gorini, L. (1972). The attachment site of streptomycin to the 30S ribosomal subunit. Proceedings of the National Academy of Sciences,69(8), 2141-2144. Chang, C. C., Schmidt, D. R. Initiation and proliferation of carrot callus using a combination of antibiotics. Planta, 1991; 185(4), 523-526. Danilova, S. A., Dolgikh, Y. I. The stimulatory effect of the antibiotic cefotaxime on plant regeneration in maize tissue culture. Russ J Plant Physiol, 2004; 51(4), 559-562. Duncan, D. B. Multiple range and multiple tests. Biometrics, 1955; 11(1), 1-42. Dung, N.N., E Szoki, G Verzar-Petri, The growth dynamics of callus tissue of root and leaf orgin in Datura innoxia Mill. Acta Botanica Academiae Scientiarum Hungaricae. 1981; 27(3/4):325-33. Holford, P., Newbury, H. J. The effects of antibiotics and their breakdown products on the in vitro growth of Antirrhinum majus. Plant Cell Rep, (1992) 11(2), 93-96. Kim, H. K., Oh, S. R., Lee, H. K., and Huh, H. (2001). Benzothiadiazole enhances the elicitation of rosmarinic acid production in a suspension culture of Agastache rugosa O. Kuntze. Biotechnology letters, 23(1), 55-60. Mathias, R. J., Boyd, L. A. Cefotaxime stimulates callus growth, embryogenesis and regeneration in hexaploid bread wheat (Triticumaestivum L em. thell). Plant sciences, 1986; 46(3), 217-223. Murashige, T., Skoog, F. A revised medium for rapid growth and bio assays with tobacco tissue cultures. Physiol planta, 1962; 15(3), 473-497. Pollock, K., Barfield, D. G., Shields, R. The toxicity of antibiotics to plant cell cultures. Plant cell reps, 1983; 2(1), 36-39. Purohit, M., Pande, D., Datta, A., and Srivastava, P. S. Enhanced xanthotoxin content in regenerating cultures of Ammimajus and micropropagation. Plantamedica, 1995; 61 (05), 481-482. Qin, Y. H., Da Silva, J. A. T., Bi, J. H., Zhang, S. L., and Hu, G. B. Response of in vitro strawberry to antibiotics. Plant Growth Regulation, 2011; 65(1), 183-193. Rathinamoorthy, R., and Thilagavathi, G. (2014). Terminalia chebula-Review on pharmacological and biochemical studies. Int. J. PharmTech Res, 6(1), 97-116.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30HealthcareEPIDEMIOLOGICAL STUDY OF THE ASSOCIATION OF HYPOTHYROIDISM WITH ANAEMIA IN NON-PREGNANT WOMEN OF REPRODUCTIVE AGE GROUP IN A TERTIARY CARE HOSPITAL IN KOLKATA English4650Joya GhoshEnglish Mriganka BaruahEnglishObjectives: Many studies suggest that hypothyroidism should be suspected in patients who have anaemia with an unknown aetiology. Thus the study was conducted to find out the proportion of hypothyroidism in both anaemic and non-anaemic women of reproductive age group and to determine the association between anaemia and hypothyroidism, if any. Methods: A cross sectional study with case control design was carried out in 100 non-pregnant women of reproductive age group in a hospital in eastern India for a period of one year. The proportion of hypothyroidism in both the groups was estimated by measuring TSH. The association between anaemia and hypothyroidism were ascertained in both the groups by Pearson’s Chi-Square test. Data analysis was also done using logistic regression. Results: The mean haemoglobin was 12.85 gm/dl in the non-anaemic population and 10.57 gm/dl in the anaemic population. The mean TSH was 2.81μIU/ml in the non-anaemic population and 2.61μIU/ml in the anaemic population. But there was no significant association between anaemia and hypothyroidism, which was one of the objectives. Logistic regression analysis showed that with increasing number of living issues, the risk of anaemia increases and the mode of delivery had a hazard ratio of 2.6. Conclusion: In our study, hypothyroidism did not show any significant association with anaemia thus, thyroid profile test may not be made mandatory in all anaemic women of reproductive age group to rule out hypothyroidism as its cause. In our study, risk factors for anaemia were found to be younger age group, caesarean mode of delivery and parity. EnglishTSH – Thyroid stimulating hormone, Hb– Haemoglobin, Menarche, ParityINTRODUCTION AND BACKGROUND: Anaemia is defined as a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weakness. It is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development. In a study conducted by WHO, worldwide prevalence of anaemia (1993–2005), showed that globally, anaemia affects 1.62 billion. Of this 468.4 million non-pregnant women are affected.