Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524183EnglishN2016February11HealthcareEVALUATION OF COLOR AND LIGHTING PREFERENCES IN ARCHITECTS' OFFICES FOR ENHANCING PRODUCTIVITY English0106Zahra PoursafarEnglish Nandineni Rama DeviEnglish Lewlyn L. R. RodriguesEnglishBackground: Knowledge of design basics is key to the successful planning and implementation of any interior design project. The elements and principles of design represent general, universal ideas that refer to every aspect of design. Aim: This paper is focusing on occupant’s Preferences regarding to Color and Lighting in the Architects’ offices in Iran and India to increase the level of personalization in work environment and improving the Productivity. The outcome of this research would establish the link between architectural elements and Productivity. Moreover, the study would give clear indicators for the future architects to have a base for understanding the requirements and produce architectural components to suit to their specific requirements. Methodology: The data was primarily sourced through a self-administered survey questionnaire using random sampling method on representative sampling basis. Result: The finding of the study indicated that for employees in offices there are wide variety of Preferences in case of Color and Lighting. Also the outcome reveals employee’s Productivity in architects’ offices is affected by architectural elements. Conclusion: There are different Preferences regarding Colour and Lighting for employees in architects’ offices under the study. This difference would depend on distinction among behavioural, attitudinal and emotional pattern of the individuals. The result is based on the user’s subjective impression and personal Preferences in case of Colour and Lighting. EnglishArchitects’ office, Preferences, Colour, Lighting, ProductivityINTRODUCTION Knowledge of design basics is the key to the successful planning and implementation of any interior design project. The elements and principles of design would create general and universal ideas which apply to every aspect of design. Once designers understand how people perceive and react to their environments, they can use the elements and principles of design to form a whole composition. cA design is created with these elements; Light, form, Color, shape, space, texture. They can be elements that make up a painting, drawing and totally create any work of art. Also a successful interior design, as an important part of human’s life would be the result of combination and cooperation of these components. The purpose of this study is to identify employee’s Preferences in the Architects’ office interiors in case of Color and Lighting to increase the level of personalization in workplace and improve the employees’ Productivity. The term of personalization applied in this study refers to utilization of the user’s desires, choices and Preferences regarding Color and Lighting in work space. The literature reveals that personalization has a positive effect on employees’ Productivity, and the same assumption is being tested in this study for the offices. The area chosen is the Architects’ offices in Iran and India. The study will be based on primary data collected through a structured questionnaire. LITERATURE REVIEW In recent years, many designers were experimented with new ideas and methods to make work spaces more productive and attract more employees. Many authors have mentioned that, the physical setting of the workspace, along with successful management techniques, is participating in enhancing employees’ Productivity and improving organizational efficiency 1, 2, 3. Colour performs a crucial part to the factors of environmental design such as concept, atmosphere, perform, built shape, location, and orientation. Therefore, the correct application of Colour can enhance users’ capability to communicate with their atmosphere effectively. In addition, Color as a design device is appropriate for introducing the aesthetical, representational or cultural implications of the surroundings by the proper utilization of Color mixture4 . Variety of Lighting in one’s office would make a very significant contribution to the overall satisfaction that a building occupier and customer will experience. Visual comfort in a room will rely on the Lighting of areas such as light sources inside the area of view. If areas are too shiny or the contrast amongst lit areas is too high this will make glare. His research that personal control over an individual’s work table has a positive impact on their convenience and inspiration. Individual control can be over shutters, the illuminance level on the table and the air conditioning of that area5 . Recently, employee’s comfort in work environment identified by workplace physical conditions, then environmental setting has been recognized as a significant issue for measuring their Productivity. According to a survey study on U.S. companies’ employees determined that any improvement in physical layout of workplace, would direct the organization to greater overall effectiveness. A number of them could possibly be capable to expand the work-hours and keep working for a bit longer, due to the fact that the re-design and upgrade of the physical surroundings make them happier. Some of the factors which can help are: increase open space, use or allow adjustable furniture, increasing the privacy and reduce the eye-contacts during working hours, etc6 . RESEARCH METHODOLOGY The purpose of the study is to find out the employees’ Preferences in case of Color and Lighting in the Architects’ office interiors to increase the level of personalization and improve employees’ Productivity. The objectives of this study are: • To identify the influence of architectural elements on employees’ Productivity, • To determine the employee’s Preferences regarding to Color and Lighting in office interior to increase the level of personalization and improve Productivity The Architects’ office interior in Iran and India has been chosen as the population for the study. The formula used for sample size is (Kothari, 2006): The primary data for the survey was collected from 202 employees. The sample size was chosen based on representative sampling technique, ensuring that the group consisted of individuals’ representative employees in different age, education and gender group. The result will be more reliable and help researchers in case of generalization. In this study a self-administered questionnaires have been administered with two type of questions: 1- Multiple choice questions, 2- Likert scale questions. The data which is collected through the survey is based on the workers’ opinions about the workplace and its impact on their quantitative output of Productivity. Based on the literature review, the relationship between elements of office interior design and Productivity is conceptualized and depicted in Figure 1. Thus, this research study explores the following research hypotheses; H1 ; Color selection in the interior design has a significant influence on Productivity. H2 ; Lighting selection in the interior design has a significant influence on Productivity . RESEARCH FINDINGS The questionnaire administered for this study, consist of three sections: I. Collecting the demographic information from 202 employees , II. Is concerned with employees’Preferences in case of Color and Lighting in form of ‘multiple-choice answer’ and ‘Likert scale’ questions. III. Questions in this part are asking about their existing working environment with respect to Productivity. Section I: Demographic Information In the first part; demographic information is gathered from the 202 employees from both countries, who answered the questionnaire. The mode of delivery was through online and hardy copy form, in two types; Persian and English questionnaires. Their gender, age, education profile are asked in the first 3 questions, as shown in tables 1 to 4. According to tables 1 to 4, around 55% of respondents are Indians. Most of the respondents in survey are female (64%). About 46% of the attendees are between 25 to 34 years old and 52% of the employees have at least undergraduate degree.  Section II: Employees’ Preferences in case of Color and Lighting This section briefly discusses the survey findings regarding to employees’ Preferences in the Architects’ office interior in terms of Color and Lighting. Morever, there are some questions concerns with the employees’ opinion regarding to importance and influences of Color and Lighting. The contents of this section have been covered in form of “MultipleChoice Answer” and “Likert scale” questions. According to research findings, Blue is one of the most popular Colors, especially between men. Blues and greens have a soothing and calming effect and red environment would increase the blood pressure and persuade people to be more active. Too much red would result anger and too much cool Colors may reduce Productivity. Of course designer have to make sure that there’s a good balance between the Colors. Overusing of any group of Colors – warm or cool- can veer towards nauseating Light Color scheme were cited as favorite of the preferred Color scheme in the survey. This study hypothesized that employees in the light Color scheme would experience greater job satisfaction and more Productivity will be demonstrated. Among three neutral Color, white is the most appropriate Color in work environment, according to respondent Preferences (black is the worst selection), because it is light, neutral, and matches with everything. According to survey results, Most of the respondents prefer to work in a room lighted by ambient Lighting in white Color, which gives the opportunity for personal control. There has been growing interest in whether employee control (or lack of control) over Lighting at work can impact on well-being and performance7 . Section III, evaluation of employees’ Productivity in their existing working environment This section in concerning with employee’s existing working environment. Their work hours and time management have been asked in three first questions. According to data collected about exiting Productivity of the employees, they are wasting around 25% of their work hours as free times. That’s because of access to social media, drinking coffee, walking around, etc. Generally this time is between 15% to 50% in offices in the world. In a survey by Salary.Com, 35% of employees responding said the number one reason for slacking at work was that they don’t feel challenged enough in their job. Around 82% of respondents mentioned they are able to finish their assignment in their work hours. They also remarked “unpleasant working environment” as the reason of incompletion their assignment (67%), for the rest “Managerial problem” was the maincause. The rest of the questions in form of Likert scale type, are concerning with their opinion about working in their desired environment- according to their selection of Color and Lighting- and the impact of this environment on their Productivity. The result would be discussed in next section. RESULT The study has established on three objectives, in connection to influences of architectural elements on employees’ Productivity. Each part in this section would answer to each particular objective. Objective no.1; To identify the influence of architectural elements on employees’ Productivity. According to in table 5, there is a significant influence of architectural elements on employee’s Productivity as per the significance value. Table 6.2 represent the effects of Lighting and Color on Productivity. The positive relationship between Lighting and Productivity (R = 0.730) at 0.01 