RESEARCH ARTICLE | Oct. 30, 2018
Influence of Student Councils’ Decision Making Roles on Curbing Frequency of Student Unrests in Public Boys Boarding Secondary Schools in Elgon Sub-County, Kenya
Leslie Kimame Simatwa, Betty Tikoko, Frederick BJA Ngala
Page no Scholars Bulletin, 2018; 4(10):803-812. |
10.21276/sb.2018.4.10.4
The purpose of this study was to assess the influence of roles played by student councils on curbing the frequency of student unrests in Public Boys Boarding Secondary Schools in Elgon Sub-county, Kenya. The study was based on Social Systems Theory. The study adopted a descriptive survey design. Stratified sampling technique was used to sample respondents from the categories of students and members of student councils. The target population for students was 750 while that of members of student councils was 78. The study used Likert type Students' Questionnaire and Questionnaire for Members of Student Councils as research instruments. Descriptive statistics namely, means, frequencies and percentages were computed. Inferential statistics derived from ANOVA were used to test hypotheses. The study revealed that there exists a negative, strong and statistically significant relationship between decision making roles played by student councils and the frequency of student unrest (r= -0.809**; p<0.01). Based on the findings of this research study, it can be concluded that if student councils participate in decision making roles played by student councils to school management on other students, frequency of student unrests will be curbed in Public Boys Boarding Secondary Schools in Elgon Sub-county. The study recommends that student councils be thoroughly prepared in their roles through seminars, workshops and regular meetings with the principals.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Phytochemical Screening and Antibacterial Activity of the Aqueous Extract of Curcuma longa (Turmeric) Rhizome
J.A Adudu, RA Sangodare, UO Edem, S Shittu, MO Otori, EH Odeke, OO Owolabi, UI Idio, VC Okezie, PB Anyim
Page no 412-415 |
10.21276/sjpm.2018.3.10.19
The development of bacterial resistance to the available antibiotics and
increasing popularity of traditional medicine has led researchers to investigate the
antibacterial compounds in plants. One traditional medicine in that category is
turmeric (Curcuma longa) which belongs to the ginger (Zingiberaceae) family. Its
major constituents are fat soluble, polyphenolic pigments known as curcuminoids
which give turmeric its unique aroma, flavour and medicinal properties. In this study,
the in-vitro antimicrobial activity of the aqueous extract of Curcuma longa rhizome
was investigated against standard strains of Staphylococcus aureus (ATCC 6571),
Escherichia coli (ATCC 25922), Salmonella typhi (ATCC 6539), Pseudomonas
aeruginosa (ATCC 27853) and Bacillus subtilis (6633) using the agar well diffusion
method. Different concentrations of the extract were prepared ranging from 12.5
mg/ml to 400 mg/ml. Staphylococcus aureus was more sensitive to the extract with
zones of inhibition ranging from 13 mm to 27 mm. Escherichia coli was the least
sensitive with zones of inhibition ranging from 7 mm to 22 mm. Mean Minimum
Inhibitory Concentration (MIC) values were as follows: S. aureus (12.5 mg/ml), E.
