Influence of sleep disturbance, depression, anxiety, and stress on quality of life in people with epilepsy

OBJECTIVES

We assessed the quality of life, sleep, depression, anxiety, and stress in people with pharmacoresistant epilepsy (PRE) and newly diagnosed epilepsy (NDE). We also assessed the influence of sleep, depression, anxiety, and stress on the quality of life (QOL) and the complex association between these factors.

METHODS

We recruited 80 PRE and 70 NDE people attending the epilepsy clinic. We assessed QOL, sleep quality, daytime sleepiness, and mood using the quality of life in epilepsy-31 inventory (QOLIE-31), Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), and depression anxiety stress scale (DASS-21). We compared the results between the two groups of epilepsy populations. We performed univariate and multivariate linear regression to determine the factors affecting the QOLIE-31 total score. We applied Spearman's rank correlation to find the interrelationship between variables influencing QOL.

RESULTS

We found significantly lower QOLIE-31 total scores (p = .001) in PRE compared to NDE. The PSQI and ESS did not differ significantly between the PRE and NDE groups. Anxiety (p = .002) and stress (p = .003) scores were significantly higher in PRE than in NDE. QOLIE-31 total scores showed a negative correlation with PSQI as well as symptoms of depression, anxiety, and stress scores in both groups. Multiple linear regression analysis revealed depression as a major factor influencing the QOLIE-31 total score in PRE (p = .001) and NDE (p = .003). We found significant complex associations between PSQI, depression, anxiety, stress, and QOLIE total scores in both groups.

SIGNIFICANCE

The QOL is poorer for people with PRE than for those with NDE. Depression is a major determinant of QOL in PWE. These factors need to be considered to improve the QOL in epilepsy.

Endowing networks with desired symmetries and modular behavior

Symmetries in a network regulate its organization into functional clustered states. Given a generic ensemble of nodes and a desirable cluster (or group of clusters), we exploit the direct connection between the elements of the eigenvector centrality and the graph symmetries to generate a network equipped with the desired cluster(s), with such a synthetical structure being furthermore perfectly reflected in the modular organization of the network's functioning. Our results solve a relevant problem of designing a desired set of clusters and are of generic application in all cases where a desired parallel functioning needs to be blueprinted.

Cardiovascular autonomic function and baroreflex sensitivity in drug-resistant temporal lobe epilepsy

OBJECTIVE

Temporal lobe epilepsy (TLE) is often associated with autonomic manifestations. Sudden unexpected death in epilepsy (SUDEP) is a leading cause of mortality in epilepsy. Cardiac disturbances and autonomic dysfunction are the potential mechanisms behind SUDEP. Though heart rate variability (HRV) and autonomic function tests are well studied in drug-resistant temporal lobe epilepsy, there is a paucity of data on baroreflex sensitivity (BRS), a better marker of cardiac mortality in this population. We aimed to study the interictal cardiac autonomic function and BRS in people living with drug-resistant temporal lobe epilepsy compared to healthy controls.

MATERIALS AND METHODS

Thirty drug-resistant temporal lobe epilepsy (TLE) individuals and thirty healthy volunteers were recruited. Heart rate variability at rest, heart rate and blood pressure (BP) at rest, during deep breathing, postural change, BP response to isometric handgrip exercise, and baroreflex sensitivity were recorded in all study participants. The results were analyzed and compared between the two groups.

RESULTS

Compared to controls, the resting heart rate, HRV, parasympathetic reactivity test, and BRS significantly differed in people living with drug-resistant TLE. Time-domain indices including SDNN (p < 0.001), RMSSD (p < 0.001), NN50 (p < 0.001), and pNN50 (p < 0.001) were significantly reduced in the patients compared to controls. In frequency-domain indices, the total power was reduced (p < 0.001) in drug-resistant TLE. The parasympathetic reactivity such as changes in heart rate during deep breathing (E: I) (p < 0.02) and postural change (30:15) (p < 0.005) were significantly reduced in the patients. Baroreflex sensitivity was also significantly reduced in the drug-resistant TLE group (p < 0.001).

CONCLUSION

The present study findings are suggestive of parasympathetic dysfunction in drug-resistant TLE. Reduced HRV and BRS may increase the risk of SUDEP in people living with epilepsy.

Antimicrobial resistance in bacteria isolated from the poultry production system in Nepal

SETTING

Twenty poultry farms in five provinces of Nepal were selected for studying bacterial pathogens and their antimicrobial resistance (AMR) patterns.

OBJECTIVE

To document the proportion of cloacal swabs collected from 3,230 broiler and 3,230 layer chickens from September to December 2021 that grew isolates of Escherichia coli, Enterococcus spp. and Salmonella spp. along with their AMR patterns.

DESIGN

This was a cross-sectional descriptive study.

RESULTS

In broiler birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 36%, 39% and 63% of swabs. In layer birds, Enterococcus spp., Salmonella spp. and E. coli were identified in respectively 31%, 48% and 60% of swabs. For both bird types, there was variation in bacterial prevalence between the regions. For all three bacterial isolates, the lowest antimicrobial resistance was found with amikacin. For the other nine antibiotics tested, >50% of bacterial isolates showed resistance; between 60% and 90% of isolates showed resistance to ciprofloxacin and trimethoprim-sulfamethoxazole. Multidrug resistance ranged from 45% to 46% for Salmonella spp., 37-44% for E. coli and 13-17% for Enterococcus spp.

