Objectives. To systematically review and meta-analyze the effectiveness of yoga for reducing blood pressure in adults with hypertension and to assess the modifying influences of type and length of yoga intervention and type of comparison group. Methods. Academic Search Premier, AltHealthWatch, BIOSIS/Biological Abstracts, CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, PsycARTICLES, Natural Standard, and Web of Science databases were screened for controlled studies from 1966 to March 2013. Two authors independently assessed risk of bias using the Cochrane Risk of Bias Tool. Results. All 17 studies included in the review had unclear or high risk of bias. Yoga had a modest but significant effect on systolic blood pressure (SBP) (4.17 [6.35, 1.99], ) and diastolic blood pressure (DBP) (3.62 [4.92, 1.60], ). Subgroup analyses demonstrated significant reductions in blood pressure for (1) interventions incorporating 3 basic elements of yoga practice (postures, meditation, and breathing) (SBP: 8.17 mmHg [12.45, 3.89]; DBP: 6.14 mmHg [9.39, 2.89]) but not for more limited yoga interventions; (2) yoga compared to no treatment (SBP: 7.96 mmHg [10.65, 5.27]) but not for exercise. Conclusion. Yoga can be preliminarily recommended as an effective intervention for reducing blood pressure. Additional rigorous controlled trials are warranted to further investigate the potential benefits of yoga.

https://downloads.hindawi.com/journals/ecam/2013/649836.pdf

Effectiveness of Yoga for Hypertension: Systematic Review and Meta-Analysis

The Face, Legs, Activity, Cry and Consolability (FLACC) scale is one of the most widely used behavioural observation pain scales. However, the psychometrics of the scale have not been adequately summarised and evaluated to provide clear recommendations regarding its use. The aim of this study was to rigorously evaluate the reliability, validity, feasibility, and utility of the scale for clinical and research purposes and provide recommendations regarding appropriate use of the scale. Databases searched were MEDLINE, CINAHL, Embase, PsycINFO (using the Ovid, PubMed, and Ebscohost platforms), The Cochrane Database of Systematic reviews and Cochrane Controlled Trials, and Google Scholar. Psychometric evaluation studies reporting feasibility, reliability, validity, or utility data for the FLACC scale applied to children (birth to 18 years) and randomised controlled trials (RCT) using the FLACC scale to measure a study outcome in infants and children. Data extraction included study design, population demographics, and psychometric data. Analysis involved in this study are quality assessment of the psychometric evaluation studies and the RCTs using the COSMIN checklist and the Jadad scale, respectively, and narrative synthesis of all results. Twenty-five psychometric evaluations studies and 52 RCTs were included. The study population, circumstances, and quality of the studies varied greatly. Sufficient data addressing postoperative pain assessment in infants and children exist. Some positive data support the psychometrics of the scale used to assess postoperative pain in children with cognitive impairment. Limited and conflicting data addressing procedural pain assessment exist. Content validity and scale feasibility have had limited psychometric evaluation. There are insufficient data to support the FLACC scale for use in all circumstances and populations to which is currently applied.

Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use?

The largest prospective cadaver study done over a 3-year period to investigate the arterial variations of the forehead is presented. The primary goal was to find anatomical support for various forehead flaps previously designed. Thirty cadaver foreheads (60 hemi-foreheads) were dissected from deep to superficial to identify arterial variations. The arteries were filled with a latex solution prior to dissection. The results show that the supratrochlear and dorsal nasal arteries have a relatively constant origin. Vertical (VB), oblique (OB), medial (MB) and lateral branches (LB) of the supraorbital artery were identified. The frontal branch of the superficial temporal artery (FBSTA) was found to continue in the direction of the scalp at the lateral orbital rim vertical line and gave off a transverse branch, the transverse frontal artery (TFA), to supply the forehead. The oblique branch of the supraorbital artery (OBSOA) most often anastomosed with either the transverse frontal artery or the frontal branch of the superficial temporal artery at the lateral orbital rim vertical line. A central artery (CA) was consistently found originating from the dorsal nasal artery usually 5mm from its origin. The central artery had a constant anastomosis with the opposite central artery in the inferior transverse third of the forehead. The central artery was not easily identifiable in the superior third of the forehead. The angular artery (AA) was found to have a variable termination. The angular artery could communicate with the supratrochlear artery (STrA) at the supraorbital rim (SOR) or it could continue up into the forehead medial to the STrA. This artery was called the paracentral artery (PCA). The central artery, paracentral artery and supratrochlear artery have an important relationship with the most prominent central vein that is relevant to flap construction. The significance of the central artery and vein favours the median forehead flap as anatomically superior and the prominent central vein is a constant landmark on which to select the side of the pedicle. Clear landmarks for defining the pedicle base for the median forehead flap are provided.

