Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524187EnglishN2016April12HealthcareBARDET BEIDL SYNDROME - A RARE PLEIOTROPIC DISORDER
English0103Sonia JaiswalEnglish Navbir PasrichaEnglish Prashant BhargavaEnglishBackground: Bardet–Biedl Syndrome is a disorder with a pleiotropic gene action on multiple phenotypic traits and thus a wide range of clinical variability is seen within and between families. Bardet Beidl Syndrome is characterized by rod cone dystrophy, truncal obesity, postaxial polydactyly, cognitive impairment, male hypo-gonadotrophic hypogonadism, complex female genitourinary malformations and renal abnormalities. Case Presentation: A one day old male child came to the Outpatient department of a private clinic. The case presented with polydactyly, absence of hard palate due to failure of fusion of bilateral premaxillary segments and macular grade corneal opacity as examined by an ophthalmologist. Conclusion: The diagnosis of Bardet Beidl syndrome (BBS) is established by clinical findings. According to studies by Beales et al in 1999 and 2001, diagnosis is confirmed with the presence of three primary features and two secondary features. An interpretation of the molecular pathogenesis with a thorough research into therapeutics may bring about new treatment options for the organ specific disorders of Bardet Beidl Syndrome.
EnglishBardet beidl syndrome, Polydactyly, Syndactyly, HypogonadismINTRODUCTION Bardet Beidl syndrome is a multisystem autosomal recessive disorder. The syndrome is named after Georges Bardet and Arthur Beidl.(1) It is synonymous with Lawrence Moon syndrome but it is a matter of debate as some workers consider it as a separate entity while some recent research suggests that the two conditions may not be distinct .(2) Bardet-Biedl syndrome is a multisystemic genetic disorder characterized by postaxial polydactyly, progressive retinal dystrophy, obesity, hypogonadism, learning difficulty, and renal dysfunction. Other manifestations include diabetes mellitus, neurological impairments (mainly ataxia), heart disease, oro- dental malformations. Due to the late onset of symptoms, the diagnosis of BBS is usually made during childhood.
For example, obesity appears around age 2–3 years, and retinal degeneration becomes clinically apparent only at age 8 years.(3,4) The only features that may be present at birth are polydactyly, kidney anomaly, hepatic fibrosis, and genital or heart malformations. Bardet-Biedl syndrome (BBS) is a rare, genetic multisystem disorder; a ciliopathy secondary to the basal body dysfunction.(5,6) Mutations in 14 genes are known to be associated with BBS ( Bardet Beidl Syndrome): BBS1, BBS2, ARL6/ BBS3, BBS4, BBS5, MKKS/BBS6, BBS7, TTC8/ BBS8, B1/ BBS9, BBS10, TRIM32/BBS11, BBS12, MKS1/ BBS13, and CEP290/BBS14 .( 7)
CASE PRESENTATION A one day old male baby with a normal birth weight of 2.5 kg came to a private clinic (Sai clinic). The father complained about the deteriorating condition of the patient due to fever and breathlessness. On careful examination by a Neonatologist the width of the head region was more as compared with the length, the back of head was flat rather than curved and the tips of ears were protruded. The patient had a flattened nasal bridge, there was presence of a bilateral cleft lip and palate and an anomaly was seen in the lower limb with hexadactyly in the left foot and brachydactyly with syndactyly in the right foot (fig 1). Hypogonadism was also present in the patient (rudimentary penile shaft was seen fig 2).
The Ophthalmologist observed a semi dense opacity in the cornea with the rest of the cornea hazyand hence diagnosed the condition as a segmental macular grade corneal opacity(fig 3). On the basis of the clinical findings a diagnosis of BardetBeidl syndrome was made. Beales et al (1999) and Beales et al (2001) have suggested that the presence of three to four primary features and two secondary features is a diagnostic feature of Bardet-Beidl Syndrome.(3,4)
DISCUSSION Bardet and Biedl first described BBS in the early 1920s. For many years it was considered as Laurence–Moon–Bardet– Biedl syndrome (MIM 245800), but now Lawrence Moon and Bardet Beidl syndromes are recognized as separate syndromes. Bardet-Biedl syndrome affects males and females in equal numbers. The prevalence is estimated to be 1 in 100,000 in the non-related (non-consanguineous) populations of Northern Europe and America. In Sweden, the prevalence is estimated to be 1 in 160,000. The disorder occurs with greater frequency in the Bedouin population of Kuwait (1 in 13,500) and in certain populations of Newfoundland (1 in 17,500).
The estimated incidence of this rare syndrome is 1/ 125 000– 160 005. (8) In almost all reported cases, digital abnormalities are invariably present. Kwitek-Black et al reported a large inbred Bedouin family from the Negev region of Israel with all nine affected subjects having polydactyly.(9) Green et al examined 32 patients with BBS and found that all cases (32) had syndactyly, whereas brachydactyly, polydactyly was present in 18 of 31 patients.(10) These findings are similar to our case with hexadactyly in the left foot and brachydactyly with syndactyly in the left foot.
Carmi et al found that there was a phenotypic variability in the number and severity of clinical manifestations in BBS(BardetBeidl Syndrome), particularly in the pattern of polydactyly thus reflecting the differing genotypes underlying the disorder.(11)Somwanshi reported four cases (three males, one female) with polydactyly, hypogonadism, retinitis pigmentosa, obesity, and mental retardation,(12) similarly the male infant in our case presented with hypogonadism. The most common defective gene associated with BardetBiedl syndrome is the BBS1 gene located on the long arm (q) of chromosome 11 (11q13). The BBS1 gene accounts for approximately 30 percent of cases. The genes associated for Bardet-Biedl syndrome contain instructions for encoding proteins.
Mutations of these genes results in altered function of these proteins. Investigators have determined that most of the Bardet-Biedl proteins are associated with cilia which are hair-like structures that cover most type of cells in the body, and structures such as the basal body (which help in anchoring the cilia to a cell) or flagella. Recent findings in genetic research have suggested that a large number of genetic disorders including both syndromes and diseases have perhaps no relation phenotypically but may be related genotypically.
BBS is one such syndrome that has now been identified to be caused by defects in the cellular ciliary structure thus making it a ciliopathy. Other known ciliopathies include primary ciliary dyskinesia, polycystic kidney and liver disease, nephronophthisis, Alstrom syndrome, Meckel– Gruber syndrome and some forms of retinal degeneration.(13)
CONCLUSION The diagnosis of BBS in this case was made on the basis of clinical features. The mechanism of the clinical and genetic diversity in BBS patients is not yet known. A careful clinical evaluation of the molecular pathogenesis of BBS will help in a better understanding of this disorder.
Englishhttp://ijcrr.com/abstract.php?article_id=297http://ijcrr.com/article_html.php?did=2971. Synd/3745 at who named it?
2. Moore S, Green J, Fan Y; et al. (2005). “Clinical and genetic epidemiology of Bardet–Biedl syndrome in Newfoundland: a 22- year prospective, population-based, cohort study”. Am. J. Med. Genet ARRAY 132 (4): 352– 60. doi:10.1002/ajmg.a.30406. PMC 3295827. PMID 15637713.
3. Beales PL, Elcioglu N, Woolf AS, Parker D, Flinter FA (1999) New criteria for improved diagnosis of Bardet-Biedl syndrome: results of a population survey. J Med Genet36:437– 446
4. Beales PL, Katsanis N, Lewis RA, Ansley SJ, Elcioglu N, Raza J, Woods MO, Green JS, Parfrey PS, Davidson WS, Lupski JR (2001) Genetic and mutational analyses of a large multiethnic Bardet-Biedl cohort reveal a minor involvement of BBS6 and delineate the critical intervals of other loci. Am J Hum Genet 68:606–616
5. Ansley SJ, Badano JL, Blacque OE, Hill J, Hoskins BE, Leitch CC, Kim JC, Ross AJ, Eichers ER, Teslovich TM, Mah AK, Johnsen RC, Cavender JC, Lewis RA, Leroux MR, Beales PL, Katsanis N: Basal body dysfunction is a likely cause of pleiotropic Bardet-Biedl syndrome. Nature 2003, 425:628-633.
6. Adams M, Smith UM, Logan CV, Johnson CA: Recent advances in the molecular pathology, cell biology and genetics of ciliopathies. J Med Genet 2008, 45:257-267.
7. Waters AM, Beales PL: Bardet-Biedl Syndrome.[http://www. ncbi.nlm.nih. gov/books/NBK1363/].
8. Klein D, Ammann F. The syndrome of Laurence–Moon–Bardet– Biedl and allied diseases in Switzerland. Clinical, genetic and epidemiological studies. Neurol Sci 1969; 9: 479–513.
9. Kwitek-Black AE, Carmi R, Duyk GM, Buetow KH, Elbedour K, Parvari R, Yandava CN, Stone EM, Sheffield VC. Linkage of Bardet– Biedl syndrome to chromosome 16q and evidence for non-allelic genetic heterogeneity. Nat Genet 1993; 5: 392–6
10. Green JS, Parfrey PS, Harnett JD, Farid NR, Cramer BC, Johnson G, Heath O, McManamon PJ, O’Leary E, Pryse-Phillips W. The cardinal manifestations of Bardet–Biedl syndrome, a form of Laurence–Moon– Biedl syndrome. New Eng J Med 1989; 321: 1002–9.
11. Carmi R, Elbedour K, Stone EM, Sheffield VC. Phenotypic differences among patients with Bardet–Biedl syndrome linked to three different chromosome loci. Am J Med Genet 1995; 59: 199– 203
12. Somwanshi PR, Nikam SH, Patni PD: Laurence Moon Biedl Bardet syndrome. J Assoc Physician India 1988, 36:333-335.
13. Badano JL, Mitsuma N, Beales PL, Katsanis N (2006). “The ciliopathies: an emerging class of human genetic disorders”. Annu Rev Genomics Hum Genet 7: 125–48. doi:10.1146/annurev.genom.7.080505.115610. PMID 16722803.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524187EnglishN2016April12HealthcareDOES BODY MASS INDEX EFFECT NERVE CONDUCTION? A CROSS SECTIONAL STUDY
English0407Vineeta ChadhaEnglish Surendra S. ShivalkarEnglishAim: Body mass index (BMI) is an important parameter in gauging adiposity and obesity. Many studies have shown higher incidence of cardiovascular diseases especially coronary artery diseases in population with BMI greater than 25. (1) Studies also reveal median and ulnar nerve compression associated with an increasing incidence of higher BMI. (2) This study is an attempt to establish a relationship between median nerve conduction parameters and BMI in a population group from a metropolitan city in urban India. Methodology: In the present study the effect of Body Mass Index (BMI) on Median nerve motor and sensory conduction latency, amplitude and velocity was analysed in 90 healthy people in the age group of 18-30 years. Standardized protocol was followed while performing nerve conduction study in all the subjects. Results: This study shows that sensory nerve conduction amplitude decreases significantly with increase in BMI whereas the effect on other parameters is non-significant. Conclusion: This could be attributed to attenuation in conduction current by thicker subcutaneous tissue in persons with higher BMI. Median nerve latency and conduction velocity do not show significant decrease. This could be due to the fact that speed of conduction is same in the fastest conducting fibres irrespective of the adiposity..
