INTRODUCTION:

Languages exquisitely structured, complex, and diverse are a distinctively human gift, at the very heart of what it means to be human. As such, language makes for both a particularly important and difficult topic in neuroscience. A dominant early approach to the study of language was to treat it as a separate module or organ within the brain. However, much modern empirical work has demonstrated that language is integrated with, and in constant interplay with, an incredibly broad range of neural processes.

Neuroimaging, and developmental studies of language in the aging brain focusing on converging evidence regarding the highly interactive relationship between linguistic functions and other cognitive functions. A clear and comprehensive model explaining the functional neuroanatomy of language in the neurologically intact brain is still a work in progress. The newest attempts to propose such models represent a consistent shift towards accounts with increasing empirical and conceptual resolution that aim to capture the dynamic nature of the biological foundations of language. Better empirical resolution is now being accomplished through the enhanced level of detail with which temporal and spatial features of language-related brain activation patterns can be examined. Greater conceptual resolution involves the increasing level of specificity with which representations/operations underlying different language functions can be described.

Unlike other areas of neuroscience investigation (e.g., vision, motor action) that have relied heavily on invasive techniques with animal models, the study of language lacks any such model. Furthermore, in language, the relationship between the form of a signal and its meaning is largely arbitrary. For example, the sound of “blue” will likely have no relationship to the properties of light we experience as blue nor to the visual written form “blue,” will sound different across languages, and have no sound at all in signed languages. No equivalent of “blue” will even exist in many languages that might make fewer or more or different color distinctions. With respect to language, the meaning of a signal cannot be predicted from the physical properties of the signal available to the senses. Rather, the relationship is set by convention.

At the same time, language is a powerful engine of human intellect and creativity, allowing for endless recombination of words to generate an infinite number of new structures and ideas out of “old” elements. Language plays a central role in the human brain, from how we process colour to how we make moral judgments. It directs how we allocate visual attention, construe and remember events, categorize objects, encode smells and musical tones, stay oriented, reason about time, perform mental mathematics, make financial decisions, experience and express emotions, and on and on.

Indeed, a growing body of research is documenting how experience with language radically restructures the brain. People who were deprived of access to language as children (e.g., deaf individuals without access to speakers of sign languages) show patterns of neural connectivity that are radically different from those with early language exposure and are cognitively different from peers who had early language access. The later in life that first exposure to language occurs, the more pronounced and cemented the consequences. Further, speakers of different languages develop different cognitive skills and predispositions, as shaped by the structures and patterns of their languages. Experience with languages in different modalities (e.g., spoken versus signed) also develops predictable differences in cognitive abilities outside the boundaries of language. For example, speakers of sign languages develop different visuospatial attention skills than those who only use spoken language. Exposure to written language also restructures the brain, even when acquired late in life. Even seemingly surface properties, such as writing direction (left-to-right or right-to-left), have profound consequences for how people attend to, imagine, and organize information.

The normal human brain that is the subject of study in neuroscience is a “languaged” brain. It has come to be the way it is through a personal history of language use within an individual’s lifetime. It also actively and dynamically uses linguistic resources (the categories, constructions, and distinctions available in language) as it processes incoming information from across the senses.

Put simply, one cannot understand the human brain without understanding the contributions of language, both in the moment of thinking and as a formative force during earlier learning and experience. When we study language, we are getting a peek at the very essence of human nature. Languages—these deeply structured cultural objects that we inherit from prior generations—work alongside our biological inheritance to make human brains what they are.

Current brain-language models emerged in response to the classical Broca-Wernicke-Lichtheim-Geschwind lesion-deficit model of aphasia. In this model, language areas were localized in left-lateralized manner, with certain regions being predicted to lead to specific patterns of language impairment following brain damage. Thus, for example, the left posterior inferior frontal region, Broca’s area, was linked to speech production (where brain damage would result in articulatory problems); the left posterior temporal region, Wernicke’s area, to auditory speech recognition (where damage would yield impaired language comprehension); and the arcuate fasciculus connecting these anterior and posterior regions to repetition (where damage would impair production by repetition but preserve comprehension).

This schematic view of brain-language mappings has given rise to clinical classifications of aphasic syndromes, which to this day continue to guide aphasia research and clinical practice in many circles. Seven major aphasic syndromes have been proposed, with varying behavioral patterns and lesion loci Over time, however, serious clinical, biological, and psycholinguistic inadequacies of these mappings were identified. These include, for example, failure to account for the wide range of lesion-deficit patterns observed in aphasia (e.g., when a lesion to a certain area does not necessarily result in a predictable behavioral profile, or when lesions to multiple regions result in behavioral patterns that would otherwise be predicted for a different area altogether) or an inability to explain changes in behavioral patterns observed in aphasia over time (e.g., when a person first diagnosed with Wernicke’s aphasia presents later, in the chronic stage, with conduction-like behavioral patterns and/or anomic-like patterns). These changes are reportedly experienced by 30%–60% of patients, with anomia being the most common end result of all aphasia-producing lesions.

This model uses a dual-route neuroanatomical architecture—dorsal and ventral streams—borrowed from the field of visual processing and from animal models of auditory processing in primates to explain how auditory language proceeds. The ventral stream, also known as the “what” stream, is implicated in auditory recognition processes required for language comprehension, such as lexical semantic processing, mediated by neural networks projecting to different regions in the temporal lobe. The dorsal stream, termed the “where” stream, provides an interface for auditory and motor processing by performing phonological mappings of sound-to-articulatory representations, sub served by projections from auditory cortical circuits to temporoparietal and frontal networks. This architecture is shown in Figure 1.

Fig.-1: Dorsal-Ventral Streams (Adapted from Hickok and Poeppel)

Limitations of the classical model have been highlighted even further with the explosion of new findings emerging from studies using advanced techniques for measuring real-time brain activity, for example, hemodynamic changes in the brain through functional magnetic resonance imaging (fMRI), intrinsic brain connectivity through resting-state fMRI, or the time course of brain activation during task performance via electroencephalography (EEG) or magnetoencephalography (MEG). With these techniques, many new inter- and intra-hemispheric language-related neural networks have been identified (extending well beyond the core language areas, including cortical networks bilaterally, as well as subcortical circuits.

Price, for example, in a review of standard coordinates of peak activations found in over 100 fMRI studies published in 2009, identified an intricate web of neural networks, mediating different processes implicated in language comprehension and production. These included the following brain-language mappings: activation of the superior temporal gyri bilaterally for prelexical acoustic analysis and phonemic categorization of auditory stimulus, middle and inferior temporal cortex for meaningful speech, left angular gyrus and pars orbitalis in for semantic retrieval, superior temporal sulci bilaterally for sentence comprehension, and inferior frontal areas, posterior planum temporale, and ventral supramarginal gyrus for incomprehensible sentences (e.g., as a measure of plausibility). Speech production was found to activate additional neural networks, including left middle frontal cortex for word retrieval, independently of articulation; left anterior insula for articulatory planning, left putamen, presupplementary motor area, supplementary motor area, and motor cortex for overt speech initiation and execution; and anterior cingulate and bilateral head of caudate nuclei for response suppression during monitoring of speech output. Such data have clearly stimulated a need to create new models of the neuroanatomy of language, with greater neural and psycholinguistic specificity. Ideally, such models would spell out the specific links between formal operations associated with certain language functions, as well as the dynamic spatial and temporal neuronal pathways mediating them.

Conclusion: Results from neuroimaging, lesion studies, and studies of language in the aging brain provide compelling converging evidence for the concept of neural multifunctionality, a concept that has both theoretical and practical/clinical implications—theoretical with regard to models of brain-language relations and practical with regard to rehabilitation of persons with cognitive deficits as a consequence of brain damage.

The question remains, of course, of how a neurally multifunctional language system might work. Borrowing from recent developments in the memory literature, which emerged, in part, to account for apparent overlaps between the neural substrates mediating “what” and “how” memory functions, we propose to adopt a component process framework to language processing.

Under such a framework, linguistic information would be processed through a neural system of component processes, in which region-specific neural configurations contribute to multiple cognitive tasks simultaneously. The component interactions are conceived as “process-specific alliances.” These alliances are small brain regions temporarily recruited to accomplish a cognitive task, given specific task demands. Each component in the alliance has a specific function, and they combine together to give rise to a complex operation. These small neural “groups” disintegrate once task demands are met and are thus distinct from larger-scale networks, whose connectivity continues to be observed at rest. The links among the components in the stable larger-scale networks can affect which alliances are formed, but they do not directly determine them. This approach is aligned with our view of neural multifunctionality of language, whose operations rest on the interaction of “neural cohorts” sub serving multiple functions in cognitive, emotional, motor, and perceptual domains.

The neural multifunctionality approach we propose here will allow the re-evaluation of current concepts of recovery from aphasia, focusing on the dynamic development of new neural support systems in the aphasic brain in service of new functions. We propose that this multifunctionality operates in a multidirectional and reciprocal fashion, such that neural networks engaged in language recovery mutually interact with neural supports of non-linguistic functions so as to give rise to new functional neuroanatomies (i.e., newly established or newly reinforced neural networks) in the neurologically compromised brain.

Also Read: Brain : The King and a King maker 

Prof. (Dr) Vivek Kumar Jha

Principal

Department of Audiology and Speech Language Pathology

Sumandeep Vidyapeeth (Deemed to be University)

Vadodara, Gujarat

Mob.No.-9560276840

Email ID: jhavivek98@yahoo.com

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The first wealth is health. Learning is the beginning of wealth. Reading is the key to learning and success in life. It is the best form of self-educating yourself, and there are no limits or boundaries to what you can learn and become. Reading is a light in the dark, mental statement, discovery, relaxation, joy, time travel, gift etc.

