Effect of oral clonidine premedication on attenuating haemodynamic response to laryngoscopy and intubation during general anaesthesia

Background: Laryngoscopy with or without tracheal intubation evokes a defense mechanism that in turn alters patients’ haemodynamic responses in terms of increased heart rate (HR) and arterial blood pressure (ABP). Aim of current investigation was to study the efficacy of orally administered clonidine in a dose of 3-3.5 µg/kg given 90 minutes prior to scheduled time of the surgery, in attenuating the adverse haemodynamic responses to laryngoscopy and intubation of the trachea. Methods: Eighty normotensive patients between 20-60 years of age and having ASA grade I/II physical status were subdivided in two groups with 40 patients in each; test group received clonidine in a dose of 3-3.5 mcg/kg of body weight orally, 90 min before surgery and control group did not receive clonidine premedication. Induction was done with Thiopentone intravenous injection (5 mg/kg), followed by succinylcholine (1-1.5 mg/kg). Results: Haemodynamic responses in terms of parameters like HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were recorded at pre induction and at 1, 2, 3, 5 minutes following laryngoscopy. The 1-minute post induction values of SBP, DBP, MAP were significantly less in clonidine group (p<0.001) and the significance in listed parameters between two groups persisted until 5 minutes. Increase in HR was less in clonidine group than in control group. Conclusions: Premedication with oral clonidine 3-3.5 mcg/kg of body weight, 90 minutes before laryngoscopy and intubation is an efficient, simple and inexpensive method in attenuating the haemodynamic response generated due to laryngoscopy and intubation.

Left Ventricular Geometry and Function in Patients with Gray Zone Hypertension

Background: Hypertension is considered as the silent killer of human because the hypertensive patient may be not aware that he has hypertension and death can occur at any time without the reason being known. We aim to study the effect of gray zone hypertension [SBP from 120-139] and or [DBP from 80-89] which was classified as prehypertension under JNC-7 on the structure, geometry, and operation of the left ventricle using echocardiography Methods: This study included 100 patients who asymptomatic apparent healthy subjects visited cardiology outpatient department (OPD) for routine checkup. Patients were grouped into two equal groups: Group A whose blood pressure was in the gray zone hypertension [SBP from 120-139] and or [DBP from 80-89], and group B with SBP <120 mmHg & DBP <80 mmHg. Results: The two groups being studied were statistically significant different as regard LV geometrical pattern (p=0.028). They were also statistically significant in LV geometrical pattern between the males and females (p<0.05). The two groups were statistically significant different regarding GLS (p =0.001). Conclusions: Gray zone hypertension affects ventricular diastolic function and LV geometry, although systolic function was normal; GLS showed that subclinical LV dysfunction can occur.

A Single Centre Experience of Spontaneous Bacterial Peritonitis in Ascites with Cirrhosis : A Record Based Observational Study

Spontaneous Bacterial Peritonitis (SBP) is one of the complicated infections in patients with cirrhosis and ascites which can be fatal if not diagnosed and treated. This is a record based observational study using the data of all patients admitted with established cirrhosis of liver with ascites. Aim of the study was to find out the incidence of SBP in cirrhosis patients and also to study the clinical profile of SBP. Thirty nine patients’ data were included in the study. Three patients had classic SBP, one patient had Culture Negative Neutrocytic Ascites (CNNA) and two had bacterascites. Patients were treated with injection cefotaxime (2 gm) 8hourly for 5 days and clinical and laboratory parameters were evaluated.

Effect of Cold Pressor Test (CPT) on Pulse Rate and Blood Pressure amongst Individuals with and without Family History of Hypertension.

