Does Lake Louise questionnaire interpret high-altitude headache as acute mountain sickness? Experience in the western Himalayas.

BACKGROUND OBJECTIVES: High-altitude headache (HAH) and headache in acute mountain sickness (AMS) are common among lowlanders ascending to the high altitude and are often confused with one another. A pilot study was undertaken to analyze HAH and AMS cases in Indian lowlanders ascending to Leh city (3500 m) in western Himalayas. METHODS: A total number of 1228 Indian lowlanders, who ascended (fresh and re-inductees) by air and acclimatized, participated in this pilot study. The intensity of headache was assessed by the Visual Analogue Score. The parameters of HAH as per the International Classification of Headache Disorders-3 and 2018 Revised Lake Louise Questionnaire (LLQ) were used to differentiate HAH and AMS. RESULTS: Out of 1228 cases, 78 (6.4%) cases had headache, of which 24 (1.95%) cases were HAH only, 40 (3.25%) cases AMS only and 14 (1.14%) cases were defined as both HAH and AMS. There was a significant difference in heart rate [F (2,51) = (4.756), P =0.01] between these groups. It also showed a difference in the correlation between the parameters within the groups. The Odd's Ratio of AMS in fresh and re-inductees was found to be 4.5 and for HAH it was 4.33. INTERPRETATION CONCLUSIONS: The findings of this study suggest that LLQ has a tendency of overestimating AMS by including HAH cases. Furthermore differential parameters exhibit differences when AMS and HAH are considered separately. Re-inductees showed a lower incidence of HAH and AMS.

Body fat content correlates with maximum aerobic capacity in healthy sedentary Indian males.

Background: Obesity is a multifactorial public health problem with varying effects on physical fitness determined by maximum aerobic capacity or VO2max. The relationship between body fat content and VO2max has shown varying results. The present study was planned as an experimental study to evaluate the relationship between body fat content and maximum aerobic capacity. Methods: 104 healthy Indian males [Age: 21 (4.87)years; Height: 171.4 (6.14)cm; Weight: 64.1 (8.57)kg] were evaluated for body fat content using body mass index (BMI), bioimpedance, skinfold thickness (SFT), body girth (BG) measurements, waist circumference (WC), and waist-hip ratio (WHR). Maximum aerobic capacity or VO2max for all subjects was determined indirectly from maximum heart rate achieved using an incremental treadmill protocol using Astrand and Astrand nomogram. Results: VO2max, when expressed in L/min, showed a statistically significant positive correlation with body fat irrespective of the method of estimation. VO2max, when expressed in ml/kg/min, showed negative correlation with five of the seven clinical parameters of fat estimation. Of these, a statistically significant negative correlation was seen with SFT. Conclusion: VO2max (L/min) shows a significant positive correlation with all methods of body fat estimation. VO2max (ml/kg/min) shows a significant negative correlation with skinfold thickness. Monitoring of body fat content using skinfold thickness could be studied further for its use in the early identification of young, healthy adult Indian males with low aerobic fitness.

Relationship between aerobic fitness and lower limb skin temperature during cycling exercise testing among well-trained athletes and nonathletes: a cross-sectional study.

Background: During prolonged physical exercise, the skin plays an important role in thermoregulation by dissipating heat to maintain core temperature. Moreover, thermal variation may be influenced by the physical fitness level of an individual. The aim of the present study was to determine the relationship between aerobic fitness and lower limb skin temperature during graded cycling exercise testing in well-trained athletes and nonathletes. Methods: Twelve trained athletes (mean ± SD maximal oxygen consumption [VO2max], 52.44 ± 4.5 ml/kg/min) and 12 nonathletes (VO2max, 36.95 ± 4.9 ml/kg/min) participated in this study. The regional skin temperature over the lower limbs was monitored continuously during incremental exercise testing using a thermal camera, and cardio-respiratory parameters were assessed and recorded using a metabolic analyzer (K5, COSMED, Rome, Italy). Results: The mean skin temperature of athletes at a high intensity of exercise was 27.23 ± 0.3 °C while that of nonathletes was 29.03 ± 0.44 °C, a difference that was statistically significant (p < 0.05). A negative correlation was observed between skin temperature and cardiovascular parameters (VO2max and heart rate) in athletes, while no such correlation was found among nonathletes. Conclusion: The present study demonstrated a negative correlation between oxygen consumption and lower limb skin temperature in athletes, while the correlation was poor in nonathletes. This suggests that physical fitness level may influence the pattern of alterations in lower limb skin temperature, which supports the hypothesis that athletes exhibit better heat dissipation mechanisms than nonathletes.

Item analysis of multiple choice questions: A quality assurance test for an assessment tool.

