Nerve Conduction Studies in Asymptomatic HIV Positive Persons

Background: Nerve Conduction Studies were performed in asymptomatic HIV positive persons and corresponding controls to detect subclinical peripheral nervous system involvement in early stage of HIV. Aims & Objective: To perform Nerve Conduction Studies in asymptomatic HIV positive persons and corresponding controls. Material and Methods: In this study,100 participants in the age group 25-45 years were selected. In study group, 50 3 participants who were HIV positive and asymptomatic (CD4 count > 350 cells/mm ) and were not on Anti Retro Viral Treatment (ART), were included. In control group 50 healthy age matched HIV negative participants were included. We performed Nerve Conduction Studies in these participants. For motor nerves, Distal Latency (DL), Motor Nerve Conduction Velocity (MNCV), Compound Muscle Action Potential (CMAP) amplitude were measured and for sensory nerves Onset Latency (OL), Sensory Nerve Conduction Velocity (SNCV) and Sensory Nerve Action Potential (SNAP) amplitude were measured. Results: Nerve Conduction Studies in asymptomatic HIV revealed that, MNCV was significantly decreased for median motor nerve and tibial motor nerve in study group compared to control group, SNAP was significantly reduced for median sensory nerve in study group compared to control group, OL was significantly prolonged for sural nerve in study group than control group and SNCV was significantly decreased for sural nerve in study group than control group. Conclusion: Nerve Conduction Studies in asymptomatic HIV positive persons suggests subclinical peripheral nervous system involvement in early stages of HIV. Hence Nerve Conduction Studies can be important to detect subclinical peripheral nervous system involvement in the early stages of HIV.

Evaluation of Oral Microbial Flora in Saliva of Patients of Oral Submucous Fibrosis.

Oral Submucous Fibrosis (OSMF) has a multifactorial origin and the risk factors vary across different parts of the world. Betel nut (areca nut) chewing is the leading cause of OSMF in parts of South East Asia as well as Indian subcontinent. Certain fungal species have been identified in the occurrence of various premalignant lesions including OSMF. Candida in mouth along with the epithelial changes like atrophy, dysplasia, and hypertrophy may predispose individuals to premalignancy. This study was carried out to evaluate the prevalence of microbial flora in saliva of patients of OSMF.METHODSThe study included a total of 48 subjects, with 24 clinically diagnosed OSMF patients and a control group of 24 healthy age sex matched patients. Demographic data and salivary samples were collected from both the groups. Swabs taken were subjected for Gram staining and Sabouraud’s Dextrose Agar. The positively cultured Candida samples were further analysed by using germ tube test for determining different Candida species.RESULTSIn total, 58.3% of the OSMF patients and 29.2% of the control patients yielded candida organisms on culture. The difference between the two groups was statistically significant (x2=4.148, p=0.042). Final results of the study indicate that presence of Candida is significantly higher in OSMF patients than healthy subjects. Thus, results of the present study confirm the phenomenon of high prevalence of oral colonization by yeast in OSMF patients than healthy subjects.CONCLUSIONSIn OSMF, there is an altered microbiome which may be used as an indicator for malignant transformation of OSMF. The present study shows higher incidence and intensity of candida in OSMF patients when compared to healthy individuals. Hence, it is mandatory to maintain proper oral hygiene status in OSMF patients to prevent further complications of candidiasis.

Functional Outcome of Isolated Posterior Cruciate Ligament Avulsion Fractures Treated by Open Reduction and Internal Fixation

Isolated Posterior cruciate ligament (PCL) avulsion fractures are uncommon, but are complicated intra-articular fractures.1 In India due to high prevalence of motorcycle transportation, the cause of PCL avulsion fractures was predominantly motorcycle accidents, though sports accidents still remain the most common cause in world over. These injuries are quite often missed in the emergency department and are often neglected. In the long run they cause severe functional disability of the knee joint. There is no consensus concerning the optimal surgical treatment approach for these injuries. Hence, we aimed to study the functional and clinical outcome of isolated PCL avulsion fractures with open reduction and internal fixation.METHODSThis is a prospective study of 28 cases of isolated PCL tibial avulsion fractures, in patients aged between 22-38 years during the period 2014 - 2018 in our hospital. All were treated with open reduction and internal fixation with 4 mm cannulated cancellous screw and washer. Postoperatively, patient leg was immobilized in posterior POP slab for 2 weeks, allowing toe touch weight bearing. All patients were regularly followed-up at 2, 4, 6, 8, 10, and 12 weeks. The functional outcome is assessed by Lyndholm scoring at the end of 12 weeks.RESULTS98% of the cases have shown excellent results with good range of movement in the knee without pain and without knee instability. The other 2% of cases had mild knee arthrofibrosis and pain.CONCLUSIONSPCL Avulsion fractures are rarity but yet need to be managed surgically. Open reduction and internal fixation by Burks and Schaffer approach has resulted in excellent results and good functional outcome.

