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Effect of yoga and naturopathy on disease activity and symptom burdens in a patient with active ulcerative colitis: a case report
Abstract
Objectives
Ulcerative colitis (UC) is a chronic idiopathic inflammatory disease that affects the large bowel. The objective of this study is to find the effect of yoga and naturopathy (YN) in a patient with active moderate pancolitis.
Case presentation
An 18-year old unmarried female diagnosed with UC in 2017. Patient’s symptoms began with abdominal pain, nausea, vomiting and diarrhea with/without blood stains more than seven times a day, daily. The symptoms reduced after taking regular conventional medication for a period of one-year. However, in February-2019, the patient visited our hospital with the same complaints and received 21-days of YN treatments. Results showed a better reduction in the abdominal pain, disease activity, stress and depression and a better improvement in hemoglobin levels, quality of sleep, and quality of life with no adverse effects.
Conclusions
YN could be considered as an alternative therapy in the management of UC. However, further studies are required to warrant this effect.
This case study investigates the possible efficacy of Yoga and Naturopathy therapies for controlling uterine fibroids. A 51-year-old lady with a big subserous fibroid (64mm x 47mm) and symptoms of excessive bleeding and discomfort underwent a six-month treatment regimen that included Yoga, hydrotherapy, mud therapy, and dietary/lifestyle changes. Ultrasound revealed that the fibroid size (58mm x 40mm) had significantly shrunk following the intervention. This instance implies that Yoga and Naturopathy may have a role in the management of fibroids, presumably through their combined impact on inflammation, oxidative stress, and overall health. Further study with bigger cohorts is required to corroborate these results
Uterine fibroids (UFs) are common in women during their reproductive age. A 40-year-old married woman was diagnosed with UF and underwent conventional treatment in March 2019. Her symptoms began with dysmenorrhea associated with bloating of the abdomen. Initially, she visited a private hospital, underwent ultrasonogram (USG) of the pelvis in a private diagnostic center, and the report suggests the presence of bulky uterus with fibroid and features of adenomyosis. Her physician advised to undergo a surgery, but she refused and thus visited our hospital. The patient underwent yoga and naturopathy intervention for the period of 11 days. The results of the study showed a reduction in the UF size from 27 mm × 22 mm to 22 mm × 18 mm in the 11 days of yoga and naturopathy intervention. Although the results are encouraging, it may vary because of a single case study. Hence, further well-planned clinical studies are suggested with a large sample size to validate our results.
A 48-year-old married woman diagnosed with rheumatoid arthritis (RA) in 2007, came to our hospital in July 2014 with the complaint of severe pain and swelling over multiple joints, especially over small joints, which was associated with stiffness (more in morning), deformities of fingers and toes, with disturbed sleep and poor quality of life (QOL) for the past 7 years. She received a combination of electro acupuncture (14 sessions), massage (18 sessions), mud (18 sessions), and sauna (3 sessions) (EMMS) therapies for 30-min, 45-min, 30-min, and 15-min per session, respectively for 3 weeks. During and postintervention assessment showed reduction in visual analog scale score for pain, Depression Anxiety and Stress Scales and the Pittsburgh Sleep Quality Index scores. It also showed an increase in the scores of 10-Meter Walk Test, isometric hand-grip test, and short form-36 version-2 health survey. This result suggest that, the EMMS therapy might be considered as an effective treatments in reducing pain, depression, anxiety, and stress with improvement in physical functions, quality of sleep and QOL in patient with RA. EMMS therapies were tolerated and no side effects were reported by the patient. Though the results are encouraging, further studies are required with larger sample size and advanced inflammatory markers.
Background:
Patients with ulcerative colitis (UC) that undergo proctocolectomy with an ileal pouch-anal anastomosis commonly develop pouch inflammation (pouchitis). Pouchitis develops in a previously normal small intestine and may involve environmental factors. We explored whether diet and microbiota alterations contributed to the pathogenesis of pouchitis.
