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Electrophysiologic studies in lumbo-sacral radiculopathy

Funding Agency: University Grants Commission
Duration of Study: 2013-15
Principal Investigator: Dr. S Pawar
Ethics Approval: Obtained from Institutional Ethics Committee, MGIMS (MGIMS/ IEC/24/2011; dated 23/07/2011)

The present study was carried out in the Clinical Neurophysiology unit of the Department of Physiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram. Specific aim of the study was to study diagnostic efficacy of motor and sensory nerve conduction study, F wave, H reflex and needle electromyography for detection of lumbosacral nerve root compression. In this cross- sectional study, a total of 283 subjects aged 40 years and above who were clinically diagnosed as having lumbosacral radiculopathy were enrolled after taking their informed written consent. The study population was selected from patients attending orthopedic department, with supportive inclusion and exclusion criteria under supervision of consultant orthopedic surgeon. The study population comprised of 168 males and 115 females. All the patients were subjected to electrophysiological evaluation using RMS EMG EP Mark –II machine. Statistical analysis was done by using descriptive and inferential statistics using Kappa Statistics, z-test for difference between two means and diagnostic accuracy.

Analysis of result revealed that Motor nerve conduction studies have reliable sensitivity and specificity in diagnosing lumbosacral radiculopathy. However, sensory nerve conduction studies are having relatively low sensitivity in the diagnosis though they have comparable specificity. Among various F-wave parameters studied, F-minimum and F-maximum latencies are highly sensitive and specific in diagnosing lumbosacral radiculopathy. Therefore, apart from F-minimum latency, the other F-wave parameters like F-maximum latency, F-mean latency, F-M latency and F-velocity should be taken into consideration while diagnosing lumbosacral radiculopathy. Among various H-reflex parameters studied, H- latency is the most sensitive and specific parameter for the diagnosis of lumbosacral radiculopathy. Other H-reflex parameters like M-latency, H-M latency and H-amplitude are less sensitive in diagnosing this disease. Among all the electrophysiological parameters studied, needle EMG has the highest sensitivity and specificity for the diagnosis of lumbosacral radiculopathy. So, it is the most effective electrophysiological method in evaluation of lumbosacral radiculopathy. Therefore, it can be concluded that electrophysiological tests are useful supportive diagnostic tool for lumbosacral radiculopathy. They should be combined with other modalities like clinical examination, radiological imaging etc. before confirming or refuting the diagnosis of lumbosacral radiculopathy.

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The role of late responses in the diagnosis of diabetic polyneuropathy

Funding Agency: MUHS, Nashik
Duration of Study: 2012 onwards
Principal Investigator: Dr. S Pawar
Ethics Approval: Obtained from Institutional Ethics Committee, MGIMS (MGIMS/ IEC/PHY/92/2012; dated 22/09/2012)

Diabetic peripheral neuropathy (DPN) is one of the most common complications of the nervous system affecting people with diabetes mellitus. However, the early stages of DPN are often symptomless, providing patients with no warning of their developing condition. In many cases, the diagnosis of DPN may also require electrophysiological testing. One such test involves measurement of the H-reflex and F-wave (late response study) which have been found to be more frequently altered in patients with recently diagnosed diabetes mellitus. Studies have shown that alterations in the late response study provide an early indication of DPN, since they are apparent before any changes in motor nerve conduction velocity (NCV) occur. Therefore, the present study was proposed to determine the proportion of patients with positive DPN diagnoses made by clinical evaluation or by measurement of the late responses, among adult patients with type- 2 diabetes mellitus referred for neuropathy screening as well as to evaluate the predictive value of the late response study in DPN diagnosis. It is a diagnostic cross-sectional study which will include 100 study subjects diagnosed with type 2 diabetes mellitus aged 20-80 years. The presence of neuropathy in study subjects will be identified using the Michigan Neuropathy Screening Instrument (MNSI). The present study will be performed on RMS EMG EP Mark-II machine in the Clinical Neurophysiology Unit, Department of Physiology, MGIMS. Electrophysiological profile includes Motor nerve conduction, sensory nerve conduction, F wave study and H-reflex study. Beginning in April 2013, we have conducted the study on 30 subjects.

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Prevalence and risk factors of obstructive sleep apnea- hypopnea syndrome in rural Indian population: A community based cross-sectional study

Funding Agency: ICMR, 2015-2017
Duration of Study:
Principal Investigator: Dr. S Pawar
Ethics Approval:
Grant received: Rs 20, 52, 960

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