Friday, 21 February 2020

Lupine Publishers | Is There Any Relation Between Blood in Urine and Eating Almonds?

Lupine Publishers | Open access journal of Complimentary & Alternative Medicine




Abstract


The main aim of the study is to find out the relation of eating almond with the blood in urine. This is the alarming situation when a person sees blood in the urine, it is called hematuria. Blood in urine is a serious disorder, but there are many situations in which it is harmless. Gross hematuria is a situation in which blood can be seen by a person. There are many benefits to eating the almonds, almonds can be eaten in the raw form or roasted form, but there are more benefits to eat raw almonds. One hundred subjects participated in the present research were students of Bahauddin Zakariya University of Multan, Pakistan [1]. The data analysis showed that 48% females eat almonds had negative results for blood in urine. The present study had been concluded that there is no relation of eating almonds with the urine in blood.

Keywords: Blood in urine; Gross hematuria; Microscopic hematuria

 

Introduction

This is the alarming situation when a person sees a blood in the urine, it is called hematuria blood in urine is a serious disorder, but there are many situations in which it is harmless. Gross hematuria is a situation in which blood can be seen by a person [2]. If bleeding occur in the urine, when a person test his or her urine then urinary blood test under a microscope, then determine the cause of the bleeding in the urine. Cola, pink, and red colored produce due to red blood cells in the urine, only small amount of blood cause to produce urine with red color. Blood in the urine is not painful for person, but when clots of blood pass in the urine, it would be harmful. When a person sees blood in the urine he or she makes sure to get an appointment from the doctor and test your urine [3]. There are different causes due to which blood in the urine present, such as infection in the urinary tract infection, infection of the kidney, injury in the kidney also cause blood in the urine. Different types of drugs such as cancer drug; cyclophosphamide, antibiotics such as penicillin cause blood in the urine. Enlarged prostate gland in the man of age 50 has occasional hematuria. People who run for long distance can also have blood in the urine [4].
Middle and Southern Asia are Mediterranean climate regions and these areas have almond trees, drupe is the fruit of the almond, that consist of harder shell, remove the shell and seed is revealed. Almonds sold in the market with shelled or unshelled. There are many benefits to eating the almonds, almonds can be eaten in the raw form or roasted form, but there are more benefits to eat raw almonds. Vitamin E, magnesium healthy fats, fiber protein, proteins is present in the almonds [5]. Almonds lower the cholesterol level, reduce the blood pressure, also lower blood sugar level, it also loss the weight, means almonds have fat burning power. Omega -3 fatty acids are found in the almonds, it also give benefits to bones and teeth. The main aim of the study is to find out the relation of eating almond with the blood in urine [6].

 

Materials and Methods

Measurement of blood in urine

A method was used to check the blood in urine of the subjects. First the sample of urine collects in a container, then a strip is dipped in container for 2-3 seconds, strip will shows colors, then match it with standard one, it will shows values and mark or write down the status of the blood in urine from the sample [7-8].

Projects designing

One hundred subjects participated in that research; subjects were students of Bahauddin Zakariya University, Multan, Pakistan. Urinalysis was performed in this research. Relation of blood in urine with eating almond was observed in this research [9-10].

 

Results

(Table 1) shows that 10% males eat almonds had negative results for blood in urine, 0% males had showed 10H, and 10N value for blood in urine. 1% males eat almonds showed that showed 50H. 0% males that not eat almonds showed 10H and 50H. 9% males that not eat almonds showed negative results. 1% males that not eat almonds showed 10N. 48% females eat almonds had negative results for blood in urine, 4% females had showed 10H, 1% females showed 10N, and 1% had 50H results. 15% females that not eat almonds had negative results, 1% females showed 10H results, and 1% females showed 50H results, and 0% showed 10N (Table 2).

Table 1: Relation of blood in urine in males with eating and not eating almond.

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Table 2: Relation of blood in urine in females with eating and not eating almond.

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Discussion

Number of benefits to eat almonds had been described in different papers. Almonds research and scientific paper had written that cardiovascular vascular disease increased with alarming level, so to eat 1.5 ounces of almonds as per diet, it reduces the heart disease. In 1992 heart health research started, to support the role of almonds. Almonds also beneficial to the cure of diabetes type 2. A research paper hematuria: blood in urine showed that there are two types of hematuria called microscopic hematuria and gross hematuria. 4% females had 10H result to eat almonds.

 

Conclusion

It is concluded from the study that there is no relation of eating almonds with the urine in blood.


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Tuesday, 18 February 2020

Lupine publishers | Modern Tools and Techniques for Diagnosis and Prognosis of Salt Affected Soils and Poor- Quality Waters

Lupine Publishers |Agriculture Open Access Journal

Introduction

Soil salinity and brackish ground water are primary concerns for reduced productivity in the arid and semiarid regions of the World covering 953 million ha of land [1]. In India, it occupied 2% of the TGA and is distributed in fifteen states that covered Genetic plain, central arid and semiarid regions, southern peninsular plain and coastal areas [2]. Transportation and deposition of salts at the lower topographic zones are primary processes controlling genesis and distribution of salty soils in the Genetic plain besides high evaporation in arid zone, salty parent materials and brackish ground use in peninsular plain and inundation of saline sea water in coastal areas are other soil salinization processes [3]. Factors of anthropogenic origin include the use of salty ground water and canal water for irrigation in poorly drained soils of arid and semiarid regions that caused the emergences of water logging, salinization and losses of soil/crop productivity [4,5].
Traditional methods of soil survey using aerial photographs and soil profile studies require enough time and manpower for soil characterization which is limited to small areas. Temporal dynamics of salts is also an important issue which is usually unaddressed in soil survey studies. Indian Remote Sensing Technology (Resources at I&II) with improved spatial and spectral resolutions have facilitated the diagnosis of salt affected soils in less time and cost effective manner with limited resources. For delineation and characterization of salt affected soils on a reconnaissance scale, a methodology was developed integrating remote sensing data with ground truth and soil studies [6]. Legends were developed to address nature, characteristics and extent of saline and sodic soils for land reclamation & management. Prognostic studies on soil salinity were also conducted using high resolution remote sensing data (SPOT, MODIS etc.) in Western Yamuna, Bhakra and Sir hind (Haryana and Punjab states); IGNP (Rajasthan state), Sharda Sahayak (Uttar Pradesh state), Ukiah Kakarpar (Gujarat state), Upper Krishna (Karnataka state) and Gandak (Bihar state) canal command areas of India to quantify soil salinization processes integrating topography, soil texture, hydrology and sub-surface soil and aquifer characteristics Spatial variability of salts was studied at farm scale in the Shivari (at Lucknow, Uttar Pradesh state) and Nain (at Panipat, Haryana state) experimental farms of ICAR-CSSRI, representing sodic soils of the Middle- and saline soil and salty groundwater in the Trans-Gang tic plains of India [7,8].
Interpretation of IRS data facilitated the identification strongly salt affected soils by the white to yellowish white tones and high spectral contrast of salt crusts from barren surfaces. Based on the dark blue/black to grey tones in the infrared range (SWIR), the waterlogged soils were clearly identified in canal irrigated areas showing stagnated water at soil surface with poor natural drainage. High reflectance from dry salts during June and freshly precipitated moist salts during March and October enabled the detection of sodic soils and areas with sodic (with high RSC, Residual Sodium Carbonate, and SAR, Sodium Adsorption Ratio) ground water [9]. Contrarily sodic soils with normal ground water showed mixed red and spotted while signatures and high NDVI values for crops with good vegetative covers. Moderately and slightly sodic soils showed mixed spectral signatures for salt crusts, moderate cropping density and surface wetness and is authenticated by ground truth study. The dark red tones of healthy vegetation and high NDVI values are found for normal cropped areas. Differential absorption from seasonal water logging and surface ponding were established in the infrared regions (SWIR) with higher accuracy [8]. Combination of red and infra red bands helped in segregating saline and sodic soils located in different geographic regions (Singh and Mandal 2007). Integration of thermal band interpretation helped in segregating salty areas and sand dunes [10].
Sodic soil profiles indicated prominent natric horizon with clay illuviation, iron and manganese mottles with higher moisture content and calcareous materials at sub-surface depths. Soils showing high PHS, ESP and SAR values and the dominance of carbonate and bicarbonates of sodium in the saturation extract indicated sodic nature [11]. High moisture content in soil profiles, salt accumulation at the root zone and salt dynamics in wet and dry cycles are common features of waterlogged (surface ponding), high water table depth (potential water logging) and seasonal water logging in the canal irrigated areas respectively [12]. Continuous use of salty ground water for irrigation in arid and semiarid regions caused salt enrichment in soil profiles. Periodic inundations of saline sea water in coastal fringes, and the use of salty water for fisheries development projects have abandoned large areas of good agricultural lands out of cultivation. Water samples with high pH and SAR values and at places high RC are typical qualities of water in arid and semiarid regions [13]. Water logging, high clay contents, smectite clay minerals and poor to very poor (sporadic) cropping density and ground water quality are some of the constraints in the peninsular plain, causing difficulty in the detection and delineation of salt affected soils [5]. Black soils of Peninsular (F) region were classified as sodic, as soil ESP (Exchangeable Sodium Percent>5) is becomes critical at this stage. For management purposes, the complex saline-sodic soils of A (alluvial), B(aeofluvial/arid) and H(others) are classed as sodic. Due to high salt enrichment in soil profiles, typical soils in coastal (D), deltaic(C) and mud flats mangrove swamps (G) were classified as saline. Benchmark salt affected soils were also identified to support monitoring and management of salt affected soils [14] distributed in fifteen agroclimatic and seven physiographic regions in India (CSSRI 2002- 2005). Interactive databases with climate and geology revealed largest areas (67%) in the 300-1000 mm rainfall, followed by 75% in the strong hypothermic (25-27.5oC) temperature zones and 39% in the Pleistocene and recent geological formations [15]. Recent IRS data [16] revealed distribution of salt affected soils (315617 ha) in 18 districts of Haryana state that showed an increase in areas under saline soils to 145054 ha and decrease of sodic soils to 170563 ha, apparently due to soil salinization in irrigated areas and sodic land reclamations (CSSRI 2017-18). Attempts were also taken to update sodic soil database in Uttar Pradesh and areas of saline soils in Gujarat state [17-21].


