Effects of physical activity breaks during prolonged sitting on vascular and executive function-A randomised cross-over trial.

Objectives: High sedentary behaviour is associated with adverse effects on central vascular function and cognitive function. Although interventions to mitigate the adverse effects of workplace sitting are intriguing, evidence of the efficacy of such interventions remains lacking. This randomised cross-over trial was aimed at exploring the effectiveness of prolonged sitting, with or without physical activity breaks, on central, peripheral vascular and cognitive function in adults. Methods: Twenty one healthy adults completed 4 h of simulated work conditions in three experimental visits: (1) uninterrupted sitting (SIT); (2) sitting interrupted by 3 min of walking every hour (LIT); and (3) sitting interrupted by 3 min of stair climbing every hour (MIT). Carotid (CA) and superficial femoral artery (SFA) diameter, velocity, shear rate and blood flow were measured with Duplex ultrasound at 50 MHz at three time points (hours 0, 2 and 4), and executive function was assessed with the computer based Eriksen Flanker task every hour. Results: The decreases in reaction time (-30.59%) and accuracy (-10.56%) during SIT conditions were statistically significant, and less of a decrease was observed under LIT and MIT conditions. No significant differences in CA and SFA function were observed with LIT and MIT interventions. Conclusion: Physical activity breaks of varying intensity during prolonged sitting improve reaction time. However, the vascular benefits of physical activity breaks should be confirmed in the future through long term studies in natural environment.

Management of excessive gingival display with mucosal coronally positioned flap.

OBJECTIVE: Current methods of managing excessive gingival display, an aesthetic concern, with gingivectomy, orthodontic intrusion, restorative dentistry and even botulinum toxin, have often been unsatisfactory. This study evaluates the efficacy of mucosal coronally positioned flap (MCPF) for reduction of gingival display. MATERIAL AND METHODS: Eight healthy patients, above 18 years, with either short or hyperactive upper lip, gingival display ≥4 mm during smiling or vertical maxillary excess, were recruited into the study. The smile line, upper lip length, upper lip vermillion length, distance between the lips and amount of gingival display along with clinical indices were assessed. The patients then underwent MCPF procedure and were re-evaluated for healing of the surgical site after 15 days and at 3 months. Patients also provided their perceptions of outcome of treatment, through a questionnaire. Paired t test and Repeated measures ANOVA were used for data analysis. RESULTS: Significant improvement in the gingival display was noted 3 months after the procedure, while no concomitant changes were observed in other parameters like upper lip length, vermillion length and distance between the lips post operatively. CONCLUSION: The results of the study suggest that the MCPF procedure provides satisfactory results in terms of reduction of gingival display. Simplicity of the surgical procedure makes it an attractive option for patients without any gross skeletal abnormalities.

Comparison of Oncostatin M in Patients with Chronic Periodontitis with and without Diabetes

Abstract Objective: To compare the Oncostatin M (OSM) concentrations in tissues of patients with chronic periodontitis with and without diabetes. Material and Methods: Sixty-four subjects visiting the dental outpatient department were categorized as "healthy" (Group 1), "periodontitis" (Group 2), and "diabetes with periodontitis" (Group 3) groups. The clinical oral examination included assessment of plaque, gingivitis, probing depth, clinical attachment level. Blood glucose was assessed for group 3 patients. OSM concentration in the tissues was assessed using ELISA in all groups. Results: The mean OSM was 0.02 ± 0.04 pg/mg in the healthy group, 0.12 ± 0.09 pg/mg in the chronic periodontitis group and 0.13 ± 0.10 pg/mg in the diabetes-periodontitis group. A significantly higher mean OSM was seen in Group 2 and Group 3 than Group 1. The amount of OSM positively correlated with probing depth and clinical attachment level. Conclusion: Periodontal disease causes a rise in Oncostatin M, independent of the diabetic status. Expression of OSM in the gingival tissues can serve as an inflammatory marker.