CONCLUSION

This study shows that a large proportion of poultry in Nepal are infected with potentially pathogenic bacteria, and these are frequently resistant to commonly used antibiotics. Nepal urgently needs to implement corrective measures.

A membrane-based green and low-cost system for ensuring safe drinking water in a selenium-affected region

Towards an efficient, low-cost solution to the problem of contamination of groundwater by selenium leached out from earth's mineral crust, a new system is developed using a novel graphene-based nanocomposite membrane. The system not only purified selenium-contaminated groundwater with high degree but also ensured safe disposal of the rejected selenium through algorithmic chemical stabilization in a mineral matrix. All experiments were conducted with live contaminated water from selenium affected area rather than using synthetic solution in a semi-pilot unit involving a largely fouling-free flat sheet cross-flow membrane module. Pure water flux of up to 190 Lm^-2h^-1(LMH) with 96-97% selenium rejection at an optimum operating pressure of only 14 bar could be achieved. Rejected selenium was stabilized in mineral matrix through chemical coagulation-precipitation using suitable coagulants following prior optimization of the critical operating parameters by Model-based calibration toolbox (MATLAB R2020a). A high degree of stabilization efficiency (99.8%) could be achieved as reflected in an error-index of only 1.13%. For selenium-affected region, the membrane-integrated hybrid treatment system proved to be a potential candidate technology offering safe drinking water at an approximate cost of only 1.77 $/m³ which was found to be affordable to the consumers in subsequent willingness to pay survey.

Enhanced etching characteristics of Si{100} in NaOH-based two-component solution

Silicon wet bulk micromachining is the most widely used technique for the fabrication of diverse microstructures such as cantilevers, cavities, etc. in laboratory as well as in industry for micro-electromechanical system (MEMS) application. Although, increasing the throughput remains inevitable, and can be done by increasing the etching rate. Furthermore, freestanding structure release time can be reduced by the improved undercutting rate at convex corners. In this work, we have investigated the etching characteristics of a non-conventional etchant in the form of hydroxylamine (NH2OH) added sodium hydroxide (NaOH) solution. This research is focused on Si{100} wafer as this orientation is largely used in the fabrication of planer devices (e.g., complementary metal-oxide semiconductors) and microelectromechanical systems (e.g., inertial sensors). We have performed a systematic and parametric analysis without and with 12% NH2OH in 10 M NaOH for improved etching characteristics such as etch rate, undercutting at convex corners, and etched surface morphology. 3D scanning laser microscope is used to measure average surface roughness (Ra), etch depth (d), and undercutting length (l). Morphology of the etched Si{100} surface is examined using optical and scanning electron microscopes. The addition of NH2OH in NaOH solution remarkably exhibited a two-fold increment in the etching rate of a Si{100} surface. Furthermore, the addition of NH2OH significantly improves the etched surface morphology and undercutting at convex corners. Undercutting at convex corners is highly prudent for the quick release of microstructures from the substrate. In addition, we have studied the effect of etchant age on etching characteristics. Results presented in this article are of large significance for engineering applications in both academic and industrial laboratories.

Effects of 12 Weeks Practice of Yoga on Heart Rate Variability in Males with Type 2 Diabetes Receiving Oral Antidiabetic Drugs: A Randomized Control Trial

Objective: To investigate the effects of 12 weeks practice of a structured yoga module on heart rate variability (HRV) and cardiometabolic risks in patients with type 2 diabetes (T2D) receiving similar kind of oral antidiabetic drugs (OAD) with yoga therapy and without yoga therapy, matched for all the known confounders. Design: Parallel design interventional (randomized control trial) study. Subjects: Eighty treatment-naive males with T2D were randomized into control group (n = 40) and study group (n = 40). Intervention: Study group participants received a structured yoga therapy that included asana and pranayama practice for 12 weeks in addition to OAD, whereas control group participants received OAD alone. Outcome measures: Before and after intervention, BP parameters, rate pressure product (RPP) as the marker of myocardial stress, total power (TP) of HRV, low-frequency to high-frequency (LF-HF) ratio of HRV, homeostatic model of insulin resistance (HOMA-IR), lipid profile and lipid risk factors, malondialdehyde (MDA), and high-sensitive C-reactive protein (hsCRP) were measured. TP of HRV was defined as the primary outcome. Association of TP (the marker of HRV) and LF-HF ratio (the marker of sympathovagal balance) with cardiometabolic parameters was assessed by correlation and regression analyses. Results: After 12 weeks yoga therapy, there was significant reduction in cardiometabolic risks (TP of HRV, RPP, lipid risks factors, levels of MDA, and hsCRP) in study group subjects compared with control subjects that did not receive yoga therapy. All cardiometabolic risk factors were significantly correlated with TP in study group, having maximum significance with homeostatic model of insulin secretion (r = 0.502, p ≤ 0.001). Multiple regression analysis demonstrated the independent contribution of decrease in RPP, HOMA-IR, hsCRP, and MDA to increased TP and decreased LF-HF ratio in T2D patients after yoga therapy. Conclusion: From the results of this study, the authors conclude that 12 weeks practice of a structured yoga module improves TP of HRV, sympathovagal balance, and metabolic functions, and reduce cardiovascular (CV) risks in patients with diabetes who received routine antidiabetic medicines along with yoga therapy, compared with the patients with diabetes who received antidiabetic medicines alone. The reduction in cardiometabolic risks in these patients is linked to the improvement in TP of HRV. Future studies should also include a control group with rapid walking or a similar exercise program of equal time to the yoga intervention group to discern whether it is in fact yoga that is leading to these results and not simply increased CV activity. Clinical Trial Registry of India (No. CTRI/2021/06/034074).

