Effect of Ramipril on Cardiac Autonomic Neuropathy in Patients With Type II Diabetes Mellitus.

Background Cardiovascular autonomic neuropathy (CAN), an important form of DAN is caused by the impairment of the autonomic nerve fibers that innervate the heart and blood vessels and leads to abnormalities in cardiovascular dynamics. The earliest finding of CAN, even at the subclinical stage, is a decrease in heart rate variability (HRV). Objective The objective is to assess the effect of ramipril 2.5mg once daily on cardiac autonomic neuropathy in type II DM patients as an add-on to a standard antidiabetic regimen for a duration of 12 months. Materials and methods A prospective, open-label, randomized, parallel-group study was conducted on type II DM with autonomic dysfunction. Patients in Group A received tablet ramipril 2.5mg daily along with the standard antidiabetic regimen which consist of Tab Metformin 500mg twice a day and Tab Vildagliptin 50mg twice a day and group B received only the standard antidiabetic regimen for 12 months. Results Among 26 patients with CAN, 18 patients completed the study. After one year in group A, Delta HR value increases from 9.77±1.71 to 21.44±8.44 and the E:I ratio (ratio of the longest R-R interval during expiration and shortest R-R interval during inspiration) improved from 1.23±0.35 to 1.29±0.23 signifying significant improvement in parasympathetic tone. Results of the postural test showed significant improvement in SBP. Analysis of HRV by time domain method showed that the standard deviation of RR (SDRR) interval and Standard deviation of differences between adjacent RR interval (SDSD) value increased significantly in group A. Analysis of HRV frequency domain indices showed that LFP:HFP ratio improved after treatment in ramipril group indicating improvement in sympatho-vagal balance. Conclusion Ramipril improves parasympathetic component more as compared to sympathetic component of DCAN in type II DM. Ramipril could be a promising option having favorable long-term outcomes in diabetic patients especially when treatment begins at subclinical stage.

Assessment of Cognitive Performance of Hypertensives with Mini-cog and Audio-visual Reaction Time.

BACKGROUND: It is hypothesized that long-term hypertension might be associated with cognitive decline. OBJECTIVES: The present study was aimed at finding out whether persistently elevated blood pressure affects the processing capability of the central nervous system. METHODS: The cognitive functions of 62 male subjects with age ranging from 40 to 60 years forming various groups as normotensives and hypertensives were assessed through Mini-Cog and audio-visual reaction time. Mini-Cog involved Clock Drawing Test and Three Item Recall Test (mini recall test). Both these tests were scored as per standard methods to find out whether the cognition was normal or abnormal. The auditory and visual reaction times were measured by the "Response Analyzer" device. RESULTS: The clock drawing test and the three item-recall tests were significantly abnormal in hypertensives. Also, both auditory and visual reaction times were significantly delayed in hypertensives as compared to that of controls. CONCLUSION: The impairment of the cognitive function 1 hypertensives as reflected by the changes in the Mini-Cog and audio-visual reaction times might be due to structural and functional changes in various areas of brain involved in perceptual motor coordination.

Motor conduction parameters in recently diagnosed and untreated hypothyroidism.

BACKGROUND: The severity of neuromuscular symptoms and signs in hypothyroidism is known to be related to the duration and degree of hormone deficiency. PURPOSE: The present study was aimed to assess whether recently diagnosed and untreated hypothyroidism affects peripheral nervous system. METHODS: The study included a total of 120 female subjects with age ranging from 20 to 45 years. The motor nerve conduction parameters viz. Distal latency (DL), amplitude of compound muscle action potential (CMAP) and motor nerve conduction velocity (MNCV) were recorded bilaterally in median, ulnar and posterior tibial nerves using standard protocols and settings. RESULTS: The observations revealed significantly prolonged distal motor latencies, reduced CMAP amplitudes and slowed MNCV in the peripheral nerves in hypothyroid. CONCLUSION: The results indicated that the alteration in motor conduction parameters in recently diagnosed and untreated hypothyroidism might be due to various functional and structural changes in peripheral nerves associated with deficiency of thyroid hormones.

Autonomic Functions In Raja-yoga Meditators.

