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BackgroundSurvivors of moderate-to-severe traumatic brain injury (msTBI) frequently experience troublesome unexplained somatic symptoms. Autonomic dysfunction may contribute to these symptoms. However, there is no previous study of clinical subjective and objective autonomic dysfunction in msTBI.MethodsWe present results from two groups of patients with msTBI. The first, a case–control comparative study, comprises prospectively recruited msTBI outpatients, in whom we measured burden of autonomic symptoms using the Composite Autonomic Symptom Score (COMPASS31) questionnaire. The second, a descriptive case series, comprises retrospectively identified msTBI outpatients who had formal clinical autonomic function testing at a national referral autonomics unit.ResultsGroup 1 comprises 39 patients with msTBI (10F:20M, median age 40 years, range 19–76), median time from injury 19 months (range 6–299) and 44 controls (22F:22M, median age 45, range 25–71). Patients had significantly higher mean weighted total COMPASS-31 score than controls (p<0.001), and higher gastrointestinal, orthostatic and secretomotor subscores (corrected p<0.05). Total COMPASS31 score inversely correlated with subjective rating of general health (p<0.001, rs=−0.84). Group 2 comprises 18 patients with msTBI (7F:11M, median age 44 years, range 21–64), median time from injury 57.5 months (range 2–416). Clinical autonomic function testing revealed a broad spectrum of autonomic dysfunction in 13/18 patients.ConclusionsThere is clinically relevant autonomic dysfunction after msTBI, even at the chronic stage. We advocate for routine enquiry about potential autonomic symptoms, and demonstrate the utility of formal autonomic testing in providing diagnoses. Larger prospective studies are warranted, which should explore the causes and clinical correlates of post-TBI autonomic dysfunction.

Background: In the Indian subcontinent, 118 million people are with hypertension, and this figure is anticipated to double by 2025. Yoga has been widely claimed to play a role in the prevention and management of psychosomatic, stress-induced, and lifestyle disorders such as hypertension. Aims and Objective: To study the effect of 12 weeks of yoga therapy as a lifestyle intervention on cardiac autonomic functions in patients of essential hypertension. Materials and Methods: Subjects with hypertension from the Medicine Outpatient Department of the Jawaharlal Institute of Postgraduate Medical Education and Research were randomized into control and yoga groups. The control group was treated only with the allopathic medicines. The yoga group was given 12 weeks of yoga therapy module designed by JIPMER Institute Advanced Center for Yoga Therapy Education and Research along with the routine medical treatment. The participants blood pressure and cardiac autonomic function were recorded before and after the 12 weeks of the study period. Result: No significant change was observed in the body weight (BW), body mass index (BMI), abdominal circumference, and waisthip ratio (WHR) in both the control and yoga groups at the end of the 12 week-study period. There was a significant decrease in the resting systolic pressure (SP), diastolic pressure (DP), rate pressure product (RPP), and mean arterial pressure (MAP) in the yoga group. In contrast, there was no significant change in the SP, DP, RPP, and MAP of the control group. High frequency (HF) power, total spectral power, and HF normalized units (nu) showed a significant increase in the yoga group. Low frequency (LF) power, HF power, and LF (nu) showed a significant (p < 0.05) decrease in the yoga group at the end of the 12-week yoga therapy. Conclusion: Twelve weeks of yoga therapy reduced both the SP and DP in the yoga group. Furthermore, yoga therapy increased the heart rate variability and vagal tone and decreased the sympathetic tone in the subjects with hypertension. At the same time, it increased both the parasympathetic and sympathetic reactivity. [Natl J Physiol Pharm Pharmacol 2016; 6(1.000): 19-26]

Background: The global burden of bronchial asthma is on the rise. Asthma is a disorder of airflow obstruction associated with deranged pulmonary functions and autonomic imbalance. Though past studies have shown the beneficial effects of various asanas and breathing exercises in bronchial asthma, the role of such non-pharmacological alternative modalities in reducing morbidity and financial burden in patients is far from clear. Aims and Objectives: To assess the effect of Pranayama techniques on pulmonary functions and heart rate variability parameters in bronchial asthma patients. Materials and Methods: In our present study, we have recruited patients with mild-to-moderate bronchial asthma after taking written and informed consent. These patients were then asked to perform three pranayama techniques, namely Suryanadi, Bhastrika, and Kapalabhati pranayama, for 30 min a day, 3 days a week, for up to 4 weeks. Pulmonary function test parameters (forced vital capacity [FVC], forced expiratory volume in 1st s [FEV1], FEV1/FVC, peak expiratory flow rate) and Autonomic function test parameters (Time domain: mean HR, mean RR, NN50, pNN50, SDNN; Frequency domain: very low frequency (LF), LF, LF/high frequency (HF) ratio, total power) were compared before and after the intervention using a paired t-test. Results: After the intervention, improvements were recorded in pulmonary functions. Furthermore, pranayama was found to cause a shift in the sympathovagal balance toward the parasympathetic system. However, the changes recorded were not statistically significant. This shows further research in this field is required with a larger sample size, which may yield statistically significant data. Conclusion: Thus, we conclude that pranayama can be a useful alternative therapy for reducing morbidity and mortality in bronchial asthma patients.

