Bidita Khandelwal

Chlamydophila pneumoniae infection and cardiovascular disease

Atherosclerosis is a multifactorial vascular inflammatory process; however, the inciting cause for inflammation remains unclear. Two decades ago, Chlamydophila pneumoniae (formerly Chlamydia pneumoniae) infection was proposed as a putative etiologic agent. We performed a PubMed search using the keywords Chlamydia and atherosclerosis in a Boolean query to identify published studies on C. pneumoniae and its role in atherogenesis, and to understand research interest in this topic. We found 1,652 published articles on this topic between 1991 and 2011. We analyzed relevant published studies and found various serological, molecular, and animal modeling studies in the early period. Encouraged by positive results from these studies, more than a dozen antibiotic clinical-trials were subsequently conducted, which did not find clinical benefits of anti-Chlamydophila drug therapy. While many researchers believe that the organism is still important, negative clinical trials had a similar impact on overall research interest. With many novel mechanisms identified for atherogenesis, there is a need for newer paradigms in Chlamydophila-atherosclerosis research.

Fast foods and physical inactivity are risk factors for obesity and hypertension among adolescent school children in east district of Sikkim, India

Background: Obesity and hypertension among school children have a huge impact on public health. Hence, we estimated the prevalence and sociodemographic correlates of childhood obesity and elevated blood pressure (BP) among adolescent schoolchildren (11-19 years) in urban areas of Gangtok, Sikkim, India. Materials and Methods: A population based cross-sectional study was conducted on 979 school children, during November 1, 2009 - April 30, 2010 in Gangtok, East Sikkim India. Anthropometric measurements and BP were recorded among the study population. Obesity and hypertension prevalent among adolescent school children and their correlates were analyzed. Results and Conclusion: Prevalence of obesity, overweight, and hypertension was 2.04%, 14.5% and 5.62%, respectively. The average fast food intake, screen time and limited outdoor activities were significantly associated with obesity. Increase in abdominal height positively correlated with increase in body mass index and body fat; however waist — hip ratio was not a reliable index. The burden of overweight/obesity as well as hypertension with all its associated risk was found to high among our study population, which necessitates framing of policies and actions at national level to address the risk associated with these noncommunicable diseases.

Psycho-neuro-endocrine-immune mechanisms of action of yoga in type II diabetes

Yoga has been found to benefit all the components of health viz. physical, mental, social and spiritual well being by incorporating a wide variety of practices. Pathophysiology of Type II DM and co-morbidities in Type II DM has been correlated with stress mechanisms. Stress suppresses bodys immune system and neuro-humoral actions thereby aff ecting normal psychological state. It would not be wrong to state that correlation of diabetes with stress, anxiety and other psychological factors are bidirectional and lead to diffi culty in understanding the interrelated mechanisms. Type II DM cannot be understood in isolation with psychological factors such as stress, anxiety and depression, neuro-endocrine and immunological factors. There is no review which tries to understand these mechanisms exclusively. The present literature review aims to understand interrelated Psycho-Neuro-Endocrine and Immunological mechanisms of action of Yoga in Type II Diabetes Mellitus. Published literature concerning mechanisms of action of Yoga in Type II DM emphasizing psycho-neuro-endocrine or immunological relations was retrieved from Pubmed using key words yoga, Type II diabetes mellitus, psychological, neural, endocrine, immune and mechanism of action. Those studies which explained the psycho-neuroendocrine and immune mechanisms of action of yoga were included and rest were excluded. Although primary aim of this study is to explain these mechanisms in Type II DM, some studies in non-diabetic population which had a similar pathway of stress mechanism was included because many insightful studies were available in that area. Search was conducted using terms yoga OR yogic AND diabetes OR diabetic IN title OR abstract for English articles. Of the 89 articles, we excluded non-English articles (22), editorials (20) and letters to editor (10). 37 studies were considered for this review. The postulated mechanism of action of yoga is through parasympathetic activation and the associated anti stress mechanism. It reduces perceived stress and HPA axis activation thereby improving overall metabolic and psychological profiles, increasing insulin sensitivity, and improving glucose tolerance and lipid metabolism. Yoga has positive effects on immune system of diabetics.– Overall, Type II DM is influenced by psycho-neuro-endocrine and immune mechanisms where Yoga has important positive role in combating stressors and improving these systems to regain health.

