Noninvasive neuromodulatory effect on cognition in individuals with traumatic brain injury: A single-blinded, two-arm parallel randomized clinical trial.

Objectives: The study aimed to compare the effect of cranial electrical stimulation (CES) and transcranial direct current stimulation (tDCS) in improving cognition among individuals with mild traumatic brain injury. Patients and methods: The pretest-posttest randomized controlled study was conducted between November 2020 and March 2022. Seventy-two patients (64 males, 8 females; mean age: 40.5±9.5 years; range, 18 to 45 years) experiencing cognitive impairment within three months of traumatic brain injury were recruited. Participants were randomly assigned into two groups: Group 1 (CES with cognitive training, n=36) and Group 2 (tDCS with cognitive training, n=36). Participants were blinded in the study. Both groups received 30-min sessions of neuromodulation along with 30 min of cognitive training five days a week for four weeks. The patients were assessed at baseline and at the end of two and four weeks of intervention. The primary outcome measure was the Montreal Cognition Assessment (MoCA), and the secondary outcome measure was the Galveston Orientation Amnesia Test (GOAT). Results: Demographic and baseline characteristics depicted normal distribution for both groups (p>0.05). Within group analyses of both groups demonstrated significant differences for both outcome measures (MoCA: p=0.001; GOAT: p=0.001). Between group analyses of MoCA showed significant improvement with p-value of 0.001 while GOAT exhibited p-value of 0.002 showing significant difference between the two groups. Time group interaction effect and covariance analyses depicted significant improvement with p-value of 0.001 for both outcome measures with excellent effect size >0.80. Conclusion: Cranial electrical stimulation was a more effective noninvasive neuromodulatory device than tDCS in improving cognition among individuals with traumatic brain injury.

Group tele-rehabilitation improves quality of life among subjects with Parkinson's disease: A two arm non-parallel non-randomized clinical trial.

INTRODUCTION: Tele-rehabilitation has lately emerged as a promising medium for increasing patient adherence with significant positive results. One of the most prevalent neurological diseases affecting movement is Parkinson's disease (PD), which causes a variety of motor and non-motor symptoms among patients. Consequentially, the study was designed to compare the efficacy of group tele-rehabilitation with individual tele-rehabilitation in improving quality of life (QoL) among subjects with PD. METHOD: A two-group pretest-posttest, non-randomized clinical study recruited 68 subjects and classified them into two groups, i.e., Group A (group therapy, n = 36) and Group B (individual therapy, n = 32). Groups A and B received a supervised protocol consisting of a 40-min session on alternate days/week for twelve weeks via the WhatsApp Messenger application through group and individual therapy, respectively. The Parkinson's disease questionnaire (PDQ-39), mental and physical components of the Short Form Survey (SF-12) were used as primary outcome variables, while the Satisfaction questionnaire was used as a secondary outcome variable. RESULT: The p-values related to within-group analyses were <0.05 except SF-12 PCS >0.05 in Group A and <0.05 in Group B. While the p-values related to between-group analyses were <0.05 except for pre-scores of SF-12 (MCS and PCS). The effect sizes for PDQ-39, SF-12 (MCS), and SF-12 (PCS) were -2.37, 3.36, and 0.66 in Group A and 1.95, 2.69, and 2.03 in Group B, respectively. CONCLUSION: The study concluded that group tele-rehabilitation is more effective in improving QoL among subjects with PD as compared to individual tele-rehabilitation. Clinical trial Registration NoCTRI/2022/04/041818.

Comparison of diagnostic capability of macular ganglion cell complex vs retinal fiber layer thickness in primary open angle glaucoma patients of Indian origin.

