Oral glucose tolerance test clearance in type 2 diabetes patients who underwent remission following intense lifestyle modification: A quasi-experimental study.

Achieving diabetes remission (HbA1c<48mmol/mol without the use of anti-diabetic medication for 3 months) might not assure restoration of a normal glycemic profile [fasting blood sugar level <5.6 mmol/L and Post-Prandial (PP) blood glucose <7.8mmol/L]. The study investigates the factors associated with OGTT clearance in patients under type 2 diabetes remission. Four hundred participants who achieved remission during a one-year online structured lifestyle modification program, which included a plant-based diet, physical activity, psychological support, and medical management (between January 2021 and June 2022), and appeared for the OGTT were included in the study. OGTT clearance was defined by fasting blood glucose < 5.6 mmol/L and 2-hour post-prandial blood glucose <7.8 mmol/L post-consumption of 75g glucose solution. Of the 400 participants, 207 (52%) cleared OGTT and 175 (44%) had impaired glucose tolerance (IGT). A shorter diabetes duration (<5 years) was significantly associated with OGTT clearance (p<0.05). Pre-intervention use of glucose-lowering drugs showed no association with OGTT clearance (p<0.1). Post-intervention, the OGTT-cleared group showed significantly higher weight loss (p<0.05) and a decrease in HbA1c compared to the IGT group (p<0.05). Improvement in Insulin resistance and ß-cell function was also higher in the OGTT-cleared group compared to the IGT group (p<0.05). In conclusion, clearing the OGTT is a possibility for those achieving remission through lifestyle interventions. Higher weight loss, a shorter duration of diabetes, and improvement in insulin resistance were significantly associated with OGTT clearance in participants in remission. Future randomized controlled trials with longer follow-ups may help substantiate our findings.

Effect of massage on blood pressure in patients with hypertension: A meta-analysis.

BACKGROUND: Hypertension (HTN) is a chronic medical condition that affects 1.13 billion people globally. Successful management of HTN is accomplished through both pharmacological and non-pharmacological interventions. Massage therapy, a widely practiced complementary and alternative medicine therapy that alleviates physical discomfort and promotes overall well-being. The current meta-analysis aims to evaluate the effect of massage on blood pressure in patients with HTN. METHODS: Electronic databases, including PubMed, Prospero, Scopus, ClinicalTrials.gov, Embase, and the Cochrane Library, were searched from their inception up to March 2021. All experimental trials that met the (PICO) criteria were included. The primary outcome of the study was blood pressure. A meta-analysis was conducted using a random-effects model to generate a summary of treatment effects, expressed as the effect size (Standardized Mean Difference - SMD), along with a 95% Confidence Interval (CI). RESULTS: Six studies were included in the review, in which 290 patients participated, 148 were in the experimental group and 142 in the control group. Meta-analysis showed a minimal reduction of systolic blood pressure (SMD: -0.65 mmHg, 95% CI: -4.75, 3.55) and diastolic blood pressure (SMD: -0.68 mmHg, 95% CI: -2.43, 1.06) with considerable heterogeneity (I2> 94%). CONCLUSION: The findings demonstrated that massage therapy resulted in a minimal reduction in blood pressure among patients with hypertension. To suggest massage as an effective intervention to reduce blood pressure further randomized control trials are recommended. Additionally, the literature is limited and still emerging, further large prospective studies with long follow-ups are warranted to verify the findings from this meta-analysis.

Does hydrotherapy influence plasma glucose levels in type 2 diabetes? - A scoping review.

