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Background: In this study we have tried to derive normative reference values for commonly tested motor and sensory nerve conduction studies of right and left side lower limb nerves in 86 healthy individuals of Bhavnagar city of Gujarat, India. Material and method: the study was done on total of 86 apparently young healthy males and females aged between 18 to 36 years. Nerve conduction studies of Tibial, common Peroneal, Superficial Peroneal, Sural nerves and F wave study for Tibial and Peroneal nerves for both sides of limbs were done. All data were recorded and statistically analysed. Result: From this study we have derived Normative reference values for lower limb nerves. Nerve conduction velocity values for Tibial nerve 46.64±4.45 m/s, Common Peroneal nerve 47.61±3.98 m/s, Superficial Peroneal nerve 51.91±7.36 m/s, Sural nerve 59.74±2.66 m/s. F min. Latency for the Tibial nerve 46.62±2.50 ms and the peroneal nerve 45.29±1.30 ms, F mean latency for Tibial 50.61±1.38 ms and Peroneal nerve 49.82±0.65 ms. Conclusion: The present study derived normative reference data for the Nerve conduction Study of commonly performed nerves of the lower limbs like the Tibial nerve, Common Peroneal nerve, Superficial peroneal nerve, and Sural nerve in the population of Bhavnagar district. [ABSTRACT FROM AUTHOR]

Background: Background: In this study we have tried to derive normative reference values for commonly tested motor and sensory nerve conduction studies of right and left side of upper limb nerves in 86 healthy individuals of Bhavnagar city of Gujarat, India. Material And Method: the study was done on total of 86 apparently young healthy males and females aged between 18 to 36 years. Nerve conduction studies of Median nerve, Ulnar nerve and Radial nerve for both sides of limbs were done. All the data were recorded and statistically analysed. Result: From this study we have derived Normative reference values for upper limb nerves. Derived nerve conduction velocity values are:Median nerve MNCV63.09 ± 1.89 m/s;SNCV 55.38 ± 6.98 m/s, Ulnar nerve MNCV 58.30 ± 8.46 m/s; SNCV 53.44 ± 3.98 m/s, Radial nerve MNCV 57.29 ± 13.31m/s;SNCV 66.19 ± 8.78 m/s, Conclusion: The present study derived normative reference data for the motor and sensory components of nerve conduction Study of nerves of the upper limbs like the Median nerve, Ulnar nerve, and radial nerve in the population of Bhavnagar district. [ABSTRACT FROM AUTHOR]

Purpose: Type 2 diabetes mellitus (T2DM) is known to produce diabetic retinopathy (DR). Pulse wave analysis (PWA) provides arterial stiffness (AS) and central hemodynamic (CH) parameters. We studied the effect of DR on AS and CH parameters in type 2 diabetics (T2D). Methods: We performed a cross-sectional study on 47 T2Ds attending a private ophthalmology clinic screened for DR by optical coherence tomography angiography and divided into NDR (non-DR), NPDR (non-proliferative DR), and PDR (proliferative DR). Mobil-o-graph (IEM, Germany) based oscillometric PWA yielded AS and CH parameters. They were further compared between groups stratified by DR with P value set at 0.05. Results: Participants had a mean age 62, mean diabetes duration 9 years, high mean BMI, and high prevalence of physical inactivity, hypertension, and poor diseases control. Significant differences were lacking in NPDR, NDR, and PDR in rate pressure product (mean 112.71 vs 116.06 vs 119.57), central pulse pressure (mean 46.50 vs 43.09 vs 42.72), stroke work (mean 153.36 vs 132.36 vs 146.08), augmentation index (mean 29.43 vs 33.14 vs 31.64), and aortic pulse wave velocity (mean 10.06 vs 9.08 vs 9.06). There was no clear pattern of distribution of most parameters among the three subgroups. Conclusion: We found a lack of association between DR and cardiovascular ageing studied by AS and hemodynamic parameters. It suggests a possible difference in risk factors for both of these aftermaths of T2DM and calls for further prospective studies with a large sample size. [ABSTRACT FROM AUTHOR]

Background:In our routine practice patient were undergone CT scan of brain as well as other laboratory investigation for various traumatic brain injury and neurological complain and its management. They visit many premises for diagnosis and investigation. If we can predict the hemoglobin level from CT brain itself, we can reduce turnaround time for patient and increase throughput of patients for hospital. Keeping this in mind we had conducted this study to see the correlation between hemoglobin level and CT attenuation value of cranial Dural sinuses. Material And Methods: A prospective observational study was performed to demonstrate association between computed tomography (CT) attenuation value (Hounsfield unit (HU)) of dural venous sinuses and hemoglobin level from unenhanced CT scan of the brain. The non-contrast CT brain of total 245 patients done during October 2017 to September 2018 at medical college attached tertiary care was observed. Two measurements of HU value were taken on two adjacent slices using 10mm2 of ROI for each site, from superior sagittal sinus (SSS) and torcular herophili (TOH). The value was averaged for superior sagittal sinus, confluence of sinus and is compared with hemoglobin of patients. Result: Mean HU VALUE in SSS of females and male had 48.47 and 51.85 respectively. Mean HU VALUE in TOH of females and male had 47.46 and 50.93 respectively. Positive and significant correlation was noted between HB and SSS average, HB and TOH Average. Conclusion: Based on our result CT attenuation value (HU) value of torcular herophili and superior sagittal sinus from unenhanced CT scan of brain can be used to predict the hemoglobin level of a person. The HU value of sinus can give insight into pathology such as anemia, polycythemia or cranial sinus thrombosis. [ABSTRACT FROM AUTHOR]

