Ominous Consequences Research Articles

Splenic abscess presenting as pneumonia with pleural effusion initially: A rare case in a 2-year-old girl: A case report

Rationale: Splenic abscess is rarely discovered during the toddler period. Although most of the cases are typically marked by fever, abdominal pain, and vomiting, some of them may suffer life-threatening situations. This study aimed to explore how early detection can prevent serious disease complications. Patient concerns: A 2-year-old child with persisted fever and shortness of breathing was admitted. Physical examination was decreasing breathing sound on the left side. We gave empirical antibiotics use with chest tube drainage for 2 days in vain. No fever dropping and persistent left upper abdominal pain were noted. A huge mass was found on left spleen incidentally during abdominal ultrasound screen. Diagnosis: Huge splenic abscess. Intervention: High-resolution ultrasound and abdominal computer tomogram were conducted to confirm the diagnosis. Percutaneous drainage under computer tomography-guided with antibiotic use was smoothly. No obvious adverse effects were noted during the treatment course. Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment and fever subsided. Outcomes: A period of 3-month follow-up revealed no evidence of recurrence of abscess. Lessons: Early diagnosis and intervention are mandatory for splenic abscess to prevent possible ominous consequences. The case study has shown that computer tomography-guided percutaneous drainage, along with appropriate antibiotic therapy, can significantly impact solitary unilocular splenic abscesses, even if they are large. This approach demonstrates the potential to effectively manage splenic abscesses and avoid the need for more invasive procedures such as splenectomy.

EFFECT OF CHANGE IN BODY SIZE ON MORTALITY IN THE INITIALLY HEALTHY COMMUNITY-DWELLING OLDER ADULTS

Abstract Utilising data from the ASPirin in Reducing Events in the Elderly trial participants [aged >70-years (Australians), >65-years (US)], we estimated percent change in body size (BMI: body mass index, WC: waist circumference) from baseline and the second annual visits. Both BMI and WC changes were categorised as 1) change within 5% (stable), 2) decrease by 5–10%, 3) decrease by >10%, 4) increase by 5–10%, and 5) increase by >10%. Mortality events were classified according to the underlying cause by adjudicators. Hazard ratios were calculated to compare mortality between body size change categories. Amongst 16,773 participants, 1,269 mortality were observed over an average 4.4±1.7 years. In men compared to stable BMI, a 5–10% decrease in BMI had a 35% higher (HR 1.35, 95% CI 1.08–1.67), and a >10% decrease in BMI had a 3.84-fold higher (HR 2.99, 95% CI 2.44–3.68) risk in all-cause mortality. A decrease in BMI was associated with a higher cause-specific (cancer, cardiovascular disease [CVD], and non-cancer non-CVD) mortality. A decrease in BMI was associated with higher mortality risk in women, however, the magnitude of association was weaker than men. A decrease in WC was predictive of mortality but with a much weaker relationship than a decrease in BMI. Weight gain was not predictive of mortality except for non-cancer non-CVD mortality in women. Physicians should be aware of the ominous consequence of weight loss, especially amongst older men. The risk extends beyond an increased risk of cancer, extending to CVD and a range of other life-limiting conditions.

Emerging and New Treatment Options for Knee Osteoarthritis.

Osteoarthritis (OA) is the most prevalent type of arthritis worldwide, resulting in pain and often chronic disability and a significant burden on healthcare systems globally. Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences. Radiotherapy of knee OA has no added value. Physical therapy, exercises, weight loss, and lifestyle modifications may give pain relief, improve physical functioning and quality of life. However, none of them has articular cartilage regenerating potential. Due to a better understanding of osteoarthritis, innovative new treatment options have been developed. In this narrative review, we focus on emerging OA knee treatments, relieving symptoms, and regenerating damaged articular cartilage that includes intra-articular human serum albumin, conventional disease-modifying anti-rheumatic drugs (DMARDs), metformin, lipid-lowering agents (statin), nerve growth factors antagonists, bone morphogenetic protein, fibroblast growth factors, Platelet-Rich Plasma (PRP), Mesenchymal Stem Cells (MSC), exosomes, interleukin-1 blockers, gene-based therapy, and bisphosphonate.

