Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2016May22HealthcareQUANTIFICATION OF ANTIOXIDANTS IN UNDERUTILIZED VEGETABLE LEAVES
English0104Mary Jenefer Sharmila P.English Dorothy JaganathanEnglish Kumaravel S.EnglishIntroduction: Green leafy vegetables are an excellent source of bioactive compounds beyond human nutrition. There are many underutilized vegetable leaves which are equally a power house of bioactive compounds with reference to antioxidants. Much literature confirms that brassicca vegetables are high in antioxidants but the antioxidant studies these vegetable leaves are scarce as they are underutilized and neglected hence the present study was framed.
Aim: To analyze the total antioxidants, total phenols and total flavonoids in the leaves of cauliflower radish and beetroot leaves. Methodology: Total antioxidants were analysed using Dpph method and phenols by Folin-Ciocalteu method and Total flavonoids were determined spectrophotometrically. Results: The observations were read in triplicates. The data was analyzed statistically showing the presence of total antioxidants, total phenols and total flavonoids in leaves of cauliflower radish and beetroot which can a therapeutic role in the health of humans. Conclusion: Hence the present study reveals the benefits of these underutilized leaves which are packed with antioxidants that can prevent from all degenerative diseases and these antioxidant leaves can be also treated in formulation of functional foods and in food and health industry.
EnglishUnderutilized vegetable leaves, Total antioxidants, Total phenols, Total flavonoids, Degenerative diseasesINTRODUCTION
Humans have used different types of leaves as food since time immemorial. Plants possess many phytochemicals with various bioactivities including, carotenoids, ascorbic acid, tocopherol and polyphenols1 . A vegetable includes leaves, stems, roots, fl owers, seed, fruits, bulb and tubers2 . Among the food groups green leafy vegetables has a signifi cant place due to its abundant presence of vitamins, minerals bioactive health promoting compounds such as antioxidants and phytochemicals for health promotion and also in supply of, which provides benefi ts beyond basic nutrition. Though the availability of these leaves are cheap, they are highly perishable affected by post harvest losses, storage, handling and transport. Recently more attention is focused on importance of antioxidants for maintaining healthy life through many researches, books and media updates. Reactive Oxygen Species are a class of highly reactive molecules formed during aerobic life.3 A good source of natural antioxidants with reference to phenols and fl avonoids play a significant role in prevention against the formation of reactive oxygen species in maintaining a healthy body. Antioxidants are free-radical scavengers which can provide protection to living organisms from damage caused by uncontrolled production of reactive oxygen species4 .The most commonly used synthetic antioxidants are Butylated Hydroxyanisole (BHA), butylated hydroxytoluene (BHT), Propylgallate (PG) and butylated hydroquinone which have side effects such as liver damage and carcinogenesis5 .There is an emerging need for the application of natural antioxidant having less or no side effects, for use in foods or medicinal preparation in order to replace synthetic antioxidants. There is a growing interest in natural additives as potential antioxidants6 . Development of safer natural antioxidants from extracts of spices and other plant materials that can replace synthetic antioxidants is of interest7 . In this respect there are many varieties of green leafy vegetables in our locality, which are discarded and not used properly for human consumption that is antioxidant rich. Brassicas are known to possess antioxidant activity7 . Brassica vegetables such as caulifl ower and broccoli are popular and are among the most consumed in the world. Many researchers have proven the presence of potential antioxidants in caulifl ower on reviewing these perspectives an attempt was made to analyze the antioxidant activities in the leaves of caulifl ower, beetroot and radish belonging to similar plant family having high waste index.
MATERIALS AND MEHODS
The leaves of vegetables that are easily available, suitable for consumption, free of cost but neglected, discarded and are used as fodder for animals were the criteria’s considered in selection of leaves namely caulifl ower beetroot and radish. The nutritional knowledge about these leaves is also ignorant and hence avoided by majority of human population. The selected leaves were purchased fresh from the farm in Ooty Tamil Nadu. The leaves were separated from the stalks and washed twice under running tap water and blanched for 10- 15 sec. Later each variety of leaves was chopped and was spread on a fi lter paper at room temperature for two hours for the remaining water to drain the excess water from the leaves. It was then dried at 40oC over-night (12 hours) in hot air oven. The dried leaves of each variety were ground to a fi ne powder and packed in air tight containers for the analysis.
1. DETERMINATION OF TOTAL ANTIOXIDANTS
DPPH method is widely used to determine antiradical/ antioxidant activity of purifi ed phenolic compounds as well as natural plant extracts8 . Assays based on the use of 1,1-diphenyl-2-picryl-hydrazyl (DPPH) and 2,2′-azino-bis (3-ethylbenzthiazoline-6- sulfonic acid) (ABTS) radicals are among the most commonly used spectrophotometric methods for determination of the antioxidant capacity of foods, beverages, plant extracts and pure compounds due to the simple, rapid, sensitive, and reproducible procedures involved9 . The capacity of the leaf extracts to scavenge the stable 2,2’-diphenyl-2-picrylhydrazyl (DPPH) free radical was measured by extracting in 80% methanolic extract. To 0.1ml of freshly prepared caulifl ower leaf extraction, 6ml of DPPH solution was added. The test tubes were kept in dark room at 35o for one hour. The optimal density of the sample and the blank was read spectrophotometrically at 517 nm. The readings were read in triplicates. Butylated hydroxytoluene was used as standard. The same procedure was followed in beetroot and radish leaves.
2. DETERMINATION OF TOTAL PHENOLS
Polyphenols in plant extracts react with specifi c redox reagents (Folin-Ciocalteu reagent) to form a blue complex that can be quantifi ed by visible-light spectrophotometry10. The Folin-Ciocalteu method is described in several pharmacopoeias11.The leaf powders were treated with 80% ethanol for leaf extraction. To 0.5ml of freshly prepared samples each 8 ml of distilled water was added to all the test tubes. Later 0.5 ml of Follin’s Ciocalteau Reagent added to all the tubes and kept under incubation at 40ºC for 10 minutes. 1ml of Sodium Carbonate solution was added to all the test tubes. Then, the tubes were kept in the dark for incubation for one hour. The absorbance was read in triplicates using UV spectrophotometer at 660 nm using Gallic acid as standard. Readings were read in triplicates.
3. DETERMINATION OF TOTAL FLAVONOIDS
The spectrophotometric assay based on aluminium complex formation is one of the most commonly used procedure for the so-called total fl avonoid determination, as the content of these compounds is considered as an important parameter for evaluating food or medicinal plant samples12. One gram of each dried leaf sample was soaked in water over night. The contents were distilled in watt man fi lter paper. To 1.5mL of the leaf extract 3.5mL of distilled water and 0.3mL of 5% Sodium Nitrate was added to the tubes. After 5 minutes, 0.3mL of 10% Aluminum Chloride was added to all the tubes. At 6th minute, 2mL of 1M Sodium Hydroxide was added to mixture. Immediately, the contents of the reaction mixture were diluted with 2.4mL of distilled water and mixed thoroughly. Absorbance of the mixture was determined at 510n.m versus a prepared blank immediately. Quercetine was used as the standard for quantifi cation of total fl avonoids. The readings were read in triplicates.
RESULTS
The role of free radicals in many ailments has been well established. Accumulation of free radicals may lead to various disease conditions. Much research confi rms that foods or plants rich in antioxidants play an essential role in the prevention of free radical related diseases13.
Free radicals are inevitably produced in biological systems and also encountered exogenously, and are known to cause various degenerative disorders, like mutagenesis, carcinogenesis, cardiovascular disturbances and ageing14. Antioxidants are the compounds, which combat the free radicals by intervening at any one of the three major steps of the free radical mediated oxidative process, viz., initiation, propagation and termination15. The results statistically reveal that the three leaves have the scavenging capacity to fi ght against the free radicals (Dpph) was observed among the three leaf powders. Caulifl ower showed a good free radical scavenging capacity followed by beetroot and radish leaf powders.
Polyphenols (PPs) are a l a r g e and diverse class of compounds, many of which occur naturally in plants characterised by the presence of several phenolic groups. Naturally occurring polyphenols can be broadly divided into phenolic acids and fl avonoids16.The presence of higher total fl avonoid content in leaf suggests higher nutritional value of leaves, as fl avonoids possess strong antioxidant activity and inhibit oxidative stress17. Supporting the above study total fl avonoids was found to be higher in caulifl ower leaf powder. Statistically contribution of fl avonoids in caulifl ower leaf powder was double compared to beet root and radish leaf powders. Thus the fl avonoid content in these leaf powders confi rms the presence of polyphenols which is an essential bioactive compound for overall health.
DISCUSSION
The study reveals the signifi cant presence of total antioxidants total phenols and total fl avonoids in all the selected underutilized vegetable leaves. Statistically caulifl ower leaves scored high in total antioxidant capacity comparing radish and beetroot leaves. Total phenols were marginally high in radish leaves comparing caulifl ower leaves. Flavonoids were signifi cantly high in caulifl ower than radish and beetroot leaves. Hence the present study assures that these selected vegetable leaves that are easy to avail contain antioxidant activities.
CONCLUSION
The results of the study reveals the presence of bioactive compounds with reference to antioxidants, phenols and fl avonoids which have positive effects on the health even though their contribution is in smaller amounts, it can play a very signifi cant role in the health of humans. Caulifl ower, radish and beetroot are less utilized leaves in our locality which are in need to be focused for human consumption. Due to lack of nutritional knowledge, negligence and its identity as animal fodder, these leaves are not included in our daily diet inspite of their easy availability and low economic cost. Hence its prime time to realize the benefi ts of these underutilized leaves which are packed with antioxidants that can prevent from all degenerative diseases and these antioxidant leaves can be treated as a natural preservative and in formulation of functional foods.
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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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2016May22HealthcareBIOINFORMATICS ADVANCES IN GENOMICS - A REVIEW
English0511Raphael John OgbeEnglish Dickson O. OchalefuEnglish Olumide B. OlaniruEnglishSummary Genomics is a discipline in genetics that applies recombinant DNA technology, DNA sequencing methods and bioinformatics to sequence, assemble and analyze the function and structure of genome, the complete set of DNA within a single cell of an organism. Bioinformatics is an inter-disciplinary scientific field that develops methods for storing, retrieving, organizing and analyzing biological data. The advances in bioinformatics have in turn made considerable impact on the development and improvements of genomics technologies such as shot-gun sequencing and high-throughput sequencing methods. The various genomics technologies are used for DNA and genome sequencing, assembly and annotations, which have several applications in medicine, agriculture, pharmaceuticals, biotechnology, research etc. These genomics technologies aided by bioinformatics have contributed to the successful completion of whole organism genome analysis, from prokaryotes to eukaryotes. In fact, the assembly of the human genome is one of the greatest achievements of bioinformatics.
EnglishAnnotation, Assembly, Biotechnology, DNA sequence, Genome analysisINTRODUCTION
Genomic technologies are generating an extraordinary volume of information never before achieved in the history of biology. With recent advances in technology and the development of ultra high-throughput research, the fi eld of biotechnology began to suffer from data overload. This lead to the emergence and evolution of a broadening fi eld of scientifi c discipline called bioinformatics, which is at the intersection betwBrief history of genomicseen biology and computation [38]. Bioinformatics is therefore often considered to be different thing by different people. In its most basic form, bioinformatics might be described as ‘the structuring of biological information to enable logical interrogation [35]. Bioinformatics addresses the specifi c needs in data acquisition, storage, analysis and integration, which research in genomics generates. This relatively new scientifi c discipline facilitates both the analysis of genomic and post-genomic data, and the integration of information from the various related fi elds of transcriptomics, proteomics, metabolomics and phenomics. This integration enables the identifi cation of genes and gene products, and can elucidate the functional relationships between genotype and observed phenotype, thereby allowing a system-wide analysis from genome to phenome [35]. Among the current research lines are the following: 1). Gene prediction and modeling of splicing, related to the research on regulation of alternative splicing, and protein synthesis 2). Identifi cation and characterization of genomic regions involved in Gene Regulation, related to the research on Chromatin, Gene Expression, and on the RNA-Proteins Interactions and 3). Molecular Evolution, which includes evolution of the exonic structure of genes and the evolution of splicing. The bioinformatics program also includes a research in microarrays, which is complemented with a new group specifi cally devoted to Microarray Informatics. Thus, the purpose of this study is to discuss the bioinformatics advances in genomics and highlights some of the applications of bioinformatics advances to biological fi elds.
