Assessment of Visual Evoked Potential to Detect Visual Pathway Dysfunction in Gestational Diabetes Mellitus: A Longitudinal Case-Control Study With Postpartum Follow-up.

BACKGROUND: The increasing prevalence of gestational diabetes mellitus (GDM) during pregnancy has opened the opportunity to study its short- and long-term effects on maternal ophthalmic health. Visual evoked potential (VEP) is a non-invasive electrophysiological test that detects functional disturbances along the visual pathway before the physical signs of diabetic retinopathy (DR) can set in. This longitudinal study is aimed at the assessment of changes in VEP in GDM during different stages of pregnancy and 6-12 weeks after parturition by comparing it with normoglycemic controls. DESIGN AND METHOD: Diagnosed cases of GDM were recruited along with normoglycemic controls at 24-28 weeks of gestation. Each participant was required to attend two follow-up appointments at 32-38 weeks of gestation and 6-12 weeks after parturition. A blood sample was taken in a fasting state to record biochemical parameters. VEP was recorded using Neuropack S1 MEB-9400 electrodiagnostic equipment (Nihon Kohden, Tokyo, Japan) in a dark room by providing pattern reversal stimuli to each eye. RESULTS: A total of 29 participants (15 in the control group and 14 in the GDM group) completed the entire study procedure. The observed mean P100 latency of both eyes in the GDM group was recorded longer as compared to that in the control group at baseline and during late pregnancy. Although the mean P100 latency saw a significant decline in postpartum visits as compared to that in late pregnancy, the values were higher than in the control group. P100 latency at baseline correlated significantly to serum advanced glycated end products' (AGE'S) levels in the GDM group. CONCLUSION: Our study findings reflect that the diagnosis of GDM is associated with significant changes in VEP during and after pregnancy as compared to that of healthy pregnant women.

Assessment of Cognition in Hypertensives and Normotensives: A Comparative P300 Study.

BACKGROUND:  Hypertension is an established risk factor for dementia, and the prevalence of hypertension and dementia is rising. Current tests to diagnose cognitive dysfunction at an early stage lack sensitivity and specificity. Recently event-related potentials (ERPs) have gained much attention in diagnosing cognitive dysfunction and are independent of the education status of the subject. This study was done to find any cognitive deficits in the hypertensive population with electrophysiological evidence, which might open the doors for the need to screen the population at an earlier stage so that the population can be prevented from dementia. METHODS:  Some 31 middle-aged (18-65 years) hypertensives were compared with 31 age, sex, education, and handedness matched normotensives about cognition by neuropsychometric test battery including Hindi Mini-mental Status Examination (HMSE), Hindi Montreal Cognitive Assessment (MoCA), choice reaction time (CRT), and auditory event-related potentials. RESULTS:  Hypertensives and normotensives differed significantly concerning P300 potentials' latency (Fz and Cz P300 latencies: p-value: 0.001), and this change was correlated well with the duration of diastolic blood pressure (BP) (r-value: 0.670). The remaining tests, HMSE, Hindi MoCA, and CRT, were dependent on the education status of the patient. CONCLUSIONS:  The effect of hypertension on cognitive impairment is evident and can be proved early in its pre-clinical stage using ERPs. Early identification can help in specifying high-risk individuals. ERPs have great potential in screening and diagnosing and can also help in assessing cognition as a reliable tool to show the effect of treatments/interventions on cognitive defects.

Sleep quality and sleep hygiene in preclinical medical students of tertiary care center amidst COVID-19 pandemic: a cross-sectional observational study.

Objectives: Due to the long-lasting pandemic measures, such as lockdown and stay-at-home orders, the COVID-19 pandemic has had a negative impact on higher education. In this study, we aimed to determine sleep quality, excessive daytime sleepiness, and sleep hygiene, and their association with anxiety, and their correlation in preclinical medical students during the COVID-19 pandemic. Materials and Methods: We included 101 medical students, aged between 17-20 years of both sex from a tertiary care medical institute. Standard questionnaires were used to assess sleep quality, sleep hygiene, daytime sleepiness, and anxiety among medical students. Results: Fifty-one percent of the medical students had good sleep quality, but 35% had borderline poor sleep quality, and 13% had poor sleep quality during the lockdown. Six percent of medical students had alarmingly high daytime sleepiness. The total Adolescent Sleep Hygiene Scale (ASHS) score was grouped into poor sleep hygiene (ASHS score ≤ 3.8) and good sleep hygiene (ASHS score ≥ 4.9). Overall, sleep hygiene of medical students was poor due to behavioral arousal and bedtime routine factors, and the scores for anxiety and sleep hygiene were significantly negatively correlated, whereas daytime sleepiness showed a significant positive correlation. Conclusion: Our study revealed a high prevalence of poor sleep quality among medical students during the lockdown. Poor sleep hygiene is an eye-opener for the mostly ignored aspect of altered sleep patterns.

