A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial

Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72 h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another.

Prevalence of Alcohol and Tobacco Use in India and Implications for COVID-19 - Niyantrita Madhumeha Bharata Study Projections

Abuse of legal substances in India includes alcohol and tobacco, which are the major risk factors for various non-communicable diseases and deaths. The current pandemic has identified tobacco consumption as a risk factor for COVID-19, highlighting the need to control substance abuse. The objective of this study was to estimate the prevalence of substance abuse in India and discuss the cost-effective public health strategies (such as yoga) to alleviate COVID-related anxiety in order to prevent substance abuse and its associated co-morbidities such as type 2 diabetes mellitus. This study reports the data on tobacco and alcohol abuse from a nationwide randomized two-arm diabetes control trial (Niyantrita Madhumeha Bharata, 2017) conducted by the Indian Yoga Association (IYA) through Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru. Data of 30,354 participants who abuse tobacco and 30,159 participants who abuse alcohol were collected all over India. The prevalence is estimated at around 8.7% for alcohol abuse and 7.9% for tobacco abuse, Arunachal Pradesh state ranking the highest regarding both alcohol and tobacco abuse, while the Tripura state ranked the lowest. School and college-based mandatory yoga programs need to be implemented to prevent the increase of substance abuse in India to alleviate the psychosocial stress of adolescents and college-going students, besides the installation of the mindfulness-based diabetes yoga protocol (DYP) in the wellness centers of Ayushman Bharat.

Comparison of biochemical markers of bone metabolism between conventional labial and lingual fixed orthodontic appliances

Objectives

The applied orthodontic force causes remodeling of the periodontium through the selective release of cytokines causing resorption of bone, enabling controlled movement of the tooth. This study compared the cytokine profile between patients treated with conventional labial and lingual fixed orthodontic appliances.

Patients and Methods

The study included 80 patients in need of orthodontic treatment, out of which 40 patients were treated by the labial fixed appliance and 40 by the lingual fixed appliance. Gingival crevicular fluid (GCF) specimens were gathered from both the groups using a microcapillary pipette. The samples were collected at the beginning of the treatment and after 21 days. Enzyme-linked immunosorbent assay was performed to evaluate the cytokine levels.

Results

Interleukin (IL)-1α, 1β, 2, 8, and tumor necrosis factor-alpha (TNF-α) levels were significantly high (P < 0.001) in GCF of participants treated with conventional labial fixed appliance. IL-1α, 1β, 2, 6, 8, and TNF-α levels were significantly high (P < 0.001) in GCF of participants treated by the lingual fixed appliance. The concentrations of TNF-α and IL-1β were increased higher than other cytokines in both the treatment groups.

Conclusion

Overall, the lingual fixed appliance had higher cytokine levels than a labial fixed appliance. Analyzing the GCF cytokine levels during orthodontic treatment could provide an ideal platform for monitoring the progress of the treatment.

Trends of Hypertension and Neurological Diseases in India: A Nationwide Survey Reporting the Distribution Across Geographical Areas

BACKGROUND

Hypertension has remained an imperative risk factor for cardiovascular and cerebrovascular diseases, increasing the national burden of premature deaths over the decades.

PURPOSE

There is limited data on the prevalence of hypertension and its distribution across all geographic regions in India. This nationwide survey was conducted in 2017 to assess the prevalence of hypertension and prehypertension among the Indian adults.

METHODS

A multilevel stratified cluster sampling technique, with a random selection among the urban and rural populations, was adopted to achieve a sample of 70,031 adults from 24 states and 4 union territories. Blood pressure was measured twice using automated oscillometric machines with a minimum of 3-min gap, and the average was recorded. This was later categorized into prehypertension (elevated blood pressure) and hypertension subgroups as defined by the new 2017 American Heart Association guidelines.

RESULTS

The prevalence of prehypertension and hypertension in our study population across all ages was found to be 18.2% and 24%, respectively. Prehypertension was common at a younger age, whereas the prevalence of hypertension was higher in the older age groups. The urban population (24.4%) and males (24.7%) were positively associated with prehypertension and hypertension. The western zone had the highest prevalence of hypertension, whereas the eastern population had the lowest.

