Raj Kumar Yadav

Efficacy of a Short-Term Yoga-Based Lifestyle Intervention in Reducing Stress and Inflammation: Preliminary Results

OBJECTIVES Previously it was shown that a brief yoga-based lifestyle intervention was efficacious in reducing oxidative stress and risk of chronic diseases even in a short duration. The objective of this study was to assess the efficacy of this intervention in reducing stress and inflammation in patients with chronic inflammatory diseases. DESIGN This study reports preliminary results from a nonrandomized prospective ongoing study with pre-post design. SETTING/LOCATION The study was conducted at the Integral Health Clinic, an outpatient facility conducting these yoga-based lifestyle intervention programs for prevention and management of chronic diseases. SUBJECTS Patients with chronic inflammatory diseases and overweight/obese subjects were included while physically challenged, and those on other interventions were excluded from the study. INTERVENTION A pretested intervention program included asanas (postures), pranayama (breathing exercises), stress management, group discussions, lectures, and individualized advice. OUTCOME MEASURES There was a reduction in stress (plasma cortisol and β-endorphin) and inflammation (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) at day 0 versus day 10. RESULTS Eighty-six (86) patients (44 female, 42 male, 40.07 ± 13.91 years) attended this program. Overall, the mean level of cortisol decreased from baseline to day 10 (149.95 ± 46.07, 129.07 ± 33.30 ng/mL; p=0.001) while β-endorphins increased from baseline to day 10 (3.53 ± 0.88, 4.06 ± 0.79 ng/mL; p=0.024). Also, there was reduction from baseline to day 10 in mean levels of IL-6 (2.16 ± 0.42, 1.94 ± 0.10 pg/mL, p=0.036) and TNF-α (2.85 ± 0.59, 1.95 ± 0.32 pg/mL, p=0.002). CONCLUSIONS This brief yoga-based lifestyle intervention reduced the markers of stress and inflammation as early as 10 days in patients with chronic diseases; however, complete results of this study will confirm whether this program has utility as complementary and alternative therapy.

Adiponectin, Interleukin-6, and Cardiovascular Disease Risk Factors Are Modified by a Short-Term Yoga-Based Lifestyle Intervention in Overweight and Obese Men

OBJECTIVE To investigate the effect of a short-term yoga-based lifestyle intervention on risk factors for cardiovascular disease (CVD) and markers of inflammation and endothelial function in overweight and obese men. DESIGN Nonrandomized prospective lifestyle intervention study with pre-post design. SETTING AND LOCATION: Integral Health Clinic, an outpatient facility providing yoga-based lifestyle intervention programs for prevention and management of chronic diseases. SUBJECTS Overweight and obese men (n=51) were enrolled in the study. Subjects who were physically unable to participate and those participating in other interventions were excluded from the study. INTERVENTION A pretested intervention program including asanas (physical postures), pranayama (breathing exercises), group discussions, lectures, and individualized advice. OUTCOME MEASURES The primary outcome measure was weight loss, and the secondary outcome measures were clinical and laboratory correlates of CVD risk, levels of interleukin-6 (IL-6), adiponectin, and endothelin-1 (ET-1). RESULTS Men (n=51, body mass index [BMI] 26.26±2.42 kg/m(2)) were enrolled and underwent a yoga-based lifestyle intervention for 10 days. Of 51 subjects, 30 completed the study. There was a significant reduction in weight from Baseline to Day 10 (74.60±7.98, 72.69±8.37 kg, p<0.001, respectively), BMI (26.26±2.42, 25.69±2.47 kg/m(2), p<0.001, respectively), and systolic BP (121.73±11.58, 116.73±9.00, p=0.042, respectively). There was a significant reduction in plasma IL-6 from Baseline to Day 10 (median 2.24 vs. 1.26 pg/mL, respectively, p=0.012). There was a significant increase in the plasma adiponectin from Baseline to Day 10 (median 4.95 vs. 6.26 μg/mL, respectively, p=0.014). Plasma ET-1 level remained unchanged. CONCLUSION These findings suggest that even a short-term yoga-based lifestyle intervention may be an important modality to reduce the risk for CVD as indicated by weight loss, reduction in systolic blood pressure, an increase in adiponectin, and decrease in IL-6 in overweight and obese men.

