Volume 34, Issue 4

Mental toughness is the ability to handle pressure, adversity, and stress by overcoming failures. It is also the state of persisting without refusing to quit, with the possession of superiority in mental skills. This review aimed to describe the effect of mental toughness on the performance of athletes and also to have an insight into the various interventions to improve mental toughness. For this, PubMed was searched using the appropriate keywords till December 2021 and a narrative synthesis was performed. Mental tightness was evident to be correlated with many important aspects such as better performance, goal progress, withholding stress, coping, optimism and self-reflection. It also helps in a better level of confidence, constancy, control, positive cognition, visualization and challenges than the opponent team. Many interventional strategies have been adopted in previous years which mainly focused on personalized programs including psychological skills training, coping and optimism training, mindfulness, yoga, general relaxation, imagery, and a combination of both, and many more other aspects were observed to be effective in improving mental toughness. However, physical training alone did not observe to be beneficial. The current evidence indicates the important role of mental toughness on the sports performance of athletics and the role of various interventional strategies focusing on mindfulness and psychological interventions in improving mental toughness. All these interventional strategies need to be implemented in the actual practice.

Cancer is a disease resulting in unbridled growth of cells due to dysregulation in the balance of cell populations. Various management procedures in handling cases of cancer are not without their adverse side effects on the normal cells. Medicinal plants/herbs have been in use in the management of various ailments, including cancer, for a long time. Medicinal plants have been credited with wide safety margins, cost effectiveness, availability and diverse activities. This study reviewed various mechanisms of anti-cancer activities of some medicinal plants from a biochemical perspective. The mechanisms of anti-cancer activities of plant compounds addressed in this article include induction of apoptosis, anti-angiogenic effects, anti-metastasis, inhibition of cell cycle, inhibition of DNA destruction and effects on key enzymes, cytotoxic and anti-oxidant effects. The anti-cancer activities of some of the plants involve more than one mechanism.

The COVID-19 pandemic continues to pose a serious global challenge, with the world engulfed in fighting second, third and fourth waves of the disease, which is reaching scary proportions in terms of cases and mortality in countries like India. Despite the urgent need of proven management protocols, there is still confusion about the best practices for treating COVID-19 with different pharmaceutical interventions. Antimicrobials are empirically used in COVID-19 patients. During the initial phase of this pandemic, hydroxychloroquine, ivermectin, azithromycin and doxycycline were widely suggested for possible prophylaxis or treatment for COVID-19 in outpatient as well as hospitalized settings. Various national and international guidelines recommended its use. However, cumulative evidence from subsequent clinical trials has revealed no significant clinical benefits in any setting, with the risk of adverse effects being high particularly in combination with azithromycin. Yet, there is continued use of antimicrobials particularly in outpatient settings which should be avoided because there is no justifiable rationale for doing so. Antimicrobial resistance (AMR) was one of the top problems for global public health before the coronavirus 2019 (COVID-19) pandemic began. AMR, which is already a difficult problem, must now be handled in the context of a changing healthcare sector.

The vestibular system inhibits both HPA and SAM axis and contributes to the management of anxiety. Both direct and indirect pathways exist in the inhibition of the HPA and SAM axis. In this review article, the authors describe various pathways through which the vestibular system can regulate the HPA and SAM axis activity. Lastly, the authors highlight the need of starting translational research work in this field. Rocking is soothing and this is a universal fact that babies in the swing will calm down and sleep. These soothing effects of vestibular stimulation may be due to the inhibition of cortical and subcortical structures. Vestibular stimulation may be able to manage anxiety through its connections with multiple brain areas. There is a need to undertake translational research in this area to establish strong scientific evidence and recommend implementation of the vestibular stimulation in the management of anxiety.

Objectives Exposure to light-at-night (LAN) has been reported to impair blood glucose regulation. The liver modulates blood glucose through mechanisms influenced by several factors that include peroxisome proliferator-activated receptor gamma coactivator-1alpha (PGC-1α) and glucose-6-phosphatase (G6Pase). This study investigated the effect of intermittent exposure to green and white LAN on some hepatic glucose regulatory factors in male Wistar rats. Methods Animals were divided into three equal groups. Group I (control) was exposed to normal housing conditions. Groups II and III were each daily exposed to either green or white LAN for 2 h (7–9 pm) for 14 days. Body weight and blood glucose was monitored on days 0, 7, and 14. Thereafter, retro-orbital sinus blood was obtained after light thiopental anaesthesia and serum insulin was determined. Liver samples were also obtained and evaluated for glycogen, PGC-1α, and G6Pase activity. Insulin resistance was estimated using the HOMA-IR equation. Results Body weight and blood glucose on days 7 and 14 increased in groups II and III compared to control. Hepatic PGC-1α and G6Pase increased in group II (2.33 ± 0.31; 2.07 ± 0.22) and III (2.31 ± 0.20; 0.98 ± 0.23) compared to control (1.73 ± 0.21; 0.47 ± 0.11). Hepatic glycogen was 71.8 and 82.4% reduced in groups II and III compared to control. Insulin in group II increased (63.6%) whiles group III values reduced (27.3%) compared to control. Insulin resistance increased in group II (0.29 ± 0.09) compared to control (0.12 ± 0.03) and group III (0.11 ± 0.03), respectively. Conclusions Exposure to 2 h green and white LAN in the early dark phase increases hepatic glycogenolysis and gluconeogenetic activities resulting in increased blood glucose. In male Wistar rats, exposure to green but not white LAN may predispose to insulin resistance.

