RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Dr. SHASHIDHARA.H.N,PG STUDENT,
DEPARTMENT OF ANATOMY,
BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE,
BANGALORE-560002.
2. / NAME OF THE INSTITUTION / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE,
BANGALORE-560002.
3. / COURSE OF THE STUDY AND SUBJECT / M.D.(ANATOMY)
4. / DATE OF ADMISSION TO THE COURSE / 29-05-08
5. / TITLE OF THE TOPIC / A STUDY OF PALMAR DERMATOGLYPHICS IN PATIENTS WITH BRONCHIAL ASTHMA.
6. BRIEF RESUME OF THE INTENDED WORK:
6.1) Need for the study:
Asthma is one of the diseases longest recognized as a disease entity. Asthma is defined as a chronic inflammatory disease of airways that is characterized by increased responsiveness of the tracheobronchial tree to a multiplicity of stimuli resulting in episodic airflow obstruction.
Asthma is one of the most common chronic diseases globally and currently affects ~300 million people. Asthma has increased dramatically in prevalence and is now recognized as a major cause of disability, medical expense and preventable death.1
Bronchial asthma occurs at all ages but predominantly in early life. About one-half of cases develop before age 10, and another third occur before age 40.2
From an etiologic standpoint, asthma is a heterogeneous disease with interplay between genetic and environmental factors. Atopy is the major risk factor for asthma, and nonatopic individuals have a very low risk of developing asthma. Atopy may be found in 40–50% of the population in affluent countries, with only a proportion of atopic individuals becoming asthmatic. This observation suggests that some other environmental or genetic factor(s) predispose to the development of asthma in atopic individuals.3
Although there is little doubt that asthma has a strong familial component, the identification of the genetic mechanisms underlying the illness has proven difficult. It seems very likely that different genetic polymorphisms in different populations can produce what to the clinician appears to be the same phenotype. Hence a greater research emphasis on factors influencing the expression of whatever genes are involved in determining atopy and bronchial reactivity may produce greater dividends in terms of prevention.
Dermatoglyphics is one of such several research methodologies as to find out a phenotypic marker of underlying genetic constitution. Dermatoglyphics is a branch of genetics concerned with the analysis of patterns of integumentary fine ridges of fingers, palms and soles by studying prints of them.
The development of dermatoglyphic patterns is under genetic control and in general the genetics are multifactorial and highly complex. They are of considerable clinical interest because they are affected by certain abnormalities of early development including genetic disorders. Abnormal dermatoglyphic patterns have been observed in several non-chromosomal genetic disorders and other diseases whose etiology may be influenced, directly or indirectly, by genetic inheritance.
The relevance of dermatoglyphics is not to diagnosis, but to prognosis; not to the definition of existing disease, but to the identification of people with genetic predisposition to the development of certain diseases; not the academic identification of associations, but their practical application. Hence if a meaningful association can be established between dermatoglyphic patterns and bronchial asthma it may be of use in screening, cheaply, populations at risk so that a watch may be kept for the early onset symptoms.4
Hence there is a need for a study of palmar dermatoglyphics in patients with bronchial asthma.
6.2) Review of literature:
Atopy is the single largest risk factor for the development of asthma and is often associated with a personal and/or family history of allergy. A significant fraction of patients with asthma present with no personal or family history of allergy and are said to have nonatopic asthma. Many patients have disease that does not fit clearly into either of the preceding categories but instead falls into a mixed group. In general, asthma that has its onset in early life tends to have a strong allergic component, whereas asthma that develops later tends to be nonallergic or to have a mixed etiology.2
Some workers conducted a case control study including 372 pedigrees to examine the relationship between child bronchial asthma and genetic factors and found that the genetic model of asthma was polygenetic. Genetic factor was a main risk factor for asthma, especially for female patients.5
In a study conducted in 1973 dermatoglyphics of patients suffering from diabetes, schizophrenia, duodenal ulcer, asthma, and various cancers have been contrasted and significant differences in the digital ridge counts, maximum atd angles, and distal palmar loop ridge counts have been found. Attention is drawn to the possibility that prognostic implications of dermatoglyphics might be relevant to screening techniques.4
A study was conducted in 2003 in which finger tip patterns of sixty patients of bronchial asthma were compared with that of 50 control cases. Higher frequency of whorls was observed in the first digit of both generations of bronchial asthma patients in comparison to controls. In all digits the frequency of arches was reduced in both generations of bronchial asthma patients as compared to controls. These findings proved highly significant statistically (p value : < 0.001). There was no significant change in finger tip patterns in second & third digit, but, fourth & fifth digits showed significant reduction in frequency of loops in both generations of bronchial asthma patients as compared to controls.6
Some workers (1993) have studied dermatoglyphic patterns in 80 patients with chronic bronchial asthma and compared with 50 controls. They found that whorls were significantly higher in both hands. No significant differences were present in total finger ridge count (TFRC), atd angle, a- b ridge count, simian line and Sydney line.7
6.3) Objectives of the study:
1. To find out various dermatoglyphic patterns in patients suffering from bronchial asthma.
2. To analyze whether these patterns are statistically significant so as to be used as an early predictor of the disease.
