Preparedness of diabetic patients for receiving telemedical health care: A cross-sectional study.

Introduction: This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country. Materials and Methods: Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called "Diab-at-ease" at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented. Results: About 51.1% (N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% (n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% (n = 35) were on insulin preparations, and 59.6% (n = 156) and 88.5% (n = 31) of which were highly compliant with treatment, respectively. About 35% (n = 78) and 43.9% (n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% (n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% (n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels. Conclusion: While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization.

Yoga Nidra for hypertension: A systematic review and meta-analysis.

BACKGROUND: Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity. OBJECTIVE: The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension. METHODS: A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively. RESULTS: Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias. DISCUSSION: This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted. CONCLUSION: This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.

Yoga as a complementary therapy in neuropathic pain: A systematic review and meta-analysis of randomized controlled trials.

Yoga is an ancient wisdom comprising a multitude of physical and mental practices that are aimed toward a state of optimum physical, mental, social, and spiritual health. Neuropathic pain (NP) is caused by a lesion or disease of the somatosensory nervous system that is often unresponsive to currently available modes of treatment, portending an inferior quality of life for patients. This systematic review and meta-analysis aim to investigate the effect and the potential role of yoga in NP syndromes. PubMed, Scopus, Elton Bryson Stephens Company (EBSCO), and Cochrane Library were screened for randomized controlled trials (RCTs) assessing the effects of yoga in patients on NP. Usual care, no treatment, or any active treatments were acceptable as control interventions. Primary outcome measures were objective or subjective assessment measures of pain intensity. For each outcome, standardized mean differences and 95% confidence intervals (CIs) were calculated. A total of four studies were included for qualitative synthesis. Meta-analysis of three studies revealed an overall effect (Z) in the favor of yoga as an intervention for NP, when compared to controls, although the effect was not statistically significant (three RCTs; Z = 1.10 [P = 0.27]; Heterogeneity: τ2 = 0.37; χ2 = 27.78, df = 2 [P < 0.00001]; I2 = 93%). This review divulged the overall favorable effect of yoga in NP, although it was not statistically significant. It highlights the promising role of yoga on pain intensity and quality of life in NP syndromes while showing that yoga has the advantage of being an inexpensive and easily accessible mode of therapy. Extensive research on the efficiency and safety of yoga must be conducted using robust RCTs with rigorous methodologies.

Yoga therapy on elderly patients with fear of fall: an open-label randomised controlled trial (YOFEAR trial).

INTRODUCTION: Fear of fall is experienced by the elderly irrespective of the presence or absence of history of fall. Falls contribute to injuries that culminate in hospitalisation that incur unwarranted medical expenses. Yoga is unique to Indian cultural practices, with a potential to enhance proprioception. It increases self-body awareness, ultimately improving the balancing capacity of older adults. Thus, the objective of this study is to compare the effect of yoga therapy in the study and control groups at 12 weeks from the baseline. METHODS AND ANALYSIS: This study is designed as an open-label, randomised controlled trial (1:1) with a sample size of 62 elderly patients more than or equal to 60 years of age. Participation of either sex, male or female with a fear of fall will be considered. Two randomised groups of 31 participants each will receive standard therapy for their primary diseases as per the local, national or international guidelines. However, participants in the intervention arm will receive additional structured yoga therapy sessions. The primary objective of this study is to assess and compare the change in fear of fall score of participants in each group using Falls Efficacy Scale (FES) and Berg Balance Scale (BBS) at 12 weeks versus baseline. The secondary endpoint will assess the change in the quality of life of participants at 3 months compared with the baseline.Data will be gathered, entered into Microsoft Excel and further analysed by R software (V.4.3.0). Changes in FES-Intervention and BBS of two groups will be compared either by Student's t-test for parametric data or Mann-Whitney U test for non-parametric data. Statistical significance will be considered if p<0.05 at 95% confidence level. ETHICS AND DISSEMINATION: Ethical approval for this study protocol (version 1.0, 22 April 2022) was obtained from the institute ethics committee (AIIMS/IEC/22/195). TRIAL REGISTRATION NUMBER: CTRI/2022/06/043287.

Efficacy of mHealth aided 12-week meditation and breath intervention on change in burnout and professional quality of life among health care providers of a tertiary care hospital in north India: a randomized waitlist-controlled trial.

