Bite-to-needle Time - An Extrapolative Indicator of Repercussion in Patients with Snakebite.

Background: Snakebite is a significant occupational and environmental hazard in tropical countries. The treatment of snakebite includes care of the wound, supportive care, and administration of anti-snake venom (ASV). Time is crucial to reducing the morbidity and mortality of patients. This study aimed to assess the "bite-to-needle time" with morbidity and mortality of snakebites and correlate it. Patients and methods: A total of 100 patients were included. Detailed history included the time since snakebite, bite site, species of snake, and symptoms at presentation, which included level of consciousness, cellulitis, ptosis, respiratory failure, oliguria, and bleeding manifestations. "Bite-to-needle time" was noted. Polyvalent ASV was administered in all patients. Duration of hospitalization and complications, including mortality were noted. Results: The age-group of the study population was 20-60 years. About 68% were males. Krait was the commonest species (40%), and the lower limb was the commonest bite site. Within 6 hours, 36% of patients received ASV, and between 6 and 12 hours, 30%. Patients with a bite-to-needle time of under 6 hours spent less time in the hospital and experienced fewer complications. Patients with bite-to-needle times longer than 24 hours had more ASV vials, complications, hospital-stay length, and death. Conclusion: An increase in bite-to-needle time increases the chances of systemic envenomation, hence, the severity of complications or morbidity and risk of mortality increases. The necessity of timing and the value of administering ASV on time must be emphasized to the patients. How to cite this article: Jayaraman T, Dhanasinghu R, Kuppusamy S, Gaur A, Sakthivadivel V. Bite-to-needle Time - An Extrapolative Indicator of Repercussion in Patients with Snakebite. Indian J Crit Care Med 2022;26(11):1175-1178.

Concurrent acute myositis and Guillain-Barre syndrome in Cytomegalovirus infection - a rare case report.

BACKGROUND: Cytomegalovirus (CMV) is a double stranded DNA virus and ubiquitous in nature. Association of Guillain-Barre syndrome (GBS) and CMV is well known but CMV acute myositis is a rare condition. Restriction of movements of limbs due to severe pain in myositis may obscure the diagnosis of GBS and this may easily miss. CASE PRESENTATION: Here we describe a 29-year-old male presenting with pain and swelling of bilateral lower limbs which progressed rapidly with increasing serum creatine kinase levels with positive IgM CMV antibodies. In view of no improvement in clinical condition, patient was further evaluated and found to have concurrent GBS. He was treated with plasmapheresis and improved. CONCLUSION: Cytomegalovirus infection presenting as acute myositis is a uncommon and further association with GBS is a rare occurrence.

Tuberculosis in elderly population: A cross-sectional comparative study.

Background: Tuberculosis (TB) is a common but neglected infectious disease of global significance. It has a varied presentation in the elderly compared to adults. The present study was conceived to study the resemblances and differences shared in terms of clinical profile, comorbidities, and laboratory investigations by TB in adults and the elderly population. Methods: In this cross-sectional study, 68 adults and 72 elderly patients of both genders were enrolled. We collected information on demographics, comorbidities, clinical presentations, and laboratory investigations. The comparison of data between groups was done using the unpaired t-test for continuous variables and the Chi-square test for frequency distribution analysis. Results: The mean age of the adults and elderly population was 42.13 ± 10.7 years and 68.78 ± 7.62 years, respectively. The elderly TB group demonstrated loss of weight, appetite, the prevalence of comorbid conditions (coronary artery disease, hypertension, and malnutrition), bilateral, predominantly lower lobe, and diffuse involvement of lungs. Conclusion: As the elderly population increases, nonspecific clinical manifestations or laboratory results in this population mandate awareness of these atypical features for effective management of TB in this group.

Platelet indices as an accouterment for monitoring short-term glycemic levels and as an economical alternative to HbA1c.