Objectives Neutrophil–lymphocyte ratio (NLR), as an indicator of heightened systemic inflammatory response, predicts increased disease burden and poor oncological outcomes in urothelial carcinoma (UC). The study was undertaken with an aim to evaluate the association of NLR with clinicopathological variables and survival outcomes. Methods A total of 80 patients of UC were enrolled in the current retrospective study. Pre-operative NLR (within one month prior to the procedure), patient age, sex, tumour grade, pathological stage, recurrence free survival (RFS), progression free survival (PFS) and cancer specific survival (CSS) were recorded. We chose a cut-off value of 2.7 for NLR and patients were divide into two groups (NLR <2.7 and ≥2.7). Results NLR ≥2.7 was significantly associated with advanced tumour stage (p=0.001), but not with tumour grade (p=0.116). Progression (p=0.032) and death rates (p=0.026) were high in patients with NLR ≥2.7. Mean RFS (p=0.03), PFS (p=0.04) and CSS (p=0.04) were reduced in patients with NLR ≥2.7. On univariate analysis, NLR ≥2.7 predicted worse RFS (HR=2.928, p=0.007), PFS (HR=3.180, p=0.006) and CSS (HR=3.109, p=0.016). However, it was not an independent predictor of outcomes on multivariate analysis. Conclusions Tumour stage and grade are the only independent predictors of RFS, PFS and CSS. High NLR at a cut-off value of ≥2.7 is associated with advanced pathological stage, but does not have an independent predictive value for RFS, PFS and CSS.

Objectives In this clinical trial, the effect of aqueous extract of Berberis vulgaris L. was investigated on opiate withdrawal syndrome, depression, anxiety, stress, and sleep quality in opioid addicts which were under methadone maintenance therapy. Methods For this purpose, 52 opiate addicts were randomly selected of whom 28 received 500 mg capsules of B. vulgaris extract (treatment) and the rest received 500 mg of starch capsules (placebo), twice daily for 4 weeks. Signs and symptoms of opiate withdrawal syndrome, depression, anxiety, stress, and sleep quality were assessed through Clinical Opiate Withdrawal Scale (COWS), Pittsburgh Sleep Quality Inventory (PSQI) and Depression Anxiety Stress Scales-21 (DASS-21) questionnaires at baseline and after 7, 14, and 28 days of receiving intervention. Results Signs and symptoms of opiate withdrawal syndrome were significantly improved in those who received the extract for 1 month compared to the placebo group. However, there were no significant differences in depression, anxiety, stress, and sleep quality scores in the treatment group compared to those in the placebo group. Conclusions The extract of B. vulgaris root as a traditional herbal product in combination with methadone could improve the symptoms and signs of opiate withdrawal.

Objectives There is extensive data pointing to offspring outcomes related to maternal life incidents, but there is less research concerning the association between paternal life events and progeny brain development and behaviour. As male gametogenesis is a continuous process, the incidences happening in life can modify the epigenetic regulation, altering the offspring’s development and behaviour. The present study evaluates the effects of paternal stress during different life periods on their offspring’s learning ability, memory, morphological and biochemical changes in the prefrontal cortex and hippocampus in the rat model. Methods Four weeks’ old male rats were subjected to five variable stressors at the rate of one per day. Stress received male rats were bred with naive female rats for 1 to 3 nights. The offspring’s learning and memory were assessed by the Morris water maze test and automated Y maze. Following behavioural studies, offspring were euthanized to examine global DNA methylation, neurotransmitter levels, namely acetylcholine, glutamate in the hippocampus and frontal cortex. Results The offspring of stress-induced animals exhibited a delay in acquiring learning and defect in memory and altered global DNA methylation in the hippocampus (p=0.000124). There was significant reduction of acetylcholine and glutamate levels in hippocampus (p=0.000018, p=0.00001, respectively) and in prefrontal cortex (p=0.00001, p=0.00001, respectively). HPA axis of offspring was altered considerably (p=0.00001). The histomorphometry of the prefrontal cortex and different hippocampal regions revealed a statistically significant (p<0.05) reduction in neuronal numbers in the offspring of stressed animals compared to that of control. These impacts were markedly high in the offspring of fathers who received stress during both pubertal and adult periods. Conclusions The findings of this study demonstrate that paternal stress can impact offspring learning and memory.

