Role of Yoga as an Adjunct in the Management of Migraine Headache-Current Status and Future Indications

Migraine headache is a painful, disabling condition afflicting 7% of the population. The long-term effort of coping with a chronic headache disorder predisposes the individual to other psychiatric illnesses, ischemic cerebrovascular disease as well as medicine overuse headache. The use of nonpharmacological methods to reduce the stress and pain associated with headache can improve the overall quality of life and reduce the burden of the disease. To examine the utility of yoga as an adjunct to pharmacological treatment of migraine headache. The review article is based on the secondary literature collected through the Google Scholar database between the years 2010 and 2020. Several themes were identified regarding the burden of migraine/headache and the need for the integration of yoga into the existing healthcare system. Despite the limitations and the need for greater scientific rigor, there have been consistent reports of the beneficial effects of yoga in the reduction of stress, anxiety, depression, and an enhanced quality of life, as well as better pain management in chronic diseases. Studies on the role of yoga in the treatment of migraine have been few in number. They have consistently shown that yoga can be a valuable adjunct to the existing pharmacological interventions in the management of migraine headache. In recent years, the Indian government has made enormous strides in establishing yoga outreach programs throughout the country. The need of the hour is to integrate evidence-based yoga with the wellness centers and noncommunicable diseases treatment plan. It can help to reduce the burden on the existing health care resources.

The impact of the introduction of fidaxomicin on the management of Clostridium difficile infection in seven NHS secondary care hospitals in England: a series of local service evaluations

Clostridium difficile infection (CDI) is associated with high mortality. Reducing incidence is a priority for patients, clinicians, the National Health Service (NHS) and Public Health England alike. In June 2012, fidaxomicin (FDX) was launched for the treatment of adults with CDI. The objective of this evaluation was to collect robust real-world data to understand the effectiveness of FDX in routine practice. In seven hospitals introducing FDX between July 2012 and July 2013, data were collected retrospectively from medical records on CDI episodes occurring 12 months before/after the introduction of FDX. All hospitalised patients aged ≥18 years with primary CDI (diarrhoea with presence of toxin A/B without a previous CDI in the previous 3 months) were included. Recurrence was defined as in-patient diarrhoea re-emergence requiring treatment any time within 3 months after the first episode. Each hospital had a different protocol for the use of FDX. In hospitals A and B, where FDX was used first line for all primary and recurrent episodes, the recurrence rate reduced from 10.6 % to 3.1 % and from 16.3 % to 3.1 %, with a significant difference in 28-day mortality from 18.2 % to 3.1 % (p < 0.05) and 17.3 % to 6.3 % (p < 0.05) for hospitals A and B, respectively. In hospitals using FDX in selected patients only, the changes in recurrence rates and mortality were less marked. The pattern of adoption of FDX appears to affect its impact on CDI outcome, with maximum reduction in recurrence and all-cause mortality where it is used as first-line treatment.

Dietary intake of trace elements, minerals and vitamins among severely malnourished children and its interrelationship with nutritional status:A prospective study

Dietary deficiency of trace elements, minerals and vitamins has been associated with severe malnutrition among young children. Although levels of severe malnutrition among children are high in developing countries, data on dietary intake of trace elements, minerals, vitamins and other nutrients by severely malnourished (SMN) children are limited. The present prospective study was conducted for a period of 12 months in order to assess the intake of trace elements, minerals, vitamins and other nutrients by SMN children and its possible interrelationship with their nutritional status. The nutritional status of 1643 children in the age group of 6 months to < 6 years, registered at 50 Anganwadi centres at district Alwar and Bharatpur in Rajasthan in India, was assessed using weight-for-age criteria. A total of 150 children were identified as severely malnourished. Mothers of 130 of the children consented to their children's participation in the study. At the end of 12 months, full data was available for 60 of the 130 SMN children. The nutritional status and intake of trace elements, minerals, vitamins and other nutrients of the 60 SMN children were analysed at monthly follow-up visits. Results revealed that there was an increase in the intake of trace elements, minerals and other nutrients during the follow-up period as compared to the baseline survey. However, in all of the follow-up visits, an overall deficient intake of all of the trace elements, minerals, vitamins and other nutrients was observed in the SMN children except for protein, calcium and magnesium. Out of 60 children, 35 moved to higher nutritional grades. It was found that the intake of trace elements, minerals, vitamin and macro-nutrients was higher among children whose nutritional status improved as compared with the group that remained in the severe malnutrition category. The present study highlights that the existence of multiple trace element and vitamin deficiencies in the diets of SMN children could play a role in the severe malnutrition of these children.

