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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30General SciencesRELATIONSHIP BETWEEN QUALITY OF LIFE AND EMOTIONAL INTELLIGENCE OF THE SAMPLE YOUTH
English0105Sarika ManhasEnglish Anupa SharmaEnglish ManishaEnglishThe present research was carried out with the aim of assessing the relationship between Quality of life and Emotional Intelligence among youth of Jammu city. The sample for the study comprised of 160 employed youth of Jammu city, half of who were males and rest females. The sample was selected through multi stage sampling technique where in the actual sample was selected randomly. The tools used for investigation / data collection were a standardized Emotional Intelligence scale developed Chadha and Singh (2003) and Quality of Life scale developed by Frish (1994). Correlation analysis reveals that for both male as well as female youth certain components of quality of life were significantly related with emotional intelligence and its sub components, pointing towards a significant association between emotional intelligence and quality of life.
EnglishEmotional Intelligence, Quality of Life, Youth, Emotional MaturityINTRODUCTION
Emotional intelligence refers to the ability to perceive emotions, to assess and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth. Emotional Intelligence (EI) is about intelligent use of our emotions. This requires being aware of our feelings and the feelings of others in order to manage our behaviour and relationships effectively. EI is an area of cognitive ability involving traits and social skills that facilitate interpersonal behavior. It is the ability to sense, understand and effectively apply the power and acumen of emotions as the sources of human energy, information, connection and influence (Copper and Sawaf 1997). World Health Organization defines Quality of life as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. Quality of life is a broad concept that incorporates all aspects of life and has been used in a variety of discipline such as: geography, philosophy, medical sciences, social sciences, health promotion, and advertising (Oort et al 2005). Lindstro (1994) has presented a model where quality of life was divided in a different way into four life spheres /the global, external, interpersonal and personal sphere where the last one was represented by the physical, mental and spiritual dimension. The main thing that determines quality of life is our ability to enjoy all that life has to offer. For instance, the ability to walk, talk, see and feel all contributes to our overall quality of life. A quality of life is a life full of meaning and purpose. A highquality life is also a life of freedom from tyranny. Emotional maturity emerges as an important factor in youth’s socio-emotional development. The current conceptualization of Emotional Intelligence provides an opportunity to see how it has been interpreted and applied throughout the world. Emotional intelligence continues to be effected by many factors. Though there is a world wide research on this topic but only a few researches have been conducted on this topic in Jammu region. Many past researchers have focused on the emotional quotient of managers and professionals already working in the field overlooking the youth who are the future leaders and managers. This study attempts to assess the relationship between emotional intelligence and quality of life of youth. It would be interesting to know the level of EI and quality of life among youth and to relate it to their sex and age. The information gathered through the present study will be helpful in understanding the youth better and also the role of some demographic characteristics in shaping the youth’s emotional intelligence and quality of life will be known. OBJECTIVE OF THE STUDY To assess the relationship between quality of life and emotional intelligence of the sample youth.
RESEARCH METHODOLOGY
The present study is designed to assess the relationship between emotional intelligence and quality of life among of the sample youth of Jammu city.
Sample Description: The sample for present study comprised of 160 working youths, half of who were males and rest females of Jammu city in the age group of 25-30 years. All sample youth were working in private sector jobs.
Locale of the Study: The sample was selected from some of the areas of Jammu East namely Purkhoo, Barnai, Muthi, Paloura, Bantalab.
Sampling Technique: Simple random sampling technique was used for initial sample identification and sample selection. Lottery method was used to select five areas namely, Purkhoo, Barnai,Muthi, Paloura, Bantalab. From these areas, a list of private offices was prepared. A total of 16 such offices which employed youth was drawn. Then from these offices 10 youth each (5 males and 5 females) were selected randomly.
Data Collection: The following tools were used for data collection.
Quality of Life Inventory: Quality of life Inventory developed by Frish (1994) was used with the sample youths. Quality of life inventory test yields an overall score and a profile of problems and strength in 16 area of life such as love, work and play. The 16 areas addressed in the QOLI assessment are Health, Self esteem, Goals and values, Money, Work, Play, Learning, Creativity, Helping, Love, Friend, Children, Community, Relative and neighbourhood.
Emotional Intelligence Scale: The scale developed by Prof. N.K Chadha and Dr. Dalip Singh(2003) was used to assess the Emotional Intelligence of the sample youth. This test has been designed in such a way that it measures all three psychological dimensions: emotional sensitivity, emotional maturity and emotional competency. This test has been standardized for professional mangers, business- man bureaucrats, artists and graduate students. This EQ Test has a test-retest and split-half reliability of 0.94 and 0.89 respectively and validity of 0.89.
Data Analysis
The data was chiefly analyzed quantitatively using various statistical measures. It was supplemented with qualitative method wherever required. Percentage of respondents falling in various categories of each scale were calculated and tabulated and correlation among the variables were studied by using statistical software SPSS.
RESULTS AND DISCUSSION
The aim of the present study was to assess the inter relationship between emotional intelligence and quality of life of youth.
The results of the study are presented as follows:
Table 2 shows the educational qualification of sample youth. Half of the respondents, 50%(53.75% males and 46.25% females) were found to be post graduates and another 42.5% (42.5% males and 42.5% females) were found to be graduates. Statistically there was insignificant difference in the level of education of males and females.
Table 3 contains data on the level of quality of life of the sample youth. Over all, the Quality of life of sample youth ranged from average (50%) to high (26.25%). It implies that majority of the sample youth perceived that their life to be average in quality. These youth usually were satisfied with the various aspects of their lives and had little or no major complaints with their lives. However, 14.37% of the sample had low Quality of life indicating the some youth were not satisfied with their life and its various aspects. Calculation of chi-square indicates insignificant difference in the Quality of life of working males and females but more males (11.25%) scored very low than females (7.5%) and more females scored (31.25%) higher than the males (21.25%).
Table 4 contains data on the level of emotional intelligence of the sample youth. Overall, the emotional intelligence of sample youths ranged from high (61.25%) to moderate (26.25%). It implies that majority of the youths had strong emotional intelligence to maintain rapport, harmony and comfort while dealing with others. Remaining 11.25% of the sample had extremely high emotional intelligence indicating that some youths had achieved extremely high control and maturity over their emotions. Calculation of chi square indicates significant differences in the emotional intelligence of working males and females with more females (18.75%) having extremely high emotional intelligence than males (3.75%). Earlier researches have also revealed that emotional intelligence scores were significantly different between males and females (Katyal and Awasthi 2005; Nicholas et al 2005). These results highlight that youth tend to have significantly higher levels of emotional intelligence and that this level of emotional intelligence was influenced by their sex.
The correlation matrix for sample males reveals that age had positive significant correlation with two dimensions namely health and helping, indicating that older males were more satisfied with their health and helping status. Education shared positive significant correlation only creativity and Emotional intelligence had positive significant correlation with health and home, showing that those with higher emotional intelligence had higher satisfaction with both their health as well as home. Emotional sensitivity had positive significant correlation with creativity. But negative significant correlation with two dimensions namely love and siblings. Emotional maturity shared positive significant correlation with two dimensions namely work, home but it had negative significant correlation with two dimensions namely love and siblings. Emotional competency also had positive significant correlation with health and creativity. These implies that some components of quality of life do have implication for the emotional intelligence and its components for the sample males.
The correlation matrix for female youth reveals that education had negative significant correlation with five dimensions namely Overall Quality of life, goals and values, work, love and relatives meaning that those who were more educated tend to have lower Quality of Life and on aspects related to work, love and relatives. For the female youth Emotional Intelligence had positive significant correlation with their Quality of life, implying that those girls with higher emotional intelligence also had higher quality of life and vice versa. Emotional intelligence was further, noted to be significantly correlated with four dimension of quality of life namely, satisfaction with goals and values, work, learning and friend. When the components of Emotional intelligence were analyzed separately, it was noted that Emotional sensitivity was not significantly correlated with any dimension of Quality of life. Emotional Maturity was correlation with quality of life, goals and values, money, work, play and friends. Emotional Competency was correlated but negatively with play, meaning that probably those female with high Emotional Competency were less satisfied with the recreational aspect of their lives. To sum for the sample youth there were significant correlation between certain aspects of quality of life and emotional intelligence.
CONCLUSION
Emotional intelligence seems to be everywhere. In recent years, it has emerged as a critical factor for sustaining high achievement, retention, and positive behavior as well as improving life success. Emotional intelligence (EI) and personality traits play a major role in maintaining work effectiveness and efficiency in any organization. Analysis of the correlation matrix reveals that for both male as well as female youth some components of quality of life were significantly correlated of emotional intelligence with health and home status. Based on the findings of the study, it is imperative that emotional intelligence should be considered not only for academic interest but also of future success in life. With the aim of building a resilient and capable human face of globalization and changing demands, efforts to increase parent-child emotional intelligence should be considered to be a factor during early ears. Student-teachers should be provided with early interventions that involve emotional intelligence skills building. Therefore, this is responsibility of teacher educators, administrators, psychologists and other persons working in the field of education that they make every effort to develop emotional skills among the student-teachers to overcome personality gap among youth.
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=646http://ijcrr.com/article_html.php?did=646Cooper, R. K., & Sawaf, A. (1997). Executive EQ: emotional intelligence in leadership and organizations. New York: Grosset Putnum
Katyal,S.,& Awasthi, E. (2005). Gender differences in emotional intelligence among adolescents of Chandigarh. Journal of Human ecology, 17 (12), 154-156
Lindströ, B., & Henriksson, B. (1996). The essence of existence on the quality of life of children in the Nordic countries. International Journal of Social Welfare, 5(2), 117-118.
Nicholas, R., & Scott, D. (2005). An exploration of adolescent emotional intelligence in relation to demographic characteristics. Journal of social science Research, 5 (1-3), 146- 153.
Oort, F. (2005). Using structural equation modeling to detect response shifts and true change. Quality of Life Research, 14(3), 587-598.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30General SciencesMETAL COMPLEXES OF SCHIFF BASE DERIVED FROM SALICYLALDEHYDE - A REVIEW
English0616K. A. MaherEnglish S. R. MohammedEnglishSalicyaldehyde and their derivatives can be condensed with amines in 1:1 and 2:1 ratio to form bi, tri and tetra dentate NO and N2O2 Schiff base Ligands. They can contain additional donor atoms like oxygen, sulphur, nitrogen etc. which makes them Suitable chelating ligands to coordinate with Metal ions to form Schiff base complexes. Thus provides the possibility synthesis of large number of Schiff base complexes with divers’ structural feature. The model system including those with bidentate, tridentate and tetra dentate Schiff base derived from Salicyaldehyde and their coordination chemistry are summarized in this review.
EnglishMetal complexes, salicylaldehyde, Schiff Bases, Bidentate, Tridentate, Tetra dentateINTRODUCTION
Salicylaldehyde
Salicylaldehyde is a key precursor to a variety chelating agent, some of which are commercially important, salicylaldehyde is a common highly functionalized arene that has often been exploited as a precursor to still other chemical. Salicylaldehyde is converted to chelating ligands by condensation with amines. With ethylenediamine, it condenses to give the ligand salen. Hydroxylamine gives salicylaldoxime. Oxidation with hydrogen peroxide gives catechol (1,2-dihydroxybenzene) (Dakin reaction)1 . {Dakin, 1923 #47}Condensation with diethyl malonate gives a derivative of the heterocycle coumarin 2 via an aldol condensation.
Schiff bases
Schiff bases are aldehyde- or ketone-like compounds in which the carbonyl group is replaced by an imine or azomethine group3 .Schiff bases are versatile ligands synthesized from the condensation of an amino compound with carbonyl compounds4,5,6 and were first reported by Hugo Schiff in 1864. Formation of Schiff base generally takes place under acid or base catalysis or with heat. The common Schiff bases are crystalline solids, which are feebly basic but at least some form insoluble salts with strong acids5 . Today, Schiff bases are used as intermediates for the synthesis of amino acids or as ligands for preparation of metal complexes having a series of different structures5.
Schiff base metal complexes
Schiff bases are the most widely used organic compounds7 for industrial purposes and also exhibit a broad range of biological activities.3 Schiff base compounds and their metal complexes are very important as catalysts in various biological systems, polymers, dyes and medicinal and pharmaceutical fields4,8 they comprise miscellaneous therapeutically potent applications in the field of medicinal chemistry.9 Their use in birth control, food packages and as an O2 detector is also outlined8 Schiff’s bases chelates also used in quantitative analysis as an analytical chemical reagents and/or separation reagents have been also listed and discussed6 and synthetic applications in the field of the organic and inorganic chemistry.9 They have been shown to exhibit a broad range of biological activities, including antifungal, antibacterial, antimalarial, antiproliferative, anti-inflammatory, antiviral, and antipyretic properties.3,7
Schiff’s base and their copper complexes possess remarkable properties as catalysts in various biological systems, polymers, dyes, antimicrobial activities, antifungal activities, antiviral activities insecticides, antitumor and cytotoxic activities, plant growth regulator, enzymatic activity and pharmaceutical fields.A variety of Schiff’ base and its complex shave been studied extensively.Several model systems, including those with bidentate, tridentate, tetradentate, multidentate Schiff base ligands, and their coordination chemistry of copper attracts much attention because of its biological relevance and its own interesting coordination chemistry such as geometry, flexible redox property, and oxidation state.4 Gou and coworker used Salicylaldehyde base-Schiff as novel, easily available colorimetric and fluorescent double-sensor. The sensor exhibits highly selective and sensitive recognition toward Cu+2 in aqueous solution via a naked eye color change from colorless to yellow and toward Al+3 via a significant fluorescent enhancement in ethanol over a wide range of tested metal ions. This represents the first reported Salicylaldehyde Schiff-based sensor capable of detecting Cu+2 and Al+3 using two different modes10.
DISCUSSION
Bidentate Schiff Base Metal complexes New Schiff bases of salicylaldehyde and their Cobalt(II) derivatives Scheme (1) have been prepared and tested for their antitumor activities. Several of these, particularly the cobalt derivatives, have shown significant Inhibitory action against mouse cancers11.
The complexes of Mn(II) and Ni(II) with Schiff base derived from salicylaldehyde and 2-amino benzoic acid have been prepared and characterized as a neutral complex with 1:1 metal to ligand ratio12Figure (1).
Yousif at el prepared and characterized a new metal complex derivatives of 2N-salicylidene-5-(p-nitro phenyl)- 1,3,4-thiadiazole, HL Scheme (2) with the metal ions Vo(II), Co(II), Rh(III), Pd(II) and Au(III). The complexes obtained are monomeric with square planar geometry except VO(II) and Co complexes which existed as a square pyramidal and tetrahedral geometry respectively. The preliminary in vitro antibacterial screening activity revealed that complexes 1–5 Figure (2) showed moderate activity against tested bacterial strains and slightly higher compared to the ligand, HL13.
Malik and coworker reported the synthesis and characterization of metal complexes of Schiff base derived from xipamide, a diuretic drug. The bidentate ligand is derived from the inserted condensation of 5-aminosulfonyl- 4-chloro-N-2,6-dimethylphenyl-2-hydroxybenzamid (Xipamide) with salicylaldehyde in a 1:1 molar ratio Figure (3). Using this bidentate ligand, complexes of Hg(II), Zn(II), and VO(IV) with general formula ML2 have been synthesized Figure (4). All the complexes are nonelectrolytic in nature with 1:2 [M:L] ratio. Complexes of Hg(II) and Zn(II) have tetrahedral geometry via deprotonated phenolic oxygen and azomethine nitrogen atoms and VO(IV) complex have square pyramidal geometry. The pure drug, synthesized ligand, and metal complexes were screened for their antifungal activities against Aspergillus niger and Aspergillus flavus. The ligand and its Hg(II) and VO(IV) complexes were screened for their diuretic activity too.The complexes are found to have higher biological activities as compared to the respective ligand and the parent drug14.
New complexes of Schiff base ligand (derived from cefotaxime with salicylaldehyde with transition metals) prepared Figure (5) and characterized as nonelectrolyte complexes [ML2 (H2 O)2 ] with an octahedral geometry for Co(II), Ni(II), and Zn(II) complexes while a tetragonal geometry for Cu(II) complex Figure (6). All complexes were tested for invitro antibacterial activity against some pathogenic bacterial strains, namely Escherichia coli, Klebsiella pneumoniae, Pseudomonasaeruginosa, Bacillus subtilis, and Staphylococcus aureus. The results show that the metal complexes possess superior antibacterial activity than the Schiff base which could be used for the development of novel antimicrobial materials15.
Silicon(IV) complexes containing mixed ligands: Shiffbases (AH) derived from 2- or 3- amino-pyridine with 2-hydroxy- or 3-methoxy- or 2-hydroxy-3-methoxy-benzaldehyde and benzaldehyde semicarbazone (BSCH), have been prepared. Benzaldehyde semicarbazone acts as bidentate chelating ligand, octahedral Complexes of the type [Si(BSCH)2 (AH)]Cl4 , [Si(BSC)2 (An H)]Cl2 and [Si(BSC)2 (A)]Cl (where n=2 or 3, A=deprotonated Schiff-base ligands , BSC= dep- rotonated semicarbazone) have been proposed in neutral and basic medium, respectively16Figure (7).
