Chronobiology and Health- Proceedings 2016

National Conference on Chronobiology and Health
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Chief Patron
Shri MK Rajagoplan
Chairman, Sri Balaji Educational and Charitable Public Trust
Patrons
Prof. P Rajaram Prof. KR Sethuraman
Chancellor, Sri Balaji Vidyapeeth Vice-Chancellor, Sri Balaji Vidyapeeth
Prof. YM Jayaraj Prof. N Ananthakrishnan
Pro-Vice Chancellor, Sri Balaji Vidyapeeth Dean- Research and AHS
Sri Balaji Vidyapeeth
Prof. M Ravishankar
Dean, MGMC & RI
Resource Committee
Prof. S Ravichandran Prof. V Nirmal Coumare
Additional Director (HS), MGMC&RI Medical Superintendent, MGMC&RI
Prof. N Seetharaman Dr. AN Uma
Head, Department of Community Medicine Assistant Professor,
Department of Anatomy
Organizing Chairman Organizing Secretary
Prof. Madanmohan Prof. K Jaiganesh
Head, Department of Physiology Professor of Physiology
Core team
Prof. K Henri Balraj Dr. T Jeneth Berlin Raj
Dr. Suchitra Parkhad Dr. Nikhilesh Singh
Dr. Richa Gupta Dr. R Sobana
Dr. K Ramya Mr. S Vasanthan
Dr. S Selvakumar Mr. P Uthiravelu

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INDEX
CONTENT PAGE NO.
Messages 3
From the desk of Organizing Chairman 12
From the desk of Organizing Secretary 13
Conference faculty 14
Scientific programme 16
Chronobiology – an overview
Prof. KR Sethuraman
20
Fundamental properties of circadian clocks – their cellular and
molecular basis
Dr. Sheeba Vasu
23
Blood pressure variability as a risk factor for cardiovascular diseases
Prof. Narsingh Verma
24
Circadian rhythm and bipolar disorder
Dr. Biju Vishwanath
25
Nasal cycle and its therapeutic applications: a yogic perspective
Dr. Ananda Balayogi Bhavanani, Dr. Meena Ramanathan
26
Chronobiology of ageing: role of telomere and lifestyle intervention
Prof. Vivek Kumar Sharma
29
Circadian sleep disorders: are they lifestyle associated?
Prof. PN Ravindra
30
Chronotherapeutics
Prof. K Manimekalai
34
Therapeutic potential of music: chrono-biological and traditional
perspectives
Prof. Sumathy Sundar
36
Adaptive resilience exercises as envisioned in yoga
Dr. Meena Ramanathan, Dr. Ananda Balayogi Bhavanani
37
Pranayam and its physiological basis
Prof. Madanmohan
39
Melatonin and chronobiology
Dr. Suchitra B Parkhad
41
Posters 46-62

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MESSAGES

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MESSAGE FROM THE HONORABLE CHAIRMAN
It gives me immense pleasure to note that the Department of Physiology of
Mahatma Gandhi Medical College and Research Institute has taken the lead in
organizing a national conference on “Chronobiology and health” on 18th and 19th
March 2016.
I am confident that this is a maiden effort by us in the field of chronobiology which
relates health with the passage of time.
The deliberations made in the conference will enlighten the new arena among the
faculty.
I wish the conference a grand success.
Shri MK Rajagopalan
Chairman - SBECT

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MESSAGE FROM THE CHANCELLOR
Chronobiology – A Physiologic Paradox
The study of biological rhythm, chronobiology, is attracting interest amongst the
scientists around the world. It is, nevertheless, a difficult field for the scientists to
understand and learn and then teach and educate others. Medical rhythm research is
rather challenging for, it need interest and inquisitive mind on the part of the
scientists to learn first.
I am glad that Department of Physiology, under the dynamic leadership of Prof.
Madanmohan, who is not only a Physiologist but has been doing research in applied
diversified fields like yoga and meditation that has been shown having scientific basis.
The researchers in this field have shown that they are not to be treated as having a
religious bias but has bearing towards social aspects of humanity. He is heading a
team of devoted scientists promoting research and education in these fields in India.
This center at Sri Balaji Vidyapeeth is unique in India.
Therefore, organizing chronobiology conference is timely and it is expected that
scientists, clinicians, and interested strata of the society will and must come together
to promote this interdisciplinary field.
The younger generation of the present era of globalization is at the verge of breakdown
of their biological clock. The outcome of research in chronobiology might help
maintain the performance and output of workforce and avoid errors while performing
their duties and avoid mental and physical health problems.
Medical scientists must join the hands of basic science researchers and try to
understand “Chronobiology” and solve the „Physiologic puzzle‟ that we are confronted
with.
Prof. Rajaram Pagadala
Chancellor

