Neeta Kumar

Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam) had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program. Standard therapy included dietary advice, brisk walking for 45 min daily, and administration of oral antidiabetic drugs. Comprehensive yogic breathing program was introduced to the participants through a course of 12 h spread over 3 days. It was an interactive session in which SKY, a rhythmic cyclical breathing, preceded by Pranayam is taught under the guidance of a certified teacher. Cardiac autonomic function tests were done before and after 6 months of intervention. Results: In the intervention group, after practicing the breathing techniques for 6 months, the improvement in sympathetic functions was statistically significant (P 0.04). The change in sympathetic functions in the standard therapy group was not significant (P 0.75). Parasympathetic functions did not show any significant change in either group. When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P 0.06). In the standard therapy group, no change in cardiac autonomic functions was noted (P 0.99). Conclusion: Cardiac autonomic functions improved in patients with diabetes on standard treatment who followed the comprehensive yogic breathing program compared to patients who were on standard therapy alone.

Comprehensive yogic breathing program improves quality of life in patients with diabetes.

Objective: To assess the effect of a comprehensive yogic breathing program on glycemic control and quality of life (QOL) in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Patients having HbA1c between 6 and 9% for at least 3 months with lifestyle modification and oral antidiabetic medication were included. They were followed-up and randomized at 6 months into two groups: one group receiving standard treatment of diabetes and the other group receiving standard treatment of diabetes and taught and told to regularly practice the comprehensive yogic breathing program (Sudarshan Kriya Yoga and Pranayam). Change in fasting and post-prandial blood sugars, glycated hemoglobin and QOL as assessed by the World Health Organization QOL WHOQOL BREF questionnaire were assessed. Results: There was a trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group following standard treatment alone, although this was not significant. There was significant improvement in physical, psychological and social domains and total QOL post-intervention in the group practicing the comprehensive yogic breathing program as compared with the group following standard treatment alone. Conclusion: There was significant improvement in the QOL and a non-significant trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group that was following standard treatment alone.

Prevalence of Hypertension and Determination of Its Risk Factors in Rural Delhi

Introduction. Hypertension is an important public health challenge in both economically developing and developed countries. It is one of the risk factors for cardiovascular mortality. Data is available on hypertension in urban population but few studies are reported in rural areas. Materials and Methods. It was a community based cross-sectional study conducted in two rural areas in Delhi among 1005 subjects selected using systematic random sampling method. WHO STEPS approach was used to collect data. Blood pressure, body mass index, and blood sugar were measured. Data analysis was done using SPSS version 16. Odds of hypertension among subjects with risk factors were calculated. p value less than 0.05 was considered significant. Results. The prevalence of hypertension was 14.1% among study subjects. Hypertension was significantly higher in individuals more than 35 years than those less than 35 years. Hypertension was significantly higher in those who take alcohol and in subjects with raised total cholesterol level but in multivariate analysis only age, education, and cholesterol levels were independently associated with hypertension. Conclusion. There is significant burden of hypertension in rural areas in Delhi. Age, education, and cholesterol levels were independent risk factors of hypertension.

Role of oxidative stress while controlling iron deficiency anemia during pregnancy - Indian scenario

Iron Deficiency anemia ranks 9th among 26 diseases with highest burden. Asia bears 71% of this global burden. Adverse maternal and birth outcome associated with hemoglobin status renders the issue worth attention. Indian scenario has worsened over the period despite continuous international and national efforts. This indicates some lacunae in the approach and strategies applied. Various reports state that even with maximum effort to increase outreach and monitoring for adherence to Iron schedule, consumer’s compliance remains abysmally low. Recent studies has pointed out biological basis of side effects (gastrointestinal complains and systemic events) as raised oxidative stress for which iron is the key catalyst. Up till now the only target of research has been to raise hemoglobin of pregnant women above 11gm/dl. With the reports of pregnancy specific morbidities i.e. hemorrhage and septicemia with low hemoglobin, eclampsia, small for gestation age, gestational diabetes with higher ranges of hemoglobin, alarm is raised to define optimum range. Use of oxidative stress as biochemical marker with different doses and schedules has been defined because India lack information for its own population upon oxidative stress status when iron is supplemented as per current guidelines. Studies done in India and abroad have defined that too much and too less, both may raise oxidative stress and studies of this sort may provide biochemical scale for optimization. This review therefore has evaluated currently available Indian research and reports to understand the need of future research area. Important findings from other countries have been incorporated for comparison.

