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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareUTILISATION OF BLOOD COMPONENTS IN A TERTIARY CARE HOSPITAL
English0107Mohammad Zubair QureshiEnglish Vijay SawhneyEnglish Humiara BashirEnglish Meena SidhuEnglish Peer MaroofEnglishBackground: Transfusion of blood components such as Packed Red Cell (PRC), Fresh Frozen Plasma (FFP) and platelet concentrates (PC) play an important role as a supportive therapy. This study was performed to study the utilisation and appropriateness of blood components in clinical practice at a tertiary care hospital–based blood bank at GMC, Jammu. Materials and Methods: A prospective analysis of blood components was conducted over a period of one year from November 2012 to October 2013. The usage of different types of blood component were recorded and correlated with the patient’s diagnosis and indications for transfusion. The appropriate use of blood components were assessed by DGHS guidelines. Results: Of the total 17634 units of blood components issued over a period of 1 year, 58.14% were Packed Red Cells (PRC), 29.43% were Fresh Frozen Plasma (FFP), 12.25% were Platelet Concentrate (PC) and 0.18% were Cryoprecipitate. The appropriate use of Packed Red Cells was 90.33% whereas inappropriate use was 9.67%. Inappropriate use of PRC was mostlyseen in patients with minor bleeding without significant changes in hemoglobin level and in patients with asymptomatic chronic anemia with Hb > 7g/dl. For Fresh Frozen Plasma 80.66% usage was appropriate and 19.34% were used inappropriately. Use of FFP for volume expansion was the most frequent form of inappropriate use followed by cases of bleeding without derang of coagulation tests. For Platelet Concentrate 93.29% transfusions were utilized appropriately and 6.71% inappropriately. Inappropriate use of PC was mostly seen in patients who had received platelets prophylactically with platelet count above 10,000/μl. Conclusion: Periodic review of blood component usage is very important to access the blood utilization pattern and judicious implementation of guidelines for use of blood components would decrease their inappropriate use.
EnglishPacked red cell, Platelet concentrates, Fresh frozen plasma, AppropriateINTRODUCTION
Over the last few decades transfusion medicine has underwent marked changes. Contrary to use of whole blood, emphasis is given on the use of specific blood components for appropriate and rational use of blood. The blood component implies separation of whole blood into various components like packed red cells, platelet concentrates, fresh frozen plasma and cryoprecipitate.1 Blood transfusion forms an important part of various treatment protocols. Blood must be transfused cautiously in view of its propensity to cause adverse effects such as introduction of donor antigens in the recipient, transfusion reactions or exposure to various transfusion transmitted diseases. The indications for ordering blood must be fully justified to avoid misuse or overuse of this precious resource. Periodic review of blood component usage is essential to assess the blood utilization pattern2 . Appropriate use of blood components results in cost effective transfusion therapy and reduces transfusion related complications3 . With the advent of blood component usage for specific needs of patients better guidelines have been suggested and put into practice. It is now a standard practice to manufacture and use different blood components from donated whole blood 4 . The current study was prospectively carried out in the Department of Transfusion Medicine at Government medical college (GMC) Jammu from November 2012 to October 2013. It was aimed at studying the utilisation and appropri ateness of various blood components in clinical practice.
MATERIALS AND METHODS:
Prospective analysis of blood component requisitions in patients from different clinical departments of GMC, Jammu were reviewed regarding age, sex, blood group, diagnosis, investigations, indication for transfusion, number of units issued and the speciality prescribing it. The usage of different types of blood component were recorded and correlated with the patient’s diagnosis and indications for transfusion. The appropriate use of blood components were assessed by Directorate General of Health Services (DGHS-2003) guidelines.
Indications of packed red cells (PRC):
• Surgery: Patient requiring urgent operation with Hb < 10g/dl.
• Anticipated surgical blood loss > 1000 ml.
• Acute blood loss of 30-40% of blood volume or more.
• Anemia associated with incipient or established cardiac failure.
• Hb value < 6 g/dl in the absence of disease and between 8 and 10 g/dl with disease.
• Patients approaching delivery and having Hb value < 7 g/dl.
• In hereditary hemolytic anemias and beta thalassemia major, guidelines are more liberal.
Indications of Platelet concentrate (PC):
• Platelet count is < 5000 / μl regardless of clinical condition.
• Platelet count is 5000-10,000 /μl, if there is increased risk of bleeding due to hematological malignancies, sepsis, severe aplastic anemia or patients undergoing bone marrow transplant.
• Platelet count is 10,000-20,000/μl, if thrombocytopenic bleeding or microvascular bleeding is present.
• Chemotherapy of malignancy (decreased production), if platelet count ≤ 20,000/ μl.
• Disseminated intravascular coagulation (increased destruction), if platelet count is ≤ 50,000/ μl.
• Massive transfusion (platelet dilution), if platelet count is ≤ 50,000/ μl.
• In major surgery if the platelet count is 1.5 × Normal. Indications of Cryoprecipitate:
• Hemophilia A. • Von Willebrand’s disease. • Congenital or acquired fibrinogen deficiency.
• Acquired Factor VIII deficiency (e.g. DIC, massive transfusion).
• Factor XIII deficiency.
• Source of Fibrin Glue used as topical hemostatic agent in surgical procedures. Statistical analysis: Data from blood component requisition forms of Department of Transfusion Medicine was collected, coded, tabulated, analysed and expressed as percentage.
RESULTS
Out of total 10980 transfusion requests, 17634 transfusion units for different blood components were issued. For PRC 8649 (78.77%) transfusion requests were received and 10252 (58.14%) units were issued with an average of 1.18 units per patient. For FFP 1482 (13.50%) transfusion requests were received and 5190 (29.43%) units were issued with an average of 3.50 units per patient. For PC 843 (7.68%) transfusion requests were received and 2161 (12.25%) units were issued with an average of 2.56 units per patient. For Cryoprecipitate 6 (0.05%) transfusion requests were received and 31 (0.18%) units were issued with average of 5.16 units per patient. Of total10980 transfusion requests received 6283 (57.22%) were for males and 4697 (42.78%) were for females. Maximum number of requests 4293 (39.10%) were between 0-15 years of age, 1889 (17.20%) were between 16-30 years, 1372 (12.50%) were between 31-45 years, 1306 (11.90%) were between 46-60 years and 2120 (19.30%) were above 60 years of age. Of total requisitions received 2537 (23.10%) were for A+ve, 3589 (32.69%) were for B+ve, 3156 (28.74%) were for O+ve, 939 (8.55%) were for AB+ve, 190 (1.73%) were for A-ve, 241 (2.20%) were for B-ve, 230 (2.10%) were for O-ve and 98 (0.89%) were for AB-ve.
For PRC highest percentage of appropriate episodes 99.18% (2551/2572) were observed in Thalassemia ward followed by ICU 96.75% (596/616), while as highest percentage of inappropriate episodes 22.27% (338/1518) were observed in Obstetrics and Gynaecology followed by Accident and Emergency 16.31% (335/2054). For FFP highest percentage of appropriate episodes 89.03% (933/1048) were observed in ICU followed by pediatrics 86.69% (241/278), while as highest percentage of inappropriate episodes 24.40% (255/1045) were observed in Accident and Emergency followed by Surgery and allied specialities 23.90% (309/1293). For PC highest percentage of appropriate episodes 97% (355/366) were observed in ICU while as highest percentage of inappropriate episodes 8.86% (80/903) were observed in Medicine and allied specialities followed by Accident and Emergency 8.10% (26/321).
DISCUSSION
Blood component therapy allows several patients to benefit from one unit of donated whole blood. Blood and blood products are considered drugs by the food and drug admin- istration (FDA). Just like any other treatment strategy with pros and cons, blood transfusions should only be administered if the benefits outweigh the risks5 . As a fact the supply of blood and blood components are finite, a high rate of inappropriate use has been reported around the world. This inappropriate use of blood and its components have a significant impact on the patients and the hospital staff in the form of health care cost, wastage of resources, depriving more needy patients and transmission of infection with unnecessary allergic reaction leading to high mortality and morbidity in patients6, 7. In the current study of the total 17634 components issued 15494 (87.86%) were used appropriately and 2140 (12.14%) were used inappropriately. The rates of inappropriate use of blood components reported by most studies vary widely, and it is difficult to compare rates because of differences in the criteria used to define appropriate and inappropriate use. Each blood product will be discussed separately because of the variety of reasons for transfusing packed red cells, fresh frozen plasma and platelets.
Packed Red Cells (PRC):
The number of requests received for packed cells were 8649 (78.77%) and number of units issued were 10252 (58.14%) with average of 1.18 units per patient. Of 10252 units of PRC issued, 90.33% belonged to a group of appropriate use and 9.67% were used inappropriately. Metz et al8 found 10-16% of transfusion units were given inappropriately and Mozes et al.9 reported a much higher rate of inappropriate use of PRCs. Maximum appropriate use of PRC (99.18%) was in patients with thalassemia followed by ICU patients (96.75%). It may be due to the fact that in beta thalassemia major, guidelines for transfusion are more liberal and in ICU proper transfusion guidelines may have been followed. Obstetrics and Gynaecology department (22.27%) followed by Accident and Emergency department (16.31%) were the main inappropriate users of PRC. Transfusions of packed red blood cells was found to be inappropriate in patients with evidence of bleeding but without significant changes in hemoglobin level, in patients with asymptomatic chronic anemia with Hb > 7 g/dl and in patients who had received transfusions preoperatively to raise Hb > 10 g/dl.. In many instances a low hemoglobin or hematocrit is used to determine a request for a transfusion of packed red cells but the correct approach is to combine the laboratory criteria and the symptoms of the patient. Clinical transfusion therapy relies on clinical experience and investigation. Recently, new evidence-based transfusion guidelines (“triggers”) have been promoted to rationalise blood utilisation and reduce harmful transfusion complications10.
Fresh Frozen Plasma (FFP):
The number of requests for FFP were 1482 (13.50%) and number of units issued were 5190 (29.43%) with average of 3.50 units per patient. It is recommended to transfuse 5-6 units of FFP to correct the haemostatic defect due to clotting factor deficiency11. Of these 5190 units of FFP 80.66% belonged to a group of appropriate use and 19.34% were used inappropriately. Percentage of inappropriate use of FFP was high compared to other blood products. Drastic reduction in the use of whole blood has been reported as the origin of inappropriate use of FFP12. There are many reports available regarding inappropriate transfusion of FFP at various centres showing 29% to 40% FFP being used inappropriately 13, 14 ,15 which was higher as compared to our study. We found maximum inappropriate use of FFP in Accident and Emergency department (24.40%) followed by Surgery and allied specialities (23.90%). A coagulation deficiency determination must be performed before request for FFP is made. FFP was given inappropriately as a volume expander, in cases of bleeding without derangement of coagulation tests and in patients of hypoproteinemia. A misconception about FFP that, it is a good volume expander and a source of albumin does not hold true. In our experience, we found two common reasons behind the inappropriate use of FFP. Some clinicians were not aware of the guidelines, while some clinicians tend to use FFP as a “precaution” against litigations and disputes. Kakkar et al.16 indicated 60.3% FFP prescriptions were inappropriate which however got reduced to 26.6% after educational campaigns of clinicians. In present study 6.07% of patients appeared to have been given FFP for reasons not clearly specified. Comparable data has been reported at national and international levels.17, 18, 19 FFP sometimes is still over-prescribed and strict clinical criteria for the utilisation of FFP need to be enforced. To establish an appropriate use of FFP, all requests needs to be sufficed with the indications for FFP as well as the patients Partial Thromboplastin Time (PT) / Activated Partial Thromboplastin Time (APTT) and International Normalized Ratio (INR) values.
Platelet Concentrate (PC):
The total number of platelet requests received were 843 (7.68%) and number of units issued were 2161 (12.25%) with average of 2.56 units per patient. We found that 93.29% of the platelet transfusions were utilized appropriately and 6.71% inappropriately. Inappropriate use of platelets was seen mostly in Medicine and allied specialities (8.86%) followed by Accident and emergency (8.10%). Makroo et al20 found about 19% of platelet transfusions were given at values in the order of 50-100 × 109 /L and significant percentage of blood request forms were incomplete.
The goal of the platelet transfusions is to prevent severe and life threatening bleeding in patients with thrombocytopenia. This aim needs to be balanced against the risk associated with platelet transfusions as well as the challenge of maintaining an adequate supply.21 In present study inappropriate use of platelets was seen in patients who have received platelets prophylactically with platelet count above 10,000/µl, in surgical or invasive procedures with platelet count > 70,000/ µl, in ITP / TTP without life threatening bleeding. Estcourt et al.22 found 34% of prophylactic transfusions were inappropriate which was higher as compared to our study. It is believed that the use of prophylactic platelet transfusions to keep the platelet count above 10x109 /L reduces the risk of haemorrhage as effectively as keeping it above any higher level.23 On the other hand, in the presence of factors such as fever or infection, ongoing chemotherapy, concurrent coagulopathy, rapid fall in platelet counts or in the presence of potential bleeding sites as a result of surgery, the use of platelet transfusions to keep the count above 20x109 /L is clinically justified.24 During the last two decades all over the world platelet utilization has increased more than the use of any other blood components.25 On one hand, the ready availability of platelet concentrates has undoubtedly made a major contribution to modern clinical practice in allowing the development of intense treatment regimens for hematological or other malignancies and on the other hand inappropriate use is also prevalent.26
CONCLUSION
Periodic review of blood component usage is very important to access the blood utilization pattern in any hospital. Judicious implementation of guidelines for use of various blood components would help decrease their inappropriate use. This will not only ensure availability of proper components to needy patients but simultaneously decrease transfusion related reactions as well. Awareness and education among all treating doctors, establishment of guidelines and regular audit will help in increasing the appropriate use of blood components.
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=390http://ijcrr.com/article_html.php?did=3901. Luk C et al. Prospective audit of the use of fresh-frozen plasma. Based on Canadian Medical Association transfusion guidelines. Canadian Medical Association Journal, 2002; 166:1539–1540.
2. Dushyant Singh Gaur, Gita Negi, Neena Chauhan, et al. Utilization of blood and components in a tertiary care hospital. Indian Journal of Hematology and Blood Transfusion. 2009; 25(3):91- 95.
3. Alving B, Alcorn K. How to improve transfusion medicine, a treating physician’s perspective. Arch Path Med 1999; 123:492– 5.
4. Zimmerman R, Buscher M, Linhardt C, et al. A survey of blood Component use in a German university hospital Transfusion 1997; 37:1075-1083.
5. Hawkins TE, Carter JM, Hunter PM. Can mandatory post transfusion approval programme be improved Transfusion Medicine 1994; 4: 45-50.
6. Joshi GP et al. Audit in transfusion practice. 19. Journal of Evaluation in Clinical Practice, 1998, 4:141–146.
7. Cheng G, Wong HF, Chan A, et al. The effects of a self-educating blood component request form and enforcements of transfusion guidelines on FFP and platelet usage. Clin Lab Haem 1996; 18: 83-87.
8. Metz J, McGrath KM, Copperchini ML, et al, Appropriateness of transfusion of red cells, platelets and fresh frozen plasma. An audit in a tertiary care teaching hospital. Med J Aust. 1995; 162:572–3.
9. Mozes B, Epstein M, Ben Bassat I, et al. Evaluation of appropriateness of blood and blood products transfusion using present criteria Transfusion 1989; 29: 473-476.
10. Tinmouth A, MacDougall L, Fergusson D, et al. Reducing the amount of blood transfused. Arch Intern Med. 2005; 165:845– 52.
11. Greene E, McCullough J, Weisdrof D. Platelet utilization and the transfusion trigger: A prospective analysis. Transfusion 2007; 47:201-205.
12. Blumberg N, Laczin J, Mellican A, et al. A critical survey of fresh-frozen plasma use. Transfusion 1986; 26: 511-513.
13. Makroo RN, Raina V, Kumar P, et al. A prospective audit of transfusion requests in a tertiary care hospital for the use of fresh frozen plasma Asian Journal of Transfusion Science 2007; (1)2: 59-61.
14. Pratibha R, Jayaranees S, Ramesh JC, et al. An audit of fresh frozen plasma Usage in a tertiary referral centre in a developing country Malays J.Pathol 2001; 23: 41-46.
15. Chaudhary R, Singh H, Verma A, et al. Evaluation of fresh frozen plasma usage at tertiary Care hospital in north India ANZ. J. Surgery 2005; 75: 573-576.
16. Kakkar N, Kaur R and Dhanoa J. Improvement in fresh frozen plasma /transfusion transfusion practice: results of an outcome audit. Transfus Med 2004; 14:231-5.
17. Schofield WN, Rubin GL, Dean MG. Appropriateness of platelet, fresh frozen plasma and cryoprecipitate transfusion in New South Wales public hospitals. Med J Aust 2003; 178:117-21.
18. Beloeil H, Brosseau M,Benhamou D. Transfusion of fresh frozen plasma (FFP): audit of prescriptions. Ann Fr Anesth Reanim 2001; 20: 686-92.
19. Hameedullah, Khan FA and Kamal RS. Improvement in intra operative fresh frozen plasma transfusion practice-impact of medical audits and providing education. J Pak Med Assoc 2000; 50:253-6.
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21. Estcourt LJ, Stanworth SJ, Murphy MF. Platelet transfusions for patients with haematological malignancies: who needs them? Br J Haematol 2011; 154(4):425–40.
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23. Schiffer CA. Prophylactic platelet transfusion. Transfusion 1992; 32: 295-8.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareA DETAILED STUDY OF SEVERITY OF ANAEMIA AND ITS RELATION WITH THE GENDER OF THE PATIENTS (MALE OR FEMALE PATIENTS) WITH HOOKWORM INFECTION FOUND WHILE DOING ENDOSCOPY
English0812Govindarajalu GanesanEnglishObjective: A detailed study was done to know about the severity of anaemia and its relation with the gender of the patients (male or female patients) with hookworm infection found in the duodenum while doing upper gastro intestinal endoscopy in our institute. Methods: A study of 1259 patients who had undergone upper gastro-intestinal endoscopy for a period of 5 years from May 2009 to April 2014 was carried out in our institute in order to find out the severity of anaemia and its relation with the gender of the patients( male or female patients) with hookworm infection found in the duodenum while doing upper gastro intestinal endoscopy in our institute. Results: 1. Out of these 1259 patients, 14 patients found to have hookworms in duodenum while doing upper gastro-intestinal endoscopy were taken into consideration for our study. 2. Out of these 14 patients with hookworms in duodenum, 9 patients had anaemia. Out of these 9 patients with anaemia, 2 patients were found to have severe anaemia,1 patient had moderate anaemia and 6 patients had mild anaemia. Out of these 14 patients with hookworms in duodenum, 5 patients did not have anaemia. 3. Out of these 14 patients, 6 patients were men and 8 patients were women. Most of the male patients with hookworm infection did not have anaemia. But almost all the female patients with hookworm infection had anaemia. The few male patients with anaemia had only mild or moderate anaemia. Severe anaemia occured only in the female patients and did not occur in any male patient. Conclusion: Hence female patients with hookworm infection were more prone for anaemia than the male patients in our study. .
EnglishGrades of anaemia, Hookworm infection in duodenum, Upper gastro intestinal endoscopyINTRODUCTION
Anaemia is commonly reported to occur in hookworm infection(1 to18). But so far detailed study was not done to know about the severity of anaemia and its relation with the gender of the patients (male or female patients) with hookworm infection found in the duodenum while doing upper gastro intestinal endoscopy. Hence a detailed study was done to know about the severity of anaemia and its relation with the gender of the patients (male or female patients) with hookworm infection found in the duodenum while doing upper gastro intestinal endoscopy in our institute.
MATERIALS AND METHODS
This study was conducted in the department of general surgery, Aarupadai Veedu Medical College And Hospital, Puducherry. A study of 1259 patients who had undergone upper gastro-intestinal endoscopy in our institute for a period of 5 years from May 2009 to April 2014 was carried out in order to know about the various grades of anaemia[mild, moderate and severe anaemia] and its relation with the gender of the patients (male or female patients) with hookworm infection found in the duodenum while doing upper gastro intes tinal endoscopy. Anaemia is defined as haemoglobin < 12g/ dl or 12g% in women(19 to 26) and haemoglobin < 13g/dl or13g% in men(25, 26). Mild anaemia is taken as haemoglobin 10to12g/dl or 10to12 g%, moderate anaemia is taken as haemoglobin 7to10g/dl or 7to10g% and severe anaemia is taken as haemoglobin 12g/dl or 12g% in women]. 3. Out of these 14 patients with hookworms in duodenum,6 patients were men and 8 patients were women. Most of the male patients with hookworm infection did not have anaemia. But almost all the female patients with hookworm infection had anaemia. The few male patients with anaemia had only mild or moderate anaemia. Severe anaemia occured only in the female patients and did not occur in any male patient.
MALE PATIENTS WITHOUT ANAEMIA
1. Out of the 6 male patients with hookworms in duodenum, 4 male patients did not have anaemia. All the 4 patients had haemoglobin >13g/dl or13g%. 2. Hence majority of the male patients with hookworm infection did not have anaemia [67%] . 3. Single hookworm in duodenum seen in the male patient without anaemia[haemoglobin >13g/dl or13g%] is shown in fig1.
