Normative values of neck muscle strength in adult population of Delhi NCR region

Background: The neck pain is common problem in the adult population. Neck muscles have the potential to regulate the neck movement and to maintain its physiological functions and hence should have a quantitative value for strength. The aim of this study was to evaluate the neck muscle strength which would be used as a reference in the analysis of neck pain. Further aim of this study was to analyze the effect of age, weight, height, gender, body mass index (BMI) on muscle strength. Methods: This study was an observational study conducted at physiotherapy department of I. T. S. Institute of Health and Allied Sciences from 23 September 2023 to 24 February 2024.The study comprised 1200 participants, both male and female, in the age group of 21 to 50 years old. Isometric strength measurements for several neck muscles were made using a handheld dynamometer after ethical approval. Normative strength values were calculated, and multivariate analysis was performed to conclude the effect of age, weight, height, gender and BMI on neck muscle strength. Data analysis was calculated using statistical package for the social sciences (SPSS) version 21.0. Results: Males are at lower risk than females to develop neck pain as males are having more strength than females in all age groups. Weight and age were positively associated with muscle strength (p<0.5). Height and BMI showed no significant correlation to muscle strength (p>0.5). Conclusions: This research provides the normative ranges of neck muscle strength in the adult population that will serve as a baseline and aid in prevention, maintenance and treatment of neck pain. It provides the standard for the clinician to compare the muscle strength of different age groups and unaffected.

Role and safety of prokinetic drugs in the treatment of upper gastrointestinal motility disorders: an Indian perspective

Upper gastrointestinal (GI) motility disorders such as functional dyspepsia (FD), gastroesophageal reflux disease, and gastroparesis are associated with symptoms such as acid reflux, regurgitation, bloating, and heartburn. This review summarizes the prevalence, diagnosis and management of upper GI motility disorders in clinical practice in India, with focus on the use of prokinetics. Lifestyle and dietary modifications, psychotherapy, and pharmacotherapy form the armamentarium for management of motility disorders. Among pharmacotherapies, prokinetics increase gastric emptying and provide symptomatic relief. However, neurological and cardiovascular safety issues are associated with commonly prescribed prokinetics making it important to judiciously select an appropriate drug after weighing out its risk-benefit profile. While metoclopramide, domperidone, and levosulpiride are widely prescribed prokinetics in Indian clinical practice, they are associated with adverse effects such as extrapyramidal symptoms (EPS) and cardiovascular side effects. Itopride, which is a prokinetic with dual mechanism of action, has been found to have equivalent efficacy to other prokinetics and has shown significant improvement in quality of life and symptoms in randomized controlled trials in patients with FD. It acts as a D2 receptor antagonist and acetylcholinesterase inhibitor. Both these actions cause increase in acetylcholine levels, which increases gastric motility. Itopride also has negligible cardiac and neurological safety concerns. Thus, it is a relatively safer molecule compared with other prokinetics, with no EPS or cardiotoxicity concerns and can be used for the long-term management of upper GI motility disorders in a wide pool of patient groups either alone or in combination with other drug classes.

Effect of addition of disodium EDTA to ceftriaxone and sulbactam on the susceptibility of gram-negative pathogens