Cardiovascular Autonomic Function Tests in Patients of Obsessive-Compulsive Disorder: A Cross-Sectional Study.

Background: Patients with psychiatric disorders are at an increased risk of developing cardiovascular disease, reducing life expectancy. Autonomic dysfunction has been linked to this increased risk; many studies have found reductions in heart rate variability (HRV). Only a few studies have systematically explored the relationship between obsessive-compulsive disorder (OCD) and autonomic function, and they have found contradicting results. The present study is intended to explore comprehensive autonomic functions in OCD patients and compare them with healthy controls. Methods: A total of 18 OCD patients meeting Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) criteria were enrolled to undergo comprehensive autonomic function testing, and the results were compared with 25 age- and sex-matched healthy controls. Results: Time-domain parameters of HRV such as standard deviation of the RR intervals, coefficient of variance of RR intervals, standard deviation of differences between adjacent RR intervals, root square of the mean of the sum of the squares of differences between adjacent RR intervals, and percentage of number of RR interval differences ≥ 50 ms were significantly lower in OCD patients, indicating lesser parasympathetic tone. Frequency-domain parameters such as total power and very low frequency were significantly lower in OCD patients, indicating a significant decrease in autonomic tone. Nonlinear parameters such as dispersion of points perpendicular to the line of identity and dispersion of points along the line of identity were significantly lower in OCD patients, indicating altered vagal and sympathetic tone. In autonomic reactivity tests, the fall in systolic blood pressure during the lying to standing test and change in diastolic blood pressure during the cold pressor test were significantly altered in OCD patients, indicating abnormal sympathetic reactivity. There was no significant correlation between autonomic parameters and the severity of OCD. Conclusion: OCD is characterized by a decreased parasympathetic tone and abnormal sympathetic reactivity compared to normal controls.

Alteration in pattern reversal visual evoked potential in pediatric population with amblyopia and spherical refractive errors.

Purpose: To study the effect of refractive errors on pattern visual evoked potential (VEP) recordings in the pediatric population. Methods: This cross-sectional observational study assessed 240 eyes of 120 participants attending the outpatient department of a tertiary care center in North India. Participants were between 8 and 18 years of age; 30 participants each were recruited into four groups, namely emmetropia, myopia, hypermetropia, and amblyopia. They were then subjected to pattern reversal VEP, with P-100 amplitude and latency recorded for each participant. Results: The emmetropic group in this study provided normal values of P-100 parameters, namely P-100 latency and P-100 amplitude with readings of 115.78 ± 10.19 ms and 11.11 ± 4.08 µV, respectively. P-100 amplitude was significant compared to P-100 latency in detecting the presence or absence of a specific type of refractive error. It was found that there was a significant association between severity of myopia and P-100 latency (both unaided and aided) with P < 0.05. The severity of hypermetropia showed a significant association with P-100 amplitude (unaided) (P < 0.05). Receiver operating characteristics analysis revealed P-100 amplitude to be a good predictor of refractive error and the cut-offs were calculated. Conclusion: The P-100 parameters of the pediatric Indian population were comparatively higher than conventional values. P-100 latency seemed to better correlate with myopia, while hypermetropia correlated with P-100 amplitude. P-100 amplitude appears to be the most significant predictor of the presence of refractive error in an individual.

Effectiveness of Large-Scale Preparedness Training on Electrocardiogram for Medical, Surgical, and Pre-clinical Doctors: A Need-Based Initiative for COVID-19 Patient Care.

