Elektrofizjologiczna ocena stanu nerwów łydkowych u chorych na cukrzycę typu 2 bez objawów neuropatii obwodowej

Wstęp. Powszechnie wiadomo o występowaniu neuropatii u chorych na cukrzycę typu 2 (T2DM). Mniej uwagi poświęca się jednak występującym u tych chorych zmianom elektrofizjologicznym w nerwach obwodowych, zwłaszcza przed rozwojem jawnej neuropatiiobwodowej. W związku z tym autorzy przeprowadzili badanie mające na celu ocenę parametrów elektrofizjologicznych nerwów łydkowych obu kończyn dolnych u chorych na T2DM bez objawów neuropatii obwodowej.Materiał i metody. Do badania włączono 35 mężczyzn z T2DM oraz 35-osobową grupę kontrolną złożoną z dopasowanych pod względem wieku i płci osób bez jakichkolwiek objawów neuropatii obwodowej ani chorób zakaźnych, ogólnoustrojowych, metabolicznych czy neuropsychiatrycznych. Od wszystkich uczestników przed rozpoczęciem badania uzyskano pisemną zgodę na udział w nim. Obustronne badanie przewodnictwa nerwowego (NCS) w nerwach łydkowych w obu grupach wykonano w pracowni elektrofizjologicznej, w temperaturze 26 ± 2ºC, z zastosowaniem standardowej antydromowej metody stymulacji. Zmierzono latencję, szybkość przewodzenia, amplitudę i czas trwania obustronnych czuciowych potencjałów czynnościowych (SNAP) w nerwach łydkowych, a następnie porównano uzyskane wyniki.Wyniki. U chorych na T2DM stwierdzono zmniejszoną amplitudę potencjałów SNAP w nerwach łydkowych obu kończyn w porównaniu z osobami z grupy kontrolnej (lewa: 12,46 ± 3,77 μV vs. 16,42 ± 4,58 μV; p = 0,000; prawa: 11,96 ± 4,45 μV vs. 16,62 ± 6,20 μV; p = 0,001), chociaż wartości te znajdowały się powyżej progu wartości prawidłowych wynoszących ≥ 4 μV. Czas trwania potencjałów SNAP w nerwach łydkowych obu kończyn był dłuższy u chorych na T2DM niż w grupie kontrolnej (lewa: 1,99 ± 0,38 ms vs. 1,67 ± 0,27 ms; p = 0,000; prawa: 1,92 ± 0,47 ms vs. 1,55 ± 0,33 ms; p = 0,000).Wnioski. Niższa amplituda i dłuższy czas trwania potencjałów SNAP w nerwach łydkowych obu kończyn dolnych to zmiany elektrofizjologiczne wskazujące na neuropatię obwodową u chorych na T2DM, które można stwierdzić przed wystąpieniem objawów klinicznych neuropatii obwodowej

Enhancing REDD+ outcomes through improved governance of community forest user groups

Since forests are both source and sink of carbon, scholars have suggested reducing emissions from deforestation and forest degradation, including conservation and sustainable management of forest and enhancement of forest carbon stock (REDD+) to be part of climate negotiation. Studies have shown that forests can play a role in reducing emissions in a cheaper, quicker and effective way, while generating important co-benefits, including biodiversity conservation and watershed management. However, governance that shapes relations between different stakeholders at grassroots level has been shown to be a crucial issue in managing local forests in a way that sequester more carbon from, and emit less of it to, the atmosphere. The authors of this paper argue that the lessons gained at community forest user group (CFUG) level regarding forest governance could be useful in designing a REDD+ governance structure at grassroots level. For this, both positive lessons and challenges faced so far could be documented, analysed, synthesized and shared at broader level. REDD+, being an external intervention to local communities, can bring a range of challenges that influence the governance dynamics. However, if the programme is managed carefully, CFUGs are capacitated adequately and governed collaboratively, REDD+ may bring synergistic outcomes with existing community forestry at grassroots level, particularly by bringing both environmental and livelihood benefits

