Risk of diabetes and expected years in life without diabetes among adults from an urban community in India: findings from a retrospective cohort.

BACKGROUND: Diabetes prevalence has increased over the past few decades, and the shift of the burden of diabetes from the older population to the younger population has increased the exposure of longer durations in a morbid state. The study aimed at ascertaining the likelihood of progression to diabetes and to estimate the onset of diabetes within the urban community of Mumbai. METHODS: This study utilized an observational retrospective non-diabetic cohort comprising 1629 individuals enrolled in a health security scheme. Ten years of data were extracted from electronic medical records, and the life table approach was employed to assess the probability of advancing to diabetes and estimate the expected number of years lived without a diabetes diagnosis. RESULTS: The study revealed a 42% overall probability of diabetes progression, with age and gender variations. Males (44%) show higher probabilities than females (40%) of developing diabetes. Diabetes likelihood rises with age, peaking in males aged 55-59 and females aged 65-69. Males aged 30-34 exhibit a faster progression (10.6 years to diagnosis) compared to females (12.3 years). CONCLUSION: The study's outcomes have significant implications for the importance of early diabetes detection. Progression patterns suggest that younger cohorts exhibit a comparatively slower rate of progression compared to older cohorts.

The lifetime risk of developing type II diabetes in an urban community in Mumbai: findings from a ten-year retrospective cohort study.

BACKGROUND: Incidence and prevalence do not capture the risk of developing diabetes during a defined period and only limited evidence exists on the lifetime risk of diabetes based on longer and continuous follow-up studies in India. Lacunae in evidence on lifetime risk can be attributed primarily to the absence of comprehensive and reliable information on diabetes incidence, mortality rates and lack of longitudinal studies in India. In light of the scarcity of evidence in India, the objective of this study was to estimate the incidence of diabetes and its lifetime risk in an urban community of Mumbai. METHODS: The research study utilized data which is extracted from the electronic medical records of beneficiaries covered under the Contributory Health Service Scheme in Mumbai. The dataset included information on 1652 beneficiaries aged 40 years and above who were non-diabetic in 2011-2012, capturing their visit dates to medical center and corresponding laboratory test results over a span ten years from January, 2012- December, 2021. Survival analysis techniques are applied to estimate the incidence of diabetes. Subsequently, the remaining life years from the life table were utilized to estimate the lifetime risk of diabetes for each gender, stratified by age group. RESULTS: A total of 546 beneficiaries developed diabetes in ten years, yielding an unadjusted incidence rate of 5.3 cases per 1000 person-years (95% CI: 4.9- 5.8 cases/ 1000 person years). The age-adjusted lifetime risk of developing type II diabetes in this urban community is estimated to be 40.3%. Notably, males aged 40 years and above had 41.5% chances of developing diabetes in their lifetime as compared to females with a risk of 39.4%. Moreover, the remaining lifetime risk of diabetes decreased with advancing age, ranging from 26.4% among 40-44 years old to 4.2% among those age 70 years and above. CONCLUSION: The findings stress the significance of recognizing age specific lifetime risk and implementing early interventions to prevent or delay diabetes onset and to focus on diabetes management programs in India.

Prevalence and correlates of perceived age-related discrimination among older adults in India.