shows that employees’ Productivity highly correlates to the Lighting conditions and Color contents in the Architects’ offices. As indicated in table 6, the coefficient of determination R. square = 0.684. This gives us the ratio of explained variation to total variation. On converting the R. square value to percentage it comes to be approximately 68 Percent. From this percentage it is concluded that 68 percent of the variability of employees’ Productivity is accounted for by the variables in this model. The regression and residual sums of squares indicated that the variation in Ra is explained by the model to about 56%. The regression co-efficient for the predictor variables; Color and Lighting are 0.383 and 0.351, respectively. The coefficient values show, the change in Productivity with a unit change in a variable value, when all the other variables are held constant. When we analyze the coefficient value for the variable, ‘Color’ we can say that there is an increase of 0.383 in the Productivity of an employee for every unit increase (betterment) in the Color contents of the office, keeping all the other variables constant. The Regression Equation: Employees’ Productivity= 0.945 + 0.383 Color + 0.351 Lighting The overall response for each factor was analyzed and the mean and standard deviation values are shown in the Table 7. According to the findings from the survey in Table 7, Tstatistic and P-value, indicate that in 1% significance level, Color and Lighting have effects on employees’ Productivity, then the hypotheses are supported. H1 ; Color selection in the interior design has a significant influence on Productivity. H2 ; Lighting selection in the interior design has a significant influence on Productivity. Objective no 2; To determine the employee’s Preferences regarding to Color and Lighting in office interior to increase the level of personalization at work and improve Productivity Table 8 shows the results concern with the employee’s Preferences regarding to Color contents and Lighting condition in the Architects’ offices; CONCLUSION The main goal of interior architecture is to improve the quality of life, with respect to interior space. There are many parameters shaping the working or living space, but this research only considering the Color and Lighting and intend to create office interiors with human Preferences regarding to these elements. That can be a new definition of personalization in the Architects’ offices. Personalization would create a sense of belonging for the employees and increase the level of satisfaction and enjoyment during the work time. The outcome of this research established the link between the architectural elements, particularly Color and Lightingand Productivity in the Architects’ office interior. Further, research demonstrates that the creation and preservation of an interior space is required to consider people preferences and attempt to increase the sense of well -being by attention to their personal opinions regarding working physical environment. Different employees with different characters can be observed in the workspace which had various selection and Preferences regarding Color and Lighting. If designers wanted to create suitable environment for the space users, they must firstly understand their needs, nature of their job and their choices in work environment. A person will be happy in a particular environment only when the interior stands for his Preferences and wishes. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=337http://ijcrr.com/article_html.php?did=3371. Uzee, A. J. the inclusive approach: creating a place where people want to work”, The International Facility Management Association, 1999: 9: 26-30. 2. Leaman, A. and Bordass, B. Building design, complexity and manageability, Facilities, 1993:11(9): 16-27. 3. Williams, C. L. The Negotiable Environment: People, WhiteCollar Work and the Office, Consulting Psychologists Pr. 1995. 4. Smith, D. Environmental coloration and/or the design process, Color Research and Application, 2003; 28(5): 360-365. 5. Clements, C. The Importance of Good Office Lighting,2009. Available from: http://www.fitmltd.com/blog/the-importanceof-good-office-lighting/ 6. Rodriguez, J. How to Increase Office Productivity, 2012, Available from; http://construction.about.com/od/ConstructionDesign/a/How-To-Increase-Office-Productivity.Pdf 7. Sutter, Y. and Dumortier, D. and Fontoynont, M. The use of shading systems in VDU task offices: a pilot study, Energy and Buildings, 2006; 38(7): 780-789.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524183EnglishN2016February11HealthcareEMERGENCY PERIPARTUM HYSTERECTOMY: INCIDENCE, INDICATIONS AND FETOMATERNAL OUTCOME IN A TERTIARY CARE HOSPITAL English0710Saima WaniEnglish Perveena FareedEnglish Yasmeena GullEnglish Neha MahajanEnglishObjectives: The objectives of this study were to determine the incidence, maternal characteristics, indications and the maternal and perinatal outcome of emergency peripartum hysterectomies done in the Department of Obstetrics and Gynecology Government Medical College Srinagar. Study Design: This was a retrospective descriptive study done from January 2011-December 2013 over a three year period. Results: The incidence of peripartum hysterectomy during the study period was 1.46/1000 deliveries. The frequent age group was 31-35 years. The main indication of peripartum hysterectomy was life threatening hemorrhage due to uterine rupture (23), uterine atony (22), placenta accrete (18), placental abruption (16), placenta previa (13), broad ligament hematoma (7), retained placenta, Secondary postpartum hemorrhage and uterine fibroid (1 each) 81.37% hysterectomies were total and 16.63% were subtotal. The average pre- and intraoperative blood loss was 2.5 Lt +0.6. All patients needed blood transfusion. All patients received Perioperative antibiotics. Intraoperative complications developed in 15 patients which were bladder injury (5), Adnexial bleeding (5) and broad ligament hematoma (4). 69.6% patients needed intensive care. The common post operative complications were febrile morbidity (15.68%), wound sepsis (10.78%), pneumonia (8.82%), coagulopathy (5.88%), Cuff cellulitis and vesicovaginal fistula (1.96% each). The stillbirth rate was 303/1000. Most stillbirths occurred in uterine rupture (61.29%) followed by placental abruption (25.80%). Maternal mortality rate was 117/1000 live births. The average hospital stay was 13+4days. Conclusion: Emergency peripartum hysterectomy has significant effect on fetomaternal morbidity and mortality. Hence antenatal identification of high risk patients and proper management of second and third stage of labor and emergency preparedness are important in decreasing the rate of peripartum hysterectomy and improving the outcome. EnglishEmergency peripartum hysterectomy, Uterine rupture, Placenta accrete and uterine atonyINTRODUCTION Emergency peripartum hysterectomy (EPH) is one of the life saving procedure performed after vaginal delivery or caesarean section or in immediate postpartum period done for intractable haemorrhage.1 The most common indication of EPH being severe uterine hemorrhage that cannot be controlled by conservative measures.2 Hemorrhage may be due to abnormal placentation like placenta accrete, atonic uterus, uterine rupture, uterine fibroid and coagulopathy.2,3,4 India the reported peripartum hysterectomy rate is 2.6 per 1000 live births.5 In United States, the rate is between 1.2 and 2.7 per 1000 births. 6,7 However the peripartum hysterectomy rate is lower in European countries( 0.2 per 1000 births in Norway8 and 0.3 per 1000 births in Ireland).9 Peripartum hysterectomy is associated with severe blood loss, risk of transfusion, intraoperative complications and significant postoperative morbidity and mortality. Maternal mortality rate with EPH ranges from 0-30%.10 MATERIALS AND METHODS This retrospective descriptive study was carried in the Department of Obstetrics and Gynecology GMC Srinagar from January 2011-December 2013. Ethical clearance was taken from ethical committee. All the patients who underwent Emergency peripartum hysterectomy were identified from operative room, labor room and intensive care unit record book. Peripartum hysterectomy was defined as hysterectomy performed after 24 weeks of gestation at the time of delivery or within 42 days of delivery. Hysterectomies done before 24 weeks gestation for any reason were excluded from the study. The total number of deliveries during that period was also identified. Medical record sheets of above patients were analyzed in detail. The age, parity, indication for hysterectomy, blood loss, type of hysterectomy, intraoperative and postoperative complications, blood transfusion, fetomaternal outcome, duration of hospital stay and need for Intensive care were noted. Records of blood loss included blood loss before and during surgery. Febrile morbidity was defined as a temperature of 38o C or more on any two consecutive days excluding first 24 hrs. Wound infection was defined as the presence of any two of the following: purulent discharge/obvious cellulitis, elevated temperature and positive wound culture. Data obtained was analyzed with the SPSS 10.0 for windows. RESULTS There were 102 peripartum hysterectomies performed during this three year period from January 2011- December 2013. During this same period there were a total of 69742 deliveries. The peripartum hysterectomy rate was therefore 1.46/1000 deliveries. The age of patients ranged from 16-45 years. (Table 1). The highest number of patients was in the 31-35 yr age group followed by 26-30 yr group. The parity of patients ranged from 1-6 (Table 2). The highest frequency was in those from Para 1-3 followed by women more than Para 6. The gestational age of patients ranged from 28-42 weeks. Most common gestational age was 37-40 weeks followed by 28-36 weeks. The indication of peripartum hysterectomy was hemorrhage due to rupture uterus; uterine atony; placenta accrete; placental abruption; placenta previa; broad ligament hematoma; secondary postpartum hemorrhage, retained placenta and uterine fibroid (1 each). Conservative methods were tried in patients with atonic uterus before the final decision of hysterectomy. The conservative methods include use of Oxytocics, Systematic devascularisation and uterine tamponade. 83(81.37%) of the hysterectomies were total and 19 (16.63%) were subtotal. Estimated blood loss ranged from 1-5 Lt with a mean of 2.5+0.9. All patients received Perioperative antibiotics. Blood transfusion was needed in all patients (100%). Intraoperative complication occurred in 15 patients. These were urinary bladder injury (5), broad ligament hematoma (4), Adnexial bleeding (5), and retroperitoneal hematoma (1). 