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Monday, 17 February 2020

Lupine Publishers | Allegric Rhinitis: Pearls of Wisdom

Lupine Publishers | Journal of Otolaryngology High Impact Factor

Abstract

Statement of The Problem

This provides an overview of Allergic Rhinitis and its management. It is very useful for students of Rhinology and clinicians managing this disease. It introduces them to a systematic approach of assessing allergic rhinitis patients which is very commonly found in most populations and causes considerably morbidity. Allergy per se is a very difficult subject to master and it is with great perseverance one can treat patients suffering from this condition. The cornerstone of managing a patient of allergic rhinitis is first and foremost obtaining a good history. This is to be followed by a thorough examination and investigations. The general practitioner is the first expert to be involved in management of allergic rhinitis patient followed by specialists otorhinolaryngologists, and finally by allied healthcare personnel. Inflammation of nose and paranasal sinuses are characterized by two or more symptoms-namely, either nasal blockage; obstruction; congestion or nasal discharge. Associated symptoms include facial pain; pressure and either reduction or loss of smell. Certain diagnostic endoscopic signs of nasal polyps and or mucopurulent discharge and or mucosal oedema in the middle meatus and or CT changes of mucosa within the ostoemeatal complex, and or sinuses are seen. Definitions, aetiologies, clinical presentations, diagnosis; prognosis and management of allergic rhinitis is dealt with. Common allergens causing the disease are mentioned, pathophysiology and classification of allergic rhinitis is discussed in detail. Different types of allergen testing are highlighted along with their specific role and uniqueness. Principles of immunotherapy in treatment of allergic rhinitis are discussed here. Health effects of allergic rhinitis along with its impact on physical quality of life is mentioned. The basic idea of this presentation is to improve diagnostic accuracy by promoting appropriate use of ancillary tests like nasoendoscopy, allergy testing, computed tomography etc. and reduce inappropriate antibiotic use. The basic treatment plan of allergic rhinitis is according to the severity and duration. It consists of allergen avoidance, pharmacotherapy, allergen immunotherapy and surgery which has limited role.
Keywords: Allergy; Rhinitis; Pollens; Molds; Insects; Penicillium; Cladosporium; Hypersensitivity; Histamine; Hay fever; Rose Fever; Transverse Nasal Crease; Rhinorrhea; Allergic Salute; Allergic Shiners (Dennie -Morgan Lines); Cobblestone Appearance Of Oropharynx; Scratch Test ; Intradermal Test; Patch Test; Rhinomanometry; Antihistaminics; Immunotherapy; Topical Nasal Steroids; Cochrane; Mast Cell Stabilizer
Abbreviations: IgA: Immunoglobulin A, IgE: Immunoglobulin E, AR: Allergic Rhinitis; NAR: Non-Allergic Rhinitis; ARIA: Allergic Rhinitis & its Impact on Asthma; Greater than; Less than; TM: Tympanic membrane; NPT: Nasal Provocation Test; n NO: Nitrogen in Nitric Oxide; PNS: Para Nasal Sinuses; OM: Occipito Mental; CECT: Contrast Enhanced Computerized Scan; L.A: Local Anaesthesia GA: General Anaesthesia; PQLI: Physical Quality of Life Index; WAO: World Allergy Organization; SCIT: Subcutaneous immunotherapy; SLIT: Sublingual immunotherapy; AIT: Allergic Immunotherapy; e-Health: Electronic Health; DBPC: Double Blind Placebo Controlled; RCT: Randomized Controlled Trial; FDA: Food & Drug Administration federal agency in USA; SMD: Submucous Diathermy; IT: Inferior turbinate; FESS: Functional Endoscopic Sinus Surgery; OMC: Osteo Meatal Complex

Introduction

Rhinitis is a common presentation in E.N.T. clinics across the globe & allergy compounded with it causes even more difficult to treat for the clinician. This article is useful and handy for students and clinicians managing Allergy& Rhinitis. There is something in this for everyone-General Practitioners, Otorhinolaryngologists, Allergologists, Rhinologists and Allied Healthcare personnel. Special computer based newer modalities of investigations are highlighted in this which helps in assessing the nasal function of the affected patient. It’s very common to sometimes feel like sneezing & have running nose but please see a doctor if the feeling persists and do take care of yourself. Allergic Rhinitis is made so easy to comprehend. Nasal function includes temperature regulation, olfaction, humidification, filtration and protection [1]. Nasal lining contains secretion of IgA, proteins and enzymes. Nasal cilia propel the matter towards the natural ostia at frequency of 10-15 beats; min. Mucous moves at a rate of 2.5 -7.5ml. per min (Figure 1). Rhinitis is the presentation of two or more nasal symptoms for more than one a day namely Nasal congestion; obstruction, Rhinorrhea, Sneezing, Itching, Impairment of smell. Rhinitis occurs most commonly as Allergic Rhinitis. Non-infectious rhinitis has been classified as either Allergic or Non-Allergic Rhinitis. Allergic Rhinitis affects 15-30% of population with a wide geographic variance. It is more common in children & adolescents. 50% of all rhinitis in E.N.T. Clinics is Allergic Rhinitis. Allergic Rhinitis is defined as immunologic nasal response, primarily mediated by IgE. Non-Allergic Rhinitis is defined as rhinitis symptoms in the absence of identifiable allergy, structural abnormality or sinus disease. So, Allergic Rhinitis is an inflammation of the nasal mucosa, caused by allergen. It is the most common Atopic allergic reaction.
Figure 1: The Human Normal Eye Anatomy.
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Aetiology