EnglishNerve conduction velocity, Nerve conduction latency, Nerve conduction amplitude, Body mass index, Median nerveINTRODUCTION
Nerve conduction study is used in the diagnosis of focal or diffuse peripheral neuropathies. Various study parameters are used to differentiate between the types of neuropathies and to know the extent and distribution of lesion. (3) Nerve conduction studies (NCS) are in turn affected by gender, age, height, weight and temperature. (4) Past studies have shown that high BMI is a risk factor for carpel tunnel syndrome and variation of body mass index (BMI) from normal is a risk factor for ulnar neuropathy at elbow. (2) Negative correlation has been shown between BMI and sensory nerve action potential amplitude (5).
BMI is an important factor taken into consideration while assessing peripheral neuropathy in diabetic patients. (6) Influence of BMI on nerve conduction velocity has been evaluated, however, majority of these studies are based on Caucasian subjects. (7) This study is aimed at deriving normative reference data on Indian population that closely relates to the demographic profile of the patients being studied. It has been hypothesized in this study that high BMI leads to decrease in nerve conduction velocity, increase in latency and decrease in amplitude of nerve conduction.
MATERIALS AND METHODS
The study was conducted in a teaching college and hospital in Mumbai with prior permission of the ethical committee on 90 healthy volunteers in the age group of 18-30yrs. Through relevant history and neurological examination, subjects with medical conditions (Diabetes Mellitus, Thyroid Disorders, Neuromuscular disorders, Drug Abuse and Chronic Alcohol Abuse) or on drugs (Antiretroviral, Antitubercular) that could affect nerve conduction were excluded. A brief explanation of the procedure was given to the subjects and voluntary informed consent was taken. Height and weight of each subject was recorded and BMI was calculated as weight (kg) divided by height (m) squared.
The study group was divided into 3 depending upon the value of BMI (BMI25). The amplitude, latency and conduction velocity were measured for Compound Muscle Action Potential (CMAP) as well as Sensory Nerve Action Potential (SNAP) component of median nerve prospectively using NEURO – MEP – NET EMG/NCV/EP (NEUROSOFT) equipment according to standard protocol and settings at a room temperature of between 24-30o C. (8, 9) For motor nerve conduction study the low frequency filter was set at 2 Hz and high frequency filter at 10 kHz. For sensory nerve conduction study the low frequency filter was set at 5 Hz and high frequency filter at 3 kHz.
The sweep speed was set at 2 milliseconds/division. (8, 9) Motor NCS requires stimulation of a nerve while recording from a muscle innervated by that nerve, whereas sensory NCS require stimulating a mixed nerve while recording from a mixed or cutaneous nerve. (10) Median motor and sensory nerve conduction velocity were recorded as described by Mishra and Kalitha. (8) Recording electrode was placed on the motor point of Abductor Pollicis Brevis, reference electrode 3cm distal to recording electrode and ground electrode was placed on dorsum of the hand for Median motor nerve conduction parameters.
Similarly median sensory conduction was performed orthodromically with respective electrodes placed on appropriate sites. (8) Conduction velocity, latency and amplitude of the median nerve were taken for analysis. ANOVA was used to analyse the effect of BMI on nerve conduction velocity, latency and amplitude. Pearson’s correlation coefficient (r) was used for finding correlation between BMI and Nerve conduction velocity, latency and amplitude.
Observations and Results
Data was statistically analyzed using appropriate tests after adjusting for age and sex. With increasing BMI, there was a decrease in amplitude of sensory median nerve which was statistically significant. No correlation was noted between BMI and nerve conduction velocity and latency. Motor and sensory nerve conduction amplitudes correlated significantly (P < or = 0.05) with BMI.
DISCUSSION In this study, effect of body mass index (BMI) on nerve conduction parameters for median nerve was evaluated. Results were statistically analyzed and normal values for median nerve conduction in healthy Indian population calculated. The findings of this study are similar to, Buschbacher RM et al (7) who showed that sensory and mixed nerve amplitudes correlated significantly (p < or = 0.01) with BMI for all the tested nerves. This study shows correlation between sensory amplitudes but not with mixed nerve amplitudes. Mean of amplitudes in subjects with higher BMI (obese) was less than in thin subjects.
This could be attributed to the fact that thicker subcutaneous tissue in persons with higher BMI causes amplitude attenuation. Hasanzadeh P et al. also showed that sensory amplitudes decrease but motor amplitudes are spared with increasing BMI. (5) This could be due to the thousand times rise in motor amplitude voltage (millivolts) as compared to sensory amplitude (microvolt). Also, Buschbacher RM et al (7) did not observe significant association of decrease in latency with higher BMI for median nerve which was similar to the findings in our study.
This observation might be due to the fact that median nerve being deeper is not much dependent on subcutaneous fat thermal insulation to maintain perineural temperature and thus individuals with various height and weights or BMI have almost similar temperatures around this nerve causing similar latent periods of conduction. They also reported no correlation between BMI and nerve conduction velocity, latency or most of the other motor and sensory parameters. This could be attributed to the fact that the speed of conduction is equal in fastest fibres in obese and thin individuals. The findings of this study are in contrast with Awang MS et al (10) who showed decrease in conduction velocity in median nerve with increasing BMI. In this study no significant increase or decrease in sensory and motor median nerve conduction velocity was found. The findings of this study are also in contrast with Baqai HZ et al (11) where no effect of BMI on nerve conduction parameters was reported. The present study also found greater influence of BMI on sensory nerve conduction as compared to motor nerve conduction studies. This was similar to the findings reported by Buschbacher RM (7) and Pawar et al (12).
Vessey et al. described an increasing risk of developing Carpel tunnel syndrome in women with higher BMI.(13) Kouyoumdjian et al. demonstrated in Brazilian population, that increasing BMI is correlated with a higher relative risk for developing compressive neuropathy. (14) Werner et al. found that the likelihood of developing median mononeuropathy at the wrist was 2.5 times higher in obese individuals (BMI > 29) than the slender ones (BMI < 20). (15) Thus there is a causal relationship between changed median nerve conduction parameters and increased BMI causing neuropathies which could be due to increased hydrostatic pressure or fatty tissue within the carpal tunnel in obese individuals. (15) Therefore the correlation between increased BMI and lower median sensory nerve amplitudes should be taken into account in clinical practice.
Another aspect is the increase in production of adipokines like plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor-alpha (TNF-α), resistin, leptin, and adiponectin in subjects with high BMI. (16) Adipocytes induce production of reactive oxygen species initiating the process of oxidative stress. (17) Diminished activity of antioxidant enzymes such as catalase, superoxide dismutase, and glutathione peroxidase due to increasing adiposity could be implicated in causing free radical injury. Hence it is highly recommended that studies be conducted on molecular level to establish a relationship between nerve conduction parameters, increasing level of adipokines and oxidative stress.
CONCLUSION In conclusion this study demonstrates that most of the parameters of nerve conduction study are not significantly associated with BMI. However the correlation between increased BMI and decreasing sensory nerve action potential amplitudes should be considered while testing for carpel tunnel syndrome and neuropathies in obese subjects.
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: None Conflict of interest: None stated
Englishhttp://ijcrr.com/abstract.php?article_id=298http://ijcrr.com/article_html.php?did=2981. Romero-Corral A, Montori V M, Somers V K, Korinek J, Thomas R J, Allison T G, Mookadam F, Lopez-Jimenez F. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies. Lancet. 2006 Aug 19;368(9536):666-78.
2. Landau ME, Barher KC, Campbell WW. Effect of body mass index on ulnar nerve conduction velocity, ulnar neuropathy at elbow and carpal tunnel syndrome. Muscle Nerve 2005; 32(3): 360–363.
3. Kimura J. Principles and pitfalls of nerve conduction studies. Ann Neurol 1984; 16: 415-429.
4. Chi-Ren Huang, Wen-Neng Chang, Hsueh-Wen Chang, NaiWen Tsai, and Cheng-Hsien; Effects of Age, Gender, Height, and Weight on Late Responses and Nerve Conduction Study Parameters; Lu Acta Neurol Taiwan 2009;18:242-249
5. Hasanzadeh P, Oveisgharan S, Sedighi N, Nafissi S. Effect of skin thickness on sensory nerve action potential amplitude. Clin Neurophysiol 2008; 119(8): 1824–1828.
6. Xuan Kong, Eugene A. Lesser, Frisso A. Potts, Shai N. Gozani. Utilization of Nerve Conduction Studies for the Diagnosis of Polyneuropathy in Patients with Diabetes: A Retrospective Analysis of a Large Patient Series. J Diabetes Sci Technol. 2008 March; 2(2): 268–274.
7. Buschbacher RM. Body mass index effect on common nerve conduction study measurements.Muscla Nerve, 1998 Nov; 21(11):1398-404
8. Misra U K, Kalita J. Clinical Neurophysiology, 2nd Edition: 1-128.
9. Misulis KE, Head TC. Nerve conduction study and electromyography. In: Pioli SF, editors. Essentials of Clinical Neurophysiology. 3rd Ed. Burlington: Butterworth-Heinemann; 2003. p.129-144.
10. Awang MS, Abdul lah JM, Abdul lah MR, Tharakan J, Prasad A, Husin ZA, Hussin AM, Tahir A, Razak SA. Nerve conduction study among healthy Malays . The influence of age, height, and body mass index on Median, ulnar , common peroneal and sural nerves. Malaysian Journal of Medical Sciences 2006; 13(2): 19–23.
11. Baqai HZ, Tariq M, Din AMU, Khawaja I, Irshad M. Sural nerve conduction; Age related variation studies in our normal population. The Professional 2001; 08(04): 439–444.
12. Sachin M. Pawar, Avinash B. Taksande and Ramji Singh. Effect of body mass index on parameters of nerve conduction study in Indian population. Indian J Physiol Pharmacol 2012; 56(1) : 88–93
13. Vessey MP, Villard-Mackintosh L, Yeates D. Epidemiology of carpal tunnel syndrome in women of childbearing age:findings in a large cohort study. Int J Epidemiol 1990;19:655-659.
