Assessment of the diagnostic accuracy of Vibrasense compared to a biothesiometer and nerve conduction study for screening diabetic peripheral neuropathy.

AIMS: Peripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN. METHODS: A total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS. RESULTS: Average VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman's correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively. CONCLUSIONS: Vibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings. TRIAL REGISTRATION: Clinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022.  https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167 .

Integrated Yoga Practice in Cardiac Rehabilitation Program: A Randomized Control Trial.

Background: Coronary artery disease (CAD) is a detrimental noncommunicable disease, which is increasing due to sedentary lifestyle and urbanization in the young population. It is further elevated with risk factors such as stress, anxiety, depression, an increase in triglycerides, dyslipidemia, hyperglycemia, hypertension, and so on, which manifests as atherosclerotic disease. Yoga-based lifestyle intervention is a noninvasive effective treatment method to control and prevent cardiac risk factors in CAD patients. Yoga has been used in India as a therapeutic method to manage hypertension and other chronic disorders and is fast gaining popularity as an effective means for the alleviation of stress, improvement of fitness, and enhancement of well-being. This study aimed to determine the feasibility of introducing the integrated approach of yoga therapy (IAYT) in a cardiac rehabilitation center in India and understand its usefulness in improving the cardiac function and managing the cardiac risk factors in acute myocardial infarction patients with left ventricular dysfunction. Methods and Design: Cardiac patients were randomized to a yoga-practicing group (n = 33) and a control group (n = 33). The yoga-practicing group was instructed to attend three supervised IAYT classes 3 days per week for 12 weeks at the hospital yoga center. The control group received standard care that included pharmacologic treatment and the instructions of the cardiologist. The outcome measures were assessed at baseline (T1 = 0) and completion (T2 = 3 months). The primary outcome measure was the left ventricular ejection fraction (LVEF). Results: There was no statistically significant difference in LVEF (U = 420.500, p value = 0.218) between the two groups. However, the yoga-practicing group showed significant reduction in depression (Cardiac Depression Scale [CDS], U = 71, p value = 0.0), anxiety (Hamilton Anxiety Rating Scale [HAM-A], U = 128, p value = 0.0), and a significant increase in quality of life (QOL) scores (Duke Activity Status Index [DASI], U = 146, p value = 0.0; and metabolic equivalents (METs), U = 136, p value = 0.0) at 3 months compared to control. Overall, the CAD patients practicing yoga showed a favorable profile compared to control individuals on CDS, HAM-A, DASI, and MET outcomes. Control and yoga practicing groups did not differ significantly in the lipid levels. Conclusion: This study indicated that the integration of yoga practice in a cardiac rehabilitation program is feasible and has no added benefit in improving the cardiac function. However, the addition of yoga to cardiac rehabilitation may be beneficial in reducing depression and anxiety and improving QOL in patients.

Cross-cultural differences in simple taste preferences.

A population of Indian laborers who show high preferences for sour and bitter tastes has been studied. Their judgments of taste intensity and pleasantness of sweet and salty stimuli are in accord with European population estimates, which suggests that dietary history may alter preferences for simple taste stimuli without affecting the gustatory system.

Evidence Base of Yoga Studies on Cardiovascular Health: A Bibliometric Analysis.

Noncommunicable diseases including coronary artery disease contribute to approximately 50% of global mortality. Pharmacological treatment alone may not be a panacea for such diseases since it may be associated with various other adverse effects. Hence, strategies such as Yoga involving healthy lifestyle and stress management are widely sought by the patient population. MATERIALS AND METHODS: An electronic search of PubMed as a standard bibliographic database was performed through February 2015 using the keywords "Yoga" and "Cardiovascular." Studies with Yoga as the independent variable and parameters related to cardiac health as the dependent variable were included and exclusion criteria were applied. RESULTS: A total of 149 publications were identified which met the inclusion criteria for analysis. Of the total publications, 44% were clinical trials of which 19% were randomized controlled trials which may be categorized as high-quality ones. An upward trend in the overall research in this area is evident. Major work has been accomplished by researchers of the United States (38%) and India (29%). CONCLUSION: The survey indicates that the number of publications in the field of "Yoga" and "Cardiovascular" health has increased rapidly in the late years. Analysis comprising the nation/state helps define its status with regard to its counterparts and helps understand science priorities and disease control strategies in an effort to provide cost-effectiveness and quality control. There is a need for further high-quality studies in the field of "Yoga" and "Cardiovascular" diseases to validate the effects of Yoga on health parameters.

Effect of high-altitude hypoxia on feeding responses and hedonic matrix in rats.

