Normative data of Ankle brachial pressure Index and Toe brachial index in normal healthy male adult using fully automated vascular Doppler.

Context: Peripheral vascular disease affects some 12%-14% of the general population, and the majority of people with the disease are asymptomatic. Risk factors for it are smoking, diabetes mellitus, hyperlipidemia, hypertension, obesity, and syndrome X. The Ankle Brachial Pressure Index (ABPI) is one of the screening noninvasive methods for the diagnosis of peripheral vascular disease. Assessment is performed by fully automated vascular Doppler, which is considered to be accurate; however, normative data are limited. Aims: To measure the normative data of ABPI and Toe brachial index (TBI) in a healthy adult. Settings and Design: A cross-sectional study done in male (n = 59) volunteers in the age group of 18 to 50 years of age group. Methods and Material: Smartdop XT fully automatic Doppler-14 ports (Hadeco, Japan) was used to measure ABPI and Toe brachial index (TBI). Statistical analysis used: Normative value (Mean, SD, Range) was calculated using Systac 13 software. Results: Right-side Ankle Brachial Pressure Index (ABPI) and left-side ABPI at the posterior tibial artery (PT) were 1.061 ± 0.098, and 1.105 ± 0.139, respectively. Right-side ABPI and left-side ABPI at the dorsal pedis artery were 0.86 ± 0.129 and 0.86 ± 0.115. Right-side toe Brachial Pressure Index (TBPI) and left-side ABPI was 0.85 ± 0.185 and 0.822 ± 0.2, respectively. Conclusions: ABPI index of more than 0.9 may be considered normal in the male population in Bhopal; however, we recommend further Multicentric trials across the Indian population.

Assessment of Pulmonary Functions and Dysfunctions in Type II Diabetes Mellitus: A Comparative Cross-Sectional Study.

Background Diabetes mellitus causes microvascular complications in the eyes and kidneys as well as the nervous system, among other parts of the body. Lungs are a potential target organ for diabetic microvascular complications and remain the least researched among diabetic patients. The aim of this study was to explore whether there is any difference in pulmonary functions in patients with diabetes mellitus compared to those without. Methodology A comparative cross-sectional study was conducted on 50 participants each with and without type II diabetes mellitus. Pulmonary function parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1 as a percentage of FVC in percentage (FEV1%), peak expiratory flow rate in L/second (PEFR), forced expiratory flow rate in L/second in 25% of FVC (FEF25%), forced expiratory flow rate in L/second in 50% of FVC (FEF50%), forced expiratory flow rate in L/second in 75% of FVC (FEF75%), forced expiratory flow rate during 25-75% of expiration (FEF25-75%), and maximal voluntary ventilation (MVV), of both groups were analyzed using the NDD Large True Flow (Easy One) spirometer (NDD Meditechnik AG., Switzerland). A fully automated chemistry analyzer and linear chromatography were used for glycemic control measurements. Results All pulmonary function test parameter values were lower in participants with diabetes mellitus compared to those without, except FEV1% and PEFR, which indicates a mixed pattern of lung dysfunction. FVC had a significant negative correlation with the duration of diabetes (r = -0.299, p = 0.034). Conclusions Type II diabetes mellitus patients had significant dysfunction in pulmonary functions with early involvement of restrictive parameters which can be monitored/diagnosed by regularly following up patients by measuring pulmonary functions, and, hence, can be taken care of.

Assessment of Cardiac Autonomic Function in Women With Polycystic Ovary Syndrome Through Ewing's Battery, Heart Rate Variability Analysis, and Composite Autonomic Symptom Score-31 Scale.

Introduction Polycystic ovary syndrome (PCOS) is a frequently occurring endocrine condition prevalent in women of reproductive age characterized by chronic anovulation, hyperandrogenism, insulin resistance, and a low-grade inflammatory state. Patients with PCOS are more vulnerable to developing cardiac and metabolic co-morbidities. Sympathetic overactivity is also reported in PCOS patients. Objective This study aimed to assess cardiac autonomic function in PCOS by Heart Rate Variability Analysis, Ewing's Test, and Composite Autonomic Symptom Scale-31 (COMPASS-31). Methods Thirty female PCOS patients and 30 age-matched control females were enrolled in the study. Both cases and controls were subdivided into sub-groups based on body mass index (BMI) and waist-to-hip ratio (WHR). The cardiac autonomic functions were assessed by the COMPASS-31 questionnaire, Ewing's battery tests, and short-term heart rate variability analysis. Results There was no significant difference in age, BMI, and WHR of both groups. Additionally, cases had a significantly higher low frequency to high frequency (LF/HF) ratio and COMPASS-31 score and also reported more derangement in Ewing's battery test, indicating cardiac autonomic dysfunction in PCOS patients. Conclusion Patients with PCOS are more prone to developing cardiac and metabolic co-morbidities. Early assessment of cardiac autonomic function can prevent future complications with timely interventions. Altered autonomic function in PCOS patients can be due to hyperandrogenism and insulin resistance.