Metal chelates, [M(HL)2 (H2 O)2 ]X2 (where M= Mn(II), Co(II), Cu(II), Ni(II) or Zn(II), X= NO3 –or Cl– and HL= Schiff base moiety), have been prepared and characterized as 1:2 (metal-ligand). The coordination to the central metal atom have been through the nitrogen of the 2- chlorophenyl hydrazine (–Ph–NH-) group and the sulfur atom of the thiophene ring forming distorted octahedral complexes Figure (8). The Schiff base and its metal chelates have been screened for their in vitro antibacterial activity against four bacteria, gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) and two strains of fungus (Aspergillus flavus and Candida albicans). The metal chelates were shown to possess more antibacterial activity than the free Schiff-base chelate 17.
Robin R. and coworkers prepared and characterized Schiff bases complexes derived from sulfanilamides or aminobenzothiazoles Figure (9) with Pd(OAc)2 as complexes of the type PdL2 Scheme (3,4). Palladium complexes and Schiff bases have been investigated as antifungal agents against Aspergillus niger and Aspergillus flavus18.
Cobalt(II), nickel(II) and copper(II) with Schiff bases derived from (2-aminobenzothiazole,6-nitro- 2aminobenzothiazole,4,6-dibromo-2-aminobenzothiazole) and 4-N dimethyl bezaldehyde to give ligands (La, Lan and Ladb) were prepared in 1:2 ratio (metal: ligand) Figure (10). These measurements indicated that the ligands coordinate with metal(II) ion in a bidentate manner through the nitrogen atoms in ligands with general formula [ML2Cl2] Where M=Co (II), Ni (II) and Cu (II), ( L=La, Lan, or Ladb) Figure (11)., Octahedral structures were suggested for metal complexes19.
T. Mahmud reported preparation of Schiff bases (L-Lysine-Salicyaldehyde, DL-2,3-Diaminopropion-Salicyaldehyde and 4-acetylamido benzylidene aniline) in basic media (using 2M NaOH) Scheme (5). A copper(II) complex with 2,2′-bipyridine and L-lysine was synthesized and characterized as a monomer with distorted square planar geometry, or a distorted octahedron if the long axial coordination from the perchlorate ions is admitted. The asymmetric unit contains two formula units of [Cu (L-Lysine) (2,2′-bipyridine)] with two perchlorate ions and one water molecule5 .
Tridentate Schiff Base Metal complexes
Mounika and coworkers reported a new Schiff base, 3-ethoxy salicylidene amino benzoic acid (ETSAN) Scheme (6), has been synthesized from 3-ethoxy salicylaldehyde and 2-amino benzoic acid. The ligand act as neutral and tridentate coordinating through nitrogen atom of the azomethine and oxygen atoms of hydroxyl group of the 3-ethoxy salicylaldehyde beside the hydroxyl group of the carboxyl group of the 2-amino benzoic acid respectively. All complexes are non-electrolytes and show 1:1 metal: ligand ratio with octahedral geometry Figure (12). Biological studies of these complexes reveal that they show better activity when compared to that of the ligand20.
Novel transition metal [Co(II), Cu(II), Ni(II) and Zn(II)] complexes of substituted pyridine Schiff-bases Figure (13) have been prepared and characterized with general formula [M(L)2] where [M=Co(II), Cu(II), Ni(II) and Zn(II) and HL=HL1 , HL2 , HL3 and HL4 ] and an octahedral geometry. The synthesized Schiff-bases act as deprotonated tridentate with Co(II), Ni(II) and Zn(II) ions Figure (14). The Schiff bases and their complexes have been screened for antibacterial activity against the strains such as Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. The complexed Schiff bases have shown to be more antibacterial against one more bacterial species as compared to uncomplexed Schiff-bases21.
Z. F. Dawood and M. W. Ibrahim reported Preparation and characterization of new cobalt (II) complexes with mixed ligands including salicylaldehyde thiosemicarbazone-STH2 and carboxylic acid-AH2 {salicylic acidSH2 or anthranilic acid-AnH2 or phthalic acid-PH2 } Figure (15) as [Co2 (AH2 )2 (STH2 )2 (NO3 )2 ](NO3 )2 or [Co2 (AH2 )2 (STH2 )2 Xn] in neutral medium whereas, in basic medium as [Co2 (AH)2 (STH)2 ] {where X = CO3 2- or CH3 CO2- , n = 2 or 4} with octahedral geometries forming dimer (binuclear complexes)22Figure (16).
Saxena synthesized and characterized metal complexes of Ti (III), V (III), VO (IV), CO (II) and MN (III) with salicylaldehyde and thiohydrazones ligand Scheme (7) and proposed an octahedral geometry for all the synthesized complexes23Figure (17).
Mohammed M. Al-Ne’aimi at el have been prepared Mononuclear complexes of two novel ligands {Diacetylmonoxime-4- nitrobenzoylhydrazone (L1 H2 ), Diacetylmonoxime-4- hydroxybenzoylhydrazone (L2 H2 )} Scheme (8) with [Co(II), Ni(II), Cu(II), Zn(II) and Cd(II)] as [M(Ln H)2 ] where (n =1,2) in the presence of Et3 N. The metal complexes [M(Ln H)2 ] are proposed to be six-coordinated with a N4 O2 donor environment through the oxime nitrogen, the imine nitrogen and the enolic oxygen atoms while the phenolic hydroxyl and oxime hydroxyl groups of aroylhydrazonemonoxime moiety do not participate in coordination24.
Dinuclear complexes from salicylaldehyde and 2-aminophenol with Cu (II), Ni (II) and Co (II) Figure (18) were obtained by new synthetic route and characterized. Low temperature intramolecular ferromagnetism was exhibited by homodinuclear complex while the heterodinuclear complexes showed antiferromagnetic coupling25.
New Schiff base ligand derived from 4-Amino antipyrine, sulphadiazine and acetoacetanilide were prepared Scheme (9) and reacted with metal salts in 1:1 ratio (metal: ligand). The complexes have the general formula [MLCI.2H2 O] where M = Co(II), Ni(II) and Cu(II) Figur (19). The ligand coordinate with the metal (II) ion in neutral tridentate manner through the azomethane nitrogen atoms, and oxygen group of the acetoacetanilide forming octahedral complexes26.
Tetra dentate Schiff Base Metal complexes
Mostafa M. and coworker synthesized macro-cyclic Schiff base ligand resulted from thecondensation of {bisaldehyde and ethylenediamine was prepared (7, 8, 15, 16, 17, 18-hexahydrodibenzo (a, g) (14) annulene)} (L) and its complexes were synthesized and characterized as 1:1 [ML] complex with octahedral structure for the all complexes via (N2 O2 ) group act as a tetradentate ligand and two chlorides as monodentate ligands Figure (20). They reported using of neutral chelating ligand as selective reagent to determine iron (III) in different types of natural water within recovery test and described that the metal complexes are more potent/ antibacterial than the parent Schiff base ligand against one or more bacterial species27.
Salicylaldehyde 2-chlorobenzoyl hydrazone (H2 LASSBio-466), salicylaldehyde 4-chlorobenzoyl hydrazone (H2 LASSBio-1064) Figure (21) and their complexes [Zn(LASSBio466)H2 O]2 and [Zn(HLASSBio-1064)Cl] were evaluated in animal models of peripheral and central nociception, and acute inflammation. All studied compounds significantly inhibited acetic acid-induced writhing response. All compounds showed levels of inhibition of zymosan-induced peritonitis comparable or superior to indomethacin, indicating an expressive antiinflammatory profile28.
Two new tetra dentate ligands (L1 and L2) N,N’-bis{(oaminophenylthio)bromo propyl} 1-phenyl butane 1,3-dilidene (L1), N, N’-bis (3- bromo propyl (phenylthio) imino)1,1,1-trifluoro -3-(2-theonyl) acetone (L2) were prepared Scheme (10) and reacted with M= Co(II), Ni(II), Cu(II) and Zn(II) chloride salts to give [M(L)]Cl2 and [Zn(L)Cl2 ] Figure (22) as tetrahedral complexes via nitrogen atoms of the azomthine and two sulfur atoms while for zinc (II) complexes from the two sulfur atoms and two chloride ions29.
New Schiff base chelates of Cu(II), Co(II), Ni(II) and Zn(II) derived from benzil-2,4-dinitrophenylhydrazone with aniline have been synthesized Figure (23) and characterized to suggest tentative structures for the complexes30.
Three new metal complexes of Cr(III), Pb(II)) and TiO(IV) ions with a Schiff base derived from salicylaldehyde and urea Figure (24) have been investigated with 1:1 [M:L] ratio. The coordination behavior of the metal ions towards to the investigated Schiff base takes place through –C=N and –OH groups31 Figure (25).
Tetra dentate N2 O2 type complexes of Co(II) have been synthesized by the condensation of o-phenylenediamine, salicylaldehyde and isatin/ naphthaldehyde/acetyl acetone and characterized as [ML(H2 O)(OAc)] with octahedral geometry Figure (26). The metal complexes have been screened for their antibacterial and antifungal activity. DNA cleavage activities of Schiff bases and their metal complexes were monitored by agarose gel electrophoresis method in the presence of H2 O2 32.
N. Kumar at el reported preparation of Schiff bases (Salicyladehyde glycine, DL-2,3-Diaminopropion-Salicyaldehyde, benzylidene glycine and 4-acetylamido benzylidene aniline) in basic media (using 2M NaOH) figure (27) and described the applications of shiff bases and their copper(II) complexes as antimicrobial activities, antifungal activities, antiviral activities. Tetra dentate Schiff base and its metal complexes with Mn (II), Ni (II), Cu (II), and Zn (II) show miscellaneous effect on membrane in amylose production33.
CONCLUSION
Salicyaldehyde and their derivatives can be good chelating ligands when they condensed with amines in 1:1 and 2:1 ratio to form bi, tri and tetra dentate Schiff base ligands suitable to form complexes with Metal ions. These Metal-Schiff base complexes have been shown to exhibit a broad range of biological activities, including antifungal, antibacterial, antimalarial, anti-proliferative, antiinflammatory, antiviral, and antipyretic properties.
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=647http://ijcrr.com/article_html.php?did=6471. Dakin, H.D.Catechol. Org. Synth. 1923; 3(28).
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3. Cleiton M. da Silva, D.L.d.S., Luzia V. Modolo, Rosemeire B. Alves, Maria A. de Resende, Cleide V.B. Martins, Angelo de Fatima Schiff bases: A short review of their antimicrobial activities. Journal of Advanced Research 2011; 2: 1-8.
4. Rishu Katwal, H.K.a.B.K.K. Applications of Copper – Schiff’s Base Complexes: A Review.Sci. Revs. Chem. Commun. 2013; 3(1):1-15.
5. Mahmud T.Synthesis and characterization of the amino acid Schiff bases and their complexes with copper(II). in School Of Chemistry2010; University Of Manchester: Manchester:p 4,5.
6. Bader, N.R.Applications of Schiff’s Bases Chelates in Quantitative Analysis A Review.Rasayan J. Chem. 2010;3(4): p. 660-70.
7. Zoubi, W.A.Biological Activities of Schiff Bases and Their Complexes: A Review of Recent Works.International Journal of Organic Chemistry 2013;3: 73-95.
8. Anant Prakash, D.A. Application of Schiff bases and their metal complexes-A Review. International Journal of ChemTech Research Oct-Dec 2011;3(4):1891-96.
9. Pallavi Goel, D.K., Sulekh ChandraSchiff’s Base Ligands and Their Transition Metal Complexes as Antimicrobial Agents. J. Chem. Bio. Phy. Sci. Sec. A 2014; 4(3):1946-64.
10. Gou, Q., Wu, Wang, Luo, and Liu A highly selective chemosensor for Cu+2 and Al+3 in two different ways based on Salicylaldehyde Schiff. Inorganic Chemistry Communications 2011;14(10).
11. Ernest M. Bodneti, W.W. Schiff Bases of Salicylaldehyde and Their Cobalt(ll) Derivatives as Antitumor Agents. Stillwater. Proc. Of The Okla. Acad. of Sci, 1965:107-11.
12. Ado, H.N.A.a.I. Studies of Mn (II) and Ni (II) complexes with Schiff base derived from 2-amino benzoic acid and salicylaldehyde. Biokemistri March 2011;23(1):9-16.
13. Emad Yousif , A.M., Khulood Al-Sammarrae, Nadia Salih, Jumat Salimon, Bashar AbdullahMetal complexes of Schiff base: Preparation, characterization and antibacterial activity. Arabian Journal of Chemistry 2013:1-5.
14. Suman Malik, S.G., Bharti Jain, Archana Singh and Mamta Bhattacharya Synthesis, Characterization, and Biological Evaluation of Some 3d-Metal Complexes of Schiff Base Derived from Xipamide Drug. International Journal of Inorganic Chemistry 2013:1-6.
15. Aurora Reiss, M.C.C., Emilia Amzoiu and Cezar Ionuu Spî- nuTransition Metal(II) Complexes with Cefotaxime-Derived Schiff Base: Synthesis, Characterization and Antimicrobial Studies. Bioinorganic Chemistry and Applications:1-17
16. Z. F.Dawood, M.A.A.-S.Preparation and Characterization of Some Silicon (IV) Complexes. Sciences & Technologie Juin. 2008; A(27): 49-54.
17. Omar B. Ibrahim, M.A.M., Moamen S. RefatNano Sized Schiff Base Complexes with Mn(II), Co(II), Cu(II), Ni(II) and Zn(II) Metals: Synthesis, Spectroscopic and Medicinal Studies. Canadian Chemical Transactions 2014;2(2):108-12.
18. Robin R. Coombs, M.K.R., Johanna M. Blacquiere, Joshua C. Smith, J. Scott Neilsen, Yoon-Seo Uh, et al.Palladium(II) Schiff base complexes derived from sulfanilamides and aminobenzothiazoles. Transition Metal Chemistry2005; 30: 411–18.
19. Saleh A. Ahmed, A.O.M., Adnan A. Humada, Ihmood K. AL-juboori, Emad M. OsajSynthesis and Characterization of Some Schiff Bases(derived from thiazole)and Their Complexes With Co(II),Ni(II) and Cu(II). Journal of Kirkuk University –Scientific Studies2009; 4(2): p. 37-45.
20. K. Mounika, B.A., J. Pragathi, and C. Gyanakumari Synthesis¸ Characterization and Biological Activity of a Schiff Base Derived from 3-Ethoxy Salicylaldehyde and 2-Amino Benzoic acid and its Transition Metal Complexes. J. Sci. Res. 2010;2(3): 513-24.
21. Zahid H. Chohan, A.M.a.C.T.S. Transition Metal Ion Complexes Of Schiff-Bases. Synthesis, Characterization And Antibacterial Properties. Metal Based Drugs 2001;8(3):137-43.
22. Z. F. Dawood, M.W. Ibrahim Preparation and Characterization of Some Cobalt (II) Complexes Containing Mixed Ligands (Salicylaldehyde Thiosemicarbazone and Carboxylic Acids).National Journal Of Chemistry 2006; 21: 24-31.
23. Saxena A.Synthesis and characterization of schiff base salicylaldehyde and thiohydrazones and its metal complexes. Advances in Applied Science Research 2013; 4(4): 152-54.
24. Mohammed M. Al-Ne’aimi, M.M.A.-K.a.S.J.M. Synthesis and Characterization of Co(II) Ni(II) Cu(II) Zn(II) and Cd(II) Complexes with Aroylhydrazonemonoximes.Raf. J. Sci. 2012;23(4):51-69.
25. VD Bhatt, S.R. Preparation and Properties of Dinuclear Schiff Base Complexes from Salicylaldehyde and 2-Aminophenol Complexes of Cu (II) Co (II) and Ni(II). Chemical Sciences Journal 2012;2012.
26. Layla A. Mohammed, A.J.K., Nadia H. AubaidSynthesis and Characterization of New Schiff Base Ligand with Its Some Complexes Derived from 4-Amino Antipyrine, Sulphadiazine and Acetoacetanilide. Acta Chim. Pharm. Indica 2013;3(2):111-18.
27. Mostafa M. H. Khalil, E.H.I., Gehad G. Mohamed, Ehab M. Zayed, Ahmed BadrSynthesis and characterization of a novel schiff base metal complexes and their application in determination of iron in different types of natural water. Open Journal of Inorganic Chemistry 2012; 2:13-21.
28. Walfrido Bispo Junior, M.S.A.-M., Marina A. Alves, Anayive Perez-Rebolledo, Gabrieli L. Parrilha, Eduardo E. Castellano, et al.Analgesic and Anti-Inflammatory Activities of Salicylaldehyde 2-Chlorobenzoyl Hydrazone (H2LASSBio-466), Salicylaldehyde 4-Chlorobenzoyl Hydrazone (H2LASSBio-1064) and Their Zinc(II) Complexes. Molecules 2011;16.
29. N. H. Buttrus, C.L., M. Refat Synthesis and characterization of some new mononuclear complexes of Co(II), Ni(II), Cu(II) and Zn(II) with N2S2 donor Schiff base ligands. International Journal of Enhanced Research in Science Technology & Engineering April 2014; 3(4):156-60.
30. N. Raman, S.R., C.ThangarajaCopper(II) cobalt(II) nickel(II) and zinc(II) complexes of Schiff base derived from benzil-2,4 dinitrophenylhydrazone with aniline. J. Chem. Sci. July 2004;116(4): 215–19.
31. F.A. Abdlseed, M.M.E. Preparation and spectroscopic investigation of a Schiff base metal complexes. International Journal of PharmTech Research 2009;1(4):1097-103.