PURPOSE: Comparison of diagnostic capability of macular ganglion cell complex thickness vs. retinal nerve fiber layer (RNFL) thickness in patients of primary open-angle glaucoma (POAG). SETTINGS AND DESIGN: This cross-sectional observational study was carried out between June 2021 and October 2022 at a tertiary care hospital in North India. METHODS: A total of 118 eyes were included in the study with 30 control and the rest 88 eyes with POAG were divided into three groups based on visual field loss Group 1 (30 eyes): early field loss with mean deviation (MD) < -6 dB; Group 2 (30 eyes): moderate field loss with MD -6 to -12 dB; and Group 3 (28 eyes): severe field loss with MD > -12 dB. Optical coherence tomography (OCT) scans to measure RNFL loss and ganglion cell inferior plexiform layer (GCIPL) loss were taken for each patient. STATISTICAL ANALYSIS USED: Categorical variables were analyzed using either the Chi-square test or Fisher's exact test. A receiver operating characteristics analysis was calculated to determine optimal cut-off values of superior, inferior, and average GCIPL and RNFL for determining the severity of field loss as compared to controls (30 normal eyes). RESULTS: In the mild field loss group the sensitivity of superior, inferior, and average GCIPL was 86.7, 96.7, and 96.7%, respectively. Similarly, the specificity was 96.7, 93.3, and 100%, respectively. In the same group, the sensitivity of superior, inferior, and average RNFL was 70, 93, and 66%, respectively. Similarly, the specificity was 46.7, 83.3, and 70%, respectively. In the moderate and severe groups, the results were comparable. CONCLUSION: The sensitivity and specificity of GCIPL loss are significantly better than that of RNFL parameters in the mild field loss group.

The combined effect of neuro-modulation and neuro-stimulation on pain in patients with cervical radiculopathy - a double-blinded, two-arm parallel randomized controlled trial.

INTRODUCTION: Cervical radiculopathy is one of those disabling conditions which results in central and peripheral pain and thus affects the quality of life. Transcutaneous Electrical Nerve Stimulation (TENS) and exercises produce analgesic effect but their long-term effect has not been available to date. Transcranial Direct Current stimulation (tDCS) is known to produce promising effects on central pain by targeting cortical activity. PURPOSE: To determine the combined effect of tDCS and TENS with exercises on pain and quality of life in patients with cervical radiculopathy. METHOD: Forty four patients (male: female = 26:18) of the age group 18-50 years were recruited and randomly allocated into the experimental group and control group. The experimental group received active anodal tDCS for 20 min with an intensity of 2 mA, while the control group received sham anodal tDCS. TENS over the pain distribution area for 20 min with 5 Hz intensity and 80-150 ms pulse duration followed by neck-specific exercises were given in both groups. This protocol was given 5 days a week for 4 weeks. Pre and post-assessments were obtained through outcome measures that the Numeric Pain Rating Scale and Neck Disability Index for the measurement of pain, functional disability, and quality of life. RESULT: Paired t-test/Wilcoxon-Signed Rank test, and Index and Mann-Whitney U test were used to compare the demographic variables within and across the groups, respectively for Neck Disability for Numeric Pain Rating Scale, keeping the P-value < 0.05 as significant. One-way repeated-measures analysis of variance (ANOVA) was applied to determine the between-subject factor differences. Post hoc tests with Bonferroni correction for repeated analyses were performed. Results depicted a significant effect for NDI (P = 0.001 for both groups) and NPRS (P = 0.003 for the experimental group and 0.007 for the control group). Significant Interaction effect (time*group) was observed for NDI (F = 42, 5382.77) and NPRS (F = 42, 1844.57) with a P-value of 0.001 for both outcome measures. Clinical significance was observed for both outcome measures having a mean difference in 50.21 and 4.57 for NDI and NPRS, respectively compared with the established MCID of 13.2 and 2.2 scores for respective outcome measures. CONCLUSION: It was concluded that active tDCS along with TENS and exercise intervention was effective on pain, disability, and quality of life in patients with cervical radiculopathy.

Dietary and Physical Exercise Facilitation for Cardiovascular Health in Indian Subcontinent.

The advent of industrialization and outburst of urbanization significantly influences the lifestyle of people. Further, the incidence of noncommunicable diseases, such as chronic lung conditions, cancer, cardiovascular diseases (including conditions affecting the heart and blood vessels), diabetes, hypertension, and obesity, has increased. The prevalence of cardiovascular diseases in India in 2016 was reported to be 54.5 million. One out of four deaths was associated with cardiovascular diseases. With time, the prevalence of cardiovascular diseases is exerting more impact on the younger Indian population aged 20-29 years. The foremost risk factors for disability-adjusted life-years include poor dietary habits, tobacco use, and low physical activity. A healthy diet and an optimum physical activity level should be projected as primary interventions for noncommunicable diseases in the Indian subcontinent. Government health organizations and associations should concentrate and prioritize the current situation and scale up cost-effective policies and innovative techniques with interventional research and funding, especially on diet and exercise facilitation, as comprehensive management toward minimizing cardiovascular diseases to safeguard Indian economy's future.

