Anand Venugopal

Effectiveness of Progressive Resistance Strength Training Versus Traditional Balance Exercise in Improving Balance Among the Elderly - A Randomised Controlled Trial

INTRODUCTION Falls are important health issues among the elderly people. Most falls in elderly result from abnormal balance control mechanisms. Balance and muscle force generation are directly related, and are associated with age related muscular changes. Studies addressing fall prevention have focused on various group and individualised strength training. However, evidence on strengthening of key muscles necessary for maintaining balance and postural control is lacking. OBJECTIVES To evaluate the effectiveness of individualised progressive resistance strength training (PRT) programme in improving balance for forward limits of stability in elderly with balance impairment, compared to traditional balance exercise (TBE), and combination of both (COMBI). MATERIALS AND METHODS This randomised controlled trial included three groups; 18 subjects in each aged ≥ 65 years, from the elderly care centres of Mangalore city in Southern India (between June 2008 and December 2012). Block randomisation technique was used and allocation concealment was done using sequentially arranged sealed opaque envelopes. The TBE group received 8 component traditional balance exercise; 4 times a week for 6 months. The PRT group received resistance training for the key muscles of lower extremities, using DeLormes and Watkins protocol. The COMBI group received PRT and TBE alternately (2 days of PRT and 2 days of TBE per week). Functional reach test (FRT) was used for measurement of forward limits of stability. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 15. RESULTS For functional reach, PRT group had steady progression from baseline to 6 months (p<0.001). The TBE and COMBI groups showed considerable initial improvement; beyond 3 months, moderate improvement was seen. The changes in scores of FRT were significantly better for PRT than TBE. CONCLUSION Individualised PRT intervention targeting the key muscles of lower limbs is more effective than TBE in improving forward limits of stability among non-frail elderly aged ≥65 years.

Clinico-epidemiological profile of burn patients admitted in a tertiary care hospital in coastal South India.

Every year a substantial proportion of deaths in India occur due to burn injuries. Prolonged morbidity as well as temporary and permanent disability due to burns results in a heavy economic loss. The etiological factors of burn injuries vary considerably in different communities and regions and hence the need for detailed epidemiological studies to understand the problem status in different regions. This study was aimed to study the sociodemographic profile of burn patients and to evaluate the causes, manner, and place of occurrence of burns injuries along with its outcome. A registry-based retrospective study was conducted at a tertiary care hospital in coastal South India, and the medical records of all the patients admitted to the burns centre during the year 2009 were reviewed. The data were analyzed using SPSS version 11.5. A total of 101 burn patients were admitted during the study period. The burn patients were aged between 4 months and 80 years with a mean age of 32.11 (± 3.46) years. The overall male to female ratio was 0.83:1. Majority of the patients were Hindus and were married. Flame burns were the most common etiology for sustaining burns (82.2%). Most of the burn injuries were sustained at home (n = 81, 80.2%), and the manner was designated as accidental in 79.2% of the cases. The TBSA involvement in burns ranged from 5 to 100% and the mean TBSA was found to be 45.8 ± 24.7%. A higher TBSA involvement is associated with an increased risk of mortality and this association between TBSA and mortality was found to be statistically significant (P < .05). Mortality rate in our study was 40.9%. Septicemia (n = 24, 63.2%) was the most common cause of death followed by shock (n = 12, 31.6%). Higher mortality is found to be associated with female sex, suicides, and flame burns. This study identifies the epidemiological and clinical features associated with burn injuries in coastal South India. Majority of the burn victims in our study were married females of younger age group. Although the manner of sustaining burns was mostly accidental, females were proportionately more commonly the victims of suicides and homicides than males. Injuries and deaths due to burns are preventable, provided a community-specific preventive program is implemented with a strong educational component.

Association between bipolar affective disorder and thyroid dysfunction

BACKGROUND Bipolar affective disorder may be associated with alterations in thyroid function. A comprehensive thyroid assessment is important for assessing clinical and sub-clinical imbalances linked to a variety of mood disorders like bipolar affective disorder. AIM To find out the association between bipolar affective disorder and thyroid dysfunction. MATERIALS AND METHOD The present cross-sectional study was conducted at Government District Wenlock Hospital, Mangalore (GDWH), India. A total of 50 newly diagnosed bipolar affective disorder patients and 50 age and sex matched controls without bipolar affective disorder as confirmed by the application of Bipolar Spectrum Diagnostic Scale were included in the study. Thyroid function was assessed among the patients and control group to study the association between bipolar affective disorder and thyroid dysfunction. Odds ratio was calculated to find out the strength of association between thyroid gland dysfunction and bipolar affective disorder. RESULTS The mean Bipolar Spectrum Diagnostic Scale score among patients diagnosed with bipolar affective disorder was 20.84 and that of the control group was 1.98. The proportion of thyroid dysfunction among bipolar affective disorder patients and among control group was 14% and 6% respectively. The odds ratio was calculated to be 2.55. Mean T3 values were higher in the bipolar affective disorder patients than the control group and this association was found to be statistically significant (p=0.031). Mean T4 and TSH values were higher among the bipolar affective disorder patients but did not show any significant differences when compared with the control group. CONCLUSION The present study concludes that a statistically significant association exists between elevated T3 hormone and bipolar affective disorder and observes that the patients with bipolar affective disorder are 2.55 times more commonly associated with thyroid dysfunction.