INTRODUCTION: One of the competencies expected of all doctors posted in coronavirus disease 2019 (COVID-19) wards, is ECG rhythm identification, interpretation, and intervention for immediate management of patients. This study was undertaken to evaluate the effectiveness of the ECG training module as a component of preparedness training to combat COVID-19. METHODOLOGY: This was a cross-sectional study conducted during training on ECG rhythm identification, interpretation, its management in COVID-19 patients. Study participants included faculty, senior residents, junior residents, and interns of medical, surgical, and paraclinical disciplines. The training session included one hour of didactic lecture and one and half hours of interactive session during which case scenarios were discussed. An objective assessment was conducted through pre-test and post-test. Mean of pre and post-test scores were compared using paired t-test for evaluating statistical significance. Feedback was also taken from participants. RESULTS: Out of the 800 participants who gave consent, only 682 who completed both pre and post-test were included in the final analysis. Mean pre-test and post-test scores were 9.29/15 (61.9%) and 11.63/15 (77.5%), respectively, with a mean improvement of +2.34/15 (+15.6%). Of the participants, 38.6% obtained low scores in pre-test and 82% of respondents agreed that knowledge and skills gained from training would be useful in providing patient care. CONCLUSION:  Low baseline knowledge on ECG highlights the need for re-training doctors posted in COVID-19 care on cardiac rhythm identification and interpretation. Interactive training is effective in improving ECG interpretative skills among doctors across disciplines and is the appropriate method to retrain/reskill, especially for large-scale capacity building.

Burden of ocular morbidities and color blindness among school-attending children in a foothill town of Uttarakhand State.

PURPOSE: To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India. METHODS: A cross-sectional study was conducted among school-going children of age group 6-16 years of standard I-XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value <0.05. RESULTS: In total, 13,492 students (mean age 10.9 ± 2.7 years) with almost equal male to female ratio were screened. Overall prevalence of ocular morbidity was 23.2%, with refractive error (18.5%) on top, followed by color blindness (2.2%). The later was observed more among males (3.0%) as compared to females (1.4%) with significantly higher odds, OR = 2.3 (1.7-2.9) (P < 0.001). CONCLUSION: Refractive error has been the most common ocular morbidity, followed by color blindness. Earliest detection can prevent permanent disability and disappointment among youngsters when rejected from entering certain professions due to color vision defect.

Maternal Chromium Levels in Gestational Diabetes: Systematic Review and Meta-Analysis.

The topic of maternal Chromium (Cr) levels in Gestational Diabetes Mellitus (GDM) has remained controversial; some studies have found lower levels of Cr in GDM population, whereas others found no significant changes in Cr status in GDM. Therefore, this systematic review and meta-analysis was aimed at qualitatively and quantitatively synthesizing past studies to find the relationship of maternal Cr levels with GDM. The study protocol was registered at International prospective register for systematic reviews (PROSPERO) (ID CRD42021272979). Strict adherence to the Preferred Reporting Items for Systematic review and Meta-analysis checklist, 2009 was followed during the entire study. Random-effect model for calculation of distribution of true effect sizes was used for the meta-analysis with a confidence interval (CI) of 95%. The pooled Standard Mean Difference of control and GDM groups were compared using Z statistics with a P value of <.05 as significant. Six studies were included for the systematic review and four studies entered meta-analysis. The test of overall effect revealed that the pooled Cr values did not differ significantly between controls and GDM group (Z = 1.52, P =0.13). Heterogeneity between the studies was high (I2 = 97%). A subgroup analysis revealed that results varied as per place of study, trimester of pregnancy, and Cr estimation technique. Results from meta regression analysis revealed that sample size of individual studies (Q = 0.003, P =0.67) and year of publication of studies (Q = 0.22, P =.48) had no significant effect on the overall Standard Mean Difference. Factors such as ethnicity, lack of history of infection, and diet history can influence the results of this study.

Yogic Pranayama and Diaphragmatic Breathing: Adjunct Therapy for Intraocular Pressure in Patients With Primary Open-angle Glaucoma: A Randomized Controlled Trial.

