ELIXIR INTERNATIONAL JOURNAL

(Available online at www.elixirpublishers.com)

Index Copernicus, Poland Value (ICV) is

5.79 in 2012 (5.09 in 2011)

January 2015 Issue

Elixir International Journal Publication January 2015

 Available online at www.elixirpublishers.com

Elixir International Journal

(ISSN: 2229 -712X)
Announcement from the Editor-in-Chief

Table of Contents
S.No Title of the Article and Author(s) Issue No. Page No. Year Month
1 Emerging trends in Human Resource Management 78 29415-29417 2015 January
B.N.Venugopala and R.C.Nagaraju
2 Adverse health effects, risk perception and pesticide use 78 29418-29422 2015 January
behavior
Muhammad Khan
3 Speed analysis for QOS in ATM network – a comparison 78 29423-29425 2015 January
Sanyam Agarwal, A.K. Vatsa and Sunil Kumar
4 Simultaneous Determination of Dorzolamide hydrochloride 78 29426-29429 2015 January
and Timolol maleate in ophthalmic solutions using HPLC
W.A. Shadoul, E.A. Gad Kariem, M.E. Adam and K.E.E.
Ibrahim
5 New spectrophotometric methods for the determination of 78 29430-29431 2015 January
Entacapone in bulk and pharmaceutical dosage forms
Neeha Tadipaneni and Devala Rao Garikapati
6 Necessity of commodity markets in Indian economy 78 29432-29434 2015 January
V.Sreedevi
7 Security issues in cloud computing 78 29435-29438 2015 January
Kevin Curran, Sean Carlin and Mervyn Adams
8 Duplicate of domestic behavior in Iran’s foreign policy 78 29439-29444 2015 January
arena during Khatami presidency
Reza Ekhtiari Amiri, Majid Khorshidi and Fakhreddin
Soltani
9 Sub Threshold Source Coupled Logic based Design of Low 78 29445-29449 2015 January
Power CMOS Analog Multiplexer
G.Deepika, P.Rama Krishna and K.S.Rao
10 Anti-inflammatory activity of Spathodea campanulata P. 78 29450-29452 2015 January
Beauv. leaves against Carrageenan Induced Paw Edema
M.Vijayasanthi, A.Doss and KV.Kannan
11 Investigational study on discovery of face in versatile 78 29453-29458 2015 January
circumstances through Genetic and Ant Colony
Optimization Algorithm
S. Venkatesan, R. Vijayakanth and S. Ramesh
12 Appraise the consequence of internal marketing strategy for 78 29459-29462 2015 January
competitive advantage (case study: motor pump industries)
S.Raj Kumar, J Clement Sudhahar, T.S.Venkateswaran
13 Evaluation of the EFL Textbook “Four Corners” from the 78 29463-29472 2015 January
Perspectives of Students
Masoomeh Hanafiyeh and Mansour Koosha
14 Prime Number Generation Using Genetic Algorithm 78 29473-29476 2015 January
Arpit Goel and Anubhooti Papola
15 Study of interpolation techniques in multimedia 78 29477-29479 2015 January
communication system - A review
Apurva Sinha
16 A Survey on Space Time Block Coding in Wireless 78 29480-29483 2015 January
Communication
Preeti Sureshwar and Achint Chugh
17 An ANN based Mobile Robot Control through Voice 78 29484-29488 2015 January
Command Recognition using Nepali Language
Neerparaj Rai and Bijay Rai
18 The Magic of the Students’ Research Houses: The Effects 78 29489-29491 2015 January
of the Students’ Research Houses on the Students’ Spirit
and Educational Achievements
Seyyed-Ali Madineh, Hosein Behzādnezhād, Mahnāz
Yazdekhāsti and Zohreh Farrokhtabār

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Elixir International Journal

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Announcement from the Editor-in-Chief

Table of Contents
S.No Title of the Article and Author(s) Issue No. Page No. Year Month
19 A Comparative Study an Experimental Investigation on 78 29492-29495 2015 January
Performance and Emission Characteristics of Diesel Engine
Using Bio-Diesel as an Alternate Fuel
P.Lakshmanan and G.Mariammal
20 Some aspects of energy efficient for refrigeration and air 78 29496-29504 2015 January
conditioning
Abdeen Mustafa Omer
21 Measuring Job Satisfaction in Hospitality Industry 78 29505-29508 2015 January
Rosliza Md Zani, Farah Merican Isahak Merican, Shuhaimi
Samanol and Mohamad Raimi Hashim
22 Initial exploration of Hydrocarbon resources by Gravity 78 29509-29512 2015 January
Data: A Case Study inthe South of Qom Province, Iran
Payam Salimi and Asghar Teymoorian Motlagh
23 The Impact of Frequent Exposure to Authentic Audio 78 29513-29517 2015 January
Visual Material on Enhancement of Iranian EFL Learners’
Listening Comprehension Ability
Touran Ahour and Samira Rahbar
24 Textbook Evaluation: ELT Teachers` Perspectives on 78 29518-29525 2015 January
"Learning to Read English for Pre-University Students"
Mehrdad Rezaeian, Mostafa Zamanian
25 Innovation of Mechanical Machinery in Medieval 78 29526-29534 2015 January
Centuries, Part V: Balances and Astrolabes
Galal A. Hassaan
26 Aromoncrypt: A Technique to Optimize the Security by 78 29535-29539 2015 January
Ensuring the Confidentiality of Outsourced Data in Cloud
Storage
L. Arockiam and S. Monikandan
27 User group model for mobile social based networks 78 29540-29543 2015 January
Amol S Nalge and S.R. Durugkar
28 A review on heat transfer enhancement in NEILS for Solar 78 29544-29548 2015 January
Applications
Hridesh Sreedharan and Jose K Jacob
29 Changes induced by meloidogyne incognita on nutrient 78 29549-29551 2015 January
content of mentha (mentha arvensis)
S. K. Thakur
30 Decomposition of a weaker form of fuzzy continuity 78 29552-29556 2015 January
M. Jeyaraman, J. Rajalakshmi and R.Muthuraj
31 Performance analysis of Image Compression using Multiple 78 29557-29560 2015 January
Description Coding based on Set Partitioning In
Hierarchical Tree
Shweta Gaur, Mukesh kumar, A.K. Jaiswal and Rohini
Saxena
32 Salt tolerance mechanism of sugarcane and management 78 29561-29562 2015 January
practices under sodic soil
S.Manjula, A.Vadivel and M.Jayalakshmi
33 Thermal designing of shell & tube heat exchanger: a review 78 29563-29569 2015 January
Sigimon.N.B, Jose K Jacob and A.Surendran
34 Modified analysis of Rathore – Bhattacharya analog 78 29570-29571 2015 January
multiplier
K.C.Selvam
35 Phase Sensitive Detector using Quadrature Oscillator 78 29572-29574 2015 January
K.C.Selvam
36 Modeling the Available Production of Wind Power Plants 78 29575-29580 2015 January
Hossein Reza Bayatpour, Mohammad Tajpour, Behrouz
Moarref
37 The Effect of Post-writing Activities on the Writing 78 29581-29585 2015 January

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Elixir International Journal

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Announcement from the Editor-in-Chief

