Kempegowda Institute of Medical Sciences is a medical college in the Indian state of Karnataka, affiliated to the Rajiv Gandhi University of Health Sciences, Jayanagar, Bangalore.
Abstract Background Traffic police personnel in rapidly urbanizing Indian cities are chronically exposed to hazardous noise levels, placing them at high risk for noise-induced hearing loss (NIHL). Conventional pure-tone audiometry (PTA) often fails to detect the earliest signs of cochlear damage. This study aims to evaluate and compare the utility of high-frequency audiometry (HFA) and distortion product otoacoustic emissions (DPOAE) in detecting early auditory damage in traffic police personnel with normal conventional audiograms. Methods A cross-sectional comparative study was conducted at a tertiary care teaching hospital in Bangalore over 13 months on 120 participants. The cohort was divided into Group 1 (60 traffic police personnel) and Group 2 (60 office workers). All participants had normal conventional PTA thresholds (≤ 25 dB HL at 0.25–8 kHz). Participants underwent HFA (10–16 kHz) and DPOAE testing. Results Despite normal conventional hearing, Group 1 exhibited significantly higher thresholds in HFA at 12.5 kHz and 16 kHz (p < 0.001). DPOAE analysis revealed significantly reduced signal-to-noise ratios (SNR) and lower emission amplitudes in Group 1, particularly at 4 kHz and 6 kHz. Conclusion Traffic police personnel suffer from latent cochlear damage missed by routine screening. HFA and DPOAE are sensitive tools for the preclinical detection of NIHL and should be considered for occupational surveillance protocols.
Rabies is a preventable zoonotic disease, yet timely and complete post-exposure prophylaxis (PEP) remains a major operational challenge in endemic countries. Compliance to the full vaccination schedule is critical for ensuring protection against rabies virus following category II and III exposures. A prospective observational study was conducted at the Anti-Rabies Clinic, Kempegowda Institute of Medical Sciences Hospital, Bengaluru, India, among all animal bite victims attending for PEP between October 2021 to December 2022. Data on socio-demographics, exposure characteristics, health-seeking behavior, vaccination compliance, and reasons for drop-out were collected using a structured case record form. Compliance was defined as completing all five doses of intramuscular anti-rabies vaccine according to the Essen regimen. A total of 735 animal bite victims were enrolled; 80.4
BACKGROUND:Subtle gait alterations and inter-limb asymmetry may precede radiographic knee osteoarthritis (OA), but isolated biomechanical variables often lack sensitivity for early detection. We evaluated whether multidomain gait and strength measures improve discrimination of symptomatic individuals without radiographic OA. METHODS:One hundred seventeen symptomatic participants with Kellgren-Lawrence grade 0 knees and 60 age-matched controls underwent assessment of walking speed, step length, knee sagittal-plane range of motion, functional mobility, and knee flexor and extensor strength. Inter-limb asymmetry indices were calculated and aggregated into a Composite Mechanical Dysfunction Index. Circulating inflammatory and tissue-turnover markers were analysed as adjunct physiological measures. Between-group differences were quantified using standardized mean differences and cross-validated receiver operating characteristic analyses. FINDINGS:Compared with controls, symptomatic participants walked more slowly, had shorter step length, reduced knee range of motion, and greater mobility and strength asymmetry (all p < 0.001). Mechanical domains showed small-to-large effects (standardized mean differences up to approximately 1.05), with gait performance demonstrating the largest mechanical difference, whereas biological markers showed larger effects (up to ∼1.7). The composite mechanical index demonstrated excellent discrimination (cross-validated AUC 0.93-0.99). Addition of physiological markers yielded only modest improvement. A simplified four-domain mechanical model retained approximately 82% of full-model performance. INTERPRETATION:Multidomain gait and asymmetry measures identify clinically meaningful functional impairment in individuals with knee symptoms despite normal radiographs. Composite mechanical metrics provide an interpretable and scalable approach for early screening and may support targeted preventive strategies.
