Fifteen Minutes of Chair-Based Yoga Postures or Guided Meditation Performed in the Office Can Elicit a Relaxation Response

This study compared acute (15 min) yoga posture and guided meditation practice, performed seated in a typical office workspace, on physiological and psychological markers of stress. Twenty participants completed three conditions: yoga, meditation, and control (i.e., usual work) separated by ≥24 hrs. Yoga and meditation significantly reduced perceived stress versus control, and this effect was maintained postintervention. Yoga increased heart rate while meditation reduced heart rate versus control (P\u3c0.05). Respiration rate was reduced during yoga and meditation versus control (P\u3c0.05). Domains of heart rate variability (e.g., SDNN and Total Power) were significantly reduced during control versus yoga and meditation. Systolic and diastolic blood pressure were reduced secondary to meditation versus control only (P\u3c0.05). Physiological adaptations generally regressed toward baseline postintervention. In conclusion, yoga postures or meditation performed in the office can acutely improve several physiological and psychological markers of stress. These effects may be at least partially mediated by reduced respiration rate

A cluster-randomised trial comparing home-based primary health care and usual clinic care for epilepsy in a resource-limited country

OBJECTIVE: To ascertain whether home-based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic-based care in community samples of people with epilepsy in a resource-poor country. METHODS: Participants included consenting individuals with active epilepsy identified in a population survey in impoverished communities. The intervention included antiseizure medication provision, adherence reinforcement and epilepsy self- and stigma management guidance provided by a primary health care-equivalent worker. We compared the intervention group to a routine clinic-based care group in a cluster-randomised trial lasting 24 months. The primary outcome was antiseizure medication adherence, appraised from monthly pill counts. Seizure outcomes were assessed by monthly seizure aggregates and time to first seizure and impact by the Personal Impact of Epilepsy scale. RESULTS: Enrollment began on 25.09.2017 and was complete by 24.07.2018. Twenty-four clusters, each comprising ten people with epilepsy, were randomised to either home- or clinic-care. Home-care recepients were more likely to have used up their monthly-dispensed epilepsy medicine stock (Regression Coefficient: 0.585; 95% Confidence Intervals, 0.289 to 0.881; P=0.001) and had fewer seizures (Regression coefficient: -2.060; 95%CI, -3.335 to -0.785; P=0.002). More people from clinic-care (n=44; 37%) than home-care (n=23; 19%) exited the trial (P=0.003). The time to first seizure, adverse effects and the personal impact of epilepsy were similar in the two arms. SIGNIFICANCE: Home care for epilepsy compared to clinic care in resource-limited communities improves medication adherence and seizure outcomes and reduces the secondary epilepsy treatment gap

Sedation in neurological intensive care unit

Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives

Impulse-control disorders and restless leg syndrome in Parkinson's Disease: Association or coexistence

Background: Both Impulse-control disorders and related behaviours (ICD-RB) and restless leg syndrome (RLS) are relatively common in patients with Parkinson's disease, but little is known are they related or independent complications of dopaminergic therapy. The aim of this study was to determine the correlation between ICD-RBs and RLS and also, to determine the associated significant psycho-behavioural profile of RLS patients in presence of ICD-RBs. Methods: PD who visited neurology OPD were screened for the presence of addictive behaviors, alcohol and substance abuse, ICDs including Impulse control disorders not elsewhere classified with the help of a QUIP questionnaire. RLS was evaluated by diagnostic criteria set by the International RLS study group. To evaluate the association of RLS and ICDs, cohort was divided into groups of patients who had both ICD and RLS, ICD with no RLS, RLS with no ICD and no ICD or RLS. Results: Among 122 PD patients who visited OPD, 95 eligible were included in the study. Out of these 95 patients, 51 (53.6%) had at least one ICD-RB and 18 (18.9%) had RLS. ICD-RB in decreasing order of frequency were compulsive medication (47.4%), compulsive eating (29.4%), compulsive buying (17.6%), gambling (11.7%), hypersexuality (3.9%), and others (29.8%). Among 18 patients with RLS, 12 (66.7%) were associated with at least one ICD-RB. The compulsive behaviours significantly associated with PD-RLS group were gambling (27.8%), followed by compulsive eating (44.2%). While comparing disease characteristics, PD-ICD/RLS patients had statistically significant disease duration (p 0.007) and higher LEDD (p 0.004). Other demographic and socioeconomic features did not reveal any differences between the groups. Conclusion: 11% of PwPD can have co-occurrence of RLS and ICD-RBs. Circadian fluctuation in levels of dopamine release on the background of hyper-dopaminergic state produces waves of crest and trough, which may be possible for this behavioral profile. Long-term dopaminergic treatment or degenerative process itself may be the cause leading to emergence of both RLS and ICD-RBs in PD patients

Parkinson's disease in intensive care unit: An observational study of frequencies, causes, and outcomes