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MESSAGE FROM THE VICE CHANCELLOR
Following the UGC directive to all the universities to stress on environmental issues
during collegiate education, SBV has undertaken to conduct Annual Faculty
Development Program on various aspects of environment and health. In 2015, it was
Climate Change and Health and in the current year we are focusing on
Chronobiology and Chronotherapeutics and Health.
It is gratifying that the Department of Physiology of MGMC&RI has undertaken to
organize this program as a national conference.
In addition, the unique strength of SBV- yoga therapy and music therapy also find a
prominent place in the conference.
On behalf of SBV, I wish the conference a successful outcome, which would motivate
us to conduct three more annual events in the years to come
Prof. KR Sethuraman
Vice-Chancellor

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MESSAGE FROM THE REGISTRAR
It gives me immense pleasure to felicitate the organizing committee of the national
conference on Chronobiology and Health. The Department of Physiology,MGMC&RI
needs to be complimented for their efforts that have culminated in this great endeavor.
The natural cycles of our body include physiological,mental and emotional facets that
are grossly governed by solar and lunar rhythms. Eminent researchers drawn from
various research areas would enthrall the discerning audience with their intellectually
stimulating talks on many a thrust area in chronobiology as related to health.
I wish the conference great success.
Prof. AR Srinivasan
Registrar

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MESSAGE FROM THE DEAN RESEARCH AND AHS
Right from its inception, SBV has been in the forefront amongst peers, in the field of
innovations and newly emerging areas of medical sciences so that it becomes part of
the exploring group along the advancing borders of modern science – in the words
from the famous serial Star trek “to boldly go where no man has been before.”
Biology has undergone considerable change in recent times from description of gross
cellular function to molecular biology at the sub-cellular level and the description of
the new biology by Bruce Lipton in his book “The Biology of Belief”. One such
emerging area is “Chronobiology” and its implication in medicine particularly in the
area of therapeutics.
I am very glad that the Department of Physiology at MGMC&RI has taken the lead in
arranging a national program in this field wherein experts from different fields would
highlight salient features of chronobiology and its application to different disciplines of
medicine.
I am sure that the proceedings of the program would go a long way in promoting our
understanding of the subject. I wish the conference all success.
Prof. N Ananthakrishnan
Dean – Research and Allied Health sciences

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MESSAGE FROM THE DEAN
It gives me great pleasure and happiness to know that the Department of Physiology is
organizing a National Conference on Chronobiology and Health on 18th and 19th March
2016 under Sri Balaji Vidyapeeth Deemed University, Accredited by NAAC with „A‟
Grade.
Chronobiology as a focused theme to analyze the effect of changing environment on
human health is a novel idea and delegates attending this conference will have lot to
think about.
I am confident that this conference will contribute to this national vision.
I wish the function every success.
Prof. M Ravishankar
Dean
MGMC&RI

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MESSAGE FROM THE ADDITIONAL DIRECTOR
I am very happy to see the Department of Physiology is going to conduct anational
conference on an important topic that is “CHRONOBIOLOGY AND HEALTH”. I think
many of you agree that the knowledge on this topic among our medical fraternity is
very limited and unpopular, where as many of the western countries started doing
many research in the field of Chronophysiology, Chronopathology,
Chronopharmacology etc.
Chronobiology or circadian biology has come a long way since 1960‟s. What was once
a difficult science to promote and teach has now become a very important field that
encompasses molecular biology, endocrinology, physiology, psychiatry, genetics,
neurology, sleep studies, and even astronomy when dealing with the cosmic origins of
our biological clocks and lunar rhythms that have an impact on the earth.
I have no doubt that this conference is going to inspire many of us to understand the
details regarding the forces that control our inner clocks and to find better ways to
adapt.
Good initiative, please keep going.
Prof. S Ravichandran
Additional director – Hospital services
MGMC&RI