coli (25 mg/ml), S. typhi (50 mg/ml), P. aeruginosa (50 mg/ml) and B. subtilis (12.5
mg/ml). Qualitative phytochemical screening revealed the presence of alkaloids,
flavonoids, saponins, glycosides and tannins.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Incidence of Chlamydia trachomatis in the Population of the City of Queimados, Province of Rio de Janeiro, Brazil
Luciana de Araújo Marciano Guerra, Fabiano Lacerda Carvalho, Antonio Neres Norberg, Fabiano Guerra Sanches, Aluízio Antonio de Santa Helena, José Tadeu Madeira de Oliveira, Paulo Roberto Blanco Moreira Norberg
Page no 614-619 |
10.36348/sjm.2018.v03i10.012
Chlamydia trachomatis is a bacterium that can only replicate in human cells and is recognized as an infectious agent of sexual and perinatal transmission. The objective of this research is to Investigate antibodies of the IgM and IgG classes against C. trachomatis in the serum of patients of both genders with clinical suspicion of Chlamydia infection in the population of the city of Queimados, Baixada Fluminense region, Province of Rio de Janeiro, Brazil. Antibody detection was performed in the serum of 55 patients of both genders. The kits used for diagnostics were: Chlamydia trachomatis IgG ELISA antigen purified reactive MOMP antigen, serotype K for IgG and C. trachomatis kit (IgM) ELISA method for IgM. Total incidence rate was determined in 51%, being more frequent among women. There was no significant association between C. trachomatis infection and the age of the patients. It is recommended to perform routine tests for the laboratory diagnosis of this pathogen in order to avoid the evolution to more worrying health conditions
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
A Comparative Study of Conventional and Automated Culture System [BACTEC] For Detection of Bacterial Infection
Dr. D. Madhavi
Page no 419-422 |
10.21276/sjpm.2018.3.10.21
Isolation of microorganisms is very important for accurate treatment and is
one of the important concerns for clinical microbiologists. The accuracy and rapidity
of treatment are critical for successful treatment. The present study was undertaken to
find the time duration for detection of various microorganisms with BACTEC 9050
system. Methods: The present study was done on inpatients the Thumbay New Life
Hospital, Chaderghat road, Hyderabad from the period of June 2016 to June 2017.
Samples are drawn from the patient and injected directly into BACTEC 9050 culture
vials. Positive cultures are immediately flagged by an indicator light on the front of
the instrument and displayed on the monitor. When positive vials are identified, it is
removed and isolated for identification of organisms. Results: Out of total 475
samples collected during this duration 315 samples were from male patients and 160
from female patients. Out of 315 male samples, 69 were found to have a positive
culture in 69 (21.9%) samples. Similarly out of 160 samples from females 41(25.62%)
were found to have a positive culture. The most common organism detected by
BACTEC in positive cultures Enterobacteriaceae in 39 (35.45%) out of 110 samples
Staphylococcus aureus in 21 (19.09%), Streptococcus spp in 15 (13.63%), CoagulaseNegative staphylococci in 13 (11.81%). The conventional method showed the growth
only in 77 (16.21%) of the total 475 samples during the study period however the
same samples in BACTEC showed 110 (23.15%) growth Average time to detection
was highest in Cryptococcus spp in 78.9 hours, Corynebacterium spp 72.1 hours,
Candida spp 65.5 hours. Least time to detection Enterobacteriaceae was 14.9 hours.
Conclusion: it can be concluded that the BACTEC culture method is superior to the
conventional method as it detects the presence of bacteria faster and it is not affected
by patient's use of antibiotics and it is also economical. Hence BACTEC culture
methods must be used whenever it is feasible.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Reference Ranges of White Blood Cells Count among Sudanese Healthy Adults
Elmutaz H. Taha, Mohammed Elshiekh, Mohamed Ali Alzain, Elnagi Y. Hajo, Abdelmohisen Hussein, Kamal M. Awad, Ibrahim A. Ali, Omer A. Musa
Page no 554-559 |
10.36348/sjm.2018.v03i10.002