It is an established fact that primary and secondary hypertension and related cardiovascular disorders have a familial predisposition. We also know that essential hypertension is the most common amongst hypertensives. The aim of our study was to find out effect of cold pressor test (CPT) on heart rate and blood pressure amongst individuals with and without family history of hypertension. MethodsPresent study was undertaken using within group design consisting of measurements at basal and CPT and the parameters studied were pulse rate and Blood pressure. ResultsIn our study we found that in males with family history of HT (n=15), the mean basal pulse rate was 78.33 beats/min and following CPT it increased to 85.73. Similarly, in males without family history of HT (n=18) mean basal pulse rate was 77.28 beats/min and following CPT it increased to 86.72 beats/min. In both cases it was statistically significant. But it is observed that in case of females with family history of HT (n= 20) mean basal pulse rate was 80.9 beats/min and following CPT it increased to 89.1. Similarly, in Females without family history of HT (n=26) mean basal pulse rate was 77.15 beats/min and following CPT it increased to 84.73 beats/min and in both these cases, it was statistically significant. In males with family history of HT (n=15), mean basal SBP was 115.13 mmHg and following CPT increased to 123.93 and this was statistically significant and the mean DBP was 74.67 mmHg and following CPT it increased to 79.82 mmHg and it was not statistically significant. In males without family history of HT (n=18) mean basal SBP was 114.67 mmHg and following CPT it was increased to 122.89 mmHg and increase was statistically significant and mean DBP was 74.44 mmHg and following CPT it increased to 76.33 mmHg and this increase was not statistically significant. In females with family with family history of HT (n=20) the mean SBP was 114.2 mmHg and following CPT it increased to 121.9 mmHg and it was statistically significant and the mean DBP was 73.75 mmHg and following CPT it increased to 78.80 mmHg and it was not statistically significant. In females without family history of HT (n= 26) the mean basal SBP was 108.23 mmHg and following CPT it increased to 117.08 mmHg and the mean basal DBP was 69.92 mmHg and following CPT it was increased to 76.69 mmHg this increase in both the cases was statistically significant (table 1,2). In both the groups, none of the subjects was found to be hyperreactive to either systolic or diastolic blood pressure when they were subjected to CPT. ConclusionsIn both the groups, subjects were found to be hyporeactive or normoreactive to either systolic or diastolic blood pressure when they were subjected to CPT. But increase in basal blood pressure response is known to be due to CPT.

Comparative study of the SBP-box gene family in rice siblings

SBP-box genes are a class of plant-specific transcription factors which have a common DNA-binding domain(SBP-domain) with an unusual zinc-finger architecture. Many of the genes in this class are thought to play adevelopmental role and a few are involved in the determination of plant architecture. We have made acomparative study of these genes in the genomes of rice (Oryza sativa japonica and Oryza sativa indica) andits nine siblings using a recently proposed hybrid method for orthology and paralogy detection (HyPPO).According to HyPPO, the SBP-box proteins of rice siblings could be divided into twenty primary orthologousgroups on the basis of their overall sequence features. This contrasts with a much less number of groups foundin earlier work with other plant genomes using phylogenetic analysis of the SBP-domains only. The orthologous groups reported by HyPPO showed close correspondence in exon–intron structure and motif conservation. Comparison between different Oryza species revealed disparity in the maintenance of orthologousgenes which may result in their different developmental characteristics. Inclusion of the SBP-box proteins fromA. thaliana did not result in any change in the orthologous groups except for the A. thaliana proteins beingadded to some of the existing groups. The closer correspondence between the proteins in the primaryorthologous clusters is expected to help in a more reliable prediction of their functions. It is also expected toprovide better insight into the evolutionary history of this class of plant-specific proteins.

Study of Effect of Shavasana on Handgrip and Cold Pressor Test on Heart Rate and Blood Pressure in Young Adults.

