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Pallavi et al., Int J Med Res Health Sci. 2014;3(2):228-232

International Journal of Medical Research

&

Health Sciences

www.ijmrhs.com Volume 3 Issue 2 (April - Jun) Coden: IJMRHS Copyright @2014 ISSN: 2319-5886

Received: 10th

Oct 2013 Revised: 22nd

Dec 2013 Accepted: 4th

Jan 2014

Research Article

EFFECT OF AGE ON TEST PERFORMANCE IN COMMUNITY DWELLING ELDERLY PEOPLE:

6 MINUTES WALK TEST AND TEN STEPS TEST

*Mahajan Pallavi Janardhan1, Mistry Hetal M

2

Department of physiotherapy, Topiwala National Medical College, Mumbai, Maharashtra, India

*Corresponding author email: [email protected]

ABSTRACT

The data available in literature for test performance in elderly people are less and insufficient for use as a basis of

comparison. The aim of the study was to investigate age related changes in functional performance tests and to

determine criterion values depending on age in older adults who are functioning independently in the community.

Aim: To study the effect of age on test performance in 6 Minute Walk Test and Ten Step test in community

dwelling elderly people. Objectives: To assess 6 minute walk distance, time taken to perform ten step test and to

report data within age cohorts. Method: Total 90 subjects were included and divided into 3 groups according to

age group, A-(61-65), B-(66-70), and C-(71-75) in each 30 subjects. 6 Minute Walk Test and Ten Step Test were

performed on them. The data obtained was analyzed using one way ANOVA and post hoc test. Result: The mean

6 MWD in group A was 317.13 ± 35.44 mts, in group B was 297.10 ± 47.14 mts and in group C was 262.83 ±42.14 mts. The 10 Step Test time was found to be 11.36 ± 2.06 sec in group A, 13.24 ± 3.49 sec in group B and

14.74 ± 3.16 sec in group C. The results showed that there is a progressive decrease in the 6 MWD and

progressive increase in the time taken to complete TST with increasing age. Conclusion: From the results it can

be concluded that there is a progressive decrease in the test performance (6MWT & 10 Step test) with age in

community dwelling elderly people. The results of this study can be used as reference values while performing

performance tests for elderly people in the community.

Keywords: 6 minute walk test, 10 step test, Community dwelling

INTRODUCTION

In recent years there has been an increasing

international awareness of health issues relating to

aging populations.1There has been a sharp increase in

the number of older persons worldwide.2,3

According

to the Demographic Profile of Elderly, India carries

15% of world population. The fastest growing age

group by percentage is between 65 – 75 years of age.

With a decline in fertility and mortality rates,

compared with an improvement in child survival and

increased life expectancy, there is a progressive rise

in the number of elderly persons (accepting 60 years

of age as a practical demarcation for defining

elderly). Aging results in significant decline in

muscle power and exercise capacity. Therefore,

elderly often function at the limit of their capacity in

order to fulfill activities of daily living.

Determination of remaining physical capacity is

important in clinical decision making.4

Many

independent older adults often due to their sedentary

lifestyles, function dangerously close to their

maximum ability level during normal activities.

Climbing stairs or getting out of a chair requires the

use of near maximum efforts for many older

individuals. Early identification of physical decline

and appropriate interventions can help to prevent

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functional impairments such as in walking and stair

climbing that often results in fall and physical frailty.5

Quality of life in old age depends to a large extent on

‘being able to continue to do what you want without

pain as long as possible. Being able to perform

everyday activities like personal care, household

work requires the ability to perform functional

movements such as walking, stair climbing, and

standing. These functional movements in turn are

dependent on having sufficient physiological reserve

i.e. strength, balance, endurance, flexibility.

Functional fitness performance is ‘having the

physiological capacity to perform normal everyday

activities safely and independently without undue

fatigue.5

Many senior fitness instructors have been

frustrated with lack of tests available to assess the

functional fitness of older adults particularly tests that

have accompanying performance standards.

The ability to walk for a distance is a quick and

inexpensive measure of physical function and

important component of quality of life. It reflects the

capacity to undertake day to day activities. 6 Minute

Walk Test is used to measure the maximum distance

that a person can walk in 6 minutes. It is a sub

maximal test of aerobic capacity commonly used to

assess cardiovascular and pulmonary function.9

6

MWT can be performed by many elderly frail people

who cannot be tested with standard maximal cycle

ergometer or treadmill tests. 10 Step Test is a test that

measures the time taken by an individual to step up

10 times. It is a simple, reliable test and requires short

time.

However, there is little data available in literature

describing variation in test performance for older

adults who are functioning independently. The

available data are less and often difficult for

clinicians to use as a basis of comparison indocumentation because they are not presented in

terms of age and gender groupings. Hence a study is

needed which will give an accurate range of

measurements on these tests in different age groups.

Thus the aim of the study was to investigate aging

related changes in physical and functional,

performance and to determine criterion values

depending on age in community dwelling elderly

people.

METHOD

After the approval of the Institutional Ethics

committee TNMC, Mumbai, total 90 subjects were

included in the present study and they were divided

into 3 groups based on their age. Group A: age group

of 61-65 years, Group B: age group of 66-70 years

and Group C: age group of 71-75 years of age. N=30

in each group. Type of sampling was a convenience

sampling and the source was an urban population in

South Mumbai.

Inclusion criteria

1. Subjects between 60 to 75 years of age

2. Both male and female

3. Subjects who can tolerate standing, walking for at

least 6 minutes and stepping without any

complaints

4. Not dependent on assistance of another person or

supportive device for walking or stepping

Exclusion criteria

1. Use of any assistive device for walking or stair

climbing

2. Any acute illness in past 3 months

3. Subjects not willing to participate in the study

Outcome measures -1. 6 minute walk test, 2. 10 step

test

Subjects who fulfilled the inclusion criteria were

taken for the study. All procedure was adequately

explained to the patients and written consent was

taken from each one before starting the test.

Procedure: Case record form was filled and

demographic data collected from each subject.

Resting heart rate, respiratory rate, blood pressure

and rate of perceived exertion were taken.

The 6 minute walk test was conducted along a long

hallway. Standardized encouragement was given in

between at 1, 3, and 5 minutes interval. After

completion of test, heart rate, respiratory rate, blood

pressure and rate of perceived exertion were taken

immediately and after 1, 3 and 5 minutes to see the

recovery of subjects to baseline parametersThe 10 step test was conducted after the subject fully

recovered from previous test. The subject was asked

to step one foot onto a block of 10 cm height and then

quickly step down from the block. The same was

done with the opposite foot and was repeated 10

times. The subject was instructed to perform the

stepping sequence as quickly as possible. Similarly,

parameters were taken before and after the test to see

the recovery.

The 6 Minute Walk Test distance and Ten Step Testtime were statistically analyzed using one way

ANOVA with post hoc (Tukey) test.


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RESULTS

Table.1: Table showing 6MWD (mts) in the 3 study groups:

Mean± SD IQR Min Max

Upper

95% CI

Lower

95% CI

Group A 317.13± 35.44 54.0 254 385 330.37 303.9

Group B 297.10± 47.14 65.0 198 380 314.7 279.5Group C 262.83±42.14 64.0 176 332 278.57 247.1

Table.2: Table showing comparison in between the groups in 6MWD

All Pair wise Multiple Comparison Procedures (Tukey Test):

Groups P value

Group A vs. Group B >0.05

Group B vs. Group C


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complete TST with increasing age. The test also

showed high reliability as a test battery.10

Due to

age related changes, the aged are weaker, slower

and less powerful and hence, there is a reduction

in performances requiring the regulating and

coordinating functions of the nervous systems,i.e. balance, reaction time, agility and

coordination. Hence, older people cannot

perform well in almost any type of activity,

except for low intensity activities in which

energy demands are easily met.6

This might be

the reason for increase in TST distance.

Cardiopulmonary fitness and skeletal muscle

mass progressively decline in aged population

and both factors contribute to weakness andfunctional disability in elderly. These changes

might be responsible for the progressive decrease

in 6 MWT with increasing age in our study.

Cardiopulmonary exercise testing is a well

established procedure that provides peak oxygen

uptake as the gold standard in determining

exercise capacity but it is poorly accessible for a

large scale community based investigation.

Among the field tests, 6 MWT and TST are easy

to administer, inexpensive and safe tests that

provide a measure of sub maximal cardio

respiratory or endurance fitness.12

Steffen and Hacker in their study said that the

choice of measurement should be based on how

well the specific problems of a given patient

match the purpose of a given test.8

Rather than

selecting participants who were healthy (free

from any pathologies), older people were

selected who functioned independently withoutassistive devices in the community. People who

were independently functioning seemed to be a

more realistic standard of comparison for the

elderly subjects seen by physical therapists. It

was anticipated that the range of performance on

the tests by such participants would show

substantial variation. Hence, while interpreting

the findings, the characteristics of the subjects

were kept in mind.Thus, this study shows the age related changes in

functional performance in community dwelling

elderly people and provides a criterion related

reference values for functional performance tests

(6MWT and TST).

