Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20IMPROVED ARTIFICIAL NEURAL NETWORK PERFORMANCE ON SURFACE OZONE PREDICTION USING PRINCIPAL COMPONENT ANALYSIS
English0106K. PadmaEnglish R. Samuel SelvarajEnglish S. ArputharajEnglish B. Milton BoazEnglishCorrelated sample data normally creates confusion over ANN (Artificial Neural network) during the learning process. In this work the Principal Component Analysis (PCA) method is used for elimination of correlated terms in data. After application of PCA, the uncorrelated input data were used to train a Multi-Layer Perceptron (MLP) ANN system. The results revealed that the elimination of correlated information by using the PCA method improved the ANN estimation performance. we measured the surface ozone and its influencing factors during the period June 2011- September 2012 at Chennai, a tropical site on the Southeast coast of India situated at 13 04’N 80 17’E. The input data that was used for building the network are the wind speed, temperature, relative humidity, UV radiation had been used in neural networks for the prediction of daily surface Ozone 24 hours in advance.
EnglishMulti-layer perceptron, Artificial neural network, Principal component analysis, activation function, hidden layers, ‘PC variance’INTRODUCTION
Continuous development of technology and on increasing population in metropolitan cities like Chennai, Delhi, etc., a series of severe problems related to environmental pollution such as air pollution, noise pollution, waste and sewage disposal have attracted much attention than ever before. Among these, air pollution has direct impact on human health through exposure to pollutants at high concentration level existing in ambient areas. Air pollution control is very important to prevent this situation from worsening in the long run. On the other hand, short-term forecasting of air quality is needed in order to take preventive action during episodes of airborne pollution (Wenjian wang, 2002). Ozone is a secondary pollutant and it is not usually emanated straight forwardly from stacks. Process in the formation of Ozone (O3 ) is highly multifaceted in nature. The ozone precursors are generally divided into two groups, namely oxides of nitrogen (NOX) and Volatile Organic Components (VOC) like evaporative solvents and other hydrocarbons. In suitable ambient meteorological condition (e.g. warm, sunny, clear day) ultra violet radiation (UV) causes the precursors to interact photo chemically in a set of reactions that result in the formation of ozone (Bandyodhyay et al., 2007). Ozone is a green house as well as secondary air pollutant, interaction between Ozone and climate occurs not only in the Stratosphere but also at the earth’s surface. Ozone comes in contacts with life form of the earth’s surface and shown it destructive nature. It damages the leaves and affects plant growth thus reduces crop yield and causes noticeable foliage damage. Human health is also affected by high concentration of Ozone (Londhe, et al. 2008. Stathopoulou, et al., 2008). Therefore, the development of effective prediction models of ozone concentrations in urban areas is important. Management of control and public warning strategies for ozone levels (particularly densely populate area) requires accurate forecasts of the concentration of ambient ozone (Prybutok, 2000). So monitoring daily Ozone level in this big city is important for today and future research whether or not a threshold is exceeded. Such information could be exploited by environmental and medical authorities to announce public health warning (Stathopoulo et. al. 2008). ANN-based method still need to improve in order to achieve good prediction performance as effectively and efficiently as expected. In fact, a number of difficulties have been associated with ANN use which hampered their effectiveness, efficiency as well as general acceptability in air quality analysis. These difficulties include susceptibility to chaotic behavior, computationally expensive training, training set problem and topology specification problem etc (Wenjian wang, 2002). In the other training method, meteorological data was preprocessed by the Principal Component Analysis (PCA) method. After applying the PCA, the size of the input sample was reduced from 4 to 3 orthogonal, uncorrelated components. Network’s architecture was composed of input layer, one hidden layer and output layer. Standard back propagation with momentum was used for training. In both cases the input data was normalized and scaled to the range (-1, 1). The sigmoidal activation (transfer) function was used in our network of all neurons except those in the input layer.
STUDY AREA
Chennai is situated on the south east coast of India and north east coast of Tamil Nadu. This area is one of the most highly populated urban sites. Chennai lies on the thermal equator and is also a coastal. The latitude and longitude of the center of the city are E80o 14’51” and N13o 03’ 40”. The geographical location of the experimental site is shown in Fig. 1 and it is located in south Chennai. The different sources of air pollution are classified under the following categories Transport, Industries, Residential in Chennai City. This Urban City can be divided into four areas, North, Central, South and West. The Northern part is primarily an industrial area comprising of petrochemical industries in the Manali area and other general industries in Ambattur. (Fig. 1). Chennai has many industrial areas. This study was conducted at Koyembedu which houses Chennai’s moffussil Bus terminus and 100’s of Buses and other vehicles ply daily and hence the vehicular emission is very high. This site is surrounded by the number of Industrial areas located within a short radius. Surface ozone was measured throughout Tamil Nadu during the year 2011 and it was found that Kanniyakumari district had the highest daily average of 17.8 ppbv (Samuel Selvaraj et. al., 2011). Moreover the surface ozone levels studied in Chennai during 2004- 2005 it was found that the hourly values varied from 1 ppbv to 50.27 ppbv (Pulikesi et al., 2005). In the urban area Delhi ozone concentration in the ambient air varied from 9 to 128 ppbv at four different sites during 1989–1990(Varshney et. al., 1992). So these studies have indicated that the effects of O3 on vegetation were quite severe in India and other parts of Asia. ( Emberson D. et al., 2001). From our knowledge of literature survey, there was no measurements have been carried out over Chennai metropolitan area in recent years (Samuel Selvaraj et. al., 2013). Hence through this study, the surface ozone (O3 ) concentration was measured in this urban site, Chennai.
DATA AND METHODOLOGY
The measurement were carried out in the area which has selected to represent the typical residential with high commercial and traffic influenced. Using Aeroqual 200 series Ozone data had measured.( Akram Ali., Sulee et al., Michael Frei et al., Dovile Laurinaviene, 2008). UV irradiation had been measured by UV light meter (UV3450A series). Surface ozone measurements were carried out daily and ten measurements were made on all days between 08.00 hrs and 17.00 hrs (IST) during the period from June 2011 to September 2012. Furthermore, wind speed, temperature, relative humidity and UV radiation were also measured simultaneously. Here two approaches are applied to predict the surface ozone which are Artificial Neural network without PCA and Artificial Neural network with PCA. The total input data set contains four variables namely wind speed, temperature, UV radiation and relative humidity. The data set is divided into two distinct sets called training and testing sets. The training set is the larger set (90%) used for the network to learn pattern presence in the data and the testing set (10%) were used to evaluate generalization ability of supposedly trained network in both (ANN with PCA , ANN without PCA ) method.
ARTIFICIAL NEURAL NETWORK WITHOUT PCA ANN is based on principle stating that a system of highly interconnected simple processing elements can learn complex interrelationships between independent and dependent variables. Yi and Prybutok presented a feed– forward neural network model for predicting ozone concentrations in an urban area. They recognized other precursors of ozone formation must be included in order to improve the prediction of their model (Elkamel et al., 2000). The particular aim is to relate the surface ozone concentration to meteorological variables. A total of 4 variables are used in preparing this model for the prediction of surface ozone concentrations. ANNs are constructed with many layers so as to be called as multilayer ANNs. First one is input layer has independent variable in statistical literature. Last layer is output layer has contains dependent or response variables. All other unit in this network is called hidden layers. There are two functions governing the behavior of layers. The input function, and The output/activation function. A number of nonlinear functions have been used in the literature as activation functions. However, most common choice is sigmoid function ( Andrew C. Comrie, 1999) . The main task of the activation function is to map the outlying values of the obtained neural input back to a bounded interval such as [0,1] or[ -1,1]. The sigmoid function has some advantages, due to its differentiability within the context of finding a steepest descent gradient for the back propagation method and moreover maps a wide domain of values into the interval [0,1] (Girish Kumar). In this study we have selected the feed-forward back propagation Multi-Layer Perceptron (MLP) to develop the ANN model with changeable neurons in the hidden layer to get good result with accuracy (Elamparai, 2011). The simulation is carried out in Mat lab using the ‘Levenberg Marquardt back propagation’ training algorithm. The performance of an ANN very much depends on its generalization capability, which in turn is dependent upon the data representation. A set of data presented to an ANN consist of correlated information. This correlated data reduce the distinctiveness of data representation and thus, introduce confusion to the ANN model during the learning process and hence, producing one that has low generalization capability to resolve unseen data. This suggests a need for eliminating correlation in the sample data before they are being presented to an ANN. This can be achieved by applying the Principal Component Analysis (PCA) technique onto input data sets prior to the ANN training process as well as interpretation stage. This is the technique examined in this research. The PCA technique was first introduced by Karl Pearson in 1901, but he did not propose the practical calculation method for two or more variables, which were useful for various applications (Junitha, 2008). ARTIFICIAL NEURAL NETWORK WITH PCA PCA is a variable compression technique. It transforms a large number of interrelated variables to a new set of uncorrelated PCs which are linear combinations of the original variables (Jolliffe,. 1986). Therefore, each principal component contains information on all meteorological variables. PCA generates the same number of meteorological indices as the original meteorological variable (including both original and quadratic terms) and orders them by the magnitude of variances. In order to reduce the number of predictor variables, the rule of thumb for most previous related studies is to take only the first several PCs with Eigen value greater than or equal to one as predictor variables. The use of the PCA function involves specifying a fraction value corresponding to the desired percentage of the least contribution of the input components. For example, a fraction value of 0.02 means that the input components which contribute less than 2% of the total variation in the data set will be discarded. From this point onwards, this fraction value will simply be referred to as the “PC variance”. The PCA method is potentially very well suited for neural networks training methods. Training is more effective when performed on uncorrelated and orthogonal data. Moreover the network is smaller the faster the training and in several cases the better generalization properties. The PCA transformation is based on the following autocorrelation matrix:
Where n is the number of vectors in the input set, xk is the k-th vector. Eigenvectors of matrix Rxx corresponding to eigenvalues sorted in the decreasing order point out the principal components. The first principal component is responsible for the highest percentage of the variance of the sample the second one – for the next highest variance, and so on (Joliffe I.T., 1986). By choosing the required number of principal components one is able to build matrix W of the PCA transformation: W = [w1,w2,...,wM]T, Where M is the required number of components and wk (for k=1,…,M) are the principal components itself. Two types of PCA data processors had been implemented for the purpose. The first one is called the PCA pre-processor, which is responsible for pre-processing raw data, to eliminate correlation in the training samples. The second is called PCA postprocessor, used to transform the validation and test datasets according to their principal components. The implementation and simulation were car ried out with the aid of built-in functions supported by MATLAB Neural Network Toolbox (Junitha, 2008). Each MLP’s performance was calculated based on the Mean Absolute Error (MAPE) .
RESULT AND DISCUSSION
The data were then divided into three datasets; the training, validation and test. The training set was used to train the ANN the validation set was used for early-stopping of the training process and the test set was used to evaluate the ANN performance after completion of the training process. In case of using the back propagation algorithm in ANN without PCA the average Root mean square error was equal to 1.4 ppbv. The respective average mean absolute percentage errors within the test set - was equal to10.5% (see Table 1).
Here ‘n’ is the total number of observed value and Ri , Pi are ith real and predicted values respectively. Where RMSE, is root mean square error and MAPE is Mean absolute percentage error and the correlation ratio between predicted and real changes were calculated from the below equation.
N denotes the size of the test set, Pi t and Ri are the i-th predicted, real values at time t, respectively. The experiment can be repeated several times with vary the number of neurons in the hidden layer. The best result of ANN without PCA given below and the correlation coefficient d was equal to 0.5.
In case the PCA was initially used for pre-processing the data (and reducing the input dimension from 4 to 3). The average Root mean square error was equal to 1.15 ppbv. The correlation ratio d was equal to 0.619 which is better than plain back propagation ANN network and % of error is 8.2 which are lesser than ANN without PCA (see Table 2).
Closer look at the principal components defined in our experiment – in case of no data compression, i.e. with all 4 principal components - revealed some interesting properties of the way the input factors were “combined” into components. That is most of the input variables are closely related to another variable. First, the sums of absolute values of all weights incoming to every principal component (from the input vector) were calculated. Intuitively, these sums should be greater for the first few components (the most relevant ones) than for the less significant components. It can be clearly seen that the rough estimation of the relative importance of the components presented in Fig. 2. It can be also seen from the figure the last input component which has low weight value relatively low contribution was discarded. Fig. 3. shows the best result of predicted values of surface ozone using ANN model without PCA with 6 neuron used in the hidden layer in neural network is compared with the observed surface ozone data. The best achieved result of predicted values of surface ozone using ANN model with PCA and 6 neuron which is used in the hidden layer in neural network is compared with the observed surface ozone data. This ANN model with PCA provides a very good prediction of daily surface ozone in one day advance as shown in fig.4. CONCLUTION In this work, Mat lab tools are used to predict the daily surface ozone data in an one day advance. The 400 days surface ozone data used for training the network while 45 day data are used for testing the network. The result obtained with average error of 8.2% (1.1ppbv) and correlations between predicted and real changes is very encouraging and provide a further exploration of the issue that is combine our approach with expert systems. One of the important conclusions of this research is applicability of the PCA method as a supporting tool for data pre – processing in the problem considered this issue deserve further investigation and reduces the complexity of network and provide good result.
AKNOWLEDGEMENT
The authors wish to thank the Tamil Nadu Pollution Control Board, Chennai for providing valuable guidance and for checking the accuracy of the instruments. We also thank our co-researchers who have given their valuable suggestions and guidance enabling us to release this research paper and their help is gratefully acknowledged. 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=777http://ijcrr.com/article_html.php?did=7771. Akram Ali, Factors affecting on response of Broad bean and corn to air quality and soil CO2 flux rates in Egypt. Water Air soil Pollute.195, 311-323, 2008.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20BISPHOSPHONATES IN DENTISTRY AN ASIAN PERSPECTIVE - EVIDENCE BASED REVIEW
English0719Vanaja Krishna NaikEnglish Aruna BalasundaramEnglish Harinath P.English Caroline JacobEnglishBisphosphonates are drugs with high affinity to bone, which accumulates in the bone matrix for a longer time and affects bone turnover. These are commonly prescribed in the management of malignant metastatic bone disorders and for several benign conditions such as osteoporosis and Paget’s disease. The objective of this review is to provide a comprehensive report on the drug bisphosphonate, clinical applications and its potential adverse effects, with special focus on Asian literature. Frequencies of patients who are on bisphosphonates are increasing in dental clinics these days. However regarding the use of this drug and its clinical implication from Asian countries are sparse, presumably due to under-reporting of cases or possibly wrong diagnoses. Hence we have made an attempt to reinforce the existing knowledge about this topic in Asian context along with latest information for the readers.