BACKGROUND: Hydrotherapy is a commonly used treatment modality to manage various conditions including diabetes in the Naturopathy system of medicine. The objective of the current scoping review is to find the effectiveness of hydrotherapy on plasma blood glucose levels in type 2 diabetes. CONTENT: Arksey and O'Malley's five-stage framework was adopted for this scoping review. The studies which used hydrotherapy intervention for the management of diabetes or the effect of hydrotherapy on plasma glucose levels were considered eligible. PubMed/MEDLINE, EMBASE, Cochrane library, and Google scholar were searched for English- language published articles till December 20, 2022. The following Medical Subject Headings (MeSH) and keyword search terms were used ("diabetes" OR "type 2 diabetes" OR "diabetes mellitus" OR "plasma glucose level") AND ("hydrotherapy" OR "water therapy" OR "balneotherapy"). Two investigators independently assessed the studies for inclusion. Review articles, abstracts, and articles including the aquatic exercises as interventions were excluded. SUMMARY: In total, six studies met the inclusion criteria. Out of six, two studies used hot therapies, two studies cold therapy, and the remaining two used both hot and cold as interventions. The study results showed that hydrotherapy can be used as an effective intervention tool for blood glucose levels in patients with type 2 diabetes. OUTLOOK: Integrating hydrotherapy treatments alongside conventional management can reduce blood glucose levels and thus reduce diabetes-related complications.

Long-term remission of type 2 diabetes through intense lifestyle modification program - A case series.

Type 2 diabetes (T2D) remission is being widely accepted and documented as feasible through calorie restriction and bariatric surgery. Recent studies with lifestyle changes have also shown T2D remission; however, long-term remission through lifestyle modifications is not yet established. Though glycated hemoglobin (HbA1c) is a universally accepted indicator of glycemic status, oral glucose tolerance test (OGTT) would be a more robust marker in understanding whether the metabolic abnormalities in glucose metabolism have undergone complete remission as well. We present a case series of four patients enrolled in the Holistic Transformation Program, a lifestyle modification program, between 2016 and 2018. The intervention was a combination of a vegan diet, structured exercises, and stress management delivered over 12 months. All four patients successfully achieved T2D remission and cleared OGTT consecutively for a minimum period of 3 years. Our findings suggest that long-term T2D remission may be possible through lifestyle modification.

Type 2 Diabetes Remission Through Intense Lifestyle Modification with Three-Year Follow-Up of an Elderly Male on High Insulin Dosage: A Case Report.

An elderly obese male patient (60 yrs.) diagnosed Type 2 Diabetes (T2D) presented to our clinic. He was on 94 units of insulin and oral hypoglycemic agents during his initial consultation visit. After obtaining informed consent, he was enrolled into intense lifestyle modification program for a duration of six months, with a three-year follow-up after the intervention. The patient underwent complete remission losing 13 kg of body weight and also successfully clearing oral glucose tolerance tests (OGTT) for three consecutive years. We present three unique features in the current case report: (1) Elderly age of the patient (2) OGTT clearance along with normalisation of HbA1c, and (3) High initial insulin dosage at baseline. A few of the common positive predictors of T2D remission documented in earlier studies include younger age and minimal or low doses of insulin. The current case study shows that older age and higher dosage of insulin, it is possible to undergo complete T2D remission along with OGTT clearance through intense holistic lifestyle modification. Future experimental studies with adequate sample sizes would help substantiate our observation.

Effectiveness of antenatal yoga in reducing intensity of labour pain: A systematic review and meta-analysis.

Background: Yoga during pregnancy was found to be beneficial in various aspects of pregnancy including pain management during the time of labour. The current systematic review and meta-analysis aims to assess the effectiveness of antenatal yoga practices in reducing pain during the time of labour. Methods: We searched electronic databases such as PubMed, Embase, Cochrane Library, and Web of Science, till January 2023. Randomized controlled trials (RCTs) which measured the effects of antenatal yoga practices on pain management during labour were included. The main outcome was the pain intensity measured with any validated questionnaire. The methodological quality of included studies was evaluated by using a risk-of-bias assessment tool developed by the Cochrane Collaboration. For the effect size, standardized mean differences (SMDs) with a 95% confidence interval (CI) were generated with a random effect model using R software (version 4.2.2). Results: Eight studies including 576 antenatal women between the age of 14 and 40 years were included. Results of this meta-analysis showed that yoga is effective in reducing labour pain (SMD: -1.34 95% of CI: -1.86, -0.81) with significant heterogeneity among the studies (I2 73%, p < 0.0008). Conclusion: Antenatal yoga can be a promising intervention in the field of obstetrics to reduce the intensity of labour pain. However, we are still in need of RCT with a large sample size to confirm the reliability of the present meta-analysis.

