Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Abstract Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a metaanalysis of randomised controlled trials

Abstract Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to Clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02-208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55-185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25-238.58; I2 = 99%; GRADE approach evidence-high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60-2.41 ; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63-10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than Clonidine.

Imaging spectrum of renal masses on multi-slice computed tomography

Background: Multi-slice computed tomography (MSCT) is the mainstay for preoperative assessment of many complex renal masses in current clinical practice. Benign renal processes may simulate malignant renal tumors and could be defined correctly by CT. MSCT has also an important role in tumor staging. The purpose of this article is to understand the imaging spectrum of renal masses on MSCT and assess the usefulness of CT in surgical planning and management.Methods: Studied 500 patients with suspected renal lesions who underwent MSCT during the period July 2017 to July 2020 at state-of-art imaging center. CT imaging was done in those patients in whom clinical examination and ultrasonography (USG) revealed possibility of diagnosis of renal masses for further detailed evaluation and deciding management.Results: Out of 500 total subjects, the common age group in this study is 51 to 60 years (25%). Male preponderance (59%) was noted. The most common presentation was pain (84%) followed by lump (29.4%) and haematuria (17.8%). Malignant masses (51%) were more common followed by benign (39%) and inflammatory masses (10%) respectively. Renal cell carcinoma has more incidence (30%) followed by simple cyst (20%). Calcification (19.6%), perinephric extension (78%) and vascular invasion (21.5%) are more common in malignant masses. Conclusion: MSCT is the modality of choice for the diagnosis of renal masses and deciding management approach in current practice. Detection of tumoral spread, invasion of surrounding organs and vascular structure are better with CT. MSCT also has a role in postoperative follow-up of renal masses.

Assessment of preoperative serum albumin level and its correlation with postoperative wound complication in major elective abdominal surgeries

Background: Patients who have signs of malnutrition have a higher risk of complications and an increased risk of death in comparison with patients who have adequate nutritional reserves. It is common and occurs in about 30% of surgical patients with gastrointestinal diseases and in up to 60% of those in whom hospital stay has been prolonged because of postoperative complications. The serum albumin level is the most readily available and clinically useful parameter. A serum albumin level greater than 3.5 g% suggests adequate protein stores and it confers a protective effect through several biological mechanisms. It predicts perioperative morbidity and mortality.Methods: Our study was conducted on a cohort of 100 Patients admitted in Department of General surgery Hamidia Hospital for major elective surgery between October 2016 and September 2017. Sample size taken was 100.Results: The present study shows that patients with serum albumin less than 3 g/dl has more postoperative complications and patients with serum albumin >3.5 g/dl has less postoperative complications which was statistically significant. The study concludes that as the serum albumin level increases the complication rate decreases.Conclusions: Our study shows that sr. albumin is a good indicator of postoperative complications. The patients with sr. albumin <3.0 g/dl had a higher complication rate which was statistically significant (p<0.05). Patients with sr. albumin >3.5 g/dl had less complications which was statistically significant (p<0.05). The correlation between the serum albumin and complication rate was statistically significant in the malignant diseases when considered separately.

Double outlet of right ventricle: imaging spectrum on multi-slice computed tomography

