Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareA CADAVERIC STUDY OF BICEPS BRACHII MUSCLE- CLINICAL AND EVOLUTIONARY CORRELATIONS
English0103Patel Dinesh K.English Shinde Amol A.English Bharambe Vaishaly K.EnglishIntroduction: Knowledge of anatomical variations of the muscles is required during diagnosis with various imaging techniques. Literature mentions variations of additional heads of biceps brachii muscles.
Aim: To find incidence and variations of additional heads of biceps brachii muscle. Methodology – Meticulous dissection of 50 limbs for variation of origin, insertion and heads of biceps brachii muscle.
Results: We found 5 (10%) limbs showing accessory head of biceps. Bilateral variation was seen in one cadaver. One cadaver showed additional head taking origin from deltoid.
Conclusion: Role of evolution can be the cause of additional heads. Knowledge of the variations in the morphology of biceps brachii muscles is of immense importance in preoperative diagnosis and planned surgeries
Non-surgical treatment plays an important role in the treatment of primary liver cancer, which includes transcatheter arterial chemoembolization, percutaneous ablation therapy, radiation therapy, chemotherapy, etc
EnglishBiceps brachi, Accessory head of biceps brachii, Additional head of biceps brachii, Supernumerary head of biceps brachiiINTRODUCTION
The biceps brachii muscle is described as arising by a long head originating from supraglenoid tubercle and a short head from the coracoid process. Both heads unite in the upper arm and insert through a common tendon into the bicipital tuberosity of the radius, with an aponeurosis (lacertus fibrosus) . The biceps brachii muscle is one of the most variable in the human body in terms of morphology and number of heads.1 Extra head of biceps may help in strong supination. Knowledge of anatomical variations is important during diagnosis using various imaging techniques. Variations like extra head of biceps have been documented in literature. Additional head, accessory head, third head, supernumerary head are terms used for the extra head of biceps brachii.
Observations Methodology
Meticulous dissection of 50 upper limbs of cadavers fixed in 10% formalin was done. All upper limbs were observed for variations of origin, insertion and number of heads of biceps brachii muscle. Results – Accessory head of biceps was seen in 5 limbs (10%). 4 bodies showed accessory head on right side. One body showed bilateral variation.4 additional heads had humeral origin (fig 1,2) while one was taking origin from deltoid.(fig3) Musculocutaneous nerve was supplying the additional heads of biceps. No other variation was observed.
DISCUSSION
In Gray's Anatomy – The anatomical basis of clinical practice, David Johnson describes biceps brachii as having two proximally attached parts or heads. Short head arising as a thick flattened tendon from coracoids process of scapula and long head as a long narrow tendon from supraglenoid tubercle of scapula. He gives a 10% incidence of third head of biceps brachii muscle arising from superomedial part of brachialis. Additional head may also arise from lateral aspect of humerus and intertubercular sulcus. Musculocutaneous nerve (C5,6) innervates biceps brachii with separate branch for each head.2 In a MR Arthrography guided study Gheno et al1 mentioned a 20% incidence of accessory head of biceps brachii muscle. In conclusion they state that anomalous muscles are one of the more frequent anatomic variations around the shoulder. Familiarity with these structures is important not only because of the clinical symptoms that they can cause by compressing the adjacent neurovascular bundles but also for correct identification at the time of imaging or surgery. Pakhale et al3 gave evolutionary importance of biceps brachii. Lemures have a single headed biceps, apes and humans have muscle with two heads while gibbons have more than two heads for biceps brachii. They state a 3.75 % incidence of accessory head of biceps brachii. This incidence rate (3.75%) is less than our study (10%).Neurovascular compression is a possibility with this variation due to close proximity with additional head. Avadhani et al4 say that accessory heads of biceps will be significant in producing strong flexion and supination. They give 16.66 % incidence of third head of biceps which is more than our study (10%) Close relationship of medial nerve and brachial artery with biceps brachii may lead to compression in case with additional heads. In a study of biceps brachii in African population R.Ashwat et al5 report the incidence of third head as 20.5% in African black and 8.3% in African white population. They state presence of a additional head will help in stronger supination and flexion. Bharambe et al6 give a 13.3% incidence of third head and state that variations of biceps brachii are a reflection of its late development in human phylum. Accessory heads can cause neurovascular compression, change the kinematics at the elbow joint and misinterpretation as muscle tears on MRI. Author classified the extra heads of biceps brachii as capsular, humeral or brachial heads. Kumar H et al7 reported 3.3% incidence of third head of biceps brachii muscle which is less than reported in our study (10%). All cases showed third head having Humeral origin while our study showed 80% humeral origin for third head. Balasbramanian8 mentions that with evolution humans have lost the long head of coracobrachialis. The third head of biceps brachii which arises in continuity with the insertion of coracobrachialis may represent a remnant of long head of coracobrachialis the ancestral hominoid condition. Embryological studies described the variation as a portion of brachialis muscle where its distal insertion has been translocated from ulna to the radius. In population who show continuous, moderate physical activity the accessory head can be a specific functional adaptation. Paudel PP and Bhattarai C9 in a study of Nepalese population found 12.5 % incidence of accessory head of biceps brachii. They state 100 % incidence of humearal heads exclusively in right hand. Rodriguez et al10 gave a 15.4% incidence of accessory head of biceps brachii. Unilateral variation was seen in 81% cases.70 % variations were seen on right side. Cheema and Singla gave a very low incidence (2.3%) of additional head of biceps brachii in North Indian population. The variation was seen in left hands. Phylogenetically, additional head was explained as a remnant of a “tuberculoseptale” third head is present in hylobates but not in humans and anthropoids. Also considered a remnant of the long head of the coracobrachialis, an ancestral hominoid.Humeral head of biceps will contribute to strong pronation of forearm.11
CONCLUSION
Additional head of Biceps has been documented by various researchers. Extra head should help in strong flexion and supination actions. A humeral head will also contribute to pronation. Evolutionary role of long head of coracobracialis and part of bracialis shifting it’s insertion to radius can be the cause for additional head of biceps brachii. Compression of neurovascular bundle by the additional head should be considered. Knowledge of this variation is beneficial during preoperative diagnosis for planned elbow and shoulder surgeries.
ACKNOWLEDGEMENT
The Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to the authors/editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Source of funding: As this study was carried out in the dissection hall of our Department, there was no separate financial aid provided for it. Conflict of interest: There is no conflict of interest
Englishhttp://ijcrr.com/abstract.php?article_id=195http://ijcrr.com/article_html.php?did=1951. Ramon Gheno, Cristiane S. Zoner, Florian M. Buck, Marcelo A. C. Nico, Parviz Haghighi, Debra J. Trudell, Donald Resnick, Accessory Head of Biceps Brachii Muscle: Anatomy, Histology, and MRI in Cadavers. American Journal of Roentgenology.2010;194:80-83.
2. Standring S, editor, Johnson D, section editor. Gray’s Anatomy - The Anatomical Basis ofClinical Practice. 40th ed. London: Churchill Livingstone Elsevier;2008 ;6: 825-26.
3. Pakhale Sandeep V, Borole Bharat S, Mahajan Amrut A, A Study on the Accessory Head of the Biceps Brachii in Indians.Journal of Clinical and Diagnostic Research. 2012 september, Vol-6(7): 1137-1139.
4. Ramakrishna Avadhani , K. Kalyan Chakravarthi, A study on morphology of the biceps brachii muscle. NUJHS September 2012, 2(3): 2-5.
5. R. Asvat, P. Candler And E. E. Sarmiento, High incidence of the third head of biceps brachii in South African populations J. Anat. 1993, 182, pp. 101-104.
6. Vaishaly Kishore Bharambe, Neelesh Subhash Kanaskar, Vasanti Arole, A study of biceps brachii muscle: Anatomical considerations and clinical implications.SMJ 2015,18(1):31-37.
7. Kumar H, Das S, Rath G. An anatomical insight into the third head of biceps brachii muscle. Bratisl Lek Listy. 2008, 109: 76–78.
8. Akhilandeswari Balasubramanian, Supernumerary head of biceps brachii. International Journal of Anatomical Variations. 2010, 3: 214–215.
9. PP Paudel and C Bhattacharai, Study on the supernumerary heads of biceps brachii muscle in Nepalese. Nepal Med Coll J 2009; 11(2): 96-98.
10. Rodríguez-Niedenführ M, Vázquez T, Choi D, Parkin I, Sañudo JR, Supernumerary humeral heads of the biceps brachii muscle revisited. Clin Anat. 2003 May;16(3):197-203.
11. Prabhjot Cheema and Rajan Singla,Low Incidence of the Third Head of the Biceps Brachii in the North Indian Population. Journal of Clinical and Diagnostic Research. 2011 November (Suppl-2), Vol-5(7): 1323-1326.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareDEVELOPING AND VALIDATING CURRICULUM FOR ADMINISTRATIVE SKILLS WORKSHOP FOR DEPARTMENTAL HEADS OF MEDICAL COLLEGE
English0409Suresh N. ChariEnglish Madhur M. GuptaEnglish Shubhada A. GadeEnglishContext: Heads of department in a medical college are required to be fully trained to assume administrative roles. Unfortunately the medical education curriculum is silent on these issues and it is left to the teacher to learn these skills either by shadowing or by self-experience while on the job. Literature is also scarce on a defined validated curriculum for holding such workshops.
Aims: To develop and validate a curriculum for administrative skills workshop for departmental heads of medical college.
Settings and Design: Initial first draft of the curriculum was prepared based on the experience and knowledge of the mentors and the author. This was circulated to 7 experts (three deans of medical college, 2 management experts, and two heads of corporate hospitals) for their comments and suggestions on the duration, content and method of delivery. Telephonic conversation, conference calls and email discussion with them was extensively done to come to a consensus. This final draft was sent back to the experts as a last phase of validation.
Results and Conclusion: The study in all probabilities demonstrates the first validated curriculum for conduct of a two day workshop on administrative skills for thirty head of departments in a medical college. This is the need of the hour since a head of department in a medical college in India has to struggle to meet the administrative needs of the organization
EnglishAdministrative skills, Head of department, Medical collegeINTRODUCTION
Administrative skills are of paramount importance for heads of department or heads of institute or for that matter for people in managerial position. Medical profession is no exception (1). All heads of department in a medical institute are medical postgraduates who have become head of departments due to either hierarchical compulsions or other reasons and have never been exposed to administrative skills. Each medical college in India have about 20-25 academic departments along with non-academic departments which are support ancillary units. Each department head has to manage three functional areas i.e academic teaching, clinical patient care and staff management. All the three are equally important and are directed towards fulfilling the objectives set for any medical college. For whatever reason, there is a large scale observable incompetency in leadership skills of people in managerial positions in medical institutes (2). Although leadership and administrative skills appears to be subtly different, they are inseparable and there is an urgent need to train people on basics of these skills. Medical council of India has in its vision document 2015 stated certain set of skills that are required for a medical graduate to enable him to become an Indian medical graduate. However the contents of this document has not yet been put to place in the right perspective. It has been also empha sized that thrust needs to be given on basic skills in human resource management, leadership qualities which is presently missing in the curriculum. (3) Robert Kartz (4 ) has explicitly documented certain set of skills that the administrative head of the department must possess for effective administration, a three scale approach which encompasses technical skill, human skill and conceptual skill. Multi-factorial complexities exist in the administrative demands of departmental heads of medical college like completing the medical curriculum, handling multiple stake holders, patient care, specific departmental facilities for health care, students activities both undergraduate and post graduate, departmental and college council meetings, filings and documentation, membership in various institutional administrative committees and many more. Administrative and leadership skill workshops are a regular feature in management colleges and administrative staff colleges where the need of the target population has been identified and a need based curriculum is in place. One workshop on administrative skills for doctors and one for hospital staff was conducted by the author preparing a need based curriculum which was highly appreciated by the participants, though the work was not published. Although, Voll et al showed that ward round administrative skills can be taught effectively to final year medical students (1) and Aluise described an administration development curriculum for academic physicians (5), there is no literature available on formal administrative skill workshop or course or curriculum for the workshop on administrative skills for faculties of the departments of medical colleges and more specifically for head of departments in a medical college. It was with this view in mind that a curriculum for administrative skill workshop was developed for department heads of medical colleges and validated taking opinion of experts in varied yet related fields.
SUBJECTS AND METHODS
The study which has a qualitative study design was carried out at a medical college in central India. After obtaining ethics clearance the process went through the following steps: Step I – The first draft curriculum for administrative skills for head of departments of medical college was prepared based on critical study of present scenario and need, the authors experience as a facilitator and trainer in leadership, communication, relationships and administrative skills workshops and discussion with two mentors from the field of medical education and administration. The first draft curriculum took into consideration: the target population, time frame, feasibility, previous curriculum, need areas and future implementation. Step II – Experts in the field of management and health care were identified for validation process of the curriculum. They were one dean from established private medical college (herein call as Dean 1), one dean from medical college attached to deemed university (Dean 2), one ex-dean from a premier government medical college (Ex Dean), two management experts both from highly reputed nationally ranked management colleges (management expert 1 and management expert 2) and two heads of leading corporate hospitals (CH head 1 and CH head 2). Consent was obtained from all the experts first telephonically and subsequently through email. The first draft curriculum was mailed requesting them to react on the content and design within one month. The email specifically requested their comments on the duration of both program and session (suggested two days), contents (including sequence) and method of delivery.
Step III - The experts sent their responses back within 20 days and the comments were discussed and analyzed with the mentors. Step IV - Individual telephonic conversation, conference calls and email discussion with the experts and mentors for understanding their suggestions and comments and for coming to consensus regarding retaining, deleting and/or addition of session(s). Step V- A final draft was developed along with the mentors, taking into consideration the suggestions and comments of the experts. Step VI – As a last step in the process of validation, the final draft was resent to experts for approval which was received back within 15 days. Step VII - Final curriculum was prepared.
RESULTS
The first draft curriculum after focused group discussion with the mentors that was sent to the experts is shown in table 1
Day2:
The changes suggested by the experts were as follows:
1. Dean 1 – suggested that the duration should be of 3 days and recommended immediate and long term assessment of the usefulness of the program.
2. Dean 2 – Opined that the content, duration and the methodology was appropriate but suggested inclusion of pre and post-test.
3. Ex Dean - suggested that the objectives and the contents should be strictly towards administrative skills and the area of the management be dealt with separately.
4. Management expert 1 – Suggested that the methodology should be adult learning centric and highly interactive. He further suggested that the workshop should be held outside the campus and that appraisal systems should be one of the inputs. He further mentioned that although there are too many sessions for the two days they should not be done away with since they will be useful in sensitizing the participants.
5. Management expert 2 – Suggested inclusion of discipline management in the session of professionalism and the size of the group should not exceed thirty.
6. CH Head 1 – Emphasized on the inclusion of rules and regulation of employment. He further suggested that one day should be included for risk and disaster management.
7. CH Head 2 – Suggested that a proper evaluation and long and short term feedback of the program and the workshop must be included though it may not be a part of this curriculum. Inclusion of financial management in this two day workshop was desirous.
