Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31General SciencesTHE FORBIDDEN SOCIAL CRIME OF CHILD LABOUR: A CASE STUDY OF ITS EXISTENCE IN THE CITY OF KOLKATA, WEST BENGAL
English0109Anandita DawnEnglishChild Labour is a grave issue and a social curse that has affected human society all over the world. It has been identified as hazardous to a child’s mental, physical, social, educational and spiritual development. This paper is an attempt to view the grave problem of child labour existing in the city of Kolkata, the administrative hub of West Bengal, the causes behind and its impact on the socio-economic scenario of the city. The engagement of children below 14 years of age in hazardous activities has been strictly condemned by the Constitution of India under several constitutional provisions. Despite several rules, regulations and measures undertaken by Government both at Central and State level, child labour continues to maintain its presence in Kolkata’s socio-economic scenario thus ignoring penal provisions. The work has been accomplished mainly through generation of primary data and extensive field visits. The existence of child labour has dramatically increased in the city over the years with its steady flow contributed by the neighboring districts and states.
Englishchild labour, parental illiteracy, poverty, social apathy, unskilled laborersINTRODUCTION
Children are incorporated into a range of different employment relations. They may be waged laborers in factories or mines or self-employed workers engaged in street trades (Bequele, et.al., 1995). Child Labour is thus accounted as a violation of human rights across the world. It is a complicated development issue affecting human society all over. Kolkata, one of the fastest developing metro cities of India still has a persistence of child labour despite strict constitutional norms. The integration of women into the labour force in ever increasing number is a feature which is common to all economies (Sharma, 2006). In Kolkata children both boys and girls below fourteen years of age as prescribed by law are employed in hazardous commercial and laborious activities. Children for these activities either come to the city with their parents or are brought from outside to serve as cheap unskilled laborers. Often their lives are found to be even worse than what they used to be in their native places. Working children in India can be broadly divided into three categories: namely full time child workers employed in hazardous economic activities; children employed for wages but in activities that are not prohibited under the Child Labour Act and children who are engaged as unpaid family workers in family enterprises such as farms, households etc (Kundu et.al., 2010).
Objectives of the Study
The study has been initiated to fulfill the following objectives:
To assess the present scenario of child labour in Kolkata
To study their social status and condition of living
To know about their economic background and present condition
To acquire knowledge about the type of exploitation they are subjected to at their work place by their employer
To have an overall understanding of their lives and agony ? To study about the various Government measures of rehabilitation to bring them into mainstream of life
To assess the initiatives of Non Government organizations in improving the lives of these exploited children.
DATA BASE AND METHODOLOGY
The work has been accomplished mainly by collection of primary data. Information was generated through extensive field visits on working condition of the child laborers as well as their socio-economic background, their living condition, the driving factors behind their exploitation and abuse at home and workplace, the initiatives of Government and Non Government Organizations (NGOs) in rehabilitation of these children. Apart from the primary data, secondary sources of information have been collected from Census of India and Directorate of Labour, Government of West Bengal. Questionnaires for the purpose of primary data collection were framed for the target groups of child workers and their families. Purposive method of sampling was followed with a sample size of 50 child workers working in different organized and unorganized sectors and 75 families from 141 municipal wards of Kolkata. Field investigation was conducted at workplaces of the child labour along with their employers too.
Area under Study
The Kolkata Municipal Corporation has a total area of 187.33 sq. km with a geographical extension of 22°27'N to 22°39'N latitude and 88°14'E to 88°26'E longitude. The territorial jurisdiction of Kolkata Municipal Corporation (KMC) has been divided into 15 Boroughs consisting of 141 municipal wards. Spatially the city can be divided into North, East, Central and South Kolkata. The district of Haora lies to the North-West, North 24 Parganas on the Northern and North-Eastern side and South 24 Parganas on the South-Eastern and South-Western side. The River Hugli flows through Western part of the city.
Definition of Child Labour
Child Labour has been an integral part of the labour force especially in third world countries and enters labour market at tender age (Nanjunda, 2008). It is defined by any work done by a child who is below the age of fourteen years as prescribed by law. The word ‘work’ means full time commercial work to support and sustain self or to add to the family income. Child labour is hazardous to a child’s mental, physical, social, educational, emotional and spiritual development. According to International Labour Organization (ILO), the term ‘child labour’ is often defined as work that deprives children of their childhood, their potential and their dignity and that is harmful to physical and mental development. It refers to work that:
is mentally, physically, socially or morally dangerous and harmful to children and
interferes with their schooling by:
a) depriving them of the opportunity to attend school;
b) obliging them to leave school prematurely;
c) requiring them to attempt to combine school attendance with excessively long and heavy work.
Factors responsible for Steady Flow of Child Labour in Kolkata
Child labour stands as one of the more persistent social and economic problems in history and in the world today (Hindman, 2002). The following factors are held responsible for the steady flow of child laborers in the city:
1. Poverty- Poverty is an important cause of child labour and that working at a young age can have lasting deleterious effects (Cigno, et.al., 2005). Low economic condition coupled with low standard of living has been identified as the most important driving cause behind child labour. Children are forced into hazardous jobs by their parents for reasons of survival. Monetary constraints and need for food, clothing and shelter drives children in the trap of premature labour. Livelihood considerations can drive a child into the dirtiest form of child labour like child prostitution and organized begging.
2. Parental Illiteracy- Absence of compulsory formal education of the parents even at primary level is another cause of child labour. It becomes difficult for the children to organize themselves against exploitation in the absence of parental guidance.
3. Low level of Awareness- Parents of the working children is ignorant about the bad effects of child labour on the mental and physical development of the child. They are even ignorant about various child labour laws and government programmes undertaken to prohibit and improve the condition of these children.
4. Social Apathy- Parental ignorance regarding the ill-effects of child labour is another factor for its steady flow. It contributes to social imbalances as well.
5. Dearth of Cheap and Skilled Labour in unorganized sector - In the urban areas there is a deficiency of cheap and skilled labour. For hiring adult labour wage rates are generally high while in case of child labour wage rate is low as they are unskilled and can be easily be exploited.
The problem of child labour is a symptom of the disease, which is widespread due to exploitative structure, lop-sided development, inequities in resource ownership with its correlate of largescale unemployment and abject poverty among the countries (Nanjunda, 2009). Thus the problem of child labour is a cumulative effect of a number of social and economic causes and hindrances in society. The incidences of child labour tend to decrease as female members of the family especially mothers begin to work. This process will likely be affected by societal factors namely level of development, the level of social expenditure and the phase of demographic transition (Grootaert, et.al., 1995). But the most important factor contributing to female participation in work is related with their social independence and level of education.
Consequences of Child Labour
The consequences of child labour are poorly educated and impoverished parents who may be forced to send their own children to work, a poorly educated and skilled workforce that may stunt the growth of economy as a whole and the potential for trade sanctions on the part of developed countries (Hindman, 2009). The following consequences have been documented based on field visits and experiences:
Child Labour is an issue contrary to human development.
It affects the sound development of a child and leads to grave social consequences.
It hampers the overall physical and psychological development of the child.
The child tends to suffer from malnutrition and a number of other ailments.
It affects the overall health of the child
A child engaged in laborious activities remains devoid of basic formal education which affects him in the long run.
The toiling children often suffer from various physical and mental tortures and exploitation at their work places which affects their personality development.
The First Attempt to combat Child Labour Child
Labour has survived in the face of increasing industrialization mainly in the developing world. According to an estimate in India there are over 20 million child workers (Joshi, et.al., 1994). The first initiative to tackle the problem of Child Labour was taken in 1979 when Gurupadswamy Committee was constituted. The Committee examined the problem in detail and made some far reaching recommendations. It observed that if poverty continued it would be difficult to totally eliminate child labour and hence any attempt to abolish it through legal recourse would not be a practical proposition. The Committee felt that the only alternative left was to ban child labour in hazardous areas and to regulate and ameliorate the conditions of work in other areas.
Scenario of Child Labour in the city core of Kolkata
The study in different Boroughs consisting of municipal wards of the city has revealed that families from South 24 Parganas (Hingalganj, Gosaba and Sandeshkhali), Malda (Harishchandrapur, Kaliachak, Bhagwanpur I and Bhagwanpur II) Murshidabad (Dhulian, Jangipur, Lalgola and Debipur), Haora (Shibpur, Uluberia, Liluah and Bauria) etc come to the city in search of work (Fig.1). The male member usually has a big family to support with at least 3-4 children, parents and wife. The eldest child is sent to work to support the family. A huge inflow of child labour is observed from Bihar, Jharkhand, Orissa and Assam especially from upper Assam valley (Fig.2) who is generally employed in hazardous industrial units in the city. The extensive field visits have revealed that 40 per cent of the working children below the age of fourteen years remain deprived of formal education and among the rest 60 per cent, 45 per cent do not get chance to study after completing primary level of education (Table.1). The incidences of school dropout are extremely high in case of these exploited children. The reasons have been social as well as economic including poverty, big size of family, status of unemployment of head of the family, parental negligence, parental illiteracy and lack of awareness.
The head of the family generally work as auto drivers, rickshaw pullers and van-pullers, marginal workers in industries or as contract laborers. Apart from their wage been spent on food and clothing, a substantial portion is wasted on liquor and gambling. The children and women in these families are subjected to immense physical and mental torture (Fig.3). The children are generally employed at very low rates as cheap unskilled labour in industries, small factories and garages as unskilled mechanics. They also work as domestic help where they are often thrashed and abused. They are also employed in roadside food stalls, tea-stalls and sweet (Table.2). The tanneries here employ children at very low wage rate as cheap unskilled labour. These children are prone to various health hazards like skin infection, breathing problem etc. Due to inadequacy of safety measures in these units they are also prone to acid and chemical burn.
Majority of the surveyed households have unemployed male head of the family (Fig.4) with working females employed as household maid, cook, nurse etc. Some of the women run tea stalls or food stalls along the roadside. The driving force of child labour identified in the city is economic where the child labour is the only earning member of the family. The child has a big family to support with ailing parents or where the earning of the parents is inadequate to run the family (Fig.5). The age group of child labour includes four-twelve years in the city with maximum dominance of children working in hazardous sector aged between ten-twelve years. Their earning is in the form of wage in industries, factories and garages where they earn approximately Rs.30-40 per day.
In case of children working as domestic help their salary ranges between Rs.250-300 per month. A number of children are brought in the city been sold by their parents who are compelled to work as child prostitutes. The girl children are often subjected to hilarious crimes like physical abuse and domestic violence. The news of disappearence of girl children from low income families often strikes newspapers. A thorough probe reveals either they are kidnapped or sold to middle-man who further sell them to brothels. Prevalence of child trafficking especially that of working children is an issue of concern in the city. Child laborers are sent to work in zaari factories in Maharastra, Andhra Pradesh, Karnataka etc. Thay are extensively employed in firework industries of Tamil Nadu. In West Bengal a massive proportion of working children are employed in illegal firework factories of South 24 Parganas. Various NGOs have been found to be working on eradication of child labour in the city. But there are some NGOs which have been found to provide education, food and clothes to these children. Their work and activities are really praiseworthy. They run night schools in various clubs in slums and shanties, give food, clothes, arranges recreational activities like sports, games for these children. They also take initiatives in rehabilitating and mainstreaming these children socially.
Child Labour (Prohibition and Regulation) Act, 1986:
As per the Child Labour (Prohibition and Regulation) Act, 1986 ‘child’ means a person who has not completed his 14th year of age. The Act prohibits employment of children in 18 occupations and 65 processes contained in Part A and B of the Schedule to the Act (Section 3). Any person who employs any child in contravention of the provisions of section 3 of the Act is liable for punishment with imprisonment for a term which shall not be less than three months but which may extend to one year or with fine which shall not be less than Rs 10,000 but which may extend to Rs 20,000 or both.
Major Activities under National Child Labour Project (NCLP) in Kolkata
Intensive Child Labour Survey in the city
Raising Public Awareness regarding the grave problem of child labour
Stepping up enforcement of Child Labour Act to withdraw children from hazardous work
Establishment of Special Schools to provide :
Bridge Education for mainstreaming in formal Education.
Pre-Vocational training
Mid-day meal provided by Ministry of Human Resource and Development
Payment of Stipend ( Rs 100 / per child / month )
Health Check up: A Doctor for every 20 schools.
Findings from the Study
The condition of Human Development especially child health condition and literacy rates are extremely miserable in various Asian countries like Bangladesh, Nepal, Pakistan, India etc. It is often assumed that the amount of child labour in a country is determined by the nature and extent of poverty in that country (Hobbes, et.al., 1999). Child Labour has emerged as a curse in the urban society of Kolkata. As an administrative hub of West Bengal, the city of Kolkata shows evidence of the clear existence of child labour in almost all activities of the city. Children below 14 years are employed here as domestic help with low monthly salary compared to adult domestic help. The children work as regular wage earners in restaurants, sweet shops, garages, furniture shops, tanneries, butadiene factories, chemical factories etc. These children are even employed as beedi (country cigar) and zaari workers. They work under hazardous conditions and are sometimes abused physically and mePoverty has been identified as the prime driving force behind child labour. These children come from families below poverty line. Their parents are either unemployed or low wage earners. The size of their families is big with the number of siblings been four-five. Literacy rate among such children are low though in some areas with initiative of NGOs and local clubs they are given basic education. In some areas night schools are run for these children. Due to low financial condition and extreme hard work these working children are found to be malnourished and underweight with improper physical growth and mental development. Sometimes these children come in contact with persons who tend to influence their proper psychological development as well. They are exploited by the local goons who use them as crime partners. It was even more shocking to know that sometimes the girl working children are forced to enter into flesh trade by their families. These children come in the city either from neighboring states or districts with their families who consider them as means of earning money. They are not only exploited by their employers but also by their drunken fathers.ntally by their employers. They are subjected to beating, scolding and abusing
Poverty has been identified as the prime driving force behind child labour. These children come from families below poverty line. Their parents are either unemployed or low wage earners. The size of their families is big with the number of siblings been four-five. Literacy rate among such children are low though in some areas with initiative of NGOs and local clubs they are given basic education. In some areas night schools are run for these children. Due to low financial condition and extreme hard work these working children are found to be malnourished and underweight with improper physical growth and mental development. Sometimes these children come in contact with persons who tend to influence their proper psychological development as well. They are exploited by the local goons who use them as crime partners. It was even more shocking to know that sometimes the girl working children are forced to enter into flesh trade by their families. These children come in the city either from neighboring states or districts with their families who consider them as means of earning money. They are not only exploited by their employers but also by their drunken fathers.
The Government has taken steps to tackle the problem of child labour but the results have not been satisfactory in various areas of the city. A number of NGOs are working in the city to rehabilitate these exploited children. They provide them with food, clothes and education. They sometimes arrange recreational activities like games and sports competition for them. Various Government run projects on child labour are also going on with inadequate coverage when compared with their huge prevalence in the city.
Suggested Remedial Measures to combat Child Labour Based on field investigation some remedial measures have been suggested to combat problem of child labour in the city:
• Laws to combat child labour should be strictly implemented both at State and Central level.
• Corruption and negligence regarding the menace of child labour offences should come under strict control.
• Vigilance and monitoring of the life style of child labour is essential.
• Rehabilitation procedures adopted by the Government and NGOs should be an orchestrated effort.
• Public awareness to be enhanced regarding the grave consequences of employing children in hazardous occupation and processes.