Introduction: Type 1 Diabetes is an early onset disease that imposes significant cardiovascular risk. Arterial stiffness and central haemodynamics are immediate and discrete parameters but studied scarcely. Pulse wave analysis (PWA) allows non-invasive measurement of them which we undertook in diabetics. Methodology: We performed a case control study on 36 treated type 1 diabetics and 36 nondiabetic, normotensive, matched controls. Oscillometric pulse wave analysis (PWA) was performed by Mobil-o-Graph (IEM, Germany). Parameters were compared between case and controls. Multiple linear regressions were accomplished to find significant predictors. P < 0.05 was taken as statistical significance. Results: - Cases showed significantly raised brachial haemodynamics (blood pressure, heart rate, rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, pulse pressure amplification) and central haemodynamics (central blood pressure, cardiac output, stroke work) than controls, with statistical significance for not all. Most outcome parameters were predicted by age, HR, BP to lesser extents. Genders, presence of hypertension, glycemic control, blood pressure control, physical activity were not significantly affecting study outcomes in case group. Conclusion: Gujarati type 1 diabetics had beyond brachial blood pressure, adverse profile of discrete cardiovascular parameters; independent of conventional confounders; suggesting vascular progeria. This baseline work hints further study of these PWA parameters. [ABSTRACT FROM AUTHOR]

Background: First-degree relatives (FDRs) of hypertensive (HT) are predisposed to hypertension (HTN) which accelerates cardiovascular aging. Same can be studied noninvasively by pulse wave analysis (PWA), encompassing central hemodynamics such as central blood pressure (cBP), cardiac output, and stroke work (SW) and vascular stiffness parameters such as pulse wave velocity (PWV) and augmentation index at HR 75 (AIx@75). We studied PWA-derived cardiovascular parameters in FDRs of HT compared to controls. Materials and Methods: We conducted a case--control study in 119 FDRs of HT and 119 matched controls. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) and cardiovascular parameters were compared. P < 0.05 was considered statistically significant. Results: Groups were comparable with gender, age, height, weight, body mass index, and physical activity. FDRs of HT had significantly higher brachial and cBPs, SW (101.41 ± 25.44 vs. 88.31 ± 20.25, P = 0.001), rate pressure product-119.40 ± 25.34 vs. 108.34 ± 18.17, P < 0.0001), PWV (5.22 ± 0.46, P < 0.0001), and AIx@75 (31.48 ± 9.01 vs. 27.95 ± 9.4, P = 0.002) than control. Dependent study variables correlated with brachial blood pressure more in magnitude and significance level than age or anthropometric variables. PWA results of FDR with maternal inheritance did not differ significantly from those with paternal inheritance. Conclusion: PWA reveals early cardiovascular aging in young FDRs of HTs. It clues to future cardiovascular disease including HTN itself, need for primary prevention, and further study for consolidation of these results. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is linked to cardiac dysautonomia that can end up as life-threatening arrhythmias. The same can be screened by simple electrocardiogram (ECG)-based QTc (QT corrected for heart rate) interval which indicates repolarization abnormality. We quantified QTc interval among treated hypertensives in comparison to controls, testing effect of age, gender, and blood pressure. Methods: We conducted a cross-sectional study was done at a tertiary care teaching hospital of Gujarat, India, on 142 hypertensives on monotherapy (60 males, 82 females) and 72 age-, sex-, and time-matched normotensives. ECG was recorded with minimum 10 complexes of Lead II. QTc was derived from average of 10 values, using Bazett's formula. QTc > 0.43 s in male and > 0.45 s in female was considered abnormal. Results: Hypertensives (mean age 40 and duration 5 years) had significantly higher QTc value than normotensives among males (0.42 vs. 0.40, P < 0.001), females (0.44 vs. 0.41, P < 0.001), and in total (0.43 vs. 0.41, P < 0.001) with 24% prevalence of ECG-based left ventricular hypertrophy. Hypertensives had odds ratio 1.63 in males (P = 0.15), 23.71 in females (P = 0.003), and 3.83 in total (P < 0.001) for prolonged QTc. QTc values were significantly affected by increasing age amongst hypertensives but not by duration of HTN or current blood pressure. Conclusions: Our study showed a high prevalence of prolonged QTc, both qualitatively and quantitatively, in hypertensives on monotherapy with poor pressure control, associated with female gender and age but not duration or blood pressure. This underscores high risk of repolarization abnormality induced future event, suggesting QTc screening as primary prevention. [ABSTRACT FROM AUTHOR]