GENOMICS
Genomics is a discipline in genetics that applies recombinant DNA technology, DNA sequencing methods, and bioinfor matics to sequence, assemble and analyze the function and structure of genomes, the complete set of DNA within a single cell of an organism [1, 2]. The fi eld includes efforts to determine the entire DNA sequence of organisms and fi ne-scale genetic mapping. It also includes studies of intragenomic phenomena such as heterosis, epistasis, pleiotropy and other interactions between loci and alleles within the genome [3].
Brief history of genomics
The term “genomics” was coined by Dr. Tom Roderick, a geneticist at the Jackson Laboratory (Bar Harbor, Maine), at a meeting held in Maryland on the mapping of the human genome in 1986 [4]. Though the word “genome” (derived from the German word Genom, attributed to Hans Winkler) was in use in English as early as 1926.
Early genes sequencing efforts
Nucleic acid sequencing became a major target of early molecular biologists, following Rosalind Franklin’s confi rmation of the helical structure of DNA around 1941, James D. Watson and Francis Crick’s publication of DNA structure in 1953 and Frederick Sanger’s publication of the amino acid sequence of insulin in 1955 [5]. In 1964, Robert W. Holley and colleagues published the fi rst nucleic acid sequence ever determined, the ribonucleotide sequence of alanine tRNA [6,7]. Extending this work further, Marshall Nirenberg and Philip Leder revealed the triplet nature of the genetic code and were able to determine the sequences of 54 out of 64 codons in their experiments [8]. In 1972, Walter Fiers and his team at the Laboratory of Molecular Biology, Ghent, Belgium, were the fi rst to determine the sequence of a gene: the gene for Bacteriophage MS2 coat protein [9].
BIOINFORMATICS
As a result of recent advances in technology and the development of ultra high-throughput sequencing research techniques, the fi eld of biotechnology started to experience data overload. This lead to the development of an ever-broadening fi eld of science known as bioinformatics, in which biology and information technology converge. This is an interdisciplinary scientifi c fi eld that develops methods for storing, retrieving, organizing, and analyzing biological data. A major activity in bioinformatics is to develop software tools to generate useful biological information or knowledge. Therefore, simply defi ned, bioinformatics uses computers to better understand biology, by working with basic biological data e.g. DNA bases. That means it works on a small scale paying attention to details unlike computational biology which builds large scale general theoretical models of biological systems.
Brief history of bioinformatics
Paulien Hogeweg was the one that coined the term “Bioinformatics” in 1970, to refer to the study of information processes in biotic systems. Bioinformatics is an interdisciplinary fi eld in a broader fi eld of biotechnology. Computers became essential in molecular biology when protein sequences became available. After the sequence of insulin was determined in the early 1950s by Frederick Sanger, comparing multiple sequences manually turned out to be impracticable, hence the need for computers. Margret Oakley Dayhoff, recognized as the “mother and father of bioinformatics”, was a pioneer in the fi eld and compiled one of the fi rst protein sequence databases, initially published as a book, and also pioneered methods of sequence alignment and molecular evolution [10].
DNA sequencing technology developed
Fier’s group then expanded on their MS2 coat protein work, determining the complete nucleotide sequence of bacteriophage MS2-RNA (whose genome encodes for just four genes with 3569 base pairs) and Simian virus 40, in 1976 and 1978 respectively [11, 12]. Frederick Sanger and Walter Gilbert shared the 1980 Nobel prize in chemistry, for independently developing methods for the sequencing of DNA. Sanger and his colleagues played a key role in the development of DNA sequencing techniques, which enabled the establishment of comprehensive genome sequencing projects [3]. In 1975, he and Alan Coulson published a sequencing procedure using DNA polymerase with radio-labeled nucleotides, which he called the “Plus and Minus technique” [13, 14]. In 1977, his group was able to sequence most of the 5,386 nucleotides of the bacteriophage φX174, completing the fi rst fully-sequenced DNA-based genome [15].
BIOINFORMATICS CONTRIBUTIONS TO ADVANCES IN GENOMICS
The primary goal of bioinformatics is to increase the understanding of biological processes. Common activities in bioinformatics include mapping and analyzing DNA and protein sequences, aligning different DNA and protein sequences to compare them, creating and viewing 3-Dimentional models of protein structures. Over the past few decades, rapid developments in genomics, other molecular research technologies and developments in information technology have combined to produce a tremendous volume of information related to molecular biology, leading to the advancement of bioinformatics. These bioinformatics advances have in turn lead to greater developments of genomics. Bioinformatics now entails the creation and advancement of databases, algorithms, computational and statistical techniques, and theories to solve formal and practical problems arising from the management and analysis of biological data. In the fi eld of genetics and genomics, it aids in sequencing and annotating genomes and their observed mutations. It plays a role in the textual mining of biological literature and the development of biological and gene ontologies to organize and query biological data. As whole genome sequences became available, again with the pioneering work of Frederick Sanger [15], bioinformatics was re-discovered to be useful in the creation of databases such as GenBank in 1982. It is now known to play a role in the analysis of gene and protein expression and regulation. Bioinformatics tools aid in the comparison of genetic and genomic data, and more generally in the understanding of evolutionary aspects of molecular biology. At a more integrative level, it helps to analyze and catalogue the biological pathways and networks that are important part of systems biology. In structural biology, it aids in the simulation and modeling of DNA, RNA and protein structures, as well as molecular interactions.
Sequence analysis
Since the bacteriophage, φX174, was sequenced in 1977 [15], the DNA sequences of thousands of organisms have been decoded and stored in databases. This sequence information is analyzed to determine genes that encode polypeptides (proteins), RNA genes, regulatory sequences, structural motifs and repetitive sequences. A comparison of genes within a species or between different species can show similarities between protein functions, or relations between species i.e. the use of molecular systematics to construct phylogenetic trees.
Phylogenetic Tree
A phylogenetic tree, also known as a phylogeny, is a diagram that depicts the lines of evolutionary descent of different species, organisms, or genes from a common ancestor. Thus, a phylogenic tree or evolutionary tree is a branching diagram or “Tree” showing the inferred evolutionary relationships among various biological species or other entities, based upon similarities and differences in their physical or genetic characteristics. Phylogenies are useful for organizing knowledge of biological diversity, for structuring classifi - cations, and for providing insight into events that occurred during evolution. Furthermore, because these trees show descent from a common ancestor, and because the strongest evidence for evolution comes in the form of common ancestry, one must understand phylogenies in order to fully appreciate the overwhelming evidence supporting the theory of evolution [37]. The importance of phylogenetic trees is that they provide effi cient structure for organizing knowledge of biodiversity and allow one to develop an accurate, non-progressive concept of the totality of evolutionary history of different organisms, species or genes. The trees are useful in the fi eld of bioinformatics, systematics and comparative phylogenetics.
Blast Analysis
BLAST – An acronym for Basic Local Alignment Search Tool, is an algorithm for comparing primary biological sequence information, such as the amino acid sequences of different proteins or the nucleotides of DNA sequences. It has long ago became impracticable to analyze DNA sequences manually, due to the growing amount of biological data. Therefore, computer programs such as BLAST are used daily to search for sequences from more than 260,000 organisms, containing over 190 billion nucleotides [16]. These programs can compensate for mutation (exchanged, deleted or inserted bases) in the DNA sequence, to identify sequences that are related but not identical. BLAST is actually a family of programs that can be used for several purposes. These include identifying species, locating domains, establishing phylogeny, DNA mapping and comparison. For example, with the use of BLAST, it is possible for scientists to correctly identify a species or fi nd homologous species, which can be useful when a scientist is working with a DNA sequence from an unknown species. The BLAST program was designed by Altschul and his colleagues at the National Institute of Health, USA [36]. BLAST is one of the most widely used bioinformatics programs because it addresses a fundamental problem and the heuristic algorithm it uses is much faster than calculating an optimal alignment.
Genome sequencing approaches
As sequencing technology continues to improve, however, a new generation of effective, fast turnaround bench-top sequencers have become available to the academic research laboratories [25, 26]. On the whole, genome sequencing approaches fall into two broad categories, the Shotgun and High-throughput (also known as Next-generation) sequencing [3].
Shotgun sequencing technique
Shotgun sequencing is a sequencing method designed for analysis of DNA sequences longer than 1000 base pairs, up to and including entire chromosomes [34]. It is named by analogy with the rapidly expanding, quasi-random fi ring pattern of a shotgun. Shotgun sequencing is a random sampling process, requiring over-sampling to ensure a given nucleotide is represented in the reconstructed sequence by computer softwares.
High-throughput sequencing method
The demand for low-cost sequencing has driven the development of high-throughput sequencing (or Next generation sequencing) technologies that perform sequences in parallel, producing thousands or millions of DNA sequences at once [27]. High-throughput sequencing technologies are intended to lower the cost of DNA sequencing beyond the standard dye-terminator methods. In ultra-high-throughput sequencing, as many as 500,000 sequencing-by-synthesis operations may be run in parallel [28].
Sequencing Complete Genome
A technique called Shotgun Sequencing (which was used by the Institute for Genomic Research for instance, to sequence the fi rst bacterial genome i.e. Haemophilus infl uenza genome) in 1995 [17], does not produce entire chromosomes, instead it generates the sequences of many thousands of small DNA fragments. The ends of these fragments overlap and when align properly by a genome assembly program, can be used to reconstruct the complete genome. The following year, i.e. in 1996, a consortium of researchers from laboratories across North America, Europe and Japan, announced the completion of the fi rst complete genome sequence of a eukaryote, Saccharomyces cerevisiae (12.1 Mb), and since then genomes have continued to be sequenced at an exponentially growing pace [18]. As at October 2011, the complete genome sequences are available for: 2,719 viruses, 1,115 archaea and bacteria, and 36 eukaryotes, out of which about half are fungi [19, 20].
Genome analysis
After an organism has been selected, genome projects involve three components: the sequencing of DNA, the assembly of that sequence to create a representation of the original chromosome, followed by the annotation and analysis of that representation [3]. Overview of a genome analysis project is that: First, the genome must be selected, which involves several factors such as cost and relevance. Second, the sequence is generated and assembled at a given sequencing centre. Third, the genome sequence is annotated at several levels: DNA, protein, gene pathways, or comparatively. Shotgun sequencing yields sequence data quickly, but the task of assembling the fragments can be quite complicated for larger genomes. For a genome as large as the human genome, it may take many days of CPU time on large-memory, multiprocessor computers to assemble the fragments, and the resulting assembly will usually contain numerous gaps that have to be fi lled later. The core of comparative genome analysis is the establishment of the correspondence between genes (orthology analysis) or other genomic features in different organisms. It is these inter-genomic maps that make it possible to trace the evolutionary processes responsible for the divergence of two genomes. A multitude of evolutionary events acting at various organizational levels shape genome evolution. At the lowest level, point mutations affect individual nucleotides. At a higher level, large chromosomal segments undergo mutations; duplication, lateral transfer, inversion, transposition, deletion and insertion. Human Genome Analysis The rationale for the human genome project is to acquire fundamental information concerning our genetic make-up which will advance our basic scientifi c understanding of human genetics and the role of various genes in health and in disease. A rough draft of human genome was provided by the Human Genome Project in 2001, while by 2003, the project was completed which sequenced the entire genome of one specifi c person. By 2007, this sequence project was declared “fi nished”, with less than one error in 20,000 bases and all chromosomes assembled [22]. Since the years after completion of the human genome project, the genomes of many other individuals have been sequenced, partly under the auspices of the 1000 Genomes Project, which announced the sequencing of 1,092 genomes in October 2012 [23]. The completion of this project was made possible by the development of dramatically more effi cient sequencing technologies and required the commitment of signifi cant bioinformatics resources from a large international collaboration [24]. The continued analysis of human genomic data has medical benefi ts but with profound political and social repercussions for human societies. It is expected that future approach to patient’s treatment will require the human genome.
Sequence assembly
Sequence assembly refers to aligning and merging fragments of a much longer DNA sequence in order to reconstruct the original sequence. This is needed because the common currently used DNA sequencing technology can not read whole genomes as a continuous sequence but only reads small pieces of between 20 and 1000 bases, depending on the technology used. Typically, the short fragments called reads, are formed from shotgun sequencing genomic DNA or gene transcripts. Multiple, fragmented sequence reads must be assembled together on the basis of their overlapping areas [3]. Assembly of the human genome is one of the greatest achievements of bioinformatics.
