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Background: Leprosy or Hansen抯 disease caused by Mycobacterium leprae is a chronic granulomatous disease characterized by hypoesthetic skin lesions and nerve involvement. The objective of the study was to find clinicohistopathological correlation of Hansen抯 disease diagnosed at a tertiary care centre of eastern India. Material and Methods: Hospital based retrospective study was conducted that included cases of leprosy diagnosed clinically and examined for histopathology at Indira Gandhi Institute of Medical Sciences, Patna from January 2021 to December 2021. Clinical diagnosis was correlated with that of histopathological diagnosis. Result: From this study, it was observed that, the commonest age group affected by leprosy was 20 to 40 years, males were more commonly affected than females (M:F = 1.83: 1) and commonest clinically diagnosed spectrum was Tuberculoid leprosy (TT) ( 48.03%). It was observed that there was complete agreement between clinical diagnosis and histopathological diagnosis in 84.3% cases and disagreement was observed in 15.7% cases. Conclusion: Combining clinical, and histopathological finding of leprosy is essential for accurate diagnosis and thus proper treatment of the patient and prevention of complications.
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Background & objectives: The pandemic caused by the SARS-CoV-2 has been a threat to humankind due to the rapid spread of infection and appearance of multiple new variants. In the present study, we report the dynamics and persistence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in asymptomatic and symptomatic COVID-19 patients by chemiluminescent assay. Methods: A total of 463 serum samples from 218 SARS-CoV-2 PCR-positive patients were collected over a period of 124 days post-onset of disease (POD). Antibody levels were measured by chemiluminescence bioanalyzer. Neutralizing antibody titres were assessed by plaque reduction neutralization test (PRNT) for SARS-CoV-2. Results: Both IgM and IgG started appearing from day five post-infection in symptomatic and asymptomatic patients. IgM antibody response peaked around day 35 POD and rapidly diminished thereafter, with the last IgM-positive sample observed at 90 days POD. IgG antibody response peaked around 45 days POD and persisted till 124 days. The chemiluminescence immunoassay (CLIA) results showed a moderate correlation (R=0.5846, P<0.001) compared with PRNT. Additional analysis indicated a neutralizing titre of 250 corresponded to 12.948 AU/ml of YHLO iFlash SARS-CoV-2 IgG units. Interpretation & conclusions: Both symptomatic and asymptomatic COVID-19 patients seem to initiate production of antibody responses from day five of onset of disease. Although the CLIA gives high sensitivity and specificity and also its binding IgG antibody titres may correlate moderately with protective immunity, our results indicate that the values of binding antibody alone may not be a perfect guide to represent virus neutralization titre during donor selection for plasma therapy. However, IgM and IgG antibody detection may help in monitoring the status of disease progression and burden in the community.
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Purpose: Health care workers [HCW] are at a higher risk of infection SARS CoV2 infection due to frequent and close contact to patients with COVID-19. Methods: Serum samples from 500 HCW's were tested for SARS CoV2 IgG antibodies in October 2020. A questionnaire was used to collect demographic and clinical data. All these HCWs were tested for COVID-19, in 2nd week of September 2020, as a hospital policy. Results: Anti SARS CoV2 antibodies were detected in 128/ 500 [25.6%] HCWs. A total of 195/ 500 [39%] enrolled cases had already tested positive for Covid-19 at least once in last six months by RT-PCR. Sixty eight percent of HCWs with previous COVID-19 positivity by RT- PCR tested positive for Anti SARS CoV2 antibodies, whereas only 2.76% of asymptomatic HCWs tested positive. Of 121 anti SARS-CoV-2 IgG positive persons, 70 [57.85%] had CT value < 25. Low CT value and asymptomatic cases had a strong reverse statistically significant association with SARS CoV2 IgG antibody positivity. Conclusions: We report that sero-conversion rate in HCWs is similar to that in general population suggesting that preventive practices used in hospitals are satisfactory. Cases with low viral counts in respiratory sample and asymptomatic cases have lower rate of seroconversion.