71(69%) patients needed ICU care. Two patients needed reexploration and 6 had coagulopathy. Postoperatively 16 patients developed febrile morbidity, 17 had wound infection, 2 developed Vesicovaginal fistula. The maternal mortality rate was 117/1000. The maternal mortality was distributed as under (Table 6).There were 71 live births and 31 still births. The still birth rate was 303/1000 births.19 stillbirths occurred in uterine rupture, 8 occurred in placental abruption and 4 in uterine atony. The mean duration of hospital stay was 13+4days with a range of 8-45days. DISCUSSION This was a retrospective descriptive study conducted in the Department of Obstetrics and Gynecology, GMC Srinagar from January 2011-December 2013. Peripartum hemorrhage is a major cause of maternal morbidity and mortality and emergency hysterectomy is a means of controlling life threatening hemorrhage. In the study period the hysterectomy rate was 1.46/1000 deliveries. This rate is comparable (1.2/1000) to rates observed by Sebitloane et al.11 Similar peripartum hysterectomy rate was observed by Nasrat et al.12 The highest frequency of patients was in age group 31-35 years. Similar observations were made by Kwame-Aryee et al.13 The major indications of peripartum hysterectomy were uterine rupture followed by uterine atony. This is consistent with findings by Shava J et al.14Nasrat et al had uterine atony as major cause followed by uterine rupture.12 83(81.37%) hysterectomies were total and 19(16.63%) were subtotal. It has been suggested that performing emergency total hysterectomies is unnecessary.15 Advocates of total hysterectomy have suggested the long term complications of vaginal discharge, vaginal bleeding and need for cervical cytology as reason for performing total hysterectomy. Emergency peripartum hysterectomy has high complications because of increased blood supply to the pelvic organs dur- ing pregnancy and distorted pelvic anatomy due to gravid uterus.16 Twenty three (22.54%) of patients had complications with some patient having more than one complication. Similar observations were made by Zorlu et al,17 Kwame-Aryee et al 13 and Sebitloane et al.11As majority of the complications are due to hemorrhage and injury to urinary tract, the obstetrician should be assertive in making early decision of hysterectomy before the patient exsanguinates, reduce operative time by clamping and the uterine pedicles off first till uterine arteries are secured, then proceed with suturing and tying the pedicles and be familiar with pelvic anatomy. The still birth rate was 303/1000 births with 19(61.29%) deaths in uterine rupture and 25.8% in placental abruption. The still birth rate is similar to rates by Sebitloane et al.11and Adanu et al.18 Maternal mortality rate was 117/1000 in the study. Uterine atony accounted for 58.3%, uterine rupture and placenta previa for 16.6% each. The mortality rate was higher than observed in some studies.17,19 Kwame-Aryee et al 13had maternal mortality rate of 12.9%. About 1/3rd of cases of peripartum hysterectomies were performed in patients who were thought to be low risk for the procedure. Residents should be made aware of the risk factors and be technically exposed to this procedure by encouraging them to assist in difficult hysterectomies. Use of live videotapes may compliment this exposure in teaching institutions. Patients at risk of peripartum hysterectomy should be identified and counseled regarding delivery in a hospital that has blood bank facility, backup of experienced obstetricians and availability of intensive care unit. As caesarean section is a risk factor for hysterectomy, its rate should be reduced and trial of vaginal birth after caesarean section should be given to patients. CONCLUSION Emergency peripartum hysterectomy has significant effect on fetomaternal morbidity and mortality. Hence antenatal identification of high risk patients and proper management of second and third stage of labor and emergency preparedness are important in decreasing the rate of peripartum hysterectomy and improving the outcome. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.   Englishhttp://ijcrr.com/abstract.php?article_id=338http://ijcrr.com/article_html.php?did=3381. Plauche WC, Grunch FG, Bourgeouis MO. Hysterectomy at the time of caesarean section: analysis of 108 cases. Obstet Gynecol.1981; 58:459-64. 2. Sellhas-CS Gilbert S, Landon MB, Verner MW, Leveno KJ, hauth JC, et al. Eunice Kennedy Shriver institutes of health and human development maternal-fetal medicine units network. The frequency and complication rates of hysterectomy accompanying caesarean delivery. Obstet Gynecol 2009; 114:224-9. 3. Zwart JJ, Dijik PD, Van Roosmalen J. Peripartum hysterectomy and arterial embolization for major obstetric haemorrhage: A nationwide cohort study in the Netherlands. Am J Obstet Gynecol 2010;202:150. 4. Rachaga S, Sivanesaratnam. Caesarean hysterectomy: a review of 21 cases in the university hospital, Kaula Lumpur. Eur J Obstet Gynecol Reprod Biol. 1984; 16:321-6. 5. Anita K, Kavitta WW. Emergency Obstetric hysterectomy. J Obstet Gynecol India 2005; 55:132-4. 6. Kastner ES, Figueroa R, Garry D, Naulik D. Emergency peripartum hysterectomy; experience at a community teaching hoslital. Obstet Gynecol 2002; 99: 971-5. 7. Stance LM, Schrimmer OB, Paul RM, Mishell DR. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol 1993; 168:879-83. 8. Engleson IB, Albrechsen S, Iverson OF. Peripartum hysterectomy- incidence and maternal morbidity. Acta Obstet Gynecol Scand 2001; 80:409-12. 9. Langdana M, Geary W, Haw D, Kean F. Peripartum hysterectomy in the 1990: a new lesson. J Obstet Gynecol 2001; 21:121-3. 10. Bodelon C, Bernabe Ortiz A, Schiff MA, Reed SD. Factors associated with peripartum hysterectomy. Obstet Gynecol 2009; 114:115. 11. Sebitloane MH, Moodley J. Emergency peripartum hysterectomy. East Afr J 2001;78(2):70-74. 12. Nasrat HA. Near-miss obstetric morbidity in inner city hospital in Saudi Arabia. East Mediterr Hlth J 1999;5 (4):712-726. 13. Kwame-Aryee R. A, Kwakye A, K, Seffah J.D. Peripartum hysterectomies at the Korle-BU teaching hospital; A review of 182 cases. Ghana Medical journal. 2007; 41:133-38. 14. Shava J, Masihleho GE, Mazibuko MD. Peripartum hysterectomy at Ga-Rankuwa hospital: A two and a half year review. Cent Afr J Med 1996; 42:25-28. 15. Heij HA, Te Velde ER, Cairns JM. Management of rupture of the gravid uterus. Trop Doct 1985; 15:127-31. 16. Barclay DL. Caesarean hysterectomy at the charity hospital in New Orleans-1000 consecutive operations. Clin Obstet gynecol 1969; 12:635-637. 17. Zorlu CG, Turan C, Isik AZ, Danisman N, Mungan T, Gokmen O. Emergency hysterectomy in modern practice. Changing clinical perspective in time. Acta Obstet Gynecol Scand 1998; 77:186-190. 18. Adanu RMK, Obed SA. Rupture uterus: A seven year review of cases from Accra, Ghana. J Obstet Gynecol Can 2003; 25:225- 230. 19. Gonsoulin W, Kennedy RT, Guirdy KH. Elective versus emergency caesarean hysterectomy cases in a residency programme setting: A review of 129 cases from 1984-1988. Am J Obstet Gynecol 1991; 65:91-94.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524183EnglishN2016February11HealthcareA COMPARATIVE STUDY OF CLONIDINE VERSUS TRAMADOL AS ADDITIVE TO BUPIVACAINE IN EPIDURAL ANAESTHESIA English1118Mahesh SutariyaEnglish Anand J. AminEnglish Miss Archana B. BehlEnglishIntroduction: Pain is unpleasant sensory-emotional experience and one of the most feared symptoms experienced. Epidural anesthesia is safe, well practiced and inexpensive neuraxial block technique. Bupivacaine is commonly used for epidural anaesthesia. Researches have been conducted to identify different techniques and drugs that improve the quality of surgical anaesthesia, prolong the effect of bupivacaine and duration of postoperative analgesia. Objectives: To evaluate efficacy of epidural tramadol and clonidine used as adjuvant to bupivacaine. To compare onset and duration of sensory and motor blockade, quality of anaesthesia and duration of postoperative analgesia. Methods: A prospective, randomized placebo control study was undertaken, involving 90 patients from SMIMER hospital, Surat. Three groups were allotted 30 patients each and were given, bupivacaine+saline (Group A)/ Bupivacaine+tramadol (Group B)/ bupivacaine+clonidine (Group C). Results were recorded and analyzed. Results: The onset of sensory block was fastest in Group C. Total duration of sensory blockade was longest in Group B. Total duration of analgesia was longest in Group B, followed by Group C based upon Visual Analogue Scale. Both tramadol (Group B) and clonidine (Group C) prolong duration of analgesia and decrease requirement of post-operative analgesic doses and amongst them tramadol (Group B) is superior. Conclusion: Tramadol and clonidine both are used as adjuvant to bupivacaine for epidural anaesthesia and post-operative analgesia. Tramadol provides longer duration of post-operative analgesia without sedation and requirement of analgesic is less within 24 hours. Tramadol is useful because of its cost-effectiveness and easy availability. EnglishPain, Pre-emptive anesthesia, Sensory blockade, Motor blockadeIntroduction Pain is unpleasant sensory-emotional experience and one of the most feared symptoms experienced. Epidural anesthesia is safe, well practiced and inexpensive neuraxial block technique. Bupivacaine is commonly used for epidural anaesthesia. Researches have been conducted to identify different techniques and drugs that improve the quality of surgical anaesthesia, prolong the effect of bupivacaine and duration of postoperative analgesia. Objectives: To evaluate efficacy of epidural tramadol and clonidine used as adjuvant to bupivacaine. To compare onset and duration of sensory and motor blockade, quality of anaesthesia and duration of postoperative analgesia. Methods: A prospective, randomized placebo control study was undertaken, involving 90 patients from SMIMER hospital, Surat. Three groups were allotted 30 patients each and were given, bupivacaine+saline (Group A)/ Bupivacaine+tramadol (Group B)/ bupivacaine+clonidine (Group C). Results were recorded and analyzed. Results: The onset of sensory block was fastest in Group C. Total duration of sensory blockade was longest in Group B. Total duration of analgesia was longest in Group B, followed by Group C based upon Visual Analogue Scale. Both tramadol (Group B) and clonidine (Group C) prolong duration of analgesia and decrease requirement of post-operative analgesic doses and amongst them tramadol (Group B) is superior. Conclusion: Tramadol and clonidine both are used as adjuvant to bupivacaine for epidural anaesthesia and post-operative analgesia. Tramadol provides longer duration of post-operative analgesia without sedation and requirement of analgesic is less within 24 hours. Tramadol is useful because of its cost-effectiveness and easy availability  Preemptive analgesia is given to decrease acute pain after tissue injury, to prevent pain-related pathologic modulation of the central nervous system, to inhibit persistent postoperative pain and development of chronic pain[2]. Epidural anaesthesia is safe, inexpensive neuraxial block technique which provides surgical anaesthesia and postoperative pain control. Nowadays anaesthesiologists use polypharmacy approach to provide the best possible surgical anaesthesia and post-operative pain relief with minimal side effects[3]. Bupivacaine is amide local anaesthetic, commonly used for epidural anaesthesia. Studies are being conducted to evaluate different techniques and add-on drugs (fentanyl, tramadol etc.) to improve the quality of surgical anaesthesia, prolong the effect of bupivacaine and duration of postoperative analgesia[4]. Clonidine is centrally acting partial α2 -adrenergic agonist which inhibits voltage gated Na+ channels and prevents action potential generation in dorsal horn cells causing analgesia. It also decreases activity of second-order neurons and weakens the input from peripheral nociceptive Aδ and C fibres. When given epidurally, 2 μg/kg of body weight, it increases the duration of analgesia without side effects like bradycardia, hypotension, respiratory depression and fall in oxygen saturation[5]. Tramadol is synthetic codeine analogue, acting by weak μ-opioid receptor agonism and reuptake inhibition of serotonin and noradrenaline, resulting in antinociceptive effect. Reports show that epidural tramadol can provide post-operative analgesia safely[6]. The purpose of this study was to evaluate efficacy of epidural tramadol and clonidine used as adjuvant to bupivacaine, to compare onset and duration of sensory and motor blockade, quality of