CONCLUDING REMARKS
Child labour is perceived to be an economic necessity of poor households and the exploitative aspect in children’s work is associated with the profit maximizing motive of commercial enterprises, wherein children are made to work long hours, paid low wages and denied opportunities for education (Sharma, 2006). The prevalence of child labour is a hindrance to human development in any area. The children are subjected to enormous physical and mental torture at their workplaces. Poverty and parental ignorance drives a child to the field of child labour. The city exhibits presence of toiling children engaged as unskilled workers in factories, hazardous industries, restaurants, shops and as domestic help in households. News about physical and mental abuse often hits the newspapers which reflect their tragic condition at their workplaces. Though both the Central and State Government has taken various policies and programmes to combat the problem of child labour but the prevalence of poverty and illiteracy in the state has limited the implementation and success of these initiatives. The Government and NGOs should undertake more strict steps and regulations to combat this grave problem. The world must be beautiful not only for the children from elite communities but also for them whose lives are stricken by poverty and negligence.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcarePREVALENCE AND EXISTING QUITTING PATTERN OF CHEWING TOBACCO AMONG URBAN POPULATION
English1015Syed Arif PashaEnglish Muneeb JehanEnglish Abdullah RehmanEnglish Umrana MirzaEnglishBackground: Awareness towards tobacco hazards has increased recently but its role alone towards cessation is still under debate. For effective formulation of quitting strategies, knowledge regarding quitting behavior is necessary to study and hence a cross-sectional study was carried out in Hyderabad city. Objectives: 1.To study prevalence of different forms of chewing tobacco and its quitting patterns in urban area. 2. To study quitting patterns in relation to various personal and family background factors. Materials and Methods: A cross sectional research involves 3000 individuals from randomly selected 30 clusters by two stage cluster sampling method for this research during June –December 2009 from urban area of Hyderabad (India). Pretested, designed and self explained questionnaire was used for interview purpose after taking verbal, written and informed consent with approval from ethical committee. Statistical analysis was done using SPSS software. Information was collected on chewing forms, quitting pattern, quitting reasons and health hazards, age of tobacco initiation, duration of tobacco chewing, daily frequency, family exposure of tobacco and knowledge regarding health hazards of tobacco. Results: About 58% of study population was ever-tobacco-chewers; 89 % of them were current-chewers and 11 % were quitters. Approximately 18 % of current-consumers were willing to quit. Mawa-masala (73 %) and Gutka (62 %) were preferred forms of chewing tobacco and 60 % of the current-chewers chewed tobacco six to eight times a day. About 51 % smokers and 71 % chewers showing willingness to quit had not consumed tobacco for more than five years, 69 % of current-chewers had a family member consuming tobacco. With initiation of health problems, 62 % subjects quit while 38 % of them already knew about health hazards but not willing to quit. Conclusions: Every 7 out of 10 residents were found to be exposed to chewing tobacco. With Mawa-masala and Gutka as a primary source of consumption, early usage in late adolescence, continuous consumption for long time and family as well as friend circle exposure seem to be inhibiting quitting. Awareness of tobacco health hazards only does not produce successful quitting results.
Englishtobacco, chewing, health hazard, quittingINTRODUCTION
Today it is known that tobacco use continues to be the leading global cause of preventable death. It kills nearly 6 million people and causes hundreds of billions of dollars of economic damage worldwide each year. Most of these deaths occur in Low and Middle-income countries, and this disparity is expected to widen further over the next several decades. If current trends continue, by 2030 tobacco will kill more than 8 million people worldwide each year, with 80% of these premature deaths among people living in Low and Middle- income countries. Over the course of the 21st century, tobacco use could kill a billion people or more unless urgent action is taken1.
Tobacco consumption is a global public health problem. Approximately one person dies every six seconds due to tobacco and this accounts for one in 10 adult deaths. Up to half of current users will eventually die of a tobacco-related disease. It kills nearly six million people a year of whom more than 5 million are users and ex users and more than 600 000 are non-smokers exposed to second-hand smoke. The burden of tobacco-related illness and death is heaviest in low- and middle-income countries. India has the second largest number of smokers in the world, after China2. According to GATS- India (2009-10), the prevalence of overall tobacco use among males is 48% and that among females is 20%3-5.
According to NFHS-III, in India, 55.8% male, 10.8% female in the age group of 12 to-60 years have been found to be consuming tobacco. Among males, 32.7% smokers while 36.5% tobacco chewers are reported, while among females; it is reported to be 1.4 and 8.4%, respectively6.
Awareness towards hazardous health effects of tobacco has increased with time but its role alone towards attainment of tobacco cessation is questionable. For effective formulation of quitting strategies, knowledge regarding quitting behavior is necessary to study and hence a cross-sectional study was carried out in Hyderabad city to find out the prevalence of chewing tobacco along with prevalence of quitters, their reasons for quitting, quitting behavior in existing consumers and associated factors.
MATERIALS AND METHODS
A cross-sectional study, based on the results of prior pilot study on prevalence of tobacco use was conducted in Hyderabad urban city. Almost 3000 individuals were selected from randomly selected 30-clusters from different political wards of Hyderabad city. The study was carried out between June-December 2009. Pre-designed and pre-tested questionnaire was used as a data tool after taking verbal and informed consent from participants. Tobacco chewing, different form, quitting pattern, age of tobacco initiation, its duration and frequency as well as knowledge regarding its health hazards, were used as study variables. Current-Tobacco-Chewers were those who had chewed tobacco regularly and chewed at least once on an average each day, during the previous 30 days at the time of study. Tobacco-Chewing-Quitters were those who chewed tobacco in the past but had quit and not chewing presently. The current-tobacco-chewers and past-tobacco-chewers together formed the term Ever-Tobacco-Chewers. Never-Tobacco-Chewers were the persons who never chewed tobacco in their lives.
Descriptive statistics like mean, percentages and proportions were used. Chi- square test was used to see the association between tobacco use and selected variables like age, educational status, occupation, income, religion, knowledge of harmful effects of tobacco and presence of another tobacco user in the family. A p-value of Englishhttp://ijcrr.com/abstract.php?article_id=987http://ijcrr.com/article_html.php?did=987
WHO. WHO Report on The Global Tobacco Epidemic, 2011:Warning about the angers of tobacco. Italy: WHO; 2011. p 8. Available
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World Health Organization. Tobacco Fact Sheet No.339. 2012. Available from:
URL:http://www.who.int/mediacentre/factsheets/fs339/en/index.html . Accessed 18 June 2012.
Global Adult Tobacco Survey (GATS): India. World Health Organisation; 2009-2010. Available from:
http://www.searo.who.int/LinkFiles/Regional_Tobacco_Surveillance_System_GATS_India.pdf . Accessed 6 July 2011.
Reddy KS, Gupta PC, editors. Report on tobacco control in India. Ministry of Health and Family Welfare, Government of India, New Delhi, India 2004;57-61.
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Control, 12,2003,341. Available from: URL: http://www.tobaccocontrol.com/cgi/content/full/12/4/e4 . Accessed 28 June, 2011.
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http://www.measuredhs.com/pubs/pdf/SR128/SR128.pdf. Accessed 1st Dec 2009.
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Kapoor SK, Anand K, Kumar G. Prevalence of tobacco use among school and college going adolescents of Haryana. Indian J Paediatrics. 1995;62:461–6.
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Sen U. Tobacco Use in Kolkata. Lifeline. New Delhi, India: WHO SEARO; 2002. pp. 7–9. Vol 8.
Singhi S, Brica JS, Mathur GM. Smoking behavior of rural school boys. Indian Paediatr. 1987;24:655–9.
Gupta PC. Survey of sociodemographic characteristics of tobacco use among 99598 individuals in Bombay, India, using hand-held computers. Tob Control. 1996;5:114–20.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcareHIV: A WEAPON OF CRIME AND ITS PHYLOGENETIC ANALYSIS
English1622Deepika BhandariEnglish Rinki SaxenaEnglish Romila LemosEnglish Swati WavhalEnglishAIDS is the most lethal disease affecting mankind in current times. It is the final stage of the infection, caused by HIV. This deadly disease can be transmitted to a healthy individual through body fluids, placenta, tattooing, unprotected sexual intercourse, etc. It can spread accidentally or intentionally. The World Health Organization (WHO) estimates that around 34 million people in the world are living with HIV and 1.8 million died of AIDS-related illnesses worldwide in 2010. An increasing number of HIV infected people are being prosecuted for transmitting the virus to their sexual partner(s). As widely reported by sundry media houses, criminal journals, print media and above all in true light of the day there has been a deliberate endeavor or case of recklessness / intentional attempt to transmit virus to non infected Homo sapiens. The three categories of HIV transmission in the context of the law are intentional, reckless, and accidental. Intentional transmission is considered as the most serious form of criminal transmission and some of the individuals concerned have even been imprisoned. Some cases have reported individuals who have used needles or other implements to intentionally infect another individuals with HIV. While some have been established on HIV affirmative individuals who have had sexual relations with the primary intent of transmitting the virus to their partner. This review paper aims to focus on how HIV is being used as a bio-weapon and how transmission of the disease can be linked to the virus employing Phylogenetic Analysis. Thus, Phylogenetic analysis can be utilized as forensic evidence in criminal HIV transmission prosecution.
EnglishHIV, Criminal Transmission, Phylogenetic Analysis.INTRODUCTION
Human immunodeficiency virus infection - acquired immunodeficiency syndrome (HIV-AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV). HIV is the mainspring of the rainbow of epidemic avowed as HIV-AIDS. Predominantly the human immune system constituents like macrophages, dendritic cells and CD4+ T cells are contaminated owing to HIV, which is a retrovirus. There are two classifications of HIV: HIV-1 and HIV-2. Most pernicious being HIV-1, is more easily instilled and contributes to majority of HIV infections
globally. Both types of HIV impair a person’s body by destroying definitive blood cells.
HIV is disseminated primarily via unprotected sexual intercourse (entailing sonant and even anal sex), hypodermic needles, infected blood transfers, wet-nursing and from infant bearer to infant during pregnancy, labor or breast feeding. Upon any less condition than being contaminated with blood, exposure to the following does not pose any threat of amassing HIV: Regurgitate, Sudor, Sputum, Nasal Suppuration, Feculence, Tears or Urine. Dilatorily stage of HIV infection is called AIDS, person’s immune system it gravely damages and has difficulty fighting diseases and certain cancers. AIDS is the most lethal disease affecting mankind in current times. The WHO estimates that around 34 million people in the world are living with HIV and 1.8 million died of AIDS-related illness worldwide in 2010.
Criminal Transmission of HIV
There has been constant reporting by sundry NGO's and gregarious groups about the rapid increase where in the HIV positive people are inculpated and constant prosecution proceedings are being initiated on the charge of transmitting infection/virus to the partners with whom they indulge sexually. Criminal Transmission of HIV is differentiated into three categories - Intentional, Reckless or Accidental in context to law.
Intentional or deliberate or willful transmission of HIV means intentional transmission of virus from the infected person to the uninfected person. The reason for intentional transmission can be revenge to a person or society by various modes such as use of unprotected sexual intercourse, needles and other implements. There are also some rare cases where negative partner has an active desire to become infected with HIV (no prosecution in this case because it was consensual).
Reckless or careless act of transmission of HIV is the act of transmission of virus by the infected person to the uninfected person out of sexual gratification or having unprotected sex but fails to inform about the HIV positive status.
Accidental transmission of HIV is the act of transmission of virus by having unprotected sex without being aware of the HIV status or upon the partners being aware, use of protection (condoms) that failed.
Cases where deliberate or criminal intention on part of any HIV infected person transmitting infection to non- infected person even if prime facie comes to light then in such cases “law of land of that individual's homeland prevails”. In some locations there is no differentiation amongst the two.
In addition to HIV a new virus has been detected that is sweeping the world and that is HIL (Highly
Ineffective Laws). The adoption of a large number of laws relating to punish persons convicted of transmitting HIV to others, in the past five years or so, different countries have added a new factor to the HIV epidemic.
HIV-AIDS is not a commonplace health status. It is an exceptional global pandemic with numerous communal and legal implications. Safe sex is advised even when both partners are HIV positive. Infection with HIV is such a life changing event that people get angry at such conduct, they look for retribution and punishment, thus a suggestion of willful, deliberate or completely reckless transmission of HIV to a sexual partner. With the exception of cases where individual actually intends to do harm, criminalizing HIV transmission does not empower people to avoid HIV infection. In fact it may make it more difficult for them to do so endangering both public health and human rights.
Countries with laws and prosecution for Criminal Transmission of HIV:
Approximately 600 people living with HIV in 24 countries have been convicted of criminal transmission of HIV till 2010. The conviction was either through general laws relating to assault or through HIV-specific legislation. Since every nation enjoys sovereignty and therefore have their own criminal laws. It is therefore, worth mentioning that quantum of punishment on conviction after following due process of law varies country to country where the judicial prosecution takes place.
United States of America
American states have prosecuted HIV positive individuals for criminal transmission or HIV exposure, with many laws specifically mentioning HIV. Quantum of punishment on conviction varies from severe to even more severe if it is proved that accused had complete knowledge of his being a carrier of HIV, even though aware of this fact he forgoes and indulges in sexual act whether by means of prostitution or in case of rape. Spitting or emitting HIV-infected bodily fluids at another person while in prison is also an offence in some states. Prosecution of an accused can be initiated irrespective of the intention which in such cases is irrelevant if an accused chose not to disclose about his being HIV positive to his sexual partner.
United Kingdom
There are numerous citations in England and Wales where there have been conviction of accused under Section 20 of Offences against the Person Act (OAPA) 1861. In 2010, the Association of Police Officers issued guidance for police investigating the criminal transmission of HIV. Under the new guidelines, people living with HIV in Wales, England and Northern Ireland can expect an investigation of reckless transmission by the police only to be pursued if a complainant has been infected with HIV.
West Africa
Several nations in West Africa have adopted HIV laws based on a ‘model law' formulated in 2004 by Action for West Africa Region - HIV/AIDS (AWARE-HIV/AIDS).Willful transmission of HIV has been identified as an offence prescribed under Article 36.
Australia
In Australia where a law is even more stringent and therefore any criminal transmission of HIV is dealt within ambit of criminal law as well as public health also. Various sovereign states to curb the menace of reckless or deliberate attempt to transmit HIV have also formulated various public health laws. Australian state criminal laws that would likely apply to HIV transmission include criminalizing actions that convey, or risk transmitting, a grave disease (including HIV), recklessly threatening another person's life or instating grievous whole body harm.
India
Many cases have been reported of HIV criminalization but there are no specific laws dealing with prosecution and penalization of such cases. Presently the cases are being registered under section 269 (Negligent act likely to spread infection of disease dangerous to life) and section 270 (Malignant act likely to spread infection of disease dangerous to life) of IPC. There is a bill titled The HIV/AIDS Bill, 2007 which provides the protection and promotion of human rights in relation to HIV/AIDS. It promotes avoidance, perception, care, support and remedy programmes to command the disperse of HIV. Its section 99 states that all offences under this Act shall be tried summarily in the manner provided for summary trial under the Code of Criminal Procedure,1973 (2 of 1974).
Some Cases Reported in India
A case of deliberate transmission of HIV was filed against a man (Doctor) by his wife in Nandurbar town in Nashik district of Maharashtra , India (2004) in which it was alleged that the person injected HIV infection to his wife and daughter to get rid of them.
A case of reckless transmission of HIV was reported in December, 2007 in Bombay, India in which the police refused to register a complaint from a woman against a HIV positive husband as he had not disclosed his HIV status before marriage.
Another case of criminal HIV transmission was reported in April, 2008 in Tamil Nadu, India against a man who allegedly raped two minors and infected them with HIV.
Very recently in August, 2013 an incidence of negligence or reckless transmission of HIV has been reported in Guwahati, Assam. In this case the officials have done transfusion of HIV positive blood to four patients at Daarang Civil Hospital. The officials are alleging that the patients were HIV positive prior to the transmission but the locals says that a HIV positive person has been donating blood in the blood bank.