Table of Contents
S.No Title of the Article and Author(s) Issue No. Page No. Year Month
Proficiency of Iranian EFL Learners
Mehdi Bagheri
38 Determinants of Stock Price Variability 78 29586-29589 2015 January
Hafiza Sidra Khurshid, Muhammad Omar and Aqsa Noreen
39 Corporate Social Responsibility: A Constitutional 78 29590-29596 2015 January
Discourse An Alternative Argument for Corporate Social
responsibility
Girjesh Shukla
40 Financial analysis of selected Indian gas distribution 78 29597-29605 2015 January
companies during 2009-2013
Rohit Bansal
41 Armenian Theory of Special Relativity 78 29606-29617 2015 January
Robert Nazaryan and Haik Nazaryan
42 The Effect of Irrigation Methods and Operational 78 29618-29621 2015 January
Pressuresin Water Use Efficiency and Productivity of
Maize (Zeamays L.)
Abdulrazzak A. Jasim Alzubaidi Zena Allawi Habeeb
Alrawshdie
43 The Contrastive Pragmatic Analysis of Refusal Speech 78 29622-29628 2015 January
Acts in English and Persian Fairy Tales: A Natural
Semantic Meta-Language (NSM) Approach
Babak Jafari Sobhe Sadegh and Reza Biria
44 Physicochemical monitoring, Biodiversity and Biological 78 29629-29634 2015 January
monitoring of the Vit River, Bulgaria
B. S. Boyanov, D. A. Kirin and M. N. Nikolova
45 j-QAF in empowering Muslim Malaysian national primary 78 29635-29637 2015 January
school students: issues and chalenges
Mohd Azmir Mohd Nizah and Mohd Azrani bin Asran
46 Groundwater quality parameters in naguleru sub-basin of 78 29638-29640 2015 January
Guntur district, Andhra Pradesh, India
Sarathbabu. P, John Paul. K and Sankara Pitchaiah. P
47 The Study of Events in Shahnameh tales due to the 78 29641-29643 2015 January
Intellectual and Signal Aspects
Ahamad Khanlary
48 Knowledge, attitude and practices of married male towards 78 29644-29647 2015 January
contraceptive methods at Mithi, Sindh, Pakistan
Aneel Kumar, Nudrat Zeba, Khalida Naz Memon, Din
Muhammad Shaikh and Haji Khan Khoharo
49 On the Comparative Study of Estimators in Seemingly 78 29648-29653 2015 January
Unrelated Regression Equations
A. A. Adepoju and E. I. Olamide
50 Removal Cu(II) ions from synthetic waste water by a novel 78 29654-29656 2015 January
biocarbon
Swaminathan Adaikalam and Singanan Malairajan
51 Removal Pb(II) ions from synthetic waste water by 78 29657-29659 2015 January
biocarbon of Ocimum sanctum (Lamiaceae)
Swaminathan Adaikalam and Singanan Malairajan
52 Integrated nutrient managaement of Soybean (Glycine max 78 29660-29665 2015 January
(L.) Merill) under temperate conditions of Kashmir Valley
Aziz M. A, Tahir Ali, Tahmina Mushtaq, S. Sheraz Madhi,
Tajamul Islam, S. A. Mir and A.P Rai
53 Fuzzy Neutrosophic soft matrix model in decision making 78 29666-29673 2015 January
I.R.Sumathi and I.Arockiaranii
54 A Study to determine the Breath Holding Time, Forced 78 29674-29676 2015 January
Vital Capacity(FVC), And Peak Expiratory Flow Rate
(PEFR) among patients with Bronchial Asthma at Selected

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Elixir International Journal

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Announcement from the Editor-in-Chief

Table of Contents
S.No Title of the Article and Author(s) Issue No. Page No. Year Month
Hospital, Chennai
M.Malarvizhi, B.Hariprasad, M.Bhavani and Prasannababy
55 Diagnosing diabetes using data mining algorithms and 78 29677-29680 2015 January
artificial intelligence systems
Amir Amiri and Vahid Rafe
56 The Impact of Organizational Change towards Employees’ 78 29681-29687 2015 January
Performance in the Banking Sector in Malaysia
Anantha Raj A. Arokiasamy and Stanley Yap PengLok
57 Energy and economic analysis of broiler production under 78 29688-29693 2015 January
different farm sizes
Sama Amid, Tarahom Mesri-Gundoshmian, ShahinRafiee
and Gholamhossein Shahgoli
58 A mathematical model by using bivariate normal 78 29694-29698 2015 January
distribution for changes in prolactin and cortisol levels in
women undergoing in vitro fertilization and embryo
transfer treatment
S.Lakshmi and M.Goperundevi
59 A study of “lactic acid production and recovery rate in the 78 001-35 2015 January
copd and normal person after an exercise
Jayesh N Parmar
60 Antimicrobial activity of Organic and Alcoholic extracts of 78 29699-29702 2015 January
Medicinal Plants against clinically important Microbial
pathogens
V.Parivuguna and A.Doss
61 Training the engineering students in soft skills through 78 29703-29708 2015 January
J.K.Rowling’s ‘Harry potter and the philosopher’s stone’
V. Vijayalakshmi and M. Renuga
62 Second minimum weight spanning tree in a network 78 29709-29710 2015 January
S.Ismail Mohideen and B.Rajesh
63 Detection of heavy metal resistance bioluminescence 78 29711-29715 2015 January
bacteria using microplate bioassay method
P. Ranjitha and E.S. Karthy
64 Minocycline in brain- a bench to bed side view 78 29716-29719 2015 January
Vivek Sharma
65 Proniosomes: a preferable carrier for drug delivery system 78 29720-29724 2015 January
Jadupati Malakar, Prabir Kumar Datta, Sanjay Dey, Amites
Gangopadhyay and Amit Kumar Nayak
66 Production of biodiesel from the catalytic transesterification 78 29725-29726 2015 January
of Jatropha oil
S.V.A.R.Sastry and Ch.V. Ramachandra Murthy
67 Study of subscriber satisfaction in slotted aloha and 78 29727-29729 2015 January
resource allocation algorithm of GSM network
Sudhindra K R and Sridhar V
68 Competition and marketing practices: a study of business 78 29730-29732 2015 January
management institutes
Iftikar M Naikwadi, N.M .Makandar and Palanvelu
69 Finite vocabulary text dependent speaker identification and 78 29733-29737 2015 January
speech recognition
Suma Swamy, Radha.K, Shwetha Rani G, Smitha Crystal
D’Almeda, Sunil M and K.V Ramakrishnan
70 Economic dispatch of electric power using clone 78 29738-29741 2015 January
optimization technique
Neeraj Kumar Mishra and Sulochana Wadhwani
71 Pyruvate kinase and haemoglobin levels in breast 78 29742-29745 2015 January
carcinoma patients
Ravi Babu.Birudu and M.Jagadish Naik

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Elixir International Journal

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Announcement from the Editor-in-Chief

Table of Contents
S.No Title of the Article and Author(s) Issue No. Page No. Year Month
72 Medicinal properties of annona squamosa in theraupitic use 78 29746-29750 2015 January
B.Ravi Babu and M.Jagadish Naik
73 Hardiness and Achievement Motivation as factors of 78 29751-29754 2015 January
Academic Achievement
Bansal, P and Pahwa, J
74 Histological Effects of Smokeless Tobacco onthe 78 29755-29757 2015 January
Endometrial Glands of the Orally Treated Female Swiss
Albino Rats
Syna Pervaiz Singha and Afroz Saleem Kazi
75 Detection of UDP, TCP and ICMP anomalies on real time 78 29758-29760 2015 January
traffic
Mahendra Kumar Rai and Vijay Shankar Mishra
76 A deterministic model for the transmission dynamics of 78 29761-29764 2015 January
infectious diseases among infants
Binuyo, Adeyemi O
77 Solid-phase extraction Citalopram by C18 modified carbon 78 29765-29768 2015 January
nanotubes in water and Human Plasma samples and
determination of using HPLC
Ali Moghimi, Masome Mokhtari, Ali Parsa and Majid
Abdouss
78 The Reliability of "Learning Environment Preferences" 78 29769-29772 2015 January
Inventory in the Malaysian Context
Norzaliza Alis, Wan Marzuki Wan Jaafar and Ahmad Fauzi
Mohd Ayob
79 Carbon Nanospheres synthesis bypyrolysis ofcrude oil and 78 29773-29779 2015 January
optimization of parameters growthby response surface
methodology (RSM)
Boufades Djamila, Doumanji Loutfi, Moussiden Anissa,
BenmebroukaHafsa, Hamada Boudjema
80 Structure and communicative teaching method of 78 29780-29782 2015 January
innovation and its application
Yingling Gu
81 Element-free Galerkin method with wavelet basis and its 78 29783-29786 2015 January
application in electromagnetic field
Xia Mao-Hui and Ren Wei-He
82 Formulation development of salicylic acid derma sticks for 78 29787-29789 2015 January
external applications
Purushotham Rao, Kaushik Valambhia, Prabhakar Reddy,
Ravindranath, Venkateshwarlu and Prashant Sagare
83 Formulation, evaluation & optimization of orally 78 29790-29793 2015 January
disintegrating tablet of cinnarizine using sublimation
method
Bhupendra G.Prajapati, Rakesh P. Patel and Saitsh N. Patel
84 Determination of the impact of Long-term Poultry manure 78 29794-29800 2015 January
use on selected soil nutrients
Elvis Kodzo Ahiahonu, Robert C. Abaidoo and Elikem
Kwaku Ahiahiay
85 Synthesis of some novel s-triazine derivatives and their 78 29811-29815 2015 January
potential antimicrobial activity
Himanshu D. Patel, Keshav C. Patel, Kalpesh M. Mehta
and Pragnesh D. Patel
86 An efficient ultra sound kidney image retrieval using neural 78 29816-29819 2015 January
network approach
S. Manikandan and V. Rajamani
87 A study on the efficiency of Erosion Potential Model 78 29820-29824 2015 January
(EPM) using reservoir sediments

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Elixir International Journal

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Announcement from the Editor-in-Chief

