3 nutritional deficiencies in indian ... - himalaya...

Fact File10

Laugh a While11

Event Calendar10

Clinical Studies 4

In Focus 8

Product Feedback 6

Health from Herbs3

Health News7

Fitness10

Latest in Medicine9

Health Tips6

Himalaya’s Health Digest for You • Vol LII • No 1 • Jul–Sep 2012

Nutritional deficiencies in Indian children manifest right from the time of birth and nutritional problems such as stunted growth and wasting rise rapidly in the first two years of life. Nutritional deficiencies generally get worse during the initial 2 years of life, which is the most critical period in the growth and development of children. Despite efforts of the Indian government oriented Integrated Child Development Services (ICDS) program to improve the nutritional status of young children, serious nutritional problems persist in Indian children during the early years of childhood.

Nutritional Status of Indian ChildrenThere has not been much improvement in the nutritional status of children below 3 years of age in the recent years.

Nutritional Deficiencies in Indian ChildrenAccording to the 3 measures of nutritional status (stunting, wasting, and underweight), lack of proper nutrition is a particularly serious problem in rural areas of India with almost half of the young children having stunted growth, another half being underweight, and 1 out of every 5 children wasted. Even in the urban areas, undernutrition is very widespread as almost 40% of young children are stunted, one-third of them are underweight, and 17% are wasted. It has been found that children in rural areas are 40% more likely to be underweight than children in urban areas. The prevalence of stunting is also 28% higher in rural areas than in urban areas.

Malnutrition in Children Under 5 YearsAlmost half of the children under the age of 5 years (48%) are chronically malnourished. In other words, they are too short for their age or are stunted. One out of every 5 children in India under the age of 5 is wasted and 43% of children under age 5 years

are underweight for their age (Figure 1).

Stunting is an excellent long-term indicator of the nutritional status of a population because it does not vary considerably by the season of data collection or other short-term factors such as epidemic illnesses, acute food shortages, or shifts in economic conditions. Acute malnutrition, as indicated by wasting results in a child being too thin for his or her height. Underweight status is a composite index of chronic or acute malnutrition and is often used as a basic indicator of the status of a population’s health.

Malnutrition Contributes to Under-five MortalityUnder-five mortality in India is mainly a result of infectious diseases and neonatal deaths.

Figure 1. Malnutrition in children under 5 years in India

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Dear reader,

The problem of child malnutrition remains critical in India and the malnutrition rate is disproportionately high. According to reports, an estimated 40% of the world’s severely malnourished children under five are in India. At least half of infant deaths in India are related to malnutrition, often associated with infectious diseases. The “Cover Page” article of this issue features a review on the nutritional status of Indian children.

The “Clinical Studies” section features beneficial effects of HiOwna-Jr, a newly launched nutritional supplement of The Himalaya Drug Company, which helps improve physical, mental, and immune development in children. The section also features articles that discuss about the clinical efficacy and safety of Bresol syrup and tablet in the management of respiratory allergic diseases and Menosan in the management of postmenopausal syndrome and improvement of quality of life in postmenopausal women.

“Health Tips” section features self-help tips that help to ease symptoms associated with menopause, and maintain good health during this phase of life. “In Focus” section features a multicentric, postmarketing surveillance study that discusses the efficacy and safety of Evecare syrup in treating menstrual irregularities.

Please write to us at [email protected] with your feedback/suggestions on this issue of Capsule.

Happy reading!– Editor

E D I T O R I A L

2 • Jul–Sep 2012 • Vol LII • No 1 www.himalayahealthcare.com

Undernutrition is a significant contributing factor to the death of young children. Malnourished children are at an increased mortality risk associated with respiratory tract infections, diarrhea, malaria, measles, and other infectious diseases.

Cumulative Distribution of Weight-for-Age In a population with normal growth patterns for children, about 2.3% of children under 5 years of age would be underweight. In contrast, in India the percentage of children who are underweight is 19 times the expected level if measured by the WHO Child Growth Standards and 21 times the expected level if measured by the National Center for Health Statistics, NCHS/WHO International Reference Population. At almost every level of the z-scores, the nutritional status of children in India is much worse than the expected level (Figure 2). The percentage of children who are stunted is also 19 to 21 times as high as would be expected in a healthy, well-nourished population (according to the international child growth standards) and

the percentage of children who are wasted is 8 to 9 times the expected level, depending on which growth standard is used.

