TO EVALUATE THE EFFICACY OF GUDUCHYADI YOGA IN THE MANAGEMENT OF RAKTACHAPADHIKYATA OR ESSENTIAL HYPERTENSION-A RANDOMIZED CONTROLLED CLINICAL TRIAL

Hypertension is the most pressing public health challenges. It is estimated that approximately 1 billion people are suffering from high blood pressure and the numbers are to increase to 2.5 billion by 2025. Raktachaapadhikya is the coined term for increased blood pressure given by recent authors where it can be understood as the pathology of Vyanvayu. The usage of Guduchyadi Yoga has been highlighted in the classics of Ayurveda for targeting the Hridaya sthitha vayu, which has not been evaluated yet. Aim: To evaluate and compare the efficacy of Navahridaya Kalpa (standard drug) and Guduchyadi Yoga (trial drug) for management of essential hypertension. Materials and Methods: A simple randomized controlled clinical study where 40 patients were equally divided as group A: Navahridaya kalpa (standard drug) and Group B: Guduchyadi yoga (trial drug) for a period of one month. Observations and results: The study result revealed that both the groups were beneficial in reducing high blood pressure however with no statistically significant difference found between the groups with p value being 0.339 for standard drug and 0.363 for trial drug. The group B was also found to be effective in reducing systolic blood pressure of stage I hypertension with p value .044 on comparing between the groups. Conclusion: The Guduchyadi yoga acts as Rasayana with the property of rejuvenation and antihypertensive which will check the high blood pressure at a very minimum cost without having any major adverse effects in the patients and hence can be advocated for use on a daily a basis

Effect of pomegranate polyphenols on lipids metabolism in patients with myocardial infarction: a double-blind placebo controlled trial

Background: Myocardial Infarction (MI) is a leading disease globally. Major risk factors for MI are smoking, hypertension, diabetes mellitus, reactive oxygen species (ROS), obesity, coronary artery disease (CAD) and abnormally altered blood lipid levels. It is recommended that for healthy living the risk factors for CAD and ROS should be less. Consumption of natural food supplements rich in antioxidants and polyphenols reduce the risk of MI. One herb is Pomegranate. Pomegranate is polyphenols and antioxidants rich fruit. This prompted us to find out whether the presence of antioxidants in pomegranate offers any prognostic benefits in patients with MI?.Methods: Pomegranate Extract of Whole Fruit (PEWF) was prepared as tablet of 300mg to investigate its effects in patients with MI. Total 100 participants were included in the trial. Participants were assigned to two groups of 50 each. One group received “Add On” PEWF and other got matching placebo of same colour, shape and size as comparator agent in the dose of 300mg BD for 1 month.Results: Results were compared by Z test, Chi square test and coefficient of variations. Statistical analysis proves the prognostic effect after active medication (p<0.05). Study results indicate the rejection of Null Hypothesis (H0) and acceptance of Alternative Hypothesis (H1).Conclusions: Our findings suggest that consumption of antioxidant and polyphenols rich food supplements such as PEWFs for one month reduces the risk factors for CAD

Novel Insights into the Use of Biologicals in Idiopathic Inflammatory Myopathies

Idiopathic inflammatory myopathies (IIMs) are a set of autoimmune disorders characterized by muscle inflammation and weakness, as well as a variety of extra-muscular presentations. IIMs are remarkably complex and difficult to treat, and glucocorticoid treatment and synthetic immunosuppressants are frequently ineffective. The pathophysiology of IIM has been linked to defects in both the innate and adaptive immune systems. Multiple prospective targets for biologic therapy have been studied because of a greater understanding of the main cytokines, as well as the cell-mediated and antibody effectors of disease. B-cell depletion with rituximab, as well as tumor necrosis factor inhibitors and other biologic treatments, is among the most extensively studied drug in IIM. There is currently no straightforward way to define all of the pharmaceuticals that are classified as biologics. This group of drugs has gained a lot of interest in the recent era for the treatment of various autoimmune and skeletal muscle disorders. This chapter shall address the mechanism of action, side effects, uses, and scope of biologics used in treatment of IIM