A study was conducted for identifying factor associated with transmission of HIV from Injecting Drug Users (IDU) to their non injecting wives in Manipur, India which concluded that 45% of the wives were HIV positive. Transmission of HIV from injecting drug users to their wives was analyzed in Manipur, North-east India, where the prevalence of HIV among IDUs is 80% during September 1996 to August 1997. However a solid conclusion could not be made then due to lack of reliable analytical techniques. How then can we establish a solid relationship between the various HIV strains to determine the direction of transmission? The transmission of HIV can be determined using Molecular Genetic Techniques and one of them is Phylogenetic Analysis.
Phylogenetic Analysis
Phylogenetic assay has taken boost connotation as lawfully admissible clues in the following and inquisition of happenings premier to HIV infections, also known as HIV forensics. Scant discordance in HIV's genes is scrutinized by means of Phylogenetic assay, utilizing computational procedures to calculate the genetic expanse between strains.
It can determine the degree of relatedness of two samples of HIV. Increased amount of genetic diversity is also owing to the fact that HIV's RNA transforms at a much higher pace than that of a human DNA, which for the entire lifespan remains constant and stable. This diversity means that researchers, utilizing Phylogenetic analysis have been able to establish where HIV comes from, as well as pathway the various strains of HIV that exist worldwide.
Assay of multiple genetic clones from each individual can invigorate the recommended reciprocity when a simple Phylogenetic tree is evocative of genetic congruence between viruses conveyed by the two individuals.
Phylogenetics acts as an important tool in the event of criminal HIV transmission. To aid criminal transmission trial in 1998 Schmidt's case, Phylogenetic or evolutionary analysis were utilized for the first time ever. Additionally the analysis helped in determining source of infection for five patients treated by Florida dentist, Dr David Acer, who was HIV positive. Since then it has been utilized as a component of the overall evidence in several HIV criminal transmission tribulations in the Amalgamated States, including a 2004 case in Washington and a 2009 case in Texas.
Basically HIV-1 isolates are classified in three groups: M, O and N group (Figure 1), of which group M is responsible for majority of infections in the HIV-1 worldwide epidemic. The group M can be further subdivided into 10 recognized Phylogenetic subtypes or clades {A - K, excluding E, which is actually a Circulating Recombinant Form (CRF)}. HIV-1 Phylogenetic collocations are presently established either on nucleotide array imitative from multifarious sub genomic regions- gag (group antigens), pol(reverse transcriptase, RNAse H and integrase activity) and env(envelope protein) of the same isolates or on full-length genome sequence analysis. These regions can be used to distinguish between different HIV isolates and establish relatedness between them.
The skyward proclivity in global HIV-1 variegation has continued tenaciously, with newer groups, subtypes, and exclusive and circulating recombinants increasingly being described, particularly in Africa. West Central Africa, which is the epicenter of AIDS, shows a very diverse population of HIV-1 subtypes with A (A1, A2, A3, A4, A5), C, CRF02_AG, and D responsible for about 85% of new infections. Subtype A and D appear to be the dominant strains in Eastern Africa, while subtype C has remained stable in Southern Africa. Western Africa shows a high stability for A, G, CRF02_AG, and CRF06_cpx, and as for the Northern region of the continent, subtype B and CRF02_AG are the dominant recombinants. Two citizens from Republic of Cameroon were reportedly found to have a unique suppositional group, designated P in the recent past.
In Bolivia, Phylogenetic analysis of env and pol regions confirmed the predominance of subtype B (72.5%). Molecular typing followed by Phylogenetic analysis of gag gene in HIV strains in Bangladesh indicated that subtype C was the predominant type, causing 41% of the HIV infections in the country.
In Finland and Estonia, 30 patients were analyzed for their gag p7/p9 coding regions using Solid Phase Direct Sequencing to determine genetic subtype of HIV-1 strains. Proviral perpetuity was found to embody at smallest four, (even five) disparate, highly diverged foremost lineages.
In Punjab, a fragment encompassing C2/V3-V5 regions of HIV-1 gp120 (650bps) was amplified and analyzed from lymphocytes of 12 Indian patients. It was concluded that the predominant strain of HIV-1 in India belongs to subtype C and little inter-patient nucleotide sequence divergence in the majority of cases could be suggestive of recent spread of HIV-1 in this region.
In Italy, Phylogenetic characterization was performed on HIV-1 variants during 1995-2005, wherein C2-V5 and p17 of env and gag amplified respectively. The average divergence in env C2-V3 region was found to be 18.08% and in gag p17 it was 11.13%. Phylogenetic analysis on pol and env sequences of HIV-2 strains was also done and env V3 region showed more similarity to group B viruses.
DISCUSSION
Thus the regional distributions of individual subtypes and recombinants although broadly stable, also show an increasing diversity and this knowledge can be exploited in HIV forensics. And although current data does not allow a clear, accurate estimation of the direction of transfer, Phylogenetic analysis can be and has recently been used in criminal trials as evidence of responsibility for HIV transmission to at least exonerate individuals and exclude the possibility that the defendant was responsible for HIV transmission.
In India, not much research work has been done on HIV forensics. Also, there are no specific/special laws criminalizing knowing exposure to or transmission of HIV. Phylogenetic analysis of various HIV isolates in the country could help set up an accessible database providing information about the regional distribution of the subtypes. This could be further employed to understand the recombination events and thereby establish a link to the direction of transfer of the virus. This along with effective enforcement of appropriate laws will help in the arrests, prosecutions, convictions and sentencing in cases of criminal transmission of HIV in the country.
CONCLUSION
From the above studies and reports cited we can infer that there are many countries which have laws for the prosecution for criminalizing the spread of HIV virus with or without intention. Country's like USA has already used Phylogenetic analysis for the prosecution of crimes related to transmission of HIV. In India, there are laws for the protection of rights of the people living with the menace of HIV but there are no specific laws criminalizing the spread of HIV. There is also a need of applying Phylogenetic analysis for legal prosecution in cases of criminal transmission of HIV.
ACKNOWLEDGEMENTS
We are grateful to Mr. Kunal D. Sharma and Mr. Prabhat Sharma for their critical reading of the manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=988http://ijcrr.com/article_html.php?did=988
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcareSYNOSTOSED COSTOCHONDRAL AND CHONDROSTERNAL JOINTS- A REVIEW
English2326Sayee RajangamEnglish Flossie JayakaranEnglish Sivacharan P. V.EnglishOssified costochondral and chondrosternal joints are often seen in radiological pictures and may be associated with some syndromes. Five such bony specimens available in our lab was studied and literature reviewed to see its prevalence, the process of ossification and if possible to evaluate the consequences of such a rigid thoracic inlet. A quick review showed that there is more to ossification than that given in standard textbooks and that it may have a role to play in sex dimorphism and age determination. This subject may definitely be of academic interest for research by postgraduate students in Anatomy.
EnglishOssified costochondral and chondrosternal joints, thoracic inletINTRODUCTION
The 1st rib’s costochondral and chondrosternal joints and the processes of ossification of the same are generally well known. Costochondral junctions are those between the anterior ends of the ribs and their costal cartilages which, with their rounded ends fit reciprocally into the depressions in the ribs. They are held in position by the continuity of the periosteum of the ribs and the perichondrium of the cartilages. These junctions are immobile and very strong. It may be noted that the adjacent bone may fracture but the bone and cartilage interface will not separate. Primary cartilaginous joints occur where bone and cartilage meet. Non-articular hyaline cartilage has the capacity to ossify with age and then a synchondrosis tends to become a synostosis upon the completion of growth. Chondrosternal articulations are found between the costal cartilages of the first 7 ribs and the articular facets on the lateral borders of the sternum. Among them, the 1ststernochondral joint between the manubrium and the first costal cartilage is an unusual form of synarthrosis and is often also called as synchondrosis. Slight gliding movements, sufficient for ventilation, may occur at this sternocostal joint. The manubrium is ossified from one to 3 centers appearing in the 5th month of fetal life and by the age of 25 years the centers in the sternum are united. The 1st rib has a primary center for the shaft that appears around the 2nd month of intrauterine life. Secondary centers for the head of the rib and tubercle appear around puberty. Fusion is completed by 20 years. The costal cartilages are the persistent un-ossified anterior parts of the cartilaginous elements from the transverse processes of the thoracic vertebrae in which the ribs develop. The 1st costal cartilage is continuous with the 1st rib and the manubrium, to form a primary cartilaginous joint that is usually replaced by bone after 25 years. (Sinnatamby 2006, Datta 2008, Standring 2008, Singh 2011) The present article is a short note and a review on the synostosed first costochondral and chondrosternal joints of the 1st rib.
MATERIAL AND METHOD
Among the teaching materials for Osteology of the thorax at the Department of Anatomy, International Medical School, Bangalore, there were five 1st ribs with intact synostosed costochondral and chondromanubrial (sternal) joints. The Method used here is subjective description of the observed features.
RESULTS
The 1st rib’s synostosed costochondral and chondrosternal joints were noted in 5 specimens and they were bilateral. From the muscular markings and the thickness of the specimens, they were subjectively sexed as male bones. The total number of manubria and 1st ribs available in the Department were 25 and 30 respectively. Hence, in the present study, the occurrence of the synostosed first ribs with their cartilages was 16.6% (5/30) and those with the manubria 20% (5/25).
Figure 1 shows the 5 specimens with complete and or incomplete forms of the synostosed costochondral and chondrosternal joints of the 1strib. Figure 1a is a complete sternum with remnants of the synostosed 1st rib on each side of the manubrium; Figure 1b shows manubrium with synostosed 1st rib, which is broken on the left side and as a stump on the right side; Figure 1c shows synostosed 1st rib, which is complete on the left side and stumped on the right side; Figures 1d and 1e are the two 1st ribs with synostosis in their anterior ends. Figure 1e had an additional feature of the presence of an oblique foramen passing medially from the superior to the inferior surface of the rib, near its inner border, between the scalene tubercle and the synostosis with the costal cartilage.
1:1a: Sternum with bilateral synostosis of the 1st rib. The right side shows a short segment of the 1st rib and on the left side is the broken 1st rib.
1:1b: Manubrium with synostosis. On the right side, a very small stump representing the 1st rib and on the left a short segment of the 1st rib is seen.
1:1c: Manubrium with bilateral synostosis. The right side shows a stump of the 1st rib and on the left side is the complete 1st rib.
1:1d: Complete right 1st rib showing synostosis with a small segment of the manubrium.
1:1e: Complete right 1st rib showing synostosis with a small segment of the manubrium. In addition, note the presence of an oblique foramen (indicated by an arrow) passing medially from the superior to the inferior surface located close to the inner border of the rib and the scalene tubercle.
DISCUSSION
A review of literature indicated the clinical importance of osteogenesis in the 1st rib in Radiology.
In 1989, a case of Teitze’s syndrome was reported in a female. Her CT scan showed the sclerosis of the manubrium, partial calcification of the costal cartilage and soft tissue swelling. A biopsy of the right 1st cartilage showed chronic inflammation with fibrosis and ossification. (Honda et al 1989)
In a radiological study by normal and polarized light microscopy on mineralization and osteogenesis of the 1st rib cartilage, the following were the findings in the words of the authors: (Kampen et al 1995)
i) Onset of mineralization occurred at the end of puberty and was located directly beneath the perichondrium.
ii) Bone was formed in a typical spur like manner medially from the upper edge of manubrium and laterally from the caudal rim of the bony part of 1st rib
iii) In the middle of the 2nd decade, large cartilage canals with several blood vessels and loose perivascular connective tissue were seen in the central areas of the 1st costal cartilage and these parts became the last to be mineralized and ossified in old age
iv) The type of osteogenesis can’t be classified according to the common patterns of the ossification. In spite of the subperichondreal localization, it can’t be intramembranous, because the new bone was separated from the perichondrium by a layer of mineralized cartilage and it can’t be called endochondral (comparable with the epiphyseal plate osteogenesis) because hypertrophied chondrocytes were absent. Moreover, immune reactivity for the collagen type ‘X’ was missing and areas where bone was formed, it was laid directly on hyaline cartilage
v) Vascularization and onset of osteogenesis could be separated in time and localization
vi) Mineralization and osteogenesis in the 1st costal cartilage being physiological age-related changes; hence, can’t be regarded as degenerative processes.
The authors concluded that the ossification could neither be directly correlated with the invasion of the blood vessels nor classified under the classical concepts of intramembranous or endochondral osteogenesis. However, the time of commencement of ossification was in accordance with that given in standard textbooks of Anatomy.
In an another study from radiographs, on the factors affecting the rate and pattern of the first costal cartilage’s ossification, the extent of the costochondral ossification of the 1st rib was determined in 13 healthy male soldiers out of 78 who were subjected to periodic follow up. (Barchilon et al 1996) The study has provided information on the process of ossification:
i) ossification of the 1stcostal cartilage may start early in adult life and progress at individual rates
ii) the process of ossification proceeds from the costal to the sternal end of the cartilage
iii) morphological age related changes range from the formation of small osseous islands in the cartilage to complete ossification between 1st rib and sternum.
The study concluded that the degree of ossification of the 1st costal cartilage as an indicator of age does not provide the precision necessary for forensic or anthropological studies.
Age and sexually dimorphic changes in costal cartilages, that appear at the microscopic level throughout life, especially during the ossification process, was also reported. (Rejtarova et al 2009).The particular research work was built on their previous study, which confirmed the presence of the two sexually dimorphic ossification patterns. The study was carried out on autopsies of 17 corpses, whose age varied greatly from newborn to 91 years. The method consisted of getting sections of costal cartilages, processed and stained. Alkaline phosphatase activity was detected with histochemistry and collagen fiber types ‘II’ and ‘X’ detected with immunohistochemistry by monoclonal antibodies. Their observations were:
i) ossification of costal cartilages could take place in the form of 2 independent processes such as localization and time.
ii) endochondral ossification in the region of the costochondral zone appears in the 1st decade, which correspond to ossifications detected by X-ray in the 2nd decade.
iii) location of sex-specific ossification is determined by the penetration of cartilage canals into the metaphyseal part of the rib.
iv) endochondral and intramembranous ossification in reserve zone appears after the 3rd decade.
v) these types of ossifications corresponded to central globular ossifications detected by X-rays and are not sexually dimorphic.
The study was concluded that it could serve for an accurate estimation of age.
Among the observations in the present study, the foramen in the rib (Figure 1e) could have been formed by the passage of a vein draining into the right subclavian vein.
CONCLUSION
The present study has reported the normal occurrence of the synostosed 1stcostochondral and chondrosternal joints. It has also reported a review from reports on their ossification processes and their importance in sex dimorphism and in age determination. The article could be considered as an academic source for postgraduate students in Anatomy for presentations in scientific programs (seminars, conferences) or dissertation topics or for research projects.
Englishhttp://ijcrr.com/abstract.php?article_id=989http://ijcrr.com/article_html.php?did=989
Barchilon V, Hershkovitz I, Rothschild BM, Wish-Baratz S, Latimer B, Jellema LM, Hallel T, Arensburg B. 1996. Factors affecting the rate and patterns of the first costal cartilage ossification.Am J Forensic Med Pathol. 17(3): 239-247.
Datta AK 2008. Essentials of Human Anatomy (Thorax, Abdomen and Pelvis) Part 1.8th ed. Current Books International, Calcutta, India.
Kampen WU, Classen H, Kirsch T 1995. Mineralization and osteogenesis in the human 1st rib cartilage. Ann Anat 177(2): 171-7.
RejtarovaO, Hejna P, Soukup T, Kuchar M 2009. Age and sexually dimorphic changes in costal cartilages. A preliminary microscopic study . Forensic Sci Int. 193(1-3): 72-8.
Singh IB 2011. Textbook of Anatomy.Volume 2, Thorax, Abdomen and Pelvis.5th edition.Jaypee Brothers Medical Publishers (P) Ltd, Delhi, India.
