Overall Feeling Of Well-being Research Articles

Mental optometry: Perceive to see with the mind’s eye

Mental optometry is a newly recognized word that refers to the interaction of the mind, brain, and sensory perceptions. The pattern established by behavioural optometry's research and assumption linking bodily orientation to the physical field of vision will be followed by the mind's eye, emotions, and actions. All three theories imply the presence of such an idea as a fundamental component of their systems, even if it isn't formally stated. The database was compiled using PubMed, PubMed Central (PMC), the Cochrane library, Google scholar, and research gate. Mental Optometry provides a neurobiologically informed knowledge of mood, emotion, and thinking. Visual stimulus interpretations, enabling for therapeutic treatments to help patients recognize and rectify skewed judgments. Optometrists have an important role in patients with mental illness. Finally, we must evaluate how enhancing ocular health and visual suppleness may assist our patients improve their overall feeling of well-being.

Effects of 60 Min Electrostimulation With the EXOPULSE Mollii Suit on Objective Signs of Spasticity.

Background: The EXOPULSE Mollii method is an innovative full-body suit approach for non-invasive electrical stimulation, primarily designed to reduce disabling spasticity and improve motor function through the mechanism of reciprocal inhibition. This study aimed to evaluate the effectiveness of one session of stimulation with the EXOPULSE Mollii suit at different stimulation frequencies on objective signs of spasticity and clinical measures, and the subjective perceptions of the intervention.Methods: Twenty patients in the chronic phase after stroke were enrolled in a cross-over, double-blind controlled study. Electrical stimulation delivered through EXOPULSE Mollii was applied for 60 min at two active frequencies (20 and 30 Hz) and in OFF-settings (placebo) in a randomized order, every second day. Spasticity was assessed with controlled-velocity passive muscle stretches using the NeuroFlexor hand and foot modules. Surface electromyography (EMG) for characterizing flexor carpi radialis, medial gastrocnemius, and soleus muscles activation, Modified Ashworth Scale and range of motion were used as complementary tests. Finally, a questionnaire was used to assess the participants' perceptions of using the EXOPULSE Mollii suit.Results: At group level, analyses showed no significant effect of stimulation at any frequency on NeuroFlexor neural component (NC) and EMG amplitude in the upper or lower extremities (p > 0.35). Nevertheless, the effect was highly variable at the individual level, with eight patients exhibiting reduced NC (>1 N) in the upper extremity after stimulation at 30 Hz, 5 at 20 Hz and 3 in OFF settings. All these patients presented severe spasticity at baseline, i.e., NC > 8 N. Modified Ashworth ratings of spasticity and range of motion did not change significantly after stimulation at any frequency. Finally, 75% of participants reported an overall feeling of well-being during stimulation, with 25% patients describing a muscle-relaxing effect on the affected hand and/or foot at both 20 and 30 Hz.Conclusions: The 60 min of electrical stimulation with EXOPULSE Mollii suit did not reduce spasticity consistently in the upper and lower extremities in the chronic phase after stroke. Findings suggest a need for further studies in patients with severe spasticity after stroke including repeated stimulation sessions.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04076878, identifier: NCT04076878.

A Comparative Study of Appearance Anxiety and Self-Esteem Among Indian Classical Dancers and Non-Dancers