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MESSAGE FROM THE MEDICAL SUPERINTENDENT
I am glad that the Department of Physiology, Mahatma Gandhi Medical College and
Research Institute is organizing a 2 day national conference on “Chronobiology and
Health” in which scientists from diverse fields are taking part. I am sure that coming
together of scientists from such diverse fields will encourage inter-disciplinary
research which will be a boon to the society.
I wish the conference a grand success.
Prof. V Nirmal Coumare
Medical Superintendent,
MGMC&RI

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FROM THE DESK OF THE ORGANIZING CHAIRMAN
At the outset, I wish to express my heart-felt gratitude to our honorable Chairman
Shri MK Rajagopalan for his constant support to organize conferences/workshops. We
have been organizing such events every year and the management has been graciously
supporting the same. The present conference on “Chronobiology and Health” is second
in a series of conferences on “Environment and Health” conceived by our honorable
Vice-Chancellor, Prof. KR Sethuraman.
I am grateful to Prof. P Rajaram, honorable Chancellor, Prof. YM Jayaraj, Pro-Vice
Chancellor, Prof. N Ananthakrishanan, Dean Research & AHS and Prof. M
Ravishankar, Dean MGMC & RI for their constant support and inspiration. I wish to
thank my colleagues and friends from the Department of Physiology without whose
support it would not have been possible to organize this conference.
Chronobiology is an interdisciplinary field and faculties of this conference arefrom
diverse fields of neuroscience, physiology, pharmacology, medicine, psychiatry,
cardiology, pulmonary medicine, endocrinology, gynecology,yoga therapy and music
therapy. I am sure that the scientific program will be an enlightening one and a
memorable experience for you and wish you all the best for the 2 day conference.
Prof. Madanmohan
Prof. and Head,
Department of Physiology,
MGMC&RI

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FROM THE DESK OF THE ORGANIZING SECRETARY
It is indeed my pleasure and privilege to invite you all to the National Conference on
“Chronobiology and Health”
We have made our fullest efforts to bring in potential resource persons from diverse
fields to enlighten our delegates.
The scientific sessions and workshop have been meticulously planned and executed
to make your participation a comfortable and fruitful experience.
I assure you that the conference will be an enriching academic experience to you in
the field of chronobiology.
Prof. K Jaiganesh
Professor of Physiology
MGMC&RI

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CONFERENCE FACULTY
Internal faculty:
KR Sethuraman, MD, PGDHE.
Vice Chancellor,
Sri Balaji Vidyapeeth.
Madanmohan, MD, DSc.
Professor & Head,
MGMC & RI &
Director, Center for Yoga Therapy, Education & Research (CYTER),
K Manimekali, MD.
Professor & Head,
Department of Pharmacology,
MGMC & RI.
Sumathy Sundar, PhD.
Director,
Centre for Music Therapy Education & Research (CMTER),
B Amirtha Ganesh, MD, DM
Professor & Head,
Department of Cardiology,
MGMC & RI.
R Pajanivel, MD, FRCP.
Professor,
Department of Pulmonary medicine,
MGMC & RI
Ananda Balayogi Bhavanani, MBBS, MD (AM).
Deputy Director,
Centre for Yoga Therapy Education & Research (CYTER),
Meena Ramanathan, PhD (Yoga).
Coordinator-cum-Yoga Therapist,
Centre of Yoga Therapy Education Research (CYTER),

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External faculty:
PN Ravindra, MD, PhD.
Professor & Head,
Akash Institute of Medical Sciences & Research Centre,
Bangalore.
Narsingh Verma, MD.
Professor of Physiology & Vice Dean,
KG Medical College,
Lucknow.
Gowri Dorairajan, MD
Professor of Gynecology,
JIPMER
Vivek Sharma, MD.
Additional Professor,
JIPMER.
Sadish Kumar, MD, DM
Associate professor,
Department of Endocrinology,
JIPMER.
Biju Vishwanath, MD, PhD.
Assistant Professor,
Department of Psychiatry,
NIMHANS,
Bangalore.
Sheeba Vasu, PhD.
Faculty Fellow,
Neuroscience unit,
Jawaharlal Nehru Centre for Advanced Scientific Research,
Bangalore.