Sinnatamby CS 2006. Last’s Anatomy: Regional and Applied. 11th edition. Churchill Livingstone / Elsevier, Edinburgh.
Snell RS 2008. Clinical Anatomy by Regions. 8thed, Wolters Kluwer/ Lippincott Williams and Wilkins. Philadelphia, USA.
Standring S 2008. Grey’s Anatomy. The Anatomical Basis of Clinical Practice.40th edition. Churchill Livingstone Elsevier, UK.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcareCOMPARATIVE STUDY OF TREATMENT OF UNSTABLE INTERTROCHANTERIC FRACTURE WITH SIMPLE DYNAMIC HIP SCREW AND LOCKING DYNAMIC HIP SCREW IN ELDERLY PATIENTS
English2733Nitin SanadhyaEnglish Abhinav LikhyaniEnglishAim: Is to evaluate the outcome of locking dynamic hip screw in comparison to standard dynamic hip screw in terms of fracture union, implant failure, range of movement of hip joint in unstable intertrochanteric fractures in elderly patients (age > 65 years), and to assess the hip function using modified Harris hip score. Methodology: This is a prospective randomized comparative study comprises of unstable intertrochanteric fracture of femur treated with dynamic hip screw and locking dynamic hip screw. The cases were selected randomly for fixation with Dynamic Hip Screw (DHS) and Locking Dynamic Hip Screw. The series consist of 50 cases divided in 2 groups. The group 1 consist of 25 cases treated by DHS and group 2 consist of another 25 cases treated by Locking DHS. The cases were followed up for minimum of 6 month duration Result and Observations: Most common mode of trauma in both groups of patients was slip (60%).Mean of Singh Index in group 1st cases was 3.64 ± 0.68 while mean of Singh Index in group 2nd was 3.56 ± 0.57.There were 5 cases (22.73%) of varus deformity in group 1st patients and 4 cases (19.05%) of varus deformity in group 2nd patients, although there were no significant varus deformity > 10º in both groups.2 cases of nonunion was seen in group 1st patients. In DHS group there was one case each of side plate pull out and screw cut out. No implant failure was seen in locking DHS. This study showed that functional outcome deteriorated when patients were more osteoporotic. Final outcome assessed using Modified Harris Hip Score. In group 1st there were 4.76% excellent, 86.37% good to fair and 9.09 % poor results, whereas in group 2nd cases 9.52% excellent, 85.71% good to fair and 4.77% was poor. Mean of Modified Harris Hip Score in group 1st was 68.33 ± 8.66 while 70.83 ± 8.35 in group 2nd cases. Conclusion: Keeping in mind of osteoporosis in geriatric population Locking DHS have some advantage in term of less chance of implant failure and functional outcome of the cases based on Harris hip score were slightly better, however they not statistically significant.
Englishunstable intertrochanteric fracture, simple dynamic hip screw, elderly patientsINTRODUCTION
Intertrochanteric fractures account for nearly 50% of all the proximal femoral fractures. Generally patients age group lies in 6th to 8th decade. The factors associated with intertrochanteric fractures include advancing age, increased number of comorbidties and history of other osteoporosis related fractures.
Sliding hip screw which is used commonly for fixation of these fractures has different biomechanical principles of fixation based on their fracture patterns. In stable fracture pattern the hip screw acts only as a lateral tension band, hence less chance of fixation failure. In unstable fracture pattern it allows controlled collapse and impaction of fragments, with shortening of lever arm acting on implant, it decreases the bending moment and thus decreasing the risk of mechanical failure. But while treating unstable intertrochanteric fracture with sliding hip screw in older patients, when sliding occurs in great amount, there is increased risk of fixation failure.
Fixation failure in unstable intertrochanteric fracture can occur in different modes like screw cutout, fatigue failure of lag screw, implant disassembly and rarely pullout or breakage of side plate. Surgical fixation of intertrochanteric femur fracture remain the standard of care, however, the best method of fixation is debatable. Fracture fixation with a compression hip screw and side plate has been gold standard but certain new implant designs have challenged it. Recent design of compression hip screw also evolves continuously like plate construct that provides biaxial dynamic compression, lag screw with improved purchase are among the many recent innovations of compression hip screw design.
The fixed angled construct allow for dynamic fracture compression for most intertrochanteric fracture pattern. Acting in load sharing capacity hip screw allows compression through a fixed angled construct in intertrochanteric fracture perpendicular to the axis of femoral neck.
However, there has been a concerted effort to increase, rigidity and fixation of dynamic hip screw in osteoporotic bone. Current consensus is that locked plating is beneficial in situations that require support to end segment fracture that are prone to varus / valgus collapse and in diaphyseal and metadiaphyseal fracture in osteoporotic patients. It is thought that non locked plating acts as a single beam scenario in healthy bone. Osteoporotic bone condition where unsatisfactory compression causes premature loosening of screw that render them ineffective.
Advantage of Locked Plating
Locking plates stability does not depend on the plate bone interface, rather stability is maintained at the angular-stable screw plate interface. As a result of this stable monoblock of the locking internal fixator, the pull out strength of locking head screw is substantially higher than that of conventional screws.
The design of locked plate construct permits reduced need for bone friction which minimizes biological insult.
In spite all dynamic hip screw remains the gold standard standing the test of time. Osteoporosis which is seen, in more than half of the patients with trochanteric fracture is associated with higher incidence of implant failure due to poor purchase it provides.
Based on these advantages dynamic hip screw was introduced with locking side plate concept. These new implant designs have increased the pull out strength of side plate in osteoporotic bone and unstable fracture configurations particularly. So this study is intended to study the advantage of applying locking side plate principle to the dynamic hip screw in the treatment of unstable intertrochanteric fractures (as classified by Boyd and Griffin).
AIMS AND OBEJECTIVES
To evaluate the outcome of locking dynamic hip screw in comparison to standard dynamic hip screw in terms of fracture union, implant failure, range of movement of hip joint in unstable intertrochanteric fractures in elderly patients (age > 65 years).
To assess the hip function using modified Harris hip score.
MATERIAL AND METHODS
The prospective comparative randomized study comprises of unstable intertrochanteric fracture of
femur treated with dynamic hip screw and locking dynamic hip screw. The cases were selected randomly for fixation with DHS and Locking DHS. The series consist of 50 cases divided in 2 groups. The group 1 consist of 25 cases treated by DHS and group 2 consist of another 25 cases treated by Locking DHS. The cases were followed up for minimum of 6 month duration. In group 1 22 cases were available for follow 1case died while 2 lost in follow up while in group 2, 21 cases turned up for follow up 2 case died and another 2 lost in follow up. The study conducted in Department of Orthopaedics, Dhanwantri Hospital and Research Center, Jaipur during the period July, 2011 to September, 2012.
Inclusion Criteria
Patients giving informed consent to take part in the study.
Unstable intertrochanteric fracture
Age > 65 years.
Radiological evidence of osteoporosis
Criteria for evaluation of results
The end results assessment of patients has been done by point system of rating including aspect of patient’s daily routine. It is mainly based upon the rating scale for hip disabilities by Harris Hip score (1963).
Based on the above scores 4 grades are given:
≥ 80 : Excellent
79-70 : Good
69-60 : Fair
< 60 : Poor
Radiological Evaluation
Radiologically anteroposterior and lateral x-rays of hip joint with thigh were taken and evaluated for
Progress of union
Non-union
Varus / valgus deformity
OBSERVATION AND RESULTS
The mean value ± standard deviation of Singh Index in group 1st was 3.64 ± 0.68.
The mean value ± standard deviation of Singh Index in group 2nd was 3.56 ± 0.57.
Mean value of Singh’s Index in both groups was comparable.
There was no pull out of side plate in LDHS group while there was pull out of side plate in one case in DHS group which has the Singh’s index 3.
Excellent to good results were seen in 61.91% cases (13 out of 21 cases ) in LDHS group as compare to 40.91% cases ( 9 out of 22 cases) in DHS group. There was one case of poor result in LDHS as compare of 2 cases in DHS group.
Mean ± standard deviation of modified Harris Hip Score in group 1st patients was 68.33 ± 8.66, as compare to 70.83± 8.35 in 2nd group patients. Although patient of group 2nd had more improved functional outcome as compare to group 1st patient but it was not statistical significant.
There was significant correlation between Singh Index and Modified Harris Hip Score in both groups. Functional outcome of intertrochanteric fractures in both groups either fixed with dynamic hip screw or locking dynamic hip screw both decreased as amount of bone osteoporosis increased as determined by Singh Index.
DISCUSSION
Intertrochanteric fractures are most commonly encountered fracture in geriatric age group. The most common underlying pathology is senile/postmenopausal osteoporosis.
This series includes randomly selected prospective study 50 cases of intertrochanteric fracture in osteoporotic patients. In our study 25 patients were treated by D.H.S (group 1st) and another 25 patients were treated by Locking D.H.S (group 2nd). Four cases out of fifty lost in follow up and three cases died during follow up, hence final assessment was done in 43 cases. All patients were admitted in the Department of Orthopaedics of Dhanwantri Hospital and Research Centre, Jaipur.
Since our study consisted of fixation of unstable intertrochanteric fractures in osteoporotic patients minimum age of the patient was 65 years and maximum age was 96 years. Mean age for group 1st was 72.84 years and in group 2nd it was 74.12 years. 64% of the patient in group 1st and 60% of patient in group 2nd were between the age group of 65-74 years. Only one patient in each group was above the age of 85 year.
Available literature suggests that osteoporosis of bone increases with age. In our study mean of Singh Index (1970) was 3.64 ± 0.68 group 1st and was 3.56 ± 0.57 in group 2nd.C.kayali et al (2006)(11) and Knobe et al (2008) in their studies treated by D.H.S had mean Singh index 2.5 and 2.9 respectively. In our study 48% patients in group 1st and 40% patients in group 2nd was in definite osteoporosis stage (Singh Index ≤ 3) which was similar to the series of K Akan et al (2011) and Yih-Shiunn Lee et al (2007) who mentioned the osteoporosis in 42.5% and 41.7% patients.
Coxa vara deformity is most common deformity in intertrochanteric fractures with reported incidence varying from 1.61% by Malcom L. Ecker et al (1975) to 9.02% by Laros and Moore (1974). Valgus deformity has also been reported at 10.24% by Laros and Moore (1974). K.S. Leung et al (1992) in his comparative study for intertrochanteric fracture fixation by D.H.S and Gamma nail in elderly patients found 2.15% Coxa Vara deformity in each group. Coxa Vara further exaggerates the limp by causing shortening and by reducing the efficiency of abductor lever arm.
In contrast to above studies we have mean higher rate of varus deformity. In the present series varus deformity was present in 22.73 cases in D.H.S group and 19.05% in L.D.H.S group. We have considered varus deformity if the neck shaft angle is less than 5º as compare to opposite side. Although higher numbers of patients were having varus deformity but the mean value of in group 1st patients was 0.89 ± 2.62º while mean value in group 2nd patients was 0.91 ± 2.67º. This is probably because of delayed weight bearing in our series.
In our study there was no case of nonunion in group 2nd treated by L.D.H.S but in group 1st treated by D.H.S there were 2 case of nonunion, out of which screw cut through occurred in one case (case no. 4) and pull of side plate in another case (case no. 5). In both these cases Singh index was 3
Simpson A.H., Varty K et al (1989) showed that side pull plate out was seen 4% cases in intertrochanteric fractures operated with dynamic hip screw. Based on their Biochemical study Dylan P.A. Jevell et al (2008) concluded that locking plate increases the pull-out strength of dynamic hip screw in osteoporotic bone. CAI Bing et al (2011) also had no side plate pull out in cases treated by L.D.H.S.
In our study side plate pull out was seen in 4.54% cases in group 1st and no side plate pull out was seen in group 2nd patients. This is explained due to better axial and torsional strength of locking DHS in patient age >65 years with osteoporotic bone.
C. Kayali et al (2006) in his study evaluated the result of patients treated by D.H.S through Modified Hariss Hip Score. He had 68.4% excellent to good results while 23.7%were fair and 7.9% had poor results. Similarly CAI Bing et al (2011) had better results in intertrochanteric
fractures treated by L.D.H.S . He had 89.5% excellent to good, 10.5% fair and no poor results in group treated by D.H.S. In our study 40.9% patients had excellent to good results in D.H.S and 61.9% in L.D.H.S group. 9.09% (2 cases) in D.H.S and 4.77% (1 case) in L.D.H.S group had poor results. High percentage of patients had fair results. The overall clinical results as evaluated by Modified Harris Hip Score were excellent to good in 51.16% cases, fair in 41.86% and poor 6.9% cases.
There were excellent to good results in 22 cases in our series out of which 19 cases had Singh index 4 or more while 3 cases had Singh index ≤3, two cases in D.H.S and one case in L.D.H.S group. There were 18 cases of fair results out of which 10 cases had Singh index ≤ 3. All 3 cases of poor results had Singh index 3. Thus our study shows significant correlation between Singh index and functional outcome. The functional outcome in both the group decreased as osteoporosis increased. K Akan et al (2011) had similar observations; in their study of intertrochanteric fractures treated by Gamma nail he had mean Harris Hip score 70 in patients of Singh Index grade I-II while mean Harris Hip score of 78.5 in patient had Singh Index III-IV. He observed that this difference to be statistically significant. Kim WY et al (2001) also had 39% implant failure in patients with osteoporotic intertrochanteric fracture treated by D.H.S had Singh Index I-II.
The above table showed the comparative outcome of intertrochanteric fracture treated by D.H.S and Locking D.H.S. Our study shows that patients had slightly better outcome with Locking D.H.S as compare to D.H.S. There was no non union and implant failure in patients treated by Locking D.H.S. The average Modified Harris Hip Score in patient treated by D.H.S was 68.33±8.66 as compare to Locking D.H.S 70.83±8.35. The osteoporosis had significant correlation with the functional outcome.
SUMMARY AND CONCLUSIONS
The series consisted of 50 patients treated by D.H.S (group 1st) and L.D.H.S. each group consisted of 25 cases.
Most common mode of trauma in both groups of patients was slip (60%).
Mean of Singh Index in group 1st cases was 3.64 ± 0.68 while mean of Singh Index in group 2nd was 3.56 ± 0.57.
There were 5 cases (22.73%) of varus deformity in group 1st patients and 4 cases (19.05%) of varus deformity in group 2nd patients, although there were no significant varus deformity > 10º in both groups.
Two case of nonunion was seen in group 1st patients.
In DHS group there was one case each of side plate pull out and screw cut out. No implant failure was seen in locking DHS.
This study showed that functional outcome deteriorated when patients was more osteoporotic.
Final outcome assessed using Modified Harris Hip Score. In group 1st there were 4.54% excellent, 86.37% good to fair and 9.09 poor results, whereas in group 2nd cases 9.52% excellent, 85.71% good to fair and 4.77 was poor.
Mean of Modified Harris Hip Score in group 1st was 68.33 ± 8.66 while 70.83 ± 8.35 in group 2nd cases.
In conclusion in patient age >65 years functional outcome after fixation of unstable intertrochanteric fractures with locking dynamic hip screw was slightly better than dynamic hip screw but it is not statistically significant.
In no cases of unstable intertrochanteric fractures fixed with locking dynamic hip screw, side plate pull out was seen. Its advantages over dynamic hip screw in osteoporotic bone (as proven by biomechanical studies).
Englishhttp://ijcrr.com/abstract.php?article_id=990http://ijcrr.com/article_html.php?did=990
Apel D.M. et al: Axial loading of unstable studies of unstable interochantric fractures of the femur:Clin Ortop No. 246,Dec,1989: 156-163.
Audige L, Henson B, Swientkowski MF: Implant related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic hip screw plate v/s dynamic screw – intramedullary nail devices. Int. Orthop. 2004, Feb; 28(1): 61 author reply 62-63.