14. Joao Aris Kouyoumdjian, Maria Da Penha Ananias Morita, Paulo Ricardo Fernando Rocha, Rafael Carlos Miranda, Gustavo Maciel Gouveia. Body Mass Index And Carpal Tunnel Syndrome. Arq Neuropsiquiatr 2000;58(2-A):252-256
15. Werner RA, Albers JW, Franzblau A, Armstrong TJ. The relationship between body mass index and the diagnosis of carpal tunnel syndrome. Muscle Nerve 1994;17:632-636.
16. Fonseca-Alaniz, M.H.; Takada, J.; Alonso-Vale, M.I.; Lima, F.B. Adipose tissue as an endocrine organ: From theory to practice. J. Pediatr. 2007, 83 (Suppl. 5), S192–S203.
17. Alba Fernandez-Sanchez, Eduardo Madrigal-Santillan, Mirandeli Bautista, Jaime Esquivel-Soto, Angel Morales-Gonzalez, Cesar Esquivel-Chirino, Irene Durante-Montiel, Graciela Sanchez-Rivera, Carmen Valadez-Vega and Jose A. MoralesGonzalez. Inflammation, Oxidative Stress, and Obesity. Int. J. Mol. Sci. 2011, 12, 3117-3132.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524187EnglishN2016April12HealthcareKNOWLEDGE OF QUALIFIED PARAMEDICAL STAFFS IN UNDERSTANDING THE SYMPTOMATOLOGY AND HORMONAL REPLACEMENT THERAPY IN MENOPAUSE
English0812Umakant ValvekarEnglish S. ViswanathanEnglishBackground: Menopause is a hormonal depletion state which may lead to psychosomatic condition where it needs psychological support by family members. Most menopausal women go untreated. It is better to have physician’s advice in some cases for normal life style. The awareness of menopause and hormonal replacement therapy (HRT) was low among paramedical staff. Methodology: A survey was conducted in 34 women paramedical staff members of Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Tamil Nadu, India. The survey was about the knowledge of women paramedical staff in understanding vasomotor, psychosocial, physical, sexual changes and hormonal replacement therapy (HRT) in menopausal women. The study subjects were divided into two groups as menopausal group (group A) and premenopausal group (group B) consists of 17 subjects in each group. Results: In the present study most menopausal group (group A) women answered that they had experienced hot flushes, insomnia, psychological disturbances, bloated feeling as major symptoms. In this survey most of the paramedical women staff members of menopausal group replied that there was a decrease in the sexual interest in them and they felt natural approaches are better than replacement therapy. Whereas majority of women from premenopausal group (group B) opinioned that sexual interest does not decrease even after menopause. However, they expressed similar opinion as that of menopausal women for the natural approach of menopause is better than hormonal replacement therapy. Conclusion: Awareness of the menopause and HRT is low even among the paramedical staffs. This clearly suggests that there is need to change the attitude of a common woman towards menopause. This can be done by conducting awareness programs on menopause and hormonal replacement therapy (HRT) to paramedical staffs and general public.
EnglishAttitude, Knowledge, HRT, Symptomatology of menopause, Nursing staffs and Medical techniciansINTRODUCTION When a woman stops menstruating, then it is termed as menopause. It is a natural event, not a disease or illness. However, for some women the physical and emotional symptoms can be difficult1 . Menopause involves hormonal changes that may cause physical symptoms. For some women, menopause may bring on feelings of sadness1 . As per a study done by Sengupta2 in 2003, more than 130 million women in India would have reached menopause by 2016. Menopause is an unspoken, unattended reality of woman, which can last 1/3rd phase of her life2 . Various types of menopausal symptoms include vasomotor, psychosocial, physical and sexual1 . 60% of post-menopausal women will experience mild symptoms, 20% severe and another 20% no symptoms3, 4.
With literacy, increasing age expectancy, urbanization, health consciousness, rapid globalization, internet, health education on T.V and improved economic conditions, menopause is emerging important health issue. Changes taking place in post-menopause are also new issues. Symptoms recognized early can help in reducing discomfort and fear3, 4. Mean age for attaining menopause is 44-45 years in developing countries and 48.2 years in developed countries. Under reporting of symptoms in India is due to socio-cultural features.
Menopause and related changes in the hormone also cause symptoms which are affected on the quality of life, such as night sweats, sleep disturbances, hot flushes, vaginal dryness, urinary frequency, poor memory and depression3-5. Hormonal replacement therapy (HRT) is the effective management to menopausal symptoms and may prevent women from increased osteoporosis and also decreases the cardiovascular risk3-5.
MATERIAL AND METHODS The present survey was conducted at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, a tertiary care centre with teaching hospital in Kanchipuram district of Tamil Nadu. Aim of the study was to find out the attitude, symptomatology, knowledge of menopause and HRT in our paramedical staff members i.e. qualified nursing staffs and medical technicians. Total of 34 women working at our hospital in different clinical departments were selected for the study. Study subjects were divided into two groups i.e, group A and group B; Group A being post-menopausal women and the age of all the subjects were more than 45 years.
The other group is, group B being pre-menopausal women and they are all in reproductive age group only. Each group consists of 17 subjects. Details of age, marital status, and duration of menopause experience of both the groups were mentioned in table 1, table 2 and table 3 respectively. By using a pre designed and tested questionnaire we collected the information about their medical history, current or past history of hormonal treatment, alternative treatment, signs and symptoms of osteoporosis and cardio-vascular diseases, dietary and life style changes were noted down carefully.
No woman had any mental problems, or was on neither any anxiolytics, anti-depressants nor any recent mishap/trauma. Comparisons were made between premenopausal and postmenopausal women. Data storage, analysis, statistics summary and chi square tests were carried out using a standard statistical package. Data was expressed in percentage. Pre menopausal women were included for the study because they could help in identifying the gap in the knowledge, understanding and differences in attitude.
RESULTS Details of age and marital status of the subjects in group A and group B was given in table 1 and table 2 respectively. Out of 17 women selected for the study in group A, four women (23.52%) were had the duration of the menopause less than one year, four (23.52%) women had 1 to 2 years of menopausal duration, another four women (23.52%) had 2 to 5 years menopausal duration, and other 5 (29.4%) women had more than five years of menopausal duration (table 3).
In the present study most menopausal group (group A) women answered that they had experienced hot flushes (47.04%), insomnia (58.8%), psychological disturbances (58.8%), bloated feeling (58.8%) as major symptoms (table 4). While assessing the attitudes of the paramedical women staff members of menopausal group (group A), 58.80% of them were answered that there was a decrease in the sexual interest in them. This may be because of dryness of vagina. Further 87.20% of the women felt natural approaches were better than hormonal replacement therapy. Majority of women from premenopausal group (group B) opinioned that sexual interest does not decrease even after menopause (table 4). However, they expressed similar opinion as that of menopausal women for the natural approach of menopause is better than hormonal replacement therapy. In group A, 58.80% women experienced that sexual desire was decreased after menopause, 23.52% had sexual discomfort.
About 47 % of women from group B did not answer about the attitudes towards sexual life after menopause as they had yet to attend menopause. More than 50% of women in both the groups were having the impression of psychological changes were physiological or due to ageing but not hormonal. Most interesting thing was that women of both the groups (group A = 47% and group B = 35.28%) think that those who suffer from the changes are those who expect it. About 47% of women of both the groups think that the risk of estrogen treatment outweighs the benefit. Further, women of both groups (group A = 87.2%; group B = 82.32%) think that natural approach is always better than hormonal replacement therapy in menopause; they say natural is natural (table 5). In answering about their male partner has reduced sexual desire after menopause, 17.64 % in group A and 11.76% in group B think so.
This clearly suggests that their male partner having normal sexual feeling even after their menopause. In the present study post-menopausal women had insomnia in 58.8%, pain in upper abdomen in 29.4% and psychological disturbances 58.8% (table 5 and table 6). The association between reported symptoms and attitude towards menopause and HRT was found to be statistically significant (p Englishhttp://ijcrr.com/abstract.php?article_id=299http://ijcrr.com/article_html.php?did=2991. Al-Azzawi F, Palacios S. Hormonal changes during menopause. Maturitas. 2009; 63(2):135-137.
2. Sengupta A. The emergence of the menopause in India. Climacteric.2003; 6:92 -95.
3. Porter M, Penney GC, Russell D, Russell E, Templeton A. A population based survey of women’s experience of the menopause. Br J. Obst. Gynaecol 1996; 103(10); 1025 – 1028.
4. Shaheen S, Mahmood A, Kadri F. Menopause and HRT; Clinical pattern and awareness. Professional Med J. 2015; 22(7)904-909.
5. Singh A, Arora AK. Profile of menopausal in rural North India. Climacteric. 2005; 8(2):177-184.
6. Pam HA, Wu MH, Hsu CC, Yao BL, Huang KE. The perception of menopause among women in Taiwan. Maturitas 2002; 41:269 – 274.
7. Jin Yong Lee, Chang Suk Suh. The attitudes of postmenopausal women towards hormone replacement therapy (HRT) and effects of HRT on lipid profiles. Proceedings of the first consensus meeting on menopause in East Asian region, 1997; May 26 – 30.
8. Ferguson KJ, Hoegh C, Johnson S. Estrogen replacement therapy: a survey of women’s knowledge and attitudes. Arch Intern Med. 1989; 149:133 – 136.
9. Mahajan N, Aggarwal M, Bagge A. Health issues of menopausal women in North India. J. Midlife Health, 2012; 3:84-87.
10. Bairy L, Shalini A, Bhat P, Bhat R. Prevalence of menopausal symptoms and quality of life after menopause in women from South India. Aust N Z J Obstet Gynaecol. 2009; 49:106–109.
11. Saka MJ, Saidu R, Jimoh A, Akande T. Behavioral pattern of Menopausal Nigeria women. Ann. Trop Med. and Public Health. 2012; 5(2): 74-79.
12. Puri S, Bhatia V, Mangat C. Perceptions of Menopause and Postmenopausal Bleeding In Women of Chandigarh, India. The Internet Journal of Family Practice. 2007; 6(2):1- 6.
13. Nedrow A, Miller J, Walker M, Nygren P, Huffman LH, Nelson HD. Complementary and alternative therapies for the management of menopause related symptoms: A systematic evidence review. JAMA. Arch Intern Med. 2006; 166(14):1453-1465.
