Assessment of the diagnostic accuracy of Vibrasense compared to a biothesiometer and nerve conduction study for screening diabetic peripheral neuropathy.

AIMS: Peripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN. METHODS: A total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS. RESULTS: Average VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman's correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively. CONCLUSIONS: Vibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings. TRIAL REGISTRATION: Clinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022.  https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167 .

Integrated Yoga Practice in Cardiac Rehabilitation Program: A Randomized Control Trial.

Background: Coronary artery disease (CAD) is a detrimental noncommunicable disease, which is increasing due to sedentary lifestyle and urbanization in the young population. It is further elevated with risk factors such as stress, anxiety, depression, an increase in triglycerides, dyslipidemia, hyperglycemia, hypertension, and so on, which manifests as atherosclerotic disease. Yoga-based lifestyle intervention is a noninvasive effective treatment method to control and prevent cardiac risk factors in CAD patients. Yoga has been used in India as a therapeutic method to manage hypertension and other chronic disorders and is fast gaining popularity as an effective means for the alleviation of stress, improvement of fitness, and enhancement of well-being. This study aimed to determine the feasibility of introducing the integrated approach of yoga therapy (IAYT) in a cardiac rehabilitation center in India and understand its usefulness in improving the cardiac function and managing the cardiac risk factors in acute myocardial infarction patients with left ventricular dysfunction. Methods and Design: Cardiac patients were randomized to a yoga-practicing group (n = 33) and a control group (n = 33). The yoga-practicing group was instructed to attend three supervised IAYT classes 3 days per week for 12 weeks at the hospital yoga center. The control group received standard care that included pharmacologic treatment and the instructions of the cardiologist. The outcome measures were assessed at baseline (T1 = 0) and completion (T2 = 3 months). The primary outcome measure was the left ventricular ejection fraction (LVEF). Results: There was no statistically significant difference in LVEF (U = 420.500, p value = 0.218) between the two groups. However, the yoga-practicing group showed significant reduction in depression (Cardiac Depression Scale [CDS], U = 71, p value = 0.0), anxiety (Hamilton Anxiety Rating Scale [HAM-A], U = 128, p value = 0.0), and a significant increase in quality of life (QOL) scores (Duke Activity Status Index [DASI], U = 146, p value = 0.0; and metabolic equivalents (METs), U = 136, p value = 0.0) at 3 months compared to control. Overall, the CAD patients practicing yoga showed a favorable profile compared to control individuals on CDS, HAM-A, DASI, and MET outcomes. Control and yoga practicing groups did not differ significantly in the lipid levels. Conclusion: This study indicated that the integration of yoga practice in a cardiac rehabilitation program is feasible and has no added benefit in improving the cardiac function. However, the addition of yoga to cardiac rehabilitation may be beneficial in reducing depression and anxiety and improving QOL in patients.

Evidence Base of Yoga Studies on Cardiovascular Health: A Bibliometric Analysis.

Noncommunicable diseases including coronary artery disease contribute to approximately 50% of global mortality. Pharmacological treatment alone may not be a panacea for such diseases since it may be associated with various other adverse effects. Hence, strategies such as Yoga involving healthy lifestyle and stress management are widely sought by the patient population. MATERIALS AND METHODS: An electronic search of PubMed as a standard bibliographic database was performed through February 2015 using the keywords "Yoga" and "Cardiovascular." Studies with Yoga as the independent variable and parameters related to cardiac health as the dependent variable were included and exclusion criteria were applied. RESULTS: A total of 149 publications were identified which met the inclusion criteria for analysis. Of the total publications, 44% were clinical trials of which 19% were randomized controlled trials which may be categorized as high-quality ones. An upward trend in the overall research in this area is evident. Major work has been accomplished by researchers of the United States (38%) and India (29%). CONCLUSION: The survey indicates that the number of publications in the field of "Yoga" and "Cardiovascular" health has increased rapidly in the late years. Analysis comprising the nation/state helps define its status with regard to its counterparts and helps understand science priorities and disease control strategies in an effort to provide cost-effectiveness and quality control. There is a need for further high-quality studies in the field of "Yoga" and "Cardiovascular" diseases to validate the effects of Yoga on health parameters.

Effect of high altitude on sensitivity to the taste of phenylthiocarbamide.

Sensitivity to the taste of phenylthiocarbamide (PTC) was studied using the Harris-Kalmus method in healthy human volunteers at sea level and then subsequently at an altitude of 3500 m over a period of 3 weeks, after which they were brought back to sea level. Blood sugar, insulin and blood cortisol levels were estimated weekly. The results indicated that, out of 51 subjects studied, 26 (55%) were PTC tasters at sea level. Eight of those unable to taste PTC at sea level tested as tasters at high altitude, and 2 of them reverted to being non-tasters on return to sea level. In the blood, an increase in cortisol and blood insulin levels was seen without any significant change in sugar levels. All the changes recorded at high altitude tended to return to basal values after re-induction to sea level. The study suggests that high-altitude hypoxia in some way, possibly involving changes in hormonal profile among other factors, causes an alteration in sensitivity to the taste of PTC, resulting in some of the individuals shifting to lower PTC sensitivity.

