Bharti Bhandari

Effect of Sub Maximal Dynamic and Static Exercises on QTc interval in Healthy Young Men.

INTRODUCTION The QTc interval depends largely on cardiac repolarization since the duration of cardiac depolarization is fairly constant in the normal heart. QTc at rest as well as during exercise has many clinical implications. In this study, we have compared the relative effects of dynamic and static exercise on QTc. AIM To measure QTc interval in young men at rest and also assess how it is further modulated by submaximal dynamic and static exercises. MATERIALS AND METHODS This observational study was conducted in the Department of Physiology on 30 non-obese young men randomly selected from the students of our institute after obtaining the consent and institutional ethical clearance. Continuous blood pressure monitoring and ECG recording was done in the subjects. Baseline (pre-exercise), post submaximal dynamic (Harvards step test) and post submaximal static exercise (hand-grip exercise) recordings of ABP and ECG were taken for analysis. The measured QT interval was corrected for heart rate using the formula of Bazett et al., {QTc=QT/RR(1/2)}.Statistical analysis was done using Graph pad Prism 5 software (California, USA). The baseline and post-exercise data were compared using paired t-test. A p<0.05 was taken to be statistical significant. RESULTS There were statistically significant increases in HR, SBP, DBP and QTc interval after dynamic exercise in comparison to the baseline values (p<0.05). Significant increase in HR (p<0.05) with no significant change in QTc and other cardiovascular parameters were recorded following static exercise (p>0.05). CONCLUSION Significant increase in QTc interval was observed after dynamic exercise, however, no change in QTc was observed following static exercise, and hence we conclude that static exercises may not be useful in assessing the cardiovascular status of an individual or in predicting cardiovascular events.

Peak Expiratory Flow Rate: A Useful Tool for Early Detection of Airway Obstruction in School Children

Context: Peak expiratory flow rate (PEFR) is an effort-dependent parameter, emerging from the large airways within about 100-120 msec of the start of forced expiration. It measures the degree of obstruction in the airways. A child from an asthmatic family, having significantly low PEFR values than its height and age matched peers, can be considered under impending asthma category.

Engaging medical undergraduates in question making: a novel way to reinforcing learning in physiology

The monotony of conventional didactic lectures makes students less attentive toward learning, and they tend to memorize isolated facts without understanding, just for the sake of passing exams. Therefore, to promote a habit of gaining indepth knowledge of basic sciences in medical undergraduates along with honing of their communication and analytical skills, we introduced this more interactive way of learning. The present study was performed on 99 first-semester medical students. After conventional didactic lectures, students were asked to prepare small conceptual questions on the topic. They were divided into two teams, which were made to ask questions to each other. If a team failed to answer, the student who questioned was supposed to answer to the satisfaction of the other teams student. Data were then obtained by getting feedback from the students on a 10-item questionnaire, and statistical evaluation was done using MS Excel and SPSS. To draft questions, students went through the whole system comprehensively and made questions from every possible aspect of the topic. Some of the questions (30%) were of recall type, but most judged higher cognitive domains. Student feedback revealed that they were satisfied, motivated to read more, and were confident of applying this learning and communication skills in future clinical practice. Students also expressed their desire to implement this activity as a regular feature of the curriculum. The activity resulted in an increase in student perceptions of their knowledge on the topic as well as communicative and analytical skills. This may eventually lead to better learning.

Evaluation of Aspartate Aminotransferase-to-Platelet Ratio Index as a Non-Invasive Marker for Liver Cirrhosis.

INTRODUCTION Liver biopsy is considered as a gold standard for the diagnosis of cirrhosis. Till date there is no non-invasive marker to replace it. AIM To investigate the effectiveness of Aspartate aminotransferase-to-platelet ratio index (APRI) as a non-invasive marker for liver cirrhosis. MATERIALS AND METHODS Fifty-one patients with cirrhosis, identified on USG abdomen were included in study. Platelet count and Aspartate aminotransferase (AST) were done using haematology automatic analyser and automatic HITACHI-912 Auto Analyser respectively. APRI was calculated for every patient using the formula {(AST / ULN) x 100}/platelet count (10(9)/L). Predictive accuracy was evaluated with a receiver-operating characteristics (ROC) curve. RESULTS APRI correctly classified 49 (96.1%) patients of cirrhosis with area under the ROC curve of 0.973 (95% CI) at cut-off 0.65 with negative predictive value (NPV) and Positive predictive value (PPV) of 96% and 96.1% respectively. The sensitivity and specificity of the test was found to be 96% and 96.1% respectively. CONCLUSION APRI could identify cirrhosis with high degree of accuracy in the studied patients.

EEG Abnormalities in Children with Speech and Language Impairment.