https://www.jprasurg.com/article/S1748-6815(06)00639-5/pdf

Forehead anatomy: Arterial variations and venous link of the midline forehead flap

War and poverty are ‘extraordinary conditions created by human intervention’ and ‘preventable public health problems.’ War and poverty have many negative effects on human health, especially women’s health. Health problems arising due to war and poverty are being observed as sexual abuse and rape, all kinds of violence and subsequent gynecologic and obstetrics problems with physiological and psychological courses, and pregnancies as the result of undesired but forced or obliged marriages and even rapes. Certainly, unjust treatment such as being unable to gain footing on the land it is lived (asylum seeker, refugee, etc.) and being deprived of social security, citizenship rights and human rights brings about the deprivation of access to health services and of provision of service intended for gynecology and obstetrics. The purpose of this article is to address effects of war and poverty on the health of reproduction of women and to offer scientific contribution and solutions.

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Women on the Other Side of War and Poverty: Its Effect on the Health of Reproduction

Context: Premenstrual stress affects 75% of women of childbearing age and yoga has been found to be beneficial in many psycho-somatic disorders. Aims: To investigate the effect of integrated yoga on autonomic parameters and psychological well-being during both pre and post phases of menstrual cycle in healthy young female subjects. Settings and Design: Present study is a randomized control trial and was conducted in the Department of Physiology, Lady Hardinge Medical College, New Delhi, India. Material and Methods: Fifty apparently healthy females in the age group of 18-20 years were randomized into two groups: Group I (n=25) consisted of subjects who practiced yoga 35-40 minutes per day, six times per week for the duration of three menstrual cycles. Training was given by qualified yoga instructor. Group II (n=25) subjects acted as controls. Following parameters were recorded at the beginning and after completion of three menstrual cycles in all the subjects: Height, weight (BW), Resting Heart Rate (HR), Resting Systolic (SBP) and Diastolic Blood Pressure (DBP), parasympathetic reactivity tests including Expiration-Inspiration Ratio (E: I ratio) and 30:15 ratio, sympathetic reactivity tests including BP changes due to Isometric Hand Grip (IHG) exercise, and Cold Pressor Test (CPT). Assessment of psychological status was done by administering DIPAS (Defense Institute of Physiology and Allied Sciences) inventories of Anger self report scale, Trait Anxiety, Sense of well-being and Depression scale. Statistical Analysis: Intra-group comparison of physiological parameters was done by using paired ‘t’ test, whereas intragroup comparison of non-parameteric data such as scores of anxiety, depression, anger and sense of well-being was done by Wilcoxon signed-rank test. Inter-group comparison of parameters was done by Students ‘t’ test for parametric tests and Mann-Whitney ‘U’ test for non-parameteric tests. Results: There was significantly higher BW, resting SBP, DBP, sympathetic activity and blunting of parasympathetic reactivity and also, significantly higher scores of anger, depression, anxiety and decreased score of well-being in premenstrual phase as compared to postmenstrual phase in both the groups in initial cycle. There was significantly higher percentage decrease in BW, HR, SBP & DBP in yoga group as compared to control group in both the phases from initial to second and onwards between second and third menstrual cycle. Also, decrease in anger, depression and anxiety and increase in well-being score was significant in yoga group as compared to control group from initial to second and third cycle in premenstrual phase while the change was significant only in depression score in postmenstrual phase. Conclusion: Our study shows that there was significant alteration of autonomic functions and psychological status in premenstrual phase when compared with postmenstrual phase in young healthy females. Also, regular practice of yoga has beneficial effects on both phases of menstrual cycle by bringing parasympathodominance and psychological well-being probably by balancing neuro-endocrinal axis.

Effect of yoga on autonomic functions and psychological status during both phases of menstrual cycle in young healthy females.

Objectives: To study the cleft lip and cleft palate in the poverty stricken Sub-Himalayan Garhwal region of India, being a commonly seen congenital abnormality and scarcity of studies about the demography of cleft in this region. Design: A prospective cohort observational case series was performed on 4657 cleft patients at a Tertiary care Hospital in Dehradun, India, over a period of 5 years. Outcome measures: The authors investigated the differences between age and sex with cleft status and family history of clefts, birth order, religion, socioeconomic status, parent literacy, source of information for treatment, haematological investigations showing the status of infection and coagulation in such children and satisfaction after treatment. Results: Seventy-two percent parents of cleft lip patients were illiterate, and only 8% were graduates, the majority of patients were from the low socioeconomic class. The siblings of 1.1% of the cleft patients had similar deformity. Anemia was seen in 83.16% cases which was commonly microcytic hypochromic type and eosinophilia was seen in 25.50% of cases. In the coagulation profile, International Nationalized Ratio was found to be raised in 52.12%. Almost 95% of the families were fully satisfied by the treatment and results. Conclusion: This study will provide baseline information on the status of these less privileged cleft patients in this mountainous region for future reference to health workers.