Background: Stress is a fundamental and inevitable experience in modern work. Nursing is a demanding profession by its inherent nature, and it promotes mild mental morbidity and physical disease. Chronic work stress may lead to deranged autonomic function in nurses, resulting in increased chances of cardiac illness. Aim and Objective: The objective of this research was to see whether work stress is linked to autonomic dysfunction. Materials and Methods: The present study comprised 30 nurses working at a tertiary care center for more than 10 years. Autonomic cardiovascular regulation was measured using sympathetic stimulation generated by prolonged handgrip and the heart rate response to the Valsalva technique (Ewing et al., 1973) and compared to non-working healthy females. The work stress was measured using a modified occupational stress inventory. Results: No sympathetic abnormalities were found in the nurses. Borderline abnormal parasympathetic reactivity (VR = 1.111.20) was found in 67% of nurses. About 76.6% of nurses were found with moderate occupational stress score (OSS) and 23.3% were having high OSS. Conclusion: It is concluded that chronic stress reduces vagal tone. Subjects with low vagal tone showed increased cardiosympathetic drive during stressful work situations. [Natl J Physiol Pharm Pharmacol 2021; 11(9.000): 1007-1011]

Background: Obesity is a medical condition in which excess body fat accumulates to an extent that it poses a negative effect on health, leading to decrease in life expectancy and increased health problems. Childhood obesity is an emerging global public health challenge such that obesity has now become the most important nutritional disease of the children and adolescents. The effect of adiposity and body mass index (BMI) on cardiovascular reactivity to stress invariably warrants documentation. Aims and Objective: To assess the hemodynamic parameters and sympathetic autonomic function tests in obese children. Materials and Methods: The study was conducted on 100 obese school-going children (BMI of more than cutoff value for their respective age and sex) aged between 10 and 16 years belonging to varied socioeconomic status. An identical number of age/sex-matched nonobese/normal weight school-going children served as controls. The subjects were interviewed for age, personal/dietary habits, relevant recent or history, etc. The children presenting any medical ailment such as diabetes, asthma, heart disease, anxiety, apprehension, or with noncooperative attitude were excluded. General physical and relevant cardiovascular system examinations were done. Blood pressure, cold pressor test (CPT), and hand grip dynamometer test were done. Statistical analysis was done by using unpaired Students t-test. Result: The study demonstrates a significant increase in body mass index, heart rate, and blood pressure in obese children, while insignificant change in the respiratory rate. The study demonstrates significant increase in maximum blood pressure response to CPT in obese male and female children, a significant increase in maximum systolic blood pressure response to hand grip dynamometer test, while insignificant decrease in maximum diastolic blood pressure response to hand grip dynamometer test in obese male and female children. Conclusion: The study demonstrates the increased propensity of obese individuals to develop hypertension in basal conditions and in response to stress as revealed by CPT and decreased peripheral vascular response owing to decreased sympathetic activation during isometric exercise indicating a weak cardiorespiratory response to exercise. [Natl J Physiol Pharm Pharmacol 2016; 6(1.000): 15-18]

Background： Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction. Methods： This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography （ECG）. Autonomic function was measured based on the heart rate variability （HRV） using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate （eGFR）, and stroke severity was rated according to the National Institutes of Health Stroke Scale （NIHSS）. The Barthel index and modifed Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression. Results： In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval （SDANN） index （P = 0.022L very low frequency （VLF） （P = 0.043）, low frequency （LF） （P= 0.023）, and ratio of low-to-high frequency power （LF/HF） （P = 0.001 ） were significantly lower than those in the patients with a normal eGFR. A lnultinomial linear regression indicated that eGFR （t - 2.47, P - 0.014）, gender （t - -3.60, P 〈0.001）, and a history of hypertension （t = -2.65, P = 0.008） were the risk factors of LF/HF; the NIHSS score （SDANN index： t = -3.83, P 〈 0.001 ; VLF： t = -3.07, P = 0.002： LF： t = -2.79, P = 0.006） and a history of diabetes （SDANN index： t = -3.58, P 〈 0.001; VLF： t = -2.54, P = 0.012; LF： t = -2.87, P = 0.004） were independent factors Ibr the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project （t = -2.38, P = 0.018） was related to the SDANN index. Conclusions： Autonomic dysfunction is aggravated with the progression ofeGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfnnction.

Background: Type 2 diabetes mellitus is increasing day by day across the world. Cardiac autonomic neuropathy (CAN) is the most overlooked but the most debilitating complication of diabetes mellitus. If the chance of a diabetic patient to develop CAN in the future is diagnosed at an early stage of the disease, proper measures can be suggested which will delay the development of the complication. Aim and Objectives: The aim and objective of the study are to compare the cardiovascular autonomic functions between type 2 diabetes mellitus patients and normal individuals and to find whether cardiac autonomic neuropathy is present in type 2 diabetes mellitus patients. Materials and Methods: This cross-sectional study included 80 male individuals. Study participants were selected from patients attending diabetic clinics based on the inclusion criteria. A total of 80 subjects were selected out of which 40 were diabetic group and 40 were normal individuals. Cardiac autonomic functions were assessed using heart rate response to a change in posture and during the Valsalva maneuver, blood pressure response to a change in posture and during sustained isometric handgrip and heart rate variability (HRV) measurements were done using Kubios HRV analyzer software version 1.1. Results: Results were analyzed using IBM SPSS version 20 software. It was found that the resting systolic and diastolic blood pressure was found to have statistically significant higher values in the diabetic group. The mean and standard deviation of the Valsalva ratio were found to have statistically significant higher values in the diabetic group. The frequency domain parameters of HRV showed significant sympathetic predominance in the diabetic group. Conclusion: The need for early identification of cardiac autonomic neuropathy by various tests as well as the importance of lifestyle modifications were emphasized among all the participants of the study.

