Lifestyle Behaviour and Obstructive Sleep Apnea (OSA): An Association Study Among Young Adults

Introduction: Lifestyle changes like low physical activity, smoking and consumption of alcohol have been reported to have an impact on Obstructive Sleep Apnea. Smoking was found to be associated with nocturnal hypoxemia and disturbed sleep. Apneic episodes are increased after alcohol consumption. Objectives: To determine the risk of developing Obstructive Sleep Apnea among young adults.Material and Methods: Participants were asked to fill in an online generated questionnaire on lifestyle habits in addition to the modified Berlin questionnaire and Epworth questionnaire. A total of 209 study participants were included in the study. A Chi-square test was applied.Results: Among 209 participants, 47(22.5%) were females and 162 (77.5%) were males. Snoring was reported in 90 (43.1%) of study participants. Around thirty-three, percent of participants were at higher risk of developing Obstructive Sleep Apnea and Obstructive Sleep Apnea was predicted in 21.5%. No as-sociation was found between the lifestyle behavioural factors and Obstructive Sleep Apnea.Conclusion: Though a significant association was not found between selected lifestyle factors and Ob-structive Sleep Apnea risk, the role of lifestyle factors could not be undermined. A healthy lifestyle helps in preventing the occurrence of Obstructive Sleep Apnea.

Correlation between the learning approaches of first year medical students and their performance in multiple choice questions in physiology.

Background: Students generally choose either a surface learning approach that focuses on rote learning or a deep approach that focuses on understanding. While selection for postgraduate medical courses is based on Multiple Choice Questions (MCQs), only some medical colleges in Tamil Nadu, India, use MCQs for assessing undergraduate students. Aims and Objectives: The aim of this study was to determine the relationship between the learning approaches of first year medical students using the Revised Two Factor Study Process Questionnaire (R-SPQ-2F) and their performance in Multiple Choice Questions in Physiology. Materials and Methods: The Revised Two Factor Study Process Questionnaire (R-SPQ-2F) was administered to 142 first year medical students of a private medical college in Tamil Nadu after the internal assessment examination in Physiology that included 20 MCQs. Pearson product-moment correlation coefficient was determined using SPSS 17 software, to find the relationship between the deep and surface learning approach scores with the performance in the MCQ examination. Results: The majority of our students (73%) preferred a deep approach while learning Physiology. There was a positive correlation between deep approach scores and MCQ marks (r=0.226, p=0.007, n=142) and a negative correlation between surface approach scores and MCQ marks (r=-0.258, p=0.002, n=142). Conclusion: The majority of our first year medical students exposed to a didactic-non Problem Based Learning curriculum in which assessment included MCQs in Physiology preferred a deep learning approach which was positively correlated with MCQ marks.

Comparison of Staining Properties of Composites.

Esthetics forms an important aspect of human’s life, because human’s personality and psychological wellbeing rests considerably on his appearance. Discolouration of esthetic restorative materials from the dietary habits vary with geographic distribution especially poor Oral Hygiene increases susceptibility to staining. Restorative resins are susceptible to softening caused by organic acids produced in plaque. Consequently plaque-covered resin restorations may be liable to pronounced staining.

Baroreceptor reflex response in paraplegia during head-up tilt position.

Paraplegia is one of the most common spinal cord lesions seen in spinal cord injury patients below 4th thoracic vertebra and is associated with autonomic loss below the level of lesion with intact vagal cardiac nerves. It occurs due to lesion of spinal cord at an appropriate level. i.e., sparing superior extremities and involving inferior extremities. The common causes of paraplegia are accidents such as gunshot injuries, spinal cord injuries, autonomic injuries and dislocation of spine. The degree of cardiovascular control impairment is related to the level and severity of the lesion. This study was to investigate the autonomic control of cardio vascular functions in paraplegia patients in response to head up tilt following spinal cord injury. The parameter studies were in head up tilt response on resting heart rate and blood pressure changes in paraplegic subjects. The results show an abnormal response to head – up tilt in paraplegia patients with decrease in diastolic blood pressure but the heart rate showed normal response. Thus, in patients of paraplegia, sympathetic reflexes below the level of the lesion induce vasoconstriction. These results indicate that increased sympathetic activity in controls during Head up tilt and decreased sympathetic activity in paraplegia. This suggests that patients with paraplegia maintain cardiovascular homeostasis during Head up tilt without increase in sympathetic activity.

Central obesity and lipid profile in North Indian Males.