Albino male rats (n = 78) were exposed to a simulated high altitude (HA) equivalent to 7,620 m for 6 h daily, contiguously for a period of 21 days, to study their feeding behavior and gustatory responses. Their food, water intake, and body weight were recorded daily, and blood sugar and blood insulin were estimated once a week. All the parameters were recorded for a period of 3 wk each before, during, and after exposure to simulated HA. The results show a decrease in daily food and water intakes and body weight and mild hyperglycemia and hyperinsulinemia during hypoxic exposure. The 1-h single-bottle taste solution test showed a preference for sweet solutions (13% glucose and 0.2% saccharine) over citric acid (0.16%), sodium chloride (0.9%), and quinine sulfate (0.001%) during exposure to simulated HA. The 1-h two-bottle test containing glucose (calories plus taste) and saccharine (taste but no calories) administration showed a preference for the glucose solution over the saccharine solution. The trend of the 1-h intake of all test solutions also showed a reversal to preexposure levels after termination of HA hypoxia. It would appear that high-altitude stress influences food intake in a manner that sensory cues (e.g., preference for sweet substances) become more important.

Taste impairment for glucose in diabetic PTC tasters and non-tasters.

Effect of high blood glucose levels in diabetes mellitus was studied on gustatory responses to glucose in PTC tasters and non-tasters, before and after the ingestion of a glucose solution. After a 12-h overnight fast, prescreening for phenylthiocarbamide (PTC) sensitivity was done in each subject, and then each subject tasted, and rated, 7 concentrations of glucose solutions for intensity and hedonic responses. Blood glucose levels were also determined under fasting and then after a 100-g glucose load. A decrease in palatability of the glucose solutions induced by the glucose load (negative alliaesthesia) was evident in both groups of subjects. Tasters showed higher hedonic ratings (Mean 4-25), as compared to non-tasters (Mean 3-70) and this difference was more evident after the glucose load in non-tasters.

Effects of medial septal stimulation & its blockade with atropine on hippocampal rhythmical slow activity in free-moving rabbits.

The influence of the medial septal nucleus (MSN) on hippocampal rhythmical slow activity (RSA) was investigated in hunger motivated free-moving rabbits. Single unit activity of 29 CA3 dorsal hippocampal neurones was studied under two paradigms viz., electrical stimulation (3v/1msec/5Hz) and chemical blockade of atropine-sensitive medial septal cells (dose of 5 micrograms in 5 microliters). The analysis of interspike interval sample histograms recorded with Apple II, along with single unit neuronal spikes recorded on polygraph showed bimodal pattern with two peaks; one at bin 10-20 (high frequency) and second at bin 100-300 (theta frequency). On stimulation of MSN, there was total suppression of bin 100-300 with peaks at bin 1-20 and at bin greater than 1000 (very low frequency). Blockade of cholinergic receptors at MSN showed reduction of bin 100-300 and peak at bin 700- greater than 1000; this was followed by gradual decrease of spike's amplitude and thereafter its total abolition. The results indicate that the septal region is not a pacemaker per se in the genesis of hippocampal RSA (theta rhythm), but serves more in the nature of a relay station for a number of inputs and that its influence on the hippocampal electrical activity depends on the integrity of cholinergic inputs, be it from hippocampus proper or from mid-brain reticular formation.

Hypobaric hypoxia and hedonic matrix in rats.

This study was carried out to evaluate the effect of continuous exposure to hypobaric hypoxia on the feeding behavior and taste responses of rats, under simulated conditions of a high altitude (HA) of 7,620 m for 21 h a day and consecutively for 18 d, which more closely resembles actual field conditions. Their food, water intake and body weight were recorded daily, and blood sugar was estimated once a week. All the parameters were recorded for a period of 18 d each, before, during, and after exposure to simulated HA. The results show a decrease in daily food and water intake and body weight, and mild hypoglycemia during hypoxic exposure. Single-bottle and two-bottle tests showed a preference for sweet solutions over water, citric acid, sodium chloride, and quinine sulfate during exposure. The two-bottle test showed a preference for glucose over calorically-inert saccharine. The continuous exposure in this study produced qualitatively similar but quantitatively accentuated results as compared to intermittent 6 h exposure contiguously for 21 d. High-altitude stress appears to influence food intake such that sensory cues assume greater significance during feeding behavior.

High altitude effects on human taste intensity and hedonics.

BACKGROUND: The study was conducted on human volunteers taken to 3500 m altitude for a period of 3 wk. METHODS: Subjects rated four compounds representing sweet, salty, sour and bitter taste, and the hedonic matrix in terms of taste threshold, taste intensity, and taste hedonicity were recorded using category scale. Blood sugar levels were estimated weekly. RESULTS: An increase in the taste thresholds for glucose and sodium chloride was shown while quinine sulphate and citric acid thresholds recorded a decrease. The taste intensity ratings showed a linear relationship with increasing logarithmic molar concentrations of each solution, as compared with taste hedonicity which showed an inverted 'U' type function. The blood picture did not reveal any change in the blood sugar level. All the parameters recorded at high altitude (HA) showed a tendency to return to basal values after reinduction to sea level. CONCLUSION: The study suggests that HA hypoxic stress brings about changes in the hedonic responses, primarily an increased palatibility for sweetness; we speculate that the mechanism may be anorexia-linked nutritional stress.