Table of Contents
S.No Title of the Article and Author(s) Issue No. Page No. Year Month
Asghar Kouhpeima, Seyed Ali Asghar Hashemi and Sadat
Feiznia
88 Molecular Identification Of Rotavirus Strains Involved In 78 29825-29828 2015 January
Gastroenteritis Among Children In Federal Capital
Territory, Abuja Nigeria
F.A Kuta, A. Uba, L.Nimzing and O.M Oyawoye
89 Relations between Metal Levels in Plant and Soil from 78 29829-29832 2015 January
Waste Dumpsite within Uyo Metropolis
Akanimo N. Ekanem
90 New Simple Stationary Solution of a Fluid Queue Driven 78 29833-29838 2015 January
By an M/M/1 Queue
Sherif. I. Ammar
91 Effect of millenium village primary school meal project on 78 29839-29843 2015 January
enrollment rate and attendance of pupils in yala division,
Siaya County, Kenya
James Bill Ouda, Rose Atieno Opiyo and Paul Ogula
92 Vector autoregressive model for monitoring carbondioxide 78 29844-29852 2015 January
(co2) emission from the consumption of fossil fuels
Olayiwola. O. M, Sowola. B .O, Bisira, H. O, Aderele O. R
and Adeniyi, M. O
93 Modelling relationship between students’ pre and post- 78 29853-29858 2015 January
admission performances
Olayiwola. O. M, Bisira, H. O, Wale-Orojo. O. A, Aderele
O. R and Adeniyi, M. O
94 Analysis of Single Phase Inverter Based Welding Machine 78 29859-29860 2015 January
using PIC
Munish Vashishath
95 Analysis of Three Phase Inverter Based Welding Machine 78 29861-29862 2015 January
using PIC
Munish Vashishath
96 New type of graph with different vertices 78 29863-29871 2015 January
Mabrok EL- Ghoul, Habiba El-Zohny and Hend El- Morsy
97 Critical Review of Success Factors of Knowledge 78 29872-29876 2015 January
Management System (KMS) on Competency Building of
IT Based Organization
Bechoo Lal and Chandrahauns R. Chavan
98 Role of Working Capital Management in Corporate 78 29877-29883 2015 January
Profitability: A Case of Manufacturing Sector
Muhammad Usman, Muhammad Bilal Khan Lodhi, Asim
Mirza and Sadia Majeed
99 Insertion opportunities of agricultural insurance in the 78 29884-29886 2015 January
Republic of Armenia
M.G. Manucharyan
100 Undergraduate students’ perception of the final year project 78 29892-29898 2015 January
supervisory process: a case study at a private university in
Malaysia
Norbaizura Mohd Naim and Saroja Dhanapal
101 In Search of Their Rights: A Womanistic Reading of 78 29899-29903 2015 January
Lorraine Hansberry’s A Raisin in the Sun
Tayebe Nowrouzi
102 Effect of integrated nutrient management on selected soil 78 29904-29908 2015 January
physical properties and grain yield of maize in abakaliki,
south eastern Nigeria
Nwite, J. N. Igboji, P.O and Okonkwo G. I
103 Evaluation of different alternative mixes for amaranthus 78 29909-29913 2015 January
cruntus l. production in abakaliki south east, Nigeria

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Elixir International Journal

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Announcement from the Editor-in-Chief

Table of Contents
S.No Title of the Article and Author(s) Issue No. Page No. Year Month
Nwite, J.N, Nwogbaga, A. C and Okonkwo, G. I
104 Inner product space in fourier approximation 78 29922-29927 2015 January
Christian E. Emenonye
105 Governance of IT in Indian Banks – An Immense Need 78 29928-29931 2015 January
R. D. Kumbhar
106 Genetic Diversity analysis in five accessions of Trigonella 78 29932-29938 2015 January
based on Seed protein Electrophoresis and RAPD
Vaseem Raja, Rajdeep Kudesia
107 Applying the integration of the Spatial Multi-Criteria 78 29939-29942 2015 January
Decision Making (SMCDM) with GIS in urban land use
planning
Hadis Safarizadeh and Mahboobe Sadat Haj Mirfattah
Tabrizi
108 Ensuring Competitive Advantage in the Nigerian Service 78 29943-29947 2015 January
Sector through Performance Base Pay
Linus Vem
109 Resource Use Efficiency in Chili Pepper Production in the 78 29948-29951 2015 January
Keta Municipality of Volta Region of Ghana
Wosor, D.K and Nimoh, F
110 The Need and Significance of Traditional Shop lot 78 29952-29956 2015 January
Pavements in the Context of Town Conservation in
Malaysia
Yazid Saleh and Fauziah Che Leh
111 Soil and foliar fertilization of mungfbean (vigna radlata (l) 78 29957-29963 2015 January
wilczek) under Egyptian conditions
Ezzat .M. Abd El Lateef, M.M Tawfik, M. Hozyin, B. A.
Bakry T.A, Elewa A.A Farrag and Amany, A Bahr
112 Synthesis, Characterization and Antimicrobial studies of 78 29964-29967 2015 January
metal complexes of 1-[2’-Chloro-5’-Sulphophenyl]-3-
Methyl -4-Azo – [2”-Carboxy-5”-Sulphonic acid]-5-
Pyrazolone and Their Transition Metal Chelates
K. C. Desai and N. S. Indorwala
113 An Overview on the Environmental Management and 78 29968-29977 2015 January
Policy in Nigeria
Aminu Muhammad Fagge and Adamu Mustapha
114 Both Ended Sorting Algorithm & Performance Comparison 78 29978-29982 2015 January
with Existing Algorithm
Anuradha Brijwal, Arpit Goel, Anubhooti Papola and
Jitendra Kumar Gupta
115 A comparison of motor development of 7- and 10-year-old 78 29983-29986 2015 January
monozygotic, dizygotic twins and singletons in
Kermanshah City
Azita Haidari, Mohammad Jalilvand and Mehdi
Rouzbahani
116 Sports accident in children: a rare cause of traumatic hip 78 29987-29988 2015 January
dislocation
R.EL Zanati, A.Berrichi, H.Aitbenali, M.Irrazi, M.Boufetal,
A.Rhanim, M.Mahfoud, M.S.Berrada, C.Cuny and M.El
Yaacoubi
117 Analysis of 238U, 235U, 137Cs AND 133Xe in soils from 78 29989-29992 2015 January
two campuses in university of douala-cameroon
M.M. Ndontchueng, R. L. Njinga, E.J.M. Nguelem and A.
Simo
118 Expression of the costimulatory molecules cd80, c86 and 78 29993-29998 2015 January
MHC ii in eosinophil, during the peak of eosinophilia in the
syndrome larvas migrans

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Announcement from the Editor-in-Chief

Table of Contents
S.No Title of the Article and Author(s) Issue No. Page No. Year Month
Joice Margareth de Almeida Rodolpho, Sandra Regina
Pereira de Oliveira, Laís Cristina de Souza Naiara Naiana
Dejani, Débora Meira Neris, Ricardo de Oliveira Correia
119 A Comparative Analysis Of Online Newsoaper Articles 78 29999-30003 2015 January
Ghaffar Khamahani
120 Evolution of Dual Containment Policy (the policy of 78 30025-30030 2015 January
Clinton’s administration - Clinton’s Doctrine) in the
Persian Gulf
Seyed Mohsen Mirhosseini
121 New Generation in Contemporary Iranian Architecture with 78 30031-30038 2015 January
Reference to Political Approaches (1980 - 2013)
Amene Doroodgar, Mohammadjavad Mahdavinejad and
Ali Sheikhmehdi
122 An investigation into senior high school three (shs3) 78 30039-30051 2015 January
physics students understanding of measurement uncertainty
of length and time of scientitfic measurement in the volta
region of Ghana
Eliot Kosi Kumassah, Joseph Ghartey Ampiah and Adjei
Eugene
123 Thermodynamic of Adsorption: Studying the effect of 78 30052-30056 2015 January
temperature on adsorption of the metal ions from aqueous
Solutions using Non-conventional adsorbents
Okon Okon and Aniekememe-Abasi Israel
124 Biologically Active Quercetin from Onion and its Effect on 78 30057-30063 2015 January
Health
Kok Fook Seng, Bazlul MobinSiddique, Ida
IdayuMuhamad, Lee Chew Tin, Firdausi Razali,
Shahrulzaman Shaharuddin
125 Education and ICT through the Lenses of Constructivism 78 30064-30066 2015 January
Mostafa KhoshKholgh Sani, Azidah Abu Ziden and
Sakineh Younesi Marzoudi
126 Comparison between simulators involved in Cloud 78 30067-30072 2015 January
Computing and intensifying security of these software’s via
Kalman Scalar Filtering
Masoud Ale Seyyedan
127 Making comparison between security providers in Cloud 78 30073-30076 2015 January
Computing and present innovative secure scheme based on
Hybrid Kalman Filtering
Masoud Ale Seyyedan
128 Using of fixed-interval smoother in cloud computing for 78 30077-30081 2015 January
preventing of permeability and malicious actions
Masoud Ale Seyyedan
129 Utilizing of Ensemble Kalman Filtering for preventing 78 30082-30087 2015 January
presence of wrecking and destructives from cloud platforms
Masoud Ale Seyyedan
130 Assessment of Vitellaria paradoxa population under 78 30088-30096 2015 January
different land use types in Northern Ghana
Damian Tom-Dery, Danial Sakyi and Hypolite Bayor

Elixir International Journal Publication January 2015

 Elixir International Journal Current Index Copernicus, Poland Value (ICV) is 5.79 in 2012

Available online at www.elixirpublishers.com (Elixir International Journal)

Thesis Publications – Physiotherapy

Elixir Thesis Physiotherapy 78TP1 (2015) 1-35

A STUDY OF LACTIC ACID PRODUCTION AND RECOVERY RATE

IN THE COPD AND NORMAL PERSON AFTER AN EXERCISE

Authors Name
Dr.Jayesh N Parmar
I/C Principal, Government Physiotherapy College, Jamnagar, Gujarat, India.