Background: India is facing a galloping diabetes epidemic with an estimated 62 million patients and is projected to explode beyond 85 million by the year 2030. There is platelet dysfunction with platelet hyper-reactivity in diabetes mellitus. Aim: To assess for any correlation between HbA1c levels with various platelet indices like mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR). Material and Methods: Applying inclusion and exclusion criteria, diabetes mellitus patients have undergone detailed history, clinical examination, and laboratory investigations. Data is statistically analyzed for levels of HbA1c and their correlation to platelet indices. Results: 58.7% study population is with HbA1c levels of more than 8%. In patients with normal range HbA1c levels between 4-6%, the MPV, PDW, and P-LCR are found to be 9.9 ± 0.97 fl, 10.84 ± 2.08 fl, and 23.75 ± 7.99%, respectively. In patients with HbA1c levels of 6.1 to 7%, the MPV, PDW, and P-LCR are found to be 10.22 ± 1.04 fl, 11.79 ± 1.8 fl, and 26.36 ± 7.05%, respectively. In patients with HbA1c levels of 7.1 to 8%, the MPV, PDW, and P-LCR values are found to be 10.21 ± 1.06 fl, 12.03 ± 2.52 fl, and 26.65 ± 8.05%, respectively. In patients with poor glycemic control with HbA1c levels more than 8%, the MPV, PDW, and P-LCR are found to be 10.64 ± 1.1 fl, 12.81 ± 2.61 fl, and 30.26 ± 8.24%, respectively. Conclusion: In type 2 diabetes mellitus patients, HbA1c is positively correlated with platelet indices.

Aluminum as a Possible Cause Toward Dyslipidemia.

Aluminum, the third most abundant metal present in the earth's crust, is present almost in all daily commodities we use, and exposure to it is unavoidable. The interference of aluminum with various biochemical reactions in the body leads to detrimental health effects, out of which aluminum-induced neurodegeneration is widely studied. However, the effect of aluminum in causing dyslipidemia cannot be neglected. Dyslipidemia is a global health problem, which commences to the cosmic of non-communicable diseases. The interference of aluminum with various iron-dependent enzymatic activities in the tri-carboxylic acid cycle and electron transport chain results in decreased production of mitochondrial adenosine tri-phosphate. This ultimately contributes to oxidative stress and iron-mediated lipid peroxidation. This mitochondrial dysfunction along with modulation of α-ketoglutarate and L-carnitine perturbs lipid metabolism, leading to the atypical accumulation of lipids and dyslipidemia. Respiratory chain disruption because of the accumulation of reduced nicotinamide adenine di-nucleotide as a consequence of oxidative stress and the stimulatory effect of aluminum exposure on glycolysis causes many health issues including fat accumulation, obesity, and other hepatic disorders. One major factor contributing to dyslipidemia and enhanced pro-inflammatory responses is estrogen. Aluminum, being a metalloestrogen, modulates estrogen receptors, and in this world of industrialization and urbanization, we could corner down to metals, particularly aluminum, in the development of dyslipidemia. As per PRISMA guidelines, we did a literature search in four medical databases to give a holistic view of the possible link between aluminum exposure and various biochemical events leading to dyslipidemia.

Comparing the Ipswich Touch Test (IpTT) and 10gm-SMWF (10-gm Semmes-Weinstein mono-filament) in Indian population subset with type 2 diabetes mellitus to detect diabetes neuropathy.

BACKGROUND: Diabetic neuropathy diagnosis involves invasive procedures like nerve biopsy and nerve conduction studies which are seldom available at rural health centers. The Ipswich Touch Test (IpTT) is one test that can be performed by the caregiver and it's simple to perform. AIM: This study was aimed to compare the validity of the IpTT and 10gm-SMWF (10-gm Semmes-Weinstein mono-filament) test with the vibration perception threshold (VPT) using biothesiometer. METHODS: Two hundred patients with type 2 diabetes, between the age of 30 and 50 years, were included in the study. The neuropathy assessment was performed by biothesiometer, 10gm-SMWF test, and IpTT. Taking VPT(> 25 V) as the gold standard; the sensitivity and specificity of IpTT and 10gm-SMWF are calculated and compared to each other. RESULTS: On comparing with the VPT, the 10gm-SMWF test had a sensitivity of 94.7% and specificity of 85.7%, and the IpTT had a sensitivity of 91.9% and specificity of 85.7%. 10gm-SMWF test (Kappa value 0.733) had better agreement with VPT than IpTT (Kappa value 0.675). On Spearman's correlation, the 10gm-SMWF test and the IpTT had r values of 0.738 and 0.686 respectively (P = 0.000). CONCLUSION: 10gm-SMWFis a better test to diagnose neuropathy than the IpTT; but in the absence of 10gm-SMWFs, the IpTT is an ideal alternative. IpTT can be performed in a bedside or chairside setting in the absence of a professional health care provider who can screen patients for neuropathy and alert the physician of an impending complication where amputation can be avoided.