Obesity is a known risk factor for metabolic syndrome in adults. Metabolic syndrome includes a group of cardiovascular disease risk factors namely impaired glucose tolerance, dyslipidaemia and hypertension. Central fat distribution, particularly intra-abdominal fat, is a greater risk factor than peripheral fat distribution. Anthropometric indices used to measure fat distribution have been shown to be associated with altered lipid profile. The objective of the present study was to compare the serum lipid profile levels in obese and non-obese males according to their Waist Circumference (WC) and Waist-Hip Ratio (WHR). A total of 60 males (aged 18-56 years, Mean age 31.00+11.81 years) were included in the study. WC and Hip Circumference (HC) were measured and WHR was calculated. An overnight fasting venous blood sample was drawn for lipid profile. Central obesity was defined as WC > 90 cm or WHR > 0.9. When compared according to WC and WHR, High Density Lipoprotein Cholesterol (HDL-C) was significantly decreased in obese compared to non-obese, while no significant change in Total Cholesterol (TC), Triglycerides (TG) and Low Density Lipoprotein Cholesterol (LDL-C) levels was observed. Both WC and WHR were positively correlated with TG, TC and LDL-C and negatively with HDL-C. The correlations with HDL-C were statistically significant. Thus, it can be concluded from our study that obesity measured either as WC or WHR is associated with altered lipid profile in the form of low HDL-C. In obese individuals the accompanying hyperinsulinaemia due to insulin resistance may be responsible for changes in lipid and lipoprotein concentration.

Power Bleaching - A Solution For Discoloured Teeth.

Bleaching is an effective method for restoring the colour of the discoloured teeth. It is a safe procedure with few side effects, and is much less invasive than other techniques such as veneering or crowning of teeth, which require tooth preparation. This article focuses on the in office bleaching method called power bleaching with discussion of two cases using this method.

Evaluation of The Accuracy of Two Apex Locators And Radiovisiograpy- An In Vistro Study.

Determination of an accurate working length is one of the most critical steps of Endodontic therapy. The cleaning, shaping and obturation of root canal system cannot be accomplished accurately unless working length is determined precisely. Locating the appropriate apical position always has been a challenge in clinical Endodontics. The cementodentinal junction (CDJ), where the pulp tissue changes into the apical tissue, is the most ideal physiologic apical limit of the working length. However, the CDJ and apical constricture do not always coincide, particularly in senile teeth as a result of cementum deposition, which alters the position of the minor diameter. In an attempt to measure the working length to a value that almost coincides with the actual length or anatomic length and to overcome all the errors that could occur due to the limitation of the present techniques used, electronic apex locators with their inherent capacity to minimize the errors and the simplicity of the technique involved in the calibration of working length seems to be an important break through in the field of Endodontics. Modern electronic apex locators can determine this position with accuracies of greater than 90% but still have some limitations. Knowledge of apical anatomy, prudent use of radiographs and the correct use of an electronic apex locator will assist practitioners to achieve predictable results.

Detection and antifungal susceptibility testing of oral Candida dubliniensis from human immunodeficiency virus-infected patients.

Context: Candida dubliniensis, an opportunistic yeast that has been implicated in oropharyngeal candidiasis (OPC) in patients infected with Human Immunodeficiency Virus (HIV) may be under-reported due to its similarity with Candida albicans. Resistance to Fluconazole is often seen in C. dubliniensis isolates from clinical specimens. Aims: To know the prevalence of C. dubliniensis in OPC in patients infected with HIV and their antifungal susceptibility pattern. Settings and Design: One hundred and thirty-two HIV seropositive individuals and 50 healthy controls were included in the study. Materials and Methods: Two oral swabs were collected from the site of the lesion from 132 HIV-infected patients. Oral rinse was obtained from 50 healthy controls. Samples were inoculated on Sabouraud's dextrose agar (SDA) medium and on HiCrome Candida Differential Agar (CHROM agar) medium. Isolates were speciated by standard tests. Dark green-colored, germ tube positive isolates, which failed to grow at 420C and negative for xylose assimilation were identified as C. dubliniensis. Antifungal susceptibility test was performed by Macro broth dilution technique (National Committee for Clinical Laboratory Standards guidelines). Results and Conclusions: From 132 patients, 22 (16.3%) C. dubliniensis were isolated; samples from healthy controls did not reveal their presence. Antifungal susceptibility test showed higher resistance among C. dubliniensis isolates to azoles compared to C. albicans. Five (22.7%) isolates of C. dubliniensis were resistant to Fluconazole followed by four (18.2%) to Ketoconazole. This study emphasizes the importance of identification and antifungal susceptibility testing of C. dubliniensis in HIV-infected patients.

