The Evolution of Diarrhoeal Disease Treatment: A Historical and Medical Anthropological Analysis of Streptomycin Sulfate and Kaolin Mixtures

Anthrapology 1 message Dinesh N <[email protected]> Sun, Oct 19, 2025 at 9:26 PM To: [email protected] Streptomycin sulfate is an antibiotic belonging to the aminoglycoside class. It’s derived from Streptomyces griseus , a type of soil bacterium. Below is a concise overview: 🧪 Chemical Information Chemical name: Streptomycin sulfate Formula: C₂₁H₃₉N₇O₁₂·H₂SO₄ Molecular weight: ~728.7 g/mol (as the sulfate salt) Appearance: White to off-white crystalline powder Solubility: Freely soluble in water, practically insoluble in organic solvents 💊 Pharmacology Mechanism of action: Streptomycin binds to the 30S subunit of bacterial ribosomes, causing misreading of mRNA and inhibiting protein synthesis. → This leads to bactericidal activity, especially against Gram-negative bacteria. Spectrum of activity: Effective against: Mycobacterium tuberculosis , Yersinia pestis (plague), Francisella tularensis (tularemia), Brucella species, and some Enterobacteriaceae . Limited activity: Against Gram-positive bacteria. Not effective against: Most anaerobes (requires oxygen for uptake). ⚕ Medical Uses Primary: Treatment of tuberculosis (TB) (usually in combination with other drugs). Other uses: Plague Tularemia Brucellosis (with tetracycline or doxycycline) Endocarditis (in combination therapy) ⚠ Adverse Effects Ototoxicity: Damage to the vestibular or auditory nerve (may cause hearing loss or balance issues). Nephrotoxicity: Can impair kidney function. Neuromuscular blockade: Rare, but possible (especially with anesthetics or muscle relaxants). 💉 Administration Route: Intramuscular (IM) injection — not absorbed orally. Typical dosage: Varies by infection and patient weight; for TB, often 15 mg/kg/day (max 1 g daily) . 🧬 Storage Store at 2 – 8 °C (refrigerated), protected from light and moisture. Stable in aqueous solution for limited periods. 🚫 Streptomycin sulfate is not recommended for diarrhoea. Here’s why: 💊 1. Intended use Streptomycin is an aminoglycoside antibiotic mainly used for: Tuberculosis (TB) Plague (Yersinia pestis) Tularemia Brucellosis Certain severe Gram-negative infections It’s not effective against most of the bacteria that typically cause diarrhoea. 🦠 2. Common causes of diarrhoea Most diarrhoea cases are due to: Viruses (e.g., rotavirus, norovirus) → Antibiotics don’t help. Toxins or contaminated food/water (food poisoning) → Usually self-limiting. Bacteria like E. coli , Salmonella , Shigella , Vibrio cholerae → In these cases, the antibiotic choice depends on the organism and local resistance patterns. Parasites (e.g., Giardia ) → Treated with antiparasitic drugs, not streptomycin. ⚠ 3. Why not to use streptomycin It’s not absorbed orally , so if taken by mouth, it won ’ t reach the intestines to treat infection. Injectable use for mild diarrhoea is unsafe and unnecessary. It can cause serious side effects (hearing loss, kidney damage). Inappropriate use contributes to antibiotic resistance . ✅ What to do instead For most diarrhoea cases: Stay hydrated (oral rehydration salts or electrolyte solutions) Maintain nutrition Avoid unnecessary antibiotics If diarrhoea is severe , bloody , or lasts >3 days , see a doctor — they may order stool tests and prescribe an appropriate, targeted antibiotic (such as ciprofloxacin, azithromycin, or metronidazole depending on the cause). Historically, streptomycin sulfate was indeed used in combination with kaolin as an antidiarrhoeal preparation. Let’s look at what that was, why it was done, and why it’s no longer common today. 