BACKGROUND: Age is one of the predominant reasons for perceived discrimination in developing world where older people are considered a non-contributing burden. The present study explores the prevalence and correlates of perceived age discrimination among older Indian adults. METHODS: A cross-sectional study was conducted using a large representative survey data from the Longitudinal Ageing Study in India conducted during 2017-18. Participants included 31,464 older adults aged 60 years and above. Multivariable logistic regression analysis was used to test the associations between selected background characteristics and perceived age discrimination. RESULTS: The analysis revealed that 10.33 percent of older adults perceived their age as the main reason for discrimination, which was 11.86% among the oldest-old. Older adults with more than 10 years of schooling were 32% [adjusted odds ratio (AOR): 0.68; confidence interval (CI): 0.51-0.89] less likely to perceive age discrimination compared to their uneducated counterparts. The odds of perceived age discrimination were higher among older adults who earlier worked [AOR: 1.73; CI: 1.46-2.05] and currently working [AOR: 1.61; CI: 1.31-1.96] as compared to those who never worked. Further, having difficulty in instrumental activities of daily living (IADL) [AOR: 1.43; CI: 1.25 -1.65] and having one chronic condition [AOR: 1.16; CI: 1.02 -1.34] were associated with increased odds of perceived age discrimination among older adults. CONCLUSION: Older adults with lower socioeconomic status, currently working, having more chronic conditions, difficulty in IADL and belonging to rural areas were found to perceive higher age discrimination than their counterparts. The findings of the study have important implications for policy makers with respect to strategies such as making the vulnerable populations aware of their legal rights that help in the prevention of age-based discrimination in the country.

Number of chronic conditions and associated functional limitations among older adults: cross-sectional findings from the longitudinal aging study in India.

BACKGROUND: Chronic conditions reduce the likelihood of physical functioning among older adults. However, the contribution of most prevalent diseases and multimorbidity to different measures of functional limitations is relatively underexplored among Indian older adults. The present study explores the prospective association between number of chronic conditions and limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) among older adults in India. METHODS: This study utilized data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 31,464 older adults aged 60 years and above. Descriptive statistics along with cross-tabulation were presented in the study. Additionally, binary logistic regression analysis was used to fulfil the objectives. The outcome variables were dichotomized; high representing no difficulty in ADL/IADL and low representing a difficulty in at least one ADL/IADL. The chronic conditions included hypertension, diabetes, neurological/psychiatric disease, lung disease, heart diseases, stroke, and bone-related disease. The number of chronic diseases was categorized into no disease, single, two and three plus based on number of reported disease. RESULTS: 26.36% of older women and 20.87% of older men had low ADL and the figures for low IADL were 56.86 and 38.84% for older men and women respectively. The likelihood of low ADL (AOR: 1.698, CI:1.544, 1.868) and low IADL (AOR: 1.197; CI: 1.064, 1.346) was higher among womenthan men. With increasing age, the prevalence of low ADL increased among older adults. Respondents with pre-existing chronic conditions had higher likelihood of low ADL and IADL. Older adults with hypertension, psychiatric disease, heart disease, stroke and bone-related disease had significantly higher odds of reporting low IADL. The chances of low ADL and IADL were 2.156 (CI: 1.709, 2.719) and 2.892 (CI: 2.067, 4.047) times respectively higher among older adults with more than three chronic conditions. After controlling for socio-economic and health-related covariates, it was found that men with more than three pre-existing chronic conditions had higher odds of low ADL than women. On the other hand, low IADL were found higher among women with more than three pre-existing chronic conditions. CONCLUSIONS: The present study demonstrates a significant burden of functional limitations among older individuals and that there is a strong association between pre-existing chronic conditions and functional disability. Those with hypertension, diabetes, psychiatric disorders, heart disease, stroke, lung disease or bone-related diseases should be effectively monitored to predict future functional limitations, which may lead to worsening health.

Prevalence and correlates of bone and joint diseases and its association with falls among older adults in India: Evidence from LASI, 2017-18.

This study explores the prevalence and correlates of bone and joint diseases and its association with falls among older adults in India. Data from the Longitudinal Aging Study in India (2017-18) were utilized for analysis (n = 31,464). Bivariate and logistic regression was used to fulfill the study objectives. The findings revealed that 19.71% of older adults had bone and joint disease, which was higher among women (22.79%) than men (16.25%). The strongest predictors of such diseases included being currently employed, physically inactive, having difficulties in performing functional activities and higher economic status. The fall in the last two years was reported by 12.63% of older adults, and bone and joints diseases were significantly associated with falls (AOR = 1.287; 95% CI: 1.117-1.483) after adjusting for several socio-demographic and health covariates. These findings imply that policymakers and providers must implement interventions designed to reduce the risk of those diseases and associated falls.