A Rare Case of Sinonasal Ameloblastoma with Immunohistochemistry.

Introduction: Ameloblastoma is benign locally aggressivedentine epithelial tumor. Mandible and maxilla are commonsites of involvement. Calretinin is specific marker and usefulto differentiate ameloblastoma from Keratocystic odontogenictumor. The rarity of site and presentation of lesion makes usreport this case.Case report: 46 year old female had recurrent nasalblockage. Polyps in right nostrils were seen on Rhinoscopy.Polypectomy was done for suspected antrochoanal polyps.Ameloblastoma was diagnosed on histopathology andconfirmed by Immunohistochemistry with Cytokeratin,Calretinin and WT1.Conclusion: Preoperative diagnosis by biopsy in unilateralnasal masses should be carried out to expect the unexpected.Immunohistohemistry should be performed in cases havingrare site to confirm the diagnosis.

A rare case of dicephalous dibrachius dipus conjoined twins:case report

Conjoined twin is a rare complication seen in 1% of monochorionic monoamniotic twins and associated with severe morbidity and mortality. We are reporting a case of 30 years old second gravida referred to our tertiary care center at 35 weeks of gestation with ultra-sonographic diagnosis of dicephalus conjoined twin and further confirmed after caesarean delivery.

A comparative analysis of anxiolytic activity of Arnica montana and alprazolam in rats using open field test

Background: Anxiety affects around 7.3% of the total population worldwide. Benzodiazepines are preferred anxiolytic agents and are still frequently used in spite of the side effect profile including muscle relaxation, memory disturbances, sedation, physical dependence. Arnica montana, a traditional herb is known to possess significant anxiolytic effect at the dose of 100mg/kg. In this study, Arnica montana has been compared for the first time with alprazolam, a most commonly used anxiolytic drug.Methods: Forced swim test was used to induce anxiety. Anxiolytic action of study drugs which were given orally, was evaluated using Open field test (OFT) in healthy wistar rats of either sex. Behavior of rats, locomotion and number of squares crossed was recorded. Rats were divided into four groups with eight rats in each group. Study groups were Group I Control; Group II Alprazolam 0.08mg/kg; Group III Arnica montana extract (AME) 100mg/kg; Group IV AME + Alprazolam group 100mg/kg+0.08mg/kg. Statistical analysis was done using ANOVA followed by Tukey抯 test (p<0.05).Results: Increase in frequency of rearing was significant (p<0.05) in AME group and highly significant (p<0.001) in Alprazolam and combination group in comparison to control. Decrease in frequency of grooming was highly significant (p<0.001) in Alprazolam and combination group. AME also showed significant (p<0.05) decrease in grooming activity.Conclusions: Arnica montana extract showed anxiolytic activity and can be used as an add on drug after further studies and validation in the treatment of anxiety disorders.

Assessment of Cognitive Performance of Hypertensives with Mini-cog and Audio-visual Reaction Time.

Background: It is hypothesized that long-term hypertension might be associated with cognitive decline. Objectives: The present study was aimed at finding out whether persistently elevated blood pressure affects the processing capability of the central nervous system. Methods: The cognitive functions of 62 male subjects with age ranging from 40 to 60 years forming various groups as normotensives and hypertensives were assessed through Mini-Cog and audio-visual reaction time. Mini-Cog involved Clock Drawing Test and Three Item Recall Test (mini recall test). Both these tests were scored as per standard methods to find out whetherthe cognition was normal or abnormal. The auditory and visual reaction times were measured by the “Response Analyzer” device. Results: The clock drawing test and the three item-recall tests were significantly abnormal in hypertensives. Also, both auditory and visual reaction times were significantly delayed in hypertensives as compared to that of controls. Conclusion: The impairment of the cognitive function in hypertensives as reflected by the changes in the Mini-Cog and audio-visual reaction times might be due to structural and functional changes in various areas of brain involved in perceptual motor coordination.

Clearfil Protect Bond™ versus Uni‑Etch™ antibacterial self‑etchant: A war of giants against shear bond strength.

