A study to evaluate the effectiveness of an indigenous exercise protocol in patients with heart failure to improve their quality of life: (Exercise in congestive heart failure study [E - CHF study])

Background: Congestive heart failure (CHF) is characterized by an intolerance to activities of daily living, office environment and shortness of breath in any level of extraneous activity depending on their level of heart failure (HF). This significantly contributes to reduced participation and poor quality of life (QoL) among these patients. Methods: The study was conducted from June 2014 to December 2014 in Cardio-Neuro-Centre, OPD, AIIMS, New Delhi on 40 medically stable CHF outpatients (mean age 46.3±11.4 years) in NYHA class -I & II with 3 month follow-up. IEP (Indigenous Exercise Protocol) training, consisting of one supervised session at baseline visit followed by home-based practice and telephonic encouragement and monitoring of the group was given. Outcome measures were QoL, physiological parameters (6 minute walk test - distance, VO2 max and double product) and frequency of hospitalization. Results: The results showed significant difference between QoL (P < 0.02) as measured by KCCQ, mean walking distance on the 6 minute walk test (P < 0.01) and VO2 max (P < 0.01) at entry and after 12 weeks within the experimental group, but compared to the control group, no significant difference was found between the two groups. Two hospitalizations and one death were reported in the control group, whereas none was reported in the experimental group. Conclusion: IEP was effective in achieving adequate exercise tolerance in experimental group. It showed no deleterious effect and is safe to practice at home, but more evidence is needed to consider using IEP when caring for stable heart failure patient

Molecular modelling and docking analysis of katG and rpoB gene in MDR-TB isolates from North Central Indian population

Tuberculosis caused by Mycobacterium tuberculosis, requires multi drug therapy approach. Drug resistance in M. tuberculosis is caused by mutations in specific regions in drug target genes. The study aimed to identify mutations in katG and rpoB genes and investigate the drug–drug target interactions. A total of 27 MDR-TB isolates were sequenced for katG and rpoB genes and docking and MIC analysis were performed. Three types of mutations for katG gene (Arg463Leu in all isolates of Sahariya and non-tribes; Asp529Thr and Asp529His, each in two isolates only, in Sahariya) were observed. In rpoB gene, the Ser531Leu change was observed in 17/21 isolates in Sahariya and 3/6 isolates in non-tribes. The docking analysis revealed that the drugs isoniazid and rifampicin bind to different residues in mutant forms than their proposed active sites, making active binding sites rigid and causing resistance. The MIC for isoniazid was found to range from 0.2 to 5 μg/ml in Sahariya tribe, whereas, in non-tribes, it is 0.2 μg/ml and 1 μg/ml. The MIC for rifampicin was observed at 64 μg/ml in both the population groups. The study explored the possible functional variation in isoniazid and rifampicin resistance with respect to the identified mutations. The present results indicate that these mutations affect the drug binding affinity and are causing resistance. Keywords: Sahariya tribe, MDR-TB, Molecular modelling, Dockin

Exercise performance after univentricular palliation

Background : The optimal timing, need for primary/staged procedure in patients undergoing univentricular palliation, is debatable. Aims : We performed this study to assess the exercise performance of patients undergoing various forms of univentricular palliation. Setting and Design : This was a retrospective, prospective comparative study conducted at a multispecialty tertiary referral center. Patients and Methods : Between January 2012 and June 2015, 117 patients undergoing either bidirectional Glenn (BDG) (n = 43) or Fontan (total cavopulmonary connection [TCPC]) (n = 74) underwent exercise testing. Statistical Analysis : Comparisons between subgroups for continuous data were made with Student's ttest if normally distributed and Wilcoxon ranksum test otherwise. Tests between subgroups for qualitative data were made with Pearson's Chisquare test. Results : Patients who underwent BDG with open antegrade pulmonary blood flow (APBF) had higher saturations (oxygen saturation [SpO2]) compared to those without it (87.5 ± 5.0% vs. 81.1 ± 4.8%; P = 0.0001). However, we found no differences in exercise parameters of patients undergoing BDG with or without APBF. Extracardiac TCPC (n = 42) patients demonstrated better exercise capacity (15.0 ± 7.7 vs. 11.2 ± 6.2 min; P = 0.02) and increased SpO2 on exercise (87.0 ± 8.0% vs. 83.4 ± 7.6%; P ≤ 0.05) compared to lateral tunnel TCPC (n = 32). Fenestrated TCPC (n = 30) patients had higher exercise capacity reflected by higher metabolic equivalents (METs) consumption (6.4 ± 2.3 vs. 5.2 ± 2.0 METs, P = 0.02), fewer pleural effusions (7.0 ± 3.2 vs. 9.2 ± 6.2 days, P ≤ 0.05), and lower hospital stay (9.5 ± 4.0 vs. 12.7 ± 7.7 days, P = 0.04) compared to nonfenestrated TCPC (n = 44) patients. Conclusions : We observed no differences in exercise parameters of patients undergoing BDG with or without APBF. Extracardiac TCPC patients had better exercise capacity but longer postoperative hospital stay and pleural effusions than patients with lateral tunnel Fontan. Fenestrated TCPC patients seemed to fare better than nonfenestrated ones. Patients undergoing TCPC had better exercise capacity than patients undergoing BDG alone

Status of multidrug resistant tuberculosis (MDR-TB) among the Sahariya tribe of North Central India

Summary: Background: The incidence/prevalence of tuberculosis (TB) is reported to be high in the Sahariya tribe of North Central India. The outbreaks of different drug-resistant isolates of Mycobacterium tuberculosis emphasized the need for continuous monitoring of resistance to anti-tuberculosis drugs. This study aimed to assess the profile of multidrug resistant TB among the Sahariya tribe and their non-tribal neighbors for first line drugs through field-based investigations. Methodology: A total of 274 sputum positive pulmonary TB individuals were enrolled and studied for their drug susceptibility profile by the proportion method. Results: A total of 21 cases from Sahariya and 6 from non-tribes were identified with MDR-TB. Thus Sahariya tribe showed a 1.95-fold increased risk of developing drug resistance than non-tribes. Significant differences were observed for developing drug sensitivity between Sahariya males and females when analyzed for resistance developed to any drug and overall drug resistance vs. sensitive isolates, respectively. A 4.46-fold risk was found for MDR-TB among the smokers of Sahariya tribe, whereas, the non-tribes did not show any significant association. Conclusion: The drug susceptibility profile developed in the present study indicates that drug-resistant tuberculosis is emerging as a serious public health concern in Sahariya tribe. Urgent and effective control measures and better management policies are needed for the prevention of MDR-TB in the tribe. Keywords: Sahariya tribe, Mycobacterium tuberculosis, MDR-T