India has a rich cultural heritage and more than thousand years of tradition of arts, classical and folk music and dance. Dance is considered as the medium of expression. It is the symbol of different cultural aspects of a civilization. Classical dance, in particular, is not just seen as an entertainment medium but it is considered as a form of meditation or yoga through which a dancer can reach the supreme Lord. It has a more spiritual rather a mere entertainment base. Dance is a good form of exercise that burns calories and builds muscles along with the release of endorphins. Hence there is instant happiness that is experienced by the dancers. Dance also influences the mind by contributing to the experience of satisfaction. Everyday a dancer may not achieve a specific goal in the process but through dancing they feel they have worked towards their goal by practicing which gives them satisfaction. An article in Scientific American Magazine 2008, a Columbia University neuroscientist put forth the fact that brain’s reward centers are stimulated by music, sensory and motor circuits are activated by dance. Dancers benefit from the physical exercise, increased heart and lung capacities and the overall feeling of wellbeing which increases their self-esteem. Many studies have indicated that dance can increase confidence and self-esteem level of the dancer. On the other hand, dancers are believed to be concerned about body image and they constantly worry about becoming thin or putting on weight to look presentable on the stage. Concerns with body image will lead to low self-esteem of the dancers as they negatively evaluate their body shape. So, there are conflicting results regarding self-esteem. On one hand, dance increases self-esteem but on the other hand, the presence of appearance concerns decreases dancers’ self-esteem. Hence, the objective of this study was to understand the appearance anxiety and self-esteem among dancers specifically among Indian Classical dancers and also to understand the interaction between appearance anxiety and self-esteem. The study adopted a quasi-experimental between-groups research design where in training in Indian classical dance form was the quasi-independent variable and the group of dancers were compared to non-dancers on appearance anxiety and self-esteem. A sample of 65 participants was chosen. The sample consisted of 35 Indian classical dancers and 30 non-dancers between the age group 16-30 years. Sample was selected through the method of purposive sampling. Participants were then given the Appearance Anxiety Inventory (AAI) (Veale, D., Eshkevari, E., Kanakam, N., Ellison, N., Costa, A., & Werner, T., 2014) and Rosenberg Self-esteem Scale (Rosenberg, 1965). It was found that that there was a negative correlation between appearance anxiety and self-esteem which means higher the appearance anxiety lower is the self-esteem. Indian classical dancers and non-dancers did not differ significantly with respect to appearance anxiety and Self-esteem.

THE DYSFUNCTIONAL UTERINE BLEEDING (DUB) DUE TO ENDOMETRIAL HYPERPLASIA WITH BULKY UTERUS IN AYURVEDIC VIEW – CASE STUDY

ABSTRACT :-
 Endometrial is inner lining of uterus. Hyperplasia is excessive growth of cells. Endometrial Hyperplasia is excessive cell growth or thickness of inner lining of uterus. Endometrial hyperplasia is excessive or abnormal thickening of the lining of the uterus, which is most probable cause of Dysfunctional Uterine Bleeding (DUB). In most of the cases, it is benign in nature. The treatment of endometrial hyperplasia of uterus is mainly done by hormonal treatment (especially by progesterone) and by surgical treatment such as hysterectomy, which are having their own side effects. Ayurveda is a health care system sensitive to women’s special health needs. Women are far more sensitive to the rhythms and cycles of nature, Ayurveda is founded on the principle of keeping the body toned in time with nature, and naturally, women find Ayurveda very suitable. In Ayurveda, Endometrial hyperplasia of uterus can be correlated with Lohitakshara Yonivyapada. The present case revealed the Raktastambhaka, Shothhara evum Tridoshahara properties of some Ayurvedicmedicines viz. Pushyanuga Churna, Ashokarishta and Dashamoola Kashaya in a known case of DUB due to endometrial hyperplasia with Bulky Uterus. After 3 months of treatment sonography report showed no hyperplasia of uterus.
 AIMS AND OBJECTIVES 
 To evaluate the efficacy of Shamana Aushadhi in the management of Dysfunctional Uterine Bleeding (DUB) due to Endometrial Hyperplasia 
 MATERIALS AND METHODS
 It is a case study of the subject of 35 yrs age with Dysfunctional Uterine 
 Bleeding (DUB) due to Endometrial Hyperplasia who has been treated with Shamana Chikitsa.
 RESULTS AND DISCUSSION 
 The subject is on follow up and without any medicine on normal cyclic rhythm till date with overall feeling of wellbeing. There is improvement and no evidence recurrence of Dysfunctional Uterine Bleeding and Endometrial Hyperplasia.
 CONCLUSION 
 The selected treatment protocol i.e. Shamana Aushadha is very effective in the management of Endometrial Hyperplasia 
 KEYWORDS –​
 Ayurveda, Lohitakshara Yonivyapada, Endometrial Hyperplasia, Raktastambhaka Drugs

Tachycardia Induced Cardiomyopathy (TIC) in Patients with Postural Orthostatic Tachycardia Syndrome (POTS) and Ehlers-Danlos Syndromes (EDS)