Background: Multi-slice computed tomography (MSCT) is the main stay of pre-operative assessment of many complex congenital heart diseases (CHD) in current clinical practice, one of them is double outlet of right ventricle (DORV). DORV is one of the conotruncal anomalies that encompasses a wide spectrum of anatomic malformations in which both the aorta and pulmonary arterial trunk arise entirely or predominantly from the morphologically right ventricle (RV). Purpose of this article is to understand spectrum of DORV and associated types of ventricular septal defect (VSD) on MSCT imaging with special emphasis of usefulness of 3-D volume rendered (VR) images in pre surgical evaluation.Methods: A total of 500 paediatric patients (<18 years old), who had undergone MSCT were studied during the period 2014 to 2019 at the tertiary cardiac care centre.Results: 500 patients having primary/suspicious diagnosis of DORV on echocardiography during the said period were enrolled in the study. All the patients who underwent MSCT scan, were studied in detail for: DORV spectrum, associated types of VSD and its relationship to the semilunar valves. Out of 500 total subjects, subaortic VSD was the most common type of VSD observed (53%), followed by subpulmonic VSD (22%), non-committed VSD (18%) and doubly committed VSD (7%). Associations of pulmonary stenosis, subaortic stenosis and aortic co-arctation with various types of VSDs were addressed. Associated other anomalies were also analysed.Conclusions: Advances in MSCT technology has revolutionized pre-surgical diagnosis, management approach and post-operative follow-up of DORV patients. Excellent image qualities along with 3D volume rendered images help surgeon understand complex morphology of DORV variants and associated types of VSD. Significant reduction in intra and post-operative mortality in DORV patients in current era is result of MSCT technology.

Assessment of levetiracetam and valproic acid as monotherapy for quality of life in partial epilepsy patients

Background: Quality of life (QOL) is important in patients of epilepsy as it is affected both by disease as well as therapy. QOL is the most overlooked component of antiepileptic treatment.Methods: An observational analytical study was conducted in the Department of Pharmacology in collaboration with Department of Neurology of Himalayan Institute of Medical Science, Dehradun over 12 months. 80 patients satisfying inclusion criteria were enrolled and divided into two groups based on physician discretion and followed up for 12 weeks. Patients were evaluated at 0 and 12 weeks for quality of life using QOLIE-10 self-administered questionnaire, they were also assessed for seizure control and drug related adverse effects.Results: 60 patients were enrolled and divided into two treatment groups as per physician discretion, levetiracetam (30) and valproic acid (30) groups. Study groups showed significant improvement in QOL (mean change in QOL17.95�527 for LEV and 11.56�540 for VPA). Levetiracetam (LEV) group showed significant improvement over valproic acid (VPA) group (p=0.05) at 12 weeks. Patients who achieved total seizure control at 6 weeks were 93.33% patients in levetiracetam and 90% in valproic acid group, reason being non adherence which was 6.67% and 10% respectively. Adverse event recorded with levetiracetam (03), most common being drowsiness and with valproic acid (08), with most common being anorexia.Conclusions: Levetiracetam therapy has led to better quality of life and has the same seizure control as valproic acid, and has shown to have lower incidence of adverse effect.

Performance and Carcass Traits of Broiler Chickens Reared on LEDs vis-a-vis CFL as a Growth Promotor

The present study was conducted to compare the performance of broiler reared under two different light sources and three different light colours. For this purpose, 120, two-week-old IBL-80 (Indian Broiler Ludhiana-80) broiler chicks were randomly distributed in four different treatment groups viz. TLEDB-G (first 2 wks, blue LED then switched to green LED for the next 2 wks), TLEDG-B (first 2 wks, green LED then switch to blue LED for the next 2 wks), TLEDW (White LED) and TCFL (CFL light; Control) with 3 replications and 10 birds in each experimental unit was applied. The effects of different lights on performance (BW, BWG and FCR), carcass traits and its economic impact on broiler chickens were investigated in the present study. The results show that performance and carcass traits of broiler birds of blue-green and green blue LED light group was at par to that of CFL group whereas benefit cost ratio of birds of TLEDB-G (1.13) was found highest among different treatment groups. Therefore, use of a combination of monochromatic Blue-Green or Green-Blue LED light could be a better alternative source of light than CFL light in terms of birds’ performance, economics and energy saving

MSCT coronary angiography in non-invasive assessment of coronary artery bypass grafts patency

Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India and worldwide and last decade has seen a steep rise in incidence of CAD in India and its treatment as bypass surgery. Direct visualization of the grafts and native coronary arteries by invasive catheterization is now being replaced by non-invasive CT coronary angiography with higher slice machines and newer technology as it has good temporal resolution, high scanning speed as well as low radiation dose. We share our experience of graft imaging on 128 slice CT machine.Methods: This is a retrospective, single-center, observational study. We included 500 symptomatic patients who have undergone CT study between the year 2014 to 2018 post bypass surgery.Results: Arterial grafts have a better patency rate than venous grafts. (88% vs. 64.1%). Amongst the individual arterial grafts RIMA had the best patency rate (100%) followed by LIMA (90.8%), RA (68.7%). LAD was the most commonly involved artery (91%).Conclusions: Significant absolute concordance between CT and catheter angiographic findings have been documented for all arterial and venous grafts patency in the literature. The MSCT with retrospective gating permits an accurate and non-invasive evaluation of patent and diseased arterial and vein grafts and could replace conventional angiography for the follow-up of symptomatic, stable patients. Moreover, an optimal diagnostic accuracy was also documented in the appraisal of native vessels distal to the graft anastomoses.

Diabetes mellitus as a risk factor for ischemic stroke: a case control study

Background: In developed countries, stroke is the third most common cause of mortality, following cancer and coronary heart disease. The increase risk is often seen in individuals with diabetes and is associated with poorer clinical outcomes (including higher mortality). That’s why assessment of risk factors for stroke are important.Methods: This age and sex matched hospital based case control study assessed the risk factors of ischemic stroke in tertiary care hospital for a period of one year. Sample size was calculated for matched case control (1:1 ratio) by n-master software and came out to be 189 pairs. All patients under WHO case definition were enrolled as cases for study purpose, controls were selected from the same hospital with disease other than stroke. Analysis was conducted through calculation of odd ratio (OR) and confidence internal (CI) by using SPSS 22.0 program. Odds ratio (OR) of risk factor was calculated using bivariate analysis.Results: Results revealed that male: female ratio among the case and control was 2.1:1, mean age of case and control were 58.86±13.03 and 58.21±12.67. Out of 189 Case, 59 (31.2%) were suffering from diabetes, while only 39 (20.6%) controls were having diabetes mellitus. P value was 0.02, which is significant.Conclusions: In the present hospital based case control study, it was found that diabetes mellitus was a significant risk factor among the ischemic stroke patients.

Comparative evaluation of levetiracetam and valproic acid as monotherapy on cognitive impairment in patients of epilepsy

Background: Cognitive decline with AEDs (Anti-epileptic drugs) is associated with learning and memory deficits especially in the younger age group. The data regarding the impact of levetiracetam and valproic acid as monotherapy on cognition in epileptic patients is scarce. The present study was done for evaluation of cognitive decline associated with the use of AEDs.Methods: Present study was a prospective study on 60 patients on AEDs for a period of 12 weeks. Patients were enrolled from the Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India and divided into group A (levetiracetam) and group B (valproic acid) with 30 patients in each group. Permission from the institutional ethics committee and written informed consent was taken from all the patients. They were analyzed for cognitive impairment using MMSE and MoCA scales at baseline and 12 weeks.Results: The mean duration of disease was 2.13�1 years and 2.08�1 years and mean age of the patients was 14.67�9 years in group A and 16.20�6 years in group B. GTCS was present in 31 patients (52%) followed by partial seizures in 29 patients (48%). The mean change in the MMSE scores from baseline to 12 weeks was significant in group A 1.30�1 (p value <0.05) and change group B was -0.20�4 not statistically significant. The mean change was observed in MoCA scores from baseline to 12 weeks was significant in both groups A and B by 1.17�1 and -0.70�1 respectively (P value <0.05).Conclusions: Patients on levetiracetam showed cognitive improvement, whereas patients on valproic acid showed a decline in the MMSE and MoCA scores.