Baumgaertner MR,Curtin SL. Lindskog DM, et al. : The value of the tip-apex distance in predicting failure of fixation of pertrochanteric fractures of the hip. J. Bone joint Surg Am 1995:77:1058-1064.
CAI Bing et al: treatment of femoral intertrochanteric fractures in the elderly with locking plate-dynamic hip screw and proximal femoral nail antirotation; journal of clinical orthopaedics;2011-12
Cummings SR, Nevitt MC, Browner WS et al: Risk factors for hip fracture in white women: study of osteoporotic fractures Research group: New Eng. Jr of Med. 1995;332:767-73.
Dylan, P.A. Jewell, Sabina Gheduzzi et al.: Locking plates increases the strength of dynamic hip screw, Injury, Int. J. Care Injured; 39:209-212, 2008.
Gundle R, Gordan MF, and Simpson AH: How to minimize failures of fixation of unstable interochantric fractures. Injury 1995; Nov,:26(9): 611-614.
Kim WY, Han CH, Park JI, Kim JY: Failure of intertrochanteric fractures fixation with a DHS in relation to preoperative fracture stability and osteoporosis: International Orthopaedics, 2001; 25(6): 360-362.
Pervez H: Prediction of fixation failure after sliding hip screw fixation: Injury (Eng.) Oct. 2004; 35(10) pg. 994-8.
Soloman, Warwik, Nayagam : Apley’s system of orthopadics and fractures 8th edn, 2001.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcareEFFECT OF HAND WASHING AMONG NURSING STAFFS IN TERTIARY CARE HOSPITAL : A STUDY
English3440Suvarna SandeEnglish Silpi BasakEnglish Vidya TawadeEnglishBackground and objective: Health care Associated Infection (HAI) is a major problem worldwide. Contaminated hands of health care workers (HCWs) play an important role in the transmission of pathogens. Hand washing is considered to be the most effective method for preventing the transmission of micro-organisms between HCWs and patients. Hence the present study was undertaken to detect the microorganisms present on the hands of Nursing staffs before and after hand washing, in a tertiary care hospital. Method: Swabs were collected from 150 nursing staffs working in various wards and Intensive Care Units (ICUs), from hands before and after hand washing with antimicrobial soap. Swabs were inoculated on blood agar and Mac-Conkey’s agar. Microorganisms were identified by standard methods. Detection of HAI pathogens were done according to Clinical Laboratory Standard Institute (CLSI) guidelines. Result: Out of total 150 samples collected before hand washing, growth was observed in107 (71.3%) samples and no growth in 43(28.7%) samples. Apart from skin commensals, Staphylococcus aureus (20.1%), Enterococcus faecalis (4.6%), Klebsiella pneumoniae (6%), E.coli (4%) and Pseudomonas aeruginosa (1.3%) were detected. 05 Methicillin Resistant Staphylococcus aureus (MRSA) strains were also isolated from hand swabs collected before hand washing. No growth was obtained in 128 (85.3%) samples and growth were observed in 22 (14.7%) samples after hand washing , Conclusion: It is important to perform proper procedure of hand washing technique using an adequate quantity of antimicrobial soap to cover all skin surfaces for the recommended length of time.
EnglishHealth care Associated Infection (HAI), Hand hygieneINTRODUCTION
Health care associated infection (HAI) is a major problem for patient’s safety and its surveillance. Prevention of HAI must be a first priority for every health care set up and institutions committed to making health care safer. The impact of HAI implies prolonged hospital stay, long-term disability, increased resistance of microorganisms to antimicrobials, massive additional financial burden for patients and their families and increased mortality. 1,2
In the mid-1800s, studies by Ignaz Semmelweis in Vienna, Austria, and Oliver Wendell Holmes in Boston, USA, established that organisms causing puerperal sepsis were transmitted via the hands of Physicians and Medical students who performed autopsy and directly entered the labour room. Semmelweis is considered not only the Father of Hand Hygiene, but his intervention is also a model of epidemiologically driven strategies to prevent infection. Many other investigations conducted over the past 40 years have confirmed that contaminated hands of Health Care Worker (HCW) play an important role in the transmission of health care-associated pathogens e.g Methicillin Resistant Staphylococcus aureus (MRSA), Vancomycin resistant Enterococci (VRE) and Extended Spectrum β-lactamases(ESBL) , Amp C β-lactamases or Carbapenemases producing Gram negative bacilli.3,4,5,6
Bacteria present on the hands could be divided into two categories, namely resident or transient.
Resident flora : Organisms like Coagulase Negative Staphylococci i.e. CONS (Staphylococcus epidermidis ,Staphylococcus hominis ,Oxacillin Resistant CONS ), Diphtheroids,Propionibacteria, Micrococci and Candida sp.,Pityrosporum (Malassezia) may survive and multiply in superficial layers of skin.
Transient flora: These organisms colonize superficial layers of skin and can be easily removed by routine hand hygiene. They can be pathogens like Gram negative bacteria or Staphylococcus aureus and are acquired by HCWs from colonized or infected patients or from inanimate objects in the patient’s immediate environment and are the organisms most frequently to cause HAIs. 7,8
The transmissibility of transient flora depends on the microorganism present, the number of microorganisms on the surface, and the skin moisture. 9,10 Various studies have reported that total bacterial counts on the hands of HCWs have ranged from 3.9 x 104 to 4.6 x 106 colony forming unit / cm2 (CFU) and fingertip contamination ranged from 0 to 300 CFU. 3,4,5,6
Hence the present project was undertaken to study the bacterial flora present on the hands of Nursing staffs before and after hand washing with antimicrobial soap and water.
MATERIAL AND METHODS
This cross sectional study was conducted in Department of Microbiology. The project was approved by Institutional Ethics committee. 150 Nursing staffs working in various wards and ICUs of a tertiary care hospital in a rural set up were included in this study. Total number of 150 swabs (sterile swabs moistened with sterile saline) were collected from various sites of the hands (palm, web spaces, fingertip and beneath nail) before hand washing.
The Nursing staffs were told to wash their hands with antimicrobial soap performing all steps within specified time (15-20seconds).They were instructed not to touch the tap after washing hands and air dry their hands. After completely drying their hands, another swab from above mentioned sites were taken. All swabs were inoculated on blood agar and Mac-Conkey’s agar and incubated at 37 0C overnight and examined for microbial growth. The microorganisms were identified by standard methods.11 Detection of Methicillin Resistant Staphylococcus aureus (MRSA) using Cefoxitin disc 30 µg and ESBL producing organisms by combined disc method (Ceftazidime 30 µg and Cefdazidime + Clavulanic acid disc 30/10 µg) were carried out. 12For detection of Carbapenemase producing Enterobacteriaceae, Modified Hodge test was done. For detection of HLAR (High level aminoglycoside resistant) Enterococci, High Level Gentamicin disc 120 µg and for Vancomycin Resistant Enterococci (VRE) , VRE agar having Vancomycin 6 µg/ml was used as per Clinical Laboratory Standard Institute ( CLSI) guidelines.12 Statistical analysis was done by standard statistical methods .13
RESULTS
Total 150 Nursing staffs working in various wards, ICUs and OT complexes were included in the study. Maximum staffs 36 ( 24%) were from Medicine ward followed by Surgery 27 (18%) and Pediatrics 27(18% ).(table1) Amongst 36 Nursing staffs from medicine ward , 28 Nursing staffs (77.7% ) had growth before hand washing. Though the number of Nursing Staffs from each specialties included in other wards were less, 18(85.7%) Nursing Staffs had growth before hand washing.
Out of total 150 samples collected before hand washing, growth of microorganisms was observed in 107(71.3%) samples and no growth in 43
(28.7%) samples. Growth of microorganisms were >103 colony forming unit (CFU) in all the samples. Out of 107 samples showing growth, 55 (51.4%) samples showed single type of bacteria, 41 (38.3%) showed two types of bacteria while 4 (3.7%) samples showed three types of bacteria.
Out of 30 Staphylococcus aureus strains isolated from hands of Nursing Staff before hand washing 5(16.6%) were MRSA. (table2) (photo 1) Out of 17 Gram negative bacilli isolated, 6 (35.2%) were ESBL producers(Klebsiella pnumoniae 4,E.coli 2) (photo 2) but no Carbapenam resistant Enterobacteriaceae (CRE) or Carbapenamase producing Gram negative bacilli were isolated. 07 (4.6%) Enterococcus faecalis were isolated and all of them were High Level Aminoglycoside resistant. No vancomycin Resistant Enterococci (VRE) was detected in the present study. Two Enterococcus faecalis strains showed vancomycin sensitivity in the intermediate range (15-16 mm) and were repeated thrice. These two strains did not grow on VRE agar and hence were considered as Vancomycin sensitive.
After hand washing with antimicrobial soap and water, no growth was obtained in 128 (85.3%) samples and single type of growth in 22 (14.7%) samples. Growth of microorganisms was in between 50- 100 CFU. Apart from skin commensals, MSSA were detected in 22.7% samples.(table 3)
After hand washing, improvement was observed as there was no isolation of MRSA, Enterococcus species and Gram negative bacilli and hence no ESBL producers.
If the number of samples positive before and after hand washing is considered, statistical analysis reveals standard error of difference is 4.7, whereas the observed difference is 56.6. Since the observed difference between two groups is much more than twice the Standard Error of difference (2× 4.7= 9.4), we hereby conclude that efficacy of hand washing is significantly higher than without i.e. before hand washing. 13
DISCUSSION
Cross-transmission of organisms occurs through contaminated hands. HAI pathogens especially Multidrug resistant organisms (MDROs) e.g .Methicillin Resistant Staphylococcus aureus (MRSA), Vancomycin resistant Enterococci (VRE) and Extended Spectrum β-lactamases (ESBL), Amp C β-lactamases or Carbapenemases producing Gram negative bacilli are transmitted by contaminated hands of HCWs. Hands also play important role in transmission of blood borne, faecal and respiratory tract viruses.14-21 Transmission of pathogens from one patient to another via HCWs’ hands requires five sequential steps.14
Organisms present on the patient’s skin, or shed onto inanimate objects in immediate vicinity of the patient;
Organisms transferred to the hands of HCWs;
Survival of organisms on HCWs’ hands;
Inadequate or entirely omitted hand washing or hand antisepsis or inappropriate agent used by the HCW
The contaminated hands of HCWs must transmit the microorganisms to another patient directly or via inanimate object.
Factors influencing the transfer of microorganisms from surface to surface and cross- contamination rates are organisms involved, source and destination surfaces, moisture level and size of inoculum.
In the present study, before hand washing ,apart from skin commensals (micrococci, coagulase negative Staphylococci i.e.CONS etc.), transient flora i.e. Staphylococcus aureus (20.1% ),Gram negative rods (11.4%) and Enterococcus faecalis (4.6 % ) were obtained.(fig 1) In our study, out of 30 Staphylococcus aureus isolated, 5 (16.6%) were MRSA and out of 17 Gram negative bacilli isolated, 6 (35.2%) were ESBL producers and is a matter of concern. These organisms are potential threat of health care associated infection and also outbreak in health care set up. Several other studies have documented that HCWs can contaminate their hands or gloves with Gram-negative bacilli, Staphylococcus aureus, Enterococci or Clostridium difficile even by performing “clean procedures” or touching intact areas of skin of hospitalized patients or after touching inanimate objects.15-21
Ayliffe and colleagues 22 found that 15% of nurses working in an isolation unit carried a median of 1x 104CFU of Staphylococcus aureus on their hands; 29% of nurses working in a general hospital had Staphylococcus aureus on their hands (median count 3.8 x 103 CFU), while 78% of those working in a hospital for dermatology patients had the organism on their hands (median count, 14.3 x 106 CFU). The same survey revealed that 17–30% of nurses carried Gram-negative bacilli on their hands (median counts ranged from 3.4 x 103 CFU to 38 x 103 CFU).
Daschner 23found that Staphylococcus aureus could be recovered from the hands of 21% of ICU caregivers and that 21% of doctors and 5% of nurse carriers had >103 CFU of the organism on their hands. A study conducted by Waters V et al in two neonatal ICUs revealed that Gram-negative bacilli were recovered from the hands of 38% of nurses.24
In the present study, after hand washing with antimicrobial soap, Micrococci (50%), Staphylcoccus aureus (MSSA 22.7%), Bacillus species (18.1%) and CONS(9.09%) were detected. In these cases, it might be possible that nurses fail to perform appropriate technique of hand washing for recommended length of time. To avoid prolonged hand contamination, it is not only important to perform hand hygiene when indicated, but also to use the appropriate technique and an adequate quantity of the product to cover all skin surfaces for the recommended length of time. 14,25
Hand hygiene practice and it’s compliance has been the core issue worldwide especially in developing countries. Poor hand hygiene practices in hospital has led to number of outbreaks and adverse outcomes.26 The role of health care workers’ hands in cross transmission of organisms is best illustrated by the striking example of the study conducted by Pittet et al , where a hospital wide hygiene campaign with emphasis on alcoholic hand rub led to a sustained increase in hand hygiene compliance and reduction in HAI by more than 40% and transmission of MRSA was reduced by more than 50%. 27 Promotion of hand hygiene has become an important initiative with most of the countries and efforts are to be strengthened worldwide to provide safe patient care.
CONCLUSION
When health care workers do not follow the steps of hand hygiene between patient contact or during patient care, the microorganisms can be transmitted from patient to health care workers to other patients. It is important to perform proper procedure of hand washing technique using an adequate quantity of antimicrobial soap to cover all skin surfaces for the recommended length of time. We hereby conclude that efficacy of hand washing with antimicrobial soap is statistically significant in controlling the microorganisms on nurses hands than without hand washing.
ACKNOWLEDGEMENT
Authors are thankful to DMIMS (DU) for the help while conducting the study.
Englishhttp://ijcrr.com/abstract.php?article_id=997http://ijcrr.com/article_html.php?did=997
All egranzi B Nejad SB, et al Burden of endemic healthcare associated infection in developing countries: systematic review and meta - analysis, Lancet, 2011; Vol 377: pg 228 - 241.
World Health Organization (2011). Report on the burden of endemic health care associated infections worldwide. WHO Document Production services ISBN 9789241501507, Geneva
Larson E. Effects of handwashing agent, handwashing frequency, and clinical area on - hand flora. American Journal of Infection Control, 1984, 11:76-82.
Larson EL et al. Changes in bacterial flora associated with skin damage on hands of health care personnel. American Journal of Infection Control, 1998, 26:513–521.
Maki D. Control of colonization and transmission of pathogenic bacteria in the hospital. Annals of Internal Medicine, 1978, 89:777-780.
Pittet D et al. Bacterial contamination of the hands of hospital staff during routine patient care. Archives of Internal Medicine, 1999, 159:821-826.
Price PB. The bacteriology of normal skin: a new quantitative test applied to a study of the bacterial flora and the disinfectant action of mechanical cleansing. Journal ofInfectious Diseases, 1938, 63:301–318.
Evans CA et al. Bacterial flora of the normal human skin. Journal of Investigative Dermatology, 1950, 15:305-324.
Marples RR, Towers AG. A laboratory model for the investigation of contact transfer of micro-organisms. Journal of Hygiene (London), 1979, 82:237-248.
Patrick DR, Findon G, Miller TE. Residual moisture determines the level of touch- contact-associated bacterial transfer following hand washing. Epidemiology and
Infection, 1997, 119:319–325.
Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Marmion BP, Fraser AG, Simmons A, editors. Mackie and Mc Cartney Practical Medical Microbiology. 14th ed. Edinburg: Churchill Livingstone; 1996 . p. 131-50.
Clinical Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests. Approved standarad M2-A7, 11th ed. Wayne PA: USA; 2007.
Park K. Park’s Text book of Preventive and Social Medicine. 22nd edition. Jabalpur: Banarasidas Bhanot; 2013. Chapter 19, Health information and basic medical statistic : p 782-796.
