Cardiovascular Reactivity to Acute Mental Stress in Post Ovulatory Females.

BACKGROUND: Female hormones fluctuate with the phases of menstrual cycle. Estrogen, which has attributes in cardio-protection, is secreted less during luteal phase. In post-ovulatory phase, days 1-2 before menstruation has minimal female hormone influence due to less secretion. Mental stress subjected at this phase might enhance sympathetic activation which in long run may precipitate cardiovascular diseases. Hence, to explore the autonomic activity to mental stress during this phase of menstrual cycle the study was undertaken. METHODS: Thirty apparently healthy young postovulatory female medical students of B. P. Koirala Institute of Health Sciences, Nepal of age 19.93 (± 0.91) years with BMI of 20.70 kg/m2 (± 2.49) kg/m2 were recruited for the present study. Their short term heart rate variability (HRV) of 5 min was recorded during rest at sitting position. Then each subject was given a mental stress (nine questions selected from MENSA workout questionnaire) for 5 min. During the stress, HRV was recorded simultaneously. Data was statistically analyzed using Friedman test followed by multiple comparisons. The p<0.005 was considered statistically significant. RESULTS: Mental stress significantly decreased RMSSD (p= 0.001), NN50 (p= 0.001) and PNN50 (p=0.001) in time domain and HF nu (p=0.012) in frequency domain parameters of HRV. CONCLUSIONS: Young healthy post ovulatory females responded to acute mental stress by withdrawing cardiac parasympathetic activity.

Visual Evoked Potentials in Primary Open Angle Glaucoma.

BACKGROUND AND AIMS: Visual evoked potentials (VEPs) assess the integrity of the visual pathways from the optic nerve to the occipital cortex. Optic disc cupping and visual field loss have been associated with prolongation of latency of VEP in primary open angle glaucoma (POAG). METHODS: Pattern reversal and flash VEP tests were done in consenting 20 primary open angle glaucoma eyes and 40 normal control eyes. RESULTS: In POAG cases, the refractive error [3.51 ± 1.88 versus 1.88 ± 1.11, D, p = 0.001], cup-disc ratio in percent [66.00 ± 16.98 versus 28.50 ± 5.80, p = 0.001], intraocular pressure [19.55 ± 2.08 versus 11.65 ± 1.64, mmHg, p = 0.001], and automated visual field pattern standard deviation [4.13 ± 6.96 versus 1.64 ± 0.45, dB, p = 0.001] were significantly more than in control. The visual acuity [0.41 ± 0.29 versus 1.00 ± 0.00, p = 0.001], foveal visual sensitivity [25.92 ± 6.88 versus 33.48 ± 1.75, dB, p = 0.001], and automated visual field mean deviation [-9.63 ± 10.58 versus 0.07 ± 1.54, dB, p = 0.001] were significantly less in cases than in control. Among VEP variables, pattern reversal latency N145 [149.00 ± 15.75 versus 137.52 ± 15.20, ms, p = 0.011], flash amplitude N75 [2.18 ± .57 versus 1.47 ± .38, µV, p = 0.001], and flash amplitude N145 [1.99 ± .39 versus 1.43 ± .38, µV, p = 0.001] were increased in cases. The pattern reversal amplitude N75 [1.97 ± .35 versus 2.47 ± .58, µV, p = 0.001], amplitude P100 [3.09 ± .46 versus 6.07 ± 1.44, µV, p = 0.001], and amplitude N145 [2.21 ± .58 versus 4.45 ± 1.99, µV, p = 0.001] were decreased in cases. CONCLUSIONS: POAG caused glaucomatous damage to optic pathway.

Introduction of problem-based learning in undergraduate dentistry program in Nepal.

