Normative data of Ankle brachial pressure Index and Toe brachial index in normal healthy male adult using fully automated vascular Doppler.

Context: Peripheral vascular disease affects some 12%-14% of the general population, and the majority of people with the disease are asymptomatic. Risk factors for it are smoking, diabetes mellitus, hyperlipidemia, hypertension, obesity, and syndrome X. The Ankle Brachial Pressure Index (ABPI) is one of the screening noninvasive methods for the diagnosis of peripheral vascular disease. Assessment is performed by fully automated vascular Doppler, which is considered to be accurate; however, normative data are limited. Aims: To measure the normative data of ABPI and Toe brachial index (TBI) in a healthy adult. Settings and Design: A cross-sectional study done in male (n = 59) volunteers in the age group of 18 to 50 years of age group. Methods and Material: Smartdop XT fully automatic Doppler-14 ports (Hadeco, Japan) was used to measure ABPI and Toe brachial index (TBI). Statistical analysis used: Normative value (Mean, SD, Range) was calculated using Systac 13 software. Results: Right-side Ankle Brachial Pressure Index (ABPI) and left-side ABPI at the posterior tibial artery (PT) were 1.061 ± 0.098, and 1.105 ± 0.139, respectively. Right-side ABPI and left-side ABPI at the dorsal pedis artery were 0.86 ± 0.129 and 0.86 ± 0.115. Right-side toe Brachial Pressure Index (TBPI) and left-side ABPI was 0.85 ± 0.185 and 0.822 ± 0.2, respectively. Conclusions: ABPI index of more than 0.9 may be considered normal in the male population in Bhopal; however, we recommend further Multicentric trials across the Indian population.

Assessment of Pulmonary Functions and Dysfunctions in Type II Diabetes Mellitus: A Comparative Cross-Sectional Study.

Background Diabetes mellitus causes microvascular complications in the eyes and kidneys as well as the nervous system, among other parts of the body. Lungs are a potential target organ for diabetic microvascular complications and remain the least researched among diabetic patients. The aim of this study was to explore whether there is any difference in pulmonary functions in patients with diabetes mellitus compared to those without. Methodology A comparative cross-sectional study was conducted on 50 participants each with and without type II diabetes mellitus. Pulmonary function parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1 as a percentage of FVC in percentage (FEV1%), peak expiratory flow rate in L/second (PEFR), forced expiratory flow rate in L/second in 25% of FVC (FEF25%), forced expiratory flow rate in L/second in 50% of FVC (FEF50%), forced expiratory flow rate in L/second in 75% of FVC (FEF75%), forced expiratory flow rate during 25-75% of expiration (FEF25-75%), and maximal voluntary ventilation (MVV), of both groups were analyzed using the NDD Large True Flow (Easy One) spirometer (NDD Meditechnik AG., Switzerland). A fully automated chemistry analyzer and linear chromatography were used for glycemic control measurements. Results All pulmonary function test parameter values were lower in participants with diabetes mellitus compared to those without, except FEV1% and PEFR, which indicates a mixed pattern of lung dysfunction. FVC had a significant negative correlation with the duration of diabetes (r = -0.299, p = 0.034). Conclusions Type II diabetes mellitus patients had significant dysfunction in pulmonary functions with early involvement of restrictive parameters which can be monitored/diagnosed by regularly following up patients by measuring pulmonary functions, and, hence, can be taken care of.

Assessing Neurocognition (P300) and Correlating Them to Depression Rating Scales in Patients With Major Depressive Disorder.

BACKGROUND: Major depression is a chronic condition that may affect cognition. Cognitive disturbances may affect clinical scales used to assess the severity of depression. AIMS: To find an association between cognitive disturbance as objectively recorded using event-related potentials (P300) with the Hamilton rating scale for depression (HAM-D) and Montgomery-Asberg depression rating scale (MADRS) in newly diagnosed cases of major depression. METHODS AND MATERIAL: A cross-sectional study with a sample size of 46 diagnosed cases of major depression. The assessment was done using the HAM-D and MADRS. The P300 assessment was done with the auditory oddball paradigm using the Nihon Kohden NCV-SMG-EP system (Tokyo, Japan). STATISTICAL ANALYSIS: Pearson correlation analysis was used to study the association between various parameters of P300 and the HAM-D and MADRS depression rating scales. RESULTS: A significant correlation was found between A21- P300 amplitude Cz and the MADRS score. No significant correlation was seen between other P300 parameters and HAM-D and MADRS scales. CONCLUSIONS: As the results were objectively recorded using various parameters of event-related potentials (P300), cognitive impairment was not significantly associated with depression rating scales i.e., the HAM-D and MADRS scores.

