National Journal of Integrated Research in Medicine

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https://imsear.searo.who.int/handle/123456789/149641

Editors in Chief : Dr.Seema Baxi / Dr. Chinmay Shah,

ISSN: 2230 - 9969 (Print)

Frequency: 4 issues a year

Language: English

Indexed in National Library of Medicine Catalogue

Open Access Peer-reviewed journal

Web site: https://njirm.pbworks.com/w/page/245499/Home /

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Now showing 1 - 20 of 1160

1St Year Resident, Department Of Radio-Diagnosis; SVP Hospital; Smt. NHL Municipal Medical College; Ahmedabad
(Association of Health Professionals and Health Educators, 2022-06) Sonarkhan, D; Jiandani.
Background:Tuberculosis (TB) is a major public health problem. Pulmonary TB sequelae can affect a person's physical and functional capacity leading to decreased quality of life and societal participation. The study aims at evaluating exercise capacity, quality of life, and social participation in patients with post-pulmonary tuberculosis. Material And Methods:An analytical cross-sectional study was carried out in 100 post-tuberculosis patients by convenient sampling. Quality of life was assessed using WHOQOL BREF and social participation was evaluated with the Impact on Participation and Autonomy Questionnaire (IPAQ). Exercise capacity was measured using a six-minute walk test (6MWT). Result:The mean 6MWT distance in males was 333.76 ± 47.10 meters and in females was 335.04 ± 52.34 meters. The mean VO2 peak in males and females was 13.32 ± 2.37 ml/kg/min and 14.02 ± 2.84 ml/kg/min respectively. The quality of life and social participation in both males and females was good. There was a very weak positive correlation between 6MWT and WHOQOL BREF (spearman's rho=0.251) and a moderate negative correlation between WHOQOL BREF and IPAQ (spearman's rho= -0.663) There was no relationship between 6MWT and IPAQ score. Conclusion:The study concludes that the majority of the patients post pulmonary tuberculosis hasfair effort tolerance and good quality of life. It also concludes that there is no statistically significant difference in the quality of life and social participation between males and females.
3 Minute Walk Test In Type 2 Diabetes Mellitus.
(2016-01) Shah, Swati; Puntambekar, Radhika; Joshi, Miheer; Kowale, Arun
Background & Objective: Type 2 Diabetes mellitus(DM) is a chronic disease. It isone of the important causes of increasing morbidity and mortality in India, which is now known as ‘Capital of Diabetes’. It affects all the major systems in the body bringing down the quality of life of the patient. Objective is to assess the Three - minute walk distance in patients and to compare it with the age and gender matched healthy controls. Methodology: A cross- sectional tertiary care Government hospital based study was conducted in forty diagnosed patients of type 2 DM taking oral hypoglycemics, aged between 40-60 years. All the patients were thoroughly interviewed by a well structured questionnaire, which included personal details as well as the history of complications. 3- Minute walk test was conducted, as per the standardized technique in diabetic patients as well as age and gender matched healthy controls. The distance was compared by applying unpaired t test. Results: The mean 3-minute walk distance in patients of type 2 DM was 139.55±54.90 meters as compared to controls which was 200.01± 45.40 meters. The decrease in distance was statistically highly significant (p<0.001). Conclusion: Type 2 Diabetes mellitus affects walking distance of the patient bringing down the quality of life. These findings are useful for targeting the importance of treatment of diabetes, which needs to be addressed with priority to improve the quality of life.
The A2DS2 Score As A Predictor Of Pneumonia In Acute Ischemic Stroke
(Association of Health Professionals and Health Educators, 2022-02) Vyas, C; Suthar, H; Parmar, N.
Background:Stroke is the second leading cause of death worldwide. In the acute phase, stroke patients are susceptible to complications like chest infections, cardiac dysfunction, and urinary tract infections. Globally, the incidence of pneumonia among stroke patients is e stimated to be around 14%. The A2DS2 score (age, atrial fibrillation [AF], dysphagia, sex, and stroke severity using the National Institutes of Health Stroke Scale[NIHSS] score) is a simple scoring system to find risk of stroke associated pneumonia (SAP). Here our aim is planned to assess the risk of SAP in patients with acute stroke using the A2DS2 score.Material And Methods:This prospective observational study was conducted on patients with Ischemic stroke, time from symptom onset within 7 days and Age > 18 years admitted in tertiary care