Objectives Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encountered otological entity, of various types and severity, with an array of associated symptoms including vertigo. This is a devastating life-changing condition with a blurry prognosis. The objective of this study was to determine the clinical association of vestibular impairment by electronystagmography (ENG) and caloric tests, and their ability to predict prognosis. Methods An observational, crossectional study was carried out amongst patients admitted with SSNHL. Each consenting patient had an audiometry test performed on admission as well as ENG and caloric tests. Treatment included oral steroids and carbogen with intratympanic steroids used only as salvage treatment. Follow-up was completed after 6 months when hearing gains were evaluated. Finally, an association was sought between the rate of recovery and ENG and caloric test results. Results Of 35 patients included, marked recovery was seen in patients without vertigo when compared to those with vertigo (p=0.003). A statistically significant association was found between the presence of vertigo and hearing deterioration (p=0.008). More so, normal electronystagmography results were associated with marked recovery (p=0.04). Conclusions The vestibular end organs are both subjectively and objectively affected in SSNHL as demonstrated by the abnormal ENG and caloric tests in our study despite the small sample size. Concomitant vestibular involvement carries poorer prognosis and routine identification may help foresee the recovery of patients with SSNHL and as such, aid in patient counseling. ENG and caloric tests are easily available and may be recommended for all patients with SSNHL.

Objectives Reactive oxygen and nitrogen species may be produced during inflammation leading to the formation of NO, H 2 S or HNO. Enzymes such as iNOS, CSE and CBS might also be responsible for polysulfide production. Since these signalling molecules might have an impact on colonic motility, the aim of this study was to compare their effect on rat colonic slow phasic contractions (SPC). Methods Organ bath measurements with strips obtained from rat proximal colon were performed using the polysulfide Na 2 S 3 , sodium nitroprusside (NaNP), sodium hydrogen sulfide (NaHS), Angeli’s salt as NO, H 2 S, and HNO donors, respectively. TTX (1 µM) was used to block neuronal activity. Results All four molecules, concentration-dependently, inhibited the amplitude and frequency of SPC both in the circular and longitudinal muscle layer. The relative potency was NaNP>Angeli’s salt>NaHS>Na 2 S 3 . The inhibitory response induced by NaNP (1 µM) and Angeli’s salt (50 µM) was reversed by ODQ (10 µM) whereas the inhibitory effect of NaHS (1 mM) was reversed by apamin (1 µM) and glibenclamide (10 µM). Na 2 S 3 (1 mM) response was partially reversed by apamin (1 µM) and glibenclamide (10 µM). High concentrations of Na 2 S 3 caused an increase in tone. Low concentrations of NaHS or Na 2 S 3 did not potentiate NaNP responses. Conclusions All signalling molecules inhibit SPC in both muscle layers. The effect is independent of neural activity and involves guanylyl cyclase (NO and HNO) and SKCa and KATP channels (NaHS or Na 2 S 3 ). Other pathways might also be involved in Na 2 S 3 responses. Accordingly, complementary mechanisms of inhibition might be attributable to these signalling molecules.

Objectives The study underwent to evaluate the adverse events, the incidence of COVID-19 and the participant’s attitude and perception towards the vaccine following Sputnik V administration through an active surveillance program. Methods The prospective observational study was conducted four months in the Sputnik V vaccination center that enrolled 700 participants. Sociodemographic details, medical histories, COVID-19 incidences and adverse events following immunization (AEFI) of each sample were collected through face-to-face interviews and a telephonic feedback system. A self-prepared and validated questionnaire addressed their acceptances and perceptions towards the vaccination drive. Results Our study reported 42.1% of AEFIs after the first dose and 9.1% after the second. Fever, pain at the injection site, body pain, headache and fatigue were predominant, while dizziness and diarrhoea were rare. However, AEFIs were not influenced by the presence of comorbidities (p > 0.05). On the other hand, there were limited post immunization (1.8%) COVID-19 patients and that too with minor severity (p < 0.01). Our participants were overall satisfied with the Sputnik V immunization. However, those presented with AEFIs on the consecutive three days depicted slightly declined gratification (p < 0.05). Conclusions Our pharmacist-directed surveillance program on Sputnik V showed fewer events of AEFIs and negligible occurrence of COVID19 following immunization. Moreover, the population had appreciable attitude and positive perceptions towards Sputnik V vaccination.