Shavasana or a corpse pose is the final pose of a yoga flow. When practiced regularly it is known to restore the body and mind. Aim of our present study was to investigate the effects of shavasana on handgrip and cold pressor test on heart rate and blood pressure in apparently healthy young adults. In today’s world all of us are under constant stress and majority of individuals with sedentary lifestyle suffer from hypertension and each of us react differently to varied internal and external stimuli.METHODSFor convenience, we took 300 apparently healthy medical students of both sexes in the age group of 18 to 22 years and a comparative study was carried out among them. Their basal pulse and BP were recorded from dominant hand. For Hand Grip Test (HGT) handgrip dynamometer (INCO) was used by left hand, and pulse and BP from right hand was recorded and similarly Cold Pressor Test (CPT) was carried out by immersing left hand up to wrist joint in cold water mixed with ice cubes to maintain temperature at 40C and pulse and BP was recorded from right hand. Shavasana was performed for 15 minutes by lying down on the wooden couch, with eyes closed and lying on back, keeping arms six inches away from the body and legs and feet “drop” open and palms facing upwards and concentrating on their breathing, after which pulse and BP was recorded. This was carried out for a period of 30 days.RESULTSData was collected and analysed using paired ‘t’ test and paired differences were calculated using 95% confidence interval of the difference and p value of < 0.05 was taken as scientifically significant. In our study we found that there is significant decrease in basal pulse rate, when compared with CPT, immediately and after performing shavasana for a period of one month, and there was significant increase in pulse rate following HGT (p< 0.001) (table 1 and graph 1). Compared to basal, SBP and DBP, it was observed that there is significant decrease; immediately and after performing shavasana for one month and significant increase with HGT and CPT was observed (p<0.001) (table 1 and graph 1).CONCLUSIONSThere is a significant decrease in basal pulse rate, when compared with CPT, immediately and after performing shavasana for a period of one month, and there was significant increase in pulse rate following HGT (p< 0.001) (table 1 and graph 1). Compared to basal, SBP and DBP it was observed that there is significant decrease; immediately and after performing shavasana for one month and significant increase with HGT and CPT was observed (p<0.001) (table 1 and graph 1).

Correlation of Risk Factors with Severity of Diabetic Retinopathy - A Retrospective Study.

Diabetic retinopathy (DR) is a major microvascular complication of diabetes. It is the most common cause of blindness in the working-age population in developed countries. We wanted to analyse the correlation between risk factors of blindness like duration of diabetes, dyslipidaemia, hypertension, HbA1c with severity of diabetic retinopathy in order to design appropriate strategies for prevention and treatment of diabetic retinopathy.METHODSThis was a retrospective study of all diabetic patients with diabetic retinopathy who presented to the eye OPD at KS Hegde Medical Academy from April 1st 2018 to March 31st 2019 that fulfilled the inclusion criteria. A dilated fundus examination was done to note the grade of diabetic retinopathy. The demographic data along with the duration of diabetes, HbA1c values, Cholesterol levels and Blood pressure were documented and correlated with the severity of diabetic retinopathy.RESULTSThe study included 92 patients, of which 63 were males and 29 were females with a mean age of 54.5±2.8 years. We found that there was statistically significant association between the duration of diabetes and HbA1c levels with severity of diabetic retinopathy (p= 0.022 and 0.034 association), whereas there was no statistically significant correlation between blood pressure and cholesterol levels with severity of diabetic retinopathy (p= 0.52 and 0.456 respectively)CONCLUSIONSDiabetic retinopathy showed a male preponderance, with risk factors like duration of diabetes and HbA1c levels having a significant association with the severity of diabetic retinopathy. Therefore, it is essential to have a good systemic control of diabetes with diet and suitable medications. Diabetic retinopathy is a preventable cause of blindness when diagnosed early and screening of diabetic retinopathy must be done in all diabetics to prevent the progression of the disease.

A 12 week prospective clinical evidence of empagliflozin efficacy in uncontrolled type 2 diabetes mellitus treated with metformin and a sulfonylurea

Background: The main aim of the study is to evaluate the efficacy of empagliflozin 10 mg once daily over 12 weeks as add-on therapy to metformin plus sulfonylurea in patients with type 2 diabetes mellitus with inadequate glycemic control.Methods: It is a prospective, observational, study conducted in patients of Sri Badhrakali Diabetic Center located in Warangal, Telangana, India. The efficacy of empagliflozin 10 mg was assessed by measuring the change in the glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), body mass index (BMI) at the baseline and 12 weeks, systolic blood pressure (SBP) and diastolic blood pressure (DBP) at the baseline and after 24 hours of treatment.Results: In the present study, the addition of empagliflozin to metformin and Sulfonylurea therapy for 12 weeks provided 0.87 % reduction in HbA1c. The mean changes of FPG from baseline to 12-week is -26 mg/dl. At 24 hours empagliflozin significantly reduced blood pressure with mean changes of SBP and DBP -4.147 and -1.526 mmHg respectively. The mean changes in BMI from baseline to week 12 is -0.638 kg/m2.Conclusions: Empagliflozin 10 mg provided ancillary reduction in HbA1c outside of metformin and sulfonylurea. Controlled body weight, HbA1c, blood pressure decreases diabetes progression, decreased risk of diabetic complications and reduced risk for cardiovascular disorders.

