Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareA STUDY OF THE RELATIONSHIP BETWEEN STRESS, ADAPTABILITY AND TEMPOROMANDIBULAR DISORDERSY
English0105Vidhya KalanjiamEnglish G.V. Murali Gopika ManoharanEnglishAim: The aim of the study is to explore the influence of stress in patients with temporomandibular disorders
Objectives: Stress affects the physiological, cognitive, emotional, behavioural functioning of human being. Initially our body compensates for stress, but when we cannot cope up with it, disorder arises. One such manifestation of stress in human body is temporomandibular disorders. The objective of the study is to first establish the diagnosis of the patients’ complaints pertaining to temporomandibular joint based on clinical and radiological examinations; then to assess the degree of stress using stress assessment questionnaire and finally to study the relationship between stress and adaptability in temporomandibular disorders. Materials and Methods: 60 patients who reported with pain, tenderness in the temporomandibular joint, clicking or crepitus, tenderness in muscles of mastication, restricted mouth opening, deviation of jaw, restricted jaw movements, and with altered condylar movements were selected for the study. Clinical examination of signs and symptoms were assessed along with a stress assessment questionnaire. Finally, statistical analysis was performed on the responses received from the patients. Results: Significant difference was found in the pain threshold i.e. pain perception between patients with stress and without stress. This leads to the conclusion that stress has a major role in affecting the adaptability of the body, and it is a front runner for various deleterious effects. Conclusion: Stress levels of patients with temporomandibular disorders should be always evaluated and in case the stress levels are high, it must be treated with appropriate stress management therapy.
EnglishStress, Pain threshold, Questionnaire, Temporomandibular disorderINTRODUCTION American Association of Orofacial pain (AAOP) defines Temporomandibular Disorder as a collective term embracing a number of clinical problems that involve the masticatory musculature, the temporomandibular joint and the associated structures or both. [1] The etiology of temporomandibular disorder is complex and multifactorial. Some of the etiological factors which are commonly associated with temporomandibular disorder are occlusal condition, trauma, emotional stress, parafunctional activities and deep pain input. [2] Even though there are enough evidences to support the contribution to temporomandibular disorder symptoms by these etiological factors, few common questions that remain unanswered are - are there varying degrees to which each of these factors affect.
Temporomandibular joint function? Does the interplay between these factors cause different effects than the individual factors? In healthy condition, our masticatory system functions smoothly but at times, an event may interfere with the normal function of the masticatory system. When the effects of the influencing factor are lower than the patient’s adaptability, no clinical effects are noticed. However, if the factors become more significant, it may exceed the patient’s adaptability and symptoms arise. [2] We observed a pattern in the case histories of patients reporting in with temporomandibular disorder - a very large population reported their lives were very stressful.
This formed the motivation for this study In this modern age, with our ever increasingly complicated lives we continue to discover that our body and mind are interlinked in complex ways. Stress takes a toll on our bodies both physically and mentally. Hans Selye described stress as the nonspecific response of the body to any demand made upon it. [3] [4] When stress acts upon the human body, it is first alerted for the changes. This is followed by activation of the autonomic activity to prepare the body to deal with the stress (host resistance). Finally, if the stress continues beyond the capacity of the body to respond, the system is damaged and may collapse. [2] Numerous studies have been conducted through the years to explore the relation between stress and temporomandibular disorders.
Many studies have proven that patients with stressful jobs are more prone to temporomandibular disorders. For example, Uhac et al conducted a study with the war veterans diagnosed with post-traumatic stress disorder (PTSD) in Croatia that concluded that war stress was directly related with temporomandibular disorders.[5] We took this endeavour to try to further explore the relationship between temporomandibular disorder and stress, to learn more deeply about the various stresses present in patients’ lives and its relationship to age, sex, predominant side affected, measure the level of pain in the stressed patient and in non-stressed patients and the interplay between stress and other confounding factors for temporomandibular disorder.
Study Design: 60 patients who reported to the Department of Oral Medicine and Radiology with symptoms of temporomandibular disorders like pain, tenderness in the temporomandibular joint, clicking or crepitus, tenderness in muscles of mastication, restricted mouth opening, deviation of jaw, restricted jaw movements were selected for the study. To remove any gender bias from the results of the study, the group was composed of 30 males and 30 female patients. The diagnosis of temporomandibular disorder was confirmed radiographically.
MATERIALS AND METHOD Detailed information about the age, sex, occupation, affected sides, family and social history, history of stress, sleep troubles, history of trauma and parafunctional habits were collected in case history document. Malocclusion, buccoverted, impacted, supraerupted teeth and missing teeth in the patients were also recorded. The clinical parameter the pain score was evaluated using Visual Analog Scale (0 to 10) given by Martin and Greenberg in 2003. To measure and compare the stress level in this group of patients we used a self-administrated questionnaire created by the Ministry of Social Security, National Solidarity and Reform Institu tions, Government of Mauritius. Questionnaires developed by this institution were used for their effective but simplistic approach of categorizing the overall stress level in patients into 4 categories and measurement of each individual question into simple 3 categories - low, medium and high.
These questionnaires have been used in many studies on stress previously.[6] [7] After giving the patients assurance of confidentiality, they were asked to complete the series of 20 question in the questionnaire. Each question is rated with a score between 0 and 3 with 0 meaning ‘no symptoms’, 1 meaning ‘rarely’, 2 meaning ‘sometimes’ and 3 being equal to ‘quite often’. Higher score indicates worse condition. Total score was calculated by adding the individual scores. The questions themselves are designed in such a way that scores of 0-20 are categorized as no stress, score values from 21-40 are good management of stress and score of 41-50 are patients in the danger zone of stress management and patients with score 51-60 points are the ones with unmanaged stress. For the patients whose stress scores were in high categories, additional data about the type of stress they were experiencing was recorded in their case histories. The questions in the questionnaire were as follows.
Questions
1. Do you neglect your diet? 2. Do you try to do everything yourself? 3. Do you seek help while doing your work? 4. Do you blow up easily? 5. Do you seek unrealistic goals? 6. Do you fail to see the humour in situations others find funny? 7. Do you get easily irritated? 8. Do you make a ‘big deal’ of everything? 9. Do you complain that you are disorganized? 10. Do you keep everything inside? 11. Do you neglect doing physical exercise? 12. Do you feel the absence of supportive relationships in difficult moments? 13. Do you feel you get too little rest? 14. Do you get angry when you are kept waiting? 15. Are you aware of your being under stress? 16. Do you put off things until later? 17. Do you feel that there is only one right way to do something? 18. Do you complain and dwell in the past? 19. Do you race through the day? 20. Do you feel that you have got too much to do at the same time?
Statistical Analysis: The patient group was originally divided into two groups – patients who had a stress score higher than good management of stress (group A) and patients who had scores lower than or equal to good management (group B). However, on analysing the data with patients who scored high, it was observed that some patients did not have any other etiological factors and displayed stress as the only factor for their disorder. This group was taken as a subset within group A thus giving rise to three groups – group A1 consisting of patients who had stress as the sole cause of temporomandibular disorder, group A2 consisting of patients who had stress along with at least one other factor for temporomandibular disorder and group B which had patients whose temporomandibular disorder was caused by any factor(s) other than stress.
Statistical analysis of the data was performed using SPSS for Windows version 17 software. The values were represented and mean ± standard deviation was calculated. For analysing the relation between multiple sets, ANOVA (analysis of variance) test was used. Statistical significance was considered to be 5% or p < 0.05 level. Since the group A was further split into subsets A1 and A2 resulting in uneven samples, we also tested using Kruskal-Wallis Test – a non-parametric method.
RESULTS The composition of the study population was that age group 20-30 years composed 38.3% of the total, patients among 31-40 years composed 25%, 41-50 years 25% and the remaining 11.7% were either older than 50 or younger than 20. Case history shows that 46.7% of the patients complained of pain on the left side of the temporomandibular joint, 43.3% complained of pain on both the sides and 10% of the patients complained of pain in the right side. From the radiographs of the patients, we observed 85 % had bony changes (flattening of anterior slope of the condylar head) and the rest 15% did not have any change in the condylar morphology. Study of the stress levels recorded using the questionnaire reveals that out of 60 patients, 11.7% had no stress, 31.7% experienced stress but it was under control (good management), 50% of the patients were in danger zone and 6.7% of them had a stress score in excess of 50 which is so high that immediate counselling is recommended. Of the 60 patients, it was observed that 5% had temporomandibular disorder caused due to stress alone, 2% due to parafunctional habits, and 17% due to partially edentulous conditions while trauma accounted for the disorder in 2%, malocclusion in 11% and buccoverted, impacted and supra erupted teeth in 10% of the patients.
All the other 53% percent had more than one factors causing the disorder one of which was stress. (Figure 1) Of the total population, 35 patients had a stress score indicating stress was a factor contributing to their temporomandibular disorder. As stated above, this group was further split into group A1 (stress as the sole cause) which accounts for 5% of the total and group A2 (stress along with at least one other cause) accounting for 53.3% of the total patients. Group B consisting of patients that had low stress scores consisted of 25 patients which amounts to 41.7% of the total.
Cross tabulating the pain score with the causes of temporomandibular disorders, shows that for Group A1 and Group A2 , the mean pain score were 3.33 (standard deviation 0.577) and 3.19 (standard deviation 0.821) respectively, which are significantly higher when compared with Group B, mean pain score of 1.79 (standard deviation 1.128) (Table 1 and 2). There was significant difference (p value less than .05) between A1 and B, A2 and B. This shows that the pain threshold significantly decreased in stressed patient but not in patients without stress.
In other words, this means that for a patient who has malocclusion with stress, the pain tolerance will be significantly lower compared to a patient who has malocclusion alone as the etiology for temporomandibular disorder. Study of the patient data showed that most of the patients who had high stress scores were software engineers and house wives and the type of stress that seemed to be affecting them most were work pressure and family problems followed by stressors like relationship problems, financial problems and stress due to personal illness or the illness of a family member. Few of them even had more than one cause of stress in their lives. (Figure 2)
DISCUSSION Stress is not always bad. Sometimes, stress can be a motivational force to complete a task when it is within the limits. However, when it exceeds the tolerance level of the patient, it has an adverse impact on the physiological (non-functional parafunctional habits), cognitive (decreased attention span, increased distractibility and deterioration in both short-term and long-term memory, unpredictable response speed, increased error rate, and reduced powers of planning and organization), emotional (panic, hopelessness or even suicidal thoughts) and behavioural (risk health behaviours like smoking, alcoholism, altered diet) functions.[3] When an individual is experiencing high levels of emotional states, such as fear, anxiety, frustration or anger, it excites the hypothalamic-pituitary adrenal (HPA) axis. On upregulation it activates the gamma efferent system.
Increased gamma efferent activity causes contraction of the intrafusal fibers, resulting in partial stretching of the sensory regions of the muscle spindles which in turn increases muscle tonus. [2] Stress can also influence the sympathetic activity. Prolonged sympathetic activity increases the tonicity of the muscle leading to painful muscle condition. This accustomed sympathetic response to stress play a crucial role converting the acute condition to a different phase. [2] So continued experience of emotional stress to a significant level becomes a perpetuating factor that can progress the condition to a more chronic pain disorder. Emotional stress not only increases the muscle activity but also the non-functional activities like bruxism and tooth clenching.
People who experience stress due to hectic family life or busy work schedule unknowingly clench their jaws. These Para functional activities can fatigue facial muscles, lead to pain around the temporomandibular joint and jaw bones, damage the teeth, and finally displacement or dysfunction of the temporomandibular joint to have far reaching effects. [8] Genetic factors like gene variability, biological factors like diet, hormones, sleep, age, sex can influence the adaptability. [9] [10] When there comes a situation of imbalance between the etiological factor and the adaptability there will be manifestation of temporomandibular symptoms. In such cases of decreased adaptability, even less significant etiology can become more influential, which makes the patient less responsive to treatments taking the condition from the acute state to a chronic state.[11]
Because of chronicity, changes can be elicited in the Central nervous system which can perpetuate the condition and can lead to different treatment plan. [2] Various studies in the past have also supported this relationship between stress and temporomandibular disorders in different ways. Manfredino et al conducted a study to find out the major contributing etiology for temporomandibular disorders. They used stress measurement questionnaire and on comparison with other etiological conditions, concluded that stress was significantly higher in patients with temporomandibular disorder.[12]
Madani et al also proved that stress has an important role in the prevalence of temporomandibular disorder.[13] Uhac et al conducted a study that evaluated temporomandibular disorder symptoms in patients diagnosed with PTSD and patients without Post Traumatic Stress disorder (PTSD) and found that war veterans with PTSD displayed significantly high levels of symptoms. [4] Other similar studies targeted at individual groups that are known to be going through stressful conditions have also proven that the group did have higher symptoms of temporomandibular disorder than their control groups.
Some such examples are the study by Ahmad Mottaghi et al that did the study on female students before university exams [14] and Leonordo et al did a study based on age group and concluded that young individuals are affected the most and the main reason for temporomandibular symptoms was identified as anxiety.[15] Digging deep into the literature shows that there are not enough evidences to assess the influence of stress on the adaptability of patients with temporomandibular disorders. In this case, pain score is treated as a direct measurement of the patient’s adaptability. So we took this task to assess adaptability by calculating the pain score in patients with stress and without stress to ascertain the association between stress, adaptability and temporomandibular disorders. What we found is that in patients with stress as the only cause for their disorder and patients where stress was one among the many cases for their disorder, the mean pain score were 3.33 (standard deviation 0.577) and 3.19 (standard deviation 0.821) respectively, which are significantly higher when compared with patients whose disorder is not caused by stress but by other factors with mean pain score of 1.79 (standard deviation 1.128).
Significant difference exists in the pain threshold i.e. pain perception between patients with stress (either alone or in combination with other etiological factors) and without stress. This leads to the conclusion that stress has a major individual role in affecting the adaptability of the body and is a front runner for various deleterious effects. The bottom line is that an eye should be kept on stress levels of patients with temporomandibular joint problems, so that proper treatment for the disease can be provided at the early stage.
CONCLUSION The chief findings of this study are that there is a definite relationship between stressful life events and adaptability i.e. pain tolerance and with onset and progression of temporomandibular disorders. Cognitive therapy should be a part of management decorum of temporomandibular disorder. Further studies should be conducted with a larger sample size along with assessment of cortisol level in patients with temporomandibular disorder, with or without stress as a major factor as ascertained by the stress questionnaire. This would help to reinforce the result regarding the role of stress in temporomandibular disorders. This may be followed by studies on role of stress management therapies in temporomandibular disorders.
ACKNOWLEDGEMENT: We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=324http://ijcrr.com/article_html.php?did=3241. J. Durham Temporomandibular disorder (TMD): An over view .Oral Surgery. May 2008:60-68. DOI: 10.1111/j.1752- 248X.2008.00020.x
2. Jeffery P. Okeson. Management of temporomandibular disorder and occlusion. 7th ed. Elsevier Mosby; 2013.
3. G. Butler Definitions of stress Occas Pap R Coll Gen Pract. 1993; (61): 1–5.
4. Schneiderman N, Ironson G, Siegel SD .Stress and Health: Psychological, Behavioural, and Biological Annu Rev Clin Psychol.2005;1: 607–628. doi:10.1146/annurev. clinpsy.1.102803.144141.
5. Uhac I, Kovac Z, Valentic M, Juretic M . The influence of war stress on the prevalence of signs and symptoms of temporomandibular disorders Journal of Oral Rehabilitation .February 2003: 211–217. DOI: 10.1046/j.1365-2842.2003.01030.x.
6. Sayal D, Dodwad V, Vaish S, Sood R. Effects of Academic Stress on Gingival and Periodontal Health - A Questionnaire Study Journal of Dental Specialities, September 2014:32-38.
7. Ganesh Pradhan, Nishitha Linet Mendinca, Manisha Kar. Evaluation of Examination Stress and Its Effect on Cognitive Function among First Year Medical Students Journal of Clinical and Diagnostic Research. 2014 Aug, Vol-8(8): BC05-BC07 DOI:10.7860/JCDR/2014/9014.4680.
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9. Markland S, Wänman A.Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders.Acta Odontol Scand. 2010 Sep;68(5):289-99. doi:
10.3109/00016357.2010.494621. 10. Holliday KL, Nicholl BI, Macfarlane GJ, Thomson W, and Davies KA, Macbeth Genetic variation in the hypothalamicpituitary-adrenal stress axis influences susceptibility to musculoskeletal pain: results from the EPIFUND study. Ann Rheum Dis. 2010 Mar; 69(3):556-60. doi: 10.1136/ard.2009.116137.
11. McBeth J, Chiu YH, Silman AJ, Ray D, Morriss R, Dickens C, Gupta A, Macfarlane GJ. Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents. Arthritis Res Ther. 2005; 7(5):R992-R1000. Epub 2005 Jun 17.
12. Manfredino D, Bandethini AB, Cantini E. Mood and anxiety Psychopathology and temporomandibular disorder. J Oral Rehabil. 2009; 4 1 :933–7.
13. Madani A, Mehdizade F. Investigating the prevalence of TMD risk factors in 100 patients referred to dental faculty of Mashhad University. J Shahid Beheshti Univ. 2003; 2: 229–37.
14. Ahmad Mottaghi, S. Mohammad Razavi, Elham Zamani Pozveh, and Milad Jahangirmoghaddam Assessment of the relationship between stress and temporomandibular joint disorder in female students before university entrance exam (Konkour exam). Dent Res J (Isfahan). 2011 Dec; 8 (Suppl1): S76–S79.