Prevent, curtail and mitigate ocular injuries: Proposal for designing an eye injury registry model for the Indian Armed Forces.

This article aims to propose a design for Eye Injury Registry (EIR) model for Indian Armed Forces, to make ophthalmologists and non-ophthalmologists aware about the existence as well as the usefulness of such a registry. This is a perspective study. The EIR model for Armed Forces was designed based on the relevant sources in PubMed, Scopus and Embase including registries of pioneering countries like United States and Canada. A questionnaire based on the model dimensions was developed (Cronbach's alpha>0.7) and filled by 04 senior ophthalmologists in Armed Forces, all of who had a significant experience in dealing with various types of ocular trauma, to give expert opinions, which were then applied to the proposed model to finalize it. In Armed Forces, a registry and reporting on eye injury along with a systematic collection of standard data on eye injuries will help ophthalmologists in the successful prevention. Such a registry and its large database once formed will permit elaborate epidemiologic investigations, highlighting preventable sources of injury, emerging patterns of trauma in our services, and the best possible treatment protocols to be adopted, for successful outcomes. EIR in Armed Forces can help in the collection of eye injury data, thereby improving the quality-of-care and expansion of prevention strategies for ocular injuries. It is a step to make a truly effective data bank, which will be instrumental in combating such preventable ocular injuries and in turn go a very long way in achieving the final goal of preventing up to 90% of such injuries.

Effects of a program consisting of strain/counterstrain technique, phonophoresis, heat therapy, and stretching in patients with temporomandibular joint dysfunction: A pilot study.

BACKGROUND: The present study was conceptualized as a pilot study to examine the effects of a 3-week program consisting of strain/counterstrain technique (SCST), phonophoresis, heat therapy, and stretching exercises on pain and functions in patients with temporomandibular dysfunction (TMD). METHODS: Seven participants (mean age 25.85 years) diagnosed with TMD having pain in the temporomandibular joint (TMJ) area with decreased jaw opening were recruited for the study. Treatment interventions consisting of SCST, phonophoresis (ultrasound gel mixed with diclofenac gel), heat therapy, and stretching (mouth-opening) exercises were performed 3 days a week for 3 weeks. SCST was performed on the masseter, medial, and lateral pterygoid muscles. No control group was present in the study. RESULTS: Paired samples t test revealed a significant difference in numerical pain rating scale (NPRS) (decreased by 50%, P < .001) and jaw functional limitation scale (JFLS) (reduced by 59.58%, P < .001) scores after 3 weeks of intervention. A large effect size (Cohen d = -3.00 for NPRS and -3.16 for JFLS) was observed for both variables. No correlation (R = 0) was found between the baseline values of NPRS and JFLS. CONCLUSION: A 3-week program consisting of SCST, phonophoresis, heat therapy, and stretching exercises was effective in reducing the pain and improving the functions related to TMJ in patients suffering from TMD. However, a randomized controlled trial is needed to reach a definite conclusion.

Association of Physical, Psychological and Psychosocial Attributes With Arterial Stiffness in Cardiovascular Disorders: A Systematic Literature Review.

The prevalence of cardiovascular diseases is increasing exponentially in the industrialized world. According to the World Health Organization, 17.8 million people died in 2019 as a result of cardiovascular diseases (CVD), accounting for 31.0% of all fatalities worldwide. Even though CVD is more common in low and middle-income countries, it is responsible for three-quarters of all cardiovascular-related deaths worldwide. The most common attributes for the occurrence of CVD are the physical, psychological, and psychosocial factors. Arterial stiffness, which is a precursor of CVD, is most commonly affected by said factors and serves as a predictor for CVD diagnosis, treatment, and prevention. The purpose of this article is to learn more about the relationship between arterial stiffness and the physical, psychological, and psychosocial characteristics of cardiovascular diseases. In addition to proposed ways to lower the co-morbidities following CVD. PubMed, Medline, and Web of Science were used for the present review. Only articles published between 1988 and 2022 that discussed physical, psychological, and psychosocial characteristics were considered. A narrative discussion is used to extract and review the information from the selected articles. Several factors related to arterial stiffness and cardiovascular illness have been reviewed, and data has been compiled. This review proposed recommendations and a list of linked factors for prevention and to lower morbidity of cardiovascular illness.

