Impact of integrated yoga therapy on cognitive impairment and cardiac dysfunction in relation to quality of life in breast cancer patients undergoing chemotherapy: Study protocol for a two-arm randomized controlled trial.

Background: Chemotherapy-related cognitive impairment (CRCI) and cardiac dysfunction (CRCD) are common adverse effects seen in breast cancer patients undergoing chemotherapy. Even though these effects significantly influence daily functioning and overall quality of life, effective strategies to avoid and/or mitigate these adverse effects remain elusive. Yoga as a Mind-body intervention has been used increasingly by cancer patients and has undergone empirical investigations as a potential intervention for patients with cancer. Furthermore, yoga is associated with improved cognition and cardiac functioning in healthy older adults and subjects with cognitive and cardiac impairments. Accordingly, in the current study, yoga holds promise as an intervention to prevent/manage CRCI and CRCD with improved overall QOL in women receiving chemotherapy for breast cancer. Methods: The study is a two-arm, randomized controlled trial. Women diagnosed with stage I-III breast cancer and awaiting neo-adjuvant or adjuvant chemotherapy will be recruited from a tertiary care center in Bangalore, India. Following recruitment, subjects are randomized to the intervention group (integrated yoga therapy intervention during chemotherapy) or the control group (standard care during chemotherapy). The study's primary outcome is to measure the quality of life (cognitive domain) using European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The other primary objectives will include cognitive functioning using neuropsychological test battery and cardiac autonomic function testing using heart rate variability. Secondary outcomes are Brain-derived neurotrophic factor (BDNF), brain function (functional MRI), Echocardiography, serum cortisol, Functional assessment of cancer therapy-cognition (FACT-Cog V3), perceived stress scale and Ryff Scales of Psychological Well-Being. Assessments take place before, during and after chemotherapy; 16-weeks post chemotherapy and 1-year post-baseline. Discussion: Yoga is a promising intervention for preventing and/or managing chemotherapy-related adverse effects (CRAE) and enhancing the quality of life among breast cancer patients. The findings from this study may also help understand the inner mechanisms involved in the protective and restorative effects of yoga on CRAE and support the use of yoga prophylactically for breast cancer patients. In addition, the results of this study could help chemotherapy-exposed individuals with other solid cancer types who have cognitive and cardiac issues. Ethics and Dissemination: The study is approved by the ethics committee of the HealthCare Global Enterprises Ltd. Hospital (EC/434/19/01) and National Institute of Mental Health and Neurosciences (NIMH/DO/ETHICS SUB-COMMITTEE (BS&NS) 9th MEETING/2018). Clinical Trial Registration: http://ctri.nic.in/Clinicaltrials/advancesearchmain.php, identifier CTRI/2020/10/028446.

Effectiveness of yoga on arterial stiffness: A systematic review.

OBJECTIVES: Arterial stiffness is a major cardiovascular (CV) risk and an independent strong predictor of CV morbidity and mortality. The aim of this systematic review is to evaluate the clinical or interventional studies that assessed the effectiveness of yoga on arterial stiffness in participants of any age or sex, healthy or with any conditions. DESIGN: Systematic review of clinical trials or interventional studies. DATA SOURCES: Cochrane Library, Medline/PubMed, Scopus, and Google Scholar databases. REVIEW METHODS: Databases were searched till July 2019 for clinical trials or interventional studies whether controlled or uncontrolled, randomized or non-randomized studies assessing the effects of yoga on arterial stiffness. Quality of the studies was assessed by using Physiotherapy Evidence Database (PEDro) Scale. RESULTS: Seven full-text articles (total number of participants = 362) that evaluated the effect of yoga on arterial stiffness were included in this review. There were three randomized controlled studies and four were non-controlled studies (single group studies). Four studies have shown significant reduction in arterial stiffness, while three studies did not find any significant change in arterial stiffness. The beneficial effects of yoga intervention on arterial stiffness in young adults and elderly hypertensive patients are encouraging. Methodological quality was good for one study, moderate for two studies and poor for four studies. CONCLUSIONS: This review shows that yoga practice is effective in preventing or reducing the arterial stiffness in young healthy and obese, and elderly hypertensive patients. As the methodology of many studies is of low quality and safety measures were not reported, there is a need of quality randomized controlled trials of yoga effects on arterial stiffness among high risk individuals.

