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Sathish et al., Int J Med Res Health Sci. 2014;3(4):785-789

International Journal of Medical Research

&

Health Scienceswww.ijmrhs.com Volume 3 Issue 4 Coden: IJMRHS Copyright @2014 ISSN: 2319-5886

Received: 9th April 2014 Revised: 28th Jul 2014 Accepted: 29th Aug 2014

Research article

EFFECTIVENESS OF RESISTED ABDOMINAL EXERCISE VERSUS RESISTED DIAPHRAGMATIC

BREATHING EXERCISE ON CARDIO VASCULAR ENDURANCE IN SPORTS MEN

*Sathish Gopaladhas1, Anilkumar Panigrahy

2, Elanchezhian Chinnavan

3, Rishikesavan Ragupathy

4

1Professor, White Memorial College of Physiotherapy, Tamil Nadu, India

2Department of Physiotherapy, Institute of Medical sciences and Sum Hospital, Odisha, India

3, 4Lecturer, School of Physiotherapy, AIMST University, Malaysia

*Corresponding author email: [email protected]

ABSTRACT

Background and Purpose: The purpose of the study is to compare the effectiveness of resisted abdominal

exercise and resisted diaphragmatic breathing exercise on cardiovascular endurance to prescribe a fitness

program. Study design and setting: Experimental study, YMCA Fitness Foundation Academy, Pachaiyappa Arts

and Science College. Study Sample: 30 sports men. Inclusion criteria: Sportsmen with the age group of 18-30

years. Exclusion Criteria: Individuals with postural deviations like scoliosis, Kyphosis, cardiovascular diseases

like history of rheumatic heart disease, obstructive lung diseases, vascular problem in lower limb. Tools: Step up

and step down endurance test Procedure: 30 individuals are divided into two groups. Group-I was taught resisted

diaphragmatic breathing exercise. Group-II was taught resisted abdominal exercise. Pre-test values of step up and

step down, endurance level of athletes were assessed and documented. Total duration of the study is 8 weeks. Atthe end of 8

thweek post-test endurance were reassessed using step test. Results: Paired t test was used to analyze

the effect of cardiovascular endurance. The post test mean values of all the variables of group-I were improved

than that of group-II (p


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exercise module, training state and muscle power2.

Skeletal muscles respond to training in well described

ways which depends on the characteristics of the

training load. Oxygen intake can be increased by

strengthening the respiratory muscles. The extent of

the muscle adaptation depends upon the application

of the principle of training such as overload,

specificity and reversibility5.

The first attempt to apply the general principles of

skeletal muscle training to respiratory muscles was

described nearly two decades ago. Aerobic capacity is

one of the important factors for marathon runners and

cross country skiers. Improvement of aerobic

capacity may enhance the cardio-respiratory fitness2.

This study was concentrated on strengthening the

respiratory muscles to improve uptake of oxygen and

thereby increasing aerobic capacity. For many

athletes, the core musculature is the weak link in the

kinetic chain. A strong core is critical because all

movements originated in trunk; this coupling action

connects movements of the lower body to those of the

upper body and vice versa6. Optimal core strength

and stability can promote efficient biomechanical

movement patterns and reduce the potential for

injuries. Resistance training is a valuable tool that can

contribute to the development of endurance athletes

of all levels and abilities3. Traditionally, coaches and

athletes were reluctant to certain level to include

strength training program because the “extra bulk”

would reduce cardiovascular performance. In recent

years, research has shown that strength training has

no adverse effect on aerobic capacity. In addition,

other benefits to the endurance athlete include:

maintaining proper muscular strength ratios,

increasing bone mineral density, enhancing

connective tissue, preventing overuse injuries,

improving lactate threshold and improving exerciseeconomy

4.

Diaphragm has endurance properties which exceed

that of a limb muscle and also of abdominal muscle7.

Strengthening the diaphragm could also help in

improving general endurance as diaphragmatic

breathing is the only way to get air into the lower

third of our lungs, where two third of the blood

supply is in the body5. This breath technique may

improve the efficiency of the athlete’s lungs. It will

enhance the ability to metabolize oxygen.Diaphragmatic breathing has been suggested by many

pioneers to improve endurance8, 9

.

On the contrary the abdominal muscles are probably

one of the most targeted areas in the world of health

and fitness marketing. The abdominal exercises

comprised of curl ups followed by progressive

resisted exercise patterns, the exercise program is

progressed by manual weights6. Numerous fitness

experts and physiotherapists advocate strengthening

some component of the abdominal musculature to

prevent musculoskeletal injury, overcome

deficiencies in sporting skill or generally enhance

performance6. Virtually every athlete is advised to

stabilize his back and pelvis. Abdominal training

programs have stayed at the top of exercises regime.

So the study is to determine the effective technique

among resisted abdominal exercise and resisted

diaphragmatic breathing exercise to improve

cardiovascular endurance.

MATERIALS AND METHODS

Ethical Clearance: The study was approved by the

Meenakshi College of Physiotherapy review board

and complies with the principle laid down in the

declaration of Helsinki in 2005.10

Study Design: Experimental study

Study Setting: YMCA Fitness Foundation Academy,

Pachiyappas Arts and Science College, Chennai

Inclusion criteria: Individuals in the age group of

18-30 years, only male subjects were included,

Hockey and football players, Non-smoking athletes

Exclusion criteria: Individuals with postural

deviations like scoliosis, kyphosis, cardiovascular

diseases like history of rheumatic heart diseases, any

obstructive lung diseases, any recent injury to chest

and vascular problems in lower limb.

Procedure:

The sampling technique used in this study was non-

probability sampling. Totally 30 both hockey and

football players were selected for this study and they

were divided into Group-I and Group-II consists of

15 subjects in each group respectively.

All the subjects were informed about the study and

their consent was obtained prior to training. The

subject’s aerobic endurance was analyzed using

steptest2. All subjects underwent two minutes of the

warm up period, which consisted of stepping up and

down.

Group-I were taught resisted diaphragmatic breathingexercise. Group-II was taught resisted abdominal


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exercise. Pre test values of step test, endurance levels

of athletes were assessed and documented. Total

duration of study was 8 weeks. At the end of 8th

week, endurance is reassessed using step test and

progression was recorded.

Exercise Prescription:

Group-I: Athletes included in the group-I was taught

resisted diaphragmatic breathing.

Resisted diaphragmatic breathing (Inspiratory muscle

strength training) is given by using weight plates. The

weight plates were placed on a folded Turkish towel

to prevent friction between weights and skin of the

subjects. The weights were placed on the epigastric

region. The weight is placed in such a way that one of

the corners touches the xiphisternum and other two

corners touches the anterior borders of the rib cage.

The subjects were in supine and directed to do the

breathing exercise11

. Inspiratory muscle training was

done for 8 weeks with progressively increasing

weights in the following manner (table 1):

Table: 1. Progressions of Duration / Weight for

Group- I and Group- II

Duration Weight

1st

and 2nd

week 2 Kg

3rd

and 4th

week 3 Kg

5th and 6th

week 4 Kg7th and 8

thweek 5 kg

Each session lasted for 30 minutes per day for six

days weekly for a period of 8 weeks. At the end of

the training, i.e. at the end of 8th

week, the step test

performance of the subjects was assessed and score

was obtained in minutes12

.

Group-II: The athletes included in group-II were

taught abdominal curl ups2. The athlete laid on his

back with his knees bent and arms crossed over his

chest with the weights held in hand. Simultaneously

lifts his head, neck, shoulders and shoulder blades off

the floor in a slow controlled manner for 2 seconds.

The position, pauses for 2 times and allow the rest of

the air out of the lungs. Then slowly lower to the

initial position barely allowing the shoulders to touch

the floor before he begins the next repetition. He

exhales as he lifts and inhales while lowering.