Comparative change in P300 indices following antidepressant treatment in patients with major depressive disorder.

Context: Cognitive disturbance is seen in patients with major depressive disorder (MDD). Event-related potential can assist in measuring the neurocognition, and P300 is the most commonly used noninvasive electrophysiological parameter for measuring cognition. Aims: The aim of this study is to assess the baseline P300 parameters, Hamilton Rating Scale for Depression (HAM-D), and Montgomery-Asberg Depression Rating Scale (MADRS) scores and compare them with their levels after 3 months of antidepressant therapy. Settings and Design: a longitudinal study was done on total 24 diagnosed cases of major depression who underwent P300, HAM-D, and MADRS assessment in the gap of 3 months before and after starting antidepressant therapy. Subjects and Methods: Newly diagnosed cases of MDD patients were assessed using HAM-D and MADRS for severity rating. P300 assessment was also carried out with auditory oddball paradigm using Nihon Kohden NCV-SMG-EP system. The assessments were repeated after 3 months of antidepressant treatment. Statistical Analysis Used: The Wilcoxon test was used to compare mean values of P300 parameters, HAM-D, and MADRS score. Spearman correlation analysis was done to study the association between various parameters of P300 and HAM-D and MADRS score before and after treatment of 3 months of antidepressant therapy. Results: Significant difference is shown in various parameters P300 except for A11-P300 amplitude and A31-P300 amplitude. A significant difference was shown in HAM-D and MADRS scores. No significant correlation was seen between other P300 parameters and HAM-D and MADRS scale before as well as after antidepressant therapy. Conclusions: P300 may be used as an index to evaluate the response to antidepressant treatment in patients with MDD.

Patterns and Trajectories of Pulmonary Function in Coronavirus Disease 2019 Survivors: An Exploratory Study Conducted in Central India.

BACKGROUND: The ongoing pandemic of coronavirus disease 2019 (COVID-19) has negatively impacted respiratory health worldwide. The severity of the disease varies considerably, and patients may present with bronchitis, pneumonia, and acute respiratory distress syndrome. This study aims to quantify the parameters of the pulmonary function test (PFT) with regard to the severity of COVID-19 and understand the pattern of PFT in reference to the status of selected morbidities and body mass index. MATERIALS AND METHODS: This is a hospital-based, comparative, cross-sectional study. A total of 255 COVID-19 survivors underwent clinical assessment, a PFT, and a 6-minute walk test. Participants were divided into mild, moderate, and severe disease groups. The parameters were compared between these groups. The PFT and 6-minute walk tests were conducted using an NDD Digital computerized spirometer (NDD Meditechnik AG., Switzerland) and a fingertip pulse oximeter (Hasely Inc., India), respectively. RESULTS: All PFT parameters showed significant differential distribution among the severity groups (p<0.001) except for forced expiratory volume in 1 s/ forced vital capacity (FEV1/FVC) and forced expiratory flow (FEF) during 25%-75% expiration and peak expiratory flow (PEF). Among severe category participants forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC, were significantly reduced as compared to mild and moderate. Severity was significantly affected by age >50 years. Severe category participants were seen in 31% of normal, 58% of pre-obese, and 53% of obese participants; however, this difference was insignificant. A significant reduction in SPO2 on the 6-minute walk test was observed in severely sick participants. CONCLUSIONS: COVID-19 is associated with a mixed pattern of spirometry. Poor prognosis is associated with older age, obesity, and multimorbidity.

Perception of e-learning in medical students and faculty during COVID time: A study based on a questionnaire-based survey.

BACKGROUND: With the emergence of COVID, we are forced to use e-learning in form of arranging online classes for students. Medical educators all over the world are conducting online classes for students. This study aimed to evaluate the perception of online learning among MBBS students and teachers through a questionnaire-based survey. MATERIALS AND METHODS: A cross-sectional study was done in the AIIMS, Bhopal. The study was based on questionnaire (online Google form) response received from 43 number of faculty and 156 number of students. STATISTICAL ANALYSIS USED: Chi-square test and unpaired t-test were used for statistical analysis using statistical software Systac 13.2. RESULTS: Handling software, technical issues, and lack of face-to-face interaction were more significant problems in students compared to faculty. The desire for the social site which causes disturbances in learning was a significant problem in the students compared to faculty. Giving and taking assessment problem was reported by 60% and 63.8% of faculty and students, respectively (P = 0.67). Both groups preferred the Google Classroom platform (P = 0.16). Students (65.3%) preferred audiovisual recording, while faculty (72%) preferred PowerPoint with narration. PowerPoint presentation without narration was the least preferred (10.8%). Both groups stressed the importance of training (P = 0.17) and infrastructure development (P = 0.85). Students, as well as faculty, strongly discouraged e-learning for practical/clinical teaching. CONCLUSIONS: Students, as well as faculty, have mixed reactions toward e-learning. Most importantly affected in the present scenario is practical/clinical teaching and assessment. Every attempt needs to be done to strengthen infrastructure and impart training to students and faculty.