INTRODUCTION Epilepsy, a chronic condition of recurrent seizures, affects language, but the extent and nature of the language disturbance varies widely according to the type, severity, and cause of the epilepsy. There is paucity of literature on the electroencephalographic abnormalities in children with speech and language impairment. The present study was therefore planned to find the association of epileptiform EEG abnormalities in children with speech and language impairment and if present, their localization and lateralization to the language areas of the brain that are present predominantly in the left hemisphere. MATERIALS AND METHODS The study was conducted on Paediatric patients having speech and language impairment (n=94, age-2 to 8 years) selected on the basis of detailed history and neurologic examination. Video Electroencephalography (EEG) was performed as per American Clinical Neurophysiology Society guidelines using 16 channel RMS computerized EEG machine for a minimum of 40 minutes to capture both wakefulness and sleep along with activation procedures like hyperventilation (if feasible) and photic stimulation. EEG was reviewed for any abnormal EEG background, benign variants, interictal epileptiform discharges and ictal discharges. RESULTS In our cohort, 19.7% boys and 22.2% girls presented with seizures in their infancy and this gender difference was found to be statistically significant (p<0.05). EEG was abnormal in 47.9% children (45 out of 94) with no significant gender difference. Epileptiform EEG was seen in 73.6% of children with history of seizures and 41.3% of children without history of seizures (p<0.05). The EEG abnormities included: abnormal background (64.5%), presence of generalized interictal epileptiform discharges (57.8%), focal epileptiform discharges (20%) exclusively from left hemisphere and multifocal interictal epileptiform discharges (33.3%), each occurring in isolation or associated with other abnormities. CONCLUSION In the current study, it is definite that presence of generalized abnormalities in EEG are seen in higher frequency and focal interictal epileptiform discharges are solely seen in left hemisphere in children with speech and language impairment. Although, there is no distinct pattern of EEG abnormalities in such patients, we recommend a routine EEG in them and also brain imaging to complement the EEG findings.

ABER Assessment in Pre-school Children with Developmental Speech and Language Impairment.

INTRODUCTION Developmental speech and language disorders (DLD) constitute a group of disorders when children with normal intelligence and hearing fail to develop language in an age-appropriate manner. There is no definite or surrogate neurophysiologic laboratory marker to quantitate the extent of speech and language impairment. The current study was designed to evaluate the abnormalities in Auditory Brainstem Evoked Responses (ABER) in children with speech and language impairment who do not have a hearing deficit or autism. MATERIALS AND METHODS ABER recording was done in a cohort of 94 children (age 2-8 y) with DLD without overt hearing deficit or autism. The mean latencies for waves I, II, III, IV and V along with inter peak latencies for I-III, I-V, III-V and amplitude ratio of wave V/I was measured after click stimulus with intensities 110 db until 40 db and compared to age appropriate normograms. RESULTS The peak latencies for waves I, III & V, inter-peak latencies I-III & I-V, III-V and wave amplitude ratio V/I was found within normal limits in both ears of all the children when compared to age appropriate normograms. CONCLUSION The current study therefore emphasizes the fact that ABER may not be used/recommended as diagnostic or prognostic tool in children with speech and language impairment without autism or hearing deficit. The results and the recommendations of this study will definitely reduce the burden on electrophysiologist, laboratories and also save time and financial resources.

Chronic effects of aerobic and resistance exercise on cardio-metabolic profile in healthy nonobese subjects

Background and Aim: Exercise is considered the best preventive measure for cardiovascular (CV) morbidity. But, it is of paramount importance to know the type of exercise that provides maximum benefits. This study was planned to compare various CV and biochemical parameters in subjects performing different types of exercise. Methods: The study was performed on young healthy nonobese volunteers divided into three groups: Sedentary controls, resistance exercise and aerobic exercise groups. In all the groups, CV parameters viz., heart rate (HR) and blood pressure (systolic and diastolic) were measured and the blood sample were analyzed for fasting blood glucose (FBG), lipid profile, serum creatinine, blood urea, uric acid and C‑reactive protein (CRP) using standard procedures. This was followed by comparison of these parameters among the three groups. Results: HR (P = 0.002), systolic blood pressure (P = 0.021) and rate pressure product (P = 0.003) were significantly low in aerobic group in comparison to the sedentary controls as well as in resistance group. FBG (P = 0.010), total cholesterol (P < 0.001), low density lipoprotein (P < 0.001), triglyceride (P = 0.012) and lipid risk factors (P < 0.001) were significantly lower in subjects performing aerobic exercises than in subjects performing resistance exercises and in sedentary controls. Serum high‑density lipoprotein (HDL) (P < 0.001) was significantly higher in resistance and aerobic groups than in the control group. Serum creatinine was found to be significantly higher in the aerobic group with no significant dif ference in CRP level among the three groups. Conclusion: Aerobic exercises might have extra benefits due to less myocardial oxygen consumption and load, and increasing HDL. However, as creatinine level gets altered due to aerobic exercise in the absence of any renal damage, this should be taken into consideration while assessing renal functions in these individuals.