MALE PATIENTS WITH ANAEMIA
1. Out of the 6 male patients with hookworms in duodenum, only 2 male patients had anaemia[33%]. 2. One male patient had only mild anaemia [haemoglobin 11.7g%]. 3. The other male patient had moderate anaemia [haemoglobin 8.6g%]. 4. None of the male patients had severe anaemia. 5. Hence male patients with hookworm infection were not much affected by anaemia in our study. 6. Single hookworm in duodenum seen in the male patient with mild anaemia [haemoglobin 11.7g%] is shown in fig 2.
FEMALE PATIENTS WITHOUT ANAEMIA
Out of the 8 female patients with hookworms in duodenum,only one female patient did not have anaemia.
FEMALE PATIENTS WITH ANAEMIA
1. All the remaining 7 female patients with hookworms in duodenum had anaemia. 2. Hence majority of the female patients with hookworm infection had anaemia[87.5%]. 3. 5 female patients with hookworms in duodenum had mild anaemia[haemoglobin 11.7g%, 11.2g%, 11.2g%, 10.4g%, 10g%]. 4. 2 female patients with hookworms in duodenum were found to have severe anaemia [haemoglobinEnglishhttp://ijcrr.com/abstract.php?article_id=391http://ijcrr.com/article_html.php?did=3911. Hyun HJ, Kim EM, Park SY, Jung JO, Chai JY, Hong ST . A case of severe anemia by Necator americanus infection in Korea. J Korean Med Sci. 2010 Dec;25(12):1802-4. 2. Wu KL, Chuah SK, Hsu CC, Chiu KW, Chiu YC, Changchien CS. Endoscopic Diagnosis of Hookworm Disease of the Duodenum: A Case Report. J Intern Med Taiwan 2002;13:27-30. 3. Kuo YC, Chang CW, Chen CJ, Wang TE, Chang WH, Shih SC . Endoscopic Diagnosis of Hookworm Infection That Caused Anemia in an Elderly Person. International Journal of Gerontology. 2010 ; 4(4) : 199-201 4. Zaher, T. I., Emara, M. H., Darweish, E., Abdul-Fattah, M., Bihery, A. S., Refaey, M. M., and Radwan, M. I. Detection of Parasites During Upper Gastrointestinal Endoscopic Procedures. Afro-Egypt J Infect Endem Dis 2012; 2 (2): 62-68. 5. Basset D, Rullier P, Segalas F, Sasso M. Hookworm discovered in a patient presenting with severe iron-deficiency anemiaMed Trop (Mars). 2010 Apr;70(2):203-4 6. Lee T.-H., Yang J.-c., L in J.-T., L u S.-C. and Wang T.-H. Hookworm Infection Diagnosed by Upper Gastrointestinal Endoscopy: —Report of Two Cases with Review of the Literature—. Digestive Endoscopy, 1994 6(1): 66–72 7. Kato T, Kamoi R, Iida M, Kihara T.Endoscopic diagnosis of hookworm disease of the duodenum J Clin Gastroenterol. 1997 Mar;24(2):100-102 8. Anjum Saeed, Huma Arshad Cheema, Arshad Alvi, Hassan Suleman. Hookworm infestation in children presenting with malena -case seriesPak J Med Res Oct - Dec 2008;47(4) ):98- 100 9. Li ZS1, Liao Z, Ye P, Wu RP Dancing hookworm in the small bowel detected by capsule endoscopy: a synthesized video. Endoscopy. 2007 Feb;39 Suppl 1:E97. Epub 2007 Apr 18. 10. Kalli T1, Karamanolis G, Triantafyllou K Hookworm infection detected by capsule endoscopy in a young man with iron deficiency. Clin Gastroenterol Hepatol. 2011 Apr;9(4):e33 11. Chen JM1, Zhang XM, Wang LJ, Chen Y, Du Q, Cai JT. Overt gastrointestinal bleeding because of hookworm infection. Asian Pac J Trop Med. 2012 Apr;5(4):331-2. 12. A Rodríguez, E Pozo, R Fernández, J Amo, T Nozal. Hookworm disease as a cause of iron deficiency anemia in the prison population Rev Esp Sanid Penit 2013; 15: 63-65 13. Cedrón-Cheng H, Ortiz C. Hookworm Infestation Diagnosed by Capsule Endoscopy. J Gastroint Dig Syst2011 S1:003. doi: 10.4172/2161-069X.S1-003 14. Yan SL, Chu YC. Hookworm infestation of the small intestine Endoscopy 2007; 39: E162±163 15. Chao CC1, Ray ML. Education and imaging. Gastrointestinal: Hookworm diagnosed by capsule endoscopy. J Gastroenterol Hepatol. 2006 Nov;21(11):1754. 16. Christodoulou, D. K., Sigounas, D. E., Katsanos, K. H., Dimos, G., and Tsianos, E. V.. Small bowel parasitosis as cause of obscure gastrointestinal bleeding diagnosed by capsule endoscopy. World journal of gastrointestinal endoscopy, 2(11), 2010: 369. 17. Genta RM, Woods KL. Endoscopic diagnosis of hookworm infection. Gastrointest Endosc 1991 July;37(4):476-8 18. Nakagawa Y, Nagai T, Okawara H, Nakashima H, Tasaki T,Soma W, et al. Comparison of magnified endoscopic images of Ancylostoma duodenale (hookworm) and Anisakis simplex. Endoscopy 2009;41(Suppl. 2):E189 19. Kabir, Y., Shahjalal, H. M., Saleh, F., and Obaid, W. Dietary pattern, nutritional status, anaemia and anaemia-related knowledge in urban adolescent college girls of Bangladesh. JPMA. The Journal of the Pakistan Medical Association, 2010; 60(8), 633.
20. Ahmed, F., Khan, M. R., Islam, M., Kabir, I., and Fuchs, G. J.. Anaemia and iron deficiency among adolescent schoolgirls in peri-urban Bangladesh. European journal of clinical nutrition, 2000 ;54(9), 678-683. 21. Ahmed F1, Khan MR, Karim R, Taj S, Hyderi T, Faruque MO, Margetts BM, Jackson AA. Serum retinol and biochemical measures of iron status in adolescent schoolgirls in urban Bangladesh. Eur J Clin Nutr. 1996 Jun;50(6):346-51. 22. Foo, L. H., Khor, G. L., Tee, E. S., and Prabakaran, D.. Iron status and dietary iron intake of adolescents from a rural community in Sabah, Malaysia. Asia Pacific journal of clinical nutrition, 2004 ;13(1), 48-55. 23. Chandyo, R. K., Strand, T. A., Ulvik, R. J., Adhikari, R. K., Ulak, M., Dixit, H., and Sommerfelt, H. Prevalence of iron deficiency and anemia among healthy women of reproductive age in Bhaktapur, Nepal. European journal of clinical nutrition, 2007;61(2), 262-269. 24. Sarita Modi, Bose Sukhwant Study of iron status in female medical studentsIndian Journal of Basic and Applied Medical Research; March 2013: Issue-6, Vol.-2, P. 518-526 25. Sikosana, P. L., Bhebhe, S., and Katuli, S.. A prevalence survey of iron deficiency and iron deficiency anaemia in pregnant and lactating women, adult males and pre-school children in Zimbabwe. Central African Journal of Medicine, 1998;44(12), 297- 304. 26. WHO. Iron deficiency anaemia: assessment, prevention, and control. a guide for programme managers. Geneva, Switzerland: World Health Organization, 2001. (WHO/NHD/01.3.) 27. Hyder, S. M. Z., Persson, L. Å., Chowdhury, M., Lönnerdal, B. O., and Ekström, E. C.. Anaemia and iron deficiency during pregnancy in rural Bangladesh. Public health nutrition, 2004 ; 7(08), 1065-1070. 28. Crompton DW, Whitehead RR. Hookworm infections and human iron metabolismParasitology. 1993;107 Suppl:S137-45.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareTRIPLE ASSESSMENT OF BREAST LUMPS, AN EFFECTIVE METHOD FOR DIAGNOSIS IN LIMITED RESOURCES SETTING
English1316Aniketan K. V.English Manjunath S. KotennavarEnglish Tejaswini VallabhaEnglishContext: Breast lumps are one of the common complaints for which a woman consults a surgeon. It is estimated that at least 50% of female population in USA consult surgeon some time in their life span for breast related symptoms, 25% among them will undergo breast biopsy and around 12% of them will develop some variant of breast cancer in their life time. Similar to worldwide trend, there is increase in the incidence of breast cancer in India too. This includes semi urban and rural areas where resources and access to facility for early diagnosis are limited. In such situations triple test for diagnosis plays an important role. It is effective in diagnosis, reliable, avoids multiple visits and helps in decision making regarding management. This study was conducted with an aim of assessing the accuracy of triple test in semi urban set up. Methods: A prospective cross sectional study on 50 women above 15 years of age with palpable breast lumps was conducted.
Triple test of lumps was done followed by definitive surgery based on inference. Inference of triple test was compared with final histopathology report. Results were analysed using Chi square test and p value of EnglishTriple assessment, Breast lumps, FNAC, Clinical examination, Mammography, SonomammographyINTRODUCTION
Breast lumps are one of the common complaints for which a woman consults a surgeon. It is estimated that at least 50% of female population of USA consult surgeon some time in their life span for breast related symptoms, 25% will undergo breast biopsy and around 12% of them will develop some variant of breast cancer in their life time [1]. Throughout the world, breast cancer is one of the leading cause of mortality and 2nd leading cancer in females. It is second leading cancer in India next only to carcinoma cervix. The incidence has doubled in last 25 years and is increasing. [2] Developed countries have well planned screening programs and interventional methods for early detection of breast cancer and optimum management for better survival. However such measures are not in place in developing country like ours due to various factors and limitations. It is equally heartening to see increased awareness among general population regarding breast diseases. Even though majority of lumps turn out to be benign, they are major source of anxiety for the patient. In such scenario, triple assessment forms the best method to diagnose and manage breast lumps. This is simple, feasible and accurate, avoids unnecessary surgeries and guides towards appropriate management. This article aims at presenting the efficacy of triple assessment in limited resource settings.
MATERIAL AND METHODS:
50 Women above the age of 15 years with complaints of lump in the breast were included in the study. Patients with known cancer breast, acute mastitis and breast abscesses were excluded. Institutional ethics committee clearance was obtained prior to the conduction of study. Detailed information was given to the study group and written consent obtained. Each individual underwent detailed clinical examination. Mammography in women above 35 years of age and sonomammography in less than 35 years was done. Then fine needle aspiration cytology was performed. Later patient underwent appropriate surgery as per the inference of triple test and the specimen was subjected to histopathology examination. Final histopathology report was compared with the inference of triple test. The data was analyzed by Chi square test. P value of Englishhttp://ijcrr.com/abstract.php?article_id=392http://ijcrr.com/article_html.php?did=3921. Kelly K. Hunt, Lisa A. Newman Edward M. Copeland III, Kirby I. Bland et al. The breast. Ch17, In Schwartz’s Principles of Surgery: 9th edn. Chief Editor: F. Charles Bruniacardi. 2010 Mc Graw Hill. pp. 424.
2. http://kidwai.kar.nic.in/statistics cited 2012 September 16.
3. Clarke D, Sudhakaran N, Gateley CA. Replace fine needle aspiration cytology with automated core biopsy in triple assessment of breast cancer. Ann Royal Coll Surg Eng. 2001; 83:110-112.
4. Jan M, Mattoo JM, Salroo NA, Ahangar S. Triple assessment in the diagnosis of breast cancer in Kashmir. Indian Journal of Surgery 2010.72:97-103.DOI:10.1007/s12262-010-0030-7.
5. Ghimire B, Khan MI, Bibhusal T, Singh Y, Sayami P. Accuracy of Triple Test Score in the Diagnosis of palpable breast lump. J Nepal Med Assoc; 2008; 47(172)189-92.
6. Al-Mulhim AS, Sultan AM, Al-Mulhim FM, Al-Wehedy A, Ali AM, Al Suwaigh A.et al. Accuracy of the triple test in the diagnosis of palpable breast masses in Saudi females. Ann Saudi Med, 2003; 23(3-4):158-61.
7. Morris A, Pommier RF, Schmidt WA, Shih RL, Alexander PW, Vetto JT. Arch Surg 1998,Sept ;133(9):930-4.
8. Vaithianathan. R, Sundaresan V, Santhanam R. Value of modified triple test in the diagnosis of palpable breast lumps.Int J Cur Res Rev. March 2013, vol 5(5):125-134.
9. Nagar S, Iacco A, Riggs T, Kastenberg W, Keidan R. An analysis of fine needle aspiration versus core needle biopsy in clinically palpable breast lesions: a report on predictive value and a cost comparison. The American Journal of Surgery. 2012 204,193- 198.doi:10.1016/j.amsurg.2011.10.018.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareCAFFEINE AND CARDIOVASCULAR RISK:A REVIEW
English1721Mahnoor AhmedEnglish Nematullah KhanEnglish Afia Masroor SaraEnglishCoffee is the leading worldwide beverage besides water and its exchange surpasses US $10 billion worldwide. Controversies
regarding its benefits and risks still exist as reliable evidence is becoming available supporting its health promoting potential;
however, some researchers have shown concerns regarding the association of coffee consumption with cardiovascular complications.
From a physiological perspective, the potential bioactivity originates from caffeine, the di-terpenes; cafestol and kahweol found
in the oil, and the polyphenols, most remarkably chlorogenic acid. We shall sift through the existing information on coffee & its
bioactivity and also their link with and impact on the risk factors which are associated with heart disease such as lipids, blood
pressure, inflammation, endothelial function, metabolic syndrome and potentially protective in vivo antioxidant activity.
Numerous epidemiological studies have scrutinized the relationship between coffee drinking and Coronary Heart Disease as a
healthy habit.
Most prospective studies have not demonstrated a positive affiliation, though case-control studies in general have reported such
an affiliation. This inconsistency could be clarified by an acute adverse effect of coffee, rather than a long-term adverse effect.
We propose that coffee drinking may have an intense negative impact in activating coronary events in all age groups, and also
post cardiovascular patients.
EnglishCardiovascular risk, Coronary artery disease, Dietary habits, Myocardial infarctionINTRODUCTION
Coffee, isn’t just water with some beans, it contains a significant amount of vitamins and minerals. It is the second largest traded commodity on earth, is the most widely consumed beverage subordinate to water. Coffee and tea are certainly not included under the healthy food category and if possibly given importance it may be only because of the dietary sources of polyphenols. It is a multiplex of more than 1,000 chemical compounds that include caffeine; the main component, phenols, vitamin B3, magnesium, potassium, fiber, quinolones, etc. It is slightly acidic in nature, and has a stimulating effect on human due to its caffeine content.1 It has now become one of the massive sources of antioxidants in modern living. It not only keeps one insomniac but also makes one smarter. The nature and action of the coffee is highly nourished by the processing and brewing of the coffee beans.2, 4 Coffee epitomize as an ultimate contributor in the total anti-oxidant capacity of the diet. However, regular consumption of coffee presents its own pros and cons. From a different prospect, coffee intake may turn down the risk of Type-2 Diabetes Mellitus and Hypertension, along with other possibilities of reducing obesity and depression. It has either beneficial or detrimental effects on cardiovascular system.3 Coffee has all the characteristics to control neurodegenerative disorders to a wide extent. Its consumption has been associated with a lower risk of death in a multitude of prospective epidemiological studies. The present review aims to unfold the increasing talk about how coffee can possibly have an impact on Cardio-vascular diseases. The Effectiveness of Caffeine: Caffeine is by far the most discussed component in coffee. It is accountable for the strong habit-forming character of coffee on a large scale. The active ingredient in coffee; caffeine, is a stimulant and the most commonly consumed psychoactive substance in the world.
Caffeine’s most basic mechanism in the brain is blocking the effects of an inhibitory neuro-transmitter that is adenosine. The act of caffeine actually increases neuronal firing in the brain and the release of other neurotransmitters like dopamine and norepinephrine by blocking the inhibitory response mediated by adenosine. It also incorporates a connection with the elevated blood pressure, arterial stiffness, plasma renin activity, epinephrine and non-epinephrine. Reviews of relatable journals have examined the effects of caffeine on the brain, demonstrating that it can improve mood, reaction time, memory, vigilance and general cognitive function. It raises the metabolic rate and helps to mobilize fatty acids from the fat tissues and can also enhance physical performance.10 Its dominant aftereffect is not only increased alertness and energy, but also other utilities as well as negative aspects to it. Its main drawbacks are addiction and overuse. Discontinuation from caffeine may end up into headaches, bad mood and a loss of focus.28 The Other types: There are about 10% of coffee lovers who would like to enjoy a good cup of coffee without the mild enlivening effect of caffeine. This type of coffee without the caffeine is known as decaffeinated coffee, which is coffee that has gone through a process of decaffeination to remove the caffeine. Most of the people drink decaffeinated coffee to escape weariness and lethargy. But some prefer it over regular coffee by the choice of taste. The greatest challenge in decaffeination is to try to separate only the caffeine from the coffee beans while leaving the other chemicals at their intact concentrations. This is not easy since coffee contains somewhere around 1,000 chemicals that are important to the taste and aroma of this miraculous complex elixir. The Possibilities: The risk factors for Coronary Artery Disease are smoking, hypertension, hypercholesterolemia, diabetes, obesity, social deprivation, physical activity and Dietary habits. The dietary habits also include the intake of beverages like coffee as it contains stimulants that may either enhance or minimize the productive output. The possible conditions prevailing coffee intake are Coronary Artery Disease, Myocardial Infarction, Cardiac Arrhythmias, Congestive Heart Failure, Ischemic Heart Disease, Atrial Fibrillation, Stroke, etc. From the past 2 decades there has been a consistent elevation in coffee consumption throughout the world in both men and women. Young adults are also liable to boost the utilization of coffee in the modern world. The use of certain addiction generating substances should be at the lowest possible level and to an extent not harmful to normal body functioning. Consumption of coffee should be limited; a minimum of 2 to 3 cups of coffee per day comes out as safe. In the past few years, the associations between coffee drinking and its risk to coronary heart disease (CHD) or coronary artery disease (CAD) remain disputable even after diverse studies. Coronary Artery Disease is one of the major causes of death worldwide in both men and women. Physical activity and dietary habits also pitch in as risk factors for Coronary Artery Disease.6 Alteration in nutritional routines can eventually increase or decrease these incidences. It is proclaimed that several characteristics of coffee should be taken into consideration, especially the preparation of coffee particularly boiled coffee as it lifts up serum lipids, homocysteine levels and also cholesterol levels. Benefits: Old research findings have linked coffee consumption with adverse cardiovascular effects plus an unpredictability of myocardial infarction. Recent studies have generally found no connection between coffee and an increased risk of heart disease. In fact, most studies find an association between coffee consumption and decreased overall mortality and possibly cardiovascular mortality, although this may not be true in younger people who drink large amounts of coffee. Many studies have shown that drinking coffee on a daily basis is safe for the heart and may actually reduce risk for heart disease. For most healthy adults, moderate coffee consumption can be part of a healthy diet, and for individuals that experience side effects from coffee, decaffeinated coffee can be the best alternative. Threadbare endothelial function increases the risk of heart attack and heart failure, because coffee helps improve endothelial function, it not only helps to protect from a heart attack to begin with, but can also reduce the risk of dying from cardiovascular disease.27,29 The Health Professional follow up study states that intake of coffee of 4 cups per day – both caffeinated and decaffeinated coffee does not increase Coronary Heart Disease risk.6 The prospective study on Finnish men and women articulates that 7 cups/day Coffee drinking is not associated with Coronary Heart Disease risk and death. Scottish Heart Health Study, the cohort study on Coffee consumption published that ≥5 cups/day has a moderate benefit.2
Researchers found among women, drinking at least 2 cups of coffee per day was associated with protection of up to 25% against dying from cardiovascular disease. And in a group of patients, both men and women, who had suffered the most common kind of heart attack, 96% of patients who were given coffee during their stay in the coronary care unit had a favorable increase in their heart rate variability, a measure of protection against premature cardiovascular death.29 Coffee consumption has been associated with improved insulin sensitivity and reduced risk of type 2 diabetes, but it has also been linked to increased cholesterol concentrations and heightened blood pressure.13A study of type II diabetics showed that those who consumed 5 or more cups of coffee daily were about 31% less likely to die from all causes and about 30% less likely to die from cardiovascular diseases, compared to those who drank no coffee at all.14 Moderate coffee consumption lessens risk of clogged arteries and heart attacks, the people consuming three to five cups of coffee a day have a lower risk of clogging arteries, and those drinking a moderate amount of coffee daily are subordinate to develop clogged arteries that could lead to heart attacks.20 According to the study conducted by HEART and Live Science, those who drank several cups of coffee a day had lesser menace of calcium buildups in the coronary arteries. Although these deposits are considered early warning signs of heart disease, the results do not mean that if you start drinking coffee you will be protected against this condition.12 On the other hand, research indicated that regular coffee drinkers may have a reduced risk of type 2 diabetes, which makes people prone to heart disease. Drawbacks: A lot of advanced epidemiological findings have analyzed the possible effects of coffee on Coronary Heart Diseases. Caffeine is the complex link between coffee and Coronary Artery Disease. Although there is strong evidence associating coffee with heart disease, caffeine is a mild stimulant and, as such, can cause a small, temporary rise in blood pressure and heart rate. The Health Professional follow up study voice out that decaffeinated coffee consumption of ≥4cups/day moderately increases Coronary Heart Disease risk.6 Moreover it was also added that decaffeinated coffee was contrarily related to cardiovascular mortality. There was no evidence of decaffeinated coffee providing a protective effect. However, certain researches appear to bear out some risks. High consumption of unfiltered coffee has been associated with mild elevations in cholesterol levels.7 And some studies found that two or more cups of coffee a day can increase the risk of heart disease in people with a specific and fairly common genetic mutation that slows the breakdown of caffeine in the body. So, how quickly the coffee metabolizes may affect health risk.21 Caffeine, especially in higher quantities, can cause elevated blood pressure, nervousness, polyuria and gastric acid.11 Drinking caffeine before bed can affect consciousness by making it harder to fall asleep, decreasing total sleep time and reducing the overall quality of sleep. Although coffee may have fewer risks compared with benefits, addition of cream and sugar to a cup of coffee adds more fat and calories. It’s Competitiveness with other Beverages: With Green Tea: Both coffee and tea have their benefits, though it’s always hard to pinpoint exactly what those are due to the large amount of contradictory studies. Coffee has higher caffeine content than tea; a typical cup of coffee has nearly three times the amount of caffeine than green tea.22 Though not enough has been studied to conclude whether tea does in fact reduce the risk of dying, tea has often been considered a therapeutic or medicinal drink that has both soothing and rejuvenating qualities. Both have other nutrients in them that have been linked with significant health benefits. Studies have indicated that both the beverages may reduce a person’s risk for heart disease, various types of cancer, Parkinson’s disease and other neurological disorders, and also Type 2 diabetes. Both beverages carry their own set of benefits that may help to maintain good energy and health, but when concerned about too much consumption of the stimulant it might be better to stick to green tea or any beverage containing a less amount of stimulant in it.23 With other Caffeinated sources: In general, coffee has more caffeine than soda and energy drinks. But coffee can provide additional naturally occurring nutrients while most sodas and energy drinks only have added sugars and artificially added vitamins.22 With Decaffeinated coffee: For many people, the pros outweigh the cons when it comes to drinking caffeinated beverages. A person may be able to gain more health benefits by choosing caffeinated products over decaffeinated as long as the consumption is in moderation. Decaffeinated happens to be a better choice for people who drink more than three cups of coffee daily and are prone to anxiety, stress, depression, sleep disturbances, palpitations,etc.25 Despite the decaffeination process, a small proportion of caffeine however remains in the decaffeinated coffee which may be not less than 5%. Conclusion: Coffee is ‘Heart Healthy’! Coffee is more in the favor of healthy living and should not be taken as a risk. After evaluating all the various prospective studies regarding the benefits and the drawbacks of coffee, we can say that coffee is highly beneficial to a person as it not only stimulates the Central Nervous System but also gives a helping hand in cardiovascular functions. It does have a minor effect on cardiac arrests and arrhythmias but that can be over looked. The employment of coffee in our daily life has a vast amount of utility like it increases energy convenience, reduces fatigue and the perception of stress related with physical action. It increases alertness, wakefulness and focus. It helps in better coagulation of blood in the body. It enhances physical performance and cognitive performance. It strengthens short-term memory and increases the ability to solve problems requiring reasoning, and the ability to make correct decisions. It boosts cognitive functioning capabilities and neuromuscular coordination. Taking coffee on a daily basis has no prime side-effect on Cardiovascular or any other vital organs. However there is still a question of whether to consume coffee after an episode of Myocardial Infarction or any other CVD or no; there is no evidence of coffee or caffeine increasing the casualties of CVD’s to a higher extent. Therefore, as coffee shows no possibilities of limitations after an episode, it can be taken by anyone post Myocardial Infarction and Cardiovascular disease also.15 Drinking of decaffeinated coffee over a caffeinated one is a matter of choice, as some feel it doesn’t make them jittery or keeps them awake. But few believe it’s a much healthier alternative for them than regular, and may actually be beneficial. Decaf may be a better choice for people who drink more than four cups of coffee daily and are prone to anxiety, stress and depression.24 But decaffeinated coffee does have a bit of caffeine present in it. It is better to avoid caffeinated coffee if there are certain medications which have the tendency to interact with the stimulant. Coffee can be taken by everyone but it should be in a moderate amounts. 4-5 cups of coffee a day has been taken as a moderate count. People with DM should look out for sugar intake in coffee as it might add up to their flaw. Drinking more coffee has no major drawbacks but surely it is no much of good as well.