MSCT imaging of various shunts and grafts in post operative cases of congenital heart diseases

Background: Multi-slice computed tomography (MSCT) plays an important role in clinical practice in assessing post-operative patients with complex CHD when echocardiography is not contributory.  Despite the great capabilities of MR imaging for anatomic and functional assessment of the heart, it is time-consuming and may require a lengthy period of patient sedation; hence its use in seriously ill or uncooperative patients is often limited. CT has the advantages of widespread availability and short acquisition times. It is imperative for a radiologist to be aware of various palliative as well as corrective procedures and their various imaging findings. Aim of this article is to demonstrate and make one aware of various checklists and imaging findings in paediatric patients who have undergone various shunts and grafts at our tertiary cardiac care centre, their immediate as well as long term complications.Methods: We studied a total of 100 paediatric patients (<12 years old), who had undergone some sort of palliative or corrective shunt or graft placement, on MSCT during the period 2014 to 2018 at our tertiary cardiac care centre.Results: We try to outline details of various shunts and grafts used in congenital heart diseases correction, MSCT technique and imaging appearances and appearances of abnormal post-operative findings.Conclusions: Advances in computed tomography (CT) scanners and electrocardiographic gating techniques have resulted in superior image quality of the aorta and pulmonary arteries for evaluating postoperative congenital heart disease. MSCT is an excellent non-invasive modality for post-operative evaluation of various shunts and grafts.

Comparative Evaluation of Efficacy and Safety of Herbal Preparation vis-a-vis Beclomethasone Cream on Radiation Induced Skin Injury in Head and Neck Carcinoma Patients Receiving Radiotherapy or Chemoradiation in Oncology Department at a Tertiary Care Hospital

Introduction: Radiation mitigators are the compounds whichcan minimize or ameliorate post irradiation-toxicity providedthey are administered before the onset of toxic symptoms.Hence, there is an urgent need to prevent harmful effectssecondary to ionizing radiations.Material and Methods: Sixty patients of Head and neckcarcinoma more than 18 years of age of either sex and willingto give informed consent were included in the study. In Group1, 30 patients received the Beclomethasone cream that wastopically applied from the day-1 of radiotherapy till 4-weeksafter completion of radiotherapy, whereas In Group-2, 30patients received the local application of the herbal paste fromthe day-1 of radiotherapy till 4-weeks after completion ofradiotherapy.Results: For measuring radiation-induced reactions, nonparametric test like chi-square test was applied and number ofpatients in different grades was calculated as per RTOGcriteria. Similarly for measuring radiation-induced mucosalreactions, chi-square test was applied and number of patientsin different grades was calculated as per RTOG-criteria.Conclusion: Present study revealed a marked beneficialeffects of herbal paste containing Azadirachta indica, aloevera, Ocimum sanctum and Curcuma longa on radiationinduced skin injury in patients with Head and neck carcinomaas compared to topical Beclomethasone cream.

Comparative Evaluation of Quality of Life in Patients of Head and Neck Carcinoma withRadiation Induced Skin-injury in Oncology Department at Tertiary Care Hospital

Radiation mitigators are the compounds which can minimize post irradiation-toxicity provided theyare administered before the onset of toxic symptoms. In present study we compared pre and posttreatment quality of life in head and neck cancer patients receiving radiotherapy.Sixty patients ofHead and neck carcinoma more than 18 years of age of either sex and willing to give informedconsent were included in the study. In Group-1, 30 patients received the Beclomethasone cream thatwas topically applied from the day-1 of radiotherapy till 4-weeks after completion of radiotherapy,whereas In Group-2, 30 patients received the local application of the herbal paste from the day-1 ofradiotherapy till 4-weeks after completion of radiotherapy. These 60 patients were evaluated at 6month post-therapy using the European organisation for research and treatment of cancer quality oflife questionnaire C30 .For measuring radiation-induced reactions, chi-square test was applied andnumber of patients in different grades was calculated as per Radiotherapy oncology group criteria.Similarly for measuring radiation-induced mucosal reactions, non-parametric test i.e chi-square testwas applied and number of patients in different grades was calculated as per radiotherapy oncologygroup criteria. As per quality of life questionnaire, evaluation on symptom scale revealed that fatigue,pain, dyspnoea, appetite loss and insomnia got worsened in Gp-1 patients, except for diarrhoea,constipation and nausea or vomiting while in Gp-2 patients, all symptoms showed improvement after6 month of completion of treatment. Comparing pre and post-treatment , the global health statusshowed statistically significant improvement in group-2 patients receiving polyherbal paste .The International Journal of Interdisciplinary and Multidisciplinary Studies (IJIMS), 2019, Vol 6, No.1,65-79. 66present study revealed a beneficial effects of polyherbal paste containing Azadirachta indica, aloevera, Ocimum sanctum and Curcuma longa on radiation induced skin injury in patients with Head andneck carcinoma as compared to topical Beclomethasone cream. Also there was improvement inquality of life in cancer patients receiving herbal paste measured at 6 month post-treatment.

