Poorvi Kulshreshtha

Introduction: - Metabolic Syndrome (MetS), a global epidemic on the rise, affects about one-third of the world’s population. MetS poses significant cardiovascular risk often assessed through the cardiac autonomic function test Heart Rate Variability (HRV). This study attempts to identify a suitable anthropometric or biochemical proxy for resource-intensive HRV to assess cardiac autonomic profile in primary and community healthcare setups. Methodology: - This cross-section study assessed relevant anthropometric, biochemical, and HRV parameters of 174 patients recently diagnosed with MetS. Results: - Waist circumference (WC) had a significant (p<0.05) moderate to strong (r=0.49) positive correlation with sympathetic predominant HRV parameters - LFnu and LF/HF ratio. Parasympathetically modulated HRV parameters like Average RR (r=-0.17), rMSSD (r=-0.23), and HF (r=-0.49) had a significant (p<0.05) negative correlation with WC. Conclusion: - The study identifies WC as a suitable indicator for cardiac autonomic profile in patients with MetS and by extension of cardiovascular posed by the disease.

Review question / Objective: A few studies have addressed the efficacy of hyperbaric oxygen therapy in patients with fibromyalgia. However, these studies have been inconclusive so far. There is no graded evidence in the form of a systematic review or meta-analysis concerning the administration of hyperbaric oxygen therapy to patients with fibromyalgia. The proposed study would be carried out to assess the efficacy and safety of hyperbaric oxygen therapy in reducing pain in patients with fibromyalgia. Primary Objective: To compare the efficacy of HBOT with the standard conventional therapy in patients with fibromyalgia of age 18 years and more. Secondary Objectives: i. To compare the adverse effects (for safety) of HBOT with the standard conventional therapy in patients with fibromyalgia of age 18 years and more; ii. To compare the change in the quality of life, sleep quality, functional impairment, depression, anxiety, and psychological distress by HBOT as compared with the standard conventional therapy in patients with fibromyalgia of age 18 years and more.

Due to the nature of the coronavirus disease 2019 (COVID-19) pandemic, final year medical undergraduate students have had to be involved in patient management in different countries. The same was the case with India. This study was conducted with the objective to analyze the effectiveness and efficiency of preparedness training to combat COVID-19 in pre-final and final-year medical students at a tertiary care institute in North India. A pre-post study was conducted among final and pre-final year medical undergraduate students. Data was collected as pre-test and post-test multiple-choice questions (MCQs) and clinical vignettes. A total of 179 medical undergraduate students attended the training. Scores on general instructions, personal protective equipment (PPE) donning and doffing, hand hygiene, biomedical waste management, contact tracing, cleaning and disinfection, ECG, and COVID-19 management improved significantly after the training. Pre-test scores on ECG, simulation, COVID-19 management were 21.58±5.311, 17.05±4.501, and 23.84±4.067, respectively. Post-test scores on ECG, simulation, COVID-19 management were 28.01±6.826, 23.84±4.067, and 6.93±1.726, respectively. Pre-test and post-test scores were statistically significant (p=0.0001). Our preparedness training program was effective in delivering the intended skills. The efficiency of the training program was demonstrated through simulation. We created a trained pool of medical undergraduate students to assist clinicians in COVID-19-related supportive care.