Intro POTS is said to be a type of dysautonomia characterized by Tachycardia brought about by postural shifts in blood volume and circulation. This results in various Symptoms (Sx) including dizziness, lightheadedness, syncope, palpitations and tremulousness. POTS is often associated with EDS, a rare inherited connective tissue disorder pertaining to the production and processing of collagen. POTS causes abnormal increases in HR. If left untreated, pts can suffer from TIC indicated by an increasing Left Ventricle End Diastolic Diameter (LVEDD). Methods Electronic health records of 1300 POTS pts were reviewed retrospectively. Female pts with EDS between the ages of 20-40 who had imaging records of 3 or more echocardiograms in the past 5 yrs, with no more than 1 yr between consecutive echocardiograms were randomly selected. Our records identified 94 pts fulfilling this criteria. An assessment of the relation between associated Sx and corresponding Echocardiogram LVEDD values was made by observing pts reported Sx such as shortness of breath, chest pain, dizziness/lightheadedness, palpitations, and their overall feeling of well-being. Corresponding Functional Capacity (FC) values of each pt analyzed by reviewing Cardiopulmonary Exercise Stress Tests were also noted. Lastly, treatment modalities including drugs, exercise and I/V fluids were also monitored. A timeline with regards to changes in LVEDD was established to determine the effectiveness of various treatments. Results Of the 94 pts fulfilling the inclusion criteria: Mean age was 30 +/- 6.3 yrs. Mean LVEDD of pts reporting min Sx was 4.02 +/- 0.43. Mean LVEDD of pts reporting max Sx was 4.28 +/- 0.45. T-Test (p-value The average FC of pts experiencing min Sx was 69% while it was 63% for pts experiencing max Sx. T-Test (p-value = 0.006665) indicates that the mean of FC with least Sx is significantly higher than FC with maximum Sx. The average Decrease in FC per 0.1 cm Increase in LVEDD was 2.55% Pts with LVEDD of 4.04 +/- 0.48 were seen to have the highest FC >70%. Overall, 40 pts were seen to have >70% FC at LVEDD with the Lowest Sx. At >70% FC, 44 pts showed improvement with medication (Midodrine 20, Florinef 12, Beta Blockers 12), 25 pts with exercise and 11 on IV Fluids (including saline and/or albumin infusions). Conclusion Pts with POTS and EDS, tend to develop a worsening of Sx as LVEDD progressively increases resulting in a Tachycardia Induced Cardiomyopathy. However, aggressive management of Sx with medication and a dedicated exercise regimen can improve Sx, decrease LVEDD and cause reversal of the disease process. From the evidence collected, it can be recommended that POTS pts’ LVEDD values be maintained between 3.8 - 4.2 cm, as this range was seen to produce the least amount of Sx as well as a higher FC (>70%).

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The Effect of Pet Therapy and Artist Interactions on Quality of Life in Brain Tumor Patients: A Cross-Section of Art and Medicine in Dialog.

With the evolution of modern medical treatment strategies, there also comes the realization that many times we reach a point where traditional goals of medical care, such as overall survival or disease-free survival, are not realistic goals for many patients facing devastating illnesses. One such disease is malignant primary brain tumors, known as malignant glioma (MG). With median survival of only 20.9 months following best available standard of care treatment strategies, including surgery, chemotherapy, radiation, and tumor treating fields, MG is one of the deadliest malignancies of the modern era. Along the course of treating patients with MG, clinicians often realize that traditional treatment therapies can at best provide incremental benefit of symptom management without any survival benefit. However, even in these difficult situations, it is possible to make significant positive changes in patients’ health-related quality of life (HRQoL) using creative, non-traditional interventions. In this paper, we describe the initial findings from our project that takes a unique approach to studying the intersections of clinical care and art by using pet therapy and art-making as interventions for patients diagnosed with brain tumors. Our preliminary findings suggest that pet therapy and the ability to reflect as well as speak about their journey through a life-altering disease significantly increases patients’ overall feeling of wellbeing and reduces anxiety about future uncertainty.

Characteristics of Unscheduled and Scheduled Outpatient Palliative Care Clinic Patients at a Comprehensive Cancer Center

ContextThere is limited literature regarding outpatient palliative care and factors associated with unscheduled clinic visits. ObjectivesTo compare characteristics of patients with unscheduled vs. scheduled outpatient palliative care clinic visits. MethodsMedical records of 183 unscheduled cancer new outpatients and 104 unscheduled follow-up (FU) patients were compared with random samples of 361 and 314 scheduled new patients and FU patients, respectively. We gathered data on demographics, symptoms, daily opioid usage, and performance status. ResultsCompared with scheduled new patients, unscheduled new patients had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P = 0.002), nausea (P = 0.016), depression (P = 0.003), anxiety (P = 0.038), drowsiness (P = 0.002), sleep (P < 0.001), and overall feeling of well-being (P = 0.001); had a higher morphine equivalent daily dose of opioids (median of 45 mg for unscheduled vs. 30 mg for scheduled; P < 0.001); and were more likely to be from outside the greater Houston area (P < 0.001). Most unscheduled and scheduled new and FU visits were for uncontrolled physical symptoms. Unscheduled FU patients, compared with scheduled FU patients, had worse Edmonton Symptom Assessment Scale subscores for pain (P < 0.001), fatigue (P < 0.001), depression (P = 0.002), anxiety (P = 0.004), drowsiness (P = 0.010), appetite (P = 0.023), sleep (P = 0.022), overall feeling of well-being (P < 0.001), and higher morphine equivalent daily dose of opioid (median of 58 mg for unscheduled FU visits vs. 40 mg for scheduled FU visits; P = 0.054). ConclusionUnscheduled new FU patients have higher levels of physical and psychosocial distress and higher opioid intake. Outpatient palliative care centers should consider providing opportunities for walk-in visits for timely management and close monitoring of such patients.