32. A. Nagajothi, A.K., S. Chitra and K. Parameswari Synthesis and Characterization of Tetradentate Co(II) Schiff Base Complexes : Antimicrobial & DNA Cleavage Studies. International Journal of Research in Pharmaceutical and Biomedical Sciences Oct – Dec 2012;3(4):1768-78.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareNORMAL FUNCTIONING MEDITATIONAL ECTOPIC THYROID - A RARE CASE REPORT
English1720Abdullateef SoftahEnglishWe reported a 34 yrs old who had presented with a huge goiter in the neck and a separate mediastinal huge thyroid mass. He had tracoesophageal compression causing dysphagia and dysphonia. After investigations patient underwent two separate operations. One for Neck goiter and second for the mediastinal goiter. Literature is reviewed
EnglishThyrothymus membrane, Mediastinal thyroid tissue, Thyroid gland embryogenesis, Mediastinal tumorsINTRODUCTION
Thyroid is normally located on thyroid cartilage. Ectopic thyroid can be found in the area of descend of thyroglossal duct from foramen cecum and thyroid cartilage Sometimes ectopic thyroid can be found in the mediastinum which is derived from thyroid rest in the thyrothymus membrane. There may or may not be a tissue continuity between the actual thyroid and the mediastinal thyroid tissue. Any of the thyroid tissue at any location can develop into a goiter and produce pressure symptoms. We are presenting a rare case of normal functioning mediastinal ectopic thyroid goiter which presented with dysphagia.
CASE
34 yrs old male presented with history of swelling in the neck progressed to big size. The swelling caused dysphagia and dysphonia. On examination the lower border was not seen not felt percussion of manubrium was dull pembuldon’d maneuver caused congestion of face Indirect laryngoscopy showed normal vocal cords movement. Investigations revealed normal T3 T4 TSH normal. Isotope Tc 99 scan showed patchy uptake (Photo 1). CT scan neck and chest revealed compression and deviation of the trachea in neck and huge anterior mediastial multinodular goiter measuring 5X 11X8 cms with dense calcification with few hypodense nodules. The mass had no connection with the proper thyroid goiter in the neck (Photo 2). FNAC report was colloid goiter. As the thyroid was huge compressing airway severely and there was a huge retrosternal mediastinal mass in chest we thought of doing this surgery in two stages. Stage one we planned to operate thro neck incision and relieve the tracheal compression. The lower poles of the goiter were delivered completely but still a separate mass could be felt in the superior mediastinum which was totally separate from the goiter. The second stage was performed after one month. Patient was operated with median sternotomy incision. Intraoperative findings revealed the mass was very vascular and big about 5cmx11cmX8cms in size (Photo 3). It was removed completely comfortably through this incision. Post operative patient had no dysphagia no injury to vital structures (Photo 4). However patient developed hypocalcaemia for which he was treated with oral calcium and vitamin D.
DISCUSSION
Ectopic thyroid tissue is a rare entity resulting from developmental defects at early stages of thyroid gland embryogenesis, during its Descent from the floor of the primitive foregut to its final pre-tracheal position. It is frequently found around the course of the thyroglossal duct. As well as in distant places such as the mediastinum and the subdiaphragmatic.
The sites of ectopic thyroid gland described are lingual, throglossal duct remnants and thyroglossal cyst. Presence of thyroid goiter in mediastinum and brancheal cyst are very rare2 Sometimes thyroid gland can be found in lateral pert of neck due to developmental anomaly. previously it was thought that papillary ca spreads to LN in lateral neck and grows in LN as a ectopic thyroid malignancy but now it has been shown that it is not the metastatic growth but it is a primary malignancy in lateral aberrant thyroid gland.3 Hence it is necessary to differentiate Ectopic thyroid tissue from papillary carcinoma. Very rarely ectopic thyroid malignancy can also be found in brancheal cyst.4 Intrathoracic or Mediastinal thyroid develops from Thyroid Rests Thyroid rests also known as thyrothymic thyroid rests are deposits of thyroid tissue arising in the thyrothymic tract below the thyroid lobes. They cause symptoms such as swallowing or breathing difficulty due to pressure on other structures .The currently accepted definition of an intrathoracic goiter is a thyroid gland with more than 50% of its mass located below the thoracic inlet.5-6 Ectopic intrathoracic thyroid is a rare presentation of thyroid disease and of all Mediastinal tumors.7 It is defined as the presence of enlarged thyroid tissue below the plane of the thoracic inlet. Utilizing the Shield’s classification of the Mediastinum.8 Wakeley and Mulvany in their 1940 seminal report divided intrathoracic thyroid into three types:
(a) “small substernal extension” of a mainly cervical thyroid goiter; (b) “partial” intrathoracic goiter, in which the major portion of the goiter is situated within the thorax; (c) “complete” intrathoracic goiter, in which all of the goiter lies within the thoracic cavity. With an overall incidence of 8.7% for substernal goiters, the incidences of the three types were 81.9%, 15.3%, and 2.7%.9 A report published from Nigeria shows that intrathoracic goiters are mostly located in the anterior and middle Mediastinum, and rarely in the posterior Mediastinal compartment.10 A report from university of Mississippi mentions that Mediastinal thyroid goiters are common on right side of chest and they commonly lie posteriorly. Most of the thyroid goiters can be tackled thro cervical incision but 5 to 10% may require additional incision. For posterior goiters it should be right ant thoracotomy and for anterior goiters it is mid sternotomy. Conversely, a “complete” or “true” intrathoracic goiter is one that is completely within the Mediastinum and separate from a coexisting cervical thyroid gland.1 Thus, the uppermost part is barely palpable in the sternal notch.5 Intrathoracic goiters tend to be attached by a thin piece of thyroid or fibrous tissue to the main body of the gland, but about 20% have no attachment at all and can migrate into the chest, presenting as an unexplained intrathoracic mass. More usually however, they are removed with rest of the thyroid at the time of a total thyroidectomy, via the standard neck incision. If completely separate, then a manubriotomy might be needed to gain access to the mass in the chest for removal.11 Although most intrathoracic goiters can be removed through a cervical incision.11,12-13 In the event that the transcervical surgical approach fails, median sternotomy may be done, particularly if thyroid cancer is suspected or the patient is experiencing acute airway compression. Generally, the decision for a more invasive procedure should be made after careful exploration of the neck and complete exposure of the thyroid.14
CONCLUSION
Although most intrathoracic goiters can be managed by removal through a cervical incision .One may not succeed in getting the thyroid out by neck incision hence preparation of median sternotomy simultaneously or in separate sitting if it is huge and vascular. Standby thoracic surgeon during surgery is essential. Conflicts of interest: None Source of Funding: None
ACKNOWLEDGEMENTS
The authors acknowledge the immense help received fro m 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=648http://ijcrr.com/article_html.php?did=6481. Noussios G, Anagnostis P, Goulis DG, Lappas D, Natsis K. Ectopic thyroid tissue: anatomical, clinical, and surgical implications of a rare entity. Eur J Endocrinol. 2011 Sep;165(3):375-82. doi: 10.1530/EJE-11-0461. Epub 2011 Jun 29.
2. Kay DJ, Meyers AD. Embryology of the Thyroid and Parathyroids. Thyroid Embryology Clinical Correlations. Emedicine. Updated: Jan 14, 2010.
3. Johnson RWP, NC. The So-called Lateral Aberrant Thyroid Br Med J. 1962 June 16; 1(5293): 1668–1669.
4. Karras S, Anagnostis P, Noussios G, Pontikides N. Thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cleft cyst. BMJ Case Rep. 2013 Apr 22;2013. pii: bcr2013009312. doi: 10.1136/bcr-2013-009312.
5. deSouza FM, Smith PE. Retrosternal goiter. J Otolaryngol1983;12:393-6.
6. Netterville JL, Coleman SC, Smith JC, et al. Management of substernal goiter. Laryngoscope1998;108:1611-7.
7. Shields TW. The Mediastinum, Its Compartments, and the Mediastinal Lymph Nodes. Shields, TW. General Thoracic Surgery. 2005. Sixth Edition. Chapter 154, 2343-2346
8. Hedayati N, McHenry CR. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg 2002;68:245-52.
9. Sakorafas GH, Vlachos A, Tolumis G, Kassaras GA, Anagnostopoulos GK, Gorgogiannis D. Ectopic intrathoracic thyroid: case report. Mt Sinai J Med 2004;71:131-133
10. degboye VO, Ogunseinde OA, Obajimi MO, Ladipo JK, Brimmo AI. Pattern of intrathoracic goiter in Ibadan, Nigeria. Niger Postgrad Med J 2002;9:226-232.
11. Johnston JH Jr, Twente GE. Surgical approach to intrathoracic (mediastinal) goiter. Ann Surg. 1956 May;143(5):572- 9.
12. Shaha AR, Alfonso AE, Jaffe BM. Operative treatment of substernal goiters. Head Neck1989;11:325-30.
13. Lahey FH, Swinton NW. Intra-thoracic goiter. Surg Gynecol Obstet1934;59:627-37.
14. Pace-Asciak P, Higgins K. Management of intrathoracic goiter. Can J Surg. 2008 October; 51(5): E111–E112. PMCID: PMC2556542.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareAGE AND GENDER RELATED CHANGES IN MIDSAGITTAL DIMENSIONS OF THE LUMBAR SPINE IN NORMAL EGYPTIANS: MRI STUDY
English2140Fathy Ahmed FetouhEnglishBackground: Degeneration of lumbar spine is a common and age related finding in the normal population. Eighty percent of adult population suffer from at least one episode of low back pain during their life time.
Objective: The present work aimed to study the midsagittal dimensions of lumbar vertebrae, intervertebral discs, and vertebral canal in normal Egyptian population in different age groups in both males and females using MRI.
Materials and methods: A retrospective study of MRI midsagittal images of lumbar spine was carried out for normal Egyptian population whose ages ranged from 20 to 60 years old and divided into 4 age groups (decades). The parameters measured for the discs were; anterior, central, posterior disc heights, relative disc height index and anteroposterior disc diameter, while the parameters measured for the vertebrae were; central height, anteroposterior diameter, midsagittal canal diameter and canal/ body ratio. The data were statistically analyzed and tested for significance between age groups and between males and females.
Results: The measured parameters of the discs increased with age progress with significant differences at different levels between age groups. Also, they were found to be greater in males than females with significant differences. The relative disc height index showed a constant relationship between males and females. For the vertebrae, the parameters showed no significant differences related to age progress, while they were greater in males than females at all levels in all age groups. The midsagittal canal diameter and canal/body ratio indicated that the canal diameter decreased steadily from 3rd to 6th decade and was more capacious in females than in males.
Conclusion: The measurements obtained in the present study can be considered as a database which can be helpful to clinicians, therapists, and researchers as ready references of lumbar spine in normal adult Egyptian population. Any deviation from these values should be correlated with clinical findings.
EnglishAging, Sexual dimorphism, Lumbar intervertebral disc, Midsagittal canal diameter, MRIINTRODUCTION
The lumbar spine has a larger mobile segment in the sagittal plane.1 Changes in the aging spine usually occur at movable intervertebral discs, facet joints, ligamentum flavum, and vertebral endplate which are adjacent to the intervertebral discs.2-4 The intervertebral discs undergo an age-related process of degeneration as early as 2nd decade, which is manifested by gradual structural transition of disc components.5 The central region of the vertebrae adjacent to nucleus pulposus is exposed to greater vertical stress than other regions.6 Among the various problems with spinal aging, lumbar spinal stenosis is the most frequent indication for spinal surgery in people over 60 years old.7 Also, pathological changes can occur in diameter of the lumbar spinal canal, therefore assessing the canal size is considered as an important diagnostic procedures.8 The sagittal anteroposterior diameter of the spinal canal is the only parameter which could be statistically correlated with the cross sectional area and it is accepted to use it as an indicator of the size of spinal canal.9 Since the magnification errors resulting from non-standardized film-tube distance is possible in the studies using the plain films, the magnetic resonance imaging is a more reliable in measurements of the intervertebral discs.10 The quantitative studies concerning the lumbar spine in Egyptians are to our knowledge still scarce. The present work aimed to study the midsagittal dimensions of lumbar vertebrae, intervertebral discs, and vertebral canal in normal Egyptian population in different age groups in both males and females using MRI.
MATERIALS AND METHODS
Subjects
A retrospective study of MRI midsagittal images of lumbar spine was done for cases referred to ELnour Radiology Center in Sharkia Governorate, Egypt in the period between August 2013 and September 2014. Patients consent was not required for the retrospective review of records and images because patient anonymity was preserved.The criteria for selection included the images which were obtained for various reason such as; abdominopelvic problems, muscle pain, and soft tissue injuries. MRI showing evidences of fracture, congenital anomalies, degenerative changes, endplate sclerosis, spinal metastasis or any other pathologies were excluded according to reading of radiologist. The data about age and sex were recorded. The selected cases were 104 in number (52 males and 52 females). In order to avoid uncertainty of measurements caused by secondary ossification centres of vertebrae before 20 years and osteoporosis after 60 years, subjects between 20 to 60 years were selected and divided into 4 age groups (decades): 3rd decade (20- 29 years), 4th decade (30 - 39 years,) 5th decade (40 - 49 years), and 6th decade (50-59 years).
Technique
The lumbar spine was examined with the use of GE Signa Pofile 0.2T Open MRI Scanner. T2-weighted images with sagittal plane were obtained with a repetition time (TR) of 2600 milliseconds and echo time (TE) of 100 milliseconds. Slice thickness was 4 mm. The field of view (FOV) used was 25-30 cm. Distances and diameters were measured in millimetres using the software that accompanies the MRI system.
Measurements
Measurements were done at the midsagittal T2-weighted images which were identified when the tips of the spine processes were seen. The landmarks for measurements were taken at extreme anterior or posterior margins of the endplates of vertebrae.11 The following dimensions were measured for intervertebral discs: 1-Anterior disc height: was measured as the distance between the extreme anterior margins of the two adjacent vertebral endplates (Fig. 1A) 2-Central disc height: was measured as the distance between the midpoints of the two adjacent vertebral endplates (Fig. 1B) 3-Posterior disc height: was measured as the distance between the extreme posterior margins of the two adjacent vertebral endplates (Fig. 1A) 4-Anteroposterior disc diameter: was measured as the distance between the midpoints of the anterior and posterior disc heights (Fig.1C) 5-Relative disc height index= mean of central disc height/mean of central vertebral height.3,11-15 For the lumbar vertebrae, the following dimensions were measured: 1-Central vertebral height: was measured as the distance between the midpoints of the superior and inferior endplates of each vertebra (Fig.1D) 2-Anteroposterior diameter of vertebral body: was measured as the greatest mid waist distance between midpoints of anterior and posterior borders of the vertebral bodies (Fig.1E) 3-Midsagittal canal diameter: was measured from midpoint of the posterior border of vertebral body to the most anterior part of spinous process. ( Fig.1F) 4-Canal/body ratio= midsagittal canal diameter/anteroposterior diameter of the vertebra.10,16-22 All the measurements were taken 2 times and the mean was assessed to minimize the intra-observer error.
Statistical analysis
Statistical analysis was carried out using SPSS for windows software program. Descriptive statistical analysis for all the data were presented as mean and standard deviation. Paired sample t-test was used to evaluate the differences between male and female measurements and between successive age groups. The differences were considered significant when P value Englishhttp://ijcrr.com/abstract.php?article_id=649http://ijcrr.com/article_html.php?did=6491. Takeda N, Kobayashi T, Atsuta Y, Matsuno T, Shirado O, Minami A. Changes in the sagittal spinal alignment of the elderly without vertebral fractures: a minimum 10-year longitudinal study. J Orthop Sci 2009; 14(6):748 -753.
2. Twomey L, Taylor J. Age changes in the lumbar spinal and intervertebral canals. Paraplegia 1988;26:238-249.
3. Shao Z, Rompe G, Schiltenwolf M. Radiographic changes in the lumbar intervertebral discs and lumbar vertebrae with age. Spine 2002; 27; 263-268.
4. Vernon-Roberts B, Moore RJ, Fraser RD. The natural history of age-related disc degeneration: the influence of age and pathology on cell populations in the L4-L5 disc. Spine (Phila Pa 1976) 2008;33:2767-2773.
5. Naylor A. The biophysical and biochemical aspects of intervertebral disc herniation and degeneration. Ann R Coll Surg 1962; 31: 91-114.
6. Ferguson SJ, Steffen T. Biomechanics of the aging spine. Eur Spine J 2003; 2: S97-S103.
7. Abbas J, Hamoud K, May H, Hay O, Medlej B, Masharawi Y, et al. Degenerative lumbar spinal stenosis and lumbar spine configuration. Eur Spine J 2010;19:1865-73.
8. Santiago FR, Milena GL, Herrera RO, Romero PA, Plazas PG. Morphometry of the lower lumbar vertebrae in patients with and without low back pain. Eur Spine J 2001; 10(3):228-233.
9. Gepstein R, Folman Y, Sagiv P, Ben David Y, Hallel T. Does the anteroposterior diameter of the bony spinal canal reflect its size? An anatomical study. Surg Radiol Anat 1991;13:289-291.
10. Sevinc O, Barut C, Is M, Eryoruk N, Safak A. Influence of age and sex on lumbar vertebral morphometry determined using sagittal magnetic resonance imaging. Ann Anat 2008; 190:277-83.
