Search results for: diabetic duration

Authors: Carolyne Ndungu, Wesley Too, Diana Kassaman

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Diabetes is a global public health problem with an increasing morbidity and mortality rate across the globe. It is reported that 422 million people worldwide have diabetes with type 2 diabetes more common in people of African descent. Whilst prevalence of diabetes is four times more than it was in the last three decades, making it the world's ninth greatest cause of mortality, treatment of complications resulting from poor glycemic control is still high, contributing to poverty level in sub-Saharan. Poor treatment adherence has also been identified as a major contributing factor poor glycemic control among diabetic patients and still remains a significant challenge especially among patients living in rural Kenya. This study therefore seeks to identify gaps, barriers and challenges towards medication non-adherence among diabetic patients on follow-up at Kiambu County Referral Hospital, Kenya. Methods: A cross- sectional descriptive study was carried out at Gatundu Level five Hospital in Kiambu County. The study population consisted of adult patients with type two diabetes mellitus (T2DM) on follow up, at the Diabetes clinic between the month of June to July 2022. Systematic sampling of 200 participants was carried out. Ethical approvals from relevant authorities were done and ethical aspects of the study were also observed. Data analysis is ongoing using logistic regression analysis. Results, recommendations -contribution of this study will be highlighted within the next one month.

Keywords: adherence, diabetes, medication, Kenya

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Authors: Lydia Foucan, Christine Rambhojan, Rachel Billy, Christophe Armand, Carl-Thony Michel, Jean-Marc Lacorte, Laurent Larifla

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Leptin, an adipocyte-derived hormone, modulates insulin secretion and action via the leptin receptor (LEPR) that is expressed in pancreatic beta cells, adipose tissue, and muscle. Several polymorphisms have been described in the human LEPR gene including p.K109R (rs1137100), p.Q223R (rs1137101) and p.K656N (rs1805094) polymorphisms. The role of these polymorphisms is not yet studied in Guadeloupian population. Our aim was to explore the association of LEPR polymorphisms (K109R, Q223R and K656N) with leptin levels and obesity in non-diabetic Afro-Caribbean subjects. Genotypic analysis of the three polymorphisms was performed in 425 subjects using TaqMan and KASPar Assays. Serum leptin was measured with ELISA kits Biovendor® (RD191001100). Logistic regressions were used for assessment of statistical associations. Mean age was 47.6 ± 12.7 years. Among the participants, 238 (56 %) were women, 124 (30%) were obese and 155 (36.5%) had abdominal obesity. Carriers of LEPR K656N rs1805094 rare allele had significant higher frequencies of obesity (P = 0.007), abdominal obesity (P = 0.004) and metabolic syndrome (P = 0.021) but mean leptin level was not significantly different between both groups (P = 0.075). Odds ratios, adjusted for age and sex associated with presence of rs1805094 rare allele were 1.8 (1.1-2.9), P = 0.012 for obesity, 2.0 (1.2-3.3), P = 0.008 for abdominal obesity and 1.8 (1.1-3.0), P = 0.031 for MetS. No significant association was found with K109R, Q223R. These findings suggest that the K656N polymorphism (but not the K109R or Q223R polymorphism) of LEPR is associated with obesity, abdominal obesity and metabolic syndrome in this Afro-Caribbean non-diabetic population.

Keywords: Afro-Caribbean, leptin levels, leptin receptor gene polymorphisms, obesity

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Authors: Harish Peri, Amit Devgan

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The aim of this study was to evaluate the impact of exclusive breastfeeding on asthma and lung function in childhood asthma. A case-control study comprising 80 cases (children with asthma) and 80 controls(children without asthma) in the age group 6-12 years were included. A diagnosis was made by the treating pediatrician. A parental questionnaire was given and data regarding the name, age, sex of the child, duration of asthma, whether breastfed or not, duration, exclusiveness of breastfeeding and maternal asthmatic status were collected. Peak Expiratory Flow Rate was measured for every child using a Peak Expiratory Flow Meter. Results showed Exclusively Breastfed children were found to better protected against asthma and have improved lung function as compared to Non-exclusively Breastfeed children, irrespective of the mother’s asthmatic status. This study demonstrated that exclusive breastfeeding has a protective action against childhood asthma.

Keywords: asthmatic mothers, childhood asthma, exclusive breastfeeding, non-asthmatic mothers

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Authors: Mohammad Soltani, Ayoub Saeidi, Nikoo Khosravi, Hanieh Nohbaradar, Seyedeh Parya Barzanjeh, Hassane Zouhal

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Exercise training and herbs supplement represent have role in the treatment for patients with type 2 diabetes (T2D). However, it is unclear combined effects of exercise training and herbs supplements on diabetic risk markers. This study aimed to determine the effect of 12 weeks of combined exercise and broccoli supplementation on decitin-1 and insulin resistance in men with type 2 diabetes. Forty-four type 2 diabetes men (age, 48.52 ± 4.36) were randomly allocated to training -supplement (TS, n = 11), training- placebo (TP, n = 11), supplement (S, n = 11) and control- placebo (CP, n = 11) groups. The combined exercise program included 12 weeks, three sessions per week, that each session contained 45 minutes of resistance training with intensity 60-70% of one maximal repetition and 30 minutes aerobic training (running) with intensity 60-70% of maximum heart rate. In addition supplement groups consumed 10 grams of Broccoli per day for 12 weeks. Plasma Decitin-1, HOMA-IR, Insulin, glucose and body composition were assessed before and after training. Plasma Dectin-1, HOMA-IR, glucose and BMI significantly decreased in TS, TP and S groups compared with CP group (P < .05). In addition Insulin and skeletal muscles mass showed significant increase in TS and TP groups compared with S and CP groups (P < .05). It is concluded that both combined exercise training (aerobic-resistance) or broccoli supplement can improve plasma Decitin-1 and insulin resistance in two diabetic patients however combine of exercise training and broccoli supplement have more effective on these markers.