[1]. In India, anaemia affects an estimated 50 per cent of the population.[2]The low dietary intake of iron and folic acid coupled with poor bioavailability of iron is the major factor responsible for very high prevalence of anaemia in the country.[3] Hypothyroidism i.e, under activity of the thyroid gland, affects 1% of general population.[4] Primary hypothyroidism is the aetiology in approximately 99% cases of hypothyroidism. Anaemia is often the first sign of hypothyroidism. In a study, that looked at the frequency of anaemia in overt hypothyroidism, clinical hypothyroidism and control groups, the frequency of anaemia in patients with subclinical hypothyroidism was as high as that in patients with overt hypothyroidism. The prevalence of anaemia was 43% in the overt hypothyroid group  and 39% in the subclinical hypothyroid group . Anaemia prevalence was 26% in the control group. They concluded that anaemia of chronic disease is the most common type of anaemia in patients who have hypothyroidism, whether it’s overt hypothyroidism or subclinical hypothyroidism. They also suggest that hypothyroidism must be ruled out in patients who have anaemia with an unknown etiology.[5] Hypothyroidism can cause macrocytic, microcytic hypochromic and normocytic normochromic anaemia. In Hypothyroidism, microcytic anaemia may be due to increased blood loss due to menorrhagia [6].Macrocytic anaemia is caused by malabsorption of vitamin B12, folic acid, pernicious anaemia and inadequate nutrition. As autoimmune disorders commonly coexist, pernicious anaemia occurs 20 times more frequently in patients with hypothyroidism than generally. Macrocytosis found in up to 55% patients with hypothyroidism and may result from the insufficiency of the thyroid hormones themselves, without nutritive deficit as well as pernicious anaemia.[7].In hypothyroidism, normocytic anaemia is considered to be an adaptation to a decreased basal metabolism. Thyroid hormones through erythropoietin, stimulate erythropoiesis.[8].A study conducted in Eastern  India showed that prevalence of anaemia in subclinical and overt hypothyroid groups was 26.6 % and 73.2 %  respectively and  most common type of anaemia in hypothyroidism was normocytic normochromic.[9].But, they did not take a control group, so the association between anaemia and hypothyroidism cannot be established, The age group selected was also very broad and they included both sexes. This study also restricts the age and sex under study, since the study population is only non-pregnant women in reproductive age group(15-49 years).We selected this study population because in the 2005-2006 National Family Health Survey (NFHS-3), it was seen that 55% females aged 15–49 years were affected with anaemia. It also estimated that about 20% to 40% of maternal deaths in India were due to anaemia.[10].Thus,if a significant association is found in between hypothyroidism and anaemia in women of reproductive age group, thyroid profile test should be made mandatory in all anaemic women of reproductive age group to rule out hypothyroidism as its cause and accordingly management of hypothyroidism can be started for patients of anaemia. MATERIAL AND METHODS:- A cross-sectional with case-control design study was carried out in the Department of Biochemistry, ESIC Medical College, Joka, Kolkata for a period of one years. The project was started after receiving the IEC clearance bearing letter number: MBBS Project/IEC 2/2016.One hundred  non-pregnant women in reproductive age group of 15-49 years attending the OPD of Obstetrics and Gynaecology were included in this study where 50 anaemic cases (Hb/=12gm/dl).  