Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareA DETAILED STUDY OF SEVERE ANAEMIA AND ITS RELATION WITH STOOL EXAMINATION FOR HOOKWORM OVA IN PATIENTS WITH SEVERE HOOKWORM INFECTION FOUND WHILE DOING
ENDOSCOPY
English0105Govindarajalu GanesanEnglishObjective: Severe anaemia is reported to occur in severe hookworm infection in many studies. But so far detailed study was not done to know about the occurence of severe anaemia and its relation with stool examination for hookworm ova in patients with severe hookworm infection. Hence a detailed study was done to know about severe anaemia and its relation with stool examination for hookworm ova in patients with severe hookworm infection found while doing upper gastro intestinal endoscopy in our institute.
Methods: A study of 1100 patients who had undergone upper gastro-intestinal endoscopy for a period of four and half years from May 2009 to October 2013 was carried out in our institute. In each of these 1100 patients, the first and second part of duodenum were carefully examined to find out the presence of hookworms. In all the patients found to have hookworms in duodenum, investigations were done to know about the presence of anaemia except in the very few patients who were lost for follow up. In patients with severe anaemia [haemoglobin EnglishSevere anaemia, Severe hookworm infection, Stool examination for hookworm ova, Upper gastro intestinal endoscopyINTRODUCTION
Severe anaemia is reported to occur in severe hookworm infection in many studies[1 to 16]. But so far detailed study was not done to know about the occurence of severe anaemia and its relation with stool examination for hookworm ova in patients with severe hookworm infection. Hence a detailed study was done to know about severe anaemia and its relation with stool examination for hookworm ova in patients with severe hookworm infection found 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 1100 patients who had undergone upper gastro-intestinal endoscopy for a period of four and half years from May 2009 to October 2013 was carried out in our institute. In each of these 1100 patients, the first and second part of duodenum were carefully examined to find out the presence of single or multiple hookworms. In all the patients found to have hookworms in duodenum, investigations were done to know about the presence of anaemia except in the very few patients who were lost for follow up. In patients with severe anaemia [haemoglobin Englishhttp://ijcrr.com/abstract.php?article_id=424http://ijcrr.com/article_html.php?did=4241. 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. 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
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., Lin J.T., Lu 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. Anjum Saeed, Huma Arshad Cheema, Arshad Alvi, Hassan Suleman. Hookworm infestation in children presenting with malena - Case series Pak J Med Res Oct - Dec 2008;47(4) ):98- 100
8. 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
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. 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
13. Cedrón-Cheng H, Ortiz C (2011) Hookworm Infestation Diagnosed by Capsule Endoscopy. J Gastroint Dig Syst S1:003. doi: 10.4172/2161-069X.S1-003
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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.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareEFFECT OF GROWTH AGE PERIOD ON BIOCHEMICAL COMPOSITION OF PLANTAGO MAJOR PLANT
English0610Lana Yousif MutalibEnglishObjectives: The present study was aimed to find the effect of growth age period of Plantago major leaves on the biochemical composition of the plant.
Methods: Leaves of P. major have been assessed for it is total phenolic, total flavonoid and total tannin contents at different growth age period (vegetative and generative).
Results: revealed significant differences in biochemical compositions between two growth age periods of the plant, generative leaves exhibited significant amount of flavonoid (0.12±0.002 mg QE\g DW) and tannin contents (0.12±0.002 mg GAE\g DW) while a significant total phenolic contents were expressed by vegetative leaves (0.015±0.001 mg GAE\ g DW).
Conclusions: The research findings emphasized great effect of growth age period on biochemical composition of the P. major leaves.
EnglishVegetative period, Generative period, Total phenolic content, Total flavonoid, Total tannin contentINTRODUCTION
Mankind has always been screened for agents to treat diseases since aliments were as old as life itself. Disease eradication has been performed by the usage of herbal remedies and medicinal plants. Everyday there were discovering of new medicinal plants. There collection must be at right season and specific growth stage for obtaining an optimized quantity of bioactive constituents [1]. Extracted phytochemical compounds from plant source are phenols, alkaloids, tannin, saponin, flavonoids and lignin which exert biological activity either as prophylactic or treating agents of various diseases such as diabetes, cancer, heart diseases and high blood pressure [2]. Recently, phytochemicals made a valuable venue of research in medical and food industry to emphasize their biological activities [3]. Phytochemical contents of plant affected by various factors. These factors comprised environmental conditions, season, plant age, growth factors and leaf maturity. The biological activity of medicinal plants changes with the respect to the plant age. Moreover, the right authenticated plant part at specified age period should be harvested in selected season before introducing the plant for the drug manufacturing process, to optimize the herbal preparation potency[4-7]. Plantago major L. is perennial herb belong to Plantaginaceae family, grows about 15 cm in height with variant size. The leaves were in rosettes having elliptical to ovate shape. The flowers are brownish-green color, small size appear on long non-ramified spikes [9]. P. major commonly known as a weed only while traditional medicine identified it is value as a medicinal plant. The plant mostly known for its therapeutic activity in wound healing properties [9,10]. Traditionally plant attributed in a number of disease curing processes distributed in worldwide like, infectious diseases, problems concerning the digestive organs, reproduction, against tumours, pain relieving, fever reducing, skin diseases, respiratory organs and the circulation [11-15]. The plant contains a number of medicinal active constituents such as phenolic compounds, flavonoids, alkaloids, irodiod glycoside, carbohydrate, lipid, vitamins and coumarin [12-22]. The present study was aimed to find the effect of different age growth period of Plantago major plant grown naturally. in Erbil city on the concentration of phytochemical more specifically total phenolic, total flavonoid and total tannin content in ethanolic extract of plant.
MATERIAL AND METHODS
Plant material collection: Leaves of Plantago major plant have been harvested at two different growth age period vegetative and generative growth periods, authenticated in Pharmacognosy Department, Pharmacy College\Hawler Medical University. Plant parts dried in shade, kept in close container at 25 0 C.
Assessment of Biochemical composition:
Plant parts have been assessed for it is biochemical composition by estimation of total phenolic, total flavonoid and total tannin contents.
Estimation of total phenol content:
Total phenol compounds have been estimated according to the Folin-Ciocalteu method with slight modifications [23]. Briefly, 1ml extract prepared from (0.5g) of crude plant material was mixed with 9 ml of distilled water. One ml of Folin-Ciocalteu phenol reagent was added to the mixture. The mixture mixed and allowed to stand for 5 minute at room temperature, then 10ml of (7%) sodium carbonate were added. The volume have been adjusted to 25ml and incubated for 90 minutes at room temperature. The absorbance was measured at 750nm using UV visible spectrophotometer. Total phenol content were estimated from calibration curve obtained from measuring the absorbance of standard concentration of gallic acid solution in distilled water with concentrations [20, 40, 60, 80 and 100 mcg\ml]. The results were expressed as mg of gallic acid equivalent (GAE)\gram of dry powdered plant material (DW).
Estimation of total flavonoid content:
Total flavonoid content was measured by the aluminium chloride colorimetric method [24]. Aliquot of 1 ml extract prepared from 1g of powdered plant material, was added to 10 ml volumetric flask containing 4 ml of distilled water. About 0.3 ml sodium carbonate 5% was added to the flask and after 5 min, 0.3 ml aluminium chloride (10%) was added. Two ml sodium hydroxide (1 M) was added at 6th min and the total volume was adjusted up to 10 ml with distilled water. The solution was mixed thoroughly and the absorbance level was determined at 510 nm using UV visible spectrophotometer. The total flavonoid content was measured from calibration curve obtained from measuring absorbance of standard concentration of querstine solution in ethanol (80%) with concentrations [20, 40, 60, 80 and 100 mcg\ml] The results was expressed as mg of querstine equivalents (QE)\ gram plant dry weight material (DW).
Estimation of total flavonoid content:
Total flavonoid content was measured by the aluminium chloride colorimetric method [24]. Aliquot of 1 ml extract prepared from 1g of powdered plant material, was added to 10 ml volumetric flask containing 4 ml of distilled water. About 0.3 ml sodium carbonate 5% was added to the flask and after 5 min, 0.3 ml aluminium chloride (10%) was added. Two ml sodium hydroxide (1 M) was added at 6th min and the total volume was adjusted up to 10 ml with distilled water. The solution was mixed thoroughly and the absorbance level was determined at 510 nm using UV visible spectrophotometer. The total flavonoid content was measured from calibration curve obtained from measuring absorbance of standard concentration of querstine solution in ethanol (80%) with concentrations [20, 40, 60, 80 and 100 mcg\ml] The results was expressed as mg of querstine equivalents (QE)\ gram plant dry weight material (DW).
Statistical analysis: All data were collected from triplicate procedure works expressed as mean ± standard deviation (SD). Two way ANOVA method used for comparison between means considering (p value < 0.0001) statistically significant.
RESULTS
Plantago major plant have been evaluated at two different growth age period (generative and vegetative) periods for it biochemical composition using standard curves of gallic acid for total phenolic, querstine for total flavonoid and gallic acid for total tannin contents (figure.1, figure.2 and figure.3). Significant total phenolic detected in vegetative growth age period while significant total flavonoid and total tannin contents were detected in generative growth age period (p value < 0.0001) (Table.1).
DISCUSSION
Plantago major leaves is a medicinal plant used by local communities in treatment of variant diseases grown naturally in different places of Erbil city, have been assessed for their biochemical composition at different growth age periods (vegetative and generative periods), since age growth period affect phytochemical concentration in plant [4-7]. The total phenolic content of Plantago major leaves were estimated from the standard curve equation (y=0.08x - 0.120, r2 = 0.9) shown in figure.1. A significant total phenolic content were exhibited by the vegetative period leaves (p < 0.0001) in comparison to the total phenol expressed by the generative period leaves [Table .1], the finding were consistent with the finding of the Achakzai et al.2009 [6], which confirmed the low levels of phenol in young leaves of Rhododendron spp., since the plant utilized the phenol for the primary metabolic process required for plant growth. A significant amount of flavonoid content [Table.1.] were estimated in generative period of P. major leaves (p < 0.0001) from standard curve equation (y=0.007x+0.036, r2 = 0.98) shown in figure .2. Our study results were compatible to the findings of Miean and Mohamed, 2001 [26] and Albach et al, 1981 [27] and in agreement to the records of Behn et al, 2011[28] who reported high flavonoid contents in generative period leaves of lettuce, while the results were in contrast to the finding of Ali, et al 2014 [29] which reported low level of flavonoid in older leaves (generative period) in correspondence to the younger ones. Similarly to the flavonoid content, tannin contents were showed upsurge with increasing of plant age. The exhibited tannin contents of plant in different age growth periods showed significant variation in tannin contents (p < 0.0001), since generative period leaves expressed higher tannin contents [Table.1.] which have been estimated from standard curve equation (y=0.001x-0.012, r2 =0.996) shown in figure .3. Plant growth age period relation with the chemical compositions of the plant have been confirmed by Farias, 2003 [30], Esmelindro et al, 2004 [31]. Generally the chemical composition varies according to the growth age period of and it is requirements for growth. P. major leaves expressed high contents of two of evaluated phytochemical constituents flavonoid and tannin contents in generative period while the total phenolic compounds showed high values at vegetative periods. Further research have been recommended to evaluate the plant from biological activity points to standardized the medicinal age growth period of the plant.
CONCLUSION
From study results we concluded that plant growth age period reflected on the biochemical composition of the medicinal plants. Plant phytochemicals concentration either increase or decrease according age growth period of plant, choosing the right period for plant harvesting is very important for the medicinal value of the herbal preparation.
ACKNOWLEDGEMENT
Research author was very gratefully thanks Pharmacognosy Department\Pharmacy College for encouraging me to perform the research. Conflict of interest: There was no any conflict of interest to be declared by the author.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareFUNGAL INFECTION COMPLICATING A CASE OF PULMONARY ALVEOLAR PROTEINOSIS
TO FATAL OUTCOME
English1115Narendra Kumar NarahariEnglish Bhaskar KakarlaEnglish Shantveer G. UppinEnglish Harsha Vardhana K.R.English Mohammed Ismail NizamiEnglish Rajendra Prasad BoddulaEnglishAim: To present clinico-pathological findings in a case of pulmonary alveolar proteinosis complicated by fungal infection.
Case Report: A 48-year-old female presented with progressively increasing exertional breathlessness for the past 6 months. On imaging she showed extensive air space filling with crazy paving pattern in the left lung with multiple nodular lesions in the right lung and mild bilateral pleural effusions. Core needle biopsies of the lung showed features consistent with pulmonary alveolar proteinosis in the left lung and fungal infection in the right lung.
Discussion: Infections with unusual organisms can complicate pulmonary alveolar proteinosis (PAP) due to inherent alveolar macrophage dysfunction and intra alveolar accumulation of surfactant offering a good culture medium for the microbes. The risk is further increased if such patients are treated with steroids.
Conclusion: Opportunistic infections can complicate the clinical course of PAP which is associated with high mortality. High index of suspicion, early diagnosis and aggressive treatment can prevent the adverse outcomes
EnglishPulmonary alveolar proteinosis, Aspergillus, Fungal infection, Steroid therapyINTRODUCTION
Pulmonary alveolar proteinosis (PAP) is a very rare entity characterized by accumulation of lipoproteinacious material in the alveoli which impairs gas exchange. [1] The incidence of PAP in the world is estimated to be around 0.2 cases per million. [1] To the best of our knowledge, not more than 13 cases were reported in Indian literature till now. [2,3,4,5] Infections with unusual organisms can occur in PAP with lungs being the most common site of infection. The alveolar macrophage dysfunction and intra alveolar accumulation of surfactant in these patients offers a good culture medium for the microbes.[6,7] Literature showed that approximately 5 to 13% of patients with autoimmune PAP present with these opportunistic infections. [7,8] These infections either precede or succeed the clinical course of PAP. The overall survival rate of PAP is very poor when complicated by these infections and the highest mortality is seen with fungal infections. [9] Here we present one such case of PAP complicated with fungal infection.
CASE HISTORY
A 48 year old female presented to us with progressively increasing exertional breathlessness for the past 6 months, with breathlessness at rest since the past 2 months. She was complaining of loss of appetite for the past 4 months. There were no complaints of fever, cough and hemoptysis. She was a non-smoker and there was no significiant history of environmental and occupational exposure. She was not a known diabetic or hypertensive. She was diagnosed with sputum negative pulmonary tuberculosis 2 years back and received anti tubercular therapy for 6 months. Before presenting to us, she was admitted in a local private hospital for similar complaints. Her chest radiograph showed extensive left lung consolidation with interspersed large nodular lesions and areas of patchy consolidation in the right lung (Fig.1A). High resolution computed tomography (HRCT) of chest showed extensive consolidation of left lung parenchyma with areas of crazy paving pattern. Right lung also showed patchy areas of ground glass opacities (Fig.1B and C). Based on these clinical and radiological findings, she was treated outside with antibiotics, steroids and supported with non invasive ventilation for 10 days duration and later referred to us in view of persisting respiratory distress. The patient was thin built and ill-nourished. Routine blood investigations were within normal limits. Chest auscultation revealed bilateral lung crepitations. Her arterial blood gas analysis showed hypoxia with type I respiratory failure. Viral markers for HIV and HBsAg were negative. Sputum examination was negative for acid fast bacilli and fungal elements. A repeat chest radiograph at our institute showed total opacification of left lung with patchy consolidation in the right mid zone (Fig.2A). Repeat chest CT showed extensive air space filling with crazy paving pattern in the left lung with multiple nodular lesions in the right lung and mild bilateral pleural effusions. (Fig.2B and C) In view of the clinical and radiological findings and persisting lung lesions, a differential diagnosis of pulmonary alveolar proteinosis or invasive mucinous adenocarcinoma of lung was considered. CT guided biopsy was obtained from both lung lesions on separate occasions due to varied morphology of the lesions in either lung. Sections from the biopsy obtained from right lung nodular lesion showed inflammatory exudate within the alveolar spaces and septae along with numerous narrow septate acute angle branching fungal hyphae. Some of these hyphal structures showed bulbous ends. These fungal hyphae were highlighted by silver methanemine stain. (Fig.3A-C) These features were consistent with invasive fungal infection possibly due to Aspergillus species. Biopsy obtained from left lung showed alveolar spaces filled with amorphous eosinophilic material. This material was PAS positive and diastase resistant. These findings were consistent with PAP. (Fig.3D-F) In view of above pathological findings patient was started on voricanazole. Her general condition did not improve and respiratory distress progressed in spite of antifungals and non invasive ventilatory support. Whole lung lavage (WLL) of left lung was done with 8 liters of saline under general anesthesia with double lumen endotracheal tube intubation, in view of her persisting respiratory distress. Her saturations improved and chest radiograph showed partial clearing of left lung opacities (Fig.2D). Further sequential lavage of the lung was planned, but she succumbed to sepsis with multiorgan failure.