EnglishBisphosphonates, osteonecrosis of the jaws, Asian perspective, Dental uses, Periodontitis.iNTRODUCTION
Dental clinicians have a distinctive and obligatory responsibility to treat the patient as a whole, not just the dental concern. Hence thorough medical histories are of paramount importance, which allows the clinician to identify systemic diseases and take necessary precautions during dental treatment. Further it is a good routine to elicit drug history at every dental visit of the patient1 . Patients on bisphosphonates [BPs] are increasingly seen in the dental clinics2 . These patients should be informed about the possibility of osteonecrosis of the jaws following any form of oral surgical procedures. The reported cases of osteonecrosis from Asian countries are sparse. Is it because of inherent protection of population against osteonecrosis or under-reporting of the cases or wrong diagnosis This review discusses comprehensively about the drug bisphosphonate and its pharmacotherapeutics, clinical uses and potential adverse effects with special focus on Asian literature.
CLASSIFICATION OF BISPHOSPHONATES
BPs are classified as Nitrogen and non-nitrogen containing2, 3,4. Novel synthetic bisphosphonate: Disodium dihydrogen4-[(methylthio) phenylthio] methane bisphosphonate [TRK-530]: has an antioxidant methylthio-phenylthio group in the R2 side chain and has both anti-resorptive and anti-inflammatory effect9 . Mechanism of action of bisphosphonates Bone is a dynamic hard tissue undergoing constant remodelling. During bone resorption, bone morphogenetic protein and insulin growth factors are released which direct the migration, differentiation and osteoid production of new bone from local and circulating stem cells.10 Most commonly used BPs is nitrogen containing, which are extremely bone selective. The basic action of BPs is to inhibit bone resorption, turnover and renewal, thus reducing serum calcium levels. They bind to the mineral crystals on bone surfaces and a repeated dose accumulates in the bone matrix. During the bone remodelling BPs are released from the bone surface and are internalized by osteoclasts. This affects the protein prenylation which is important for the activity and survival of osteoclasts, subsequently leading to apoptosis.5,11,12
THERAPEUTIC USES
MEDICAL APPLICATIONS
The earliest medical applications of bisphosphonates were in the treatment of Fibrodysplasia ossificans progressiva, in patients who had undergone total hip repl acement surgery and for bone imaging. Subsequently it became treatment of choice in various bone diseases, such as Paget’s disease, osteolytic bone diseases, osteoporosis, 13,14,15,16 hypercalcemia of malignancy and in metastases of malignant tumours, further this was applied in paediatrics in the management of brittle bone disorders and osteogenesis imperfecta.13Finally interesting observations such as antiparasitic and analgesic effects are found with BPs.
PERIODONTAL APPLICATIONS:
The potential dental applications of BPs have been explored not only for the treatment or prevention of periodontal bone loss but also as a diagnostic aid to detect bone loss associated with periodontal disease and cessation of bone loss following treatment. However this application did not come into routine use for reasons possibly related to cost, accessibility and full-body irradiation due to intravenous administration.3 The anti-resorptive effects of systemic3,8,17-,23 and topical24-30 BPs have been applied in the management of periodontitis.31-33 Takaishi Y et al 2001 reported clinical effect of etidronate 200 mg daily for two weeks, followed by off-periods of 10 weeks or more for 2-3 years and suggested marked improvement in the appearance of gingival tissue, depth of periodontal pockets and radiographic appearance of alveolar bones. They concluded that the effect may be owing to the anti-resorptive and the anti-inflammatory action of etidronate.34 On the contrary Graziani F 2009 conducted a study to determine the efficacy of adjunctive short term intramuscular neridronate in non surgical periodontal therapy and found no additional short term improvements in periodontal conditions of chronic periodontitis patients when compared to periodontal treatment alone.8 A Chinese report in 2011 summarized the mechanism of bone regulation and local delivering system of BPs in the management of peri-implant bone loss and suggested that calcium phosphate ceramics, polylactic acid, fibrinogen film and collagen membrane can be used as BPs carriers35 Sharma A and Pradeep A R 2012 conducted series of studies with the objective of assessing the clinical efficacy of 1 % alendronate gel as local drug delivery agent in adjunct to mechanotherapy in the treatment of chronic periodontitis, chronic periodontitis with diabetes mellitus, aggressive periodontitis, and in the treatment of degree II furcation involvement. The results of these studies indicated probing depth reduction, attachment gain and improved bone fill.24,25,28,30 Basma Mostafa et al 2012 conducted a study to evaluate the combined effect of systemic bisphosphonates, calcium and vitamin D supplements along with surgical periodontal therapy on the alveolar bone in osteoporotic post menopausal females with chronic periodontitis. They found that this combination showed better improvement in treatment outcomes as in clinical and radiographic parameters.36 Bisphosphonate coating on dental implant surface: The BP coated implants have been studied to investigate its effects on osseintegration.37-40Yoshinari M41 2002 conducted a study to evaluate the bone response to titanium implants coated with thin calcium-phosphate followed by bisphosphonate and they concluded that there was highest percentage of bone contact with these test implants group compared to the control group, suggesting the promotion of osteogenesis on surfaces of dental implants Despite the listed applications in dentistry the usage of BPs is not popular, possibly because of the major adverse effects as osteochemonecrosis. Although the local delivery of BPs in the management of periodontitis and periimplantitis are reported, these needs to be interpreted with caution as there are very few reports to support this mode of delivery and also there were no reports on short and long term soft and hard tissue adverse effects, besides most of the data are from few centres. Hence further long term, multicentre, multiethnic, prospective studies should be encouraged. The comparison of Asian studies24, 28, 30, 22 with that of western studies23, 42,19,39,40, 43 are outlined in table 6, which focuses only on human studies. TOXICITY: Bps have been reported to cause several adverse effects such as skeletal and non skeletal. Although skeletal adverse effects as BRONJ has drawn major attention, there are non skeletal effects such as oesophagitis like symptoms, oesophageal cancer, fever, flu like symptoms, potential renal failure, risk of atrial fibrillation, cardiovascular and valvular calcifications with iv and oral bisphosphonates. However few of these non skeletal adverse effects have not been reported in Asian literature. The most sinister skeletal adverse effect of BPs is BRONJ, bisphosphonate related osteonecrosis of the jaws. Patients may be considered to have BRONJ if they have exposed bone in the maxillofacial region for atleast 8 weeks are currently on or have taken bisphosphonates and have no history of radiotherapy to the jaws 44 The risk factors for developing BRONJ can be systemic and local. The systemic factors such as malignancy, patients on long term concurrent corticosteroid therapy, reduced immunity as in diabetics and smokers. In addition the route of administration, dose and potency of BPs predisposes the patient to develop BRONJ. Further the local risk factors as dentoalveolar surgeries with osseous modifications in areas of thin mucosa overlying tori and mylohyoid ridge and patients with dental abscesses who are on iv bisphosphonates are susceptible to BRONJ. Incidence of BRONJ: Patients undergoing oral bisphosphonate therapy are at a considerably lower risk for BRONJ than oncology patients on monthly IV bisphosphonates. The incidence of BRONJ in patients on oral BPs varies from 0.01 to 0.04%45 the incidence of BRONJ in patients with IV bisphosphonates is about 0.8-12%45. The incidence of BRONJ in Asian population was unknown till 2010. The first few reported cases of BRONJ in Asia were from South Korea. W.Park.N et al 201046 reported 5 cases of BRONJ caused by oral BPs in Asian population. Authors concluded that irrespective of race elderly women undergoing steroid therapy have an increased incidence of BRONJ even with oral BPs. Another
retrospective study conducted by Hong JW 2010,47 suggested the prevalence of BRONJ to be 0.05 to 0.07%. The authors concluded that the prevalence of oral BRONJ in Korea is similar to that reported previously in Western populations. The BRONJ is clearly an uncommon complication of oral BP administration, however the sheer volume of prescriptions of this drug throughout Asia may mean that many cases are likely to present in future. The summary of incidence of BRONJ in Asian literature46-49 and comparison with that of western literature is outlined in table 7. Although the reported incidence of BRONJ in western literature50-54 is more, we have outlined only a few, as it is beyond the scope of this review to list them all Aetio-pathogenesis of BRONJ: The incidence of BRONJ is more in jaw bones compared to rest of the skeleton owing to its vascularity. However this view has been challenged by Bauss F and Pfister T, 200855 suggesting similar uptake of ibandronate by spine, femur and jaw bones. Hence the aetiology for BRONJ remains unclear. The alternative explanation could be the initiation of BRONJ is in the mucosa rather than in bone. This view has been supported by Landesberg 2008,56 who showed pamidronate inhibits oral keratinocyte wound healing. Further Kim et al 201157,58 in their in vitro study showed that BPs can cause aging of keratinocyte and result in defective re-epithelialisation inside the mouth and they hypothesised that this could be contributing factor towards poor mucosal healing. Primarily the action of BP is said to be on bone cells3 . However few reports suggests bps inhibit angiogenesis by hampering vascular endothelial growth factor and also endothelial proliferation, thus reduced capillary tube formation, vessel sprouting and loss of blood vessel resulting in avascualr necrosis. However the anti angiogenic property of BPs has been challenged by a histological study who reported normal vascularity in bones exposed to BPs4,59,60 CLINICAL FEATURES: BRONJ can be presented in various forms such as unexplained pain, numbness, altered sensation to frank necrosis of the bone depending on the severity of the condition. The procedures such as placement of dental implants, minor oral surgical procedures, periodontal non surgical and surgical procedures and ill-fitting dentures can lead to BRONJ.6 Frequently non healing sockets presentation following extraction is common.6
Diagnosis of BRONJ:
Several investigative procedures are available for detecting early BRONJ [see box 2], yet there are no confirmatory tests available till date. The lab based investigation such as tissue biopsy is useful to rule out the possibility of metastatic malignant lesions. In addition panoramic radiographs may also be useful in cases of suspected metastases, though they are non specific. If there is a sequestrum shown on the radiograph this could help to differentiate from metastatic lesions.
Differential diagnosis58:
The diagnosis of potential BRONJ case needs the elimination of other possibilities such as Osteoradionecrosis, infectious osteomyelitis, neuralgia induced cavitational osteonecrosis, bone tumours, periapical pathology due to carious lesion, periodontal disease causing exposure of bone but with no history of bisphosphonate use, mucositis. “Concept of drug holiday”4,58,45,63 Temporarily withdrawing BPs for the purpose of reducing the risk of BRONJ following dental extractions has been recommended. Drug holiday can be three months before and after the extraction, with physician’s approval. Besides the dental purpose this concept has place even to reduce the non skeletal adverse events.64
Management of patients with established BRONJ:6,62,65
The exposed and sharp edges of necrotic bone should be debrided under local anaesthesia, If associated with infection, such as erythematous tender areas with suppuration and/or sinus tracts, systemic antibiotics are administered.59,66 The management of these patients may range from pain control till surgical resection of the jaws. Teeth with extensive carious lesion should undergo endodontic therapy instead of extraction. The endodontically treated teeth can be used as an abutment for over denture. Grade III mobile teeth can be extracted atraumatically and the patient should be followed up weekly for the first four weeks, then monthly until the sockets are healed and also there could be an indication for the empirical use of systemic antibiotics. Amoxicillin is the drug of choice, however the combination of amoxyllin and / clindamycin could offer extra benefit of bone penetration and wider spectrum of activity.60 PRINCIPLES IN THE CLINICAL USE OF BISPHOSPHONATES: Pre treatment evaluation Patient should be assessed by dentist before starting of the BP therapy. This requires communication between the physician/oncologist, patient and the dentist. As per the western literature about 41% 45 of physicians warn their patients about the risk of BRONJ and Asian literature does not provide any data on this issue. Benefits and risks:45,65,67 The issue of BRONJ must be dealt with caution as we cannot ignore the beneficial effects of bisphosphonates, such as prevention of morbidity and mortality in osteoporotic patients. Besides in-vitro research has suggested the bisphosphonates may have anti-tumour effects in breast cancer, prostate and lung cancers via alteration of adhesion of malignant cells to the extracellular matrix. Alternative bone modifiers may be considered, however their costs, potential adverse effects and the suitability influence the final decision
Alternative bone modifiers:
Denosumab58 is a monoclonal antibody, acts on the RANK ligand system, thus inhibiting osteoclastic resorption68. Stopeck A T 201069 conducted a randomized double blind study and found that denosumab compared to zoledronic acid reduced events such as skeletal fractures. Teriparatide [PTH 1-34]68 is a synthetic parathyroid hormone with anabolic effects on the bone. Although the net effect of excess PTH is to induce bone resorption, in low and intermittent doses it promotes bone formation by indirectly involving insulin growth factor 1, without stimulating bone resorption.70
Raloxifene is a selective estrogen-receptor modulator, which retains the beneficial effects on bone without deleterious effects on breast and uterus. This is approved for treatment of osteoporosis68,71 Strontium ranalate is composed of an organic ion, ranelic acid, bound to two atoms of strontium. This acts by blocking osteoclast differentiation and induces apoptosis and thus inhibiting bone resorption68. To conclude, there are plenty of evidence to suggest that bisphosphonates are used extensively by physicians and oncologists. In addition therapeutic application in dentistry have also been explored in invitro, animal and human studies. This review focussed on human studies alone. Available Asian literature based on randomized controlled clinical trials on the local drug delivery have shown promising results. However there is lack of evidence on the systemic use of bisphosphonates in the treatment of periodontal disease. Further, there are very few Asian literatures regarding BRONJ. This could be due to lack of communication between dentists and medical specialists. In our view pretreatment dental evaluation must be made mandatory and perhaps some guidelines by Asian authorities across the continent would be useful in assessing the incidence of BRONJ and prevention of the same
ACKNOWLEDGEMENTS
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=778http://ijcrr.com/article_html.php?did=7781. Newman,Takei, Klokkevold, Carranza. Carranza’s Clinical Periodontology 11th edition: Perry R, Klokkevold and Brian L Mealey, Part 5, Chapter 27: influence of systemic condition on the periodontium. Elsevier publications, 2011: 315- 317.
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15. You L, Sheng ZY, Chen JY, Pan L, Chen L. The safety and efficacy of early-stage bi-weekly alendronate to improve bone mineral density and bone turnover in chinese postmenopausal women at risk of osteoporosis J Int Med Res 2011;39(1):302-10.
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33. Salvi GE, Lang NP. Host response modulation in the management of periodontal diseases. J Clin Peridontol 2005; 32 (Suppl. 6): 108–129.
