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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1General SciencesMulti-Functional Silver Nanoparticles for Drug Delivery: A Review
English0105Prashob Peter K JEnglishAn operative management of complex physiochemical properties of drugs is vital for their effective cellular uptake and action. During the last decade, the complexity of drugs addressed in the state-of-the-art therapeutics has increased along with the computational capability to generate more and more detailed information from the structure activity relationships. With the development of drug delivery carrier, particularly polymer carriers, targeted release of drugs have reached new levels. Whilst slower than other architectures - like hydrogels - at the beginning of the new generation cargo molecules, silver nanoparticle (AgNPs) incorporated drug carriers have now reached new levels in both amelioration of toxicity and in enhancing stability and solubility of drugs. These progresses allow AgNPs integrated systems to generate output which are competent with the ones obtained from the cutting-edge polymer carriers, while keeping the benefits of conserved action at varying physiological conditions.
EnglishDrug delivery, Silver nanoparticles, Photothermal therapyINTRODUCTION
The need for drug delivery systems with novel mode of action to improve the solubility and stability and to minimize the toxicity of potent drugs is a major impetus for research in drug transport systems 1-6. This paper highlights the recent developments in drug delivery units using AgNPs, to enhance the therapeutical index and its successful in vivo applications. Hybrid molecular units containing AgNPs are used in the designing of drug-delivery systems responsive to optical, thermal and pH modulations to target malignance, inflammatory and infectious ailments, as these nanoscale metals posses exceptional biocompatibility viable for therapeutic settings 7-8. AgNPs(Fig. 1) are extensively used in the state-of-the-art drug delivery carriers in recent years, because of their facial synthesis methods to functionalize surface and tune optical features7-12. Colloidal silver with superior quality, high yield and responsive to changing environment and external stimuli can be rapidly synthesized 12. Synthetic progress in the last decade stimulates AgNPs of different shapes and structure including silver nanoplates, Fe/Ag nanoshells, AgNP prisms and Ag Nanowiers, which all show surface plasmon absorbance which can be effectively utilized in photothermal therapy to supress malignant cells 12-15. In this mini review, highlight will be on the photo thermal features of AgNPs in different morphologies and their biomedical applications along with synthetic methods opted to functionalize the carrier molecule and impart biocompatibility to the structure.
SILVER NANOPARTICLES FOR DELIVERY
AgNPs can be tailored to incorporate nucleic acid making them ideal delivery agents for RNAi based therapy 7. Lee and co-workers developed conjugates suitable for spherical nucleic acid colloids using AgNPs functionalized with oligonucleotide8. These tri cyclic disulphide moieties in the oligonucleotide enhance the particle stability and effectively tolerate heat, aging and oxidative degradation. Exceptionally high cooperative binding properties were shown by these AgNPs functionalized with oligonucleotide. Due to sharp melting transitions shown by these colloids, hybridization and dehybridization can easily be achieved by varying sodium chloride concentration, making them an apt choice for gene delivery8.
Biocompatibilty and potential of nano-silver molecular unitsto detect pathophysiological faults in maligant cells and cargo therapeutic genestargeting tumour was significantly improved, when integrated with graphene oxide. For example, uptake of GO@Ag-DOX-NGR by tumour cells were 8.4 times efficient than normal cells 9. These grapheme oxide-nanosilver loaded with DOX not only selectively released the drugs but also assisted in the photothermal ablation of tumor when stimulated with Near-infrared (NIR)9. As precise response of these composites to external stimuli along withan enhanced affinity for malignant cells, compared to normal cells, apparently reduce the toxic side effects and enhance the chemo-photothermal potential of therapeutic agents 9. Fe3O4@C@Ag hybrid nanoparticles developed by Chen and co-workers is another example for NIR light-responsive drug delivery templates with high drug loading capacity. These templates were effectively used to deliver doxorubicin near cell nucleus to enhance apoptosis16. Photothermal transducing property of colloidal silver can be effectively used in activating localized hyperthermia of tumours10. For example, silver nanotriangles synthesized using chitosan showcased a strong surface plasmon resonance in near-infrared, to function as photothermal mediators against human non-small lung cancer cells10. These chitosin functionalized AgNPs demonstrated excellent biocompatibility as inferred from the cellular uptake studies performed on healthy human embryonic cells. This result along with high selectivity towards malignant cells enhances their potential in in vivo applications. Further, number of viable cells exponentially decreased in presence of silver nanotriangles coated with chitosan, when compared to gold nanorods stabalized using thiolated poly(ethylene) glycol, a commonly used hyperthermia agent 10.
Photoactivated gene silencing can be achieved through drug delivery system made of silver, moulded to nanoscale-antisense platforms11. Their usefulness in photo activated drugs has been attributed to the unique optical properties. In order to enhance the photo activations, Brown and associates functionalized the AgNPs surface with thiol-terminated photo-labile DNA oligonucleotides11. Compared to commercially available transfection vectors, these engineered nanosilver templates showcased increased stability to nucleases, enhanced hybridization activity upon photo-release and effective cellular uptake11. Modulation of Intracellular Adhesion Molecule-1 silencing by these functionalized AgNPs demonstrate their potential as effective agents for the delivery of oligonucleotide based therapeutics.
AgNPs can be engineered to deliver drug molecules in response to electromagnetic and pH stimuli. A multifunctional drug carrier responsive to photo and pH stimuli has been developed by Fang and co-workers by uniformly coating mesoporous silica on the surface of Pd@Ag nanoplates. Pd@Ag nanoplates function as transducers that convert NIR to thermal energy. Presence of mesoporus silica with pores of approximately 10 nm on the surface of nanocomposite increase the drug loading capacity. pH sensitive coordination bonds formed between mesoporus silica and drugs are responsible for the specific release of drugs inside the cells12.
Silver incoperated multi-metal nano-cage can be used in designing drug-carriers without surface functionalization13. Liu and co-workers developed gold-silver alloyed triangular nano-cages and investigated their potential as drug delivery carriers for anti-cancer drug. This carrier molecule showcased strong absorbance in the NIR and was susceptible to laser induced near-field ablation13. Hollow nano-cage structure of nano-template encapsulated the drug, which was effectively delivered on ablation13.
AgNPs can be hybridized with carbon nanotubes(CNT)for the in situ production of NO from RSNO 17. These CNT@Ag hybrids can be used in the slow delivery of NO from external aromatic nitrosothiols when compared to CNT@AuAg 18. And this slow release is extremely important in the prevention of infections arising from colonization of bacteria and formation of biofilim 19.
Silver nano-carriers to target folate receptor expressing tumour were developed by functionalizing the surface of AgNPs with folic acid. This folic acid functionalized AgNPs delivered exceptional receptor-mediated cellular uptake along with electrostatic binding to drugs. Receptor-mediated cellular uptake has been verified by surface enhanced raman scattering imaging and fluorescent lifetime imaging. Electrostatically bound drug (DOX) were slowly released into the cytoplasm of cells and induced apoptosis 20. AgNPs integrated hydrogel demonstrated excellent potential to deliver antibacterial drugs21. These cross linked nano-hydrogel composites loaded with curcumin showcased high swelling rate and thermal stability. These hydrogel nano-composites were particularly useful in the slow release of loaded curcumin, emphasising their vital role in preventing infections while wound and burn healing treatments 21.
A biocompatible triplex Ag@SiO2@mTiO2 core–shell nano-colloids developed by wang and co-workers in 2012 is an excellent example for the utilization the endocytosis mechanism of nanoparticles to enhance the cellular uptake and consequent delivery of anti-cancerous drugs. Cytotoxicity studies carried out using these nano-colloids against human breast adenocarcinoma cell line studies established their biocompatibility. And mesoporus silica siginificantly increased the drug loading capacity of the carrier22. The successful in vitro internalisation and potential to induce apoptosis in lung adenocarcinoma cells and lung normal fibroblasts using nano silver wire along with their biocompatible nature highlight the prospects as novel drug delivery carriers to suppress lung cancer 15.
PREPARATION OF SILVER NANOPARTICLES
The synthesis of target specific and biocompatible nano silver in cooperated drug carriers is one of the most challenging task in drug carrier research. This section comprehends the synthesis of AgNPs that are responsive to photo, thermal and pH stimuli. Drug delivery platform responsive to NIR light was realised by integrating AgNPs on the surface of Fe3O4@C nanospheres. A 200 nm superparamagnetic Fe3O4@C nanospheres, functionalized with carboxyl and negative charge were dispersed in dimethyl formamide prior to hybridization of silver nanoparticles on their surface. These carbon encapsulated Fe3O4 nanospheres was synthesised using the one step solvo-thermal process of ferrocene 23. AgNPs used for surface hybridization were synthesised by reducing silver ions in DMF solution using glucose at 70 °C. Purified Fe3O4@C@Ag nanospheres were dried and encapsulated with drug 16. GO@Ag is an another example for drug carriers that are responsive to NIR9. They have been rapidly synthesised by facile method in which AgNPs are deposited uniformly on the surface of graphene oxide by hydrothermal reaction. These GO@Ag incorporate drugs (DOX) via ester bonds and showcased high drug loading capacity9. In order to impart tumour targeting potential and stability in physiological conditions, these doxorubicin loaded GO@Ag was again functionalized by DSPE-PEG2000-NGR 9.
AgNPs incorporated polymer composites sensitive to photo-stimuli has been synthesised by Park and co-workers in 2011 by using epoxy resin and photo acid generator 14. Composites synthesised in this method consist of uniformly dispersed AgNPs. In an another attempt to develop photosensitive drug delivery carriers, Anandhakumar and coworkers in 2011 effectively utalized polyol reduction method 24. Drug loading in these composites are modulated by the electrostatic interaction between drug and carriers. Drug can be easily loaded to silver incorporated nano composites by thermal encapsulation method. Encapsulated drug are effectively delivered by applying laser pulses24.
Drug loading capacity of mesoporus nano silica and their response to NIR have been effectively increased by incorporating AgNPs. Fang and co-workers effectively utilized the potential of silver nanoplates to absorb and convert NIR light into thermal energy, to enhance the delivery of drugs from mesoporus silica 12. In this case, seeding method used for the preparation of core shell architecture 25 developed by Huang and associates was opted. Initially, Pd@Ag nanoplate core of mean diameter 41 nm was synthesised, to impart photothermal stability to the carrier molecule. Prior to functionalizing the Pd@Ag nanoplates with mesoporous silica, a thick layer of silica was developed on the nanoplates as per Stöber method to function as template to electrostatically adsorb CTAC micelles26. The oblate spheroids with an average diameter of 110 nm and a thickness of 60 nm Pd@Ag@sSiO2 particles obtained were then functionalized with mesoporous silica as reported by Yokoi et al. 26. In a mild basic reaction media, mesostructure of co-assembled silica and CTCA are obtained. Rate of reaction in this process was regulated by L-Arginine. In order to enhance the pore surface trimethylbenzene was used as a swelling agent. Stability of co-ordination bonds formed by these carrier molecules is highly sensitive towards pH and thermal energy. High porous area and electrostatic interactions along with pH and thermal responsive nature enhance the drug loading capacity and delivering capacity of Pd@Ag@sSiO2@mSiO226.
Unique pH responsive AgNP-hydrogel composite can be synthesised using silver ions, poly(2-hydroxyethyl methacrylate, poly(ethylene glycol) methyl ether methacrylate and methacrylic acid27. Deprotonized polar carboxylic acid present in the reaction media assist in the synthesis of AgNPs from silver ions anchored in the hydrogel. Morphology and size of the nanoparticle synthesized can be effectively tuned by altering the silver ion concentration in the hydrogel. Along with pH switchable electrical properties these hydrogel composite also have higher swelling ratio and faster deswelling rate compared to pure poly(HEMA–PEGMA–MAA) hydrogel 27.
DISCUSSION
The preparative methods used for developing silver incorporated nano-carriers are facile and cheap. Even though these synthesis methods developed carriers that are highly selective and biocompatible, much emphasis is necessary in this field to overcome the challenges faced in this area of application. In this regard polymers from marine compounds are useful prospects for developing drug delivery units using AgNPs. Recently silver-nanoplates were synthesised using biocompactible humic acids, isolated from mangrove ecosystem, with potential against Dalton lymphoma ashites 28. Biocompactible nature of humic acid along with polar functional groups are useful in designing self-assembled AgNPs29. Another extensively available biocompactible marine resource is fucoidan, a sulphated polysachride, capable of synthesising stable spherical AgNPsfor suppressing both human and marine pathogens 30.
CONCLUSION
Common challenges in drug delivery workflow can be addressed by hyphenating silver nanoparticles with carrier molecules. The desired biocompactibility throughput vital for in vivo applications can be achieved by functionalizing the surface of AgNPs with apt agents and synthetic methods. Since NIR photo activation can be easily achieved by stimulating the surface plasmons on the surface of AgNPs, nano silver in cooperated carrier matrix is a perfect choice for photo dynamic therapy. The high selectivity and target specific response to photo, thermal and pH stimuli enable both bio-compatibility and enhancement of theraputical efficiency. Due to the dynamic range of functionalization provided by facile synthetic methods, both high and low molecular weight drugs can be delivered with same efficiency. Even though topical and systemic side effects have been associated with long-term exposure to silver incorporated products, intake of nano-silver in small concentrations is often considered safe to humans. Considering the fact that, results concerning the side effects of colloidal silver and its composites are inconclusive, much in vitro and animal studies are required prior to their extensive use as drug carriers.
ACKNOWLEGMENT
Author is thankful to the facilities provided by dept. of Chemical Oceanography and Inter University Center for Development of Marine Biotechnology, Cochin University of Science and Technology, to prepare this article. 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. In addition, author thanks Miss Ektha Martin for grammatical correction.
CONFLIT OF INTREST: Author declare no conflict of interest.
ABBREVIATIONS
AgNPs : Silver nanoparticle
CNT : Carbon nanotubes
CTAC : Critical micelle concentrations of cetyltrimethylammonium
chloride
DOX : Doxorubicin
DSPE-PEG2000 : 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-
N-[methoxy(polyethylene
glycol)- 2000]
GO : Graphene Oxide
HEMA : 2-hydroxyethyl methacrylate
MAA : Methacrylic acid
NGR : Asparagine-glycine-arginine
NIR : Near-infrared
NO : Nitric oxide
PEGMA : Poly(ethylene glycol) methyl ether
methacrylate
RSNO : S-nitrosothiols
Englishhttp://ijcrr.com/abstract.php?article_id=637http://ijcrr.com/article_html.php?did=637
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1General SciencesEffect of Hydrochloric Acid (HCl) on Synthesis, Spectral and Thermal Properties of Triglycine Phosphate (TGP) Single Crystals
English0611M.R. MeeraEnglish T. Joselin BeaulaEnglish S.L. RayarEnglish V. Bena JothyEnglishThe effect of hydochloric acid (HCl) addition on the growth of triglycine phosphate (TGP) crystal has been studied from the aqueous solution by slow evaporation technique. Significant changes in the crystal size and morphology have been observed in all the grown samples. The structure and cell parameter values of pure and HCl doped TGP crystal are confirmed by powder X-ray diffraction analysis. The characteristics absorption bands of pure and HCl admixtured TGP crystals are confirmed by FT-Raman and FTIR spectra. Anisotropic phenomena such as therrmal, and mechanical studies have been performed. The dielectric of the crystals have been studied and the result suggests that the HCl is doped into TGP crystal and that the doping increases its dielectric parameters..