DISCUSSION:
Three main categories of PAP are defined based on etiology. (i) Autoimmune/idiopathic PAP accounts for 90% of the cases and is characterized by loss of GM-CSF signaling due to presence of neutralizing GM-CSF auto antibodies. This leads to a state of functional deficiency which interferes with surfactant clearance mechanisms. [10] (ii) Secondary PAP may develop with chronic infections, hematological disorders, inhalation of dust and fumes and immunodeficiency disorders. In secondary PAP, there is acquired loss of GM–CSF signaling due to reduction in number or certain functions of alveolar macrophages. (iii) Congenital or genetic PAP is a autosomal recessive disease occurring in children and exhibiting a wide range of phenotypic variations. [6] PAP has a variable clinical course and presentation which can range from spontaneous resolution to progressive worsening. [11] Most of the patients present with progressive dyspnea on exertion although few of them are asymptomatic. Fever and hemoptysis are rare if present should suggest secondary infection. [6,10] Chest radiograph is often inconclusive which reveals bilateral symmetric, patchy, peri - hilar alveolar opacities without air bronchogram resembling pulmonary edema. [1] Chest CT is more diagnostic showing typical geographic pattern of ground glassing with superimposed septal reticulations forming a crazy paving pattern. Although the CT finding of crazy-paving is highly characteristic of PAP, it is also seen in many other conditions including left heart failure, pneumonia (especially pneumocystis pneumonia), alveolar hemorrhage, bronchoalveolar carcinoma, lymphangitic carcinomatosis, diffuse alveolar damage (adult respiratory distress syndrome), radiation or drug induced pneumonitis, hypersensitivity pneumonitis, and pulmonary veno-occlusive disease. Mediastinal lymph node enlargement, pulmonary nodules, pleural effusions and focal consolidation in the lung imaging are atypical and if present should suggest an opportunistic infection or malignancy. [12,13] The presence of interspersed nodular lesions and pleural effusions in the chest CT done after the administration of steroids suggested the possibility of superadded infection in our patient which was proved to be invasive fungal infection of Aspergillus species on histopathological examination. We consider infection to be a secondary event due to synergistic effect of inherent alveolar macrophage dysfunction, rich intra alveolar accumulation of surfactant offering a good culture medium for the microbes and to the administration of steroids. Literature also suggests that most of the infections encountered in PAP are secondary to the disease process rather than a primary event, as the lavage fluid samples were found to be microbiologically sterile in many patients. [7] In the present case, the appearance of the nodules after starting steroid therapy gives more credence to the role of steroids. The major complication of PAP is infections with opportunistic and unusual organisms like aspergillus species, nocardia, mycobacterium species, pneumocystis jiroveci and viruses which are responsible for significiant mortality if not diagnosed early and treated aggressively. [6] In a recent article by Punatar et al,[9] opportunistic infections preceded (40%), occurred simultaneously (27%) or followed (33%) the diagnosis of PAP. Lungs were the most common site involved and most common opportunistic infections were mycobacterial followed by fungal and nocardial species. The overall survival rate was found to be 56%, with mycobacterial being the greatest while the fungal carrying the poor survival with high mortality. The administration of steroids in PAP is found to be highly detrimental [6] as it can exacerbate these opportunistic infections as was seen in our case. GM-CSF cytokine plays a key role in the pathophysiology of PAP. GM-CSF by inducing terminal differentiation of alveolar macrophages can cause normal surfactant clearance mechanisms and certain functions of alveolar macrophages like antigen presentation and phagocytosis. [14] Concomitant neutrophilic dysfunction due to GM- CSF antibodies, defective chemotaxis and phagocytosis due to impaired alveolar function, superoxide production and secretion of pro inflammatory cytokines predisposes PAP to opportunistic infections. [6,14] The presence of anti GM- CSF antibodies in the BAL which can differentiate between primary and secondary PAP couldn’t be demonstrated in our case due to lack of availability. Although histopathological examination of lung tissue is gold standard, the diagnosis of PAP can be made confidentially by characteristic HRCT appearance along with typical BAL findings. [15] The typical appearance of milky white opalescent, viscous material in the bronchial lavage confirms the diagnosis. Histopathology usually reveals granular lipoproteinaceous material filling the alveoli which stains deep pink with PAS stain. [7] However BAL and lung biopsy are usually done to exclude infections in case of clinical suspicion. The presence of atypical radiological findings and diagnostic dilemma in the present case prompted for more invasive procedures like lung biopsy which demonstrated concomitant fungal infection along with PAP. Therapeutic whole lung lavage is the accepted standard of treatment in PAP. WLL, apart from physical removal of proteinaceous material, can improve alveolar macrophage function by correcting the defects in phagocytosis and migration thereby decreasing the risk of opportunistic infections. [16] Sufficient accumulation of surfactant to cause progressive respiratory failure or exercise desaturation warrants WLL. Other modes of treatment are exogenous administration of GM-CSF, which by restoring the functional availability could alter the natural course of the disease. Reducing the levels of anti GM – CSF auto antibodies with plasmapheresis and rituximab are under investigation. The therapeutic efficiency of all these, when compared to WLL is found to be inferior. [7]
CONCLUSIONS
Opportunistic infections can complicate the clinical course of PAP which is associated with high mortality. High index of suspicion, early diagnosis and aggressive treatment can prevent the adverse outcomes. The presence of nodules, pleural effusions and focal consolidations in lung imaging along with crazy paving pattern should prompt for more invasive procedures for diagnosing these infections. Corticosteroids can aggravate these opportunistic infections and should not be used during the management or in the initial suspicion of PAP. [6]
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of funding: nil
Conflict of interest: nil
Englishhttp://ijcrr.com/abstract.php?article_id=426http://ijcrr.com/article_html.php?did=4261. Borie R, Danel C, Debray MP, Taille C, Dombret MC, Aubier M. Pulmonary alveolar proteinosis. Eur Respir Rev 2011; 20: 98–107.
2. Khan A, Agarwal R, Aggarwal AN, Bal A, Sen I, Yaddanapudi LN et al. Experience with treatment of pulmonary alveolar proteinosis from tertiary care centre in north India. Indian J Chest Dis Allied Sci 2012; 54:91-7.
3. Hasan A, Ram R, Swamy T. Pulmonary alveolar proteinosis due to mycophenolate and cyclosporine combination therapy in a renal transplant recipient. Lung India 2014; 31: 282-4.
4. Chaudhuri R, Prabhudesai P, Vaideeswan P, Mahashur AA. Pulmonary alveolar proteinosis with pulmonary tuberculosis. Ind. J. Tub 1996; 43: 27-9.
5. Davis KR, Vadakkan DT, Krishnakumar EV, Anas AM. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia. Lung India 2015; 32: 162-4.
6. Shah PL, Hansell D, Lawson PR, Reid KB, Morgan C. Pulmonary alveolar proteinosis: clinical aspects and current concepts on pathogenesis. Thorax 2000; 55: 66-77. Seymour JF, Presneill JJ. Pulmonary alveolar proteinosis: Progress in the first 44 years. Am J Respir Crit Care Med 2002; 166: 215-35.
7. Inoue Y, Trapnell BC, Tazawa R, Arai T, Takada T, Hizawa N et al. Characteristics of a large cohort of patients with autoimmune pulmonary alveolar proteinosis in Japan. Am J Respir Crit Care Med 2008; 177: 752-62.
8. Punatar AD, Kusne S, Blair JE, Seville MT, Vikram HR. Opportunistic infections in patients with pulmonary alveolar proteinosis. J Infect 2012; 65: 173-9.
9. Trapnell BC, Whitsett JA, Nakata K. Pulmonary alveolar proteinosis. N Engl J Med 2003; 349: 2527-39.
10. Kariman K, Kylstra JA, Spock A. Pulmonary alveolar proteinosis: prospective clinical experience in 23 patients for 15 years. Lung 1984; 162: 223-31. Frazier AA, Franks TJ, Cooke EO, Mohammed TL, Pugatch RD, Galvin JR. From the archives of the AFIP: pulmonary alveolar proteinosis. Radiographics 2008; 28: 883-99.
11. Holbert JM, Costello P, Li W, Hoffman RM, Rogers RM. CT features of pulmonary alveolar proteinosis. AJR Am J Roentgenol 2001; 176: 1287-94.
12. Uchida K, Beck DC, Yamamoto T, Berclaz PY, Abe S, Staudt MK et al. GM-CSF autoantibodies and neutrophil dysfunction in pulmonary alveolar proteinosis. N Engl J Med. 2007; 356:567-79.
13. Bonella F, Bauer PC, Griese M, Ohshimo S, Guzman J, Costabel U. Pulmonary alveolar proteinosis: new insights from a single – center cohort of 70 patients. Respir Med 2011; 105: 1908-16.
14. Hoffman RM, Dauber JH, Rogers RM. Improvement in alveolar macrophage migration after therapeutic whole lung lavage in pulmonary alveolar proteinosis. Am Rev Respir Dis 1989; 139:1030-2.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareSALBUTAMOL NEBULISATION: IS IT A PREDISPOSING FACTOR FOR POSTOPERATIVE ATRIAL FIBRILLATION IN CORONARY ARTERY BYPASS GRAFTING PATIENTS?
English1619Megha ShahEnglish Hetal D. ShahEnglishBackground: Atrial fibrillation (AF) is one of the known complications of cardiac surgery and represents a major cause of morbidity. However, improvements in surgical and anaesthesia technique and controlling various predisposing factors have not helped to curb the incidence. Therefore, search is going on for various modalities to decrease the incidence.
Aim: This retrospective study was conducted to evaluate the risk of AF with nebulised ß2 agonists in postoperative cardiac bypass surgery patients.
Methods: In this observational study, data of 100 eligible patients operated for coronary artery bypass grafting (CABG) was collected. Patients were divided in two groups: Group A: Patients who had received postoperative nebulised salbutamol Group B: Patients who had not received postoperative nebulised salbutamol The data was analyzed for onset, duration, severity, treatment, outcome of post operative AF (POAF) and also regarding dose, duration of salbutamol.
Results: POAF occurred frequently in patients who had received nebulised salbutamol (pEnglishAtrial fibrillation, ß2 agonists, Post cardiac surgery patients, Salbutamol nebulisationINTRODUCTION
Atrial fibrillation (AF) is most common type of arrhythmia in post cardiac surgery patients; more common with valvular surgeries. It may cause hemodynamic disturbances and so increase in ICU stay and thus treatment cost. It can also increase stroke and other thromboembolic complications.(1) Post operative atrial fibrillation (POAF) has been associated with higher risk of postoperative congestive heart failure (CHF) and renal insufficiency. (2) Various preoperative factors like past history of AF, concomitant valvular disease and intraoperative factors like duration of surgery, intraoperative arrhythmia may increase risk of AF post surgery.(3,4) Increased catecholamine and ionic imbalance during the postoperative period may be associated with AF.(5) Other factors like pericardial inflammation, hypokalemia, systemic arterial hypertension could also increase risk.(6) However, the exact cause for AF post cardiac surgery is not well established. Hence, the search is on to find out other predisposing factors and preventing measures. A study (7) published in American journal of respiratory critical care medicine has showed an association between major cardiovascular events and ß2 agonists in asthma and chronic obstructive pulmonary disease (COPD) patients. They observed modest increase in risk of myocardial infarction (MI) in those taking ß2 agonists (OR=1.67). (7) Over many years, various cardiovascular adverse events, including MI, heart failure, ventricular ectopy, AF and sudden cardiac death resulting from ß2 agonists use in patients with COPD have accumulated.(8,9,10) However, the risk of AF with ß2 agonist is not confirmed in post coronary artery bypass grafting (CABG) patients. As ß2 agonists are used for excess respiratory secretions after cardiac bypass surgery, our study aimed to examine the risk of AF with nebulised ß2 agonists in post cardiac surgery patients.
MATERIALS AND METHODS
This observational, retrospective study was conducted at a tertiary cardiac care hospital, Gujarat. The study was in accordance with the Helsinki Declaration. Information about patients operated for CABG was obtained from case records and also verified with computer records during one year period. A well-designed case record form was used to collect the data of the recruited patients. Patients with risk for AF like concomitant valvular surgery, left main coronary artery disease , age>70 yrs, preoperative/ intraoperative arrhythmias (including AF) and hypo or hyperkalemia, COPD, Asthma, poor left ventricle (LV) function, recent MI, renal impairment, CHF, hypothyroidism, patients requiring IABP and longer duration of CPB(> 120 mins ) and aortic-cross clamp time were excluded . Also, patients on ß blockers and drugs with arrhythmogenic potential, diuretics, angiotensin converting enzyme (ACE) inhibitors or corticosteroids were excluded. Data of eligible patients were collected. Patients did receive their routine medications till the day prior to surgery except anticoagulants which were stopped three days prior as per institute protocol. All other variables like myocardial protection, closure of pericardium, elective maintenance of potassium and analgesia remained same in both the groups. The patients were given salbutamol or normal saline nebulisation therapy for lung recruitment, to remove excess respiratory secretions every 8 hrly for three days after surgery as per hospital protocol. Based on post CABG nebulisation exposure, data of total 100 patients was collected (equal number of patients taken in both groups):
Group A: Patients had received nebulised salbutamol post CABG (n= 50)
Group B: Patients had received saline nebulisation post CABG (n= 50)
Information about baseline characteristics of patients, CABG (on pump or of pump), occurrence of POAF and use of nebulisation in post-operative period was obtained from case record forms. In POAF patients details regarding onset, duration, treatment, outcome and other complications were also analysed.
Statistics Data analysis was performed using chi square test and student’s t test (Sigma stat 3.5software, trial version).The p Englishhttp://ijcrr.com/abstract.php?article_id=427http://ijcrr.com/article_html.php?did=4271. Hashimoto, Hsturp. Influence of clinical and hemodynamic variables on risk of supraventricular tachycardia after CABG. J Thorac Cardiovascular Surg. 1993; 56: 405.
2. Ma JP, Fontes ML, Tudor IC, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004; 291:1720- 9.
3. Chidambaram M, Akhtar MJ, Al-Nozha M, Saddique A. A relationship of atrial fibrillation to significant pericardial effusion in valve replacement patients. Thorac Cardiovascular Surg. 1992; 10 :70 -3.
4. Dimpi Patel, Marc A Gillinov, Andrea Natale. Atrial Fibrillation after Cardiac Surgery: Where are we now? Indian Pacing and Electrophysiology Journal. 2008; 8 (4): 281-91.
5. Steve ommen, John A. Odel, Marshall S. Stanton. Atrial arrhythmias after cardiothoracic surgery. NEJM. 1997; 336(20): 1429-34.
6. Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest. 2004; 125: 2309–21.
7. Au DH, Lemaitre RN, Curtis JR, Smith NL, Psaty BM. The risk of myocardial infarction associated with inhaled beta-adrenoceptor agonists. American journal of respire criti care med. 2000;161: 827-30.
8. Cazzola M, Matera MG, Donner CF. Inhaled beta 2-adrenoceptor agonists: cardiovascular safety in patients with obstructive lung disease. Drugs. 2005; 65(12):1595-610.
9. Appleton S, Poole P, Smith B, Veale A, Lasserson T, Chan M.
structive pulmonary disease. Cochrane Database Syst Rev. 2006;3:CD001104.
10. Salpeter SR, Buckley NS, Salpeter EE. Meta-analysis: anticholinergics, but not beta-agonists, reduce severe exacerbations and respiratory mortality in COPD. J Gen Intern Med. 2006; 21:1011-9.
11. Maisel WH, Rawn JD, Stevenson W. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135;1061-73.
12. B J Lipworth .Revisiting interactions between hypoxaemia and ß2 agonists in asthma. Thorax. 2001; 56 :567-9.
13. Carlos A. Viegas, Antoni Ferrer, Josep M. Montserrat, Joan A. Barbera, Josep Roca, Robert Rodriguez-Roisin. Ventilationperfusion response after fenoterol in hypoxemic patients with stable COPD. Lancet. 1990; 336 :1396-99.
14. Breeden C, Safirstein B. Albuterol and spacer induced atrial fibrillation. Chest. 1990; 98:762-3.
15. Crystal E, Connolly S, Sleik K et al. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: A meta- analysis. Circulation. 2002; 106:75-80.
16. Anderson PJ, Zhou X, Breen P, Gann L, Logsdon TW, Compadre CM, et al. Pharmacokinetics of (R,S)-Albuterol after aerosol inhalation in healthy adult volunteers. J Pharm Sci. 1998; 87: 841–4.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareGENDER DIFFERENCE ON BEHAVIORAL CHANGES AFTER COLD STRESS IN WISTAR ALBINO RATS
English2025B. ManikandanEnglish E. KayalvizhiEnglish Rupasri Dutt-RoyEnglish Damel LakshmiEnglish PriyadarshiniEnglish ChandrasekharEnglishAim of the study: To determine the effect of acute and chronic cold water swimming stress on male and female Wistar albino rats.
Materials and methods: This study was done in department of Physiology, MMCH and RI, Kanchipuram. 36 Wistar albino rats of both sexes were divided into six groups with six animals in each group. Group I and II control group male and female, group III and IV acute cold stress male and female, group V and VI chronic cold stress male and female respectively. Stress animals were subjected to cold stress by placing animals at 10 C until it sinks. After some interval animals were subjected to behavioral assessment by using standardized models as Elevated Plus Maze (EPM) and Open Field Maze (OPM).
Results: Statistical analysis of behavioral assessment showed significant changes in both acute and chronic cold stressed animals. In open field data showed significant increase in immobilization time (P< 0.05) accompanied with significant decrease in no. of rearing (P< 0.05) grooming (P< 0.05) and ambulation behavior both in peripheral (P< 0.05) and central squares in both male and female rats of all groups, In elevated plus maze there was a significant increase in transfer latency duration (P< 0.05) with closed arm duration (P< 0.05) significant decrease in open arm duration (P< 0.05 ) and number of times arms crossed (P< 0.05) in both male and female rats, but comparatively the female rats showed high significance of behavioral changes when compared to male rats. Simultaneously the group subjected to chronic cold stress showed more stressor level than acute group.
Conclusion: This study concluded that female rats exposed to chronic stress showed high stressor effect than acute and male rats on behavioral changes.
EnglishGender difference, Cold stress, Elevated plus maze (EPM), Open field maze (OPM).INTRODUCTION
Stress is a common factor observed long back and become popular in recent era. Stress affects almost all the systems of the body especially both behavior and physiology1 . Stressful conditions stimulate the hypothalamo pituitary adrenal (HPA) axis2 which in turn release the corticotrophin releasing hormone (CRH) which cause release of adrenocorticotropic (ACTH) from anterior pituitary that further stimulate the secretion of glucocorticoids from the adrenal cortex3,4. Stress alters homeostasis which involved in the pathogenesis of number of diseases like gastric ulcer5 , diabetes6 , hypertension, heart diseases7 , immuno–suppression8 , mental depression9 etc. The increased level of glucocorticoids is a prime marker of stress. Exposure to changes in temperature may alter the homeostasis. The changes in temperature might be hot or cold environment, when exposed extremely produces stress. The changes in temperature especially extreme cold affect negatively the performance and behavior of humans10. Extreme Cold exposure impairs motor performance11, 12, cognition13, 14, muscle endurance15 etc. The effect of stress altered due to duration like acute or chronic which might affects the homeostasis. The changes resulted after stress may vary depends upon the duration of the stress16.This leads to various changes in HPA axis reflected in changes in neuroendocrine system of the body like increased corticosterone17, increased free radicals18,altered behavior19, psychological changes20 etc., Behavioral changes are the important assessment of stress in recent times which found to be important marker of stress. The behavior was assessed by standardized behavioral models. Different animal models for stress have been developed recently and used frequently to evaluate the stress effect. The behavior models like Open Field maze, Elevated plus Maze will implement the effective changes after exposure to stress21. These behavioral models assess the changes including general loco motor activity and exploratory behavior. Animals exposed to acute or chronic stress might be altered according to the type of exposure. There was evidence that males and females respond differently to stress, which determined genetically. This dimorphic change in behavior is due to influence of genes, gonads, sexual hormones, influence on brain, social integration etc.22. The temperature changes especially cold also show sexual dimorphism. The cognitive function and voluntary motor function varies between male and female after exposure to stress. The aim of the present study is to investigate whether the cold stress shows sexual dimorphism in both and female rats. The rats exposed to cold stress of both acute and chronic type does influence the behavioral changes using standardized behavioral models.