Aetiology is classified as Precipitating factors and Predisposing factors. Precipitating factors are classified into aerobiological flora and nasal physiology. Aerobiological flora are Allergens present in the environment, House dust & dust mites, Feathers, Tobacco smoke, Industrial Chemicals and Animal dander. Nasal physiology are Disturbances in normal nasal cycle. Predisposing factors are classified into genetic, endocrine, psychological, focal sensitivity tests, infections, physical, age & sex, IgA deficiency and common allergens [2]. Genetic factors indicate towards Multiple gene interactions are responsible for allergic phenotype. Chromosomes 5,6,11,12 & 14 control inflammatory process in atopy. 50% of AR pts. Have positive family history. Endocrine factors are Puberty, Pregnancy; Postpartum stages and Menopause. Infections such as Fungal. Physical factors are Degree of pollution of air, Humidity & Temperature differences, Temperature changes. Common allergens such as pollens (Spring tree pollens (Maple ; Alder ; Birch), Summer grass pollen (Blue grass, Sheep sorrel etc.), Autumn Weed pollen (Ragweed)), molds) Penicillium, Cladosporium etc.), INSECTS (Cockroaches, Houseflies, Fleas, Bedbugs) (Figure 2). Rhinitis is the presentation of two or more nasal symptoms for more than one a day namely Nasal congestion; obstruction, Rhinorrhea, Sneezing, Itching, Impairment of smell. Rhinitis occurs most commonly as Allergic Rhinitis. Non-infectious rhinitis has been classified as either Allergic or Non-Allergic Rhinitis. Allergic Rhinitis affects 15-30% of population with a wide geographic variance. It is more common in children & adolescents. 50% of all rhinitis in E.N.T. Clinics is Allergic Rhinitis [3]. Allergic Rhinitis is defined as immunologic nasal response, primarily mediated by IgE. Non-Allergic Rhinitis is defined as rhinitis symptoms in the absence of identifiable allergy, structural abnormality or sinus disease. So, Allergic Rhinitis is an inflammation of the nasal mucosa, caused by allergen. It is the most common Atopic allergic reaction.
Figure 2:
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Pathophysiology

Immunoglobulin IgE mediated type 1 hypersensitivity response to an antigen (allergen) in a genetically susceptible person. IgE is produced from plasma cells & the process is regulated by T-Suppressor lymphocytes or T-helper cells. IgE has affinity for mast cells & basophils and gets fixed to the surface of mast cells by its Fc end. Type 1 Hypersensitivity causes local vasodilation & increased capillary permeability. There is edema of the submucosal tissue by allergic fluid followed by infiltration by eosinophils and plasma cells leading to vascular dilatation which causes engorgement of the inferior turbinates and there is increased activity of seromucinous glands [4]. Histamine exerts its pharmacologic effect on smooth muscle, vascular endothelium & mucous glands. Number of IgE molecules has been estimated as 5300 to 27,000 in non-allergic subject & 15,000 to 41,000 in allergic subjects. Hypersensitivity of the host depends on antigen dose, frequency of exposure, genetic make-up, and hormone activity of the body.

Classification

Allergic Rhinitis is currently classified into intermittent and persistent. In intermittent AR the symptoms are present less than 4 days per week and less than 4 weeks per year [5]. In persistent AR the symptoms are present for greater than 4 days per week and for greater than 4 weeks per year. The severity of AR is classified into mild and moderate to severe. Mild AR doesn’t interfere with daily activities or doesn’t produce any troublesome symptoms. Moderate to severe AR interferes at least with one of the factors such as impaired sleep, hampered daily activities/work, school/ sick absenteeism, also produces troublesome symptoms. AR is formerly classified into seasonal and perennial based on the allergens. Seasonal Hay Fever, misnomer- no hay/no fever. Summer Cold caused by viruses causing URTI. Rose Fever seen usually in Indian Subcontinent (colorful/fragrant flowering plants). Perennial Allergens present throughout the year.

Signs and symptoms of AR

Symptoms of AR are sneezing, itching of eyes, ears & palate, rhinorrhea, postnasal drip, congestion, anosmia, headache, otalgia, epiphora, red eyes, swollen eyes, fatigue, drowsiness and malaise.
Figure 3(a): Transverse Nasal Crease
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Figure 3(b): Allergic salute
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Figure 3(c): Allergic shiners (Dennie-Morgan lines).
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Figure 3(b): Cobblestone appearance of oropharynx.
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Physical Examination: During Physical examination we check for TRANSVERSE NASAL CREASE (Horizontal crease across the lower half of the bridge of nose), RHINORRHOEA (Thin watery secretions from nose) (Figure 3). Associated features with AR are Injected & swelling of palpebral conjunctiva with excess tearing, Retracted T.M.’s, Overbite, Periorbital oedema.
Investigations
Skin prick tests---gold standard. This is also known as Scratch Test; Intradermal Test. Controlled amounts of allergen & control substances are introduced into the skin this procedure is convenient, safe & widely accepted (Figure 4). Goal of the investigation is the detection of immediate allergic response caused by release of mast cells or basophil IgE specific mediators Wheal; Flare after 15 mins [6]. More investigations are such as RAST-Radio-Allergo-Sorbent Test for specific IgE estimation. PRIST-Plasma Reactive Immuno- Sorbent Test for specific IgE estimation. SET Test-Skin End-Point Titration Test Latest skin test for allergy & is more reliable. Less common tests are total serum IgE, total blood eosinophil count, nasal smears may show increased eosinophilic level, PATCH TEST is used to determine delayed type hypersensitivity & the allergen is placed in the skin for 48hrs [7]. The area of reaction is noted and if any allergens present are identified. This is more useful in skin problems & food allergy.
Figure 4:
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a) Nasal provocation tests (NPT)

Figure 5(a): Rhino meter.
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Figure 5(b): Spraying Device for NPT.
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The potential allergen is sprayed into the nose & the number of SNEEZES counted or any change in Rhinomanometry is noted. Very time-consuming test as each allergen takes 20 mins. To test in order to allow the nose to return to normal after the challenge. It is useful for rare & occupational allergens. Contraindications of NPT are Pregnancy; < 5yrs. age; Recent nasal surgery <8 wks; Uncontrolled asthma, Nasal; systemic corticosteroids should be avoided for 1wk & Antihistaminics for 72hrs (Figure 5).

New Diagnostic Methods

Exhaled Nitric Oxide (E No): Like e NO in asthma, n NO is a noninvasive marker. Potentially suitable to monitor upper airway inflammation following allergen-induced late response. In AR pts., increased levels of n NO have been measured. However, the applicability of n NO as a marker of upper airway inflammation awaits validation. Exhaled nitric oxide (e NO) is currently the MOST RELIABLE MARKER of rhino-bronchial inflammation, but its routine assessment is difficult as the test is available only in highly specialized centers.
Other Investigations
X-RAY PNS-Water’s (OM view). CECT of PNS…2mm. Coronal cuts are preferred. NASOENDOSCOPY. under L.A.; G.A. Hopkins rod 0º; 30º; 70º). Evaluate the individual for asthma. At some centres FAST-Fluro Allergo Sorbent Test is done.

Complications of AR

Complications of AR are allergic asthma, chronic otitis media, hearing loss, chronic nasal obstruction, sinusitis, orthodontic malocclusion in children (Figure 6).
Figure 6: The Human Normal Eye Anatomy.
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Prognosis

Treatment is available & pts. remain asymptomatic only until re-exposure to allergic antigen. There is no evidence of mortality from the disease but there is very high morbidity. PQLI is affected. Seasonal allergic symptoms improve as patients age.