BACKGROUND: The item analysis of multiple choice questions (MCQs) is an essential tool that can provide input on validity and reliability of items. It helps to identify items which can be revised or discarded, thus building a quality MCQ bank. METHODS: The study focussed on item analysis of 90 MCQs of three tests conducted for 150 first year Bachelor of Medicine and Bachelor of Surgery (MBBS) physiology students. The item analysis explored the difficulty index (DIF I) and discrimination index (DI) with distractor effectiveness (DE). Statistical analysis was performed by using MS Excel 2010 and SPSS, version 20.0. RESULTS: Of total 90 MCQs, the majority, that is, 74 (82%) MCQs had a good/acceptable level of difficulty with a mean DIF I of 55.32 ± 7.4 (mean ± SD), whereas seven (8%) were too difficult and nine (10%) were too easy. A total of 72 (80%) items had an excellent to acceptable DI and 18 (20%) had a poor DI with an overall mean DI of 0.31 ± 0.12. There was significant weak correlation between DIF I and DI (r = 0.140, p < .0001). The mean DE was 32.35 ± 31.3 with 73% functional distractors in all. The reliability measure of test items by Cronbach alpha was 0.85 and Kuder-Richardson Formula 20 was 0.71, which is good. The standard error of measurement was 1.22. CONCLUSION: Our study helped teachers identify good and ideal MCQs which can be part of the question bank for future and those MCQs which needed revision. We recommend that item analysis must be performed for all MCQ-based assessments to determine validity and reliability of the assessment.

Is it time to revise the acclimatization schedule at high altitude? Evidence from a field trial in Western Himalayas.

BACKGROUND: In Western Himalayas, Indian Army soldiers take 11 days (6 days of acclimatization and 5 days of travel) on a sea-level to high altitude road (SH road) to reach a high altitude location (HAL) situated at an altitude of 11,500 feet from sea-level location (SLL) at an altitude of 1150 feet while following acclimatization schedule (AS). AS has an extra safety margin over the conventional 'mountaineering thumb rule' of not exceeding 500 m sleeping altitude above 3000 m altitude. We carried out this randomised field trial to study the feasibility of moving large number of troops rapidly from SLL to HAL on SH road in western Himalayas in 4 days under pharmaco-prophylaxis. METHODS: Based on the pharmaco-prophylaxis, at SLL 508 healthy lowland soldiers were divided into two groups: 'A' (n = 256) with Acetazolamide + Dexamethasone and 'B' (n = 252) with Acetazolamide + Placebo. They travelled rapidly by road to HAL in 4 days and prevalence of acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) during the ascent was measured. RESULTS: Prevalence of AMS was found to be 1.56% and 1.59% in group 'A' and group 'B' respectively during the ascent with no cases of HAPE and HACE. CONCLUSION: At least on SH road, troops can be inducted rapidly to HAL from SLL in 4 days under pharmaco-prophylaxis with Acetazolamide with minimal occurrence of acute high altitude illnesses.

Blood lactate changes in professional Indian divers under hyperbaric conditions.

BACKGROUND: Hyperoxia due to hyperbaric conditions influences lactate metabolism. Previous studies on lactate levels in hyperbaric conditions have reported varied results depending on the depth of evaluation and breathing gas mixture used. METHODS: This study compared post-exercise blood lactate levels of Indian professional male divers (breathing ambient air under normobaric conditions) with their post-exercise blood lactate levels measured under simulated hyperbaric conditions. RESULT: In the present study, blood lactate levels in divers were found to have decreased significantly during recovery phase of exercise in hyperbaric conditions of dry diving at 2.8 Atmospheres Absolute (ATA) as compared to normobaric conditions. A significant improvement was observed in physical performance in terms of HR max and duration of exercise. CONCLUSION: This study revealed that hyperoxia due to moderate hyperbaric condition leads to improvement in lactate metabolism in muscles and organs (liver and heart) for its removal.

Is concurrent prophylactic use of acetazolamide and dexamethasone superior to acetazolamide alone in un-acclimatized lowlanders on ascent to high altitude?

This pilot study was undertaken in lowlanders, during their ascent from 2600 m to 3500 m, to evaluate the effects of Acetazolamide and Dexamethasone on Cardio-Respiratory parameters and Exercise Capacity. 40 unacclimatised low-landers were divided into 2 groups. Subjects of Group 'A' were given Acetazolamide and Dexamethasone and those of Group 'B' were given Acetazolamide and placebo. 8 subjects matched for age, physical fitness, height and weight were randomly selected from each study group and were evaluated for their Exercise Capacities. Both study groups showed significant rise in Heart Rate, Respiratory Rate and a significant fall in Systolic Blood Pressure. There was no difference in Exercise capacities achieved by subjects of two groups at 3500 m.