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India shoulders a heavy burden of diabetes mellitus (DM), the management of which is suboptimal globally. Objectives: Insulin Management: Practical Aspects in Choice of Therapy (IMPACT) survey was designed to gain insight into the ground (in-clinic) reality of DM management by physicians in India. Methods: A survey consisting of 12 multiple-choice questions was conducted by SurveyMonkey ® , focusing on practice profile, patient profile, and other aspects of DM management. Results: The survey included 2424 physicians. Majority of them were general physicians (58.5%) followed by diabetologists (31.1%). Most (49.2%) of the respondents specified that the ideal time for a DM consultation is 15 min. However, 73.4% of them provided consultation of <10 min because of heavy patient load. Nearly half of the respondents reported that their patients consumed a diet with carbohydrate content of 60% to 80%, and 79.4% of them admitted that <50% of their patients adhered to dietary advice. About 73.5% of the respondents believed controlling fasting plasma glucose (FPG) level alone would not adequately control postprandial plasma glucose (PPG) level, and 93.0% of them preferred an insulin therapy at the initiation that controls both FPG and PPG levels. Conclusion: Limited consultation time, high-carbohydrate diet, and a need for choosing insulin regimens that provide control for both PPG and FPG levels are some ground realities of DM management in India. These realities need to be factored in while choosing treatment options to achieve the desired glycemic control and improve the status of diabetes care.
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Cardiovascular Diseases (CVDs) are taking the biggest toll on human health since the last few decades. Around the middle of the 20th century, morbidity and mortality due to CVDs began to increase exponentially due to drastic change in lifestyle and rapid urbanization. At that point of time a very little was known about its causes or risk factors. Identification of risk factors is crucial in planning the treatment and prevention strategies for any disease. Profound research works have been conducted worldwide to identify risk factors of CVDs. Conventional risk factors like obesity, smoking, hypertension, diabetes, dyslipidemia, physical inactivity etc are already given due importance in risk prediction, prevention and management of CVDs. The risk assessment tools available at present are mainly based on these conventional risk factors. Even after adjusting the conventional risk factors, CVD related morbidity and mortality are still growing. Moreover CVDs are now reported at an early age. Hence there is also a need to identify novel risk factors which can be helpful in predicting and identifying CVDs earlier. The future of CVD risk assessment is an integration of both traditional as well as emerging risk factors for better prediction, diagnosis and planning therapeutic and preventive interventions of CVDs.
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Bibliometric analysis is of paramount importance in assessing the research impact wherein studies are ranked on the basis of citations received. It also brings out the excellent contribution of authors and journals in adding evidence for future research. This study aimed at evaluating the top 100 most cited articles on anterior communicating artery (ACoA) Aneurysms. Scopus database was searched using title specific search for the aneurysm of ACoA and top 100 most cited articles along with their authors, author IDs, affiliated institutions, countries and funding bodies were identified. Search yielded 841 articles and top 100 articles were identified to include in this analysis which secured 5615 citations. Citations per year was also calculated to minimize the risk of bias. Maximum citations by any article were 242. The United States was the major contributor to the number of articles while Kessler Institute for Rehabilitation became the highest contributing institution. DeLuca J proved to be a pioneer in this specialized area as he penned 6 studies being first author in 4 of them, making him the most frequent author. National Institutes of Health and the U.S. Department of Health and Human Services were the main funding bodies. Subcategory analysis revealed, 50% studies provided evidence for the treatment and the surgical outcome of the aneurysm. Studies like these can aid in better neurological and neurosurgical management in decision making of ACoA aneurysm.
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Background: The occurrence of Diabetes Mellitus (DM) has been creating a havoc since past few decades on a global platform. As per available literature, prevalence of DM in Mumbai is around 10%. Comprehensive Diabetes Care (CDC) is a form of Ayurvedic therapy which combines panchkarma and diet management. The present study was planned to evaluate the effectiveness of CDC in patients of DM by analysing changes in body mass index (BMI), body weight, OGTT, HbA1c, etc.Methods: The present study was of retrospective design, conducted at Madhavbaug clinics in western Mumbai. The duration of study was of one year, conducted from October 2018 to September 2019. It included patients diagnosed with type 2 DM i.e. HbA1c>6.5%, who were given CDC therapy.Results: In the present study, out of 183 type 2 diabetic patients, 99 were males (52%), while 84 were females (48%), thus male: female ratio was 1.17:1. On analysing the results of HbA1c in patients who had completed 12 weeks of CDC therapy, it was found that controlled DM status was seen in 109 patients (59%), while uncontrolled DM status was noted in 33 patients (19%) as compared to 102 patients (58%) at baseline.Conclusions: From the findings of the present study, it is clear that CDC is effective in the form of increasing number of euglycemic patients at the end of study period, as well as reduction in all glycaemic and anthropometric parameters, and reducing dependency on conventional medicines.