MATERIALS AND METHODS
The experiment was carried out in the department of Physiology, Meenakshi Medical College Hospital and Research Institute, Enathur, Kanchipuram. The approval of Institutional Animal Ethical committee (Ref no: KN/COL/3410/2014) and care of experimental animals was taken as per CPCSEA guidelines. Wistar albino rats of both sex weighing 200 -300g were used for the study. The total number of animals used was 36 which was divided into 6 groups with 6 animals each group. Group I and II divided as control group for male and female, group III and IV as acute cold stress for male and female, group V and VI as chronic cold stress for male and female rats respectively. Group (III, IV, V, and VI) rats were subjected to both acute and chronic cold water swimming stress. Control group rats were left free in home cage with free access to food and waterto study baseline data in the same environment were stress to other group tobe performed.
Cold stress The cold stress test was conducted according to the method of Porsolt et al.(1978) the rats were forced to swim in a fresh water at 10? c were introduced into the container. Initially the response will be vigorous swimming and after few minutes their activity begin to subside and eventually they ceased to move and float an upright position making only small movements to keep their heads above the water. After some time the rat began to sink down then rat was taken out of water wiped with dry cloth and protected. After 20 minutes of standard recovery time the albino rats were subjected to behavioural studies.
Behavioral Assessment The changes in behaviour of rats following stress were evaluated by open field maze and elevated plus maze method.
Open Field Maze This is the classical model of loco- motor and exploratory activities (Bhattacharya and Satyan, 1997 and Takayoshi et.al, 2006).The apparatus for the open field test is a square enclosure made of wood. The field was a closed area which is divided into 25 spaces equally. The 100 W frosted bulb was placed above the field during the activity testing. The behavioral parameters of each rat were tested in a wake condition in open field Maze for 3 minutes. Testing was carried out in a temperature, noise and light controlled room. During the test procedure silence was maintained in the test room. The rats were placed in a cage in the testing room an hour before the test in order for them to acclimatize to the new environment31. The open field was cleaned with 70% ethanol after each rat had been tested individually. Throughout the entire testing-session, the sequence of events and procedures should always be the same and the test circumstances (handling, room-features, equipment used) were all standardized and controlled as possible. To analyze exploratory and loco motor activities as an indication of stress in the rat, animals were placed in the left rear quadrant of an open field. The number of line crossings and the total distance covered by the rat were measured. The more time the rat spends in the inner zone of the open field maze, and the more exploratory the rat is, the less stressed it is perceived to be32
I) Immobilization Time: It is the duration of time the rats were holding its head against the gravity but without movements of head, body or limb with opened eyes.
II) Grooming: Rhythmic paw movement over the face or head for face rubbing includes episodes of biting and cleaning of paws.
III) Rearing: Standing still on upright on its hind limb only
IV) Ambulation: When all the four limbs were in one particular square (central or peripheral) of the open field maze
Elevated Plus Maze
The maze had two open arms (50 cm X 10 cm) at right angle to it, two crossed arms (50 cm X 10 cm X 40 cm) with the roof uncovered an open central crossing (10cm X 10 cm) and was rising to a height of 50 cm from floor. The behavioral parameters of each rat were tested for 5 minutes in wake condition in Elevated Plus Maze by placing them at the end of an open arm are:
i) Transfer latency: Time taken by the animal to move from the outer end of the open arm to either of two closed arm
ii) Percentage time in open arm: The percentage of total testing time spent in the open arm
iii) Percentage time in closed arm: The percentage of total testing time spent in the closed arm
iv) Number of crossing of the arms: The number of times the animal crosses the center for going one arm to any other of three arms.
RESULTS
Statistical analysis was done by using statistical software package SPSS Windows Version 14.0. The results were expressed as Mean±SD if the variable were continuous. The two tailed student ‘t’ test was used for comparing control, acute and chronic stress groups. The P value Englishhttp://ijcrr.com/abstract.php?article_id=428http://ijcrr.com/article_html.php?did=4281. Robert J. Blanchard, Christina R. McKittrick, D. Caroline Blanchard.Animal models of social stress: Effects on behavior and brain neurochemical systems Physiology and Behavior 2001 feb 8; 261-271
2. Kvetnansky R., J. Jelokova, M. Rusnak, S. Dronjak, B. Serova, B. Nankova and E.L.Sabban. Novel stressors exaggerate tyrosine hydroxylase gene expression in the adrenal medulla of rats exposed to long-term cold stress”, in: Stress: Neural, Endocrine and Molecular studies.2002.Taylor and Francis, London, pp. 121-28002.
3. Pacak K1, Palkovits M, Kvetnanský R, Yadid G, Kopin IJ, Goldstein DS.Effects of various stressors on in vivo norepinephrine release in the hypothalamic paraventricular nucleus and on the pituitary-adrenocortical axis. 1995 Dec 29;771:115-30.
4. Venihaki M, Gravanis A, Margioris AN. Comparative study between normal rat chromaffinand PC12 rat pheochromocytoma cells: Production and effects of Corticotropin-Releasing Hormone. Endocrinology, 1997. 138(2): 698-704.
5. Roy MP, Kirschbaum C, Steptoe A.Psychological, cardiovascular, and metabolic correlates of individual differences in cortisol stress recovery in young men.Psychoneuroendocrinology. 2001 May;26(4):375-91
6. Yadin E, Thomas E. Stimulation of the lateral septum attenuates immobilization-induced stress-ulcersPhysiology and behavior.1996,59(4-5), pp. 883-886.
7. Fitzpatrick F1, Christeff N, Durant S, Dardenne M, Nunez EA, Homo-Delarche F. Glucocorticoids in the nonobese diabetic (NOD) mouse: basal serum levels, effect of endocrine manipulation and immobilization stress.Life Sci. 1992;50(14):1063-9.
8. Purret SB: Quantitative aspects of stress-induced immunomodulation. International Journal of Immunology and Pharmacology 2001; 1: 507-520.
9. Gareri P1, Falconi U, De Fazio P, De Sarro G Conventional and new antidepressant drugs in the elderly. Prog Neurobiol. 2000 Jul;61(4):353-96.
10. RimaSolianik, AlbertasSkurvydas, Dalia Mickeviciene, MariusBrazaitis. Intermittent whole-body cold immersion induces similar thermal stress but different motor and cognitive responses between males and females Cryobiology (2014)69.323–332.
11. E. Drinkwater, Effects of peripheral cooling on characteristics of local muscle. Medicine and sport science.2008.53:74-88.
12. S. Racinais, J. Oksa, Temperature and neuromuscular function. Scandinavian journal of medicine sports 20.(2010).1-18.
13. H.R. Lieberman, J.W. Castellani, A.J. Young, Cognitive function and mood during acute cold stress after extended military training and recovery. Aviation, space, and environmental medicine.80 (2009) 629–636.
14. R.M. Shansky, J.Lipps, Stress-induced cognitive dysfunction: hormone–neurotransmitter interactions in the prefrontal cortex, Front. Hum. Neurosci.7 (2013) 1–6.
15. S.B. Rutkove, Effects of temperature on neuromuscular electrophysiology, Muscle Nerve 24 (2001) 867–882.
16. Kioukia-Fougia N, Antoniou K, Bekris S, Liapi C, Christofidis I, Papadopoulou-Diafoti Z. The effects of stress exposure on the hypothalamic-pituitary-adrenal axis, thymus, thyroid hormones, and glucose levels.ProgNeuropsychopharmacolBiol Psychiatry. 2002;26:823–830.
17. NuriaDaviu , RaulAndero , Antonio Armario , RoserNadal, Sex differences in the behavioural and hypothalamic–pituitary–adrenal response to contextual fear conditioning in rats Hormones and Behavior 66 (2014) 713–723.
18. Claire Arnaud, Marie Joyeux, Catherine Garrel, Diane GodinRibuot, Pierre Demenge, and Christophe Ribuot.Free-radical production triggered by hyperthermia contributes to heat stressinduced cardioprotection in isolated rat hearts.Br J Pharmacol. 2002 Apr; 135(7): 1776–1782.
19. Martha M. Faraday.Rat sex and strain differences in responses to stress.Physiology and Behavior 75 (2002) 507– 522.
20. Iva Z. Mathewsa, Aleena Wilton , Amy Styles , Cheryl M. McCormicka et al., Increased depressive behaviour in females and heightened corticosterone release in males to swim stress after adolescent social stress in rats. Behavioural Brain Research 190 (2008) 33–40
21. Nitish Bhatia1, ParthaPratim Maiti1, AbhinitChoudhary et al., Animal models in the study of stress: A review. NSHM Journal of Pharmacy and Healthcare Management Vol. 02, February (2011) pp. 42-50.
22. G.M. Renarda, M.M. Sua´reza,, G.M. Levinb, M.A. Rivarola .Sex differences in rats: Effects of chronic stress on sympathetic system and anxiety. Physiology and Behavior 85 (2005) 363 – 369.
23. Thomas Campbella, Stacie Lina, Courtney DeVriesb, Kelly Lambert ., Coping strategies in male and female rats exposed to multiple stressors. Physiology and Behavior 78 (2003) 495– 504.
24. Halliwell, B., and Gutteridge . Free radicals in biology and medicine (3rd ed.). J. M. C. (1999); Oxford University Press.
25. Williams T.D.M., Carter D.A., Lightman S.L. Sexual dimorphism in the posterior pituitary response to stress in the rat. Endocrinology (1985) 116: 738-740.
26. Dai W.J., Yao T. Effects of dehydration and salt-loading on hypothalamic vasopressin mRNA level in male and female rats. Brain Res.(1995) 676: 178-182
27. Droste, S.K., de Groote, L., Lightman, S.L., Reul, J.M., Linthorst, A.C. The ultradian and circadian rhythms of free corticosterone in the brain are not affected by gender: an in vivo microdialysis study in Wistar rats. J. Neuroendocrinol. (2009). 21, 132–140.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareEFFECT OF ULTRASOUND ON PAIN IN AMATEUR SQUASH PLAYERS WITH PATELLOFEMORAL PAIN SYNDROME
English2630Anil T. JohnEnglish H.R. RaiEnglish Vinod KumarEnglish Jimshad T.U.EnglishObjectives of the study was to find out the effectiveness of Ultrasound therapy on pain in amateur squash players with patellofemoral pain syndromes. Total of 15 subjects (11 males and 4 females) were included in the study. All of the subjects were amateur squash players were diagnosed with chondromalacia patella by an Orthopedecian and referred for physiotherapy. Subjects who fulfilled the inclusion and exclusion criteria were selected by convenience sampling,. Informed consent was taken from each of the subjects prior to participation. Instructions were given to the subjects about techniques performed. A total of 15, subjects received UST exercises. Study concluded that UST along with exercises caused significant relief of pain and improvement in functional activity in amateur squash players with patellofemoral pain syndromes
EnglishPFPS, US, Squash playersINTRODUCTION
Patellofemoral pain syndrome (PFPS) is very common in active individuals. Sports medicine centers report that there is 25% to 40% PFPS in sporting population.1 The common characteristic Patellofemoral pain syndrome (PFPS) is pain in front of the knee which is increased by activities like walking up and down stairs, sitting with flexed knees for long periods, running, kneeling and squatting2 (PFPS) affects both athletes and non-athletes. PFPS patients complain that pain is aggravated by daily activities. Patellar crepitation, swelling and locking are other symptom. Patellofemoral pain syndrome can be caused by direct trauma to the knee, or the cause can be insidious in nature., such as poor hip rotation control, excessive foot pronation, femoral anteversion, tibial torsion, bone configuration, or tight muscles are thought to cause PFPS because of altered lowerextremity biomechanics Vastusmedialis oblique muscle dysfunction also has been proposed as a contributor to altered patellofemoral kinematics. 4 A critical review of squash epidemiological studies indicated that squash players most commonly report acute soft-tissue injuries at hospital emergency departments. Lower-limb injuries account for the majority of the injuries sustained by squash players. The knee and ankle joint are reportedly the most commonly injured body regions in squash. Some of the factors that may increase your risk of injury include age, poor fitness level, poor technique – puts unnecessary strain on joints and muscles.[18] Squash requires high-speed movements around the court while maintaining control over ball placement and is a high intensity sport. The players need large range of joint motion and velocity of limb action in order to hit the ball. the physical demands of the sport, the speed, size and physical properties of the ball, court surfaces, the confined area of play and close proximity of players while swinging a racket causes the risk of injury which is about 45%. [20] In this sport, 58% of injuries affected the lower limb. Injuries in squash players most frequently affected the knee, lumbar region, ankle and muscles, especially the calf. In comparison with the tennis (21%) and badminton (21%) Squash players face up more injuries (59%). On the other hand, injuries to the lower limbs in squash are common and relate to the acute physical stresses increase in the nature of the sport, as well as the more chronic overuse type of injuries. Since players are active for most time of the game, they may face more sport injuries.
[21]A study showed that knee injuries seen in squash players are collateral ligament (33%), patello femoral (23%), patella dislocation, meniscal (19%), cruciate ligament (6.8%) traumatic synovitis (9%) other (6.7%).[19] The American Physical Therapy Association’s Guide for Physical Therapist Practice recommends the use of therapeutic modalities for a variety of musculoskeletal conditions, including PFPS. A combination of physical therapy and NSAIDs (non-steroidal anti-inflammatory drugs) is also very effective in reducing pain for patients who are suffering from PFPS. Therapeutic ultrasound is one of many rehabilitation interventions available for reducing pain and inflammation. “Ultrasound is a form of mechanical energy consisting of high frequency vibrations”. These vibrations result in acoustic streaming and radiation forces, which enhance the flow of particles from one side of a cell membrane to the other. Thus, ultrasound increases cell permeability. Pulsed ultrasound is generally recommended for treatment of pain and inflammation in acute stages, while the continuous ultrasound is recommended for reducing the swelling. It has also been observed that patients who have been diagnosed with PFPS and who have neglected therapy have developed osteoarthritis of the knee joint. There has been a variety of treatments prescribed for relief pain in patients with PFPS but has been found to have recurred because of lack of fitness, so the aim of this study is to find out whether ultrasound has any effect in the reduction of pain of PFPS in amateur squash players.
Objectives of the study:-was to find out the effectiveness of Ultrasound therapy on pain in patellofemoral pain syndromes in amateur squash players.
Null hypothesis (Ho ): Ultrasound therapy will have no effect on pain in amateur squash players with patellofemoral pain syndrome
Experimental hypothesis (H1 ) Ultrasound therapy will have significant effect on pain in amateur squash players with patellofemoral pain syndrome,
METHODS
Total of 15 subjects (11 males and 04 females) were included in the study. All of the subjects were amateur squash players were diagnosed as chondromalacia patella by an Orthopedecian and referred for physiotherapy. All of the Subjects diagnosed with chondromalacia patellae who fulfilled the inclusion criteria were included. Subjects between the age group of 18 – 45 years, both males and females were included. And subjects who had exclusion criteria of any fractures in and around the hip, knee and ankle, Subjects diagnosed with osteoarthritis of knee, Subjects above 45 years of age, Subjects with any systemic diseases were excluded. An experimental pre- post study designed, all the patients were recruited from Squash center at Jayanagar 5th block, Bangalore. Total duration of the study was 8 months and pre post measurement of outcome assessed for statistical analysis. Subjects who fulfilled the inclusion and exclusion criteria were selected by convenience sampling,. Informed consent was taken from each of the subjects prior to participation. Instructions were given to the subjects about techniques performed. A total of 30, subjects received UST and exercises
Ultrasound Therapy: The subject underwent ultrasound therapy with an intensity of 1W/cm2 for 8 minutes using a pulsed mode 1: 1 ratio with frequency of 1MHz for 3 sessions per week was given for 4 weeks
Strengthening exercise
DAPRE REGIMEN: The Daily Adjustable Progressive Resistance Exercise(DAPRE) technique is more systematic and takes into account the different rates at which individuals progress during rehabilitation and conditioning programs. The system is based on a 6RM working weight. The adjusted working weight, which is based on maximum number of repetitions possible using the working weight in a set #3 of the regimen, determines the working weight of the exercise session.
Data Analysis
• Data analysis was performed by SPSS (version 17) for windows. The alpha value is set as 0.05.
• Descriptive statistics was used to find out mean, standard deviation and range for demographic and outcome variable.
• Wilcoxen signed Rank test will be used to find out the significant difference for ordinal scales within the group
• Paired t-test will be used to find out homogeneity for baseline and demographic and ratio outcome variable within the group.
• Chi square test was used to find out gender differences among the two groups. • Microsoft word, excel was used to generate graph and tables etc.
RESULTS
In the Group pre VAS mean is 7.00 with standard deviation of 0.53 and post VAS is 2.20 with standard deviation of 0.41 which was statistically significant to the p-value 0.001. Pre WOMAC score is 75.80 with standard deviation of 3.63 and Post WOMAC is 92.99 with standard deviation of 3.26 which was statistically significant with p-value 0.001 . Pre KUJALA is 72.67 with standard deviation of 5.29 and Post.
KUJALA is 92.47 with standard deviation of 2.56 which was statistically significant to the p-value 0.001.
Table 1 Data are number and percent of age. Mean percent of the Group between the age of 21 – 30 is 60 % and mean percent of Group between the age of 31 – 40 is 40 % . The number of subject within the age group of 21-30 is 9 and the number of subject within the age group of 31-40 is 6.
Table 2 Data are number and mean percent of gender. Mean percent of Males is 73.4 %. Number of male subjects is 11 and Mean percent of Females is 26.6, Number of female subjects is 4.
DISCUSSION
The purpose of the study was to find out the effectiveness of Ultrasound therapy on pain in amateur squash players with patellofemoral pain syndromes. Baseline data of demographic and outcome Variable did not show any significant difference in patient population. All the patients were able to finish the study. For the Group the Pre VAS Score was 7.00 and the Post test score was 2.20 following treatment and was statistically significant with p value 0.001. Also, the pre KPSS Score was 72.67 and the Post test score was 92.47 and was statistically significant with p value 0.001. Then, the Group Pre WOMAC was75.80 and the Post test score was 92.99 and was statistically significant with p value 0.001. Group was given ultrasound and strengthening exercises. The outcome measures used were VAS, KPSS and WOMAC. There was tremendous decrease in pain, increase in the KPSS score and increase in the WOMAC score. Pain reduction also enhanced patient compliance with the rehabilitation programme, and improved patients satisfaction and was used as an inexpensive adjunct to a rehabilitation programme in the management of PFPS. This is supported by study done by Hartley Therapeutic ultrasound is one of many rehabilitation interventions available for reducing pain and inflammation. “Ultrasound is a form of mechanical energy consisting of high frequency vibrations” These vibrations result in acoustic streaming and radiation forces, both of which enhance the flow of particles from one side of a cell membrane to the other. Thus, ultrasound increases cell permeability. As a result of stable cavitations ultrasound also “exerts mechanical stresses on the surrounding cells or other structures” This statistical significance in outcome was due to the healing effect of ultra sound which helps in reduction of pain and inflammation, this was also compounded with the fact that exercises helped in reducing the frictional forces of patella on lower end of femur and upper end of tibia, thereby giving the part rest as well as sufficient time for healing to take place. Heintjes EM, Berger M stated that effectiveness of exercise therapy in reduces anterior knee pain and improves knee function in patients with PFPS. Quadriceps strength is strongly associated with knee pain and disability in the community, even when activation and psychological factors are taken into account. This has important therapeutic implications.