CONTEXT: Problem-based learning (PBL) is a methodology widely used in medical education and is growing in dental education. Initiation of new ideas and teaching methods requires a change in perception from faculty and institute management. Student-centered education is a need of the day and PBL provides the best outlet to it. AIM: To introduce PBL, assess feasibility and challenges in undergraduate dentistry program and evaluate the impact on their learning. SETTINGS AND DESIGN: PBL was used as a teaching methodology on 37 students in 2(nd) year BDS program. The PBL was duplicated as that of MBBS program. PBL was spread over 5 days. Pre- and post-test questions along with different questionnaires were designed for the students and tutors/faculty to be administered after PBL session. SUBJECTS AND METHODS: Case with temporomandibular joint and muscles of mastication and occlusion was designed as a module with five triggers given to students who were divided into five groups over two tutorials facilitated by tutor. Resource sessions were held by involved departments (Oral Biology, Oral Pathology, Oral Medicine and Radiology, Orthodontics, and Oral Surgery). Students were allotted time for search, research and discover to search literature. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: Pre and post-test comparison showed that the knowledge increased immensely following PBL sessions. Students' assessment by tutors following two PBL tutorials showed a mean score of 34.9 ± 4.01 and 35.5 ± 3.86, respectively. Students' feedback showed that most of them preferred PBL because they found it interactive, collaborative, goal and research oriented. Students were motivated to learn new topic because learning objectives were formulated by themselves and they developed self-directed learning skills. The tutors learned to design cases. CONCLUSIONS: PBL encouraged students to use more interactive methods of learning which possibly will make them lifelong learners.

Reaction time in Stroop test in Nepalese Medical Students.

BACKGROUND: Stroop test is one of the widely used tests in cognitive psychology. It is used both in healthy population and also in patients to assess the selective attention. The selective attention as assessed by it is also found to be altered in bilinguals. In Nepal, most of the students are bilingual since most of the courses are in English language. Thus, they learn English language along with their native languages. This study is aimed to assess the selective attention in healthy Nepalese medical students. OBJECTIVE: To study the reaction time in stroop test in medical students of Nepal. MATERIALS AND METHODS: This study was conducted on 30 healthy male students aged 23.1±2.8 yrs. They were asked to read congruent (red printed in red ink) and incongruent (red printed in blue ink) tests in classical stroop cards. The reaction times for both the tests were calculated. Median with inter-quartile range was obtained for reaction time. Wilcoxon's Sign Rank Test was used to compare reaction time and errors between congruent and incongruent cards. RESULTS: The subjects took 82.10 (63.75-107.76) sec longer to read incongruent stroop test (p<0.001). The error made was 0 in congruent stroop test and 1.5 (0-3) in incongruent stroop test (p<0.001). No students made error in the congruent test but 60% (18) of students made error in incongruent test (p<.001) and interference percentage in incongruent was 157 (115.32-213.50)%. CONCLUSION: The reaction time and interferences were more in incongruent stroop test than congruent test. The interference was very high than that of previous literature's value. This indicates that Nepalese students have delayed attention while performing classical English version of stroop test.

Mild-to-moderate intensity exercise improves cardiac autonomic drive in type 2 diabetes.

AIMS/INTRODUCTION: The aim of the present study was to determine the effect of moderate aerobic exercise on cardiac autonomic function in type 2 diabetic patients. MATERIALS AND METHODS: Heart rate variability of 20 patients with type 2 diabetes was assessed. Resting electrocardiogram for the heart rate variability analysis at spontaneous respiration was recorded for 5 min in the supine position before and after 6 months of supervised aerobic training given three times per week. RESULTS: In time domain measures, the square root of the mean of the sum of the squares of differences between adjacent R-R intervals (RMSSD; 29.7 [26-34.5] vs 46.4 [29.8-52.2] ms, P = 0.023) and the percentage of consecutive RR intervals that differ by more than 50 ms (pNN50; 10.7 [5.5-12.7] vs 26.1 [6.6-37.2]%, P = 0.025] were significantly increased after exercise. In frequency domain measures, low frequency (62.4 [59.1-79.2] vs 37 [31.3-43.3] nu, P = 0.003) and low frequency/high frequency (1.67 [1.44-3.8] vs 0.58 [0.46-0.59]%, P = 0.009) were significantly decreased, whereas high frequency (95 [67-149] vs 229 [98-427] ms(2), P = 0.006) and high frequency (37.6 [20.8-40.9] vs 63 [56.7-68.7] normalized units, P = 0.003) were significantly increased after exercise. In a Poincaré plot, standard deviation perpendicular to the line of the Poincaré plot (SD1; 21.3 [18.5-24.8]-33.1 [21.5-37.2] ms, P = 0.027) was significantly increased after exercise. CONCLUSIONS: These data suggest that three times per week moderate intensity aerobic exercise for 6 months improves cardiac rhythm regulation as measured by heart rate variability in type 2 diabetic patients.