Survey of knowledge of school children towards the prevalence, severity, management of maxillofacial injuries, and rescue skills in the event of a dog bite.

BACKGROUND: Maxillofacial injuries are reported commonly in children encountering animal/dog attack. The level of knowledge of children on such events can form a sound basis for the prevention of maxillofacial injuries resulting from dog bites/attacks. AIM: This study aims to assess the knowledge of children on maxillofacial injuries resulting from dog bites, their management, and rescue skills to be used during the event of a dog attack. SETTINGS AND DESIGN: The study is a cross-sectional questionnaire survey. MATERIAL AND METHODS: Seven hundred children aged 7-12 years participated in the study. A questionnaire consisting of 21 questions assessed the common site and management of injury resulting from dog bites, the source of exposure, and the knowledge of children on rescue skills to be used in the event of dog attack. This was followed by an awareness program to educate the children on rescue skills and management of dog bite injuries. STATISTICAL ANALYSIS: Descriptive statistics were calculated for all the variables. RESULTS: A significant percentage of dog bite injuries occurred on the face and hands in children. Boys were more common victims. Familiar dogs inflicted injuries to the children commonly than stray dogs. The children lacked knowledge on the management of dog bite injuries; however, they were aware of rabies and its prevention. The children were not well aware of rescue skills to be used in the event of a dog attack. CONCLUSION: Children are innocent and behavior of dogs are unpredictable hence they become victims of the dog attacks. Educating children on safe animal behavior can prove vital in reducing gruesome maxillofacial injuries resulting from dog attacks.

Effect of plasma component transfusion on conventional coagulation screening tests.

BACKGROUND: Conventional coagulation screening tests such as Prothrombin time, International normalized ratio (INR) and activated partial thromboplastin time are often used to predict bleeding in various clinical situations. We aimed to observe the effect of Fresh-frozen plasma (FFP) on these parameters. METHODS: Patients' demographics, pre- and post-transfusion coagulation parameters were noted to assess the level of correction. The magnitude of improvement in INR was determined using the formula given by Holland and Brooks. Data was analyzed using IBM SPSS Statistics 20. RESULTS: Among 2082 episodes, 4991 units of FFP were transfused at an average of 5 units per patient. Median dose of FFP administered per episode was 10 mL/kg (5.8-13.4). The mean change in INR following transfusion was 8.9% of the pre-transfusion INR and thus considered to be statistically significant. CONCLUSION: FFP transfusions as a prophylactic measure especially in patients with mildly deranged conventional coagulation screening tests without any empirical evidence of clinical bleeding needs further scrutiny. Reduction in INR following FFP transfusions was better in cohort having higher pre-transfusion INR value (> 3.0).

A Randomized Controlled Trial Studying the Role of Dexamethasone in Scalp Nerve Blocks for Supratentorial Craniotomy.

BACKGROUND: The aim of this double-blinded randomized control study was to examine the role of the steroid dexamethasone as an adjuvant to lignocaine and ropivacaine in scalp nerve blocks in adults undergoing supratentorial craniotomy under general anesthesia. We compared the intraoperative anesthetic and postoperative analgesic requirement with and without the addition of dexamethasone to the local anesthetics. METHODS: The consented 90 patients were randomized into 2 groups: one group received 8 mg (2 mL) of dexamethasone, whereas the other received 2 mL of normal saline along with the local anesthetics in the scalp nerve block administered soon after induction of general anesthesia. All patients received oral/intravenous dexamethasone perioperatively to decrease cerebral edema. The general anesthetic technique for induction, maintenance, and recovery was standardized in the 2 groups. The primary outcome assessed was the time to administration of the first dose of analgesic postoperatively. The secondary outcomes included intraoperative opioid requirement, time to emergence, and incidence of postoperative nausea and vomiting. RESULTS: There was no significant difference between the dexamethasone and saline groups with respect to time to first analgesic requirement, intraoperative fentanyl requirements, time to emergence from general anesthesia, and incidence of postoperative nausea and vomiting. CONCLUSIONS: Addition of dexamethasone as an adjuvant to local anesthetics in scalp nerve blocks in the setting of perioperative steroid therapy does not appear to provide any additional benefit with respect to prolongation of the duration of the block.