11. Aydinlioglu A, Diyarbakirli S, Keles P. Heights of the lumbar intervertebral discs related to age in Turkish individuals. Tohoku J Exp Med 1999; 188: 11-22.
12. Amonoo-Kuofi HS. Morphometric changes in the heights and anteroposterior diameters of the lumbar intervertebral discs with age. J Anat 1991; 175: 159-168.
13. Al-Hadidi MT, Badran DH, Al-Hadidi AM, Abu-Ghaida JH. Magnetic resonance imaging of normal lumbar intervertebral discs. Neurosciences 2001; 6 (4): 227-232.
14. Shao Z, Rompe G, Schiltenwolf M. Radiographic changes in the lumbar intervertebral discs and lumbar vertebrae with age. Spine 2004; 29:108-9.
15. Gocmen-Mas N, Karabekir H, Ertekin T, Edizer M, Canan Y Izzet duyar I. Evaluation of lumbar vertebral body and disc: a stereological morphometric study. Int J Morphol 2010;28 (3):841-847.
16. Amonoo-Kuofi HS. The sagittal diameter of the lumbar vertebral canal in normal adult Nigerians. J Anat 1985; 140 (1): 69-78.
17. Twomey LT, Taylor JR. Age changes in lumbar vertebrae and intervertebral discs. Clin Orthop Relat Res 1987; 224:97-104.
18. Lee HM, Kim NH, Kim HJ, Chung IH. Morphometric study of the lumbar spinal canal in the Korean population. Spine 1995 (Phila Pa 1976) 20:1679-1684.
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22. Kim KH, Park JY, Kuh SU, Chin DK, Kim KS, Cho YE. Changes in spinal canal diameter and vertebral body height with age. Yonsei Med J 2013;54 (6):1498-1504.
23. Oda J, Tanaka H, Tsuzuki N. Intervertebral disc changes with aging of human cervical vertebra from neonate to the eighties. Spine 1988; 13: 1205-1211.
24. Frobin W, Brinckmann P, Biggemann M, Tillotson M, Burton K. Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech 1997; 12(1):51- 63.
25. Bernick S, Cailliet R. Vertebral end-plate changes with aging of human vertebrae. Spine 1982;7:97–102.
26. Anderson DG, Li X, Tannoury T, Beck G, Balian G. A fibronectin fragment stimulates intervertebral disc degeneration in vivo. Spine 2003;28:2338–45.
27. Buckwalter JA. Aging and degeneration of the human intervertebral disc. Spine (Phila Pa 1976) 1995;20 (11):1307- 14.
28. Pokharna HK, Phillips FM. Collagen cross-links in human lumbar intervertebral disc aging. Spine 1998;23:1645- 1648.
29. Eijkelkamp MF, Klein JP, Veldhuizen AG, Van Hom JR, Verkerke GJ. The geometry and shape of the human intervertebral disc. The International Journal of Artificial Organs. 2001; 24: 75-83.
30. Moeller TB, Reif E. Normal Findings in CT and MRI. First edition, Thieme, Stuttgart, Germany. 2000: 82 & 174.
31. Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat 1981; 132: 39-56
32. Shukri IG, Mahmood KA, Abdulrahman SA. a morphometric study of the lumbar spine in a symptomatic subjects in Sulaimani city by magnetic resonance imaging. JSMC, 2013; 3(1):21-31.
33. Masharawi Y, Salame K, Mirovsky Y, Peleg S, Dar G, Steinberg N, et al. Vertebral body shape variation in the thoracic and lumbar spine: characterization of its asymmetry and wedging. Clin Anat 2008;21:46-54.
34. Sone T, Tomomitsu T, Miyake M, Takeda N, Fukunaga M. Age-related changes in vertebral height ratios and vertebral fracture. Osteoporos Int 1997; 7:113-118.
35. Goh S, Tan C, Price RI, Edmondston J, Song S, Davis S, Singer KP. Influence of age and gender on thoracic vertebral body shape and disc degeneration: an MR investigation of 169 cases. J Anat 2000; 197: 647-657.
36. Frobin W, Brinckmann P, Biggemann M, Tillotson M, Burton K. Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech (Bristol, Avon) 1997;12(suppl 1):51- 64.
37. Gilsanz V, Boechat MI, Gilsanz R, Loro ML, Roe TF, Goodman WG. Gender differences in vertebral sizes in adults: biomechanical implications. Radiology 1994;190: 678-682.
38. Standring S, Ellis H, Healy JC, Johnson D, Williams A, Collins P et al. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. Thirty-ninth edition, Elsevier Churchill Livingstone, Edinburgh; 2005: 735-756 & 789-793.
39. Panjabi MM, White AA. 3rd Basic biomechanics of the spine. Neurosurgery 1980;7:76-93.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareA RANDOMIZED OPEN LABELED COMPARATIVE CLINICAL STUDY ON THE EFFICACIES OF HIJAMATBILA SHURT AND HABBE GULE AAKH IN CERVICAL SPONDYLOSIS
English4146Mirza Ghufran BaigEnglish Mohd Aleemuddin QuamriEnglishIntroduction and Objectives: Cervical Spondylosis is a degenerative disease of intervertebral discs and adjacent vertebral bodies of the cervical region with or without neurological sign. Despite the advancement in pharmacological, non pharmacological and surgical interventions, the management remains unsatisfactory due to high cost, and unusual eventualities. Unani physicians managed such joint disorders with diverse treatment modalities viz., diet, drugs, regimens such as dalk (massage) , riyazat (excercise), hijama (cupping), etc. Hence to scientifically validate the efficacies of Hijamat Bila Shurt (regimen) and Habbe Gule Aakh (a poly herbal formulation) a comparative clinical trial was conducted. Material and Methods: The study was conducted as a comparative, open labeled, randomized clinical trial on 30 patients with 15 in each group. Both groups received treatment for 21 days, Hijamat Bila Shurt group subjected once daily and Habbe Gule Aakh 2 BD orally with three follow ups (7th, 14th and 21st). The pre and post treatment effects were assessed based on subjective and objective parameters.
Results and Conclusion: The subjective parameters like neck pain, tenderness, and difficulty in neck movement were reduced with high statistical significance (p0.05). Objective parameters Northwich Park Neck Pain Questionnaire (NPQ) revealed strong statistical significance (p0.05). Inter group analysis reveals no statistical significance (p>0.05) difference between the groups, but Hijamat Bila Shurt is found comparatively more
effective than Habbe Gule Aakh using ANOVA and student ‘t’ test (two tailed and independent). Moreover, both groups were found safe without any adverse effect.
EnglishCervical spondylosis; Hijamat Bila Shurt; Habbe Gule Aakh; Unani medicineINTRODUCTION
Cervical Spondylosis (s?rv ??-k?l + (spondyl osis) the terms are derived from Latin cervic means “neck”, and spondyl, osis means “vertebra condition” which stands for the degenerative arthritis, osteoarthritis of the cervical vertebrae and related tissues. 1 it is a collective term describing degenerative changes that occur in the apophysial joints and intervertebral disc joints (cervical vertebrae), with or without neurological sign.2 The etiology was thought to be related to aging process and or mechanical over load applied to the spine.3 As age advances degeneration sets into the spine, however, there are some exceptions where spinal injuries to the disc can augment the degenerative process in the younger patient. Compression of the vascular and neural structures can leads to the manifestation of spondylosis secondarily and it is caused by a loss in the disc height and impinging osteophytes (mechanical cause) that contribute to cervical radiculopathy and later myelopathy.4 In general population the prevalence of Cervical spondylosis with incidence rate of 83 per one lakh populations and with the prevalence of 3.3 cases per one thousand people, and it occurs mostly between the 4th and 5th decades of life.3 As per the estimates over half of the adults experience some degree of neck pain every year, and 60–80% of older adults experience neck pain due to degenerative changes.5 Cervical spondylosis is a common and disabling condition and it is felt that it should be managed through multiple approaches viz., physical or non pharmacological, pharmacological, and or surgical. Surgery should be reserved for cases of myelopathy. 5,6,7,8 All these treatment modalities have a range of effects and their availability is meagre and cost over burdened, apart from this the unexpected or unusual eventualities ranges from mild to moderate and sometimes even severely observed. Unani physicians managed joint disorders with diverse treatment modalities viz., diet, drugs, and regimens. Cervical Spondylosis is described as Waja ul Unuq a type of Waja ul Mafasil, and treated as per the line of treatment of Amraze Mafasil with regimens including diet, drugs, and surgery. More specifically certain regimens like Takmeed (Fomentation), Zimad (paste), Tila (liniment), Roghaniyat (Oils), Dalk (massage), Hijamat Bila Shurt (dry cupping), Mahjima Nariya (fire cupping), Fasd (venesection) etc are advised as treatment modes for Cervical Spondylosis, besides this pharmacologically it will be treated with single and compound drugs such as Suranjaan (Colchicum luteum) , Muqil (Cammiphora mukul), Gule Aakh (Calotropis gegentia), Zanjabeel (Zingiber officinalis), Habbe Suranjaan, Habbe Gule Aakh, Roghane Baboon, Roghane Hifte Barg, Roghane Suranjaan, Roghane Chanbeli, Roghane Sosan, and Rogane Shibit, etc.9,10, It was hypothesized that a regimen Hijamat Bila Shurt (Dry Cupping) and a pharmacopoeial poly herbal formulation Habbe Gule Aakh (Drug) will be evaluated comparatively for their efficacies, and further to validate scientifically the interventions this study was conducted. The Habbe Gule Aakh a poly herbal pharmacopoeial formulation comprises of Zanjabeel (Zingiber officinalis), Gule Aakh (Calotropis gigentia), Filfil Siyah (Pepper nigrum), and Barge Bans (Bambosa aurundinacea), and it is indicated as anti inflammatory and analgesic 11,12 Hijamat Bila Shurt (Dry Cupping) in which a suction cup will be placed over the muscular surface and suctioned so as to create a negative pressure beneath the cupped area. The objective of this regimen is for Imalae mawad (diversion of vitiated matter), 13,14,150,16 Tanqiae mawad (evacuation of matter), 13 Taskeen alam (to alleviate pain)13,15 Tehleele auram (to resolve inflammation) 13 Tehleele riyah 13,14,15 and Taskheene muqam (local calorific). 13, 14, 15
MATERIAL AND METHODS
The study was conducted between March 2013 to March 2014 as an open labeled, randomized, comparative clinical trial on 30 patients after obtaining ethical clearance vides IEC No: NIUM/IEC/2011-12/003/Moal / 03 from the institutional ethical committee for biomedical research of NIUM Hospital, Bangalore. Based on the criterion of inclusion patients of both gender, between 20-60 years of age, having cervical headache with or without radicular symptoms ( paraesthesia,) Spurling Test (ST) and Neck Distraction Test (NDT) positives, and patients having other type of arthritis of neck (except osteoarthritis), trauma of neck, wry neck, Vertebro basilar insufficiency, local wound and infection over neck, cervical rib syndrome, Psycho somatic disorder, spinal cord disorders, carpal tunnel syndrome, pregnancy and lactation, all chronic diseases, patient who do not report for follow up, unwillingness or inability to comply the requirements of the protocol were excluded. A total of 170 patients were screened clinically and subjected to laboratory investigations, out of which 55 cases fulfilled the inclusion criterion, but 33 cases participated in the study by exercising the written informed consent, then they were randomly allocated into two groups by using G pad soft. Group A: Hijamat Bila Shurt (n=17) and Group B: Habbe Gule Aakh (n=16 ) were received interventions for 21 days with three follow ups on 7th, 14th and 21st day. At last 30 cases completed the study protocol (15 in each group) and they were alone taken in account for analysis; 3 cases lost to follow up (Group A; 2, Group B; 1)
Interventions:
Group A: Hijamat Bila Shurt (dry cupping) patients were subjected to the procedure, in which 4 manual suction cups were applied bilaterally over the cervical region for 20 minutes. Group B: Habbe Gule Aakh (poly herbal formulation) 125 mg (prepared at NIUM pharmacy) given two pills (250 mg) orally twice i.e., 500 mg a day with water after meal.
The study effects are observed in three different follow ups and recorded in pre approved case report form in the form of subjective parameters (Neck pain (axial / radiating/ referred), tenderness, difficulty in neck movement and paraesthesia in upper extremities) and Objective parameters (VAS, Spurling Test (ST), Neck Distraction Test (NDT) and Northwich Park Neck Pain Questionnaire (NPQ). The pre and post treatment values of subjective, objective along with Safety parameters (Haemograme, Erythrocyte Sedimentation Rate, Alanine aminotransferase, Aspartate aminotransferase, Alkaline phosphatase, Blood Urea and Serum Creatinine) were analyzed statistically to draw the inference of the study.
OBSERVATION AND RESULTS
In this study 30 patients participated out of which 19 (63.2%) were found in the age group of 21- 40 and 11 (36.8 %) were between 41-60 years, 14 (46.7%) were males and 16 (53.3%) females, all were married 30 (100%), socio-economically 4 (13.3%) patients were from upper class followed by 17 (56.6%) middle and 9 (30 %) from lower class, 27 (90%) were having mixed dietary habit and 3(10%) pure vegetarian. The Mizaj (temperament) findings evidences 18 (60%) were Balghami (Phlegmatic) 11 (36.7%) Damavi (Sanguineous), and 1(3.3%) Safravi (Bilious). Occupationally 9 (30%) patients were house wives, 9(30%) skilled worker, 3(10%) professional, 2(6.7%) unskilled worker, 1(3.3%) businessmen 6(20%) others. The body mass index of 20 (66.67%) cases was found >25 and 10 (33.3%) were Englishhttp://ijcrr.com/abstract.php?article_id=650http://ijcrr.com/article_html.php?did=6501. Venes D, editor. Taber’s Encyclopedic Medical Dictionary. 21st ed. USA, America: F.A. Davis Company Philadelphia; 2009:413,1407,2183.
2. Coblyn JS, Bermas B, Weinblatt M, Helfgott S. Brigham and Women`s Experts Approach to Rheumatology. New York: Library of Congress Cataloging in Publication Data; 2011:66-69.
3. Reddy RS, Maiya GA, Rao SK. Proprioceptive Reposition Errors in Subjects with Cervical Spondylosis. International Journal of Health Sciences & Research. 2012; 1(2): p. 65- 73.
4. Lisa AF. The Biomechanics of Cervical Spondylosis. Advances in Orthopedics. 2012:p. 1-5.
5. Marie AR. Massage Therapy for Cervical Degenerative Disc Disease:Alleviating Pain in the Neck. International Journal of Therapeutic Massage and Bodywork. 2012 September; 5(3): p. 41-46.
6. Graham N, Gross AR, Carlesso LC, Santaguida PL, MacDermid JC, Walton D, et al. An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders. The Open Orthopaedics Journal. 2013; 7: p. 440-460.
7. Hirpara KM, Butler RJS, Dolan RT, O’Byrne JM, Poynton AR. Non Operative Modalities to Treat Symptomatic Cervical Spondylosis. Advances in Orthopedics. 2012; p. 1-5.
8. Rana SS. Diagnosis and Management of Cervical Spondylosis. Medscape Drug Disease and Procedures. 2013 Jun; p. 1-8.
9. Zohar AMAMI. Kitabut Taisir Fil Madawa wat Tadbir. CCRUM, New Delhi: Ministry of Health and Family Welfare,Govt of India; 1986:78-85.
10. Baig MG, Quamri MA, Ali SJ, Imtiyaz S, Sheeraz M, Ahmad Z. Concept and Management of Waja ul Mafasil (Arthritis) in Greeco Arabic Medicine- An Overview. International Journal of Current Research and Review. 6 (20):p 41-47.
11. Kabeeruddin M. Bayaze Kabeer part-2nd. Idarae Kitabus shifa. New Delhi :2010: 30, 37, 50, 57, 80,88, 89-93, 94, 176, 177, 179.
12. Anonymous. National Formulary of Unani Medicine. Part- 3rd. 1st ed. New Delhi: Govt. of India , Ministry of Health and Family Welfare; 2001:15.
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14. Grunner OC. The Canon of Medicine of Avicenna Incorporating a Translation of the First Book. London: Luzac & Co;1930: p.353, 508-512.
15. Sina I. Kulliyate Qanoon (Urdu translation by Mohammad Kabeeruddin). New Delhi: Ejaz publishing House; 2006:150-154,344-350.
16. Zarnigar, Arshi R. Clinical Efficacy of Al Hijama (Cupping) in Waja ul Mafasil Muzmin (Osteo arthriris). Indian Journal of Traditional Knowledge.2011; 10 (2): p 327-329.
17. Das KVK. Textbook of Medicine. 5th ed. New Delhi: Jaypee Brothers Medical Publishers (P) LTD; 2008: 1318-1319.
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19. Wheeless CR. Wheeless` Textbook of RheumatologyOrthopaedics References and Discussions for Physicians. [Online].;1996-2014 [cited 2014 March 25] http://www. wheelessonline. om/ortho/cervical_spondylosis.
20. Hoy DG, Parotani M, De R, Buchbindar R. The Epidemiology of Neck pain. Best Practice & Research Clinical Rheumatology. 2010; 24(6): p. 783-792.
21. Groenewes R, Kropman H, Assen LV, Mulder J, Tulder MW, Oostendrop RA. The Effectiveness and Cost-evaluation of Manual Therapy and Physical Therapy in Patients with Sub-acute and Chronic Non specific Neck pain. Rationale and Design of a Randomized Controlled Trial (RCT). BMC Musculoskeletal Disorder. 2010; 11(14): p. 1-9.