Awareness, Practices and Treatment Seeking Behavior of Type 2 Diabetes Mellitus Patients in Delhi

Background: Type 2 diabetes mellitus is a multisystem disorder that is associated with number of complications. Patient’s awareness and practices are crucial components in reducing the burden of diseases and its complications. Aim: To assess patient’s knowledge about their disease and its complications, practices, treatment seeking behavior and average expenditure incurred by its management. Subjects and Methods: A community based cross sectional study was conducted in rural and urban slum areas of Delhi selecting a total of 98 diabetic patients diagnosed during the two community surveys and interviewed using pretested and predesigned questionnaire. Data were analyzed using SPSS software, version 17 (Chicago II, USA). Chi square, fisher or Mann–Whitney tests were used for test of significance and considered statistically significant at P < 0.05. Results: Of 98 participants, 31.6% (31/98) were from urban slum area, and 68.4% (67/98) were from the rural area. In both urban and rural areas, majority were Hindu, married, literate and unemployed. Significantly less subjects (61.3%, 19/31) of urban slum area than of rural area (85.1%, 57/67) could name at least one complication of DM (P < 0.01, odds ratio [OR] =3.6, 95% confidence interval [CI] =1.3–9.6). Majority of participants in both urban slum and rural area have knowledge about at least one component of management but significantly lesser in urban (83.9%, 26/31) than rural area (97.0%, 65/67) were reported (P = 0.02, OR = 6.2, 95% CI = 1.1–34.2). Significantly more subjects (29.0%, 9/31) in urban slum area than rural areas (7.5%, 5/67) reported that they were not taking any treatment for DM (P < 0.01, OR = 0.2, 95% CI = 0.1–0.6). In urban area, 32.2% (10/31) patients told that it is a burden on their family while in rural area 44.7% (30/67) of the patients told that they have to squeeze money from the family expenditure to afford drugs. Conclusion: Patients need to be made aware of the asymptomatic phase of DM and its long term complications. At the same time, efforts should be made to sensitize them about the importance of taking regular treatment and management.

Weekly iron folic acid supplementation plays differential role in maintaining iron markers level in non-anaemic and anaemic primigravida: A randomized controlled study

Anaemia during pregnancy is most commonly observed and highly prevalent in South-East Asia. Various effective programmes have been laid down for its management, mainly daily supplementation of iron folic acid (IFA) tablets. Following the same, standard obstetrical practice has included the IFA supplementation without requiring the determination of iron deficiency. In this study, a total of 120 primigravida (N = 60; non-anaemic (Hb > 11 g/dl) and N = 60 anaemic (Hb = 8–11 g/dl)) were selected among those attending the Antenatal Clinic in Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. They were supplemented with daily and weekly IFA tablets till 6 weeks postpartum. Corresponding changes in haemoglobin level on advance of pregnancy, side effects and compliance associated with daily and weekly IFA supplementation and its associations with iron status markers were studied. The inflammatory markers were also estimated. The statistical significance level (p < 0.05) between the groups were assessed by applying unpaired t-test using SPSS (version 16.0). The obtained results publicized the salutary role of daily IFA supplementation in improving the haemoglobin level and iron status markers in anaemic pregnant women though the levels could not reach up to the non-anaemic haemoglobin levels. However, weekly IFA supplementation seems to be a better approach in non-anaemic pregnant women where almost comparable results were obtained in terms of haematological parameters, gestation length and birth weight. Conclusion Weekly IFA supplementation found to be as effective as daily supplementation in iron sufficient non-anaemic pregnant women whereas anaemic pregnant women should be prescribed daily IFA supplementation irrespective of iron replete/deplete state.

Differential Iron Status and Trafficking in Blood and Placenta of Anemic and Non-anemic Primigravida Supplemented with Daily and Weekly Iron Folic Acid Tablets

Abstract The molecular mechanism of iron transfer across placenta in response to maternal anemic status/ iron supplementation is not clear. We hypothesized that maternal iron/ anemia status during early trimesters can be utilized as a biomarker tool to get estimates of placental iron status. Early interventions can be envisaged to maintain optimum placental/ foetal iron levels for healthy pregnancy outcomes. One hundred twenty primigravida were recruited and divided into non-anemic and anemic group on the basis of hemoglobin levels. The groups were randomly allocated to receive daily and weekly iron folic acid (IFA) tablets till six weeks postpartum. Hematological and iron status markers in blood and placenta were studied along with the delivery notes. Weekly IFA supplementation in anemic primigravidas resulted in significantly reduced levels of hematological markers ( p < 0.01); whereas non-anemic primigravidas showed lower ferritin and iron levels, and higher soluble transferrin receptor levels ( p < 0.05). At baseline, C-reactive protein and cortisol hormone levels were also significantly lower in non-anemic primigravidas ( p < 0.05). A significantly decreased placental ferritin expression ( p < 0.05); and an increased placental transferrin expression was seen in anemic primigravidas supplemented with weekly IFA tablets. A significant positive correlation was observed between serum and placental ferritin expression in anemic pregnant women (r = 0.80; p < 0.007). Infant weight, gestational length and placental weight were comparable in both the supplementation groups. To conclude, mother’s serum iron / anemia status switches the modulation in placental iron transporter expression for delivering the optimum iron to the foetus for healthy pregnancy outcomes. Trial Registration Clinical Trial Registry-India: CTRI/2014/10/005135.