Evaluation of Various Non Culture Methods for the Diagnosis of Spontaneous Bacterial Peritonitis

Introduction: Spontaneous Bacterial Peritonitis (SBP) iscommon and serious complication of patients with livercirrhosis and ascites, without an apparent surgically treatableintra abdominal source of infection. Its prevalence rangesfrom 10% to 30%. Mortality rate was earlier reported morethan 90%, but it has now reduced to 30% -50% as a resultof rapid diagnosis and prompt initiation of antibiotics. Thepresent study was done to evaluate the various non culturemethods for the diagnosis of SBP.Material and Methods: Ascitic fluid sample were collectedaseptically from 100 cirrhotic patients with ascites. PMN(polymorphonuclear leukocyte) count was determined byNeubauer’s manual counting chamber and Leishman’s stainfor differential PMN cell counts. Granulocyte esterase activitywas detected using LER (Leukocyte esterase reagent) dipstickstrips.Results: Out of 100 samples processed, PMN cell count >250 cells/mm3 was found in 91% samples by conventionallight microscopy. Scale of > 2+ by LER strip was found in61 samples. Reading of PMN cell count of > 250 cells/mm3matched in 60 samples and < 250 cells/mm3 matched in 8 cellsby both microscopy and LER strip test. Sensitivity, specificity,positive predictive value and negative predictive value ofLER strip test was 65.9%, 88.89%, 98.36% and 20.51%respectively.Conclusion: LER strips as a screening tool for SBP haveadvantage of speed, low cost, availability at odd hours, requiresno technical expertise and can be performed everywhere.Its high specificity and PPV may help in early institution ofempirical antibiotic therapy in patients.

Comparative Study to Evaluate Efficacy, Safety and Quality of Life of Metoprolol and Telmisartan versus Metoprolol and Ramipril in Patients of Hypertension

Background: Hypertension(HTN) is a major cardiovascular disease and is a major worldwide clinical problem. The prevalence of hypertension increases in urban and rural areas. The treatment of hypertension began in the 1960s with oral diuretics. The other modalities of treatment of hypertension are beta – blockers, calcium-channel blockers, alphareceptors blockers, ACE inhibitors and ARBs. The better compliance occurs with single-pill combination, and may be even double or even triple pill combination therapy should be used. Also quality of life was improved better with Metoprolol and Telmisartan as compared with Metoprolol and Ramipril. Quality of life was assessed by SF -36 Quiestionnare. Objective: To compare the effect of Metoprolol and Telmisartan versus Metoprolol and Ramipril on BP and quality of life in patients of hypertension. Material and Methods: In this prospective, open, randomized, parallel group, comparative study, 80 patients of hypertension attending the Cardiology Outpatient Department, Govt. Medical College & Rajindra Hospital, Patiala were recruited. This randomized comparative study was done on 80 patients for 4 months. Quality of Life: In my project of Quality of life, I had taken total 80 patients and the patients were divided into two groups and 40 patients each of Metoprolol and Ramipril versus Metoprolol and Telmisartan. To assess quality of life questionnaire SF-36 was administered to the patients. Results: There was a marked decrease in SBP and DBP with the use of Metoprolol and Telmisartan than Metoprolol and Ramipril. There was also no change in demographic parameters. There was significant improvement in the quality of life with Metoprolol and Telmisartan. Conclusion: Metoprolol and Telmisartan was a better choice than Metoprolol and Ramipril in treating hypertension as this combination causes more reduction in BP and little effect on HR.