anaesthesia and duration of postoperative analgesia. MATERIALS AND METHOD After approval from institutional ethical committee and written informed consent, a prospective, randomized placebo controlled, parallel group clinical study was conducted on 90 patients. Preanaesthetic evaluation was done on the previous day of surgery and procedure was explained. Study duration: From November 2011 to January 2014. Inclusion Criteria: Patients of either sex belonging to ASA (American Society of Anaesthesiologists) I or II between age group of 20 to 60 years. Exclusion Criteria: - History of cardiac or renal diseases and taking antihypertensive medications. - History of analgesic use. - Chronic pain syndrome. - Patients with communication difficulties. - History of any adverse reaction to study drugs. Methodology: - Preloading was done with injection Ringer’s lactate 15 ml/kg intravenously. - Injection glycopyrrolate 0.004 mg/kg and injection midazolam 0.08 mg/kg was given intramuscularly as premedication 30 minutes before surgery. - Epidural space was located by using loss of resistance technique into the space between L2-L3 or L3-L4 spine and 20G epidural catheter was inserted through 18G Touhy needle. Placement of epidural catheter in epidural space was confirmed by 3cc injection of lignocaine with adrenaline. The patients were randomly divided into 3 groups using a computer generated random numbers (30 patients in each). Blinding was not done. Study groups: Group-A: 19ml of 0.5% bupivacaine + 2ml 0.9% saline Group-B: 19ml of 0.5% bupivacaine +2ml tramadol (2 mg/ kg) Group-C: 19ml of 0.5% bupivacaine + 2ml clonidine (2 μg/ kg) Volume of bupivacaine (0.5%) was kept constant 19ml. Total volume was 21ml. Sensory blockade: was assessed by using pinprick with hypodermic needle. 0= No sensation 1= Pin sensed as dull pressure 2= Sharp Motor blockade: Assessed by modified Bromage scale. 0= No block 1= Inability to raise extended leg 2= Inability to flex knee 3= Inability to flex ankle and foot Sedation: Assessed by five point scale. 1= alert and awake, 2= arousable to verbal command 3= arousable with gentle tactile stimulation 4= arousable with vigorous shaking 5= unarousable Observations: were recorded as following: - Measurement, time of onset and total duration of sensory blockade: - Effective analgesia: - Measurement, time of onset and total duration of motor blockade: - Time to achieve T6 level: - Time from epidural medication to two segment regression: - Visual analogue scale (VAS) for postoperative pain assessment. 0= no pain, 2= annoying, 4= uncomfortable, 6= dreadful, 8= horrible, 10= worst pain. - Top up dose given when VAS ≥ 4 Group-A: 0.125% bupivacaine 8ml + 2ml 0.9% NS Group-B: 0.125% bupivacaine 8ml+ 2ml tramadol (1mg/kg) Group-C: 0.125% bupivacaine 8ml+2ml clonidine (1μg/kg) - Time of 1st top up dose. Definitions: - Onset of sensory blockade - Time from injection of study drugs to complete ablation of pin prick (score 0). - Effective analgesia - Time between complete sensory block to the return of pain sensation which is tolerable (VAS 4). - Onset of motor blockade - Time from injection of study to the time till complete paralysis (Modified Bromage scale 3). - Duration of motor blockade- Time of onset of complete motor block to the restoration of normal musculature force (Modified Bromage scale 0). Statistical analysis: Results were presented a ± mean ± SD (standard deviation). ANOVA test was applied for quantitative data and chi-square test for qualitative data. Significance of p value was suggested as follows: ‘p’ Value was >0.05 insignificant. ‘p&#39; Value was 0.05). Out of 90 patients, 45 patients underwent lower limb and 45 patients underwent lower abdominal surgery. Patients were comparable as per type of surgery. The onset of sensory block in both Group-C (10.06 ±2.03 minutes) and Group-B (12.6 ±2.01 minutes) were faster than the Group-A (13.83 ±1.96 minutes), with that in Group-C being faster (p< 0.001) (Table 2). Total duration of sensory blockade was longer in Group-B (251.33 ±58.5 minute) and Group-C (160 ±46.46 minutes) as compared to Group-A (143.33 ±53.5 minutes) (p< 0.001) (Table 2). The time to achieve T6 sensory block was shorter in GroupC (15.12 ±2.96 minutes) and Group-B (17.38 ±4.19 minutes) than Group-A (19.82 ±2.33 minutes) (p 0.05) (Table 3). Time of onset of motor blockade was comparable in GroupA (14.7 ±2.24 minutes), Group-B (13.93 ±2.74 min) and Group-C (13.2 ±4.30 min) (p> 0.05) (Table 4). Total duration of motor block were, 136.33 ±27.47 minutes, 139.33 ±35.03 minutes and 141 ±38.26 minutes in Group-A, B and C respectively (p> 0.05) (Table 4). In Group-A, patients had VAS ≥4 at an average duration of 170.66 ±51.44 minutes after giving epidural anaesthesia when 1st rescue analgesic dose was supplemented. In GroupB, analgesia lasted longer and VAS exceeded 4 after an average of 354.33 ±90.19 min. In Group-C, patients were comfortable till 220.33 ±96.34 minutes, when first rescue analgesic was required (Table 5). The total duration of analgesia was longest in Group-B, followed by Group-C. Time required for first rescue analgesic was longer in GroupB (354.33 ±90.19 minutes) than Group-C (218 ±30.10 minutes) and minimum in Group-A (168.33 ±26.40 minutes) (p< 0.001) (Table 6). Requirement of total number of analgesic doses in 24 hours were higher in Group-A (3.73 ±0.5) than in Group-C (2.9 ±0.5) and minimum in Group-B (2.4 ±0.5) (p 0.05). Shobhana Gupta et al [10] evaluated the analgesic effect of combination of epidural clonidine with bupivacaine versus epidural bupivacaine alone. In their study the mean time for onset of sensory anaesthesia was significantly faster (493.8 ±31.66 seconds) in clonidine group than control group (686.4 ±47.42 seconds). Yaun-Shiou Huang et al [11] conducted a dose-response study of epidural clonidine for postoperative pain after total knee arthroplasty. They divided patients in 4 groups (20 of each). After surgery, groups C0, C1, C2, C4 received patient control epidural analgesia (PCEA) with clonidine 0, 1.0, 2.0, 4.0 μg/ml respectively and morphine 0.1 mg/ml in 0.2% ropivacaine. They observed that five patients in group C4 and one patient in group C2 suffered from prolonged sensory blockade (longer than 24 h). They concluded that the highest concentration of clonidine (4.0 μg/mL; group C4) produced the best analgesia, but the degree of sedation, sensory and motor blockade were more severe and longer lasting than with lower concentrations of clonidine, and required careful monitoring of patients. Noha Sayed Hussien [12] compared magnesium sulphate and clonidine as an adjuvant to epidural anaesthesia. They noted that onset of anaesthesia was significantly rapid in magnesium group, 11.80 ±3.24 minutes, compared to 13.83 ±3.72 minutes in clonidine group and 17.71 ±2.66 minutes in control group. Time to reach T6 sensory level were 17.71 ±2.66 minutes, 10.80 ±3.24 minutes and 13.63 ±3.72 minutes in control, magnesium and clonidine group respectively. These differences between the groups were highly significant (p 0.05). The results of all the studies above were consistent with the present study. Administration of clonidine with local anaesthetic accelerates onset and increases duration of sensory block. The probable mechanisms are – (1) Interference with vascular resorption of local anaesthetic by producing vasoconstriction. (2) Direct action on neural tissue especially at the spinal level reducing the release of substance P from primary afferent neurons [13]. Addition of tramadol and clonidine to epidural bupivacaine produce rapid onset and prolong duration of sensory block without affecting two segment regression times. In present study the onset and total duration of motor block wasn’t significantly (p> 0.05) affected by either tramadol or clonidine. Noha Sayed Hussien [12] and Tanmoy Ghatak et al [3] observed no difference in the quality of motor blocks between the groups. Yaun-Shiou Huang et al[11] observed that higher concentration of clonidine produce prolonged motor block. The results of above studies were consistent with the present study. The onset and duration of motor blockade remained statistically insignificant in present study (p >0.05). In the present study, time required for first rescue analgesic were 354.33 ±90.19 minutes, 218 ±30.10 minutes and 168.33 ±26.40 minutes in Group-B, C and A respectively. The differences were statistically highly significant (p Englishhttp://ijcrr.com/abstract.php?article_id=339http://ijcrr.com/article_html.php?did=3391. Wall PD. The prevention of postoperative pain. Pain 1988;33:289–90. 2. Wu CT, Jao SW, Borel CO, Yeh CC, Li CY, Lu CH, Wong CS. The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery. Anesth Analg 2004;99:502-09. 3. Ghatak T, Chandra G, Malik A, Singh D, Bhatia VK. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine. Indian Journal of Anaesthesia. 2010;54:308–13. 4. Davis M., Gendelman D. S., Tischler M. D., Gendelman P. M. 1982 A primary acoustic startle circuit: lesion and stimulation studies. J. Neurosci.; 2:791-805. 5. Upadhyay KK, Prabhakar T., Handa R., Beena H. Study of the efficacy and safety of clonidine as an adjunct to bupivacaine for caudal analgesia in children. Indian Journal of Aanaesthesia, 2005; volume 49(3): 199-201. 6. Anis Baraka, Samar Jabbour, Antoun Nader, Abla Sibai. A comparison of epidural tramadol and epidural morphine for post-operative analgesia. Can J Anaesth. Volume 40, Issue 4 , pp 308-13 7. Rodgers A, Walker N, Schug S et al. Reduction of post operative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials. Brit Med J. 2000;321:1493–97. 8. M De Kock, M.D., B Crochet, M.D., C Morimont, M.D., J-L Scholtes, M.D.; Intravenous or Epidural Clonidine for Intra- and Postoperative Analgesia. Anesthesiology 1993;79(3):525-31. 9. Wylie and Churchill Davidson: A practice of Anaesthesia, 7th edition. Edward Arnold publication. 608-13. 10. Gupta S, Raval D, Patel M, Patel N, Shah N. Addition of epidural Clonidine enhances postoperative analgesia: A doubleblind study in total knee- replacement surgeries. Anesthesia, Essays and Researches. 2010;4(2):70-74. doi:10.4103/0259- 1162.73510. 11. Huang Yuan-Shiou, Lin Liu-Chi, Huh Billy K. Epidural clonidine for postoperative pain after total knee arthroplasty: A doseresponse study. Anesth Analg. May 2007: Volume 104: Issue 5- pp 1230-1235. 12. Noha Sayed H. A comparative study between magnesium sulphate and clonidine as adjuvant to epidural anaesthesia in patients undergoing abdominal hysterectomyhy. Ain-Shams Journal of Anaesthesiology. 2011: 4: no. 3: 1-9. 13. Sterling K. textbook of Pharmacology and Physiology in Anaesthesia practice (Lippincott Williams and Wilkins) 4th edition. Cha-15 – (clonidine) antihypertensive drugs. 340-345. Cha-7, local anaesthesia. 179-207. 14. Shahid Khan and Mohammad Iqbal memon et al: caudal bupivacaine alone and bupivacaine-tramadol in children with hypospadias repair.JCPSP- J Coll Physici 2008. Vol. 18 (10). 601- 604. 15. Y. demiraran, B. Kocaman and R. y. Akman. A comparision of the postoperative analgesic efficacy of single dose epidural tramadol versus morphine in children. Brit J Anaesth. (October 2005) 95 (4): 510-513. 16. S. Prakash, R. Tyagi, A. R. Gogia, R. Shing, S. Prakash. Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy. Brit J Anaesth. 97(3): 385- 388 (2006).