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35. Zang C, Zhai J, Meng Y, Liang X. Developments in research of local bisphosphonate delivery system of implant denture. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2011: Apr; 28(2):415-8. [Article in Chinese]
36. BasmaMostafa, Ebtehalhamdy, NermineNassif. Combined effect of systemic Bisphosphonates, calcium and vitamin D on alveolar bone in osteoporotic post menopausal females having chronic periodontitis following surgical periodontal therapy. Life science journal 2012;9(3):613-622.
37. Bastian Peter, Olivier Gauthier, Samia La?¨b, Bruno Bujoli, Je´roˆme Guicheux, Pascal Janvier, G. Harry van Lenthe, Ralph Mu¨ ller, Pierre-Yves Zambelli, Jean-Michel Bouler, Dominique P. Pioletti. Local delivery of bisphosphonate from coated orthopedic implants increases implants mechanical stability in osteoporotic rats: J Biomed Mater Res 76A: 133–143, 2006.
38. Ying Gao, Shujuan Zou, Xiaoguang Liu, Chongyun Bao, Jing Hua, The effect of surface immobilized bisphosphonates on the fixation of hydroxyapatite-coated titanium implants in ovariectomized rats: Biomaterials 30 (2009) 1790–1796 [Chinese].
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40. Abtahi J, Tengvall P, Aspenberg P. A bisphosphonate-coating improves the fixation of metal implants in human bone. A randomized trial of dental implants. Bone. 2012 May; 50(5):1148-51.
41. M. Yoshinaria, Y. Odaa, T. Inoueb, K. Matsuzakab, M. Shimono. Bone response to calcium phosphate-coated and bisphosphonate immobilized titanium implants: Biomaterials 23 (2002) 2879–2885.
42. Lane N, Armitage GC, Loomer P, Hsieh S, Majumdar S, Wang HY, Jeffcoat M, Munoz T. Bisphosphonate therapy improves the outcome of conventional periodontal treatment: results of a 12-month, randomized, placebo-controlled study. J Periodontol. 2005 Jul; 76(7):1113-22.
43. Rocha M, Nava LE, Vázquez de la Torre C, Sánchez-Márin F, Garay-Sevilla ME, Malacara JM. Clinical and radiological improvement of periodontal disease in patients with type 2 diabetes mellitus treated with alendronate: a randomized, placebo-controlled trial. J Periodontol. 2001 Feb;72(2):204- 9.
44. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate Related Osteonecrosis Of The Jaws. Update: 2009; 67:2-12. Task Force On Bisphosphonate Related Osteonecrosis Of The Jaws.
45. Gareth Brock, Kate Barker, Christopher J Butterworth, Simon Rogers. Practical considerations for treatment of patients taking bisphosphonates medications: An Update. Dent Update 2011;38:313-326.
46. W.Park.N, K.Kim.M, Y.Kim.Y, M.Rhee, H.J.Kim . Osteonecrosis of the jaw induced by oral administration of bisphosphonates in Asian population-5 cases. Osteoporos Int 2010;21:527-533.
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48. Kwon TG, Lee CO, Park JW, Choi SY, Rijal G, Shin HI. Os-teonecrosis associated with dental implants in patients undergoing bisphosphonate treatment. Clin Oral Implants Res. 2012 Dec 26. doi: 10.1111/clr.12088. [Epub ahead of print].
49. Yamazaki T, Yamori M, Ishizaki T, Asai K, Goto K, Takahashi K, Nakayama T, Bessho K. Increased incidence of osteonecrosis of the jaw after tooth extraction in patients treated with bisphosphonates: a cohort study. Int J Oral Maxillofac Surg. 2012 Nov; 41(11):1397-403. doi: 10.1016/j. ijom.2012.06.020. Epub 2012 Jul 26.
50. Assaf AT, Smeets R, Riecke B, Weise E, Gröbe A, Blessmann M, Steiner T, Wikner J, Friedrich RE, Heiland M, Hoelzle F, Gerhards F. Incidence of bisphosphonaterelated osteonecrosis of the jaw in consideration of primary diseases and concomitant therapies. Anticancer Res. 2013 Sep;33(9):3917-24.
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54. Hom-Lay Wang, Daniel Weber, Laurie K. McCauley. Effect of Long-Term Oral Bisphosphonates on Implant Wound Healing: Literature Review and a Case Report; Journal of Periodontology, March 2007, Vol. 78, No. 3, Pages 584-594.
55. Bauss F, Pfister T, Papapoulos S. Ibandronate uptake in the jaw is similar to long bones and vertebrae in the rat. J Bone Miner Metab 2008;26;406-408.
56. Regina Landesberg, Matthew Cozin, Serge Cremers, Victoria Woo, Stavroula Kousteni, Satrajit sinha, LeeAn Garrett Sinha, Srikala Raghavan. Inhibition of Oral mucosal cell wound healing by bisphosphonates. J Oral Maxillofac Surg 2008; 66:839-847.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20PREVALENCE OF DOMESTIC VIOLENCE AND HEALTH SEEKING BEHAVIOR AMONG WOMEN IN RURAL COMMUNITY OF PUDUCHERRY - A CROSS SECTIONAL STUDY
English2023S. RajiniEnglish C. Kamesh vellEnglish S. SenthilEnglishBackground: Violence against women is one of the major public health and human rights problem in the world today. Domestic violence refers to the violence emanating from the household and within relationships covered by familial or emotional attachment. Objectives: To estimate the prevalence of Domestic Violence among rural women. To find out the type, reasons and help seeking behavior of Domestic Violence. Materials and methods: A Descriptive cross sectional study was undertaken among 380 women in three villages, which comes under the field practice area of Department of Community Medicine, AVMC&H. The prevalence of Domestic Violence (DV) was (200 women) 52.6%, among 380 women who participated in the study. Prevalence of DV was more among 31-40 yrs of age group, 44%, and 95% were Hindus, 83.5% lived in nuclear family, 43% were married for more than 6-10 yrs and 48.5% has 2-3 living children. The study shows that 79.5% of husbands were involved in the act of DV and 52% of the participants reported slapping/kicking/beating are the more common physical act of violence. Regarding the types of injury 63 (31.5%) women had minor injuries, which needed no treatment, 44.5% had pain which lasted for more than one day. It was reported that 65.5% faced DV because of the influence of alcohol by their partners and regarding the help seeking behavior, 35% of them had sought some help and 26% have never told anyone about the incident. Conclusion: These results provide vital information to assess the situation to develop interventions as well as policies and programmes towards preventing domestic violence against women.
EnglishINTRODUCTION
According to available statistics from around globe, one out of every 3 women has experienced violence in an inmate relationship at some point of time in her life. In recent years violence against women has emerged as an important social problem in rural India. It has attracted the attention of a wide spectrum of agencies, from health care providers to law enforcement authorities. Domestic violence is a global issue reaching across national boundaries as well as socio-economic, cultural, racial and class distinctions. Domestic Violence against women is an age old phenomenon. Women always considered weak, vulnerable and in a position to be exploited. Violence IJCRR has long been accepted as something that happens to women. The gender imbalance in Domestic Violence is partly related to differences in physical strength and size. Moreover, women are socialized into their gender roles in different societies throughout the world. (1) Females can suffer from violence throughout their life cycle as fetuses may be aborted just because they are female, infants may be killed just because they are females, girls may be neglected or subjected to various other types of abuse, adolescents may be raped, married women may be beaten, raped or killed by their husbands and widows may be neglected.
The prevalence of domestic violence (DV) in India ranges from 6 percent to 60 percent, (2) with considerable variation across states in different settings. (3,4) In India, few community-based micro level studies (5) are available, which confine to physical violence but evidence on psychological violence and sexual violence is limited.(6) The term domestic violence includes any form of verbal abuse, physical, psychological or sexual violence faced by women.
MATERIALS AND METHOD
The study was a community based cross- sectional descriptive study, done in 3 villages which were randomly selected in Puducherry which comes under the field practice area of Community Medicine, AVMC&H. A houseto- house survey was conducted to all women more than 18 yrs of age, married and having at least one child who were present during the visit were included in the study. The data was collected by the trained paramedical workers by interview method after obtaining oral consent. Houses locked and those not willing to participate were not included in the study. Demographic data including their age, education, social class, religion, type of family, number of married years, occupation of their husband and living children were collected. Other particulars like type of injury, type of violence, help seeking behavior and reasons for the violence were also collected. The data was collected by using a predesigned and pretested questionnaire. The collected data was analyzed using descriptive statistical methods.
RESULTS
The study was conducted in three villages and 380 women participated in the study. Among these 380 women, who were interviewed the prevalence of domestic violence was present in 200 women (52.6%). Almost 94.5% were Hindus, 83.5% living in nuclear family, 43% of females were married for more than 6-10yrs and 48.5% had 2-3 living children. Prevalence of Domestic Violence was more (44%) among women in the age group of 31- 40 yrs, followed by < 20yrs (25.5%). Table 1 also shows that prevalence of Domestic Violence were more among females with primary and middle schooling 31.5% and 29% respectively and less (8.5%) among diploma/ graduates. It was also observed that 33% of Domestic Violence cases were with husband who had only middle school education. Even husband with higher education level, 24.5% were involved in the Domestic Violence act. Domestic Violence was reported in 31% and 25.5% of women with their husband’s occupation as agriculture and other coolie laborers respectively. This study shows that mostly husbands (79.5%) were involved in the act Domestic Violence. Table 2 shows the types of violence reported by the respondents. The 52% of the participants reported slapping/kicking/beating were the more common physical act of violence, which was followed by usage of abusive language as 36.5%. Twenty one women (10.5%) reported that they have been threatened by immolation or hanged to death by their husbands. Regarding the types of injury 63 women (31.5%) had minor injuries, which needed no treatment, 44.5% had pain for more than one day and 17% of the females required medical treatment. The participants were asked about the causes which led to the Domestic Violence. It was observed that 131 of the women (65.5%) faced Domestic Violence when their partners were under the influence of alcohol. Other reasons were dominant nature, quarrelsome, extramarital affairs and financial problems, which contributes 12%, 6.5%, 6.5% and 5% respectively as shown in Figure 1. Regarding the help seeking behavior of the women facing Domestic Violence, 35% sought help from any source. Seventy eight women (39%) have told someone and 26% have never told or sought help from anyone regarding the incident (Figure 2).
DISCUSSIONS
The actual prevalence of Domestic Violence against women in many countries are not known due to under reporting, as women still consider it to be social stigma.
The present study shows that prevalence of Domestic Violence (52.6%), as in India which is considerably high persisting across all socioeconomic strata. In the study it was also observed that 44% of the participants in the age group of 21-30 yrs experienced Domestic Violence. Similar finding was reported in the study done by Shreemanta kumar et al(7) and Madhutandra sarkar et al(8) that 43% experienced Domestic Violence in the same age group. Maximum prevalence was observed among Hindus (94.5%), 31.5% have done primary schooling and 14.5% been illiterates. No significant association was found with socio-demographic variables like no. of married years, no. of children, and type of family and socio economic status of the family. The present study shows that 79.5% of Domestic Violence was caused by the husbands, which was similar to Madhutandra (72.73%) in his study. one thirty one females (65.5%) reported that the perpetrators were intoxicated during the act of violence. Slapping/kicking/beating were the most common physical assault experienced by 52% of the respondents. Similar finding was reported by the study done by Nair et al in Gujarat (9) and Madhutandra in West Bengal(8) as 80% and 72.73% respectively. Women subjected to verbal abuse and threats by their partners were 36.5% and 10.5% respectively. Dr. shreemanta et al,(7) also observed similar finding in their study at 42% and 8% respectively. The study also showed 44.5% of them who had injuries had pain lasted for more than a day, followed by 31.5% of them having minor injuries. Medical attention/hospitalization was required by 17% of the individuals. More or less similar finding was reported by Shreemanta(7) in his study. The woman who has undergone Domestic Violence, only 35% have sought help from some source and 26% of the respondents have never sought any type of help from anyone. Some of the women (39%) have told someone about the violence. In a study done by VR.S .Kavitha(10) only 23% of the women have sought some help and most (73%) of them have never sought any help. In the present study 65.5% of the women reported that alcohol intoxication was the main reason for the violence, followed by dominant nature of their husband 12%, quarrelsome and extramarital affairs as 6.5% and 6.5% respectively.
CONCLUSIONS
Domestic violence is associated with literate level of the females. Most of the females are not aware of their rights. They tend to accept violence as something normal. There is a need for sustained educational campaigns to bring change in the community’s attitudes, particularly those of the females themselves. There is also a need for organizations that would support and victims of the domestic violence with shelter, legal aid and awareness. The women organizations and mass media in the villages should play a more active role in preventing and reducing domestic violence.
ACKNOWLEDGEMENT
Authors are thankful to CRRI students of AVMC&H and Mrs. Kousalya, Non-teaching staff of Department of Community Medicine for their support in data collection & analysis. 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=779http://ijcrr.com/article_html.php?did=7791. Ravneet Kaur and Suneela Garg, et al. Addressing Domestic Violence against women; An unfinished Agenda. Indian J Community Medicine. Apr 2008; 33 (2): 73-76.
2. International institute of population sciences and ORC macro. National family health survey (NFHS-3), 2005-06: India. Mumbai: IIPS; 2007.
3. Jeyaseelan L,Kumar S, Neelakantan N,et al. Physical spousal violence against women in India: some risk factors. J Biosoc sci 2007; 39:657-70.
4. Krishanan S. Do structural inequalities contribute to marital violence? Ethnographic evidence from rural South India. Violence against women 2005; 11:759-75.
5. Visaria L. Violence against women: a field study. Econ Polit wkly 2000; 351742-51.
6. Babu BV, Kar SK. Domestic violence against women in Eastern India: a population based study on prevalence and related issues. BMC Public Health 2009; 9:129.
7. Violence against women; Evidence from rural Andra Pradesh. (Eluru, W.G.Dist), India. JIAFM, 2006: 28(4) ISSN; 0971-0973.
8. A study on Domestic Violence against Adults and Adolescent females in a rural area of West Bengal. Indian Journal Community Med. April 2010;35 (2):311-315.
9. Nair U, Sadhwani H, Uttekar V. CRDC Research summary. Baroda: centre for Research in Development and change; 2000. A study on domestic violence in rural Gujarat.