ACKNOWLEDGEMENT
The completion of this undertaking would not have been possible without the participation and assistance of the people who whole-heartedly expressed their advices for the research that proved to be a landmark effort towards its success. We would like to show our gratitude to Dr. Syed Abdul Azeez, the principal of our institution, Deccan School of Pharmacy for his co-operation and the confidence he showed in us. We would also like to thank Sadia Farooqui and Maria Ansari for their support and motivation which encouraged us in accomplishing our goal. Once again we would like to thank you for your kind interest in our work.
Englishhttp://ijcrr.com/abstract.php?article_id=393http://ijcrr.com/article_html.php?did=3931. Effects of Habitual Coffee Consumption on Cardio metabolic Diseases, Cardiovascular Health and All-Cause Mortality – James H. O’Keefe, Salman K. Bhatti, Harsh R. Patil, et al. Journal of the American College of Cardiology. Vol. 62, No. 12, September 17, 2013. 2. Caffeinated beverage intake and the risk of heart disease mortality in the elderly: a prospective analysis - James A Greenberg, Christopher C Dunbar, Roseanne Schnoll, Rodamanthos Kokolis, Spyro Kokolis, and John Kassotis. The American Journal of Clinical Nutrition. 3. Coffee drinking is dosedependently related to the risk of acute coronary events in middle-aged men - Happonen P, Voutilainen S, Salonen JT. Journal of Nutrition - 2004 4. Coffee consumption and coronary heart disease in men and women: a prospective cohort study - Lopez-Garcia E, van Dam RM, Willett WC, et al. Circulation - 2006 5. The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and metaanalysis - Arthur Eumann Mesas, Luz M Leon-Mun ‘oz, Fernando Rodriguez-Artalejo, and Esther Lopez-Garcia. The American Journal of Clinical Nutrition. 6. Coffee consumption and risk of coronary heart diseases: a metaanalysis of 21 prospective cohort studies - Wu JN, Ho SC, Zhou C, Ling WH, Chen WQ, Wang CL, Chen YM. International Journal of Cardiology – 2009. 7. Cardiovascular effects of caffeine in men and women - Hartley TR, Lovallo WR, Whitsett TL. American Journal of Cardiology - 2004. 8. Possible Health Effects of Caffeinated Coffee Consumption on Alzheimer’s disease and Cardiovascular Disease - Dong-Chul You, Young-Soon Kim, Ae-Wha Ha, Yu-Na Lee, et al. Official Journal of Korean Society of Toxicology. Vol. 27, No. 1, pp.7- 10, January 25, 2011. 9. Consumption of coffee is associated with reduced risk of death attributed to inflammatory and CVD in the Iowa women’s Health study 26 - Anderson, L.F., Jacobs, D.R., Carlsen, M.H. and Blomhoff, R. American Journal of Clinical Nutrition, 2006. 10. Coffee Consumption and risk of Coronary heart diseases; a meta-analysis of 21 prospective cohort studies – Jiang-nan Wu, Suzanne C Ho, Chun Zhou, et al. International Journal of Cardiology (2009). Accepted 28 June 2008.
11. Consumption of cocoa, tea and coffee and risk of cardiovascular disease - Augusto Di Castelnuovo, Romina di Giuseppe, Licia Iacoviello, Giovanni de Gaetano. European Journal of Internal Medicine - 2011. 12. Does coffee drinking increase risk of coronary heart disease? Results from a meta-analysis - Kawachi I, Colditz GA, Stone CB. Heart Journal - 1994. 13. A meta-analysis of coffee, myocardial infarction, and coronary death - Greenland S. Epidemiology – 1993. 14. Coffee, Caffeine, and Cardiovascular diseases in Men – Diederick E. Grobber, Eric B. Rimm, Edward Giovannucci, et al. The New England Journal of Medicine. October 11, 1990. 15. Coffee drinking and acute myocardial infarction: report from the Boston Collaborative Drug Surveillance Program. Lancet – 1972. 16. Coffee consumption and mortality with ischemic heart disease and other causes: from the Lutheran Brotherhood Study. American Journal of Epidemiology – 1981. 17. Does coffee drinking increase the risk of coronary heart disease? Results from a meta-analysis. Ichiro Kawachi, Graham A Colditz, Catherine B Stone. Br Heart J, 1994. 18. A review of the relationship between coffee consumption and coronary heart disease - Christensen L, Murray T. Journal on Community Health - 1990. 19. Coffee Consumption and the risk of Coronary Heart Disease and Death – Palvi Kleemola, Pekka Jousilhati, Pirjo Pietinen, et al. Division of Nutrition, University of Helsinki, Finland. Arch Intern Med/Vol.160, December 2000. 20. Coffee consumption and coronary artery calcium in young and middle-aged asymptomatic adults. Journal: Heart. 21. Effects of Habitual Coffee Consumption on Vascular Function. JNCC Vol.63, No.6 February 18, 2014. Department of Cardiology, University of Athens Medical School, Greece. 22. Caffeine in Green Tea vs. Coffee - Jason Machowsky, February 18, 2015. 23. Caffeine - Not just a stimulant. The Nutrition Doctor, Skokie, Illinois, USA. October 26, 2010. 24. Caffeinated vs. Decaf: Which is better? - Erin Coleman. 25. Drinking Coffee is good for your Heart - Justine Alford. March 4, 2015. 26. Drinking Coffee for Heart Health - Melaina Juntti. 2015. 27. A perception on health benefits of coffee - George SE, et al. Critical Reviews in Food Science and Nutrition, 2008. 28. Effects of habitual coffee consumption on cardio-metabolic disease, cardiovascular health, and all-cause mortality - O’Keefe JH, et al. Journal of the American College of Cardiology, 2013. 29. New Findings on Coffee’s Cardiovascular Benefits - Julia Pace. Life Extension Magazine, August 2013. 30. Caffeinated coffee consumption, cardiovascular disease, and heart valve disease in the elderly (from the Framingham Study) - Greenberg JA, Chow G, Ziegelstein RC. American Journal of Cardiology – 2008.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareKNOWLEDGE OF OBESITY AMONG THE STAFF OF THE INTERNATIONAL INSTITUTE OF TROPICAL AGRICULTURE, NIGERIA
English2228Samson Adegoke AdelekeEnglish Emmanuel Akintunde Abioye-KuteyiEnglish Opeyemi Olubunmi SikuadeEnglish Amole Isaac OlusayoEnglishBackground: Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. The health implication of obesity is of growing significance in public health especially in the developing nations like Nigeria and knowledge is the most powerful weapon to prevent a disorder such as obesity. Objectives: The aim of this study was to determine the extent of the problem of obesity and people’s awareness about causes, health implications and complications of obesity. Method: A cross-sectional descriptive survey was carried out and 206 employees were selected randomly proportional to the staff categories. A pre-tested structured questionnaire was used to obtain socio-demographic data and knowledge of obesity. The weight and height of the subjects were measured. Results: A total of 206 subjects were recruited with male to female ratio of 1.9:1. The senior and junior staff constituted 45.1% and 54.9% of the subjects respectively. The overall prevalence of obesity among the subjects was 12.1% (9.7% for male; 16.7%
for female, p = 0.29) and almost two-third of the subjects (64.6%) had good overall knowledge of obesity. The prevalence of obesity among the subjects who had poor overall knowledge of obesity was 25.0% while it was 9.0% among the subjects who had good overall knowledge of obesity (p = 0.30). Conclusion: It was discovered from this study that majority of the subjects had good overall knowledge of obesity and that the prevalence of obesity was lower among the subjects who had good knowledge of obesity.
EnglishObesity, Knowledge, Staff, NigeriaINTRODUCTION
Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. Body mass index (BMI), expressed as the ratio between weight (measured in kilogram) and the square of height (in metres), is used to measure the ‘degree of fatness’.1 A BMI between 25 and 29.9 is defined as overweight, whilst a value above or equals 30 is defined as obese.1 Obesity was once considered a problem only in high income countries but is now dramatically on the rise in low- and middle-income countries, particularly in urban settings. Obesity also appears to be increasing rapidly among children and adults, implying that the health consequences will become fully apparent in the future.2 Overweight and obesity are the fifth leading risk for global deaths. At least 2.8 million adults die of related diseases each year as a result of being overweight or obese. In addition, 44.0% of the diabetes burden, 23.0% of the ischaemic heart disease burden and between 7.0% and 41.0% of certain cancer burdens are attributable to overweight and obesity.3 Obesity has been found to increase the risk of developing chronic non-communicable diseases such as hypertension, diabetes mellitus, osteoarthritis, ischaemic heart diseases, hypercholesterolaemia and certain cancers.4 The health implication of obesity is of growing significance in public health especially in the developing nations like Nigeria where it is contributing significantly to the added burden of non-communicable diseases to the existing communicable diseases, thus resulting in a double burden of disease.5 Many factors have been identified as the causative agents of obesity. They include hormones, high adipose cell count, heredity, defective metabolic mechanism, large fat cell, brown fat, lack of physical exercise and over-eating. However, the most common and main cause is consumption of calories in excess of the normal body requirements.6 Knowledge is the most powerful weapon to prevent a disorder such as obesity and many adults put on weight and get to be obese because they simply do not know simple facts, like the causes of obesity and how to prevent it. This study was carried out to find out the extent of the problem of obesity and people’s awareness about causes, health implications and complications of obesity. Setting The research was carried out at the International Institute of tropical Agriculture headquarter located in Ibadan, one of the two largest cities in the South Western part of Nigeria. The International Institute of Tropical Agriculture is a multinational agricultural institute involved primarily in research for development that is aimed at ensuring food security and the eradication of hunger in Africa. The headquarter at Ibadan, Nigeria has approximately 605 workers of different cadre mainly from Nigeria and few expatriates from other countries of the world. The institute has a clinic which is operates 24 hours a day and caters for the health need of the staff. The internet facility is readily available for all the staff. Ethical considerations The concepts of ethics were duly observed. Approval was obtained from the ethical committee of medical studies of the Institute. Consent was also obtained from the subjects before enlisting them for the study and each subject was given the liberty to decline being part of the survey if there is any personal reservation in participating in the survey. The information obtained from the subjects were handled confidentially with protection of the respondent rights. Method The research design was a cross-sectional descriptive survey. The employees were stratified by staff category. Two hundred and six (206) employees were selected randomly proportional to staff categories among junior and senior staff for the study to ensure proportionate representation for each staff category. Pregnant women and staff who had illnesses warranting hospital admission 2 months preceding the time of the survey were excluded from the study. A pre-tested structured questionnaire designed for the purpose was used to obtain socio-demographic data and knowledge of obesity. The weight was measured and recorded in kilogram to the nearest 0.5kg with the respondent in light clothing using the Seca model weighing scale. The height was measured in centimetres to the nearest 0.1 centimeter using a self-retaining AW tape measure fixed to the wall. The body mass index was computed to the nearest single decimal by dividing the weight in kilogram by the square of the height in meter. Body mass index of 19-24.9Kg/m2 , 25-29.9Kg/m2 and at least 30Kg/m2 was regarded as normal, overweight and obesity respectively.1 The knowledge of obesity was assessed with 26 questions, 8 questions on aetiology of obesity, 8 questions on the health implications of obesity and 10 questions on the prevention of obesity. The questions were in form of multiple choice and the expected responses were either Yes, No or do not know for each of the questions. Responses to the questions on the knowledge of obesity were scored as follows: Correct responses to the questions were scored one point each. Wrong or no responses were scored zero. Aggregate knowledge score was determined for each respondent. Percentage scores of ≤33%, 34-66% and ≥67% were rated as poor, average and good respectively in line with Smith et al classification.7 The data were analyzed using the Statistical Analysis System (SAS version 9.2) software. Simple descriptive and inferential statistics were employed to illustrate findings and ascertain relationships and effects. The level of significance was set at p < 0.05.
RESULTS
A total of 206 subjects were recruited with a mean age of 37.0±10.8 years. The senior and junior staff constituted 45.1% and 54.9% of the subjects respectively. Almost, twothird of subjects (65.0%) were male with a male to female ratio of 1.9:1. Overwhelming majority (97.6%) were Nigerian and more than two-third (68.0%) had tertiary education (Table 1). The overall prevalence of obesity among the subjects was 12.1 % (Figure 1). The prevalence among the female subjects (16.7%) was higher than that of male subjects (9.7%) (p = 0.29) while the proportion of the junior staff who were obese (13.3%) was higher than that of the senior staff category (10.8%) (p = 0.55). The prevalence of obesity increased with age from age 26 and the prevalence of obesity among the subjects whose educational level was below tertiary (13.4%) was greater than that of whose educational level were tertiary (11.5%) (p = 0.82) (Table 2). Almost two-third of the subjects (64.6%) had good overall knowledge of obesity. The proportion of the subjects who had good knowledge of the causes of obesity, health implications of obesity and prevention of obesity were 49.0%, 66.5% and 64.1% respectively (Table 3). The proportion of the senior staff that had overall knowledge of obesity (71.0%) was greater than that of the junior staff (59.3%) (p = 0.04) while the proportion of the female that had overall knowledge of obesity (66.7%) was greater than that of male subjects (63.4%) (p = 0.53). Considering the level of education, the proportion of the subjects who had good overall knowledge of obesity was higher among the subject that had tertiary education (66.9%) than those whose educational level was below tertiary (59.7%) (p = 0.22) (Table 4). The prevalence of obesity among the subjects who had poor overall knowledge of obesity was 25.0% while it was 9.0% among the subjects who had good overall knowledge of obesity (p = 0.30) (Table 2). Considering the sources of knowledge of obesity among the subjects, hospitals/clinics was the leading (26.9%) source of information for the subjects, followed by information derived from personal search from internet and books (24.1%) (Table 5). DISCUSSION This study revealed that obesity increased with age among the study population and this finding is in agreement with findings from other part of the country.1,8,9 The prevalence of obesity found was 12.1% and this finding is similar to what Amira et al8 and Siminialayi et al9 found in Lagos and Port Harcourt, Nigeria respectively but this value is lower than that obtain in Canada and United State of America.10 The difference in prevalence may not be unconnected with the difference in diet, level of physical activity and socioeconomic status. In this study female subjects were found to be more obese than the male subjects and this finding is the same with what was found in other studies.1,8,9,10 It was discovered from this study that almost two-third of the subjects had good overall knowledge of obesity and this finding is in support of what Soriano et al11 and Prakash et al12 found in Mexico and Nepal respectively but differs from the findings of Ojofeitimi et al13 in Ile-Ife Nigeria. This finding is not surprising and may not be unconnected with the level of education of the staff of the institute in which more than two-third of the staff had tertiary education. In addition, the sources of knowledge of obesity may be another factor that was responsible for the good knowledge of obesity in this study. The leading source of knowledge of obesity in this study was hospitals/clinics and the availability of a clinic at the institute may be responsible for this. The clinic is open 24 hours a day and patients usually listen to health talk at least once a week before consultation. Furthermore, next to the information received from the clinic is information derived from personal search from internet and books and availability of the internet facility and level of education of the staff may be the factors that were responsible for this. It was discovered from this study that the prevalence of obesity among the subjects who had poor overall knowledge of obesity was greater than the prevalence found among the subjects who had good overall knowledge of obesity. This study revealed that the proportion of the senior staff that had good overall knowledge of obesity was greater than that of the junior staff. This is not unexpected because of the level of education of senior staff and access to internet facility. The disparity in the overall knowledge of obesity may be one of the factors that was responsible for the higher prevalence of obesity among the junior staff than the senior staff. However, it is surprising that female who had higher prevalence of obesity than male had greater proportion of subjects who had good overall knowledge of obesity than male. Though, physical activity was not considered in this study but it has been established that female are generally less active than male and this may be a factor that was responsible for this findings.
CONCLUSION
It was discovered from this study that majority of the subjects had good overall knowledge of obesity and that the prevalence of obesity was lower among the subjects who had good knowledge of obesity. It is imperative to intensify health education about the causes, health implications of obesity and prevention of obesity in order to bring down rising prevalence of obesity in this community.
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=394http://ijcrr.com/article_html.php?did=3941. Amole IO, OlaOlorun AD, Odeigah LO, Adesina SA. The prevalence of abdominal obesity and hypertension amongst adults in Ogbomoso, Nigeria. Afr J Prm Health Care Fam Med. 2011;3(1), Art. #188, 5 pages. doi:10.4102/phcfm. v3i1.188
2. World Health Organization. Obesity [homepage on the Internet]. c2012 [Cited 2012 Aug 31].Available from: http://www.who.int/ topics/obesity/en/
3. World Health Organization. Obesity and overweight [homepage on the Internet]. c2012 [Cited 2012 Aug 31].Available from: http://www.who.int/mediacentre/factsheets/fs311/en/
4. Mollentze WF, Morre A J, Steyn AF et al – Coronary heart disease risk factors, rural and urban orange free state population. SAMJ 1995; 85(2): 90–6.