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524183EnglishN2016February11HealthcareASSESSMENT OF KNOWLEDGE ON REPRODUCTIVE HEALTH AMONG THE WOMEN English1922Kumari M. J.EnglishIntroduction: The aim of study was to assess the level of knowledge on reproductive health among the women at Puducherry and find out relationship between the knowledge on reproductive health and the selected clinical variables of women. Material and Methods: A descriptive cross-sectional research design was adapted to assess the level of knowledge on reproductive health among the women in multi-specialty Hospital, Puducherry. Consecutive sampling technique was used to select 500 women who were fulfilling the inclusion criteria. The data collection was done in regional language (Tamil) by face to face interview method through using structured interview schedule. Results: The study findings revealed that the level of knowledge on reproductive health among the 500 women, 220(44%) had inadequate knowledge, 253 (50.6%) women had moderately adequate knowledge and only 27 (5.4%) women had adequate knowledge. The mean value of knowledge regarding reproductive health among the women was 6.8 with the standard deviation of 2.4. There was statistically significant relationship found between the knowledge and history of reproductive health problems, family history of reproductive illness and use of family planning methods among the women. Conclusion: The study concluded that out of 500 women, only 27 had adequate knowledge on reproductive health. It shows that they want to improve their knowledge on reproductive health to prevent reproductive disease and promote their health. The health care providers have to take right steps promptly to reduce mortality and morbidity of the women.. EnglishReproductive health, Women reproductive health problems, Sexual disordersINTRODUCTION A healthy person is an asset to the society. Health of women is not merely a state of physical well-being but also an expression of many roles they play as wives, mothers, health care providers in the family and in the changed scenario even as wage earners. Health picture of Indian Women is still not satisfactory. In the Indian context the female children before, during and after the birth have suffered a neglect, which is reflected in their higher infant mortalities, low proportion in the total population, female infanticide and even feticides and lower levels of nutrition. Reproductive health of the women means that they have the ability to reproduce and to regulate their fertility and are able to undergo pregnancy and child birth safely. A woman’s reproductive system is a delicate and complex system in the body. Half of the young women in India got married before legal age of 18 years. They are unaware about reproductive health and health reproductive practice. It will cause unnecessary illness to them. It is important to take steps to protect it from infections and injury, and prevent problems—including some long-term health problems. The aim of study was to assess the level of knowledge on reproductive health among the women at Puducherry and find out relationship between the knowledge on reproductive health and the selected clinical variables of women. It is a challenging task to raise awareness regarding reproductive health care issues in women because of the social standing of women which distances them from the right source of information and also because of the taboos regarding the discussions on issues like menstruation, safe sex, unsafe sexual practices etc. Knowledge on reproductive health among women is very important to prevent reproductive problems. The health care team members have a vital role to create awareness regarding reproductive health among the women. MATERIAL AND METHODS A descriptive cross-sectional research design was adapted to assess the level of knowledge on reproductive health among the women in multi-specialty Hospital, Puducherry. The study population was all the married women who were living in Puducherry. The sample size consists of 500 married women who were fulfilling the inclusion criteria such as residence of Puducherry with age group of 18 to 50, women who were able to speak in Tamil or English and who were attending female gynecological out patients department. Exclusion criteria of the study were women who were unmarried and not willing to participate in the study. Consecutive sampling technique was adopted for selection of samples. Ethical clearance was obtained from Institute before the main study. There was no fund support from any agencies for the study. The data collection was done in regional language (Tamil) by face to face interview method through using structured interview schedule for each woman. The studytool consisted of two parts such as clinical variables related to reproductive problems and structures multiple choice questionnaires were used to assess the level of knowledge on reproductive health. Each correct answer carried one score. The total score less than 50% considered as inadequate, 50% to 74% noted as moderately adequate and 75% and above mentioned as adequate knowledge. After completing the data collection as per the interview schedule, the investigator has given health education on reproductive health, with the help of Laptop and explained about anatomy and physiology of reproductive system, menstruation cycle, menstrual hygiene, how the baby forms, antenatal care, delivery, postnatal care and immunization in power point presentation. The data obtained was analyzed and interpreted by descriptive and inferential statistical based on the objectives of the study. FINDINGS AND DISCUSSION Table 1 shows the distribution of clinical variables related to reproductive health of the women in number and percentage. The study findings shows that among the 500 women, 263 (52.6%) were stated that the girls become psychological and emotionally matured at the age of 18 years; this was through the awareness created by mass media and other informative sources like friends, relatives, neighbors. Totally 245 (49%) women answered correctly that the changes in size and shape of the body will occur during puberty. May be based on their own experiences and by seeing the other girls they came to know correct answer. One fourth of the women 124 (24.8%) stated that uterus, ovaries and fallopian tubes are reproductive organs. Because of lack of education, they have not known about the own body organs. Only 117 (23.4%) women stated that ovum and sperm are necessary to form a fetus and 63 (12.6%) women expressed that ovum was produced from ovary. This was also due to illiteracy, ignorance and lack of knowledge. Most of the women 289 (57.8%) were had knowledge on menstruation was a cyclic process, 359(71.8%) women were aware about menstruation happens once in a month and 351(70.2%) women stated that normal interval of menstrual cycle is 28 days. Nearly 275 (55%) women reported that duration of menstrual bleeding was 3-5 days and 281 (56.2%) were knew that menstrual bleeding starts from uterus. They knew all these the information due to their own experience in their reproductive life. Most of the women 385 (77%) said that above 21 years in female is the recommended age for marriage life. Among 500 women,181(36.2%) had said that iron rich diet was very important for pregnant women, 158(31.6%) women understand the dangers of premarital sex and it leads unwanted pregnancy and infections and 428(85.6%) women knew that pregnancy is getting through sexual contact. The level of knowledge on reproductive health among the 500 women, 220(44%) had inadequate knowledge, 253 (50.6%) women had moderately adequate knowledge and only 27 (5.4%) women had adequate knowledge. The mean value of knowledge regarding reproductive health among the women was 6.8 with the standard deviation of 2.4. The study findings supported by the Kiran, Susan, Jiny and Joseph (2013)study. They conducted a descriptive cross sectional study on the reproductive health status and its related factors among the women living in the post tsunami intermediate shelters of Andaman Islands, India among the 166 women in the reproductive age group (15 - 49 years). The study finding revealed that the knowledge of women regarding specific aspects of reproductive health and morbidity was found to be deficient. The women were lacking knowledge on reproductive health and its problems. This study was supported by Haque et al (2015) who conducted a comparative study on knowledge about reproductive health among the urban and rural women of Bangladesh on 2015. The study finding revealed that the proportion of poor knowledge regarding reproductive health was more (84%) among rural women, but good knowledge was more rampant (75%) among the urban women. The overall knowledge difference between urban and rural women regarding reproductive health was highly significant (p < 0.001). Table 2 shows that there was statistically significant relationship between the knowledge and history of reproductive health problems, family history of reproductive illness and use of family planning methods among the women. There was no significance between knowledge with other clinical variables such reason of reproductive health problems, type of family planning and person adopted family planning methods. A significant difference in the knowledge about family planning methods was observed between the two sub-centers (urban and rural). Women were better informed about family planning methods compared in urban than in rural. CONCLUSION The present study findings revealed that minimum number of women only had adequate knowledge on reproductive health. The health care providers and school teachers have the vital responsibilities in motivating and increasing awareness on reproductive health among the women and the school going girls. The women mortality and morbidity will reduce only by the self-awareness among the women which should be facilitated through creating mass health education in hospitals, community and schools. ACKNOWLEDGEMENT I acknowledge Dr. Mrs. A. Kalaimathy, Mother Teresa Women’s University, for her guidance. I would like to thank the Head of the Institute for permitting me to conduct the study in Sri Venkateswaraa Medical College Hospital and Research Centre, Puducherry. I delight to Thank Dr. Thirunaaukarasu, Professor, Department of Community, for edit this article. I express my gratitude toall participants who were involved in the study. Englishhttp://ijcrr.com/abstract.php?article_id=340http://ijcrr.com/article_html.php?did=3401. Vinitha CT, Singh S, and Rajendran A.K. (2007). Level of Reproductive Health Awareness and Factors Affecting it in A Rural Community of South India. Health and Population Perspectives and Issues: 30 (1) 24-44. 2. Kiran PR, Susan A, Jiny S, Joseph B. A study of the reproductive health status and its related factors among women living in the post tsunami intermediate shelters of Andaman islands, India. Annals of Community Health, . 2013.Vol.1 No1 . 3. Haque M, Hossain s, Ahmed KR, Sultana T, Chowdhury HA, and Akter J.A Comparative Study on Knowledge about Reproductive Health among Urban and Rural Women of Bangladesh. J Family Reprod Health. 2015 Mar; 9(1): 35–40. PMCID: PMC4405515. 4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405515/ 5. Yadav N,Women & Reproductive Health. http://www.cdc.gov/ reproductivehealth/womensrh/.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524183EnglishN2016February11HealthcareSERUM LACTATE DEHYDROGENASE LEVELS IN GASTROINTESTINAL TRACT CARCINOMA PATIENTS BEFORE AND AFTER SURGERY English2327V. BhagyalakshmiEnglish N. Sundara VeenaEnglish C. H. Ratna KumarEnglish G. V. BenerjiEnglish M. Jaiprakash BabuEnglishBackground and Objectives: To study the role of Serum Lactate Dehydrogenase (LDH) as a diagnostic parameter in gastrointestinal tract (GIT) carcinoma patients. To compare the level of serum Lactate Dehydrogenase in metastatic and non metastatic Gastrointestinal tract carcinoma patients. To evaluate preoperative and post operative serum Lactate Dehydrogenase level in Gastrointestinal tract carcinoma patients. Materials and Methods: Studied 20 patients of Gastrointestinal tract carcinoma admitted in surgical ward were selected for study group. Out of 20 patients, 15 patients were Gastrointestinal tract carcinoma without metastasis. 