Blood Pressure Variability is Better Associated with Acute Relative Hyperglycemia Than the Heart Rate Variability in Healthy Young Adults.

BACKGROUND: Deranged cardiovascular autonomic functions are well-reported complications of diabetes mellitus, where chronic hyperglycemia is an important factor. The role of acute relative hyperglycemia on cardiovascular autonomic functions, particularly on blood pressure variability in healthy subjects, has been rarely explored. Therefore, this study aimed to examine the effect of acute relative hyperglycemia on cardiovascular autonomic functions in healthy young adults. METHODS: Beat-to-beat blood pressure and electrocardiogram were recorded to assess the heart rate variability and blood pressure variability in 42 young, healthy subjects during fasting and relative hyperglycemic states. Recorded cardiovascular parameters were analyzed in time and frequency domains. Correlations among analyzed parameters of cardiovascular autonomic variabilities were explored during fasting and relative hyperglycemic state. RESULTS: A few of the systolic, mean, and diastolic blood-pressure-variability parameters were significantly altered during acute relative hyperglycemia when compared to the fasting state. However, no significant changes were observed in any of the heart-rate-variability parameters. Also, novel significant correlations were found among many of the parameters of cardiovascular autonomic variabilities during fasting and relative hyperglycemic states. CONCLUSIONS: The blood pressure variability is affected significantly during acute relative hyperglycemia in healthy young adults; however, the heart rate variability does not show such changes. Also, many blood pressure variability parameters show significant correlations with heart rate variability and baroreflex sensitivity. It may be hypothesized that although the variabilities in heart rate and blood pressure assess cardiovascular autonomic functions, blood pressure variability is a better indicator of cardiovascular autonomic effects of acute relative hyperglycemia.

Role of Meditation in Ameliorating Examination Stress Induced Changes in Cardiovascular and Autonomic Functions.

Background: Examination stress is a very well-known model of psychological stress in students. It induces changes in systolic (SBP) and diastolic blood pressure (DBP), along with changes in heart rate variability (HRV) and baroreflex sensitivity (BRS), due to autonomic perturbations. Purpose: To find out if Raj Yoga meditation (RYM) practice affects autonomic and cardiovascular function in healthy young subjects during periods of examination stress. Our primary objective was to evaluate the effect of one month of supervised RYM practice on ameliorating examination-induced changes in cardiovascular and autonomic function. The secondary objective was to measure the stress levels of medical students before and after RYM. Methods: Pre-training measurements of SBP, DBP, HRV, and BRS were done, and the Medical Student Stressor Questionnaire (MSSQ) was administered to 80 participants one month before examinations. They were then trained in RYM. Post-training assessment of the same parameters was done after examinations and also after two months. Results: In our study, RYM training decreased DBP (p = 0.01) but not SBP. BRS showed a trend towards an increase after RYM practice, but it was not statistically significant (p = 0.44). The standard deviation of the NN interval (SDNN) (p = 0.03), low-frequency (LF) nu (0.003), and high-frequency (HF) nu (0.04) showed a statistically significant change. Average RR, median RR, average rate, square root of the mean squared differences of successive NN intervals (RMSSD), pRR, total power, LF (µs2), and LF/HF ratio were not statistically significantly different between the three groups. There was a statistically significant decline in MSSQ scores for MSSQ I (p = 0.04), MSSQ II (p = 0.04), and MSSQ IV (p = 0.03). Conclusion: Short-term practice of supervised RYM during stressful periods is protective for the cardiovascular and autonomic systems and decreases stress in medical students.

Flipped classroom for undergraduate medical students in India: are we ready for it?

The teaching-learning environment has undergone a paradigm shift with the recent implementation of a Competency-Based Medical Curriculum in India. Despite this, the concept of flipped classrooms for medical students is still in its infancy in our country. We conducted an experimental randomized crossover study to find if a flipped teaching model improves learning for first-year medical undergraduate students. Students' perceptions of this novel method were also obtained and analyzed. In the first period (first part of the study), one group of students underwent the flipped model teaching (flipped teaching group), and the second group (traditional teaching group) was taught by the conventional method. A crossover was done with a second topic in the second period. A written test was conducted at the end of each period. Student feedback was also obtained. There was no statistically significant difference in students' performance on comparing traditional and flipped teaching methods. Reasons for this could be the level of the learner, prior exposure to active learning strategies, learner readiness/motivation for active learning, and timing of the study. Out of the participants, 80% of students preferred the flipped model classroom teaching, especially the interactive discussion, and expressed their desire for more frequent similar learning activities. We conclude that there was no difference in marks obtained by students in the two groups, yet they preferred the flipped classroom method, which indicates that it is feasible to adopt this method in the Indian medical undergraduate classroom.NEW & NOTEWORTHY We conducted a study to find if flipped teaching model improves the learning of medical undergraduate students and assess students' perceptions. There was no difference in marks obtained by students taught with either flipped or traditional methods. The reasons for this could be differences in the level of learner, prior exposure, or learner readiness for active learning. Since students prefer the flipped method of classroom teaching, it is feasible to adopt it in the Indian classroom.

Effect of acute hyperglycemia on baroreflex sensitivity in healthy young adults.