Management of AR

Management of Allergic Rhinitis includes Allergen avoidance & environmental control measures, Medical; pharmacologic treatment, Immunotherapy and Surgery [8]. Choice of treatment will depend on efficacy, safety, cost-effectiveness, patient preferences, combination, objectives of treatment, likely adherence to recommendations, severity & control of disease and presence of co-morbidities. Practical allergen avoidance tips given by WAO for public education purposes are as follows in (Figure 7).
Figure 7: The Human Normal Eye Anatomy.
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Pharmacotherapy

Oral antihistaminic are
1ST GEN: - Chlorpheniramine maleate; Diphenhydramine; Clementine.
2ND GEN: - Loratadine; Terfenadine; Acrivastine
3rd GEN.: - Fexofenadine; Cetrizine. Topical application of Azelastine.
NEWER - Desloratadine; Levocetrizine.

Acute Phase Medications

Antihistaminics are effective in blocking histaminic effects. (Runny nose; Watery eyes). Side Effects of antihistaminics are Sedation, Dry mouth, Nausea, Dizziness, Blurred vision, Nervousness. Non-sedating antihistaminics (Cetirizine; Loratadine) has fewer side effects. Fexofenadine is more effective (has a lower risk of cardiac arrythmias). Decongestants will Shrink mucous membranes by vasoconstriction. These are available OTC; in combination with antihistaminic, analgesics & anti cholinergic [9]. Anticholinergic Agents Inhibit mucous secretions which acts as drying agents. Topical Eye Preparations reduces inflammation; relieves burning and itching (Figure 8).
Figure 8:
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Preventive Therapy

Intranasal Corticosteroids Reduces inflammation of mucosa, prevents mediator release, can be used safely daily, can be given systemically as a short course during a disabling attack. Intranasal Cromolyn Sodium Mast cell stabilizer Prevents release of chemical mediators. Oral Mast Cell Stabilizer, Ophthalmic solution cromolyn. Topical nasal steroids are dexamethasone, beclomethasone dipropionate, triamcinolone acetonide, flunisolide, budesonide, fluticasone propionate, mometasone furoate and ciclesonide [10]. LEUKOTRIENE RECEPTOR ANTAGONISTS (ANTI LEUKOTRIENE AGENTS) are MONTELEUKAST(Singular); ZAFIRLEUKAST(Accolate) & PRANLEUKAST. These drugs reduce inflammation, oedema & mucous secretions of Allergic Rhinitis. ZILEUTON (5-Lipoxygenase inhibitor) is a similar drug & is used in many parts of the world.

Immunotherapy (AIT)

SCIT is effective in seasonal pollinosis & mite allergy. SLIT is Effective & safe alternative, best in seasonal AR. COCHRANE reviews shows that both are equally effective & the patient is in equipoise. These are more effective in adult pts. 3yrs. Of treatment with both SCIT & SLIT has been shown to provide long term clinical benefits for at least 2 yrs. after their discontinuation. The choice of therapy depends on grounds of convenience, availability of resources & personal preferences. SCIT requires administration in a specialist clinic whereas SLIT can be self-administered.

Current Concepts & Future Needs

Although AIT is considered a safe & effective treatment for AR, however, its clinical effect is still contested by many due to: Heterogenicity in clinical trial designs, Study populations, Therapeutic formulations, Efficacy criteria. There is ample scope for physicians, patient organizations, companies & regulators to improve clinical trials in AIT and, to provide patients with better treatments. Inclusion of allergic pts. with relevant diseases(s) in AIT trials. Exclusion of polyallergic pts. (with clinically relevant, overlapping allergen exposures) in AIT trials. Clinically defined responders in AIT trials. Allergen exposure chambers in AIT trials. Differences in regional & seasonal exposures. Adaptive trial designs should be discussed with regulatory bodies. Patient-to-patient differences in treatment adherence & allergen exposure. (Use of “e-health” is recommended). The placebo effect in AIT is to be considered. Ethical & technical aspects of DBPC; RCT’s, especially in paediatric populations. The importance of safety reporting. (WAO guidelines for reporting systemic & local adverse events should be applied).

Omalizumab for Treatment of AR

Figure 9:
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(Figure 9) This is a new treatment strategy for allergic rhinitis DBPC study of RAGWEED immunotherapy7 is done. Prohibitive high cost. It is not FDA approved for this indication. Periodic use is justified in treatment of resistant patients especially those with seasonal disease. This drug acts by removal of circulating free IgE by the recombinant humanized monoclonal anti IgE antibody.
Surgical Treatment: Surgical treatment has limited use, SMD of I.T. reduces the size of boggy turbinates. Septoplasty is done for the Correction of septal deviation. FESS is done for the Clearance of sinuses and OMC If indicated. VIDIAN Neurectomy is done in certain selected cases.
Surprising Relief for Stuffy Nose: Sex: According to Dr. Michael Benninger, Otolaryngologist, Chairman of Cleveland Clinic’s Head & Neck Institute, in a study done in May 2018 has some surprising findings. The potential effect of sexual activity works the same for man & women. Swollen tissues in nose block the passages in AR creating congestion & making it harder to breathe. During arousal, the Sympathetic NS gets into play, adrenaline levels go up & blood vessels constrict. Less blood flow to the nose means less inflammation, so the nose opens up & one can breathe more easily. Lying on back position for both men and women, one cannot experience the same level of congestion relief due to effects of gravity.
Stepladder Approach in Treatment of AR: (Figure 10) Allergic Rhinitis Guide: Frequently Asked Questions (FAQ’S)
Figure 10:
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a) What is common medication mistake that people make?
b) How long should one stay on allergy treatment?
c) How can one differentiate between common cold & AR?
d) What are the side effects of allergy medications?
e) How to use nasal sprays? (Figure 11)
Figure 11:
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f) Are the steroids in nasal sprays safe?
g) What is the difference between the nasal medications & oral medications?
h) How quickly can one expect to get relief from allergy treatment?
i) Taking corticosteroids inhalers to control asthma symptoms, can one also take allergy medications?
j) What are the types of allergy tests? IgE skin test; Intradermal test; Specific IgE in blood.

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Friday, 14 February 2020

Lupine Publishers: Lupine Publishers | The Prevention and Treatment o...

Lupine Publishers: Lupine Publishers | The Prevention and Treatment o...: Lupine Publishers | Open Access Journal of Complementary & Alternative Medicine  Abstract Native people in West...

Lupine Publishers | The Prevention and Treatment of Malaria in Traditional Medicine of Tetun Ethnic People in West Timor Indonesia

Lupine Publishers | Open Access Journal of Complementary & Alternative Medicine 






Abstract

Native people in West Timor Indonesia have been exposed to malaria since long time ago. Because of this experience, it is believed that this community has developed their local concept about malaria, and how to manage it. This research was intended to document and analyze local knowledge and practices of malaria prevention and treatment developed by Tetun ethnic people in West Timor. The research was a field study, conducted through some interviews, discussions and observations. The results of this study showed that this community has long been developing various methods to prevent and threat malaria. The prevention and treatment of malaria in traditional medicine of Tetun ethnic people consists of both herbal and non-herbal methods and supported by some prohibitions and restrictions. The results also showed that the practice of traditional medicine for prevention and treatment of malaria by Tetun ethnic people can be explained scientifically. Medicinal plants that widely used like Strychnos ligustrina, Carica papaya, Momordica sp., Cleome rutidosperma, Physalis angulata, Alstonia spectabilis, Alstonia scholaris and Melia azedarach have been proven to have antimalarial activities as anti-plasmodial, antipyretic, analgesic, anti-inflammatory and immunostimulant.


