Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241812EnglishN2016June20HealthcareDEPRESSION AMONG OLD AGE IN URBAN SLUMS English0105Pranay JadavEnglish Rhythm PanchaniEnglishAim: Present study was carried out to assess the prevalence and factors associated with depression among old age living in urban slums. Methodology: A cross sectional community based study was done in field practice area of urban health training center of a Medical Institute. A total of 150 participant of age 60 or more had been interviewed by house to house survey. Depression was measured by Geriatric Depression scale (GDS)-15. Results: Overall prevalence of depression among old age in urban slums was 30.7%. Prevalence among female was 33.82% and among male was 28.04%. Conclusion: Depression among geriatric population was significantly associated with illiteracy, living alone, chronic morbidity and poly-pharmacy. EnglishDepression, Old age, Urban slumsINTRODUCTION Ageing is a natural process which begins with conception and ends with death; this progressive state is associated with physical, social, psychological spheres.1 According to Geriatric literature, those above 60 years of age are considered to be ‘old’ and belonging to the elderly segment of the population.2 As a result of improved medical facilities and awareness there is decline in mortality and increased life expectancy leading to progressive increase in proportion of elderly people.1,3Moreover this vigorous growth in their numbers in the total population in recent years is termed as “graying of the world”.4 The UN defines a country as ‘ageing’ where the population of people over 60 years reaches 7%. Indian population is expected to reach 12.6% in 2025. The Indian aged population is currently the second largest in the world.3 The elderly people are matured and experienced persons of any community. Their experience, wisdom and foresight can be useful for development and progress; they are valuable asset for any nation.5 Geriatric psychiatry has emerged in early part of nineteenth century with the differentiation of senile dementia, atherosclerotic dementia and presenile psychosis. High geriatric population leads to high geriatric psychiatric problems.6 ‘Depression’ is not a specific term for a single diagnostic condition. It mainly consists of Major Depression Disorder (MDD), dysthymia and Minor Depression. This silent disorder can be characterized by loneliness, grief, change in sleeping pattern, alteration in appetite, feeling of hopelessness and sometimes suicidal tendencies. It can occur in any age, but the most vulnerable age group is geriatric population.1 As per the disability adjusted living years(DALYs) rankings, by 2020 unipolar major depression disorder will become the second leading cause of morbidity in forms of global disease burden.3 As the age advances, there is a progressive decline in the normal functioning of the body; which leads to several deteriorating conditions like impaired vision and hearing ability, poor mobility, loss of control over several functions and cognitive impairment. This is making their lives miserable apart from those diseases affecting the other systems of the body. Eventually this leads to chronic states like ischemic heart disease, diabetes mellitus, hypertension and cancer and if person in this stage does not get enough care and attention, he/she would be mentally broken.3 There is a misconception regarding depression that it is due to aging and so it cannot be treated. But, if it is left untreated it can lead to clinical and social implications in old age. Although treatment of depression is as effective for older patients as for younger adults, the condition is often under-recognized and under-treated. According to WHO data, proportionately more geriatric people commit suicide than any other age groups, and most have major depression. Older people who attempt suicide are more likely to die than younger people, while in those who survive, prognosis is worse for older adults.7 Hence depression is an important health challenge especially in developing countries. However in most of the countries the allocation of total health expenditures to mental health budgets is shockingly less than 1%. In a country like India with second largest aged population in the world, this matter is of great concern.8 The magnitudes of depression varies in different studies from 10% to 55%.6,9 Community based studies in India have found a prevalence of depression from 6% to 50%.10,11 From a national public health point of view it is utterly important to document the distribution and characteristics of the depressive symptomology in the older populations in Gujarat2 . There is a paucity of studies regarding geriatric depression here. So, this study will further explore the magnitude and factors affecting depression in old age. It has been observed that age, gender and illiteracy were significantly associated with the cognitive impairment while only age and illiteracy were significantly associated with depression. Cognitive impairment and Depression both were also significantly associated with each other. But they have found no significant association between co factors affecting this disorder. Death of a spouse renders them vulnerable to mental stress. Indeed, widowhood has been found to be strongly associated with depression in several instances. The absence of a caregiver was deduced to be a possible risk factor for depression. However, we did not find any significant association with depression in our study. One possible reason for this finding could be that we did not ask the number of caregivers or who the caregiver was. There was a higher rate of depression in literates, mainly because of a higher life expectancy amongst them. There were no significant differences which could be attributed to gender.12-13 Since, the Indian version of WHO (five) Well-being Index (1998 version) showed a good Internal and external validity and reliability for identifying depressive disorders in elderly population, this could be considered a useful instrument for identifying elderly subjects with depression in Indian community. Studies have shown that the validity of self-reported depression questionnaires may be influenced by somatic symptoms such as chronic pain. The purpose of this study was to compare the validity of two self-reported questionnaires, the Taiwanese Depression Questionnaire (TDQ) and the Beck Depression Inventory (BDI), for screening depression in patients with chronic pain. Thus, results suggest that the TDQ is superior to the BDI in detecting depression in patients with chronic pain in Taiwan.14-15 Present study was carried out to assess the prevalence and factors associated with depression in Geriatric population (≥60 years) living in urban slums. MATERIALS AND METHODS Study setting: The study was done in the field practice slum area of urban health training center. As per census 2011 there were 7047 households in the slum areas including 19.92% of total population in Gandhinagar Municipal Corporation. Out of which 627 households were covered by urban health training center of GMERS Medical College, Gandhinagar Study type: Cross sectional Study participants: Geriatric people -person having age ≥60 years. Exclusion criteria: Persons who were Comatose, with preexisting mental or psychiatric illness, who could not hear and/or speak and Non-cooperative were excluded from the study. Sample size and Sampling technique:A sample size of 150 was obtained using the hypothesis testing method and based on following assumptions: 95% confidence intervals, 39.04% prevalence of depression in geriatric population from previous study in Surat city of Gujarat state13 and 10% margin of error. The calculated minimum sample was inflated by 10% to account for anticipated subject non response. Geriatric participants were acquired purposively by house to house survey in the field practice slum area of urban health training center. Measurement tools: There was a face to face interview in form of pre designed structured questionnaires. Questionnaire comprised of two parts: First part was of socio-demographic questionnaire and second part was of Geriatric Depression Scale- short Form (GDS-15). Socio-demographic details included information regarding name, age, gender, marital status, education, occupation, monthly total family income, family type, self-reported comorbidities etc. For the assessment of the Depression, Geriatric Depression Scale-15 (GDS-15), prepared by Sheikh et al., (1986)16 was used. It is easy to administer and needed no prior psychiatric knowledge. Hindi version2 and Guajarati version12 were also applied successfully in previous studies. Total score is 15. Cut-off score for GDS-15 is 5. Score > 5 was suggestive of Depression. Score of 5 to 8 suggested mild depression, 9 to 11 suggested moderate depression and 12 to 15 was considered as severe depression Data collection: After approval from Institutional Ethical Committee, data collection was carried out. House to house survey was done to find the study participants. After acquiring the study participants, the details regarding the study viz. purpose of the study, method of the study were explained in the vernacular language to each subject and head of the family. Participant’s information sheet was provided to each and every participants. Written consent was taken from the each subject with assuring that their name will not be disclosed other than the persons concern with the study. As far as possible privacy was maintained while conducting interview. Questionnaire was filled by personal interview. Questionnaire consistedof two parts. First part contained socio demographic details Second part of questionnaires had Gujarati translation of Geriatric depression Score- short form (GDS15). Study variables: Age, gender, marital status, occupation, education, source of income, involvement in recreational and spiritual activities, intake of alcohol, smoking habits, other existing morbidities, poly-pharmacy were predictor variables. Outcome variable was in form of geriatric Depression Score. A score > 5 was considered as depression. Score of 5 to 8 suggested mild depression, 9 to 11 suggested moderate depression and 12 to 15 was considered as severe depression Statistical methods: Data were entered in Microsoft excel 2007 and they were analyzed through Epi info 7. For continuous variables range, mean and standard deviation were calculated and for categorical variables proportion and percentage were obtained. To know the association between dependent and independent variable chi-square or z-test was applied accordingly. Odds ration with 95 % confidence interval was calculated. A value of p less than 0.05 was considered as statistically significant. RESULTS Table 1 shows that majority of the participants (59.33%) belonged to age group of the 60-70 years. Proportion of male subjects is higher (54.7%) in the old age group. Most of the subjects (94.00%) belonged to Hindu religion. Out of the total respondents 76.6% were married and 20.7% were widow/ widower. Those subjects living alone constituted 