Assessment of Upper Limb Nerves in Coronary Artery Disease Patients Undergoing Coronary Artery Bypass Graft.

Background Many patients experience pain in their upper limbs following surgical procedures involving median sternotomy, particularly those undergoing coronary artery bypass grafting (CABG). This type of pain, commonly reported by CABG patients, is often overlooked in hospital settings. Our study aims to address this issue by utilizing electrodiagnostic studies to understand this postoperative discomfort better. Objectives Cardiovascular procedures are standard and are trending toward endovascular interventions. Through this study, we aim to assess the occurrence of neurological issues in the upper limbs after CABG by comparing patients' preoperative and postoperative electrophysiological studies of the upper limb nerves. Materials and methods A prospective study was performed on 32 coronary artery disease (CAD) patients undergoing CABG to determine the effects of surgery on the upper limb nerves (median and ulnar nerves). We performed nerve conduction studies (NCS) and analyzed different parameters of both median and ulnar nerves pre and post-surgery. Results A change was noted in different NCS parameters of the median and ulnar nerves when we compared the pre and post-surgical values. The mean latency of the median nerve sensory increased from a minimum of 3.01 milliseconds at the preoperative level to a maximum of 3.60 milliseconds when assessed two weeks post-surgery. The mean amplitude decreased from 16.49 microvolts to a minimum of 12.30 microvolts when assessed two weeks post-surgery. The mean velocity decreased from 55.83 m/s at the preoperative value to a minimum of 45.03 m/s at the two weeks post-surgery assessment. The ulnar nerve also underwent similar changes. Conclusion The observed changes in latency, amplitude, and velocity might be attributed to various factors, including surgical trauma, inflammation, or alterations in the physiological state post-surgery. The sternotomy technique and the position and extent of opening the sternal retractor determine the prevalence of complications by causing injury to the medial and lateral cords of the brachial plexus after CABG. Careful preoperative and postoperative assessments of patients may aid in preventing, minimizing, and treating these often undiagnosed complications.

Influence of Sociodemographic Factors on Stunting, Wasting, and Underweight Among Children Under Two Years of Age Born During the COVID-19 Pandemic in Central India: A Cross-Sectional Study.

Introduction The adverse effects of the coronavirus disease 2019 (COVID-19) pandemic on maternal and reproductive health extend beyond the immediate morbidity and mortality attributed directly to the disease. Pandemic-induced disruptions in the healthcare, social and economic infrastructures can exacerbate the already high burden of childhood undernutrition in India. Method A cross-sectional study was conducted in a selected district of the central Indian province of Madhya Pradesh. Data was collected from eligible children born during the COVID-19 pandemic (February 2020 to December 2021) who visited a selected tertiary care hospital for routine immunization during the study period. Weight-for-length, weight-for-age, and length-for-age were compared with reference values to obtain corresponding z-scores. Children with z-scores two standard deviations below the reference values were considered wasting, underweight and stunting, respectively. Descriptive statistics were employed to summarise the sociodemographic characteristics of participants. The association of sociodemographic, nutritional, and pregnancy-related factors with the z-scores were assessed via unpaired t-test and ANOVA. Result The studied 147 children were in the age group of nine to 29 months, of which 61 (58.1%) were males. Forty-two (28.6%) were found to be underweight, 22 (14.9%) had wasting and 51 (34.7%) were stunted. These prevalences were comparable to the estimates of the National Family Health Survey 2019-2021 (NFHS-5) for Madhya Pradesh and lower than the NFHS-4 (2015-2016), showing no discernible effect of being born during the pandemic on growth indicators. However, mothers' employment and family income were independent predictors of stunting whereas gestational age at birth, maternal education, and prolonged breastfeeding were all substantially linked with wasting in this study. Conclusion This study adds to the evidence base by reporting the prevalence of stunting, wasting and underweight along with their determinants in central India among children born during the COVID-19 pandemic. Our data did not reflect the expected increase in child malnutrition due to the COVID-19 pandemic-related disruptions in healthcare, social and economic infrastructure. Future research should incorporate the lessons learnt from our study to design a population-based study of under-five children and compare the prevalence of undernutrition in pandemic-born versus non-pandemic-born children.

Multi-level Analysis of HbA1c in Diagnosis and Prognosis of Diabetic Patients.