The reference values of hematological markers currently used in Sudan have been obtained from researches on populations in developed countries and may not be applicable in Sudan. It has previously been shown that the normal hemoglobin level in Sudanese children is different from international values. The objectives of this study were to establish the reference ranges of white blood cells and differential count in healthy Sudanese adults. The present study included 1076 healthy Sudanese adults from both sexes and five states, with age range of 20 – 60 years. Clinical examination was performed, weight and height were measured, and BMI was calculated. Blood samples were obtained from brachial veins and drawn in EDTA tubes. WBCs and differential count were analyzed using Sysmex KX-21 automated hematology analyzer. SPSS version 25 statistical software was used for data analysis, P value < 0.05 was considered significant and 95% CI was accepted. The mean age of participants was 25.23±9.64 years. The median of WBCs count was 5×103/µL with reference range of (2.9-9.6× 103/µL). Neutrophils count was 2.3(1.7-3.1× 103/µL), while lymphocytes was 2.1(1.8-2.5× 103/µL). The median of WBCs was significantly higher in female [5.1 × 103/µL (range: 4.2- 6.3× 103/µL)] than male [5.0× 103 /µL (range: 4.0- 6.0× 103/µL)] (p <0.05). Our results showed that WBCs count was positively correlated with BMI. The count was found to be significantly higher in Red sea and Darfur states compared with the other states. The reference ranges of WBCs count in Sudanese are lower than the international one and should be used in Sudan
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Effects of Moringa oleifera Leaf Meal on Lipid Profile and Levels of Some Serum Enzymes in Nigerian Local Chickens
Musa Suleiman Ibrahim, Umar Mohammad Dogara, Idris Habiba, Mohammad Jibrin, Hassan Danladi Idris
Page no 596-599 |
10.21276/haya.2018.3.10.1
There is the need to move away from chemical growth promoters to natural
products in the poultry industry, as these have negative effects especially with regard
to fat accumulation. In this regard, Moringa oleifera is known to have a number of
beneficial effects on hematology and serum chemistry of humans. This study was
therefore conducted to investigate the effects of M. oleifera leaves on lipid profile and
some serum enzymes in Nigerian local Chickens. Thirty adult Chickens were used for
the study. The birds were randomly assigned to three groups(n=10).One group served
as control while two treatments received a daily oral dose of 12.5mg and 25mg
Moringa leaf solution respectively. The experiment lasted for 28 days. Data obtained
were subjected to analysis of variance. Results indicate that the mean values of total
cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol,
Triglycerides were statistically similar for all groups. Furthermore, mean values for
serum levels of aspertate aminotransferase, alanins aminotranferae and alkaline
phosphatase were statistically similar for all treatment groups. It is concluded that the
administration of M. oleifera leaves at the dose used in this study has no significant
effects on lipid profile and the serum enzymes evaluated. It is recommended M.
oleifera leaf meal can be used to supplement expensive protein sources in chicken
diets.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
LDL and Small Dense LDL in Normal Pregnancy and Post partum
Basabdatta Samanta, Bharti K. Uppal
Page no 71-78 |
10.36348/sijb.2018.v01i03.003
Abstract: Normal pregnancy is associated with significant hyperlipidemia. Hyperlipidemias are well known as a modifiable risk factor for ischemic heart disease, which is one of the leading causes of morbidity and mortality worldwide. Traditionally LDL is referred to as 'Bad Cholesterol'. It is now established that more than LDL as a whole, it is the small dense subtype of LDL in particular which is responsible for the atherogenicity of LDL. In this study we aimed to determine whether normal pregnancy is associated with a shift in distribution of LDL subtypes, and whether a shift to a more atherogenic lipid profile is an inevitable consequence of normal pregnancy. 100 women with normal, uncomplicated pregnancy were enrolled in the study. Blood samples were collected in the middle of each trimester and 3-4 months post partum, and LDL and small dense LDL levels were estimated. Repeated Measures Anova with post hoc correction was used to compare the mean values of LDL and sdLDL among the different trimesters. P value < 0.05 was considered statistically significant. Normal pregnancy was associated with a progressive and significant rise in both LDL and sdLDL levels, peak values being attained in the third trimester. Post partum, LDL levels returned to the base line, whereas the sdLDL levels still remained significantly higher than the baseline. Normal pregnancy is associated with an increase in the levels of small dense sub fractions of LDL, which is not fully reversed by 3-4 months postpartum.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Chemical Composition and Antimicrobial Activity of the Essential Oils from Aquillaria malaccensis in Bangladesh
Md. Najmol Hoque, Md. Fuad Mondal, Mohammad Mehedi Hasan Khan
Page no 600-608 |
10.21276/haya.2018.3.10.2
Agarwood oil is a highly priced type of oil due to its unique aroma.
