Improving walking via real-time visual feedback after stroke in treadmill training (RE-VISIT): a protocol for randomized controlled trial / Melhorando a caminhada por meio de feedback visual em tempo real após acidente vascular cerebral em treinamento em esteira (RE-VISIT): um protocolo para ensaio clínico randomizado

BACKGROUND: After a stroke, most patients often suffer reduced walking ability and balance. Restoring walking ability and improving balance are major goals of stroke rehabilitation. Treadmills are often used in clinical setups to achieve these goals. Adding dimensions to the visual feedback in addition to the mirror for real-time frontal view is proven to enhance the gait. It is, therefore, important to design additional real-time visual feedback in treadmill training, in particular for the sagittal view involved side. OBJECTIVE: The objective of this study is to test if the real-time sagittal visual feedback during treadmill training is superior to the conventional mirror feedback treadmill training program of equivalent intensity in improving walking speed and balance after stroke. METHODS/DESIGN: The RE-VISIT trial (Real-time Visual feedback after Stroke in Treadmill training) is registered in the Clinical Trial Registry of India (CTRI/2023/10/058299). In this two-arm randomized control trial, which will be a single-blinded study, 42 eligible stroke survivors undergoing rehabilitation will be randomly allocated (1:1 ratio) to either real-time visual sagittal feedback along with front mirror (experimental) group or only front mirror treadmill training (control) group, all the participants will receive 15 sessions of treadmill training for up to 15 min at a safe self-selected speed over 5-6 weeks. The RE-VISIT (experimental) group will receive real-time, visual sagittal view feedback of the involved lower limb trajectory along with the routine front mirror view during treadmill training and will be asked to modify their gait pattern. The control group will receive treadmill walking training only with the routine front mirror view feedback. Clinical and gait assessments will be conducted at the baseline, immediately following the final session of training, and at the 9th week during follow-up. The outcome measures of interest are walking speed (primary) and balance (secondary), which will be measured prior to baseline, post 15 sessions of training, and at the 9th week following training. DISCUSSION: This REVISIT trial will provide insight and contribute to the existing innovation and modifications of incorporating realtime visual feedback during treadmill training in post-stroke gait rehabilitation. The findings will help the better designing of a gait rehabilitation program with a treadmill for post-stroke subjects to improve walking speed, and balance for those who have greater difficulties in community ambulation. We anticipate that those in the REVISIT training will demonstrate improved walking ability.

CONTEXTO: Após o acidente vascular cerebral, a maioria dos pacientes frequentemente sofre redução da capacidade de caminhar e do equilíbrio. Restaurar a capacidade de caminhar e melhorar o equilíbrio são os principais objetivos da reabilitação do AVC. As esteiras são frequentemente usadas em ambientes clínicos para atingir esses objetivos. Está comprovado que adicionar dimensões ao feedback visual, além do espelho para visão frontal em tempo real, melhora a marcha. É, portanto, importante projetar feedbacks visuais adicionais em tempo real no treinamento em esteira, em particular para o lado envolvido na visão sagital. OBJETIVO: O objetivo deste estudo é testar se o feedback visual sagital em tempo real durante o treinamento em esteira é superior ao programa de treinamento em esteira com feedback de espelho convencional de intensidade equivalente na melhoria da velocidade de caminhada e equilíbrio após acidente vascular cerebral. MÉTODOS/ DESENHO: O ensaio RE-VISIT (feedback visual em tempo real após acidente vascular cerebral no treinamento em esteira) está registrado no Registro de Ensaios Clínicos da Índia (CTRI/2023/10/058299). Neste ensaio de controle randomizado de dois braços, que será um estudo cego, 42 sobreviventes de AVC elegíveis em reabilitação serão alocados aleatoriamente (proporção de 1:1) para feedback sagital visual em tempo real junto com grupo de espelho frontal (experimental) ou apenas Grupo de treinamento em esteira com espelho frontal (controle), todos os participantes receberão 15 sessões de treinamento em esteira por até 15 minutos em uma velocidade segura e autosselecionada durante 5-6 semanas. O grupo RE-VISIT (experimental) receberá feedback visual em tempo real da visão sagital da trajetória dos membros inferiores envolvidos, juntamente com a visão rotineira do espelho frontal durante o treinamento em esteira e será solicitado a modificar seu padrão de marcha. O grupo de controle receberá treinamento de caminhada em esteira apenas com o feedback rotineiro da visão do espelho frontal. Avaliações clínicas e de marcha serão realizadas no início do estudo, imediatamente após a sessão final de treinamento e na 9ª semana durante o acompanhamento. As medidas de resultados de interesse são a velocidade de caminhada (primária) e o equilíbrio (secundário), que serão medidos antes da linha de base, após a 15ª sessão de treinamento e na 9ª semana após o treinamento. DISCUSSÃO: este ensaio REVISIT fornecerá insights e contribuirá para a inovação e modificações existentes na incorporação de feedbacks visuais em tempo real durante o treinamento em esteira na reabilitação da marcha pós-AVC. As descobertas ajudarão no melhor desenho de um programa de reabilitação da marcha com esteira para indivíduos pós-AVC para melhorar a velocidade de caminhada e o equilíbrio para aqueles que têm maiores dificuldades na deambulação comunitária. Prevemos que aqueles no treinamento REVISIT demonstrarão melhor capacidade de caminhada.