The final draft after the comments of the experts were discussed with the mentors and is shown in table 2
DISCUSSION
We often see a large number of heads of department in every medical college of India struggle to meet the needs and demands of the organization. A head of department in a medical college are required to assume many leadership roles like resource management, program implementation, decision making, relationship management and financial regularities. They should also have this capacity to develop second line of leadership. Since an organization grows only when the head is the role model for others. Medical schools equip the students with a vast knowledge of clinical medicine which is no doubt important but equally important are many administrative skills which are only assumed to be learnt during a shadowing period or deferred until doing the job for real. A qualified medical doctor could be an expert physician but with deficit administrative skills he could fail to take the organization to the next level. Skills can be developed and one of the methods is structured training programs. In this era of modern medical education, time has come to impart administrative skills to all medical professionals more so to the top level management i.e head of departments. In spite of extensive review, literature indicating conduct of formal administrative skills workshop for head of departments of medical colleges was inadequate. This validated curriculum on administrative skills workshop for head of departments of medical colleges is the need of the hour since they are responsible for multitude of tasks like communicating with people, understanding financial management, horning people skill, setting the right target with a clear vision, handling of emotions yet with professionalism and ethics. In the present study, all the experts who were a part of this project during one on one discussion felt this need of developing a validated curriculum for administrative skills workshop. In fact they also recommended that this curriculum can be used by any medical institute in India since the challenges faced by head of departments are almost similar in any medical college in the country. The first author and the mentors have a vast experience of administration in a medical college in various capacities. The first author has been regularly conducting sessions on leadership, team building, communication-relationship skills, goal setting, time management, group communication for corporate and institutional setups. He has also been conducting such training programs in management colleges, engineering colleges and institute of chartered accountants since last twenty years. All these sessions in the above programs were designed as per the need of the organization taking several factors into consideration. Of the two mentors one has been head of institute, university and academic governing council, the other mentor has been in public and private sector medical college as head of department and administrative head of many committees for more than forty years and both are well aware of the importance of professionalism, ethics and administrative demands of a head of department in a medical college. Based on their experience and expertise in training, administrative and leadership skills the first draft of the administrative skills workshops for head of departments of medical college was designed. The authors and the mentors took into consideration all the facets and challenges faced by head of the department in a medical college while preparing the first draft. The experts found the first draft very appealing but added a few inputs. During discussion with mentors it was felt that most of the suggestions and comments given by the experts were relevant and have were incorporated in the second draft in one form or the other taking the duration into consideration. Except one all experts felt that the duration of the program should not exceed two continuous days since the head of departments can probably spare only these many days for training. All the experts agreed that the program should be for not more than 30 participants and that it should be highly interactive with more of activity than being only didactic. Inputs like rules governing employment, appraisal system and purchase procedure were added in the final draft as per recommendations by the experts and approval by the mentors. They further said that the titles of the administrative skill sets required may appear to be same in different organizational setups but the fashion and method of applying them will differ depending on size, nature, work culture, ethics and level of demand of professionalism of the organization. Like any head of the department in any organization, the head of department of a medical college has to deal with his teaching staff, peer group, the non-teaching staff who could be a clerk, technician, asst. technician or attendant. The other stake holders in his area of operation are parents, students, patients, relatives, nursing staff, administrator and the management. In short, the heads of department of a medical college have to be good leaders.(2) They have to give direction and support in blended proportions that suit a situation and this is a major essential for man management. Hence a sessions on situational leadership, team building, interpersonal communication relationship, group communication, decision in difficult situation and individual and organizational goals were included in the curriculum. Professionalism includes strict adherence to courtesy, honesty and responsibility while dealing with individuals. Ethics is concerned with personal values that can be demonstrated by the seniors which can be instilled in the other employees. Professionalism and work ethics can go hand in hand and helps in establishing a good reputation of the place of work and its work culture. In fact, a physician charter on professionalism (6) emphasizes on active dedication to the three principals of professionalism and enlists ten commitments to the welfare of the patients with an aim to improve global health care systems for the welfare of the society. Hence a session on professionalism and ethics is relevant before understanding the basics of administrative skills. Moreover, it is important that heads of department working in the institute must have almost similar views on professionalism and work ethics as the Dean and the management. One of the two very basic yet very important areas in administration is the art of articulate filing systems which help retrieve documents as and when the need arises. The second important input which doctors shy away from is accounts. As you grow in hierarchy in the departmental setup in medical institutes one is never exposed to terms like budgeting, comparative statements and purchase and final procurement of instruments, equipment’s etc. although this needs an independent session, the experts felt that one session should be devoted to these areas with the objective of at least sensitizing the head of departments on the financial management of the institute. After seeing the second draft, in general all experts felt that the contents, the design and the time duration (two days) were appropriate. It takes care of the immediate need of the heads of department of medical college, they said.
This is probably the first validated curriculum for the conduct of a two day workshop for heads of department of medical colleges in India. This curriculum evolved as a result of extensive deliberation with the mentors and experts about the content, duration, feasibility, utility and need of the participants in question. During these discussion issues like some sessions being cramped up and some being given “less time” cropped up. However, the general consensus was that the input of the two days should be sufficient to sensitize the head of departments of issues that have never been formally discussed by them early. It was also recommended that apart from pre and post-test participants should be assessed for the usefulness after a period of 6-8 months where a session could be held for reflection on issues / situations faced by the participants and strategies adopted by them to overcome the same. One other point of discussion with the mentors and experts was about the challenges during implementation. It was felt that since creativity and effectiveness of each session will differ from trainer to trainer and hence a simultaneous curriculum for training the trainers should be in place to develop a pool of trainers for this program. Similarly a trainers and participants guide / manual should be available with the trainer much before the start of the workshop. Hence, this work talks about a curriculum for an administrative skill workshop which is only a first step and would be complete only when it is implemented.
CONCLUSION
Administrative skills is necessary for a medical professional whether in a medical college or in a health care setup. A validated need based curriculum was the need of the hour and all such people should undergo a two day workshop using this curriculum. This would probably improve the working environment and ultimately help patient care.
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.
Englishhttp://ijcrr.com/abstract.php?article_id=196http://ijcrr.com/article_html.php?did=1961. Voll J, Bragg D and Maxwell-Armstrong C. A master class in administration skills for future foundation doctors. International Journal of Healthcare Education and Medical informatics 2015, 97 (3): 15-18.
2. Jindal SK. Editorial: Leadership in medicine. Indian J Chest Dis Allied Sci 2014.56: 69-70.
3. Sood R, Adkoli BV. Medical Education in India-Problems and Prospects. Indian Academic of Clinical Medicine.2000; 1(3):210-212.
4. Robert. L. Katz. Skills of an Effective Administrator. A Harvard Business Review Classic. 1974; 52(5): 90-102.
5. Aluise JJ, Scmitz CC, Dland CJ and McArtor RE. Administrative skills for academic physicians. Medical teacher 1989, 11(2): 205-212.
6. Medical professionalism in the new millennium: A physicians charter. Project of the ABIM foundation, ACP-ASIM foundation and EFIM. Ann Intern Med 2002; 136 (3): 243-246.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareISOLATION OF MYCOBACTERIUM TUBERCULOSIS COMPLEX FROM STOOL SPECIMEN IN A RETROVIRAL DISEASE PATIENT
English1012Nilma HiraniEnglish Pranali MedhekarEnglish Ameeta JoshiEnglish Vaishali WabaleEnglish Abhay ChowdharyEnglishAmongst various forms of TB, TB of the gastrointestinal tract is the sixth most frequent form of extra-pulmonary TB. Though any part of the gastrointestinal tract can be involved, the most common site of involvement is ileocaecal region. It can have a varied presentation, frequently mimicking other diseases, thus causing delay in diagnosis and management. Therefore a high degree of suspicion along with proper use of diagnostic modalities is essential for timely diagnosis of the disease. Here, we present a case of isolation of a strain of MTB complex resistant to rifampicin from stool specimen of a retroviral disease patient diagnosed with abdominal Koch’s.
EnglishAbdominal Koch’s, MTB complex, Rifampicin resistanceINTRODUCTION
Tuberculosis (TB) can involve any part of the gastrointestinal tract from mouth to anus, the peritoneum and the pancreatobiliary system. It can have a varied presentation, frequently mimicking other diseases.1,2 Amongst various forms of TB, TB of the gastrointestinal tract is the sixth most frequent form of extra-pulmonary site, after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis as cited by Paustian FF et al3 and Dabhi L, Suthar H et al.4 Both the incidence and the severity of abdominal TB are expected to rise with increasing incidence of HIV infection in India.5 Isolation of acid fast bacilli (AFB) is the gold standard for diagnosis of pulmonary TB but it may not be possible to establish the diagnosis of various forms of abdominal TB using culture techniques. Diagnosis of abdominal TB is made either on the histological evidence of TB in the tissues (eg. evidence of tubercles with caseation or demonstration of AFB in the lesion.) or typical operative findings suggestive of TB or by using radio-imaging procedures.6 Here, we present a case of isolation of Mycobacterium tuberculosis from stool specimen of a retroviral disease (RVD) patient with abdominal tuberculosis.
CASE REPORT
A 42-year-old male patient presented with chief complaints of loose motions (10-12 episodes daily) since three months. Patient also complained of body ache and giddiness since two months. He was a known case of RVD on ZLN (Zid ovudine+Lamivudine+Nevirapine) regimen since six years. There was no history of blood in stool, fever with chills, nausea or vomiting. There was no past history of diabetes, hypertension and tuberculosis. On examination, patient was conscious with vitals stable. Per abdomen examination revealed soft abdomen, no organomegaly. Results of haemoglobin, complete blood count, renal function tests, liver function tests were within normal limits. Test for HIV 1 antibodies was positive.
Chest X-ray PA view revealed chronic infiltration suggestive of Koch’s, though patient did not give any past history of pulmonary TB. USG abdomen revealed thickening of ileocolic junction and caecal wall, minimal interbowel free fluid and mesenteric lymphadenopathy. Stool sample of this patient was received in TB culture and DST laboratory in sterile container for mycobacterial culture. The stool specimen was subjected to Ziehl-Neelsen staining7 and direct microscopic examination revealed presence of pus cells along with presence of slender, elongated, curved acid fast bacilli with varied morphology. The stool specimen was then subjected to decontamination by NALC-NaOH method. Resultant sediment was inoculated onto two slopes of Löwenstein-Jensen(LJ) medium and one slope of Para nitrobenzoic acid(PNB)8 . The slopes were incubated at 370 C. After initial examination after 72 hours, these slopes were examined weekly. Solid culture on LJ medium showed slow growth of rough, buff coloured colonies suggestive of M. tuberculosis at 6 weeks. PNB slope did not reveal any growth. For drug susceptibility testing (DST), the culture was subjected to both, solid DST by economic variant of 1% proportion method8 and line probe assay (LPA). LPA is a molecular method based on reverse hybridization technique, used for detection of MTB complex and resistance to Isoniazid (INH) and Rifampicin (RIF).9 The strain was found to be resistant to RIF and sensitive to INH, ethambutol (ETH) and streptomycin (STR) on solid DST. Results of LPA showed presence of TUB band, thus confirming the identity as MTB complex. rpoB gene locus for RIF resistance showed absence of wild type 8 band and presence of mutation band 3 representing mutation at codon S531L. All wild type bands were present along with absence of mutation band in katG and inhA gene loci for high level and low level INH resistance respectively. Thus, the strain was reported as resistant to RIF and sensitive to INH. The patient was diagnosed as a case of abdominal Koch’s and anti Koch’s treatment (AKT) was started. Since patient showed signs of hepatotoxicity, drug regimen was changed to hepatosafe AKT (Ethambutol+Streptomycin) and was advised monitoing of liver function tests (LFT). Patient was advised shifting to AKT when results of LFT’s would be within normal limits. Thereafter, patient was put on extended regimen since rifampicin resistant strain was isolated. He responded to treatment and showed clinical improvement.
DISCUSSION
Abdominal tuberculosis constitutes a major public health problem in developing countries and is associated with significant morbidity and mortality.10,11 Though any part of the gastrointestinal tract can be involved, the most common site of involvement is ileocaecal region, possibly due to increased physiological stasis, increased rate of fluid and electrolyte absorption, minimal digestive activity and an abundance of lymphoid tissue at this site.1 Abdominal TB is a disease that predominantly affects young adults. Two-thirds of all cases involve patients between 21 and 40 years of age. This patient also fits in the above mentioned range. There is no difference in the incidence rate between male and female subjects, although some studies suggest a slightly increased female predisposition.1 The postulated mechanisms by which the tubercle bacilli reach the gastrointestinal tract are (i) hematogenous spread from the primary lung focus in childhood with later reactivation (ii) ingestion of bacilli in sputum from active pulmonary focus (iii) direct spread from adjacent organs and iv)through lymphatic channels from infected nodes.1 Gastrointestinal tuberculosis constitutes 70-78% cases of abdominal tuberculosis1 . Ileocaecal area is the most commonly involved site followed by colon and jejunum.1,12 Rarely tuberculosis may involve stomach, duodenum and oesophagus. The three characteristic intestinal lesions produced in tuberculosis include i) ulcerative ii) hypertrophic and iii) stricturous or constrictive.12 A combination of these morphological forms may also occur. Most cases of gastrointestinal tuberculosis have associated lymph node and peritoneal involvement. Peritoneal involvement may be in the form of peritoneal adhesions or exudative fluid in the peritoneal cavity (ascites). The nodal involvement in abdominal tuberculosis is mainly mesenteric or retroperitoneal. Lymph nodes may show caseation or calcification.12 The clinical presentation may vary from asymptomatic disease (an incidental finding on laparotomy) to acute, acute on chronic or chronic symptomatic disease. The symptomatology mainly includes constitutional symptoms such as fever, malaise, night sweats, loss of weight, weakness in about onethird of patients. Local symptoms and signs such as chronic diarrhoea, constipation, pain in abdomen, vomiting, abdominal distension may be present according to site and type of involvement. Physical examination of abdomen may show signs of ascites, lump in abdomen or visible peristalsis with dilated loops of gut. However, in a large number of cases it may be unrewarding. Because of varied clinical presentations, one or the other form of abdominal tuberculosis may mimic malignant neoplasms or inflammatory bowel disease. Therefore, a high degree of suspicion along with proper use of diagnostic modalities is essential for timely diagnosis of the disease.1,6 Isolation of acid fast bacilli is the gold standard for diagnosis of pulmonary TB, but, may not be possible for establishing the diagnosis of various forms of abdominal TB. New criteria suggested for the diagnosis of abdominal TB by Lingenfelser13 are as follows: (i) Clinical manifestations suggestive of TB (ii) Imaging evidence indicative of abdominal TB (iii) Histopathological or microbiological evidence of TB and/or (iv) Therapeutic response to treatment. This is the first report of M. tuberculosis complex isolated from stool specimen of a patient diagnosed with abdominal Koch’s from the TB culture and DST laboratory in a tertiary care hospital. He was a retroviral disease patient, developed persistent diarrhoea for three months along with constitutional symptoms. There was imaging evidence of abdominal TB as suggested by ileocolic junction and caecal wall thickening and mesenteric lymphadenopathy. Microbiological isolation of the agent is very rare and it has remained under 50% in all the reported series.14 However in this case we could isolate MTB complex from stool specimen and detect rifampicin resistance by performing DST by both solid as well as molecular method (LPA). The isolation of MTB is also essential for performing susceptibility tests, the importance of which is growing because of high incidence of multi drug resistance.15 A past history of pulmonary TB is quite frequent in patients with abdominal TB.16 In this case though patient did not give any past history of pulmonary TB, chest X-ray findings revealed chronic infiltration suggestive of Koch’s. By using clinical, imaging and microbiological evidence, the patient was diagnosed as a case of abdominal TB and AKT was started.
CONCLUSION
Tuberculosis can involve any part of gastrointestinal tract. Symptomatology can be varied and disease often mimics malignancy or inflammatory bowel disease. It can cause delay in diagnosis as well as treatment. Therefore, a strong clinical suspicion along with a combination of imaging, histopathological, microbiological and molecular tests can provide accurate diagnosis of the disease. Microbiological isolation further aids in susceptibility testing for anti-TB drugs, which is important to combat the problem of MDR-TB.
Englishhttp://ijcrr.com/abstract.php?article_id=197http://ijcrr.com/article_html.php?did=1971. Abdominal tuberculosis Sharma MP, Bhatia V Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India Review Article Indian J Med Res 120, October 2004, pp 305-315
2. Peda Veerraju E. Abdominal tuberculosis. In: Satya Sri S, editor. Textbook of pulmonary and extrapulmonary tuberculosis. 3rd ed. New Delhi: Interprint; 1998 p. 250-2.
3. Paustian FF. Tuberculosis of the intestine. In: Bockus HL, editor. Gastroenterology, vol.11, 2nd ed. Philadelphia :W.B. Saunders Co.; 1964 p. 311.