Clinical implications: To make a tailored

exercise program for elderly people, their

functional capacity should be known andaccordingly exercises should be prescribed. Most

of the Indian population is suffering from one or

the other pathology like osteoarthritis,

spondylosis, diabetes which is not taken into

consideration while planning an exercise

program. Such people seem to be a more realistic

standard of comparison for elderly subjects seen

by physical therapists. The reference values

available in litterateur are mainly for healthyelderly people. If we apply these standard values

to community dwelling elderly, their functional

capacity might be overestimated. In this study,

subjects taken were independently functioning in

community without the use of assistive devices.

Hence, the reference values obtained from this

study can be used as a basis of comparison while

planning an exercise program for community

dwelling elderly people. No research has been

done yet by using combinations of these two

tests (6MWT and TST) in Indian population. The

two tests used in this study are simple to

understand and perform and does not require the

use of any equipment. Walking and stair

climbing are two basic forms of ambulation

required in day to day life. By testing

performance in these activities, one can come to

know the functional capacity of an individual.

Limitations: 1. The sample size was small. 2.Comparison of test values between genders was

not analyzed. Females could have had a

confounding effect on the test results. 3. Subjects

were not compared with different age groups.

CONCLUSION

From the results it can be concluded that there is

a progressive decrease in the test performance

(6MWT & 10 Step test) with age in communitydwelling elderly people. The results of this study

can be used as reference values while performing


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performance tests on elderly people in the

community.

ACKNOWLEDGEMENT

I sincerely thank my H.O.D. and Guide for

inspiring me and guiding me throughout this

project. I thank our Dean whose permission for

the study did it occur. I also thank all subjects

who willingly participated in my study without

whom my study would not be completed. I

would also like to thank my statistician who

helped and guided me in preparing my tables and

graphs.

REFERENCES

1. Szucs TD. Future disease burden in the

elderly: Rationale for economic planning.

Cardiovascular Drugs Ther 2001; 15:359 –

61.

2. Hafez G, Bagchi K, Mahaini R. Caring for

the elderly: a report on the status of care for

the elderly in the Eastern Mediterranean

Region. EMHJ July 2000; 6 (4):636-43.

3. World Population Prospects: The 2002Revision, Highlights. New York: United

Nations Population Division; 2003.

(ESA/P/WP. 180).

4. Ivan Bautmanns , Margareta L, Tony M.

The six minute walk test in community

dwelling elderly: Influence of health status.

BMC Geriatrics. July 2004; 4:6

5. Jesse Jones, Roberta ER. Fitness of Older

Adults. Journal on Active Aging. 2002:24-

30

6. James Skinner. Exercise Testing and

Exercise Prescription for Special Cases. 2nd

Edition. USA: Williams and Wilkins; 2005

Pg no 85-98

7. Kenzo Miyamoto, Hideaki Takebayashi,

Koji Takimoto, Shoko Miyamoto, Shu

Morioka, Fumio Yagi. A New Simple

Performance Test Focused on Agility in

Elderly People: The Ten Step Test.Gerontology 2008;54:365-72

8. Teresa S, Timothy A H, Louise M. Age and

Gender Related Test Performance in

Community Dwelling Elderly People: Six

Minute Walk Test, Berg Balance Scale,

Timed Up & Go Test and Gait Speeds.

American Physical Therapy Journal. Feb2002;82(2):128-37.

9. Guidelines for Six Minute Walk Test.

American Journal of Respiratory and

Critical Care Medicine.2002;166:111-17.

10. Troosters T, Gosselink R, Decramer M.

Six minute walking distance in healthy

elderly subjects. Eur Respir J 1999;14:270-

74

11. Shin S, Demura S. Comparison and ageLevel differences among various step tests

for evaluating balance ability in the elderly.

Archives of Gerontology and Geriatrics.

May June 2010;50(3): 51-54

12. Chien MY, Hsu KK, Ying TW. Sarcopenia,

Cardiopulmonary Fitness And Physical

Disability In Community Dwelling Elderly

People. American Physical Therapy Ass.

2010;90(9):1277-87


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Shazia et al., Int J Med Res Health Sci. 2014;3(2):233-236

Doppler visually reflects the state of blood flow to the

tumor. It is based on Folkman’s theory of

neovascularization6

which states that tumor releases

the factor known as tumor angiogenesis factor which

stimulates rapid formation of new capillaries.

Neovascularisation occurs in malignant tumors and

results in lower pulsatile and resistance index.7

Resistance index is defined as the maximum systolic

velocity minus end diastolic velocity divided by

maximum systolic velocity. Pulsatility index is

defined as maximum systolic velocity minus end

diastolic velocity divided by mean systolic velocity.

Both indices increase with increasing distal vascular

resistance and the two indices have a high correlation.

A comparison of different studies shows that no

standard has been established concerning which

Doppler index to use or what cut off is most

appropriate. However the resistivity index less than

0.4-0.88

and pulsatility index less than 1 are generally

considered to be suspicious of malignancy.8,9

Doppler

ultrasound has yielded variable results in

distinguishing benign from malignant mass with a

sensitivity of 50-100% and specificity of 46-

100%10,11,12

. Different results are partly due to varying

threshold values and corresponding trade-offs between

specificity and sensitivity.

MATERIALS AND METHODS

This prospective study was conducted at Lalla Ded

Hospital, Government Medical College, Srinagar, over

a period of one and half year.100 patients (Women in

reproductive age group and postmenopausal women)

diagnosed with adnexal masses on pelvic examination,

conventional sonography and referred cases of

adnexal masses to our hospital were included in the

study. Prior to the study ethics committee permission

was obtained from our college. An inform consentform was obtained from all the participants.

Exclusion Criterion

Unilocular anechoic small cyst (less than 5

centimeters) which resolves on follow up ultrasound

examination, Tubal gestation, Masses that were found

to arise from uterus .

All the patients were evaluated by colour Dopplerultrasonography using a Philips IU-22 machine with

pulsed Doppler system and equipped with a colour

velocity imaging system for colour blood flow

codification. After characterizing masses by their

morphology, colour velocity imaging gate was

activated to identify blood flow. The resistance index

and Pulsatility index were calculated in each case. The

lowest pulsatility index and resistive index detected at

any point in the mass were considered for analysis.

The masses which were completely avascular with noblood flow were considered as benign.

The Doppler findings were considered suggestive of

malignancy when:

Resistive index (RI) < 0.4513

Pulsatility index (PI)


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Table 2: Mean RI and Mean PI in Benign and Malignant Adnexal Masses

n Mean95% Confidence Interval for Mean

p valueLower Bound Upper Bound

Doppler_RIMalignant 18 0.34 0.30 0.39


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was 84.2%, 96.3% , 84.2% and 96.3% respectively.

Our results are consistent with the studies of Fleischer

et al17

, Timor Tritsch et al18.

CONCLUSION

Colour Doppler sonography has added to theunderstanding and characterization of the adnexal

lesions, based on its depiction of the vascularity of the

masses. Doppler study is effective in the

differentiation of adnexal masses.

REFERENCES

1. Carter J, Saltzman A, Hartenbach E ,Fowler J,

Carson L, Twiggs LB. Flow characteristic in

benign and malignant gynaecological tumors

using transvaginal colour flow Doppler. Obstet

Gynecol 1994; 83(1): 125-30

2. ACOG. Practice Bulletin. Management of adnexal

masses. Obstet Gynecol 2007; 110(1): 201-14.

3. Drake J. Diagnosis and management of the

adnexal mass. Am Fam Physician. 1998; 57(10):

2471-76

4. Gallup DG, Talledo E. Management of the

adnexal mass in the 1990s. South Med J. 1997;

90(10): 972-81

5. EC Hill. Gynaecology in current surgical

diagnosis and treatment. East Norwalk, conn:

Appleton and Lange 1994: 1004-07

6. Folkman J, Watson K, Igber D, Hassahan D.

Induction of angiogensis during transition from

hyperplasia to neoplasia. Nature 1989; 339: 58-61.

7. Goldstein SR. Conservative management of small

postmenopausal cystic masses. Clin Obstet

Gynecol 1993; 36: 395-401

8. Hamper UM, Sheth S, Abbas FM, Rosenshein

NB, Aronson D, Kurman RJ. Transvaginal colour

Doppler sonography of adnexal masses:differences in blood flow impedance in benign

and malignant lesions. Am J Roentgenol 1993;

160: 1225-28

9. Stein SM, Laifer Narin S, Johnson MB, Roman

LD, Muderspach LI, Tyszka JM, Ralls PW.

Differentiation of benign and malignant adnexal

masses, relative value of gray scale colour

Doppler and spectral Doppler sonography. Am J

Roentgenol 1995; 164: 381-86

10. Salem S, White LM, Lai J. Dopler sonography of adnexal masses, the predictive value of the

pulsatility index in benign and malignant diseases.

Am J Roentgenol. 1994; 163: 1147-50

11. Hata K, Hata T, Manalse A, Sugimora K, Kiato

M. A critical evaluation of transvaginal colour

studies, transvaginal sonography, MRI and CA

125 in detecting ovarian cancer. Obstet Gynecol

1992; 80: 922-26

12. Lerner JP, Timor Treitsch TE, Federman A,

Abramouich G. Transvaginal ultrasonographic

characterization of ovarian masses with improved

weighted scoring system. Am J Obstet Gynecol

1994; 170: 81-85

13. JL Alcazar, T Errasti, A. Zornoza, JA Minguez, M

J Galan. Transvaginal colour doppler

ultrasonography, and CA 125 in suspicious

adnexal masses. Int J Gynecol and Obstet 1999;

66: 255-61

14. Curtin JP. Management of the adnexal mass.

Gynecol Oncol 1994; 55: 542-46

15. Luxman D, Bergamn A, Sagi J, David M. The

postmenopausal adnexal mass: correlation

between ultrasonic and pathological findings.