Sambucus nigra linn., a new record from valley of flowers.

Under the present paper, authors have reposted finding of Sambucus nigra L. as new introduction in medicinal plans in the flora of "Valley of flowers'. Sambucus nigra L. Originally is an European plant and is very important for its medicinal potential, being used in various systems of medicine to cure number of ailments. In natural order Sambucus nigra L. belongs to family caprifoliaceae.

High altitude effects on human taste intensity and hedonics.

BACKGROUND: The study was conducted on human volunteers taken to 3500 m altitude for a period of 3 wk. METHODS: Subjects rated four compounds representing sweet, salty, sour and bitter taste, and the hedonic matrix in terms of taste threshold, taste intensity, and taste hedonicity were recorded using category scale. Blood sugar levels were estimated weekly. RESULTS: An increase in the taste thresholds for glucose and sodium chloride was shown while quinine sulphate and citric acid thresholds recorded a decrease. The taste intensity ratings showed a linear relationship with increasing logarithmic molar concentrations of each solution, as compared with taste hedonicity which showed an inverted 'U' type function. The blood picture did not reveal any change in the blood sugar level. All the parameters recorded at high altitude (HA) showed a tendency to return to basal values after reinduction to sea level. CONCLUSION: The study suggests that HA hypoxic stress brings about changes in the hedonic responses, primarily an increased palatibility for sweetness; we speculate that the mechanism may be anorexia-linked nutritional stress.

Hypobaric hypoxia and hedonic matrix in rats.

This study was carried out to evaluate the effect of continuous exposure to hypobaric hypoxia on the feeding behavior and taste responses of rats, under simulated conditions of a high altitude (HA) of 7,620 m for 21 h a day and consecutively for 18 d, which more closely resembles actual field conditions. Their food, water intake and body weight were recorded daily, and blood sugar was estimated once a week. All the parameters were recorded for a period of 18 d each, before, during, and after exposure to simulated HA. The results show a decrease in daily food and water intake and body weight, and mild hypoglycemia during hypoxic exposure. Single-bottle and two-bottle tests showed a preference for sweet solutions over water, citric acid, sodium chloride, and quinine sulfate during exposure. The two-bottle test showed a preference for glucose over calorically-inert saccharine. The continuous exposure in this study produced qualitatively similar but quantitatively accentuated results as compared to intermittent 6 h exposure contiguously for 21 d. High-altitude stress appears to influence food intake such that sensory cues assume greater significance during feeding behavior.

Ontogeny of taste sense.

Developmental changes in the taste receptors and CNS, in physiological and behavioural patterns in fetus and postnatal animals constitute the ontogeny of taste. Tongue epithelial cells are modified into taste buds only with innervation and are seen to degenerate on denervation. On removal of a portion of the tongue, with its taste buds, the central projections of gustation also atrophy, indicating an interdependence of taste receptors and central areas for their development. Gradual transitions in electrical responses to taste stimuli are shown from fetal to adult stage. While responses to ammonium chloride are marked in early fetus, with advancements in age responses to a wide variety of chemicals are shown. Again, early in the development, fibers responsive to chloride are predominant while at a later stage fibers responsive to sodium increase in number. Behaviourally, human fetus and neonatal mammals showed increased swallowing movements on sweet taste and decreased movements on bitter taste which is somewhat at variance with electrophysiological evidence and reflects on the multimodal involvement of taste cell functional and behavioural dynamics with age.

Electroacupuncture, morphine and clonidine: a comparative study of analgesic effects.

This is a comparative study of the analgesic effects of the modified traditional method of analgesia, electroacupuncture (EA), a standard analgesic drug, morphine, a potential analgesic drug, clonidine and the combination of EA + morphine and EA + clonidine. In each case, the index of analgesia (IA) was determined by recording the tail flick latency (TFL) in 60 rats divided into 6 groups of 10 rats each. Group I rats served as control group while Group II-VI were subjected to EA for 20 min (at Zusanli and Kunlun points), morphine (5 mg/kg bw i.p.), clonidine (150 micrograms/kg bw i.p.), EA + morphine and EA + clonidine respectively. TFLs were recorded after the procedure and at 10 min intervals for 150 min or til the TFL returned to¿ the baseline. The IA, analyzed using the Kruskal-Wallis test and its significance determined by multiple comparison test (at 5% level), was found to be significantly different, at various time intervals, in the 6 groups studied.

Effect of high-altitude hypoxia on feeding responses and hedonic matrix in rats.