4. CLINICAL DILEMA- ABDOMINAL TUBERCULOSIS Dr. Leena Dabhi, Dr. Hemang Suthar http://themedicalacademy.in/ fxconsult1/userfiles/CLINICAL%20DILEMA.pdf
5. Rathi PM, Amarapurakar DN, Parikh SS, Joshi J, Koppikar GV, Amarapurkar AD, et al. Impact of human immunodeficiency virus infection on abdominal tuberculosis in western India. J Clin Gastroenterol 1997;24 : 43-8.
6. Chugh SN, Jain V Abdominal tuberculosis: Current concepts in diagnosis and management www.apiindia.orgpdf/medicine_update_2007/102.pdf
7. Revised National Tuberculosis Control Programme: Guidelines on Programmatic Management of Drug Resistant TB (PMDT) in India May 2012
8. Manual of Standard Operating Procedures (SOPs). Culture of Mycobacterium tuberculosis and Drug Susceptibility Testing on solid medium. 1-142(2009) available at www.tbcindia.org
9. GenoType MTBDRplus,version 2.0 (product insert). Nehren, Germany; Hain Lifescience, GmbH. Available from: http:// www.hain-lifescience.com/pdf/304xx_pbl.pdf
10. Global tuberculosis control 2012. [Internet]: World Health Organization. (Online) http://www.who.int/tb/publications/global_ report/en/index.html Cited 2011 April 11.
11. Wadhwa N, Agarwal S, Mishra K. Reappraisal of abdominal tuberculosis. J Indian Med Assoc. 2004;102:31–32
12. Marks IN. Abdominal tuberculosis baillierers. Clin Trop Med Common Dis 1998;3:329. 13. Lingenfelser T, Zak J, Marks IN, et al. Abdominal tuberculosis;still a potentially lethal disease. Am J Gastroenterol 1993;88:744.
14. Uygur-Bayramiçli O, Dabak G, Dabak R. A clinical dilemma:abdominal tuberculosis. World J Gastroenterol 2003; 9(5):1098-1101
15. Iseman MD. Treatment of multidrug resistant tuberculosis. N Engl J Med 1993: 784-791
16. Gorbach SL. Infectious diarrhea and bacterial food poisoning. In: Sleisenger MH, Fordtran JS, eds. Gastrointestinal disease. Philadelphia: Saunders 1993: 1128-1161.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareISOLATION AND CHARACTERISATION OF DIATOMS FROM WATERBODIES OF MUMBAI
English1321Disha RanaEnglish Deepika BhandariEnglishDiatom plays an important role in Forensic Science and in the studies of water quality. Diatom acts as a supportive evidence for ascertaining the cause of death as well as the place of drowning. Presence of diatoms in the distant vital organs is an important method to distinguish between ante-mortem and post-mortem drowning. It is possible to pinpoint the site of drowning, if diatom species recovered from the tissues of the corpse are compared to that found in the water body from where the corpse is recovered. In the present study, 10 water bodies located in various parts of Mumbai were sampled for the study. Isolation of diatoms was carried out using acid digestion method. Total 35 species of diatoms were isolated and characterised. The diatom species identified belong to the following genera: Gyrosigma, Navicula, Melosira, Pinnularia, Surirella, Hantzschia, Eunotia, Fragilaria, Nitzschia, Gomphonema, Cymbella, Cyclotella, Neidim, Caloneis, Synedra, Epithemia, Frustulia. The information obtained helped to create a reference database on diatoms which can be utilized in future for ecological assessment and ready reference in drowning cases
EnglishDiatoms, Drowning, Genera and species from Mumbai water bodies, Acid digestion methodINTRODUCTION
Diatoms are the most common types of phyto-planktons in aquatic ecosystems. They have unique feature called frustules. The frustules are cell walls composed of two valves, one overlapping the other and are made up of silica (SiO2 ). It is through frustules that different varieties of diatoms can be distinguished. By adding concentrated nitric acid (HNO3 ) to suspected materials, diatoms can be easily distinguished from other algal group. The acid will have no effect or will cause no injury to the diatoms as their silica cell walls do not decompose. Particularly in India, diatoms as compared to other group of algae are less studied due to several reasons such as scarcity of literature, tedious process of isolation, eye straining study/ observation as they are visualized under oil immersion. The diatoms may fall under one of the following three classes:
1. Class: Coscinodiscophyceae Order: centrales or centric diatoms with symmetry about a point (radial)
2. Class: Fragilariophyceae Order: pennales or pennate diatoms with symmetry about a line (bilateral) and without a raphe (araphids)
3. Class: Bacillariophyceae Order: pennales with a raphe (raphids) Professor H. Gandhi has added much to our knowledge in the field of diatomology/ limnology and is considered as the father of limnology in India. In India, the early records of diatoms are those of Ehrenberg (1854), Dickie (1882), Carter (1926), Majeed (1935), Skvortzow (1935) and Biwas (1936), Gangla (1949), Venkataraman (1939,1956), Krishnamurthy (1954), Gandhi (1952), Desikachary (1954), Lakshminarayana (1962), Thomas (1965), Zahamensk (1973), Pandey and Pandey (1980), Somashekar (1983), Sarode and Kamat (1984),Mann and Droop (1996),Tarar and Bodhke (1998),Kociolek and Spaulding (2000), Kociolek and Stoermer (2001), Bhagat (2002), Mishra and Mishra (2002), Kilroy et al. (2003), Mishra (2006), Patil and Kumawat (2007), Vanormelingen et al.(2008), etc. The first to record the diatom from Maharashtra was probably Gonzalves(1947).
MATERIALS AND METHODS
Collection of Water Samples: The water samples was collected during the month of February from 10 selected water bodies of Mumbai, India. The samples were collected in different reagent bottles. Before the samples were collected in the bottle, the floor of the water bodies was disturbed so that more amount of mud enters the bottle, thereby increases the number of diatoms in the samples collected. The bottles were labelled mentioning the place, date, time of collection and sample number. The mud was allowed to settle down in the bottle. Digestion Method: Nitric acid digestion method was used. The water sample (approximately 1 ml) from the bottom of the bottle was collected using dropper and was transferred in vials of 1.5 ml .The sample was then digested by adding 4 drops of concentrated nitric acid and incubated overnight at room temperature. Cleaning of Diatoms: The samples were centrifuged at 7000 rpm for 7 minutes. The supernatant was decanted and replaced with distilled water. The sample was made transparent by vortexing it at 7000 rpm for 5 minutes. This process of centrifuging and vortexing was repeated thrice to produce a pellet. The supernatant was decanted and the pellet was used for further examination. Preservation of Diatoms: The cleaned diatoms were preserved in 4% formalin added with glycerine. Mounting: The sediments were taken on slides and examined under compound microscope (Olympus CX41; Model: CX41RF) (magnification up to 100X)
RESULTS
Table 1 represents the list of diatoms isolated and characterised from different water bodies of Mumbai. Description of various species found during study period is as follows: (Figures 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10). Gyrosigma acuminatum(Kuetz.) Rabh. Frustules solitary; valves 99-106.5μ long, 11.9-12.8μ broad, sigmoid, lanceolate in outline, gradually tapering from the middle towards the ends; ends broadly rounded; raphe sigmoid and central; axial area narrow; central area small and elliptical; striae 18 in 10μ, transverse and longitudinal striae at equal distances from one another. (Figure 1a) Navicula confervacea Kuetz.f.nipponica Skv. Frustules broadly rectangular in girdle view, united together to form filaments; valves 10-15μ long, 5-6.5μ broad, elliptic, with obtusely rounded ends; axial and central areas broad, lanceolate; striae 22-24 in 10μ, marginal and radial. (Figure 1b) Melosira granulata( Ehr .)Ralfs Frustules 5.5-8.3μ in diameter, short, cylindrical, united in short or long chains; semi-cells 7-25.6μ high; end cells with spines, furrows and straight rows of areoles; row of areoles 10-14 in 10μ, spirally disposed. (Figure 1c) Pinnularia borealis Ehr. Valves 30.2-42μ long, 7.5-9.2μ broad, linear, elliptical with broadly rounded ends; axial area somewhat widened in the middle; raphe thread like with strongly hooked terminal fissures; striae 5-6 in 10μ, coarse, slightly radial in the middle. (Figure 1d) Pinnularia divergens W.Smith. Valves 75-85μ long, 14-15μ broad, linear lanceolate with constricted, broadly produced rounded ends; raphe thin and somewhat undulate with central pores unilaterally bent and terminal fissures thick, bayonet shaped; axial area linear; central area large, rhomboid, reaching the margins with conical projections formed into the sides; striae 9-10 in 10μ, thick, strongly radial in the middle and convergent at the ends. (Figure 1e)
Surirella tenera Greg.v.ambigua Gandhi Valves 88-102.3μ long,22-26.2μ broad, robust, hetero-polar, linear ovate with rounded apex and cuneate rounded base; axial field narrowly lanceolate with a median line; marginal folds strongly developed with distinct projections; costae 18- 22 in 100μ, strong, radial at the ends; striae indistinct.(Figure 2a and 9c) Hantzschia elongate (Hantz.) Grun. Valves 10-239μ long,10.5-11.5μ broad, slender, linear with parallel sides, sometimes bent in the middle; ends constricted, narrowed and produced, slightly backwardly bent and sub-capitate; keel excentric, keel punctae 8-9 in 10μ,fine, and indistinctly punctate.(Figure 2b) Eunotia sudetica O.Muell. Valves 54-56.8μ long,5.5-7.2μ broad, linear, slightly arcuate; dorsal margin convex, ventral margin straight or slightly concave; ends slightly detached; end nodules centrally retracted, inner nodules well visible; striae 12-14 in 10μ,feebly radiating towards the ends.(figure 2c). Fragilaria construens (Ehr.)Grun.v.venter Grun.f.Pusilla Grun. Frustules linear, attached together to form short chains; valves 12-15μ long, 2.8-3μ broad, linear lanceolate, gradually tapering towards the ends; ends somewhat broadly rounded; pseudoraphe narrow, linear; central area not formed; striae 14-16 in 10μ,strong.(figure 2d,4b and 10c).
Nitzschia maharashtrensis sp.nov. Valves 45.5-63μ long,3.5-5.2μ broad, linear to linear lanceolate, tapering towards the ends, with prolonged, very slightly capitates ends; keel excentric, keel punctae 28-30 in 10μ,very small; striae not clearly visible.(Figure 3a) Nitzschia subtilis Grun.v. paleacea Grun. Valves 26-35μ long, 2.2-2.7μ broad, narrowly lanceolate with acute ends; keel punctae 16-18 in 10μ, small; striae more than 30 in 10μ, indistinct.(Figure 3b). Nitzschia paradoxa(Gmelin)Grun. Frustules linear, rectangular, united in bundles in girdle view; valves 91-121.5μ long,4.5-5.5μ broad, linear, spindle shaped; keel central, keel puntae 6- in 10μ,forming a row in the middle portion of the valve; striae about 30 in 10μ,very fine.(figure 3c). Fragilaria zafarii sp.nov. Frustules in short chains, rectangular in girdle view; valves 52.2μ long,7.5-10.5μ broad, linear lanceolate or rhomboid with gradually tapering somewhat acutely rounded ends; pseudo-raphe narrow; central area slightly bilateral with an elliptic margin enclosing two mucilage pores; striae 9-10 in 10μ,coarse.(figure 3d and 4d). Gomphonema constrictum Ehr.v.capitata (Ehr.)Cleve. Valves 55-63μ long,12-13.3μ broad, broadly clavate with feebly constricted, broadly rounded subtruncate apex and attenuated rounded base;raphe thick and straight; axial area narrow, linear; central area somewhat rhomboid, slightly unilateral with a stigma on the opposite side; striae 10-12 in 10μ,coarse and radial, alternately long and short in the middle.(figure 3e). Cymbella gracilis(Rabh.)Cleve. Valves 137-148μ long, 22-23μ broad, linear with broadly rounded ends; raphe thick, strongly complex and folded with central pores prominent and terminal fissures thick and obliquely comma shaped; axial area about ¼ the breadth of the valves, linear; central area slightly dilated; striae 5-6 in 10μ, thick, radial in the middle and convergent at the ends with fairly broad longitudinal bands.(figure 4a and 7c and 9b). Fragilaria brevistriata Grun.v.vidarbhensis v.nov. Frustules linear, loosely attached together to form short chains in girdle view; valves 19.7-23μ long,3.5-4.8μ broad, linear lanceolate, strongly tumid in the middle and slightly inflated towards the end with somewhat acutely rounded ends; pseudoraphe broad in the middle, linear lanceolate; striae 11-13 in 10μ,thick.(figure 4c). Gomphonema subtile Eher. Valves 32-45μ long, 5-6μ broad, narrowly lanceolate clavate, delicate, with slightly capitate, broadly rounded apex and gradually attenuated, produced rounded base; raphe thin and straight; axial area narrow; central area unilateral with an isolated stigma on the opposite side; atriae 12-14 in 10μ,distinctly punctuate.(figure 5a). Cyclotella striata(Kuetz.)Grun. Valves with strong wavy margins in the girdle view and more or less broad evenly striated border; valves discoid,14.5-25μ in diameter; central field with flexes and coarsely punctate; striae 7-9 in 10μ.(figure 5b and 7b). Neidium productum (W.Smith)Cleve v.bombayensis Gonzalves et Gandhi. Valves 85-103μ long,18-27μ broad, linear elliptical with slightly undulate margins and abruptly constricted produced, broadly rounded ends; raphe thin and straight with central pores bent in opposite directions and terminal fissures bifurcated; axial area wide; central area large and transversely elliptical; striae 20-22 in 10μ,radial,finely punctuate, crossed by longitudinal furrows near the margins.(figure 5c). Caloneis silicula( Ehr.)Cleve Valves 52-55μ long,8-9.9μ broad, linear, slightly swollen broadly rounded ends; raphe thin with distinct central pores and hooked terminal fissures; axial area narrow; central area large and elliptic, sometimes reaching the margins; striae 22- 24 in 10μ,fine,parallel but becoming radial and longer towards the ends, crossed by a fine longitudinal line near the margin.(figure 6a).