Background: With the looming threat of recurrent waves of coronavirus disease-2019 (COVID-19) in the presence of mutated strains, it is of paramount importance to understand the demographic and clinical attributes of COVID-19 related mortalities in each pandemic wave. This could help policy makers, public health experts, and clinicians to better plan preventive and management strategies to curb COVID-19 related mortality. Materials and methods: This was a hospital record-based, retrospective cross-sectional descriptive study, at a tertiary care hospital in Rishikesh, India. The study included all deceased patients between March 2020 and January 2021 (first wave) who had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) and were hospitalized. The study was done to describe demography, clinical presentation, laboratory parameters, treatment given, and associated complications of all COVID-19 deaths. Result: Out of 424 mortalities, 298 (70.38%) were males and 126 (29.62%) were females. Mean age of patients was 55.85 +/- 16.24 years, out of which 19.5% were less than 45 years old, 33.6% were 45-60 years old, and 41.8% were more than 60 years old. Comorbidity in the form of type II diabetes mellitus was present in 41.4% [95% CI (41.4-51.1)], hypertension in 39.8% [95% CI (35.1-44.6)], and coronary artery disease (CAD) in 15.2% [95% CI (11.8-18.8)]. At the time of presentation, shortness of breath was present in 73.6% [95% CI (69.1-77.7)], fever in 64.92% [95% CI (60.1-69.4)], and cough in 46.1%, [95% CI (41.1-50.8)]. Deranged laboratory parameters were lymphopenia in 90.2% [95% CI (86.8-92.7)], transaminitis in 59.7% [95% CI (54.8-64.3)], and hypercreatinemia in 37.7% [95% CI (33.1-42.5)]. Complications manifested were acute respiratory distress syndrome (ARDS) in 78.3% [95% CI (74-82.1)] and shock in 54.7% [95% CI (49.8-59.5)]. Median time duration between onset of symptom and hospital admission was 5 days (interquartile range (IQR) = 3-5 days) and median length of hospital stay was 9 days (IQR = 4-14 days). Conclusion: During the first pandemic wave, COVID-19 related mortality was 2.37 times higher among males, 2.14 times in the age group >60 than 40%) were type II diabetes mellitus and hypertension. The most common associated symptoms (>60%) were shortness of breath and fever. Lymphopenia was seen in >90% cases while liver involvement in 60% and kidney in 38% cases. Median hospital stay was doubled the prehospital illness.

Summary: This review imparts an impressionistic tone to our current understanding of autonomic nervous system abnormalities in fibromyalgia. In the wake of symptoms present in patients with fibromyalgia (FM), autonomic dysfunction seems plausible in fibromyalgia. A popular notion is that of a relentless sympathetic hyperactivity and hyporeactivity based on heart rate variability (HRV) analyses and responses to various physiological stimuli. However, some exactly opposite findings suggesting normal/hypersympathetic reactivity in patients with fibromyalgia do exist. This heterogeneous picture along with multiple comorbidities accounts for the quantitative and qualitative differences in the degree of dysautonomia present in patients withFM. We contend thatHRVchanges in fibromyalgia may not actually represent increased cardiac sympathetic tone. Normal muscle sympathetic nerve activity (MSNA) and normal autonomic reactivity tests in patients with fibromyalgia suggest defective vascular end organ in fibromyalgia. Previously, we proposed a model linking deconditioning with physical inactivity resulting from widespread pain in patients with fibromyalgia. Deconditioning also modulates the autonomic nervous system (high sympathetic tone and a low parasympathetic tone). A high peripheral sympathetic tone causes regional ischaemia, which in turn results in widespread pain. Thus, vascular dysregulation and hypoperfusion in patients withFMgive rise to ischaemic pain leading to physical inactivity. Microvascular abnormalities are also found in patients withFM. Therapeutic interventions (e.g. exercise) that result in vasodilatation and favourable autonomic alterations have proven to be effective. In this review, we focus on the vascular end organ in patients with fibromyalgia in particular and its modulation by exercise in general.

Objective. Amitriptyline (10–50 mg) is the most common drug prescribed for the treatment of fibromyalgia. Amitriptyline influences the autonomic nervous system, as is well known; fibromyalgia is also associated with dysautonomia. The present preliminary study was designed to observe the effects of amitriptyline prescribed in a low dose (10 mg) on the autonomic function tests and blood flow measurements in well‐diagnosed patients with fibromyalgia.

The hypothesis of autonomic nervous system involvement in pathophysiology in the patients with fibromyalgia has been addressed and tested time and again but the existing reports are both contradictory and inconclusive. A complete knowledge of the degree of autonomic dysfunction in fibromyalgia patients would be more substantial. We conducted a comprehensive non-invasive study to investigate the complete autonomic profile of female patients with fibromyalgia. An autonomic function test using a standard battery and heart rate variability analysis in the 42 fibromyalgia patients as well as 42 age matched healthy controls was performed. Both autonomic activity (tone) and reactivity were measured. Autonomic tone (both time and frequency domain parameters) was measured using heart rate variability (HRV) analysis. Autonomic reactivity was measured using a standard battery of autonomic function tests. Resting blood pressure (both systolic and diastolic) was significantly higher in the fibromyalgia patients than controls. The time domain variables and HF% as recorded by HRV were significantly lower in the patients than the controls. The autonomic reactivity for sympathetic and parasympathetic nervous system was found to be within normal limits. The cardiac autonomic function is normal and the autonomic reflex arc seems to be intact in the patients with fibromyalgia.