Aims and Objectives: To use antibacterial agents with two conventional bonding systems and evaluate the shear bond strength (SBS) of bracket to enamel. Materials and Methods: Overall, 120 human‑extracted first premolars were used. The specimens were equally divided into six sub‑groups of 20 samples. Control groups were bonded with Transbond XT™ light cure (Group I, after etching with 37% phosphoric acid, 3M Unitek™) and Unite™ self‑cure adhesive (Group II, after etching with 37% phosphoric acid, 3M Unitek™). Experimental groups included teeth surface first coated with Clearfil Protect Bond™ (Kuraray, Osaka, Japan) (and then bonded with Transbond XT™ [Group III] or Unite™ [Group IV]) or bonded with Uni‑Etch™ antibacterial self‑etchant (and then bonded with Transbond XT™ [Group V] or Unite™ [Group VI]). The third generation MBT bracket bonding system with 0.022 slots was used for bonding. All specimens were tested on Instron machine 5567 (SIES Institute of packaging, Nerul, Navi Mumbai, India) to evaluate the SBS. The sheared surfaces were also investigated with a stereomicroscope to assess adhesive remnants index (ARI scores) on the specimen surfaces. Results: Mean SBS in Group I–Group VI was 10.53 (2.91), 9.12 (2.56), 9.86 (1.98), 6.96 (2.92), 9.57 (2.02), and 7.65 (2.34) megapascals, respectively. Significant differences were only seen between Group III and IV and between Group II and IV. With respect to ARI scores, significant differences were seen only for comparison between Groups II, IV, and VI. Conclusion: Newly developed antibacterial agent could be used with conventional bonding systems effectively to decrease white spots; when used with Transbond XT™ light cure, the original SBS did not get affected, but when used with Unite™ self‑cure bonding system, it led to reduced SBS significantly.

Poly-e-caprolactone-loaded miglitol microspheres for the treatment of type-2 diabetes mellitus using the response surface methodology

Objectives: to formulate and characterize miglitol [MGL]-loaded microspheres as a drug delivery system for oral administration to prolong the duration of action for achieving reductions of multiple doses. MGL, an oral antihyperglycaemic agent, possesses a short elimination half-life of 2 h, so it must be administered in multiple doses

Methods: a 3[2] full factorial design was employed for microsphere formulation using the solvent evaporation technique. The influences of two independent variables, the polymer and surfactant concentrations, on dependent variables, such as drug loading [DL] and the encapsulation efficiency [EE], were statistically investigated using Design Expert Software. Microspheres were characterized using field emission scanning electron microscopy [FE-SEM], Fourier transform infrared spectrophotometry [FTIR], and X-ray diffraction [XRD] and were evaluated for their in vitro drug release and stability at accelerated conditions

Results: the statistical evaluation of the design showed quadratic and linear models as significant models for DL [R[2]: 0.9932] and EE [R[2] 0.9696]. The sizes of particles ranged from 54.7 [micro]m to 140 [micro]m, and the particles were spherical in shape with coarse surfaces. The most significant factor was the polymer amount. FTIR and XRD studies confirmed the drug-polymer compatibility. In vitro release of MGL from polymeric microspheres was found to occur a slower rate of up to 10 h

Conclusion: the developed poly-e-caprolactone-loaded MGL microspheres can be successfully formulated. These microspheres can provide a promising sustained release drug delivery system for the treatment of hyperglycaemia associated with type-2 diabetes mellitus

Autonomic Functions In Raja-yoga Meditators.

Stress, an inevitable and constant feature throughout the lifetime, induces autonomic dysfunctions, for which meditation is considered to be an antidote. So the case control study was planned including 50 Raja-yoga meditators practicing meditation for 5 years and 50 age matched non-meditators. Autonomic function tests were performed and results were compared using the Student- t test. Mean values of resting HR, SBP and DBP were less in meditators. Galvanic Skin Response in meditators was significantly more (p<0.001). Mean increase BP response to Hand Grip Test and Cold Pressor Test was significantly less in meditators than non-meditators (p<0.001). Standing: Lying ratio, Valsalva ratio, Inspiration: Expiration ratio and 30:15 ratios were significantly increased in meditators than non-meditators. From the results, there was shifting of the autonomic balance to parasympathetic side in Raja-yoga meditators, which suggests its utility to combat the ill effects of stress.

Pulmonary Thromboembolectomy in Chronic Thromboembolic Pulmonary Hypertension: A Case Report and Review of Literature.

