Cardiovascular Responses to Commonly Used Tests In and Outside of the Laboratory Settings

Several tests are available for assessing cardiovascular response to various interventions which may be given in the laboratory, or outside of it in the field. The tests are meant to excite or deactivate cardiovascular and other sensory receptors which signal the central mechanisms. They have been found useful in generating data to study cardiovascular effects on subjects exposed to specialized physical training (e.g., athletes), in the evaluation of people engaged in special occupations such as pilots, astronauts, and other military personnel, and in training undergraduate and postgraduate students. If the response does not fit into the physiological norm, it may reflect a temporary aberration, or a more serious defect in the cardiovascular control mechanism because of disease. Interpretation of data generated may vary between various operators/observers. Here, an attempt has been made to bring out responses of the cardiovascular system to the commonly used tests, and their applicability in clinical situations.

HIV/AIDS and Its Prevention: A Cross-sectional Study to Evaluate Knowledge, Awareness, and Attitude among Medical Students

Background and Objective: HIV and AIDS is a major global health problem. The lack of knowledge and misconceptions about its modes of transmission among the public, medical students, and healthcare professionals is accountable for the rapid spread of HIV, social stigmatization and discrimination of HIV infected patients. This study aimed to evaluate the knowledge and awareness about HIV and AIDS and also to know the attitude of medical students towards HIV and AIDS patients. Materials and methods: A total of 117 medical students of the 5th year participated voluntarily in this descriptive cross-sectional study. The data was collected in a pretested questionnaire, tabulated and analyzed in Microsoft Excel and SPSS software version 22. The quantitative data were expressed in terms of numbers and percentages. Results: The knowledge among students about HIV is satisfactory. All students (100%) were aware of HIV and AIDS, and its causative agent. The majority of students were aware of modes of transmission, diagnostic tests, and major preventive measures. However, only a few students were aware of the availability of anti-retroviral drugs for treating HIV, few had an erroneous belief that HIV is curable and vaccine-preventable. The study also observed misconceptions among students (12-40%) about spreading of HIV such as by mosquito bite, handshaking, sharing toilets, utensils, and food. Conclusion: From the results of our study, it is suggested that there is a need for an implementation of HIV and AIDS training programs at regular intervals to medical students at the beginning of their inception into a medical course. This would reduce the knowledge, attitude, and practice gap among medical students.

Current Concepts of Pathophysiology of Vasovagal Syncope and its Evaluation and Management: A Review

Vasovagal syncope (VVS) with a sudden, temporary loss of consciousness (LoC) is a common phenomenon in the young and the elderly. Though generally described as innocuous, it may lead to serious consequences in special category of people (pilots), or in the elderly in whom LoC may lead to a fall and serious injury. The topic has been copiously researched upon and discussed in medical literature over the last few decades, but the exact mechanisms which lead to the disability have yet to be fully agreed upon. Changes in cardiovascular baroreceptor sensitivity, aberrations in the complex interaction amongst the nucleus of the tractus solitarius and the nuclei around it, inability of the peripheral circulation to respond to autonomic vasoconstrictors, or excess production of vasodilators such as nitric oxide produced locally have been considered in its pathophysiology. Various extraneous situations like dehydration, exposure to heat stress, medications, psychological factors may adversely stress regulatory physiological responses and promote occasional episodes of VVS. More complex dysautonomia could be a reason for the recurrent VVS. Differences between brain structure of VVS sufferers and normal subjects have been proposed. Head-up tilt table (HUT) test is the most widely applied investigation for evaluating VVS episodes. Lower body negative pressure (LBNP) has also been used. Enhancement of the orthostatic stress may be done by simultaneous use of both, or with peripheral vasodilators. As to whether such an enhancement is necessary is debatable. Management with increased salt and fluid intake, corticosteroids, beta adrenergic receptor blockers, alpha adrenergic receptor stimulants, selective serotonin reuptake inhibitors, and nitric oxide synthase inhibitors have been tried with variable success.

Improved detection of Shigella using Escherichia coli medium enrichment: Polymerase chain reaction from stool samples.