Association of serum cathelicidin and Vitamin D levels with infectiousness in patients with pulmonary tuberculosis: A prospective cohort study.

Background: The immunomodulatory effects of Vitamin D expand to induce the synthesis of an antimicrobial peptide, cathelicidin. There is evidence showing altered levels of cathelicidin in tuberculosis (TB). It has been suggested that Vitamin D-mediated antimicrobial activity depends on its ability to induce cathelicidin. The present study was designed to assess the alterations in serum anti-microbial peptide cathelicidin and 25-hydroxy Vitamin D levels in patients with newly diagnosed pulmonary TB at different treatment times and to study the association between serum Vitamin D levels and cathelicidin. Methods: Serum 25-hydroxyvitamin D and cathelicidin levels were estimated in 147 patients with newly diagnosed pulmonary TB at different times: at the start of anti-tubercular treatment, end of the intensive phase of treatment, and at the end of treatment. Results: There was a statistically significant difference between the levels of serum 25-hydroxyvitamin D and serum cathelicidin at different treatment periods. However, no significant correlation was found between serum Vitamin D and cathelicidin levels or between serum Vitamin D and cathelicidin levels with infectiousness in patients with pulmonary TB. Conclusion: Serum Vitamin D levels and serum cathelicidin levels were significantly reduced at diagnosis, and there was an incremental increase following treatment. However, there was no correlation between the levels of serum cathelicidin and serum Vitamin D or with the infectiousness of the illness.

Risk factors and inflammatory markers in acute coronary syndrome-ST elevation myocardial infarction (STEMI).

OBJECTIVES: The increasing prevalence of coronary artery disease [CAD] poses worrying statistics. Atherosclerosis of coronary vessels is the main culprit for the spectrum of CAD especially acute coronary syndrome. Atherosclerosis is regarded as a consequence of inflammatory changes in the coronaries. Our study aimed to assess the role of risk factors and inflammatory markers with acute ST-elevation myocardial infarction [STEMI]. METHODS: 100 patients with ST-elevation Myocardial infarction [STEMI] and 100 age and sex matched controls were included in the study. A history of risk factors like smoking, hypertension, diabetes and hypertension was noted. A venous blood sample was obtained for analysis of inflammatory markers. The data thus obtained was statistically analyzed. RESULTS: The cases had a significant number of risk factors such as smoking, hypertension, and diabetes mellitus, previous history of CAD, increased body mass index [BMI], and raised high sensitive C-reactive protein [hs-CRP]. Patients with anterior myocardial infarction were older and had hypertension and diabetes mellitus. Patients with inferior myocardial infarction had high BMI, raised erythrocyte sedimentation rate [ESR] and alcoholism. Smokers, patients with diabetes mellitus, high total cholesterol, Low-density lipoprotein [LDL] cholesterol, and hs-CRP were more prone to complications. CONCLUSIONS: Patients with a greater number of risk factors and raised inflammatory markers were at high risk of STEMI and its complications. An approach to control the modifiable risk factors like obesity and lifestyle changes can reduce the disease burden.

Metabolic syndrome - cardiac structure and functional analysis by echocardiography; a cross sectional comparative study.

