Comparison of cardiac autonomic functions among postmenopausal women with and without hormone replacement therapy, and premenopausal women.

The aim of present study was comparison of cardiac autonomic status during different phases of reproductive life in women – in premenopausal women between proliferative and secretory phase, in postmenopausal women and in postmenopausal women receiving hormone replacement therapy (HRT). The study included 30 premenopausal women (Group 1) who were assessed in both proliferative (Group 1A) and secretory phase (Group 1B) of menstrual cycle, 30 postmenopausal women (Group 2) and 30 postmenopausal women on HRT (Group 3). Various autonomic function tests were done to assess parasympathetic and sympathetic functions. Results were obtained by ANOVA followed by Tukey test. The postmenopausal women (Group 2) showed increased sympathetic and decreased parasympathetic tone compared to premenopausal women (Groupl). The women on HRT (Group 3) showed parasympathetic dominance and decrease in sympathetic activity compared to postmenopausal women (Group 2). Across the menstrual cycle, increased parasympathetic activity was seen in secretory phase while no change was observed in the sympathetic activity in the two phases.

Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: A randomized control trial.

Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Chronic low back pain (LBP) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture. This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy. Chronic LBP patients (n=60) were recruited from the Department of Orthopaedics, GTB Hospital, Delhi. Age and sex matched healthy volunteers were selected as controls (n=30). Following a written consent, LBP patients were randomly allocated into two study groups – Group A received 10 sittings of electro acupuncture, on alternate days, at GB and UB points selected for back pain, while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy. Controls were assessed once while the patients were assessed twice, before and after completion of the treatment program (3 weeks). The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio, postural challenge test and sustained handgrip test. Pain intensity was measured with the visual analogue scale (VAS) and the global perceived effect (GPE). Statistical analysis was performed using repeated measure’s ANOVA with Tukey’s test. Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls (P<0.05 to P<0.001 in different variables). Following treatment, both the study groups showed a reduction in vagal tone together with a decrease in the sympathetic activity. There was also a considerable relief of pain in both groups, however, the acupuncture group showed a better response (P<0.01). We conclude that there is autonomic dysfunction in chronic LBP patients. Acupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/ additive treatment modality in these cases.

Effect of Hormone Replacement Therapy on Memory in Post Menopausal Women.

To study the differential effects of estrogen and progestin on memory in postmenopausal women receiving hormone replacement therapy (HRT). Methods: Thirty women between ages 45 and 60 years who had attained natural menopause and received combined estrogen progestin therapy constituted group I. While group II included 30 surgically menopausal women who received only estrogen, PGI memory scale having a battery of ten subtests devised specially for Indian subjects was used. Results were analyzed by repetitive measure analysis. Results: Women showed an improved score on memory scale after 6 months of HRT in both the groups. The comparison of both groups post therapy revealed improvement in scores of delayed recall & visual retention in group II indicating that only estrogen users benefited more. Conclusion: This study supports the view that estrogens with or without progestin if given early after menopause i.e. below 60 yrs if age do have a beneficial role on memory.

The beneficial effect of yoga in diabetes.

Twenty NIDDM subjects (mild to moderate diabetics) in the age group of 30-60 years were selected from the out patient clinic of G.T.B. hospital. They were on a 40 days yoga asana regime under the supervision of a yoga expert. 13 specific Yoga asanas < or = done by Type 2 Diabetes Patients included. Surya Namaskar, Trikonasana, Tadasana, Sukhasana, Padmasana, Bhastrika Pranayama, Pashimottanasana, Ardhmatsyendrasana, Pawanmuktasana, Bhujangasana, Vajrasana, Dhanurasana and Shavasana are beneficial for diabetes mellitus. Serum insulin, plasma fasting and one hour postprandial blood glucose levels and anthropometric parameters were measured before and after yoga asanas. The results indicate that there was significant decrease in fasting glucose levels from basal 208.3 +/- 20.0 to 171.7 +/- 19.5 mg/dl and one hour postprandial blood glucose levels decreased from 295.3 +/- 22.0 to 269.7 +/- 19.9 mg/dl. The exact mechanism as to how these postures and controlled breathing interact with somatoendocrine mechanism affecting insulin kinetics was worked out. A significant decrease in waist-hip ratio and changes in insulin levels were also observed, suggesting a positive effect of yoga asanas on glucose utilisation and fat redistribution in NIDDM. Yoga asanas may be used as an adjunct with diet and drugs in the management of Type 2 diabetes.

Differential effects of exogenous estrogen versus a estrogen-progesterone combination on auditory evoked potentials in menopausal women.

The study was undertaken to determine the differential effects of estrogen and progestin on auditory evoked responses in postmenopausal women receiving hormone replacement therapy (HRT). Forty-seven women between 45 and 70 years of age attending menopause and HRT clinic were divided into two groups. Group I included 32 women who attained natural menopause and receiving combined estrogen progestin therapy. While group II included 15 surgically menopausal women receiving only estrogen. Evoked potentials were recorded in form of auditory brainstem response (ABR), middle latency response (MLR) & slow vertex response (SVR). There was improvement of conduction in auditory pathways at the level of brainstem and thalamocortical projections as indicated by the decrease in latencies of most of the waves of ABR and/MLR after 6 months of HRT in both the groups. The conduction in association areas, as indicated by SVR, did not show a significant change. The intergroup comparison after therapy revealed a decrease in latency of wave V and I-V interpeak latency in group II indicating that only estrogen users are benefited more. Thus HRT facilitates the process of sensory conduction, which may form one of the mechanisms of improved neuropsychological functions in menopausal women on HRT. The addition of progestin to estrogen does not have a negative or potentiating effect on it.

Post-task P3-changes following a brief, rigorous visual task indicate individual differences in the task-specific ability.

The P3 latency in an auditory oddball ERP paradigm is known to get prolonged after a few hours of mental task. The present study shows that it takes merely a few minutes of challenging visual mental activity to produce significant changes in P3 latency in the visual oddball ERP paradigm. However, the mental activity results in a shortening of P3-latency almost as often as it results in its prolongation. Similarly, the post-task P3 amplitude is higher or lower with nearly equal incidences. Following the task, the reaction time shortens as often as it prolongs. It seems that the P3 changes and their variations through electrode sites signify individual differences in the amount and extent of additional neuronal resources tapped by the subject in coping with the challenging task, and that it leaves an aftereffect for several minutes after the mental workload is withdrawn. These aftereffects get indexed in the P3 wave characteristics of a much simpler ERP paradigm with more change occurring in the better performers. In the clinical context, these observations raise doubts about the diagnostic value of P3 latency or amplitude without knowledge of the immediate history of mental workload.