Evaluation of Mental Health and Quality of Life among Indian Professionals Embarked as COVID-19 Survivors.

Background: Government guidelines for lockdown and quarantine measures impacted the daily lives and health of individuals amid the coronavirus disease 2019 (COVID-19) pandemic. The pandemic caused significant changes in the daily routine and lifestyles of individuals worldwide with the simultaneous emergence of mental health disorders. Stress caused by COVID-19 pandemic outbreaks and consequent social isolation significantly influenced the mental health and quality of life of professionals among Indian population. This study aimed to evaluate the mental health and quality of life among Indian professionals embarked as COVID-19 survivors. Methods: A 20-item self-administered questionnaire was developed and circulated among the participants with the following domains: helplessness, apprehension, mood swing, physical activity, restlessness, insomnia, irritation, mental stress, and emotional instability to assess their mental health and quality of life. Results: Of the total 322 participants, 73.6% of individuals experienced helplessness, 56.2% felt the need for counseling, 65.5% reported feeling irritated even over minor issues, 62.1% experienced negative thoughts during isolation, 76.5% experienced difficulty in falling asleep, and 71.9% felt restless during their course of illness. Conclusion: The study concludes that mental health and quality of life among COVID-19 survivors was affected by sleep, physical activities, emotional instability, and job profile, as well as support from others, mood swings, and the need for counseling.

Effectiveness of High Power Laser Therapy on Pain and Isokinetic Peak Torque in Athletes with Proximal Hamstring Tendinopathy: A Randomized Trial.

Athletes such as long-distance runners, sprinters, hockey, and/or football players may have proximal hamstring tendinopathy (PHT). Laser therapy has been shown to be effective in tendinopathies. High power laser therapy (HPLT) is used for the treatment of several musculoskeletal conditions; however, its efficacy on PHT has not been investigated. This study is aimed at examining the effects of HPLT on pain and isokinetic peak torque (IPT) in athletes with PHT. The two-arm comparative pretest-posttest experimental design was used with random allocation of 36 athletes aged 18-35 years into two groups (experimental and conventional group). The experimental group included the application of HPLT for 3 weeks. The conventional group included treatment with a conventional physiotherapy program including ultrasound therapy, moist heat pack, and home exercises for a total of 3 weeks. Pain and IPT of the hamstring muscle were measured before and after the application of the intervention. Pain score decreased, and IPT increased significantly (p < 0.05) after application of HPLT, by 61.26% and 13.18%, respectively. In the conventional group, a significant difference (p < 0.05) was observed in pain scores only, which decreased by 41.14%. No significant difference (p > 0.05) was observed in IPT in the conventional group. When HPLT was compared with conventional physiotherapy, a significant difference was found in pain scores only. HPLT for 3 weeks was found to be effective in improving pain in athletes with PHT. However, no significant difference was found between HPLT and conventional physiotherapy (US, moist heat, and home exercises) in improving the IPT of the hamstring muscle.

Physical Activity for Health and Fitness: Past, Present and Future.

It's a saying "The early we start, the early we attain good health". Health is a state of complete physical, mental and social well-being and not merely absence of disease Fitness is an ability to execute daily functional activities with optimal performance, endurance, and strength to manage minimalist of disease, fatigue, stress and reduced sedentary behavior. In the modern era with advancement in technology, erosion of physical activity has drastically led to retardation in health and fitness. Hoods of luxurious and competition among students for scores/grades and professionals for promotions/incentives/benefits have deviated people from concentrating towards their health and putting it secondary. In 2016, across the globe, prevalence of physical inactivity was estimated at 27.5%, among adult population. To support further, in June 2018, WHO reported, 1 in five adults, and 4 of five adolescents to pose reduced physical activity. In the current ongoing pandemic era this scenario has been further negatively impacting the society to suffer from psychosocial, financial and economic loss, contributing to lack of physical activity. Health benefits of physical activity are not limited only to improved cardiorespiratory and muscular fitness, bone and cardiometabolic health, and positive effects on weight status, but it also boosts mental health and social health. Acknowledging the significance and urgency of decreasing insufficient physical activity globally, WHO endorsed a Global Action Plan on Physical Activity (GAPPA) at the World Health Assembly in 2018, wherein the member countries agreed to reach a new target of 15% relative reduction in insufficient physical activity among adolescents by 2030.