Organoleptic study of deacidified and deodourised palm oil

Deficiency of vitamin A has long been identified as a serious and preventable nutritional disorder, associated with increased risk of mortality and morbidity amongst children. The present study was conducted with the objectives (i) to perform organoleptic testing of food products cooked in Deacidified and Deodourised Palm Oil (DDPO), by sensory evaluation method and (ii) to compare the characteristics of these food products with the same products cooked in routinely used oil. Eleven commonly used weaning food items were prepared with routinely used oil (Group A). The same recipes were also prepared with DDPO (Group B). A food testing panel conducted the sensory evaluation for assessing the acceptability of the various food items. It was observed that with respect to all characteristics there was no significant difference in the recipes made with the two types of oil. Results Indicated that DDPO can be used in India for preparation of weaning foods which are routinely given to young children.

Nutritional risk factors in esophageal cancer

OBJECTIVE

The present case-control study was undertaken with the objective to study the nutritional risk factors associated with esophageal cancer.

METHODOLOGY

One hundred and fifty diagnosed esophageal cancer patients and an equal number of healthy individuals constituted the patient and control groups, respectively. Dietary consumption pattern during the preceding 20 years prior to the diagnosis of esophageal cancer was assessed utilising the standard food frequency questionnaire method. Information on alcohol consumption, smoking habits, chewing of betel leaf with tobacco was also collected.

RESULTS

Multivariate analysis revealed that the risk of esophageal cancer was 7.81 times (p < 0.01) higher with daily consumption of alcohol. The risk increased to 3.16 times (p < 0.01) with the daily habit of chewing of betel leaf with tobacco. Nearly a two fold risk was observed when the consumption of "other vegetables" was less than four times per week. A 1.95 times (p < 0.01) increase in risk was observed with the daily habit of bidi smoking.

CONCLUSION

Cancers in general are multifactorial in origin, and several environmental interactions are possible. It is not easy to quantify the contribution of diet to cancer risk. However, the results of the present study suggested that nutritional factors do play a role.

Assessment of status of salt iodization in Delhi

The National Capital Territory (NCT) of Delhi was identified as an iodine deficiency endemic area in 1980. The government of NCT of Delhi banned the sale of non-iodised salt since 1989. The present study was aimed to estimate the iodine content of salt consumed in the households of the state. Thirty clusters were selected using population proportionate to size cluster sampling procedure. In each identified cluster one primary school was randomly selected. In each school, 60 salt samples were collected from an equal number of school children. The iodine content of a total of 1854 salt samples collected was analyzed using the standard iodometric titration method. Forty one per cent of families consumed salt with an iodine content of less than 15 ppm. Salt with nil iodine content was consumed only by 1.4% of the beneficiaries which indicated successful implementation of universal salt iodization programme in the state.

Dr. P. C. Sen Memorial Award Paper. Status of salt iodisation and iodine deficiency in selected districts of different states of India

Iodine deficiency disorders (IDD) is a major public health problem. Surveys conducted by the National Goitre Survey team of the Directorate General of Health Services during the past three decades have revealed a high prevalence of endemic goitre in different states. Out of a total of 267 districts surveyed till date, 226 have been reported to be endemic to iodine deficiency. A successful measure for the prevention of IDD is salt iodisation. The Salt department, Government of India has taken an intensive programme of production of iodised salt in the country. The production has increased from 1.5 lakh metric tonnes in 1984 to 40 lakh metric tonnes in 1996. To assess the impact of increased production of iodised salt on the availability of iodised salt at the beneficiary and trader level and also on the status of iodine deficiency, surveys were undertaken in selected districts of 10 states and 2 union territories of the country. These studies have been presented and discussed here.