15. Leonardo R Bonjardim, Ricardo J Lopes-Filho1, Guilherme Amado, Ricardo LC Albuquerque Jr, Suzane R J Gonçalves. Association between symptoms of temporomandibulardisorders and gender, morphological occlusion, and psychological factors in a group of university students Indian J Dent Res, 2009 AprJun;20 (2):190-4 20(2) . DOI: 10.4103/0970-9290.52901.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareA STUDY OF HEMATOLOGICAL PARAMETERS AND ANTHROPOMETRIC INDICATORS IN HYPERTENSIVE AND NORMOTENSIVE MALES
English0612Divya R.English Ashok V.EnglishIntroduction: Hypertension is one of the factors associated with stroke, congestive heart failure, heart or kidney failure. Overweight and obesity are the two most key determinants of health that leads to adverse metabolic changes including increase in blood pressure. The cellular components of blood contribute to the viscosity and volume of blood, thus playing a vital role in regulating blood pressure. Objectives: To compare the hematological parameters and anthropometric indicators in hypertensive and normotensive males. Materials and Methods: This was a hospital based case control study which included 60 normal healthy male subjects and 60 hypertensive male subjects. Blood pressure was measured in supine position by mercury sphygmomanometer. Hematological indices were estimated using an autoanlayser. The data collected were entered and analyzed using software Statistical Package for the Social Science 16.0 (SPSS 16.0). Results and Discussion: The mean levels of hemoglobin and hematocrit were significantly lower in the hypertensive group compared to the normotensives in our study. The anthropometric measurement waist hip ratio, showed a statistically significant positive correlation with systolic blood pressure. Multiple regression analysis showed waist hip ratio, hemoglobin and hematocrit were significant predictors of systolic blood pressure. Conclusion: The present study concludes that Waist hip ratio, a simple and inexpensive anthropometric measurement can be used as a significant predictor of systolic blood pressure. Also monitoring of hematological indices like hemoglobin and hematocrit is essential in the prevention of development of cardiovascular complications in hypertension.
EnglishHypertension, Anthropometric indicators, Hematological indices, BMI, WHRINTRODUCTION Hypertension is defined as blood pressure more than 140/90 mm Hg as per US Seventh Joint National Committee on Detection, Evaluation and Treatment of Hypertension (JNC VII).1 The prevalence of hypertension in India is 23.10 % among men and 26.60% among women.2 Prevalence of hypertension in South India was found to be 20% according to the CURES 2007 study.3 Overweight and obesity are the two most important key determinants of health that leads to adverse metabolic changes including increase in blood pressure.
Obesity and weight gain are independent risk factors for hypertension. Also 60- 70% of hypertension in adults may be directly attributable to adiposity.4 Body mass index or BMI is propagated by the WHO as the most beneficial epidemiological measure of obesity. Waist hip ratio (WHR) and waist circumference (WC) are frequently used to forecast the danger of obesity linked morbidity and mortality as they account for regional abdominal adiposity.
Visceral fat is a more significant determinant of blood pressure elevation than is peripheral body fat.5 In longitudinal studies, a direct association exists between change in weight and change in blood pressure over time.4 Though hypertension and obesity are closely linked but there is no universal anthropometric marker due to distinct population features. Studies in urban population showed a strong relationship between different anthropometric indicators and blood pressure levels but very little is known about these relationships in rural Indian population.6, 7, 8
The cellular components of blood contribute to the viscosity and volume of blood, thus playing a vital role in regulating blood pressure. It has been newly realized that many hematological parameters varies with hypertension in comparison with normotensives. This gives a vision into the connection between blood cell defects and blood pressure. There are number of disputes in different studies with respect to variability of hematological parameters in hypertensive and normotensive subjects.9, 10, 11 The pathophysiology of hypertension is multifactorial which is affected by sympathetic over activity contributing to alterations in hematological parameters like hematocrit, viscosity and hypercoagulability of blood.
These factors change the kinetics of blood flow acting as contributory risk factor for coronary artery diseases, stroke and thromboembolism.12Thus the hematological parameters gives an insight to prognosis of disease also. So the present study was therefore undertaken to compare the hematological parameters and anthropometric indicators in hypertensive and normotensive males. The present study was carried out with the following objective: To compare the hematological parameters and anthropometric indices in normotensive and hypertensive males.
Materials andmethods This study was conducted in Sri ManakulaVinayagar medical college hospital(SMVMCH) Madagadipet, Puducherry. Study design: Hospital based case control study. Sample size: 120 subjects. We included 60 normal healthy male subjects of 35-55years of age. 60 hypertensive male subjects of 35-55 years of age. Data collection: A representative sample of local population comprising of 120 subjects aged 35-55 years were selected from 1. Hypertensive patients attending medicine OPD in SMVMCH. 2. Normotensives were attendants of patients, workers in SMVMCH. Inclusion criteria 1. Hypertensive subjects having blood pressure >140/90 mmHg. 2. Normotensive subjects having blood pressure ≤120/80mmHg.
Exclusion criteria Subjects with any systemic illness, subjects on drug medications (steroids, α methyl dopa) for past three months Subjects who fulfilled the inclusion and exclusion criteria were included in the study. After explaining the nature of the study, informed consent was obtained from the study subjects.
Methodology 1. Measuring Blood pressure: Blood pressure was measured by a mercury sphygmomanometerin supine position. Blood pressure was measured two times. The average of two readings was taken as correct systolic and diastolic blood pressure.13, 1 The classification of blood pressure is as follows4 Normal BP: 160/100 mmHg. 2. Hematological parameters: From the subjects 2 ml of blood were withdrawn to which anticoagulant solution was added and fed into the ABX Pentra DF120 Hematology analyser from Horiba Medicals Pvt Ltd. The RBC’s, WBC’s and PLT’s are measured by an electronic impedance variation principle. The hemoglobin(Hb) freed by the lysis of the red blood cells combines with potassium cyanide to form a cyanmethemoglobin compound.
Absorbance is then measured by spectrophotometry, at a wave length of 550 nm.MCV (Mean Corpuscular Volume) is calculated directly from the RBC histogram.MCH (Mean Corpuscular Hemoglobin) is calculated from the Hb value and the RBC count. MCHC (Mean Corpuscular Hemoglobin Concentration) is calculated according to the Hb and HCTvalues.The hematocrit is measured as a functionof the numeric integration of the MCV.14 3. Body weight: Body weight was measured while the subject minimally clothed and without shoes, standing steady on a weighing scale and it was recorded to the nearest 0.1kg.15 4. Height: Height was measured to the nearest 0.1 cm while the subject was standing barefoot in erect position with a wallmounted stadiometer.15 5. Body mass index:
BMI was measured by weight in kilograms divided by square of height in meters (kg/m2). (BMI in the range of 18.50 to 24.99 kg/m2 is considered to be normal.15 6. Waist circumference: Waist circumference was measured in centimeters over light clothing at a point mid-way between the lower rib and iliac crest.15 7. Hip circumference: Hip Circumference was measured in centimeters over light clothing at the widest girth of the hip. For waist and hip circumference two consecutive readings were made at each site on a horizontal plane without compression of the skin. The mean was taken as the final reading. 15 8. Waist Hip Ratio: It was calculated by dividing waist circumference by hip circumference.15
Statistical analysis The data collected were entered and analyzed using software Statistical Package for the Social Science 16.0 (SPSS 16.0). All parameters were presented as mean ± standard deviation (mean ± SD). Comparison of parameters between hypertensive subjects and normal healthy controls was done with student ‘t’ test. Correlation analysis was done with Pearson’s correlation method. A linear regression analysis was performed to evaluate the independent predictors of hypertension. A p value of less than 0.05 was considered statistically significant.
RESULTS Table 1 presents the demographic characteristics and the anthropometric indices of the study participants. A significant difference however existed between the cases and controls with respect to systolic blood pressure and diastolic blood pressure (pEnglishhttp://ijcrr.com/abstract.php?article_id=325http://ijcrr.com/article_html.php?did=3251. The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. JAMA2003; 289:2560-71.
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27. Karlsson C, Lindell K, Ottosson M, Sjostrom L, Carlsson B, Carlsson L. Human adipose tissue expresses angiotensinogen and enzymes required for its conversion to angiotensin II. J Clin Endocrinol Metab 1998;83(11):3925-9.
28. Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006;148(2):188-94.
29. Hall JE, Jones DW, Kuo JJ, da Silva A, Tallam LS, Liu J. Impact of the obesity epidemic on hypertension and renal disease. Curr Hypertens Rep 2003;5(5):386-92.
30. Silverberg DS, Wexler D, Iaina A, Steinbruch S, Wollman Y, Schwartz D. Anemia, chronicrenal disease and congestive heart failure-the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. Int Urol Nephrol 2006; 38(2):295- 310.
31. Beauloye V, Zech F, Tran HT, Clapuyt P, Maes M, Brichard SM. Determinants of early atherosclerosis in obese children and adolescents. J Clin Endocrinol Metab 2007; 92(8):3025-32.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareHISTOMORPHOLOGICAL SPECTRUM OF SKIN ADNEXAL TUMORS AT A TERTIARY CARE HOSPITAL - A RETROSPECTIVE STUDY
English1318Nirali AminEnglish Smita ShahEnglish Shreedhan PrajapatiEnglish Hansa GoswamiEnglishBackground: Skin adnexal tumors (SAT) are a large and diverse group of benign and malignant tumors which exhibit morphological differentiation towards one of the different types of adnexal epithelium present in normal skin: pilosebaeceous unit, eccrine and apocrine. The aim of this study was to recognize various histomorphology of skin adnexal tumors, their frequency, age and site distribution. Methods: It was a retrospective study of 50 cases of skin adnexal turmors, diagnosed on histopathological examination over a period of 3 years (January 2012 to December 2014) in the Department of Pathology, B.J. Medical college, Ahmedabad. Histopathological examination was done on Formalin fixed, Paraffin embedded tissue sections stained with Haematoxylin and Eosin. Special histochemical stains like PAS stain and Reticulin stain were also used, wherever required. Results: Skin adnexal tumors were most common in the age group of 31 to 40 years (38%, 19/50). Male to female ratio was 1:1.27. The head and neck region was the most common site affected (60%) with 32% cases located on the face. 98% cases were benign and only a single case (2%) was malignant. The sweat gland tumors formed the largest group involving 70% of cases followed by hair follicle tumors followed by sebaceous gland tumors. Nodular hidradenoma was the most common benign tumor. Sebaceous carcinoma was the only malignant adnexal tumor reported in our study. Conclusion: Skin adnexal tumors are relatively rare. Benign adnexal tumors are far more common than their malignant counterparts. There is slight Female preponderance. Face is the commonest site for occurrence of SATs. Nodular hidradenoma is the most frequently encountered tumor among all SATs. Histopathological examination is mandatory in their diagnosis as they have very wide spectrum and frequency of differentiation along different lines in the same lesion.
EnglishSkin adnexal tumor, Nodular hidradenoma, Sebaceous carcinoma, PAS stainINTRODUCTION Skin adnexal tumors (SAT) are a large and diverse group of benign and malignant neoplasms which exhibit morphological differentiation towards one of the three different types of adnexal epithelium present in normal skin: pilosebaeceous unit, eccrine and apocrine [1]. SAT may display more than one line of differentiation (hybrid/composite tumors), rendering precise classification of these neoplasms difficult [1]. These tumors are derived from multipotential undifferentiated cells present within the epidermis or its appendgeal structures.
Adnexal tumors arising from the skin are usually missed clinically as most of the SATs present as asymptomatic papules or nodules. Anatomic location, number and distribution of lesions provide important clue but histopathology is invaluable in confirmation of the diagnosis. Diagnosis of skin adnexal tumors is possible by performing an elliptical skin biopsy, submitting for haematoxylin and eosin (HandE) staining and histochemistry.
Most SAT are benign, but a malignant counterpart of every SAT has been described [1]. Malignant skin adnexal tumors are rare, locally aggressive and have the potential for nodal involvement and distant metastasis with a poor clinical outcome. Therefore establishing a diagnosis of malignancy in SAT is important for therapeutic and prognostic purposes [1]. The aim of the current study was to recognize various histomorphology of skin adnexal tumors, their frequency, age and site distribution.
MATERIALS AND METHODS The data for this retrospective study was obtained from Department of Pathology of a tertiary care hospital, from January 2012 to December 2014. The tumors were subjected to meticulous gross and microscopic examination. The histopathological examination was done on formalin fixed paraffin embedded tissues. Haematoxylin and Eosin stained sections were examined and few special stains like PAS and reticulin were performed wherever required. Age and gender prevalence, comparison of clinical diagnosis, site of involvement with biopsy diagnosis were done.
RESULTS During the study period, 50 adnexal tumors of skin were diagnosed on histopathological examination (Table 1). Benign adnexal tumors constituted 98% (49/50) cases and only one case of malignant adnexal tumor (2%) was noted. In the present study, skin adnexal tumors were observed in all age groups ranging from 3 to 80 years (Table 2). However, the highest incidence was observed in the age group of 31-40 years followed by age groups 11-20 years and 41-50 years. The Male: Female ratio was 1:1.27. The head and neck region was the most common site affected followed by lower limb and upper limb (Table 3). In head and neck region, face was the most common site followed by scalp.
The neck region was least affected site. The sweat gland tumors formed the largest group involving 70% of cases followed by the hair follicle tumors, followed by sebaceous gland tumors. Amongst the benign tumors, nodular hidradenoma was the most common tumor representing 16% of all cases. A single case of Sebaceous carcinoma was the only malignant adnexal tumor reported in our study.
Benign tumors were observed in age ranging from 3-80 years and a single case of sebaceous carcinoma was noted in a person at 42 years of age. Sweat gland tumors were all benign and included nodular hidradenoma, chondroid syringoma, eccrine spiradenoma, syringocystadenoma papilliferum, eccrine poroma, hidradenoma papilliferum, syringoma, cylindroma, tubular adenoma and ceruminous adenoma.
Among 3 sebaceous gland tumors, 2 were benign and the remaining one was malignant. Sebaceous naevus was the only benign lesion encountered in this study. Sebaceous carcinoma was seen in 1(2%) patient. All hair follicle tumors in this study were benign and included trichofolliculoma, trichoepithelioma, pilomatrixoma and proliferating trichelemmal tumor. Comparison of observations from the present study and other published studies is shown in Table 4.
DISCUSSION Adnexal tumors of the skin, though rare have been recognised from the later part of 19th century [4]. We also observed that adnexal tumors of skin appear to be relatively uncommon tumors. They are thought to have a genetic basis. Mendelian inheritance and P53 mutations are important contributing factors [3]. The histogenesis of these tumors are from either primary epithelial germ cells or pluripotential cells or cells of pre-existing structure [5]. Skin adnexal tumors have a wide range of age distribution. In our study, commonest age group was 31-40 years and Male: Female ratio was found to be 1:1.27; Head and neck region was the most common site of occurrence.
All these findings were consistent with the results with the study by Radhika et al [5]. Incidence of benign tumors was more as compared to malignant cases. This finding was consistent with other studies. Benign tumors showed smooth borders, absence of ulcers, presence of adnexae and absence of necrosis. The occurrence of benign tumors in our study was 98% and 2% (Only one case) was malignant. Nair et al observed that tumors of sweat gland differentiation were most common followed by hair follicle tumors and then sebaceous glands tumors [6].
The present study showed similar results with sweat gland tumors constituting the largest group (70%), followed by hair follicle tumors (24%) and sebaceous gland tumors (6%). Nodular hidradenoma (Figure 1) was the most frequently encountered benign sweat gland tumor in the present study. Similar observations were reported by Radhika et al [5]. Histopathologically most of these tumors are circumscribed and solid with few showing cystic change. Tumor is composed of varying sizes of tubules and papillary projections lined by inner cuboidal and outer myeoepithelial cell layer. Solid portions of the tumor show nodules comprised of clear and polygonal cells [2].
Chondroid syringomas usually present as well circumscribed lobulated masses centered in deep dermis or subcutaneous fat, with prominent chondroid or myxoid stroma, tubulo-alveolar structures lined by epithelial- myoepithelial cell bilayer, ducts lined by single layer of epithelium, nests of polygonal cells and sometimes keratinous cysts. (Figure 2) Syringomas are characterized histologically by interweaving nests, cords and small cysts that are located in the upper half of the dermis. They are enmeshed in a dense collagenous stroma without any epidermal contact.
The ducts of syringoma are composed of 1- 2 layers of cuboidal cells rarely showing clear cell change. Tadpole appearance is quite common in syringoma (Figure 3). Syringocystadenoma papilliferum (Figure 4) is a rare adnexal neoplasm. We observed 4 cases in our study. Microscopically there are papillary projections with squamous epithelial lining and ductal invaginations. These ductal structures are lined by inner columnar and outer cuboidal cells [2]. Cylindroma (Figure 5), Hidradenoma papilliferum (Figure 6) and Ceruminous adenoma were the least common sweat gland tumors in the present study accounting for single case of each. Cylindroma is a benign basaloid tumor that has a mosaic architecture.
They are solitary or multiple. Histologically these are circumscribed non encapsulated dermal nodules composed of islands and cords of basaloid cells surrounded by a thick hyalinized, Periodic acid-Schiff (PAS) positive basement membrane. Not a single case of malignant sweat gland tumor was observed in the present study. Sebaceous naevus was the common sebaceous gland tumor observed by us. However this tumor was not documented in other published studies [4]. Sebaceous nevus histologically consists of zones of epidermal hyperplasia with small foci of sebaceous glands, miniature hairs and minimal numbers of ducts or glands.
In the present study we reported only one case of malignant adnexal tumor- sebaceous carcinoma. Microscopically, sebaceous carcinoma revealed irregular epithelial lobules with an infiltrative growth pattern in the dermis. Lesional cells demonstrated marked cytologic atypia, mitotic activity and focal sebaceous differentiation (Figure 7). In pilomatrixoma, the histopathological hallmark is that of basaloid lobules which are contiguous with eosinophilic ghost cells or shadow cells (Figure 8).
Dystrophic calcifications are usually present. Trichoepithelioma histologically is a symmetric lesion that contains a mixture of epithelial elements ranging from hair germs associated with capillary mesenchymal bodies to small horn cysts, to lace like reticular basaloid structures to mature hairs. Tricofolliculoma and Proliferating trichelemmal tumor were observed as single case of each in our study. Malignant hair follicle tumors were not observed in this study.
CONCLUSION We conclude that skin adnexal tumors are relatively rare. Benign adnexal tumors are far more common than their ma lignant counterparts. Sweat gland tumors are most common among all skin adnexal tumors. There is slight Female preponderance. Head and neck are frequent sites for occurrence of these tumors, among which face is the commonest site. Nodular hidradenoma is the most frequently encountered tumor among all skin adnexal tumors. Skin adnexal tumors cannot be diagnosed on clinical grounds only and histopathological diagnosis plays a major role in diagnosing these tumors.