Removal and identification of a subconjunctival parasite by light and scanning electron microscopy

Background: Ophthalmic dirofilariasis is an uncommon zoonotic parasitic infection caused by species of Dirofilaria, a dog tapeworm that is transmitted to human by mosquitoes. Man is a dead?end host for the parasite. Ophthalmic involvement is rare and includes periorbital, subconjunctival, subtenon, and intra?ocular involvement. We report the removal of a subconjunctival worm and identification by light microscopy (LM) and scanning electron microscopy (SEM). Purpose: A 62?year?old female presented with complaints of redness, discharge, and foreign body sensation with difficulty in opening eyes in the left eye for the last 3 days. The patient is a non?vegetarian. On examination, her best corrected visual acuity in both eyes was 20/20. On slit lamp examination, there was a long, thin, round, coiled white subconjunctival live worm in the left eye superiorly. The rest of anterior segment evaluation, intra?ocular pressure, and fundus was normal in both eyes. The parasite was removed under local anesthesia from subconjunctival space [Video]. External surface morphology under LM revealed fine transverse cuticular striations with tapered cephalic and caudal ends. Uterus was long and coiled with indistinguishable masses inside. The finding was also confirmed by SEM. Synopsis: A subconjuctival parasite was removed and identified as Dirofilaria repens by characteristic LM and SEM findings. Highlight: Dirofilaria species may lodge in many tissues of human bodies including eye and adnexa. Dirofilaria is a natural parasite of carnivorous animals, mostly dogs, cats, and foxes.[1] The most common mode of transmission to human is usually by bite of mosquitoes like Culex and Aedes, which are considered as vectors, and it is often thought that parasitemia is because of accidental conduction.[1] Simple surgical removal of the worm is curative. After removal, the worm should be visualized directly under LM. All the internal structures of the transparent worm could be seen and compared with those under SEM.

Impact of asymptomatic genu recurvatum on patellar mobility in young males / Impacto do genu recurvatum assintomático na mobilidade patelar em jovens do sexo masculino

BACKGROUND: Genu recurvatum is one of the most commonly presented lower extremity postural malalignments in individuals. Though genu recurvatum and its impact on impaired knee proprioception, anterior cruciate injuries and posterior soft tissue dysfunctions are reported, its association with patellar mobility is scarcely reported and warrants exploration. OBJECTIVES: To evaluate the medial and lateral patellar mobility differences in adult young males with genu recurvatum and normal knee alignment. METHODS: The ethical approval for this cross-sectional study protocol was obtained and the study was conducted in Research Department of Alva's College of Physiotherapy and Research Centre, Moodubidire, DK, Karnataka, India. The study participants were recruited through an institutional-based musculoskeletal and sports clinic. The estimated sample size for this study was 174. A total of 87 young males with genu recurvatum and 87 young males with normal knee alignment fulfilling the selection criteria were enrolled in two groups. Participants' knee joint was examined by an assessor and individuals with > 5° knee hyperextension were assigned to genu recurvatum group, and individuals with knee extension < 5° from neutral were assigned to the normal knee alignment group. Further, the patellar glide test was performed to examine the presence of patellar hypermobility in both groups. RESULTS: The mean age of the participants in genu recurvatum and normal knee alignment group was 22.04 + 1.860 and 21.91 + 1.869, respectively. A significant higher proportion (86.2%) of participants with genu recurvatum identified with patellar hypermobility compared to normal knee alignment. Within the genu recurvatum subjects, 66.66& and 19.54% were observed to have medial and lateral patellar hypermobility. The odds for occurrence of patellar hypermobility in genu recurvatum was estimated to be 13.007 (95%, CI, 5.481 ­ 30.866), respectively. CONCLUSION: The study result suggests that medial patellar hypermobility is more common in individuals with genu recurvatum. Further study investigating on the mechanism contributing towards medial patellar mobility in genu recurvatum populations could validate the present study findings.