Force Sensing Resistors Used as Plantar Impedance Plethysmography Electrodes

Diabetic Foot Ulcers are an ominous consequence of Diabetic Foot. To develop a multidimensional lesion warning device, several variables must be considered, among which vascular parameters. To minimize the number of sensors, we investigate the use of standard flexible Force Sensing Resistors, FSR402 and FSR406, to detect not only plantar pressure, but also bioimpedance plethysmography. Since FSRs include conductive electrodes covered by polymer film, the interface with the subject can be considered a capacitive electrode. We present a special impedance plethysmography circuit to inject current using FSRs and measuring the resulting voltage from other FSRs contacts. Impedance plethysmography simulations with two modelled FSRs, two contacts each, was not successful but using four FSRs, one capacitive contact each, shows a precision within 4% of the expected FSR resistor value. Impedance plethysmography system was verified with simultaneously matching ECG-lead I, Ag-AgCl and capacitive electrodes signals alongside power spectra. For the first time, four sole pressure sensors are used also as bioimpedance electrodes to detect cardiac activity with standard components at frequencies up to 50 kHz, simulated as well as experimentally verified on one healthy subject.

The Oesophageal Squamous Cell Carcinoma Cell Line COLO-680N Fails to Support Sustained Cryptosporidium parvum Proliferation.

Cryptosporidium parvum is an important diarrhoea-associated protozoan, which is difficult to propagate in vitro. In 2017, a report described a continuous culture of C. parvum Moredun strain, in the oesophageal squamous cell carcinoma cell line COLO-680N, as an easy-to-use system for C. parvum propagation and continuous production of oocysts. Here, we report that—using the Köllitsch strain of C. parvum—even though COLO-680N cells, indeed, allowed parasite invasion and early asexual parasite replication, C. parvum proliferation decreased after the second day post infection. Considering recurring studies, reporting on successful production of newly generated Cryptosporidium oocysts in the past, and the subsequent replication failure by other research groups, the current data stand as a reminder of the importance of reproducibility of in vitro systems in cryptosporidiosis research. This is of special importance since it will only be possible to develop promising strategies to fight cryptosporidiosis and its ominous consequences for both human and animal health by a continuous and reliable methodological progress.

Preventive Rules in the Management of Epidemics as per Sunnah

The research aims at understanding the meaning of the preventive rules in the management of epidemics in the Prophet’s Sunnah as visualized by the Prophet, PBUH along with its explanation. The prevention of epidemics through quarantine and sanitary isolation is endorsed by the Sunnah of the Prophet. Moreover the Prophet has recommended actions like prohibition of adultery and sodomy, the clean utensils, mental health and appropriate medical treatment and the like. Good hygiene avoids falling into crises and dangers of ominous consequences, and contributes to the practical application of the preventive rules in managing epidemics according to the Sunnah in contemporary Islamic societies. The preventive measures like maintenance of good hygiene are the focus of this article.

1610P Delivery of ONCOlogic care at HOME: Ready for “ONCOHOME”

During COVID pandemic, many cancer patients (pts) refused to come to hospital, suspending therapies, with ominous consequences. Based on positive (+) results of DOMONCOVID, our homecare project for COVID+ cancer pts, we created a new model of assistance, ONCOHOME, delivering cancer care at home to immune-compromised pts. We aim to provide data on feasibility, efficacy and costs of this innovative model.

Emerging infectious disease preparedness and response in healthcare: perspectives from COVID-19 and the role of College-Learnt Microbiology

Coronavirus disease 2019 (COVID-19) pandemic began in December 2019 in Wuhan City China where it is believed to have been transmitted to humans from an unknown animal species. The public health, social and economic impact of the pandemic world over is detrimental. Health care providers at the frontline in the fight against COVID-19 are at the greatest risk of infection and so far, many have been infected and some have already died from the disease. Thus, it is imperative that healthcare providers have adequate knowledge of infectious diseases and microbial pathogens to comprehend the scale of risk for better recognition and response. Microbiological concepts of infection prevention and control, hand hygiene and aseptic techniques are essential in slowing down the spread of the virus. COVID-19 has proven that infectious agents can emerge from any region in the world and can spread rapidly with ominous consequences to all humanity. This narrative review discusses the role of college-learnt microbiology in health care provider preparedness for emerging infectious diseases in light of the current pandemic.
 Keywords: Emerging; Infections; Preparedness; Response; Microbiology; COVID-19; Training

Association between Trypanosoma cruzi DTU TcII and chronic Chagas disease clinical presentation and outcome in an urban cohort in Brazil.