Link of neurocognitive deficit to impaired cardiovagal modulation in prehypertensives is comparable to newly diagnosed hypertensives in young Indian population

BACKGROUND

Hypertension has been reported to cause impaired cardiovagal modulation and a wide variety of cognitive loss. However, the link cardiovagal modulation to neurocognitive impairment has not been studied yet. The present study has compared the link cardiovagal modulation to neurocognitive impairment between prehypertension and newly diagnosed hypertension in young adults.

METHODS

One hundred forty-seven subjects (42 normotensives, 54 prehypertensives and 51 newly diagnosed hypertensives) aged between 18-44 years were included in this case-control study. The demographic, anthropometric, basal parameters, heart rate variability (HRV), cardiovascular autonomic function tests (CAFTs), event-related potential P300 and biochemical parameters were recorded in all the groups. Association of various parameters with neurocognitive deficit was studied by Pearson correlation analysis and independent contribution of various factors to cognitive deficit was assessed by multiple regression analysis in the study groups.

RESULTS

Total power (TP) of HRV, the marker of cardiovagal modulation was reduced in both prehypertensives and hypertensives compared to controls. Among CAFTs, the ΔDBP_IHG was increased, and 30:15 ratio and E:I ratio were decreased in both study groups. The latency of P300 (the marker of neurocognition) was significantly prolonged in prehypertensives and hypertensives and P300 latency was significantly associated with reduction in TP in both the groups. HOMA-IR was increased, and total oxidant capacity was decreased in prehypertensives and hypertensives, and both these parameters had independent contribution to P300.

CONCLUSION

Prehypertensives had considerable autonomic imbalance, reduced cardiovagal modulation and neurocognitive deficit that were comparable to newly diagnosed hypertensives. Though the causal relationship between cardiovagal modulation and neurocognitive impairment can't be established from the findings of the present study, it appears that neurocognitive deficit might have some possible link to the decreased cardiovagal modulation and metabolic derangements in young prehypertensives and hypertensives.

Effects of Three Months of Honey Supplementation on Quality of Life and Neuropathy in Type 2 Diabetic Patients

CONTEXT

Diabetic neuropathy, a common debilitating complication of type 2 diabetes, can occur despite adequate treatment. To date, no studies have occurred on the use alternative medicine as an adjunct therapy for treating diabetic neuropathy.

OBJECTIVE

The study assessed the effects of three months of honey supplementation on insulin resistance, lipid profiles, oxidant status, nerve conduction, and QOL in patients with diabetic neuropathy.

METHODS/DESIGN

The research team designed a single-arm, open-label pilot study.

SETTING

The study took place at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in Puducherry, India.

PARTICIPANTS

The study included 48 patients with diabetic neuropathy at the institute, with a mean age of 58.91 ± 7.976 years.

INTERVENTION

Participants took honey for three months at a dose of 0.5 gm/Kg of body weight per day.

OUTCOME MEASURES

Participants completed the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire and the Norfolk QOL Diabetic Neuropathy (Norfolk QOL-DN) questionnaire at baseline and postintervention. Also, participants' glucose levels, lipid profiles, and biochemical markers were obtained and a nerve conduction study was completed at baseline and postintervention.

RESULTS

A significant reduction occurred in the NTSS-6 score (P < .0001) and the Norfolk QOL-DN total score (P < .0001) from baseline to postintervention. Participants' fasting blood glucose (FBG), triglycerides (TG), and total cholesterol (TC) decreased significantly, at P = .0192, P = .0371, and P = .0049, respectively. Their malondialdehyde (MDA), and inflammatory markers interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) also decreased significantly, and MDA showed a significant correlation with neuron specific enolase (NSE).

CONCLUSIONS

Three months honey supplementation reduced participants' subjective pain scores and symptoms from diabetic neuropathy and improved their QOL. However, the nerve conduction study showed that no significant change had occurred in motor velocity.

Decreased baroreflex sensitivity is associated with cardiometabolic risks and prehypertension status in early-postmenopausal women

OBJECTIVE

We studied the link of decreased baroreflex sensitivity (BRS) to cardiometabolic risks and prehypertension status in postmenopausal women during their early menopausal phase.

METHODS

Premenopausal women (n = 55) and early-postmenopausal women (n = 50) of age group between 40 and 55 years were recruited for the study, and their anthropometric parameters, complete battery of autonomic function tests (AFT), BRS, hormone levels, and cardiometabolic risk parameters were measured and compared between two groups. Correlation analysis of BRS with various physiological and biochemical parameters in these two groups were performed. Multiple regression analysis of BRS with various other associated factors in postmenopausal subjects and bivariate logistic regression analysis for assessing prediction of prehypertension status by BRS in postmenopausal group were performed.

RESULTS

There was a significant difference in AFT and metabolic parameters between premenopausal and postmenopausal women. Sympathovagal imbalance (increased sympathetic and decreased parasympathetic) was prominent in early-postmenopausal women. Decreased BRS, the marker of cardiovascular (CV) risk was found to be significant (P < .001) and correlated with various cardiometabolic parameters in early-postmenopausal subjects. Multiple regression analysis demonstrated that decreased BRS is independently linked to parameters of decreased vagal activity, inflammation, and oxidative stress in early-postmenopausal group. Decreased BRS could predict prehypertension status in early-postmenopausal subjects as confirmed by bivariate logistic regression analysis.