Athletes performed this exercise 20 times (1 set). An

interval of 2 minutes was given before starting the

next set. The session lasted for 30 minutes. The

subject’s aerobic endurance was analyzed using step

test which is measured in minutes13

. Abdominal curls

ups were done 6 days a week with an interval of not

exceeding 48 hours between each workout3. Resisted

abdominal exercise was done 8 weeks with

progressively overloading in according the

inspiratory muscle training method (Table 1) each

session lasted for 30 minutes and it was followed

twice a day. At the end of training, i.e. at the end of

8th

week, step test performance of the subjects was

assessed and the score was obtained. All the

statistical analysis was performed using SPS Software

package (20.0 version). Values were presented as

mean, ± standard deviation and paired t test were

used to analyze the effect of resisted diaphragmatic

breathing exercise.

RESULTS

Table: 2. Comparison of Step test between Group-I

and Group-II before study:

Values are mean + SD and tests showed a statistical

insignificance before test (*p>0.005)

Using Independent sample “t” test, we compared both

the groups, the results showed both groups had very

less difference in the mean and standard deviation

and the P values were insignificant initially.

Table 3: Comparison of step test in Group – I and

Group – II (pre – post test values)

Values are mean + SD and tests showed a statistical

significance (*p


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99.99%significance of the result. Subjects from the

group-I had improved better in cardiovascular

endurance.

DISCUSSION

The present study was designed to determine theeffectiveness of resisted diaphragmatic exercise and

resisted abdominal exercise and to compare the more

effective way to improve cardiovascular endurance.

The male athletes were selected for the study and

were divided into two groups. Group-I received

resisted diaphragmatic exercises while Group-II

received resisted abdominal exercise. The post-test

measures were calculated on the basis of step test

score and their results were tabulated. Both the

groups had registered an increase in theircardiovascular endurance. But the statistical analysis

indicates that Group-I subjects who underwent

resisted diaphragmatic breathing exercise reported a

higher level of improved cardiovascular endurance.

This has been supported by various research papers:

They demonstrated that a significant improvement in

diaphragm thickness increased lung volumes and

exercise capacity in healthy individuals3.

A study has proved that specific inspiratory muscle

training can increase the inspiratory muscle

performance in well trained athletes 13. A study stated

that the purpose of the endurance component is to

improve cardio-respiratory and musculoskeletal

function, which will be reflected in increased exercise

capacity14

. Also, this was supported by an author in

his book of exercise physiology stating that when

endurance training is added to strength training

additional improvements occur in endurance than that

was generated by strength training alone8. The

resisted abdominal exercises which were prescribed

to Group-II is one of the widely performed exercises

irrespective of the type of sports. It is one of the most

focused areas of fitness and the exercise program

showed improvement in cardiovascular endurance in

athletes. The improvement in endurance of athletes

who underwent resisted abdominal exercise is

supported by a study, they pointed out that

strengthening the abdominal muscles helped in

improving the overall endurance in cyclists15

.

Hence, both the interventions i.e. resisted

diaphragmatic breathing as well as resisted abdominalexercise improved cardiovascular endurance. Group-I

who underwent resisted diaphragmatic exercise

showed an enhanced cardiovascular endurance than

the athletes who underwent resisted abdominal

exercise.

CONCLUSION

The study is found to be apparent; the results show

that the improvement in cardiovascular endurance

measured using resisted diaphragmatic breathing is

higher than that of resisted abdominal exercises.

Hence, this indicates that resisted diaphragmatic

breathing exercise can successfully be incorporated in

a fitness training program to improve cardiovascular

endurance for sportsmen.

ACKNOWLEDGMENT

The authors extend their gratitude to the Department

of Physical Education, Pachaiyappa Arts & Science

College, The Young Men Christian Association

(YMCA) College of Physical Education, Chennai and

the participants.

Conflicts of interest: Nil

REFERENCES

1. William D Mc Ardle, Frank I. Katch, Victor L.

Katch. Exercise Physiology: Energy, Nutrition,and Human Performance. Lippincott William’s

and Wilkins publisher.1996; 4th

Edn.

2. ACSM's Guidelines for Exercise Testing and

Prescription. American College of Sports

Medicine, Lippincott Williams & Wilkins

publisher.2006, 7th Edn.

3. Stephanie J Enright, Viswanathan B Unninathan,

Clare Heward, Louise Withnall and David H

Davies: Effect of High-Intensity Inspiratory

Muscle Training on Lung Volumes, DiaphragmThickness, and Exercise Capacity in Subjects

Who Are Healthy. Phys Ther. 2006 ;86(3):345-54

4. Madanmohan, Udupa K, Bhavanani AB,

Vijayalakshmi P, Surendiran A. Effect of slow

and fast pranayamas on reaction time and cardio-

respiratory variables. Indian J Physiol

Pharmacol.2005; 49(3):313-8.

5. European Respiratory Monograph 31: Lung

Function Testing. Volume 31of European

respiratory Monograph, European Respiratory

Society. Chapter 4, 2005, 51-77.


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6. Hedrick, Allen MA. Training the Trunk for

Improved Athletic Performance. Strength and

Conditioning Journal.2005; 22(3):50-61.

7. Gandevia SC, McKenzie DK, Neering IR.

Endurance properties of respiratory and limb

muscles Respire Physiol. 1983; 53(1):47-61.

8. Scott K. Powers, Edward T. Howley- Exercise

Physiology: Theory and Application to Fitness

and Performance. Chapter 13, 2011, 8th

Edn.

9. Leith DE, Bradley M. Ventilatory muscle

strength and endurance training. J Appl Physiol.

1976; 41(4):508-16.

10. Lesley D Henley, Denise m Frank. Reporting

ethical protections in Physical Therapy research

Physical Therapy; 2006; 86(4), 499-09.

11. Stanley John Winser, Priya Stanley, George

Tarion, Respiratory rehabilitation with abdominal

weights: a prospective study. Scientific

research.2010; 2(5):407-11.

12. Stanley John Winser, Jacob George, Priya

Stanley, George Tarion, A comparison study of

two breathing exercise techniques in tetra

plegics.Health.2009; 1(2):88-92.

13. Inbar O, Weiner P, Azgad Y, Rotstein A,

Weinstein. Y, Specific inspiratory muscle

training in well – trained endurance athlete Med

Sci Sports Exerc 2000; 32 (2):1233-7.

14. Mador MJ, MagalangUJ, KufelTJ. Twitch

Potentiation Following Voluntary Diaphragmatic

Contraction. Am.J.Resir. Crit. Care Med. 1994;

149(3):739-43.

15. Burke, Edmund R.Improved Cycling

Performance through Strength Training. National

Strength & Conditioning Association

Journal.1983; 5(3),6-10.


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Rajajeyakumar et al., Int J Med Res Health Sci. 2014;3(4):790-796


&

Health Sciences

www.ijmrhs.com Volume 3 Issue 4 Coden: IJMRHS Copyright @2014 ISSN: 2319-5886Received: 5

thJune 2014 Revised: 9

thJuly 2014 Accepted: 11

thAug 2014

Research article

EFFECT OF SLOW RHYTHMIC VOLUNTARY BREATHING PATTERN ON ISOMETRIC HANDGRIP

AMONG HEALTH CARE STUDENTS

*Rajajeyakumar M1, Janitha A2, Madanmohan3, BalachanderJ4

1Assistant Professor, Department of Physiology, Chennai Medical College Hospital & Research Centre, Trichy2Senior Medical Officer, Bharat Heavy Electrical Limited, Main Hospital, Trichy

3Professor& Head, Department of Physiology, Mahatma Gandhi Medical College & Research Centre,Pondicherry4Professor & Head, Department of Cardiology, JIPMER, Pondicherry

*Corresponding author email:[email protected]

ABSTRACT

Introduction: Hand grip strength is a widely used test in experimental and epidemiological studies. The measure

of hand grip strength is influenced by several factors, including age; gender; different angle of the shoulder,

elbow, forearm, and wrist; and posture. So we planned to study the effect of slow voluntary breathing exercise

(Savitri Pranayam) on the various strengths of isometric hand grip (IHG) among young health care students.Methods: The present study was conducted on 60 volunteers 17-20 yrs. The subjects were randomly assigned to

Pranayam and control groups. They were divided into two groups: control (n=30), Savitri (n=30 Savitri group

were practiced slow yogic breathing for three months, Paired’ test was done to compare the values within groupand unpaired’ test was done to compare the values between male and female subjects. Results: In SavitriPranayam group, the blood pressure responses to IHG were higher in males, as compared to females. The rate

pressure product (RPP) also decreased during IHG 60%. A decrease in SBP and DBP was observed at the end of

the study period. Briefly, a gender difference in various parameters such as MAP, QTc existed in the control

group at the beginning of the study and the differences persisted at the end of three months. Conclusion: Our

study reported that slow Pranayam are known to enhance parasympathetic tone, produce a highly significant

decrease in oxygen consumption and psychosomatic relaxation.