In this narrative review, a theoretical framework on the crosstalk between physical exercise and blood-brain barrier (BBB) permeability is presented. We discuss the influence of physical activity on the factors affecting BBB permeability such as systemic inflammation, the brain renin-angiotensin and noradrenergic systems, central autonomic function and the kynurenine pathway. The positive role of exercise in multiple sclerosis and Alzheimer’s disease is described. Finally, the potential role of conditioning as well as the effect of exercise on BBB tight junctions is outlined. There is a body of evidence that regular physical exercise diminishes BBB permeability as it reinforces antioxidative capacity, reduces oxidative stress and has anti-inflammatory effects. It improves endothelial function and might increase the density of brain capillaries. Thus, physical training can be emphasised as a component of prevention programs developed for patients to minimise the risk of the onset of neuroinflammatory diseases as well as an augmentation of existing treatment. Unfortunately, despite a sound theoretical background, it remains unclear as to whether exercise training is effective in modulating BBB permeability in several specific diseases. Further research is needed as the impact of exercise is yet to be fully elucidated.

Background Idiopathic REM sleep behavior disorder (iRBD) is a prodromal marker of the alpha-synucleinopathies, in which autonomic nervous system (ANS) involvement may occur. We aimed to characterize the presence and severity of subjective and objective ANS dysfunction in iRBD and assess its capacity to predict short-term clinical progression to a synucleinopathy. Methods Prospective study of patients with polysomnography-confirmed iRBD in whom symptomatic ANS involvement was assessed using the Composite Autonomic Symptom Score (COMPASS-31) and objective dysfunction with the Composite Autonomic Severity Score (CASS). Baseline ANS data were compared between those who later developed a synucleinopathy and those who did not. Results We evaluated 25 subjects with iRBD without risk factors for autonomic neuropathy and at least 6 months of follow-up (mean: 19 months). At the end of the study, seven (28%) patients developed a synucleinopathy, namely Parkinson's disease ( n  = 5) and dementia with Lewy bodies ( n  = 2). 73.7% of patients had COMPASS-31 scores above the normal cut-off, while no score differences regarding phenoconversion status were observed. At baseline, 85.7% of the subjects who phenoconverted exhibited at least one abnormal result in the CASS score, compared to 38.9% of subjects who remained disease-free ( p  = 0.035). Adrenergic dysfunction evaluated by an impaired overshoot in Valsalva phase IV and by pressure recovery time was associated with the development of overt synucleinopathy ( p  = 0.032 and 0.033, respectively). Conclusion Symptomatic and subclinical ANS dysfunctions are common in iRBD. ANS dysfunction affecting mainly the adrenergic system seems to be a short-term risk for the development of a synucleinopathy.

Background: Drug abusing is a worldwide major cause of preventable morbidity and mortality. Substance abusing affects the cardiovascular system by several mechanisms. Aims and Objectives: The objective of the present study was to study the effect of drugs on the cardiovascular autonomic functions among different drug abusers and also to identify early neurological damage in autonomic system so that proper counseling and timely intervention can be undertaken. Materials and Methods: This cross-sectional study was done at GGS Medical College, Faridkot, Punjab, during the period from August 2012 to July 2013 in 50 drug abusers within the age group of 15-45 years, as well as in age matched 50 healthy controls. The subjects were recruited from Faridkot region of Punjab which included subjects from general population and the patients admitted in Drug De-addiction Centre of GGS Medical College and Hospital, Faridkot, Punjab. Prior informed written consents were obtained from them after explaining to them, the procedure and the purpose of the study tests. Lying to standing test was carried out for assessing parasympathetic reactivity and hand grip test for sympathetic reactivity. Results: After applying the t test for the difference between the two sample means, it was observed that there was a highly significant difference between the mean values of the parasympathetic function tests among the drug abusers and the controls (i.e., P < 0.001). The 30:15 ratio (response to standing) had significantly decreased in the drug abusers as compared to those in the controls. Also a highly significant difference was observed between the mean values of the sustained handgrip test in the drug abusers and controls (i.e., P < 0.001). Conclusion: This study provides good evidence for autonomic dysfunction following chronic abuse of different drugs. By using these simple tests, we can detect the early involvement of the autonomic nervous system before the clinically related symptoms appear and they are thus useful in taking steps to prevent the further progress of the disease. [Natl J Physiol Pharm Pharmacol 2017; 7(1.000): 80-84]