Obstet Gynecol. 1991; 77: 726

16. Tekay A, Jouppila P. Validity of pulsatility and

resistance indexes in classification of adnexal

tumors with transvaginal colour Doppler

ultrasound. Ultrasound Obstet Gynecol. 1992; 2:

338-44

17. AC Fleischer, JA Cullinan, HW Jones, W Peery,

RF Bluth, DM Keppler. Serial assessment of

adnexal masses with transvaginal colour Doppler

sonography. Ultrasound in Medicine Biology.

1995; 21(4): 435-41

18. Timor-Tritsch LE, Lerner JP, Monteagudo A,

Santos R. Transvaginal ultrasonographic

characterization of ovarian masses by means of

colour flow directed measurement andmorphologic scoring system. Am J Obstet

Gynecol 1993; 168: 909


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Surya et al., Int J Med Res Health Sci. 2014;3(2):237-240


&

Health Scienceswww.ijmrhs.com Volume 3 Issue 2 (April - Jun) Coden: IJMRHS Copyright @2014 ISSN: 2319-5886

Received: 11th Nov 2013 Revised: 24th Dec 2013 Accepted: 5th Jan 2014Research Article

GONIOSCOPIC CHANGES IN CONVENTIONAL ECCE VS MANUAL SICS: A COMPARATIVE

STUDY

Surya Joseph1, Sundararajan D

2, *Rajvin Samuel Ponraj

3, Srinivasan M

4, Veluchamy

5

1Senior Resident,

2Associate Professor,

3Postgraduate,

4Professor

, 5Senior resident Dept of Ophthalmology,

Meenakshi Medical College, Kanchipuram, Tamilnadu, India


ABSTRACT

The aim of the study is to observe and compare the Gonioscopic changes in the angle of the anterior chamber of

the eye after surgeries namely; Conventional Extra capsular cataract extraction (ECCE) with Posterior chamber

Intraocular lens (PC IOL) implantation, Manual Small incision Cataract Surgery with PCIOL implantation. The

clinical study was undertaken after Institutional Ethical committee clearance, securing the inform consent, total

number of 100 patients were enrolled in the study. 50 ECCE; 50 SICS consisting of 57 Males and 43 Females

aged between 40 - 80yrs who were admitted and operated for Cataract at Meenakshi Medical college Hospital &

Research institute. The following parameters are studied: Gonioscopic changes in the angle, namely the PAS

formation in the quadrants, pigment dispersion in each of the methods. After this study, we arrive to a conclusion

that complications in the angle of anterior chamber occur mostly in Conventional with insignificant change inmanual SICS. So manual Small incision Cataract Surgery with PCIOL implantation is preferable over

Conventional ECCE with PCIOL implantation.

Keywords: Gonioscopy, Peripheral anterior synechiae, Scheie’s classification, Pigment dispersion,

Malpositioning of the Superior Haptics

INTRODUCTION

Cataract is the leading cause of Reversible Blindness

in our country. The ultimate goal of a cataract surgery

is to restore and preserve the pre cataract vision andto alleviate the other cataract related symptoms. In

the quest for perfection, the techniques and

approaches followed by cataract surgeons have

constantly changed over the years.

Hence the realistic portrayal of the trends in cataract

surgery can be best described as a wide spectrum,

ranging from Intra Capsular Cataract Extraction

(ICCE) to Phaco Emulsification. Such a diversity of

trend is governed by multiple factors, the most

pertinent of which are economical, patients'

awareness, surgeon’s caliber, availability of

equipments and the cataract backlog.

The current surgical trend for the majority of

surgeons in the developing world is towards

Conventional Extra capsular cataract extraction(ECCE) with PC IOL implantation. Small Incision

ECCE techniques are becoming quite popular for

those who have accepted the challenges of transition

towards a better technique. Perhaps about 5-10% of

the cataract surgeons in India routinely perform

Phaco. The advent of Phaco emulsification has

minimized the size of the incision and its related

complications, with an added benefit of early

stabilization of refraction.

The main objective of this study is to observe and to

compare the Gonioscopic changes in the angle after

conventional ECCE with PC IOL implantation and

DOI: 10.5958/j.2319-5886.3.2.052


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Surya et al.,

Small Incision Cataract Surgery

attempt has been made to note an

these changes and the possible

changes over the Intra Ocular Pre

Acuity.

Aim of the study: The main objecti

to observe and compare the Gonios

the angle after

Conventional ECCE with PC IOL i

Manual Small incision Cataract Sur

PC IOL implantation

An attempt has been made to note t

these changes and the possible

changes over the Intra Ocula

Postoperative Visual acuity.

MATERIALS AND METHOD

This clinical study was undertaken

ECCE; 50 SICS consisting of 5

Females aged between 40 - 80yrs w

and operated for Cataract at Me

college Hospital & Research institut

the inform consent, total number of

enrolled in the study.

Institutional Ethical clearance ha

before initiating the study. Patien

observing all proper inclusion and e

Inclusion criteria: No past history o

accidents, Diabetic patients with a

than 10 years, Non- Prolife

retinopathy, Best corrected visual ac

Exclusion criteria: Cataract, Gla

opacities or any evidence of optic at

nervous system disease, Prolif

retinopathy

Gonioscopic changes in the angle

chamber by Shaffer grading while dplane mirror gonioscopy. Based

posterior structure visible in the

Peripheral Anterior Synechiae f

quadrants, Pigment dispersion in

SICS.

Partial or complete closure Grade 0

≤10° angle of approach Grade I AC‡

20° angle of approach Grade II AC

20° – 35° angle of approach Grade III

35° – 45° angle of approach Grade IV

Int J Med Res Health

ith PCIOL. An

y progression of

effects of these

ssure and Visual

ve of this study is

copic changes in

plantation

gery (SICS) with

he progression of

effects of these

Pressure and

in 100 Eyes- 50

Males and 43

ho were admitted

enakshi Medical

. After Securing

100 patients were

s been obtained

ts were enrolled

clusion criteria.

f cerebrovascular

duration of less

rative Diabetic

uity at least 6/9

ucoma, Vitreous

rophy, Peripheral

erative diabetic

of the anterior

oing Goldmann 3 upon the most

ngle. Namely

rmation in the

CCE as well as

< 1/4 CT§

1/4 CT

AC = 1/2 CT

The Scheie’s method o

was followed. Larger n

amount of pigmentation.

Scheie classification

Grade 0 – Entire angle v

wide ciliary body band

Grade I - Last roll of iris

body

Grade II - Nothing poste

visible

Grade III - Posterior por

hidden

Grade IV - No structures

visible6.

RESULTS

Fig 1: Age-sex wise gro

Fig 2: Incidence of perip

ECCE

PAS formation was obse

which underwent conve

implantation. Superior a

Inferior angle PAS in 5

eyes that underwent SIC

238

ci. 2014;3(2):237-240

f grading TM pigmentation

umbers represent increasing

isible as far posterior as a

obscures part of the ciliary

rior to trabecular mesh-work

ion of trabecular mesh-work

posterior to Schwalbe’s line

p distribution graph

heral anterior synechiae in

rved in 28 eyes of 50 cases,

tional ECCE with PC IOL

ngle PAS noted in 23 eyes.

eyes. No PAS was seen in


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Surya et al.,

Fig 3: As overlying the lens haptics p

in angle structure

20 eyes showed PAS overlying th

IOL. Which accounts to 71.4%.

Haptics PAS were observed eaoperative period (3 Months) and rem

Fig 4: Incidence of pigment disper

DISCUSSION

The incidence of PAS in the presen

which is comparable to 54% observ

Liu.Y, et al in “Gonioscopic

posterior chamber IOL implantati

observed by Maden A, Gunenc U“Gonioscopic changes in eyes with

was seen in eyes in which SICS

(Capsular Bag Fixation of IOL)

Involvement of the Superior angle

suggested by 46% of PAS in the S

to malpositioning of the Sperior

ciliary Sulcus).

PAS were seen more frequently wit

vertical position than in Eyes

oriented Lens Haptics

3

.PAS overlying the Haptics of PC I

in 20 eyes (71.4%) in this study is c

Int J Med Res Health

igment dispersion

e Haptics of PC

ost of the lens

ly in the Post ain stable in size.

sion

t study was 56%,

d by Lis, Liao R,

bservation after

ion” and 41.8%

, Erkin E et al10

C IOL” No PAS

was performed a

is prominent as

perior angle due

Haptics (in the

h Lens Haptics at

ith horizontally

L was observed

mparable to 80%

observed by R Blair

Haptics of PC Lenses”

possessed a distinct m

marked anterior displace

broad iris apposition to t

more anterior angle struc

Most of the lens haptic

the Postoperative peri

progression in size was

rise in IOP attributable

changes in the postop

observed secondary to

Pigment dispersion is e

chafing effect of the len

aspect of iris and also d

Interestingly, it’s also no

limited clumping of pig

in 40 eyes (40%) compa

Maden A, Gunenc “Goni

PC IOL”. Inferior angl

due to gravitational settli

28 eyes with PAS had pa

related to the positio

compared to 88% of ey

Liu Y. Guoy & Pan H5

After three months, p

Cortex still existed in

PCIOL.