5 patients were Gastrointestinal tract carcinoma with metastasis. 20 healthy individuals were included in the control group. The correlation of serum Lactate Dehydrogenase levels in pre operative and post operative Gastrointestinal tract carcinoma patients were studied. Results: Serum Lactate Dehydrogenase levels were elevated in pre operative GIT carcinoma patients with and without metastasis. Serum Lactate Dehydrogenase levels were decreased in post operative patients of Gastrointestinal tract carcinoma without metastasis but elevated in postoperative patients with metastasis. Conclusion: The study showed serum Lactate Dehydrogenase as an independent diagnostic and prognostic bio marker. EnglishGIT carcinoma, Lactate Dehydrogenase, MetastasisINTRODUCTION Lactate Dehydrogenase (LDH) is an enzyme universally distributed in various tissues of the body. LDH is a cytoplasmic enzyme reversibly catalyses the conversion of pyruvate to lactate. Pyruvate+NADH+H+ L lactate+NAD+ Recently metabolic reprogramming has been recognized as a hall mark of cancer. Tumor cells produce a substantial amount of their energy through glycolysis. Cancer cells utilize glycolysis for energy production under normoxic conditions. This allows cancer cells to sustain higher proliferation rates. Due to rapid tumor cells divided, high metabolic demands, tumor avascular area formation, hypoxia is a characteristic property in solid tumor cells, in turn convert majority of their glucose stores into lactate. Gastro intestinal carcinoma is one of the most common cause leading to death in developed as well as developing countries. The more common gastrointestinal carcinomas are of stomach, colorectal, esophageal, pancreas and biliary tract. Gastric cancer is the fourth most commonly diagnosed malignancy and the second leading cause of cancer death in worldwide [1]. The main problem of GIT tract malignancies is late detection of disease as the symptoms appear in late stage. The increasing rate of mortality in case of GIT carcinoma is also due to poor screening as well as negligence by the patient itself specially in developing countries. So the main challenge is to detect the cancer in early stage so that curative surgery can be done which has better prognosis. A biochemical marker which acts as an indicator of the disease at the beginning can be really be helpful in providing better management. Lactate Dehydrogenase enzyme estimation provides a better prognostic indicator[2]. Biochemical screening can be done by estimating serum lactate dehydrogenase either pre operatively for diagnosis or post operatively for prognosis. Serum lactate dehydrogenase is estimated to evaluate its diagnostic as well as prognostic implication in established GIT carcinoma cases[3]. Serum LDH has been found elevated in serum of GIT carcinoma cases. The degree of elevation of serum LDH closely reflects the clinical status of the patient. In case of distant metastasis the level of serum LDH is found to be significantly high. This study showed Serum LDH as tumor marker of GIT tract carcinoma. As per cost wise this investigation is highly suitable, cheaper, accurate, feasibility as compared to any invasive procedure and is found to be higher in GIT carcinoma as well as higher in GIT carcinoma with metastasis. MATERIALS AND METHODS This is a prospective randomized study done for one year at Department of Biochemistry and the samples were collected from Department of General Surgery, Rangaraya Medical College, Kakinada. Samples were collected from two groups. They were: Study Group: 20 patients were selected with various types of GIT carcinomas from General Surgery wards of Government General Hospital, Kakinada. Control Group: 20 healthy individuals were selected. Persons who did not have a medical history of Blood, skeletal muscle, cardiac, hepatic or renal diseases and any type of cancer previously which are associated with increased serum LDH levels. Consent was taken from the patients and Ethical clearance has approved. The medical report was kept confidential. Detailed history and thorough clinical examination was done. Special investigations like ultrasound, endoscopy and radiological investigations and other investigations as the case demanded. After confirmation of GIT carcinomas by the investigations. Blood Samples were collected preoperatively, hemolysis was avoided as it increases serum LDH levels. This was followed by laparotomy with definite surgery to patients with GIT carcinoma, excised tissue was sent for histopathology examination for confirmation of Carcinoma. Out of 20 patients -15 patients were GIT carcinomas without metastasis 05 patients were GIT carcinomas with metastasis. Confirmation of pathological diagnosis of GIT carcinoma done by pathology department of Andhra Medical College, Visakhapatnam. Blood Samples were also collected from study group postoperatively on 7th day as routine follow up of cases after surgery for prognostic purpose and also from control group to estimate serum LDH levels. Methodology: Measurement of Serum LDH levels in both control and study group by UV kinetic method. Lactate dehydrogenase catalyses the conversion of pyruvate to lactate and the reduced coenzyme NADH to NAD+ . LDH activity in the sample is directly proportional to the rate of decrease in the absorbance of NAD+ at 340nm. Pyruvate + NADH + H+ ------LDH Lactate + NAD+ Statistical analysis: Statistical analysis has done by calculating p value using graphpad software. RESULTS Among total 20 study group, 15 patients diagnosed as GIT carcinoma without metastasis and 5 patients diagnosed as GIT carcinoma with metastasis. Various type of Carcinomas were evaluated. Those GIT carcinomas were depicted in Table no:1. In one year study Carcinoma of stomach was most commonly diagnosed among various GIT carcinomas. Among study group patients were in the age group of 35-75 years. Age and sex wise distribution were tabulated in Table No:2 DISCUSSION Tumor cells has capacity to proliferate infinitely, which causes alteration in the metabolism of cells in turn there is a change in the levels of various factors like hormones, enzymes. Exploring these objective indicators is extremely important for clinical practice [4,5]. Serum LDH is a non-functional enzyme and the level is very low in growing periods. They appear in plasma only after destruction of erythrocytes and other cells. The pattern of rise of this intracellular enzyme vary according to involvement of specific organ and its rise in blood is helpful in the diagnosis of specific disease. Several independent studies have shown that increased serum LDH levels or LDH-5 expression (as detected by immunohistochemistry) predicted poor prognosis and high metastasis risk in a spectrum of neoplastic diseases, including breast cancer, colorectal cancer, non–small cell lung cancer, endometrial cancer, and gastric cancer[6,7]. In malignancy the newer cells are being generated and the large number of malignant cells are destroyed by tumor necrosis factors and others. As discussed earlier this process leads to rise of various intracellular enzymes level in blood. In this study only SLDH was taken on the same lines that the cell destruction might result in increased level of it, especially in GIT Carcinoma. LDH was recently recommended as an objective indicator of tumor prognosis[8,9]. As per this study, in the study group 20 cases of various types of GIT Carcinoma were selected in which carcinoma esophagus consisted 25%, carcinoma stomach 30%, Carcinoma colon 20% and carcinoma rectum 25%. Gastric cancer is the fourth most commonly diagnosed malignancy and the second leading cause of cancer death in worldwide. Although the prognosis of gastric cancer has improved in the recent few decades, the overall 5-year survival rate is still poor [1,10]. The main causes of death in gastric cancer patients are recurrence and metastasis. There is much difference in serum LDH levels in between preoperative and postoperative estimation about 17.35IU/L. High levels of Serum LDH in cases with metastasis preoperatively compared to cases without metastasis. Post-operatively Serum LDH value is slightly raised in cases with metastasis (0.25%), but the value decreased in cases without metastasis. Guo Li et al[11] reported that decrease in serum LDH value were 74.9% during therapy. There was no difference in survival between the patients with decreased serum enzyme levels and those without decreased levels. Lee H et al [12] observed that among patients with advanced gastric cancer, high serum LDH level was related to better response to chemotherapy but shorter survival duration. The normalization of elevated serum LDH level after chemotherapy was related to good response to treatment. CONCLUSION We conclude that from this study, elevated SLDH levels in this study showed as independent diagnostic marker in preoperative GIT carcinoma patients with and without metastasis. Decreased SLDH levels in postoperative GIT carcinoma patients without metastasis showed as a prognostic marker. Elevated SLDH levels in GIT carcinoma patients with metastasis showed as a poor prognostic marker. ACKNOWLEDGEMENTS We are thankful to Biochemistry technical personnel for aiding us in doing the present study. We also grateful to authors/ editors of all publishers and books in the references cited. Englishhttp://ijcrr.com/abstract.php?article_id=341http://ijcrr.com/article_html.php?did=3411. Atrkar-Roushan Z, Kazemnejad A, Mansour-Ghanaei F, and Zayeri F. Trend analysis of gastrointestinal cancer incidences in guilan province: comparing rates over 15 years. Asian Pacific Journal of Cancer Prevention 2013;14(12):7587–7593. 2. Russell J Erickson. Lactic dehydrogenase activity of effusion fluids as an aid to differentiate diagnosis. JAMA 1961 Jun3;176(9):794-796. 3. Morton K Schwartz. Enzymes as prognostic markers and therapeutic indicators in patients with cancer. clinica chimica acta 1992 Mar13;206: 77-82. 4. Bidart JM, Thuillier F, Augereau C, Chalas J, Daver A, Jacob N, Labrousse F, Voitot H. Kinetics of serum tumor marker concentrations and usefulness in clinical monitoring. Clin Chem. 1999 Oct; 45(10):1695-707. 5. Patel PS, Rawal GN, Balar DB. Combined use of serum enzyme levels as tumor markers in cervical carcinoma patients. Tumour Biol. 1994; 15(1):45-51. 6. Kolev Y, Uetake H, Takagi Y, Sugihara K. Lactate dehydrogenase-5 (LDH-5) expression in human gastric cancer: association with hypoxia-inducible factor (HIF-1alpha) pathway, angiogenic factors production and poor prognosis. Ann Surg Oncol. 2008 Aug;15(8):2336-44. 7. Koukourakis MI, Giatromanolaki A, Sivridis E, Bougioukas G, Didilis V, Gatter KC, Harris AL. Lactate dehydrogenase-5 (LDH-5) overexpression in non-small-cell lung cancer tissues is linked to tumour hypoxia, angiogenic factor production and poor prognosis, Tumour and Angiogenesis Research Group. Br J Cancer. 2003 Sep 1; 89(5):877-85. 8. Füssenich LM, Desar IM, Peters ME, Teerenstra S, van der Graaf WT, Timmer-Bonte JN, van Herpen CM. A new, simple and objective prognostic score for phase I cancer patients. Eur J Cancer 2011 May; 47(8):1152-60. 9. Arkenau HT, Barriuso J, Olmos D, Ang JE, de Bono J, Judson I, Kaye S Prospective validation of a prognostic score to improve patient selection for oncology phase I trials.. J Clin Oncol. 2009 Jun 1; 27(16):2692-6. 10. Kunz PL, Gubens M, Fisher GA, Ford JM, Lichtensztajn DY and Clarke CA. Long-term survivors of gastric cancer: a California population-based study. Journal of Clinical Oncology 2012; 30(28):3507–3515. 