Abortion care seeking in India: patterns and predictors.

Unsafe abortions remain a considerable public health problem and continue to be a leading cause of maternal morbidity and mortality throughout the world. This study assessed whether women's choice of type of health care facility for abortion in India varied by their socio-demographic and economic characteristics, and aimed to determine the significant predictors of choice of health care facility. Data were taken from the 2015-16 Indian National Family and Health Survey (NFHS-4). The study sample included women aged 15-49 years, irrespective of their marital status, who had terminated their last pregnancy by induced abortion in the five years before the survey (N = 6876). A bivariate analysis was carried out to assess the pattern in the choice of health care facility type for an abortion, and a multinomial logistic regression model was fitted to assess the predictors affecting the choice of health care facility type for an abortion. The results showed that, at the time of the 2015-16 survey, women in India went to private facilities more than public facilities for abortion care, irrespective of their age, distance to facility and financial constraints. The probability of visiting a private facility increased with women's age, gestational age and the wealth quintile. A wide variation in choice of health facility for abortion care by socioeconomic characteristics was observed.

Internet-of-things-integrated molecularly imprinted polymer-based electrochemical nano-sensors for pesticide detection in the environment and food products.

To ensure environmental and health safety, relevant pollutants such as pesticides must be screened thoroughly to set their permissible limit. Various approaches have been used to identify pesticides such as capillary electrophoresis, gas and liquid-liquid chromatography, high-performance liquid chromatography, and enzyme-linked immune-absorbent tests. However, these techniques have some drawbacks, including time-consuming difficult steps, expensive bulky equipment, expert personnel, and a lack of selectivity. Recent advances in the field of biosensing have introduced biosensors for the onsite detection of pesticides which offer several advantages including rapid, simple, selective, sensitive, low-cost operation, and on-site detection. With the advent of molecularly imprinted polymer which substituted the traditional biorecognition elements (BREs) such as enzymes and antibodies, biosensors' sensitivity, selectivity, and reproducibility enhanced many folds. Molecularly imprinted polymers (MIP) are artificial polymer molecules that resemble natural BREs. They are synthesized when functional monomers are polymerized in the presence of a target analyte. Owing to the advantages of MIP, in this paper, the development of MIP-based electrochemical biosensors for pesticide detection is reviewed critically. A brief introduction to pesticides and the use of MIPs-based electrochemical sensors for pesticide detection is presented along with pros and cons. Further, Internet of Things (IoT) integrated MIP-based nanosensors for pesticide detection and information distribution have been discussed. In the end, future perspectives and challenges while implementing MIP-based nanosensors for onsite pesticide recognition have eventually been highlighted.

MXene-based aptasensor for the detection of aflatoxin in food and agricultural products.

The detection of toxins that contaminate food needs highly sensitive and selective techniques to prevent substantial monitory loss. In this regard, various nanostructured material-enabled biosensors, have recently been developed to improve the detection of food toxins among them aflatoxin is the prevalent one. The biosensor-based detection of aflatoxin is quick, cheaper, and needs less skilled personnel, therefore overcoming the shortcomings of conventional techniques such as LC/MS-MS, HPLC, and ELISA assays. 2D MXenes manifest as an efficient material for biosensing due to their desirable biocompatibility, magnificent mechanical strength, easiness of surface functionalization, and tuneable optical and electronic features. Contrary to this, aptamers as biorecognition elements (BREs) possess high selectivity, sensitivity, and ease of synthesis when compared to conventional BREs. In this review, we explored the most cutting-edge aptamer-based MXene-enabled biosensing technologies for the detection of the most poisonous mycotoxins (i.e., Aflatoxins) in food and environmental matrices. The discussion begins with the synthesis processes and surface functionalization/modification of MXenes. Computational approaches for designing aptasensors and advanced data analysis based on artificial intelligence and machine learning with special emphasis over Internet-of-Thing integrated biosensing devices has been presented. Besides, the advantages of aptasensors over conventional methods along with their limitations have been briefed. Their benefits, drawbacks, and future potential are discussed concerning their analytical performance, utility, and on-site adaptability. Additionally, next-generation MXene-enabled biosensing technologies that provide end users with simple handling and improved sensitivity and selectivity have been emphasized. Owing to massive applicability, economic/commercial potential of MXene in current and future perspective have been highlighted. Finally, the existing difficulties are scrutinized and a roadmap for developing sophisticated biosensing technologies to detect toxins in various samples in the future is projected.