EnglishHCl, TGP, FTIR, FT Raman, TG DTAIntroduction
The unique physical and chemical properties of crystals in the crystal symmetry, molecular structure, purity and the physiochemical environment of their formation do enhance considerably their significance in the electronic industry [1]. Especially with respect to optical devices, photonic crystals are inevitable [2,3]. The quality of optical nonlinearity would enhance the possibilities of device possibilities of photonic crystals in optical devices such as high speed optical switching for communication and even optical computing [4-10]. Hence the advancement of technologies in the above field are highly necessary. New technologies as above are focused on evolving new optical materials with better performance. The materials with a nonlinear optical (NLO) response is the most important requirement in optoelectronics. A number of NLO single crystals are identified with potential to be used in optical and electro-optical devices. Especially the solid-state laser sources are used in many such devices which further enhance the significance of nonlinear optical materials [11]. Aminoacids are interesting materials for NLO application as they contain proton donor carboxyl acid (-COO) group and the proton acceptor amino (NH2) group in them [12]. Among the aminoacids, glycine which is found in proteins is the smallest compound used for studies [13]. Doping is a well-chosen and widely accepted technique for incorporating the required physical properties in a bulk material for technological applications [14–16]. The technique has been extensively explored to modify the properties like electrooptical (photoluminescence), conductivity and crystal growth [17].The additional impurities alter the optical and electrical properties of materials due to creation of localized states and defects created by the doping [18]. Previously glycine phosphate doped GPI [19], urea and thiourea doped GPI [20,21] have been reported. In this direction, attempts are made to dope TGP crystal with an organic complexing agent HCl(0.25, 0.50, 075 and 1.0 mole % concentrations), because the chloride ions play a partial role for NLO applicants and also the hydrochloric acid can be expected to increase dielectric constant and Tc due to its intrinsic dipole moment. Doping efforts on the growth aspects, structural perfection, phase transition temperature, and optical properties are studied by conducting various characterization techniques.
Experimental Details
Material synthesis
A.R. grade chemicals of glycine and phosphoric acid selected for experimental purpose were taken in the stoichiometric ratio 3:1. Salts of estimated quantities were dissolved in double distilled water and the resultant mixture was stirred well at room temperature using a stirrer. Triglycine phosphate (TGP) salt was synthesized according to the reaction:
3(NH2CH2COOH) + H3PO4® (NH2CH2COOH)3.H3PO4.
For the cases HCl doped TGP solutions, the same procedure was adopted by keeping the constant amount of AC in the respective solutions. For the growth of HCl doped TGP crystals, the TGP solution was saturated by dissolving a particular amount of HCl ( 0.25,0.50,0.75 and 1.0mol%) in double distilled water at 300C. After saturation, the solution was filtered by means of a filter paper. The filtered solution was filtered with filter paper and the solvent was allowed to evaporate slowly at an ambient temperature in a dust free chamber. After obtaining supersaturation, the crystals were grown for a period of 10 days. Photographs of the grown crystals are shown in Figure 1.
Instrumentation
FT-IR spectra of pure and doped TGP have been recorded using Bruker IFS 66 V Spectrometer in the range 4000-100 cm-1. FT Raman spectra were recorded using Bruker RFS 27: Stand FT-Raman Spectrometer with resolution of 2 cm-1. UV-Vis spectra were recorded in the range of 190-1200 nm using Lambda 35 Spectrometer. Thermal analysis was carried out simultaneously employing Perkin Elmer thermogravimetric and differential analyser (Mode: PYRIS DIAMOND) in nitrogen atmosphere heated from 400 to 7300 with a heating rate of 100ºC to understand thermal behavior. Dielectric studies of the grown crystals were carried out to an accuracy of ±2oC using an LCRZ meter with five different frequencies, viz. 100 Hz,1 KHz, 10 KHz, 100 KHz and 1 MHz at various temperatures ranging from 30oC to 150oC.
Results and Discussion
Powder XRD Analysis
Single crystal XRD data of the pure TGP crystal suggests that the crystal belongs to monoclinic structure. In order to confirm the material of the grown crystal, powder XRD data was collected from the pure and hydrochloric added TGP crystals.
The high crystalline nature of the grown crystals is revealed by the prominent and well resolved Bragg’s peak at specific 2q angle .Using observed 2q(Bragg angle) and d (interplanar spacing) all the reflections were indexed (JCPDS file). Powder diffractogram and (h k l) values of the pure and HCl admixture TGP are shown in Fig 2. Comparing PXRD patterns of doped crystals with those of pure TGP single crystal, small changes in‘d’ - spacing values were observed, which may be attributed to the presence of dopants in TGP crystal. All the grown crystals a ≠ b ≠ c ensure that all the grown crystals is of monoclinic structure [22].The data lattice parameters and the cell volume were calculated and are given in Table 1. Analysis of the PXRD spectra confirmed the excess HCl only acted as the additive rather than as dopant.
Figure 3(a) and (b) show the FT-IR and FT Raman spectra of pure and HCl doped TGP crystals as it were recorded in the region 400-4000 cm-1 and the vibrational assignments were given in Table 2. Asymmetric and the symmetric stretching mode of NH2 appear 3380-3350 cm-1and 3310-3280 cm-1respectively [23]. Asymmetrics tretching mode of NH2is observed as a strong broad band in IR at3110 cm-1and the symmetric stretching mode is observed in Raman at 2962cm-1. The band observed at 2962.97 cm-1 and 2890.02 cm-1 are assignable to CH2 stretching mode. P-O stretching vibrations are expected in the region 1040-910cm-1 [24] which is observed in IR at ~1042 and 926 cm-1with the counterpart in Raman at ~900 cm-1.Generally H-Cl stretching mode is observed at 685-680 cm-1 which is observed in IR at ~683 cm-1. Its absence in the pure TGP spectrum and its presence in the doped TGP spectra clearly indicate the presence of Cl- in the lattice of TGP crystal. C=O stretching vibrations in saturated aliphatic aldehydes, ketones and acids have frequencies in range 1740–1700 cm−1. In amides the frequency is lowered to 1690 cm−1 [25] which is due to existence of resonance structures.C=O stretching band is observed at 1590 cm-1. The deformation vibration of the carboxylate ion is observed at 682.95 cm-1. C=O and NH2 stretching vibrations are shifted and strongly evidences of intra-molecular interactions.CH2stretching vibration is observed at 2890, 2792 and 2605cm-1.
Fig 3 FT-IR and FT-Raman Spectra for the grown (A) Pure TGP (B) 0.25 mol % HCl doped TGP (C) 0.50 mol % HCl doped TGP (D) 0.75 mol % HCl doped TGP (E) 1.0 mol % HCl doped TGP crystals respectively
Thermal Analysis
Thermogravimetry (TG) and differential thermal analysis (DTA) of pure and HCl doped TGP were carried out at room temperature to 730ºC and the thermograms are depicted in Fig.4. In pure TGP, up to 200ºC there is no weight loss which reveals that the compound is devoid of physically adsorbed water and water of crystallization [26].Slight variations appear in the TGA traces of HCl doped TGP crystals with various concentrations 0.25, 0.50, 0.75 and 1.0 mole % that are 203, 185, 206 and 195 respectively.
The decomposition of the compound takes place in single stage. Between 243ºC and 730ºC the weight loss of 71% is observed. This weight loss is due to the loss of glycine fragments in the compound. This weight loss decreases as the concentration increases (242, 241, 239and 233ºC).The decomposition pattern is explained based on the formulated pattern of the compound which accounts for 70.094 to -54 % weight loss. The variation of experimental and the formulated weight losses are insignificant. At 730ºC, almost 29 % of the compound remains as residue. An exothermic peak observed in DTA at 238ºC complement to HCl admixtured TGP are due to the decomposition of the compound. Pure TGP crystal showed a major weight loss (∼49 wt.%) in the temperature range between 218 and 268ºC. This can be attributed to the decomposition of glycine into CO2 and HCl. DTA curve revealed a sharp peak at 233ºC corresponding to the decomposition of glycine. Further increase in temperature resulted in the removal of HCl in the form of H2O with a total weight loss of 24 wt.%. Thus DTA curve of TGP crystal also showed to be due to combustion of glycine and removal of carbon. Melting point of Pure and HCl admixtured TGP crystals are given in Table 3.
AC Electrical Conductivity Studies
The capacitances for various frequencies in the range of 100Hz to 1MHz at different temperatures of the samples were measured. The variation of dielectric constant(εr) with temperature at various frequencies of pure and HCl admixtured TGP crystals with various concentrations (0.25, 0.50, 0.75, 1.0 mole %) were shown in Fig. 5.The dielectric constant is small at low temperature, which increases with temperature for pure and HCl admixtured TGP crystals, reaching maximum at the Curie point Tc.(328K).The rapid increase may be due to the space charge polarization of thermally generated carriers [27]. Above Tc.(328K), the dielectric constant decreases, following the Curie–Weiss law. It shows that all the grown crystals (pure and doped TGP) behave as para electric before 328K and becomes ferroelectric above 328K, at varying frequencies. Thus all grown crystals may exhibit ferroelectric nature at higher temperatures. It is noticed that there is very small change of Curie temperature when TGP crystal is doped with HCl at various concentrations. HCl being a dipolar impurity, creates a high dipole moment in the TGP lattice, thereby increasing the dielectric constant. Moreover the observed enhancement in the dielectric constant at low frequency could be attributed to the multi domain state of the HCl doped sample. The magnitude of dielectric constant depends on the degree of polarization charge displacement in the crystals. The increase in dielectric constant for HCl admixtured TGP crystal may be due to frittering of domains in the space charge polarization of thermally generated carriers [28]. Also the increase in dielectric constant for HCl doped TGP crystals may be due to frittering of domains due to the incorporation of impurities into TGP crystal lattice [29]. The peak value of dielectric constant was found to decrease with frequency. Very small significant shift in the temperature of dielectric maxima with different frequencies was found, which shows the absence of any relaxation behavior. According to Miller’s rule, the low value of dielectric constant enhances SHG coefficient [30]. The variation of dielectric loss(tan d) with temperature at various frequencies of pure and HCl doped TGP crystals with various concentrations (0.25, 0.50, 0.75, 1.0 mole %) were shown in Fig. 6. At higher frequencies due to the low value of dielectric constant and dielectric loss, its optical quality is enhanced with lesser defects which are important parameters for making it useful for various NLO applications [31]. This low value of dielectric loss indicates that crystal has minimum defects [32].
A plot of ln σac versus 1000/T gives -Ea/k as the slope and ln σac as the intercept. Activation energies at the ferroelectric phase (above Tc) of the grown crystals are estimated using the slopes of the line plots, [E= -(slope)k x1000] and are found to be 0.5255eV ,0.2039eV , 0.2454eV, 0.2454eV, and 0.5851eV respectively for pure and HCl doped TGP (0.25,0.50, 0.75 and 1.0 mol %) crystals. A similar range of activation energy values have been reported which infer that pure and Hydrochloric acid added crystals will behave at high temperatures as a super-ionic conductor [33]. The lower activation energies estimated from electrical conductivity studies suggest that the material contains less number of charge carriers for conduction process and the dielectric behavior is very well understood.
Conclusion
Good optical quality crystals of pure and HCl (0.25, 0.50, 0.75 and 1.0 mole %) doped TGP crystals were grown successfully from aqueous solution by slow evaporation technique. The spectral investigations by IR and Raman spectroscopy strongly suggested that the Zwitter and glycinium ions were present in both pure and HCl admixtured TGP crystals. C=O and NH2 stretching vibrations are slightly shifted and there are strong evidences of intra-molecular interactions. Pure and HCl doped TGP crystals are useful as a good non-linear material and for optoelectronics applications due to low cut off wavelength and are transparent to the entire visible region, which shows the wide window for nonlinear applications. Observed low dielectric constant and low dielectric loss suggests that the grown crystals are suitable for NLO applications in accordance with Miller’s rule.
Englishhttp://ijcrr.com/abstract.php?article_id=638http://ijcrr.com/article_html.php?did=638[1] Springer Handbook of Crystal Growth Dhanraj, Byrappa, Prasad, Dadley
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1HealthcareAssociation of Physical Activity and Complications of Diabetes among Patients Having Type 2 Diabetes Miletus
English1216Maha Mohammed BilalEnglish Ahmed Abdella Mohammed OsmanEnglish Anoud R. OmerEnglishObjective: To assess the physical activities and complications of diabetes among patients having type 2 diabetes mellitus (T2DM).
Methods: We conducted a cross-sectional study inpatients having (T2DM) to measure the effect of physical activity and development of complication among the patients.
Results: Most of patients having (T2DM) were elderly female with the low standard level of living. Just one-quarter of them was performing exercises and they had poor Diabetes control evident by the high blood glucose level the increasing levels of HbA1c,increase levels of total cholesterol and High-Density Lipoprotein. The reported complications included: retinopathy (30 %), neuropathy (25 %), cardiovascular system diseases (13 %), blood vessel diseases (9%) and nephropathy (6 %) respectively.
Conclusions: Physical activity carries significant benefits offered to patients having (T2DM) and there is a need to address physical activity and prescribed it to the patients to prevent, control and postpone the appearance of the complication of the (T2DM).
EnglishComplication of Diabetes, Physical Activity, Type 2 Diabetes Miletus
Introduction
Nowadays, Diabetes constitutes a widespread epidemic(1). World Health Organization (WHO) data revealed an increase in the number of people having Diabetes from 108 million in 1980 and reaching 422 million in 2014. And it is accounted as a major cause of heart attacks, stroke, blindness, kidney failure and lower limb amputation. The risk factors for Diabetes include insufficient physical activity, rising levels of obesity, and sedentary life(2,3).When Diabetes occurred, a lot of intervention can be undertaken like adequate treatment, regular physical exercises, regular screening and adequate treatment for complications(4).Exercise training carries a lot of benefits extending from improving glucose level, cardiorespiratory fitness, cardiovascular risk, body composition, physical well-being and functioning in patients having (T2DM) or pre-Diabetes(5).
Exercises and Complications of Diabetes
Macrovascular and microvascular complications of Diabetes are prevalent in (T2DM)(6). The long term microvascular complications usually appear in poorly controlled patients. Vascular Disease: Diabetes carries a major risk factor that related to the development of cardiovascular disease. The risk of myocardial infarction (MI) is greater in patients having Diabetes and need to treat and consider seriously(7).
Peripheral Neuropathy: It is a special form of neuropathy that affects the extremities of the patients, more in the lower legs and feet(8,9) it affects patient and leads to loss of distal sensation and the patient will be prone to musculoskeletal injury and infections. Regarding the exercises, it’s recommended that non-weight-bearing training should be applied by patients having peripheral neuropathy in order to relieve trauma and irritation to the lower extremities of the patient(10,11).
Nephropathy: High blood pressure is a well-known complication of Diabetes and it worse kidney functions of the patient(10), but, it needs to be proven whether exercise-induced high blood pressure can lead to the progression of nephropathy. physical activity may help to deal with some factors like blood glucose level and blood pressure, which may lead to the progression of nephropathy in patients having (T2DM)(12,13).
Retinopathy: Although exercise training carries risk of increasing systemic and retinal blood pressures, but some studies found that there were no clear associations between physical activity and the development or progression of proliferative retinopathy(14). Bernbaum and associates(15) revealed that there was an improvement in cardiovascular function(15%) in patients who performed a low-intensity training program and having diabetic proliferative retinopathy. It is recommended that the systolic blood pressure should be limited to 20–30 mm Hg above the baseline in each training session(16).
The Aim of this study was to assess the physical activities that are undertaken by patients having type II diabetes attending the Academy Charity Teaching Hospital (ACTH) in Khartoum State, Sudan 2015.
Methods
This study is a cross-sectional hospital based study conducted during the period from10th June to10th July 2015 in (ACTH) Khartoum, Sudan. We included all patients having (T2DM) and whom were attending (ACTH) during the study period and whom were adult Englishhttp://ijcrr.com/abstract.php?article_id=639http://ijcrr.com/article_html.php?did=6391. Facts F, Diabetes ON. National Diabetes Fact Sheet. Centers Dis Control Prev US Dep Heal Hum Serv. 2011;CS217080A(Division of Diabetes Translation):1–12.
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3. Venables MC, Jeukendrup AE. Physical inactivity and obesity: links with insulin resistance and type 2 diabetes mellitus. Diabetes Metab Res Rev [Internet]. 2009;25(S1):S18--S23. Available from: http://dx.doi.org/10.1002/dmrr.983
4. Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications. 2006
5. Snowling NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: A meta-analysis. Diabetes Care. 2006;29(11):2518–27.
6. Statement C. Role of Cardiovascular Risk. 1989;12(September):573–9. Available from: http://care.diabetesjournals.org/content/diacare/12/8/573.full.pdf
7. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction. N Engl J Med [Internet]. 1998 Jul 23;339(4):229–34. Available from: http://dx.doi.org/10.1056/NEJM199807233390404
8. Albers JW, Brown MB, Sima AAF, Greene DA. Frequency of median mononeuropathy in patients with mild diabetic neuropathy in the Early Diabetes Intervention Trial (EDIT). Muscle and Nerve. 1996;19(2):140–6.
