PRACTICE OF YOGA IN PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY ATTENDING A TERTIARY CARE HOSPITAL IN NORTHERN INDIA: IMPLICATIONS DURING CORONAVIRUS DISEASE-19 PANDEMIC

Objective: The objective of this study was to determine the prevalence of yoga practice in patients with Diabetic Peripheral Neuropathy (DPN) and to compare its acceptance among patients with chronic diseases other than DPN practicing non-yoga physical activities. Methods: A pre-formed structured questionnaire-based cross-sectional study was conducted with a total of 98 out of 240 patients screened recruited during face to face structured interview, with a diagnosis of DPN. Data on the socio-demographics, age, duration of disease, glycemic controls (hemoglobin A1C [HBA1C] levels), and pain scores, numbness, and physical activity and other comorbid illnesses were collected. Results: A total of 248 pre-diagnosed diabetic patients were screened; 98 study subjects (M: F=66:32) were enrolled with a mean age found to be 55.28 years. As diagnosed clinically and electrophysiologically, the prevalence of peripheral neuropathy was found to be 39.51%. The mean pain score was 3.27. Risk factors for peripheral neuropathy included male sex, advanced age, higher body mass index (%), higher HbA1C (n=67.34%), having a sedentary lifestyle (38.77%), overweight (43, 44.89%), and obesity (21, 21.42%) and <40% belong to the diabetes of duration group of more than 10 years. A total of 16, male: 9 and female: 5 (22.85%) out of 70 subjects were using yoga as physical activity in peripheral neuropathy group and of the control group (non-peripheral neuropathy group), only 8 (25%) out of 25 were doing yoga. The overall proportions were compared using Chi-square, results were non-significant with p=−0.49; Chi-square statistic −0.47. Conclusion: This implies that those with DPN are as likely to accept yoga as a physical activity compared to patients with other chronic illnesses practicing non-yoga physical activities

Complementary and alternative medicine for management of premature ejaculation: a systematic review and meta-analysis

Introduction: Premature ejaculation (PE) is defined as ejaculation within one minute (lifelong PE) or three minutes (acquired PE); inability to delay ejaculation; and negative personal consequences. Management includes behavioral and pharmacological approaches. Aim: To systematically review effectiveness, safety, and robustness of evidence for complementary and alternative medicine (CAM) in managing PE. Methods: Nine databases including MEDLINE were searched to September 2015. Randomized controlled trials (RCTs) evaluating CAM for PE were included. Outcome measures: Studies were included if they reported intra-vaginal ejaculatory latency time (IELT) and/or another validated premature ejaculation measure. Adverse effects were summarized. Results: Ten RCTs were included. Two assessed acupuncture, five Chinese herbal medicine, one Ayurvedic herbal medicine, and two topical “severance secret” (SS) cream. Risk of bias was unclear in all studies due to unclear allocation concealment or blinding, and only five studies reported stopwatch-measured IELT. Acupuncture slightly increased IELT over placebo in one study (mean difference [MD]=0.55 min, p=0.001). In another study, Ayurvedic herbal medicine slightly increased IELT over placebo (MD=0.80 min, p=0.001). Topical SS cream improved IELT over placebo in two studies (MD=8.60 min, p<0.001), though inclusion criteria were broad (IELT <3 min). Three studies comparing Chinese herbal medicine against selective serotonin reuptake inhibitors (SSRIs) favored SSRIs (MD=1.01 min, p=0.02). However, combination treatment with Chinese medicine plus SSRIs improved IELT over SSRIs alone (two studies, MD=1.92 min, p<0.00001) and over Chinese medicine alone (two studies, MD=2.52 min, p<0.00001). Adverse effects were not consistently assessed, but where reported were generally mild. Conclusions: There is preliminary evidence for effectiveness of acupuncture, Chinese herbal medicine, Ayurvedic herbal medicine and topical SS cream in improving IELT and other outcomes. However, results are based on clinically heterogeneous studies of unclear quality. There is little data on adverse effects or potential for drug interactions. Further well-conducted RCTs would be valuable

Protocol of systematic reviews on implementation research on cardiovascular diseases, diabetes mellitus and mental ailments in India [version 2; peer review: 2 approved]

Introduction The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success. Objective The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India. Materials and methods Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced. Intended Outcomes The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country

Co-morbidity and drug treatment in Alzheimer's disease. A cross sectional study of participants in the Dementia Study in Northern Norway

Inappropriate medical treatment of co-morbidities in Alzheimer’s disease (AD) is an increasing concern in geriatric medicine. The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway. Setting: Nine rural municipalities with 70 000 inhabitants in Northern Norway. Participants: Participants with and without AD recruited in general practice and by population based screening. 187 participants with a recent diagnosis of AD were recruited among community dwellers. Of 791 respondents without cognitive symptoms, 500 were randomly selected and invited to further clinical and cognitive testing. The final control group consisted of 200 cognitively healthy individuals from the same municipalities. Demographic characteristics, data on medical history and current medication were included, and a physical and cognitive examination was performed. The statistical analyses were carried out by independent sample t-test, chi-square, ANCOVA and logistic regression. A co-morbidity score was significantly higher in AD participants compared to controls. The mean number of drugs was higher for AD participants compared to controls (5.1 ± 3.6 and 2.9 ± 2.4 respectively, p < 0.001 age and gender adjusted), also when adjusted for co-morbidity. AD participants used significantly more anticholinergic, sedative and antidepressant drugs. For nursing home residents with AD the mean number of drugs was significantly higher compared to AD participants living at home (6.9 ± 3.9 and 4.5 ± 3.3, respectively, p < 0.001). AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls, even after adjustment for co-morbidity. An inappropriate use of anticholinergic and sedative drugs was identified, especially among nursing home residents with AD. The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors

