Impact of early intervention of speech and language therapy among hearing impaired child

Background: Hearing impairment is a factor that directly compromises the individual’s language which can affect emotional and academic defects by delayed development of communicative ability. This can vary according to the type and degree of hearing loss. Speech therapy intervention is important, along with the use of sound amplification devices, so that the child may have a chance to develop speech, consequently learning and re-habilitation to the society. Aims of the present study was performed to assess the effectiveness of early intervention of speech and language therapy after use of hearing aids to hearing impaired children on their syntactic and lexical development.Methods: This quasi-experimental study conducted on 100 children having different degree of hearing loss at department of Neurology and department of ENT, King George’s Medical University, Lucknow, Uttar Pradesh. After collecting socio-demographic data of subjects by observation, completion of questionnaires, and speech recording by audiologist; Speech and language therapy provide by audiologist for six month after providing hearing aids and improvement in their syntactic and lexical development recorded.Results: There is significant improvement in verbal response from 14% before therapy to 81% after therapy and non-verbal response before therapy was 86% and after therapy was 19%. Before giving speech and language therapy to subjects pointing score was 24%, sign language was 10% and words response was 0% which increases after therapy were 1%, 2% and 39% respectively. Early identified/intervened hearing-impaired children had a notable positive difference in all assessed lingual gains.Conclusions: This is study results definitely point to positive effects of intensive and continuous application of speech and language therapy to syntactic and lexical development of hearing impaired children.

Cognitive Impairment and Depression in Sleep-Deprived Individuals: A Systematic Review

Introduction: Upto 300 per 100000 men are affected byurethral stricture disease. Urethral stricture is by definitiona narrowing of urethra caused by scarring. Stricture diseasecould be induced due to a variety of causes and can bedetrimental for the health and quality of life of the patient. Awide variety of interventions are performed by the practisingurologist for stricture urethra including dilatation, visualinternal uretherotomy (VIU) and urethroplasty. The aim ofthis study was to review the outcomes of various treatmentmodalities for stricture urethra at our centre.Material and methods: The study was conducted in aprospective observational manner in a tertiary care centreover a period of 18 months. All cases of male urethral strictureundergoing intervention were included in this study. Treatmentoptions included Visual internal uretherotomy (VIU),anastomotic urethroplasty and augmented urethroplasty.Patient factors, stricture factors and surgical outcomes,recurrence rates were analysed.Results: Eighty seven cases of male stricture urethra wereincluded in the study. Idiopathic strictures(40%) werethe commonest aetiology followed by traumatic(36.7%),iatrogenic(14.9%) and inflammatory strictures(8%).Commonest site was the bulbar urethra(35.6%) followedby penile urethra. Augmented urethroplasty was donein 33 patients, while 25 patients underwent anastomoticurethroplasty. VIU was done in 29 patients. Success rateof interventions in our study was 89.7% at 12 months offollow-up (VIU-80%, augmented urethroplasty-96.6% andanastomotic urethroplasty-92.2%).Conclusion: A reconstructive urologist must be familiar witha variety of techniques to tackle strictures of the urethra.VIU was used predominantly for single short segmentbulbar strictures but showed high recurrence rates(20%).Urethroplasty had better outcomes in terms of recurrencerate(5%), proving why it is considered the gold standard fortreating urethral strictures.

Anthropometric Profile and Nutritional Status in Children with Generalized Epilepsy

Background: Epilepsy is widespread in developing countriescompared to that in developed countries. The reason ofepilepsy in most cases is unknown. Considering the factthat the nutritional status of children in developing countriesis generally poor, our objective was to determine possiblerelationship between nutritional status and epilepsy.Material and methods: Towards this, we gather a datasetof 34 Cases from the Department of Pediatric and as manyControls from the local populace. The age group (5-8.5 years),sex, and gender data is also augmented with educationaland socioeconomic history along with the results of clinicalexaminations, such as, weight, height and body mass index.Results: Our statistical results unveil insignificantdifference in socioeconomic status and educational levels inbetween the parents of Cases and Controls. Additionally, asignificantly higher value of anthropometric measurementsin Controls is observed compared to that of the Casesi.e.Height (117.38±6.05 vs. 112.21±6.82 cm; p value 0.002),Weight (21.29±2.83 vs. 18.14±2.94 kg; p value <0.001) andBody mass index(15.39±1.03 vs.14.33±1.26 kg/m2; p value<0.001).Conclusion: Our results show that generalized epilepsymay have effect on growth and development of children,reflecting that nutritional programs are required to improvethe nutritional status in children with generalized epilepsy soas to optimize their growth and development.