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Up-regulation of MMP-2 and MMP-9 plays a significant role in promoting cancer progression by degradingthe components of the extracellular matrix, thereby enhancing the migration of tumor cells. Although the antiproliferative and apoptotic effect of Annona muricata is well established, its effect on MMP-2 and MMP-9, amajor target in several types of cancers, has not been studied. Powdered samples of various parts of A.muricata like fruit, stem, seed, and twig extracted using aqueous methanol showed significant dose-dependentinhibition of MMP-2 and MMP-9 in a highly metastatic fibrosarcoma cell line, HT1080. Additionally, theseextracts also up-regulated the expression of several endogenous inhibitors of MMP-2 and MMP-9 likeREversion-inducing Cysteine-rich protein with Kazal motifs (RECK) and Tissue Inhibitor of Metalloproteinase-2 (TIMP-2). Furthermore, primary cells developed from tumor tissues obtained from patients notexposed to chemotherapy, also exhibited similar results. Remarkably, the inhibition of MMP-2 and MMP-9observed was tumor specific, with the A. muricata fruit extract showing only 2% inhibition in cells obtainedfrom normal tissues, when compared to 60% inhibition observed in cells obtained from tumor samples. Thepresent study elucidates a novel mechanism by which A. muricata extracts selectively exhibit their anti-canceractivity in tumor cells by down-regulating MMP-2 and MMP-9 that are important biomarkers in cancer.
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Altered glucose uptake and metabolism is the key characteristic of cancer cells including hepatocellularcarcinoma (HCC). However, role of glucose availability in chemotherapeutic outcome of HCC is unclear. Thepresent study investigates the effect of glucose facilitated sensitization of HCC cells towards doxorubicin(DOX) and sorafenib (SORA). In HCC cells, we observed that hyperglycemic culture condition (HG) isassociated with increased sensitivity towards DOX and SORA. P-glycoprotein (P-gp), a transporter involved indrug efflux, was elevated in HCC cells in NG, rendering them less susceptible to DOX and SORA. Further, thisstudy demonstrated that knockdown of dickkopf protein 4 (DKK4), a Wnt antagonist protein, causes enhancedglucose uptake and reduction in P-gp level rendering HCC cells in NG sensitive to DOX and SORA.Moreover, HG elevates the level of intracellular reactive oxygen species (ROS), which regulates P-gp.Alteration in intracellular ROS did not directly affect regulation of DKK4 in HCC cells. Functional assayssuggest that alterations in DKK4 and P-gp level in HCC cells are dependent on glucose availability andchanges in ROS level because of enhanced glucose utilization, respectively. Collectively, the present studyhighlights direct involvement of glucose-induced ROS, DKK4 and P-gp in altering the sensitivity of HCC cellstowards DOX and SORA.
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Introduction: Chronic abdominal pain which is difficult to diagnose initially not only encumbers the patient but it also affectstheir daily routine, leading to physical and psychological disability, here comes the role of diagnostic laparoscopy which provesto be beneficial aiding in diagnosing most of these cases. Hence, the aim was to evaluate the diagnostic value of laparoscopyin cases with chronic abdominal pain.Materials and Methods: This study was done in the Department of General Surgery at Indira Gandhi Institute of Medicalsciences, Patna, Bihar, from July 2019 to March 2020 in 40 patients. Prior Institutional Ethical Committee approval was alsoobtained for this study.Results: Out of 40 patients included in this study, maximum number of patients were females. Male-to-female ratio was 1:1.4.The maximum number of patients were in the age group of 21–40 years (60%). Maximum patients 45% (n = 18) had complaintof pain in the right lower quadrant of abdomen. The most common finding during diagnostic laparoscopy was found to bepathology in the appendix accounting for 27.5% of cases (11/40).Conclusion: Diagnostic laparoscopy is a safe and effective tool to establish the etiology of chronic abdominal pain and allowsfor appropriate interventions. It can serve as a time saving and cost-effective implement for these patients.