Malnutrition in Children Under 3 YearsDespite ongoing efforts to improve the nutritional status of young children, there has not been much improvement in the nutritional status of children under 3 years of age in recent years (Figure 3). The percentage of children who are too short for their age (stunted) decreased by <1 percentage point per year over the 7 years between the 2 surveys, from 51% in National Family Health Survey, NFHS-2 to 45% in NFHS-3. The percentage of children underweight also decreased by 3 percentage points. Over this period, the percentage of underweight children decreased by 4 percentage points in urban areas, but by less than 2 percentage points in rural areas. Wasting (low weight-for-height) among young children has become worse over time, increasing from 20% in NFHS-2 to 23% in NFHS-3. The increase in wasting is a consequence of

the fact that there was a greater improvement in stunting than in underweight during this period.

Nutritional Anemia in Young ChildrenMicronutrient deficiency, particularly inadequate intake of iron, affects the nutritional status of young children and is the most common cause of anemia. Children who are stunted, wasted, or underweight are more likely than other children to suffer from moderate to severe anemia. Half of young children who are stunted or underweight are moderately or severely anemic, compared with 36% to 37% of those who are not stunted or underweight.

Anemia has been a great problem in India and the NFHS-3 data showed the prevalence of anemia among children <5 years of age to be around 70%. The prevalence of anemia among children under 3 years of age jumped to 79% and this is 5% more than the NFHS-2 survey done 6 years prior to the NFHS-3 survey (2005–2006). However, over the last 7 years, there has been a slight reduction in the prevalence of severe anemia, while there has been an increase in the overall incidence of anemia.

Sources1. Arnold F, et al. 2009.

Nutrition in India. National Family Health Survey (NFHS-3), India, 2005-06.

2. Kotecha PV, et al.Indian J Community Med. 2011;36(1):8-16.

Figure 2. Cumulative distribution of weight-for-age z-scores

Figure 3. Trends in malnutrition among children under three years

www.himalayahealthcare.com Jul–Sep 2012 • Vol LII • No 1 • 3

Health from Herbs

English name

Bellirica myrobalan, Chebulic myrobalan, and Indian Gooseberry

Sanskrit/Indian name

Triphala (Vibhitaki, Haritaki, and Amalaki)

English name Winter cherry

Sanskrit/Indian name Ashvagandha

Withania somnifera, an erect, evergreen, tomentose shrub with fleshy and stout roots, grows abundantly in the subtropical regions of India, Nepal, Bangladesh, Pakistan, Sri Lanka, and parts of northern Africa. The leaves of W somnifera are ovate with entire margin and arranged in an alternate manner. The flowers are greenish in color and fruits are small, round, orange–red when mature. Root extracts of W somnifera have nervine tonic, aphrodisiac, and sedative properties. In traditional systems of medicine, W somnifera has been used as aphrodisiac and geriatric tonic and also in treating rheumatism and general weakness.

In an experimental study, it was observed that treatment of stress with an extract of W somnifera for 30 days, significantly reversed the stress-induced NADPH-d activation. The study findings suggested that

inhibition of NADPH-d by W somnifera was not a direct effect of the extract on NADPH-d, instead it inhibited via the suppression of corticosterone release and activation of choline acetyl transferase, which in turn increased serotonin level in hippocampus to inhibit NADPH-d. To summarize, the main mechanism underlying the neuroprotective effects of W somnifera can be attributed to its role in the downregulation of nNOS and neurochemical alterations of specific neurotransmitter systems. These observations suggested that root extracts of W somnifera could be developed as a potential preventive- or therapeutic-drug for stress-induced neurological disorders.1

Other studies have shown that W somnifera possesses antidepressant, antistress, and adaptogenic properties, and can be used as a mood stabilizer in social isolation behavior.2,3

Triphala is an Ayurvedic formulation comprising equal amounts of fruits of three herbs - Terminalia bellirica, Terminalia chebula, and Emblica officinalis.

T bellirica, found throughout India, is a large deciduous tree with elliptic-obovate leaves and green to yellow colored fruits. T chebula is also a large deciduous tree with dark brown bark, glabrous leaves—ovate or elliptical, yellowish-white flowers, and fruit which is an ellipsoidal, pendulous drupe, yellow to orange–brown in color. T chebula grows in the outer Himalayas and throughout central and south India. E officinalis is a deciduous tree with smooth, greenish grey bark and small narrow linear and pinnate-like leaves. E officinalis is found throughout tropical and subtropical India. The flowers are yellowish and axillary while the fruits are fleshy, globose, and pale yellow in color.