The specific roles of parasite characteristics and immunological factors of the host in Chagas disease progression and prognosis are still under debate. Trypanosoma cruzi genotype may be an important determinant of the clinical chronic Chagas disease form and prognosis. This study aimed to identify the potential association between T. cruzi genotypes and the clinical presentations of chronic Chagas disease. This is a retrospective study using T. cruzi isolated from blood culture samples of 43 patients with chronic Chagas disease. From 43 patients, 42 were born in Brazil, mainly in Southeast and Northeast Brazilian regions, and one patient was born in Bolivia. Their mean age at the time of blood collection was 52.4±13.2 years. The clinical presentation was as follows 51.1% cardiac form, 25.6% indeterminate form, and 23.3% cardiodigestive form. Discrete typing unit (DTU) was determined by multilocus conventional PCR. TcII (n = 40) and TcVI (n = 2) were the DTUs identified. DTU was unidentifiable in one patient. The average follow-up time after blood culture was 5.7±4.4 years. A total of 14 patients (32.5%) died and one patient underwent heart transplantation. The cause of death was sudden cardiac arrest in six patients, heart failure in five patients, not related to Chagas disease in one patient, and ignored in two patients. A total of 8 patients (18.6%) progressed, all of them within the cardiac or cardiodigestive forms. TcII was the main T. cruzi DTU identified in chronic Chagas disease Brazilian patients (92.9%) with either cardiac, indeterminate or cardiodigestive forms, born at Southeast and Northeast regions. Other DTU found in much less frequency was TcVI (4.8%). TcII was also associated to patients that evolved with heart failure or sudden cardiac arrest, the two most common and ominous consequences of the cardiac form of Chagas disease.

Left Atrial Structure and Function Predictors of New-Onset Atrial Fibrillation in Patients with Chagas Disease

Atrial fibrillation (AF) carries ominous consequences in patients with Chagas disease. The aim of this study was to determine whether left atrial (LA) volume and function assessed using three-dimensional echocardiographic (3DE) imaging and two-dimensional speckle-tracking echocardiographic deformation analysis of strain (ε) could predict new-onset AF in patients with Chagas disease. A total of 392 adult patients with chronic Chagas disease (59% women; mean age, 53±11years) who underwent echocardiography were consecutively enrolled in this prospective longitudinal study. Echocardiographic evaluation included two-dimensional (2D) Doppler echocardiography, with evaluation of left ventricular systolic and diastolic function, LA size, and LA and left ventricular function on 3DE and ε analyses. Multivariate Cox proportional-hazards regression analysis models adjusting for age, sex, hypertension, presence of a pacemaker, and 2D Doppler echocardiographic parameters were used to test if the variables of interest had independent prognostic value for AF prediction. Patients with Chagas disease were followed for 5.6±2.7years. Among these, 139 (35.5%) had the indeterminate form, 224 (57.1%) had the cardiac form, five (1.3%) had the digestive form, and 24 (6.1%) had the cardiodigestive form. The study end point of AF occurred in 45 patients. Total LA emptying fraction (hazard ratio, 0.93; 95% CI, 0.89-0.98; P=.002), passive LA emptying fraction (HR, 0.95; 95% CI, 0.91-0.99; P=.02), and peak negative global LA ε (HR, 1.22; 95% CI, 1.05-1.41; P=.01) were predictors of new-onset AF independent of clinical and 2D Doppler echocardiographic parameters. LA function assessed on 3DE and ε analyses predicts new-onset AF in patients with Chagas disease independent of clinical and 2D Doppler echocardiographic indexes.