WHO guidelines on Hand Hygiene in Health care. Geneva : World Health Organization : 2009.
Sanderson PJ, Weissler S. Recovery of coliforms from the hands of nurses and patients: activities leading to contamination. Journal of Hospital Infection, 1992, 21:85–93.
Boyce JM et al. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infection Control and Hospital Epidemiology, 1997, 18:622–627.
McBryde ES et al. An investigation of contact transmission of methicillin-resistant Staphylococcus aureus. Journal of Hospital Infection, 2004, 58:104–108.
Duckro AN et al. Transfer of vancomycin-resistant Enterococci via health care worker hands. Archives of Internal Medicine, 2005, 165:302–307.
Ray AJ et al. Nosocomial transmission of vancomycinresistant Enterococci from surfaces. JAMA, 2002, 287:1400–1401.
Riggs MM et al. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility
residents. Clinical Infectious Diseases, 2007, 45:992–998.
Bhalla A et al. Acquisition of nosocomial pathogens on hands after contact with environmental surfaces near hospitalized patients. Infection Control and Hospital
Epidemiology, 2004, 25:164–167.
Ayliffe et al. Hand disinfection: a comparison of various agents in laboratory and ward studies. Journal of Hospital Infection, 1988, 11:226–243.
Daschner FD. How cost-effective is the present use of antiseptics? Journal of Hospital Infection, 1988, 11(Suppl.A):227–235.
Waters V et al. Molecular epidemiology of gram-negative bacilli from infected neonates and health care workers’hands in neonatal intensive care units. Clinical Infectious
Diseases, 2004, 38:1682–1687
Lucet JC et al. Hand contamination before and after different hand hygiene techniques: a randomized clinical trial. Journal of Hospital Infection, 2002, 50:276–280.
Hugonnet S, Harbarth S, Saz H, Duncan RA and Pitet D, Nursing resourus: a major determinant of nosocomial infection? current opin. Infect Dis. 2004: Vol 17 (4), PG 329-333.
Pittet D, Hugonnet S, Harbarth S et al , effectiveness of a hospital wide programme to improve compliance with hand hygiene Lancet 2000; 356:1307-1312.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcareVARIATIONS IN THE MORPHOLOGICAL APPEARANCE OF LINGULA IN DRY ADULT HUMAN MANDIBLES
English4145Smita TapasEnglishObjective: This study aims to analyse the different forms of presentation of lingula in dry adult human mandibles. Materials and Methods: Fifty dry adult human mandibles (100 sides) were studied to analyse the different forms of presentation of lingula. Results: Four different shapes of lingula were identified: triangular, truncated, assimilated and nodular type. The triangular shape of the lingula was noticed in 42 sides (42 %). The truncated shape lingula was noticed in 36 sides (36 %). The assimilated lingula was noticed in 12 sides (12 %). The nodular lingula was noticed in 10 sides (10 %). Conclusion: A prior knowledge of such variations in the morphological appearance of lingula will minimise the damage to the important nerves and vessels related to it during anaesthetic block or during operative procedures on the lower jaw. Morphological types of lingula can also be useful as anthropological marker.
Englishmandible, lingula, variationsINTRODUCTION
Lingula also known as Spix's ossicle or Spine after Johannes-Baptist Spix.1 Ireland called it as ligula mandibulae or spixs spine.2 Lingula is a tongue shaped bony projection located on the medial surface of mandibular ramus. It lies in close proximity to the mandibular foramen through which inferior alveolar nerves and vessels passes into the mandibular canal.3 Due to the close proximity of lingula to the mandibular foramen and in turn to the neurovascular bundle, it is used as an important landmark by the oro - maxillofacial surgeons for injection of local anaesthetics during dental surgical procedures.3,4 Lingula is also an important clinical landmark for bilateral sagittal split osteotomy, the most common surgical method to correct mandibular deformities.5 Structural variability in lingula can account for failure in inferior alveolar nerve block,6 as well as inaccurate localization may lead to the intraoperative complication like haemorrhage, fracture and nerve injury.5
Keeping the above factors in view, the present study is undertaken to analyse the different forms of presentation of lingula in dry adult human mandibles.
MATERIALS AND METHODS
The study conducted on fifty dry adult human mandibles (100 sides) to analyse the different forms of presentation of lingula. The morphological appearances of lingula were compared on either side.
OBSERVATION AND RESULTS
Four different shapes of lingula have been identified: triangular, truncated, assimilated and nodular type.
A. Triangular – The lingula with wide base and narrow rounded or pointed apex and apex being directed postero superiorly i.e., towards condyle or towards posterior border of ramus of mandible was classified as triangular. (Fig 1)
B. Truncated: The lingula with quadrangular top with superior, inferior and posterior borders was classified as truncated. (Fig 2)
C. Assimilated: Lingula completely incorporated into ramus of mandible was classified as assimilated. (Fig 3)
D. Nodular: Entire lingula except for its apex merged into the ramus of mandible was classified as nodular. (Fig 4)
The triangular shape of the lingula was most prevalent (42 %). It was noticed bilaterally in 30 mandibles and unilaterally in 9 right and 3 left mandibles. The truncated shape lingula was noticed in (36 %). It was noticed bilaterally in 28 mandibles and unilaterally in 4 right and 4 left mandibles. The assimilated lingula was noticed in (12 %). It was noticed bilaterally in 7 mandibles and unilaterally in 3 right and 2 left mandibles. The nodular lingula was noticed in (10 %). It was noticed bilaterally in 5 mandibles and unilaterally in 4 right and 1 left mandibles. (Table 1)
DISCUSSION
The medial surface of the ramus of mandible is characterized by the lingula, a small tongue of bone at the anterior margin of mandibular foramen7 to which the sphenomandibular ligament is attached. Another end of sphenomandibular ligament is attached to the spine of sphenoid.8 The spine of sphenoid, the sphenomandibular ligament and the part of the mandible bearing the lingula have a common origin from the Meckels cartilage of first branchial arch.9
Earlier studies have reported the presence of various shapes of lingula but did not provide details about the various types and incidence.6, 10 Standard books describe the shape of this lingula to be triangular.7, 8 Truncated type was described by Hollinshead (1962)11, nodular by Berkovitz et al. (1978)12, and assimilated type by Morgan et al. (1982)13. Tuli et al (2000), have carried out a study on 165 dry mandibles of Indian origin, to determine the shape, direction and borders of lingula. They found triangular lingula in 68.5% mandibles, truncated, nodular and assimilated shape in 15.8%, 10.9% and 4.8% respectively.14 According to Devi, Arna et al (2003), the truncated and nodular types of lingula are most frequent.15 Study on 144 dry mandibles of Thai population by Kositbowornchai et al (2007) showed truncated (47%) to be most common followed by nodular, triangular and assimilated in 23%, 17% and 13% respectively.16 Jansisyanont et al (2009) studied on 92 Thai cadavers and found truncated lingula in 46.2% cases, triangular, nodular and assimilated shape in 29.9%, 19.9% and 4.3% respectively.17 Lopes et al (2010) did a study on 80 dry mandibles in south of Brazil. In their study the triangular shape of lingula was found in 41.3%, truncated in 36.3%, nodular in 10.5% and assimilated in 11.9%.18According to the Khan et al (2011), Triangular shape lingula is more prevalent in males (59.25%). The least prevalent in males is nodular (4.5%) and in females is assimilated (0%). The truncated type is almost twice as common in males (6%) than females (3.5%).19 Samanta et al (2012), reported the most prevalent shape of lingula was triangular and the least prevalent shape of lingula was assimilated type.3 Nirmale et al (2012) reported most prevalent shape of lingula was triangular and the least prevalent shape of lingula was truncated type.20 Varma et al (2013) study shows nodular lingula in 42%, truncated in 29 %, triangular in 13 %, assimilated in 6 % and M shaped in 4%.4 (Table 2). Gite et al studied location and the distance of lingula from sigmoid notch on panaromic radiograph.21
In present study, triangular shape of lingula was most prevalent and the least prevalent shape of lingula was nodular (Table 1) which is in accordance with the study of Lopes et al (2010) in southern brazil6, but contradictory to the findings of varma et al.1 where nodular shape of lingula is most prevalent.
As to why the shape of the lingula varies is not understood. According to Tuli et al14, the sphenomandibular ligament which is attached to the tip of the lingula is an accessory ligament to the temporomandibular joint and has minimal influence on altering the shape of the lingula.14
CONCLUSION
In present study, four different shapes of lingula have been identified: triangular, truncated, assimilated and nodular type. Triangular shape of lingula was most prevalent and nodular shape of lingula was least prevalent. It becomes a necessity to know the morphology of lingula so as to preserve the important structures during surgical interference of mandible around the lingula region.
Englishhttp://ijcrr.com/abstract.php?article_id=998http://ijcrr.com/article_html.php?did=998
Dobson J., Anatomical Eponyms, 2nd edition. Edinburgh, London: E. and S. Livingstone. 1962; Pp: 194
Ireland R, Oxford Dictionary of Dentistry. Oxford University Press, New York. 2010; 1: Pp: 410
Samanta PP, Kharab P. Morphological Analysis of Lingula in Dry Adult Human Mandibles of North Indian Population. J Cranio Max Dis. 2012; 1:7-11.
Varma CL, Sameer PA. Morphological Variations of Lingula in South Indian Mandibles. Res and rev J Med Health Sci. 2013; 2(1): 31-34.
Behrman SJ. Complications of sagittal osteotomy of the mandibular ramus. J oral surg. 1972; 30: 554-561.
Nicholson ML. A study of position of the mandibular foramen in the adult mandible. Anat Record. 1985;212:110-112.
Sinnatamby CS. Mandible, Osteology of skull and hyoid bone. Last’s Anatomy, Regional and Applied. Eleventh edition. Churchill Livingstone, Elsevier. 2006. Pp. 532-533.
Standring S, Collins P, Healy JC, Wigley C, Beale TJ. Mandible: Infratemporal and pterygopalatine fossae and temporomandibular joint. Gray’s Anatomy - The Anatomical Basis of Clinical Practice, Fortieth edition. Churchill Livingstone, Elsevier. 2008. Pp. 530-532.
Moore KL, Persaud TVN. The Developing Human-Clinically Oriented Embryology, Seventh edition, Saunders, Philadelphia. 2003. Pp: 204.
Dubrul E L, Sicher. DuBrul's Oral Anatomy, Eighth edition Tokyo and New York: Ishiyaku Euro America.1988; Pp: 32-35.
Hollinshead W H. Textbook of Anatomy. First edition. Calcutta, India: Harper and Row.1962; Pp: 855- 856.
Berkovitz BKB, Holland GR, Moxham BJ. Colour atlas and textbook of oral anatomy. Second edition. London: Wolfe Medical Publication. 1978; Pp:15.
Morgan DH, House LR, Hall WP, Vamuas S J. Diseases of temporomandibular apparatus. Second edition. Saint Louis: CV Mosby. 1982 ; Pp: 19.
Tuli A, Choudhry R, Choudhry S, Raheja S, Agarwal S. Variation in shape of the lingula in the adult human mandible. J Anat. 2000; 197(2):313-317.
Devi R, Arna N, Manjunath KY, Balasubramanyam M. Incidence of morphological variants of mandibular lingula. Indian J Dent Res. 2003; 14(4):210-213.
Kositbowornchai S, Siritapetawee M, Damrongrungruang T, Khongkankong W et al. Shape of the lingula and its localization by panoramic radiograph versus dry mandibular measurement. Surg Radiol Anat. 2007; 29(8):689-694.
Jansisyanont P, Apihasmit S, Chompoopong. Clin Ana. 2009; 22:787-793.
Lopes PTC, Periera GAM, Santos AMPV. J Morphol Sci. 2010; 27(3-4):136-138.
Khan TA, Sharieff JH. Observation on Morphological Features of Human Mandibles in 200 South Indian Subjects. Anatomica Karnataka. 2011; 5(1): 44-49.
Nirmale VK, Mane UW, Sukre SB, Diwan CV. Morphological Features of Human Mandible. Int J of Recent Trends in Sci Technol. 2012; 3 (2): 38-43
Gite M, Padhye M. Location of lingula from sigmoid notch in an Indian population - A Radiographic study. Scientific J. 2007; 1.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcareEPIDEMIOLOGICAL STUDY RELATED TO RISK FACTORS OF BREAST TUMOURS IN POPULATION OF SOUTHERN RAJASTHAN, INDIA
English4651Mukul DixitEnglish Jyoti JainEnglishObjectives: This study was planned to identify different factors related to breast cancer with the intention that early detection and for better understanding of course and pathogenesis of benign and malignant breast cancer. Material and methods: The patients of breast tumours who attended surgical outdoor or breast clinic or patients admitted to the surgical wards of Maharana Bhopal Hospital, Udaipur from Jan’97 to Jun’97 were included in this study. Complete clinical examinations of the patients were done to see the symptoms, clinical manifestations, involvement of tissues etc. Results: There was an increased risk of benign breast tumour at a considerably younger age. Majority of the patients both in benign as well as in malignant were married, but this did not show any statistical significance in the present study. Occupational status of cases in the present study indicates that majority (63.82%) were housewives. The association of age at menarche and breast tumours was non-significant. Association observed between age at menopause and breast tumours was found to be statistically significant (PEnglishbreast cancer, occupational status, menopause, breast self examination.INTRODUCTION
Tumours of the breast are the leading cause of the morbidity and mortality in females in the world. Benign as well as the malignant neoplasms are the commonest of all the neoplasms occurring in females. Despite the high incidence rates of benign neoplasms of the breast, their epidemiology has not been adequately described.
However, there are several studies about epidemiology about the breast cancer. Until recently benign disorders of the breast were regarded as relatively unimportant: far more attention was focused on breast cancer.
Duct Papilloma and fibroadenomas are common variant of benign breast tumours. The majority of Duct Papilloma tumours are single. In contrast, certain patients have multiple intraductal papillomas, which Haagensen believes are more likely to be peripherally located and associate an increased risk of cancer.(1) The majority of patients are found to have solitary Papilloma, which is benign, but identical symptoms are associated with multiple papillomatosis or rarely a papillary adenocarcinoma.
Fibroadenomas is the commonest tumour of the breast below the age of 35. Fibroadenomas usually presents as a solitary, firm, well defined, lobulated, extremely mobile lump, 1-3 cm in diameter. There is a well marked capsule. (2)
Although fibroadenomas are not considered to have a malignant potential, the epithelial elements appear to be at risk for neoplasia just as epithelium elsewhere in the breast. More than 100 invasive and non-invasive carcinomas have been reported in pre-existing fibroadenomas since l985. (3)
Breast cancer is the commonest malignant disease of women in England and Wales. It is estimated that 1 in 12 of all female children born will develop the disease during their lifetime.(4) Epidemiological data indicate well defined factors that indicate an increased liability to developing the disease. Such risk factors for breast cancer fall into three main groups: genetic, endocrine, and environmental
Previous attempts have been based on a number of different factors such as clinical symptoms, patients age, histological features, or that part of the secretary system in which the abnormality seen. This study were deigned to describe some other factor other than clinical symptom and related to breast cancer.
MATERIAL AND METHODS
For the present study 179 patients of breast tumours who attended surgical outdoor or breast clinic or patients admitted to the surgical wards of Maharana Bhopal Hospital, Udaipur from Jan’97 to Jun’97 were included. They were contacted in the outdoor or breast clinic or during their stay in the hospital and a complete clinical examination of the patients were done to see the symptoms, clinical manifestations, involvement of tissues etc.
All the patients whether newly admitted, operated for the malignant or benign lesions or who were receiving chemotherapy post-operatively and the patients attending breast clinic for advice were taken for study. The diagnostic criteria were based upon the histopathological examination.