7.3% and rest 92.7% lived with their families. Overall 60% subjects were illiterate and 40% subjects were literate. Higher education was quite low in both male and female (12.7%). Moreover 80% of the subjects were not working (either retired or unemployed).Around 97 % study participants were not engaged in any form of recreational activities. It can be inferred that they ledan inactive lifestyle but 70% of subjects had a regular participation in religious and spiritual activities. (Table 1)  Overall prevalence of depression among the old age group is 30.7% with mean score 7.43 and standard deviation 3.08. Old age females had prevalence of 33.82% as compared to old age males having 28.04%. (Table-2) Table 3 shows univariate analysis of the factors associated with depression among the elderly participants. The association between depression and age, gender and marital status was not statistically significant. Depression was significantly higher among participants who were living alone compared to those who were living with their wives and/or children (OR=2.93, CI=1.0-8.67).Participants with no formal education were significantly more depressed as compare to literate (OR=2.17, CI=1.01-4.17).Elderly participants having more than two chronic morbidities were more depressed and association was also statistically significant (OR=5.09, CI=2.18-12.07). There was also statistically significant association between depression and poly-pharmacy OR=2.73, CI=1.26-5.97). DISCUSSION Present study was carried out in the urban slums of Gandhinagar city of Gujarat state. In present study prevalence of depression was 30.7% among people aged more than 60 years of age. A study done in the Surat city11 of same state showed similar prevalence of depression of 39.04% in old age which is comparable for the same region. A community based study done in Vellore-south India17 (Raj Kumar AP et al 2009) had shown prevalence of depression among elderly was 12.7%. Which is lower than the present study. Jain RK et al18 found prevalence of depression among old age was 45.9% which was assessed by geriatric depression scale which was higher than the present study. We have included participants only from urban slums. Another reason in differences in the prevalence may be due to use of different screening tools used to detect depression. In present study females had more depression as compared to males (Table 2). But the association with gender and de-pression was not statistically significant (Table-3). Findings are comparable with a previous study done by Begda A et al12 in a Vadodara city of Gujarat state showed that females had more depression than males. Other studies done in the different regions also showed higher prevalence of depression among females as compared to males.2, 19 Present study shows significant depression among the participants who were living alone (Table 3). This finding is comparable with the previous study done in Malasiya.1 In our study literacy was significantly associated with depression (Table 3). Due to illiteracy, there is unavailability of good jobs which leads to unproductive and frustrated life may lead to depression. Studies done by Ganguly et al and Jain RK et al showed similar results.2, 18. Our study proves significant relationship between chronic illness and depression (Table 3). Also, there was a significant association between poly-pharmacy and depression (Table 3). Hypertension, diabetes, age related morbidities like osteoarthritis, cataract, dental problems and may other diseases are quite common among geriatric age group. People among slums are also economically poor and some of chronic diseases require round the clock medications which they can hardly afford. So, they are physically, mentally as well as economically frustrated and this may be the reason of the depression. Other studies done by Pennix et al, Dorsey SM et al, and Tellez-Zenteno et al had also proved this fact.19, 20, 21 CONCLUSION Prevalence of depression among geriatric age group in urban slum area was 30.7%. Prevalence among female was 33.82% and among male was 28.04%. Depression among geriatric population was significantly associated with illiteracy, living alone, chronic morbidity and poly-pharmacy. Funding: Presenting study was carried out as a short term student scholarship which was funded and supported by Indian Council of Medical Research (ICMR) Conflict of interest: None ACKNOWLEDGEMENT We are thankful to all study participants for their full cooperation during the study Englishhttp://ijcrr.com/abstract.php?article_id=236http://ijcrr.com/article_html.php?did=2361. Sherina MS, Rampal L, Mustaqim A. The Prevalence of Depression among the Elderly in Sepang, Selangor. Med J Malaysia 2004; 59(1):45-49. 2. Ganguli M, Dube S, Johnston JM, Pandav R, Chandra V, Dodge HH. Depressive symptoms, cognitive impairment and functional impairment in a rural elderly population in India: a Hindi version of the geriatric depression scale (GDS-H).Int J Geriatr Psychiatry1999; 14(10):807-20. 3. Dasgupta A, Ray D, Roy S, Sarkar T, Ghosal A, Das A, Pal J. Depression among the Geriatric Population is a Matter of Concern: A Community Based Study in a Rural Area of West Bengal. Nepal Journal of Epidemiology 2013; 3(4): 282-287. 4. Seby K, Chaudhari S, Chakraborty R. Prevalence of Psychiatric and physical morbidity in an urban geriatric population. Indian Journal of psychiatry 2011; 53(2):121-27. 5. Singh C, Mathur JS, Mishra VN, Singh JB, Garg BS, Kumar A. IJCM 1995; 20(1-4):24-27 6. Tipple P, Sharma SN, Shrivastave AS. Psychiatric morbidity in geriatric people. Indian j Psychiatry 2006;48:88-94 7. Manthorpe J, Iliffe S. Suicide in later life: public health and practitioner perspectives. Int J Geriatr Psychiatry2010; 25:1230- 8. 8. Shah A, Herbert R, Lewis S, Mahendran R, Platt J, Bhattacharyya B. Screening for depression among acutely ill geriatric in patients with a short geriatric depression scale.Age and Ageing1997;26:217-221 9. Chou K L, Chi I. Prevalence and correlates of depression in Chinese oldest-old. International Journal of Geriatric Psychiatry 2005:41–50. 10. Khattri JB, Nepal MK. Study of depression among geriatric population in Nepal. Nepal Med Coll J 2006;8(4):220-3 11. Jariwala V, Bansal RK, Patel S, Tamakuwala B.A study of depression among aged in Surat city. National Journal of Community Medicine 2010; 1(1):47-49 12. Begda A, Kantharia SL. Screening of Cognitive Impairment and Depression in Elderly Patients.Indian Journal of Gerontology 2006;20( 4): 347-58 13. Vishal J, Bansal RK, Patel S, Tamakuwala B.A study of depression among aged in surat city. National Journal of Community Medicine 2010; 1(1):47-49. 14. Barua, A, Kar, N. Screening for depression in elderly Indian population. Indian journal of psychiatry 2010;52(2):150-53 15. Lee, Y, Lin, P. Y, Hsu, S. T, Cing-Chi, Y, Yang, L. C, Wen, J. K. Comparing the use of the Taiwanese Depression Questionnaire and Beck Depression Inventory for screening depression in patients with chronic pain. Chang Gung Med J 2008; 31(4):369- 377. 16. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS) - Recent evidence and development of a shorter version. Clinical Gerontologis 1986; 5: 165-173. 17. Rajkumar AP, Thangadurai P, Senthilkumar P, Gayathri K, Prince M, Jacob KS. Nature, prevalence and factors associated with depression among the elderly in a rural south Indian community. International Psychogeriatric 2009; 21:2, 372–378 18. Jain RK, Aras RY. Depression in geriatric population in urban slums of Mumbai. Indian J Public Health. 2007; 51(2):112-3. 19. Pennix BWJH, Geerlings SW, Deeg DJH, van et al. Minor and Major Depression and The Risk of Death in older Persons. Arch Gen Psychiat 1999; 56:889-895 20. Dorsey SM, Rodriguez HD, Brathwaite D. Are things really so different? A research finding of satisfaction, illness and depression in rural South African elderly. ABNF J 2002; 13: 41-4. 21. Tellez-Zenteno JF, Cardiel MH. Risk factors and associated with depression in patients with type 2 diabetis mellitus. Arch. Med. Res.2002; 33: 53-60.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241812EnglishN2016June20HealthcareSUBSTANCE ABUSE DISORDER AMONG YOUTH: A CROSS-SECTIONAL STUDY FROM A SLUM IN MUMBAI English0613Abhishek V. RautEnglishBackground: Many of the common causes of morbidity and mortality for today and tomorrow can be prevented by reducing certain categories of behavior among youth with health promotion against tobacco use, alcohol and substance use being one of them. Objective: The objective of the study was to study the magnitude, patterns and various determinants of substance abuse disorders prevalent in the youth population in a slum of Mumbai Materials and Methods: This was a cross-sectional study conducted in Malvani slum area of Mumbai among 540 youth between 15 to 24 years of age. Two stage systematic random sampling method was used with individual household being the sampling unit. Results: 43.5% of the study participants had habit of abusing one or more than one substance. 22.6% of female participantsalso indulged in substance abuse. 28.9% of all substance abusers were consumers of alcohol. The habit of substance abuse began early, with 14% beginning before 13 years of age. Majority (78.3%) had taken to substance abuse in adolescence. Around 1/5th of the monthly wages in 40% of substance abusers was spent on substance abuse. Conclusion: The gap between knowledge and practice was marked in case of substance abuse. Alternative approaches will have to be tapped to find out the effective strategies to prevent the youth from indulging in substance. EnglishYouth, Substance abuse, Tobacco, Smoking, AlcoholINTRODUCTION Youth are critical to the development of the society. They have a right, as well as duty, to be a part of this development. The international health agenda focuses on the achievement of the Millennium Development Goals (MDGs). Each of these goals is related directly or indirectly to the health and development of youth.(1) Almost half of the current global population is under the age of 25, making it a very youthful world. There are around 1.2 billion young people in the world today, and the next generation of youth, children less than 15 years of age will be soon a part of this vulnerable group swelling the population to 1.8 billion. Poverty, illiteracy, unemployment, high-risk behavior, substance abuse make a clear case for investing in young people. (2) Youth are defined as women and men age 15-24. The youth of India, representing a fifth of our population, constitutes a vital and vibrant human resource.(3)The youth population in an urban slum area is a vulnerable population with lack of access to appropriate health information. There is global concern for the rising premature morbidity and mortality due to non-communicable diseases (cardiovascular diseases, diabetes, obesity, cancers, non-communicable lung diseases etc).