Effectiveness of Semmes Weinstein 10 gm monofilament in diabetic peripheral neuropathy taking nerve conduction and autonomic function study as reference tests.

Context: Diabetic peripheral neuropathy (DPN) if detected early can reduce the burden on the health system and prevent the development of diabetic foot ulcers and amputation. Aim: To study the effectiveness of Semmes Weinstein 10 gm monofilament in detecting DPN taking nerve conduction studies (NCS) and autonomic function testing (AFT) as reference tests. Settings and Design: Observational and comparative cross-sectional study conducted in the Physiology department AIIMS, Bhopal in collaboration with the Medicine department of the institute. Methods and Material: A total of 72 diagnosed type-2 diabetes mellitus patients were examined using Semmes Weinstein 10 gm monofilament, DPN was confirmed using NCS (Nihon Kohden Neuropack XI machine) and autonomic neuropathy was confirmed using AFT (Ewing's battery and Power lab) with heart rate variability (HRV). Diagnostic value of Semmes Weinstein 10 gm monofilament taking NCS and AFT as reference test was calculated. Statistical Analysis Used: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were calculated using the standard formula. Results: Sensitivity, specificity, PPV, and NPV using monofilament are 69.23%, 20%, 69.23% and 20% respectively taking NCS as reference test and 70.59%, 0, 92.30%, and 0 respectively taking AFT as reference test. Conclusions: Semmes Weinstein 10 gm monofilament is not the ideal screening test for the diagnosis of DPN. Sole clinical use of monofilament should be discouraged.

Effect of head down tilt on heart rate variability.

CONTEXT: Sirshasan is supposed to increase blood flow to the brain and considered to be beneficial for intellectual function, however mastering these techniques may be difficult. AIMS: To see the effect of headstand using a tilt table on heart rate variability (HRV). SETTINGS AND DESIGN: A cross-sectional study that was done on 26 healthy volunteers. METHODS AND MATERIAL: HRV was assessed in the supine position and 30° head tilt position for 5 min. HRV recording was done on the power lab (AD Instruments P Ltd, Castle Hill Australia). The tilt table used was Medica Podium, New Delhi, HLT-200. STATISTICAL ANALYSIS USED: Paired t-test. RESULTS: All the HRV parameters showed non-significant change except low-frequency parameters which showed significant change during head tilt. CONCLUSIONS: Headstand to a 30° using tilt table cause a decrease in the autonomic activity which is mainly because of decrease in sympathetic activity.

Neurophysiological parameters of sensory perception and cognition among different modalities of learners.

INTRODUCTION: Different types of learners based on sensory modalities are observed. Cognition or physiological alterations in the sensory pathways might play its role in different modalities of visual, auditory, read and write, and kinesthetic learners which are based on different sensory modalities of perception. OBJECTIVE: The objective of this study is to ascertain an objective parameter (neurophysiological parameters) for the classification of learners based on their preferred sensory modality. MATERIALS AND METHODS: An experimental cross-sectional study was conducted among 100 medical students. Learners were classified into visual, auditory, read-write, and kinesthetic learners based on the interpretation drawn on the basis of the VARK questionnaire. Sensory-evoked potentials (SEPs), including pattern shift visual (PSVEPs), brain stem auditory (BAEPs), short-latency somatosensory (SSEP), and event-related potentials (P300) were measured. SEPs measured in microvolts were recorded from the scalp with the help of active and reference electrodes. Multiple responses to sensory stimuli (using NIHON KOHDEN Corporation Neuropack X1, Tokyo, Japan) were recored and averaged using the computerized signal averging technique. RESULTS: No statistically significant difference was observed in conduction velocities (in terms of latency and amplitude) of SEP among different type of learners, except latency N145 wave form in VEP (P < 0.05). A characteristic pattern of minimal comparative latency was observed among the majority of visual learners. Similary, P300 has shown a characteristic pattern of decreased comparative latency among majority of read and write learners. CONCLUSION: Study findings suggested that among existing teaching and learning modalities, visual modalities were observed faster but to retain it in memory and for abstract thinking, students should utilize read and writing skills which are lacking in the era of digitalization and overuse of electronic devices.

Effect of meditation on autonomic function in healthy individuals: A longitudinal study.