CONCLUSION

Our study revealed an alarmingly high prevalence of hypertension, accounting up to one hypertensive in every four adults in India. There is a need for more robust national strategies for identifying and treating hypertension to reduce the national and the global burden of hypertension by 25% before 2025.

Ayurveda Body-Mind Constitutional Types and Role of Yoga Intervention Among Type 2 Diabetes Mellitus Population of Chandigarh and Panchkula Regions

Background:

Type 2 diabetes needs a better understanding of etiological factors and management strategies based on lifestyle and constitutional factors, given its high association rate with many cardiovascular, neurological disorders, and COVID-19 infection.

Purpose:

The present study was undertaken to investigate the effect of Diabetes-specific integrated Yoga lifestyle Protocol (DYP) on glycemic control and lipid profiles of diabetic adults. Along with the DYP intervention, the individuals residing in Chandigarh and Panchkula union territories in the northern part of India were assessed for Ayurveda-based body–mind constitutional type. Ayurveda describes body–mind constitution as “prakriti,” which has been discussed from two angles, namely physiological and psychological as body and mind are correlated.

Methods:

Cluster sampling of waitlist control study subjects was used as the sampling method for the study. A total of 1,215 registered subjects (81 diabetic) responded in randomly selected clusters in Chandigarh and Panchkula. Ayurveda physicians did Ayurveda body–mind constitutional assessment called prakriti assessment (physiological body–mind constitution assessment) in 35 participants (23 diabetic, 12 prediabetic) as a part of the study.

Results:

A group of 50 subjects was randomly selected for yoga intervention out of 81 diabetes mellitus adults, and 31 subjects were enrolled as waitlist controls. A significant decrease in the glycosylated hemoglobin levels from 8.49 ± 1.94% to 7.97 ± 2.20% in the intervention group was noticed. The lipid profiles of the DYP intervention and control groups were monitored. Three-month follow-up results of lipid profile diagnostic tests in intervention and control groups showed a significant difference between the two groups (P < 0.05). Most diabetic and prediabetic individuals were found to have pitta dosha (pitta controls all heat, metabolism, and transformation in the mind and body) as dominant constitution type.

Conclusion:

The study results demonstrated significant positive effects of yoga in diabetic individuals. This study has indicated the evidence for the safety and efficacy of the validated DYP for community-level interventions to prevent maladies like brain damage and stroke.

Profound approach to check legitimacy of an old technique used to gauge palatal rugae

Aims

The present study aimed at assessing two fixed points of reference from where the mesial and distal point of all rugae can be measured so that the exact movement of particular rugae in any direction can be evaluated and assessing the changes in the palatal rugae after orthodontic treatment.

Methods

A longitudinal study conducted among a sample of 20 (8 male and 12 female) adult patients. Pre- and post-orthodontic treatment casts of patients were obtained from the Department of Orthodontics College of Dentistry Jazan University. Antero-posterior linear distances (Technique I) between medial and lateral points of primary, secondary and tertiary rugae were measured. Also, the transverse linear distance (Technique II) between medial and lateral points of right and left rugae were measured. Technique III involved marking two fixed points and using these two points a third point is located on the medial or lateral end of rugae of right and left side in pre and post-treatment orthodontic casts. The independent sample t-test was employed to compare gender. Difference between the pre- and post-treatment mean values were checked by the paired t-test.

Results

Technique III successfully showed the statistically significant difference (P ≤ 0.05, 95% CI) in the overall pre and post-treatment values on the patients' cast (N = 20) which was not observed with a technique I and technique II.

Conclusion

The triangle created by the three reference points in the technique III was able to identify the changes in the palatine rugae more precisely than the technique I and Technique II.