Bilateral calcified stylohyoid ligament: an incidental autopsy finding with medicolegal significance.

Eagles syndrome occurs due to elongation of the styloid process or calcification of the stylohyoid ligament, which then may produce a pain sensation due to pressure exerted on various structures in the head and neck region. A case report of calcified stylohyoid ligament found incidentally at autopsy and further confirmed by computed tomography scan and histopathology is herein discussed with associated medicolegal significance.

Extensor Pollicis Longus Injury in Addition to De Quervain’s with Text Messaging on Mobile Phones

OBJECTIVE To do a clinical and ultrasonic evaluation of subjects with thumb pain with text messaging. BACKGROUND Thumbs are commonly used for text messaging, which are not as well designed for fine manipulative or dexterous work. Repetitive use as in text messaging can lead to the injury to the tendons of the thumb. MATERIALS AND METHODS Ninety eight students with symptoms of Repetitive Strain Type of injuries of the thumb were selected from a survey and evaluated both clinically and by ultrasound analysis of the musculotendinous unit of the thumb to note changes due to excessive use of the mobile phone. Age and sex matched controls were also subjected to ultrasound evaluation. RESULTS Clinical examination showed positive Finkelstein test in 40% of the cases, significant reduction in the lateral and tip pinch strengths in the cases. Ultrasound detected changes in the first and the third compartments in 19% of the cases. CONCLUSION Isolated cases of pain in the thumb have been reported but this study noted changes both clinically and by ultrasound in the tendons of the thumb. These changes should be taken as warning signs of possible subclinical changes taking place in the soft tissues of the thumb in these subjects due to repetitive use of mobile phones and thus, making them prone for developing painful Musculoskeletal Disorders. APPLICATION Repetitive use of mobile phones for text messaging can lead to the damage of Extensor pollicis longus of the thumb in addition to the tendons of the first compartment of the wrist.

Carpal tunnel syndrome: Ultrasonographic evaluation of median nerve diameter

Background: Carpal tunnel syndrome is the most frequently encountered peripheral compression neuropathy. Diagnosis of carpal tunnel syndrome involves physical examination, nerve conduction studies and electromyography. Ultrasonography (USG) examination of median nerve in carpal tunnel has been proposed as a useful alternative in diagnosing carpal tunnel syndrome. Materials and Methods: Patients were selected from those undergoing diagnostic workup for carpal tunnel syndrome in pre-treatment period. USG was performed using 11 MHz linear array transducer. Cross-sectional area at each level, major and minor axes were measured. Results: In our study, the mean median nerve cross sectional area at proximal part of carpal tunnel by direct method was 12.33 mm 2 in patients and 7.33 mm 2 in controls. By indirect method it was 12.01 mm 2 and 6.633 mm 2 in cases and controls respectively. In this study we found significant difference in flattening ratio between cases and controls. The mean flattening ratio in distal part of tunnel (at the level of hook of hamate) was 2.97 and 2.38 in cases and controls respectively. The sensitivity and specificity for cut-off value ≥2.5 was 76% and 63% respectively. Conclusion: We found that best discriminatory criterion for diagnosis of carpal tunnel syndrome are median nerve cross sectional area in the proximal part of carpal tunnel ≥9 mm 2 (Direct method) and ≥8.5 mm 2 (Indirect method). With our experience, we found it easier to evaluate the median nerve in the carpal tunnel in the disto proximal sequence by identifying the flexor pollicislongus (FPL) first with dynamic evaluation. As the percentage of space occupying lesions causing symptoms in unilateral (atypical) carpal tunnel syndrome is 35%, we highly recommend this pre-operative investigation in all carpal tunnel syndrome patients.