Electrophysiological status of sural nerves in type 2 diabetes mellitus patients before symptomatic peripheral neuropathy

Introduction. Neuropathies in type 2 diabetes mellitus (T2DM) patients are well known. However, electrophysiological changes in their peripheral nerves, particularly before overt peripheral neuropathy have received much less attention. Hence, we aimed to study the electrophysiological status of bilateral sural nerves in T2DM patients who do not show symptoms and signs of peripheral neuropathy. Material and methods. We selected 35 T2DM male patients and 35 age- and sex-matched control subjects without any clinical evidence of peripheral neuropathy and infectious, systemic, metabolic, and neuropsychiatric illnesses after informed written consent. Nerve conduction study (NCS) of bilateral sural nerves of both the groups was done at the lab temperature of 26 ± 2ºC by antidromic method of stimulation using standard methods. Their latency, conduction velocity, amplitude, and duration of bilateral sural sensory nerve action potentials (SNAPs) were measured and compared. Results. T2DM patients had reduced amplitudes of bilateral sural SNAPs compared to control subjects [left (12.46 ± 3.77) μV vs. (16.42 ± 4.58) μV, p = 0.000; right (11.96 ± 4.45) μV vs. (16.62 ± 6.20) μV, p = 0.001] though they were above the normal cut-off value of ≥ 4 μV. T2DM patients showed prolonged durations of bilateral sural SNAPs compared to the control subjects [left (1.99 ± 0.38) ms vs. (1.67 ± 0.27) ms, p = 0.000; right (1.92 ± 0.47) ms vs. (1.55 ± 0.33) ms, p = 0.000]. Conclusion. Reduced amplitudes and prolonged durations of bilateral sural SNAPs are the electrophysiological alterations, suggestive of peripheral neuropathy, in T2DM patients that appear before they show clinical symptoms and signs of peripheral neuropathy

Do cortisol affects the brain electrical activity (EEG powers)?

Background: Glucocorticoids at very low/high levels are detrimental for memory performance. But how electroencephalogram (EEG) activity correlates with the cortisol in high and low efficient brains are still controversial. Objective: To find the association of cortisol with EEG powers in high and low cognitive brains at the time of examination preparation. Method: The EEG was recorded in an eye-closed state for 5-minutes in high (n-59) and low (n-24) cognitive individuals. Their salivary cortisol was estimated and correlated with the EEG activity by Spearman correlation test (p<0.05). The cortisol level between two groups was compared by Mann-Whitney U test. Result: Cortisol (ng/ml) was high in low cognitive group (1.36) than to the other group (1.32).There was a negative association of cortisol with EEG powers (r= -0.41 to -0.5) in central (beta, alpha2), frontal (alpha2) and left-temporal (alpha2) regions of the low cognitive brains. In high cognitive brains, cortisol was negatively associated with beta activity in right-temporal (r=-0.27) but positively associated with theta activity in mid-frontal (r=0.33) brain area. Conclusion: The less efficient brain has high cortisol level during preparation for their examination. This might have decreased the alpha2 activity in them that will impair the processing of long term memory. However, these individuals seem to manage the examination stress by decreasing the firing of the beta activity. Conversely, in the high cognitive brain, the rise in cortisol level seemed to increase the mid-frontal theta activity that might improve the attention and encoding of the information in these individuals