Limitations of the study
The sample being small and convenient limits the population to which the results can be confidently applied, the duration of the study and the recommended sessions were less which again limits study, Long term follow up was not done.
Recommendations for further study The future scope of the study include the studies with a larger sample size should be conducted, studies with longer duration are recommended, recommendation for longer follow up for long term benefits, studies with different treatment combined with our treatment approaches can be done, different duration of exercises and ultrasound dosages can be used and studied further in treatment of PFPS.
CONCLUSION
UST along with exercises caused significant relief of pain and improvement in functional activity in amateur squash players with patellofemoral pain syndromes.
ACKNOWLEDGEMENT
Authors acknowledge the immense helprecieved from the scholars whose articles are cited and included in references in the 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=429http://ijcrr.com/article_html.php?did=4291. S.T. Green. Patellofemoral syndrome, Judah Street 2717, San Francisco, Journal of Bodywork and Movement Therapies (2005) 9, 16–26.
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5. Erik Witvrouw, S. Werner, C. Mikkelsen, D. Van Tiggelen, L. Vanden Berghe, G. Cerulli. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc (2005) 13: 122–130.
6. Heintjes EM, Berger M, Bierma-Zeinstra SMA, Bernsen RMD, Verhaar JAN, Koes BW. Exercise therapy for patellofemoral pain syndrome (Review).The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 1.
7. Cristina Maria Nunes Cabral1, Angela Maria de Oliveira Melim, Isabel de Camargo Neves Sacco, Amelia Pasqual Marques. Effect of a closed kinetic chain exercise protocol on patellofemoral syndrome rehabilitation, OuroPreto – Brazil, ISBS Symposium 2007;688.
8. Carina D. Lowry, Management of Patients with Patellofemoral Pain Syndrome Using a Multimodal Approach: A Case Series. Journal of orthopaedic and sports physical therapy | volume 38 | number 11 | November 2008 | 691.
9. Christian J. Barton, Hilton B. Menz. Evaluation of the Scope and Quality of Systematic Reviews on Non-pharmacological Conservative Treatment for Patellofemoral Pain Syndrome. Journal of orthopaedic and sports physical therapy | volume 38 number 9 September 2008 | 529.
10. McConnell J. The management of chondromalacia patellae: a long term solution. Aust J Physiother. 1986;32:215–223.
11. Mark Overington, Damian Goddard, Wayne Hing. A critical appraisal and literature critique on the effect of patellar taping – is patellar taping effective in the treatment of patellofemoral pain syndrome?.New Zealand Journal of Physiotherapy 34(2): 66-80.
12. Sheehan FT, Derasari A, Brindle TJ, Alter KE. Understanding patellofemoral pain with maltracking in the presence of joint laxity: complete 3D in vivo patellofemoral and tibiofemoral kinematics. J Orthop Res. 2008;27:561–570.
13. Wilson NA, Press JM, Koh JL, et al. In vivo and noninvasive evaluation of abnormal patellar tracking during squatting in patellofemoral pain. J Bone Joint Surg Am. 2008;91:558–566.
14. Boucher JP, King MA, Lefebvre R, Pepin A. Quadriceps femoris muscle activity in patellofemoral pain syndrome. Am J Sports Med. 1992;20:527–532.
15. Cowan SM, Bennell KL, Hodges PW, et al. Delayed onset of electromyographic activity of vastusmedialisobliquus relative to vastuslateralis in subjects with patellofemoral pain syndrome. Arch Phys Med Rehabil. 2001;82:183–189.
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21. Brosseau L, Casimiro L, Welch V, Milne S, Shea B, Judd M, Wells GA, Tugwell P. Therapeutic ultrasound for treating patellofemoral pain syndrome (Review). The Cochrane Library 2009, Issue 1.
22. Ann-Katrin Stensdotter, Paul W. Hodges, Rebecca Mellor, Gunnevi Sundelin, And Charlotte Ger-Ross, quadriceps. Activation in Closed and in Open Kinetic Chain Exercise. Submitted for publication December 2002.
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24. H. Minoonejad , R. Rajabi , E. Ebrahimi-Takamjani, M.H. Alizadeh, A.A. Jamshidi , A. Azhari and E. Fatehi . Combined open and closed kinetic chain exercises for patello femoral pain syndrome , randomized controlled trial.World Journal of Sport Sciences 6 (3): 278-285, 2012.
25. Bert M. Chesworth, E Lsie G. Culham, G. Elizabeth Tata, M Alcolm Peat. Validation of Outcome Measures in Patients with Patellofemoral Syndrome, 302 chesworth et al jospt, February 1989.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareNODAL NETWORK ANALYSIS TO ASSESS THE TRANSPORT EFFICIENCY THROUGH HIGHWAYS IN THE STATE OF WEST BENGAL
English3136Eshita BoralEnglish Sukla BhaduriEnglishTransportation network development is considered to be one of the keys to modernization and development. An efficient road network is inevitable for meeting the needs of a sound transportation system in the country. This paper seeks to derive the transport efficiency of selected nodes within West Bengal through the existing highway system in the state. The study of network includes an analysis of intersections or nodes with the help of connectivity and centrality indices. Results derived indicates that
with increase in number of highways within the state not only has the degree of connectivity between nodes enhanced but also has the accessibility, since nodes are becoming more and more centrally located in the system with the development of the integrated network of highways over the Road Plans.
EnglishNetwork analysis, Transport efficiency, Direct connectivity, Matrix, Degree of centralityINTRODUCTION
Transportation is a measure of relations between areas and therefore an important indicator of development of a region. Highway system induces changes in relative location of urban centers (Garrison, 1974). It has been observed that within the state of West Bengal intersections between highways or nodes lying along highways are the major centers of development. This can be related to the fact that highways support maximum traffic movement within the state and beyond for both passenger and freight. There has been a substantial shift in the mode of transportation from railways towards the road sector accounting to a rail-road ratio of 40:60 since 2005-06 (Directorate of Industries, 2008). Thus highways are increasingly gaining importance and their connectivity and accessibility within a state and with its neighbouring states are being directly related with the development of the area it passes through. The state of West Bengal has been of great significance in the eastern part of the country since the British rule. With Kolkata as the state capital as well as a port city, transport linkages with it were of importance for the northern and eastern part of the country. In this context it is necessary to analyze the efficiency of the transport network of the state in terms of highways, which is the most important category road in the country.
Objectives
This research work attempts to determine the competence of the highway network in the state through nodal perspectives.
The objectives of the paper therefore are –
i) To derive the direct connectivity linkages of the intersections within the highway system with one another.
ii) To determine the degree of centrality of the selected nodes.
iii) To analyze the transport efficiency of the state of West Bengal on the basis of its highway network.
Study Area
The research work is undertaken in the state of West Bengal, situated in the eastern part of India. The state, covering an area of 88752 sq. km and consisting of a total population of about 90,310,785, includes one of the major metropolis in the country, Kolkata. 17 National Highways and 19 State Highways run through the nineteen districts of the state.
MATERIALS AND METHODS
The materials for the study has been collected from Government of India organizations i.e. National Highway Authority of India (NHAI) and Census of India and Government of West Bengal organizations namely Public Works Department (PWD). The analysis of overall development of highway network in the state of West Bengal involves selection of certain nodes. Accordingly twenty six nodes are selected on basis of it being a District Head quarter and town greater in population than the District Head quarter, directly connected by either a National Highway or a State Highway. The regional highway network determines connection between these nodes. For the purpose of the study this system of highways has been developed into a topological map, where the line patterns or networks are described in terms of their topological characteristics, which do not rely so much upon distances and directions but rather upon contiguity, relative locations and systematization of lines and junctions (Saxena, 2010). Fig 1 depicts topological transformation of actual routes. It is necessary to mention that topological properties in a transportation system determine the efficiency of the transportation network if the system is idealized as a set of points (vertices) connected by a set of line segments (edges). Efficiency of transport network has been assessed through –
i) Degree of Direct Connectivity
ii) Degree of Centrality
DERIVATION OF TRANSPORT EFFICIENCY
The total length of the National and State Highways in West Bengal has been increasing over the years and so has their connectivity. More and more cities and towns have been linked with highways directly over the plan periods in the state. An analysis of these grouping of nodes makes it apparent that the linkage of nodes has been characteristic over the years. After independence roads were recognized as National Highways and there emerged five National Highways in West Bengal. State Highways were not yet recognized, however, few of the existent state roads served as excellent feeder to National Highways.
DEGREE OF DIRECT CONNECTIVITY
Direct Connectivity measures the number of direct connection of each node in terms of the linkage it establishes with any other nodes through the highways. For this purpose a matrix has been prepared where horizontal rows represent places of origin and vertical columns the places of destination. The number of rows and columns correspond to the total number of nodes in the network. This matrix is not without limitations. Roads extend even beyond political boundaries, but for the study it is necessary to determine the connectivity within specified boundaries which may lead to places near boundaries to have lesser connectivity which otherwise might emerge as a highly connected node. On basis of the twenty six selected nodes the connectivity measure has been determined. The degree of connectivity is represented as 1, depicting direct connections and 0, indicating absence of direct connections instead the nodes concerned are indirectly connected. The nodes are ranked hierarchically in terms of the magnitude of direct connections both in case of National Highways as well as State Highways. The higher the value of an individual node, the greater is its accessibility (Taffee et.al., 1973).
RESULTS FOR DEGREE OF CONNECTIVITY
Direct Connectivity Analysis, 1981 Transport efficiency measurement for 1981 indicated Haora as being the only node to have highest degree of connectivity with four direct connections. Number of direct connections for Siliguri and Kharagpur was two direct connections. Haldia emerged as an important transport node as it became the major port city after the decline of the Kolkata Port and established two direct connections with Kharagpur and Haora. This was made possible by the development of NH 41 under port connectivity project of NHAI connecting Haldia with NH 6. However as far as direct connectivity through State Highways were concerned the degree of direct connections between nodes was raised to a maximum of six by the end 1981(Table 1). Though seven nodes were yet to be linked with any State Highway, headquarters like Bankura, Medinipur and Barddhaman developed six, five and four direct connectivity respectively. Among the three, Bankura and Medinipur was not connected by any National Highway yet but had huge traffic movements that were supported by these State Highways few of which were converted to National Highway later. Kolkata still linked two nodes directly namely Diamond Harbour and South Dum Dum while Haora and Chinsurah developed three connections each being linked by the B.T. Road.
Direct Connectivity Analysis, 2012
Direct connectivity increased upto five, with Bankura and Siuri having the maximum direct connections alongside Haora (Fig 2a). These two nodes were centrally located and had to be crossed for east-west or north-south movement within the state. Thus upgradation of state roads connecting Bankura and Siuri to NH 60 were of great benefit to the state. It connected Durgapur, the industrial center of the state, directly with Bankura and Siuri extending the industrial benefits to the interior parts of Bankura and Birbhum districts. With emergence of NH 60 Durgapur developed four direct connections. The development of this single National Highway improved the direct connections of English Bazar and Berhampore as well. Upgradation of yet another state road to NH 55 linked Siliguri directly with Darjiling by a National Highway. Among the selected nodes Chinsurah and Serampur lost any connection with a National Highway due to the opening up of the Durgapur Expressway which linked Kolkata much faster with NH 2. The former route was turned into a State Highway. Therefore the direct connectivity of Haora with Barddhaman was established. Kolkata also increased its direct connectivity to three, linking Diamond Harbour through NH 117 which was converted to a National Highway in the Third Road Plan (1981 – 2001). Direct connectivity by State Highways emerged to a maximum of nine for three nodes i.e. Barddhaman, Bankura and Haora as seen in Fig 2b. As many as five State Highways were included in the already existing list of fourteen at the end of 2001, among which SH 13 and SH 15 ran through the district of Haora increasing its connectivity. This not only enhanced the within district connectivity of Haora but also connected city of Haora with other major district headquarters. Currently alongside Haora, Barddhaman and Bankura has emerged as nodes with very high direct connectivity because of their strategic location. Though Bankura connects to places mostly in the south and western part of the state, connectivity of Barddhaman extends to places even in the northern part of the state. Mention is to be made of Chinsurah which though lost connections with NH 2, with the shortcut created by Durgapur Expressway between Kolkata and Barddhaman, emerged as the node with as many as seven direct connections through State Highways namely SH 2 and SH 6. Other than Serampur which lie in the same district, Chinsurah also connected Siuri, Berhampore, Krishnagar, Barddhaman, Bankura and Medinipur directly. Siuri developed five direct connections, whereas Kolkata, Medinipur, Krishnagar and Berhampore displayed four direct connections each. Nodes like Koch Behar, Krishnagar, Durgapur, Asansol, Serampur, South Dum Dum and Rajpur-Sonarpur became directly linked with State Highways. Thus except for Haldia no other nodes lacked direct connectivity by any State Highway.
DISCUSSION FOR DEGREE OF CONNECTIVITY
In the period following independence emphasis was laid on integrating the system of National Highways with that of the State Highways. As a result the degree direct connectivity through National Highways was extended to a maximum of only four degrees while that with State Highways to six. State Highways were not distinctly recognized in the state by this time so direct connections between nodes through system of highways were somewhat limited. Emphasis on highway development in the consecutive Road Plan, focused on expanding the National Highway system including ten more National Highways to their list in the state by 2001. This was further strengthened after the establishment of NHAI in 1998, which was entrusted with the construction, maintenance and upkeep of important National Highways in the country. Consequently the degree of direct connectivity was developed. Moreover, in 1981 state roads serving as feeder to National Highways were recognized as State Highways therefore marked development in the performance of State Highways connecting important nodes were evident. At present National Highway development Project (NHDP) is under operation which have helped Siliguri to develop four direct connections, being linked by NH 31D under East-West corridor project. Furthermore, Barddhaman, Haora, Kharagpur, Medinipur linked by the Golden Quadrilateral project also showed immense development as far as direct connectivity measures are concerned.
DEGREE OF CENTRALITY
Degree centrality measures the proportion of node directly connected to the node in question out of the totality of nodes in the network. It identifies the average minimum number of transfers or degrees of separation, required to access every other node in the system. Another matrix has been prepared, wherein horizontal rows represent places of origin and vertical columns the places of destination. It considers the number of transfers necessary for a particular node to connect to any other node in the network. Otherwise it measures the shortest path distance between two nodes. The node which in connecting to all other nodes in the network derives shortest aggregate distance is the most accessible node. The centrality is then derived by the following formula –
It is related with the number of linkages that develop with time. Therefore it could be stated that the degree of centrality is related with that of degree of direct connectivity. Having assessed the development of highway network in the state over time and the changes in the degree of direct connectivity between the cities, consideration of degree of centrality would help to decipher the most benefited node in the system.
RESULTS FOR DEGREE OF CENTRALITY
Centrality Analysis, 1981 An analysis of the centrality for the selected twenty six nodes within the state of West Bengal shows that the nodes in northern mountainous region of the state namely Darjiling Siliguri, Jalpaiguri and Koch Bihar have greater accessibility scores being connected with south Bengal by a narrow region through which only a single highway, NH 31 pass. Higher values are also observed in the western and southern most nodes in the system, like Puruliya, Asansol, Diamond Harbour and Rajpur-Sonarpur. Therefore these nodes have very high centrality values being located at the extremes of the highway network in the state. Kharagpur, though a very important railway junction, was only connected by NH 6. Thus its accessibility through roads was limited during 1981. On the other hand nodes like Siuri, Barddhaman, Durgapur, English Bazar, Chinsurah were more centrally located and was well connected by National Highways viz. NH 2, NH 34 and NH 60, thus recorded lower accessibility scores and thus degree of centrality. It is to be mentioned here that Haldia, was yet to be connected by any highway till 1981.
Centrality Analysis, 2012
Accessibility scores reduced to a minimum of forty seven for Barddhaman, which in 1981 measured sixty eight, making it the central and the most benefited node in the network with degree of centrality as 1.88 (Table 2). Its central location caused most of the highways, be it either National or State Highway, to pass through the city. Accessibility scores improved for the nodes in the northern districts, however due to their extreme locations they displayed higher centrality values. Haldia got connected by NH 41, and by the inclusion of this single highway the node measured quite a central location. Chinsurah lying on SH 6, emerged as the second most centrally located node. Siuri shifted to the third position along with English Bazar and was followed by Haora, which too was very well connected by highways. Kolkata, the capital of the state was once a centrally located node, at which most traffic originates and terminates. However, due to the expansion of the state westward, it no longer holds the central most location, neither is it very well served by highways as in the case of Barddhaman and Chinsurah.
DISCUSSION FOR DEGREE OF CENTRALITY
A proper network of National and State Highways developed during the Bombay Plan. As a result direct connectivity between nodes became significantly strong. However, State Highways were only recognized during this phase and they were yet to fully influence the transport mobility in the state. Moreover their riding quality was yet to be upgraded to the standards of a highway. Thus values of centrality in 1981 indicate an accessibility which not fully integrated. With the development of new National and State Highways to enhance the direct connections between nodes and the improvement in the riding quality of the already integrated system of highways, every node became more easily connected with one another. Accessibility scores by 2012 being much lower as compared to 1981, signify a much more developed highway linkages.
CONCLUSION
The highways in West Bengal have not only been increasing in numbers but also in their ability to carry more and more traffic. The increased connectivity through highways within the state as well as with other states, have helped in urbanization and industrialization of the state thus contributing to its development. Both NHAI and PWD are working to maintain the standards of highways in the state, but lack of integration between the organizations have often caused distress to moving traffic. Thus inspite of the connections between them, accessibility declines between them. In order to derive the benefits out of the direct connectivity and centrality measurements, therefore a cooperative approach towards upgradation of highways within the state is of necessity at present.
ACKNOWLEDGEMENT
Authors would like to express sincere gratitude to the various organizations like NHAI, PWD and Directorate of Census Operations for providing the necessary data and information for undertaking this research. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. Authors are also grateful to the publishers of all those articles, books and journals from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=430http://ijcrr.com/article_html.php?did=4301. Government of India. Road Development Plan for India (1981 - 2001), New Delhi: Indian Roads Congress, Ministry of Shipping and Transport (Roads Wing); 1984
2. Government of West Bengal: Statistical Abstract, West Bengal, Kolkata: Bureau of Applied Economics and Statistics; 1985
3. Government of West Bengal (1990) : District Statistical Handbook, Bureau of Applied Economics and Statistics, Kolkata.
