Systemic Anti-Inflammatory Therapy Aided by Curcumin-Laden Double-Headed Nanoparticles Combined with Injectable Long-Acting Insulin in a Rodent Model of Diabetes Eye Disease.

Therapeutic interventions that counter emerging targets in diabetes eye diseases are lacking. We hypothesize that a combination therapy targeting inflammation and hyperglycemia can prevent diabetic eye diseases. Here, we report a multipronged approach to prevent diabetic cataracts and retinopathy by combining orally bioavailable curcumin-laden double-headed (two molecules of gambogic acid conjugated to terminal carboxyl groups of poly(d,l-lactide-co-glycolide)) nanoparticles and injectable basal insulin. The combination treatment led to a significant delay in the progression of diabetic cataracts and retinopathy, improving liver function and peripheral glucose homeostasis. We found a concurrent reduction in lens aggregate protein, AGEs, and increased mitochondrial ATP production. Importantly, inhibition of Piezo1 protected against hyperglycemia-induced retinal vascular damage suggesting possible involvement of Piezo1 in the regulation of retinal phototransduction. Histologic evaluation of murine small intestines revealed that chronic administration of curcumin-laden double-headed nanoparticles was well tolerated, circumventing the fear of nanoparticle toxicity. These findings establish the potential of anti-inflammatory and anti-hyperglycemic combination therapy for the prevention of diabetic cataracts and retinopathy.

Effect of Mobile Phone-Induced Electromagnetic Field on Brain Hemodynamics and Human Stem Cell Functioning: Possible Mechanistic Link to Cancer Risk and Early Diagnostic Value of Electronphotonic Imaging.

The mobile phones (MP) are low power radio devices which work on electromagnetic fields (EMFs), in the frequency range of 900-1800 MHz. Exposure to MPEMFs may affect brain physiology and lead to various health hazards including brain tumors. Earlier studies with positron emission tomography (PET) have found alterations in cerebral blood flow (CBF) after acute exposure to MPEMFs. It is widely accepted that DNA double-strand breaks (DSBs) and their misrepair in stem cells are critical events in the multistage origination of various leukemia and tumors, including brain tumors such as gliomas. Both significant misbalance in DSB repair and severe stress response have been triggered by MPEMFs and EMFs from cell towers. It has been shown that stem cells are most sensitive to microwave exposure and react to more frequencies than do differentiated cells. This may be important for cancer risk assessment and indicates that stem cells are the most relevant cellular model for validating safe mobile communication signals. Recently developed technology for recording the human bio-electromagnetic (BEM) field using Electron photonic Imaging (EPI) or Gas Discharge Visualisation (GDV) technique provides useful information about the human BEM. Studies have recorded acute effects of Mobile Phone Electromagnetic Fields (MPEMFs) using EPI and found quantifiable effects on human BEM field. Present manuscript reviews evidences of altered brain physiology and stem cell functioning due to mobile phone/cell tower radiations, its association with increased cancer risk and explores early diagnostic value of EPI imaging in detecting EMF induced changes on human BEM.

Designing, validation and feasibility of a yoga-based intervention for elderly.

CONTEXT: Ageing is an unavoidable facet of life. Yogic practices have been reported to promote healthy aging. Previous studies have used either yoga therapy interventions derived from a particular school of yoga or have tested specific yogic practices like meditation. AIMS: This study reports the development, validation and feasibility of a yoga-based intervention for elderly with or without mild cognitive impairment. SETTINGS AND DESIGN: The study was conducted at the Advanced Centre for Yoga, National Institute for Mental Health and Neurosciences, Bangalore. The module was developed, validated, and then pilot-tested on volunteers. MATERIALS AND METHODS: The first part of the study consisted of designing of a yoga module based on traditional and contemporary yogic literature. This yoga module along with the three case vignettes of elderly with cognitive impairment were sent to 10 yoga experts to help develop the intended yoga-based intervention. In the second part, the feasibility of the developed yoga-based intervention was tested. RESULTS: Experts (n=10) opined the yoga-based intervention will be useful in improving cognition in elderly, but with some modifications. Frequent supervised yoga sessions, regular follow-ups, addition/deletion/modifications of yoga postures were some of the suggestions. Ten elderly consented and eight completed the pilot testing of the intervention. All of them were able to perform most of the Suksmavyayama, Pranayama and Nadanusandhana (meditation) technique without difficulty. Some of the participants (n=3) experienced difficulty in performing postures seated on the ground. Most of the older adults experienced difficulty in remembering and completing entire sequence of yoga-based intervention independently. CONCLUSIONS: The yoga based intervention is feasible in the elderly with cognitive impairment. Testing with a larger sample of older adults is warranted.