(4) Since non-communicable diseases(NCDs) are slowly evolving diseases, their early clinical recognition is difficult. These diseases are very closely related to changing lifestyle patterns and hence, early detection of some parameters will help in preventing the progress of disease. These parameters have been labeled as ‘risk factors’, since their presence or absence directly influences disease occurrence. A group of risk factors may influence the occurrence of more than one disease. The basis of non-communicable diseases prevention is the identification of these major common shared modifiable risk factors and their prevention and control.(5) The major risk factors for these non-communicable diseases are smoking, alcohol abuse, a sedentary lifestyle, and an unhealthy diet. As a result, 40-50% of non-communicable disease related, premature deaths are preventable.(6) Small changes or modifications made in the lifestyles of youth done today will determine the health of these youth in the future and indirectly will reflect on the development and betterment of community. (1) Apart from the obvious effects that substance abuse have either in terms of morbidity and mortality, the burden of indulgence in substance abuse to the economy of a nation is often substantial in terms of loss of productivity, increased absenteeism, loss of employment, and health care expenditures. (6) Hence we thought it prudent to conduct a study on youth population focusing on the substance abuse with an objective to study the magnitude, patterns and various determinants of substance abuse disorders prevalent in youth population, as substance abuse especially tobacco and alcohol are one of the most important shared modifiable risk factors for noncommunicable diseases prevention besides rendering the youth vulnerable for psychological dependence and antisocial activities. MATERIALS AND METHODS This was a cross-sectional study conducted in Malvani slum area of Mumbai. The study population included youth between 15 to 24 years of age as defined by the United Nations Population Fund (United Nations, 2009) and as has been used while describing the profile of youth in National Family Health Survey-3. (3), (7) Two stage systematic random sampling method was used with household being the sampling unit. The population of entire slum area was approximately 1,41,900. The study area was divided into six areas based on the geographical boundaries. The areas were numbered from I to VI. In stage I, by using simple random sampling method, one area (Patel compound) was selected for the study purpose with approximate population of 23720 and 4651 households. In stage II, every 10th house was selected for the study purpose. The first household was selected randomly, after which every 10th household was included in the study. The next household moving in the right-hand side direction was selected in the study when either a household was locked or when there were no eligible study participants in a household. Ethical approval was taken from the Institutional Ethical Committee while written informed consent was taken from the youth. The total numbers of households interviewed for the study purpose were 466. In the 466 households 586 potential study participants were found. 46 (7.9%) who did not consent for participation were excluded from the study and hence the sample size was 540. All the eligible population in a household between the age group of 15 to 24 years who were living in the study area for more than 6 months of age, were included in the study. Data collection instrument was designed by using standard, validated questionnaires based on National Family Health Survey 2005-06. (8) It was pilot-tested and suitably modified to meet the study objectives. It contained questions on baseline demographic information about individuals in households (age, gender, education, occupation etc), knowledge, attitudes and practices regarding patterns of substance abuse. The Alcohol Use Disorders Identification Test (AUDIT) tool was used for assessment of alcohol dependency in study participants. (9)Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 16 software. Univariate and bivariate analysis was performed to find out the variables having significant associations. A multivariate logistic regression was performed to find out the predictors for substance abuse among the youth. RESULTS 540 youth were found in the 466 household interviewed for study purpose. 37.7% of the youths were in the adolescent age group (10-19 years). 283 (52.4%) participants were males while 257 (47.6%) were females. 61.1% of the participants were Muslims, 38.1% were Hindus while other religions constituted 0.8% of study participants. 206 (38.1%) of the participants were married. 72.8% of the study participants lived in joint families, 8.7% lived in nuclear families while 18.5% of the population was living either with some of their relatives or staying at their work place e.g. ‘jarikarkhana’. 37 (6.9%) of participants were illiterate and had never gone to school. As compared to males (34.6%) more females (58.4%) had received primary education however 15.3% males had received higher education as compared to 5.1% among females. 85.6% females were unemployed while majority of males (48.4%) were involved in semiskilled jobs.81.5% of the participants belonged to the poor socio-economic class by modified B G Prasad’s socio-economic classification while only 1.1% belonged to upper high category. As shown in Table 1,43.5% of the participants had history of substance abuse. Tobacco chewed in raw form was the most common (91.5%) substance abuse seen followed by smoking (46.4%). 14.5% abused other substances like ‘bhang goli’, whitener solution, charas etc. Most of them abused more than one substance simultaneously. 98.5% of the participants said that they are aware that health hazards could be caused by such substance abuse, as is depicted in Table 2. Cancer was the most common condition named by 46.9% followed by Tuberculosis. 14.1% who had answered in affirmative for health hazard awareness couldn’t specify any particular condition or disease. 10.4% named conditions like chest pain, cough, and abdominal pain as hazards that could be caused by substance abuse. Table 3 shows the age of initiation for substance abuse, 14% of those who had a history of substance abuse had began before 13 years of age. Majority (78.3%) had taken to substance abuse in adolescence. As shown in Table 4, 31.1% of the participants said that they knew of legal prohibitions for preventing substance abuse. However 58.3% could not specify any specific law, 25.5% were aware of ban on smoking in public places. Table 5 shows the reasons stated by the study participants for initiating the habit of substance abuse.91.4% who had taken up to substance abuse had at least one family member who abused similar substance in their homes. Peer pressure was identified as the cause for starting substance abuse by 85.5% of abusers. 61.2% owed their habit of substance abuse to inquisitiveness. Table 6 shows gender wise distribution of study participants by substance abuse.22.6% of the females had substance abuse history. The association between male gender and substance abuse was found to be statistically significant, Chi square value was 87.5 with DF = 1 and P < 0.001. As shown in Table 7, the association between substance abuse by participants and substance abuse in their families was found to be statistically significant (Chi square value 21.4 with DF=1 and PEnglishhttp://ijcrr.com/abstract.php?article_id=237http://ijcrr.com/article_html.php?did=2371. United Nations. Guide to the Implementation of the World Programme of Action for Youth. 2006. 2. United Nations. World Youth Report 2005. Young people today, and in 2015. [Internet]. United Nations publication. 2005. Available from: http://www.un.org/esa/socdev/unyin/documents/wyr05book.pdf 3. Sulabha Parasuraman, Sunita Kishor, Shri Kant Singh and YV. A Profile of Youth in India [Internet]. Mumbai; 2009. Available from: http://www.rchiips.org/nfhs/youth_report_for_ website_18sep09.pdf 4. Alwan A, Armstrong T, Bettcher D, Branca F, Chisholm D, Ezzati M, et al. Global status report on noncommunicable diseases 2010 [Internet]. World Health Organization. 2011. Available from: http://www.who.int/nmh/publications/ncd_report_full_ en.pdf 5. World Health Organization. Preventing Chronic diseases - a vital investment: WHO Global report [Internet]. World Health Organization. 2005. Available from: http://www.who.int/chp/ chronic_disease_report/full_report.pdf?ua=1 6. D. Wayne Taylor. The Burden of Non-Communicable Diseases in India [Internet]. Hamilton, Ontario, Canada; 2010 [cited 2015 Jul 15]. Available from: http://www.cameroninstitute.com/wpcontent/uploads/2014/11/044_The-burden-of-non-communicable-dieases-in-India.2010.pdf 7. United Nations. Definition of youth [Internet]. 2014. Available from: http://www.un.org/esa/socdev/documents/youth/factsheets/youth-definition.pdf 8. International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005- 06: India: Volume I. 2007. 9. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The alcohol use disorders identification test [Internet]. World Health Organization. 2001. Available from: http://whqlibdoc.who.int/ hq/2001/who_msd_msb_01.6a.pdf 10. Tiwari R. Tobacco use and cardiovascular disease. A knowledge, attitude and practice study in rural Kerala. Indian J Med Sci 2006; 60:271-6. 11. Gajalakshmi V, Asma S, Warren CW. Tobacco survey among youth in South India. Asian Pac J Cancer Prev 2004; 5:273-8. 12. Sinha D N, Gupta P C, Pednekar M. Tobacco use among students in Bihar (India). Indian J Public Health 2004; 48:111-7. 13. Kotwal A, Thakur R, Seth T. Correlates of Tobacco-use pattern amongst adolescents in two schools of New Delhi, India, Indian J Med Sci, Vol. 59, No. 6, June 2005, 243-252. 14. Kadri A. M, Bhagyalaxmi A: A Study of Socio-Demographic Profile of Substance Abusers Attending a De-Addiction Centre in Ahmedabad City. Indian Journal of Community Medicine, Vol. 28, No. 2 (2003-04 - 2003-06). 15. Pandey G K, Raut D K, Hazra S, Vajpayee A, Pandey A, Chatterjee P. Patterns of tobacco use amongst school teachers. Indian J Public Health. 2001 Jul-Sep; 45(3):82-7. 16. Alam A Y, Iqbal A, Khalif B M, Laporte R E, Ahmed A, and Nishtar S. Investigating socio-economic-demographic determinants of tobacco use in Rawalpindi, Pakistan, BMC Public Health. 2008; 8: 50. PMCID: PMC2268929. 17. A study on economic factor in context of curative health care in Saharia tribe of Madhya Pradesh: Annual report 2002, ICMR Jabalpur.