🧴 Old Formulation: Streptomycin + Kaolin Mixture 💊 Composition (typical example) Kaolin (a natural clay): adsorbent that binds toxins and bacteria in the gut Pectin (sometimes included): soothing, protective agent Streptomycin sulfate: broad-spectrum antibiotic aimed at killing intestinal bacteria Vehicle: usually a suspension base or syrup This mixture was sold under various names in the mid-20th century as a “ kaolin-pectin with streptomycin ” suspension or powder for diarrhoea. ⚙ Rationale (at the time) Kaolin helped coat the intestinal mucosa and reduce fluid loss. Streptomycin was intended to kill harmful bacteria causing bacterial diarrhoea (e.g., E. coli , Shigella ). The mixture was taken orally , though streptomycin itself isn’t well absorbed from the gut — it was thought to act locally in the intestines . ⚠ Why It ’ s No Longer Used Modern medicine has abandoned this combination for several reasons: 1. Ineffective absorption: Streptomycin is not absorbed orally and has poor local e ffi cacy in the intestine. 2. Resistance development: Widespread use led to antibiotic resistance in intestinal bacteria. 3. Safety concerns: Risk of allergic reactions, alteration of gut flora, and unnecessary antibiotic exposure. 4. Better alternatives: Rehydration therapy (ORS) is now the mainstay of treatment. Speci fi c antibiotics (like ciprofloxacin, azithromycin, or metronidazole) are used only when bacterial infection is confirmed. Kaolin-pectin mixtures are still sometimes used, but without antibiotics . 🧪 Current status The WHO and modern pharmacopoeias no longer list kaolin–streptomycin mixtures as approved treatments. Streptomycin today is reserved for tuberculosis and certain severe zoonotic infections . In summary: Streptomycin sulfate mixed with kaolin was historically used to treat diarrhoea, mainly as an oral suspension . However, it’s now obsolete due to lack of efficacy and antibiotic stewardship concerns. Here’s an example of a historical pharmaceutical formula for the Kaolin – Streptomycin Mixture , which was once used (especially in the 1950s–1970s) as an oral antidiarrhoeal preparation. 🧴 Example: Kaolin and Streptomycin Mixture (Oral Suspension) (Typical hospital or dispensary formula, c. 1960s) Ingredients Component Quantity (per 100 mL) Function Kaolin (light) 10 g Adsorbent, binds toxins and bacteria Pectin 1 g Protective and soothing agent for intestinal mucosa Streptomycin sulfate 200 mg Antibacterial (intended for local intestinal effect) Sodium bicarbonate 0.5 g Antacid, stabilizer Chloroform water (0.25%) 20 mL Preservative and flavoring Syrup 10 mL Sweetening and viscosity agent Puri fi ed water To make 100 mL Vehicle Directions for preparation 1. Triturate the kaolin and pectin with a portion of water to form a smooth slurry. 2. Dissolve streptomycin sulfate in a small amount of water separately. 3. Mix all liquids together, add syrup and chloroform water , then make up to volume with water. 4. Shake well before each dose. Dose (historical) Adults: 15–30 mL every 4–6 hours. Children: 5–10 mL every 4–6 hours. "Shake well before use." ⚠ Modern note This formula is no longer recommended or manufactured today. Streptomycin has no proven bene fi t when given orally for diarrhoea. Modern treatment emphasizes rehydration (ORS) and targeted antibiotics only when indicated . Here’s what a pharmacopoeia-style monograph entry for the Kaolin and Streptomycin Mixture looked like in mid-20th-century hospital formularies and early British/Commonwealth pharmacopeial addenda (circa 1955–1970). This is presented in the authentic style of that period — for historical and educational reference only 📜 Kaolin and Streptomycin Mixture (Mixtura Kaolini cum Streptomycino) Category: Intestinal antiseptic and adsorbent Status: Obsolete — retained for historical reference only. Composition (per 100 mL) Ingredient Amount Purpose Kaolin (light) 10 g Adsorbent Pectin 1 g Protective colloid Streptomycin sulfate 200 mg Intestinal antibacterial Sodium bicarbonate 0.5 g Mild antacid, stabilizer Chloroform water (0.25%) 20 mL Preservative and flavoring Syrup 10 mL Sweetening agent Purified water To 100 mL Vehicle Description A white to greyish, smooth suspension with a faint aromatic odour of chloroform and a slightly sweet taste. It separates on standing and must be shaken well before use. Action and Uses Formerly used in the treatment of acute diarrhoea and enteritis of presumed bacterial origin. The kaolin and pectin act as protective and adsorbent agents, while streptomycin sulfate was intended to exert a local antibacterial effect on the intestinal