Sequence assembly approaches
Assembly can be broadly categorized into two approaches: de novo assembly, for genomes which are not similar to anyone sequenced in the past, and comparative assembly, which uses the existing sequence of a closely related organism as a reference during assembly [29]. Finishing - Finished genomes are defi ned as having a single continuous sequence, with no ambiguities representing each replicon [30].
Genome Annotation
Another aspect of bioinformatics in sequence analysis is annotation. This involves computational gene fi nding, to search for protein-coding genes, RNA genes, and other functional sequences within a genome. Not all of the nucleotides within a genome are part of genes. Within the genomes of higher organisms, for example, large parts of the DNA do not serve any obvious purpose. This so-called “junk DNA” may however, contain unrecognized functional elements. Bioinformatics helps to bridge the gap between genome and proteome projects-for example, in the use of DNA sequences for protein identifi cation. In the context of genomics, annotation is the process of marking the genes and other biological features in a DNA sequence. The fi rst genome annotation software system was designed in 1995 by Owen White, who was part of the team that sequenced and analyzed the fi rst genome of a free-living organism to be decoded. i.e. the bacterium, Haemophilus infl uenza. White built a software system to fi nd the genes (fragments of genomic sequence that encode proteins), the transfer RNAs and to make initial assignments of function to those genes. The DNA sequence assembly alone is of little value without additional analysis [3]. Genome annotation is the process of attaching biological information to sequences. Most current genome annotation systems work similarly, but the programs available for analysis of genomic DNA such as the GeneMark program, which was developed and used to fi nd protein-coding genes in Haemophilus infl uenza, are constantly changing and improving.
Steps in Genome Annotation
Genome annotation consists of three main steps [21]:
1. Identifying portions of the genome that do not code for proteins
2. Identifying elements on the genome, a process called gene prediction, and
3. Attaching biological information to these elements.
OTHER APPLICATIONS OF BIOINFORMATICS
Computational evolutionary biology Evolutionary biology is the study of the origin and descent of species, as well as their change over time. Bioinformatics has assisted evolutionary biologists by enabling researchers to:
- Trace the evolution of a large number of organisms by measuring changes in their DNA, rather than through physical taxonomy or physiological observations alone.
- More recently compare entire genomes, which permits the study of more complex evolutionary events, such as gene duplication, horizontal gene transfer, and the prediction of factors important in bacterial speciation.
- Build complex computational models of populations to predict the outcome of the system over time.
- Track and share information on an increasingly large number of species and organisms.
Genomic medicine Next-generation genomic technologies allow clinicians and biomedical researchers to drastically increase the amount of genomic data collected on large study populations [31]. When combined with new bioinformatics approaches that integrate many kinds of data with genomic data in disease research, they allow researchers to better understand the genetic bases of diseases and drug responses, which can lead to personalized medical care.
Understanding the genetic factors of diseases
With the advent of next-generation sequencing technology, we are beginning to obtain enough sequence data to map the genes of complex diseases such as infertility, breast cancer, or Alzheimer’s disease. Genome-wide association studies are essential to pinpoint the mutations for such complex diseases [33]. This is made possible with the advancement of bioinformatics and genomics. Analysis of mutations in cancer In cancer, the genomes of affected cells are arranged in complex or even unpredictable ways. Massive sequencing efforts are used to identify previously unknown point mutations in a variety of genes in cancers. Bioinformaticians continue to produce specialized automated systems to manage the volumes of sequence data produced. They create new algorithms and softwares to compare the sequencing results to the growing collection of human genome sequences and germline polymorphisms, which is one of the causes of cancer. New physical detection technologies are being employed, such as oligonucleotide micro-arrays, to identify chromosomal gains and losses (called comparative genomic hybridization), and single-nucleotide polymorphism arrays, to detect known point mutations. Analysis of gene expression The expression of genes can be determined by measuring mRNA levels with multiple techniques including Microarrays, Expressed cDNA sequence tag (EST) sequencing, Serial Analysis of Gene Expression (SAGE) tag sequencing, Massively Parallel Signature Sequencing (MPSS), RNA-seq, also known as “Whole Transcriptome Shotgun Sequencing” (WTSS) or various applications of multiplexed in-situ hybridization. All of these techniques are extremely noise-prone and subject to bias in the biological measurements. Thus, a major research area in computational biology involves developing statistical tools to separate signal from noise, in high-throughput gene expression studies. Such studies are often used to determine the genes implicated in a disorder; so that one might compare microarray data from cancerous epithelial cells to data from non-cancerous cells, to determine the transcripts that are up-regulated and down-regulated in a particular population of cancer cells.
Synthetic biology and bioengineering
The growth of genomic knowledge has enabled increasingly sophisticated applications of synthetic biology. In 2010, researchers at the J. Craig Venter Institute announced the creation of a partially synthetic species of bacterium, Mycoplasma laboratorium, derived from the genome of Mycoplasma genitalium [32]. More of such synthetic bioengineering are expected in the near future.
CONCLUSION
Recent advances in genomic technologies have led to an explosion of data and a rapid growth in bioinformatics within biotechnology and the broader biomedical sciences. The advances in bioinformatics have in turn greatly advanced the development of the fi eld of genomics. Biotechnology demands intelligent searching and fi ltering of numerous, complex data, to address specifi c issues, cutting across specialist research fi elds outside the knowledge of any one person, hence the importance of bioinformatics. Applications of bioinformatics include prediction of protein structure from genome analysis, medicine and health care, genomics and metabolomics research, agriculture, pharmaceuticals, biotechnology, etc. Though bioinformatics is rapidly expanding its applications alongside the rise of the new “-omic” technologies such as genomics, transcriptomics, metabolomics, and post-genomic technologies such as proteomics, its focus and strengths remain in the analysis of DNA sequences and genomes of living organisms, with their ever increasing applications. Despite the achievements in genomics research brought about by advances in bioinformatics, there are still challenges in applications of specifi c methods. It is therefore recommended that more methods should to be developed to tackle the problems encountered in the applications of bioinformatics in genomics research.
ACKNOWLEDGEMENTS
The authors would like to appreciate the Professors and Senior Lecturers of the Department of Biochemistry, Faculty of Medical Sciences, University of Jos, Jos, Plateau state, Nigeria; for their guidance and contributions to make this work successful. They are also grateful to the Scholars and Publishers of all scientifi c articles cited in this review manuscript.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2016May22HealthcareUNUSUAL CAUSE OF BLEEDING PER RECTUM IN CHILDREN – CASE REPORT
English1215Ahmed A. Al-JarieEnglish Abdullah HilalEnglish Mohammed R. AL-HAYLIEnglish Zainah A. SabrEnglish Safa M. AL-HaiderEnglish Maha T. almofarehEnglish Nihal I. MirzaEnglishBackground: Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. The Zygomycetes includes two fungal orders: Mucorales and Entomophthorales, with completely different pathogenic potentials. asidiobolusranarum was firs tdescribed in 1886 in frogs. We present a case of bleeding per rectum in a 3-year-old male patient, resident of Southwestern of Saudi Arabia. The diagnosis was confirmed by characteristic histopathlogical findings. The aim of presenting the case is to increase awareness among health care professionals in areas of endemicity, so appropriate specimen processing may lead to enhanced case detection and reporting. Conclusion: Antifungal therapy is adequate to cure Gastrointestinal Basidiobolomycosis infection if the fugal mass is unrespectable.
EnglishBleeding per rectum, Gastrointestinal Basidiobolomycosis, ItraconazolINTRODUCTION
Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum[1] Basidiobolus ranarum (B. haptosporus, B. meristoporus) belongs to the order Entomophthorales in the family of Zygomycota[2,3]. The Zygomycetes includes two fungal orders: Mucorales and Entomophthorales, with completely different pathogenic potentials [4,5,6]. Mucorales involve only the immunocompromised patient, while Entomophthorales, which include Basidiobolus genera, causes infection in immune competent individuals, mostly chronic infection of the subcutaneous tissue[4,5,6]. This fungus is an environmental saprophyte found in soil and decaying vegetable materials[7]. This fungus is endemic in some parts of the world such as India[8,9,10]. It is commonly found in soil and decaying vegetable materials and occasionally found as a commensal in the gastrointestinal tracts of amphibians, reptiles, fi sh, dogs, frogs, and bats[11,12,13]. Fatal cases have been reported in toads [14,15].
CASE REPORT
A previously healthy 3 year-old male child from Aseer Region (Mohyil in Tohama area) presented to medical attention with history of bleeding per rectum for three months. It was fresh, intermittent bleeding, and small amount. The bleeding was associated with supra pubic abdominal pain, intermittent fever, weight loss (about 4 kg) and diarrhea alternate with constipation in last two months prior to admission . No history of bleeding from other orifi ces and no jaundice. The patient’s past history was unremarkable. On examination he was pale not jaundiced with normal vital signs. By rectal examination he found to have anterior wall mass rounded smooth 3by 4 cm with fresh blood and no anal fi ssure or external mass. Other systemic examination was unremarkable. Initial laboratory workup showed WBC 16.8×10³/mm, eosinophils 6%, Absolute eosinophilic count 1.0008cell per microliter. Hemoglobin 6.8g/dL, Platelets 599×10³/mm and Erythrocyte sedimentation rate 33 mm/ hour with normal liver function tests. Abdominal CT-scan showed ill identifi ed solid hypo dense non enhancing lesion measuring 3.5cm by 1.9cm involving the left anterior lateral aspect of the rectum(Figure 1 ). Patient was admitted as case of bleeding per rectum with rectal mass for investigation. Evacuation of pus collection was done and biopsy was taken .Infectious disease team were consulted. The patient was started on vancomycin , tazocin and liposomal amphotericin B . The gram stain and culture were negative for bacteria and fungus . Acid fast bacilli and culture were negative .The histopathology showed degenerate material and fi brin infi ltrated by eosinophils with microabscess formation .Fungal hyphea surrounded by an eosinophilic sheath are seen intermingled within the infl ammation ,which was characteristic for Basidiobolomycosis (Figure-2) . Antifungal was changed to itraconazol. No more bleeding or constipation and the mass size regressed with time. follow up CBC showed, WBC = 11.000/mm3 Hemoglobin = 10.5 gm/dl Platelet =353,000/ mm and normal abdominal ultra sound . The patient was treated by PO itraconazol for 1 years. He did well tolerated his medication during the course and showed remarkable improvement. His weight at end of therapy was increase by 3 kg.
DISCUSSION
Since the fi rst report of GIB in 1964 until the present, there have been 71 cases of GIB, in the English literature. Cases have been reported from Saudi Arabia with 23 cases, Iran with 17 cases, USA with 23 cases, Kuwait with 2 cases, The Netherlands with one case, and Iraq with 6 cases. The patients age ranged from1.5 to 80 years old. This disease was signifi cantly more common in males; from 71 reported cases, only six patients were female. Nearly all patients had abdominal pain and fever as their initial symptoms; however, some cases additionally had constipation (4 cases), diarrhea (1 case), and gastrointestinal bleeding(1 case). Only one patient presented with mucoid stool. Furthermore, one case presented with perforated appendicitis because of fungal invasion in the appendiceal wall. Radiologic examination by ultrasonography and CT scan were reported in 20 cases. Wall thickening in mass seen 8 and intestinal, gastric or abdominal masses in other 12 cases. There were 3 cases with preliminary diagnosis of infl ammatory bowel disease such as Crohn’s disease with and without fi stula. In 12reported cases, there were concomitant liver and intestinal masses. The method of diagnosis was pathology and culture. In 32 cases, culture was performed, however only 50% turned out to be positive. Pathologic diagnosis of the cases was characteristic and showed the same picture in all of them, i.e. the presence of Splendore- Hoeppli bodies and many eosinophils as well as intensely radiating eosinophilic granular material surrounding the fungal elements. This histological fi nding is very characteristic of this fungus and other invasive fungi with gastrointestinal involvement. Mucormycosis causes extensive necrosis and vascular invasion and even their granulomas are morphologically different with no eosinophils. Immunologic diagnosis of B. ranarum with methods such as immunodiffusion has been reported, which seems to be specifi c and has no cross reactivity with other fungi of Entomophthorales; however, its sensitivity is controversial. This immunodiagnostic test can also be helpful for follow up of patients. Molecular diagnosis has also been performed in some reports with optimum results by DNA extracted from formalin fi xed paraffi n embedded tissue, however, due to the rarity of the disease many centers do not have the set up for this method .Another important concern with this fungal infection is prompt treatment by combined surgery and medical therapy to eradicate disease and prevent early recurrence. Delayed treatment can cause disseminated disease, which has life threatening outcome. Then only and causes postmortem diagnosis can be done on autopsy studies. Additionally, delayed treatment can cause complications such as bowel perforation, obstructive uropathy, esophageal varices, and duodenobiliary fi stula [16].