INTRODUÇÃO: Genu recurvatum é um dos desalinhamento posturais dos membros inferiores mais comumente apresentado em indivíduos. Embora o genu recurvatum e seu impacto na propriocepção prejudicada do joelho, lesões cruzadas anteriores e disfunções dos tecidos moles posteriores sejam relatados, sua associação com a mobilidade patelar é pouco relatada e merece exploração. OBJETIVOS: Avaliar as diferenças de mobilidade patelar medial e lateral em homens adultos do sexo masculino com genu recurvatum e alinhamento normal do joelho. MÉTODOS: O protocolo do estudo foi explicado e a aprovação ética para o protocolo do estudo foi obtida e o estudo foi conduzido no Departamento de Pesquisa do Alva's College of Physiotherapy and Research Centre, Moodubidire, DK, Karnataka, India. Os participantes do estudo foram recrutados por meio de clínica musculoesquelética e esportiva de base institucional. O tamanho estimado da amostra para este estudo foi de 174. Um total de 87 jovens do sexo masculino com genu recurvatum e 87 jovens do sexo masculino com alinhamento normal do joelho foram incluídos em dois grupos. A articulação do joelho dos participantes foi examinada por um avaliador e os indivíduos com hiperextensão do joelho > 5° foram designados para o grupo Genu recurvatum, e os indivíduos com extensão do joelho < 5° do neutro foram designados para o grupo de alinhamento normal do joelho. Além disso, o teste de deslizamento patelar foi realizado para examinar a presença de hipermobilidade patelar. RESULTADOS: A média de idade dos participantes do grupo genu recurvatum e alinhamento normal do joelho foi 22,04 + e 21,91 + 1,869, respectivamente. Uma proporção significativamente maior (86,2%) de participantes com genu recurvatum identificados com hipermobilidade patelar em comparação com indivíduos com alinhamento normal do joelho. Entre os indivíduos com genu recurvatum, observou-se que 66,66% e 19,54% apresentavam hipermobilidade patelar medial e lateral. Entre aqueles com alinhamento normal do joelho, 44,83% apresentaram hipermobilidade patelar. A razão de chances para ocorrência de hipermobilidade patelar no genu recurvatum foi estimada em 13,007 (95%, IC, 5,481 ­ 30,866), respectivamente. CONCLUSÃO: O resultado do estudo sugere que a hipermobilidade patelar medial é mais comum em indivíduos com genu recurvatum. Um estudo mais aprofundado que investigue o mecanismo detalhado que contribui para a mobilidade patelar medial em populações de genu recurvatum poderia validar os resultados do presente estudo.

Correlação entre resistência de preensão manual e resistência muscular escapular em indivíduos assintomáticos / Correlation between hand grip endurance and scapular muscle endurance in asymptomatic individuals

INTRODUÇÃO: A atividade de preensão é uma ação diária essencial em casa e no local de trabalho, onde muitas vezes é necessário levantar e segurar cargas com uma preensão relativamente estática usando contração isométrica. A força e resistência muscular no aspecto proximal das extremidades superiores influenciam na função da mão, e indivíduos com força e resistência reduzidas são mais propensos a desenvolver distúrbios musculoesqueléticos relacionados ao trabalho. Uma boa resistência de preensão pode ser influenciada pela estabilização fornecida pelos músculos do ombro. Este estudo tem como objetivo determinar a extensão da correlação entre resistência de preensão manual e resistência muscular da escápula em jovens assintomáticos. MÉTODO: O tamanho da amostra para este estudo foi n = 62, com base em estudos anteriores. Indivíduos saudáveis, com idade entre 18 e 25 anos, de ambos os sexos, foram incluídos. Uma avaliação objetiva da resistência da preensão foi realizada usando um dinamômetro manual hidráulico, e a resistência escapular foi avaliada usando o teste muscular escapular. RESULTADOS: A análise de dados foi realizada usando o SPSS versão 20. Houve correlações positivas significativas entre as medidas de resistência escapular e a resistência de preensão palmar para ambos os lados (teste de correlação de Pearson, r = 0,612 (p < 0,001) e r = 0,524 (p < 0,001), respectivamente, para resistência de preensão da mão não dominante e dominante). CONSIDERAÇÕES FINAIS: Os achados preliminares deste estudo sustentam que a resistência do músculo escapular exibe uma relação com a resistência da preensão palmar, sugerindo que o treinamento de resistência escapular pode ser um complemento eficaz no processo de reabilitação das funções da extremidade superior.