Introduction: Burnout is "Chronic workplace stress that has not been successfully managed." Professional quality of life (PQL) includes work related experiences of compassion satisfaction and compassion fatigue. Healthcare providers (HCPs) are highly susceptible to burnout and compassion fatigue due to their demanding work, which lowers PQL. Burnout leads to poor care, medical errors, and patient safety across healthcare disciplines. Yoga has been shown to improve resilience, reduce stress, and increase self-compassion and psycho-physiological coherence. This study compared HCPs in a mHealth-aided 12-week yoga-based meditation and breath intervention to waitlist controls for HCP burnout and PQL at a north Indian tertiary care hospital. Methods: This was randomized waitlist-controlled trial. Total 98 HCPs (62 males and 36 females) with an average age of 28.26 ± 3.547 years were enrolled consecutively from March 2021 to November 2022. Randomization was done with opaque sealed envelopes numbered in a computer-generated sequence. The experimental group (n = 49) received 12 online weekly yoga sessions and performed daily home practice (6 days a week). The waitlisted control group (n = 49) continued their daily routine. Maslach's burnout inventory (MBI), professional quality of life (PQL) and anthropometric measurements were assessed at baseline and after 12 weeks. Results: After 12 weeks, the MBI outcomes of emotional exhaustion, depersonalization, and personal accomplishment showed a highly significant difference between the two groups (p < 0.001). PQL outcomes of compassion satisfaction, burnout, and secondary trauma also differed significantly (p < 0.001). Within group analysis showed that MBI and PQL outcomes improved significantly (p < 0.001) for the experimental group after 12 weeks. Conclusion: The current study contributes to the existing evidence on the effectiveness of Yoga in managing stress and developing resilience among doctors, nurses, and other medical professionals. Integrating yoga into healthcare settings is crucial for addressing the detrimental impact of burnout on decision-making and promoting positive patient outcomes. mHealth technologies have the potential to enhance the user-friendliness of yoga-based interventions by personalizing the practice space and time. Yoga-based interventions and mHealth technologies can effectively address physician burnout, in a simple and implementable manner.

Effectiveness of ayurvedic formulation, NAOQ19 along with standard care in the treatment of mild-moderate COVID-19 patients: A double blind, randomized, placebo-controlled, multicentric trial.

BACKGROUND: Medicines in indigenous systems such as Ayurveda have strong antimicrobial activity but double-blind randomized control trials are infrequent in this system of medicine. The efficacy of a new ayurvedic formulation was evaluated during the pandemic. METHODS: 150 mild-moderate COVID-19 patients were enrolled and randomized in 1:1 to NAOQ19 and placebo group. RT-PCR was done on Day 3, 5 and 7. CBC, CRP, LFT, and KFT were assessed at baseline and exit. Duration of hospital stay was noted and clinical assessment was also performed. RESULT: The results demonstrated more people turning RT-PCR negative in the NAOQ19 group compared to the placebo group on day 3 (p-value = 0.033). The mean time duration to turn RT-PCR negative was significantly lower in the NAOQ19 group (4.6 days) compared to placebo group (5.2 days) (p-value = 0.018). There was significant reduction in hospital stay among patients in the NAOQ19 arm who were discharged earlier (5.6 days) compared to placebo group (6.4 days) (p-value = 0.046). Patients in NAOQ19 arm did not show any adverse life-threatening events. CONCLUSION: The ayurvedic preparation given along with standard of care therapy reduced the duration of hospital stay and there was earlier conversion to RT-PCR negative.The integrated approach can help to reduce patient workload in the hospitals as well as limit the transmission of the virus in the community. STUDY REGISTRATION: CTRI/2021/05/033790.

Artificial intelligence in clinical medicine: catalyzing a sustainable global healthcare paradigm.

As the demand for quality healthcare increases, healthcare systems worldwide are grappling with time constraints and excessive workloads, which can compromise the quality of patient care. Artificial intelligence (AI) has emerged as a powerful tool in clinical medicine, revolutionizing various aspects of patient care and medical research. The integration of AI in clinical medicine has not only improved diagnostic accuracy and treatment outcomes, but also contributed to more efficient healthcare delivery, reduced costs, and facilitated better patient experiences. This review article provides an extensive overview of AI applications in history taking, clinical examination, imaging, therapeutics, prognosis and research. Furthermore, it highlights the critical role AI has played in transforming healthcare in developing nations.

Geriatric Goalposts: Of Independence And Interdependence.

Our elder population has a unique set of needs and necessities, challenges and concerns. This reflects in the approach of geriatric medicine, which aims to ensure functional freedom and independence, as well as healthy ageing, of older citizens. We propose another, higher, aim of geriatric medicine: that is interdependence. This creates a spirit of optimism, in persons of geriatric age group as well as in their health care providers, who are able to interpret goals of medical care in a broader perspective.