Background: Indiscriminate use of antibiotics has resulted in the emergence of resistant pathogens. Ethylenediaminetetraacetic acid (EDTA) is a well-known chelating agent. EDTA is also a potentiating and sensitizing agent when combined with antibiotics. Objectives of current study were to examine the antibacterial activity of Ceftriaxone+Sulbactam+ Disodium EDTA against pathogens isolated from urine, blood, and respiratory secretions (sputum, tracheal tube aspirates) and compare it with other antibiotics. Methods: The study was a retrospective study conducted in a tertiary care hospital between January 2019 and December 2019. Gram-negative isolates were obtained from clinical samples of urine, blood and respiratory samples were tested for susceptibility to different antibiotics and also for ESBL and MBL production Results: Respiratory isolates: Against Acinetobacter baumannii, 64% of isolates were sensitive to Ceftriaxone Sulbactam EDTA. Highest resistance rates were observed with Piperacillin tazobactam, amoxicillin clavulanate and Cefoperazone+Sulbactam. All Clinical isolates of Pseudomonas were sensitive to Ceftriaxone Sulbactam EDTA. Blood isolates: 25% isolates of Acinetobacter were sensitive to Ceftriaxone Sulbactam EDTA as compared to just 13% susceptibility for Cefoperazone+Sulbactam Urine isolates: 78% E. coli were sensitive to Ceftriaxone Sulbactam EDTA. Conclusions: The combination of ceftriaxone, sulbactam and disodium edetate was effective even against pathogens isolated from isolates from respiratory secretions, blood and urine resistant to other antibiotics.

Impact Of Integrated Yoga Practice on Immune Parameters and Quality of Life of Adult People Living With HIV: Protocol for A Randomized Open-Label Trial in Chittoor, India

Background: Yoga therapy can be a promising adjunct to antiretroviral therapy. However, evidence on the ef-fectiveness of Yoga therapy is scanty. The proposed trial will estimate the effect of integrated yoga practice for six months on immune parameters (CD4 (cluster of differentiation 4), viral load) among adult people living with HIV (PLWH) and its cost-effectiveness from the healthcare system’s perspective. Methods: In this randomized open-label parallel-group trial, 110 PLWH in stage 2 HIV, between 18 and 49 years in the intervention arm and 220 PLWH in the same stage will be recruited by block randomization. Inte-grated yoga practice will be given for six months in the intervention arm, and health education on yoga prac-tice in the control arm, besides antiretroviral therapy. After six months, the difference in immune parameters, cardio-metabolic indicators and quality of life (QOL) will be assessed. Besides, an economic evaluation will be done with sensitivity analysis. If found useful, the intervention can be tested at large scale for further confir-mation of the outcomes. Irrespective of the study's outcome, the results will be disseminated through peer-reviewed journals.

Nutritional Status of Pre-School Children Attending Anganwadi Centres in Chittoor, Andhra Pradesh, India

Context/Background: Malnutrition among children is a major public health problem in India. The objective of the study is to assess the nutritional status of pre-school children and to identify the so-cio-demographic determinants of malnutrition. Methodology: In this community-based cross-sectional study, 194 under-five children were recruited from rural and urban areas of Chittoor district, Andhra Pradesh. Anthropometric measurements were measured and age standardized weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated. The proportion of under nutrition (WAZ <-2 standard deviation (SD)), stunt-ing (HAZ <-2SD), and wasting (WHZ <-2SD) were calculated along with the determinants. Results: The mean age of the participants was 40.5 months (SD- 9.1 months), 101 (52.1%) were from rural areas, and 96 (495%) females. The HAZ values were significantly low in- urban children (-0.81; 95%CI: -0.4, -1.21), among the non-Hindu children (-0.92; 95%CI: -0.35, -1.5). The overall prevalence of underweight, stunting, and wasting were- 13.4% (95%CI: 8.5%, 18.3%), 23.7% (95%CI: 17.6%, 29.8%), and 19.6% (95%CI: 11.9%, 25.3%) respectively. Urban residence (OR 6.75; 95% CI: 3.03 – 15.04) was a strong predictor of stunting. Conclusion: Malnutrition remains to be a public health problem in this area. Strengthening of existing programs should be the key strategy in combating malnutrition.

