Does Dual Motor Tasks Provokes Posture Adaptations in Healthy Young Adults? A Cross-sectional Study

Introduction: Most studies on postural deviations during single and dual tasks have been extensively studied in neuromuscular and older adult populations. Nevertheless, further research is warranted to identify whether such tasks can impose postural adaptations in young, healthy adults without sensory impairments. Aim: To assess postural stability modifications in young adults during single tasks and dual motor tasks (holding a cup filled with water) while concomitantly challenging the sensory systems. Materials and Methods: This was the cross-sectional study on 82 young adults (18-45 years old) from Texas Woman’s University (TWU) Health Science Center in Dallas, Texas, and surrounding areas. Standing postural control was measured by collecting total sway, direction of sway and velocity in the Anterior-Posterior (AP) and Medial-Lateral (ML) directions during different balance tasks. For single and dual tasks, the tests were performed with a bipedal stance on foam involving challenging the sensory input via Eyes Open (EO), Eyes Closed (EC), and head movements with eyes open (EO HUD) and closed (EC HUD). The dual motor tasks were similar to the single tasks with the addition of holding a cup full of water to split attention. Data were placed into the Statistical Package for Social Sciences (SPSS) Data Analysis 25.0 system and were analysed for repeated measures Analysis of Variance (ANOVA) analysis. Results: Eighty-two healthy young adults participated in this study (mean age of 24.6±2.7 years, 13 males and 69 females). An ANOVA analysis revealed that postural stability was considerably altered during motor tasks. Sway in the Antero-Posterior (AP) direction, and velocity of sway increased as the complexity of the tasks intensified. A substantial difference in total sway during single tasks when eyes were closed compared to eyes open (p-value <0.01) was noted. There was a significant difference in total sway (AP and ML) during eyes open (EOM) to eyes closed (ECM) and during eyes open with head moving up and down (EOM HUD) (p-value 0.001). There were significant differences in mean AP velocity during EO (0.11±0.12) compared to EC HUD (0.19±0.15), and when comparing EOM (0.07±0.04) to ECM HUD (0.13±0.08) (p=0.01) Conclusion: This study identified postural changes when comparing single and dual tasks in healthy young adults, and the outcomes of this study showed definite distinctions in postural responses during single and dual motor tasks.

Impact of Structured Patient Education and Outpatient Cardiac Rehabilitation Program on the Disability Profile of Conservatively Treated Medically Stable Postmyocardial Infarction Individuals: A Protocol

Introduction: Cardiac rehabilitation and patient education are the two parallel components in the management of coronary heart disease. Although, it is recommended strongly to join an outpatient cardiac rehabilitation program, the enrollment rates are always low. The role of structured patient education in increasing the enrollment in an outpatient cardiac rehabilitation program and its impact on the disability profile of conservatively treated medically stable postmyocardial infarction individuals, after joining and completing the rehabilitation program has not been studied. Aim: To study the impact of structured patient education and outpatient cardiac rehabilitation program on the disability profile of conservatively treated medically stable postmyocardial infarction individuals. Materials and Methods: The study is a mixed method design and will be conducted in two steps. Step 1: It is a qualitative study in which a structured patient education program will be developed based on the framework given by the working Group of Exercise Rehabilitation and Sports (GERS). Step 2: Implementation of the developed program and an outpatient cardiac rehabilitation program in an open-label non randomised clinical trial. Conclusion: The findings of this study will evaluate the need for the development of structured patient education programs for coronary artery disease patients, which may increase the enrollment rates in outpatient cardiac rehabilitation programs and thereby, reducing their disability.

COVID-19 Associated Rhino-orbito-cerebral Mucormycosis: Clinical Profile and Imaging Spectrum