7. MATERIALS AND METHODS:
7.1) Source of data:
The present study will be carried out on 100 patients with bronchial asthma, comprising 50 male patients and 50 female patients, selected from outdoor & indoor Department of Medicine and Pediatrics of various hospitals attached to Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. Diagnosis of bronchial asthma will be based on detailed history, clinical signs and symptoms. The age of the patients will be from 1– 20 years. Hundred healthy subjects (50 male and 50 female) of control group not suffering from any respiratory disease will be selected from the I M.B.B.S students of Bangalore Medical College and Research Institute.
7.2) Method of collection of data:
Sample size:
The sample for study will consist of 100 patients of bronchial asthma and 100 healthy individuals as specified under ‘7.1’, Source of data (q.v.).
Sampling procedure:
Materials to be used are stamp pad, bond papers roller and gauze. The modified Purvis-Smith method (1969)8 will be applied. Patients will be asked to wash their hands with soap and water so as to remove oil and dirt. Black duplicating ink (Kores, Bombay) will be smeared on both hands one by one with gauze and prints will be taken by rolling the hands from the wrist crease to the finger tips on the roller covered with bond paper.
Type of study:
The quantitative study includes total finger ridge count, absolute finger ridge count, ridge count of individual fingers, a-b ridge count, angles atd, dat, adt, main line index and axial triradii.
The qualitative study includes finger print patterns (arches, radial loops, ulnar loops and whorls), palmar patterns (simian line and Sydney line), ‘C’ main line types, main line termination and palmar flexion creases.
Statistical analyses– for quantitative analysis, arithmetic mean, Z test and standard deviation will be calculated. For qualitative analysis, chi square test will be applied.
7.3) Inclusion criteria:
Patients of bronchial asthma of both sexes in the age group of 1– 20 years will be included in the study. Diagnosis of bronchial asthma will be based on detailed history, clinical signs and symptoms.9
7.4) Exclusion criteria:
Patients with deformed fingers and palms, infections and injuries like burns of fingers and palms, scars of burns of fingers and palms of either hand will be excluded from the study. Individuals with any other respiratory illness, either in study or control group will also be excluded. Doubtful cases will not be included in the study.
7.5) Does the study require any investigation or interventions to be conducted on the patient or other human or animals? If so please describe briefly.
Investigations required are: Nil.
7.6) Has the ethical clearance been obtained from your institution?
Yes.
8. LIST OF REFERENCES:
1. Masoli M, Fabian D, Holt S and Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004; 59:469- 478.
2. Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL. Ed.Harrison’s Principles of Internal Medicine. U.S.A: Mc Graw Hill, 2005; 2:1508-1509.
3. Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL et al. Ed.Harrison’s Principles of Internal Medicine. U.S.A: Mc Graw Hill, 2008; 2:1596.
4. Fuller I C. Dermatoglyphics: A diagnostic aid? Journal of Medical Genetics 1973; 10:
165- 169.
5. Tang G, Li T, Zhang D. A study of genetic epidemiology on child bronchial asthma.
Zhonghua Liu Xing Bing Xue Za Zhi 1999 Jun; 20(3):151- 154.
6. Gupta UK and Prakash S. Dermatoglyphics: a study of finger tip patterns in bronchial asthma and its genetic disposition. Kathmandu University Medical Journal 2003; 4(1): 267- 271.
7. Gupta M, Sood A and Bharihoke V. Dermatoglyphic pattern in patients of chronic
bronchial asthma. Journal of Anatomical Society of India 1993; 42:71.
8. Purvis-Smith SG. Finger and palm printing techniques for the clinician. Medical Journal of Austria 1969; 2: 189.
9. Behrman RE, Kliegman RM, Jenson HB. Ed.Nelson Textbook of Pediatrics. U.S.A: Saunders, 2004:762- 763.
9. SIGNATURE OF THE CANDIDATE:
10. REMARKS OF THE GUIDE: These studies are important because of their applications in clinical practice in early detection of individuals at risk of developing asthma and taking preventive measures. Hence it is approved and forwarded.
11. NAME AND DESIGNATION OF THE
11.1) GUIDE: Dr. IMTIAZUL HAQ
MBBS, MS
PROFESSOR AND HEAD
DEPARTMENT OF ANATOMY
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE
BANGALORE.
11.2) SIGNATURE:
11.3) CO-GUIDE (IF ANY): NO
11.4) SIGNATURE:
11.5) HEAD OF THE DEPARTMENT:
Dr. IMTIAZUL HAQ
MBBS, MS
PROFESSOR AND HEAD
DEPARTMENT OF ANATOMY
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE
BANGALORE.
11.6) SIGNATURE:
12.1) REMARKS OF THE CHAIRMAN AND PRINCIPAL:
12.2) SIGNATURE:
10