Iodine deficiency in district Kinnaur, Himachal Pradesh

The state of Himachal Pradesh is a known iodine deficiency endemic region since the last 40 years. The state government is supplying iodised salt to the district since 1970. No recent survey has been conducted on the prevalence of iodine deficiency from the district Kinnaur which is located at an average altitude of 10,000 feet above sea level. A total of 1094 children in the age group of 6-10 years were included in the study and clinically examined. The total goitre prevalence of 6.1% was found in the subjects studied. Urine samples were collected from 226 children and were analysed using standard laboratory procedures. It was found that the percentage of children with < 2 mcg/dl, 2-4.9 mcg/dl, 5-9.9 mcg/dl and 10 and above mcg/dl of urinary iodine excretion (UIE) level was 1.3, 5.8, 10.6 and 82.3 respectively. A total of 242 salt samples were collected and analysed using the standard iodometric titration method. Results showed that almost 90% of the families were consuming salt with an iodine content of 15 ppm and more which is the stipulated level of iodisation of salt. The findings of the study indicate that iodine nutrition is in the transition phase from iodine deficient to iodine sufficient. Findings revealed a need for further strengthening the monitoring of the quality of salt being distributed in Kinnaur to achieve elimination of iodine deficiency.

Dietary intake of trace elements and minerals among adults in underprivileged communities of rural Rajasthan, India

In developing countries, data on dietary intake of trace elements, and even major elements, is limited. The dietary intake of 1277 adults of underprivileged communities of rural Rajasthan was studied. Intake was assessed by the 24-h dietary recall method from which the average daily intake of macronutrients, some major elements, and trace elements was computed. The zinc intake was 69.7 and 49.7% of the recommended daily allowance in males and non-pregnant non-lactating females, respectively. The intakes of manganese and molybdenum were adequate when compared with the suggested daily intakes. Element intake during the physiological stress conditions of pregnancy and lactation was 42.4 and 53.0% for zinc, 36.5 and 29.8% for copper, and 21.0 and 23.1% for calcium, respectively. The intake of iron was less than 20 mg/day for all female subjects studied. No significant difference was observed in the trace element intake of subjects with different grades of malnutrition. Assessment of dietary intake may provide a useful indication of the possible status of major and trace elements among adult subjects.

Iodine status of pregnant mothers residing in a district of endemic iodine deficiency in the state of Himachal Pradesh, India

For the last 40 years the Kullu district in Himachal Pradesh, India, has been recognised as an area of endemic iodine deficiency. The state government has adopted a policy of universal iodisation of salt since 1984. The iodine status of pregnant mothers is an indicator of the community status of iodine deficiency. This study was, therefore, undertaken on the iodine status of pregnant mothers to assess the impact of universal salt iodisation. A total of 147 pregnant mothers between 20-30 years of age in their second and third trimesters, attending the antenatal clinic at the district hospital, were selected for the study. Urine samples were collected from all the pregnant mothers and analysed using standard laboratory methods. It was found that 0.68% of the pregnant mothers had urinary iodine excretion between 2.0-4.9 mcg/dL, 8.8 % between 5.0-9.9 mcg/dL and 90.5% had 10 mcg/dL or more, where below 10 signifies iodine deficiency disorder (IDD). This indicates that there is a need to strengthen the implementation of the universal salt iodisation program in the Kullu district to combat IDD.

Nutritional factors in carcinoma oesophagus: a case-control study

A case control study was conducted on 170 patients with oesophageal cancer. An equal number of healthy persons (attendants of patients) were included in the study as controls to identify nutritional risk factors for oesophageal cancer. The majority (55%) of the patients were of low socio-economic status and from Northern parts of India. They were predominantly male (66%). Increase in risk was associated with low consumption of green leafy vegetables, other vegetables and fresh fruits, milk and milk products. Heavy use of spices and use of very hot tea or food were also associated with increased risk. Differences in the past dietary consumption patterns of oesophageal cancer patients and controls suggest a role for nutritional factors in oesophageal cancer pathogenesis. At the same time substance abuse by cigarette or bidi smoking, alcohol consumption, paan and tobacco chewing also increased risk. After multivariate analysis, green leafy vegetables, other vegetables spices, bidi usage and fresh fruits provided protection against oesophageal cancer.