Reading is a foundational skill, which enables us to gain knowledge, acquire perspective etc. A person who knows how to read can educate themselves in any area of life they are interested in. With reading, a person can go anywhere in the world. Reading  more helps to know more, learn more,  grow smarter, stronger voice, speaking your mind, making your choice etc.   

Reading is a Healthy Relationship :

Good condition of body, mind and emotion are all parts of good health that make our body alive. Good health of both mind and body helps one maintain the required energy level to achieve success in life. Reading will boost your health and basically make you a better person.

Reading is a positive habit that has life long impacts on your health. It is both entertaining and beneficial to your overall well-being. Whatever you choose to read, you can count on the variety of benefits that reading offers to your mind and your body. Regular reading confers substantial benefits for health and your well-being.

Health Benefits : Reading 

1. It strengthens your mind, gives muscle to your memory.

2. It stimulates your brain to be able to focus on tasks better.

3. It builds a critical mind and attention span.

4. It keeps your brain young and sharp.

5. It sets a calm mood and clears mind off toxic thoughts.

6. It enhances thinking power, concentration and empathy.

7. It adds longevity to your health / Increase your life span.

8. It lowers blood pressure and heart rate.

9. It improves sleep quality.

1o. It reduces symptoms of depression.

11. It reduces stress levels and anxiety.

12. It is an exercise for the brain which can strengthen neuronal pathways.

13. Preserve brain health and lower the risk of Alzheimer’s and Dementia.

Well-Being Benefits : Reading

1. It improves your stronger conversational or communication skills, sharpens written skills and listening skills.

2. It increases your vocabulary and can make you better writer.

3. It enhances your imagination and creativity.

4. It expands their ability to build knowledge overall and helps us accomplish life goals.

5. It helps you learn about yourself and better ability to read other people.

6. It makes you confidence on what you expecting.

7. It provides entertainment.

8. It offers inspiration and can be humbling.

9. It turnoff electronic overload.

10. It make you becomes a better person.

11. It boosts happiness and overall life satisfaction

12. For those who don’t enjoy reading, you might change your mind after hearing about the benefits.

13. Develop or Encourage Reading Habits in People  :Some Examples are Below.

National Digital Library for Reading :

During the lockdown period the union ministry of human resource had given an opportunity for the public free access to the national digital library for reading. The digital version of the books and magazines public can be read using any digital devices. (https ://ndl,litkgp.ac.in, 28 Sept 2020)

Auto Driver Creates Mini Bhagavad Gita to Boost Reading Habit :

Striving to encourage the reading habit in an era driven by technology, an auto driver has come up with miniature version of the Bhagavad Gita and eminent Kannada author DV Gundappa’s Mankuthimana Kagga. The books created by K Jagannath 53 years, a resident of Chandra layout in Bengaluru, measure 2cm x 1.5 cm, almost equivalent to an old five rupee coin size. (The Times of India, 07 Oct 2018)

Read a Good Book :

The department of health cited “ Get into reading as an example of best practice in helping improve mental health”. by Padmathi Subrananan, (Reader’s Digest, October 2010, Page.73)

Scientific Research Proved :

1. Reading Enhances a Child’s Development: Reading for pleasure can benefit a child’s education, social and cognitive development, their well-being, and their mental health. (Source :Why is Reading so Important for Children?, 24May 2019.)

2. A study published in Perspectives on Psychological Science in January 2013 concluded that “reading to a child in an interactive style raises his or her IQ by over 6 points.

3. According to Dr. John S. Hutton, a clinical research at Cincinnati Children’s Hospital Medical Center Reading helps your child build brain networks that will serve him long-term when he transitions from verbal to reading.

Senior Citizen Reading :

Scientific studies have found many benefits of reading for older adults, from reducing stress and enhancing sleep to improving memory circuits, sharpening decision-making and possibly even delaying the onset of dementia and Alzheimer’s Disease.

As you grow older, your memory may not be what it once was. The studies have shown that engaging in reading can reduce symptoms of memory decline, helping you to retain your short-term memory for longer.

When we read, not only are we improving memory and empathy, but research has shown that it makes us feel better and more positive too. Science has shown that reading has some amazing health benefits, including helping with depression, cutting stress, and reducing the chances of developing Alzheimer’s later in life. (Source :14 Ways Reading Improves Your Mind and Body by Brendan Brown, 27 Nov 2016.)

According to research people with poor reading skills are likely to be less healthy then those who read easily. Source : Reading is good for your health, The university of stavanger, 8 October 2013.

Conclusion :

Reading improves health, wealth and important for overall well-being. Once you start reading, you experience a whole new world, you have every reason to continue reading. If you do not read often, you do not have any reason to be left behind, start reading now and make yourself better. Reading something uplifting, something peaceful, something that makes us smile has positive effects on the body and lowers stress.

Reading is good habit for students, children, young and senior citizens, and also we will never feel lonely. It is very important to develop a good reading habit. We must all read on a daily basis for at least 30 minutes to enjoy the sweet fruits of reading. Reading makes better health, and better person. All of us must strive to achieve wholesome health.

Dr. V. Anasuya

Librarian, Medical College Library

Vydehi Institute of Medical Sciences and Research Centre

Whitefield, Bangalore – 560066

Phone : 99454 09794

anasuya.bangalore@gmail.com

The post Reading a book is a good relationship for better health and well-being appeared first on Health Vision.

According to survey of (2018), average life span of an individual in India is 69.42 years. Humans have an average life span of 53.7 years in Central African Republic and 84.7 years in Hong Kong. Life expectancy in various Musicians has been studied and variable results has been observed in various groups. The aim of this study is to study life expectancy of Indian singers. Average Life expectancy is a measure of how long the average person lives in a given country. This is usually calculated by just averaging out the ages at which people die to get the mean value. Various factors contribute to an individual’s longevity.

Significant factors in life expectancy include gender, genetics, access to health care, hygiene, diet and nutrition, exercise, lifestyle, and crime rates. Having some goals and responsibilities drives a lot of people to live years longer than people who feel lost or unimportant. This might be a career goal or a hobby, or even taking care of a pet. The big thing is that, in countries with high life expectancy, their old people are more likely to feel engaged. This can be a cultural difference, or it can be geographical; old people are more likely to do things if they can physically get around.

There was the list of Indian singers taken from the following categories;

1. Those been awarded Padmasree, Padmabhusan, Padmavibhusan and Bharat Ratna the highest civilian award given by the President of India.

2. Recipients of Sangeet Natak Akademi Puraskar , an award given by the Sangeet Natak Akademi, India’s National Academy of Music, Dance & Drama. It is the highest Indian recognition given to practicing artists.

3. Sangeetha Kalanidhi award is the title awarded yearly to a Carnatic Musician by the Madras Music Academy.

Year of birth and death was collected from Wikipedia. Singers who are alive, 2020 was taken to calculate their age. Those alive and born in 1951 or later were excluded. According to James C. Riley (2005)average life expectancy at birth was 35.8 years in India in 1950. Between 1800 and 1920, life expectancy in India remained in the mid to low twenties because of the Great Famine of 1876-1878, and the Spanish Flu Pandemic of 1918-1919 as well as the presence of other endemic diseases in the region, such as smallpox. From 1920 onwards, India’s life expectancy has consistently increased. 1950 was taken the year as average longevity as there were no apparent known reasons for poor longevity after that year.

Results & Discussion 

There were total 236 awardees , 16 awardees whose details were not available, 43 awardees born in or after 1951 and alive were excluded. Of balance 177 awardees in study 130 are deceased and 47 are alive. 125 were male and 52 were females.  The number of singers in different age group is given in table 2. The mean longevity was 80.21, 79.54 years among the male singers and 81.83 years for the female singers.  t-Test analysis tools test was used to see the significance and it was observed that Indian singers have higher life than normal average (p >.05).  However, there was no significance difference in longevity in both sexes

Life-span rate in India was 31 years in 1935, 35.8 in 1950 and has gone up to 69.7 years in 2019. This study shows that the longevity of Indian singers is much higher (80.21) than average life expectancy in India (p>.05). Even taking average longevity by 2019 record of 69.7, the singers have statistically higher life expectancy. The result will be still higher as 43 singers in different age group are still alive and all the 34 singers of age group 60-69 are alive.  ZHARINOV et al  found average life of singer to be 54 while classical singers has life of 67.6. The results of longer life in classical singers is thus comparable to Indian singers.

Comparing average life of Russians in 1950 of 55.2, Indian singers have more longevity. Kenny and Asher has reported popular musicians have shortened life expectancy average 47-58 from 1955 to 2015, compared with comparable general populations. They attributed excess mortality from violent deaths (suicide, homicide, accidental death, including vehicular deaths and drug overdoses) and liver disease. Only one of the Indian singers had been reported to die due to road accident.

What could be reason for this variability? May be the lack of data of non-popular singers in India is giving false high value or it is because a different music system of Indian music giving longer life to Indian singers? Here I draw the attention on Pranayama.

In the Yoga Sutra, Patanjali an ancient Indian sage, describes pranayama as a process by which you can break your unconscious breathing pattern and make the breath long, easeful, and smooth. Most people’s unconscious breathing patterns are anything but easeful and smooth; they tend to be tense, shallow, and erratic when we are afraid or hear bad news, we often gasp, inhaling and then holding the breath. These breathing patterns can activate the sympathetic nervous system (often referred to as the “fight or flight response”).

Pranayama helps to improve general well-being

One of the primary reasons that pranayama techniques that foster a long, smooth exhale  are so beneficial is because, when practiced correctly, they can support the parasympathetic nervous system and activate what is commonly known as the “relaxation response,” reducing stress and its effects on your body and mind. Pranayama is the formal practice of controlling the breath, which is the source of our prana, or vital life force. Pranayama has been advocated for treatment of Chronic obstructive Pulmonary disease , Bronchial Asthma , cognition, anxiety and improves general well-being. Pranayama helps to increase the parasympathetic activity.