Keywords: broccoli supplements, combined training, decitin-1, insulin resistance, type 2 diabetes

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Authors: Yu-Ching Huang

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Background: Delivery bridges the antepartum and postpartum period. Subsequent fatigue can affect indices, including postpartum recovery and life quality. Milk secretion, breastfeeding quality, and newborn participation may be compromised. Correspondingly, using proper pushing skills during the second stage of labor has the potential to effectively reduce postpartum fatigue and enhance birth satisfaction in new mothers. Purpose: To compare the effects of using different pushing skills on maternal pushing perception, postpartum fatigue, and birth satisfaction. Methodology: The present study used a descriptive research approach and recruited 382 participants from a medical center in northern Taiwan. Data were collected using a structured questionnaire, which included a demographic and obstetrics information datasheet, the Labor Pushing Experience Scale, a fatigue scale, and a birth satisfaction scale. Research Results: Using pushing skills (including upright position [t= 2.28, p < .05] and delayed pushing [t= -1.98, p < .05] during the second stage of labor was shown to enhance birth satisfaction in participants. Additionally, open glottis pushing ( t = 5.46, p < .001) resulted in a mean duration of second-stage labor that was 17.67 minutes less than that achieved using Valsalva pushing. Moreover, a better perceived pushing experience was associated with lower perceived postpartum fatigue (r = .46, p < .05) and higher birth satisfaction (r = -.16, p < .05). Finally, postpartum fatigue perception was negatively associated with birth satisfaction (r = -.16, p < .05). Conclusion and Clinical Application: The findings suggest that midwives should advocate that women adopt upright positions, delayed pushing, and open glottis pushing during the second stage of labor in order to enhance their birth satisfaction.

Keywords: second stage labor duration of pushing skill, pushing experience perception, postpartum fatigue, birth satisfaction

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Authors: Muhammad Anjum Aqueel, Zaighum Abbas, Mubasshir Sohail, Muhammad Abubakar, Hafiz Khurram Shurjeel, Abu Bakar Muhammad Raza, Muhammad Afzal, Sami Ullah

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Keeping in view the increasing demand, queen of Apis mellifera L. (Hymenoptera: Apidae) was reared artificially in this experiment at varying diets including royal jelly. Larval duration, pupal duration, weight, and size of pupae were evaluated at different diets including royal jelly. Queen larvae were raised by Doo Little grafting method. Four different diets were mixed with royal jelly and applied to larvae. Fructose, sugar, yeast, and honey were provided to rearing queen larvae along with same amount of royal jelly. Larval and pupal duration were longest (6.15 and 7.5 days, respectively) at yeast and shortest on honey (5.05 and 7.02 days, respectively). Heavier and bigger pupae were recorded on yeast (168.14 mg and 1.76 cm, respectively) followed by diets having sugar and honey. Due to production of heavier and bigger pupae, yeast was considered as best artificial diet for the growing queen larvae. So, in the second part of experiment, different amounts of yeast were provided to growing larvae along with fixed amount (0.5 g) of royal jelly. Survival rates of the larvae and queen bee were 70% and 40% in the 4-g food, 86.7% and 53.3% in the 6-g food, and 76.7% and 50% in the 8-g food. Weight of adult queen bee (1.459±0.191 g) and the number of ovarioles (41.7±21.3) were highest at 8 g of food. Results of this study are helpful for bee-keepers in producing fitter queen bees.

Keywords: apis melifera l, dietary effect, survival and development, honey bee queen

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Authors: Mohammadjavad Sotoudeheian, Navid Farahmandian

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Cardiac hypertrophy arises in response to persistent increases in hemodynamic loads. In comparison, diabetic cardiomyopathy is defined by an abnormal myocardial changes without other cardiac-related risk factors. Pathological cardiac hypertrophy and myocardial remodeling are hallmarks of cardiovascular diseases and are risk factors for heart failure. The transcription factor forkhead box class O (FOXOs) can protect heart tissue by hostile oxidative stress and stimulating apoptosis and autophagy. FOXO proteins, as sensitive elements and mediators in response to environmental changes, have been revealed to prevent and inverse cardiac hypertrophy. FOXOs are inhibited by insulin and are critical mediators of insulin action. Insulin deficiency and uncontrolled diabetes lead to a catabolic state. FOXO1 acts downstream of the insulin-dependent pathways, which are dysregulated in diabetes. It regulates cardiomyocyte hypertrophy downstream of IGF1R/PI3K/Akt activation, which are critical regulators of cardiac hypertrophy. The complex network of signaling pathways comprising insulin/IGF-1 signaling, AMPK, JNK, and Sirtuins regulate the development of cardiovascular dysfunction by modulating the activity of FOXOs. Insulin receptors and IGF1R act via the PI3k/Akt and the MAPK/ERK pathways. Activation of Akt in response to insulin or IGF-1 induces phosphorylation of FOXOs. Increased protein synthesis induced by activation of the IGF-I/Akt/mTOR signaling pathway leads to hypertrophy. This pathway and the myostatin/Smad pathway are potent negative muscle development regulators. In cardiac muscle, insulin receptor substrates (IRS)-1 or IRS-2 activates the Akt signaling pathway and inactivate FOXO1. Under metabolic stress, p38 MAPK promotes degradation of IRS-1 and IRS-2 in cardiac myocytes and activates FOXO1, leading to cardiomyopathy. Sirt1 and FOXO1 interaction play an essential role in starvation-induced autophagy in cardiac metabolism. Inhibition of Angiotensin-II induced cardiomyocyte hypertrophy is associated with reduced FOXO1 acetylation and activation of Sirt1. The NF-κB, ERK, and FOXOs are de-acetylated by SIRT1. De-acetylation of FOXO1 induces the expression of genes involved in autophagy and stimulates autophagy flux. Therefore, under metabolic stress, FOXO1 can cause diabetic cardiomyopathy. The overexpression of FOXO1 leads to decreased cardiomyocyte size and suppresses cardiac hypertrophy through inhibition of the calcineurin–NFAT pathway. Diabetes mellitus is associated with elevation of O-GlcNAcylation. Some of its binding partners regulate the substrate selectivity of O-GlcNAc transferase (OGT). O-GlcNAcylation of essential contractile proteins may inhibit protein-protein interactions, reduce calcium sensitivity, and modulate contractile function. Uridine diphosphate (UDP)-GlcNAc is the obligatory substrate of OGT, which catalyzes a reversible post-translational protein modification. The increase of O-GlcNAcylation is accompanied by impaired cardiac hypertrophy in diabetic hearts. Inhibition of O-GlcNAcylation blocks activation of ERK1/2 and hypertrophic growth. O-GlcNAc modification on NFAT is required for its translocation from the cytosol to the nucleus, where NFAT stimulates the transcription of various hypertrophic genes. Inhibition of O-GlcNAcylation dampens NFAT-induced cardiac hypertrophic growth. Transcriptional activity of FOXO1 is enriched by improved O-GlcNAcylation upon high glucose stimulation or OGT overexpression. In diabetic conditions, the modification of FOXO1 by O-GlcNAc is promoted in cardiac troponin I and myosin light chain 2. Therefore targeting O-GlcNAcylation represents a potential therapeutic option to prevent hypertrophy in the diabetic heart.