Evaluation of levetiracetam and valproic acid as monotherapy on quality of life in patients of generalized tonic clonic epilepsy

Background: Quality of life plays an important role in patients of epilepsy and is the most neglected part during management. The antiepileptic drugs treatment results in seizure control but adversely affect the quality of life in patients.Methods: An observational analytical study was conducted in the Department of pharmacology with Department of Neurology of Himalayan Institute of Medical Sciences, Dehradun over 12 months. 85 patients fulfilling the inclusion criteria with diagnosis of generalized tonic clonic seizures (GTCS) were enrolled and divided into two groups based on physicians discretion and followed up for 12 weeks. Patients were evaluated for quality of life by QOLIE-10 self administered questionnaire at 0 and 12 weeks, assessed for seizure control and drug related adverse effects.Results: 85 patients were enrolled and divided into two treatment arms as per physician discretion, levetiracetam (41) and valproic acid group (44). Study drugs showed significant improvement in quality of life, levetiracetam showed mean change that was significantly greater than valproic acid (p=0.003) at 12 weeks. Patients who failed to achieve seizure control at 6 weeks were 17% patients in levetiracetam and 20% in valproic acid group, reason being non-adherence which was 17% and 20% respectively. Adverse events recorded with Levetiracetam (10), most common being increased sleep and with valproic acid (18), with most common being increased sleep and weight gain.Conclusions: Levetiracetam treatment resulted in better quality of life, with similar seizure control but decreased number of adverse effect then Valproic acid.

Analysis of structure-function relationship in porcine rotavirus A enterotoxin gene

Rotavirus (RV)-infected piglets are presumed to be latent sources of heterologous RV infection in humans and other animals. In RVs, non-structural protein 4 (NSP4) is the major virulence factor with pleiotropic properties. In this study, we analyzed the nsp4 gene from porcine RVs isolated from diarrheic and non-diarrheic cases at different levels of protein folding to explore correlations to diarrhea-inducing capabilities and evolution of nsp4 in the porcine population. Full-length nsp4 genes were amplified, cloned, sequenced, and then analyzed for antigenic epitopes, RotaC classification, homology, genetic relationship, modeling of NSP4 protein, and prediction of post-translational modification. RV presence was observed in both diarrheic and non-diarrheic piglets. All nsp4 genes possessed the E1 genotype. Comparison of primary, secondary, and tertiary structure and the prediction of post-translational modifications of NSP4 from diarrheic and non-diarrheic piglets revealed no apparent differences. Sequence analysis indicated that nsp4 genes have a multi-phyletic evolutionary origin and exhibit species independent genetic diversity. The results emphasize the evolution of the E9 nsp4 genotype from the E1 genotype and suggest that the diarrhea-inducing capability of porcine RVs may not be exclusively linked to its enterotoxin gene.