Comparison Of Propofol, Etomidate And Propofol-Etomidate Combination As Induction Agent On Haemodynamic Parametres During Endotracheal Intubation In Patients Undergoing Laparoscopic Cholecystectomy

Endotracheal intubation during general anaesthesia has been associated with change in haemodynamic parameters such as pulse rate and blood pressure. In this study we have compared propofol, etomidate and propofol-etomidate combination as induction agent in patients undergoing laparoscopic cholecystectomy. Material & Methods:After approval from the institutional ethical committee and informed written consent, prospective randomised double blind study was done with ASA physical status I and II. Three groups propofol(P),etomidate(E) and propofol-etomidate combination(PE) including 30 patients in each group were assigned. Haemodynamic parameters heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP),mean bood pressure(MBP),side effects and complications were seen just before induction, at 0 hr soon after intubation, than from 1min to 7min and at 10 min after intubation. Result:There was no significant differences in HR,SBP,DBP,MBP after intubation and post intubation in etomidate group as compared to propofol-etomidate and propofol group. Conclusion: Etomidate has better haemodynamic stability than etomidate-propofol combination alone at 1 min after intubation, though propofol-etomidate combination was equally stable.

Cardiovascular Responses to Isometric Handgrip Training in Normotensive Medical Students

Background: Dynamic handgrip exercise evaluates autonomicresponses to physical activity. The isometric hand gripexercises training effect on cardiovascular system so thatsimilar benefits if any could also be obtained to same extent insimilar age group if they practice physical training regularly.Though there is a vast knowledge on exercise, but data onexercise and its effects on the cardiovascular system and longterm survival are still limited.Material & Methods: A Randomized cross sectional studydone on 100 MBBS students from Mulayam Singh YadavMedical College Meerut. Subjects were evaluated before andafter the training sessions of isometric handgrip exercise forhemodynamic changes like blood pressure, Pulse rate andmaximum volumetric contraction.Results: In present study the mean value of SBP weresignificant but DBP non- significant (P=0.001, 0.005NSrespectively) in Male and Female (P=0.001, 0.005NSrespectively).Conclusion: Thus the arterial pressure reduction reported inthis study would have an important impact on thesecardiovascular related illnesses. Furthermore, our resultssupport the concept that isometric training is an effectivemodality in the prevention of hypertension.

Cisatracurium Pretreatment with Tourniquet - Role in Propofol Injection Pain: A Prospective, Randomized, Double Blind and Control Study

Introduction: Propofol is an anaesthetic drug which is given toinduce and maintain anaesthesia in adults undergoing surgery.This prospective, randomized, controlled study was designedto evaluate the efficacy of cisatracurium as a pretreatment drugin reducing incidence and severity of propofol injection pain.Material and methods: Patient undergoing generalanaesthesia were randomized in four groups of 25 patientseach. Group A received normal saline (control group), GroupB received Cisatracurium 0.05mg/kg IV, Group C receivedCisatracurium 0.1mg/kg IV, Group D received Cisatracurium0.15mg/kg IV. All drugs were administered into the largestdorsal vein of the hand with venous occlusion for 30 sec,followed by propofol (0.5mg/kg). Pain was evaluated usinga four point scale.Result: Cisatracurium 0.15mg/kg significantly lowers bothincidence and severity of propofol induced pain. Cisatracurium0.1mg/kg and cisatracurium 0.05mg/kg both significantlylower the severity of pain but not the incidence as comparedto control group.Conclusion: Cisatracurium is an effective drug in reducingpropofol induced pain. It reduces the incidence and severityboth of pain in 0.15mg/kg dose. Whereas only severityis decreased with 0.10 mg/kg and 0.05 mg/kg dose ofcisatracurium without any significant complications.