10. Spousal Domestic Violence of Married women in India. V.R.S. Kavitha; J Sociology Soc Anth, 3(1): 7-13 (2012).
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20Study of demographic profile of skin tumors in a tertiary care hospital
English2428Sonam S NandyalEnglish Rekha B. PuranikEnglishIntroduction: Skin tumors encompass a wide spectrum and belong to a diverse group of neoplasms arising from epidermis, adnexal structures and dermis rendering the classification difficult. Worldwide these tumors show a striking variation in demographic profile. Aim: The aim of our study was to analyse the distribution of skin tumors with reference to age and sex. Materials and methods: This is a descriptive study conducted for a period of five years at Department of Pathology in a tertiary hospital. The study included all histopathologically confirmed cases of skin tumors. Results: Out of 135 skin tumors, 46 were benign and 89 were malignant. Malignant epidermal tumors formed the majority (57%). The benign tumors had a peak incidence between 3rd and 5th decade (52%) with female predominance (60.87%). The malignant tumors showed a peak incidence between 5th and 7th decade (68.5%) with male preponderance (71.91%).
Conclusion: Benign tumors were common in younger age group and more common in females where as malignant tumors were commonly seen in males and displayed an ascending trend in age. Patients with basal cell carcinoma(BCC) and melanoma were on an average a decade older at the time of diagnosis when compared to squamous cell carcinoma(SCC). The present statistics show that skin cancer incidence in men is higher than women which attributes to the cumulative effect of sun exposure in males. Most of our findings correlate with Indian published literature.
EnglishSkin tumors, demographic profile, age distribution, sex distribution.INTRODUCTION
The skin is a complex organ and because of its complexity anextensive range of diseases can develop from the skin including tumors. Skin tumors are so ubiquitous that they can affect people of all ages and they are an ideal subject for study from demographic point of view. We have divided the skin tumors into benign and malignant epidermal, adnexal and melanocytic categories. The frequency of skin cancer increases with age.1 Melanomas are rare before puberty.2 Cumulative sun exposure which differs between males and females is believed to be the principalcause of non melanoma skin cancer (NMSC) and melanomas.2,3The specific aim of our study was to estimate the age and sex distribution of skin tumors encountered in our department. IJCRR
Materials and methods
This is a 5 year retrospective and prospective study conducted at Department of Pathology in a tertiary care hospital, Hubli which mainly caters to the large area in Northern Karnataka. All the biopsies and specimens submitted for histopathological study during the period from July 2005 to June 2010 were included in the study. The paraffin embedded, H and E stained histopathology slides were reviewed. The relevant clinical details available from the histopathology request forms were also noted.The cases were categorized according to WHO classification. The study included tumors of epidermis along with melanocytic tumors and appendageal tumors. Mesenchymal tumours, hematological tumors and skin secondaries were excluded.
Results
We received a total of 25,658 specimens for histopathology during the study period. 229 cases presented as skin tumors and out of these, 94 were non neoplastic lesions which were excluded from the study and the remaining 135 were histopathologically confirmed cases of tumors of skin. Out of 135 cases, 46 were benign and 89 were malignant tumors among which malignant epidermal tumors formed the majority (57%).The ratio of benign to malignant tumors was 1:1.93. The ratio of benign epidermal (11) to malignant counterpart (77) was 1:7, benign adnexal (25) to malignant adnexal (6) was 4.2:1 and benign melanocytic (10) to malignant(6) counterpart was 1.6:1. Among the benign tumors, adnexal tumors (54%) formed the majority. Among the malignant tumors, squamous cell carcinoma (SCC) was commonest (55%), followed by basal cell carcinoma(BCC), verrucous carcinoma and malignant melanoma and adnexal carcinomas.
Benign Tumors
Among the 11 benign epidermal tumors, 6 were verruca vulgaris and 5 were seborrheic keratosis. Patients with verruca vulgaris showed age range of 10-65years with amale to female ratio of 2:1. Five cases of seborrheic keratosis were seen in 3 male and 2 female subjects, with male to female ratio of 1.5:1. Age range was 38-72 years. Among the 25 cases of benign adnexal tumors, 8 were males and 17 were females. The male to female ratio of 1:3.3 and 1:1.2 was observed in hair follicle tumors and sweat gland tumors respectively. There were 9 cases of intradermal nevus and one case of compound nevus.Peak incidence was seen between 20-40 years (60%). There was female predominance with male to female ratio of 1:2.3. Malignant tumors Current study had 49 histologically confirmed cases of SCC with peak incidence in 7th decade in males and 6th decade in females with male preponderance (80%).The youngest age was 24 years and oldest age was 78 years. Majority of cases were between 6th and 7th decade(59%). Eight cases of verrucous carcinoma were encountered. Patients’ age ranged from 25 to 75years with a peak incidence in 5th to 6th decade (50%). Majority of cases occurred in males (75%). BCC showed a Peak incidence in 8th decade. The male to female ratio was 1.2: 1. Mean age at diagnosis was 60.6 years. There were 6 cases of malignant melanoma. The youngest age was 28 years and oldest age was 70 years. Majority of cases were seen between 60-79 years (66.66%). Sex distribution showed a significant male predominance (83%). Six cases of adnexal carcinomas showed an equal sex ratio with mean age of 47 years. The youngest age was 11 years and oldest was 78 years.
Discussion
Only 135 cases in a 5 year period indicate that skin tumors are relatively uncommon. To our knowledge, no significant data on the study of age and sex distribution of overall skin tumors is available. Benign tumors Among the benign tumors, epidermal tumors showed a male predominance where as adnexal and melanocytic tumors showed a significant female predominance. Seborrheic keratosis is a common benign epidermal skin growth after middle age.5 The larger studies are done by Maize JC et al6 and Rajesh G et al7 who observed 108 and 250 cases of seborrheic keratosis respectively. Rajesh G et al7 observed a male-to-female ratio of 1:1.04 and the most common age group affected was 60 years and above (40%). In our study the most common age group affected was > 40 years (80%) with male predominance. Viral warts are common in the younger age groups. Sudhakar Rao KM et al studied 90 cases of verruca vulgaris and majority of the patients were students and belonged to the age group of 11-20 yrs and males outnumbered females(74.44%).8 In our study majority of cases were seen Englishhttp://ijcrr.com/abstract.php?article_id=780http://ijcrr.com/article_html.php?did=7801. Noorbala MT and Kafaie P. Analysis of 15 years of skin cancer in central Iran. Dermatology Online Journal. 13 (4):1.
2. Sampat MB, Sirsat MV. Malignant melanoma of the skin and mucous membranes in Indians. Ind J Cancer1966; 6: 228-53.
3. Dias Souza et al. Topography of BCC and their correlation with gender, age and histologic pattern: a retrospective study of 1042 lesions. An Bras Dermatol 2011; 86(2):272- 7.
4. Glanz K, Carbone E and Song V. Formative research for developing targeted skin cancer prevention programme for children in multi ethnic Hawii. Health Educ. Res 1999; 14(2):155-66.
5. Chen M, Shinmori H, Takemiya M and Miki Y. Acantholytic variant of seborrheic keratosis. J Cutan Pathol 1990;17:27- 31.
6. Maize JC and Sinder RL. Non melanoma skin cancer in association with seborrheic keratosis: Clinicopathologic correlations. Dermatol Surg1995; 21: 960-962.
7. Rajesh G, Thappa DM, Jaisankar TJ and Chandrashekar L. Spectrum of seborrheic keratosis in South Indians: a clinical and dermoscopic study. Indian J DermatolVenereolLeprolJul-Aug 2011;77(4):483-8.
8. Sudhakar Rao KM, Ankad BS, Naidu V, SampaghaVi VV, Vinod, Aruna M.S. A Clinical Study on Warts. Journal of Clinical and Diagnostic Research 2011; Vol-5(8): 1582-4.
9. Saimila MOA. Adnexal skin tumors in Zaria, Nigeria. Annals of African Medicine 2008; Vol. 7, No.1: 6-10.
10. Solanki RL, Anand VK, Gaur SK, Arora HL and Gupta R. Neoplasms of hair follicle. Indian journal of Dermatology Verereol Leprology 1989;55:33-7.
11. Solanki RL, Anand VK. Neoplasms of sweat gland. Indian J of Dermatol Venerol Leprol1989; 55:108-12.
12. Azam S, Mubarik A, Ahmad M. Histopathological study of benign melanocytic nevi. Pakisthan Armed Forces Medical Journal 2008;(2).
13. Gayathri S, Alavandar E and Kumar KA. Clinicopathological study of melanocytic tumors of skin. Int J Pharm Bio Sci2013; 4(1):416 – 21.
14. Deo SV. Surgical management of skin cancers: Experience from a regional cancer centre in North India. Indian Journal of Cancer2005; 42:145-50.
15. Katalinic A. Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig- Holstein, Germany: incidence, clinical subtypes, tumour stages and localization. British Journal of Dermatology2003;149:1200-06.
16. Kulkarni PV, Jaiswal SS. Profile of malignancies at medical college. Ambojogai (15 years retrospective study).Ind J Cancer 1996; 33:31-6.
17. Kapoor R, Goswami KC. Pattern of cancer in Jammu region (Hospital based study 1978-89). Ind J Cancer 1993; 30:67- 71.
18. Al-Hilli F. Skin cancer in Bahrain. Bahrain Medical Bulletin 2005: 27(3):1-9.
19. Budharaja SN, Pillai VCV, Periyanagam WJ, Kaushik SP and Bedi BMS. Malignant neoplasms of skin in Pondicherry- a study of 102 cases. The Indian Journal of Cancer 1972: 284-95.
20. Chuang TY, Popescu AP. Squamous cell carcinoma. A population based incidence study in Rochoster, Minn. Arch Dermatol1990;126:185-8.
21. Kotwal M, Poflee S and Sudhakar B. Carcinoma cuniculatum at various anatomical sites. Indian J Dermatol2005;50:216-20.
22. Schwartz RA. Verrucous carcinoma of skin and mucosa Continuing medical education. J Am Acad of Dermatol1995;32(1):1-15.
23. Tiftikcioglu YIT, Karaaslan O, Aksoy HM, Aksoy B and Koçer U. Basal cell carcinoma in Turkey. The Journal of Dermatology 2005;32:946-50.
24. Solanki RL, Arora HL, Anand VK, Gaur SK, Gupta R. Basal cell epithelioma (A clinicopathological study of 172 cases). Indian J Dermatol Venerol Leprol 1989;(55):33-43.
25. Kikuchi A, Shimizu H and Nishikawa T, Clinical and histopathological characteristics of basal cell carcinoma in Japanese patients, Arch Dermatol 1996;132:320-24.
26. Scrivener Y, Grosshans and Cribier B. Variations of BCC according to gender, age, location and histological type. British journal of Dermatology 2002: 147:41-47.
27. Lipozencic J, Jurakic-Toncic R, Rados J and Celic D. Epidemiology of nonmelanoma and melanoma skin cancer in Zagreb, Croatia. Acta Dermatovenerol Croat 2008;16(4):193- 203.
28. Mukhopadyay S, Ghosh S, Siddhartha D and Mitra PK. A clinicopathological study of malignant melanoma with special reference to atypical presentation. IJPM 2008;51(4):485-88.
29. Reddy MK, Veliath AJ, Nagarajan S and Aurora AL. A clinicopathological study of adnexal tumours of skin. Indian journal of medical research 1982:882-89.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20Assessment of implementation status of Janani-Shishu Suraksha Karyakram (JSSK) for free referral transport
services at selected Public health facilities in Wardha district, of Central India
English2934R. C. GoyalEnglish Priya L. SinghEnglish Abhay MudeyEnglishBackground: In India about 67,000 women die every year due to pregnancy related complications like haemorrhage, infection, high blood pressure; unsafe deliveries, etc that may result in maternal and infant mortality. However, 25% pregnant women still hesitate to access health facilities due to High out of pocket expenses on Medical care and transport required to take pregnant women from home to the health facility and back. Govt. of India had launched, Janani-Shishu Suraksha Karyakram (JSSK) in Wardha district from September, 2011 to ensure that each and every pregnant woman and sick neonates up to 30 days gets timely access to health care services including transport free of cost. Objective: To assess awareness, availability and utilization of Referral transport services to pregnant women and sick newborns at selected Public health facilities in Wardha district, Maharashtra. Material and Methods: This was a community and facility based observational cross-sectional study conducted from September 2012 to August 2013 at two Primary Health Centres (PHCs). All mothers (120) having children less than six months of age were interviewed. A modified pre-tested Questionnaire (JSSK Guidelines)(1) was used to assess the implementation status of JSSK for free referral transport services at villages. All health professionals from selected public health facilities were also interviewed. The collected data was entered and analysed by using software SYSTAT 12.0 version. Results: Only 28.00 % pregnant women and NO sick newborns availed free referral transport services from home to health institutions; Nearly one-fifth (19.24%) pregnant women and 50.00% sick newborns availed free referral transport services from transfer to higher level facility for complications; Nearly two-third (65.83%) pregnant women and no sick newborns availed free referral transport services to drop back home in the study area. Conclusion: Although JSSK had been started in Wardha district since September 2011; however, the awareness and utilization of free referral transport services were not to the fullest extent. Gaps were found between the reported figures by health professionals and actual responses of study participants (mothers).
EnglishJSSK, Pregnant woman, free referral transport services, Utilization, AvailabilityINTRODUCTION
In India about 67,000 women die every year due to pregnancy related complications like haemorrhage, infection, high blood pressure; unsafe deliveries, etc that may result in maternal and infant mortality. Similarly, every IJCRR year approximately 13 lakhs infants die within one year of birth. Out of this, 9 lakhs newborns that die within four weeks of birth (2/3rd of the infant deaths); about 7 lakhs i.e. 75 % die within the first week (a majority of these in the first two days after birth). The first 28 days of infancy period are therefore very important and critical to save children. Both maternal and infant deaths could be reduced by ensuring timely access to quality services, both essential and emergency, in public health facilities without any burden of out-of-pocket expenses. (1) However, 25% pregnant women still hesitate to access health facilities. Important factors affecting access include: High out of pocket expenses on transport required to take pregnant women from home to the facility, to higher facility in case she is referred further, and for going back from the health institution to her home.(1) Govt. of India had launched Janani-Shishu Suraksha Karyakram (JSSK), to ensure that each and every pregnant woman and sick neonates upto 30 days gets timely access to health care services including transport free of cost.(1) JSSK was implemented in September 2011 in Wardha district and till the time of this study evaluation of JSSK was not done at any place in Vidharbha region and especially in Wardha district. Hence, this topic was selected to know the implementation status (availability and utilization) of JSSK in relation to provision for free referral transport services at selected government health facilities in Wardha district, Maharashtra.
Objectives
1. To assess awareness of free referral transport services among pregnant women at selected Public health facilities.
2. To find out availability and utilization of referral transport services to pregnant women and sick newborns at selected Public health facilities in the study area.
