Rajalakshmi Rajasegaran’s research while affiliated with Jawaharlal Institute of Post Graduate Medical Education and Research and other places

Context Patients with Parkinson’s disease (PD) commonly experience cardiac autonomic dysfunction, cognitive impairment, and psychological disturbances. Limitations in current treatment modalities warrant the need for simple, cost-effective adjuvant therapies. Pranayama, a fundamental component of yoga, has been proven to be beneficial for several medical disorders. Aim This study aimed to assess the effects of the 12-week practice of Anulom Vilom Pranayama (AVP) or Alternate Nostril Breathing (ANB) as an adjunctive therapy on the cardiac autonomic balance, cognition, psychological status, and quality of life (QoL) in individuals with PD. Subjects and Methods This randomized controlled trial involved 86 individuals (55 males, 31 females, aged 35–70 years) with mild-to-moderate PD. Participants were randomized into the control group receiving conventional treatment only or the test group receiving AVP as an adjunctive therapy to the conventional treatment. Cardiac autonomic status (heart rate variability [HRV]), cognition (P300, Reaction Time), affect, psychological status, and QoL were assessed in all the participants at baseline and after 12 weeks of respective intervention. Statistical Analysis The change in study parameters (0–12 weeks) was compared between the control and test groups using the Mann–Whitney U test or Independent samples t -test. The correlation between the change in low-frequency (LF)/high-frequency (HF) ratio and QoL and its effect at 12 weeks was assessed using the Spearman correlation coefficient test. P < 0.05 was considered statistically significant. Results The test group revealed significantly high total HRV (standard deviation of normal-to-normal intervals [SDNN], total power) and HRV indices of cardiac parasympathetic activity (square root of the mean of the sum of the squares of differences between adjacent NN intervals [RMSSD], percentage of NN50 [pNN50], HF power, HF normalized unit) and significantly low HRV indices of cardiac sympathetic activity (LF normalized unit) and cardiac sympathovagal balance (LF/HF ratio) compared to the control group. Similarly, significant improvement in cognition, psychological status, and QoL was also observed in the test group. While significant correlations were observed between the change in LF/HF ratio and QoL in both the groups, a significant correlation between the change in LF/HF ratio and positive affect was observed only in the test group. Conclusions Twelve weeks of practice of AVP significantly improved the cardiac sympathovagal balance, cognition, positive affect, and QoL and decreased the negative affect, depression, stress, and anxiety in patients with mild-to-moderate PD.

Objectives Improvements in acute trauma management have contributed to an increase in morbidity and survival rates among traumatic brain injury (TBI) patients. Caregivers report high levels of physical strain and emotional stress. Yet, research on stress and quality of life (QoL) in caregivers of patients with TBI remains limited, especially in low- and middle-income countries (LMICs). The objectives of this study are to assess the stress and QoL in caregivers of patients with TBI and their association with socio-demographic (age, sex, relationship with patient) and clinical factors (mode of injury, type of TBI, time since injury). Materials and Methods We conducted a cross-sectional observational study involving 55 adult primary caregivers of patients diagnosed with moderate-to-severe TBI at a tertiary care hospital. Caregivers were recruited from the Department of Neurosurgery outpatient section. Data on sociodemographic and clinical characteristics were collected, and stress levels and QoL were assessed through the Kingston Caregiver Stress Scale (KCSS) and relevant components of the TBI-Caregiver QoL (TBI-CareQOL) scale, respectively. Statistical analyses were performed to evaluate the relationships between variables. Results Caregivers recruited ranged from 19-64 years in age (Mean ± standard deviation [SD] = 37.51 ± 10.01 years) and were predominantly women (63.6%). TBI patients ranged from 15 to 70 years of age (Median [Q1, Q3] = 31 [24, 44]) and were predominantly male (36.4%). Moderate TBI occurred in 63.6% of patients, and the most common etiology was road traffic accidents (RTAs) (87.3%). Caregivers experienced severe stress (KCSS Total Score Mean ± SD = 30.18 ± 9.3) and worse QoL than the standard population mean. Caregivers of patients with TBI due to RTAs had significantly worse stress levels in terms of financial issues and worse QoL in terms of feelings of loss of self compared to TBI due to falls. Caregivers of patients with severe TBI had a significantly worse QoL in terms of feelings of loss of self compared to those with moderate TBI. Stress levels were highly correlated with all measured components of QoL. Increasing caregiver age was significantly correlated with a worse emotional suppression component of QoL (r = −0.289, P < 0.05). Conclusion The study highlights the substantial burden of stress and impaired QoL among caregivers of TBI patients, necessitating targeted interventions. Stress and QoL are closely linked, and some sociodemographic and clinical factors were associated with increased stress and impaired QoL, while other factors, such as the severity of TBI and time since injury, did not appear to have a significant effect. Further research should explore longitudinal changes in caregiver well-being and the development of tailored support services to mitigate these challenges.