OBJECTIVES: Metabolic syndrome (MS) is a collection of metabolic disorders including hyperglycemia, hypertension and dyslipidemia. The outcome of metabolic syndrome depends on structural changes in heart like increased left atrial size or increased left ventricular mass. This study was done to determine the echocardiography abnormalities in metabolic syndrome. METHODS: After obtaining informed consent, 75 subjects with metabolic syndrome and 75 controls were included in the study. 2D echo/M mode examination was performed for all. Aortic root, left atrial size, left atrial volume, septal wall thickness during systole (SWs) and diastole (SWd), posterior wall thickness during systole (PWs) and diastole (PWd), left ventricle dimension during systole (LVDs) and diastole (LVDd), and ejection fraction were measured. The values were compared between the groups. RESULTS: After adjustment for age, sex, smoking, alcohol and BMI; left ventricular diameter in systole and diastole was significantly more than controls (p<0.001); HR of 1.29 (95% CI 1.13-1.46), 1.29 (95% CI 1.15-1.45) respectively. Left ventricular mass and left atrial volume were increased significantly in subjects with metabolic syndrome (p<0.001); HR were 1.06 (95% CI 1.03-1.08), 1.13 (95% CI 1.06-1.19) respectively. Ejection fraction was low normal in subjects with metabolic syndrome compared to controls (p<0.05); HR 0.90 (95% CI 0.83-0.98). CONCLUSIONS: Cardiac abnormalities were common in subjects with metabolic syndrome, predominantly affecting the left ventricular mass, diameter and left atrial volume. Early life style modifications are essential to prevent these complications.

Anti-spike Antibody Status in Pre-vaccinated Healthy Participants and Rheumatoid Arthritis Patients During the Third Wave of COVID-19.

Introduction Anti-spike severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies produced after infection with the coronavirus disease of 2019 (COVID-19) will offer protection and prevent re-infection for a few months. Seroprevalence studies measuring the SARS­CoV-2 immunoglobulin G (IgG) levels will be helpful to know the herd immunity level that prevents community transmission. Very few studies have addressed the antibody titer among healthy participants and rheumatoid arthritis (RA) patients. The present study was conducted to determine the anti-spike SARS-CoV-2 antibody (Ab) status before COVID-19 vaccination in healthy participants and RA patients. Methodology A cross-sectional study was conducted at a tertiary care hospital to estimate the serum anti-spike antibody levels against COVID-19 among the pre-vaccinated healthy participants and patients with RA during the third wave of COVID-19. After receiving written informed consent, participants were recruited as per the inclusion and exclusion criteria. Demographic details, co-morbid status, and medication details were collected. Five milliliters of blood samples were collected, and anti-spike antibodies were estimated. The SARS-CoV-2 Ab positivity rate was expressed in percentage and was correlated with gender and age groups. Ab-positive participants were classified into three categories based on the neutralizing antibody titers (NAT). Results A total of 58 participants (49 healthy volunteers and nine RA patients) were recruited. Out of 58 participants, 40 were males, nine were females among healthy participants, and one male and eight females in the RA group were enrolled. Among the RA patients, one participant was found to have the chronic obstructive pulmonary disease (COPD), and two participants with hypothyroidism. Antibody positivity was found to be 83.6% among the healthy volunteers and 100% in the RA patients. About 48% had NAT between 50 and 90%. There was no significant difference for age and gender-specific positivity for SARS-CoV-2 neutralizing antibodies and neutralizing antibody titers among healthy participants. Conclusion Our study showed 84% positivity for anti-spike SARS-CoV-2 antibodies around the third wave (between November 2021 and February 2022). The majority had high neutralizing antibody titers. The probable reason for the SARS-CoV-2 antibody positivity before vaccination was either asymptomatic infection or herd immunity.

Seizure in geriatric population - An unheeded integer.