22. Cote P, Carroll L, Cassidy JD. The Epidemiology of Neck Pain: What We Have Learned from Our Population-Based Studies. Journal of Canadian Chiropractic Association. 2003; 47(4): p. 285-290.
23. Colledge NR, Walker BR, Ralston SH. Davidson’s Principles and of Practice of Medicine. 21st ed. Edinburgh: Churchill Livingstone; 2010.1221-1222.
24. Rana SS. Diagnosis and Management of Cervical Spondylosis. Medscape Drug Disease and Procedures. 2013 Jun; p. 1-8.
25. Baghdadi IH. Al-mukhtarat Fit Part-4th. New Delhi: CCRUM, Ministry of Health and Family Welfare.Govt of India; 2007:79.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareNISIN: PRODUCTION AND MECHANISM OF ANTIMICROBIAL ACTION
English4753Sukrita Punyauppa-pathEnglish Parichat PhumkhachornEnglish Pongsak RattanachaikunsoponEnglishNisin is a heat stable lantibiotic consisting of 34 amino acids. Of these amino acids, there are several unusual amino acids including dehydroalanine, dehydrobutyrine, aminobutyric acid, lanthionine and β-methyllanthionine. It has antimicrobial activity against many species of Gram positive bacteria, but not Gram negative bacteria due to their outer membrane barriers. However, when used in combination with other chemical or physical treatments that destabilize the outer membranes, nisin can inhibit Gram negative bacteria. Nisin has been used as a food preservative in many food industries because it is legally approved as safe for use in food and beverage. The knowledge on the production and mechanism of antimicrobial action of nisin is important for the understanding how nisin contains unusual amino acids and how it kills sensitive bacteria. The knowledge may also be a factor for the successful application of nisin. Therefore, this review focuses on presenting these two aspects of nisin.
EnglishBacteriocin, Lactococcus lactis, lanbiotic, nisinINTRODUCTION
Nisin is the antimcirobial peptide produced by Lactococcus lactis subsp. Lactis1 . It is the only bacterioicin that have been legally approved as safe for use in food and beverage. Nisin was first commercially marketed in England in 1953. In 1969, a joint commission between the Food and Agriculture Organization of the United Nation (FAO) and The World Health Organization (WHO) recognized nisin as a safe and legal biological food preservative. In the United States, the use of nisin in food has been legally approved by the American Food and Drug Administration (FDA) since 19882 . The word “nisin” (Group N Inhibitory Substance + the suffix “in”) was coined by Mattick and Hirsch3 to distinguish nisin from the bacteriocin produced by Lactococcus lactis subsp. cremoris called diplococcin. Nisin is a heat stable, cationic lantibiotic belonging to class I bacteriocin according to the classification criteria of Klaenhammer4 . It consists of 34 amino acids. Of these amino acids, there are several unusual amino acids including dehydroalanine (Dha), dehydrobutyrine (Dhb), aminobutyric acid (Aba), lanthionine (Ala-S-Ala) and β-methyllanthionine (Aba-S-Ala). Nisin has antimicrobial activity against many species of Gram positive bacteria (Table 1), but not Gram negative bacteria due to their outer membrane barrier. Normally, nisin producer has immunity to its own produced nisin but not to other lantibotics. This is for protecting itself from being killed by its own nisin. Although it is a protein, it is not digested by all of the protein digesting enzymes. It is sensitive to chymotrypsin, but not to trypsin and pronase5 . At present, several natural nisin variants have been reported including nisin A1 , nisin Z6 , nisin Q7 , nisin F8 , nisin U8 and nisin U28 . Nisin A, nisin Z, nisin Q and nisin F are produced by Lactococcous lactis while nisin U and nisin U2 produced by Streptococcus sp.8 Of the bacteriocins, only nisin A and nisin Z have been extensively studied. These variants differ in a single amino acid residue at position 27 which is histidine in nisin A and aspartic acid in nisin Z.
PRODUCTION AND MODIFICATION OF NISIN
Nisin is ribosomally produced from a structural gene as a prenisin having 57 amino acids (Fig. 1 A). It is an inactive form of nisin containing a leader peptide (having 23 amino acids) at the N terminus of the molecule. Modifications after nisin synthesis are dehydration (Fig. 1 B), cyclization (Fig. 1 C) and leader peptide digestion (Fig. 1 D). In the dehydration step, serine and threonine are dehydrated to dehydroalanine (Dha) and dehydrobutyrine (Dhb), respectively. In cyclization step, several thioether crosslinks (S) are formed between alanine and alanine and between aminobutyric acid and alanine. The thioether crosslink between alanine and alanine results in the formation of lanthionine (A-S-A) and that between aminobutyric acid (Abu) and alanine results in the formation of β-methyllanthionine (Abu-S-A). Upon export of nisin outside the cell, leader peptide is digested from the prenisin resulting in the active nisin that is containing 34 amino acids.
MECHANISM OF ANTIMICROBIAL ACTION OF NISIN
For its killing activity, nisin does not require a membrane receptor on its target cell. This is unlike killing activity of many bacteriocins such as colicin that need membrane receptors on target cells. There are two major steps for nisin to kill sensitive cells. 1. Passage through cell wall To pass through target cell wall, nisin generally interactions (via hydrophobic or electrostatic interactions) with anionic components in the cell wall of sensitive cells such as teichoic acids, teichuronic acids and lipoteichoic acids, acidic polysaccharides or phospholipids9 . 2. Interaction with lipid II Lipid II (Fig. 2) is a membrane anchored cell wall precursor that is essential for bacterial cell wall biosynthesis. It is composed of a membrane anchor of 11 polyisoprene residues to which, via a pyrophosphate, the basic building block of the cell wall (peptidoglycan monomer), Nacetylglucosamine-N-acetylmuramic acid(pentapeptide), is attached. It brings the peptidoglycan monomer from cytoplasm of the bacterial cell to incorporate into growing peptidoglycan network in the bacterial cell wall (Fig. 3).
Once nisin reaches cell membrane of the sensitive cells, it may perform one of these actions. 2.1. It binds to lipid II and prevents the peptidoglycan monomer to incorporation into the growing peptidoglycan network (Fig. 4).
2.2. It uses N-terminal binding motif to bind to the carbohydrate-pyrophosphate moiety of lipid II. This enables the C-terminal segment of nisin to insert into the cell membrane. Several nisin-lipid II complexes assemble to form a stable pore with diameter of 2 nanometers in cell membrane of target cells (Fig. 5)10. However, some reports state that the pore is formed by 4 nisin-lipid II complex and 4 nisin molecules (Fig. 6). Once the pore is formed in cell membrane, it can cause an increase in membrane permeability which can lead to the dissipation of the membrane potential, an efflux of small cytoplasmic contents such as amino acids, nucleotides and ions from the damaged cells11,12. Consequently, the damaged cells cannot produce energy as well as vital macromolecules resulting in cell death eventually11,13.
Besides the lipid II mediated mode of action, nisin can cause lysis of the cell wall of sensitive cells (Fig. 7), particularly in staphylococci.
Inhibition of Gram negative bacteria by nisin together with other treatments As mentioned earlier, nisin has antimicrobial activity against some Gram positive bacteria but not against Gram negative bacteria because of their outer membrane barriers. However, many research works show that nisin can inhibit Gram negative bacteria when it is used in combination with substances or physical treatments that destabilize their outer membranes. Table 2 shows some examples of antimicrobial activity of nisin together with other substances or treatments against a variety of Gram negative bacteria both in vitro and in foods.
CONCLUSION
Although the production and posttranslational modification of Nisin are now fully understood, its mechanism of antimicrobial action still requires further investigation. This may be because nisin has more than one mechanisms of antimicrobial action depending on several factors such as structural properties of target bacteria. Nisin, by itself, is only active against Gram positive bacteria. However, the use of Nisin together with outer membrane destabilizing treatments makes it become active against Gram negative bacteria. This finding broadens the application of Nisin as a food preservative
. ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors /publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of funding: The Faculty of Science, Ubon Ratchathani University, Thailand
Conflict of Interest: The authors declare that there is no conflict of interest regarding the publication of this article
Englishhttp://ijcrr.com/abstract.php?article_id=651http://ijcrr.com/article_html.php?did=6511. Gross E and Morell JL. The structure of nisin. J Am Chem Soc 1971; 93(18):4634-5.
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24. Coma V, Sebti I, Pardon P, Deschamps A and Pichavant FH. Antimicrobial edible packaging based on cellulosic ethers, fatty acids, and nisin incorporation to inhibit Listeria innocua and Staphylococcus aureus. J Food Prot 2001; 64(4): 470-5.
25. Calderon-Miranda ML, Barbosa-Canovas GV and Swanson BG. Inactivation of Listeria innocua in liquid whole egg by pulsed electric fields and nisin. Int J Food Microbiol 1999; 51(1): 7-17.
26. Dutreux N, Notermans S, Gongora-Nieto MM, BarbosaCanovas GV and Swanson BG. Effects of combined exposure of Micrococcus luteus to nisin and pulsed electric fields. Int J Food Microbiol 2000; 60(2-3): 147-52.
27. Mauriello G, De Luca E, La Storia A, Villani F and Ercolini D. Antimicrobial activity of a nisin-activated plastic film for food packaging. Lett Appl Microbiol 2005; 41(6): 464-9.
28. Sobrino-Lopez A and Martin Belloso O. Enhancing inactivation of Staphylococcus aureus in skim milk by combining high-intensity pulsed electric fields and nisin. J Food Prot 2006; 69(2): 345-53.
29. Goldstein BP, Wei J, Greenberg K and Novick R. Activity of nisin against Streptococcus pneumoniae, in vitro, and in a mouse infection model. J Antimicrob Chemother 1998; 42(2): 277-8.
30. Lebel G, Piche F, Frenette M, Gottschalk M and Grenier D. Antimicrobial activity of nisin against the swine pathogen Streptococcus suis and its synergistic interaction with antibiotics. Peptides 2013; 50: 19-23.
31. Yuste J and Fung DY. Inactivation of Salmonella typhimurium and Escherichia coli O157:H7 in apple juice by a combination of nisin and cinnamon. J Food Prot 2004; 67(2): 371-7.
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38. Stevens KA, Sheldon BW, Klapes NA and Klaenhammer TR. Nisin treatment for inactivation of Salmonella species and other Gram-negative bacteria. Appl Environ Microbiol 1991; 57(12): 3613-5.
39. Lee JI, Lee HJ and Lee MH. Synergistic effect of nisin and heat treatment on the growth of Escherichia coli O157:H7. J Food Prot 2002; 65(2): 408-10.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareBILATERAL ABNORMALITIES IN THE COURSE OF RENAL VEINS AND SUPERNUMERARY LEFT RENAL ARTERY: A CASE REPORT
English5456Preksha SharmaEnglish Sangita ChauhanEnglish Seema GuptaEnglish Shreya SharmaEnglishIntroduction: A precise knowledge of variations in origin and course of both renal and gonadal vessels is of utmost importance
during diagnostic and operative abdominal surgical procedures.
Methods: A variation was found in the gonadal vein and renal artery during routine dissection of a formaline fixed adult male
cadaver in the department of Anatomy, SMS Medical college, Jaipur, Rajasthan.
Results: Following variations were found during the routine dissection –
• Double gonadal veins were found on both the sides.
• Three renal arteries were found on the left side arising from the abdominal aorta. Anomaly in other system was not obvious.
Conclusions: In the present case supernumerary renal arteries were found on the left side which took origin from the lateral aspect of abdominal aorta and double gonadal vessels were found on both the sides. The pair of gonadal veins on the left side drained into lateral aspect of inferior vena cava whereas on the right side the pair of gonadal veins drained into Inferior Vena Cava, one on the anterior aspect and the other on its posterior aspect.Very less incidences of anomalous renal arteries and gonadal vessels have been reported so far. Anomalous renal artery has clinical implication in nephrotomy procedure and renal transplants whereas variation in gonadal vessels has shown its importance in the treatment of syndrome of pelviureteral junction.
EnglishVariations, Left renal artery, Gonadal veins.INTRODUCTION
During the routine dissection of an adult male cadaver for medical undergraduates, variations in the origin of the left renal artery and course of bilateral gonadal veins were observed in the department of Anatomy, SMS Medical College, Jaipur , Rajasthan .
METHOD
A variation was found in the gonadal veins bilaterally and renal artery on the left side during routine dissection of a formaline fixed adult male cadaver in the department of Anatomy, SMS Medical college, Jaipur, Rajasthan.During dissection other organs were also preserved and specimens were made for the purpose of teaching.
RESULT
The left kidney received three renal arteries , all of them took origin from the lateral aspect of the abdominal aorta. Two gonadal veins were seen on both the sides. On the right side one gonadal vein was draining on the anterior aspect of inferior vena cava and the other one on its posterior aspect. Similarly both the left gonadal veins were seen draining on the lateral aspect of inferior vena cava, as illustrated in figure-1and figure-2
DISCUSSION
Precise knowledge about variations in renal and gonadal vasculature is mandatory to rule out various anomalies. [1] Soni S et al 2010 reported case of right sided triple renal arteries with double renal arteries on the left side. He also reported variation in testicular arteries and origin of phrenic arteries.[1] Patel S et al 2012 showed a case of unilateral left double renal artery in 54-year-old male cadaver in which first renal artery (RA) arose from aorta at the level of L1 vertebra, whereas 2nd renal artery arose from same 5 cm below to the first one and both RA ran laterally and entered the kidney through the hilum with their anterior and posterior divisions.[2] Similarly a case of additional renal vein was reported by Sharmistha Biswas et al 2006 reported presence of an additional renal vein on the right side draining directly into IVC which was observed during a routine dissection in a middle-aged male cadaver. [3] We found left sided variation in the renal artery but in contradiction to our study, in a study done in thirtyseven formalin-fixed cadavers, the kidneys along with their arteries were explored and the morphological variations of renal arteries were noted during routine abdominal dissection conducted for medical undergraduates. In this study, supernumerary renal arteries were present in 23/37 (62.2%) cases (48.6% of aortic origin and 13.5% of renal origin) on the right side and 21/37 (56.8%) cases (45.9% of aortic origin and 10.8% of renal origin) on the left side.[4].Embryological explanation of such variations has been discussed by Felix.The developing mesonephros, metanephros, gonads and suprarenal glands are supplied by 9 pairs of lateral mesonephric arteries arising from the dorsal aorta and this was seen in an 18mm fetus. These arteries were divided by Felix into three groups- 1st and 2nd arteries were in the cranial group, 3rd to 5th in the middle, and 6th to 9th in the caudal group. Renal arteries were arising from the middle group.[5] Therefore, persistence of more than one artery of the middle group results in multiple renal arteries as seen in our cadaver.
CONCLUSION
Knowledge of variations in renal as well as gonadal artery is mandatory in various renal surgeries, renal transplantations and different radiodiagnostic procedures to prevent serious consequences. Inspite of huge importance there is scarcity of literature in this field.our sudy has tried to fill this gap.
ACKNOWLEDGEMENTS
The authors would like to thank Dr. Sangita Chauhan for her valuable support throughout the study. 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, books from where the literature for this article has been reviewed and discussed.
CONFLICTS OF INTEREST: The authors declare that they have no competing interests.
FUNDING: Not Applicable
Englishhttp://ijcrr.com/abstract.php?article_id=652http://ijcrr.com/article_html.php?did=6521. Sony S, Wadhwa A. Multiple variations in the paired arteries of abdominal aorta- Clinical implications. Journal of Clinical and Diagnostic Research. 2010 June ;(4):2622- 2625.
2. PatelS,Wanjari A, Naik A. A case report: double renal arteries. International Journal of Anatomical Variations (2012) 5: 22–24.
3. Sharmistha Biswas, J.C.Chattopadhyay, H. Panicker.Variations In Renal And Testicular Veins –A Case Report. J.Anat. Soc 2006. India 55 (2) 69-71 2006.
4. Virendra Budhiraja, Rakhi Rastogi, Vaibhav Anjankar. “Supernumerary Renal Arteries and Their Embryological and Clinical Correlation: A Cadaveric Study from North India,” ISRN Anatomy 2013. Volume 2013, Article ID 405712, 4 pages.
5. W.Felix. “Mesonephric arteries (aa. Mesonephrica)”, in Manual of Human Embryology, F. Keibel and F.P. Mall, Eds, vol.22, pp.8820-825, Lippincott, Philadelphia, Pa, USA,1912.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareCRYSTALLOGRAPHIC ANALYSIS OF URINARY CALCULI
English5760Rajesh NarayanEnglishAim: Urolithiasis is a global phenomenon. New frontiers have developed not only on therapeutic lines but also in understanding
process of calculogenesis.
Methodology: Urinary calculi have been analyzed and studied by different techniques with diverse merits and demerits. Urinary
stones are multicomponent system containing mainly crystalline and partially non-crystalline components. Crystallographic
analysis by X-ray diffraction & Polarized Transmission Microscopy yield more information than other techniques.
Result: X-ray diffraction patterns obtained was unique to the particular crystalline constituents with unique diffraction angles,
corresponding “d” value (lattice spacing) and relative line intensities. X-ray diffraction showed a significant difference in detection
of pure stone 36.67% compared to 43.2% on chemical spot test. Polarized transmission microscopy revealed the crystal matrix
inter relationship and architectural design accounted for concentrically laminated 30% followed by plexiform-cum laminated in 13.33% tombstone coffin -lid, compact and crystalline aggregated observed in 10% each.