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241812EnglishN2016June20TechnologyEFFECT OF CORROSION ON THE MECHANICAL PROPERTIES OF STEEL REINFORCEMENT English1420Ponjayanthi D.English Vinodh K.R.EnglishReinforced concrete structures in coastal areas under goes severe damage due to corrosion of reinforcement during its design life. The gradual degradation of the structural integrity due to corrosion results in considerable financial burden. Such structure when subjected to seismic action undergoes severe damage. Under the action of seismic loads, the reinforcement bars are subjected to tension and compression. Hence in present study, the effect of corrosion on the mechanical properties of reinforcement is studied. In compression test there is no significant reduction in average ultimate stress and average ultimate load for corrosion level of 5% for specimens with L/D ratio of 10 and 15. The reduction in average ultimate load is not proportional to the level of corrosion. It is also observed that the percentage decrease in average ultimate load is higher than the level of corrosion. It could be noted that the average ultimate stress decreases slightly lesser than the level of corrosion. The effect of L/D ratio affects both average ultimate load and ultimate stress significantly. In cyclic test the maximum load decreases slightly lesser than the level of corrosion. It is also observed that the percentage decrease in maximum stress in cyclic test is lesser than the level of corrosion in tension and it is higher than the level of corrosion in compression. A huge reduction in both mean load and mean stress beyond 0.5% of strain in compression is observed in cyclic test. EnglishReinforced concrete, Corrosion, Severe damage, Ultimate load, Ultimate stressINTRODUCTION Reinforced concrete structures are durable and strong, hence are versatile. However, reinforced concrete exhibit structural distress due to inadequate design, substandard construction practice and environmental effects or a combination of above factors. Corrosion of reinforcing bars is the most common environmental effect that results in premature deterioration of reinforced concrete structures. The diameter of the steel bar diminishes causing reduction in cross section and thereby affecting the load carrying capacity of member. Corrosion reduces the ductility of the steel and energy absorption capacity of steel significantly (Du et al. (2005), Almusallam (2001), Palsson and Mirza (2002). It is well known reinforced concrete structures in coastal areas; under goes severe damage due to corrosion of reinforcement during its design life. The behavior of corroded rebar under tension is well understood. Hence in present study, the effect of corrosion on the mechanical properties of reinforcement is studied. METHODOLOGY Corrosion of steel in concrete is a slow process. Due to protective nature of concrete, it takes reasonably a long time for initiation and progress of reinforcement corrosion even in the case of severe exposure conditions which is too long for laboratory studies. It is difficult to achieve a significant degree of corrosion in reinforcement within a limited duration (Shamsad Ahmad, 2009). Thus for laboratory studies, the corrosion is accelerated. Acceleration corrosion process is a technique based on the fact that corrosion process is activated by Chloride ions and accelerated by electrical polarization of the reinforcement steel. For present study the rebars are subjected to three different levels of corrosion viz, 5%, 10% and 20% of weight loss over the gauge length and also the L/D ratio of the specimen are varied as 5, 10 and 15. Three specimens are tested for each case hence totally 36 specimens of 8mm diameter are tested in compression. The details of test specimens are given in table I ACCELERATED CORROSION PROCEDURE Accelerated corrosion is carried out by connecting reinforcement to the positive terminal (Anode) of the DC pack and the stainless steel plates to the negative terminal (Cathode) of the DC pack of 32V and immersing reinforcement rod in 3.5% NaCl solution. The time taken for inducing particular level of corrosion is estimated based on Faraday’s law of electrolysis and the typical accelerated corrosion test setup is shown in figure 1. Typical calculation to estimate time required for corrosion: EXPERIMENTAL PROGRAMME COMPRESSION TEST ON REBARS The compression tests are carried out on Compression Testing machine of 2000kN capacity in load control mode. The steel specimen are mounted between the grips and subjected to monotonic increase in loading till failure. The initial lengths between the grips are noted and displacements of the ram during the test are measured using LVDT. The applied loads are monitored using load cell. Figure 2 gives the typical test setup. The load data from load cell and LVDT are acquired using data logger (MGC+) at the sampling rate of 50Hz. The load is increased monotonically till the failure. Totally 36 numbers of specimens are tested under compression on 8mm diameter by varying L/D ratio and different level of corrosion. Three L/D ratios are chosen for study are 5, 10 and 15 and are subjected to three levels of corrosion (5%, 10% and 20%). It is also observed that with increase in level of corrosion the buckling load decreases. It is observed that for L/D ratio of 15 the influence of corrosion decreases the load carrying capacity drastically. Hence, cyclic tests are carried out on failure pattern of specimen with L/D ratio 15. 16mm diameter bars with L/D ratio of 15 and subjected to three levels of corrosion namely 5%, 10% and 20%. CYCLIC TEST ON REBARS A total of 12 specimens are subjected to reverse cyclic loading for L/D ratio of 15 with three different levels of corrosion. Cyclic test carried out on servo controlled Universal Testing machine of capacity 250kN with a grip length of 80mm as shown in figure 3. The displacement and load are recorded using data acquisition system (MGC+). The specimens are subjected to reverse cyclic loading in displacement control mode. The displacement histories are calculated as percentage strain shown in figure 4. Three cycles of each displacement are applied. All the specimens failed at the centre except one specimen with 20% of corrosion. RESULTS OBSERVED COMPRESSION TEST RESULTS Average ultimate stress and load observed in compression tests are given in Table II. The ultimate stresses reported are calculated as load divided by reduced area due to corrosion. The reduced area is obtained by calculating diameter of the rebar at ten locations over the gauge length by digital vernier caliper are shown in Table III. The mean of ten readings are recorded as the diameter of the reduced area due to corrosion. Variation in ultimate stress and ultimate load with respect to different L/D ratio for each level of corrosion is shown in figure 5 to 10. OBSERVED CYLIC LOAD–DISPLACEMENT RESPONSE The mean load- displacement graphs observed from cyclic tests are shown in following figure 11 to figure 14. OBSERVED CYCLIC STRESS-STRAIN RESPONSE The mean stress verses strain observed from the cyclic tests are shown in following figure.15 to figure.18. CONCLUSIONS FROM COMPRESSION TEST ON REBAR` • It is observed that there is no signification reduction in average ultimate stress and average ultimate load for corrosion level 5% for specimens with L/D ratio of 10 and 15. • It could be observed that reduction in average ultimate load is not proportional to the level of corrosion. It is also observed that the percentage decrease in average ultimate load is higher than the level of corrosion • It could be noted that the average ultimate stress decreases slightly lesser than the level of corrosion. For example, for 20% level of corrosion the average ultimate stress is reduced by 9.1% and 9% for L/D ratio of 10 and 15. • The effect of L/D ratio affects both average ultimate load and ultimate stress significantly. FROM REVERSE CYCLIC TEST ON REBAR • It could be noted that the maximum load decreases slightly lesser than the level of corrosion. It is also observed that the percentage decrease in maximum stress is lesser than the level of corrosion in tension and it is higher than the level of corrosion in compression. • It is observed that there huge reduction in both mean load and mean stress beyond 0.5% of strain in compression. ACKNOWLEDGEMENT Apart from the efforts of me, the success of this project work depends on the encouragement and guidelines of many others. I take this opportunity to express my gratitude to the people who have been instrumental in the successful completion of this project. I am happy to express our proud reverence and deep sense of gratitude to my external guide Ms. A. Kanchanadevi, Scientist, ACTEL, CSIR-SERC, Chennai. I greatly benefited under the invaluable guidance, efficient encouragement, and informative suggestions. 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=238http://ijcrr.com/article_html.php?did=2381. Johnet, D. G. (1980) “corrosion measurements of reinforcing steel and monitoring of concrete structures” proc. Of the symposium on corrosion of metal in concrete corrosion /87. 159-167. 2. Aziz, M. A. and Ramaswamy, S. D. (1981) “Steel corrosion in concrete marine structures” Building Research practice. 118 -122. 3. Gjory, O. E. (1986) “Diffusion of dissolved oxygen through concrete” Mater. Perform. vol.25, no.12. 4. Okada, K. and Miyagawe, T. (1980) “Chloride corrosion reinforcement steel in cracked concrete”, proceedings International Symposium on offshore structures coppe., 61-78. 5. Kashani, M. M, Crewe, A. J. and Alexander, N. A. (2012) “ Stress- Strain response of corroded reinforcing bars under monotonic and cyclic loading” 6. Du, Y. G., Clark, L. A. and Chan, A. H. C. (2005a) “Residual capacity of corroded reinforcing bars.” Mag. of Con. Res., 57(3), 135–147. 7. Almusallam, A. A. (2001) “Effect of degree of corrosion on the properties of reinforcing steel bars.” Constr. and Building Mat., 15, 361-368. 8. Ou Y., Tsai L., Chen H. (2011) “Cyclic performance of large scale corroded reinforced concrete beams” Earthquake Eng. Struct. Dyn., 41 (4), 592-603. 9. Apostolopoulos, Ch. Alk. (2007) “Mechanical behavior of corroded reinforcing steel bars s500s tempcore under low cycle fatigue.” Constr. and Building Mat., 21, 1447–1456. 10. Sekhar, S. N., Raghunath, P. N. (2013) “Static and cyclic behaviour of high performance corroded steel concrete” Jour. Of engg and advanced technology. vol.2. 11. Xia, J., Zhao, Y., Jin, W. and Li, L.(2013) “ Mechanical properties of corroded steel bars in concrete” Structures and buildings., 235-246. 12. Impertone, S. and Rinaldi, Z. (2009) “Mechanical behavior of corroded rebars and influence on the structural RC elements” Concrete Repair, rehabilitation and retrofitting II. 13. Shamsad Ahmad (2009) “Techniques for inducing accelerated corrosion of steel in concrete” The Arabian Journal for Science and Engineering .vol.34.  

