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.

Formative evaluation of a teledentistry training programme for oral health professionals.

INTRODUCTION: The objective of this study was to conduct a formative evaluation of a teledentistry (TD) programme that was developed for a predominantly rural state in the Midwestern United States. MATERIALS AND METHODS: Formative evaluation data were collected on programme activities from the TD programme records. In addition, the effectiveness of the TD training programme was evaluated using a self-administered paper-based survey administered to the participants, immediately following completion of the training activity. Ninety-three dental students, oral health and other health professionals participated in the TD training programme. RESULTS: Overall, the trainees rated the TD training programme highly, with regard to the content, format and skills improvement. The evaluation also demonstrated a positive change in all trainees' attitudes following the training sessions, with most trainees acknowledging a positive impact of the training on their knowledge and competency. DISCUSSION AND CONCLUSIONS: We identified challenges in the development of the TD programme and in expanding access to oral health care for rural communities. Challenges included reimbursement and a limited interest amongst established dental offices. Dental schools can play an important role in preparing both dental health professionals and other health professionals in the use of TD by providing training and oral health expertise. The use of TD by non-dental providers for consultation, referral and disease management has the potential to improve oral health outcomes, particularly for rural and underserved populations. Evaluation data provide critical feedback to programme planners and administrators.

Elevated basal cytosolic calcium of endothelial cells influences the post-surgical outcome in diabetic CTS.

Background Type 2 diabetes mellitus (T2DM)-induced neuropathy and ischemia-reperfusion post-surgery prolong carpal tunnel syndrome (CTS) pathology, but the effect of T2DM on the prognostic outcome of carpal tunnel (CT) release surgery needs to be investigated. Materials and methods A total of 64 individuals with CTS underwent CT release surgery. HbA1c levels identified their diabetic status. The individual prognostic outcomes were measured by nerve conduction velocity (NCV), amplitude, and latency. Measurement of [Ca2+]c and reactive oxygen species (ROS) from isolated endothelial cells (ECs) revealed the oxidative burden of the normal and diabetic CTS phenotypes. Results CTS individuals with HbA1c > 7 showed decreased NCV (≈22 m/s) and amplitude (≈4.2 mV) with increased latency (≈6 ms), compared to groups with HbA1c ≤ 7. Further to CT release surgery, the reversal of the nerve conduction to normalcy was greatly influenced by the diabetic profile of the individuals. Our results showed elevated basal [Ca2+]c and corresponding high cytosolic ROS in the ECs isolated from individuals with HbA1c > 7 compared to the diabetic and healthy control groups. Conclusion The individuals with diabetic index showed suboptimal neuronal performance pre- and post-CT release surgery. Oxidative stress mediated by high [Ca2+]c and ROS of ECs dissipates to adjoining cells worsening the pathology of the untreated CTS.

Familial hemophagocytic lymphohistiocytosis.

A 45-day-old infant presented with hepatosplenomegaly and fever since 15 days. Hemogram revealed bicytopenia and bone marrow aspirate showed hemophagocytosis. With the history of death of two siblings, the baby was diagnosed with hemophagocytic lymphohistiocytosis (HLH), likely to be of familial origin.

Serum myeloperoxidase: a novel biomarker for evaluation of patients with acute coronary syndrome.