Only untreated cases of anaemia and hypothyroidism were included. The patients did not have any obvious cause of anaemia like chronic diseases, infection, malignancy, haemoglobinopathies and bleeding diathesis. All procedures for the study is followed and informed consent was obtained from all patients and control subjects participating in this study. A detailed history and meticulous physical examination were carried out. Inclusion criteria- Women of reproductive age group: (15-49) years and  haemoglobin :4.0µIU/L (0.4-4.0). Statistical Methods: Random sampling procedure was followed to ensure that the selected study participants were representative of NPW (Non-Pregnant Women) of child bearing age group in the population of the study area. The data was compiled in Microsoft Excel Sheet. The results obtained were presented in Mean± SD. Association between hypothyroidism and anaemia was assessed in 2 x 2 contingency table by Pearson&#39;s Chi square test. Odd&#39;s Ratio was also calculated to find out the strength of association by using Epi-info software (version 3.2). Fischer&#39;s exact was used whenever the assumption of Chi -Square tests were not met. Logistic regression analysis was also used for the data analysis, probability (p) less than 0.05 was considered significant. OBSERVATIONS and RESULTS: The anaemic group largely belongs to age group 31-40 years and the non-anaemic group largely belongs to age group 21-30 years both being 38%. In the anaemic group, 70% belong to age group 21-40 years. Study also showed that 32% of caesarean deliveries  were anaemic as compared to 14% being non anaemic.72 % of anaemic women had normal bleeding pattern.  The mean age of the study population is  lower in the non-anaemic than anaemic population. Moreover the mean haemoglobin and TSH was higher in the non-anaemic population  than the anaemic population. The age of onset of menarche is also lower in anaemic than in non-anaemic population.(Table 1). Anaemia is further classified as Mild, Moderate and Severe Anaemia but there is no significant association with TSH as p>.05 Neither there was any statistical significance between different degrees of anaemia and hypothyroidism as evidence from (Fig.1) Logistic regression analysis showed that with increasing number of living issues, the risk of anaemia increased and the mode of delivery had a hazard ratio of 2.6.Increasing age and higher age of onset of menarche had a protective effect on anaemia. DISCUSSION:- Studies in India and elsewhere shows that iron deficiency is the major cause of anaemia followed by folate deficiency and contribution of B12 deficiency has also been highlighted.[12,13]In India prevalence of iron- deficiency anaemia is high because of poor iron intake and poor bioavailability of iron in phytate and fibre rich  diet. Chronic blood loss and hook worm infestation also contribute to this [14]In a study in Ethiopia, a developing country like India it was seen that lower socio-economic. status, illiteracy, mutiparity, intestinal parasitic infestation, menorrhagia etc. were found as risk factors for anaemia in nonpregnant women of child bearing age group[15]In India, a study conducted in women of reproductive age group by  Dey et al, in the state of Meghalaya, predictors responsible for anaemia were explored. In their study women of lower socioeconomic status and under nutrition were cited as risk factors, apart from various types of addictions e.g. bidi, gutka, pan etc. Even in their study hypothyroidism was not seen as a risk factor for anaemia corroborating with our study.[16] The prevalence of hypothyroidism in our study was found to be higher in the non-anaemic group. This further establishes the fact that in our study population there was no relation between  the hypothyroid status and Hb levels. However, this can be accounted to the fact that in hypothyroidism, there is concomitant reduction of plasma volume leading to false high values of haemoglobin in blood. To override this factor, in various studies the actual degree of anaemia were estimated by radioisotopic analysis of red blood cell mass and plasma volume[17,18,19]We could not use these methods, so that might account for false high values of haemoglobin in the hypothyroid patients and paradoxical results. The small sample size due to the limited time of research work can also suggest that our finding is incidental. In our study highest percentage of anaemic women were in the age group of (21-40 yrs.).This is accounted by the percentage of parous women in this group which was 70% .Parity itself is a well established risk for the anaemia, due to extra demand by the foetus on the mother as well as blood loss during the process of delivery. In a study in Tehran by Majid et al it was seen that high parity index  were associated with higher prevalence of anaemia.