9. Fluckey JD, Hickey MS, Brambrink JK, Hart KK, Alexander K, Craig BW. Effects of resistance exercise on glucose tolerance in normal and glucose-intolerant subjects. J Appl Physiol. 1994;77(3):1087–92.
10. Graham C, Lasko-McCarthey P. Exercise options for persons with diabetic complications. Diabetes Educ. 1990;16(3):212–20.
11. Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Vol. 68, Cleveland Clinic Journal of Medicine. 2001. p. 928–44.
12. Kang J, Robertson RJ, Hagberg JM, Kelley DE, Goss FL, DaSilva SG, et al. Effect of exercise intensity on glucose and insulin metabolism in obese individuals and obese NIDDM patients. Diabetes Care. 1996;19(4):341–9.
13. John L, Rao PS, Kanagasabapathy AS. Rate of progression of albuminuria in type II diabetes. Five-year prospective study from south India. Diabetes Care [Internet]. 1994;17(8):888–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7956637
14. Cruickshanks KJ, Moss SE, Klein R, Klein BEK. Physical Activity and the Risk of Progression of Retinopathy or the Development of Proliferative Retinopathy. Ophthalmology [Internet]. 2017 Feb 19;102(8):1177–82. Available from: http://dx.doi.org/10.1016/S0161-6420(95)30893-7
15. Bernbaum M, Albert SG, Brusca SR, Drimmer A, Duckro PN, Cohen JD, et al. A model clinical program for patients with diabetes and vision impairment. Diabetes Educ. 1989;15(4):325–30.
16. Vitug A, Schneider SH, Ruderman NB. Exercise and type I diabetes mellitus. Exerc Sport Sci Rev [Internet]. 1988;16(4):285–304. Available from: http://www.sciencedirect.com/science/article/B7RM4-4G7WH7M-9/2/4f16c4b28561cb3c82d0db402d3035aa
17. Rosengård-Bärlund, Milla, Heikkilä, Outi, Lakka TA, Tikkanen, et al. Physical Activity and Diabetes Complications in Patients With Type 1. Diabetes Care; Feb. 2008;31(2).
18. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: Joint position statement. Diabetes Care. 2010.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1HealthcareA Study of Motor Component of Median Nerve Conduction in Individuals with Type II Diabetes Mellitus
English1720Abiramasundari R.English K. Sathish KumarEnglishBackground: Diabetes mellitus is a major public health concern that has a significant socioeconomic impact. Diabetic peripheral neuropathy is a common complication in diabetic subjects. Electrophysiological study is commonly used for the assessment of diabetic poly neuropathy.
Aim and Objectives: This study was designed to assess the motor component of median nerve conduction in type II diabetic individuals of more than 5 years duration of illness under regular treatment and also to find out the correlation between the nerve conduction study parameters and the duration of illness.
Subjects and Methods: It is a cross sectional study. The left median nerve conduction study was carried out in 30 type II diabetic subjects in the age range of 40-60 years. The study group includes the diabetics of more than 5 years duration of illness who are regularly attending diabetic outpatient department. The control group includes 30 of age and gender matched healthy volunteers. Nerve conduction parameters like Motor distal latency, Amplitude and Conduction Velocity were measured.
Results: It was observed that the motor distal latency of left median nerve was higher in diabetics than in healthy controls with a statistically significant difference. There was a statistically significant decrease in amplitude and conduction velocity of left median nerve in diabetic subjects than in controls also observed. All the nerve conduction study parameters were found to be correlated with the duration of the illness in diabetics.
Conclusion: The present study insists upon the regular monitoring of nerve function in diabetics to prevent the crippling complications.
EnglishPeripheral neuropathy, Nerve conduction study, Duration of illnessINTRODUCTION
Diabetes mellitus is a major public health concern that has a significant socioeconomic impact. The long term systemic complications of diabetes are destructive. They are the major cause of morbidity and mortality. They significantly impair the quality of life and also constitute a significant health cost in the society (1, 2).
The International Diabetes Federation has estimated the total number of diabetic subjects in the year of 2006 to be around 40.9 million in India and also reported that this level can be increased to 69.9 million by the year 2025 (3). Diabetic peripheral neuropathy is a common complication in diabetic subjects. The type of neuropathy occurring in the upper limb and the lower limb is known as the Diabetic Peripheral Neuropathy. Diabetic neuropathy may affect motor, sensory and autonomic nerves. It develops slowly and worsens over time. The advanced stage of diabetic neuropathy can cause serious complications such as diabetic foot ulcer and gangrene resulting in amputation. Therefore, early detection of nerve dysfunction is important to provide appropriate care.
Evaluation of neuropathy is commonly done by electrophysiological measurements (4, 5). Nerve conduction study investigates the condition of the large myelinated nerve fibres. The test reveals the normal condition of the nerve and also the abnormality which may be due to the axonal injury and the myelin loss. Parameters of nerve conduction study such as latency, amplitude and conduction velocity are sensitive indicators of diabetic neuropathy (6). They are also specific and reproducible measures (7).
The incidence and prevalence of diabetic neuropathy associated with duration of diabetes affects up to 50% of diabetic subjects after 25 years of disease (8).
The present study was designed to study and compare the motor component of left median nerve conduction in type II diabetes mellitus individuals and controls. Also to correlate the parameters of nerve conduction study with the duration of illness.
SUBJECTS AND METHODS
The institutional ethical committee approval was obtained. Statistically adjusted sample size of 60 was enrolled for the study. In this 30 type II diabetes mellitus subjects of more than 5 years duration of the illness on regular treatment in the age group of 40-60 years of both gender were selected
as study group from the Diabetic out-patient department. 30 age and gender matched healthy volunteers were selected as controls. The study duration was for the period of six months.
Subjects with Hypertension, Alcoholism, and intake of drugs except oral hypoglycemic drugs, Liver and Kidney diseases, Endocrine disorders were excluded from the study.
After obtaining a written and informed consent from the subjects, questionnaire regarding the personal data and the information pertaining to diabetic status were obtained.
After a complete clinical examination of sensory and motor system, the nerve conduction study was done by using RMS EMG EPII instrument at the neurophysiology laboratory in the department of Physiology. Nerve conduction study was done by the conventional methods with surface electrodes. The action potentials of the motor component of left median nerve were recorded. The nerve conduction study parameters like the distal motor latency (msec), amplitude (microvolt) and conduction velocity (m/sec) were noted. On the basis of duration of illness diabetics were divided into two groups. One group includes diabetics with 5-8 years of illness and the other group 9-12 years of duration illness.
STATISTICAL ANALYSIS
The data was evaluated and analyzed using SPSS version 17. Independent Student’s t test was used to compare the mean value of nerve conduction study parameters between diabetics and controls. Pearson`s correlation coefficient was applied to correlate the duration of the illness and the nerve conduction parameters in diabetic individuals. The probability value of Englishhttp://ijcrr.com/abstract.php?article_id=640http://ijcrr.com/article_html.php?did=6401. Tam TKW, Lau CM, Tsang LCY, Ng KK, HO KS, Lai TC. Epidemiological study of diabetic retinopathy in a primary care setting in Hong Kong. Hong Kong Med J 2005;11:438-444.
2. Tai TY, Tseng CH, Sung SM, Huang RF, Chen CZ, Tsai SH. Retinopathy, neuropathy and nephropathy in non-insulin-dependent diabetic patients. Formos Med Assoc 1991;90:936-940.
3. Sicree R., Shaw J., Zimmet P.-Diabetes and impaired glucose tolerance. In: Gan D, editor. Diabetes Atlas. International Diabetes Fedaration. 3rded.Belgium: International Diabetes Fedaration: p15-103,2006.
4. Hyllienmark L, Bresman T, Ludvigsson J. Subclinical nerve dysfunction in children and adolescents with IDDM. Diabetologia 1995;38:685-92.
5. Holland NR, Stocks A, Hauer Pet al. Intra epidermal nerve fibre density in patients with painful sensory neuropathy. Neurology 1997;48:708-11.
6. Andrew JMB, Arthur IV, JOSEPH CA, Vera B, Eva LF, Roy F, Rayaz AM, Raelene EM, Jay MS, DanZ. Diabetic neuropathies. A statement by the American Diabetes association
7. SK Bhadada, RK Sahay,VP Jyotsna, JK Agrawal-Diabetic Neuropathy: Current Concepts, Journal, Indian Academy of Clinical Medicine. Vol. 2, No. 4 .October- December 2001.P305-318.
8. Graham W.A., Goldstein R., Keith M., Nesathurai S.-Serial Nerve Conduction studies of rhesus monkey(Macacamulatta) and potential implications for interpretation of human neurophysiological studies. Ann Indian Acad Neuro. 10: 252-254,2007.
9. Tae Sun Park-Can nerve conduction studies detect earlier and predict clinical diabetic neuropathy? J Diabetes Invest Vol. 6 No 1, January 2015 P 18-20.
10.Dyck PJ, Davies JL, Wilson DM, Service FJ, Melton LJ 3rd, O'Brien PC. Risk factors for Severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes Care 1999;22:1479-1486.
11.World Health Organisation. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Report of a WHO/IDF consultation. 2006.
12.Sulaiman AAA, Ismail HM, Sultan AA I. Electrophysiological findings in newly diagnosed non-insulin dependant diabetic: A prospective study. Annals of Saudi medicine 1997;17(4):399-401.
13.Vinik A, Mehrabyan A, Colen L, Boutton A. Focal entrapment neuropathies in diabetes. Diabetes care 2004;27(7):1783-1788.
14.Davidson’s principles & practice of Medicine.21st edition 2010, Elsevier publication.
15.Early photocoagulation for diabetic retinopathy. ETDRS report number.
16.Kawano M, Omori Y, Katayama S, Kawakami M, Suzuki Y, Takahashi K, Takemura Y, Nagata N, Hiratsuka A, Matsuzaki F, Kanazawa Y, Akanuma Y. A questionnaire for neurological symptoms in patients with diabetes-cross-sectional multicenter study in Saitama Prefecture, Japan. Diabetes Res Clin Pract 2001;54: 41-47.
17.Zahed Ali et al, Role of Electrophysiological tests in Early detection of Diabetic
Neuropathy. Bangladesh journal of Neuroscience 2008, Vol. 23(1):p36.
18.P. Noel: Sensory nerve conduction in the upper limbs at various stages of diabetes of Diabetic neuropathy. J of Neurology, Neurosurgery& Psychiatry,1973,36,786-96.
19.CerizzaM, Miniciotti G, Meregalli S, Gorosi V, Crosti P, Frattola L. Central nervous system involvement in elderly patients with non-insulin dependent diabetes mellitus. Acta Diabetol Lat1990;27(4):143-8.
20.Neelambala Prasad, Indu K. Pisharody, M.S. Karandikar, S.A. Diwanji, Pankaja R. Raghav- Comparative Analysis of Electrophysiological Parameters of Median Nerve in Normal and Diabetic Subjects. Indian Medical Gazette-July 2013:261-264.
21.A. Mythili, K. Dileep Kumar, K.A.V. Subrahmanyam, K. Venkateswarlu, Raju G, Butchi. A comparative study of examination scores and quantitative sensory testing in diagnosis of diabetic polyneuropathy. Int J Diabetes Dev Ctries.2010 Jan-Mar;30(1):43-48.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1HealthcareAnatomical Study of the Ankle Joint in Relation to the Anterior, the Posterior and the (New) Medial Arthroscopic Portals: A Cadaveric Study
English2129Bharambe Vaishaly K.English Shinde Amol A.English Patel Dinesh K.English Chaudhary SumedhaEnglishContext: Several arthroscopic portals are used for arthroscopy for which understanding of anatomy of ankle and foot is very important. Aims: To study the anatomy of ankle joint in relation to the anterior, posterior and medial midline arthroscopic portals by dissection method. Methods and Material: The distance of the portals to the corresponding neurovascular structures was measured in 20 cadavers using a vernier caliper. Results: The mean distance between the anteromedial portal and the great saphenous vein and saphenous nerve was found to be 7.7 mm, that between the medial midline portal and the dorsalis pedis artery and deep peroneal nerve was found to be 1.7 mm. The mean distance between the anterocentral portal and the dorsalis pedis artery and deep peroneal nerve was found to be 1.4 mm, and that between the anterolateral portal and superficial peroneal nerve was found to be 2.5 mm. Absence of peroneus tertius was found in 2 out of 20 cases. The mean distance between posterolateral portal and sural nerve was found to be 15.9 mm.
Conclusions: The present study confirmed that use of anteromedial portal for ankle arthroscopy is comparatively safe while indicating high chances of injury to dorsalis pedis artery and deep peroneal nerve in both anterocentral and middle midline portals. In case of anterolateral portal the study found the mean distance to be 2.5mm but variations in distribution of superficial peroneal nerve and in tendons of this region have to be studied beforehand to avoid injury to the nerve.
EnglishAnkle arthroscopy, Anteromedial portal, Anterolateral portal, Posteromedial portal, Posterolateral portal, Medial midline portalIntroduction
Symptoms and complaints related to ankle joint are very commonly encountered by orthopedicians. For this, ankle arthroscopy is a common, less invasive and valuable procedure for diagnosis and treatment of any ankle injuries.[1] It is generally performed as outpatient surgery. This is done either under general or regional anesthesia or under epidural anesthesia with the patient sedated. The space within the ankle joint can be temporarily enlarged, and the space can be observed using instruments and a special camera. For entry of the camera and related instruments, incisions are made in the ankle. These are referred to as portals i.e. they act as portals for entry of machine or instrument into the ankle joint. Through the camera, ankle arthroscopy helps in direct visualization of inside of ankle without large cosmetically unsightly scars. At the end of the procedure the incisions are closed by putting tiny sutures on the skin to close the portals and covered by a sterile dressing. Often patient can go home on the same day. [2]
Today arthroscopy is used not only as a tool for investigation, but also as an alternative to open ankle surgery. It has become popular surgical approach for addressing many ankle pathologies that are intra-articular. It is used for treatment of conditions like synovitis, osteochondral defect of talus (osteochondritis dessicans), arthrofibrosis, infection, tibiotalar arthritis, loose bodies, impingement, intra-articular fractures and osteochondral lesions. Patients may be able to begin rehabilitation sooner, and return to high level activities like sports.[3]
Several arthroscopic portals are utilized during ankle arthroscopy, like anteromedial and anterolateral which are most commonly used and allow access to all sides of the joint. [4] The anterocentral portal helps us to see both sides of the joint but is less used because of associated risk to dorsalis pedis artery and related nerve. Other portals are posteromedial, posterolateral, medial transmalleolar and through the Achilles tendon. New portal for ankle arthroscopy has been described called medial midline portal which approaches ankle joint through space between extensor hallucis longus and tibialis anterior.[4]
Variations are seen in terms of distances of portals to the neurovascular structures around the ankle joint. A variety of these neurovascular structures may be encountered during ankle arthroscopy through any of above portals and could be damaged. Same structures can also be damaged during open surgeries of the ankle, but chances of injuring them during mini open approaches or ankle arthroscopy are higher as in open surgery neurovascular structures are better visualized and thus iatrogenic injuries can be avoided.[5]
It is mandatory to have a thorough understanding about the anatomy of the ankle and foot to perform ankle arthroscopy. It becomes important to study the structures in vicinity of the above portals and to note any associated variations. Knowledge of such variations is important as these variant nerves and/ or blood vessels can be injured during the arthroscopic procedures and/or regional anaesthesia. It can explain some unusual clinical symptoms caused due to variations.[6]
The purpose of present study is to discuss the portals used for ankle arthroscopy and to discuss their surgically relevant anatomy and related variations.