BACKGROUND: Autonomic dysfunction, impaired baroreflex sensitivity (BRS), and deranged circulatory homeostasis have been observed in chronic hyperglycemia and found to be associated with increased cardiovascular morbidity and mortality. However, the acute effects of hyperglycemia in healthy subjects have been rarely studied. The present study explores the effect of acute hyperglycemia on conventional and unconventional parameters of BRS in healthy young adults. METHODS: For the estimation of BRS beat-to-beat blood pressure (BP) and electrocardiogram were recorded in forty-two young, healthy subjects during fasting and at 1hr of the oral glucose load. Analysis of BRS was carried out by sequence and spectral method. Number of UP-, DOWN- and ALL-sequences between ramps of BP and RR-interval were calculated as an unconventional measure of BRS along with the other conventional parameters. RESULTS: We observed significant alteration of unconventional parameters of autonomic functions [the number of sequences of UP- (p = 0.0039) and ALL-sequences (p = 0.0233) of systolic BP and RR interval; and, UP- (p = 0.0380), DOWN- (p = 0.0417) and ALL-sequences (p = 0.0313) of mean BP and RR- interval] during acute hyperglycemia as compared to the fasting state. However, no significant changes were observed in any of the conventional parameters of BRS during acute hyperglycemia as compared to the fasting state. CONCLUSIONS: Present study concludes that the unconventional parameters of BRS - the number of sequences between the ramp of BP and RR-interval - change significantly during acute hyperglycemia. However, the conventional parameters do not show significant changes during acute hyperglycemia. We may hypothesize that the relatively constant BRS is maintained at the expense of increased oscillations in the ramp of BP and RR-interval.

Association of heart rate variability, blood pressure variability, and baroreflex sensitivity with gastric motility at rest and during cold pressor test.

AIM: To understand the mutual interaction of gastric motility and autonomic functions, the present study evaluated the association of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) with gastric motility assessed by electrogastrography (EGG) at rest and during CPT and explored the effect of sympathetic activation by cold pressor test (CPT) on gastric motility. BACKGROUND: The autonomic nervous system has a significant influence on gastrointestinal motility. HRV is commonly employed to assess the functions of the autonomic nervous system. BPV and BRS are relatively newer techniques and give a more holistic picture of autonomic functions along with the short-term regulation of blood pressure (BP). METHODS: In fourteen young, healthy subjects, gastric motility was assessed by EGG. Beat-to-beat BP and lead II ECG were recorded to assess HRV, BPV, and BRS. BPV and BRS parameters were calculated for systolic, mean, and diastolic BP. Parameters of HRV and BPV were calculated for time and frequency domains. BRS was calculated by sequence and spectral methods. RESULTS: Significant increases in diastolic BP (p = <0.0001) and EGG frequency (p = 0.0229) were observed during CPT. Significant correlations were observed between EGG frequencies and many of the HRV, BPV, and BRS parameters. The correlation coefficient was found to be highest between total power of HRV and EGG frequencies during baseline (p = 0.0107, r = -0.6571) and during CPT (p = 0.0059, r = -0.6935). CONCLUSION: EGG frequency can be decreased by an acute increase in sympathetic activity induced by CPT. The novel findings are the significant correlations between many of the HRV, BPV, and BRS parameters and EGG frequency.

Serial profile of flow-mediated dilatation in primigravida for prediction of preeclampsia and gestational hypertension.

OBJECTIVE: Assessment of endothelial dysfunction for prediction of gestational hypertension/preeclampsia (GH/PE). METHODS: Serial assessment of flow-mediated vasodilatation (FMD) of brachial artery was done in first, second, and third trimesters, and within 6 weeks of delivery in primigravida (n = 654). Logistic regression was used to assess the predictive value of FMD for the development of GH/PE. RESULTS: Significant fall in FMD was observed from first trimester to third trimester but decrease in FMD in GH/PE group (57%) was more marked as compared to normal (39%) (p < 0.01). FMD (third trimester) was able to predict the development of GH/PE (OR = 1.303; 95% CI 1.088-1.562; p = 0.004). CONCLUSIONS: FMD can be used as a non-invasive marker to predict the development of GH/PE.

Qualitative Analysis of the Most Cited Publications from Leading Indian Medical Institutions.

BACKGROUND AND OBJECTIVES: The most important responsibility of physicians is research - advancement of medical knowledge is the core on which the other responsibilities, patient care and research, are based. This study was planned to conduct a qualitative analysis of the major publications from the the country's leading medical institutions. METHODS: We used Scopus to generate a list of total number of publications from the topmost institutions, the number of citations, and citations per article. We calculated the h-index, g-index, i-10 index, and h5-index for these institutions. A more detailed analysis was carried out for the top 20 most cited papers in each of the institutions. Only descriptive statistics were used. RESULTS: Among the top 10 medical institutions included, AIIMS, Delhi and PGIMER, Chandigarh were the top institutes, accounting for more publications and citations than the next eight institutions combined. The other institutions also managed to publish a large number of highly-cited papers. AIIMS was the leading institution when other indices were calculated. Among the most-cited articles, >80% had first/corresponding authors from outside India. A large number papers remained uncited, even after many years of publication. INTERPRETATION AND CONCLUSIONS: Uncited papers could be a result research conducted with the purpose of getting the numbers needed for promotion (NNP). Importance of collaborative research was seen to be an important factor when citations are considered. Even with the huge resource deficit, our institutes managed to publish a decent number of highly cited articles, which can be boosted if funding situation is improved.

Pedagogical effectiveness of innovative teaching methods initiated at the Department of Physiology, Government Medical College, Chandigarh.

Modern teaching trends in medical education exhibit a paradigm shift from the conventional classroom teaching methods adopted in the past to nonconventional teaching aids so as to encourage interactive forms of learning in medical students through active participation and integrative reasoning where the relationship of the teacher and the taught has undergone tremendous transformation. Some of the nonconventional teaching methods adopted at our department are learning through active participation by the students through computer-assisted learning (CD-ROMs), Web-based learning (undergraduate projects), virtual laboratories, seminars, audiovisual aids (video-based demonstrations), and "physioquiz."