A STEP TOWARDS UNDERSTANDING BALANCE CONTROL IN INDIVIDUALS WITH INCOMPLETE SPINAL CORD INJURY

Purpose: Frequent falls are reported by individuals with spinal cord injury (SCI) suggesting impairments in their balance control. This thesis examined balance assessment and balance control in individuals with SCI. Methods and Results: To investigate the effects of light touch on standing balance, center of pressure (COP) sway during standing was measured in 16 participants with incomplete SCI (iSCI) and 13 able-bodied (AB) participants. Participants with iSCI showed reduction in COP sway with light touch similar to AB participants. To study the association between stability during normal walking (NW) and unexpected slip intensity, NW behaviour and intensity of an unexpected slip perturbation were assessed in 20 participants with iSCI, and 16 AB participants. Participants with iSCI demonstrated greater stability by walking slower, taking shorter steps, and more time in double support. Walking slower was associated with lower slip intensity in individuals with iSCI. To study reactive balance control, change in margin of stability with a compensatory step, activation of lower extremity muscles, and change in limb velocity trajectories in response to an unexpected slip perturbation were studied in 16 participants with iSCI and 13 AB participants. Participants with iSCI demonstrated limitations in reactive responses including a smaller increase in lateral margin of stability, slower onset of trail limb tibialis anterior activity, and decreased magnitude of trail limb soleus activity. To identify balance measures specific to individuals with SCI, a systematic review of 127 articles was conducted. Thirty balance measures were identified; 11 evaluated a biomechanical construct and 19 were balance scales designed for use in clinical settings. All balance scales had high clinical utility. The Berg Balance Scale and Functional Reach Test were valid and reliable, while the Mini Balance Evaluation Systems Test was most comprehensive. Conclusions: Individuals with iSCI have impaired balance control, as evidenced by limitations in reactive balance; however, they have the ability to modify their balance, as demonstrated by greater stability during NW and with light touch while standing. No single balance measure met all criteria of a useful measure - high clinical utility, strong psychometric properties, and comprehensiveness in the SCI population. Combined, the findings highlight the need for the comprehensive assessment and rehabilitation of balance control after iSCI

A comparative analysis of retrospective records of antibiotic usage in patients before and after surgery in a tertiary care government hospital in Delhi

Background: Antimicrobial resistance (AMR) is major problem in most of countries worldwide. Antimicrobial Stewardship program (AMSP) encourages both government and private hospitals in country to bring out guidelines regarding antimicrobial usage and hospital infection control (HIC). However, it is still in nascent stage.  A retrospective study to generate lacking data about usage of antibiotics in inpatient settings in a government hospital. Methods: Retrospective records of antibiotic usage in adult patients before and after surgery admitted in department of surgery, LHMC and Smt. Sucheta Kriplani hospital, New Delhi. The prescribed doses were converted to a number as per WHO defined daily dose (DDD) of each antibiotic and presented as per ATC/DDD methodology. Results: The records of 121 patients admitted between June 2021 to February 2022 were retrieved. Ceftriaxone, was the leading choice of antibiotic both pre and post operatively, while co-amoxyclav was second most preferred antimicrobial. Mean ± SD for DDD pre-op and post-op was 3.345±1.602 with p<0.001 which was highly significant. Mean ± SD for average duration of stay pre-op and post-op was 3.041±1.179 with p<0.01 which was significant. Only 16 patients had complications before, during or after the procedure which prolonged their stay in hospital. There were no procedure related deaths till last follow up.  Conclusions: Guidelines for selection of proper antimicrobial usage in peri-operative period were not consistent. We advocate evidence-based pre-operative and post-operative antibiotic prophylaxis practices and rational antibiotic usage depending on prevailing antibiogram

Evaluation of anxiolytic properties of BacoMind extract of plant Bacopa monnieri Linn. in comparison with diazepam in rodent model