Background: Epilepsy is one of the most prevalent neurological conditions among the elderly. Age-related epileptogenic disorders as well as the ageing itself pose a risk for seizures in the elderly. The lack of witnesses, non-specific symptoms, and transient symptoms make the diagnosis challenging in the elderly. Aim: This study aimed to assess the various presentation and aetiology for the seizure disorder in the elderly population. Materials and Methods: A total of 125 elderly patients ≥60 years with new onset seizure were included in the study. Demographic data, co-morbidities, and clinical presentation of seizure were elicited. Hemogram, liver and renal function tests, random blood sugar, electrolytes, and serum calcium were analysed. Computed tomography (CT), magnetic resonance imaging (MRI) brain, and electroencephalogram (EEG) were performed. Results: Seizure was seen predominantly in the males with age group of 60-70 years. Generalized tonic-clonic seizure was the commonest presentation, followed by focal seizures. The leading causes of seizures were cerebral vascular accidents, metabolic conditions, and alcohol. CT brain was abnormal in 49%, and 73% of the patients showed abnormality in MRI brain. EEG was abnormal in 17.3% of patients. Temporal lobe infarction was the commonest, trailed by parieto-temporal and frontal lobe involvement. Conclusion: Seizures in the elderly have varied clinical signs and aetiology. An awareness about these atypical presentation and aetiology is essential for the early diagnosis and management to prevent morbidity.

Channeling of Brain Towards Engaging Sensorimotor Tasks for Inducing Hedonic Pleasure to Alleviate Blood Pressure in Hypertension.

Background: Hypertension is a modifiable risk factor for cardiovascular disease and is responsible for major deaths due to stroke and coronary heart disease. Several pharmacological and non-pharmacological interventions for reducing blood pressure have been tried earlier. Modulating brain regions such as prefrontal cortex (PFC) to channelize activities is an effective tool to target blood pressure. Purpose: Prefrontal cortex (PFC) exerts inhibitory control over sympathoexcitatory circuits, which was explored using a novel reaction time paradigm. Methods: Thirty participants of both genders in the age group 40-70 years with established hypertension were included. A structured reaction time paradigm was designed to include psychomotor and visuomotor elements with integrated sensory attention and motor performance tasks. Blood pressure, Lead II ECG, and EEG from F3 and F4 were recorded. A paired t-test was used to examine the variations in these parameters across tasks. Results: A significant reduction in mean arterial pressure by 4.04 mmHg (p = .0232) during the visuomotor task and a reduction of 3.38 mmHg during the auditory cue task (p = .0446) were observed. Analysis of the difference in heart rate has shown a profound decrease after passive listening tasks by 3.7 beats (p < .0001*). Spectral analysis from F3 and F4 shows high power in low-frequency zone of EEG indicating a relaxed state during auditory cues and passive listening. Conclusion: The reaction time paradigm, when applied to hypertensives, helped decrease blood pressure and heart rate and improved the high frequency (HF) component of heart rate variability, indicating parasympathetic dominance. Such reward-oriented paradigms may act as biofeedback modules that cause hyperactivity of the PFC to suppress the sympathoexcitatory circuit with increased parasympathetic activity beneficial to hypertensive individuals.

Detection of Metallo Beta-Lactamase (MBL) Producing Pseudomonas aeruginosa in a Tertiary Care Hospital, Ghanpur, Medchal, India.