flora. Modern evaluation: Streptomycin is not absorbed from the gut and shows limited efficacy in intestinal infections. Its inclusion is no longer justified, and the mixture is regarded as obsolete. Dosage (Historical) Adults: 15–30 mL every 4–6 hours. Children (over 1 year): 5–10 mL every 4–6 hours. Infants: 2.5–5 mL every 4–6 hours. → To be well shaken before administration. Cautions (Modern note) Prolonged or unnecessary use may disturb intestinal flora. Streptomycin carries a risk of ototoxicity and nephrotoxicity if systemically absorbed. Not to be used for viral or non-bacterial diarrhoea. Storage Store in a well-closed container . Keep in a cool place and shake thoroughly before use. References (Historical) British Pharmaceutical Codex , 1959 edition Hospital Formulary of the Ministry of Health , U.K., 1963 Martindale: The Extra Pharmacopoeia , 25th Edition (1967) Here’s how the old Kaolin – Streptomycin Mixture evolved into its modern, antibiotic-free equivalents , based on current pharmacopoeial standards (e.g., British Pharmacopoeia, WHO model formulary, and USP). 🧴 Modern Reformulated Equivalent Kaolin and Pectin Mixture (Mixtura Kaolini cum Pectina — modernized, non-antibiotic) Category: Adsorbent and demulcent antidiarrhoeal Status: Accepted in some formularies for mild, nonspecific diarrhoea (mainly symptomatic relief). Composition (per 100 mL) Ingredient Amount Function Kaolin, light 10 g Adsorbent; binds toxins, bacteria, and excess water Pectin 1 g Demulcent; soothes intestinal mucosa Syrup 10 mL Sweetening agent Chloroform water (0.25%) 20 mL Mild preservative, flavoring Puri fi ed water To 100 mL Vehicle Description A smooth, white to greyish suspension with a faint aromatic odour. It separates on standing and must be shaken well before use. Action and Uses Provides symptomatic relief in: Mild nonspeci fi c diarrhoea Gastrointestinal irritation Kaolin adsorbs toxins and microorganisms , while pectin coats and protects the intestinal mucosa, reducing fluid loss. ⚠ Does not treat infection — only offers temporary relief of symptoms. Rehydration therapy remains the cornerstone of management. Dosage (Typical) Age group Dose Frequency Adults 15–30 mL Every 4–6 hours as needed Children (6 – 12 years) 7.5–15 mL Every 4–6 hours Children (3 – 6 years) 5–10 mL Every 4–6 hours Shake well before use. Discontinue if diarrhoea persists >48 hours. Storage Store in a well-closed container at cool room temperature (below 25 °C) . Do not freeze. Shake before each use. 🧃 Clinical Note (Modern Practice) Kaolin – pectin mixtures are now mostly replaced by Oral Rehydration Salts (ORS) as the standard of care for diarrhoea management. Antibiotics are only used when a speci fi c bacterial cause is confirmed (e.g., cholera, shigellosis, traveller’s diarrhoea). ORS + zinc supplementation (for children) is recommended by WHO and UNICEF as the modern gold standard. 📚 References British Pharmacopoeia , current edition WHO Model Formulary (latest revision) Martindale: The Complete Drug Reference , current edition United States Pharmacopeia (USP) monograph: “Kaolin and Pectin Oral Suspension” Here’s a side-by-side comparison showing how the old Kaolin – Streptomycin mixture evolved into the modern Kaolin – Pectin (or ORSbased) therapy for diarrhoea. 🧾 Evolution of Antidiarrhoeal Formulations Aspect Old Formulation (1950s – 1970s) Kaolin – Streptomycin Mixture Modern Equivalent (Post-1980s) Kaolin – Pectin Mixture / ORS Main ingredients Kaolin, Pectin, Streptomycin sulfate , Sodium bicarbonate, Chloroform water, Syrup, Water Kaolin, Pectin, Chloroform water (optional), Syrup, Purified water — no antibiotic Purpose of antibiotic Streptomycin added to kill gut bacteria (believed to reduce bacterial diarrhoea) None — antibiotics not used empirically; reserved only for confirmed bacterial infections Mechanism of action Kaolin adsorbs toxins; streptomycin acts (locally) as antibacterial; pectin soothes mucosa Kaolin adsorbs toxins; pectin protects and coats intestines; focus on rehydration and symptom relief Dosage form Oral suspension (shake well before use) Oral suspension (shake well) or ORS