Anorexia nervosa con desenlace fatal: a propósito de un caso

La Anorexia Nervosa (AN) es el trastorno psiquiátrico con mayor nivel de mortalidad directa y, a la vez, causa de múltiples y riesgosas complicaciones somáticas tales como: bradicardia, hipotensión ortostática, arritmias cardiacas, hipoglicemia, falla hepática, alteraciones hidroelectrolíticas y hormonales, osteopenia, dilatación gástrica y, finalmente, muerte súbita por diferentes causas. A pesar de su prevalencia relativamente baja, afecta a personas jóvenes con larga expectativa de vida. Su manejo, cuando llega a niveles de gravedad severa (IMC < 15), es complejo, pues requiere trabajo conjunto de psiquiatría y otras especialidades médicas y puede tener consecuencias ominosas. Se presenta y discute el caso de una paciente mujer de 19 años cuyo IMC llegó a 11 y que, lamentablemente, falleció mientras recibía atención hospitalaria. Se revisan las principales complicaciones médicas de la AN, remarcándose la necesidad de considerar los parámetros pertinentes para una atención hospitalaria oportuna que pueda evitar desenlaces fatales.

Respuesta ultrarrápida a la terapia electroconvulsiva en un caso de trastorno psicótico agudo polimorfo.

Existe la errónea percepción de que la Terapia Electroconvulsiva (TEC) debe usarse como último recurso de manejo psiquiátrico y únicamente en casos crónicos y/o refractarios. Esto, entre otras causas, ha llevado a la lamentable disminución de su empleo a lo largo de los últimos tiempos en nuestro medio y en otras latitudes. Sin embargo, las psicosis agudas con síntomas motores de tipo catatoniforme presentan tasas de respuesta de hasta 100% y la TEC debiera, por ende, hallarse en la primera línea de los recursos de tratamiento para estos cuadros, evitando o previniendo, de ese modo, connsecuencias ominosas de la catatonía. A propósito de un cuadro de trastorno psicótico agudo polimorfo sin síntomas de esquizofrenia (F23.0, CIE-10) que presentó remisión completa de síntomas catatónicos y psicóticos luego de una sola sesión de TEC (lo que es, de hecho, un resultado infrecuente), se realiza una revisión de la literatura pertinente. Se concluye que la TEC debiera retomar su relevancia en casos psicóticos agudos de buen pronóstico, en los que su postergación acarreará consecuencias innecesariamente negativas.

Heroic memory and contemporary war

AbstractInter-State wars seem to have come to an end in the late 1990s; ever since, the global reality of collective violence has come down to the chaos of contemporary civil wars and terrorist attacks. In this article, it will be argued that in today's civil wars, as well as in terrorist violence, the traditional warrior ethos is fading, giving way to types of violence governed by a new psychological and social paradigm. In other words, it is assumed that the very set of values that has universally determined the male gender role and the frame of hegemonic masculinity since time immemorial has also informed the waging of war according to a “heroic regime of violence”, and this phenomenon has made war a desirable option for countless generations of young men. On the other hand, the global changes entailed by modernity seem to have undermined this warrior ethos, giving way to a “post-heroic regime” in which extermination-oriented violence, rather than combat-oriented violence, is fostered. In this article, the author will scrutinize the founding psychological and social determinants that have so far upheld the cultural construct of the heroic model, in order to illuminate the ominous consequences of the deculturation of war in today's chaotic conflicts. In such contexts, the men who are fighting1 suffer from a loss of meaning and the impossibility of gaining dignity and social recognition in an ecosystem of humiliation and ubiquitous violence that has little to do with the expectations of pride and dignity conveyed by the past ideals of heroism associated with a certain vision of masculinity. The article will also discuss ways and means of getting the message of international humanitarian law through to men on the front lines caught up in such circumstances.

Efficacy of infantile hepatic hemangioma with propranolol treatment

Rationale:Hepatic hemangioma is rarely discovered during the infantile period. Although most of the cases are asymptomatic, some of them may suffer life-threatening situations. In this regard, early detection is mandatory for preventing the ominous consequences that might be culminated from the disease.Patient concerns:A 2-month-14-day-old female infant was found incidentally to have multiple hepatic lesions during a newborn ultrasound screen. She was born smoothly at term after a non-eventful pregnancy course. Physical examination was completely normal and postnatal vital signs were stable.Diagnosis:Infantile multiple hepatic hemangiomas.Intervention:High-resolution ultrasound and abdominal computer tomogram were conducted to confirm the diagnosis. Propranolol was started at the age of 3 months and 7 days old with an initial dosage of 1.5 mg/kg per day and increased gradually to 2.5 mg/kg per day. No obvious adverse effects were noted during the treatment course. Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment. Eventually, hepatic lesions totally disappeared 4.5 months later. Propranolol in dosage of 2.5 mg/kg per day was continued until 6 months after the initial prescription.Outcomes:A period of 11-month follow-up revealed no evidence of recurrence of hemangiomas.Lessons:Early diagnosis and intervention are mandatory for infantile hepatic hemangiomas to prevent possible ominous consequences. Though the propranolol therapy protocol for the disease is still under developing, the current report strengthens the recommendation to use propranolol as the first-line medication for treating infantile hepatic hemangiomas.