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241812EnglishN2016June20HealthcareCORRELATION OF MICROALBUMINURIA AND C-REACTIVE PROTEIN AS MARKERS OF SEPSIS English2124Shruti R. MulgundEnglish Subodhini A. AbhangEnglishSepsis is one of the challenges for the doctors who treat critically ill patients. Delay in diagnosis and late administration of antibiotics have been shown to increase the mortality in this cohort. Objective: This study was done to evaluate whether microalbuminuria can be used as a marker of sepsis and also to compare with the levels of C-reactive protein (CRP a traditional marker) of patients admitted in ICU. The study was carried out in the department of Biochemistry, B.J. Medical College and Sassoon general hospitals, Pune. Method: 50 adult patients with ICU stay of more than 24 hrs were included in the study. 50 healthy and age, sex matched controls were also included in the study. Patients with pregnancy, menstruation, anuria, macroscopic hematuria, urinary tract infection, any renal disorder and marked proteinuria were excluded from the study. Blood and spot urine samples were collected on admission and after 24 hrs. Urinary microalbumin was measured in terms of albumin creatinine ratio (ACR) and serum CRP levels were measured on ICU admission (ACR1,CRP1) and after 24 hrs (ACR2,CRP2). Results and Conclusion: In the study we observed that there was a marked correlation between ACR1 and CRP1 (r=0.786) and also ACR2 and CRP2 (0.787). There was a significant increase in the values of both the parameters on admission as compared to controls (pEnglishMicroalbuminuria, Critically ill, CRP, Systemic inflammationINTRODUCTION Sepsis is defined as the presence of the Systemic Inflammatory Response syndrome (SIRS) and a presumed or confirmed infection. It is a condition which is difficult to diagnose as the clinical and laboratory signs are similar to those presented in different severities of SIRS. So the mortality due to severe sepsis remains high, despite advances in its management (1). Sepsis develops when the initial appropriate host response to an infection becomes amplified, and then disregulated (2). In sepsis the endothelium has key roles in regulating vascular tone and permeability and its activation is pivotal in initiating both the inflammatory and coagulation cascades (3). Inflammatory mediators such as tumor necrosis factor, interleukins and oxygen free radicals can dramatically alter the role of the endothelium in acute diseases and in sepsis particularly (4-7). The inflammatory response is associated with an increase in the vascular permeability due to damage of the vascular endothelium. There have been many attempts to augment clinical decision making with diagnostic tests to increase sensitivity and specificity when diagnosing and treating sepsis and bacteremia. Initial studies employed fever and leukocytosis to define sepsis (8,9), though these tests were nonspecific. Subsequent studies focused on erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to help in the diagnostic algorithm. CRP is commonly used as a marker of an acute inflammatory state. Plasma concentration of CRP has been reported to parallel the clinical course of infection, and the fall of the protein level indicating the resolution of infection (10,11). Inspite of being a traditional marker of sepsis it is not specific enough for clinicians to give their clinical judgement. Microalbuminuria (MA) is known to be a sensitive expression of the increased permeability of the systemic microcirculation (12,13). Microalbuminuria, typically defined as albumin excretion in urine of 30-300 mg/24 hrs, occurs rapidly after acute inflammatory insult and is shown to be associated with outcomes in many clinical settings, including sepsis, multiple trauma and intracranial hemorrhage (14-16). The mechanisms of development of microalbuminuria, have been extensively studied but remain elusive (16). In view of all these facts the present study was planned to estimate the serum CRP levels and urinary microalbumin levels in patients admitted in ICU having SIRS. AIMS AND OBJECTIVES To evaluate whether microalbumin can be used as a marker of sepsis and the correlation between the levels of microalbumin and CRP ( the inflammatory marker) on the day of admission and at 24 hrs. The aim was achieved by following objectives; estimation of serum CRP levels, estimation of urinary microalbumin and creatinine levels and their ratio. Microalbumin was expressed as the Albumin/creatinine ratio(ACR) to correct for variations in urinary flow rate (17). MATERIAL AND METHODS The study was carried out in department of Biochemistry, B.J. Medical College, Pune. Patients admitted in medical and surgical ICU were screened for signs of SIRS and then 50 adult patients (Age >18 yrs) with SIRS and ICU stay for more than 24 hrs from Sassoon General hospitals Pune were included in the study. 50 age and sex matched healthy controls were analyzed for comparison. On admission, the following data was collected for each patient: age; gender; date and time of admission, provisional diagnosis; co-morbid conditions such as diabetes, hypertension and chronic kidney disease. Clinical and laboratory data was collected; cultures sent and antibiotics administered within 24 hours of admission were noted. Exclusion criteria: Patients having anuria, macroscopic hematuria [confirmed with dipstick], female patients with menstruation or pregnancy were excluded. Retrospectively, patients with significant proteinuria [more than 1+ protein on dipstick] due to renal and post renal causes, for example urinary tract infection, were excluded. Pediatric patients were also excluded. The study was carried out after the approval from institutional ethical committee. Collection of serum: 5ml of intravenous blood samples of the subjects was also collected, centrifuged to separate the serum and stored at -20ºC till the analysis was done. Estimation of CRP Estimation of CRP was done by Turbilatex kit method. The reagent CRP-Turbilatex agglutination assay is a quantitative turbidimetric assay for measurement of CRP in human serum. (18) CRP levels were also referred as CRP1 and CRP2 i.e. patients sample collected on the day of admission and after 24 hrs of admission. Estimation of Urinary microalbumin (ACR) Spot urine samples were collected within 6 hours of admission and again at 24 hours, for quantification of ACR, which were referred to as ACR1 and ACR2 respectively. Urine samples were stored at -20°C till analysis. Urinary microalbumin was measured by the immunoturbidimetric method and urinary creatinine by modified kinetic Jaffe reaction .The methods covered an analytical range of 1.3–100 mg/L for microalbumin and 0-20 mg/dl for creatinine. Microalbuminuria was defined by ACR values between 30 and 299 mg/g. ACR of > 300 mg/g is considered as clinical proteinuria. ACR < 30 mg/g is normal for a healthy population.(14) However, to obtain comparable data, microalbumin was expressed as the microalbuminuria/creatinine ratio to correct for variations in urinary flow rate (17). These threshold values are well accepted for clinical use and have been predefined on the basis of published literature. Statistical analysis: Results are presented as mean ± standard deviation value and statistically analyzed by Student’s t’ test. A ‘p’ value of 0.05 or less was considered significant RESULTS CRP has been known for a long time to be elevated in inflammatory conditions, including infection, and was used widely as an adjunctive test in sepsis and has often been used as a comparator for newer biomarkers (19). Elevated CRP levels in sepsis have been correlated with increased risk of death and organ failure (20), but in part due to the persistence of elevated levels, were unable to predict survival when evaluating CRP trends(21,22). CRP has been used successfully during initial sepsis diagnosis, but its specificity is further reduced later in the course due to persistently elevated levels(23). The present study was aimed to evaluate the levels of CRP and urinary microalbumin and also to see whether ACR can be useful in the diagnosis of sepsis. CRP was done as a marker of inflammatory response and was correlated with ACR. All fifty patients included in the study showed increased levels of CRP1 and ACR1 as compared to controls (pEnglishhttp://ijcrr.com/abstract.php?article_id=239http://ijcrr.com/article_html.php?did=2391. Angus DC, Pereira CA, Silva E : Epidemiology of severe sepsis around the world. Endocr Metab Immune Disord Drug Targets 2006,6:207-212. 2. Jonathan Cohen: The immunopathogenesis of sepsis: Nature; Vol 420, December 2002; 885-891. 3. Aird WC: The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood 2003,101: 3765-3777. 4. Omar Abid, Qinghua Sun, Kerji Sugimoto, Dany Mercan, and Jean Louis Vincent: Predictive value of microalbuminuria in medical ICU patients. Chest/120/6 December,2001;1984-1988. 5. Remick DG, Kunkel RG, Larrick JW. Acute in vivo effects of human recombinant tumour necrosis factor. Lab invest 1987; 56; 583-590. 6. McCord J. Oxygen derived free radicals. New Horiz.1993;1: 70- 76. 7. Astiz ME, Degent GE, Lin RY et al. Microvascular function and rheologic changes in hyperdynamic sepsis. Crit Care Med 1995;23: 265-271. 8. Bone RC, Balk RA, Cerra FB. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. THE ACCP/SCCM consensus conference committee. Chest.1992;101:1644-1655. 9. George E. Nelson, Vidya Mave, and Amita Gupta : Biomarkers for sepsis : A Review with special Attention to India ; Biomed Res Int.2014;2014:264351. 10. Clyne B, Olshaker JS: The C-Reactive Protein. J. Emerg Med. 1999; 17: 1019-1025. 11. Aldo Luzzani, Enrico Polati, RomoloDorizzi, AlessioRungatscher, RaffaellaPavan, Alberto Merlini: Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003 vol 31,no.6; 1737-1741. 12. Yoshiaki Terao, Masafumi Takada, Takahiro Tanabe, Yuko Ando, Makoto Fukusaki, Koji Sumikawa : Microalbuminuria is a prognostic predictor in aneurysmal subarachnoid hemorrhage : Intensive Care Med ; 2007; 33; 1000-1006. 13. Nakamura M, Onoda T, Itai K, Ohsawa M, Satou K, Sakai T, Segawa T, Sasaki J, Tonari Y, Hiramori K, Okayama A, (2004). Association between serum C-reactive protein levels and microalbuminuria: A population based cross-sectional study innorthern Iwate, Japan. Intern Med.43: 919-925. 14. Basu S, Bhattacharya M, Chaterjee TK, Chaudhari S, Todi SK, Majumdar A. Microalbuminuria: A Novel biomarker of sepsis. Indian J Crit Care Med. 2010; 14(1): 22-28. 15. De Gaudio AR, Adembri C, Grechi S, Novelli GP. Microalbuminuria an early index of impairement of glomerular permeability in post-operative septic patients. Intensive Care Med. 2000; 26(9) 1364-1368. 16. Zhongheng Zhang, Baolong Lu, Hongying Ni, Xiaoyan Sheng, NiJin: Microalbuminuria can predict the development of acute kidney injury in critically ill septic patients. J Nephrol 2013; 26(4):724-730. 17. Dezier JF, Le Reun M, Poirier JY (1988) Usefulness of the urinary albumin / creatinine ratio in screening for microalbuminuria. La PresseMedicale 17/18: 897-900. 18. Lars-Olof Hanson et al. Current opinion in infect diseases 1997; 10; 196-201 Chetana Vaishnavi. Immunology and infectious diseases 1996; 6; 144 19. Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret G-Y. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Critical Care Medicine. 2006;34(7):1996–2003. 20. Lobo SMA, Lobo FRM, Peres Bota D, et al. C-reactive protein levels correlate with mortality and organ failure in critically III patients. Chest. 2003;123(6):2043–2049. 21. Tschaikowsky K, Hedwig-Geissing M, Braun GG, RadespielTroeger M. Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis. Journal of Critical Care. 2011;26(1):54–64. 22. Tschaikowsky K, Hedwig-Geissing M, Schmidt J, Braun GG. Lipopolysaccharide-binding protein for monitoring of postoperative sepsis: complemental to C-reactive protein or redundant? PLoS ONE. 2011;6(8)e23615 23. Sakr Y, Burgett U, Nacul FE, Reinhart K, Brunkhorst F. Lipopolysaccharide binding protein in a surgical intensive care unit: a marker of sepsis?Critical Care Medicine.2008;36(7):2014–2022. 