An in vitro study, which was conducted to evaluate the antioxidant activity, showed that Triphala has the ability to scavenge free radicals such as superoxide and 2,2-diphenyl-1-picryl hydrazyl (DPPH). As the phenolic compounds present in these extracts are mostly responsible for their radical scavenging activity, the total phenolic contents present in these extracts were determined and expressed in terms of gallic acid equivalents and were found to vary from 33% to 44%. The study revealed that all three constituents of Triphala are active and the mixture is expected to be more efficient due to the combined activity of the individual components.4 Another study reported that Triphala mixture prevents oxidative stress associated with noise-stress.5

In addition to these, Triphala also possesses antineoplastic, chemo- and radio-protective, and antidiabetic properties.6

Triphala

Withania somnifera

1. Bhatnagar M, et al. Neurochem Res. 2009;34(11):1975-1983.2. Gupta GL, et al. Indian J Physiol Pharmacol. 2007;51(4):345-353.3. Bhattacharya SK, et al. Pharmacol Biochem Behav. 2003;75(3):547-555.

4. Naik GH, et al. Phytother Res. 2005;19(7):582-586.5. Srikumar R, et al. Mol Cell Biochem. 2006;283(1-2):67-74.6. Baliga MS. J Altern Complement Med. 2010;16(12):1301-1308.

References:


Clinical Studies

Role of HiOwna-Jr in General Health and Cognition of ChildrenAn open clinical trial was conducted to evaluate the clinical efficacy and safety of HiOwna-Jr (health drink) in maintaining general growth, health, and cognition in children. The study included children aged between 2 and 10 years, whose parent/guardian had given consent to participate in the clinical study. Children between the age group of 2 and 6 years were instructed to take 12.5 g of health drink and those between 7 and 10 years of age were instructed to take 25 g of health drink with milk, orally twice daily for a period of 2 months. The children were monitored at monthly intervals for 2 months to evaluate the effect of health drink. Cognition was evaluated in children aged between 5 and 10 years.

Height, weight, body mass index, and general health improved with the use of HiOwna-Jr as determined by improvement of appetite and reduction in frequency of respiratory illness (Table 1). Improvement in cognition parameters such as attention, memory, and concentration were noted in children aged between 5 and 10 years. All the participants liked the formulation and completed the study. No adverse effects were either reported or observed.

From these results it can be concluded that HiOwna-Jr, given in addition to regular balanced diet, helps to maintain adequate natural linear growth, enhance immunity, and favorably improve cognition in children.

Table 1. Effect of HiOwna-Jr on Height, Weight, and BMI (n = 40)

Parameter At entry 1st month 2nd month

Height (cm) 110.6 ± 18.1 111.3 ± 18.3 aP<.001 112.4 ± 18.5 a, bP<.001

Weight (kg) 18.70 ± 5.23 19.12 ± 5.23 aP<.001 19.27 ± 5.23 a, bP<.001

BMI (kg/m2) 15.19 ± 1.85 15.36 ± 1.96 aP<.001 15.29 ± 1.97 a, bP<.001aAs compared to “at entry values”; bAs compared to 1st month values

Management of Upper and Lower Respiratory Tract Allergic Diseases with Bresol TabletsAn open label, non-comparative, phase III clinical trial was conducted to evaluate the efficacy and safety of Bresol tablets in upper and lower respiratory tract allergies. The study included a total of 105 children between the age group of 3 to 12 years who presented with symptoms of rhinitis or bronchitis. They were administered with Bresol at a dosage of 1 tablet twice daily for 2 weeks. All children were followed-up fortnightly for a period of 3 months. All children were subjected to hematological and biochemical tests along with peak expiratory flow rate (PEFR) at the end of the study period.

There was a highly significant reduction in mean scores for sneezing, nasal congestion, itching of the eyes and nose, postnasal drip, rhinorrhea, watery eyes, and total rhinitis symptom score (Figure 1) at the end of study. A significant reduction in mean scores of chest tightness, daily asthmatic symptoms, wheezing, shortness of breath, cough, sputum production, and total asthma symptom score was also noted.

In addition, significant improvement was seen in mean scores of PEFR. The increased levels of white blood cells, eosinophils, lymphocytes, polymorphs, and erythrocyte sedimentation rate were normalized at the end of the study. No clinically significant adverse events were reported.

Therefore, it can be concluded that Bresol tablets are clinically effective and safe in treating allergic rhinitis, allergic bronchitis, or asthmatic bronchitis in children.

— Palani D, et al.Ind J Clin Pract. 2012;22(11):557-562.

Figure 1. Reduction in symptom score of total rhinitis after treatment with Bresol tablets

— Sengupta K, et al.Med Update. 2004;12(3):37-46.


Management of Postmenopausal Syndrome and Improvement in Quality of Life with Menosan TabletsA double-blind, randomized, placebo-controlled, phase III clinical trial was conducted to evaluate the safety and efficacy of Menosan in postmenopausal syndrome, with special reference to improvement in quality of life (QOL).