INTRODUCTION: Gripping activity is an essential daily activity at home and at the workplace, where lifting and holding loads with a relatively static grip using isometric contraction is often required. Muscle strength and endurance in the proximal aspect of the upper extremities influence hand function, and individuals with reduced strength and endurance are more prone to developing work-related musculoskeletal disorders. Good grip endurance might be influenced by the stabilization provided by shoulder muscles. This study aims to determine the correlation between hand grip endurance and scapula muscle endurance among young asymptomatic individuals. METHOD: The sample size for this study is n = 62, based on previous studies. Healthy individuals of both genders, aged between 18 and 25 years, were included. An objective assessment of grip endurance was performed using a hydraulic hand dynamometer, while scapular endurance was evaluated using the scapular muscle test. RESULTS: Data analysis was performed using SPSS version 20. There were significant positive correlations between scapular endurance measures and the hand grip endurance on both sides (Pearson correlation test, r = 0.612 (p < 0.001) and r = 0.524 (p < 0.001), respectively, for non-dominant and dominant hand grip endurance). FINAL CONSIDERATIONS: The preliminary findings of this study support the notion that scapular muscle endurance is related to hand grip endurance, suggesting that scapular endurance training may be an effective adjunct in the rehabilitation process for upper extremity functions.

Antioxidants Role Against Acrylamide Toxicity on Urogenital System: An Overview

@#Acrylamide (AA) is a chemical substance which is used as a soil stabilizing agent and in the production of copolymers and polymers since 1970. The presence of an AA adduct in food was observed in rats fed with fried food which led to a substantial increase in levels of hemoglobin adduct. Foods that are rich in carbohydrate when prepared at high temperature (above 120 ºC) by baking, toasting, frying, roasting or cooking results in the production of AA by the reaction of the amino acid with glucose present in it. Several studies observed AA toxicity on nervous system, reproductive system, and immune system. To justify this toxicity there is not a clear mechanism described. In this review article the mechanisms of AA toxicity on urogenital system and role of antioxidants against its toxicity has been reviewed. According to previous studies the main factor that induces AA toxicity is oxidative stress. AA treated groups revealed degeneration of the kidney’s epithelial lining and the glomerular tuft. Adverse effect on reproductive system by AA has been evidenced by sperm-head abnormalities, dominant lethal effects, and testicular epithelial tissue degeneration. Therefore, it is advised that modifying of food processing methods and consuming lot of vegetables and fruits containing antioxidants. These antioxidants give us some supports to the cells of our body organs against the AA sources which cause cell defects.

Prevalence of QTc prolongation among hypertensive patients and its association with other co-morbidities

Background:Hypertension, an iceberg disease contributes significantly to the global health burden. This pan-endemic disease is a harbinger for cardiovascular events, especially life-threatening arrhythmias. A simple and cost-effective electrocardiogram serves as an effective tool to identifyand evaluate hypertensives with high cardiovascular risk.QTc interval which indicates repolarization abnormality is one such effective tool.The study aimed at describing the prevalence of QTc prolongation among hypertensive individuals and also to assess the association of QTc prolongation with various co-morbidities.Methods:One hundred and fifty-nine hypertensive patients were evaluated in this cross-sectional study for six months. Demographic variables, biochemical parameters, blood pressure and electrocardiogram were recorded for all the patients. Data obtained were statistically evaluated.Results:The mean age of participants was 55.6 years (SD�76). There were 103 males (64.4%) and 43 females (35.6%). QTc prolongation was noted in 52.5% of the population studied.Statistically significant QTc prolongation among poorly controlled hypertensive was 59% when compared to that of controlled hypertensive at 37.5% was noted. About 26% of the participants were smokers, 27% were alcoholics and 60% had co-existing diabetes mellitus. Diabetes and gender were found to have a statistically significant association with QTc prolongation.Conclusions:The study found a positive correlation between prolonged QTc and hypertensives and hypertensives with coexisting diabetes. To mitigate the consequences of hypertension, the study recommends early diagnosis, stringent blood pressure control, efficient and effective use of QTc measurement, and preventive pharmacotherapy.