Ferkel has described that ankle and foot injuries are frequent today. They are usually diagnosed clinically or using imaging techniques. But some are difficult to evaluate by these methods. Such cases are a diagnostic challenge. He says that though bony disorders are easy to diagnose radiologically, injuries to articular cartilages are best diagnosed arthroscopically. Thus arthroscopy has become very popular as a means to diagnose and treat various ankle disorders. Ferkel also described that arthroscopy can be done under general, spinal, epidural or local anaesthesia using an arthroscope with a diameter of 2.7 to 4 mm. He says that 3 portals have been established to routinely examine the ankle joint cavity. They provide complete access to the joint and also adequate flexibility of approach during examination and surgery. These are the anterolateral, anteromedial and posterolateral portals. He stressed that the placement of portals must be based on thorough knowledge of extra-articular anatomy of the ankle joint to avoid injury to the neurovascular structures as well as tendons around the ankle. He recommended two anterior portals, namely anteromedial and anterolateral, anteromedial being just medial to the tibialis anterior tendon and anterolateral being just lateral to the peroneus tertius tendon. He stated that posterior portals, also used for arthroscopy were posterolateral and posteromedial portals, lying lateral and medial to Achilles tendon respectively. The posteromedial portal is used popularly but should be used with great caution.[7]
Golano et al in their article for arthroscopists stress on the need for adequate knowledge of the anatomy of ankle joint, intra as well as extra articular, along with anatomic variations to avoid confusion and intraprocedure complications. They state that in arthroscopy a three dimensional picture of interior of ankle joint as seen by surgeon or anatomist by opening the ankle joint has been converted into a two dimensional picture seen through the arthroscope. The authors state that most important aspect of preventing injury to structures related to ankle joint is to make skin incisions parallel to the tendons and neurovascular structures running from leg distally to the foot and that it is necessary to carry out blunt dissection to prevent injury while reaching the joint capsule. Golano et al stressed on the necessity to identify tendons such as tibialis anterior, peroneus tertius and that of tendocalcaneus or Achilles tendon and neurovascular structures such as saphenous vein and superficial cutaneus nerve and its two branches i.e. medial and intermedial cutaneus nerves which can be easily identified in thin patients.[8]
Golano et al stated that in case of anteromedial portal which is made just medial to the tibialis anterior tendon there is a potential to damage the great saphenous vein as well as the saphenous nerve. In case of anterolateral portal, the structure likely to be damaged is the intermediate dorsal cutaneous nerve which is the lateral branch of superficial peroneal nerve. They also stated that it is essential for the arthroscopist to remember that the superficial peroneal nerve and its branches lie close to anterolateral portal and injury to them needs to be avoided. However he emphasized that since the nerve is subcutaneous and visible on clinical examination, injury to it can be avoided by careful inspection of the lateral ankle region after inversion of the foot. In case of anterocentral portal, there is potential to injury to the deep peroneal nerve and to dorsalis pedis artery. Due to these possibilities the use of anterocentral portal is discouraged. While discussing the posterior portals, Golano et al stated that the posterolateral portal is more popularly used compared to medial. It lies 1.2 to 2.5 cm proximal to the lateral malleolus and is in close proximity to the sural nerve and the short saphenous vein. The posteromedial portal has potential to damage the tibial nerve, posterior tibial artery and tendons of flexor hallucis and flexor digitorum longus muscles.[8]
Buckingham et al introduced the medial midline portal wherein the ankle joint was approached through a portal just lateral to the tibialis anterior tendon. This portal was said to have a lesser risk of injury to neurovascular structures of this region.[4]
Woo et al carried out a study wherein they investigated the anatomic variations of neurovascular structures in the ankle in relation to safety margins for arthroscopic portals. They studied 23 ankles by dissection method after marking the various portals namely anterolateral, anteromedial, posterolateral and posteromedial and measured the distances of each portal with related neurovascular structures. They found significant variations in the neurovascular structures and concluded that care must be taken to avoid inadvertent injury to the neurovascular structures during ankle arthroscopy.[9]
Sitler et al studied the safety of posterior portals by marking them and then studying their MRI images. The proximity of these portals to adjacent structures were measured on the images and also by dissection and these 2 distances were compared. They concluded that with patient in prone position, arthroscopy can be done using posterior portals without gross injury to the posterior neurovascular structures. The measurements of MRI images were used as additional measurements to confirm the dissection results. No significant differences were detected.[10]
Balci et al in a similar study involving the posterior ankle arthroscopic portals, studied the distance of important neurovascular structures from either of the posterior portals in different ankle positions namely neutral, plantar flexed and dorsiflexed. They concluded that the distance between the neurovascular structures and the portals was more in plantarflexed and dorsiflexed positions compared to that in neutral position.[11]
Scholten and C Niek van Dijk have described a anterior and posterior arthroscopy wherein first patient was in supine position for anterior approach and then in prone position for posterior approach through the portals.[12]
Zengerink M and C Niek van Dijk in a retrospective study involving 1305 patients who had undergone ankle arthroscopy, found the complication rate to be 3.5%. 1.9% were neurological problems and were found to be due to due to errors during placement of the portal.[13]
Materials
Materials used were:
Gloves, scalpel, blunt and tooth forceps, fine small scissors, 23 guage needle, vernier caliper and a 12 megapixel camera for photography.
Methods
Institutional Ethical Committee clearance was obtained before study was commenced. (Attached)
30 lower limbs were obtained from formalin fixed cadavers. Each limb was examined, rejecting five which were damaged. Once selected, each limb was labeled separately for identification.
The surface landmarks such as medial and lateral malleoli, borders of Achilles tendon and medial border of tibialis anterior muscle were identified. The different portals were marked using a 23 guage needle as follows:
With the limb in supine position (Figure 1 depicts the positions of the 4 anterior portals):
Medial to the tibialis anterior tendon and parallel to the joint line we marked the anteromedial portal.
Lateral to the peroneus tertius tendon and parallel to the joint line we marked anterolateral portal.
Between tibialis anterior and extensor hallucis longus we marked the medial midline portal
Lateral to the extensor hallucis longus tendon we marked the anterocentral portal.
With the limb in the prone position
The posterolateral portal was marked just lateral to the Achilles tendon and about half inch proximal to the distal tip of lateral malleolus
The posteromedial portal, just medial to the Achilles tendon and 1.2 cm proximal to a horizontal line drawn from the tip of lateral malleolus.
After the portals were marked the dissection was commenced. However the needles inserted were removed during dissection as they interfered with the finer dissection. The skin and subcutaneous fat was dissected from underlying fascia for visualization of the neurovascular structures below. Throughout the dissection care was taken not to disturb the dissected tendons, nerves or blood vessels. The distance of the portals to the corresponding neurovascular structures was measured using a vernier caliper. For each individual portal, care was specially taken for important structures. For the anteromedial portal, the great saphenous vein and saphenous nerve were dissected with care and their distance from the portal was measured. For the anterolateral portal the superficial peroneal nerve and its branches were dissected.
Any variation in branching mentioned. Distance between these nerves and the portal was noted. The area round the anterocentral portal was dissected carefully to note the dorsali pedis artery, deep peroneal nerve and its branches and distance between these and the portal was noted. The medial midline portal and its distance from deep peroneal nerve and dorsalis pedis artery was measured (Figure 2). Similarly the distance between the sural nerve and the posterolateral portal and between the posterior tibial neurovascular bundle and the posteromedial portal was measured taking care to note any variations in branching pattern of the nerves and vessels. All measurements were taken in millimeters. (Figures 3,4)
Observations and Results
The data presented here is for a total of 20 lower limbs. Five lower limbs were not suitable as parts of them were damaged and the other 5 lower limbs could not be dissected due to constraints of time. The distance between the anteromedial portal and the great saphenous vein and saphenous nerve is depicted in Table 1. The mean distance between the anteromedial portal and the great saphenous vein and saphenous nerve was found to be 7.7 mm, range being 6.5 to 9.5mm. The distance between the medial midline portal and the dorsalis pedis artery and deep peroneal nerve is depicted in Table 1. The mean distance between the medial midline portal and the dorsalis pedis artery and deep peroneal nerve was found to be 1.7 mm, range being 1 to 2 mm. The distance between the anterocentral portal and the dorsalis pedis artery and deep peroneal nerve is depicted in Table 2. The mean distance between the anterocentral portal and the dorsalis pedis artery and deep peroneal nerve was found to be 1.4 mm, range being 1 to 2 mm.
The distance between the anterolateral portal and the superficial peroneal nerve is depicted in Table 2. The mean distance between the anterolateral portal and superficial peroneal nerve was found to be 2.5 mm, range being 1 to 3 mm. Absence of peroneus tertius was found in 2 out of 20 cases i.e. an 10% incidence. (Figure 5) The distance between posteromedial portal and posterior tibial neurovascular bundle is depicted in Table 2. The mean distance between them was found to be 11 mm and the range found to be 8-13 mm. The distance between posterolateral portal and sural nerve was measured in 6 cases as in other cases the sural nerve was damaged during removal of skin. The mean distance between them was found to be 15.9 mm and the range found to be 9.5-19.5 mm.
During the measurement of all above distances wide variations were found in the distances measured between the portals and related neurovascular structures in cases of the posteromedial and posterolateral portals.
DISCUSSION
\
Arthroscopy is increasingly being used for diagnosis and treatment of ankle related pathologies. The ankle arthroscopy is thus used for survey of ankle joint from within and for reparative ankle surgery. [14] Ankle arthroscopy was the first attempted in 1931 and fol lowing the attempt it was concluded that this joint was not suitable for arthroscopy due to its narrow joint cavity. Since then narrow small diameter arthroscopes have resulted in improved ability to perform diagnostic and operative arthroscopy. [14] However there are some possible complications with arthroscopy. To prevent them the surgeon must be well versed with anatomy of the ankle region. Ferkel described an complication rate of about 9%. 49% of these were neurological. The most commonly injured nerve was the superficial branch of common peroneal nerve. Lesser complications were due to injury to sural, deep peroneal and saphenous nerves. Ferkel also reported complications with anterocentral and posteromedial portals. It was concluded that thorough understanding of the extra-articular anatomy of the ankle region was mandatory to avoid complications. [7]. The present study was aimed at studying this extra-articular anatomy of the ankle region with respect to the anterior (anteromedial, anterocentral and anterolateral), posterior (posteromedial and posterolateral) and medial midline portals. The distances between each of the respective portals and the commonly injured neurovascular bundles near them was measured.
The Anteromedial portal
In the present study the mean distance between the anteromedial portal and the great saphenous vein and saphenous nerve was found to be 7.7 mm, range being 6.5 to 9.5mm.
Stetson and Ferkel state that the anteromedial portal is made first as it is easy to establish and the region where it is placed is devoid of any major neurological structures.[6] Woo et al reported the mean distance to be 10.2mm (range 1.1 to 20.2) in a study carried out on Chinese cadavers, which is more than the finding reported by present study. [9] Golano et al while describing ankle anatomy for the arthroscopists, report the mean safe distance between the portal and the great saphenous vein as 9mm (range 3-16mm) and for saphenous nerve as 7.4mm (range 0-17mm).[8] Though these structures are relatively risk-free, there are reports of a case of lesion of the great saphenous vein and 5 cases neurological complications during arthroscopy using the anteromedial portal. [7,15] The mean distance reported by present study is lesser than findings of all above authors and this could indicate higher possibility of damage to both great saphenous vein and saphenous nerve during use of anteromedial portal for arthroscopy in case of Indian population.
The medial midline portal
This portal was described by Buckingham et al as a new portal for ankle arthroscopy. [4] Here the arthroscope passes between the tendons of extensor hallucis longus and tibialis anterior. The authors reported a mean distance of 11 mm (range 5-15mm) from the dorsalis pedis artery. In the present study a mean distance between the medial midline portal and the dorsalis pedis artery and deep peroneal nerve was found to be 1.7 mm, range being 1 to 2 mm. This distance reported by present study is very much less compared to findings reported by Buckingham et al. Golano et al state that this portal gives an intra-aricular view similar to that by anterocentral portal but with lower chances of lesion to vital structures.[8]
The anterocentral portal
In the present study the mean distance between the anterocentral portal and the dorsalis pedis artery and deep peroneal nerve was found to be 1.4 mm, range being 1 to 2 mm. Buckingham et al reported the mean distance to be 0.7 (range 0-5) in case of dorsalis pedis artery and 1.1 (range 0-5) in case of deep peroneal nerve. The authors state that in 90% of the cases where this portal was used, the arthroscope touched the dorsalis pedis artery and in one case it lacerated the deep peroneal nerve. In all cases the arthroscope was in contact with the superficial peroneal nerve and in 3 cases this nerve too showed lacerations.[4] Feiwell and Frey found the average distance of this portal from the neurovascular bundle to be 3.3mm (range, 0-10mm).[16] In 1 case the arthroscope penetrated and in 4 cases was related to the neurovascular bundle. Golano et al state that use of this portal is discouraged due to high associated risk of injury to superficial peroneal nerve superficially and deep peroneal nerve and dorsalis pedis artery on the deeper plane.[8] The present study reports the distance of portal from close neurovascular structures to be 1.4 mm which is close to that reported by Buckingham (0.7 mm) but less than the 3.3 mm distance reported by Feiwell and Frey. Golano et al state that any associated variations of the artery may also lead to vascular lesions. [8] Basarir et al studied the lateral and medial malleolar arteries and their distances from the arthroscopic portals in plantar and dorsiflexion positions of foot. The authors go on to state that risk of vascular injury is quiet high in case of arthroscopy and advised position of plantar flexion during portal placement which increases the distance of the portal from the blood vessels.[17]
The anterolateral portal
In the present study the mean distance between the anterolateral portal and superficial peroneal nerve was found to be 2.5 mm, range being 1 to 3 mm. Buckingham et al reported a mean distance of 0.5 mm (range, 0-10 mm). They reported 2 cases of laceration to the nerve during arthroscopy using this portal. [4] Stetson and Ferkel state that this portal is made just lateral to the peroneus tertius tendon at the joint level.[6] The superficial peroneal nerve branches are at risk. [14] They report a mean distance of the portal from the superficial peroneal nerve branch to be 6.2 mm (range, 0-24mm). Woo et al found the mean distance between the portal and superficial peroneal nerve to be 5.5mm (range, 0.4 to 14.4). They state that the anterolateral portal should be placed as close to the fibulas as possible to avoid injury to the nerve. [9]The mean distance reported by present study is greater than that reported by Buckingham et al but less than that reported by Stetson and Ferkel and Woo et al. The present study reports absence of peroneus tertius muscle in 2 limbs. This could mislead the surgeon while placing the portal. Such absent peroneus tertius muscle was also reported by Das et al, though the study did not correlate the absence of the muscle with relation to the anterolateral arthroscopic portal. [18] C Niek van Dijk clearly states that in absence of peroneus tertius (which is present in 90%of the population), the anterolateral portal is placed adjacent to extensor digitorum longus tendon.[19]
The posteromedial portal
In the present study the mean distance between posteromedial portal and the posterior tibial neurovascular bundle was found to be 11mm and the range found to be 8-13 mm. Balci et al reported the mean distance to be 6mm (range, 3.9 to 9.5mm).[11] Woo et al found the mean to be 14.2mm (range, 5.2 to 22.1mm).[9] The distance reported by present study of 11mm is greater than that reported by Balci et al and less than the findings of Woo et al in their study on Chinese cadavers.