Development and feasibility of yoga therapy module for out-patients with depression in India.

CONTEXT: Evidence suggests that certain yoga practices are useful in the management of depression. To the best of our knowledge, there has been no study that deals with the formulation of a yoga module for the particular clinical features of depression. AIM: The main aim of our study was to develop a comprehensive yoga therapy module targeting specific clinical features of depression. SETTINGS AND DESIGN: Specific yoga practices were matched for clinical features of depression based on a thorough literature review. A yoga program was developed, which consisted of Suksmavyayama, (loosening exercises), äsanas (postures), relaxation techniques, Pranayama (breathing exercises) and chanting meditation to be taught in a 2 week period. MATERIALS AND METHODS: A structured questionnaire was developed for validation from nine experienced yoga professionals. The final version of yoga therapy module was pilot-tested on seven patients (five females) with depression recruited from outpatient service of National Institute of Mental Health and Neuro Sciences, Bangalore. RESULTS: The final yoga therapy module had those practices that received a score of three or more (moderately/very much/extremely useful) from all responders. Six out of nine (>65%) experts suggested Suksmavyayama should be included. Five out of nine experts opined that training with 10 sessions (over 2 weeks) is rather short. All experts opined that the module is easy to teach, learn and practice. At the pilot stage, the five patients who completed the module reported more than 80% satisfaction about the yoga practices and how the yoga was taught. Severity of depression substantially reduced at both 1 and 3 months follow-up. CONCLUSION: The developed comprehensive yoga therapy module was validated by experts in the field and was found to be feasible and useful in patients with depression.

Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function.

CONTEXT: Elderly have increased risk for cognitive impairment and dementia. Yoga therapy may be helpful in elderly to improve cognitive function. AIMS: We examined the benefits of yoga-based intervention compared with waitlist control group on cognitive function in the residents of elderly homes. SETTINGS AND DESIGN: Single blind controlled study with block randomization of elderly homes. MATERIALS AND METHODS: Study sample included yoga group (n=62) and waitlist group (n=58). A total of 87 subjects (yoga=44, waitlist=43) completed the study period of 6 months. Yoga group received daily yoga sessions for 1 month, weekly until 3(rd) month and encouraged to continue unsupervised until 6 months. They were assessed on Rey's Auditory Verbal Learning Test (RAVLT), Rey's complex figure test (CFT), Wechsler's Memory Scale (WMS)-digit and spatial span, Controlled Oral Word Association (COWA) test, Stroop Color Word Interference Test and Trail Making Test A and B at baseline and at the end of 6(th) month. STATISTICAL ANALYSIS: Paired t-test and analysis of covariance (ANCOVA) to compare the difference in neuropsychological test scores. RESULTS: Yoga group showed significant improvement in immediate and delayed recall of verbal (RAVLT) and visual memory (CFT), attention and working memory (WMS-spatial span), verbal fluency (COWA), executive function (Stroop interference) and processing speed (Trail Making Test-A) than waitlist group at the end of 6 months after correcting for corresponding baseline score and education. CONCLUSION: Yoga based-intervention appears beneficial to improve several domains of cognitive function in elderly living in residential care homes. Study findings need to be interpreted after considering methodological limitations like lack of active comparison group.

Positive antidepressant effects of generic yoga in depressive out-patients: A comparative study.

CONTEXT: Therapeutic effects in depression of yoga adopted from different schools have been demonstrated. The efficacy of a generic module of yoga on depressed patients has not yet been tested in the literature. AIMS: The study was aimed to compare the therapeutic effect of a generic yoga module with antidepressant drugs in non-suicidal out-patients of major depression attending a psychiatric hospital. SETTINGS AND DESIGN: The study was outpatient-based using an open-labeled design. MATERIALS AND METHODS: A total of 137 out-patients of depressive disorders received one of the three treatments as they chose - yoga-only, drugs-only or both. The yoga was taught by a trained yoga physician for over a month in spaced sessions totaling at least 12. Patients were assessed before treatment, after 1 and 3 months on depression and Clinical Global Impression Scales. Out of 137, 58 patients completed the study period with all assessments. RESULTS: Patients in the three arms of treatment were comparable on demographic and clinical variables. Patients in all three arms of treatment obtained a reduction in depression scores as well as clinical severity. However, both yoga groups (with or without drugs) were significantly better than the drugs-only group. Higher proportion of patients remitted in the yoga groups compared with the drugs-only group. No untoward events were spontaneously reported in the yoga-treated patients. CONCLUSION: Within the limitations of this study, it can be concluded that the findings support a case for prescribing yoga as taught in the study in depressive non-suicidal out-patients.