hospital. NIHSS score and A2DS2 score were calculated on admission. Follow up of all thepatients was done during their hospital stay and those who fulfilled Mann’s diagnostic criteria for pneumonia were diagnosed as SAP. Result:Out of 110 patients (M:60, F:50, Mean age 60.37+7.07), the commonest comorbidity was Hypertension (85, 77.27%) andthe commonest symptom was Facial Asymmetry (73, 66.4%). Among these, 19 (18.8%) patients developed SAP. Patients with SAP had higher mean age, male preponderance, commonest symptom dysphagia, higher NIHSS score and higher A2DS2 score. Patients with acute ischemic stroke who had high A2DS2 scores (5-10) higher risk of developing SAP and worse outcome (P <0.05). Conclusion:In conclusion, patients in the high A2DS2 score group had higher incidence of SAP and non-favourable outcome compared to patients with low A2DS2 scores who had more favourable outcomes
Academic counselling: Impact of an intervention program on medical students of pharmacology.
(2012-04) Sukhlecha, Anupama; Patel, Bhumika J; Mistry, Suresh D
Background: Students are anxious and stressed during exams; so are not able to perform well in them. Counselling has been found to improve performance of students. Hence, we wanted to conduct academic counselling for medical students and evaluate it. Objective: To improve performance of medical students in exams through academic counselling (AC). Method: Faculty was trained on conducting AC through role play. A pre-test was taken to assess the baseline knowledge of students. AC of students was conducted. A post-test was then taken for the students. Marks of pre-test and post test were compared to see for improvement of students following our intervention. Feedback was taken from students on the effectiveness of counselling using a questionnaire based on 5-point Likert scale. Feedback was also taken from faculty. Results and interpretation: There was a marked improvement in post-test marks of students who underwent counselling. Feedback from students and faculties was positive. Conclusion: Faculty can guide students on study skills through AC. It can be conducted as formative feedback at mid-term or following internal exams of students.
Academic performance of school children with their intelligence quotient.
(2010-07) Kulkarni, S D; Pathak, N R; Sharma, C S
Present study was carried out to correlate academic performance of Indian school children with their intelligence quotient (as measured by Porteus Maze Tests). These tests have been tried and tested successfully in previous studies, don’t require sophisticated equipment and are easier to administer than traditional tests like Wechsler Tests. Contrary to popular belief, no statistically significant correlation was found in this study between intelligence and academic grades. Thus intelligence is not a prerequisite to succeed in examinations and therefore in life.
Academic performance of school children with their intelligence quotient.
(2010-04) Kulkarni, S D; Pathak, N R; Sharma, C S
Present study was carried out to correlate academic performance of Indian school children with their intelligence quotient (as measured by Porteus Maze Tests). These tests have been tried and tested successfully in previous studies, don’t require sophisticated equipment and are easier to administer than traditional tests like Wechsler Tests. Contrary to popular belief, no statistically significant correlation was found in this study between intelligence and academic grades. Thus intelligence is not a prerequisite to succeed in examinations and therefore in life.
Acceptance And Impact Of Integrated Teaching In Undergraduate Medical Student: An Observational Cross- Sectional Study.
(2016-01) Kumar, Sudhir; Kumar, Govind; Ahmad, Arshad; Ranjan, Ashish; Mishra, Amit; Barat, D
Background & Objective: Among various method of medical education integrated teaching help in integration of basic, clinical and psychosocial sciences. Integrated teaching involves bringing together traditionally separate subjects so that students can grasp subject with more authentic understanding. We conducted the study to compare this scientific method of teaching with traditional learning and also obtained student’s and teacher’s feedback. Methodology: After approval from ethic committee faculty members from various departments we arranged integrated teaching program on important topic. Basic science faculty were made toparticipate actively in both case based learning and hospital visits along with clinical experts. The completed program was evaluated based on structured questionnaire and student and teacher feedback. Results: Among 58 students of 8th semester students, Pre test (TL) and post test (IL) mean of incorrect answers out of 10 structured questionnaires were 4.5517 and 2.9310. There was 35.5% improvement in result after integrated method of learning. 63% of faculty members felt that integrated teaching could be very useful. 85% students were enthusiastic about the new teaching methodology& felt that they had a better clinico pathological correlation. Conclusion: The new method of integrated teaching was found to be more effective than the traditional one. This method was well accepted by faculty as well as students. So it is need of today’s medical curriculum.