14. Meherishi S, Khandelwal S, Swarankar ML, Kaur P. Attitudes and practices of gynecologists in Jaipur towards management of menopause. J. Midlife health, 2010; 1(2):74-78.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524187EnglishN2016April12HealthcareSIMULATING THE ACTIVITY OF VINCRISTIN (AN ANTICANCEROUS DRUG) WITH BIOGENIC NANOPARTICLES USING VIGNA RADIATASEEDS
English1322Himakshi Bhati KushwahaEnglish C. P. MalikEnglishBackground: The present study reports the inhibitory effects of biogenic nanoparticles synthesized from Tridax procumbens stem (fresh and powder) aqueous extract on seed germination and seedling growth of Vigna radiata. These synthesized nanoparticles were well characterized by UV-visible spectroscopy; SEM; XRD and FTIR analysis. The constituents in the extract were also well characterized using FTIR analysis. The cytotoxic propertiesof the biogenic nanoparticles were then compared with the individual aqueous extract and vincristin (an anti-cancerous drug- used for ease in cancer.). The inhibition of seed germination and seedling growth was found to be dose-dependent and was suitable to quantify the bioactivity of biogenic nanoparticles preparations. Objective: The present investigation, emphasizes on simulating the activity of the synthesized biogenic nanoparticles from T. procumbens withan anticancerous drug –vincristine using in vitro bioassay system (Kumar and Singhal, 2009). The growth promotion and/or retardation activity of crude plant extractis also described. Method:After reviewing number of peer-reviewed published articles the safest and eco-friendly method for the synthesis of the nanoparticles had been adopted. Biogenic nanoparticles were later well characterized by SEM, XRD, and FTIR analysis. Their activity against anticancerous drug – vincristine, was tested using an in vitro bioassay on Vigna radiata. Results: Present study brings out the role of biogenic nanoparticles in inhibiting seed germination which was dose dependent. With vincristin comparable inhibition was observed. The plant extract, bionanoparticles and vincristin, promoted water imbibitions by the seeds though their higher concentrations inhibited this process. Reduction in water imbibitions, caused by these failed to trigger processes leading to reduced seed germination and radicle decay. The growth retardation following these treatments could be attributed to the inhibition of cell division and radicle protrusion brought about by osmotic stress (de Castro et al., 2000). From these observations it could be safely inferred that the plant extracts exhibited effective inhibitory activity, though biogenic nanoparticles and vincristin were most effective at 1.0 and 2.0 mg ml-1. Conclusion: Biogenic nanoparticles are eco-friendly, cost effective, and rapidly synthesized, and hence are more acceptable than the anti-cancerous drugs available in the market. The latter have side effects, cost issues, toxic chemicals involved in their synthesis, storage complexities, etc. The present study opens new avenue for medical sciences where plant extract synthesized nanoparticles via “green route” can be the safer alternative than synthetic anti-cancerous products.
EnglishSeed germination, Bioactivity, Seedling growth, Tridax procumbens, Vigna radiata, Vincristin, UV-visible, SEM, XRD, FTIRINTRODUCTION Nanotechnology chiefly concerns with the synthesis of nanoparticles of variable sizes, morphology, shapes and chemical composition and because of their unique physiochemical characteristics e.g. optical and electronic properties, catalytical activity, magnetic properties and antibacterial traits, they are being extensively researched for their potential applications in the field of life sciences. The physical and chemical processes are generally employed for the manufacture of nanoparticles, but these methods are not ecofriendly and involve toxic metals in the synthesis process.
These technical hitches in the nanoparticle synthesis are surmounted by biogenic process involving micro-mediated and plant-mediated route. Such a process is preferred because of simplicity, eco friendliness and biocompatibility. In the plant-mediated biological synthesis of nanoparticles, different plant constituents play a critical role in the reduction of Ag+ to *\ silver nanoparticles. Tridax procumbens Lin (Fam: Asteraceae) is a medicinally important plant found throughout India especially in Rajasthanwith several valuable chemical constituents e.g. flavone glycosides, chromone glycosides, sterols and polysaccharides with a Beta-1,6-D-galactan main chain. Further the ethyl acetate soluble fraction of hexane extract revealed trisbisbitiophene along with four terpenoids taraxasteryl acetate, lupeol, oleanolic acid and some flavonoids, etc.
Unsaponiable fraction of petroleum ether fraction yielded campesterol, stigmasterol, beta-sitosterol. A number of pharmacological activities have been described by various investigators and these are furtherance of clotting time, e.g. wound healing, hepatoprotective, antimicrobial, anti-juvenile hormone, antiinflammatory, anti-diarrhoeal, anti-protozoal, immunomodulatory, hair growth promoting, insecticidal, antioxidant activities, cardiovascular effects, etc. Additionally, its chemical constituents possess antimicrobial and immunomodulatory action (Malik et al., 2012). Several chemicals, drugs and plant extracts are shown to have cytotoxic properties and are either used and /or proposed to be used for treating various cancers. These drugs have diverse modes of activity e.g. interference with cellcycle kinetics, inhibition of proliferation of mitotically active cells by damaging the DNA during S-phase of the cell cycle or blocking the formation of mitotic spindle during the M phase or arrest mitotic activity.
Several natural products, having variable chemical structures, have been isolated as anti-cancerous agents. Srivastava et al. (2005) have reviewed plant-based anti-cancerous molecules and have discussed the chemical and biological profile of some significant lead molecules.These leads have variable effects ranging from interference with cell cycle kinetics, inhibition of the proliferation of mitotically active cells in variable ways e.g. damaging the DNA during S-phase of the cell cycle or blocking the formation of mitotic spindle during the M phase. Some plant derived lead molecules affect microtubules dynamics and signalling pathway causing mitotic arrest. Many of the drugs exhibit anti-mitotic activity both in vivo and in vitro and are anti-cancerous. Currently, several anti-cancerous agents are available and there is a continuous search for new leads that may be more effective and harmless (Murthy et al., 2011).
Multiple bioassay systems and experimental models are used to decipher the anti-mitotic activity. These include bacterial cultures, in vivo investigations based on mice, root tip meristem etc. Most of these bioassays are cumbersome and time consuming. In recent years a simple in vitro bioassay has been successfully evaluated for the rapid and preliminary screening of anti-cancerous drugs (Kumar and Singhal, 2009). In the present investigation, the synthesis of biogenic nanoparticles using T.procumbens has been undertaken and the growth promotion and/or retardation activity of crude plant extract, using in vitro bioassay system (Kumar and Singhal, 2009) is described. The activity is also compared with the action of the biogenic nanoparticles synthesized from the same source as well as anti-cancerous drug vincristin.
MATERIAL AND METHODS Our current investigation was carried out at Jaipur National University and Indian Institute of Technology (IIT)-Kanpur. Plant Material Fresh branches of T. procumbens were collected from the campus of JNU, Jaipur. Synthesis and characterization of Biogenic Nanoparticles A known amount of stem(fresh and powder) of T. procumbenswas added to 100 ml of triple deionized water individually and boiled for 15 min. The mixture was then filtered using WhatmanNo.1 filter paper to obtain aqueous extract of definite concentrations. For synthesis of nanoparticles, a known concentration of stem filtrate was interacted with different concentrations (1, 10, 15 and 20 mM) of AgNO3 solution in a defined ratio (9:1) to make up 100 ml volume. The solution was incubated at room temperature for 1- 5 h and observed for the change in colour from greenish to brownish. This was followed by UV –vis. analysis (recording absorbance at 300 – 600 nm)using Genesys 10uv spectrophotometer.
Further SEM, XRD and FTIR analyses were done (Kushwaha and Malik, 2012).FT-IR analysis of the sample was done using BRUKER-VERTEX-70 Model at a resolution of 4 cm-1 in KBr pellets. This analysis helped to reveal the capping agents responsible for biogenic synthesis. Biogenic Nanoparticles - Stock Preparations These synthesized biogenic nanoparticles werefurther used for making stocks comprising - 0.3, 0.5, 1.0 and 2.0mg ml-1, respectively. Different dilutions (0.3, 0.5, 0.6, 0.8 and 1.0µl of stock/µl of distilled water) were prepared and used for evaluating the inhibitory effect of the biogenic nanoparticles on seed germination of Vigna radiata.
Plant Extract- Stock Preparations Different quantities of fresh material (stem) and their powder(100, 130, 200, 400mg ml-1)were soaked and heated separately in on hot plate with distilled water for 15 min.The extracts were filtered separately with aWhatman No.1 filter paper to remove the suspended particles and the filtrate (the extract) was either used directly in the experiments or stored at 4°C until further use. Fivedilutions of individual stock extract were prepared (0.3, 0.5, 0.6, 0.8 and 1.0µl of stock/µl of distilled water) to make up the final volume of 300 µl using deionised water and were further used for testing cytotoxicity. Seed germination An inexpensive, simple quantitative assay was used for screening herbal aqueous extract for cyto-toxicity test as proposed by Kumar and Singhal (2009)and Murthy et al., (2011).
Seeds of Vigna radiata were obtained from Rajasthan State Seed Corporation, Durgapura, Jaipur. Uniformly selected seeds were sterilized with 5% NaOCl for 2 min and repeatedly washed under running tap water followed by distilled water. 15 seeds were sown in each Petri dish and incubated in BOD incubator set at 25° C. Petri dishes were irrigated with various test solutions. The data were sampled after 48h.Each experiment was run in triplicate and values represent their mean. Drugvincristin (anticancerous) solutions were prepared as dilutions mentioned above and added to the filter paper in the Petri dishes.
Petri dishes areirrigated with water(control) andanother onewith nanoparticlessolution and vincristin. Care was taken to moisten the filter paper with control, drug and biogenic nanoparticlessolutions every 6 h. The length of the radicle (cm) was measured at the end of 48 h and percent mean values of the germinating seeds as well as seedling growth were evaluated inwater control and treated samples (extracts, biogenic nanoparticles and vincristin).
RESULTS AND DISCUSSION Formation of Biogenic nanoparticles Due to splitting of AgNO3 into Ag+ and NO3 - change in colour of the reaction mixture was observed, with progressive time. Apparently the metabolites in the stem (fresh and powder) extract acted as e donor and reduce Ag+ ions into Ag. Consequently, the formation of nanoparticles was indicated by brown colour of the aqueous solution following the excitation of surface plasmon vibrations (Figure 1). Our findings substantiate the data from Capsicum annum (Li et al., 2007), Aloe vera extracts (Chandran et al., 2006), Citrullus colocynthesis(Satyavani et al., 2011)and Boswellia ovalifoliolata(Savithramma et al., 2011)except that in our instance we accomplished formation of nanoparticles at 5 and 10 mM of the aqueous solution.
Characterization of Biogenic nanoparticles The reduction of silver ions during the incubation period is generally deciphered through UV-visible spectroscopy and this period is variable ranging from few minutes to several hours. During UV-visible analysis most of the absorbance peaks obtained with different sample used were located within a range of 420 nm which coincided with the results obtained with the extract of mangrove plant (leaf bud) with an absorbance peak at 426 nm (Umashankari et al., 2012). These peaks were obtained as in metal nanoparticles, conduction band and valence bands lie very close to each other and through these electrons are capable of making free movement.