BACKGROUND: Type 2 diabetes (T2D), a multifaceted metabolic disorder, may cause health tribulations and changes in biochemical blood markers. Other research has examined the relationships between several biomarkers and the risk of T2D. Few studies have examined the relationships between these biomarkers and potential changes to the network of biomarkers associated with diabetes. METHOD: Glycated hemoglobin, or HbA1C, is used to evaluate and track the blood glucose history throughout the previous two to three months of testing. The ability to reflect the cumulative glycemic history of the previous two to three months makes HbA1c an essential biomarker of long-term glycemic control. HbA1c offers a trustworthy indicator of chronic hyperglycemia and strongly correlates with the likelihood of long-term consequences from diabetes. RESULT: Additionally, elevated HbA1c has been recognized as a stand-alone risk factor for patients with and without diabetes developing coronary heart disease and stroke. One HbA1c test offers a wealth of information that makes it a reliable biomarker for the diagnosis and prognosis of diabetes. A clinical examination may be required to establish the connection between diabetes, prediabetes, biochemical blood indicators, age, and body mass index (BMI). CONCLUSION: We observed that diabetes, BMI, age, HbA1c, cholesterol, triglycerides, LDL, VLDL, and HDL were all linked using multivariate analysis.

Clinical Risk Assessment and Comparison of Bias Between Laboratory Methods for Estimation of HbA1c for Glycated Hemoglobin in Hyperglycemic Patients.

INTRODUCTION: Hemoglobin A1c (HbA1c), also known as glycated hemoglobin, is a blood test used to evaluate and track a patient's blood sugar levels over the previous 2-3 months. We have compared the analytical performance of the D10 hemoglobin (HPLC) testing system to that of the immunoturbidimetric technique, which is a light-scattering immunoassay. OBJECTIVES: To assess the clinical risk assessment between two methods (Compare the two Immunoturbidometric methods (AU680) vs HPLC method (D10)) in hyperglycemic patients and assess the acceptability of the respective methods in the clinical biochemistry Laboratory. METHODS: The charge of the globins in Hb was used as the basis for the HPLC method used to measure HbA1c. HPLC detects and quantifies even the tiniest Hb fractions and the full spectrum of Hb variants. HbA1c was measured using the immunoturbidimetric (AU 680 Beckmann coulter analyzer) and high-performance liquid chromatography (HPLC) techniques. Experiments also made use of immunoturbidimetric techniques (using an AU 680 Beckmann coulter analyzer equipment). RESULTS: There is no statistically significant difference in HbA1c readings between male and female patients, as measured by either the Immunoturbidimetric or HPLC techniques. CONCLUSION: The immunoturbidimetric and high-performance liquid chromatography techniques for estimating HbA1c yielded identical results. From the results of this study, we may deduce that both techniques are valid for estimating HbA1c. As a result, it may be suggested that both approaches can be used to estimate HbA1c in diabetic individuals.

A Cadaveric Study to Define the Variant Patterns of Median Nerve Formation.

The median nerve is one of the important nerves of the upper limb which supplies the muscles of the front of the forearm, muscles of the hand, and skin of the hand. Many works of literature mentioned its formation by the fusion of two roots, the medial root from the medial cord and the lateral root from the lateral cord. But multiple variations in the median nerve formation have clinical importance from surgical and anesthetic points of view. For the study purpose, we dissected 68 axillae of 34 formalin-fixed cadavers. Out of 68 axillae, two (2.9%) showed median nerve formation by a single root, 19 (27.9%) showed median nerve formation by three roots, and three (4.4%) showed median nerve formation by four roots. A normal pattern of median nerve formation by fusion of two roots was seen in 44 (64.7%) axilla. The knowledge of variant patterns of median nerve formation will be helpful to surgeons and anesthetists while performing surgical or anesthetic procedures in the axilla to avoid any injury to the median nerve.

Heart Rate Variability among Healthy Untrained Adults during Mild Intensity Stationary Cycling Exercise.