Surirella capronii Breb. Valves 13-183μ long,55-3μ broad, hetero-polar, ovate with broadly rounded, somewhat narrowed apex and acutely rounded base; middle line present, discontinuous, with strong spines developed on elevated cushions; axial area narrowly lanceolate; marginal folds strongly developed, with clear projections, flap windows quite evident;costae;9-13 in 100μ,thick,radial at the ends; striae fairly visible.(figure 6b and 7e). Surirella robusta Ehr.f.minor Gandhi. Valves 62-69.5μ long,30-35μ broad, hetero-polar, ovate with broad rounded ends; middle line absent; axial field linear lanceolate; marginal folds strongly developed; costae at unequal distances; striae indistinctly radiate.(figure 6c). Synedra ulna(Nitz.) Ehr.v.biceps Kuetz. Valves 298-455.2μ long, 5.9-7.1μ broad, linear, slightly bent, with swollen broadly subcapitate ends; pseudo-raphe narrow; striae 7-8 in 10μ,very coarse.(figure 6d). Melosira granulata( Ehr .)Ralfs.v.mazzanensis Meister. Frustules 12.2-15μ in diameter, short, cylindrical, flat, united in chains; semi-cells 8.5-11μ high; end cells with spines and furrows; rows of areoles 8-9 in 10μ .(figure 6e). Cyclotella antique W.Smith Valves 11-14.5μ in diameter, discold central field finely punctate and with 4-5 triangular depressions forming a ring; striae 18-20 in 10μ,punctate.(figure 7a). Melosira juergensii Agardh. Frustules 9.5-12μ in diameter, cylindrical, united in chains; outer mantal line straight, inner slightly wavy; neck absent; semi-cellls 13.5-15μ high; cell wall finely punctuate; rows of punctae 30 in 10μ,very faint.(figure 7d). Gomphonema acuminatum Ehr. v. turris Ehr. Valves 5-65μ long,12-14μ broad, clavate with gradually tapering lower half and biconstricted upper half with subcapitate apex and obtuse to subacute base; raphe somewhat thick; axial area narrow; central area small, unilateral with an isolated stigma on the opposite side; striae 10-12 in 10μ,slighty radial and distinctly punctate.(figure 8a). Gomphonema intricatum Kuetz.v.fossile Pant. Valves 95-115μ long,9.5-11.5μ broad, narrowly lanceolate, slightly inflated in the middle, with septate broadly rounded apex and gradually tapering rounded base; raphe somewhat thickened with distinct terminal fissures and unilateral central nodules; axial area broad; central area moderate with an isolated stigma on the opposite side and with two coarse punctae on one side of the central nodules; striae 8-9 in 10μ in the middle and 9-10 in 10μ towards the ends, radial, slightly curved and coarsely punctate.(figure 8b). Surirella capronioides Gandhi. Valves 80-130.6μ long,42-49 broad, hetero-polar, ovate with cuneate base; axial field narrowly lanceolate with a middle line interrupted throughout and with spines at both ends; flap marginal with clear flap projections; costae 24-26 in 100μ,strong,radial at the ends; striae fine and indistinct.(figure 8c). Surirella subsalsa W. Smith Valves 25-34.5μ long, 9.8-13μ broad, hetero-polar, ovate or ovate lanceolate with cuneate rounded base; axial field with projections; costae 32-40 in 100μ distinct (figure 8d). Epithemia zebra (Ehr.)Kuetz Frustules rectangular in girdle view; valves 16-113μ long, 8.5-10.5μ broad, arcuate with dorsal side convex and ventral side concave; ends very slightly or not constricted, narrow to obtusely rounded; raphe in the raphe canal, reaching 1/3-1/2 the breadth of the valve; costae 3-4 in 10μ, strong and radial, alternating with 3-5 rows of alveoli, rows of alveoli 12-13 in 10μ.(figure 9a). Frustulia jogensis Gandhi. Valves 56-59.6μ long,13-13.4μ broad, linear lanceolate with constricted, produced beak like rounded ends; raphe thin, delicate and straight, enclosed between the siliceous ribs; axial area very narrow, linear; central area small; striae about 32 in 10μ,perpendicular to the middle line, finely punctate, punctae arranged in straight longitudinal rows.(figure 9d). Navicula viriduloides Gandhi v.lanceolata Gandhi Valves 28-39.5μ long,.8-9μ broad, lanceolate with rostrate rounded ends; raphe thin, in between siliceous ribs with central pores unilaterally bent and terminal fissures curved; axial area narrow; central area suborbicular; striae 13-15 in 10μ,radial and curved in the middle and convergent at the ends.(figure 10a).
Surirella biseriata Breb.v.diminuta A.Cl Valves 1.5-25μ long,7.8-9.5μ broad, isopolar, linear lanceolate or elliptic lanceolate with acutely rounded ends; axial area linear to linear lanceolate; middle line indistinct; flap margin distinct; costae 30-35 in 100μ,quite evident and radial.(figure 10b).
Nitzschia kuetzingiana Hilse
Valves 26.2-32μ long,5.5-6μ broad, lanceolate with strongly produced constricted, small capitates ends; keel punctae 14- 16 in 10μ,small striae more than 30 in 10μ,fine and almost indistinct.(figure 10d).
DISCUSSION
In the present study, 35 diatom species under 17 genera were identified from 10 waterbodies of Mumbai, Maharashtra, India. The selected water bodies are as follows: Bandra(Swami Vivekanadare Talav), Valkeshwar (Balganga), Borivali (Meethi Nadi), Chembur(Ganesh Talav), Kalyan(Durgadi, Kala Talav, Umberdenadi), Thane (Brahmala Lake, Talav Pali) and Navi Mumbai(Palm Beach). The diatoms species identified belong to the following genera: Gyrosigma, Navicula, Melosira, Pinnularia, Surirella, Hantzschia, Eunotia, Fragilaria, Nitzschia, Gomphonema, Cymbella, Cyclotella, Neidium, Caloneis, Synedra, Epithemia, Frustulia. The 35 species described are as follows: G.acuminatum, N. Confervacea, M. granulata, P. Borealis, P. divergens, S. tenera, H. elongata, E. sudetica, F. construens, N. maharashtrensis, N. subtilis, N. paradox, F. zafarii, G. constrictum, C. gracilis, F. brevistriata, G. subtile, C. striata, N. productum, C. silicula, S. capronii, S. robusta, S. ulna, C. antique, M. juergensii, G. intricatum, S. capronioides, S. subsalsa, E. zebra, C. gracilis, S. tenera, F. jogensis, N. viriduloides, S. biseriata, N. kuetzingiana
CONCLUSION
The information obtained can be an aid in creating a reference database on diatoms for utilization in ecological assessment and identifying the location in the drowning cases.
ACKNOWLEDGEMENT
We would like to thank the Director, Institute of Forensic Science, Mumbai for the laboratory and library facilities. We 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.
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14. Www2.mcdaniel.edu, (2016). Diatoms. [online] Available at: http://www2.mcdaniel.edu/Biology/botsyl01/microalg/diatomsf/diatoms.html
15. Ucl.ac.uk, (2016). Diatoms. [online] Available at: http://www. ucl.ac.uk/GeolSci/micropal/diatom.html
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareLEPTOSPIROSIS - AN ENIGMATIC ZOONOSIS
English2228Mythri B.A.EnglishLeptospirosis is a zoonosis which has a global distribution. The disease is still an enigma 130 years post discovery. Leptospirosis is mainly a disease of the animals like the rodents and various other animals, wherein man is an accidental host. Leptospira is a spirochete, which to be visualised in a dark field microscope or in a light microscope after special staining techniques. It is a slow growing organism and requires special media like the Fletcher`s medium. Leptospirosis results when the person comes in contact with the organism either as an occupational hazard or during avocational exposure or during floods. The pathogenesis of leptospirosis is incompletely understood. Despite years of speculation, the route and mode of entry of leptospires in natural infections is not clear. The site of entry into host is through mucosal surfaces. Important portals of entry are fresh or partially healed abrasions of the skin and intact mucosa of the buccal cavity, nasal passages or conjunctiva. The disease can be seen in two forms, the mild anicteric form and the severe icteric form also known as Weil`s disease. The diagnosed leptospirosis cases are just the tip of the iceberg; many go undiagnosed due to the protean manifestations of the disease. The drug of choice for treatment is Penicillin. Vaccines are available for animals. An approved vaccine for humans is still awaited.
EnglishPotentially fatal, Leptospirosis, Anicteric leptospirosis, Leptospira icterohaemorrhagiaeINTRODUCTION
Leptospirosis is recognized as the most common zoonotic infection in the world.1 It is caused by infection with pathogenic Leptospira species.2 Leptospirosis is a fairly common disease in humid and warm climates.3 A wide spectrum of human disease is caused by leptospires, ranging from an asymptomatic subclinical infection to a life threatening multiorgan infection.2 In man anicteric leptospirosis is an acute febrile disease with few complications.4 The severe, potentially fatal, icteric leptospirosis also known as Weil`s syndrome is typically characterized by renal, hepatic and vascular complications.5 Leptospirosis is often under diagnosed because of its protean clinical manifestations leading to significant morbidity and mortality.6 The diagnosis of leptospirosis can be established by demonstration of organism and detection of antibodies.7
HISTORY
Over 100 years ago Adolf Weil in Heidelberg first reported the syndrome of icteric leptospirosis with renal failure.2 In the year 1883 leptospirosis was noted to be an occupational disease of the sewer workers .8 The term Weil’s disease was used first by Goldschmidt in 1887.9 In 1907, Stimson stained tissues from a patient using the Levaditi technique for staining spirochetes in tissue sections, the kidneys contained spiral organisms with hooked ends which he called “Spirocheta interrogans”.10 Leptospira icterohaemorrhagiae was first demonstrated as the cause of Weil’s disease in Japan in 1914.11 During 1914-15 in Japan Weil’s disease was common among coal miners. 10 Inada and colleagues succeeded in transmitting the infection to guineapigs, from the blood of which they were able to grow an organism, a spirochete which they called “Spirocheta icterohaemorrhagiae”. 10 In the year 1916 the causative agent was identified by Inada et al in Japan. 8 The organism was recovered for the first time by Noguchi in the year 1917 from a Norway rat. 12 The name ‘Leptospira’ was proposed by Noguchi in 1918. 13 In the year 1929 Taylor and Goyal reported the first case of leptospirosis in India from Andaman and Nicobar islands.14 The two forms of leptospirosis -anicteric and icteric were recognized by Feigin and Anderson in 1975. 4
MORPHOLOGY
Leptospires are tightly coiled spirochetes, usually 6-20um X 0.1um by length X breadth, the cells have pointed ends bent into a distinctive hook. 2 The organisms are characterized by a flexible thread like structure consisting of a large number of fine, regular spiral coils.7 Due to their narrow diameter, dark-field illumination or phase contrast microscopy is ideal to visualize the leptospires.13 Leptospires can also be visualized by electron microscopy.15 There is an outer envelope, surrounding a cell wall or peptidoglycan complex, wound in a helical shape.10 Based on the morphology the free living (Leptospira biflexa) and parasitic leptospires (Leptospira interrogans) cannot be distinguished. 13
RESISTANCE
Leptospires do not survive drying, as in dehydrated cultures, tissues or contaminated water or urine, or in the environment, consistent with their essentially aquatic nature. 10 They are relatively easily preserved by lyophilisation of cultures. 10 Leptospires survive in water and culture media for long periods. 10 Leptospires are able to survive in alkaline soils, mud, swamps, streams and rivers, organs and tissues of live or dead animals. 10 All leptospires are sensitive to acid, at pH of 6.8 or lower, but they survive alkaline conditions of up to pH 7.8-7.9. 10
CULTURAL CHARACTERISTICS
Leptospires require an optimum temperature of 28° C to 30° C .2 Cultures are incubated at 28° C to 30° C in the dark for 6 weeks or longer.12 Leptospira are slow growing organisms having a generation time of approximately 24 hrs at 30° C.16 Optimum growth occurs in the pH range 7.2-7.6. 10 Under aerobic conditions growth can occur from very small numbers, in adequate media and under optimum conditions. 10 Growth is best checked by observing under dark field microscopy. 10 Leptospires grow well in tubes of semi-solid media containing 0.1-0.3% agar, following inoculation of one or more drops onto the surface or stab inoculation into the depths. 10 Growth appears after a variable period as a disc, known as Dinger`s disc, which is about 0.2-0.5 mm thick. 10 Leptospires are fastidious in their nutritional requirement and need addition of an animal protein in the form of fresh rabbit serum or bovine serum albumin fraction V for their growth.1 Vitamins B1 and B 12, and long chain fatty acids are the only organic compounds required for their growth. 13 A wide variety of media have been described: Liquid media Media containing serum- Traditional media containing approximately eight to ten % rabbit serum e.g. Stuart`s, Korthof`s and Fletchers media. 17 Media without serum a) Media containing protein: a serum-free oleic-acid albumin medium, and derivatives containing tweens as the sources of fatty acids, with bovine serum albumin (BSA) as a detoxifier, such as the widely used, commercially available Ellinghausen-McCullough-Johnson-Harris medium (EMJH). 10 Low-protein media containing 0.1% or 0.01% BSA are sometimes used as a compromise to cultivate strains which cannot be adapted to protein-free media or for maintenance of strains in protein-free medium. 10 b) Media without protein: are those in which conditions are balanced and ingredients selected or purified so as to avoid toxicity. 10 Their main application is in use for vaccines where BSA is unacceptable because of the risks of hypersensitivity or auto-immune reactions in vaccinated animals or people. 10
Solid media
Any liquid medium can be solidified by the addition of agar. 10 The usual concentrations for semi-solid media are 0.1- 0.2% agar. 10 Special selective media have been developed for the primary isolation of leptospires from animal tissues and organs, based on the premise that some leptospires could be more easily cultivated on primary inoculation if the media were more suited to their fastidious nutritional and growth requirements and the risk of contamination avoided on prolonged incubation. 10 These include 5-fluorouracil; a combination of nalidixic acid, vancomycin, and polymyxinB-sulfate; or rifampicin. 10
Pathogenesis
The pathogenesis of leptospirosis is incompletely understood. 18 Despite years of speculation, the route and mode of entry of leptospires in natural infections is not clear. 10 The site of entry into host is through mucosal surfaces. 19 The main modes of entry are fresh or recent abrasions of the skin and even intact mucosa of the buccal cavity, conjunctiva or nasal passages. 19 They may also enter directly into the bloodstream or lymphatics via the conjunctiva; the genital tract in some animals; the nasopharyngeal mucosa, possibly through the cribriform plate; the lungs following inhalation of aerosols; or through invasion of the placenta from mother to fetus at any stage of pregnancy in mammals.10 The organisms enter the blood stream where they multiply and this process is accompanied by the development of transient fever. 18 At the same time the bacteria also start acting upon other organs and further symptoms depend on the organ which is affected.18 Leptospires take just a few days to establish in organs like liver, spleen, kidney and the pathological changes are initiated there. 19 By the time the immune system gets activated, leptospires get established in the parenchyma of the liver and spleen and in tubular region of the kidneys where they may persist. 19
Potential virulence factors include attachment, toxin production, immune mechanisms and surface proteins Leptospiral lipopolysaccharide exhibits weak endotoxic activity but a number of serovars produce haemolysins, which may act as sphingomyelinases, phospholipases or pore forming proteins.20 The primary lesion in leptospirosis is disruption of the integrity of the cell membrane of the endothelial cells lining small blood vessels in all parts of the body resulting in capillary leakage and haemorrhages. 13 Widespread petechial haemorrhages are apparent in all organs and tissues, particularly the lungs, omentum and pericardium. 13 Ischaemia from damage to blood vessels in the renal cortex leads to renal tubular necrosis. 13 The resulting anatomical damage causes renal failure that can be fatal. Ischaemia results in liver cell necrosis, which leads to the characteristic icterus of severe leptospirosis. 13 Following formation of antibodies, the leptospires are removed from all sites other than the proximal renal tubules, brain and the eye where they can persist for a period ranging from few weeks to months. 18 Leptospires enter the cerebrospinal fluid (CSF) in the early septicaemia phase of the illness. 13 The anterior chamber of the eye is invaded by leptospires during acute infection. 13 The leptospires can persist in specific immunologically privileged sites, even after antibodies and phagocytes have cleaved the leptospires have been cleaved from all other sites. 13 The most significant site of persistence is the renal tubule. 13 Leptospires are excreted by animals regularly or intermittently for months to years, sometimes even throughout their lifespan. 13 However, humans do not remain carriers for long, and the urine is free of leptospires at the time of clinical recovery. 13 Diagnostically significant bacteraemic phase lasts for about 1-7 days. 10 Once immunity develops, leptospires are removed from the circulation and from tissues and organs by phagocytosis, following opsonisation. 10 Clinical features The spectrum of human disease caused by leptospires is extremely wide, ranging from subclinical infection to a severe syndrome of multiorgan infection with high mortality . 2 As a result of its protean clinical manifestations and non specific presentations, leptospirosis has been under diagnosed and frequently misdiagnosed as other diseases such as influenza, viral hepatitis, encephalitis, pneumonitis and acute renal failure.21 Weil`s disease is only one of the many manifestations of leptospiral infection in man.4 In most cases leptospirosis presents as a mild flu like illness. 22 Leptospirosis occurs as two clinically recognizable syndromes. 13 Anicteric leptospirosis is the most common syndrome, a self-limited illness seen in almost 90% of the total cases. 13 Icteric leptospirosis or Weil’s syndrome is a more serious, potentially fatal syndrome and occurs in 5% to 10% of the cases. 13 Even though subclinical infection is not common, serological testing has shown that it could occur in people following occupationally exposure to leptospires.13 After the incubation period, an acute leptospiraemic phase is followed by an immune phase. 18 The distinction between the first and second phase is not always clear and milder cases do not always include the second phase. 18