A comprehensive study of autonomic dysfunction in the fibromyalgia patients

ObjectivesThe hypothesis of autonomic nervous system involvement in pathophysiology in the patients with fibromyalgia has been addressed and tested time and again but the existing reports are both contradictory and inconclusive. A complete knowledge of the degree of autonomic dysfunction in fibromyalgia patients would be more substantial. We conducted a comprehensive non-invasive study to investigate the complete autonomic profile of female patients with fibromyalgia.MethodAn autonomic function test using a standard battery and heart rate variability analysis in the 42 fibromyalgia patients as well as 42 age matched healthy controls was performed. Both autonomic activity (tone) and reactivity were measured. Autonomic tone (both time and frequency domain parameters) was measured using heart rate variability (HRV) analysis. Autonomic reactivity was measured using a standard battery of autonomic function tests.ResultsResting blood pressure (both systolic and diastolic) was significantly higher in the fibromyalgia patients than controls. The time domain variables and HF% as recorded by HRV were significantly lower in the patients than the controls. The autonomic reactivity for sympathetic and parasympathetic nervous system was found to be within normal limits.InterpretationThe cardiac autonomic function is normal and the autonomic reflex arc seems to be intact in the patients with fibromyalgia.

Peritoneal fluid leptin levels are increased but adiponectin levels are not changed in infertile patients with pelvic endometriosis

Objective. Endometriosis is a leading cause of infertility, and recent studies suggest that leptin and adiponectin may have a role in its causation and progression. This study assessed levels of leptin and adiponectin in serum and peritoneal fluid (PF) in patients with endometriosis and infertility. Design and setting. This cross-sectional study included women undergoing diagnostic and/or therapeutic laparoscopy for endometriosis with chief complaint of infertility. Following laparoscopy, patients diagnosed with endometriosis served as cases while patients with no endometriosis served as controls. Patients with polycystic ovarian syndrome, diabetes, thyroiditis and patients on prior therapy with danazol or leuprolide were excluded from the study. Leptin and adiponectin levels were analysed in blood and PF using commercially available ELISA kits. Results. Of the 50 patients (aged 22–41 years), 15 had endometriosis (cases) while 35 had no endometriosis (controls). The median PF leptin level was significantly higher in cases as compared to controls (27.7 vs. 15.6 ng/ml, p = 0.019), and this remained significant even when PF leptin was BMI-normalised (p = 0.004). However, median serum leptin and adiponectin levels remained comparable between the two groups. Conclusions. This study confirmed the role of PF leptin in causation and progression of endometriosis. However, this would have been definitive if healthy fertile females were included in this study.

A Short-Term, Comprehensive, Yoga-Based Lifestyle Intervention Is Efficacious in Reducing Anxiety, Improving Subjective Well-Being and Personality

Objective: To assess the efficacy of a short-term comprehensive yoga-based lifestyle intervention in reducing anxiety, improving subjective well-being and personality. Materials and Methods: The study is a part of an ongoing larger study at a tertiary care hospital. Participants (n=90) included patients with chronic diseases attending a 10-day, yoga-based lifestyle intervention program for prevention and management of chronic diseases, and healthy controls (n=45) not attending any such intervention. Primary Outcome Measures: Change in state and trait anxiety questionnaire (STAI-Y; 40 items), subjective well-being inventory (SUBI; 40 items), and neuroticism extraversion openness to experience five factor personality inventory revised (NEO-FF PI-R; 60 items) at the end of intervention. Results: Following intervention, the STAI-Y scores reduced significantly (P<0.001) at Day 10 (66.7 ± 13.0) versus Day 1 (72.5 ± 14.7). Also, positive SUBI scores (F1– F6) improved significantly (P<0.01) at Day 10 versus Day 1. Similarly NEO-FF PI-R scores improved significantly (P<0.001) at Day 10 versus Day 1. Control group showed an increase in STAI-Y while SUBI and NEO-FF PI-R scores remained comparable at Day 10 versus Day 1. Conclusions: The observations suggest that a short-term, yoga-based lifestyle intervention may significantly reduce anxiety and improve subjective well-being and personality in patients with chronic diseases.

Improvement in Sperm DNA Quality Following Simple Life StyleIntervention: A Study in Fathers of Children with Non-Familial SporadicHeritable Retinoblastoma