Mifepristone Prevents Stress-Induced Apoptosis in Newborn Neurons and Increases AMPA Receptor Expression in the Dentate Gyrus of C57/BL6 Mice

Chronic stress produces sustained elevation of corticosteroid levels, which is why it is considered one of the most potent negative regulators of adult hippocampal neurogenesis (AHN). Several mood disorders are accompanied by elevated glucocorticoid levels and have been linked to alterations in AHN, such as major depression (MD). Nevertheless, the mechanism by which acute stress affects the maturation of neural precursors in the dentate gyrus is poorly understood. We analyzed the survival and differentiation of 1 to 8 week-old cells in the dentate gyrus of female C57/BL6 mice following exposure to an acute stressor (the Porsolt or forced swimming test). Furthermore, we evaluated the effects of the glucocorticoid receptor (GR) antagonist mifepristone on the cell death induced by the Porsolt test. Forced swimming induced selective apoptotic cell death in 1 week-old cells, an effect that was abolished by pretreatment with mifepristone. Independent of its antagonism of GR, mifepristone also induced an increase in the percentage of 1 week-old cells that were AMPA+. We propose that the induction of AMPA receptor expression in immature cells may mediate the neuroprotective effects of mifepristone, in line with the proposed antidepressant effects of AMPA receptor potentiators

Interventions to treat premature ejaculation: a systematic review short report

Background: Premature ejaculation (PE) is commonly defined as ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it. PE can be either lifelong and present since first sexual experiences (primary), or acquired (secondary), beginning later (Godpodinoff ML. Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther 1989;15:130–4). Treatments include behavioural and pharmacological interventions. Objective: To systematically review evidence for clinical effectiveness of behavioural, topical and systemic treatments for PE. Data sources: The following databases were searched from inception to 6 August 2013 for published and unpublished research evidence: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects and the Health Technology Assessment database; ISI Web of Science, including Science Citation Index, and the Conference Proceedings Citation Index-Science. The US Food and Drug Administration website and the European Medicines Agency (EMA) website were also searched. Methods: Randomised controlled trials (RCTs) in adult men with PE were eligible (or non-RCTs in the absence of RCTs). RCT data were extrapolated from review articles when available. The primary outcome was intravaginal ejaculatory latency time (IELT). Data were meta-analysed when possible. Other outcomes included sexual satisfaction, control over ejaculation, relationship satisfaction, self-esteem, quality of life, treatment acceptability and adverse events (AEs). Results: A total of 103 studies (102 RCTs, 65 from reviews) were included. RCTs were available for all interventions except yoga. The following interventions demonstrated significant improvements (p < 0.05) in arithmetic mean difference in IELT compared with placebo: topical anaesthetics – eutectic mixture of local anaesthetics (EMLA®, AstraZeneca), topical eutectic mixture for PE (Plethora Solutions Ltd) spray; selective serotonin reuptake inhibitors (SSRIs) – citalopram (Cipramil®, Lundbeck), escitalopram (Cipralex®, Lundbeck), fluoxetine, paroxetine, sertraline, dapoxetine (Priligy®, Menarini), 30 mg or 60 mg; serotonin–noradrenaline reuptake inhibitors – duloxetine (Cymbalta®, Eli Lilly & Co Ltd); tricyclic antidepressants – inhaled clomipramine 4 mg; phosphodiesterase-5 (PDE5) inhibitors – vardenafil (Levitra®, Bayer), tadalafil (Cialis®, Eli Lilly & Co Ltd); opioid analgesics – tramadol (Zydol SR®, Grünenthal). Improvements in sexual satisfaction and other outcomes compared with placebo were evident for SSRIs, PDE5 inhibitors and tramadol. Outcomes for interventions not compared with placebo were as follows: behavioural therapies – improvements over wait list control in IELT and other outcomes, behavioural therapy plus pharmacotherapy better than either therapy alone; alpha blockers – terazosin (Hytrin®, AMCO) not significantly different to antidepressants in ejaculation control; acupuncture – improvements over sham acupuncture in IELT, conflicting results for comparisons with SSRIs; Chinese medicine – improvements over treatment as usual; delay device – improvements in IELT when added to stop–start technique; yoga – improved IELT over baseline, fluoxetine better than yoga. Treatment-related AEs were evident with most pharmacological interventions. Limitations: Although data extraction from reviews was optimised when more than one review reported data for the same RCT, the reliability of the data extraction within these reviews cannot be guaranteed by this assessment report. Conclusions: Several interventions significantly improved IELT. Many interventions also improved sexual satisfaction and other outcomes. However, assessment of longer-term safety and effectiveness is required to evaluate whether or not initial treatment effects are maintained long term, whether or not dose escalation is required, how soon treatment effects end following treatment cessation and whether or not treatments can be stopped and resumed at a later time. In addition, assessment of the AEs associated with long-term treatment and whether or not different doses have differing AE profiles is required