PRCIS: Yogic pranayama and diaphragmatic breathing are potential adjunctive therapies for patients with glaucoma; however, they are not substitutes for medicine or eye drops. PURPOSE: Currently, medical or surgical lowering of intraocular pressure is the only therapeutic approach for treating primary open-angle glaucoma. Intraocular pressure maintenance is influenced by autonomic activity (sympathetic and parasympathetic). "Yogic pranayama" and "diaphragmatic breathing" are exercises that can affect autonomic activity by stimulating a wakeful hypometabolic state of parasympathetic dominance. We aimed to assess the effect of yogic pranayama and diaphragmatic breathing on intraocular pressure to determine whether it can be recommended for individuals with established glaucoma in combination with glaucoma medication as an adjuvant therapy. MATERIALS AND METHODS: In this prospective, randomized trial, 90 patients with primary open-angle glaucoma (180 eyes, age: above 40 y) were assigned to either the control or yogic pranayama and diaphragmatic breathing exercise group. In the latter group, yogic pranayama and diaphragmatic breathing were practiced daily for 6 months. We measured the intraocular pressure at presentation and subsequently after 1, 3, and 6 months. RESULTS: Compared with the wait-list group, the yogic pranayama and diaphragmatic breathing exercise group had significantly lowered intraocular pressure (right eye: 20.85±3.39 to 14.90±2.86 mm Hg; left eye: 20.30±4.12 to 14.25±3.85 mm Hg; P<0.001). CONCLUSION: Yogic pranayama and diaphragmatic breathing exercises can reduce intraocular pressure in patients with primary open-angle glaucoma and can therefore be recommended as an adjuvant therapy.

Comparison of choroidal thickness in systemic hypertensive subjects with healthy individuals by spectral domain optical coherence tomography.

Purpose: The purpose of the study was to compare the choroidal thickness in normal population and hypertensive patients and to assess the possible effect of hypertension on choroidal thickness using Spectral Domain Optical Coherence Tomography (SD-OCT). Methods: This was a comparative cross-sectional study. A total of 68 eyes of 34 individuals in the age group of 40-60 years were included in both the hypertensive group and control group. Individuals with refractive error beyond ± 3 D and posterior segment pathology were excluded. The choroidal thickness was measured at the sub-foveal region, 500 µm nasal and 500 µm temporal to the fovea on SD-OCT with enhanced depth imaging (EDI) mode. Systolic blood pressure (SBP), Diastolic blood pressure (DBP), and Mean arterial pressure (MAP) were recorded in all individuals. Duration of hypertension was also noted in hypertensive individuals. Results: The choroidal thickness at all locations was significantly lower in the hypertensive group (subfoveal, nasal, temporal and mean choroidal thickness 253.24 ± 63.96 µm, 249.35 ± 63.57 µm, 250.01 ± 63.37 µm, 250.87 ± 63.38 µm, respectively) as compared to the control group (subfoveal, nasal, temporal and mean choroidal thickness 301.25 ± 55.79 µm, 298.97 ± 57.07 µm, 299.49 ± 55.06 µm, 299.90 ± 55.50 µm, respectively). The choroidal thickness in the hypertensive group also had a significant negative correlation with the SBP (Spearman correlation coefficient, rho = -0.35, P = 0.003) and the duration of hypertension (rho = -0.25, P = 0.037). Conclusion: The study demonstrated decreased choroidal thickness in systemic hypertensive subjects as compared to age-matched healthy individuals. The choroidal thickness in hypertensive subjects also had a significant but weak negative correlation with SBP and duration of hypertension.

A case of hypertension with dementia: Common but underdiagnosed.

We report a case of a 55-year-old known hypertensive female who presented with features suggestive of dementia, which, on further workup unveiled background dyslipidemia and type 2 diabetes mellitus. An magnetic resonance imaging of the brain revealed findings suggestive of Binswanger's disease. This is a discussion of this unusual disease and its presentation and the differentials of this presentation which may be encountered in general clinical practice.

A rare adverse drug reaction to escitalopram.

Selective serotonin reuptake inhibitors are considered to be low side effect profile drugs as compared to conventional antidepressants. The primary care physicians should be aware of the rare and depressing side effect of these drugs when they are prescribed in young, nonpregnant females. Mastalgia has been reported in <1% of the cases. Galactorrhea as an adverse drug reaction has been reported in very few case reports, and the frequency of this side effect is unknown.

Effect of Organic Dust Exposure on Pulmonary Functions in Workers of Vegetable Market with Special Reference to its Microbial Content.