Severe Acute Malnutrition in Tribal Under-Five children in Javvadu Hills, Tamil Nadu

Background: Severe acute malnutrition (SAM) in under-5 children is an important public health problem that is associated with high mortality and long-term health consequences. Globally, 26 million children suffer from SAM, of these more than 8.1 million children are in India. National Family Health Survey-4 indicates a higher prevalence of SAM (7.5%) in the general population than the previous report (6.4%). Indeed the burden of malnutrition is expected to be higher among the tribal children in India. Hence this study aimed to explore the Severe Acute Malnutrition among the tribal under-five children in Javvadu Hills of Tamil Nadu. Methods: A community-based cross-sectional survey was conducted among 450 tribal under-five children and mothers residing in Javvadu Hills in Thiruvannamalai District, Tamil Nadu from September 2019 to Feb 2020 using PPS-Cluster sampling technique with semi-structured questionnaire with anthropometric measurements. Data were analyzed using SPSS. Chi-square test and logistic regression were used. Results: Out of 450 children, about 42(9.3%) had weight-for-Ht (M<-3S.D.) suggestive of SAM. Among those with SAM, 71% were females. About 66% had low birth weight, 79% were Anemic, 81% had calorie and protein inadequacy, 88.1% were partially immunized and 88% had food insecurity and 78% had the recurrent illness. Maternal illiteracy, poor awareness of nutrition, Food insecurity and poor access to health facilities were significant factors in SAM. Conclusions: SAM is highly prevalent among tribal children, a serious threat to child survival and morbidity. Improving literacy, Socioeconomic status, nutritional awareness, food security, health-seeking behaviour will alleviate this public health problem.

Health and nutritional status of school children from a rural area of Andhra Pradesh

Background: Healthy children build a wealthy nation. Good health of children is of paramount importance to the nation’s growth. Health and nutritional status of school children is highly variable from one region to another due to different environmental, socioeconomic and cultural factors. Hence health status of school children from each area should be assessed periodically so that relevant health programmes can be applied to prevent common morbidities such as malnutrition, infections and infestations. Methods: A cross sectional study of 500 rural school children from 5 to 15 years was conducted to assess the nutritional status by anthropometry and health status by clinical examination.Results: Out of the 500 school children 46.8% girls, 71.4% were 5 to 10 years old, 70.2% studying in 1st to 5th class.  33.4% were stunted. 25.6% and 27% were underweight according to weight and Body mass index criteria respectively. Common health problems among school children in this study were anemia (31%), dental caries (27.2%), upper respiratory infections (13.4%), skin infections and scabies (12.6%), head lice infestation (6.8%), refractive errors (6%) and ear discharge (5.2%).Conclusions: Though the pattern of nutritional and health problems were same in different studies, the severity of them varied from region to region. Hence periodic screening of school children to identify them and to apply relevant health programmes goes a long way in reducing such morbidities.

Rare presentation of mycoplasma pneumonia: a case report

Mycoplasma is a frequent cause of community acquired pneumonia in children accounting for 20 percent of the cases. Though CNS complications are the most common extra pulmonary manifestations of M. pneumoniae stroke is a rare entity. Here we report a case of 7 years old male child with macrolide resistant M. pneumoniae complicated pneumonia that developed right hemiparesis and dysphasia. Brain magnetic resonance imaging and angiography showed left fronto parietal infarct and left carotid artery stenosis. He responed to non-macrolide antimicrobial regimen. This potential yet rare complication should be considered and closely monitored for in children presenting with complicated pneumonia.

Correlation between serum ferritin and gall stones

Background: The incidence of gall stones is in increasing trend. The old axiom that a typical gall stone sufferer is a fat, fertile, female of fifty, is only partially true, as the disease is found in women soon after their first delivery, in underweight and thin people. So, while searching for other parameters, iron deficiency was found to be a new parameter of interest in the aetiology of gall stones.7Methods: 50 cases of cholelithiasis and 40 cases of anaemia with low serum ferritin levels from September 2017 to August 2019 was studied. Serum iron was estimated by carbonyl metallo-immunoassay method. Serum cholesterol was estimated by the CHOD-POD Enzymatic method. Biliary cholesterol was estimated after extraction of biliary lipids from bile from the gallbladder specimen of the patients by the method of Folch et al which was followed by the procedure similar to the analysis of serum cholesterol by CHOD-POD enzymatic method. Fischer’s chi square exact test was used as statistical method.Results: It was observed that 70% of the group A study group with cholelithiasis had normal serum ferritin levels and 30% had low serum ferritin levels. It was observed that 95% had normal sonographic findings and 5% had cholelithiasis with normal ferritin levels in group B.Conclusions: In our study low serum ferritin levels with cholelithiasis was associated with raised bile cholesterol levels and so it can be concluded that low serum ferritin level is causing biliary stasis and hence leading to increase in the incidence of cholelithiasis.