CONCLUSION

Sympathovagal imbalance, decreased BRS and considerable metabolic derangements were observed in women in their early phase of menopause. Decreased BRS appears to be associated with the cardiometabolic risks in these women. Prehypertension status in early-postmenopausal subjects could be predicted by decreased BRS.

Effect of honey and insulin treatment on oxidative stress and nerve conduction in an experimental model of diabetic neuropathy Wistar rats

Diabetic neuropathy is the most common complication affecting more than 50% of patients with longstanding diabetes. Till date, there are no reports to explain the scientific basis of alternative medicine as an adjunct therapy for treating diabetic neuropathy. Hence, we studied the effect of honey and insulin treatment on hyperglycemia, dyslipidemia, oxidant and anti-oxidant status and nerve conduction in experimental diabetic neuropathy Wistar rats. In this experimental study, forty healthy male Wistar albino rats of 10-12 weeks age, weighing between 150 to 200g were obtained from our institute central animal house. After acclimatization, the rats were divided into control (n = 8) and experimental (n = 32) groups randomly. In the experimental group, type 2 diabetic neuropathy was induced with high fat and high sugar diet for 8 weeks followed by streptozotocin at a dose of 35 mg/kg body weight. Three days after streptozotocin injection, blood glucose levels of rats were measured from fasting samples to confirm diabetes. After the development of diabetes, rats were given standard rodent chow and allowed four more weeks to remain diabetic and to develop neuropathy. Every second week, nerve conduction study was done to confirm neuropathy. All the diabetic rats of experimental group developed neuropathy after 4 weeks of developing diabetes, which was confirmed by significant reduction in conduction velocity of sensory and motor nerve when compared to non-diabetic control group. After the development of neuropathy, these rats were randomly divided into diabetic neuropathy with no treatment group (n = 8) and three treatment groups (n = 8, each). The rats of treatment group were administered with either honey or insulin or honey+insulin for six weeks. After six-weeks of intervention, there was significant decrease in blood glucose and lipids in honey, insulin and honey+insulin treated neuropathy rats, when compared with no treatment group. Malondialdehyde was reduced and total anti-oxidant status improved in all the three treatment groups. There was no significant increase in conduction velocity of sciatic tibial motor nerve in treatment groups when compared with no treatment group. However, the sensory nerve conduction velocity improved significantly in honey+insulin treated neuropathy rats. In conclusion, six-week honey treatment helped in reducing dyslipidemia and oxidative stress. Honey given along with insulin for six-weeks improved sensory nerve conduction velocity in experimental diabetic neuropathy Wistar rats.

Acute effects of prone asanas and Pal’s pranayama on myalgia, headache, psychological stress and respiratory problems in the COVID-19 patients in the recovery phase

Introduction and Aim: It has been observed that recovery from COVID-19 is delayed due to continuation of myalgia, fatigue, headache and some respiratory problems even after the discharge from the hospital. Reports indicate the improvement of sensory, cardiorespiratory and psychological functions following practice of Prone asanas and Pal’s pranayama. Therefore, we conducted a pilot study to assess if practice of asanas in prone posture and slow breathing exercise of Pal’s pranayama schedule can facilitate recovery from the COVID-19 illness and alleviate post-recovery complications in these patients. Materials and Methods: This is an interventional pilot study conducted in COVID positive patients. A structured module of prone asanas and Pal’s pranayama schedule was given to the COVID positive patients in addition to the routine medical treatments and their stress levels were assessed prior to and after the practice. Also, the acute effects of asana-pranayama schedule on the improvement of cardiorespiratory functions and occurrence of other complications in the recovery phase was recorded. Results: Following practice of asana-pranayama schedule, the patients recovered faster from myalgia, fatigue, headache and respiratory problems and they had a feeling of well-being. Further, the complications in the recovery phase of COVID-19 were prevented and the intensity of stress was reduced with the practice of asana-pranayama schedule. Conclusion: This pilot study has shed some light on the early recovery and the prevention of complications in the recovery phase of COVID-19.

Role of Ventromedial Hypothalamus in Sucrose-Induced Obesity on Metabolic Parameters

BACKGROUND

Obesity is because of excessive fat accumulation that affects health adversely in the form of various diseases such as diabetes, hypertension, cardiovascular diseases, and many other disorders. Our Indian diet is rich in carbohydrates, and hence the sucrose-induced obesity is an apt model to mimic this. Ventromedial hypothalamus (VMH) is linked to the regulation of food intake in animals as well as humans.

PURPOSE

To understand the role of VMHin sucrose-induced obesity on metabolic parameters.

METHODS

A total of 24 adult rats were made obese by feeding them on a 32% sucrose solution for 10 weeks. The VMH nucleus was ablated in the experimental group and sham lesions were made in the control group. Food intake, body weight, and biochemical parameters were compared before and after the lesion.

RESULTS

Male rats had a significant weight gain along with hyperphagia, whereas female rats did not have a significant weight gain inspite of hyperphagia. Insulin resistance and dyslipidemia were seen in both the experimental and control groups.

CONCLUSION

A sucrose diet produces obesity which is similar to the metabolic syndrome with insulin resistance and dyslipidemia, and a VMH lesion further exaggerates it. Males are more prone to this exaggeration.