Impedance cardiography for monitoring changes in cardiac output.

Impedance Cardiography (ICG) is a non invasive method useful for continuous monitoring of cardiac output but, it still has not found wide usage for measuring cardiac output in clinics and research. Most studies focused on comparing the cardiac output measured at rest with reference methods. In the present study we evaluated the validity of ICG against Doppler Echocardiography (DE) in measuring cardiac output changes that occur during static exercise. Cardiac output of 30 healthy males between 18-26 yrs of age was measured during supine rest, during and 5 min after completion of 3 minute static exercise by ICG and DE. The increase in cardiac output during exercise measured with ICG and DE does not differ significantly (1.04 +/- 0.72 L/min and 1.05 +/- 1.24 L/min respectively) and has significantly high correlation (r = 0.76, P < 0.001). The bias and limits of agreement are (-0.01 +/- 0.83) in acceptable limits. The pooled means of cardiac output measured by ICG and DE do not differ significantly and bears a significant correlation (r = 0.812, P < 0.001). The bias (d +/- s) calculated is 0.15 +/- 0.64 L/min. ICG could provide valid information regarding the relative changes in cardiac output.

Patterns and Trajectories of Pulmonary Function in Coronavirus Disease 2019 Survivors: An Exploratory Study Conducted in Central India.

BACKGROUND: The ongoing pandemic of coronavirus disease 2019 (COVID-19) has negatively impacted respiratory health worldwide. The severity of the disease varies considerably, and patients may present with bronchitis, pneumonia, and acute respiratory distress syndrome. This study aims to quantify the parameters of the pulmonary function test (PFT) with regard to the severity of COVID-19 and understand the pattern of PFT in reference to the status of selected morbidities and body mass index. MATERIALS AND METHODS: This is a hospital-based, comparative, cross-sectional study. A total of 255 COVID-19 survivors underwent clinical assessment, a PFT, and a 6-minute walk test. Participants were divided into mild, moderate, and severe disease groups. The parameters were compared between these groups. The PFT and 6-minute walk tests were conducted using an NDD Digital computerized spirometer (NDD Meditechnik AG., Switzerland) and a fingertip pulse oximeter (Hasely Inc., India), respectively. RESULTS: All PFT parameters showed significant differential distribution among the severity groups (p<0.001) except for forced expiratory volume in 1 s/ forced vital capacity (FEV1/FVC) and forced expiratory flow (FEF) during 25%-75% expiration and peak expiratory flow (PEF). Among severe category participants forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC, were significantly reduced as compared to mild and moderate. Severity was significantly affected by age >50 years. Severe category participants were seen in 31% of normal, 58% of pre-obese, and 53% of obese participants; however, this difference was insignificant. A significant reduction in SPO2 on the 6-minute walk test was observed in severely sick participants. CONCLUSIONS: COVID-19 is associated with a mixed pattern of spirometry. Poor prognosis is associated with older age, obesity, and multimorbidity.

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.

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.

Neurophysiological parameters of sensory perception and cognition among different modalities of learners.

INTRODUCTION: Different types of learners based on sensory modalities are observed. Cognition or physiological alterations in the sensory pathways might play its role in different modalities of visual, auditory, read and write, and kinesthetic learners which are based on different sensory modalities of perception. OBJECTIVE: The objective of this study is to ascertain an objective parameter (neurophysiological parameters) for the classification of learners based on their preferred sensory modality. MATERIALS AND METHODS: An experimental cross-sectional study was conducted among 100 medical students. Learners were classified into visual, auditory, read-write, and kinesthetic learners based on the interpretation drawn on the basis of the VARK questionnaire. Sensory-evoked potentials (SEPs), including pattern shift visual (PSVEPs), brain stem auditory (BAEPs), short-latency somatosensory (SSEP), and event-related potentials (P300) were measured. SEPs measured in microvolts were recorded from the scalp with the help of active and reference electrodes. Multiple responses to sensory stimuli (using NIHON KOHDEN Corporation Neuropack X1, Tokyo, Japan) were recored and averaged using the computerized signal averging technique. RESULTS: No statistically significant difference was observed in conduction velocities (in terms of latency and amplitude) of SEP among different type of learners, except latency N145 wave form in VEP (P < 0.05). A characteristic pattern of minimal comparative latency was observed among the majority of visual learners. Similary, P300 has shown a characteristic pattern of decreased comparative latency among majority of read and write learners. CONCLUSION: Study findings suggested that among existing teaching and learning modalities, visual modalities were observed faster but to retain it in memory and for abstract thinking, students should utilize read and writing skills which are lacking in the era of digitalization and overuse of electronic devices.

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.

Learning styles among first professional northern and central India medical students during digitization.

