ABSTRACT
Purpose of the study: Nerve-muscle physiology is a very basic and vital module in undergraduate physiologycurriculum. The practical sessions on this system are demonstrated on amphibian (frog) nerve-musclepreparation, which becomes a limiting factor in most of the medical colleges of India. In this study, wepropose an alternative approach by using mammalian (rat) model for nerve-muscle physiology undergraduatepractical experiments.Materials and methods: Rat in-situ sciatic nerve-soleus muscle preparation was used to study neuromusculartransmission. Stimulation of nerve and recording of muscle contraction (force) were done by using digitalrecording system. To demonstrate fatigue, repetitive electrical stimulation was applied to nerve-musclepreparation and muscle twitches were recorded. A reduction in amplitude of contraction to 50% of their basalrecording was considered as onset of fatigue. To demonstrate site of fatigue, the muscle was stimulateddirectly after the fatigue was observed with nerve stimulation and muscle twitch recorded. To observe theeffect of neuromuscular blocking drug Pancuronium bromide, on neuromuscular transmission, in a separateset up the drug was injected in muscle belly at multiple sites and nerve was stimulated to elicit muscletwitch. The response (amplitude of muscle twitch) was compared with control (injection of 0.9% saline).Main findings: On repeated stimulation of nerve muscle preparation, initially there was an increase inamplitude of contraction but progressively amplitude went on decreasing. After development of fatigue ondirect muscle stimulation, amplitude recorded was same as the initial twitch amplitude. This demonstratesthat the site of fatigue is not the muscle. Further, as nerve is also non- fatigable, site of fatigue wasneuromuscular junction.Injection of Pancuronium bromide showed that the twitch amplitude decreased substantially than the control(saline injection) on stimulation of nerve, but on direct muscle stimulation amplitude of contraction remainedsame as initial, confirming the effect of drug on neuromuscular junction.
ABSTRACT
Purpose of the study: Physiology practical complement learning of concepts taught in didactic theorylectures. Therefore, they are instrumental to comprehensive learning. Learning of physiology of excitabletissues is supplemented by observing the same phenomena in action in the laboratory. We developed anin-situ rat nerve-muscle model to demonstrate nerve-muscle physiology phenomenon to undergraduate andpostgraduate students. This mimics the physiological conditions unlike the Rana tigrina experiments whichwere done earlier. Further, frequent unavailability of frogs envisaged us to find an alternative for demonstrationof these concepts.Materials and methods: We developed and standardized an in-situ rat soleus muscle-sciatic nerve modelto demonstrate the phenomenon of nerve-muscle properties like simple muscle twitch, effect of strength ofstimulus, effect of two successive stimuli and tetanus to the undergraduate and postgraduate students atour institute.Results: Simple muscle twitch was recorded and effect of increasing strength of stimuli was observed.Thereafter, effect of two successive stimuli and genesis of tetanus was recorded in the same experimentalset up. We successfully standardised this in-situ model for teaching nerve and muscle physiology to our students.Conclusion: We propose an easy and effective experimental rat in-situ model for nerve-muscle physiologyteaching to students
ABSTRACT
Background & objectives: The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and financial position. Methods: Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was “staggered implementation” cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results. Results: Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH’s location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations. Interpretation & conclusions: The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations.
ABSTRACT
Background & objectives: Despite remarkable progress in airborne, vector-borne and waterborne diseases in India, the morbidity associated with these diseases is still high. Many of these diseases are controllable through awareness and preventive practice. This study was an attempt to evaluate the effectiveness of a preventive care awareness campaign in enhancing knowledge related with airborne, vector-borne and waterborne diseases, carried out in 2011 in three rural communities in India (Pratapgarh and Kanpur-Dehat in Uttar Pradesh and Vaishali in Bihar). Methods: Data for this analysis were collected from two surveys, one done before the campaign and the other after it, each of 300 randomly selected households drawn from a larger sample of Self-Help Groups (SHGs) members invited to join community-based health insurance (CBHI) schemes. Results: The results showed a significant increase both in awareness (34%, p<0.001) and in preventive practices (48%, P=0.001), suggesting that the awareness campaign was effective. However, average practice scores (0.31) were substantially lower than average awareness scores (0.47), even in post-campaign. Awareness and preventive practices were less prevalent in vector-borne diseases than in airborne and waterborne diseases. Education was positively associated with both awareness and practice scores. The awareness scores were positive and significant determinants of the practice scores, both in the pre- and in the post-campaign results. Affiliation to CBHI had significant positive influence on awareness and on practice scores in the post-campaign period. Interpretation & conclusions: The results suggest that well-crafted health educational campaigns can be effective in raising awareness and promoting health-enhancing practices in resource-poor settings. It also confirms that CBHI can serve as a platform to enhance awareness to risks of exposure to airborne, vector-borne and waterborne diseases, and encourage preventive practices.