Englishhttp://ijcrr.com/abstract.php?article_id=326http://ijcrr.com/article_html.php?did=3261. K O Alsaad, N AObaidat, D Ghazarain, Skin adnexal neoplasms-part 1: An approach to tumors of pilosebaceous unit, J Clin Pathol 2007; 60: 129:44
2. W Klein, E Chan, J T Seykora, Tumors of epidermal appendages,DE Elder (Ed) Lever’s Histopathology of the Skin9thedn. Philadelphia, PA: Lippincott Williams and Wilkins, 2005, 867-926.
3. Perez MI, Robins P, Biria S, Roco J, Siegel E, Pellicer A. P53 oncoprotein expression and gene mutations in some keratoacanthomas. Arch Dermatol 1997;133:189-93.
4. M K Reddy, A J Veliath, S Nagarajan, A L Aurora, A clinicopathological study of adnexal tumors of skin, Indian J Med Res 75, 1982, 882-9
5. K Radhika, B V Phaneendra, N Rukmangadha, M K Reddy A biopsy confirmed skin adnexal tumors: experience at a tertiary care teaching hospital, Journal of Scientific Research, 2, 2013, 132-138
6. P S Nair, A clinico-histopathological study of skin appendageal tumors, Indian Journal of Dermatology,Venerology and Leprology, 74 (550), 2008
7. Kartha CC, Shankar SK, Bhuyan UN. Benign mixed tumor of skin–a histopathologic study of 7 cases. Indian J Pathol Microbiol 1980;23:1-6
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareSPECTRUM OF LESIONS IN URINARY BLADDER -A HISTOPATHOLOGICAL STUDY
English1924Pooja Y. ShahEnglish Monika NanavatiEnglish Ravi G. PatelEnglish Hansa M. GoswamiEnglishBackground: Diseases of the bladder, particularly inflammation (cystitis), constitute an important source of clinical signs and symptoms. Tumors of the bladder are an important source of both morbidity and mortality. Objectives: 1) To study the histopathological features of various lesions in bladder. 2) To study the frequency of different pathological lesions, particularly Papillary Urothelial Neoplasms in urinary bladder. Results: 35 cases of urinary bladder were received. Out of 35 patients, 27 were males and 8 were females with male to female ratio being 3.38:1.The spectrum of pathological lesions included inflammations, metaplastic lesions, cystic lesions and tumors. Out of 35 cases 12(34.28%) were Non neoplastic lesions and 23(65.71%) were Neoplastic lesions. Among the non neoplastic lesions cystitis (41.67%) was the most common finding. Others were non-specific inflammation due to various etiology, hydatid cyst, benign epithelial inclusion cyst and abscess. Most common age groups affected by the neoplastic lesions were 41-50 years and 61-70 years with male to female ratio being 2.29:1. Among the neoplastic lesions 19(82.60%) cases were of urothelial neoplasms, others being Squamous Cell Carcinoma, Poorly Differentiated Carcinoma with Neuroendocrine differentiation and Paraganglioma. Most common Urothelial neoplasm was Non invasive Papillary Urothelial Carcinoma, Low Grade (9 cases). Among all the bladder biopsies received there was no muscle layer in 3 cases (8.3%). Conclusions: Our study has revealed that the bladder tumors are the commonest lesions in the urinary bladder tissues received and Papillary Urothelial Neoplasms were the predominant tumor type.
EnglishBladder, Papillary urothelial neoplasms, Paraganglioma.INTRODUCTION Diseases of the bladder, particularly inflammation (cystitis), constitute an important source of clinical signs and symptoms. Usually, however, these disorders are more disabling than lethal. Neoplasms of bladder pose biologic and clinical challenges [1]. Tumors of the bladder are an important source of both morbidity and mortality. It is the second most common malignancy seen by the urologist[2]. Various risk factors include cigarette smoking, industrial exposure to acrylamine, schistosoma hematobium, cyclophosphamide, artificial sweeteners and long-acting use of analgesics. How these influence to induce cancer is unclear, but a number of cytogenetic and molecular alterations are heterogeneous [3].
In general, the prevalence of bladder tumours in developed countries is approximately 6 times higher compared with that in developing countries. The most common type of bladder cancer in developed countries is urothelial carcinoma, derived from the uroepithelium, which constitutes more than 90% of bladder cancer cases in USA, France or Italy. However, in other regions (e.g. Eastern and Northern Europe, Africa, Asia) the relative frequency of urothelial carcinoma of the bladder is lower [4]. The relative frequency of histological subtype of bladder carcinoma depends on the clinical setting. About 90% of bladder carcinoma reported from the West is transitional cell type. In large series reported from Egypt, squamous cell carcinoma (SCC) accounted for 59– 73% of bilharzial bladder cases which are endemic areas for Schistosoma Haematobium[3].
Objectives:
1) To study the histopathological features of various lesions in bladder.
2) To study the frequency of different pathological lesions, particularly Papillary Urothelial Neoplasms in urinary bladder.
MATERIAL AND METHODS Source and Method of collection of data: This was a four years (January 2012 to October 2015) retrospective study conducted in histopathology section of Department of Pathology, B.J Medical College, Civil Hospital Ahmedabad, Gujarat from January 2012 to October 2015. All specimens of urinary bladder were included in the study. Patient’s age, sex and other details were retrieved from the request forms manually. The data was analyzed with emphasis on age, sex and histology. The surgical specimens were fixed in 10% formalin. Surgical specimens were examined grossly concerning the size and shape of material and were processed routinely. Light microscopic technique was used for diagnosis. Special stains and immunohistochemistry were applied, where ever required.
RESULTS Out of 35 cases, 12 (34.28%) were non neoplastic lesions and 23 (65.71%) were neoplastic lesions (Table 1). Among the non neoplastic lesions most common lesion was cystitis (41.67%), with 2 cases of cystitis glandularis (metaplasia), 1 of cystitis cystica, 1 of polypoid cystitis and 1 of eosinophilic cystitis. Cases of non specific inflammation constituted 4 cases (33.33 %) of non neoplastic lesions. Among them 2 were associated with trauma,1 with fistula and 1 with diverticulum. Among the other non neoplastic lesions there were Benign Epithelial Inclusion Cyst, Abscess and Hydatid Cyst, 1case (8.33%) of each.
Table 2 shows histopathological spectrum of non neoplastic lesions of urinary bladder. Among the neoplastic lesions most common was Papillary Urothelial Neoplasm 19 cases(82.60%) with 2 cases of Squamous Cell Carcinoma(8.69%),1 case of Poorly differentiated Carcinoma of Neuroendocrine Differentiation (4.35%) and 1 case of Paraganglioma(4.35%)[Table 3]. Among the urothelial neoplasms, most common were Papillary Urothelial Carcinoma, Low Grade with 9 cases(47.36%) [Table 4]. Most common age groups affected by the neoplastic lesions were 41-50 years and 61-70 years with male to female ratio being 2.29:1[Table 5]
DISCUSSION Cystoscopy is the primary diagnostic tool in the diagnosis of urinary bladder carcinoma. The histopathological study of the cystoscopic biopsy not only gives the diagnosis but also provides the additional information to the urologist that can have impact on the treatment. Out of 35 patients, 27 (77.14%) were males and 8(22.86%) were females with male to female ratio being 3.3:1.Among the neoplastic lesions out of 23 cases, 16(59.26%) were male and 7(40.74%) were females with male to female ratio being 2.28:1.Similar finding were seen in several studies of cystoscopic biopsy.[5-8] Bladder carcinoma is more common in elderly males. The most common age groups of presentation of neoplastic lesion of the bladder were 41-50 years and 61-70 years, followed by 51-60 years. This is similar to that reported in the existing literature [6,9,10]. Out of 35 cases 12(34.28%) were non neoplastic lesions most common being cystitis. Out of 5 cases of cystitis 2 cases were of Cystitis glandularis and 1 each of cystitis cystica, polypoid cystitis and eosinophilic cystitis.
Out of 4 cases of non specific inflammation 2 were associated with trauma, one with diverticula and another with fistula formation. One case was of Hydatid Cyst in the bladder which was also associated with hydatid cyst of liver and kidney. One case of epithelial inclusion cyst was there in our study.One case of abscess in the muscular wall was also there in our study. Out of 35 cases 23(65.71%) were neoplastic lesions. Among the neoplastic lesions urothelial neoplasms were most common consisting of 19(82.60%) cases. There was no detrusor muscle in 3(15.79%) cases of urothelial neoplasm to assess the muscle invasion. Laishram et al [6] could also assess only 83% cases for invasion and out of that 42.1% cases showed muscle invasion [6].Muscle invasion was seen in 26.31% cases of urothelial neoplasm in study done in Nepal [11].The same study showed 26.7% cases of invasive urothelial carcinoma. Other studies showed 35.8%, 27.2% and 26% of muscle invasion in urothelial carcinoma respectively [7,12,13]. Comparable to these, in our study 26.31% of Urothelial Neoplasms showed muscle invasion. About 70 % of all carcinomas of the urinary bladder are either non- invasive (pTa) or only minimally invasive (pT1) at the time of presentation[14].
Correct histologic grading and tumor staging is crucial for proper and optimal patient management. The corner stone of bladder cancer diagnosis, treatment and staging is a high quality transurethral resection of the bladder tumor (TURBT) [15]. In our study most common urothelial neoplasm were Papillary Urothelial carcinoma,Low Grade consisting 9 cases out of 19 cases with 3 showing lamina propria invasion and in two cases biopsy were inadequate. There were 7 cases of Papillary Urothelial carcinoma, High Grade with 5 cases showing muscularis propria invasion, one showing lamina propria invasion and in one case biopsy was inadequate. In most analysis, less than 10% of low grade cancers invade, but as many as 80% of high grade TCC are invasive [17]. In our study 3 cases were of Papillary urothelial neoplasm of low malignant potential.
As compared to Matalka et al observations, their study showed 40% cases of high grade TCC and 60% of low grade TCC. In our study 47.36% of urothelial neoplasms were Low Grade(Micrograph 2),36.84% were High Grade(Micrograph 3) and 15.79% were with Low Malignant Potential(Micrograph 1). In our study there were only 2 cases of Squamous Cell Carcinoma. In contrast to the studies done in South East Asian countries and Western countries,
Nigeria has squamous cell carcinoma as the most common type of urinary bladder carcinoma. This is because of high frequency of association of squamous cell carcinoma with schstosomiasis [17]. However this pattern has been changing in Egypt in the last few years. There is decline in squamous cell carcinoma and increase in urothelial carcinoma [18]. In India there is only a focus of population infected by Schistosomia haematobium as compared to other countries[19]which explains lower incidence of Squamous cell carcinoma of bladder. Our study showed one case of Poorly Differentiated Carcinoma with Neuroendocrine Differentiation which was confirmed by IHC. Tumor was positive for NSE and negative for Chromogranin.
CONCLUSIONS Our study has revealed that the bladder tumours are the commonest lesions seen in the received specimens of bladder tissue and Papillary Urothelial Neoplasm was the predominant tumour type. Besides, other investigations, cystoscopic bladder biopsies help in the early diagnosis and treatment of various bladder lesions. This study documents a high frequency of urothelial tumor, mostly non invasive papillary urothelial neoplasm, low grade with a male preponderance in the age group above 40 years. Invasion to the muscle layer correlates with high grade tumor. Hence, inclusion of detrusor muscle in the cystoscopic biopsy is very important.
Englishhttp://ijcrr.com/abstract.php?article_id=327http://ijcrr.com/article_html.php?did=3271. Vinay Kumar, Abbas AK, and Fausto N. The lower urinary tract and male genital system. Robbins and Cotran. Pathologic basis of disease. 9th Edition. Philadelphia:Saunders 2004; 1026-1036.
2. Matalka et al. Transitional cell carcinoma of the urinary bladder: a clinicopathological study. Singapore Med J 2008; 49(10): 791.
3. Hasan SM et al. Frequency of transitional cell carcinoma in local suburban population ofkarachi. JLUMHS 2007; 83-85.
4. Beltran AL et al. Infiltrating urothelial carcinoma. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. IARC Press: Lyon 2004; 93-109.
5. Al- Samawi AS, Aulaqi SM. Urinary bladder cancer in Yemen. Oman Med J 2013; 28: 337-40.
6. Laishram RS, Kipgen P, Laishram S, Khuraijam S, SharmaDC. Urothelial tumors of the urinary bladder in Manipur: ahistopathological perspective. Asia Pacifi c Journal of CancerPrevention. 2012; 13: 2477-9.
7. Viadya S, Lakhey M, KC S, Hirachand S. Urothelial tumors ofthe urinary bladder: a histopathological study of cystoscopicbiopsies. J Nepal Med Assoc 2013; 52: 475-8.
8. Kumar UM, Yelikar BR. Spectrum of lesions in cystoscopicbladder biopsies- a histopathological study. Al Ameen J MedSci 2012; 5: 132- 6.
9. Stepan A, Simionescu C, Margaritescu C, Ciurea R. Histopathological study of the urothelial bladder carcinomas.Current health Science Journal 2013; 39:147-150.
10. Islam AHMT, Mostafa SN, Rahman M, Nahar Z. Role of ultrasound in the evaluation of urinary bladder neoplasm with histopathological correlation. Journal of Teachers Association TAJ 2008; 21:155-9.
11. Nepal Med Coll J 2014; 16(1): 9-12 Cystoscopic bladder biopsies: A histopathological studyPudasaini S,1 Subedi N,2 Prasad KBR,1 Rauniyar SK,1 Joshi BR,2 Bhomi K K 2
12. Biswas RR, Mangal S, Guha D, Basu K, Karmakar D. Anepidemiological study of cases of urothelial carcinoma ofurinary bladder in a tertiary care centre. Journal of KrishnaInstitute of Medical Sciences 2013; 2: 82-8.
13. Gupta P, Jain M, Kapoor R, Muruganandham K,Srivastava A, Mandhani A.Impact of age and gender on the clinicopathological characteristics of bladder cancer. Indian J Urol 2009; 25: 207-10.
14. I. Tosoni .U. Wagner, G Sauter. MEG Coff et al. Clinical Significance of Inter Observer Differences in the Staging and Grading of Superficial Bladder Cancer. BJU International 2000;85:48- 53.
15. Peter J Bostrom, Bas W.G. Van Rhijn, Neil Fleshner et al. Staging and Staging Errors in Bladder Cancer. European Urology Supplements 2010;9:2-9.
16. Mahesh Kumar U and B.R. Yelikar, Spectrum of Lesions in Cystoscopic Bladder Biopsies: A Histopathological study. Al Ameen J Medical Sci 2012;5 (2):132-136.
17. Felix AS, Soliman AS, Khaled H et al. The changing patterns of bladder cancer in Egypt over the past 26 years. Cancer Causes and Control 2008;19: 421-9.
18. Eble JN, Sauter G, Epstein JI, Sesterhenn IA, editors. World Health Organization of tumors- tumors of the urinary system and male genital organs. IARC Press, Lyon, 2004.
19. The global status of schistosomiasis and its control , L. Chitsulo, D. Engels, A. Montresor, L. Savioli, Acta Tropica 77 (2000) 41–51.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareREVIEW OF MESENCHYMAL HAMARTOMA OF CHEST WALL IN INFANCY- AN UNUSUAL TUMOUR
English2528Ravi G. PatelEnglish Sanjay V. DhotreEnglish Hansa M. GoswamiEnglish Hitendra P. BarotEnglish Manan P. JadavEnglishMesenchymal hamartoma of the chest wall (MHCW) occurs as intraosseous expansile mass involving the ribs typically present at birth or in early infancy[1]. The incidence is about 0.03% among primary bone tumors with male predominance, and appropriately 100 cases have been reported. We present a case of 3-month-old female baby with slowly growing left sided chest wall swelling since birth. Computerized tomography (CT) revealed a Approx. 58x55x64mm3 sized expansile heterogeneous soft tissue density lesion (calcific, fluid and soft tissue) arising from posterior aspect of left fourth and fifth ribs with large intrathoracic component resulting in compression of left parenchyma. The lesion causes mass effect in form of widening of 4th and 5th intercostal spaces and shift of mediastinum towards left side. Rest of both lung fields appear normal. Thoracotomy with en bloc excision of the tumor was performed and tissue was sent for histopathological examination. Microscopy revealed structure of well circumscribed lesion chiefly consisting of fascicles of spindled shaped fibroblast admixed with cartilaginous and bony tissue with evidence of endochondral ossification. A final diagnosis of mesenchymal hamartoma of the chest wall was made. Oncologist deferred the chemotherapy The 80% of cases occur prenatally or within first 6 months of life and are usually solitary, but bilaterality or multicentricity also rarely occur[3,4]. Mesenchymal hamartoma is not a true neoplasm, but rather they are hamartomas with focal overgrowth of normal skeletal elements with no propensity for invasion or metastasis. Malignant transformation in MHCW is very rare[6]. The definitive diagnosis is established only by histopathological examination[5]. We hereby conclude that these tumors are very rare and they look aggressive both radiologically and microscopically, so it is essential to be aware of this condition, so that unnecessary over diagnosis and aggressive treatment with chemotherapy and radiotherapy can be avoided considering the fast recovery of the patient when managed with surgery alone.
EnglishMesenchymal hamartoma, Cartilagenous hamartomaINTRODUCTION
Mesenchymal hamartoma of the chest wall (MHCW) occurs as intraosseous expansile mass involving the ribs typically present at birth or in early infancy[1]. The incidence is about 0.03% among primary bone tumors with male predominance, and appropriately 100 cases have been reported. The distinction between this benign tumor and malignant tumors like well differentiated chondrosarcoma is seldom clear cut[1]. The aggressive clinical presentation, radiological features, and histological features like actively proliferating fibroblastic and chondroid elements can be mistaken for malignant process [1].