Objectives: To study the electrocardiogram (ECG) based QT parameters namely QTc (heart rate corrected QT), QTd (QT dispersion) in treated type 2 diabetics (T2D) and the effect of hypertension (HTN), blood pressure (BP) control, and antihypertensives used on the above parameters. Materials and Methods: We performed a cross-sectional study in a tertiary care hospital of Gujarat, India, on 199 T2D (67 males and 132 females). Standard 12-lead ECG was recorded to derive QTc (Bazett's formula), QTd, and ECG left ventricular hypertrophy (LVH). QTc >0.43 s in male and >0.45 s in female and QTd >80 msec were considered abnormal. Results: Hypertensives (n = 138) and normotensives (n = 61) were comparable for most confounders. Hypertensives had better profile of QTc and QTd than normotensives. T2D with controlled BP revealed slightly better, though insignificant; QTc, QTd than those with BP uncontrolled. QT parameters were not significantly correlated with age, heart rate, or BP. Qualitative differences exceeded quantitative difference in QTc and QTd evaluation. There was no significant effect of use or nonuse of preventive pharmacotherapy on QT parameters. Conclusion: Low-to-moderate prevailing cardiac repolarization abnormality in T2D with very low ECG LVH was unaffected by HTN as a disease, its control status, and treatment modalities suggesting primary preventive role of antihypertensive use without class difference. [ABSTRACT FROM AUTHOR]

Objectives: To study the effect of disease duration, treatment and risk factors on QTc interval among young hypertensives. Materials and Methods: A case-control study was conducted on 142 hypertensives (60 males, 82 females) taking calcium channel blocker (CCB) or angiotensin-converting enzyme inhibitor (ACEI) as monotherapy. After blood pressure measurement, we recorded lead II electrocardiograph with minimum ten waveforms. QTc was derived from average of ten values using Bazett's formula. QTc interval >0.43 s in male and >0.45 s in female was considered abnormal. Results: Cases had mean duration of hypertension 5 years, mean age of 40 years, and poor blood pressure control (systolic blood pressure >140 and diastolic blood pressure >90 mm of Hg). Newly diagnosed hypertensives had significantly higher QTc values than the matched known cases (0.44 vs. 0.42 s, P < 0.05). Known hypertensives did not differ significantly in QTc values by the duration of disease. CCB users showed small, insignificant disadvantage for abnormally prolonged QTc values than ACEI users. With coexisting diabetes, smoking, and positive family history of hypertension, there was odds risk of 7.69, 2.75, and 2.54, respectively for prolonged QTc. Conclusion: Our study showed prolonged QTc in hypertensives more so in newly diagnosed, unaffected by duration or use of ACEI, or CCB but associated with modifiable risk factors. This underscores high risk of repolarization abnormality-induced future events, suggesting early screening of hypertension, strict blood pressure control, optimum use of QTc measurement, and preventive pharmacotherapy to reduce this aftermath. [ABSTRACT FROM AUTHOR]

Objective: To correlate BMI, lipidemic control, and statin therapy with PAD measured by ABI in low risk type 2 diabetics. Materials and Methods: A sample of 101 nonsmoking, asymptomatic type 2 diabetics (50 males, 51 females) with known glycemic (fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin) and lipidemic (total cholesterol, lipoproteins, and triglycerides [TGAs]) control was taken. Vascular Doppler was used to derive ABI and PAD was defined as ABI <0.9. ABI values were compared amongst groups and P < 0.05 was considered statistically significant. Results: We found fairly good lipid but poor glycemic control and prevalence of PAD 30%. There was insignificantly low ABI profile in patient having BMI ≥25, hyperlipidemia and absent statin therapy with odds ratio being highest for TGAs ≥150 (3.23) followed by BMI ≥25 (2.61), high-density lipoprotein ≤50 (1.61), low-density lipoprotein ≥100 (1.20), and disuse of statin (1.14) with significance only for BMI. Conclusion: We observed small, insignificant PAD risk by dyslipidemia or non-use of statins in low-risk ambulatory T2DM patients, not so by BMI. This suggests importance of good glycemic control, maintenance of optimum weight, and lifestyle modifications as primary prevention rather than opting for costly and inefficient secondary prevention. [ABSTRACT FROM AUTHOR]

Introduction: Smoking is an increasingly popular indulgence in India. Assessment by routine spirometry falls short of direct functional parameter like Diffusion Lung Capacity (DLC), also known as lung transfer factor (LTF). Aim: To measure LTF amongst middle aged male smokers and to study various correlates for it. Materials and Methods: Total of 45 asymptomatic male current smok ers were enrolled for this cross-sectional study conducted at pulmonary function testing lab of Physiology Department of our college. Smoking history was evaluated and smoking index was defined by product of number smoked per day and years smoked. We used instrument Ultima PFX of Medgraphic Company. After pre syringe calibration LTF was measured by Methane mixture using protocols of ATS. Parameters measured were Dlco-uncorrected, corrected and normalized to VA (alveolar volume). Results were compared for statistical significance and significance was set as p <0.05. Results: In case group of 45(25 bidi and 20 cigarette smokers) mean age was 30 years, mean duration was 8 years, mean smoking index was 60. We found small insignificant decline in actual LTF values than predicted which was not significantly different between bidi and cigarette smokers. Duration, age and intensity of smoking were negatively and significantly correlated with LTF value while anthropometric parameters were not. Conclusion: Smoking adversely affects LTF in young asymptomatic current male smoker that further declines with severity of smoking and with duration regardless of type of smoking. With years to come, these alterations can largely be prevented by smoking cessation, at least theoretically. [ABSTRACT FROM AUTHOR]