When we consider Indian singing, to begin the practice, one has to hold a frequency of note for a longer time. The practice of Hmmin learning Indian singing is same as Brahmari Pranayama and practice of “O” is same as Udgeeth Pranayama. One can easily say that learning Indian music is a better form of Pranayama where rhythm of music with long exhalation makes it more symmetrical. Further concentration in music leads to reduce anxiety and tension. This may explain the longer life of Indian singers. More study may be considered on this subject and emphasis can be given to incorporate vocal Indian music for entertainment and healthy long life.

Also Read: What is music therapy? Know its healing power

CONCLUSION

Long-life of Indian singers is seen to be higher than normal population. It may be attributed to their practice which is similar to pranayama. So, incorporation of singing can increase one’s life span. Specially that is very significant in case of professional singers. The breathing pattern, pranayama also plays significant role in singing.

Vivek Kumar Jha
Associate Professor(Speech Pathology & Audiology)
Department of Audiology & Speech Language Pathology
Faculty of Behavioural Sciences
SGT University, Gurugram, Haryana
Email: jhavivek98@yahoo.com
Mob: 95602 76840

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 A clinical case report

ABSTRACT

PCOS, Fallopian Tubal Blockage, Repeated Spontaneous Abortions are some of the causes of female infertility.  Hormonal treatment or drilling of ovaries, micro-surgery of fallopian tubes, IVF are some of the treatment. In Ayurveda it is named as Vandhyatva. Garbhasrava, Beeja Dushti and Mithya Ahara Vihara are some of the causes mentioned by our Acharyas. We are reporting a case of infertility due to PCOS with a surgical history of emergency laparoscopic right sided salpingectomy for ectopic pregnancy. And medical history of tab methotrixate for left side ectopic pregnancy, consequently for second time & left sided hydrosalpinx. As per the classical reference treatment was planned for four- karma (virechana karma, kala basthi and marsha nasya karma, and Uttara basthi karma) along with music therapy and yoga chikitsa, accompanied by rasayana chikitsa, to achieve shuddha garbha sambhava samagri (pure factors of fertilization & conception). Treatment plan was successful with intra uterine pregnancy and she has delivered a healthy female baby through caesarian section.

 INTRODUCTION

According to the World Health Organization (WHO), infertility can be described as the inability to become pregnant, maintain a pregnancy, or carry a pregnancy to live birth.⁽¹⁾ A clinical definition of infertility by the WHO and ICMART is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” ⁽²⁾ Infertility can further be broken down into primary and secondary infertility. Primary infertility refers to the inability to give birth either because of not being able to become pregnant, or carry a child to live birth, which may include miscarriage or a stillborn child. ⁽³⁾⁽⁴⁾

PCOS – Poly Cystic Ovarian Syndrome is a set of symptoms due to elevated androgens (male hormones) in females.⁽⁵⁾⁽⁶⁾ Signs and symptoms of PCOS include irregular or no  menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, mood disorders, velvety skin.⁽⁷⁾

PCOS is the most common endocrine disorder among women between the ages of 18 and 44.⁽⁸⁾ It affects approximately 2% to 20% of this age group depending on how it is defined.^(9)(10) When someone is infertile due to lack of ovulation, PCOS is the most common cause.⁽⁵⁾

PCOS is due to a combination of genetic and environmental factors .^(11)(12)(13) Risk factors include obesity, a lack of physical exercise, and a family history of someone with the condition.⁽¹⁴⁾ Diagnosis is based on two of the following three findings: no ovulation, high androgen levels, and ovarian cysts.⁽¹⁵⁾ Cysts may be detectable by ultrasound.⁽¹⁶⁾

 Figure of pcod

PCOS has no cure.⁽¹⁷⁾ Treatment may involve lifestyle changes such as weight loss and exercise.^(18)(19) Birth control pills may help with improving the regularity of periods, excess hair growth, and acne.⁽²⁰⁾ Metformin and anti-androgens may also help.⁽²⁰⁾ Other typical acne treatments and hair removal techniques may be used.⁽²⁰⁾ Efforts to improve fertility include weight loss, clomiphene, or metformin.⁽²¹⁾ In vitro fertilization is used by some in whom other measures are not effective.⁽²¹⁾

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus.⁽²²⁾.

Causes of tubal pregnancy

Any sexually active woman of childbearing age is at risk of an ectopic pregnancy and often the reason for the ectopic pregnancy will never be determined. Tubal pregnancy is when the egg is implanted in the fallopian tubes. Hair-like cilia located on the internal surface of the fallopian tubes carry the fertilized egg to the uterus. Fallopian cilia are sometimes seen in reduced numbers subsequent to an ectopic pregnancy, leading to a hypothesis that cilia damage in the fallopian tubes is likely to lead to an ectopic pregnancy.⁽²³⁾ Women who smoke have a higher chance of an ectopic pregnancy in the fallopian tubes. Smoking leads to risk factors of damaging and killing cilia.⁽²³⁾ As cilia degenerate, the amount of time it takes for the fertilized egg to reach the uterus will increase. The fertilized egg, if it doesn’t reach the uterus in time, will hatch from the non-adhesive zona pellucida and implant itself inside the fallopian tube, thus causing the pregnancy.⁽²³⁾ Women with pelvic inflammatory disease (PID) have a high occurrence of ectopic pregnancy.⁽²⁴⁾ This results from the build-up of scar tissue in the fallopian tubes, causing damage to cilia ⁽²⁵⁾.  If however both tubes were completely blocked, so that sperm and egg were physically unable to meet, then fertilization of the egg would naturally be impossible, and neither normal pregnancy nor ectopic pregnancy could occur.⁽²⁵⁾

A history of a tubal pregnancy increases the risk of future occurrences to about 10%.⁽²⁵⁾ This risk is not reduced by removing the affected tube, even if the other tube appears normal.  Fertility following ectopic pregnancy depends upon several factors, the most important of which is a prior history of infertility.

CASE PRESENTATION

A lady with married life of 6yrs from Bidadi in Banglore, presented with amenorrhoea -1 & ½ month, with history of irregular, scanty, painful menstruation. Her past medical history revealed twice tubal ectopic pregnancy.

Timeline

Lady had developed irregular, scanty, painful menstruation after undergoing IVF (In-Vitro-Fertilization) in one of the Hospital at Banglore in 2017. However, IVF was not successful. Ultra-sonography of the abdomen & pelvis revealed bilateral PCOD (Poly Cystic Ovarian Disease). She was treated with oral hormonal pills for 6moths. During the course of oral hormonal treatment she had regular but painful menstruation. But she did not conceive. Later she visited Ayurveda clinic in Mysore for her problems. Later in June 2018 she consulted our hospital. She underwent ultra-sonography of abdomen & pelvis (August 2018). This report also revealed as bilateral PCOD.

In 2013, she had undergone emergency laparoscopic right sided salpingectomy under spinal anaesthesia, as she was diagnosed very late with right sided ruptured tubal ectopic pregnancy.

In 2015, she had conceived second time, however, again it was left tubal pregnancy, as it was diagnosed early at 5wks, it was terminated by oral pills & was treated with medicine Methotrixate.

After that she underwent HSG (Hystero-Salpingography) & the report showed,

Left tube –hydrosalpinx in ampullary region, fimbrial end clumped. However, free spill was seen.

After this event she did not conceive.

In 2017, once she underwent IVF (In-Vitro-Fertilization) in Milan Hospital Banglore. However, it was not successful. Since then she developed irregular menstruation & diagnosed with PCOD (Poly Cystic Ovarian Disease) in ultrasonography report.

In June 2018, she came to SDM Institute of Ayurveda & Hospital Banglore. From august 2018 she was regular in taking medicine and councelling.

Menstruation was found to be irregular (50- 90 days usually gets after taking hormonal pills she used to get her menstruation), scanty, painful, 3 – 4 days -dark blackish red, more clots than liquid bleeding & required 1 pad/day, but she changed 2pads/day to maintain hygiene. Her inner garment used to get stained during menstruation.

 Diagnostic focus and Assessment

Per Vaginal Examination revealed – Uterus- AVNS, vagina was bathed in yellowish – white discharge.

Per Speculum Examination revealed – Cervical erosions all over the cervix with severe yellowish- white discharge adhered to the cervix & vagina.

HSG (Hystero-Salpingography) in 2015 – Left tube –hydrosalpinx in ampullary region, fimbrial end clumped. However, free spill was seen.

After analyzing, with the ayurvedic principles, it was diagnosed as,

‘Vandhyatva’ ‘Secondary Infertility’ due to PCOS ( PCOD, Pimples, Hair loss)

In this case, the six causative factors (Ashuddha garbha sambhava samagri (impure factors of fertilization & conception) & manasika shalyas ) for vandhyatva are explained as follows,

• Beeja dushti – Anovulation due to PCOD,
• Rutu dushti – Irregular menstrual cycle,
• Kshetra dushti – Hydrosalpinx in the ampullary region of the left fallopian tube, right sided – salpingectomy done, cervical erosion.
• Arthava dushti (Arthavakshaya,Athyarthava,Kashtarthava) – irregular menstruation, sometimes amenorhoea and other time meno-metrorrhgia/oligomenorrhoea, dysmenorrhoea.
• Ambu dushti – Body fluids -All the doshas vitiated (in bhedhavastha of shad kriyakala) and ama (free radicals) produced also vitiates body fluids. Her vyadhi kshamatva (immunity) decreased (often she gets rhinitis, cough). Homeostasis was disturbed in the body.
•  Shalyas – Stressful factors (manaha shareera bhadhakarani iti shalyani.) were present in her. As she was, physically, mentally, emotionally & socially stressed out, due to medical history. This leads to disturbance in homeostasis. Lady had entered into flight mode due to stress.