The acceptance rate of contraception.
(2013-03) Gohil, Jagdish T; Agarwal, Shonali N; Gupta, Dolly Kirti
Objectives : To study acceptance rate of contraception after 3 or more pregnancy after 2 live issues. Methods : It is a prospective study of 1321 cases that had third or more pregnancy after having two live issues done over a period of 1 year(01/01/2010 to 31/12/2010) at SSGH, Vadodara. Two groups were included – women who came for the termination of the pregnancy after having two live issues (57.15%) and women who came in the labour room either for delivery or spontaneous abortion. Results : incidence of the study cases was 23.46% with 57.15% cases for termination. 89.63% were from lower socio economic. Mistimed conception was seen in 63.29% cases and the most common reason being negligence of contraception(33.97%) against planned conception in only 36.71%. 64.35% accepted contraception at the time of hospitalization, but 36.73% came for accepting contraception. Conclusion : A small planned family has many advantages. Every pregnancy should be planned and every baby should be wanted. Capsule: The most common reason for unwanted pregnancy is the non use of contraception or contraceptive failure. Unintended and unwanted pregnancies add to population’s burden or the need for pregnancy termination. Every pregnancy should be planned and every baby should be wanted.
Accessory Infraorbital Foramen And Morphometric Localization Of Infraorbital Foramen In North Indian Region.
(2015-09) Singh, Alok Kumar; Agarwal, Preeti; Singh, Nishtha; Debberma, Soubhik
Abstract: Background: Aim of present study was to note the frequency of accessory infraorbital foramen in north Indian population and to determine the distance of infraorbital foramen from various anatomical landmarks in adult dry human crania. Methodology: 64 adult north Indian dry human crania of unknown age and gender were analysedfor the presence ofaccessoryinfraorbital foramen and their unilateral or bilateral prevalence was calculated.Shortest distance between the infraorbital foramen from midline, pyriform margin, nasion, infraorbital margin, anterior nasal spine and frontozygomatic suture was measuredon both sides in each craniawith Vernier caliper accurate to 0.1 mm for linear measurement.Observations thus made were compiled and tabulated followed by comparison using appropriate statistical tests. Results: Prevalence of accessory infraorbital foramen is 7.81%, while bilateral prevalence of accessory infraorbital foramen is only 1.56 %, however unilaterally accessory infraorbital foramen is present in 6.25% (2.34 % on right side and 3.9 % on left side). Mean shortest distance of infraorbital foramen from midline was 34.78 ± 3.19mm, while mean shortest distance between the infraorbital foramen to the pyriform margin was 21.26 ± 2.78 mm.Mean shortest distance of infraorbital foramen to the nasion andinfraorbital marginwas 44.95 ± 4.62mm. and 6.58 ± 1.59 mm respectively.Mean shortest distance of infraorbital foramen to the anterior nasal spine and frontozygomatic suture was 36.63 ± 3.16mm.and 35.62 ± 1.98 mm respectively. Conclusion: The knowledge of the distances from surgically encountered anatomic landmarks may be of assistance in locating these important maxillofacial neurologic structures during many procedures. Understanding the location of these foramina will also assist the clinician in performing local anesthetic blocks.
Accreditation-a public reporting of healthcare quality data.
(2012-09) Joshi, Himanshu A
Internet facility provides the easy and accurate access of the hospital performance on key matrics and because of this information the consumer has become more knowledgeable. Further, more to empower the consumer to make informed decision public reporting of healthcare data is Essential & that initiates the concept of ‘Report Card’ model for Hospital. Accreditation of hospital is public recognition awarded by National Healthcare Accreditation Body on the achievement of standard level of performance. National Accreditation Board for hospital and healthcare providers (NABH), set up to establish and operate Accreditation programme for Healthcare organization. Concept of Accreditation can be utilized successfully as a ‘Report Card’ is reviewed in this article.