Background: Obesity and Type 2 diabetes mellitus are on rise with cause-effect relationship. Diabetics monitor blood sugar, neglecting qualitative body composition, leaving residual threat of ectopic fat unattended. We tried to correlate glycemic triad with parameters of body composition derived objectively by bioelectrical impedance analysis (BIA). Materials and Methods: A sample of 78 under treatment sedentary Type 2 diabetics of either sex with known glycemic and lipidemic control from our city. Following baseline assessment measurement was done by instrument Omron Karada Scan (Model HBF-510, China) using the principle of tetra poplar BIA to derive parameters of body composition. We tried to correlate glycemic triad with these parameters, both directly as well as after defining them as per established cutoff norms. Results: We found poor glycemic control in the study group (20% for Hb1AC), high body mass index, subcutaneous fat, visceral fat (VF), total body fat (TBF), and lesser mass of skeletal muscle in Type 2 diabetics. However, there were small, insignificant, and inconsistent difference of these parameters while directly correlating with the fasting blood sugar, postprandial blood sugar, and glycosylated hemoglobin. On qualitative assessment, the impact of glycemic control as per standard norms, the risk of high VF, high TBF, low skeletal muscle mass was though high (between 1 and 2) in Type 2 diabetics with poor glycemic control as compared to good glycemics, but each strength lacks statistical significance. Conclusion: BIA reveals that Type 2 diabetics have more ectopic fat on expense of skeletal muscle that do not correlate with current glycemic status, both quantitatively and qualitatively. Measurement of body composition can be included and subjects can be motivated for lifestyle modification strategies while managing metabolic derangements of Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Deranged body fat and muscle mass are aftermaths of uncontrolled diabetes. Anthropometric methods like body mass index (BMI) do not give qualitative inferences like total body fat (TBF), visceral fat (VHF) or subcutaneous fat (S) that can be given by bio-electrical impedance analysis (BIA). We studied body composition of type 2 diabetics in comparison to controls matched by age-sex, weight and BMI separately. Methods: Seventy-eight under-treatment type 2 diabetics of either sex with known glycemic and lipidemic control and equal number of controls with three patterns of matching were taken from our city. We derived parameters of body composition in both groups by Omron Karada Scan (Model HBF-510, China), using the principle of tetra poplar BIA and compared them for statistical significance. Results: We found significantly more SF (30.47% ± 7.73%), VF (11.94% ± 4.97%) and TBF (33.96% ± 6.07%) and significantly lesser skeletal muscle mass (23.39% ± 4.49%) in type 2 diabetics as compared to controls, persisting even after matching with weight or BMI. On assessing qualitatively, the risk of high VF, high TBF, low skeletal muscle mass was significantly high in type 2 diabetics, which were 10.41, 3.01, 9.21 respectively for comparable BMI and 6.78, 3.51, 11.93 respectively for comparable weight. Conclusions: BIA reveals that type 2 diabetics have more ectopic fat on the expense of skeletal muscle that persists even after matching by weight or BMI, both quantitatively and qualitatively. Measurement of body composition can be included as a primary care strategy to motivate lifestyle modifications while managing metabolic deran-gements of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Air pollution due to road traffic is a serious health hazard and air quality crisis in cities is mainly due to vehicular emission. Thus the persons who are continuously exposed are at an increased risk. The study was carried out to evaluate the extent of impairment in lung function in traffic police personnel compared to matched unexposed control group. Materials and Methods: A cross-sectional study was conducted to measure the spirometric parameters of 100 traffic police personnel, aged 20-55 years, working in Saurashtra region, as compared to matched control group, consisting of 100 unexposed males. Measurement of lung volumes and capacities was done with SPIROEXCEL. The statistical analysis was carried out with Graph pad instat 3. Results: Traffic police personnel had significantly declined forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), slow vital capacity (SVC) and maximum voluntary ventilation (MVV) when compared with predictive normal values, which is probably due to exposure to vehicular exhaust. Comparison of test values between groups showed significantly reduced FVC, MVV and increased FEV1/FVC ratio and insignificantly declined FEV1 and SVC in cases as compared to controls. Traffic personnel with longer duration of exposure showed significantly reduced lung functions than those with shorter duration. Smokers showed lower test values as compared to non-smokers with significance only in unexposed group. Conclusion: The effect of pollution by vehicular exhausts may be responsible for these pulmonary function impairments and traffic police personnel should be offered personal protective or preventive measures. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension represents a multifactorial disease of blood pressure (BP) regulation with persistently elevated systolic and/or diastolic BP over 140/90 mmHg. 90% cases of hypertension have to be assigned as essential hypertension. Research has proven that patients with essential hypertension, especially at an early stage without any medication, display autonomic disturbance in the form of increase in sympathetic and a reduction in parasympathetic activity of the ANS. The heart rate variability analysis is a powerful tool in assessment of the cardiac autonomic nerve function. It is non-invasive, an accurate, reliable, reproducible, yet simple to measure and to process and It is indicative of neuro-cardiac fitness and overall health. Objective - The aim of the present study was to (1) measure Heart rate variability (HRV) in Essential Hypertension (2) effect of different drugs on Heart rate variability in hypertension among hypertensive subjects. Materials and Methods: This study was conducted On 100 Hypertension subjects & 100 Normal subjects after obtaining informed written consent by use of Heart rate variability Analysis System Variowin-HR Medical System. Results: The mean values of Very low frequency (VLF), Low frequency (LF), High frequency (HF), Normalized High Frequency (HF (nu) & all time domain parameters were found to be reduced significantly in hypertensive subjects as compared to control subjects. The mean values of LF (nu), LF / HF ratio were significantly high in hypertensive subjects as compared to control subjects. Conclusion: observations in our study demonstrate that hypertensive subjects had markedly reduced heart rate variability (HRV) in comparison with normal subjects which indicate cardiac autonomic disturbances in hypertension subjects in causation of essential hypertension. [ABSTRACT FROM AUTHOR]