CONTEXT: Wholesale vegetable market is a rich source of generation of organic dust as loads of fruits and vegetables are loaded and unloaded here daily. Thus, regular workers are exposed to this organic dust for a considerable period of time depending on their work schedule. This study was planned to determine the microbial status of organic dust and to explore its association with pulmonary functions in the workers of wholesale vegetable market in Rishikesh. MATERIALS AND METHODS: It was a cross-sectional exploratory/observational study. Thirty-five apparently healthy adult males were selected from vegetable market having no history of any chronic illness. Smokers and alcoholic were excluded from the study. The same number of age- and sex-matched controls with the same exclusion criteria were recruited from workers not working in the vegetable market and also not exposed to any other kinds of organic dust. Microbial culture of air in the vegetable market was done. It was compared with the microbial status of air in the working place of controls. Pulmonary functions of all the workers were performed with the help of digital spirometer (Helios 401). RESULTS: Bacterial and fungal concentration was found to be significantly higher in the air of vegetable market as compared to air in the workplace of controls (such as coagulase-negative staphylococci >25 colony-forming unit (CFU) at incubation temperature vs. 10-12 CFU at incubation temperature, significant growth of Mucor, Aspergillus niger, and Candida nonalbicans in vegetable market as compared to workplace of controls). Pulmonary function parameters (percentage forced expiratory volume in 1st s (FEV1), percentage predicted forced expiratory flow in mid-half of expiration, and FEV1) of workers exposed to organic dust in vegetable market were also significantly lower (P < 0.05). CONCLUSION: Exposure of organic dust is associated with compromised pulmonary functions and there is a need of formulation of safety guidelines.

Gender Preference for Auditory Versus Visual Routes for Memorization.

Objective: Memory is formed on the basis of sensory stimuli perceived. Vision and Auditory sense are the most common modes to form visual and auditory memory. This study was planned to find the preferred sense route for the formation of memory, between the two genders. Method: In the present cross sectional experimental study, 40 male and 40 female subjects between 18-20 years of age were tested for visual & auditory memory. Results: Results: The results suggested statistically significant higher scores of 'Memory Test' in women in comparison to men (F479 3.312, p=<0.001). The mean score for memory subtests was best for black & white pictures followed by colored pictures, visual words, visual digits, auditory digits and auditory words in that order in men, whereas in women, mean score was best for colored pictures followed by black & white pictures, auditory words, auditory digits, visual words and visual digits. Conclusion: It may be concluded that in men visual sense and in women auditory sense are more effectual for the formation of memory.

Gender based variation in cognitive functions in adolescent subjects.

BACKGROUND: Cognition can be defined as all mental activities that are involved in acquisition, processing, storage and retrieval of information. PURPOSE: There is paucity of the data related to cognitive function amongst healthy adolescent age group which limits our ability to distinguish and compare cognitive changes that occur across the adult lifespan in female and male subjects separately and can provide some help to understand dementia related conditions. METHODS: Cognitive function was assessed in 100 healthy subjects of each sex of 17-20 years by using 'Montreal Cognition Assessment Test', a 10 minutes: 30-points test which is used in assessing a wide range of cognitive abilities on 7 subscales : 1) Visuospatial Skills, 2) Language, 3) Memory, 4) Attention, 5) Mathematical ability, 6) Abstraction, and 7) Orientation. RESULTS: Overall score (Male: 25.16 ± 1.8, Female: 25.72 ± 1.8) of cognition functions was statistically significantly higher in female adolescents (p=<0.02). However male subjects showed higher score in Mathematical ability. CONCLUSION: There are variations in the cognitive functions in male and female individuals and neuroanatomical and physiological differences contribute to these variations.

Sample complexity reduction aids efficient detection of low-abundant proteins from human amniotic fluid.