The study included 40 female patients who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, and thereby attained surgical menopause. The patients were randomly divided into 2 groups and each group received either Menosan or placebo at a dosage of 1 tablet twice daily, from the 7th postoperative day till completion of 3 months. QOL status was analyzed using 2 different scales—“WHOQOL-BREF” and “World Health Organization Disability Assessment Schedule (WHODAS)” questionnaires.

At the end of the study period, highly significant improvement in “physical health,” “psychological health,” (Figure 3) and “social relationship” domains were noted in Menosan group, as compared to the placebo group. No clinically significant changes in hematological and biochemical parameters were noted nor were any significant adverse reactions recorded.

Safety and Efficacy of Bresol Syrup in Allergic RhinitisThis study was planned to evaluate the short- and long-term clinical efficacy and safety of Bresol syrup in children (between 2 and 12 years of age) with allergic rhinitis (AR). The study comprised 110 children who presented with symptoms of AR (sneezing, nasal congestion, itching of eyes and nose, postnasal drip, rhinorrhea, and watery eyes).

The patients were advised to take 1 teaspoonful of Bresol syrup, twice daily for 4 weeks. All children were followed-up on a weekly basis for a period of 1 month and were then subjected to hematological and biochemical tests to evaluate symptomatic improvement of rhinitis. The predefined primary endpoints of the study included rapid symptomatic control, and clinical, biochemical, and hematological improvement.

Out of 110 enrolled children, 25 (22.72%) children were lost to follow-up and data of the remaining 85 (77.27%) children were analyzed. The results of the study showed that there was a highly significant reduction in mean scores for symptoms of AR at the end of 1 week. Almost all children were symptom-free at the end of 1 month. Total leucocyte count, erythrocyte sedimentation rate, and absolute eosinophil count (Figure 2) were normalized at the end of the study period. No clinically significant adverse events were reported.

Therefore, it can be concluded that Bresol syrup is clinically effective and safe in treating AR in children.

Figure 3. Improvement in the mean score for psychological health with Menosan treatment

— Goyal U, et al. Med Update. 2004;12(8):39-48.

Figure 2. Reduction in absolute eosinophil count (AEC) before and after treatment with Bresol syrup

— Chatterjee S, et al.Ind J Clin Pract. 2004;15(2):25-36.


Health Tips Product Feedback

Coping with Menopause Liv.52 is a time-tested medicine. It is very useful in pregnancy- induced anorexia and vomiting. I successfully treated a

patient with pregnancy-induced anorexia by prescribing Liv.52 and got good results.

– Dr Shakuntala Gupta Jiwan Rekha Clinic

Olympic Cinema, Jodhpur – 342001 Rajasthan

The efficacy of Liv.52 is noticeable in almost 100% of the cases, whether it is used for prophylactic or therapeutic

indications. Rapid normalization of hepatic functions is noticed even in fulminant or severe acute hepatitis. Patients with ATT-induced hepatitis have shown drastic improvement after administration of Liv.52 DS and liver function test results of these patients were normal.

– Dr M Kamran Khan Patal Babu Road, Bhagalpur - 812001

Bihar

Liv.52 has proven itself excellent in cases like hepatitis, loss of appetite, and chronic constipation. I have treated many

challenging cases with Liv.52 and got excellent results.

– Dr Razaullah Khan No. 36/570, Bayran Bazaar, Raipur – 492001

Chattisgarh

Liv.52 is a product I know as far back as my memory goes. Previously, I used to take Liv.52 on physician’s advice; now

I prescribe it. It is a product of choice in liver disorders and the results are excellent.

I tried Liv.52 in hyperemesis gravida when allopathic drugs failed. One teaspoonful of Liv.52 syrup showed good results in morning sickness.

– Dr Sapna Agrawal 665/2, Mangal Pandey Nagar, Meerut - 250001

Uttar Pradesh

Menopausal transition is a natural stage for every woman in her forties or fifties. With menopause, symptoms such as hot flashes, night sweats, mood swings, irritability, anxiety, and tiredness can make a woman’s life stressful during this period. Here are 5 self-help tips that ease these symptoms and help protect women’s health during this phase of life.

Eat Nutritious FoodAccording to the Indian Menopause Society, daily recommendations for women >50 years include 2 to 4 servings of dairy products and calcium-rich foods such as curds, paneer, broccoli, and legumes; 3 servings of iron-rich foods (lean red meat, poultry, fish, eggs, leafy green vegetables, and nuts); 2 to 4 servings of fruits; and 3 to 5 servings of vegetables. Consumption of saturated fat should be <10% of total daily calories.