Introduction and objectives: Genomic integrity of gametes is important for birth of healthy offspring. As compared to ova the sperm is more susceptible to mutation due to limited DNA damage detection and repair mechanism. Life style habits adopted by father before conception may adversely affect genomic DNA integrity in male gametes. Oxidative stress damages sperm nuclear and mitochondrial DNA. Complementary and alternative medical therapies such as yoga/meditation are being increasingly used as adjuncts to modern medicine in treatment of several clinical conditions. Therefore, in this pilot study, we analyzed the effects of yoga and meditation on seminal oxidative stress and sperm DNA integrity in fathers of children with non-familial sporadic heritable retinoblastoma (Rb) after intervention (3 and 6 months). Methods: A total of 10 men (father of children with sporadic non-familial Rb) were recruited in this study. Semen samples were collected at base line (day 0), 3 months and after 6 months of yoga practice. Reactive oxygen species (ROS), DNA fragmentation index (DFI) and 8-hydroxy-2’-deoxyguanosine (8-OHdG) levels were estimated at day 0.3 months and 6 months interval. Results: There was reduction in mean DFI levels [p>0.05] at 3 months and 6 months [p 0.05] 6 months [p<0.05] with respect to the base line levels (day 0). Conclusions: Yoga/meditation significantly lowers oxidative stress and oxidative nuclear DNA damage, and levels of the mutagenic base 8OHdG. Thus yoga and meditation are simple life style interventions which are therapeutic for maintaining/restoring sperm DNA integrity

Interleukin-6, vitamin D & diabetes risk-factors modified by a short-term yoga-based lifestyle intervention in overweight/obese individuals.

Background & objectives: Several diabetes prevention programmes have demonstrated a reduction in incidence of diabetes in individuals with prediabetes through weight loss. Short-term yoga-based lifestyle intervention programmes have also been shown to be efficacious in weight loss. This study was undertaken to investigate if interleukin (IL)-6, vitamin D, neopterin, vaspin, and diabetes risk factors can be modified by a short-term yoga-based lifestyle intervention in overweight/obese subjects. Methods: In this pilot study, 34 overweight/obese [body mass index (BMI) ≥23 to <35 kg/m2 per Asian cut-off values] individuals were enrolled, and received directly supervised intervention for 10 days. Thereafter, they were advised to follow this yoga-based lifestyle at home for one month, and were reassessed for study variables at day 30. Results: There was a reduction from baseline to day 10 in weight (P<0.001), BMI (P<0.001), waist/hip-ratio (P<0.05), blood glucose (P<0.01), and a significant improvement in lipid profile. There was a decrease in median fasting insulin (P<0.05), homeostatic model assessment-insulin resistance (P<0.01), and IL-6 (P<0.05). A non-significant increase in 25-OH-vitamin D, and a decrease in neopterin and vaspin were observed. Twenty subjects returned for follow up assessments. At day 30, weight loss was sustained while systolic blood pressure also showed reduction (P<0.05). Changes in vitamin D levels were significantly and negatively correlated with changes in weight, BMI and fasting blood glucose, and positively with change in high density lipoprotein. Changes in body weight and BMI significantly and positively correlated with insulin. Changes in IL-6 levels positively and significantly correlated with change in neopterin levels. Interpretation & conclusions: The findings showed that IL-6, vitamin D, and diabetes risk factors were favourably modified by a short-term yoga-based lifestyle intervention in obesity. This study also highlighted the challenges in compliance associated with the follow up of subjects following an aggressive supervised intervention of 10 days.

Distinct peritoneal fluid ghrelin and leptin in infertile women with endometriosis and their correlation with interleukin-6 and vascular endothelial growth factor.

Abstract Objective: The objective of the present study was to evaluate the levels of leptin, ghrelin, interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in peritoneal fluid in patients with endometriosis and infertility, and study their correlation. Design and setting: This cross-sectional study included women undergoing diagnostic and/or therapeutic laparoscopy for endometriosis with chief complaint of infertility and/or pain at a tertiary care hospital. Based upon laparoscopic and histopathological findings, patients were categorized as with endometriosis and no endometriosis. Of the 50 patients with infertility (age 23–41 years), 19 had endometriosis while 31 had no endometriosis. The markers were assessed using ELISA kits. Results: The median levels of leptin in patients with endometriosis (10.20 ng/mL) were higher (p = 0.04) and median levels of ghrelin in patients with endometriosis (150.4 pg/mL) were lower (p = 0.037) versus patients with no endometriosis (5.07 ng/mL and 229.6 pg/mL, respectively). The median levels of IL-6 and VEGF in patients with endometriosis were not different between the groups. The correlation analyses showed that leptin levels and IL-6 were positively correlated (p = 0.0001). Conclusions: The results suggest that ghrelin and leptin might play a key role in pathophysiology of endometriosis, and leptin is associated with inflammation in endometriosis. Chinese abstract 目的：本研究的目的是测定子宫内膜异位症合并不孕患者瘦素，生长激素释放肽，白介素-6（IL-6）和血管内皮生长因子（VEGF）的水平，并研究它们的相关性。 设计：横断面研究纳入了那些因不孕和/或疼痛为主诉而在三级医院行诊断和/或治疗性腹腔镜手术的子宫内膜异位症不孕患者。根据腹腔镜手术及病理组织学结果，患者被分为子宫内膜异位症患者和非子宫内膜异位症患者。50例不孕患者（年龄23-41岁）中，19例有子宫内膜异位症，而31没有子宫内膜异位症。该标记用ELISA试剂盒。 结果：与非子宫内膜异位患者瘦素和生长素水平（分别5.07 ng / mL和229.6皮克/毫升）相比，子宫内膜异位患者瘦素的平均水平（10.20毫微克/毫升）较高（P = 0.04），生长素平均水平（150.4皮克/毫升）较低（P = 0.037）。而IL-6和VEGF的平均水平两组之间无明显差异。相关分析表明，瘦素与IL-6呈正相关（P = 0.0001）。 结论：研究结果显示，生长激素释放肽和瘦素可能在子宫内膜异位症的病理生理中发挥关键作用，瘦素与子宫内膜异位症炎症相关。