5. Wang G, Dietz W. Economic burden of Obesity in Youth. Paediatrics 2002;22(2): E81-1.
6. Antia FP, Clinical dietetics and nutrition. Oxford University Press, London, 1989.
7. Smith GE, De Haven MJ, Grundig JP, Wilson G.R. AfricanAmerican Males and Prostate Cancer: Assessing knowledge levels in the community. J Natl Med Assoc1997; 89(6): 387 – 391.
8. Amira CO, Sokunbi DOB, Sokunbi DA. Prevalence of obesity, overweight and proteinuria in an urban community in South West Nigeria. Niger Med J 2011;52(2):110-13.
9. Siminialayi IM, Emem-Chioma PC, Dapper DV. The prevalence of obesity as indicated by BMI and waist circumference among Nigerian adults attending Family Medicine clinics as outpatients in Rivers State. Niger J Med. 2008;17(3):340−345.
10. Statistics Canada. Adult obesity prevalence in Canada and the United States.[homepage on the Internet].c2011[Cited 2012 Aug 31].Available from: www.statcan.gc.ca › ... › Publications
11. Soriano R, Ponce de León Rosales S, García R, García-García E, Méndez JP. High knowledge about obesity and its health risks, with the exception of cancer, among Mexican individuals. J Cancer Educ. 2012 Jun;27(2):306-11.
12. Prakash S, Amudha P,Padam P ,Raja A,Lorna A. Knowledge, Attitude, and Prevalence of Overweight and Obesity Among Civil Servants in Nepal. Asia-Pac J Public Health. 2011; 23(4): 507-17.
13. Ojofeitimi EO, Adeyeye AO, Fadiora AO, Kuteyi AO, Faborode TG, Adegbenro CA, et al. Awareness of obesity and its health hazard among women in a university community. Pakistan Journal of Nutrition.2007;6(5):502-5.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcarePROXY MODEL FOR OPTIMIZATION OF BIODEGRADATION OF PYRENE BY CORYNEBACTERIUM SP AND PSEUDOMONAS PUTIDA
English2937Azeez Taofik OladimejiEnglish Owabor Chiedu NgoziEnglish Nwakaudu Madueke StanleyEnglish Opebiyi SamsonEnglishA proxy model for optimization of operating conditions (pyrene concentration, biodegradation time and aeration) for biodegradation of pyrene by Corynebacterium sp and Pseudomonas putida was aimed to be investigated. The proxy model for biodegradation of pyrene with activity of Corynebacterium sp and Pseudomonas putida was developed from experimental data using response surface methodology (RSM) with central composite design (CCD) of the design of experiments software. Corynebacterium sp degraded 96.71 % of pyrene at optimal conditions of 68.16 mg/L of pyrene concentration, biodegradation time of 82.57 hours and aeration condition of 3.0125vvm, while Pseudomonas putida degraded 93.84 % of pyrene at optimal conditions of 69.90 mg/L of pyrene concentration, biodegradation time of 84 hours and aeration condition of 3.4995 vvm. The developed proxy model of biodegradation of hazardous pyrene disposal under the stated operating conditions is fit and acceptable for optimization.
EnglishPyrene, Biodegradation, Optimization, Response surface methodology, Proxy modelINTRODUCTION
Pyrene is a peri-condensed four-ring, hydrophobic compounds, high molecular weight (HMW) polycyclic aromatic hydrocarbon (PAH) and biochemical persistence within ecosystem as a result of dense clouds of p-electrons on both sides of the ring structures, making them resistant to nucleophilic attack (Johnsen et al, 2005; Obayori et al, 2009; Azeez, 2012). Pyrene contains domains of carcinogenesis and mutagenesis in its molecule and it has been classified as pollutant by the US-EPA as the 16 priority polycyclic aromatic hydrocarbons (Obayori et al, 2009; Valentin et al, 2007). The structural symmetry and stability enable pyrene hard to be biologically attacked. It has been reported that microbes that can specifically degrade pyrene include Mycobacterium sp., Rhodococcus sp., Saccharothrix sp, Gordona sp., Pseudomonas sp., Cycloclasticus sp., Corynebacterium sp, Sphingomonas yanoikuyae and it could degrade or merely convert pyrene by co-metabolism (Hu et al, 2003; Hu et al, 2003; Rentz et al, 2005; Sanghvi, 2005; Liang et al, 2006; Mahanty et al, 2008; Kim et al, 2004; Azeez et al, 2013; Azeez, 2012; Lease et al, 2011). Versatility of this species makes it a probable inoculant in the remediation of pyrene contaminated sites (Van Hamme et al, 2003). Corynebacterium variabilis sp. Sh42 completely metabolized all representative compounds to CO2 and H2 O (El-Gendy et al, 2006). Rentz et al (2005) reported that mineralization of 14C7 benzo [a] pyrene by S. yanoikuyae JAR02 yielded 0.2 to 0.3% 14CO2 when grown with plant root products which indicated that the enhancement of phytoremediation of high molecular weight PAH indicated that co-metabolism of plant/microbe interaction plays an important role in rhizoremediation. Valentin (2007) reported that about 80.6 % pyrene was degraded by Bjerkandera sp with no significant effect of soil microflora presence. The identification of key organisms that play a role in pollutant degradation processes is relevant to the develop ment of optimal in situ biodegradation strategies (Viggiani et al, 2004; Abed et al, 2002). The discovery of aligned bacteria for remediation with hazardous environmental pollutants has been a driven agent of a large research community and generated biochemical, genetic and physiological knowledge about the degradation capacities of microorganisms and their applications in bioremediation (Van Hamme et al, 2003; Dua et al, 2002). Biodegradation, a bioremediation technique employed for cleaning up contaminants of petroleum hydrocarbons because it is simple to maintain, leads to the destruction of contaminants, applicable over large areas and cost effective (Vila et al, 2001). Different genera of bacteria are known for their potential oil degradation which contains different degradative enzymes involved in the metabolism of hydrocarbons (Palmroth et al, 2005; Pazoa et al, 2004). Researchers have developed models for kinetics, transport and diffusivity of biodegradation of pyrene with activity of Corynebacterium sp and Pseudomonas putida without considered the optimal conditions of the variables in the reactors and the medium (Owabor et al, 2010; Azeez et al, 2014). The stimulation of removal of contaminants from soil could not only be brought about through several mechanisms of plant/ soil interaction but by increase in soil microbial activity, increase in microbial association with the root and toxic compounds, and changes in the physical and chemical properties of the contaminated soil (Singh and Jain, 2003). Wang et al (2009) reported that pyrene degradation efficiency increases by the presence of Iron oxides as a photocatalyst. It has also been demonstrated that the addition of nitrogen and phosphorus as essential nutrients obtained from mineral salt medium (MSM) composition with continuously mixed slurry or field-wet soil incubations not only increased the rate of mineralization but increased the extent of mineralization of pyrene and decreases the lag period before significant pyrene mineralization could occur (Jones et al, 2008). Aeration condition, nitrogen and light in the presence of TiO2 and iron oxide enhanced degradation or loss of PAHs concentrations with variable degradation time (?wietlik et al, 2002; Wang et al, 2009) but the optimal conditions for biodegradation of pyrene have not been studied. The aim of this research was to develop and examine optimal model for biodegradation of pyrene by the activity of Corynebacterium sp and Pseudomonas putida with aeration condition, biodegradation time and pyrene concentration which contributes significantly to in - situ biodegradation.
MATERIALS AND METHOD
Pyrene, dichloromethane and hexane (Analytical grade Chemicals) were purchased from Patanne Chemicals, a renowned laboratory chemicals and equipment dealer in Benin City. Preparation of Mineral Salt Medium and Isolation of Microbes The microorganisms Corynebacterium sp and Pseudomonas putida for the experiment were isolated from the subsurface soil of about 0-15cm depth obtained from an uncultivated land in the Nigerian Institute for oil palm research (NIFOR), Benin City in Nigeria. The subsurface soil used for isolation of microbes has been described by (Azeez et al, 2010). The method described by Azeez et al (2012) was employed in which the soil was sieved using 2mm mesh screen for uniform particle size and stored in sterilized polyethylene bag at room temperature covered with aluminium foil for further use. Mineral salt medium (MSM) was used to avoid drastic fluctuation of pH which may be detrimental to the viability of the microbes in the batch medium and it was carbon free before pyrene was added after autoclaved at 1210 C for 15 minutes. The MSM was prepared with Analytical grade chemicals composition: KH2 PO4 (9.0g/l), K2 HPO4 (1.5g/l), NH4 Cl (1.5g/l), CaCl2 (20mg/l), and MgSO4 (0.2g/l) at a standardized pH of 7.2 using 0.1N NaOH. The MSM was sterilized in an autoclaved at 1210 C for 15 minutes and then stored in a secured corner in the laboratory until the experiment was set up. 0.5 g of soil samples were added into 100 ml MSM. The medium containing the soil sample and 0.1w/v % pyrene was incubated at 28±20 C on a rotary incubator shaker at 150 revolutions per minute for 24 h. The pure culture of colonies of Corynebacterium sp and Pseudomonas putida were maintained on nutrient agar plates for 72 hours at 28±20 C temperature for production of the microbes’ enmasse mainly for reduction of the lag phase and suitability of the inoculums in pyrene contaminated environment before the biodegradation. Biodegradation Analysis of Pyrene The quantity of pyrene as presented in the Table 1 was dissolved in 10% dichloromethane solution and make up to 1 liter by water. The solvent was volatized from pyrene solution under fume-hood. 250 ml of each of the pyrene solution measured into bioreactor vessel and 10 ml of inoculums was transferred from each agar plate of Corynebacterium sp and Pseudomonas putida into pyrene contaminated water and incubated at 28±20 C on a rotary incubator shaker at 150 revolutions per minute and supernatant was withdrawn for analysis at designed biodegradation time (3.546, 24, 54, 84 and 104.45 hour), centrifuged, decanted and cells of Corynebacterium sp and Pseudomonas putida settled down at the bottom of the centrifuged tube were scooped and dried in an oven at 600 C for 8 hours. The method described by (Azeez, 2012) was employed using UV visible spectrophotometer to measure absorbance of the pyrene in aliquot. The absorbance of the pyrene was recorded at a wave- length of 267 nm in the UV region after isolation of the microbes from centrifuge of 10 ml aliquots at 10,000 revolutions per minute for 20 minutes and allowed to settle for 30 minutes to obtain a clear supernatant. Pyrene was extracted from 5 ml of the clear supernatant using 5ml of hexane for 10 minutes in a separating funnel. The top solution in a separating funnel was a solution of pyrene in hexane and poured into the corvettes of the spectrophotometer and absorbance readings at a wavelengths of 267 nm was recorded. The procedure was repeated in designed biodegradation time immediately after inoculation with Corynebacterium sp and Pseudomonas putida for a period of 104.45 hours of incubation and solutions of pyrene in the hexane were prepared to give a concentration of 0.3mg/ml. The absorbance of the solutions was read at the appropriate wavelengths 267nm for the pyrene solution. The standard model obtained by Azeez (2012) was used for the conversion of pyrene absorbance to mg/L. The percentage of biodegradation of pyrene was evaluated as follows: (1) Where gi is the concentration of pyrene utilized or degraded, C0 and Ci is the initial concentration of anthracene and concentration of pyrene at any time after inoculums respectively measured in mg/L. Experimental design and Statistical Optimization A 23 full factorial Central Composite Design (CCD) with response surface methodology of Design – Expert software version 6.0.8 (2002 East Hennepin ave., Suite 480 Minneapolis, MN 55413, stat Ease, Inc.) was used. Eight hundred milliliters of the autoclaved MSM and 0.4 liters of pyrene solution with variable concentration and inoculum of 200 mL were introduced aseptically to make up 0.5 liters of the working volume. Three factors were considered to perform response surface methodology (RSM) with CCD at variable concentration of pyrene (X1 ), fermentation time (X2 ) and aeration (X3 ). The bioreactor was operated for variable concentration (9.66, 25, 47.5, 70, 85.34 g/L), aeration (2.159, 2.5, 3.0, 3.5 and 3.841 vvm) and biodegradation time (3.55, 24, 54, 84 and 104.45 hours) at a temperature of 28±20 C as presented in the Table 1. Aliquot was withdrawn for analysis based on designed factors from bioreactor as presented in the Table 2 for experimental variables. The range of these values was considered since it characterized the optimum range for the microbes and the expected range in which the process could be operated. The experiments were performed in triplicates and the average of pyrene degraded by Corynebacterium sp (Y1) and Pseudomonas putida (Y2) obtained were taken as the response function (Yi) of the factors. The Second degree polynomials equation (2) which contains factors with interaction terms were used to calculate the predicted response: (2) Where is the response of anthracene degraded by Corynebacterium sp and Pseudomonas putida as dependent variables; n is the number of independent variables (factors), Xi (i =1, 2, 3…) and Xj (j = 1, 2, 3…) are the concentration of pyrene degraded, degradation time and aeration respectively; is the random error; β0 is offset term, and βi, βij and βii are the coefficients of linear, interaction and quadratic term respectively. The model was developed based on experimental data using response surface methodology with statistical optimization using analysis of variance (ANOVA). The quadratic models were represented as 3D with contour plots and response surface curves were generated for variables. RESULTS AND DISCUSSION The results of the experimental data shows that the degradation of pyrene by the activity of Corynebacterium sp is more fit than that of Pseudomonas putida due to high correlation coefficient (R2 ) of Corynebacterium sp 0.96108 (> 0.9) compared with Pseudomonas putida 0.61095 (< 0.9) as shown in the Figure 1 and 2 respectively. This indicates 96.11 % for Corynebacterium sp and 61.10 for Pseudomonas putida are variability in the response that could be explained by the quadratic and linear model respectively. The Model F-value of 27.44 with 0.01% error and 8.38 with 0.014 error for Corynebacterium sp and Pseudomonas putida respectively as presented in the Table 3. The error values for the activity of Corynebacterium sp and Pseudomonas putida indicated that the model terms are significant. The determination of the significant parameters was performed through a hypothesis test (p – value) with a 5 % level of significance. Parameters with p – value higher than 0.05 is significance while parameter with p – value less than 0.05 is significant. The response surface model obtained for Corynebacterium sp was for quadratic while for Pseudomonas putida was linear and presented as equation (3) and (4) respectively: (3) (4) Though, the adjusted correlation coefficient (adj. R2 = 0.92606) for the activity of Corynebacterium sp on pyrene was also satisfactory for confirming the significance of the response surface model but fairly significant in the case of activity of Pseudomonas putida on pyrene due to low correlation coefficient (adj. R2 = 0.538) (see Table 3). Furthermore, an adj. R2 close to the R2 values insures a satisfactory adjustment of the quadratic models to the experimental data by the activity of the two microbes used for this research as presented in the Table 3. Therefore, the regression models explained the removal efficiency well. Though, the “Pred R2 ” for both microbes are not as close to the “Adj R2 ” as presented in the Table 3 and it does not justify that the proxy model cannot be used for design since the adequate precision 19.777 (> 4) and 10.139 (>4) for the response surface model of Corynebacterium sp and Pseudomonas putida respectively. Based on linear regression analysis presented in the Table 4, parameters or model terms with a level of significance higher than p value (p > 0.05) were dismissed (Azeez et al, 2013; De Lima et al, 2010; Nwabanne and Ngwu, 2013). The significant model terms for pyrene degradation by the activity of Corynebacterium sp include the intercept ( , biodegradation time (X1 ) quadratic of the biodegradation time ( and interaction of the pyrene concentration and biodegradation time (X1 X2 ) while for pseudomonas putida were intercept ( and biodegradation time (X1 ). The equation (3) and (4) reduced to equation (5) and (6) which represents proxy model for biodegradation of pyrene by the activity of Corynebacterium sp and Pseudomonas putida respectively. (5) (6) The obvious prominence in the response surfaces indicated that the optimal conditions were located exactly inside the design boundary indicating the stationary point and it was a single point of maximum response. The model gave a maximum solution of 96.711 % pyrene degraded by Corynebacterium sp with pyrene concentration of 68.16 mg/L, biodegradation time of 82.57hours and aeration condition of 3.0125vvm, while the highest pyrene degraded by Pseudomonas putida obtained was 93.843% under conditions of 69.90mg/L pyrene concentration, biodegradation time of 84 hours and aeration 3.4995 as shown in the Figure 3 and 4. The biodegradation of pyrene with activity of Corynebacterium sp (96.71 %) and Pseudomonas putida (93.84) using response surface methodology with central composite design gave the best result compared with 89.1 % and 79.4 % pyrene degraded by Mycobacterium sp reported by Farshid (2013), 80.6 % pyrene degraded by Bjerkandera sp with no significant effect of the presence of soil microflora as reported by Valentin (2007), and 70 % of pyrene degraded by Corynebacterium variabilis sp. Sh42 to carbon (VI) oxide and water reported by El-Gendy et al (2010) as well as report of Shokrollahzadeh et al (2012) in which 78 % of pyrene was degraded by Sphingopyxis sp. This may be attributed to enrich mineral salt medium composition and kinetics. To validate the agreements of the results achieved from the model and experiments, two additional experiments were conducted by using pyrene concentration, biodegradation time and aeration condition in the optimum region. As shown in Table 5, the degraded pyrene by the activity of Corynebacterium sp and Pseudomonas putida obtained from the additional experiments are very close to those estimated using the model, implying that the response surface methodology approach was appropriate for optimizing the conditions of the biodegradation process of pyrene.
CONCLUSION
The central composite design and response surface methodology successfully enabled in obtained proxy model for the determination of optimal operating conditions for biodegradation of pyrene with the activity Corynebacterium sp and Pseudomonas putida in a short period of time with the least number of experiments. The proxy model validity of the model was proven by repeating the experiment at optimal conditions. The response surface methodology demonstrated the best optimal conditions of pyrene degraded by Corynebacterium sp with 96.71 % of 68.16 mg/L of pyrene concentration, biodegradation time of 82.57 hours and aeration condition of 3.0125vvm, while the pyrene degraded by Pseudomonas putida was 93.84 % at optimal conditions of 69.90 mg/L pyrene concentration, biodegradation time of 84 hours and aeration of 3.4995vvm. The validated results of an experiment were found to be in good agreement with the optimal solution predicted by the model. Source of funding The source of funding of this work is financed by the authors.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
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11. Kim S-J., Jones R. C., Cha C-J., Kweon O., Edmondson R. D., Cerniglia C. E. (2004). Identification of proteins induced by polycyclic aromatic hydrocarbon in Mycobacterium vanbaalenii PYR-1 using two-dimensional polyacrylamide gel electrophoresis and de novo sequencing methods. Proteomics, 4: 3899 - 3908.
12. Lease C. W. M., Bentham R. H., Gaskin S. E. and Juhasz A. L. (2011). Isolation and Identification of Pyrene Mineralizing Mycobacterium spp. from Contaminated and Uncontaminated Sources. Applied and Environmental Soil Science, 2011: 1 – 11. doi:10.1155/2011/409643
13. Liang Y., Gardner D. R., Miller C. D., Chen D., Anderson A. J., Weimer B. C. and Sims R. C. (2006). Study of Biochemical Pathways and Enzymes Involved in Pyrene Degradation by Mycobacterium sp. Strain KMS^. Applied and Environmental Microbiology, 72 (12): 7821 - 7828. doi:10.1128/AEM.01274-06.
14. Mahanty B., Pakshirajan K. and Venkata Dasu V. (2008). Biodegradation of pyrene by Mycobacterium frederiksbergense in a two-phase partitioning bioreactor system. Bioresource Technology, 99: 2694 – 2698. doi:10.1016/j.biortech.2007.05.042
15. Nwabanne, J.T. and Ekwu, F. C. (2013). Experimental Design Methodology Applied to Bleaching of Palm Oil Using Local Clay. International Journal of Applied Science and Technolog., 3(4): 69 - 77.
16. Obayori O. S., Adebusoye S. A., Ilori M. O. Oyetibo G. O. Omotayo A. E. and Amund O. O. (2009). Effects of Corn Steep Liquor on Growth Rate and Pyrene Degradation by Pseudomonas strains. Curr Microbiol, 60: 407 – 411. doi: 10.1007/s00284- 009-9557-x
17. Owabor C. N., Agarry S. E. and Azeez T. O. (2010). Development of a Transport Model for the Microbial Degradation of Polycyclic Aromatic Hydrocarbons in a Saturated Porous Medium. Journal of the Nigerian Association of Mathematical Physics (J of NAMP), 16: 317 - 324.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareAPPLICATION OF COMPUTERIZED TOMOGRAPHY IN IMPLANT DENTISTRY
English3841Anjana RautEnglish Sadanand HotaEnglishIn investigating an implant site, a surgeon requires information on bone volume and quality, topography and the relationship
to important anatomical structures, such as nerves, vessels, roots, nasal floor, and sinus cavities. This information is obtained with a clinical examination and appropriate radiographic findings. The decision to proceed to cross-sectional imaging must be based on clearly identified needs and the clinical requirements of the clinicians involved.13 The paper discusses the application of computerized tomography in preoperative and postoperative assessment of proposed implant site.