Accuracy of fine needle aspiration cytology in diagnosis of thyroid swelling.
(2012-11) Patel, Meena; Shah, Pragnesh; Goswami, Hansa; Gonsai, R N; Shah, Sangeeta; Patel, Avinash
Fine needle aspiration cytology is a well established, safe and out patient procedure used in diagnosis of thyroid swelling. Aims: The aim of this study is to determine the accuracy of FNAC in detection of thyroid lesions at our institute. Material and methods: 100 cases of thyroid swelling were diagnosed and treated at M.P.Shah medical college, Jamnagar from Jan1997 to May 1998. FNAC results were compared with final histopathological diagnosis. FNA results were classified as inadequate material, non-neoplastic, neoplastic and malignant lesions. Results: FNA analysis showed 74.19%(69 cases) non-neoplastic lesion, 19.35%(18cases) neoplastic lesion and 6.45%(6cases) malignant lesion. Histopathological analysis showed 70.18%(40) non-neoplastic lesion and 29.83%(17) neoplastic lesion – 15.79%(9) adenomas and 14.04%(8) carcinomas. Conclusions: The accuracy rate of FNAC in diagnosis for non-neoplastic, neoplastic and malignant lesions were 90.91%,100% and 100% espectively. So, overall accuracy of FNA in present study was 92.98%.
Acute Non-Traumatic Paraparesis: A Comprehensive Analysis of Aetiology and Clinical Profile in an Indian Subpopulation.
(2014-09) Vaishnav, Bhumika; Suthar, Nilay; Modi, Dilip
Background and Objectives: This study was performed in a tertiary care hospital in western India. Our aim was to understand and analyze the clinical profile and causes of acute non-traumatic paraparesis and correlate them with relevant biochemical and radiological investigations. Methods: 100 cases of acute nontraumatic paraparesis admitted over a period of three years were studied. Data on age, sex, presenting symptoms, clinical signs and medical investigations was analyzed critically. This study used the mean and the median as measures of central tendency and standard deviation as a measure of dispersion. Results: Incidence of acute non-traumatic paraparesis was found to be the highest in the third and fourth decade of life (36% of cases). Incidence among males (54%) and females (46%) was fairly equal. An inability to walk (72%) or a difficulty in walking (28%) were the chief presenting symptoms. 76% of cases presented in a stage of spinal shock. Tuberculosis was the commonest cause (40%), followed by acute transverse myelitis (26%). 50% of cases had compressive myelopathy while 30% had non-compressive myelopathy. Investigations such as cerebrospinal fluid (CSF) analysis, nerve conduction studies and Magnetic Resonance Imaging (MRI) were useful in diagnosing the causes. Conclusion: The commonest cause of acute non-traumatic paraparesis was tuberculosis. Early use of the MRI scan helps to confirm etiology and site of lesion.
Acute Onset Dyspnea Due To Foreign Body (Pill) Aspiration In Left Main Bronchus.
(2015-09) Gupta, Ashish Kumar; Gautam, Aditya Kumar; Kumar, Adesh; Bhattacharya, Somnath; Khan, Mohd Haroon
Abstracts: Aspiration of tracheobronchial foreign commonly affects young children and it is uncommon in adults. Bronchoscopy both flexible and rigid is recommended to reveal the aetiology and therapeutic removal of foreign body aspiration. Here we report a case of pill aspiration presenting with acute onset breathlessness in emergency. Investigation of a case revealed left lung atelectasis on chest X-ray. Further workup by bronchoscopy showed an endobronchial mass lesion in left main bronchus causing left lung atelectasis. The obstruction was removed and patient improved promptly.
Acute Viral Hepatitis E Infection With Conjugated Hyperbilirubinemia In 9-Year Boy
(Association of Health Professionals and Health Educators, 2021-04) Shah, T; Pathak, S; Baria, D; Brahmbhatt, S.
Hepatitis E virus (HEV) infection is most common among acute viral hepatitis (AVH) infections in developed countries. It is an enteric virus which usually causes a self-resolving hepatitis. We report the case of a 9-year old boy who presented with anorexia, fever, pain in abdomen and jaundice. Ultrasound revealed no signs of cholestasis. Laboratory findings revealed conjugated hyperbilirubinemia, transaminitis, and bilirubinuria. There was no evidence of any autoimmune or metabolic disease, and routine viral serology was normal except for immunoglobulin M to HEV suggestive of acute origin of disease. The jaundice resolved slowly after a period of 2 months. Hepatitis E virus RNA was not detectable in the convalescent serum. This case is an example of conjugated hyperbilirubinemia seen in acute phase of viral hepatitis caused by HEV.
Adenoid cystic carcinoma arising from minor salivary glands of palate involving maxillary sinus.
(2014-03) Shah, Jigna S; Kharodia, Neha