Keywords: SavitriPranayam, Hand grip strength, Yoga, Maximum Voluntary Contraction.

INTRODUCTION

Pranayama is a part of the ancient Indian art of yoga,

which is the fourth step of Ashtangayoga. There are

more than ten types of Pranayam. Some are on slow

and soft rhythm and some are on fast and forceful

rhythm.1-4Pranayama is a controlled and conscious

breathing exercise which involves mental

concentration. Hand grip strength (HGS) is a widelyused test in experimental and epidemiological

studies.5 The measure of hand grip strength is

influenced by several factors, including age; gender;

different angle of the shoulder, elbow, forearm, and

wrist; and posture.6The rate pressure product (RPP) is

a reliable index of the myocardial oxygen

consumption and the cardiac work and it correlates

well with the myocardial oxygen consumption of

normal subjects as well as of patients with angina

pectoris.7Pranayam may influence the RPP by

altering the preload and/or the after load. Handgrip

DOI: 10.5958/2319-5886.2014.00002.2


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strength is an important test to evaluate physical

fitness and nutritional status. HGS is a physiological

variable that is affected by a number of factors,

including age, gender, body size and posture etc.The

endurance of the muscle refers to its capacity to

withstand the power produced during the activity.

Poor muscle strength has also been found to be

associated with lower body weight and poor

nutritional status is associated with poor HGS.8In

view of this, the present work was planned, to study

the effect of pranayama training on cardiovascular

parameters like the heart rate, blood pressure, pulse

pressure, mean arterial pressure and the rate pressure

product.

OBJECTIVES

1. To assess the gender differences in HSG and

endurance in young males and females.

2. To assess the correlations between various

anthropometric and HGS on cardiovascular

parameters in young males and females.


The present study was conducted on 60 young right

handed healthy volunteers after obtaining ethical

clearance from the institutional Human Ethics

Committee. The duration of the study period was

between 2007 to 2008. Their age ranged between 17-

20 years (17.65 ± 0.15), body weight between 46 - 65

kg (53.72 ± 2.28) and height between 146 – 173 cm(168.5 ± 1.12). All volunteers underwent ENT,

mental or neurological examination at the beginning

of the study to rule out any major illness. The subjects

were randomly divided into control group and Savitri

Pranayam group. Each group consisted of 30

volunteers and was further divided into two sub – groups based on gender. The participants were

explained in detail about the study protocol andinformed consent was obtained from them after

meeting inclusion and exclusioncriteria.

Inclusion criteria: Subjects aged between 17 years

and 20 years of either gender.

Exclusion criteria: 1.Subjects who practiced yogic

techniques in past one year. 2. Subjects were unable

to practice pranayama due to physical and other

abnormalities. 3. Subjects with history of previous or

current organic diseases. 4. Non vegetarian, a high-fat

& energy, with regular physical activity.

Equipment used:

Blood pressure and heart rate were recorded with the

subject seated comfortably, using the noninvasive

automated BP monitor NIBP (Colin Press-Mate,

Model BP 8800, Colin Corporation Inc., Japan). This

measures BP by the oscillometric method. A standard

adult-size cuff measures 23 cm by 12 cm was used

for all subjects. Handgrip dynamometer (INCO India

Ltd Ambala) was used to measure the muscle strength

and endurance of the upper limbs, according to the

technique described and validated by Madanmohan et

al 2005.9

IHG at 10% of MVC: This test assesses the

sympathetic reactivity of an individual. Using a

handgrip dynamometer, the volunteer was asked to do

maximum voluntary contraction (MVC) for a few

seconds. After five minutes rest, they were requested

to maintain 10% of MVC for up to one minute while

blood pressure was monitored in the non – exercisingarm. The difference between the diastolic blood

pressure just before release of handgrip was taken as

the measure of the response.

IHG at 30% of MVC: The procedure was same as

that of IHG 10% of MVC; however, instead of 10%

the volunteer was asked to maintain 30% of his MVC

for a period of one minute.

IHG at 60% of MVC: Here, the volunteer wasasked to maintain 60% of his MVC for a period of

one minute.

Following these recordings, the volunteers were

trained in Savitri Pranayam and instructed to refrain

from any yogic practice or exercise depending on

whether they belonged to group II (Savitri group) or

group I (Control group) Each group consisted of 30

volunteers and was further divided into two sub – groups based on gender. After explaining the

procedure to the study subject and giving ademonstration, they were asked to hold the handgrip

dynamometer in the dominant hand in sitting

position. 10 The forearm was extended over a table

and elbow flexed at 90°. Subjects were asked to hold

the dynamometer and the second phalanx was against

the inner stirrup where they asked to grip the

dynamometer handle with as much force. The

handgrip muscle strength was recorded in kilograms

as indicated by the pointer on the dynamometer.

Three recordings were taken with a gap of twominutes between each effort and the maximum value

was recorded for the analysis.


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Table 4: Parameters of group II (Savitri female)

subjects at the beginning and end of the three

months study period

Parameter Begining End Pvalue

Rest HR 7.00 ± 1.00 72.40 ± 1.21** 0.006

SBP 114.80 ± 2.62 111.26 ± 2.93 0.426DBP 67.66 ± 2.83 63.40± 2.10 0.28

MAP 88.20 ± 3.71 79.35 ± 2.15* 0.042

RPP 88.51 ± 2.61 80.73 ± 2.82 0.065

QTc .375 ± 0.005 0.352 ± 0.005* 0.014

IHG

10%

HR 86.80 ± 2.58 82.66 ± 1.75 0.188

SBP 128.53 ± 2.84 120.86± 2.90* 0.016

DBP 9.66 ±3.65 71.80 ± 2.67* 0.021

MAP 7.33 ± 3.00 87.13± 2.36** 0.002

RPP 111.69 ± 4.40 97.51± 3.78** 0.004

QTc .370 ± 0.008 0.354 ± 0.006 0.165

IHG

30%

HR 2.20 ± 2.09 87.80 ± 1.97 0.154

SBP 131.06 ± 2.58 124.53 ± 3.47 0.152

DBP 7.53 ± 2.79 76.13 ± 3.88 0.787

MAP 5.37 ± 2.41 92.26 ± 3.57 0.503

RPP 120.93 ± 3.85 109.57 ± 4.46 0.09

QTc .379 ± 0.009 0.360 ± 0.006 0.066

IHG

60%

HR 87.26 ± 2.02 89.13 ± 2.04 0.57

SBP 126.13 ± 3.54 128.53 ± 3.73 0.647

DBP 75.13 ± 3.58 74.60 ± 2.54 0.899

MAP 94.66 ± 4.27 92.57 ± 2.74 0.663

RPP 109.88 ± 3.64 114.90 ± 4.78 0.403

QTc 0.361 ± 0.008 0.369 ± 0.005 0.29$

Values are expressed as mean ± SEM.Paired t test was applied to compare the parameters at

the beginning and end of the study. HR – heartrate,SBP – systolic blood pressure, DBP – diastolicblood pressure, MAP – mean arterial pressure, RPP – rate pressure product,QTc – corrected QT interval,IHG – isometric handgrip.*P≤0.05.,**P≤0.01,***P≤0.001To summarize, The RPP was also decreased during

IHG 60%. The female subjects of Savitri group

exhibited a similar trend of decreasing, HR, MAP &

QTc during rest. Briefly, a gender difference in

various parameters such as MAP, QTc existed in the

control group at the beginning of the study and the

differences persisted at the end of three months in the

group. In the Savitri group, a similar trend was

evident at the beginning and the end of the study. In

savitri pranayam group, the blood pressure responses

to IHG were higher in males, as compared to females.