The impact of lifestyles on the periodontal health of adults in Udupi district: A cross sectional study.

OBJECTIVES: (1) To assess the impact of different lifestyle factors on periodontal health of adults. (2) To assess the impact of overall/combined lifestyle variable (calculated by health practice index [HPI]) on periodontal health of adults. MATERIALS AND METHODS: A cross-sectional study consisting of a structured questionnaire on HPI, oral health-related behavior, and personal habits as well as sociodemographic variables was conducted on 800 subjects aged 20-50 years attending dental outreach set-ups of Manipal College of Dental Sciences, Manipal. Clinical examination for periodontal status was done by recording loss of attachment scores using community periodontal index (FDI/WHO-1982). Statistical analysis was done by bivariate analysis using Chi-square followed by multivariate analysis to obtain adjusted odds ratio with 95% confidence interval. RESULTS: After adjusting for all the confounding variables in multivariate logistic regression analysis, the variables that showed an independent association with periodontitis were age, location, marital status, smoking, hours of sleep per night, physical activity, and overall poor lifestyles. CONCLUSION: Our results support studying a combined approach using various lifestyle behaviors for controlling chronic periodontitis. Necessary public health action on conditions which determine unhealthy lifestyle behaviors across population is needed which is possible by patient's involvement in self-care by promoting healthy lifestyles.

Mobilization of patients in neurological Intensive Care Units of India: A survey.

CONTEXT: The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs) vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance. AIM OF THE STUDY: To study the current mobilization practices by the physiotherapists in neurological ICUs of India. SUBJECTS AND METHODS: A cross-sectional survey was conducted with a content validated questionnaire about the mobilization practices. Online questionnaire was distributed to physiotherapists working in neurological ICUs of India. Descriptive statistics were used. RESULTS: Out of 185 e-mails sent, 82 physiotherapists completed the survey (survey response rate = 44%). Eighty participants (97.6%) mentioned that the patients received some form of mobilization during the day. The majority of the physiotherapists (58.5%), "always" provided bed mobility exercises to their patients when it was found appropriate for the patients. Many physiotherapists (41.5%) used tilt table "sometimes" to introduce orthostatism for their patients. CONCLUSION: Mobilization in various forms is being practiced in the neurological ICUs of India. However, fewer mobilization sessions are conducted on weekends and night hours in Indian Neurological ICUs.

Comparison of two walk tests in determining the claudication distance in patients suffering from peripheral arterial occlusive disease.

BACKGROUND: The purpose of this study was to compare the six-minute walk test (6MWT) and the incremental shuttle walk test (ISWT) in terms of the initial onset of pain (IOP), maximal claudicating pain (MCP), maximum walking distance (MWD), initial ankle brachial index (IABI), post ankle brachial index (PABI), and difference in ankle brachial index (DFABI), as well as to correlate changes in IOP and MWD, MCP and MWD, IABI and MWD, PABI and MWD, and DFABI and MWD in the 6MWT and ISWT. MATERIALS AND METHODS: Participants (n = 19, 17 men and 2 women) were randomly allocated to the 6MWT or ISWT and crossed over to the other test after 24 hours. The baseline ankle brachial index (ABI) measurements were taken using the Doppler, following which the participants performed the tests. Post-test MWD, IOP, MCP, and ABI were measured. The paired t test was used pre- and post the walk test and the Pearson correlation was used to find any relationship between the desired variables. RESULTS: The paired t test at 95% confidence interval for IABI and PABI (P > 0.05) was insignificant for the 6MWT and ISWT. The Pearson correlation of MWD with IOP showed a fair correlation, and the correlation of MWD to MCP showed a strong correlation in ISWT. CONCLUSION: ISWT can be of vital importance as a tool to assess the functional status of patients suffering from Peripheral Arterial Occlusive Disease (PAOD) in both the clinical and research areas, and reflects a better assessment of the functional limitation when walking with PAOD as compared to the 6MWT.

