Inter arm blood pressure difference: an indicator of cardiovascular risk

Background: Overall prevalence of hypertension in India is 33% in urban and 25% in rural areas. For optimal health blood pressure of less than 120 mm of Hg systolic and 80mm of Hg diastolic is to be maintained. According to American heart association, inter arm BP difference of more than 20 mm of Hg systolic and 10 mmm of Hg diastolic are associated with peripheral vascular disease, vasculitis, connective tissue disorders and congenital anomalies. Though the guidelines quote that it is mandatory to examine pressure in both arms before diagnosing hypertension this system is not followed, which has led to increase in misdiagnosis of HT. The present study aims to determine the magnitude of interarm difference in young healthy individuals and to assess whether family history of HT and BMI is related to higher interarm difference.Methods: 110 normal healthy medical students both males & females are recruited for the study .after obtaining institutional ethical clearance the participants in the study are informed about the study process and detailed history obtained .after 5 min of rest BP is assessed by sphygmomanometer first in right arm & then left. Statistical analysis done using paired t test, correlation between variables done with chi square test. Results: statistically significant difference p10mm of Hg and diastolic interarm >5mm of Hg ,though this value is not statistically significant ,it shows that people with family history of hypertension is more prone to interarm BP difference.Conclusions: Interarm difference exists in norma lhealthy volunteers and interarm difference  of >10 mm of Hg systolic & >5 mm of Hg diastolic should be investigated further as these subjects are more prone to develop cardiovascular morbidities .hence we conclude that interarm difference is a sensitive noninvasive and simple method of detecting individuals prone for cardiovascular morbidities.

Correlation of sleep quality with anthropometric parameters in young healthy individuals

Background: Obesity, which is the harbinger of various diseases, is considered as the epidemic of this era. Various lifestyle changes have resulted in a younger generation being prone to obesity. On investigating the etiology of obesity in young individuals, besides the change in food habits, sleep has also found a place. Various investigators have come up with conflicting results regarding the correlation between sleep and anthropometric parameters. In this backdrop, the present study was planned to analyze the correlation of sleep quality with anthropometric parameters.Methods: 100 first year MBBS students were given the Pittsburgh sleep questionnaire which gives a self-reported assessment of their sleep quality. Anthropometric parameters of the students were recorded along with body fat analysis using Omron body fat analyzer. The results obtained were tabulated and analyzed.Results: Out of the 100 students 45 were found to be poor sleepers. On analyzing the anthropometric parameters, no significant difference was noted between good sleepers and poor sleepers. The body fat content also did not show any significant difference between the two groups.Conclusions: The findings of the present study show a nonmonotonic relationship between sleep quality and anthropometric parameters. This shows that the response of the adolescent population may differ in comparison with other groups. Hence it is recommended that the poor sleepers in the adolescent group need to be followed up in future.

Analysis of dynamic pulmonary functions in air conditioned work environment

Background: Thermal comfort is the condition of mind that expresses satisfaction with the thermal environment. Maintaining thermal comfort is the prime aim of heating, ventilation and air conditioning (HVAC) design engineers. Thus air conditioning has become a necessary luxury. Work environment is made comfortable to increase productivity by using air conditioners (ACs), but literature shows that long term exposure to ACs has deleterious effects.Methods: After obtaining institutional ethical clearance, the participants for this descriptive study are recruited from the staff of the hospital, based on inclusion and exclusion criteria. 40 subjects in the age group of 25-45 years using ACs for at least last 6 months for a minimum duration of 6 hours per day are included in the study. The pulmonary functions of the subjects are assessed using computerized spirometer (micro Quark) in the afternoon hours. The dynamic lung volumes obtained are compared to the predicted values according to age and sex of the individual.Results: The dynamic pulmonary function parameters such as FEV1, FVC, FEV1/FVC and PEFR were assessed. FEV1, FVC and PEFR were found to be decreased in subjects when compared to their predicted values. Marked deterioration in dynamic pulmonary functions was noted in 40-50 years age group. As the duration of exposure increases, the dynamic pulmonary functions have decreased to a statistically significant level. Pulmonary parameters are markedly decreased in subjects with BMI>23.5.Conclusions: The results of the study indicate that the subjects working in AC environment for a long duration are prone to develop restrictive lung diseases. Hence, study concludes that periodic pulmonary function assessment should be made mandatory. Further, regular maintenance of ACs is also recommended.