Social Mapping in Nursing Education- Steps and Implication

Background: Social mapping, though an old approach in public health education and research, not prac-ticed much in nursing education. This study was conducted to describe the social mapping process in a semi-urban area in the Chittoor district of Andhra Pradesh in India and to describe the implications of such social mapping from the students' perspective. Methods: This participatory rural appraisal was conducted for the Bachelor of Nursing Students in a semi-urban settlement in the state of Andhra Pradesh in India. The social mapping process was conduct-ed in three broad steps- classroom-based teaching of social mapping, conducting social mapping in the community and a debriefing session with the students. The major outcome of this educational activity was the social map. In addition, we also came up with the students’ implications through group discus-sion. Results: A facility map was constructed by the community members which was replicated by the teach-ers. The map was triangulated by the teachers through a transect walk in that area. The students came out with various academic, clinical, and administrative implications from this educational session. Conclusion: Social mapping can be used as a potential tool in nursing education. More evidence is re-quired on this learning approach before recommending it in the Community Nursing curriculum.

The Epidemiological and Mycological Profile of Superficial Mycoses in India from 2015 to 2021: A Systematic Review

Background: The epidemiological and mycological patterns of superficial mycoses across various geographic regions of India across the last few years are changing. Objective: This study was performed to evaluate the epidemiological and mycological profile of superficial mycoses in India between 2015 and 2021. Methods: In this systematic review, the PubMed database was searched for all observational studies published between January 1, 2015, and December 31, 2021, which had evaluated the clinico‑mycological profile of superficial mycoses among outpatients from various parts of India. Descriptive statistics was used to represent the results. Results: Forty studies(21 from the north, three from the northeast, five from the east, seven from the south, one from the west, and three from multiple regions of India) were included. Male patients and those of the age group of 21–40 years were most commonly affected. The proportion of dermatophytes as causative organisms was consistently high across all regions and throughout the study period (23.6%–100%). Among dermatophytes, the proportion of Trichophyton mentagrophyte (14.0%–97.2%) and Trichophyton rubrum (0%–69.1%) was consistently high across all regions. The prevalence of T. mentagrophyte showed a rising trend, while that T. rubrum showed a declining trend from 2015 to 2021. Conclusions: The epidemiological and mycological pattern of superficial mycoses showed a fairly similar trend across various regions of India from 2015 to 2021. Dermatophytes were the main causative agents of superficial mycoses; the most common species were T. mentagrophyte and T. rubrum. A rising trend of T. Mentagrophyte infection was found.

Internet addiction among medical undergraduates in a medical college of West Bengal- a cross-sectional study

Background: The era of 21st century is burdened with internet usage worldwide specially in the developing countries such as India. Internet addiction has been related to physical, social, psychological impairment. Aim& Objectives: To find out the prevalence of internet addiction among the medical students and the effect of internet addiction on health status among them. Settings and Design: This was an observational descriptive study of cross-sectional design conducted in a tertiary medical college of West Bengal. Material & Methods: All the undergraduate medical students were approached and interview was done using interview schedule consisting of sociodemographic characteristics, Young’s criteria of internet addiction test and Duke’s health profile screening test. Statistical analysis used: Data was analysed using SPSS version 20&presented in percentages, mean with standard deviation, ANOVA with Tukey’s Post-hoc test. Results: Total of 201 participants responded giving a response rate of about 50%. The distribution of respondents as per Young’s criteria of internet addiction which showed that majority of the respondents were mild addicted (58.7%) & moderate addicted (15%).Comparison of Duke health profile score across various internet addicts where physical health score differs significantly among the non-addicted (81.42+20.02) vs mildly addicted (67+20.36)& moderately addicted (63.31+ 20.15) participants (p=0.00). Mental health score also differs considerably among the non-addicts (78.16+18.36) vs mildly addicts (67+18.28) & moderately addicts (61.87+18.33) (p= 0.00). Conclusions: A good number of medical students were addicted to internet that requires timely remedial action. Educational institutions had to formulate strategies so that proper action could be taken.

A Case of Bilateral Retinal Hemorrhage with Cotton Wool Spot Following Viper Bite.