Introduction:Pseudomonas aeruginosa is a leading cause of nosocomial infections and is especially prevalent among patients with burn wounds, cystic fibrosis, acute leukemia, organ transplants and intravenous-drug addiction. Acquired metallo-â-lactamases (MBLs) are carbapenemases which require zinc in the active site and are predominantly produced by P. aeruginosa. They belong to Ambler's class B and Bush-Jacoby Medeiros Group 3 and hydrolyse virtually all â-lactam agents, including the carbapenems. In India, only blaVIM and NDM-1 have been reported in P. aeruginosa. Metallo beta-lactamases have recently emerged as one of the most worrisome resistance mechanisms owing to their capacity to hydrolyse all beta-lactams, including carbapenems. Aims and objectives: The present study aimed to investigate the prevalence and resistance patterns of MBL-producing P. aeruginosa in a tertiary care hospital of Ghanpur, Medchal, India, and to compare the effectiveness of two different methods of screening and detecting MBL-producing P. aeruginosa in order to formulate a policy of empirical therapy and to take preventive measures in hospital settings. Methodology: In the present study, 60 isolates of Pseudomonas aeruginosa were obtained from various clinical specimens, including pus, urine, burns, wound, sputum, pleural fluid, and CSF, which were taken from inpatients and outpatients admitted to MIMS, Ghanpur, India. The study period was from January 2017 to July 2018. The microbial isolates were studied for the detection of the prevalence of MBL production, including their antibiogram. Results:Of the 60 Pseudomonas aeruginosa isolates, 12 were Imipenem resistant, of which nine were MBL producers. Most isolates (14) were collected in the age group of 21-30 years, followed by that of 31-40 years (13) and 1-10 years (2). Of the total number of samples, 40 strains were isolated in male subjects, with a male-female ratio of 2:1. Total wound swabs accounted for 40% of the studied specimens, followed by ear swabs (20%) and sputum samples (18.3%). Wound swabs also included most Imipenem-resistant isolates (41.6%). Metallo beta-lactamase producers accounted for 75% of all carbapenem-resistant isolates, using the combined disc method and E-test. By comparison, DDST retrieved 41% of Pseudomonas MBL producers. Isolates were 100% sensitive to Polymyxin-B and showed a 44.4% sensitivity to Piperacillin/Tazobactam, followed by 22.2% for Amikacin and Tobramycin and 11.1% for Ciprofloxacin and Gentamicin. Conclusion:The study found a relatively high prevalence of Pseudomonas MBL producers (9/60) with 100% Polymyxin susceptibility. Hence, our results warn against an expected high use of Polymyxins in clinical settings. Additionally, the study supports the use of E-tests, CDST and DDST for the screening of Pseudomonas MBL producers in regions where PCR detection cannot be performed.

Performance-Oriented Mobility Assessment test and Timed Up and Go test as predictors of falls in the elderly - A cross-sectional study.

Background: Falls are common in the elderly and frequently have serious consequences, which lead to physical and psychological complications. Assessment of fall risk in the elderly is performed by using functional assessment tools that assess the muscle strength, balance, functional mobility, and gait. Timed Up and Go test (TUG) assesses functional mobility and the Performance-Oriented Mobility Assessment test (POMA) assesses balance, postural control, and gait. Aim: This study compares the TUG test and POMA test in fall prediction among elderly patients. Materials and Methods: Patients with acute illness, acute painful lower limb conditions, dementia, severe depression, and those who are not willing were excluded from the study. Patient demographic data, co-morbidities, habits, and risk factors such as a previous history of falls, arthritis, depression, and vision impairment were noted. Gait and balance were assessed by the TUG and POMA tests. TUG and POMA were compared with the patients with a history of falls. Results: The mean age of participants was 70.79 ± 5.38 years. The females (57.6%) were more than the males. Hypertension was the commonest co-morbidity (54.4%). Out of 340 subjects, 105 subjects had a history of falls. The sensitivity of the TUG and POMA tests was 76.2 and 69.5%, respectively, and the specificity was 91.1 and 89.8%, respectively. The Kappa values were 0.680 and 0.606, respectively. POMA (r = -0.372) was negatively correlated to falls and TUG (r = 0.642) was positively correlated to falls. Conclusion: TUG is a useful measure for determining the risk of falling in older persons.

Is the National Institute of Health Stroke Scale a valid prognosticator of the aftermath in patients with ischemic stroke?

Background: Cerebrovascular disease is the second most common cause of death in people more than 60 years of age. Predicting the outcome of the stroke is a great challenge for physicians. Various risk factors such as age, sex, co-morbidities, smoking and alcohol habits, type of stroke, National Institute of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS), and others play the role in the outcome of stoke. Aim: To assess the degree of impact of NIHSS score in comparison to the other traditional risk factors on the functional outcome and 30-day mortality by mRS in the patients with acute ischemic stroke. Materials and Methods: Patients with acute ischemic stroke and age more than 18 years were included. Their admission NIHSS score and the 30-day mRS were analyzed. Patients were divided into two groups as survivors and non-survivors. Results: The mean age of survivors and non-survivors was 59.77 ± 10.99 and 65.58 ± 6.67 years, respectively. The NIHSS score on day 1 for non-survivors was 21.21 ± 8.21, and almost half of this score was seen in survivors. The NIHSS score on day 1 had a significant association with mortality with a relative risk of 0.79 (95% CI = 0.70-0.89). The NIHSS score has 73.7% sensitivity and 74.1% specificity with cutoff value of 15.5 for discriminating the outcome of ischemic stroke. Conclusion: The NIHSS and mRS scales are simple, validated, easily applicable, and reliable tools for assessing the mortality and the functional outcome of ischemic stroke patients.