CONCLUSION
Bleeding per rectum secondary to basidiobolomycosis is extremely unusual and so far no reported cases in pediatrics. The aim of presenting the case is to increase awareness among health care professionals in areas of endemicity and appropriate specimen processing may lead to enhance case detection and reporting. The best outcome of this unusual fungal infection is achieved by combination of medical and surgical treatment. In our case the mass was unreachable and patient was cured by medical therapy only.
ACKNOWLEDGMENT
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=252http://ijcrr.com/article_html.php?did=2521. Al-Shanafey S, AlRobean F, Bin Hussain Surgical management of gastrointestinal Basidiobolomycosis in pediatric patients. J Pediatr Surg. 2012;47:949-51. PubMed PMID:22595579.
2. Anaparthy UR, Deepika G. A case of subcutaneous zygomycosis. Indian Dermatol Online J. 2014;5:51-4. doi: 10.4103/2229-5178.126033. PubMed PMID: 24616857; PubMed Central PMCID: PMC3937489.
3. Kumar Verma R, Shivaprakash MR, Shanker A,Panda NK. Subcutaneous zygomycosis of the cervicotemporal region: Due to Basidiobolusranaram. Med Mycol Case Rep. 2012;1:59-62. doi: 10.1016/j.mmcr.2012.07.004. PubMed PMID: 24371740; PubMed Central PMCID:PMC3854634.
4. Mohta A, Neogi S, Das S. Gastrointestinal mucormycosis in an infant. Indian J PatholMicrobiol. 2011;54:664-5. doi: 10.4103/0377-4929.85149. PubMed PMID: 21934265.
5. Chakrabarti A, Chatterjee SS, Das A, Panda N, Shivaprakash MR, Kaur A, et al. Invasive zygomycosis in India: experience in a tertiary care hospital. Postgrad Med J. 2009;85:573- 81. doi: 10.1136/pgmj.2008.076463. PubMed PMID: 19892892.
6. Mantadakis E, Samonis G. Clinical presentation of zygomycosis. Clin Microbiol Infect. 2009;Suppl 5:15-20. doi: 10.1111/j.1469-0691.2009.02974.x. PubMed PMID: 19754751.
7. Al-Shanafey S, AlRobean F, Bin HussainI. Surgical management of gastrointestinal basidiobolomycosis in pediatric patients. JPediatr Surg. 2012;47:949-51. PubMed PMID:22595579.
8. Jayanth ST, Gaikwad P, Promila M,Muthusami JC. The Sinus That Breeds Fungus: Subcutaneous Zygomycosis Caused by Basidiobolus ranarum at the Injection Site. Case Rep Infect Dis. 2013;2013:534192.doi: 10.1155/2013/534192. PubMed PMID:24349806; PubMed Central PMCID:PMC3852275.
9. Sujatha S, Sheeladevi C, Khyriem AB, Parija SC, Thappa DM. Subcutaneous zygomycosis caused by Basidiobolus ranarum - a case report. Indian J Med Microbiol. 2003;21:205-6. PubMed PMID: 17643022.
10. Maiti PK, Bose R, BandyopadhyayS, Bhattacharya S, Dey JB, Ray Entomophthoromycosis in South Bengal(Eastern India): a 9 years study. Indian J Pathol Microbiol. 2004;47:295-7. PubMed PMID: 16295506.
11. Saadah OI, Farouq MF, Daajani NA, Kamal JS, Ghanem AT. Gastrointestinal basidiobolomycosis in a child; an unusual fungal infection mimicking fi stulising Crohn’s disease. J Crohns Colitis. 2012;6:368-72. PubMed PMID: 22405176.
12. Rabie ME, El Hakeem I, Al-Sharim M, Al Skini MS, Jamil S. Basidiobolomycosis of the colon masquerading as stenotic colon cancer. Case Rep Surg. 2011;2011:685460. doi: 10.1155/2011/685460. PubMed PMID: 22606589; PubMed Central PMCID: PMC3350237.
13. Paré JA. Fungal diseases of amphibians: an overview. Vet Clin North Am Exot Anim Pract.2003;6:315-26. PubMed PMID: 12827724.
14. Taylor SK, Williams ES, Mills KW. Mortality of captive Canadian toads from Basidiobolus ranarum mycotic dermatitis. J Wildl Dis.1999;35:64-9. doi: 10.7589/0090- 3558-35.1.64. PubMed PMID: 10073347.
15. Taylor SK, Williams ES, Mills KW. Experimental exposure of Canadian toads to Basidiobolus ranarum. J Wildl Dis. 1999;35:58-63. doi:10.7589/0090-3558-35.1.58. PubMed PMID:10073346.
16. Bita Geramizadeh, MinaHeidari, Golsa Shekarkhar, Gastrointestinal Basidiobolomycosis, a Rare and Underdiagnosed Fungal Infection in Immunocompetent Hosts, A Review Article, Iran J Med Sci March 2015.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2016May22HealthcareINFLUENCE OF END STAGE RENAL DISEASE IN ALTERATION OF SOME TRACE ELEMENTS IN SUDANESE PATIENTS
English1619Kamal Eldin Ahmed AbdelsalamEnglish Eshteag Mohammed MusllemEnglishBackground: The role of trace elements in hemodialysis (HD) patients has not yet been clearly recognized. To minimize the health consequences of persistent HD, the levels of trace elements should be seriously adjusted.
Methods: The study was across-sectional conducted in Khartoum state ofSudan between August 2013 and April 2015 included 150patients with end stage renal disease treated with hemodialysis and 75 healthy volunteers as control group. Informed consent was assigned by each participant before taking the blood sample. All samples were analyzed for magnesium, zinc and copper. Results: Compared with healthy controls, in hemodialysis patients average serum levels of zinc (Zn) (663 μg/L) and copper (Cu) (797μg/L) were insignificantly different; however, magnesium (Mg) levels (38.61 mg/L) were significantly increased. According to sex of ESRD patients, serum Mg level was increased significantly in females, while insignificant changes were observed in Culevel. This study stated that Zn, Cu and Mg levels were significantly increased in elder patients more than younger ones. Zn, Cu and Mg were increased as increasing duration of dialysis, changing significantly in serum Zn and Cu. Conclusions: Our results concluded that in hemodialysis, aging, and sex have significant effects on Zn, Cu and Mg.
EnglishCopper, ESRD, Hemodialysis, Magnesium, ZincINTRODUCTION
End-stage renal disease (ESRD) has a high prevalence and progression throughout the world and it is a common co-morbidity disease. Many people around the world suffer from ESRD and require long-term dialysis. Despite dialysis treatment, ESRD patients still have high morbidity and mortality rates[1]. Recent studies have suggested that the dialysis treatment is associated with some complications and incon Svenient events [2].Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are more common in certain patient populations, including the elderly, those with youth-onset diabetes mellitus, obese persons, some ethnic groups, and disadvantaged population [3]. Patients from low and middle income countries are often the least able to deal with the burden of ESRD and the health-care facilities of these countries least able to provide the demand for convinced access to renal replacement therapies [4]. ESRD patients are commonly suffered of malnutrition and/or infl ammation [5]. The accurate assessment of nutritional status and body composition is of highly importance in providing nutritional care to patients with CKD and ESRD, as malnutrition and the trace elements wasting syndrome are among the strongest risk factors for morbidity and mortality [6]. Study of Guo et al. [1]mentions that long-term dialysis leads to signifi cant changes in the concentrations of some trace elements. The human body needs a number of minerals in trace quantities. These include iron, copper, magnesium and zinc. Usually mineral defi ciency binds more than one, and these collective defi ciencies have cumulative effect on health. Trace elements play important roles in human body because they serve a variety of functions. Some serve multiple functions ranging from representing as cofactors in enzyme reactions to organizing and contributing to the hardness of bone. Metal ions are always joined to particular proteins where they often play a crucial part in maintaining the protein’s three dimensional structure [7]. Zinc is a cofactor in more than 100 enzymatic reactions, essential component of nuclear DNA binding proteins and serves in genes’ codes for metallothioneins. Copper also is essential cofactor in several reactions concerning iron use, collagen synthesis, suppression of free radicals and serves in the expression of genes for several enzymes. While, magnesium in human body is needed for more than 300 biochemical reactions. It supports and helps to maintain normal functions of nerve, muscle, and healthy immune system, keeps the heart beat steady, and helps bones remain strong [8]. Many of the functions described above are vital metabolic functions. Defi ciency of any of those trace minerals can produce a variety of diseases [7]. The aim of this study was to assess the levels of serum zinc, copper and magnesium among ESRD Sudanese patients before dialysis as affected by gender, age and duration.
MATERIALS AND METHODS
Study area: The study was conducted in Sudan, Khartoum state, in Omdurman Teaching Hospital and Khartoum North Center for dialysis. Study design: This was across-sectional study. Study period: The study was carried out between August 2013 and April 2015. Sample size and study population: the study included 150 (75 males, 75 females) ESRD patients(already diagnosed patients with end stage renal failure under dialysis). Mean age of patients was 33.14±4.58 years. Control group was consisted of 75 healthy volunteers whose mean age was matched (35.6±5.64). Any patient with disease can affect the results was excluded as well as the patients refused to participate in the study. Ethical clearance: The ethical committee of Omdurman Islamic University approved the ethical clearance of the present study. Informed consent was obtained from each participant before taking the samples. Data collection: data was collected using pre-prepared questionnaire which include age, sex, duration of renal failure, duration of dialysis, and patients health condition. Sampling: 5 mL venous blood was obtained from antecubital vein by standard venipuncture technique without venous stasis, in serum separator tube. Serum was separated after 20 minutes and stored in -20o C till time of analysis. Methods of estimation: All samples were analyzed after warming to room temperature.Analysis of zinc and copper is carried in the center of researches, Information Technology College using Atomic absorption spectrometer (Thermo Scientifi c™ iCE™ 3300 AAS, USA) following the manufacturer procedure. Serum magnesium was measured using mass spectrometry (ICP-MS, Agilent 7700x, Agilent Technologies, Tokyo, Japan) as described by Harari et al[9] . Statistical analyses: The data obtained were expressed as mean values ± SD. Statistical analyses were performed using SPSS (Statistical Package for Social Sciences) version 19.00 (SPSS, Inc., Chicago, IL). Differences in mean values between groups were evaluated by a Student’s t-test. P-value was statistically signifi cant at P 0.05), but serum magnesium level were signifi cantly increased in males more than females (p< 0.001). However, EL-Habibi et al. [13] showed that Cu and Zn are reduced insignifi cantly in ESRD females comparing to ESRD males; On the other hand, João et al. [14] showed no changes in serum magnesium levels (p> 0.05) between ESRD males and females patient. The study revealed that serum levels of Zn, Cu and Mg in ESRD patients of less than 18 years old were signifi cantly decreased when compared to ESRD patients of more than 18 years old (p < 0.05). The results of Kiziltas et al. [15] and Cunningham et al. [16] were in line with our results but with few differences in restriction and limitation of age groups. Moreover, ESRD patients were classifi ed according to duration of hemodialysis into two groups, patients who treated with hemodialysis for less than one year and more than one year.Comparing to patients who treated with hemodialysis for less than one year, Cu and Zn levels in serum of patients who treated for more than one year showed signifi cant increase (p < 0.05) while serum Mg level showed insignifi - cant increase (p > 0.05). Mastrangelo et al. [17] revealed that Mg, Cu and Zn concentrations in the blood increased with increasing the treatment time of dialysis. In contrast, Cunningham et al. [16] and Koca et al. [18] reported that CRF patients for more than fi ve years experienced low results in Cu and Zn much less than patients who have started the dialysis treatment more recently.