Assessment of the association of heart rate variability and baroreflex sensitivity with depressive symptoms and stress experienced by women in pregnancy

BACKGROUND

Pregnancy is a unique physiological state with systemic changes including cardiovascular, autonomic, hemodynamic and psychological. Increase in incidence of stress and depression in antenatal period has been reported. Autonomic changes in pregnancy and its dysfunction in depression are well documented. However, there is lack of evidence associating cardiovascular autonomic dysfunction to stress and depressed mood in pregnant women.

METHODS

In this correlation study, we assessed cardiovascular autonomic functions of 172 pregnant women using heart rate variability (HRV) and baroreflex sensitivity (BRS). The Edinburg postnatal depression scale (EPDS) was used to evaluate depressive symptoms and perceived stress scale (PSS) was used to assess stress. The HRV and BRS parameters were correlated with EPDS and PSS. Multiple regression analysis was performed for EPDS and PSS individually to study their association with cardiac autonomic functions(CAF).

RESULTS

HRV and BRS were well correlated to EPDS and PSS scores. The depression and stress were found to be significantly associated to autonomic dysfunctions as increased sympathetic and decreased parasympathetic activity. Among various CAF parameters, LF:HF ratio and BRS were found to be significantly associated with depression and stress among these women.

CONCLUSION

LF:HF ratio and BRS may be associated with depression during antenatal period. The depression in antenatal period may add on to cardiovascular risk in expecting mothers.

Pulmonary function severity in relation to interleukin-23 levels in patients with psoriasis vulgaris

Background Interleukin-23 (IL-23), a key inflammatory regulator in the pathogenesis of psoriasis, is suspected to play a role in the onset of pulmonary dysfunction (chronic obstructive pulmonary disease) in psoriasis. Despite that, pulmonary function tests are rarely studied in these subjects. This study aims to seek a possible relation between pulmonary function in psoriasis patients serum IL-23. Methods For this analytical cross-sectional study, male psoriasis patients in the age group of 25-45 years were recruited from dermatology out patient department (n = 40). Age and BMI matched apparently healthy individuals were recruited as control group (n = 40). After obtaining demographic and personal details, anthropometric parameters and blood pressure were recorded. The severity of psoriasis was assessed using Psoriasis Area and Severity Index score. Pulmonary function was assessed using computerized spirometry, and serum IL-23 was measured using ELISA. Results Forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow rate, and forced expiratory flow at 25%-75% of the pulmonary volume (FEF25%-75%) were significantly reduced in psoriasis. Based on the percentage of predicted values FEF25%-75% was significantly reduced in psoriasis. Serum IL-23 (pg/mL) was significantly higher in psoriasis. The increase in IL-23 in psoriasis subjects does not correlate with their pulmonary function. Conclusions Psoriasis may be associated with a reduced lung function even when the disease is in the mild stage. Increased IL-23 found in these subjects is suggestive of systemic inflammation, which indirectly lowers lung function.

Enhanced magnetic and room temperature intrinsic magnetodielectric effect in Mn modified Ba2Mg2Fe12O22 Y-type hexaferrite

We have reported a systematic investigation on structural, magnetic, magnetodielectric and magnetoimpedance characteristics of Y-type Ba₂Mg₂(Fe_1-x Mn _x )₁₂O₂₂ (0  ⩽  x  ⩽  0.12) hexaferrite synthesized by solid-state reaction route. Rietveld refinement of x-ray diffraction pattern confirms the phase purity of all the samples with rhombohedral crystal structure. The Mn dopant modulates not only superexchange angle near to the boundary of magnetic blocks but also magnetic transition temperature. Temperature-dependent magnetization data suggests that due to Mn doping at Fe sites, ferrimagnetic to proper screw transition temperature (T _II) increases from 190 K to 208 K, while there is a decrease in proper screw to longitudinal conical spin transition temperature (T _I) from 35 K to 25 K. We observe remarkable decrease in the magnetic field from 20 kOe to 12 kOe to produce intermediate spin ordering from ferrimagnetic ordering which can be understood because of modification of superexchange angle due to Mn doping. The value of loss tangent decreases with increasing doping concentration at 300K, i.e. ~60% and 180% in BMFM4 (x  =  0.04) and BMFM8 (x  =  0.08) respectively as compared to BMF, suggesting the evolution of intrinsic feature in the doped samples. Magnetodielectric (MD) effect shows that in the low-frequency regime, the robust MD effect is because of Maxwell-Wagner interfacial polarization, whereas in the high-frequency regime intrinsic effect dominates. Further, magnetoimpedance measurement confirms the presence of substantial intrinsic MD% (~6%) at 1.3 T applied field at 300 K for 4% Mn-doped sample. Finally, the nature and strength of magnetoelectric coupling in BMFM4 and BMFM8 samples at 300 K is found to be biquadratic (P ² M ²) and maximum strength of coupling is 3.09  ×  10^-4 emu² g^-2 and 2.34  ×  10^-4 emu² g^-2, respectively.