Objectives Obstructive sleep apnoea (OSA), an often underdiagnosed and undertreated sleep-related breathing disorder, is associated with an increased risk of cardiovascular morbidity and mortality. Hence, this study aimed to assess the prevalence of OSA risk and its association with anthropometric indices (AI) of cardiometabolic risks, domain-specific cognitive functions and quality of sleep in apparently healthy young and middle-aged adults. Materials and Methods One hundred and eighty-nine apparently healthy individuals (123 males and 66 females) aged 19–45 years were included in this cross-sectional study. The participant’s current risk of OSA was assessed using the STOP-Bang questionnaire, and AI indicative of cardiometabolic risk (body mass index, waist-hip ratio [W/H ratio], waist-height ratio [WHtR], conicity index and a body shape index) was assessed using standard techniques. Domain-specific cognitive tests were performed to assess the cognitive status of the individual. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. The correlation between the OSA risk score and the study parameters was assessed using the Pearson or Spearman correlation coefficient test. Results The prevalence of high current risk of moderate to severe OSA was found to be 12.7%. Significant positive correlations were observed between OSA risk score and W/H, WHtR and sleep quality scores. While a significant positive correlation was observed between OSA risk score and executive functioning, significant negative correlations were observed with the other cognitive tests (short-term memory, verbal fluency, visuospatial memory and sustained attention and response speed). Conclusion A high risk of moderate to severe OSA is associated with obesity, cognitive decline and poor sleep quality in apparently healthy young and middle-aged adults.

Background Smartphone addiction among young adults is a growing concern that is often underestimated despite its significant health hazards. The objective of this study was to assess the extent of smartphone addiction and its association with physical activity level, anthropometric indices, and quality of sleep in young adults. Material and Methods This cross-sectional study was conducted among 138 allied health sciences undergraduates of a tertiary care medical school in Puducherry, South India. The participants’ extent of smartphone addiction, physical activity, and sleep quality were assessed using the Smartphone Addiction Scale (SAS), International Physical Activity Questionnaire, and Pittsburgh Sleep Quality Index (PSQI), respectively. Anthropometric indices (body mass index [BMI], waist-to-hip [W: H] ratio, waist-to-height [W: Ht] ratio, Conicity Index, and A Body Shape Index [ABSI]) were also measured following standardized procedures. Correlations between smartphone addiction, physical activity, anthropometric indices, and sleep quality were evaluated using Pearson’s/Spearman’s rank correlation coefficient. P <0.05 was considered statistically significant. Result Over 50% of participants showed smartphone addiction and poor sleep quality. Although a significant negative correlation was observed between SAS scores and physical activity levels, significant positive correlations were noted between SAS scores and BMI and SAS and PSQI scores. Conclusion Smartphone addiction is associated with decreased physical activity, increased BMI, and poor sleep quality in young adults.

Introduction: Obesity, a major health hazard in both developed and developing countries, is greatly influenced by an individual’s eating behaviour or appetitive trait. While eating disorders are known to be associated with abnormal body composition and cardio-metabolic risks, on par with metabolic syndrome, knowledge regarding the relationship between appetitive traits and body composition and anthropometric indices is very limited. Aim: To assess the appetitive traits of young and middle-aged individuals and correlate them with their body composition, anthropometric indices, and appearance anxiety. Materials and Methods: Sixty-eight healthy volunteers aged 19-45 years were included in this cross-sectional study. The appetitive traits, appearance anxiety, and perceived body shape of the study participants were assessed using the Adult Eating Behaviour Questionnaire (AEBQ), Appearance Anxiety Inventory (AAI), and Contour Drawing Rating Scale (CDRS). Body composition was assessed using Bioelectrical Impedance Analysis (BIA). The correlation between appetitive trait scores and the study parameters was assessed using the Pearson or Spearman correlation coefficient test. Comparison of appetitive traits between males and females was done using the Independent t-test or Mann-Whitney U test. A p-value <0.05 was considered statistically significant. Results: There were 43 males and 25 females. Significant negative correlations were observed between food avoidance scores and body composition parameters such as BMI, waistto-height ratio, lean mass, dry lean weight, body cell mass, basal metabolic rate, and Fat-Free Mass Index (FFMI). While food approach behaviour was similar between females and males, the overall food avoidance behaviour trait (53.4±11.2 vs. 47.26±9.09, p=0.016) and satiety responsiveness (12.28±3.2 vs. 10.51±2.93, p=0.024) were significantly more pronounced in females than in males. Moreover, the food avoidance behaviour of females revealed significant negative correlations with BMI, fat mass, lean mass, body cell mass, basal metabolic rate, Body Fat Mass Index (BFMI), free-fat mass index, and CDRS scores. Conclusion: The food avoidance trait is associated with abnormal changes in specific body composition parameters in adults. Satiety responsiveness and body dis-satisfaction related to being overweight are more common among young females and are associated with abnormal changes in their body composition.