Effect of middle ear and mastoid air space volume on acoustic transmission of sound in tympanic membrane perforation

Background: Loss of hearing is a national health problem with significant social and psychosocial implications. Worldwide there are about 65-330 million people affected with hearing impairment, of which 60% suffers from significant hearing loss. Role of tympanic membrane and ossicular chain in the physiology of hearing is well documented. The emergence of the role played by mastoid air space volume in sound transmission is being critically evaluated these days. The present study is designed to analyze the effect of mastoid air space volume in tympanic membrane perforation with conductive hearing loss.Methods: 32 subjects both male and female with medium sized tympanic membrane perforation were included in the study. They were grouped into two (those with sclerotic and cellular mastoid). Hearing threshold assessed using pure tone audiometer. Mastoid air space volume evaluated using digital X-ray mastoid schuller’s view. Tympanic membrane perforation size assessed using otoscope.Results: The hearing loss in first group having cellular mastoid and second group with sclerotic mastoid were 22.82±6.28 and 27.82±5.66 respectively. Their p value was 0.026 which was statistically significant.Conclusions: Mastoid air space volume is inversely proportional to conductive hearing loss. Therefore mastoid air space volume also plays a key role in the sound transmission. The awareness of the pneumatisation status of the mastoid helps clinicians to choose appropriate line of management.

Handedness and learning styles: a study of its inter relationship

Background: The alleged link between handedness and learning is debatable. Studies unveil that handedness has a way of influencing learning and affects the academic performance of students. Despite the researchers pointing out that handedness influences the brain organization and function, teaching strategies have largely ignored this fact. The concept of using various sensory modalities as a part of learning has not been comprehended well. The aim of the study is to find out the prevalence of handedness among our medical students and to look onto the types of learning styles amongst them and to determine the correlation between handedness with learning styles.Methods: A cross sectional study was conducted among hundred medical students using handgrip dynamometer for handedness and VARK questionnaire (Visual, auditory, read/write, kinesthetic; a validated tool that helps one to identify the most preferred sensory modality for learning) for determining the learning preference. Data was analysed using univariate and bivariate analysis through cross tabulation and Pearson chi square test using SPSS version 20.Results: Right handers preferred VARK with dominancy for auditory learning styles, left handers preferred VARK with dominancy for auditory and kinesthetic learning styles while ambidextrous prefer visual learning styles.Conclusions: The awareness of the association of handedness with various learning styles and its implications on academic performance should be at the forefront of teaching strategies adopted by teachers. Hence, we conclude that to be an effective learner, the learning needs have to be understood and cater to by the trainers

Variations of physiological parameters in newly detected hypothyroidism

Background: Emergence of hypothyroidism as a public health issue apart from a common clinical entity, has gained much attention nowadays. The non-specific features of hypothyroidism lead to incorrect diagnoses, inadequate treatment and complications in the future. The present study was designed to unravel the effects of hypothyroidism on physiological parameters and to highlight the importance of early diagnosis and treatment. This study was done to assess the effects of hypothyroidism on pulse rate, blood pressure and respiratory rate.Methods: This descriptive cross-sectional study was done in 60 hypothyroid patients of 18-45 years age, both males and females, who were either newly detected or on treatment for less than 6 months. Patients with history of other systemic diseases, pregnancy and hyperthyroidism were excluded. After obtaining written consent from the patients, clinical examination was done.Results: Student t-test and ANOVA were used for analysis. Physiological parameters like pulse rate, blood pressure and respiratory rate had variations in the patients and there were changes with age, gender and BMI even though they were not significant. These changes were attributed to increased arterial wall thickness and endothelial dysfunction in blood vessels.Conclusions: The patients showed changes in cardiovascular and respiratory profiles. The variations in systolic and diastolic blood pressures were significant with increase in age. Physiological parameters had variations with gender and BMI also. This proves the cardiovascular and respiratory morbidity in newly detected hypothyroidism, which emphasizes the importance of early diagnosis and treatment in them