Using Image Processing on MRI Scans

Alzheimers disease (AD) is an irreversible and progressive brain disease that gradually destroys memory and thinking skills to an extent that it starts affecting the daily life. It has become the most common cause of dementia among older people. The work presented in this paper evaluates the utility of image processing on the Magnetic Resonance Imaging (MRI) scans to estimate the possibility of an early detection of AD. The total brain atrophy and specifically the hippocampal atrophy are considered strong diagnostic tests for AD. T1 weighted MRIs have been used for the purpose of image processing to evaluate atrophy. The paper demonstrates the applications of several image processing techniques such as K-means clustering, wavelet transform, watershed algorithm and also a customized algorithm tailored for the specific case. It has been implemented on the open source platforms, OpenCV and Qt, which facilitates the implementation and utility of the developed product in the hospitals without requiring any proprietary software. The results obtained from the project could aid the analysis to detect AD along with correlation with the psychiatric results and could thus assist the doctors in detecting AD at an early stage. This could progressively help in understanding and treating AD.

Knowledge, risk perceptions and attitudes of nurses towards HIV in a tertiary care hospital in Mangalore, India

Introduction: Infectious diseases like HIV are on the rise in developing countries like India, which puts a heavy burden on the health care needs. Nurses have a key role and they spend considerable time taking care of the HIV positive patients who are admitted to hospitals. Hence, a study was conducted in our hospital to have an insight into the knowledge of nurses about HIV, their apprehensions while taking care of such patients and their attitudes and willingness to take care of them. Methods: This was a cross sectional study which was done among 200 nurses of KMC Hospital, Mangalore. They were given a validated questionnaire which comprised of 67 items which included the knowledge on the spread of HIV, universal precautions, risk perceptions and their attitudes towards the HIV positive patients. Their responses were analyzed by using the SPSS software. Results: Of the 200 nurses who were selected, 152 completed the questionnaire. Regarding the knowledge of the HIV transmission, the correct response for the widely advertised modes of transmission were higher-sexual contact (97.4%) and vertical transmission (88.8%). However, 11.2% did not know about the mother to child transmission and 28.9% did not know about the transmission through breast feeding. 90.1% felt that HIV could be transmitted by the sharing of plates and 83.6% felt that it could be transmitted through mosquito bites. 93.4% knew about the universal precautions and 78.3% routinely practised it. 80.3% were aware of the post exposure prophylaxis.79.2% described that caring for the HIV positives was rewarding, 86.5% were willing to assist in the operations on HIV patients and 84.9% were willing conduct deliveries. 13.4% felt they had a right to refuse care for the HIV patients and 97% felt that the surgical patients needed to be routinely tested for HIV. Conclusions: This study demonstrated that there were deficiencies in the knowledge about HIV and that false beliefs existed among the nurses about the spread of HIV. There is a need to improve the awareness about HIV and HIV patient care through training programmes to clear the misconceptions among the nurses so that the HIV positive patients are not discriminated against and are treated without discrimination.

Toxoplasma encephalitis among AIDS patients in a tertiary care hospital in Mangalore, India

Background Toxoplasmosis associated with HIV infection is caused by reactivation of a chronic infection and manifests primarily as toxoplasmic encephalitis. This study was done to determine clinical presentations and outcomes of CNS toxoplasmosis and to find out their association with CD4 counts at time of diagnosis and initiation of ART. Materials and methods Retrospective study done by reviewing medical records of HIV-positiveS diagnosed with toxoplasmosis from Jan 2000 to Dec 2010. Diagnosis was based on clinical features, demonstration of elevated IgG by ELISA and associated CT findings. Data obtained was correlated with CD4 count and whether or not patient was on ART. Analysis was done using SPSS version 11.5. Results 2826 HIV positives attended Infections Disease Cell from 2000 –2010, of which 33 (1.12%) had CNS Toxoplasmosis. Among 33 cases, 29 were males (88%) and 4 females (12%). Mean age was 37.33 yrs. 10 cases (30.3%) had CNS toxoplasmosis as the initial manifestation of HIV. Most common clinical presentations were fever (58%) and headache (52%). Mean CD4 at diagnosis of toxoplasmosis was 160.6. Mean level of IgG was 255.69. CT / MRI finding of ring enhancing lesion or cerebritis was seen in 79 % of the cases with 18% of lesions in both basal ganglia and parietal lobes. Cerebritis was most common lesion in CT/MRI, seen in 16 cases while ring enhancing lesions were seen in 10 cases. 82% improved with treatment and 18% expired. Conclusions The possibility of cerebral toxoplasmosis should be considered in every HIV-positive patient with neurological symptoms. In our study, Toxoplasmosis occured at CD4 levels >150, which should warrant prophylaxis for Toxoplasmosis at higher CD4 count. Parietal lobe lesions were common in our study, contrary to other existing data which say toxoplasma lesions are usually midline lesions.