Dr.R.D.Jani
Professor, MP Shah Government Medical College, Physiology Department,
Jamnagar, Gujarat, India.

Dr.F.D.Ghanchi
Professor, MP Shah Government Medical College, Pulmonary Medicine
Department, Jamnagar, Gujarat, India.

ARTICLE INFO
Art i cl e h i st ory : Tele:
Received: 5 January 2015; E-mail addresses: drjaymeet@gmail.com
Published: 8 January 2015; © 2015 Elixir All rights reserved

1
Elixir International Journal Thesis Publication January 2015
 ABBREVIATION
COPD Chronic Obstructive Pulmonary Diseases

OBLA Onset Of Blood Lactate Accumulation

FEV1 Forced Expiratory Volume In 1 Second

FVC Forced Vital Capacity

PEFR Peak Expiratory Flow Rate

CB Chronic Bronchitis

CAL Chronic Airflow Limitation

COLD Chronic Obstructive Lung Disease

CO2 Carbon dioxide

P CO2 Partial Pressure Of Carbon Dioxide

O2 Oxygen

GOLD Global Initiative for Chronic Obstructive Lung
Disease

SaO2 Saturation Of Oxygen

SBP Systolic Blood Pressure

DBP Diastolic Blood Pressure

HR Heart Rate

HRR Heart Rate At Rest

HR1 Heart Rate Immediately After Exercise

RR Respiratory Rate

RRR Respiratory Rate At Rest

BLA Blood Lactate

BLAR Blood Lactate At Rest

BLA1 Blood Lactate Immediately After Exercise

BLA2 Blood Lactate After 15 Minutes Of Exercise

BLA3 Blood Lactate After 30 Minutes Of Exercise

SaO21 Saturation Of Oxygen Immediately After Exercise

I.H.D. Ischemic Heart Disease

L+ Lactate Plus

Gm Grams

L Liter

CS Citrate synthase

HADH 3-hydroxyacyl CoA dehydrogenase

2

NADH Nicotinamide Adenine Dinucleotide

LDH Lactate Dehydrogenase

ATP Adenosine triphosphate

PFT Pulmonary Function Test

PH

CF Cystic Fibrosis

AECOPD Acute Exacerbation of COPD

BMRC British Medical Research Council

ATS American Thoracic Society

LVRS Lung Volume Reduction Surgery

TCA Tricarboxylic Acid Cycle

VA/Q Ventilation/Perfusion

PFK Phosphofructokinase

PHT Pulmonary Hypertension

PDH Pyruvate Dehydrogenase

LT Lactate Threshold

Mm milimole

TUT Time Under Tension

6MWT Six Minute Walk Test

PRE Perceived Rate Of Exertion

3
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) has only recently been seen as a
(1)
multi-systemic rather than a respiratory system disease It is acknowledged that the
inflammation which occurs and installs in COPD leads to remodeling of the airway, with
consequent impaired pulmonary mechanism and obstructed air flow (2)
Chronic obstructive pulmonary disease (COPD) has been variously labeled in the past
as chronic bronchitis (CB) and emphysema, chronic nonspecific respiratory disease, chronic
airway obstruction (CAO), chronic airflow limitation (CAL) and chronic obstruction lung
disease (COLD) depending upon the understanding of the path physiology and clinical
features of the syndrome of chronic cough and/or airways obstruction. It is only in the last
century that the disease has been better understood. Yet, the confusion in the terminology has
persisted till now. COPD is presently accepted as an overall umbrella term for a variety of
clinical disorders with chronic bronchitis at the one and emphysema at the other end of the
spectrum.
Globally, COPD has emerged as the major cause of morbidity and mortality expected
to become the 3rd most leading cause of death and the 5th leading cause of loss of ‘Disability
Adjusted Life Years’ (DALYs) as per projection of the Global Burden of Disease Study
(GBDS).The region-wise projections for the developing countries including India were even
worse. (3)
Extra pulmonary manifestations in COPD, in addition to pulmonary component, are
common. It has been observed in the ECLIPSE study that co morbidities were significantly
(4).
higher in patients with COPD than in smokers and never smokers The important co
morbidities associated with COPD are cardiovascular disorders (coronary artery disease and
chronic heart failure, hypertension), metabolic diseases (diabetes mellitus, metabolic
syndrome and obesity), bone disease (osteoporosis and osteopenia), stroke, lung cancer,
cachexia, skeletal muscle weakness, anemia, depression and cognitive decline (5) (6).
Worldwide, COPD affects 329 million people or nearly 5% of the population. In
2011, it ranked as the fourth leading cause of death, killing over 3 million people. (7).The
number of deaths is projected to increase due to higher smoking rates and an aging
population in many countries. (8) It resulted in an estimated economic cost of $2.1 trillion in
2010. (9)
It is generally known that a substantial portion of patients with chronic obstructive
pulmonary disease (COPD) develop lactic acidosis early in exercise and at very low work
rates (10) (11) Lactic acidosis is unfavorable, since it puts additional stress on these patients’

4
limited ventilatory system during exercise. Recently, evidence has become available that a
reduced oxidative capacity of skeletal muscle correlates with the accelerated lactate (La)
response to exercise in COPD (12)
It has been described that COPD patients develop early lactic acidosis during lower
limb exercises, which enhances the ventilator output and imposes certain limits to the
exercise tolerance. (13)
EXERCISE AND LACTATE
The effect of lactate production on acidosis has been the topic in the field of exercise
physiology. The production of lactate does result in a hydrogen ion, potentially resulting in a
fall in pH. However, the hydrogen ion is quickly buffered by bicarbonate which forms an
intermediary in the blood stream which is quickly converted into water and carbon dioxide.
CO2 is transported to the lungs and exhaled to maintain acid-base status. This is the reason
for the increased respiratory rate with the accumulation of lactate in the blood. This process
can be written as chemical equation:
Lactic Acid →dissociates→ Lactate + H+
H+ + HCO3- → H2CO3 → H2O + CO2 (CO2 is expired at the lungs to maintain pH)
The bicarbonate buffering system is extremely efficient at removing the acidifying
hydrogen ion and expelling it form the body in the form of carbon dioxide. The only
remaining by product of anaerobic metabolism is lactate.
Increasing partial pressure of CO2, PCO2, also causes an increase in [H+]. During
exercise, the intramuscular lactate concentration and PCO2 increase, causing an increase in
[H+], and thus a decrease in pH. Strenuous anaerobic exercise causes a lowering of pH and
pain, called acidosis.
The by-product of anaerobic glycolysis, lactate, has traditionally been thought to be
detrimental to muscle function. However, this appears likely only when lactate levels are very
high. Elevated lactate levels are only one of many changes that occur within and around
muscle cells during intense exercise that can lead to fatigue. Fatigue, that is muscular failure,
is a complex subject. Elevated muscle and blood lactate concentrations are a natural
consequence of any physical exertion. The effectiveness of anaerobic activity can be
improved through training. (14) (15)

At slightly higher exercise intensity than lactate threshold a second increase in lactate
accumulation can be seen and is often referred to as the onset of blood lactate accumulation
or OBLA. OBLA generally occurs when the concentration of blood lactate reaches about
4mmol/L (16)