Metacognitive awareness- evaluation and implications in medical students

Background: Medical education is at cross roads today with a mismatch between students’ expectations of their performance and the reality. This led us to explore the reason for the academic decline. During our search, we found that metacognitive awareness plays a key role in moulding the learning skills of adult learners. Hence this study was conducted to evaluate the metacognitive awareness of medical students studying in the first year of MBBS.Methods: 100 first year medical students were included in the study and metacognitive awareness inventory questionnaire, a validated tool was administered to the students. This measures metacognitive knowledge and regulation. The results were obtained, tabulated and analysed.Results: Metacognitive awareness among medical students was average. Metacognitive knowledge was found to be significantly better than regulation. On comparing the genders, we note that females have better metacognitive regulation while males score higher in metacognitive knowledge which was statistically significant.Conclusions: The findings of the present study points towards the need of introduction of metacognitive strategies in the medical curriculum with more emphasis on problem based learning in order to make our learners become independent thinkers and efficient care givers.  

The effect of waist hip ratio on the various stress types in I year Indian medical students

Background: A medical student faces tremendous academic and non-academic stress owing to the vast curriculum and inadequate time. The impact of stress results in detrimental mental and physical health which is assessed here using stress questionnaires and anthropometric parameters. Stress need not be only academic.  Hence it becomes vital to identify and target the specific and common non-academic stressors to enable the students to have a stress-free learning environment. The objective of this study was to find the inter relationship between waist hip ratio (WHR) and various stressors the student is exposed to.Methods: 97 I year medical students participated in this cross-sectional study and were administered the medical student stress questionnaire (MSSQ), a validated tool and the anthropometric measurements (waist and hip circumference, waist hip ratio, body mass index) were taken. The data was analyzed using SPSS version 22.Results: The study showed a negative correlation of WHR with all the stress parameters of which inter personal relationship stress (IRS) and teaching learning related stress (TLRS) were significant.Conclusions: Increasing the duration of I year MBBS course and helping learners acclimatize to the new study environment may help in reducing stress. Stress relaxation techniques, psychological counselling and strengthening the mentor- mentee programs along with exercise regimen may aid in the stress reduction process and facilitate physical health.

Age and sex variation in the distribution of visceral fat among healthy doctors

Background: Non Communicable Diseases (NCDs) are a mushrooming problem and accounts for majority of deaths. Paradoxically the population of Kerala is increasingly susceptible to NCDs despite having good access to health care. Doctors work in highly stressful conditions and often adopt sedentary lifestyles thereby forming a subset of the NCD prone population. The objective of this study was to assess the health status of the doctors which would provide an insight into their health and level of awareness regarding the role of lifestyle in prevention of NCDs.Methods: Sixty five doctors participated in this Cross-Sectional Observational study conducted at a CME in Kerala. After obtaining Institutional Ethical clearance, demographic profile was collected, and fat levels were estimated using body composition analyzer (OMRON-HBF375). The results were tabulated using Microsoft Office Excel, analyzed using SPSS version 20.Results: On classifying the study group based on BMI, only 34 were normal, 26 were Overweight, and 4 were Obese. Gender wise distribution of body fat revealed only 4 had normal body fat composition. The study also showed that as age advances the amount of total and visceral fat shows a significant upward trend in males.Conclusions: BMI alone cannot be used as a predictor of health status. Body Fat percentage analysis should be included in routine screening programs. Men have a tendency to develop visceral adiposity with age. Females depend more on fat as primary source and hence females will respond better to a properly programmed exercise regime and men to a well guided diet program with exercise