Mental Heath in Womens and its Treatment by Tissue Remedies

In this article the author argues that complete presentation of Psychosomatic disorders in general, is used to mean a healthy balance of the mind and body in an overall feeling of well-being to describing the existence of positive health in an individual as exemplified by quality of life, Tissue remedies it is like rejuvenation and cleanup process on all levels physical, mental and emotional. The concept of Psychosomatic Problems of mind and these determine Homeopathy is guided best treatment. tissue remedies is highlighted as a holistic system with its concern for prevention and promotion of psychosomatic disorders and mental health. Key words: Anxiety, Stress, Depression etc. mental health and Tissue remedies

Characteristics of patients with unscheduled versus scheduled visits to outpatient supportive care center (SCC) at a comprehensive cancer center.

144 Background: There is limited literature regarding outpatient palliative care, and even more limited literature describing factors associated with unscheduled visits. Our aim was to identify clinical characteristics of patients who walk-in (present unscheduled) to the outpatient SCC with the hypothesize that the patients who present for unscheduled visits have more severe symptom distress as compared to those patients who present for scheduled appointments. Methods: We compared 183 patients with unscheduled consults (CO) vs a random sample of 361 patients with scheduled CO and 159 patients with unscheduled follow-up (FU) visits vs a random sample of 318 patients with scheduled FU visits. Results: Among 544 total CO visits, unscheduled visits had worse median Edmonton Symptom Assessment Scale (ESAS) symptoms (on a scale from 0 to 10): pain (6.5 vs 4.7, p &lt; .0001), fatigue (p = .002), nausea (p = .017), depression (p = .003), anxiety (p = 0.02), sleep (p = .0002), and overall feeling of well-being (p = 0.0009). There was no statistical difference in shortness of breath, financial distress, nor spiritual pain. Daily opioid dose (MEDD in mg) was significantly higher in unscheduled CO visits (119.7 vs 62.9, p = .0004). Among 344 total FU visits, unscheduled visits had worse median ESAS symptoms: pain (5.7 vs 4.2, p = .0001), fatigue (p = .0006), depression (p = .019), anxiety (p = .014) and higher MEDD (111.3 vs 73.6, p = .0009). There was no difference in type of insurance coverage and better ECOG (p = .015) in unscheduled vs scheduled CO visits. Unscheduled CO visits were more likely to be from outside the Houston area (161/361, 45% vs. 40/133, 30%, p &lt; 0.0001). Conclusions: Patients who are either referred as unscheduled CO visits or who present as unscheduled FU visits have higher levels of physical and psychosocial distress and higher opioid dose. Outpatient palliative care centers need to provide opportunity for walk-in referrals for timely management of these issues.

Reconstruction of NK Cells During Complex Cancer Treatment

AIM: The role of glucan in potentiation of immune system is well established, including effects on cancer development. In this study, we focused on effects of short term glucan supplementation in patients during complex cancer treatment. MATERIALS AND METHODS : We measured the levels of leptin and changes in NK cell numbers after oral application of 200 mg/day of glucan. RESULTS : We found significant improvement in total numbers of NK cells. Levels of leptin remained unchanged. CONCLUSIONS : Our findings show the significant effects of glucan supplementation on induction of NK cell, suggesting that addition of glucan to the diet could be beneficial for prevention of cancer remission. The glucan-supplemented group exhibited some improvements in psychic conditions, nutritional state and overall feeling of well-being. Longer supplementation seems to be necessary.