EnglishComputerized tomography, Radiation exposure, Diagnosis, Maxilla, MandibleINTRODUCTION
Implant technology has enabled the dental surgeons to rehabilitate a broad spectrum of patients with challenging needs with application of precise surgical and prosthodontic techniques.1 A 5-year success rate of 90% or higher has been reported.2 Acceptance of dental implantology as an integral part of conventional practice makes it necessary for the general dentist to be knowledgeable of the implant imaging techniques and their clinical applications.1 Because of the increasingly important role of advanced imaging procedures in implant dentistry and the lack of comprehensive guidelines for appropriate imaging strategies, the American Academy of Oral and Maxillofacial Radiology (AAOMR) provided a position paper in the year 2000.2 Its purpose is to inform the dental profession of the multiple imaging options available for the assessment of potential implant sites and to recommend suitable imaging modalities. The AAMOR holds the position that the success of the dental implant restorations is, in part, dependent on adequate diagnostic information about bony structures of the oral region. Acquiring this information actually requires some form of images, which may vary from simple two dimensional views, such as panoramic radiographs, to more complex views in multiple planes, depending on the case and the experience of the practitioner. Also, in the year 2000, the Board of the European Association for Osseointegration Trinity College Dublin, concerned that the rapid adoption of these sophisticated techniques into routine practice might lead to a significant increase in the radiation burden of patients without a proper risk benefit analysis, and formulated guidelines in various clinical situations that will ensure essential diagnostic information is obtained with as low as reasonably achievable (ALARA principle) radiation exposure.3
HISTORY
A literature review was carried out using PubMed database. The following terms was used: computerized tomography, alveolar bone, maxillary sinus, implant, and support. The search was performed in the articles published between 1985 and 2010. After the reading of the title and abstract, 25 articles were selected, because they seemed to have a greater correlation with this study. Cranial computed tomography (CT), introduced in the early 1970s, revolutionized the way neuroscientists viewed the brain. For the first time, it allowed an anatomic definition in the axial plane. The tomographic angle4 (the amplitude of the movement of the x-ray tube) determines the thickness of the image slice.
An average thickness of approximately 3 mm, which is similar to the diameter of many dental implants, is usually used. The measurement error for tomograms falls below 1 mm of the actual measurements made on cadaver mandibles.5 In about 1% of the patients the inferior alveolar canal is bifurcated.6,7,8 Diagnostically this canal may or may not be realized from periapical or panoramic radiographs. Complex motion tomography is useful aid in preoperative planning in such cases.12The advantages of conventional film tomography include moderate expenses (compared with CT), uniform magnification, cross-sectional views available at any location and reproducible imaging geometry when used with a cephalostat. The disadvantages of conventional tomography include limited availability and more time needed to produce the images than the standard panoramic radiography. Significant experience and training is necessary to interpret the images.2 Computerized Tomography Evaluation of the Mandible: Five anatomic parameters be assessed when mandible is evaluated for dental implants.10 1. The height of the alveolar bone 2. The buccolingual dimension of the ridge at the implant site 3. The contour of the ridge 4. The relative amount of bone and fat at the implant site 5. The position of the inferior alveolar nerve Height of alveolar bone The edentulous mandible will demonstrate generalized loss of height of the alveolar ridge because of diffuse atrophy of the bone. It may also show localized bone loss at any extraction sites. Periodontal disease can cause asymmetric destruction and remarkable localized destruction. All these components combine to produce a shrunken and deformed alveolar ridge. In partially edentulous patients who require implants near, or posterior to, the mental foramen, the measurement must be made from the occlusal surface to the superior edge of the alveolar canal. If the occlusal surface is deformed or unusually thin and tapered, the measurement is made from a point below the occlusal surface where the width of the ridge is capable of supporting an implant. Buccolingual dimension of the ridge The buccolingual dimension is measured on the cross-sectional oblique images. Even patients who appear to have adequate height to their alveolar process, may have profound buccolingual atrophy. The bone may be symmetrically atrophied and the ridge thin and knifelike. This is especially true in the anterior mandible and maxilla. Asymmetric loss of the labial bone is also very common in the anterior mandible. Usually the labial cortex is lost to periodontal disease and the medullary bone atrophies. Only the lingual cortex may remain. Implantation may not be possible in such patients. Contour of the ridge In addition to losing thickness as a result of atrophy, the ridge may be deformed by underlying periodontal pathosis. Apical periodontal abscesses cause local bone destruction. If an abscess is left untreated and the tooth is removed, the extraction socket may enlarge. The cavity it produces may be so large and irregular that it may preclude implantation. The full extent of the cavity is difficult to assess on conventional radiographs. It is impossible to determine whether there is adequate bone adjacent to the cavity to support an implant. Mineralization of the mandible In young people, the medullary space is well ossified. Medullary bone appears dense and homogeneous on the images. The mandibular canal is often visible because of a thin shell of bone that can be seen surrounding the nerve. The rim of bone is sometimes complete, but often the rim only partially encircles the nerve. The geriatric patients and those with osteoporosis have the most demineralized mandibles. Fatty marrow has replaced most of the hematopoietic marrow by this stage in life. Osteoporosis reduces the number and size of the medullary bony trabeculae and thins the cortical bone. Periodontal disease destroys the alveolar process. Quantitative assessment of mineral content The mineral content of the mandible can be estimated from the CT scan. It is likely that the amount of medullary bone at the implant site is important to the overall success rate of the surgical procedure. If the implant site has a very low CT number, the implants may benefit from being left in place longer than usual before the prosthesis is attached. If the implant site is denser than average, extra care should be taken not to heat the bone with the drill. Position of alveolar nerve In younger patients without total alveolar loss, there is nearly always enough bone present to implant a series of fixtures anteriorly between the mental foramina. In older patients who have been edentulous for long duration, there may be profound bone loss. Asymmetric erosion may leave either the labial or the lingual cortex relatively intact but cause profound central loss. The lateral and posterior portions of the mandible distal to the mental foramen pose the most problems for the implant surgeon. With loss of the alveolar process, the inferior alveolar nerve may come to lie immediately below the eroded occlusal surface of the bone.
Neurologic dysfunction of the inferior alveolar nerve following implantation is generally caused by encroachment on the nerve by one of the implants. Computerized tomography is very useful in determining which of a series of implants is within the canal. If the diagnosis is made in the early postoperative period, the implant can be slightly withdrawn to relieve the neural compression. Computerized tomography evaluation of the maxilla Five anatomic parameters must be evaluated when maxillary implant surgery is contemplated: 11 1. The height of the alveolar ridge 2. The buccolingual dimension of the ridge 3. The contour of the alveolar ridge 4. The maxillary sinuses 5. The incisive fossa and canals Height of the alveolar ridge The height of the alveolar ridge is measured on the crosssectional oblique reformations, in the area where implantation is desired. In the maxilla, the height of the alveolar bone is measured from the external surface of the residual ridge to the level of the palate or to the lateral wall of the nasal cavity. The desired angle of inclination of the fixture is usually not the same as the angle of the anterior portion of the alveolar process. The more prognathic the jaw, the less the angle of the implants conforms to the angle of the alveolar process. In partially edentulous patients, an attempt is made to align the implants with the residual teeth. This will improve the ultimate position of the prosthesis and optimize the esthetics of the final restoration. In the posterior maxilla, the height of the residual alveolar process will depend on the extent of the development of the maxillary sinus. The more extensive the pneumatization of the maxillary sinus, the less alveolar bone will be present and available for implantation. A small number of adult patients fail to fully pneumatize the maxillary sinuses during their youth. The majority of the maxilla, therefore, is bony rather than pneumatized sinus. In patients with these juvenile-type sinuses, it may be possible to place sufficiently long implants in the alveolar process posteriorly. The availability of adequate bone for implantation of the anterior portion of the alveolar process is considerably less problematic than in the area below the pneumatized sinus. In the great majority of patients, there is a dense pyramid of bone suitable for implantation at the base of the lateral wall of the nasal cavity, where the nasal cavity meets the anterior wall of the maxillary sinus. Implants placed in this area anchor into a wedge of cortical bone at the base of the lateral wall of the nasal cavity. These implants tend to be longer than implants placed anywhere else in the maxilla. Buccolingual dimension of the ridge The buccolingual width of the alveolar process is extremely important in planning implant placement, especially in the maxilla. Periodontal erosion within the anterior maxilla tends to be more prominent along the buccal surface of the teeth, because the bone tends to be extremely thin. A relatively modest amount of buccal bone loss may cause the thin buccal plate to resorb dramatically. In completely edentulous patients and those with a long segment of anterior maxillary tooth loss, there may be a disproportionate decrease in the buccolingual dimension, limiting implant placement even when the height of the ridge would otherwise be adequate to support implants. Routine radiographs and panoramic radiographs routinely overestimate the amount of bone available for implantation. Even manual palpation of the ridge overestimates the amount of bone present. The soft tissues are hard and feel bony. It is often impossible to distinguish bone from soft tissue callus resulting from years of denture use. Contour of the ridge Abnormalities of the contour of the maxillary alveolar ridge are caused by localized erosion or the presence of extraction sockets. This is due to buccal bone erosion resulting from loss of several teeth. It is much more likely that craters from dental extractions will persist in the alveolar bone in the posterior maxilla. There are more root sockets posteriorly because of the molars. These residual craters in the bone also tend to be larger posteriorly. In most patients with long-term edentulousness, the posterior maxillary bone is incapable of supporting any implants. Maxillary sinuses Chronic inflammation within the maxillary sinuses leads to thickening of the mucosa of the sinus. Normally, the mucosa of the sinus is invisible on computerized tomography (CT) scans because it is much thinner than the resolution of the best scanners. Chronically inflamed mucosa, however, is visible on CT scans. The soft tissue appears dark on the CT scan, easily differentiated from the white-appearing bone of the sinus wall and the very black air within the remainder of the sinus. Cysts and polyps tend to be asymptomatic and are found incidentally on the CT images. When they become very large they may obstruct the sinus and produce symptoms. The bony floor is intact beneath a retention cyst but is locally de- stroyed by the associated dental abscess. A retention cyst is a quiescent process that will generally not complicate implantation. Contiguous inflammation from a periapical abscess should be treated prior to implantation so that implants are not placed in a zone of smoldering infection. Anatomic variations of the incisive foramen and canal In most patients, there are two fairly symmetric incisive foramina piercing the palate. The nasopalatine nerves traverse these foramina. The nasopalatine (incisive) canal appears on the CT scan as a conical tube that is wider towards its oral opening. If there is a large, common foramen for the two nerves, there may be too little space to place the desired number of implants. In some instances, there may be a lateral outpouching of the neurovascular structures, producing a grossly asymmetric canal. This may also limit the number of possible implants. DISCUSSION Various parameters should be considered before planning for implants for successful outcome. Dental implants have revolutionized conventional prosthodontics treatment for patients of all age groups and need meticulous assessment and examination of supporting tissues. Surgeons need to evaluate all surrounding anatomical structure with various diagnostic aids for better prognosis and longevity of the prosthesis. Geriatric patients are a great challenge but not a contraindication.
CONCLUSION
Conventional imaging, such as panoramic and periapical radiographs, are generally useful and cost effective but cannot provide the cross sectional visualization or interactive image analysis that can be obtained from more sophisticated imaging techniques. CT offers considerable diagnostic advantage in acute cases of implant failure, paresthesis or infection.
ACKNOWLEDGEMENT
Author(s) 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=396http://ijcrr.com/article_html.php?did=3961. Shetty V, Benson BW. Orofacial implants. In White SC, Pharaoh MJ. Eds: Oral radiology: principles and interpretation.5th ed. Mosby 2004: 677-693.
2. Tyndall DA, Brooks SL. Selection criteria for dental implant site imaging: a position paper for the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:630-7.
3. Harris D, Buser D, Dula K, Grondalh K, Harris D, Jacobs R, Lekholm U, Nakielny R, Vansteenberghe D, Vanderstelt D. E.A.O. Guidelines for use of diagnostic imaging in implant dentistry. Clin Oral Impl Res 2002;13:566-70.
4. Wyatt CCL, Pharaoh MJ. Imaging techniques and image interpretation for dental implant treatment. Int J Prosthodont 1998;11:442-452.
5. Petrikowski CG, Pharaoh MJ, Schmitt A. Presurgical radiographic assessment for implants. J Prosth Dent 1989;61:59-64
6. Discoll C. Bifid mandibular canal. Oral Surg Oral Med Oral Pathol 1990;70:807-811.
7. Langais R, Broadus R, Glass B. Bifurcated mandibular canals in panoramic radiographs. J Am Dent Assoc 1985;110:923-926.
8. Wyatt W. Accessory mandibular canal: Literature review and presentation of an additional variant. Quintessence Int 1996;27:11-113.
9. Darlo LJ. Implant placement above a bifurcated mandibular canal: a case report. Implant Dentistry 2002;11:258-60.
10. Rothman SLG. Computerised tomography of the mandible. In Rothman SLG, ed: Dental applications of computerized tomography - surgical planning for implant placement. Quintessence 1998: 39-63.
11. Rothman SLG. Computerised tomography of the maxilla. In Rothman SLG, ed: Dental applications of computerized tomography - surgical planning for implant placement. Quintessence 1998: 65-86.
12. Dula K, Mini R, Lambrecht JT, Van der Stelt PE, Schneeberger P, Clemens G et al. Hypothetical mortality risk associated with spiral tomography of maxilla and mandible prior to endosseous implant treatment. Eur J Oral Sci 1997;105:123-9.
13. Harris D, Buser D, Dula K et al.E.A.O. Guidelines for the use of Diagnostic Imaging in Implant Dentistry. Clinical Oral Implants Research 2002;13:566-70.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareHYDROLOGICAL DROUGHT FREQUENCY ESTIMATION USING STREAM FLOW DROUGHT INDEX AND MODIFIED GUMBEL METHOD IN UPPER TANA RIVER BASIN
English4251Raphael M. WambuaEnglish Benedict M. MutuaEnglish James M. RaudeEnglishObjective: To estimate the hydrological drought frequency for upper Tana River basin in Kenya using absolute Stream flow Drought Index (SDI) and modified Gumbel technique. The frequency of drought event of a defined severity for a defined return period is fundamental in planning, designing and operation of water storage systems in the basin.
Materials and Methods: Based on a 41-year (1970-2010) stream flow data, hydrological droughts of 2, 5, 10, 20, 50, 100, 200, 500 and 1000-year return periods are evaluated based on the stream flows, Stream flow Drought Index (SDI) and a simplified mathematical model for hydrological drought estimation which is formulated using Gumbel’s technique.
Results: The absolute SDI increases while the magnitude of the stream flow decreases with return period. The minimum and maximum drought events were exhibited in gauge stations 4AC03 and 4CC03 with absolute SDI ranging from 0.667 to 1.265 and 1.213 to 2.42, and corresponding stream flows of 4.341 to 2.719 and 18.246 to 1.021m3/s for a 2 and 1000-year return period respectively.
Conclusion: A simplified mathematical model for estimating hydrological drought event that uses mean flows of the annual minimum and average of the first three minimum stream flows as input variables is formulated for different return periods for the river basin.
EnglishUpper tana River basin, SDI, Hydrological drought, Return period, Gumbel technique, Drought frequency, Mathematical modelINTRODUCTION
Hydrological drought is a natural hazard associated with water deficiency in a hydrological system. Drought may be manifested in below average water availability such as stream flow in rivers, quantity of water in reservoirs, lakes and ground water (Tsakiris, 2009; Mishra and Singh, 2010; Sheffield and Wood 2011). Hydrological drought decreases the availability of water resources (Liu et al., 2012) in river basins, adversely impacting on economic aspects (Carrol et al., 2009; Van Vliet et al., 2012) social dimensions such as increased human conflicts and mortality rates (Garcia-Herrera et al., 2010) and ecological systems (Lake 2011, Lewis et al., 2011). There is need to understand the drought events in order to develop drought mitigation mechanisms in river basins (Wambua et al., 2014). Hydrological drought impacts on large areas and large human population and may be triggered by climate change and /or variability (Mondal and Mujumdar, 2015). Like other drought events, hydrological drought is considered to be a ‘creeping hazard’ because it develops slowly, it is not easily noticed, covers extensive areas and it lasts for long a period of time with adverse impact on ecological systems and socio-economic development (Liu et al., 2015; Van-loon, 2015). In addition to hydrological droughts, other types of droughts Include meteorological agricultural/ soil moisture droughts and socio-economic drought. However, according to Van-loon and Laaha (2015), hydrological drought has the most significant effects almost across different sectors as shown in Table.
The key parameters of droughts are the longest duration and highest severity for a defined return period. Such parameters aid in designing water storage systems capable of withstanding effects of droughts (Kyambia and Mutua, 2014). Since occurrence of drought contributes to adverse socio-economic impacts, they need to be quantified so as to improvise coping and/or mitigation mechanise. Thus hydrological drought estimation using stream flow data for a defined range of return period in a river basin is crucial. The commonly used return periods are 2, 5, 10, 20, 50, 100, 200, 500 and 1000 years. A 50-year hydrological drought is defined as the drought magnitude which is equalled or exceeded, on average, once per 50 years. The original version of Gumbel approach in the prediction requires computation of coefficient of variation (Cv) and determination of expected mean (yn ) and standard deviation (σn ) as given in the Gumbel’s table. However, in this paper, a mathematical model is formulated for hydrological drought estimation using annual minimum average stream flow and the mean of three lowest stream flows from the recorded data as the main input variables of a modified mathematical model. From an engineering point of view, design of water storage structures requires critical information of longest duration, largest severity for a specific return period. Extreme drought may be treated as a stochastic variable that is challenging to estimate. For practical engineering work, extrapolation and interpolation of drought frequency is crucial for reliable designs. Gumbel (1958) put forth a method for estimating flood frequency. Such a technique may be modified and applied in drought frequency estimation. The Gumbel extreme value distribution for instance has been applied in drought studies in Greece (Dalezios et al., 2000) river basin and Dudhkumar River (Asad et al., 2013).
Hydrological drought process The occurrence of hydrological droughts is considered to exhibit stochastic characteristics and thus complex in nature. Hydrological droughts are influenced by hydrological processes of the hydrologic cycle (Peters et al., 2006; Vidal et al., 2010) such as precipitation, evapotranspiration, soilwater storage, runoff flow on land and streams, and groundwater recharge or discharge. The fundamental cause of hydrological drought is climatic change and/ or variability. For instance, an abnormally prolonged precipitation deficit leads to low input into hydrological system. Droughts may be triggered by anomalies in temperature in large scale atmospheric and or oceanic patterns and low sea temperature. For any river basin, the rate of depletion of soil-moisture is a function of antecedent moisture condition, evaporation from bare soil surface, evapo-transpiration from vegetated areas, deep percolation of water into the groundwater and runoff into stream networks. For a dry season, runoff and drainage are significantly low while potential evapo-transpiration may be high as a result of increased solar radiation, vapour pressure deficit and wind velocity. During an extreme drought event, soil-moisture may be depleted to wilting point below which plants significantly undergo wilting due to response to the moisture decline in the soil media. This condition leads to reduction in actual evapo-transpiration and locally generated precipitation. The depletion of soil-moisture leads to decrease in recharge of the groundwater storage. Soil-moisture is significantly influenced by the quantity of precipitation, recharge, discharge and aquifer storage and transmisivity characteristics. The relationship between precipitation, soil moisture, runoff, recharge, discharge, ground water and discharge is well explained using the hydrologic water balance Equation 1.
The above relation presents an old concept of hydrology and has been well researched in numerous catchments in the world. However, the application of the hydrologic water balance relationship in drought studies is a relatively new concept (Van loon, 2015). Any climate change and /or variability directly affect precipitation and evapo-transpiration, and indirectly influencing the runoff, soil-moisture storage, and groundwater components of the water balance model. Meteorological droughts propagates into other types of droughts through processes of runoff, stream flow, recharge and discharge which are mainly influenced by river basin characteristics and climatic change or variability. However, the frequency of occurrence of drought is not well researched and thus not understood for numerous river basins in the world.
Objective
The objective of this research was to estimate hydrological drought frequency using absolute Stream flow Drought Index (SDI) and modified Gumbel’s technique for upper Tana River basin, Kenya.
MATERIALS AND METHODS
Description of upper Tana River basin The Tana River basin from which upper Tana River basin is delineated is the largest river basin in Kenya (Jacobs et al., 2004; WRMA, 2010). It lies between latitudes 000 05’ and 010 30’ south and longitudes 360 20’ and 370 60’ east. The upper Tana River basin has an area of 17,420 km2 (Figure 1). The basin plays a critical role in regulating the hydrology of the entire basin (IFAD, 2012), and in the process, it controls the hydro-electric power generation within the Seven-Folk dams downstream of the Tana River. The basin is very critical in Kenya as it drives the socio-economic development through water supply and agricultural production. The elevation of the upper Tana River basin ranges from approximately 730 m to 4,700 m above mean sea level (a.m.s.l.). These elevations are adjacent to Kindaruma hydro-power dam and Mount Kenya respectively. The dominant soil types in the basin are Andosols, Nitosols, Ferrasols and Vertisols at higher, middle and lower elevations respectively (Jacobs et al., 2004).
Precipitation and temperature vary spatially across the entire river basin. The annual precipitation at Mount Kenya and the Aberdares ranges is 1800 mm (Otieno and Maingi, 2000). In the mid elevation of 1200 to 1800 m a.m.s.l., the annual rainfall ranges from 1000 to 1800 mm, while the lower elevations at 1000 m, and receive annual rainfall of 700 mm. The basin is characterized by seasonal rainfall fluctuations as influenced by orographic forces (Saenyi, 2002). Subsequently, this leads to seasonal variation of stream flows in Tana River. Generally the basin experiences bimodal rainfall pattern which is triggered by inter-tropical convergence zone (Wilschut, 2010). The two main rain seasons as shown in Figure 2, are distributed in the months of March to June, and September to December where the monthly average precipitation is considerably high compared to the other months.