Anicteric leptospirosis
The incubation period for leptospirosis is usually 7 to 12 days, but it can range from 2 to 20 days. 13 The onset of anicteric leptospirosis is abrupt and is characterized by fever, headache, severe myalgia, chills with rigors, prostration and sometimes, circulatory collapse. 13 The septicemic (or first) phase lasts 3 to 7 days. 13 Fever is high and remitting. Headache is intense, unremitting and possibly throbbing. 13 Anorexia, nausea, vomiting and abdominal pain occur in most patients. 13 The most common physical finding is conjunctival suffusion in the absence of purulent discharge. 13 Other signs include maculopapular skin rash, pharyngeal injection, lymphadenopathy, splenomegaly, hepatomegaly, and muscle tenderness.13 Cervical, axillary and mediastinal lymph nodes may be enlarged.8 The symptoms are prominent for 4 to 7 days during the septicemic stage. 13 Leptospires can be isolated from the blood and the CSF during this phase. 13 The immune stage of anicteric leptospirosis is preceded by a one to three-day asymptomatic period. 13 The onset of the immune stage coincides with the appearance of IgM antibodies. 13 The duration of the immune stage ranges from 4 to 30 days, and the leptospires are cleared from the blood and the CSF after this stage. 13 Leptospiruria develops and persists for 1 to 3 weeks. 13 Aseptic meningitis is the hallmark of the immune stage.13 Leptospiral meningitis accounts for 5 - 40% of all cases of aseptic meningitis. 23 Uveitis, iritis, iridocyclitis and chorioretinitis may also appear during the immune stage. 13
Icteric leptospirosis
Icteric leptospirosis or Weil’s syndrome is a form of disease characterized by symptoms of hepatic, renal and vascular dysfunction. 13 Jaundice remains the hallmark of Weil syndrome, the intensity of jaundice varies. 12 Jaundice may appear as early as the third day of illness or may not appear until the second week.12 The clinical manifestations vary in terms of severity and symptomatology. 13 Supportive therapy has reduced the mortality to between 5% and 10%. 13 During the leptospiraemic phase of icteric leptospirosis, the symptoms do not suggest leptospirosis until the third to seventh day of illness, when jaundice and azotaemia develops. 13 The biphasic course of the disease is obscured by severe and persistent fever, jaundice and azotaemia. 13 Jaundice appears, but there is no evidence of hepatocellular destruction. 13 Hepatic dysfunction occurs, but it resolves and it is rarely the cause of death. 13 Azotaemia, oliguria and anuria commonly occur during the second week of illness. 13 Epidemics of leptospirosis in Korea, Brazil and Nicaragua were characterised by massive pulmonary haemorrhages, including fatal sudden haemoptysis. 10 Haemorrhages of varying severity frequently occur in any organ or tissue. 10 They may bleed into the lumina of the respiratory, gastrointestinal, renal and genital tracts, subarachnoid space and adrenals, causing appropriate symptoms and occasional fatal results. 10 Thrombocytopenia occurs in severe cases with renal failure. 10 Complications Serous meningitis is the most common form of neurological complication, in the second phase. 10 Occasionally encephalitis may occur, in which the patients may lose memory and hallucinate, be delirious, confused, disorientated, or semicomatose, or develop extra pyramidal symptoms. 10 Renal failure is an important cause of death in patients with leptospirosis.12 Cardiac dysfunction may also lead to hypo perfusion in severe leptospirosis.12 Focal haemorrhagic myocarditis, pericarditis and cardiac arrhythmias have also been well documented. 12 Acute hemorrhagic lobar pneumonia and massive haemoptysis have been observed in fatal cases. 12 Myocarditis is a cause of death in those whom renal failure can be managed successfully. 10 Inflammation of the uveal tract, presenting as iritis, iridocyclitis or occasionally chorioretinitis are important but less frequent complications. 10 Acute infection in pregnancy has been reported to cause abortion and foetal death.2 Rare complications include cerebrovascular accidents, rhabdomyolysis, thrombotic thrombocytopenic purpura, acute acalculous cholecystitis, erythema nodosum, aortic stenosis, Kawasaki syndrome, reactive arthritis, epididymitis, nerve palsy, male hypogonadism and Guillain Barre syndrome.2 Epidemiology Leptospirosis is recognized as the most common zoonotic infection in the world.1 Leptospirosis has been known as Weil`s disease, mud fever, trench fever, rice field fever, cane cutters fever, swamp fever, flood fever, autumnal fever, seven days fever of Japan, Swine herds disease ,pea picker’s fever, spirochaetal jaundice, canicola fever etc. etc.19 The source of infection in humans is usually either direct or indirect contact with the urine of an infected animal. 2 The incidence is significantly higher in warm climate countries than in temperate regions, this is due mainly to longer survival of leptospires in the environment in warm, humid conditions. 2 The disease is seasonal with peak incidence occurring in summer or fall in temperate regions, where temperature is the limiting factor in survival of leptospires and during rainy seasons in warm climate regions, where rapid desiccation would otherwise prevent survival .2 The core determinants of transmission of Leptospiral infection are the presence of carrier animals, suitability of the environment for the survival of leptospires and interaction between man, animals and environment.24 South east Asia is an endemic area for leptospirosis and infection in humans has been reported throughout the region.25 The spirochete requires a warm, moist, climate of 250 C and water and soil PH level of 7.0-8.0 for optimal survival outside the host.26
Human infections may be acquired through occupational, recreational or avocational exposures. 2 Direct contact with infected animals accounts for most infections in farmers, veterinarians, abattoir workers, meat inspectors, rodent control workers and other occupations which require contact with animals. 2 Indirect contact is important for sewer workers, miners, soldiers, septic tank cleaners, fish farmers, game keepers, canal workers, rice field workers, taro farmers, banana farmers, and sugar cane cutters. 2 The major occupational risk today is among farm workers.27 There is a significant risk associated with recreational exposures occurring in water sports including swimming, canoeing, white water rafting, fresh water fishing and other sports. 2 Animals including humans can be divided into maintenance hosts and accidental hosts. 2 Maintenance population is defined as “a population of a species of animal which acts as a continuous reservoir of a serotype in a particular ecosystem”. 28 Accidental hosts are characterized by low susceptibility to infection, if the infection is established the pathogenic effect may be severe, with a short renal phase and inefficient intraspecies transmission. 28 A human case of Weil`s disease demonstrates most of the features of an accidental host. 28.
The disease is maintained in nature by chronic infection of the renal tubules of maintenance hosts. 2 Other animals (such as humans) may become infected by indirect contact with the maintenance host.2 Humans are dead end hosts and do not provide an infection reservoir.29 The natural reservoir for pathogenic leptospires is wild animals ,particularly the rodent family.27Rodents are prolific shedders of leptospires voiding them in urine continuously.1 The most important sources for infection of humans are the various forms of rodents with which humans live in all parts of the world in domestic, agricultural or occupational association, and the domesticated large animals used for work or for food. 10 Rodents closely associated with human habitation, such as the black and brown rats (Rattus rattus and Rattus norvegicus) and the common domestic mouse (Musmusculus) can act as sources of leptospirosis for humans, dogs and farm animals. 10 Pets and laboratory animals are also potential carriers and excretors. 10 Severe leptospirosis seems to be the tip of the iceberg of leptospiral infection. 30 The incidence of leptospirosis is remarkably under estimated in estimates from endemic regions. 8 According to the recently available reports, incidence ranges from approximately 0.1-1 per 100,000 per year in temperate climates to 10-100 per 100,000 per year in humid tropic climates.15 Leptospirosis is estimated to affect tens of millions of humans annually with case fatality rates ranging from 5 to 25%. 8 Leptospirosis is under reported due to lack of clinical suspicion and barriers to diagnostic capacity.8 Occupational exposure probably accounts for 30-50% of human cases.8 Men suffer more frequently from leptospirosis than women because of greater occupational exposure to infected animals and contaminated environment. 19 Leptospiral infections occur more frequently in persons 20-30 years of age. 19 The rural epidemiologic pattern, which occurs often in agrarian communities in the developing world, is usually associated with cultivation cycles which in turn depend on meteorological phenomena such as monsoons. 24 The urban epidemiological form is often seen in overcrowded cities and towns of developing countries where the environmental sanitation and the personal hygiene of the people are poor. 24 Two other epidemiological forms are the recreational leptospirosis and leptospirosis associated with natural disasters.24 The disease typically occurs as an epidemic lasting a few weeks during the monsoon season. 31 Extensive flooding and seasonal rainfall are significant risk factors for exposure to water contaminated with leptospires. 26 Certain serovars of Leptospira are of greater epidemiological significance. 19 These include L.pomona, L.grippotyphosa, L.hebdomadis, L.canicola, L.icterohaemorrhagiae etc. 19 The majority of infections in humans and farm animals are caused by these serovars. 19 Leptospirosis in animals Leptospirosis is widespread in domestic animals. 4 Bovine leptospirosis is common throughout the world. 4 Infections are often inapparent. 4 Leptospires isolated from cattle include those belonging to serogroups Australis, Autumnalis, Ballum, Bataviae, Canicola, Grippotyphosa,Hebdomadis,Ja vanica,Sejroe,Mini,Icterohaemorrhagiae,Pomona,Tarassovi, Panama and Pyrogenes. 4 Hardjo is the commonest serotype in cattle throughout the world.4 Rats are generally maintenance hosts for serovars of the serogroups Icterohaemorrhagiae and Ballum, dairy cattle may harbour serovars hardjo, pomona and grippotyphosa, pigs may harbour pomona, tarrasovi or bratislava, sheep may harbor hardjo and pomona and dogs may harbor canicola. 2 Dogs are a significant reservoir for human infection in many tropical countries and may be an important source of outbreaks. 2 Treatment There is still some dispute about the value of antimicrobial therapy for leptospirosis. 32 It is generally believed that antimicrobial agents are effective only if given as early as possible.32 Antimicrobial treatment benefits leptospirosis patients, whether children or adults, decreasing the duration of the illness, reducing the accompanying thrombocytopenia and limiting the severity of the renal failure.33 In the mild forms of leptospirosis management is symptomatic, as indicated by the nature and severity of the manifestations.10
Treatment should be initiated as early as possible. 18 The severe form of leptospirosis requires intensive-care support and urgent symptomatic treatment. 10 In severe cases of renal failure, intensive renal management, including peritoneal dialysis, may be necessary. 10 Dialysis support should continue until natural renal function recovers, which it usually will unless the patient succumbs to other lesions.10 Those with Weil ‘s syndrome may need transfusions of whole blood and\ or platelets. 18 Penicillin G Sodium is the generally recommended treatment for leptospirosis.34 For severe cases of leptospirosis, intravenous administration of Penicillin G, Amoxicillin, Ampicillin or Erythromycin is recommended.18
Prevention and Control
Prevention of leptospirosis in all situations is not possible, because it is widespread in so many animals and places all over the world. 13 The best that can be done is to limit the effects of leptospirosis on humans and the animals they depend on. 13 This involves identification of sources, containing them and eliminating them or their effects. 13 The best way to avoid leptospirosis is to keep away from animals and areas that may be contaminated by their urine. 13 People whose occupation, travel or hobbies involve risks should know of the disease and how to avoid it.13 Occupational hygiene is relevant for prevention of human leptospirosis, wherever the disease is known to occur predominantly in certain occupational groups.10 People should be aware of the dangers and be dissuaded from swimming in rivers or pools suspected to be contaminated. 13 Rat control in and around food storage and preparation areas, crop storage areas, stables, milking sheds, intensive animal production installations and dwellings is difficult but will remove a major source of leptospirosis for humans and domesticated animals. 13 All the people involved in high-risk activities should wear protective clothing and need to adopt a reasonable standard of hygiene. 13 Long term control strategies of the disease include adoption of hygienic measures, rodent control and vaccinations.35
Vaccines for animals
They are made by combining suspensions of different serovars, chosen according to local needs.10 Dogs are immunized to protect them and human companions. 13 Effective vaccines containing suspensions of killed L.borgpetersenii serovar hardjo and L. interrogans serovar pomona are widely available commercially. 13 The use of locally prevalent strains is recommended.13
Vaccines for humans
Vaccination of humans is justified where they cannot be separated from the animal sources of leptospirosis, or where the animals cannot be immunized successfully. 10 Examples are where people live and work in proximity to rodents in wet, tropical conditions, in wet rice planting and harvesting, in military operations, or working in sewers.10 Vaccines composed of killed cultures of leptospires protect people against leptospirosis. 13 These vaccines may cause side effects, ranging from local soreness to fever and incapacity for a few days. 13 Two doses are given subcutaneously, 3 to 4 weeks apart, followed by annual boosters. 13 Multivalent combinations effective against several serovars are compounded, as required by local needs. 13 They are made available to selected high-risk groups, wherever the side effects are preferable to severe leptospirosis.13 In France, a monovalent vaccine, containing only serovar icterohaemorrhagiae is licensed for human use. 2 A vaccine containing serovars Canicola, icterohaemorrhagiae and Pomona has been developed recently in Cuba.2 Vaccines for use in humans were used in Vietnam, China and Japan. 10 The Chinese and Japanese vaccines are not available or licensed for use outside those countries at present. 10 The vaccines are given annually in two doses, and boosters are required annually. 10 In addition to their use to protect occupationally or environmentally exposed people, they are used to immunize large numbers of people exposed to natural emergencies, especially floods, and laboratory workers prophylactically or after exposure to risk in laboratory accidents.10 The use of a DNA construct encoding leptospiral proteins is a promising new approach for vaccination against leptospirosis. 35 Constraints in leptospirosis vaccine development and use- since the vaccines largely confer serovar specific immunity, continuous epidemiological monitoring of the prevalence of Leptospira serovars in a zone or region is desired to select the correct serovars for incorporating into the vaccine.35
DISCUSSION
Leptospirosis is an acute febrile disease. It is recognized as being emerging and re-emerging infection. The disease ranges from an inapparent infection to a fatal fulminant disease. The actual number of leptospirosis cases could be several folds the number of patients clinically diagnosed as having leptospirosis as it is under reported due to lack of clinical suspicion and barriers to diagnostic capacity. Early suspicion and confirmation is crucial to reduce the morbidity and the case fatality rate. Vaccines are available only for animals. No approved vaccine is available for humans.
CONCLUSION
Leptospirosis is frequently underdiagnosed because of the nonspecific symptoms in the initial stage of the disease. Early diagnosis is essential as untreated the illness can progress rapidly and mortality rates are high in severe cases. Hence leptospirosis should be suspected in all fever cases, especially in the males of the occupationally active group with history of animal contact.
Source of funding None
Conflict of interest None
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareA REVIEW OF MONOPOLISITC COMPETITION AMONG INTERNET SERVICE PROVIDERS
English2934Jehangir BharuchaEnglishThe purpose of this research paper is to explore and analyse the monopolistically competitive Internet Service Providers’ (ISPs) market structure in Mumbai and their operative strategies. Assessing the various factors at play, the project focuses on the relative effect of the corresponding marketing strategies on subscribers and attempts to identify how inconsistencies between the assured services and its subsequent delivery, results in failing to capture the competitive advantage that is observed in other marketplaces. Factoring in the opinions and feedback of the survey respondents, as well as the conceptual tactics of non-price competition and product or service differentiation in a monopolistic market, the study proposes an informed framework to tackle the existing issues therein.