DISCUSSION

In our control group of male as well as femalevolunteers the recorded cardiovascular parameters

were similar and BMI of both genders were not

attained statistical significance at the beginning and

the end of the three months study period. BMI was

significantly decreased in both male and female

Pranayam groups in compared with the control group.

Regular practice of Pranayam in the right manner can

help increase the metabolism and helps in burning off

more calories. It is important to realize that the

process of weight loss through Pranayama or most

other yoga forms slow and gradual. However, when

pranayama is modified by several levels, it can help

facilitate weight loss at a faster rate.

Savitri Pranayam group: Savitri Pranayam is a slow

type of breathing, known to enhance parasympathetic

tone. The results of this group are in accordance with

this. The heart rate and blood pressure during rest was

lower in male as well as female volunteers, but

attained statistical significance only in the latter. In

general, the rise in HR & BP in response to IHG was

less at the end of the study period. This may be due to

the improved autonomic tone resulting in an

increased parasympathetic drive, calming of stress

responses, neuroendocrine release of hormones and

thalamic generators. This blunting of the presser

response was more prominent during IHG 10% of

MVC and more so in the female group. The values in

the male volunteers did not attain statistical

significance. This is consistent with earlier reportsfrom our laboratory that Savitri Pranayam can

produce a highly significant decrease in oxygen

consumption and psychosomatic relaxation. The RPP

was also less after Savitri Pranayam training in both

male and female subjects. RPP is an index of

myocardial oxygen consumption and load on the

heart10,-12.This interesting finding of ours has great

applied value as this indicates that Savitri pranayam

can be used as an effective technique to reduce load

on the heart during stressful situations. Deepbreathing reduced blood pressure in male as well as

female subjects after Savitri pranayam.

At the beginning of the study, the resting HR, RPP,

and QTc were significantly higher in females (N=15)

as compared to males. During IHG exercise of

various grades of all values was higher in males

(N=15) volunteers, but the SBP attained statistical

significance. At the end of the study in this group

during rest, HR and QTc were higher in females as

compared to males, but the values were less ascompared to the values at the at the beginning of the

study period. Pramnic et al (2009)have reported that


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Sarita et al., Int J Med Res Health Sci. 2014;3(4):797-803

can then transfer the genetic information in a

horizontal fashion by plasmid exchange.3

One of

such gene is a KPC encoding gene. KPC is a class A

carbapenemase enzyme which hydrolyzes broad

spectrum beta lactum agents. The KPC encoding

genes are plasmid mediated and thus have great

potential for spread.4

Resistance to carbapenem by

such enzyme is a global concern due to limited

therapeutic options and their association with life

threatening infections. L arge referral hospitals and

teaching institutions are at great risk for a wide

spread outbreak of infections and responsible for the

spread of such strains from one location to another

and to other hospitals. Thus, detection of these

strains and knowledge about their prevalence is o f

utmost importance.

Klebsiella pneumoniae is ubiquitous in nature and can

be isolated from soil, farm production and different

water sources like lakes, rivers, sewage, fresh water.

They are the component of the normal microflora in

upper respiratory tract and gastrointestinal tract of

human being and mice.5

Keeping in mind the

importance of Klebsiella pneumoniae as a human

pathogen and their emerging carbapenem

resistance, this study was undertaken to identify

and characterize carbapenem resistant Klebsiella

pneumoniae from various clinical samples. Efforts

were also made to study the clinical details,

particularly the associated risk factors, co-morbid

conditions and outcome in patients infected with

these strains.


This is a cross-sectional descriptive study, approved

by institutional human research ethics committee of

our institution. The study was conducted on a total

number of 5455 clinical samples received and

processed from indoor patients admitted in Shree

Krishna Hospital, a tertiary care health centre located

in rural part of Gujarat, India from May 2011 to

April 2012. Informed consent was taken from

patients when detailed clinical history was required.

The study includes all the patients admitted in tertiary

care hospital from whom Klebsiella pneumoniae were

isolated from various clinical samples. Those

specimens from where Klebsiella pneumoniae was

isolated as laboratory contamination confirmed on thebasis of clinical correlation were excluded. The

isolates were identified to species level and

antimicrobial sensitivity was performed using

miniAPI system according to Clinical and Laboratory

Standards Institute (CLSI) 2011guidelines.6

Ertapenem disc (10µg, Himedia, code-SD280-1VL)

was used as surrogate marker for detection of

carbapenem resistance. Ertapenem sensitivity was

performed by disk diffusion method (CLSI

2011guidelines).6

Isolates, that were found resistant

to ertapenem, were considered as potential

carbapenemase producers, confirmation of

carbapenemase production was done with the

Modified Hodge test.7-9

The modified Hodge test (MHT):7 - 9

Mueller-

Hinton agar plate was inoculated with a 1:10

dilution of a 0.5 McFarland suspension of E.coli

ATCC 25922 and inoculated for confluent growth

using a swab. A 10 µg E rtapenem disk was placed

in the center, and each test isolate was streaked

from the disk to the edge of the plate along with

control strains.

After 16 – 24 hours at 37̊ C of aerobic incubation,

plates were examined for a clover leaf-type

indentation at the intersection of the test organism

and the E. coli 25922, within the zone of inhibition

of the carbapenem susceptibility disk. MHT

positive test had a cloverleaf-like indentation of the

E.coli 25922 growing along the test organism

growth streak within the disk diffusion zone. MHT

negative test had no growth of the E.coli 25922

along the test organism growth streak within the

disc diffusion. Quality control was performed using

control strains using MHT positive Klebsiella

pneumoniae ATCC BAA-1705 and for negative

control Klebsiella pneumonia ATCC (American Type

Culture Collection) 700603.

Patients were grouped into two categories; one

included patients with infection by carbapenemaseproducing strains and other with infection by

carbapenemase non - producing strains. Patient’s

clinical and demographic details were collected from

the case files as well as by history taking and physical

examination as and when required. Klebsiella

infections are mostly seen in people with a weakened

immune system. They may spread by inhalation or

contact through skin or mucus membrane and are also

spread by the indwelling devices or instruments used

in procedures contaminated with K. pneumonia.Many of these infections are obtained as nosocomial

infections.


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Data like age, sex, date of admission, date of culture

isolate, presence of risk factors (age, sex, indwelling

devices, duration of hospital stay, prior exposure to

antibiotics) and co-morbid conditions (liver

dysfunction, renal insufficiency, surgery/ invasive

procedure in last 30 days, chronic lung disease,

diabetes mellitus and heart disease), type of

antibiotics given and response to therapy were

collected. The co-morbid conditions were considered

as per the clinical diagnosis with supporting

laboratory data. Clinical outcome was evaluated in

terms of length of hospital, stay after the diagnosis of

infection, response to therapy and mortality. Death

was considered due to infection when it occurred

within two weeks from the diagnosis of infection with

evidence suggestive of active infection and absence

of any other fatal event. Patients were followed till

discharged from the hospital. Infections caused by

Klebsiella pneumonia are treatable with antimicrobials

like beta lactum, amino glycosides, quinolones, folic

acid inhibitors, nitrofurantoin and carbapenems.

Statistics: The Master Chart of the data of the

patients collected using the questionnaire was

computerized on day to day basis on Micro Soft Excel

2007. Descriptive statistics was used to describe the

observations of the study and Chi Square Test was

applied as a test of significance. The Odds ratio was

calculated wherever relevant. The tests of

significance were calculated using SPSS Version 16

software.

RESULTS

During the study period of a year, a total of 5455

clinical samples were processed from indoor patients

with a culture positivity rate of 1571(28.8%).

Klebsiella pneumoniae were isolated from 102

(6.5%) samples. Klebsiella pneumoniae were isolated

more from male patients (68.6%) as compared to

female patients (31.4%). Ertapenem resistant isolates

in males (71%) were found to be more than in

females (29%). Even KPC producing isolates in

males (70.6%) were found more than females

(29.4%). Respiratory sample was the major sample

from which Klebsiella pneumoniae was isolated i.e.