Frank et al state that the posterior tibial artery could be damaged during creation of the posteromedial portal.[5] Ilyas et al stated that this portal was contraindicated due to proximity to posterior tibial artery and nerve and also risk to flexor hallucis and flexor digitorum longus tendons.[19] Sitler et al in a study of posterior ankle arthroscopy state that though arthroscopy has generally been performed with the use of anterior portals with the patient in supine position, the authors advise that with the patient in prone position, posterior ankle arthroscopy can be performed without gross injury to the posterior neurovascular structures.[10]
The posterolateral portal
The distance between posterolateral portal and sural nerve was measured in 6 cases in the present study. The mean distance between them was found to be 15.9 mm and the range found to be 9.5-19.5 mm. Woo et al report a mean distance of 12.6mm (range, 7.0 to 23.0) and Feiwell and Frey reported it to be 6mm (range, 0-12mm). [9,16] Balci et al reported it to be 6mm (range, 2.7 to 14.5mm).[11] The distance reported by present study is found to be the highest among all reported. However considering that only 6 cases could be dissected successfully to demonstrate the sural nerve, this mean of 15.9 mm cannot be reliably used for comparison. Both the posterior distances measured in present study were found to be higher than those reported by other authors. Regarding the posterior ankle arthroscopic portals, Zengerink M and C Niek van Dijk state that posterior ankle arthroscopy using a 2 portal approach is a safe procedure with the rate of complication similar to anterior ankle arthroscopies. [13]
CONCLUSION
The mean distance between the anteromedial portal and the great saphenous vein and saphenous nerve is 7.7 mm as reported by present study which is lesser than findings of all above authors and this could indicate higher possibility of damage to both these structures during use of anteromedial portal for arthroscopy in case of Indian population. In case of the medial midline portal which is a new portal for ankle arthroscopy, the mean distance of the portal from the dorsalis pedis artery was found to be 1.7 mm. This distance reported by present study is very much less compared to findings reported by other authors and does not give much space for maneuvering of the arthroscope and likelihood of damage to the dorsalis pedis artery seems to be very likely. In the present study the mean distance between the anterocentral portal and the dorsalis pedis artery and deep peroneal nerve was found to be 1.4 mm. This finding is similar to findings of most other authors and indicates high chances of injury to the dorsalis pedis artery and deep peroneal nerve in case this portal is used for arthroscopy.
In the present study the mean distance between the anterolateral portal and superficial peroneal nerve was found to be 2.5 mm. An associated absence of peroneus tertius was noted in 2 limbs. The mean distance reported by present study is greater than that reported by Buckingham et al but less than that reported by Stetson and Ferkel and Woo et al.[4,6,9] Careful observation of the branches of superficial peroneal nerve and examination and palpation of the limb involved to note all related tendons can reduce chances of damage to underlying structures in case of use of this portal as well as in portal placement. In the present study the mean distance between posteromedial portal and the posterior tibial neurovascular bundle was found to be 11mm. The distance reported by present study of 11mm is greater than that reported by other authors. The mean distance between posterolateral portal and sural nerve measured in 6 cases in the present study was found to be 15.9 mm and was the highest reported by any author. However considering that only 6 cases could be dissected successfully to demonstrate the sural nerve, this mean of 15.9 mm cannot be reliably used for comparison.
The present study measures the distances of 4 anterior portals and 2 posterior portals used for arthroscopy at the ankle joint, from the closest neurovascular bundles. The study confirmed that use of anteromedial portal for ankle arthroscopy is comparatively safe due to the distance existing between the portal and the great saphenous vein and saphenous nerve. The study also indicated high chances of injury to dorsalis pedis artery and deep peroneal nerve in both anterocentral and middle midline portal. In case of anterolateral portal the study found the mean distance to be 2.5mm but variations in distribution of superficial peroneal nerve and in tendons of this region have to be studied beforehand to avoid injury to the nerve or wrongful placement of the portal. In case of the posterior portals, the mean distances measured for both medial and lateral portals were found to be more than the mean distances reported by other authors. In present study 20 limbs were dissected for 5 of the portals. For the posterolateral portal the sural nerve was dissected successfully in only 6 limbs and was damaged during dissection in others. Further study using more number of limbs would help bring more authenticity to the data and may also reveal further details of some of the variations encountered.
ACKNOWLEDGEMENT
The Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to the 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: As this study was carried out in the dissection hall of our Department, there was no separate financial aid provided for it. Conflict of interest: There is no conflict of interest
Englishhttp://ijcrr.com/abstract.php?article_id=641http://ijcrr.com/article_html.php?did=6411. Andrews JR, Previte WJ, Carson WG. Arthroscopy of the ankle: technique and normal anatomy. Foot Ankle 1985;6:29-33.
2. Amendola A, Petrik J, Webster-Bogaert S. Ankle arthroscopy: outcome in 79 consecutive patients. Arthroscopy. 1996 Oct;12(5):565-73.
3. Calder JD, Sexton SA, Pearce CJ. Return to Training and Playing After Posterior Ankle Arthroscopy for Posterior Impingement in Elite Professional Soccer. Am J Sports Med,38(1):120-4
4. Buckingham RA, Winson IG, Kelly AJ. An Anatomical Study Of a New Portal For Ankle Arthroscopy. J Bone Joint Surg Br.1997;79:650-2.
5. Frank RM, Hsu AR, Gross CE, Walton DM, Lee S. Open and Arthroscopic Surgical Anatomy of the Ankle. Hindawi Publishing Corporation Anatomy Research International Volume 2013, ArticleID 182650,9pages.
6. Stetson WB, Ferkel RD. Ankle arthroscopy I:Technique and Complications. J Am Acad Orthop Surg 1996;4:17-23.
7. Ferkel RD. Ankle and Foot Arthroscopy Contemporary Approach to Diagnosis and Treatment. (?)
8. Golano P, Vega J, Carro LP, Gotzens V. Ankle Anatomy for the Arthroscopist Part 1: The Portals. Foot Ankle Clin N Am 11 (2006) 253-273.
9. Woo SB, Wong TM, Chan WL, Yen CH, Wong WC, Mak KL. Anatomic variations of neurovascular structures of the ankle in relation to arthroscopic portals: a cadaveric study of Chinese subjects. Journal of Orthopaedic Surgery 2010.18(1):71-5
10. Sitler DF, Amendola A, Bailey CS, Thain LMF, Spouge A. Posterior Ankle Arthroscopy An Anatomic Study. JBJS.ORG 2002.84(5):763-769.
11. Balci HI, Polat G, Dikmen G, Atalar A, Kapicioglu M, Asik M. Safety of posterior ankle arthroscopy portals in different ankle positions: a cadaveric study. European Society of Sports Traumatology, Knee Surgery, Arthroscopy 2014.DOI 10.1007/s00167-014-3475-6
12. Scholten PE, Dijk CNV. Combined Posterior and Anterior Ankle Arthroscopy. Case Reports in Orthopedics 2012, Article ID 693124, 4 pages.
13. Zengerink M, Dijk CNV. Complications in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc (2012) 20:1420–1431.
14. Ilyas J. Ankle Arthroscopy. http://dx.doi.org/10.5772/54013.
15. Chen YC. Clinical and cadaver studies on the ankle joint arthroscopy. J Jpn Orthop Assoc 1976;50:631-51.
16. Feiwell LA, Frey Cankle 1993;14:142-147 :Anatomic study of arthroscopic portal sites of ankle. Foot
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19. Dijk CNV. Ankle Arthroscopy: Techniques Developed by the Amsterdam Foot and Ankle School. 32-33.ISBN:978-3-642-35989-7(Online)
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1HealthcareCongenital External Ear Deformity and Their Hearing Rehabilitation With Bone Anchored Hearing Aid: A Retrospective Analysis
English3035Hetal MarfatiaEnglish Ratna PriyaEnglishObjectives: Microtia-anotia is a spectrum of congenital anomalies of the auricle ranging from mild structural abnormalities to complete absence of the ear. Early amplification, auditory training, and speech therapy can improve speech and language development.
Materials and Methods: Case Records of 30 patients with congenital external deformity during the time period from January 2010 to June 2013 were reviewed for the grade of microtia, the degree and type of hearing loss and hearing rehabilitation.
Results: Out of 30 patients, 22 patients were given hearing rehabilitation either in the form of bone anchored hearing aid – soft -band or Baha implant. 9 patients underwent Baha surgery. Mean post rehabilitation improvement was 23.4 dB. Closure of the air- bone gap was observed in one patient.
Conclusion: Baha is an excellent option for hearing rehabilitation in patients with congenital conductive hearing loss.
EnglishMicrotia-anotia, Baha softband, Baha surgery, Osseointegration, RehabilitationIntroduction
Microtia-anotia is a spectrum of congenital anomalies of the auricle ranging from mild structural abnormalities to complete absence of the external ear (anotia). It may occur as an isolated condition, or as part of a spectrum of anomalies or a syndrome. The prime concern in the young child is the assessment and improvement of hearing. Early amplification, auditory training, and speech therapy can improve speech and language development.
Ours is a retrospective study of patients with congenital external ear deformity and their hearing rehabilitation. Medical records of 30 patients who presented during the period from January 2010 to June 2013 were evaluated.
Materials and methods
Case Records of patients with congenital external deformity who presented to the E.N.T. Department during the time period from January 2010 to June 2013 were reviewed for the grade of microtia, the degree and type of hearing loss and hearing rehabilitation. Hearing evaluation was done by behavioural audiometry and pure tone audiometry (PTA). BC BERA was done to rule out sensorineural hearing loss.
According to Marx classification, the deformity was graded.(Figure 1) All these patients underwent Baha trial with Baha Divino, BP 100 or Baha Intenso depending on the hearing loss using headband or softband. Patients with bone thickness less than 3 mm and children less than 5 years of age were given Baha soft band and others were considered for surgery.
Baha surgery was done under general anaesthesia. The Linear Incision technique was used.2-6The implant site was positioned 6-6.5cm from the ear canal. A 3 cm incision was made through the periosteum at the hairline to expose the planned implant site. Approximately 1 cm of the periosteum was elevated around the site. A 3mm deep guide hole was drilled at that site (at 2000 rpm); Drill indicator was used to keep the insertion strictly 90 degree to the bone. The hole was enlarged slowly, carefully inspecting the bone. Continuous irrigation was provided to avoid thermal injury to osteoclasts. If the bone thickness was more than 3mm then spacer was removed and 4 mm drilling was done. The guide hole was used to align a countersink burr, which widened the guide hole and created a shallow countersink in the adjacent bone surface. A self tapping titanium bone screw with attached abutment (the percutaneous part to which a processor would be affixed 2 to 3 months postoperatively) was carefully picked up with an abutment inserter and then advanced to full depth at a slow revolution rate and controlled insertion torque of 20-30Ncm which was slowly increased to 40-50Ncm . First turn of the implant was placed without irrigation and later continuous irrigation was done for cooling. Soft tissue reduction was done all around. Skin wound edges were sutured to underlying periosteum to coapt dead space; the skin flap was sutured back in its original position. Healing cap was placed and compression dressing using umbilical tape was given for 7 days. Suture removal was done after seven days and Patients were kept on regular two weekly follow up. ( Figure 2) After waiting for 3-6 months (depending on bone quality) for osseointegration the Baha processor was snapped on to the abutment and the hearing improvement was documented using pure tone audiometry and plotted as Baha aided audiogram. (Figure 3)
Results
In our study mean age of the patients was 13.33 years ranging from 3 months to 31 years of age and a male: female ratio was 4:1. Bilateral congenital microtia – anotia was found in 53.3% of patients compared to unilateral microtia – anotia in 46.7% of cases.(Table1)Among the 14 unilateral cases, out of total 30, right sided deformity was found in 64.3% of patients. The distribution of patients showed male predominance.( Table 2) Grade III microtia was the most common congenital external ear malformation in our study. External auditory canal atresia is present in 83% of cases. Conductive hearing loss was most common type of hearing loss being present in 86.7% subjects. (Figure 4) Maximum number of subjects with grade III microtia fell in the hearing threshold of moderately – severe hearing loss i.e.55-70 decibels. Rest 13.3% of subjects had presented with mixed hearing loss. Pure sensorineural hearing loss was seen in one patient. ( Table 3)
Out of 30 patients, 22 patients were given hearing rehabilitation either in the form of bone anchored hearing aid – soft -band or Baha implant. 9 patients underwent Baha surgery. Out of the nine patients, 7 underwent single staged procedure. The side of the implantation was decided on the cochlear function, temporo-parietal suture line thickness as well as on the handedness of the patient. Among the nine implanted patients, 8 underwent right sided surgery and one left sided surgery as on the right side patient complained of discharge from the redundant EAC.
13 patients were given Baha- soft-band for amplification of hearing among which 6 were infants who were given soft- band for early language development. Rest of the 7 patients were given Baha- soft band till they were arranging funds for Baha- surgery
It was observed that 5 patients with unilateral microtia with mild to moderate conductive hearing loss did not opt for Baha soft band or implant, as the other ear was completely normal and they could manage with unilateral hearing loss. 3 patients had bilateral profound hearing loss that did not have any benefit following Baha trial.
The mean pre- rehabilitation air- bone gap of all 22 patients was 50.9 Db ± 10.5 dB. Post rehabilitation Baha aided air bone gap, after 3 months of use, was 27.5 dB ± 11.2 dB. Mean post rehabilitation improvement, calculated by subtracting mean post rehabilitation Baha aided threshold from mean pre rehabilitation air conduction threshold, was 23.4 dB. Closure of the air- bone gap was observed in one patient. Thus, bone anchored hearing aid is a reliable method of rehabilitation in patients with congenital external ear deformity.
The complications observed were skin infection (Holgers grade 2)( Figure 5) around the site of implant in two patients. This settled following two weeks of oral antibiotic and meticulous wound care and cleaning. One of the patients developed skin overgrowth due to more thickness of scalp (Holgers grade 4) and also the abutment height was inadequate. The patient had to undergo revision surgery to replace the abutment. And one of the patients underwent failure of osseointegration and was reimplanted later on the opposite side.
Discussion
Microtia is found in approximately 0.03 percent of all newborn infants.1 It is associated with atresia or stenosis of the external auditory canal and frequently with ossicular abnormalities. The etiology of microtia-anotia is poorly understood. There is strong evidence supporting the significance of environmental causes for microtia-anotia, such as altitude and gestational exposure to retinoid, alcohol, thalidomide and, mycophenolatemofetil. In many cases it occurs as a mutation without any precipitating factors. However, none of our patients had any of the above predisposing factors or any positive family history.
The recommended tests for hearing evaluation are pure tone audiometry (PTA), BC BERA (Brainstem-evoked response audiometry) and Behavioural Audiometry. A HRCT scan was done to determine the anatomy of the bony structures and middle and inner ears and bone thickness which is usually measured behind the temporo-parietal suture line. ( Figure 6)
In order to characterise the severity of microtia, many grading systems have been developed. We followed Marx’s microtia classification.7 Grade III microtia was the most common congenital external ear malformation in our study. External auditory canal atresia is present in 83% of cases.
Microtia surgery is technically difficult, and not infrequently, the results are somewhat disappointing. The surgery should be performed by individuals with special expertise.5 Auricular reconstruction is an elective procedure. The deformity can usually be masked by a longer hair style. Generally, the slight deformity of a grade I microtia may be cosmetically acceptable.1 Reconstruction of a moderately deformed grade II microtia must be individualized. Correction of a severe grade III microtia may require multiple surgery as well as need for additional incision on chest for rib graft. Ear prosthesis can also be an option for some individuals with microtia-anotia.1 There can be difficulties in matching the appearance of the other ear, and it is just for cosmesis.
Congenital conductive hearing loss caused by a malformation of the middle or external ear resulting in external auditory canal atresia is effectively managed with a Bone Anchored Hearing Aid (Baha). Such people have option of bone conduction hearing aids but they have to be worn on the head using a steel spring headband or included in the frame of a pair of glasses, hence they are uncomfortable as patients complain of pain and headaches due to the constant pressure of the headband, cumbersome, obtrusive and insecure.8 Also, the sound quality is poor as the skin acts as a barrier for the sound to travel to the inner ear. The Baha system can be a real solution for people with this type of impairment. The Baha implant is directly integrated to the skull bone. Because of this direct interface, the Baha offers significantly better sound quality than that of a traditional bone conductor. The Baha sound processor works without pressure on the skin avoiding headache and soreness associated with the conventional bone conductor. Baha offers excellent wearing comfort and a better aesthetic result.8 The surgery can only take place once the skull is at least 2.5 mm thick.9 In the meantime the child with bilateral atresia can be fitted with a soft band around the head called the Baha soft band; these are available in colourful patterns. This is offered at the age of 3-6 month. These small babies often tolerate this arrangement very well.10
The Baha is a surgically implantable system for treatment of hearing loss that works through direct bone conduction. It has been used since 1977, and was cleared by the FDA in 1996 as a treatment for conductive and mixed hearing losses in the United States. It consists of three components: a titanium implant, an external abutment and an electronic sound processor.