Background: Anxiety is a state characterized by somatic, emotional, cognitive, and behavioral components, associated with significant disability. The pharmacotherapy for anxiety remains limited for achievable safety and tolerability of the medicines. Benzodiazepines use associated with side effects like psychomotor impairment and addiction liability. Due to the ADRs associated with antianxiety drugs, the drug trials have focused on screening herbal medicines that are reportedly used in the treatment of anxiety and which have minimal side effects.Methods: The anxiolytic activity was examined by using the elevated plus maze (EPM) and open field test (OFT), forty Albino wistar strain rats of both sex of weighing 120 to 200 g were divided into four groups of ten rats each.. Group 1 received vehicle (normal saline); group 2 received diazepam (1 mg/kg); groups 3 and 4 received BacoMind™, 30 and 60 mg/kg oral, respectively.Results: Rats treated with diazepam (1 mg/kg, p.o.) showed significant (p<0.001) increase in the percentage of open arms entries and time spent whereas, in closed arm the number of entries and time spent were significantly (p<0.05) decreased. Intraperitonial administration of BacoMind™ extract of plant Bacopa monnieri Linn. exhibited significant (p<0.05) increase in the number of open arm entries and time spent with significant (p<0.05) reduction in number of entries and time spent in the closed arm as compared to group 1. BacoMind™ treated rats also produced significant increase in the number of rearings (p<0.05), assisted rearings and number of squares crossed (p<0.01).Conclusions: BacoMind™ extract of plant Bacopa monnieri Linn possess significant anxiolytic activity in the rats. It can be a promising anxiolytic agent

Evaluation of antioxidant potential of Emblica officinalis and Murraya koenigii and their role in modulation of cognitive function in diabetic rats

Background: Hyperglycaemia and hyperlipidaemia seen in diabetes mellitus result in oxidative stress and pose significant risk of cognitive decline that may lead to Alzheimer’s disease. Approved anti-diabetic drugs have so far failed to demonstrate anti-oxidant and anti-hyperlipidemic activity, apart from saroglitazar. Therefore, this study was done to find a suitable anti-diabetic drug that possesses anti-hyperglycaemic, anti-oxidant and anti-hyperlipidemic activities and can reverse cognitive decline.Methods: Emblica officinalis (250 mg/kg, p.o. and 500 mg/kg, p.o.) and Murraya koenigii (250 mg/kg, p.o. and 500 mg/kg, p.o.) were chosen to study these activities in Wistar rats. Diabetes was induced by single intraperitoneal injection of streptozotocin [STZ] (50 mg/kg). Fasting blood glucose levels and lipid profile were measured on day 1 and day 30 of the experiment. Cognitive function was assessed by measuring transfer latency (TL) on elevated plus maze, step-down latency (SDL) on passive avoidance apparatus and retention latency (RL) and quadrant time (QT) in Morris water maze. Oxidative stress was assessed at end of study by measuring brain MDA and GSH levels. Cholinergic marker of cognition, AChE was measured in brain at end of study.Results: Both E. officinalis and M. koenigii showed dose dependent anti-hyperglycemic, anti-hyperlipidemic and anti-oxidant effects in diabetic rats with 500 mg/kg dose showing significantly higher effect. Both 250 mg/kg and 500 mg/kg dose of E. officinalis and M. koenigii partially reversed cognitive decline in diabetic rats by day 30.Conclusions: 500 mg/kg p.o. dose of E. officinalis or M. koenigii has potential to reverse cognitive decline in diabetic patients.

