Impact of environmental temperature on the survival outcomes of breast cancer: A SEER-based study.

BACKGROUND: Experimental evidence in tumor-bearing mouse models shows that exposure to cool, that is, sub-thermoneutral environmental temperature is associated with a higher tumor growth rate and an immunosuppressive tumor immune microenvironment than seen at thermoneutral temperatures. However, the translational significance of these findings in humans is unclear. We hypothesized that breast cancer patients living in warmer climates will have better survival outcomes than patients living in colder climates. METHODS: A retrospective population-based analysis was conducted on 270,496 stage I-III breast cancer patients, who were retrieved from the Surveillance, Epidemiology and End Results (SEER) over the period from 1996 to 2017. The average annual temperature (AAT) was calculated based on city level data from the National Centers for Environmental Information. RESULTS: A total of 270, 496 patients were analyzed. Temperature as assessed in quartiles. After adjusting for potential confounders, patients who lived in the 3rd and 4th quartile temperature regions with AAT 56.7-62.5°F (3rd quartile) and > 62.5°F (4th quartile) had a 7% increase in the OS compared to patients living at AAT < 48.5°F (1st quartile) (HR 0.93, 95% CI 0.90-0.95 and HR 0.93, 95% CI 0.91-0.96, respectively). For DSS, When comparing AAT quartiles, patients living with AAT in the range of 56.7-62.5°F and > 62.5°F demonstrated a 7% increase each in DSS after adjustment (HR 0.93, 95% CI 0.90-0.96 and HR 0.93, 95% CI 0.90-0.96). CONCLUSIONS: Higher environmental temperatures are associated with significantly better OS and DSS in breast cancer patients. Future research is warranted to confirm this observation using large datasets to elucidate the underlying mechanisms and investigate novel therapeutic strategies to minimize this geographic disparity in clinical outcomes.

Impact of Environmental Temperature on the Pathological Complete Response and Survival Outcomes of Breast Cancer: A NCDB and SEER study.

Background: Experimental evidence in tumor-bearing mouse models shows that exposure to cool, that is, sub-thermoneutral environmental temperature is associated with a higher tumor growth rate with an immunosuppressive tumor immune microenvironment than seen at thermoneutral temperatures. However, the translational significance of these findings in humans is unclear. We hypothesized that breast cancer patients living in warmer climates have higher odds of achieving pathologic complete response (pCR) and better survival outcomes than patients living in colder climates. Methods: A retrospective population-based analysis was conducted on Stage I-III breast cancer patients utilizing data from National Cancer Database (NCDB) from 2010-2018 with 892,092 patients and Surveillance, Epidemiology and End Results (SEER) from 1996-2017 with 270,496 patients. The average annual temperature (AAT) was calculated based on data from the National Centers for Environmental Information. Results: In the SEER cohort, patients residing at AAT ≥47.5°F had a 16% higher overall survival (OS) (HR 0.84, 95% CI 0.81-0.88, p <0.001) and 15% higher disease specific survival (DSS) (HR 0.85, 95% CI 0.80 - 0.90; p <0.001). Similarly, 4% higher OS (HR 0.96, 95% CI 0.95-0.97, p <0.001) and DSS (HR 0.96, 95% CI 0.94-0.97, p <0.001) was noted with every 5°F increment in AAT. In the NCDB cohort, patients in regions with AAT ≥ 60.9°F had 9% greater odds of achieving a pCR, odds ratio (OR 1.09, 95% CI 1.05, 1.13, p <0.001) and a 5% higher OS (HR 0.95, 95% CI 0.93 - 0.97, p<0.001). Conclusions: Higher environmental temperatures are associated with significantly better OS and DSS, as well as higher odds of achieving pCR in these patients. Future research is warranted to confirm this observation using large datasets, to elucidate the underlying mechanisms and investigate novel therapeutic strategies to minimize this geographic disparity in clinical outcomes.

Effect of Practicing Meditation, Pranayama, and Yoga on the Mental Health of Female Undergraduate Medical Students: An Interventional Study.