Visual evoked potentials’ responses in hypothyroidism and hyperthyroidism

Background: Visual Evoked Potentials (VEP) provides important diagnostic and prognostic information regarding the functional integrity of the visual system. This study, describes the effects of less or excess thyroid hormones of adults in visual conduction that helps to know the progression to neurological functional defects.Methods: The study was done in 75 consenting subjects (hypothyroid = 24, hyperthyroid = 25, euthyroid = 26). The VEP parameters N75, P100, N145 latencies and its amplitudes within different thyroid status (hypothyroidism, hyperthyroidism and euthyroidism) were compared. One way ANOVA was used to compare VEP parameters among three groups and Pearson’s correlation to find relation between thyroid hormones and VEP parameters.Results: There was positive correlation of 0.335, 0.338 and 0.301 between amplitudes of N75, P100 and N145 waves and fT3 hormone respectively. Furthermore, fT4 showed a positive correlation of 0.186 and 0.185 with the wave amplitudes of N75 and N145 waves respectively and negative correlation of TSH levels of -0.492, -0.280, -0.397 with amplitudes of N75, P100, N145 waves respectively. Hyperthyroid group had higher in VEP latency than euthyroid group in N75 (73±5.77 vs. 68.54±4.32), P100 (106.42±9.74 vs. 100.94±8.17) and N145 (153.03±16.39 vs. 144.37±7.02) waves. Similarly, hypothyroid group had higher in VEP latency than euthyroid group in N75 (72.12±6.34 vs. 68.54±4.32) wave.Conclusions: Both hypothyroidism and hyperthyroidism led to conduction delay in adults, possibly adversely affecting function of myelin. The prominent visual evoked potential abnormalities in hyperthyroidism and less change in hypothyroidism show that the visual neuropathy is more common in hyperthyroidism

Analysis of cardiac autonomic modulation in normotensive obese and eutrophic adults of Nepal

Background: Obese people have a higher prevalence of cardiovascular disease, though unknown mechanism, supposed to be due to autonomic dysfunction which is still in controversy. This study aimed to assess and compare heart rate variability (HRV) between normotensive obese and adults.Methods: The study was conducted on 30 normotensive obese adults (mean age 32.07±7.25 years) with BMI>30 and 29 age- and sex-matched normal weight controls (mean age 30.48±8.01 years) with BMI: 18-24 Kg/m2. Short-term HRV variables were assessed using standard protocol. The data were compared between the groups using Mann Whitney ‘U’ test.Results: In obese group, there was significant increase in the mean heart rate [79.17±8.80 Vs 71.48±8.41 beats/min, p=0.001], systolic blood pressure [121.20±9.89 Vs 113.24±11.07, mmHg, p=0.004] and diastolic blood pressure [84.97±7.87 Vs 74.83±10.31 mmHg, p=0.000]. The HRV parasympathetic indicators were less [RMSSD {28.75(16.72-38.35) Vs 41.55(30.6-56.75) ms, p=0.018}, NN50 {15.5(2-39) Vs 83.5(32.75-116.25), p=0.010}], and sympathetic indicator LF/HF ratio [1.2(0.65-2.20) Vs 0.79(0.5-1.02), p=0.004] was more in obese group.Conclusions: Obese persons have increased sympathetic activity with a reduction in parasympathetic (vagal) tone indicating poor autonomic cardiac rhythm control. Moreover, the altered autonomic activity could be the reason for increased mean heart rate and blood pressures in normotensive obese persons

Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations

<p>Abstract</p> <p>Background</p> <p>This report describes a new technique of sphincter saving anorectoplasty (SSARP) for the repair of anorectal malformations (ARM).</p> <p>Methods</p> <p>Twenty six males with high ARM were treated with SSARP. Preoperative localization of the center of the muscle complex is facilitated using real time sonography and computed tomography. A soft guide wire is inserted under image control which serves as the route for final pull through of bowel. The operative technique consists of a subcoccygeal approach to dissect the blind rectal pouch. The separation of the rectum from the fistulous communication followed by pull through of the bowel is performed through the same incision. The skin or the levators in the midline posteriorly are not divided. Postoperative anorectal function as assessed by clinical Wingspread scoring was judged as excellent, good, fair and poor. Older patients were examined for sensations of touch, pain, heat and cold in the circumanal skin and the perineum. Electromyography (EMG) was done to assess preoperative and postoperative integrity of external anal sphincter (EAS).</p> <p>Results</p> <p>The patients were separated in 2 groups. The first group, Group I (n = 10), were newborns in whom SSARP was performed as a primary procedure. The second group, Group II (n = 16), were children who underwent an initial colostomy followed by delayed SSARP. There were no operative complications. The follow up ranged from 4 months to 18 months. Group I patients have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination with an average number of bowel movements per day was 3–5. In group II the rate of excellent and good scores was 81% (13/16). All patients have an appropriate size anus and regular bowel actions. There has been no rectal prolapse, or anal stricture. EAS activity and perineal proprioception were preserved postoperatively. Follow up computed tomogram showed central placement the pull through bowel in between the muscle complex.</p> <p>Conclusion</p> <p>The technique of SSARP allows safe and anatomical reconstruction in a significant proportion of patients with ARM's without the need to divide the levator plate and muscle complex. It preserves all the components contributing to superior faecal continence, and avoids the potential complications associated with the open posterior sagittal approach.</p