Data acquisition
Stream flow data used in the present study was obtained from the Ministry of Water and Irrigation, and Water Resources Management Authority (WRMA) for eight stations for a period of 41 years (1970-2010). Data from eight stations with consistent data that had less than 20% missing data was selected for the study. The Double mass curve was used to check for the data consistence.
Gumbel’s extreme value (EV1) method
Gumbel’s method was originally developed for flood estimation. However, it has previously been adopted in drought studies (Dalezios et al., 2000). The form of Gumbel technique used for the present study for estimating extreme drought event is expressed as:
The frequency factor and the coefficient of variation are determined from the relation:
In an attempt to simplify Equation (5), Powell (Asad et al., 2013) developed an equation to estimate K using the relation:
Although the above function improved the method of estimating the frequency factor K, which can now be computed based on return period T and not number of years of record, the method for calculating Cv still remains as suggested by Gumbel.
Stream flow drought index
A drought index is an integration of either one or more of hydro-meteorological variables such as precipitation, stream flow, soil moisture, temperature, ground water, water reservoir volume or level (Sun et al., 2011). In this study, Stream flow drought index (SDI) that uses stream flow data is applied. The SDI for each gauged station was determined using the following relation:
SDIi =stream flow drought index for i th hydrological month
Qi =stream flow for the i th hydrological month
K=length of period of data record/reference period
σk =the standard deviation of the cumulative stream flow volumes for kth reference period
The original function was developed by Gumbel (Gumbel, 1958) for extreme flood estimation that used data that exhibit positive values. In this research, the stream flow drought index with negative values as shown in Table 2 represent the period of drought episodes. These negative values are converted to their corresponding absolute values and fitted to Equation (2). Then the SDI for 2, 5, 10, 20, 50, 100, 200, 500 and 1000-year return periods were computed using Equation (7). The resulting SDI data was arranged into ascending order alongside the corresponding stream flow. The stream flow corresponding to the computed SDIm of rank m for specific return period was selected. Those stream flow values without corresponding SDI were interpolated using the relations:
Where;
Qm= the stream flow of rank m and specific return period (m3 /s)
Q1 =higher rank stream flow (m3 /s)
Qo =lower rank stream flow (m3 /s)
SDI1 =the higher stream flow drought index
SDIo = the lower rank stream flow drought index
SDIm= interpolated value of stream flow drought index
RESULTS AND DISCUSSION
For instance for a 2-year return period, whose computed SDIm is 0.6665, Qm value was interpolated using Equation (8) based on the data in Table 3. The results of the fitted curves show that the absolute SDI increases with the return period in all gauged stations (4AB05, 4BC02, 4AC03 and 4AD01) as given in Figure 3. For instance, hydrological droughts represented by magnitude of absolute SDI of 0.667and 1.265 are equaled or exceeded once on average every 2 and 1000 years respectively. The same applies to the other hydrological droughts of defined absolute SDI. For water resources managers, data on stream flow is important for ease of water resources planning and management. Thus in this research, the absolute SDIs are tied to their respective stream flow magnitudes
Figure 3: The relationship between the Qm, SDI and return period for (a) 4AB05 (Amboni), b) 4BC02 (Tana Sagana) c) 4AC03 (Sagana) and (d) 4AD01 (Gura) gauge stations Generally the results show that, the minimum and maximum drought episodes were exhibited in gauge stations 4AB05 (Amboni) and 4CC03 (Yatta furrow) with absolute SDI ranging from 0.667 to1.265 and 1.213 to 2.42 for 2 and 1000-year return period respectively.
Using Table 2 and results from Figure 3, the critical points are identified. The critical point is the level of hydrological drought beyond which the water facilities is significantly affected by drought. For instance the critical point for 4AB05 (Amboni) gauge station, as shown by dotted line, coincides with return period of 28 years with absolute SDI of 0.92 and stream flow of 3.6 m3 /s (Figure 3a), while that of 4BC02 (Tana sagana) is 20 years with absolute SDI of 1.2 and stream flow of 45 m3 /s (Figure 3b). In this case, if a water resource system is to be designed for example at the gauging stations 4AB05 and 4BC02, the systems should be designed for return periods of less or equal to 28 and 20 years respectively. Form Figure 4, the results show that the ratio of QT /Q represented by Y increases with Cv for different return periods. This confirms that the Gumbel method is also applicable in drought frequency estimation just like in flood frequency analysis (Al-Mashindani et al., 1978).
Development of the modified mathematical model
Gumbel method has been modified before for flood studies. However, scanty research as far as its application in drought studies is concerned. In this research the principles used by Al-Mashindani (1978) in flood assessment was used in hydrological drought estimation for upper Tana River basin. The value of QT for drought studies in Gumbel’s technique is written as:
Considering a stream flow drought index (SDIm) with a rank m that corresponds to a particular stream flow Qm, then by applying Equation (9) this results to:
When Equations (9) and (10) are reorganized and then dividing Equation (9) by (10) the relation becomes:
Simplifying Equation (11) leads to:
From Gumbel’s method the estimated values of yn as given in Table 5 are 0.5236 and 0.5745 for the data record of 20 and 1000 years respectively. Thus the parameter yn can be assumed to be a constant that arbitrarily lies between 0.5236 and 0.5747 and estimated using the relation:
The computed value of 0.55 corresponds to hydrological drought event of a particular severity with a return period of 50 years (Table 5).
Based on Gumbel’s method the return period T and yT, are determined using the following functions:
For a particular stream flow drought index corresponding to stream flow Qm with a rank m, the value of ym is determined from:
This relation reduces to:
Substituting Equation (15) into Equation (10) results to:
From the principles of Schulz (1973), it can be shown that:
Neglecting the quantities inside the brackets on the right side of Equation (20), it reduces to:
Also neglecting the quantities in the brackets for Equation (17) yields:
Therefore, Equation (19) can be reduced further into the following relation:
Table 4 show stream flow values corresponding to absolute stream flow drought index that were computed for different return periods using Equations (22) and (23) based on data acquired for the upper Tana River basin. By redefining Equation (23) in X and Y as shown in Equations (24) and (25), and plotting the corresponding data for the upper Tana River basin gives Figure 5.
The results from Figure 5 show that all the gauged stations exhibit strong linear correlation.
The plot shows that there is a strong correlation between the expressions on the left and right side of Equation (23), with correlation coefficients at gauge stations of IDs 4BC02 (Tana Sagana) and 4AC03 (Sagana) of 0.826 and 0.793 respectively. This means that the stream flow QT of any return period can be determined from mean flows of the annual minimum and the average of the first three minimum mean stream flows for the upper Tana river basin as per Equation (23). This is found to be consistence with the similar plot developed for flood estimation by Al-Mashindani et al. (1978).
CONCLUSION
i) From the study SDI, stream flows have been explored and their corresponding return periods estimated. It is concluded that the computed absolute SDI vary across the gauge stations and increase while the corresponding stream flow decline with increase in return period
ii) A simplified mathematical model for estimating hydrological drought event that uses the mean of the annual minimum and average of the first three minimum stream flows as input variables is developed for different return periods in the upper Tana River basin.
iii) Critical points upon which design of water storage systems can be based are identified for different gauge stations. These indicate the level of hydrological drought beyond which the water facilities is significantly affected by the drought.
ACKNOWLEDGEMENT
The authors of this article acknowledge the Egerton University, Division of Research and Extension for availing funds to support in publication of articles from the on-going research on drought assessment and forecasting for the upper Tana River basin. The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors, editors and publishers of journals and books from where the literature of this article has been referred. In addition, the authors are very grateful to the members of IJCRR editorial board and the reviewers who assisted in improving the quality of this article.
Englishhttp://ijcrr.com/abstract.php?article_id=397http://ijcrr.com/article_html.php?did=3971. Al-Mashindani, G. Lal, P. B. B. and Mujda, M. F. (1978). A simple version of Gumbel’s method for flood estimation, Hydrological sciences journal, 23 (3): 373-379.
2. Asad, M. A., Ahmeduzzaman, M., Kar, S., Khan, M. A., Rahman, M. N., Islam, S. (2013). Flood frequency modelling using Gumbel’s and Powel’s method for Dudhkumar River, Journal of water resources and ocean sciences, 2(2): 25-28.
3. Carroll, N, Frijters, P, Shields, M. A. (2009). Quantifying the costs of drought, new evidence from satisfaction data, J. of population economics, 22(2): 445-461, doi.org/10.1007/s00148- 007-0174-3
4. Dalezios, N. R., Loukas, A., Vasiliades, L. and Liakopoulos, E. (2000). Severity-duration-frequency analysis of droughts and wet periods in Greece, J. Hydrological sciences, 45(5):751-769.
5. Garcia-Herrera, R., Das, J., Trigo, R. M., Lutterbacher, J. and Fischer, E. M. (2010). A review of a European summer heat wave of 2003, Crit Rev. Environ. Sci. Technol 40 (4); 267-306.
6. Gumbel, E. J. (1958). Statistics of extremes, Columbia University press, New York.
7. IFAD. (2012). Upper Tana catchment natural resource management project report, east and southern Africa division, project management department.
8. Jacobs, J. Angerer, J., Vitale, J., Srinivasan, R., Kaitho, J. and Stuth, J. (2004). Exploring the Potential Impact of Restoration on Hydrology of the Upper Tana River Catchment and Masinga Dam, Kenya, a Draft Report, Texas A & M University.
9. Kyambia, M. M. and Mutua, B. M. (2014). Analysis of drought effect on annual stream flows of River Malewa in the Lake Naivasha basin, Kenya, Int. J. Cur Res Rev, 6(18): 1-6.
10. Lewis, S. L. Brando, P. M. Philips, O. L., van der, G. M. F., Nepstad, D. (2011). The 2010 Amazon drought science 331(6017), 554.doi.org/10.1126/science1200807.
11. Liu L., Hong, Y., Bednarczyk, C. N., Yong, B., Shafer, M. A. Riley, R. and Hocker, J. E .(2012). Hydro-climatological drought analysis and projections using meteorological and hydrological drought indices: A case Study in Blue River Basin, Oklahoma, Water Resour Manage 2012(26): 2761-2779.doi 10.1007/ s11269-012-0044-y.
12. Liu, X, Wang, S., Zhou, Y, Wang, F., Li, W. and Liu, W. (2015). Regionalization and spatiotemporal variation of drought in China based on standardized precipitation evapotranspiration index (1961-2013). Advances in meteorology, 2015: 1-18, doi. org/10.1155/2015/950262.
13. Mishra, A. K. and Singh, V. P. (2010). A review of drought concepts, J. of Hydrology, 391 (1-2): 202-2016, doi.org/10.1016/j. jhydrol.2010.07.012.
14. Mondal, A. and Mujumndar, P. P. (2015). Regional hydrological impacts of climate change implications and for water management in India, hydrological sciences and water security, past, present and future, Proceedings of the 11th Kovacs Colloquium, Paris France, June 2014 IAHS Pub.366(2015), doi:10.5194 piahs-366-34-2015.
15. Otieno, F. A. O. and Maingi, S. M. (2000). Sedimentation problems of Masinga reservoir. In land and water management in Kenya. Eds. Gichuki F. N., Mungai, D. N., Gachere, C. K.
16. Peters, E, Bier, G., van lonen, H. A. J.and Torfs, P. J. J. F. (2006). Propagation and distribution of drought in groundwater catch-ment, J. Hydrology, 321(1/4): 257-275, doi.org/10.1016/j.hydrol.2005.08.004.
17. Saenyi, W. W. (2002). Sediment management in Masinga reservoir, Kenya, PhD thesis (Published), University of Agricultural Sciences (BOKU), Vienna Austria.
18. Schulz, E. F. (1973). Problems in applied hydrology, part 9, water resources publications, Fort Collins, Colorado, U. S. A.
19. Sheffield, J. and Wood, E. (2011). Drought: past problems and future scenarios, Earth scan, London. 20. Sun, L., Mitchell, S. W. and Davidson, A. (2011). Multiple drought indices for agricultural drought risk assessment on the Canadian prairies, Int. J. Climatol. 2011: 1-12, doi: 10.1002/ joc.2385.
21. Tsakiris, I. N. (2009). Assessment of hydrological drought revised, Water Resour Manage 2009(23): 881-897.doi 10.1007/ s11269-008-9305-1.
22. Van loon, A. F. and Laaha, G. (2015). Hydrological drought severity explained by climate and catchment characteristics, J. of hydrology, 526 (2015): 3-14.
23. Van Vliet, M. T. H. Yearsley, J. R. Ludwig, F. Vogele, S., Latternmaier, D. P., Kabat, P (2012). Vulnerability of US and European electricity supply to climate change, J. nature clim change 2(9): 676-681,doi.org/10.1038nclimate1546.
24. Van-loon, A. F. (2015). Hydrological drought explained, WIREs, water 2:359-392. doi:10.1002/wat2.1085.
25. Vidal, J P, Martin, E, Frandisterguy, L, Habets, F., Soubeyroux, J. M., Blanchard, M. and Ballen, M (2010). Multilevel and multiscale drought reanalysis over the France with the Sifanisba-Modcou hydrometeorological site, J. Hydrol Earth Syst Sci 14(3): 459-478 doi.org/10.5194/hes-14-459-2010.
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27. Wilschut, L. I. (2010). Land use in the upper Tana: Technical report of a remote sensing based land use map. In green water credits report 9 edited by Mcmillan B., Kauffmann, S. and De Jon, R. Wageningen, ISRIC-world soil information.
28. WRMA. (2010). Physiological survey in the upper Tana catchment, a natural resources management project report, Nairobi.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareSTUDY ON ANALYSIS OF FUNCTIONAL OUTCOME OF FENESTRATION TECHNIQUE IN SINGLE LEVEL LUMBAR INTERVERTEBRAL DISC PROLAPSE
English5256Imran B.M.English Pisudde P.M.English Aravind KumarEnglishObjective: Aim of this study was to assess functional and neurological outcome by fenestration technique, since standard laminectomy and discectomy carries a risk of spine instability, it is preferable to perform discectomy through fenestration.
Methods: Out of the 51 patients who were operated for single level lumbar disc herniation by fenestration discectomy between 2009 to April 2011, only 48 patients were available for follow up. Patients were followed up for a period of 1 year. The post operative outcome was analysed using the JOA score. The outcome was analysed with motor deficit, sensory deficit and bladder function as variables.
Results: Back pain improved immediately in almost all 48(100%) patients. The outcome was excellent in 35.4%% patients good in 56.3% and fair in 8.3%.
Conclusion: Fenestration technique with minimal disc removal is an effective technique for treating properly selected patients.
EnglishLaminectomy, Discectomy, Herniation, Fenestration techniqueINTRODUCTION
Disc prolapse is most common cause of the Low Backache. Disc prolapse commonly occurs in males with a male to female ratio of 2:1, highest prevalence is found to be in the age group of 30- 50 years.1 In India Prasad et al found that in their hospital 65.6% were male and 34.4% were female most common age of presentation was 31-40 years, they also found that disc prolapse is more common in moderate workers (59.4%) in rural India population2 . It is the responsibility of the orthopaedic surgeon to diagnose and treat this disease, since disc prolapse is the most common cause of low back pain. Disc prolapse is more common at the L4-L5 and L5-S1 levels followed by L3-L4 and L3-L2 levels.3 Lumbar discectomy is very commonly performed to treat disc prolapse if conservative management fails. Pain is the common indication to do fenestration, but neurological status is also to be taken inconsideration, other factors are far less of functional importance because they appear to be more of objective than pain related signs.4 Even with the advent of newer techniques like percutaneous endoscopic lumbar discectomy and use of Nd: YAG Laser, fenestration and microdiscectomy, technique still remains a good tool for treating patients of Low back pain with disc related pain.5,6Fenestration though relieves pain in almost all patients, it is important to select the patients carefully to get a good result. Fenestration is less time consuming, with lower blood loss and lesser postoperative complications and maintains the stability of the spine better than procedures like laminectomy and discectomy.3, 7 To assess objectively, the results of lumbar disc surgery, there are no specific criteria. Interestingly, the results of lumbar disc disease present a challenge to surgeons. Dissimilarity among the population undergoing surgery compared the problems of wide variability in analyzing results. This subjective and objective obser vation and purposed implication from data assembled tends to confuse rather than illuminate. Clearly there is a need for simple systematic protocol for analyzing results of lumbar disc disease. There are very few literatures which emphasize on improvement about the various parameters after different disc surgery and also fenestration surgery. So the present study was undertaken to analyze the improvement of various parameters after fenestration for example gait, activities of daily living etc. Aim of this study was to access functional and neurological outcome by fenestration technique, since standard laminectomy and discectomy carries a risk of spine instability, it is preferable to perform discectomy through fenestration.
MATERIALS AND METHODS
Present cross sectional study which was prospective in nature was carried out between the period of February 2011 to April 2013. Patients visiting to orthopaedics Out Patient Department(OPD) in hospital were included in study. A detailed history and thorough clinical examination was done in all patients. Magnetic Resonance Imaging(MRI) was done followed by routine pre op investigations. All details were recorded in a proforma. The study subjects having Single level disc disease, low back pain and radicular pain, sensory, motor deficit and bladder symptoms were included in study. Study subjects showing significant evidence of disc prolapse in MRI were carefully selected and included in study. Study subjects those who were excluded were those who underwent surgical treatment for disc prolapse, suffering from other associated disease of spine, not undergone conservative management and suffering from only back pain and no associated signs or symptoms. Pre op and post op assessment was done using the Japanese Orthopaedic Association scoring (JOA score)system.8 For uniformity all surgeries were done by single surgeon, all patients underwent fenestration and intra-op complications were noted. Follow up was done at 14 days, 1 month, 3 months and 6 months and 1 year was done. Neurological status and signs for radicular pain and LBA were checked.Operative technique of fenestration: Patient is positioned in the prone knee-chest position, care being taken to see the abdomen is free so as to prevent undue engorgement of the epidural veins and thus decrease the extent of intra operative blood loss. A vertical mid-line incision is made after localizing the level of the disc. The para-spinal muscles are retracted and the interlaminar space is exposed. Only the ligementum flavum is excised removing only small part of the lamina. The thecal sac is retracted the disc herniation identified and discectomy carried out using disc removing forceps. The disc at that level is removed partially. The thecal sac and the roots are confirmed to be decompressed and lying freely in their respective canals. The wound is closed in layers and dressing done. After treatment: IV Antibiotics were given routinely for 2 days; the suction drain was removed within 48 hrs and the patient was mobilized with a lumbo sacral corsette on the second post operative day. Suture removal done on 10th post operative day. Patient was explained the different methods of taking care of the back and advised against doing any strenous activity for the first six weeks after which patient was gradually encouraged to get back to his previous level of activity. It is proved that limited disc excision is sufficient, rather than entire disc removal which can cause collapse of disc space and degeneration of apophyseal joints at a later date. 9, 10,11
RESULTS
A total number of 53 patients were selected for fenestration and operated during the period of February 2011 to April 2013. 48 patients were available for follow up of one year. Most of them had central paracentral PIVD more commonly and less commonly lateral and far lateral PIVD. Distribution of the study subjects were as follows mentioned in table 1
Above table 1 shows that majority of study subjects were males (56.3%) and female (43.7%). Table also shows that males were more in age group of 31-40 years and females were more in 41-50 years. Majority of the study subject were indulge in doing light work 56.3% followed by 43.8% performing heavy work. Majority of study subject had gradual onset of the symptoms ie 89.6% and only 10.4% had sudden onset of symptoms.75% of study subjects witnessed dull aching pain followed by catching pain in 22.9% study subject and 2.1% witnessed severe type of pain.