Effectiveness of Kabasura Kudineer tablets in the management of asymptomatic and mild cases of COVID-19: A pilot double-blinded, randomized controlled trial.

INTRODUCTION: COVID-19 was declared a pandemic in 2020. It has had a devastating effect on human life and the global economy. To date, there is no proven therapy for COVID-19, even though rigorous research is ongoing to test multiple compounds across all systems of medicine. A need was felt to systematically explore the Indian system of medicine to assess its efficacy against COVID-19. The objective of the present study was to examine the effect of Kabasura Kudineer as a standalone therapy on the following: time required to achieve symptom relief & resolution, virological clearance, and levels of IL6, CRP and IgG, and compare it to the standard therapy available for treatment of COVID-19. METHODOLOGY: A double-blinded randomized controlled trial was conducted in 110 participants. 55 participants were enrolled in the Kabasura Kudineer arm and 55 in the control (standard therapy + Kabasura Kudineer placebo) arm. Study participants were randomly allocated into the two study arms. They were assessed for symptoms at baseline, and on Day 5 and Day 10. RT PCR, CRP, IL6 and IgG levels were measured at baseline, Day 5 and Day 10. On day 28, participants were interviewed telephonically for symptom assessment alone. STATISTICAL ANALYSIS: A per-protocol approach was used. Significant difference between two groups was assessed at baseline, day 5 and day 10 using the Chi-square and Mann Whitney test. RESULT: A total of 110 patients participated in study. Four patients in the Kabasura Kudineer arm and 9 in the Standard therapy arm were lost to follow-up. Baseline characteristics for both the groups were matched at baseline. 83.9% and 93.9% patients were relieved of all symptoms by the 10th day in Kabasura and standard therapy groups respectively. Decrease in CRP level was more pronounced in the Kabasura group compared to standard therapy viz. 3 mg/l and 1.26 mg/l. No significant difference was found in IgG level and IL6 levels in both the study groups. However, it was noticed that among the unvaccinated group, the surge in IgG levels was much higher in Kabasura Kudineer group than the standard therapy group. CONCLUSION: Kabasura Kudineer as a standalone therapy was as effective and safe as the standard therapy among patients with asymptomatic to mild COVID-19.

Prolonged Corticosteroid Use Leading to Cerebral Venous Sinus Thrombosis: A Rare Association.

Partial or complete obstruction of blood flow in venous sinuses of the brain leads to a clinical condition termed cerebral venous sinus thrombosis (CVST). In most diagnosed cases, CVST has at least one risk factor identified among many postulated, and it most commonly includes acquired or inherited prothrombotic conditions. Steroid intake for intentional weight gain is prevalent in the general population, especially among new-generation bodybuilders and athletes. Excess exogenous steroids have many adverse effects, and increasing the risk of venous thromboembolism is one of them. The role of these steroids in developing CVST among such individuals has not been reported frequently in the literature. We report a case of a young male with a history of chronic exogenous steroid intake to increase his body weight, who presented with clinical features of CVST.

Association of Vitamin D Status With Metabolic Syndrome and Its Individual Risk Factors: A Cross-Sectional Study.

Background Vitamin D deficiency has been associated with metabolic syndrome and its related outcomes, including type 2 diabetes mellitus, cardiovascular disease, myocardial infarction, and stroke. However, studies in Indian populations have provided conflicting results. Methods This single-center cross-sectional study was conducted in a tertiary care hospital in north India to determine the prevalence of vitamin D deficiency in patients with metabolic syndrome and to study the correlations of individual components of metabolic syndrome with 25 hydroxy vitamin D levels. The study included 235 patients aged between 30 to 70 years who met the criteria for metabolic syndrome. Patients with diabetes, hypothyroidism, Cushing's, and other disorders affecting vitamin D status, on supplements of vitamin D or anti-dyslipidaemic drugs were excluded. Information regarding socio-demographic characteristics, medical history, and anthropometric measurements were collected. Blood samples were collected to assess vitamin D levels. Results The prevalence of vitamin D deficiency (<20 ng/ml) was 76% among the study population. There was a significant negative correlation between vitamin D levels and diastolic blood pressure (Spearman's rho: -0.134, 95% CI: -0.82,-0.260, p=0.040), fasting blood glucose (Spearman's rho: -0.142, 95% CI: -0.101,-0.269, p=0.029), A weak correlation was also found between vitamin D3 levels and total cholesterol (Spearman's rho: -0.246, 95% CI: -0.119,-0.367, p<0.001), triglyceride levels (Spearman's rho: -0.246, 95% CI: -0.118,-0.370, p<0.001) and low-density lipoprotein (LDL) levels (Spearman's rho: -0.229, 95% CI: -0.102,-0.351, p<0.001). Conclusion The study findings suggest that vitamin D deficiency is prevalent among patients with metabolic syndrome in north India. There is a significant negative correlation between vitamin D levels and some components of metabolic syndrome. This highlights the need for further research to understand the underlying mechanisms and potential benefits of vitamin D supplementation in this population. Identification of high-risk individuals for hypovitaminosis D can aid in streamlining treatment guidelines and preventing unnecessary prescription of investigations in developing countries.