This study was under

suggestion that routine

should be performed afte

CONCLUSION

Conventional Extra Caps

PC IOL implantation si

alters the Gonio Anatom

to Small Incision CataracDecrease in the incision

cornea with a self- se

and a Corneal lip preven

the Bag fixation of IOL

pigment dispersion int

incidence of changes in t

Continuous Curvilinear

important for proper cap

(P


13/281

240

Surya et al., Int J Med Res Health Sci. 2014;3(2):237-240

REFERENCE

1. Chen Weirong ,LIU Yizhi, Wang Ningli Guo

Yan, HE Mingguang , Comparison of the efftypes

of intraocular lens, Chinese Medical Journal

2001;114(12):1286-89

2. Maden A, Gunenc V, Erkin E. Doc. Ophthalmol,‘Gonioscopy changes in eye with posterior

chamber intraocular lens’ by. 1992, 82(3), 231-8.

3. Peripheral anterior synechiae overlying the

haptics of posterior chamber lenses’ Occurrence

and Natural history, Ophthalmology 1990, 97:

415-23.

4. Evans RB. Peripheral anterior synechiae

overlying the haptics of posterior chamber lenses.

Occurrence and natural history’,Ophthalmology

1990: 97(4), 415-23.5. LiaoR, LiS, LiuY, Guo Y, Pan H, Tao X. The

relation of the location of haptics of posterior

chamber intraocular lenses and peripheral

anterior synechiae’ by. Source: Medicine: PMID:

8575604, UI: 96148006.

6. Steven V. L Brown., Basic and Clinical Science

Cours e, Faculty, Section 10, Steven T. Simmons,

MD, Steven V. L. Brown, Consultants William

LH, Janis ER. Gonioscopy in the Management of

Glaucoma James A. Savage, MD , Focal PointsAmerican Academy of Ophthalmology.

2006;XXIV: (Section 3 of 3)


14/281

241

Karthick et al., Int J Med Res Health Sci. 2014;3(2):241-244


&

Health Sciences

www.ijmrhs.com Volume 3 Issue 2 (April - Jun) Coden: IJMRHS Copyright @2014 ISSN: 2319-5886Received: 13

thDec 2013 Revised: 8

thJan 2014 Accepted: 10

thJan 2014

Research Article

HISTOLOGICAL AND HISTOMETRIC STUDY OF TESTIS IN ALBINO RATS TREATED WITH

AMLODIPINE

*Karthick S, Harisudha R

Department of Anatomy, Melmaruvathur Adhiparasakthi Institute of Medical Science & Research,

Melmaruvathur, Tamil Nadu, India


ABSTRACT

Amlodipine is the most common drug of choice to treat hypertension, one of its side effects is infertility and its

effect on the testis of male albino rats is not well documented. Aim: To observe the effect of amlodipine in testis

of male albino rats by the histological and histometric method. Materials& Method: we selected 12 adult male

albino rats divided into 2 groups, group 1 treated as control group 2 treated as experiment and amlodipine is

administered for 30 days. After 30 days testis were removed and analysed histologically and histometrically.

Result: Though there are no marked changes, but early degenerative changes and reduction in weight of testis of

experimental rats observed. Conclusion: Presence of vacuolated spermatogenic cells in some of the seminiferous

tubules indicates early degeneration and arrest of spermatogenesis.

Keywords: Hypertension, Infertility, Amlodipine Side Effects.

INTRODUCTION

Hypertension is one of the leading causes of the

global burden of disease. Approximately 7.6 million

deaths (13 – 15% of the total) and 92 million

disability-adjusted life years worldwide were

attributable to high blood pressure in 2001.1

Hypertension doubles the risk of cardiovasculardiseases, including coronary heart disease (CHD),

congestive heart failure (CHF), ischemic and

hemorrhagic stroke, renal failure, and peripheral

arterial disease.1The burden of hypertension increases

with age and among individuals aged ≥ 60, i ts

prevalence is 65.4%. Amlodipine has become the

second drug of choice for hypertension2, though its

side effect on infertility has been proved to some

extent.3,4

The exact mechanism of amlodipine causing

infertility in male remains to be completelyelucidated moreover, its effect on the microscopic

structure of the testis is not well documented

histometrically, and therefore it has been planned to

observe histological observation of testis, histometric

analysis of testis, determine the weight of testis.


A total of 12 adult male albino rats was obtained from

the central animal house, Rajah Muthiah Medical

College, Annamalai University, which were

maintained under standard laboratory conditions at

28±2°C were provided with standard rat diet and

water ad libitum. After getting ethical committee

clearance, the animals were divided into 2 groups.

Group I comprised of 6 animals; Control: received

vehicle only (0.01% ethyl alcohol) and group II

comprised of 6 animals; Experimental (Test group):

received amlodipine orally (0.45mg/kg/day) given for30 days. All the animals were sacrificed after 30 days

DOI: 10.5958/j.2319-5886.3.2.053


15/281

Karthick et al.,

of the experimental period, the testi

trimmed free of adipose tissue and

The weight of the testis was reco

were fixed in Bouin’s fluid for a t

hours. After fixation, the tissues w

light microscopy, the tissues w

Haematoxylin and Eosin and Mas

stain for connective tissue. The st

testis were examined in low power

power (x400). Qualitative evaluati

sections were supplemented by the

quantitative testicular biopsy score

Johnson (1970) to estimate the ex

alterations. For histometric assessm

emphasized by Hans Elias and Paul

as Weibel and Hans Elias (196

employed for estimating the volume

of various tissue components. Volu

and stroma were estimated by poin

eyepiece reticule with low ma

formula used for estimation of volu

Where Vi = volume of tissue co

volume of tissue, Pi = number of p

tissue component, PT = total numbe

reticule. The height of the secretor

the diameter of tubules was measur

micrometer with high magnification.

Statistical Analysis: Using latest HP

RESULTS

There is a decrease in weight of

experimental rats than the control

table 1. Histological observation

there was no testicular alteration a

was intact with normal sperm

experimental animals, when companimals. However, on closer exami

power revealed an interesting find

group animals.

Fig 1: Sections of testis Control and tes

Int J Med Res Healt

is were removed,

onnective tissue.

ded. The organs

otal period of 24

re processed for

re stained with

son’s Trichrome

ined sections of

(x 100) and high

ons of testicular

use of the semi

count (TSBC) of

tent of testicular

nt the principles

ly (1996) as well

7) were strictly

and surface area

e of parenchyma

t count using the

gnification. The

e (Vi = Pi / PT)

ponent per unit

ints touching the

r of points in the

y epithelium and

d using as ocular

SS software

the testis of the

rats presented in

f testis revealed

d the epithelium

atogenesis from

red with control ation under high

ing in these test

t rats (H &E 100X)

Fig 2: Testis control and te

100X)

Fig 3: Sections of testis fGieson’s stain 100X)

Fig 4: Sections of seminifer

(H& E 400X)

Arrow (test) shows early

spermatogenic cells

Fig 6: Seminiferous tubules

trichrome 400X)

Arrow (test) shows early

spermatogenic cells

Fig 7 : Seminiferous tubule

Gieson’s 400X)Arrow in (test) shows ea

spermatogenic cells

242

Sci. 2014;3(2):241-244

t (Masson’s trichrome stain

rom control and test (Van

ous tubules from control , test

fatty degeneration of

from control, test (Masson’s

fatty degeneration of

s from control, test (Van

ly fatty degeneration of


16/281

243


Table 1 : Weight of testis, Volume of tissue components (values are expressed as Mean ± SEM)

Animal group Testis

(grams)

Volume of tissue components Diameter of

Seminiferous Tubules

(µm)Seminiferous

tubules (mm3 /mm

3)

Connective tissue

(mm3 /mm

3)

Leydig cell

(mm3 /mm

3)

Control 1.2595 0.7747 ± 0.0216 0.1309 ± 0.0245 0.0719 ± 0.0075 279.64 ± 10.922*

Test group 0.9109 0.6764 ± 0.0233 0.2342 ± 0.0233 0.0867 ± 0.0087 268.45 ± 16.19*

* - p < 0.05

There was the presence of vacuolated spermatogenic

cells interspersed among the seminiferous epithelium.

(Fig 2). Histometric data of testicular tissue

components are summarized in table 1. The

quantitative analysis of various tissue components of

the testis showed no significant change in any

component. But the diameter of seminiferous tubules

showed a significant increase in testis of experimental

(Test group) animals when compared to those of

control animals.