Neutrophil Lymphocyte Ratio (NLR) as a Bio Inflammatory Marker in Pre-eclampsia

Introduction: Pre-eclampsia, a systemic disease unique topregnancy, affects 3–14% of pregnant women. The aim ofthe present study was to evaluate Neutrophil LymphocyteRatio (NLR) as a bio inflammatory marker of pre-eclampsia(PE), a hypertensive disorder of pregnancy characterized byhypertension and proteinuria after 20 weeks of gestation.Material and Methods: This case control study was carriedout over a period of 10 months after informed consent andethical clearance. The study population included 70 pregnantwomen (35 pre-eclampsia cases and 35 normotensive pregnantsubjects as controls). 3 ml venous blood samples were obtainedfrom both the cases and controls. Complete blood count wasdone using semi-automated three part haematology analyserwhich gives the reading of cell counts, NLR was calculatedmanually.Results: The case group (subjects with pre-eclampsia) werefound to have higher neutrophil to lymphocyte ratio (NLR)than that of the control group. This difference was statisticallysignificant (p<0.001). The receiver operating curve (ROC)analysis showed significant diagnostic accuracy of NLR todiscriminate cases and controls (area under the curve [AUC]= 0.73, P < 0.001) at cutoff value of >= 4.86, 68.6% sensitivityand 80% specificity.Conclusion: Unlike many other inflammatory markers, NLRproves to be an inexpensive and readily available biomarkers,obtained from routinely done complete blood counts that maybe useful for prediction and diagnosis of pre-eclampsia.

Cosinor Analysis of Circadian Rhythm of Peak Expiratory Flow in Young Adults

Introduction: Peak expiratory flow (PEF), exhibit a 24 hour circadian rhythm with nadir in the early morningand peak in the evening. This diurnal variability gets accentuated in asthmatics. Rhythm characteristics ofsuch time series data can be better explained using Cosinor analysis by fitting a cosine curve. Also itmakes easier to compare data even when there is a difference in sampling time points. Data of PEFcircadian rhythms in Indian population with Cosinor analysis is lacking making it difficult to frame guidelineto diagnose asthma.Methods: PEF was recorded from 249 subjects using Wright’s portable Peak Flow Rate meter at 5:00, 8:00,11:00, 14:00, 17:00, 20:00, and 23:00 hours for one day. Cosinor analysis was done and rhythm characteristicswere determined for individual subjects.Results: The mean PEF values after a minimum in morning at 05:00 hours tend to increase throughout theday peaking in afternoon and there is a regular fall in PEF levels after 17:00 hours till 05:00 hours. Meandiurnal variation expressed as amplitude percent mean (A%M)is 8.81±4.8. With Cosinor analysis significantrhythms were detectable in 64% of subjects. For this population MESOR (Midline Estimate Statistic ofRhythm) is 528.49 L/min, Amplitude is 8.2% and acrophase is 15.49 Hours.Conclusion: Results are comparable with the data published in other studies for other populations. Thevariability (amplitude) in normal subjects is lesser than that of smokers and asthmatics. Amplitude andacrophase characteristics will help unifying the data and guide in deciding the cut-off values for diagnosingasthma

Variations in Iron Status Indicators in Different Phases of Menstrual Cycle – A Study of Two Age-Matched Socio- Economic Groups of 18 – 25 Years of Age.