Kimura disease: A rare cause of painless lymphadenopathy in South Asia.

Kimura disease is an uncommon disease entity that typically involves the lymph nodes predominantly in the head and neck region together with frequent involvement of salivary glands. Very few cases of it have been reported in literature globally, and in the context of India, it is even rare. Early suspicion of Kimura disease may prevent the patient from unnecessary invasive diagnostic tests. We present a case scenario of a 35 years old female, from a hilly area who presented with painless neck swelling for 3 months that was followed by fever, new onset pain at the site of neck swelling, and skin rashes. Diagnosis of Kimura disease was made based on histopathological findings aided by peripheral eosinophilia and elevated serum Immunoglobulin E (IgE) levels. Following the diagnosis, the patient was treated with a short course of oral steroids which produced an excellent response with a consequent decrease in the size of lymph nodes and resolution of the skin rashes.

The Role of Yoga in Hospitalized COVID-19 Patients: An Exploratory Randomized Controlled Trial.

Introduction The unpredictable course and sheer magnitude of coronavirus disease 2019 (COVID-19) have sparked a search for novel and repurposed pharmacological interventions. Non-pharmacological interventions may also play a role in the management of this multifaceted disease. This study aimed to evaluate the safety, feasibility, and effect of yoga in hospitalized patients with moderate COVID-19. Methods Twenty patients satisfying the inclusion criterion were randomized (1:1 ratio) into Intervention and Control groups. Patients in the intervention arm performed a one-hour yoga session that included pranayama and Gayatri mantra (GM) chant for up to 14 days. Sessions were fully supervised by a trained yoga trainer via an online platform. Patients in both groups received the normal treatment as per national guidelines. Outcome parameters were recorded on the 14th day/end of the hospital stay. Results Yoga is safe and feasible in hospitalized patients with COVID-19. The decline of high-sensitivity C-reactive protein (hs-CRP) levels was significantly greater in the Intervention Group. Quality of life (QOL), depression, anxiety, and fatigue severity scale (FSS) showed a decline in both groups with a significant decline observed in FSS scores of the Intervention Group. Median chest X-ray score values, duration of hospital stay, and reverse transcription-polymerase chain reaction (RT-PCR) conversion days were observed to be lower in the Intervention Group but were not significant (p>0.05). Conclusion The study found that incorporating pranayama and GM practices in hospitalized patients with moderate COVID-19 pneumonia was safe and feasible. It showed a notable reduction in hs-CRP levels and FSS scores in the Intervention Group, but the study was not powered to detect statistically significant results. Further research with larger sample sizes is needed for conclusive findings.

Giant Cell Arteritis in an Elderly Female With Pulmonary Tuberculosis.

Giant cell arteritis (GCA) is a type of systemic vasculitis that primarily affects people over the age of 50 and affects the medium to large arteries. GCA's clinical manifestations can be varied and non-specific, similar to those observed in atherosclerosis. Here, the authors present a case of an elderly woman with pulmonary tuberculosis with GCA masquerading as atherosclerosis.

Disseminated Tuberculosis Presenting as Venous Thromboembolism.

Tuberculosis (TB) is one of the leading causes of morbidity and mortality throughout the world and can have both pulmonary and extrapulmonary manifestations. Among the myriad extrapulmonary manifestations of TB, deep vein thrombosis (DVT) is rare. We present the case of a 25-year-old woman who presented with progressive painful swelling of the left upper limb associated with intermittent low-grade fever. Upon evaluation, she was found to have DVT along with a subsegmental pulmonary embolism. Further workup of the patient revealed bilateral pleural effusion and constrictive pericarditis along with microbiological evidence of Mycobacterium tuberculosis. The patient was started on anti-tubercular therapy along with therapeutic anti-coagulation, after which there was a substantial clinical improvement. Though rare, this case elucidates the venous thrombosis risk associated with one of the most common diseases in developing countries.

A comparative study of mortality differences and associated characteristics among elderly and young adult patients hospitalised with COVID-19 in India.