EnglishCompetition, Internet service providers, Strategies.INTRODUCTION
Web penetration is increasing at a brisk pace, partly fuelled by easy internet access on smartphones and the addition of certain economical subscription plans. As per a recent report by NASSCOM, India’s Internet base is likely to cross 730 million by 2020. With the population of Mumbai bursting at the seams, the city currently has an internet user base in excess of 1.2 crores, much higher than any other city in the country. For the purpose of this project, monopolistic competition is studied among the following three Internet Service Providers (ISPs) that are meant for home / domestic customers in Mumbai: 1. Mahanagar Telephone Nigam Limited – MTNL 2. Tata Teleservices Limited – Tata 3. Reliance Communications Limited – Reliance
RESEARCH OBJECTIVE
The objectives established for this project provide a direction to the study and analysis of the current home internet services landscape and puts forth certain recommendations that could enhance the overall effectiveness of service delivery. The primary research is aimed at achieving the following objectives:
• To review the internet services provided by various ISPs, their pricing and marketing strategies.
• To determine the advantage of the differential service offerings
• To examine various challenges faced by customers while availing of such services.
• To propose measures based on the analysis presented and suggest a methodical approach towards improving the service providers’ operational strategies that would lend a competitive advantage.
PRIMARY DATA
A research survey was created using an online application. The survey was distributed to 60 respondents via email. In addition to gathering the personal details of the respondents, the survey consisted of a total of 21 questions. The data gathered from this would contribute toward understanding the market structure and deducing how certain systemic changes could help advance the general industry functioning. Age-wise and Gender-wise profile of the respondents
Notes
• While selecting the target audience, the mixed age groups of the consumers have been kept in mind.
• Though the researcher has made the attempt to get a balanced proportion of respondents from every age group, there is a specific focus on the age groups of 18-25 and 26-45 with a view to get responses from those people who make the decision of selecting a particular internet plan.
• A few responses were also specifically administered to people in distinct regions of Mumbai to cover for the regional internet service differences.
SECONDARY DATA
Certain parts of the study have also been compiled through various secondary data sources. These include online news articles, research papers, websites and reliable review sites. Wherever possible, this content has been integrated with the findings of the primary data. The information obtained through secondary references facilitated the analysis of data collected through the survey. Secondary data is also used to detail out particular recommendations and facts that would contribute towards achieving the objectives of this project.:
As seen in the table, respondents predominantly use a DSL Broadband service, which is also referred to as high speed internet. Data Cards are used by 26 respondents. For the most part, data cards are used for their portability function – that is, one can use it while travelling; while only a small percentage use it as their primary internet connection. The survey statistics clearly indicate that most people using a data card, already have another type of internet connection. It was also found that most people using a data card and another internet connection fall in the age group of between 18 to 25 years. In Mumbai, DSL Broadband is the most widely used broadband or high speed internet connection type for home purposes. On the other hand, as indicated in the table, a very small number of users opted for fibre broadband and cable internet connection.
MTNL is a state-owned telecommunications service provider in Mumbai. Due to the telecom services monopoly it enjoys in several pockets of Mumbai, it is able to effectively provide wired internet services to those users. Like MTNL, Reliance and Tata can provide wired internet services, but to only those who either have or opt for a telephone connection that subscribes to their services. Though MTNL has wireless services on offer, none of the respondents uses them.
Most respondents have cited that they use the internet predominantly for college or work purposes and emails could be regarded as an integrated element of that. A good number of respondents also suggested that they use their ISP for video chatting and downloading multimedia from the web. It was observed that all users in the age group of 18-25 stated that they use the internet for downloading or streaming online multimedia. Among this age group, this is particularly important as there are several different internet plans that could be target to highlight this need of increasing online content consumption. The researcher is of the opinion that understanding data usage patterns not only helps the user in selecting the appropriate connection plan, but also in effectively marketing particular internet plans.
39 out 41 males under the survey suggested that they are the key decision maker for the internet connection plan one wishes to take in the house while only 1 of the 19 females stated that they are responsible for the same. Though 3 females have a say in the decision, most females stated that they do not intend on playing a role in deciding on a connection plan. For an effective marketing strategy, it is imperative to identify the key decision makers so that personal selling could be more targeted by analyzing the needs of the family itself. In this regard, it is pertinent to pay attention as to how internet usage takes place on familial level than at an individual level. The ISPs should look beyond decision makers and focus on laying out their promotional and personal selling messages as to how the internet speed and data limit could suffice the needs of the entire family
As indicated in table 5, most respondents have availed of a connection speed that ranges up to 2 Mbps. A majority of these 512 Kbps and 2 Mbps users have MTNL as their ISP. Both these segments are DSL Broadband. Speeds ranging up to 8 Mbps (4 Mbps in case of Reliance) are offered at competitive prices by all three firms. Speeds ranging from 10 Mbps to 50 Mbps are usually, either Fibre Broadband plans or cable internet plans. However, consumers primarily differentiate these on the basis of service and speed reliability, as well as the data limits for each plan. The speed particularly comes into question while analyzing the needs of the family. If there are multiple heavy users of internet data in one family, it is recommended that the customer opts for a plan of greater speed and a higher data limit.
When asked about the prices, most respondents stated that they pay between Rs. 751 to Rs. 1100 for their existing primary ISP. However, the researcher has observed that when multiple family members of the respondents use the internet and if there are multiple heavy users, there is a need for a higher speed, as it gets divided between the users in an equitable manner depending on their usage requirements. For example, a 2Mbps connection might suffice an individual or 2 individuals with slight challenges. However, a 4 Mbps or an 8 Mbps connection would easily suffice internet usage between 3 to 6 individuals, at a decent internet speed. Another important finding in this research was that many respondents made a specific mention to this researcher that when they required additional downloads or need for higher speeds, they would use their data card. As per the tariff rates of the ISPs, the price and speed are similar – due to the ISPs being characterized as monopolistically competitive market structure.
The respondent internet users in the survey were asked if the speed is as advertised by the primary ISP. Only about 47% answered in the affirmative, while 35% replied otherwise There is a strong correlation between the internet speed satisfaction and the service provider. It was found that 19 out of the 21 respondents who stated that the speed was not as advertised were MTNL subscribers. Moreover, only 17 out of the 28 respondents who answered in the affirmative stated that MTNL provides the speed advertised. The researcher has found that though MTNL is said to be the most reliable ISP in several pockets of Mumbai, this is only the case where the distance between the user and the ISP’s access point (locational internet hub) is within the recommended distance limits. Where the speed opted for is 512 Kbps to 2 Mbps, most MTNL customers are satisfied – whereas speeds upwards of 2 Mbps, have received negative reviews among respondents as well as online review websites.
50% of the respondents believe that the amount they are paying is not justified compared to the services and speed. There are three main components of ISP pricing:
• Speed and Data limit
• Service reliability
• Infrastructure requirements
Keeping the above three considerations in mind, Reliance and Tata’s wireless services have done fairly well.
As indicated in table 9, though customers might have overall satisfaction with their ISP, there are some issues they would like to be addressed. 31 of the respondents mentioned that they have a problem with a price – a similar trend to what was asked in question 8. Speed issues are a close second. However, a slight disorientation in answers has been observed when it comes to speed issues, in comparison to the responses seen in question 7. An overall review and recommendation has been suggested in the ‘Recommendations’ section of this project.
This question does not shows a weak correlation when weighed against some of the responses determined in earlier questions. Though most respondents state they are satisfied with their current ISP, they do seem to have some issues with their plans. There is a sizeable percentage 45 percent of respondents who are not willing to shift to another ISP because of price or certain other restrictions. This is primarily seen in the case of MTNL users. This question was particularly asked to judge the non-price differences that consumers would perceive in terms of not switching from their current ISP to another. Even though the customer may want to definitely switch from their current ISP, the objective of this assumption has been made as to assess the competitive factors that influence customer decisions in this monopolistic market.
CONCLUSION
MTNL, as a state-owned organization operating in Mumbai has enjoyed a sizeable chunk of market leadership until now. With the entry of several small and big level private players in the city, it is gradually losing out on its market monopoly. Competitive tariff schemes and lightening fast services are the main strengths of these private players and they are able to attract consumers that were earlier MTNL subscribers. Thus MTNL has had to lower its tariffs significantly. Reliance and Tata are the two biggest private sector players. Both these private sector players have various wired and wireless connection types that need independent infrastructure setups. Akamai, a firm that runs a globally distributed network of servers, has commented that the average internet speed in India is a grey area as there are several connections below the 2 Mbps mark which is a basic threshold speed for broadband services. Taking these recommendations in to consideration, the National Broadband Plan had proposed that the minimum broadband speed should be increased to 2 Mbps by January 1, 2015; however, this has not been implemented until yet.
RECOMMENDATIONS OF THE STUDY
Some of the recommendations are as follows:
• India’s information and communications-technology expenditures need to be increased significantly. Though certain suggestions have been laid out in the Digital India initiative, the time frame of this project execution has to be reduced. As robust as the potential may be, various regions of India, including Mumbai, face challenges to get ready for an aggressive ramping up of Internet adoption and improvement of existing technologies.
• Though Mumbai has a robust high-speed broadband network, a lot of enterprises cater to the commercial segment. The lack of focus and cost reduction for homes is one of the major reasons that has hampered broadband penetration in Mumbai.
• With the increase in cellular towers for transmitting mobile internet, it is also important for the government to invest in and subsidize the city’s cable infrastructure.
• Since the fundamental internet infrastructure is the responsibility of the government which is then parted through spectrum auctions, there is a need for improving cable connectivity. Fibre cable connectivity is extremely important in this regard - most of the developed countries have been able to ramp up extremely high speed broadband through this technology.
• With respect to the promotional strategies followed by the three ISPs, it is particularly important as seen from the primary survey that ISPs identify key age-groups and modify internet plans – in terms of speed and data limit – to cater to this market. Though such age groups would already have an ISP, the gaps in service delivery, is an area where companies can gain significant competitive advantage.
• Further, when it comes to pricing strategies, it is critical to have comparable prices. Though Reliance and Tata’s early advent in to the internet foray led to MTNL lowering its prices, now the situation has reversed. MTNL has been able to significantly subsidize its prices on account a vast customer base and additional services that it provides. However, Reliance and Tata have extremely capable wireless services. It should look to aggressively promote its wireless services against the wired services provided by other players at a comparative price. In part, this issue is caused due to regulations of TRAI that has set certain price caps.
• More importantly, the private sector players, as well as, MTNL need to improve its service delivery for the domestic customer segment. The response to customers’ service queries on the part of ISPs is at a very low level in Mumbai. This has not only been conveyed by the respondents, but also, several online reviews reflect the same scenario. Thus, speed in complaint resolution and establishing conclusive and time-framed settlement metrics that are looked into by the respective regulatory bodies will aid in improving this chief concern among several customers.
ACKNOWLEDGEMENTS
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=200http://ijcrr.com/article_html.php?did=2001. Anwer, Javed. ‘Internet Speed Reducing In India’. The Times of India 2011. Web. 24 Jan. 2015.
2. Department of Electronics and Information Technology, Government of India, Digital India. 2014. Print.
3. Digit,. ‘India’s Average Internet Speed Expected To Improve By 50 Percent | Digit.In’. N.p., 2015. Web. 26 Jan. 2015.
4. Economics Online, ‘Monopolistic Competition’. N.p., 2015. Web. 25 Jan. 2015.
5. Forbes, ‘India’s 243 Million Internet Users And The Mobile ECommerce Revolution’. N.p., 2014. Web. 23 Jan. 2015.
6. Ghosh, Shauvik. ‘Digital India: Govt To Spend Up To Rs1.13 Trillion In Three-Five Years’. http://www.livemint.com/. N.p., 2014. Web. 26 Jan. 2015.
7. McKinsey and Company, India’s Internet Opportunity. McKinsey and Company, 2013. Web. 25 Jan. 2015.
8. More, Avinash. ‘Monopolistic Competition And Optimum Product Diversity’. Print. 9. MTNL Mumbai, ‘Broadband - MTNL Mumbai’. N.p., 2015. Web. 26 Jan. 2015.
10. Ramachandran, T. ‘India’s Indifferent Scorecard In Global Move To Improve Internet And Broadband Access’. The Hindu. N.p., 2013. Web. 26 Jan. 2015.
11. Reliance Communications, ‘Reliance Wireless Internet Broadband Connection | Reliance Wireless Connection’. Web. 25 Jan. 2015.
12. Tata DOCOMO, ‘Tata DOCOMO :: Broadband and Wired Internet’. N.p., 2015. Web. 26 Jan. 2015.
13. Tata Tele Enterprises, Web. 27 Jan. 2015.
14. Tele.net.in, ‘MTNL: Survival Strategies’. N.p., 2015. Web. 26 Jan. 2015.
15. Tembhekar, Chittaranjan. ‘MTNL: More High-Speed Internet Connections In Mumbai’. The Times of India 2012. Web. 25 Jan. 2015.
16. Vaidyanathan, Rajini. ‘Indian Internet Seeks The Masses’. BBC News. N.p., 2012. Web. 25 Jan. 2015.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareISOLATION AND PHARMACOLOGICAL STUDIES OF KARANJACHROMENE FROM THE SEEDS OF PONGAMIA PINNATA (L. PIERRE)
English3540Devendra N. KageEnglish Nuzhahat TabassumEnglish Vijaykumar B. MalashettyEnglish Raghunandan DeshpandeEnglish Y. N. SeetharamEnglishContext: Isolation of chemical compound karanjachromene from the Seeds of Pongamia Pinnata and evaluation of its anti-inflammatory and analgesic activities.
Materials and methods: Karanjachromene has been successfully extracted from the seeds of Pongamia Pinnata using n-hexane, petroleum ether and alcohol with Soxhlet extraction. Anti-inflammatory and analgesic activities of the some were assessed administering in Swiss albino mice. The anti-inflammatory activity of the test compound was determined by mice paw edema inhibition method. The analgesic activity was determined by both acetic acid induced writhing and tail immersion methods.
Results: Karanjachromene at doses 25 mg/kg and 50 mg/kg shown 40.48% and 59.6% inhibition of paw edema respectively, at the end of 3 h standard drug diclofenac sodium produced 63.01% inhibition in paw volume at 10 mg/kg. The oral administration of test compound karanjachromene significantly inhibited writhing response induced by acetic acid in a dose dependent manner. Karanjachromene produced 29.64% and 42.14% inhibition of writhing at doses 25 mg/kg and 50 mg/kg respectively. Standard drug diclofenac sodium produced 56.47 % inhibition of writhing at 10 mg/kg.