Quantifying the Amount of Bleeding and Associated Changes in Intra-Abdominal Pressure and Mean Airway Pressure in Patients Undergoing Lumbar Fixation Surgeries: A Comparison of Three Positioning Systems

STUDY DESIGN: Prospective, randomised controlled, single centre study of 45 patients posted for two level lumbar fixation surgery in the prone position. PURPOSE: To compare intra-abdominal pressure (IAP), mean airway pressure mean airway pressure and blood loss during the spine surgery in prone position using three different positioning systems. OVERVIEW OF LITERATURE: Studies have correlated IAP with the amount of perioperative bleeding. However, IAP and airway pressures while assessing the bleeding comparing two or more prone positioning systems are unclear. METHODS: This prospective study was conducted on a cohort of 45 patients scheduled for two-level lumbar fixation. Patients were randomly allocated to a spine table, Wilson's frame, and thermomodulated pads. Bladder pressure as an indicator of IAP, mean and peak airway pressures, and blood loss were monitored. RESULTS: IAP increased whenever patient position was changed to prone .The increase in pressure was more in the Wilson's frame group but was statistically significant only on prolonged positioning. Adopting the prone position always increased the mean airway pressure, but the increased was significant only in the Wilson's frame group. Mean airway pressure decreased in the spine table group and was statistically significant. The blood loss in the spine table group was significantly less as compared to the other groups. CONCLUSIONS: Positioning on a spine table results in less blood loss and low mean airway pressure. The Wilson's frame results in high IAP, increased mean airway pressure, and more blood loss. The thermomodulated frame increases mean airway pressure and produces a moderate increase in IAP and airway pressure.

Quantifying the Amount of Bleeding and Associated Changes in Intra-Abdominal Pressure and Mean Airway Pressure in Patients Undergoing Lumbar Fixation Surgeries: A Comparison of Three Positioning Systems

STUDY DESIGN: Prospective, randomised controlled, single centre study of 45 patients posted for two level lumbar fixation surgery in the prone position. PURPOSE: To compare intra-abdominal pressure (IAP), mean airway pressure mean airway pressure and blood loss during the spine surgery in prone position using three different positioning systems. OVERVIEW OF LITERATURE: Studies have correlated IAP with the amount of perioperative bleeding. However, IAP and airway pressures while assessing the bleeding comparing two or more prone positioning systems are unclear. METHODS: This prospective study was conducted on a cohort of 45 patients scheduled for two-level lumbar fixation. Patients were randomly allocated to a spine table, Wilson's frame, and thermomodulated pads. Bladder pressure as an indicator of IAP, mean and peak airway pressures, and blood loss were monitored. RESULTS: IAP increased whenever patient position was changed to prone .The increase in pressure was more in the Wilson's frame group but was statistically significant only on prolonged positioning. Adopting the prone position always increased the mean airway pressure, but the increased was significant only in the Wilson's frame group. Mean airway pressure decreased in the spine table group and was statistically significant. The blood loss in the spine table group was significantly less as compared to the other groups. CONCLUSIONS: Positioning on a spine table results in less blood loss and low mean airway pressure. The Wilson's frame results in high IAP, increased mean airway pressure, and more blood loss. The thermomodulated frame increases mean airway pressure and produces a moderate increase in IAP and airway pressure.

Oxidant and Antioxidant Status in Parkinson’s Disease.

Parkinson’s disease (PD) is a progressive, neurological disease that mainly affects movements and occurs at older ages and is clinically characterized by resting tremor, rigidity, bradykinesia and postural imbalance. These clinical manifestations of PD are caused by a selective degeneration of dopamine-producing neurons in substantia nigra in the brain stem and the consequent dopamine shortage in the striatum. Oxidants and antioxidants related substances may contribute to the pathogenesis and the progression of Parkinson’s disease. Research can make great progress in understanding and further treating the PD. This study demonstrates significant variation of oxidants-antioxidants status in Parkinson’s disease. Oxidative stress plays a crucial role in progression of PD; however, oxidative stress is a cause or the consequence of PD is debatable. In our study we observed there is significant increase in the levels of serum Malondialdehyde (p< 0.001), Nitric oxide end products (p< 0.001), and significant decrease in the activity of Glutathione peroxidase (p< 0.001), Superoxide dismutase (p< 0.001), and Catalase (p< 0.001) in PD patients as compared with controls. Further Vitamin C (p< 0.05), Vitamin E (p< 0.05) significantly decreased, but Uric acid levels (p> 0.05) remain unchanged and this may be due to compensatory mechanism of body against oxidative stress, which not allowed much alteration in other parameter in the PD patients as compared with controls.