BACKGROUND: Learning style is an individual's natural or habitual pattern of acquiring and processing information in learning situations. Different sensory modalities are used by different types of medical students for assimilating the knowledge and information. Currently, the usage of electronic tools for teaching is widespread that can influence learning styles. METHODS: The purpose of this study was to know the pattern of learners among first- and second-year medical students from different institutions in India. For this purpose, we have used latest English Version 7.0 of the Visual-Aural-Read/write-Kinesthetic. RESULTS: Analysis was carried out using the IBM SPSS Version 21 software. Numerical variables were summarized by mean and SD or median and IQR as appropriate. Differences in scores among Visual-Aural-Read/write-Kinesthetic-learning styles were tested by Friedman's test with post hoc pair wise comparison. Pattern of learning styles was different, and it was statistically significant (P<0.001). In this study, aural (median score 6) and kinesthetic (median score 6) styles were preferred. Pair-wise comparisons revealed that each style was different from each other except kinesthetic and aural. CONCLUSION: Results of the study suggest that to improve learning, one should try to use multimodal styles with special emphasis given to auditory and kinesthetic modes especially among first professionals in medical education during digitization.

Age Related Changes in Autonomic Functions.

INTRODUCTION: Autonomic Nervous System (ANS) imbalance may trigger or enhance pathology in different organ systems that varies in different age groups hence objective of present study was to evaluate association of different Age-groups with autonomic functions. MATERIALS AND METHODS: A cross-sectional study was conducted in 62 healthy volunteers in Department of Physiology LLRM Medical College Meerut, India. Volunteers were divided into three groups as younger (15-45 years), middle (45-60) and elder age (above 60), Autonomic functions were tested in three domains viz. Cardio-vagal, adrenergic and sudomotor functions. Numerical data was summarized as mean and standard deviation and categorical data as count and percentage. ANOVA and Chi-square test were used to find difference among groups, p<0.05 was considered statistically significant. RESULTS: Mean ± standard deviation OHT(Orthostatic Hypotension Test) among of younger, middle and elder age groups were 8.80±2.28, 13.40±4.64 and 21.82±6.04 respectively which represent decrease in sympathetic functions with age (p<0.001). Cardio-vagal or parasympathetic responses indicated by DBT (Deep Breathing Test) Valsalva and 30:15 ratio of HR response to standing tests has shown statistically significant (p<0.001) decrease in mean response with increasing age. Sudomotor response appeared normal in younger and middle group but was interrupted in more than half of elderly people (p<0.001). CONCLUSION: Sympathetic responses & para-sympathetic responses have shown the significant decline with increasing age group. Sudomotor responses were partially interrupted in elderly age group.

Migraine: is it related to hormonal disturbances or stress?

BACKGROUND: Common neurological syndrome (migraine without aura) is more common among women than men. Migraine is among the top 20 causes of disability. Menstruation is known to be a powerful trigger for migraine, and so is stress, but the presentation of headache is similar in both. Also, women are more vulnerable to stress as well as migraine, and this makes a complex relationship of menstruation, stress, and migraine. OBJECTIVE: This study was done to understand the association of hormonal fluctuation in menstruation and stress with common migraine. MATERIALS AND METHODS: A cross-sectional comparative study was conducted in 40 young adult females, of whom 20 participants were cases of migraine without aura (18-35 years old), and the remaining 20 participants were age-matched controls. The study was done in Maulana Azad Medical College, New Delhi. Study participants were selected on the basis of International Headache Society (ICHD-IIA1.1) (2004) classification. Study participants with neurological disorders, chronic diseases, and disease suggestive of any hormonal disturbances were excluded. Clinically diagnosed migraine cases were asked to maintain a headache diary and to fill in the Depression Anxiety Stress Scales questionnaire. Biochemical assessment of hormonal status for thyroid-stimulating hormone, triiodothyronine, thyroxine, estrogen, follicle-stimulating hormone, luteinizing hormone, and prolactin was also done on the second day of their menstrual cycle. We used the Mann-Whitney U test to compare hormonal levels and the χ (2) test to compare anxiety- or depression-related stress among the migraine and nonmigraine groups. RESULTS: Significantly higher values of prolactin were observed in cases (mean ± standard deviation, 152.7 mIU/L±30.5) compared to controls (76.1 mIU/L±8.7), with a P-value <0.001. There was no statistically significant difference observed in levels of thyroid-stimulating hormone (P=0.081), estrogen (P=0.086), luteinizing hormone (P=0.091), or follicle-stimulating hormone (P=0.478). Also, anxiety with stress or depression with stress was significantly higher among the migraine group than the controls (P=0.002). Odds of any stress in migraine were higher in the migraine group than in the nonmigraine group (odds ratio 12, 95% confidence interval 2.7-53.33). CONCLUSION: Migraine, particularly without aura, in women is mainly associated with stress-related anxiety or depression, and are more susceptible to stress in the premenstrual period.