Methods:
Patients were recruited and prospectively followed at a comprehensive pouch clinic. Pouch behavior was clinically defined as a normal pouch (NP) or pouchitis. Patients completed Food Frequency Questionnaires (FFQs). Fecal samples were analyzed for microbial composition (16S rRNA gene pyrosequencing).
Results:
Nutritional evaluation was performed in 172 patients (59% females), of which, fecal microbial analysis was performed in 75 patients (microbiota cohort: NP [n=22], pouchitis [n=53]). Of the entire cohort, a subgroup of 39 (22.6%) patients had NP at recruitment (NP cohort). Of these, 5 (12.8%) developed pouchitis within a year. Patients at the lowest tertile of fruit consumption (<1.45 servings/day) had higher rates of pouchitis compared to those with higher consumption (30.8% vs. 3.8%, log rank, p=0.03). Fruit consumption correlated with microbial diversity (r=0.35, p=0.002) and with the abundance of several microbial genera, including Faecalibacterium (r=0.29, p=0.01), Lachnospira (r=0.38, p=0.001) and a previously uncharacterized genus from the Ruminococcaceae family (r=0.25, p=0.05). Reduction in fruit consumption overtime was associated with disease recurrence and with reduced microbial diversity (Δ=0.80.3, p=0.008).
Conclusions:
Fruit consumption is associated with modification of microbial composition, and lower consumption correlates with the development of pouchitis. Thus, fruit consumption may protect against intestinal inflammation via alteration of microbial composition.
Background:
Perceived stress seems to be a risk factor for exacerbation of ulcerative colitis. Yoga has been shown to reduce perceived stress.
Aims:
To assess the efficacy and safety of yoga for improving quality of life in patients with ulcerative colitis.
Methods:
A total of 77 patients (75% women; 45.5 ± 11.9 years) with ulcerative colitis in clinical remission but impaired quality of life were randomly assigned to yoga (12 supervised weekly sessions of 90 min; n = 39) or written self-care advice (n = 38). Primary outcome was disease-specific quality of life (Inflammatory Bowel Disease Questionnaire). Secondary outcomes included disease activity (Rachmilewitz clinical activity index) and safety. Outcomes were assessed at weeks 12 and 24 by blinded outcome assessors.
Results:
The yoga group had significantly higher disease-specific quality of life compared to the self-care group after 12 weeks (Δ = 14.6; 95% confidence interval=2.6-26.7; P = 0.018) and after 24 weeks (Δ = 16.4; 95% confidence interval=2.5-30.3; P = 0.022). Twenty-one and 12 patients in the yoga group and in the self-care group, respectively, reached a clinical relevant increase in quality of life at week 12 (P = 0.048); and 27 and 17 patients at week 24 (P = 0.030). Disease activity was lower in the yoga group compared to the self-care group after 24 weeks (Δ = -1.2; 95% confidence interval=-0.1-[-2.3]; P = 0.029). Three and one patient in the yoga group and in the self-care group, respectively, experienced serious adverse events (P = 0.317); and seven and eight patients experienced nonserious adverse events (P = 0.731).
Conclusions:
Yoga can be considered as a safe and effective ancillary intervention for patients with ulcerative colitis and impaired quality of life.
Trial registration:
ClinicalTrials.gov identifier: NCT02043600.
Objectives
The 36 item short form health survey (SF-36) has proved to be of use in a variety of settings where a short generic health measure of patient-assessed outcome is required. This measure can provide an eight dimension profile of health status, and two summary scores assessing physical function and mental well-being. The developers of the SF-36 in America have developed algorithms to yield the two summary component scores in a questionnaire containing only one-third of the original 36 items, the SF-12. This paper documents the construction of the UK SF-12 summary measures from a large-scale dataset from the UK in which the SF-36, together with other questions on health and lifestyles, was sent to randomly selected members of the population. Using these data we attempt here to replicate the findings of the SF-36 developers in the UK setting, and then to assess the use of SF-12 summary scores in a variety of clinical conditions.