5
 Owing to its major and better recognized burden from both individual and societal
perspectives, chronic obstructive pulmonary disease (COPD) is an area of intensive
epidemiological, fundamental and clinical research, leading to the publication of more than
10,000 papers each year in the Pub Med database. Among these, many report important
advances in the understanding of and care for COPD. Epidemiological aspects are the topic
of another manuscript in this issue of the European Respiratory Review. (17)
Patients with COPD have generally limited exercise capacity because of the reduced
ventilatory capacity. During a progressive exercise test, generally a patient with COPD will
reach his maximum work rate earlier and be unable to continue exercise.
Most often, treatment of the dyspnoea of patients with COPD is designed to improve
pulmonary mechanics by the use of medicine and control or reduce the chances of infection.
However, reduction of the metabolic acidosis during the exercise by exercise training is also
an important approach to reduce the ventilatory drive and ultimately exertional dyspnoea and
improve the exercise capacity of a patient. (11)
In patients with COPD strength and endurance exercise capacity are impaired. (18) (19)
Exercise capacity may be affected by many factors such as ventilator limitation, dynamic
hyperinflation and diminished oxygen uptake in the lung. (20) In addition, impaired exercise
capacity could be caused by factors outside the lung, such as early lactate production, (10) (21)
(22)
muscle dysfunction1 and cardiovascular deconditioning (e.g. higher heart rate and lower
stroke volume during exercise) (23) (24) which may at least be partially induced by sedentary
lifestyle due to dyspnea. (25)
In so many study it is shown that early lactate is the one of the factor for the exercise
limitation in the COPD patients but how early it starts accumulating in the COPD patients
compared to normal individual and how fast it is eliminated by CO2 production is also
important as this will determine the duration of exercise so this study is mainly to compare
the rate of production and recovery of lactate in the COPD and in normal individual after an
exercise.
OVERVIEW AND DEFINITIONS
The term chronic obstructive pulmonary disease, abbreviated COPD, or sometimes
COLD (chronic obstructive lung disease), refers to a disease state characterized by the
presence of airflow obstruction resulting from chronic bronchitis or emphysema. As defined
in the recent American Thoracic Society guidelines statement regarding COPD” COLD
(chronic obstructive lung disease) is a treatable disease state characterized by airflow
limitation that is not fully reversible. The airflow limitation is usually progressive and

6
associated with an abnormal inflammatory response of the lungs to noxious particles or
gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also
produces significant systemic consequence.”
Similarly, the recent Global Initiative for Chronic Obstructive Lung Disease (GOLD)
defines as “a disease state characterized by airflow limitation that is not fully reversible, is
abnormal inflammatory response of the lungs to noxious particles or gases” (26)
ETIOLOGY
Tobacco smoking is the most common cause of COPD, with a number of other factors
such as air pollution and genetics playing a smaller role. (27) In our country, bidi smoking is
an important factor in addition to cigarette smoking that causes COPD (28) .
It also appears that outdoor air pollutants are significant environmental triggers for
AECOPD and chronic exposure to the traffic exposure affects the respiratory health
conditions, from increasing symptoms to emergency department visits, hospital admissions
and even mortality. Improving ambient air pollution and decreasing indoor biomass
combustion exposure by improving home ventilation appear to be effective interventions that
could substantially benefit the health of the general public. (29) (30)
PREVALENCE OF COPD GLOBALLU AND IN INDIA
The prevalence and morbidity data greatly underestimate the total burden of COPD
because the disease is usually not diagnosed until it is clinically apparent and moderately
advanced. (31)
Globally, as of 2010, COPD affected approximately 329 million people (4.8% of the
(32)
population) and is slightly more common in men than women this is as compared to
64 million being affected in 2004. (33)
By 2020, COPD is predicted to be the third leading cause of death and fifth leading
cause of chronic disability worldwide. (34)
The current prevalence of COPD in India is unclear because of variation in study
design and lack of adherence to strict protocol of the definition of COPD. (35)
SYMPTOMS
The characteristic symptoms of COPD are chronic and progressive dyspnoea, cough
and sputum production that can be variable from day to day (36). Chronic cough and sputum
production may precede the development of airflow limitation by many years. Conversely
significant airflow limitation may develop without chronic cough and sputum production.

7
CLASSIFICATION OF SEVERITY OF COPD
The global initiative for chronic obstructive lung disease (GOLD) has proposed a
universal guideline for the classification of COPD on the basis of both spirometry and
clinical symptoms to define stage of the disease. (37)
Universal Guideline for the Classification of Disease
PREDICTED FEV1/FVC FEV1
MILD COPD <70% >80%
MODERATE COPD <70% <50% to 80%
SEVERE COPD <70% <30%
PATHOPHYSIOLOGY OF COPD
COPD comprises pathological changes in four different compartments of the lungs
(central airways, peripheral airways, lung parenchyma and pulmonary vasculature), which are
variably present in individuals with the disease (31)
The path physiology of chronic obstructive pulmonary disease (COPD) is complex
and can be attributed to multiple components: mucociliary dysfunction, airway inflammation
and structural changes, all contributing to the development of airflow limitation, as well as an
important systemic component. (38)
PULMONARY HYPERTENSION:
P.H.T may develop late in the course of COPD and is due mainly to hypoxic vaso
constriction of small pulmonary arteries eventually resulting in structural changes that
include intimal hyperplasia and later smooth muscle hypertrophy/hyperplasia. Progressive
pulmonary hypertension may lead to right ventricular hypertrophy and eventually right side
cardiac failure.
EXACERBATIONS:
An exacerbation of respiratory symptoms often occurs in patients with COPD
triggered by infection with bacteria or viruses, environmental pollutants or unknown factors.
During this period there is more hyperinflation which leads to increased dyspnoea at the end.
SYSTEMIC FEATURES:
It is increasingly recognized that many patients with COPD have comorbities that
have a major impact on quality of life and survival. Airflow limitation and particularly
hyperinflation affect cardiac function and gas exchange. Inflammatory mediators in the
circulation may contribute to skeletal muscle wasting and cachexia and may initiate or
worsen comorbities such as I.H.D., Heart failure, osteoporosis, normocytic anemia, diabetes,
metabolic syndrome and depression.

8
 Study show that the earliest manifestation of chronic obstructive pulmonary disease
(COPD) is an increase in residual volume suggesting that the natural history of COPD is a
progressive increase in gas trapping with a decreasing vital capacity (VC). The reduction in
VC forces the forced expiratory volume in 1 s to decline with it. This is aggravated by rapid
shallow breathing leading to dynamic hyperinflation. (39) (40) (41) (42)
MANAGEMENT OF COPD
An effective COPD management plan includes four components: (1) assess and
monitor disease; (2) reduce risk factors; (3) manage stable COPD; (4) manage exacerbations.
The goals of effective COPD management are to: (43)
• Prevent disease progression
• Relieve symptoms
• Improve exercise tolerance
• Improve health status
• Prevent and treat complications
• Prevent and treat exacerbations
• Reduce mortality
Appropriate diagnosis and management (from a pharmacologic and nonpharmacologic
perspective) of COPD and its associated comorbidities are important to ensure optimal
patient care. An evolving understanding of COPD as a multimorbid disease that affects an
aging population, rather than just a lung-specific disease, necessitates an integrated,
tailored disease-management approach to improve prognoses and reduce costs. (44)
PHARMACOLOGICAL THERAPY IN STABLE COPD:
Pharmacological therapy or drug which is used in the management of COPD is to reduce
the different symptoms which is associated with the COPD. The following group of the drug
is used
1. BRONCHODILATOR:
This medication is given as and when it is needed. It improves the FEV1 or other spirometry
values by altering the tone of the smooth muscle. This drug widens the airways so it easy the
expiration and so it improves the hyperinflation of the lung during the exercise and rest
2. ANTICHOLINERGICS :
The most important action of the anticholinergic drug on COPD is it block the effects of
acetylcholine on muscarinic receptors and modify the transmission at the pre-ganglionic
junction

9
3. METHYLXANTHINE:
Controversy remains about the exact effects of this drug as it has been reported to
have a range of non-bronchodilator action. Change in the inspiratory muscle function has
been reported by theophyline.
4. CORTICOSTEROIDS: It improves the symptoms, lung function and quality of life and
reduces the frequency of exacerbations in patients of COPD.
5. ORAL CORTICOSTEROIDS:
The details of corticosteroids are given below in table.
NON-PHARMACOLOGICAL THERAPY IN COPD
• SMOKING CESSATION
• PULMONARY REHABILITATION:
American Thoracic Society defined pulmonary rehabilitation as “a multidisciplinary
programme of care for patients with chronic respiratory impairment that is individually
tailored and designed to optimize physical and social performance and autonomy”
Pulmonary rehabilitation comprises a variety of interventions grouped into three main
categories: Exercise training, education, and psychological support. Typically, patients
participate in a programme of exercise rehabilitation 2–3 times a week for 6–12 weeks, at the
same time being encouraged to incorporate breathing and stretching exercises as part of their
daily routine. The physiological rationale for pulmonary rehabilitation in COPD is primarily
based on its effect on peripheral muscle dysfunction. A recent meta-analysis demonstrated
that pulmonary rehabilitation is effective in reducing dyspnoea and fatigue as well as
improving patients’ sense of control (mastery) over their condition. Without compliance with
a maintenance programme these improvements will diminish with time. The value of various
components of rehabilitation, programme length, the required degree of supervision, the
intensity of training and the best approach to maintaining programme adherence represent
issues that remain to be explored. (45) (46) (47) (48) (49) (50)
• RELAXATION
Premature expiratory flow limitation is naturally countered by pursed lip breathing in
some people, while hyperventilation may also be a component of exacerbation or episodes of
breathlessness for these reasons it has been popular to include relaxation exercises or
breathing retraining in rehabilitation classes. (45)
• NON INVASIVE VENTILATION
• LONG TERM OXYGEN THERAPY