Introduction: Rhino-orbito-cerebral mucormycosis is a fatal disease caused by saprophytic fungi seen almost exclusively in diabetic and immunocompromised patients. Aim: To describe various imaging findings of mucormycosis, and to emphasise the importance of imaging in its diagnosis and management. Materials and Methods: A retrospective, observational, single centre study was done including patients with clinical and microbiological evidence of rhino-orbito-cerebral mucormycosis, who had a history of Coronavirus Disease 2019 (COVID-19) infection and had undergone Computed Tomography (CT) and/ or Magnetic Resonance Imaging (MRI) scan of the head, orbit, and paranasal sinuses during the period of one month from 1st-31st May 2021. The clinical and imaging data of 67 such cases were interpreted and analysed by two radiologists. Results: The study included 67 patients out of which 44 were male and 23 were female, and the average age of patients was 49±13 years. During their treatment for COVID-19, 55 (82.08%) patients had a history of hospitalisation and administration of supplemental oxygen, all 67 (100%) patients had taken broad spectrum antibiotics, 56 (83.58%) patients had taken steroids, 20 (29.85%) patients previously had a history of diabetes with worsening of glycaemic control during COVID-19 infection, and 47 (70.15%) patients were diagnosed with new onset hyperglycaemia. On imaging i.e., on CT and/or MRI with or without contrast, the infection was found to primarily affect the sino-nasal region. There was unilateral or bilateral involvement of single or multiple paranasal sinuses in all 67 patients with involvement of nasal cavity in 42 patients. Maxillary sinus was the most common and consistently involved sinus seen in all 67 patients, followed by ethmoid sinus seen in 54 patients. Additionally, 56 patients had extra-sinus disease with spread along vessels, nerves, or via bone erosion. CT showed soft tissue thickening, oedema, and fat stranding with or without bone erosion as the predominant finding in involved areas, while MRI showed Short Tau Inversion Recovery (STIR) hyperintense soft tissue thickening and postcontrast enhancement as the main finding. Conclusion: There is a complex interplay of various COVID-19 infection and treatment related factors that are responsible for increased susceptibility to mucormycosis infection. Imaging plays an important role in aiding the diagnosis, determining the extent and spread of infection, guiding the extent of the surgical intervention, and determining the prognosis of these patients. The contrast enhanced MRI along with plain CT should be the preferred choice of imaging.

Long COVID Syndrome Following Infection with SARS-CoV-2- A Devastating Influence on Health Status in Some Affected Individuals

Almost a year since the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) began causing COVID-19, our knowledge about its manifestations continues to expand. As more people become fatally ill with COVID-19, it is now clear that many patients who developed a mild illness, recovered from a serious illness, or had an asymptomatic infection are also beginning to suffer from a newly described entity called Long COVID. Studies show that show COVID-19 influences the cardiovascular framework, yet the general effects stay obscured. Impaired diffusion capacity, lower respiratory muscle strength, and lung imaging abnormalities are seen in COVID-19 patients in the early recovery stage. As compared to non-severe cases, severe patients had a higher incidence of Diffusion capacity of lung for carbon monoxide (DLCO) impairment and are more prone to total lung capacity decrease and 6-Minute Walk Test (6MWT) decline. The degree and seriousness of long-term well-being outcomes remain unclear, yet increasing information points in the direction of poorer physiological outcomes. Long-term sequelae of COVID-19 will have enduring implications on those afflicted’s physical, mental, and social health while having a substantial monetary impact on society.

Clinico-epidemiological and Outcome Analysis of Anogenital Injuries in Children: Retrospective Study from a Tertiary Care Centre, Central India

Introduction: Paediatric perineal trauma or Anogenital Injury (AGI) in the paediatric age group remains lesser reported in under-developed areas or rural areas of India. Most of these injuries remain under reported to tertiary care centres because of a social stigma or poor access to a health facility. Aim: To present the clinico-epidemiological parameters of AGI in children and to assess the outcome of staged and definitive management in these children, comparing the results with other similar studies. Materials and Methods: This was a retrospective study on data of 11 cases (age range 1-14 years, seven cases were boys and 4 cases were girls) of paediatric anogenital injuries, admitted at the tertiary care centre from 1st July 2018 to 30th June 2020 were analysed. Data of all the patients, demographic details, relevant clinical history such as time of presentation, mode of injury and type of management, outcomes and complications was collected and studied. All the collected data was analysed by calculating mean±SD, frequency (n) and percentages (%). Results: Road traffic accident was the most common cause of AGI (n=5, 45.5%), followed by sexual assault (n=3, 27.3%). Wound infection in late presenters (n=5, 45.5%) was the most common complication affecting the outcome. Children with a primary diversion of the faecal stream or diversion colostomy (n=5, 45.5%) as an associated procedure had a better outcome. Primary repair without diversion (n=3, 27.3%) was noticed to have a high incidence of wound infection and anovaginal scaring. Conclusion: A high incidence of poor wound healing related to late presentation and malnutrition noted among these AGI cases belonging to rural or semi-urban settings. Management of these injuries, therefore, needs to be individualised on case-to-case basis. The diversion stoma formation seems to be considered in all high grade anogenital injuries and selected lower grade injuries with evidence of secondary infection or poor healing of the primary repair.