Chest physiotherapy techniques in neurological intensive care units of India: A survey.

CONTEXT: Neurological intensive care units (ICUs) are a rapidly developing sub-specialty of neurosciences. Chest physiotherapy techniques are of great value in neurological ICUs in preventing, halting, or reversing the impairments caused due to neurological disorder and ICU stay. However, chest physiotherapy techniques should be modified to a greater extent in the neurological ICU as compared with general ICUs. AIM: The aim of this study is to obtain data on current chest physiotherapy practices in neurological ICUs of India. SETTINGS AND DESIGN: A tertiary care hospital in Karnataka, India, and cross-sectional survey. SUBJECTS AND METHODS: A questionnaire was formulated and content validated to assess the current chest physiotherapy practices in neurological ICUs of India. The questionnaire was constructed online and a link was distributed via E-mail to 185 physiotherapists working in neurological ICUs across India. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: The response rate was 44.3% (n = 82); 31% of the physiotherapists were specialized in cardiorespiratory physiotherapy and 30% were specialized in neurological physiotherapy. Clapping, vibration, postural drainage, aerosol therapy, humidification, and suctioning were used commonly used airway clearance (AC) techniques by the majority of physiotherapists. However, devices for AC techniques such as Flutter, Acapella, and standard positive expiratory pressure devices were used less frequently for AC. Techniques such as autogenic drainage and active cycle of breathing technique are also frequently used when appropriate for the patients. Lung expansion therapy techniques such as breathing exercises, incentive spirometry exercises, and positioning, proprioceptive neuromuscular facilitation of breathing are used by majority of physiotherapists. CONCLUSIONS: Physiotherapists in this study were using conventional chest physiotherapy techniques more frequently in comparison to the devices available for AC.

An evaluation of the Pi analysis in the assessment of anteroposterior jaw relationship.

OBJECTIVE: This study has investigated two new cephalometric variables, the Pi angle and Pi linear in the evaluation of anteroposterior skeletal discrepancy. DESIGN: Retrospective cross-sectional study. SETTING: Manipal College of Dental Sciences, Manipal, India SUBJECTS AND METHOD: A sample of 155 subjects (mean age 19·7 years) were subdivided into skeletal class I, II and III groups based upon ANB angle. Descriptive data were calculated for each variable and group. Receiver operating characteristics curves were used to examine sensitivity and specificity of the Pi angle in the discrimination between different skeletal groups. Correlation coefficients were obtained for each of the parameters to compare their relationship with other parameters in the class I group. Coefficient of determination, regression coefficient, regression equation and standard error of estimate were also calculated from the parameters showing significant correlation with the Pi angle. RESULTS: Mean values for the Pi angle in skeletal class I, II and III subjects were 3·40 (±2·04), 8·94 (±3·16) and -3·57 (±1·61) degrees, respectively. For the Pi linear they were 3·40 (±2·20), 8·90 (±3·56) and -3·30 (±2·30) mm for class I, II and III subjects, respectively. Receiver operating characteristic curves showed that a Pi angle greater than 5 degrees had 89% sensitivity and 82% specificity for discriminating a skeletal class II group from class I. A Pi angle of less than 1·3 degrees had 100% sensitivity and 84% specificity in discriminating skeletal class III groups from class I. The overall accuracy for discriminating class II groups from class I was 85% and for class III from class I, 90%. Thus, a cut-off point between class I and II groups could be considered a Pi angle of approximately 5 degrees and between class I and class III, approximately 1·3 degrees. There were no statistically significant correlations found between Pi angle and ANB (0·07), Beta angle (-0·04) and WITS analysis (0·19). The highest level of correlation was obtained for the Pi angle and Pi linear (0·96). CONCLUSION: The anglar and linear components of the Pi analysis are a suitable method for assessing anteroposterior jaw discrepancy in daily clinical practice.