3. To suggest measures to improve availability and utilization of services under JSSK at selected Public health facilities.
Material and Methods
Wardha district has a total population of 12, 96,157 (Census 2011)(4) inhabitants in eight blocks and situated in eastern part of Maharashtra. This was a community and facility based observational cross-sectional study conducted between September 2012 to August 2013 at Two Primary Health Centres (PHCs) i.e. one best performing and other least performing for JSSK services based on District Health Office Reports in two blocks i.e. Deoli and Wardha block. All mothers (120) having children less than six months of age who delivered between September 2012 to February 2013 and public health professionals at selected Government Health Facility were included in the study. Multi-stage simple random sampling method was used. Information was collected by face-toface interview techniques using a third party validated modified pre-tested Questionnaire (JSSK Guidelines) in local language after obtaining informed written consent from mothers and health professionals. The information obtained from mothers include-Socio-demographic information, Awareness, availability and utilization of free referral transport services provided under JSSK. The information from JSSK service providers included Health worker female at Sub-Centres, Medical Officer at Primary Health Centres, Medical superintendent at Rural Hospital, Civil Surgeon at DH, Taluka Health Officers at Taluka health office and District Nodal Officer (JSSK, RCH officer) as per guidelines for JSSK. Secondary data was collected from the available reports and the records at health facility regarding the availability and utilization of the services under the JSSK for verification of primary data. A written permission from the District Health Officer was obtained. The study protocol was approved by Institutional Ethics Committee. The collected data was entered and analysed by using software SYSTAT 12.0 version. The descriptive analysis of data was depicted in graphs, percentages etc. Chi–square test and Z-test was used and significance level was considered, at p-value < 0.05.
Results
This study was done at two blocks of Wardha district wherein beneficiaries of JSSK and JSSK service providers were studied. JSSK Beneficiaries (Mothers) Socio-demographic profile of study participants(mothers) revealed that maximum number of study participants belong to age group of 20-24 yrs (68.33%) followed by 25-29 yrs (23.33%). Housewives were more (83.07%) followed by farm labours (12.05%) and self-employed (04.88%). Literacy rate was very high (98.00%). However, education level up to intermediate was high (63.65%) at PHC Nachangaon under Deoli block as compared to PHC Talegaon(Ta) under Wardha block (18.51%) at a significance level of pEnglishhttp://ijcrr.com/abstract.php?article_id=781http://ijcrr.com/article_html.php?did=7811. Ministry of Health and Family Welfare. Guidelines for Janani-Shishu Suraksha Karyakram (JSSK). National Rural Health Mission, Maternal Health Division, Government of India, Nirman Bhavan, New Delhi, June 2011.
2. Ministry of health and Family Welfare, UNICEF and Government of India (2009). Coverage evaluation survey 2009 All India report 2010; PP: 68,73. (Available at- http://www.unicef.org/india/health.html)
3. Gayatri Rathore. Janani-Shishu Suraksha Karyakram: Rajasthan Experience, National Rural Health Mission, Rajasthan 2012.
4. Jhimly Baruah. Janani Shishu Suraksha Karyakram-Progress and challenges (10states). Public health planning, National Health Systems Resource Centre.Government of India, Nirman Bhawan, New Delhi 2012.
5. Indian Institute of Health Management and Research. Janani Shishu Suraksha Karyakram- Report; Rajasthan Oct 2011 to March 2012.
6. Himanshu Bhushan. Janani- Shishu Suraksha KaryakramReview. Ministry of Health and Family Welfare, Government of India, Nirman Bhawan, New Delhi, September 2012.
7. National Rural Health Mission. Implementation status of JSSK Report. Government of West Bengal. West Bengal 2012. (Availableat-www.wbhealth.gov.in/NRHM/pdf/JSSKReport )
8. National Rural Health Mission. Implementation status of JSSK Report. Government of Nagaland, Nagaland 2012 (Available at-www.wbhealth.gov.in/NRHM/pdf/JSSKReport)
9. Department of health and Family Welfare. Implementation status of JSSK Report. National Rural Health Mission, Government of Meghalaya, Meghalaya 2012. (Available athttp://meghealth.nic.in/NRHM/pdf/JSSK Report/)
10. National Health System Resource Centre. Janani-Shishu Suraksha Karyakram- Review New Delhi, Quarter report 2012-2013.
11. National Rural Health Mission. Implementation status of JSSK (District level) Report, Goverment of Uttarakhand , Tehri Garhwal Uttarakhand 2013.
12. Ministry of health and family welfare. Implementation status of JSSK Report; National Rural Health Mission (2011- 2012) Maharashtra. (Available at- www.nrhm.maharashtra.gov.in/schjssk. html)
13. Rakesh Kumar. Maternal Health: Review meeting of state mission directors: Janani-Shishu suraksha karyakram. Ministry of Health and Family Welfare, Government of India Oct 2012.
14. State Institute of Health and Family Welfare. Implementation status of JSSK Report. Jaipur Sep 2012- July 2013. (Available at-www.sihfwrajasthan.com/ppt/full/JSSY.pdf)
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20PREDICTION OF AN INCREASE IN EYE PROBLEMS, IN IJEBU-ODE AND IJEBU NORTH LOCAL GOVERNMENT AREA OF OGUN STATE IN THE NEAREST FUTURE AS A RESULT OF SPENDING MUCH TIME ON COMPUTER / SMARTPHONE
English3540Akinola Kayode E.English Badmus N. IdowuEnglish Ogunobi Steven GbengaEnglishGood eyesight is an important part of wellbeing and a significant factor in retaining independence and quality of life as we get older. The World Health Organisation (WHO) estimates that up to 80 per cent of blindness and serious visual loss around the world is avoidable through prevention or treatment (https://www.guidedogs.org.au/importance-of-eye-health). The study is set out to predict an increase in eye related problems in the nearest future in Ijebu-Ode and Ijebu North Local Government of Ogun State, judging from the personal experience of the respondents. To elicit response for the study, the research design adopted was the surveyed method using questionnaire as the instrument for data collection. Five hundred and fifty (550) questionnaires were administered to different categories of people that use computer or handset from the two local government areas, out of which 519 (97.9%) were duly answered and returned to the researcher . Those that participated in the study are people from banking sector, tertiary institutions, health sector, and civil service. The selection cut across different professions. The data obtained were analyzed using Frequency Distribution, Pearson Correlation, Chi-Square and Crosstab. The result obtained showed in fig. 1 that headache, eyestrains, double vision, redness of eye, blurred eye and irritation of eyes are different problems majority of those who spent much time with Smartphone/Computer mostly have, while watery eyes and dryness of eye are in the minority. Also the results consistently show that in the nearest future there will be an increase in eye related problem in Nigeria.
EnglishComputer, Eyes Problem,Smartphone, Vision, Visual Display, Optometrist,Eyes Strain, DurationINTRODUCTION
Computer system has been very useful in almost every field of human endeavour, from offices to different shops and homes. Many people now work with computer for longer hours of time per day. Despite this computer usefulness there are a lot of problems that can be associated with the usage of computer over a long time (Olabiyisi, Akingboye, Abayomi, Izilien and Adeleke, 2013). Mobile devices such as smartphones or tablet PCs have already become ubiquitous. Recently, it has been increasIJCRR ingly common for people to check e-mail, browse on the Internet, watch movies, and even read books on their portable devices. Computers have become an indispensable part of modern life. Working for long hours in front of the computer is no longer confined to the office. Computers are now extensively used in schools and at home as well. With increased popularity of notebooks, tablets, smartphones and e-book readers, use of digital devices is no longer only limited to desktops. People use computerized devices for work, web surfing, social networking and playing video games. In this techno-age, children as young as two years are given touch screen devices like iPads to play and learn with. Professional video game players in South Korea are known to spend as long as 18 hours per day in front of their screens at a stretch. These accoutrements of modern living may give rise to a number of visual and ophthalmic problems. The ocular discomfort appears to increase with the amount of computer usage. Up to 90% of computer users may experience visual symptoms like blurred vision, eyestrain, headaches, ocular discomfort, dry eye and diplopia. The human focusing system responds well to images that have well defined edges with good contrast between the background and the letters. The characters on a computer screen are made of tiny dots called pixels. Pixels are the result of electronic beam striking the phosphorcoated rear surface of the screen. These characters have blurred edges as compared to letters on a printed page with sharply defined edges. This makes it difficult for the eye to maintain focus, thereby leading to eyestrain and fatigue (Chakrabarti 2007; Abelson and Ousler 1999, p.115). Presence of glare and reflections on the screen also worsen the symptoms (Rathore et al 2010). Computer users who are middle-aged and older may have presbyopia, an eye condition characterised by decreased near and intermediate visual acuities, which are needed for the various working distances of computer users (Izquierdo 2010). Working for prolonged hours of time looking at the computer monitor is a risk factor that may also lead computer users to have dry eye symptoms. Further, patients with pre-existing dry eyes may have exacerbated symptoms when using a computer (Izquierdo 2010). The specific objectives of this article is to: Determine if the number of respondents having eyes related problem from prolong use of computer/smartphone was significantly different from the number of respondents who does not have eyes related problem from prolong use of computer/smartphone and identify the variation in eyes related problems from prolong use of computer/smartphone as measured by a survey instrument. The article is arranged as follows: Section 2, contains the prediction of an increase in eye problems in two local governments’ areas of Ogun state in the nearest future , as a result of spending much time on computer/smartphone. The research methodology and the hypothesis of the study were carried out in section 3, section 4 deal with the results and suggestions and the concluding remark is in section 5.
THE PREDICTION OF AN INCREASE IN EYE PROBLEMS, IN IJEBU-ODE AND IJEBU NORTH LOCAL GOVERNMENT AREA OF OGUN STATE.
Facts and figures of problems resulted from long usage of computer or handset in Nigeria have not been documented. About sixty million people suffer from CVS (Computer Vision Syndrome) globally and a million new cases occur every year (Sen and Richardson 2007, p.45). In other parts of the world, the 2001 United States Census report states that more than 143 million Americans spend time on a computer every day, and that 54 million of them are children. According to the National Centre for Education Statistics, 95% of schools and 62% of all classrooms in the USA have had computers since 1999 (Izquierdo 2010). According to Dr. David Allamby, a leading laser eye surgeon: there has been a 35% increase in the number of people with advancing myopia since the launch of smartphones in 1997. He also warned that the problem could increase by 50 per cent in the next ten years. “The information age has taken a toll on our eyesight” says Jefrey Anshel, an optometrist in Carlsbad, California, and president of Corporate Vision Consulting, which advises employers on vision issues . According to the American Optometric Association (AOA), 90% of employees who use computers at least three hours a day experience vision problems. More than 70% of computer users in the United States are having eye problem one way or the other (Torrey 2003). Recent studies also show that 70% of computer users worldwide report having vision problems (Divjak and Bischof 2009). Some studies suggest that one out of six patients requiring eye examination have a computerrelated eye problem (Sheedy 1992; Sheedy and Shaw-McMinn 2003). Computer work is particularly stressful for contact lens wearers. Long non-blinking phases may cause the surfaces of most lenses to dry out which can lead to discomfort and reduction in visual clarity (Anshel 2006). According to Dr. Blakeney, an optometric adviser to the college of optometrists, USA, computers will not permanently damage the eyes, however, they can cause strain or exacerbate existing eye conditions. The level of visual discomfort that occurs with computer users appears to increase with the amount of computer use. Based on current evidence, it is unlikely that use of computers causes permanent damage to the eyes. However, some users of computer may experience continued reduced visual abilities such as blurred distance vision even after work (Chiemeke et al 2007).
Reading from digital displays – especially from computer screens - creates severe usability problems that the readers must cope with (Bus and Neuman, 2009; Quinn and Stark-Adam, 2007; Van Den Broek, Kendeou, and White, 2009). Among these problems are the large readingdistance from the display, the long lines, the problem in shifting the eye-gaze from line to line (Evans, Charland, and Saint-Aubin, 2009) and the blurring of text on computer monitors. In Nigeria low back pain, neck pain, headache, shoulder pain and eyestrain, are the most prevalent Occupational Overuse Syndrome (OOS) symptoms/pains (Allen E. Akhowa, 2007), He recommended that there is need for computer workplaces to improve on their designs towards finding a lasting solution to the hazardous problem. CVS is marked by eyestrain, tired and burning eyes, headaches, blurred vision, neck and back pain and muscle spasms. Computer work has not yet proven to cause permanent damage to eyes, but temporary discomfort that may occur can reduce productivity. It can cause lost work time and reduce job satisfaction. The performance on a specific task can be significantly decreased due to CVS, as much as 40 percent. This includes a reduction in work accuracy and a decrease in task volume. Employees using Visual Display Unit (VDU) for a larger part of their working days frequently report their eyesight is quite badly affected at work and for some time afterwards. Daum (2002) strongly suggests that improving the visual status of workers using computers results in greater productivity in the workplace, as well as improved visual comfort. The visual symptoms can largely be resolved with proper management of the environment and by providing proper visual care for the employees (Sheddy 1992). The symptoms of CVS-headaches and eyestrain- can force employees to shut down. Even the symptoms are negligible; they can affect performance and productivity in a big way. Companies can choose to understand and address the hazards of computer use. The gain can be extremely significant, both for employer and the employees (Torrey 2004).
RESEARCH METHODOLOGY AND HYPOTHESIS TEST
Social survey design was used for this research in other to obtain relevant information from respondents on the incidents of eye problems among computer users in Ijebu North Local Government of Ogun State in Nigeria. Questionnaire was the instrument used for data collection in this study. The questionnaire was designed and selfadministered to different categories of computer/smartphone users in various works of life in Nigeria, ranging from banking sector, civil service, educational sector, health sector to private sector. The distribution was ensured to cut across different field of professionalism. The data obtained from the questionnaires administered were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 17.0 for windows. The analysis was done in three facets: descriptive analysis through the frequencies procedure which produced frequency tables that displayed both the numbers and percentages of cases for each observed value of variables. Hypothesis were tested using Pearson Correlation to establish whether or not there is relationship between incidence of eye problems and duration of computer/ smartphone usage (years of computer usage and hours of computer usage at a stretch).
RESEARCH HYPOTHESIS
Hypothesis 1 H0:
There is no significant relationship between the duration of computer usage and the incidence of eye related problem. HA: There is significant relationship between the duration of computer usage and the incidence of eye related problem. Criteria for Rejection and Acceptance of Hypothesis α = 0.01 If p < = 0.01 the null hypothesis is rejected If p > 0.01 null hypothesis is accepted Where α is the level of significant and p-value is the probability that the observed correlation coefficient r was seen by chance.