Serum rhodanese in goitre and calcific pancreatitis of tropics.

Rhodanese is one of the enzymes concerned in the detoxification of cyanide. Cassava intake and consequent cyanide toxicity are incriminated in the pathogenesis of goitre and calcific pancreatitis of tropics. So we studied the activity of rhodanese in these patients. 14 controls, 13 patients with pancreatitis and 12 with goitre were studied. The median (and range) of rhodanese in these groups were 82 (50-144), 110 (64-180) and 71 (22-160) units respectively. The serum rhodanese was significantly higher (P less than 0.05) in patients with pancreatitis when compared to the other groups. There was no significant difference between the serum rhodanese in patients with goitre and the controls. The presence of adequate amounts of rhodanese indicates that goitre and chronic pancreatitis are not produced by impaired cyanide detoxification.

Effects of disruption of diurnal rhythms in food intake of rats.

The calorie intake, body weight (bw) maintenance and oral intake of ad lib fed (Gr I) and feeding rhythm-disrupted (Gr II) adult rats of either sexes are investigated. Gr I calorie intake (19.2 +/- 0.6 cal/100 gm bw) and bw (214 +/- 5.6 gms) were stabilized after 130-140 days of age. Rats of similar age (130-140 days) on feeding rhythm disruption (Gr II) showed initial decrease in calorie intake and bw but 136 days later their bw (224 +/- 6.5 gms) was similar to Gr I bw (226 +/- 9.2 gms) though calorie intake (17.5 +/- 0.4 cal/100 gm bw) was still less as compared Gr I intake. This disparity in calorie intake and bw in Gr II appears to be linked to the adaptive metabolic changes. The solution and mixed-diets tests showed that oral intake is taste-dependent in Gr II but not in Gr I. Gr II intake was increased on sweet taste and decreased on salt and bitter tastes indicating that feeding rhythm-disruption enhances sensory regulation of intake in contrast to calorie regulation found predominant on free feeding.

Effect of dehydration and a few regimes of rehydration on human performance.

The present study was prompted by the controversy about the effect of heat-induced dehydration on human performance, and the popular Indian belief that it is not advisable to take water immediately after prolonged exertion in the sun. The points investigated were: (i) the effect of dehydration on some aspects of physical and mental performance, and (ii) variation in the post-dehydration performance caused by the timing of rehydration. Dehydration amounting to 2% of body weight did not impair mechanical efficiency while 3% dehydration reduced the endurance time for isometric contraction of extensors of the forearm. The maximum isometric tension and mental performance, measured by proof reading and a choice reaction time experiment, were not affected. The studies suggested that once dehydration had been produced, rehydration or its timing did not make any difference. Analysis of the results in terms of the sequence in which the experiments were done suggested the influence of psychological factors on the performance measured.

Diuresis during fluid infusion : buffer nerve and spinal influences on it.

The rate and cumulative volume of diuresis were measured sequentially for each incremental infusion dose of 5 ml/kg body weight till a 100 ml/kg or more dose was reached. Normal saline (NS), Ringer-Locke (RL) and tender coconut water (TCW) were infused in three groups each of paraldehyde (PLD), and chloralose and urethane (C & U) anaesthetised dogs. The slow infusion rate of about 0.5 ml/kg/min was used. The RL infusion was repeated in vagotomised and/or carotid sinus (CS) denervated dogs and spinal dogs with or without intact vagi. During the NS and RL infusion schedules in PLD anaesthetised dogs produced much less urine than C & U groups. The order of minimum to maximum diuretic effect caused by these fluids were RL, NA and TCW in PLD groups and NA, TCW and RL in C & U groups. The study indicates that the type of anaesthesia and the composition of infusion fluid determines the rate of infusion induced diuresis. PLD anaesthesia has antidiuretic effect, which is not overcome by vagotomy. In C & U anaesthetised dogs the vagotomy and CS denervation performed separately greatly increased the rate of infusion induced diuresis but the diuresis largely decreased when combined surgery was performed. The diuresis in spinal dogs was very low, though in the vagotomised-spinal dogs, the rate of diuresis was more than in the spinal dogs.

Vagus stimulation effects during various doses of fluid infusion in dogs.