Conclusion: Crystallographic method of urinary analysis by X-ray Diffraction and Polarized Transmission Microscopy can identity
quickly and certainly different Urates, Oxalates and Phosphates with a certainty that cannot be equaled or attempted by any
other technique. They are considered a reference technique for identification and differentiation of crystals. Identification of the
constituents have bearing in prevention and recurrent of future stone formation.
EnglishCrystallography, Urinary calculi, X-Ray Diffraction Optical Microscopy, Chemical Spot Test.INTRODUCTION
Urinary calculi have been analyzed and studied by different techniques with diverse merits and demerits[1] [2]. The urinary stones are multi component systems containing crystalline and non-crystalline materials, crystallographic methods of analysis yield more information than other techniques. Crystallographic analysis yield more information than other techniques. Crystallographic analysis done by X-ray diffraction and optical microscopy provide specific X-Ray Diffraction patterns and optical properties of calculi that cannot be equaled or attempted by any other technique [3].
RESEARCH METHODOLGY
This study was carried out in the Department of Urology, I.M.S B.H.U in collaboration with Departments of Geology and Metallurgical Engineering, IIT B.H.U. 30 randomly selected urinary calculi were picked from Urology ‘Rockery’
(A) FOR X-RAY DIFFRACTION
The stone was crushed in a mortar and pestle to form a fine powdered specimen in order to produce smooth diffraction lines. The powder was produce smooth diffraction lines to cover an area approximately 5-12m.m. The specimen was placed over the holder in the Rigaku Xray Diffractometer and X-ray diffracted were recorded by linking a strip chart recorder to the Diffractometer . The diffraction pattern unique to the particular crystalline constituent present with diffraction angles and ‘d’ value (or lattice spacing) relative intensities matched with standard values. First 3 most intense lines with d-values were matched with reference of standards of Sutor [4].
(B) FOR POLARIZING MICROSCOPY
The urinary calculus was cut into two halves through the center using cut a fine hack-saw. The cut surface was polished on a glass plate using carborundum powder. The polished surface of the stone was mounted on a glass slide with the help of cooked Canada balsam as a cementing material. The other side of the stone was then grounded over the rotating disc using carborundum powder till the thickness of the stone became quite thin(0.03m.m) This thickness of section show great degree of transparency and interference of colors. The final preparation of the slide was done by washing excess of carborundum powder and Canada balsam removed with cotton soaked in methylated spirit or Xylol. The cover slip finally applied over the section with help of warm Canada Balsam. Care taken not to introduce air bubble. The slide prepared was ready for petrological assessment using Fuji Film 125 and analyzed for the architectural pattern of a given stone from nucleus, midzone and periphery of a given stone.
OBSERVATION
A retrospective stone analysis of 30 uroliths clinically showed preponderance in third and fourth decades of life. Male: Female ratio 2:1. Majority stones were oval grey colored, uneven with hardness of 2-3 (Moh’s scale). Chemical analysis revealed 53.33% stones were mixed as against 46.67% pure. Oxalate was the commonest stone in pure variety and oxalate-phosphate uric acid 20% in mixed stones. The X-ray diffraction patterns of the powdered specimen recorded on film as spectrum of peaks of varying intensity unique for the particular crystalline constituent present in the sample as the finger print of that substance. Simple measurement permit the calculation of the characteristic distance between lattice plane of atom compared with published reference standards of Sutor[4]. The commonest pure variety of stones we Whewellite 26.67%.Of 63.33% mixed stones, 13 possible combinations were encountered. Majority of the mixed urinary calculi were Phosphate 36.69% whereas oxalate was 26.64% .While pure uric acid calculous was non-entity in the present series. It was a solitary minor constituent in 6.67% more commonly with the oxalate type, more common was the acid urate admixed with oxalate 20%. Both uric acid and ammonium acid urate was uncommon associate (6.67%). Pure oxalates show a specific architectural anatomy of concentrically lamination 30% Phosphates do not typify for a fixed design due to diverse admixture constituents. Presence of micro channels, subsidiary channels and whorls formation showed presence of intercommunicating channels, festoon cross bending and contemporaneous deformation. Petrographic architectural pattern were assessed by hand lens magnification and Polarized Transmission Microscopy to revel architectural anatomy of the calculi. On hand lens magnification (x2) showed Rath and Nath design, a majority of urinary calculi were Type A 60% which contained ill defined central nucleus surrounded by a few laminations at periphery. 33.33% calculi were Type B with distinct central nucleus with concentric light and dark colored laminations. Pure oxalates show a specific architectural anatomy of concentrically lamination 30% Phosphates do not typify for a fixed design due to diverse admixture constituents. Presence of micro channels, subsidiary channels and whorls formation showed presence of intercommunicating channels, festoon cross bending and contemporaneous deformation. Phosphates do not typify for a fixed design due to diverse admixture constituents. Presence of micro channels, subsidiary channels and whorls formation showed presence of intercommunicating channels, festoon cross bending and contemporaneous deformation.
DISCUSSION
Chemical “ spot test ” showed 2% error in detecting calculi components[5].In pure stones 6.67 phosphates were detected on X-Ray Diffraction and 13.2% on spot test whereas in mixed stones 63.34% were oxalates and phosphates on X-Ray Diffraction and 53.33% by spot test. X-Ray Diffraction distinguished different urates oxalates and phosphates with certainty that cannot be equal led or attempted by any other techniques and case considered as the reference technique for identification and differentiation of crystals. X-Ray Diffraction analysis in my series is in confirmation with the survey of Sutor, Wooley, Illingworth and Rodgers 1974[6]. Under Zeiss polarizing microscope irrespective of the chemical nature of stone, formation of stone is an active process with centrifugal growth. Stones show presence of micro channel both central and dispersed micro units joined by subsidiary channels. Whorls formation looks like festoon cross bending on contemporaneous deformation. The presence of intercommunicating micro channels lamellar arrangement of the deposit, festoon cross bending and contemporaneous deform action indicate feeding micro channels Oxalates had concentric laminated pattern with striation whereas phosphates had diverse architectural patterns. Whewellite:Weddellite ratio in the current series was 4:1 similar to other workers and Rodgers 1974[6]. Under Zeiss polarizing microscope irrespective of the chemical nature of stone, formation of stone is an active process with centrifugal growth. Stones show presence of micro channel both central and dispersed micro units joined by subsidiary channels. Whorl formation looks like festoon cross bending on contemporaneous deformation. The presence of intercommunicating micro channels, la- mellar arrangement of the deposit, festoon cross bending and contemporaneous deformations indicate feeding micro channels Oxalates had concentric laminated pattern with striation whereas phosphates had diverse architectural patterns.
SUMMARY AND CONCLUSION
Crystallographic analysis done by X-ray diffraction and optical microscopy provide specific X-Ray Diffraction patterns and optical properties of calculi that cannot be equaled or attempted by any other technique. X-Ray Diffraction analysis showed a significant difference in detection of pure stone 36.67% in X-Ray Diffraction as compared to 43.2% on Chemical spot test. X ray diffraction is considered as a reference technique for identification and differentiation of crystals (Khan et al 1981) Polarized transmission microscopy revealed the crystal matrix interrelationship the predominant architectural design accounted was concentrically laminated (30%) followed by plexiform-cum-laminated in 13.33%.
Of 63.33% mixed stones, 13 possible combinations were encountered. Majority of the mixed urinary calculi were Phosphate 36.69% whereas oxalate were 26.64% .
ACKNOWLEDGEMENT
The author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature of this article has been reviewed and discussed. The author is thankful to Prof. Dr. G.M.K. Sharma Dept. of Metallurgy IIT, BHU and Prof. M.S. Srinivasan Dept. of Geology BHU for their supervision and guidance. The author is thankful to Prof. Dr. V.N.P. Tripathi Ex. Director Institute of Medical Sciences BHU for the completion of his multi disciplinary work.
Englishhttp://ijcrr.com/abstract.php?article_id=653http://ijcrr.com/article_html.php?did=6531. Finlayson,B:Symposium on renal lithiasis. Renal lithiasis in review. Uro Clinic North Am.,1:181,1974
2. Carr , R.J: A new theory on the formation of renal calculi. Br.J. Uro, 26:105-117,1954
3. Beeler, M.F;Veith, DA:Analysis of urinary Calculus – Comparison of methods. Am.J.Clin.Patho 1964.
4. Sutor, D.J and WooleyS.E:Composition of urinary calculi by X-Ray Diffraction Br.J. Urology 46,229,1974.
5. AggrawalS.L : Chemical Composition of urinary calculi. Ind.Med.Asso.57,171,1971
6. Rodgers AL et al : A multiple technique approach to the analysis of urinary calculi. Urol. Res. 10:177-184, 1982.
7. Bailey, C.B., : A scanning electron microscope study of siliceous urinary calculi from cattle. Investigative Urology, 10(2) : 178-185, 1972
8. Beeler, M.F., Veith, D.A., Monis, R.H. and Biskind, G.R. : Analysis of Urinary Calculus – comparison of methods. Am. J.Clin. Patho., 41(5) : 553-560, 1964
9. Brien. G, Schubert, G and Bick, C. : 10,000 analysis of urinary calculai using X-ray diffraction and polarizing microscopy. Eur. Urol.., 8:251-258, 1982
10. Hazarika, E.Z., Balakrishna and Rao, B.N. : upper urinary tract calculi analyzed by X-ray diffraction and chemical methods. Indian J.Med. Res., 62:443, 1974
11. Kabra, S.G., Patni, M.K., Sharma, G.C., Banerji, P. and Gaur, S.V. : Urolithiasis : Histochemical study of microscopic section of urinary calculi prepared by petrographic method. Indian J. Surg., 34:309, 1972
12. Kirby, J.K., Pelphrey, C.F. and Roi-Ney, Jr : The analysis of urinary calculi. Am J.Clin. Path, 27:360-362, 1957
13. Malek, R.S. , and Boyce, W.H. : observation on the ultrastructure and genesis of urinary calculi. J. Urol. , 117:336, 1977
14. Winer J.H and Mattice, M.R. : Routine analysis of urinary calculi, rapid, simple method using spot test – J. Lab & Clin Med , 28:898-904, 1943 Quoted by Beeler et at 1964
15. Spector, M.Garden, N.M and Rous, S.N. : ultrastructure and pathogenesis of human urinary calculi. Br. J. Urol.., 50:12- 15, 1978
16. Prien, E.L., Prien, E.L. Jr. : Composition and structure of urinary stone. Am J. Med 45:655, 1988
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareCORRELATION BETWEEN BIOFILM FORMATION AND HIGHLY DRUG RESISTANT UROPATHOGENS (HDRU)
English6165V. S. DeotaleEnglish Ruchita AttalEnglish S. JoshiEnglish N. BankarEnglishBackground: The biofilms have a major medical significance as they decrease the susceptibility to the antimicrobial agents.
Furthermore, the proximity of cells within a biofilm can facilitate a plasmid exchange and hence enhance the spread of antimicrobial
resistance.
Objectives: The present study intends to detect biofilm formation and High Drug Resistance amongst the uropathogens and
to correlate between biofilm formation and HDRU.
Methods: This cross-sectional study was carried out over a period of two months, including 37 catheterized urinary isolate with
symptoms of UTI. Following their identification, these isolates were checked for biofilm formation by three different phenotypic
methods which includes tube adherence, Congo red agar method & tissue culture plate method. Antibiotic Susceptibility Test
was done by Kirby – Bauer Disk Diffusion method as per CLSI guidelines.
Results: Out of total 37 uropathogens isolated from catheterized urine samples, 30 (81.1%) were positive in vitro for biofilm
production & 22 (59.5%) isolates were HDRU. Maximum biofilm production was shown by E.coli (50%) , followed by Klebsiella
pneumoniae (33.3%).
EnglishTissue Culture Plate Method (TCP), Catheter Associated Urinary Tract Infections (CAUTI), Congo red agar methodINTRODUCTION
Biofilms are a population of multilayered cells growing on a surface . These cells have a layer of adhesins in their cell walls that allow them to colonize many types of substrate, and, on contact with a surface, the cells secrete exopolysaccharides that secure their attachment. The bacteria multiply to form microcolonies of cells that subsequently spread over the surface, forming populations embedded in a gel-like polysaccharide matrix. It was found that the major pathogenic factor is the ability to form biofilm on polymeric surfaces to which it adheres and colonizes artificial materials 1 . The biofilms play major role in decreasing the susceptibility to the antimicrobial agents; as the proximity of cells within a biofilm can facilitate a plasmid exchange and hence enhance the spread of antimicrobial resistance.2 Microorganisms that are apparently fully sensitive to antibiotics and antiseptics in conventional laboratory testing methods become fully resistant in the biofilm mode in vivo3 . Microbial biofilms are considered as the major problem in catheterized patients because they cause chronic infections which are difficult to treat, lead to longer hospitalization time, and can result in much higher treatment costs 4 . Urinary tract infections in catheterized patients can occur in several ways. Organisms that colonize the periurethral skin can migrate into the bladder through the mucoid film that forms between the epithelial surface of the urethra and the catheter. In addition, contamination of the urine in the drainage bag can allow organisms to access the bladder through the drainage tube and the catheter lumen.5,6 Importance of correlation between biofilm production and Highly Drug Resistant Uropathogens ( HDRU) makes the therapeutic options very limited, have large impact on the empirical therapy to newer and more potent antimicrobials. Urinary Gram Negative Rods (GNRs) that are resistant to third generation Cephalosporins , Ciprofloxacin and Gentamicin/ Amikacin are defined as highly drug resistant uropathogens (HDRU) 7 . Keeping this in view the present study was conducted with following objectives;
OBJECTIVES
1. To detect biofilm formation by the tube adherence method(TA)8,9, Congo Red agar method (CRA)10,11 and Tissue culture plate method( TCP)12.
2. To correlate biofilm formation with development of high drug resistance amongst the uropathogens (HDRU).
MATERIAL & METHODS
The study was conducted in a period of 2 months duration in the department of Microbiology, a tertiary care rural hospital in Central India. A total of 37 bacterial isolates obtained from catheterized urine samples of catheter associated urinary tract infection (CAUTI) were included in the study. Urine samples were collected from indoor patients with a urinary catheter for at least 2 days suffering from symptoms of UTI like fever> 380 C, urgency, frequency, dysuria or suprapubic tenderness. Samples were collected under all aseptic precaution with sterile syringe from the distal end of urinary catheter into a sterile container and transported immediately to the laboratory. The urine samples were inoculated with the help of sterile inoculating calibrated standard loop of 4mm inside diameter onto Blood Agar, MacConkey’s agar and the Cystine Lactose Electrolyte Deficient (CLED) medium to determine the Colony Forming Units (CFU).. All Isolates were identified by standard microbiological procedures13. Reference strain of positive biofilm producer Staphylococcus epidermidis ATCC 35984, Staphylococcus aureus ATCC 25923 (non-slime producer) were used as a control.
Biofilm detection:
The detection of the biofilms was done by the tube adherence method(TA)8,9,Congo Red agar method (CRA)10,11 and Tissue culture plate method( TCP)12. Urine samples were collected from indoor patients with urinary catheters since 48 hours and symptoms of UTI.
TA8,9:
The investigation of the biofilm production was done on the basis of the adherence of the biofilms to borosilicate test tubes, as was done by Christensen et al. (1982)8 Suspensions of the tested strains were incubated in glass tubes which contained Brain Heart Infusion Broth (broth) aerobically at a temperature of 35°C for a period of 2 days. Then, the supernatants were discarded and the glass tubes were stained with a 0.1% Safranin solution, washed with distilled water 3 times and dried. A positive result was interpreted as the presence of a layer of a stained material which adhered to the inner wall of the tubes. The exclusive observation of a stained ring at the liquid-air interface was considered as negative9 [Fig-1].
CRA10,11:
The suspensions of the tested strains were inoculated into tubes which contained a specially prepared solid medium- Brain Heart Infusion broth (BHI) which was supplemented with 5% sucrose and Congo Red. The medium was composed of BHI (37 gms/L), sucrose (50 gms/L), agar no.1 (10 gms/L) and the Congo Red stain (0.8 gms/L). The plates were inoculated and incubated aerobically for 24-48 hours at 37°C. A positive result was indicated by black colonies with a dry crystalline consistency [Fig-2]. A darkening of the colonies, with the absence of a dry crystalline colonial morphology, indicated an indeterminate result11. The experiment was performed in triplicate and it was repeated 3 times.
TCP 12,14:
All isolates were screened for their ability to form biofilm by the TCP method as described by Christensen et al. 12 with a modification in duration of incubation which was extended to 24 hours, according to O’Toole and Kolter 14. Isolates from fresh agar plates were inoculated in trypticase soy broth with 1% glucose and incubated for 24 hours at 37o C in stationary condition and diluted (1 in 100) with fresh medium. Individual wells of sterile, polystyrene, flat-bottom tissue culture plates were filled with 0.2 ml aliquots of the diluted cultures, and only broth served as control to check for the sterility and non-specific binding of media. The tissue culture plates were incubated for 24 hours at 37°C. After incubation, the content of each well was gently removed by tapping the plates. The wells were washed four times with 0.2 ml of phosphate buffer saline (PBS pH 7.2) to remove freefloating planktonic bacteria; then 25 µl of 1% solution of crystal violet was added to each well (this dye stains the cells but not the polystyrene) plates. The plates were incubated at room temperature for 15 minutes, rinsed thoroughly and repeatedly with water. Adherent cells were uniformly stained with crystal violet which was solubilized in 200 µl of 95 % ethanol ; of which 125 µl were transferred to a new polystyrene microtiter dish, which was then read15. Optical densities (OD) of stained adherent bacteria were determined with a micro ELISA auto reader (model 680, Bio rad), and the wavelength of values was considered as an index of bacteria adhering to surface and forming biofilms. Experi-ments for each strain were performed in triplicate and repeated three times. The OD of each well was measured at 578 nm using ELISA reader. Biofilm production is considered high, moderate, or weak (OD570 nm)15.