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We report an infant with necrotizing pnuemonia and bilateralbroncho pleural fistula, who failed on conventional and highfrequency ventilation and was managed successfully on Veno-venous Extra Corporeal Membrane Oxygenator (V-V ECMO)with a unique configuration for 12 days, and weaned offsuccessfully.
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Objectives: To evaluate association between total IgE levels and wheezing in preschoolchildren from India. Methods: Datawere collected in a prospective birth cohort study relatedto wheezing till three years of age. Total IgE was measured at enrolment, at one year and twoyears of age and correlated with wheezing episodes. Results: A total of310 (167 boys)children were enrolled. Total IgE levels increased with age (P<0.001). Overall, 101 (32.6%)children had 182 episodes of wheezing. The median (IQR) total IgE levels in children withwheezing and without wheezing were similar at one year [42.1 (12.7, 93.5) vs 41.9 (17.1,96.7) kU/L; P=0.39] and two years of age [62.8 (32.4, 212.0) vs 75 (25.8, 173.0) kU/L,P=0.92). Conclusion: Total IgE levels increased with age and were not different in preschoolchildren with and without wheezing.
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Introduction: Oral health is an important factor in maintainingsound psychological and physical health. Periodontaldiseases, including gingivitis and periodontitis, are infectionsthat if left untreated, can lead to tooth loss. The main causeof periodontal disease is bacterial plaque, the initiation andprogression of gingivitis and periodontitis. The aim of thisstudy was to evaluate the knowledge and awareness regardingperiodontal disease among medical students.Material and methods: The present cross-sectional studywas carried out among the MBBS students to evaluatethe knowledge regarding periodontal disease. All theundergraduate students studying in the college were eligibleto participate in the study. 300 students of first, second andthird professional enrolled in MBBS program were selectedfor the study. The students who had attended lectures ofDentistry or exposed to clinical practice were excluded thestudy and questionnaires were distributed the students. Theself-administered questionnaire was used to assess the studyparticipant's personal data and level of knowledge on issuesrelating to periodontal diseases. The data were collected andanalyzed using the Statistical Package for the Social Sciencesversion 21.0 for Windows (SPSS Inc., Chicago, IL, USA).Statistical significance was based on P < 0.05.Results: In the present study total students were 270. 37.66%students think vertical brushing technique is better for goodoral health. 31.66% students think vitamin C deficiency is themost common cause for bleeding gums. 72.66% students thinkpoor oral hygiene is the most common cause for bad breath.68.33% students think coffee or tea causes staining of teeth.61.66% students think bad oral hygiene affects your generalhealth. 65.66% students think improper tooth brushing is themost common cause for receding gums. In 86.66% studentsno family member lost more than 6 teeth at young age of <35years.Conclusion: The students showed reasonable knowledgeregarding periodontal health. But, also there is need tostrengthen the diagnostics for early detection of periodontaldisease in young adults.
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Background: Improving maternal health is one of the eight-millennium development goals (MDGs). Since 1990, maternal deaths worldwide have dropped by 47%. This study aimed to determine the level of knowledge, attitude, and practice on ANC among pregnant women attending the antenatal clinic at a tertiary care hospital in Gujarat and their association with various sociodemographic factors.Methods: A cross-sectional study was carried out among 384 pregnant women in their 3rd trimester attending the antenatal clinic in a tertiary care hospital of Gujarat during April 2018 to September 2018. Pretested questionnaire was used for collecting data by interview after obtaining informed consent. Statistical analysis was performed using SPSS version 20 and Epi Info software.Results: Study reveals that about 58% women had adequate knowledge regarding ANC. It was found that almost all the variables such as age, education, occupation, parity, type of family, and socioeconomic status (SES) had a significant association with awareness about ANC. 100% women were having a positive attitude toward ANC. Around 70%, women were practicing adequately, and variables such as education and SES had a significant association with practices about ANC.Conclusions: These findings can be used to plan a health intervention program aiming to improve the maternal health practices and eventually improve the health status of the women.