Adenoid cystic carcinoma (ACC) was first described by Billroth in 1856 and was called ‘cylindroma’ due to its characteristic histological appearance. ACC is the most common malignant neoplasm of the lacrimal gland, and the second most common type of carcinoma arising in the salivary glands, following mucoepidermoid carcinoma. Palate is the most commonly affected site followed by parotid gland, submandibular gland, antrum & tongue. Characteristic features include aggressive, slow growth, with insidious destruction of surrounding tissues, perineural invasion, prolonged clinical course and the tendency for delayed onset of the distant metastases which worsens the prognosis. Long term survival can be achieved particularly with combined surgery and radiotherapy. The most common pattern is the cribriform architecture. Histopathology is the gold standard for the diagnosis of ACC. CT & MRI are considered to be of almost similar significance in detection of perineural spread with preference to MRI because of its high soft tissue contrast. Here we have mentioned a case of Adenoid Cystic carcinoma arising from minor salivary glands of palate.
Admission To Medical Colleges- Predictive Validity Of Selection Criteria.
(2016-07) Parate, Vrushali R; Pande, Sushma S; Lokare, Pushpa O
Background & objective: Appropriate selection criteria for admission to medical college is a fundamental prerequisite where number of aspirants seeking admission to medical college has increased. The selection criteria used by medical colleges has been changing from time to time and not uniform all over India. Hence it is important to validate the selection criteria by observing performance of students during medical course. The study aims to find predictive value of entrance test & science score obtained at HSC level on the performance of medical students in I MBBS University Examination. Methods: The study included marks obtained in science subjects at HSC level, Entrance and I MBBS University examination for four consecutive batches(2009 to 2012). Correlation between all three variables was found using spearman rank correlation. Results: Performance in I MBBS examination showed no correlation with Entrance score but correlated significantly with science scores at HSC level (p<0.001). Also on Linear Regression Analysis, only HSC score showed strong positive correlation with First MBBS score(p<0.001). Interpretation & conclusion: This study indicates that Entrance test needs revision. Either the test should be modified or several selection tools like giving additional weightage to science score at HSC level should be combined, so as to select the optimum standard students.
Adverse drug reaction monitoring in psychiatric outpatient department of a Tertiary Care Hospital.
(2013-03) Prajapati, Hiren K; Joshi, Nisarg D; Trivedi, Hiren R; Parmar, Manubhai C; Jadav, Shilpa P; Parmar, Dinesh M; Kareliya, Jalpan G
Background:Pharmacovigilance in psychiatry units can play vital role in detecting adverse drug reactions (ADRs) and alerting physician to such events, thereby protecting the user population from avoidable harm. Objective: To assess the suspected ADRs profile of psychotropic drugs in psychiatry OPD of a tertiary care hospital and its comparison with available literature data as well as to create awareness among the consultant psychiatrists to these ADRs profile. Materials and Methods: A prospective study was conducted in the psychiatry OPD. Thirty five consecutive patients per day were screened irrespective of their psychiatric diagnosis for suspected ADRs on 3 fixed days in a week from January 2011 to December 2011. CDSCO form was used to record the ADRs. Causality was assessed by WHO causality assessment scale while severity was assessed using Hartwig and Siegel scale. Results: Out of 4410 patients were screened, 383 patients were suspected of having at least one ADR. Thus, 8.68 % of our study population reported ADRs. Of 407 events recorded, 369(90.60%) were “probable” and rest “possible” according to WHO-UMC causality assessment scale. According to Hartwig and Siegel scale, 268 ADRs (65.85%) were “moderate” category. Twenty one different kinds of ADRs were noted. Conclusion: This study enables to obtain information on the incidence and frequency of ADRs in the local population that allows opportunity for education to the physicians to improve the patient’s quality of life.
Aerobic microbiological profile of contigious focus osteomyelitis.
(2014-05) Hassani, Umesh; Jalgaonkar, S V; Agrawal, Gopal