Optical-vortex diagnostics via Fraunhofer slit diffraction with controllable wavefront curvature

Far-field slit diffraction of circular optical-vortex (OV) beams is efficient for measurement of the topological charge (TC) magnitude but does not reveal its sign. We show that this is because in the common diffraction schemes the diffraction plane coincides with the incident OV waist plane. Based on the examples of Laguerre-Gaussian incident beams containing a spherical wavefront component, we demonstrate that the far-field diffracted beam profile possesses an asymmetry depending on the incident wavefront curvature and the TC sign. This finding enables simple and efficient ways for the simultaneous diagnostics of the TC magnitude and sign, which can be useful in many OV applications, including OV-assisted metrology and information processing.

Mechanistic insights into controlled depolymerization of Chitosan using H-Mordenite

Kinetics of chitosan depolymerization were studied in dilute acetic acid solution, in presence of H-Mordenite (H-MOR). Rate constants for chitosan depolymerization were determined by measurement of molecular weight, using Gel permeation Chromatography (GPC). Depolymerization rate of chitosan was altered in presence of an acidic, porous material like H-MOR. Maximum concentration of H-MOR studied during process led to minimal increase in energy of activation, from 20.54 kJ/moL to 23.25 kJ/moL. Infra-red spectroscopy, adsorption studies and rheological assessment indicated adsorption /grafting of chitosan onto porous H-MOR surface as the possible mechanism for facilitation of the depolymerization process. Under extreme conditions investigated during process optimization, H-MOR resulted in a three-fold reduction in 5-Hydroxy Methyl Furfural (5-HMF) formation and over ten times decrease in glucosamine content, as compared to reactions conducted without H-MOR. Therefore, presence of H-MOR is imperative to cleave chitosan in controlled manner and obtain products of desired molecular weight, with fewer impurities.

Distribution of glycated haemoglobin and its determinants in Indian young adults

AIM

The aim of the present study is to understand the distribution of A1c in four different age groups in young adults and its relation to other co-variants.

METHODS

The countrywide data was collected in 2017 in Individuals with high risk analysed by Indian Diabetes Risk Score (IDRS) and self-declared diabetics were identified after screening a sample of 240,968 individuals from rural (4 villages of about 500 adults each) and urban (4 census enumeration blocks of about 500 adults each) population spanning 65 districts of 29 states/UTs of Indian subcontinent. Blood tests and other detailed assessments were carried out on this selected group. This study presents the analysis of the A1c values of 2862 young adults (<35 years).

RESULTS

In the age group of 31-34 years, the proportion of Diabetes (22.36%) and Prediabetes (9.86%) was higher in comparison with younger age groups. Also, Diabetes (7.3%) and Prediabetes (22%) were highest among those who had parental history of DM in both parents as compared to those with Diabetes history in one parent [Diabetes (7.1%) or Prediabetes (19.0%)] and no Diabetes Parental History (Diabetes (7.3%) and Prediabetes (18.3%) cases. BMI was found to play a significant positive correlation with Diabetes and Prediabetes (p < 0.001) with range of A1c.

CONCLUSION

Age, BMI and parental history were found to be correlated with A1c levels in IDRS screened high-risk population. With increasing age, the proportion of Diabetics and Prediabetics also increased with positive correlation of age with A1c levels.

Detection of CMB-Cluster Lensing using Polarization Data from SPTpol

We report the first detection of gravitational lensing due to galaxy clusters using only the polarization of the cosmic microwave background (CMB). The lensing signal is obtained using a new estimator that extracts the lensing dipole signature from stacked images formed by rotating the cluster-centered Stokes QU map cutouts along the direction of the locally measured background CMB polarization gradient. Using data from the SPTpol 500  deg^{2} survey at the locations of roughly 18 000 clusters with richness λ≥10 from the Dark Energy Survey (DES) Year-3 full galaxy cluster catalog, we detect lensing at 4.8σ. The mean stacked mass of the selected sample is found to be (1.43±0.40)×10^{14}M_{⊙} which is in good agreement with optical weak lensing based estimates using DES data and CMB-lensing based estimates using SPTpol temperature data. This measurement is a key first step for cluster cosmology with future low-noise CMB surveys, like CMB-S4, for which CMB polarization will be the primary channel for cluster lensing measurements.