24. Parillo JE (1993) Pathogenic mechanisms of septic shock. N Engl J Med 328: 1471-1477. 25. Gopal S, Carr B, Nelson P. Does microalbuminuria predict illness severity ill patients on the intensive care unit ? A systematic review. Crit Care Med.2006;34:1805-10. 26. Thorevska N, Sabahi R, Upadya A, Manthous C, AmoatengAdjepong Y. Microalbuminuria in critically ill medical patients: Prevalence, predictors, and prognostic significance. Crit Care Med 2003;31:1075-81 27. Gosling P, Czyz J, Nitingale P, Manji M. Microalbuminuria in the intensive care unit: Clinical correlates and association with outcomes in 431 patients. Crit Care Med 2006;34(8):2158-66.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241812EnglishN2016June20HealthcareSCREENING OF ADULTERANTS IN MILK English2529Pradeep S.English P. LakshminarayanaEnglish Varsha R.English Shriya K. KotaEnglishMilk is the most commonly adulterated consumable in India. The addition of urea, detergent, sugars and vanaspati oil to create synthetic milk render it unfit for consumption according to the standards that define the quality of milk. This paper investigates the different milk adulterants and two methods of detecting them. The chemical methods of testing and electrical conductance method were performed. It was found that urease test can detect as low as 0.2 g/L of urea present, iodine test for starch is able to detect 0.04g/L starch present and the sensitivity of Benedict’s test is 5g/L. It was also observed that there was significant difference in conductance of adulterant containing milk from that of raw milk. Therefore these methods can be used for reliable detection of adulterants and can be incorporated into a device for easy detection of adulterants. EnglishAdulteration, Conductance, Chemical methodsINTRODUCTION Adulteration is the act of addition of substances to a product that makes it unfit for consumption. These impurities are added to substitute the contents of a product at a cheaper rate to increase the quantity. Milk adulteration is one of the most common and old form of adulteration. This is because India is the largest country in milk production and consumption according to WSPA (World Society for the Protection of animals) and the National Dairy Development Board, India. As the population increases, the demand will increase because there will be more mouths to feed. To meet the exponentially increasing demand, adulteration is being employed on regular basis. Adulteration not only includes the intentional addition or substitution of materials but also the incidental contamination during the process of preparation, storage and transportation. Adulterated food has adverse effects on heath because of the toxic nature of the substituting compounds or lack of compounds of nutritional value. [1]The most common adulterants added to milk are water, urea [2], starch, oils etc. Consumption of urea will lead to kidney failure, damages the heart and liver. A study in Varanasi showed that the majority of milk consumers are children and these children experienced headache, eyesight problems and diarrhoea due to large scale use of urea.[3]Excessive intake of starch may displace nutrients and contribute to obesity.[4]A 2007 report in the Journal of American Heart Association found that consumption of vanaspati elevates cholesterol levels in the body thus causing diabetes and coronary ailments. A national survey shows that almost 70% of our nation’s milk is adulterated with detergent, neutralizers but impure water was the major contaminant. Water is the most common adulterant; dilution of milk with impure water not only reduces nutritional value to a great extent but also causes water borne diseases. To enhance SNF value of milk, detergents are added which on consumption may cause health hazards.[5] Therefore, a need for methods to detect is entailed. Chemical method of detection is one of the various methods of detection. Here, the adulterant is detected by inducing a reaction with a particular compound thus producing a coloured compound whose appearance is enough to detect whether adulterant is present or not. Furthermore, OD can be read for calculating the concentration of adulterant in the sample. These chemical tests are very specific to a particular compound and hence false positive results will not be obtained. The sensitivity of the certain tests discussed below is very high. It has been found that urease test can detect as low as 0.2 g/L of urea present. [6] Milk conducts electricity due to the presence of ionic minerals of which chloride and sodium ion are key players. The conductivity can be used to detect added neutralizers and other adulterants in milk. [7]The conductance of milk has been used for many decades to measure the fat and protein content of milk. Current research is focused onto determining the quality of milk by measuring the electric admittance of milk.[8]The milk composition and rheology affects the conductivity. Presence of more fats decreases the conductivity of milk. Milk conductance measurement has also been used as a reliable method for detection of mastitis in cows. It is observed that there is a sharp increase in conductance of milk from cows infected with mastitis. Storage period and storage temperature also affects electric conductance. It was observed that storage at 10°C and for short periods maintains the good quality of milk. This is because the microbial flora present in the milk will expand and ferment milk releasing lactic acid that reduces pH of milk. The presence of lactic acid will increase conductance due to formation of lactate ion.[9] MATERIALS AND METHODS The most common impurities found in milk available in India are water, urea, detergent, starch, glucose and Vanaspati or vegetable oils. 1. Impurities in milk were detected by carrying out certain chemical tests according to the protocol given by Food Safety and Standards Authority of India. [10] 2. Preparation of standard graph: a) Starch standard graph: 0.008 g, 0.01g, 0.012g till 0.1g of starch were weighed and dissolved in 20ml of distilled water separately. 2ml of the starch solution was added to test tubes containing 2ml of milk sample each. To the test tubes few drops of iodine solution were added. The violet / blue black colour was read at 420nm.[11] b) Urea standard graph: 0.004g, 0.006g, 0.008g till 0.30g of urea were weighed and dissolved in 20ml of distilled water separately. 2ml of the urea solution was added to 2ml milk sample and 1ml of phenol red was added. The test tubes are incubated in water bath at 35°C for 5mins. Then 0.5 ml of urease was added. The absorbance was read at 670nm (according to enzyme assay protocol by Sigma Aldrich). c) Glucose standard graph: 0.1g, 0.12g, 0.14g till 1g of glucose were weighed and dissolved in 20ml of distilled water separately. 2ml of the glucose solution was added to 2ml milk sample and equal volume of Benedict’s reagent was added into the test tubes. The test tubes were then incubated in boiling water bath for 5 minutes and absorbance was read at 550nm (according to protocol in Lab manual for biochemistry and immunotech). 3. DOE: The conductance was measured using multimeter. The electrodes were dipped in the beaker containing milk solution. The readings were taken at RT around 25°C. A comparative analysis was done. a) The conductance of raw milk was recorded initially followed by boiling the milk for 5 minutes and conductance of boiled milk was read. b) Small amounts (0.001g) of different adulterants were added and conductance was read. c) Dilution with water was done using raw milk and distilled water in different ratios like 1:1(1ml milk and 1ml water) and so on till 1:4. The conductance was measured. d) A milk sample was used to measure the conductance. RESULTS The above tests were performed on milk sample which tested negative for all tests. The tests mentioned above are highly sensitive and can detect even trace amounts of the respective adulterant present in milk. DISCUSSION The sensitivity of urease test was verified. Iodine test for starch is able to detect 0.04g/L starch present. The sensitivity of Benedict’s test was found to be 5g/L. The standard graphs were generated which can be used for finding unknown concentration of the adulterant in samples. The conductance of raw milk was found to be 0.032V. The sample was diluted with water but didn’t contain any of the adulterants mentioned above. The conductance results show that the milk sample is 1:2 diluted. From the conductance and chemical test results it can be concluded that the milk sample is diluted and there was presence of microbial flora. CONCLUSION By performing the above simple tests conclusion can be drawn that the samples are adulterated or not. The chemical tests can be employed to effectively detect these common adulterants because of their high sensitivity. Conductance measurements can be used for qualitative analysis of adulterants. The above conductance tests reveal that it is a reliable method for detection of adulterants. FUTURE SCOPE Since adulteration of food is becoming a common practice due to exploding population in India, it is essential that consumers be aware of the methods for detecting these adulterants and most importantly about the ill effects on human health by short term and long term consumption. Keeping this in mind and by considering the tolerable level of the adulterants, a biosensor can be devised that incorporates the above tests for detection of adulterants. By a single input the adulterants can be detected based on pH change, colour change resulting due to induced chemical reactions and conductance measurements for qualitative analysis. Furthermore, research can be done to increase the sensor’s sensitivity and repeatability by considering the extraneous factors like temperature etc. The sensor can be made such that it can be utilized by consumers at home for easy detection of these adulterants. ACKNOWLEDGEMENT 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. Englishhttp://ijcrr.com/abstract.php?article_id=240http://ijcrr.com/article_html.php?did=2401. FAO/WHO. Assuring food safety and quality: guidelines for strengthening national food control systems. Rome: Food and Agriculture Organization, 2003. 28 p. (FAO food and nutrition paper no. 76). 2. S Das, M Sivaramakrishna, K Biswas, B Goswami (2011), Performance Study Of A ‘ Constant Phase angle Based ’ Impedance Sensor To Detect Milk Adulteration, Sensors and ActuatorsA:Physical, 167(2), 273–278. 3. A Singh, J Sharma and S R Bhatt (2011), Detection of ill-effects of urea adulterated milk in Varanasi, Food Science Research Journal, 2(1), 46-49. 4. Institute of Medicine of the National Academies, Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) , The National Academies Press (2005). 5. The National Survey on Milk Adulteration 2011 (snap shot survey) was conducted by the Food Safety and Standards Authority of India. 6. H Kumar, A Kumar, P Kumari, S Jyotirmai and N B Tulsani (2000), A rapid estimation of urea in adulterated milk using dry reagent strip, Indian Journal of Chemical Technology, 7, 146- 147. 