CONCLUSIONS
Compared with healthy controls, in hemodialysis patients’ average serum Zn and Cu were insignifi cantly different; however, Mg levels were signifi cantly increased. According to sex, the results of ESRD patients showed signifi cant increase in male patients, serum Mg level was increased signifi cantly in females, while insignifi cant changes were observed in Cu level. This study stated that Zn, Cu and Mg levels were signifi cantly increased in elder patients more than younger ones. Zn, Cu and Mg were increased as increasing duration of dialysis changing signifi cantly in serum Zn and Cu.
ACKNOWLEDGEMENT
Authors are grateful to Center of Researches, Information Technology College and V C R Center for providing machines and reagents of this study. 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. Conflict of Interests The authors declare that they have no confl ict of interests. Source of funding This study was carried out by self-fi nancing.
Englishhttp://ijcrr.com/abstract.php?article_id=253http://ijcrr.com/article_html.php?did=2531. Guo C H, Wang C L, Chen P C, Yang T C. Linkage of Some Trace Elements, Peripheral Blood Lymphocytes, Infl ammation, and Oxidative Stress in Patients Undergoing Either Hemodialysis or Peritoneal Dialysis. Perit Dial Int 2011, 31(5):583-91.
2. Ibrahim S, El Salamony O. Depression, quality of life and malnutrition-infl ammation scores in hemodialysis patients. Am J NepFhrol 2008, 28(5):784–791
3. Merlin T C, Mark C E, Paul Z. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nature Reviews Nephrology 2016, 12; 73–81
4. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013, 20:382 (9888):260-72.
5. Kalantar-Zadeh K, Streja E, Molnar M Z, Lukowsky L R, Krishnan M, Kovesdy C P. Mortality prediction by surrogates of body composition: an examination of the obesity paradox in hemodialysis patients using composite ranking score analysis. Am J Epidemiol 2012, 175:793– 803.
6. Li Z, An X, Mao H, Wei X, Chen J, Yang X, et al. Association between depression and malnutrition–infl ammation complex syndrome in patients with continuous ambulatory peritoneal dialysis. International Urology and Nephrology 2011, 43(3), pp 875-882
7. Kocha W, Karimc R, Marzeca Z, Miyatakac H, Himenoc S, Asakawa Y. Dietary intake of metals by the young adult population of Eastern Poland: Results from a market basket study. Journal of Trace Elements in Medicine and Biology 2016, 35; 36–42.
8. Francisco A L M, Rodríguez M. Magnesium - its role in CKD. Nefrologia 2013, 33(3):389-99.
9. Harari F, Åkesson A, Casimiro E, Lu Y, Vahte, M. Exposure to lithium through drinking water and calcium homeostasis during pregnancy: A longitudinal study. Environ Res. 2016, 29;147:1-7.
10. Tonelli M, Wiebe N, Hemmelgarn B, Klarenbach S, Field C, Manns B, et al. The Alberta Kidney Disease Network. Trace elements in hemodialysis patients: a systematic review and meta-analysis. BMC Medicine 2009,7:25
11. Ortega O, Rodriguez I, Cobo G, Hinostroza J, Gallar P, Mon C, et al. Lack of Infl uence of Serum Magnesium Levels on Overall Mortality and Cardiovascular Outcomes in Patients with Advanced Chronic Kidney Disease. ISRN Nephrology 2013, 2013:191786.
12. Bhogade R B, Suryakar A N, Joshi N G. Effect of Hemodialysis on Serum Copper and Zinc Levels in Renal Failure Patients. Eur J Gen Med 2013, 10(3):154-157
13. EL-Habibi E M, Bakr M A, Kamal N. Impact of haemodialysis on certain trace elements among patients suffering from end stage renal disease. Journal of American Science 2012, 8(12)
14. JoãoMatias P, Azevedo A, Laranjinha I, Navarro D, Mendes M, Ferreira C, et al. Lower Serum Magnesium Is Associated with Cardiovascular Risk Factors and Mortality in Haemodialysis Patients. Blood Purif 2014, 38:244-252
15. Kiziltas H, Ekin S, Erkoc R. Trace Element Status of Chronic Renal Patients Undergoing Hemodialysis. Biological Trace Element Research 2008, 124, 2, Page 103
16. Cunningham J, Rodríguez M, Messa P. Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients. Clinical Kidney Journal 2012, 5 (Suppl. 1):i39-i51.
17. Mastrangelo A, Paglialonga F, Edefonti A. Assessment of nutritional status in children with chronic kidney disease and on dialysis. Pediatric Nephrology 2014, 29(8), pp 1349-1358.
18. Koca T, Berber A, Koca H B, Demir T A, Koken T. Effects of hemodialysis period on levels of blood trace elements and oxidative stress. ClinExpNephrol 2010, 14(5):463-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2016May22HealthcareMECONIUM PERITONITIS - REPORT OF A RARE CASE
English2022Jeevitha K. J.English Senthiru RamachandranEnglish SaravananEnglish Mahesh BoseEnglishAim: To report on a rare case of meconium peritonitis (MP). Case Report: We report a case of G2P1L1 at 37 weeks of gestation, a post caesarean pregnancy with all prior normal ultrasound reports, came with complaints of decreased fetal movements. On ultrasound scan there was features suggestive of meconium peritonitis with small bowel perforation. She was delivered by emergency repeat caesarean section and the neonate underwent laparotomy on the first neonatal day.
Discussion: Meconium peritonitis is a rare condition diagnosed in antenatal period which has a high neonatal morbidity and mortality. Meconium peritonitis is an aseptic chemical peritonitis caused due to in-utero bowel perforation, most frequently secondary to obstruction, often diagnosed by routine fetal ultrasound. Conclusion: Early diagnosis and treatment are the keys to successful management of MP.
EnglishMeconium, Chemical peritonitis, Bowel perforationINTRODUCTION
Bowel obstruction (like atresia, intussception, bands and meconium plug) may result in bowel perforation and cause meconium peritonitis (MP). It is a sterile chemical peritonitis caused in utero. Meconium leaks into abdominal cavity and causes secondary infl ammatory reaction which results in 4 types of MP- Fibro adhesive, cystic, generalized or healed1 . It is a rare condition with estimated incidence of 1:30,000 cases2 . This can be diagnosed with routine prenatal ultrasound and have classic features of intra-abdominal calcifi - cation, ascites, intra-abdominal mass, bowel dilatation and polyhydramnios. It is diffi cult to prognosticate the outcome on the basis of the above fi ndings. Most of the neonates require emergency laparotomy and some may need second laparotomy and rarely third laparotomy for anastomosis of the intestine3 . The prenatally diagnosed MP causes overall morbidity of 22% and mortality of 11% and has better prognosis than postnatally diagnosed MP4, 5.
CASE REPORT
A 24 years old G2 P1 L1 post-caesarean pregnancypresented to our hospital, with an antenatal ultrasound at 37 weeks which was suggestive of small bowel perforation with meconium peritonitis (fi g1). Although her previous ultrasound scans were normal, the presenting condition warranted an emergency repeat lower segment cesarean section in view of fetal distress. She delivered a 3 kg boy baby with gross abdominal distention (fi g2) and mild respiratory distress. Following NICU admission, the baby was started on intravenous fl uids and an ultrasound was done to confi rm the diagnosis. Baby was posted for emergency laparotomy (Fig 3, 4, 5) under general anesthesia. Following layered dissection, bowel distention with perforation in the distal ileum was noted and the caecum was fi lled with meconium. Meconium was drained and ileostomy was done. In view of poor general condition of the neonate due to severe peritonitis, colon was not explored and drain was placed. On day 2 there was meco-nium drained in the drainage tube and neonate was posted for second laparotomy and found to have perforation in transverse colon with meconium in entire segment. Excision of 2 cm bowel and end to end anastomosis was done. Multiple bowel biopsies were taken to look for ganglion cells and their presence in the histopathology report ruled out aganglinosis. Neonate was placed on ventilator support and inotropes. Later baby was supported with total parenteral nutrition and gradually feeding established with concomitant ileostomy care. Neonate was discharged on day 12 and was advised for review and follow up after 3 months.
DISCUSSION
Meconium peritonitis should be considered when hyper-echogenic areas are found in the fetal abdomen during II and III trimester scan6 . Some of the common causes of obstruction which cause meconium peritonitis are atresia, volvulus, intussception, congenital bands, and meckel’s diverticulum- all of which accounts for 50% incidence. Other causes of MP include viral infections caused by cytomegalovirus and parvo virus B19, meconium ileus(25%) and cystic fi brosis (7-40%)7 . Bowel obstruction leads to perforation and causes meconium peritonitis which can be diagnosed by routine prenatal screening ultrasound. Some of the ultrasound features are ascites, polyhydramnios, dilated bowel loops, and intra-abdominal calcifi cation. Some of the complications following MP are prematurity (20% to 30%) and polyhydramnios(10%- 20%)8 . The prognosis depends on the etiology for bowel rupture. If MP is diagnosed before 24 weeks of gestation cystic fi - brosis should be ruled out by cordocentesis, chorionic villi sampling or amniocentesis. The defi nitive diagnosis is sweat chloride test in post natal period. Termination of pregnancy is the fi rst step in the management of MP followed by postnatal fetal x-ray and ultrasound to confi rm the diagnosis. The fetus can also be delivered vaginally but due to the presence of massive ascites and abdominal distention, dystocia have been reported. However in progressive disease, delivery by caesarean section is the preferred option9 . The neonate can be managed conservatively if there is no feature of bowel obstruction or peritonitis and the prognosis is good. In presence of bowel obstruction, surgery is the treatment of choice – drainage of the cyst/ascites, identifying the site of lesion and resection anastomosis with ileostomy care, which can be closed in later months. In the reported case the neonate was managed by resection anastomosis with ileostomy care.
CONCLUSION
Meconium peritonitis is a rare condition; however it can be effectively diagnosed on routine prenatal ultrasound. Management requires a multidisciplinary approach with astute NICU care and meticulous follow up. Early identifi cation and timely intervention signifi cantly reduces the concomitant morbidity and mortality associated with the disease. Consent of the patient: Obtained Source of funding: Nil Confl ict of interest: None
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 greatful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. The author wish to acknowledge the help and contribution of Dr. Vijai Anand DNB, Mch.(Paediatric Surgery), Consultant peadiatric surgeon, Rio hospital, Annanagar, Madurai.
Englishhttp://ijcrr.com/abstract.php?article_id=254http://ijcrr.com/article_html.php?did=2541. Mcnamara A, Levine D. Intraabdominal fetal echogenic masses: a practical guide to diagnosis and management: Radiographics, 2005;25(3):633-45.
2. Nadia S, Annegret G, Ulrich G, Axel H, Andreas H, Peter B et al. Prenatal diagnosis and postnatal management of meconium peritonitis. J Perinat Med, 2009;37:535-38.
3. Amagada JO, Premkumar G, Arnold JM. Prenatal meconium peritonitis managed expectantly. J Obstet Gynaecol, 2004;24:311-12.
4. Saeed AI, Mahmood A. Meconium peritonitis in neonates: Management dilemma. Bahrain medical bulletin, 2008;30:1-6.
5. Hyun N, Chul SK, Yeon DK. Experience with meconium peritonitis. J Pediatr Surg,007;42:1822-25.
6. Maha S, Rukhsana I, Osama O. a case of in utero meconium peritonitis in a fetus delivered to a woman diagnosed with primary extrahepatic biliary atresia. JMC,2011;2:15-17
7. Ahmadu BU. Meconium peritonitis associated with meconium pseudocyst and intraperitoneal calcifi cation- a case report. IJBPAS, 2013; 2(5):1214-19.
8. Saxena P, Dabral A, Arora R, Minocha B. Meconium peritonitis- two case reports. J Obstet Gynecol India,2009;59: 475-76
9. Konje JC, Chazal R, MacFadyen, Taylor DJ. Antenatal diagnosis and management of meconium peritonitis: a case report and review of literature. Ultrasound Obstet Gynecol,1995;6:66-69.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2016May22HealthcareWHY HOMEBIRTH RURAL SOCIETY'S PARADIGM OF THE DELIVERY
English2328Zamir PhulEnglish Rehana KhalilEnglish Mohammad Ali TalpurEnglishIntroduction: Pakistan is a country where home delivery is a cultural norm despite of high Maternal mortality ratio (MMR) of 178 per 100 000 live births (lb) (WHO, 2015).1These statistics become more worrisome when the disproportion between the rural and urban areas is compared. The rural areas have higher rate of home birth. The aim of this study was to explore in depth the prime rationale for home delivery norm in rural area of Sindh, Pakistan. Material and Methods: A cross sectional study was carried out in 2015 in District Khairpur Mirs, Sindh, Pakistan. Trained interviewers used a semi-structured questionnaire to interview 439 women of child bearing age (18-45 years) selected through random sampling. The data were analyzed using SPSS version 20 and Microsoft excel. Results: The mean age of the sample was 29.6± 6.9 years.Three forth (64.7%) of the respondents had no formal education, with half of the sample (51%) an agricultural background for earning. Two third (70%) sample had home delivery for their last baby.