41 (40.2%), followed by pus 24 (23.5%), urine 19

(18.6%) and blood 14 (13.7%). Distributions of

Clinical samples in relation to ertapenem sensitivityare summarized in Table 1. Respiratory sample was

the major sample from which ertapenem resistant

Klebsiella pneumoniae was isolated i.e. 11/102

(35.5%) followed by pus 10 (32.3%). Respiratory

tract infection was the most common clinical

condition in Klebsiella pneumonia (37%) followed by

soft tissue infections (21%) even in ertapenem

resistant Klebsiella pneumoniae respiratory tract

infection (35.5%) was common followed by soft

tissue infections i.e. 25.8% .

Table 1: Distribution of Clinical Sample in

Relation to Ertapenem Sensitivity (n=102)

Specimen Ertapenem

sensitive

(%)

Ertapene

Resistance

(%)

Total

(%)

Urine 13 (18.30) 6 (19.4) 19 (18.6)

Pus 14 (19.72) 10 (32.3) 24 (23.5)

Sputum/ET/ 30 (42.25) 11 (35.5) 41 (40.2)

Blood 10 (14.08) 4 12.9) 14 (13.7)

Others 4(5.63) 0 (0.0) 4 (3.9)

Total 71(69.6) 31 (30.4) 102 (100)

Table2: Distribution of Ertapenem

Resistant K. pneumoniae in Different

Locations (n=31)

Specimen

M I C U

N I C U

S I C U

W a r d

I s o l a t i o n

&

B u r n s

W a r d

T o t a l

Blood 3 1 0 0 0 4

Pus 1 0 6 1 2 10Sputum/ET/T 4 0 3 4 0 11

Urine 2 0 1 3 0 6

Total 10 1 10 8 2 31

The prevalence of ertapenem resistance is 30.4%.

As seen in Table 2, the majority of ertapenem

resistant i.e. 21 out of 31. ( 67.74%) Klebsiella

pneumoniae w e r e isolated from ICUs ((MICU,

SICU, and NICU). Thus the location of patients inthe hospital was found to be a significant risk for

acquisition of infection by ertapenem resistant strains

of Klebsiella pneumoniae. An association of

Ertapenem resistant Klebsiella pneumoniae with

different co-morbid conditions is shown in Table 4.

Out of 102 Klebsiella pneumoniae isolated patients,

57 recovered, 29 worsened, nine died and seven

patients were discharged against medical advice.

Among nine patients who died, six were infected with

ertapenem resistant strains. Sixty percent of those

who were ertapenem resistant died or worsened

while remaining 39.3% survived. Among those who


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and 4th generation cephalosporins) and to

fluoroquinolones, some of them are sensitive to

tetracycline and co-trimoxazole. Some of the

KPC-producing strains were still susceptible to

antimicrobials (cotrimoxazole, tetracycline) that are

not commonly used as alternative therapy for the

treatment of nosocomial infections caused by to

MDR (Multi Drug Resistant) gram-negative

organisms. So culture and antibiotic sensitivity are

utmost important to know the drug resistance in any

infection caused by Klebsiella pneumoniae.

CONCLUSION

We found a high prevalence of KPC producing

Klebsiella pneumoniae with high degree of

antimicrobial resistance in our study. This is a

challenge for clinicians as well as for administrators.

Formulating an antimicrobial policy and its strict

implementation with regular surveillance of KPC

producing isolates is needed along with appropriate

infection control measures to curtail its emergence

and spread.

ACKNOWLEDGEMENT

I would like to acknowledge Shree Krishna Hospital,

Karamsad, Anand, Gujarat for allowing me to conduct

this study and the staff of Microbiology Department

for supporting me to conduct this study.

Conflict of interest: None

Source of funding: Nil

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Iran, The open Microbiology Journal. 2011;5:91-95.

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2005;43:5639-41

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9. Anderson KF, Lonsway DR, Rasheed JK,

Biddle J, JensenB, Mcdougal LK, Carey RB,

et al. Evaluation of Methods To

Identify the Klebsiella pneumoniae

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10. Hyle EP, Ferraro MJ, Silver M, Lee H, Hooper

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factors for acquisition and outcomes. Infect

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1249.

11. Jiunn-Jong Wu, Li-Rong Wang, Yi-Fang

Liu, Hung-Mo Chen, Jing-Jou Yan.

Prevalence and Characteristics of Ertapenem-

Resistant Klebsiella pneumoniae Isolates in

a Taiwanese University Hospital. Microbial

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12. Parveen RM, Harish BN, Parija SC. EmergingCarbapenem Resistance Among Nosocomial

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13. Orsi GB, García-Fernández A, Giordano A,

Venditti C, Bencardino A, Gianfreda R,

Falcone M, Carattoli A, Venditti M. Risk

factors and clinical significance of ertapenem-

resistant Klebsiella pneumoniae in hospitalised

patients. J Hosp Infect. 2011;78(1):54-58

14. Zagorianou A, Sianou E, Iosifidis E, Dimou V,Protonotariou E, Miyakis S, Roilides E,

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characteristics of carbapenemaseproducing

Klebsiella pneumoniae endemic in a tertiary

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16. Lledo W, Hernandez M, Lopez E, Molinari OL,

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due to beta-Lactamase Klebsiella

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S, Schwartz D, Leavitt A, Carmeli Y.

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46:104-08

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Gelsomino F, Bielli A, Landini MP, Sambri V.

Rapid increase of carbapenemase-producing

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Dinesh et al., Int J Med Res Health Sci. 2014;3(4):804-807


&


Received: 9thJuly 2014 Revised: 5th Sep 2014 Accepted: 15th Sep 2014

Research article

EFFECTS OF PRANAYAMA ON GALVANIC SKIN RESISTANCE (GSR), PULSE, BLOOD

PRESSURE IN PREHYPERTENSIVE PATIENTS (JNC 7) WHO ARE NOT ON TREATMENT

Dhodi Dinesh K1, Bhagat Sagar B

2, Karan Thakkar

2, Peshattiwar Aishwarya V

3, Arati Purnaye

4, Sarika

Paradkar4

1Assistant Professor,

2Senior Resident,

3UG Student,

4Junior Resident, Department of Pharmacology, Grant Govt.

Medical College & Sir JJ Group of Hospitals, Mumbai.


ABSTRACT

Background: Psychological stress, in this era of urbanization, has become a part and parcel of our lives and has

lead to serious problem affecting different life situation and carries a wide range of health related disorders. Aims

& Objective: To observe the effects of Pranayama on GSR. Pulse rate and blood pressure. Material & Method:

This was an open labeled, prospective, uncontrolled, single centered, single arm, comparative, clinical

intervention study conducted in the Department of Pharmacology, Grant Govt. Medical College, Mumbai, over a

period of two months period August-September 2009 on 15 Prehypertensive subjects. Results: A total of 15

subjects who were Borderline hypertensive / Pre-Hypertensive, according to the JNC VII Classification, were

enrolled in the study. Of which 10 were male and 5 were females, all in the age group of 22-35 yrs with a BMI of

19.63 – 30.11 with an average of 24.80. No significant change was seen when baseline GSR reading was

compared with 15th

day reading, but on 30th

day significant change observed. When the baseline value of pulse

was compared with that of the 15th and 30th day, a good positive change was seen in resting pulse. Similarly, BP

recording also showed a good positive effect when baseline value was compared with that 15th

and 30th

day.

Conclusion: The study concludes that practicing Pranayama on a regular basis increases the parasympathetic

tone and blunts the sympathetic tone of the body. This has shown good beneficial effects on the Pulse, BP and

GSR.

Keywords: Galvanic Skin Resistance, Pranayama, Sympathetic tone.