Albino male rats (n = 78) were exposed to a simulated high altitude (HA) equivalent to 7,620 m for 6 h daily, contiguously for a period of 21 days, to study their feeding behavior and gustatory responses. Their food, water intake, and body weight were recorded daily, and blood sugar and blood insulin were estimated once a week. All the parameters were recorded for a period of 3 wk each before, during, and after exposure to simulated HA. The results show a decrease in daily food and water intakes and body weight and mild hyperglycemia and hyperinsulinemia during hypoxic exposure. The 1-h single-bottle taste solution test showed a preference for sweet solutions (13% glucose and 0.2% saccharine) over citric acid (0.16%), sodium chloride (0.9%), and quinine sulfate (0.001%) during exposure to simulated HA. The 1-h two-bottle test containing glucose (calories plus taste) and saccharine (taste but no calories) administration showed a preference for the glucose solution over the saccharine solution. The trend of the 1-h intake of all test solutions also showed a reversal to preexposure levels after termination of HA hypoxia. It would appear that high-altitude stress influences food intake in a manner that sensory cues (e.g., preference for sweet substances) become more important.

Airway functions in pregnant Indian women.

The airway functions in pregnancy have been widely studied but reports obtained from Western and Indian population show divergence. While the Indian populations show significant changes in total and timed vital capacity (FVC and FEV1), the Western counterparts dismiss such changes as insignificant. Our results show insignificant alteration in airway function and support the results reported for Western population.

Urinary bladder serosal chemoreceptor induced cardio-respiratory responses: possible pathway.

There is limited experimental information about pain originating from the urinary bladder. In the present study application of 3-5 ml of 1% ammonium oxalate, 1% potassium chloride, 100m M citric acid, IM ammonium chloride, 1% oxalic acid, 0.5% sodium hydroxide, or 2 micrograms/ml bradykinin, to the serosal surface of the urinary bladder in anaesthetized dogs, resulted in an increase in heart rate, rise of both systolic and diastolic blood pressures and increase in respiratory rate and depth. These facilitatory cardio-respiratory responses were coupled with powerful contractions of the urinary bladder wall. By contrast, mucosal application of the chemicals did not bring about any significant change. The cardio-respiratory responses obtained were completely abolished on serosal application of procaine (1%), section of the hypogastric nerves or by spinalectomy at T8. Bilateral cervical vagotomy and pelvic nerve section did not modify the responses. However, the blood pressure responses were abolished by the administration of tolazoline hydrochloride, indicating a major role of sympathetics in this nociceptive reflex.

Taste impairment for glucose in diabetic PTC tasters and non-tasters.

Effect of high blood glucose levels in diabetes mellitus was studied on gustatory responses to glucose in PTC tasters and non-tasters, before and after the ingestion of a glucose solution. After a 12-h overnight fast, prescreening for phenylthiocarbamide (PTC) sensitivity was done in each subject, and then each subject tasted, and rated, 7 concentrations of glucose solutions for intensity and hedonic responses. Blood glucose levels were also determined under fasting and then after a 100-g glucose load. A decrease in palatability of the glucose solutions induced by the glucose load (negative alliaesthesia) was evident in both groups of subjects. Tasters showed higher hedonic ratings (Mean 4-25), as compared to non-tasters (Mean 3-70) and this difference was more evident after the glucose load in non-tasters.

Morphine-induced modulation of sciatic nerve stimulation evoked blood pressure responses.

Effect of i.v. morphine (1-2 mg/kg) on blood pressure changes evoked by sciatic nerve stimulation (SNS) were studied in chloralose anaesthetised cats. SNS gave a depressor, pressor or a biphasic BP response generally linked to the parameters of stimulation. Morphine produced marked attenuation of depressor and some facilitation of pressor response, suggesting a possible reciprocal relationship between depressor and pressor responses. Depressor response has been correlated with deep tissue or visceral pain mediated through A delta fibres and pressor response to cutaneous nociception involving C fibres or non nociceptive input via group II fibres. Involvement of medullary regions in differential modulation of these depressor and pressor response has been suggested.

Changes in the responses of the neurons of the sensorimotor cortex to stimulation of the hunger centre of the lateral hypothalamus.

The responses of sensorimotor cortical neurons in hungry and in fed rabbits to stimulation of the lateral hypothalamic (LH) hunger centre were studied in the presence and absence of food. It was found that in the absence of food the response of the sensorimotor cortical neurons to LH stimulation differed between hungry and fed animals. No changes in firing rate were observed in 50% of neurons in hungry rabbits, and firing was inhibited in 45% of neurons in fed animals. Feeding reinforcement changed the nature of neuronal responses to LH stimulation. Qualitative changes in the responses to LH stimulation were observed in 77% of neurons in hungry rabbits, and in 61% of neurons in fed rabbits. Most neurons increased their rate of firing both in hungry and in fed animals.