RESULTS AND DISCUSSION
This section discusses the results from the data analysed.
AGE OF RESPONDENTS
Table 1: presents the distribution of the study respondents by their age. It shows that the majority (74.5%) were aged between 26 and 25 years.
GENDER OF RESPONDENTS
Table 2 above: presents the gender distribution of the respondents. 46.8% of the respondents were males while 43.9% were females.
DISTRIBUTION OF HOURS AND YEARS OF COMPUTER /SMARTPHONE USAGE
Table 3 and 4: presents the distributions of hours and years of computer usage. It shows that respondents who used computer /smartphone for 3-5 hours and 3-5 years have the highest percentage of 46.5% and 28.1%
respectively. The table also revealed that majority of respondents 83.8% used computer/smartphone more than 3 hours in a day and that 90% of the respondents have been using computer/smartphone for more than 3 years. Research question 1: Which of these problems do you experience while using smartphone/computer
Table 5 and the chart above: Shows that majority of the respondents’ experienced one problem or the other in their eyes as a result of long use of computer / smartphone. From the table and chart, 68.8% of the respondents experienced headache, 62.2% experienced eyestrains, 58.8% experienced double vision, 68.6% experienced redness of eye, 38.5% experienced watery eyes, 28.9% experienced dryness of eyes, 64.5% experienced blurred vision and 68.2% experienced irritation. It follows therefore that headache, eyestrains, irritation, redness of eye, blurred vision and double vision are the problems majority of those who spent much time on smartphone/computer have. Hypothesis 1: There is no significant difference between those experiencing eye problems as a result of prolong use of smartphone/computer and those who do not experience any problem.
Table 6 above, reveals that there is significant difference between those experiencing eye problems and those who do not. In all the identified problems, it was only in dryness of the eyes that there is no significant difference between those experiencing eye problems and those who do not. The chi-square value has p > 0.05. Hypothesis 2: There is no significant relationship between the duration of computer usage and the incidence of eye related problem.
Table 7 above reveals that, there is a strong relationship between duration of computer usage and incidence of eye related problems. The result showed a significant correlation at 0.01 levels (p=0.00, pEnglishhttp://ijcrr.com/abstract.php?article_id=782http://ijcrr.com/article_html.php?did=7821. Abelson, MB and Ousler III, GW (1999), How to fight Computer Vision Syndrome, Review of Ophthalmology, pp. 114-116, July 1999, viewed 3 February 2012 from http:// www.dryeyesummit.org/sites/default/files/ROOjul1999_ Howtofight_Computer_Vision_Syndrome.pdf.
2. Anshel, JR (2006), CVS: Constructing a new approach to visual ergonomics, Optometric management, September 2006, viewed 15 January 2012 from http://www.optometricmanagement.com.
3. Bus, A. G. and Neuman, S. B. (editors) (2009). Multimedia literacy development. Routledge, New York.
4. Chakrabarti, M (2007), What is Computer Vision Syndrome Kerala journal of Ophthalmology, Vol. XIX, No. 3, viewed 27 December 2011 from http://www.ksos.in/journal_Article_9_110.pdf.
5. Chiemeke, SC, Akhahowa, AE and Ajayi, OB (2007), ‘Evaluation of vision-related problems amongst computer users: a case study of University of Benin, Nigeria’, Proceedings of the world congress on Engineering, 2007, Vol. 1, WCE (2007), July 2-4, London, U.K.
6. Daum KM, Clore KA, Simms SS, Vesely JW, Wilczek DD, Spittle BM, Good GW (2002). Productivity associated with visual status of computer users. Optometry, 75(1): 1-15.
7. Divjak, M and Bischof, H (2009), ‘Eye blink-based fatigue detection for prevention of computer vision syndrome’, MVA 2009, IAPR conference on machine vision applications, May 20-22 2009, Yokohama, Japan.
8. Evans, M. A., Charland, A. R. and Saint-Aubin, J. (2009). A new look at an old format: Eye-tracking studies of shared book reading and implications for eBook and eBook research. In Bus, G. And Neuman, S. (eds.) Multimedia and Literacy Development. Routledge: New York. pp. 89-111 http ://www.guidedogs.org.au/importance-of-eye-health
9. Izquierdo, NJ (2010), Computer Vision Syndrome, viewed 21 December 2011 from http://www.emedicine.medscape.com/article/1229.
10. Izquierdo, JC, Garcia, M, Buxo, C and Izquierdo, N (2004), ‘Factors leading to the computer vision syndrome: an issue at the contemporary workplace’, Bol. Assoc. Med., P.R, Vol.96, no.2, pp.103-110.
11. Torrey J (2004). Computer eyeglasses for employees - good business. http://www.allaboutvision.com/cvs/sidworkerproductivity.htm (As retrieved on March 23, 2006).
12. Sheddy J E (1992). Vision Problems at Video Display Terminals: A survey of Optometrists. J Am Optom Assoc, 63: 687-692.
13. Sheedy, JE and Shaw-McMinn, PG (2003), Diagnosing and treating computer-related vision problems, Butterworth Book publishers, Boston.
14. Rathore, KS, Bagdi, P and Rathore, S (2010), Computer Vision Syndrome: An update, viewed 17 November 2011 from http://www.articlesbase.com.
15. Sen, A and Richardson, S (2007), ‘A study of computer-related upper limb discomfort and computer vision syndrome’, J. Human Ergol., 36, pp. 45-50.
16. Olabiyisi Olatunde, Akingboye Yusuff, Abayomi –Alli Adebayo, Izilien Fred and Adeleke 17. Iyiola (2013). “An Investigation of the Incidences of Repetitive Strain Injury among computer Users in Nigeria”, International Journal of Computer Science Issues, Vol. 10, Issue 4, p254.
18. Quinn, S. and Stark-Adam, P. (2007). What are the differences in reading news in print and online? The Poynteronline, April, 2007.
19. Van Den Broek, P., Kendeou, P. and White, M. J. (2009). Cognitive processes during reading: Implications for the use of multimedia to foster reading comprehension. In Bus, G. and Neuman, S.Multimedia and Literacy Development. Routledge: New York. pp 57-74.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20DIRECT HYPERBILIRUBINEMIA AS AN INITIAL PRESENTATION OF PRECURSOR B-CELL ACUTE LYMPHOBLASTIC LEUKEMIA IN A SAUDI CHILD
English4143Mona S. AsseriEnglish Ali M. AlsuheelEnglish Mohammed H. AlbarEnglish Ahmed AlhanshaniEnglish Safa AlhaiderEnglishIntroduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy in Saudi children according to the Saudi cancer registry 2011. It involves excessive proliferation and impaired differentiation of leukemic blasts cells that lead to inadequate normal hematopoiesis. Case Report: 4 year-old Saudi boy presented to the emergency department at Aseer Central Hospital with obstructive jaundice. Bone marrow aspiration done and confirms the diagnosis of pre B-cell acute lymphoblastic leukemia. Conclusion: ALL is a rare cause of obstructive jaundice due to hepatic involvement. However, it should be considered in the differential diagnosis of any child presenting with obstructive jaundice and hence considering the subsequent investigation
EnglishAcute Lymphoblastic Leukemia, Direct HyperbilirubinemiaINTRODUCTION
Acute lymphoblastic leukemia (ALL) is the most common malignancy in Saudi children according to the Saudi cancer registry 2011 [1]. It involves excessive proliferation and impaired differentiation of leukemic blasts cells that lead to inadequate normal hematopoiesis. Thus patients usually present with symptoms due to bone marrow failure commonly bleeding tendency, anemia and recurrent infections. The extra-medullary form of this disease is rarely reported in children. However, when exist; it most commonly involves the bones, followed by soft tissue, skin and lymph nodes. It is extremely rare for patients with ALL to present with hepatic manifestations as the initial presentation of the disease. In this present case report we had a child who has precursor B-cell (pre-B-cell) Acute Lymphoblastic Leukemia (ALL) who presented in September 2013 as obstructive jaundice and otherwise quite healthy. This case presented with this unique presentation and that infiltrative involvement of leukemia should be considered when the initial work-up for obstructive jaundice is inconclusive. Moreover, it highlights IJCRR the challenges in planning chemotherapeutic treatment in the presence of an already compromised hepatic function [2], of which most of the reported cases from adult patients and few pediatric cases [3]. The rationale of the report is to alert health workers generally and pediatrician in particular about the possibility of an unexpected presentation of ALL which is a treatable condition and to share the challenges regarding plan of chemotherapy in patients who is already have compromised hepatic function.
CASE REPORT
A 4 year-old Saudi boy presented to emergency department at Aseer Central Hospital (a tertiary care Hospital at southern-west province of Saudi Arabia) with history of yellowish discoloration of sclera and skin for two weeks. He was well till two weeks prior to admission when he started to have yellowish discoloration of sclera and skin , noticed by his family, then gradually started to develop generalized body itching. His illness was preceded by vomiting and diarrhea for one week. He has history of fever, documented 38.5Co responding well to antipyretics for one day prior to admission. No change in urine or stool color was observed. There was no bleeding tendency, contact with jaundiced patient or drug ingestion. Past medical and surgical history was unremarkable. There was no previous hospitalization or blood transfusion. His developmental history was appropriate for his age and vaccinated to his date. Her parents are non-consaguionus with no family history of hematological disease or liver disease. On examination he was conscious, good body built, alert looks jaundiced, mild dehydrated, no pallor. Vital sign T: 38.50 C other signs were within normal range. his liver was enlarged with span of 11cm and spleen palpable 3cm below costal margin. There was no lymphadenopathy and other systemic examination was unrevealing. Laboratory investigations showed a complete blood count was significant for pancytopenia, with hemoglobin 10.4g/dL, platelet count 47000/ mm3, WBC count 2880/mm3 (Neutrophils 23%, lymphocytes 70%, myelocytes 4.9%, ANC 662), erythrocyte sedimentation rate was 90 mm/hr, and Peripheral blood smear examination showed pancytopenia with absolute neutropenia, thrombocytopenia and no abnormal cells. Liver function test showed serum bilirubin 9.1mg/ dL (conjugated bilirubin 6.4 mg/dL), SGOT 1788 IU/L, SGPT 228 IU/L, gamma glutamyl transferase 358 U/L, alkaline phosphatase 395 and LDH 758 uL (120-300) serum ferritin was 2290. Serology for HIV, CMV, EBV, leishmania and HBsAg were negative. Anti HCV titers were negative. Ultrasonography showed hepatosplenomegally [fig-2], no intrahepatic biliary ducts dilatation and normal gallbladder. The patient was initially admitted under care of pediatric gastroenterology then, later referred to oncology department. The presence of pancytopenia make bone marrow studies a real indication to help this child which confirmed the diagnosis of pre B-ALL acute lymphoblastic leukemia [fig-1]. The patient was started on chemotherapy according to the appropriate protocol and he finished the induction therapy during hospitalization. His hospitalization was complicated by febrile neutropenia which was treated with an appropriate antibiotic therapy. in addition the patient developed an episode of seizure, radiological investigation with MRI of the brain showed ischemic changes in the areas of the anterior and middle cerebral artery on the right side. Then, the patient was seen by the pediatric neurology team and he was started on antiepileptic drugs with keppra (levetiracetam) which he needs to continue for several months. Now the patient is following at the pediatric hemato-oncology clinic and he is on the maintenance chemotherapy.
LITERATURE REVIEW
Although ALL is primarily a disease of bone marrow and peripheral blood, any organ or tissue may be infiltrated by the abnormal cells. Such infiltration may be clinically apparent by physical examination or it may be occult and detectable only by histological sampling [4]. Cholestatic jaundice as an initial presentation of acute lymphoblastic leukemia (ALL) is extremely rare [5], Several patterns of hepatic involvement in hematologic malignancies have been described in the literature. It varies from an asymptomatic hepatic lesion or hepatomegaly to liver failure. Four adult cases of fulminant hepatic failure were reported by Zafrani et al. [6]. Some cases of T-cell ALL [7] and B-cell ALL [8] have been reported to have presented in association with jaundice. Only a few of these cases had no evidence of biliary obstruction on imaging. The pathophysiology of jaundice in these cases of ALL was leukemic infiltration of hepatic sinusoids. There are few pediatric cases of ALL were reported with obstructive jaundice as the first presentation [9]. In our case report the patient presented with fever, vomiting and jaundice, and initially he was admitted under care of hepatology service as case of obstructive jaundice. Later on, he was referred to oncology after the result of bone marrow study which confirmed the diagnosis of pre-B ALL. To my knowledge this is the first case to be reported in our region, however Abdurrahman from neighboring country Iraq published a rare case of ALL presented with obstructive jaundice secondary to pancreatic mass [10].
CONCLUSION
ALL is a rare cause of obstructive jaundice due to hepatic involvement. It should be considered in the differential diagnosis of any child presenting with obstructive jaundice and who has evidence of bone marrow infiltrate, since such extramedullary involvement by the leukemic process is highly responsive to systemic antileukemic therapy, which may be critical for subsequent management.
CONFLICTS OF INTEREST
There are no conflicts of interest.
ACKNOWLEDGEMENTS
We thank the patient’s family for participation and special thanks for Dr. Kareem Elden, Pediatric Consultant for reviewing this paper. Also, 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=783http://ijcrr.com/article_html.php?did=7831. Saudi cancer registry, http://www.scr.org.sa. Date retrieved: 10 August 2014.
2. Siddique et al.Precursor B-cell acute lymphoblastic leukemia presenting as obstructive jaundice: a case report. Journal of Medical Case Reports 2011, 5:269.
3. Rajeswari et al, Acute Myeloid Leukemia Presenting as Obstructive Jaundice. Indian Pediatrics, 2012; 49: 414-317.
4. Silverman LB. Acute lymphoblastic leukemia. Oncology of Infancy and Childhood. 2009; 10: 297-317.
5. Mori T, Sugita K, Suzuki T, et al.: Histopathologic features of the biopsied liver at the onset of childhood B-precursor acute lymphoblastic leukemia presenting as severe jaundice. J Pediatr Gastroenterol 1997, 25:354-357.
6. Zafrani ES, Leclercq B, Vernant JP, Pinaudeau Y, Chomette G, Dhumeaux D: Massive blastic infiltration of the liver: a cause of fulminant hepatic failure. Hepatology 1983, 3:428-432.
7. Patel KJ, Latif SU, de Calaca WM: An unusual presentation of precursor T cell lymphoblastic leukemia/lymphoma with cholestatic jaundice: case report. J Hematol Oncol 2009, 2:12.