Therapeutic focus and Assessment

Chikitsa was aimed at objectives ‘A’ and ‘B’

Objectives ‘A’

1. Ashuddh garbha sambhava samagri – impure factors of fertilization & conception-rutu (ovulation & menstruation), kshetra (female reproductive system), ambu (body fluids), beeja (ovum, sperm & zygote), in order to achieve shuddha garbha sambhava samagri (pure factors of fertilization & conception).
2.  Arthava dushti irregular menstruation, sometimes amenorhoea and other time meno-metrorrhgia/oligomenorrhoea, dysmenorrhoea, in order to achieve shuddha arthava (purity & alignment in menstrual cycle & endocrinal co-ordination).
3. Shalyas -Physical, Mental, Emotional & social Stressful factors, in order to attain prassannatmendriya mana (satiation of body, mind & spiritual).

 Objectives ‘B’

1.  To attain health in mother at all levels (physical, mental, emotional, spiritual and social).
2. To obtain healthy progeny.

The chikitsa (treatment) schedule planned as below,

Deepana Pachana chikitsa – digestive & assimilative medicine-is given prior to shodhana chikitsa.

Shodhana chikitsa – detoxification treatment

Virechana karma (detoxification- Medical purgation treatment),

Sarvanga Abhyanga & Swedana (medicated oil massage & steam).

Kala basthi karma (medicated enema),

Nasya karma (medicated nasal drops),

Uttara basthi (medicated intra-uterine treatment),

Music therapy councelling and yoga – mohana raga, surya namaskara, chinmudra pranayama & meditation, omkara recitation

Oral medicines

For cervical erosion –

Sthanika chikitsa per-vaginal treatment as follows,

Yoni prakshalana- medicated vaginal wash (vaginal douch)

Yoni dhoopana – medicated vaginal fumigation  

Yoni pichchu dharana- medicted vaginal tampoon

Regular councelling was planned as per the changes & feedback from the lady and her husband.

The treatments were carried out as scheduled in the Table 1,2,3,4.

 TREATMENT SCHEDULED.

From August 2018 to October 2018

Deepana – Pachana was done with Tablet Trikatu 1-1-1 continuously for 6months.

Councelling was done daily 1hour for 10 days, then once in week for 1month- 1hr, followed by once in a week for 1month-15min.

Yoga –Surya namaskara 6times 5days in a week, Chinmudra pranayam, Meditation & Omkara recitation for 15min twice daily.

Music therapy – Mohan raga music was done for 2hours, once in a week for 3months.

Prayer –Universal Prayer shloka was given in writing & advised to recite twice daily accompanied by her husband.

 Table 1 Oral medicine

 From last week of October 2018 to first week of November 2018

Table 2 Virechana karma  Sthanika chikitsa Sarvadaihika chikitsa

SP-Sneha Pana, SAAS-Sarvanga abhyanga and swedana, VK-Virechana karma, YP-Yoni prakshalana, YD – Yoni dhoopana, YPD – Yoni pichchu dharana, C – Councelling, Music therapy.

 From last week of November 2018 to first week of December 2018

Table 3 Kala Basthi karma Sarvadaihika chikitsa

ABK – Anuvasana Basthi Karma, NBK – Niruha Basthi Karma, SAAS-Sarvanga abhyanga and swedana, SN – Surya Namaskara, CM – Chin Mudra, MT – Music Therapy, C – Councelling.

 In first week of January 2019

Table 4 Nasya karma chikitsa

MNK – Marsha Nasya Karma, C – Councelling, MT – Music Therapy

 RESULTS

 After the virechana karma followed by kala basthi, she had her menstruation on 28/12/2018 (after 6 months of amenorrhoea). Menstruation was uneventful, that is she did not suffer with any pains and liquid part was more than the clots in menstrual bleeding. Color of menstrual bleeding was light blackish red. Her inner garments were not stained.  5 Days bleeding with less small clots was observed by the patient.  Her weight also increased by 2kg after the kala basthi (from 58kg to 60kg). By this time, pimples had reduced completely. She was happy as her face was clear & chubby cheeks.

After the sthanika chikitsa (local per-vaginal treatment) through vaginal route, cervical erosion healed and healthy cervix noted.

The two follow up examination showed- P/V- uterus –AVNS, no white discharge was seen. P/S- Cx –healthy.

She missed her menstruation on 28^thJanuary 2019. On 22^nd February 2019 urine test for pregnancy was positive.

It was confirmed as intra-uterine pregnancy with gestation sac & yolk sac, in ultra-sonography of abdomen & pelvis.

Repeat scan was done on 14/03/19 which showed CRL-1.95cm, yolk sac was seen, fetal heart pulsation seen 178beats/min. Intra-uterine pregnancy of 8wks 4days.

 Discussion:

Discussion is a detailed treatment of a topic in speech or writing, in order to reach a decision or to exchange ideas. Herewith I have tried to analyse the ayurvedic samprapthi & treatments for the infertility due to PCOS & ectopic pregnancy, with the help of our proud Acharya’s principles.

It has been explained in our samhitas, the purity of arthava (menstrual flow) is the primary unit for garbhotpatti (fertilization & conception). Our acharyas have highlighted that the menstrual blood does not leave any stain on the cloth. ⁽²⁶⁾ This is the sign of purity in menstrual blood & indicates the forthcoming ovulation.

It was noted that, after course of deepana, pachana,virechana karma & kala basthi karma, menstruation was uneventful, that is she did not suffer with any pains and liquid part was more than the clots in menstrual bleeding. Color of menstrual bleeding was light blackish red. Her inner garments were not stained.  5 Days bleeding with less small clots was observed by the patient.  This indicates the purity of the arthava menstrual bleeding.

Her weight also increased by 2kg after the kala basthi (from 58kg to 60kg). By this time, pimples had reduced completely. She was happy as her face was clear & chubby cheeks.

In Charaka Samhita Shareera Sthana 4^th chapter named Mahati garbhavakranthi, commentator of Charaka Samhitha, Acharya Chakrapani has explained that, garbha gradually enters garbhashaya. However, if there is vikara in garbha, by the time it reaches kukshi or garbhashaya, it may get destroyed (kukshau jayamana; kukshau vinasham prapnoti) & brings in death (katsnyernavinashyan iti marana gachchan) ⁽²⁷⁾.

Our Acharyas have written in sutra form. While explaining the early growth of fertilized ovum, Acharya Charaka has used the term kheta bhuta which means shleshma sadrashya- slippery in nature⁽²⁸⁾, which is quiet similar to Zona pellucida-outer layer of the zygote. This layer helps the zygote, to slide down with its slippery nature, from fallopian tube to the intra-uterine cavity of the uterus for the implantation. One of the etiological factors for the tubal pregnancy is pre-mature loss of the layer zona-pellucida, loss of kheta bhuta can be compared to sthanika shleshma ksheena, when the fertilized ovum is in the ampulla part of the fallopian tube, as the fertilization occurs in the ampulla. Thus the zygote gets fixed to the fallopian tube, leading to rupture of the tube & destruction of the zygote if goes unnoticed by the medical faculty. Thus tubal pregnancy gets destroyed & increases the mortality rate of the mother.

Subserosa layer of the fallopian tube is composed of loose adventitious tissue, blood vessels, lymphatics, an outer longitudinal and inner circular smooth muscle coats. This layer is responsible for the peristaltic action of the fallopian tubes. In turn this peristaltic movement helps in the gliding movements of zygote towards the intra-uterine cavity of the uterus. These movements can be compared to apana-vata, which is present in shroni pradesh & is responsible for all the movements in the shroni. There is apana vata vigunata (improper function of apana vata). This is exhibited in the form of, irregular menstruation, sometimes meno-metrorragia other time oligomenorrhoea, dysmenorrhoea.

The inner layer of fallopian tube is a single layer of simple columnar epithelium. The columnar cells have microscopic hair-like filaments (cilia) predominantly throughout the tube, but are most numerous in the infundibulum and ampulla. Estrogen increases the production of cilia on these cells. Between the ciliated cells are peg cells, which contain apical granules and produce the tubular fluid. This fluid contains nutrients for spermatozoa, oocytes, and zygotes. This can be compared to shleshma, rasadhatu. Tubal fluid flows against the action of the cilia, toward the fimbrial end. The fertilized ovum, now a zygote, travels towards the uterus aided by activity of tubal cilia and activity of the tubal muscle. Again these movements are responsibility of apana-vata.

The early embryo requires critical development in the fallopian tube. After about five days the new embryo enters the uterine cavity and on about the sixth day implants on the wall of the uterus, which is again co-ordinate activity of vata-kapha-pitta in shroni & minute srotas in shroni.

Fallopian tube obstruction is associated with infertility and ectopic pregnancy. Risk factors for ectopic pregnancy include: pelvic inflammatory disease, often due to chlamydia infection, tobacco smoking, prior tubal surgery, a history of infertility, and the use of assisted reproductive technology. Those who have previously had an ectopic pregnancy are at much higher risk of having another one. Most ectopic pregnancies (90%) occur in the fallopian tube, which are known as tubal pregnancies (29).

Presence of multiple pimples, heavy perspiration in palms and soles, often suffering from cold, constipation, irregular menstruation (more often amenorrhoea), anxiety and depression indicates the reduced immunity, accumulation of free-radicals in the body, disturbances at mental, emotional, spiritual and social levels due to loss of zygote in twice ectopic tubal pregnancies and unsuccessful IVF.

Our acharyas have highlighted the importance of shuddh garbha sambhava samagri (pure sperm, ovum, uterus and bod fluids) to obtain a healthy garbha. And shuddhata of shareera & manas (pure body & mind) is also equally important.