Structural aspects of SARS-CoV-2 mutations: Implications to plausible infectivity with ACE-2 using computational modeling approach.

Some of the SARS-CoV-2 variants are said to be more infectious than the previous others and are causing panic around the globe. Cases related to Delta plus (δ+) and omicron (ο) variants are on the rise worldwide. This sudden surge warrants an investigation into the reasons for its binding with ACE-2. The present study attempts to find out the structural basis of binding interactions of SARS-CoV-2 mutants based on computational modeling and comparative analysis. In silico strategies including protein-protein docking, mutation analysis, molecular dynamics, and binding energy calculations were used to study the binding of the 'receptor binding domain' (RBD) of the seven 'variants of concern' which include Alpha (α), Beta (ß), Gamma (γ), Kappa (κ), Delta (δ), Delta plus (δ+) and omicron (ο) with ACE-2 (human angiotensin-converting enzyme-2) and with antibodies. Among all the variants dealt with in this study, Delta plus and omicron were found to be binding more strongly to ACE-2 than others due to inherent mutations and the consequent change in the hydrophilic and hydrophobic environment of the binding site. Furthermore, molecular dynamic (MD) simulations and subsequent MM/PBSA calculations provided useful structural insights into key residues participating in the interaction. Infectivity of a virus could be dependent on the interplay of evading antibodies and simultaneously attaching strongly with the host receptor. A cross-correlation between mutant spike proteins' binding with ACE-2 and antibodies provides a holistic assessment of the binding nature of these mutants vis-à-vis native virus and offers opportunities for designing potential therapeutics against these new mutants.Communicated by Ramaswamy H. Sarma.

Binding studies of sertraline hydrochloride with CT-DNA using experimental and computational techniques.

Sertraline Hydrochloride (STH) is an antidepressant drug that belongs to the selective serotonin reuptake inhibitor family (SSRIs), which inhibits serotonin uptake in presynaptic nerve fibers. The use of these medications without a legitimate prescription might result in adverse effects, and in rare circumstances, death. The interaction mechanism and binding mode of STH with duplex DNA were extensively investigated using spectroscopic and modeling techniques at different temperatures. The hypochromic shift of the absorption spectra of STH on binding with CT-DNA indicated groove binding. Fluorescence spectroscopic studies showed that CT-DNA quenches the fluorescence intensity of STH through a static quenching mechanism. The thermodynamic parameters indicated that the complex formation was spontaneous, and enthalpy driven. The competitive displacement binding study revealed that STH displaced DAPI from the minor groove of DNA. Molecular docking and molecular dynamics simulations also revealed that the complex was stable over 150 ns and that STH preferred the minor groove of DNA. The binding energy of the stable conformations were evaluated through MM/PBSA methods. A comparison of the bound poses at different timescales showed minor changes in STH structure upon DNA binding. Furthermore, a structural analysis of CT-DNA indicated that STH induced changes in the sugar-phosphate backbone had an impact on the minor groove's width which are in agreement with the CD spectroscopic results. This study provides a better understanding of STH binding with duplex DNA.

Depression by gender and associated factors among older adults in India: implications for age-friendly policies.

Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017-2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to examine our study objectives. Depression was reported in - 7.4% (95% CI 7.0, 7.8) of older men and 9.5% (CI 9.1, 10.0) of older women. Poor self-rated health, multimorbidity status, physical activity, difficulty in activities of daily living (ADL) and instrumental ADL (IADL) were the significant health-related factors associated with depression among older men and women. Not being satisfied with one's life, not being satisfied with their present living arrangement, receiving any type of ill-treatment, and being widowed were the significant factors associated with depression among older men and women. We found gender disparity in self-reported depression. Marital status contributed-to 36.7% of the gender gap in depression among older adults. Additionally, ADL and IADL difficulties among men and women contributed to 17.6% and 34.0%, gender gap, self-rated health contributed to 18.8% gap, whereas not having equal social participation (4.4%) and not satisfied in present living arrangements (8.1%) were other factors that contributed to gender gap for depression in India. Depression is a critical and persistent public health problem among-older females in India. Our findings provide a broader framework for policymakers and health practitioners to focus on gender-specific strategies to mitigate this highly emergent problem.

Green Synthesis of CdS and CdS/rGO Nanocomposites: Evaluation of Electrochemical, Antimicrobial, and Photocatalytic Properties.

The green approach has been employed for the synthesis of various types of nanomaterials including metal nanoparticles, metal oxides, and carbon-based nanomaterials. These processes involve natural sources that contain bioactive compounds that act as reducing, stabilizing, and capping agents for the formation and stabilization of nanomaterials. This study reports the green synthesis of CdS and CdS/rGO nanocomposites using Lactobacillus bacteria. The UV-visible spectrophotometer, field emission scanning electron microscopy, transmission electron microscopy, energy-dispersive X-ray spectroscopy, Raman spectroscopy, and Fourier transform infrared spectroscopy spectra confirm the synthesis of the nanocomposite. The electrochemical characterization using cyclic voltammetry, differential pulse voltammetry, and EIS revealed that the CdS/rGO nanocomposites showed a higher electron transfer rate compared with CdS nanoparticles, indicating the potential of the nanocomposites for biosensing applications. The zone of inhibition revealed significant antimicrobial activity against Escherichia coli and Staphylococcus aureus for both CdS nanoparticles and CdS/rGO nanocomposites. Additionally, CdS/rGO nanoparticles exhibited high photocatalytic activity for the degradation of methylene blue dye. Overall, this study demonstrates that the synthesized CdS and CdS/rGO nanocomposites have good electrochemical properties, photocatalytic, and antimicrobial activity and, therefore, can be employed for various applications such as biosensing, photocatalysis, and antimicrobial activity.

Targeted Atrial Fibrillation Therapy and Risk Stratification Using Atrial Alternans.

Atrial fibrillation (AF) is the most persistent arrhythmia today, with its prevalence increasing exponentially with the rising age of the population. Particularly at elevated heart rates, a functional abnormality known as cardiac alternans can occur prior to the onset of lethal arrhythmias. Cardiac alternans are a beat-to-beat oscillation of electrical activity and the force of cardiac muscle contraction. Extensive evidence has demonstrated that microvolt T-wave alternans can predict ventricular fibrillation vulnerability and the risk of sudden cardiac death. The majority of our knowledge of the mechanisms of alternans stems from studies of ventricular electrophysiology, although recent studies offer promising evidence of the potential of atrial alternans in predicting the risk of AF. Exciting preclinical and clinical studies have demonstrated a link between atrial alternans and the onset of atrial tachyarrhythmias. Here, we provide a comprehensive review of the clinical utility of atrial alternans in identifying the risk and guiding treatment of AF.

Effects of Manual Therapy in Somatic Tinnitus Patients Associated with Cervicogenic and Temporomandibular Dysfunction Domain: Systematic Review and Meta Analysis of Randomised Controlled Trials.