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SCIENTIFIC PROGRAMME
Day1: 18 March 2016 (Friday)
Venue: Ground Floor Lecture Hall, College Block
8.00 to 9.00 AM Registration
9.00 to 9.30 AM Pre- test
9.30 to 10.00 AM
molecular basis.
Sheeba Vasu, PhD. JNCASR, Bangalore
10.00 to 11.00 AM
Inaugural function and
lead talk by KR Sethuraman Vice Chancellor, Sri Balaji Vidyapeeth.
11.00 to 11.30 AM High tea
11.30 to 12.00
Noon
Blood pressure variability as a risk factor for cardiovascular
diseases: chronobiological perspective.
Narsingh Verma, MD. Professor of Physiology & Vice Dean,
KG Medical College, Lucknow.
12.00 to 12.30 PM
Biju Vishwanath, MD. Assistant Professor, Department of
Psychiatry, NIMHANS, Bangalore.
12.30 to 1.00 PM
Nasal cycle and its therapeutic applications: a yogic perspective.
Ananda Balayogi Bhavanani, MBBS, MD (AM).
Deputy Director, CYTER, Sri Balaji Vidyapeeth.
1.00 to 2.30 PM Poster session and lunch
2.30 to 3.00 PM
Chronobiology of ageing: role of telomere and lifestyle
intervention.
Vivek Sharma, MD. Additional Professor, Department of Physiology,
JIPMER, Pondicherry.
3.00 to 3.30 PM
PN Ravindra, MD, PhD. Professor & Head, Department of
Physiology, Akash Institute of Medical Sciences & Research Centre,
Bangalore.
3.30 to 3.45 PM Tea
3.45 to 4.15 PM
Therapeutic potential of music: chronobiological and traditional
perspectives.
Sumathy Sundar, PhD. Director, CMTER, Sri Balaji Vidyapeeth.
4.15 to 4.45 PM Question / answer session.

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SCIENTIFIC PROGRAMME
Day 2: 19 March 2016 (Saturday)
Venue: Ground Floor Lecture Hall, College Block
9.00 to 10.15 AM
Panel discussion on chronotherapeutics:
Chairperson: K Manimekalai
Panelists: B Amirtha Ganesh
R Pajanivel
Gowri Dorairajan
Sadish Kumar
10.15 to 10.30 AM Tea
10.30 to 11.00 AM Post test
11.00 AM to 12.30 PM
Practice sessions at CYTER, I Block, First floor
Practice sessions on adaptive resilience cyclic exercises and
pranayam.
Meena Ramanathan, Ananda Balayogi Bhavanani,
Madanmohan
12.30 to 1.00 PM Valedictory
1.00 PM Lunch

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ABSTRACTS

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Chronobiology – an overview
Prof. KR Sethuraman. MD, PGDHE.
Vice Chancellor, Sri Balaji Vidyapeeth (A Deemed University)
Biological Rhythms are cyclical changes at the level of body chemistry or function.
They can be i) internal or endogenous controlled by the internal biological clock e.g.
body temperature cycle) or ii) external or exogenous (controlled by synchronizing
internal cycles with external stimuli, e.g., sleep/wakefulness synchronizing with
day/night.
Such stimuli are called zeitgebers (German word meaning “time givers”). Zeitgebers
include environmental time cues such as sunlight, food, noise, or social interaction
and they help to reset the biological clock to a 24-hour day- night cycle. The circadian
clock is genetic transcription-translation feedback machinery. It exists in most organs
and cells, termed the peripheral clock, which is orchestrated by the central clock in
the supra-chiasmatic nucleus.
Depending on the duration, biological rhythms are:
 Circadian rhythms – endogenously generated rhythms with a period close to 24
hours.
 Diurnal rhythms – a circadian rhythm that is synchronized with the day/night
cycle.
 Ultradian rhythms – biological rhythms (e.g. feeding cycles) with a period much
shorter (i.e., frequency much higher) than that of a circadian rhythm.
 Infradian rhythms – biological rhythms with a cycle of more than 24 hours (e.g.
the human menstrual cycle).
Circadian is derived from a Latin phrase meaning “about a day”. Circadian rhythms
have a period of approximately 24 to 25 hours. When the rhythm is synchronized with
the day-night cycle, it is termed a diurnal rhythm.
Physiological and behavioural rhythms of the circadian type include:
 sleep/wakefulness cycle
 body temperature

