Evidence-based National Vaccine Policy.

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form.

Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy.

Hypothesis This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy.Methods Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion Yoga may provide the greatest mental-health-related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health-related QOL by increasing ability to find benefit in the cancer experience.

Oxidative damage and altered antioxidant enzyme activities in the small intestine of streptozotocin-induced diabetic rats.

The small intestine exhibits numerous morphological and functional alterations during diabetes. Oxidative stress, a factor implicated in the pathogenesis of diabetic complications may contribute towards some of these alterations. We therefore investigated the occurrence of oxidative stress in the small intestine during diabetes by measuring the extent of oxidative damage as well as the status of the antioxidant defense system. Significant increases in lipid peroxidation (four-fold) as measured by TBARS and protein oxidation (38%) as measured by protein carbonyl content were observed after 6 weeks of diabetes. A distinct elevation in the activities of catalase (123.9%) and superoxide dismutase (71.9%) and a decline in the activity of glutathione peroxidase (67.7%) were also observed. The steady state mRNA levels of these enzymes measured by RT-PCR were, however, unchanged suggesting the absence of transcriptional control. In contrast, no changes in the levels of protein and non-protein thiols as well as the activities of glutathione reductase and glutathione-S-transferase were detected. Interestingly, decreases in the activities of xanthine oxidase (XO; 25.7%) and xanthine dehydrogenase (XDH; 42.6%) indicate that they do not contribute significantly to oxidative damage. The results thus reveal the occurrence of oxidative stress in the small intestine during diabetes and suggest its possible involvement in some of the accompanying functional alterations.

Yoga for high-risk pregnancy: a randomized controlled trial.

BACKGROUND: Improvements in technology have increased the chances of survival for the micro-premature infant and the very low birth-weight infant but have significantly increased the financial burden of health care organizations. This economic burden has a significant impact on third-party payers and on society in general. AIM: The study was designed to assess yoga therapy (YT) module on maternal stress level in high risk pregnancy. SUBJECTS AND METHODS: In the present study, sixty-eight pregnant women (38 in the control group with standard antenatal care and 30 in the YT group) with 27.2 (5.2) years of mean age recruited from the outpatient services of medical college and hospital in Bangalore, South India, were participated. The study was a single-blind randomized controlled clinical trial. Perceived stress scale (PSS) was measured during the 12(th), 20(th), and 28(th) weeks of pregnancy. SPSS version 16.0 (Chicago, IL, USA) was used for all data analysis. When the data were found to be normally distributed, the RMANOVA were used to assess the PSS scores between the yoga and control groups. Significant values were set at P < 0.05. RESULTS: There was a significant difference in the PSS level of the YT group with significantly reduced scores at the second follow-up (28(th) week of pregnancy) compared to the control group (P = 0.02). Women who took part in the YT module reported significantly fewer pregnancy discomforts decrease in PSS (P = 0.02) than the control group where the stress level was increased (RMANOVA test using SPSS-16). CONCLUSION: The present study suggests that the YT module can decrease the stress level during high-risk pregnancy complications. Thus, practicing YT during high-risk pregnancy is not only a cost-effective option but also a feasible and safe option. Additional well-designed studies are needed before a strong recommendation can be made.

Effect of integrated Yoga on neurogenic bladder dysfunction in patients with multiple sclerosis-A prospective observational case series.

