Transcutaneous neuromodulation versus oxybutynin for neurogenic detrusor overactivity in persons with spinal cord injury: A randomized, investigator blinded, parallel group, non-inferiority controlled trial.

STUDY DESIGN: This study is a randomized, investigator-blinded, controlled trial with a non-inferiority design. OBJECTIVE: To investigate the effectiveness of neuromodulation by transcutaneous electrical stimulation of the somatic afferent nerves of the foot in neurogenic detrusor overactivity (NDO) in persons with spinal cord injury (SCI) and compare its effectiveness with oral oxybutynin. SETTING: The study was conducted in a rehabilitation in-patient ward of a tertiary care hospital. METHODS: Twenty-nine persons with SCI with NDO, either sex, aged 18 years and above were randomized into two groups, one group receiving oral oxybutynin (5 mg thrice a day for two weeks) and the other transcutaneous electrical stimulation (5 Hz, 200 µs pulse, biphasic, amplitude up to 60 mA, 30 min/day for two weeks). Bladder capacity was evaluated by clinical bladder evaluation (i.e. bladder capacity measured by adding leak volume, voiding volume if any, and post-void residue using a catheter) and cystometric bladder capacity by one-channel cystometry. Maximum cystometric pressure was evaluated by one-channel water cystometry. Data were analyzed with Fisher's Exact, t-test, and Wilcoxon rank sum tests. RESULTS: Bladder capacity improved significantly in the oxybutynin and neuromodulation groups as measured by one-channel water cystometry (136 ml vs. 120.57 ml) and clinical evaluation (138.93 ml vs. 112 ml). The increase in the neuromodulation group achieved the pre-decided non-inferiority margin of 30 ml over the oxybutynin group when measured by one-channel water cystometry but not by clinical evaluation. Maximum cystometric pressure did not significantly improve in either group when compared with the baseline. CONCLUSION: Transcutaneous neuromodulation and oxybutynin effectively increased bladder capacity in persons with SCI with NDO. Neuromodulation by once-a-day transcutaneous electrical stimulation was non-inferior to thrice-a-day oxybutynin when evaluated by one-channel water cystometry.Trial registration: Clinical Trials Registry India identifier: CTRI/2018/05/013735.

Normative Data of Liquid Gastric Emptying and Small-bowel Transit: A Prospective Cross-sectional Study.

Purpose of the Study: The primary objective was to establish the reference values for liquid gastric emptying and small bowel. The secondary objectives encompassed comparing the anterior view and geometric mean methods, assessing gender differences, and exploring potential correlations with age. Materials and Methods: Thirty-five consecutive healthy participants (28 females and 7 males) with a mean age of 42 ± 11 years (median, 42; range, 23-65) underwent liquid gastric emptying scintigraphy at five intervals (0, 0.5, 1, 2, and 4 h), with optional additional imaging at 24 h. Liquid gastric emptying was evaluated using percent retention and half-time (T1/2). Small-bowel transit was assessed using the index of small-bowel transit (ISBT), calculated as the ratio of terminal ileal reservoir counts to total abdominal counts at 4 h. Reference values were established based on percentiles or mean and standard deviation (SD). Rapid small-bowel transit was determined through visual inspection. Statistical analysis involved paired Samples t-test or Wilcoxon signed-rank test for comparing imaging methods, independent Samples t-test or Mann-Whitney U-test for gender comparison, and Spearman's rank correlation for assessing age-related associations. A 2-tailed P < 0.05 indicated significance. Results: Rapid liquid gastric emptying based on the geometric mean method was defined as percent retention <8% at 30 min, while delayed emptying as percent retention >33%, >20%, and >4% at 1, 2, and 4 h, respectively. The reference range of T1/2 of gastric emptying was 10-60 min. The reference value for small-bowel transit using the geometric mean method was established as ISBT >30% at 4 h, while rapid small-bowel transit was defined as the first visualization of activity in the cecum-ascending colon within 1 h. Parameters for liquid gastric emptying and small-bowel transit were notably higher in the anterior view method compared to the geometric mean method (P ≤ 0.019), except for percent retention at 2 h (P = 0.510). Nevertheless, the obtained reference values, whether based on percentiles or mean and SD, showed no notable variance between the two methods to warrant clinical significance. Gender did not display an impact on liquid gastric emptying or small-bowel transit in either method (P ≥ 0.173), and age demonstrated no significant moderate or strong correlations (Spearman's ρ ≤ 0.397). Conclusion: The study determined reference values for liquid gastric emptying and small-bowel transit through a standard gastric emptying scintigraphy protocol, avoiding additional complex procedures or extended imaging sessions. The established normative data can apply to individuals of both genders aged ≥18 years. While advocating the geometric mean method as the primary choice, the study acknowledges that in busy centers handling multiple studies with limited resources and a single-head gamma camera catering to multiple studies, the anterior view method remains a feasible alternative.