Iodine content of salt in the Union Territory of Andaman and Nicobar Islands, India

Iodine is an essential micronutrient, deficiency of which causes a number of disorders including goitre and cretinism. Inadequate data are available on the iodine content of salt consumed by beneficiaries in Andaman and Nicobar islands. A systematic study was therefore, undertaken to assess the iodine content of salt to initiate intervention measures, if required, to improve the quality of salt. A total of 275 salt samples, collected from equal number of households constituted the study sample. It was found that 57.1% of the salt samples had an iodine content of 15 ppm and above, 16% had between 10 ppm to <15 ppm, 26.5% had less than 10 ppm and only one salt sample had nil iodine content. The results of the study indicate that there is a need for further strengthening and monitoring of the quality of iodised salt procured and distributed by traders in the Union territory in order to combat iodine deficiency disorders.

Assessment of iodine deficiency disorders using the 30 cluster approach in the National Capital Territory of Delhi

OBJECTIVE

Iodine Deficiency Disorders (IDD) are a major public health problem in India. The National Capital Territory (NCT) of Delhi is a known iodine deficiency endemic area. The Delhi Government banned the sale of non-iodised salt since 1989. The present study was conducted to assess the status of IDD after 7 years of salt iodisation programme in the state.

DESIGN

Cross sectional.

METHODOLOGY

The recent indicators recommended by the World Health Organization-United Nations Childrens Fund-International Council for the Control of Iodine Deficiency Disorders (WHO-UNICEF-ICCIDD) were utilized for the assessment of IDD. A total of 30 clusters were selected using population proportionate to size cluster sampling procedure. In each identified cluster, one primary school was selected using random sampling. A total of 6911 school children in the age group of 8-10 years were included for the study.

RESULTS

The total goiter prevalence rate was 8.6% while 2.1, 8.4, 17.6 and 71.9% of the children had urinary iodine excretion levels of < 2, 2-4.9, 5-9.9 and 10 and above mcg/dl, respectively. The median urinary iodine excretion was 17 mcg/dl. Of the 1854 salt samples analyzed, salt with a nil iodine content was consumed only by 1.4% of the beneficiaries. Forty one per cent of families consumed salt with an iodine content of less than 15 ppm.

CONCLUSION

IDD continues to be a public-health problem in the NCT of Delhi. There is a need of strengthening the existing monitoring system for the quality of iodised salt.

Breast-feeding practices in Schedule Caste communities in Haryana state

A study was conducted to assess exclusive breast-feeding, continued breast-feeding, bottle-feeding, predominant breast-feeding, timely complementary feeding and other breast-feeding practices in 818 children in the age group of 0-3 years belonging to the Schedule Caste communities of Haryana. The exclusive breast-feeding rate was 0.15 and the predominant breast-feeding rate 0.75 in children < 4 months. Timely complementary feeding rate was 0.42. The continued breast-feeding rate at 1 year and 2 years was 0.84 and 0.58, respectively. The bottle-feeding rate, ever breast-fed rate, timely first-suckling rate and exclusive breast-feeding rate by mother were 0.09, 1.0, 0.0 and 0.15, respectively. The median duration of breast-feeding was 16 months.

Diarrhoea amongst under three children in rural Haryana

A community based study was conducted to assess the magnitude of the problem of diarrhoea and factors associated with it amongst children below three years of age. Two districts in Haryana state were selected by using multistage random sampling procedure. Eight hundred eighteen children in the age group of 0-35 months belonging to scheduled caste communities were studied. All children suffering from diarrhoea at the time of survey or within last 2 weeks were included for the detailed study. The occurrence of diarrhoea was highest in age group 6-11 months (28%) and was lowest in age group 0-5 months (16%). No relationship was found between the nutritional status of children and the occurrence of diarrhoea. The percentage prevalence of diarrhoea was 42, 32 and 36 per cent amongst normally, moderately and severely malnourished children, respectively. Thirty seven percent of children suffering from diarrhoea received bottle feed.