Keywords: diabetes, cardiac hypertrophy, O-GlcNAcylation, FOXO1, Akt, PI3K, AMPK, insulin

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Authors: Gauri Shankar Shah

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Objectives: The Type I diabetes mellitus in children is frequently a missed diagnosis and children presents in emergency with diabetic ketoacidosis having significant morbidity and mortality. The present study was done to find out the clinical presentation and outcome at a tertiary-care centre. Methods: This was retrospective analysis of data of Type I diabetes mellitus reporting to our centre during last one year (2012-2013). Results: There were 12 patients (8 males) and the age group was 4-14 years (mean ± 3.7). The presenting symptoms were fever, vomiting, altered sensorium and fast breathing in 8 (66.6%), 6 (50%), 4 (33.3%), and 4 (33.3%) cases, respectively. The classical triad of polyuria, polydypsia, and polyphagia were present only in two patients (33.2%). Seizures and epigastric pain were found in two cases each (33.2%). The four cases (33.3%) presented with diabetic ketoacidosis due to discontinuation of insulin doses, while 2 had hyperglycemia alone. The hemogram revealed mean hemoglobin of 12.1± 1.6 g/dL and total leukocyte count was 22,883.3 ± 10,345.9 per mm3, with polymorphs percentage of 73.1 ± 9.0%. The mean blood sugar at presentation was 740 ± 277 mg/ dl (544–1240). HbA1c ranged between 7.1-8.8 with mean of 8.1±0.6 %. The mean sodium, potassium, blood ph, pCO2, pO2 and bicarbonate were 140.8 ± 6.9 mEq/L, 4.4 ± 1.8mEq/L, 7.0 ± 0.2, 20.2 ± 10.8 mmHg, 112.6 ± 46.5 mmHg and 9.2 ± 8.8 mEq/L, respectively. All the patients were managed in pediatric intensive care unit as per our protocol, recovered and discharged on intermediate insulin given twice daily. Conclusions: Thus, it shows that these patients have uncontrolled hyperglycemia and often presents in emergency with ketoacidosis and deranged biochemical profile. The regular administration of insulin, frequent monitoring of blood sugar and health education are required to have better metabolic control and good quality of life.

Keywords: type I diabetes mellitus, hyperglycemia, outcome, glycemic control

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Authors: Ram Prasad Baral, Vinogradov Dmitriy Valerievich, Rameshwar Adhikari

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Diabetes has posed a great threat to the human health worldwide, both in developed and developing countries. The disease has basically rooted from the dramatically changed way of living of the present day human civilization as our living has deviated from what the nature has adapted us for. In this context, due to availability of wide range of climatic condition and hence the wide spectrum of biodiversity, Nepal is blessed with a valuable reservoir of medicinal herbs. These assets have been utilized and developed practices in traditional medicines and Ayurvedic way of treatment over several thousand years in the region. It has been established since ancient times that each and every plant has a specific medicinal value. There are many plants’ products which have been utilized in Ayurvedic medicine for the effective treatment of diabetes. The medicaments are less expensive and pose practically no side effects. In this work, we report a general survey of anti-diabetic properties of some medicinal herbs with pronounced effects and their applications. The plants covered in this study originate from far western region of Nepal and include Ficus racemosa, Momordica charantia, Azadirachta indica, Helieteres isora, Saraca asoca, Ichnocarpus frutescens, Tinospora sinensis, Commiphora mukul, Coccinia grandis, and Hippophae salicifolia.

Keywords: Ficus racemosa, Momordica charantia, Azadirachta indica, Helieteres isora, Saraca asoca, Ichnocarpus frutescens, Tinospora sinensis, Commiphora mukul, Coccinia grandis, Hippophae salicifolia

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Authors: Jun Ren, Zhen-Hua Ming, He-Feng Huang, Jian-Zhong Sheng

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Adverse intrauterine stimulus during critical or sensitive periods in early life, may lead to health risk not only in later life span, but also further generations. Intrauterine hyperglycaemia, as a major feature of gestational diabetes mellitus (GDM), is a typical adverse environment for both F1 fetus and F1 gamete cells development. However, there is scare information of phenotypic difference of metabolic memory between somatic cells and germ cells exposed by intrauterine hyperglycaemia. The direct transmission effect of intrauterine hyperglycaemia per se has not been assessed either. In this study, we built a GDM mice model and selected male GDM offspring without pre-diabetic phenotype as our founders, to exclude postnatal diabetic influence on gametes, thereby investigate the direct transmission effect of intrauterine hyperglycaemia exposure on F2 offspring, and we further compared the metabolic difference of affected F1-GDM male offspring and F2 offspring. A GDM mouse model of intrauterine hyperglycemia was established by intraperitoneal injection of streptozotocin after pregnancy. Pups of GDM mother were fostered by normal control mothers. All the mice were fed with standard food. Male GDM offspring without metabolic dysfunction phenotype were crossed with normal female mice to obtain F2 offspring. Body weight, glucose tolerance test, insulin tolerance test and homeostasis model of insulin resistance (HOMA-IR) index were measured in both generations at 8 week of age. Some of F1-GDM male mice showed impaired glucose tolerance (p < 0.001), none of F1-GDM male mice showed impaired insulin sensitivity. Body weight of F1-GDM mice showed no significance with control mice. Some of F2-GDM offspring exhibited impaired glucose tolerance (p < 0.001), all the F2-GDM offspring exhibited higher HOMA-IR index (p < 0.01 of normal glucose tolerance individuals vs. control, p < 0.05 of glucose intolerance individuals vs. control). All the F2-GDM offspring exhibited higher ITT curve than control (p < 0.001 of normal glucose tolerance individuals, p < 0.05 of glucose intolerance individuals, vs. control). F2-GDM offspring had higher body weight than control mice (p < 0.001 of normal glucose tolerance individuals, p < 0.001 of glucose intolerance individuals, vs. control). While glucose intolerance is the only phenotype that F1-GDM male mice may exhibit, F2 male generation of healthy F1-GDM father showed insulin resistance, increased body weight and/or impaired glucose tolerance. These findings imply that intrauterine hyperglycaemia exposure affects germ cells and somatic cells differently, thus F1 and F2 offspring demonstrated distinct metabolic dysfunction phenotypes. And intrauterine hyperglycaemia exposure per se has a strong influence on F2 generation, independent of postnatal metabolic dysfunction exposure.