A cross-sectional study to assess dual-task interference in postural control in people with lower limb amputation.

BACKGROUND: In people with lower limb amputation (LLA), the loss of limb structures and peripheral motor and sensory systems result in significant mobility challenges, including impaired postural stability. OBJECTIVE: The primary objective of this study was to evaluate the dual-task interference (DTI) on postural control and dual-task interference on cognition during static and dynamic balance in people with LLA and compare the same with controls. The secondary objective of this study was to compare the DTI on postural control and DTI on cognition between LLA of different etiology. DESIGN: Cross-sectional observational study METHODOLOGY: Fifteen people with unilateral LLA and 15 age and gender-matched controls participated in this study at a tertiary care hospital. The outcome measures used were anterior-posterior stability index (APSI), medial-lateral stability index, and overall stability index (OSI) using Biodex Balance System and a cognitive task parameter, namely correct response rate in serial seven subtraction test. Quantitative variables were compared using a Wilcoxon rank-sum test. Spearman's correlation test was used to establish the correlation between the DTI on cognition and the DTI on postural control. RESULTS: DTI on postural control during static balance was significantly higher in people with LLA than controls (APSI, OSI). No significant difference was observed in DTI on postural control during dynamic balance. No significant difference was observed in DTI on cognition during static and dynamic balance. A significant negative correlation was observed between DTI on cognition and DTI on postural control (APSI) during static balance people with LLA. SIGNIFICANCE: In people with unilateral LLA, the addition of a cognitive task results in significant deterioration of sagittal plane postural control during static balance but not during dynamic balance due to the over-allocation of resources to a cognitive task.

Assessment of Small-bowel and Colonic Transit on Routine Gastric Emptying Scintigraphy: Establishment of Reference Values.

Purpose of the Study: The primary objective was to establish the reference values for small-bowel and colonic transit within the context of the routine standard solid meal gastric emptying scintigraphy (GES). The secondary objective was to compare the small-bowel and colonic transit between the anterior view and geometric mean methods. Materials and Methods: Twenty-nine healthy controls underwent routine GES, with additional imaging at 24 h if feasible. Small-bowel transit was assessed using the index of small-bowel transit (ISBT), calculated as the ratio of terminal ileal reservoir counts to total abdominal counts at 4 h. Colonic transit was evaluated using the colonic geometric center (CGC) by dividing the large bowel into four segments, with an additional fifth segment accounting for the eliminated counts. Reference values were established based on the fifth percentile or mean ± 1.96 standard deviations. Rapid small-bowel transit was visually determined. Paired Samples t-test or Wilcoxon signed-rank test, as applicable, was used to compare the small-bowel and colonic transit between the anterior view and geometric mean methods. For comparing small-bowel and colonic transit between females and males, the Independent samples t-test or Mann-Whitney U-test was applied, as appropriate. The correlation between age and small-bowel and colonic transit was assessed using Spearman's rank correlation analysis. Results: The reference value for small-bowel transit using the geometric mean method was established as ISBT >37% at 4 h, whereas rapid small-bowel transit was defined as the first visualization of activity in the cecum-ascending colon within 2 h. For colonic transit, the reference range was established as CGC 2.8-4.4 at 24 h. Comparing the anterior view and geometric mean methods, there were no significant differences in ISBT and CGC values (P ≥ 0.125). Gender did not affect small-bowel and colonic transit in both methods (P ≥ 0.378), and age showed no significant correlations (P ≥ 0.053). Conclusion: This study determined the reference values for small-bowel and colonic transit in the Indian population using routine GES, avoiding the need for additional complex procedures. The results may be generalized to the Indian population, emphasizing the importance of assessing small-bowel and colonic transit in patients with normal gastric emptying parameters to enhance gastrointestinal transit evaluation.