Prescribing pattern of antimicrobials and adverse drug reactions in children suffering from lower respiratory tract infection in tertiary care hospital

Background: Acute respiratory tract infections are leading cause of mortality in children in India. Further, indiscriminate use of antimicrobials has led to increased drug resistance and large number of adverse drug reactions (ADR). Therefore, aim of study was to study antimicrobial prescribing pattern and record incidence and causality assessment of ADRs in pediatric in-patients having lower respiratory tract infection (LRTI).Methods: In this prospective and observational study total of 300 children aged 2 months to 12 years suffering from LRTI and hospitalized for minimum 48 hrs duration were included. A descriptive analysis was carried out to determine frequency and combinations of antibiotics prescribed and causality and number of ADRs.Results: Out of 300 subjects, 70.3% of patients were males and 54.6% of cases with LRTI belonged to 2-6 months age group. The most frequently prescribed antibiotic was ceftriaxone alone in 67 (22.3%) patients while ceftriaxone and amikacin was the most common 2 drug combination in 60 (20%) patients. Ceftriaxone, ampicillin and gentamicin was most common 3 drug combination in 7 (2.3%) patients. There were 49 cases (16.3%) of ADRs and maximum were in 2-6 months age group and ceftriaxone with amikacin was associated with maximum number 10 (20.4%) of cases. Diarrhoea was most frequent adverse effect associated with antibiotics in 36 (76.6%) cases.Conclusions: The use of cephalosporins (single or combination) are most commonly used drug and associated with maximum number of ADRs in 2-6 months male children with LRTI so clinicians should use them judiciously and rationally

Impact of increase of caesarean section on postpartum hemorrhage in a tertiary care center of India over 6 years

Background: PPH (postpartum hemorrhage) is the leading cause of maternal mortality. Despite of all the medical advancement, maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Caesarean section is an obstetric intervention where, normal delivery can pose a risk for mother or foetus. The rate of caesarean section has increased worldwide. A survey conducted by WHO found that the worldwide rate of caesarean section increased from 26.4% between 2004 to 2008, to 31.2% between 2010 to 2011.Methods: We collected data of the caesarean sections and patients who developed PPH over 6 years. We studied the association of temporal increase of caesarean section with PPH.Results: Uterine atonicity continues to be the most common etiology of PPH each year, however, there is an increase in tissue abnormality (retained placenta, placenta praevia, accreta, increta, percreta) over years as there is a significant increase in the incidence of caesarean section. Atonic uterus was the most common cause for obstetric hysterectomies and mortality due to PPH every year.Conclusions: Family planning advise is essential in developing country like ours to counsel patients to prevent multiparity, thus reducing PPH. It is also important to train all the health workers in periphery and referral centers to manage the third stage of labor and atonic uterus to save the mothers. Sagacious attitude towards the decision of caesarean section is needed to prevent maternal morbidity and mortality

Mechanisms of Theta Burst Transcranial Ultrasound Induced Plasticity in the Human Motor Cortex

BACKGROUND: Transcranial ultrasound stimulation (TUS) is a novel non-invasive brain stimulation technique with high depth penetrance and spatial resolution. Theta-burst TUS (tbTUS) is a plasticity-inducing protocol which increases motor cortical excitability for up to 30 min following 80s of sonication. While this protocol may have therapeutic potential for the treatment of psychiatric and neurological disorders, the mechanisms of action of TUS remain unclear. OBJECTIVE: We conducted the first pharmacological study to examine the mechanisms of TUS in human primary motor cortex. By administering brain-active drugs with known mechanisms of action, we aimed to elucidate the mechanisms of tbTUS. METHODS: Fourteen healthy subjects participated in a within-subjects randomized, double-blind, cross-over study with five visits. At each visit, one of four study drugs (carbamazepine - Na RESULTS: The plasticity effects of tbTUS on motor cortex excitability measured by motor-evoked potential amplitudes elicited by transcranial magnetic stimulation were reduced by all study drugs compared to placebo. CONCLUSION: tbTUS may induce NMDA-dependent synaptic plasticity since the effects are blocked by increased GABAA receptor activities and voltage-gated Na+ and Ca2+ channels blockers. These results are consistent with the hypotheses that tbTUS induced long-term potentiation-like mechanisms and that TUS involves activation of mechanosensitive Na+ and Ca2+ channels. Alternatively, non-specific pharmacologically induced changes in excitatory/inhibitory balance might have interfered with the effects of tbTUS