10
• LUNG VOLUME REDUCTION SURGERY
• NUTRIOTIONAL SUPPLEMENTS
• VACCINATION
Several viruses and bacteria play a role in the exacerbation in the COPD which leads
to morbidity so it is recommended that health care professionals should use the vaccination
for the COPD patients against influenza, pneumococcal, pertusis. (51) (52).
The managements of COPD are not only done by chest physician but it includes many
other health care professionals like medical practitioners, nursing staff, respiratory therapist
and patient as well. (53)
LACTATE: NORMAL VALUE AND UNIT
The units of measurement of lactate vary between laboratories. Some use milligrams
per deciliter (mg.dl-1), whereas others use milimoles per liter (mmol.l-1) conversion between
these units is based on knowing that the molecular weight of lactic acid is 90, hence
mg.dl/L= mmol.l-1*9
or
Mmol/L= mg.dl-1*0.111
The normal reference value for blood lactate at rest is 5-20 mg.dl-1
Or 0.5 to 2.2 mmol/L (54)
LACTATE PRODUCTION
Before we understand that how lactate is produced it is necessary to understand the
normal metabolic pathway of the energy system in human body which is very well shown
here in diagram.
The citric acid cycle — also known as the tricarboxylic acid cycle (TCA cycle), or the
Krebs cycle,is a series of chemical reactions used by all aerobic organisms to generate energy
through the oxidation of acetate derived from carbohydrates, fats and proteins into carbon
dioxide and chemical energy in the form of adenosine triphosphate (ATP). In addition, the
cycle provides precursors of certain amino acids as well as the reducing agent NADH that is
used in numerous other biochemical reactions. Its central importance to many biochemical
pathways suggests that it was one of the earliest established components of cellular
metabolism and may have originated abiogenically.
The name of this metabolic pathway is derived from citric acid (a type of
Tricarboxylic acid) that is consumed and then regenerated by this sequence of reactions to
complete the cycle. In addition, the cycle consumes acetate (in the form of acetyl-CoA) and

11
water, reduces NAD+ to NADH, and produces carbon dioxide as a waste byproduct. The
NADH generated by the TCA cycle is fed into the oxidative phosphorylation (electron
transport) pathway. The net result of these two closely linked pathways is the oxidation of
nutrients to produce usable chemical energy in the form of ATP.
Lactate production occurs whenever the rate of pyruvate production from glycolysis
exceeds glucose oxidation by the mitochondria. Therefore, for increased lactate production to
be important physiologically, mitochondrial glucose oxidation must decrease under
conditions known to result in increased gluconeogenesis.
Above all this process is shown in the figure below. (55)

Glycolysis,Kreb’s cycle and oxidative phosphorylation

The dissociation of lactic acid

12
 The Ox-Phos Shuttle
During rest and moderate exercise, some lactate continually forms in two ways.1-
energy metabolism of red blood cells that contain no mitochondria and 2-limitations posed by
enzyme activity in muscle fibers with high glycolytic capacity. Any lactate that forms in this
manner readily oxidized for energy in neighboring muscle fibers with high oxidative capacity
or in more distant tissue such as the heart and ventilatory muscles. Consequently lactate does
not accumulate because its removal rate equals its rate of production. (16)
During intense exercise, the respiratory chain cannot keep up with the amount of
hydrogen atoms that join to form NADH. NAD+ is required to oxidize 3-
phosphoglyceraldehyde in order to maintain the production of anaerobic energy during
glycolysis. During anaerobic glycolysis, NAD+ is “freed up” when NADH combines with
pyruvate to form lactate (as mentioned above). If this did not occur, glycolysis would come to
a stop. However, lactate is continually formed even at rest and during moderate exercise. This
occurs due to metabolism in red blood cells that lack mitochondria, and limitations resulting
from the enzyme activity that occurs in muscle fibers having a high glycolytic capacity.
During power exercises such as sprinting, running, cycling when the rate of demand
for energy is high, glucose is broken down and oxidized to pyruvate, and lactate is produced
from the pyruvate faster than the tissues can remove it, so lactate concentration begins to rise.
Once the production of lactate is occurs it regenerates NAD+, which is used up in the
creation of pyruvate from glucose, and this ensures that energy production is maintained and
exercise can continue. The increased lactate produced can be removed in two ways:
• Oxidation back to pyruvate by well-oxygenated muscle cells

13
• Pyruvate is then directly used to fuel the Krebs cycle.
• Conversion to glucose via gluconeogenesis in the liver and release back into circulation;
Cori cycle. (16)
• If not released, the glucose can be used to build up the liver's glycogen stores if they are
empty.
ONSET OF BLOOD LACTATE ACCUMULATION:
During low-intensity, steady-rate exercise, blood lactate concentration does not
increase beyond normal biologic variation observed at rest. As exercise intensity increases,
blood lactate level exceed normal variation. Exercise intensity associated with a fixed blood
lactate concentration that exceeds normal resting variation denotes the LT. This often
coincides with a 2.5 milimoles (mM) value. A 4.0 mM lactate value indicates the onset of
blood lactate accumulation (OBLA). (16)
An increased blood lactate concentration is common during physiological (exercise)
and patho physiological stress (stress hyperlactataemia). In disease states, there is
overwhelming evidence that stress hyperlactataemia is a strong independent predictor of
mortality. However, the source, biochemistry, and physiology of exercise -induced and
disease-associated stress hyperlactataemia are controversial. The dominant paradigm suggests
that an increased lactate concentration is secondary to anaerobic glycolysis induced by tissue
hypo perfusion, hypoxia, or both. (56) The normal plasma lactate concentration is 0.3–1.3
mmol litre_1. Considered once as a special investigation, it is increasingly measured
automatically with the blood gas analysis. Plasma concentrations represent a balance between
lactate production and lactate metabolism. In humans, lactate exists in the levorotatory
isoform. Normal lactate production Glycolysis in the cytoplasm produces the intermediate
metabolite pyruvate (Fig. 1). Under aerobic conditions, pyruvate is converted to acetyl CoA
to enter the Kreb’s cycle. Under anaerobic conditions, pyruvate is converted by lactate
dehydrogenase (LDH) to lactic acid. In aqueous solutions, lactic acid dissociates almost
completely to lactate and Hþ (pKa at 7.4 ¼ 3.9) (Fig. 2). Consequently, the terms lactic acid
and lactate are used somewhat interchangeably. Lactate is buffered in plasma by NaHCO3.
Tissue sources of lactate production include erythrocytes, perivenous hepatocytes, skeletal
myocytes and skin. Basal lactate production is 0.8 mmol kg_1 h_1 (1300 mmol day_1). (55)
AIMS AND OBJECTIVES:
1. Aims of this study are to find out lactic acid production and recovery rate in the COPD
patients and in normal individual.
2. Suggest suitable modifications in exercise/stress regimes to these patients.

14
EXCLUSION AND INCLUSION CRITERIA:
1. Inclusion criteria :
• Subjects willing to participate in the study
• Age between 40-80
• Patients with C.O.P.D
2. Exclusion criteria :
• Subjects who have acute attack of dyspnoea or any respiratory infection within last 3-4
weeks
• Subjects who does regular exercise.
• SpO2 is lower than 85%.