Clinical profile of COVID-19 infection among persons with spinal cord injury: a case series.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To report the clinical features and outcomes of spinal cord injury (SCI) patients with COVID-19 and to see if they are any different from COVID-19 in the general population. SETTING: A tertiary care hospital in North-East India. METHODS: Data of already diagnosed traumatic SCI patients with COVID-19 infection reporting to the COVID-19 management team (from June 2021 to November 2021) were collected. The source of data was hospital records (admitted patients) and home visits and teleconsultation logs (home isolation patients). RESULTS: There were eight traumatic SCI patients (five admitted, three in home isolation) with COVID-19 infection. Four patients had complete injury with American Spinal Injury Association Impairment Scale (AIS) Grade A, two with AIS Grade C, and one each of Grade B and D respectively. Five patients were cervical level injuries, and others were T10 level and below. Six patients were categorized as mild clinical illness and one each as moderate and severe illness. Cough was the most common symptom which was seen in seven patients. Only two patients needed oxygen therapy. All eight traumatic SCI patients recovered eventually from COVID-19 symptoms and regained their pre-COVID-19 functional status, 1 month after being free from COVID-19 symptoms. CONCLUSION: The COVID-19 infection did not result in a worsening of functional ability among SCI people after 1-month post-recovery. It also did not affect the SCI patients in doing activities such as rehabilitation exercises at 6 months follow up.

Understanding health care seeking behavior in a tribal setting in West Bengal.

Background: The health-related problems of the tribal population depend on their ecology and culture. Often the tribal people do not utilize the medical and preventive health services available to them. Health problems in tribal groups need special attention because many tribal communities are backward. The current study was planned to determine the healthcare-seeking behavior of the tribal population in India. Method: A descriptive, cross-sectional study, conducted by interviewing key respondents of each participating family. Result: Two-thirds of the key respondents were literate and half (53.8%) of the total households in the three villages had a per capita monthly income between Rupees 500-1499. More than half (57%) of all respondents preferred government institutions for moderate illness, and the rest equally opted for private practitioners and quacks. However, for emergencies, dog bites, and snake bites, all key respondents in the three study villages unanimously preferred government institutions. A significant population (38.5%) got their children delivered at home. The majority of illiterate respondents (86.1%) preferred government institutions for health care of under-five children, while 60% of literates expressed a similar view. The choice of government institutions as a source of health care was increasingly favored with decreasing per capita monthly household income. Conclusion: Traditional healers are no longer preferred among the tribal population but they are reluctant to avail them because of the loss of valuable time. Home delivery is still prevalent. With improving socioeconomic status, people are going further away from government services as private practitioners, and quacks take less time.

Standard Clinical Screening Tests, Sural Radial Amplitude Ratio and F Wave Latency Compared to Conventional Nerve Conduction Studies in the Assessment of Sensorimotor Polyneuropathy in Patients with Type 2 Diabetes Mellitus.

Background and Aims: The measuring tools used for assessment of neuropathy include various questionnaires, monofilament testing, Biothesiometry and the gold standard test, nerve conduction studies (NCS). This study aims to evaluate the diagnostic accuracies of Michigan Neuropathy Screening Instrument (MNSI), Biothesiometry, Semmes Weinstein Monofilament (SWMF), Sural Radial Amplitude Ratio (SRAR) and minimal F wave latency as compared to conventional NCS and arrive at a simple diagnostic algorithm for early detection of Diabetic Peripheral Neuropathy (DPN). Methods: In a cross-sectional observational study on 48 Type 2 diabetes mellitus patients, MNSI, Biothesiometry, SWMF and NCS including F waves and SRAR were done and diagnostic accuracies (sensitivity, specificity, positive and negative predictive values) calculated taking NCS as gold standard. Results: MNSI, Biothesiometry, SWMF, SRAR and minimal F wave latency had a sensitivity of 64.3%, 78.6%, 14.3%, 100% and 78.6% and specificity of 67.7%, 52.9%, 94.1%, 23.53% and 76.47% respectively, with reference to NCS. Based on combined sensitivities and specificities, we arrived at a simple algorithm for early diagnosis of DPN, which showed that DPN could either be diagnosed or ruled out in 75% of the patients by a combination of the Biothesiometry, SRAR and left lower limb minimal F wave latency results. Conclusions: In the setting of an outpatient, multidisciplinary diabetic clinic, simple tests such as questionnaires, monofilament testing and biosthesiometer could be performed with greater ease while considering NCS as the gold standard. This algorithm, combining Biothesiometry, SRAR and left lower limb minimal F wave latency would be less time consuming and help in early diagnosis of DPN.