DISCUSSION

The anti-reproductive effect of amlodipine on male

reproductive organs varies from decrease in weight of

testis, epididymis, seminal vesicle and prostate,

decrease in hormone levels of testosterone, FSH andLH, and partial / complete arrest of spermatogenesis

by de-regulation of Ca2+ homeostasis, loss of libido

and erectile dysfunction. In our present study, we

observed that sacrificed rats after 30 days of

treatment with amlodipine showed a reduction in the

weight of testis. This finding is in agreement with the

findings of many investigators. Rabia et al. 5

showed a

significant drop in absolute testicular weight, gonado

– somatic index and serum testosterone levels in rats

after amlodipine treatment. Similar anti reproductiveeffects were described by Ayodele O et al., Benoffet

al.6,7

. They noticed altered serum parameters

(reduction in sperm count & motility) The drug may

not have a direct effect on Leydig cells, as the present

study shows that Leydig cells are not affected

histologically and histometrically in the treated

animals. It appears that, the mode of action of this

calcium channel blocker is through hypothalamo –

hypophyseal – testicular axis by altering either the

release of GnRH from hypothalamic neurons or the

release of gonadotrophins from the pituitary, this can

be augmented by the findings of Bourguignon JP, et

al.8

Who showed that in the presence of calcium

channel blockers, the release of GnRH was marked

and reversibly reduced. Lee JH et al9told nifidepine

causes male infertility by deregulation of Ca2+

homeostasis in testis of mice and arrest of

spermatogenesis. Juneja.R et al., Suresh C. Joshi et

al.10,11

also told calcium channel blocker causes

decrease in sperm density, sperm motility and cellular

energy content in guinea pigs. Histopathological

findings exhibited partial arrest of spermatogenesis in

experimental animals. With above findings, we

carried the present work i.e degenerative changes

occurring in the seminiferous epithelium indicate that

the amlodipine causes partial arrest of

spermatogenesis due to the deregulation of Ca2+

homeostasis. This partial arrest of spermatogenesis isdue to degeneration of spermatogenic cells observed

by us and is supported by reduction in weight of

testis. Although marked changes were not observed

in the histological structure of testis under low power,

early degenerative changes were noticed in the

seminiferous epithelium under high power this

indicates the beginning of the arrest of

spermatogenesis. Probably the complete arrest may

be noticed after long term treatment for more than 64

days as the spermatogonia takes 64 days to becomemature spermatozoa.

CONCLUSION

The following conclusions are arrived at from the

findings of our study on effect of amlodipine on testis

in albino rats. There is a marked decrease in weight

of testis, which may be correlated to decrease in

spermatogenesis as evidenced from the sparse content

of the spermatozoa presence of vacuolated

spermatogenic cells in some of the seminiferoustubules indicates early degeneration and arrest of

spermatogenesis. Further the mode of action of the


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drug is probably through hypothalamo – hypophyseal

– testicular axis as the Leydig cells parameters are not

disturbed in the experimental animals, and a long

term study is planned to identify the effects caused by

amlodipine.

ACKNOWLEDGEMENT

I will convey special thanks to my professor

Dr.J.P.GUNASEKARAN to given me an immense

support and valuable needy guidance for this work.

REFERENCES

1. Harrison. Principles of Internal Medicine. The

McGraw-Hill Companies, 2013;18th

edi; 247

2. http://www.nhs.uk/Conditions/Blood-pressure-

(high)/Pages/Treatment.aspx3. Almeida SA, Teofilo JM, AnselmoFranci JA,

Brentegani LG, Lamano TL. Antireproductive

effect of the calcium channel blocker amlodipine

in male rats. Exp Toxic Pathol 2000; 52: 353 – 56

4. Yoshida J. Amlodipine besylate. Eur J

Pharmacol. 2003;472:23 – 31

5. RabiaLatif, Ghulam Mustafa Lodhi, Muhammad

Aslam. ffects of amlodipine on serum

testosterome, testicular weight and gonado

somatic index in adult rats. J Ayub Med Coll

Abbottabad 2008;20(4):8-10

6. Ayodele O, Morakinyo, Bolanle O, Iranloye,

Olufeyisipe A, Adegoke.“Antireproductive effect

of calcium channel blockers on male rats. Reprod

med biol 2009;8(3): 97-102

7. Benoff S, Cooper GW, Hurley I, Mandel FS,

Rosenfeld DL, Scholl GM, Gilbert BR, Hershlag

A. “The effect of calcium ion channel blockers on

sperm fertilization potential. Fertility Sterility.

1994 ; 62(3):606-11

8. Jean-pierre bourguignon, Arlettegerard,

Georgette debougnoux, Joan rose and Paul

franchimont. Pulsatile release of GnRH from the

rat hypothalamus in vitro: calcium and glucose

dependency and inhibition by

superactiveGnRHanalogs. Endocrinology

1987;121: 993 – 99.

9. Lee JH, Kim H, Kim DH, GyeMC. Effects of

calcium channel blockers on the spermatogenesis

and gene expression in peripubertal mouse testis.

Arch Androl., 2006; 52(4):311-8.

10. Juneja.R, I. Gupta, A. Wall, S.N. Sanyal, R.N.

Chakravarti, S. Majumdar. “Effect of verapamil

on different spermatozoal functions in guinea

pigs — A preliminary study”. Contraception;

1990; 41 (2):179-87.

11. Suresh C. Joshi, Reena Mathur, Anita Gajraj,

Tripta Sharma. Influence of methyl parathion on

reproductive parameters in male rats.

Environmental Toxicology and Pharmacology ;

2003;14(3):91-98


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Sudharshan Int J Med Res Health Sci. 2014;3(2):245-249


&

Health Sciences




thJan 2014

Research article

CLINICAL PROFILE AND ANTIBIOTIC SENSITIVITY PATTERN OF TYPHOID FEVER IN

PATIENTS ADMITTED TO PEDIATRIC WARD IN A RURAL TEACHING HOSPITAL

Sudharshan Raj C*

Dept. of Pediatrics MNR Medical College, MNR Nagar, Narsapur road, Sanga Reddy, Andhra Pradesh,


ABSTRACT

Introduction: Typhoid is a major endemic health problem among children in India. The last two decades have

witnessed the emergence and spread of multidrug resistance against conventional anti typhoid drugs (Ampicillin,

chloramphenicol and trimethoprim – sulfamethoxazole) especially in the South and South-East Asia. Materials

and Methods: Children under twelve years of age with signs and symptoms suggestive of enteric fever were

included in this study. Blood cultures were carried by collecting aseptically 5ml of blood and inoculating into bile

broth and subcultured onto blood agar and Mac Conkey agar. Antimicrobial sensitivity performed according to

CLSI guidelines. Widal test was performed. Other investigations like haemoglobin, total count and differential

count of WBC, ESR were carried out. Results: The incidence of enteric fever in this study was 3%. The

maximum children were in age group more than 5 years. Maximum cases were admitted during June-September.

The most common symptoms were fever, anorexia, vomiting, and pain abdomen. The culture positivity of

Salmonella typhi (S.typhi) was 35.4%. The overall positivity of Widal test was 89.8%. Multidrug resistant isolates

in this study was 53.6%. Conclusion: Majority of the children were greater than 8 years old. Fever (intermittent

type), anorexia, vomiting were the three major symptoms. Among the signs spleenomegaly, hepatomegaly, coated

tongue and toxemia were common. Relative bradycardia was not seen. Widal test was found positive in the

majority of cases. Blood cultures were positive mainly in the first week of illness. The sensitivity pattern of

S.typhi revealed significant proportion of multidrug resistant strains and simultaneous presence of

chloramphenicol sensitive and resistant strains in the study.

Keywords: Typhoid, Salmonella typhi, multidrug resistant.

INTRODUCTION

Typhoid fever, also known as enteric fever is caused

by the Gram negative bacterium Salmonella enterica

serovar Typhi. The disease is mainly associated with

low socioeconomic status and poor hygiene, with

human beings the only natural host and reservoir of

infection.1

Estimates for the year 2000 suggest that

there are approximately 21.5 million infections and 2,

00,000 deaths from typhoid fever globally eachyear.

2-4

Typhoid is a major endemic health problem among

children in India. The last two decades have

witnessed the emergence and spread of multidrug

resistance against conventional antityphoid drugs

(Ampicillin, Chloramphenicol and Trimethoprim –

Sulfamethoxazole) among typhoid Salmonellae,

especially in South and Southeast Asia.5,6

Typhoid

fever caused by such multidrug-resistant (MDR)strains of Salmonella enterica serotype Typhi

presents a serious problem in many developing

DOI: 10.5958/j.2319-5886.3.2.054


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246


countries.7,6

It has left fluoroquinolones as the

antimicrobial agents of choice for the treatment of

typhoid fever.8

Fluoroquinolones, especially

ciprofloxacin, have been in use for more than 18

years and have remained an important weapon

against typhoid infections. Effective antimicrobial

therapy is required to control morbidity and prevent

death from typhoid.

This study aims to know the clinical profile of

pediatric enteric fever and the sensitivity of the

disease to drugs in this region.


The prospective study was carried out in a rural

teaching hospital over a period of one year.

Data regarding admitted children below 12yrs of agewith signs and symptoms suggestive of enteric fever

and fulfilling any of the following criteria were

included in the study.

Inclusion criteria:

1. Positive culture for Salmonella typhi

2. Widal titre;TO and TH>=1:160

3. Fourfold or greater rise in Widal titres.

Thorough and detailed history, clinical examination

and laboratory investigations were done in all cases.