Efficacy of yoga as an add-on treatment for in-patients with functional psychotic disorder.

CONTEXT: The efficacy of yoga as an intervention for in-patients with psychosis is as yet unknown; although, previous studies have shown efficacy in stabilized out-patients with schizophrenia. AIM: This study aimed to compare the effect of add-on yoga therapy or physical exercise along with standard pharmacotherapy in the treatment of in-patients with psychosis. SETTINGS AND DESIGN: This study was performed in an in-patient setting using a randomized controlled single blind design. MATERIALS AND METHODS: A total of 88 consenting in-patients with psychosis were randomized into yoga therapy group (n=44) and physical exercise group (n=44). Sixty patients completed the study period of 1½ months. Patients who completed in the yoga group (n=35) and in the exercise group (n=25) were similar on the demographic profile, illness parameters and psychopathology scores at baseline. RESULTS: The two treatment groups were not different on the clinical syndrome scores at the end of 2 weeks. At the end of 6 weeks, patients in the yoga group however had lower mean scores on Clinical Global Impression Severity (CGIS), Positive and Negative Syndrome Scale (total and general psychopathology subscale) and Hamilton Depression Rating Scale (HDRS) (P<0.05). Repeated measure analysis of variance detected an advantage for yoga over exercise in reducing the clinical CGIS and HDRS scores. CONCLUSION: Adding yoga intervention to standard pharmacological treatment is feasible and may be beneficial even in the early and acute stage of psychosis.

Feasibility and efficacy of yoga as an add-on intervention in attention deficit-hyperactivity disorder: An exploratory study.

CONTEXT: Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. Stimulant medication is frequently used in management, with significant adverse effects. There is a growing interest in complementary treatments like yoga. AIMS: To study the effects of yoga as a complementary therapy in children with moderate to severe ADHD. SETTINGS AND DESIGN: The study was performed on children (consent was taken from parents) admitted in a child psychiatry unit using an open-label exploratory study. MATERIALS AND METHODS: Children between 5 and 16 years of age diagnosed with ADHD and co-operative for yoga were included. Subjects with other serious psychiatric and medical illnesses were excluded. The participants were given yoga training daily during their in-patient stay. They were rated on Conners' abbreviated rating scale - (CARS), ADHD-rating scale-IV (ADHD - RS IV) and clinical global impression (CGI)-Severity, at the beginning of study, at discharge and subsequently at the end of 1(st), 2(nd) and 3(rd) month by a research associate not involved in yoga instruction. Paired t-test was employed to compare the means of scores between baseline and follow-ups. RESULTS: A total of 9 children (8 males, 1 female) were recruited into the study. All, but one were on medications. An average of 8 yoga training sessions was given to subjects. They were able to learn yoga reasonably well. There was a significant improvement in the ADHD symptoms as assessed on CARS (P-0.014), ADHD-RS IV (P=0.021) and CGI- S scales (P=0.004) at the time of discharge.

Effect of yoga therapy on anxiety and depressive symptoms and quality-of-life among caregivers of in-patients with neurological disorders at a tertiary care center in India: A randomized controlled trial.

CONTEXT: The concerns of caregivers of patients with neurological disorders have been a felt need for a long time, with many of them experiencing significant psychiatric morbidity. AIMS: This study aimed to find the effect of yoga in reducing anxiety and depression, as well as improving quality-of-life in caregivers of patients with neurological disorders. SETTINGS AND DESIGN: The study was conducted using a randomized controlled design, with yoga intervention and waitlisted controls. METHODOLOGY: SIXTY CONSENTING CAREGIVERS OF INPATIENTS IN NEUROLOGY WARDS WERE RANDOMIZED INTO TWO GROUPS: Yoga and control. Demographic variables except years of education and length of caretaking were comparable in the two groups, as also baseline scores of anxiety, depression and quality-of-life. A specific yoga module comprising yogasanas, pranayama, and chanting was taught to the participants in the yoga group by the researcher. At follow-up 43 patients (yoga n=20 and control group n=23) were available. Two-way repeated measures analysis of variance was used to test the change from pre-test to post-test scores within and between groups. Analysis of covariance was performed to compare the post-test scores between the groups adjusting for education and length of caretaking. RESULTS: Following one month intervention of yoga therapy, there was a significant (P<0.001) decrease in anxiety and depression scores, as well as improved quality-of-life among the participants in the yoga group as compared with the control group. CONCLUSION: This study highlights the usefulness of a yoga intervention for caregivers of inpatients with neurological problems. The small sample size and lack of blinding were some of the limitations of this study.