[20]While, a study in south India has reported higher rate of anaemia for a parity index more than four. [21] Increasing age had a protective effect on anaemia as seen by logistic regression analysis in our study. A study in India  has assigned the younger women (Englishhttp://ijcrr.com/abstract.php?article_id=141http://ijcrr.com/article_html.php?did=141  1.WHO, Worldwide prevalence of anaemia 1993–2005 : WHO global database on anaemia, Edited by Bruno de Benoist, Erin McLean, Ines Egli and Mary Cogswell. 2.Florentino RF. The burden of iron deficiency and anaemia in Asia: Challenges in prevention and control. Nutrition goals for Asia - vision 2020; Proceedings IX Asian Congress of Nutrition; 2003 p. 313-8. 3. Indian Council of Medical Research, Micronutrient Profile of Indian Population, New Delhi, 2004. 4. Stephen J. Mcphee, Maxine A.P. Endocrine disorders. In: Paul A. Fitzgerald, eds. Current Medical Diagnosis and Treatment. 51st ed. New York, NY: McGraw-Hill; 2012: 182. 5.Erdogan M, Kösenli A, Ganidagli S, Kulaksizoglu M. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012;59(3):213-20.   6.Weeks AD. Menorrhagia and hypothyroidism?: Evidence supports association between hypothyroidism and menorrhagia. BMJ?: British Medical Journal. 2000;320(7235):649. 7.Sims EG  Hypothyroidism causing macrocytic anemia unresponsive to B12 and folate. J Natl Med Assoc 1983 75(4): 429-431. 8.Malgor LA, Blanc CC, Klainer E, Irizar SE, Torales PR, Barrios L. Direct effects of thyroid hormones on bone marrow erythroid cells of rats. Blood. 1975;45:671-9. 9.Das C, Sahana PK, Sengupta N, Giri D, Roy M,Mukhopadhyay P. Etiology of anemia in primary hypothyroid subjects in a tertiary care center in Eastern India. Indian J EndocrMetab 2012;16:S361-3. 10.F. Arnold, S. Parasuraman, P. Arokiasamy, and M. Kothari, “Nutrition in India,” in National Family Health Survey (NFHS-3) India 2005-06, 2009. 11.WHO, haemoglobin concentration for the diagnosis of anaemia and assessment of severity, Vitamin and nutrition information system. WHO, Geneva ,Switzerland,2011. 12.Yajnik CS, DeshpandeSS, Jackson AA,   Refsum H,  Rao S, Fisher DJ, et al. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study. Diabetologia 2008; 51: 29-38 . 13.Prema Ramachandran, Nutrition   in Pregnancy.  In: Gopalan C,            Kaur S, editors. Women and nutrition in India,   Special Publication No. 5. New Delhi: Nutrition Foundation            of India; 1989. p. 153-93. 14.Toteja GS, Padam Singh, Dhillon BS, Saxena BN, Ahmed FU, Singh RP . Prevalence of Anaemia among pregnant women and adolescent girls in 16 districts of India. Food Nutr. Bull.,2006 27(4): 311- 315. 15.Yaregal Asres, Tilahun Yemane, and Lealem Gedefaw, Determinant Factors of Anemia among Non pregnant Women of Childbearing Age in Southwest Ethiopia: A Community Based Study, International Scholarly Research Notices Volume 2014 (2014), Page:1-8. 16.Sanku Dey, Sankar Goswami, Madhuchhanda Goswami, Prevalence of anaemia in women of reproductive age in Meghalaya: a logistic regression analysis Turk J Med Sci.2010; 40 (5): 783-789. 17.Antonijevi? N, Nesovi? M, Trbojevi? B, Milosevi? R. [Anemia in hypothyroidism]. Med Pregl. 1999 Mar-May;52(3-5):136-40.   18..Das KC, Mukherjee M, Sarkar TK, Dash RJ, Rastogi GK. Erythropoiesis and erythropoietin in hypo- and hyperthyroidism. J Clin Endocrinol Metab. 1975Feb;40(2):211-20.   19.Buso R, Olavarrieta ST, Suarez RM. Studies on the pathogenesis of the anemia of hypothyroidism. J Clin Endocrinol Metab 1958, 18: 501–5.   20.MajidSadeghian, M.D., Ali Fatourechi, M.D., and Elham Ahmadnezhad, Ph.D., Sadeghian M, Fatourechi A, Lesanpezeshki M, Ahmadnezhad E. Prevalence of Anemia and Correlated Factors in the Reproductive Age Women in Rural Areas of Tabas. Journal of Family and Reproductive Health. 2013;7(3):139-144. 21.Raghuram V, Manjula Anil, Jayaram S. Prevalence of anaemia amongst women in the reproductive age group in a rural area in  south india. International Journal of Biological and Medical Research. 2012;3:1482–4. 22., Parashar A, Thakur A, Sharma D Anemia among adolescent girls in Shimla Hills of north India: does BMI and onset of menarche have a role? Indian J Med Sci. 2012 May-Jun;66(5-6):126-30. 23.MajidSadeghian, M.D., Ali Fatourechi, M.D, and Elham Ahmadnezhad, Ph.D., Sadeghian M, Fatourechi A, Lesanpezeshki M, Ahmadnezhad E. Prevalence of Anemia and Correlated Factors in the Reproductive Age Women in Rural Areas of Tabas. Journal of Family and Reproductive Health. 2013;7(3):139-144. 24.Kaur S, Deshmukh R, Garg B. Epidemiological Correlates of Nutritional Anemia in Adolescent Girls of Rural Wardha. Indian Journal of Community Medicine. 2006;31:102. 25. M E Bentley and P L Griffiths, The burden of anemia among women in India, European Journal of Clinical Nutrition (2003) 57, 52–60. 