Background: Iron requirements are increased in adolescent girls with growth and the onset of menarche and remain high in women until menopause. Methods: We conducted a study on two study groups of girls in age group 18-25 years belonging to different socioeconomic classes as per the Modified Kuppuswamy’s Scale to study the effect of the phases of menstrual cycle & socioeconomic class on the iron status indicators (Hb, Serum Iron, TIBC, MCV & TS%).Menstrual phases were defined and blood samples were drawn from all the girls in all the 3 phases (menstrual, follicular & luteal) and Hb, Serum iron & Total iron binding capacity were assessed on a semi-auto-analyzer & MCV was estimated using a fully automated CBC machine. Transferrin Saturation was derived as Serum Iron / TIBC × 100. Results: We found significant (p< 0.01) difference in iron status indicators in both our groups, the values of iron status indicators varied significantly according to the menstrual cycle, with values highest during the luteal phase and lowest during the menstrual phase. From our observations we can conclude that the nutritional status (assessed by the height, weight & BMI) and the iron status indicators both differ significantly in the two age-matched comparable socio-economic groups. Conclusion: socioeconomic class has a major determining role on an individual’s health. The effect of hormonal fluctuations during the menstrual cycle also has a part to play in the variation of iron status measures, which has to be considered while measuring them in a female during her reproductive years

Cardiac Output Assessment by Transthoracic Electrical Bio-impedance in Patients of Acute Myocardial Infarction: Comparative Analysis with Echocardiography.

Objectives: Transthoracic electrical bio-impedance (TEB) has been proposed as a non-invasive and continuous method of cardiac output (CO) measurement, but it still has not found wide usages in clinics. The present study measured CO, using a new instrument NICOMON, and compared it with Echocardiography (ECHO) in acute myocardial infarction (AMI) patients. Methods: In the present study 100 patients of AMI were assessed by both ECHO and NICOMON for cardiac output and ECHO is considered as a reference method for comparison. TEB CO was measured by passing an alternating current and measuring the bio-impedance across the thorax. End diastolic volume (EDV), End systolic volume (ESV) & Left ventricular outflow tract (LVOT) diameter, measured by ECHO were used to calculate CO. Various statistical methods like “t”-test & correlation coefficient (r) were used where found suitable. Results: Mean TEB-CO (4.03±1.11 l/min) was significantly higher (p<0.001) than mean ECHO-CO (3.80±1.28 l/min) with a mean difference of 0.25±1.02 l/min. Conclusions: NICOMON measures CO non-invasively but, it needs more elaborative studies on a larger sample to establish it as an alternative method of ECHO for cardiac output measurement on regular basis.

Pacing Indications and Modes in Bradyarrhythmia Patients: Gender Related Differences.

Gender differences are increasingly recognized in cardiology. It is also well known that women have higher complications and a higher mortality related to coronary procedures. In arrhythmias, gender-specific variations in the electrophysiological structure of the heart or hormonal effects may explain some of the gender differences. The aim of this study was to evaluate gender differences according to their risk factors, indications and modes of pacing. A total of 267 patients who had pacemaker implantation for bradyarrhythmia indications were enrolled in our study. A pre-designed questionnaire was filled to record their baseline characteristics, clinical indications and mode of pacing. Out of 267 patients 190 were male and 77 were female. Data was analyzed with SPSS 16.0 software (SPSS, Chicago, IL, USA) The pacemaker implantation requirement was 31% significantly lower among males compared with females who were hypertensive (RR=0.69, 95%CI=0.58-0.82, p=0.0001) and 1.57 times (RR=1.57, 95%CI=1.32-1.87, p=0.0001) significantly higher among male patients than females who were the tobacco user in any form. The single chamber requirement was 1.41 times significantly (RR=1.41, 95%CI=1.16-1.71, p=0.0001) higher in males than females. The risk analysis showed that complete heart blockage (p= 0.02) and sick sinus syndrome (p= 0.01) were significantly higher in males as compared with females. In conclusion male patients had more CHB, sick sinus syndrome and syncope as primary pacemaker indication, compared with female patients. Smoking was the most prominent risk factor in male and hypertension in female and most importantly there were significant gender differences in indications leading to pacing.

Influence of APOA5 (rs662799 and rs3135506) gene polymorphism in acute myocardial infarction patients and its association with basic coronary artery disease risk factors.

