The MRI of Lumbar Vertebral Canal in Low Back Pain: A Cross-Sectional Study

Background The imaging of the lumbar canal is an important aspect of low back pain (LBP) management. Magnetic resonance imaging (MRI) has gained widespread acceptance for the evaluation of spine anatomy. Objective The objective of the study is to compare the MRI findings of the anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal in symptomatic low back pain patients to that of patients without low back pain. Methods The cross-sectional study included 200 subjects of which 100 subjects (49 males and 51 females) were symptomatic cases of low back pain and 100 subjects (53 males and 47 females) had no symptoms of low back pain and were enrolled as controls. The MRI scans were studied for the anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal. Results In our study, the anteroposterior diameter of the lumbar vertebral canal among cases was found to have a mean of 14.42, 14.09, 13.44, 13.63, and 13.79 with a standard deviation (SD) of 1.25, 1.32, 1.75, 1.75, and 2.65 at L1, L2, L3, L4, and L5 levels, respectively. The anteroposterior diameter of the lumbar vertebral canal among controls was found to have a mean of 15.26, 15.16, 14.71, 14.68, and 15.28 with an SD of 1.60, 1.67, 1.30, 1.36, and 1.97 at L1, L2, L3, L4, and L5 levels, respectively. The difference in anteroposterior diameters of the lumbar vertebral canal was found to be statistically significant at each level, between cases and controls. The transverse diameter of the vertebral canal was found to be smaller in cases as compared to controls with a statistically significant difference at each of the levels studied. The thecal sac area of the vertebral canal was found to be less in subjects with low back pain at each of the vertebral levels studied. Conclusion The study results provide insight into the lumbar vertebral parameters in the study population and give comparative data among the symptomatic low back pain patients and control subjects without low back pain. The MRI reflected decreased anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal among symptomatic low back pain patients.

Childhood Tuberculosis and Isoniazid Preventive Therapy Among Household Contacts of Sputum Positive Pulmonary Tuberculosis Patients: A Descriptive Observational Study

Background

The prevalence of tuberculosis (TB) disease among household contacts of adult TB patients is very high. Contact screening and isoniazid preventive therapy (IPT) are recommended for household contacts, but their uptake by families and implementation by the national TB program are poor. This study was performed to estimate the yield of tuberculosis disease, risk factors associated with disease development, and coverage of IPT in household contacts of sputum-positive pulmonary tuberculosis patients in the Aurangabad district of Maharashtra.

Methods

A cross-sectional study was conducted at MGM Medical College Hospital Aurangabad. Sputum-positive adult TB patients were enrolled in the study. Their household contacts were screened for TB disease, and the status of IPT in eligible contacts was studied. Serial screening and follow-up of these contacts were performed for one year.

Results

A total of 82 contacts of 55 index cases were studied. At the one-year follow-up, 15 (18%) patients developed TB disease. Twelve had pulmonary TB, and three had extrapulmonary TB. The mean age of diseased contacts was 5.5 years. The disease was more common in contacts under six years of age. Sixty-four percent of eligible contacts received IPT. There was a statistically significant association between disease development and noncompliance with IPT (p-value 0.005913).

Conclusions

The yield of tuberculosis disease is high in children contacts with sputum-positive pulmonary TB cases. IPT implementation is inadequate in child contact.

Assessment of Attitude of First Year Medical Undergraduate Students Towards Communication Skills Training: A Cross-sectional Study

Introduction: Attitude, Ethics and Communication modules (AETCOM) for undergraduate medical students have been suggested by the Indian Medical Council (2015) in the new curriculum based on competencies. There is a need to assess the attitude of students towards communication skills training modules. Communication Skills Assessment Scale (CSAS) is an accepted tool for it. Aim: To assess the attitude of first year medical undergraduate students towards communication skills learning programme. Materials and methods: The present cross-sectional study was conducted in Department of Physiology at Government Medical College, Aurangabad, Maharashtra, India, in the third week of November 2016. Total 60 students from first year undergraduate (MBBS) course were included in the study. The CSAS questionnaire has 26 items using five-point Likert scale with 13 positive and 13 negative statements about communication skills training labelled as Positive Assessment Scale (PAS) and Negative Assessment Scale (NAS). The scores were compared for gender groups and English medium and vernacular medium group by Independent two-tailed student’s t-test. Results: Sixty students (34 females and 26 males) were present with mean age of 18.4±0.8 years. Overall, PAS was 53.5±7.8, and NAS was 32.2±6.1. Among 26 males, PAS was 52±10.7, and among 34 females it was 54.7±4.4 (p-value=0.18). NAS in males was 34.2±6.3, whereas, in females, it was 30.7±5.6 (p-value= 0.026). Conclusion: The findings indicate the acceptability of communication skills training among first year MBBS students. There is a need to utilise these positive perception among students and train them to become competent doctors with the desired communication skills.

The Effect of Traditional Aerobic Exercise and Sprint Interval Training on Insulin Resistance in Men With Prediabetes: A Randomised Controlled Trial

Introduction

Prediabetes is an intermediate stage with hyperglycaemia below the threshold of diabetes mellitus. Insulin resistance is a significant factor in its pathogenesis. Lifestyle modifications are suggested and found to be more beneficial in this stage. Moderate-intensity exercise for 30 to 45 minutes a day is routinely recommended but has low compliance, and lack of time is a significant deterrent. Sprint interval training (SIT) is an alternate exercise regimen with higher intensity and less time requirement. The present study compares the effect of a three-month intervention of traditional aerobic exercise and sprint interval training on insulin resistance in prediabetic men.