Background: Bone and Joint infections are painful for patients and frustrating for them and their doctors. Eradication of infection from bone is difficult since there is fibrosis and low vascularity due to chronic inflammation where antibiotics are difficult to reach. Such infections tend to persist until the infected biomaterial and the adjacent tissues are removed. Osteomyelitis is also a disease in transition with ongoing changes in predisposing factors, causative organism and treatment. The relative frequency of haemetogenous osteomyelitis and relapsing osteomyelitis continues to decline, conversely the incidence of bone infections related to joint replacements, complex surgical interventions and wound infections are increasing. Factors involved in choosing the appropriate antibiotics include infection type, infecting organism, sensitivity results and antibiotic characteristics. Objective: To know microbiological etiology in different types of osteomyelitis in our region. Material & Methods: Specimens were collected from clinically and radiologically diagnosed 97 patients of Contiguous focus osteomyelitis, In cases of contiguous focus osteomyelitis presenting with sinus tract, deeper material from sinus tract was collected, wherein surgical intervention was required operative biopsy from bone or scrapping from prostheis was collected. Tissue biopsy/ sequestrum obtained were homogenized with sterile mortar and pestle with little sterile broth, for microscopic examination and inoculation. Pus, aspirate, sinus swab were directly used for microscopic examination and Inoculation. All the samples were inoculated on sheep blood agar and MacConkey agar. The plates were examined for growth after 24 hrs. Any growth was identified by colony characters & standard biochemical tests. Results: Staphylococcus aureus was etiological agent (42.05%) in majority of contiguous focus osteomyelitis. Enterobacteriaceae organisms and Pseudomonas aeruginosa were also found to be common agents (11.36% each).Poly-microbial etiology was evident in 15 (17.04%) cases In all 9 cases of contiguous focus osteomyelitis secondary to vascular insufficiency poly-microbial flora was seen. Conclusion: Bone infections that originate from contiguous soft tissue infections can have various etiologies and may even be due to mixture of bacteria from multiple genera Staphylococcus aureus is most common etiology.
Age Determination From Macroscopic Examination Of Sphenooccipital Synchondrosis Closure.
(2015-05) Pipaliya, Krunal N; Aghera, Viral J; Dabhi, Dipen M; Mangal, H M; Manvar, Prince J; Varu, Pratik R
Abstracts: Background & Objective: Age determination from degree of closure of sphenooccipital suture (Synchondrosis). Methodology: This study was conducted during the period of January 2012 to August 2013 at Department of Forensic Medicine, P.D.U. Govt. Medical College & Hospital, Rajkot. 100 cases of age between 8 to 26 years have been taken to cover minimum period of starting the fusion and maximum period of completion of fusion for age determination from sphenooccipital suture. Results: For male, minimum age for open, semi closed and closed sphenooccipital suture was 8 years, 13 years and 18 years respectively while for female, it was 8 years, 13 years and 16 years respectively. For male, maximum age for open, semi open and closed sphenooccipital suture was 13 years, 18 years and 26 years respectively while for female, it was 13 years, 16 years and 26 years respectively. Conclusion: Commencement of union at sphenooccipital suture occurs at the age of 13 years in both sex and complete obliteration of cartilaginous disc occurs at the age of 18 years in male and 16 years in female.
Age Determination From Macroscopic Examination Of Sphenooccipital Synchondrosis Closure.
(2015-05) Pipaliya, Krunal N; Aghera, Viral J; Dabhi, Dipen M; Mangal, H M; Manvar, Prince J; Varu, Pratik R
Abstracts: Background & Objective: Age determination from degree of closure of sphenooccipital suture (Synchondrosis). Methodology: This study was conducted during the period of January 2012 to August 2013 at Department of Forensic Medicine, P.D.U. Govt. Medical College & Hospital, Rajkot. 100 cases of age between 8 to 26 years have been taken to cover minimum period of starting the fusion and maximum period of completion of fusion for age determination from sphenooccipital suture. Results: For male, minimum age for open, semi closed and closed sphenooccipital suture was 8 years, 13 years and 18 years respectively while for female, it was 8 years, 13 years and 16 years respectively. For male, maximum age for open, semi open and closed sphenooccipital suture was 13 years, 18 years and 26 years respectively while for female, it was 13 years, 16 years and 26 years respectively. Conclusion: Commencement of union at sphenooccipital suture occurs at the age of 13 years in both sex and complete obliteration of cartilaginous disc occurs at the age of 18 years in male and 16 years in female.

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