INTRODUCTION: Studies have shown that elderly have been disproportionately impacted by COVID pandemic. They have more comorbidities, lower pulmonary reserve, greater risk of complications, more significant resource utilization, and bias towards receiving lower-quality treatment. OBJECTIVES: This research aims to determine the characteristics of those who died inhospital due to COVID illness, and to compare these factors between elderly and young adults. METHODS: We conducted a large retrospective study at a government run center in Rishikesh, India, from 1st May 2020 till 31st May 2021, and divided study population into adults (aged 18 to 60 years) and elderly (aged 60 years). We evaluated and compared our data for presenting symptoms, vitals, risk factors, comorbidities, length of stay, level of care required, and inhospital complications. Long-term mortality was determined using telephonic follow-up six months after discharge. RESULTS: Analysis showed that elderly had 2.51 more odds of dying inhospital compared to younger adults with COVID. Presenting symptoms were different for elderly COVID patients. The utilization of ventilatory support was higher for elderly patients. Inhospital complications revealed similar profile of complications, however, kidney injury was much higher in elderly who died, while younger adults had more Acute Respiratory Distress. Regression analysis showed that model containing cough and low oxygen saturation on admission, hypertension, Hospital Acquired Pneumonia, Acute Respiratory Distress Syndrome, and shock, predicted inhospital mortality. CONCLUSION: Our Study determined characteristics of inhospital and long-term mortality in elderly COVID patients and compared them from adults, to help better triaging and policy making in future.

Dehydration in Elderly: Revisiting the Assessment and Management Strategies.

Dehydration, like many other aspects of an aging body, is often neglected by patients and physicians alike. Not only does it sometimes become difficult to clinically assess and identify dehydration in the elderly, but it also becomes difficult to attribute gross changes in functioning to something as simple as water depletion. This can be counterproductive to the overall health and even survival of elderly patients if diagnosis is delayed. We propose a comprehensive hydration stewardship program, with public health and clinical interventions, to prevent dehydration and its complications in vulnerable segments of society, such as the elderly. This short review summarizes current evidence available for the diagnosis and identification of dehydration in the elderly and shares preventive strategies to prevent its occurrence and complications.

Yoga as an Adjuvant therapy in management of migraine- An open label randomised trial.

Introduction: Drug treatment is not very satisfactory in migraine and is associated with adverse effects. The effect of yoga as an add-on therapy in migraine was evaluated in the present study. Methods: Patients between the age of 18 and 60 years suffering from migraine were recruited from Internal Medicine and Neurology OPD. Migraine was diagnosed according to the International Headache Society, International Classification of Headache Disorders-3rd edition (IHS, ICHD-3). At baseline, clinical and autonomic parameters of patients were assessed, and consenting patients were randomized into two equal groups by using a computer-based random number generator program (version 1): conventional (C group) and conventional plus yoga (C+Y group). Both groups were given conventional therapy for migraine, and the C+Y group was given yoga as an add-on therapy. Yoga therapy was given for 5 days/week for 12 weeks, and a post-intervention assessment was done at the 14th week. Subjective variables such as frequency and average duration were assessed through headache diaries or telephonic conversation, while severity was assessed using the visual analog scale (VAS) and headache impact test (HIT-6). Statistical Analysis: Independent t test and Mann-Whitney U Test (Wilcoxon rank-sum test) were used for comparing normally and non-normally distributed endpoint outcomes after treatment (AT). Results: Out of 170 patients screened, 75 were diagnosed with migraine and only 34 patients completed the study (17 in each group). All clinical and autonomic parameters showed significant improvement in pre- and post-intervention values in both groups (P < 0.0001). On comparing the conventional (C) group and conventional + yoga (C+Y) group, the change in the VAS score was more in the C+Y group (P = 0.041) and heart rate variability showed more reduction in the C+Y group (P = 0.032). Conclusion: We did not find any significant difference in the clinical outcome by adding yoga therapy to conventional therapy, except reduction in VAS score and reduction in heart rate variability.

Rhupus Syndrome: A Diagnostic Dilemma.

Rhupus syndrome, a rare coexistence of systemic lupus erythematosus (SLE) and rheumatoid arthritis, is characterized by symmetrical erosive polyarthritis and permanent deformities in addition to the clinical and serological characteristics of SLE. Its prognosis is further complicated by neurological and hematological involvement, which dramatically lowers patients' perceptions of their quality of life in terms of their health. Rhupus individuals have significantly less kidney involvement than SLE patients do. We present a case of a young female who had symmetric, bilateral, erosive polyarthritis for one and a half years preceding the signs and symptoms of SLE, which occurred about six months later.