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.

Heart Rate Variability among Healthy Untrained Adults during Mild Intensity Stationary Cycling Exercise.

Background: Stationary cycling is the popular, preferred, and convenient form of exercise. During exercise, autonomic modulation is seen which can be assessed by heart rate variability (HRV). The aim of the study was to evaluate the changes in HRV during mild-intensity cycling exercise. Materials and Methods: An observational cross-sectional study was done on 20 healthy male volunteers with the age (35.44 ± 4.12), height (71.12 ± 11.98), and weight (161.23 ± 11.65), BMI (27.12 ± 3.49) attending various YOGA sessions in AYUSH OPD. Volunteers underwent an exercise program at the mild intensity of 30% to 50% of maximal heart rate on a stationary cycle for 20 min. HRV was recorded by the HRV mobile unit Dynamika Machine at rest, every 5 min (4×) over 20 min and during the recovery period. Repeated measures of analysis of variance with post-hoc analysis with Bonferroni and Holm's multiple comparisons. Results: Significant change was observed in mean heart rate and time domain parameters. Frequency domain parameters that showed significant change were total power, High Frequency- HF (ms2), Very Low Frequency -VLF (ms2), Low Frequency -LF (ms2), and Very Low Frequency %-VLF (%). Conclusions: The HRV parameters conclusively point towards cardiac parasympathetic withdrawal and sympathetic dominance at the initiation of exercise. With the progression of exercise, the sympathetic influence is retained. In the recovery period parasympathetic reactivation gains control over heart rate as well as HRV. The HRV response to exercise challenges may be helpful in designing exercise programs based on variations in the autonomic response.

Comparative change in P300 indices following antidepressant treatment in patients with major depressive disorder.

Context: Cognitive disturbance is seen in patients with major depressive disorder (MDD). Event-related potential can assist in measuring the neurocognition, and P300 is the most commonly used noninvasive electrophysiological parameter for measuring cognition. Aims: The aim of this study is to assess the baseline P300 parameters, Hamilton Rating Scale for Depression (HAM-D), and Montgomery-Asberg Depression Rating Scale (MADRS) scores and compare them with their levels after 3 months of antidepressant therapy. Settings and Design: a longitudinal study was done on total 24 diagnosed cases of major depression who underwent P300, HAM-D, and MADRS assessment in the gap of 3 months before and after starting antidepressant therapy. Subjects and Methods: Newly diagnosed cases of MDD patients were assessed using HAM-D and MADRS for severity rating. P300 assessment was also carried out with auditory oddball paradigm using Nihon Kohden NCV-SMG-EP system. The assessments were repeated after 3 months of antidepressant treatment. Statistical Analysis Used: The Wilcoxon test was used to compare mean values of P300 parameters, HAM-D, and MADRS score. Spearman correlation analysis was done to study the association between various parameters of P300 and HAM-D and MADRS score before and after treatment of 3 months of antidepressant therapy. Results: Significant difference is shown in various parameters P300 except for A11-P300 amplitude and A31-P300 amplitude. A significant difference was shown in HAM-D and MADRS scores. No significant correlation was seen between other P300 parameters and HAM-D and MADRS scale before as well as after antidepressant therapy. Conclusions: P300 may be used as an index to evaluate the response to antidepressant treatment in patients with MDD.

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.

Effectiveness of Semmes Weinstein 10 gm monofilament in diabetic peripheral neuropathy taking nerve conduction and autonomic function study as reference tests.

Context: Diabetic peripheral neuropathy (DPN) if detected early can reduce the burden on the health system and prevent the development of diabetic foot ulcers and amputation. Aim: To study the effectiveness of Semmes Weinstein 10 gm monofilament in detecting DPN taking nerve conduction studies (NCS) and autonomic function testing (AFT) as reference tests. Settings and Design: Observational and comparative cross-sectional study conducted in the Physiology department AIIMS, Bhopal in collaboration with the Medicine department of the institute. Methods and Material: A total of 72 diagnosed type-2 diabetes mellitus patients were examined using Semmes Weinstein 10 gm monofilament, DPN was confirmed using NCS (Nihon Kohden Neuropack XI machine) and autonomic neuropathy was confirmed using AFT (Ewing's battery and Power lab) with heart rate variability (HRV). Diagnostic value of Semmes Weinstein 10 gm monofilament taking NCS and AFT as reference test was calculated. Statistical Analysis Used: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were calculated using the standard formula. Results: Sensitivity, specificity, PPV, and NPV using monofilament are 69.23%, 20%, 69.23% and 20% respectively taking NCS as reference test and 70.59%, 0, 92.30%, and 0 respectively taking AFT as reference test. Conclusions: Semmes Weinstein 10 gm monofilament is not the ideal screening test for the diagnosis of DPN. Sole clinical use of monofilament should be discouraged.

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.

Clinical Utility of Blood Pressure Measurement Using the Newer Palpatory Method for Both Systolic and Diastolic Blood Pressure.

BACKGROUND: Blood pressure (BP) measurement being a part of clinical examination gives a fair idea about the hemodynamic status. The auscultatory method is considered as a gold standard, a simple, noninvasive way to measure BP in patients as well as in the healthy controls. The present study was designed to compare systolic BP (SBP) and diastolic BP (DBP) readings using a newer palpatory method with the standard auscultatory method and further assessing the reliability of the newer palpatory method. MATERIALS AND METHODS: A cross-sectional study comprising of a total of 400 (240 males and 160 females) individuals in the age range of 20-60 years were included in this study. BP measurement was done by the standard auscultatory method by one observer. Another observer blinded with BP records of the auscultatory method, measured BP using the newer palpatory method on the same individuals. The two methods were compared for the inter-rater reliability using intraclass correlation (ICC) statistics and agreement between two methods using Bland-Altman analysis. RESULTS: The present study observed excellent reliability of the newer palpatory method with the standard auscultatory method with an ICC value of 0.997 and 0.993 for SBP and DBP, respectively. Bland-Altman plot for both SBP and DBP using the auscultatory and newer palpatory method has shown minimum variability and good reliability when both methods are used by independent observers. CONCLUSIONS: With practice and experience newer palpatory method can be used to assess BP with accuracy.

Effect of music tempo on exercise performance and heart rate among young adults.

BACKGROUND & OBJECTIVES: Music captures attention, triggers a range of emotions, alters or regulates mood, increases work output, heightens arousal, induces states of higher functioning, reduces inhibitions and encourages rhythmic movement. Music has ergo-genic effect as well, it increases exercise performance, delays fatigue and increases performance and endurance, power and strength. Our study tried to evaluate the effect of music on exercise performance in young untrained subjects. METHODS: In this study, we tested the effect of music on sub maximal exercise performance time duration in young adults. 25 Male and 25 females were subjected to standard submaximal exercise with and without music. Resting HR and Max. HR during exercise and the exercise time duration was recorded. RESULTS: Total exercise duration in whole group with music (37.12 ± 16.26** min) was significantly greater than exercise duration without music (22.48 ± 10.26 min). Males (42.4 ± 15.6** min) outperformed significantly better than females (31.84 ± 15.48 min). Also, we observed statistically significant higher values of Maximal heart rate with music than without music. But there was no significant correlation between duration of exercise, music and change in Heart rate. INTERPRETATION & CONCLUSION: We can conclude that Music increases duration of exercise in both sexes and hence endurance.