Intravenous Anesthesia With Bispectral Index Monitoring vs Inhalational Anesthesia for Rhytidoplasty

Minor adverse effects related to anesthesia are common and worrisome to patients, including perioperative vomiting, gagging on the endotracheal tube, incisional pain, and nausea. A previously published intravenous anesthesia protocol reports extremely low rates of postoperative nausea and vomiting (<1%) and decreases in postoperative pain perception compared with rates reported following administration of inhalational anesthetics. To evaluate and compare postoperative outcomes in patients after administration of combined propofol and ketamine hydrochloride anesthesia with bispectral index monitoring (PKA-BIS protocol) vs inhalational anesthesia (IA) during lower rhytidoplasty. We performed a prospective, double-blind, randomized comparison trial of the PKA-BIS protocol and IA in 30 consecutive female patients undergoing rhytidoplasty by a single surgeon at a single outpatient surgery center from October 2013 to June 2014. Outcome measures included nausea, vomiting, pain, overall feeling of well-being, time to awaken, time to discharge, and cost. Patient measures were recorded using a combination of a 40-item validated postoperative quality of recovery questionnaire (QOR-40) and visual analog scales (VASs). Results were recorded immediately after surgery and on postoperative days 1 and 7. A statistically significant reduction in emergence time (mean [SD], 29.8 [10.6] vs 46.0 [10.2] minutes; P < .001) and time to meet discharge criteria (51.4 [19.3] vs 66.1 [12.9] minutes; P = .02) was seen in patients in the PKA-BIS group. Patient-reported (subjective) postoperative nausea (3 of 15 [20%] vs 7 of 15 patients [47%]; P = .12; χ2 = 2.40), vomiting (0 vs 2 of 15 patients [13%]; P = .14; χ2 = 2.14), and confusion on the day of surgery (3 of 15 [20%] vs 6 of 14 patients [43%]; P = .18; χ2 = 1.77) were also decreased in the PKA-BIS group, but these differences did not reach significance. Differences in global recovery scores (QOR-40 scores in the postanesthesia care unit, 158.13 [22.68] vs 155.33 [18.09]; P = .71; at day 1, 166.47 [26.39] vs 166.00 [16.00]; P = .96), postoperative overall feeling of well-being (VAS scores at day 1, 6.10 vs 6.26; at day 7, 7.49 vs 8.00), and postoperative pain perception (VAS scores at day 1, 3.40 vs 3.65; at day 7, 2.26 vs 1.81) between the PKA-BIS and IA groups, respectively, did not reach significance. The costs of anesthesia administration were similar between the PKA-BIS ($10.37/h) and IA ($8.47/h to $9.87/h) groups. The PKA-BIS protocol for anesthesia appears to be a comparable alternative to traditional IA in patients undergoing elective rhytidoplasty. A larger patient sample size is needed to determine whether trends toward decreased nausea, vomiting, and postoperative confusion and differences in postoperative pain perception are significant. clinicaltrials.gov Identifier: NCT02410460. 1.

Effect of Exercise Programs on Symptoms of Fibromyalgia in Peri-Menopausal Age Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: The aim of this review and meta-analysis was to summarize evidence regarding the effect of physical exercise programs on fibromyalgia syndrome symptoms in peri-menopausal age women, and the characteristics of these programs.Findings: Nineteen randomized controlled trials [N = 1077 women] satisfied the inclusion criteria. Methodological quality of papers was assessed using the PEDro scores. Data on the study, subject, and exercise program characteristics as well as assessment of changes in depression, fatigue, global well-being [overall feeling of well-being and health-related quality of life], pain, sleep, and stiffness were extracted. The studies were grouped according to the intervention program: land interventions [aerobic, combined [aerobic endurance, strength, and flexibility], vibrations, and alternative programs], and aquatic interventions. Nineteen studies were selected for systematic review, but clinical heterogeneity limited the meta-analysis to two aerobic, three combined, two alternative, and five aquatic studies.Conclusions: In general, exercise programs have a positive effect on the symptoms of fibromyalgia in women in peri-menopausal age. The meta-analysis indicates that programs based on combined exercise and aquatic exercises have, respectively, a moderate [d = −0.63; I2 = 0%] and small effect [d = −0.41; I2 = 30%] on functional global well-being [assessed using the Fibromyalgia Impact Questionnaire total score]. Short-term interventions [12 weeks], including two to three sessions lasting 30–60 min each per week seem to improve symptoms in peri-menopausal age women with fibromyalgia, although high-quality studies with larger sample sizes are necessary to confirm these results.