Oxidative stress in inflammatory cells of patient with rheumatoid arthritis: clinical efficacy of dietary antioxidants

Rheumatoid arthritis (RA) is an autoimmune disease responsible for significant human morbidity in modern life. However, oxidative stress is one of the key markers for determining pathophysiology of patients with RA. The interaction between cellular immune system and body’s endogenous and/or exogenous antigens produce reactive oxygen species (ROS) and reactive nitrogen species (RNS) in autoimmune disease like RA. ROS and RNS include highly toxic superoxide (O2−) and peroxynitrite (ONOO−) radicals, which activate the signaling cascades of inflammatory cells to synthesize pro-inflammatory cytokines and chemokines. Previous studies reported that Th1 cytokines could promote the development of autoimmune disorders like RA, whereas the Th2 cytokines may attenuate the same diseases. An increased awareness of the relationship between food and health led to a tremendous increase of antioxidant research in the last decade. Evaluation of the efficacy of dietary antioxidants is also becoming highly acceptable in RA research. A number of dietary phytomolecules are already established as having antioxidant activity in isolated synovial cellular infiltrate or peripheral blood neutrophils and lymphocytes. This review aims to highlight the oxidative stress in inflammatory cells of patients with RA and to summarize the clinical relevance of dietary antioxidants as a first step in assessing beneficial effect, safety and dose safety ratio in patients with RA.

Effectiveness of short-term aerobic exercise program on cardiovascular risk profile in moderate risk adults: A randomized controlled pilot study

Background: According to World Health Report 2002, cardiovascular diseases (CVDs) will be the largest cause of death and disability by 2020 in India. In 2020, 2.6 million Indians are predicted to die due to coronary heart disease, which constitutes 54.1% of all CVD deaths. Nearly half of these deaths are likely to occur in young and middle-aged individuals (30-69 years). We undertook this study with objectives to evaluate the cardiovascular risk profile in asymptomatic individuals with moderate risk factors and to understand the effect of the short-term (3 weeks) exercise over cardiovascular risk factors. Materials and Methods: A randomized controlled trial was conducted with a total of 34 subjects comprising of 17 subjects in each group. Subjects underwent biochemical tests like fasting lipid (total cholesterol [TC], triglyceride, high-density lipoproteins [HDLs], low-density lipoproteins [LDLs]) and fasting blood glucose. Other outcome measures were VO 2 max, body mass index and body fat % (BF%). Results: This study suggested that 3 weeks of moderate intensity aerobic training has a beneficial effect in lowering the cardiovascular risk profiles in adults with moderate risk factors. This training reduced TC, improves HDL, reduced LDL and improved aerobic capacity by improving VO 2 max and reducing BF%.

Abdominal Palpation-An art in the Heart of Midwifery Practice to Determine Persistent Oblique Lie-A Rare Condition at Term Pregnancy

Persistent oblique lie is extremely rare and is frequently missed during antenatal care, despite the routine antenatal examination and obstetrics ultrasonography. An oblique lie is usually only transitory, however for either a longitudinal or transverse lie commonly result when labor supervenes. The main risk of an oblique lie is in association with preterm rupture of membranes and cord prolapsed. Abnormal lie of the fetus present the midwife with a challenge of recognition and diagnosis both in the antenatal period and during labour. The past obstetrical history and abdominal palpation may be of help. The assessment of fetal lie, position and presentation by abdominal palpation is a fundamental antenatal care skill, by which the midwife uses her hands to gently feel the position and presentation of the baby through the mothers abdomen, in order to assess which way the baby is lying in the uterus. The clinical purpose of this activity is to enable appropriate interventions to be offered and care to be planned. Here we report a rare case of persistent oblique breech with oligohydramnios and non progress of labour. This case report looks at how the art of midwifery is used as a cost effective method in screening the antenatal women at labour along with the use of sophisticated technology. Overdependence and abuse of ultrasound remains a problem and it should be emphasized that ultrasound is to complement and not a substitute to clinical judgment. The effects of ultrasound on the low-risk pregnancy need to be evaluated. The overuse of such technology can have detrimental effects, not only for the midwife but also for the woman in labour. While this technology has made a great impact in obstetric nursing.

A difficult case of subacromial bursitis in diabetes treated by steroid injection and physiotherapy combined with yoga

Subacromial injections of steroid when given accurately to the subacromial space followed by appropriate physiotherapy and yoga resulted in significantly reduced pain and increased functional outcomes in subacromial bursitis in a type II diabetes patient. Steroidal injections wherever indicated and if injected correctly into the subacromial space under proper sterile condition leads to enhanced healing, reduced pain, improved range of motion, and increased functional ability and return to work. In situations of doubt, ultrasonography (USG) or magnetic resonance imaging (MRI) can provide better insight to its pathology and site which in turn helps the clinician to take correct decisions about injection therapy, drug, and approach to be used. Inaccurately administered injections may delay the healing process and burden the patient further to undergo surgical intervention. It is better to use physiotherapy exercises and yoga asanas as adjuvant to enhance recovery and functions after injection therapy.