A 38 years male, admitted in the department of Internal Medicine with a history of snake bite in his left lower leg during agriculture work. He was treated with anti snake venom after admission. He had history of dimness of vision in both eyes. On examination, swelling and subcutaneous hemorrhage was noted in his left leg. His best corrected visual acuity (BCVA) was 6/60 in the both eyes. Fundus examination with 90 D lens and Indirect Ophthalmoscopy of both eyes showed retinal hemorrhage with cotton wool spots. Blood tests revealed increased titers of D-dimer and fibrin degradation products. The patient was followed up regularly at 2 weeks interval and BCVA and Fundus examination was carried out. At the end of 10 weeks, retinal hemorrhages had significantly cleared in both eyes with improvement of vision in both eyes (BCVA of right eye at last follow-up 6/6 and left eye 6/9).

Alopecia universalis in a case of systemic lupus erythematosus.

We report a case of systemic lupus erythematosus (SLE) who presented with alopecia universalis. MR, a 23 years female patient was admitted with alopecia universalis and other features of SLE like peripheral arthritis, fever, nephritis, butterfly rash over the malar regions, positive ANA and anti-ds DNA antibodies. There was a gap of four years between the onset of alopecia universalis and other clinical features of SLE. The alopecia was of non-scarry variety and responded to systemic and topical steroids.

Estimation of vacuolating cytotoxin secreted by different strains of Helicobacter pylori using bead enzyme-linked immunosorbent assay & its correlation with bacterial genotype.

BACKGROUND & OBJECTIVES: A highly sensitive bead enzyme-linked immunosorbent assay was applied for the quantitative determination of vacuolating cytotoxin (VacA) released in the culture supernatant of 40 well characterized Helicobacter pylori strains in order to clarify the significance of allelic combination of the vacA gene as the predictor of the level of toxin secretion and also to determine the most appropriate genotype of H. pylori associated with high VacA release. Attempts were also made for the detection of VacA in the gastric juice of patients for the rapid diagnosis of H. pylori infection. METHODS: The genotypes of 40 H. pylori strains cultured from the gastric biopsy samples were determined by specific PCRs. The cell-free culture supernatant of the strains as well as the gastric juice of the patients were used for bead-ELISA and the purified VacA from the H. pylori strain ATCC49503 was used as positive control. RESULTS: Ninety per cent of the strains with vacAs1m1 allele combination secrete on an average 146.4 ng/ml of VacA while the corresponding value was 19.1 ng/ml for s1m2 strains. None of the s2m2 as well as the ice negative H. pylori strains produced detectable VacA in the medium while strains expressed the toxin irrespective of the presence or absence of cagA gene. Fifteen of 22 gastric juice samples yielded positive bead-ELISA results. INTERPRETATION & CONCLUSION: vacAs1, vacAm1 and iceA1 could be considered as the determinants of high VacA secretion. Also, the detection of VacA by bead-ELISA in the gastric juice could be considered as an alternative approach in the diagnosis of H. pylori infection.

Treatment of chronic anal fissure with topical glyceryl trinitrate: a double-blind, placebo-controlled trial.

BACKGROUND: Topical glyceryl trinitrate (GTN) may produce healing of anal fissure by decreasing the high resting anal sphincter pressure in these patients. The present study assessed the efficacy of GTN in chronic anal fissure in a double-blind placebo-controlled trial. METHOD: Patients with chronic anal fissure (for more than 8 weeks) underwent measurement of maximum anal resting pressure (MARP) before and 12 minutes after application of either 0.2% GTN or placebo ointment in a randomized manner. They then received twice-daily local application of their respective ointment for 6 weeks. Symptoms and healing of fissure were assessed; patients were evaluated at 3 months for evidence of relapse. RESULTS: 19 adult patients (12 men) were studied; 10 received GTN and 9 placebo. Mean (SD) MARP decreased from 131.0 (32.3) cm H2O to 93.5 (28.4) cm H2O (p<0.05) with GTN and from 150.5 (36.9) cm H2O to 142.8 (35.0) cm H2O (p=ns) with placebo. Fissure healed in 7 of 10 patients treated with GTN and 2 of 9 patients treated with placebo (p<0.05). There was no relapse of fissure in either group. CONCLUSION: Local application of GTN was effective in healing chronic anal fissure.