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241824EnglishN-0001November30HealthcareCASE REPORT OF SPINDLE CELL CARCINOMA OF THE CONJUNCTIVA- A RARE TUMOUR English5153Mehulkumar K. PatelEnglish Sanjay V. DhotreEnglish Mahesh B. PatelEnglish Hansa M. GoswamiEnglish Hitendra P. BarotEnglish Monika S. NanavatiEnglishAim: To present a case of spindle cell carcinoma of the conjunctiva to emphasize the importance of detailed pathological examination to differentiate the cell type for the prognosis and the decision of proper treatment. Case Report: A 55 year old male patient presented at civil hospital, Ahmedabad with complain of decreased vision in the left eye. There was no history of trauma and pain. On examination, a pedunculated lesion over the conjunctiva with no ulceration, which grew slowly over 4 months. Histopathological examination showshistology of poorly differentiated squamous cell carcinoma of the conjunctiva with sarcomatoid differentiation (spindle cell variant of squamous cell carcinoma) which was confirmed on subsequent immunohistochemical examination. Discussion: Squamous cell carcinoma is the most common malignant tumor of the ocular surface8. Spindle cell carcinoma is a poorly differentiated variant of squamous cell carcinoma that rarely occurs in the conjunctiva 3,4,5,6,7. Cervantes et al. reported a total 287 cases of squamous cell carcinoma of conjunctiva, in which only two cases were documented as spindle cell carcinoma11. Surgical excision with or without cryotherapy and radiotherapy remains widely accepted treatment for squamous cell carcinoma of the conjunctiva9,10. Conclusion: Because of their possible aggressive behaviour, spindle cell carcinoma of the conjunctiva is known to be sight- and life threatening. It is important to differentiate this variety of squamous cell carcinoma from mimics specially sarcomas with spindle cell morphology and spindle cell predominant malignant melanoma. Hence detailed pathological examination is very important to differentiate the cell type for the prognosis and the decision of proper treatment. EnglishConjunctiva, Spindle cell carcinoma, Immunohistochemical examinationINTRODUCTION: Spindle cell carcinoma, a variant of squamous cell carcinoma is a rare biphasic malignant tumor, which has long been recognized in numerous tissues (including the skin, conjunctiva, the upper respiratory tract, the oral cavity, and the esophagus) 1,2,3. Spindle cell carcinoma is a poorly differentiated variant of squamous cell carcinoma that rarely occurs in the conjunctiva3,4,5,6,7.   AIM: To present a case of spindle cell carcinoma of the conjunctiva to emphasize the importance of detailed pathological examination to differentiate the cell type for the prognosis and the decision of proper treatment.   CASE REPORT: A 55 year old male patient presented atcivil hospital, Ahmedabad with complain of decreased vision in the left eye. There was no history of trauma and pain. On examination, a pedunculated lesion over the conjunctiva with no ulceration, which grew slowly over 4 months. In his ophthalmologic examination, best corrected visual acuity was counting fingers at 4m in his left eye and 1m in his right eye. His intraocular pressure was 17 mmHg in both eye. Anterior segment examination revealed a large vascularised lesion located in the superior bulbar conjunctiva with extension onto cornea closing 2/3 of the pupillary area. The right eye revealed no pathology in the anterior segment of the eye. The patient underwent a surgical enucleation involving whole tumor. On Gross Examination: Received specimen of eyeball with growth on conjunctiva measuring: 1.3x1 cm2. Eyeball measuring: 2.3x2x2 cm3. On cut surface, clear vitreous is identified. Optic nerve is identified. On Microscopic Examination: Section shows histology of poorly differentiated squamous cell carcinoma of conjunctiva- a spindle cell variant. Tumor cells have a spindle–shaped configuration, oval vesicular nucleoli, large basophilic or eosinophilic nucleoli, pink homogenous cytoplasm and mitotic