Keywords: inheritance, insulin resistance, intrauterine hyperglycaemia, offspring

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Authors: Raad Nari, Maura Moriaty, Maha T. Barakat

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Introduction: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a new class of oral anti-diabetic drugs with a unique mechanism of action. They are used to improve glycaemic control in adults with type 2 diabetes by enhancing urinary glucose excretion. In the UAE, there has been certainly an increased use of these medications. As with any new medication, there are safety considerations related to their use in patients with type two diabetes. A retrospective study was conducted at the three main centres of the Imperial College London Diabetes Centre. Methodology: All patients in electronic database (Diamond) from October 2014 to October 2017 were included with a minimum of six months usage of sodium glucose co-transporter inhibitors that comprise canagliflozin, dapagliflozin and empagliflozin. There were 15 paired sample biochemical and clinical correlations. The analysis was done at the start of the study, three months and six months apart. SPSS version 24 was used for this study. Conclusion: This study of sodium glucose co-transporter-2 inhibitors used showed significant reductions in weight, glycated haemoglobin A1C, systolic and diastolic blood pressures. As the case with systematic reviews, there were similar changes in liver enzymes, raised total cholesterol, low density lipopoptein and high density lipoprotein. There was slight improvement in estimated glomerular filtration rate too. Our analysis also showed that they increased in the incidence of urinary tract symptoms and incidence of urinary tract infections.

Keywords: SGLT2 inhibitors dapagliflozin empagliflozin canagliflozin, adverse effects, amputation diabetic ketoacidosis DKA, urinary tract infection

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Authors: Kamel Abd Elaziz Mohamed, Ahmed Yehia Mousa, Ahmed Samir ElSawy, Adel Mohamed Saleem

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Introduction: Critically ill patients frequently require tracheostomy to simplify long term air way management. While tracheostomy indications have remained unchanged, the timing of elective tracheostomy for the ventilated patient has been questioned. Aim of the work: This study was performed to compare the differences between early and late percutaneous dilatational tracheostomy (PDT) regarding, mechanical ventilation duration (MVD), length of ICU stay, length of hospital stay, incidence of ventilator associated pneumonia and hospital outcome. Patients and methods: Forty patients who met the inclusion criteria were randomly divided into early PDT who had the tracheostomy within the first 10 days of mechanical ventilation (MV) and the late PDT who had the tracheostomy after 10 days of MV. On admission, demographic data and Acute Physiology and Chronic ill Health II and GCS were collected. The duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS were all calculated. Results: Total of 40 patients were randomized to either early PDT (n= 20) or late PDT (n= 20). There were no significant differences between both groups regarding demographic data or the scores: APACHE II (22.75± 7 vs 24.35 ± 8) and GCS (6.10 ±2 vs 7.10 ± 2.71). An early PDT showed fewer complications vs late procedure, however it was insignificant. There were significant differences between the two groups regarding mean (MVD) which was shorter in early PDT than the late PDT group (32.2± 10.5) vs (20.6 ± 13 days; p= 0.004). Mean ICU stay was shorter in early PDT than late PDT (21 .0± 513.4) vs (40.15 ±12.7 days; p 6 0.001). Mean hospital stay was shorter in early PDT than late PDT (34.60± 18.37) vs (55.60± 25.73 days; p=0.005). Patients with early PDT suffered less sepsis and VAP than late PDT, there was no difference regarding the mortality rate between the two groups. Conclusion: Early PDT is recommended for patients who require prolonged tracheal intubation in the ICU as outcomes like the duration of mechanical ventilation length of ICU stay and hospital stay were significantly shorter in early tracheostomy.

Keywords: intensive care unit, early PDT, late PDT, intubation

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Authors: Mi̇hri̇ban Müge Aras

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The present study aims to investigate the learner autonomy usage of prep school students. This research focuses on the prep school students' autonomy habits according to their self-regulated studies, age and duration of learning English. The research also analyzes whether prep school students have strong autonomy to learn the English language or depend on teachers and English classes only. The participants of the study consisted of 32 prep school students. The "Likert- type of questionnaire " was adopted by the researcher from the survey of Dede (2017). The scale was a one-dimensional 4-Likert type, which has the options of 1=never, 2= sometimes, 3=often, and 4=always. There are 19 questions in the questionnaire to understand the autonomy of students when they try to learn English. Descriptive statistics and OneANOVA were used to analyze the data. The results of the study showed that there is no significant correlation between their ages and their duration of learning English according to their autonomy studies for English.

Keywords: learner autonomy, self-regulated learning, independent learning, English language learning, prep school students

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Authors: Neha Singh, Anuj Ranjan, Tanu Jindal

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Over the last decade, the exponential growth of mobile communication has been accompanied by a parallel increase in density of electromagnetic fields (EMF). The continued expansion of mobile phone usage raises important questions as EMF, especially radio frequency (RF), have long been suspected of having biological effects. In the present experiments, we studied the effects of RF-EMF on cell death (apoptosis) and DNA damage of a well- tested biological model, Drosophila melanogaster exposed to 2400 MHz frequency for different time duration i.e. 2 hrs, 4 hrs, 6 hrs,8 hrs, 10 hrs, and 12 hrs each day for five continuous days in ambient temperature and humidity conditions inside an exposure chamber. The flies were grouped into control, sham-exposed, and exposed with 100 flies in each group. In this study, well-known techniques like Comet Assay and TUNEL (Terminal deoxynucleotide transferase dUTP Nick End Labeling) Assay were used to detect DNA damage and for apoptosis studies, respectively. Experiments results showed DNA damage in the brain cells of Drosophila which increases as the duration of exposure increases when observed under the observed when we compared results of control, sham-exposed, and exposed group which indicates that EMF radiation-induced stress in the organism that leads to DNA damage and cell death. The process of apoptosis and mutation follows similar pathway for all eukaryotic cells; therefore, studying apoptosis and genotoxicity in Drosophila makes similar relevance for human beings as well.