MATERIAL AND METHODS We present a case of 3-month-old female baby with slowly growing left sided chest wall swelling since birth. The patient was treated with thoracotomy and en bloc excision. A 3-month-old female baby presented with history of gradually progressive left sided chest wall swelling since birth with recent onset of breathlessness. Obstetric and developmental history was uneventful. On examination, baby had a firm, nontender, nonmobile, nonfluctuant swelling measuring 4x5 cm2 on the left chest wall. All hematological and biochemical parameters were within normal limits. Computerized tomography (CT) revealed a Approx. 58x55x64mm3 sized expansile heterogeneous soft tissue density lesion (calcific, fluid and soft tissue) arising from posterior aspect of left fourth and fifth ribs with large intrathoracic component resulting in compression of left parenchyma.
The lesion causes mass effect in form of widening of 4th and 5th intercostal spaces and shift of mediastinum towards left side. Rest of both lung fields appear normal. Thoracotomy with en bloc excision of the tumor was performed and tissue was sent for histopathological examination. On Gross examination, encapsulated greyish brown nodular hard tissue structure attached to ribs (3 ribs) noted measuring 7x6x5 cm3 with cut surface showing partly solid partly cystic, whitish areas (cartilage) with hemorrhagic areas. Microscopy revealed structure of well circumscribed lesion chiefly consisting of fascicles of spindled shaped fibroblast admixed with cartilaginous and bony tissue with evidence of endochondral ossification. A final diagnosis of mesenchymal hamartoma of the chest wall was made. Oncologist deferred the chemotherapy treatment. Diaphragm and pericardium were free from tumour.
DISCUSSION MHCW is a very rare benign tumor of bone which was first described by Nash and Stout in 1961[2]. McLeod and Dahlin coined the term hamartoma of the chest wall; however, many authors coined in different names like mesenchymal, vascular, cartilaginous, and chondromatous hamartoma, whereas the preferred term is mesenchymal hamartoma of the chest wall[2,3]. Almost 80% of cases usually occur in prenatal age or within first 6 months of life. Lesions are usually solitary, but bilaterality or multicentricity also occur in rare cases[3,4,7]. Typically, the lesion appears as a hard, immobile, subcutaneous, and extrapleural chest wall mass with deformed ribs. Respiratory distress and ventilator dependence may occur even in term or near-term newborns[2]. Mesenchymal hamartoma is not a true neoplasm, but rather they are hamartomas with focal overgrowth of normal skeletal elements with no propensity for invasion or metastasis[7]. Malignant transformation in MHCW is very rare[6].
Plain X-ray shows expansile mass with well-defined sclerotic margins with secondary aneurysmal bone cysts and popcorn-like speckled calcifications[2,3,5]. CT scan is a better modality which helps to determine the site of origin, tumor density, enlargement, and effect on adjacent structures[5]. Prenatal diagnosis is possible by ultrasonography, but most are diagnosed postnatally. Radiologically, MHCW can be confused with malignant tumors like congenital neuroblastoma, Ewing’s sarcoma, and malignant teratoma[5]. The definitive diagnosis is established only by histopathological examination[5]. Grossly, they are well circumscribed comprising both cystic and solid areas. Microscopically they have immature spindle shaped mesenchymal cells, osteoclastic giant cells, fragments of hyaline cartilage, areas of woven bone formation, areas of endochondral ossification and aneurysmal bone cyst-like changes[2].
Immunohistochemically, chondrocytes stain for S-100 protein and factor VIII highlighting the blood vessels. The differential diagnosis includes well-differentiated chondrosarcoma, aneurysmal bone cyst (ABC), chondroma, osteosarcoma, langerhans cell histiocytosis (LCH), and osteochondromas[2,3]. Chondrosarcomas occur at the periphery of the ribs and grow rapidly with presence of atypical mitosis, hence differentiated from MHCW. In the series of Ayala et al.,[5] one case of MHCW was misdiagnosed as chondrosarcoma[3]. Presence of cartilaginous tissue with mesenchymal cells ruled out the possibility of primary ABC. Tumors with such huge size, cystic change, and hypercellularity with presence of mesenchymal cells are usually not seen in chondromas.
Osteosarcoma, LCH, and osteochondromas can be ruled out by the absence of pleomorphic spindle cells with malignant osteoid, atypical histiocytes with longitudinal grooves in the background of eosinophils and osteocartilagenous cap with marrow tissue, respectively. Symptomatic patients have compromised cardiorespiratory function and it can cause deformity as well. They are best treated by complete resection and prognosis is very good[3].
However, MHCW stops growing within the first year of life and some patients may have an excellent outcome with conservative treatment alone[2,3]. Spontaneous regression has been observed in children even with bilateral involvement supporting the concept that conservative management is appropriate for asymptomatic children. Chemotherapy as well as radiation is not indicated in the treatment of MHCW. The most important postsurgical complication is scoliosis seen in 20% of patients[2].
CONCLUSION We hereby conclude that these tumors are very rare and they look aggressive both radiologically and microscopically, so it is essential to be aware of this condition, so that unnecessary over diagnosis and aggressive treatment with chemotherapy and radiotherapy can be avoided considering the fast recovery of the patient when managed with surgery alone. Abbreviations MHCW- Mesenchymal hamartoma of chest wall, ABC- aneurysmal bone cyst, LCH- Langerhans cell histiocytosis.
Englishhttp://ijcrr.com/abstract.php?article_id=328http://ijcrr.com/article_html.php?did=3281. Conlan AA, Hurwitz SS, Gritzman MC. Giant chondromatous hamartoma of the first rib. A case report. S Afr Med J 1982; 62:703-4.
2. Haase R, Merkel N, Milzsch M, Lieser U, Sauer H, Hinz L, et al. Mesenchymal chest wall hamartoma-surgery is preferred. Arch Perinat Med 2007; 13:56-61.
3. Amstalden EM, Carvalho RB, Pacheco EM, Oliveira-Filho A, Stragea- Neto L, Rosenberg AE. Chondromatous hamartoma of the chest wall: Description of 3 new cases and literature review. Int J SurgPathol 2006;14:119-26.
4. Ozolek JA, Carrau R, Barnes EL, Hunt JL. Nasal chondromesenchymal hamartoma in older children and adults: Series and immunohistochemical analysis. Arch Pathol Lab Med 2005; 129:1444-50.
5. Kabra NS, Bowen JR, Christie J, Glasson M. Mesenchymal hamartoma of chest wall in a new born. Indian Pediatr2000; 37:1010-3.
6. Okutan O, Ilvan A, Kartaloglu Z, Tunc H. Giant hamartoma originating from the chest wall in an adult. Saudi Med J 2006; 27:1054-6.
7. Mesenchymal hamartoma of the chest wall- mimicker of malignancy. Yeshvanth SK, Shivamurthy V, Patil C, Rai S, Lakshminarayana KP, Makannavar JH. J Cancer Res Ther. 2011 OctDec;7(4):496-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareHISTOPATHOLOGICAL PATTERN AND RELATIVE FREQUENCY OF OVARIAN MASSES IN TERTIARY CARE HOSPITAL
English2933Shreedhan G. PrajapatiEnglish Smita A. ShahEnglish Nirali S. AminEnglish Hansa M. GoswamiEnglishIntroduction: Ovarian tumours are one of the major causes of gynaecological problems in females and present marked variation in their histological types. Relative frequency of these lesions is different for Western and Asian countries. This study was designed to find out frequency of various histological patterns of ovarian tumours in patients attending Pathology Department of Tertiary care Hospital.
Material and Methods: A retrospective case – series study was conducted on 186 cases of ovarian masses, reported from august 2013 to July 2014.
Results: Mean age of the subjects was 35.6 years, ranging from 4 to 80 years. In a total of 186 cases of ovarian masses, 104(55.91%) were non-neoplastic and 82 (44.09%) were neoplastic. Among neoplastic lesions, 80.48% (66/82) were benign and 19.52% (16/82) were malignant. The commonest non-neoplastic lesion was Luteal cyst (43/104) followed by simple serous cyst (25/104). The commonest benign tumor was serous cystadenoma(40/66) followed by dermoid cyst(12/66). The commonest malignant tumour was serous cystadenocarcinoma (5/16) followed by mucinous cystadenocarcinomama (3/16).
Conclusion: Non-Neoplastic lesions were more common than neoplastic lesions, while benign tumours outnumbered the malignant ones. The commonest benign tumour was serous cystadenoma and malignant was serous cystadenocarcinoma. The commonest non-neoplastic lesion was Luteal cyst. Among histological types of ovarian tumours, surface epithelial tumours dominated the other types.
EnglishOvarian tumours, Luteal cyst, Serous cyst, Dermoid cyst, CystadenocarcinomaINTRODUCTION The incidence of cancer is increasing in developing countries.1,2 There are marked differences in distribution of different cancers in different regions of the world.2,3 Ovarian cancer is the most frequent cause of death from gynaecological cancers and the fourth most frequent cause of death from cancer in women in Europe, United States4 and Eastern India.5 Exact incidence in India is not known, but ovarian cancer is the 4th most common cancer among females of India and continues to present at an advanced age.6 The lifetime risk of ovarian cancer in women with no family history is 1.6%; with one affected first degree relative is 5%,7 and 7% with two or more affected first degree relatives.8 Ovarian tumours are insidious in onset and usually diagnosed at a late stage. They are rare in young age group.9 They commonly present with abdominal pain, a lump or menstrual irregularities.10 In addition to biopsy, various diagnostic modalities include transvaginal ultrasonography, MRI, positron emission tomography,11 and markers like serum CA 125.8 Diverse histopathologies are common in ovarian lesions. Relative frequency of different ovarian tumours is different for western world and Asian countries.
For example surface epithelial tumors account for 50.0 – 55.0% of all ovarian tumors and their malignant counterpart for approximately 90.0% of all ovarian cancers in Western world whereas this figure is 46.0 – 50.0% and 70.0 – 75.0% respectively in Japan. Similarly mucinous tumors account for 12.0 – 15.0% of all ovarian tumors in Western world. This figure is 20.0 – 23.0% for Japan. Germ cell tumors account for 30.0% of primary ovarian tumors and malignant germ cell tumors account for 3.0% of all ovarian cancers in Western world.12 Determination of these patterns is important for diagnosis, management and prognosis. This study was conducted to find out the histopathological patterns of ovarian lesions in patients attending a civil hospital, Ahmedabad.
MATERIALS AND METHODS A retrospective case – series study was carried out on 186 patients who had undergone surgical oophorectomy. Samples were analysed in the Pathology department of B.J.M.C., Civil Hospital, Ahmedabad. All Histopathological diagnosed cases of ovarian lesions referred to this department during August 2013 to July 2014 were included in this study. These were mostly referred from gynaecology and obstetrics department of our civil Hospital, Ahmedabad, but a few were referred from other hospitals in the vicinity. The data was retrieved from the record files of pathology department. Patients with abdominal– pelvic masses other than of ovarian tumours diagnosed on histopathology were excluded from the study. The histological characterisation of ovarian tumour was done according to the International Classification of Diseases, 9th ed. (ICD9) (WHO Classification, 1995).13 The acquired data was analysed using the descriptive statistics.
RESULTS During the study period from august 2013 to July 2014, one hundred and eighty six consecutive cases of ovarian lesions were selected. Ages of the patients and their histopathology diagnoses were recorded. Patients were divided into eight age groups, with a difference of 10 years in each group. The commonest age group affected was from 21 to 30 years followed by age group from 31 to 40 years. The youngest patient was 4 years old and the oldest was 80 years old. Mean age was 35.6 years (Table 1). In a total of 186 ovarian lesions, 104 (55.91%) were non-neoplastic and 82 (44.09%) were neoplastic. The neoplastic lesions comprised 66/82 (80.48%) benign and 16/82 (19.52%) malignant tumours (Fig. 1).
In non-neoplastic lesions, Luteal cyst was the predominant category (43/104) followed by simple serous cyst (25/104) (Table 2). The neoplastic tumours were divided in four groups, namely, epithelial tumours, germ cell tumours, sex cord stromal tumours and metastatic tumours. Epithelial tumours were maximum in number(62/ 82; 75.60%), followed by Germ cell tumours (14/82; 17.07%) (Table 3). Frequency pattern of different classes and subtypes of benign and malignant ovarian neoplasms (n = 82) is show in table 4. The commonest histological class is surface epithelial tumours (62/82; 75.60%) followed by germ cell tumours (14/82; 17.07%). Among all the benign lesions (n = 82), serous cyst adenoma is the commonest (40/82), while dermoid cyst is at the second number (14/82).
Frequency pattern of different classes and subtypes of benign and malignant ovarian neoplasms (n = 82) is show in table 4. The commonest histological class is surface epithelial tumours (62/82; 75.60%) followed by germ cell tumours (14/82; 17.07%). Among all the benign lesions (n = 82), serous cyst adenoma is the commonest (40/82), while dermoid cyst is at the second number (14/82). On the other hand, among all the malignant lesions (n = 16), serous cyst adenocarcinoma is at the top (05/45), followed with a little difference by mucinous cyst adenocarcinoma (03/45) and endometrioid carcinoma (01/45) respectively.
DISCUSSION Age range of our subjects was from 4 to 80 years and mean age was 35.6 years. Mean age observed in our study is lower than that observed in few other studies carried out in india. Our study shows the maximum incidence of ovarian masses between 21 and 40 years of age. This differs from the western data where it is between 50 and 70 years16 but correlates with other studies conducted in India. In our study non-neoplastic lesions were 55.91% (104/186) and neoplastic lesions were 44.09% (82/186). Neoplastic lesions contained (66/82) benign and (16/82) malignant. Tanwani19 documented 31.4% non-neoplastic lesions, 46.4% benign tumours and 22.2% malignant tumours. Among non-neoplastic lesion, Luteal cyst was most common (43/104) followed by simple serous cysts (25/104) in our study.
The pattern of distribution of non-neoplastic lesions is quite variable in other studies. Among the 82 neoplastic lesions in our study, 80.48%were benign and 19.82% were malignant. The higher incidence of benign tumours is also documented in various other studies,19,21,22 where it is 85%, 78%, 89.7% and 72.73% respectively and ratio of benign to malignant tumours is lower in these studies as compared to our study. No borderline tumor was found in our study. Among the major histological classes, the commonest type of ovarian neoplasm seen in our study was surface epithelial tumours, whether benign or malignant (62/82; 75.60%). Our finding is closer to the observations made in several other studies i.e. 64%, 66% and 70%7,24,25 respectively. However, Guppey et al26 documented a higher incidence of epithelial tumours than in our study i.e. 90%.
Germ cell tumours (GCT) in our study were 17.07%. This value is quite high as compared to Western data (370)4 and data collected from other parts of india (1470)16 and (27.13%).7 This difference may be due to variations in sample size but genetic, socioeconomical and environmental factors may also be involved. The frequency of sex – cord – stromal tumours (SCST) in our study was 4.87%. This value is comparable with that of studies carried out in the west (5%)27 and other parts of india (370).16 Our study showed that serous tumours (whether benign or malignant) were more common than mucinous tumours (40/67 vs 16/67 cases). This finding correlates with other studies.28,29 The studies carried out by Khanum and Rehman22 and Aziz et al17 also observed serous cyst-adenomas to be the commonest tumours.
The frequency of malignant tumours in our study was highest for serous cyst adenocarcinoma (5/16) followed by mucinous cyst adenocarcinoma (03/ 16). Similar pattern of distribution of malignant tumors are shown by many other studies.7,20 However, Study conducted by Yasmeen et al shows endometrioid carcinoma to be more prevalent.21 Germ cell tumours (GCTs) comprise the second largest group in our study in which benign tumours dominated the malignant ones (12/14 vs. 02/14 ). Among the benign GCTs our study showed the highest incidence of mature teratomas followed by dermoid cysts (08/14and 04/14 respectively). A study of Thanikasalanm et al 30 conducted in India shows teratomas to be the predominant GCT, whereas study conducted by Ahmad et al 7 in Pakistan documents dermoid cysts to be the commonest GCT.
Sex cord stromal tumours (SCSTs) were the least common in our study, next to metastatic tumours (4/82; 4.87%). The incidence of these tumours is variable in other studies. Zohra18 found only 1% SCSTs while Tanwani19 documents 10.1% cases of SCST. Granulosa cell tumours were the commonest SCSTs in our study (2/4) while studies carried out by Yasmeen et al21 and Ahmad et al31 mentioned a variable incidence of 28.5% and 5.62% respectively. In conclusion according to this study ovarian tumours are common in age group of 21 to 40 years. Neoplastic lesions are more common than non-neoplastic lesions. Luteal cyst is the commonest nonneoplastic lesion.
Among the histological classes of neoplastic lesions, surface epithelial tumours are predominant type, followed by germ cell tumors. The commonest benign tumour is serous cystadenoma and commonest malignant tumour is serous cystadenocarcinoma. This study is institutional – based, therefore the results obtained may or may not reflect the actual histological pattern of ovarian tumours in indian women. Therefore, multicentric study with larger sample size should be carried out.
CONCLUSION Non-Neoplastic lesions were more common than neoplastic lesions, while benign tumours outnumbered the malignant ones. The commonest benign tumour was serous cystadenoma and malignant was serous cystadenocarcinoma. The commonest non-neoplastic lesion was Luteal cyst. Among histological types of ovarian tumours, surface epithelial tumours dominated the other types.
ACKNOWLEDGEMENTS Acknowledgements are due for my colleagues and the paramedical staff of the department of pathology, B.J.M.C., Civil Hospital, Ahmedabad for their cooperation and continuous moral support. Thanks are also due for the staff of Gynec and Obstetric department of our hospital and all others who sent the biopsy specimens of ovarian masses to our department.
Englishhttp://ijcrr.com/abstract.php?article_id=329http://ijcrr.com/article_html.php?did=3291. Parkin DM, Muir CS, Whelan SL et al. eds. Cancer incidence in five countries. Lyon: IARC, 1997; 8: 1028-9.
2. Pisani P. Burden of cancer in developing countries. IARC Scientific Pub 1994; 129: 31-9.
3. Parkin DM, Pisani P, Farlay J. Estimates of worldwide incidence of 18 major cancers in 1985. Int J Cancer 1993; 54: 594-6.
4. Jacob IJ, Menon U. Progress and challenges in screening for early detection of ovarian cancer. Mol Cell Proteomics, 2004; 3: 355-66.
5. Sen U, Sankaranarayanan R, Mandal S, Romana AV, Parkin DM, Siddique M. Cancer pattern in eastern India: the first report of Kolkata cancer registry. Int J Cancer 2002; 100: 86-91.