The following investigations were done:

Routine investigations: Haemoglobin estimation,

Total and differential count for white blood cells,

Erythrocyte sedimentation ratio, Urine and stool

examination, Other investigations such as a chest X

ray, liver function test, abdominal sonography were

done where ever required

Bacterial cultures: Blood cultures were carried out

by collecting aseptically 5ml of blood and added to

50ml of bile broth, incubated at 37°C for 24hrs.

Initial subculture was made after 24hrs and if found

negative, further sucultures were made after 48hrs,

4days and 7 days. Positive growths were subjected to

standard biochemical tests.9Species confirmation was

done by agglutination with high titre sera.

Stool specimens were plated directly onto

MacConkey and Salmonella, Shigella agar (SS), and

inoculated into Selenite F broth for enrichment. The

identity of isolates was confirmed by standard

biochemical tests9

and slide agglutination with

specific antisera.

Widal test: The Widal tube agglutination test was performed according to the manufacturer’s

instruction, using Tidal (Span diagnostics) containing

O and H antigens of S. typhi and S. paratyphi A and

S.paratyphi B. Positive and negative serum controls

were included, a titre of ≥1/160 to either antigen in a

single serum specimen (in addition to the

seroconversion) was taken to be indicative of typhoid

fever. The results were correlated with blood culture

results and interpreted in conjunction with the

patient’s history and recent clinical presentation on

admission.

Antimicrobial susceptibility testing: Susceptibility

to antimicrobial agents was performed using the

Kirby Bauers disc diffusion method as described by

the Clinical and Laboratory Standards Institute.10

Antimicrobial agents (discs) tested and reported were

obtained from Hi media and included: ampicillin

(10μg), trimethoprim – sulfamethoxazole

(25/23.75

μg), chloramphenicol (30

μg), ceftriaxone

(30μg) , ciprofloxacin (5μg), cefixime(30μg) and

cephalexin(30μg). MDR isolates of S. typhi were

those resistant to all three first line antityphoid drugs

(ampicillin, chloramphenicol and trimethoprim –

sulfamethoxazole).

RESULTS

In this study a total number of 79 cases of enteric

fever in children 12 years or less, admitted to the

pediatric ward were studied. Total number of

admissions in the pediatric ward during this period

was 2601 so the incidence was 3%.

The maximum children were in the age group of

more than 5 years (50, 63.3%). The youngest child in

this study was 13 months old.

Among the children affected 42 were males and 37

females. The male to female ratio was 1.1:1. Cases

were admitted throughout the year showing the

endemicity of the disease. Maximum cases were

admitted during June-September 36 (45.6%)

(Table1).

The most common presenting symptom was fever 79

(100%) followed by anorexia 43 (54.4%) and

vomiting 38 (48.1%), pain abdomen 21 (26.6%),

loose motions 10 (12.6%), altered sensorium 10

(12.6%). In this study maximum cases 35 (49.3%)

had fever for 8-14 days prior to admission. Almost

half the cases 39 (49.4%) showed intermittent type of

fever. The signs of enteric fever in this study were

(table2).


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Complications seen in this study were bronchitis 9

(11.3%), encephalopathy 7 (8.9%), cholecystitis 5

(6.3%), enteric hepatitis 3 (3.8%), shock 2 (2.53%)

and paralytic ileus 1 (1.26%).

Routine investigations: In this study haemoglobin <

10gm/dl was found in 41.8% of cases. Majority of the

children had WBC count in the range 5000-10000/cu

mm (70.9%).

Table 1: Month wise distribution of cases

Month No. of cases Percentage

January 05 6.3%

February 04 5.1%

March 04 5.1%

April 05 6.3%

May 07 8.8%

June 08 10.2%July 08 10.2%

August 12 15.2%

September 08 10.2%

October 05 6.3%

November 06 7.6%

December 07 8.8%

Total 79 100%

Table 2: Signs of enteric fever

Signs Number of

cases

Percentage

Tachycardia 64 81%

Spleenomegaly 54 68.4%

Hepatomegaly 44 55.7%

Coated tongue 41 51.9%

Pallor 41 51.9%

Table 3: Antibiotic resistance pattern of

salmonella typhi

Antibiotic Number n =

28

Percentage

Multi drug resistant 15 53.6%

Chloramphenicol 18 64.2%

Ampicillin 25 89.3%

Co-trimoxazole 27 96.4%

Ciprofloxacin 28 00%

Ceftriaxone 28 00%

Cefixime 28 00%

Cephalexin 13 46.4%

In this study S.typhi was isolated in 28 out of 79

cases (35.4%), 17 (53.1%) cases were Widal positive

in 1st

week showed TO & TH >1:160.The positivity

increased in 2nd

and subsequent weeks (91.4% &

100% ) respectively. Among 15 cases which were

widal negative in first week 9 cases (60%) showed

rise in titres. The overall positivity of Widal test was

89.8%. The sensitivity of the Widal test was 71.4%.

Antibiotic resistance pattern in this study was (table

3)

DISCUSSION

The incidence of enteric fever in this study was 3%,

which was in accordance with the studies conducted

by Pohawalla et al who also reported an incidence of

3%11

but Bavdekar etal reported 23%12

and Taneja

19%.13

The maximum children were in the age group

of more than 5years (63%) which is comparable to

that in Pandey K.K et al 86.5%14

and Subindra

73%.15

The male to female ratio in this study was1.1:1. Pandey etal reported 1.2:1.

14

In this study cases were admitted throughout the year

showing the endemicity of the disease. Maximum

cases were admitted during June-September (45.6%).

This period coincides with the onset of monsoon and

increase in housefly population, which facilitates

faeco-oral transmission. Pandey K.K et al reported

maximum incidence between May-July14

and Arora

et al reported 40.6% cases in the period of

September-October.

16

The most common symptoms were fever (100%),

anorexia (54.4%), vomiting (48.1%), pain abdomen

(26.6%), constipation (25.3%), loose motions

(12.6%) and altered sensorium (12.6%). These

symptoms were also seen in studies conducted by

Taneja Sood et al13

and Pandey KK et al.14

In the present study maximum cases (44.3%) had

fever for 8-14 days prior to admission which was

comparable to that of Kapoor JP et al (51.6%).16

Almost half the cases (49.4%) showed intermittent

type of fever. No case in this study had stepped

ladder type of fever and this finding is same as

reported by Pandey KK etal14

, Kapoor JP, et al.17

The

use of antipyretics and antibiotics were probably

responsible for this pattern.

The common signs seen were spleenomegaly

(68.4%), hepatomegaly (55.7%), coated tongue

(51.9%), pallor (51.9%) which was also reported by

Kapoor JP et al17

. The other signs tachycardias, toxic

look, dehydration seen in this study were not reported

by others.


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In this study haemoglobin 1 year were seen to be affected, majority

being >8 years old. Fever (intermittent type),

anorexia, vomiting were the three major symptoms.

Among the signs spleenomegaly, hepatomegaly,

coated tongue and toxemia were common. Relative

bradycardia was not seen. Bronchitis,encephalopathy, hepatitis, and cholecystitis were

common complications. Widal test was found

positive in majority of cases. Blood cultures were

positive mainly in the first week of illness. The

sensitivity pattern of S.typhi revealed significant

proportion of multidrug resistant strains and

simultaneous presence of chloramphenicol sensitive

and resistant strains in the study. Both ciprofloxacin

and ceftriaxone were effective in the treatment with

no major adverse effects.

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in children in Africa. Trop Med Int Health.

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3. Bhan M, Bahl R, Bhatnagar S. Typhoid and

paratyphoid fever. Lancet. 2005;366:749 – 62

4. Bhutta Z. Current concepts in the diagnosis and

treatment of typhoid fever. British Medical

Journal. 2006;333:78 – 82.

5. Chandel DS, Chaudhry R, Dhawan B, Paudey A,

Dey AB. Drug-resistant Salmonella enterica

serotype Paratyphi A in India. Emerg Infect Dis

2000; 6: 420 – 21.

6. Rowe B, Ward LR, Threlfall EJ. Multidrug-

resistant Salmonella Typhi: a worldwide

epidemic. Clin Infect Dis 1997;24(1): S106 – 09.

7. Ivanoff B, Levine MM. Typhoid fever:

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foe. Bull Inst Pasteur. 1997;95: 129 – 42

8. Parry CM, Hien TT, Dougan G, White NJ, Farrar

JJ. Typhoid fever. N Engl J Med.2002; 34:1770 –

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9. Colle JG, Miles RS, Watt B. Tests for

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149.

10. Clinical and Laboratory Standards Institute.

Methods for Disk Susceptibility Tests for

Bacteria that Grow Aerobically. Wayne, PA:

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2005;7th edn, document M2 – A8

11. Pohawalla JN, Bhandari NR. Some observations

on typhoid encephalopathy in chidren. I. J. of

child health 1960;9:375-80.


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12. Bavdekar A, Chaudhari M, Bhave S, Pandit

A.Ciprofloxacin in typhoid fever. Indian j pediatr

1991;58(3):335-39

13. Taneja PN, Sood SC. Typhoid fever :Clinical

picture and diagnosis .I.J. of child health

1961;69-76.

14. Pandey KK, Srinivasan S, Mahadevan S, Nalini

P, Rao RS. Typhoid fever below five years.

Indian pediatr 1990;27(2):153-6.