15
METHODS:
The present study was carried out in Shri Guru Gobindsinghji Hospital, Jamnagar
with the basic aim of finding any difference between the rate of production and recovery in
the COPD and in normal individual.
17 Stable patient who met the clinical diagnosis from the department of chest and
respiratory diseases GGH, Jamnagar were recruited from GGH and the 17 normal individual
matched with age were recruited from the physiotherapy department and other department for
the measurement of lactate test.
Full approval was obtained from the MP SHAH MEDICAL COLLEGE RESEARCH
ETHICAL COMMITTEE and all participants provided informed written consent.
OUTCOME MEASURE:
The primary outcome for this study is to measure sub maximal exercise lactate
measurement and its recovery rate in patients of COPD as well as in age matched group of
normal individuals. They were recruited in consecutive disorder: They had to be considered
clinically stable without a history of any kind of infection or exacerbation and without
changes in their medication during the last 3-4 week before the commencement of the test.
We have excluded the patients whose resting SpO2 is lower than 85%.
All participants attached to the hospital, an initial baseline data were recorded. They
were introduced with the physiotherapist, disease process, pulmonary function test machine,
methods & methodology, equipment within ½ an hour. All participants were properly
instructed about PFT machine. They were instructed to sit comfortably on the chair, and
mouth piece was given to them and nose clip was kept on nose so subject may not inspire or
expired through nose. After that they were instructed to do forceful expiration followed by
forceful inspiration without any pause in between this cycle. Five to ten minutes rest was
given after the PFT test is performed
After that subjects were asked to performed incremental exercise test on an electronic
cycle ergometer. First 1 minute was only warm up with the cycling .After 1 minute of cycling
workload was increased by applying more resistance at wheel (by tightening the knob of
resistance) at every 60 seconds till the end of 5 minute. At every minute exertion level was
asked by the chart of PRE (perceived rate of exertion) which is given here, at the end of test
again the level of exertion was asked to each individual and the score was measured for each
patient and the entire normal individual in the control group. Most of the patients and normal
individuals PRE were between 13-17.

16
 Lactate level was measured with the instrument known as lactometer, before the
exercise, immediately after the test, after 15 and 30 minutes of test.
The methods of using lactometer (Lactate Plus):
Lactate Plus (L+, Nova Biomedical, and USA) uses an electrochemical lactate oxidase
biosensor for the measurement of lactate in whole blood. The reliability and accuracy of
lactate plus is checked with the laboratory –based analyzer, it was good compared to the
lactate pro instrument. (57) (58) .A blood sample of 0.7 µL is required: sample analysis time is
11 seconds .Test strips used with the L+ does not required calibration codes or specific
calibration strips. The L+ displayed good reliability and accuracy when compared to a
laboratory based analyzer. (59)
For measurement of lactate one side index finger was chosen and pulp of distal
phalanx was cleaned properly with spirit and cotton. After that lancet was used to prick the
finger and blood is taken on strip after that strip was kept in lactometer instrument area for
atleast 10-11 seconds till the value of lactate is shown on the display. Same way immediately
after exercise, after 15 and 30 minutes procedure was done on alternative finger.
Materials to be used:

Weighing scale

Instrument to measure lactate i.e. lactometer

Measure tape

17

Sphygmomanometer

PRE scale (Perceived rate of exertion)

Watch

Oxymeter

Cycle

PFT Machine

Pen

Paper

PFT instrument

• Lactometer
• Lancet and its instrument
• Measure tape
• Blood lactate measurement strip
• Oxymeter
• Pen

18
 CHART NO 1 AGE
COPD CONTROL
AGE 56 59.94

AGE
61 59.94
60
59
58
57 56
56
55
54

CONTROL
COPD

AGE

CHART NO 2-3 HRR AND SBP

COPD CONTROL
HRR 92.58 80.94

95 92.58

90

85
80.94 Series1
80

75
COPD CONTROL

Systolic blood pressure

COPD CONTROL
SBP 130 127.41

19
 SBP
131
130
130

129

128 127.41 SBP

127

126
COPD CONTROL

CHART NO 4-5 DBP AND SPO2

COPD CONTROL
DBP 83.52 81.35

DBP
84 83.52
83.5
83
82.5
82
81.35 DBP
81.5
81
80.5
80
COPD CONTROL

COPD CONTROL
SPO2 96.35 97.29

SPO2
97.5 97.29

97

96.5 96.35
SPO2
96

95.5
COPD CONTROL

20
 CHART NO 6-7 RRR AND BLAR
COPD CONTROL
RRR 24.7 20.17

RRR
30
24.7
25 20.17
20
15
10 RRR

5
0
COPD CONTROL

COPD CONTROL
BLAR 2.38 2.5

BLAR
2.55
2.5
2.5
2.45
2.4 2.38
BLAR
2.35
2.3
COPD CONTROL

21
 CHART NO 8-9
8 BLA1 AND BLA2
COPD CONTROL
BLA1 6.339 5.29

7 6.39
6 5.29
5
4
3 Series1
2
1
0
COPD CONTROL

COPD CONTROL
BLA2 5.15 4.26

BLA2
6
5.15
5 4.26
4

3
BLA2
2

0
COPD CONTROL
 CHART NO 10 BLA3
COPD CONTROL
BLA3 2.85 2.49

BLA3
2.9 2.85
2.8
2.7
2.6
2.49 BLA3
2.5
2.4
2.3
COPD CONTROL

CHART NO 11
PRODUCTION & RECOVERY RATE OF LACTATE

REST IMMEDIAT AFTER 15 AFTER 30

COPD 2.5 6.394117647 5.15882 2.85294

CONTROL 2.382352941 5.294117647 4.08235 2.49412

4
COPD
3 CONTROL

0
REST IMMEDIAT AFTER 15 AFTER 30
STATISTICAL ANALYSIS
COPD GROUP AND ITS DATA
No FEV1% of predicted FVC % of predicted FEV1/FVC % of predicted
AVERAGE 50.17 64.05 0.77
SD 17.16 19.38 0.06
T 8.70441E-08 0.02 3.07392E-10
SIGNIFICANT SIGNIFICANT SIGNIFICANT

NO HRR SBPR DBPR

AVERAGE 92.58 130 83.52
SD 11.41 11.95 7.52
T 0.01 0.49 0.35
SIGNIFICANT

NO BLAR BLA1 BLA2 BLA3

AVERAGE 2.5 6.39 5.15 2.85
SD 1.00 1.68 1.53 1.18
T 0.72 0.06 0.065 0.33

NO SPO2R SPO21 RRR

AVERAGE 96.35 92.47 24.70
SD 2.78 2.40 4.90
T 0.35 0.014 0.003
SIGNIFICANT SIGNIFICANT

CONTROL GROUP AND ITS DATA

NO FEV1% of predicted FVC % of predicted FEV1/FVC % of predicted
AVERAGE 95.29 81.70 1.19
SD 20.57 23.57 0.14

24
 NO HRR HR1 RRR
AVERAGE 80.94 124.11 20.17
SD 14.78 9.51 2.98

NO BLAR BLA1 BLA2 BLA3

AVERAGE 2.38 5.29 4.08 2.49
SD 0.95 1.68 1.74 0.91

NO SPO2R SPO21
AVERAGE 97.29 94.82
SD 3.01 2.89

NO SBPR DBPR
AVERAGE 127.41 81.35
SD 9.91 5.77

Anova: Single Factor

SUMMARY
Groups Count Sum Average Variance
BLAR 17 40.5 2.382353 0.907794
BLA1 17 90 5.294118 2.851838
BLA2 17 69.4 4.082353 3.037794
BLA3 17 42.4 2.494118 0.845588
ANOVA
Source of Variation SS df MS F P-value F crit
Between Groups 98.64985 3 32.88328 17.20959 2.65E08 2.748191
Within Groups 122.2882 64 1.910754
Total 220.9381 67

25
RESULT
17 patients with COPD and 17 normal individual were enrolled for this study. The
detail anthropometric data and other necessary information are given in the below chart. The
criteria of GOLD classification were adopted for the COPD patients.
As per the result there is small rise in RR, SBP, and DBP in COPD patients as
compare to the normal individuals. There is no significant difference in resting blood lactate
level between COPD and normal individuals.
There is a significant difference in FEV1, FVC and FEV1/FVC between COPD and
control group. This is because COPD is an obstructive lung disorder which gives reduced
FEV1 and FEV1/FVC.
Blood lactate level at rest, immediately after exercise, after 15 and 30 minutes of
exercise are shown in the chart, which suggests that blood lactate level is increased in both
the group immediately after exercise but the increment is more in COPD group of patients
compared to the control group. Once the exercise is stopped and again blood lactate is
measured after 15 minutes, in both the group blood lactate level is reducing but still it was
higher than the baseline level, after 30 minutes of exercise the blood lactate level is almost
reached to the baseline level. The lactate level is increasing in both the group but it is
increasing more in COPD group than the control group significantly.
Heart rate immediately after an exercise is significantly more in COPD group
compared to the control group. The difference between saturation in both the group was not
significant at rest but after an exercise there is significant difference between COPD and
control group with respect to the blood saturation.
DISCUSSION
Patients with COPD may develop high ventilatory and metabolic output when they
perform simple household activity in routine base. Impaired exercise tolerance is a prominent
complaint of patients with obstructive lung disease. Unlike healthy subjects, patients with
obstructive lung disease are often limited in their exercise tolerance by the level of ventilation
they are able to sustain .Improving physical performance is an important therapeutic goal in
COPD. Recent evidence has said that muscle mitochondrial (oxidative) capacity is reduced
and that may be the reason for the exercise intolerance in this population. (60) (61) (58).One of
the important factor that has an effects on exercise ventilation is CO2 production which is
generated by aerobic metabolism and buffering of lactic acid, which is formed an aerobically
when oxygen demand exceeds supply to exercising muscles. (61)