Purpose: Remarkable and uncontrollable changes with modification during pregnancy are connected with the autonomic control and consequently with the heart rate variability (HRV). Heart rate variability is a sum of different mechanisms and if pregnancy is a state of change, these modifications could be extracted from HRV analysis. Objective: To assess the effect of pregnancy on heart rate variability among pregnant mothers during first trimester of pregnancy and third trimester of pregnancy. Materials and Methods: HRV was measured for 5 minutes of continuous recording of electrocardiogram (ECG) lead II, using windows based HRV analysis system variowin-HR after obtaining permission from the Institutional Review Board of Government Medical College, Bhavnagar and written consent from 30 pregnant subjects and 30 non-pregnant control subjects at autonomic function lab, Dept of Physiology, Bhavnagar. Result: Frequency domain parameters, very low frequency (VLF), low frequency (LF), high frequency (HF) and HF normalized unit (nu) were significantly decreased and LF (nu) and LF/HF significantly increased in pregnant subject in 3rd trimester as compared to their 1st trimester of pregnancy. Time Domain parameters like SDNN, RMSSD, SDSD, NN50 count, pNN50, SD1/SD2, triangular HRV index and average R-R interval were significantly decreased during 3rd trimester of pregnancy. Conclusion: The inhibition of resting parasympathetic activity or vagal blockage and an increment of the sympathetic modulation during the 3rd third trimester of gestation in pregnancy as compared to their 1st trimester and healthy non-pregnant subjects. Sympathovagal imbalance and abnormally low HRV may more pronounce during later stage of normal pregnancy. [ABSTRACT FROM AUTHOR]

Background: Exposure to Occupational noise is the major avoidable cause of permanent hearing loss that is preventable by protective measures. Present study evaluated hearing profile and effects of shift, sex, and smoking on hearing loss in plastic weavers working in textile industry exposed to impact type of noise. Materials and Methods: A cross-sectional study of hearing threshold of various shift workers of plastic weaving industries (18 males, 32 females) at various frequencies was done and effect of various factors was tested at low and high frequencies and compared at 4 kHz, 6 kHz, and 8 kHz statistically. Results: Hearing thresholds were significantly higher at high frequencies than speech frequencies, in day shift workers than night shift workers and within day shift workers more with continuous type of shift work than interrupted type. Females showed better hearing than males and for non-smokers than smokers, but the difference observed in both instances proved statistically insignificant. Conclusion: It can be concluded that the use of alternate day and night shift, interrupted day shift may be used to prevent hearing loss and for further confirmation few more studies are warranted. Being female and non smoking also proved an advantage. Comparatively, mild to moderate degree of hearing loss further reinforces the scope of prevention by hearing protective devices and interrupted shift design of work. [ABSTRACT FROM AUTHOR]

Background: The textile workers exposed to industrial noise are prone to develop hearing loss concentrated mainly at high audible frequencies. It is affected by duration of exposure and type of noise. Aims: Present study was conducted to (a) investigate hearing thresholds of textile workers by pure tone audiometry, (b) correlate thresholds at 4 kHz, 6 kHz and 8 kHz between noise exposed and unexposed group and (c) study effect of duration of exposure on hearing profile. Materials and Methods: A cross-sectional study was carried out on 50 weavers of plastic industries exposed to high levels of constant noise. Objectively, hearing defects were inquired by self-administered questionnaires. Subjectively, pure tone audiometry was carried out to measure hearing thresholds at various frequencies. It was simultaneously compared with the similar data of matched control group. Results: Prevalence of hearing loss symptom and hearing thresholds were more in exposed group than in control group. There was significant hearing loss at high frequency as compared to lower ones. Audiometry revealed notch at 4 kHz with less effect at 6 or 8 kHz, cumulative effect of duration of exposure. Conclusion: Textile weavers are more at risk to develop Occupational Noise Induced Hearing Loss (ONIHL) mainly affecting higher frequencies concentrated at 4 kHz. Despite least effects on hearing, this disease silently progresses and there is a definite scope of prevention by appropriate protective measures. [ABSTRACT FROM AUTHOR]