Proton pump inhibitor: a risk factor for spontaneous bacterial peritonitis in Indian cirrhotics decompensated with ascites

Background: Spontaneous bacterial peritonitis (SBP) is common complication of cirrhosis caused by bacterial translocation. Bacterial colonization and overgrowth may occur in GI tract on suppression of gastric acid secretion. Beta-blockers have been postulated to reduce intestinal permeability. There is no significant Indian study to evaluate association of PPI with SBP in cirrhotic ascites. We aimed to assess the effect of PPI in cirrhotic patients decompensated with ascites.Methods: A retrospective case control study (January 2016 to April 2018), evaluated subjects with cirrhosis and ascites. Two study groups of cirrhotic subjects with and without SBP were formed. In each of the two study groups, 143 subjects, were enrolled by matching for age, year of admission, Child-Pugh-Turcotte (CTP) class after considering the inclusion and exclusion criteria. PPI use and various other correlates were compared in both study groups. SPSS ver 24.0 was used for statistical analysis.Results: About 69.23% subjects were using PPI prior to admission in SBP group, which was significant compared to only 31.47% in cirrhotics without SBP (p 0.003). On multivariate analysis PPI use was an independent risk factor for SBP (OR 2.24, 95% CI: 1.01-4.24; p value 0.033) and beta blocker use was protective (OR 0.58; 95% CI: 0.4-0.8; p 0.001).Conclusions: PPI use doubles the risk of development of SBP in cirrhotics decompensated with ascites. In contrast, Beta blockers use significantly lowers the risk of SBP.

Cardio vascular response to core stability exercises in healthy individuals

Background: Low back pain is the most common problem which is present among 60 to 80 percent of population in the world at least once in their life time. It is considered as the most influencing aspect of health of an individual as well as their daily living status. Objective: To examine the cardiovascular responses (Heart Rate, Systolic Blood pressure and Rate Pressure Product) in the abdominal techniques that are (bracing and hollowing) used in core stability exercises. Core stability exercises have been used in the management of low back pain. The cardiovascular effects of exercises that involve postural stabilization, arms and exercises in a lying position are well known. Therefore, the purpose of this study was to examine the cardiovascular effects of 6 core stability exercises on cardiac patients which were used commonly for the treatment of low back ache. Materials and methods: This was a descriptive study which was conducted on a single group of 40 healthy males and females volunteers between age group of 18-25 years. With the mean age group of 21.12+1.042. Subjects were undergraduate students of MNR Sanjeevani College of physiotherapy, Sangareddy and were taken on the basis of convenient sampling. Prior to the participation all subjects were explained briefly about the aims and objectives of the study, health benefits of the core stability exercises and about the procedure of measuring Heart rate (HR), Systolic Blood pressure (SBP) and Rate Pressure product (RPP). All subjects were screened and a detail medical history was taken to exclude any serious illness. Health screening tool questionnaire (AACVPR) was used to identify the serious illness in the subject. One day before to the exercise session subjects were taken to the Gayathri Balakavi, Sreenivasu Kotagiri, Anup Kumar Songa, S. Purna Chandra Shekhar. Cardio vascular response to core stability exercises in healthy individuals. IAIM, 2019; 6(10): 35-42. Page 36 experimental room for familiarization of the procedure. The selected core stability exercises were demonstrated and subjects were instructed not to eat an hour before and not to wear tight clothes, Exercise protocol was designed properly and perfectly for the subjects so that they will be able to perform the exercises easily and effectively and the subjects were asked to participate in the exercise sessions after taking all the necessary measures. Pre and post exercise measurements of Systolic Blood pressure (SBP), Heart rate (HR) and Rate pressure product (RPP) values were measured. Before starting the exercise session subjects were made to relax for 15- 20 minutes, then the initial parameters of cardiovascular performance Systolic Blood pressure (SBP) were measured using automatic BP apparatus Omron M 10. BP cuff was tied to the left arm and patient was in high sitting position with arm supported at heart. Heart rate (HR) and Rate pressure product (RPP) were also measured at the same time along with (SBP). Subjects were asked to do 5 repetitions of all the exercises without any rest period. Post exercise Heart rate (HR), Systolic Blood pressure (SBP), and Rate Pressure Product (RPP) were recorded immediately after they finish the exercise. Now they were made to take rest till resting heart rate (RHR) was achieved. So for the given exercise sessions Systolic Blood pressure (SBP), Heart rate (HR) and, Rate Pressure Product (RPP) were measured for pre and post exercises. Results: There was marked increase in the cardiovascular parameters (heart rate, Systolic Blood pressure, and Rate Pressure Product). After exercise was performed, all the exercises were hemodynamically demanding. The study was done on single group of 40 healthy subjects with the mean age of 21.12 ± 1.04 in which 20 were males and 20 were female subjects. The baseline systolic blood pressure was 110.30 ±11.00 and baseline rate pressure product was 8797.15 ± 1419. The study was done with the aim to measure the acute cardiovascular responses to the core stability exercises. Repeated measures of ANOVA were used as the statistical tool. Conclusion: Core stability exercises can have cardiovascular effects in people with no cardiovascular or cardiopulmonary conditions. These cardiovascular effects may be important with respect to cardiac work, in Cardiac patients for whom these exercises are indicated. So, There was a significant increase in the cardiovascular parameters (Heart Rate, Systolic Blood Pressure, Rate Pressure Product) after the entire exercise session was performed by the subjects of the study.