The pioneering work in osseointegration was done by Branemark et al.11 in 1965. Nine years later, Tjellstrom et al12 introduced the concept of direct bone conduction using a skin-penetrating coupling from an osseointegrated titanium implant in the mastoid bone.9 Tjellstrom and Granstrom13 modified the original technique of two staged procedure into a single-stage procedure.
Baha is used for conductive or mixed hearing loss with good cochlear reserve. It is a very effective hearing option for children with conductive hearing loss.14-16 The major limitation is the relative thinness of the paediatric skull (average 3mm) which requires shorter screw lengths. Also, the surgeon is faced with continuous growth of the skull, and the fact that the majority of children who are candidates for this type of hearing aid often have abnormal skull contour.17-19
In our retrospective review of 30 cases of congenital external ear deformity, we found that bilateral microtia – anotia is more common compared to unilateral variety, as those with bilateral condition seek for the help more often. Patients with bilateral hearing loss warrant early intervention to prevent delay in development of speech. Hearing amplification is provided either by Baha band or Baha surgery, depending on age and bone thickness. Also, patients with Baha band can be later considered for surgery.
Patients with bilateral profound mixed hearing loss cannot be benefitted by using Baha and are candidates for cochlear implants. Even cochlear implant is challenging due to associated middle and inner ear anomalies. Baha surgery can be done either as single staged or double staged depending on age and bone thickness. In case the required thickness is less than 3 mm, then two-staged surgery is planned. However, even patients with adequate bone thickness may have soft bone, demanding staged procedure. The mean improvement in our series was 23.4 dB. The Closure of the air- bone gap was observed in one patient. Thus, we can conclude that Baha is a reliable method of rehabilitation in patients with congenital external ear.
The risks associated with Baha surgery were skin infection around the site of implant seen in 1 out of 9 implanted patients, skin overgrowth in 1 patient and Baha extrusion in 1 patient.
Conclusion
Hence in this retrospective analysis we conclude Baha is an excellent option for hearing rehabilitation in patients with congenital conductive hearing loss. Candidates for Baha band are children less than 5 years of age, those with bone thickness less than 3mm and the ones awaiting Baha surgery. Surgical outcome doesn’t change whether we do a single or a staged procedure. Baha is proved to be one of the simplest surgery to perform and the easiest to fail if the surgery is not done meticulously and the implant is not perpendicular to scalp.
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.
Disclosure of potential conflicts of interest: None of the authors have any conflict of interest
Ethical approval: All procedures performed were in accordance with the ethical standards of the·institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent: Informed consent was obtained from the patient included in this study.
Role of funding source: None
Englishhttp://ijcrr.com/abstract.php?article_id=642http://ijcrr.com/article_html.php?did=6421) Simon C. Parisier MD, Jose N. Fayad MD, Charles P. Kimmelman MD.Microtia, Canal Atresia, and Middle Ear Anomalies. Ballenger’s Otorhinolaryngology and Head and neck surgery (16th edition): 997-1008.
2) van der Pouw CT, Mylanus EA, Cremers CW. Percutaneous implants in the temporal bone for securing a bone conductor: surgical methods and results. Ann Otol Rhinol Laryngol. 1999 Jun; 108(6):532-6.
3) de Wolf MJ, Hol MK, Huygen PL, Mylanus EA, Cremers CW. Clinical outcome of the simplified surgical technique for Baha implantation. Otol Neurotol. 2008; 29(8):1100-8.
4) de Wolf MJ et al. Nijmegen results with application of a Bone-Anchored Hearing Aid in children: Simplified Surgical Technique Ann Otol Rhinol Laryngol. 2008; 117(11):805-14.
5) Bovo R. Simplified technique without skin flap for the bone-anchored hearing aid
(Baha®) implant Acta Otorhinolaryngol ItaI 2008; 28:252-255.
6) Wilkinson EP, Luxford WM, Slattery WH, De la Cruz A, House JW, Fayad JN. Single vertical incision for Baha implants surgery: Preliminary results. Otolaryngology-Head and Neck surgery 2009, 1401 573-578.
7) Samuli Suutarla microtia academic dissertation department of Otorhinolaryngology University of Helsinki Finland and cleft and craniofacial centre Helsinki University Hospital, Finland 2014.
8) Baha implant University of Maryland Medical Centre umm.edu/programs/hearing/services/bone-anchored-devices. Jul 15, 2014
9) Tjellstrom A, Hakansson B. The bone anchored hearing aid (BAHA) design principles, indications and long-term clinical results. Otolaryngol Clin North Am 1995; 115:1–20.
10) Papsin BC, Sinmanna TK, Albert DM, Bailey CM. Surgical experience with bone-anchored hearing aids in children. The Laryngoscope, 1997: 104(6):801-6.
11) Branemark PI, Adell R, Breine U, Hansson BO, Lindstrom J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg. 1969; 3(2):81–100.
12) Tjellstrom A, Hakansson B, Lindstrom J, Branemark PI, Hallen O, Rosenhall U, et al. Analysis of the mechanical impedance of bone-anchored hearing aids. Acta Otolaryngol. 1980; 89(1–2):85–92.
13) Tjellstrom A, Granstrom G. One-stage procedure to establish osseointegration: a zero to five years follow-up report. J Laryngol Otol. 1995; 109(7):593–598.
14) Papsin BC, Sirimanna TK, Albert DM, Bailey CM. Surgical experience with bone-anchored hearing aids in children. Laryngoscope. 1997; 107(6):801–806.
15) Powell RH, Burrell SP, Cooper HR, Proops DW. The Birmingham bone anchored hearing aid programme: paediatric experience and results. J Laryngol Otol Suppl. 1996; 21:21–29.
16) Stevenson DS, Proops DW, Wake MJ, Deadman MJ, Worrollo SJ, Hobson JA. Osseo integrated implants in the management of childhood ear abnormalities: the initial Birmingham experience. J Laryngol Otol.1993; 107(6):502–509. nchored hearing aids in children. Laryngoscope. 1997; 107(6):801–806.
17) Tjellstrom A, Granstrom G. One-stage procedure to establish osseointegration: a zero to five years follow-up report. J Laryngol Otol. 1995; 109(7):593–598.
18) Granstrom G, Tjellstrom A. The bone-anchored hearing aid (BAHA) in children with auricular malformations. Ear Nose Throat J. 1997; 76(4):238–7.
19) Granstrom G. Osseo integrated implants in children. Acta Otolaryngol Suppl. 2000; 543:118–121.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1HealthcareMicrobial Forensics- Issues and Challenges
English3640Moumita SinhaEnglish I. Arjun RaoEnglishBioterrorism has been known to exist since hundreds of years by utilising microorganisms as weapons. The terrorist attack using anthrax in the fall of 2001 in U.S. highlighted this kind of utilisation of microorganisms. To criminally prosecute with the help of forensic evidence the perpetrator is necessary and such attacks of bioterrorism are very few. A comprehensive technological network is necessary to strengthen defence against bio crimes by acquiring knowledge of various fields needs to be developed. One such new field connected microbiology and scientific science is known as Microbial Forensics. It utilizes advanced molecular methods like DNA microarray examination and DNA fingerprinting and so on to relate the wellspring of the causative specialist with a particular individual or gathering by measuring varieties between related strains. Excellent affirmation and quality control models for microbial legal sciences will guarantee very dependable outcomes that will stand up in the official courtroom. The more exact and refined a microbial framework turns into, the more appropriate rules for examinations will be characterized. An incorporated approach towards building up this field of microbial crime scene investigation should be taken after, to meet the difficulties of bioterrorism all the more successfully.
EnglishMicrobial, Bioterrorism, Forensics, DNA, FingerprintingINTRODUCTION
The human body is a place of residence for trillions of microorganisms, living both outwardly and additionally characteristically. Such microorganisms are massively differing and extend from microbes, infection, parasites, to protozoa. The viroids are additionally thought to be a piece of it, while a few researchers consider them as non-living organisms (1). The passing extraneous gathering of organisms is gotten from the outer environment, while the inborn microorganisms are available in the human body for a more drawn out period of time. The review in connection to such microorganisms is alluded to as microbiology.
The microbial legal sciences that have been assigned as a specialized train connecting microbiology and legal pharmaceutical perpetrated to the examination of bioterrorism and bio-wrongdoing. The branch grasps a colossal chance of legal science pummelled with microbiology, which includes examination of microorganisms or their poisons and additionally the constituents used to figure, stockpile and dispersal of the pathogenic organism. The mammoth noticeable quality of this novel branch is imperative for the contemporary space attributable to the reality the information and mastery controlled by the felonious terrorist could be disastrous to the humankind. The impact and heading of such an assault have been seen complex extends ever. In any case, it was genuinely reflected when the United States watched a risk of a Bacillus anthracis assault in the United states in the year 2001. Detecting the capability of such science, there was another branch planned in crime scene investigation, alluded to “Microbial Forensics” (2).
On the other hand, the essential belief system to use forensic science with the end goal of the criminal examination started in the year 1995. It was clearly helpful to utilize forensic solution as opposed to the normal examination inferable from the view that examinations with the guide of forensic science could be easily performed without the acquire capacity of witnesses, opportune reportage, files available for evaluation, and unanticipated confirmation. In those days it was seen that one day a minor number of research experts would flourish in such an activity, by having associate with microbial crime scene investigation, utilizing safe keeping, and utilizing tricky assets all through dissemination of a natural operator (3).
The Bio weapons concept
Microorganisms are potential weapons since they can be obtained from a single creature or cells and not at all like nuclear weapons, can be delivered in a little foundation with low capital speculation and without the requirement for modern instruments and skilled labourers (4). In spite of the fact that there are numerous techniques to make biological weapons the basic alternative is discharge microorganism that is possibly pathogenic or might be lessened to more pathogenic structures and afterward discharged into the group which makes it most deadly than some other weapon. Any microbiological specialist can be effectively utilized as weaponry, of which the essential concentration will be an operator which is more environment safe and pathogenic. With the utilization of genetic engineering, even an ecological commensal might be outfitted with a compelling poison creating quality. This would make it naturally steady and a very powerful weapon. A rundown of the conceivable species as a bio danger is past the extent of composing as any living being might be lessened and utilized as the trigger. For a rundown of high ready living beings, per users are alluded to Friedrich et.al (5) and the Centre for Disease Control (CDC) site (6). The recognition strategy must incorporate a convention that can be delicate, particular and fast. Molecular finding favours the most extreme in such a setting. It’s relevance in a creating nation can however be testing, attributable to assets. Additionally numerous life forms required in the crime might be absolutely obscure or the DNA succession in part known which makes it hard to build up a molecular assay.
Objectives of Forensic Microbiologists
The fundamental objectives of microbial crime scene investigation is distinguish and organize natural dangers, recognize the powerless populace, make a data database and create conventions for ID which incorporates deciding special hereditary marks, protein marks, create programs for guaranteeing the legitimacy of results and continually overhaul in view of existing writing (7, 8). Recognizing and organizing the objective is more troublesome than normally suspected. The life form that should be organized might be absolutely obscure or the life form may not be a human pathogen, yet rather a plant pathogen which can incur high financial harm (9, 10). Recognizable proof of helpless populace would be similarly testing. Making a data database would help in directing towards the outcomes, however unexpectedly it can likewise help the criminal in recognizing those living beings which are not ordered and hence clear a path for the expansion of a living being more hard to distinguish. Legitimacy of utilization of such a database ought to be clear for similar reasons. The database that is utilized will include contribution from different established field’s comprehensive of microbiology, genomics, scientific strategies, science and immaculatescience (11). A potential rundown of dangers ought to be promptly accessible to all concerned. This ought to be implying as need targets.
Distinguishing proof of powerless populace is similarly testing. Making a data database would help in directing towards the outcomes, however unexpectedly it can likewise help hoodlums in distinguishing those life forms which are not sorted and in this manner clear a path for the multiplication of a living being harder to recognize. Authentic utilization of such a database ought to be clear for similar reasons. The database that is utilized ought to include contributions from different established field’s comprehensive of microbiology, genomics, forensic methods, chemistry and pure science.
Control of Quality and Substantiation
The quality confirmation and quality control program is an unavoidable part of any research and microbial legal sciences are also imparted. Building up a convention for identification may make utilization of routine demonstrative approaches, for which quality rules exist. Furthermore, methods that have not experienced approval may likewise must be utilized, particularly when the living being is obscure or once in a while experienced which is right now not prescribed by any directing documentations. Such outcomes may not be exceptionally dependable but rather can make signs for judging the conceivable living being. This is of exceptional worry as the life form being managed may not be much known to the logical world. Scientific Working Group on Microbial Genetics and Forensics (SWGMGF) sets up and supports rules as well as norms for quality frameworks distinguishing procedures and techniques, characterize criteria for learning frameworks and above all fill in as an accomplished asset on issues as they emerge (8). The SWGMGF characterizes the rules and overhauls it as and when required. The advancement of these rules helps the research centre to perform different measurable investigations and host the outcomes as legitimate and consistent with the best of logical learning accessible to that day. Extra stringent guidelines are required (11) contrasted with routine reviews as the issues include lawful matters and information will be depended upon vigorously. An incorrect quality administration or absence of value control may misdirect the last conclusion. The chain of authority ought to be immaculate
to get flawless outcomes, particularly the biological confirmations acquired in this specific situation. A standard operating procedure (SOP) may not be accessible dependably and regularly direction from different organizations might be required and suppositions considered. Additionally, developing an approval plan and its execution will help the cause (11). The improvement of guidelines ought to be founded on benchmarks of human DNA writing, clinical research facilities norms and International Standards Organization.
Laboratory based approach
Laboratories involved in analysis of forensic microbiological evidences must be geared up to deal with chain-of custody documentation, assured storage of facts, tracking of individual items of evidence and their derivatives and all the legal requirements for handling evidence. Chain- of-custody customizes the records in uninterrupted chain of records screening who had contend with the evidence, where and under which conditions [temperature, time etc.] the material had been stored and whether access to the samples was restricted knowledge available to that day. Further rigorous set of laws are required (12) compared to tedious appraisals as the matters involve official issues and records will be relied upon heavily. A flawed quality management or lack of quality control may delude the ultimate finale. The chain of custody should be impeccable to obtain perfect results, especially the biologic evidences obtained in this context. A standard operating procedure (SOP) may not be available always and often guidance from other institutions may be required and opinions considered. In addition, constructing a validation plan and its execution will help the cause (13). The development of rulesshould be based on standards of human DNA typing, clinical laboratories standards and International Standards Organization (ISO).
The knowledge of microbial forensics becomes an integral factor when examiners are given a presumed case with a strange introduction or in a place where the dispersion of illness is irregular. If there should be an occurrence of a biocrime, commonly, the laboratory that acquires the specimen as the standard test is the one to first raise a doubt. In the event that a strongly doubted is summoned to be imparted to an investigative body or national reference hub, particularly when a strain that looks genetically built or test examination demonstrates multi-strains of conceivable aetiology (14).
The steps required for the examination are basically the same as the examination of a characteristic flare-up. Be that as it may, they are more requesting than the routine analytic or epidemiological test (15). The example accumulation is of most extreme significance. The specimens to be gathered incorporate each material found in the scene which is marked with time and site of accumulation. The name of the individual who has gathered the specimen ought to likewise be specified. The code of practice ought to be the same regardless of the sort of the example from, a group or person. Microbiological proof could incorporate; suitable examples of the microbial operators, protein poisons, nucleic acids, clinical examples from casualties, research centre hardware, spread gadgets and their substance, natural specimens, sullied garments, or follow confirm particular to the procedure that delivered as well as weaponries the organic specialist. On the criminological front, the technique for gathering ought to be touchy, dependable and powerful to secure the nearness of conceivable life form (16). Convenient natural examining is of tremendous value as it might be quickly devastated and the confirmation of deliberate spread might be lost (8). Every specimen ought to be considered possibly unsafe and prepared just in an all around prepared research facility, or in a perfect world sent to a reference lab outfitted with stringent biosecurity levels (15).