6. Parveen S, Ilyas N, Asghar S. Patterns of care for ovarian cancer: patients at institute of Nuclear Medicine and Oncology (INMOL) india.
7. Ahmad Z, Kayani N, Hasan SH, Muzaffar S, Gill MS. Histopathological pattern of ovarian neoplasm. J Pak Med Assoc, 2000; 50: 416-9.
8. Kauff ND, Satagogan JM, Robson ME, Offit K. Risk reducing salpingo-oophorectomy in women with a BRCA1 or BRCA 2 mutation. N Engl J Med, 2002; 346: 1609-15.
9. Saadia Tariq, Rubina Sohail. Study of ovarian tumors in young girls. Professional Med J. 2011; 18 (1): 41-5.
10. Shahin R, Ghulam S, Abid A. A clinic – pathological study of ovarian cancer. Mother and Child 1998; 36: 117-25.
11. Rieber A, Nussle K. Preoperative diagnosis of ovarian tumors with MR imaging, comparison with transvaginal sonography, positron emission tomography and histological findings. AJR Am J Roentgenol 2001; 177: 123-9.
12. Tavassoli FA, Devilee P. WHO. Classification of Tumors. Pathology and Genetics. Tumors of breast and Female Genital Organs. IARC Press: Lyon 2003.
13. WHO Histologic Classification of Ovarian Tumors, Geneva, WHO, 1995.
14. Shahbaz Sarwar CM, Neelam Siddiqui, Rizwan Anwar Khokhar, Farhana Badar. Epithelial ovarian cancer at a cancer hospital in a developing country. Asian Pacific J Cancer Prevention, 2006; 7: 595-598.
15. Aria M, Utsunomiya, Miki Y. Familial breast and ovarian cancers. Int J Clin Oncol, 2004; 9: 270-82.
16. Mariam Malik, Farooq Aziz. Malignant ovarian tumors: a study of 75 patients. Pak J Obstetric Gynaecology May 1999; 12 (1,2): 83-6.
17. Aziz F., Mariam Malik, Nosheen Yousaf. The pattern of ovarian malignancies – a retrospective study over a period of three years. A retrospective study over a period of three years. Ann King Edward Coll Oct – Dec 1999; 5 (3,4): 276-8.
18. Zahra F. The pattern of ovarian masses. Ann King Edward med Coll Oct – Dec 2006; 12 (4): 480-2.
19. Tanwani A.K. Prevalence and pattern of ovarian lesions. Ann Pak Inst Med Sci Oct – Dec 2005; 1 (4): 211-4.
21. Yasmin S, Aiman yasmin, Mohammad Asif. Frequency of benign and malignant ovarian tumors in a tertiary care hospital. J postgrad Med Inst Oct – Dec 2006;20 (4): 393-7.
22. Khanum Z, Amanur Rehman. The prevalence and age distribution of ovarian cysts. Ann King Edward Med Coll Oct – Dec 2005; 11 (4): 392-3.
23. Naseem Junejo, Sheikh F, Mumtaz F. Clinical presentation and treatment outcome of ovarian tumors at gynaecology ward. J Liaquat Uni Med Health Sci. Jan – Apr 2010; 9 (1): 30-2.
24. Gatphol ED, Darnal HK. Pattern of ovarian neoplasm in Manipur. J Indian Med Assoc, 1990; 88: 338-9.
25. Tyagi SP, Maheswari V, Tyagi N, et al. Solid tumors of the ovary. J Indian.med assoc, 1993; 91: 227-30.
26. Guppy AE, Nathan PD, Rust n GJ. Epithelial Ovarian Cancer: A review of current management. Clin oncology (R coll Radiology), 2005; 17: 399-411.
27. Morrison J. Advances in the understanding and treatment of ovarian cancer. J Br Menopause Soc, 2005; 11: 66-71.
28. Yasmin S, Yasmin A, Asif M. Clinicopathological pattern of ovarian tumours in Punjab region. J Ayub Med Coll Abbottabaad 2008; 20 (4): 11-13.
29. Prabarker, Maingi K. ovarian tumors – prevalence in Punjab. Indian J Pathology Microbiology 1989; 32: 276-81.
30. Thanikasalam K, Ho CM, Adeed N, Shahida MN, Azizah WK. Links Pattern of ovarian tumors among Malaysian women at General Hospital, Kuala Lumpur. Med J Malaysia 1992; 47: 139-46.
31. Ahmad M, Malik TM, Afzal S, Mubarik A. Clinicopathological study of 762 ovarian neoplasms at Army Medical College india. ind J Pathology 2004; 15 (4): 147-52.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareA STUDY ON DATA MINING TECHNIQUES, METHODS, TOOLS AND APPLICATIONS IN VARIOUS INDUSTRIES
English3438R. JayaEnglish S. Mohan KumarEnglishData Mining is special and important technique utilized to have better business solutions. General survey on Data Mining Techniques, Methods, Tools and Challenges of Data Mining in all the domains, is at most important and so much in demand, applying machine learning concepts and techniques in medical field is also most essential in the present scenario. In this paper the following chapters are presented- various data mining techniques, merits and demerits of data mining, open source data mining tools available, and also domains or industries applied DM.
EnglishData mining, DM tools, HealthCare software, DM techniques, Classification, Clustering, Decision tree, DM challengesINTRODUCTION The survey conduction and publishing the survey result is most expected one, in this research report. DM Techniques and how much the DM technique contributed in the healthcare field [14] is presented.
II. TYPES OF DM TECHNIQUES: 1. CLASSIFICATION: It is important DM Technique; Classification predicts a certain output based on a set of pre classified examples and it is the mostly used data mining technique. Classification can be broadly divided into supervised and unsupervised algorithms .Major classification method are decision tree induction, Bayesian networks, linear programming, neural network and fuzzy logic technique. [13][26][27][28][29][30].
2. CLUSTERING: It is important DM Technique; Clustering groups similar and dissimilar objects. There are number of clustering models which can be used for different applications. It can also be used as a pre-processing approach for attribute subset selection and classification [4].Clustering mainly used for pattern recognition, machine learning and information retrieval.
2.1 K-MEANS CLUSTERING: It is very Simple clustering approach, less complex method and also efficient. In advance it requires number of cluster to proceed further. It is having problem in handling categorical attributes. It will not predict the cluster with non-convex shape. Outcome varies in the presence of outlier.
2.2 HIERARCHICAL CLUSTERING: Easy to implement and having good visualization capability. Not necessary to mention the number of clusters in advance. It has cubic time complexity in many cases so it is slower. Once a decision is made it cannot be withdrawn. It will not work proper in the presence of noise. It is not scalable one.
2.3 DENSITY BASED CLUSTERING: No need to specify number of cluster in advance. It is very simple to handle cluster with arbitrary shape. It will work well in the presence of noise. It will not handle the data points with varying densities. Results will be based on the distance measure.
3. PREDICTION: It is important DM Technique; The prediction as it name implied is one of a data mining techniques that discovers relationship between independent variables and relationship between dependent and independent variables. Unfortunately many real world problems are not simply prediction. For instance, stock price, sales volumes are difficult to predict, therefore we need more complex techniques like logistic regression, decision tress and neural networks [4].
4. ASSOCIATION: It is important DM Technique; Association is one of the best known data mining technique. In association, a pattern is discovered based on a relationship of a particular item on other items in the same transaction. For example, the association technique is used in heart disease prediction as it tell us the relationship of different attributes used for analysis and sort out the patient with all the risk factor which are required for prediction of disease[4].
5. NEURAL NETWORK: It is important DM Technique; Neural networks models have been studied for many years in the hope of achieving human like performance in several fields. As the human brain consists of millions of neurons that are interconnected by synapses, a neural network is a set of connected input/output units in which each connection has a weight associated with it. The network learns in the learning phase by adjusting the weights so as to be able to predict the correct class label of the input. They are the best at identifying patterns or trends in data and well suited for prediction or forecasting needs .due to their performance neural networks have been widely used in experiments and adopted for critical biomedical classification and clustering problems. Its merits and demerits are it will easily identify complex relationships between dependent and independent variables. Able to handle noisy data, Local minima and over-fitting. The processing of ANN network is difficult to interpret and require high processing time if there are large neural networks[12].
6. DECISION TREE(DT): It is important DM Technique; Decision tree learning uses a decision tree as a predictive model which maps observations about an item to conclusions about the item’s target value. In decision analysis, a decision tree can be used to visually and explicitly represent decisions and decision making. In data mining, a decision tree describes data but not decisions; rather the resulting classification tree can be an input for decision making. The goal is to create a model that predicts the value of a target variable based on several input variables.
Its merits and demerits are there are no necessities of domain knowledge in the construction of decision tree. It minimizes the ambiguity of complicated decisions and assigns exact values to outcomes of various actions. It can easily process the data with high dimension. It is easy to interpret. Decision tree also handles both numerical and categorical data. It is restricted to one output attribute. It generates categorical output. It is an unstable classifier i.e. performance of classifier is depend upon the type of dataset. If the type of dataset is numeric than it generates a complex decision tree[9].
7. SUPPORT VECTOR MACHINE (SVM): It is important DM Technique; Support vector machine is an algorithm that attempts to find a linear separator (hyperplane) between the data points of two classes in multidimensional space. SVMs are well suited to dealing with interactions among features and redundant features. Its merits and demerits are Better accuracy as compare to other classifier. Over fitting problem is not as much as other methods. Easily handle complex nonlinear data points. It is computationally expensive. The main problem is the selection of right kernel function. For every dataset different kernel function shows different results. As compare to other methods training process take more time. SVM was designed to solve the problem of binary class. It solves the problem of multi class by breaking it into pair of two classes such as one- againstone and one-against- all [9].
8. GENETIC ALGORITHMS (GAS) AND EVOLUTIONARY PROGRAMMING (EP): It is important DM Technique; Genetic algorithms and evolutionary programming are algorithmic optimization strategies that are inspired by the principles observed in natural evolution. Of a collection of potential problem solutions that compete with each other, the best solutions are selected and combined with each other. In doing so, one expects that the overall goodness of the solution set will become better and better, similar to the process of evolution of a population of organisms. Genetic algorithms and evolutionary programming are used in data mining to formulate hypotheses about dependencies between variables, in the form of association rules or some other internal formalism [12].
9. FUZZY SETS (FS): It is important DM Technique; Fuzzy sets form a key methodology for representing and processing uncertainty. Uncertainty arises in many forms in today’s databases: imprecision, non-specificity, inconsistency, vagueness, etc. Fuzzy sets exploit uncertainty in an attempt to make system complexity manageable. As such, fuzzy sets constitute a powerful approach to deal not only with incomplete, noisy or imprecise data, but may also be helpful in developing uncertain models of the data that provide smarter and smoother performance than traditional systems[12].
10. ROUGH SETS(RS): It is important DM Technique; in this a rough set is determined by a lower and upper bound of a set. Every member of the lower bound is a certain member of the set. Every nonmember of the upper bound is a certain non-member of the set. The upper bound of a rough set is the union between the lower bound and the so-called boundary region.
11. K-NEAREST NEIGHBOR (KNN): It is important DM Technique. It is very easy to implement. Training is done in faster manner. It requires large storage space. It is very sensitive to noise. Testing is slow [14].
12. BAYESIAN BELIEF NETWORK (BBN) It is important DM Technique, It makes computations process easier. Have better speed and accuracy for huge datasets. It does not give accurate results in some cases where there exists dependency among variables [3].
III. DATA MINING MERITS AND DEMERITS MERITS:
• It predicts future trends
• It helps in decision making
It helps to improve company revenue
• It is mainly used in Market Analysis
• It is effectively utilized in fraud detection
• DM techniques applied in health care insurers to detect fraud and abuse.
• DM helps the Physicians to identify effective treatments and best practices through healthcare software’s.
• Using data mining it is possible to speed up the work in large data sets.
• DM facilitates generation of quicker reports and faster analysis, which will increase operational efficiency and also diminishes operating cost.
• Data mining can extract predictive information from large database, which is a very important.
DEMERITS:
• Heterogeneity of data volume and complexity will create unnecessary mathematical categorization.
• Must consider Ethical legal and Social issues.
• Dealing Data ownership, Lawsuits
• Privacy and Security of Human Data Administrative Issues – Medical data.
• Other general Security Issues.
• Misuse of information or in accurate information.
V. DATA MINING TECHNIQUES APPLIED DOMAINS: Data mining is an interdisciplinary field and with wide diverse applications. There be nontrivial gaps between data mining principles and domain-specific applications, few application domains of Data Mining are listed below, • Healthcare • Finance • Retail industry • Telecommunication • Text Mining • Web Mining • Higher Education , etc Tremendous results and reports received in all the above fields by the effective utilization of DM[30].
VI. CONCLUSION: In this paper we presented various data mining techniques that have been employed for medical data mining. Data mining techniques have higher utility in medical data mining as there is voluminous data in this industry. Due to the rapid growth of medical data, it has become in dispensable to use data mining technique to help decision support and prediction system in the field of health care. This paper has provided the summary of data mining techniques used for all the domains.
ACKNOWLEDGEMENT We acknowledge the immense help from scholars whose articles are cited and included in references of this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=330http://ijcrr.com/article_html.php?did=3301. Sheetal L. Patil "Survey of Data Mining Techniques in Healthcare" International Research Journal of Innovative Engineering Volume1, Issue 9 of September 2015.
2. Shubpreet Kaur1 and Dr. R.K.Bawa2 "Future Trends of Data Mining in Predicting the Various Diseases in Medical Healthcare System", International Journal of Energy, Information and Communications Vol.6, Issue 4 (2015), pp.17-34.
3. Kittipol Wisaeng, "An Empirical Comparison of Data Mining Techniques in Medical Databases”, International Journal of Computer Applications (0975-8887) Volume 77- No.7, September 2013.
4. Divya Tomar and Sonali Agarwal, "A survey on Data Mining approaches for Healthcare"”, International Journal of Bio--Science and Bio-Technology Vol.5, No.5 (2013), pp. 241-266.
5. Dhanalakshmi D., Dr. J. Komala Lakshmi, "A Survey on Data Mining Research Trends", International Journal Of Engineering And Computer Science ISSN:2319-7242 Volume 3, Issue 10 October, 2014 Page No. 8911-8919.
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24. Mohan Kumar S, et al. "Categorization of Benign And Malignant Digital Mammograms Using Mass Classification – SNE and DWT", Karpagam Journal of Computer Science, Volume-07, Issue-04, June-July-2013 - Numbers: 237-243. ISSN No: 0973-2926.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareASSESSMENT OF GROUND WATER QUALITY OF PEESANGAN BLOCK OF AJMER DISTRICT
English3946Priyanka KhannaEnglish Nidhi RaiEnglishPhysicochemical study of the ground water of some rural areas of Peesangan Block of Ajmer district has been carried out to examine the suitability of water for drinking, irrigation and other domestic purposes. Water samples from these areas were collected during Pre-Monsoon (April-June) and Post monsoon seasons (Oct-Dec) of the year 2013. The data were analyzed for mainly Electrical Conductivity (EC), Total Dissolve Solids (TDS), Chloride (Cl-), Fluoride (F-), Nitrate (NO3-), Total Hardness, Alkalinity, Sodium (Na+), Potassium(K+), Carbonates(CO3-2), Bicarbonates (HCO-3) etc. with reference to BIS and WHO standards. It has been observed that most of the water samples have the concentration of different parameters beyond the permissible limits. The groundwater of the present study area was not found suitable for drinking and other domestic purpose.
EnglishGround water of rural area, Physicochemical characteristics, Drinking water, Water pollution.INTRODUCTION
Water is one of the five (Earth, Air, water, fire and space) essential elements of life. The safe potable water is absolutely essential for healthy living. Groundwater is ultimate and most suitable fresh water resource for human consumption in both urban as well as rural areas. There are several states in India where more than 90% population is dependent on groundwater for drinking and other purposes (Ramachandraiah, 2004). Ground water is also being used frequently as the alternative source for agriculture and industry. Importance of groundwater for existence of human society cannot be overemphasized. India is a vast country with varied hydrogeological situations resulting from diversified geological, climatological and topographic settings.
The natural chemical composition of ground water is influenced predominantly by type and depth of soils and subsurface geological formations through which ground water passes. Ground water quality is also influenced by the atmosphere and surface water bodies. There are various ways of contamination of ground water such as use of fertilizers in farming seepage from effluent bearing water body, industrial discharge etc. Now a days qualitative analysis of ground water is very important as compared to the quantity available(Hem.J.D.).
However ground water quality have not received much attention although it is a one of the most important tool in Environmental impact assessment (EIA) (Krishna Rao,P.R.1971.), so attention on quality of ground water and to aware each person for their right of safe water for drinking and other domestic uses. Water is one of the most important compounds in the ecosystem. Better quality of water can be described by its Physical, Chemical and Biological characteristics. But some correlations are possible among these parameters and the significant one would be useful to indicate the quality of water. Due to increased population, industries, use of fertilizers in agriculture and Man-made activity, drinking water gets contaminated and due to use of Contaminated Drinking water,
Human Population Suffers From a variety of water borne diseases, so it becomes necessary to evaluate the Quality of Drinking water which should be done at regular intervals of time. It is difficult to understand The Biological Phenomena fully because the Chemistry of water reveals much about the metabolism of the ecosystem and explain the general Hydro biological relationship. The physicochemical parameters of water and the dependence of all life process of these.
STUDY AREA
Peesangan is a Tehsil in Ajmer District of Rajasthan State of India. The latitude 26.38°37'195" and longitude 74.41°05'291" are the geo-coordinates of the Peesangan tehsil. It belongs to Ajmer Division. It is located 31 KM towards west from District headquarters Ajmer, 180 km from State capital Jaipur towards East. Peesangan Tehsil is bounded by Riyan Badi Tehsil towards North, Ajmer Tehsil towards East, Beawar Tehsil towards South, Masooda Tehsil towards South. Ajmer City, Beawar, Nasirabad, Merta City are the nearby Cities to Pisangan. It is in the 438 m elevation (altitude). Near destinations for visit of tourist are Pushkar, Ajmer, Kishangarh, Kuchaman, Khimsar.