Aromatherapy for Postpartum Depression: A Systematic Review and Meta-Analysis.

Objective: The incidence and prevalence of postpartum depression is increasing due to multiple factors. Aromatherapy is a widely used complementary and alternative (CAM) therapy in the management of depression. This systematic review and meta-analysis was done to find the effect of aromatherapy on postpartum depression. Materials and methods: Electronic databases like PubMed, Scopus, Cochrane Library and Science Direct since inception till February 2021 were searched using related keywords to obtain eligible studies. Randomised controlled trial studies (RCTs) reporting the effects of aromatherapy therapy in women with postpartum depression were included. Aromatherapy studies conducted on population other than postpartum women were excluded. The primary outcome was depression scores obtained by using valid depression scales. Meta-analysis was performed using the random-effects model of Der Simonian and Laird to produce summary treatment effects in terms of Hedges' g effect sizes with 95% confidence interval (CI). Results: A total of 4 RCTs (n=303) were included. The results indicate that aromatherapy (Hedges' g =-0.94, 95 CI= -2.55, 0.61, I2=88%, p<0.01) reduces depression levels among postpartum women without statistical significance. Conclusion: The available evidences suggest aromatherapy may be effective in reducing post-partum depression. The number of scientific evidences currently available are very limited and more studies with robust study designs are required to strongly recommend aromatherapy in the management of post-partum depressions. However, being a safer intervention with no adverse effects being reported in previous studies, aromatherapy could definitely be added as an effective complementary therapy in the management of post-partum depression along with conventional medicine.

E-learning and E-modules in medical education-A SOAR analysis using perception of undergraduate students.

BACKGROUND: Application of e-learning and e-modules in medical education has been shown to have a positive impact on learning outcomes among all types of learners, across diverse educational settings. Despite its benefits, e-learning and e-modules has not yet reached its full potential in medical education in India. Objective of this study is to evaluate the perception of undergraduate students regarding e-learning and e-modules using an appreciative inquiry tool SOAR (Strengths, Opportunities, Aspirations, Results) analysis, and to identify the barriers and challenges for the same. METHODS: This longitudinal study was conducted among participants from three consecutive batches (n = 250 x 3) of first-year medical students and two consecutive batches (n = 100 x 2) of first-year dental students. The sample was selected using a purposive sampling method. Two structured and validated questionnaires were developed for this study based on the modified Zhou's Mixed Methods Model; the 'Knowledge, Attitude and Practice' Questionnaire (KAPQ) on e-learning and the feedback questionnaire (FBQ) on e-modules. The questionnaires were administered via MOODLE / hard copy, before and after the implementation of e-modules, respectively. Identified strengths, potential opportunities, probable aspirations and likely results for e-learning and e-modules were tabulated based on the qualitative analysis of perceptions of large number students sampled across three years. RESULTS: Six hundred and ninety students returned both questionnaires representing a response rate of 76.6%. Nine themes were identified in the "Strengths" domain as follows: Regular Update of Knowledge, Innovative Learning, Availability, Knowledge Sharing, Abundance of Information, Accessibility, Source of Knowledge, Creativity, and Increased Engagement. Eleven themes were identified in the "Opportunities" domain as follows: Clinical Skills training, Timesaving, Flexibility, Creativity, Increased engagement, Standardized content, Capacity building for students, Capacity building for faculty, Skills training, and Self-assessment. Thirteen themes were identified under the "Aspirations" domain with the three key themes being "maintaining and building on current strengths", "increasing potential opportunities", and "addressing the barriers and challenges identified in the responses to the KAPQ and FBQ questionnaire". Four themes identified for 'Barriers' were eye strain, distractions, preference for conventional methodologies, and internet connectivity. CONCLUSIONS: The findings of this qualitative study are based on the responses received from first-year medical and dental students of a Private University in Chennai, India. In this population of students, implementation of e-learning as blended learning using structured and interactive e-modules may provide more engagement during learning as well as support self-directed learning (SDL) directly or indirectly. Adoption of blended learning with e-modules as an integral part of curriculum planning may be beneficial for the achievement of Competency-Based Medical Education (CBME) goals in India.