Association of Cervical Vestibular-Evoked Myogenic Potentials (VEMP) and Postural Instability in Patients with Parkinson's Disease: A Cross-Sectional Study.

Background: Postural instability is a common problem in patients with Parkinson's disease (PD). The appropriate cooperation of vestibular, visual, and proprioceptive signals along with apt anticipatory and adaptive postural responses is essential for postural stability. Abnormalities in this sensorimotor admixture lead to postural instability in PD. The function of vestibular otolith function and its central connections in postural instability of PD is still obscure. Cervical vestibular-evoked myogenic potentials (VEMP) can be used to assess the function of the saccular part of otolith and its connections. Purpose: We aimed to study the role of dysfunction of the saccule and its connections at the brainstem by comparing the VEMP with normal controls and correlating it with the postural instability in patients with PD. Methods: Thirty patients with PD and 30 healthy volunteers were included in the study, after obtaining the institutional ethical committee approval. Patient's demographic data, stage and duration of illness, treatment history, history of fall, postural instability, Unified Parkinson's Disease Rating Scale (UPDRS) score, and Non-Motor Symptoms Scales (NMSs) were noted. Cervical VEMP analysis was done for both patients and controls. Results and Conclusion: Patients with absent VEMP had significant postural instability, a history of falls, and a high UPDRS score. Mean P13 and N23 latencies were prolonged, and the amplitude was significantly low in patients with PD. Absent cVEMP was significantly associated with postural instability, non-motor symptoms, especially gastrointestinal, miscellaneous symptoms, and mood/cognition. VEMP can be considered an early electrophysiological marker for dysfunction of otolith and its central connections.

Serum Adiponectin and Nitric Oxide Levels in Type II Diabetes and Its Correlation With Lipid Profile.

Introduction Various markers for diabetes have been identified in this new era of medicine, the most recent being adiponectin, which is primarily secreted from adipose tissue and has anti-diabetic, anti-inflammatory, and anti-atherogenic properties. It is also known to increase insulin sensitivity. Adiponectin deficiency or decreased secretion causes a variety of complications, including insulin resistance and the onset of type 2 diabetes mellitus (T2DM). One such complication of T2DM is endothelial dysfunction, which leads to decreased synthesis of nitric oxide (NO), another potent marker that normally disrupts key events in the progression of atherosclerosis. Aims and objectives The aim of the study was to compare and correlate serum adiponectin and nitric oxide levels with glycemic status in patients with T2DM and healthy controls. Materials and methods This comparative cross-sectional study included known cases of type II diabetes under group I and healthy age-matched controls under group II. Serum levels of adiponectin and nitric oxide were assessed in both the groups along with glycemic status [fasting blood sugar (FBS) and glycated hemoglobin (HbA1c)] and these parameters were compared between both groups using a t-test. Adiponectin and NO levels were correlated using Pearson's correlation with glycemic status in group I. Results The mean adiponectin levels in group I were 5.94 ± 1.490 µg/mL, which was significantly (p<0.00) less than in group II, 10.30 ±1.669 µg/mL. The mean NO levels in group I (42.98 ± 6.300 µmol/L) were also significantly (p<0.00) less than in group II (56.126 ± 7.579 µmol/L). FBS and HbA1C levels were significantly higher in group I than in group II. Conclusion Adiponectin and NO levels were significantly reduced in individuals with T2DM when compared to healthy controls. Therapeutic interventions that increase adiponectin and NO levels may be useful targets for improving diabetes control and reducing complications.

Sleep and Alzheimer: The Link.