Pre- and postovulatory auditory brainstem response in normal women.

Studies with ovarian hormones on auditory brainstem response (ABR) have conflicting reports although women have ABR shorter than men. This study compared ABR between pre- and postovulatory phases of menstrual cycle in consenting 40 healthy female volunteers (age 19 ± 2.35 years). The study was conducted under standard laboratory conditions (room temperature 26 ± 2°C) using Neuropack (Nihon Kohden machine, NM-420S; H636, Japan) and earphone dynamic receiver ELEGA (Type DR-531; no.237, Japan) in sound proof room. Ears were stimulated simultaneously using standard protocol. ABR was recorded in pre- and postovulatory phases. Ovulation was estimated by measuring basal body temperature. The ABR wave latencies (WLs) I, II, III, IV, V and inter-peak latencies (IPLs) I-III, III-V, I-V were compared between the two phases of menstrual cycle using paired t test. The postovulatory phase had shorter WL V (5.71 ± 0.18 ms vs. 5.81 ± 0.19 ms, p < 0.01), IPL III-V (1.89 ± 0.16 ms vs. 1.94 ± 0.19 ms, p < 0.05), and I-V (3.88 ± 0.16 ms vs. 3.95 ± 0.18 ms, p < 0.05) than in preovulatory. Other WLs and IPLs showed decreasing trend in postovulatory phase. ABR is better in postovulatory phase as compared to preovulatory phase probably due to progesterone hormone which might be involved in modulating auditory hearing pathway at postovulatory phase.

Cardiovascular autonomic function and vibration perception threshold in type 2 diabetes mellitus.

OBJECTIVE: The aim of this study was to compare cardiovascular autonomic function tests (AFT) and vibration perception threshold (VPT) of patients with type 2 diabetes mellitus (T2DM) with controls. RESEARCH DESIGN/METHODS: The study was conducted on 60 diabetic patients comparing with 30 controls. The cardiovascular AFT and VPT were assessed in both groups. RESULTS: Among cardiovascular AFT, E:I ratio [1.24 (1.2-1.32) vs 1.3 (1.24-1.4), p=0.001], and Valsalva ratio [1.28 (1.22-1.4) vs 1.6 (1.5-1.73), p=0.001], the indicators of parasympathetic reactivity were reduced in T2DM. Rise in DBP during handgrip, an indicator of sympathetic reactivity was lower in T2DM [12 (10-14) vs 16 (14-18) mmHg, p=0.001] whereas, fall in SBP during head up tilt [4 (4-8) vs 5 (4-8) mmHg] was comparable. VPT (somatic sensation) was comparable between T2DM and control. CONCLUSION: Autonomic involvement is more marked than somatic, and parasympathetic involvement is more marked than the sympathetic, possibly reflecting severity and chronological pattern of their involvement.

An evaluation of training of teachers in medical education in four medical schools of Nepal.