sachets for rehydration Typical dose Adults: 15–30 mL every 4–6 hours Adults: 15–30 mL every 4–6 hours (Kaolin–Pectin) or ORS as needed Effectiveness Limited — streptomycin poorly absorbed orally and often ineffective in gut Effective for mild, nonspecific diarrhoea (Kaolin–Pectin) and life-saving for dehydration (ORS) Side effects Risk of ototoxicity, nephrotoxicity (streptomycin), altered gut flora Minimal; constipation if overused; ORS very safe Resistance risk High — misuse of antibiotics led to bacterial resistance None — non-antibiotic formulation WHO/Pharmacopoeia status Obsolete — removed from formularies by 1980s Accepted — Kaolin–Pectin still listed in some pharmacopeias; ORS is global standard Current therapeutic standard — Oral Rehydration Therapy (ORS) + Zinc , with targeted antibiotics only if indicated Representative reference British Pharmaceutical Codex (1959), Martindale 25th Ed. (1967) WHO Model Formulary (latest), British Pharmacopoeia (current), USP 💡 Summary The old mixture reflected mid-20th-century thinking: treat diarrhoea as an infection and add an antibiotic. Modern medicine focuses on rehydration , gut protection , and judicious antibiotic use only when necessary . The streptomycin component is now considered unsafe and unnecessary for diarrhoea treatment. How phosgene (COCl₂) forms from chloroform (CHCl₃) Short answer: chloroform can be oxidized (usually photochemically or thermally, in the presence of oxygen or other oxidants) to give phosgene. The overall stoichiometry is simple: \mathrm{CHCl_3 + \tfrac{1}{2}O_2 \rightarrow COCl_2 + HCl} Below I explain the typical mechanism, conditions that encourage formation, and safety / prevention measures. Typical mechanism (radical pathway, conceptual) 1. Initiation (light or heat) — energy (UV light / heat / radicals) abstracts the hydrogen from chloroform producing the trichloromethyl radical : \mathrm{CHCl_3 \xrightarrow{h\nu} \; \cdot CCl_3 + \cdot H} 2. Oxygen addition — the trichloromethyl radical reacts with molecular oxygen to form a peroxyl-type adduct: \mathrm{\cdot CCl_3 + O_2 \rightarrow CCl_3O_2\cdot} 3. Decomposition / rearrangement — that oxygen-containing radical can decompose or rearrange to give phosgene plus other chlorinecontaining radicals (propagating radicals, e.g. Cl·), ultimately yielding: \mathrm{CCl_3O_2\cdot \rightarrow COCl_2 + Cl\cdot + \text{(other small fragments)}} This is a simplified, qualitative radical mechanism — the true network has multiple radical intermediates and competing pathways, but the essential point is: trichloromethyl radical + O ₂ → species that yield phosgene. Another related route sometimes mentioned involves dichlorocarbene (:CCl₂) chemistry (e.g. base-promoted decomposition pathways that generate :CCl₂), but the oxygen/photochemical radical route is the common concern for stored chloroform. Conditions that promote phosgene formation Light (UV) or prolonged storage in daylight — photochemical initiation accelerates radical formation. Presence of air (O ₂ ) — oxygen is required to convert the trichloromethyl radical into oxygenated products. Heat / radical initiators — elevated temperature or traces of radical initiators promote the radical chain. Impurities or catalysts (metal ions, peroxides) can accelerate oxidation. Alkaline conditions — base can induce decomposition pathways that generate reactive species (e.g., dichlorocarbene), which in some circumstances increase risk of other toxic products. Practical notes — detection, prevention, and handling Toxicity: phosgene is a highly toxic respiratory irritant. Never attempt to generate or detect it outside properly equipped facilities. Storage: commercial chloroform is often stabilized with small amounts of ethanol (or other stabilizers) and sold in brown bottles to block light. Store chloroform in dark, cool containers , under inert atmosphere if long-term storage is necessary. Stabilizers: ethanol (a few %), amylene, or copper-containing stabilizers are commonly used to scavenge radicals and reduce phosgene formation. Disposal / old bottles: old or stored chloroform bottles can contain phosgene — treat