Effect of Yoga on Endothelial Function: A Systematic Review and Meta-Analysis.

Introduction: Endothelial dysfunction is the initial step in the pathogenesis of atherosclerosis; and it plays a central role in the development of cardiovascular diseases and many types of human diseases (diabetes, kidney failure, cancer, and viral infections). Strategies that are effective in protecting vascular endothelial function and retard or reversing endothelial dysfunction in the early stage appear to be potential in the prevention of vascular, cardiac, and many human diseases. Several studies have been carried out on the effects of yoga on endothelial function, but the results of these studies have not been synthesized. This study aimed at conducting a systematic review and meta-analysis to determine the effectiveness of yoga on endothelial function. Methods: A systematic review and meta-analysis of studies that assessed the effect of yoga practice on vascular endothelial function was done as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, Google Scholar, and Cochrane controlled register of trials (CENTRAL) were searched from inception to August 2022. The search strategy was constructed around yoga-based techniques and endothelial function. All the yoga-based interventional studies on endothelial function or dysfunction were included in this review. A narrative synthesis and descriptive analysis were done due to the diverse methodology of selected studies. We carried out a formal meta-analysis of controlled trials that assessed the effect of yoga on flow-mediated dilatation (FMD), a measure of endothelial function. Results: A total of 18 studies were included for review involving 1043 participants. Yoga training showed improved endothelial function in 12 studies, whereas 6 studies did not find any statistically robust effect. Meta-analysis (n = 395 participants, 6-studies, 7 comparisons) showed an increase in brachial FMD by yoga practice (mean difference = -1.23%; 95% confidence interval -2.23 to -0.23; p = 0.02). The heterogeneity between the studies was 43% (Tau2 = 0.70, χ2 = 10.49). The risk of bias was low to moderate in these studies. No adverse effects were reported. Conclusions: Yoga practice improved endothelial function. Yoga could be a safe and potential integrative medicine to improve endothelial function. However, as the statistical heterogeneity, that is, variation in the FMD among the studies was moderate, large clinical trials are necessary for its clinical recommendations.

Association of Low BMI with Aortic Stiffness in Young Healthy Individuals

BACKGROUND: Increased arterial stiffness is an independent predictor of cardiovascular morbidity and mortality. It is unknown whether low BMI has any detrimental effect on the arterial wall during young age. OBJECTIVES: The present study was aimed to determine if low BMI can increase arterial stiffness in young, healthy individuals. METHODS: A cross-sectional study was conducted on young, healthy subjects (n=100) with low BMI <18.5 (n=50) and normal BMI: 18.5-24.9 (n=50) with ages ranging between 15-23 years. BMI, heart rate, blood pressure, and arterial stiffness indices such as regional pulse wave velocity (PWV) between brachial-ankle (baPWV), carotid-femoral (cfPWV), heart-ankle (haPWV), heartbrachial (hbPWV) were measured. RESULTS: A significantly increased pulse pressure (p=0.014), baPWV (1059.2 ± 140.26 cm/s vs 994.66 ± 129.23 cm/s; p=0.019) and cfPWV (641.03 ± 113.83 cm/s vs 583.96 ± 120.48 cm/s; p=0.017) was found in individuals with low BMI than normal BMI group. There was a significant negative correlation between BMI and central arterial PWV. Further multiple regression analysis showed that BMI was robustly associated with cf-PWV (p=0.004) and baPWV (p=0.016) even after multiple adjustments with potential confounders using several models. CONCLUSION: These findings show a significant increased aortic stiffness and pulse pressure in low BMI subjects compared to those with normal BMI. Low BMI was inversely and independently associated with central arterial or aortic stiffness. These findings suggest that low BMI may be a risk factor for aortic stiffness in young, healthy individuals.

Effectiveness of yoga on arterial stiffness: A systematic review.