INTRODUCTION

Cardiovascular diseases are one of the leading causes

of mortality and morbidity around the globe.1

High

Blood pressure (BP) is a major risk factor and is

associated with several types of cardiovascular

disease.2

A significant proportion, i.e., 57% of all

stroke deaths and 24% of all coronary heart disease

deaths in India can be attributed to hypertension.3

Studies have shown that nearly two-fifths of the

Indian adult population are hypertensive.4

Althoughno direct cause has been identified for primary/

essential hypertension, the contributing factors are

sedentary lifestyle, smoking, stress, visceral obesity,

potassium deficiency, obesity, salt sensitivity, alcohol

intake, and vitamin D deficiency. Out of the above,

the most important risk factors are obesity and

psychological stress.5

Psychological stress, in this era of urbanization, has

become a part and parcel of our lives. Chronic stress

has become a serious problem affecting different life

situation and carries a wide range of health relateddisorders such as cardiovascular disease,

cerebrovascular disease, Diabetes and Immunological

DOI: 10.5958/2319-5886.2014.00004.6


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was represented as mean and standard deviation. The

Student t test was used to determine the statistical

significance at p


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4. Mourya M, Mahajan AS, Singh NP, Jain AK.

The Jornal of alternative and complementary

medicine. 2009;15(7):711-717.

5. Yadav S, Boddula R, Genitta G, Bhatia V, Bansal

B, Kongara S et al. Prevalence & risk factors of

pre-hypertension & hypertension in an affluent

north Indian population. Indian J Med Res

2008;128 :712-720

6. Cacioppo J, Tassinary L, Berntson G. Handbook

of Psychophysiology. Cambridge University

Press, 2000.

7. W. Boucsein. Electrodermal activity. New York

and London: Plenum Press, 199

8. Handri, S, Nomura S, Kurosawa Y, Yajima K,

Ogawa N, Fukumura, Y. User Evaluation of

Student’s Physiological Response Towards E-

Learning Courses Material by Using GSR Sensor.

In Proceedings of 9th IEEE/ACIS International

Conference on Computer and Information

Science, Yamagata, Japan, 18 – 20 August 2010

9. Sengupta P. Health Impacts of Yoga and

Pranayama: A State-of-the-Art Review.

International journalof preventive medicine

2012;3(7):444-458

10. Jerath R, Edry JW, Barnes VA, Jerath VS.

Physiology of long pranayamic breathing; neural

respiratory elements, may provide a mechanism

that explains how slow deep breathing shifts the

autonomic nervous system. Med Hypotheses

2006; 67: 566-71.

11. Chobanian AV. The seventh report of the Joint

National Committee on Prevention, Detection,

Evaluation, and Treatment of High Blood

Pressure: The JNC 7 report. JAMA 2003 May 21;

289:2560-72.

12. Bhargava R, Gogate MG, Mascarenhas JF.

Autonomic responses to breath holding and itsvariations following pranayama. Indian J Physiol

Pharmacol 1988; 42: 257-64.

13. Pal GK, Velkumary S, Madanmohan. Effect of

short term practice of breathing exercises on

autonomic functions in normal human volunteers.

Indian J Med Res 2004;120: 115-21

14. Joseph CN, Porta C, Casucci G, Casiraghi N,

Maffeis M, Rossi M, et al. Slow breathing

improves arterial baroreflex sensitivity and

decreases blood pressure in essentialhypertension. Hypertension 2005; 46 : 714-8.

15. Kaushik RM, Kaushik R, Mahajan SK, Rajesh V.

Effects of mental relaxation and slow breathing in

essential hypertension. Complement Ther Med

2006; 14 : 120-6.

16. Pinheiro CH, Medeiros RA, Pinheiro DG,

Marinho Mde J. Spontaneous respiratory

modulation improves cardiovascular control in

essential hypertension. Arq Bras Cardiol 2007; 88

: 651-9.

17. Pramanik T, Sharma HO, Mishra S, Mishra A,

Prajapati R, Singh S. Immediate effect of slow

pace bhastrika pranayama on blood pressure and

heart rate. J Altern Complement Med 2009; 15 :

293-5.


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Revathi et al, Int J Med Res Health Sci. 2014; 3(4): 808-812


&

Health Sciences

www.ijmrhs.com Volume 3 Issue 4 Coden: IJMRHS Copyright @2014 ISSN: 2319-5886Received: 21

stJune 2014 Revised: 28

thJuly 2014 Accepted: 19

thAug 2014

Research article

A CLINICAL STUDY OF SERUM PHOSPHATE AND MAGNESIUM IN TYPE II DIABETES

MELLITUS

*Revathi.R1, Julius Amaldas

2

1PhD Research scholar, Bharat University,

2Professor and Head, Department of Biochemistry, Balaji Dental

College


ABSTRACT

Objective: To assess serum phosphate and magnesium level in type-2 diabetic patients in comparison with those

of control subjects. Methodology: There were 100 diabetic patients and 100 age matched non-diabetic (control)

subjects included in this study. Serum phosphate, serum magnesium and fasting and postprandial blood sugar

measured among the diabetic and control groups using SPSS version 16.0 for analysis. Results: Serum phosphate

level was significantly lower in diabetic patients (2.92 ± 0.75) as compared to control subjects (3.38 ± 0.49).

Serum magnesium levels were significantly lower in diabetic patients (0.9 ± 0.15) compared to controls (2.75 ±

0.46) Conclusion: The study reveals that hyperglycemia may reduce serum levels of magnesium and phosphorus.

Keywords: Magnesium, phosphate, type 2 diabetes mellitus.

INTRODUCTION

Diabetes mellitus is a metabolic disorder which

affects many people in the world. Diabetes is

currently emerging as an important health problem

with a significant global burden1.

Assuming that age –

specific prevalence remains constant, the number of

people with diabetes in the world is expected to

approximately double between 2000 and 2030, basedsolely upon demographic changes

2Accordingly, the

WHO has called the disease [the emerging

epidemic]3. Genetic and environmental factors

contribute to the pathogenesis of diabetes and acts as

a trigger for the disease among subjects at high-risk

because of inherited susceptibility. Earlier works

demonstrating the existence of glucose tolerance

factor in yeast with the identification of the active

component as trivalent chromium sparked off interest

on the status of other trace and macro elements inhealth and diseases including diabetes. Direct

associations of trace macro elements with Diabetes

mellitus have been observed in many research

studies. Insulin action on reducing blood glucose was

reported to be potentiated by some trace elements as

chromium, magnesium, vanadium zinc, manganese

and phosphate. Mg depletion has a negative impact

on glucose homeostasis and insulin sensitivity in

patients with type 2 diabetes4, 5 as well as on theevolution of complications such as, retinopathy,

thrombosis and hypertension6-8

mostly age group

between 35- 60. Moreover, low serum Mg is a strong

independent predictor of the development of type 2

diabetes9Phosphorus is widely distributed element in

the human body. Diabetes mellitus may result in

whole body phosphate depletion due to osmotic

dieresis and decreased muscle mass. Therefore, the

aim of our study was to determine the serum levels of

phosphate and magnesium in diabetic patients andcontrol subjects and their association with age, gender

and glycemic status.

DOI: 10.5958/2319-5886.2014.00005.8


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This is a cross sectional study approach on diabetic

patients. It was conducted at the clinical chemistry

laboratory. Patients were enrolled based on the

following:

Inclusion criteria: All type 2 diabetic patients, both

genders, aged 30-65 years.

Exclusion criteria: Include past medical history of

hyperactive and hypothyroidism, current smokers,

heavy alcoholics. Chronic infection affects bone

(tuberculosis, osteomyelitis), bone tumors, chronic

renal failure, hematological disorders and connective

tissue disorders.

Study area and study population: One hundred

diabetic patients (50 males, 50 females), aged 30-65

years; and other 100 healthy subjects (matched forage and sex), were included in the study. All subjects

Signed informed consent and filled questionnaires.

The study was approved by the ethical committee of

the faculty. Duration of the study is around 6 months.

Methodology: Blood samples were collected after a

twelve hour fasting period (Overnight fasting) under

aseptic. Conditions, the obtained blood sample were

centrifuged and plasma was separated. The plasma

was analyzed for the fasting and postprandial blood

sugar, estimated by GOD-POD method10

.Serumsamples were separated from whole blood collected

into tubes without anticoagulant, after clotting was

complete, the tubes were then centrifuged at 2700g

for 10 minutes. Serum was removed and assayed for

magnesium and phosphorus. Taussky, H.H., and

Shorr, E.: a micro colorimetric method for the

Determination of Inorganic Phosphorus11

. Gindler,

E.M. and D.A. Heth, a Colorimetric determination

with bound calmagite of magnesium in human blood

serum12

.