Tobacco Use and Its Association with Risk Factors of Non-Communicable Diseases in the Rural Areas of Delhi, India

Introduction: Tobacco use is one of the leading risk factors for global disease burden in all countries. Its association with non-communicable diseases (NCDs) is well documented; however, little is known about the relationship with other risk factors of NCD. Objectives: To find prevalence of tobacco use and its associated socio-demographic variables, other behavioral and metabolic risk factors of non-communicable diseases. Materials and Methods: It was a community-based cross-sectional study conducted in two rural areas in Delhi among 1005 subjects aged above 18 years selected using systematic random sampling method. WHO STEPS approach was used to collect data about socio-demography, tobacco and alcohol use. Blood pressure, body mass index, blood sugar and lipid profile were measured. Data analysis was done using SPSS version 16. Differences between groups were assessed using Chi-square test for their statistical significance. P value less than 0.05 was considered statistically significant. Results: The overall prevalence of current tobacco use was 11.1%. Out of 112, 107 (95.5%) subjects reported daily use of tobacco. The age of initiation of tobacco use was significantly lower among males than females (p<0.01). The mean number of bidi/cigarette consumed per day was significantly lower among females than males (p<0.01). Alcohol use was significantly higher in those with present tobacco use as compared to non-tobacco users (p<0.05). Proportion of subjects with hypertriglyceridemia was significantly higher among current tobacco users (35.7%) than non-users (20.2%) (p<0.05). A significantly higher percentage of tobacco users (18.8%) was underweight than non-users (9.3%) (p<0.05). Conclusion: There is significant burden of tobacco use in rural areas of Delhi. Male gender, age and occupation, hypertriglyceridemia and underweight were associated with tobacco use.

Determination of Prevalence of Type 2 Diabetes Mellitus by Screening Tests using a Mathematical Formula in Place of Invasive Blood Tests.

INTRODUCTION True prevalence rate of diabetes mellitus in a population can be obtained by using invasive tests but it is practically difficult on large scale. AIM To find out the feasibility of mass non-invasive screening test to detect the prevalence of diabetes mellitus in rural population of India with the help of a mathematical formula. MATERIALS AND METHODS From population of 18800 residing in two adjacent rural areas of Delhi, a systematic random sample of 1005 adult subjects was screened for diabetes by using urine benedicts test, Canrisk questionnaire, Madras Diabetes Research Foundation-Indian Diabetic Risk Score (MDRF-IDRS) and determined prevalence of diabetes (pA) gauzed by each of these screening tests. Simultaneously, each subjects glycaemic status was confirmed by standard fasting Plasma glucose (FPG) and postprandial plasma glucose (PPPG) levels. The blood test was also used to determine true prevalence which was cross-checked with the prevalence estimated (Pe) by the above stated screening tests using a mathematical formula. RESULTS The true prevalence of T2DM in more than 18 years of population by Fasting Plasma Sugar (FPS) was 4.5% while that by using mathematical formulae that estimated by urine test, Canrisk test and MDRF-IDRS was 4.4%, 4.4 and 4.3% respectively. When more than 35 years age-group was selected, true prevalence was 7.4% and estimated prevalence by Canrisk test was 7.1% (as against gold standard of Fasting) and 6.9% (as against PP). By fasting urine test it came out to be 7.2% and by PP urine test it was 7.4%. In population l8-35 years, the prevalence of diabetes was 1.1% by plasma glucose test. By using Canrisk, it came out to be 1.04%. CONCLUSION Individual screening tests such as urine, Canrisk and MDRF-IDRS can be used to estimate prevalence rates of diabetes in rural areas by means of mathematical formula which would be close to true estimates.

PS 15-15 HYPERTENSION: PREVALENT PRACTICES OF PREVENTION AND CONTROL IN THE RURAL COMMUNITY OF DELHI, INDIA

Objective: To know practices for hypertension prevention and control and related factors in the rural areas of Delhi. Design and Method: A community based study was conducted in two village areas in Delhi. A total of 1005 subjects were selected using systematic random sampling method. Study population was constituted by all people above 18 years of age residing in the two areas. Self reported history of hypertension was asked. Blood pressure was measured of all participants using standard procedure. Data was collected for prevalent practices of participants for prevention of hypertension. Those who were known cases of hypertension, data were collected about treatment seeking, compliance and practices for self management. Data analysis was done using SPSS version 16. Appropriate statistical tests were used and P value less than 0.05 was considered significant. The prior ethical clearance for the study was obtained from the institutional ethics committee. Results: Out of 1005 subjects, 504 (50.1%) participants reported that they got their blood pressure levels checked in past one year. 68 (6.8%) were known cases of hypertension in study population. Out of 68 known cases of hypertension, 52 (76.4%) used to follow less salt diet for hypertension management. Only 37 (54.4%) were taking allopathic medication for hypertension. Out of these 37, only 31 participants reported taking medications regularly. 74 (7.3%) subjects were newly diagnosed for hypertension during study, i.e., 14.12% (68+74) of the total population had hypertension. When asked about preventive practices followed for hypertension, out of 1005 participants, 46 (4.5%) reported that they take measures to control weight, 40 (3.9%) for smoking cessation and 25 (2.4%) said they do exercise. Conclusions: More than half of Hypertensives were not aware of their disease status and small proportions were doing preventive practices. Therefore community needs to be made aware of symptomatology, regular checkups, preventive and control measures of hypertension.