Changing characteristics of Vibrio cholerae: emergence of multidrug resistance and non-O1, non-O139 serogroups.

The serogroups and antimicrobial susceptibility patterns of V. cholerae isolated in Hubli, India during the years 2000 to 2004 were monitored. A total of 256 V. cholerae isolates were obtained during the study period, of which 129 (50.4%) belonged to serogroup O1 while the O139 and non-O1, non-O139 serogroups constituted 61 (23.8%) and 66 (25.8%) isolates, respectively. V. cholerae O1 Ogawa was the predominant isolate during the first 2 years of the study. However, this was replaced by V. cholerae non-O1, non-O139 serogroups in the following years. The V. cholerae, which was susceptible to most enteric antimicrobials in 2000, was found to be multidrug resistant in subsequent years, with the development of fluroquinolone resistance since 2002. Surveillance of the epidemiological and microbiological characteristics of V. cholerae provides useful information for managing cholera cases. The V. cholerae non-O1, non-O139 serogroups coupled with multiple antimicrobial resistance may form a group of emerging diarrheal pathogens in the tropics.

Significance of isolation and drug susceptibility testing of non-Candida albicans species causing oropharyngeal candidiasis in HIV patients.

Oropharyngeal candidiasis (OPC) continues to be a common opportunistic infection in patients infected with Human Immunodeficiency Virus (HIV) and is predictive of increasing immunosuppression. Though Candida albicans remains the predominant isolate, a rise in the frequency of isolation of non-albicans Candida (NAC) species is being observed. The levels of virulence and the sensitivities to available antifungal drugs vary among these species. Of 340 HIV seropositive patients in this study, 132 (38.8%) had oral lesions suggestive of candidiasis. Samples were collected from the lesion using sterile cotton swabs. Isolation and speciation were done by standard techniques. Antifungal drug susceptibility testing was done by macro broth dilution. The total number of Candida isolates was 135, of which, 45 (33.3%) were NAC species and 90 were C.albicans (66.6%). Of the NAC species, C. dubliniensis was the predominant pathogen (22,48.9%). Antifungal susceptibility testing showed that 14 (31.1%) of the NAC species and 11 (12.2%) of C. albicans were resistant to fluconazole (MIC > 8 microg/ml). A very high MIC of > 32 microg/ml was noted among the NAC species resistant to fluconazole.

Listeria monocytogenes meningitis: an uncommon opportunistic infection in HIV/AIDS.

OBJECTIVE: To report an interesting case of meningitis caused by Listeria monocytogenes meningitis in an HIV seropositive individual. MATERIALS & METHODS: A previously healthy 45 years old HIV seropositive man, presented with atypical clinical features of meningitis. Blood and Cerebrospinal fluid (CSF) were obtained for biochemical and microbiological investigations. RESULTS: CSF analysis showed pleocytosis with lymphocytic predominance. Gram stain of CSF was negative; however culture yielded growth of gram positive bacilli with tumbling motility. Based on relevant biochemical tests the isolate was identified as Listeria monocytogenes. Patient was treated with i.v. ampicillin and recovered completely. CONCLUSION: Listeriosis is relatively rare in HIV/AIDS among the immunodeficient populations. Atypical clinical and laboratory findings make the diagnosis difficult and these infections may go undiagnosed. Since it is easily treated with readily available antibiotics, it is important to diagnose them at the earliest and thereby prevent treatment failure.

Extended spectrum beta lactamase producing Klebsiella pneumoniae in neonatal intensive care unit.

OBJECTIVE: As infections due to Extended Spectrun beta Lactamase (ESbetaL) producing Klebsiella pneumoniae were increasing in the NICU at Karnataka Institute of Medical Sciences Hospital, Hubli, India, the present study was carried out to identify any environmental sources and the mode of transmission. METHODS: Environmental samples from various sites were collected monthly for a period of six months. RESULTS: ESbetaL producing K. pneumoniae were isolated from all the sites except room air at least on one occasion. ESbetaL producing K. pneumoniae was always isolated from one of the incubators, medicine trolley and sink; while at least one of the health care workers carried it in the hands four out of six times tested. ESbeta L producing K. pneumoniae with similar antibiogram were also isolated from the clinical samples obtained from the neonates. CONCLUSION: Widespread use of third generation cephalosporins as a pre-emptive antibiotic for suspected cases of septicaemia may have contributed to emergence of ESbetaL producing K. pneumoniae in addition to other risk factors. ESbetaL producing K. pneumoniae have extensively colonised the environment of the NICU. Transmission of these pathogens to the neonates has probably occurred through the healthcare workers. Efforts to improve hand hygiene among the healthcare workers and mothers are urgently needed.