The aim of this study was to examine the allele and genotype of APOA5 -1131T/C (rs662799) and APOA5-56C/G (rs3135506) gene in acute myocardial (AMI) case and control subjects. 304 case and 304 controls were enrolled in this study. DNA was extracted using salting out method followed by polymerase chain reaction amplification and restriction endonuclease digestion (using MseI for -1131T/C and Taq1 for -56C/G). Digested PCR products were identified using agarose gel electrophoresis and stained with ethidium bromide. There was a strong association between APOA5 -1131T/C (TC vs. TT, OR= 1.58 and CC vs. TT OR= 2.43) and APOA5 -56C/G (CG vs. CC, OR= 1.64 and GG vs. CC, OR= 2.44) polymorphisms with AMI. Out of the six potential risk factors for coronary artery disease, only smoking, diabetes and hypertension were found to be associated with APOA5 gene and increased the risk of AMI. Smoking was the most prominent risk factor for both the genes. Other risk factors like history of dyslipidemia, obesity and family history of coronary artery disease did not reveal any potential association with the candidate gene. Our data demonstrate that both the SNPs in the APOA5 gene (-1131T/C, and -56C/G) were strongly associated with AMI in north Indian population.

Role of Vitamin-D in the prevention and treatment of Alzheimer’s disease.

Alzheimer’s disease is the most common form of age related cognitive impairment. Aim of the present study was to see the effect of vitamin D on cognitive function in elderly. The study was conducted in Department of Physiology, King George’s Medical University (KGMU). A total of 80 subjects were enrolled based on Mini Mental State Examination (MMSE) score < 24 and vitamin D deficiency. They were divided into two groups as Group A (case) and Group B (control), each group having 40 subjects. Intervention (Vitamin D supplementation) was given in Group A. The assessment of dementia was done by Mini Mental State Examination (MMSE) score. Every subject was clinically evaluated and estimation of vitamin D was done by direct ELISA kit. Gender, weight, height, BMI, residence and education were also similar between two groups. A significant (p=0.0001) change in MMSE score was observed in both Group A and Group B from baseline to 3 & 6 months and from 3 to 6 months, however, mean change was higher in Group A than Group B. In conclusion, vitamin D supplementation caused significant improvement in the cognitive performance in subjects with senile dementia.

Clinical profile of acute hemorrhagic stroke patients: a study in tertiary care hospital in Northern India.

Background: Acute hemorrhagic stroke, a subtype of acute stroke is one of the leading cause of death and major cause of morbidity and mortality throughout the world. The incidence of acute hemorrhagic stroke is increasing with gradual increase in obesity, diabetes mellitus, hyperlipidemia, hypertension and various cardiac problems. This study had been conducted with an objective to study the risk factors and clinical presentation of acute hemorrhagic stroke patients in north-Indian population. Methods: This study was carried out among 100 acute hemorrhagic stroke patients (clinically and radiologically confirmed) irrespective of age and sex admitted to Emergency Department of KGMU, Lucknow after getting clearance from Institutional Ethical Committee(IEC). These patients had been subjected to plane CT (computed tomography) scan brain on admission by the CT scan model 16 slice Brivo 385 for radiological confirmation and to localize the lesion in brain. Data were collected in prescribed protocol. Results: Majority of the patients were in the (50-60) age group with male predominance. Hypertension (62%) was the most common risk factor for acute hemorrhagic stroke followed by Non-veg diet (46%). The commonest clinical feature at presentation was hemiplegia (76%). Majority (47%) of the patients presented with Glasgow Coma Scale (GCS) of (9-12). Cerebral cortex (41%) was the most common site of brain lesion in acute hemorrhagic stroke patients. Conclusion: This study focuses on the clinical profile and risk factors of acute hemorrhagic stroke, by targeting which the burden of this disabling disease can be prevented.

A study on association of leptin receptor gene polymorphism with obstructive sleep pnea syndrome in overweight and obese north indian subjects.