11. Guo Li, Jin Gao, Ya-Lan Tao, Bing-Qing Xu, Zi-Wei Tu, ZhiGang Liu et al. Increased pretreatment levels of serum LDH and ALP as poor prognostic factors for nasopharyngeal carcinoma. J Cancer. 2012 Apr; 31(4): 197–206. 12. Lee H, Yuh Y, Kim S. Serum lactate dehydrogenase (LDH) level as a prognostic factor for the patients with advanced gastric cancer Sanggyepaik Hospital, Seoul, Republic of Korea. J Clin Oncol 2009;27. 13. Kemeny N et al. Prognostic factors in advanced colorectal carcinoma, Importance of lactic dehydrogenase level, performance status and white blood cell count. AM J Med 1983. 14. Michael I Koukourakis et al. Prognostic and predictive role of LDH5 expression in colorectal cancer patients treated with PTK 787/2K 222584 anti angiogenic therapy. Clin Cancer Res 2011 Jul 15;17:4892-4900. 15. Najib R et al. P-O 217-Prognostic factors in colorectal cancer, serum LDH Levels predict survival in metastatic disease. Annals of oncology 2014;25(2). 16. Ghool AM et al. A comparative study of LDH and PchE in sera of cancer patients , a preliminary report . Indian J .cancer 1980;17:31-3. 17. Cornelia Hoch ligeti et al. Effect of malignant growth on the organ lactic dehydrogenase in the human. cancer 2006 Jun 23;18(9). 18. Nyandieka HS. Influence of therapeutic radiation on serum enzyme levels in patients with cancer of thoracic esophagus . Indian J. Med. Res. 1984 jun;794-800.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524183EnglishN2016February11HealthcareSCIENTOMETRICS: A NEED FOR PHYSICAL THERAPY English2829Mahamed AteefEnglishDear Sir, Due to the emergence of electronic media into science and technology, the awareness and acquaintance to scientific data has been increased during the past three decades. Internet facilities have made possible the reach of data to all the academicians/ researchers. Mushrooming of publications and duplication of articles has been tremendously increased in the recent years. Due to the emergence of new science called scientometrics, the quality and quantity of scientific material is expected to be measured and analyzed on the basis of scientific measures. This modern technology measures not only the published material also the evaluation of scientists (H-index) and their role in particular field along with the ranking of field experts and expertise. These measures and analysis not only determines the impact of scientific work but also the upcoming researchers to choose particular field experts for their ongoing work to yield authenticated outcomes and validation of research performance. Scientometrics basically focuses on assessment and evaluation of scientific rigor 1.And emphasize the relative growth and scientific priority in many fields. The modern Scientometrics also means to explain the quality of work based on bibliometric analysis of scientific publications and citations. In brief Scientometrics is the study of measuring and analysis of science and its innovations. EnglishScientometrics, Physical therapy, Effect sizeROLE OF SCIENTOMETRICS IN THE FIELD OF PHYSICAL THERAPY So far Scientometrics have been playing a role to measure various disciplines and their extended levels of educational performance. One recent study has concluded that citation analysis through Scientometrics does not mean the scientific merit of the research work done2 . The work of numerous research articles mostly reveals the probability of the observed difference between the samples in terms of P value. But the future research analysis would also be based on the amount of difference between the samples, the statistical‘Effect Size’ analysis do explains not only the significant difference but alsothe concept of amount of difference between the samples. Since physiotherapy involves different methods of treatment interventions, only P-value variability may not serve the purpose of observed/ significant difference to be applicable on patient population but also needs the amount of difference whether it is a large or small treatment‘effect size’ of interventions between the samplesobserved. Hence, the scientific measure of ‘effect size’ analysis would bring the citation weightage to scientific merit of the research work done thereby increases the ‘impact factor’ of the journals. 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. Conflict of interest: None Funding source: None Englishhttp://ijcrr.com/abstract.php?article_id=342http://ijcrr.com/article_html.php?did=3421. Solla Price D.editorial statement. Scientometrics1978.Volume 1. Issue 1. 2. Paci M, Landi N,Briganti G, Lombardi B. Factors associated with citation rate of randomized controlled trials in physiotherapy. Archives of Physiotherapy. 2014.5:9.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524183EnglishN2016February11HealthcareANIMATION TECHNIQUE: AN EFFECTIVE TOOL TO UNDERSTAND CERTAIN BIOCHEMICAL PROCESSES LIKE BIOLOGICAL OXIDATION English3032Joshi P. N.EnglishBackground: Learning or computer-assisted teaching-learning is becoming popular at every stage of life. An animation is one of the computer applications and can have its impact on the teaching-learning process. Aims: The present study was designed to know whether the use of animation technique, in teaching can improve the process of understanding Methods: For this a group of 50 students was selected. The objectives of the study were explained to them. Pre-test was conducted by giving questionnaire. The topic was taught to them using overhead projector slides. Post test 1 was conducted giving same questionnaire. Then same topic was taught to them using animation tool. Post test 2 was conducted. The data obtained in the form of correct answers for all the three tests was analyzed statistically. At the same time feedback forms were given to all the students for purpose of analyzing the results qualitatively. Results: The results of pretest (P= NS) and posttest1 (pEnglishAnimation, Teaching aids, Overhead projector, Audio-visual aids, Visual impactINTRODUCTION Teaching and learning are important events for an individual during his life. Throughout the life, any individual is either teaching or learning something. Teaching is effective when learner understands what is being taught. To make teaching effective various teaching aids are used [1, 2]. Chalk and board were used previously. Then teachers started using overhead projector slides (OHP). Nowadays teachers are using PowerPoint presentations for delivering lectures [3]. The choice of the teaching aid depends upon an individual. In Biochemistry, it is very difficult to imagine various biochemical processes as they occur in the cell. To make the learner understand these biological processes, animation tool may be more powerful than the others [4]. Movement of molecules, their interaction could be better explained with animation. The visual impact is better than the descriptive lectures as we know that movies are remembered for longer time. With this idea, the present study was conducted in the Department of Biochemistry to know the effectiveness of animation technique as a teaching tool over the other tools in understanding certain biological processes. As the study aimed to make use of teaching-learning tool in teaching to improve understanding. MATERIALS AND  METHODS Study design: Descriptive study Inclusion criteria: 1st M.B.B.S. students ready to participate in the study were included. Sample size: Total 50 students of 1st M.B.B.S. were included in the study conducted for a period of a month. The descriptive study was designed as follows: The pre-test was conducted by giving self designed questionnaire based on question answer type, on the topic to be taught, This was to make sure that the students have no or poor knowledge about the topic to be taught. Then the topic "Biological Oxidation", one of the most difficult topic to understand was taught to them by preparing and using OHP slides. The topic was taught by displaying slides on overhead projector. The post-test1 was conducted by giving same questionnaire based on question answer type. Then the same topic was taught using power point slides and giving animation to the molecules. To see the effect of animation tool, posttest 2 was conducted. The effectiveness of the tool was also judged qualitatively with the help of feed-back forms [5] to know their views about use of this tool. Statistical analysis: The data obtained was entered in micorsoft excel 2010 and after pre test, post test1 and post test 2 was analyzed statistically by applying paired t test. RESULTS The results of the study are shown in the tables 1 and 2. DISCUSSION In the present study, the results obtained as correct answers in the pre-test, post-test1 and post-test2 were analyzed statistically by applying paired T test. As observed in Table 1 the results obtained by using OHP slides as teaching aid are significant (p0.001). When the results of pre-test and post-test 1 were compared (t = 4.8) while that of posttest1 and post-test2 were compared (t= 7.43) as shown in Table 2. Secondly, the objectives of the study were explained to the students and were not under pressure while answering the questions. The students were frank enough about not answering the questions if they do not know the answer, as number of guess answers were low and number of questions not attempted were much more in the pre-test. This number of questions not attempted was decreased in post-test 1 and still further decreased in post-test 2. All the students participated in the study have stated in the feedback form that the presentation using animation technique was more interesting and more effective than those using OHP slides .The results of the study are in agreement with previous study 6, 7. In addition to this, if choice is given, all the students want teachers to use the animation technique for teaching as compared to OHP slides. The students had given various reasons for the same. 25% (n = 13) students say that it is easy to grasp information or knowledge with it, 50% (n =25) feel it easy to understand and 12% (n = 5) feel it easy to explain while 13% (n = 7) find it easy to remember moving pictures like movie than information. Visual impact is more effective. Thus from the feedback results, response to the use of animation technique out of various teaching aids available is 100%. The reason is it can explain the events that could be occurring in the cell step by step. Movie or animated objects make us the feel as if the process is happening in front of us, thus increasing involvement of the students. The effect of animated objects appears as if one is experiencing it actually in front of him. As the moving objects give more detail information of an object from several different angles. In addition to this moving objects better capture observer’s attention. This increased attention may be responsible for better understanding [8, 9] Thus "Animation" is the most powerful tool in understanding biological processes. CONCLUSION In conclusion I can definitely say that "Animation is a powerful tool than other traditional teaching tools, in understanding biochemical processes" ACKNOWLEDGMENT To dthe epartmental staff and to authors, editors and publishers of articles referred by author for this manuscript. Funding for the work: NA Conflict of interest: NA   Englishhttp://ijcrr.com/abstract.php?article_id=343http://ijcrr.com/article_html.php?did=3431. Jorge G Ruiz, David A Cook, Anthony J Levinson. Computer animation in medical education: a critical literature review. Medical Education 2009: 43; 832-846. 2. Seth V, Upadhyaya P, Mushtaq ahmad, Moghe V. Powerpoint or chalk and talk: perceptions of medical students in a medical college in India. Advances in medical education and practice. 