Prevalence and correlates of cognitive impairment in a north Indian elderly population.

Background: Cognitive impairment, an age-related condition, is often considered a precursor to more serious diseases such as depression/dementia/Alzheimer’s disease. Alzheimer’s disease, which is characterized by cognitive impairment, could have a devastating impact on low- and middle-income countries whose populations are ageing rapidly. The disease has, so far, largely remained neglected by researchers and national health services in India. In view of the growing elderly population and diverse sociocultural and geographical milieu of India, epidemiological data for the condition are desirable for different populations. Moreover, there is a dearth of population-based epidemiological studies on cognitive impairment in the Punjab state of India. Methods: Three thousand and thirty-eight consenting elderly adults aged over 60 years, of both sexes, residing in Ludhiana, Punjab state, India were examined for cognitive functioning, using a modified Hindi Mental State Examination, and a score of ≤25 was considered to be indicative of cognitive impairment. Data analysis included calculations of proportions; odds ratio and their 95% confidence intervals (CIs) were also calculated. The chi-square test and multiple logistic regression model were used to determine the association of cognitive impairment with various sociodemographic parameters. Results: The prevalence of cognitive impairment in the study population was 8.8% (95% CI = 8.06 to 9.54). Increasing age, unmarried/widowed status, illiteracy, unemployment and poverty were found to be independently associated with cognitive impairment. Conclusions: The prevalence of cognitive impairment in this north Indian population of elderly individuals is higher than that found in northern India. With emerging focus on geriatric health services, cognitive impairment, which is a precursor of Alzheimer’s disease/dementias, needs to be included in priority care within the national primary health-care framework.

Evaluation of Surrogate Markers for Insulin Resistance for Defining Metabolic Syndrome in Urban Indian Adolescents.

Objective: To compare parameters of insulin resistance, with special reference to McAuley index, in urban Indian adolescents, and to establish their cut-off values for defining metabolic syndrome. Design: Cross-sectional study. Setting: Schools located in four different geographical zones of Delhi, India. Participants: 695 apparently healthy adolescents grouped as normal weight (298), overweight (205) and obese (192). Outcome measures: Cut-off point for indices of insulin resistance was assessed by fasting insulin, insulin glucose ratio, and other methods (HOMA model, QUICKI, McAuley index) to define metabolic syndrome. Results: The McAuley index increased progressively from normal weight to obese adolescents in both sexes. McAuley index was significantly lower in adolescents with metabolic syndrome (5.36 ± 1.28 vs. 7.05 ± 1.88; P<0.001). McAuley index had the highest area under curve of receiver operator characteristics [0.82 (0.02)] as compared to other indices of insulin resistance. McAuley index of 6.23 had the highest specificity (88%) with sensitivity of 63.3% for diagnosing metabolic syndrome, whereas insulin glucose ratio had the highest sensitivity (79.7%) but low (55.5%) specificity. McAuley index was negatively correlated with height (r= -0.257, P=<0.001), weight (r= -0.537, P=<0.001), body mass index (r= -0.579, P<0.001), waist circumference (r= -0.542, p<0.001), and waist hip ratio (r= -0.268, P<0.001). Conclusions: Among various parameters of insulin resistance, McAuley index had the highest specificity, and insulin glucose ratio had the highest sensitivity in diagnosing metabolic syndrome in urban Indian adolescents.