Discussion and Conclusion: The administration of karanjachrome is potent to inhibit the paw edema starting from the 1st hour and during all phases of inflammation, which may be due to inhibition of different inflammatory mediators. The acetic acid induced writhing response could be mediated by peritoneal mast cells, acid sensing ion channels and the prostaglandin pathways. The test compound inhibited both mechanisms of pain and inflammation and are more found active peripherally than centrally. Karanjachromene exhibited significant anti-inflammatory and analgesic agents
EnglishAnti-inflammatory activity, Analgesic activity, KaranjachromeneINTRODUCTION
Pongamia pinnata belongs to the family Fabaceae. All parts of the plant viz, root, stem, leaves, flower, bark, seeds and its oil too are used in Ayurveda for the treatment of Antihyperglycemic (Badole SL, Bodhankar 2008, Badole SL, Bodhankar 2009), Antilipid peroxidase (Tamrakaretal., 2008; Ahmadetal., Punitha and Manoharan 2006a; Punitha and Manoharan 2006b), Antifungal and antibacterial (Siminetal., 2002, Amit et al., 2011), Antimicrobial (Koysomboon et al.,2004, Alam, 2004, Krishna and Grampurohit, 2006), antiviral (Elanchezhiyan, 1993), antidiarrheal activity (Brijesh et al., 2006), antiplasmodial (Simonsen et al.,2001), anticonvulsent (Ashish and sunita, 2010; Ashish and sunita 2009), antidiabetic (Badole and Bodhankar, 2010), Antioxident (Sachin et al., 2011), anti-filarial (Uddin et al., 2003), Antiulcerant (Prabhaetal., 2009), antihyperammonic activity (Chopade et al., 2010, Dahanukumar et al., 2000), Cures leprosyand gonorrhea (Kirtikar and Basu, 1975), liver infections (Nadkarni, 1982) and the oil is used for scabies and rheumatism (Burkill, 1996, Bimla et al., 2003). Many biologically active chemical compounds have been isolated from various parts of the plant. An aliphatic waxy mat ter kaempferol, pongamin, γ-sitosterolglucoside, quercertin, neoglabrin (A complex amino acids) resembling glabrin and galbrosaponin A furanoflavone (i.e., Penguin) (The Wealth of India 2003). Pongaglabol, a hydroxyfuranoflavone, and aurantiamide acetate, phenyl alanine dipeptide, have been isolated together with four furanoflavones (karanjin, lancheolatin B, kanjone and pinnatin (Talapatraetal., 1980) have been isolated from flowers. Various chemical constituents are isolated from the bark of this plant include seven flavonoids viz., pongaflavone, karanjin, pongapin, pongachrome, 3,7-dimethoxy-3’,4,7-tetramethoxyflavone (Yin et al.,2004) two prenylated flavonoid derivatives viz., pongaflavonol and tunicatachalcone (Yinetal., 2006) cycloart-23-ene-3?, 25-diol (Badole et al., 2011) phenylpropanoids viz., pongapinone A and B (Kitagawa et al., 2008). Moreover, two hydroxychalcones – onganones I and II – have been isolated from the bark and characterized (Rastogi et al., 2011). Three furano flavonoids (Pongamosides A, B and C) and a flavonol, glucoside Pongamoside D, have been reported from the n-butanol-soluble fraction of the ethanolic extract P. pinnata fruit (Ahmad et al., 2004).The seeds contain traces of essential oil, complex amino acid termed glabrin, furano flavones, karanjin, kanjone, pongaglabrone, furano flavone (Rastogi et al., 2011; Li et al., 2006) and pyrano flavonoid called Karanjachromene (Naghmana et al., 2008). Furoflavones viz. Keranjin, pongapin and pinnatin isolated from the seeds, leaves and bark (Chopra, 1969; Parmar et al., 1976) and roots also indicated the presence of protocatechuic, elegiac, ferulic, gallic, gentisic, 4-hydroxybenzoic and 4-hydroxycinnamic acids in bark, sorbic, ferulic, gallic, salicylic and p-coumaric acids in leaves; vanillic, gallic and tannic acids in seeds as the main phenolic acids (Sajid et al., 2012), flavonoids and its related compounds including flavones, furanoflavonoids, chromenoflavone, chromenocalchones, coumarins, flavone glycosides sterol, terpenes and modified phenylalanine dipeptides are found to be present (Khare, 2004). Since flavonoids are effective anti-inflammatory and analgesic compounds, and as per our knowledge there are no reports of anti-inflammatory and analgesic activities of Karanjachromene, hence we have carried out these experiments.
MATERIALS AND METHODS
Chemicals
All chemicals and reagents used to carry out the research work were analytical grade and were obtained from Hi-Media Mumbai, India.
Plant material
P. pinnata pods were collected from Gulbarga University campus in October 2010. This plant is as identified by using Flora of Gulbarga District (Seetharam et al., 2000) (Voucher No. HGUG-169). The voucher specimen is kept for the record in the Department of Botany Gulbarga University, Gulbarga.
Flora of Gulbarga District (Seetharam et al., 2000) (Voucher No. HGUG-169). The voucher specimen is kept for the record in the Department of Botany Gulbarga University, Gulbarga.
Extraction and Isolation of karanjachromene
P. pinnata seeds were finely ground for an approximate particle size of 2 mm). The oil content of the seed was extracted with Soxhlet extractor with n-hexane for 20 h and maintaining the temperature at 60?C. Oil recovered was stored at 4?C in airtight container for further analysis. After 15 days of storage, granular particles were settled at the bottom of the container. These particles were separated and washed with n-hexane followed by petroleum ether repeatedly. These fine powdered particles were re-dissolved in double distilled alcohol; pointed yellowish crystals were formed at the bottom of the container within a week. This is most convenient and easiest method of isolation of this compound as compared to the previous methods of isolation.
Characterization
The characterization of the compound have been made by taking melting points, infrared spectra, 1 H and 13C nuclear magnetic resonance (NMR) and mass spectral analysis.
Structure of Karanjachromene
Animal experiments
Experimental animal Albino mice of either sex weighing 20-25 g were taken for experimental study. They were acclimated to animal house conditions fed with commercial pellets (Hindustan Lever Ltd., Bangalore, India), and tap water ad libitum. The experimental protocol was approved by the Institutional Animal Ethics Committee.
Determination of median lethal doses (LD50) LD50 values were estimated by the acute toxicity test as described. The test compound is dissolved in 3% DMSO administered orally to different groups with increasing doses. Four animals were taken in each group. Mortality was determined after 24 h of treatment. The dose, at which the 50% mice survived, was considered as LD50 value of the compound. Anti-inflammatory activity The anti-inflammatory activity (Winter et al., 1962) of the compound was determined using the carrageenan induced mice paw edema inhibition method employing 1.0% carrageenan solution as the phlogestic agent. The test compound was administered orally as suspensions in 3% DMSO, 30 min before the injection of phlogistic agent, at the dose level 25 and 50 mg/kg body weight. Diclofenac sodium was used as a standard at a dose level of 10 mg/kg body weight. 3% DMSO served as a control. Groups of four albino mice of either sex were used in each experiment. The volume of paw edema was measured with the help of plathysmograph by mercury displacement method at 0h (soon after injection of carrageenan). Then, the volume of paw edema was observed at 1, 2 and 3 h and the results are presented in the Table 1. The percentage inhibition of paw edema was calculated using the formula. % Inhibition =1-Vt/Vcx 100 Vt and Vcx the volumes of paw edema in treated and control group, respectively. Acetic acid induced writhing test for analgesic activity The analgesic activity of the test sample was studied (Ahmed et al., 2004) using acetic acid induced writhing model in mice. Swiss albino mice of either sex were divided into control, standard and different test groups contain four mice in each. The control group received 3% DMSO and standard group was treated with diclofenac sodium at a dose level of 10 mg/kg test sample and the vehicle were administered orally 30 min before intraperitonial administration of 0.6% acetic acid but diclofenac sodium was administered intraperitonially 15 min before injection of acetic acid. After an interval of 5 min, the mice were observed for specific contraction of the body referred to as writhing for the next 30 min the analgesic activity was expressed as percentage inhibition of writhing in mice. The results are given in table 2. Tail immersion test for analgesic activity The procedure was based on the observation that morphine like drugs selectively prolongs the reaction time of the typical tail withdrawal reflex in mice (Palanichamy and Nagarajan 1990). The animals were treated as discussed above. From 1-2 cm of the tail of mice was immersed in warm water kept constant at (54±1) ?C and the reaction time was the time taken from the mice to deflect their tails. A cutoff period of 5 sec was observed to avoid damage to their tail. Reaction time was recorded when animal picked up their tails from the hot water at 0, 30, 60 and 90 min after the administration of drugs. The results are shown in Table 3. Statistical analysis Data obtained from the experiments are expressed as Mean ± SEM. The difference between the control and the treatments in these experiments was tested for significance using one way ANOVA followed by a Dunnett’st – test.
RESULTS
LD50 value of karanjachromene was found to be 500 mg/kg body weight. Two doses of Karanjachrome25 mg/kg and 50 mg/kg have been selected throughout the work. In the carrageenaninduced mouse paw edema test (Table 1) for acute inflammation, the test compound Karanjachromene at doses 25 mg/kg 50 mg/kg shown 40.48 and 59.6% inhibition of paw edema, respectively, at the end of 3 h standard drug diclofenac sodium produced 63.01% inhibition in paw volume at 10 mg/kg.
Table 2 shows the effect of Karanjachromene on acetic acid-induced writhing in mice. The oral administration of test compound Karanjachromene significantly inhibited writhing response induced by acetic acid in a dose dependent manner. Karanjachromene produced 29.64% and 42.14% inhibition of writhing at doses 25 mg/kg and 50 mg/kg respectively. Standard drug diclofenac sodium produced 56.47 % inhibition of writhing at 10 mg/kg the tail withdrawal reflex time following administration of the test compound was found to increase with increasing dose of the samples. The results were statistically significant and comparable to that of the reference standard drug morphine. The data are shown in Table 3.
DISCUSSION
The carrageenan induced paw edema is characterized by a biphasic event with the involvement of various inflammatory mediators. In the first phase (during 1st and 2nd hour after carrageenan injection), inflammatory mediators like serotonin and histamine play their role, while in the second phase (i.e., 3rd hour after carrageenan injection) bradykinins and prostaglandins are involved (Crunkhorn and Meacock, 1971). Our results revealed that administration of Karanjachrome is potent to inhibit the paw edema starting from the 1st h. and during all phases of inflammation, which may be due to inhibition of different inflammatory mediators. Acetic acid-induced writhing model shows pain by enhancing localized inflammatory response. Such pain stimulus leads to the production of free arachidonic acid from phospholipids in the tissue. The acetic acid induced writhing response is a highly sensitive procedure to evaluate peripherally acting analgesics. The response could be mediated by peritoneal mast cells (Ronaldo et al., 2000) acid sensing ion channels (Voilley, 2004) and the prostaglandin pathways. The tail immersion test is considered to be selective to examine compounds acting through opioid receptor, the test compound increased mean basal latency which indicates that they may act via centrally mediated analgesic mechanism (Dinesh Kumar, 2011). Narcotic analgesic inhibits both peripheral and central mechanisms of pain, while non-steroidal anti-inflammatory drugs inhibit only peripheral pain (Elisabetsky et al., 1995). Through the test compound inhibited both mechanisms of pain, these are more active in peripherally than centrally.
CONCLUSION
The experimental findings in this study suggest that the Karanjachromene possesses analgesic and anti-inflammatory activities, possibly mediated through central and peripheral mechanisms involving inhibition of release or the actions of vasoactive substances like prostaglandin and histamine, serotonin and kinins. The results obtained justify the use of the seed oil in traditional Indian medicine for the treatment of painful and inflammatory conditions. Further work is going on to elucidate the exact mechanism of action. Conflict of interests The authors report no conflicts of interest. The authors are merely responsible for the content and writing of the paper.
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.
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27. Li L, Li X, Shi C, Deng Z, Fu H. Pongamone A–E, five flavonoids from the stems of a mangrove plant, Pongamiapinnata. Phtochemistry 2006; 67:1347- 1352. 28. Nadkami, KM. Indian MateriaMedica, Popular Book Depot. Bombay, 1982; ed.3. p – 1003. 29. Naghmana R, Muhammad SAA, Muhammad KT, Nurdiyana MY, Bohari MY. Isolation and Crystal Structure of Karanjachromene. Analytical Sciences 2008; Vol. 24X21.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareAN ANTHROPOMETRIC STUDY OF STATURE ESTIMATION AMONG MALES FROM THE MEASUREMENTS OF FEET IN UDAIPUR DISTRICT OF RAJASTHAN
English4145Charu TanejaEnglish Hitesh BabelEnglish L.K. JainEnglishBackground: Estimation of stature has a very significant role to play in forensic anthropometry for personal identification.
Objective: To discover out the correlation among proportions of feet with stature in tribals of Udaipur district in Rajasthan (India). Material and Methods: The present study was conducted on a total number of 481 male tribals of Udaipur district by using standard anthropometric techniques. Results: There was a high correlation between height and right (0.184) foot length and left (0.186) Foot Length in males.
Conclusion: Linear regression equations were deduced in males out of which lowest standard error of estimate was experienced in combined foot length of males.
EnglishStature, Foot length, Regression equationsINTRODUCTION
Anthropometry is an important tool of physical anthropology for obtaining different measurements like stature on the living as well as dead (skeleton and skeletal remains) of man using scientific method. Physical anthropologists mainly deal with study of human origin and evolution of human beings. They also deal with study of different races in various parts of the world. Stature estimation has a very important role to play in forensic anthropometry for personal identification. Even anatomists and anthropologists apart from forensic experts have shown keen interest in estimating the height of an individual by measuring different parts of body like hand length, foot length. Previous researchers have established a very well defined relationship between height of individual and different parts of body like head, trunk and lengths of upper and lower limb. Important differences /variations between various ethnic groups have been studied in detail by comparing relationship between body segments and this has also been shown to be related to life style and locomotion. Prediction of dimensions of body segments is useful in many areas of modern science. The relationship between body segments and height is used in assessing growth in normal individuals as well as in people suffering from specific syndromes. The relationships between proportions of various body segments especially of long bones of limb (femur) with height have been most widely studied. It has been proved that stature can be estimated from a shoe left at the scene of a criminal offense. Similarly the stature of a victim can be estimated when a part of body, such as a long bone, or hand, is all that corpse. (Santosh K et al. ,2014)1 There is significant correlation between stature and foot length. If one is known, the other could be predicted and vice versa. This could be of help in medicolegal instances for recognition of body parts and also be of use in cosmetic surgery ( Oommen A et al., 2005)2
MATERIAL AND METHODS
Methodology
Inclusion Criteria Tribal males and females of age group 18-32 years who were born and brought up in the tribal community of Udaipur region. Exclusion criteria Males and females having physical deformity, injury, disease, fracture, amputation or record of any surgical procedures affecting stature, hands and feet were excluded from the study. Nutrition and socioeconomic status were not assessed. Statistical Analysis The data obtained was subjected to statistical analysis to derive the mean, standard deviation, correlation coefficient, regression coefficient. For testing the significance level, t test was applied. The following dimensions were measured based on the specific anatomical landmarks and the values were measured in millimeters. Stature It is the vertical distance between the highest point on vertex and the floor. The subject was made to stand barefoot on the foot place of the stature meter in an erect posture with the hands hanging down on the sides with the palm facing the thighs. Subject was asked to maintain upright posture and the movable piece was kept on the vertex and the height was recorded in millimeter. Foot Length It is the distance between the most backward and prominent part of heel and most distal part of longest toe of the foot, when the foot was fully stretched. The study design of the current study is Cross- sectional descriptive type.
RESULT
We have come across that the mean age of males was 24.688 years and S.D. was 4.319. The average stature of males was 1613.457 ± 72.096 mm and ranged between 1426 to 1800 mm. In males the mean (mm) and S.D. of Foot Length measured of right side was 225.75 ± 19.299 and left side was 225.964 ± 19.275. In males the Foot Length was highly significant of right and left sides (p < 0.05). In males there was a high correlation between right and left side Foot Length (1.000).In males there was a near to mild correlation between right (0.184) foot length and left (0.186) side Foot Length in males with the stature.
DISCUSSION
FOOT LENGTH
In 1988 Philip TA 3 studied correlation between height and foot length in Male students of Karnataka and found correlation coefficient(r) as 0.71.
In 2007 Bhavna, Nath Surinder 4 studied correlation between height and Foot length in male Shia Muslims of New Delhi and found correlation coefficient(r) to be 0.546. A significant correlation was observed between foot length and stature.
In 2008 Krishan K 5 studied correlation between height and Foot length in male Gujjars of North India and found correlation coefficient(r) as 0.86.The highest correlation coefficient was shown between stature and foot measurements.
In 2011 Parash MTH et al. 6 studied correlation between height and Foot length in students of Dhaka and found correlation coefficient(r) as 0.69 for right foot and r for left side was 0.70. Both the length of right and left foot showed significant positive correlation with the stature.
In 2013 Singh JP et al. 7 studied correlation between height and Foot length in Male Volunteers of New Delhi and found correlation coefficient(r) as 0.583 for foot length in males. The foot length exhibited statistically significant correlation with stature (pEnglishhttp://ijcrr.com/abstract.php?article_id=202http://ijcrr.com/article_html.php?did=2021. Santosh K, Garg R, Dagal N, Shekhawat S.Determination of human body height by the measurement of hand and foot length in population of Rajasthan.Medico-Legal Update 2014;14(1):178- 82.
2. Oommen A, Mainker A, Oommen T. A study of the correlation between hand length and foot length in humans. Journal of the Anatomical Society of India 2005; 54(2):1-9.