Cardiovascular Response to Exercise: Static v/s Dynamic.

Background: Limited research has been carried out to compare acute cardiovascular responses to static and dynamic exercise in older adult. So in our study we compared the responses to static and dynamic exercise in older adults to find out and support the inclusion of resistance exercise as a part of fitness program designed for healthy subjects of older age group. Aims & Objective: The purpose of this study was to compare the acute cardiovascular responses of healthy older adults to static and dynamic exercise. Methods: In the present study 8 healthy normotensive volunteers, recruited in age group of 40-60 years, performed IHG exercise. Their HR and BP were recorded prior to and after one minute of 40% maximum voluntary contraction of the forearm. Then after a gap of two weeks subjects, performed dynamic exercise using ergo metric cycle. Their HR and BP were recorded prior to and after one minute of completion of exercise. All the recordings were compared before and after both types of exercise. Results: Both types of exercise led to significant rise in SBP, & HR. The rise in DBP was significant in subjects who performed static exercise only. From BP and HR responses, it is clear that acute responses to both exercises are almost similar, supporting the inclusion of static exercise in exercise programs for older adults. Conclusion: This study indicates that the press or response is well regulated in both exercise groups. This supports the inclusion of resistance exercise as part of an overall fitness program designed for healthy older adults.

Assessment of overweight, obesity and metabolic variables among students of a private medical college in Dhaka city.

Background: Overweight and obesity are recognized as recent threat which affecting both developing and developed countries. Obesity and its associated morbidities are leading cause of most non-communicable diseases. Few recent studies have indicated the presence of increase in overweight and obesity among children and adolescent but there is no study among adult groups. Method and material: This cross sectional study was done to assess the prevalence of overweight, obesity and metabolic variables with their relation among medical students. Result: Our result reveals that 8.6% & 1.9% male and 15% & 3.2% female are suffering from overweight and obesity (based on BMI) respectively. More females (31.3% and 65.2%) are centrally obese than males (3.5% and 34.8%) (According to Waist Hip ratio and Waist Height ratio respectively). But according to Waist circumference more males (30.7%) are obese than females (24%). There is also significant difference of male and female BP. DBP and SBP of male (79.22mmHg & 118.9 mmHg) have high normal level than female (72.71mmHg and 108.67mmHg) (P<0.001). There is no significant difference of glycaemic status (p<.286) and lipid profile (p<.347) with central obesity. Conclusion: Although male students have high upper level of blood pressure, female students are more obese than males (both according to BMI and central obesity). High blood pressure and obesity both acts as risk factors for the development of non communicable disease. Student’s awareness therefore should be increased to reduce central obesity and BP within normal range.

Haemodynamic Responses to Tobacco Smoke Inhalation in Male Adolescents in Lusaka, Zambia.