26
 Lactate production is a natural process and it is produced even at rest and it is
removed also, but when the production rate is increased more than removal it is accumulated,
or the removal of lactate is done by the heart, kidney, liver and non exercising muscle.
The increase in blood lactate level during the progressive exercise is the interest of
many physician, clinician, sports coaches and many researchers in today’s new era. Lactate is
(62).
the marker of peripheral muscle anaerobic metabolism and fatigue. The blood lactate
response to exercise has interested physiologists for over many years, but has more recently
become as routine a variable to measure in many exercise laboratories as is heart rate. This
rising popularity is probably due to: a) the ease of sampling and improved accuracy afforded
by recently developed micro-assay methods and/or automated lactate analyzers; and b) the
predictive and evaluative power associated with the lactate response to exercise. Several
studies suggest that the strong relationship between exercise performance and lactate-related
variables can be attributed to a reflection by lactate during exercise of not only the functional
capacity of the central circulatory apparati to transport oxygen to exercising muscles, but also
the peripheral capacity of the musculature to utilize this oxygen. (63)
The precise mechanism by which blood-lactate accumulation occurs during exercise
comprises many factors like the mass of exercising muscle, supply of oxygen to that muscle
in blood, diffusion into cells, and the efficiency of utilization by those muscle cells. (64)
The production of more lactate is one of the primary factors for the limitation of the
exercise performance in the COPD patients. Our result confirms that lactic acid production is
increased as the level and stress of exercise is increasing, but there is no significant difference
in increment level between COPD and control group with respect to the production and
recovery of the lactate.
This study has some limitation like sample size should be more, we have not
categorized the severity of COPD patients and we did not compare the lactate production and
recovery in different group of the COPD patients. We did not measure the lactate production
at the maximal cardiopulmonary exercise level as it was not the purpose of this study. In the
current study the other parameters like blood pressure and oxygen saturation is measured
only at rest and not immediately after exercise, after 15 and 30 minutes of an exercise as the
primary concern was just to measure the rate of production and recovery of lactate.
In our study the lactate production is more in the COPD patients, as in COPD patients
the oxygen supply to the body is limited or reduced as compared to the other normal
individual so during exercise as the oxygen supply is reduced the exercise shift towards the
anaerobic metabolism and the end product of anaerobic metabolism is pyruvate which

27
converts into lactate and this increases the production of lactate in COPD patients compared
to the normal individual so anaerobic metabolism break down the glycogen leads to an
accumulation of inorganic acid that is lactic acid, as lactic acid is a very strong acid it
immediately converts into lactate and hydrogen ion which indirectly causes fatigue in many
COPD patients and this is supported by the study done by Hakan westerblad in 2002. (65)
In COPD patients the respiratory rate is increased more which leads to less time for
the expiration and causes dynamic hyperinflation which is the main cause of respiratory
discomfort and exercise limitation. (66)
Katz and Sahlin (67) had collected data and postulates that lactate production is O2
dependent .In fact they said that when O2 supply is less or limited then mitochondrial
respiration is begin by increase in ATP and Pi (inorganic phosphate) and the reduced form of
NADH (nicotinamide adenine dinucleotide).This favors the stimulation of glycolysis, which
will increases cytosolic NADH formation which will shift the lactate dehydrogenase (LDH)
equilibrium toward increase lactate production. They propose that oxygen supply plays the
most important factor in lactate production.
In 1996 F Maltais and et al done a study on COPD subjects and each subject
performed a stepwise exercise test on an ergo cycle up to their maximum limit and they
concluded that lactic acid rises steeply in COPD group and they said that the activity of the
oxidative enzymes (citrate synthase CS, and 3-hydroxyacyl CoA dehydrogenase HADH) was
significantly lower in COPD than in control group so this study also supports our study
results. (12)
F Maltais , A A Simard and et al in 1996 suggested that in COPD group compared to
the normal group, the increment in lactate production is steeper in COPD group, they said
that reason for this is the activity of the oxidative enzymes was significantly lower in COPD
groups than the control subjects. They have also found no difference in glycolytic enzymes.
They concluded that oxidative capacity of the skeletal muscle is reduced, and increase in
arterial lactate during exercise is excessive, and these both results are interrelated. (12)
In our study the increase in heart rate, respiratory rate, and systolic blood pressure is the
response of exercise in both the group. But resting heart rate and respiratory rate in COPD
group is significantly higher than the control group. The reason for this is that the impairment
in COPD brings to the pulmonary mechanism which can leads to the decrease venous return
and ultimately leads to increase heart rate at rest, and because of this there is higher blood
pressure at rest compared to the normal individuals. In this way COPD can affect the heart

28
rate at rest also and this is a very important factor as it decreases the reserve heart rate
available for any kind of exercise/efforts. (68)
In our study results suggest that lactate is increasing in both the group significantly
when they perform sub maximal level of exercise but the increment of lactate is more in the
COPD group which suggests that COPD patient gets fatigue early and easily as lactate
production is increased more than the control group at sub maximal exercise level, this is
very interesting as well as important as our routine day to day activity involves sub maximal
exercise and that might be the reason that COPD patient either don’t perform the routine
activity or if they perform these activity they gets fatigue very easily and which turns them
into avoidance of these activity which deteriorates their functional ability and capacity to
perform the routine task.
The respiratory rate is more at rest in the COPD group than the control group,
because the hydrogen ion which is produced by the dissociation of the lactic acid into lactate
and hydrogen ion with the help of bicarbonate and converts to produce CO2 and this increases
the load onto patient. Moreover the hydrogen ion itself is the stimulus for the ventilatory
drive .Both the increased in CO2 generated by buffering and the respiratory stimulation by
the hydrogen ion are perceived by the patient as breathing stimuli and which increases the
respiratory rate. (11)
The occurrence of metabolic acidosis in patients with COPD during exercise may be
crucial for the designing the proper rehabilitation protocol. For example in patents in which
develop the metabolic acidosis, exercise training has the some potential to improve exercise
tolerance. Reduction of metabolic acidosis translates into ventilatory requirements and the
same amounts of exercise can be performed with less ventilation which also reduces the
dyspnoea.
Immediately after an exercise there is more increment of heart rate in the COPD
group than the control group which suggests that in mild to moderate activity like in our
study (sub maximal exercise) also increment of heart rate is more in COPD group. The
explanation for this is again as like how heart rate is more in COPD group at rest, same way
the heart rate immediately after an exercise is more in COPD group. As the level of exercise
increases the oxygen and other nutrient material are more required to the working muscle and
in COPD group the oxygen supply is less because of the obstruction which is compensated by
more increment in the heart rate compared to the control group after a sub maximal exercise.
The lactate level is not significantly different in both the group at resting level. The
lactate level is increasing in both the group immediately after an exercise, 15 and 30 minutes

29
of an exercise but the level of increment is higher in COPD group compared to the control
group at the sub maximal level of exercise. We have not allowed any person from both the
group to reach at the maximal level of exercise as it was not the aim of my study. The level or
stress of the exercise was measured by the PRE at each minute of the exercise and at end of 5
minutes the PRE of both the group was somewhat hard to hard.
The reason why I have not chosen the maximal level of exercise is that in routine, day
to day activity mostly occurs in the sub maximal level of stress and what is the lactate level
during sub maximal level of an exercise.
So the finding of lactate production in patients with COPD may prove to be useful in
deciding whether to include exercise training as part of an individual’s rehabilitation
program. (11) (69)
CONCLUSION AND FURURE DIRECTIONS
The overall prevalence of COPD in India and in other countries in increasing day by
day despite profound research in COPD.
As COPD not only affects respiratory system but it also affects the other system in
our body, it is not confined only to the lungs but it is a multisystem manifestations. So it is
very important to understand the effects of exercise and its response to the COPD patients
which is done by this study with respect to the production of lactate and its recovery rate in
COPD patients.
The physiological change which is associated with the lactate production and
accumulation has significant influence on the cardiopulmonary performances. The lactate
accumulation leads to hyperventilation, altered oxygen kinetics and impaired muscle
performances in any individual. Thus it is very important to find out any early lactate
accumulation in COPD or any normal individual and accordingly some kind of intervention
can be given to reduce or to delay the lactate accumulation during exercise.
In conclusion the COPD group not only generates high concentration of blood lactate
similar to those observed in normal controls at sub maximal level of exercise but also this
occurs earlier than the normal group. The recovery rate is almost similar in both the group.
Measurement of the lactate threshold is a very useful way of assessing fitness and the
response to intervention, such as exercise training.

30
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