Stimulation of caudal and cranial ends of vagi in vagotomised chloralose-urethane anaesthetised dogs with 7.5V, 30Cps pulses of 2 msec width after 0, 25, 50, 75 and 100 ml/kg body weight infusion dose of Ringer-Locke solution caused well known effects on heart rate, BP, amplitude of peripheral blood pressure waves, amplitude and frequency of respiration and amplitude of ECG waves. The vagal stimulation effects did not appear to be related to volume of fluid infused into circulation except that caudal end stimulation effect on QRS amplitude was prominent during higher infusion doses while its effect on amplitude of peripheral blood pressure waves and respiration was prominent during lower infusion doses.

Electrolyte changes in plasma and urine during tender coconut water infusion in dogs.

Intravenous infusion of tender coconut water to paraldehyde and chloralose-urethane anaesthetised dogs at a rate of 0.5 ml/kg/min to a total dose of 100 ml/kg body weight decreased serum Na and increased K and Ca levels. Simultaneously, urinary Na excretion decreased and K and Ca excretion increased and there was glycosuria. Serum electrolyte changes were more prominent in paraldehyde anaesthetised dogs.

Electrophysiological correlates of diurnal feeding rhythm disruption in rats.

Electrical activity was recorded simultaneously from Ventromedial (VMH) and Lateral Hypothalamus (LH) in chronically prepared rats before and during one hour gustation tests as also during and after food intake in Group I (ad lib feeding) and Group II (3-hour food schedule) animals. The VMH/LH activity designated as Response Ratio (RR) was calculated and gave a better index of the food related behaviour. The basal RR was higher in Group I as compared to Group II rats but the response to glucose and saccharin ingestion showed a differential pattern of decrease after glucose intake in Group I and an increase in Group II. By contrast, on saccharin intake, Group I showed an increase. RRs after food intake did not show a significant change in both Group I and II rats.

Visual evoked potential in young adults: a normative study.

It is important to acquire adequate normative data of visual evoked potential before using it as a diagnostic tool. A study using visual evoked potential with pattern (VEP-P) was conducted in Twenty male and seven female young healthy subjects of 17-35 years age. Ag/Agcl electrodes anchored on scalp with collodion at O1-A1, O2-A2 (10-20 system), with transition skin to electrode impedence kept at less than 5 K ohms were connected to MEB 5200 Evoked potential Recorder (Nihon Kohden, Japan). The evoked responses to 256 visual stimuli were recorded using transient pattern reversal (checker size 32'), frequency 1/sec and contrast between black and white checks 67%. The responses were averaged by the computer and absolute peak latency values for P100 alongwith other positive and negative waves worked out. P100 latency of 95.37 +/- 6.85, amp. 6.4 +/- 2.38 for males and 91.07 +/- 49 msec, amp. 6.88 +/- 2.79 microv for females are being reported. The P100 latency values of present study are similar to those reported in age and sex matched subjects of the western world, indicating that there are no ethnic variations in P100 of VEP.

Effect of third ventricular injection of beta-endorphin on the electrophysiological responses of some regions of endocrine hypothalamus.

Multiunit activity (MUA) of arcuate nucleus and cortical EEG were recorded in the regularly cycling female rats on the day of proestrous under urethane anaesthesia. The MUA was compared before and after injection of beta-endorphin in third ventricle. In some animals MUA increased after 30-40 min and persisted for 3-4 hr, in others MUA got inhibited within 5-10 min of injection of beta-Endorphin and effect lasted for 5-6 hr. There was no change in frontoparietal EEG activity. In another group of animals medial pre-optic responses (MPO) to stimulation of medial amygdala were tested before and after ventricular infusion of beta-endorphin. Most of the facilitatory MPO responses got blocked. These observations suggest the involvement of opioid receptors in the mediation of neuroendocrine control of preovulatory events through the amygdalo-preoptico-medial basal hypothalamic axis. There seems to be heterogeneity of beta-endorphin receptors in the arcuate nucleus.

Urinary bladder serosal chemoreceptor induced cardio-respiratory responses: possible pathway.

There is limited experimental information about pain originating from the urinary bladder. In the present study application of 3-5 ml of 1% ammonium oxalate, 1% potassium chloride, 100m M citric acid, IM ammonium chloride, 1% oxalic acid, 0.5% sodium hydroxide, or 2 micrograms/ml bradykinin, to the serosal surface of the urinary bladder in anaesthetized dogs, resulted in an increase in heart rate, rise of both systolic and diastolic blood pressures and increase in respiratory rate and depth. These facilitatory cardio-respiratory responses were coupled with powerful contractions of the urinary bladder wall. By contrast, mucosal application of the chemicals did not bring about any significant change. The cardio-respiratory responses obtained were completely abolished on serosal application of procaine (1%), section of the hypogastric nerves or by spinalectomy at T8. Bilateral cervical vagotomy and pelvic nerve section did not modify the responses. However, the blood pressure responses were abolished by the administration of tolazoline hydrochloride, indicating a major role of sympathetics in this nociceptive reflex.