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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: gdssathish@gmail.com
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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International Journal of Medical Research
&
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:rajakumar60@gmail.com
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.
MATERIALS AND METHODS
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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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.
MATERIALS AND METHODS
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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21. Schwaber MJ, Klarfeld-lidji S, Navon-venezia
S, Schwartz D, Leavitt A, Carmeli Y.
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22. Gupta V, Bansal N, Singla N, Chander J.
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23. Gaibani P, Ambretti S, Berlingeri A,
Gelsomino F, Bielli A, Landini MP, Sambri V.
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International Journal of Medical Research
&
Health Scienceswww.ijmrhs.com Volume 3 Issue 4 Coden: IJMRHS Copyright @2014 ISSN: 2319-5886
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.
*Corresponding author email: dhodidinesh@gmail.com
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
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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
International Journal of Medical Research
&
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
*Corresponding author email: revathi_3aug@yahoo.co.in
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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MATERIALS AND METHODS
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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International Journal of Medical Research
&
Health Scienceswww.ijmrhs.com Volume 3 Issue 4 Coden: IJMRHS Copyright @2014 ISSN: 2319-5886
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: muhammed_nasser7788@yahoo.com,
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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U.N Reddy et al, Int J Med Res Health Sci. 2014; 3(4): 813-818
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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U.N Reddy et al, Int J Med Res Health Sci. 2014; 3(4): 813-818
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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U.N Reddy et al, Int J Med Res Health Sci. 2014; 3(4): 813-818
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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U.N Reddy et al, Int J Med Res Health Sci. 2014; 3(4): 813-818
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