Acharya Sushruta while explaining swastha laxana, has given equal importance to equilibrium at physical level-shareera (samadhosha, samagni, samadhatu, sama mala & kriyas of dosha-agni-dhatu-mala), spiritual level -prasannata of atma (satiation or brahmananda), mental level -prasannata of mana (happiness in all situations), emotional level -prasannata of indriyas (liveliness jnyanendriyas & karmendriyas).

In jathaharini adhyaya, it has been mentioned that, to get a healthy progeny, the couple have to follow ‘Dharma palana ( Dharanath dharmaha)’that is good conduct to maintain health at physical, mental, emotional, spiritual and social levels.

By considering the above mentioned etiological factors, the exclusive treatment schedule was planned to target health at physical, mental, emotional, spiritual and social level. The plan is shown in the following table 5.

Table 5 Treatment plan

      After the Deepana Pachana for 2months, virechana karma was done after the samyak snigdha laxana with trivruth leha & gandharva hasthadi taila respectively on 9^th & 10^th day.

On 15^th day follow up after the virechana karma, her pimples had subsided. Sweating in palms and soles had reduced completely. Sneezing, running nose, cold had been subsided completely. Up to 1month same health was maintained.

In second course, kala basthi karma as follows,

Anuvasana basthi- was done with Phala ghrita 75ml- for 9 days. On 6^th 12^th day of kala basthi karma, Gandharva hasthadi taila 50 ml- for 2days was used for Anuvasana basthi karma.

Niruha basthi- was done with Honey 50ml+ Saindhava lavana10gms+ Shatapushpa churna10gms+ Phala ghrita75ml+ Eranda mula churna kashaya-300ml-for 5days.

After the completion of kala basthi karma, lady had her menstruation (after 6months of amenorrhoea) on 28^th December 2018.  Lady reported that, her menstruation was uneventful, without any pains. Consistency wise liquid part was more than the clots in menstrual bleeding. The colour of menstrual bleeding was light blackish red. 5 Days bleeding with less small clots was observed by the patient. 3pads/day changed by the lady. Arthava (menstrual bleeding) highlights about homeostasis in the body, as arthava is the upadhatu (sub-part) of rasa dhatu. Homeostasis was attained. It also indicates the forthcoming ovulation.

Activeness, good healthy raport with family and friends, involvement in her daily chores and smiling face throughout the day in lady (observed by her husband, friend and in follow up check-up). This indicates the stress free body, mind, emotions, spiritual and social well being in lady. Music therapy, surya namaskara, chinmudra pranayama are the parts of rasayana chikitsa. They have succeeded in returning her regular dinacharya. Music and yoga are the part and parcel of our daily work. For manasika shalya harsha chikitsa is indicated.

From 8^th day of menstruation that is on 5^th January 2019, marsha nasya karma was started with anu-taila. The nasya treatment was done up to 11^th January 2019. Councelling and music therapy were carried out on 5^th and 11^th January 2019.

She missed her menstruation in January 2019. On 22^nd February 2019 urine test for pregnancy was done at home by patient herself, which was positive for pregnancy. It was confirmed as intra-uterine pregnancy with gestation sac & yolk sac, in ultra-sonography of abdomen & pelvis.

Repeat scan was done on 14/03/19 which showed CRL-1.95cm, yolk sac was seen, fetal heart pulsation seen 178beats/min. Intra-uterine pregnancy of 8wks 4days.

 Patient consent:

 Informed consent regarding documentation and publication of the case study was obtained from the lady & her husband. Her husband has written about this case in review column in SDMIAH.   

Conclusion:

Quality of life was hampered in lady due to irregularity in consuming food, sleep pattern, stress in day today life.

Emotional stress had taken over her completely. Hampered quality life had negative effect on shuddha garbha sambhava samagri, leading to ashuddha garbha sambhava samagri (impure factors of fertilization), irregular menstrual cycles & irregular flow, scanty flow.

She was unable to conceive child. She had history of bilateral ectopic tubal pregnancy & losing one tube in salpingectomy and the other tube with hydrosalpinx.

Ayuveda has played very impotant role through dinacharya, virechana karma, kala basthi and marsha nasya karma, music therapy, yoga and pranayama, in obtaining shuddha garbha sambhava samagri (pure factors of fertilization) in the form of delivering a healthy female child through elective caesarian section. The aim and objects which was planned before starting the treatment, has been reached successfully.

So, the term has been used as ‘tapas by the couple’ to get a healthy child.

So the saying ‘Child by choice & not by chance’ should be taught to our people.

Aviruddhe Dhruvam Daive Kale Yukthasya Karmanaha.

 Financial support & sponsorship

Lady and her husband have taken care of financial situation. No other support or sponsorship was given for this case throughout the treatment courses.

Conflicts of Interest

Author has no competing interest, as this case study was done with exclusive interest to make the lady to conceive naturally and healthy progeny.

 SARVESHAM AROGYAM BHAVATU

Dr. Bharathi D. Anvekar BAMS, MS, PhD
Professor and Consultant,
Dept of Shalya tantra, Prasuthi Tantra & Stree-Roga
S. D. M. Institute of Ayurveda & Hospital,
Banglore-74 Ph:080-22718025 Mob:98864 10690 

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13. Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS (2015). “Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome”. Endocrine Reviews (Review). 36 (5): 487–525. doi:10.1210/er.2015-1018. PMC 4591526. PMID 26426951.
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17.  “Is there a cure for PCOS?”. US Department of Health and Human Services, National Institutes of Health. 2013-05-23. Archived from the original on 5 April 2015. Retrieved 13 March 2015.
18. Mortada R, Williams T (2015). “Metabolic Syndrome: Polycystic Ovary Syndrome”. FP Essentials (Review). 435: 30–42. PMID 26280343.
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22. Kirk E, Bottomley C, Bourne T (2014). “Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location”. Human Reproduction Update. 20 (2): 250–61. doi:10.1093/humupd/dmt047. PMID 24101604.
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25. ^ Jump up to:^a b c d Speroff L, Glass RH, Kase NG (1999). Clinical Gynecological Endocrinology and Infertility, 6th Ed. Lippincott Williams & Wilkins (1999). p. 1149ff. ISBN 978-0-683-30379-7.
26. शुक्रशोणितशुद्धिशारीरं तत्र शुक्रशोणितयोः शुद्धयोरेव शुद्धिर्दुष्टदोषासम्पर्कता||१-२|| यदार्तवं वासः- स्थितं शुष्कमुदकप्रक्षालितं वासो न विरञ्जयेत् रागोपेतं वस्त्रं न कुर्यात् तत् प्रशंसन्ति, ‘गर्भजननाय’ इति शेषः||१७||
27. शारीरस्थानम् – २. शुक्रशोणितशुद्धिशारीरम् निबन्धसङ्ग्रह व्याख्या (डल्हण कृत )
28. Charaka samhitha shareera sthana 4^th chapter kukshau jayamana; kukshau vinasham prapnoti) & brings in death (katsnyernavinashyan iti marana gachchan) यतश्च जायमानःकुक्षौ विनाशं प्राप्नोति, यतश्च कार्त्स्न्येनाविनश्यन् विकृतिमापद्यते, तदनुव्याख्यास्यामः||३|| 
29. स सर्वगुणवान् गर्भत्वमापन्नः प्रथमे मासि सम्मूर्च्छितः सर्वधातुकलुषीकृतः  खेटभूतो भवत्यव्यक्तविग्रहः सदसद्भूताङ्गावयवः||९|| खेटः श्लेष्मा; तेन खेटभूत इति श्लेष्मसदृश इत्यर्थः
30. Cecchino GN, Araujo Júnior E, Elito Júnior J (September 2014). “Methotrexate for ectopic pregnancy: when and how”. Archives of Gynecology and Obstetrics. 290 (3): 417–23. doi:10.1007/s00404-014-3266-9. PMID 24791968.

The post Role of ayurveda in the management of female infertility due to pcos appeared first on Health Vision.

 The third COVID-wave led by the Omicron variant has started in India. Although the initial data indicates that this wave will be milder than the previous Delta one with less hospitalization, still a large section of the population might get affected. At this point, when the Government of India has approved “Prevention” vaccine doses for the healthcare workers, elderly, and the vulnerable population, it is important to find out the cross immunity generated by mixing of the available vaccines. It is also crucial that the safety profiles are well-established before administrating different vaccines as prevention or booster dose.

AIG Hospitals, one of India’s largest tertiary care centres, along with researchers from the Asian Healthcare Foundation conducted a pilot study to determine the safety profile of mixing COVISHEILD and COVAXIN along with checking the antibody response. A total of 330 healthy volunteers who were not vaccinated and had no history of COVID infection were selected and screened for SARS-CoV-2 antibodies for the study. Out of these 330, 44 (~13%) participants were found to be seronegative, i.e., they didn’t have COVID-related antibodies. “One of the incidental findings of the study is the seropositivity among our population. 87% participants who didn’t get vaccinated and never tested positive for COVID had the COVID-related antibodies. This means our population might have developed significant antibodies against the COVID because of the huge Delta wave that we endured,” said Dr. D Nageshwar Reddy, Chairman, AIG Hospitals.

The 44 participants were divided into two four groups.

Group 1: First Dose COVIDSHEILD + Second Dose of COVISHEILD

Group 2: First Dose of COVAXIN + Second Dose of COVAXIN

Group 1 and 2 were the homologous vaccine groups in which same vaccine have been given and relevant antibody titers were checked.

Group 3: First Dose of COVISHEILD + Second Dose of COVAXIN

Group 4: First Dose of COVAXIN + Second Dose of COVISHEILD

 Group 3 and 4 were the heterogenous vaccine groups in which different vaccines were given and antibody titers were checked.