Study of the Prevalence of Dyspepsia in the Adult Population in a Rural Community of Bangladesh

Dyspepsia is a symptom complex that includes epigastric pain, post-prandial fullness, bloating, early satiety, belching, nausea, vomiting, heartburn, acid regurgitations and anorexia. The most widely applied definition of dyspepsia is the Rome working team formulation namely chronic or recurrent pain or discomfort centered in the upper abdomen. Till date the prevalence of dyspepsia in Bangladesh has not been studied much. The last study was done in 1987 in a rural community and the prevalence of dyspepsia was found to be 41.4%. However, associated risk factors were not assessed and definition of dyspepsia was much narrower as well as the dysmotility type dyspepsia was not included in that study. Hence it is now high time to carry out another study to see the prevalence of dyspepsia in Bangladesh and the risk factors associated with it. To determine the prevalence of dyspepsia and the demographic risk factors associated with dyspepsia in the adult population in the rural community of Bangladesh. This cross sectional population based study carried out in Ghior Union of Manikgonj district of Bangladesh from January 2007 to April 2008. All persons 18 years or above living in Ghior Union were considered as the study populations with using a pre-designed questionnaire. This study showed that the prevalence of dyspepsia to be 61.9%. Reflux- like dyspepsia was the commonest sub-type of dyspepsia without reflux symptoms comprising 43.9% of the total population and 70.9% of the dyspeptics. Dysmotility like dyspepsia comprised more than half of the dyspeptics. Nausea (40.7%) was the most predominant dysmotility like dyspeptic symptoms followed by early satiety (38.4%); 13.9% of the population had history of recurrent upper abdominal pain and 11.9% of the population had gastro-esophageal reflux disease (GERD). There was considerable overlapping (16.7%) of IBS with dyspepsia. Female sex, younger age (<40 years), low family income (<5000 Taka per month), lower educational level (up to primary level), smoking and use of NSAIDs were significantly associated with dyspepsia. The prevalence of dyspepsia in adult population of Bangladesh is 61.9% which is very high compared to other countries and also much higher than the prevalence found in our country thirty years back. A great change in the socio-economic status and lifestyle of the people along with environmental pollution and food adulteration may be responsible for this increase in prevalence. This study was conducted in only one union of this country, so it was not representative of the whole population of the country. Therefore further study with large population size including rural and urban peoples from different parts of Bangladesh is needed to estimate the accurate prevalence of dyspepsia in our country.

Contribution of insulin resistance to decreased baroreceptor sensitivity & cardiometabolic risks in pre-obesity & obesity

Background & objectives:

Although insulin resistance (IR) is a known complication in obesity, the physiological mechanisms linking IR with cardiometabolic risks in obesity have not been well studied. This study was conducted to assess the difference in cardiovascular (CV) risk profile in IR and non-IR (NIR) conditions, and contribution of IR to cardiometabolic risks in pre-obese and obese individuals.

Methods:

Basal CV, blood pressure variability, autonomic function test and cardiometabolic parameters were recorded in pre-obese (n=86) and obese (n=77) individuals during 2012 and 2015. The association of altered cardiometabolic parameters with homeostatic model for IR (HOMA-IR) in pre-obese and obese groups and with baroreceptor sensitivity (BRS) in IR and NIR groups was calculated by appropriate statistical analysis.

Results:

Decreased BRS, a known CV risk and cardiometabolic parameters were significant in IR (pre-obese and obese) group compared to the NIR group. Sympathovagal imbalance in the form of increased sympathetic and decreased parasympathetic activities was observed in individuals with IR. There was no significant difference in the level of independent contribution of HOMA-IR to cardiometabolic parameters in pre-obese and obese groups. Adiponectin and inflammatory markers had an independent contribution to BRS in IR group.

Interpretation & conclusions:

Findings of the present study demonstrated that the intensity of cardiometabolic derangements and CV risk were comparable between IR, pre-obese and obese individuals. Pro-inflammatory state, dyslipidaemia and hypoadiponectinaemia might contribute to CV risk in these individuals with IR. IR could possibly be the link between altered metabolic profile and increased CV risks in these individuals independent of the adiposity status.

Risk factors for diagnostic delay in Crohn's disease and their impact on long-term complications: how do they differ in a tuberculosis endemic region?

BACKGROUND

The diagnosis of Crohn's disease (CD) can be delayed in clinical practice. In tuberculosis endemic areas, empirical anti-tubercular therapy further delays treatment.

AIM(S)

To assess risk factors for diagnostic delay and its impact on the long-term complications of Crohn's disease in India where tuberculosis is endemic.

METHODS

Data from a large prospectively established inflammatory bowel disease registry were analysed retrospectively. The time from onset of symptoms to diagnosis (diagnostic delay) was calculated and categorised into two groups based on median diagnostic delay. The risk factors for delay including anti-tubercular therapy were analysed. Logistic regression analysis was done to assess impact of diagnostic delay on development of stenotic and fistular complications including need for surgery.

RESULTS

Seven hundred and twenty Crohn's disease patients (60.3% male, median: 28 years) were included. Main outcome measures were stenosis, fistula and need for surgery. Subjects with diagnostic delay >18 months (median) developed significantly higher stenotic complications and surgery (OR 4.12; 95% CI: 2.74-6.33, P < 0.001 and OR 2.41, 95% CI: 1.68-3.42, P < 0.001), respectively, compared to those ≤18 months. There was no difference in the development of fistulous complications. 193/720 (27%) received anti-tubercular therapy which significantly contributed to diagnostic delay (OR: 2.47; 95% CI: 1.76-3.47, P < 0.001) with 47% showing initial clinical response (Crohn's disease activity index- CDAI decrease >100). Moreover, the incidence of stenotic complications was significantly higher in patients who had received prior anti-tubercular therapy (55/193 (28.49%) vs 78/527 (14.8%), P < 0.001, OR: 2.60, 95% CI: 1.64-4.12).