7. J A. C?pri??, Rodica C?pri??, (2006), Effect Of Mineral Composition On The Electrical Conductance Of Milk, Journal of Agroalimentary Processes and Technologies, 12(1), 141-144. 8. B. Kaptan., S, Kay??o?lu., M. Demirci, (2011) The Relationship Between Some Physico-Chemical, Microbiological Characteristics and Electrical Conductivity of Milk Stored at Different Temperature, Food And Agriculture Organization Of The United Nations,8(2), 13-21. 9. L.I. Ilie, L. Tudor, Anca Maria Gali? ,(2010) The Electrical Conductivity Of Cattle Milk And The Possibility Of Mastitis Diagnosis In Romania, Veterinary Medicine Scientific Papers, 43(2), 220-227. 10. Food Safety and Standard Authority of India (FSSAI), Ministry of Health and Family Welfare, Government of India New Delhi 2012, manual of methods of analysis of foods (milk and milk products). p1-22 11. Xiao Z, Storms R, Tsang A. (2007), A quantitative starch–iodine method for measuring alpha-amylase and glucoamylase activities, Anal Biochem, 351(1), 146-148.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241812EnglishN2016June20HealthcareA DRUG UTILIZATION STUDY OF FIXED DOSE COMBINATIONS USED IN HYPERTENSION IN RURAL TERTIARY HEALTH CARE CENTRE OF CENTRAL INDIA English3034Shende T.R.English Siddiqui R.A.English Mahajan H.M.EnglishHypertension (HTN) accounts for 7.6 million deaths (13–15% of the total) worldwide. The efficacy of antihypertensive agents in lowering blood pressure (BP) and complications of hypertension is well documented. For prime control of BP, two or more antihypertensive agents are required by large number of patients. Aims and Objectives: To analyze the pattern of fixed dose combinations (FDCs) prescribed for treatment of hypertension and blood pressure `control in patients who came to Medicine department of a tertiary care hospital of central India, to get a better perspective in the fallacies and implement improvements to overcome them for better management of hypertension. Material and Methods: The present study was a cross-sectional retrospective record based observational study conducted at Medicine Department of NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur (M.S.). Results: Out of total 164 case records analyzed, 94 (57.3%) were males and 70 (42.6%) were females. Maximum patients belonged to age group >50 years-64 (39%). FDCs were prescribed in 70 patients out of 164 (42.6%), out of which 2 drug FDCs was used most commonly. Overall most commonly prescribed FDC was that of beta blocker (BB) + calcium channel blocker (CCB) used in 23 patients (32.8%), amongst which metoprolol + amlodipine was most commonly prescribed. Conclusion: In the present study physicians preferred monotherapy over FDCs. Such studies should be conducted on timely basis to detect emerging trends in treatment of hypertension, so that health care policies can be planned accordingly. EnglishFixed dose combinations, Antihypertensive agentsINTRODUCTION Hypertension (HTN) accounts for 7.6 million deaths (13– 15% of the total) and 92 million disability-adjusted life years worldwide, thus acting as major contributor to global burden of disease. It is associated with many deleterious effects like coronary heart disease, stroke, congestive cardiac failure, peripheral arterial disease and renal failure.[1] The efficacy of antihypertensive agents in lowering blood pressure (BP) and complications of hypertension is well documented.[2] For prime control of BP, two or more antihypertensive agents are required by large number of patients.[3,4] Due to multifaceted chemistry between numerous elements like deficiency of apt antihypertensive agents, lifestyle, derisory adherence to drugs/poor patient compliance and meagre acquiescence of physicians with treatment guidelines, majority of patients with HTN do not exhibit fine BP control. [5,6]Drug utilization studies have been defined as evaluation of social, medical and economic outcomes of drug therapy. [7,8]To achieve lucid and cost-effective health care medical audits are done on a timely basis, out of which analysis of prescribing trends, which examine the current scenario in prescribing practices and thus identify potential fallacies and help in formulating policies to overcome them.[9] Such studies also help to identify irrational prescribing habits. Fixed dose combinations (FDCs) are used wherever it is feasible, since they have a positive effect on patient compliance and treatment outcome and this is far more important in view of public health care prospective, which has added benefit that specific FDC of drugs in particular ratio is known for known set of population. This results in increased efficacy, cost effectiveness, patient compliance and reduced adverse drug reactions. From physicians point of view also, this is also beneficial since ultimately physician needs drug such that it achieves therapeutic plasma concentration with least adverse drug reaction/s.[10]There are very limited available data on use of FDCs used in treatment of hypertension used in India.[11]The present drug utilization study analyzes FDCs used in treatment of HTN in order to increase rationality in prescribing medicines and minimize adverse drug reactions. Almost all of the drug utilization studies done on antihypertensive agents are done in urban health care setting, where there is better manpower, health setup, literacy rates, socioeconomic status of patients, which is different as compared to rural health care setting, where situation is more or less opposite. Hence the present study was conducted to establish the drug prescribing trend of anti-hypertensive agents used as FDCs in Medicine department of rural health care setting of central India. AIMS AND OBJECTIVES To analyze the pattern of FDCs prescribed for treatment of hypertension in patients who came to Medicine department of a tertiary care hospital of central India, to get a better perspective in the fallacies and implement improvements to overcome them for better management of hypertension. MATERIAL AND METHOD The present study was a cross-sectional retrospective record based observational study conducted at Medicine Department of NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur (M.S.). The study duration was of three months from November 2015 to January 2016.Medical case records were obtained from Medical Record Department. The study was initiated after taking approval from Institutional Ethics Committee. Extra care was taken to follow all clauses laid down in protocol at each and every step in the study. Inclusion and exclusion criteria as under: Inclusion criteria: 1. All patients admitted coming to Medicine department who were diagnosed with hypertension. Exclusion criteria: 1. Pediatric patients, 2. Pregnant patients. 3. Hypertensive patients taking drugs other than antihypertensive drugs which can modify blood pressure. After screening through all inclusion and exclusion criteria total of 164 case records were chosen and included into the study. All demographic details like age, sex, their basal blood pressure (BP), other co-morbidities, fixed dose combinations used was recorded in specially designed information sheet in Microsoft EXCEL 2013. All data was expressed as n (%). RESULTS Out of total 164 case records analyzed, 94 (57.3%) were males and 70 (42.6%) were females. Maximum patients belonged to age group >50 years-64 (39%) followed by 40 (24.4%) in 41-50 age group, 30(18.2%) in 31-40, 25(15.2%) in 21-30 and least in the age group of 50 years- 148.8/97.3 mm Hg. It was least in the age group 21-30 years age-134.6/89.5 mm Hg. FDCs were prescribed in 70 patients out of 164 (42.6%). Out of which 2 drug FDCs was used most commonly in 61 patients (87.1%) while 3 drug FDC was used in 9 patients (12.9%). Four drug FDC was not used in any of the patient (TABLE 1).Maximum FDCs were prescribed in the age group 41-50 followed by age group >50 years and least in the age group of Englishhttp://ijcrr.com/abstract.php?article_id=241http://ijcrr.com/article_html.php?did=2411. Kasper DL, Fauci AS. Hypertensive Vascular Disease. In: Theodore A. Kotchen editor. Harrison’s principles of internal medicine. 19th ed. McGraw Hill Medical NewYork;2015: 1611. 2. Lemogoum D, Seedat YK, Mabadeje AFB, et al. Recommendation for prevention, diagnosis and management of hypertension and cardiovascular risk factors in sub Saharan Africa. J Hypertension. 2003; 21: 1993-2000. 3. Cushman WC, Ford CE, Cutler JA, et al. Success and predictors of blood pressure control indiverse North American settings. The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens. 2002; 4:339- 40. 4. Olanrewaju TO, Aderibigbe A, Busari OA, et al. Antihypertensive drug utilization and conformity to guidelines in a sub- Saharan African hypertensive population. International Journal of Clinical Pharmacology and Therapeutics 2010; 48(1):68-75. 5. Busari OA, Olarewaju TO, Desalu OO, et al. Impact of knowledge, attitudes and practices on hypertension on compliance with antihypertensive drugs in a resource-poor setting. TAF Preventive Medicine Bulletin 2010; 9(2): 87-92. 6. Monae M, Bohn RL, Gurwitz JH, et al. Th effects of initial drug choice and comorbidity on antihypertensive therapy compliance: results from a population-based study in elderly. Am J Hypertens. 1997; 10:697-704. 7. Kapoor B, Raina RK, Kapoor S. Drug prescribing pattern in a teaching hospital. Ind J Pharmacol. 1985;17:168. 8. Pradhan SC, Shewade DG, Shashindran CH, et al. Drug utilization studies. National Med J India. 1988;1:185. 9. Gupta N, Sharma D, Garg SK, et al. Auditing of prescriptions to study utilization of antimicrobials in tertiary hospital. Indian J Pharmacol. 1997;29:411-5. 10. Tahir A, Gulati K, Mohan L, et al. Evaluation of prescribing pattern of fixed dose combination of drugs in outpatients of cardiology in a tertiary care hospital. World Journal of Pharmacy and Pharmaceutical Sciences 2014; 3(11): 625-32. 11. Manjula Devi AS, Sriram S, Rajalingam B, et al. Evaluation of the rationality of fixed dose combinations of cardiovascular drugs in a multispecialty tertiary care hospital in Coimbatore, Tamilnadu, India. Hygeia J D Med. 2012; 4(1): 51-8. 12. Connor J, Rafter N, Rodgers A. Do fixed dose combination pills or unit-of-use packaging improve adherence? A systematic review. Bull World Health Organ. 2004; 82(12):935-9. 13. Pan F, Chernew ME, Fendrick AM. Impact of fixed-dose combination drugs on adherence to prescription medications. J Gen Intern Med. 2008 ; 23(5):611-614. 14. Ekwunife OI, Ubaka CM. Drug utilization of antihypertensive therapy among patients with compelling indications in two hospitals n south-eastern Nigeria. J Pharm Pharmacol Res. 2011 ; 2(1): 25-28. 15. Busari OA, Oluyonbo R, Fasae AJ, et al. Prescribing pattern and utilization of antihypertensive drugs and blood pressure control in adult patients with systemic hypertension in a rural tertiary hospital in Nigeria. Am J Int Med.2014; 2(6): 144-9. 16. Marrick LK, Ronald SF, Michael MM, et al. Short term and long term effects of metoprolol alone and combined with amlodipine in patients with chronic heart failure. Am Heart J. 1999; 138: 261-8. 