Above table 2 shows that there is improvement in all the parameters after fenestration operation majorly in low back pain with 66.7%, motor disturbances (65), followed by leg pain (63.3), and followed by gait (60%). Activity of daily living improved by 43.6% followed by SLR (passive)
Above table 3 shows that maximum study subjects had good JOA score falling in the good outcome with 56.3%, followed by 35.4% having excellent outcome and only 4% were having 8.3% outcome
DISCUSSION
Lumbar laminectomy is the most common operation for a herniated lumbar disc. But laminectomy has its inherent draw backs of a prolonged surgical time, more blood loss and a delayed convalescence period as compared to fenestration7. The post-operative complication (e.g., Arachnoiditis and adhesions) are found to be more when laminectomy is used as a procedure. To add this it is also found to Jeopardize the mechanical stability of the Spine.7 In such a situation a surgical procedure which is less damaging to the stability of the spine, has a shorter surgical time, less blood loss, lesser incidence of post-operative complications and ultimately has a shorter convalescence period would be more beneficial. Excision of a herniated disc for relief of sciatica provides rapid relief of sciatica and low back pain.12 The best result is achieved if the patient was operated on before two months of onset of symptoms of disabling sciatica.13In the younger patients it is important to aim toward an early return to duty via surgical treatment.14 Discectomy by fenestration method is kind of a surgical procedure wherein only the inter laminar space is utilized with removal of minimal part of the superior lamina, the cord is exposed, retracted and the discectomy carried out. The present study analysis the results of this surgical technique on the basis of the functional outcome of the patient, it shows an improvement in activities of daily living, gait, back pain, leg pain, sensory, motor and bowel bladder symptoms. The change in improvement in all above parameters and outcome after surgery indicate JOA to be a useful tool in evaluation. Present study stated that there is near about 50% improvement in the patient’s condition when JOA Score was taken into consideration, and in some parameters there were upto 65% improvements. Other studies stated that there was not more significant difference in the surgical procedure used, and they found fenestration was complicated process and not much useful. Similar results were found with the fenestration surgery which was equivalent to the results of study done by Sharma et al.15 In the present study similar type of prognostic factors were used and the results were also similar with studies of Smith M et al and Spangfort et al study which showed that lumbosacral discectomy appear favorable as evaluated in this study. Preoperative factors useful as predictors of short-term outcome are much less reliable when considering the longterm results. These factors were number of previous hospitalization, duration of leg pain, straight leg-raise examination, and presence of osteophytes, disc bulge, and duration of surgery. 9,16, In the present study duration of symptoms in study subjects was associated with surgical outcome of fenestration technique similar was found in other studies.17In the present study it was found that the clinical outcome was better after the fenestration surgery similar was found in study conducted in Rohtak.3
CONCLUSION
Form the following study it can be concluded that Interlaminar technique of fenestration is a safe and reliable method for treating patients of lumbar disc prolapse which shows improvement in all the aspects of the criteria which was taken into consideration in JOA score, but patients has to be closely scrutinized for surgery. The outcome was excellent in 35.4%% patients good in 56.3% and fair in 8.3% this satisfactory outcome is only because of carefully selecting patients. Change in the outcome score preoperatively compared to post operative shows that JOA score is a useful tool for evaluation of fenestration technique. Good neurological recovery has been noted following fenestration.
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=398http://ijcrr.com/article_html.php?did=3981. F. Postacchini, G.cinnotti, lubar disc herniation, Etiopathogenesis inFranco postacchini in Lumbar disc herniation, Thompson press, newDelhi, springerwein 1999: 151-152.
2. R.Prasad, M.F. Hoda, M.M. Dhakal, K. Singh, et al: Epidemiological Characteristics of Lumbar Disc Prolapse in a Tertiary Care Hospital. The Internet Journal of Neurosurgery. 2006 Volume 3 Number 1.
3. SS Sangwan, ZS Kundu, Raj Singh, P Kamboj, RC Siwach, et al:Lumbar disc excision through fenestration, Indian journal ofOrthopaedics, [2006], 40[2]:86-9.
4. Bo Johnson 1996 “Neurological signs of lumbar disc herniations” acta Otho scand 67[5]:466-69.
5. Sasani M, Ozer AF, Oktenoglu T, Canbulat N, Sarioglu AC. Percutaneous endoscopic discectomy for far lateral lumbar disc. Herniations, Minim Invasive Neurosurg. 2007 Apr; 50[2]:91-7.
6. Savitz MH, Doughty H, Burns P. Percutaneous lumbar discectomy with a working endoscope and laser assistance. Neurosurg Focus.Cited 1998 Feb 15; 4[2]:e9.Available from: http://www. ncbi.nlm.nih.Gov/pubmed/17206772.
7. Nagi, O.M. ‘Early results of discectomy by Fenestration technique’ Indian Journal of Orthopaedics, 1985;19[1]: 15-9
8. Japanese Orthopaedic Association (JOA). Japanese Orthopaedic Association Assessment Criteria Guidelines Manual. 1996. p-46-9.
9. Spangfort EV. The Lumbar disc herniation – a computer aided analysis of 2504 operation. Acta Orthop. Scand suppl 142:3-95, 1972.
10. Astrand, 2000 “Pain and orthopaedic and neurologic signs after lumbar discectomy”. Clinical Orthopaedics and related reserch, 379: 154–160.
11. Loupasis, George A, Stamos, Konstadinos, Katonis, et.al Sevento 20-Year Outcome of Lumbar Discectomy, Spine, 1999 November, 24[22]:2313.
12. Toyone, T., Tanaka, T., Kato, D. and Kaneyama, R. Low-back pain Following surgery for lumbar disc herniation. A prospective study. J.Bone Joint Surg (Am). 2004; 5: 86-A (5): 893-896.
13. Deyo, R. A. Non-operative treatment of low back disorders: differentiating useful from useless therapy. In: Frymoyer J.W., editor. The adult spine: principles and practice. New York: Raven Press. 1991; 1559–1560.
14. Ishihara, H., Matsui, H., Hirano, N. and Tsuji, H. Lumbar intervertebral disc herniation in children less than
16 years of age. Long-term follow-up study of surgically managed cases. Spine. 1997; 22 (17): 2044-2049.
15. Sharma, 1980 “A clinical profile of prolapsed intervertebral disc and Its management”. Indian Journal of Orthopaedics, 14(2): 204–212. 16. Smith M, Gallagher J, Memanus F. Surgery in lumbar disc protrusion. A long term follows up. In Med J 76:25-26, 1983.
17. D. Olsen, D. McCord and M. Law. Laparoscopic discectomy with Anterior interbody fusion of L5-S1, surgical endoscopy, 1996. December; 10[12]:1158-63.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareMANAGEMENT PRACTICES, EMPLOYEE TRAINING AND ITS IMPACT ON WORKING OF ORGANIZATIONS IN JAIPUR RAJASTHAN
English5761Sandesh Kumar SharmaEnglish Cheidam Kumar SharmaEnglish Kiran SharmaEnglishAim: To find out employees’ view at work place their carrier growth and management practice.
Methodology: Sample size is 50 to carry out research. Sampling method is random sampling. The work was done on Microsoft word and graphical charts etc. are prepared for better understanding.
Results: The data collection is done through survey method. The Questionnaire were given to the employees based on their feedback, the surveys measure the internal environment, or in general how people view their work, and the workplace. The types of issues covered in an environment survey are; work satisfaction, rewards and recognition from organization. Management practices its leadership and opportunities given by employer to employee, the positive impact of employee training increases the productivity and growth new policies has significant effect on Productivity growth.
Conclusion: This study examined to show the effectiveness of management practice and how the organization environment affects the behavior of the employees. The study is carried out by taking feedback from employees who have gone through the training programme. It is clear in the study that the training programme in the organization is good but yet step can be taken in order to make the training programme much more effective and to get a positive output from the employees. The study also shows that performance of employees depends upon the training they received for the job and at the same time on job behavior of the employees is also affected by the training programme, i.e. if the employees is trained well about his job, he/she is confident about his/her work will that reflect in the performance of the employees..
EnglishManagement practice, Job satisfaction, Training, Team work, Employee participationINTRODUCTION
It is very difficult to justify the training of employee in Organization; there are times when organization has to give good reason for expenditure on training and rewards for employees at the same time the organization also face financial difficulties to continue these Program, the objective of organization is to improve the performance of employee and also to identify the key areas which are hindering production, reducing effectiveness and which might generate unexpected costs. The idea behind this not to simply perform an academic exercise (training) every year, but to generate higher level of performance for the Organization, once opportunities are identified to reinforce approaches and also select appropriate interference for addressing the weak areas, which should be aggressively pursued for the maximum benefit of everyone. Management has to include facilities like health, safety and waste management. The organization has to arrange programmes on health issues such as free medical Check-up, other than this the organization also has to arrange programmes on safety related topics with the help of trainers in the field. The organization continues to focus on maintenance and performance improvement of related pollution control facilities like treatment plant and waste disposal facility at its manufacturing locations. Enterprise has to ensured eco-friendly disposal of waste at the designated disposal site in addition; the organization has complied with the environmental norms. Organization’s value proposition is based on customers, through innovation and by consistently improving efficiency. With a view to create there source bandwidth for the future organization initiated various measures such as investing in new skills, technologies, business models and training programmes for key technology areas. Growth in the organization extends beyond just numbers and includes personal growth for each individual of the organization. Organization continued its focus in creating an aesthetic, environmentfriendly industrial habitat in its factory units, mobilizing support and generating interest among staffing and labor for maintaining hygienic and green surroundings. Good human resource management plays a key role in company performance. The employee relations during the year have remained cordial and satisfactory. Attracting and retaining dedicated and skilled human resource, off erring them a conducive work environment and excellent career development opportunities are currently prime HR priorities.
MATERIALS AND METHODS:
For this study Descriptive research design has been adopted.
Objective of Study
• Analysis of how employee view their work and work place
• To study of management practices
• To study how to maintain co-operation in company
• To know the carrier growth and opportunity in company for employee Data Collection:
• Primary data is collected through survey.
• Secondary data is collected from internet, annual report of the company, magazine, and newspaper.
Types of Questions for This Project: - Open ended questions are used in this project.
Sampling plan:
The selection of respondents were accordingly to be in a right place at a right time and so the sampling were quite easy to measure, evaluate and co-operative. The sampling method that attempts to obtain is Random Sampling. Sample size It is the basic unit of the population to be sampled herePlan analysis To minimize manual work of calculation, the work was done on Microsoft word and graphical charts etc. are prepared for better understanding.
Limitation of the Study:
• The study was conducted and confined to the Jaipur region only.
• Limited time period and sample size due to monitory restriction is another limitation of study
• There was always a hidden fear of management to the employee that was depriving employee of giving the correct responses.
• Sincere efforts is made to remove this fear but still it is difficult to read a human mind and the thoughts regarding the questions asked is another limitation.
RESULTS
From the Environmental Survey it was observed that the employee agrees with the statement that training facilities will improve the performance of organization in today’s competitive world. Co-operation with co-workers and subordinates is very necessary to work in an organization and it was seen that in most of the organizations subordinate’s support is important. After training team work within mills is of high-quality. Growth career opportunities are good for all the employees in the organizations, job profile given to the employees was up to the mark all employee said that they were satisfied with their job profile. Welfare facilities are also necessary for organization more than 50% employee satisfies with the welfare facility of organization. One of the question asked from the employees that how do you rate working culture and working environment of organization it was observed that about 40% of respondents say that working is good and 16% employees say that working culture is excellent as give feedback in favors of Organizations shown in bar chart:
WORKING CULTURE and WORKING ENVIRONMENT OF ORGANIZATION
The second question asked from the employee is what kind of co-operation you are getting from your co-workers and superior about 38% rated well and 6% rated excellent and another 8% says that it is average which shows that there is positive co-operation from co-workers and superior
CO-OPERATION YOU ARE GETTING FROM YOUR CO-WORKERS AND SUPERIOR
Organization should provide behavioral training to the employees for the mutual understanding and better team work. There is a need for better learning environment and for the future growth and advancement of employees. The next question which is asked is are you getting an opportunity to enhance your skill the opportunities are good for all the employees in the organization which is clearly visible from the graph about 22% people say that they get an opportunity to enhance their skill it assumes that organization spent their money and time for employees.
OPPORTUNITY TO ENHANCE SKILLS
The employees reply on the question how do you rate team work and atmosphere of organization 28 % respondents said it is very good.
HOW DO YOU RATE TEAM WORK
Organization should provide more challenging task and opportunities for the enhancement and sharpening the skills utilization of employees. For that the organizations have to provide training both in-house and out-house. The question which is asked from the staff is how do rate the quality of training, 24% of employee says it is good and only 10% of employees disagree with statement as shown in this chart.
QUALITY OF TRAINING PROVIDED
Employees of the respective organization find that they have future prospects and growth in their own organization the question asked from them is are you satisfied with prospects and career growth 40% say Yes to the statement and only 9% say no.
SATISFIED WITH PROSPECTS AND CAREER GROWTH
Organization needs to provide the effective reward and reorganization systems for the motivation ofemployees and to improve their performance. The recognition system been carried out by Organization is very successful and majority of people said they are satisfied with it about 48% say yes to the statement.
REWARD AND REORGANIZATION
Job Profile is important factor to retain the employee and to improve the performance of organization the question which is asked from the employee is are you satisfied with the Job Profile, all respondents said that they were satisfied with their job profile.
JOB PROFILE
The success of any organization depends upon different impact factors that affect the organization performance and employee. Management can play important role in achieving high-quality service and Product. The study is an attempt to analyze the importance of management practices on job satisfaction of employees. This model identified that employee Training, Performance Appraisal, Team Work and rewards has significant importance to satisfy employee especially in Indian scenario where appraisal and retention policy of any Organization works well.
DISCUSSION
In order to examine the relationship between the Management Practices, employee training and its impact on Organization the management and workers are investigated in several studies in different time and periods. Several studies demonstrated that the Practice of management and training of workers is the key for employee retention and performance. This study attempt to assess that Organization is successful because of the quality of work employees perform. When employees are cared for, and the right environment is created where there are no barriers to performance, their true value to the organization can be fully realized. Lamba and Choudhary (2013) revealed that how HRM practices provide an edge to employee’s commitment towards an organization goal in the global competitive market. The study concluded that HRM practices such as training and development, compensation and welfare activities has significant effect on organizational commitment and are associated with superior organizational performance, which help in retention of knowledgeable and skilled employees. Human resource incentives such as training, employment security, high relative pay, and practices that build trust are likely to induce employee attachment and commitment. Good management practice includes employee views about how they see the business and their involvement in the business. According to (Heskett, J. L. (2002) Labor costs are minimized through low investment in selection, training, participation, and compensation. Information technology is used primarily to automate tasks and electronically monitor performance. However, customer satisfaction and loyalty are likely to suffer because employees have little discretion to meet customer needs. Customization is a good thing: this survey allows modifications to fit each unique organization. Necessary actions to help organizations start performing customer service better. Hussain and Rehman (2013) examined the relationship between the Human resource practices implemented by the organization on employee’s intention to stay and work effectively for the organization. The result of the study explored that HRM practices viz-a-viz: personorganization fit, employment security, communication and training and development are contributing strongly in developing the employees’ intentions to stay with organization. Further, strong positive inter-relationships were found between HRM practices and employees’ retention and such practices enhances employees’ retain ability of organizations. As with the work of Black, S. E., and Lynch, L. M. (2001), have shown that different dimensions of training can have different impacts. While they and others, looked at the distinction between on-the-job and off-the job training, the results here show that the crucial distinction in training types when assessing impacts on productivity growth may be that of general versus specific. As we argued above, employees are not mechanical black-boxes into whom training is injected. Rather they are rational players who must choose the amount of energy they will devote to turning the training they receive into additions to their human capital. Training which increases an individual’s wage with both the existing employer and potential employers provides greater incentives for effort than training which only increases wages with the existing employer. Organization initiated various measures such as investing in new skills, technologies, business models and training program for key technology areas. Growth in the organization extends beyond just numbers and includes personal growth for each individual of the enterprise, growth for customers and growth of our relationships and partnerships.
CONCLUSION
This survey concludes by expressing views about the importance of organization environment. The effectiveness of research depends on its continuous monitoring, evaluation and experience of employee. Monitoring and evaluation must be made available to those who are involved in this process so that they can take the necessary action to improve organization environment. Employee-Employee relationship, Management-Employee relationship, Welfare Policy, Industrial Relation Policies can improve with appropriate Management Practice and appropriate employee education. Experience of employee play very important role because it gives tremendous learning experience with training if we get help from experience/ renowned person in the field, it gives tantamount lift to the employee performance and organization environment.
Englishhttp://ijcrr.com/abstract.php?article_id=399http://ijcrr.com/article_html.php?did=3991. Smith, K. G., Collins, C. J., and Clark, K. D. 2005. Existing knowledge, knowledge creation capability, and the rate of new product introduction in high-technology firms. Academy of Management Journal, 48: 346– 357.
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11. Hussain, T., and Rehman, S. S. (2013). Do Human Resource Management Practices Inspire Employees’ Retention. Research Journal of Applied Sciences, Engineering and Technology, 6(19), 3625-3633.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareSAAS EXPLOSION LEADING TO A NEW PHASE OF A LEARNING MANAGEMENT SYSTEM
English6266R. GurunathEnglish K. R. Anil KumarEnglishCloud computing is still a baby having compound eyes with omnidirectional vision. It is slowly embracing all possible sectors and eLearning technology gaining more benefit out of it. The essential characteristic of cloud computing is easy and timely access to the required information. Education has seen a lot of changes from the ancient Gurukula stage where students had to go to the master for a particular period of time to study and to complete their learning. As the time pass by the learning became
central many big educational systems evolved through Schools, Colleges and Universities, to impart knowledge. These learning centers offered face-to-face learning. Even further blended learning helped student understand, innovate, and implement faster. With the advent of Learning Management Systems teaching and learning becomes effortless. A distinct stage of development in the field of LMS is Cloud-based LMS wherein time is not at all a constraint. This paper covers interesting aspects of E-learning- Cloud/SaaS LMS, different standards pertaining to LMS, and types of LMS. The authors analyze the case studies of MOODLE, BLACKBOARD and SaaS-based LMS and a comparison of SaaS vs. Installed LMS’s.
EnglishSCORM, AICC, IMS GLOBAL, IEEE, MOODLE, BLACKBOARD, TALENTLMS, HACP, Tin Can, G-CubeINTRODUCTION
The education and business are the fields which are gaining a steady growth due to the advent of new technologies such as e-learning and similar forms. These technologies are used for the advancement in terms of teaching and learning. Every year we are witnessing new applications to cater to the needs of the education in the form of cutting costs and expanding accessibility. Not only the students and teachers benefitted however, the employee efficiencies are boosted, managements looking for a revolution (Brian Westfall, 2015)9 . Training no longer time and place dependent; learners can share ideas, infrastructure and tools. Thanks to cloud-based learning management systems, today instructional designers can create courses that are more cost efficient and more accessible. The benefits of the cloud-based learning management systems are mostly grabbed by employee-training rather than academics. Learning Management Systems are several; it is all up to the user to select. The types are open-source, proprietary, and cloud-based. Open source and proprietary require infrastructure locally and depends mainly on time for installations, configurations, incur cost. The Cloud-based LMSs comes handy for small and large organizations. Since the LMS is stored on a cloud no need to manage the software. User needs to login, create the course content and distribute the courses. The system has the ability to store documents and arrange data that can be created in Excel or PDF reports. One can access the cloud by a variety of internet on devices even through the mobiles (Henson Gawliu, 2014)8 .
LEARNING MANAGEMENT SYSTEM
Managing curriculum, training is the basic essential part of the education system. This has been the challenge from ancient times. For the past 15 years a rapid revolution took place in the field of education. Learning environment becoming digital and powerful software systems such as Learning Management systems have been emerged; capable of managing curriculum, training material, assessment and evaluation tools electronically. It allows organizations to develop intelligent eCoursework; and deliver it with unmatched reach and flexibility. Nearly a billion-dollar industry, LMS products are associated with ease-of-use and can be a lifelong learning as it is impossible with conventional learning. Today’s classrooms are changing dramatically with the aid of LMS offering a modern user interface. The Learning management systems are hosted on the internet and can be accessed by logging into a service provider’s site. This does not need any installation, of course design and management software. Instructional designers simply use Internet browsers to upload course content, create new courses and communicate with the learners directly. The entire setup is secured so that the designers can store information in the cloud, which can be remotely accessed by authorized users.
NORMS OF LMS
A) SCORM standard is a result of Department of defense’s Advanced Distributed learning (ADL) initiative. The purpose of the ADL is to ensure access to high-quality education and training materials. SCORM-compliant courseware elements are easily merged with other compliant elements to produce a highly modular repository of training materials (David Boggs, Cyber works). The standard uses XML, and it is based on the results of work done by AICC, IMS Global and IEEE. SCORM Stands for “Sharable Content Object Reference Model”, and it is a standard to develop e-Learning software particularly Learning Management System. This is a model containing set of technical Specifications and procedures for building e-Learning software. When applied to e-Learning Course content, produces small, reusable e-Learning objects. SCORM enables interoperability between e-Learning software products. The online learning content and LMS software communicates with each other to bring the specific courses to the learner; the SCORM facilitates to do that. SCORM has several modules such as Content Aggregation Model (CAM), Run-time Environment (RTE), and Sequencing and Navigation (SN). These modules are the core of the SCORM. There are various LMS supporting SCORM: They are Blackboard, Contento LMS, DLMS, DoceboLMS, Dokeyos, and Moodle etc. B) AICC started in 1988 by Aircraft manufacturers to address Airline concerns about e-Learning training materials. A series of development took place and it has now been the one of the standards of e-learning. AICC stands for Aviation Industry CBT Committee and primarily uses HACP (HTTP AICC Communication Protocol) Protocol to provide communication between the course content and LMS. In comparison with SCORM, AICC is older. Both are efficient and SCORM is more user friendly. Features of AICC are same as of SCORM. These standards provide Interoperability, Durability, Accessibility and Reusability of learning objects. Apart from SCORM and AICC, the other e-Learning standards are xAPI or Tin Can, CC/LTI and CMI-5 (e-Learning Chef, 2014)4 .
MOODLE AS AN OPEN SOURCE
LMS Moodle is free, open source software learning management system written in PHP (Hypertext Pre-Processor). Moodle is used for blended learning, distance education, and workplaces (Martin, 2003). A Moodle acronym for Object-oriented dynamic learning environment allows for extending and tailoring learning environments.