Background Medical education is a rigorous formal education with a vast syllabus. Burnout and stresses are common among medical students and more prominent in females. Female medical students suffer from a higher level of stress than male medical students. For the improvement of physical and mental health, meditation, pranayama, and yoga are some of the ancient techniques. Meditation is a technique of focusing the mind on a target like an object, activity, or any thought. Pranayama is an ancient yogic practice focusing on the breath. Yoga is a combination of physical, mental, and spiritual dimensions that has the potential to improve mental and physical health. Objective This study aimed to find the effect of meditation, pranayama, and yoga on the improvement of mental health among female undergraduate medical students. Materials and methods This was an interventional study. A total of 105 females with a median age of 19 years (first quartile - third quartile: 18-20) first-year undergraduate medical students were recruited for this study. They were randomly allocated to control, meditation, pranayama, and yoga groups. The control group did not practice any form of meditation, pranayama, or yoga. The rest of the group practiced a designated program for their group, six days a week for 12 weeks. The anxiety, depression, anger, and sense of well-being were assessed by a validated self-administered questionnaire developed by the Defence Institute of Physiology and Allied Sciences, New Delhi before starting the study, at six weeks, and at 12 weeks after the intervention. Inter-group levels of anxiety, depression, anger, and well-being were compared by the Kruskal-Wallis test with Dunn's posthoc test. Intra-group parameters at baseline, at six weeks, and at 12 weeks after the intervention was tested by Friedman's test. Result The age (years) (p = 0.07), height (cm) (p = 0.98), and weight (kg) (p = 0.26) of participants among groups were similar. Anxiety, depression, and anger significantly decreased after six weeks in all three intervention groups. A further decrement was seen after 12 weeks of meditation, pranayama, and yoga. The maximum effect was seen in the yoga group. A sense of well-being was improved after practicing all types of interventions. However, meditation was found to increase a sense of well-being to the highest level compared to pranayama and yoga. Conclusion Introduction and sustainment of meditation, pranayama, and yoga programs for first-year female undergraduate medical students may help reduce anxiety, depression, and anger and promote a sense of well-being. Although a six-week program helps to improve mental health, a 12-week program helps in further improvement. A yoga program is more effective for improving the mental health of the students in comparison with pranayama and meditation.

Air pollution and environmental risk factors for altered lung function among adult women of an urban slum area of Delhi: A prevalence study.

BACKGROUND: Household and ambient air pollution are jointly responsible for about 7 million premature deaths annually. Women living in slums, with unhealthy environment, both indoors and outdoors, particularly those living close to industrial and/or vehicular pollution zones due to multiple sources of air pollution, are at the higher risk of having impaired lung function tests. OBJECTIVE: The aim of this study was to estimate the prevalence of abnormal lung functions and to identify the environmental risk factors associated with them among adult women of 18-59 years. MATERIALS AND METHODS: A total of 550 women aged 18-59 years were approached in a representative urban slum. Five hundred consented to participate and 299 had prebronchodilator spirometry satisfying ATS standards. House visits to assess environmental conditions were conducted to determine their association with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Chi-square test was used to test the association of risk factors with lung functions. ANOVA was used to test the association of mean values of FEV1 and FVC with age. RESULTS: Out of 299 participants with acceptable spirometric curves, 5% had reduced FEV1/FVC ratio than the normal and 26.8% and 17.4% had lower values than predicted for FVC and FEV1, respectively. Altered lung function was related to age, tobacco smoking, and history of respiratory disease. CONCLUSIONS: Both ambient and household air pollution have a deleterious pulmonary effect on long-term women residents of a representative urban slum in Delhi.

Alteration of Heart Rate Variability in Patients of Depression.