Observer-masked trial comparing efficacy of topical olopatadine (0.1%), bepotastine (1.5%), and alcaftadine (0.25%) in mild to moderate allergic conjunctivitis

Purpose: With increasing environmental pollution, the incidence of allergic conjunctivitis is increasing. Newer anti-allergic medications with combined anti-histaminic and mast cell stabilization action can help reducing the use of topical steroids for milder form of disease. There is no study directly comparing olopatadine (0.1%), bepotastine (1.5%), and alcaftadine (0.25%) for mild to moderate allergic conjunctivitis cases. Hence, we decided to methodically study the efficacy of three topical medications. Methods: Prospective, observer-masked clinical trial enrolled 45 patients with 15 patients in each of the three groups. Patients with mild to moderate allergic conjunctivitis were sequentially assigned to respective groups, and relief of symptoms and signs were noted upto 1-month follow-up. Results: All three topical medications faired almost equally in resolving symptoms of the patients with mild to moderate allergic conjunctivitis, and most of them reported complete relief after 1 week of use of medication. Few cases with limbal or palpebral papillae reported symptomatic relief after use of medication, but the resolution of these signs was not noted in all three groups. Conclusion: We concluded similar efficacy of three medications in relieving symptoms and inefficacy in regressing palpebral and limbal papillae in cases of allergic conjunctivitis.

Assessment of immunization status among under five children in a census town of South India

Background: Deaths among children of less than five years are preventable, mostly by vaccination. In India, the coverage still remains low, as low as 44% children between 12 to 23 months age are fully immunized. This study was intended to assess the immunization status of the children between the age group of 12-60 months, and study the possible socio demographic factors influencing it.Methods: This cross-sectional study was conducted in 16 wards of a census town, selected by Multi-stage simple random sampling, for a period of 4 months among 400 children. Data was collected from the mothers of these children, using structured questionnaire.Results: Immunization status among these children showed that 32.5% were fully immunized, 52.0% were immunisation update, 14% were partially immunized, and 0.5% was not immunized. Immunization status was highest for BCG and OPV-0 (99%) and least for Measles 2nd dose and DPT booster (52%). Inadequate knowledge about immunization was the most common reason for partial and un-immunization. Multivariate Logistic regression analysis showed that, factors like religion (Hindus had 2.843 odds of being partially immunised than other religions), availability of Immunization card (Those without Immunisation card had 2.025 odds of being partially immunised than those with immunisation card) and place of immunization (Those immunised at private facilities had 1.441 odds of being partially immunised than those at government facilities), were found to be significantly associated with the immunization status of the child.Conclusions: Government facilities remain the main pillars of immunisation. Coordination with Anganwadi centres is the key. Tracking of the child for subsequent doses of immunisation remains a challenge.

Hypovitaminosis D and effect of vitamin D supplementation in type 2 diabetes mellitus: a rural population based study

Background: Deficiency of Vitamin D in general population and its association with various disease conditions have been studied worldwide. Type 2 Diabetes mellitus is increasing at an alarming rate in Indian subcontinent, contributing to increased morbidity and mortality. This study aimed to estimate level of Vitamin D and its association with patients with type 2 diabetes mellitus of rural origin. This study objective was to estimate the Vitamin D level of patients with Type 2 Diabetes mellitus and the effect of Vitamin D supplementation on glycemic statusMethods: This study was conducted at the Department of General medicine for a period of 1 year. Eighty patients with type 2 Diabetes mellitus were recruited in the study and baseline parameters of glycemic control and Vitamin D levels were assessed. Only 36 patients complied with the recommendation and evaluated further.Results: All the patients included in the study had insufficient or deficient levels of Vitamin D. The mean vitamin D levels before and after supplementation were 17.75±6.30 and 29.33±6.34 respectively. The mean plasma HbA1c level before and after supplementation were 7.78 and 7.30 respectively. Patients after vitamin D replacement showed significant improvement in their glycaemic status.Conclusions: Vitamin D supplementation of 2000 IU/day had shown to improve the glycaemic status. The beneficial effect of Vitamin D on diabetes was evident in a short period of supplementation

Alcohol use and its correlates in suicide attempters in a rural tertiary care teaching hospital in south India

