Addressing Challenges in Insulin Storage: An Ethical Dilemma among Physicians.

Background and Aims: Insulin is a temperature-sensitive protein; hence, its potency is highly dependent on appropriate storage. Ideally, insulin should be stored in the refrigerator, but when in use it can be stored at room temperature for up to four weeks. However, room temperatures vary widely across regions and countries, and all rural areas of developing countries like India are not electrified. This study explored physicians' perception of alternative methods for appropriate storage of insulin, such as indigenous storage methods like clay pots. Methods: A Study was conducted among 188 Indian physicians attending a diabetes conference in December 2018 to evaluate the feasibility of indigenous storage methods. Results: It was observed that although the use of alternate indigenous methods like clay pots was recommended by them, the proportion was low. The awareness of literature on these methods for insulin storage validation was also less than 50%. Owing to the lack of validation studies on indigenous methods, nearly 80% of the physicians felt that they were not confident to recommend them. Besides, the study results highlighted the necessity of conducting an adequate number of validation studies on indigenous methods in the Indian setting, considering their scarcity. Conclusion: This is the first time we highlight ethical dilemmas through a study among physicians when they advise non-refrigerator methods for insulin storage, in the event of a lack of electricity supply. It is hoped that results from these studies would highlight ethical dilemmas among physicians and would motivate researchers in this field to conduct studies to validate alternative methods of insulin storage.

Autonomic Function Tests, Heart Rate Variability, and Electrophysiological Evaluation in Patients With a Primary Episodic Headache: An Observational Study.

PURPOSE: Cranial autonomic symptoms are typically associated with the trigeminal autonomic cephalalgias and also present in substantial cases of migraine. Autonomic nervous system dysfunctions are also been reported in headache disorders and postulated to promote headache attacks. This study was aimed to evaluate the parasympathetic and sympathetic autonomic functions tests in patients with a episodic primary headache and to investigate, if any, electrophysiological abnormalities in the blink reflex test and sympathetic skin response test in these patients. METHODS: In this cross-sectional study, a total of 100 patients, 50 patients each of migraine and tension-type headache attending the neurology OPD and fulfilling the diagnostic criteria of headache disorders were enrolled. Autonomic functions tests were performed in the Department of Physiology, whereas electrophysiological tests were powered by the Editorial Manager and ProduXion Manager from Aries Systems Corporation performed in the Department of Neurology. RESULTS: Significant association ( P < 0.05) was observed in "blood pressure response to sustained handgrip" (sympathetic activity) and "heart rate response to Valsalva maneuver" (parasympathetic activity) among patients with migraine. Although the mean sympathetic skin response latency of patients with migraine was within the normal range, it was significantly prolonged in comparison with the control group. "Blood pressure response to sustained handgrip" and "heart rate variability" were found to be significantly ( P < 0.05) different in patients with a tension-type headache. The blink reflex test was observed to be normal in all patients with a headache. Patients with migraine showed a significant dysautonomia in category three of the Ewing battery for autonomic functional disability. CONCLUSIONS: Autonomic functional abnormality, both sympathetic and parasympathetic, does exist in patients with a primary episodic headache.

Heart rate recovery in normal and obese males with and without parental history of cardiovascular disease.

BACKGROUND: Parental history of cardiovascular disease (CVD) and obesity is associated with delayed parasympathetic nervous system reactivation after exercise. Heart rate recovery (HRRe) after a minute of exercise is inversely related to cardiovascular events. AIM: To determine the effect of body mass index (BMI) and parental CVD history on HRRe in apparently healthy young Indian males. METHOD: The present cross-sectional experimental study involved 100 males, aged18-25 years. Subjects were divided into two equal groups based on the parental CVD history-(i) Parental CVD history present, and (ii) Parental CVD history absent. Each of these groups were further divided into two equal sub groups based on BMI-(a) BMI <23kg/m2, and (b) BMI ≥25 kg/m2. Participants exercised on the treadmill at variable speeds and grades to achieve their target HR (THR). THR was calculated by adding 60-90% HR-reserve (HRR) in their basal HR (BHR). HRR was calculated by subtracting maximal HR (MHR) from BHR. MHR was estimated by the formula: 208-0.7 × age. The HRRe was calculated by subtracting the immediate postexercise HR with the HR after a minute of rest postexercise. ANOVA with post-hoc Tukey was applied and a P value ≤0.05 was considered as statistically significant. RESULTS: HRRe value was significantly lesser in subjects having a positive parental history of CVD than the subjects with no parental history of CVD, irrespective of BMI. Also, HRRe was inversely related to BMI. CONCLUSION: Not only obesity but also a family history of CVD impacts the recovery of HR after vigorous-intensity exercise.