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important cause of severe pulmonary hypertention (PH) resulting in significant morbidity and mortality. Chronic thromboembolic PH occurs when a pulmonary embolism fails to undergo complete thrombolysis leading to vascular occlusion and pulmonary hypertension. Despite the fact that CTEPH is a potential consequence of pulmonary embolus, diagnosis requires a high degree of vigilance as many patients will not have a history of thromboembolic disease. The ventilation perfusion scan is used to evaluate for the possibility of CTEPH although right heart catheterization and pulmonary artery (PA) angiogram are needed to confirm the diagnosis. Pulmonary thromboendarterectomy is the first-line treatment for patients who are surgical candidates. This case report and review describes the pathophysiology, risk factors, diagnosis, and management of CTEPH. As it is a potentially curable cause of PH, its accurate diagnosis is vital. The gold standard and effective treatment for CTEPH is pulmonary endarterectomy (PEA). Pulmonary endarterectomy is an uncommon procedure with less than 50 years of experience worldwide. Research on the development of new surgical approaches is essential. In the present case, a new successful surgical technique for PEA was introduced. Conclusion: The surgical procedure used on the present patient was a unique technique. We do not claim that our technique is better than the original San Diego technique, but it is suggested as a modification that may improve patient survival. However, this procedure has its own limitations and cannot be used for clots that are located distally. Therefore, further experience should be obtained in order to overcome the limitations and improve the applicability of the technique.

Tertiary Prevention of Ischemic Heart Disease: Post Coronary Artery Bypass Surgery.

Coronary heart disease is more prevalent in Indian urban populations and there is a clear declining gradient in its prevalence from semi-urban to rural populations. Epidemiological studies show a sizeable burden of coronary heart disease in adult rural (3-5%) and urban (7-10%) populations. Thus, of the 30 million patients with coronary heart disease in India, there would be 14 million who are in urban and 16 million in rural areas. In India, about 50% of coronary heart disease-related deaths occur in people younger than 70 years compared with only 22% in the West. Extrapolation of these numbers estimates the burden of coronary heart disease in India to be more than 32 million patients. In India, there are large spectrums of patients who present at tertiary stage when first examined. These patients are left with very little margin of safety. Heart disease is one of the commonest causes of mortality and morbidity worldwide. Coronary artery bypass graft (CABG) surgery is a frequently used cardiothoracic revascularization to treat coronary artery disease (CAD). In addition to physical impairments and activity restrictions in the immediate postoperative period, patients encounter some obstacles to exhibit improvements in quality of life in the long run. Cardiac tertiary prevention programs generally consist of the prevention of disease progression and patient suffering. Aim of these interventions is to reduce the negative impact of disease by restoring function and reducing disease-related complications and therefore, include the rehabilitation of disabling conditions. Cardiac rehabilitation programs are interventions aimed to reduce mortality and morbidity of patients with ischemic heart diseases through promoting a healthier lifestyle among patients. These programs are used to restore, maintain, or improve both physiologic and psychosocial outcomes and finally the quality of life in patients through a combination of exercise, education and psychological support.

Effectiveness of the addition of citicoline to patching in the treatment of amblyopia around visual maturity: A randomized controlled trial.

Aim: To study the effectiveness of the addition of citicoline to patching in the treatment of amblyopia in the age group of 4‑13 years. Materials and Methods: A randomized controlled trial, which included patients who were randomly divided into two groups. Both the groups received patching therapy till plateau was achieved in phase 1 of the study. Then in phase 2, group I received citicoline plus patching and group II continued to receive only patching. Outcome Measures: Outcome was measured by the visual acuity in logMAR every month in phase 1 till plateau was achieved and then for 12 months in phase 2. Results: No significant difference was found in the mean visual acuities in these two groups in phase 1 till plateau was reached. In phase 2, for the initial four months, there was no significant difference in the visual acuities in these two groups, at the respective intervals. However, five months onward, up to 12 months, there was a significant difference in the visual acuities in these groups.The result was the same in younger patients (< seven years of age) as well as in older patients (> seven years of age). In phase 2, the mean proportional improvement in group I was significantly more than that in group II, at two months and onward, at the respective intervals. Conclusion: The improvement in visual acuity with citicoline plus patching was significantly more than that with patching alone, in one year of treatment.

Effect of indoor air pollution during cooking on peak expiratory flow rate and its association with exposure index in rural women.

Routine exposure to domestic cooking fuels is an important source of indoor air pollution causing deterioration of lung function. We conducted a community based cross-sectional study in 760 non-smoking rural women involved in household cooking with four types of cooking fuels i.e. Biomass, Kerosene stove, Liquid Petroleum Gas (LPG) and Mixed (combination of two and more cooking fuels). Peak Expiratory Flow Rate (PEFR) less than 80% of the predicted was considered as abnormal PEFR. The overall prevalence of abnormal PEFR was found to be 29.1% with greater predominance among biomass fuel users (43.3%) with high risk ratio (1.86) as compared to kerosene (0.63), LPG (0.75) and mixed (0.66) fuel users. However the pair wise comparison of different groups of cooking fuels by Marascuilo procedure reported significant differences within different groups except kerosene - mixed group. The study also demonstrated a negative correlation between observed PEFR and exposure indices in different cooking fuels (r=–0.51). Our results indicate that prolonged exposure to cooking fuels particularly biomass fuels as a source of cooking adversely affects PEFR in nonsmoking rural women.