Plant-based foods such as whole grains and beans containing isoflavones (phytoestrogens) act as weak forms of estrogen in the body and may help relieve menopausal symptoms in some women. Eating dried plums or prunes protects against bone loss which accelerates in women at the time of menopause.

Quit SmokingMenopausal symptoms such as hot flashes are worse in women who smoke. It is a good idea to abstain from smoking in order to stay healthy.

Get Some Exercise DailyActive women tend to suffer lesser menopausal symptoms. Brisk walk for at least 3 times in a week is a simple way to get some exercise. Regular exercise not only relieves short-term symptoms but also keeps bones and muscles strong.

Avoid StressRecognizing trigger factors of stress can help to avoid troublesome situations in the future. Recreational activities help in combating stress. Also, relaxation breathing and meditation can help release tension.

Sleep WellRestful sleep can help to deal with the menopausal symptoms such as night sweats and psychological problems. Avoiding exercise for 2 hours before bedtime and going to bed at the same time every day helps improve sleep.

Sources:1. UC Berkeley Wellness Letter. 2011;28(3):5.2. www.indianmenopausesociety.org3. www.nia.nih.gov


Health News

Whole-grain Foods and Cardiac Health

egg breakfast reported less hunger several hours later because of which they consumed 112 fewer calories at lunch and on average 400 fewer calories over the entire day as compared to when they ate a bagel breakfast. The egg breakfast also helped keep blood sugar more steady and suppressed ghrelin, a hormone that stimulates hunger. Of course, some of the appetite-suppressing effect may have been due to the fat in the eggs, not just the protein. Other protein sources are likely to have the same effect.2

Cancer Screening: Crucial in Diabetes

A Harvard study of 7,800 female nurses with diabetes has found that, over a 26-year period, those who ate the most bran (a component of whole grains) had a 35% lower risk of dying from heart attack or stroke than those who ate little or no bran, and a 28% lower overall mortality rate. Many people with diabetes still believe they should cut down on all carbohydrates. But while they should cut down on refined carbohydrates such as white bread and added sugars, there are many reasons for them to eat more whole grains.1

High-protein Breakfast Better for Weight LossIn a recent study from the University of Connecticut, men who ate a high-protein

links between diabetes and cancer include blood sugar levels, insulin resistance, and inflammation.3

Use Measuring Cap to Take Liquid Medicine

The kitchen spoon should not be used to measure the dose of liquid medicine, instead the measuring cap or dropper that comes with the medicine or another appropriate measuring device is recommended. It is easy to over- or under-dose, as was shown in a study in the Annals of Internal Medicine. When people were asked to measure a teaspoon (5-milliliter) dose of medicine, they poured too little (8% less) when they used a medium-sized tablespoon, and too much (12% more) when they used a larger spoon. If you consistently under-dose, the medicine may not be as effective and at the same time getting much of some drugs can also be dangerous.4

High Protein Diet: Good for BonesAccording to a study and systematic review, both

published recently in the American Journal of Clinical Nutrition, adequate protein is needed to build and maintain bones. But can consuming too much protein actually cause calcium loss and this contribute to bone loss? Over the years, there has been much debate about this and research has yielded inconsistent results. In the new study, higher intakes of protein, whether from animal or plant sources, did not have adverse effects on bone health in 560 premenopausal women. And the review, which included 61 studies focusing on adults of all ages, found that increasing protein intake had a small beneficial effect on bone density. This did not translate into a decreased risk of fractures, however.1

References1. UC Berkeley Wellness Letter.

2010;27(1):1.

2. UC Berkeley Wellness Letter. 2010;26(11):8.



According to a recent consensus report from the American Diabetes Association and American Cancer Society, people with diabetes are at higher risk for certain cancers such as liver, breast, colon, pancreatic, and bladder cancer. Since the link between diabetes and cancer may be due in part to shared risk factors namely obesity, physical inactivity, poor diet, and smoking; it is especially important to reduce or eliminate these factors. Potential biological


In Focus

Evecare Syrup in the Treatment of Menstrual Irregularities: A Multicentric, Postmarketing Surveillance StudyUmarji M, Patki PS.

Ind J Clin Pract. 2012;23(2):21-26.

AimThe objective of this study was to evaluate the clinical efficacy and safety of Evecare syrup in the treatment of menstrual irregularities.