Effective teaching is a concern of all teachers. Therefore, regular teachers' training is emphasized globally. B. P. Koirala Institute of Health Sciences (BPKIHS), a health science deemed university situated in eastern region of Nepal has an established Medical Education unit which attempts to improve teaching-learning skills by training faculty members through organizing regular medical education training programs. The aim of the present study was to assess the effectiveness of 3-day training workshop on "Teaching-learning methodology and Evaluation" held in four different medical colleges of Nepal. The workshop was targeted at middle and entry level of health profession teachers who had not been previously exposed to any teacher's training program. The various components, such as teaching-learning principles, writing educational objectives, organizing and sequencing education materials, teaching-learning methods, microteaching and assessment techniques, were incorporated in the workshop. A team of resource persons from BPKIHS were involved in all the four medical institutions. The collection data had two categories of responses: (1) a questionnaire survey of participants at the beginning and end of the workshop to determine their gain in knowledge and (2) a semi-structured questionnaire survey of participants at the end of workshop to evaluate their perception on usefulness of the workshop. The later category had items with three-point likert scale (very useful, useful and not useful) and responses to open-ended questions/ statements to document participants general views. The response was entered into a spreadsheet and analyzed using SPSS. The result showed that all participants (n = 92) improved their scores after attending the workshop (p < 0.001). Majority of respondents expressed that the teaching-learning methods, media, microteaching and evaluation techniques were useful in teaching-learning. The workshop was perceived as an acceptable way of acquiring teaching-learning skills but 39.4% participants expressed that the duration of the workshop was too short. The overall impression about trainers was very positive. Therefore, regular organization of such workshops with addition of new advances in medical education would be highly beneficial to improve teaching learning skill of medical teachers.

Assessment of pulmonary function in local healthy Nepalese men of Dharan and it's anthropometric correlation.

Healthy non smoking male subjects (n = 150) aged 18-40 years were subjected to pulmonary function testing to establish linear multiple regression model. Pulmonary parameters were considered as independent variables and physical parameters (age, height, weight, body mass index (BMI) and body surface area (BSA) and anthropometric parameters (skin fold thickness (SFT), mid arm circumference and abdominal girth) were taken as dependent variables. This study was undertaken to determine correlation coefficients between dependent variables and different pulmonary independent variables and to derive regression equations or prediction formulae in order to find out the expected normal values for the different lung function tests in a given individual. Present study revealed that the upper body fat distribution, as reflected by biceps skin fold thickness and mid arm circumference, is a significant predicator of ventilatory function.

Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations.

BACKGROUND: This report describes a new technique of sphincter saving anorectoplasty (SSARP) for the repair of anorectal malformations (ARM). METHODS: Twenty six males with high ARM were treated with SSARP. Preoperative localization of the center of the muscle complex is facilitated using real time sonography and computed tomography. A soft guide wire is inserted under image control which serves as the route for final pull through of bowel. The operative technique consists of a subcoccygeal approach to dissect the blind rectal pouch. The separation of the rectum from the fistulous communication followed by pull through of the bowel is performed through the same incision. The skin or the levators in the midline posteriorly are not divided. Postoperative anorectal function as assessed by clinical Wingspread scoring was judged as excellent, good, fair and poor. Older patients were examined for sensations of touch, pain, heat and cold in the circumanal skin and the perineum. Electromyography (EMG) was done to assess preoperative and postoperative integrity of external anal sphincter (EAS). RESULTS: The patients were separated in 2 groups. The first group, Group I (n = 10), were newborns in whom SSARP was performed as a primary procedure. The second group, Group II (n = 16), were children who underwent an initial colostomy followed by delayed SSARP. There were no operative complications. The follow up ranged from 4 months to 18 months. Group I patients have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination with an average number of bowel movements per day was 3-5. In group II the rate of excellent and good scores was 81% (13/16). All patients have an appropriate size anus and regular bowel actions. There has been no rectal prolapse, or anal stricture. EAS activity and perineal proprioception were preserved postoperatively. Follow up computed tomogram showed central placement the pull through bowel in between the muscle complex. CONCLUSION: The technique of SSARP allows safe and anatomical reconstruction in a significant proportion of patients with ARM's without the need to divide the levator plate and muscle complex. It preserves all the components contributing to superior faecal continence, and avoids the potential complications associated with the open posterior sagittal approach.