RESULTS
Most of patients of benign group young age group while in patients with malignant tumours most of them were from higher age group suggesting an increased risk of benign breast tumour at a considerably younger age.
Majority 65.95% of patients with benign tumours were Hindus. The association between Hindu and other religion which was however comes out to be non significant (> 0.05).
The association between type of family and the breast tumours was non-significant statistically. Majority of the patients in both groups were married, but this did not show any statistical significance in the present study.
Regarding the educational status, Association between literacy status and breast tumours was found to be non-significant. Occupational status of cases in the present study indicates that majority (63.82%) were housewives but no statistical association could be established.
The association of age at menarche and breast tumours was non-significant.
Association observed between age at menopause and breast tumours was found to be statistically significant (P24) at first child birth and breast tumours.
As regards abortion status, the association was insignificant between abortion and MTP and breast tumours.
Only 5.32 percent patients in case of benign and 3.52 percent patients in case of malignant group used oral contraceptive and that too for a short period.
DISCUSSION
The present study was taken out in the patients attending surgical outdoor and Breast Clinic or admitted in Maharana Bhopal Hospital, Udaipur
from January to June, 1997. In this study, 94 patients with benign tumours and 85 patients with malignant tumours were studied.
Breast cancer is a major and important form of malignant disease in the western world and is becoming frequent in developing countries as well. In North America it was the most common malignancy among the women, accounting for 27 percent of all female cancers. Mortality rates from breast cancer have increased during the past 60 years in every country.
In any case the age-incidence pattern of benign strongly implies that the condition is highly dependent upon some hormonal correlate of the reproductive years.
The association between 15-45 and more than 46 age groups with the benign and malignant tumours as shown in table was statistically significant (P3 children. 47 (55.29%) patients had 1-3 children, 38 (44.7%) patients had > 3 children in case of malignant group. The association between parity of the patient and breast tumours was found to be non-significant (P>0.05).
Cole P et al found no meaningful association of risk of benign breast disease with parity or with age at first birth either in crude data or after controlling the social class. Their findings are thus not consistent with those of some previous workers who have reported indirect association of risk with parity. In previous studies dealing with the risk factors of benign breast lesions, nulliparous women were found to have a high risk of benign breast disease and the risk was inversely associated with increasing number of pregnancies whereas late first pregnancy had no effect on risk or was associated with an increased risk.(5)
3.19 percent patients in case of benign group and 2.12 percent patients in case of malignant group gave a history of abortions. As regards MTP, in case of benign 15.29 percent patients underwent MTP and 14.11 percent patients in case of malignant group had undergone MTP.()
Several studies have demonstrated a protective effect of oral contraceptives while Nomura A and Comstock GW have shown no association. In our study, only 5.32 percent patients in case of benign and 3.52 percent patients in case of malignant group used oral contraceptive and that too for a short period. Since the number of oral contraceptive users as too small, association could not be established. (22)
CONCLUSION
Women should be advised to self examines their breasts regularly so that they can find out any abnormality occurring in the breast so as to diagnose the tumours at earlier stages.
Breast self examination strategy should be implemented at a community level so that more and more women can be benefitted. For this, Breast Clinic should be launched at every level of health system viz. District Hospital, Community Health Centre and Primary Health Centre.
Englishhttp://ijcrr.com/abstract.php?article_id=999http://ijcrr.com/article_html.php?did=999
Yuasa S, McMahon B. Lactation and reproductive histories of breast cancer patients in Tokyo, Japan. Bull WHO 1970; 42:195
Love and Belly. A Short Practice of Surgery. 4th edition. P 802-805
Pathak DR, Whittemore AS. Combined effects of body size, parity, and menstrual events on breast cancer incidence in seven countries. Am J Epidemiol 1992; 135:153-68.
Hughes LE, Mansel RE, Webster DJT. Benign disorders and diseases of the breast: concepts and clinical management. London, England: Bailliere Tindall, 1989;27-39
Cole P, Elwood JM, Kaplan SD. Incidence rates and risk factors of benign breast neoplasms. Am J Epidemiol 1978;108:1 12-20
Salber EJ, Trichopoulos D, MacMahon B. Lactation and reproductive histories of breast cancer patients in Boston, 1965-66. J Natl Cancer Inst 1969; 43:1013-1024
Clemmesen, J. (1979). In: Measurement of Levels of Health, WHO Reg. Pubi. EURO. Ser. No.7, p.
Hughes L.E. and Courtney, S.P. (1985). Brit. Med. J. 290: 1229 (editorial)
Somdatta P, Baridalyne N . Awareness of breast cancer in women of an urban resettlement colony of Delhi. Indian J Cancer. 2005; 42: 149.
Prince AH, Kavitha S, Binu VS, MS Vidyasagar, Suma N Risk factors for breast cancer among women attending a tertiary care hospital in southern. J Collaborative Res Int Med and Public Hlth.2010; 2:109-16.
National Cancer Registry Programme: Consolidated report of the population based cancer registries 1990-1996. Indian Council of Medical Research, New Delhi, 2001
Rao DN, Ganesh B, Desai PB (1994). Role of reproductive factors in breast cancer in a low-risk area: acase-control study. Br J Cancer, 70, 129-32.
Singh MM, Devi R, Walia I, Kumar R (1999). Breast self examination for early detection of breast cancer. Indian J Med Sci, 53, 120-6.
Tavani A, Gallus S, La Vecchia C, et al (1999). Risk factors for breast cancer in women under 40 years. Eur J Cancer, 35, 1361-7.
Mathew A, Gajalakshmi V, Rajan B, et al (2008). Anthropometric factors and breast cancer risk among urban and rural women in South India: a multicentric case–control study. Br J Cancer, 8, 207-13.
Nomura A, Comstock GW, Tonascia JA Epidemiologic characteristics of benign breast disease. Am J Epidemiol 1977;105:505-12
Vessey MP, Doll R, Sutton PM. Oral contraceptives and breast neoplasia: A retrospective study. Br Med J 1972;3:719-24.
MacMahon B, Cole P, Brown J. Etiology of human breast cancer: A review. J Natl Cancer Inst 1973 ;50:21-42.
Fasal E, Paffenbarger RS. Oral contraceptives as related to cancer and benign lesions of the breast. J Nati Cancer Inst 1975;55:767-773.
Kelsey JL, Gammon MD. Epidemiology of breast cancer. Epidemiol Rev 1990;12:228-40.
Soini I, Aine R, Lauslahti K, et al. Independent risk factors of benign and malignant breast lesions. Am J Epidemiol 1981; 114:507-14.
Nomura A, Comstock GW. Benign breast tumours and estrogenic hormones: A population based retrospective study. Am J Epidemiol 1976;103:439-444
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcareMICROCHIP INSERTION IN HUMAN BEINGS - A NEW IDENTIFICATION TOOL
English5256Ajay Kumar S. English Manjula Bai K. H.English D.R.Mahadeshwara PrasadEnglish Nagesh C. KuppastEnglish Chandan V.English Sidramappa GoudaEnglishDuring mass disasters, victim identification is one of the great challenges for the investigating teams especially in case of most markedly putrefied and partially skeletonised bodies. In these cases an adequate body tagging method is essential. Conventional body bag tagging in terms of writing on body bags and placing of tags inside body bags was not satisfactory and consequences of cold storage, embalming and body numbers inside storage facilities may raise problems. The placement of sub dermal implant of Radio Frequency Identification Device (RFID) microchips in human beings which contains a unique ID number that can be linked to information contained in an external database, such as personal identification, medical history, medications, allergies, and contact information. This is also useful to find lost children or confused Alzheimer's patients, or to determine if job applicants are illegal immigrants or criminals as well as victims in major accidents or mass disasters.
EnglishMicro-chip, Sub dermal implant, Identification, Mass disaster.INTRODUCTION
RFID technology was introduced in the beginnings of WWII to identify the Allied airplanes. Since then, RFID technology was used for multiple purposes, mainly to track nuclear materials as well animals etc. A RFID chip is a microchip that transmits a static identifier or serial number for a short distance1. More improvised microchip devices are available for identifying stray animals and these implants are about the size of a grain of rice, have been a great boon for the owners with lost or stolen pets. Implantation of more than six million has been reported. Recovering a lost animal is greatly increased and a wandering can quickly be scanned. The animal's owner can be easily identified if it has a microchip2. Many researches have been done to help the people medically with this technology. This technology is being used to implant people with microchips1.
As early as in 1967 Alan Westin discussed the possibility of "permanent impalements of 'tagging' devices on or in the body" and he also stated that if the technology were extended to human beings, a lot of identification related applications, such as the capability to find confused Alzheimer's patients or lost children, or criminals or to determine if job applicants are illegal immigrants could have been envisaged 2.
But some issues may arise with implanting microchips in people and which include the ability to track a person's exact location, legal and privacy concerns, their purchasing habits, as well as hacking their information about personal and financial matters.
Historical Aspects
In 1998 the first reported experiment with an RFID implant was carried out by the British scientist Kevin Warwick. As a test, his implant was used to open doors, switch on lights, and cause verbal output within a building. After this, several additional hobbyists have placed RFID microchip implants into their different parts of the body or had them placed there by others. Author of the book "RFID Toys" Amal Graafstra asked doctors to place implants in his hands. A scalpel was used by a cosmetic surgeon to place a microchip in his left hand, and using a veterinary Avid injector kit doctor injected a chip into his right hand. Graafstra used the implants to open his home and car doors and to log on to his computer4. Mikey Sklar had a chip implanted into his left hand and filmed the procedure along with that he did number of personal interviews about his experience of being microchipped5.
Procedure and details of biochip implant6
The newly available biochip implant is basically a small (micro) computer chip (Fig 1), inserted under the skin, for multiple purposes. The biochip implant system consists of two components; a transponder and a reader or scanner. The transponder is the actual biochip implant. The biochip system is radio frequency identification (RFID) system, using low-frequency radio signals to communicate between the biochip and reader. The reading range or activation range, between reader and biochip is small, normally between 2 and 12 inches. The two Components are (Fig 2)
1) The transponder: The transponder is the actual biochip implant. Transponder is of two types, a passive transponder, meaning it contains no battery or energy of its own. In comparison, an active transponder would provide its own energy source, normally a small battery. Because the passive biochip contains no battery, or nothing to wear out, it has a very long life, up to 99 years, and no maintenance. Being passive, it's inactive until the reader activates it by sending it a low-power electrical charge. The reader "reads" or "scans" the implanted biochip and receives back data (in this case an identification number) from the biochip. The communication between biochip and reader is via low-frequency radio waves.
The biochip-transponder consists of four parts; computer microchip, antenna coil, capacitor and the glass capsule. A) Computer Microchip: The microchip stores a unique identification number from 10 to 15 digits long. The storage capacity of the current microchips is limited, capable of storing only a single ID number. AVID (American Veterinary Identification Devices), claims their chips, using a nnn-nnn-nnn format, has the capability of over 70 trillion unique numbers. The unique ID number is "etched" or encoded via a laser onto the surface of the microchip before assembly. Once the number is encoded it is impossible to alter. The microchip also contains the electronic circuitry necessary to transmit the ID number to the "reader". B) Antenna Coil: This is normally a simple, coil of copper wire around a ferrite or iron core. This tiny, primitive, radio antenna "receives and sends" signals from the reader or scanner. C) Tuning Capacitor: The capacitor stores the small electrical charge (less than 1/1000 of a watt) sent by the reader or scanner, which activates the transponder. This "activation" allows the transponder to send back the ID number encoded in the computer chip. D) Glass Capsule: The glass capsule "houses" the microchip, antenna coil and capacitor. It is a small capsule, the smallest measuring 11 mm in length and 2 mm in diameter, about the size of an uncooked grain of rice. The capsule is made of biocompatible
material such as soda lime glass. After assembly, the capsule is hermetically (air-tight) sealed, so no bodily fluids can touch the electronics inside. Because the glass is very smooth and susceptible to movement, a material such as a polypropylene polymer sheath is attached to one end of the capsule. This sheath provides a compatible surface which the bodily tissue fibres bond or interconnect, resulting in a permanent placement of the biochip.
The biochip is inserted into the subject with a hypodermic syringe. Injection is safe and simple, comparable to common vaccines. Anaesthesia is not required nor recommended. In dogs and cats, the biochip is usually injected behind the neck between the shoulder blades. According to AVID once implanted, the identity tag is virtually impossible to retrieve. The number can never be altered.
2) The reader: The reader consists of an "exciter" coil which creates an electromagnetic field that, via radio signals, provides the necessary energy (less than 1/1000 of a watt) to "excite" or "activate" the implanted biochip. The reader also carries a receiving coil that receives the transmitted code or ID number sent back from the "activated" implanted biochip. This all takes place very fast, in milliseconds. The reader also contains the software and components to decode the received code and display the result in an LCD display. The reader can include a RS-232 port to attach a computer.
How it works6: The reader generates a low-power, electromagnetic field, in this case via radio signals, which "activates" the implanted biochip. This "activation" enables the biochip to send the ID code back to the reader via radio signals. The reader amplifies the received code, converts it to digital format, decodes and displays the ID number on the reader's LCD display. The reader must normally be between 2 and 12 inches near the biochip to communicate. The reader and biochip can communicate through most materials, except metal.
Uses7
1. A newer kind of microchip called a VeriChip, which is also about the size of a grain of rice and which contains an identification number or other data, such as medical information, a person's address and phone number.
2. In animals the chip is used extensively, but VeriChip can be used in humans who have a pacemaker, artificial heart valves, or orthopaedic knee devices. If a patient would need help, a hospital could use a scanner to obtain information from the VeriChip.
3. A potential market for the chips would be a potential kidnap victim who could use these chips in combination with global positioning devices. Society in general could use them in place of ATM or credit cards.
4. In coming years, this new chip will be used in children, the elderly, prisoners, and by employers at facilities such as nuclear plants. Already airports are beginning to use similar micro-devices to improve security by tagging bags with more detailed instructions about how they are to be handled and screened. Automakers are installing the chips in keys to deter auto theft and Libraries are beginning to use the technology to track books.
The insertion of radio frequency identification (RFID) tag8 into dentures could be used as an aid to identify decomposed bodies, by storing personal identification data in a small transponder that can be radio-transmitted to a reader connected to a computer.
Limitations1
There are so many potential problems and benefits with human micro chipping. One problem is invading of a person’s privacy. This could happen because of tracking of person’s movements, both physically and financially. Personal data about an individual could be sold or hacked into. A third potential problem could be storage of information and who can access that information. Above all these there are potential health problems as well.
Health Risks9
Health risks are involved as with any type of surgery. The FDA has reported on the specific risks of the VeriChip microchip, some of which are: adverse tissue reaction, migration of implanted transponder, electromagnetic interference, electrical hazards, and magnetic resonance imaging incompatibility. The civil libertarians warn that mass human implantation has not received enough debate and may put us on a slippery slope towards a system of human numbering. Also they contend that human microchip implantation will first be sold to the populace as being beneficial, fun, and ultra-convenient, convincing many that microchip implantations are benign. There is some worry that mass implantation will lead to large scale abuse.
CONCLUSION
Identification of person is very important in present world, because of globalization. There are many modes of identification such as fingerprints, dental casts, biometrics, DNA fingerprints and others. These methods are simple and economical, but large data has to be stored. So if the data is lost, identification of all the cases will be lost. In biochip, the data is stored in chip itself which is implanted in the person and there is no need to store the data separately. Easily the data can be read by a reader and it may become a new identification tool in future.
Englishhttp://ijcrr.com/abstract.php?article_id=1000http://ijcrr.com/article_html.php?did=1000
Smith C. Human Microchip Implantation. J .Technol. Manag. Innov. 2008; 3(3): 151-160.
