Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus

Introduction

Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile.

Materials and Methods

The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT.

Results

The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation.

Conclusion

The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.

Selection of Medical Teachers: An Initiative for Ensuring a Fair and Transparent Selection Process

BACKGROUND

The first step towards creating a sound educational environment and healthcare in a medical institute is employing medical teachers who maintain ethical behavior in their professional practice. A method where bias and subjectivity can be minimized is by making the recruitment process objective.

MATERIAL AND METHODS

The recruitment started as an offline process and was soon converted into an online form incorporating parameters for scoring. A total of 1,151 medical teachers had submitted their applications for posts in various departments, and 778 candidates were shortlisted and called for an interview. After the interview process, a unique symposium on the selection of medical teachers was organized. The feedback was incorporated into the online application that was released for the subsequent phases of recruitment.

RESULTS

The response rate of the study was 96.55%. Analysis of the feedback by the applicants showed that 47.59% of the applicants were of the opinion that the prevailing selection process in the country needs a change; 84.14% felt that the inclusion of objective criteria would make the selection process more transparent; and 91.03% were happy with the stratification of marks; 82.75% of the applicants and experts felt that knowledge of statistics for quality research and publications in indexed and institutional journals may be considered for the selection process; and 52.41% thought that all authors of an article should be given equal weightage. Adopting a fairly new concept of workplace-based assessment (WPBA) in India was acceptable to 83.45%.

CONCLUSIONS

Parameter-based, objective selection reduces bias, and merit alone is recognized.

Comprehensive, continuous, and compulsory monitoring of frailty in elderly

Background

The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression.

Objectives

To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool.

Materials and Methods

In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared.

Results

Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively.

Conclusion

Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.

Impact of COVID-19 on thyroid gland functions with reference to Graves' disease: A systematic review

Coronavirus disease 2019 (COVID-19) is caused due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Both immediate and long-term adverse effects arise out of this disease's aftermath. It involves various organs, which include endocrine glands, nervous system, musculoskeletal system, and other organs. The long-term outcomes of the SARS-CoV-2 infection are influenced by preexisting comorbidities. Genetic, environmental, and immunological factors contribute to the development of various autoimmune diseases, which include Graves' disease (GD). The growing mystery surrounding this virus is exacerbated by auto-inflammatory diseases, such as pediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), which raises concerns about the nature of the virus' connection to the autoimmune and auto-inflammatory sequelae. There is a need to understand the underlying mechanisms of developing GD in post-COVID-19 patients. There are limited data regarding the pathogenesis involved in post-COVID-19 GD. Our goal was to understand the various mechanisms involved in post-COVID-19 GD among patients with confirmed COVID-19 infection. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for 2020, a literature search of medical databases (PubMed, Cochrane Central Register of Controlled Trials, and Scopus) from February 2021 to February 2022 was performed by five authors. The keywords used were "Post COVID-19," "Grave's disease," "Cytokine storm," "Autoimmunity," and "Molecular mimicry." This review revealed three underlying mechanisms that resulted in post-COVID GD, which included cytokine storm, molecular mimicry, ACE2 receptor concentration, and cell-mediated immunity. The full spectrum of the effects of COVID-19 needs to be researched.

Transition From Observational to Collaborative Learning to Augment Practical Skill Training in First-Year Medical Students

Introduction Students exhibit less interest in hematology demonstration experiments as they are not expected to do it during their examination. Adopting a different strategy, like collaborative learning, might spark interest, motivate them to work together towards a shared objective, and help further learning and understanding. The current study aimed to assess the effectiveness of collaborative learning in comparison with traditional practical demonstration. Methodology First MBBS students were divided into two groups of 50 each (1 - collaborative learning, 2 - traditional demonstration). In the traditional demonstration, the experiment was demonstrated by faculty using the required materials. In the collaborative learning method, 50 students were divided into groups (seven of seven each) and each group was provided with procedural details of the experiment and requisite materials. At the end of the experiment, assessment was done. In collaborative learning groups, the team cohesion scale (TCS) was employed to analyze group dynamics. Students' perceptions, and feedback regarding collaborative learning as a tool in practical experiments were collected using a five-point Likert scale. Results Post-experiment assessment scores in collaborative learning (8.65±1.54) were significantly higher than the traditional demonstration group (7.06±1.46). High scorers in TCS consistently belonged to groups that completed the experiment on time (positive outcome), whereas students with low scores often belonged to groups that did not complete the experiment (negative outcome). Conclusion Collaborative learning may be used for practical teaching in medical education as it fosters good communication, enables problem-solving, aiding the Indian medical graduate in fulfilling the role of a team member.

