Effect of glycemic status on peripheral nerve conduction in lower limbs in type 2 diabetes mellitus patients.

Background: Diabetes mellitus (DM) is one of the most common chronic diseases globally. Diabetic neuropathy is the most common & troublesome complication. But exact pathogenesis is not yet known. Comparatively there are few studies showing relation between glycemic status & diabetic neuropathy. Hence present study was conducted, which was aimed to assess the same in lower limbs in type 2 DM. Methods: 60 type 2 diabetes mellitus male patients were selected from diabetic OPD. 30 were having glycated hemoglobin (HbA1c) 6%-9% (group B), 30 were having HbA1c > 9% (group C). They were compared with age and sex matched 30 normal healthy controls (group A). Conduction velocity and amplitude of bilateral sural sensory nerve action potential (SNAP) and peroneal compound muscle action potential (CMAP) were recorded. Glycated hemoglobin was measured using ion exchange resin method. Results: Group B and group C had significantly lesser means of conduction velocity and amplitude of sural SNAP (p<0.001) and peroneal CMAP (p<0.05) as compared to group A. Hb A1c had statistically significant negative correlation with conduction velocity and amplitude of sural SNAP (p<0.001) as well as peroneal CMAP (p<0.001). Conclusions: This study shows that diabetic patients with higher blood glucose levels are at increased risk of diabetic neuropathy. Diabetic neuropathy in lower limbs worsens with increasing blood glucose levels. Hence stringent action has to be taken at an early stage to control blood glucose levels. Also, patients should be encouraged for regular follow up and strict glycemic control.

Upper limb muscle strength & endurance in chronic obstructive pulmonary disease.

Background & objectives: There are very few studies that have investigated the muscle strength and endurance of upper limbs (UL) in chronic obstructive pulmonary disease (COPD). We undertook this study to measure and compare the skeletal muscle strength and endurance of UL in COPD patients and age matched healthy controls and to study the association between lung function parameters and UL muscle strength and endurance. Methods: Forty one COPD patients and 45 height and weight matched healthy subjects of the same age group were studied. UL skeletal muscle strength and endurance were measured using the hand grip dynamometer test. Forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), forced expiratory flow during 25-75% FVC (FEF25-75%) and peak expiratory flow rate (PEFR) were measured. The handgrip muscle strength and endurance between the two groups were compared and correlations between FVC and FEV1 with muscle strength and endurance were analyzed. Results: The mean handgrip strength and mean muscle endurance in COPD patients were significantly lesser than the normal subjects in both males and females (P<0.001). There was significant positive correlation between muscle strength and FVC in males (r2=0.32, P<0.05); and between muscle strength and FEV1 in females (r2=0.20, P<0.05). Interpretation & conclusion: The study showed that the handgrip muscle strength decreases as the FVC and FEV1 decrease in patients with COPD. Identifying those patients who have reduced strength and endurance will allow early interventions targeted at improving the quality of life of the patient.

Students assessment of 1st MBBS curriculum in relation to duration, teaching learning methodologies and evaluation techniques.

Background: Medical education has become dynamic and challenging. But teaching time has remained the same, In fact it is reduced to one year for I M.B.B.S. Though the curriculum is meant for I MBBS students, they were never involved directly in planning the curriculum and assessment methods. So this study is an effort to throw some light on what students feel about the current scenario. Materials and Method: Input from 200 I MBBS students were collected by using a questionnaire comprising of questions relating to the curriculum, teaching methodology and assessment techniques in the Department of Physiology at B. J. Medical College, Pune. Results :50% students felt that the duration of I MBBS should be 10-12 months while 31% felt that it should remain same (8-10 months). Regarding most enjoyable way of learning 46% students said Practical’s are most enjoyable way of learning followed by Lectures (30%).About the usefulness of various teaching aids, 71% students felt that PowerPoint presentations are most helpful for understanding the topic. Students strongly felt that one system should be taught by single teacher (78.5%).For clinical demonstration in physiology, 55% students think ratio of teacher to student should be 1:25. Regarding assessment, 70% students felt that it should be at the end of each system. As far as the mode of assessment is concerned, 53% students felt that short answer questions are the most effective way of theory assessment Conclusion :Planning about the duration of course, teaching methodology and assessment techniques can be revised taking into consideration the student’s opinion.

Are we ignoring diabetic disability: A cross sectional study of diabetic myopathy.

Background: The complications associated with type 2 Diabetes Mellitus (DM) may cause functional impairment in older people. Recently it has been proved that motor dysfunction in the form of skeletal muscle dysfunction does occur in type II DM. However very few studies have assessed the upper limb skeletal muscle dysfunction. Objectives: The study was aimed to assess the hand grip strength, endurance in type 2 DM patients and compare the same with age matched healthy controls. We also correlated glycosylated Hb and duration of illness with the hand grip strength and endurance in the patients. Materials and Methods: Hand grip dynamometer was used to measure the hand grip strength and endurance in sixty diagnosed patients of type II DM. Similar tests were performed in age matched healthy controls. Blood samples were collected for blood glucose fasting, postprandial levels and Hb1AC in both the groups. Comparisons between patients and controls, and correlations were done by applying suitable tests. Results: The hand grip muscle strength and endurance in type II DM patients were significantly lower as compared to the normal controls (P < 0.05, P < 0.001). There was no correlation between the hand grip muscle strength and endurance with HbA1c and the duration of the disease in the patients of type II DM (P > 0.05). Conclusions: The present study shows that type II DM patients suffer from skeletal muscle dysfunction in the form of reduced hand grip strength and endurance. Hence the treating Physician should not be ignorant about these disabilities. In addition to the strict measures to control the blood glucose levels, interventions to improve the muscle mass and strength in these patients should be undertaken.