These free electrons give rise to Surface Plasmon Resonance (SPR) absorption band. SPR results due to the collective oscillations of electrons of synthesized nanoparticles in resonance with light waves (Figure 2 (a) and (b)). Once the nanoparticles are synthesized they tend to agglomerate and the latter largely depends on the chemistry as well as the electromagnetic property. This agglomeration also depends on surface energy and thermodynamic instability of the synthesized Ag nanoparticles (Olenin et al., 2008). To prevent their agglomeration the synthesized nanoparticles can be coatd with non-magnetic substances or different types of stabilizing agents can be used including PEG (used in the present studies) .
The synthesized biogenic nanoparticles obtained were in an aqueos from which was converted into powder through the process of lyophilization ( Figure 3 (a) and (b)). Further characterization of synthesized biogenic nanoparticles is ascertained using SEM and XRD (Kushwaha and Malik, 2012a; Kushwaha and Malik, 2013). Biogenic nanoparticles from the powder extract of Tridax plant organs (stem) is already reported where the synthesized nanoparticles are of size ranging from 35.44 nm (Kushwaha and Malik, 2012) while from the fresh stem extract nanoparticles of an average size 21.84 is obtained (Figure 3 (c) and (d); Figure 4 (a) and (b) respectively). Figure 5 (a) and (b)shows the graph of FTIR analysis of stem extract and the data on corresponding wave number and resultant group are set in table 1.As is evident the resultant groups varied and of special mention are aldehydes, primary amines, amides, lactones, aliphatic amines, alkanes, etc. Figure 5 (a) and (b)and table 1
Cytotoxicity test Seed germination and seedling growth assay was employed to decipher the cytotoxicity of synthesized nanoparticles. Seeds germination was 100% in the water control under the test conditions. Aqueous extract (fresh) of stem caused a dose-dependent inhibitory effect on seed germination (table 2 and Figure 6). With 100mg ml-1 stem extract (fresh) stock solution, 100% seed germination was observed at 0.3 and 0.5µl of stock/µl of distilled waterdilutions while 0.6µl of stock/µl of distilled watercaused 75% germination. At higher concentrations (0.8 and 1.0µl of stock / µl of distilled water) of stock dilutions seed germination was completely inhibited. With stem extract (powder) 100% germination was observed at 0.3, 0.5 and 0.6 µl of stock/µl of distilled waterdilutions and seed germination was 75% at 0.8 and 1.0µl of stock/µl of distilled waterdilutions. At higher concentration of stocks (130 and 200 and 400mg ml-1)obtained from stem extracts seeds imbibed water but failed to germinate(table 2 and Figure 6) Table 3 shows data on biogenic nanoparticles,synthesized from fresh and powder extract of the same with varying concentrations (0.3, 0.5, 1.0 and 2.0mg ml-1 ).
Both inhibited seed germination and seedling growth (Figures 6 and 7). Inhibition was evident even at low concentrations. Fresh extract of stem even atlow concentration wascapableof interferingwith seed germination.In brief, at low concentrations, nanoparticles effectively arrested seed germination and possibly exhibited anti-mitotic behaviour. Figures 6 and 7, Table 2 and Table 3 In another experiment, we compared the effect of biogenic nanoparticles,with an anti-cancerous drug (vincristin). The data revealed that the effect with vincristin was dose dependent but seed germination was totally absent at the stock concentrations used. When the data from biogenic nanoparticles were compared with vincristin it was found that the results obtained with 1 mg ml-1 of biogenic nanoparticles (powder stem extract) were more inhibitorythan the vincristin at the same stock concentration. Interestingly, the effect of fresh stem extract (400 mg ml1) was nearly the same asvincristin (1.0mg ml-1). Biogenic nanoparticles (fresh stem extract) at 2.0mg ml-1 of stock concentration were more effective than 1.0mg ml-1 of vincristin , whereas1.0mg ml-1 of the biogenic nanoparticles was nearly as effective as 1.0mg ml-1 of vincristin.
The efficacy of this assay system in screening inhibitory activity of stem extract along with nanoparticles in T. procumbens has been compared with an established anti-cancerous drug vincristin. There are many reports that support the use of antioxidant supplementation in reducing the level of oxidative stress and in slowing or preventing the progress of complications associated with diseases (Rose et al., 1982). The important aspects that have shifted the interest towards the naturally occurring antioxidants are the toxic and/or mutagenic effects of synthetic antioxidant components. Numerous phyto-constituents are shown to be concerned with free radical scavenging or antioxidant activity (Aruoma and Cuppett, 1997). Flavonoids and other phenolic compounds (hydroxyl cinnamic derivatives, catechines, etc.) have been reported as scavengers and inhibitors of lipid peroxidation (Formica and Regelson, 1995). There are many interesting ways of isolating active principles from the drugs. In the present investigation successful identificationthroughin vitro assay was performed using the plant extract (fresh and powder). Many other methods and system are available through which inhibition of growth specified cancer cell lines in tissue culture have been studied (Tominagaa et al, 1999; Skehan et al., 1990). In, a recent report an inexpensive assay was performed using sprouting parameters in green gram (Kumar and Singhal, 2009), using plant extract of different stocks with variable dilutions were used.
In the present study, the phyto-constituents of the extract obtained from T. procumbens were identified using FTIR analysis, which revealed the chemical composition of the plant source. Further it aided, in identifying the compounds possibly responsible for the inhibitory behaviour. As, stated earlier the presence of alkanes, aldehydes, ketones, phenols, aliphatic amines and lactones was identified. It has been reported that the inhibitory effect of long chain alcohols, aldehydes, ketones increased with enhanced lypophilicity, as they amplified the solubility across the cell membrane. These constituents are most effective against seed germination and early seedlings growth. The lead compounds are reported to interfere with the metabolic processes concerned with energy regulating organelles (chloroplast and mitochondria) or with the cell division process (microtubule organization). Some, workers have reported that lactones inhibit germination of seeds at concentrations of 250-300 ppm (Orcutt and Nelson, 1996). The available information on chemical constituents tempts one to explain the inhibitory behaviour caused by the plant extract.
Presently we have employed germinating seeds bioassay to compare the response against plant extracts, biogenic nanopartices and vincristin. It may be added that seed germination comprises various phases e.g. water imbibitions following soaking of seeds in various chemicals as well as biogenic nanoparticles. The quiescent embryo begins to grow due to water imbibitions, leading to cracking of seed coat and protrusion of radicle. Clearly the imbibitions by seeds are followed by concomitant metabolic activity of embryo and active cell division leading to seedling growth.
As is evident, the reduction in seed germination was associated with increase in extract concentrations as well as biogenic nanoparticles. At highest concentrations of the two (plant extracts and biogenic nanoparticles) the retardation of germination could be compared with the one caused by vincristin. From this it is inferred that the drug as well as biogenic nanoparticles affected water uptake and hence osmotic potential of the seeds causing reduction in turgid pressure within the seed and precluded the radicleprotrusion. We observed that fresh extract of stem was comparatively moreinhibitory arrestingvarious stages of seed germination.
When the dilution decreased from 0.3 to 1µl of stock/µl of distilled waterusing fresh stem stock, the retardation of seed germination was most pronounced, whereas powder extract was less effective. This inhibiting capability of the stem extract of T. procumbensusing seed germination bioassay is demonstratedfor the first time. Present studyalso brings out the role of biogenic nanoparticles in inhibiting seed germination which was dose dependent. With vincristin comparable inhibition was observed. The plant extract, bionanoparticls and vincristin, promoted water imbibitions by the seeds though their higher concentrations inhibited this process.Reduction in water imbibitions,caused by these failed to trigger processes leading to seed germination and radicle decay.
The growth retardation following these treatments could be attributed to the inhibition of cell division and radicle protrusion brought about by osmotic stress (de Castro et al., 2000). From these observations it could be safely inferred that the plant extracts exhibited effective inhibitory activity, thoughbiogenic nanoparticles and vincristin were most effective at 1.0 and 2.0mg ml-1.
CONCLUSION Biogenic nanoparticles are more eco-friendly, cost effective, and rapidly synthesized, and hence are more acceptable than the anti-cancerous drugs available in the market. The latter have side effects, cost issues, toxic chemicals involved in their synthesis, storage complexities, etc. Change in colour of the reaction mixture during the time of incubation indicated the formation of silver nanoparticles and was confirmed by the characteristic peaks obtained by UV–visible spectra analysis. The size of particles was well characterized by SEM and XRD analysis. It can be predicted that the formation of nanoparticles occurs due to the presence of lactone, ketones, phenols and amines, which are abundantly found in T. procumbens and are also confirmed from the FTIR spectra.
The present study opens new avenue for medical sciences where plant extract synthesized nanoparticles via “green route” can be the safer alternative than synthetic anti-cancerous products.
ACKNOWLEDGEMENT Authors wish to thank management of Rajasthan University-Jaipur, for providing the facility for lyophilisation and management of IIT-Kanpur for helping in characterization of synthesized nanoparticles through SEM, XRD and FTIR analysis. Authors also 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=300http://ijcrr.com/article_html.php?did=3001. Aruoma,OI. and Cuppett, SL. 1997. Antioxidant methodology In vivo and In vitro concepts. AOCS press, Champaign, Illinois, pp.41-172.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524187EnglishN2016April12HealthcareEFFECTS OF VITAMIN-D AND SUNLIGHT ON THE HEMATO-BIOCHEMICAL PARAMETERS IN MICE
English2329Muhammad Rakibul HasanEnglish Md. Kamrul IslamEnglish Ziaul HaqueEnglishModerate exposure to sunlight increases vitamin-D status in the body and vitamin-D helps in absorption of calcium from intestine. This study was aimed to investigate the efficacy of vitamin-D and sunlight on blood parameters and serum biochemistry in mice. For this purpose, 50 adult Swiss albino mice were collected and randomly divided into five equal groups (Group A, B, C, D and E). Group A was considered as control and fed only on balanced normal feed. Group B was supplied with 15% butter in feed as a semi-synthetic source of vitamin-D, group C was exposed to direct sunlight (1.5 hours daily) and group D and E were supplied with oral synthetic form of vitamin-D @ 50 IU and 100 IU daily, respectively. After 120 days, blood and serum samples were collected for analysis. Our results showed that total erythrocytes count (TEC) and total leukocytes count (TLC) were found higher in group D but insignificant. Lymphocytes were significantly (PEnglishSunlight, Vitamin-D, Blood, Biochemical analysisINTRODUCTION Vitamin-D is needed for bone growth and bone remodeling from osteoblasts and osteoclasts (Cranneyet al., 2007). The main function of vitamin-D is maintaining calcium homeostasis and low levels of vitamin-D result in lower absorption of calcium from intestine (Lane, 2010). Without vitamin-D, the body cannot absorb calcium and phosphorus adequately, the skeleton loses mineral content (secondary osteoporosis) and new bone is not adequately mineralized (rickets or osteomalacia). It is recommended that dietary allowance for human is 600 IU in a day for ages 1-70 years for this vitamin (Aloia, 2011; Abrams, 2011; Gallagher et al., 2014).