Evidence-based medicine in pre-clinical years: a study of early introduction and usefulness.

INTRODUCTION: Evidence Based Medicine (EBM) has established itself as a strong predictor of future medical practice by medical students. The purpose of this study was to determine the effectiveness of EBM in pre-clinical years and reflect on self-assessment skill of 4th semester medical students regarding the understanding of EBM and its various determinants. METHODS: All of the 4th semester (MD4) medical students at the Avalon University of Medical School, Curacao who had completed their EBM curriculum were asked to voluntarily participate in a cross sectional student survey containing qualitative and quantitative questionnaires in a 10-point scale. The students' responses were analyzed statistically and the results reported. RESULTS: Twenty-three students participated in the survey. 91% of them reported that EBM had helped them to better understand research process and 95% believed that EBM was necessary to develop clinical skills in the future. 78% of the students agreed that they were provided with enough resources for effective implementation of EBM in the university. All participants (100%) self reported that they could appraise the research articles effectively (mean score 8.26, S.D-1.45). CONCLUSIONS: EBM is an integrative and comprehensive way to successfully adopt concepts of acquired medical knowledge for effective medical practice. Early introduction of EBM in preclinical years proved favorable in students and better equipped them with the ability to critically apprehend and appraise new research and innovations in medicine for optimal learning experience. There is a definitive need for scientific and systematic design of the curriculum for early introduction of EBM in pre-clinical years, best suited for the students. The principles should be directed towards further research for the effective implementation of EBM to enhance clinical skills.

(177)Lu-DOTATATE therapy in patients with neuroendocrine tumours: 5 years' experience from a tertiary cancer care centre in India.

PURPOSE: The choice of an appropriate treatment option in patients with inoperable or metastatic neuroendocrine tumours (NETs) is limited, and approximately 50 % of patients have advanced NET at diagnosis, and 65 % die within 5 years. Treatment with (177)Lu-DOTATATE ((177)Lu-[DOTA(0),Tyr(3)] octreotate) is a promising new option in the treatment of metastatic NETs. METHODS: Patients with metastatic NET who underwent (177)Lu-DOTATATE during the period 2009 to 2013 were included in this retrospective study. Follow-up imaging studies including a (68)Ga-DOTANOC PET/CT scan and a posttherapy (177)Lu-DOTATATE scan were compared with baseline imaging to determine response to treatment. Progression-free survival (PFS) was calculated using the Kaplan-Meier method and Cox regression analysis was also done. RESULTS: Ten patients (25 %) had a minimal response, 13 (32.5 %) had a partial response and 9 (22.5 %) had stable disease. Progressive disease was seen in 8 patients (20 %), including 6 patients who died during or after the treatment period. The estimated mean PFS in those who received one or two cycles of (177)Lu-DOTATATE was 8.3 months (95 % CI 6.2 to 10.3 months) compared to an estimated mean PFS of 45.6 months (95 % CI 40.9 to 50.2 months) in those who received more than two cycles of (177)Lu-DOTATATE (log-rank Mantel-Cox Χ (2) = 8.01, p = 0.005). CONCLUSION: Our study showed that treatment with (177)Lu-DOTATATE should be considered in the management of NETs, considering the limited success of alternative treatment modalities. Treatment response and PFS is determined primarily by the dose delivered and best results are obtained when more than two cycles of (177)Lu-DOTATATE are given, with careful monitoring for possible side effects.

Detection of Bacterial Flora in Orofacial Space Infections and Their Antibiotic Sensitivity Profile.

INTRODUCTION: Most odontogenic infections arise as a sequel of pulp necrosis caused by caries, trauma, periodontitis, etc. They range from periapical abscesses to superficial and deep infections in neck. Some resolve with little consequence and some lead to severe infections of head and neck region. The purpose of this study was to identify microbial flora present in orofacial space infection of odontogenic origin and thereby provide better perspective in management of odontogenic infection. MATERIALS AND METHODS: Twenty-six patients with space infection of odontogenic origin were selected irrespective of their age and gender. Pus samples were collected and processed in the microbiology laboratory for the growth of anaerobic and aerobic bacteria and antibiotic sensitivity profile. RESULTS: Demographic profile of the patients showed that male patients were more commonly involved and most patients fell in to the third and fourth decade of age groups. Most common site of involvement was submandibular space. Alpha hemolytic streptococci were the frequent aerobic bacterial isolate and among anaerobes, anaerobic streptococci followed by bacteroids were the major pathogens. Clindamycin, Gentamycin, Linezolid, Imipenam were the most effective antibiotics. 20 % of the aerobes were resistant to penicillin. CONCLUSION: Streptococcus species are still the commonest pathogen in orofacial infections of odontogenic origin. Administration of amoxicillin clavulanic acid combination and metronidazole followed by surgical drainage of abscess and extraction of infected teeth, yielded satisfactory resolution of infection.

Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial.

UNLABELLED: Objectives. This study compares the effects of an integrated yoga program with brief supportive therapy in breast cancer outpatients undergoing adjuvant radiotherapy at a cancer center. METHODS: Eighty-eight stage II and III breast cancer outpatients are randomly assigned to receive yoga (n = 44) or brief supportive therapy (n = 44) prior to radiotherapy treatment. Assessments include diurnal salivary cortisol levels 3 days before and after radiotherapy and self-ratings of anxiety, depression, and stress collected before and after 6 weeks of radiotherapy. RESULTS: Analysis of covariance reveals significant decreases in anxiety (P < .001), depression (P = .002), perceived stress (P < .001), 6 a.m. salivary cortisol (P = .009), and pooled mean cortisol (P = .03) in the yoga group compared with controls. There is a significant positive correlation between morning salivary cortisol level and anxiety and depression. CONCLUSION: Yoga might have a role in managing self-reported psychological distress and modulating circadian patterns of stress hormones in early breast cancer patients undergoing adjuvant radiotherapy.

Fungal glucoamylases.

Glucoamylase (alpha-1,4-glucan glucohydrolase, EC 3.2.1.3) from fungal sources is one of the microbial glycoproteins that has received considerable attention particularly because it is used in the commercial production of dextrose. Several investigators have isolated glucoamylase from various fungal sources. In many instances the presence of more than one form of enzyme is common. The enzymes from most sources have pH optima between 4 and 5 and exhibit maximum activity between 40 and 60 degrees C. The enzyme does not require any cofactors for activity or for stability. The enzyme has an Mr between 48,000 and 80,000 and usually has no subunit structure. The amino acid composition of multiple forms of glucoamylases differ in general, but all of them are glycoproteins. The carbohydrate content of the enzyme ranges from 3 to 30% containing mainly mannose, but glucose, galactose, and in some instances glucosamine and xylose are also present. In the enzyme from Aspergillus the carbohydrate structures are present as mono-, di-, tri-, and tetrasaccharide units linked O-glycosidically through mannose to the hydroxyl groups of serine and threonine. In the enzyme from Rhizopus part of the carbohydrate is present as disaccharide (Man-Man-) units linked O-glycosidically and the remainder is present as large heterosaccharide structures attached by N-glycosidic linkages involving aspargine and glucosamine. Carbohydrate moieties seem to have no influence on the enzyme activity or antigenicity but appear to stabilize the enzyme by preserving the three-dimensional structure.

Methionine-repressible homoserine dehydrogenase of Serratia marcescens: purification and properties.

Serratia marcescens Sa-3 possesses two homoserine dehydrogenases and neither has any aspartokinase activity unlike the case of Escherichia coli enzymes. The two enzymes have been separated. One of them is active with either NAD+ or NADP+ and has been purified about 180-fold to homogeneity. This enzyme is completely repressed by the presence of 1 mM methionine or homoserine in the growth medium, but its activity is unaffected by any amino acid of the aspartate family either singly or together. In many of its properties (such as pH optimum, Km for substrate and cofactors), it resembles its counterpart in E. coli K12. Potassium ions stabilize the enzyme but are not essential for activity. Its molecular weight is around 155,000 as determined by gel filtration and approximately 76,000 by SDS-polyacrylamide gel electrophoresis. This suggests that the enzyme has two subunits (polypeptide chains) in the molecule: 8 M urea has no effect on enzyme activity. This enzyme represents approximately 30% of the total homoserine dehydrogenase activity of S. marcescens unlike in Salmonella typhimurium and E. coli K12 where it is a minor or a negligible component.