All these 44 participants were followed for 60 days to see if there’re any adverse effects. The study conclusively showed that mixing of vaccines are absolutely safe as none of the participants developed any adverse effect.

The most important finding of the study was that the Spike-protein neutralizing antibodies found in the mixed vaccine groups were significantly higher than the same-vaccine groups. Dr. Reddy, who is also among the researchers, involved in the study said “Spike-protein neutralizing antibodies are the ones which kills the virus and reduces the overall infectivity. We found that when the first and second dose are of different vaccines, the Spike-protein antibody response is four times higher compared to two-dose of same vaccine.”

This is particularly important when considering the third booster dose. The concept of a booster is to elicit robust antibody response and help in killing the virus. Mixed doses can certainly boost these Spike-protein neutralizing antibodies and will enhance the vaccines’ effectiveness even against the Omicron variant,” Dr. Reddy further added.

The study results show that mixing of COVID Vaccines (COVISHEILD and COVAXIN) provide higher antibody response and is safe as well.

Furthermore, AIG Hospitals has shared the data from the study with the ICMR (Indian Council for Medial Research) to be considered as a reference study while deciding on the “Prevention” doses starting January 10th.

The post Mixing of COVID Vaccines COVISHEILD and COVAXIN provide higher antibody response appeared first on Health Vision.

The world has come under the radar of covid-19, along with the restrictions that follow, every aspect of human life has been affected. Covid-19 presents itself in many stress-inducing situations such as the death of loved ones, separation from friends and family via social distancing, financial and occupational struggles, exercising judgement, and the health risks posed by the virus. It is of utmost importance that we prioritise our mental health just as much as we do our physical health.

Loneliness and depression:

The virus demands people to practice social distancing and avoid going out unless it’s of absolute necessity. And with that comes, loneliness and depression. According to research, psychologists in the field of psychoneuroimmunology voice that the state of mind affects one’s mental health. During times like these, when one is expected to have a strong immunity, which is getting compromised. Doctors recommend home workouts, however, there is a lack of motivation to carry out any such physical activity. People often end up staring at their screens for hours in end, be it either for work, school or entertainment purposes. Young adults have complained about burn-out along with irregular sleep schedules.

There have been lab studies that stressed people for a few minutes which showed bursts of one type of “first responder” activity mixed along with other signs of deterioration. All facets of immunity go downhill when exposed to stress for a period of time- i.e from a few days, months or years. As a result of too much wear and tear, long-term or chronic stress may wreak havoc on the immune system.

Stresses  can lead  to unhealthy habits:

Coping with stress can involve other unhealthy habits, lifestyles and substance abuse. Asthma and chronic inflammatory lung diseases are categorised by recurrent breathing problems caused by changes in weather, pollution, dust, insecticides and heavy smoking. Some individuals may have breathing issues due to emotional factors and hormonal issues. Those with a weakened psyche are most at risk of contracting the virus. The stresses of the pandemic can lead many to turn to unhealthy recreational activities that leave them weakened and prone to illnesses. It is important to maintain good habits during the pandemic so as to avoid such asthmatic problems.

The majority of people over the age of 60 have hypertension, and it’s been proposed that they’re more vulnerable to COVID-19’s impact. People with high blood pressure and other health conditions are more susceptible to coronavirus because their immune systems are weakened. Long-term health problems and ageing weaken the immune system, making them less likely to combat the virus. High blood pressure affects almost two-thirds of people over the age of 60. The most important thing one can do if they have high blood pressure is stick to the recovery plan recommended by their doctor.

Medication and lifestyle changes can help

Medication and lifestyle changes such as; choosing healthy heart food, avoiding alcohol/smoking, decreasing salt intake in food, managing stress, etc. can help one protect themselves from serious health issues especially during this time of covid-19. Many COVID-19 survivors, according to an increasing number of reports, suffer from heart damage, even though they don’t have underlying heart disease or aren’t ill enough to be hospitalised. Health experts are concerned about a possible rise in heart disease as a result of this new twist. Hypertension acts as a catalyst, increasing the likelihood of cardiovascular disease.

Dr. Gregg Fonarow, chief of the division of cardiology at the University of California, Los Angeles said that Complications like myocarditis, a heart muscle inflammation, may lead to a rise in heart failure in the future. He’s also worried about people with pre-existing heart disease who don’t have COVID-19 but stop going to the hospital because they’re afraid of contracting the virus. Cardiovascular complications have been diagnosed in nearly one-fourth of those hospitalised with COVID-19, and have been linked to about 40% of all COVID-19-related deaths.

A peptic ulcer is a sore on the lining of the stomach, digestive tracts and the mouth that can be caused due to unhealthy eating habits, smoking, drinking alcohol, stressful events, compromised sleep schedules, and a lack of physical exercise. In many cases, ulcers cause a burning pain on the upper parts of the abdomen that require physical treatment. Apart from seeking medical consultation, the individual must maintain a relaxed state of mind, should attempt to mediate their work habits as it is important to work in a tension-free environment.

The maintenance of a healthy diet can also prevent high glucose levels and diabetic tendencies that arise due to irregular eating and other unhealthy coping mechanisms. Maintaining a cool head and a stress-free attitude not only keeps us healthy but also helps us tackle the problems posed by the pandemic in a more effective manner. It is important to prioritise our mental health and remain calm during these troubling times. And this too shall pass.

Shubhra Vinod and Roshan Yohann Anand
Undergrad students from CHRIST (Deemed to be University)
Under the guidance of;
Dr. K. Jayasankara Reddy
Professor, Department of Psychology
CHRIST (Deemed to be University)
Hosur Road, Bangalore – 560 032

References

1. Stress Weakens the Immune System. (2006, February 23). Apa.Org. https://www.apa.org/research/action/immune

2. Clark, C. E. (2021, January 22). COVID-19 and hypertension: risks and management. A scientific statement on behalf of the British and Irish Hypertension Society. Journal of Human Hypertension. https://www.nature.com/articles/s41371-020-00451-x

3. Marshall, W. F. (2020, June 30). COVID-19 and high blood pressure: Am I at risk? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-high-blood-pressure/faq-20487663

4. Williamson, L. (2020, September 3). What COVID-19 is doing to the heart, even after recovery. Www.Heart.Org. https://www.heart.org/en/news/2020/09/03/what-covid-19-is-doing-to-the-heart-even-after-recovery

5. Baron, R. A., & Misra, G. (2001). PSYCHOLOGY Indian subcontinent Edition (Fifth Edition). Pearson.

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Positivity is for a long time seen as the hallmark of psychological health. This fantastical momentum of the word is so attractive that optimism, in the 21^st century, has become a consumer commodity. Everywhere that goes, someone is trying to sell optimism. It comes wrapped in different packages. Sometimes, it is the sparkly package of faith at other times it is the somber package of hope. But the question that we should all ask ourselves is that are we approaching  positivity negatively?

In today’s pandemic hit the world, it would seem foolish to dismiss the need for optimism but perhaps, it would be disastrous to keep telling ourselves a fictitious story and expecting everything will fall into place. By doing so we risk falling into the vicious trap of optimism bias. If we are optimistic that we will not catch the illness but remain reckless then we are bound to become prays of the proverbial predator. Tali Sharrot (2012) calls this one of the “greatest deceptions” in human history (Sharot, 2012). It has led to many destructive outcomes from economic meltdown to wars. Even India’s tackling of the covid-19 was affected by this fateful bias. But it would be incorrect to dismiss optimism as a smokescreen therefore, perhaps, what is necessary is to understand how to engage in healthy positivity.

Even when it comes to diseases like HIV and cancer there exists a negative relationship between dispositional optimism i.e.,belief that the future outcomes would be better and the course of the disease (C.Segerstrom, 2005).  The explanation for this is that because stress forces us to be on-guard and conscientious, it inadvertently helps increase our chances of vigilance and therefore, predicts a better course of progression of the disease. It also doesn’t help increase antibodies in the immune system (Lena Brydona, 2009).  But it would be fraudulent to dismiss optimism altogether. Because although dispositional optimism doesn’t account for the eradication of illness, it does, however, affect the mood, T-helper cells, and natural killer cells count in the body. There exists a positive relationship between optimism, elevated mood, T-cell, and natural killer cells count in the body (Segerstrom, 1998). Optimism helps deal with disease-related stress by increasing proactive behavior, reducing avoidant coping, and reducing depression (Gail Ironson, 2005).

How to handle stress?

Therefore, a better way to handle stress would be through learned optimism rather than dispositional optimism. This can be done by what Seligman called the ‘ABCDE’ approach. He derived this from the CBT therapeutic techniques of Aaron Beck and Albert Ellis. This stands for adversity, belief, consequence, disputation, and energization. So, a person should first analyze their adversities. For example- during the pandemic, one adversity may be that one has lost their job. Then they should evaluate their beliefs, for example- one might believe that they will never be able to find another job.

After this one needs to engage in consequence visualization i.e., think of the consequences of your belief. For example- because one feels that they will never be able to get employed again, their self-esteem and self-efficacy go down. The consequence of this could be that they are being unproductive and suffer from additional mental illnesses like anxiety and depression. Then the person should engage in the disputation of this irrational belief. By doing so they will realize the negative effect it was having in their life. finally, they should engage in energization i.e.,after one has disputed the past beliefs, they should create healthy goals that motivate them to achieve more.

This way one can, if not solve problems, at least try reducing the effect of toxic positivity and pessimism. Other additional things that one can do is-

1. Engage in self-talk– the truth remains that humans are best convinced when the opinion comes from within. Therefore, there is no shame in having a conversation with oneself. You will be surprised by your hidden wisdom!

2. Focus on solutions, instead of problems- developing a problem-oriented coping mechanism is always healthier than avoidance-oriented. This will also motivate you to work further.