Efficacy of mHealth aided 12-week meditation and breath intervention on change in burnout and professional quality of life among health care providers of a tertiary care hospital in north India: a randomized waitlist-controlled trial

IntroductionBurnout is “Chronic workplace stress that has not been successfully managed.” Professional quality of life (PQL) includes work related experiences of compassion satisfaction and compassion fatigue. Healthcare providers (HCPs) are highly susceptible to burnout and compassion fatigue due to their demanding work, which lowers PQL. Burnout leads to poor care, medical errors, and patient safety across healthcare disciplines. Yoga has been shown to improve resilience, reduce stress, and increase self-compassion and psycho-physiological coherence. This study compared HCPs in a mHealth-aided 12-week yoga-based meditation and breath intervention to waitlist controls for HCP burnout and PQL at a north Indian tertiary care hospital.MethodsThis was randomized waitlist-controlled trial. Total 98 HCPs (62 males and 36 females) with an average age of 28.26 ± 3.547 years were enrolled consecutively from March 2021 to November 2022. Randomization was done with opaque sealed envelopes numbered in a computer-generated sequence. The experimental group (n = 49) received 12 online weekly yoga sessions and performed daily home practice (6 days a week). The waitlisted control group (n = 49) continued their daily routine. Maslach’s burnout inventory (MBI), professional quality of life (PQL) and anthropometric measurements were assessed at baseline and after 12 weeks.ResultsAfter 12 weeks, the MBI outcomes of emotional exhaustion, depersonalization, and personal accomplishment showed a highly significant difference between the two groups (p &lt; 0.001). PQL outcomes of compassion satisfaction, burnout, and secondary trauma also differed significantly (p &lt; 0.001). Within group analysis showed that MBI and PQL outcomes improved significantly (p &lt; 0.001) for the experimental group after 12 weeks.ConclusionThe current study contributes to the existing evidence on the effectiveness of Yoga in managing stress and developing resilience among doctors, nurses, and other medical professionals. Integrating yoga into healthcare settings is crucial for addressing the detrimental impact of burnout on decision-making and promoting positive patient outcomes. mHealth technologies have the potential to enhance the user-friendliness of yoga-based interventions by personalizing the practice space and time. Yoga-based interventions and mHealth technologies can effectively address physician burnout, in a simple and implementable manner

Psychological Impact of the COVID-19 Pandemic on Frontline Health Care Physicians

The Coronavirus Disease 2019 (COVID-19) pandemic began in December 2019 in Wuhan, China. Such sudden infectious outbreaks take a toll on the psychological health of our brave frontline health care physicians. Frontline health care physicians become vulnerable to psychological problems like depression, anxiety, stress, and insomnia. Long working hours, increased patient load, and risk of spread of contagion to family members are a few of the major contributing factors. Such factors, coupled with chronic stress and emotional exhaustion predispose doctors to experience burnout which has also been reported to increase the risk of mental morbidities. Early counselling, pandemic preparedness, self-care efforts, and stress management can help to cope in these adverse times. Various online portals have also been developed as an intervention strategy in mitigating the negative impact of this pandemic. The purpose of this viewpoint is to highlight the need to address such issues in physicians, find possible root causes, and suggest relevant measures to curb the incidence of these problems

Scrub typhus: Overview of demographic variables, clinical profile, and diagnostic issues in the sub-Himalayan region of India and its comparison to other Indian and Asian studies