Introduction

Traditional communities in ancient times developed their local knowledge about the prevention and treatment of a disease based on their experience interacting with the disease for a long time. This local knowledge was then become a guidance for them to establish strategies to prevent and treat the disease, which were practiced widely in the community, and become their traditional medicine [1,2]. Traditional medicine is a term imposed on pre-scientific medical systems, and defines as a sum total of knowledge, skills and practices based on theories, beliefs and experiences of different cultural customs used in health care, disease prevention and increased physical and mental performance, which have been used for generations from one generation to the next [3,4]. Malaria is an ancient disease that has not been fully eradicated until this time [5]. Since long time ago, malaria was the main infectious disease that often attacks Timorese people, especially in Belu and Malaka Districts in West Timor (Indonesia). Several old manuscripts noted that Timorese people in early of 19th century were suffered from malaria which caused many deaths [6,7]. Until this time, Belu and Malaka Districts are still hyper-endemic areas of malaria. According to the Global Fund report, in 2014, Belu and Malaka Districts were classified as high malaria endemic areas, with the Annual Parasite Insidence (API) of 12.87o/oo and 11.58o/oo respectively, higher than Indonesian average API 1.38o/oo. Various programs for malaria prevention and eradication sponsored by the Indonesian Ministry of Health and World Health Organization such as insecticide-impregnated net, fogging, mass blood survey for early diagnosis and prompt treatment, and treat malaria patient using Artemisinin Combination Therapy (ACT) have been implemented, but decreasing of the API value is still not too convincing [8]. Cultural factors that influence public attitudes and acceptance on the programs of prevention and treatment of malaria are estimated to be one of the obstacles to the success of these programs. The implementation of various disease control programs and strategies often faces major challenges stemming from the social and cultural situation of the community. The social and cultural situation of a community in a particular place can negatively influence the choice, acceptance and use of interventions in disease control. Many programs of disease control and eradication are unsuccessful because of these social and cultural barriers. Therefore, it is very necessary to understand the local knowledge of the community, including an understanding of the health-illness concept that they believe in. An understanding of this can help policy makers in designing a sustainable and more effective disease control programs [9]. The Tetun ethnic is one of native communities that inhabit territories from the central part of Timor island (in Belu and Malaka districts, Indonesia) to the east (in Republic Democratic de Timor Lester, RDTL). Tetun people are still using traditional medicines to date, and often running various traditional medication rituals [10]. Because of their long-time interaction with malaria, it should be assumed that they have developed their own local knowledge about malaria and methods to prevent and treat it. Therefore, this research was intended to study the local knowledge of the Tetun ethnic people regarding malaria and the methods they have developed for the prevention and treatment of this disease.

 

Introduction

Study Design

This study is a kind of research in the field of medical anthropology. This study was conducted as a qualitative exploratory research, with a field study as main technique, supported by a literature study.

Profile of Study Site and People

This research was conducted in Belu and Malaka Districts located in the central part of Timor island. These areas are located at 9°15’ S-9°34’ S and 124°40’ E-124°54’ E. Belu and Malaka are two of Indonesian territories that border directly with the Republic Democratic Timor Leste (RDTL). The topography of Belu Districts is mainly hilly, while Malaka is generally a stretch of flat land. Some areas of Malaka at the south part meet the rainy season twice in a year, while the areas of north part and also Belu areas are only have one rainy season. The main rainy season takes place between November-March due to wind that brings rain from the Indonesian Ocean. This rain occurs evenly in Malaka and Belu regions. The additional rainy season in April-June, which is limited in some areas of Malaka, is affected by wind from Australia that carries moisture from the Timor Sea. Based on the ethnolinguistics, there are four indigenous ethnic groups that live in Belu and Malaka Districts, namely Tetun, Dawan, Kemak, and Bunaq (Marae). Tetun ethnic is the majority ethnic group in Belu and Malaka, consists of approximately 80% of the population. They scaterred in almost all sub-districts of Belu and Malaka [11].

The Informants

The informants of this study were people of Tetun ethnic who have lived for long time in Belu or Malaka Districts. They were people with good knowledge and experiences of traditional medicine practices. The informants were selected through the purpossive and snowball tehniques. A total of 94 informants (42 men and 52 women) with the age of 40-90 years old were involved in this study. They came from 15 vilages of five sub-districts in Malaka (Wewiku, Malaka Barat, Weliman, Malaka Tengah and Kobalima Timur Subdistricts), and 14 vilages of ten sub-districts in Belu (Raimanuk, Tasifeto Barat, Nanaet Duabesi, Tasifeto Timur, Lasiolat, Raihat, Lamaknen, Kakuluk Mesak, Atambua Barat and Atambua Selatan Sub-districts). These informants consist of traditional public healers, home healers, and traditional medicine users.

Data Collection

Data were collected through several interviews, discussions, and observation. Interviews were conducted with a semi-structured questionnaire. Interviews were intended to collect informations about local knowledge on health-illness concept, symptoms, signs and causes of malaria, traditional methods for the prevention and treatment of malaria, and medicinal plants used for the prevention and treatment of malaria. More deep questions were developed spontaneously based on the answers given by the informants to the previous questions. Interviews and discussions were conducted in Tetun (local language) and Indonesian. We recorded the contents of every interview by wrote a detailed essence of the conversation, but not fully word by word. Several interviews were recorded with audio and video recorder. In this field study, we were assisted by several local guides to search for informants, accompanied in the interviews, to interpreted specific local terms that strange for us, and help us to search, document and collect plant specimens. All plants mentioned by informants were collected in-situ and documented by making photographs and herbaria for taxonomic identification. This field study was conducted from April 2017 to December 2017.

Data Analysis

Data obtained from interviews, discussions and observations were analyzed qualitatively, and presented in narrative or qualitative descriptions [12]. The steps of qualitative analysis are as follows:
a) Transcription of data: first of all, the interview data, discussions and field observation records were well-transcribed in a neat text.
b) Data reduction: transcripts were analyzed to marked meaningful parts, and then grouped based on the same characteristics into certain categories, i.e. the local knowledge about health-illness, local concepts about malaria, methods for the prevention and treatment of malaria, and plants used for the prevention and treatment of malaria.
c) Presentation of data: data that has been grouped were arranged regularly according to each category to make them easy to understand. Data of plants used in malaria prevention and treatment were presented in a table.
d) Verification and conclusion: determined the meaning of the data presented.

Local Concepts about Health-Illness

The concept of health and illness in Tetun community is very simple. Tetun people define health as a condition of normal, good and not sick. Illness is interpreted as a condition in which someone feels unwell or sick or has a disease in the body. Tetun traditional people state a condition as health or ill by seeing physical signs. A person is said to be health if he/she looks physically strong, fresh, agile, has a bright face and good appetite; and vice versa, if the physical performance seems weak, lethargic, pale face, lack of appetite, then the person is said to be sick or has an illness in the body. Someone is said to have recovered from illness when showing physical signs such as being able to get up, not feel dizzy anymore, being able to walk quickly and to work again, and his/her appetite is back and improved. The concept of Tetun people about health and illness is also associated with the ability to carry out daily life activities. Someone who is still able to work or move without feeling bad or pain in his body, then that person is not said to be sick. People who are clinically suffering from a certain disease but not feel sick and still able to carry out daily activities without being disturbed by the disease, then that person is not considered sick. WHO and Indonesian Ministry of Health define health as a state of complete physical, mental and social well-being, and not merely the absence of diseases or infirmity [13]. Comparing the concept of health according to Tetun people’s understanding with this official definition, it can be concluded that the concept of health of Tetun ethnic people is inadequate to describes whole condition called health, because for this community, health and illness are more related to physical performance than psychological and social performance.