Yoga and epilepsy: What do patients perceive?

CONTEXT: Benefit of yoga therapy in the management of epilepsy is emerging. However, there is no data available about the knowledge, attitude and practice (KAP) of yoga amongst people living with epilepsy (PLWE). AIMS: This study was designed to explore the KAP about yoga among PLWE. SETTINGS AND DESIGN: The study was conducted on 300 PLWE attending the neurology out-patient services of a tertiary care hospital. METHODOLOGY: Three hundred PLWE (male:female=173:127; age: 31.6±12.4 years) attending the neurology out-patient services of a neuropsychiatry hospital were administered a pre-tested KAP questionnaire. RESULTS: About 87.4% were on regular anti-epileptic drugs and half (50.3%) on monotherapy. Use of complementary and alternative medicine by the respondents included: Ayurveda (26.7%), yoga (25.6%) and homeopathy (16.3%) or folk medicine (29.1%). Nearly 33.7% of the respondents reported that yoga is beneficial in managing epilepsy. More than half the respondents (54.8%) were willing to practice yoga. Those who practiced yoga opined that regular practice of yoga might reduce dosage of medication (62.8%), their side effects (51.3%) and frequency of seizures (54.5%). Majority of the patients were willing to practice yoga, if yoga services were offered. CONCLUSION: The gaps in KAP identified in this study point to the need for more systematic effort to bring about awareness of yoga in patients with epilepsy.

Positive therapeutic and neurotropic effects of yoga in depression: A comparative study.

CONTEXT: Therapeutic effect of yoga in depression is recognized. Neuroplastic effects of antidepressant therapies are inferred by elevations in brain-derived neurotrophic factor (BDNF). Role of yoga in both these effects has not been studied. MATERIALS AND METHODS: Non-suicidal, consecutive out-patients of depression were offered yoga either alone or with antidepressants. The depression severity was rated on Hamilton Depression Rating Scale (HDRS) before and at 3 months. Serum BDNF levels were measured at the same time points. Repeated-measures analysis of variance was performed to look at change across groups with respect to HDRS scores and BDNF levels over 3 months of follow-up. Relationship between change in serum BDNF levels and change in HDRS scores was assessed using the Pearson's correlation coefficient. RESULTS: Both yoga groups were better than drugs-only group with respect to reduction in HDRS scores. Serum BDNF rose in the total sample in the 3-month period. This was not, however, different across treatment groups. There was a significant positive correlation between fall in HDRS and rise in serum BDNF levels in yoga-only group (r=0.702; P=0.001), but not in those receiving yoga and antidepressants or antidepressants-alone. CONCLUSIONS: Neuroplastic mechanisms may be related to the therapeutic mechanisms of yoga in depression.

Cortisol and antidepressant effects of yoga.

CONTEXT: Hypercortisolemia is well-known in depression and yoga has been demonstrated earlier to reduce the parameters of stress, including cortisol levels. AIM: We aimed to find the role of yoga as an antidepressant as well as its action on lowering the serum cortisol levels. SETTINGS AND DESIGN: An open-labeled study consisting of three groups (yoga alone, yoga along with antidepressant medication and antidepressant medication alone) was conducted at a tertiary care psychiatry hospital. METHODOLOGY: Out-patient depressives who were not suicidal were offered yoga as a possible antidepressant therapy. A validated yoga module was used as therapy taught over a month and to be practiced at home daily. Patients were free to choose the drugs if their psychiatrist advised. Patients (n=54) were rated on Hamilton Depression Rating Scale (HDRS) with serum cortisol measurements at baseline and after 3 months. In 54 patients, assessments and blood test results were both available. 19 each received yoga alone or with drugs and 16 received drugs only. Healthy comparison subjects (n=18) too underwent morning cortisol measurements once. RESULTS: Serum cortisol was higher in depressives compared with controls. In the total sample, the cortisol level dropped significantly at the end of treatment. More patients in the yoga groups had a drop in cortisol levels as compared to drug-only group. In the yoga-only group, the cortisol drop correlated with the drop in HDRS score (antidepressant effect). CONCLUSION: The findings support that yoga may act at the level of the hypothalamus by its 'anti-stress' effects (reducing the cortisol), to bring about relief in depression.