Background: Tobacco smoke is said to cause changes in the levels of catecholamines in the blood, this leads to an increase in blood pressure and heart rate. This is due to nicotine which has also been noted to cause a decrease in vasodilatory activities leading to an increase in both the blood pressure and heart rate. Aim: To determine the acute effects of tobacco smoke on haemodynamics in black male adolescents in Lusaka, Zambia. Study Design: This was an observational study done at the University of Zambia School of Medicine Cardiovascular Research Laboratory in the month of December, 2014. Methodology: Twenty-two (22) black, male-adolescent (age range 19-25 years), active-smokers, consented to participate in the study. The Diasys Ambulatory Blood Pressure Monitoring system (Novacor, France) was used to obtain the Systolic and Diastolic blood pressures (SBP and DBP) and the heart rate. These were obtained 15 minutes before smoking at 5 minute intervals and averaged to obtain the baseline, during the 15 minutes of smoking and on immediate cessation of smoking and thereafter every 15 minutes up to an hour after smoking. Results: There was a significant rise in SBP (mmHg) during smoking (127.9±13.80 mmHg) from baseline values (113.5±13.15 mmHg) (P < .001). It took 30 minutes for the SBP to return to baseline after cessation of smoking. DBP (mmHg) also increased from baseline (79.5±8.79 mmHg) to 85.6±10.92 mmHg during smoking (P <.01). It returned to baseline values immediately after cessation of smoking. The heart rate (bpm) was also noted to significantly increase during smoking (95.2±16.72 bpm) from the values noted before smoking (74.3±13.75 bpm) (P < .05). The mean value for heart rate returned to baseline value by the 15th minute of recovery. Conclusion: The present study demonstrates that smoking may be the cause for the acute increases in SBP, DBP and heart rate in smokers. The smoking caused significant increases in all the haemodynamic indices considered in this study within 15 minutes. Both SBP and DBP increases are indices for stroke and coronary heart disease respectively. The effect of increased SBP was noted to last for 30 minutes while DBP returned to baseline immediately after smoking. A significant increase in heart rate was also noted in the study.

¿Quién es Donald Woods Winnicott? / Who is Donald Woods Winnicott?

Tres abordajes teóricos permitieron obtener un amplio conocimiento sobre D. W. Winnicott, dando lugar a la presente producción escrita sobre la vida y obra de este psicoanalista inglés: el de B. Kahr (1996) -específicamente biográfico, A. Philips (1998) -en una delicada articulación entre las influencias que ejercieron los estudios académicos, la experiencia de su vida profesional y personal y la producción teórica y R. Rodman (1997) -a través de una selección de cartas escritas por Winnicott, permitiendo apreciar la originalidad y estilo singular del autor . Para concluir se realiza un análisis de lo expuesto señalando los puntos de encuentros y divergencias desde una lectura psicoanalítica.

Three theoretical approaches allowed to obtain a broad knowledge of D. W. Winnicott, leading to this production written about the life and work of this English psychoanalyst: The text of B. Kahr (1996)-specifically biographical, A. Philips (1998)-in a delicate articulation between the influences exerted by academic studies, the experience of his professional and personal life and the theoretical, and R. Rodman (1997), through a selection of letters written by Winnicott, allowing to appreciate the originality and unique style of the author. As a conclusion, an analysis of the above meetings noting points and divergences from a psychoanalytic reading.

Winnicott, un modo particular de leer psicoanálisis / Winnicott, a particular way of reading psychoanalysis

Considerar el contexto histórico- político en la intención de comprender los aportes de este singular psicoanalista, su estilo de pensar la clínica y la particularidad de leer el psicoanálisis en la época de posguerra, fue la causa del presente desarrollo. Su desempeño como miembro de la Sociedad Británica Psicoanalítica (SBP) desde 1935 hasta su muerte y el cargo de presidente en dos períodos diferentes; se caracteriza por sostener la continuidad del psicoanálisis, destacando la importancia del aporte de nuevas ideas y descubrimientos, en oposición a un psicoanálisis ortodoxo rígidamente instituido a partir de 1940, luego del fallecimiento de S. Freud, consolidándose la escisión político-teórica entre M. Klein y A. Freud. Renuente a sumarse a uno u otro grupo, se aparta y declara “independiente”. Es desde esta posición, que Winnicott recrea un lenguaje psicoanalítico que transmite la particularidad de la enunciación de su clínica...