Methicillin resistant Staphylococcus aureus infections-implications in hospital infection control.

BACKGROUND: A significant part of nosocomial infections are caused by methicillin resistant Staphylococcus aureus (MRSA). Nosocomial MRSA are known to be multidrug resistant and thus difficult to treat. METHODS: A 2 year study was conducted between January 2001 and December 2002 at Karnataka Institute of Medical Sciences Hospital, Hubli to assess the prevalence of MRSA and its antibiotic susceptibility pattern in various wards. RESULTS: S. aureus was isolated from 714 patients, 283 (37.53%) of which exhibited methicillin resistance. Although these MRSA were multidrug resistant in all the wards, the problem was more severe in NICU and orthopedic wards. CONCLUSION: The results highlight the need for effective implementation of infection control measures in the hospital. There is a need for the judicious use of antimicrobial agents in the hospital and outside as their indiscriminate use can exert pressure in selecting out MRSA and other multidrug resistant organisms.

Neonatal sepsis caused by Salmonella enterica serovar Weltevreden.

Salmonella enterica serovar Weltevreden is an uncommon cause of gastroenteritis occurring worldwide. For the first time, we report 2 cases of neonatal sepsis caused by S. Weltevreden from Hubli, India. In the first case, the neonate had features of septicemia and S. Weltevreden was isolated from a blood culture. The other neonate had omplalitis and clinical features of septicemia. S. enterica serovar Weltevreden was isolated from the umbilical swab culture of this neonate. Even though extensive investigations were conducted, the source of infection could not be identified. Both neonates recovered completely after appropriate antibiotic and supportive therapy.

Community-acquired methicillin-resistant Staphylococcus aureus infections in a south Indian city.

There are increasing numbers of reports of community-acquired Staphylococcus aureus being resistant to methicillin. The present study was undertaken as no such reports are available for the developing nations. In a prospective study, between June to December 2001, at the Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, methicillin-resistant S. aureus (MRSA) isolates were tested for clindamycin-susceptibility, a surrogate marker for community-acquired strains. Patients with clindamycin-susceptible isolates were interviewed to determine if they had acquired them in the community and also to identify any risk factors. Of the 116 patients with S. aureus infection, 18.1% had infection with methicillin-resistant strains. Clindamycin-susceptible MRSA accounted for 61.9% of cases. Among these, 46.1% patients were confirmed to have acquired the MRSA from the community, based on inclusion criteria. The community-acquired MRSA were susceptible to multiple antibiotics, as compared to nosocomial isolates. Except for one patient with diabetes mellitus, no other patient had any known risk factor for acquiring MRSA. As significant numbers of MRSA infections are being acquired from the community, treatment options for S. aureus infections may need to be reviewed. Effective infection control programs for the community should be considered to prevent the spread of these infections.

Intestinal helminthic infestation in children.

In this study of fecal samples from 1000 children below 6 years of age, 680 (68.0%) detected to have intestinal helminthic infection. The incidence of intestinal helminthiasis in urban group of children was 56.8% (284 out of 500 tested) while in rural group of children was 79.2% (396 out of 500 tested). Both in rural and urban population Ascaris lumbricoides was the single predominant species, whereas a combination of A. lumbricoides and Trichuris trichiura was common multiple infection. All cultures of fecal samples positive for hook worm ova revealed the prevalent species as Necator americanus in this area.

Incidence of Vibrio cholerae serogroup O139 infection with low virulence in Hubli, Karnataka (India).

384 stool samples from patients with acute gastroenteritis were processed by standard culture techniques and antibiogram of V. cholerae was performed. Stool samples from 93 (24.22%) patients yielded V. cholerae, 58 (62.37%) of which were V. cholerae, El Tor O1 Ogawa, 31 (33.33%) V. cholerae O139 and 4 (4.30%) V. cholerae non O1 non O139. Of the culture proven cholera cases watery diarrhoea was observed in 79 (84.95%), vomiting in 57(61.29%), muscle cramps in 21 (22.58%) and sweating in 18 (19.35%). Majority of these patients presented with moderate dehydration 57 (61.29%). Mild dehydration was found in 19 (20.43%) and severe dehydration in 17 (18.28%). While majority of patients with O139 infection had mild to moderate dehydration 25 (80.65%), severe dehydration was more common with O1 infection 11 (64.71%). This study reflects the importance of monitoring the V. cholerae by serogrouping, antibiogram typing, which keep on varying constantly.