MATERIALS AND METHODS
Water samples were collected from various ground water sources covering the study area in two different seasons Premonsoon and Post-monsoon season of the year 2013. Samples were collected into pre-cleaned polyethylene bottles of one liter capacity with utmost care to avoid any kind of contamination and were brought to laboratory for the estimation of various physicochemical parameters. Volumetric and instrumental techniques were adopted for systematic analysis of the water samples using Standard procedures [APHA, BIS].
The analysis was carried out for estimation of pH, EC, TDS, Alkalinity, Hardness, Chloride, fluoride, Nitrate etc. The reagents were standardized from Standard solutions and instruments were calibrated by known standards before analysis. The reagents of AR grade were used for analysis work and double distilled water was used for the preparation of solutions.
RESULTS AND DISCUSSION:-
The results of Physicochemical Parameters obtained and seasonal variation are presented in Table1.1 and 1.2 In general Salinity, alkalinity, fluoride, nitrate and TDS are the major factors, which affect the water quality most. pH: As observed in the tables 1.1 and 1.2 the pH of ground water in this area varies within minimum 7.5 to maximum 8.5 in both seasons. Almost all the water samples in this area are alkaline in nature though the values of pH of all water samples were found to be within the permissible limits in both seasons.
The standard limits prescribed by WHO and IS 10500:2012 are 6.5- 8.5. Electrical Conductivity (EC): E.C. depends on the concentration of dissolved mineral matter content. The salt concentration is generally measured by detecting EC. In the present study area, the EC has been observed from 942 to 9771 μS.cm-1. About 60 % water samples have EC more than the permissible limit. If the TDS is high then EC will be high [Tiwari, T.N.; Das, S.C.; Bose, P.K. Poll. Res 1986].
Total Dissolved Solids(TDS):
The value of T.D.S. is very important for the assessment of water quality (Ahmad Ashfaq and Faizan Ahmad 2014). High TDS value of water indicates the higher mineralization of water. The desirable limit for TDS is 500 mg/L and maximum permissible limit is 2000 mg/L (Maruthi and Rao, 2004). As the result of analysis the values of total dissolved solid ranges from 660 to 6840 mg/L during pre-monsoon and 780 to 6280 mg/L in Post-monsoon season. Maximum TDS has been observed at handpump, Gomawat Mohalla near tanki inTabiji village. About 46% samples have TDS beyond permissible limit of 2000 mg/L. It concludes that mostly water is saline in Peesangan block of Ajmer district. This shows that anthropogenic impact which can be due to agricultural activity leading to local spatial and temporal variability of runoff (Chatterjee, R. Gourab 2010). Away from the permissible level, palatability decreases and may cause gastrointestinal irritation.
Alkalinity:
Alkalinity of the water is due to presence of carbonates, bicarbonates and hydroxide salts. The alkalinity values in the study area were recorded between 260 to 1220 mg/L in pre monsoon season and 220 to 1220 mg/L during Post-monsoon season. The hydroxide, carbonates and bicarbonate probably released from limestone sedimentary rocks, carbonate rich soils, cleaning agents etc.( Tiwari, T.N. Mishra). The Maximum value (1220 mg/l) is observed in Open well situated at Mayapur Road in Naharpura village and minimum value (220mg/l) recorded at Handpump, Bus stop, Daurai village. The Maximum permissible level of alkalinity is 600 mg/L (BIS Standard). About 83% of water samples tested were found to be within permissible limits.
High amount of alkalinity in water is harmful for irrigation which leads to soil damage and reduces crop yields. Chloride (Cl): All the natural types of water contain chlorides. Chloride is added to water due to the agricultural activities, industries and chloride rich rocks. itis a widely distributed element in all types of rocks in one or the other form. Its affinity towardssodium is high. High concentration of chloride is due to the invasion of domestic wastes and disposals by human activities (Jha and Verma, 2000). Soil porosity and permeability also play a key role in building up the chlorides concentration (Chanda D K, 1999,).
According to IS:10500:2012the desirable limit of chloride is 250 mg/Land the permissible limit is 1000mg/l. In the present analysis, chloride concentration lies between the range of 90 mg/L to 2370 mg/L in pre-monsoon season and Minimum and Maximum values are decreasing in post monsoon seasons.(120 to 2270 mg/l.). The highest value 0f 2370 mg/l is observed at Handpump of Gomawat Mohalla of Tabiji village. Excessive chloride in water is particularly not harmful but increase of chloride level in water is injurious to People suffering from heart and kidney diseases.(Sudhir Dahiya and Amarjeet Kaur, 1999).
Hardness:
The total hardness is the measure of the capacity of water to precipitate soap. Hardness of the water is due to presence of Ca and Mg salts. Usually the hardness is not harmful to health but it has been suspected to play some role in heart diseases (Ahmad Ashfaq and Faizan Ahmad2014). In this study area, the range of total hardness was found to be from 260 mg/L to maximum 3880mg/L in Pre-monsoon season and 320mg/L to 3050mg/L in Post-monsoon season in more than 50% of samples hardness as crossed permissible limit.
The hardness of the water is due to dissolved minerals from sedimentary rocks through seepage and runoff (Milovanovic, M. Desalination 2007), Detergents and soaps also aggravate the situations. The standard limits of total hardness are 200 to 600 mg/l. as per IS 10500:2012. Sulphate (SO4 ): In Present study area the sulphate values exhibited between 16 to 660 mg/l in pre monsoon season, and 16 mg/l to 555 mg/l. in Post-monsoon season Sulphate occurs naturally in water as a result of leaching from gypsum and other common minerals(Gupta S, KumarA, Ojha C K and Singh G, 2004).
Discharge of industrial wastes and domestic sewage tends to increase a concentration of sulfate in water. Only 3 samples have concentration beyond the permissible limit as prescribed by IS 10500:2012 (400 mg/l.).High concentration of sulphate may cause gastrointestinal irritation particularly when the concentration of magnesium and sodium is high. Nitrate(NO3 ): The values of nitrates in the study area were recorded between 30 mg/L and 860 mg/L.About 75% of samples exceed the desirable limit of 45 mg/L.
If the concentration of nitrate is higher than 45 mg/L, it will cause a disease called blue baby disease or methaemoglobinaemia in infants [Maruthi Devi, C.H.; Usha Madhuri, T. Nature, 2011]. The high level of nitrate in study area has reported that nitrate contamination of water is due to increasing use of nitrogenous fertilizers and nitrites can cause depletion of dissolve oxygen content of water [D. Fairchild,1987 and A.T.Ajao, G. B. Adebayo and S. E. Yakubu J. Microbiol. Biotech. Res., 2011]. NAEP have concluded that residual nitrate in the soil in the major cause of nitrate contamination in ground water. The appreciable quantities of nitrates and nitrites found in these investigations have some public health implications. Calcium:
The Calcium in the sampling sources ranges from 48 to 808 mg/L during pre-monsoon season and 48 to 660 mg/L during Post-monsoon season of 2013. In most of the samples it falls above the desirable limit of 75 mg/ L(IS:10500:2012), and only 30% samples have calcium concentration above the permissible limit of 200 mg/L. The higher value is mainly attributed due to the abundant availability of lime stone in the area. Consequently more solubility of calcium ions is present.
Magnesium In these samples, the minimum concentration of magnesium has been increased from 26 mg/L in Pre-monsoon to 36 mg/L in Post- monsoon season. But the maximum value decrees from 446 mg/L to 336 mg/L in post-monsoon season 2013.In all most of all the samples magnesium falls above the standard desirable limit 30 mg/L in both seasons. The concentration of magnesium may be due the dissolution of magnesium calcite, gypsum and dolomite [Garrels, R.M.;Christ, C.L. 1965 , Rao, S.N. 1997]. All the major parameters in both seasons were found to be in excess of the desirable limit given by WHO / ICMR / IS (10500:2012) standards, so that water quality of the study areas of poor quality as shown in the analysis tables 1.1 and 1.2 Further the comparative Water Quality values have been shown in the bar Diagrams.
CONCLUSION
The above observations in the present study indicate that about 75% samples exceed he permissible limits of most of the parameters of the samples. So the ground water of the Peesangan belt is saline in nature and unpotable for drinking and other domestic uses. They need to minimize the use of ground water for drinking purposes without treatment. The government is making new plans for supply of clean fresh treated water for drinking and other domestic uses for the population of the study area.
Englishhttp://ijcrr.com/abstract.php?article_id=331http://ijcrr.com/article_html.php?did=3311. Rijsberman, F. R. Agricultural Water Management, 2006, 80(1- 3), 5.
2. Burjia, J.S.; Romani, S.. Groundwater Development–Present scenario and future needs. Indian J. Pub. Adm. 2003, XLIX(3), 301. CPCB, Water Quality, Parivesh, 1995, 1(4), 6.
3. Abraham BairuGebrehiwot; NataTadesse; Elias Jigar. ISABB J. Food and Agriculture Sci.,2011, 1(1), 22.
4. Gupta S, Kumar A, Ojha C K and Singh G, 2004, Journal of Environmental Science and Engineering. 46(1), pp7478.
5. Lakshmanan, E; Kannan, K.; Senthil, M.K. Indian J. Env. Geosciences,2003, 10(4),157.
6. Kalavathy, S; RakeshSharmas, R; Sureshkumar, P. Arch. Environ.Sci., 2011, 5, 55.
7. APHA. 2005, Standard methods for the examination of water and waste water (2st Ed.), American Public Health Association, Washington.
8. BIS. 2003, Indian standards specifications for drinking water, IS:10500, Bureau of Indian Standards, New Delhi.
9. ICMR, 1975, Manual of standards of quality for drinking water supplies, Special report series no. 44, Indian Council of Medical Research, New Delhi.
10. D. Fairchild, Lewis Publication. Chelsea, Michigan., 1987, 402,161-174.
11. A.T. Ajao, G. B. Adebayo and S. E. Yakubu J. Microbiol. Biotech. Res., 2011, 1 (3), 50-56
12. WHO. 2005, International standards for drinking water, World Health Organisation, Geneva.
13. Vogel, A. I.; A textbook of Quantitative Inorganic Analysis Including Elementary Instrumental Analysis ,4th Ed., The English Language Book Society and Langman Co., 1978, 504-506.
14. Vasanthavigar, M; Srinivasamoorthy, K; Vijayaragavan, K; Gandhi, R; Chidambaram, S; Anandhan, P;Manivannan,R and Vasudevan.S, Environ Monitoring Assess.,2010, DOI 10.1007/ s10661-009-1302-1.
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16. Chatterjee, R; Gourab, T.; Paul,S. Bull. Eng. Geol. Environ., 2010, 69, 137.
17. Sudhir Dahiya and Amarjeet Kaur, 1999, J Environ Pollution, 6 (4), 281.
18. Garrels, R.M.;Christ, C.L. Solutions minerals and equilibrium, New York: Harper and Row,1965, 450.
19. Rao, S.N. Studies on water quality index in hard rock terrain of Guntur district Andhara Pradhesh, India. National Seminar on Hydrology of Precambrian Terrains and Hard Rock Areas, 1997, pp: 129-13425
21. Maruthi Devi, C.H.; UshaMadhuri, T. Nature, Environment and Pollution Technology, 2011, 10, 481.
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23. Garrels, R.M.; Christ, C.L. Solutions minerals and equilibrium, New York: Harper and Row, 1965, 450.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareISOLATION OF CRYPTOCOCCUS NEOFORMANS FROM ABSCESS ASPIRATE IN A PULMONARY TUBERCULOSIS PATIENT
English4749Charmi N. ShahEnglish Mannu R. JainEnglish Manish G. PatelEnglish Parul VadgamaEnglishCryptococcus neoformans is ubiquitous encapsulated yeast found throughout the world. It predominantly causes significant infections in immunocompromised individuals, of which 80-90% occur in people with human immunodeficiency virus(HIV) infection. Disseminated disease, especially cryptococcal abscess is exceedingly rare. We report a case of disseminated cryptococcosis with abscess in a tuberculosis patient. A case of Cryptococcus neoformans and Mycobacterium tuberculosis (pulmonary) coinfection in an otherwise healthy young man is reported.
EnglishCryptococcosis, Abscess, TBINTRODUCTION
Cryptococcus neoformans is opportunistic yeast commonly found in soil contaminated with pigeon droppings throughout the world.[1,2] Cryptococcosis continues to cause significant morbidity and mortality in immunocompromised as well as immunocompetent persons.[1] The predisposing factors are advanced stage of human immunodeficiency virus (HIV) and other conditions like prolonged use of corticosteroid, lymphomas, solid organ transplant recipients and patients with immune suppressive disease or receiving such drugs.[2,5,8,9] Noncutaneous cryptococcal abscess without osseous involvement is exceedingly rare around 10-15%.[1]
The mainstay of host defence against this pathogen is innate and T-cell-mediated immunity, likely explaining its high incidence among immunosuppressed patients. There is evidence that both M tuberculosis and C neoformans may have suppressive effects on the host immune system. This suggests a mechanism by which an otherwise healthy individual developed these two infections.[[3] A case of Cryptococcus neoformans and Mycobacterium tuberculosis (pulmonary) coinfection in an otherwise healthy young man is reported.
Case description A 30 years old male with history of pulmonary TB presenting with chief complaint of painful swelling over left site of chest since 10 days and fever since 5 days. There was history of anorexia and significant weight loss over last 3 months. There was no history of dyspnoea, chest pain and hemoptysis, abnormal behavior or movements. Patient is on antituberculosis treatment since 3/3/2014 (cat 1 TB).His TB was confirmed by sputum smear AFB examination. The montoux test was positive (>10 mm) with dose of 5 TU PPD after 48 hours. On local examination, tender oval swelling of 11cmx8cmx2cm in size, red in colour and hot on palpation present on left lateral site of chest wall. Systemic examination is normal.
In routine investigation, his ESR was found raised(112mm/hr).All other investigations such as liver function test and renal function tests are found normal. His HIV testing was also non-reactive. He had the history of right frontal bone depressed fracture 2 years back and also had the history of an eviscerated right eye due to injury which was corrected by prosthetic implantation 1 year back. He had steroid administration at that time which could contribute to his immunosuppressed condition. Direct microscopy of aspirate revealed 6-8 pus cells/hpf and very few gram-positive yeast cells.
Inoculation on Sabouraud's Dextrose Agar revealed small opaque creamy white colonies. Gram’s stain from colony showed gram positive budding yeast cells of varying size. India ink preparation of colony showed round, budding halos of varying size. Urease test was positive after 48 hours of incubation. Antifungal Sensitivity done with fluconazole, nystatin, itraconazole, amphotericin B in which only amphotericin B showed sensitivity which was also confirmed by vitek.
Case discussion The patient came to our hospital for his antituberculosis treatment. Meanwhile he was referred to surgery OPD because of swelling which was suspected as cold abscess on the basis of clinical presentation .Direct microscopy (Gram’s stain, India ink preparation) of the aspirate showed round, budding, capsulated yeast cells resembling Cryptococcus. Patient was initially started empirically with itraconazole but no improvement observed. The isolate was susceptible only to amphotericin B, which was started at a dose of 1 mg/kg/ day in 2 divided doses slowly over 2 hours for 2 weeks followed by capsule fluconazole 400 mg for 8 weeks. After that, the patient’s condition was improved.
CONCLUSION Cryptococcal infection is the most common opportunistic fungal infection in immunocompromised individuals. A high index of suspicion is needed for early diagnosis and it is a good clinical practice to use India ink stain in all cases of cryptococcal infections. Early diagnosis and adequate treatment may save the lives of these unfortunate patients. It is thus recommended that all the body fluids should be subjected to fungal culture and sensitivity even if there is a rarest possibility of fungal infection.
ACKNOWLEDGMENT
To the Department of TB and Chest for continuous support and valuable help. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=332http://ijcrr.com/article_html.php?did=3321. Suchitha S., Sheeladevi C.S., Sunila R., Manjunath G.V., Disseminated cryptococcosis in an immunocompetent patient, Hindawi Journal 2012;652351
2. G Serrano Ocana, J.Ortiz Sablon,I Ochoa Tamayo, Disseminated Cryptococcosis :case report, The IntJ of Neurology Jan 2009,vol.10 Issue 2,p5
3. Van Tongeren L, Shaipanich T, Fleetham JA., Coinfection with Cryptococcus gattii and Mycobacteriumtuberculosis in an otherwise healthy 18-year-old woman, Can Respir J 2011 JulAug;18(4): e62-e63.
4. Manfredi R, Calza L., Severe brain coinfection with Cryptococcus neoformans and Mycobacterium tuberculosis in a young, otherwise healthy student recently immigrated from China,Int J Infect Dis 2008; 12(4): 438-441.