Background: The relationship of alcohol and suicide is well documented. The interactions of alcohol use and suicide are complex. Neurobiological, genetic, psychological, social, cultural, and environmental factors are postulated to influence the outcome Aim was to find the frequency of alcohol use in suicide attempters and evaluate the association of alcohol use and its correlates in subjects who use alcohol to facilitate the attempt.Methods: It is a cross sectional observational study set in rural background in south India. Consecutive referrals of suicide attempters (n=175) were selected for the study. Details regarding the socio-demographic profile, suicide related details like lethality, intent, suicidal ideation, previous attempts, and alcohol related details like frequency, quantity and age at onset of alcohol consumption were recorded. Statistical significance of various socio demographic and clinical variables in correlation with use to facilitate attempt were analyzed. Logistic regression was used to determine the predictors in this at risk group of suicide attempters.Results: Over 43.43% of suicide attempters consumed alcohol. Intentional alcohol use prior to attempt to facilitate the attempt group constitutes about 18.29 %. High suicide intent and previous suicide attempt emerged as risk factors when alcohol was used to facilitate the attempt.Conclusions: Determinants, which increase the risk of suicide with alcohol use in rural south India, were identified.

Comparison of resting and adenosine-free pressure indices with adenosine-induced hyperemic fractional flow reserve in intermediate coronary lesions

Objective Fractional flow reserve (FFR) using adenosine has been the gold standard in the functional assessment of intermediate coronary stenoses in the catheterization laboratory. We aim to study the correlation of adenosine-free indices such as whole cycle Pd/Pa [the ratio of mean distal coronary pressure (Pd) to the mean pressure observed in the aorta (Pa)], instantaneous wave-free ratio (iFR), and contrast-induced submaximal hyperemia (cFFR) with FFR. Methods This multicenter, prospective, observational study included patients with stable angina or acute coronary syndrome (>48 h since onset) with discrete intermediate coronary lesions (40–70% diameter stenosis). All patients underwent assessment of whole cycle Pd/Pa, iFR, cFFR, and FFR. We then evaluated the correlation of these indices with FFR and assessed the diagnostic efficiencies of them against FFR ≤0.80. Results Of the 103 patients from three different centers, 83 lesions were included for analysis. The correlation coefficient (r value) of whole cycle Pd/Pa, iFR, and cFFR in relation to FFR were +0.84, +0.77, and +0.70 (all p values < 0.001), respectively, and the c-statistic against FFR ≤0.80 were 0.92 (0.86–0.98), 0.89(0.81–0.97), and 0.91 (0.85–0.97) (all p values < 0.001), respectively. The best cut-off values identified by receiver–operator characteristic curve for whole cycle Pd/Pa, iFR, and cFFR were 0.94, 0.90, and 0.88, respectively, for an FFR ≤0.80. By the concept of “adenosine-free zone” (iFR = 0.86–0.93), 59% lesions in this study would not require adenosine. Conclusion All the three adenosine-free indices had good correlation with FFR. There is no difference in the diagnostic accuracies among the indices in functional evaluation of discrete intermediate coronary stenoses. However, further validation is needed before adoption of adenosine-free pressure parameters into clinical practice.

Is Platelet-rich Plasma Injection more Effective than Steroid Injection in the Treatment of Chronic Plantar Fasciitis in Achieving Long-term Relief?

@#Introduction:Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Many modalities of treatment are commonly used in the management of plantar fasciitis including steroid injection. Many studies show that steroid injection provides pain relief in the short term but not long lasting. Recent reports show autologous platelet-rich plasma (PRP) injection promotes healing, resulting in better pain relief in the short as well as long term. The present study was undertaken to compare the effects of local injection of platelet-rich plasma and Corticosteroid in the treatment of chronic plantar fasciitis. Materials and methods:Patients with the clinical diagnosis of chronic plantar fasciitis (heel pain of more than six weeks) after failed conservative treatment and plantar fascia thickness more than 4mm were included in the study. Patients with previous surgery for plantar fasciitis, active bilateral plantar fasciitis, vascular insufficiency or neuropathy related to heel pain, hypothyroidism and diabetes mellitus were excluded from the study. In this prospective double-blind study, 60 patients who fulfilled the criteria were divided randomly into two groups. Patients in Group A received PRP injection and those in Group B received steroid injection. Patients were assessed with visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score. Assessment was done before injection, at six weeks, three months and six months follow-up after injection. Plantar fascia thickness was assessed before the intervention and six months after treatment using sonography. Results: Mean VAS in Group A decreased from 7.14 before injection to 1.41 after injection and in Group B decreased from 7.21 before injection to 1.93 after injection, at finalfollow-up. Mean AOFAS score in Group A improved from 54 to 90.03 and in Group B from 55.63 to 74.67 at six months’ follow-up. The improvements observed in VAS and AOFAS were statistically significant. At the end of six months’ follow-up, plantar fascia thickness had reduced in both groups (5.78mm to 3.35mm in Group A and 5.6 to 3.75 in Group B) and the difference was statistically significant. Conclusion: Local injection of platelet-rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effect.