8. Alvaro F, Jain M, Morris LL, Rice MS: Childhood acute lymphoblastic leukemia presenting as jaundice. J Pediatr Child Health 1996, 32:466-468.
9. Tetsuya et al, Histopathologic Features of the Biopsied Liver at Onset of Childhood B-precursor Acute Lymphoblastic Leukemia Presenting as Severe Jaundice. Journal of Pediatric Gastroenterology and Nutrition, 1997; 25(3): 354-357.
10. Khalid N. Abdurrahman. A Rare Presentation Of Childhood Acute Lymphoblastic Leukemia With Obstructive Jaundice Due To Pancreatic Involvement - Case Report. Duhok Med J 2011; 5(1): 78-83.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20EXPOSURE OF MICE TO 900 - 1900 MHZ RADIATIONS FROM CELL PHONE RESULTING IN MICROSCOPIC CHANGES IN THE KIDNEY
English4449N. MugunthanEnglish J. AnbalaganEnglish S. MeenachiEnglish A. Shanmuga Samy4EnglishObjective: The study was to evaluate possible effects of chronic exposure to 900 - 1900 MHz radiations emitted from 2G cell phone on kidney of mice at the histological level. Methods: Mice were exposed to 2G ultra-high frequency radiation, 48 minutes per day for a period of 30 to 180 days. The amount of electromagnetic field (EMF) exposed was measured by radiation frequency meter. The sham control mice were subject to similar conditions without 2G exposure. Six animals each were sacrificed at the end of 30, 60, 90,120,150 and 180 days of exposure in the experimental group after 24 hours of last exposure. Same numbers of control animals were sacrificed on similar period. Both kidneys were harvested and processed for histomorphometric study. Kidneys size, weight and volume were measured and analysed. Kidney sections were analysed under the light microscope and structural changes were studied. Results: In 2G exposed group the kidney weight and volume was significantly reduced in the first month. Kidney weight alone was significantly increased in the fifth month. Glomerulus showed dilated capillaries and increased urinary space. Proximal convoluted tubule showed wider lumen with reduced cell size. Brush border interrupted at places and vacuolated cytoplasm and pyknotic nuclei. Wider lumen with decreased cell size and marked basal striations were found in the distal convoluted tubule.Conclusion: Chronic exposure to ultra-high frequency radiation from 2G cell phone could cause microscopic changes in glomerulus, proximal and distal convoluted tubules of the kidney.
EnglishUltra-high frequency radiation, 2G cell phone, mice kidney, glomerulus, kidney tubules.INTRODUCTION
Rapid development in telephone technology has made communication faster and easier. However, increased use of mobile phones by all classes of humanity, it has become imperative to assess the exposure damage to the biological models (animals or humans). Electromagnetic fields (EMFs) emitted from mobile phones and towers are a big public concern today. Most of the cellular phones operate within the ultra-high frequency bandwidth of 900-2200 MHz’s. Ultra high frequency (UHF) electromagnetic radiation or radiofrequency radiation (RFR) with a frequency range of 300- 3000 MHz is “non-ionizing”. The present inquest is regarding this form of radiation either to incriminate it as potentially hazardous or absolve it as absolutely harmless. IJCRR The second generation cell phone (2G) network operates in the 900-1900 MHz frequency for GSM (Global System for Mobile Communications). Mobile phone in operation emits a pulsed radiofrequency electromagnetic field (RF-EMF). Most of the energy is absorbed into user’s body particularly in the head region which can produce heat stress and non-thermal stress in the form of releasing free radicals, alter the enzyme reaction and there by compromises immune system. Specific absorption rate (SAR) is a unit of Watt per kilogram to measure the amount of electromagnetic radiation absorbed by body tissue whilst using a mobile phone. The higher the SAR the more radiation is absorbed. International Commission on Non-Ionising Radiation Protection (ICNIRP Guidelines 1998) recommendations set a SAR limit of 2.0 W/Kg in 10 grams of tissue. Whole body average SAR of 0.4W/Kg is widely adopted in most guidelines as the basic restriction based on the threshold of the observed effects due to whole-body heating to cause significant elevation of core temperature (>1°C). Public fear of possible unrevealed effects of exposure below guideline levels is still increasing1 . Earlier reports have shown that exposure of mobile phone radiation induced damage to tissues which ranges from those at the molecular level manifested as an increase in single and double strand DNA breakages2 , increased risk of acoustic neuroma associated with mobile phone use of at least ten years duration3 , genotoxic effects in human peripheral blood leukocytes4 , keeping a cell phone on or close to the waist can decrease sperm concentration5 , non-thermal DNA breakage by mobile phone radiation in human fibroblasts, decrease in sperm motility and viability after direct exposure of the semen to cell phone radiation6 , reduction of Purkinje cell number in the adult female rat cerebellum7 , long- term exposure to mobile phone radiation lead to reduction in serum testosterone levels8 , and short – term memory in mice is affected by mobile phone radiation9 . Similarly the authors found that short term exposure of mobile phone radiation induced damage to kidney10, 11,12,13,14. In contrary to above findings some researchers reported no adverse biological effects of exposure to non-ionizing radiation emitted from the cell phone, these includes no double stranded DNA breaks or effects on chromatin of rat brain15, no effect on mouse embryonic lens development16, psychomotor performance was not influenced by brief repeated exposures to mobile phones17 and the lack of histological changes on rat testis18. The present study was carried out because of the contradictory findings on effects of exposure to non-ionizing radiation emitted from the 2G cell phone on kidney.
MATERIALS AND METHODS
Our study was approved by the Institutional Animal Ethics Committee of Mahatma Gandhi Medical College and Research Institute, Puducherry. Seventy two neonatal albino mice (one day old) of both sexes were obtained from the King Institute of Preventive Medicine and Research, animal section, Guindy, Chennai. New born mice were kept with the mother for twenty one days followed by randomly divided into two independent groups and housed in mice cages at the temperature of 22 ± 1°C and 60% relative humidity. Animals were housed in the central animal house and provided with adequate ventilation, twelve hours of illumination alternated with twelve hours of darkness. During the study, all the animals were received appropriate animal care and were fed with laboratory diet and water ad libitum. Thirty six mice were exposed to 900-1900 MHz frequency radiation emitted from 2G cell phone and thirty six mice were sham control. The roof of the mice cage was designed to hang the 2G cell phone from the distance of five centimetres from the floor which allow the mice to move freely and to avoid direct thermal injury to mice. 2G mobile phone in non-vibrating, silent, do not disturb (DND) and auto answer activated mode was kept hanging inside the mice cages. EMF was emitted from a standard 2G handset with frequency bandwidth of 900-1900 MHz and power of 2W/Kg. The highest specific absorption rate (SAR) value for this standard handset was 1.69 W/Kg (10gm) and this SAR value was within the limit of the International Commission of Non-Ionizing Radiation Protection (ICNIRP) recommendation. The mobile phone which was kept inside the mouse’s cage was rung upon from other cell phone for every half an hour, each call lasting for two minutes. Exposure time was forty eight minutes per day for twelve hours periods (from 8.00AM to 8.00PM) and total duration of exposure was thirty to hundred and eighty days. RF meter was kept inside the mice cage in switch on mode to measure the amount of radiation exposed (Fig.1). The sham control group of thirty six mice were kept under similar conditions without 2G exposure. 2G cell phone and RF meter were kept in switch off mode. We measured weights of the mice before sacrificing them in both groups. Six mice each were sacrificed at the end of thirty, sixty, ninety, hundred and twenty, hundred and fifty, hundred and eighty days of exposure in the experimental group after 24 hours of last exposure. Equal numbers of control mice were sacrificed on similar time points. Mice were sacrificed under anaesthesia and their both kidneys were dissected out. Kidney weight and volume were measured. Weight measured by Denver’s digital weighing machine (0.001gm) and volume measured by the water displacement method. After the morphometric analysis, the kidney specimens were immediately fixed in 4% formalin solutions for twenty four hours then tissues were processed and embedded in paraffin. Tissues were sectioned at five microns, stained with Haematoxylin & Eosin and Periodic Acid Schiff (PAS). Kidney sections from random slide, random sections and random field were analysed under the light microscope and structural changes were studied.
STATISTICAL ANALYSIS
We applied non-parametric Mann Whitney U test for comparing the morphometric data and the t test for comparing histomorphometric data of kidney. P value Englishhttp://ijcrr.com/abstract.php?article_id=784http://ijcrr.com/article_html.php?did=7841. International Commission on Non-Ionizing Radiation Protection. Review of the scientific evidence on dosimetry, biological effects, epidemiological observations and health consequences concerning exposure to high frequency electromagnetic fields (100 KHz to 300 GHz). Germany. ICNIRP 16/2009.
2. Lai H, Singh NP. Single and double strand DNA breaks in rat brain cells after acute exposure to radiofrequency electromagnetic radiation. Int J Radiat Biol.1996; 69(4):513- 21.
3. Lonn S, Ahlbom A, Hall P, Feychting M. Mobile phone use and the risk of acoustic neuroma. Epidemiology.2004; 15(6):653-9.
4. Zeni O, Romano M, Perrotta A,Lioi MB, Barbieri D, d’Ambrosio G, Massa R, Scarfi M.R. Evaluation of genotoxic effects in human peripheral blood leukocytes following an acute in vitro exposure to 900 MHz radio frequency fields. Bioelectromagnetics 2005; 26:258-265.
5. Sarah J Kilgallon, Leigh W Simmons. Image content influences men’s semen quality. Biol.Lett.2005; 1:253-255.
6. Ashok Agarwal, Nisarg Desai, Kartikeya Makker, Alex Varghese, Rand Mouradi, Edmund Sabanegh, Rakesh Sharma. Effects of radiofrequency electromagnetic waves (RFEMW) from cellular phones on human ejaculated semen: an invitro pilot study. Fertil Steril.2008:1318-1325.
7. Osman Fikret Sonmez, Ersan Odaci, Orhan Bas and Suleyman Kaplan. Purkinje cell number decreases in the adult female rat cerebellum following exposure to 900 MHz electromagnetic field. Brain Research. 2010. Volume 1356: 95- 101.
8. Meo SA, Al-Drees AM, Husain S, Khan MM, Imran MB. Effects of mobile phone radiation on serum testosterone in Wistar albino rats. Saudi Med J.2010; 30(8):869-73.
9. Ntzouni MP, Stamatakis A, Stylianopoulou F, Margaritis LH. Short- term memory in mice is affected by mobile phone radiation. Pathophysiology.2010: 25.
10. Al-Glaib B, Al-Dardfi M, Al-Tuhami A, Elgenaidi A and Dkhil M. A technical report on the effect of electromagnetic radiation from a mobile phone on mice organs. Libyan J Med.2007.AOP: 080107:8-9.
11. Laila K. Hanafy, Sawsan H, Karam, Anisa Saleh. The adverse effects of mobile phone radiation on some visceral organs. Research Journal of Medicine and Medical Sciences. 2010. 5(1):95-99.
12. Latifa Ishaq Khayyat. The histopathological effects of an electromagnetic field on the kidney and testis of mice. Eur Asian Journal of BioSciences.2011, 5:103-109.
13. N Hanafi, F.Eid,A.El-Dahshan.Radiation emitted from mobile phone induces amyloidosis features in some tissues of infant mice. The Egyptian Journal of Hospital Medicine.2012.Vol.47:132-144.
14. Ingole IV, Ghosh SK. Cell phone radiation and developing tissues in chick embryo: A light microscopic study of kidneys. J. Anat. Soc. India 2006, 55(2):19-23.
15. Belyaev IY, Koch CB, Terenius O, Roxstrom Lindquist K, Malmgren LO, H Sommer W, Salford LG, Persson BR. Exposure of rat brain to 915 MHz GSM microwaves induces changes in gene expression but not double stranded DNA breaks or effects on chromatin conformation. Bioelectromagnetics. 2006; 27(4):295-306.
16. Ke Yao, YiBo Yu,KaiJun Wang, Juan Ye, DeQiang Lu, Huai Jiang. Absence of effect of power-frequency magnetic fields exposure on mouse embryonic lens development.Bioelectromagnetics.2007; 28 (8):628-635.
17. Curcio G, Valentini E, Moroni F,Ferrara M, De Gennaro L,Bertini M. Psychomotor performance is not influenced by brief repeated exposures to mobile phones. Bioelectromagnetics.2008; 29 (3):237-241.
18. Hae - June Lee, Jeong - Ki Pack, Tae - Hong Kim, Nam Kim, Soo - Yong Choi, Jae - Seon Lee, Sung - Ho Kim, Yun - Sil Lee. The lack of histological changes of CDMA cellular phone - based radio frequency on rat testis. Bioelectromagnetics.2010; 31 (7):528-534.
19. Robert E.Anderson, Morgan Berthrong, Louis F.Fajardo. Radiation injury. Anderson’s Pathology. 10th edition. Volume.1. Missouri. Von Hoffman Press.1996: Page.484-512.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20SUDDEN CARDIAC DEATH - A CASE REPORT
English5052S. Peranantham1English G. ManigandanEnglish V TamilselviEnglish K. ShanmugamEnglishThe Forensic autopsy or post-mortem examination is ordered by the competent legal authority to investigate sudden, unexpected, suspicious, unnatural, or criminal deaths. A medico-legal expert conducts an accurate autopsy examination is to ascertain the underlying and possible contributing cause and manner of death. Herein, we report a case of accidental death turn into sudden natural death following careful autopsy.
EnglishForensic autopsy, meticulous autopsy examination, sudden natural death.INTRODUCTION
Medico-legal autopsy is performed to ascertain the cause and manner of death. Death due to unnatural causes and deaths that are believed to be due to natural causes, but where the medical cause of death is not certain or known are subjected to an examination that is usually done by investigating police officer of the case. This inquest is achieved by inquiry and at the conclusion of the inquest verdict arrives as to whether the death was due to a natural, accidental, suicidal or a homicidal cause1 . Numerous definitions of sudden cardiac death have been proposed over the past twenty-five years. However, such deaths can be caused by many mechanisms, and no allpurpose definition can be applied to every situation2 . SCD is a natural death due to cardiac causes, heralded by an abrupt loss of consciousness within one hour of the onset of acute symptoms; pre-existing heart disease may or may not have been known to be present, but the time and mode of death are unexpected3 . The worldwide incidence of sudden cardiac death is difficult to estimate because it varies largely as a function of the prevalence of coronary heart disease in different countries 4, 5. Approximately 50% of all coronary heart disease deaths are sudden and unexpected, often occurring shortly after the onset of symptoms. Because coronary heart disease is the dominant cause of both sudden and non-sudden cardiac deaths in worldwide, the fraction of total cardiac deaths that are sudden is similar to the fraction of coronary heart disease deaths that are sudden. Hereby, we report a case of sudden cardiac death after performing the meticulous autopsy examination. IJCRR
CASE REPORT
A 40-year-old male brought to our tertiary care hospital with an alleged history of road traffic accident while riding a bicycle. The patient was declared as brought dead by a casualty medical officer at JIPMER hospital, Puducherry. The body was brought to the department of Forensic Medicine for post-mortem examination. History of the case revealed that the deceased was a bicycle rider, hit on the median strip of the road and brought to our hospital. During external examination the deceased was an average built adult male, no external injuries over the body. On internal examination, weight of the heart is about 600gm, heart chambers were examined by inflow-outflow method of dissection. The right and left ventricular wall thickness measures about 1.5cm and 3cm respectively. The left descending coronary artery shows 50% block (narrowed by atheromatous plaque) 2cm from the left coronary ostia and aorta shows multiple patches of atheromatous plaques. Cross section of right coronary artery showed complete block of the lumen by fresh thrombus. All other organs were intact and congested. The organs and blood were preserved, sent for toxicological analysis and reported as negative.