Knowledge, attitude and perception of complementary and alternative system of medicine in Tamilnadu and Pudhucherry, South India.

OBJECTIVES: Complementary and Alternate medicine (CAM) remains as the major source of healthcare for majority of the Indian population. This widespread resource needs to be strengthened, adequately trained and effectively utilized in the national health care delivery system for delivering an integrated and effective health care system. METHODS: A cross sectional study was conducted involving 200 adults in two different settings-a community setting (n=100), and a hospital setting (n=100). A semi-structured questionnaire was used. RESULTS: Both in the community and in the hospital, siddha (80%) was the most well-known system of medicine, followed by Yoga (72%) and Naturopathy in the study population. However, the knowledge about the various available CAM therapies still seemed to be limited. CONCLUSIONS: Opinion on the integrated approach along with conventional medicine was welcoming. Still more awareness about these systems is required to facilitate integrative medicine in healthcare settings.

Effect of Bhramari Pranayama intervention on stress, anxiety, depression and sleep quality among COVID 19 patients in home isolation.

Background: COVID-19 outbreak is considered to be a major public health concern as it has a negative impact on the patient's psychological health. In addition, patients under home isolation might be more panic and in stress. In this study, we examined the effect of Bhramari Pranayama (Bhr.P) intervention on patients' psychological distress during home isolation. Methods: Ninety-two asymptomatic COVID-19 patients were recruited from the host hospital and willing patients who satisfied the inclusion criteria (n = 42) were selected for the study. The patients were given Bhr.P intervention (20 min) through online for 15 days. Participants were assessed with Depression Anxiety and Stress Scale-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Quality of life (WHOQOL-BREF) at baseline and post-intervention. Results: Bhr.P practice has shown a significant (P < 0.05) reduction in DASS-21 score of depression, anxiety and stress. In addition, the patients stated significant improvement in quality of sleep (PSQI; p < 0.05) and quality of life (WHOQOL-BREF; p < 0.05) after the intervention. Conclusion: Our findings indicate that Bhr.P intervention had a positive impact on psychological health as well as quality of sleep among the COVID-19 patients during home isolation. However, it needs to be confirmed by multi-site randomized controlled trials.Clinical trial registration: CTRI/2021/04/032845.

Validation of Metacognitive Awareness Inventory from a Private Medical University in India.

BACKGROUND: Metacognition is the awareness and the capability to regulate one's own thinking process. Metacognition is critical in medical education for clinical reasoning and management. Hence, the objective of this study is to evaluate the construct validity and reliability of the Metacognitive Awareness Inventory (MAI) among first-year medical and dental students, from a private medical university in India, using confirmatory analysis and internal consistency method. MATERIALS AND METHODS: This was a cross-sectional study using convenient sampling. Fifty-two-item MAI was administered to 933 first-year medical and dental students from a private medical university in India. Exploratory factor analysis (EFA), principal component analysis, Cronbach's α, and confirmatory factor analysis with global fit indices were performed. Structural equation modeling (SEM) was performed to evaluate the relationship between the structural path and factors using AMOS version 22. RESULTS: During EFA, 12 items with <0.40 factor loadings were trimmed sequentially. The remaining items with respective factors had a good internal consistency of ≥ 0.9. Comparative fit index (0.78), goodness-of-fit index (0.8), adjusted goodness of fit index (0.77), Tucker-Lewis index (0.7), standardized root mean square residual (0.06), and root mean square error of approximation (0.09) values showed that six-factor model fits to satisfactory. Pearson's correlation coefficient was found to be high between factors (>0.80). SEM for each item (observed) and factor (unobserved) illustrated the hypothesized model. CONCLUSION: The resultant 40-item model based on MAI designed by Schraw is a valid and reliable tool for assessing the metacognitive awareness of Indian students. Employing a valid and reliable tool in assessing the metacognitive awareness will help the academicians in incorporating appropriate curricular interventions.