5. Sasisopin K., Sirirat W., Roongnapa P.,Somnuck S., Cryptococcosis in human immunodeficiency virus-negative patients, Int J of Inf Dis Jan.2006,vol.10(1):72-78
6. M.capoor,D.nair,M.deb,B.Gupta,P.Aggarwal,Clinical and mycological profile of cryptococcosis in a tertiary care hospital, Ind J of Med Micro., vol 25,no.4,pg. 401-404,2007
7. B.R.Yehia,M.Eberlein,S.D. siscon, D.N. Hager, Disseminated cryptococcosis with meningitis, peritonitis and cryptococcemia in a HIV negative patient with cirrhosis, Cases J,vol 2,no.10,article 170,2009
8. Aoi Kuroda et al., A Case of Disseminated Cryptococcal Infection and Concurrent Lung Tuberculosis in a Patient under Steroid Therapy for Interstitial Pneumonia, Hindawi Case Reports in Pulmonology Volume 2015 (2015), Article ID 358926, 6 pages
9. P Satishchandra1, T Mathew1, G Gadre1, S Nagarathna1, A Chandramukhi2, A Mahadevan3, SK Shankar3,Cryptococcal meningitis: Clinical, diagnostic and therapeutic overviews, Publication of the Neurological society of India Year : 2007 | Volume : 55 | Issue : 3 | Page : 226-232
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareSEXUAL DIMORPHISM OF MASTOID PROCESS IN DRIED SKULLS OF NORTH KARNATAKA POPULATION
English5153Rajendrakumar D. VirupaxiEnglish Sanjay Kumar YadavEnglish Suresh P. DesaiEnglish Veereshkumar ShirolEnglishObjectives: Morphometric and morphological study of the bones play an important role in determination of sex, age and identification of an individual and skull is the second important tool to pelvis in this regard. Mastoid process is a dimorphic bone situated at the basolateral region of the skull and remains least damaged due to its position. This study was an attempt to evaluate the use of mastoid process in the determination of sex. Methodology: This cross sectional study was carried out in the settings of Department of Anatomy and Forensic Medicine at North Karnataka for the period of one year from July 2014 to June 2015. A total of 100 complete undamaged dried skulls of known sex were used for the study, (50 male and 50 female skulls). Length of the mastoid process on both sides was recorded using the Frankfurt’s plane. Measurements were taken by using Vernier caliper. Results: The mean mastoid process length among males at right was 30.20 ± 2.64 mm and at left it was 30.70 ± 3.09 mm compared to 26.20 ± 2.57 mm in females at right and 26.20 ± 3.49 mm at left respectively. The difference observed was statistically significant (pEnglishMastoid process, Mastoid process length, Skull, Sexual dimorphismINTRODUCTION
Identification of an individual and sex is one of the important factors in many circumstances like, mutilated bodies, skeletal remains, wars, and suicide and homicide cases. In the living identification is easy as many characters, particular physique and traits are unique to the individuals. But in cases of fragmented and mutilated bodies it is very difficult to identify the individual. Study of skeleton using individual bones exhibiting sexual dimorphism has been reported among different populations.1 Determination of the sex of human or human skeletal remains is an important initial step in its identification.
This skillful process is carried out by forensic and anatomy experts. Anthropological knowledge of human skeleton is one of the important parameters in identification of this biological profile.2 The first indicator for the sex determination is the pelvic bones and pelvis which is more accurate than the skull bones.3 The above study also confirmed by Saini et al,4 in 2012. Several studies have shown that cranium is also an excellent indicator for sexual dimorphism by morphometric and morphological analysis. It is probably the second best region of the skeleton next to the pelvis for this purpose.5 Krogman states that skull is the most dimorphic and easily sexed portion of skeleton after pelvis, providing up to 92% reliability6 Bayers2 and Pickering and Bachman7 also presented that skull plays the second best role to estimate the sex of the dead body. The skull measurements vary significantly in different populations of the world.
The mastoid process of the skull plays a vital role in determination of the sex as it is the most dimorphic bone present at the baso-lateral region of the skull. It is least vulnerable in this position. The mastoid region is favorable for sex determination for two reasons, the compact nature of the petrous bone and its protected position in the skull. Even in old age it remains intact. Usually skull is heavier in males as compared to females. Same thing holds good to mastoid process also, i.e. larger in males than in females. But it is subjective and it cannot be relied. A number of research studies have done in western countries on these aspects. Nagaoka T method was employed by some experts using two parameters on both sides of skull i.e. height and width of the mastoid.8
Some researchers used the triangular area between the points porion, mastoidale and asterion, measured from xerographic copy of skulls.9 Very few works have been done on this in India especially in Northern Karnataka population. Considering this entire scenario an attempt is made to determine the sex by using the mastoid length in this area. In present study 100 adult human dried skulls (50 male and 50 female skulls) of North Karnataka population were studied to determine the sexual dimorphism of mastoid process. A quantitative blind study of the mastoid length was studied by using the Frankfurt’s plane.
MATERIALS AND METHODS This cross sectional study included 100 dried skulls of known sex, (50 male and 50 female skulls) taken from KLE University’s department of Anatomy and Forensic Medicine. Written permission was taken from the respective departments. Adult normal skulls without any damage were taken for the study. Deformed skulls were excluded from the study. All were native of North Karnataka Region. Frankfurt’s plane was chosen and marked on the skull.
This line starts from the infraorbital margin, and upper border of the external acoustic meatus. (Figure 1). From this line on the mastoid process a vertical length was measured up to the tip of the mastoid process.10 With the help of digital verneir caliper length of the mastoid process was taken from the upper border of the external auditory canal at the level of the Frankfurt’s plane to the tip of the mastoid process on both sides. Figure 2 shows the measurement of the length of the mastoid process.
Statistical methods The mastoid process length of skulls was expressed as mean ± standard deviation (SD0 and median with range. The comparison of mean length was done using independent sample ‘t’ test. Probability value (p) of Englishhttp://ijcrr.com/abstract.php?article_id=333http://ijcrr.com/article_html.php?did=3331. Bilge Y, Kedici PS, Alacoc YD, Ulkuer KU, Likyaz YY. The identification of a dismembered human body; A multidisciplinary approach. Forensic Sci Int 2003; 137(2-3):141-6.
2. Bayers SN. Introduction to Forensic Anthropology. Boston: Pearson Education; 2008.
3. Phenice TW. A newly developed visual method of sexing the os pubis. Am J Phys Anthropol 1969;30:297-301.
4. Saini V, Srivastava R, Rai RK, Shamal SN, Singh TB, Tripathi SK. Sex estimation from the mastoid process. Rev Hosp Clin Fac Med S Palo 2012;58(1):15-20.
5. Bass WM. Human Osteology; A Labortary, Field manual of the Human Skeleton. Columbia: Missouri Archeological Society; 1971.
6. Spradley MK, Jantz RL. Sex estimation in forensic anthropology: skull versus postcranial elements. J Forensic Sci 2011;56(2):289-96.
7. Bachman DL, Pickring RB. The use of Forensic Anthropology. Boca Raton, FL: CRC Press; 1977.
8. Nagoka T, Shizushima A, Sawada J, Tomo S, Hoshino K, Sato H, et al. Sex determination using mastoid process measurements: Standards for Japanese human skeletons of the medieval and early modern periods. Anthropology Sic 2008;116: 105.3.
9. Paiva LA, Segre M. Sexing the human skulls through the mastoid process. Rev Hosp Clin Fac Med 2003;58/1:15-20.
10. Passey J, Mishra SR, Singh R, Sushobhana K, Singh S, Sinha P. Sex determination using mastoid process. Asian J Med Sci 2015;6(6):93-5.
11. Hoshi H. Sex difference in the shape of the mastoid process in norma occipitalis and its importance to the sex determination of the human skull. Okajma’s Folia Ana Japonica 1962;38:309-17.
12. Giles F, Elliot U. Sex determination by discriminant function analysis of crania. Am J Phys Anthropol 1963;21:53-68.
13. Nidugala H, Avadhani R, Bhaskar B. Mastoid process- A tool for sex determination, an anatomical study in South Indian skulls. International J Biomed Res 2013;04(02): 106-10.
14. Dasgupta A, Banerjee A, Kumar A, Rao SR, Jose J. Discriminant Function Analysis of mastoid Measurements in sex determination. J Life Sci 2012;4(1):1-5.
15. Patnaik SVVG. Determination of sex from mastoid process by discriminant function analysis. J Anat So India 2010;59(2):222- 8.
16. Song HW, Lin ZQ, Jia JT. Sex diagnosis of Chinese skulls using multiple stepwise discrinant function analysis. Forensic Sci Int 1992;54(2);135-40.
17. Patil KR, Mody RN. Determination of sex by discriminant function analysis ans stature by regression analysis a lateral cephalometric study. Forensic Sci In 2005;147(2-3):175-80.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareTISSUE DISTRIBUTION AND PHARMACOKINETICS OF BROMOXYNIL IN RAT
English5460Ahmed K. SalamaEnglish Khaled A. OsmanEnglish Ahmed S. El-BakaryEnglish Maher S. SalamaEnglishThe tissue distribution and excretion of bromoxynil were studied in male rat. A single oral dose of 12.9 mg bromoxynil /kg body weight was administered to rat. Rats were killed after 0.5, 1, 3, 6, 12, 24, 48, 72, 120, and 168 h. At termination of 24 h, 2.80 and 0.01 % of the compound were excreted in the urine and feces, respectively. By 168 h the urinary and fecal cumulative excretion rose to 21.90 and 14.11%, respectively. Bromoxynil was readily absorbed and subsequently distributed throughout the body. Bromoxynil concentrations increased in serum as the time passed reaching a peak concentration of 256.09ng/ml at 48 h following administration. Peak concentrations of bromoxynil were also reached at 48 h in liver (345.15ng/g) and brain (67.85ng/g). However, bromoxynil level in kidneys reached peak concentration (647.19ng/g) at 24 h after dosing. Bromoxynil begin to decline in the tissues as time passed to reach 10.67, 27.86 and 22.31ng/g(ml) in serum, liver and kidneys, respectively. In case of brain, the lowest amount of bromoxynil (23.01ng/g) reached at 120 h and disappeared after 168 h following administration. Bromoxynilwas disappeared biexponentially from serum, liver, kidneys and brain. The terminal half-life t½ of bromoxynil was 48.0, 62.0, 60.0, and 34.8 h for the serum, liver, brain and kidneys, respectively. This indicates that there was no tendency for bromoxynil to retain in rat tissue.
EnglishBromoxynil, Pharmacokinetics, Distribution, Excretion, RatINTRODUCTION
The benzonitrile herbicides including bromoxynil have been widely used in agriculture and households to control growth of weeds (Agriculture Canada, 1989, U.S. EPA, 1997, 1998 and Tomlin, 1997) and their residues persist in the environment. The studies addressing the fate of benzonitrile herbicides in the environment show that some metabolites of these herbicides are very persistent. The toxicity studies of these pesticides in many prokaryotic and eukaryotic systems provided detailed information on acute and chronic toxicity, carcinogenicity, and mutagenicity ( USEPA, 1998). The chronic exposure to bromoxynil is of public health interest. It is classified as moderately hazardous (Class II) by the World Health Organization (IOMC, 2004). In this concern, the cytotoxic effects of benzonitrile herbicides including bromoxynil and their microbial metabolites using two human cell lines, Hep G2 and HEK293T were carried out by Lovecka et al (2015). They indicated that bromoxynil has moderate cytotoxic effect at concentration several times higher than its limit allowed in the drinking water. However, this does not exclude its potential risk connected with chronic exposure to such compounds.
A review carried out by Deziel et al (2015) summarizes the evidence for the contribution of non occupational pathways to pesticide exposures in women living in North American agricultural areas, who may be exposed to a greater number of pesticides and at higher concentrations than women in the general population. Pharmacokinetics is a comprehensive study with concurrent absorption, distribution, metabolism, and elimination of the compound by determining the target organ dose of toxic moiety over time, and in turn the magnitude and duration of toxicity (Caldwell et al, 1995 and Xie et al, 2011). Pharmacokinetics was studied in male and female Sprague Dawley rats given single oral doses of 14C-bromoxynil octanoate. Radioactivity was distributed in most tissues where the highest concentrations were observed in blood, plasma, liver, kidneys and thyroid (especially in females). Levels of radioactivity in tissues were generally higher in females than in males. Seven days following oral administration, 84 -89% of the radioactivity were excreted in male urine and 76-80% were found in female urine. However, lesser amounts (6- 10%) were detected in the feces of both males and females (U.S. Environmental Protection Agency, 2005). In another study by Stahler et al (1991), the bromoxynil concentrations measured in serum proceed with a terminal half-life of 20 h. However, kidneys showed saturation kinetics after oral administration of a high dose (100 mg/kg) in case female rats. Cessna and Grover (2002) reported that the exposure to bromoxynil in agricultural regions may be via inhalation of ambient air and/or dermal contact with surface water where the pesticide is actively being used. They found that the median value of bromoxynil inhaled by farmers during applying the pesticide was 0.018 μg/ kg body weight. They also found that the amounts of bromoxynil excreted via urine were increased over the first few days after application and then remained relatively constant during the study period of 10 days. Series of our studies were conducted to examine the pharmacokinetic profile of pesticides in rat (Salama et al, 1992a, 1992b, 1992c and 1993) and mouse (Salama, 1992 and Bakry et al, 1999). Therefore, the present study aimed to investigate the pharmacokinetic pattern and tissue distribution of the phenolic herbicide,bromoxynil in male rat following oral administration of 12.9 mg/kg body weight.
MATERIALS AND METHODS Chemical Bromoxynil (3,5-dibromo-4-hydroxybenzonitrile) was supplied by Chem Service, West Chester (98.9% purity). All other chemicals used in this study were obtained either from Sigma or BDH Companies and they were of the highest grade available. Animals Adult male Ratusnorvegicus rats weighing an average of 75g ± 5 were obtained from the High Institute of Public Health, Alexandria University. Animals were randomly separated and housed in stainless steel cages (four per cage) and left two weeks under the laboratory conditions. Rats were kept under 12 h light/dark cycle and about 23° C. They provided feed and water ad libitum.
Pellet feed containing 23% crude protein and 7% crude cellulose. The use of animals for this study was approved by the Ethics Committees of the High Institute for Experimental Animals, Alexandria University. Treatment of animals Thirty male rats were used for the study. Animals were received a single oral dose of 12.9 mg bromoxynil/kg body weight in corn oil (4ml corn oil/kg) using a glass syringe at tached with a curved stainless steel animal intubation needle with a spherical ball tip.
Three animals were orally received corn oil as the same manner of pesticide treated animals and served as vehicle control. The condition of the animals was monitored after bromoxynil treatment and there is no any adverse effect on the overall health of the animals was noticed. There is no animal died without euthanasia during the work study. Also, there is no any unintended death of animals during the study.
Tissue samples Blood samples were withdrawn from eyes without anesthesia following the time intervals of 0.5, 1, 3, 6, 12, 24, 48, 72, 120 and 168 h. Blood collected in non-heparinized glass vials and then centrifuged at 3000 rpm for 5 min at room temperature to separate the red blood cells from serum. At each time interval, three animals were killed by decapitation. To minimize suffering of the animals, they anaesthetized with diethyl ether just before decapitation. Brain, liver, and kidneys were removed rapidly, weighed, placed in glass vials and stored at -18 °C until analysis.
Collection of excreta Animals were individually placed in glass metabolism cages at least 24 h prior to dosing for acclimatization and the collection of control samples. Immediately after oral administrant, the animals were replaced in their metabolism cages which were designed for the studyto separate urine and feces. Excreta were collected at the end of each time intervals of 1, 2, 3, 4, 5, 6, and 7 days.
Extraction of bromoxynil from tissues and excreta Extraction of bromoxynil from serum, liver, kidneys or brain tissue was carried out according to the method described by EPA (1974) with major modifications. Tissue sample was placed into flask and then 2.5 ml of 5% methanolic potassium hydroxide per g (ml) tissue was added. Samples were refluxed for one hour on a hot plate in the presence of porcelain chips and then left to cool at room temperature. Samples were filtered and then 0.75 ml of concentrated sulfuric acid per g (ml) tissue was added.10 ml of saturated sodium chloride solution and 30 ml of distilled water per g (ml) tissue were added.
Samples were filtered through a bed of florisil (5g) and then extracted three times with methylene chloride (10 ml per g or ml tissue). The organic layers were taken, combined, dried over anhydrous sodium sulfate and rotary evaporated at 40 °C to 5 ml. Extraction of bromoxynil from feces and urine was carried out according to the method of EPA (1979) with slight modifications. Urine samples were taken in a conical flask and then 2ml of 2% acetic acid and 3 ml of hexane were added.
The samples were mixed very well with the presence of few drops of acetonitrile and then partitioned three times. The organic layers were separated and dried over anhydrous sodium sulfate. Samples were rotary evaporated to dryness and then dissolved in 5 ml acetonitrile. Feces samples were homogenized with acetone (5ml/g sample). The homogenates were filtered and partitioned three times with hexane (3x5ml). Hexane layers were collected and concentrated to 2 ml using rotary evaporator.
Clean up procedure Tissue samples were cleaned up according to the method of Bogus et al (1990) with a slight modification. The sample (5 ml) was transferred to a column packed with 2g florisil (60-80 mesh) and 2 g of anhydrous sodium sulfate per gram tissue. The column was rinsed with 60 ml of petroleum ether. Samples were loaded onto the column and eluted with 100 ml of 5% ethyl ether: petroleum ether (40-60°C). The eluate was evaporated to dryness under nitrogen and the residue was dissolved in 2ml acetonitrile to be ready for high pressure liquid chromatographic determination. Urine and feces sample extracts were cleaned up onto a column packed with 2 g of anhydrous sodium sulfate and 2g activated florisil per g (ml) sample. Samples were eluted using 10 ml hexane. The eluates were evaporated to dryness and then dissolved in 2 ml acetonitrile to be ready for high pressure liquid chromatographic analysis.
Fortification Recovery percentages of bromoxynil from serum, brain, liver and kidneys were carried out by the addition of bromoxynil at two levels of 5 and 10 µg. Urine and feces were only fortified with one level of 10 µg of bromoxynil. The fortified samples were extracted and cleaned up as described before.
Chromatographic analysis Analysis was performed on Perkin-Elmer 200High pressure liquid chromatograph, equipped with UV/VIS detector set at 254 nm. The separation was performed with an inertsil ph-3 C18 stainless steel column (150 x 4.6 mm I.D.), using a mobile phase of acetonitrile: water (1:1) at a flow rate of 1 ml/min. Identification of bromoxynilin serum, liver, kidneys, brain, urine and feces was accomplished by retention times and compared with standards of bromoxynil at the same conditions. The quantities were calculated on peak height basis, except for broad peaks which were calculated from area under the peak.
Kinetic analysis Kinetic analysis of bromoxynil concentrations in serum, liver, brain and kidneys was performed. The terminal half-life of the compound in tissues was calculated from the elimina tion rate constant, β which was obtained by linear regression of terminal linear exponential decline in bromoxynil concentration using the formula: t ½ = 0.693 / β The total area under the bromoxynil concentration versus time curves for serum AUCserum, and the various tissues, AUCorgan, was counted by the numerical integration method and extrapolated to infinity by using the last data point and the respective terminal linear exponential decline.
RESULTS Bromoxynil was extracted from serum, liver, kidney, brain, urine and feces as described before. Recoveries of bromoxynil from tissues and excreta at two different levels of fortification are presented in Table (1). The average recovery percentages were 90.40, 95.72, 88.63, 84.65, 95.21 and 96.25% for serum, liver, kidneys, brain, urine and feces, respectively.