Materials and MethodsA total of 1000 female patients aged between 18 and 45 years with menstrual irregularities were included in this multicentric, postmarketing surveillance study. Out of the 1000 patients, 372 had dysmenorrhea, 388 had menorrhagia, and 240 patients had oligomenorrhea. These patients were given Evecare syrup at a dosage of 15 mL, twice daily, for a period of 3 months. Bleeding was graded using a predefined symptom-score scale from 0 to 2 (0 - normal, 1 - moderate, and 2 - profuse). The character of blood flow was graded from 0 to 2 where 0 was normal flow, 1 was passing 1 to 4 clots, and 2 was >4 clots.

The primary endpoint of the study was clinical recovery from the presenting symptoms of menstrual irregularities. Results were analyzed statistically by repeated measures of ANOVA and Friedman’s test followed by Dunnett’s multiple comparison test for evaluation of symptomatic scores. The minimum level of significance was fixed at 95% confidence limit and a 2-sided P value of <.05 was considered significant.

ResultsAmong the 372 patients with dysmenorrhea, only 14 patients had slight abdominal pain and 358 patients reported total absence of symptoms (P<.001) (Table 1). In patients with menorrhagia, significant (P<.001) reduction in the mean score of duration of menstruation, quantity of blood loss (number of sanitary napkins changed per day), and bleeding (graded as profuse to normal) were noted at the end of the 3-month treatment (Table 2). In patients with

Table 1. Effect of Evecare on Symptomatic Relief in Patients with Dysmenorrhea (n = 372)

Menstrual irregularity

Duration of treatment

No. of cases showing recovery

Complete Partial Persistent

Dysmenorrhea

1st month 0 18 354

2nd month 14 132 226

3rd month 358* 14 0

*P<.001 as compared to “at entry values”

Table 2. Effect of Evecare on Symptomatic Relief in Patients with Menorrhagia (n = 388)

ParameterDuration of treatment

Score Significance

Duration of menstruation (no. of days)

Baseline 12.80 ± 0.37 -

1st month 9.80 ± 0.72 NS

2nd month 6.77 ± 0.48 P<.05

3rd month 5.12± 0.76 P<.001

Quantity of blood loss (no. of sanitary napkins changed/day)

Baseline 6.76 ± 0.14 -

1st month 5.35 ± 0.20 NS

2nd month 3.93 ± 0.12 P<.05

3rd month 3.06 ± 0.32 P<.001

Bleeding (profuse to normal)

Baseline 1.62 ± 0.09 -

1st month 1.14 ± 0.04 NS

2nd month 0.86 ± 0.06 NS

3rd month 0.72 ± 0.02 P<.001

Character of blood flow (clot or flow)

Baseline 1.08 ± 0.12 -

1st month 0.88 ± 0.16 NS

2nd month 0.64 ± 0.14 NS

3rd month 0.58 ± 0.08 P<.05

NS: Not significant

oligomenorrhea, 238 patients reported normal menstruation and flow for optimal duration. No clinically significant adverse drug reactions were reported.

ConclusionFrom the above findings, it can be concluded that Evecare is a promising drug in the management of menstrual irregularities.


Latest in Medicine

Increased Exhaled Nitric Oxide Predicts New-onset Rhinitis and Persistent RhinitisMalinovschi A, et al.

Clin Exp Allergy. 2012;42(3):433-440.

The portion of nitric oxide in exhaled air (FE[NO]) is increased in rhinitis and asthma. It has been suggested that elevated levels of FE(NO) in the absence of symptoms of asthma may be an indicator of “early asthma.” A study was conducted in a cohort of adolescents to investigate whether or not increased exhaled-NO levels at the age of 13 to 14 years predicted symptoms of new-onset or persistent rhinitis within a 4-year period. In the present study, a total of 959 adolescents between 13 and 14 years were selected randomly and requested to complete a questionnaire on respiratory symptoms at baseline and on follow-up, 4 years later. Exhaled NO level was measured at the baseline. Followed by exclusion of subjects with asthma symptoms at baseline, 657 participants were eligible for the study.Increased levels of FE(NO) were recorded at baseline which is associated with higher risk for new-onset (P = .009) and persistent rhinitis (P = .03) within a 4-year period. The risk of new-onset rhinitis was 2.32 (1.23, 4.37) [OR (95% CI)] times higher if FE(NO)was greater than 90th percentile of the group without rhinitis at baseline. This increased risk for new-onset rhinitis was even more significant [2.49 (1.24, 5.01)] after excluding subjects with allergic symptoms. The risk of persistent rhinitis was 5.11 (1.34, 19.57) times higher if FE(NO) was greater than 90th percentile of the group without rhinitis at baseline.From the above findings, it can be hypothesized that elevated NO levels in exhaled air predicts incident and persistent rhinitis. Moreover, as the findings were consistent after excluding subjects with allergic symptoms, it appears that elevation of exhaled NO precedes airway symptoms and predicts development of rhinitis in subjects without allergic symptoms or family history of allergic disease.