Despite manual therapy has been used as an effective treatment but there is limited of literature emphasizing its role to improve quality of life and pain pressure threshold in patients with somatic tinnitus. In this Meta analysis we compared the effects of manual therapy on quality of life and pain pressure threshold in the patients with somatic tinnitus associated with cervicogenic and temporomandibular dysfunction domain. We systematically searched different databases such as Pubmed, Google Scholar and Scopus to find out the relevant studies compairing the effects of manual therapy with quality of life and pain pressure threshold. Two independent reviewers performed quality check and data extraction. We analyzed the data using RevMan ver. 5.4 software. Total three randomised controlled trials were included in this study. Manual Therapy proven to be effective in improving quality of life as well pain pressure threshold in somatic tinnitus patients. {ORs 0.80; 95% Confidence Interval (95%CI), P = 0.97}. Further clinical trials are needed to explore manual therapy as an effective intervention.

Recent developments in plant-derived edible nanoparticles as therapeutic nanomedicines.

The use of nanotechnology in the treatment of numerous disorders has proven effective. The predicted development of plant-derived edible nanoparticles (PDNPs) as potential therapeutic agents for treating illness or in the delivery of drugs is inevitable. PDNPs generated from plants resemble mammal-extracted exosomes structurally. In contrast to their excellent biocompatibility with healthy cells, PDNPs are skewed toward malignancies by selectively targeting those cells via unique endocytic pathways. They can be generated in large quantities, are nontoxic, and have tissue-specific targeting abilities. Thus, with fewer off-target effects, using these PDNPs could broaden the breadth of pharmacological therapy. In this discussion, we emphasize the properties and biological activities of PDNPs isolated from fruits and vegetables and discuss the promising implications of these particles as nanomedicines. PRACTICAL APPLICATIONS: PDNPs have reportedly been employed for therapeutic applications for several ailments and are believed to have characteristics in common with exosomes generated from mammals. The advantages of PDNPs over mammalian-derived exosomes are numerous. Firstly, they may be produced on a commercial scale using a variety of efficient renewable sources. Secondly, the PDNPs' natural components developed in plant cells promise improved cytocompatibility, tolerability, low cytotoxicity, or other adverse effects. We evaluated some current studies on the applications and potential of PDNPs in this article. PDNPs could create new opportunities for drug discovery because of recent advancements in medicine and drug delivery system nanotechnology. Unfortunately, the precise mechanisms behind PDNP's functions and interaction in pathogenic processes have not yet been completely elucidated; as a result, the potential consequences of their clinical use are uncertain. Overall, PDNPs show a wide range of therapeutic possibilities that may be advantageous to patients and might eventually make up the next generation of pharmaceuticals.

National Burden Estimates of healthy life lost in India, 2017: an analysis using direct mortality data and indirect disability data.

BACKGROUND: Many countries, including India, seek locally constructed disease burden estimates comprising mortality and loss of health to aid priority setting for the prevention and treatment of diseases. We created the National Burden Estimates (NBE) to provide transparent and understandable disease burdens at the national and subnational levels, and to identify gaps in knowledge. METHODS: To calculate the NBE for India, we combined 2017 UN death totals with national and subnational mortality rates for 2010-17 and causes of death from 211 166 verbal autopsy interviews in the Indian Million Death Study for 2010-14. We calculated years of life lost (YLLs) and years lived with disability (YLDs) for 2017 using published YLD-YLL ratios from WHO Global Health Estimates. We grouped causes of death into 45 groups, including ill-defined deaths, and summed YLLs and YLDs to calculate disability-adjusted life-years (DALYs) for these causes in eight age groups covering rural and urban areas and 21 major states of India. FINDINGS: In 2017, there were about 9·7 million deaths and 486 million DALYs in India. About three quarters of deaths and DALYs occurred in rural areas. More than a third of national DALYs arose from communicable, maternal, perinatal, and nutritional disorders. DALY rates in rural areas were at least twice those of urban areas for perinatal and nutritional conditions, chronic respiratory diseases, diarrhoea, and fever of unknown origin. DALY rates for ischaemic heart disease were greater in urban areas. Injuries caused 11·4% of DALYs nationally. The top 15 conditions that accounted for the most DALYs were mostly those causing mortality (ischaemic heart disease, perinatal conditions, chronic respiratory diseases, diarrhoea, respiratory infections, cancer, stroke, road traffic accidents, tuberculosis, and liver and alcohol-related conditions), with disability mostly due to a few conditions (nutritional deficiencies, neuropsychiatric conditions, vision and other sensory loss, musculoskeletal disorders, and genitourinary diseases). Every condition that was common in one part of India was uncommon elsewhere, suggesting state-specific priorities for disease control. INTERPRETATION: The NBE method quantifies disease burden using transparent, intuitive, and reproducible methods. It provides a simple, locally operable tool to aid policy makers in priority setting in India and other low-income and middle-income countries. The NBE underlines the need for many more countries to collect nationally representative cause of death data, paired with focused surveys of disability. FUNDING: Ministry of Health and Family Welfare, Government of India.