Obesity is an important risk factor of Obstructive Sleep Apnea Syndrome (OSAS). Previous studies suggested Leptin Receptor (LEPR) gene Polymorphisms is associated with obesity and OSAS. Study was conducted to asses association of LEPR gene polymorphism K109R, Q223R and K656N with OSAS in North Indian subjects. Genotyping and estimation of serum Leptin levels were done in 190 subjects. Polysomnography, anthropometrical measures and biochemical investigations were done in all the subjects who qualified for inclusion in the study. We observed significant association of Q223R gene polymorphism with blood pressure (BP) (P<0.05) and nocturnal max pulse rate (P<0.05). K656N gene polymorphism was associated with AHI (P<0.05), average desaturation levels (P<0.05) and HDL-C (P<0.05). No association was observed in genotype distribution of these subjects according to obesity and disease severity. These findings suggest that LEPR Q223R and K656N gene Polymorphism may influence BP, Max Pulse rate, AHI, Average desaturation levels and HDL levels in these Subjects.

Impedance cardiography for monitoring changes in cardiac output.

Impedance Cardiography (ICG) is a non invasive method useful for continuous monitoring of cardiac output but, it still has not found wide usage for measuring cardiac output in clinics and research. Most studies focused on comparing the cardiac output measured at rest with reference methods. In the present study we evaluated the validity of ICG against Doppler Echocardiography (DE) in measuring cardiac output changes that occur during static exercise. Cardiac output of 30 healthy males between 18-26 yrs of age was measured during supine rest, during and 5 min after completion of 3 minute static exercise by ICG and DE. The increase in cardiac output during exercise measured with ICG and DE does not differ significantly (1.04±0.72 L/min and 1.05±1.24 L/min respectively) and has significantly high correlation (r=0.76, P<0.001). The bias and limits of agreement are (–0.01±0.83) in acceptable limits. The pooled means of cardiac output measured by ICG and DE do not differ significantly and bears a significant correlation (r=0.812, P<0.001). The bias (d±s) calculated is 0.15±0.64 L/min. ICG could provide valid information regarding the relative changes in cardiac output.

Effect of examination stress on mood, performance and cortisol levels in medical students.

Stress produces definable mental and physiological reactions in the body. Mild stress is beneficial in cognitive tasks and performance but persistently high stress may lead to neuropsychiatric illnesses like anxiety and depression. Examinations act as stressor and activate hypothalamicpituitary adrenal axis causing an increase in cortisol level, which is reflected in saliva. Present study was done on 35 medical students. Their mood parameters were assessed, using Depression Anxiety Stress Scale (DASS) scoring, and salivary cortisol levels using quantitative ELISA. Subjects were evaluated for mood parameters two times, one during relaxed state (with no examinations in preceding 2 weeks and in coming 2 weeks) and another during stressed state (on the day of viva voce examination). The levels of mood parameters and salivary cortisol were significantly raised during examination stress. The changes in stress level significantly correlated with change in levels of anxiety and salivary cortisol though there was no significant effect on the performance. Males and females showed similar changes in mood parameters. This study suggests that as examinations act as unavoidable stressors, the medical educators as well as students should be made aware of the negative consequences of stress faced during medical training. Efficient relaxation program as well as counseling services should be provided to stressed students so that they are able to cope better with examination stress.

"Effect of short-term cigarette smoking on insulin resistance and lipid profile in asymptomatic adults".

Present study examined the effect of short-term cigarette smoking on insulin resistance and lipid profile in asymptomatic healthy adults. This case control study comprised of 44 healthy male subjects in the age group of 18-40 yrs having BMI 25+3 and WHR < 1.0. Of these 22 smokers were included in the study group and 22 non-smokers in the control group. Subject selection was done such that one smoker and one non-smoker sibling or first degree male relative were selected from the same family. We compared fasting plasma glucose, insulin, lipid profile, and homeostatic model assessment index (HOMA Index) as a measure of insulin resistance between both the groups. Our observation showed that significantly higher values of serum glucose (133.36 +/- 23.45 mg/dl; P < 0.001), serum insulin (32.04 +/- 6.0 2 microU/ml; P < 0.001) and HOMA index (3.62 +/- 0.21; P < 0.001) were found in smokers as compared to non-smokers (serum glucose 86.95 +/- 19.32 mg/dl, insulin 20.09 +/- 4.8 microU/ml, HOMA index 3.29 +/- 0.30). No significant difference was observed for number of subjects having insulin resistance (HI > 3.8) and lipid profile in both the groups. Thus it appears that smokers are prone to develop hyperinsulenemia, hyperglycemia and the metabolic syndrome.