Background: India is a tropical country with a high burden of febrile zoonotic/infectious illnesses, scrub typhus being such a cause with multiple epidemics reported from different regions of the country. Objective: This study was plotted to document the clinical and diagnostic manifestations, treatment, and outcomes of scrub typhus in the sub-Himalayan region of India and to compare the results with other Indian and Asian studies. Materials and Methods: This was a retrospective observational study involving collection of data for 54 IgM ELISA-confirmed in-patient cases of scrub typhus at a tertiary care institute in Uttarakhand, India, from their case records. Results: The majority of patients were from rural background. Housewives constituted 28 (51.85%) patients. The most common symptoms were due to involvement of gastrointestinal tract in the form of abdominal pain in 39 (72.22%) and vomiting in 29 (53.7%) patients. Central nervous system involvement in the form of altered sensorium in 14 (25.9%) patients and pulmonary involvement as cough in 28 (51.85%) patients was observed. An eschar was found in 7 (12.96%) patients and upper eyelid edema in 40 (74.07%) patients. The most common laboratory abnormality documented was elevation of liver transaminases (aspartate aminotransferase > alanine aminotransferase), 40 (74.07%), and blood urea levels, 47 (87.03%). There was no difference in the clinical presentation, severity, or mortality in pregnant females when compared with nonpregnant females. One (1.45% mortality) died in our study. Conclusion: Scrub typhus is an important cause of acute febrile illness with variable, often nonspecific and multisystem involvement. Early recognition and antibiotic administration are the key to reduce complications and mortality, especially for a primary care physician

Geriatric Goalposts: Of Independence And Interdependence

Our elder population has a unique set of needs and necessities, challenges and concerns. This reflects in the approach of geriatric medicine, which aims to ensure functional freedom and independence, as well as healthy ageing, of older citizens. We propose another, higher, aim of geriatric medicine: that is interdependence. This creates a spirit of optimism, in persons of geriatric age group as well as in their health care providers, who are able to interpret goals of medical care in a broader perspective. Keywords: ADL, geriatrics, gerontology, independence, interdependence, Person centred care

Prevalent infant feeding practices among the mothers presenting at a tertiary care hospital in Garhwal Himalayan region, Uttarakhand, India

Introduction: There is paucity of studies on infant feeding practices from the rural areas of garhwal Himalayas of the state of uttarakhand. The present study was designed to assess the infant feeding practices in Garhwal region. Infant feeding practices have significant implications on a child's health. Early nutritional status especially during the first year of life has been shown to have a significant effect on child health and development. Optimal infant feeding practices are crucial for nutritional status, growth, development, health, and ultimately the survival of infants and young children. The study of infant feeding practices is essential before formulation of any interventional programme. Settings and Design: A study was conducted in HNB Base Hospital and Teaching Institute with the aim to assess the infant feeding practices and the prevalence of malnutrition in the study population reporting at the hospital in garhwal region of uttarakhand. Methods and Material: This is an observational cross sectional study. 275 infants were included in the study. After taking informed consent, case study forms were filled by interviewing the infants' mothers. Weight, length and head circumference of each infant was also measured. The information thus obtained was compiled, tabulated and analysed statistically. Results: The study findings revealed that 46.4% infants in the age group 0-5 months were breastfed within 1 hour of birth. 52.8% infants aged 0-5 months of were exclusively breastfed. 33.6% infants in age group 0-5 months received prelacteal feeds. 53.12% infants in age group 6-8 months received solid, semi-solid or soft food, in addition to breast milk. 53.33% infants were partially or fully bottle fed. Age appropriate feeding was found in 56% infants. The percentage of wasting, stunting and underweight in 0-5 months was 33.6%,30.4% and 36.8% respectively . The percentage of wasting, stunting and underweight in 6-11 months was 28%, 26.5% and 30.7% respectively. There appeared to be an association between longer duration of exclusive breastfeeding and lower prevalence of stunting and underweight at 6 months of age. Conclusions: This study shows that undesirable infant feeding practices are still prevalent in the community. Lower prevalence of stunting and underweight was observed in infants with longer duration of exclusive breastfeeding. A comprehensive plan to address the problems in infant feeding should be formulated. Antenatal counselling of mothers should be done. Revitalization of the Baby Friendly Hospital Initiative(BHFI) in health facilities is recommended

Hemophagocytic lymphohistiocytosis as a diagnostic consideration of fever of unknown origin with pancytopenia and chronic liver disease

Hemophagocytic lymphohistiocytosis (HLH) is a severe disorder of systemic immune dysregulation which can be primary or secondary to autoimmune disorders, malignancy, or infections. We hereby describe a case of a 23-year-old male with severe hepatitis along with pancytopenia and prolonged fever of unknown origin that developed HLH triggered by staphylococcal urinary tract infection. This is a discussion of this unusual disease and its presentation and the diagnostic difficulties which may be encountered in general clinical practice