Stress, an inevitable and constant feature throughout the lifetime, induces autonomic dysfunctions, for which meditation is considered to be an antidote. So the case control study was planned including 50 Raja-yoga meditators practicing meditation for 5 years and 50 age matched non-meditators. Autonomic function tests were performed and results were compared using the Student-t test. Mean values of resting HR, SBP and DBP were less in meditators. Galvanic Skin Response in meditators was significantly more (p < 0.001). Mean increase BP response to Hand Grip Test and Cold Pressor Test was significantly less in meditators than non-meditators (p < 0.001). Standing: Lying ratio, Valsalva ratio, Inspiration: Expiration ratio and 30:15 ratios were significantly increased in meditators than non-meditators. From the results, there was shifting of the autonomic balance to parasympathetic side in Raja-yoga meditators, which suggests its utility to combat the ill effects of stress.

Indoor air pollution from biomass combustion and its adverse health effects in central India: an exposure-response study.

BACKGROUND: Some of the highest exposures to air pollutants in developing countries occur inside homes where biofuels are used for daily cooking. Inhalation of these pollutants may cause deleterious effects on health. OBJECTIVES: To assess the respiratory and other morbidities associated with use of various types of cooking fuels in rural area of Nagpur and to study the relationship between the duration of exposure (exposure index [EI]) and various morbidities. MATERIALS AND METHODS: A total of 760 non-smoking, non-pregnant women aged 15 years and above (mean age 32.51 ΁ 14.90 years) exposed to domestic smoke from cooking fuels from an early age, working in poorly ventilated kitchen were selected and on examination presented with various health problems. Exposure was calculated as the average hours spent daily for cooking multiplied by the number of years. Symptoms were enquired by means of a standard questionnaire adopted from that of the British Medical Research Council. Lung function was assessed by the measurement of peak expiratory flow rate (PEFR). PEFR less than 80% of the predicted was considered as abnormal pulmonary function. RESULTS AND CONCLUSIONS: Symptoms like eye irritation, headache, and diminution of vision were found to be significantly higher in biomass users (P < 0.05). Abnormal pulmonary function, chronic bronchitis, and cataract in biomass users was significantly higher than other fuel users (P < 0.05). Moreover an increasing trend in prevalence of symptoms/morbid conditions was observed with increase in EI. The presence of respiratory symptoms/morbid conditions was associated with lower values of both observed and percent predicted PEFR (P < 0.05 to 0.001). Thus women exposed to biofuels smoke suffer more from health problems and respiratory illnesses when compared with other fuel users.

Effect of indoor air pollution during cooking on peak expiratory flow rate and its association with exposure index in rural women.

Routine exposure to domestic cooking fuels is an important source of indoor air pollution causing deterioration of lung function. We conducted a community based cross-sectional study in 760 non-smoking rural women involved in household cooking with four types of cooking fuels i.e. Biomass, Kerosene stove, Liquid Petroleum Gas (LPG) and Mixed (combination of two and more cooking fuels). Peak Expiratory Flow Rate (PEFR) less than 80% of the predicted was considered as abnormal PEFR. The overall prevalence of abnormal PEFR was found to be 29.1% with greater predominance among biomass fuel users (43.3%) with high risk ratio (1.86) as compared to kerosene (0.63), LPG (0.75) and mixed (0.66) fuel users. However the pair wise comparison of different groups of cooking fuels by Marascuilo procedure reported significant differences within different groups except kerosene--mixed group. The study also demonstrated a negative correlation between observed PEFR and exposure indices in different cooking fuels (r = -0.51). Our results indicate that prolonged exposure to cooking fuels particularly biomass fuels as a source of cooking adversely affects PEFR in nonsmoking rural women.

Effect of short-term and long-term Brahmakumaris Raja Yoga meditation on physiological variables.

Effect of short-term and long-term Brahmakumaris Raja Yoga meditation on physiological variables like heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) was evaluated in 100 subjects practicing Raja Yoga meditation. All 100 subjects (33 men and 67 women) were aged 30 years and above (mean age 52.06 +/- 12.76 years). Short-term meditators (STM) (n = 27) practiced Raja Yoga meditation for duration of six months to five years (mean duration 3.37 +/- 1.67 years) and long-term meditators (LTM) (n = 73) practiced Raja Yoga meditation for more than five years (mean duration 11.19 +/- 5.13 years). The participants were asked to meditate and the physiological variables (HR, RR, SBP and DBP) were recorded twice (15 minutes and 30 minutes) after beginning of meditation. Also, the fasting blood sugar was estimated by glucometer. The study subjects did not differ significantly in age and various anthropometric characteristics such as body weight, body mass index, waist-hip ratio and fasting blood sugar. Comparison between STM and LTM showed that the changes from baseline values (from premeditation to post-meditation at 15 and 30 minutes) in LTM were not statistically significant with those in STM (P > 0.05). However, within group differences in LTM revealed that changes in the physiological variables were statistically significant when compared between pre and post meditation both at 15 and 30 minutes. The study suggests that the long-term practice of Raja Yoga meditation improves basic cardio-respiratory functions due to shifting of the autonomic balance in favor of parasympathetic instead of sympathetic system.