Background: Influence of sex on brainstem auditory evoked potential (BAEP) is not well understood with few studies in India that targets young Teenagers. Aim: Our study aimed to look into gender, head circumference, and body mass index (BMI) as a factor affecting BAEPs of healthy late teenagers. Materials and Methods: BAEP responses were elicited in age-matched teenager college students using standard protocol. Results of absolute latencies and interpeak latencies (IPLs) were compared among Male and female groups and compared for significance as such and after normalizing head size and BMI and tested for significant difference, if any. Results: Latencies and IPLs of BAEP were lower in males when compared with females, but significance was found only for the later parameter. IPLs showing significant gender difference were for I-III and III-V but not I-V. When test groups with comparable head size and BMI were compared, the difference decreased with neither of the parameter being statistically significant. Conclusion: Utility of BAEP can be optimized by establishing normative data for every setup based on BMI and head circumference along with age and gender before using it as a clinical tool. [ABSTRACT FROM AUTHOR]

Background: Good Clinical Practice (GCP) is an international quality standard for conducting trials that involve participation of human subjects. Good Clinical Practice guidelines are provide the human rights protection, assurance of the safety and well being of subject participating in clinical trials of the newly developed compound. The objective of this study was to show the effectiveness of workshop training in basic principles of Good Clinical Practice among the Medical teachers of Government Medical College, Bhavnagar and will learn the practical application of GCP regulations for critical components of the clinical research Process. Objective: The main objective of this study was to show the effectiveness of workshop training in basic principles of Good Clinical Practice among the Medical teachers Methods: A total 125 medical teachers of Government Medical College attached with Sir Takhtsinhji Hospital, a tertiary care hospital, Bhavnagar, Gujarat professionals were participated in Good Clinical Practice training workshop. The study was included total twenty questioners based on the most widely accepted international document forming the base for ICH Harmonised Tripartite Guideline for GCP (ICH-GCP E6), which defines in detail the responsibilities and obligations of parties engaged in clinical research. They were submitted given questioners with answers before and after the workshop training. The data was Mean and SD calculated using SPSS software. Results: The total twenty questions were analyzed and compare with the standard key of this. Pre training test score of Question no. 2, 5, 7, 16 was 19(15%), 35 (28%), 21 (17%), 14 (11%) and post training score was 70(88%), 95(76%), 64(51%), 75(60%) respectively. This number as well as percentage could show more improvement in knowledge regarding basic principle of Good Clinical Practice. In our study results shown that there was improve overall knowledge after the given Good Clinical practice training. Conclusion - Training workshop with interactive sessions among the participants after some lectures followed by Multiple Choice Questions test not only improved but also update the participations knowledge regarding subject. [ABSTRACT FROM AUTHOR]

Context: The knowledge of pharmacology is an important necessity for the prevention and treatment of diseases. The study aimed to find out the beneficial effects of case-based learning (CBL) compare to didactic lecture in pharmacology and to evaluate the perceptions of students regarding the CBL. Methods: A total of 68 students took part in the study and were randomly assigned to two equal groups: Group 1 (CBL group) and Group 2 (lecture group). Cases, test items, students feedback questionnaires were developed and peer viewed by experts. Group 1 underwent the CBL and the same topics were handled as a didactic lecture in Group 2 concurrently. Written tests were conducted after completion of each session and the perceptions of students were evaluated. Results: The Group 1 showed significantly increased (P < 0.001) test score in knowledge-based and critical thinking (clinical application) as compared to Group 2. The perceptions of students were quite positive regarding the CBL as a majority revealed that they has better understanding of concepts (82.35%), self-learning approach (91.17%), critical thinking with integration clinical subjects (97.05%), and active participation in discussion (76.47%) as well as interest in subject (88.24%) through the CBL process. Conclusion: Self-learning approach, critical thinking with the integration of subject, and arousal of interest in the subject were positive effects of CBL in the teaching of concepts of pharmacology. [ABSTRACT FROM AUTHOR]

Background: Present study aimed to see effect of number of stimuli on auditory reaction time. Reaction is purposeful voluntary response to different stimuli as auditory stimuli. Auditory reaction time is time required to response to auditory stimuli. Materials and Methods: The auditory reaction time was measured by the reaction time instrument in subjects. Simple reaction time and choice reaction time measured. During the reaction time testing, auditory stimuli were given for three times and minimum reaction time was taken as the final reaction time for that sensory modality of that subject. The results were statistically analyzed and were recorded as mean ± standard deviation and Student's paired t-test was applied to check the level of significance. Results and Conclusion: The study shows that simple auditory reaction time is less than choice auditory reaction time. Mental processes are involved in identification of stimulus, response selection, and programming and this takes certain time. Response to stimuli would be faster if number of stimuli is lesser in number. In routine life, many works done on information of auditory stimuli. Person should be careful while driving in talking with others or in mobiles. Training reduces reaction time. In medical examination, there are identification of instruments, graphs, bones, and viva questions as well. Student can practice and decrease mental processing time for identification of all this and can respond quickly. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A Study of Effect of Shift Work, Sex and Smoking on Development of ONIHL in Plastic Weavers" by J. D. Solanki and colleagues that was published in a 2013 issue.