Criteria for Peer Reviewing the Original Articles Submitted to a Biomedical Journal: Intellectual Honesty is the Best Policy.

Peer review - a process of assessing the quality of manuscripts submitted to a journal – is an established norm in biomedical publications. It is viewed as an extension of scientific process. The peer-reviewed research articles are considered trustworthy because they are believed to be unbiased and independent. The process of reviewing is a privilege and prestige. It is highly responsible, intellectually honest, and difficult job. Being expert in certain area of biomedical science is a prerequisite for reviewers. Young peer reviewers trained in epidemiology or statistics produce high-quality review. The International Congresses on Peer Review in Biomedical Publication have shown many unresolved issues related to preparation or handling of manuscripts by a journal. Therefore, it is vital to identify authentic peer reviewers to ensure quality publication, thus, a set of peer review criteria is proposed for peer reviewing original articles. It is useful in quantifying (scoring) the manuscript quality. The proposed scoring system yields three categories of manuscripts: the first category is considered acceptable for publication after minor modification by editorial board and/or reviewers, the second – requires rewriting and resubmission, and the third – rejected. These criteria are preliminary guidelines, and require timely review. They are expected to sensitise peer reviewers, editors, contributors, and readers to move towards greater honesty and responsibility while working with manuscripts. In summary, if the criteria are used they will facilitate editorial management of manuscripts, render more justice to authors and biomedical science, and improve publication quality. Key Words: Biomedical publication, peer review, peer review criteria, scoring of manuscripts, categories of manuscripts, journal of Nepal Medical Association

EFFECT OF WATER AND SALINE LOAD ON URINARY OUTPUT IN HEALTHY UNDERGRADUATE MEDICAL STUDENTS

ABSTRACT Water and electrolyte balance is a vital homeostatic function. Their excretion depends on various factors – state of hydration, plasma osmolarity etc. There are rare reports on effect of hypertonic solution on urinary output. Therefore, the study aimed at investigating the effect of water or saline (especially the hypertonic) load on urinary output (UO) in healthy undergraduate male medical students (17-20 years). They (n=20) were randomised into 4 equal groups: control, water, normal and hypertonic saline (1.8%). The study was a part of undergraduate practical conducted under controlled conditions in the Physiology Department, BPKIHS. The day before the experiment, all of them were given same instructions. Next day, the experimental groups drank water/saline solution 12 ml/kg. Then the UO was measured ½-hourly. A non-parametric – Friedman test was used for intra- and inter-group differences in UO and specific gravity. The data are presented as median (range). In water group the 60-min UO was significantly higher than the 30-min UO [178.5 (24-415) vs. 22.5 (21-81) ml, p<0.05]. This group also had significantly higher UO than the control at 90-min [84 (20-250) vs. 19 (18-23) ml, p<0.05)]. The UO of normal-saline group was significantly higher than that of control at 90-min [40 (22-250) vs. 19 (18-23) ml, p<0.05]. There was no significant difference in specific gravity. The water and normal saline loads were adequate to elicit physiological response, the hypertonic solution was not strong enough to show significant physiological response suggesting need of saline load to be more than twice of the plasma osmolarity. Key Words: homeostasis, water-electrolyte balance, salt load, water load