Techniques used in elucidating the causative agent(s)
The recognizable proof of microbial specialists – as characterized by the SIBCA handbook - can be temporary [presumptive], when immunological strategies, nucleic corrosive recognition or development and metabolic examines have been tried positive. Distinguishing proof is affirmed by the blend of no less than two of the previously mentioned criteria. Unambiguous recognizable proof requires development and in vivo thinks about [animal models] that demonstrate the pathogenicity of the specialist. In any case, creature models ought to be stayed away from for moral reasons at whatever point conceivable. Organic specialists can be hard to develop because of test defilement, low number of microbes or pre-treatment of patients with anti-microbial. A few microscopic organisms are fussy [F. tularensis, Brucella spp.] and require extraordinary supplement media, and some need delayed development times [Brucella spp.] (17)
Phenotypical attributes, for example, anti-toxin helplessness and biochemical response profiles, weakness to particular phages, settlement morphology and others are not generally dependable. Transformations of operators can be initiated or designed, however normally happening atypical strains have likewise been discovered e.g. among Bacillus anthracis and Yersinia pestis confines which can bring about misidentification and treatment disappointment (18). Commercial biochemical distinguishing proof frameworks are not streamlined for these operators and can bring about misidentification. Numerous antimicrobial resistances can happen through the regular flat quality exchange or by hereditary. Common imperviousness to a huge number of antimicrobials is regular for Burkholderia pseudo mallei.Francisella tularensis is normally impervious to penicillins and cephalosporines. An extremely hazardous multidrug safe strain of Yersinia pestis has been segregated from a patient with bubonic torment in Madagascar. This strain conveys a self-transmissible plasmid with a hereditary spine likewise pervasive among Escherichia coli, Klebsiella spp. furthermore, Salmonella spp. giving abnormal state imperviousness to streptomycin, tetracyclin, chloramphenicol, and sulfonamides (19). These actualities underline the significance of development and the appraisal of antimicrobial weakness notwithstanding more fast analytic devices. A polyphasic approach for recognizable proof and writing will maintain a strategic distance from issues because of atypical genotype and phenotype, restraint, or absence of specificity or affectability of measures. Treatment of select operators is profoundly unsafe and bulky and confined to labs with bio safety-level 3 regulation. Biosafety-level 3 research facilicustody documentation, assured storage of facts, tracking of individual items of evidence and their derivatives and all the legal requirements for handling evidence. Chain- of-custody customizes the records in uninterrupted chain of recordsscreening who had contend with the evidence, where and under which conditions [temperature, time etc.] the material had been stored and whether access to the samples was restricted knowledge available to that day. Further rigorous set of laws are required (12) compared to tedious appraisals as the matters involve official issues and records will be relied upon heavily. A flawed quality management or lack of quality control may delude the ultimate finale. The chain of custody should be impeccable to obtain perfect results, especially the biologic evidences obtained in this context. A standard operating procedure (SOP) may not be available always and oftenguidance from other institutions may be required and opinionsconsidered. In addition, constructing a validation plan and its execution will help the cause (13). The development of rules should be based on standards of human DNA typing, clinical laboratories standards and International Standards Organization (ISO). The knowledge of microbial forensics becomes an integral factor when examiners are given a presumed case with a strange introduction or in a place where the dispersion of illness is irregular. If there should be an occurrence of a biocrime, commonly, the laboratory that acquires the specimen as the standard test is the one to first raise a doubt. In the event that a strongly doubted is summoned to be imparted to
an investigative body or national reference hub, particularly when a strain that looks genetically built or test examination demonstrates multi-strains of conceivable aetiology (14). The steps required for the examination are basically the same as the examination of a characteristic flare-up. Be that as it may, they are more requesting than the routine analytic or epidemiological test (15). The example accumulation is of most extreme significance. The specimens to be gathered incorporate each material found in the scene which is marked with time and site of accumulation. The name of the individual who has gathered the specimen ought to likewise
be specified. The code of practice ought to be the same regardless of the sort of the example from, a group or person. Microbiological proof could incorporate; suitable examples
of the microbial operators, protein poisons, nucleic acids, clinical examples from casualties, research centre hardware, spread gadgets and their substance, natural specimens, sullied
garments, or follow confirm particular to the procedure that delivered as well as weaponries the organic specialist. On the criminological front, the technique for gathering ought to be touchy, dependable and powerful to secure the nearness of conceivable life form (16). Convenient natural examining is of tremendous value as it might be quickly devastated and the confirmation of deliberate spread might be lost (8). Every specimen ought to be considered possibly unsafe and prepared just in an all around prepared research facility, or in a perfect world sent to a reference lab outfitted with stringent biosecurity levels (15).
Techniques used in elucidating the causative agent(s)
The recognizable proof of microbial specialists – as characterized by the SIBCA handbook - can be temporary [presumptive], when immunological strategies, nucleic corrosive recognition or development and metabolic examines have been tried positive. Distinguishing proof is affirmed by the blend of no less than two of the previously mentioned criteria. Unambiguous recognizable proof requires development and in vivo thinks about [animal models] that demonstrate the pathogenicity of the specialist. In any case, creature models ought to be stayed away from for moral reasons at whatever point conceivable. Organic specialists can be hard to develop because of test defilement, low number of microbes or pre-treatment of patients with anti-microbial. A few microscopic organisms are fussy [F. tularensis, Brucella spp.] and require extraordinary supplement media, and some need delayed development times [Brucella spp.] (17) Phenotypical attributes, for example, anti-toxin helplessness and biochemical response profiles, weakness to particular phages, settlement morphology and others are not generally dependable. Transformations of operators can be initiated or designed, however normally happening atypical strains have likewise been discovered e.g. among Bacillus anthracis and Yersinia pestis confines which can bring about misidentification and treatment disappointment (18). Commercial biochemical distinguishing proof frameworks are not streamlined for these operators and can bring about misidentification. Numerous antimicrobial resistances can happen through the regular flat quality exchange or by hereditary control. Common imperviousness to a huge number of antimicrobials is regular for Burkholderia pseudo mallei. Francisella tularensis is normally impervious to penicillins and cephalosporines. An extremely hazardous multidrug safe strain of Yersinia pestis has been segregated from a patient with bubonic torment in Madagascar. This strain conveys a self-transmissible plasmid with a hereditary spine likewise pervasive among Escherichia coli, Klebsiella spp. furthermore, Salmonella spp. giving abnormal state imperviousness to streptomycin, tetracyclin, chloramphenicol, and sulfonamides (19). These actualities underline the significance of development and the appraisal of antimicrobialweakness notwithstanding more fast analytic devices. A polyphasic approach for recognizable proof and writing will maintain a strategic distance from issues because of atypical genotype and phenotype, restraint, or absence of specificity or affectability of measures. Treatment of select operators is profoundly unsafe and bulky and confined to labs with bio safety-level 3 regulation. Biosafety-level 3 research facilities must be worked by uncommon controls that require e.g. a modern ventilation framework and individual defensive equipment [e.g. FFP3 masks, overalls, face shields, gloves etc.].
1. Nucleic Acid Amplification Techniques
Several PCR assays are very particular and delicate and abbreviate the time required to build up a determination in correlation with ordinary PCR conventions, development, and biochemical distinguishing proof techniques. Thusly, continuous PCR measures have been produced for the distinguishing proof of Bacillus anthracis, Brucella spp., Burkholderia
mallei and Burkholderia pseudomallei, Francisella tularensisand Yersinia pestis (20). PCR results can be false negative because of deficient nature of clinical specimens, low number of microscopic organisms in tests, DNA degradation, inhibitory substances and incorrect DNA readiness.
2. Serology
Seroconversion may demonstrate the presentation to a particular operator before. Be that as it may, seroconversion can be normal simply following a few days or weeks and is of little use for quickly diagnosing contaminations brought on by exceptionally pathogenic specialists. It will be hard to arrange serological examinations [including follow-up tests] when a fear monger assault causes mass losses that need medicinal treatment or when the circumstance is convoluted by disasters and civil wars in the meantime. Different immunological measures have likewise been utilized to distinguish pathogens in tests of patients and natural examples. Manual test units can be utilized as bed-side tests and are helpful under field conditions, however, clinical approvals barely exist and most tests are “for logical utilize as it were”. Immunochromatographic sidelong stream tests have been created e.g. for brucellosis, tularemia, and plague (21-24). Confinements of these immunological examines are that they are habitually not accessible economically, not sufficiently particular, or have not been approved and authorized for use in people or creatures. Also, cross-responses may bring about false positives and adjusted or miss antigenic structures can bring about false negatives.
Typing and strain identification
Differences among microorganisms must be evaluated to figure out if strains are from a similar source or ancestry or from an alternate beginning. The exactness and accuracy will rely on upon the writing strategy, expected transformation rates, and different attributes of the creature. In court, researchers may need to measure the unwavering quality of a relationship among strains decided to utilize molecular phylogenetic examinations. This will build up the likelihood of relationship to a specific wellspring of disease (25). Methods for forensic microbiology can be fundamentally the same as those being utilized for phylogenetic and epidemiological examinations e.g. for food-borne outbreaks. Molecular epidemiological instruments utilized for genotyping are most encouraging and have been connected in the
past to explain the birthplace of organic specialists. Particularly entire genome sequencing and bioinformatic apparatuses for examination of genomes are intense instruments, however,
many-sided quality and expenses are still restrictive for routine application. In a few sections of the exceedingly recommendable book “Microbial Forensics” by Bruce Budowle and numerous other “authors” of this new logical train it was exhibited that exclusive exceptionally particular learning of microbial hereditary qualities will permit an appraisal of the significance of writing results acquired by Multi-locus Sequence Typing [MLST], Variable Number of Tandem Repeats
[VNTR], Single Nucleotide Polymorphisms [SNPs] examination or other writing instruments (26). Approval of writing examines and information of vast accumulations of strains from everywhere throughout the world are critical for microbial legal examinations. Writing techniques ought to be reproducible, stable amid the review time frame, pertinent to each confine, segregating among detaches, and separation ought to be concordant with the epidemiological picture (27). DNA sequence-based information is strong, versatile, simple to contrast and amiable with electronic examination for phylogeographical and epidemiological reviews. Be that as it may, the nature of open get to arrangement databases relies on upon the exactness of submitted successions and is thus infrequently not firm (26).
Indian scenario
To the best of our insight, there is no reported instance of natural fighting in India. This might be translated as no case happening or as the absence of criminological microbiology work up. Remembering the last probability, microbial crime scene investigation has an unfathomable potential in India. As a nation which is regularly undermined by fear assaults, there are most likely natural weapons will be made utilization of by different psychological militant outfits sooner rather than later. Foundation of a national association which coordinates ability of pros from different fields of science will turn out to be helpful regardless of the cost that will be caused in making and keeping up such a group. Three parts will be significant to set up a completely useful National Microbial Forensic Laboratory. The first would be a learning focus made out of databases on genomics, microbiology, legal strategies, SOPs, prove examines, for example, fingerprinting, bioinformatics and institutionalized devices. The second segment will be upkeep of solid organizations between the current government, the research centre in charges, researchers and exploring operators. The third segment will be quality control and approval of more up to date examines (28).
CONCLUSION
Microbial forensics is a logical train devoted to breaking down confirmation from a bioterrorism demonstration, biocrime or incidental microorganism/poison discharge for attribution purposes. The unlawful utilization of natural specialists postures generous threats to people, general wellbeing, the earth, the economies of countries, and worldwide peace. A national and universal cooperative approach can be utilized to deal with the hazard of bioterrorism by setting up a national and global reference research centre in this manner guaranteeing straightforwardness of investigation and strict activity against all bio wrongdoing culprits. Considering all the logical realities as of now examined, “Microbial Forensics” ought to be a perfect prerequisite in India.
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=643http://ijcrr.com/article_html.php?did=6431. Lwoff A. “The concept of virus”. J. Gen. Microbiol.1956; 17 (2); 239–253.
2. Budowle B, Schutzer SE, Einseln A, Kelley LC, Walsh AC, et al. Public health. Building microbial forensics as a response to bioterrorism. Science 2003; 301: 1852–1853.
3. Marshall JC; Gastrointestinal flora and its alterations in critical illness. Curr Opin Clin Nutr Metab Care, 1999; 2: 405–411.
4. Priyabrata Pattnaik, Krisnamurthy Sekhar. Forensics for tracing microbial signatures: Biodefense perspective and preparedness for the unforeseen. Indian Jn of Biotech 2008; 7:23-31.
5. Friedrich Frischknecht, The history of biological warfare, Human experimentation, modern nightmares and lone mad men in the twentieth century; EMBO reports 2003;Vol 4 Special issue.
6. http://www.bt.cdc.gov/agent/agentlist.asp. Accessed on January 2nd, 2016.
7. Microbial forensics: A new forensic discipline, Sharad Jain, Ashish Kumar, Pratima Gupta, Ramjee Prasad, Dept. of Microbiology, Himalayan Institute of Medical Sciences, Dehradun,
JIAFM, 2005; 27 (2).
8. Defining a New Forensic Discipline: Microbal Forensics Bruce Budowle Laboratory Division, Federal Bureau of Investigation, Washington, DC, U.S.A. March 2003. www.promega.com. Accessed on Dec 20, 2011
9. Whitby S, Rogers P. Anticrop biological warfare—Implications of the Iraqi and US programmes. Defense Analysis 1997;13: 303–318
10. Whitby SM. The potential use of plant pathogens against crops. Microbes Infect 2001; 3(1):73–80
11. Budowle, Quality sample collection, handling, and preservation for an effective microbial forensics program. Appl. Environ. Microbiol.; 72: 6431-6438.
12. Chakrakodi Narayana Varun, Kuruvilla Thomas S, Furtado Zevita. (2012). Microbial Forensics- Past, Present and Future. International Journal of Biological & Medical Research. Int J Biol Med Res. 2012; 3(2): 1546-1549.
13. Kaur M, Gupte S, Aggarwal P, Manhas A, Bala M ,Mahajan S. (2014). Methods in Microbial Forensics. J Punjab Acad Forensic Med Toxicol ;14(1).
14. Treadwell TA, Koo D, Kuker K and Khan AS. (2003). Epidemiologic clues to bioterrorism. Public Health Rep; 118:92–98.
15. Ronald M. (2004). Atlas. Microbial Forensics- Taking Diagnostic Microbiology to the Next Level. Clinical Microbiology Newsletter. 26, 13
16. National science and technology council (2015) National strategy to support research in microbial forensics attribution investigations and national security.http://www.whitehouse.gov/files/ documents/ostp/NSTC%20 Reports/National%20MicroForensics% 20R&DStrategy%202009%20UNLIMITED%20DISTRIBUTION. pdf. Accessed on Nov 24.
17. Wilmoth BA, Chu MC and Quan TJ (1996) Identification of Yersinia pestis by BBL Crystal Enteric/Nonfermenter Identification System. J Clin Microbiol. (34), 2829-30.
18. Welch TJ, Fricke WF, Mc Dermott P.F,White DG, Rosso ML, Rasko DA et al (2007) Multiple antimicrobial resistance in plague: an emerging public health risk. PLoS One. (2),e309 EOF
19. Jones SW, Dobson ME, Francesconi SC, Schoske R and Crawford R (2005) DNA assays for detection, identification, and individualization of select agent microorganisms. Croat Med J. (46), 522-9.
20. Chanteau S, Rahalison L, Ralafiarisoa L, Foulon J, Ratsitorahina M, Ratsifasoamanana L et al (2003) Development and testing of a rapid diagnostic test for bubonic and pneumonic plague. Lancet. (361), 211-6
21. Mizanbayeva S, Smits HL, Zhalilova K, Abdoel TH, Kozakov S aand Ospanov KS (2009) The evaluation of a user-friendly lateral flow assay for the serodiagnosis of human brucellosis in Kazakhstan. Diagn Microbiol Infect Dis. (65), 14-20.
22. Splettstoesser W, Guglielmo-Viret V, Seibold E and Thullier (2010) Evaluation of an immunochromatographic test for rapid and reliable serodiagnosis of human tularemia and detection of Francisella tularensis-specific antibodies in sera from different mammalian species. J Clin Microbiol. (48), 1629-34
23. Tomaso H, Thullier P, Seibold E, Guglielmo V, Buckendahl A, Rahalison L et al (2007) Comparison of hand-held test kits, immunofluorescence microscopy, enzyme-linked immunosorbent assay, and flow cytometric analysis for rapid presumptive identification of Yersinia pestis. J Clin Microbiol, (45):3404-7.