Alzheimer's disease is the most common type of dementia which has both cognitive and non-cognitive disabilities. Recent research has proved that sleep deprivation and insomnia have been related to the pathophysiology of Alzheimer's disease and would influence the symptoms and progression of the disease. We look at the current research that supports the idea that the lack of sleep relates to cognitive decline and dementia, with an emphasis on Alzheimer's disease. We integrated the various possible mechanisms of sleep deprivation leading to Alzheimer's disease and cognitive decline. The role of neuroinflammation, generation of reactive oxidative species and sleep disturbances play a central role in tau generation and Aß deposition. An approach to manage sleep changes can widely prevent the cognitive decline of Alzheimer's disease.

Audits of Antimicrobial Usage in a Tertiary Care Center in Hyderabad.

Background Irrational prescriptions have an ill effect on health as well as on healthcare expenditure. Prescription auditing is an important tool to improve the quality of prescriptions, which in turn improves the quality of health care provided. Regular and timely audits of antibiotic prescriptions can prevent irrational antibiotic usage. Introduction The inappropriate use of drugs is a global health problem, especially in developing countries like India. In 2015, during the 68th World Health Organization (WHO) Regional Committee for Southeast Asia, all Member States of the region, including India, endorsed the "Regional Strategy for Patient Safety in the WHO Southeast Asia Region (2016-2025)" aiming to support the development of national quality of care and patient safety strategies, policies, and plans and commit to translating those objectives of the Regional Strategy into actionable strategies at country level. Methodology A retrospective observational study was conducted in a 330-bedded, National Accreditation Board for Hospitals & Healthcare Providers (NABH)-accredited tertiary healthcare center. The study period was six months, from January 2019 to June 2019. Results Ninety-five point four-five percent (95.45%) of the doctors attended the sensitization program and all accepted following the standard prescribing protocols. Sixty-nine point seven percent (69.7%) of the doctors were aware of the availability of drugs in the hospital pharmacy stores. Seventy-four point two-four percent (74.24%) of the doctors were aware of the ongoing prescription audits. Seventy-two point two-seven percent (72.27%) of the treating doctors were of the opinion of selecting the appropriate antibiotics based on hospital antibiogram. The importance of antibiograms from cultures and environmental surveillance was followed well only after sensitizing all the treating doctors. Ninety-five point four-five percent (95.45%) of the doctors were of the opinion of taking the permission of a higher authority to start high-end antibiotics. Seventy-seven point one-zero percent (77.10%) doctors recommended sample collection prior to antibiotic administration. Sixty-three percent (63%) of the patient's clinical condition improved with the antibiotics prescribed prior to the culture report. Conclusion By judicious use of antibiotics, we can reduce the evolution of antibiotic resistance in bacteria and extend the useful life of antibiotics that are still effective. Antibiotic use patterns must be studied to address complications resulting from a large number of antibiotics.

Depression in Patients on Hemodialysis: A Dilapidated Facet.

Introduction End-stage renal disease (ESRD) has increased in India due to the growing load of non-communicable diseases. The most prevalent psychological issue among these patients has been identified as depression, which may have an impact on treatment success. Around 20% to 90% of hemodialysis patients experience depression. The current study aimed to determine the prevalence of depression among patients undergoing hemodialysis as well as the relationship between this condition and the sociodemographic and clinical parameters of the patients. Methods Basic demographic information and particulars of chronic morbidity, duration, and the number of cycles of hemodialysis per week were noted. The Beck Depression Inventory (BDI) score was administered to screen for depression. Results A total of 92 participants were enrolled in the study; 69 (75%) were males. The mean age of participants was 52 years. Hypertension (100%) was the most common co-morbidity followed by diabetes mellitus (38%). The mean duration of chronic kidney disease was 3.9 years. The majority (68.5%) had hemodialysis twice per week. Forty-one percent (41%) screened positive for borderline clinical depression or more. The mean BDI score was 17.07. The number of hemodialyses per week had a significant relation with depression with an odds ratio of 4.16 and 95% CI of 1.4-12.38. Conclusion Depression is prevalent among patients with chronic kidney disease who are on dialysis. The management of this preventable illness demands a repertoire of measures such as launching a program for the detection and treatment of depression combining psychiatric professionals and social volunteer organizations.