Objectives Chemotherapy-induced cognitive impairment is a gruesome outcome of chemotherapy among breast cancer survivors. Electroencephalogram (EEG) power measurement is a known sensitive neurophysiologic correlate of cancer treatment-related cognitive dysfunction. The objective of this study was to assess the changes in specific quantitative EEG markers of cognition among breast cancer patients before, immediately, and three months after chemotherapy. Materials and Methods Twenty-three women planning to undergo adjuvant chemotherapy for breast cancer underwent EEG assessment before, immediately, and three months after chemotherapy. Repeated measures analysis of variance was used to analyse the data. Post hoc pairwise comparison was done with Bonferroni correction to determine the pair in which the difference existed. Results A significant increase in resting state EEG total power was observed ( P = 0.012) after chemotherapy in the frontal area. The relative alpha power (RAP) significantly decreased with chemotherapy ( P = 0.039), with post hoc pairwise comparison with Bonferroni correction revealing the significant decline to be present immediately after chemotherapy ( P = 0.036) only over the posterior channels. Furthermore, the alpha-to-theta ratio (ATR) over posterior areas decreased ( P = 0.012) both after completion of chemotherapy ( P = 0.039) as well as three months after chemotherapy ( P = 0.048). However, similar changes were not observed over frontal areas. Conclusion Chemotherapy induces enhanced frontal power with a coincidental decline in RAP and ATR in the posterior areas.

Background and Aim: Vitamin D is linked to the prevalence and severity of cardiac autonomic neuropathy in Type 2 Diabetes Mellitus (T2DM). Autonomic dysfunctions are evident in newly diagnosed T2DM subjects. However, the association of Vitamin D level with autonomic dysfunction in newly diagnosed T2DM remains unclear. To study the relationship between Vitamin D status and cardiovascular autonomic function in newly diagnosed T2DM. Methods: One group descriptive study with 47 newly diagnosed T2DM patients (mean age 39±4 years, with 23 males and 24 females), recruited based on American Diabetes Association (ADA) criteria in outpatient clinic of Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India. Cardiovascular autonomic functions including heart rate variability, baroreflex sensitivity and other conventional autonomic function tests were measured. The level of 25-hydroxy Vitamin D[25(OH)D] was measured using chemiluminescence assay technique. Results: The mean serum 25(OH)D concentration was 17.49±7.10, and all patients had Low Vitamin D levels (<30 ng/mL). There were significant negative correlations of Vitamin D level with basal HR (P=0.006), LF(nu) (P=0.010), LF-HF ratio (P=0.023); and positive correlations with BRS (P=0.007), HF(nu) (P<0.001) and TP (P=0.002). Conclusion: There was decrease in Vitamin D level in all subjects and it showed association with markers of sympathovagal imbalance. This might increase the cardiovascular risk in them.

Background: Chronic stress, a potential risk factor for cardiac autonomic dysfunction and cardiovascular (CV) risk, is known to induce the onset and exacerbation of chronic spontaneous urticaria (CSU), a psychodermatological disorder. However, data regarding CV risks due to the stress associated with CSU are very limited. Aims and objectives: This study aimed at comparing the cardiac sympathovagal balance (SVB), inflammatory markers, perceived stress and quality of sleep in patients with CSU (test group) and normal subjects (control group). In addition, it also aimed at assessing the correlation between the SVB and other study parameters in individuals with CSU. Materials and methods: Thirty-four patients with CSU and twenty-eight age- and gender-matched healthy controls were recruited for the study. Heart rate variability (HRV), baroreflex sensitivity (BRS) and biochemical markers of stress and inflammation (s-cortisol, interleukin (IL)-6, IL-18 and high sensitivity C-reactive protein (hs-CRP)) were assessed following standard procedures. Perceived stress and sleep quality were assessed using pre-validated questionnaires. Study parameters were compared between the test and control groups using the independent-samples Student's t-test or Mann-Whitney U-test. The correlation between SVB and other study parameters was assessed using Spearman's rank correlation coefficient test. P < 0.05 was considered statistically significant. Results: Levels of perceived stress, inflammatory markers, mean arterial pressure (MAP), myocardial workload (rate pressure product (RPP)), and HRV indices indicative of cardiac sympathetic activity were significantly high in individuals with CSU. In contrast, BRS and HRV indices indicative of parasympathetic activity and sleep quality were significantly low in these individuals. There was no significant correlation between SVB and other study parameters. Conclusions: Patients with CSU have cardiac dysautonomia characterised by increased sympathetic activity and decreased parasympathetic activity. Also, the reduced BRS and increased RPP point towards an increased risk of CV morbidity in these individuals.