24. Gonzalez-Candelas F, Bracho M.A, Moya A (2003) Molecular epidemiology and forensic genetics: application to a hepatitis C virus transmission event at a hemodialysis unit. J Infect Dis. (187), 352-8.
25. Van Belkum A, Tassios PT, Dijkshoorn L, Haeggman S, Cookson B, Fry N.K et al (2007) Guidelines for the validation and application of typing methods for use in bacterial epidemiology. Clin Microbiol. (3), 1-46.
26. Tomaso H and Neubauyer H (2011) Forensic Microbiology. In: Vieira D.N (ed), Forensic Medicine-From old problems to new challenges, Intech.
27. Bruce Budowle (2008) Criteria for validation of methods in microbial forensics, Applied And Environmental Microbiology. Vol. 74, No. 18, P. 5599–5607.
28. Bhatia Mohit, Mishra Bibhabati, Thakur Archana, Dogra Vinita, Loomba Poonam Sood (2016) Concept of Forensic Microbiology and its Applications. SMU Medical Journal. Volume – 3, No. 1.v
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1TechnologyFiber Sensor Based Pulmonary Function Test
English4143Manjusha S.English Preethi S. BabuEnglish Swapna M. S.English S. SankararamanEnglishAim: Development of fiber optic vibration sensor based Spirometer.
Methodology: A fiber vibration sensor is set up and is used to measure the variation of wind velocity with distance. For a source, driving air at constant speed, the variation of the light intensity level of the optical fiber sensor is studied. The experiment is repeated for various separations of source and detector fiber. The set up has also been used to measure the wind velocity. The results obtained from these preliminary studies tell the possible functioning of the sensor as a spirometer. For calibrating the fiber optic spirometer, commercially available spirometer is used. Noting down the air volume a person can inspire, from the standard spirometer, and the light intensity level at the output fiber while blowing, the spirometer can be calibrated.
Results: A fibre optic vibration sensor is constructed and is used to measure the wind velocity. The set up is used as a fiber optic spirometer by calibrating it against a standard spirometer.
Conclusion: The study thus reveals the application of fiber sensor as a fiber spirometer.
EnglishFiber optic sensor, Spirometer, Anemometer, Pulmonary function testINTRODUCTION
The changing life style, food habits, and environmental pollution has proved to affect the health adversely. Now a day’s lots of people are suffering from lungs related diseases. Increased number of vehicles and factories lead to high-level air pollution. In connection with world Spirometry Day, Forum of International Respiratory Societies (FIRS) released the data that lung diseases kill 4 million people every year [2]. The ignorance of people about lung diseases has doubled the mortality rate during the last three years. Hence, continuous monitoring of lungs is essential for maintaining good health. The efficiency of lungs can be understood from a spirometer. A spirometer is equipment used for basic pulmonary function test for measuring the volume of air involved in respiration. A test for measuring the movement of air into and out of the lungs can help to diagnose various lung conditions, most commonly Chronic Obstructive Pulmonary Diseases (COPD). It is also used to monitor the severity of some other lung conditions and their response to treatment. The earlier the test is performed, the earlier lung disease can be detected and treated.
The advent of lasers and fiber optic sensor system has revolutionized the medical field of diagnoses and treatment of diseases [3]. Optical fiber sensors work on the principle of analysis of the optical energy flowing through the fiber. Fiber sensors have gained the attention because of their smaller size, lighter weight, higher sensitivity, larger bandwidth and immunity to electromagnetic interference [4]. Because of smaller size and easiness in implementing, fiber sensors find applications in biomedical field [5]. Since measurands alter the light energy in the fiber, even smaller changes in the parameters can be accurately measured. Temperature, pressure, strain etc are the widely studied measurands. Various types of fiber optic sensors used are temperature sensor[6,7], pressure sensor [9-11], rotation sensor [12], vibration sensor [8, 13], fiber optic current sensors [14], fiber grating sensors [14] etc. In the present work, we have extended the principle of fiber optic vibration sensor as anemometer and spirometer.
METHODOLOGY
The Fig. 1 shows the experimental arrangement for the Fiber optic spirometer. The light from the He-Ne laser with a wavelength of 632 nm and a power of 5mW is focused on to the step index multimode fiber of core diameter 120 micron meter and cladding 200 micron meter. The other end of the fiber is fixed inside a box as shown in Fig.1. The light from the source fiber is coupled to another identical fiber whose end inside the box can vibrate freely. When the detector fiber vibrates, the amount of light coupled into it varies. The pipe attached to the box directs the air onto the detector fiber. The amount of light coupled to the detector fiber also depends on the separation between the source and the detector fiber tips. The experimental setup is calibrated by studying the variation of wind intensity with distance. For this study, a hair drier generating wind at a constant speed in a given direction is used. When the wind source is close to the detector fiber the misalignment for the detector fiber is maximum. Hence the amount of light coupled into the detector fiber is a minimum and we get a low voltage at the output of the photodetector. The deviation of the detector fiber from the initial aligned position depends on the amount of force exerted by the wind on the detector fiber. This setup can be used as anemometer or spirometer.
RESULT AND DISCUSSION
The experimental setup is calibrated using constant wind source. The variation of detector output with distance is shown in Fig.2. The experiment is repeated for different separation between the source and the detector fiber tip. The separation between the fiber tips decides the maximum amount of light intensity entering the detector fiber. From Fig.1, it is clear that for a given wind velocity as a separation decreases the detector output increases. Also it can be seen that the response curve is linear. That is as the distance of the source from the detector fiber increases the wind intensity decreases and this in turn reduces the force exerted on detector fiber and thus the deviation of the fiber from the aligned position. Hence we get the increasing value of detector output with increasing distance. The experiment setup can be used for measuring the wind velocity and hence function as an anemometer. For this the source is kept at a distance (d) and noting down the time required for the detector output to change the time (t). The wind velocity (v) can be calculated as v = d/t. The setup can be used as an anemometer once calibrated against a standard anemometer. The variation of wind velocity is shown in Fig.3. For working the experimental setup as a fiber optic spirometer, it is calibrated against a clinical spirometer as shown in Fig.4. The standard spirometer gives a measure of the maximum air a person can breathe in. The amount of air a person can breathe in depends on the efficiency of the lungs. People of different age group are participated in the study. Each person is asked to breath in using a standard spirometer and the volume of air intake is noted. Then the person is asked to blow the air inhaled through the pipe provided in the fiber optic spirometer with a maximum speed possible to him. The amount of air the person exhale is related to his inhaling capacity. The detector output changes with respect to the amount of air blown in. Since the input air pipe is fixed, the error that may occur when different persons blow air can be avoided. The different people who inhale the same amount of air are grouped together and the average value of the detector output while blowing air is calculated. The graph relating the amount of air a person can inhale and the corresponding detector output is shown in Fig.5. Since blowing of air pushes the detector fiber away from the initial aligned position. There is a greater chance of no light falling on the detector fiber. This problem can be overcome by introducing a slight modification in the fiber optic spirometer as shown in Fig.6. Here the detector fiber is initially kept misaligned as shown in Fig.6. When air is blown in the detector, fiber moves towards the aligned position, where the amount of light coupling between the source and the detector fiber is a maximum.
CONCLUSION
Thus, the present work fiber optic vibration sensor is constructed and demonstrated how it can be used as an anemometer. By calibrating against standard spirometer, the device can be used as a high sensitive fiber optic spirometer for getting information about one’s lungs efficiency.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in reference of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Conflict of interest : Nil
Source of funding: Nil
Englishhttp://ijcrr.com/abstract.php?article_id=644http://ijcrr.com/article_html.php?did=6441. J. Parikh Meera, P. Gharge Anuradha , “A Survey Paper on Optical Fiber Sensor”, vol2, pp.2321-8169, 2014.
2. Forum of International Resipiratory Society (FIRS) United for Lung Health, Home page- Publications, https://www.firsnet.org/ Access date April 1, 2017.
3. O. Temitope. Takpor, Member, IAENG, and Oboyerulu E. Agboje, “Advances in Optical Biomedical Sensing Technology”,vol1. WCE 2016, 2016.
4. “Review of the present status of optical fiber sensors”, Byoungho Lee, vol.9, pp.57-79, 2003.
43 Int J Cur Res Rev | Vol 9 • Issue 8 • April 2017 Manjusha et.al.: Fiber sensor based pulmonary function test
5. Alexis Mendez “Biomedical fiber optic sensor application”, pp.521-1069, 2015.
6. A.T. Augousti, K.T.V. Grattan and A.W. Palmer, “Visible- LED pumped fiber optic temperature sensor”. IEEE Trans. Instrument. Measurement 37, vol.37, pp.470-472, 1988.
7. Zengling Ran, Shan Liu, Qin Liu, Yanjun Wang, Haihong Bao, and Yunjiang Rao “Novel High-Temperature Fiber-Optic Pressure Sensor Based on Etched PCF F-P Interferometer Micromachined by a 157 nm Laser, IEEE sensors journal,vol.15, p. 7, 2015.
8. J. R. Guzman-Sepulveda1, I. Hernandez-Romano2, M. Torres- Cisneros3, and D. A. May-Arrioja, “Fiber Optic Vibration Sensor based on Multimode Interference Effects”, p.117, 2012.
9. A. Daniel May-Arrioja, Victor I Ruiz-Perez, Yaneth Bustos-Terrones, and Miguel A. Basurto-Pensado, “Fiber Optic Pressure Sensor Using a Conformal Polymer on Multimode Interference
Device”, vol.16, p.1956, 2016.
10. J.N.C.K. Asawa,O.G.Ramer, and M.K. Barnoski, “Fiber optic pressure sensor”, J. Acoust. Soc.,vol. 67, p.816, 2016.
11. Sven Poeggel , Daniele Tosi , Dinesh Babu Duraibabu, Gabriel Lee, Deirdre McGrath and Elfed Lewis,”Optical Fiber Pressure sensor in medical application”, vol.15, pp.17115-17148, 2015.
12. W. C. Goss, R. Goldstein, M. D. Nelson, H. T. Fearnehaugh, and O. G. Ramer, “Fiber Optic Rotation Sensor Technology”, vol.19, pp.852 858,1980.
13. J.R. Guzman-Sepulveda, I. Hernandez-Romani, M. Torres- Cisneros, and D.A. May-Arrioja, “Fiber Optic Vibration Sensor based on Multimode Interference Effects”, Optical Society of America, JW2A117 (2012).
14. K.T.V. Grattan, Dr. T. Sun, “Fiber optic sensor technology: an overview”, vol.82, pp.40-61, 1999.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524198EnglishN2017May1TechnologyReliability Measurement Technique for Evaporator used in Domestic Refrigerators
English4447Vivek DwivediEnglish Praveen PandeyEnglishIntroduction: The evaporator used in domestic refrigerator is a heat exchanger in which the heat exchanging occurs by the mean of air. In general the reliability of evaporator is considerably high. It is seen the technical problems arising in evaporator is comparatively lesser than the other components used in it such as compressor, condenser and filter drier etc. But during long run of its use the problems arise in different components of evaporator such as due to leakage of refrigerant, choking or blockage of evaporative coil etc.
Aim and Objectives: The aim is to find the reliability of evaporator used in domestic refrigerators, working on the principle of vapour compression refrigeration system.
Material and Methods: The data used for analysis is collected from a reliable workshop and a system dynamic method is used for the analysis on Vensim-PLE modeling software.
Result: In result output table for year wise reliability of important components are shown. The comparative graph of reliability is also given to easily compare the reliability of each sub components.
Conclusion: In this research paper a newer technique is used to calculate the time based reliability of evaporator used in domestic refrigerator. This method of calculation is also applicable for all types of dynamic system. The reliability of evaporator appears almost 95.45% at the end of fifteenth year.
EnglishEvaporator, Reliability, Refrigerant, Domestic refrigerator, Dynamic system
INTRODUCTION
Evaporator is that component of refrigerator in which actual purpose of refrigeration of commodity is fulfilled. It the part from where the actual performance of refrigeration system can also be calculated.[1],[7]
In general the evaporator used in domestic refrigerator is also known as freezer. The refrigerant flowing in the system enters in evaporator in liquid state and leaves in gaseous or vapor state. To achieve higher heat exchanging response and low material cost the evaporator is built by aluminum metal.[5]
Here the data used for reliability calculation of evaporator is collected from a certified refrigeration sales and servicing agency named as Chandra Sales which is providing its technical solution and services since last eighteen years. The data picked contains the record of 216 domestic refrigerators in which the servicing details of the evaporators and related components are given[8]. Here from the observation of log book it is clear that the reliability of evaporator is largely affected by choking or blockage of evaporative coil and leakage of refrigerant.[3,4]
MATERIALS AND METHODS
Data Collection and Measurement: The reliability measurement technique is totally based on the data collected. The collected data provide the average failure rate for system dynamic modeling on Vensim-PLE software.
In modeling the reliability of various components of evaporator is considered as decay in these components is exponentially with time. Since all components are in different working condition, but the components considered above are most important and directly affect the reliability and performance of the evaporator.
System Dynamic Modeling of Evaporator
Reliability of Evaporator : ROE
Leakage of Refrigerant : LOR
Choking/ Blockage in evaporative coil
: CEC
Fig-1 : Showing the system modeling of evaporator used in VCRS
Programming Details
. (1) CEC= EXP(-0.0015*Time)
Units: RELIABILITY
(2) FINAL TIME = 15
Units: Year
The final time for the simulation.
(3) INITIAL TIME = 0
Units: Year
The initial time for the simulation.
(4) LOR= EXP(-0.0016*Time)
Units: RELIABILITY
(5) ROE= CEC*LOR
Units: RELIABILITY
(6) SAVEPER = TIME STEP
Units: Year [0,?]
The frequency with which output is stored.
(7) TIME STEP = 1
Units: Year [0,?]
The time step for the simulation.
RESULT
Graphical Outputs for Evaporator: Fig-2: Comparative reliability graphs showing reliability from 0 to 15 years Output Table: Table -2
From the above data it is confirmed that choking in evaporative coil is important parameter that considerably affects the
reliability of evaporator. During modification in the functioning of evaporator we must concentrate towards the rectification regarding choking of evaporative coil. From the observation table it is found that at the end of fifteenth year the reliability of choking coil falls to 97.77%. The reliability parameter like leakage of refrigerant falls to 97.62% at the end of fifteenth years which also affect the performance of evaporator.
DISCUSSION
Domestic refrigerator has four important components like evaporator, compressor, condenser and expansion devices like capillary tubes with filter drier. The reliability of overall vapour compression refrigeration system like domestic refrigerator can be calculated by calculating the reliabilities of above components separately.
CONCLUSION
Overall reliability of evaporator decreases from 100% to 95.45% at the end of fifteenth year from starting. This percentage is not feasible for confident running of vapor compression refrigeration system for fifteen years. Hence at this stage of design modification is necessary.
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.
Authors are also thankful to Teerthankar Mahaveer University Moradabad for providing us a good research atmosphere and valuable guidance to complete our research work. We are also thankful to the refrigeration servicing agency for providing us the valuable data regarding the problems of maintenance of evaporators used in domestic refrigerators.
Englishhttp://ijcrr.com/abstract.php?article_id=645http://ijcrr.com/article_html.php?did=645
Evaporator:http://www.airconditioning-systems.com/evaporator.html
: access on 02.02.2017
From Wikipedia, the free encyclopedia :”https://en.wikipedia.org/wiki/Evaporator : access on 05.12.16
Fennema, Owen R., Marcus Karel, and Daryl B. Lund. Physical Principles of Food Preservation. Marcel Deker, Inc. New York and Basel, 1975.
http://absorptionchiller4u.blogspot.com/2013/01/evaporator-types-of-evaporators.html : 0n 11.09.16
www.actrol.com.au/Showcase/Refrigeration-Evaporators/ access 0n 04.12.15
nptel.ac.in/courses/112105129/pdf/R&AC%20Lecture%2023.pdf : access 0n 02.12.16
www.probrewer.com › Library › Refrigeration : access 0n 09.02.17
Handbook on Handbook of Research on Advances and Applications in Refrigeration , page 696 . 2013