Bone Mineral Content and Density in Indian Children with Congenital Adrenal Hyperplasia

Objective: To study the bone mineral content and density in children with congenital adrenalhyperplasia (CAH). Methods: 35 children with congenital adrenal hyperplasia and 35 healthycontrols. Bone mineral content and density were studied by Dual Energy X-rayabsorptiometry. Results: The mean (SD) of lumbar spine bone mineral density (g/cm2) [0.590(0.100) vs 0.589 (0.088) (P=0.97)], total Body less head bone mineral density (g/cm2) [0.536(0.090) vs 0.548 (0.111) (P=0.64)], lumbar spine bone mineral content (g) [29.85 (27.63) vs31.03 (29.19) (P=0.86)], and total body less head bone mineral content (g) [254.27 (281.25)vs 273.07 (330.71) (P=0.79)] were not different between children with CAH and controls,respectively. Conclusion: Bone mineral density and content in children with congenitaladrenal hyperplasia are maintained in the normal range.

Autotransplantation: A biological treatment alternative for a patient after traumatic dental injury / 대한치과교정학회지

Traumatic dental injury is considered a public dental health problem because of a high childhood incidence, high treatment costs, and prolonged treatment time. Although management guidelines for traumatized teeth have been outlined, tooth loss following trauma is occasionally unavoidable. Here, we describe the successful interdisciplinary management of a traumatized central incisor in an 11-year old boy that was extracted because of a poor prognosis and restored by the autotransplantation of an immature donor tooth into the site. The patient underwent orthodontic treatment in order to close the donor site space and bring the autotransplanted tooth to an ideal position. Postorthodontic treatment radiographs and photographs revealed an esthetic and functional natural tooth replacing the lost tooth. The findings from this case suggest that autotransplantation offers unique advantages as a treatment modality for the restoration of missing teeth, particularly in growing children.

Sequence-based identification of microbial contaminants in non-parenteral products

ABSTRACT Phenotypic profiles for microbial identification are unusual for rare, slow-growing and fastidious microorganisms. In the last decade, as a result of the widespread use of PCR and DNA sequencing, 16S rRNA sequencing has played a pivotal role in the accurate identification of microorganisms and the discovery of novel isolates in microbiology laboratories. The 16S rRNA region is universally distributed among microorganisms and is species-specific. Accordingly, the aim of our study was the genotypic identification of microorganisms isolated from non-parenteral pharmaceutical formulations. DNA was separated from five isolates obtained from the formulations. The target regions of the rRNA genes were amplified by PCR and sequenced using suitable primers. The sequence data were analyzed and aligned in the order of increasing genetic distance to relevant sequences against a library database to achieve an identity match. The DNA sequences of the phylogenetic tree results confirmed the identity of the isolates as Bacillus tequilensis, B. subtilis, Staphylococcus haemolyticus and B. amyloliqueficians. It can be concluded that 16S rRNA sequence-based identification reduces the time by circumventing biochemical tests and also increases specificity and accuracy.

RESUMO Os perfis fenotípicos para identificação microbiana são incomuns para micro-organismos raros, de crescimento lento e exigentes. Na última década, em resultado do uso generalizado de PCR e sequenciação de DNA, a sequenciação do rRNA 16S tem desempenhado papel crucial na identificação precisa do micro-organismo e a descoberta de novos isolados em laboratórios de microbiologia. A região de rRNA 16S é universalmente distribuída entre micro-organismos e é espécie-específica. A genotipagem foi realizada sobre os organismos isolados a partir de formulações farmacêuticas não parenterais. O DNA foi separado dos cinco isolados obtidos a partir das formulações. As regiões alvo dos genes de rRNA foram amplificados por PCR e sequenciados utilizando os iniciadores adequados. Os dados dos sequência foram analisados e alinhados na ordem crescente de distância genética de sequências relevantes contra biblioteca de dados para obter a identidade. A sequência de DNA de árvores filogenéticas confirma a identidade dos isolados como Bacillus-tequilensis, B. subtilis, Staphylococcus haemolyticus e B. amyloliqueficians. Pode-se concluir identificação baseada na sequência do rRNA 16S reduz o tempo por evitar testes bioquímicos e também aumenta a especificidade e a precisão.