During adolescence, there is a tendency to sleep late and sleep less because of altered psychosocial and life-style changes. Recent studies have demonstrated the link between sleeping less and gaining weight in children, adolescents, and adults. We studied the effect of late sleeping and sleeping less on body mass index (BMI) in medical college freshmen. All participants were adolescents (104 male and 38 female adolescents, mean age 17.77±0.79 years). After obtaining informed consent, they filled out a questionnaire about their sleeping habits. Height and weight were measured after a brief history taking and clinical examination. BMI increased significantly with decrease in total sleep duration and with delayed bedtime. Late sleeping individuals (after midnight) had significantly less sleep duration (6.78 hours v 7.74 hours, P<0.001), more day time sleepiness (85.2% v 69.3%, P=0.033) and more gap between dinner time and going to sleep (234.16 min v 155.45 min, P<0.001). Increased BMI in late sleepers may be explained by low physical activity during the day caused by excess sleepiness and increased calorie intake with a gap of 5-6 hours between dinner and sleep. Sleep habits of late sleeping and sleeping less contribute to increase BMI in adolescents. [ABSTRACT FROM AUTHOR]

Background: Obesity and vascular ageing are two facets of type 2 diabetes (T2Ds) to study. The former can be studied by qualitative body fat analysis using bio-electrical impedance (BIA) and later with blood pressure by pulse wave analysis (PWA). We studied the association between BIA and PWA parameters in T2Ds., Methodology: One hundred and fifty-six T2Ds on treatment were evaluated for BIA (Omron Karada Scan, China) and PWA (IEM, Stolberg, Germany). BIA parameters (weight, BMI, total body fat, visceral fat, subcutaneous fat, skeletal muscle mass) and PWA parameters (arterial stiffness, brachial haemodynamics, aortic blood pressures, central haemodynamics) were studied. Comparison, correlation, risk association, and predictions were done with a p-value < 0.05 as statistically significant., Results: The mean age was 57.7 years, while the mean BMI was 22.8 kg/m2. The prevalence of hypertension was 50%, while the prevalence of glycaemic control was 10%. The correlation between BIA and PWA parameters in >75% instants was weak and insignificant (especially for aortic parameters and central haemodynamics). Female gender, BMI < 22.5 kg/m2, VF< 10, and low/normal TBF were associated with comparatively high PWA parameters, but inconsistently. High BMI or VF did not impose a significant Odds risk of high aortic pulse wave velocity or central pulse pressure. Visceral fat and aortic pulse wave velocities were not significantly predicted by blood pressure, BMI, and heart rate., Conclusion: Among rural type 2 diabetics with a mean BMI of 22.8 kg/m2 and poor glycaemic control, there is largely a lack of association between obesity and vascular aging, suggesting differences in time course and pathology of the two entities in type 2 diabetics. Further studies are recommended., (Copyright © 2023 Nigerian Medical Association.)

Background: Diabetic peripheral neuropathy (DPN) is common microvascular complication with lack of data from many regions. Vibration perception threshold (VPT) is an objective tool to screen vibration-based neuropathy both quantitatively and qualitatively. We studied prevalence that correlates VPT in diabetic sample population., Methods: A cross-sectional study was performed in 100 under treatment urban type 2 diabetics. Using bioesthesiometer, we tested VPT from sole of lower limbs of each participant. VPT >25 was considered as DPN. VPT was further correlated to determinants using t test, chi square, and multiple linear regressions. P < 0.05 was taken as statistically significant., Results: Mean age was 57, mean duration was 9.42 years, 40% were good glycemic, 28% were symptomatic for neuropathy, half subjects had co-existing hypertension and positive family history. VPT >25 was prevalent in 38% participants and mild, moderate, severe grades of DPN were present in 10%, 20%, 38%, respectively. VPT was associated with all three measures of glycemic control both quantitatively and qualitatively imposing significant odds risk (3.45, 2.63, 3.63 for HbA1C, FPG, 2hPG, respectively). Presence of symptoms, duration, and family history were significant predictors of VPT, whereas age, gender, hypertension, hyperlipidemia, and glycemic control were not., Conclusion: In chronic type 2 diabetics from a city Gujarat, we report 38% prevalence of DPN, related to symptoms, duration, family history, and all measures of glycemic triad. Unrelated to age and gender, VPT is superior to symptoms to detect DPN and it should be used optimally to insinuate timely preventive measures., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Background: Menopause, a cardiovascular risk in mid-life women, is studied in terms of blood pressure mostly. Arterial stiffness (AS) and central hemodynamics (CH) are direct surrogates measured by pulse wave analysis (PWA) with no study from our region., Objective: We studied AS, CH in relation to menopause using PWA., Materials and Methods: A cross-sectional study was performed in 134 middle-aged females divided into groups with or without menopause. Oscillometric PWA done by Mobil-o-Graph (IEM, Germany) gave - AS like augmentation pressure, augmentation index at heart rate (HR) 75, aortic pulse wave velocity (aPWV), and total AS pulse pressure amplification; CH like aortic blood pressure, cardiac output and related parameters, peripheral resistance, stroke work, prevalent brachial/central hypertension, and raised central pulse pressure. They were further compared between groups, in relation to body mass index (BMI) and by multiple regressions with P < 0.05 as statistical significance., Results: Postmenopausal women were significantly elder, physically inactive with comparable BMI and showed higher AS (only aPWV was significantly different) and CH. BMI was unrelated to AS or CH in postmenopausal group. Age (except for aPWV), BMI, and HR (except for AIx@75) were insignificant predictors, while systolic blood pressure (SBP) in premenopausal and diastolic blood pressure (DBP) in postmenopausal group was major AS predictors. Age, HR, and BMI were insignificant predictors, while SBP more than DBP was significant predictors of CH., Conclusions: In obese, predominantly sedentary midlife Gujarati women, menopause negatively affects AS and hemodynamics, central more than peripheral. Menopause accelerates cardiovascular aging, independent of BMI, and age that calls for further studies., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Mid-life Health.)