OBJECTIVES: Myeloperoxidase, an abundant leucocyte enzyme, is elevated in culprit lesions that have ruptured in patients with sudden cardiac injury. Multiple lines of evidence suggest an association between myeloperoxidase and inflammation and acute coronary syndrome. Myeloperoxidase has been proposed as a potent risk marker and diagnostic tool in acute coronary syndrome (ACS). Recent studies have reported the potential use of myeloperoxidase in acute coronary syndrome, but limited reports are available on its utility in different groups of ACS in the emergency department. Therefore the circulating levels of serum myeloperoxidase in patients with acute coronary syndrome and control subjects were studied. DESIGN AND SETTING: The levels of serum myeloperoxidase were measured by ELISA in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as non-cardiac chest pain (NCCP). The levels of myeloperoxidase were significantly increased in patients with ACS when compared with controls and NCCP. From the receiver operator characteristic (ROC) curve analysis, the optimum value above which myeloperoxidase can be considered positive was found to be 48.02 U/ml. The area under the curve was found to be 0.956 with 95% CI (0.934 to 0.973) (p<0.0001). A combination analysis of ROC curves of troponin, creatine kinase MB (CK-MB) and myeloperoxidase showed myeloperoxidase to be highly significant. Multivariate analysis revealed myeloperoxidase to be an independent diagnostic marker for early diagnosis of ACS. CONCLUSION: Myeloperoxidase, in contrast to troponin and CK-MB, identified patients at risk of ischaemic events, even in the absence of myocardial necrosis, thus highlighting its potent usefulness for risk stratification among patients presenting with chest pain.

Disseminated cryptococcosis in an immunocompetent child.

Cryptococcosis is caused by cryptococcus neoformans. Immunosuppression is a predisposing factor for the development of cryptococcosis. However, reports exist that cryptococcus neoformans can cause infection in immunocompetent hosts. We report a case of disseminated cryptococcosis in a 7.5-year-old immunocompetent child.

Prosthetic valve endocarditis caused by Scedosporium apiospermum.

Scedosporium apiospermum, the asexual state of Pseudallescheria boydii, is increasingly recognized as an opportunistic pathogen. We report a case of prosthetic valve endocarditis caused by this organism that developed in a patient following cardiac surgery.

Congenital lobar emphysema and sequestration--treatment by embolization.

A case of congenital lobar emphysema associated with pulmonary sequestration, presenting with respiratory distress in infancy, is reported. The lobar hyperinflation was managed by emergency lobectomy. The ipsilateral lower lobe affected with vascular sequestration was salvaged by therapeutic embolization, thus avoiding the long-term sequelae of pneumonectomy. The case is reported for its rarity.

Senior grassroots organizations in India.

Organizations for the elderly at the grassroots level began to function in India from the third decade of the 20th century. They belong to two major types: Pensioners' Associations (PAs) and Senior Citizens' Associations (SCAs). PAs claim a membership of approximately 13 million and are structured and vertically organized. The SCAs are loosely organized and most are unitary. They have together a membership of less than 5 million. Programs of PAs are mainly confined to members; those of SCAs are wider but mainly urban-biased and middle-class oriented. Neither of them is powerful in lobbying. Of late, Government of India's (GOI) policy on the elderly (NPOP, 2000) has given a fillip to the SCAs which are gathering strength, and some, at least, are vying for availing GOI program benefits.

Protochlorophyllide reductase. III: Synthesis of a protochlorophyllide-dihydroflavin complex.

A mild and efficient method of linking a dihydroflavin to the C-17 carboyxlic acid side chain of protochlorophyllide, without degradation of the sensitive E ring or loss of magnesium, is described. The appended dihydroflavin was shown to quench the fluorescence of protochlorophyllide. In contrast, a dihydronicotinamide moiety was unable to effect fluorescence quenching. the relevance of these findings to a possible mechanism of action of the enzyme protochlorophyllide reductase is discussed.

Recurrent spontaneous perforation of intestinal lymphoma.

The possibility of intestinal lymphoma should be kept in mind when operating upon an immunodeficient child with an intestinal perforation without apparent reason; the phenomenon can recur during the post-operative period without being recognized early.

Case report: brain metastases from papillary carcinoma thyroid.

Papillary carcinoma, the commonest thyroid malignancy, has a good prognosis and low incidence of distant metastases. Brain metastasis is extremely rare with a frequency of 0.1-5% in reported series. The clinical details of two cases of histologically proven brain metastases from papillary thyroid cancer treated in our centre are presented. In one patient, the lesion was in the cerebellar hemisphere, and in the other, the frontal lobe. Also presented is a review of the literature of this unusual clinical presentation.