Contributory Parenting: A "Priceless Shift" from Indirect to Direct Parenting

Parenting is a valuable investment that determines the quality of future independent life. From an evolutionary aspect, it has been well ingrained in the minds of humans as to how much resource each parent should contribute to this energy and time-consuming task. To encourage father's contribution towards parenting and reduce the stress on mother, the concept of paid paternal leave has been implemented. Mere presence of the father in terms of the quantity of time spent without much qualitative value has no benefit, but the assumption that fathers are less competent based on their lower performance might also not be acceptable. An intriguing finding has demonstrated that prolonged contact with the infant triggers a change in previously absent male parenting behavior. With incentives on one hand and associated societal stigma on the other hand, it is to be analyzed whether the purpose of true parenting by fathers is being achieved. Hence, in the concept of contributory parenting it is necessary to recognize and respect each parenting style with the ultimate benefit being passed on to the child.

A Validation Study on the Physiological Parameters Recorded by COVIDBEEP - An Indigenous Remote Health Monitoring System Designed for COVID-19 Care in India

Background

COVID-19 pandemic has affected mankind globally. After the three waves since March 2020, the threat continues instilling fear in the minds. Vital parameter monitoring through remote health monitoring system (RHMS) becomes critical for effective disease management and manpower safety and confidence. In a low resource setting like India, a comprehensive, wearable, and remotely operable device that is economical was required to be introduced for COVID-19 care. Present study validated the remote health monitoring device named COVIDBEEP with gold standard equipment.

Materials and Methods

Six parameters, namely heart rate, SpO2, respiratory rate, temperature, blood pressure, and ECG were acquired in the supine position using the devices.

Result

Analysis was performed using Graph Pad Prism. Intraclass correlation coefficients were used to measure concurrent validity. Bland-Altman graphs were plotted to know the agreement for each vital parameter. Confidence limits were set at 95%. All the parameters recorded from the devices showed a significant correlation with an "r" value between 0.5 and 0.9 with P value between 0.001 and 0.0002. Bland-Altman plots showed a minimum bias of 0.033 for heart rate and maximum of 3.5 for systolic blood pressure and respiratory rate.

Conclusion

The association between the parameters recorded by the devices strengthened as the time of collection of data increased. Agreement between the two methods in 95% confidence interval was also proven to be significant for the parameters. Therefore, the indigenously developed COVIDBEEP has shown good validity in comparison to standard monitoring device.

Channeling of Brain Towards Engaging Sensorimotor Tasks for Inducing Hedonic Pleasure to Alleviate Blood Pressure in Hypertension

Background

Hypertension is a modifiable risk factor for cardiovascular disease and is responsible for major deaths due to stroke and coronary heart disease. Several pharmacological and non-pharmacological interventions for reducing blood pressure have been tried earlier. Modulating brain regions such as prefrontal cortex (PFC) to channelize activities is an effective tool to target blood pressure.

Purpose

Prefrontal cortex (PFC) exerts inhibitory control over sympathoexcitatory circuits, which was explored using a novel reaction time paradigm.

Methods

Thirty participants of both genders in the age group 40-70 years with established hypertension were included. A structured reaction time paradigm was designed to include psychomotor and visuomotor elements with integrated sensory attention and motor performance tasks. Blood pressure, Lead II ECG, and EEG from F3 and F4 were recorded. A paired t-test was used to examine the variations in these parameters across tasks.

Results

A significant reduction in mean arterial pressure by 4.04 mmHg (p = .0232) during the visuomotor task and a reduction of 3.38 mmHg during the auditory cue task (p = .0446) were observed. Analysis of the difference in heart rate has shown a profound decrease after passive listening tasks by 3.7 beats (p < .0001*). Spectral analysis from F3 and F4 shows high power in low-frequency zone of EEG indicating a relaxed state during auditory cues and passive listening.

Conclusion

The reaction time paradigm, when applied to hypertensives, helped decrease blood pressure and heart rate and improved the high frequency (HF) component of heart rate variability, indicating parasympathetic dominance. Such reward-oriented paradigms may act as biofeedback modules that cause hyperactivity of the PFC to suppress the sympathoexcitatory circuit with increased parasympathetic activity beneficial to hypertensive individuals.