17. Lacourciere Y, Tytus R, Keefe DO, et al. Efficacy and tolerability of a fixed dose combination of telmisartan plus hydrochlorothiazide in patients uncontrolled with telmisartan monotherapy. Journal of human hypertension. 2001; 15: 763-770. 18. Marc PM, Michel B. Is the fixed dose combination of telmisartan and hydrochlorothiazide a good approach to treat hypertension Vascular health and risk management. 2007;3(3): 265-278. 19. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206-52.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241812EnglishN2016June20HealthcareGROSS ANATOMICAL VARIATIONS IN THE THEBESIAN VALVE COVERING THE CORONARY SINUS OSTIUM: A CASE STUDY English3538Anitha ThillaiEnglish Anjana TSREnglish Sivakami ThiagarajanEnglishObjectives: The Coronary Sinus (CS) is a widely employed structure for cannulation during electrophysiologic procedures like catheter ablation of arrhythmias, implantation of resynchronization therapy devices and percutaneous mitral valve repair. The present study aims to evaluate the variations in the Thebesian valve covering the coronary sinus ostium. Materials and Methods: The present study was conducted in randomly selected 100 human cadaveric hearts from the Department of Anatomy and autopsied bodies of Department of Forensic Medicine, Thanjavur Medical College. The presence or absence of Thebesian valve, shape of the valve, presence or absence of fenestrations in Thebesian valve were noted. Results: The Thebesian valve was present in 84% and was absent in 16%.The shape of the valve was semicircular in 84.7%, strands in 8.3% and bands in7%.The valve was fenestrated in 20.2%. An interesting variation of double crescentic Thebesian valve was present in one specimen. Conclusion: This study showed that the Thebesian valve was present in 84% of heart specimens. The prominent Thebesian valve or a fenestrated valve or a large band may be an under recognised problem interfering with cannulation. It may pose a significant challenge with regards to cannulation of coronary sinus ostium during various invasive procedures like catheter ablation for arrhythmias, implantation of resynchronization therapy devices and percutaneous mitral valve repair and coronary lead placement. EnglishCoronary sinus, Coronary sinus ostia, Thebesian valve, CannulationINTRODUCTION In the past, the importance of the cardiac venous system had been overshadowed by the proximate presence of the coronary arterial tree. Off late, the venous system has captured wider attention. The veins of the cardiac venous system can be used as a potential conduit in performing coronary artery bypass graft procedures and delivery of stem cells to infarcted myocardium(1). Coronary Sinus (CS) is a short and wide venous trunk of about 2- 3 cm long. It begins as the continuation of Great Cardiac Vein at the confluence of the Oblique vein of the left atrium (Vein of Marshall)(2,3). It lies posteriorly in the coronary sulcus between the left atrium and left ventricle. The sinus opens into the smooth part of right atrium through the Coronary Sinus ostium(CSo)(2,3,4,5). The CS ostium is covered to a variable extent, by the Thebesian valve. It is also called as Thebesius valve or valve of Coronary Sinus. Sometimes the valve may be absent(3,6,7,8,9). The shape of the valve is crescentic or semi-circular in most cases. If the valve is not crescentic, it may be strand shaped or band shaped. Normally the valve covers the superior and posterior surfaces of the ostium. Sometimes it may cover the ostium completely with the formation of fenestrations. Rarely, the valve may cover the inferior hemi-circumference (10,11). These valves with increased coverage may obstruct during cannulation of the CS. If the valve covers about 75% of CS ostium, it may pose difficulty during cannulation of CS. It has been known to display significant variation and it is noteworthy that even as early as 1951, investigators have speculated on the potential of the valve to interfere with cannulation of the coronary venous system(2). Hence the present study aims to analyse and reemphasise the importance regarding the anatomy and variations of the Thebesian valve covering the Coronary Sinus ostium. MATERIALS AND METHODS The hearts were removed en bloc from 100 adult cadavers in the Department of Anatomy and at autopsy in the Department of Forensic Medicine, Thanjavur Medical College, during the study period 2009-2011. The hearts thus removed were washed thoroughly in running water and preserved in a solution containing 10% formalin and thymol after numbering them from 1 - 100. The specimens were studied by gross anatomical dissection. The right atrium was opened and the Coronary Sinus ostium and Thebesian valve were identified. The presence or absence of Thebesian valve was noted. The shape of the valve whether it was semi-circular or in the form of strands or band shape was also noted. Presence or absence of fenestration in the valve were also noted. RESULTS Variations in the Thebesian valve: In the present study, Thebesian valve was present in 84% of specimens and was absent in 16% of specimens(Fig. 1). Variations in the shape of Thebesian valve : The Thebesian valve was found to be semi-circular in 84.7% of specimens, in the form of strands in 8.3% specimens and in 7% of specimens it was band shaped (Fig. 2). Remnants were not found in any of the specimens. Among the 100 specimens in the present study, a rare and significant variation of double Thebesian valve was observed, constituting 1% of the total study specimens. It was semicircular in shape and was devoid of fenestrations (Fig.3A) Presence or absence of fenestrations in Thebesian valve: Usually the Thebesian valve was not fenestrated. Sometimes it may be fenestrated and it was classified based on the presence or absence of fenestrations. In this study, fenestrations in the Thebesian valve were found in 20.2% of specimens and it was absent in 79.8% of specimens (Fig.3B and 3C). DISCUSSION The variability of the coronary venous system has been studied by the anatomists, radiologists, electro physiologists and cardiologists. In their studies, they emphasized the views related to their own field of interest. The present study was done in 100 human cadaveric heart specimens which showed significant variations and the results were compared with those of the previous studies. Presence or absence of Thebesian valve: The Thebesian valve was present in 84% of specimens and this result correlated with the studies by various authors including Hellerstein and Orbison(12) (1951), Mak et al(2)(2009), Mustafa Karaca(13)and S.El. Maarasany et al(14). According to Anh et al(15) (2009) where the study was conducted using fibre optic technology, the thebesian valve was noted only in 54% of subjects. The lower prevalence of the presence of the valve in their study could be attributed to the limitations of the technology used in visualizing smaller valves(2). The comparison of the percentage of presence or absence of Thebesian valve by different authors and in the present study is shown in table 1. Shape of the Thebesian valve: The predominant shape of the Thebesian valve was found to be semi-circular in 84.7% of specimens and the least common shape was band shape seen in 7% of specimens in the present study. There were no remnants observed in the present study. This pattern of shape distribution correlated with that of Mak et al (2)(2009) study except for the presence of remnants in their study(Table 2). A rare variation of double crescentic Thebesian valve was seen in 1 % of specimens in the present study. According to Hellerstein H.K and Orbison J.L(12) double crescentic fold was seen in 2% of cases. C. Presence or absence of fenestrations in Thebesian valve: The majority of the Thebesian valves were devoid of fenestrations in the present study and the results correlated with those of other authors including Mak et al(2) and Hellerstein and Orbison.(12) CONCLUSION In the present study, the predominant shape of the Thebesian valve was found to be semi-circular and fenestrations were seen only in 20% of specimens. The rare possibility of the presence of double Thebesian valve was observed in 1% of specimen. A prominent Thebesian valve may be an under recognised problem which may interfere during cannulation procedures. They may also pose a significant threat in coronary venous lead placement done for cardiac resynchronization therapy. The knowledge of variations in the shape, number and type of the Thebesian valve may help in preventing inadvertent injury during catheterization procedures. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in the references of this manuscript. The authors are also grateful to the authors/editors/publishers of the journals, articles and books from where the literature of this article was reviewed and discussed. Source of Funding: Nil Conflict of Interest: None Englishhttp://ijcrr.com/abstract.php?article_id=242http://ijcrr.com/article_html.php?did=2421. Singh J.P, Houser S, Heist E.K, Ruskin J.N, The Coronary Venous Anatomy, A Segmental Approach to Aid Cardiac Resynchronization Therapy. American College of Cardiology J; 2005; 46:48-74. 2. Mak G. S, Hill A.J, Moisiuc F, Krishnan S.C, Variations in Thebesian valve anatomy and Coronary Sinus Ostium Implications for Invasive Electrophysiology Procedures Europace J;2009;11: 1188–1192. 3. Gray’s Anatomy, The Anatomical Basis of Clinical Practice, 40th Edition, Churchill Living Stone; 2008; 964,978-82. 4. Snell R.S, Clinical Anatomy by systems, Edition, Philadelphia, Williams and Wilkins; 2007: 145-147. 5. Willerson J.T, Cohn.Jn, Cardiovascular Medicine, NewYork, Churchill Livingstone; 1995; 55-58. 6. Grant B.J.C,A, Method of Anatomy Descriptive and Deductive, 6th Edition, Baltimore: Williams and Wilkins; 1959; 555-561. 7. Skandalakis J.E, Surgical Anatomy, The Embryologic and Anatomic Basis of Modern Surgery, 1stEdition,Paschalides Medical Publication; 2004; 305-07. 8. Sinnatamby C.S, Last’s Anatomy Regional and Applied, 11th Edition, Edinburg; Churchill Living Stone; 2006:206-213. 9. Hollinshead H.W, Anatomy for Surgeons Vol-2, 2nd Edition, New York: Harperand; 1966; 112-119,124,125. 10. Habib A, Lachman N, Kevin N, Christensen and Asirvatham S.J, The Anatomy of the Coronary Sinus Venous System for the Cardiac Electrophysiologist, Europace; 2009; vol 11:v15–v21. 11. Topol E.J, Text book of interventional cardiology 5th Edition, Philadelphia , Saunders. 12. Hellerstein H.K, Orbison J.L, Anatomic Variations of the Orifice of the Human Coronary Sinus Circulation, American Heart Association.J:1951; 3:514-523. 13. Karaca , M et al, The anatomic barriers in the coronary sinus: implications for clinical procedures. J Interv Card Electrophysiol. 2005;14:89–94. 14. El-Maasarany, et al, The Coronary Sinus Conduit Function: Anatomical Study (relationship to adjacent structures). Europace J.2005,7, 475-481. 15. Anh et al, Characterization of human coronary sinus valves by direct visualization during biventricular pacemaker implantation. Pacing Clin Electrophysiol J. 2008;31:78-82.