Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus.

Introduction: Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile. Materials and Methods: The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT. Results: The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation. Conclusion: The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.

Impact of COVID-19 on thyroid gland functions with reference to Graves' disease: A systematic review.

Coronavirus disease 2019 (COVID-19) is caused due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Both immediate and long-term adverse effects arise out of this disease's aftermath. It involves various organs, which include endocrine glands, nervous system, musculoskeletal system, and other organs. The long-term outcomes of the SARS-CoV-2 infection are influenced by preexisting comorbidities. Genetic, environmental, and immunological factors contribute to the development of various autoimmune diseases, which include Graves' disease (GD). The growing mystery surrounding this virus is exacerbated by auto-inflammatory diseases, such as pediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), which raises concerns about the nature of the virus' connection to the autoimmune and auto-inflammatory sequelae. There is a need to understand the underlying mechanisms of developing GD in post-COVID-19 patients. There are limited data regarding the pathogenesis involved in post-COVID-19 GD. Our goal was to understand the various mechanisms involved in post-COVID-19 GD among patients with confirmed COVID-19 infection. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for 2020, a literature search of medical databases (PubMed, Cochrane Central Register of Controlled Trials, and Scopus) from February 2021 to February 2022 was performed by five authors. The keywords used were "Post COVID-19," "Grave's disease," "Cytokine storm," "Autoimmunity," and "Molecular mimicry." This review revealed three underlying mechanisms that resulted in post-COVID GD, which included cytokine storm, molecular mimicry, ACE2 receptor concentration, and cell-mediated immunity. The full spectrum of the effects of COVID-19 needs to be researched.

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.

Transition From Observational to Collaborative Learning to Augment Practical Skill Training in First-Year Medical Students.

Introduction Students exhibit less interest in hematology demonstration experiments as they are not expected to do it during their examination. Adopting a different strategy, like collaborative learning, might spark interest, motivate them to work together towards a shared objective, and help further learning and understanding. The current study aimed to assess the effectiveness of collaborative learning in comparison with traditional practical demonstration. Methodology First MBBS students were divided into two groups of 50 each (1 - collaborative learning, 2 - traditional demonstration). In the traditional demonstration, the experiment was demonstrated by faculty using the required materials. In the collaborative learning method, 50 students were divided into groups (seven of seven each) and each group was provided with procedural details of the experiment and requisite materials. At the end of the experiment, assessment was done. In collaborative learning groups, the team cohesion scale (TCS) was employed to analyze group dynamics. Students' perceptions, and feedback regarding collaborative learning as a tool in practical experiments were collected using a five-point Likert scale. Results Post-experiment assessment scores in collaborative learning (8.65±1.54) were significantly higher than the traditional demonstration group (7.06±1.46). High scorers in TCS consistently belonged to groups that completed the experiment on time (positive outcome), whereas students with low scores often belonged to groups that did not complete the experiment (negative outcome). Conclusion Collaborative learning may be used for practical teaching in medical education as it fosters good communication, enables problem-solving, aiding the Indian medical graduate in fulfilling the role of a team member.

Contributory Parenting: A "Priceless Shift" from Indirect to Direct Parenting.

Parenting is a valuable investment that determines the quality of future independent life. From an evolutionary aspect, it has been well ingrained in the minds of humans as to how much resource each parent should contribute to this energy and time-consuming task. To encourage father's contribution towards parenting and reduce the stress on mother, the concept of paid paternal leave has been implemented. Mere presence of the father in terms of the quantity of time spent without much qualitative value has no benefit, but the assumption that fathers are less competent based on their lower performance might also not be acceptable. An intriguing finding has demonstrated that prolonged contact with the infant triggers a change in previously absent male parenting behavior. With incentives on one hand and associated societal stigma on the other hand, it is to be analyzed whether the purpose of true parenting by fathers is being achieved. Hence, in the concept of contributory parenting it is necessary to recognize and respect each parenting style with the ultimate benefit being passed on to the child.

Impact of Air Conditioners on Sick Building Syndrome, Sickness Absenteeism, and Lung Functions.