3. Positive visualization- let your imagination run wild. Think about things that make you feel happier, safer, and comfortable.

In conclusion, I encourage you to explore the vast and magical territory of optimism but don’t be too mesmerized by its fantastical nature. The important thing to remember is that one has what one needs within themselves. Optimism doesn’t increase antibody cell counts but it does aid in strengthening the immune system. Therefore, whenever you are tormented by demons think about the line from the Albert Camus poem, an invisible summer- “In the depth of winter, I finally learned that within me, there lay, an invincible summer. And, that makes me happy. (Camus, 1958)”

Srishti Sharma
UG student from CHRIST (deemed to be university).
(under the guidance of Dr. K Jayasankar Reddy)

References

• C.Segerstrom, S. (2005). Optimism and immunity: Do positive thoughts always lead to positive effects? Brain, Behaviour, and Immunity, 195-200.
• Camus, A. (1958). the invincible summer. new york George Braziller, Inc.
• Gail Ironson, E. B. (2005). Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression. International Journal of Behavioral Medicine, 86–97.
• Lena Brydona, C. W. (2009). Dispositional optimism and stress-induced changes in immunity and negative mood. Brain, Behaviour, and Immunity, 810-816.
• Segerstrom, S. C. (1998). Optimism is associated with mood, coping, and immune change in response to stress. Journal of Personality and Social Psychology, 1646-1655.
• Sharot, T. (2012). The Optimism Bias: Why we’re wired to look on the bright side. New York: Random House.

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Abstract

The novel Coronavirus Disease 2019 (COVID-19) has affected the healthcare systems badly and put a massive challenge across the globe. The traditional healthcare system didn’t imagine the severity and intensity of the COVID-19 pandemic which dented the economy, personal health, and human lives. As of more than one year, the challenge still persists, to save the humans from pandemic. During first wave, the situations were different as the healthcare system was not prepared and little knowledge was available. So at that time, several experiments with treatments and management of COVID-19 patients were employed, some were successful and some failed badly. However, in second wave, the lessons learnt from the previous experiments are implemented as early care. In terms of treatment, intensive care unit admissions of the critically ill patients, procedures used, are in place, which were lacking during the first wave. Though not much differences in mortality rates are observed in second wave (rate similar to first wave), in coming days, the condition may be better with development of vaccine and rapid vaccination program across the globe.

Keywords: SARS-CoV-2, COVID-19, antiviral drugs, first wave, second wave, ICU

Introduction

The first case of novel Coronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was reported in Wuhan, China, in December 2019. Since then, a total of 133,552,774 cases are recorded globally, with 2.89 million death so far (1, 2) and the counting is increasing day by day. The actual number of deaths due to COVID‑19 may be likely to be higher than the number of confirmed deaths, which could be due to limited testing and problems associated with the attribution of the cause of death (3). The entire world faced the lockdown during first wave and disconnected from each other, with merely virtually connected. The common public and the healthcare professional, including doctors, nursing, and paramedical staff, lost their lives, saving the patient’s life and fighting against the pandemic. India is no behind the rest of the world (4).

Coronaviruses, a group pf viruses, was named due to presence of crown-like spikes on surface and constitute four groups namely alpha, beta, gamma, and delta. The common human coronaviruses include 229E (alpha coronavirus), NL63 (alpha coronavirus), OC43 (beta coronavirus), and HKU1 (beta coronavirus). The other human coronaviruses include MERS-CoV (the beta coronavirus causing Middle East Respiratory Syndrome, or MERS), SARS-CoV (the beta coronavirus causing severe acute respiratory syndrome, or SARS), and SARS-CoV-2 (the novel coronavirus causing COVID-19) (5). Sometimes, the infected animals with coronaviruses provide a medium to evolve in a new human coronavirus and examples include SARS-CoV, 2019-nCoV, and MERS-CoV (5).

All virus mutate and SARS-CoV2 is no exception. Through mutation viruses constantly change over time. Due to wide circulation of virus in a population and causing infection, the virus has more opportunities to spread and replicate itself to undergo changes (6). As per research, the mutation rate of SARS-CoV-2 is estimated as 1-2 mutations per month (7). The mutation continued throughout the global crisis and currently multiple SARS-CoV-2 variants are circulating globally. The virus mutated drastically and accumulated in short span of time and causing global concern (8). There are many new SARS-CoV-2 variants with increased transmissibility and causing much higher severity of diseases than before (9). Centers for disease control and prevention identified the following variants which can spread more easily and infect quickly than other variants, and are of much concerns (10):

• 1.1.7: The variant was first identified in the US in December 2020, however, was initially detected in the UK.
• 1.351: The variant was first identified in the US at the end of January 2021, however, was initially detected in South Africa in December 2020.
• 1: The variant was first detected in the US in January 2021, however, was initially identified in travelers from Brazil tested during routine screening at an airport in Japan, in early January.
• 1.427 and B.1.429: The two variants were first identified in California in February 2021 and were classified as variants of concerns in March 2021.

COVID-19, a global pandemic now,is a serious health threat and many countries have witnessed two wave form (11).In India, COVID-19 was detected in late January 2020 and as a precautionary measure, lockdown was imposed to save 1.37 billion citizens from the infection in March 2020 (12). India witnessed the first COVID-19 wave of infections in August 2020 that peaked from September to October 2020. Now the severity and intensity of the virus can be understand by the fact that it took around 32 days for the cases to rise from 18000 to 50000 in first wave but it took only half time (17 days) for the cases to rise from 18377 to 50518 in March 2021 in the second wave as depicted in Figure (12, 13)

Picture Source: Times of India; 29 March 2021

As of now, by 09 April 2021, India witnessed a total of 13.2 million cases of COVID-19 infection with 168 thousand deaths reported and increasing at a higher pace now than before (14). The most common clinical symptoms in the first wave included fever, fatigue, dry cough, myalgia, dyspnea, anorexia, and sputum production. The clinical signs and symptoms in first, as well as second wave include fever, dyspnea, cough, pneumonia, cough and most relevant comorbidities reported in patients with cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases (15). The current data for India is depicted below:

Treatment and Management of COVID-19 Patients

In the beginning, many countries and healthcare systems, unaware of the pandemic and limited information about the intensity of COVID-19, had confusion in efforts and treatments that led to controversial decisions about the resources, testing, and treatment (16). However, the situation improved somewhat, scientists had tried and tested various treatment to tackle the issue and were also succeeded to develop the vaccine. The strategies which were used for to manage the infection included non-pharmacological interventions (social distancing, personal protective equipment, testing and contact tracing) and pharmacological interventions (use of anti-viral therapies, other optional therapies, immune-boosters etc.) (17, 18).

Anti-viral Therapies

The most tried and tested anti-viral treatment include treatment with lopinavir/ritonavir, remdesivir, and favipiravir.

• Lopinavir/ritonavir (available in oral and liquid formulation) can also be tried in combination with interferon alpha or ribavirin, estimated to reduce replication by 50% in MERS corona virus. The adult dose is 400/100 mg per oral (PO) Q12H whereas pediatric dose varies from 12 mg/kg to 400 mg according to body weight.
• Remdesivir is one of the mostly used ant-viral used to treat the COVID-19 infection and various clinical studies were conducted to evaluate its efficacy and safety. Remdesivir has reported in-vitro activity against SARS-CoV-2 and also used against Ebola virus and found to reduce pulmonary pathology in in-vitro studies, however, hepatotoxicity was also observed (19, 20, 21). The adult dose is 200 mg intravenous (IV) on Day 1(loading dose) followed by 100 mg IV once daily (OD) for9 days, whereas pediatric dose include 5 mg/kg IV on Day 1, then 2.5 mg/kg IV Q24H in children ˂40 kg.
• Favipiravir, originally designed for influenza, is an emerging candidate in the management of COVID-19 (22). Primarily used in China and Japan, it is also garnering in India, Russia, Ukraine, Uzbekistan, Moldova, and Kazakhstan, along with UAE (22). The treatment dose is 1600 mg twice daily on Day 1, followed by 600 mg twice daily for 7 to 14 days.

Other Therapies

Other treatments used for the management of COVID-19 are provided below:

• Chloroquine or hydroxychloroquine (CQ/HCQ), though used, but no conclusive evidence established against COVID-19 (23). Better tolerability and lower incidence of toxicity were observed with use of HCQ. The treatment dose is 400 mg per oral every 12 hours on Day 1, followed by 400 mg OD. Pediatric dose include 6.5 mg/kg on Day 1 then 3.25 mg/kg Q12H for 4 days.
• Azithromycin, used with HCQ is reported to have a faster reduction in viral carriage, however, current resources are not adequate to support the use of this combination(24, 25). The treatment dose is 500 mg OD for 5 days
• Interferons (IFN-α2a, IFN- α2b or IFN-β1a) impair the antiviral adaptive type 1 T‑helper cell, however, in-vitro effects hasn’t been fully established.
• Ascorbic acidhas limited evidence suggesting that it could be beneficial in animal models of corona virus.

The other tested anti-viral medicines (oseltamivir, ganciclovir, ribavirin, favipiravir, nelfinavir, arbidol and remdesivir) with combination of CQ may be effective for COVID-19 treatment.

Who all needs intensive-care unit (ICU) admission in COVID-19

There are various factors which provide the indication for the requirement of ICU admission for COVID-19 patients. Not all COVID-19 patients require admission in ICU but there are crucial situations that lead to admission in ICU. To characterize those, there should be a uniform criterion for admission to the ICU (26). The critical conditions which require admission to ICU involve (26):

• Aged patients ≥ 65 years,
• Patients with comorbidities like hypertension, diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and malignant tumors
• Patients with critical respiratory diseases
• Patients requiring frequent monitoring of the symptoms

However, patients with more than two comorbidities have escalated risks of ICU admission than those with one or no comorbidities (26, 27). So, early recognition of such patients is most important to be benefitted from ICU admission.