Olfactory Dysfunction in Patients with Chronic RhinosinusitisMaría VS, et al.

Int J Otolaryngol. 2012;2012:327206.

An analytical, prospective, and observational study was conducted in patients with a diagnosis of chronic rhinosinusitis, to measure

the prevalence of and identify the clinical characteristics associated with olfactory decline. The study included a total of 33 patients. Within the group of patients aged 18 to 39, 9% had normosmia, 73% hyposmia, and 18% anosmia (P<.001). Between 40 and 64 years, there was no patient with normosmia, 63% hyposmia, and 37% anosmia (P<.001). Of patients >65 years old, 33% showed mild hyposmia, 34% severe hyposmia, and 33% anosmia (P<.001). From this study, it can be concluded that nasal polyposis, asthma, septal deviation, turbinate hypertrophy, tobacco, and allergic rhinitis are predicting factors of olfactory dysfunction.

Fatty Acid Oxidation and Cardio-vascular Risk during Menopause: A Mitochondrial Connection?Oliveira PJ, et al.

J Lipids. 2012; 2012: 365798.

Menopause is a consequence of the normal aging process in women. This fact implies that the physiological and biochemical alterations resulting from menopause often blur with those from the aging process. It is thought that menopause in women presents a higher risk for cardiovascular disease although the precise mechanism is still under discussion. The postmenopausal lipid profile is clearly altered, which can present a risk factor for cardiovascular disease. Due to the role of mitochondria in fatty acid oxidation, alterations of the lipid profile in the menopausal women will also influence mitochondrial fatty acid oxidation fluxes in several organs.The progressive deterioration of mitochondrial function in the aging woman with menopause contributes to the metabolic alterations observed in the heart, including a decreased capacity for lipid oxidation. A decreased mitochondrial flux of fatty acid beta-oxidation can result in the accumulation of toxic intermediates in the cytosol and also of nonmetabolized fatty acids in mitochondria, which leads to further deterioration of mitochondrial function and progressive metabolic changes that can increase cardiovascular risk.This study proposes that alterations of mitochondrial bioenergetics in the heart, consequence from normal aging and/or from the menopausal process, result in decreased fatty acid oxidation and accumulation of fatty acid intermediates in the cardiomyocyte cytosol, resulting in lipotoxicity and increasing the cardiovascular risk in menopausal women.

Editor in chief: Dr Pralhad S Patki • Managing Editor: Dr Jayashree B Keshav • Editorial Team: Shruthi VB, Dr Latha Shanbhogue, Shruthi V Kumar • Layout Artists: Dayananda Rao S, Santosh G Edited and published by Dr PS Patki, MD. Printed at M/s Sri Sudhindra Offset Process, #97, DT Street, 8th Cross, Malleshwaram, Bangalore - 560 003


Fitness Fact File

Event Calendar

this position for a moment. Then bend the fingers into a fist, hiding your nails. Next, make a modified fist (showing nails). Then, raise your fingers so that they are bent at a right angle. Hold each of these positions for 3 seconds.

Benefits: Keeps the tendons functioning well to help move all the finger joints through their full range of motion.

Exercise 2: Thumb active range of motion Rest your elbow on a table with forearm and hand in the air. Touch tip of the thumb to the tip of each finger. Then, bend the tip of your thumb toward the palm. Hold each of these positions for 3 seconds.

Benefits: Improves the ability to move thumb in all directions.

Exercise 3: Web-space massageGrasp your left hand with your right hand as if while shaking hands. With the left thumb, massage the web of your right thumb for 30 seconds. Then, reverse the position and massage the web space next to your left thumb.

Benefits: Using one hand to massage the other hand strengthens muscles in the “active” hand while increasing circulation in the “passive” hand.

— Excerpted from: Bottom Line Health. 2012;26(7):13-15.

To be continued in the next issue…

Hand/wrist exercises, performed for just a few minutes in a day can improve joint lubrication and subsequently reduce pain and stiffness. Approximately 40% of patients with arthritis eventually restrict their daily activities as a result of joint pain or stiffness. Here are some hand/wrist exercises one can do at home without any special equipment or training. These exercises should be done 5 times on each hand and can be worked up to 10 times, if possible. The entire series will take not more than 5 minutes.

Note: Warm the joints before doing these exercises. This helps prevent microtears that can occur when stretching cold tissue. Warm your hands by running warm water over your hands in the sink for a few minutes, or with the help of a heating pad, before beginning the exercise.