DISCUSSION
The necessary steps in the investigation of sudden death are obtaining the history and crime scene information, performing a gross and microscopic autopsy, performing appropriate laboratory tests, and making the diagnosis. A complete post-mortem examination includes detailed neuropathological and cardiovascular examination with toxicological analysis, must be performed in the context of all available clinical data and the circumstances of death6 .The highest incidence of sudden death in adults is between 45 and 75 years of age7 . As per WHO census statistics death due to cardiac causes has overtaken mortality due to all cancers put together. Approximately 4280 out of every one lakh people die every year from sudden cardiac death in India alone8 . Based on autopsy studies, it has been shown that 50–60% of patients dying suddenly from coronary atherosclerosis have luminal coronary thrombi, another 20–30% has healed myocardial infarction, and approximately 10– 15% of patients have stable severe coronary narrowing involving one to three vessels, in the absence of any myocardial fibrosis or necrosis9, 10. The frequency of coronary thrombosis in sudden coronary death varies from 20% to 70%. The time interval between onset of symptoms and death, the presence of concurrent conditions that may cause arrhythmias, and the type of prodromal symptom all affect the incidence of thrombi in coronary sudden cardiac death. The commonest cause of sudden cardiac death in adults over the age of 30 years is coronary artery atheroma. The most common finding at post-mortem examination is chronic high-grade stenosis of at least one segment of a major coronary artery, the arteries that supply the heart muscle with its blood supply. A significant number of cases also have an identifiable thrombus (clot) in a major coronary artery, which causes transmural occlusion of that vessel10.The heart must be carefully weighed, and left ventricular wall thickness has to be measured at several different locations. Heart size is an independent risk factor for sudden cardiac death, and the measurement may prove to be a very significant factor in determining the cause of death.
CONCLUSION
In utmost cases where, after the visiting the crime scene and the external examination of the body, the manner and cause of death remain unclear, and of course whenever there is a suspicion of unnatural death, it is advisable to carry out a medico-legal autopsy. A meticulous post-mortem examination can help to interpret the nature, pattern of injury, circumstances and cause of death.
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 author / 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=785http://ijcrr.com/article_html.php?did=7851. Nadesan K. The importance of the medico-legal autopsy. Malays J Pathol. 1997 Dec; 19 (2):105–9.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241616EnglishN2014August20SCENARIO OF ACUTE POISONING IN A SUB DIVISION HOSPITAL OF WEST BENGAL, INDIA
English5357Md. Hamid AliEnglish Arijit SinhaEnglish Kapildev MondalEnglish Subhra Jyoti MitraEnglish Anupam MandalEnglish Pranab Kumar MaityEnglishBackground: Acute poisoning is one of the leading causes of morbidity and mortality throughout the world. Review of the sociodemographic profile of poisoning is of much important for recognizing this public health concern and to find the way out. Objective: Few literatures are available regarding the poisoning in eastern India. . In India incidence of accidental and selfpoisoning are increasing day by day .Our objective is to study the sociodemographic profile of acute poisoning and its outcome. Materials and Methods: This retrospective study was done among patients admitted with acute poisoning in a subdivision hospital of West Bengal,India,during the year 2011 and 2012. Our study included 1237 patients admitted with acute poisoning admitted through emergency in one year period. The demographic pattern, type of poisoning, route of exposure,seasonal variation, patient survival and referral were collected in a pre-structured proforma. Data collection was performed according to hospital regulations after approval by the hospital authorities.Then the data were analyzed by descriptive statistical method by using software. Results: Acute poisoning cases are burden of 2.72% of total admission and 5.08% of medical ward admission. Highest number of admission are seen in September (n=147) and October(n=149) months. Male to female ratio of poisoning is 1.22:1. Organo phosphorus (n=594) poisoning is the commonest and next is snakebite (n=451). Overall death rate is 4.36% (n=54). Commonly affected age groups are 11 to 20 years (n=435), 21 to 30 years(n=414). Death is also common in age group of 11 to 20 (n=18) and 21 to 30 years(n=16).Rate of referral to higher center is 2.10%. Average hospital stay is 2 days. Among self- poisoning cases
(n=746), 1.73% (n=13) were already under treatment for psychiatric illness. Conclusion: As the affected patients are mostly in adolescent and young age group and as they are the future of a nation, it is important to take measure to prevent poisoning. Psychological assessment, social and economic security is important in this regard.
EnglishAcute poisoning; organophosphorus; snakebite.INTRODUCTION
A poison is any substance that is harmful to our body by means of inhalation, ingestion, injection or absorption through skin. Acute poisoning is an important cause of morbidity and mortality. In India incidence of accidental and self-poisoning are increasing day by day. Over the last few decades, agricultural pesticides have become common household items in the developing world, which are commonly used for self poisoning. Acute poisoning is an important cause of body injury IJCRR which may be accidental or self-inflicted. During the year 2008 about 24.26% death occurred due to poisoning in India [1]. Acute poisoning is responsible for 10% hospital admission in U.K. and in-hospital mortality is less than 1%. [2]. Commonest cause of acute poisoning in India is pesticides (organophosphorus compounds) due to their low cost, easy availability, particularly in rural areas. Snake bite is the most common accidental poisoning and accounts for 0.47% of total deaths in India with male preponderance (59%) [3]. Anxiety, depression, isolation, unemployment, failure in examination, marital disharmonies are the common precipitating factors for self poisoning [4].Rural populations of low socioeconomic groups are commonest sufferer. It is important to know the patterns and outcome of acute poisoning.
MATERIAL AND METHOD
The present study is a retrospective, observational, epidemiological study conducted over a period of one year (1.1.2011 to 31.12.2011) at Jangipur subdivision hospital, Murshidabad district of West Bengal (India). Ethical clearance was obtained before the study data were collected. Patients admitted with history of acute poisoning were included in this study but those who absconded were excluded. All patients in the study were examined clinically with details history taken from patients and their relatives. Previous psychiatric illnesses of poisoning cases were assessed from history and past medical records. After discharge patients were advised for psychiatric consultation. Patients economic condition, race, sex, educational qualification, residential area, age group, type of poison, hospital stay, death rate, referral rate were assessed. Total 1237 number of patients was included in this study. Socio economic status was judged by APL, BPL (above or below poverty line) card issued by government authority. Patients of non-municipality areas were designated as rural and of municipal areas were urban. Then the data were analyzed by descriptive statistical method by using computer based software.
Observation
Our present study consists of 1237 patients, of which 682 were male and 555 were female (M: F=1.2:1).Total number of acute poisoning cases were 2.72% of total hospital admission (n=45375) and 5.08% of medical ward admission (n=24337) during that year. Among them self- poisoning cases were 746(60.30%) and accidental cases were 491(39.70%). Accidental cases included snake bite, wasp, bee or scorpion sting, ingestion of kerosene oil in children, exposure to organophosphorus compounds during spraying. 1008 cases (81.48%) were BPL category and 229 cases (18.51%) were APL category. 864 (69.84%) were Hindu and 373(30.75%) were Muslim. Age wise incidences were 0-10 years (n=36,2.91%),11-20 years(n=435,36.16%), 21-30 years (n=414,33.46%),31-40 years (n=184,14.87%), 41-50 years (n=96,7.76%), 51-60 years 9n=46,3.63%), 61 years+ (n=26,2.10%). Month wise incidences were January (n=56,4.52%), February (n=32,2.58%), March (n=81,6.54%), April (n=109,8.81%), May (n=117,9.45%), June (n=142,11.47%), July (n=144,11.64%), August (n=129, 10.42%), September (n=147,11.88%) October (n=149,12.04%), November (n=93, 7.51%), December (n=38,3.07%). Types of poison were organophosphorus (n=594,48.01%), Snakebite (n=451,36.45%), sedatives (n=39,3.15%), rat killer(n=38,3.07%) bee and wasp(n=25,2.02%), acid ingestion (n=23,1.85%), kerosene ingestion(n=21 ,1.69%),dhatura(n=9,0.72%), lice killer(n=8,0.64%), unknown(n=8,0.64%), organocarbamate (n=4,0.32%), paracetamol(n=4,0.32%), phenyl(n=2,0.16%), Gamoxene (n=2,0.18%) and contraceptive pills (n=2,0.18%), scorpion sting(n=2,0.18%). Snake bite was the major accidental poisoning (n=451) and month wise incidence were-January (n=5,1.1%), February (n=6,1.33%), March (n=12,2.66%), April (n=20,4.43%), May (n=35,7.76%), June (n=64,14.19%), July (n=72,15.96%), August (n=77,17.07%), September (n=73,16.18%), October (n=53,1.75%), November (n=29,6.43%), December (n=5,1.10%). Organophosphorus poisoning was the major self-poisoning and month wise incidences were-January (n=37,6.22%), February (n=21,3.53%), March (n=56,9.42%), April (n=69,11.61%), May (n=60,10.10%), June (n=58,9.70%), July (n=54,9.09%), August (n=35,5,89%), September (n=58,9.76%), October (n=72,12.12%), November (n=48,8.08%), December (n=26,4.37%).13 patients (1.74% of self-poisoning cases) were under treatment for psychiatric illness (depression 69.23%, schizophrenia 23.07%,anxiety 7.69%). Other precipitating factors for self-poisoning were impulsion, unemployment, poverty, marital disharmony, stressful life events, alcohol abuse, divorce, isolation, failure in examination.26 patients (2.10%) were referred to higher medical centre. Average hospital stay was 2 days. Among 1237 patients, 54 (4.36%) were expired in hospital. Among dead patients male were 33 and female were 21 (M: F=1.57:1) and age group wise incidence were 11-20 years (n=18,33.3%) 21-30 years (n=16,29.62%) 31-40years(n=8,14.81%), 41-50 years (n=7,12.96%), 51-60 (n=5,9.29%). Month wise death (n=54) were – January (n=3,5.55%), February (n=2,3.70%), March (n=4,7.40%), April (n=6,11.11%), May (n=8,14.81%), June (n=7,12.96%), July (n=8,14.8%), August(n=4,7.40%), September (n=1,1.85%), October (n=4,7.40%), November (n=5,9.25%), December (n=2,3.70%). Among death cases 2 died from snake bite (0.44% of snake bite cases), 2 from acid poisoning (8.69% of acid poisoning cases) and 50 for organophosphorus poisoning (8.41% of organophosphorus poisoning cases).
DISCUSSION
Acute poisoning may be self-inflicted or accidental. With increasing of population and socio-psychological hazards the burden of acute poisoning is increasing day by day. Poisoning ranked in the 5th position in India according to priority [5]. Acute poisoning accounts for about 10% hospital admission in United Kingdom in-hospital mortality is less than 1%[6].Types of poisoning varies from country to country and state to state. Paracetamol is the drug most commonly used in U.K while an insecticide (organophosphorus and carbamates) is more common in India. On the other hand aluminium phosphide is more common in Haryana followed by organophosphoruscompounds [7]. In our study total 1237 acute poisoning cases are 2.72% of total hospital admission and 5.08% of medical ward admission patients.Of them 81.48% was BPL category and 74.2% was of rural origin.It is 1% of medical ward admission in a study in Nepal [8].In our study self-poisoning was 60.30% and accidental poisoning was 39.70%, whereas in a study conducted in Haryana,91.4% was self-poisoning, 8.1% was accidental poisoning and 0.5% was homicidal poisoning, 75% patients were of lower socio-economic status [7]. In a study by Srivastava etal male to female ratio was 53:43,suicidal cases was 53% and accidental 45% [9]. Murad Zaffar Mari etalfound male to female ratio 1.5:1 with 34.30% at the age group of 20-30years[10].In our study male to female ratio is 1.2:1 and commonly affected age groups are 11-20years (35.16% ) 21-30years(33.46%). Acute poisoning are more common in the month of June (11.47%), July (11.64%), August (10.42%), September (11.85%),October (12.04%). Among them snake bite are more common in the month of June (14.69%),July (15.96%), August (17.07%), September (16.18%), October (11.75%). Mahapatra B,Warrel DA etal found maximum cases of snake bite during June to September[3]. Organophosphorus poisoning are more common in the month of April(11.61%),May(10.10%) and October(12.12%).1.05% of all acute poisoning cases and 1.74% of self-poisoning cases had history of treated psychiatric illness. Among them 69.23%(9/13) were suffering from depression, 23.07%(3/13) from schizophrenia, 7.69%(1/13) from anxiety disorder, which are correlating to previous studies. [8] Commonest type of accidental poisoning is snake bite(36.45%) and self- poisoning is organ phosphorus poisoning (48.01%) but kerosene is more common in children. Ramesh KN et al [11] found that organophosphorus was the commonest suicidal poison and Thomas M. et al. found kerosene as the commonest poison in children. [12] In present study mortality is 4.36% among total acute poisoning cases and mostly in the age group of 11-20 years,(33.33%) and 21-30 years (29.62%). Individually mortality are 0.40% in snake bite cases, 8.69% in acid poisoning cases and 8.4% in organophosphorus poisoning cases.The overall mortality in acute poisoning varies in different studies – 4%[11], 3.3%[12],6.9%[8] and it is in organophosphorus poisoning varies from 5 to 20 % in Asian countries[13].
CONCLUSION
As the affected patients are mostly in adolescent and young age group and as they are the future of a nation, it is important to take measure to prevent poisoning. Psychological assessment, social and economic security is important in this regard.
ACKNOWLEDGEMENT
To Dr.Sawasata Mondal, Superintendent and staffs of record section, Jangipur SD Hospital,West Bengal,India.
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