Impact of Air Conditioners on Sick Building Syndrome, Sickness Absenteeism, and Lung Functions

Introduction

Modernization has led to greater usage of Air Conditioners (ACs) in our daily lives. It is observed that the occupants of office buildings with ACs consistently report on average more symptoms than do occupants of office buildings with natural ventilation referred to as Sick Building Syndrome (SBS). The appearance of symptoms reduces work efficiency and increases absenteeism due to sickness (sickness absenteeism). Therefore, the present study was planned to evaluate the impact of usage of ACs on SBS and to find out the association of ACs with sickness absenteeism and lung function tests.

Materials and Methods

This study was conducted on 200 healthy non-smoker adults in the age group of 18 to 45 years who were using ACs for at least 6 to 8 h/day for more than 2 years (group I). And 200 healthy adults, age and gender-matched, with the same work pattern, not using ACs at all served as controls (group II). The basic information on the usage of ACs and the prevalence of discomfort related to neural symptoms, respiratory symptoms, and skin and mucous membrane related to SBS was obtained through a questionnaire.

Results

The building-related symptoms in group I males were more compared to group II males and significantly higher in group I males compared to females. We observed that the appearance of symptoms of SBS led to sickness absenteeism among group I participants. Lung function tests especially FVC, FEV1, PEFR, and MVV were significantly reduced among group I males and females compared to group II males and females.

Conclusion

ACs have a profound effect on the quality of the air we breathe and on human health than just lowering the temperature. There is a higher prevalence of SBS-Respiratory and allergic symptoms in AC users.

Assessing the interrelation between oestrogen receptor status, heart rate variability and serum nitric oxide in breast cancer patients: Understanding their prognostic relevance

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Background: Heart Rate Variability (HRV) is a non-invasive procedure to assess cardiac functions and provides an index of autonomic function that intricately controls vascular tone. Studying the alteration in HRV with agents producing oxidative stress will provide useful information about disease progression. Lower HRV indicates low level of Parasympathetic Nervous System activation and dysregulation of cardiac functions. Elements of tumour microenvironment like prostaglandin E2, oestrogen and hypoxia stimulate nitric oxide (NO) production which reacts with free radicals released by tumour tissue forming oxidising agents. NO enhances oxidative stress causing vascular dysfunction. Very few studies have reported an interrelationship between NO and HRV parameters in breast cancer. The aim of the study is to verify the relation between HRV and serum NO levels in ER+ and ER- breast cancer groups. Methods: Study design: Analytical, Cross sectional. Sample Size: 135 women above 20 years of age with and without breast cancer. 69 women with histologically proven breast cancer in different stages and 66 women who were healthy age matched controls were included. Oestrogen Receptor (ER) status was obtained from clinical records. Out of 69 women with breast cancer, 31 were ER- with 15 in stage 1 and 16 in stage 2. 38 women were ER+ with 5 in stage 2 and 33 in stage 3. Serum NO was measured using colorimetry. Heart Rate Variability was measured from lead II ECG using Power Lab 15T and lab chart software. Serum NO levels and HRV parameters were compared between ER groups. Results: ER+ women had higher HRV with parasympathetic predominance compared to ER- with p<0.001. ER+ women also had higher serum NO levels compared to ER- group with p<0.001. Though no direct correlation was noticed between NO and HRV, multiple analysis of variance showed significant (p<0.001) difference of all values across the groups. irrespective of menopausal status. Conclusions: A significant difference was observed in HRV of ER+ and ER- women with breast cancer. Most ER+ women were in stage 3 with significantly higher NO levels. Serum NO is expected to be the factor most responsible for HRV changes particularly in stage 3/ER+. Parasympathetic predominance seen in ER+ women possibly is due to high NO levels.[Table: see text]

Artificial Intelligence-Based Portable Bioelectronics Platform for SARS-CoV-2 Diagnosis with Multi-nucleotide Probe Assay for Clinical Decisions