Effect of Low-Dose Amitriptyline on Autonomic Functions and Peripheral Blood Flow in Fibromyalgia: A Pilot Study

OBJECTIVE Amitriptyline (10-50mg) is the most common drug prescribed for the treatment of fibromyalgia. Amitriptyline influences the autonomic nervous system, as is well known; fibromyalgia is also associated with dysautonomia. The present preliminary study was designed to observe the effects of amitriptyline prescribed in a low dose (10mg) on the autonomic function tests and blood flow measurements in well-diagnosed patients with fibromyalgia. METHODOLOGY Amitriptyline (10mg) was prescribed for 3 months to 21 female patients with fibromyalgia. A standard battery of noninvasive autonomic function tests comprising of lying to standing test, hand grip test, cold pressor test, deep breathing test, and Valsalva maneuver was performed both before and after amitriptyline therapy to study the autonomic reactivity of the patients with fibromyalgia. Heart rate variability analysis was done to quantify autonomic tone (activity). Blood flow measurement around the knee joint was performed using impedance plethysmography technique. The patients were also assessed for 10 major clinical symptoms of primary fibromyalgia and state and trait anxiety (state and trait anxiety inventory) at both instances. RESULTS No significant changes in autonomic activity (tone) and reactivity were observed after amitriptyline therapy. Clinical symptom score and anxiety scores (both state and trait) decreased significantly from the pretreatment values. Blood flow measurement showed significant improvement in blood flow index values at the affected sites after amitriptyline therapy. CONCLUSION Amitriptyline therapy (10mg for 3 months) increases blood flow to the affected sites. It does not affect autonomic tone and reactivity in the patients with fibromyalgia.

Hemodialysis Patients Treated for Hepatitis C Using a Sofosbuvir-based Regimen

Introduction There is paucity of data on sofosubvir (SOF)−based therapy in patients on maintenance hemodialysis (MHD). The objective of this report is to describe our experience using SOF-based direct antiviral agent (DAA) therapy in MHD patients in India. Methods All patients on MHD and treated with SOF-based therapy were included in this study. Before starting treatment, viral load, genotype, liver fibroscan, and upper gastrointestinal endoscopy were performed in all patients. SOF 400 mg/d or on an alternate day, ribavirin 200 mg/d and daclatasvir 60 mg/d were used in different regimens. Hepatitis C virus RNA was assessed at day 10 and at 4 weeks, at end of therapy, and at 12 weeks after stopping therapy. Results A total of 62 treatment-naïve patients were included. Mean age was 33.3 ± 10.2 years; 66% were men. Median number of copies were 106/dl. None had clinical evidence of cirrhosis. The most common genotype was genotype 1 in 64.5% of cases, followed by genotype 3 in 29% of cases. Thirty-nine patients were treated with SOF every other day/ribavirin, 2 patients with SOF daily/ribavirin, 6 with SOF every other day/daclatasvir, and 15 patients with SOF daily/daclatasvir. All patients were treated for 12 weeks. Fifty-nine (95.2%) patients had a sustained viral response (SVR). There was no impact of genotype on SVR. Twenty-three patients (37%) had complications while on therapy; 13 (20.3%) had dyspepsia, 4 had tuberculosis, and 3 had bacterial pneumonia. Most of the patients (n = 23; 56%) in the ribavirin group required an increase in the erythropoietin dose. No patient discontinued therapy due to complications. Discussion SOF-based DAAs were well tolerated and efficacious in this cohort of patients on MHD.