Agarwood oil is widely used in perfume, medicine and cosmetic industries due to its
unique properties and high medicinal value. The oil is generally extracted from the
fragrant resins that form in the heartwood of agarwood tree. These unique properties
of agar oils are contributed by the presence of certain chemical compounds. The
market demand for agarwood oil is very high. Agarwood oil is traded based on grade,
corresponding to expensive and cheap price. Currently, the grading of agar oil depends
on its physical appearance such as color, odor and essential oil components, like
present of sesquiterpenes. The present research analyzed essential oils from Aquilaria
malaccensis obtained from Moulvibazar, Bangladesh based on GC-MS data and
antimicrobial properties. GC-MS analysis found Sesquiterpenes, alcoholics, fatty acids
and other chemical groups in the exportable agar oils. Farm-1 contained 94.95%,
Fram-2 contained 95.37% and Farm-3 contained 93.90% sesquiterpenes which is the
most important properties for stronger odors and high quality. All the agar oils
contained about 75% 5-Azulenemethanol-1,2,3,4,5,6,7,8-octahydryo.alpha.alpha.3.8-
tetramethyl-3,7-Cyclodecad iene-1- ethanol.alpha.alpha.4,8–tetramethyl-[s-(Z,Z)].
They also contained other sesquiterpenes like Ledene oxide- II; Aromandendrene;
Bicyclo[4.4.0]dec-5-ene,1,5-dimethyl-3-hydroxy-8-(1-methylene-2-hydroxyethyl-1)-
1H-3 a,7-methanolazulene, deca hydro-1,4,9,9-tetramethyl-Diethyl Phthalate;
Isoaromadendrene epoxide. Other groups like alkane ~2%, alcoholics ~1% and fatty
acid were found above 2%. The essential oils from all the farms except farm-2 have
shown non-significant sensibility in antimicrobial test against E. coli, S. aureus,
Salmonella,Vibrio.
CASE REPORT | Oct. 30, 2018
Caesarean Scar Pregnancy: A Case Report and the Review of Literature
Grine Asmae, Zniber Oum Hani Hanae, Gribi Najlaa, Bzikha Rachid, Bakkali Bachira, Bouhache Sara, Khallouk Zineb, A.Kharbach, N Zraidi, Baidada Aziz
Page no 70-73 |
10.36348/sijog.2018.v01i04.003
Abstract: Caesarean scar Pregnancy (CSP) implanted in the caesarean section scar is a rare location among ectopic pregnancies that can be life-threatening. It can be classified at the same level of gravity as the placenta accreta. Hysterectomy is the gold standard treatment for massive bleeding. The diagnosis of pregnancy implanted in the caesarean section scar is a difficult diagnosis of the first trimester. It must be done as early as possible. Clinical manifestations are not specific, bleeding and pain is the most common symptoms. Endovaginal and pelvic ultrasound associated with Doppler is the first-line examination, provides optimal and panoramic vision, and studies reports of the gestational sac and its vasculature. Recent studies report the value of MRI in diagnosis because of its affinity for the study of pelvic tissue and the relationship of structures. The treatment remains non-consensual but it appears that the injection of methotrexate in situ by preferring the vaginal route is effective and not very morbid. We present here the case of a patient with CSP whose diagnosis was initially unknown.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
The Impact of Non- Timber Forest Products on the Livelihood of Rural Dwellers in the South-Western Zone of Ekiti State, Nigeria
Modupe Janet Ayeni, Joshua Kayode, Taiwo Oluwaromilola Akingbade
Page no 609-618 |
10.21276/haya.2018.3.10.3
The study examined the impact of Non Timber Forest Products (NTFPs) in
the livelihood of the rural dwellers in the southern zone of Ekiti State, Nigeria. Three
villages from within the vicinities of each of the three major towns in Ekiti South West
Local Government area were randomly selected for this study. Fifty households in
each village were randomly selected making a total of 450 households sampled in the
study. Primary data were collected through semi structured questionnaire matrix
administered to the head of each selected household. The results obtained revealed that
the respondents were diverse and cut across the socio-economic classifications. These
classifications were not pre-requisites to their consciousness on NTFPs. Eight
important NTFPs were identified in the study area and valued for foods, soup or soup
ingredients or spices or condiments, medicine, fuel wood, weaving, wrapping and
sweeteners. A tripartite mode of NTFPs utilization was established in this study.
While 14% of the respondents claimed exclusive consumption of the products, 7%
claimed exclusive use of the products as sources of income while a vast majority of
the respondents used the products for both subsistence and economics as sources of
income. Three levels of respondents’ involvements were observed for NTFPs in the
study area. These included collections, processing and marketing, each of which was
dominated by females. Though the amount of income generated by considerable
proportion of the respondents in this study is low compared to the national minimum
wage yet serve as safety net for the poor and offer opportunity for employment.