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Background: Eclampsia is a life threatening condition and one of the leading causes of maternal deaths worldwide. It is also associated with complications like acute renal failure, DIC, postpartum hemorrhage, etc. and adverse fetal outcomes. Hence we aimed to study fetomaternal outcomes in cases of Eclampsia.Methods: A total of 75 cases of eclampsia out of 13524 deliveries were evaluated, from 1st January 2016 to 30th June 2017 at RZ Hospital, a government tertiary referral centre. Maternal outcomes were studied for its complications, effectiveness of magnesium sulphate treatment, fetal outcome and mode of delivery.Results: Incidence rate of eclampsia was 0.55%, 62.66% of all cases were primigravida, 76% of cases were in age group of 21-26 years, 84% cases were from lower socio economic status, maternal mortality occurred in 2 of 75 cases. 66.67% of patients were of term pregnancy (37 to 42 weeks). 71%(53) patients delivered vaginally out of which 9 deliveries were spontaneous and 44 deliveries were induced vaginal delivery. 22 patients required caesarean section.Conclusions: Early detection and prevention of pregnancy induced hypertension and pre-eclampsia and other associated risk factors for eclampsia might help to reduce the incidence of eclampsia. Maternal adverse outcomes in this study were magnesium toxicity, acute renal failure (ARF), disseminated intravascular coagulation (DIC) and post partum hemorrhage (PPH) while 92% patients had no complications.
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Incidence of new cases of a severe form of unchecked primary hyperparathyroidism is decreasing day by day. Here, we report the case of a 40-year-old female patient of primary hyperparathyroidism with a maiden visit to the hospital with multiple osteolytic lesions and multiple pathological fractures. The diagnosis was installed and managed accordingly
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To classify vascular anomalies using clinico-radiological parameters. Settings: Government Medical College Srinagar and Army Hospital Research and Referral New Delhi. Methods: 129 cases of vascular anomalies were studied and classified using clinical and radiological methods from March 2011 to June 2018. Outcome: Vascular anomalies were broadly classified into vascular tumours and vascular malformations and these anomalies were further sub-classified based on clinical and radiological parameters. Results: Among 129 vascular anomalies studied there were 51 vascular tumours which included 50 hemangiomas (H) and 1 case of pyogenic granuloma (PG). Among Hemangiomas there were 34 Hemangiomas of Infancy (HOI) and 16 Congenital Hemangiomas (CH). Among HOI there were 26 Simple (Localized-17, Segmental-2, Indeterminate-6, Multifocal-1), 8 complex visceral hemangiomas (Liver-2, Subglottic-2, Parotid-4). Among Congenital Hemangiomas there were 4 Rapidly Involuting Congenital Hemangiomas (RICH) and 12 Non involuting congenital hemangiomas (NICH). There were 78 vascular malformations which included 51 slow flow malformations and 27 fast flow malformations based on colour doppler studies. Among slow flow there were 42 Simple {2 Capillary Malformations, 26 Venous Malformations (VM), 14 Lymphatic Malformations (LM), 4 Combined (2 each of Lymphohemangiomas - LH and Lymphovenous Malformations – LVM} and 5 Complex-combined (4 Klipple Trenaunay Syndrome – KTS and 1 case of Blue Rubber Bleb Nevus Syndrome - BRBNS). Among fast flow there were 6 simple (Nasopharyngeal Angiofibromas), 20 combined (Arteriovenous Malformations - AVM) and 1 Complex combined malformation (Sturge Weber Syndrome - SWS). Conclusion: Newborn with birthmark should always be documented by the attending health care provider at birth and referral to an expert for proper evaluation and careful parental/Guardian counseling. Doppler US should be the first line of investigation in broadly classifying vascular anomalies whereas CT Scan, MRI/MRA/MRV, Angiography, Venography help in further sub-classification. Some confusion still persists in classifying few lesions like Lympho-hemangioma (LH), Complex combined Malformations (Syndromes) like Sturge Weber Syndrome (SWS), Blue Rubber Bleb Nevus Syndrome (BRBNS), and Nasopharyngeal Angiofibroma (NPA).