Keywords: cell death, apoptosis, Comet Assay, DNA damage, Drosophila, electromagnetic fields, EMF, radio frequency, RF, TUNEL assay

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Authors: Himanshi Rathore, Shalinee Prasad, Satyawati Sharma, Ajay Singh Yadav

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Medicinal mushrooms are acceptable all over the world not only because they have a unique flavour and texture but also due to the presence of great nutritional, nutraceutical and functional properties. High content of physiologically active substances like ergosterol, vitamin D, phenolic compounds, triterpenoids and steroids make these medicinal mushrooms a key source of nutraceuticals. Calocybe indica is a popular medicinal mushroom of India which is known to possess high amount of secondary metabolites including ergosterol (vitamin D2). The ergosterol gets converted to vitamin D in the presence of UV rays by a photochemical reaction. In lieu of the above facts the present study was undertaken to investigate the effect of UV-B light treatment on the vitamin D2 concentration, phenolic content and non volatile compounds in Calocybe indica. For this study, UV-B light source of intensity 5.3w/m2 was used to expose mushrooms for the time period of 0min, 30min, 60min and 90 min. It was found that the vitamin D2 concentration increased with the time duration i.e. 85±0.15 (0 min), 182±1.6 (30 min), 187±0.4 (60 min) and 182 ±0.8 (90 min) μg/g (dry weight). Highest concentration of vitamin D2 was found at 60 min duration. No discoloration in sliced mushrooms was observed during the exposure time. The results revealed that the exposure of mushrooms for a minimum of 30 min duration under UVB source can be a novel, convenient and cheapest way to increase the vitamin D content in mushrooms. This can be one of richest source to fulfil the recommended dietary allowances of vitamin D in our daily diets. The paper provides information on the enhancement of vitamin D content by UV lights and its effects on the non volatile (soluble sugars, free amino acids, 5′-nucleotides and phenolics) compounds will also be presented.

Keywords: Calocybe indica, ergosterol, nutraceutical, phenolics

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Authors: Junior B. N. Adohinzin, Ling Xu

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Nitrogen is among the main nutrients encouraging the growth of organic matter and algae which cause eutrophication in water bodies. Therefore, its removal from wastewater has become a worldwide emerging concern. In this research, an innovative Membrane Bioreactor (MBR) system named “moving bed membrane bioreactor (MBMBR)” was developed and investigated under intermittently-aerated mode for simultaneous removal of organic carbon and nitrogen. Results indicated that the variation of the intermittently aerated duration did not have an apparent impact on COD and NH4+–N removal rate, yielding the effluent with average COD and NH4+–N removal efficiency of more than 92 and 91% respectively. However, in the intermittently aerated cycle of (continuously aeration/0s mix), (aeration 90s/mix 90s) and (aeration 90s/mix 180s); the average TN removal efficiency was 67.6%, 69.5% and 87.8% respectively. At the same time, their nitrite accumulation rate was 4.5%, 49.1% and 79.4% respectively. These results indicate that the intermittently aerated mode is an efficient way to controlling the nitrification to stop at nitrition; and also the length of anoxic duration is a key factor in improving TN removal.

Keywords: membrane bioreactor (MBR), moving bed biofilm reactor (MBBR), nutrients removal, simultaneous nitrification and denitrification

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Authors: Haya Salah, Srinivas Sharan

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Healthcare facilities use appointment systems to schedule their appointments and to manage access to their medical services. With the growing demand for outpatient care, it is now imperative to manage physician's time effectively. However, high variation in consultation duration affects the clinical scheduler's ability to estimate the appointment duration and allocate provider time appropriately. Underestimating consultation times can lead to physician's burnout, misdiagnosis, and patient dissatisfaction. On the other hand, appointment durations that are longer than required lead to doctor idle time and fewer patient visits. Therefore, a good estimation of consultation duration has the potential to improve timely access to care, resource utilization, quality of care, and patient satisfaction. Although the literature on factors influencing consultation length abound, little work has done to predict it using based data-driven approaches. Therefore, this study aims to predict consultation duration using supervised machine learning algorithms (ML), which predicts an outcome variable (e.g., consultation) based on potential features that influence the outcome. In particular, ML algorithms learn from a historical dataset without explicitly being programmed and uncover the relationship between the features and outcome variable. A subset of the data used in this study has been obtained from the electronic medical records (EMR) of four different outpatient clinics located in central Pennsylvania, USA. Also, publicly available information on doctor's characteristics such as gender and experience has been extracted from online sources. This research develops three popular ML algorithms (deep learning, random forest, gradient boosting machine) to predict the treatment time required for a patient and conducts a comparative analysis of these algorithms with respect to predictive performance. The findings of this study indicate that ML algorithms have the potential to predict the provider service time with superior accuracy. While the current approach of experience-based appointment duration estimation adopted by the clinic resulted in a mean absolute percentage error of 25.8%, the Deep learning algorithm developed in this study yielded the best performance with a MAPE of 12.24%, followed by gradient boosting machine (13.26%) and random forests (14.71%). Besides, this research also identified the critical variables affecting consultation duration to be patient type (new vs. established), doctor's experience, zip code, appointment day, and doctor's specialty. Moreover, several practical insights are obtained based on the comparative analysis of the ML algorithms. The machine learning approach presented in this study can serve as a decision support tool and could be integrated into the appointment system for effectively managing patient scheduling.

Keywords: clinical decision support system, machine learning algorithms, patient scheduling, prediction models, provider service time

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Authors: Hannah Rachel Vasanthi, Paomipem Phazang, Veereshkumar, Sali, Ramesh Parjapath, Sangeetha Marimuthu Kannan

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Garcinia indica (G. indica) fruit rind extract commonly used in South Indian culinary and Indian System of medicines is reported to exhibit various biological activities. The present study envisages the influence of the phytoconstituents in G. indica extract (Vrikshamla capsules- a herbal supplement) on diabetic condition. The condition of type 2 diabetes was triggered in experimental animals by feeding high fat diet for 8 weeks followed by a sub-diabetogenic dose of 35mg/kg bw of streptozotocin intraperitoneally. Oral supplementation of the extract at two doses (100 and 200 mg/kg body weight) for 14 days reduced hyperglycemia, hypercholesterolemia and dyslipidemia (p< 0.001). Pathophysiological changes of obesity and diabetes associated complications majorly mediated by oxidative stress were analyzed by measuring the markers of oxidative stress such as lipid peroxidation, enzymatic (SOD, Catalase, GPx) and non-enzymatic markers (GSH). Conspicuous changes markers were noticed in diabetic condition which was reverted by the G. indica extract. Screening the extract by AccuTOF-DART (MS) revealed the presence of hydroxycitric acid and garcinol in abundant quantity which probably has influenced the biological activity. This was also corroborated through docking studies of hydroxycitric acid and garcinol both individually and synergistically with the antioxidant proteins. Altogether, hydroxycitric acid and garcinol present in G. indica fruit extract alleviates the pathophysiological conditions such as hyperglycemia, dyslipidemia, insulin resistance and oxidative stress mediated by diabesity.