/pdf/a-clinical-and-demographic-profile-of-the-cleft-lip-and-32z9mgncbq.pdf

A clinical and demographic profile of the cleft lip and palate in Sub-Himalayan India: A hospital-based study.

Aims and Context: To evaluate the efficacy of adding clonidine to bupivacaine in bilateral infraorbital nerve block for hemodynamic changes, requirement of opioids, volatile agent, and muscle relaxants intraoperatively and relief of pain postoperatively . Setting and Design: Prospective, randomized, double-blind study. Methods: Fifty pediatric patients aged less than 24 months undergoing elective cleft lip repair were randomly allocated to two groups of 25 each. After tracheal intubation, group A received bilateral infraorbital nerve block with 1 ml solution of clonidine (1 μg/kg) and bupivacaine 0.25%, and group B received 1 ml of 0.25% bupivacaine. Hemodynamic parameters, intraoperative requirement of volatile anesthetic agent, muscle relaxant, and analgesic were recorded. Pain was assessed postoperatively using the Face, Legs, Activity, Cry, Consolability scale till the first rescue drug was given. Statistical Analysis: Two sample unpaired t-test and the correlation r test. Results: The duration of analgesia from the time of administration of block in group A was 667.72 ± 210.74 min compared to 558.48 ± 150.28 min in group B (P<0.05). Conclusion: Addition of clonidine as an adjunct to local anesthetic significantly decreased the requirement of other anesthetic drugs and significantly prolonged the duration of postoperative analgesia without any adverse effects.

Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery.

Premenstrual Syndrome is a psychoneuroendocrine stress related disorder and more than 300 treatment modalities for PMS show that the existing remedies have not provided satisfactory help to relieve PMS. 61-points relaxation exercise (61-PR), a relatively less known hatha yoga technique, is a successful means of stress relaxation and is expected to relieve PMS as well. The present study was conducted on 50 clinically healthy women volunteers who were in their reproductive age group and in their premenstrual period, from which a control group (n = 20) and a PMS group (n = 30) based on the symptoms were identified. In both groups basal heart rate (HR/min), systolic (SBP; mmHg) and diastolic blood pressure (DBP; mmHg), electromyogram (EMG; mV), electrodermal galvanic activity (EDG; microv), respiratory rate (RR/min) and peripheral temperature (T; degrees F) were recorded and the subjects were taken through a guided 61-PR. The symptoms and parameters were re-recorded after the 61-PR. In control group, the basal HR was 82.06 +/- 8.07, SBP 111.95 +/- 8.23, DBP 76.8 +/- 6.42, EMG 4.08 +/- 2.99, EDG 9.77 +/- 3.29, RR 15.60 +/- 3.77 and T was 97.86 +/- 0.63. After 10 minutes of 61-PR, HR (77.27 +/-10.85, P 0.05) rose significantly. In the PMS group, the basal HR was 90.61 +/- 8.46, SBP 122.5 +/- 11.52, DBP 83.53 +/- 8.26, EMG 5.79 +/-2.75, EDG 13.14 +/- 6.54, RR 19.13 +/- 3.76 and T was 93.43 -/+ 5.29. After 10 minutes of 61-PR, HR (75.58 +/- 10.11, P < 0.0001), SBP (114.53 +/- 9.70, p < 0.0001), DBP (77.46 +/- 8.68, P < 0.0001), EMG (2.56 +/- 1.77, P < 0.0001), EDG (10.64 +/- 5.72, P < 0.0001), and RR (16.13 +/- 3.76, P < 0.0001) declined to a much greater extent and T (93.49 +/- 5.28, P < 0.0001) rose more significantly. These results suggest a reduction in sympathetic activity by 61-PR, also the high basal sympathetic tone present in subjects of PMS group due to stress is considerably reduced by relaxation. 61-PR is effective in providing relief from PMS and may be a useful adjuvant to medical therapy of PMS and other stress disorders.

Effect of '61-points relaxation technique' on stress parameters in premenstrual syndrome.