CONCLUSIONS

Diagnostic delay in Crohn's disease is associated with significantly higher stenotic complications and need for surgery. Empirical anti-tubercular therapy is the single largest contributor to diagnostic delay in tuberculosis endemic areas. Despite initial clinical response to anti-tubercular therapy, long-term stenotic complications are higher.

Evaluation of Pharmacokinetic and Pharmacodynamic Drug-Drug Interaction of Sacubitril/Valsartan (LCZ696) and Sildenafil in Patients With Mild-to-Moderate Hypertension

Sacubitril/valsartan (LCZ696) is indicated for the treatment of patients with heart failure and reduced ejection fraction (HFrEF). Since patients with HFrEF may receive sacubitril/valsartan and sildenafil, both increasing cyclic guanosine monophosphate, the present study evaluated the pharmacokinetic and pharmacodynamic drug interaction potential between sacubitril/valsartan and sildenafil. In this open‐label, three‐period, single sequence study, patients with mild‐to‐moderate hypertension (153.8 ± 8.2 mmHg mean systolic blood pressure (SBP)) received a single dose of sildenafil 50 mg, sacubitril/valsartan 400 mg once daily for 5 days, and sacubitril/valsartan and sildenafil coadministration. When coadministered with sildenafil, the AUC and C_max of valsartan decreased by 29% and 39%, respectively. Coadministration of sacubitril/valsartan and sildenafil resulted in a greater decrease in BP (–5/–4/–4 mmHg mean ambulatory SBP/DBP/MAP (mean arterial pressure)) than with sacubitril/valsartan alone. Both treatments were generally safe and well tolerated in this study; however, the additional BP reduction suggests that sildenafil should be administered cautiously in patients receiving sacubitril/valsartan. Unique identifier: NCT01601470.

Effect of 12 Weeks of Yoga Therapy on Quality of Life and Indian Diabetes Risk Score in Normotensive Indian Young Adult Prediabetics and Diabetics: Randomized Control Trial

Introduction

India has become the epicentre for diabetes, a stress-related disorder affecting the working skills and day-to-day lifestyle management of younger population. Most of the studies have reported the effect of yoga on improving Quality of Life (QoL) in diabetic patients with other comorbidities. Till date, no randomized control trial reports are available to show the effect of yoga therapy on QoL and Indian Diabetes Risk Score (IDRS) in normotensive prediabetic and diabetic young individuals.

Aim

To determine the effect of 12 weeks of yoga therapy on QoL and IDRS among normotensive prediabetic and diabetic young Indian adults.

Materials and Methods

A randomized control trial was conducted in Endocrinology Outpatient Department (OPD). Normotensive participants (n=310) aged 18-45 years were divided into healthy controls (n=62), prediabetics (n=124) and diabetics (n=124). Study group subjects were randomly assigned to Group II (n=62, prediabetes-standard treatment), Group III (n=62, prediabetes-standard treatment + yoga therapy), Group IV (n=62, diabetes-standard treatment) and Group V (n=62, diabetes-standard treatment + yoga therapy). Flanagan QoL scale, IDRS questionnaire, Fasting Plasma Glucose (FPG) and insulin were assessed pre and post 12 weeks of intervention. Statistical analysis was done using Student's paired t-test and one-way ANOVA.

Results

Pre-post intervention analysis showed significant improvement in QoL scale with p<0.01 in Group II and Group IV; p<0.001 in Group III and Group V respectively. There was significant reduction in IDRS in Group II (p<0.05); p<0.001 in Group III, Group IV and Group V respectively. Significant difference (p<0.001) in QoL scale and IDRS were found when study groups with standard treatment along with yoga therapy were compared to standard treatment alone.

Conclusion

Yoga therapy along with standard treatment for 12 weeks improved QoL and attenuated the diabetes risk among Indian prediabetics and diabetics compared to standard treatment alone.

Decreased baroreflex sensitivity is linked to the atherogenic index, retrograde inflammation, and oxidative stress in subclinical hypothyroidism

Purpose/aim of the study: The present study investigated the link of hyperlipidemia, inflammation and oxidative stress (OS) to cardiovascular (CV) risks in subclinical hypothyroidism (SCH).

MATERIALS AND METHODS

We enrolled 81 subclinical hypothyroid patients and 80 healthy subjects as control. Their CV and autonomic functions were assessed by spectral analysis of heart rate variability (HRV), continuous blood pressure variability (BPV) measurement and conventional autonomic function testing. Thyroid profile, lipid profile, immunological, inflammatory and OS markers were estimated and correlated with the baro-reflex sensitivity (BRS), the marker of sympathovagal imbalance (SVI) & CV risk.

RESULTS

Mean arterial pressure (MAP, P<0.0001), total peripheral resistance (TPR, P<0.0001), ratio of low-frequency to high-frequency power of HRV (LF-HF ratio) (P<0.0001) were significantly higher and BRS (P<0.0001) was significantly lower in SCH group than the control group. BRS significantly correlated with heart rate, MAP, LF-HF ratio, lipid risk factors, anti-thyroperoxidase antibody, thyroid-stimulating hormone, high-sensitive C-reactive protein (hsCRP), malondialdehyde (MDA) and SCH.