Rotational stability of Toric intraocular lenses.

BACKGROUND: A prospective study to evaluate the rotational stability of toric intraocular lenses (IOLs). METHODS: A prospective study of 30 eyes in 29 patients. All patients with regular astigmatism of range 0.75-4 D were included in the study. Exclusion criteria included irregular corneal astigmatism, post-refractive surgery and corneal dystrophies. All patients underwent uncomplicated phacoemulsification cataract surgery by the same surgeon. Three eyes with corneal astigmatism of 0.75-1.5 D were implanted with the AcrySof SA60T3 IOL, eight eyes with astigmatism between 1.5 and 2.0 D received the SA60T4 IOL and eight eyes with astigmatism between 2.0 and 2.50 D received the SA60T5 and rest with astigmatism of 2.5 D and higher received SA60T6 and above models. Main outcome measure was the post-operative position of the lens, assessed at day 1, 1 week, 1 month and 6 months, using toric marker and the slit lamp. RESULTS: There was no significant rotation of IOL observed during a follow-up period of 6 months. Overall, the post-operative rotation was within 5° in 95% of cases. There was no trend for either clockwise or anti-clockwise rotation. However, IOL rotation happens mostly within the first month of surgery, and if it is significant, it requires early repositioning. CONCLUSION: Toric IOLs are very effective and consistent in correcting astigmatism during the cataract surgery. Once placed to its position, toric IOLs demonstrate rotational stability in the capsular bag.

Risk factors for childhood illness and death in rural Uttar Pradesh, India: perspectives from the community, community health workers and facility staff.

BACKGROUND: Uttar Pradesh (UP), India continues to have a high burden of mortality among young children despite recent improvement. Therefore, it is vital to understand the risk factors associated with under-five (U5) deaths and episodes of severe illness in order to deliver programs targeted at decreasing mortality among U5 children in UP. However, in rural UP, almost every child has one or more commonly described risk factors, such as low socioeconomic status or undernutrition. Determining how risk factors for childhood illness and death are understood by community members, community health workers and facility staff in rural UP is important so that programs can identify the most vulnerable children. METHODS: This qualitative study was completed in three districts of UP that were part of a larger child health program. Twelve semi-structured interviews and 21 focus group discussions with 182 participants were conducted with community members (mothers and heads of households with U5 children), community health workers (CHWs; Accredited Social Health Activists and Auxiliary Nurse Midwives) and facility staff (medical officers and staff nurses). All interactions were recorded, transcribed and translated into English, coded and clustered by theme for analysis. The data presented are thematic areas that emerged around perceived risk factors for childhood illness and death. RESULTS: There were key differences among the three groups regarding the explanatory perspectives for identified risk factors. Some perspectives were completely divergent, such as why the location of the housing was a risk factor, whereas others were convergent, including the impact of seasonality and certain occupational factors. The classic explanatory risk factors for childhood illness and death identified in household surveys were often perceived as key risk factors by facility staff but not community members. However, overlapping views were frequently expressed by two of the groups with the CHWs bridging the perspectives of the community members and facility staff. CONCLUSION: The bridging views of the CHWs can be leveraged to identify and focus their activities on the most vulnerable children in the communities they serve, link them to facilities when they become ill and drive innovations in program delivery throughout the community-facility continuum.

Solitary retinal capillary hemangioma with combined retinal detachment- rare presentation.