Laboratory diagnosis of shigellosis using conventional culture technique is limited by lower sensitivity and higher turnaround time. Here, we have evaluated the role of polymerase chain reaction from stool samples after enrichment in Escherichia coli medium for detection of Shigellae. The technique not only increased the sensitivity but also decreased the turnaround time.

Pyonephrosis due to Chryseobacterium gleum: A first case report.

Chryseobacterium spp are widely distributed in nature but data of their isolation from clinical samples is scanty. Here, we report the first case of AmpC producing C. gleum causing pyonephrosis in a patient having bilateral nephrolithiasis on double J (DJ) stent. The present isolate was resistant to vancomycin, erythromycin, clindamycin, carbapenems and ciprofloxacin and susceptible to tetracycline and minocycline. The patient was treated with tetracycline and recovered without the need for removal of the DJ stent. The environmental surveillance carried out to trace the nosocomial origin of the isolate was negative. Since antimicrobial susceptibility of this isolate is different from previous reports, we emphasise that in vitro susceptibility testing should be sought to choose optimal antimicrobial agents for these Nonfermentative Gram-Negative Bacilli (NFGNBs) with different susceptibility patterns.

Newborn Screening for G6PD Deficiency: A 2-year Data from North India.

Glucose-6-phosphate dehydrogenase (G6PD) defi ciency is the most common erythrocyte enzymopathy, being present in more than 400 million people worldwide that may lead to neonatal jaundice or hemolytic crisis due to drugs or infections. In our study, we aimed to study the frequency of G6PD defi ciency in neonates and the proportion of defi cient neonates, who developed neonatal hyperbilirubinemia in the study population. The study was an observational one, conducted at the Division of Genetics of Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, over a 2-year period from January 2011 to December 2012. A total of 6,000 newborns delivered during that period underwent newborn screening on 24-72 h of birth. Neonatal hyperbilirubinemia was presented in 13.3% of the study population. Of female neonates, 16% demonstrated G6PD defi ciency. This is worth noting for an X-linked recessive trait. Thus, in view of a high gene frequency for a disorder that is manageable with just elimination of few drugs and foodstuff, we stress the need for a newborn screening program for G6PD deficiency.

Community acquired pneumonia and cardiac diseases: A fatal association.

Background. Community acquired pneumonia (CAP) remains a common disease condition attributing to a significant mortality and morbidity worldwide. Acute cardiac events (ACEs) are one of the most life-threatening complications in patients with severe pneumonia. Methods. Retrospective study of burden of ACE in 105 patients admitted with CAP. Results. Twenty-five patients with (CURB-65) score ranging between 0 – 2 did not require intensive care unit (ICU) admission and were admitted in the ward and high dependency unit. Of these, 12 developed ACE and 4 required to be shifted to the ICU for further management. Eighty patients with a CURB—65 score of greater than 3 were admitted to the ICU. Of the patients admitted to the ICU, 10 with ACE died; 2 patients without ACE also died. Conclusions. Our observations suggest that ACE constitute an important cause of morbidity and mortality in patients with CAP requiring hospitalisation.

Community Based Monitoring Under National Rural Health Mission in Maharashtra: Status at Primary Health Centers.

This study compares the implementation of community-based monitoring (CBM) in 45 primary health centers (PHCs) in the pilot phase in Maharashtra with the equal number of randomly selected PHCs not implementing CBM (non- CBM) from the same districts. Information was collected by teams from Community Medicine Departments by visiting selected PHCs. Establishment of monitoring committees and training of medical offi cers (MOs) had been completed as required but only 36.36% MOs were trained. Only 43.18% MOs received the facility report card. Most of the MOs (90.90%) attended Jansunwai and opined that it had increased community awareness and the barriers between the people and PHC staff were broken. There was no difference in fund utilization and meetings of Rugna Kalyan Samittees. Percentage of Institutional deliveries and women receiving Janani Suraksha Yojana benefi ts among home deliveries was more in the non-CBM group of PHCs.

Incidence of chronic thrombo-embolic pulmonary hypertension following acute pulmonary thrombo-embolism: An Indian perspective.