OBJECTIVES: Arterial stiffness is a major cardiovascular (CV) risk and an independent strong predictor of CV morbidity and mortality. The aim of this systematic review is to evaluate the clinical or interventional studies that assessed the effectiveness of yoga on arterial stiffness in participants of any age or sex, healthy or with any conditions. DESIGN: Systematic review of clinical trials or interventional studies. DATA SOURCES: Cochrane Library, Medline/PubMed, Scopus, and Google Scholar databases. REVIEW METHODS: Databases were searched till July 2019 for clinical trials or interventional studies whether controlled or uncontrolled, randomized or non-randomized studies assessing the effects of yoga on arterial stiffness. Quality of the studies was assessed by using Physiotherapy Evidence Database (PEDro) Scale. RESULTS: Seven full-text articles (total number of participants = 362) that evaluated the effect of yoga on arterial stiffness were included in this review. There were three randomized controlled studies and four were non-controlled studies (single group studies). Four studies have shown significant reduction in arterial stiffness, while three studies did not find any significant change in arterial stiffness. The beneficial effects of yoga intervention on arterial stiffness in young adults and elderly hypertensive patients are encouraging. Methodological quality was good for one study, moderate for two studies and poor for four studies. CONCLUSIONS: This review shows that yoga practice is effective in preventing or reducing the arterial stiffness in young healthy and obese, and elderly hypertensive patients. As the methodology of many studies is of low quality and safety measures were not reported, there is a need of quality randomized controlled trials of yoga effects on arterial stiffness among high risk individuals.

Effect of yoga on cardiac autonomic dysfunction and insulin resistance in non-diabetic offspring of type-2-diabetes parents: A randomized controlled study.

OBJECTIVE: The present study was aimed to determine the effect of yoga program on cardiac autonomic dysfunction and insulin resistance in non-diabetic offspring of diabetes parents. METHODS: A randomized passive-controlled study was conducted on 64 non-diabetic offspring of type-2-diabetes parents (mean-age:25.17years). Yoga group participants received yoga training for 8 weeks. Heart-rate variability (HRV) indices: low frequency (LF), high frequency (HF) and LF/HF ratio; fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin resistance (IR) were estimated at baseline and after 8-weeks of intervention. RESULTS: We found a significant decrease in LF (p = 0.005), LF/HF ratio (p = 0.004), IR (p < 0.001), OGTT (p = 0.003) and increase in HF (p = 0.022) in yoga group participants. Control group participants did not show any significant change in any variables. CONCLUSIONS: Improvement in cardiac autonomic function and insulin resistance by yoga training implies that yoga can reduce the risk of development of diabetes in offspring of diabetes parents.

How to plan and write a budget for research grant proposal?

Medical research can have an enormous positive impact on human health. Health research improves the quality of human lives and society which plays a vital role in social and economic development of the nation. Financial support is crucial for research. However, winning a research grant is a difficult task. A successful grant-winning application requires two key elements: one is an innovative research problem with best probable idea/plan for tackling it and appropriate planning of budget. The aim of the present paper is to give an insight on funding agencies providing funding for health research including traditional Indian medicine (from an Indian perspective) and key points for planning and writing budget section of a grant application.

Elevation of Oxidative Stress and Decline in Endogenous Antioxidant Defense in Elderly Individuals with Hypertension.

INTRODUCTION: Hypertension is becoming an important medical and public health problem all over the world and is the most common disorder of ageing. There is a growing evidence of involvement of vascular oxidative stress in the development of hypertension from animal studies. However, studies on humans with hypertension, particularly in elderly are least and data remained controversial. Moreover, studies in elderly people with hypertension are scarce. AIM: To investigate the possible role of oxidative stress and antioxidant defense in the pathogenesis of hypertension in elderly. MATERIALS AND METHODS: A cross-sectional study was conducted on elderly males (n=60) with newly diagnosed hypertension and with normal blood pressure. Oxidative stress and antioxidant status were evaluated by assessing the following parameters: plasma Malondialdehyde (MDA), and antioxidants: Superoxide Dismutase (SOD) activity, reduced Glutathione (GSH), and vitamin C levels; and total Nitric Oxide concentration in plasma (NOx). Difference between groups was determined by using unpaired t-test/Mann-Whitney U test. Bivariate correlation and multiple regression analysis were used to determine the relationship between variables. RESULTS: A significant rise in plasma MDA (p-value=0.013) and lower levels of endogenous antioxidants: SOD (p-value≤0.001) and GSH (p-value≤0.001) were observed in elderly individuals with hypertension when compared to healthy controls. Though not significant, there was a mean decrease in plasma NOx in hypertensive subjects than normotensive ones. While vitamin C showed no significant difference between two groups. Decrease in GSH (ß=-0.398; p-value=0.001) and SOD (ß=-0.423; p-value≤0.001) were the significant determinants of hypertension in elderly individuals. CONCLUSION: Above findings indicate that elevation in oxidative stress and decrease in endogenous antioxidant level may be involved in the pathogenesis of hypertension. However, it remains unclear whether oxidative stress causes or augments hypertension.