Statistical analysis: Student’s t-test was performed

to analyze the difference in means between groups. P

value was considered significant when it is less than

or equal 0.001.

RESULT

Table1: Blood sugar levels

Blood sugar

variables

Levels Controls CasesP Value

FBS(mg/dl)


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Table 4: Levels of FBS, PLBS, Serum phosphorus

and Serum magnesium

Biochemical

parameters Controls Cases

P

value

FBS (mg/dl) 89.74±9.82 155.5±86.6


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microalbuminuria or clinical proteinuria compared to

diabetics with normal albumin excretion. In contrast,

Corsonello et al.,21

demonstrated significantly lower

ionised serum Mg in type 2 diabetic patients with

microalbuminuria or clinical proteinuria. Similar to

findings from other countries in Europe and North

America, the mean plasma Mg concentration of the

type 2 diabetics was significantly lower than in

controls. The striking finding in our study was the

high prevalence of low plasma Mg concentrations

among the diabetic subjects. Serum Mg

concentrations of 44% of the diabetics were below

the reference range, a prevalence of low magnesium

status that is similar to that reported in type 2

diabetics in outpatient clinics in the US .

CONCLUSION

Our findings suggest that low magnesium status and

phosphorus in type 2 diabetes mellitus. Phosphorus

and magnesium depletion may increase the risk of

secondary complications, preventing low magnesium

and phosphorus status in diabetes may therefore be

beneficial in the management of the disease.

ACKNOWLEDGEMENT

The research for this study was supported by KarpagaVinayaga Institute of Medical Science,

Madhuranthagam.

Conflict of Interest: Nil

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U.N Reddy et al, Int J Med Res Health Sci. 2014; 3(4): 813-818


&


Received: 21st June 2014 Revised: 17th July 2014 Accepted: 15th Aug 2014

Research article

IMPACT OF MATERNAL RISK FACTORS ON THE INCIDENCE OF LOW BIRTH WEIGHT

NEONATES IN SOUTHERN INDIA

U.N.Reddy1, VamshiPriya

2, SwathiChacham

3, SanaSalimKhan

4, J Narsing Rao

5, *Mohd Nasir Mohiuddin

6

1Professor and Head,

2Senior Resident,

3DM Neonatology, Assistant Professor,

4Junior Resident,

5Professor,

Department of Pediatrics Princess Esra Hospital, Deccan College of Medical sciences, Hyderabad, India,6pharm D, clinical pharmacist, Dept of Pediatrics, Princess esra Hospital, Deccan School of Pharmacy, Hyderabad

*Corresponding author email: [email protected],

ABSTRACT

Introduction: Birth weight is recommended as one of the twelve global indicators for monitoring the health of

the community and is an important determinant of adverse perinatal and neonatal events. LBW infant carries five

times higher risk of dying in the neonatal period and three times more in infancy. Aims and Objectives: To

estimate the incidence of LBW and impact of various maternal and biosocial factors on the incidence of LBW

neonates in the study population. Material and methods: This prospective observational study was carried out in

Princess Esra hospital, a tertiary care hospital in south India, over a period of six months. All consecutive LBW

(single ton) neonates admitted to the neonatal intensive care unit were enrolled, while those born of multiple

gestation and those with major congenital malformations were excluded. Results: A total of 300 neonates were

included in the present study out of which 150 were LBW and 150 weighed ≥2500 gm. Higher maternal weight

(>60kgs) had low incidence of LBW neonates (p value-0.03). Illiterate women had a remarkably higher incidence

of LBW babies (p value-0.001). In primigravida incidence of LBW was 61.2%. Higher incidence of LBW was

seen in mothers with oligo hydramnio’s. Conclusions: This study showed that maternal age, weight, literacy level

and parity have a significant influence on the incidence of LBW. Incidence of LBW neonate in the study was

50%. Risk of having LBW neonates was higher in primigravida. There was a significant association between

LBW with oligo hydramnio’s and female gender.

Key words: Low Birth Weight, Neonate, Maternal weight, Age, Parity.

INTRODUCTION

The essential newborn care has been a challenge to

the pediatrician, more so the care of low birth weight

neonates. Birth weight is the single most important

marker of adverse perinatal and neonatal events.

Low birth weight (LBW) is defined by WHO as

birth weight


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which 26% of all the live births in india4.Birth weight

is governed by two major processes; duration of

gestation and intrauterine growth rate. Thus LBW is

caused either by premature delivery or retarded

intrauterine growth (or a combination of both).

Prematurity is usually defined as a gestational age

less than 37 weeks. The causes of LBW are

multifactorial and the birth weight is determined by

the interaction of the both socio-demographic and

biological factors.5Many socio-biological factors

have been postulated to determine the birth weight of

the newborn. The causes are classified into three

broad categories. Firstly, maternal causes in which

maternal age, weight, height, education,

socioeconomic status, ethnic differences, parity, birth

spacing and dietary intake are the factors. Secondly,

placental causes that includes: Fetoplacental and

uteroplacental insufficiency. Lastly, Fetal causes:

Normal Small Fetuses, fetal infection and fetal

abnormalities. Other factors that might have an

impact on the incidence of LBW are antenatal care,

maternal smoking, hard manual labor, genetic factors,

and sex of the neonate. The effect of these factors has

been shown to be dependent on the geographic location

of study6.

MATERIAL AND METHODS

The current study was a Hospital based prospective

observational study carried in Dept. of pediatrics in

princess esra hospital, Deccan College of medical

sciences, Hyderabad, Andhra Pradesh, India, over a

period of six months. A total of 300 neonates were

included in the present study, out of which 150 were

LBW and 150 weighed ≥2500gms. All relevant

maternal and neonatal data was documented on a

predesigned and pretested structured Performa.

Maternal details like maternal age, height, weight,

parity, consanguinity and maternal hemoglobin were

recorded after obtaining informed consent from the

parents. Demographic details like maternal

occupation, education, socioeconomic status,

community and paternal age were noted. Numbers of

antenatal checkups as well as antenatal

complications were documented. Delivery details

and neonatal details such as mode of delivery,

gender of the neonate, birth weight and gestational

age were documented. All consecutive LBW

(singleton) neonates admitted to the neonatal

intensive care unit were enrolled, while those born

of multiple gestation and those with major

congenital malformations were excluded.And

Gestational age was assessed from last menstrual

period of the mother and by using new Ballard

scores in the neonate. Kuppuswamy’s scale7

was

used to assess the socioeconomic status of the

mother. All consecutive low birth weight (singleton)

neonates admitted in the neonatal intensive care unit

were enrolled, while those born of multiple gestation

and those with major congenital malformations were

excluded. This study involved the procedures which

were very simple, using the instrument available in

the hospital which did not cause any undue distress

to the babies or mothers. Moreover, all the

investigations were necessary. However a verbal

consent was obtained from institutional ethics

committee as well as from the enrolled subjects.

Data analysis: Epi info 2000 and SPSS version

10software were used to obtain the statistical results.

Odds ratio, with confidential interval for various risk

factors of LBW were done. Chi square test was used

for calculating P value and was considered significant

if < 0.05.

RESULTS

During this observational study, a total of 300

neonates were included out of which 150 were LBW

and 150 weighed ≥2500 grams. Incidence of LBW

was 50 %. Maternal age ranged from 13 to 35 years

and was classified into 3 groups as 30 years.

Mothers in the age group of 20-29 had given birth to

babies with birth weight >2500 grams, which was

statistically significant as shown in (fig 1). This

group was further divided into two age groups of 20-

24 and 25-29 years. In this division statistical

significance was found in maternal age group of 25-

29 years (p-value: 0.028). Higher maternal weight

had higher birth weights which showed statistical

significance (p-value: 0.03). The P value was

significant in mothers weighing >60 kg (fig 2).

However, maternal height did not influence the

incidence of low birth babies.


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U.N Reddy et al,

Fig 1: Correlation between mat

neonate birth weight.