Objectives Heart rate variability (HRV) is an important marker of cardiac autonomic modulation. Metabolic syndrome (MetS) can alter cardiac autonomic modulation, raising the risk of cardiovascular disease (CVD). Poincaré plot analysis (PPA) is a robust scatter plot-based depiction of HRV and carries similar information to the traditional HRV measures. However, no prior studies have examined the relationship between PPA and traditional HRV measures among different risk levels of MetS. We evaluated the association between the Poincare plot and traditional heart rate variability indices among adults with different risk levels of MetS. Methods We measured anthropometric data and collected fasting blood samples to diagnose MetS. The MetS risk was assessed in 223 participants based on the number of MetS components and was classified as control (n=64), pre-MetS (n=49), MetS (n=56), and severe MetS (n=54). We calculated the Poincaré plot (PP) and traditional HRV measures from a 5 min HRV recording. Results Besides the traditional HRV measures, we found that various HRV indices of PPA showed significant differences among the groups. The severe MetS group had significantly lower S (total HRV), SD1 (short-term HRV), SD2 (long-term HRV), and higher SD2/SD1. The values of S, SD1, SD2, and SD2/SD1 were significantly correlated with most traditional HRV measures. Conclusions We found gradual changes in HRV patterns as lower parasympathetic and higher sympathetic activity alongside the rising number of MetS components. The HRV indices of PPA integrating the benefits of traditional HRV indices distinguish successfully between different risk levels of MetS and control subjects.

Objectives In preclinical research, etodolac, a non-steroidal anti-inflammatory drug, affected transient receptor potential ankyrin 1 (TRPA1) activation. Yet, whether the in vitro interaction between etodolac and TRPA1 translates to altered TRPA1 functionality in vivo in human remains to be investigated. Methods A randomized, double-blinded, celecoxib-controlled study was conducted to assess the effect of etodolac on TRPA1-mediated dermal blood flow (DBF) changes on the forearm of 15 healthy, male volunteers aged between 18 and 45 years. Over four study visits, separated by at least five days wash-out, a single or four-fold dose of etodolac 200 mg or celecoxib 200 mg was administered orally. Two hours post-dose, TRPA1 functionality was evaluated by assessing cinnamaldehyde-induced DBF changes. DBF changes were quantified and expressed in Perfusion Units (PUs) using laser Doppler imaging during 60 min post-cinnamaldehyde application. The corresponding area under the curve (AUC 0–60min ) was calculated as summary measure. Statistical analysis was performed using Linear mixed models with post-hoc Dunnett. Results Neither the single dose of etodolac nor celecoxib inhibited the cinnamaldehyde-induced DBF changes compared to no treatment (AUC 0–60min  ± SEM of 17,751 ± 1,514 PUs*min and 17,532 ± 1,706 PUs*min vs. 19,274 ± 1,031 PUs*min, respectively, both p=1.00). Similarly, also a four-fold dose of both compounds failed to inhibit the cinnamaldehyde-induced DBF changes (19,235 ± 1,260 PUs*min and 19,367 ± 1,085 PUs*min vs. 19,274 ± 1,031 PUs*min, respectively, both p=1.00). Conclusions Etodolac did not affect the cinnamaldehyde-induced DBF changes, suggesting that it does not alter TRPA1 functionality in vivo in human.

Objectives Exercise is one of the beneficial mediators for the regulation and prevention of obesity through the role of irisin, so it potentially enhances metabolism health. This study aims to investigate the dynamic of irisin secrecy change after chronic exercise in obese females. Methods Thirty-one female adolescents aged 20–22 years enrolled in the study and were given interventions aerobic, resistance, and a combination of aerobic and resistance training. The exercises were performed at moderate-intensity, for 35–40 min per session, and three times a week for four weeks. The measurement of irisin level, IGF-1 level, and bio-anthropometry was carried out before and after the four weeks of exercise. The bio-anthropometry measurement was carried out using seca mBCA 514, while the measurement of insulin-like growth factor 1 (IGF-1) and irisin was completed using an enzyme-linked immunosorbent assay (ELISA). The obtained data were analyzed using a one-way ANOVA test with 5 % significance. Results Our results indicated higher dynamic of irisin and IGF-1 increases in the group with a combination of aerobic and resistance training exercises than the other two groups with a different exercise. Further, we also observed different dynamics of irisin and IGF-1 level increase (p<0.05). Besides, the irisin was also correlated with the IGF-1 and bio-anthropometric parameters (p<0.05). Conclusions The combination of aerobic and resistance training exercises is considered as the alternative for enhancing the dynamic of irisin and IGF-1 increase. Thus, it can be used to prevent and regulate obesity.