For almost half (53%) cases, place of delivery was a husband dominated decision, while prime reason behind was the trust on dais (70%) for their privacy, 64% distance from health care facility, half (49%) of the sample’s reason was cost of hospitalization, (3%) following traditional values, and (12%) of them thought place of delivery is not important.
Conclusion: Home delivery choice was prevalent among 70% of the women of child bearing age (18-45 years), in District Khairpur Mirs, Sindh, Pakistan. Most of the reasons identified through our study, were cultural values, financial unaffordability and accessibility. Among these reasons culture bound impediments were sizable whichincluded trust on dais (unskilled traditional birth attendants), husband dominated decision and familytradition. The distance from hospital was physical accessibility constraint while financial issue was also one of the leading causes for home birth preference. The findings of the present study can not be generalized due to the limited sample. Still, the study provides evidence of paradigm related factors, being the main constraint of the cycle. Future research is needed to formulate compelling public health interventions to create awareness for paradigm shift to reduce high MMR in the low and middle income countries like Pakistan.
EnglishHomebirth, Rural society’s paradigm, DeliveryINTRODUCTION
An estimated 529,000 maternal deaths occur every year worldwide, almost all of them in developing countries.5 According to WHO, immediate and effective professional care at the time of delivery can make the difference between life and death for both women and their newborns.1 The high level of maternal mortality in developing countries has been attributed partly to the non-availability of services and partly to the poor utilization of these services when they are available. The immediate medical causes of maternal deaths are similar for women all over the world: postpartum hemorrhage, infection, toxaemia, obstructed labor and septic abortions.2 Access to quality care during pregnancy and especially at delivery seems to be the crucial factor in explaining the disparity in maternal mortality and morbidity between the developing and the industrialized world. An estimated 90% of maternal deaths could be avoided, if adequate care was provided.3 According to the latest WHO survey 2015, the maternal mortality ratio of Pakistan is 178/100,000 live births. Home deliveries by traditional birth attendants (TBAs/dais) are a cultural norm in Pakistan. This is true both for rural areas as well as the urban slums. It’s a common traditional belief that childbirth is a natural process which does not require any medical attention and should be conducted at home by the family ‘dai’ who is a well-known and trusted fi gure for the family, is easily available and is not very expensive.4,5Childbirth is a risk-producing incident, which can be minimized through well timed and appropriate health care for women who experience obstetric complications.6 However, for effective interventions,it is important to identify the risk factors, which leads to home delivery especially in rural areas of Pakistan where most of the maternal mortality and morbidity is mediated through the place of delivery. Hence we are reporting the factors affecting the choice between home and hospital deliveries through our study. The current study was conducted at District. Khairpur Mirs Sindh, Pakistan, which mainly comprises of rural areas. Total population of the district is 2.32 million. Comprising 1.11 million (52%) of male population and 1.02 million (48%) females. Total child bearing age (CBA) in female population is 383,857.7 We selected two union councils of Taluka Thari Mirwah namely Baqi Khan and Tando Mir Ali, where population mainly depends on farming and labor for their livelihood.
SUBJECTS AND METHODS
A descriptive cross-sectional study was carried out in 2015 (June 2015 to August 2015) on 439 women of child bearing age (18-45 years) living in District Khairpur Mirs, Sindh , Pakistan. The study sample was randomly selected from the area. WHO sample size calculation softwarewas used to calculate the required sample size. A minimum sample size (n) of 439 was required while taking 4.5% (b) bound on error of estimation, 95% confi dence level (1-a), and assuming 65% prevalence (P)of home birth in rural areas of Pakistan. Therefore, a total of 439 women were recruited for the study. All females of age between 18 to 45 years of age, living in District Khairpur Mirs and willing to participate in the study were eligible for the study. Data was collected through a semi-structured questionnaire developed through literature review. The data were entered and analyzed using, Microsoft Excel and IBM SPSS version for Windows 20.0 software. Mean with standard deviation was calculated for age (in years) while frequency with percentages was calculated for qualitative scale variables.
ETHICAL CONSIDERATIONS
Informed verbal consent was obtained and all of the participants were informed about the nature of the study and use of the data prior to the interview. The participation of the women was voluntary in the data collection process. Participants were also ensured of confi dentiality.
RESULTS
A total of 439 women of child bearing age (18-45 years) fulfi lled the inclusion criteria and consented for the study after assurance of confi dentiality of data. The investigators endeavored hard to complete the target sample because most participants were fretful of counter-accusation despite of anonymity assurance. Socio-demographic variables including age, education, income and husbands’ source of income have a signifi cant infl uence on person’s choice for place of delivery. The mean age of the sample was 29.6± 6.9 years. Table 1 shows, 207 (47.2%) of the participants had age between 27 to 35 years of age followed by 163 (37.1%) of the participants between 18 to 26 years. Table 1 reveals 284 (64.7%) of the subjects had no formal education, while 20.27% completed their primary, 9.11% secondary, 3.19% intermediate and only 2.73% were graduate among them. All of them were unemployed and dependent on their husbands for fi nances. Regarding profession of their husband, half of the sample 225 (52%) had agricultural background for their earning, while 14.8% were Govt. Employee, 23% were Labourer and 9.95% were related to other occupations. About 200 (45.6%) of them had income less than Rs. 5000 per month. (see table 1) while 32.42% had Rs.5000- 10000 per month and 21.92% had Rs.>10000 per month. The data discloses that majority 308 (70%) of the births were at home (see Chart 1). Two hundred thirty four 234 (53%) participants’ husbands decided where to deliver the baby and for 25.9% other family members decided. Only for 20.7% cases, women herself was the decision maker (see Chart 2). Surprisingly enough accessibility was not a problem for almost one third, 157 (35.8%) of the subjects as they were residing at a distance between 1 to 6 km from health care facility but for two third 64% had accessibility issue as compiled in table 1. Cost of hospitalization was unaffordable for 215 (49%) (see Chart 3) and for 3% traditional and cultural values were the reason while for 12% believed place of delivery makes no difference in care, in table 1.Three hundred (68%) of the respondents delivered their babies by unskilled traditional birth attendants (Dais).However, 323 (73.6%) of the participants intended to have future delivery in a nearby health care facility.
DISCUSSION
The present study was designedto explore the rationale for home delivery norm in rural area among women of child bearing age of Sindh, Pakistan. Despite extensive efforts made over the past years to improve the maternal and newborn morbidity and mortality in the country, we found inadequate utilization of maternity homes and hospitals for delivery.Our study showed a very high frequency (70%) of home deliveries among of the women of child bearing age (18-45 years)and 68% of them were attended by un skilled attendants, in province of Sindh which is in agreement with fi ndings of a study conducted by Gani N in 2013, in the Khyber Agency, FATA, Pakistan, where even higher frequency (82.7%) of deliveries were at subject’s home, and 7.1% at TBA’s home. 8 One of the study done in 2015 by Shamsa Zafar in which nationally, 29%% of respondents expressed a preference for home deliveries (Sindh, Punjab, Balochistan and KPK).9 Our fi ndings are also consistent with the studies conducted in Oromia region in Dodota district and in Ethopia in which 81.8% and 79.4% of women gave birth at home respectively. 10 As far as the rationale for preference to home birth is concerned, the situation analysis necessitates discerning it from two perspectives; Subjective and objective. Subjective reasons were stated by the women themselves and the objective assessment from the demographic and other factors. Subjective discloser by the patients pointed to two main factors; family tradition and unaffordability. The family tradition was testifi ed by theirtrust on dais (unskilled traditional birth attendants), husband dominated decision and no importance of place of delivery.Unaffordable cost of hospitalization was due to low income and lower rated occupations of their husband. Our objective analysis of socio-demographic factors revealed that94% of women were either illiterate or had primary schooling only. Studies from Sri Lanka and Bangladesh have also reported poor maternal education to be important risk factors for home delivery.11,12 Lack of affordability, and illiteracy can all be attributed to poor socioeconomic status. Studies from Nepal and Nigeria have also shown a signifi - cant relationship between the socioeconomic condition of a family and the place of delivery.13,14 In our study, among other factors indicative of low socioeconomic, one wasthe distance to the maternity hospital as having a causal role for place of delivery. The most of respondents were of the view that health care facilities are at distance from their residence but the interesting thing to note was that even the one third of the respondents who had maternity hospital within their vicinity, were reluctant to utilize the services by giving an excuse of inaccessibility. Apart from this, for two third of the sample the accessibility was a genuine issue.Long distance from the maternity hospital was found to be signifi cantly associated with home delivery and a linear trend could be seen.15 In Kenya, the most signifi cant predictors of choosing home delivery (an informal delivery setting) are the distance from the household to the nearest maternity bed.16 Le Bacq, and Rietsema reported that hospital delivery in Kasama, Zambia seemed generally to be possible only for mothers living within walking distance of that institution, and that a dose-response relationship between distance and maternal mortality existed.17 By inquiring about resources and stress, Yantzi, Rosenberg, Burke, and Harrison studied the impacts of the distance to the hospital on families with a child suffering from a chronic medical condition.18
CONCLUSION
Home delivery choice was prevalent among 70% of the women of child bearing age (18-45 years), in District Khairpur Mirs, Sindh, Pakistan. Home delivery choice was prevalent among 70% of the women of child bearing age (18-45 years), in District Khairpur Mirs, Sindh, Pakistan. Most of the reasons identifi ed through our study, were cultural values, fi nancial unaffordability and accessibility. Among these reasons culture bound impediments were sizable which included trust on dais (unskilled traditional birth attendants), husband dominated decision and family tradition. The distance from hospital was physical accessibility constraint while fi nancial issue was also one of the leading causes for home birth preference.The fi ndings of the present study can not be generalized due to the limited sample. Still, the study provides evidence of paradigm related factors, being the main constraint of the cycle. Future research is needed to formulate compelling public health interventions to create awareness for paradigm shift to reduce high MMR in the low and middle income countries like Pakistan.
RECOMMENDATIONS
1. Future researches are needed on this important issue for a paradigm shift. 2. Setting up of a well-organized awareness program for the women of child bearing age is recommended. 3. Guidance and counselling through Mass media should be provided.
LIMITATION OF STUDY
The participation in the study was voluntary so the data gathered for this study may not be generalized.
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.
SOURCE OF FUNDING
There is no source of funding for this manuscript.
CONFLICT OF INTEREST
We have no pecuniary or other personal interest, direct or indirect, in any matter that raises or may raise a confl ict with our duties as researchers.
Englishhttp://ijcrr.com/abstract.php?article_id=255http://ijcrr.com/article_html.php?did=2551. WHO: The World Health Report 2005. Make every mother and child count, Geneva, 2005.
2. Figa’-Talamanca I: Maternal mortality and the problem of accessibility to obstetric care; the strategy of maternity waiting homes. Soc Sci Med 1996, 42:1381–1390.
3. Faundes A, Rosenfi eld A, Pinotti JA: Maternity care in developing countries: relevance of new technological advances. Int J Gynecol Obstet 1988, 24:103–109.
4. Imogie AO, Agwubike EO, Aluko K. Assessing the role of traditional birth attendants (TBAs) in health care delivery in Edo State, Nigeria. Afr J Reprod Health 2002; 6: 94- 100.
5. Maternal mortality update 2004: Delivering into good hands. (Online) Cited 2008 Aug 29. Available from URL:http://www.unfpa.org/upload/lib_pub_file/381_ fi lename_mmupdate05_eng21.pdf.
6. Kaunitz AM, Spence C, Danielson TS, Rochat RW, Grimes DA: Perinatal and maternal mortality in a religious group avoiding obstetric care. Am J ObstetGynecol 1984, 150:826–831.