Ontology Model for Wellness Contents Recommendation Based on Risk Ratio EM

Recently, there are high demand on healthy life and wellness due to the increased lifespan. Wellness is generally used to meana healthy balance of the mind, body and spirit that results in an overall feeling of well-being. To monitor the physical and mental wellness of object, we developed an inspection service middlewarefor monitoring physical and mental health conditionbyanalyzing EEG (electroencephalography), ECG (electrocardiography), respiration rate, SpO2 and EMG (Electrocardiogram) waveforms from multi-modal biosensors under the coverage of a wireless sensor network (WSN).We also use ontologies are an adequate methodologyto model sensors and their capabilities. For the inspection service middleware, we propose a prediction model based onrisk ratioExpectation Maximization (EM) by monitoring bio-sensor data in real-time. We also used ontology model which enables reasoning, classification of datasets from sensor network and wellness contents recommendation. This inspection middleware for monitoringhealthcare condition and support recommendation of wellness contents such as customized exercise, proper diet, and hospital checkup. In this paper, there are the five modules as follows: (1) The measurement of biometrics such as body temperature,EEG, ECG, respiration rates and EMG, (2) Object assessment from measurement wavelength, (3) Situation assessment using GPS in smart device, (4) Maximized health condition using risk ratio EM, (5) decision making and recommendation of wellness contents.

Comparative Study of Unilateral Laminotomy versus Conventional Laminectomy

Introduction Prolapsed intervertebral disc and lumbar canal stenosis have been major challenging problem of mankind since ages. Many different methods have been evolved for its diagnosis and management. The purpose of this study is to determine the efficacy and safety of unilateral laminotomy for decompression in case of PIVD and lumbar canal stenosis compared with conventional laminectomy. Materials and Methods A retrospective and prospective study of 40 patients who had undergone surgery for PIVD or lumbar canal stenosis at our institute was performed. They were assigned in the two groups: Group 1 ( n = 20) consisted of patients who underwent laminotomy for decompression, and Group 2 ( n = 20) consisted of patients treated by decompressive laminectomy. Neurological status of the patients was evaluated by physical examination both pre- and postoperatively. Pain, disability, and other criteria were assessed by Greenough scoring system. Plain AP and lateral radiographs and MRI of concerned segment of every patient were obtained. Lumbar flexion-extension films were obtained to assess spinal instability. Minimum follow-up was done at 6 months and results were assessed by using Greenough scoring system and radiographs at final follow-up. Results Excellent clinical outcome was obtained in 80% of patients in Group 1 and in 65% of patients in Group 2. Increase in Greenough score was more in Group 1. Postoperative spinal instability occurred in four patients in Group 2, none in Group 1. Early rehabilitation and early return to work was more possible in Group 1. There was one surgical complication in the each group (dural tear dealt during surgery). Postoperative infection developed in four patients (two in each group) among which one require surgical debridement in Group 2. Neurological impairment occurred in one patient in Group 2. Conclusion Duration of hospital stay is significantly reduced amongst the patients operated by unilateral laminotomy compared with laminectomy, and rehabilitation was also faster by starting earlier sitting and thereby reducing morbidity and burden to hospital. Consequent earlier return to normal routine life can be expected. Although overall outcome of the patients at final follow-up remains mostly unchanged, technique of sparing unilateral paraspinal muscles and thereby sparing supraspinous and interspinous ligaments does help in earlier rehabilitations of the patients, fastens the recovery, and thereby reducing psychiatric problems related to it, saves many man hours of one's life going in wastage and brings in overall feeling of well-being and patient satisfaction. Disclosure of Interest None declared References Young S, Veerapen R, O’Laoire SA. Relief of lumbar canal stenosis using multilevel subarticular fenestrations as an alternative to wide laminectomy: preliminary report. Neurosurgery 1988;23(5):628–633 Spetzger U, Bertalanffy H, Naujokat C, von Keyserlingk DG, Gilsbach JM. Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations. Acta Neurochir (Wien) 1997;139(5):392–396 Weiner BK, Walker M, Brower RS, McCulloch JA. Microdecompression for lumbar spinal canal stenosis. Spine 1999;24(21):2268–2272 Cavuşoğlu H, Türkmenoğlu O, Kaya RA, et al. Efficacy of unilateral laminectomy for bilateral decompression in lumbar spinal stenosis. Turk Neurosurg 2007;17(2):100–108 Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine. Spine 2002;27(4):432–438 Kim SW, Ju CI, Kim CG, Lee SM, Shin H. Minimally invasive lumbar spinal decompression: a comparative study between bilateral laminotomy and unilateral laminotomy for bilateral decompression. J Korean Neurosurg Soc 2007;42(3):195-199 Greenough CG, Fraser RD. Assessment of outcome in patients with low-back pain. Spine 1992;17(1):36–41 Greenough CG. Results of treatment of lumbar spine disorders. Effects of assessment techniques and confounding factors. Acta Orthop Scand Suppl 1993;251(Suppl 251):126–129