Keywords: antioxidants , diabesity, hydroxycitric acid, garcinol, Garcinia indica, sreptozotocin

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Authors: Bundit Pungnirund

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This research aimed to investigate the relationship between attitude towards marketing mix, brand image and consumer behavior of the passengers of low-cost airlines service. This study employed by quantitative research and the questionnaire was used to collect the data from 400 sampled of the passengers who have ever used the low-cost airline services based in Bangkok, Thailand. The descriptive statistics and Pearson’s correlation analysis were used to analyze data. The research results revealed that the attitude of the marketing mix of the low-cost airline services including product, price, place, promotion and process had related to the consumer behavior on the aspects of duration of service and frequency of service. While, the brand image of the low cost airline including the characteristics of organization, service quality and company identity had related to the consumer behavior on duration of service, frequency of service and cost of service at the significant statistically acceptable levels.

Keywords: brand image, consumer behavior, low-cost airline, marketing mix

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Authors: Ahmad Abdi, M. Golzadeh Gangeraj, Alireza Barari, S. Shirali, S. Amini

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Aims: Diabetes is one of the common metabolic diseases in the world that has the dire adverse effects such as nephropathy, retinopathy and cardiovascular problems. Pharmaceutical and non-pharmaceutical strategies for control and treatment of diabetes are provided. Exercise and nutrition as non-drug strategies for the prevention and control of diabetes are considered. Exercises may increase oxidative stress and myocardium injury, thus it is necessary to take nutrition strategies to help diabetic athletes. Methods: This study was a semi-experimental research. Therefore, 24 men with type 2 diabetes were selected and randomly divided in four groups (1. control, 2. saffron extract, 3. aerobic exercises, 4. compound aerobic exercises and saffron extract). Saffron extract with 100 mg/day was used. Aerobic exercises, three days a week, for eight weeks, with 55-70% of maximum heart rate were performed. At the end, levels of Heart-type fatty acid-binding protein (HFABP) and Troponin T were measured. Data were analyzed by Paired t, One-way ANOVA and Tukey tests. Results: The serum Troponin T increased significantly in saffron extract, aerobic exercises and compound saffron extract -aerobic exercises in type 2 diabetic men(P=0.024, P =0.013, P=0.005 respectively). Saffron extract consumption (100 mg/day) and aerobic exercises did not significantly influence the serum HFABP (P =0.365, P =0.188 respectively). But serum HFABP decreased significantly in compound saffron extract -aerobic exercises group (P =0.003). Conclusions: Raised cardiac Troponin T and HFABP concentration accepted as the standard biochemical markers for the diagnosis of cardiac injury. Saffron intake may beneficially protect the myocardium from injuries. Compound saffron extract -aerobic exercises can decrease levels of Troponin T and HFABP in men with type 2 diabetes.

Keywords: Saffron, aerobic exercises, type 2 diabetes, HFABP, troponin T

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Authors: Arslan Masood Pirzada, Muhammad Naeem, Hafiz Haider Ali, Muhammad Latif, Aown Sammar Raza, Asad Hussain Bukhari, Muhammad Saqib, Muhammad Ijaz

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Cyperus rotundus (Cyperaceae), a medicinal herb, is being traditionally used as a home remedy for the treatment of various clinical conditions like diarrhea, diabetic, pyretic, inflammation, malaria, and for treating stomach and bowel disorders. Its current status is one of the most widespread, troublesome, and economically damaging agronomic weeds, growing wildly in various tropical and sub-tropical regions of the world. Tuber and rhizomes of Cyperus rotundus possess a higher concentration of active ingredients in the form of essential oils, phenolic acids, ascorbic acids and flavonoids, responsible for its remedial properties. Exploitation of any medicinal plant application depends on the crucial and comprehensive information about the therapeutic potential of a plant. Researchers have evaluated and characterized the significance of Cyperus rotundus as an anti-androgenic, anti-bacterial, anti-cancerous, anti-convulsant, anti-diabetic, anti-diarrheal, anti-genotoxic, anti-inflammatory, anti-lipidemic, anti-malarial, anti-mutagenic, anti-obesity, anti-oxidant, anti-uropathogenic, hepato-, cardio-, neuroprotective, and nootropic agent. This paper comprises a broad review to summarize the current state of knowledge about chemical constituents, potential economic uses and therapeutic aspects of Cyperus rotundus that will aid in the development of bioethanol and modern herbal medicine through latest technologies that will promote the ability of this plant in the cure of many clinical disorders.

Keywords: purple nutsedge, chemical composition, economic uses, therapeutic values, future directions

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Authors: Joo-Heon Lee, Ho-Won Jang, Hyung-Won Cho, Tae-Woong Kim

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Drought is a recurrent climatic feature that occurs in virtually every climatic zone around the world. Korea experiences the drought almost every year at the regional scale mainly during in the winter and spring seasons. Moreover, extremely severe droughts at a national scale also occurred at a frequency of six to seven years. Various drought indices had developed as tools to quantitatively monitor different types of droughts and are utilized in the field of drought analysis. Since drought is closely related with climatological and topographic characteristics of the drought prone areas, the basins where droughts are frequently occurred need separate drought preparedness and contingency plans. In this study, an analysis using statistical methods was carried out for the historical droughts occurred in the five major river basins in Korea so that drought characteristics can be quantitatively investigated. It was also aimed to provide information with which differentiated and customized drought preparedness plans can be established based on the basin level analysis results. Conventional methods which quantifies drought execute an evaluation by applying a various drought indices. However, the evaluation results for same drought event are different according to different analysis technique. Especially, evaluation of drought event differs depend on how we view the severity or duration of drought in the evaluation process. Therefore, it was intended to draw a drought history for the most severely affected five major river basins of Korea by investigating a magnitude of drought that can simultaneously consider severity, duration, and the damaged areas by applying drought run theory with the use of SPI (Standardized Precipitation Index) that can efficiently quantifies meteorological drought. Further, quantitative analysis for the historical extreme drought at various viewpoints such as average severity, duration, and magnitude of drought was attempted. At the same time, it was intended to quantitatively analyze the historical drought events by estimating the return period by derived SDF (severity-duration-frequency) curve for the five major river basins through parametric regional drought frequency analysis. Analysis results showed that the extremely severe drought years were in the years of 1962, 1988, 1994, and 2014 in the Han River basin. While, the extreme droughts were occurred in 1982 and 1988 in the Nakdong river basin, 1994 in the Geumg basin, 1988 and 1994 in Youngsan river basin, 1988, 1994, 1995, and 2000 in the Seomjin river basin. While, the extremely severe drought years at national level in the Korean Peninsula were occurred in 1988 and 1994. The most damaged drought were in 1981~1982 and 1994~1995 which lasted for longer than two years. The return period of the most severe drought at each river basin was turned out to be at a frequency of 50~100 years.