4. Government of West Bengal (2000) : District Statistical Handbook, Bureau of Applied Economics and Statistics, Kolkata.
5. Government of West Bengal (2011) : District Statistical Handbook, Bureau of Applied Economics and Statistics, Kolkata.
6. Government of India. Investment Industry and Trade in West Bengal, Directorate of Industries, Quarterly Bulletin. December 2007 and March 2008; VI(No. 3 and 4): 58-71
7. Saxena, H.M. Transport Geography. Jaipur: Rawat Publications; 2010
8. Taaffe, Edward. J, Guathier, Howard. L. and O’ Kelly, Morton. E. Geography of Transportation. New Jersey: Prentice - Hall, Inc.; 1973
9. Garrison, W.L. Connectivity of Interstate Highway System. In : Eliot Hurst, M.E., editor. Transportation Geography. 1st ed. New York: McGraw-Hill Book Company; 1974. p. 81 – 92.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareKNOWLEDGE RATE OF ARDABIL DENTISTS REGARDING DENTAL TREATMENTS IN PATIENTS UNDERGONE RADIOTHERAPY PROCEDURES
English3739Emran HajmohammadiEnglish Abolfazl BagheriEnglish Reza GhorbandoustEnglishRadiation therapy is the main treatment methods that can be used alone and in combination with other therapeutic methods. It is obvious that without dental care, complications of radiation therapy cannot be avoided, or reduce the severity of complications. The aim of this study was to assess the knowledge rate of Ardabil Dentists regarding Dental treatments in Patients undergone Radiotherapy Procedures
Methods and Materials: This cross-sectional study was performed on 120 Ardabil dentists. Data collected by a questionnaire by interview and then analyzed by SPSS.19. using statistical methods.
Results: 58.3% of dentists were female and the mean age of dentists was 22.6±7. The mean time from graduation was 6.1±5.4 years. 51.7% of dentists had moderate knowledge. There was no significant relation between graduation, age and sex of dentists with knowledge.
Conclusion: Results showed that the knowledge of dentists in Ardabil about patients undergoing radiation was in moderate level, Therefor we recommend some established educational programs in this field.
EnglishDental treatment, General dentist, RadiotherapyINTRODUCTION
Radiotherapy is a treatment for cancer that uses high-energy radiation and high-dose radiation to kill cancer cells and prevent their spread. (1) Radiation therapy can be external or internal; sometimes some patients receive both types. More than 60% of cancer patients undergoing radiation therapy and radiation therapy can be used to treat, stop or reduce the growth of cancer cells. (2) During radiotherapy, oral mucosa show as soon as the effects of treatment. Changes in and around the oral cavity due to damage delicate vascular system, often is changed in dentistry. Salivary glands, and bones are relatively resistant to radiation therapy but due to the severe weakening of the tissues occurs in the vascular system, these sites can be tolerated a significant problem in the long-term use. (3) One of the most serious and the most problematic symptom for patients with head and neck cancer radiotherapy is Osteonecrosis. Radiation, bone endarteritis (inflammation of the inner lining of the arteries) that leads to tissue hypoxia induced and hypo cellularity. (4) It is obvious that without special care dentistry, we cannot prevent the complications caused by radiation therapy or reduced the severity of unavoidable complications. Dental care should begin before radiotherapy by physical examination and appropriate treatment plans for each patient, doing radiotherapy time and continue after the end of radiotherapy. Dentists, before radiotherapy should be examined the patient’s mouth and provide appropriate treatments for teeth’s storage and extraction and with prescription appropriate mouth rinse and advice on rise oral hygiene, reduce mucositis in the mouth. Also about dry mouth, decreased pain and irritation can be recommended to use water, glycerin and captopril as a prophylaxis for patients. The use of anti-fungal agents such as Nystatin, can lead to reduce oral Candida infection in these patients. Therefore patients should be monitored at all stages by dentists so that in case of incidence radiation side effects, there was controlled quickly. (5) The aim of this study was to assess the knowledge rate of Ardabil Dentists regarding Dental treatments in Patients undergone Radiotherapy Procedures.
METHODS
This was a descriptive cross-sectional study that has been done on a sample of 120 dentists in Ardabil city at 2014. The sampling method was census and the data collected by a questionnaire include question about knowledge rate which was completed by interview with dentists. The knowledge rate divided in four levels week, moderate, high and very high. Collected data analyzed by statistical methods in SPSS.19 and for measure the significant relation between variables we used Chi-Square test. The pEnglishhttp://ijcrr.com/abstract.php?article_id=431http://ijcrr.com/article_html.php?did=4311. Langendijk JA, Bijl HP. Late radiation-induced side effects. In: Harari PM, Connor NP, Grau C. Functional preservation and quality of life in head and neck radiotherapy. Heidelberg:Springer.2009; pp: 227-4.
2. Taheri M, Najafi MH, Salehi Mh. Clinical evaluation of the effects of radiotherapy on oral mucosa and gingival health in radiotherapy of Ghaem hospital. Journal of Mashhad Dental School 2006; 30(1-2):87-98.
3. Nevil BW, Dam DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 3rd ed. ST. Louis Elsevier Inc;2009; p:429-43.
4. Sheets NC, Goldin GH, Meyer AM, et al. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA. 2012;307(15):1611-1620.
5. Rabiei M, Rahimi A, Kazemnezhad Leyli E, Jalalian B, Massoudi Rad S. (Complication of post radiation in patients with head and neck cancer). J Gorgan Uni Med Sci. 2014; 16(2): 114- 120. [Article in Persian]
6. Daniel Henrique Koga, João Victor Salvajoli. Dental extractions related to head and neck radiotherapy: ten-year experience of a single institution.2008; 105(5): 1-6.
7. AM Frydrych, LM Slack-Smith, JH Park and AC Smith Expertise Regarding Dental Management of Oral Cancer Patients Receiving Radiation Therapy Among Western Australian Dentists 2012;70(7):197-207.
8. Ogama N, Suzuki S, Umeshita K, Kobayashi T, Kaneko S, Kato S, et al. Appetite and adverse effects associated with radiation therapy in patients with head and neck cancer. Eur J Oncol Nurs. 2010 Feb;14(1):3-10.
9. Jennifer M., Schuurhuis A, Monique A., Stokman A, Efficacy of routine pre-radiation dental screening and dental follow-up in head and neck oncology patients on intermediate and late radiation effects. A retrospective evaluation 2011;101(1):403-409.
10. Niall M.H. McLeod, Michael C. Bater, Peter A. Brennan, Management of patients at risk of osteoradionecrosis: results of survey of dentists and oral and maxillofacial surgery units in the United Kingdom, and suggestions for best practice 2010;48(5):301-304.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareBILATERAL UNDESCENDED TESTES : ITS CLINICAL SIGNIFICANCE
English4042Jeneeta BaaEnglish J. S. PrustiEnglishCryptorchidism is a condition in which one or both the testes have not reached the scrotal sac. During routine dissection of an unclaimed middle aged male cadaver, we found bilateral undescended testes. The testes were located at the superior inguinal ring and both the scrotal sacs were empty. An empty scrotum raises suspicion of a number of testicular anomalies. Early diagnosis and intervention is necessary as testicular variations can result in many diseased conditions like testicular torsion, tumors and cancers
EnglishSuperficial inguinal ring, Retractile testis, Empty scrotum, InfertilityINTRODUCTION
Testes are a pair of male gonads which begins its development at 6 weeks of intrauterine life in the posterior abdominal wall and is completed by the 5th month of intrauterine life. Differential growth of the embryo in intrauterine life causes certain organs to ascend and some to descend for functional reasons. During descent into the scrotal sac the testis can be arrested anywhere along its normal path. Cryptorchidism is a condition in which one or both the testes have not reached the scrotal sac. If it deviates from its normal path of descent, the condition is known as ectopic testis [1].
CASE REPORT
During routine dissection, we noted bilateral undescended testes in an approximate 50 years old male cadaver. Both the testes were found at the superficial inguinal ring. The dimensions observed were : Right testis : length-5.5 cm, width-3 cm, thickness-1.3 cm and Left testis: Length-5.7cm, width-3.5 cm, thickness-2 cm. Both the scrotal sacs were found to be empty.
DISCUSSION
The descent of testes occurs in two phases under the control of different factors [2]. The anti-mullarian hormone influences the trans-abdominal phase whereas the gubernaculum guides the inguino-scrotal phase. The testis appears in the iliac fossa by the fourth month of fetal life, in the deep inguinal ring at the seventh month, in the inguinal canal during eighth month and in the scrotum at birth [1, 3]. According to a study in 223 patients, the most common abnormal location was the high scrotal position in 44% of patients, in 26% it was the superficial inguinal pouch, in 20% at the inguinal canal and in 10% it was in the abdomen [4]. In the present case both the testes were found arrested at the superficial inguinal ring. If undescended at birth, the testis completes its descent in the first three months of life. Therefore 3-5% of the full term babies with undescended testes show a reduced incidence of 0.8% by three months of age [5]. Incidence of undescended testes is approximately 1 in 1000 to 1 in 2500 [6]. Factors like exposure to maternal estrogen in fetal life, deficiency of androgen, inadequate internal secretions, genitofemoral nerve function failure, low intraabdominal pressure and lack of differential growth are also known to cause the condition [7].The commonest cause is believed to be a defect in prenatal androgen secretion secondary to either deficient pituitary gonadotrophin stimulation or low production of gonadotrophins by placenta[8]. Cryptorchidism is a part of several chromosomal anomalies like Prader willi syndrome, Klinefelter syndrome, Laurence moon-biedl syndrome, Lowe syndrome. In trisomy13 and trisomy15, 50% of the male infants have undescended testes whereas it is less frequently seen in trisomy18 and trisomy21 [9]. It is also associated with inguinal hernia, renal anomalies and other male genital organ deformities. An empty scrotum can be due to testicular anomalies like absent testis, undescended testis, ascended testes, nonpalpable testes, ectopic testis, and retractile testis. Non-palpable testes, if bilateral are difficult to diagnose. In such a case intersex anomalies must be ruled out and possibility of anorchia must be considered [9]. Approximately 20% of cryptorchid testes cannot be palpated on physical examination as they are associated with a patient processes vaginalis are thus show reasonable degree of mobility [10]. A retractile testis is due to an overactive cremasteric reflex. It’s diagnosis is made if the testes that is undescended has earlier been seen in the scrotum. Such reflex contraction of the genitofemoral nerve due to tactile stimulation is present in all boys after age 2 years [11].So these patients belong to an age group of 2-6 years. An ascended testes results from limited ability of the spermatid cord to elongate. Iatrogenic ascent is also a common finding in upto 10% cases after repair of indirect inguinal hernia and after liposuction of the prepubic fat pad for buried penis repair [12].
CONCLUSION
Men with undescended testis have a lower sperm count, poor quality of sperms and low fertility rates [1]. In the present case we could not get any family history as it was an unclaimed body. Undescended testis have higher chances of development of germ cell tumor than the normal and the incidence increases with advancement of age [13 ].Early detection of the cause by imaging techniques like ultrasonography, CT scan , MRI ,spermatic venography and laparoscopy therefore becomes necessary . Surgical intervention (Orchiopexy) as early as six month of age can prevent testicular cancer. Hormonal therapy can distinguish a retractable testes from a congenital undescended testes. In addition, it is equally beneficial because hormone stimulation may restore a normal testicular function after surgery. It is often assumed that a descended testes remains descended permanently. However there are documented cases in which previously descended testes have been found to ascend permanently out of the scrotum [14].The mechanism behind this ascent is unknown. Clinicians must therefore be aware that finding a scrotal testes does not rule out the future possibility of its ascending out again.
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=432http://ijcrr.com/article_html.php?did=4321. Keith L. Moore, T.V.N.Persaud- The Urogenital System. In:chapter 12, The Developing Human-Clinically Oriented Embryology, 8th ed. Philadelphia Saunders Inc,2008: 279-281.
2. Kolon TF, Patel RP Huff DS(2004). “Cyptorchidism:diagnosis, treatment, and long-term prognosis”. Urol. Clin. North Am. 31(3):469-80, viii-ix. doi:10.1016/j.ucl.2004.04.009.PMID 15313056.
3. Susan Standring- Male Reproductive system. In:Chapter 97, Neil R. Borley editor-Gray’s Anatomy. 39th ed. Edinburgh: Elsevier Churchill Livingstone, 2005: 1306.
4. Scrorer CG,Farrington GH:Congenital deformities of the testis and epididymis. NewYork;Appleton-Century-Crofts,1972.
5. Steven G Docimo, Richard I Silver and William Cromie-The Undescended Testicle: Diagnosis and Management. The American Academy of Family Physicians Nov 1 2000 ;2047.
6. Pinczowski D, McLaughlin JK, Lackgren G, Adami HO, Persson I. Occurrence of testicular cancer in patients operated on for cryptorchidism and inguinal hernia. J Urol. 1991:146:1291-4.
7. A.K. Datta-The Urogenital System. In Chapter 16-Essentials of Human Embryology. 5th ed.Kolkata:Current Books International Publication ,2005:238-241.
8. Husmann DA, Levy JB. Current concepts in the pathophysiology of testicular undescent. Urology1995; 46(2): 267-276.
9. Micropenis, Hypospadias,and Cryptorchidism in Infancy and childhood. Kenneth L Becker (ed).Principles and Practice of Endocrinology and Metabolism, 3rd ed. USA: Lippincott Williams and Wilkins; 2001. pp. 912.
10. Mital V K, Garg Brijendra K. Undescended testicle. The Indian Journal of Pediatrics 1972; 39(5):171-174.
11. Caesar RE,Kaplan GW.The incidence of the cremasteric reflex in normal boys.J Urol 1994;152:779-780.
12. Kaplan GW.Iatrogenic cryptorchidism resulting from hernia repair. Surg Gynecol Obstet 1976;142:671-672.
13. Moller H, Cortes D, Engholm G, Thorup J (1998).Risk of testicular cancer with cryptorchidism and with testicular bio. PMC: 28664. psy: cohort study. BMJ 317 (7160): 729. PMID 9732342.
14. Mayr J, Rune GM, Holas A, Schimpl G, Schmidt B, Haberlik A. Ascent of the testis in children. European Journal of Pediatrics 1995; 154(11):893 .
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareCULTURAL CAPITAL IN HEALTHCARE DELIVERY: FROM PATIENT-PROVIDER PERSPECTIVE IN NIGERIA
English4346Nduka Uzoma C.EnglishHealthcare delivery system in Nigeria has been replete with decadence and decay. Overwhelmed persistently by several social inequalities and inequities, the system continues to receive backlashes in spite of spirited efforts by concerned professional groups to revamp it. Healthcare delivery in Nigeria still remains a labor-intensive industry rather than the less complicated, technologically-enhanced one (Obansa, 2013). In addition, healthcare delivery in Nigeria is supplied through a weak conduit
(National Strategic Health Development Plan, 2009). Government has been accused of not being sincere in injecting health into the healthcare system. Thus, the growing perception by the public of some concerted efforts at some quarters to create unequal care in the society (Shim, 2010). But a variable that needs to be factored in into this schism could be the influence of cultural capital in patient-provider interaction. This article will essay to explore the multifaceted nature of patient-provider involvement and its ramifications within the context of Bourdieu’s conceptual model of cultural capital.
EnglishSociety’s symbolic, Cultural capital theory, Cultural capital in healthcareWHAT IS CULTURAL CAPITAL?
Coined by Pierre Bourdieu, a French sociologist, cultural capital connotes an avalanche of artistic, aesthetic, and innate knowledge held by individuals in a community (Dunt, Hage, and Kelaher, 2010; Khawaja and Mowafi, 2007; Smith-Morris and Epstein, 2014). The concept of cultural capital has also been described and defined as interpersonal competence and shibboleth received via interactions with the society and being able to make and show treasured normative behaviors and knowledge (Vorhies, Davis, Frounfelker, and Kaiser, 2012). Bourdieu’s idea of cultural capital show that social stratification contributes to social inequities (Ergin, n.d.) and that cultural competence consists of linguistic and cultural elements (Dumais, 2002). As a cultural signal, including such things as attitudes, preferences, formal knowledge, behaviors, goods, and credentials, cultural capital has been used to examine relationships between so many social and health outcomes (Byun, Schofer, and Kim, 2012; Hernandez and Grineski, 2012; McCrone, 2005). Finally, cultural capital, according to (Fismen, Samdal, and Torsheim, 2012) is an embodiment or repertoire of society’s symbolic and informational resources that could have an impact on health behaviors.
CULTURAL CAPITAL THEORY
The theory of cultural capital presages that success or failure are both tied to either the possession or lack of cultural capital. For instance, success in education equals possession of cultural capital while failure in education exemplifies absence of such capital (Sullivan, 2002). In addition to the bifocal presentation of cultural capital is the issue of social class. Two fundamental fulcrum of Bourdieu’s cultural capital theory are the “field” or the environment and the “habitus” or how the individual perceives the world (Dumais, 2002; Ringenberg, McElwee, and Isreal, 2009). These two factors shape or determine the degree of cultural capital. It is crucial to consider the function of the environment in which the individual resides and how this social ambiance shapes the individual’s worldview when analyzing the patient-provider paradigm (the social action) in healthcare delivery system.
As Fig. 1 above illustrates, the field or environment, in relation to this discussion, could be explained as the community, city, village, town, state one lives in. On the other hand, the habitus could be described as one’s decision to interact, reveal, and explain every details of one’s health condition with the healthcare provider (nurse, physician, dietician, pharmacist, dentist, etc) for the recipient and giver to make informed healthcare decisions. This decision to interact fluently and openly with the healthcare professional could be guided by the field or environment in which one comes from. Transmitted tradition and received culture could bar an individual, especially those who live in the village or suburbs, not to tell his or her healthcare provider every detail of her health issue. This could result into wrong diagnosis and treatment. But with exposure to city life and interaction with technology and people, there are chances that someone who lives in the city could be more open with the healthcare provider than someone from the village. Thus, the likelihood for good prognosis and treatment. Cultural capital theory has three core elements or attributes. These three states of cultural capital, as shown in Fig. 2 below, are institutionalized, objectivized, and incorporated (Abel and Frohlich, 2012; Abel, n.d.).
