A RANDOMIZED CASE–CONTROL PILOT STUDY ON THE NEUROCHEMICAL BASIS OF PAIN MODULATION IN PATIENTS WITH MIGRAINE, WHO PRACTICED INTEGRATED AMRITA MEDITATION TECHNIQUE

Objective: The objective of the study was to determine the changes in duration and intensity of headache and associated changes in the plasma levels of neurochemicals, serotonin, glutamate, vasoactive intestinal peptide (VIP), and nitric oxide (NO) in patients with migraine after 6 months of regular practice of integrated Amrita meditation (IAM). Methods: Sixteen patients aged 18–50 with migraine were randomly assigned to 2 groups, one with standard medical care and IAM, and the other only standard medical care. Data were collected before IAM, after 3 and 6 months of IAM practice Results: After 6 months, a significant decrease in the duration of headache from 2.4±0.54 to 1.4±0.54 (p=0.034) hours and intensity of pain from 3.6±0.54 to 2.6±0.89, (p=0.035) was seen in patients who practiced IAM. Plasma levels of serotonin within the IAM group increased (47.29±26.85 to 53.85±29.73ng/ml), where as there was decrease in glutamate (38.47±8.2 to 29.68±12.57μg/ml), VIP (28.01±13.64 to 22.23±7.79pg/ml) and NO levels (642.26±167.42 to 423.18±97.96μmol/L). A correlating trend was seen in comparison with control group after 6 months showing a statistically significant difference in plasma Serotonin (p value 0.007) and NO (p value-0.023) levels. Discussion: The results of our study have been discussed with other migraine and meditation-related studies. Conclusion: Regular practice of IAM reduces the intensity and duration of headache in migraine patients and is associated with alterations in the neurotransmitter levels

Effect of dexamethasone implant on intraocular cytokines in diabetic macular edema

Purpose: Our primary aim was to evaluate intraocular cytokines (IC) before and after dexamethasone in diabetic macular edema (DME). Our secondary aim was to study the early and late effects of single dexamethasone implant in DME. Methods: This before and after comparative study was conducted at the Department of Ophthalmology and Centre for Nanosciences at a quaternary referral center in Kerala, India, from September 2016 to September 2018. Patients underwent complete ophthalmological examination and cytokine analysis before and after dexamethasone implant. Levels of cytokines at baseline and repeat sample were studied. Results: Twenty-seven eyes (21 patients) were divided into two groups depending on time from baseline to second injection. Group 1 included patients with 3 months between the two samples –15 (55.6%). Best corrected visual acuity (BCVA) and central macular thickness (CMT) improved significantly post-dexamethasone in group 1, but not in group 2. Interleukin (IL)-4, IL-6, IL-10, vascular endothelial growth factor (VEGF), IL-1β, interferon-gamma inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), and IL-2 decreased post-injection in group 1. But cytokines increased post-dexamethasone in group 2, except IL-10. When compared to baseline, IL-6 reduced to half in group 1 (P-value 0.814) and it tripled in group 2 ( P-value 0.009). The level of VEGF in the first and second samples was not different in either group. Conclusion: Our study suggests that dexamethasone acts more on IC than VEGF in DME. This is significant in the first 3 months with a rebound effect on IL-6 after 3 months. Our study also suggests that repeat injection of DEX in DME should be done at 3 months to prevent deterioration of visual acuity (VA) and worsening of CMT

Ocular surface changes in patients who have undergone head and neck radiation therapy

Purpose: Dry eye syndrome (DES) is a familiar sequelae of radiation therapy (RT) for head and neck cancers (HNC). Ocular surface changes such as DES occur due to injury to the conjunctival epithelium, goblet cells, corneal surface, lacrimal glands, and meibomian glands. This study aimed at the evaluation and early detection of changes in ocular surface parameters in patients receiving RT for extraocular HNC. Methods: Forty-two eyes of 21 patients undergoing HNC RT were evaluated. Radiation technique and dose of radiation to the lens and eye were recorded. Subjects were evaluated for meibomian gland changes by meiboscore grading, ocular surface disease index (OSDI) questionnaire, Schirmer’s test, tear film break-up time (TBUT), and slit-lamp examination before RT, immediately post RT, and 6 weeks post RT. A comparison of the ipsilateral eye on the irradiated side to the contralateral eye was done. Results: A significant reduction in TBUT was seen immediately post RT and 6 weeks post RT (P 13 was seen in 23.80% of patients post RT, with a significant difference from baseline (P 1 second in TBUT and >1.7 in meiboscore was seen with a mean dose of around 8 Gy to the lens. Conclusion: All patients undergoing HNC RT should be followed up for ocular surface and meibomian gland changes. The contralateral eye should also be evaluated. Patients receiving lower doses to the ocular structures should also be kept under follow-up