Local Concept about Symptoms and Signs, and Causes of Malaria

The indigenous people of Tetun know malaria as is in mana’s (hot body, fever) with primary signs and symptoms are high fever, shivering, intermittent fever, headache, muscle and joint pain, pale, yellow eyes, and abdominal pain and/or diarrhea. Many informants did not know that swollen spleen (splenomegaly) is also one of the signs of malaria that is already severe, but they assumed that the swollen spleen can cause fever (they say “malaria”). In general, almost all the informants assumed that malaria is a common, mild and not serious disease, only a sick of hot body or fever. This local concept seems to greatly influences people’s perceptions of the danger of malaria and result in reduction of their alertness on malaria and the seriousness of managing this disease. In the local knowledge of Tetun ethnic people, the causes of malaria are: sweet food and drink, chilled, sunburn, fatigue, presence of other disease in the body, magic, cold food and drink, lack of sleep, inadequate post-natal care, spicy food, alcohol, and oily or fatty food. Tetun ethnic people assumed that sweet food and drink, sunburn, magic, spicy food, alcohol, and oily or fatty food cause an excessive heat in the body, and as a result, someone will get high fever malaria. Chilled, cold food and drink, lack of sleep is assumed to cause cold entering the body, and as the result, someone will get shivering malaria. The fatigue, presence of other disease in the body and inadequate post-natal care for mother and infant are assumed to destroy the equilibrium of hot and cold in the body and result in malaria with high fever and/or shivering. According to some informants, mosquito as malaria transmitter was a new knowledge that coming from outside, introduced by the Catholic missionaries from Europe. According to Foster dichotomous on causes of disease [14], the causes of malaria in the local concept of Tetun people are naturalistic, not personalistic. Factors such as sweet foods or drinks, long time in rain, water or cold places, long working under the hot sun, fatigue and the presence of other diseases in the body are naturalistic properties that cause heat-cold balance in the human body to be disrupted, and then causes someone to get malaria. Many Tetun people do not consider mosquito as carrier of malaria, causing them to have low awareness of the threat of mosquitoes. This may be one of the causes of the still high endemic of malaria in Belu and Malaka until this time [15].

Methods for The Prevention and Treatment of Malaria

The Tetun ethnic people have their own patterns or habits of life that they do for generations to prevent malaria attacks. The methods that are considered effective in preventing attacks of malaria are: luli or hale’u, drink medicinal concoction of bitter herbs, eat bitter food, and drink tua moruk. Luli or hale’u means avoiding things that can cause malaria (according to their local concepts about the cause of malaria), which are: not eating sweets frequently, not working for long time under the rain or hot sun, and not too tired at work or physical activities. Eating bitter foods, especially papaya and bitter melon, and drinking bitter palm sap tua moruk are also considered effective to prevent someone from being attacked by malaria. Some informants who previously linked malaria with mosquitoes stated that repelling mosquitoes using smoke of burned aromatic plants and sleeping under mosquito nets are effective for malaria prevention. The treatment of malaria in traditional medicine of Tetun ethnic consists of herbal and non-herbal methods. Herbal method consists of drinking herbal concoction, inhaling the vapor of boiled medicinal plant, massage with paste of medicinal plant, bath with water of boiled medicinal plant, and attach the paste of medicinal plant as a cataplasm on the swollen spleen. A non-herbal method is sunu kok, that is burning the waist above the swollen spleen using a piece of coconut shell coal or a heated metal. The results of the interviews showed that most traditional medication for malarial patient usually combine two or more methods. It was found also that the role of traditional healer in the treatment of malaria patient is not so important. Tetun ethnic people assumed that malaria is a common and not a serious disease, thus the treatment of malaria does not require a high competency healer. Several informants stated that they usually conducted self- and home-medication for malaria complaint. In the traditional medicine of Tetun ethnic people, the treatment of malaria is a simple treatment for reducing heat or fever [15]. The assumption of malaria as a common, mild and not a serious disease results in lack of awareness about dangers of malaria. It was found that in many cases, health workers often complain of disobedience of patients who stop taking antimalarial drugs immediately after they feel cured (being able to get up, not feel dizzy anymore, being able to work again, and the appetite is improved), even though Plasmodium in their blood has not been completely eliminated. As the result, the success of the malaria eradication program in this area has increased very slowly [8].

Plants Used for The Prevention of Malaria

Tetun ethnic people believe that consumption of bitter food or drink can prevent someone from malaria attacks. Therefore, small children are often forced by their parents to eat stew and drink decoctions of flowers, leaves and young fruit of Carica papaya, or young fruit of Momordica sp. (M. charantia or M. balsamina). Some informants gave information that if they feel tired, achy and lack of appetite, they will drink decoction of Carica papaya leaves, fruit of Momordica charantia, Melia azadarach leaves, Alstonia scholaris, Alstonia spectabilis or Strychnos ligustrina stem bark. Consumption of these plants’ decoction is believed to restoring body freshness, increasing appetite, eliminating fatigue, and thus, preventing from malaria attack. Some informants also believed that drinking tua moruk is effective in malaria preventon. Tua moruk is a traditional drink made by fresh tapped palm sap soaked with the stem bark of Alstonia scholaris, Alstonia spectabilis or Strychnos ligustrina soaked in it. Several publications of other previous studies showed that the bitter plants used by Tetun people to prevent malaria has been shown to have pharmacological activities as antiplasmodium and immunostimulant [16-18].

Plants Used for The Treatment of Malaria

In this study, we recorded a total of 96 species from 39 families used by Tetun people in various formula for drink, massage, bath, inhalation and cataplasm (Table 1). Strychnos ligustrina, Carica papaya, Cleome rutidosperma, Physalis angulata, Alstonia spectabilis, Alstonia scholaris and Melia azedarach are some of the most widely plants used in various formula for drink. For massage, Garuga floribunda, Jatropha curcas, Acorus calamus, Allium cepa, Drynaria quercifolia, Ocimum sp. and Ruta graveolens are common. For bathing, people use Tamarindus indica, Psidium guajava, Melicope latifolia and Blumea balsamifera. Leaves of Brucea javanica, Annona muricata and Annona reticulata are used in inhalation method. Root of Moringa oleifera and leaves of Ficus hispida are used as cataplasm to reduce the swollen spleen [19]. Several plants were found in various formula for more than one mode of application. Several previous publications showed that most of these plants are also used in other traditional medicine for the same purpose in many areas of Indonesia and the world [16,18], and have been scientifically proven to have pharmacological activities as true antimalarial (antiplasmodial) and/or indirect antimalarial such as antipyretic, analgesic, anti-inflammatory and immunostimulant [20].

Table 1: Plants used by Tetum ethnic people for the treatment of malaria.

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Conclusion

The practice of preventing and treating malaria in the traditional medicine of Tetun ethnic people is a direct implementation of their local knowledge about malaria. The local concept of signs and symptoms and the causes of malaria encourage traditional people to create methods to prevent and treat malaria. The local concept of the Tetun ethnic people about malaria is the main reference in the creation of rules regarding prohibitions and restrictions, and recommendations for preventing attacks of malaria. The local concept of the causes of malaria determines the choice of plants for the treatment of malaria. Scientifically, these plants have been proven to have activities as true antimalarial and indirect antimalarial. The local concept of malaria as a common, mild and harmless disease causes that the role of traditional healer is not always needed in the treatment of malaria. Methods for the prevention and treatment of malaria developed by Tetun ethnic people consist of both herbal and non-herbal methods and supported by the implementation of several prohibitions and restrictions to provide healing for the sufferers of malaria.


Acknowledgement

We thank to Indonesian Ministry of Research, Technology and Higher Education, for financial support (Research Contract No. 0668/K8/KM/2018).