Cardiorespiratory response to aerobic exercise programs with different intensity: 20 weeks longitudinal study.

CONTEXT: participation in regular intensive exercise is associated with a modest increase in left ventricular wall thickness and cavity size. The magnitude of improvement depends on frequency, intensity, type, and duration of exercise program. AIMS: to determine the effect of sports training on LV morphology and function, lung function, and to know the intensity of the exercise program enough for these changes. SETTINGS AND DESIGN: this was a longitudinal study (20 weeks duration) done on the medical college students. MATERIAL AND METHODS: three groups, doing exercise at different intensities, high intensity group (HG) [74.9±3.9 %HRmax], low intensity group (LG) [59.46±4.1%HRmax] and no exercise group (NG) were made, and their assessments were done using the echocardiography and pulmonary function test three times, first before start of the exercise program, second at the end of 10th week, and then at the end of the 20th week. STATISTICAL ANALYSIS USED: 3 × 3 Anova test and Bonferroni's post-test using Graph pad prism5 software. RESULTS: significant improvement was seen in HG in majority of cardio respiratory parameters (VO2max, heart rate, LVIDD, LVIDS, EDV, MVV, PEFR, FVC) as compared to the LG (VO2max, heart rate, MVV, PEFR) and this improvement was specially seen at the end of the twentieth week. CONCLUSIONS: twenty weeks of training is helpful in improving aerobic power, MVV, and PEFR even the exercise is of moderate (LG) to high intensity (HG) but for overall cardio respiratory development physical training must be associated with very hard intensity if duration of the exercise program is short.

A longitudinal study of antenatal changes in lung function tests and importance of postpartum exercises in their recovery.

A study of changes in lung function tests during pregnancy was undertaken in fifty pregnant women beginning from third month of gestation. Fifty nonpregnant age and height matched women formed the controls. Forced Vital Capacity (FVC), Timed Vital Capacity (FEV1), Inspiratory Capacity (IC), Expiratory Reserve Volume (ERV) and peak Expiratory Flow Rate (PEFR) were performed in each month of pregnancy. However ten subjects were not available for follow-up during postpartum period. Remaining forty women were divided into two groups of twenty each. Group I performed daily graded active exercises to strengthen the anterior abdominal wall muscles. Group II women did not perform any exercises. It was observed that the antenatal changes in percent FVC and FEV1 were insignificant, but the decline in ERV and PEFR were very highly significant (P < 0.001) and the increment in IC was significant (P < 0.05). In the postpartum period the percentage variation of values in group I was less than 5% from controls (P > 0.05) and in group II it was 15-20% from controls (P < 0.05), resulting in a significant variation in group II women as compared to the controls. It is concluded that there are adaptive changes in lung functions in the antenatal period. We stress the importance of regular graded active exercises in the postpartum period for the speedy recovery of these changes.

An epidemiological study of pulmonary function tests in geriatric population of central India.

We have studied Pulmonary Function Tests (PFTs) namely Vital Capacity (VC). Forced Vital Capacity (FVC), and Forced Expiratory Volume in First Second (FEV1). Forced Expiratory Flow(FEF 25-50%) in 1200 elderly subjects above 60 years of age of which 570 were females and 630 males. Mean age was 69.22 +/- 5.57 years in males and 68.77 +/- 5.44 in females. The mean value of ventilatory parameters were as follows-1) VC 2.99 +/- 0.5 lt in males and 1.89 +/- 0.29 lt in females. 2) FVC 2.69 +/- 0.58 lt. in males and 1.76 +/- 0.21 lt in females. 3) FEV1/FVC% 83.82 +/- 10.62% in males and 83.37 +/- 11.93% in females. 4) FEF 25-75% was 2.81 +/- 1.20 lt/sec in males and 2.13 +/- 1.27 lt/sec. Physical as well as ventilatory parameters were less in females than for males. The correlation of age with VC and FEV1 was highly significant (P < 0.01) but with FVC was not significant (P > 0.05). The correlation of height, weight and body surface area was not significant with any ventilatory parameter (P > 0.05). Multiple regression equations for VC, FVC and FEV1 were formulated for males and females taking height and age as variables. The predicted values correlated excellently with observed values.