3. Philip TA. Foot size for predicting stature of males. J.Ind.Acad. Forensic Sci 1988; 27:30-9
4. Bhavna, Nath Surinder. Estimation of stature from measurements of lower limbs. Anthropologist Special 2007; 3: 219-22
5. Krishan K. Estimation of stature from foot print and foot outline dimensions in Gujjars of North India. Forensic Science International 2008; 175: 93-101.
6. Parash TH, Naushaba, Paul UK, Rahaman A,Farhat N, Tabriz SE. Estimation of stature of adult Bangladeshi male from the length of the foot. Bangladesh Journal of Anatomy 2011; 9(2):84-8
7. Singh JP, Meena MC, Rani Y, Sharma GK. Stature Estimation from the Dimensions of Foot in males. Antrocom Online Journal of Anthropology 2013; 9(2): 237 - 41.
8. Dayananda R, Babu U, Kiran J .Estimation of stature from dimensions of foot. Medico- Legal Update 2014; 14(1):6-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareSTUDY OF LABORATORY PARAMETERS IN HEMOPHILIA PATIENTS
English4649T. B. SadariaEnglish H. M. GoswamiEnglish Safal PatelEnglishIntroduction: Haemophilia is X- linked congenital bleeding disorder with a frequency of about one in 10,000 births. Haemophilia is caused by deficiency of coagulation factor VIII (haemophilia A) or factor IX (haemophilia B) related to mutations of clotting factor gene. Objectives: To check effectiveness of various screening and confirmatory tests for diagnosis of haemophilia. Methods: Retrospective study of laboratory diagnosis of haemophilia was conducted in our haematology section of pathology department of Tertiary Care Teaching Centre from 1 August 2014 to 30 July 2016. Patients in the age group of 0 year to 55 years with factor VIII and factor IX level below 50% of normal were included in the study. Routine haematological tests like haemoglobin and platelet count and coagulation profile of patient for prothrombin time, activated partial prothrombin time, factor VIII and factor IX level were analysed. Results: Out of 122 cases, 97 cases were of haemophilia A while 25 cases were of haemophilia B. Haemoglobin count of patients ranged from6gm% to 14.2 gm%. Platelet count and PT (prothrombin time)of patients were within normal limits. APTT (Activated Partial Thromboplastin Time) was prolonged (41.6 sec. to 124 sec) in all patients. Factor VIII level was reduced (EnglishHaemophilia A, Haemophilia B, Factor VIII, Factor IXIntroduction:
Haemophilia is X- linked congenital bleeding disorder with a frequency of about one in 10,000 births. Haemophilia is caused by deficiency of coagulation factor VIII (haemophilia A) or factor IX (haemophilia B) related to mutations of clotting factor gene.
Objectives: To check effectiveness of various screening and confirmatory tests for diagnosis of haemophilia.
Methods: Retrospective study of laboratory diagnosis of haemophilia was conducted in our haematology section of pathology department of Tertiary Care Teaching Centre from 1 August 2014 to 30 July 2016. Patients in the age group of 0 year to 55 years with factor VIII and factor IX level below 50% of normal were included in the study. Routine haematological tests like haemoglobin and platelet count and coagulation profile of patient for prothrombin time, activated partial prothrombin time, factor VIII and factor IX level were analysed.
Results: Out of 122 cases, 97 cases were of haemophilia A while 25 cases were of haemophilia B. Haemoglobin count of patients ranged from6gm% to 14.2 gm%. Platelet count and PT (prothrombin time)of patients were within normal limits. APTT (Activated Partial Thromboplastin Time) was prolonged (41.6 sec. to 124 sec) in all patients. Factor VIII level was reduced (Englishhttp://ijcrr.com/abstract.php?article_id=203http://ijcrr.com/article_html.php?did=2031. Shrivastava A. Haemophilia in developing countrieschallenge of detection and diagnosis. In Sohail MT, Heijunen L. comprehensive haemophilia case in developing countries. Lahore : Ferozsons. 2001: p.17-25
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2016September11HealthcareROLE OF MIRNA-122 AND MIRNA-200B IN INTRATUMOR HETEROGENEITY FORMATION AND HUMAN BREAST CANCER PROGNOSIS
English5059Lukianova N.English Borikun T.English Yalovenko T.English Chekhun V.EnglishAim: To determine the features of miR-122 and -200b expression signature in BC patients due to major clinical-pathological characteristics of the disease.
Methodology: The expression levels of miR-122 and -200b and ER, PR, Her2/neu, Ki-67, E-cadh, N-cadh, FTH1, Hepc were analyzed in cancer tissue and sera of BC patients. Relative expression levels of the miR-122 and -200b were examined using qRT-PCR (Quantitative Reverse Transcription PCR), protein expression was measured by immunohistochemical analysis.
Results: Correlation between miR-122 and -200b expression clinical-pathological characteristics of BC was established. Prognostic value of miR-122 and -200b was estimated.
Discussion and Conclusion: Changes of miR-122 and -200b expression in tumor tissue and sera of BC patients provide information about major clinical-pathological characteristics of BC.
EnglishmiRNA, Breast cancer, PrognosisINTRODUCTION
Intratumor heterogeneity is considered to be characteristic of most malignant tumors and is the main obstacle to effective treatment. Exploration of intratumor heterogeneity, mechanisms of its formation are in the number of the urgent fields of fundamental oncological research. The biological phenomenon of intratumor heterogeneity, based on the genetic and epigenetic instability, is regarded to be a key factor that determinates tumor development from of its origin, to implementing of various pathways of tumor progression, ie aggressiveness. According to many researchers, intratumor heterogeneity plays a crucial role in the rate of tumors, supporting its oncogenic potential, cell survival in a dynamic microenvironment. Manifestation of existing heterogeneity within a tumor are morphological structure, genetic, epigenetic status differences in cells populations, as well as the variability of expression of different molecular markers. [1]. MiRNAs play an important role in the formation of cell diversity inside the tumor. MiRNAs are noncoding class of small RNAs that regulate the expression of almost a third of all genes at posttranscriptional level [2]. MiRNAs play a key role in maintaining of cellular homeostasis and are involved in regulation of cell cycle, differentiation, processes of inflammation, apoptosis and invasion [3]. At the same time, miRNAs can act as a paracrine and autocrine regulators of biological behavior of tumor microenvironment. According to the literature the origin and progression of several tumors may be due to changes in specific miRNAs expression [4]. Different miRNAs can either stimulate or inhibit tumor development and metastasis, and increase sensitivity or resistance to chemotherapy, thereby acting as tumor suppressors or oncogenes. It is known that the level of miRNAs correlates with vascular invasion and proliferation. Numerous studies demonstrate the possibility of using the expression levels of tissue-specific miRNAs as diagnostic biomarkers for prognosis and response evaluation to therapy [6, 7].
Important advantage of miRNAs over using other known markers is that unlike screening of expression of a large number of genes, it is enough to analyze a small number of miRNAs. As in plasma and in paraffin blocks miRNAs remain stable [8]. The development of tumors of different histogenesis is accompanied by changes in levels of circulating and tumor miRNAs, which are specific to certain tumors localization. For today several dozens of miRNAs that may be potential markers of breast cancer were studied. But changes in the concentration of many miRNAs are the same for different types of malignancies and their molecular subtypes. Therefore, it is necessary to search for miRNAs that are specific for breast cancer and each of its subtype. The fact that miR-122 and 200b are involved in breast cancer carcinogenesis, and act as oncosuppressors is well-known, but their role in tumor prognosis remains ultimately undefined. Therefore the aim of this study was to investigate the participation of miR-122 and -200b in the shaping of intratumor heterogeneity and prognosis of human breast cancer.
MATERIAL AND METHODS
A total of 134 subjects were recruited for this study of which 120 were those who suffering from breast cancer, 14 subjects included age-matched healthy individuals. 120 tumor samples and 14 samples of normal breast tissue obtained during surgery and 120 samples of blood serum of patients with breast cancer and 14 blood serum samples of healthy donors were studied. Tumor stage was determined by TNM staging system (2008). The histological type of tumor verified at the morphological study of paraffin-embedded tissue according to the WHO (2006). All patients before surgery received neither radiation nor chemotherapy. All patients were examined using conventional clinical and laboratory methods according to the standards of diagnosis and treatment of cancer patients, approved by the Ministry of Health of Ukraine ?554 from 17.09.2007. All patients and donors were informed and agreed to the use of serum and surgical material for research purposes. All samples were encoded and depersonalized.
Immunohistochemical analysis
Immunohistochemical analysis was performed on series of 4-5 µm sections from paraffin-embedded tissue. Rabbit antihuman antibodies (Dako ?ytomation, Denmark, Diagnostic BioSystems, USA, ThermoScientific, USA, GeneTex, Bioworld Technology, USA ) were used for staining according to manufacturer’s instructions. The presence of brown staining was considered a positive result of ER, PR, Her2/neu, Ki-67, E-cadh, N-cadh, FTH1, Hepc expression. To estimate the results classic H-Score method was used: H-Score: S=1xN1++2xN2++3xN3+, where S – «H-Score», N1+, N2+ and N3+ - number of cells with low, average and high expression. End result is presented in next grade: 50-100 points – low expression, 101-200 points – average expression, 201-300 points – high expression [9].
Samples collection for RNA isolation
The 5 ml of blood was collected in a BD vacutainer (yellow top) and was centrifuged at 1500 rpm. Serum was extracted and transferred to a conical bottom tube. Around 3-5 ml serum was obtained. Serum was stored at -80°C till further use. Frozen tissue samples also were stored at -80°C till further use.
Total RNA isolation
Total RNA was extracted from tissues/serum using “Ribozol” RNA Isolation Kit (Amplisens, Russia). Isolated RNA concentration was determined on a spectrophotometer “NanoDrop 2000c” Spectrophotometer (Thermo Scientific, USA). The purity of isolated RNA was controlled by using the ratio of optical absorption values at a wavelength of 260 and 280 nm. RNA was dissolved in TE buffer and stored at -200 ?. Single-stranded cDNA was synthesized from 100 ng of total RNA using TaqMan® MicroRNA Kit for reverse transcription.
Real-Time Quantitative Reverse
Transcription PCR Preparation of reverse transcription reaction mix was performed according to the manufacturers protocol. Reverse transcription was performed at a “Tertsik” (“DNA tehnolog?ya”, Russia). After the RT-PCR reaction product was added to the mixture of reagents to perform real-time PCR with specific conditions, to manufacturer’s protocol. QRT-PCR was performed on Applied Biosystems 7900HT Fast Real-Time PCR System. Small nucleolar RNA RNU48 was used as an endogenous control for normalization of expression. Relative expression of the studied miRNAs was identified by comparative CT method. Experiment was performed in three parallels for each sample. The threshold cycle averaged in all technical and biological replicas within each sample. Fold change between the studied miRNAs expression relative to control was calculated by the formula 2-DDCt [10].
Statistical methods
Statistic analysis of the obtained data was performed using the program STATISTICA 6.0. All data were expressed as the mean ± SD of at least 3 independent experiments. The differences between the groups were analyzed using the Student’s t-test and ANOVA; PEnglishhttp://ijcrr.com/abstract.php?article_id=204http://ijcrr.com/article_html.php?did=2041. Chekhun VF, Sherban SD, Savtsova ZD Tumor cell heterogeneity. Experimental oncology 2013; 35 (3): 154-162.
2. Janga SC, Mittal N. Construction, structure and dynamics of post-transcriptional regulatory network directed by RNA-binding proteins. Adv Exp Med Biol 2011; 722: 103-17.
3. Bartel DP. MicroRNAs: target recognition and regulatory functions. Cell 2009; 136(2): 215-33.
4. Bagnyukova TV, Pogribny IP, Chekhun VF. MicroRNAs in normal and cancer cells: a new class of gene expression regulators. Exp Oncol 2006; 28(4): 263-269.
5. Iorio MV, Croce CM. MicroRNAs in cancer: small molecules with a huge impact. J Clin Oncol 2009; 27:5848-5856.
6. Kovalchuk O, Filkowski J, Meservy J, Ilnytskyy Y, Tryndyak V, ChechunV, Pogribny I. Involvement of microRNA-451 in resistance of the MCF-7 breast cancer cells to chemotherapeutic drug doxorubicin. Molecular cancer therapeutics 2008; 47(7): 2152- 2159.
7. Blenkiron C, Miska EA. miRNAs in cancer: approaches, aetiology, diagnostics and therapy. Hum Mol Genet 2007; 16(1): 106- 13.
8. Ferracin M, Veronese A, Negrini, M. Micromarkers: miRNAs in cancer diagnosis and prognosis. Expert review of molecular diagnostics 2010; 10(3): 297-308.
9. Aye Thike, Mei Jiuan Chng, Stephanie Fook-Chong, Puay Hoon Tan, A. Immunohistochemical expression of hormone receptors in invasive breast carcinoma: correlation of results of H-score with pathological parameters. Pathology 2001; 33(1): 21-25.
10. Livak K, Schmittgen T, Analysis of relative gene expression data using real–time quantitative PCR and the 2−CT method. Methods 2001; 25: 402–408.
11. Filipowicz W, Jaskiewicz L, Kolb FA et al. Post-transcriptional gene silencing by siRNAs and miRNAs. Current opinion in structural biology 2005; 15(3): 331-341.
12. Wang B, Wang H, Yang Z. MiR-122 Inhibits Cell Proliferation and Tumorigenesis of Breast Cancer by Targeting IGF1R. PLoS ONE 2012; 7(10).
13. Berber U, Yilmaz I, Narli G, Haholu A, Kucukodaci Z, Demirel D. miR-205 and miR-200c: Predictive micro RNAs for lymph node metastasis in triple negative breast. Journal of breast cancer 2014; 17(2):143-148.
14. Chekhun VF. Cancer epigenetics. Experimental oncology 2008; 30 (3): 170-170.
15. Radojicic J, Zaravinos A, Vrekoussis T, Kafousi M, Spandidos DA. MicroRNA expression analysis in triple-negative (ER, PR and Her2/neu) breast cancer. Cell Cycle 2015; 10: 507–517.
16. Lukyanova NY, Rusetskya NV, Tregubova NA, Chekhun VF. Molecular profile and cell cycle in MCF-7 cells resistant to cisplatin and doxorubicin. Experimental Oncology 2009; 31(2): 87-91.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241817EnglishN2020October27HealthcareLife after Death: Knowledge, Attitude and Ethical Perceptions of Medical and Engineering Students on Voluntary Body Donation
English187192Varalakshmi KLEnglish Uma KulkarniEnglishIntroduction: In the medical curriculum of undergraduate and postgraduate medical students, the sound knowledge of anatomy forms the cornerstone for the foundation of medicine. Due to the budding of many medical colleges and increased demands of cadavers in medical colleges, voluntary body donation programmes have gained more importance in our country. Aim/Objective: To assess and compare the knowledge and attitude of medical and engineering students on voluntary body donation. To determine and compare the knowledge and attitude of medical and engineering students on various ethical issues associated with voluntary body donation. Material and Methods: This study was conducted on consented 75 medical students(8th and 9th terms) and 75 (final year) engineering students by distributing structured questionnaires covering the various ethical principles involved in body donation such as vulnerability, informed consent, autonomy, dignity, confidentiality and post act benefit. The obtained data were analyzed through descriptive statistics. Result: The data analysis showed that there is a difference in the knowledge, attitude and ethical perception of body donation among the students of both the groups. Conclusion: A comprehensive understanding of ethical and legal issues associated with the procurement of cadavers and its dissection is very important for the successful outcome of voluntary body donation programmes. Hence this study to assess the level of knowledge and attitude of medical and engineering students about voluntary body donation with special emphasize on ethical issues associated with body donation such as vulnerability, informed consent, dignity, autonomy, confidentiality, post act benefits.
English Body donation, Informed consent, Autonomy, Dignity, Confidentiality, Post act benefithttp://ijcrr.com/abstract.php?article_id=3014http://ijcrr.com/article_html.php?did=3014