A Sample Look on the Moodle Screen as shown in fig 1. A flexible tool sets called plugins allow moodle users to extend the features. There are over thousand plugins available for moodle as per the new moodle report. Graphical themes are used to change the look and functionality of a moodle site or of an individual course. People in different countries can use moodle in their languages. There are over 100 Languages moodle supports. Even through mobile moodle can be accessible. Moodle adopted a number of eLearning standards such as SCORM 1.2, Tin Can and AICC (Aviation Industry Computer-Based Training Committee), and LTI (Learning Tools Interoperability). Moodle can be deployed through the Apache HTTP server; a number of database management systems such as PostgresSQL are supported. Different platforms like Microsoft Windows and Macintosh are moodle supported. Moodle can be portable to UNIX, Linux, FreeBSD, Windows, Mac OS X, and Netware without any modification. In the higher education sector moodle is the second largest provider with a 23 % market share following Blackboard with 41%. In the corporate market the sixth largest LMS providers constitutes approx 50% of the market (Forbes, 2015)2 . Moodle has released about 20 different versions. The new release is expected by the end of 2015. According to the survey conducted in 2014 by Technology enhanced learning in higher education in the UK, Moodle tops the table with most aspects.
BLACKBOARD AS A COMMERCIAL
LMS Blackboard LMS established in 1997 and owned by Blackboard; it is an online Virtual Learning Environment (Yefim Kats, 2013)6 Blackboard LMS provides Enterprise software applications as well as services for learning and development. It can be used for small and medium sized business associations and government agencies. It can be deployed based on customer need. Blackboard comes in flavors such as Installed version, web version, and even a mobile version. It offers training through webinars, live online, documentation and in person. It supports any types of rich media from computer or from a mobile. End user license agreement is required for the use; slightly expensive, US-centric, rigid design.
SAAS BASED LMSS
The Present buzzword across the world is eLearning. Specifically the SaaS-based LMS is getting popularity constantly. The SaaS-based LMS can also be called as Web-based or Cloud-based LMS. Most organization’s human resource departments are thinking to adapt the technology to save the valuable resources instead of spending money for training their employees conventionally. New Employees will get their training from their home or wherever they are there. Not only the training, however the evaluation of the employees is done using LMS software. Even academic administrators are able to open their branches worldwide to provide courses through online. Some of the Cloud-based LMS is Digital Chalk, TalentLMS, Sky Prep, LitmosLMS, FirmwaterLMS (Stephanie Miles, 2013)5 .
(b) Robust Data Security: People often use social networking sites such as Facebook, Twitter and similar kind of applications to communicate with the collaborators7 . Of course, these free sites do not have the security features offered by a cloud-based LMS. Even then there is no worry. The cloudbased LMS platforms are well secured and safe to use. The LMS service providers employ a series of methods to ensure security and privacy of the data stored with utmost importance. Most of these systems are better encrypted using the SSL protocol. A strict authentication procedure is followed in order to allow only authorized users. Online payment transactions are done through PayPal and payment processors.
(c) Improved Accessibility: There are two kinds of users who access cloud-based LMS, learners and instructional designers. Instructional designers can use any internet-ready device to upload content and communicate other collaborators and learners. For Learner training is independent of place and time. They simply log into their LMS account and start learning new skill sets and expanding their knowledge base, without limitations.
(d) Rapid Deployment: Here there is a need to differentiate the deployed vs. cloud-based LMSs. In normal deployment the worry part is the setup; it requires different hardware and software are to be configured and takes much of the time and effort. On the other hand the cloud-based eLearning is faster to setup and requires less time to actually deploy. The instructional designers just have to sign up with a cloud-based service provider once and allow learners access it. The training sessions can be started immediately and begin offering courses to students.
(e) Storage Space: Put an end to corrupted hard drives or permanently deleted files. Since the all the information is stored in cloud including images, content, will be uploaded directly to the LMS and in turn frees up space on local devices. Users such as content creators, collaborators, will be able to share information with ease and these are stored on a remote secured server.
(f) Cost Predictability: In Cloud-based LMSs tariffs are very much clear that means the cost per monthly or quarterly, or half yearly is known. Organizations have a clear picture on money to be invested in. There are typically different hosting and service packages; based on the need the respective package can be selected. The administrators have the ability to choose between the tariff plan.
(g) Easier to Maintain: Basically there are no maintenance and service providers solve each and every issue then and there. The new features and upgraded functions are available to the end user on a regular basis. The organizations can concentrate or devote IT resources to other aspects.
(h) Fully Customizable and Scalable: Cloud-based LMS is an advantage to organizations in training their employees, be it for small or large companies. The training Programs can be easily customizable according to the need and organizations expands their learning environment without much of the investment10.
SIGNIFICANCE OF DIFFERENT LMSS
(a) Talent LMS: This is a SaaS eLearning platform or cloudbased Management system. This is currently aimed at training employees of small, medium and large companies. This platform offers tools for content creation, re-purposing, test building, assignment management, reporting, internal messaging and discussions, surveys. Presently, this product is used by over 20,000 organizations and business world-wide, including education, retail, construction, public sector and nonprofit companies.
(b) Litmos: It is used for corporate training. 1.6 million Users worldwide, including technology, education, retail, public sector and non-profit companies. The most user friendly enables rapid creation of web based courses and easy distribution to learners of all kinds. There is no social learning aspect.
(c) WizdomLMS: This product is from G-Cube with over a million users and offers two flavors such as online as well as offline courses. Users can choose between the options. It prioritizes the ease of use, lightweight structure. It has won many awards, including Brandon Hall award and LearnX awards.
(d) Mindflash: This is a cloud-based LMS contains features such as course preparation, corporate learning. However, doesn’t support standard like SCORM. Automatic conversion of PowerPoint, Video, Word or PDF files into an online course are possible.
(e) ScholarLMS: It is a cloud-based; Tin Can enabled learning management system based on the world’s most popular open source virtual learning environment (VLE). Free for startups and nonprofits.
(f) VTA Talent Management Suite: This product from RISC integrates training, assessment and robust reporting to support the needs of organizations spanning multiple-sites, languages and currencies. RISC is a technology innovator as a Tin Can early adopter and a cloud LMS provider since 1999 supporting hosted sites on six continents in a number of heavily regulated industries.
FUTURE OF CLOUD-BASED LMS
The Cloud-based LMS and installed LMS, both have a very bright future. A recent research study (eLearning Industry, 2015) indicates about 87% of organization choosing Cloudbased LMS. This shows very good prospects for Cloudbased LMS in the future. The reasons we have discussed in the effects of cloud-based LMS. In addition to that the framework provides privacy within a teaching environment for instructors as well as students. It provides flexibility to accommodate a variety of teaching styles. More importantly, it provides greater accountability and transparency demanded by institutions7 .
CONCLUSION
The association of E-Learning and Cloud-computing is wellcomposed and it has promoted the knowledge sharing to greater heights. Students and Teachers can exchange their thoughts by sitting apart far distances with no time restrictions. The reuse of learning objects is another important feature of LMS thereby reduces redundant work. We have seen a steady growth of Cloud-LMS and it is the best among other forms of LMS’s. Finally, the Cloud-computing paved way for the e-Learning significantly.
ACKNOWLEDGEMENT
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors also grateful to authors / editors / publishers of all these articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=400http://ijcrr.com/article_html.php?did=4001. Julie Voce, Joe Nicholls, Elaine Swift, Jebar Ahmed, Sarah Horrigan and Phil Vincent, 2014, “2014 Survey of Technology Enhanced Learning for higher education in the UK”. UCISA Richard Walker.
2. Bersin, Josh., 2015, “Talent Management Software Market Surges Ahead”. Forbes. Forbes. Retrieved 13 April 2015.
3. E-Learning India, 2014, “SCORM and AICC – A Comparison”, E-Learning Articles.
5. Stephanie Miles. 2013, “Cloud-Based Learning Management Systems”, GetApp.
6. Yefim Kats, 2013, “Learning Management Systems and Instructional Design: Best Practices in Online Education”, Idea Group Inc.
7. Arunima Majumdar,2014, “Benefits of the Cloud LMS – Is it the future of Learning Management Systems?”, G-Cube.
8. Henson Gawliu Jr, 2014, “Cloud-based LMS - 4 Reasons Why is it Important?”, LITMOS.
9. Brian Westfall, 2015, “LMS Buyer’s view” , Software Advice.
10. Gauri Reyes, 2015, “Uncovering the Full Advantages of CloudBased Learning Solutions”, MindFlash.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241722EnglishN2015November21HealthcareCLINICOPATHOLOGICAL STUDY OF ENDOMETRIUM IN PATIENTS WITH ABNORMAL UTERINE BLEEDING
English6773Humaira BashirEnglish Nazia BhatEnglish Mehnaz Sultan KhurooEnglish Ruby ReshiEnglish Mir Junaid NazeirEnglish Mohammad Zubair QureshiEnglishObjectives: Abnormal Uterine Bleeding (AUB) is considered one of the most common and challenging problems presenting to the gynaecologist, regardless of the age the women .The present study was done with the aim of studying the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding.
Methods: This was a prospective study conducted on endometrial curettings of 460 patients in the Department of Pathology, from January 2013 to August 2014.
Results: The age of patients ranged from 18 to 70 yrs. The patients were categorized in reproductive age group (40yrs and post-menopausal group (>50yrs/clinical scenario). Maximum number of patients were in the perimenopausal group, 220 patients (47.8%), followed by 182 patients (39.6%) in the reproductive age group. Post-menopausal patients constituted 12.6 % ( 58) of total no of cases. Menorrhagia was the most common presenting symptom. Normal cyclic endometrium, 210 cases (45.65%), was the most common histopathological pattern seen in the reproductive and perimenopausal group,
whereas in the postmenopausal group simple hyperplasia, 16 cases (27.6%), followed by complex hyperplasia, 8 cases (13.7%) was the commonest pattern seen. Malignancy was seen in 7 cases (1.52%)
Conclusion: Histopathological examination of endometrial curetting specimens in patients with Abnormal uterine bleeding showed a wide spectrum of histopathological changes ranging from normal endometrium on one hand to malignancy on another hand thus rendering endometrial curetting an important diagnostic procedure in evaluation of Abnormal uterine bleeding. Accurate analysis of endometrial samplings is the key to effective therapy and optimal outcome
EnglishAbnormal uterine bleeding, Endometrial hyperplasia, HistopathologyINTRODUCTION
Normal menstruation is defined as bleeding from secretory endometrium associated with ovulatory cycles, not exceeding a length of five days. Any bleeding not fulfilling these criteria is referred to as Abnormal Uterine Bleeding (AUB)1 . It is one of the frequently encountered gynaecological problem and is responsible for about one third of patients visiting gynaecological OPD (Out Patient Department)2. It can be caused by a wide variety of structural and functional causes. Common structural causes include fibroids, polyps, adenomyosis or neoplasia. The largest single group encompasses functional disturbances, referred to as Dysfunctional Uterine Bleeding (DUB). DUB is defined as any excessive bleeding (excessively heavy, pro longed or frequent) of uterine origin which is not due to demonstrable organic disease, complications of pregnancy or systemic disease3 . Histopathological examination of endometrial biopsy, taken by dilatation and curettage, remain the standard diagnostic procedure for the diagnosis of endometrial pathology4 . It should be considered in all women if AUB does not resolve with medical management and particularly in those above the age of 40 years, and in women who are at increased risk of endometrial cancer. An accurate histopathological diagnosis facilitates the implementation of optimal treatment strategies and unnecessary radical surgery may be avoided.The present study was undertaken to determine the histopathological pattern of the endometrium in women of various age groups presenting with Abnormal Uterine Bleeding
MATERIAL AND METHODS
The Present study was conducted in the Department of Pathology, Government medical College, Srinagar. This was a prospective study conducted on 460 specimens of endometrial curetting’s received from patients presenting with Abnormal Uterine Bleeding over a period of 20 months from January 2013 to August 2014. Patients were divided into three groups; Reproductive age group : 40 yrs and Postmenopausal age group : Patients who have had cessation of menstrual cycles for at least a period of twelve months with dating of postmenopausal period from the final menstrual period. Patients with bleeding due to pregnancy related complications such as abortions, gestational trophoblastic diseases or ectopic pregnancy were excluded from the study. Detailed clinical history was obtained. Specimens were fixed in 10% formalin followed by routine processing. The paraffin block sections were cut at 4-5μ and the sections were stained by routine Haematoxylin and Eosin (H&E) stains, and special stains were used when required. Data was analysed using the Statistical Package for Social Science (SPSS version 20) for windows.
RESULTS
A total of 460 cases of endometrial curetting’s presenting with Abnormal Uterine Bleeding were studied. Of these 51(11.08%) specimens were inadequate /inconclusive for opinion. The age of patients ranged from 18 to 70yrs. Maximum number of patients, 47.8 %( 220), were in the perimenopausal group followed by 39.6 %( 182) patients in the reproductive age group. Postmenopausal patients constituted 12.6% (58) of total number of cases. The most common presenting symptom was menorrhagia (56.73%) followed by polymennorrhea (17.82%). (Table 1) Functional causes accounted for majority of the diagnosis, 274 (59.56%). Of these secretory endometrium being the most common histological pattern (27.17% cases) followed by proliferative endometrium (18.69% cases). While secretory endometrium was the most common functional cause of AUB in reproductive and perimenopausal age groups respectively, atrophic endometrium predominated among postmenopausal patients. Among organic causes simple cystic hyperplasia accounted for majority of the diagnosis in all the three age groups. In the reproductive age group (table 2) secretory endometrium seen in 34.06% (62 cases) of cases, was the most common histopathological pattern observed followed by proliferative endometrium 24.72% (45 cases) and disordered proliferative endometrium 9.3% cases (17 cases). Among organic causes, most common histological finding was endometrial hyperplasia 10.98% cases (20 cases), out of which simple hyperplasia without atypia was seen in 16 cases , complex hyperplasia without atypia in 3 cases and complex hyperplasia with atypia in 1 case. One case of uterine malignancy (rhabdomyosarcoma) was also seen. In addition acute endometritis and endometrial polyp was also seen in 8 cases and 7 cases respectively In the perimenopausal patients (Table 2) functional causes predominated and most common pattern seen was secretory endometrium in 30% cases (66 cases) followed by proliferative endometrium in 16.8% cases (37 cases), disordered proliferative endometrium in 12.3% cases (27 cases) and hormonal effect in 4.1% cases (9 cases). Simple hyperplasia seen in 14.5% cases (32 cases), followed by complex hyperplasia without atypia in 4.5% cases (10 cases), endometrial polyp in 2.7% cases (6 cases), chronic endometritis in 2.27% cases (5 cases), complex hyperplasia with atypia in 0.5% cases (1 case) and malignancy in 0.9% cases (2 cases) were the organic lesions seen. Among malignant lesions, one case each of endometriod carcinoma and malignant mixed mullerian tumour was diagnosed. Among postmenopausal patients (Table 2) organic causes were more common than functional causes. Simple hyperplasia without atypia was seen in 27.6% cases (16 cases), complex hyperplasia without atypia in 10.3% cases (6 cases), complex hyperplasia with atypia in 3.4% cases (2 cases) and malignant lesions 6.9% in cases (4 cases). Malignant lesions in post-menopausal group included 2 cases of endometriod carcinoma and one case each of clear cell adenocarcinoma and endometrial stromal sarcoma. Endometrial polyps in 3.4 % cases (2 cases), acute endometritis in 3.4% cases (2 cases) and granulomatous endometritis in 1.7 % cases (1case) were other organic lesions diagnosed. Among functional causes most common was atrophic endometrium seen in 12.06 % cases (7 cases), followed by proliferative endometrium in 6.8% cases (4 cases), disordered proliferative endometrium in 3.4% cases (2 cases) and secretory endometrium in 3.4 % cases (2 cases).
DISCUSSION
AUB is a common gynaecological complaint accounting for one third of patients visiting outpatient clinics5 . It is caused by a wide variety of disorders represented by an aberrant physiologic status at one hand to uterine malignancy at the other. The present study was done to evaluate the histopathology of endometrium in abnormal uterine bleeding. In our study organic causes of AUB were seen in 29.34 %( 135) and functional causes in 59.56 %( 274) patients. Similar observations were made in the study done by Vaidya S et al 6 . Most patients in our study were in the perimenopausal age group (47.8%). This could be due to the fact that as menopause approaches, decreased number of ovarian follicles and their increased resistance to gonadotrophic stimulation, results in a low level of estrogen, which cannot keep the normal endometrium growing7 . Lesser number of patients were seen in the higher ages which may be due to earlier evaluation, detection as well as management of the disease. Menorrhagia was the most common presenting feature (56.73%) followed by polymennorrhea (17.82%).These findings were compatible with the study done by Muzaffar M et al 8 . The two most common histopathological pattern were normal cyclic pattern (secretory and proliferative endometrium) in the perimenopausal and reproductive age group and atrophic endometrium in the post-menopausal age group. The abnormal bleeding in the proliferative phase could be due to anovulatory cycles and in the secretory phase due to ovulatory dysfunctional uterine bleeding. Similar results were reported by Doraiswami et al 9 . Disordered proliferative serves as a bridge between normal proliferation and hyperplasia. It denotes an endometrial appearance that is hyperplastic but without an increase in endometrial volume. An essentially normal proliferative phase endometrium with a few widely scattered cystic glands would better be called “disordered proliferative” than simple hyperplasia10. Disordered proliferative endometrium was seen in 12.17% of patients in our study. Study of Vaidya et al6 showed 13.4% cases. In our study disordered proliferative endometrium was more common in perimenopausal group similar to study of Doraiswami et al9 . Endometrial hyperplasia is a precursor of endometrial cancer. The incidence of endometrial hyperplasia without and with atypia peaks in the early fifties and early sixties respectively with symptoms of irregular or prolonged bleeding due to anovulatory cycles in majority of cases, secondary to sustained level of oestrogens11. The overgrowth not only affects glands and stroma but there is also abnormal vascularisation. In our study endometrial hyperplasia was found in 18.9% of cases, which is concordant to observations made by Sheetal G P12 (20%) but higher than that observed by Doraiswami et al9 (6.11%) and Abid et al13 (5%). Most common type of hyperplasia encountered was simple hyperplasia without atypia (Fig 1) in 13.91% cases. Hyperplasia was found to be the most common cause of AUB in post-menopausal women and most common organic cause of AUB in reproductive and peri- menopausal women. However, its frequency peaked in perimenopausal age group accounting for about 50% cases. Similar observations were made by Vaidiya et al6 and Muzaffar M et al 8 . Endometrial cancer is the most common malignancy of the female genital tract with 80% patients being post menopausal14. In our study malignancy was observed in 1.52% cases (7cases). Of these there were 5 cases of endometrial carcinomas with 3 cases diagnosed as type1 (Fig 2) and 2 cases as type 2 endometrial carcinoma. Other tumours included one case each of endometrial stromal sarcoma and rhabdomyosarcoma. Most of the patients belonged to post-menopausal age group. Similar observations are seen in literature from sub contienent6, 12, 13, 15 as compared to the west16,17 where higher incidence is reported. This may be attributed to early child bearing and multiparity practised by women in our subcontinent. Polyps such as endometrial polyps and submucosal leiomyomatous polyps are common source of AUB in all age groups18. In our study 15 polyps (3.26%) were seen of which 12(2.62%) were reported as endometrial polyps and 3(0.65%) as submucosal leiomyomatous polyps. Data from other studies shows variable trends ranging from 1.2% to 14.10%8, 9, 12, 13. None of the polyps in our study showed atypical changes. Atrophic endometrium was seen predominantly in postmenopausal group accounting for 12.6% cause of AUB in this group. This is compatible to the observation made by Doraiswami et al9 (9.5%) but lower than the results observed by Abid et al13 and Gredmark et al19. Anovulatory cycles followed by ovarian failure leads to atrophic changes in the endometrium at menopause.14 Chronic endometritis was observed in 2.6% of endometrial curetting’s of which 2 were granulomatous endometritis (due to tuberculosis) positive for AFB (Fig 3). Study by Vaidya et al6 showed chronic endometritis in 3.23% cases. The diagnosis of chronic endometritis is made on the basis of presence the basis of presence of plasma cells. Chronic endometritis is often a result of intra uterine contraceptive devices (IUCD), pregnancy and incomplete abortions. Hormonal effect (exogenous administration) was noted in 2.17% cases (10cases) out of which 9 cases were seen in perimenopausal group. Muzzafar et al8 have reported 2.3% cases as pill effect similar to our observation however majority of their cases were in the 31-40 year age group were as in our study cases were in the 41-50 year age group Specimens inadequate for reporting were 51, accounting for 11.8% of the total cases. . In our study specimens were labelled unsatisfactory for reporting when there were scant glands and stroma, fragmented tissues and haemorrhage. A study by Harmanli et al20 revealed that an inadequate endometrial sample has a high negative predictive value of ruling out endometrial neoplasm. Similar views were expressed by Bakour et al21 in their study wherein they observed scant tissue in atrophic endometrium with no focal lesion on ultrasound scan has little chance of missing relevant pathology.
CONCLUSION
Histopathological examination of endometrial curetting’s in patients with AUB showed a wide spectrum of pathological changes ranging from normal endometrium on one hand to malignancy on other hand thus rendering endometrial curetting an important diagnostic procedure in evaluation of AUB. In the present study since most of the preneoplastic lesions were seen in the perimenopausal group and neoplastic in postmenopausal age group, therefore it is especially recommended in women above 40 years of age presenting with AUB, to rule out preneoplastic lesions and malignancy. Accurate analysis of endometrial samplings is the key to effective therapy and optimal outcome.
ACKNOWLEDGEMENTS
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
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