Calcium and bone metabolism in adults depend heavily on concentration of vitamin-D (Silver, 2011). According to Bikle (1994), vitamin-D treatment is safe and probably most efficacious in populations with marginal vitamin-D intake or limited sunlight exposure and does not need high doses. Vitamin-D is present in many foods, including fishes, eggs, fortified milk, and cod liver oil. In this experiment butter is used as vitamin-D source. Although milk is normally low in vitamin-D but butter contains high fat and is rich in vitamin-D (Schmid and Walther, 2013).
Regular receiving of butter through diet may also be helpful for immunity development (Cope et al., 1996). Shankar et al. (2002), reported that moderate level of butter has some unique potential benefits on health, particularly in relationship to its vitamin-K and vitamin-D content. As per experiment of Astrup, (2014), consumption of yogurt and other dairy products like butter reduced risk of weight gain and obesity as well as of cardiovascular disease. Sunlight is an electromagnetic radiation and gives off different types of lights and rays having different wave length. They produce either positive or negative response in living cells. Moderate sun exposure, physical activity and normal-weight maintenance are modifiable factors, for improving vitaminD status (Touvieret al., 2014; Beneret al., 2009).
The ultraviolet radiation has both positive and negative health effects, as it is source of both vitamin-D3 and a mutagen (Osborne and Hutchinson, 2002; Ohnaka, 1993). Cholesterol under the skin surface called provitamin-D3 reacts with the ultravioletB rays to form vitamin-D3 . From there, it first goes to the liver and then through the kidneys, converting it into the form of active vitamin-D that the body needs (National Institutes of Health). Lack of sun exposure and vitamin-D deficiency has been linked to serious cardiovascular problems and cancers (Holick, 2008).
METHODOLOGY Animals: From seventy Swiss albino mice (Musmusculus), a total of 50 mice were randomly selected after acclimation for 7 days. Their weight was approximately 22-27 gm/mouse and the age was between 40 and 45 days which were divided into five equal groups. Treatment: One group was fed on balanced pellet only and was considered as control group (group A). The remaining groups were considered as treated groups (B, C, D and E). Among the treated groups, only group B was fed with butter supplemented diet (15% of solid feed) and others were maintained with balanced diet. Group C was directly exposed to sunlight for 1.5 hrs daily and group D was supplied with additional vitamin-D @ 50 I.U and group-E with vitamin-D @ 100 I.U orally.
This treatment regime was continued for 120 days without any changes. Sample Collection: Samples were collected from mice by sacrificing them for hematological and serological study. For hematological test, blood was stored in test tubes containing anticoagulant (3.8% sodium citrate) except for DLC (Differential Leukocyte Count). For serum collection, blood without anticoagulant was kept in slanting position and serum supernatant was collected after 24 hours and being centrifuged. A drop of blood directly placed on slide and made a thin smear for DLC. For blood and serum analysis, we collected 5 samples from each group. Blood Analysis: Hematological parameters were total erythrocytes count (TEC), estimation of hemoglobin by acid-hematin method, determination of erythrocyte sedimentation rate (ESR) by Wintrobe’s method, determination of packed cell volume (PCV) or hematocrit (Hct) value, total leukocytes count (TLC), differential leucocyte count (DLC).
All measurements were performed in the hematological laboratory, Department of Physiology, Bangladesh Agricultural University, Mymensingh, as described by Ghai (2008) Serum Biochemistry: Alanine transaminase (ALT/GOT) and aspartate transaminase (AST/GPT), alkaline phosphatase, triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL) were analyzed to know the blood and liver response to additional supplement of vitamin-D. For serological analysis end point method was used for AST, ALT and AP and kinetic method was used for TC, HDL and TG (Human Humalyzer-3000, Germany). Statistical analysis: The result was analyzed statistically by paired t-test and compared significance level at 95%, 99% and 99.99% by using SPSS software (Version 16.00, IBM Corporation). In this analysis, we compared each treatment group with control group separately.
RESULT Hematological Tests Table 1 and figure 1 shows the effects of vitamin-D and sunlight on blood parameters. The application of butter, sunlight and synthetic vitamin-D caused significant increase of blood cell counts in treated groups.
Hemoglobin level in experimental mice was gradually increased with increased level of vitamin-D supplementation (Figure-1).It was the highest in group-D (7.84±0.082 gm/ dl) followed by group E (7.62±0.17 gm/dl) in comparison to control group (6.34± 0.22 gm/dl). Its value was 7.28±0.12 gm/dl in group B and 7.14±0.027 gm/dl in group C. PCV was found significantly higher (44.20±0.80 %, PEnglishhttp://ijcrr.com/abstract.php?article_id=301http://ijcrr.com/article_html.php?did=3011. Abrams SA 2011: Calcium and vitamin-D requirements for optimal bone mass during adolescence. Current Opinion in Clinical Nutrition and Metabolic Care 14 605-609.
2. Aloia JF 2011: Clinical Review: The 2011 report on dietary reference intake for vitamin-D: where do we go from here? The Journal of Clinical Endocrinology and Metabolism 96 2987- 2996.
3. Amina N, Hussain MM, Aslam M 2010: Correlation of serum alanine aminotransferase and aspartate aminotransferase levels to liver histology in chronic hepatitis C. Journal of the College of Physicians and Surgeons Pakistan 20 657-661.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524187EnglishN2016April12HealthcareEFFECT OF SUPPLEMENTATION OF KADIPATTA AND NEEM LEAF POWDER ON NUTRITIONAL QUALITY OF EGG
English3031Khushboo RishishwarEnglish Anshu RahalEnglishNowadays herbs are used in poultry diet as feed additive. In present trial the effect of supplementing tree leaves on egg quality was studied. One hundred twenty white leghorn layers were selected, divided randomly and subjected to six treatments. Eggs collected were analyzed for nutrient composition and quality. Egg protein content increased and significant differences were found in cholesterol and low density lipoprotein. Neem and/or Kadipatta leaves @0.5% can be used in poultry diet.
EnglishNeem leaf powder, Medicinal herbs, Kadipatta leaf powderINTRODUCTION Medicinal herbs have long been used in poultry diet as feed additive replacing antibiotics which leave their residue in animal products. Neem and Kadipatta are used worldwide due to their notable pharmacological activities like hepatoprotective, cholesterol reducing property, anti-microbial, antibacterial, antiulcer and phagocytic activity.The present investigation was done to assess the effect of supplementation of leaves of neem and Kadipatta on egg quality. One hundred and twenty white leghorn layers(22 weeks) were selected ,divided randomly and fed six treatment diets as follows; viz., T1 , Control; T2 , 0.5% kadipatta leaf powder; T3 , 0.5% neem leaf powder; T4 , 0.5% kadipatta and neem leaf powder (50:50); T5 , 0.5%kadipatta and neem leaf powder ( 25:75 ); T6 , 0.5% kadipatta and neem leaf powder (75:25 ratio) for 12 weeks. Production performance was studied in 3 different phases viz., Phase I (22-25 weeks) and phase II (26-29 weeks) and phase III during post treatment period (30-33 weeks). At the end of feeding trial a metabolic trial was conducted to know the nutrient utilization. For the egg composition and quality study three eggs were collected randomly for three days per replicate.
The data obtained were analysed using Analysis of Variance (ANOVA) and the critical difference (CD) was calculated to determine any significant difference among the treatment means (Snedecor and Cochran, 19941 ) by using STPR3 analysis software. The average egg production, feed intake and feed conversion ratio in various treatments during phase I and overall period were non- significantly different from each other while highly significant difference (P≤0.01) was found in phase II. In overall period (22-29 weeks) although the groups were non significantly different from each other, highest egg production was noted in group T4 in which neem and kadipatta leaf powder was supplemented in ratio 50:50 followed by T5 and T3 . Supplementation of neem and kadipatta leaf powder in 50:50 ratio caused increase in egg production which may be possibly due to presence of macrominerals i.e. potassium, magnesium, calcium, phosphorus and microminerals such as iron, copper, manganese and zinc in the leaves of neem and kadipatta(Atangwho,20092 and Bhowmik et al. ,20083 ).
Supplementation of kadipatta and neem leaf powder affected feed nutrient utilization. Increased utilization of dry matter, crude protein, ether extract and crude fibre was noted on addition of kadipatta to neem leaf powder in different proportion to the basal diet of layer. The values of T4 group differed significantly from the control group in crude protein and ether extract utilization. In egg quality parameters egg weight was significantly (P≤0.05) increased in group T4, T5 and T6 respectively, in which neem and kadipatta leaf powder were supplemented in different combination.
The shape index, yolk weight, shell thickness and shell weight were found to be unaffected by supplementation of neem and kadipatta leaf powder during whole experimental period. Table 1 depicts the nutritional composition of egg of different supplemented groups. The dry matter content of egg of experimental layers showed non-significant differences among the treatment group. Crude protein was observed to be significantly (P≤0.05) increased in the neem leaf powder supplemented group. Ether extract was highly significantly (P≤0.01) increased in the supplemented group.
Ash content showed non-significant differences among the treatment groups. Egg cholesterol and Low Density Lipoprotein differed significantly (P≤0.05) among the different treatment groups while non-significant differences (P≥0.05) were noted in High Density Lipoprotein and triglycerides value. Das et al. (2011)4 reported that kadipatta leaf powder at low concentration 0.2% was effective inhibitor of primary and secondary oxidation products in raw ground and cooked meat patties and has potential as a natural antioxidant in cooked and raw meat system.
CONCLUSIONS It can be concluded that Neem and Kadipatta leaves @ 0.5% can be incorporated in layer diet to improve egg quality.
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. This project was funded through Directorate of research , Govind Ballabh Pant University of Agriculture and Technology, Pantnagar.
Englishhttp://ijcrr.com/abstract.php?article_id=302http://ijcrr.com/article_html.php?did=3021. Snedecor, G.W. and Cochran, W.B. Statistical methods. 8th Edn. The lowa state University Press,1994. Ames, IOWA, USA.
2. Atangwho, I.J., Ebong, P.E., Eyong, E.U., Williams, I.O., Eteng, M.U. and Egbung, G.E. Comparative chemical composition leaves of some antidiabetic medicinal plants: Azadirachta indica, Vernonia amygdalina and Gongronema latifolium. African Journal of Biotechnology , 2009.8 (18): 4685-4689.
3. Bhowmik, D., Yadav, C. J., Tripathi, K.K. and Sampath, K.P. Herbal remedies of Azadirachta indica and its Medicinal Application. J. Chem. Pharm. Res. 2010.2(1) : 62-72.