Effect of short-term and long-term Brahmakumaris Raja Yoga meditation on physiological variables.

Effect of short-term and long-term Brahmakumaris Raja Yoga meditation on physiological variables like heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) was evaluated in 100 subjects practicing Raja Yoga meditation. All 100 subjects (33 men and 67 women) were aged 30 years and above (mean age 52.06±12.76 years). Short-term meditators (STM) (n=27) practiced Raja Yoga meditation for duration of six months to five years (mean duration 3.37±1.67 years) and long-term meditators (LTM) (n=73) practiced Raja Yoga meditation for more than five years (mean duration 11.19±5.13 years). The participants were asked to meditate and the physiological variables (HR, RR, SBP and DBP) were recorded twice (15 minutes and 30 minutes) after beginning of meditation. Also, the fasting blood sugar was estimated by glucometer. The study subjects did not differ significantly in age and various anthropometric characteristics such as body weight, body mass index, waist-hip ratio and fasting blood sugar. Comparison between STM and LTM showed that the changes from baseline values (from premeditation to post-meditation at 15 and 30 minutes) in LTM were not statistically significant with those in STM (P>0.05). However, within group differences in LTM revealed that changes in the physiological variables were statistically significant when compared between pre and post meditation both at 15 and 30 minutes. The study suggests that the long-term practice of Raja Yoga meditation improves basic cardio-respiratory functions due to shifting of the autonomic balance in favor of parasympathetic instead of sympathetic system.

A longitudinal study of antenatal changes in lung function tests and importance of postpartum exercises in their recovery.

A study of changes in lung function tests during pregnancy was undertaken in fifty pregnant women beginning from third month of gestation. Fifty nonpregnant age and height matched women formed the controls. Forced Vital Capacity (FVC), Timed Vital Capacity (FEV1), Inspiratory Capacity (IC), Expiratory Reserve Volume (ERV) and peak Expiratory Flow Rate (PEFR) were performed in each month of pregnancy. However ten subjects were not available for follow-up during postpartum period. Remaining forty women were divided into two groups of twenty each. Group I performed daily graded active exercises to strengthen the anterior abdominal wall muscles. Group II women did not perform any exercises. It was observed that the antenatal changes in percent FVC and FEV1 were insignificant, but the decline in ERV and PEFR were very highly significant (P < 0.001) and the increment in IC was significant (P < 0.05). In the postpartum period the percentage variation of values in group I was less than 5% from controls (P > 0.05) and in group II it was 15-20% from controls (P < 0.05), resulting in a significant variation in group II women as compared to the controls. It is concluded that there are adaptive changes in lung functions in the antenatal period. We stress the importance of regular graded active exercises in the postpartum period for the speedy recovery of these changes.

An epidemiological study of pulmonary function tests in geriatric population of central India.

We have studied Pulmonary Function Tests (PFTs) namely Vital Capacity (VC). Forced Vital Capacity (FVC), and Forced Expiratory Volume in First Second (FEV1). Forced Expiratory Flow(FEF 25-50%) in 1200 elderly subjects above 60 years of age of which 570 were females and 630 males. Mean age was 69.22 +/- 5.57 years in males and 68.77 +/- 5.44 in females. The mean value of ventilatory parameters were as follows-1) VC 2.99 +/- 0.5 lt in males and 1.89 +/- 0.29 lt in females. 2) FVC 2.69 +/- 0.58 lt. in males and 1.76 +/- 0.21 lt in females. 3) FEV1/FVC% 83.82 +/- 10.62% in males and 83.37 +/- 11.93% in females. 4) FEF 25-75% was 2.81 +/- 1.20 lt/sec in males and 2.13 +/- 1.27 lt/sec. Physical as well as ventilatory parameters were less in females than for males. The correlation of age with VC and FEV1 was highly significant (P < 0.01) but with FVC was not significant (P > 0.05). The correlation of height, weight and body surface area was not significant with any ventilatory parameter (P > 0.05). Multiple regression equations for VC, FVC and FEV1 were formulated for males and females taking height and age as variables. The predicted values correlated excellently with observed values.