Incorporated cultural capital is invisible, personally acquired or learned, and associated with the innate biological traits of the individual. In other words, incorporated cultural capital comprises all the stored skills and knowledge of the individual that can be acquired through the culture. The other subcategories, objectivized and institutionalized are equally linked to the incorporated cultural capital. By objectivized cultural capital we mean things that represent knowledge and has been accumulated over time in a culture or society such as a book. Finally, institutionalized cultural capital simply means the formal recognition or acknowledgement of the cognitive skills and pragmatic competence exemplified through the acquisition of a college degree. Since Bourdieu, there has been criticisms about the empiricism of Bourdieu’s theory of cultural production (Dumais, 2002; Holt, 1997). All these trilaterally related states of cultural capital could help healthcare and public health practitioners develop clinical and population health programs. DISCUSSION Patient-centered care is all about the patient and the patient’s healthcare needs (Epstein and Street, 2011; Reynolds. 2009). To have a successful outcome while attending to the patient and his needs, there should be an understanding of the patient’s cultural knowledge, skills, needs, values and preferences (Dubbin, Chang and Shim, 2013) and a built trust between the patient and the healthcare professional. This trust enhances openness on the patients’ part and confidentiality and ability to deliver best care on the healthcare professional’s part. This dual-patriate deal reinforces patients’ empowerment. But empowerment cannot occur in a vacuum. An interaction to enable understanding of the patients’ perspectives and the environment that shapes the patient’s worldview must occur. Full exchange of information and understanding of the information being exchanged determines the individual’s health outcome (Shim, 2010). In other words, during clinical encounters, both the patient and the clinicians are expected to possess this package called cultural health capital. Healthcare literacy, knowledge and understanding of medical resources could enhance health outcomes and increase patient-provider interaction. Given the dictates of cultural capital, individuals who are less educated could be prone to subjugation by the dominant culture and may have a lowlevel medical assistance or care (Vikram, Vanneman, and Desai, 2012). The educated population have greater propensity to navigate the ever changing healthcare system, especially in the developed worlds. Understanding of several cultural products such as eating habits, educational levels, verbal skills, acts as forms of capital to patient-practitioner conversation (Dubbin, Chang and Shim, 2013). Furthermore, building this bridge of understanding may involve living between two tracks from the patient perspective. For example, one may be trapped between choosing a lived experience embodied in what has been transmitted or passed on from parental knowledge and skills and the culture of the healthcare system as explained by the nurses, pharmacists, physician, and other healthcare professionals (Smith-Morris and Epstein, 2014). In Nigeria, for instance, physicians have been perceived to have the notion that they know what is best for the patient and, therefore, limiting the patient’s input in his or her care (Udonwa and Ogbonna, 2012). The above notion could foreclose seamless interaction between the physician and the patient and may not provide room for understanding of the cultural capital. Moreover, 95% of patient’s treatment are decided by the physician with less patient involvement (Onotai and Ibekwe, 2012). Healthcare literacy should be broadened to include understanding of the patient’s field and habitus by healthcare professionals. Acquiring this knowledge-based competency by nurses, doctors, dentists, pharmacists, and other allied healthcare workers may enhance health promoting behaviors among patients (Abel, n.d.). Health literacy may be approached as a dual mechanism that might result into health gain. In this sense, the patient and the provider works towards understanding each other’s environment and worldview. Healthcare workers, especially in a diverse culture like Nigeria, may begin to decipher whether handing out brochures, leaflets, promotional pamphlets, using the internet suits the patient’s learned environment and habitus. As herculean and utopian as this may be, the goal may be working towards a net gain for all players. Presently, the healthcare delivery system in Nigeria is doctor-centered. In other words, the physician makes the diagnosis and treatment with little or no patient involvement. So, the doctors bring into the medical practice their cultural capital via their field and habitus. Abiola, Udofia, and Abdullahi (2014) has described this as paternalistic or asymmetric relationship between doctors and patients. This physician paternalism has been replicated in Brazil, a developing country like Nigeria, where the focus of medical students is not on the interactional skills or humanistic attitudes rather on biomedical subjects (Ribeiro, Krupat, and Amaral, 2007). The paternalistic physician behavior has been described as being beneficial to the patient because the doctor pays attention to holistic medicine (Israel, 2014). Doctor-patient relationship in some Nigerian hospitals have been described as dialogical and transactional with a mention of understanding the field and habitus of the patient (Adegbite and Odebunmi, 2006).
CONCLUSION
This article builds on existing literature to buttress the importance of cultural capital in healthcare promotion and patientprovider interaction in Nigeria. Given the backdrop of events in the healthcare system in Nigeria, time is of the essence to finding practical panaceas to the ailing industry. One of such solutions may be using cultural capital in fostering better partnership between patients and healthcare professionals. The debate in relation to cultural capital in health promotion may portray two divergent perspectives of the impact of this variable on health outcomes. Future research may establish whether promoting cultural capital could improve health for all and strengthen patient-provider partnership in the Nigerian healthcare landscape.
ACKNOWLEDGEMENT
Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of Funding This work received no funding from any organization, agency, or body.
Conflict of Interest No conflict of interest
Englishhttp://ijcrr.com/abstract.php?article_id=433http://ijcrr.com/article_html.php?did=4331. Abel, T., and Frohlich, K.L. (2012). Capitals and capabilities: linking structure and agency to reduce health inequalities. Social Science and Medicine, 74(2012), 236-244.
2. Abel, T. (n.d.). Cultural capital in health promotion. Retrieved January 20, 2015 from World Wide Web: http://eknygos.lsmuni. lt/springer/685/43-73.pdf.
3. Abiola, T., Udofia, O.M and Abdullahi, A. (2014). Patient-doctor relationship: the practice orientation of doctors in Kano. Nigerian Journal of Clinical Practice, 17(2), 241-247.
4. Adegbite, W., and Odebunmi, A. (2006). Discourse tact in doctor-patient interactions in English: an analysis of diagnosis in medical communication in Nigeria. Nordic Journal of African Studies, 15(4), 499–519.
5. Byun, S.Y., Schofer, E., Kim, K.K. (2012). Revisiting the role of cultural capital in East Asian educational systems: the case of South Korea. Sociology of Education, 85 (3). Retrieved January 20, 2015 from World Wide Web: http://web.b.ebscohost.com. ezp.waldenulibrary.org/ehost/resultsadvanced?sid=f03bcf76- 0ad7-4e97-8d5d-6766693e2ecc%40sessionmgr113andvid=11a ndhid=106andbquery=cultural+capitalandbdata=JmRiPW1uaC Z0eXBlPTEmc2NvcGU9c2l0ZQ%3d%3d.
6. Dubbin, L.A., Chang, J.S., and Shim, J.K. (2013). Cultural health capital and the interactional dynamics of patient-centered care. Social Science and Medicine, 93:10.
7. Dumais, S.A. (2002). Cultural capital, gender, and school success: the role of habitus. Sociology of Education, 75(1), 44-68.
8. Dunt, D., Hage, B., and Kelaher, M. (2010). The impact of social and cultural capital variables on parental rating of child health in Australia. Health Promotion International, 26(3), 290-301. 9. Epstein, R.M., and Street, R.L. (2011). The values and value of patient-centered care. Annals of Family Medicine, 9(2), 100- 103. 10. Ergin, M. (n.d). Taking it to the grave: gender, cultural capital, and ethnicity in Turkish death announcements. Omega, 60(2), 175-197. 11. Fismen, A., Samdal, O., and Torsheim, T. (2012). Family affluence and cultural capital as indicators of social inequalities in adolescent’s eating behaviours: a population-based survey. BMC Public Health, 12:1036. 12. Hernandez, A.A., and Grineski, S.E. (2012). Disrupted by violence: children’s well-being and families’ economic, social, and cultural capital in Ciudad Juarez, Mexico. Pan American Journal of Public Health, 31(5), 373-379. 13. Holt, D.B. (1997). Distiction in America? Recovering Bourdieu’s theory of tastes from its critics. Poetics, 25: 93-120. 14. Israel, P.C. (2014). A study of power relations in doctor-patient interactions in selected hospitals in Lagos State, Nigeria. Advances in Language and Literary Studies, 5(2), 177-184. 15. Khawaja, M., and Mowafi, M. (2007). Types of cultural capital and self-rated health among disadvantaged women in outer Beirut, Lebanon. Scandinavian Journal of Public Health, 35(5), 475–480. 16. McCrone, D. (2005). Cultural capital in an understated nation: the case of Scotland. The British Journal of Sociology, 56(1), 65-82. 17. National Strategic Health Development Plan. (2009). The National Strategic Health Development Plan Framework (2009- 2015). Retrieved January 18, 2015 from World Wide Web:http://www.internationalhealthpartnership.net/fileadmin/uploads/ihp/Documents/Country_Pages/Nigeria/Nigeria%20National%20Strategic%20Health%20Development%20Plan%20 Framework%202009-2015.pdf.
18. Obansa, S.A. (2013). Health care financing in Nigeria: prospects and challenges. Mediterranean Journal of Social Sciences, 4(1), 221-236.
19. Onotai, L.O., and Ibekwe, U. (2012). The perception of patients of doctor-patient relationship in otorhinolaryngology clinics of the University of Port Harcourt Teaching Hospital (UPTH) Nigeria. Port Harcourt Medical Journal, 6(1), 65-73.
20. Reynolds, A. (2009). Patient-centered care. Radiologic Technology, 81(2), 133-147.
21. Ribeiro, M.M., Krupat, E., and Amaral, C.F. (2007). Brazilian medical students’ attitudes towards patient-centered care. Medical Teacher, 29(6):e204-e208. 22. Ringenberg, M., McElwee, E., and Isreal, K. (2009). Cultural capital theory and predicting parental involvement in Northwest Indiana schools. The South Shore Journal, 3:86-124.
23. Shim, J.K. (2010). Cultural health capital: a theoretical approach to understanding health care interactions and the dynamics of unequal treatment. Journal of Health and Social Behavior, 51(1), 1-15.
24. Smith-Morris, C., and Epstein, J. (2014). Beyond cultural competency: skill, reflexivity, and structure in successful tribal health care. American Indian Culture and Research Journal, 38(1), 39-58.
25. Sullivan, A. (2002). Bourdieu and education: how useful is Bourdieu’s theory for researchers? The Netherlands’ Journal of Social Sciences, 38(110), 144-166.
26. Udonwa, N.E., and Ogbonna, U.K. (2012). Patient-related factors influencing satisfaction in the patient-doctor encounters at the General Outpatient Clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria. International Journal of Family Medicine, 2012 (2012), Article ID 517027. http://dx.doi. org/10.1155/2012/517027.
27. Vikram, K., Vanneman, R., and Desai, S. (2012). Linkages between maternal education and childhood immunization in India. Social Science and Medicine, 75(2), 331–339.
28. Vorhies, V., Davis, K.E., Frounfelker, R.L., and Kaiser, S.M. (2012). Applying social and cultural capital frameworks: understanding employment perspectives of transition age youth with serious mental health conditions. The Journal of Behavioral Health Services and Research, 39(3), 257-270.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareA RARE CASE OF TEMPOROMANDIBULAR JOINT ANKYLOSISDUE TO BURN INJURY IN CHILDHOOD
English4750S. WakeelEnglish Ajaz A. ShahEnglish IsrarEnglish Latief NajarEnglish AnwarEnglish FarahEnglishAnkylosis of the temporomandibular joint (TMJ) is an extremely disabling affliction. TMJ ankylosis is most commonly associated with trauma (13-100%), local or systemic infection (10-49%), or systemic disease (10%). We are presenting 13 yr old female unilateral TMJ ankylosis due to burn injury at age of four years treated conservatively. Burn injury at early age and lack of jaw physiotherapy with subsequent fibrosis and contracture favoured development of ankylosis.
EnglishTemporomandibular, Trauma, Radiotherapy, Clavicular osteochondral graftsINTRODUCTION
Ankylosis is a Greek terminology meaning ‘stiff joint’.It can be defined as “inability to open mouth due to either a fibrous or bony union between the head of the condyle and the glenoid fossa”. Ankylosis of the temporomandibular joint (TMJ) is an intracapsularunion of the disc-condyle complex to the temporal articular surface that restricts mandibular movements, including the fibrous adhesions or bony fusion between condyle, disc, glenoid fossa, and eminence (1). It causes disturbances of facial and mandibular growth, and acute compromise of the airway invariably resulting in physical and psychological disability [2]TMJ ankylosis is most commonly associated with trauma (13-100%), local or systemic infection (10-49%), or systemic disease (10%), such as ankylosing spondylitis, rheumatoid arthritis, and psoriasis. Trauma, radiotherapy, surgical excision of TMJ tumors, infection, andsystemic disease can all result in mandibular hypomobility [4]. The treatment of TMJ ankylosis poses a significant challenge. Proponents of interpositional arthroplasty have used a variety of materials. Chossegros et al 5 have reported good results with full-thickness skin grafts and temporalis muscle flaps and poor results with homologous cartilage.Wonderful results with costochondral grafting have been reported (3).
CASE REPORT
We are presenting a case of 13 year old female who reported to our department with complain of inability to open the mouth. On examination maximum mouth opening 4mm, condylar movements were absent on right side condyle, assymtric face and deviation towards right side. Examination reveals burn mark on right side temporal region and around temporomandibular joint with a history of burn injury on right side face at age of 4 years fig 1. Patient has no history of trauma during childhood or ear discharge/infection or any other bone and joint diseases or any autoimmune condition. OPG reveals absence of joint space and bony union between condyle and glenoidfossa. CT reveals bony union and graded as type 2 according to Sawhney’s classification fig 2. Burn injury was treated by conservative means .Treatment plan formulated as interpositional gap arthoplasty and ipsilateral coronoidectomy. The surgical exposure was by means of a preauricular incision Alkayat and Bramely combined with an extended temporal incision. When the ankylosed joint was exposed fig3, liberal resection of the ankylotic joint and coronoid process and burring of the glenoid fossa created a gap of at least 15 mm between the roof of the fossa and the mandible fig 4. Surgical resection of ankylotic mass [gap arthoplasty] and placement of interposition material temporomyofacial flap and also coronoidectomy of ipsilateral side MMO =36mm achieved intra operatively fig 5. Jaw exercises began as early as 24 hours postoperatively and advised to follow jaw exercise physiotherapy strictly and with periodic follow up. Patient has 2 year followup without recurrence.
DISCUSION
The main causes of TMJ ankylosis are trauma and infection (2,3). Estimates of a traumatic origin range from 26% to 75% and of infection from 44% to 68% [2]. Rare causes of ankylosis are systemic disease, rheumatoidarthritis, psoriaticarthritis, Mariestumpell disease and burn. In burn injurydeep as well as subcutaneous tissues in the vicinity of burns are subjected to severe damage. Soft-tissue fibrosis is a common problem and may be followed by calcification and ossification 7. Patients with burns from thermal or electrical injury may develop bony ankylosis. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction 8. Untreated TMJ ankylosis in children results in significant adverse consequences. Interpositional arthroplasty with autogenous or alloplastic material at the osteotomy site is a mechanism for preventing recurrence (3,9,10). Various materials have been used suchas skin, dermis , flaps of the temporal muscle/fascia (2), silicone (9,10,) and cartilage . TMJ reconstruction may be necessary for patients with extensive osteotomy and consequently insufficient ramus height,and can be performed with costochondral grafts, clavicular osteochondral grafts, iliac crest grafts, coronoid processgrafts and alloplastic condylar implants (3,9). Aggressive physiotherapy should be recommended in order to disrupt and prevent adhesions, prevent soft-tissue contractions and redevelop normal muscle function .Regardless of the surgical approach used to gain access to the TMJ, the final dissection places the facial nerve at risk for damage (11,12). A loss of function of the frontalis and orbicularis oculi muscles is always a possibility (11). The incidence of complications such as permanent injury of the facial nerve is 1.5 to 32% (12), usually disappearing within 6 months
CONCLUSION:
Usually the cause of ankylosis is trauma and infection around temporomandibular joint but it was rare case of ankylosis due to burn injury at an early age,that result in contracture and subsequently decreased movements and hypomobility of condyle, predisposing the temporomandibular joint to ankylosis [mmo=4mm].T reated by interpositional gap arthoplasty using temporomyofascial flap as glenoid fossa lining to prevent recurrence and ipsilateralcoronoidectomy done to achieve mouth opening of 35mm,followed by aggressive physiotherapy. Patient has 2 year followup without any complication.
Englishhttp://ijcrr.com/abstract.php?article_id=434http://ijcrr.com/article_html.php?did=4341. Long X, Li X, Cheng Y, Yang X, Qin L, Qiao Y, et al. Preservation of disc for treatment of traumatic temporomandibular joint ankylosis. J Oral Maxillofac Surg. 2005 Jul;63(7):897-902.
2. Chidzonga MM. Temporomandibular joint ankylosis: review of thirty-two cases. Br J Oral Maxillofac Surg. 1999 Apr;37(2):123- 6.
3. Kaban LB, Perrott DH, Fisher K. A protocol for management of temporomandibular joint ankylosis. J Oral Maxillofac Surg. 1990 Nov;48(11):1145-51.
4. Kaban LB, Troulis MJ (eds): Pediatric Oral and Maxillofacial Surgery. Philadelphia, PA, WB Saunders, 2004, p 469 1.
5. Chossegros C, Guyot L, Cheynet F, Blanc JL, Gola R, Bourezak Z, Conrath J. Comparison of different materials for interposition arthroplasty in treatment of temporomandibular joint ankylosis surgery: a long term follow-up in 25 cases. Br J Oral Maxillofac Surg 1997;35:157-60.
6. Gunaseelan R. Condylar reconstruction in extensive ankylosis of temporomandibular joint in adults using resected segment as autograft: a new technique. Int J Oral MaxillofacSurg 1997;26:405-7.
7. Rubin M M, Cozzi GM. Ankylosis following burn injury of face; J Oral MaxillofacSurg 1986(44) 11:897-9 8. Paul F. Balen, C.A. Helms. Bonyankylosis following thermal and electrical injury. Skeletal Radiol. 2001;30(7):393-7.
9. Erdem E, Alkan A. The use of acrylic marbles for interposition arthroplastyin the treatment of temporomandibular joint ankylosis: follow-up of 47 cases. Int J Oral Maxillofac Surg. 2001 Feb;30(1):32-6.
10. Matsuura H, Miyamoto H, Ogi N, Kurita K, Goss AN. The effect of gap arthroplasty on temporomandibular joint ankylosis: An experimental study. Int J Oral Maxillofac Surg. 2001 Oct;30(5):431-7.
11. Schobel G, Millesi W, Watzke IM, Hollmann K. Ankylosis of the temporomandibular joint. Follow-up of thirteen patients. Oral Surg Oral Med Oral Pathol. 1992 Jul;74(1):7-14.