Ibuprofen Compared to Acetazolamide for the Prevention of Acute Mountain Sickness: A Randomized Placebo-Controlled Trial.

INTRODUCTION: Acetazolamide is recommended for the prevention of acute mountain sickness (AMS); however, its use is limited in some areas because of side effects. Previous studies report ibuprofen to be similar to or slightly inferior to acetazolamide. This randomized, triple-blinded, parallel-group, placebo-controlled trial was designed to compare ibuprofen with acetazolamide for the prevention of AMS. METHODS: Four hundred forty-three healthy Asian Indian men with a mean age of 29 (range: 20-49) years were randomized into three groups A, B, and P at 350m (SL). Acetazolamide (A): 85 mg; ibuprofen (B): 600 mg; or placebo (P): calcium carbonate was administered thrice daily, starting one day prior and continuing for three days after arrival at 3500m (HA). Participants were evaluated for AMS using the Lake Louise Questionnaire and for pulse, BP, SpO2, and respiratory rate twice daily for the first two days during rest and once a day for days three to six at HA. RESULTS: Of the 443 participants recruited at SL, 139 could not be airlifted due to logistical limitations, and 304 were available for follow-up at HA. Among these, 254 had ascended as per protocol. By intent to treat (IT) (N = 304; A = 99, B = 102, P = 103), the incidence of AMS (LLQS>/=3) was 12%, 5%, and 13%, and the incidence of severe AMS was 1%, 2%, and 6%, in groups A, B, and P, respectively. Using per protocol analysis (PP) (N = 254; A = 83, B = 87, P = 84), the incidence of AMS was 12%, 6%, and 13% in groups A, B, and P, respectively. The relative risk for developing AMS vs. placebo was A-0.96 (CI:0.46-2.0, p=0.91), B-0.39 (CI:0.14-1.04, p=0.06), A-0.94 (CI:0.42-2.1, p=0.88), and B-0.45 (0.16-1.24, p=0.12) by IT and PP, respectively. CONCLUSION: Ibuprofen is effective in males for the prevention of AMS with rapid ascent to 3500 m-rest for the first two days. Acetazolamide was superior to ibuprofen in the prevention of moderate-to-severe AMS.

Computational evaluation of transport parameters and logic circuit designing of L-Lysine amino acid stringed to Au, Ag, Cu, Pt, and Pd electrodes.

The integrants of proteins, i.e., amino acids, have grossed exceptional recognition for their applications towards designing imminent switching devices. Among 20 amino acids, L-Lysine (i.e., positively charged) has the highest number of CH2 chains, and such chains affect the rectification ratio in several biomolecules. Towards molecular rectification, we investigate the transport parameters of L-Lysine in conjunction with five different coinage metal electrodes, i.e., Au, Ag, Cu, Pt and Pd to form five distinct devices. We deputize the NEGF-DFT formulism for computing conductance, frontier molecular orbitals, current-voltage, and molecular projected self-Hamiltonian calculations using a self-consistent function. We focus on the most widely used electron exchange correlation combination, i.e., the PBE version of GGA with DZDP basis set. The molecular devices under inquisition exhibit phenomenal rectification ratios (RR) in conjunction with negative differential resistance (NDR) regimes. The nominated molecular device offers a substantial rectification ratio of 45.6 with platinum electrodes and a prominent peak to valley current ratio of 1.78 with copper electrodes. We deduce from these findings that L-Lysine based molecular devices would implicit in future bio-nanoelectronic devices. The OR and AND logic gates are also proposed hinged on highest rectification ratio of L-Lysine-based devices.

Molecular electronics behaviour of L-aspartic acid using symmetrical metal electrodes.

Protein-based electronics is one of the growing areas of bio-nanoelectronics, where novel electronic devices possessing distinctive properties are being fabricated using specific proteins. Furthermore, if the bio-molecule is analysed amidst different electrodes, intriguing properties are elucidated. This research article investigates the electron transport properties of L-aspartic acid (i.e. L-amino acid) bound to symmetrical electrodes of gold, silver, copper, platinum and palladium employing NEGF-DFT approach using self-consistent function. The theoretical work function of different electrodes is calculated using local density approximation and generalized gradient approximation approach. The calculated work function correlates well with the hole tunneling barrier and conductance of the molecular device, which further authenticate the coupling strength between molecule and electrode. Molecule under consideration also exhibits negative differential resistance region and rectification ratio with all the different electrodes, due to its asymmetrical structure. The molecular device using platinum electrodes exhibits the highest peak to valley ratio of 1.38 and rectification ratio of 3.20, at finite bias. The switching characteristics of different molecular device are justified with detailed transmission spectra and MPSH. These results indicate that L-aspartic acid and similar biomolecule can be vital to the growth of Proteotronics.