BACKGROUND: Neurogenic bladder dysfunction (NBD) is a common distressful symptom in multiple sclerosis (MS) affecting quality of life. Yoga has been widely used in treating various symptoms of patients with MS. OBJECTIVES: To evaluate the effect of integrated Yoga for NBD in patients with MS as an adjunct to standard medical care. DESIGN: This open arm, pre-post study design assessed the outcome measures at base line and after 21 days of integrated Yoga intervention. SETTING: study was conducted at the center for neurological rehabilitation at KWA-Klinik Stift Rottal in Bad Griesbach, Germany. Eleven MS patients with NBD (mean age 46.7±11.24 years) with mean duration 17.2 years volunteered to participate in the study. INTERVENTIONS: integrated Yoga which includes preparatory yogic loosening and breathing practices, Nadishuddi pranayama (alternate nostril breathing), moola bandha (anal lock), kapalbhati (rapid nostril breathing) and deep relaxation technique was given for 2h per day for continuous 21 days. OUTCOME MEASURES: ultrasound scanning for post void residual urine volume (PVR), micturition check list (MCL), incontinence impact questionnaire-7 (IIQ-7) andurogenital distress inventory-6 (UDI-6) were used. RESULTS: Paired sample t-test showed significant improvement in post void residual urine (62.34%, p<0.05), scores on micturition frequency checklist (25%, p<0.05), incontinence impact questionnaire-7 (32.77%, p<0.05) and uro-genital distress inventory-6 (26.33%, p<0.05). CONCLUSION: This study points to the safety and effectiveness of integrated Yoga for bladder symptoms as an adjunct to standard care in multiple sclerosis patients with neurogenic bladder dysfunction in Germany. Further trails are necessary to confirm these findings.

Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer.

This study examined the effects of yoga on quality of life (QOL) and psychosocial outcomes in women with breast cancer undergoing radiotherapy. Sixty-one women were randomly assigned to either a yoga or a wait-list group. Yoga classes were taught biweekly during the 6 weeks of radiotherapy. Participants completed measures of QOL, fatigue, benefit finding (finding meaning in the cancer experience), intrusive thoughts, sleep disturbances, depressive symptoms, and anxiety before radiotherapy and then again 1 week, 1 month, and 3 months after the end of radiotherapy. General linear model analyses revealed that compared to the control group, the yoga group reported significantly better general health perception (p = .005) and physical functioning scores (p = .04) 1 week postradiotherapy; higher levels of intrusive thoughts 1 month postradiotherapy (p = .01); and greater benefit finding 3 months postradiotherapy (p = .01). There were no other group differences in other QOL subscales for fatigue, depression, or sleep scores. Exploratory analyses indicated that intrusive thoughts 1 month after radiotherapy were significantly positively correlated with benefit finding 3 months after radiotherapy (r = .36, p = .011). Our results indicated that the yoga program was associated with statistically and clinically significant improvements in aspects of QOL.

Evidence for some common signal transduction events for opposite regulation of nitrate reductase and phytochrome-I gene expression by light.

We have explored the possible involvement of the phosphoinositide (PI) cycle and protein kinase C (PKC) in the phytochrome (Pfr)-mediated light signal transduction pathway using nitrate reductase (NR) and phytochrome-I (PhyI) genes as model systems. We have shown earlier that phorbol myristate acetate (PMA) completely replaces the red light effect in stimulating nitrate reductase activity and transcript levels in maize. In this paper, we present detailed evidence to show that PMA mimics the red light effect and follows similar kinetics to enhance NR steady-state transcript accumulation in a nitrate-dependent manner. We also show that PMA inhibits phyI steady-state transcript accumulation in a manner similar to red light, indicating that a PKC-type enzyme(s) may be involved in mediating the light effect in both cases. Serotonin or 5-hydroxytryptamine (5-HT), a stimulator of PI turnover, was also found to mimic the red light effect in enhancing NR transcript levels and inhibiting phyI transcript accumulation, indicating the role of the PI cycle in generating second messengers for regulating the two genes. These results indicate that phytochrome-mediated light regulation of NR and phyI gene expression may involve certain common steps in the signal transduction pathway such as the PI cycle and protein phosphorylation by a PKC-type enzyme.

Roles of nitrate, nitrite and ammonium ion in phytochrome regulation of nitrate reductase gene expression in maize.