12. Politi M, Toro C, Cian R, Costa F, Robiony M. The deep subfascial approach to the temporomandibular joint. J Oral Maxillofac Surg. 2004 Sep;62(9):1097-102.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareIDENTIFICATION OF UROVIRULENT MARKERS IN UROPATHOGENIC ESCHERICHIA COLI
English5154D. Vijaya BharathiEnglish R. Lakshmi KumariEnglish G. Rajya LakshmiEnglish Supriya PandaEnglishContext: Escherichia coli is the most frequent urinary pathogen isolated from uncomplicated urinary tract infection. These isolates express chromosomally encoded virulence markers.
Aims: The present study was designed to determine the urovirulence factors of E.coli isolated from the patients of urinary tract infection and to study their antimicrobial susceptibility pattern.
Methods and Material: The study was conducted in the department of microbiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, from October 2010 to September 2011.One hundred and fifty E.coli strains isolated from urine samples and fifty faecal isolates were studied for 1) alpha haemolysin on 5% sheep blood agar, 2) mannose resistant haemagglutination,3) cell surface hydrophobicity, 4) antibiotic susceptibility testing by Kirby-Bauyer’s disc diffusion method.
Results: Among 150 E.coli isolates from urine tested 82 (54%) and out of 50 E.coli isolates from stool (control), 10 (20%) were positive for virulence markers. In the urinary isolates, the most common virulent marker was Haemolysin 59 (39%), followed by Mannose Resistant Haemagglutination (MRHA) 47(31%) and Cell Surface Hydrophobicity (CSH) 43 (28%). In control group, the occurrence of Haemolysin was 3 (6%), MRHA 6 (12%), CSH 9(18%). The difference between cases and controls for Haemolysin and MRHA were significant. (pEnglishUropathogenic E. coli, Urovirulent markers, Urinary tract infectionINTRODUCTION
Urinary tract infection is one of the most important causes of morbidity and mortality. Escherichia coli is the most frequent urinary pathogen isolated from 50%-90% of all uncomplicated urinary tract infection [1]. It is now recognized that there are subsets of faecal E.coli which can colonize periurethral area, enter urinary tract and cause symptomatic disease. These are currently defined as Uropathogenic Escherichia coli. It has been traditionally described that certain serotypes of E.coli were consistently associated with uropathogenicity and were designated as uropathogenic E.coli [2]. These isolates express chromosomally encoded virulence markers. The virulence factors include different adhesins, haemolysin production, haemagglutination and cell surface hydrophobicity. Fimbriae mediate the ability of E.coli to adhere to the uroepithelium, thereby resisting elimination by the flow of urine. Adhesion is therefore considered to be an important step in the pathogenesis of urinary tract infection [3]. The studies on the virulence factors of uropathogenic E.coli is limited. So, the present study was designed to determine the urovirulence markers of E.coli isolated from the patients of urinary tract infection and to study their antimicrobial susceptibility pattern.
MATERIALS AND METHODS
The study was conducted in the department of microbiology, Rangaraya Medical College, Kakinada, East Godavari district from October 2010 to September 2011 after taking ethical clearance from Institutional Ethics Committee..One hundred and fifty E.coli strains isolated from urine samples and fifty faecal isolates were studied for 1) alpha haemolysin on 5% sheep blood agar 2) mannose resistant haemagglutination 3) cell surface hydrophobicity 4) antibiotic susceptibility testing by Kirby-Bauyer’s disc diffusion method.
Inclusion criteria
Adult patients with urinary tract infection (UTI) attending various clinical departments of RMC and adult healthy individuals for stool samples are taken.
Samples: 1. Clean-catch midstream urine samples from the patients (n=150) 2. Stool samples of adult healthy individuals (n=50).
Collection and culture of sample: Sample is transported to Microbiology laboratory within half an hour and processed by 1) Wet film preparation for pus cells 2) Culture on Mac Conkey’s agar, Blood agar and Cysteine-Lactose-ElectrolyteDeficient (CLED) agar medium and incubated aerobically at 370 C for 24 hrs 3) Growth on plates and significant bacterial count (i.e. more than 105 colonies / ml of urine) was tested for further identification of E.coli by various biochemical reactions [4] .Such E.coli were screened for virulence markers
Hemolysin: The cytolytic protein secreted by most haemolytic E.coli is known as alpha haemolysin [5]. For detecting haemolysin, 5% sheep blood agar (BA) is used and a zone of alpha haemolysis around each colony is observed after overnight incubation at 370 C aerobically, if haemolysin is produced.
Mannose resistant haemagglutination (HA): HA is detected by clumping of erythrocytes by bacterial fimbriae in the presence of D-Mannose. The test was carried out as per the direct bacterial HA test slide method and mannose sensitive and resistant HA tests [6]. The strains of E.coli were inoculated into 1% nutrient broth and incubated at 37ºc for 48 hours for full fimbriation. Human blood group O+ve red blood cells (RBC) were then washed thrice in normal saline and made up to 3% suspension in fresh saline. They were used immediately or within a week when stored at 3º-5ºc. The slide haemagglutination test was carried out on multiple concavity slide. One drop of RBC suspension was added to a drop of broth culture and slide was rocked to and fro at room temperature for 5 minutes. Presence of clumping was taken as positive for haemagglutination. Control for MSHA is ATCC 25922 and for MRHA in-house control is used. HA was considered to be mannose resistant when it occurred in the presence of 2 % D- mannose and mannose sensitive, when it was inhibited by D-mannose.
Cell surface hydrophobicity: This was done by Salt aggregation test [7]. E.coli grown on Mac Conkey plates was inoculated on to 1ml phosphate buffered saline(PBS) at pH6.8 and turbidity was matched with Mc Farland tubes 6 and 7 to get a colony count 5×109 col/ml. Different molar concentrations of ammonium sulphate 1M,1.4M,2M was prepared. Forty µL PBS at pH 6.8 was taken in first coloumn of VDRL slide. Forty µL of 1M, 1.4M, 2M concentration of ammonium sulphate was taken in each well of other columns of VDRL slide. Forty µL of E.coli suspension is added to each of these wells. The clumps formed in different molar concentration of ammonium sulphate were seen by naked eyes. Positive control used was a strain of E.coli which was haemolytic, MRHA+ve, positive for cell surface hydrophobicity. Negative control used was a strain of E.coli which was non lytic, MRHA-ve, negative for cell surface hydrophobicity. Strains were considered hydrophobic, if they were aggregated in concentration of < 1.4 M. ammonium sulphate.
Antibiotic susceptibility testing: This was performed on all isolates of E.coli by Kirby-Bauer`s disc diffusion method on Muller Hinton agar according to clinical and laboratory standard institute (CLSI) guidelines.
Results:
In the present study, out of the 150 patients, 0 – 15 years age group comprised of 42 persons, 16 - 40 years age group comprised of 51 persons and > 40 years group comprised of 57 persons. Females (96) were more than male (54) patients. Among various clinical entities, 84cases presented with lower UTI (56%), 36 cases with asymptomatic bacteriuria (24%), 18 cases presented with renal failure (12%) and 12 with pyelonephritis (8%). Among 150 E.coli isolates from urine tested 82 (54%) were positive for virulence markers and out of 50 E.coli isolates from stool (control), 10 (20%) were positive for virulence markers. Among the urinary isolates tested, the most common virulent marker was Haemolysin 59 (39%), followed by Mannose Resistant Haemagglutination (MRHA) 47(31%) and Cell Surface Hydrophobicity (CSH) 43 (28%). In control group, the occurrence of Haemolysin was 3 (6%), MRHA 6 (12%), CSH 9(18%). There are 38 cases positive for 1 marker, 21 cases positive for 2 markers and 23 cases positive for 3 markers. Ninety two percent isolates were sensitive to amikacin, 85 % to nitrofurantoin, 61 % sensitive to cefotaxime, 28 % to cotrimoxazole. High resistance was seen for ampicillin (91%) followed by norfloxacin (85%) and cefuroxime (82%). Statistical analysis used: Significance of the occurrence of virulence markers in cases and controls was compared by Chi Square test. P value less than 0.05 was considered significant.
Discussion:
Considering the high degree of morbidity in urinary tract infection the uropathogenic E.coli is receiving the more attention and it is important to identify UPEC isolates in the urinary samples [2]. Regarding the positivity of virulence markers, in the present study 54% of urinary isolates were positive for various types of virulence markers indicating their uropathogenicity, whereas 20 % of faecal isolates which were taken as controls were positive for virulence markers (pEnglishhttp://ijcrr.com/abstract.php?article_id=435http://ijcrr.com/article_html.php?did=4351. Steadman R., and Topley N. 1998. The virulence of Escerichia coli in Urinary tract. Chapter 3 In: Urinary tract infections, 1st ED, Brumfitt W. JeremyMT, Hamilton Miller, Eds, (Chapmanand Hall publication, London). 3741.
2. Raksha R., and Srinivasa, N. 2003. Occurrence and characterization of uropathogenic E.coli in urinary tract infections, Indian. J. Med. Microbiol. 21 (2): 102–107.
3. Struve C., and Krogfelt K.A. 1999. In vivo detection of Escherichia coli type-1 fimbrial expression and phase variation during experimental urinary tract infection. Microbiol. 145:2683-90
4. Cowan and Steel’s Manual for identification of Medical bacteria, 3rd ed. Eds. Barrow Gl, Feltham RKA. Eds. (University of Cambridge) 1993.
5. Cavalieri S.J., Bohach GA and Snyder, I.S. 1984. Escherichia coli alpha haemolysin: characteristics and probable role in pathogenicity. Microbiol. Rev. 48:326-343.
6. Duguid J.P., Clegg S and Wilson MJ.1979. The fimbrial and non-fimbrial haemagglutinins of Escherichia coli . J. Med. Microbiol. 12:213-27.
7. Lindahl M, Faris A, Wadstrom T, Hjerten S. A new test based on salting out to measure relative surface hydrophobicity.
8. Yasmeen Kausar, Sneha K Chunchanur ,Shoba D Nadagir, LH Halesh and MR Chandrasekhar. Virulence factors, Serotypes and antimicrobial susceptibility pattern of Escherichia coli in urinary tract infections.Al Ameen Journal of Medical Sciences(2009) 2(1):47-51
9. Smith,H.W,1963.The hemolysin of Escherichia coli, J Pathol Bact.85:197-211
10. Prabhat Ranjan, K., Neelima Ranjan, Arindam Chakraborthy, D R Arora. 2010. An Approach to Uropathogenic Escherichia coli in Urinary Tract Infections. J. Lab. Physic.2, issue2:70-73.
11. Jonson, J.R. Virulence factors in Escherichia coli urinary tract infections. Clin. Microbiol Rev. 1991. 4:81-128.
12. Mudd S, Mudd EBH. The penetration of bacteria through capillary spaces IV. A kinetic mechanism in interfaces J Exp Med 1924;40:633-45.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareANTIOXIDANT ACTIVITY (IN-VITRO) OF CALOTROPIS PROCERA EXTRACT FROM ARID REGIONS OF RAJASTHAN
English5559Sangeeta LoonkerEnglish Wasim A. QadriEnglish Jasmine SinghEnglishAim: To study in-vitro antioxidant activity of Calotropis procera.
Methodology: The evaluation of antioxidant activity was done using 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging activity via Double Beam UV-Visible Spectrophotometer.
Result: The IC50 values in leaves, fruits and flowers of Calotropis procera were found to be 16.08, 16.06 and 10.31μg/mL respectively.
Conclusion: The results explore the strong antioxidant activity of Calotropis procera which can be harvested by medical and pharmaceutical industries for curing several diseases.
EnglishCalotropis procera, Antioxidant activity, DPPH, DiseasesINTRODUCTION
Calotropis procera is a wild shrub found in tropics of Asia and Africa. It is commonly called as ‘Akra’ in Rajasthan (India) and grows upto a height of 1-3m long with broad10-13cm wide and 17-19 cm long cutaneous leaves.1 It is traditionally used as a medicinal plant in India.2 The latex of Calotropis is used in the treatment of leprosy, eczema, inflammations, malarial and low hectic fevers3 while the leaves, fruits and roots are used in rheumatism, as anti-inflammatory, antimicrobial, antioxidant and hepatoprotective agents. The flowers are found to be effective in asthma, piles and malaria. 4-10 With this view the present research work is concentrated on evaluation of antioxidant activity of Calotropis procera. Antioxidant protects human body against oxidative stress and damage to all types of biomolecules like proteins, lipids and nucleic acid caused by overproduction or inefficient elimination of Reactive Oxygen Species (ROS). 11-12 Scientific evidences reveals that antioxidants play an important role in reducing the risk for chronic diseases including cancer and heart diseases.13
MATERIALS AND METHODS
i. Collection of plant materials and their extraction: The leaves, fruits and flowers of the plant were collected from local areas of Rajasthan. The shade dried materials were then pulverized separately to 40 mesh size, 100g each of which were then extracted in 500mL methanol using a soxhlet extractor. Finally the extracts were filtered and used for antioxidant activity evaluation.
ii. Chemicals: All chemicals were of A.R. Grade and were procured from Ases Chemical Works, Jodhpur Rajasthan
iii. Determination of Antioxidant activity using DPPH via free radical scavenging activity: DPPH free radical scavenging activity was measured according to the procedure described by Blios.14 Methanolic extracts of the samples of different concentrations (100, 200, 300, 400, 500, 600, 700, 800, 900, 1000 ppm) were added separately to each of the 3.5mL, 100µM methanolic DPPH which were then incubated for 30 min. Taking ascorbic acid as the standard, the absorbance of each of the solutions were determined at 517nm using Double Beam UV-Visible spectrophotometer (Rayleigh UV-2601).A blank reading is also noted and finally the DPPH free radical scavenging activity was calculated by the formula:
where are absorbance of blank and sample extract solutions. The IC50 values were calculated from percentage inhibition v/s concentration curves by linear regression analysis.
RESULTS
The results of the DPPH free radical scavenging activity of ascorbic acid, leaves, fruits and flowers are tabulated in tables 1-4 respectively. The variation of antioxidant activities in ascorbic acid, leaves, fruits and flowers with the increasing concentration of samples have also been depicted through the curves given in the figures 1-4 respectively.
DISCUSSIONS
The study shows that %RSA increases gradually with increase with concentration of samples. The concentration at which the %RSA value i.e. the inhibition value reaches 50% is called the IC50 value. The lower IC50 value indicated high antioxidant value in analyte.15 The IC50 values in leaves, fruits and flowers of Calotropis procera were found to be 16.08, 16.06 and 10.31µg/mL respectively.
CONCLUSION
The results showed a good antioxidant activity in the plant which can be efficiently used in the pharmaceutical purposes in arid regions of Rajasthan and world over.
ACKNOWLEDGEMENT
The authors are thankful to the Department of Chemistry, J.N.V. University, Jodhpur for providing all the laboratory facilities. The authors greatly acknowledge the indispensible help received from the scholars whose articles have been cited in this manuscript. The authors are also thankful to the authors, editors and publishers of all those articles and journals from where the literature of this manuscript is received and discussed.
DECLARATION Of CONFLICT OF INTEREST
The manuscript has no conflict of interest.
Englishhttp://ijcrr.com/abstract.php?article_id=436http://ijcrr.com/article_html.php?did=4361. Mainasara MM, Aliero BL, Aliero AA, Yakubu M. Phytochemical and antibacterial properties of root and leaf extracts of Calotropis procera. Nigerian J of Basic and Applied Science 2012; 20(1): 1-6.
2. Ahmed MKK, Rana AC, Dixit VK. Calotropis species (Ascelpediaceae) a comprehensive review. Pharmacog Mag 2005;1 (2):48-52.
3. Yesmin MN, Uddin SN, Mubassara S, Muhammad AA. Antioxidant and antibacterial activities of Calotropis procera Linn. American-Eurasian J Agric and Environ Sci 2008 4 (5): 550-553
4. Chandrawat P, Sharma RA. GC-MS analysis of fruits of Calotropis procera: A medicinal shrub. Res J Recent Sci 2015; 4: 11-14.
5. Mukherjee B, Bose S, Dutta SK. Phytochemical and pharmacological investigation of fresh flower extract of Calotropis procera Linn. Int J of Pharmaceutical Sciences and Research 2010; 1(2):182-187.
6. Meena AK, Yadav A, Rao MM. Ayurvedic uses and pharmacological activities of Calotropis procera Linn. Asian J of Traditional Medicines 2011; 6(2): 45-53.
7. Ansari SH, Ali M. Norditerpenic ester and pentacyclic triterpenoids from root bark of Calotropis procera (Ait) R.Br. Pharmazie 2001; 56(2):175-177.
8. Begum N, Sharma B, Pandey RS. Evaluation of insecticidal efficacy of Calotropis procera and Annona squamosa ethanol extracts against Musca domestica. J Biofertil Biopestici 2010; 1(1): 1-6.
9. Jain SC, Sharma R, Jain R, Sharma RA. Antimicrobial activity of Calotropis procera.Fitoterapia1996; 67(3): 275-277.
10. Yazna srividya B, Ravishankar K, Priya Bhandhavi P. Evaluation of in vitro antioxidant activity of Calotropis procera fruit extract, Inter J Res in Pharm and Chem 2013, 3,2231-2781
11. Dorge W. Free radicals in the physiological control of cell function. Physiol Rev 2002; 82: 47-95.
12. Thambiraj J, Paulsamy S, R. Sevukaperumal. Evaluation of in vitro antioxidant activity in the traditional medicinal shrub of western districts of Tamilnadu, India, Acalypha fruticosa Forssk. (Euphorbiaceae).Asian Pacific J of Tropical Biomedicine 2012: S127-S130.
13. Himaja M, Anand R, Ramana MV, Anand M, Karigar A. Phytochemical screening and antioxidant activity of rhizome part of Curcuma zedoaria. IJRAP 2010;1(2):414-417.
14. Blios MS. Antioxidant determinations by the use of a stable free radical. Nature 1958; 26:1199-1200.
15. Murali A, Ashok P, Madhaban V. In vitro antioxidant activity and HPTLC studies on the roots and rhizomes of Smilax zeylanica L. (Smilacaceae). Int J Pharm Sci. 2011; 3(1):192–195.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareKNOWLEDGE OF BREAST CANCER AND ITS RISK FACTORS AMONG RURAL WOMEN OF PUDUCHERRY - A CROSS SECTIONAL STUDY
English6064S. RajiniEnglish C. Kamesh VellEnglish S. SenthilEnglishBackground: Breast cancer is the most common cause of cancer deaths in our country and worldwide. It is originating from the ducts or lobules in the breast tissue, called as ductal or lobular carcinomas.
Aims and Objectives: To estimate the awareness of breast cancer among rural women and to find out the knowledge regarding, risk factors, sign and symptoms of breast cancer among the participants.
Materials and Methods: A descriptive cross-sectional study was under taken among 258 women in the villages, which comes under the rural field practice area of Department of Community Medicine, AVMC and H.