Introduction: Hypertension is the most prevalent noncommunicable disorder, studied in terms of brachial blood pressure. Direct parameters like central hemodynamics and arterial stiffness, though superior, are not studied much. The same can be studied by pulse-wave analysis (PWA) and we did that in euglycemic treated hypertensives., Materials and Methods: A case-control study was conducted in 258 treated euglycemic hypertensives and 258 matched controls. Oscillometric PWA was accomplished by Mobil-O-Graph (IEM, Germany). Parameters were further analyzed for the effect of gender, physical activity, body mass index (BMI) (cutoff 23), blood pressure control, and duration (cutoff 5 years). Multiple linear regressions were used to find significant predictors. P < 0.05 was taken as statistically significant., Results: Cases had significantly higher brachial arterial parameters (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse-wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) compared to age, gender, and BMI-matched controls. In the case group, female gender, BMI ≥ 23, and uncontrolled blood pressure were significant factors affecting results. Heart rate and pulse pressure were major predictors of study parameters. Central pressure parameters were not predicted significantly by corresponding brachial pressure parameters., Conclusion: PWA revealed the adverse profile of arterial stiffness and central hemodynamics in treated Gujarati hypertensives, associated with female gender, BMI, and blood pressure control, predicted mainly by heart rate and pulse pressure, independent of brachial blood pressure. It indicates both potential and further study of these parameters., Competing Interests: There are no conflicts of interest.

Introduction: Diabetes is a modern epidemic imposing significant cardiovascular risk. Immediate and discrete parameters such as arterial stiffness and central hemodynamics are studied scarcely. Pulse wave analysis (PWA) offers noninvasive measurement of the same and we performed that in diabetics., Materials and Methods: We performed a case-control study on 148 treated diabetic not on antihypertensive and 148 nondiabetic normotensive controls. Oscillometric PWA was performed by Mobil-O-Graph (IEM). Parameters were further analyzed for effect of gender, physical activity, body mass index (BMI; cut-off 23), glycemic control, and disease duration (cut-off 4 years). Multiple linear regressions were used to find significant predictors. P <0.05 was taken as statistical significance., Results: Cases had significantly raised brachial hemodynamics (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥ 23, and physical inactivity were the significant factors affecting results (arterial stiffness more than central hemodynamics); glycemic control and duration were not. Heart rate was the major predictor of study parameters. Brachial pressure parameters were not significant predictors of corresponding central pressure parameters., Conclusion: Gujarati diabetics not using any antihypertensive had adverse profile of beyond brachial blood pressure discrete cardiovascular parameters, independent of duration and glycemic control, related to gender, BMI, and physical activity, indicating vascular progeria in the absence of hypertension. This baseline study suggests further work on these potential parameters., Competing Interests: There are no conflicts of interest.

Context: Type 2 diabetes is the modern epidemic wherein patient care needs multiple approaches, education, and self-awareness being one of them. There are some knowledge, attitude, and practice (KAP) studies from India but very few relating it with disease control., Aims: We tried to study KAP of treated type 2 diabetics and its correlation with glycemic control., Settings and Design: Cross-sectional KAP study., Subjects and Methods: We formulated KAP questionnaires in the form of KAP - 10 points for each and total 30. We recruited 200 type 2 diabetics (96 males, 104 females) treated by MD physicians with known current glycemic status. They were asked KAP questionnaires one to one by a direct interview in local language and results were associated with various factors and glycemic control., Results: KAP score on was average 19 out of 30 in type 2 diabetics having mean age 58 years, mean duration 9 years. KAP score was unaffected by gender, occupation, duration of disease but significantly affected by current age, and education level. Only 40% patients had good glycemic control who scored better KAP than poor glycemic. There was positive correlation between KAP score and glycemic control, with significance for only glycosylated hemoglobin and not fasting blood sugar, postprandial blood sugar., Conclusions: Physician treated type 2 diabetics of our region had moderate KAP score, affected by age, education which suggested to affect glycemic control. Lacunae in knowledge regarding incurability of disease, attitudes toward complication, self-care, and good practices like walking, enriching knowledge need improvement so as an optimum glycemic control., Competing Interests: There are no conflicts of interest.