Chronic thrombo-embolic pulmonary hypertension (CTEPH) remains a severe disabling disease causing a significant amount of mortality and morbidity worldwide. The incidence and severity of this condition is quite obscure. The initial inciting event, the reason of progression, the natural history of the disease and the predictors of adverse outcomes are not yet adequately clarified. From the Indian subcontinent, data regarding this disease is limited. But with the advent of the multi-detector computed tomography, the understanding of this disease is gradually improving. As most of the available data suggests, acute pulmonary embolism (PE) as the main initial trigger leading to CTEPH, we prospectively analysed all patients being admitted in our hospital with acute PE and followed them over a period of one-and-a-half years to determine the incidence of CTEPH in this group. This is just an attempt to increase the awareness about the disease pattern and determine the rate of progression, risk factors of poor outcome, so that early detection and prompt treatment can benefit the patient care.

Implementation of RNTCP in a private Medical College: Five years' experience.

Background: Revised National Tuberculosis Control Programme (RNTCP) recognizes the need for involvement of all sectors, public and private, to create an epidemiological impact on Tuberculosis control .The private health sector in the country is an important source of care, even with the availability of public health services and Directly Observed Treatment Strategy (DOTS).The data regarding Private-Private mix in our country is lacking. Aim: To evaluate the contribution of {private health sector (Private Medical Colleges and Private practioners (PP)} in TB case-detection, diagnosis and treatment outcomes in Delhi NCR , Ghaziabad, India. Methodology: We analyzed the TB registers from May 2006-Dec 2010 from our institution and recruited the patients in our study, irrespective of the source. We strengthened the referral by promoting educational intra and inter departmental activities and awareness programme with more stress on retrieval action by contact tracing and counselling. We made a list of PP in our drainage area and regularly met them and tried to understand the barriers in referring cases to DOTS centre. During the study, we tried to maintain the flow of information working as a single window information system. We regularly passed on the information of follow up of patients to private practioners referred to us by them to generate confidence in them. During the study, no incentive was offered to any patient. Various indicators and data were collected annually and analyzed statistically. Statistics: Retrospective, Descriptive Analysis Results: There was a substantial increase of 116.3% in the total patients referred from all sources to Santosh Hospital. The proportion of extra-pulmonary cases was 29.1% to 34.4% of all total cases from the year 2006 to 2010. During subsequent years, we found a significant increase in referral from Private Practioners that was the result of our activities performed in private set up. It was 12.5%, 21.2%, 30.8%, 27.3%, and 29% during 2006, 2007, 2008, 2009 and 2010 respectively. The outcome in our study was in accordance with the outcome at national level under RNTCP. Conclusion: Because of extensive educational activities, single window information system and referring the patients back to private sector after completion of treatment increased the confidence amongst the private physicians. These results strengthen the Private - Private Collaboration and show that a stronger link can be developed between medical college and private setup, leading to implementation of successful Private-Private Strategy.

Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population.

Background & objectives: Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions. Methods: Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group. Results: Mean age of participants was 40.9 ± 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and >3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while it continued to be high in the control arm without interventions (both within group and between group P<0.001). The proportion of ‘low risk phenotype’ increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P<0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 13.3 to 17.8 per cent in the control arm (P<0.001). Interpretation & conclusions: Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden.

Effects of Pranayam breathing on respiratory pressures and sympathovagal balance of patients with chronic airflow limitation and in control subjects