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Background: The aim of the study was to know occurrence, incidence, and various histopathological variants of eyelid tumors.It is incidence with respect to age and to analyse the distribution of tumors in various age group at new civil Hospital, Asarwa,Ahmedabad.Materials and Methods: A total of 100 cases of eyelid tumors were analyzed retrospectively in a period from May 2008to November 2010. Cases were studied in detail about general information of the patient including age and sex and grossexamination and histological features.Result: Of 100 tumors, 56 (56%) were benign and 44 (44%) were malignant. Of 56 benign lesions, 41 were in pediatric agegroup (<18 years) and 15 were in adult patients (>18 years). The common benign lesion seen was nevi (21%) followed bysquamous papilloma (12%). The common malignant lesion seen was meibomian gland carcinoma (22%) followed by basal cellcarcinoma (12%). Distribution of tumor based on origin on descending order was epithelial origin (33%), adnexal origin (23%),melanocytic origin (22%), and mesenchymal origin (22%).Conclusion: As eyelid skin is the thinnest and most sensitive skin in our body, it is often the first area in body to show changesoccur from sun damage and aging. Skin cancer of the eyelids is relatively common and of several types. Overall, the incidenceof benign tumors (56%) was more than malignant tumors (44%) in the present study. Benign tumors were more common inadolescent and young adults. Mean age of benign tumors was 33.83 years. Malignant tumors were more common in elderly. Meanage of malignant tumors was 61.40 years. Overall, sex distribution of benign and malignant tumors is equal in both the sexes.
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Background: Second-trimester pregnancy termination comprises 10 to 15 percent of the approximately 42 million abortions performed annually worldwide. Second-trimester procedures can be performed either with medication or by mechanical methods (Foleys catheter) or surgically by dilation and evacuation (D and E) or hysterotomy. The objective of the present study was to evaluate and compare the efficacy and safety of Tablet Misoprostol and extra amniotic infusion of normal saline with balloon catheter in second trimester abortion, to find out the maternal outcome, to compare the induction- to delivery interval between tablet misoprostol and extra amniotic infusion of normal saline with balloon catheter and to compare the cost of induction between tablet misoprostol and extra amniotic infusion of normal saline with balloon catheter.Methods: This randomized controlled study was carried out in the Obstetrics and Gynecology. Department of C.U. Shah Medical College, Surendranagar, from 23th August 2017 to 20th August 2018.Results: Amongst the 100 participants, 50 induction is done with tab. Misoprostol and 50 induction done with EASIBC. Success rate is higher in tab. Misoprost which is 90.20% and in EASIBC is 75.51%. There were longer induction abortion interval in EASIBC: Need for curettage among Misoprostol is 5 and EASIBC is 9. Major complication like PPH occurred in two cases in induction with tab. Misoprostol, which is managed by further intervention and no death occurred. No major complication occurred in induction with EASIBC.Conclusions: Excluding the side effects and complications, which are manageable induction with tab. Misoprostol is better than EASIBC in terms of induction abortion interval, effectiveness, acceptability.
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Globally, the epidemic of obesity in children and young adults is on a constant rise over the past decade. Obesity makes individual highly susceptible to a variety of chronic diseases and their complications. An altered autonomic response in the form of enhanced baseline sympathetic activity, feeble response to sympathetic stimuli and compromised parasympathetic activity is observed in obesity. We have assessed potentially perturbed autonomic responses in young overweight/obese first year medical students. Methods: This cross sectional analytical study was undertaken in the research lab of the Department of Physiology, M.K.C.G. Medical College over a period of 12 months on 300 students (both males and females) to determine sympathetic and parasympathetic responses to stress using hand-grip dynamometer and sinus arrhythmia test respectively. Independent ‘t’ test, Pearson’s correlation coefficient and multiple linear regression analysis in SPSS 20.0 was used to statistically ascertain the differences for the aforementioned parameters between obese and non-obese adults. Results: Weight, Body mass index (BMI), waist hip ratio (WHR), Pulse rate (PR), baseline systolic blood pressure (BSBP) & baseline diastolic blood pressure (BDBP) is significantly greater in obese than in non-obese. BMI shows positive correlation with BSBP & BDBP (r=0.660**; p<0.001 & 640**; p<0.001) and negative correlation with ΔDBP, and E/I Ratio. A negative correlation is appreciated amongst ΔDBP and BMI (R2 = 39.6). A similar negative correlation is again seen between E/I ratio and BMI (R2 = 37.2). Conclusion: Obesity potentially alters autonomic balance with increased sympathetic and reduced parasympathetic tone posing elevated risk of cardiovascular and cerebrovascular accidents.