Expression of LDLRs (Low-Density Lipoprotein Receptors), Dyslipidemia Severity, and Response to PCSK9 (Proprotein Convertase Subtilisin Kexin Type 9) Inhibition in Homozygous Familial Hypercholesterolemia

Homozygous familial hypercholesterolemia (HoFH) is characterized by extremely elevated low-density lipoprotein cholesterol (LDL-C) levels (usually 4–5-fold normal) and appearance of xanthomas, aggressive atherosclerotic cardiovascular as well as aortic and supra-aortic valve diseases, before the age of 20 years.1 The severity of the HoFH phenotype and its ominous consequences correlate with LDL-C levels. The latter are influenced primarily by the type of familial hypercholesterolemia (FH)-causing molecular defect. The gravest phenotypes result from homozygous or compound heterozygous mutations in the LDLR gene (low-density lipoprotein receptor) encoding null or negative alleles that are associated with <2% of LDLR activity. Less severe forms are encountered in homozygotes or compound heterozygotes for LDLR -defective alleles encoding LDLRs with 2% to 25% activity, or variants in other genes, such as APOB (apolipoprotein B), PCSK9 (proprotein convertase subtilisin kexin type 9), or rarely LDLRAP1 (LDL receptor adaptor protein-1).2 See accompanying article on page 592 HoFH patients have been treated mainly with statins, ezetimibe, and, when available, lipoprotein apheresis.2 Unfortunately, despite best efforts with these traditional therapies, individuals with HoFH remain severely undertreated and seldom achieve target or even acceptable LDL-C levels. The residual LDLR expression and consequent function certainly play a role in LDL-C reduction induced by statins.3 For instance, Stein et al3 encountered significantly greater LDL-C–lowering effects of rosuvastatin in HoFH patients who had receptor-defective alleles in comparison to those with receptor-negative ones, namely, 23% and 14% lowering, respectively. On the contrary, despite effectiveness of ezetimibe in reducing LDL-C in HoFH, it is uncertain whether this is …

Acute disseminated encephalomyelitis and reactivation of cerebral toxoplasmosis in a child: Case report.

Toxoplasma gondii is an opportunistic parasite that infects a broad range of hosts including humans. The chronic latent phase of the disease manifests as intra-neuronal cerebral cysts tightly controlled by the host immune system. In immunocompromised patients, reactivation of cerebral toxoplasmosis can have severe neurological outcomes that may sometimes lead to death. Despite the efficient prophylactic and treatment measures taken against the rare reactivation of cerebral toxoplasmosis, many reports including several recent ones revealed the still occurrence of this spectrum of disease. We present the case of a 4 years-6 months old apparently immunocompetent child whose premortem clinical presentation and investigations were highly consistent with severe acute disseminated encephalomyelitis (ADEM). The patient received all appropriate medications with initial improvement followed by rapid deterioration and death. Postmortem brain autopsy revealed a wide reactivation of cerebral toxoplasmosis. This is a peculiar case presentation as such medical treatment for ADEM (i.e. steroids) may worsen the Toxoplasma infection with ominous consequences. This case highlights the importance to rule out the possibility of such infections in apparently immunocompetent hosts by performing the appropriate investigations to prevent complications.

Gastroseal: A Novel Stent Design for the Management of Post-Bariatric Surgery Leaks

Bariatric surgery leaks remain a dreaded complication with ominous consequences. Fully covered stents have shown efficacy in the treatment of leaks; however, stent migration remains a major drawback. Ultra-large stents have shown reduced rates of migration and coapt better against the walls, but deep ulcers occur in almost all patients, as well as frequent severe intolerance, bleeding, and perforation. We have developed a large expandable stent with physical characteristics and a particularly flexible mesh design that make it much less traumatic than conventional large stents while maintaining the advantage of being less prone to migration. In this patient with a post-sleeve gastrectomy leak, we provide a proof of concept that the Gastroseal stent is effective and nontraumatic despite its very large size.

Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion.

Spontaneous intracerebral hemorrhage (ICH) is a common and ominous consequence of cerebral small vessel disease. It is now known to be a dynamic disease, with up to one third of patients experiencing continued bleeding after initial presentation.1 This growth, also termed hematoma expansion is an independent predictor of early neurological deterioration and worse long-term outcome and represents an appealing therapeutic target.2 Early identification of patients at high risk of ICH expansion is, therefore, crucial to target therapies to those likeliest to expand.3 The presence of active contrast extravasation within the hematoma, also known as the spot sign, is a validated imaging marker of hematoma expansion.4 However, this sign has a limited sensitivity for expansion.5,6 Furthermore, the identification of the spot sign requires computed tomography angiography (CTA), with potential drawbacks including additional radiation delivery. Several noncontrast CT (NCCT) biomarkers have been studied since the early 1980s and have recently gained attention as promising predictors of ICH expansion.7–11 Unlike CTA, NCCT is almost universally performed to diagnose ICH in the emergency department. NCCT biomarkers have the potential to become an inexpensive and readily available tool to stratify the risk of hematoma growth in clinical practice and for clinical trials. In this review, we summarize the current evidence on spontaneous ICH expansion prediction using NCCT and aim at paving the way toward a standardization of NCCT biomarker nomenclature. ### Initial Hemorrhage Formation The imaging appearance of an acute ICH varies by many biological factors, including the patient’s hematocrit and the intrahemorrhage protein concentration.12 It is constantly though characterized by the presence of a spontaneously hyperattenuating area within the brain parenchyma, explained by the relative higher attenuation of fresh blood by comparison to the surrounding brain tissue.12,13 The higher attenuation of recent blood has …

The moderating effect of skills development transfer on organizational commitment – a case-study of Free State TVET colleges

One of the legacies of Apartheid South Africa which has ominous consequences for the economy, is the insidious dire skills shortage for majority of the citizens. Compelling government to embark on an intensive wholesale skills development to ameliorate and stimulate the general economic performance. This paper therefore, explored the relationship between employee organizational commitment and skills development transfer. A longitudinal study, with a pre- and post-quasi experimental research design was adopted in this paper employing Organizational Climate (OC) instrument to collect data from 59 randomly selected TVET college employees. The study revealed significant correlation between organizational commitment and skills development transfer. For example, appreciative of the access to training opportunities, involvement and frequency of training, sense of belonging, an indicative of the affective organizational commitment, with meagre 23% indicating intention to use acquired new skills to look for greener pastures elsewhere. This paper attempts to assist organizations better tailor their training provision to align it with certain desirable behavioral patterns, so as to enhance organizational commitment and reduce the turnover rate of staff. Keywords: TVET colleges, skills transfer, organizational commitment, staff turnover, performance JEL Classification: D23

Sopana musicians of Kerala temples : Problems and prospects

Studies dealing with ritualistic music and allied arts of Kerala are rare. Not much research has gone deep into this area which cut across the periphery and superficial layers and touch the real core. An analytical study on the virtually vanishing temple art of Kerala, the Sopana Music, is really significant in this context. Their existence is greatly threatened by the process of modernisation and commercialization of life in the contemporary age and the accompanying changes in social and economic structure. At one time, Sopana music system was associated with most of the rituals and the performing arts. Yet what one sadly realises now-a-days is the fact that Sopana music is still groping in darkness and is yet to be restored to its original spirit and charm. Owing to historical reasons, the recital of this music came to be neglected and virtually discarded in most of the areas except in some temples where it was preserved as a ritual. The reasons for its setback could be manythe practitioners inability to verbalise the content and substance of their art and their inhibition to violate the rigid, protective, orthodox rules and norms intended to preserve their sanctity. The foremost among the reasons being the fear of ominous consequences, if sacred practices were exposed outside the temple sanctum. It was apprehended, that putting the sacred oral traditions in writing ,would defile the divinity and sanctity of the art forms, as it might distort the authentic expression of many typical sounds, their volume, cadence, intonations, signs, accents etc. There appears to be no consensus regarding the mode of preservation of this ritualistic art form.