Keywords: drought magnitude, regional frequency analysis, SPI, SDF(severity-duration-frequency) curve

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Authors: Roopam Gaur, K. Chandramani Singh, Radhapiyari Laishram

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In order to produce lead free piezoceramics with optimum piezoelectric and dielectric properties, KNN modified with Li+ (as an A site dopant) and Sb5+ (as a B site dopant) (K0.49Na0.49Li0.02) (Nb0.96Sb0.04) O3 (referred as KNLNS in this paper) have been synthesized using solid state reaction method and conventional sintering technique. The ceramics were sintered in the narrow range of 10500C-10900C for 2-3 hours to get precise information about sintering parameters. Detailed study of dependence of microstructural, dielectric and piezoelectric properties on sintering conditions was then carried out. The study suggests that the volatility of the highly hygroscopic KNN ceramics is not only sensitive to sintering temperatures but also to sintering durations. By merely reducing the sintering duration for a given sintering temperature we saw an increase in the density of the samples which was supported by the increase in dielectric constants of the ceramics. And since density directly or indirectly affects almost all the associated properties, other dielectric and piezoelectric properties were also enhanced as we approached towards the most suitable sintering temperature and duration combination.

Keywords: piezoelectric, dielectric, Li, Sb, KNN, conventional sintering

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Authors: Imene Skhakhfa, Lahbaci Ouerdachi

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The design of sewerage systems is directly related to rainfall, which has a highly random character. Showers are usually described by three characteristics: intensity, volume and duration. Several studies considered only in two of the three models. The objective of our work is to perform an analysis of the impact of three variables on put in charge of sewerage system, responsible for misbehavior, origin of urban flooding. 30 events were considered events for the longest, most rushed and most intense period which runs from 1986 -2001. We built the IDF curves and heavy projects double symmetrical triangles associated with this selection. A simulation of the operation, with the model canoe, sewage from the city of Annaba (Algeria) in the three rain solicitation project, double triangles associated with events considered. It appears that the sewage of the city of Annaba, in terms of charging, is much more sensitive to rain most precipitous, and the more intense causing loadings and last the longest. Further analysis of all the rain and the field measurements are underway to confirm the test simulations.

Keywords: intensity, volume, duration, sewerage, design, simulation

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Authors: Caio E. G. Reis, Jose G. Dórea, Teresa H. M. da Costa

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Objective: Epidemiological data shows an inverse association of coffee consumption with risk of type 2 diabetes mellitus. However, the clinical effects of coffee consumption on the glucose metabolism biomarkers remain controversial. Thus, this paper reviews clinical trials that evaluated the effects of coffee consumption on glucose metabolism. Research Design and Methods: We identified studies published until December 2014 by searching electronic databases and reference lists. We included randomized clinical trials which the intervention group received caffeinated and/or decaffeinated coffee and the control group received water or placebo treatments and measured biomarkers of glucose metabolism. The Jadad Score was applied to evaluate the quality of the studies whereas studies that scored ≥ 3 points were considered for the analyses. Results: Seven clinical trials (total of 237 subjects) were analyzed involving adult healthy, overweight and diabetic subjects. The studies were divided in short-term (1 to 3h) and long-term (2 to 16 weeks) duration. The results for short-term studies showed that caffeinated coffee consumption may increase the area under the curve for glucose response, while for long-term studies caffeinated coffee may improve the glycemic metabolism by reducing the glucose curve and increasing insulin response. These results seem to show that the benefits of coffee consumption occur in the long-term as has been shown in the reduction of type 2 diabetes mellitus risk in epidemiological studies. Nevertheless, until the relationship between long-term coffee consumption and type 2 diabetes mellitus is better understood and any mechanism involved identified, it is premature to make claims about coffee preventing type 2 diabetes mellitus. Conclusion: The findings suggest that caffeinated coffee may impairs glucose metabolism in short-term but in the long-term the studies indicate reduction of type 2 diabetes mellitus risk. More clinical trials with comparable methodology are needed to unravel this paradox.

Keywords: coffee, diabetes mellitus type 2, glucose, insulin

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Authors: Alyaa Farouk AbdelFattah Ibrahim, Agnes Monica, Dolores I. Cabansag

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The prevalence of diabetes mellitus is reaching epidemic proportions in many parts of the world causing an increasing public health concern. Cases of Type 2 diabetes are rapidly increasing in the Middle East region. Deprived of lifestyle deviations, a section of the Middle East’s inhabitants will be pretentious by 2035. As all sociocultural factors have created unhealthy lifestyles, which have become part of the social norms within Saudi society, thereby increased the prevalence of sedentary lifestyle and obesity in women living in Saudi Arabia. So, this study aimed to assess the impact of diabetes mellitus on quality of life of female nursing students in King Saud bin Abdulaziz University for Health Sciences, Riyadh. In a crossectional study design, 151 nursing students at King Saud bin Abdulaziz University for health sciences in Riyadh were included in the study. Biosociodemographic questionnaire and Short-Form 36 (SF-36) Health Related Quality of life Survey Arabic version were used for data collection, and all included students were screened for random blood glucose level. Results depicted that among 151 subjects included in the study 17 (11.3%) had diagnosed medical problems, and 29.4% of those participants with medical problems were diabetics. Univariate regression model for the relation between diabetes mellitus and overall percent score of SF-36 health survey domains showed no statistically significant difference between diabetic and non-diabetic subjects 0.990(0.931-1.053). In conclusion, although the diabetes prevalence was high among the study subjects it did not affect their quality of life may be due to age of the study population.