The objective of this study was to compare the effects of Pranayam breathing on respiratory muscle strength measured as maximum expiratory and inspiratory pressures [MEP and MIP] and relevant spirometry parameters in patients with chronic obstructive pulmonary disease [COPD] and in control subjects, and on the sympatho-vagal balance in both the groups. The research was performed in the Clinical physiology Department, Sultan Qaboos University Hospital, Oman. Eleven patients [mean age 43.91 +/- 20.56 yr; mean BMI 21.9 +/- 5.5 kg/m[2]] and 6 controls [43.5 +/- 14.6 yr; 25.4 +/- 3.2 kg/m[2]] learnt and practiced Pranayam. Their respiratory "well being" was noted as a visual analogue score [VAS]. The respiratory parameters were expressed as a percentage change of predicted values. Patients' respiratory parameters were significantly lower than those of controls. Patients' maximum respiratory pressures did not improve after Pranayam; however, they showed significant improvement in VAS 5.4 +/- 2.4 to 7.2 +/- 1.2 [P< 0.03]. Controls showed significant increase in their systolic blood pressure and stroke index after exercise. The vago-sympathetic balance shifted towards sympathetic in both patients and controls after exercise. The improvement in MIP in controls indicated the positive effect of Pranayam exercise; however, it may not be an adequately stressful exercise to produce changes in the respiratory parameters of COPD patients. The increase in VAS in patients suggested improvement in respiratory distress and quality of life

To err is human-case reports of two military aircraft accidents: possible mechanisms of human failure

It has been postulated that pilot error or in-flight incapacitation may be the main contributory factors to 70-80% of aircraft accidents. Two fatal aircraft accidents are presented in which either of the above possibilities may have played a role. The first case report describes an erroneous decision by a fighter pilot to use a seat position adjustment of the ejection seat leading to fatal injuries when he had to eject from his aircraft. Injuries to the body of the pilot, and observations on the state of his flying clothing and the ejection seat were used to postulate the mechanism of fatal injury and establish the cause of the accident. The second case report describes the sequence of events which culminated in the incapacitation of a fighter pilot while executing a routine manouevre. This resulted in a fatal air crash. Possible contributions of environmental factors which may have resulted in failure of his physiological mechanisms are discussed

Phytotoxicity of cadmium on the physiological dynamics of Salvinia natans L. grown in macrophyte ponds.

The objective of this experiment is to study the potential ability of Salvinia natans L. to use in phytoassay for the cadmium toxicity in ecotoxicological studies. It is a simple and cost competitive method. The sensitivity of S. natans in terms of biochemical changes and enzyme activities to Cd2+ was remarkably noticeable. The catalase and protease activity was significantly decreased in the presence of cadmium, with increase of peroxidase and superoxide dismutase activity. The level of protein, carbohydrate and chlorophyll decreased and proline content increased in plants. The maximum permissible concentration of cadmium in different general water quality standards was evaluated and found that cadmium standard is not stringent enough.

In vitro pulp chamber temperature rise during composite resin polymerization with different curing lights.

The damaging effect of temperature increase on the pulp tissue during restorative treatment has been a matter of concern in dentistry for many years. Aesthetic restorative dentistry relies on polymerization of light-activated resin composites which can cause damaging effects to the dental pulp as a result of temperature rise caused by both the exothermic reaction process and the energy absorbed during irradiation. This in vitro study was carried out to measure the increase in pulp chamber temperature induced during composite resin-polymerization with various light curing units in three different and common clinical situations (Veneer, Class II, Class III) and the clinical implications of the results. Measurement of pulp temperature changes during polymerization was performed with a Al-Cr Thermocouple positioned at the pulp-dentin junction. Mean values were calculated from six measurements with each light curing unit.

Effects of elevated temperatures on various restorative materials: an in vitro study.

In cases of mass disasters associated with fire, identification of the burnt victims can be a real challenge to the forensic team. Teeth and their restorations play a significant role to aid in the identification process, as various restorative materials have varying resistance to high temperatures. A study was undertaken to evaluate the changes taking place on teeth restored with amalgam, composites, glass ionomers, heat cure acrylic, and ceramics. The specimens were placed in a furnace and heated to predetermined temperatures of 200, 400, 600, 800, and 1000 degrees C and the changes were examined using a digital camera and stereomicroscope. Our observations show that while some restorations were able to withstand elevated temperatures, others were reduced to an unrecognizable mass at relatively low temperatures.

Sparfloxacin induced toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a life-threatening cutaneous adverse drug reaction. TEN is known to occur with the fluoroquinolone class of antibiotics, but only four cases of sparfloxacin induced TEN have been reported to the WHO database. This is another case report of sparfloxacin induced TEN.