CONCLUSIONS

It was concluded that SVI is associated with SCH. Though dyslipidemia, inflammation and OS contributed to decreased BRS, SCH per se contributed maximally to it. Decreased BRS could be a physiological basis of increased CV risks in patients with SCH.

Decreased baroreflex sensitivity is linked to sympathovagal imbalance, low-grade inflammation, and oxidative stress in pregnancy-induced hypertension

Pregnancy-induced hypertension (PIH) has been reported as a cardiovascular (CV) risk. We assessed the sympathovagal imbalance (SVI) and the association of inflammation and oxidative stress (OS) with CV risks in PIH. A total of 125 pregnant women having a risk factor for PIH were followed till term and the incidence of PIH was observed. Retrospectively, they were divided into two groups: Group I (those who did not develop PIH, n = 82) and Group II (those who developed PIH, n = 43). Blood pressure variability (BPV) parameters including baroreflex sensitivity (BRS), spectral heart rate variability (HRV), autonomic function tests (AFTs), inflammatory markers (interleukin-6, TNF-α, interferon-γ), and OS markers were measured in both the groups. Alterations in parasympathetic and sympathetic components of AFTs were analyzed. Link of various parameters to BRS was assessed by correlation and multiple regression analysis. Parasympathetic components of AFTs were decreased from the early part of pregnancy and sympathetic components were increased toward the later part of pregnancy. Decreased BRS, the marker of CV risk, was more prominent in Group II subjects. Independent contribution of interleukin-6 (β = 0.276, P = 0.020), TNF-α (β = 0.408, P = 0.002), interferon-γ (β = 0.355, P = 0.008), and thiobarbituric-acid reactive substance (β = 0.287, P = 0.015) to BRS was found to be significant. It was concluded that sympathetic overactivity that develops more in the later part (third trimester) of pregnancy contributes to SVI and genesis of PIH. In PIH women, CV risks are present from the beginning of pregnancy that intensifies in the later part of pregnancy. Retrograde inflammation and oxidative stress contribute to the decreased BRS in PIH.

Endothelial nitric oxide synthase gene polymorphisms are associated with cardiovascular risks in prehypertensives

Though endothelial nitric oxide synthase (eNOS) gene polymorphism is documented in the causation of hypertension, its role in prehypertension has not been investigated. The present study was conducted in 172 subjects divided into prehypertensives (n = 57) and normotensives (n = 115). Cardiovascular (CV) parameters including baroreflex sensitivity (BRS) by continuous BP variability assessment and sympathovagal imbalance (SVI) by heart rate variability analysis were recorded. Biochemical parameters for insulin resistance (homeostatic model for assessment of insulin resistance), oxidative stress, lipid risk factors, renin, and inflammatory parameters were measured. Genotyping for eNOS polymorphisms rs1799983 (298G>T) and rs2070744 (-786T>C) was performed by polymerase chain reaction-restriction fragment length polymorphism method. Multiple regression analysis was done to assess the association between SVI and metabolic markers, and multivariate logistic regression was done to determine the prediction of prehypertension status by genotype, BRS, and ratio of low-frequency to high-frequency in these subjects. The BP variability, heart rate variability, and biochemical parameters were significantly altered in prehypertensives. The eNOS polymorphisms were found to be associated with prehypertension. BRS, the marker of SVI, was significantly associated with BP, homeostatic model for assessment of insulin resistance, and tumor necrosis factor alpha in 298GG genotype of prehypertensive population. The eNOS gene polymorphisms appear to be associated with prehypertension. 298G>T and -786T>C contribute to SVI in young prehypertensives attributed by insulin resistance and inflammation. The CV risks were associated with prehypertension status in prehypertensives expressing both 298GG and -786TT genotypes. Association of CV risks with SVI appears to be stronger in prehypertensives expressing GG genotype.

Attenuated baroreflex sensitivity in normotensive prediabetes and diabetes in Indian adults

PURPOSE/AIM OF THE STUDY

Though attenuated baroreflex sensitivity (BRS) is known to promote cardiovascular disease (CVD) risk in diabetics, its status in prediabetes has not been reported. Also, the link of BRS to CVD risk in normotensive diabetics has not been reported. This study aimed to evaluate the association of BRS to CVD risk in normotensive prediabetics and diabetics.

MATERIALS AND METHODS

Participants (n = 154) of 18-45 years were divided into normoglycemics (n = 52), prediabetics (n = 64) and diabetics (n = 38) based on American Diabetes Association criteria. Body mass index, waist-hip ratio, waist-height ratio, body fat mass index, basal heart rate, systolic blood pressure, diastolic blood pressure, rate pressure product, BRS, heart rate variability (HRV), fasting plasma glucose, fasting insulin, lipid profile and atherogenic index of plasma (AIP) were measured. Indian Diabetes Risk Score (IDRS) and homeostatic model assessment of insulin resistance were calculated.

RESULTS

There was significant increase in all the parameters except BRS, HRV and high-density lipoprotein in prediabetics and diabetics compared to normoglycemics. All these parameters were significantly altered in prediabetics compared to diabetics. Significant negative correlation was found between BRS and other parameters in prediabetics and diabetics.

CONCLUSIONS

BRS was attenuated in normotensive prediabetics and diabetics with high IDRS, insulin resistance, AIP, dyslipidemia and reduced HRV that predisposes them to CVD risk. The study demonstrates CVD risk quite early in the prediabetics with reduced HRV, high body fat, hyperinsulinemia, insulin resistance, AIP and rate pressure product.