7. Population welfare development, government of Sindh, khairpur, Accessed on 30th January 2016. Retrieved from: http://www.pwdsindh.gov.pk/districts/Khairpur.htm
8. Gani N, Ali TS, prevalence and factors associated with maternal postpartum haemorrhage in khyber agency, pakistan. J Ayub Med Coll Abbottabad 2013;25(1-2)
9. Shamsa Zafar,Siham Sikander, Ikhlaq Ahmad, Mansoor Ahmad, Nazia Parveen, Shumaila Saleem,et al, Is home delivery really preferred a mixed-methods national study in Pakistan. Health Research Policy and Systems201513(Suppl 1):52
10. GistaneAyele, MaralignTilahune, BehailuMerdikyos, WorkuAnimaw, WondimagegnTaye. Prevalence and Associated Factors of Home Delivery in ArbaminchZuria District, Southern Ethiopia: Community Based Cross Sectional Study. Science Journal of Public Health. Vol. 3, No. 1, 2015, pp. 6-9. doi: 10.11648/j.sjph.20150301.12
11. Lukumar P, Pathmeswaran A. Factors associated with home deliveries in Thampalakamam, Trincmalee. Ceylon Med J 2006; 51: 59-62.
12. Islam MA, Chowdhury RI, Akhtar HH. Complications during pregnancy, delivery and postnatal stages and place of delivery in rural Bangladesh. Health Care Women Int 2006; 27: 807-21.
13. Wagle RR, Sabroe S, Neilson BB. Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy Childbirth 2004; 4: 8.
14. Obi SN, Ozumba BC, Okaro JM. Emergency obstetric referrals at a university teaching hospital, Nigeria. East Afr Med J 2001; 78: 262-4.
15. Raj R, Sabroe S, Bruun BN, Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal, BMC Pregnancy and Childbirth 200 44:8. DOI: 10.1186/1471-2393-4-8.
16. Hodgkin D: Household characteristics affecting where mothers deliver in Rural Kenya. Health Econ 1996, 5:333– 340.
17. Le Bacq F, Rietsema A: High maternal mortality levels and Additional risk from poor accessibility in two districts of Northern Province, Zambia. Int J Epidemiol 1997, 26:357– 363.
18. Yantzi N, Rosenberg MW, Burke SO, Harrison MB: The impact of distance to hospital on families with a child with chronic condition.SocSci Med 2001, 52:1777–1791.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2016May22HealthcareLICHENS- ENSHROUDING THE BARE ROCKS IN PAPPAD AREA OF SAMBA DISTRICT, JAMMU AND KASHMIR
English2932Mukhtar Ahmad SheikhEnglish Anil K. RainaEnglish Dalip Kumar UpretiEnglishA field survey was conducted for collection of lichens in the Jammu division, on fragile, loose sandstone rocks in Pappad area of Samba district of Jammu and Kashmir, on way to famous Mansar Lake. The rocks were devoid of the original forest cover and appear black due to dense growth of dark olive green lichens. Under such climatic conditions, the loose sandstone rocks remains exposed to scorching heat and were mostly dry thus not suitable for the growth of most plants. The lichen specimens were collected from the rocky substrates with the help of hammer, chisel. The specimens were identified by studying the morphology, anatomy and chemistry. The recent literature was consulted for identification of most of the lichen taxa. The study revealed the occurrence of 04 species of lichens belonging to 03 genera and 03 families, it was observed that some unique lichen taxa such as Endocarpon nanum A. Singh and Upreti; Endocarpon subrosettum A. Singh and Upreti; Peltula patellata (Bagl.) Swinsc. and Krog and Phylliscum indicum Upreti are present. The hair like growth on the lower surface (Rhizinae or haptera or umbilicus) of the lichens bind together the sand particles of the rock. The lichens are nature’s pioneers and establish themselves where other organisms cannot. Thus from the above observation it is well evident that lichens in the Pappad area of Samba district, J and K are playing important role in the binding, stability, hydrology and fertility of these rocks. The lichen taxa growing on the rocks have thick cushion like squamulose thallus, which are closely adpressed to the rocks. The organs of attachment present on the lower side of the thallus compactly bind the sandstone particles tightly together.
EnglishLichens, Pappad, Rocks, Erosion, Stabilize, SandstoneINTRODUCTION
Lichens are some of the most amazing living things on this planet and are the most successful symbiotic organisms in nature. They have no specialized organs such as root, shoot and leaves and this permit them to live economically in the harshest of environmental conditions. They have developed and diversifi ed as a result of symbiotic association between the green/ cynobacteria or blue green algae (Photobiont) and the fungus (Mycobiont), dominating over 8% of the earth’s land surface (Hale, 1983; Ahmadjian, 1995) and have attracted considerable attention because of their perceived position on the ladder of evolution to land plants (Heckman et al., 2001; Selosse, 2002). This unique association probably evolved as an adaptation to the varied microhabitats with standing extreme microclimatic conditions unfavorable for the fungi and algae in the isolation. The associated entity grows at an average rate of 1-5 mm per year and persists for tens or hundreds of years on their substratum. Lichens grow on any substratum that provide a convenient foot hold to them or any structure that has been standing for a reasonable amount of time is likely to be adorned with lichen. They colonize great variety of substrates both natural as well as the manmade. By virtue of the peculiar structure and physiological quality, the lichens have high tolerance of drought and cold and are able to grow in the diverse geographical regions from icy expanses of the Himalaya to tropical and subtropical part of south India, from drier hot deserts of Rajasthan to moist, humid climate of Eastern Himalayas (Upreti, 1998). They also survive in extremes of climatic conditions, ranging from low tide level on the sea shore to the high reaches of the Himalaya beyond the tree line and also in the arctic tundra (Negi, 2003).
During a fi eld survey for collection of lichens in the Jammu division, the authors observed a unique feature of lichen growth on fragile, loose sandstone rocks in Pappad area of Samba district of Jammu and Kashmir, on way to famous Mansar Lake. The rocks were devoid of the original forest cover and appear black due to dense growth of dark olive green lichens (Fig.1a and b).
MATERIALS AND METHODS
The lichen specimens were collected from the rocky substrates with the help of hammer, chisel. The closely adnate forms were collected along with substratum. Along with the lichen collection the details of locality, substratum and altitude were also recorded. The collections made during the day time were placed in separate polythene bags, on reaching the camp in the evening the specimens were sorted out, packed in newspapers and left to dry. In the laboratory the dried specimens brought from the fi eld were placed in lichen herbarium packets of 17x10 cm size, with the details of locality, date of collection, fi eld number, collector and other ecological notes. The labeled and dried specimens are lodged in the Lichen Herbarium of National Botanical Research Institute (LWG), Luck now. The specimens were identifi ed by studying the morphology, anatomy and chemistry. The recent literature of Awasthi (1988, 1991, 2000 and 2007), Upreti (1988), Divakar (2001), Nayaka (2004) and Singh and Upreti (1984) was consulted for identifi cation of most of the lichen taxa. Identifi cation of lichen substances was performed by methods of Culberson (1972), Walker and James (1980) and White and James (1985).
RESULTS
The study revealed the occurrence of 04 species of lichens belonging to 03 genera and 03 families (Table 1). We found only crustose growth form of lichens. During major part of the year the climate of the area is characterized by high temperature. Under such climatic conditions, the loose sandstone rocks remains exposed to scorching heat and were mostly dry thus not suitable for the growth of most plants. It, however invites some unique lichen taxa such as Endocarpon nanum A. Singh and Upreti; Endocarpon subrosettum A. Singh and Upreti; Peltula patellata (Bagl.) Swinsc. and Krog and Phylliscum indicum Upreti, to thrive (Fig. 1., c, d, e and f ).
DISCUSSION
The thalli of these lichens form dense cushion on the rock surface. Due to luxuriant growth of the lichens, the surface of rocks appear black. The hair like growth on the lower surface (Rhizinae or haptera or umbilicus) of the lichens bind together the sand particles of the rock. The lichens are nature’s pioneers and establish themselves where other organisms cannot. These plants are well known organisms in pedogenic succession (soil formation), which changes the rocky mountains into the waving forest (Topham, 1977). The time scale required to convert the rocky mountain into a waving forest is indeed long,over 1000 years are involved in a system (Richardson, 1958). The biophysical and biochemical weathering of rocks by lichens is well known. However, in the present study it was observed that most of the rock surfaces devoid of lichen growth clearly exhibit weathering while the areas having lichen cover were intact. The adaptation which permit certain lichen species to ‘enshrouding the bare rocks’ and exploit an environment inimical to most other forms of life include resistance to desiccation and to extremes of temperature, longevity and a growth rate commensurate rock . The lichens are remarkably resistant to drought. They have an ability to adhere, penetrate and digest the substance of the rock. They can extract nutrients from nutrient poor rocks that are unavailable to higher plants. The ability of lichens to completely cover the substratum in dry region has an important impact on soil stability, hydrology and fertility. Lichen crust retard erosion of soil by wind and water to a marked extent. The lichen thalli prevent raindrop impact of the soil and their rhizoids binds the usually fragile rock particles. Lichen crusts capping uneroded soil pedestals upto 10 cm higher than the surrounding eroded areas (Cameron and Blank, 1966). Due to inclined plane in the study site, the rocks are not able to hold the water, however the porous texture of the rocks exhibits excellent water holding capacity. The lichen cushion on soil surface retain a great deal of water which could not infi ltrate into the soil and also reduce the fl ow rates to a great extent. Lichen stabilized soil crusts contribute signifi - cantly to the fertility of soil and presumably, to the growth of vascular plants (Rogers, 1977). The nitrogen content of soil with a lichen crust is 2-7 times higher than soils without lichen crust (Shields, 1957., Shields et al.1957). The organic carbon levels in lichen stabilized soils are higher than that of other desert soils. Apart from the fi xation of nitrogen by certain pioneer species the favorable effects of lichens on soil seems to depend on the physical effect of the lichen layer as a protective crust or mulch. A moss-lichen layer may reduce the soil temperature at a depth of 7.6 cm by 10-11o C relative to bare soil (Kreshaw and Rouse 1973). The decomposition of lichens invading bare rock surfaces contribute small amount of humus on the surface, permitting the establishment of other humus requiring species of plants. The destruction of lichen crusts by the trampling animals or by other biotic and abiotic factors has far- reaching effects. Once the crust is destroyed, the surface soil which contain most of the soil nutrient is easily blown away. The soil texture changes when the lichen crust is damaged and the living conditions for the soil microfl ora are radically changed. This will in turn affect the growth of higher plants especially by alteration of seedbed characteristics.
CONCLUSION
The lichens are well known biodeteriorating agent, responsible for physical and chemical weathering of rocks and help in soil formation. However, from the observation in the study area it is clear that most of the lichens growing on the rocks of the Pappad area of Samba district of J and K belongs to a group of lichens lacking the chemical substances involved in chemical weathering of rocks by chelating action. The lichen taxa growing on the rocks have thick cushion like squamulose thallus, which are closely adpressed to the rocks. The organs of attachment present on the lower side of the thallus compactly bind the sandstone particles tightly together. Thus from the above observation it is well evident that lichens in the Pappad area of Samba district, J and K are playing important role in the binding, stability, hydrology and fertility of these rocks.
ACKNOWLEDGEMENTS
We are thankful to the Head, Department of Environmental Sciences, University of Jammu, Jammu, to the Director, National Botanical Research Institute, Lucknow for providing necessary laboratory facilities and to Ministry of Environment and Forest, New Delhi for fi nancial support to one of the authors (DKU). 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=256http://ijcrr.com/article_html.php?did=2561. Ahmadjian, V. Lichens are more important than you think. Bioscience 1995; 45: 124.
2. Awasthi DD. A key to Macrolichens of India and Nepal. J Hattori Bot Lab 1998; 65: 207-302.
3. Awasthi DD. A key to Microlichens of India, Nepal and Sri Lanka. Biblioth. Lichenolog 1991; 40:1-337.
4. Awasthi DD. A Compendium of the Macrolichens from India, Nepal and Sri Lanka. Bishen Singh Mahendra Pal Singh, Dehra Dun, India; 2007.
5. Awasthi DD. Lichenology in Indian Subcontinent. Bishen Singh Mahendra Pal Singh, Dehradun, India; 2000.
6. Cameron, R. E. and Blank, G. B. Desert algae: Soil crust and diaphanous substrata as algal habitats. NASA Tech. Report 1966; 32-971:1-41.
7. Culberson. Improved conditions and new data for the identifi cation of lichen products by a standardized thin layer chromatographic method. Journal of chromatography 1972; 72:113-125.