Background: Stationary cycling is the popular, preferred, and convenient form of exercise. During exercise, autonomic modulation is seen which can be assessed by heart rate variability (HRV). The aim of the study was to evaluate the changes in HRV during mild-intensity cycling exercise. Materials and Methods: An observational cross-sectional study was done on 20 healthy male volunteers with the age (35.44 ± 4.12), height (71.12 ± 11.98), and weight (161.23 ± 11.65), BMI (27.12 ± 3.49) attending various YOGA sessions in AYUSH OPD. Volunteers underwent an exercise program at the mild intensity of 30% to 50% of maximal heart rate on a stationary cycle for 20 min. HRV was recorded by the HRV mobile unit Dynamika Machine at rest, every 5 min (4×) over 20 min and during the recovery period. Repeated measures of analysis of variance with post-hoc analysis with Bonferroni and Holm's multiple comparisons. Results: Significant change was observed in mean heart rate and time domain parameters. Frequency domain parameters that showed significant change were total power, High Frequency- HF (ms2), Very Low Frequency -VLF (ms2), Low Frequency -LF (ms2), and Very Low Frequency %-VLF (%). Conclusions: The HRV parameters conclusively point towards cardiac parasympathetic withdrawal and sympathetic dominance at the initiation of exercise. With the progression of exercise, the sympathetic influence is retained. In the recovery period parasympathetic reactivation gains control over heart rate as well as HRV. The HRV response to exercise challenges may be helpful in designing exercise programs based on variations in the autonomic response.

Comparative Analysis of Heart Rate Variability Parameters between Surya Namaskar and Stationary Bike Exercise Groups.

Background: Yoga practice has multiple health benefits. Surya Namaskar (SN) also known as sun salutation presents mental and physical health benefits equivalent to physical exercise. It consists of a sequence of 12 Hatha yoga postures with coordinated breathing. Aims: This study evaluated the effect of SN against mild intensity stationary cycling exercise (SCE) on parameters of heart rate variability (HRV). Methodology: This study was conducted in the department of physiology of a nationally important institute after obtaining ethics approval. A total of 40 healthy participants (males aged 46 ± 2.3 years) were enrolled in the study and divided into two groups, namely SN group and exercise group (SG and EG). The allocation on the group was based on subjects' choice and interest in performing SN or SCE. Baseline HRV, anthropometric measurement, and blood pressure were assessed. SG was subjected to 14 rounds of SN in about 20 min and EG to a 20-min mild-intensity stationary cycling session (30%-50% maximal heart rate). Assessments were conducted preexercise and postexercise recovery. HRV was assessed with the NeuralChek device. Results: SN led to increased SDNN, pNN50, RMSSD, and total power, indicating improved autonomic balance, cardiovascular health, and parasympathetic dominance. Conversely, SCE decreased SDNN, pNN50, and RMSSD, suggesting immediate postexercise sympathetic dominance. Spectral analysis of HRV highlighted autonomic balance differences, with SN increasing low frequency (LF%) reflecting both sympathetic and parasympathetic dominance, whereas exercise reduced LF% due to sympathetic activation. Minimal changes were observed in high-frequency percentage. SN combines flexibility, strength, and balance, providing a balanced physical activity. This balance results in a mixed autonomic response, with sympathetic activity for the physical effort and parasympathetic activity for the relaxation components. Conclusions: SN positively impacted HRV, promoting parasympathetic dominance and cardiovascular health, whereas exercise induced sympathetic activation with potential recovery benefits. Monitoring HRV offers insights into cardiovascular fitness and well-being. The study underscores the merits of incorporating yoga such as SN into daily activity routines.

Assessment of Alternative Body Points for Temperature Screening As Precautionary Screening During the Pandemic Using Infrared Thermometry.

BACKGROUND: The recent coronavirus disease 2019 (COVID-19) pandemic, which swept across the globe in a short period, demonstrated that disease transmission management is a critical step in preventing an outbreak, as is good viral infectious disease screening. Infrared thermography (IRT) has long been considered ideal for screening body temperatures during pandemics. METHODS: Single-centre cross-sectional study with 159 participants. Using infrared thermometry, participants were subjected to temperature measurement twice daily on various sites. This was compared to oral temperature. RESULTS: The findings of the study revealed that infrared thermometry could be utilised as a proxy approach for screening by both individuals and medical professionals when employed at the glabella, cubits, or axillae. CONCLUSION:  Temperature screening is implied as a prophylactic method during pandemics. Owing to contact limitations, oral thermometry cannot be used for mass screening during the pandemic. Infrared thermometry is a noncontact method of temperature screening that can readily be applied for mass temperature screening in congested venues such as airports, shopping malls, places of public convenience, and other similar locations.

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.

Immediate autonomic changes during right nostril breathing and left nostril breathing in regular yoga practitioners.