Yoga for children in the new normal - experience sharing.

OBJECTIVES: Covid-19 Pandemic has affected everyone's mental health. In addition to several preventive measures such as wearing a mask, using sanitizer, measures also need to be taken to prevent anxiety and depressive disorders due to this unexpected crisis situation. Practicing yoga is one of the simple, scientific methods to combat stress and prevent anxiety among children. METHODS: The scientific evidence and anecdotal experiences on benefits of yoga is described in this paper, highlighting the importance of yoga in nurturing the mental well-being in children. RESULTS: Scientifically designed and conducted studies as part of the research programs by health professionals objectively conclude that mental health parameters improve significantly with yoga as an intervention. In addition to mental health, yoga will also improve the physical health and boost immunity among children which will also help in reducing the infection rate in children. CONCLUSIONS: As a way forward, authors strongly recommend establishing yoga as a curriculum at scale to cover the vast vulnerable population of young children who are the future of the nation.

Cortisol and polycystic ovarian syndrome - a systematic search and meta-analysis of case-control studies.

BACKGROUND: Polycystic ovarian syndrome (PCOS) has become an emerging disorder affecting women of reproductive age group. Its intricate presentation of signs and symptoms makes it a disease of interest to research. While there are varied hypotheses related to its cause and pathogenesis, role of stress in this disease is yet to be grounded. There is emerging body of evidence on cortisol and PCOS, although it is currently equivocal. METHODS: Medline, Embase, Pubmed, Science Direct, Google Scholar, and Scopus were searched from March 1985 to March 2020 using MeSH terms. After dual quality assessments and data abstraction, the final articles were included for meta-analysis. RESULTS: Forty-one studies qualified for the analysis. Pooled meta-analysis showed that the level of cortisol was significantly higher in PCOS when compared to healthy controls (standard mean difference [SMD] = 0.83, 95% confidence interval [CI] = 0.42-1.23) with highly significant heterogeneity (I2 = 94%). Subgroup analysis done based on type of sample stated high effect size for blood cortisol levels (SMD = 0.9, 95%CI = 0.32; 1.51) compared to overall effect. CONCLUSIONS: This systematic review and meta-analysis on cortisol and PCOS have helped in generating evidence regarding the role of cortisol in the pathogenesis of PCOS and the use of cortisol estimation as a potential stress marker in PCOS.

Angiotensin-converting enzyme 2 (ACE2): COVID 19 gate way to multiple organ failure syndromes.

BACKGROUND: Globally, the current medical emergency for novel coronavirus 2019 (COVID-19) leads to respiratory distress syndrome and death. PURPOSE: This review highlighted the effect of COVID-19 on systemic multiple organ failure syndromes. This review is intended to fill a gap in information about human physiological response to COVID-19 infections. This review may shed some light on other potential mechanisms and approaches in COVID -19 infections towards systemic multiorgan failure syndromes. FINDING: SARS-CoV-2 intervened mainly in the lung with progression to pneumonia and acute respiratory distress syndrome (ARDS) via the angiotensin-converting enzyme 2(ACE2) receptor. Depending on the viral load, infection spread through the ACE2 receptor further to various organs such as heart, liver, kidney, brain, endothelium, GIT, immune cell, and RBC (thromboembolism). This may be aggravated by cytokine storm with the extensive release of proinflammatory cytokines from the deregulating immune system. CONCLUSION: The widespread and vicious combinations of cytokines with organ crosstalk contribute to systemic hyper inflammation and ultimately lead to multiple organ dysfunction (Fig. 1). This comprehensive study comprises various manifestations of different organs in COVID-19 and may assist the clinicians and scientists pertaining to a broad approach to fight COVID 19.