8. Divakar PK. Revisionary studies on the lichen genus Parmelia sensu Lato in India. Ph.D. Thesis, Lucknow, University Lucknow, India; 2001.
9. Hale, M.E. The lichen line and high water levels in fresh water streams in Florida, Bryologist 1983; 87: 261-265.
10. Heckman, D.S; Geiser, D.M; Eidell, B.R; Stauffer, R.L; Kardos, N.L. and Hedges, S.B. Molecular evidence for the early colonization of land by fungi and plants. Science 2001; 293: 1129-1133.
11. Kreshaw, K. A. and Rouse, W. R. Studies on lichen dominated systems V. A primary survey of a raised – beach system in north- western Ontario. Can. J. Bot. 1973 ; 51, 1285-1307.
12. Nayaka S. Revisionary studies on the lichen genus Lecanora sensu Lato in India. Ph.D. Thesis, Dr. R.M.L. Avadh University Faizabad, India; 2004. 13. Negi, H.R. Lichens: a valuable bioresource for environmental monitoring and sustainable development. Resonance 2003; pp. 51-58.
14. Richardson, J. A. The effect of temperature on the growth of plants on pit heaps. J. Ecol. 1958; 46: 537-546. 15. Rogers, R. W. Lichens of hot- arid and semi –arid lands .In Lichen Ecology (Ed. Seaward M. R. D) Academic press, London 1977; pp. 213-252.
16. Selosse, M.A. Prototaxites, a 400 myr old gaint fossil, a saprophytic holobasidiomycete, or a lichen. Mycol. Res. 2002; 106:642- 644.
17. Shields, I. M. Algal and lichen fl oras in relation to nitrogen content of certain Volcanic and acid range soils. Ecology 1957; 38: 661-663.
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23. White, F.J. and James, P.W. A new guide to the microchemical technique for the identifi cation of lichen
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2016May22HealthcareUTILITY OF PH AND WHIFF TEST FOR SCREENING OF ABNORMAL VAGINAL DISCHARGE AMONG WOMEN OF REPRODUCTIVE AGE IN RURAL AREA
English3336Smita S. DamkeEnglish Ramesh P. FuleEnglish Neelima S. TankhiwaleEnglishThree vaginal infections are frequent causes of vaginal discharge: (1) bacterial vaginosis, (2)
vulvovaginal candidiasis, and (3) Trichomoniasis. Simple tool like pH and Whiff test can be carried out without any expertise. This
study was carried out to evaluate sensitivity and specificity of pH test and Whiff test individually and in combination in diagnosis
of abnormal vaginal discharge, considering microscopy as gold standard.
Material and methods: This prospective observational cross sectional study includes 189 women of reproductive age group
with vaginal discharge attending OBGY clinic from September 2010 to May 2012. Both pregnant and non-pregnant women were
included in the study with chief complaint of vaginal discharge. Vaginal discharge were collected for determining pH, to perform
Whiff test and for Gram staining and microscopy.
Results: Of 189 women 86 (45.5%) were diagnosed to have bacterial vaginosis by applying Nugent’s criteria as a gold standard.
Vulvovaginal candidiasis and Trichomoniasis was found in 61(32.27%) and 24(12.69%) respectively. The pH ? 4.5 was recorded
in 136 (71.95%) and Whiff test positive in 120 (63.49%) of women with abnormal vaginal discharge.
Conclusion: Simple tools like pH test and Whiff test can be used as a reliable test for determining abnormal vaginal discharge.
EnglishAbnormal vaginal discharge, pH test, Whiff testINTRODUCTION
Vaginitis is a common medical problem in women that is associated with substantial discomfort and frequent medical visits. Vaginal discharge is an extremely distressful condition for women, which can result from a variety of pathological conditions. Three vaginal infections are frequent cause of vaginal discharge: (1) bacterial vaginosis, (2) vulvovaginal candidiasis, and (3) Trichomoniasis. Research in recent years has increased our understanding of the disease process and its potential sequelae and results in improved diagnostic and treatment modalities(1-5). Confi rmation of aetiological diagnosis of abnormal vaginal discharge is important for specifi c and prompt treatment. National AIDS control organisation (NACO) introduced syndromic approach to treat patients with abnormal vaginal discharge[6]. Many times it is confusing to differentiate between normal and abnormal vaginal discharge and therefore it is important to draw defi nite conclusion regarding pathological nature of vaginal discharge by performing vaginal pH test and Whiff test. Bacterial vaginosis is reported to be one of the most common causes of abnormal vaginal discharge or vaginal symptoms in women of reproductive age[7-12]. There are many non-infectious causes of vaginal discharge however it is the role of microbiology laboratory to determine the presence of recognised microbial pathogens and disturbances of normal fl ora. The importance of bacterial vaginosis is emphasized by its association with pelvic infl ammatory diseases, adverse outcome of pregnancy in the postpartum period, endometritis and cuff cellulitis (13). Bacterial vaginosis has also been associated with infections after hysterectomy, as well as low birth weight infants and pre-term births in affected women(14). The complications arising out of bacterial vaginosis necessitate early diagnosis to institute prompt treatment of this polymicrobial syndrome. Bacterial vaginosis increases a woman’s susceptibility to HIV infection (15). Bacterial vaginosis is diagnosed when three of four of Amsel’s clinical criteria are present (i) abnormal, thin, homogenous discharge (ii) vaginal pH >4.5 (iii) positive Whiff test, and (iv) presence of clue cells. Vaginal pH test and Whiff test which are the components of Amsel’s clinical criteria if performed can help to draw defi nite conclusion so that proper therapy can instituted without further delay. Specifi city and sensitivity of pH test and Whiff test varies from study to study when compared with Gram’s stain vaginal smear scoring for morphotypes for diagnosis of bacterial vaginosis a major cause of abnormal vaginal discharge. Chijareenont et.al [10] reported that both vaginal pH and Whiff test has 100% sensitivity. Various studies have shown that in Trichomoniasis pH more than 4.5 and in candidiasis pH is less than 4.5[11]. Considering the risk factors associated with abnormal vaginal discharge the present prospective study was carried out to evaluate utility of pH test and Whiff test in terms of sensitivity and specifi city individually and in combination in diagnosis of abnormal vaginal discharge considering microscopy as a gold standard[12].
MATERIAL AND METHODS
This prospective study was carried out in the tertiary care rural hospital of central India. Ethical clearance was obtained from institute’s ethics committee. A total of 189 women of reproductive age group having abnormal vaginal discharge attending obstetrics and gynaecology outpatient department were included in the study. All such women were subjected to gynaecological examination. Vaginal speculum assisted vaginal swabs from lateral wall of vagina were collected for pH test and Whiff test. Vaginal pH was determined by dipping the pH paper strip of narrow range into the vaginal secretion and colour change compared with colour fi xed indicator strip. Whiff test was done by adding few drops of 10% potassium hydroxide (KOH) on the secretion and fi shy odour emitted due to liberation of aromatic amines was interpreted as positive test. Further vaginal fl uid was subjected to microscopic examination for demonstration of motile trichomonads by wet mount and budding yeast cells and pseudomycelia by Gram’s stain. Another slide of vaginal secretion fi xed with ethanol was stained by Gram’s method and was scored by using Nugent’s criteria for diagnosis of bacterial vaginosis. Smears were screened by two observers separately to obviate observer’s bias and graded according Nugent’s criteria.
RESULTS
A total of 189 women of reproductive age with symptomatic vaginal discharge were screened for vaginitis/vaginosis using pH and Whiff test. The pH ≥ 4.5 was found in 136 (71.95%) and Whiff test positive in 120 (63.49%) women. Both pH ≥ 4.5 and whiff test positive was recorded in 118 (62.43%) cases. Laboratory testing of vaginal discharge by Gram’s staining (Nugent’s morphotypes criteria) as agold standard revealed 86 (45.50%) patients suffering from bacterial vaginosis. Both pH ≥ 4.5 and Whiff test positive was recorded in 24 patients with trichomoniasis and negative in 71 cases of vulvovaginitis. Vaginal pH in diagnosing bacterial vaginosis was the most sensitive criterion, with the sensitivity of 97.05% and positive Whiff test was the most specifi c criterion with specifi city of 47.57%.
DISCUSSION
Bacterial vaginosis, vulvovaginal candidiasis and trichomoniasis are the most common causes of abnormal vaginal discharge in women of reproductive age that can be associated with signifi cant morbidity and complications. The estimated prevalence of vaginitis ranged from approximately 28% to nearly 100% depending on the diagnostic strategy [13]. In a study by Posner et.al. [13], evaluation of pH plus Whiff test was better than syndromic management protocols and easiest to implement in resource-poor setting. Based on Gram’s stain the gold standard, the prevalence of bacterial vaginosis was 45.50% inthe present study. Vaginal pH in bacterial vaginosis and trichomonas vaginalis infection is ≥ 4.5 and ≤ 4.5 in vulvovaginal candidiasis [14]. Generally, diagnosis of trichomoniasis is made by visualising active trichomonads on microscopy, but this method has only 60% to 70% sensitivity. A culture has great sensitivity, but generally not used outside a research setting. Simple test i.e. pH ≥ 4.5 is 100% sensitive as observed in the present study. In the presence of signs and symptoms suggesting possible genital tract infection laboratory evaluation for specifi c diagnosis is needed to avoid empiric treatment. The useful simple techniques used for diagnosing abnormal vaginal discharge includes pH testing, Whiff test, direct microscopy of vaginal secretions suspended in saline or potassium hydroxide (KOH), Gram’s stained vaginal smear scoring for bacterial vaginosis. Clinical criteria for diagnosing bacterial vaginosis can be simplifi ed to two clinical criteria without loss of sensitivity and specifi city. Appropriate testing, including microscopy, should be performed as clinically indicated, to rule out other infectious aetiologies. In more complicated cases of recurrent or persistent bacterial vaginosis, a Gram stain should be considered to corroborate the diagnosis [15]. Bacterial vaginosis is currently the most prevalent vaginal infection. In the present study 86 (45.50 %) patients were di-agnosed to have bacterial vaginosis on the basis of Nugent’s criteria. Twenty four and 71 patients were diagnosed to have trichomoniasis and VVC respectively. Demonstration of clue cells were the most reliable single indicator for bacterial vaginosis as reported [16] however, identifi cation of clue cells requires on-site microscopy facility, a trained personnel and time. In the present study, a total of 136 (71.95%) symptomatic women had vaginal pH>4.5 and 120 (63.45%) women were Whiff test positive, suggesting abnormal vaginal discharge associated with vaginitis. Much higher results were reported by Neelam S and Sohail I [17]. As regard to sensitivity and specifi city of pH test and Whiff test, it was found that both test showed 97.05% and 92.53% sensitivity and 47.57% and 56.31% specifi city respectively. Similar fi nding have been reported by Hemlata et.al. [18].
CONCLUSION
There is a great need for an inexpensive diagnostic method that is reliable and unifi es clinical and microbiological parameters to make it more sensitive while retaining the specifi city. A diagnostic strategy that uses the pH test and Whiff test is most likely to be the best solution in resource poor settings because, although it is not the most sensitive and specifi c test, it offers a middle ground on sensitivity and specifi city compared with technologically demanding Amsel’s criteria. Thus pH and Whiff test can improve diagnostic value of speculum examination where microscope facilities are not available. Confl ict of interest: None. Source of Funding: Nil
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=257http://ijcrr.com/article_html.php?did=2571. Eschenbach DA, Hillier SL. Advances in diagnostic testinh for vaginitis and cervicitis, J Reprod Med. 1989;34:555-65
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241810EnglishN2020October27HealthcareImplementation of RFID Technology in Managing Health Information in a Hospital
English177182Sharan Vinothraj A/L Kumaraseh Hariraj1English Vinesha SelvarajahEnglishObjective: This paper identifies the necessity for an RFID based technology that increases the management in hospitals. Problem: The following paper discusses the current issues faced by hospitals with traditionally based system and shows the effectiveness of implementing RFID systems in hospitals. Similar systems that utilize RFID in hospitals are explored and analyzed on their efficiency in managing health information systems. Data was also collected from various government and private hospitals to further understand the current state of technology being used to manage systems.
EnglishRFID, Hospitals, Healthcare, AIDC, Patient, Information Systemhttp://ijcrr.com/abstract.php?article_id=3012http://ijcrr.com/article_html.php?did=3012