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Wednesday, 12 February 2020

Lupine Publishers | The Dynamics of Mounds-Clusters in the Mouhoun Bend (Burkina Faso)

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Abstract

Mounds are human made accumulations of settlements debris of varying size and shapes, found in different parts of the world. In West Africa, they tend to be located in relatively flat lands, at low elevations, in wetlands, marshlands or flood plains. Some are large single mound sites. Others are made of groups of scattered or clustered mounds – mound-clusters -, spread over varying surface extent. The dynamics of such settlement systems is still poorly understood partly because of inadequate field methodology. Ethno-historical and ethnographic data from West Africa recent past are relied upon to suggest some of the key processes behind mounds clustering: ethnicity, craft affiliations, or a combination of both. The Mouhoun Bend Archaeological Project (MOBAP 1997- 2000) was designed to address this issue. The field methodology was articulated on testing all mounds parts of the mound-clusters under investigation. Two mound-clustering strategies were identified:
a. Tight-clustering resulting in the formation of a large “single mound site”, and
b. Loose-clustering with scattered individual mounds of different size and shape.
Residential and craft requirements combined differentially in the 2000 years Mouhoun Bend settlement history, have generated the settlement patterns investigated in the study area. The ethnicity component of the identified dynamics – that is plausible – could not be tracked with the current methodology and is accordingly undecidable.


Introduction

The Mouhoun bend was settled by iron-using communities in the first millennium BCE (Figure 1, Table 1). The climate was wetter [1]. The Sudanian savanna and the Mouhoun River offered a diversified resources mix that allowed for the stabilization and growth of these mixed farming fishing populations. Their settlements consisted of multi-mound complexes – moundclusters. The sample of sites excavated within the Mouhoun Bend Archaeological Project (MOBAP 1997 – 2000) offers an entry into the dynamics of this kind of settlement that developed and spread in the study area for a little more than 2000 years, from ca. 700/500 BCE to 1650 CE (Figure 1, Table 1).
Table 1: Radiocarbon dates from the Mouhoun Bend Archaeological Project.
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Key: LLNL = Lawrence Livermore National Laboratory:
* Radiocarbon dates from iron objects processed by Dr. Andrea C. Cook at Lawrence Livermore National Laboratory, UC Berkeley.
*1 = from an iron ring
*2 = from a small iron spear
*3 = from a large iron spear
Mounds result from the piling up on the same spot of human occupation by-products. They include habitation features, craft installations, collapsed building material as well as discarded and abandoned material culture. They are therefore exclusively human-made and, depending on circumstances, can be either well preserved or significantly disturbed by erosion agencies. These formation processes that combine cultural (C-transforms) and natural (N-transforms) are well understood in general [2,3].
Habitation mounds dating from the Late Stone Age onwards are recorded in different parts of West Africa, from the Chadian basin to Mali and Guinea [4-18]. They consist either of a single small or large mound or of multiple mounds (mound-cluster). It has been suggested that mound-clusters may have derived from residential segregation, inhabited by different specialized more or less endogamic groups such as blacksmiths, potters, hunters, fishing folks, bards, etc. [19,20]. Distinct mounds are thus axiomatically considered to materialize residential segregation, and as such, are the signature of craft-specialization. The explanation is tautological. No excavation program was implemented to test the accuracy the hypothesis mentioned above. The testing procedure may have required an appropriate methodology, consisting at least of the probing of all the mounds part of the settlement complex under investigation, a precise and fine-grained chronology backing detailed analyses of material culture, architecture, and subsistence remains. It is then and only then that variation – or lack thereof – can be assigned to differences in social status. These principles have guided the field strategy implemented in the Mouhoun Bend Archaeological Project [21,22].
The Mouhoun River flows from the SW to NE, winds its course in a U-shape bend to follow a N-S direction (Figure 1). The study area located in the Sudano-sahelian zone is delimited in the north and northeast by the meandering river course. It measures 40km East-West (3o 11’ North / 3o 32’ East) and 38km North-South (12o 30’/ 12o 45’ latitude North). The land, prone to cyclical droughts, is flat with elevation ranging from 294 to 249m above sea level. The vegetation is characteristically a highly anthropic wooded savanna, with the protected shea-butter tree (Butyrospermum parkii) largely predominant, followed by different kinds of Acacia sp.
Figure 1: Distribution of archaeological sites in the Mouhoun Bend (Burkina Faso).
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Three mound-clusters located in in different environments were selected for excavation: Diekono in the Mouhoun River floodplain, Kerebe-Sira-Tomo (KST) on the cliff delimiting the river valley, and Tora-Sira-Tomo (TST) and its satellite Gnambakouon-Sira- Tomo (GST) on the topographic rise in the central part of the study area. Each of the above mentioned sites is comprised of a number of mounds of different size and shape, iron-working workshops, and laterite quarries.

The Dynamics of TST and KST Mound-clusters

The long-term pattern of growth of inhabited space within a mound cannot be assessed with the field methodology implemented in this case, with one test unit per mound. A general time line of the settlement complex formation can nonetheless be reconstructed.
TST settlement complex (12o 35’ 07” N and 3o 22’ 07” E) is located at 280m asl. With 17 distinct mounds, it is the largest settlement complex of the study area, spread over 900m westeast and 500m north-south, some 45ha in total surface extent (Figure 2). TST-3, the largest mound stretched along the north edge measures 260m west-east, and 120m north-south. All 17 mounds were tested after three field seasons (1997, 1999, and 2000). Five, TST-1 (Iron smelting), TST-2 (quarry), TST-4 (cloth weaving and dyeing workshop), TST-9 (cemetery), and TST-17 (oil production workshop), are special purpose sites. The fourteen remaining ones were standard habitation mounds with varying occupation intensity

Figure 2: Tora-Sira-Tomo settlement complex.
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KST settlement complex is located on the cliff top along the edge of the Mouhoun River valley (Figure 3). The complex consists of eleven more or less distinct mounds stretched on 350m westeast and 600m north-south. The cluster is made of three distinct sites categories: a quarry (KST-2) located at some 800m east, iron-working stations both smelting and forging, and habitation mounds. Habitations mounds, clustered in the north, resulted in the formation of a large 15ha village site. All iron-working stations, arranged along a roughly ENE-WSW axis, are concentrated at 100 to 200m along the south flank of the main habitation cluster. KST settlement complex was inhabited from the second half of the first millennium BC to the second half of the thirteenth-century AD, with an important 500 years occupation hiatus in the second half of the 1st millennium AD. The development of TST and KST settlement complexes can be arranged in four successive phases, from the middle of the first millennium BC to the middle of the second millennium AD.

Figure 3: The evolution of TST settlement complex.
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Phase I (650 BC-800 AD)

At TST, the initial settlement phase (650 BC-800 AD) that started in the mid-1st millennium BC is documented at TST-1, TST-2, and TST-3-East (Figure 4, Table 2). The earliest occupations are found at TST-1, an iron-smelting site dated to 650-395 BC (Figure 5), TST-2, the quarry site that provided raw material for house construction and iron production, and finally, the blacksmith workshop exposed at the bottom of TST-3-East probe.

Figure 4: View of TST-1 iron smelting furnace.
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Figure 5: Differential mounds size in m2 during TST phase IV (1400 – 1650 CE).
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Table 2: Tora-Sira-Tomo mound cluster at Phase I (650 BC – 800 AD).
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KST settlement complex phase I dated to 350 BC-150 AD was shorter. It is documented in the west-central part of the complex, in KST-1A and KST-2 the quarry site (Figure 6). KST complex grew in two directions during its phase II dated to 250 – 550 AD. KST- 1B and KST-3 areas were settled. The mound was of an irregular potato- shape, oriented SW-NE. KST-2, the quarry site, was relied upon for the supply of iron ore and construction material during the whole existence of the settlement complex

Figure 6: Kerebe-Sira-Tomo settlement complex.
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Phase II (800 – 1100 AD)

TST Phase II (800-1100 CE) settlement with a total of 8 mounds, witnessed the foundation of 5 new sites. They were arranged in two sub-clusters of four sites each: TST-1, TST-2, TST-3, and TST-6 in the west, and TST-4, TST-12, TST-13, and TST-15 in the east (Figure 4, Table 3). The western sub-cluster consisted of two residential mounds: TST-3 and TST-6, and two special purpose sites: TST- 1(iron-smelting and ritual) and TST-2 (quarry). The eastern subcluster includes TST-13 and TST-15 residential sites, and TST-4 (weaving and cloth dyeing workshop) and TST-12 (a blacksmith workshop) special purpose sites (Holl 2014). KST complex was abandoned during all the second half of the 1st millennium AD, from ca. 550 to 1000 AD.
Table 3: Tora-Sira-Tomo mound cluster in Phase II (800 – 1100 AD).
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Phase III (1100 – 1400 AD)