15. Sudhindra BK. Enteric fever in young children.

Indian pediatr 1995;32:1127

16. Arora RK, Gupta A, Joshi NM, Kataria VK, Lall

P, Anand AC. Multidrug resistant typhoid fever:

Study of outbreak in Calcutta. Indian pediatr

1992;29(1):61-65

17. Kapoor JP, Man Mohan, Vibha Talwar, Daral TS,

Bhargava SK. Typhoid fever in young children.

Indian pediatr 1985;22(11):811-13

18. Mishra AK, Patwari VK, Anand PK, Pillai S,

Aneja J, Chandra, Sharma D. A clinical profile of

multidrug resistant typhoid fever. Indian pediatr

1991;28(10):1171-74

19. Manchanda SS, Harjit Singh, Chitkara HL. A

Review of 270 cases of enteric fever in children.

Ind J Child Health 1959; 8 : 273-80

20. Garg K, Mangal N, Mathur HC. Clinical profile

of multi drug resistant typhoid fever in Jaipur

city. Indian pediatr 1994;31(2):191-93

21. Urmila Jhamb. Multidrug resistant typhoid in

children. NCPID – IAP 2001


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thJan 2014

Research Article

ANTIBIOGRAM STUDY OF AEROBIC BACTERIAL ISOLATES FROM UROPATHOGENS

Mallikarjuna Reddy C1, Himabindu M

2, Maity Soumendranath

3, Kanta R.C

4, Kapur Indu

5

1Assistant Professor,

2Assistant Professor,

3Tutor,

4Professor,

5Professor & HOD Departments of Microbiology,

Mallareddy Institute of Medical Sciences, Hyderabad


ABSTRACT

Background: Bacteria are capable of invading and infecting humans, leading to disease and sometimes death.

Systems and tissues in human body are vulnerable to different organisms. Infection pattern is likely to differ by

geographical regions. Aim: This study was aimed to isolate and identify the type of aerobic bacteria causing

Urinary Tract Infections (UTI) in different age groups and sexes, and also in some predisposing conditions. Their

antibiogram also was done. Materials and Methods: Midstream urine sample collected aseptically from 276

patients were subjected for isolation and identification of aerobic bacteria by standard technique and subsequently

antibiogram was done by Kirby – Bayer Method. Both sexes of patients with an age range of 10-70 years and

patients with diabetes (22), hypertension (8) and anemia (8) were also included in the study. Results: Escherichia

coli was the predominant organism(50%) among other isolates –

Klebsiella species (27.3%), Proteus

species(7.14%), Staphylococcus saprophyticus (5.95%), Staphylococcus aureus (3.57%), Enterococci (3.57%),

Pseudomonas species(2.38%). UTI was more common among patients of 60 and more years of age; however,

incidence was more in female patients (36.2 – 38.5%) compared with male patients (25-30%). Anemia, Diabetes

and Hypertension conditions were found to predispose UTI. Aminoglycosides and Quinolones were found to be

more effective against the isolates. Conclusion: The present study reveals in spite of the topographical diversity, the

infecting bacterial isolates from this area were found to be the same as from any other part of India.

Key words: UTI, Predisposing factors, Antibiogram.

INTRODUCTION

Urinary tract infection (UTI) is the commonest of all

infections seen in clinical practice. It is estimated that

10% of the patients visiting hospitals suffer from UTI.1

Both sexes of all age groups are vulnerable to UTI.

Women are especially prone to UTI. It is estimated

that 20% of women experience UTI in their life time.2

UTI is one major cause among hospital acquired

infections.2

Apart from socioeconomic reasons such as illiteracy,

ignorance and insanitation other factors are known to

predispose UTI which could be anatomical position of

the urethra, prostate hypotrophy, renal calculi, stricture

urethra, catheterization, and diabetes.3-5

UTI presents protein manifestations and may also be

asymptomatic.6

Reports indicates that different

spectrum of aerobic bacteria causes UTI. There seems

to be change in type of organisms in different areas.7

Hitherto study on isolation of aerobic bacteria and

their antibiogram associated with UTI has not been

done from this area. Hence this study was undertaken.

DOI: 10.5958/j.2319-5886.3.2.055


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MATERIALS & METHODS

This study was conducted in the department of

microbiology MNR Medical College and Hospital,

Sangareddy, Andhra Pradesh; from September 2008 to

August 2009. Two hundred and seventy six midstream

urine samples were collected in sterile container, frompatients from whom consent was obtained, with a

suggestive history of UTI. These patients were from

10 to 70 years of age; and of sex, 8 patients with

essential hypertension, 22 with diabetes mellitus and

36 with anemia. Pregnant women, women having

thyrotoxicosis, genitourinary procedure, carcinoma,

vaginitis, prostitis, recipient of renal transplant were

excluded from this study.

Midstream urine samples collected aseptically & with

all sterile precautions from the patients with symptomslike fever, chills, frequency, and urgency of urination,

dysuria and suprapubic pain were inoculated onto

MacConkey Agar, Blood Agar and Urichrome Agar,

and incubated at 370C for 18-24 hours for isolation.

Identification of the aerobic bacteria was performed by

various biochemical reactions.8

Antibiotic sensitivity

was done by disc diffusion method (Modified Kirby

Bayer) on Mueller-Hinton agar9

using Amoxycillin

(AMC) 20mcg, Cefepime (CPM) 30mcg, Cefotaxime

(CTX) 30mcg, Amikacin (AK) 30mcg, Gentamicin(G) 10mcg, Ofloxacin (OF) 5mcg, Ciprofloxacin (CIP)

5mcg, Norfloxacin (NR) 10mcg, Nalidixic Acid(NA)

30mcg, Nitrofurantoin (NIT) 300mcg and

Cotrimoxazole (COT) 1.25mcg discs from Himedia

Pvt Ltd.

Ethical clearance: Clearance from institutional ethical

committee was obtained prior to conducting this study

RESULTS & DISCUSSIONS

Total of 276 midstream urine samples, collected

aseptically were processed for isolation of aerobic

bacterial isolates, using standard methods.8

Out of 276

samples, 84 (30.43%) yielded aerobic bacterial isolates

(Table 1). The results indicate that out of 84 positive

aerobic isolates, 42 (50%) Escherichia coli followed

by Klebsiella spp. 23 (27.38%), Proteus spp.6 (7.14%),

Staphylococcus saprophyticus 5 (5.45%),

Staphylococcus aureus and Enterococci each 3

(3.57%) and the least isolate was Pseudomonas spp. 2

(2.33%).

Our findings 84 (30.43%) out of 276 were

considerably higher compared to the reports from Aziz

Marjan Khattak 8

which were 6.2%. Present findings of

the percentage of UTI which are noticeably high is

probably due to illiteracy, ignorance on the part of the

population and also that the study region comprises of

many poorly sanitated towns & villages. It was also

observed that the public &personal hygienic

conditions are poor.

Table: 1 Aerobic bacteria isolated from urine

Aerobic bacterial

isolates

No of isolates %

Escherichia coli 42 50%

Klebsiella Spp 23 27.38%

Proteus spp 6 7.14%

S. saprophyticus 5 5.95%

S. aureus 3 3.57%

Enterococci 3 3.57%

Pseudomonas spp 2 2.38%

*Total number of samples studied = 276, number of

positive samples = 84

The present study indicates that the predominant

isolate was Esch. coli (50%). Various studies7,11-13

(Table:2) on aerobic bacterial isolates from urine

samples including both sexes and all age groups show

a wide range of percent isolates from 30 – 53%.

Table 2: Aerobic isolates from other workers

References % of aerobic

isolates

Predominant

organism

Acharya et al 30% E. coli

Shobha Ram et al 45.5% E. coli

Mandal et al 53% E. coli

Ethel et al 53% E. coli

Incidence of aerobic bacterial isolates from UTI in

male and female patients with age ranging from 10 –

70 years is shown in Table: 3.

Table 3: Incidence of aerobic bacterial isolates from

UTI among male and female of different age groups

Age

(Years)

Male Female

Tota

l

+Ve % Total +Ve %

10 - 20 20 5 25 16 6 37.5

21 – 30 22 4 18.1 52 19 36.5

31 – 40 32 6 18.7 36 14 38.5

41 – 50 16 4 25 25 8 32

51 – 60 13 3 23 23 8 34.7

>61 10 3 30 11 4 36.3

Incidence was moderately higher in female patientsthan male patients and in the age group of 60 – 70

years in males, whereas prevalence is almost same in


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all age groups in female patients.Our findings are

almost consistent with the findings of Marie-vic O

etal.14

Women are prone to develop UTI and 20% of women

are known to develop UTI sometime during their

lifetime. More incidences in males could be due to

retention of urine due to prostate enlargement as it is

known that residual urine as minimal as 2-3ml is likely

to cause UTI.

Predisposing factors such as some metabolic diseases

might play some role in UTI17

. Hence the study was

done to know the role of diabetes, hypertension,

anemia,17

which are common ailments, nowadays.

Proven cases were considered for the study and the

results are depicted in Table: 4

The results indicate the association of these diseases

with UTI . However, more detailed study in this area

needs to be done. Studies conducted by Bahl et al

(1970)15

, Hansen RO (1964)16

on association of UTI

with diabetes and hypertension respectively throws

some message in this direction. Mandal et al. reported

64.3% diabetics having UTI.6

Table 4: Association of UTI with other conditions

Diseases No of cases

studied

No of +ve cases

Diabetes 22 6 (23.2%)Hypertension 8 2 (25%)

Anaemia 36 8 (22.2%)

Another important factor of the study was to evaluate

the antibiotic pattern of the bacterial isolates from the

UTI patients. The results are shown in Table 5.