RESULTS
Amongst the 37 bacterial isolates from the CAUTI, E.coli were found to be 51.4% followed by Klebsiella pneumoniae 29.7% , A. baumanii 8.1% ,CONS 5.4% , Pseudomonas aeruginosa and E. faecalis 2.7% each (Table 1). In the present study, 30 (81%) isolates were in vitro positive for the biofilm production and 7 (19%) were negative for biofilm production. Maximum biofilm production was shown by E.coli (50%) , followed by Klebsiella pneumoniae (33.3%) (Table 2). The results for biofilm production with CRA was 70.3% followed by TA 59.5% and by TCP 81%. There was complete agreement for biofilm production in 54% isolates by all the three methods. In this study, out of 37 isolates, 26 (70.3%) were slime producers developing almost black or very black colonies on CRA plate as presented in Figure 1 and the remaining 11 were non-producers developing red colonies. 22 strains (59.5%) revealed in vitro biofilm formation by TA method. (Table3) In our study, biofilm formation and HDRU were mostly isolated from medicine Intensive Care Unit & Paediatrics Intensive care unit (MICU and PICU). (Table 4). We have observed higher drug resistance uropathogens in highest number (32%) in patients who were catheterized for acute retention of urine associated with Benign Prostatic hypertrophy(BPH) followed by post-operative catheterization(28%). Most of the biofilm formation was observed in those who were catheterized post-operatively (40%) in cases of DUB, Ca Cervix, Prolapse uterus, fibroid uterus, post-partam eclampsia.
Statistical Analysis of TCP, TM and CRA methods:
Considering TCP method as a gold standard for this study sensitivity data was compared with the data from tube method and CRA method. Parameters like sensitivity, specificity, negative predictive value and positive predictive value were calculated. Sensitivity & specificity of TM was found to be 70% and 85.7% respectively while that of CRA was 80% and 71.4%.
DISCUSSION
Bacteria have a basic survival strategy to colonize surface and grows as biofilm communities embedded in gel like polysaccharide matrix. The catheterized urinary tract provides ideal conditions for the development of enormous biofilm population and induces problems in patient’s management. Clinical prevention strategies are needed, as bacteria growing in the biofilm mode are resistant to antibiotics.CAUTI is the most common nosocomial infection in hospitals and comprising >40% of all institutionally acquired infections9 . The correlation between biofilm formation & CAUTI is that a foreign body, such as an indwelling urethral catheter, connects a normally sterile hydrated body site to the outside world which inevitably become colonized with microorganisms. In our study, out of 37 isolates, E.coli was found to be the most frequently isolated uropathogen 51.4% , followed by Klebsiella pneumoniae 29.7%, Acinetobacter baumanii 8.1%, Coagulase Negative Staphylococcus 5.4% and Enterococcus fecalis and Pseudomonas aeruginosa 2.7% each. Pramodini et al9 in her study found E.coli (70%) remains the predominant uropathogen isolated from CAUTI. Hassin et al16 also reported predominant uropathogen from catheterized urine as E.coli (74%) followed by Klebsiella spp. (17.7%) and Pseudomonas spp. (2.5%). The current study reveals 81.1% of strains were in vitro positive for biofilm production. Reid et al17 reported 73% biofilm production by uropathogens from UTI. Significant production of biofilm was seen in E.coli (50%) followed by, Klebsiella pneumoniae (33.3%) which is similar to Pramodini et al9 (63%) and Sharma et al18 (70.3%). Amongst 30 biofilm producing isolates, 20 (66.7%) isolates were biofilm producer by all the three methods and 21 (70%) isolates were biofilm producers by TA, 24(80%) by CRA and 30(100%) by TCP. Antimicrobial resistance is an innate feature of bacterial biofilms that may further complicate patient treatment. We also studied the antibiotic susceptibility pattern of all uropathogens and correlated that with biofilm production. In this study, 22 (59.5%) isolates were HDRU while 15(40.5%) were non-HDRU. Similar to biofilm production, maximum HDRU were E.coli 11(50%) followed by Klebsiella pneumonia 8( 36.7%). Out of 30 biofilm producing isolates 20(66.6%) were Highly Drug Resistance Uropathogens. Amongst 22 HDRU, 20 (90%) were biofilm producers. Sanchez et al19 also observed that strains capable of forming biofilms were more frequently observed to be an MDR phenotype. Significant bacteriuria was present in all symptomatic catheterized patients and E.coli was the most common uropathogen.
CONCLUSION
It has been shown that there is significant association between biofilm production and Highly Drug Resistant Uropathogens. Tissue culture plate method is the gold standard for detection of biofilm formation. Proper management of patients and implementation of standard guidelines for care of catheters to prevent the device associated nosocomial infections. The future goal is to identify molecular targets of biofilm bacteria as well as the urinary components that are involved in biofilm formation. An ideal surface device to resist protein has to be developed. Bacterial adhesion and the interaction between the biomaterial surface and urine also need to be defined.
ACKNOWLEDGEMENT
We kindly acknowledge the immense help received from scholars whose articles are cited and included in reference of this manuscript. We 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=654http://ijcrr.com/article_html.php?did=6541. Kloos WE, and Bannerman TL (1994) Update on clinical significance of coagulase–negative Staphylococci. Clin Microbiol Rev 7: 117–40.
2. Watnick P, Kotler R. Biofilm,city of microbes. J.Bacteriol 2000; 182: 2675–2679.
3. David J Stickler. Bacterial biofilms in patients with indwelling urinary catheters. Nature clinical practice urology November 2008 vol 5 no 11.
4. Desgrandchamps F, Moulinier F, Doudon M, Teillac P, Le Duc A. (1997) An in-vitro comparison of urease induced encrustation of JJ stents in human urine. Br J Urol 79: 24
5. Stamm WE (1991) Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 91 (Suppl 3B): 65S–71S
6. Tambyah PA et al. (1999) A prospective study of pathogenesis of catheter-associated urinary tract infections. Mayo Clin Proc 74:131–136
7. Basak, S Bose, S Mallick, R Attal Highly Drug Resistant Uropathogens (HDRU) and their Antibiotic Susceptibility Profile – A case study. Ind Med Gaze, 2009 May;. (5):182- 5.
8. Christensen GD, Simpson WA, Bismo AL, Beachery EH. The adherence of the slime-producing strains of Staphylococcus epidermidis to smooth surfaces. Infect immune 1982; 37: 318-26.
9. Pramodini S et al. Antiobiotic resistance pattern of biofilmforming uropathogens isolated from catheterized patients in Pondicherry, India. AMJ 2012, 5, 7, 344–348. http// dx.doi.org/10.4066/AMJ.2012.1193
10. Freeman DJ, Falkiner FR, Keane CT. A new method for the detection of the slime production by the coagulase negative Staphylococci. J Clin Pathol 1989; 42: 872-74
11. Niveditha S et al. The isolation and Biofilm Formation of Uropathogens in the patients with Catheter Associated Urinary Tract Infections (UTIs). Journal of Clinical and Diagnostic Research. 2012 November, Vol-6(9): 1478-1482
12. Christensen GD, Simpson WA, Younger JA, Baddour LM, Barrett FF, Melton DM, Beachey EH (1985) Adherence of coagulase negative Staphylococci to plastic tissue cultures: a quantitative model for the adherence of staphylococci to medical devices. J Clin Microbiol 22: 996-1006.
13. Collee J G., Miles RS, Watt B. Test for identification of bacteria, in Chapter: 7 Mackie & McCartney’s Practical Medical Microbiology14th ed. In: JG Collee, AG Fraser, BP Marmion, A Simmons, Editors. Churchill Livingstone: Indian Reprint; 2008. p. 131-49.
14. O’Toole AG and Kolter R (1998) Initiation of biofilm formation in Pseudomonas fluorescence WCS365 proceeds via multiple, convergent signaling pathways: a genetic analysis. Molecular microbiology 28: 449.
15. Gad et al. Detection of icaA, icaD genes and biofilm production by Staphylococcus aureus and Staphylococcus epidermidis isolated from urinary tract catheterized patients. J Infect Dev Ctries 2009; 3(5):342-351.
16. Hassin SKR. Studies on Urinary Tract Infections. Bangladesh Medical Journal 1991; 20: 29–32.
17. Reid G, Charbonneau–Smith R, Lam D, Kang YS, Lacerte M, Hayes KC. Bacterial biofilm formation in the urinary bladder of spinalcord injured patients. Paraplegia. 1992; 30:711–717.
18. Sharma M, Aparna, Yadav S, Chaudhary U. Biofilm production in uropathogenic Escherichia coli. Indian J Pathol Microbiol 2009; 52: 294.
19. Sanchez et al. Biofilm formation by clinical isolates and the implications in chronic infections. BMC Infectious Diseases 2013, 13:47.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareBILATERAL OCCURENCE OF THIRD HEAD OF BICEPS BRACHII ASSOCIATED WITH UNILATERAL VARIATION IN THE COURSE OF MUSCULOCUTANEOUS NERVE - A CASE REPORT
English6668Shastrakar Rupali SureshraoEnglish Sawant V. G.EnglishIt is very common to see variations in the course of nerves and muscles of the arm. We observed one bilateral concurrent variation in the course of musculocutaneous nerve and origin of biceps brachii muscle. Musculocutaneous nerve, after piercing the coracobrachialis muscle gives one communicating branch to the median nerve and then supply the third head of biceps brachii and brachialis muscle in the right upper limb. After that it continues as the lateral cutaneous nerve of forearm.In the left upper limb musculocutaneous nerve is not piercing the coracobrachialis muscle but otherwise following the normal course.
EnglishNerve, Musculocutaneous, Median, Biceps brachii, Third head of biceps brachiiINTRODUCTION
Brachial plexus is formed by the anterior primary rami of spinal nerves C5, C6, C7, C8 and T1. The plexus is said to be prefixed when the branches of fourth cervical fibers join the plexus and postfixed when joined by branches from second thoracic nerves. C5 and C6 roots join to form upper trunk. C7 root forms the middle trunk. C8 and T1 roots join to form lower trunk. Each trunk divides into ventral and dorsal divisions. Ventral division of the lower trunk forms medial cord. Dorsal divisions of all the three trunks join to forms posterior cord. Ventral divisions of upper and middle trunk joint to forms lateral cord. Musculocutaneous nerve (MCN) is the branch from the lateral cord of the brachial plexus. The nerve initially accompanies the axillary artery, pierces the coracobrachialis muscle, and then passes downwards between the biceps brachii and brachialis. It supplies coracobrachialis, biceps brachii and medial part of brachialis muscles. Below the elbow joint the nerve is continuous as the lateral cutaneous nerve of the forearm. It should be noted that the brachial plexus is the most variable part of the peripheral nervous system [1]. The prevalence of variations ranges from 12.8 up to 53% [1, 2].Variations of the musculocutaneous nerve may occur in 6.25% of cases [3]
CASE REPORT
During routine dissection for medical undergraduates ,in a middle aged Indian cadaver we observed a variation in the course of musculocutaneous nerve associated with third head of biceps brachii muscle . In the right upper limb , musculocutaneous nerve after piercing the coracobrachialis muscle gives one communicating branch to the median nerve to supply the third head of biceps brachii and brachialis muscle . In the left upper limb ,third head of biceps brachii associated with normal course of musculocutaneous nerve except that it is not piercing the corachobrachialis . After that it continues as lateral cutaneous nerve of forearm in the right and the left upper limb.
DISCUSSION
Variations in the course and termination of musculocutaneous nerve are common . As reported by Venieratos D. and Anagnostopoulou S. [4],there are three types of communications between musculocutaneous and median nerve with reference to coracobrachialis muscle. In one type ,communication was proximal to entry of musculocutaneous nerve into coracobrachialis. In second type communication was distal to entry of musculocutaneous nerve into coracobrachialis. In third type nerve and communicating branch did not pierce the coracobrachialis muscle. According to Loukas M. and Aqueelah H. four different patterns of communication exist between musculocutaneous and median nerve.Type I (54 communications , 45%).The communications were proximal to the point of entry of musculocutaneous nerve into coracobrachialis. Type II (42, communications, 35%) the communications were distal to the point of entry of the MCN into the coracobrachialis; type III (11 communications, 9%): the MCN did not pierce the coracobrachialis; and Type IV (9 communications, 8%) : the communications were proximal to the point of entry of the MCN into the coracobrachialis and additional communication took place distally. [5] In this case report the findings coinside with second type of communication mentioned by Venieratos D. and Anagnostopoulou S. and Type II by Loukas M .and Aqueelah H., in the right upper limb. The lateral root of the MN carries fibres that may pass through the MCN, and a communicating branch from the later usually joins the MN in the lower third of arm[13].In the left upper limb it coinside with Type III by Loukas M .and Aqueelah H. A supernumerary head of biceps brachii is the most frequently occurring muscular variation in the upper limb, prevalence is upto 22.9%.[6] Variations include bifurcate origin of long head[7], occurrence of third head [8-9] and occurrence of four heads[10-11].Greig, Anson and Budinger found one or more accessory heads of biceps brachii in 28 (21.5 %) of 130 muscle studied. In most of them extra head was arising from middle third of humerus. In another two it arose from intertubercular groove and in other five from the pectoralis major. In this case the third head is arising from the middle of the shaft of humerus. The clinical relevance of such variations might also be correlated to entrapment syndromes. Entrapment of MCN is rare and has its origin either in physical activity according to Falsenthal et al., 1984[14] or in violent passive movements of arm and forearm according to Kim and Goodrich, 1984[15 ]. This knowledge may prove useful for clinicians in order to avoid an unnecessary Carpal tunnel release [4]. Knowledge of these variations is important in traumatology and in plastic and reconstructive surgeries.
Englishhttp://ijcrr.com/abstract.php?article_id=655http://ijcrr.com/article_html.php?did=6551. Johnson E, Vekris M, Demesticha T, Soucacos P (2010) Neuroanatomy of the brachial plexus: normal and variant anatomy of its formation. Surg Radiol Anat 32:291–29
2. Pandey SK, Shukla VK (2007) Anatomical variations of the cords of brachial plexus and the median nerve. Clin Anat 20(2):150–156
3. Bhattarai C, Poudel PP (2009) Unusual variation in musculocutaneous nerves. Kathmandu Univ Med J 7:408–410
4. Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and median nerves. Clin Anat 1998; 11: 327–331.
5. Loukas M, Aqueelah H. Musculocutaneous and median nerve connections within, proximal and distal to the coracobrachialis muscle. Folia Morphol (Warsz). 2005; 64: 101–108.
6. Vijayabhaskar P, Baral P, Vaishya R, Shrestha RN (2008) Supernumerary head of biceps brachii: a rare occurrence in the Nepalese population. Kathmandu Univ Med J 6:225– 227.
7. Enad JG. Bifurcate origin of the long head of the biceps tendon. Arthroscopy. 2004; 20: 1081–1083. 8. Abu-Hijleh MF. Three-headed biceps brachii muscle associated with duplicated musculocutaneous nerve. Clin. Anat. 2005; 18: 376–379.
9. G. Sreedevi, S.S. Sarada Devi, K. Krupadanam, K. Anasuya. Bilateral occurrence of additional heads of biceps brachii-A case report. Int J Res Dev Health.Nov 2013;Vol1(4):195-9.
10. Vazquez T, Rodriguez-Niedenfuhr M, Parkin I, Sanudo JR. A rare case of a four-headed biceps brachii muscle with a double piercing by the musculocutaneous nerve. Surg. Radiol. Anat. 2003; 25: 462–464.
11. Poudel PP, Bhattaraj C. Study of the supernumerary heads of biceps brachii muscle in Nepalese. Nepal Med Coll J. 2009 Jun; 11 (2):96-8.
12. Greig HW, Anson BJ ,Budinger JM:Quart Bull Northwestern Univ M. School , 26:241,1952 (Quoted by ,W.Henry Hollinshead,’The Back And Limbs ‘, Third edition , Vol 3:354, 1982).
13. Bergmann RA, ThomsonSA and Saadeh F.A Compendium of human anatomic variation urban &schwarzebergMunich.1988; 139-143.
14. Falsenthal, G., Mondell, DL., Reischer, MA., Mack, RH. Forearm pain secondary to compression syndrome of the lateral cutaneous nerve of the forearm. Archaeological Physical Medical Rehabilitation, 1984, vol. 65, p. 139-141. PMid:6608339.