TST settlement complex reached its maximum extent during phase III (1100-1400 AD) with the addition of 7 new sites. All 15 mounds (Figure 4 & 7, Table 4) were located in the space delineated during phase I and II. The new additions are set in two patterns. TST-5, TST-7, TST-8, and TST-10 present a rectilinear arrangement of equidistant mounds at 100m from one to the next. TST-5, TST- 7, and TST-8 residential mounds ‘sits’ on burials dug deep in the laterite crust in what may have been an earlier cemetery. TST-14, TST-16, and TST-17 are along the northeastern flank of the complex, at 100m from one to the next, in a linear east-west arrangement. TST-14 and TST-16, were residential and TST-17 a karité oil production workshop.
Table 4: Tora-Sira-Tomo mound cluster in Phase III (1100 – 1400 AD).
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Figure 7: The evolution of KST settlement complex.
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KST complex also witnessed an accelerated growth during Phase III (1000-1250). KST-IA and 1B, KST-2 (quarry site), KST-3, KST-4 (occupation I and II), KST-5, and KST-6 (Figure 6) were all inhabited and in use. Fire destroyed habitation units from KST-3 occupation I and KST-4 occupation II (Figure 8 & 9), located along the southeast flank of the complex. There was also a significant intensification of iron-working, with the foundation of workshops devoted to iron-smelting, blow-pipes making, and blacksmithing along the south margins of the main village.

Phase IV (1400 -1650 AD)

TST settlement complex shrunk significantly during Phase IV (1400-1650 AD). The number of inhabited sites dropped from 15 to 9. The eastern part of the cluster was abandoned (Table 5, Figure 4). A new restricted access cemetery was founded at TST-9. TST-3, TST-4, TST-5, TST-6, TST-7, and TST-8, were residential. TST-1, TST- 2, and TST-9, respectively iron-smelting site, quarry, and cemetery, were special purpose sites. In general, with the exception of TST- 8 set between TST-4 and TST-7 (Figure 4), the distance between neighboring mounds oscillates around 100m.
An identical phenomenon occurred at KST. The inhabited space also shrunk considerably during KST phase IV (1250-1450 AD) (Figure 6). Shallow occupation evidence is documented at KST-4 occupation III and IV, then used as a cemetery.

Figure 8: Partial view of KST phase III domestic unit.
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Figure 9: Habitation complexes from Phase III KST-4 .
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Table 5: Tora-Sira-Tomo mound cluster in Phase IV (1400 – 1650 AD).
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Variability of mounds clustering processes

Data collected from the excavation of four settlement complexes point to the existence of two main mound-clustering strategies: a tight and a loose one. KST settlement complex that lasted from ca. 350 BC to 1450 AD, with a half millennium occupation hiatus in the second half of the 1st millennium AD, features tight-clustering (Figure 7 & 8). All the residential sites, with the exception of KST- 4, are tightly packed in a 15ha village. Iron-working sites located along the south periphery of the village display no habitation. Craft people and work crews were KST villagers who commuted to their workshops during the iron-production seasons.
TST-GST settlement complex with a total of 20 mounds features the loose-clustering strategy. The mound-sites, 17 for TST and 3 for GST are well demarcated, with each sub-set presenting a large dominant mound. Residential and special purpose sites are represented in varying combinations all along TST settlement complex occupation history.
Archaeological data indicate that flexible strategies were adopted by the different ‘self-sustaining’ autonomous ancient villages during the 2200 years’ occupation of the Mouhoun bend. In KST, craft people resided in the village and commuted to their workshops located in the southern outskirts of the complex. In the TST alternative, with more or less inter-phase variations, craft people built their residence in distinct places and supplied local communities from their workshops. There is no fixed and permanent pattern of residential and occupational segregation in the analyzed archaeological record [21,22].

Peer-village interaction

The study area is relatively flat. The recorded settlement complexes are more or less evenly distributed in the landscape. In site-catchment analysis terms, each village is surrounded by rings of cultivated fields, fallow zones, and bush [23,24]. At their peak, during the first centuries of the 2nd millennium AD, each of the recorded settlement complex was a large autonomous and selfsustaining village. Some, like KST and Kirikongo, were compact villages with a few outlying mounds and special purpose sites. Others, as was the case for TST – GST and Diekono, were spread out with a multiplicity of distinct mounds.
There are no significant wealth differences. Grave-goods and burial offerings are too marginal to be significant. Some individuals, male, female, children, and infants, were nonetheless buried in “restricted access” cemeteries while others were buried in their compounds. This differential treatment points to subtle variations in social status without detectable and/or durable material correlates. The accelerated growth at the beginning of the 2nd millennium AD initiated a scramble for land, villages rivalry, violence, and wars.

Fire: accidents or wars?

Burnt houses were recorded in some of the excavated mounds. It is the case at TST-3-West in occupation I and II, dated to 1000- 1150 AD. Domestic installations belonging to two successive occupations were totally burnt down. KST complex also present two instances of burnt domestic installations dated to 1050 – 1380 AD: one at KST-3 occupation I and the other at KST-4 occupation II. In the latter case, a whole household complex with its food supply was destroyed by fire (Figure 9). Similar cases of burnt installations dated to 1300-1450 AD were recorded at Kirikongo, Mound III, level 8 and Mound IV, level 7 [8]. These events took place during a period of accelerated growth that triggered violent confrontations.

War, Violence and surgery

There is no direct one to one correlation but the unrest indicated by burnt houses is partly corroborated by traumatic injuries found on some of the deceased. Two male and female adult individuals buried in the same context at TST-7 appears to have been victims of the same violent encounter. One, a 35-50 years old adult female presents 4 well healed cranial fractures on the occipital, frontal, and left parietal. The other, an impressive 1.95m tall 45+ years old male presents two distinct episodes of trauma. He recovered from previous blows indicated by a well healed circular defect on the occipital. He has multiple trephinations with no signs of healing on the right, left parietals and frontal, showing that the second series of blows was fatal. Remarkably, both adults present similar blows patterns: they were hit on the frontal, occipital, left and right parietals, as if the aggressors were well trained fighters [25-27]. The surgery may have taken place after a violent raid. Finally, a 9-11 years old pre-adolescent, individual 18 from phase IV TST- 9 cemetery, presents multiple peri-mortem depressed cranial features made by a sharp object, that was very likely the cause of death [26].
The recorded evidence on traumatic injuries is dated to phase III (1000-1200 AD) and IV (1250-1500 AD) when the area witnessed a significant growth acceleration followed by the onset of devolution. There are convincing evidence of conflict and intervillage warfare during the first half of the second millennium AD. The nature and characteristics of the kind of warfare that may have developed in the area during this phase of accelerated growth are difficult to decipher. The tactics involved may have consisted of surprise raiding and counter-raiding with the aim of seizing supplies and host [27-37].


Conclusion

Each village had its autonomous system of government, with horizontally differentiated groups. These mixed farming communities included a number of craft specialists, potters, ironsmelters and blacksmiths, masons, cloths weavers and dyers, karite-oil producers, as well as part-time warriors, and healers (surgeons). The Mouhoun Bend peer-villages were autonomous and self-sustaining but not autarkic. A general compatibility of “worldviews” is suggested by the strong coherence of mortuary practices. Despite variations, pottery decoration techniques and syntax suggest a shared cultural universe. The mound-dwellers of the Mouhoun Bend developed an original socio-political system that, for approximately two centuries, from 1200 to 1400 AD, existed on the periphery of the powerful expansionist Mali Empire.