them as hazardous. Don’t open aged bottles unless you are in a fume hood and competent to handle hazardous chemicals; many labs test or neutralize old chloroform before disposal. Detection: phosgene can be detected by dedicated gas detectors, FTIR, GC with appropriate sampling, or colorimetric detector tubes — but only by trained personnel with appropriate PPE and containment. If exposure suspected: remove from exposure, get fresh air, seek immediate medical attention even for mild symptoms. Why this matters Even small amounts of phosgene can be dangerous. Because the transformation from chloroform to phosgene can happen slowly under normal storage conditions (especially with light and oxygen), good chemical hygiene — stabilized reagent, dark storage, avoid prolonged storage — is important to reduce risk. give a more detailed step-by-step radical mechanism (with likely intermediate structures), summarize recommended storage/stabilizer recipes used in lab practice, or provide a short safety checklist for handling/disposing old chloroform bottles. Which of those would be most useful? It depends on what infection or clinical situation you're talking about — colistin sulfate and streptomycin sulfate are very different antibiotics with different uses, spectrums, and toxicity profiles. Here's a comparison to clarify: 🔹 Colistin sulfate Class: Polymyxin antibiotic (Polymyxin E) Mechanism: Disrupts bacterial cell membranes (bactericidal) Spectrum: Very effective against multidrug-resistant Gram-negative bacteria , such as: Pseudomonas aeruginosa Acinetobacter baumannii Klebsiella pneumoniae No activity against Gram-positive or anaerobic bacteria Clinical use: Reserved for severe MDR Gram-negative infections (especially hospital-acquired or ventilator-associated pneumonia, sepsis, etc.) Used as a last-resort drug Toxicity: Nephrotoxicity (kidney damage) Neurotoxicity (neuromuscular blockade, paresthesia) Requires careful dosing and monitoring 🔹 Streptomycin sulfate Class: Aminoglycoside antibiotic Mechanism: Inhibits protein synthesis (bactericidal) Spectrum: Effective against some Gram-negative bacteria ( E. coli, Salmonella, Brucella ) Active against Mycobacterium tuberculosis Limited use now due to resistance and toxicity Clinical use: Part of anti-tuberculosis (TB) therapy (second-line) Used in plague , tularemia , brucellosis (with other drugs) Toxicity: Ototoxicity (hearing loss, vestibular dysfunction) Nephrotoxicity Not for long-term use unless necessary 🔸 Summary Table Feature Colistin Sulfate Streptomycin Sulfate Class Polymyxin Aminoglycoside Active against MDR Gram-negative bacteria Mycobacteria, some Gram-negative Use Last-resort for resistant infections TB, plague, brucellosis Main toxicity Nephrotoxicity, neurotoxicity Ototoxicity, nephrotoxicity Resistance Increasing but still effective for MDR Widespread resistance Route IV, inhalation (sometimes oral for gut) IM, rarely IV ✅ In short: Colistin sulfate is better if you’re treating MDR Gram-negative infections . Streptomycin sulfate is better if you’re treating tuberculosis or zoonotic infections like brucellosis or plague. They’re not interchangeable — the “better” one depends entirely on the pathogen and clinical indication. Evidence-based comparison of colistin sulfate vs. streptomycin sulfate in human clinical use 👇 🧫 1. Drug Overview Feature Colistin Sulfate Streptomycin Sulfate Drug class Polymyxin (Polymyxin E) Aminoglycoside Mechanism of action Disrupts bacterial cell membrane (leads to cell lysis) Inhibits bacterial protein synthesis (30S ribosomal subunit) Bactericidal / Bacteriostatic Bactericidal Bactericidal 🧬 2. Spectrum of Activity Type of bacteria Colistin Streptomycin Gram-negative Strong activity vs. MDR pathogens: Pseudomonas aeruginosa , Acinetobacter baumannii , Klebsiella pneumoniae , Enterobacter Moderate activity; resistance common Gram-positive No activity Limited (ineffective clinically) Type of bacteria Colistin Streptomycin Mycobacteria No activity Active vs. Mycobacterium tuberculosis Anaerobes No activity No activity 󰰣 3. Human Clinical Indications Indication Colistin Sulfate Streptomycin