Objective: To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit (ICU) among Parkinson's disease (PD) population so that preventive measures can be developed. Methods: We prospectively observed patients with diagnosis of PD admitted to ICU from January 2014 to December 2016. Based on etiology for hospital admission, they were divided into two groups – related to PD (further divided into direct or indirect) or not associated with PD at all. Etiology for hospitalization was determined from history and investigational data. The primary outcome was death or discharge from the hospital. Factors contributing to ICU admission were analyzed by comparing these patients with a cohort of 50 PD patients admitted to the neurology ward during the same study period. All values were expressed as mean (standard deviation) and percentages using SPSS version 16.0. Results: Fifty-three (36%) out of a total of 146 patients required ICU admission. Most common causes leading to admission in decreasing order of frequency were fever (34%), delirium (16%), falls (12%), encephalopathy (8%), gastrointestinal emergencies (6%); while direct disease-related severe dyskinesias were seen only in two patients (4%). 13.7% needed mechanical ventilation and mean duration of ventilation was 5.94 days with mortality rate of 20%. Significant factors predicting ICU admission, and thus, poor outcomes were age >65 years, history of previous admission within the last 12 months, delirium, and hypoalbuminemia. There was no significant association between the incidence of ICU admission and duration of disease or severity of the disease. Conclusions: Poor outcome in PD patients is due to systemic causes, hence multidisciplinary teamwork may improve outcome in these patients

A randomized controlled trial for the effect of passive stretching on measures of hamstring extensibility, passive stiffness, strength, and stretch tolerance

To measure hamstring extensibility, stiffness, stretch tolerance, and strength following a 4-week passive stretching program. Randomized controlled trial. Twenty-two healthy participants were randomly assigned to either a 4-week stretching program consisting of 4 hamstring and hip stretches performed 5 times per week, or a non-stretching control group. Hamstring extensibility and stiffness were measured before and after training using the instrumented straight leg raise test (iSLR). Stretch tolerance was measured as the pain intensity (visual analog scale; VAS) elicited during the maximal stretch. Hamstring strength was measured using isokinetic dynamometry at 30 and 120◦ s−1. Hamstring extensibility increased by 20.9% in the intervention group following 4 weeks of training (p ˂ 0.001; d = 0.86). Passive stiffness was reduced by 31% in the intervention group (p˂ 0.05; d = −0.89). Stretch tolerance VAS scores were not different between groups at either time point, and no changes were observed following training. There were no changes in hamstring concentric strength measured at 30 and 120◦ s−1. Passive stretching increases hamstring extensibility and decreases passive stiffness, with no change in stretch tolerance defined by pain intensity during the stretch. Compared to previous research, the volume of stretching was higher in this study. The volume of prescribed stretching is important for eliciting the strong clinical effect observed in this study

Fifteen Minutes of Chair-Based Yoga Postures or Guided Meditation Performed in the Office Can Elicit a Relaxation Response

This study compared acute (15 min) yoga posture and guided meditation practice, performed seated in a typical office workspace, on physiological and psychological markers of stress. Twenty participants (39.6±9.5 yr) completed three conditions: yoga, meditation, and control (i.e., usual work) separated by ≥24 hrs. Yoga and meditation significantly reduced perceived stress versus control, and this effect was maintained postintervention. Yoga increased heart rate while meditation reduced heart rate versus control (<0.05). Respiration rate was reduced during yoga and meditation versus control (<0.05). Domains of heart rate variability (e.g., SDNN and Total Power) were significantly reduced during control versus yoga and meditation. Systolic and diastolic blood pressure were reduced secondary to meditation versus control only (<0.05). Physiological adaptations generally regressed toward baseline postintervention. In conclusion, yoga postures or meditation performed in the office can acutely improve several physiological and psychological markers of stress. These effects may be at least partially mediated by reduced respiration rate

Effect of progressive resistance training on measures of skeletal muscle hypertrophy, muscular strength and health-related quality of life in patients with chronic kidney disease : a systematic review and meta-analysis

Background and Objective Skeletal muscle wasting resulting in reduced muscular strength and health-related quality of life (HR-QOL) is common in chronic kidney disease (CKD) and may be reversed with progressive resistance training (PRT). Therefore, we systematically assessed the effect of PRT on measures of skeletal muscle hypertrophy, muscular strength and HR-QOL in this cohort to inform clinical practice and guidelines. Design We performed a systematic review and meta-analysis. Inclusion Criteria We included randomised controlled trials (RCTs) that investigated the independent effect of PRT (>6 weeks) on measures of skeletal muscle hypertrophy [muscle mass or cross-sectional area (CSA)], muscular strength and/or HR-QOL in adults with CKD. Data Extraction and Analysis The standardised mean difference (SMD) from each study was pooled to produce an overall estimate of effect and associated 95 % confidence interval (95 % CI) between treatment and control groups on primary outcomes. Results Seven RCTs in 271 patients with Stage 3-5 CKD yielded seven studies on muscular strength (N = 249), six studies on total body muscle mass (N = 200) and six studies on HR-QOL (N = 223). PRT significantly improved standardised muscular strength [SMD 1.15 (95 % CI 0.80-1.49)] and HR-QOL [SMD 0.83 (95 % CI 0.51-1.16)], but not total body muscle mass [SMD 0.29 (95 % CI -0.27 to 0.86)] in our primary analysis. However, secondary analysis of six studies showed that PRT induced significant muscle hypertrophy of the lower extremities (leg mass, or mid-thigh or quadriceps CSA) [SMD 0.43 (95 % CI 0.11-0.76)], a pertinent analysis given that most studies implemented lower-body PRT only. Conclusions Robust evidence from RCTs indicates that PRT can induce skeletal muscle hypertrophy and increase muscular strength and HR-QOL outcomes in men and women with CKD. Therefore, clinical practice guidelines should be updated to inform clinicians on the benefits of PRT in this cohort