Role of prophylaxis in COVID-19 patients

Due to the greatly varied incidence of COVID-19 pandemic among different countries, it raises a question if the nations with a lower incidence of COVID-19 share any medical commonalities which could suggest the reason for low incidence and prophylactic treatments for other nations with high incidence rate. One such example is use of ivermectin, African countries which has the ability to inhibit SARS-CoV-2 replication, and may likely leads to lower infection rates (28).Ivermectin, as aprophylactic treatment against parasitic infections is most common in Africa, may show a correlation between prophylaxis and low incidence of COVID-19 in some countries (28). So prophylaxis plays a major role in reducing the incidence and transmission, thereby effectively slowing the spread of the disease until safe, highly efficacious vaccine is available. However, as per a review article, the use of existing molecules being evaluated in randomized clinical trials to identify successful prophylaxis against COVID-19 is yet to be established (29).

Major difference in ICU admission during first and second wave

During first wave, there was enormous admission of COVID-19 patients in ICUs, necessitating invasive mechanical ventilation, led saturation of ICUs. This exposed the specificities including necessity of deep sedation and neuro muscular blockade, increase risk of thrombotic and hemorrhagic events (30, 31) and the lengthy duration of mechanical ventilation (32) with high rate of delirium in COVID-19 patients (33). During the first wave of COVID-19, various clinical trials showed the benefits of early use of glucocorticoids in critically ill COVID-19 patients admitted in ICUs (34, 35).

During the first wave of COVID-19, many hits and trials methods were used to manage the pandemic, some were successful and some failed miserably. So the lessons and skills gained during the first wave will certainly going to help in managing the second wave of COVID-19. Researches are conducted to gain the information by comparing the features of patents, age groups, ICU treatments, and comorbidities in first and second wave, however, no major differences were noted. In second wave, the proportion of patients receiving invasive mechanical ventilation reduced and so were the incidence of thrombotic events, which could be due to early administration of glucocorticoids (36). However, there was no difference in ICU mortality and duration of ICU stay. The lower incidence of thrombotic events reported during the second wave is likely inherent to the increased intensity of thromboprophylaxis (36). Similar results for the mortality and other parameters were reported in another study conducted (37).

As far as treatment is concerned, various lessons were learned from the first wave and implements during the second wave to manage the COVID-19 patients in a better way. In first wave around 12% patients received glucocorticoids and 57% patients received intermediate or full-dose thromboprophylaxis. However, in second wave, all patient admitted received early glucocorticoids and intermediate or full-dose thromboprophylaxis that resulted in the lower rates of patients requiring invasive mechanical ventilation and lower incidence of thrombotic events (36).

Another study that evaluated the smoking and alcohol consumption revealed that smoking and alcohol consumption rate was higher in patients during second wave (13.2% and 7.3%, respectively) compared with first wave (4.9%). However, the signs and symptoms in both waves were reported as similar (fever, dyspnea, pneumonia, and cough). Patients in second wave were reported to have high incidence of vomiting and abdominal pain and less incidence of cough and chills compared with patients in the first wave. High frequency of pregnant women in second wave is noteworthy. Compared with the first wave, higher percentage of patients in second wave received treatment with corticosteroids and anticoagulants; only 4.2% patients required invasive mechanical ventilation whereas in first wave it was 13.2% patients (15) which are establishing the facts as discussed above.

Conclusion

Since its reporting to as a cluster of disease in China in December 2019 it has spread to all continents, reaching around more than 200 countries, which made WHO declare it as a pandemic. The hit and trials were tested during the first wave made some conclusions to use the best practice and those were implemented in the second wave. However, there is no difference observed in the mortality rate in first and second wave but patients admitted during second wave less likely require invasive mechanical ventilation. A combination of antiviral drugs with hydroxyl chloroquine and azithromycin (with the consultation of medical practitioner) may be the best option to treat the patients, depending on the patient’s conditions and symptoms. The lower rate of thrombotic events observed during the second wave is likely inherent to the increased intensity of thromboprophylaxis. The research and learnings from the past are continuing and warrants more robust approach as the threat still exists.

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A recent survey conducted by CSIR (Council of Scientific Industrial Research), Government of India, has revealed that smokers and vegetarians are less likely to contract Covid-19 infection. The survey suggested smoking may be protective, despite Covid-19 being a respiratory disease, due to its role in increasing the mucous production that may be acting as the first line of defense among the smoking population. It indicated that vegetarian food rich in fiber may have a role to play in providing immunity against COVID-19 due to its anti-inflammatory properties by modification of gut microbiota.

The pan India survey was conducted by an eminent team of 140 doctors and research scientists to study the presence of antibodies against SARS-CoV-2, the virus that causes Covid-19, and their neutralization capability to infer possible risk factors for infection. The study assessed 10,427 adult individuals working in more than 40 CSIR laboratories and centers in urban and semi-urban settings spread across and their family members. These people voluntarily participated in the study.

Earlier, two studies from France and similar reports from Italy, New York, and China reported lower Covid infection rates among smokers. A study by America’s Centers for Disease Control and Prevention (CDC), which examined over 7,000 people who tested positive for COVID-19, also vindicated the above findings. Interestingly, the study found that only 1.3 percent of survey participants were smokers, compared to the CDC report that 14 percent of all Americans smoke.

Similarly, UCL (University College London) academics that looked at 28 papers across the UK, China, US, and France found the proportions of smokers among hospital patients were ‘lower than expected. One of its studies showed that in the UK the proportion of smokers among COVID-19 patients was just five percent, a third of the national rate of 14.4 percent. Another found in France the rate being four times lower (7.1% vs 32% among all population). In China, a study noted that only 3.8 percent of patients were smokers – despite more than half of the population regularly smoking cigarettes.

In a separate study by Jin-jin Zhang to understand the influence of smoking behavior on the susceptibility to Coronavirus observed that only 9 (6.4%) patients had a history of smoking, and 7 of them were past smokers. The study found that smoking populations were less likely to be infected with SARS-CoV-2. These findings were also confirmed by a French study of public health data that showed people who smoke, were 80% less likely to fall prey to COVID-19 than non-smokers of the same age and sex.

The Council of Scientific & Industrial Research (CSIR), known for its cutting-edge R&D knowledge base in diverse S&T areas, is a contemporary R&D organization. Having a pan-India presence, CSIR has a dynamic network of 40 national laboratories, 39 outreach centers, 3 Innovation Complexes, and 5 units. CSIR’s R&D expertise and experience are embodied in about 4600 active scientists supported by about 8000 scientific and technical personnel.

CSIR covers a wide spectrum of science and technology – from radio and space physics, oceanography, geophysics, chemicals, drugs, genomics, biotechnology, and nanotechnology to mining, aeronautics, instrumentation, environmental engineering, and information technology. It provides significant technological intervention in many areas with regard to societal efforts which include environment, health, drinking water, food, housing, energy, farm and non-farm sectors. Further, CSIR’s role in S&T human resource development is noteworthy.

CSIR is ranked at 84th among 4851 institutions worldwide and is the only Indian organization among the top 100 global institutions, according to the Scimago Institutions Ranking World Report 2014. CSIR holds the 17th rank in Asia and leads the country at the first position.

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Morning walkers have better cardiovascular fitness than evening walkers, revealed a recent study performed by experts of Nanavati Super Speciality Hospital, Mumbai. The study, ‘Effects of Morning Walking v/s Evening Walking on Cardiovascular Fitness in Adults,’ was performed by the department of Physiotherapy and Sports Medicine, Nanavati Super Speciality Hospital. Total 203 healthy adults walking 30 minutes for at least thrice a week, over a period of three months or more. The average age of the participants was 45-years.

The subjects were tested for their vital capacity (the maximum amount of air that can be inhaled after maximum expiration), peak expiratory flow (maximum speed of expiration), YMCA 3 min test (3-minute step-up and step down test), resting heart rate and blood pressure. Those with musculoskeletal or joint pain and those performing indoor exercise were excluded from the study.

The results demonstrated that subjects walking in the morning have superiority over subjects walking in the evening in terms of their vital capacity and peak expiratory flow. Experts noted that morning walks enhanced the oxygen carrying ability of the blood, increased blood circulation and delivered blood to peripheral nerves. Another reason for high VC and PEFR in morning walkers was probable effect of temperature and ozone which is less concentrated in the evening.

The Resting Heart Rate between evening and morning walkers showed no statistical difference. However, more hypertensive individuals were found among evening walkers than in the morning. Morning walkers had higher systolic and diastolic BP since they walk before taking their medicines, researchers said.

The study also used YMCA categorization to assess the fitness level of individuals, based on how quickly the heart rate recovers after exercise. Overall physical fitness consists of five different elements: Aerobic or cardiovascular endurance, Muscular strength, Muscular endurance, Flexibility and Body composition. The YMCA test measures the duration of heart rate stabilization post-exercise. Fitter the individual, quicker the heart rate returns to normal. More number of morning walkers (71) belonged to Excellent, Good and Above Average YMCA categories as compared to their evening (55) counterpart. Similarly, 46 evening walkers fell in Average, Below Average and Poor categories as compared to 28 morning walkers.

Talking about the study, Prof. (Dr.) Ali Irani, Head of Department, Physiotherapy and Sports Medicine, Nanavati Super Speciality Hospital said, “With this study, we have statistically concluded that there are greater health benefits of morning walks as opposed to evening walks; benefits that extend beyond inhaling fresh air. While walking in itself improves heart health, regulates BP, improves circulation, improves lung capacity and builds muscle strength and endurance, morning walks, especially those taken between 5 a.m. to 6 a.m., have proven to build the highest vital capacity and peak expiratory flow rate among individuals.”

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