The influence of nitrate and its metabolites on the nitrate reductase (NR) gene expression and its relationship with phytochrome (Pfr) regulation of NR in etiolated maize leaves is examined. Nitrate induction and Pfr stimulation are brought about by independent signalling phenomena. Phorbol myristate acetate (PMA), a stimulator of protein kinase C (PKC), mimicked the effect of red light but could not replace the nitrate requirement for the induction of NR transcript accumulation. This suggests that while PKC-type enzymes may be involved in mediating the Pfr signal, nitrate may follow an independent signalling mechanism. Experiments with 5-hydroxytryptamine (5HT) and lithium ions (Li+), which are known to modulate phosphoinositide (PI) turnover, indicated that in addition to generating Pfr-induced second messengers for PKC activation, PI cycle may also generate other signals which mediate nitrate induction of NR gene expression in the dark. The products of nitrate reduction i.e., nitrite and ammonium ion had inhibitory and stimulatory effects respectively, on NR transcript accumulation. They work mainly at the level of nitrate induction.

Light regulation of nitrate reductase gene expression in maize involves a G-protein.

This paper reports three lines of evidence to demonstrate the presence of heterotrimeric G-proteins in maize and their involvement in the regulation of nitrate reductase gene expression by light: (1) Southern blot analysis of maize genomic DNA using a human Ha-ras cDNA probe revealed specific bands indicating the presence of G-protein (alpha subunit) gene(s) in maize. Northern blot analysis of maize total RNA using the same probe revealed that the putative Galpha gene(s) is transcriptionally active. (2) Western blots containing purified plasma membrane proteins from maize leaves showed specific binding of gamma [35S]-labeled GTP in a red light-dependent manner, indicating the involvement of G-proteins in mediating the light signal. The size of the putative Galpha gene product (approximately 45 kDa) indicates that it may be a heterotrimeric G-protein. (3) Cholera toxin mimicked the effect of red light to enhance the transcript levels of nitrate reductase (NR), indicating that G-proteins may mediate light regulation of NR gene expression.

Effects of exogenous nitric oxide and hyperoxia on lung fibroblast viability and DNA fragmentation.

Effective lung repair after acute injury requires elimination of proliferating mesenchymal and inflammatory cells without inducing an acute inflammatory response or disturbing concomitant repair of lung microvasculature. Previous studies have shown that endogenous NO regulates programmed cell death in fibroblasts and can modulate wound fibroblast synthetic function. We hypothesized that exposure of human lung fibroblasts to NO gas would decrease viability and induce apoptotic cell death. Primary cultures of normal human lung fibroblasts were exposed for 4 h to room air (RA), 80% oxygen, NO (at either 20 or 50 ppm) blended with RA, or NO blended with 80% O(2), then incubated for 24 to 72 h. Cell viability was determined by fluorescence viability/cytotoxicity assay and DNA fragmentation by TUNEL assay. Peroxynitrite formation was assessed using immunoblotting for S-nitrosotyrosine. NO plus O(2) induced significant cell death at 20 and 50 ppm NO when compared to either RA or O(2) alone at both 24 and 72 h (p < 0.05). Incubation with superoxide dismutase (SOD), catalase (CAT) or SOD + CAT significantly decreased cell death in fibroblasts treated with NO(20)/O(2) and NO(50)/O(2) compared with controls (p < 0.05). NO(20)/O(2) and NO(50)/O(2) exposure significantly increased TUNEL mean fluorescence intensity (MFI), consistent with increased DNA fragmentation, compared to RA at 24 and 72 h (p < 0.05). Antioxidants decreased MFI in cells exposed to NO(20)/O(2) (CAT and SOD + CAT) compared to controls at 24 h (p < 0.05). Western blot analysis for S-nitrosotyrosine showed increased signal intensity in fibroblasts exposed to NO at 20 and 50 ppm plus O(2) compared to RA or O(2) alone. Incubation with SOD + CAT reduced signal intensity for peroxynitrite in cells exposed to NO(20)/O(2). We conclude that NO in hyperoxic conditions induces fibroblast cell death and DNA fragmentation, which could be partially mediated by peroxynitrite synthesis.