Background Chronic musculoskeletal disorders (MSDs) are a leading cause of disability worldwide, and long-term treatment with nonsteroidal anti-inflammatory drugs, corticosteroids, and opioids is frequently limited by adverse effects. We developed the Unified Musculoskeletal Dysfunction Index (UMDI) and Unified Musculoskeletal Aging Index (UMAI) as multidomain quantitative tools to assess musculoskeletal dysfunction and estimate model-derived musculoskeletal biological age. Methods In this 16-week randomized controlled trial, 180 adults with chronic MSDs were randomized (1:1) to receive either a standardized oral and topical multi-target phytotherapeutic intervention or standard management. The primary outcome was the change in UMDI. Physical domains, including symptom and functional disability, gait, structural asymmetry, mobility restriction, and anthropometric risk, together with biological domains comprising inflammation, muscle–cartilage degeneration, bone turnover, cardiometabolic status, and neurovascular function, were integrated into the Composite Musculoskeletal Dysfunction Index (CMDI) and Composite Biological Musculoskeletal Index (CBMI) using random-effects standardized mean differences (Cohen's d ). Weighted integration of CMDI and CBMI generated the UMDI, from which the UMAI and model-derived musculoskeletal biological age were estimated. Treatment effects were evaluated using mixed-effects models. Results Compared with standard management, the phytotherapeutic intervention significantly improved all primary and secondary outcomes (all P < 0.001), except suprapatellar, infrapatellar, and thigh girth measurements, which did not differ significantly between groups . CMDI and CBMI effect sizes were 0.73 and 0.92, respectively. UMDI decreased from 2.64 to 0.846, UMAI from 0.264 to 0.0846, and model-derived musculoskeletal biological age from 68.55 to 64.10 years, reducing the biological age acceleration gap by 67.9%. Conclusions A standardized oral and topical multi-target phytotherapeutic intervention significantly improved multidomain clinical function and biological biomarkers in adults with chronic MSDs. The newly developed UMDI and UMAI provide integrated quantitative measures of treatment response and estimated musculoskeletal biological age, supporting their use as multidimensional outcome measures in phytotherapy research and musculoskeletal medicine.
BACKGROUND:Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral arterial disease, associated with high rates of amputation and mortality. AIM:The aim of this study was to classify infrainguinal arterial disease according to the Global Limb Anatomic Staging System (GLASS) staging and evaluate limb-based outcomes according to both GLASS and Wound, Ischemia, and foot Infection (WIfI) classifications in patients undergoing revascularization for CLTI at a tertiary vascular center in South India. MATERIALS AND METHODS:This prospective observational study enrolled 300 consecutive CLTI patients undergoing infrainguinal revascularization over 24 months. Patients were classified according to GLASS (Stage I-III) and WIfI (Stage 1-4) systems preintervention. The primary outcome was limb salvage at 6 months. Secondary outcomes included major amputation rate, wound healing time, mortality, and amputation-free survival. Statistical analysis compared outcomes across classification stages. RESULTS:The mean patient age was 63.4 ± 12.1 years; 82.4% were male and 78.2% diabetic. Most patients presented with Rutherford Category 6 disease (68.1%) and WIfI Stage 3-4 (79.5%). GLASS distribution was Stage I (28.6%), Stage II (60.9%), and Stage III (10.5%). Endovascular therapy was performed in 80.7% of cases. Overall, 6-month limb salvage was 85.3%, with no significant difference across GLASS stages (I: 83.3%, II: 87.4%, and III: 82.4%; P = 0.412). However, WIfI classification demonstrated superior stratification: Stage 1-2 achieved 100% limb salvage, Stage 3 - 85.3%, and Stage 4 - 78.1% ( P < 0.001). The major amputation rate was 10.9%, and the mean wound healing time was 2.96 ± 0.9 months. CONCLUSION:WIfI classification provides superior prognostic stratification for limb salvage compared to GLASS classification in South Indian CLTI patients. While GLASS effectively guides anatomic treatment planning, the WIfI stage is the dominant predictor of amputation risk, facilitating evidence-based patient counseling and resource allocation.