INTRODUCTION: Altered cardiac autonomic functions in form of reduced Heart Rate Variability (HRV) have been found to be associated with increased cardiovascular morbidity and mortality in depressive patients. AIM: To investigate the relationship between HRV measures, which is a non-invasive marker of autonomic nervous system and depression. MATERIALS AND METHODS: The study included a convenient sample size of drug naive depressive patients (n=30) diagnosed on basis of ICD-10 and compared with age and gender matched healthy volunteers (n=30). Five minute ECG recording was done for HRV analysis and frequency domain measures like LF (Low Frequency), HF (High Frequency), LF/HF ratio as well as time domain measures like SDNN (Standard Deviation of all NN interval) and RMSSD (Root Mean Square of Successive differences of NN intervals) were obtained. RESULTS: In the frequency domain parameters, values of LF (nu) and LF/HF Ratio were found to be significantly higher (p<0.001) whereas, that of HF (nu) was significantly lower (p<0.001) in depression group as compared to control group. However, in the time domain parameters, no significant difference was observed in SDNN and RMSSD values in between the two groups. CONCLUSION: HRV recordings showed significant changes in frequency domain parameters in the patients suffering from depression. Thus, it could be said from our study that autonomic imbalance reflecting enhanced sympathetic activation relative to parasympathetic component is associated with depression.

Hearing Sensitivity in 40-60 Years Old Hypertensive Male Adults.

Declining hearing sensitivity is appreciated as a normal age related change. However, studies reveal that health variables other than age play significant role in hearing impairment over time. Hypertension is one such variable. The objective of this study was to assess whether the hypertension has an accelerating effect on age related reduction in hearing function in males in the age group of 40-60 years. Systolic and Diastolic blood. pressure and Pure Tone thresholds in frequency range 250-8000 Hz were measured in 30 known hypertensive (HT) male subjects in the age group of 40-60 years and 30 age and sex-matched normotensive (NT) controls. There was no significant difference in hearing thresholds at various frequencies between HT and NT group and between uncontrolled HT (n = 15) and controlled HT subgroups (n = 15). However, a significantly positive correlation between the systolic blood pressure and Air conduction thresholds at 4000 Hz and 8000 Hz and Bone conduction thresholds at 4000 Hz were noted in uncontrolled HT subgroup. Results of the current study demonstrated towards the potentially negative impact of uncontrolled hypertension on the auditory function in the age group of 40-60 years.

Effect of yoga on autonomic functions and psychological status during both phases of menstrual cycle in young healthy females.

CONTEXT: Premenstrual stress affects 75% of women of childbearing age and yoga has been found to be beneficial in many psycho-somatic disorders. AIMS: To investigate the effect of integrated yoga on autonomic parameters and psychological well-being during both pre and post phases of menstrual cycle in healthy young female subjects. SETTINGS AND DESIGN: Present study is a randomized control trial and was conducted in the Department of Physiology, Lady Hardinge Medical College, New Delhi, India. MATERIAL AND METHODS: Fifty apparently healthy females in the age group of 18-20 years were randomized into two groups: Group I (n=25) consisted of subjects who practiced yoga 35-40 minutes per day, six times per week for the duration of three menstrual cycles. Training was given by qualified yoga instructor. Group II (n=25) subjects acted as controls. Following parameters were recorded at the beginning and after completion of three menstrual cycles in all the subjects: Height, weight (BW), Resting Heart Rate (HR), Resting Systolic (SBP) and Diastolic Blood Pressure (DBP), parasympathetic reactivity tests including Expiration-Inspiration Ratio (E: I ratio) and 30:15 ratio, sympathetic reactivity tests including BP changes due to Isometric Hand Grip (IHG) exercise, and Cold Pressor Test (CPT). Assessment of psychological status was done by administering DIPAS (Defense Institute of Physiology and Allied Sciences) inventories of Anger self report scale, Trait Anxiety, Sense of well-being and Depression scale. STATISTICAL ANALYSIS: Intra-group comparison of physiological parameters was done by using paired 't' test, whereas intra-group comparison of non-parameteric data such as scores of anxiety, depression, anger and sense of well-being was done by Wilcoxon signed-rank test. Inter-group comparison of parameters was done by Students 't' test for parametric tests and Mann-Whitney 'U' test for non-parameteric tests. RESULTS: There was significantly higher BW, resting SBP, DBP, sympathetic activity and blunting of parasympathetic reactivity and also, significantly higher scores of anger, depression, anxiety and decreased score of well-being in premenstrual phase as compared to postmenstrual phase in both the groups in initial cycle. There was significantly higher percentage decrease in BW, HR, SBP & DBP in yoga group as compared to control group in both the phases from initial to second and onwards between second and third menstrual cycle. Also, decrease in anger, depression and anxiety and increase in well-being score was significant in yoga group as compared to control group from initial to second and third cycle in premenstrual phase while the change was significant only in depression score in postmenstrual phase. CONCLUSION: Our study shows that there was significant alteration of autonomic functions and psychological status in premenstrual phase when compared with postmenstrual phase in young healthy females. Also, regular practice of yoga has beneficial effects on both phases of menstrual cycle by bringing parasympathodominance and psychological well-being probably by balancing neuro-endocrinal axis.