Ramesh EM. Time Enough? Consequences of Human Microchip Implantation. Pierce Law Review, vol. 8, 1997. Available: http://www.fplc.edu/risk/vol8/fall/ramesh.htm.
"Is human chip implant wave of the future?". CNN. January 13, 1999. http://www.cnn.com/TECH/computing/9901/14/chipman.idg/. Retrieved May 12, 2010.
Tutu S. Tick! Tock! the Clock Is Ticking. United States of America and United Kingdom: Holy Fire Publishing; 2011.p.39.
http://www.jonnygoldstein.com/2005/12/29/mikey-sklar-gets-an-rfid-tag-implanted-in-his-hand/ Johnny Goldstein Interviews Mikey Sklar.
Rao TVN, Sukruthi GS, Raj G. Biochip Technology –A Gigantic Innovation. International Journal of Emerging Technology and Advanced Engineering 2012; 2(3): 129-135.
Sickler M. The microchip under the skin. Michael Journal 2012; jan-Feb: 13.
Nuzzolese E, Marcario V, Di Vella G. Incorporation of Radio frequency identification tag in dentures to facilitate recognition and forensic human identification. Open Dent J 2010; 4: 33-6.
Gad A. Human Microchip Implantation. Legislative Briefs from the Legislative Reference Bureau. Legislative Brief 06−13. June 2006, 1-2. Available from http://legis.wisconsin.gov/lrb/pubs/lb/06lb13.pdf.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcareCORRELATION BETWEEN BREAST CANCER AND RISK FACTORS
English5760R. A. MustafaEnglish A. AbdelbadieEnglish Ihsan OsmanEnglish H. OmerEnglishTo evaluate the correlation between breast cancer and many risk factors which include family history of breast cancer, history of benign breast disease, obesity, age at menarche, menopause, abortions, older ladies at first full-term pregnancy, parity, lactation. 328 females, all originating from the Sudanese, were eligible for analysis. An age-stratified random sample of 100 women was used as a control group. The interview followed a structured questionnaire. 153 (47%) of patients their age 50 years, 148 (45%) of the patients from rural areas, while 180 (55%) from urban areas. There is association between breast cancer and residence. Premenopausal patients were 158 (48%) and postmenopausal patients were 170 (52%), there is statistically significant difference. There is no statistically significant difference observed between patients approaching menopause at an age of >50 years and those approach it at age EnglishBreast cancer, risk factors, menopause.INTRODUCTION
The American cancer society estimates that about 30% of Americans will get cancer at some point during their lives and about 40% of those in whom cancer is diagnosed will be alive five year later. Currently in the United States, one death in five is from cancer.
Breast cancer is the most frequently diagnosed cancer among women in the United States and is the second leading cause of cancer deaths among women today (American Cancer Society). Although breast cancer continues to be a leading cause of cancer morbidity and mortality today, the death rates have drastically decreased due to earlier detection and more effective treatment methods (Connor CS, et al, 2002).
Breast cancer is the commonest cancer in women in the world; it is rising at, a rate of approximately 2% per year in all population (Parkin, et al, 1992). The number of annual deaths from breast cancer has remained about the same for the past 50 years, although the number of cases is increasing. This shows the benefits of early detection, which impacts survival. Also, effective treatment is increasing survival in all breast cancer patients. One in nine women will get breast cancer in the U.S.A. during their lifetimes.
In U.K it accounts for 20% of all cancer, and 25% of all deaths and it is the commonest cause of death amongst women in the 35-55 age group. They are 24.000 new cause each year it is estimated, in the high risk area, that any individual women has 1 in 10 - 12 chance of developing the disease in her life time (Underwood JCE, 1996).
According to data from UK at 2001the breast cancer is most common (29% of all cancers) (Souhami R, et al, 2001).
In the Sudan breast cancer accounts for 34.5% of all female cancer. The alarmingly high frequency of women presenting with advanced breast cancer to the Radiation Isotope Center Khartoum (RICK record) (Hidytalla, 1988).
Breast cancer rates vary widely amongst the world's populations, with incidence in most Asian and developing countries traditionally being less than one- fifth as that in affluent Western countries. Moreover, populations migrating from low to high incidence areas adopt the rates of the new environment in two to three generations, indicating that genetic differences cannot explain the high rates in the west (Jemal A, et al, 2007).
Dietary factors and dietary fat in particular, have been hypothesized to account for the large variation in breast cancer incidence around the world and the increases amongst migrants. Belief that dietary fat is a major cause of breast cancer has had important implications for dietary guidelines, and this has been the primary justification for recommendations to reduce total fat intake (Willett WC, 2001).
Many risk factors have been identified either genetic factors which include family history of breast cancer, obesity and high fat diet or hormonal factors which include female sex, long interval between menarche and menopause and older ladies at first full-term pregnancy (Underwood JCE, 1996).
Several well-established factors have been associated with an increased risk of breast cancer. These include family history, nulliparity, early menarche, advanced age, and a personal history of breast cancer (in situ or invasive).
Since criteria for menopausal status vary widely, some studies have substituted age greater than 50 years as a surrogate for the postmenopausal state.
Depending on the results of the mammograms and/or ultrasounds, doctor may recommend that a biopsy has to be taken. Biopsy allows cells to be examined under a microscope and it the only way to confirm cancer (Chaney AW, et al, 2000).
MATERIALS AND METHODS
328 females, all originating from the Sudanese, were eligible for analysis.
An age-stratified random sample of 100 women was used as a control group, derived from the Breast Unit's database of screened patients who had not developed breast cancer after a median follow up period of 40 months (range 12–92 months). Personal interviews were conducted with each woman during her first visit (both patients and controls) by a consultant or a senior resident. The interview followed a structured questionnaire, which did not change during the study period. Anthropometric measures were also made during the first visit.
Females were classified as postmenopausal if their menstrual cycles had ended naturally at least 12 months before the interview or from surgery or radiation therapy at any age. Those who reported not having menstrual cycles for the last 10 months were considered as perimenopausal and were combined with premenopausal women for the purpose of analysis.
The following variables were analyzed for all patients and controls:
residence (rural/urban), age at interview (≤ 50 and >50 years), age at menarche (≤ 12 and >12 years old), age at first full birth (3), lactation (yes/no), use of medications to suppress lactation (yes/no), abortions and miscarriages (yes/no), age at menopause for postmenopausal women (≤ 50 and >50 years old), use of HRT for more than 2 months (yes/no), use of oral contraceptives for more than 2 months (yes/no), family history of breast cancer in a first degree relative (yes/no), history of benign breast disease (yes/no), obesity on the day of the interview (BMI ≤ 29 kg/m2 vs. BMI>29 kg/m2, median value for the study population) and radiation history of the chest (yes/no).
RESULT
The breast cancer Patients having age less than 50 years are 153 (47%) while more than 50 years are 175 (53%) . breast cancer Patients coming from rural area are 148 (45%) whereas, those coming from urban area are180 (55%). The Pre/per menopausal patients are 158 (48%) which is less than Postmenopausal patients who comprises 170 (52%).The breast cancer Patients who become postmenopause at an age more than 50 years are 166 (98%), while those become postmenopause at an age less than 50 years are 4 (2%).The breast cancer Patients having menarche at an age more than 12 years are 187 patients (58%).Among the study group patients not using oral contraceptive were 309 (94%), while those using oral contraceptives were 19 (6%). The number of breast cancer patient who did not use HRT is 166 (98%), while those used HRT are 4 (2%). Patients with no history of cancer in a first degree relative are 298 (91%) while those with history of cancer are a first degree relative is 30 (9%). The breast cancer patients who have a first full pregnancy at an age less than 23 years are 77 (38%) which is less compared to patients having the first full pregnancy at an age more than 23 years, the figure for the last group is 125 (62%). Breast cancer patients having no children (nulliparous) are 126 (38%) of the cases, patients having one to two Childs are 24 (12%) and chose having three children or more are 178 (88%) of the cases. The breast cancer patients not having a history of abortion or miscarriage are 233 (71%), which is more than the breast cancer patients who have a history of abortion or miscarriage giving the number of 95 (29%). The breast cancer patients not having history of lactation are 8 (4%), which is less than the breast cancer patients having history of lactation which constitutes 194 (96%). The breast cancer patients not having used medication to suppress lactation are 198 (98%), which is more than breast cancer patients having used medication to suppress lactation who are 4 (2%).The breast cancer patients not having exposed to radiation to the chest are 321 (98%), which is more than the breast cancer patients group having exposed to radiation to the chest, the last group constitutes 3 (2%). The breast cancer patients with body mass index less than 29 kg/m2 are 288 (88%) which is more than the breast cancer patients with body mass index more than 29 kg/m2 who are 40 (12%) of the cases. The breast cancer patients not having history of benign breast disease are 282 (86%), which is more than the breast cancer patients with history of benign breast disease the numbers for the last group are 46 (14%) .
DISCUSSION
The interview was conducted during the subjects' first visit to the unit and before clinical examination or any other intervention took place. This constitutes an advantage, because there was no chance that the subjects (both cases and controls) would be influenced by the diagnosis and might therefore falsely inflate the relative risk. Thus, the likelihood of recall bias is not high; improving the comparability of several covariates in both groups, and the selection bias is lessened since all subjects had taken the same route through the Breast Unit's standard routine procedures.
Since each case group was compared with the same control group, any selection bias would be expected to have a similar effect on the estimates in the tumor subgroups.
CONCLUSION AND RECOMMENDATION
Their findings will provide us with greater insight into breast cancer aetiology and will help us identify any association that would help discriminate subgroups of women at higher risk.
Further innovative studies with larger sample sizes are needed to examine how the status of this potentially modifiable breast cancer risks factors.
Lastly, we recommend further studies in this field with wider scope.
ACKNOWLEDGEMENT
Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript
Special thanks to the medical laboratory and blood bank staff as general and specially for histopathology and cytology staff.in radiation and isotopes Center- Khartoum, for their help and valuable advices.
My thanks to all people who helped me and I may miss to say their name.
Englishhttp://ijcrr.com/abstract.php?article_id=1001http://ijcrr.com/article_html.php?did=1001
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241524EnglishN2013December31HealthcarePHAEOHYPHOMYCOSIS - A RARE INFECTION WITH TWO DIFFERENT CLINICAL PRESENTATION
English6163Volga HarikrishnanEnglish Sonti SulochanaEnglish Meenakshi SundaramEnglish Aruna GnanaguruparanEnglish Chitra SrinivasanEnglishPhaeohyphomycosis is rare mycotic infections caused by melanized fungi. We report two cases of phaeohyphomycosis with different clinical scenario but with typical similar histopathological features.
Englishphaeohyphomycosis, melanised fungiINTRODUCTION
Phaeohyphomycosis is caused by ubiquitous fungai and it can occur in any forms like septate hyphae, pseudohyphae, and yeast forms in tissue. Clinical manifestations of the disease range from localized superficial infections of the stratum corneum to subcutaneous cysts (phaeomycotic cyst) to invasion of the brain.
CASE REPORT
Case 1
A 70 year old male presented with swelling in the dorsum of right little finger for 2 months duration. The lesion was associated with pain which was intermittent and pricking type. History of trauma (Thorn injury) was present. He was non- diabetic and had no other systemic or underlying disease. Clinically the case diagnosed as sebaceous cyst.
Case 2
An immunodeficient, 50 year old female presented with swelling in the left hand for 3 weaks duration. The lesion was not associated with pain. No history of trauma present. She was diabetic for the past 15 years.
PATHOLOGICAL FINDINGS
Gross features
Both cases showed typical similar gross features. No contents were present. Inner surface of the cyst was brownish, case 1 showed fine nodularity in addition. Wall showed whitish and yellowish areas.
Microscopic features:
Sections from both cases showed fibrocollagenous cyst (Fig 1) wall lined by granulomas composed of epitheliod cells, foreign body and Langhan giant cells. The wall contains aggregates of foamy histiocytes, mixed inflammatory cell infiltrate and necrosis. Pigmented and branching fungal hyphae (Fig 2 &3) seen.
We did Periodic acid schiff (PAS) stain for both cases which showed branching and septate fungal hyphae morphologically consistent with Phaeohyphomycetes (Fig 4).
Ziehl-Nielsen staining was done for acid fast bacilli and it was negative for tubercle bacilli
DISCUSSION
The dematiaceous (brown-pigmented) fungi are heterogenous group of moulds that cause a wide range of diseases including phaeohyphomycosis, chromoblastomycosis and eumycotic mycetoma (1).
Phaeohyphomycosis, is a rare infection, although the number of cases has been increasing in recent years (2). These fungi are found in soil, wood and plant as saprophytes. The presence of melanin in their cell walls may be a virulence factor for these fungi (3).
Typically, phaeohyphomycosis follows traumatic implantation (4) of the fungus by a wooden splinter, as in one of our case. The primary risk factor is decreased host immunity, although cases in apparently immunocompetent patients (5) have been reported.
The spectrum of the disease includes superficial, cutaneous, subcutaneous and systemic infection (6).
Etiologic agents include Exophiala, Phoma, Bipolaris, Phialophora, Colletotrichum, Curvularia, Alternaria, Exserohilum, and Phialemonium sp (7).
Rarely it can cause fatal disease as reported by (8) .He reported a case of cerebral phaehyphomycosis in a patient with neurosarcoidosis with the history of marijuana smoking and chronic steroid therapy.
The common manifestations clinically are cystic lesions as seen in our cases or abscesses (9).
Most forms of disease caused by dematiaceous fungi require both medical and surgical treatment. The most effective antifungal agent for subcutaneous phaeohyphomycosis is Itraconazole. Complete surgical resection can also be done for discrete lesions (1).
CONCLUSION
Since it is a rare fungal infection, the incidence has been increasing irrespective of immune status of the patient. We have presented two case reports with different clinical presentation one in immunocompetent individual, with trauma history and another one, immunodeficient patient without any triggering factor. Histopathological examination of tissue section along with special stain plays an important role in the diagnosis of Phaeohyphomycosis.
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Brandt ME ,Warnock DW. Epidemiology, clinical manifestations, and therapy of infections caused by dematiaceous fungi. J Chemother. 2003 Nov; 15 Suppl 2:36-47.
Vasquez-del-Mercado et al. Subcutaneous phaehyphomycosis due to Curvularia lunata in renal transplant patient.Rev Iberoam Micol.2013 Apr-Jun;30(2):116-8
Sanjay G. Revankar, Jan E. Patterson, Deanna A. Sutton, Disseminated Phaeohyphomycosis:Review of an Emerging Mycosis, Clinical Infectious Diseases 2002; 34:467–76.
Madhavan Manoharan, Natarajan Shanmugam, Saveetha Veeriyan. A Rare Case of a Subcutaneous Phaeomycotic Cyst with a Brief Review of Literature. Malaysian J Med Sci. Apr-Jun 2011; 18(2): 80-83.
Devesh Mishra, Maneesh Singal, Mahaveer Singh Rodha. Subcutaneous Phaeohyphomycosis of Foot in an Immunocompetent Host. J Lab Physicians, 2011 Jul; 3(2):122-4. doi: 10.4103/0974-2727.86848
McGinnis MR, Chromoblastomycosis and phhaehyphomycosis: new concepts, diagnosis, and mycology. J Am Acad Dermatol.1983 Jan; 8(1):1-16.
Isa-Isa R, Garcia C, Isa M, Arenas R. Subcutaneous phaeohyphomycosis (mycotic cyst). Clin Dermatol. 2012 Jul-Aug; 30(4):425-31.
Gongidi P et al. Cerebral phaehyphomycosis in a patient with neurosarcoidosis on chronic steroid therapy secondary to recreational marijuana usage, Case Rep Radiol.2013; 2013:191375.
Yoon Ya et al. Subcutaneous phaehyphomycosis caused by Exophiala salmonis. Ann Lab Med.2012 Nov; 32(6); 438-41.