Methods
Factor analytical methods were used to derive the weights used to construct the physical and mental component scales from the SF-36. Regression methods were used to weight the 12 items recommended by the developers to construct the SF-12 physical and mental component scores. This analysis was undertaken on a large community sample ( n = 9332), and then the results of the SF-36 and SF-12 were compared across diverse patient groups (Parkinson's disease, congestive heart failure, sleep apnoea, benign prostatic hypertrophy).
Results
Factor analysis of the SF-36 produced a two factor solution. The factor loadings were used to weight the physical component summary score (PCS-36) and mental component summary score (MCS-36). Results gained from the use of these measures were compared with results gained from the PCS-12 and MCS-12, and were found to be highly correlated (PCS: ρ = 0.94, p < 0.001; MCS: ρ = 0.96, p < 0.001), and produce remarkably similar results, both in the community sample and across a variety of patient groups.
Conclusions
The SF-12 is able to produce the two summary scales originally developed from the SF-36 with considerable accuracy and yet with far less respondent burden. Consequently, the SF-12 may be an instrument of choice where a short generic measure providing summary information on physical and mental health status is required. Crispin Jenkinson DPhil, Deputy Director
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.
The appropriate medical treatment of patients with ulcerative colitis is determined largely by the severity of symptoms. Hospital assessment of the severity of disease activity includes investigation of laboratory indices and sigmoidoscopic assessment of mucosal inflammation.
To develop a simplified clinical colitis activity index to aid in the initial evaluation of exacerbations of colitis.
The information for development of the simple index was initially evaluated in 63 assessments of disease activity in patients with ulcerative colitis where disease activity was evaluated using the Powell-Tuck Index (which includes symptoms, physical signs, and sigmoidoscopic appearance). The new index was then further evaluated in 113 assessments in a different group of patients, by comparison with a complex index utilising clinical and laboratory data, as well as five haematological and biochemical markers of disease severity.
The newly devised Simple Clinical Colitis Activity Index, consisting of scores for five clinical criteria, showed a highly significant correlation with the Powell-Tuck Index (r = 0.959, p < 0.0001) as well as the complex index (r = 0.924, p < 0.0001) and all laboratory markers (p = 0.0003 to p < 0.0001).
This new Simple Colitis Activity Index shows good correlation with existing more complex scoring systems and therefore could be useful in the initial assessment of patients with ulcerative colitis.
Repifermin (keratinocyte growth factor-2) has been shown to reduce inflammation in animal models of colitis.
To evaluate repifermin for the treatment of active ulcerative colitis.
Eighty-eight patients with active ulcerative colitis were enrolled in a 6-week, double-blind trial. Patients were randomized to receive treatment for five consecutive days with intravenous repifermin at a dose of 1, 5, 10, 25 or 50 microg/kg, or placebo. The primary objective of the study was to evaluate the safety of repifermin. The primary efficacy outcome was clinical remission at week 4, defined as a score of zero on the endoscopic appearance and stool blood components of the Mayo score and a score of zero or unity on the stool frequency and physician's global assessment components.
At week 4, the rates of clinical remission in the 1, 5, 10, 25 and 50 microg/kg repifermin groups were 19%, 9%, 0%, 0% and 0%, respectively, and 11% for the placebo group (P = 0.32 for repifermin vs. placebo). The frequencies of commonly occurring adverse events and severe adverse events were similar in both groups.
Intravenous repifermin at a dose of 1-50 microg/kg was very well tolerated, but there was no evidence that repifermin was effective for the treatment of active ulcerative colitis at these doses. An additional study to determine the efficacy of repifermin at doses of > 50 microg/kg or for a longer treatment duration may be warranted, as the maximally tolerated dose was not reached in the present study.
The PHQ-9 validity of a brief depression severity measure
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