Effect of yoga therapy on plasma oxytocin and facial emotion recognition deficits in patients of schizophrenia.

CONTEXT: Yoga therapy has been demonstrated to be useful in treatment of negative symptoms and improving the socio-occupational functioning and emotion recognition deficits in antipsychotic-stabilized schizophrenia patients. Oxytocin has been recently implicated in social cognition deficits in schizophrenia. The effect of yoga therapy on oxytocin levels in schizophrenia has not been studied. AIMS: This study aimed to assess the effect of yoga therapy on symptoms, socio-occupational functioning, facial emotion recognition deficits and plasma oxytocin levels in antipsychotic stabilized schizophrenia patients. SETTINGS AND DESIGN: Randomized controlled study on 43 consenting, medication stabilized patients with schizophrenia in a tertiary psychiatric center using yoga intervention and waitlisted groups. MATERIALS AND METHODS: A total of 43 schizophrenia patients were randomized to yoga group (n=15) or waitlist group (n=28). Patients in the yoga group received training in a specific yoga therapy module for schizophrenia. Patients in both groups were continued on stable antipsychotic medication. Assessments included scale for assessment of positive symptoms, scale for assessment of negative symptoms, socio-occupational functioning scale and tool for recognition of emotions in neuropsychiatric disorders (TRENDS) and plasma oxytocin levels; performed at baseline and at the end of 1 month. RESULTS: A total of 15 patients in the yoga group and 12 in waitlist group completed the study. The yoga therapy group showed a significant improvement in socio-occupational functioning, performance on TRENDS (P<0.001) and plasma increase in oxytocin levels (P=0.01) as compared with the waitlist group. CONCLUSION: The study supported the role of add-on yoga therapy in management of schizophrenia and demonstrated an improvement in endogenous plasma oxytocin levels in schizophrenia patients receiving yoga therapy.

Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.

OBJECTIVE: Facial emotion recognition deficits have been consistently demonstrated in schizophrenia and can impair socio-occupational functioning in these patients. Treatments to improve these deficits in antipsychotic-stabilized patients have not been well studied. Yoga therapy has been described to improve functioning in various domains in schizophrenia; however, its effect on FERD is not known. METHOD: Antipsychotic-stabilized patients randomized to receive Yoga (n=27), Exercise (n=17) or Waitlist group (n=22) were assessed at baseline, 2nd month, and 4th month of follow-up by raters blind to group status. Assessments included Positive and Negative Syndrome Scale (PANSS), Socio-Occupational Functioning Scale (SOFS), and Tool for Recognition of Emotions in Neuropsychiatric DisorderS (TRENDS). RESULTS: There was a significant positive correlation between baseline FERD and socio-occupational functioning (r=0.3, P=0.01). Paired samples t test showed significant improvement in positive and negative symptoms, socio-occupational functioning and performance on TRENDS (P<0.05) in the Yoga group, but not in the other two groups. Maximum improvement occurred at the end of 2 months, and improvement in positive and negative symptoms persisted at the end of 4 months. CONCLUSION: Yoga therapy can be a useful add-on treatment to improve psychopathology, FERD, and socio-occupational functioning in antipsychotic-stabilized patients with schizophrenia.

Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: a randomized controlled trial.

OBJECTIVES: This study compares the anxiolytic effects of a yoga program and supportive therapy in breast cancer outpatients undergoing conventional treatment at a cancer centre. METHODS: Ninety-eight stage II and III breast cancer outpatients were randomly assigned to receive yoga (n=45) or brief supportive therapy (n=53) prior to their primary treatment i.e., surgery. Only those subjects who received surgery followed by adjuvant radiotherapy and six cycles of chemotherapy were chosen for analysis following intervention (yoga, n=18, control, n=20). Intervention consisted of yoga sessions lasting 60min daily while the control group was imparted supportive therapy during their hospital visits as a part of routine care. Assessments included Speilberger's State Trait Anxiety Inventory and symptom checklist. Assessments were done at baseline, after surgery, before, during, and after radiotherapy and chemotherapy. RESULTS: A GLM-repeated measures ANOVA showed overall decrease in both self-reported state anxiety (p<0.001) and trait anxiety (p=0.005) in yoga group as compared to controls. There was a positive correlation between anxiety states and traits with symptom severity and distress during conventional treatment intervals. CONCLUSION: The results suggest that yoga can be used for managing treatment-related symptoms and anxiety in breast cancer outpatients.