In the context of the recent pandemic, the necessity of inexpensive and easily accessible rapid-test kits is well understood and need not be stressed further. In light of this, we report a multi-nucleotide probe-based diagnosis of SARS-CoV-2 using a bioelectronics platform, comprising low-cost chemiresistive biochips, a portable electronic readout, and an Android application for data acquisition with machine-learning-based decision making. The platform performs the desired diagnosis from standard nasopharyngeal and/or oral swabs (both on extracted and non-extracted RNA samples) without amplifying the viral load. Being a reverse transcription polymerase chain reaction-free hybridization assay, the proposed approach offers inexpensive, fast (time-to-result: ≤ 30 min), and early diagnosis, as opposed to most of the existing SARS-CoV-2 diagnosis protocols recommended by the WHO. For the extracted RNA samples, the assay accounts for 87 and 95.2% test accuracies, using a heuristic approach and a machine-learning-based classification method, respectively. In case of the non-extracted RNA samples, 95.6% decision accuracy is achieved using the heuristic approach, with the machine-learning-based best-fit model producing 100% accuracy. Furthermore, the availability of the handheld readout and the Android application-based simple user interface facilitates easy accessibility and portable applications. Besides, by eliminating viral RNA extraction from samples as a pre-requisite for specific detection, the proposed approach presents itself as an ideal candidate for point-of-care SARS-CoV-2 diagnosis.

Pathophysiology and Clinical Presentation of COVID-19 in Children: Systematic Review of the Literature

Introduction: Coronavirus disease 2019 (COVID-19) is due to severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection, which belongs to beta-coronaviruses of the Coronaviridae family. SARS-coV-2 causes acute respiratory infection with varying severity in different age groups, wherein adults can develop severe disease, while children are relatively spared until now, with COVID-19 in children accounting for only 1-5% of diagnosed cases. Although COVID-19 incidence rate in children is relatively low, their protection from COVID-19 is still a matter of increasing concern as children constitute a large vulnerable population. In order to develop effective therapeutic management and preventive measures against COVID-19 in children, there is an urgent need for a better understanding of its pathophysiology at the molecular level and clinical presentation as well as possible protective mechanisms in the pediatric population. Objectives: There is limited data regarding the incidence and clinical presentation of SARS-CoV-2 infection in children. Our goal was to understand the clinical picture and presentation of pediatric patients with confirmed COVID-19. Methods: A systematic literature search of popular medical databases (PubMed, Cochrane Central Register of Clinical Trials and Scopus), restricted to English language publications only, was conducted by us. We chose published peer-reviewed and cross-sectional articles as well as case series providing clinical signs, imaging findings and laboratory results of pediatric patients, using the following inclusion criteria: children aged up to 18 years who tested positive for COVID-19 and in whom SARS-Co-V-2 was detected in the nasal/throat swab by real time polymerase chain reaction (RT-PCR). Conclusion: Our review revealed that, in children, COVID-19 was milder in terms of disease severity and clinical presentation, and it had a better prognosis and a lower mortality rate than adults.

Assessment Of Hemostatic Condition In Patients After Surgical Trauma

Hemostatic system is designed to maintain blood in a fluid state yet provide important defenses against bleeding when injury occurs to the vessel. During surgery, patients are exposed to hemostatic stress causing complications of either hypercoagulability or hemorrhage. The goal of the present study was to describe the clotting changes in patients who underwent major surgeries especially procoagulant mechanisms.

METHODS

30 patients belonging to both sexes who were undergoing surgery for various reasons were included in the study. Tests to assess the integrity of hemostatic system were conducted. Results: Analysed and expressed in mean and SD. There was a significant (p < 0.05) difference in the hemostatic parameters like bleeding time, clotting time, thrombin time, platelet count and fibrinogen concentration between the preoperative and postoperative periods.

Prediabetes in South Indian rural adolescent school students

Prediabetes is a condition with blood glucose levels higher than normal but not high enough to be diagnosed as diabetes. Most people with prediabetes are asymptomatic but are considered to be at a high risk of developing heart disease and stroke. 140 students of both sexes between ages 14-18 years were given a predesigned questionnaire to obtain information on socio-economic status and family history of Diabetes mellitus. A fasting plasma glucose level was measured and 6.8% of students were in the prediabetic range (> 100 mg/dl). No significant correlation was found between fasting plasma glucose and Body Mass Index or waist to hip ratio. 41.5% of the boys and 10.3% of the girls had a family history of DM but were in euglycemic range. It is beneficial to identify people with prediabetes so that appropriate lifestyle modification may be done to prevent or postpone onset of Diabetes mellitus.