An Assessment of the Effects of Iyengar Yoga Practice on the Health-Related Quality of Life of Patients with Chronic Respiratory Diseases: A Pilot Study

To assess the effects of an Iyengar yoga program (IYP) on patients with chronic respiratory diseases. Patients attending lung transplant clinics in a tertiary institution were invited to participate in a two-phase, 12-week IYP that included 2 h biweekly classes. Doctors completed a formal physical and clinical assessment on candidates before enrollment. Patients with New York Association Class III or IV, or dyspnea grade IV were excluded. At baseline and at the end of 12-weeks, patients completed the Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Questionnaire (CRQ) and Health Utilities Index (HUI). Medication(s), 6 min walk test results and other clinical parameters were also recorded. Patients recorded the effects of the IYP on their daily living in journals. Nonparametric and qualitative methods were used to analyze the data. Twenty-five patients diagnosed with pulmonary arterial hypertension and chronic obstructive pulmonary disease (mean age 60 years) were invited to participate. At the end of the 12-week period, changes in HADS anxiety and CRQ fatigue scores were statistically significant (P<0.05) and changes in HUI ambulation, pain, emotion and overall score were clinically important. The content of the journals revealed patients' improvement in breathing capacity, mobility, energy, sleep and included positive feedback such as: "increased tidal volume with slowing expiration", "I have an overall feeling of wellbeing" and "excellent amount of energy". The findings suggest that yoga has significant potential to produce benefits. Potential benefits will be further explored in a national multisite study.

Immunological and metabolic effects of cis-9, trans-11-conjugated linoleic acid in subjects with birch pollen allergy

Animal studies suggest that conjugated linoleic acid (CLA) may modulate the immune response, while studies in healthy human subjects have shown little effect and results are controversial. However, the effects of CLA may be more prominent in situations of immune imbalance, such as allergy. We studied the effects of the natural CLA isomer, cis-9, trans-11-CLA, on allergy symptoms and immunological parameters in subjects with birch pollen allergy. In a randomised, placebo-controlled study, forty subjects (20-46 years) with diagnosed birch pollen allergy received 2 g CLA/d in capsules, which contained 65.3 % cis-9, trans-11-CLA and 8.5 % trans-10, cis-12-CLA (n 20), or placebo (high-oleic acid sunflower-seed oil) (n 20) for 12 weeks. The supplementation began 8 weeks before the birch pollen season and continued throughout the season. Allergy symptoms and use of medication were recorded daily. Lymphocyte subsets, cytokine production, immunoglobulins, C-reactive protein, lipid and glucose metabolism and lipid peroxidation were assessed before and after supplementation. The CLA group reported a better overall feeling of wellbeing (P < 0.05) and less sneezing (P < 0.05) during the pollen season. CLA supplementation decreased the in vitro production of TNF-alpha (P < 0.01), interferon-gamma (P < 0.05) and IL-5 (P < 0.05). Total plasma IgE and birch-specific IgE concentrations did not differ between groups, whereas plasma IgA (P < 0.05), granulocyte macrophage colony-stimulating factor (P < 0.05) and eosinophil-derived neurotoxin (P < 0.05) concentrations were lower after CLA supplementation. Urinary excretion of 8-iso-PGF2alpha, a major F2-isoprostane (P < 0.01), and 15-keto-dihydro-PGF2alpha, a primary PGF2alpha metabolite (P < 0.05), increased in the CLA group. The results suggest that cis-9, trans-11-CLA has modest anti-inflammatory effects in allergic subjects.

Helicobacter pylori eradication ameliorates symptoms and improves quality of life in patients on long-term acid suppression. A large prospective study in primary care.