Overexpression in Escherichia coli of 12 vitamin B12 biosynthetic enzymes.

The first 12 enzymes involved in the biosynthesis of vitamin B12 from its five-carbon precursor, aminolevulinic acid, have been overexpressed in recombinant strains of Escherichia coli. The activity of each enzyme has been demonstrated by the biosynthesis of hydrogenobyrinic acid from aminolevulinic acid.

Stoichiometry and spectroscopic identity of copper centers in phenoxazinone synthase: a new addition to the blue copper oxidase family.

Phenoxazinone synthase catalyzes the oxidative condensation of two molecules of substituted o-aminophenols to the phenoxazinone chromophore of actinomycin. Cyclization occurs with the concomitant reduction of molecular oxygen to water. We have shown that the enzyme requires 4-5 copper atoms/monomer for full activity and the additional copper inhibits the enzyme. The optical absorption spectrum of phenoxazinone synthase is also dependent on the Cu per monomer ratio, and the absorption peak at 598 nm has a maximum extinction coefficient of 4000 +/- 150 M-1 cm-1 at a ratio of 4-5 Cu atoms per monomer. The electron paramagnetic resonance (EPR) spectrum of enzyme as isolated with low copper content (0.8 Cu/monomer) only shows the presence of type 1 (blue) copper centers (g parallel = 2.24, A = 0.0067 cm-1, and g perpendicular = 2.07). Enzyme incubated with 4-5 Cu per monomer demonstrates the presence of both type 1 and type 2 copper centers with a stoichiometry of one type 1 center per monomer and the remainder bound as type 2 Cu2+. Anaerobic incubation of substrate with enzyme containing five Cu atoms per subunit results in bleaching of the blue center. The EPR spectrum of the enzyme reduced under these conditions suggests that one of the type 2 Cu2+ centers with a g parallel = 2.34, A = 0.016 cm-1, and g perpendicular = 2.07 remains oxidized and is not involved in catalysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Phenoxazinone synthase: mechanism for the formation of the phenoxazinone chromophore of actinomycin.

Phenoxazinone synthase is a copper-containing oxidase that catalyzes the coupling of 2-aminophenols to form the 2-aminophenoxazinone chromophore. This reaction constitutes the final step in the biosynthesis of the potent antineoplastic agent actinomycin. The mechanism of this complex 6-electron oxidation was determined by using a variety of substituted 2-aminophenols, designed to block the reaction at intermediate stages. Thus, with 3,5-di-tert-butyl-2-aminophenol as substrate, the reaction was blocked at the o-quinone imine 17; with 5-tert-butyl-2-aminophenol (19) as substrate, the reaction was blocked at the p-quinone imine 20; and with 5-methyl-2-aminophenol (21) as substrate, the reaction was blocked at the dihydro-2-aminophenoxazinone 22. These findings suggested a mechanism in which 2-aminophenoxazinone formation proceeded via a quinone imine intermediate 4 that was trapped by a second molecule of 2-aminophenol. Oxidation of the adduct 5 to the p-quinone imine 6 was followed by a second conjugate addition and a final 2-electron oxidation to give the product, 2-aminophenoxazinone. The role of the enzyme in the catalysis of each of these steps was examined. It was found that the second conjugate addition generated a racemic center at C4a, suggesting that this reaction did not occur at the active site. A deuterium isotope effect on the cleavage of the C4-H bond of 2-aminophenol suggested that partial dissociation of an intermediate from the enzyme occurred after the first conjugate addition. It is proposed that 2-aminophenoxazinone synthesis proceeds via a sequence of three consecutive 2-electron aminophenol oxidations and that the aminophenol moiety is regenerated during the reaction sequence by facile tautomerization reactions. Thus, what initially appears to be an impressively complex mechanism may, in fact, be ingeniously simple.