Tissue distribution of bromoxynil: Bromoxynil was readily absorbed and subsequently distributed throughout the body. Within 0.5 h. following administration, the compound was observed in all tissues analyzed. At this early time interval, the highest amount was observed in the kidneys (23.31ng/g tissue), while the lowest amount was associated with liver (0.33ng/g tissue). At this time point, brain does not show any appreciable amounts of bromoxynil. Bromoxynil concentrations increased in serum as the time passed reaching a peak concentration of 256.09ng/ ml at 48 h following administration.
Peak concentrations of bromoxynil were also reached at 48 h in liver (345.15ng/g) and brain (67.85ng/g). However, bromoxynil level in kidneys reached peak concentration (647.19ng/g) at 24 h after dosing. Bromoxynil begin to decline in all tissues as time passed to reach 10.67, 27.86 and 22.31ng/g(ml) in serum, liver and kidneys, respectively. In case of brain, the lowest amount of bromoxynil (23.01ng/g) reached at 120 h and disappeared after 168 h following administration (Figure 1).
Excretion of bromoxynil: Bromoxynil was rapidly excreted via urine and feces soon after the oral administration. Thus, within 24 h of dosing, 2.80 and 0,01 % were eliminated in urine and feces, respectively. By 168 h the urinary and fecal cumulative excretion rose to 21.90 and 14.11%, respectively (Figure 2 ).
Pharmacokinetics of bromoxynil: The mean concentration of bromoxynil in serum, liver, kidneys and brain as a function of time were determined, and the pharmacokinetic profiles were fitted to a bi-exponential curve according to a two-compartment open model system (Gillette, 1974). The pharmacokinetic parameters were described by the exponential equation: Ct = A0 exp-αt + B0 exp-βt Where: Ct is bromoxynil concentration in the tissue at time t (h), α and β are the rate constants for the first and second phase of the biphasic model, respectively. The pharmacokinetic parameters for bromoxynil in different tissues are listed in Table (2).
DISCUSSION This investigation was carried out to study the pharmacokinetics, tissue distribution and excretion of a single oral dose of bromoxynil in male rats. The present data suggest that the compound was rapidly distributed and then eliminated from the animal. The longest elimination t½was associated with the liver (62.0 h) followed by the brain (60.0 h), while the shortest elimination was associated with the kidneys (34.8 h). Stahler et al (1991) found that the concentrations of bromoxynil measured in serum proceed with a terminal half-life of 20 h after oral administration of two dosages in male and female rats. However, kidneys showed saturation kinetics after oral administration of a high dose (100 mg/kg) in case female rats. AUC values were 9.30, 20.58, 32.69, and 5.74 for serum, liver, kidneys and brain, respectively.
This finding indicates that there was no tendency for the compound to retain in animal tissue. Most of bromoxynil was recovered in the urine (21.90% of the dose) 7 days following administration. The amount of bromoxynil excreted in the feces was 14.11% of the dose. The large amounts excreted in the urine may be due to the high aqueous solubility of the compound. Excretion study of 14C-bromoxynil octanoate in male and female Sprague Dawley rats following different single oral doses showed that Most radioactivity was excreted in the urine (about 84-89% in males and 76-80% in females at 7 days) and considerably lesser amounts in the feces (about 6-10% in both males and females at 7 days)(U.S. Environmental Protection Agency ,2005).The rapid distribution of bromoxynil after oral administration may be indicated by its high aqueous solubility. Therefore, bromoxynil is distributed primarily in body water.
The bromoxynil amount was reached the peak value in the kidneys following 24 h (647.19ng/g), however, it was reached the peak concentrations in the liver (345.15 ng/g), serum(256.09 ng/ml) and brain (67.85 ng/g) after 48 h. Large amounts of bromoxynil that observed in the kidneys during 24 h, indicating that the compound and/or its metabolites may be rapidly excreted in the urine. The absorption and distribution of 14C-bromoxynil octanoate in male and female Sprague Dawley rats given single oral doses indicated that the highest concentrations were observed in blood, plasma, liver and kidneys (U.S. Environmental Protection Agency,2005). They also found that levels of radioactivity in tissues were generally higher in females than in males.
CONCLUSION The study suggested that the herbicide bromoxynil was rapidly distributed in the body and there was no tendency for the compound to retain in animal tissue.
ACKNOWLEDGEMENT The author extends his appreciation to the Deanship of Scientific Research at Majmaah University for funding the work study. Authors also acknowledge the immense help received from the scholars.
Englishhttp://ijcrr.com/abstract.php?article_id=334http://ijcrr.com/article_html.php?did=3341. Agriculture Canada (1989): CAPCO (Canadian Association of Pesticide Control Officials) note on bromoxynil.Ottawa, Ontario: Pesticides Directorate, Agriculture Canada.
2. Bakry, N.M., Abdel-Halim, K.Y. and Salama, A.K. Placental and milk transfer of chlorpyrifos and profenofos in mice. Alex. J. Pharm. Sci. 1999; (13): 29 – 33
3. Bogus, E.R., Watschke, T.L. and Mumma, R.O. Utilization of solid-phase extraction and reversed-phase and ion-pair chromatography in the analysis of seven agrochemicals in water. J. Agric. Food Chem. 1990; 38: 142-144
4. Caldwell, J., Gardner, I., and Swales, N.An introduction to drug disposition: the basic principles of absorption, distribution, metabolism, and excretion. ToxicolPathol. 1995; 23, 102-14.
5. Cessna, A.J. and Grover, R. Exposure of Ground-Rig Applicators to the Herbicide Bromoxynil Applied as a 1:1 Mixture of Butyrate and Octanoate. Archives of Environmental Contamination and Toxicology. 2002; 42(3): 369-382.
6. Deziel, N., Friesen, M., Hoppin, J. Hines, C. Thomas, K. and Freeman, L. (2015). A Review of Nonoccupational Pathways for Pesticide Exposure in Women Living in Agricultural Areas. Environ Health Perspect. 123(6): 515–524.
7. EPA (1974): Manual of analytical quality control for pesticides in human and environmental media. Research Triangle Park, N.C. 27711, USA
8. EPA (1979): Manual of analytical quality control for pesticides in human and environmental media. Research Triangle Park, N.C. 27711, USA
9. Gillette, J.R. The importance of tissue distribution in pharmacokinetics. In: Pharmacology and pharmacokinetics, ed. Toerell, T; Dedrick, R.L.; Canliffe, P.G. 1974;(pp. 209-231) Plenum Press, New York.
10. Inter-Organization Programme for the Sound Management of Chemicals (IOMC) (2004): International Programme on Chemical Safety: The WHO recommended classification of pesticides by hazard and guidelines to classification 2000–2002.
11. Lovecka, P., Thimova, M. Grznarova, P., Lipov, J., Knejzlik, Z., Stiborova, H., Nindhia, T., Demnerova, K., Ruml, T. (2015). Study of Cytotoxic Effects of Benzonitrile Pesticides. Biomed Res Int. 2015: 381264.
12. Salama, A.K. Pharmacokinetic and metabolism of methamidophos in female mice following a single oral administration. Alex. J. Agric. Res. 1992; 37(1): 431-445.
13. Salama, A.K., Bakry, N.M., Aly, H.A. and Abou-Donia, M.B.Placental and milk transfer, disposition, and elimination of a single oral dose of [14C-acetyl] acephate in Sprague-Dawley rats. J. Occupational Medicine and Toxicology. 1992a; 1(3): 265- 274.
14. Salama, A.K., Bakry, N.M., Aly, H.A. and Abou-Donia, M.B. (1992b).Placental and milk transfer, disposition, and metabolism of a single oral dose of [14CH3 S] methamidophos in SpragueDawley rats. J. Occupational Medicine and Toxicology. 1992c; 1(3): 275-291.
15. Salama, A.K., Radwan, M.A. and Bakry, N.M.Pharmacokinetics and excretion of ametryn in rat following a single oral administration. J. Pest Cont. Environ. Sci. 1993; 5(1): 61-76
16. Salama, A.K., Radwan, M.A. and El-Shahawi, F. Pharmacokinetic profile and anticholinesterase properties of phenamiphos in male rats. J. Environ. Sci. and Health B. 1992; 27(3): 307-323
17. Stahler, M., Gericke, S. and Beitz, H. Results of the toxicokinetics of bromoxynil in rats. Zeitschriftfur die Gesamte Hygiene und Ihre Grenzgebiete. 1991;37(2): 56-58.
18. Tomlin, C. D. S., ed. (1997): The pesticide manual: A world compendium, 11th ed. Farnham, Surrey, United Kingdom: British Crop Protection Council.
19. U.S. Environmental Protection Agency (1997): Bromoxynil; Pesticide tolerances. Fed. Reg. 62(85):24065–24073. Available from http://www.epa.gov/fedrgstr/EPA-PEST/1997/May/Day02/p11504.htm.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareTHE EFFECT OF MUCUNA PRURIENS SEED EXTRACT ON PANCREAS AND LIVER OF DIABETIC WISTAR RATS
English6167Rajesh R.English S. Arunchandra SinghEnglish K. Anandraj VaithyEnglish K. ManimekalaiEnglish Dhananjay KotasthaneEnglish S. S. RajasekarEnglishAims and Objectives: The study was to evaluate the remedial effect of alcohol extract of Mucuna pruriens seeds on pancreas and liver of Streptozotocin induced diabetic rats. Materials and Method: Five day old neonate wistar rats (n -24) were used for the study. Out of this, 6 rats were kept as Normal control i.e. Group A. Remaining 18 rats were made diabetic by intraperitoneal injection of streptozotocin (65mg/kg body weight). After 12 weeks, they were divided equally into 3 groups i.e. Group B - Diabetic control, Group C- Mucuna Pruriens group (200mg/kg), Group D - Glibenclamide group (1 mg/kg body weight). Drugs were administered orally for 28 days in group C and D. Blood Glucose Level was monitored once in a week during this period. On completion of drug treatment period, animals were sacrificed for the collection of blood and visceral organs to carry out histological and biochemical investigations. Results: The Mucuna Pruriens seed extract (200mg/kg) were effectively controlled blood glucose levels in diabetic rats. Serum insulin and cholesterol levels were significantly improved when compared to diabetic group (p >0.05). In pancreas, the islets showed increase in beta cell mass and reduced necrotic changes. Liver functions were partially restored and hepatocytes showed minimal necrotic changes. Conclusion: Mucuna pruriens seeds are capable of exerting positive structural changes in pancreas & liver through its antioxidant and antidiabetic properties.
EnglishINTRODUCTION
Diabetes mellitus is considered as one of the most serious threat to human in the twenty first century(1). it is a systemic disease characterized by consistent hyperglycemia by damage to the liver and pancreas .The word diabetes is derived from the Greek word ‘diabetes’ meaning 'siphon' - 'to pass through' and the Latin word ‘mellitus' meaning honeyed or sweet(2). This is because the presence of excess sugar in blood and urine. Sushrutha (6th century BC) identified diabetes and named it as ‘Madhumeha' meaning honey in the urine(3). Of the two types of diabetes mellitus, Type II is more prevalent than the Type I variant. The underlying pathology is defect in the mechanism of insulin secretion and insulin resistance(4) by the damage in the beta cells of pancreatic islets and disturbances in the liver, which hampers carbohydrate, protein and lipid metabolism(5). The free radical formation is also playing a pivotal role in the progress of diabetes (4). The common drugs used in the management of Type 2 Diabetes in the modern medicine are Metformins, Biguinides, Sulphonylurea etc. However, the efficacy of these drugs is limited in long term due to its side effects. In Ayurvedic med icine, Momordica Charantia, (Bitter gourd)(6)(7)(8) Helicterus Isora(9), Curcurmin(10), Trigonella foenum graecum (Fenugreek)(11)are used for the treatment for diabetes. Researches on these herbal drugs documented minimal adverse effects and prevention of the secondary complications (6). Mucuna Pruriens (Linn), a leguminous plant which belongs to fabaeceae family, is found in the tropical regions of India, Africa and West Indies(12). The seeds and leaves of this plant are well known and widely used for the treatment of Erectile dysfunctions(13)(14)(15), Epilepsy and Parkinsonism in Ayurveda. The seeds are rich in fiber content and antioxidants (27). Previous researchers like Anusha et al, Enechi et al and Majekudunni et al studied the biochemical aspects of Mucuna seeds in Type I diabetes. None of these works examined the histological perspective to reveal the structural modifications in pancreas and liver, Moreover no studies have been reported on Type II diabetes in this drug. The present study was undertaken with a novel aim to explore the histological and biochemical aspects of medicinal properties of Mucuna Pruriens seeds in Type II diabetic rats.
MATERIALS AND METHODS
Source of plant extract The ethanolic extract of Mucuna pruriens was procured from Herbal Research Department, VPSV Ayurveda College. Kottakkal, Kerala. Experimental Study Design The experimental protocol was approved by Institutional Animal Ethics Committee (IAEC) of Mahatma Gandhi Medical College and Research Institute, SBV University, Puducherry (686/02/a/CPCSEA). Five-day-old neonate wistar rats (n-24) were received from the Central Animal House of Mahatma Gandhi Medical College and Research Institute. The neonate rats were made diabetic by a single dose i.p. injection of streptozotocin (Sigma Aldrich, U.S.A) (65 mg/kg body weight) dissolved in freshly prepared citrate buffer (0.1M, pH-4.5) (18) (19). After 6 weeks, blood sugar levels [BGL] were measured by using a one-touch glucometer (AccuChek, Roche Diagnostics, USA) and animals showing value > 150mg/dl of BGL were selected for the study. After 12 weeks, rats were classified into four groups of six animals each. Food and water were provided ad libitum to the rats. The groups are as follows Group A – Normal control (Non diabetic rats); Group B – Diabetic control; Group C – Experimental drug (Mucuna); Group D-Standard drug (Glibenclamide).
Mode of feeding of drugs The Mucuna Pruriens (200mg/kg body weight) and glibenclamide (1 mg/kg body weight) administered orally for 28 days in Group C and D respectively. Group A and B were given equal volume of purified water.
Assessments of Biochemical Parameters: The Total Body Weight and Fasting Blood Glucose Levels [FBGL] were measured once in a week during the drug treatment period by using standard glucometer strips with working principle of lactate dehydrogenase method. After the completion of experiment period, all the rats were deprived of food overnight and then sacrificed by painless cervical dislocation under mild chloroform anesthesia. The blood samples were collected in a heparinized tube for biochemical assessments. The parameters evaluated were (A) Serum insulin level-using a standard commercial diagnostic kit with reference values. (B) High Density Lipoprotein , Low Density Lipoprotein and Total Protein were assessed by Spectrophotometric method as per standard laboratory guidelines(20).
Histological studies
Pancreas and Liver were carefully dissected out and fixed in 10% neutral buffered formalin for 48 hours. After processing, the tissues were embedded in paraffin wax. Histological sections were cut at 5micron thickness by using a semiautomatic rotary microtome and stained with H and E. Photographic and Light microscopic studies are carried out by using Olympus research microscope (CX41RF), Germany.
Statistical analysis One-way analysis of variance (ANOVA) (SPSS 15.0) and the related post- hoc test were applied for data investigation. All the observed data are entered, tabulated and shown as Mean ± SD range and P value < 0.05 were identified as significantly different.
RESULTS
A. Blood Glucose Level and Bodyweight. During the experimental period, the animals among the experimental groups and diabetic control groups were ill looking and showed marked weight loss. In diabetic group, there was a significant increase in the blood glucose level on comparison with the normal rats (P-value Englishhttp://ijcrr.com/abstract.php?article_id=335http://ijcrr.com/article_html.php?did=3351. Soumya D, Sreelatha S. Late Stage Complications of Diabetes and Insulin Resistance. J Diabetes Metab. 2011 Dec 25;2(9):PP 2:167.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524184EnglishN2016February21HealthcareEFFECT SIZE ANALYSIS : AN INNOVATIVE METHOD TO POINT ESTIMATE
English5050Mahamed AteefEnglishMillions of publications and duplication of articles have been increased in the recent years. Due to the emergence of internet technology the quality and quantity of scientific material is expected to reach everyone today. The modern technology measures not only the published material but also the evaluation of scientists (H-index) and their role in particular field along with the ranking of field experts and their expertise. These measures and analysis not only determines the impact of scientific work but also the upcoming researchers to choose particular field experts for their ongoing work to yield authenticated outcomes and validation of research performance. In statistical hypothesis testing the work of numerous research data mostly reveals the probable observed difference between the samples in terms of prabability- value. Findings of difference is not the end of any research but the future research analysis would also be based on the treatment of effect size of interventions between the samples, the statistical‘Effect Size’ estimate shows not only the significant difference but also the effect of proposed treatment dose ‘Effect size’ is generally used in statistical analysis and measure of ‘Effect size’provides quality of outcomes of the research1,2
EnglishEffect size, Point estimate, PhysiotherapyINTRODUCTION
Since not only physiotherapy but many discipline of medical sciences involves different methods of treatment interventions, only P-value variability may not serve the purpose of observed/ significant difference to be implemented on patient population but also needs the amount of difference whether it is a large or small ‘effect size’ of interventions between the treatment variables.But if all the researchers do follow and present the concept of effect size analysis in their work, a great phenomenal change would occur to retrieve the best and result oriented material which would be implacable to the patient population. Since randomized control trials are the best methods of establishing trial results, the effect size is one among the evaluating criteria for qualitative methodological research for patient result oriented outcomes3 .Hence, the scientific measure of ‘effect size’ would bring the citation weightage to scientific merit of the research work done thereby effects and raises the true ‘impact factor’ of the concern discipline journals.
ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Conflict of interest: None Source of funding: None
Englishhttp://ijcrr.com/abstract.php?article_id=336http://ijcrr.com/article_html.php?did=3361. Wilkinson, Leland. APA Task Force on Statistical Inference. “Statistical methods in psychology journals: Guidelines and explanations”. American Psychologist.1999; 54 (8): 594–604.
2. Nakagawa S, Cuthill, IC. “Effect size, confidence interval and statistical significance: a practical guide for biologists”. Biological Reviews Cambridge Philosophical Society.2007; 82 (4): 591–605.
3. www.pedro.org.au/english/downloads/pedro-scale