Diverse sources, including household area, household farms free area, and forest,
abound for NTFPs species in the study area. Most of the species domiciled in the
household farms were cultivated while those of free areas and forest were mostly
wildlings. Constraints abound on transportation, storage and spoilage that greatly
affect the contributions of the NTFPs in the study area, sustainable strategies that
could ameliorate these problems and further boost the contributions of NTFPs were
proposed.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Derrangement of K+, Na+, Cl- and HCO3- levels by Chronic Consumption of oxidized Palm Oil
Beshel FN, Beshel JA, Osim EE, Antai AB
Page no 1214-1220 |
10.36348/sjmps.2018.v04i10.018
The study was undertaken to find out the effects of chronic consumption of oxidized palm oil on renal handling of Na+, K+, Cl-, HCO3- in Wistar rats. Twenty four male wistar rats weighing 140-160 grams at the begining of the experiment were randomly divided into four groups namely: control, fresh palm oil diet fed (fed 15% w/w fresh palm oil), photoxidized palm oil diet fed (fed 15%w/w photoxidized palm oil), thermoxidized palm oil diet fed ( fed 15% w/w thermoxized palm oil) groups. All four groups received water at libitum. At the end of twelve weeks, urine and blood samples were collected for the analyses of the concentration of Na+, K+, Cl-, HCO3-. Results showed that Plasma Na+ and Cl- concentrations in the TPO and PPO groups were significantly lower than the control (P<0.001) groups and FPO (P< 0.001 and 0.01 respectively)groups. Their (TPO and PPO) Na+ urine concentrations were however significantly (P<0.001) higher than the control and FPO. K+ plasma levels on the other hand, were significantly higher in the TPO (P<0.001) and PPO (P<0.05 and P< 0.01respectively) groups when compared with the control and FPO; but significantly (P<0.001 and P<0.01)lower in the urine. Plasma HCO3- concentration in the TPO group was significantly (P<0.01) lower than the control, FPO and PPO groups while that of PPO was significantly (P<0.05) lower than FPO. Urine K+ concentration of TPO was significantly(P<0.001) lower that the control and FPO while PPO levels were significantly (P<0.05) lower than the FPO only. In conclusion, chronic consumption of oxidized palm oil causes hyperkalemia, hyponatremia and hypobicarbonatemia.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Effect of Extraction Solvents on Phytochemical Composition of Selected Medicinal Ferns in Ekiti State, Nigeria
Adedeji Olayinka Adebiyi
Page no 619-623 |
10.21276/haya.2018.3.10.4
The effect of extraction solvents (water, ethanol and hexane) on the content
of phytochemicals such as alkaloids, saponins, total phenols, tannins and flavonoids in
three selected medicinal ferns (Nephrolepis cordifolia (L.) Presl, Nephrolepis
biserrata (Sw.) Schott and Pneumatopteris afra (Christ) Holttum) in Ekiti State,
Nigeria was investigated. Matured leaflets were collected from healthy plants in Ekiti
State University, Ado Ekiti, Nigeria. Extracts from shade dried and powdered leaflets
of each of the ferns were subjected to phytochemical screening using standard
methods. The results showed the presence of total phenols, tannins and flavonoids in
all the extracts of the ferns while saponin was present only in water extracts. Hexane
was not able to extract alkaloids and saponins in the three ferns. The results showed
that extraction solvents significantly affected the phytochemical composition of the
ferns. The water and ethanol extracts had higher content of the phytochemicals than
the hexane extracts. The diversity of phytochemicals found present suggests that the
ferns could serve as sources of useful drugs.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Analysis of Multi Drug Resistant Mycobacterium tuberculosis Clinical Isolates for Susceptibility to Linezolid and Verapamil using MGIT 960
Adeel Ahmad, Fizza Mushtaq, Sidrah Saleem, Irfan Ahmad
Page no 1205-1213 |
10.36348/sjmps.2018.v04i10.017