8 Tassman WS, O'Brien DD, Hahn K. Retinal lesions in kalaazar. Am J OphthalmoI1961;SO:161-3 9 Bialasiewiecz AA, K1aul3 V, Knothe H, Kramer A, Werner H-P. Infektionskrankheiten des Auges. Stuttgart: Gustav Fischer, 1995 10 Bialasiewicz AA, Balmes R, Busse H. Einseitige chronischgranulomatose Blepharitis als Leitbefund der orientalischen kutanen Leishmaniase in Deutschland. Klin Mbl Augenheilk 1992;200:219-23 II Cairns IE. Cutaneous leishmaniasis (oriental sore). A case with corneal involvement. Or J OphthalmoI1968;52:481-3 12 Chu FC, Rodrigues MM, Cogan DG, Neva FA. Leishmaniasis affecting the eyelids. Arch OphthalmoI1983;101:84-91 13 Ferry AP. Cutaneous leishmaniasis (oriental sore) of the eyelid. Am J OphthalmoI1977;84:349-54 14 Morgan G. Case of cutaneous leishmaniasis of the lid. Or J OphthalmoI1965;49:542-5 15 Oliveira-Neto MP, Martins VI, Mattos MS, Pirmez C, Brahin LR, Benchimol E. South American cutaneous leishmaniasis of the eyelids. Ophthalmology 2000;1:169-72 16 O'Neill DP, Deutsch J, Carmichael AJ, Taylor R. Eyelid leishmaniasis in a patient with neurogenic ptosis. Or J OphthalmoI1991;75:506-7 17 Sodaify M, Aminlari A, Resaei H. Ophthalmic leishmaniasis. Clin Exp DermatoI1981;6:485-8 18 Tabbara KF, Hyndiuk RA. Infections of the Eye. Boston: Little, Brown, 1996 19 Dusseldorp M. Amerikanische Hautleishmaniosis mit Augenkomplikationen. Zentralbl Ges Ophthal Grenzgebiete I929;XX:467-8 20 Rentsch FJ. K1inik und Morphologie der Leishmaniose der Lider. Klin Mbl Augenheilk 1980;177:75-9 21 Roizenblatt I. Interstitial keratitis caused by American (mucocutaneous) leishmaniasis. Am J Ophthalmol 1979; 87:175-9

Injuries caused by the black Himalayan bear in the foothills of Garhwal, Himalayas.

INTRODUCTION Vertical Jump (VJ) is a good measure of athletic performance and occupational activities. Earlier studies reported conflicting results on anthropometric influence. AIM To evaluate the relationship between anthropometric characteristics and VJ in national level hockey and cycling players. MATERIALS AND METHODS Fifty four (32 males) national level hockey and cycling players of 11-21 years were the volunteers. Following standard protocols, these variables were measured: VJ, Weight (WT), Height (HT), Trochanterion-Height (TH), Sum of Skinfold Thickness (SSF), Lengths [Acromiale-Stylion (AS) and Midstylion-Dactylion (SD)], Breadths [Biacromial (AB), Biiliocristal (IB), Biepicondylar Humerus (HB) and Biepicondylar Femur (FB)], Girths [Relaxed Arm (AG), Mid Thigh (TG) and Calf (CG)], Lower Back and Hamstring Flexibility (SR), Grip [Left Hand Grip (LHG) and Right Hand Grip (RHG)] and Back Strength (BS). International Society for the Advancement of Kinanthropometry (ISAK) procedures were followed for anthropometric variables measurement. Unpaired-'t'-test was used for comparison between genders. Pearson's correlation and multiple regression analysis were used to evaluate correlates and predictors of VJ respectively. RESULTS Males had significantly higher VJ, HT, SD, AB and BS; but lower SSF, AS and TG. VJ correlated positively with age, WT, HT, SD, TH, girths, SR and strength among males; but only with WT and LHG among females. After controlling gender, TH and LHG predicted VJ significantly with 69% of total variance. HT, SSF and BS; and LHG were the significant predictors among males and females respectively. CONCLUSION Anthropometric and physiological variables like TH, grip, HT, skinfold and BS had major influence on VJ. The result might help in training-monitoring and player's selection.

Sanjay Dvivedi

Papers

A clinical and demographic profile of the cleft lip and palate in Sub-Himalayan India: A hospital-based study.

Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery.

Effect of '61-points relaxation technique' on stress parameters in premenstrual syndrome.

Injuries caused by the black Himalayan bear in the foothills of Garhwal, Himalayas.

Anthropometric Basis of Vertical Jump Performance: A Study in Young Indian National Players.