Our study revealed that Esch. coli which was a

predominant isolate showing multidrug resistance,

particularly higher resistance to Nalidixic acid,

hitherto considered drug of choice for UTI. It

highlights the point that without confirming thesensitivity pattern of the organism, it is not advisable

to use the drug for treatment. Klebsiella showed

resistance to almost all antibiotics used. Proteus was

found to be less resistant to the antibiotics used

Table 5: Antibiotic sensitivity of the isolate

Organism Penicillin Cephalosporins Aminoglycosides Quinolones

COTAMC CPM CTX AK G OF CIP NR NA NIT

E.coli 19 16 15 24 33 18 15 22 8 26 14

Klebsiella 8 10 8 17 19 13 9 14 17 7 6

Proteus 3 4 4 5 5 3 3 4 4 2 1

Staph.

sapro

3 2 4 2 3 4 3 4 5 4 2

Enterococci - - - - - 2 1 2 - 3 -

The antibiotic pattern in this study correlates with the result of McFadyen et al18

. (AMC – Amoxyclav, CPM –

Cefepime, CTX – Cefotaxime, AK – Amikacin, G – Gentamicin, OF – Ofloxacin, CIP – Ciprofloxacin, NR –

Norfloxacin, NA - NAlidixic Acid, NIT - Nitrofurantoin, COT - Cotrimoxazole)

CONCLUSION

In spite of the topographical diversity the infecting

bacterial isolates from this area were found to be the

same as from any other part of India. Aerobic urinary

pathogens infectivity percentage is almost same as is

shown by other studies from different parts of our

country. Although incidence and infectivity pattern

match with other studies, antibiotic susceptibility

profile needs to be done for every isolate for proper

treatment.

ACKNOWLEDGEMENTS

We sincerely thank Dr. Chandrakanth Shirole, Dean,

Dr. Badhra Reddy and Dr. Preethi Reddy, Directors,

Mallareddy Institute of Medical Sciences, Mr. M. Ravi

Verma, Director, MNR Medical College for their

encouragement. We also thank Dr. Swarajya Lakshmi,Associate Professor and Mrs. Madhuri, Assistant

Professor and Mr. Amar Kumar, Department of

Microbiology, MNR Medical College for their

guidance.

REFERENCES

1 TaslimaTaher Lina, Sabitha Razwana Rahaman,

Donald James. Multiple antibiotic resistances

mediated by plasmids and integrons of

uropathogenic Escherichia coli and Klebsiellapneumoniae. Bangladesh J Microbiol.2007;24:19-

23.


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2 Ramprasad AV, Jayaram N, Nageshwara G. Urine

culture sensitivity pattern in a private laboratory

set up. Indian J path microbial. 1993;36(2):119-23

3 Ananthanarayan, Paniker. Text book of

microbiology. 9thed: Universities Press; 2013.

4 Ann pallett, Kieran Hand.Comlicated urinary tract

infections: practical solution for the treatment of

multiresistant Gram-negative bacteria. Journal of

antimicrobial chemotherapy 2010; 65(S3):25-33.

5 Thomas MH, Delia Scholes,James P . Hughes,

Carol Winter, Pachita L Roberts, Ann E

Stapneton, Andy Stergachis and Winter E Stamm.

A prospective study of risk factors for

symptomatic urinary tract infections in young

women. The New England Journal of

Medicine:1996;335:467-74.

6 Hanif S. Frequency and pattern of urinary

complaints among pregnant women .JCPSP.

2006; 16(8):514-17.

7 Mandal P, Kapil A, Goswami K, Das B, Dwivedi

SN. Uropathogenic Escherichia coli causing

urinary tract infections. Indian J Med

Resh.2001;114:207-11.

8 Collee JG, Fraser AG, Marmion BP Simmons -

Mackie and McCartney Practical Medical

Microbiology -14th

ed:Elsevier; 2013

9 Lisa PA. National committee for laboratory

standards-1984,performance standards for anti

microbiological susceptibility testing second

informational supplement M100-S2, nation

committee for clinical laboratory standards ,

villanova, Mackie & MacCartney: Practical

Medical Microbiology; 14 ed.

10 Aziz Marjan Khattak. Prevalence of asymptomatic

bacteriuria. Pak J Med Sci.2005;22(2):162-66

11 Acharya VN, JadavSK. Urinary tract infection -

current status. J Postgrad Med.1980; 26:95-9812 Ethel S. Bacterial adherence and humoral immune

response in women with symptomatic and

asymptomatic UTI. Indian J Med

Microbiol.2006;24(1):30-33

13 Ram S, Gupta R, Gaheer M. Emerging antibiotic

resistance among the uropathogens. Department of

Microbiology, Dayanand Medical College and

Hospital, Ludiana. Indian J Med Sci. 2000 Sep;

54(9):388-94

14 Marie-vic O. Rac. and Marie Yvette C. Barez.Profile of Community Acquired Urinary Tract

Infections in Davao City, Phil. J Microbiol Infect

Dis. 1998;27(2):62-66

15 Bhal AL , Chugh RN, Sharma KB, Asymptomatic

bacteriuria in diabetes attending a diabetic clinic.

Indian J of Med Sc. 1970; 24:1-6

16 Hansen RO. Bacteriuria in diabetic and non-

diabetic outpatients. Acta medica Scandinavia.

1964;176:721-30

17 Ghumman Surveen, Goel Neerja, Rajaram Shalini,

Harsha. Renal disease and pregnancy. J Obstet

Gynecol India.2006; 56(3): 219-23

18 McFadyen IR, Eykyn SJ. Suprapubic aspiration of

urine in pregnancy. Lancet.1968;1:1112-14.


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thJan 2014

Research Article

A STUDY ON RADIAL ARTERY IN CADAVERS AND ITS CLINICALIMPORTANCE

*Prakash KG1, Saniya K

2

1Associate Professor,

2Assistant Professor, Department of Anatomy, Azeezia Medical College, Meeyyannoor, Kollam,

Kerala, India


ABSTRACT

As the radial artery is the second most commonly used graft in coronary bypass (CABG)surgery(internal thoracic

artery first most common)and for transcatheter coronary interventions (angioplasty),cardiac surgeons should have

thorough knowledge about the normal anatomy and possible variations of it before these cardiac procedures.

Methods: 50 radial artery specimens(both right and left sided)were studied by dissection method in 25 cadavers

(20 male and 05 female). The data were tabulated in Microsoft excel and analysed by using Statistical Package for

Social Science (SPSS 17th

version). Mean, Proportion, Standard deviation and Unpaired‘t’ test were applied for

analysing the data obtained. Results& conclusion: Radial artery in all the specimens take origin from brachial

artery at or just below the elbow joint in the cubitalfossa, running superficially and laterally, giving radial recurrent,

manycollaterals, radial carpal and superficial palmar branches; total mean length of artery from origin to wrist jointis 20.63± 1.96cm; mean luminal diameter at its termination 2 cm proximal to styloid process just above the wrist

joint is 2.14± 0.28mm.This study revealed anomalies like tortuosity (30%)in distal 1/3rd

segment and radio-ulnar

loops were not found in any specimens.

Keywords: Radial artery, Coronary bypass graft, Transcathetercoronary interventions (Angioplasty), Internal

thoracic artery.

INTRODUCTION

Graft patency is a fundamental predictor of long term

survival after coronary bypass graft (CABG) surgery.

Given its proven survival benefit, left internal thoracic

artery to left anterior descending artery (LITA-LAD)

grafting has become a fundamental part of CABG.

This grafting also led to increased use of other arterial

conduits, of which radial artery is most popular(second

most common next to internal thoracic artery).1

In 1973, Carpentier suggested the use of radial artery

as a conduit for coronary bypass graft surgery.2

Eventhough radial artery had been abandoned in early

1970’s due to high rate of graft failure in post-

operative period,butdue to the latest concepts of total

arterial revascularisation in coronary bypass surgery in

1989, it has been proved thatradial artery is as good as

an internal thoracic artery in CABG due to histological

similarities.3

Radial artery is nowadays commonly used for

transcatheter coronary interventions (angioplasty)

compared to transfemoral or transbrachial technique

due to the lower risk access site related complications.

Lower risk is because of the radial artery being

superficial; haemostasis can be easily achieved just by

local compression.4Harvesting radial artery for

CABG5or during transcatheterisation does not cause

any damage as there are no large veins or nerves exist

nearby it and even does not cause ischemia in hand as

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Prakash et al.,

there exist collateral circulation

(ulnar artery).4

Normally, the radial artery is a small

of the brachial artery, arises at the

radius in the cubitalfossa. It runs su

to the ulnar artery, (another terminal

artery).During its course, at the begi

radial recurrent artery which takes p

around the elbow joint; it also giv

collateral or muscular branches whi

muscles and finally giving a palma

the lower part of the forearm. It lea

turning posteriorly and enters the an

Just before it leaves, gives a superfi

which completes the superficial p

with the ulnar artery.6

It is also

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