Study of Trauma Profile and its Outcomes at a Tertiary Care Centre: A Cohort Study of 1000 Cases

Introduction: Trauma has been the leading cause of mortality and morbidity. However, there are changes in pattern of trauma and their outcomes with time. Aim: To study the mode and nature of injury and mortality associated with trauma of head, chest and abdomen. Materials and Methods: A prospective cohort study was conducted on 1000 individuals that presented to emergency surgery ward from 2014 to 2019. Patients presented to emergency surgery of Government Medical College, Amritsar, Punjab, India were observed for various characteristics i.e., age group, mode of injury, site of injury, outcomes and management. Results: The mean age of patients was 33.91±16.29 years with significant male predominance (n=794, 79.4%) (p-value 0.00001). Road Traffic Injuries (RTIs) were the most common mode of trauma affecting 490 patients (49%). Head injury was the most common of all injuries (n=834). Overall mortality was 3.6% (n=36). Mortality was higher in males (p-value 0.00933) and mortality rate of 25% was seen in age group of 61-70 years. Conclusion: RTIs followed by assaults are the most common cause of trauma and it significantly affects young male population. However, mortality rate increases with increase in age group with higher rates in older age groups.

Awareness of Chronic Kidney Disease among Tamil Nadu Population- ACross-sectional Study

Introduction: Chronic kidney failure in India and around the world is a significant health problem. The most effective and affordable treatment may require screening for early detection,intervention and prevention. Public awareness is a key determinant to overcome the burden of Chronic Kidney Disease(CKD). However, there is a lack of information on CKD among South Indian people. Aim: To assess the awareness and knowledge of CKD among the South Indian population. Materials and Methods: A questionnaire-based cross-sectional study was conducted through an online form; the questions were generally based on the physiological role of kidney and awareness questions related to CKD. The sample size was 500 participants, of age >18 years and snowball sampling method was implemented. Among the study population, 68 participants had a family history of CKD and they were excluded. The data were analysed through Pearson Chi-Square test. Results: The mean knowledge score was 13 (SD±5.0), with values ranging from 0 to 22. The mean age of the population was 47.80±8.5 years. Multiple regression on demographic data and knowledge yielded statistically negligible results.The study population included 432 participants and the result showed the realms that most responded incorrectly were physiology of kidney, CKD symptoms, risk factors and the domain of testing and diagnosis. Conclusion: The participants had ample knowledge of the risk factors, signs and symptoms of CKD and insufficient knowledge of the physiological function of the kidney and the diagnosis of CKD. Therefore, efforts are necessary to create awareness and educate people about the early detection and prevention of CKD.

Improved Diagnosis of Tuberculous Meningitis Using a Combination of Multiplex Antigens and Antibodies Testing Methods

Introduction: Various serological assays exists, including Antigen and Antibody detection (IgM and IgG) for diagnosis of Tuberculous Meningitis (TBM) cases. To the best of our knowledge, most of the laboratories either do Antigen detection or IgM or IgG, at a time. As different antigens get expressed in a different stage of infection it may be possible that many cases remain undiagnosed due to one test at a time approach. Aim: To evaluate the combination of Mycobacterium Tuberculosis (MTB) antigen (Ag85 Complex and Rv2623) and antibody (Anti-Ag85, Anti-45kD, Anti-HSP-16, Anti-CFP-10 Anti-GroES and Anti-ESAT-6) immunoassay panels in the Cerebrospinal Fluid (CSF) samples for diagnosis of TBM patient. Materials and Methods: In the present prospective study conducted at Central India Institute of Medical Sciences (CIIMS) from October 2013 to April 2015, a total of 200 CSF samples of different groups {confirmed TBM (n=100) and noninfectious neurological diseases as control (n=100)} were analysed by Enzyme-Linked Immunosorbent Assay (ELISA). A panel of MTB antigens consisting of Ag85B, 45kDa, HSP-16, CFP-10, GroES and ESAT-6 were used for detection of antibodies response, whereas polyclonal antibodies were used for antigen detection of Ag85 complex and Rv2623 in the CSF samples. The comparison of the CSF parameter between TBM and non-TBM patients was performed using a student t-test. A p-value <0.05 was considered statistically significant for all the analyses. Results: The study population has similar age and sex distribution (p>0.05). Symptoms of headache, fever, neck stiffness, vomiting, abnormal behaviour, unconsciousness were more common among the TBM patients as compared to non-TBM patients (p<0.05) (TBM Vs non-TBM). Similarly TBM patients had an increase (p<0.05) Vs non-TBM total cell count, protein, parallel blood sugar and decline in CSF sugar and Parallel blood sugar ratio (p<0.05) (TBM Vs non-TBM). We found diagnostic accuracy of 67% to 76% with either antigen or antibody assay, however, combinations of antigen and antibody immunoassay together increase the diagnostic accuracy of up to 96%. Conclusion: Our study recommends that a combination of antigen and antibody assay should be considered for early and accurate diagnosis of TBM cases.