Methods

The study subjects were males aged 25 to 40 years with prediabetes as per the American Diabetes Association criteria of fasting and two-hour plasma glucose levels. The study is a parallel-group randomised trial with one arm (AE group) involved in the traditional aerobic exercise (brisk walking) for 30 minutes, five days a week. The other arm was the sprint interval training (SIT) group performing an ‘all-out’ run effort for one minute followed by a recovery rest period of one and a half minutes, completing one cycle of two and half minutes. Four such cycles were completed in each session. Thus, the exercise sessions were just 10 minutes daily, three days a week. The duration of the intervention was three months. One hundred and sixty participants were recruited after screening and randomly assigned in a 1:1 ratio to the two groups. The primary outcome measure was insulin resistance estimated by homeostasis model assessment -estimated insulin resistance (HOMA-IR). The secondary outcome measures were fasting plasma glucose and serum insulin, glycated haemoglobin, body mass index and waist-hip ratio.

Results

The mean age of the AE group was 30.7 ± 3.3 years, and the SIT group was 31 ± 3.4 years. Seventy-two men from the AE group and 74 from the SIT group completed the study. After the three-month AE and SIT exercise, the per-protocol analysis reflected a significant reduction in insulin resistance, i.e., HOMA-IR (3.6 ± 1.1 to 3 ± 1.2, p<0.0001) after traditional aerobic exercise. Similarly, the HOMA-IR was significantly reduced after sprint interval training (3.3 ± 1.2 to 2.5 ± 1, p<0.0001). The intention-to-treat analysis also found that the reductions in HOMA-IR after both exercise protocols were statistically significant. The change in insulin resistance compared for the SIT vs AE group was not statistically significant. Secondary outcome measures HbA1c, fasting glucose, fasting insulin, BMI, and waist-hip ratio showed significant improvement with AE and SIT. 

Conclusions

The sprint interval training similarly improved insulin resistance and other parameters compared to the traditional exercise group. SIT can be a time-efficient exercise protocol suggested as a part of lifestyle modification for men with prediabetes.

Effect of Vitamin D3 Supplementation on Insulin Sensitivity in Prediabetes With Hypovitaminosis D: A Randomized Placebo-Controlled Trial

Introduction The interplay of vitamin D and glucose metabolism is an area of ongoing research. The need for vitamin D supplementation trials in individuals with prediabetes and hypovitaminosis D has been stressed by earlier research studies. The objective of this study was to assess the effect of vitamin D3 supplementation on oral glucose insulin sensitivity (OGIS) index in patients with prediabetes and hypovitaminosis D. Methods  We enrolled 120 individuals with prediabetes (ADA definition) and hypovitaminosis D (vitamin D < 30 ng/mL) and randomized them into the vitamin D supplementation (60,000 IU weekly) group and the placebo group. Primary outcome measure (i.e., 2-hour OGIS index) and secondary outcome measures (i.e., fasting and postprandial blood glucose, glycosylated hemoglobin, body mass index, and insulin sensitivity indices, i.e., quantitative insulin sensitivity check index [QUICKI] and homeostatic model assessment for insulin resistance [HOMA-IR]) were analyzed for change with the 12 weeks of intervention. Results  A total of 52 subjects in the vitamin D group and 49 in the placebo group completed the study. Serum vitamin D levels (10.11 ± 2.73 to 52.2 ± 13.14 ng/mL; p < 0.0001) and OGIS index (376.4 ± 39.7 to 391.7 ± 40.7 mL/min/m²; p = 0.011) increased significantly on per-protocol analysis in the vitamin D group. There was no significant change observed in vitamin D levels and OGIS index in the placebo group. Between-group comparison showed a rise in OGIS index (15.3 ± 47.1 mL/min/m²) in the vitamin D group and decrease in OGIS index (-10.4 ± 44.7 mL/min/m²) in the placebo group, and the difference was statistically significant (p = 0.0029). The inter-group comparison showed relative fall in fasting glucose levels in the vitamin D group, with no significant change observed in the other secondary outcome measures. Conclusions The correction of hypovitaminosis D in subjects with prediabetes led to improved insulin sensitivity as assessed by OGIS index at 120 minutes, signifying the role of vitamin D in glucose homeostasis.

Assessment of aerobic capacity in overweight young females: A cross-sectional study

Context:

Overweight/obese people are prone to develop cardiovascular, respiratory and other chronic diseases at young age because of abnormal weight. Aerobic capacity (VO₂ max) is an accepted index of cardio respiratory fitness. Decrease in VO₂ max can be an early marker for altered cardiovascular physiology.

Objectives:

The present study was carried out with the objective of evaluating aerobic capacity in overweight young females and comparing it with that of normal weight females.

Materials and Methods:

Twenty-three female subjects aged 18–20 years were enrolled in each group. Group 1 comprised overweight subjects and group 2 comprised normal weight subjects. Analysis to assess the difference in VO₂ max between the groups was done by unpaired t-test.

Results:

Mean age of group 1 and 2 was 18.91 ± 0.67 years and 18.83 ± 0.78 years, respectively. Mean BMI in group 1 and 2 was 26.18 ± 1.06 kg/m² and 20.65 ± 1.5 kg/m² respectively. VO₂ max in groups 1 and 2 was 34.52 ± 3.26 ml/min/kg and 37.51 ± 2.88 ml/min/kg respectively. The difference in VO₂ max found in overweight girls was statistically significant with P value of 0.002.

Conclusion:

Overweight girls had significantly reduced, cardio-respiratory fitness when compared to normal weight young females.