Induction of oxidative stress in antitubercular drug-induced hepatotoxicity.

BACKGROUND AND AIM: Oxidative stress could play a role in the pathogenesis of antitubercular drug (ATD)-induced hepatotoxicity. We therefore studied the plasma level of reduced glutathione (GSH) and malondialdehyde (MDA) in patients with ATD-induced hepatotoxicity (cases), ATD-treated controls (disease controls) and in healthy volunteers. METHODS: This study was carried out in a case-control design. Twenty-one cases, 21 age- and sex-matched disease controls, and 10 healthy volunteers were enrolled. Plasma levels of GSH and MDA were measured. RESULTS: Plasma levels of GSH (median [range] 11.5 [6.2-21.2] mmol/dL) and MDA (1390 [560-2310] nmol/dL) of cases were significantly different (p<0.01) from GSH (18.4 [10.5-24.4]) and MDA (290 [240-550]) of disease controls. Further, plasma GSH and MDA levels of both the ATD-treated groups were different from those in healthy controls. CONCLUSION: Lower levels of plasma GSH and higher levels of MDA may be due to oxidative stress resulting from ATD therapy.

Esophageal and gastric dysmotility in non ulcer dyspepsia.

BACKGROUND: The pathophysiology of non ulcer dyspepsia is poorly understood. Data on gastrointestinal motility alterations in this condition in the Indian population are scanty. We studied esophageal and gastric motility in patients with non ulcer dyspepsia. METHODS: 58 consecutive patients with non ulcer dyspepsia (according to the Rome criteria) were studied; 10 healthy volunteers were studied as controls. Esophageal transit of solid and liquid boluses (in all patients) and solid-phase gastric emptying (in 20 patients) were studied using scintigraphic techniques. RESULTS: Delayed esophageal transit and delayed gastric emptying were observed in 32 (55%) and 9 (45%) patients, respectively. Delay of both esophageal and gastric transit was found in 5 patients. Mean (SD) esophageal transit for liquid bolus was significantly delayed in patients (9.3 [3.7] s) compared to controls (7.0 [2.0] s; p < 0.01). Mean (SD) gastric emptying time (T50) was significantly delayed in patients (61.6 [13.6] min) compared to controls (50.0 [5.0] min; p < 0.001). Esophageal and gastric delayed transit was found in about two thirds of patients with dysmotility-like dyspepsia, but there were no significant difference in these abnormalities among different subgroups of dyspepsia. CONCLUSION: High prevalence of esophageal and gastric transit delay was found in non ulcer dyspepsia, particularly in the dysmotility subgroup.

Micropropagation of sweet orange, Citrus sinensis Osbeck. for the development of nucellar seedlings.

Protocol for micropropagation of elite plants of sweet orange (Citrus sinensis) through nucellar embryo culture has been standardized. Three to four nucellar embryos and a zygotic embryo could be excised from a single mature seed and successfully generated as healthy plants in basal MS medium. MS medium supplemented with NAA (1 mg/L) or 2, 4.D (1 mg/L) promoted callus development in both nucellar and zygotic embryos. GA3 (1 mg/L) enriched medium induced plantlets initiation but their growth was very poor. No significant differences were observed between initial growth patterns of nucellar and zygotic seedlings developing from the same ovule. Five to six shoots were obtained from collar region of both category of embryos in MS medium supplemented with BAP (1 mg/L) within 60 days of inoculation. The number of plantlets were almost doubled after their transfer in the same medium and culture for another 30 days. Higher doses of BAP resulted in initiation of callus directly from the embryos. The regenerated shoots (2-3 cm) could be rooted in MS medium supplemented with either only NAA (0.75 mg/L) or NAA (0.50 mg/L) and IBA (2.0 mg/L). A number of plantlets could be obtained from a nucellar embryo grown shoot within a limited time period.