Keywords: diabetes mellitus, diabetes prevalence, quality of life, university students' health

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Authors: Lai Yi-Hsiu

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The present paper aims to examine the language processing of Chinese-speaking seniors with Alzheimer’s disease (AD) from the perspective of temporal cues. Twenty healthy adults, 17 healthy seniors, and 13 seniors with AD in Taiwan participated in this study to tell stories based on two sets of pictures. Nine temporal cues were fetched and analyzed. Oral productions in Mandarin Chinese were compared and discussed to examine to what extent and in what way these three groups of participants performed with significant differences. Results indicated that the age effects were significant in filled pauses. The dementia effects were significant in mean duration of pauses, empty pauses, filled pauses, lexical pauses, normalized mean duration of filled pauses and lexical pauses. The findings reported in the current paper help characterize the nature of language processing in seniors with or without AD, and contribute to the interactions between the AD neural mechanism and their temporal parameters.

Keywords: language processing, Alzheimer’s disease, Mandarin Chinese, temporal cues

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Authors: E. Rama Devi Jothilingam

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Diabetes mellitus is now one of the most common non communicable diseases globally. India leads the world with largest number of diabetic subjects earning the title "diabetes capital of the world". In order to reduce the mortality rate, a fuzzy expert system is designed to predict the severity of cardiac and renal problems of diabetic patients using fuzzy logic. Since uncertainty is inherent in medicine, fuzzy logic is used in this research work to remove the inherent fuzziness of linguistic concepts and uncertain status in diabetes mellitus which is the prime cause for the cardiac arrest and renal failure. In this work, the controllable risk factors "blood sugar, insulin, ketones, lipids, obesity, blood pressure and protein/creatinine ratio" are considered as input parameters and the "the stages of cardiac" (SOC)" and the stages of renal" (SORD) are considered as the output parameters. The triangular membership functions are used to model the input and output parameters. The rule base is constructed for the proposed expert system based on the knowledge from the medical experts. Mamdani inference engine is used to infer the information based on the rule base to take major decision in diagnosis. Mean of maximum is used to get a non fuzzy control action that best represent possibility distribution of an inferred fuzzy control action. The proposed system also classifies the patients with high risk and low risk using fuzzy c means clustering techniques so that the patients with high risk are treated immediately. The system is validated with Matlab and is used as a tracking system with accuracy and robustness.

Keywords: Diabetes mellitus, fuzzy expert system, Mamdani, MATLAB

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Authors: S. Haider, B. Bhushan

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Eye Gaze behaviour of individuals with and without intellectual disability are investigated in an eye tracking study in terms of sensitivity to Nonaccidental (NAPs) and Metric (MPs) shape properties. Total fixation time is used as an indirect measure of attention allocation. Studies have found Mean reaction times for non accidental properties (NAPs) to be shorter than for metric (MPs) when the MP and NAP differences were equalized. METHODS: Twenty-five individuals with intellectual disability (mild and moderate level of Mental Retardation) and twenty-seven normal individuals were compared on mean total fixation duration, accuracy level and mean reaction time for mild NAPs, extreme NAPs and metric properties of images. 2D images of cylinders were adapted and made into forced choice match-to-sample tasks. Tobii TX300 Eye Tracker was used to record total fixation duration and data obtained from the Areas of Interest (AOI). Variable trial duration (total reaction time of each participant) and fixed trail duration (data taken at each second from one to fifteen seconds) data were used for analyses. Both groups did not differ in terms of fixation times (fixed as well as variable) across any of the three image manipulations but differed in terms of reaction time and accuracy. Normal individuals had longer reaction time compared to individuals with intellectual disability across all types of images. Both the groups differed significantly on accuracy measure across all image types. Normal individuals performed better across all three types of images. Mild NAPs vs. Metric differences: There was significant difference between mild NAPs and metric properties of images in terms of reaction times. Mild NAPs images had significantly longer reaction time compared to metric for normal individuals but this difference was not found for individuals with intellectual disability. Mild NAPs images had significantly better accuracy level compared to metric for both the groups. In conclusion, type of image manipulations did not result in differences in attention allocation for individuals with and without intellectual disability. Mild Nonaccidental properties facilitate better accuracy level compared to metric in both the groups but this advantage is seen only for normal group in terms of mean reaction time.

Keywords: eye gaze fixations, eye movements, intellectual disability, stimulus properties

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Authors: Deepthy Ann Joy, N. Sreedevi

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Hearing impairment (HI) at an early age, identified before the onset of language development can reduce the negative effect on speech and language development of children. Early rehabilitation is very important in the improvement of speech production in children with HI. Other than conventional hearing aids, Cochlear Implants are being used in the rehabilitation of children with HI. However, delay in acquisition of speech and language milestones persist in children with Cochlear Implant (CI). Delay in speech milestones are reflected through speech sound errors. These errors reflect the temporal and spectral characteristics of speech. Hence, acoustical analysis of the speech sounds will provide a better representation of speech production skills in children with CI. The present study aimed at investigating the acoustic characteristics of vowels in Malayalam speaking children with a cochlear implant. The participants of the study consisted of 20 Malayalam speaking children in the age range of four and seven years. The experimental group consisted of 10 children with CI, and the control group consisted of 10 typically developing children. Acoustic analysis was carried out for 5 short (/a/, /i/, /u/, /e/, /o/) and 5 long vowels (/a:/, /i:/, /u:/, /e:/, /o:/) in word-initial position. The responses were recorded and analyzed for acoustic parameters such as Vowel duration, Ratio of the duration of a short and long vowel, Formant frequencies (F₁ and F₂) and Formant Centralization Ratio (FCR) computed using the formula (F₂u+F₂a+F₁i+F₁u)/(F₂i+F₁a). Findings of the present study indicated that the values for vowel duration were higher in experimental group compared to the control group for all the vowels except for /u/. Ratio of duration of short and long vowel was also found to be higher in experimental group compared to control group except for /i/. Further F₁ for all vowels was found to be higher in experimental group with variability noticed in F₂ values. FCR was found be higher in experimental group, indicating vowel centralization. Further, the results of independent t-test revealed no significant difference across the parameters in both the groups. It was found that the spectral and temporal measures in children with CI moved towards normal range. The result emphasizes the significance of early rehabilitation in children with hearing impairment. The role of rehabilitation related aspects are also discussed in detail which can be clinically incorporated for the betterment of speech therapeutic services in children with CI.

Keywords: acoustics, cochlear implant, Malayalam, vowels

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