Effect of yoga on oxidative stress in elderly with grade-I hypertension: a randomized controlled study.

BACKGROUND AND OBJECTIVES: Hypertension, especially in elderly is a strong risk factor for cardiovascular mortality and morbidity. Oxidative stress has been implicated as one of the underlying cause of hypertension. Yoga has been found to control hypertension in the elderly, but the underlying benefits of mechanism in relation to oxidative stress regulation remains unclear. The purpose of the study was to investigate the effect of yoga on oxidative stress in elderly with Grade-I hypertension. METHODS: An open parallel-arm randomised controlled study was conducted at BLDE University's Shri B.M.Patil Medical College, Hospital and Research Centre, India on elderly male individuals with Grade-I hypertension (n=57, age 60-80 years). Study (Yoga) group was assigned for yoga intervention and control group for walking for one hour in the morning for six days in a week for three months under the supervision of yoga instructor and physical training instructor respectively. Serum malondialdehyde (MDA) as an indicator of oxidative stress and antioxidants such as serum superoxide dismutase (SOD), reduced glutathione (GSH) and vitamin C levels were estimated. RESULTS: Yoga practice for three months has significantly reduced serum MDA level (p<0.001), and enhanced antioxidants level such as SOD activity (p=0.007), serum GSH (p=0.002) and vitamin C (p=0.002). In the control group, we observed a significant increase in serum MDA level (p=0.04) and reduction in serum vitamin C level (p=0.015) with no significant difference in the SOD activity and GSH level. CONCLUSION: These findings suggest that yoga is an effective means to reduce oxidative stress and to improve antioxidant defense in elderly hypertensive individuals.

Effect of yoga on short-term heart rate variability measure as a stress index in subjunior cyclists: a pilot study.

Subjunior athletes experience mental stress due to pressure from the coach, teachers and parents for better performance. Stress, if remains for longer period and not managed appropriately can leads to negative physical, mental and cognitive impact on children. The present study was aimed to evaluate the effect of integrated yoga module on heart rate variability (HRV) measure as a stress index in subjunior cyclists. Fast furrier transform technique of frequency domain method was used for the analysis of HRV. We have found a significant increase in high frequency (HF) component by 14.64% (P < 0.05) and decrease in the low frequency component (LF) of HRV spectrum by 5.52% (P < 0.05) and a decrease in LF/HF ratio by 19.63% (P < 0.01) in yoga group. In the control group, there was decrease in the HF component and, no significant difference in the LF component of HRV spectrum and LF/HF ratio. The results show that yoga practice decreases sympathetic activity and causes a shift in the autonomic balance towards parasympathetic dominance indicating a reduction in stress. In conclusion, yoga practice helps to reduce stress by optimizing the autonomic functions. So, it is suggested to incorporate yoga module as a regular feature to keep subjunior athletes both mentally and physically fit.

Heterotopic ossification: an unusual presentation.

Heterotopic ossification (HO) is usually seen after-trauma, following traumatic injuries, surgeries involving major joints, neurogenic injury, and burns; however, atraumatic cases have also been reported. HO tends to cause pain, swelling, and limitation of joint movements. HO has been reported in adults as well as in pediatric cases, however, our search in the English literature has not revealed a single case in the infratemporal region, especially in children of developing age, where HO tends to affect the development and growth of adjacent bones. We are reporting a case of HO in close proximity to TMJ affecting the development of mandible and maxilla.