Pakistan stands among the top five highest tuberculosis burden countries. Emergence of multi drug resistant Mycobacterium tuberculosis limited the spectrum of drugs of choice to treat tuberculosis. Among several, the activation of efflux pumps is one of mechanisms that mediate drug resistance in M. tuberculosis. Here, we tested efflux pump inhibitor verapamil and third line tuberculosis drug linezolid for antimicrobial activity against locally isolated multi drug resistant M. tuberculosis isolates using MGIT 960. M. tuberculosis isolates were collected from two tertiary care hospitals based in Lahore. Out of 100 isolates, 56 % (n=56) were found to be multi drug resistant (MDR). Out of MDR-TB, 5.36% (n=3) were additionally resistant to linezolid and 41.07% (n=17) were resistant to amikacin. One moxifloxacin resistant isolate was identified. In linezolid resistant strains, rplC gene was sequenced where rplC T640C mutation was identified in two of three linezolid resistant strains. The minimum inhibitory concentration of verapamil in 84.5% isolates was 256 μg/ml and the growth of remaining 16.5% isolates was inhibited by verapamil at the concentration of 512 μg/ml. Assessment of synergism between verapamil and other drugs including rifampicin, isoniazid, linezolid, amikacin and moxifloxacin revealed that verapamil at the concentration of 256 μg/ml inhibited the growth of MDR-TB isolates in presence of respective drugs. Our findings suggest that linezolid resistance have started emerging in local isolates. Further studies are required at higher level to identify the exact mechanism.
REVIEW ARTICLE | Oct. 30, 2018
Facts about Virgin Copra Oil: Chemistry, Production - A Review on Potential Applications and Functional Properties
G. V. Pavan Kumar, N.V.V.S.S. Lakshmi, Ch. Deena, B. Bhavani, P. Rajendra Kumar
Page no 624-633 |
10.21276/haya.2018.3.10.5
Coconut oil also commonly known as Copra oil is edible oil obtained from
the kernel of harvested mature coconuts of the coconut palm .In recent years this oil
has attained superstardom in the health food world. Celebrities are adopting its use,
nutritionists advocating it, and patients acclaiming its many virtues. A number of
health benefits have been attributed to this oil. These include benefits in skin care, hair
care, stress relief, weight loss and cholesterol level maintenance, immunomodulatory
effects, cardiovascular uses, and more recently in Alzheimer‘s disease .However for
several years, coconut oil was demonized and consumers were made to believe that
coconut oil is deleterious to health as it would block the arteries and cause heart
disease. The tide has turned and in recent times recognition of the positive health
effects of coconut oils have emerged stronger. The use of coconut oil, especially virgin
coconut oil is in vogue, though some people still remain skeptical. This article
attempts to scientifically review the therapeutic benefits of this oil.
ORIGINAL RESEARCH ARTICLE | Oct. 30, 2018
Assessment of Health-Related Quality of Life, Anxiety and Depression in Patients with Rheumatoid Arthritis
Peruri Pavan Kumar, V. Verendra, A. Revanth Kumar Reddy
Page no 1195-1204 |
10.36348/sjmps.2018.v04i10.016
In an attempt our study was to assess health-related quality of life, anxiety & depression among patients with Rheumatoid arthritis. In this study demonstrates that the Rheumatoid arthritis patients evaluated were more likely to have lower Quality of Life, and high prevalence rates of depression and anxiety, the factors leading to an increased risk of depression among Rheumatoid arthritis patients included being female and older. As depression is the one of the major factor for medication non adherence ,So it could be better if Rheumatoid arthritis patients should be regularly assessed and should be monitored for accompanying anxiety and depression during follow-up, to achieve better therapeutic outcome, and to improve patient Quality of Life. We are taking Out of 50 patients, both men and women. It is a six months observational prospective cohort study conducted at King George Hospital, we have to assess the health-related quality of life in patients with RA along with Anxiety and depression in these who are patients suffering with Rheumatoid arthritis. In the data was collected from the direct patient-reported survey, and we are analysed the data by using the Microsoft excel spread sheet along with, Hamilton Rating Scale for Depression HAM-D, Hamilton Anxiety Rating Scale (HAM-A) and we are taken informed consent forms and with proper compliance and age greater than 18 years those who are positively diagnosed with rheumatoid arthritis.