Results: Among the 258 women, who were interviewed only 251 (97.2%) participants, were aware about Breast cancer. Most of the participants (26.69%) received information from Television and followed by Neighbors/friends (22.31%). Approximately 30% 0f the individuals were not aware of most of the risk factors, causing breast cancer. Almost 20% were unaware that all risk factors which were asked will cause breast cancer. Most of the respondents identified that lump in the breast (68.12%), pain in
the breast (45.21%), ulcer in the breast (49.8%), lump under armpit (41.43%) are one of the sign and symptoms of breast cancer.
Conclusion: Overall, the participants had limited knowledge of risk factors and sign and symptoms of breast cancer. The need of an intensive breast cancer awareness campaign is necessary in these areas to help them in early detection and prevention of breast cancer.
EnglishBreast cancer, Awareness, Knowledge, Risk factors, Sign and symptoms and rural women.INTRODUCTION
Breast cancer is by far the most frequent cancer among women, with an estimated 1.38 million new cases diagnosed in 2008. It is now the most common cancer both in developed and developing regions with about 690,000 new cases estimated in each region. (1) Most cancer cases and deaths are potentially preventable, including Breast cancer. (2) Having adequate knowledge of Brest cancer encourages and empowers women to participate in the screening programme to prevent the disease. Cancer is now the third leading cause of death, with more than 12 million new cases and 7.6 million cancer deaths estimated to have occurred globally. By 2030, it is projected that there will be 26 million new cancer cases and 17 million cancer deaths per year. The projected increase will be driven largely in low-and medium- resource countries. Under current trend, increase in longevity in developing countries will nearly triple the number of people who survive to age 65 by 2050. (3) Breast cancer is an increasing health problem in India too. The trend of rising incidence rates is likely to continue due to further changes in life style factors such as child bearing and dietary habits. India faces a high burden of breast cancer disease in the late stage presentation being a common feature. (4) Data from the International Agency for Research on Cancer (IARC) registry suggest that 45% of newly diagnosed cases of breast cancer and 55% of breast cancer-related mortality currently occur in low- and middle-income countries. IARC trends also show a 20-30% increase in the incidence of breast cancer in developing countries during the past decade. (5) As per the ICMR-PBCR data, breast cancer is the commonest cancer among women in urban registries of Delhi, Mumbai, Ahmedabad, Kolkata, and Trivandrum where it constitutes >30% of all cancers in females (National Cancer Registry Programme, 2001). In the rural PBCR of Barshi, breast cancer is the second commonest cancer in women after cancer of the uterine cervix (National Cancer Registry Programme, (2001).(6) Many studies have been carried out in our country both in urban as well as rural area. We have planned to carry out the study in our field practice area to know about the awareness level in our community, so that we can plan for the awareness programme in the community with our students and medical interns.
METHODOLOGY
This was a descriptive cross-sectional study done over a period of 6 months, from March 2014 to September 2014. The study was carried out in the field practice area of Department of Community Medicine, A V Medical College and Hospital Pudhucherry. A door to door survey was done to identify women of more than 20 years of age group by the trained paramedical workers and CRRI’s. The houses which were locked and the women who were not willing to participate in the study were excluded from the study. Oral consent was obtained to the participants before collecting the data. The data was collected by using a structured and a pre-tested questionnaire. The questionnaire consisted of information such as preliminary data, socio-demographic factors, awareness regarding breast cancer, risk factors and signs and symptoms of breast cancer. The data was collected and analyzed using suitable statistical methods.
RESULTS
The total number of study participants was 258 in the age group of 20 to 65 years. Majority of the participants were in the age group of 20-29 and 30-39 years of age group as 34% and 32% respectively. Their mean age was 36.2 years and standard deviation was 10.1. 96% of the study participants were Hindus, 90.7% were married, 56.6% has completed their middle schooling, 88.4% were unskilled workers and 30% of them were belongs to class IV and class V social class respectively, according to Modified BG. Prasad “s classification.(Table 1) Among 258 women, who were interviewed only 251 (97.2%) participants were aware about the breast cancer. The majority of the participants obtained information regarding breast cancer by means of television (26.69%), neighbours/friends (22.31%), doctors/health care personnel (19.52%) and relatives (16.33%) respectively as shown in fig. 1. Regarding the knowledge and risk factors of breast cancer, the participants gave the responses as yes/no/don’t know. Approximately 30% of the individuals were not aware of most of the risk factors, which can cause breast cancer. Only 42.2%, 67.1% and 43% knew that high fat intake, not breast feeding the child and smoking respectively were the risk factors which may cause breast cancer. The participants, who were interviewed, did not have any idea about some of the risk factors such as, intake of alcohol (45.3%), early menarche (48.8%), stress (38.4%) and family history of breast cancer (41.9%) can cause breast cancer. Almost 20% of the study participants were sure that all the above risk factors will not cause breast cancer. Some of the respondents did not know that, the risk factors like late age of 1st child birth (52.2%), late menopause (44.2%) and large breast (32.2%) can cause breast cancer as shown in table 2. Data was collected regarding the signs and symptoms of breast cancer to the participants who were aware of the breast cancer (n = 251). Most of the respondents identified that lump in the breast (68.12%), pain in the breast (45.21%), ulcer in the breast (49.8%), lump under armpit (41.43%) and chance in the skin of the breast (42.23%) are one of the signs and symptoms of breast cancer. Many individuals were not aware that these were also some of the signs and symptoms of breast cancer such as, weight loss(64.1%), change in the size/shape of the breast (64.94%), change in the skin (57.76%) and pulling in of the nipple (70.91%) as shown in fig. 2.
DISCUSSION
This was a community based cross-sectional study conducted in the field practice area of Department of community Medicine, A V Medical College. Most of the study participants were in the age group of 20-30 and 31-39 years as 34% and 32.6% respectively and 90% were married and 88.4% were unskilled workers. Breast cancer awareness was found in 97.2% of the study participants. More or less similar findings were observed in the study done by Anantha Lakshmi Satyawathi et al. (7) In their study most of the participants (72.3%) were in the age group of 21-40 years and 96.1% were aware about the disease. This study shows majority of them acquired information regarding breast cancer over Television (26.69%) and followed by neighbours/ friends (22.31%) and by Doctors and Health care providers (19.52%). These results were consistent with the findings of the similar study done by Sim et al, (8) in 2009. Some of the previous studies have suggested that awareness and knowledge of breast cancer through health education by Doctors and Nurses may be very effective resources for women as shown by Seow et al. (9) In the present study data was collected regarding the knowledge of signs and symptoms of breast cancer. It was observed that only less number of participants were aware about the signs and symptoms. Majority of them were not knowing pain/ulcer in the breast, swelling under armpit, change in the size/shape of the breast and pulling in of the nipple as one of the sign and symptoms of breast cancer. Similar findings were observed in the study done by Sami Abdo Al- et al. (10) Our study also showed 68.12% of the respondents were clear that lump in the breast as one of the sign and symptom of breast cancer. This finding seems to be consistent with the study done by Monteazeri et al. (11) Regarding the risk factors, it was reported 44.6%, 42.2%, 67.1% and 43% has agreed that high fat diet, increase in the age, no breast feeding and smoking respectively are one of the risk factors to develop breast cancer. More or less similar observation was noticed in the study done by S. Ahuja et al. (12) A vast majority of the study participants did not appreciate positive family history of breast cancer (41.9%), 1st child at late age (52.3%) and late menopause (44.2%) as the risk factors of breast cancer. Almost same results were noted by Muhammad A et al, in their study conducted at Malaysia. (13)
CONCLUSION
This study reveals there is lack of awareness and knowledge regarding common risk factors as well as the signs and symptoms of breast cancer. There is a need to promote the knowledge of breast cancer by imparting greater health education methods by using suitable audio and visual aids. Breast cancer awareness education should be integrated into existing health education programme within the community level, at the hospital and government level.
Englishhttp://ijcrr.com/abstract.php?article_id=437http://ijcrr.com/article_html.php?did=4371. Park’s textbook of Preventive And Social Medicine. K. Park. Twenty –second edition; 2013: Non- Communicable Diseases; Breast cancer; page. No; 359.
2. Stein, CJ, Colditz, GA (2004). Modifiable risk factors for cancer. Br J Cancer, 90,299-303.
3. Thun MI, John Oliver De Lancey, Melissa M. Center et al, (2010). The global burden of cancer: priorities for prevention, carcinogenesis, 31,100-10.
4. Chopra R (2001), The Indian Scene. J ClinOncol, 19,106-11.
5. Curado MP, Edwards B, Shin HR, et al (2007). Cancer incidence in five continents, vol.IX. Lyon: International agency for research on cancer; 2007 (IARC Scientific publication no.160).
6. Anita Khokhar (2012). Breast cancer in India: Where do we stand and where do we go? Asian Pacific J Cancer Prev,13(10), 4861-4866.
7. Anantha Lakshmi Satyavathi Devi Kommula, et al (2014). Awareness and practice of Breast self examination among women in South India. International Journal of Current Mirobiology and Applied sciences; Vol.3.num.1; pp.391-394.
8. Sims HL, Seash M, Tan SM(2009). Breast cancer Knowledge and screening practices: A survey of 1,000 Asian women. Singapore Med J, 50,132-8.
9. Seow A, Stranghan PT, Ng EH, et al (1997). Factors determining acceptability of mammography in an Asian population: A Study based among women in Singapore. Cancer causes control, 8, 771-9.
10. Sami Abdo Radman Al-Dubai et al (2011). Awareness and Knowledge of Breast Cancer and Mammography among a group of Malaysian women in Shah Alam. Asian Pacific Journal of Cancer Prevention, Vol 12, 2531-2538.
11. Montazeri A, Vahdaninia M, et al (2008). Breast cancer in Iran: Need for greater women awareness of warning signs and effective screening methods. Asia Pacific Family Med,7,6.
12. S. Ahuja, N Chakrabarti (2009). To determine the level of Knowledge Regarding breast cancer and to Increase Awareness about breast cancer screening practices among a group of women in a Tertiary care hospital in Mumbai, India. Internet Journal of Public Health, vol1, number 1.
13. Muhammad A-HADI, Mohammed A. Hassali, et al (2010). Evaluation of breast cancer awareness among female university students in Malaysia. Pharmacy Prractice (internet) 2010. JanMar; 8(1): 29-34.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241719EnglishN2015October10HealthcareEFFECT OF SUPPORTED STANDING ON FUNCTIONAL ABILITY IN PATIENTS WITH ACUTE STROKE: A SINGLE-BLINDED RANDOMIZED CONTROLLED TRIAL
English6570Rehani Dhara RakeshEnglish Mahesh HegdeEnglish Purusotham ChippalaEnglishIntroduction: Early Mobilization improves the functional ability and the balance in acute stroke subjects. Supported standing is a common adjunct treatment procedure in early mobilisation of acute stroke individuals who have insufficient lower limb strength, poor trunk to stand actively.
Objectives of the Study: To determine the effect of supported standing on functional ability in patients with acute stroke.
Study design: Single-blinded Randomized Controlled Trial.
Study setting: University teaching hospital in Mangalore.
Methodology: Fifty stroke subjects were equally randomized to either the intervention or the conventional group. The Intervention group received the support standing along with the conventional therapy. Supported standing was done with the help of assistive devices like tilt table, standing frame. Thirty minutes of supported standing (based on the tolerance of the patient) with frequent rest periods were given, once in a day for 5 days per week for 2 weeks.
Outcome Measures: Functional ability was measured by the River mead Motor Assessment Gross Function Subscale and the Berg Balance Scale.
Results: The results of this study showed that the River mead Motor Assessment Gross Function Subscale and the Berg Balance Scale were statistically significant for both within and between group comparison (pEnglishSupported standing, Functional ability, Motor recovery, Stroke, Early mobilizationINTRODUCTION
Stroke is the second leading cause of mortality and morbidity in India.The overall age adjusted prevalence rate of stroke in India is estimated range of 44-843/100,000 population and the age adjusted annual incidence (per 100,000 population) is 152.1 Stroke often results in problems of the weakness of one side of the body part, postural instability and immobility related complications like pressure sores, shoulder pain, urinary tract infection, chest infection, deep vein thrombosis, fall and depression may impair the function ability and balance. 2-4 During the acute stroke phase, 70 to 80% of subjects demonstrate mobility problems in ambulation. In such cases early and frequent out of bed activities like, sitting, supported standing with the use of supportive devices may be included in the acute stroke patients. 5 Supported standing is a common adjunct treatment procedure in early mobilization of acute stroke individuals who have insufficient lower limb strength, poor trunk to stand actively. 5-7 Supported standing reinforces the antigravity muscles and can be used to retrain trunk control, to improve or maintain standing ability and in preparation for gait training. 8-11 Supported standing also provides a prolonged weight-bearing stretch to the hip, knee and ankle flexors and is often used to manage muscle length and spasticity. 12, 13 Supported standing has a few harmful effects that include hip fracture, increased pain and spasms and symptoms of hypotension. 8-10 It also places additional demands on individuals, therapists and caregivers. Supported standing requires great commitment, time and availability of resources and ease of use of standing equipment impact on its success. 9-11 Based on the study outcomes from Bagley et al 14 and Ferrarello et al, 6 there is fair evidence to suggest that supported standing treatment in conjunction with traditional physical therapy for post stroke, does not improve functional ability including mobility and balance compared to traditional physical therapy alone.
Need for the Study
Very few Randomized control trials were conducted to address the effect of supported standing on functional ability in acute stroke subjects. Most of the published randomized control trial states that the supported standing practice is not above and beyond beneficial than the conventional physiotherapy for improving the motor function and mobility in subjects with acute stroke. 15 The need of this study is therefore to determine whether the provision of supported standing practice will increase the functional ability post stroke.
Objectives of the Study
To determine the effect of supported standing on functional ability in patients with acute stroke.
Methodology
The study was a single blinded, randomized controlled trial. The subjects were selected from the stroke population group satisfying the inclusion criteria from the Department of Medicine and Neurology of Justice K S Hegde Charitable Hospital, Mangalore.
Inclusion Criteria
The subjects included were above 18 years. Adults with acute stroke, subjects with both ischaemic and haemorrhagic stroke, they were able to react to verbal commands, both the sex, medically stable subjects.
Exclusion Criteria
The subjects were excluded if they had unstable cerebral perfusion, uncontrolled diabetes mellitus and hypertension, associated cardiac problems, associated problems in the lower limb (e.g., deep vein thrombosis), any orthopaedic conditions (e.g., arthritis, fractures, etc.), if the physiological variables (blood pressure, oxygen, heart rate, temperature) go beyond set safety limits and patients with severe fatigue.
Method of Data Collection
The total number of fifty subjects fulfilled the inclusion criteria were randomly allocated equally to either of two groups by the computer generated randomization procedures using concealed opaque envelopes. Where group one received the supported standing along with the conventional therapy and group two received the conventional therapy. The Intervention group received the supported standing and conventional therapy. Supported standing was done with the help of supportive devices like tilt table, standing frame, brace or walker. Protocol Involved physiological monitoring of blood pressure, heart rate, oxygen saturation, and temperature before, during and after making the patient stand. 6, 14-16 The subjects were given thirty minutes of supported standing (based on the tolerance of the patient) with frequent rest periods in between. Thirty minutes of supported standing (based on the tolerance of the patient) with frequent rest periods were given, once in a day for 5 days per week for 2 weeks. The Conventional therapy group received routine stroke unit care, including, positioning, active and passive movements, activities within the bed (strengthening exercises, balance exercises in sitting), postural awareness and education. Both the group, subjects were received thirty minutes of the conventional therapy, once in a day for 5 days per week for 2 weeks.
Outcome Measures
The River mead Motor Assessment Gross Function Subscale and the Berg Balance Scale were selected as an outcome measure for this study. The River mead Motor Assessment Gross Function Subscale is one of the most commonly used quantitative measure of the functional ability in stroke subjects.It has excellent intraand inter-rater reliability and constructs validity. It contains a 13-point measure of gross function which can be completed by direct observation and include a range of activities from turning over in bed to running. 17 The Berg Balance Scale is considered a psychometrically sound measure of balance impairment in stroke subjects. It is a 14 item scale; it measures both the static and dynamic components of balance in various functional mobility activities. 18, 19 Outcome measures were taken before starting of the study at baseline, at the end of the first week and at the end of the second week.
Ethical clearance
The study was approved by the Central Ethical Committee of the Nitte University (Ref: NU/CEC/P.G.44/2013). Signed informed consent was obtained from all subjects, or their representatives at the beginning of the study
Statistical Analysis
Descriptive statistics were used to provide information about the subject’s baseline and clinical characteristics and to assess River mead Motor Assessment Gross Function Subscale, Berg-Balance Scale in acute stroke subjects. Continuous data were presented as mean and standard deviation and categorical data were presented as number and percentage. The differences of these characteristics among the group were analysed by using the Independent Student t-test for continuous and the chi-square test for ordinal and categorical variables respectively. Non-parametric analysis of the intra-group and between group comparison of admission, at the end of the first week, at the end of the second week for the River mead Motor Assessment Gross Function Subscale and Berg-Balance Scale were analysed by the Wilcoxon signed rank test and the Mann-Whitney U-test, respectively. All analyses were performed using the Statistical Package for Social Science (SPSS), version 16.0 (SPSS Inc., Chicago, IL, USA). The significance level was set at P 0.05).
RESULTS
A total of eighty-two stroke subjects were screened for eligibility during the period of August 2013 to March 2014. Fifty stroke subjects were randomized (mean age = 56.25 years, standard deviation (SD) = 11.872) into two groups with equal numbers in each group. Two subjects were withdrawn from the study (one in each group) due to personal reasons. Recruitment and participant flow chart is given in figure 1. Descriptive statistics of the characteristics were represented in table-1, all demographic and clinical characteristics were equally distributed among the groups (p>0.05).Table 2 shows the change scores (1st week - admission) in the River mead Motor Assessment Gross Function Subscale obtained similar scoring for the Intervention group (median=2, Inter quartile range (IQR) =2-3) and the Conventional group (median=2, IQR=1-2) and change scores (2nd week - admission) in River mead Motor Assessment Gross Function Subscale obtained higher scores for the Intervention group (median=4, IQR=3.25-5.75) and the Conventional group (median=3, IQR=3-4). In between-group comparison, showed that improvement in the River mead Motor Assessment Gross Function Subscale scores were statistically high significant (PEnglishhttp://ijcrr.com/abstract.php?article_id=438http://ijcrr.com/article_html.php?did=4381. Wasay. M, Katri IA, Subhash Kaur. Stroke in South Asian countries. Nature Reviews Neurology 2014; 10:135-143.
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