Exercise 1: Tendon glidesRest your elbow on a table with forearm and hand raised such that fingertips point upwards. Bend the fingers at the middle joint and hold in

Hand and Wrist Exercises Healthy Eating• Healthy eating in childhood and adolescence is essential for

optimal growth and development and can prevent health problems such as obesity, dental caries, iron deficiency, and osteoporosis.

• Iodine deficiency is the number one cause of preventable brain damage, affecting millions of people worldwide.

• About 2 billion people are affected by inadequate iodine nutrition worldwide.

• More than one third of preschool-age children globally are vitamin A-deficient.

• As many as 4 to 5 billion people, 66% to 80% of the world’s population, may suffer from reduced learning ability and work capacity due to iron deficiency.

• Scientific evidence has shown that adequate zinc level in children decreases the prevalence of diarrheal diseases and reduces stunting in children.

— Sources: Centers for Disease Control and Prevention, 2012;

World Health Organization, 2012.

3rd International Conference on Stem Cells and Cancer (ICSCC-2012): Proliferation, Differentiation and ApoptosisDate: October 27 to 30, 2012

Venue: New Delhi, India

For more details, visit: http://www.icscc.in

International Conference on Anesthesia & Perioperative CareDate: November 26 to 28, 2012

Venue: Texas, USA

For more details, visit: http://www.omicsonline.org/anesthesia2012/

Write to UsWe would like to hear from you. Write to us at [email protected].


“Winning isn’t everything, but wanting to win is.”

— Vince Lombardi

While crossing the US-Mexican border on his bicycle, the man was stopped by a guard who pointed to 2 sacks the man had on his shoulders. “What’s in the bags?,” asked the guard.

“Sand,” said the cyclist.

“Get them off; we’ll take a look,” said the guard.

The cyclist did as he was told, emptied the bags, and proving they contained nothing but sand, reloaded the bags, put them on his shoulders and continued across the border.

Two weeks later, the same thing happened. Again the guard demanded to see the 2 bags, which again contained nothing but sand. This went on every week for 6 months, until one day the cyclist with the sand bags failed to appear.

A few days later, the guard happened to meet the cyclist downtown. “Say friend, you sure had us crazy,” said the guard. “We knew you were smuggling something across the border. I won’t say a word, but what is it you were smuggling?”

“Bicycles” said the cyclist!• • •

A fellow stopped at a rural gas station and, after filling his tank, he paid the bill and bought a soft drink. He stood by his car to drink his cola and he watched a couple of men working along the roadside. One man would dig a hole about 2 or 3 feet deep and then move on. The other man came along behind and filled in the hole. While one was digging a new hole, the other was about 25 feet behind filling in the old.

The men worked right past the fellow with the soft drink and went on down the road. “I can’t stand this,” said the man tossing the can in a trash container and heading down the road toward the men.

“Hold it, hold it,” he said to the men. “Can you tell me what’s going on here with this digging?”

“Well, we work for the county government,” one of the men said.

“But one of you is digging a hole and the other is filling it up. You’re not accomplishing anything. Aren’t you wasting the county’s money?”

“You don’t understand, Mr,” One of the men said, leaning on his shovel and wiping his brow.

“Normally there are 3 of us—me, Rodney, and Mike. I dig the hole, Rodney sticks in the tree, and Mike here puts the dirt back.”

“Yeah,” piped up Mike. “Now just because Rodney’s sick, that doesn’t mean we can’t work, does it?”

• • •These are supposedly actual signs that have appeared at various locations.

Found written on the wall in front of a photocopier of a company going through hardships: “Double your pleasure—xerox your paychecks”

At a car dealership in Maryland to announce new seat belt legislation: “Belt your family. It’s the law.”

Seen while traveling in the Yucatan Peninsula: “Broken English spoken perfectly”

In a restaurant: “Open 7 days a week and weekends.”

On the freeway in Boston during a major transformation of the streets and bridges: “Rome wasn’t built in a day. If it was, we would have hired their contractor.”

• • •

Laugh a While, It’s Healthy!

A quarterly journal dedicated to the emerging multidisciplinary field of perinatal medicine

Indexed in EMBASE, the Excerpta Medica database, CINAHL® database, and Cumulative Index to Nursing and Allied Health Literature® print index

To subscribe, write to us at: [email protected]

Worth Sharing with You

Registered with the registrar of newspapers for India under R.N. 9073/63ISSN 0927-9681

Only for reference by a registered medical practitioner, hospital, or laboratory.

www.himalayahealthcare.comE-mail: [email protected]

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