BACKGROUND: The ancient Indian science of Yoga makes use of voluntary regulation of breathing to make respiration rhythmic and calm the mind. This practice is called pranayama. Nadisuddhi pranayama means "purification of subtle energy paths," inhalation and exhalation are through alternative nostrils for successive respiratory cycles. Surya Anuloma-Viloma pranayama means "heat generating breathing particle" when the respiratory cycle of inhalation and exhalation is completed through the right nostril exclusively. When completed through the left nostril alone, the practice is called "Chandra Anuloma-Viloma pranayama," which means a heat-dissipating or cooling liberating practice. We compared the effect of right nostril breathing (RNA) and left nostril breathing (LNB) pranayama on heart rate variability. MATERIALS AND METHODS: The study was conducted at the Department of Physiology at an institute of national importance, after obtaining necessary ethical approvals from the Institutional Ethics Committee. Twenty healthy kriya yogi volunteers (mean age: 44 years), who are regular practitioners for the last 10-20 years, were inducted into the study. RNB pranayama starts with closing the right nostril with the thumb of the left hand followed by exhalation through the right nostril and inhaling slowly through the same nostril. This forms one round of RNB pranayama. In contrast, inhalation through the left nostril and exhalation through the right nostril exclusively is called chandrabhedana pranayama (chandrabhedana means moon-piercing breath in Sanskrit) with a similar variation called Chandra Anuloma-Viloma pranayama in which inhalation, as well as exhalation, is performed through the left nostril exclusively. The recording of electrocardiogram (ECG) for heart rate variability (HRV) analysis was taken by heart rate variability (Dinamika HRV-Advanced Heart Rate Variability Test System, Moscow, Russia). The resting and during readings of heart rate variability parameters were compared and post hoc analysis was done using Bonferroni and Holm multiple comparisons for repeated measures. RESULTS: Time domain parameters: Standard deviation of normal to normal RR intervals (SDNN) and root mean square of successive NN interval differences (RMSSD) were increased at a high level of statistical significance during both pranayama maneuvres. Frequency domain parameters: LF, LF/HF ratio increased significantly. Parasympathetic activity is represented by LF when the respiration rate is lower than 7 breaths per min or during taking a deep breath. Thus, when the subject is in a state of relaxation with slow and even breathing in both RNB-right nostril and Chandra-LNB, the LF values can be very high, indicating an increase in parasympathetic activity rather than an increase in sympathetic regulation. CONCLUSION: Our study is an acute study, where changes in HRV were seen after 5 min of RNB and LNB. However, statistically, there is not much difference in the immediate effects of the two pranayamas on heart rate variability in regular yoga practitioners.

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.

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.

Study of immediate neurological and autonomic changes during kapalbhati pranayama in yoga practitioners.

Background: Kapalbhati is a fast pace respiratory exercise or pranayam, which is supposed to be practiced by yogis to clean their brain. Pranayamas are well known to improve heart rate variability (HRV) ultimately leading to better autonomic functions. Other studies have observed the immediate effect of kapalbhati on various neurological (brain and spine) and autonomic functions, but their results are varied and inconclusive. Objective: The aim of this study is to find out the changes in HRV and brain waves during and after practice of kapalbhati as compared with the baseline values of different parameters. Methods: Various parameters were measured at baseline, during and after kapalbhati pranayam with the help of Dinamika HRV-Advanced HRV Test System, Moscow, Russia. Statistical analysis was accomplished employing repeated measures analysis of variance with Bonferroni post-hoc analysis and Holm's multiple comparisons using the Version 28.0.0.0 of the Statistical Package for the Social Sciences (SPSS) for Windows (190) SPSS Inc., Chicago. Results: We found that during and after kapalbhati, changes in HRV were significant in time and frequency domain showing parasympathetic withdrawal and insignificant changes in brain waves as compared with reference point values. Conclusion: Kapalbhati is initially energizing, cleansing, and heating. There occurs parasympathetic withdrawal and sympathetic activation during pranayama. There is an increase gamma wave activation post pranayama showing control of the default mode network.

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.

Marinacci Anastomosis: A Case Report.

Marinacci anastomosis or the reverse Martin-Gruber anastomosis is a rare anomalous intercommunication from the ulnar nerve to the median nerve in the forearm. A young lady was involved in a road traffic accident that resulted in the fracture of both forearm bones for which she was treated surgically. A nerve conduction study was performed later on, which incidentally demonstrated findings of this communication. Knowledge of this anastomosis can help prevent misdiagnosis of clinical findings and misinterpretation of electrophysiological studies and help mitigate iatrogenic injury during surgical procedures.

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.

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.

Electrodiagnostic description of a rare variant of Berrettini anastomois: A case report.