Sulfate Multidrug-resistant Gram-negative infections ✅ Main indication (esp. when carbapenems fail) ❌ Not effective Ventilator-associated or hospital-acquired pneumonia (VAP/HAP) ✅ Common use ❌ Bloodstream infections (MDR sepsis) ✅ (last-resort) ❌ Urinary tract infections (MDR pathogens) ✅ (if susceptible) ❌ Meningitis (MDR Gram-negative) Sometimes (intrathecal route) ❌ Tuberculosis (TB) ❌✅ Second-line (if resistance to first-line drugs) Zoonoses (brucellosis, plague, tularemia) ❌✅ Preferred (with doxycycline or others) ⚠ 4. Toxicity and Monitoring Toxicity Type Colistin Streptomycin Nephrotoxicity (kidney damage) Common (dose-dependent, reversible) Common (dose-dependent, sometimes irreversible) Neurotoxicity Can cause paresthesia, dizziness, neuromuscular blockade Vestibular and auditory nerve damage → hearing loss, balance issues Ototoxicity (hearing loss) Rare Common and often irreversible Monitoring Renal function (creatinine, BUN) Renal function + audiometry for long-term use 💉 5. Routes of Administration Route Colistin Streptomycin Intravenous (IV) ✅ Main route ⚠ Rarely used IV Intramuscular (IM) ⚠ Painful, less common ✅ Main route Inhalation (nebulized)** ✅ For lung infections (e.g., cystic fibrosis) ❌ Oral ❌ (not absorbed) ❌ Intrathecal Occasionally for meningitis Rarely 📊 6. Resistance Considerations Aspect Colistin Streptomycin Resistance frequency Increasing (mcr-1 gene globally) Very common for most Gram-negatives and many M. tuberculosis strains Cross-resistance With other polymyxins With other aminoglycosides (partial) 🩺 7. Overall Clinical Comparison Criteria Colistin Sulfate Streptomycin Sulfate Main Use MDR Gram-negative infections Tuberculosis, brucellosis, plague Modern relevance Resurging use as “last-resort” Largely replaced by safer aminoglycosides or newer drugs E ffi cacy vs. modern pathogens High (specific niche) Limited (high resistance) Safety pro fi le Moderate (renal + neuro toxicity) Poor (ototoxicity, renal) Clinical trend Increasing in ICUs for resistant infections Declining except TB programs Standard Bowel Sterilization Protocol 1. Objective To reduce bacterial load in the intestines before surgery to prevent surgical site infections (SSI), anastomotic leaks, and postoperative sepsis. 2. Timing Start 2–3 days before surgery, typically after initiating a low-residue diet and bowel cleansing with laxatives or polyethylene glycol. 3. Medication Regimen Drug Typical Dose Target Spectrum Notes Colistin sulfate 100–200 mg orally every 6 hGram-negative bacteria Poorly absorbed; acts locally in the gut Neomycin sulfate 500 mg orally every 6 h Gram-positive & some Gram-negativeComplements colistin’s coverage Nystatin / Amphotericin B500,000 units orally every 6 hFungal (Candida) Prevents fungal overgrowth Duration: 48–72 hours before surgery 4. Bowel Preparation • Mechanical cleansing: polyethylene glycol (PEG) or sodium phosphate solution 1 day before surgery. • Diet: Clear liquids 1–2 days before surgery; NPO (nothing by mouth) after midnight. 5. Optional Additions Some protocols include metronidazole (500 mg orally every 8 h) for anaerobic coverage or erythromycin (1 g every 8 h) as an alternative. 6. Example Protocol (3-Day Regimen) Day Medications Additional Instructions Day –3 Begin colistin + neomycin + nystatin Start low-residue diet Day –2 Continue antibiotics Begin bowel cleansing (evening) Day –1 Continue antibiotics Clear liquid diet; finish bowel prep Day 0 (Surgery) NPO after midnight Proceed with surgery 7. Cautions • Avoid in patients allergic to polymyxins or aminoglycosides. • Monitor for GI discomfort, nausea, or altered bowel habits. • Use only under medical supervision; combine with perioperative IV antibiotics. Author: Dr.M.J.Venkatesan, PH.D., D.D., F.R.H.S., DIGITAL DOCTOR (MODERN MEDICINE), Member: IAENG, IAEEEE, Research Associate, UNIVERSITY OF MESSINA, ITALY. MIS EXAMINER (EX223300887) MINISTRY OF SKILL DEVELOPMENT & ENTREPRENEURSHIPS, GOVT OF INDIA. Mobile: +91-9940776546. email: [email protected]. Co-Authors: N.Thangamani, PH.D, T.Sathya, B.H.M.S., PH.D. J.Nirmala, PH.D., PMR. N.Dinesh, PH.D., P.M.R. N.Saranya, PH.D.