Eficácia da terapia manual nos fatores modulatórios duais do zumbido somático: um protocolo de estudo / Efficacy of manual therapy on somatic tinnitus dual modulatory factors: a study protocol

A literatura tem demonstrado efeito promissor da terapia manual na melhora da gravidade do zumbido somático. No entanto, não há nenhum estudo anterior que tenha demonstrado o efeito da terapia manual nos fatores modulatórios duplos (disfunções temporomandibulares e músculos da coluna cervical). O objetivo do estudo é avaliar a eficácia da terapia manual nos fatores modulatórios duais do zumbido somático (TMD e coluna cervical). MÉTODOS / PROJETO: Trinta e nove pacientes com zumbido somático serão aleatoriamente designados para um dos três grupos, ou seja, A (zumbido somático cervicogênico), B (zumbido somático induzido pela TMD) e C (fatores modulatórios duplos induzidos ao zumbido somático), respectivamente. Este ensaio clínico randomizado de vários grupos, braços paralelos, pré-teste pós-teste, centro único, com três grupos paralelos receberá seis sessões de tratamento de terapia manual integrada em dias alternados durante duas semanas. Os exercícios de reeducação postural serão aconselhados aos pacientes como exercícios em casa. O desfecho primário será o Tinnitus Handicap Inventory (THI) e os desfechos secundários incluem Escala Visual Analógica (VAS) e Algômetro Calibrado Digitalizado (DCA) para medir pré e pós efeito de intervenção dos tratamentos. DISCUSSÃO: A eficácia da terapia manual em pacientes com zumbido somático em cada grupo será estabelecida com este estudo.

The literature has shown promising effect of manual therapy in improving the severity of somatic tinnitus. However, no previous study which has demonstrated the effect of manual therapy on dual modulatory factors (Temporomandibular disorders and cervical spine muscles). The purpose of the study is to evaluate the efficacy of manual therapy on somatic tinnitus dual modulatory factors (TMD and cervical spine). METHODS/DESIGN: Thirty nine patients with somatic tinnitus will be randomly assigned to one of the three groups i.e., A(Cervicogenic somatic tinnitus),B(TMD induced somatic tinnitus) and C(Dual modulatory factors induced somatic tinnitus) respectively. This multi group, parallel arms, pre-test post-test, single centre, randomized clinical trial with three parallel groups will receive six treatment sessions of integrated manual therapy on alternate days for two weeks. Postural re-education exercises will be advised to the patients as home exercises.The primary outcome measure will be Tinnitus Handicap Inventory (THI) and secondary outcome measures include Visual Analogue Scale (VAS) and Digitalized Calibrated Algometer (DCA) to measure pre and post intervention effect of the treatments. DISCUSSION: The efficacy of manual therapy in patients with somatic tinnitus in each group will be established with this study.