Working with biological fluids poses a challenge of visualizing proteins present in lower concentrations. This study describes a batch-mode chromatographic method for the fractionation of human amniotic fluid (AF). This method is easy to use with minimal sample quantity, resin volume and sample processing time. For albumin depletion, two methods were evaluated. The results demonstrated that specific depletion of albumin, using affinity-ligand-based resin, is more efficient than the conventional dye-based method. The albumin-depleted human AF was fractionated by strong anion-exchange resin in spin devices, for sample, complexity reduction and enrichment of low-abundant proteins. Analysis of four eluate fractions generated after this step shows enrichment of few low-abundant proteins. Two novel low-abundant proteins, Rab GDP dissociation inhibitor beta and peptide methionine sulfoxide reductase, were identified from human AF. Alpha-1-B glycoprotein was successfully identified by this strategy, whereas the published literature reports that it was not identified by strong anion-exchange FPLC followed by SDS-PAGE. Therefore, the current method has distinct advantages over the conventional column-based chromatography. This study also reports altered expression of some proteins in Rh-isoimmunized AF samples in comparison with normal AF.

Gender based alteration in color perception.

Human beings are able to perceive hundreds of shades of color which depends on the three types of cone system and various ratios of stimulation in response to different wavelengths. Perceptually and cognitively, men and women may experience appearance of color differently. Therefore, this study was planned to assess and compare color vision in male and female subjects. This study was carried out in the department of Physiology, SGRRIM&HS, Dehradun on 60 ocular healthy subjects (equal number of males and females) of 17-22 years of age group. The task was to match 22 test color strips with 2 shade charts of different colors. Total number of correct answers and total time taken in matching all the test color strips with the shade charts was recorded in both the sexes and analyzed. The results of this study showed that overall, females gave more correct responses (P < 0.001) and also took less time (P < 0.01) than males. Color wise also, females gave more correct responses especially for red (P < .001) and green color (P < 0.01). The conclusion states that the females can see more shades of colors than males.

Effect of '61-points relaxation technique' on stress parameters in premenstrual syndrome.

Premenstrual Syndrome is a psychoneuroendocrine stress related disorder and more than 300 treatment modalities for PMS show that the existing remedies have not provided satisfactory help to relieve PMS. 61-points relaxation exercise (61-PR), a relatively less known hatha yoga technique, is a successful means of stress relaxation and is expected to relieve PMS as well. The present study was conducted on 50 clinically healthy women volunteers who were in their reproductive age group and in their premenstrual period, from which a control group (n = 20) and a PMS group (n = 30) based on the symptoms were identified. In both groups basal heart rate (HR/min), systolic (SBP; mmHg) and diastolic blood pressure (DBP; mmHg), electromyogram (EMG; mV), electrodermal galvanic activity (EDG; microv), respiratory rate (RR/min) and peripheral temperature (T; degrees F) were recorded and the subjects were taken through a guided 61-PR. The symptoms and parameters were re-recorded after the 61-PR. In control group, the basal HR was 82.06 +/- 8.07, SBP 111.95 +/- 8.23, DBP 76.8 +/- 6.42, EMG 4.08 +/- 2.99, EDG 9.77 +/- 3.29, RR 15.60 +/- 3.77 and T was 97.86 +/- 0.63. After 10 minutes of 61-PR, HR (77.27 +/-10.85, P < 0.05), SBP (107.35 +/- 7.41, P < 0.05), DBP (75.25 +/-7.57, P < 0.05), EMG (2.07 +/- 1.90, P < 0.05), EDG (8.06 +/- 2.87, P < 0.05), RR (16.00 +/- 4.12, P < 0.05) fell significantly and T (97.97 +/- 0.64, P > 0.05) rose significantly. In the PMS group, the basal HR was 90.61 +/- 8.46, SBP 122.5 +/- 11.52, DBP 83.53 +/- 8.26, EMG 5.79 +/-2.75, EDG 13.14 +/- 6.54, RR 19.13 +/- 3.76 and T was 93.43 -/+ 5.29. After 10 minutes of 61-PR, HR (75.58 +/- 10.11, P < 0.0001), SBP (114.53 +/- 9.70, p < 0.0001), DBP (77.46 +/- 8.68, P < 0.0001), EMG (2.56 +/- 1.77, P < 0.0001), EDG (10.64 +/- 5.72, P < 0.0001), and RR (16.13 +/- 3.76, P < 0.0001) declined to a much greater extent and T (93.49 +/- 5.28, P < 0.0001) rose more significantly. These results suggest a reduction in sympathetic activity by 61-PR, also the high basal sympathetic tone present in subjects of PMS group due to stress is considerably reduced by relaxation. 61-PR is effective in providing relief from PMS and may be a useful adjuvant to medical therapy of PMS and other stress disorders.