Introduction: Modernization has led to greater usage of Air Conditioners (ACs) in our daily lives. It is observed that the occupants of office buildings with ACs consistently report on average more symptoms than do occupants of office buildings with natural ventilation referred to as Sick Building Syndrome (SBS). The appearance of symptoms reduces work efficiency and increases absenteeism due to sickness (sickness absenteeism). Therefore, the present study was planned to evaluate the impact of usage of ACs on SBS and to find out the association of ACs with sickness absenteeism and lung function tests. Materials and Methods: This study was conducted on 200 healthy non-smoker adults in the age group of 18 to 45 years who were using ACs for at least 6 to 8 h/day for more than 2 years (group I). And 200 healthy adults, age and gender-matched, with the same work pattern, not using ACs at all served as controls (group II). The basic information on the usage of ACs and the prevalence of discomfort related to neural symptoms, respiratory symptoms, and skin and mucous membrane related to SBS was obtained through a questionnaire. Results: The building-related symptoms in group I males were more compared to group II males and significantly higher in group I males compared to females. We observed that the appearance of symptoms of SBS led to sickness absenteeism among group I participants. Lung function tests especially FVC, FEV1, PEFR, and MVV were significantly reduced among group I males and females compared to group II males and females. Conclusion: ACs have a profound effect on the quality of the air we breathe and on human health than just lowering the temperature. There is a higher prevalence of SBS-Respiratory and allergic symptoms in AC users.

Implications of lifestyle medicine in medical practice.

Globally, we are seeing a rise in non-communicable diseases such as obesity, hypertension, diabetes, metabolic syndrome, chronic respiratory diseases, cancer, etc., due to stressful lifestyle in this competitive world. Most of the non-communicable diseases are associated with lifestyle behavior. Presently, the role of lifestyle medicine is very critical and important in the management of chronic lifestyle-associated disorders. Considering the above facts, we decided to review the literature to gain a deeper insight into the implications of lifestyle medicine in medical practice. A literature search was conducted on PubMed, Scopus and Google Scholar databases. We observed that lifestyle medicine intervention is a growing and newer discipline and is being employed along with conventional management of non-communicable diseases by medical practitioners today, as they are strongly associated with lifestyle behaviors and practices. Motivation for change in lifestyle is challenging because it depends on the patient's determination and eagerness to adapt and accommodate to the newer lifestyle pattern. The medical practitioners should spend time in coaching patients on lifestyle-related health education. Guidance and coaching by medical practitioners will help patients adapt to practices of maintaining regular physical activity, a balanced diet, good sleep hygiene, and avoid addictions of tobacco and alcohol as part of life. Introducing real and progressive evidence-based behavioral changes to reduce the risks of lifestyle-related acute and chronic diseases in medical practice will reduce the burden of non-communicable disease.

Comprehensive, continuous, and compulsory monitoring of frailty in elderly.

Background: The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression. Objectives: To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool. Materials and Methods: In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared. Results: Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively. Conclusion: Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.

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.

Brain-Derived Neurotrophic Factor-Mediated Cognitive Impairment in Hypothyroidism.

Brain-derived neurotrophic factor (BDNF), which is expressed at high levels in the limbic system, has been shown to regulate learning, memory and cognition. Thyroid hormone is crucial for brain development. Hypothyroidism is a clinical condition in which thyroid hormones are reduced and it affects the growth and development of the brain in neonates and progresses to cognitive impairment in adults. The exact mechanism of how reduced thyroid hormones impairs cognition and memory is not well understood. This review explores the possible role of BDNF-mediated cognitive impairment in hypothyroid patients.

Face Mask in COVID-19 and Its Association With Dry Eye Disease: A Cross-Sectional Study.

AIM: To determine whether wearing a face mask for more than three to six hours/day leads to the new onset of symptoms or worsening of pre-existing dry eye disease (DED) in healthcare workers (HCWs) of our institute. METHODOLOGY: An observational cross-sectional study, where 114 HCWs using face masks regularly participated voluntarily in the study. A survey with a modified Ocular Surface Disease Index (OSDI) questionnaire was completed by participants. They were divided into groups based on their sex, age, how long they had been wearing face masks, and whether they had a history of DED. RESULTS: We found that for HCWs who had previously experienced DED and who were under the age of 40, wearing a face mask for more than three to six hours/day could contribute to or worsen symptoms of DED. Also, we observed that the N-95 mask has a higher chance of causing DED than surgical masks. CONCLUSION: Medical professionals need to be aware of any potential dry eye symptoms related to the prolonged use of a face mask. Additional consideration should be given to patients who already have DED. The possible concerns that incorrectly fitted facemasks may cause to the health of their ocular surface should be discussed with patients by ophthalmologists. Future research involving larger populations will shed light on the prevalence and scope of the mask-associated dry eye problem.