Fig 2: Influence of maternal we

birth weight.

Lower birth weights were seen in ne

laborers with an incidence of 65.3%

towards statistical significance

Working women with professional

significantly higher number of nor

babies.

Fig 3: Impact of maternal occup

birth weight.

Maternal education ranged fro

graduation. Maternal education was

groups as illiterates, primary

secondary education and above. Illit

19.3%

12.6%

73.3%

83.2

7.3%

0

20

40

60

80

100

120

140

< 2500 gms ≥ 2500

f r e q u e n c y

neonate birth weigh

48%

38%39.3% 39.

12.6%

0

20

40

60

80

< 2500 gms ≥ 250

f r e q u e

n c y

neonate birth weig

0

50

100

150

< 2500 gms ≥ 2500 gms

86% 86%

11.3%

6%2.6% 8%

Int J Med Res Health S

ernal age and

ight on neonate

onates of manual

hich had a trend

(p-value: 0.07).

occupation had

mal birth weight

tion on neonate

illiteracy to

divided into three

education, and

erate women had

a higher incidence of

statistical significance.

Fig4: Educational st

influence on neonate bi

The mothers in this st

classes according to Ku

consideration of matern

family income6. Most o

economic class III. Ther

LBW in class IV thou

significance. As the soc

the birth weights increa

and was classified into t

Multigravida and Grand

incidence of LBW in pri

Fig 5: Parity distributio

As the parity increased i

In primigravidas the inc

Whereas in Multigravid

which was significant s

Higher incidence of L

hydramnios during pre

with oligohydramnios,

(18/21=86%). This was s

p value-0.001. Odds rati

done in a tertiary level, al

noted. Cesarean inclu

4%

gms

< 20

20-29

> 30

3%

22.6%

gms t

< 50

51-60

> 60

house wife

labourer

others

0

20

40

60

< 2500 gms

58

4548

n u m b e r o

f s u b j e c t s

61.2%43.2%

33.3%

0

20

40

60

80

100

120

< 2500 gms

f r e q u e n c y

815

ci. 2014; 3(4): 813-818

LBW babies which had

tus of mother and its

th weight.

dy were divided into four

pu swami scale taking into

l education, occupation and

the mothers were in socio

e was a higher incidence of

gh there was no statistical

ioeconomic status improved

sed. Parity ranged from 1-5

hree groups as Primigravida,

Multi. There was a higher

igravidas (p-value: 0.003).

n in neonate birth weight

ncidence of LBW decreased.

idence of LBW was 61.2%.

the incidence was 43.2 %,

tatistically (p-value: 0.006).

BW was seen with oligo

nancy. Out of 21 mothers

18 had LBW neonates

tatistically significant with a

o was 6.7. As the study was

ll the modes of delivery were

ed both emergency and

2500 gms

44

57 56

illiterates

primary

education

secondary

and above

38.8%

56.8%

66.6%

≥ 2500 gms

n e o n a t e

b i r t h

w e i g h t

primi

multi

grand

multi


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elective. Vaginal deliveries included spontaneous,

episiotomy and forceps deliveries. A higher incidence

of LBW was seen in caesarean section delivery

compared to vaginal mode. Among 168 caesarean

section, 41.6% were low birth babies and among 132

vaginal deliveries 60.6% were low birth weights

which showed statistical significance (p-value:

0.001). Male babies were higher in number compared

to female babies in this study. Among male babies

45.1 % were LBW and among female babies 55.9 %

were LBW. There was a trend towards a lower

incidence of LBW in male babies (p-value: 0.08).

Number of antenatal checkups ranged from 0-12.

Mothers were classified into three groups- who did

not have any antenatal checkups, who had 1-3 ante

natal checkups and those with 4 checkups and above.

Among the mothers who did not have any antenatal

checkups the incidence of LBW was 48.6%. Among

those who had more than 4 checkups the incidence

was 48.6 %. There was no statistical significance

between number of checkups and birth weight. The

difference between 4 or more antenatal checkups and

those who did not have any checkups was nearly

insignificant. There was no correlation between birth

weight and paternal age. No association was noted for

consanguinity with birth weight.

DISCUSSION

LBW is one of the most serious challenges in

maternal and child health, especially in developing

countries like India. LBW neonates are at risk of

both short term (immediate) neonatal morbidity as

well as long term neonatal morbidities. Short term

neonatal complications include metabolic

derangements like hypoglycemia, hypocalcaemia,

hypomagnesaemia and infection related

consequences like meningitis, bone and joint

infections. Long term consequences like cerebral

palsy, hearing deficits and ocular abnormalities are

also highly prevalent in LBW neonates8. These

LBW neonates are at high risk of mortality due to

anatomical and functional immaturity of various

body organs. The present prospective study was

undertaken to estimate the incidence and

determinants of LBW, as majority of the published

studies were retrospective in nature. Maternal age

had a significant influence on the incidence of LBW

in the current study. Mothers aged between 20-29

years gave birth to neonates with normal birth

weight. Subgroup analysis showed a significantly

lower incidence of LBW neonates among mothers

aged between 25-29 years. This study was similar to

a study done by K.D as and Ganguly et al where the

higher birth weight of neonates was found in

mother’s aged 25-29 years9. Similarly maternal

weight and neonatal birth weight showed a positive

relationship on linear regression analysis. As the

weight of the mother increased the birth weight of

the babies increased. These findings were similar to

a study done by Sushma Malik et.al.3Maternal height

and father’s age did not have any influence on the

neonatal birth weight in our study. Mothers who

were manual labors had higher incidence of LBW

neonates. This was similar to the study by Saroj

Pachauri and Marwah et al6, 10.

Illiterate mothers had

significantly higher incidence of LBW neonates,

Illiteracy is usually associated with poverty and

maternal malnutrition, hence may be associated with

higher incidence of low birth weight neonates. This

was supported by the study carried out by

SarojPachauri and S. M. Marwah et. al6, 10

. However,

on linear regression analysis, a higher

socioeconomic status was associated with a lesser

incidence of low birth weight. This was similar to a

study done by N. Sreekumaram Nairetal11

.

Statistically, there was no association between

neonatal birth weight and community and also there

was no significant association between

consanguinity, number of antenatal checkups and

low birth weight. This shows that the number of

antenatal checkups is not the only criteria, but also

the quality of antenatal care. There was a significant

association between parity and Birth weight. A

Multiparous woman is likely to have neonates withhigher birth weights. With successive pregnancy,

neonatal birth weight increases till 4th

pregnancy.

Studies done by SushmaMalik 3, D.K. Mukherjee et

al and N.J. Sethna et.al12

also showed similar results.

In this study, mothers with systemic diseases and

obstetric complications were also included. Subjects

with systemic diseases were less and did not impart

any significance. However, patients presented with

obstetric complications like pregnancy induced

hypertension (PIH), oligo hydramnios, ante partum


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hemorrhage (abruption and placenta pravia) and

premature rupture of membranes showed significant

influence on the incidence of LBW. Out of 21

mothers with oligohydramnios, 18 had LBW

neonates (18/21=86%). This was statistically

significant with a p value-0.001, of LBW babies.

The incidence of LBW neonates was 80% with

maternal ante partum hemorrhage (APH), 66% with

maternal premature rupture of membranes and 59%

with maternal pregnancy induced hypertension PIH.

However, it was not statistically significant.

According to WHO, hemoglobin


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8. Al-saley E, Di Renzo GC. Actions needed to

improve maternal health. Int J Gynecology

Obstetric 2009; 106(2):115-19

9. Das K, Ganguly SS, Saha R, Ghosh BN Inter

relationship of birth weight with certain

biological & socio-economic factors. Ind J publichealth. 1981; 25 (1): 11-9.

10. Sreekumaram Nair N, Phanea rao RS, Shalini

Chandrashekara Das Acharya, H. Vinod Bhat.

Sociodemographic and maternal determinants of

low birth weights: A Multivariate approach

Indian J Pediatr2000; 167(1): 9-14

11. Saroj Pachauri and S.M. Marwah.Socio economic

factors in relation to birth weight. Indian pedia

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