4. Das, A.K., Rajkumar, V. and Dwivedi, D.K.. Antioxidant effect of curry leaf (Murraya koenigii) powder on quality of ground and cooked goat meat. Int. Food Research J.,2011. 18 : 563-569.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524187EnglishN2016April12HealthcareAN EPIDEMIOLOGICAL STUDY OF ROAD TRAFFIC ACCIDENT CASES AT A TERTIARY CARE HOSPITAL IN UDAIPUR
English3237Solanki S.L.English Mittal HemlataEnglishBackground: In present century, road traffic injuries represent a major epidemic of non-communicable diseases. Road traffic accidents cause considerable economic loss to nation, victims, and society. The price we pay in terms of hospitalization of victims for longer duration, incurring disability and death. If the cause is probed, it would be possible to reduce its number, severity of injury and even the prevention of RTAs. Objectives: To study the various epidemiological factors associated with road traffic accidentcases. Materials and Methods: 400 road traffic accident cases were studied, at emergency unit of RNT Government medical college, Udaipur, during the period of July 2010 to December 2010. Results: Among the 400 study subjects, majority (81.0%) were males, while (19%) females, most of them (33.25%) were in age group of (15-25) years. The motorcyclist comprised (42.5%) of RTA cases, followed by (20.25%) of occupants of car and jeep. Fatal injury (death) was more common(27.56%) in cases of motorized vehicle followed by the pedestrians (10.40%). Among 252 drivers majority (85.71%) were male and (32.94%) of them were not having driving licence. Highest RTAs (33.14%) occurred in drivers who had driving licence issued within two years. Nearly half (49.25%) of RTA cases took place between 5 PM to 9 PM and a good number of drivers(20.23%) reported that they were fatigued at the time of accident. Conclusion: Road traffic accident is a major public health problem which needs to accelerate the efforts of road safety preventive measures.
EnglishMotorized vehicle, Fatal injuries, Driving licence, Fatigue, Public healthINTRODUCTION The importance of accident as a health problem is perhaps not looked sufficiently by health planners, even not enough weightage is given by lay people. Road traffic accident is a major but neglected public health problem, warranting us for initiation of effective preventive measures of road safety and we have to sustain them. An accident has been defined as an unexpected unplanned occurrence due to a chain of causes, which may involve severe and fatal injury but RTAs are preventable to some extent by safe driving. Accidents are the major burden of the both the developed and developing nations.
It is increasing rapidly as a cause of death in absolute numbers and alsoin terms of proportion.Road traffic accidents are projected to become second leading cause of deaths in the world by 2020. In many countries, the motor vehicle accidents rank first among all fatal accidents. During 2002, there were almost 1.19 million deaths due to road accidents in the world and the global rate of death was about 19.0 per 100000 people. The SEAR Region in the world, leads to higher rates of RTAs, with (16-18%) of annual increase in motorization. Person injured in RTAs occupy nearly (10-30%) of beds in hospital and shall be the biggest cause of ill health and death for adult men aged 15-45 years worldwide.
The RTAs are the primary cause of disease among the children below 15 years of age. In India, out of total deaths in non-communicable diseases, 11 per cent deaths are due to injury and 78 per cent of injury deaths are due to RTAs. The Indian council of Medical Research (ICMR) study on “Causes of Death by Verbal Autopsy” has revealed that injury ranked among the first five major cause of death in adults. It is the leading cause of mortality for young adults less than 45 years and a major burden of disease across all age group. Road injuries are not only placing a heavy burden on nation economy but also affecting the households. Objectives: To study the various epidemiological factors related to road traffic accident cases.
MATERIALS AND METHODS All cases of motorized vehicle accident, urban and rural attending emergency unit ofM.B. hospital, a tertiary level care, of R.N.T. Medical College Udaipur, during July to Dec. 2010, were included in this cross sectional study.The information of injury pertaining to epidemiological factors and demographic profile was collected on a pre-designedproforma. Complete history was taken from the patient, attendant and case sheets, at casualty, OPD, IPD and forensic department and cross checked with the police reports with the information on environmental factors like roads, time of occurrence of accident, type of vehicle, driving licence and non-observation of traffic rules etc. on part of victim or driver with oral or written consent.
RESULTS 400 RTA cases were studied which caused 366(91.50%) injury and 34(8.5%) fatal injury (deaths). Among all the RTA cases there were 252 drivers and among them 169 drivers had driving licence. Table 1. Out of total 400 RTAs, the maximum 321(80.25%) cases were from the age group of 15 to 45 years. There were (15.75%) of cases in age of 45 years and above, while (4.0%) were under 15 years of age. This indicates the major involvement of young productive age group in RTAs. Majority of RTA cases were male 324(81.00%), while 76(19.00%) female, indicating 4:1, male female ratio. Males are more prone to meet an accident because of the preponderance act of driving the motor vehicle along with more outdoor activity than females. Table 2.
Out of all the RTAs, according to type of injury and road user the majority affected were single vehicle motorcyclist (42.5%) followed by occupant of car/jeep (20.25%), pedestrian (12.00%) and cyclist (6.50%). In 34 fatality cases the majority 27(27.56%) were observed in motor vehicle, followed by 5(10.40%) of pedestrians and 2(7.69%) of cyclist. Table 3. Among 400 RTA cases, the affected were252(63.00%) drivers against other person 148(37.00%). Males were affected more in boththe drivers and other persons (85.71% and 72.97%) v/s females (14.28% and 27.02%).
Table 4. Among the 252 drivers, 169(67.07%) were observed with driving licence against 83(32.94%) without issue oflicence. The fatal and serious injuries were observed more (10.84% and 54.21%) among the victims with no driving licence v/s (5.30% and 35.50%) with driving licence. Table 5. Among the 169 drivers, highest casesof road traffic accident 56(33.14%) were observed in victim of driving licence issued with two years of duration. There was decrease in incidence of accidents in drivers with the increase in duration of driving licence.
The fatal and serious injuries (8.92% and 50.0%) were more in drivers having driving licence of less than two years against (0% and 20.0%) in drivers having driving licence of more than 10 years of duration Table 6. Nearly half (49.25%) of the study subjects of RTA cases met with accident between 5 PM to 9PM,followed by (24.75%) occurred between 1 PM to 5 Pm. Maximum (87.0%) of the RTAs occurred during (9 AM to 9 PM). Table 7. Among the driver related causal factors, majority of drivers responded forfatigued/drowsy 51(20.23%), followed by listening music 48(19.05%), smoking 22(8.73%) and talking on mobile or other person 17(6.74%).
DISCUSSION In this study on RTAs the age of the victims varied from less than 15 to above 65 years. Majority (80.25%) of the study subjects were both males and females in the age group 15 and 45 years. Similar findings were also reported by Lee MC(1) et.al. (84.0%). N Jha(2) et.al. (69.2%). In our study (33.25%) of the cases were accounted in age group 15 to 25 years where as P. Shruthi(3) et.al. observed (55.11%). N Jha(2) et.al. reported (31.0%)among age 21-30 years.The victimsbelong tomost active and productive age group add to a serious economic loss to community. Sex of the victims: The majority of the subjects were male (81.0%) and female (19.0%), similar results were observed by Jha S.et.al.(4) (78% and 22%), Sinha and Sengupta(5) (80% and 20%),
Banerjee(6) (86% and 14%), M Johnson(7) (89% and 11%). Majority of males were the victims in RTAs observed in the study by Sathiyasekaran(8) (82.5%) and N. Jha(2) et.al.(83.0%), Chaudhary(9) et.al. from Maharashtra, (83.20%). Higher incidence in males can be explained due to their part of occupation with more exposer to risk of road accidents. In the distribution of victims according to road users, majority (42.51%) were motorcyclist, followed by (20.25%) car/ jeep and(12.0%) pedestrians. Results of our study were supported by Abhisek Singh(10) et.al. (41.51%) motorcyclist, (19.39%) car/jeep, and( 13.41%)pedestrian.
DISCUSSION In this study on RTAs the age of the victims varied from less than 15 to above 65 years. Majority (80.25%) of the study subjects were both males and females in the age group 15 and 45 years. Similar findings were also reported by Lee MC(1) et.al. (84.0%). N Jha(2) et.al. (69.2%). In our study (33.25%) of the cases were accounted in age group 15 to 25 years where as P. Shruthi(3) et.al. observed (55.11%). N Jha(2) et.al. reported (31.0%)among age 21-30 years.The victimsbelong tomost active and productive age group add to a serious economic loss to community. Sex of the victims: The majority of the subjects were male (81.0%) and female (19.0%), similar results were observed by Jha S.et.al.(4) (78% and 22%), Sinha and Sengupta(5) (80% and 20%), Banerjee(6) (86% and 14%), M Johnson(7) (89% and 11%). Majority of males were the victims in RTAs observed in the study by Sathiyasekaran(8) (82.5%) and N. Jha(2) et.al.(83.0%), Chaudhary(9) et.al. from Maharashtra, (83.20%). Higher incidence in males can be explained due to their part of occupation with more exposer to risk of road accidents. In the distribution of victims according to road users, majority (42.51%) were motorcyclist, followed by (20.25%) car/ jeep and(12.0%) pedestrians. Results of our study were supported by Abhisek Singh(10) et.al. (41.51%) motorcyclist, (19.39%) car/jeep, and( 13.41%)pedestrian.
N Jha(2) et. al. reported (24.4% and 21.2%), Mondal(11) et.al (20.70% and 16.9%), Gunjan B(12) et.al. (26.95% and 43.02%) cases of two wheelers and car/jeep respectively Gururaj(14) et.al. and Sahdev(15) et.al also reported the same findings for two wheelers and car/jeep. Vimla Thomas(13) et.al. observed more cases of motorcyclist and car/ jeep (37.33% and 21.26%). The two wheeler motorized vehicle are affected more as they are comparatively unstable in moving condition on road than four wheelers. In our study majority of fatal injuries were motorized vehicle of all the types (27.56%) followed by pedestrians (10.40%). Manisha Ruikar(16) observed pedestrian (8.3%) and two wheelers ( 23.2%), P Shruthi(3) et.al revealed that majority of victims were pedestrians (44.89%). Among the 252 drivers, majority 216(85.71%) weremale.
This is supported by a comprehensive review of 46 studies conducted by Odero W(17) et.al. observed that in low and moderate income countries males were involved in a mean of (80.0%) of road crashes and (87.0%) of drivers were male. Whereas V. Thomas(13) reported (64.22%) of the drivers were victims. In our study out of 252 drivers, (32.94%)were not without issue of driving licence, which is higher comparative to the study of Abhisek singh(10) et.al. (16.24%), N Jha(2) et.al. (15.3%), V. Thomas(13) et.al. (12.80%). In our study fatal injuries (10.84%) were more in drivers with no licence against the drivers (5.30%) with licence.The reason may be the casual attitudeof thedrivers towards obtaining thedriving licence with no fear of check by traffic police. In the 169 drivers with licence, the majority of accidents 56(33.14%) were observed in drivers who had driving licence issued within two years, with maximum fatal injury 5(8.92%) and serious injury 28(50.0%). Practice makes a man more prefect, more the experience less the chance of accident. Number of years of experience after issuing of licence is inverselyproportional to outcome of accidents.