Objective. To report a rare presentation of solitary retinal capillary hemangioma manifesting with combined retinal detachment as initial presentation and its successful management. Methods. A 35-year-old healthy Indian male presented with combined retinal detachment associated with solitary retinal capillary hemangioma as initial presentation; a clinical entity still not reported in literature. Patient was managed with pars plana vitrectomy combined with retinectomy, endolaser, & silicon oil tamponade with good visual & anatomical recovery. Results. Patient had good clinical outcome with final best-corrected visual acuity (BCVA) of 6/ 24 and well attached retina at last follow-up. Conclusion. Solitary retinal capillary hemangiomas can rarely present with advanced vitreo-retinal complications like combined retinal detachment as initial manifestation that can be effectively managed with skilled & appropriate surgical intervention.

Wandering Ozurdex in eyes with scleral fixated intraocular lens and its management: A report of two cases.

PURPOSE: To report a complication little reported until now: to and fro migration of the dexamethasone implant between the anterior and posterior segment (wandering Ozurdex) of sclera fixated intraocular lens (IOL) eyes and its effective management. METHODS: Two cases of to and fro migration of Ozurdex (wandering Ozurdex) in two pseudophakic patients with scleral fixated posterior chamber IOL: first, a case of Vogt Koyanagi Harada (VKH) disease and second, a case of pseudophakic cystoids macular edema (CME) were successfully managed. RESULTS: Both patients were initially managed with repositioning of implants by supine posturing and use of drugs, but implants again migrated into anterior chamber and underwent surgical removal with preservation of corneal transparency. CONCLUSIONS: Patients with scleral fixated posterior chamber IOL present a high risk of anterior chamber migration of the Ozurdex implant. Prompt removal of Ozurdex implant in these patients can reduce risk of endothelial decompensation. In such cases, returning the implant with positioning is not a good option.

Pneumatic Displacement of a Dense Sub-inner Limiting Membrane Pre-macular Hemorrhage in Dengue Maculopathy: A Novel Treatment Approach

Sub-inner limiting membrane (ILM) hemorrhage is a rare presenting feature of dengue maculopathy. A 24-year-old man in active military service who was recently treated for dengue hemorrhagic fever presented with sub-ILM bleeding in right eye (dominant eye) with profound diminution of vision. Spectral domain optical coherence tomography and fundus fluorescein angiography confirmed sub-ILM hemorrhage with no evidence of vasculitis/venous occlusion or neovascularization. He refused active surgical management by pars plana vitrectomy and was treated with pneumatic tamponade of C3F8 (100%) gas with prone positioning in order to achieve faster visual recovery. He responded well to treatment with complete visual recovery in 1 week. This case report documents for the first time treatment of sub-ILM hemorrhage in the premacular area with pneumatic tamponade in prone position leading to rapid and complete visual recovery in a patient with dengue maculopathy. This novel approach can be employed for patients who are ineligible for more active surgical management.

Change in subfoveal choroidal thickness in diabetes and in various grades of diabetic retinopathy.

BACKGROUND: To evaluate subfoveal choroidal thickness (SFCT) change in diabetes and in various grades of diabetic retinopathy (DR) in comparison to age-matched healthy subjects. METHODS: This prospective observational study included 100 eyes of diabetic patients without DR (group D), 100 eyes with DR (group R), and 100 eyes of healthy subjects (group N). The assessment included demographics, duration of diabetes, comprehensive ocular examination, fundus photography with/without fundus fluorescein angiography, spectral domain optical coherence tomography with enhanced depth imaging to assess SFCT. RESULTS: The SFCT was comparable between groups N (310.65 ± 37.34 µm) and D (308.48 ± 30.06 µm; P = 0.60), but was significantly lower in R (296.52 ± 21.41 µm; P < 0.01). The SFCT was significantly lower in proliferative DR (n = 36; SFCT = 284.56 ± 21.09 µm) as compared to non-proliferative DR (n = 64; SFCT = 303.25 ± 18.59 µm; P < 0.001). The SFCT had moderately negative correlation with severity of DR (R = - 0.50; P < 0.01). The difference in SFCT when compared with normal subjects was significant only in severe/very severe non-proliferative DR (294.47 ± 15.65 µm; P < 0.01) and in proliferative DR (284.56 ± 21.09 µm; P < 0.01). There was a negative correlation of SFCT with the duration of diabetes (R = - 0.41; P < 0.01). CONCLUSION: SFCT decreases with increasing duration of diabetes. The decrease is significant after the onset of severe DR, and is proportionate to the severity of DR.