INTRODUCTION: Berrettini Anastomosis is a common purely sensory anastomosis between ulnar and median nerves in palm. Here, via a communicating branch, ulnar nerve can provide sensory supply to digits 3 and 2.There have been electrodiagnostic (EDX) descriptions of the former. However, till date, to the best of our knowledge, there have been no EDX descriptions of the latter. Here, in our case report we would like to describe first instance of the same. PRESENTATION OF CASE: During an assault with a knife a 25-year-old male sustained laceration injury of right median nerve and flexor tendons which were repaired surgically. During rehabilitation, a nerve conduction study (NCS) was performed which incidentally revealed that ulnar nerve was responsible for sensory innervation of digit 2. DISCUSSION: Until recently, it was generally believed that EDX of BA was not possible. However, recent studies on EDX features in BA, have recorded small sensory nerve action potentials (SNAP) from digit 3 on distal ulnar nerve stimulation. But there are no published reports where SNAP from digit 2 on ulnar nerve stimulation were studied, even though anatomical evidence of the same exists. In our patient, we incidentally recorded the same. CONCLUSION: Although our patient had a complete laceration of median nerve, he did not have major sensory disturbances. NCS findings suggested sensory supply of digits 5, 4, 3 and 2 were by ulnar nerve. Without adequate knowledge of communicating branch crossovers in palm, there is a possibility that clinical findings can be misdiagnosed and NCS features can be misinterpreted. For surgeons, awareness of these communicating branches can prevent iatrogenic injuries during surgical interventions.

Clinical Utility of Blood Pressure Measurement Using the Newer Palpatory Method for Both Systolic and Diastolic Blood Pressure.

BACKGROUND: Blood pressure (BP) measurement being a part of clinical examination gives a fair idea about the hemodynamic status. The auscultatory method is considered as a gold standard, a simple, noninvasive way to measure BP in patients as well as in the healthy controls. The present study was designed to compare systolic BP (SBP) and diastolic BP (DBP) readings using a newer palpatory method with the standard auscultatory method and further assessing the reliability of the newer palpatory method. MATERIALS AND METHODS: A cross-sectional study comprising of a total of 400 (240 males and 160 females) individuals in the age range of 20-60 years were included in this study. BP measurement was done by the standard auscultatory method by one observer. Another observer blinded with BP records of the auscultatory method, measured BP using the newer palpatory method on the same individuals. The two methods were compared for the inter-rater reliability using intraclass correlation (ICC) statistics and agreement between two methods using Bland-Altman analysis. RESULTS: The present study observed excellent reliability of the newer palpatory method with the standard auscultatory method with an ICC value of 0.997 and 0.993 for SBP and DBP, respectively. Bland-Altman plot for both SBP and DBP using the auscultatory and newer palpatory method has shown minimum variability and good reliability when both methods are used by independent observers. CONCLUSIONS: With practice and experience newer palpatory method can be used to assess BP with accuracy.

Perceived stress and generalized anxiety in the Indian population due to lockdown during the COVID-19 pandemic: a cross-sectional study.

Background: Research on the psychosocial toll of the COVID-19 pandemic is being conducted in various countries. This study aimed to examine stress levels and causal stressors for perceived stress and generalized anxiety in the Indian population related to the lockdown during the COVID-19 pandemic. Methods: A total of 300 adults were invited to participate in the online study via snowball and virtual snowball sampling. They were requested to complete electronic survey forms for assessing perceived stress and anxiety, and questions related to psychosocial stressors. Frequency and percentage were used for categorical variables. One-way ANOVA test was applied to compare responses based on gender, level of education, employment, and place of residence. A p-value of <0.05 was considered statistically significant. Result: In total, 257 out of the 300 invited, responded and completed the survey. Men accounted for 58% (n=149) of the respondents. Overall, 84% (n=217) of participants had moderate to severe levels of perceived stress and 88% (n=228) had moderate to severe levels of anxiety. Women, as well as those not employed, reported significantly higher perceived stress and anxiety, urban residents reported higher perceived stress, while level of education had no difference in terms of perceived stress as well as anxiety. Fear of contracting COVID-19 was the highest stressor followed by difficulties in executing a routine exercise schedule and worry about the future. Conclusion: The psychosocial impact of the nationwide lockdown on the Indian population has been high. Vulnerable groups for increased stress and anxiety include women, younger ages, and the unemployed. The stressors recognized include fear of contracting COVID-19, inability to execute a routine exercise schedule and worry about the future.