2010; 1: 11-16. 3. Savoy A, Proctor RW, Salvendy G. Information retention from powerpoint and traditional lectures. Comput Educ. 2009: 52; 858-867. 4. Rao M.P. Animation in medical education: You can do it. Medical J. of DY Patil University 2012: 5; 18-22. 5. Ende J Feedback in clinical medical education JAMA: 1983; 250(8): 777-781. 6. Saima Rasul, Qadir Bukhsh , Shazia Batool A study to analyze the effectiveness of audio visual aids in teaching learning process at uvniversity level. Social and Behavioral Sciences 28 (2011) 78 -81. 7. Elijah Ojowu Ode. Impact of audio-visual (AVs) resources on teachers and learning in some selected private secondary schools in Makurdi. + International Journal of Research in Humanities, Arts and Literature.2014;2(5):195-202. 8. Lander, K., and Bruce, V. The role of motion in learning new faces. Visual Cognition. 2013;10:897-912. 9. W. J. Matthews, Clare Benjamin and Claire Osborne . Memory for moving and static images. Psychonomic Bulletin and  Review 2007, 14 (5), 989-993.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524183EnglishN2016February11Healthcare4&#39;-THIODNA: UNEXPECTED BEHAVIOUR English3335Mohamed I. ElzagheidEnglishThis viewpoint briefly discusses the impact of 4’-thiosubstitution on oligonucleotides behaviour. The study in the reviewed articles has shown unexpected A-form formation, and unexpected RNA-like behaviour of the 4’-thioDNA. This has been confirmed by the unexpected interaction of 4’-thioDNA with Lividomycin A, a RNA major groove binder, and by resistance to cleavage by DNase I, which is a DNA-specific endonuclease. 4’-ThioDNAwas also recognized by RNase V1 which is a RNA-specific endonuclease. These all findings will trigger the main focus of this viewpoint. EnglishNucleic acids, ThioDNAs, 4’-ThioDNAs Structure and PropertiesINTRODUCTION Irrational unpredictable changes may lead to dramatic effect on people, nature and the world. Changes can be political, environmental, personal or chemical. What chemical changes can do to the behaviour of certain molecules? This leads me to ask the following questions: What a dramatic change will the replacement of oxygen atom by sulphur have on oligonucleotide structure and properties? Shall it really change the structural behaviour of those thio-oligonucleotides (thioONs)? Will they really exhibit any resistance to enzymatic cleavage? In this viewpoint, I will try briefly to answer the above mentioned questions through the discussion of the findings of the two papers on 4’-thioDNAs that were published by both Matsuda [1] and Katahira [2] groups. DISCUSSION Matsuda group researchers were working on developing 4’-thionucleic acids as functional oligonucleotides. These oligonucleotides consist of 4’-thionucleosides, a sugar-modified nucleoside analogue, as building blocks (Figure 1) [1, 3, 4]. Although there have been investigations by Walker and his co-workers on the synthesis and properties of 4’-thioDNA (Figure 2) [5], the ONs prepared on those studies were only partially modified with 2’-deoxy-4’-thiopyrimidine nucleosides [6-9]. However, the preliminary results have shown high hybridization to the complementary RNA and promising endonuclease (nuclease S1) resistance [8]. Matsuda group carried out more investigations on 4’-thioDNAs, oligonucleotides batch 1, ONs1 (DNA1, thioDNA1 and RNA1) followed by a series of the complementary oligonucleotides batch 2, ONs2 (DNA2, thioDNA2 and RNA2) (Figure 3) [1]. Ultraviolet melting experiments were used to measure the thermal stabilities of the complementary duplexes. The homo duplex of thioDNA1:thioDNA2 showed a higher Tm value (65.2 ± 0.2_C) than that of DNA1:DNA2 and it was similar to that of RNA1:RNA2. The hetero duplex RNA1:DNA2 (Tm ¼ 51.6 ± 0.2_C) was less thermally stable than the corresponding homo duplexes (DNA1:DNA2 and RNA1:RNA2). When RNA1 was changed to thioDNA1, the corresponding Tm value was nearly the same (thioDNA1:DNA2 ¼ 48.3 ± 0.2_C) as that of the RNA1:DNA2 hetero duplex. In contrast, thioDNA1 formed a thermally stable duplex with RNA2 (thioDNA1:RNA2) to give a Tm value of 64.6 ± 0.2_C, which is similar to that of RNA1:RNA2. These results made us to believe that 4’-thioDNA may behave as an RNA-like molecule despite the absence of the 2’-hydroxyl groups in the sugar moiety. To further confirm this speculation, CD spectra of each duplex were measured. The duplex DNA1:DNA2 showed a typical B-form spectrum (having a positive band near 280 nm), while that of RNA1:RNA2 showed a typical A-form spectrum (having a positive band near 260 nm). The CD spectrum of thioDNA1:thioDNA2 had a positive band near 260 nm though a small shoulder was observed near 280 nm, and thus A-form of the duplex was suggested. Additional confirmation of the RNA-like behaviour of 4’-thioDNA has been done by Matsuda group. They prepared a series of oligonucleotides batch 3 (ONs3) consisting of a self-complementary Dickerson sequence (DNA3, thioDNA3 and the corresponding RNA3). The thioDNA3, as the case for RNA3, has formed more thermally stable self-complementary duplex than DNA3, and the resulting duplex showed a preference for interacting with the RNA groove binder, lividomycin. The CD spectrum of thioDNA3 has closely resembled that of RNA3 showing an A-form structure. Katahira group has further studied the A-form structure of the 4’-thioDNA by NMR. DNA usually takes on the B-form in solution, although a structural change to the A-form occurs under dehydrating conditions [10, 11]. Structure determination by means of NMR has shown that the fully modified 4’-thioDNA unexpectedly takes on the A-form in the solution of moderate salt and neutral pH conditions. The Bform of DNA is stabilized through interactions with hydration spines located in the minor groove [10, 12]. This is due to the involvement of the O4’ atoms of 2’-deoxynucleosides in these interactions through a series of hydrogen bonds, and thus contribute to the stabilization of the B-form. Because the 2’-deoxy-4’-thionucleosides S4’ atoms are more hydrophobic than the 2’-deoxynucleosides O4’ atoms, the hydration spines essential for stabilization of the B-form would not be formed for fully modified 4’-thioDNA, which could account for the resultant formation of the A-form in solution. The nuclease sensitivity of 4’-thioDNA was also examined using DNase I, an endonuclease hydrolysing single- and double- stranded DNA, SVPD and 90% human serum. The DNA1 and thioDNA1 were labelled at the 50 mers end with 32P and incubated under appropriate conditions in the presence of nuclease or serum. The reactions were then analysed by PAGE under denaturing conditions, and the calculation of resulting half-lives (t 1/2 s) was based on the ratio of fulllength ON at each time point. The single-stranded thioDNA1 was completely intact in the presence of DNase I for up to 12 h under conditions in which DNA1 was readily hydrolysed (t 1/2 ¼ 1.5 ± 0.1 min), and these results agreed with those previously reported for nuclease S1 [8].In addition, the thioDNA1:thioDNA2 duplex was also intact in the presence of the same enzyme, while the DNA1:DNA2 duplex afforded a t 1/2 of 3.3 ± 1.2 min. For sensitivity to SVPD, the thioDNA1 was slowly hydrolysed by SVPD (t 1/2 ¼ >8 h) under conditions in which the DNA1 was readily hydrolysed (t 1/2 ¼ 2.8 ± 0.4 min). On further investigation of sensitivity in 90% human serum, the thioDNA1 was hydrolysed by the 30-exonuclease [13] and t 1/2 was 190 ± 12 min. Under the same conditions, the DNA1 afforded a t 1/2 of 40 ± 1.3 min. From these results we can conclude that the 4’-thioDNA showed significant resistance to both endonucleases and exonucleases. CONCLUSION On the basis of the defined structure, I can say that the remarkable properties reported for the fully modified 4’-thioDNA is supported by the following findings: • ThioDNA exhibits a CD spectrum characteristic of the A-form [14] although DNA usually gives a CD spectrum characteristic of the B-form. • The fully modified 4’-thioDNA unexpectedly interacts with lividomycin-A, resulting in an increase in thermal stability [1]. Lividomycin A is known to be an RNA major groove binder. In general, RNA usually takes on the A-form, and 4’-thioDNA was shown to take on the A-form. • The fully modified 4’-thioDNA has shown resistance to cleavage by DNase I, which is a DNA-specific endonuclease [1].This result is consistent with the earlier report by Walker and collaborators [6, 8]. • The fully modified 4’-thioDNA is recognized by RNase V1 [1], which is an RNA-specific endonuclease [14]. ACKNOWLEDGEMENT Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is 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. ABBREVIATIONS RNA= ribonucleic acid/ DNA= deoxyribonucleic acid/ ONs= oligonucleotides/ SVPD= snake venom phosphodiesterase/ CD= Circular dichroism/ PAGE= Polyacrylamide gel electrophoresis Englishhttp://ijcrr.com/abstract.php?article_id=344http://ijcrr.com/article_html.php?did=3441. Inoue N, Minakawa N, and Matsuda A. Synthesis and properties of 4’-thioDNA: unexpected RNA-like behaviour of 4’-thioDNA. Nucleic Acids Res 2006; 34: 3476–83. 2. Matsugami A, Ohyama T, Inada M, Inoue N, Minakawa N, Matsuda A, and Katahira M. Unexpected A-form formation of 4’-thioDNA in solution, revealed by NMR, and the implication as to the mechanism of nuclease resistance. Nucleic Acids Res2008; 36: 1805–12. 3. Otter G P, Elzagheid M I, Jones G D, MacCulloch A C, Walker R T, Oivanen M, and Klika K D. Synthesis and hydrolytic stability of α and β anomers of 4’-thio-2’-deoxyuridine and their 5-substituted analogues. Competition between the acid-catalysed depyrimidination and isomerisation to a 5-thiopyranoside nucleoside. J Am Soc, Perkin Trans 2 1998; 11: 2343-49, and references therein. 4. Elzagheid M I, Oivanen M, Walker R T, and Secrist III J A. Kinetics for the acid-catalysed hydrolysis of purine and cytosine2’- deoxy-4’-thionucleosides.Nucleosides Nucleotides 1999; 18: 181-86. 5. Elzagheid M I, Introduction to Macromolecule Chemistry, Book Code 559, Jubail Industrial College, Media Resources, Print shop, KSA, 2009, p. 39-41. 6. Hancox E L, Connolly B A, and Walker R T. Synthesis and properties of oligonucleotides containing the analogue 2’-deoxy-4’-thiothymidine. Nucleic Acids Res 1993; 21: 3485–91. 7. Kumar S, Horton J R, Jones G D, Walker R T, Robert R J, and Cheng X. DNA containing 4-thio-2’-deoxycytidine inhibits methylation by methyltransferase. Nucleic Acids Res 1997; 25: 2773–83. 8. Jones G D, Lesnik E A, Owens S R, Risen L M, and Walker R T. Investigation of some properties of oligodeoxy- nucleotides containing 4’thio-2’-deoxynucleotides: duplex hybridization and nuclease sensitivity. Nucleic Acids Res 1996; 24: 4117–22. 9. Jones G D, Altmann K H, Husken D, and Walker R T. Duplexand triplex-forming properties of 4’-thio-modified oligodeoxynucleotides. Bioorg Med Chem Lett 1997; 7: 1275–78. 10. Saenger W, Principles of Nucleic Acid Structure Springer-Verlag Inc., New York, 1983. 11. Johnson C W Jr. Determination of the Conformations of Nucleic Acids by Electronic CD in Fasman, G.D. (Ed). Circular Dichroism and the Conformational Analysis of Biomolecules, Plenum Press, NY, 1996; 433–68. 12. Kopka M L, Fratini A V, Drew H R, and Dickerson R E. Ordered water structure around a B-DNA dodecamer. A quantitative study. J Mol Biol 1983; 163: 129–46. 13. Shaw J P, Kent K, Bird J, Fishback J, and Froehler B. Modified oligodeoxynucleotides stable to exonuclease degradation in serum. Nucleic Acids Res 1991; 19: 747–50. 14. Lockard R E and Kumar A. Mapping tRNA structure in solution using double-strand-specific ribonuclease V1 from cobra venom. Nucleic Acids Res 1981; 9: 5125–40.