15. Kim, SM., Goodrich, JA. Isolated proximal musculocutaneous nerve palsy: Case report. Archaeological Physical Medical Rehabilitation, 1984, vol. 65, p. 735-736.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcareA RARE CASE OF DIFFUSE NEUROFIBROMA - A CASE REPORT
English6973Ramkumar G.English Sudha V.English Subbiah S.English Karthi Sundar V.English Jasmine Deva ArulselviEnglishDiffuse neurofibroma is the rarest form of neurofibroma which is more common among children and young adults.The lesions are ill defined and infiltrative in nature and usually affects the skin and subcutaneous tissue.We present a case of 10 year old boy whose initial clinical and radiological evaluation did not reveal the diagnosis and it was only after the histopathological study we concluded the case as neurofibroma
EnglishDiffuse neurofibroma, Café au lait patches, Spindle cells, Meissners corpusclesINTRODUCTION
Neurofibroma is a benign nerve sheath tumour of the peripheral nervous system.It has three distinct types namely localized, diffuse and plexiform type.This case report is of a patient who presented with diffuse neurofibroma, which is also the rarest form. The aim of presenting this case of diffuse neurofibroma is to emphasize the importance of clinical and histopathological examination in its diagnosis. Also, this condition when detected early can be monitored on a periodic basis to detect complications of the same and improve patient outcome.
CASE REPORT
A 10 year old boy presented with swelling in the right leg for seven years.The swelling was initially small and gradually got bigger to attain the present size.There was pain for two days after being hit over the swelling while playing.There was no history of bleeding or discharge from the swelling.There was no history of fever or other similar swelling elsewhere. It was interesting to note that over the past seven years patient has been thorughly investigated for recurrent pain in his leg.In 2010, patient underwent medial epiphysiodesis of right ankle for calcaneo valgus deformity correction in a government hospital. CT and MRI taken in a private hospital showed periosteal based lesion along the tibial diaphysis possibly sub periosteal hematoma or sub periosteal abscess. The patient continued to have pain inspite of an extended treatment for infection.A repeat MRI in 2012 showed small resolving abscess with haemorrhagic contents.No other new clinical finding was noted that time. On this occasion, the general condition was fair. The swelling on the right leg was 15x7cms on the anterolateral aspect extending from 3cms below the knee to 4cms above the medial malleolus.The swelling was not warm and non tender.The surface was smooth and firm in consistency.It was not mobileand fixed to the underlying bone. There was no scars and no dilated or engorged veins. There was limb lengthening which measured 2cms. The limb girth on the right side was 3cms more than theleft. There was full range of movements at both the knee and ankle joints.Examination did not reveal any neuro vascular deficit. Routine blood investigations were normal.X-ray of the leg showed sclerosis,periosteal thickening, anterolateral bowing and deformity of the bone.CT angiography revealed residual hematoma probabaly infective in aetiology. Excision biopsy was planned.Per-operatively, a soft tissue mass was found and was sent for histopathological examination along with a piece of bone. Histopathological examination of the soft tissue mass showed a neoplasm composed of elongated, spindleshaped cells with wavy, buckled nuclei and (Fig A,C) some with oval nuclei arranged in a haphazard fashion (Fig B) entrapping lobules of mature adipose tissue and skeletal muscle fibres.Some areas show differentiation towards Meissner type of tactile corpuscles and scattered ectatic blood vessels were also seen (Fig D). Neurofibromatous tissues show immunoreactivity with S-100 protein (Fig E,F). It is a sensitive, but non-specific marker of benign nerve sheath tumors.1 Sections from the bone showed normal mature lamellated bone.(Fig G)Based on these findings, it was reported as diffuse neurofibroma. Following the tissue diagnosis,the patient was examined retrospectively for café au lait patches and multiple café au lait spots were seen over the trunk. (Fig H) .An ophthalmology opinion was sought to detect Lisch nodules which was however absent.CT brain and trunk showed no abnormalities.The post operativecourse was uneventful. DISCUSSION Neurofibromas are benign nerve sheath tumors in the peripheral nervous system, which frequently occur as a part of Neurofibromatosis 1.Neurofibromatosis is a genetic disorder that may be associated with multiple neurofibromas. They arise from the non myelinating type of Schwann cells that exhibit biallelic inactivation of the NF1 gene that codes for the protein neurofibromin.Neurofibromas are classically described as localized, diffuse, and plexiform types2 depending on the growth pattern. Localized and plexiform neurofibromas are well known subtypes. The localized form is the most common and they usually present as skin-colored dome-shaped or pedunculated papules that display the pathognomonic “buttonhole” sign. They can be sporadic or Neurofibromatosis associated. Plexiform neurofibromas are larger and more extensive tumors that are usually associated with Neurofibromatosis. Diffuse neurofibroma is an uncommon but distinctive subtype of neurofibroma.They are usually solitary lesions and are progressively enlarging and infiltrating type, simulating malignant tumors.They occur most commonly among children and young adults. They typically involvethe skin and subcutaneous tissues of the head and neck3,4,5 . Trunk and extremities are also commonly involved and constitute more than one third of the lesions.6 They are poorly defined lesions that spreads extensively along connective tissue septa and between fat cells.They surround rather than destroy adjacent normal structures 3,4,5. This lesion has also been termed “paraneurofibroma” as the tumor extends beyond the confines of the perineurium 7 . They differ from conventional neurofibromas by the presence of uniform matrix of fine fibrillary collagen , less elongated schwann cells and clusters of meissner body-like structures which are the characteristic feature of this lesion. The incidence of neurofibromatosis among patients with diffuseneurofibroma has been reported to be approximately 10% 4 .For the diagnosis of Neurofibromatosistype 1, two or more of the cardinalsignsare required:
• 6 or more brownish discolorations on the skin, more than 5mm in diameter in pre-adolescents and greater than 15 mm in adolescents and adults.
• 2 or more neurofibromas.
• Freckling in the axilla or groin.
• Optic glioma
• 2 or more Lisch nodules, or small masses on the iris.
• Bone lesions like sphenoid dysplasia.
• A first degree relative with Neurofibromatosis 1.
In our case , as solitary neurofibroma and multiple café au lait spots are present there is a high potency for the development of Neurofibromatosis I. 8 Malignant transformation rarely occurs in solitary diffuse neurofibromas9 . Pain or enlargement of a neurofibroma may herald malignant transformation.Surgical excision is not mandatory as malignant transformation is rare 2 .Resection is performed when the tumor is severely disfiguring or severely compromises function 10. Partial or complete surgical excision is done for large neurofibromas. The extensive and infiltrative nature of the lesions precludes complete surgical resection.2,3,10Recurrence may develop even after complete excision because of it’s infiltrative growth pattern in Diffuse neurofibroma. As there is a relatively high incidence of recurrence and the potential development of neurofibromatosis, yearly follow-up is warrented.3,7,10.
CONCLUSION
Most often neurofibromas are of histopathological diagnosis especially in solitary lesions because of the indefinite clinical characteristics. Relevant history taking, clinical examination and ophthalmic and radiological investigations are needed for thepreoperative suspicion. In order to exclude neurofibromatosis, special attention is needed for the detection of café au lait spots.
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.
E,F -S 100 Positivity G - Normal mature bone
Englishhttp://ijcrr.com/abstract.php?article_id=656http://ijcrr.com/article_html.php?did=6561. Ito H, Akagi O, Nomura N, Tahara E. Giant pigmented tumour of the scalp--a diffuse neurofibroma or a congenital naevus showing neurofibromatous changes? Immunohistochemical and electron microscopic studies. Histopathology. 1988;13:181–189.
2. Coakley D, Atlas MD. Diffuse neurofibroma obstructing the external auditory meatus. J Laryngol Otol 1997; 111:145– 147
3. Van Zuuren EJ, Posma AN. Diffuse neurofibroma on the lower back. J Am Acad Dermatol 2003; 48:938–940
4. Weiss SW, Goldblum JR. Benign tumors of peripheral nerves. In: Enzinger and Weiss’s soft tissue tumors, 4th ed. St. Louis, MO: Mosby, 2001:1132 –1140
5. Kransdorf MJ, Murphey MD. Neurogenic tumors. In: Imaging of soft tissue tumors, 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2006:334 –338
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524172EnglishN-0001November30HealthcarePRIMARY BULLOUS LUNG DISEASE - A CASE REPORT
English7477Vishnukanth GovindarajEnglish Venkateswara Babu RanganathanEnglish Venkatesh CouppoussamyEnglish Jayashalini JayabalanEnglish Madhumidha BhaskaranEnglish Gokulavasanth BalakrishnanEnglishBullae are thinwalled air-containing space within the lung parenchyma. They are usually larger than 1 cm in diameter, and their walls are composed of attenuated and compressed lung parenchyma. (1) Presence of bulla in a background of smoking is usually attributed to chronic obstructive pulmonary disease and is termed bullous emphysema. Bullous lung disease is presence of bulla in an otherwise normal lung. We present a case of bullous lung disease in a sixty five year old man with a clinical presentation of pneumothorax. The confounding factor was presence of smoking. The diagnosis was established by high resolution computed tomography(HRCT) of the chest.
EnglishBullous lung disease, HRCTINTRODUCTION
Presence of airspace opacity on chest x ray often is a diagnostic challenge to many a clinicians. Bulla, bleb and cyst are terms used to describe air filled opacity in the chest radiogram. These terms are often used interchangeably. Bleb is an intrapleural collection of air within the layers of visceral pleura. The source of air is usually a ruptured alveolus. Bulla is an air filled space within the lung parenchyma resulting from destruction of alveolar tissue. Cysts are thin-walled, air- or fluid-filled space with a wall that contains respiratory epithelium, cartilage, smooth muscle and glands. (1, 2) Bulla (pleural- bullae) can develop in a lung with underlying normal parenchyma. But most often it develops in a background of chronic obstructive lung disease. The former is termed as bullous lung disease and the latter as bullous emphysema. Bullous lung disease accounts for 20% of bullae and is less commonly mentioned in the differential diagnosis of an air filled space, mostly overshadowed by bullous emphysema.(1) We present a case of bullous lung disease in a sixty five year old man with a clinical presentation of pneumothorax. The confounding factor was presence of smoking. The diagnosis was established by high resolution computed tomography (HRCT) of the chest. CASE SCENARIO A sixty five old agricultural labourer presented with complaints of progressively worsening breathlessness and cough with minimal expectoration of six months duration. He developed sudden onset of right sided chest pain three days prior to presentation. He had no past history of tuberculosis and had no co morbid illness. He was an occasional smoker of thirty years. On presentation he was dyspneic and mildly tachypneic. General physical examination was unremarkable. His room air saturation was 84%. Blood pressure was 110/70 mm Hg, respiratory rate was 26breaths/ min and heart rate was 90 beats/ min. Respiratory system proper examination revealed a central trachea with diminished movements on the right side. Tactile vocal fremitus was diminished in the right infraclavicular, mammary, infra axillary and infra scapular region. There was a hyperresonant note and absent breath sounds in the same areas. A possibilty of secondary spontaneous pneumothorax in a background of chronic obstructive pulmonary disease was considered and he was subjected to chest radiogram. Chest x ray revealed a partial pneumothorax on the right side with hyperlucent opacity in the left upper zone. There was no hyperinflation in the chest radiogram.(fig 1) An intercostal chest tube(ICT) was placed on the right side.(fig 2,3) Post intercostal tube insertion the right lung expanded. There was a minimal airleakage and minimal subcutaneous emphysema around the ICT side. Though there was a complete expansion of the pneumothorax, he continued to be tachypneic. Arterial blood gas analysis (ABG) showed a persistent hypoxia with a normal carbon dioxide levels. Patient was subjected to a high resolution computed tomography (HRCT) scan of the chest. HRCT chest revealed multiple bullae bilaterally with intervening normal lung parenchyma.(fig 4,5) There was no evidence of pan acinar or paraseptal emphysema. Echo cardiogram showed no evidence of pulmonary hypertension. Taking into consideration his chest x ray which showed no evidence of hyperinflation, his persistent hypoxic status with normal carbon di oxide tension in ABG, his HRCT picture of bilateral bullae with intervening normal lung parenchyma, a possibility of primary bullous lung disease was considered. His alpha one antitrypsin levels were within normal limits. Patient underwent pleurodiesis on the right side with tetracycline. He was advised for domiciliary oxygen therapy and advised to restrain from performing strenuous physical activity. Patient is currently on home oxygen cylinder therapy and has not worsened till the last contact.
DISCUSSION
Bulla refers to an air-filled space that may be subpleural or intrapulmonary in location, with a diameter more than 1cm and a wall less than 1mm thick. Bulla commonly develops in persons with underlying chronic obstructive lung disease. Bullous emphysema refers to development of bulla in patients of chronic obstructive pulmonary disease. Bullous lung disease refers to presence of bulla in an apparently normal lung parenchyma. Cocaine smoking, Pulmonary Sarcoidosis, α1-antitrypsin deficiency, 1-antichymotrypsin deficiency, Marfan’s syndrome, Ehlers-Danlos syndrome , exposure to inhaled fiberglass have all been implicated in the development of bulla.(3,4,5) Bullae are classified anatomically into three main types. Type I bullae are characterized by a narrow neck that connects the bullae with the pulmonary parenchyma. They are usually found at the lung apices andalong the edges of the lingula and middle lobes and often occur in association with paraseptal emphysema. Type II bullae arise from the subpleural parenchyma and are characterized by a neck of panacinar emphysematous lung tissue. Type II bullae are most frequent in the upper lobe, at the anterior surface of the middle lobe, and over the diaphragm.Type III bullae consist of slightly hyperinflated lung connected to the rest of the lung by a broad base extending deep into the parenchyma. This type is believed to represent an atrophic form of emphysema (1, 6).Various hypothesis are put forth for the development of bulla but none of them are conclusive. The clinical presentation of bullous lung disease depends on the extent of bulla and their size and number. Occasionally bulla can enlarge and encompass more than one-third of the lung volume leading to compression of adjacent normal lung tissue. Giant bullous emphysema or vanishing lung syndrome (7, 8) is mainly seen in young men with history of tobacco smoking and Marijuana use and is characterized by the presence of large progressive bullae that occupy a significant volume of a hemithorax and are often asymmetrical. Patients with bullous lung disease may be asymptomatic and bulla may be incidentally detected on routine chest radiography. Symptomatic patients may complain of progressive dyspnea or chest paindue to gradual increase in the size of the bullae (9). Sudden onset of severe chest pain or sudden worsening of breathlessness may be due to air trapping in bulla or a spontaneous pneumothorax secondary to rupture of bulla. Increase in cough with sputum production usually indicates infection in a bulla. Young patients with large bullae are predisposed to lung cancers. Dystrophic changes caused by bulla in the adjacent lung parenchyma due to compression and the presence of scar tissue that predispose to development of bulla may be the reason for increased incidence of lung cancer in these patients. Poor ventilation of the bullae may lead to accumulation of carcinogens in them(10, 11). The clinical findings in patients of bullous lung disease are variable. Giant bullae may clinically mimic a pneumothorax with the presence of diminished breathsounds and increased resonance on percussion. Fever, purulent expectoration may occur when bulla is secondarily infected. Radiological features of bulla: Bulla is often suspected radiologically and is mostly an incidental finding. An area of hyperlucency with presence of thin hairline shadows may be an identifying feature. However, occasionally it is difficult to differentiate the hairline shadows produced by a bulla from irregular walls of a cavity or cysts in the lung parenchyma. A forced expiratory film may be needed to confirm the presence of bulla. Bulla tends to trap air and during a forced expiratory maneuver their outline becomes more accentuated as the surrounding normal parenchyma shrinks. Large bulla may sometimes displace the mediastinum contralaterally and may even compress the opposite lung. Ultrasound imaging helps to differentiate between a pneumothorax and bulla. A typical ‘comet tailing’ phenomenon of the movement of the lung tissue againstthe pleura during respiration can be seen in bullous disease, but is absent in pneumothorax.(12) Computed tomography study of the thorax is perhaps the best method for identifying bulla. A bulla is identified as area of transradiancy that usually do not contain blood vessels and is confined by visible walls. The complications of bulla like pneumothorax, secondary infection can be better detected with CT. (13) The double wall sign is a valuable sign to help distinguish a pneumothorax from adjacent giant bulla (14). Double wall sign is presence of air outlining both the sides of the bulla wall parallel to the chest wall. Treatment of bulla depends on the symptomatology of the patient, the extent of the disease, presence of coexisting illness. Bulla that cause few respiratory symptoms are treated conservatively. Patient is advised to quit smoking, avoid physical activities or exercise that may promote the rupture of bulla. Scuba diving are better avoided. An annual chest radiograph evaluation may be advised. Infection of a bulla is treated by antibiotics and chest physiotherapy. Surgical treatment of bulla allows normal but compressed lung parenchyma to expand.Surgical removal of bulla is needed when there is a progressive increase in bulla size, recurrent pneumothorax due to rupture of bulla, giant bulla causing respiratory insufficiency due to compression of adjacent lung and recurrent infection. Bullectomy or resection of the entire bulla, either through a video assisted thoracoscopic surgery (VATS) or a standard open thoracotomy, is the most common surgical technique used for treatment Total pneumonectomy is indicated in those withsevere unilateral bullae with essentially no functioning lung.(16,17,18)
CONCLUSION
It is not uncommon to attribute all cases of bulla to chronic obstructive pulmonary disease and name them as bullous emphysema. Our patient was an occasional smoker and in the presence of bulla on chest x ray one would have been tempted to treat him as bullous emphysema. The treatment for bullous lung disease and bullous emphysema are different. Our case also highlights the need for evaluation with a HRCT scan in patients with suspected bulla in chest x ray.
ACKNOWLEDGEMENT
S 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. The authors have received no funding for this work. The authors assure that there is no conflict of interest .
Figure 2: Presence of a bulla in the left upper zone
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