Chronic Lymphocytic Leukaemia Presenting with Pancytopenia: ARare Haematological Coincidence

Chronic Lymphocytic Leukaemia (CLL) is commonly associated with autoimmune cytopenias but CLL presenting with pancytopenia is a rare occurrence. Here, we present a case of 56-year-old male patient, who presented with pallor, mild hepatosplenomegaly, right-sided pleural effusion in chest x-ray, pancytopenia and his bone marrow showed infiltration by mature appearing lymphoid cells making a diagnosis of CLL. Despite the frequency of these immune mediated cytopenia, only few cases of pancytopenia have been described so far to the best of our knowledge. Hence, to emphasise the rarity of such haematological coincidence we are presenting this case report. CLL generally presents with persistent absolute lymphocytosis on peripheral smear with an absolute monoclonal lymphocyte count of more than 5000/cumm. There is a common association with Autoimmune Haemolytic Anaemia (AIHA) and Immune Thrombocytopenia (ITP) and the association is called as Evan’s syndrome. Its pathogenesis is associated with autoimmune process. AIHA, ITP, and Pure Red Cell Aplasia (PRCA) are commonly associated complications seen in CLL. The pathogenesis of AIHA and ITP are antibody this inplace of the reactions and abnormal T cell activity is noted in the pathogenesis of PRCA. Despite of the frequency of these immune mediated cytopenias noted in CLL, bone marrow was seen to be hypercellular in most of the cases and marrow hypoplasia have been reported in only 2 cases reported in literature so far. In the present case, although pancytopenia was present on peripheral blood smear examination but bone marrow was hypercellular for age with diffuse infiltration by monoclonal mature appearing lymphoid cells which makes this case all the more interesting. Despite repeated blood transfusions,antiviral drug Tenofovir and aggressive supportive measures for 6 months, he developed right-sided pleural effusion and succumbed to his illness.

Urinary Effects of Routine Urethral Catheterisation during Elective Caesarean Section in Enugu, Nigeria: A Randomised Controlled Study

Introduction: Routine urinary catheterisation during elective caesarean section is a common practice. However, this practice involves some urinary bladder morbidities. Aim: To determine the effect of non-catheterisation of the urinary bladder on the incidence of significant bacteriuria and other perioperative urinary bladder morbidities during elective caesarean section in Enugu, Nigeria. Materials and Methods: A multicentre, non-inferiority randomised controlled study was conducted. The study centres were the University of Nigeria Teaching Hospital (UNTH), Mother of Christ Specialist Hospital (MOCSH), and Blessed Assurance Specialist Hospital (BASH), all in Enugu State, Southeast Nigeria. A total of 264 eligible consenting term pregnant women who had a caesarean section in these three specialist centres in Enugu, Nigeria over a one-year period were recruited and they completed the study and their results were analysed. Study group (A) did not receive urethral catheterisation while the control group (B) had urethral catheterisation on the operating table and the catheters were removed 24 hours after the surgery. Clean catched urine samples were collected from each participant 72 hours after the surgery for urine microscopy and culture. The primary outcome measure was the incidence of significant bacteriuria 72 hours postoperatively while the secondary outcome measures included incidence of intraoperative bladder injury (accidental cystostomy), primary postpartum haemorrhage and urinary retention. Results: Nine (6.8%) women in the non-catheter group (n=132) had significant bacteriuria as against 17 (12.9%) women in the catheter group (n=132), (Relative Risk (RR)=0.5 (95% CI: 0.24-1.14) p=0.098). Urinary retention was observed in 10.6% (14/132) of the non-catheter group while there was no case of urinary retention in the control group (p<0.001). There was neither a case of accidental cystostomy nor postpartum haemorrhage in either group. Conclusion: Non-catheterisation of the urinary bladder during elective caesarean section had no significant relationship with the incidence of significant bacteriuria in Enugu, Nigeria. Rather, it was associated with postoperative urinary retention when compared to women who had a urinary catheter.