Effect of integrated yoga practices on immune responses in examination stress - A preliminary study.

BACKGROUND: Stress is often associated with an increased occurrence of autonomic, cardiovascular, and immune system pathology. This study was done to evaluate the impact of stress on psychological, physiological parameters, and immune system during medical term -academic examination and the effect of yoga practices on the same. MATERIALS AND METHODS: The study was carried out on sixty first-year MBBS students randomly assigned to yoga group and control group (30 each). The yoga group underwent integrated yoga practices for 35 minutes daily in the presence of trained yoga teacher for 12 weeks. Control group did not undergo any kind of yoga practice or stress management. Physiological parameters like heart rate, respiratory rate, and blood pressure were measured. Global Assessment of Recent Stress Scale and Spielbergers State Anxiety score were assessed at baseline and during the examination. Serum cortisol levels, IL-4, and IFN-γ levels were determined by enzyme-linked immunosorbent assay technique. RESULT: In the yoga group, no significant difference was observed in physiological parameters during the examination stress, whereas in the control group, a significant increase was observed. Likewise, the indicators of psychological stress showed highly significant difference in control group compared with significant difference in yoga group. During the examination, the increase in serum cortical and decrease in serum IFN-γ in yoga group was less significant (P<0.01) than in the control group (P<0.001). Both the groups demonstrated an increase in serum IL-4 levels, the changes being insignificant for the duration of the study. CONCLUSION: Yoga resists the autonomic changes and impairment of cellular immunity seen in examination stress.

Effect of iron deficiency anemia on audiovisual reaction time in adolescent girls.

Adolescent girls are at high risk of developing iron deficiency because of increased iron demands during puberty, menstrual losses, and limited dietary iron intake. This study was carried out to demonstrate the effects of Iron Deficiency Anemia on Audiovisual reaction time in adolescent girls. Adolescent girls between 17-19 years of age with similar socioeconomic background were recruited from college of nursing for the study. They were all screened and categorized into two groups depending on their haemoglobin status. Students having Hb > 12 gm/dl formed the control group i.e. Group I (n=30). All students having Hb < 12 gm/dl and S. Ferritin < 12 microg/dl formed group II i.e. iron deficient anemic (IDA) group. The following haematological parameters were studied Hemoglobin (Hb), MCV, MCH, MCHC (using Sysmex kx-21 Autoanalyser), Serum.Iron, TIBC (Spectrophotometry), Serum.Ferritin (ELISA). Auditory and Visual reaction time were measured by reaction time instrument supplied by Medicaid system, chandigarh. The mean Hb levels in Group I was 12.93 +/- 0.86 and Group II was 10.08 +/- 0.51 (P<0.001). The MCV, MCH, MCHC, S. Iron, S. Ferritin was also significantly less in group II as compared to group I (P<0.001). TIBC was significantly more in group II as compared to group I (P<0.001). Results showed that both ART and VRT were significantly increased (P<0.001) in iron deficient adolescents suggesting a deterioration in sensorimotor performance in anemics.