Our findings are supported by Mclean AJ(18) in his study of injuries in Australia, Japan, Malaysia and Singapore and Williams AF(19) also observed that the risks were high during the first 12 months after a full licence had been issued. In our study peak time of accident was 5PM to 9 PM197(49.25%) followed by 1 PM to 5 PM 99(24.75%), whereas Mondal(11) et.al. reported maximum RTA (16.3%) during 3PM to 6PM, followed by (15.2%) during 9AM to 12 noon. N Jha(2) et.al. observed two peaks 4PM to 5PM (8.9%) and 6PM to 7PM (7.4%). V Thomas(13) reported (71.10%) of RTAs in day time, 6AM to 6PM while N. Jha(2) observed (60.0%). In our study RTAs occurred (87.0%) (9AM to 9PM), while Khajuria(20) et.al. observed (54.2%). The peak time of accident may be because of the busiest hours of increased activity such as commercial, school, college and offices etc. This increases the probability of the accidents onbusy and crowded roads with heavy traffic. In our study for driver related factors for RTAs, the major factor observed was fatigue/drowsy 51(20.23%) followed by listening music 48(19.05%), smoking 22(8.73%) and talking on mobile (6.74%). An analysis of road accident data in 2011 by Press information bureau(21) revealed that fatigue (77.5%) was the single most important factor responsible for accidents, similarly Mondal P(11) et.al. observed (75.0%) due to drivers fault. Donald A R(22) et.al. observed that the risk of collision was four times higher when cellular telephone was being used during driving.
Limitation: This is a single hospital based cross sectional study with small sample size hence results of this study cannot be generalized to general population but still be useful and relevant for our country especially regarding the preventive aspect. Ethics and data management: The ethical clearance was taken from the RNT Government medical college Udaipur and the collected data was analysed in excel sheet of MS office with Chi-square test.
CONCLUSION Road traffic accidents are increasing the burden of severe injuries, disability and deaths. RTAs are affecting the nation’s economy. The family of the victims face the hardshipof day to day activity of livelihood. Present study showed that road traffic accidents were more common in the younger age groups. Two wheelers are more vulnerable, good number of drivers was found without issue of driving license. The incidence of road traffic accidents can be minimized by increasing the awareness among the drivers, family and community. Government should step in forefficient transport system, safety traffic rules, cashless treatment policy in emergency, instructions for strict governance and implementation of driving license, traffic rules and regulations by police and transport authority.
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 Review2231-21960975-524187EnglishN2016April12HealthcareUNILATERAL VARIATION OF THE RENAL VEIN AND TESTICULAR VEIN - A CASE REPORT
English3841Veena Vidya ShankarEnglish Snigdha DasEnglishBackground: The right and left renal veins open into the inferior vena cava at right angle. The left renal vein is 3 times longer as compared to right. The right gonadal vein (testicular in male or ovarian in female) drains directly into inferior vena cava and left gonadal vein into left renal vein. Method: During the routine dissection teaching of posterior abdominal wall for first year MBBS students in the Department of Anatomy, MSRMC, Bangalore, we found the presence of double right renal veins along with variation in the termination of right testicular vein in an adult male cadaver aged 65 years. All the structures were carefully dissected, measurements noted and photographed using a digital camera. Observation: In the present case, two right renal veins (superior and inferior) were found to be draining into inferior vena cava separately and right testicular vein into inferior right renal vein Conclusion: This type of variation will help the radiologists for planning radiographic procedures; the surgeons for planning surgery to avoid intra and post-operative complications and the clinicians in recognition and protection of the variation..
EnglishAdditional renal vein, Renal transplantation, Testicular veinINTRODUCTION Kidneys are a pair of excretory organs situated in the posterior abdominal wall. They are drained by renal veins. The arrangement of structures at the hilum of kidney from before backwards isrenal vein, renal artery and pelvis of ureter. Both the renal veins open into the inferior vena cava at right angle. The right renal vein lies posterior to second part of duodenum. The left renal vein is 3 times longer as compared to right. It lies posterior to splenic vein and body of pancreas at its origin, at the hilum, then crosses in front of the aorta before joining into inferior vena cava1 . Other than renal vein, any extra vein emerging out of hilum of kidney and draining separately into inferior vena cava is known as ‘additional vein’. The kidneys having this additional vein are classified as type 3 kidney. 14% cases have been reported to occur with additional renal veins.
These variations are ten times more common on the right side as compared to left side2 . The right gonadal vein (testicular in male or ovarian in female) drains directly into inferior vena cava and left gonadal vein into left renal vein1 .Right testicular vein draining into right renal vein instead of inferior vena cava has also been reported3 . Knowledge of these variations is important for the surgeons as well as for the radiologists in their daily practice. Embryology: During 5th week of development , venous system are arranged into 3 sets: vitelline veins draining blood from gut derivatives, umbilical veins carrying oxygenated blood from placenta to foetus and cardinal system of veins draining from body wall.
All the veins are bilaterally symmetrical and drain ultimately into sinus venosus. The cardinal system consists of anterior and posterior cardinal veins. The anterior and posterior cardinal veins join to form common cardinal vein which drains into right and left horn of sinus venosus on each side. The posterior cardinal vein appears in the mesonephric ridge. Following that the sub-cardinal and supra-cardinal veins appear ventro-medial and dorso-lateral to it respectively on each side4 .
The ‘renal collar’ is formed during the development of inferior vena cava as in the form of a circum aortic venous ring which is contributed anteriorly by sub-cardinal veins andinter-subcardinal anastomosis, posteriorly by supra-cardinal veins and inter-supra-cardinal anastomosis and on each side by supra-subcardinal anastomosis at 15mm stage of embryo5 . After the definitive positioning of metanephros the permanent venous pattern appears at 22mm stage of embryo. At around 8 weeks bilateral cardinal system of veins convert into unilateral right sided inferior vena cava right to aorta due to venous shifting to right side of body. In relation to it, two renal veins are present on each side (ventrally and dorsally).
One renal vein opens into the lateral part of renal collar and the other one towards the cranial part of supra-cardinal vein posteriorly in the right side. Following that there will be confluence of these two tributaries forming I single vessel which joins with the lateral portion of renal collar. Persistence of these tributaries leads to the formation of additional renal veins in the right side as observed in the present case. The right shifting of venous arrangement limits the retention of additional vein in the left side which would be required to reach across the aorta. The left renal vein develops from 3 sources: pre-aortic inter-sub-cardinal anastomosis, left subcardinal vein and left supra-subcardinal anastomosis.
This complex embryogenesis also limits the retention of additional left renal veins. Hence, presence of additional renal veins is more common in right side than the left side. Caudal parts of sub-cardinal veins give rise to gonadal veins. Gonadal veins drain into supra-sub-cardinal anastomosis. The right supra-sub-cardinal anastomosis and part of right sub-cardinal vein form inferior vena cava, so right gonadal vein drains into inferior vena cava. But in the present case, right testicular vein drained into right renal vein because here part of right supra-sub-cardinal anastomosis forms part of right renal vein.
The left gonadal vein drains into left renal vein because left supra-sub-cardinal anastomosis gives rise to part of left renal vein6 . Method: During the routine dissection teaching of posterior abdominal wall for first year MBBS students in the Department of Anatomy, MSRMC, Bangalore, we found the presence of double right renal veins along with variation in the termination of right testicular vein in an adult male cadaver aged 65 years. All the structures were carefully dissected; measurements noted and photographed using a digital camera.
OBSERVATION RIGHT KIDNEY: Two right renal veins (named as superior and inferior right renal veins) were found to be terminating separately into inferior vena cava. Superior right renal vein: 3 tributaries (upper, middle and lower) from upper and middle parts of hilum of right kidney joined to form single superior right renal vein which was draining into the inferior vena cava at the level of termination of left renal vein (T12 level). Inferior right renal vein: From the lower part of hilum of right kidney it was draining into the inferior vena cava 1.5cm below the termination point of superior right renal vein running parallel to it. Right testicular vein was draining into inferior right renal vein at a distance of 0.8cm from the IVC instead of draining directly into it.
DISCUSSION In the present study we found double right renal veins draining separately into inferior vena cava. Another significant finding was right testicular vein terminating into inferior right renal vein instead of inferior vena cava. Incidences of presence of these similar additional veins were observed in 26% cases in the right side and 2.6% in the left side2 . Literature review showed that additional renal veins are common on right side(27.8%) as compared to left side(1%)7 . Several case reports have been reported with similar variations. Segmental branches of renal artery were found to be compressed between two right renal veins at the emergence of the veins at the hilum of right kidney8 . In a 50 years old male, double renal and testicular veins were observed bilaterally4 .
CLINICAL SIGNIFICANCE These variations as seen in the present case have practical importance in renal transplantation, renal and gonadal sur geries, uroradiology, gonadal or testicular colour Doppler imaging and other retroperitoneal therapeutic and diagnostic procedures9 .Veins and arteries of testes play an important role in their thermo-regulation that is essential for efficient functioning of the organs. Thus anatomical variations of renal and gonadal veins are very significant while performing surgery or radiology such ascendo-urological procedures, as lesions in them may cause severe back bleeding during and after surgery10. During renal transplantation both the recovery and implant surgeon should be aware of these anatomical variants of cadaver kidneys. The criteria to select a donor kidney suitable for transplantation may be based on the incidence of additional renal vein11.
If the inferior vena cava has been interrupted between additional veins, these veins may act as an alternate collateral route during surgery12.Knowledge of these variations of renal vascularanatomy are important during exploration and treatment of renal trauma, renal transplantation, renovascular hypertension, renal artery embolization, angioplasty or vascular reconstruction for congenital and acquired lesions, surgery for abdominal aortic aneurysm and conservative or radical renal surgery13.
CONCLUSION The knowledge of these venous anomalies are very important for the general and uro-surgeons approaching retro-peritoneal region especially during renal transplantation, physicians attending clinics, radiologists while performing investigations, as well as for anatomists for academic purpose.
ACKNOWLEDGEMENT The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Source of Funding: Nil Conflict of Interest: Authors declare that they do not have any conflict of interest ABBREVIATIONS USED: IVC- Inferior vena cava, SRRV- Superior right renal vein, IRRV- Inferior right renal vein, RTV- Right testicular vein, UT- Upper tributary, MTMiddle tributary, LT- Lower tributary.
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