CONTEXT: Meditation is very useful to relieve stress via hypothalamo-pituitory axis. Meditation is considered to be useful to relieve stress and cardio-respiratory health. AIMS: To compare the effect of meditation on autonomic function including heart rate variability (HRV) over a period of 3 months of meditation. SETTINGS AND DESIGN: Longitudinal study conducted at Physiology Department, AIIMS Bhopal. METHODS AND MATERIALS: Thirty healthy volunteers doing meditation were evaluated for autonomic function using autonomic function test battery (Ewing's battery) and HRV using Power lab (Ad instrument) and digital electrocardiograph (MARKS). STATISTICAL ANALYSIS USED: Statistical analysis was done using statistical software. Wilcoxon signed rank test was used. RESULTS: Significant change was seen in Valsalva ratio and lying to standing 30:15 ratio. There was no significant change in other parameters studied with 3 months of meditation. CONCLUSIONS: Three months of meditation does not have any significant effect on major parameters of autonomic functions.

Comparison of Pulmonary Function Test in Petrol Pump Worker and Auto-rickshaw Driver.

BACKGROUND: Rapid rise in petrol pump filling station is seen in the last decade, and air pollution had increased drastically. Air pollutants and components in petrol may have delirious effect on respiratory health. Petrol pump workers are exposed to both factors, whereas auto-rickshaw drivers are exposed mainly to air pollutants. In the present study, respiratory function in petrol pump workers was compared with auto-rickshaw driver and healthy controls. MATERIALS AND METHODS: This was the cross-sectional study done on petrol pump workers, auto-rickshaw drivers, and healthy volunteers. ndd Large TrueFlow™ (EasyOne) spirometer was used to assess pulmonary function. One-way ANOVA and Chi-square test were used using statistical software. RESULTS: No significant difference was seen in various spirometry parameters studied. Furthermore, no significant difference was observed the pattern of the lung function in three groups. CONCLUSIONS: Nine years of occupation as petrol pump worker and auto-rickshaw drivers are not having any significant effect on lung function; however, large multicentric trials are recommended, whereby the role of various factors controlling pollution would be studied.

Learning styles among first professional northern and central India medical students during digitization.

BACKGROUND: Learning style is an individual's natural or habitual pattern of acquiring and processing information in learning situations. Different sensory modalities are used by different types of medical students for assimilating the knowledge and information. Currently, the usage of electronic tools for teaching is widespread that can influence learning styles. METHODS: The purpose of this study was to know the pattern of learners among first- and second-year medical students from different institutions in India. For this purpose, we have used latest English Version 7.0 of the Visual-Aural-Read/write-Kinesthetic. RESULTS: Analysis was carried out using the IBM SPSS Version 21 software. Numerical variables were summarized by mean and SD or median and IQR as appropriate. Differences in scores among Visual-Aural-Read/write-Kinesthetic-learning styles were tested by Friedman's test with post hoc pair wise comparison. Pattern of learning styles was different, and it was statistically significant (P<0.001). In this study, aural (median score 6) and kinesthetic (median score 6) styles were preferred. Pair-wise comparisons revealed that each style was different from each other except kinesthetic and aural. CONCLUSION: Results of the study suggest that to improve learning, one should try to use multimodal styles with special emphasis given to auditory and kinesthetic modes especially among first professionals in medical education during digitization.

Cardiorespiratory response to aerobic exercise programs with different intensity: 20 weeks longitudinal study.

CONTEXT: participation in regular intensive exercise is associated with a modest increase in left ventricular wall thickness and cavity size. The magnitude of improvement depends on frequency, intensity, type, and duration of exercise program. AIMS: to determine the effect of sports training on LV morphology and function, lung function, and to know the intensity of the exercise program enough for these changes. SETTINGS AND DESIGN: this was a longitudinal study (20 weeks duration) done on the medical college students. MATERIAL AND METHODS: three groups, doing exercise at different intensities, high intensity group (HG) [74.9±3.9 %HRmax], low intensity group (LG) [59.46±4.1%HRmax] and no exercise group (NG) were made, and their assessments were done using the echocardiography and pulmonary function test three times, first before start of the exercise program, second at the end of 10th week, and then at the end of the 20th week. STATISTICAL ANALYSIS USED: 3 × 3 Anova test and Bonferroni's post-test using Graph pad prism5 software. RESULTS: significant improvement was seen in HG in majority of cardio respiratory parameters (VO2max, heart rate, LVIDD, LVIDS, EDV, MVV, PEFR, FVC) as compared to the LG (VO2max, heart rate, MVV, PEFR) and this improvement was specially seen at the end of the twentieth week. CONCLUSIONS: twenty weeks of training is helpful in improving aerobic power, MVV, and PEFR even the exercise is of moderate (LG) to high intensity (HG) but for overall cardio respiratory development physical training must be associated with very hard intensity if duration of the exercise program is short.