Our objective was to determine prescribing patterns for H2 receptor antagonists (H2RA) in primary care and to establish the prevalence and impact of Helicobacter pylori (Hp) eradication in this population of patients. Patients on long-term (6 months or longer) H2RA were identified through a computerized database at the six primary care practices in North England. Hp status was identified by serology, and those positive received standard proton pump-based triple therapy followed by a urea breath test to confirm Hp eradication. The main outcome measures were the indications for prescribing long-term H2RA in primary care, the prevalence of patients with a positive Hp serology, and the impact of Hp eradication on the subsequent need for acid suppression, severity of dyspepsia, gastrointestinal symptom rating score (GSRS), quality of life (QOL), and overall feeling of well-being. One thousand seven (1.5%) patients were on long-term H2RA. Peptic ulcer disease (PUD) was the most common indication for prescribing (42%), followed by nonulcer dyspepsia (28%) and gastroesophageal reflux disease (23%). In 81% of the patients treatment with H2RA therapy followed a previous endoscopic or radiological investigation. Only 27 (2.5%) patients had had their Hp status checked within the last 6 months. Of the 471 patients who eventually had their Hp serology tested, 297 (63%) were Hp positive. Fifty-eight percent of the Hp-positive patients had PUD. Successful Hp eradication was achieved in 250 (84%) of the patients, of whom 247 (83%) finished the 1-year follow-up. This was associated with a significant reduction in the amount of H2RA being consumed (P < 0.00001). There was also a significant improvement in the symptom scores and the GSRS after successful Hp eradication (P < 0.00001). Overall 67% of the patients reported an improvement in the QOL and 77% noted a feeling of well-being 1 year after Hp eradication. A significant proportion of patients in primary care is still being maintained on long-term H2RA, imposing a considerable financial drain on the NHS resources. Approximately two-thirds of these patients will be Hp positive, and among them the largest group will comprise patients with PUD. Hp eradication in such patients results in a significant reduction in usage of acid suppression and an improvement in overall QOL and severity of dyspeptic symptoms.

Androgen cotherapy in menopause: Evolving benefits and challenges

The hormonal effects of estrogen and androgen were first investigated at the beginning of the twentieth century. Estrogen, which was first synthesized in the 1920s, has been shown to improve menopausal symptoms, decrease the incidence of osteoporosis, have a beneficial impact on plasma lipid profiles, probably reduce ischemic cardiovascular disease, and possibly improve cognition. In addition, retrospective studies have found a decreased incidence of Alzheimer’s disease among women receiving estrogen replacement therapy compared with those not receiving this form of postmenopausal therapy. Androgen has been written about in the medical literature since 1936, when Mocquot and Moricard described its use to relieve vasomotor symptoms in postmenopausal women. During the 1940s and 1950s numerous reports appeared in the literature describing the effectiveness of estrogen-androgen combination therapy for improving the overall feeling of well-being, energy level, libido, and quality of life for postmenopausal women. Recent studies have also shown estrogen-androgen therapy to contribute to the prevention of osteoporosis and reduce serum levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. Both historical data and evolving data support further evaluation of the use of estrogen-androgen replacement therapy in postmenopausal women. (Am J Obstet Gynecol 1999;180:S308-11.)

Angina pectoris in a contemporary population: characteristics and therapeutic implications. TIDES Investigators.

We characterized a contemporary, nonhospitalized population with angina pectoris by obtaining data from a geographically diverse cohort of 5125 outpatients with chronic stable angina cared for by 1266 primary-care physicians. Diagnosis was based on history supported by evidence for coronary artery disease (coronary angiography, old myocardial infarction [MI], and/or an abnormal stress test). Their mean age was 69 years and 53% were women. Seventy percent had more than one associated illness, and 65% used more than one cardiovascular drug. Calcium antagonists (46%) and nitrates (61%) were used most frequently. Median angina frequency was approximately 2 episodes/week, and increased angina frequency was associated (P < 0.0001) with decreased overall feeling of well-being. Although effort angina was present in 90% of patients, 47% also had rest angina and 34% had mental stress-evoked angina. Female gender (odds ratio: 1.09; 95% CI: 1.02-1.16), concomitant illness (1.17, 1.09-1.25), and pharmacotherapy (1.14, 1.07-1.22) were associated with rest angina. Younger age (1.30, 1.20-1.41), female gender (1.16, 1.07-1.26), concomitant illness (1.13, 1.03-1.24), and pharmacotherapy (1.28, 1.15-1.93) were associated with mental stress angina. Calcium antagonists were used for rest-evoked (1.09, 1.03-1.16) and mental stress-evoked (1.12, 1.04-1.21) angina. These data suggest that contemporary outpatients with angina are most likely to be women and elderly patients with high frequencies of associated illness, calcium antagonist and nitrate use, as well as rest- and mental stress-related angina. These characteristics differ from previous perceptions.