figures. The cells are arranged in fascicles with stromal desmoplasia. Tumor involved whole conjunctival epithelium. Optic nerve is free from tumour. Immunohistochemical Examination: Immunohistochemical examination was done. The tumor cells show reactivity for cytokeratin AE1, cytokeratin 5/6 (CK5/6), and Vimentin. S-100 protein and human melanoma black 45 (HMB-45) were negative which ruled out amelanotic spindle cell melanoma. DISCUSSION: Squamous cell carcinoma is the most common malignant tumor of the ocular surface8. Squamous cell carcinoma has the potential to penetrate the corneoscleral lamella into the anterior chamber and can breach the orbital septum to invade the soft tissue of the orbit, sinuses, and brain as well as it may metastasize via lymphatics or blood during the disease9. Surgical excision with or without cryotherapy and radiotherapy remains the widely accepted treatment for squamous cell carcinoma of the conjunctiva9,10.   Spindle cell carcinoma is a poorly differentiated variant of squamous cell carcinoma that rarely occurs in the conjunctiva 3,4,5,6,7. Cervantes et al. reported a total 287 cases of squamous cell carcinoma of the conjunctiva, in which only two cases were documented as spindle cell carcinoma11. Spindle cell carcinoma is considered to be more aggressive and can also affect the progress and outcome of the disease. Histopathologically, spindle cell carcinoma of the conjunctiva may be difficult to distinguish from amelanotic melanoma, malignant schwannoma, fibrosarcoma and other spindle cell tumor4,5. Immunohistochemical examination demonstrates the presence of cytokeratin and epithelial membrane antigen (EMA) 4.   CONCLUSION: Because of their possible aggressive behaviour, spindle cell carcinoma of the conjunctiva is known to be sight- and life threatening. It is important to differentiate this variety of squamous cell carcinoma from mimics specially sarcomas with spindle cell morphology and spindle cell predominant malignant melanoma. Hence detailed pathological examination is very important to differentiate the cell type for the prognosis and the decision of proper treatment.   ACKNOWLEDGEMENT: Acknowledgements are due for my faculties, colleagues and paramedical staff of the Department Of Pathology, B. J. M.C., Civil Hospital, Ahmedabad for their cooperation and continuous moral support. Thanks are also due for the staff of ophthalmology department who sent the biopsy specimen to our department. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=142http://ijcrr.com/article_html.php?did=142  1. Zheng Y, Xiao M, Tang J. clinicopathological and immunohistochemical analysis of spindle cell carcinoma of larynx or hypopharynx: A report of three cases. Oncol Lett. 2014;8:748-52. 2. Torenbeek R, Hermsen MA, Meijer GA, Baak JP, Meijer CJ. Analysis by comparative genomic hybridization of epithelial and spindle cell components in sarcomatoid carcinoma and carcinosarcoma: Histogenetic aspects. J Pathol. 1999;189:338-43. 3. Cohen BH, Green WR, Iliff NT, Taxy JB, Schwab LT, de la Cruz Z. Spindle cell carcinoma of the conjunctiva. Arch Ophthalmol 1980;98:1809-13. 4. Huntington AC, Langloss JM, Hidayat AA. Spindle cell carcinoma of the conjunctiva. An immunohistochemical and ultrastructural study of six cases. Ophthalmology. 990;97:711-7. 5. Ni C, Guo BK, histological types of spindle cell carcinoma of cornea and conjunctiva. A clinicopathologic report of 8 patients with ultrastructural and immunohistochemical findings in three tumors. Chin Med J (Engl) 1990;103:915-20. 6. Schubert HD, Farris RL, Green WR. Spindle cell carcinoma of the conjunctiva. Graefes Arch Clin Exp Ophthalmol. 1995;233:52-3. 7. Slusker-Shternfeld I, Syed NA, Sires BA, Invasive spindle cell carcinoma of the conjunctiva. Arch Ophthalmol. 1997;115:288-9. 8. Sun EC, Fears TR, Goedert JJ, Epidemiology of squamous cell conjunctival cancer. Cancer Epidemiol Biomarkers Prev. 1997;6:73-7. 9. Shields CL, Shields JA, Tumors of the conjunctiva and cornea. Surv Ophthalmol. 2004;49:3-24. 10. Miller CV, Wolf A, Klingenstein A, Decker C, Garip A, Kampik A, et al. Clinical outcome of advanced squamous cell carcinoma of the conjunctiva. Eye (Lond) 2014;28: 962-7. 11. Cervantes G, Rodriguez AA Jr, Leal AG, squamous cell carcinoma of the conjunctiva: Clinicopathological features in 287 cases. Can J Ophthalmol. 2002;37:14-9