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 hormone secretion patterns
 blood pressure variation
 digestive secretions
 alertness level
 reaction time
Variations of circadian rhythm (the morning-evening types): “morningness” and
“Eveningness” describe a person‟s individual circadian profile.
 Most people fall somewhere between these two types.
 Morning people usually prefer to rise between 5 a.m. and 7 a.m., and retire
between 9 p.m.and 11 p.m.
 Evening people tend to prefer both a later wake up (9 a.m. to 11 a.m.) and a
later bed time (11 p.m. to 3 a.m.).
 Morning people also tend to be more rigid in their circadian rhythms.
 Evening people find adjustment to new schedules somewhat easier.
Post-lunch dip effect: The "post-lunch dip" is a period of decreased alertness that
strikes between 1 p.m. and 4 p.m. Most of us would have experienced this, especially
after a heavy lunch.
Between 1 pm and 4 pm:
 work performance suffers
 people in dimly lit meeting rooms are apt to nod off
 The likelihood of getting into a car accident increases.
 The body temperature, hormone levels and other physiological cycles place us
at low ebb in the early afternoon, in contrast to periods of peak alertness we
experience in the morning and early evening.
 The post-lunch dip occurs even if we skip the lunch, but a heavy lunch
exaggerates the effect.
Strategies for coping with the post-lunch dip:
 a brief power nap (no longer than 10-15 minutes)
 a brisk walk outside
 drinking tea, coffee or ice-cold juice
 doing work that requires moderate physical exertion.
 If possible, the most mentally demanding work should be done in the morning
or evening, depending on a person‟s rhythm.
Human errors and time-of-day:
 Disasters caused by human errors, such as 3-Mile Island, Bhopal and
Chernobyl, occurred at middle of the night.
 The majority of single-vehicle driving accidents occur in the hours near dawn.

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 Compared to nocturnal predatory animals, we humans have relatively poor
night vision, hearing and smell. Therefore, our circadian rhythms put us to
sleep at night for our own protection.
 The biological imperative to sleep creates problems for shift work.
 Studies revealed that performance of visual search is better in the morning than
the evening.
 Performance on thinking tests is better around lunchtime than in the morning
or evening
Caution: The above findings on time-of-day (TOD) effects are highly variable in any
given individual and we should not generalize.
Biorhythms theory - a myth
A pseudoscientific theory claims that our lives are affected by 3 rhythmic cycles:
– Physical – 23 days cycle; Emotional – 28 days cycle; Intellectual – 33 days cycle.
A systematic review of 134 biorhythm studies found that there is no scientific evidence
to support the theory.
Chronotherapeutics
Coordinating biological rhythms with medical treatment is called chronotherapy. It
considers a person‟s biological rhythms in determining the timing and sometimes the
amount of medication to optimize a drug‟s desired effects and minimize the undesired
ones.
Recent studies linking circadian rhythms with blood pressure control and type-2
diabetes have forced the scientists to look for the ways to set the clock right. The risks
of myocardial infarction, cardiac arrest and of stroke are higher by 40%, 29% and 49%
respectively, between 06:00 am and noon. Therefore, our focus has shifted towards
chrono-therapeutics i.e., dosing of the medications at 10 pm with novel drug delivery
systems to keep the drug levels high at 6 am and for 6 to 8 hours thereafter.
A clinical study of 1995 has shown that administration of an HMG-CoA reductase
inhibitor in the evening was more effective at lowering serum cholesterol levels than
the same dose given in the morning, because higher rates of cholesterol synthesis
occur during the evening hours.
Another study in 2009 has revealed that the proportion of patients with controlled
ambulatory blood pressure increased from 43% to 65% with single bedtime dose of
angiotensin converting enzyme inhibitor, ramipril.
To sum up, the physicians of 21st Century, who practise salutogenesis (promoting
wellness) need to be aware of chronobiology and chronotherapeutics.

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molecular basis.
Dr. Sheeba Vasu. PhD.
Faculty Fellow, Neuroscience Unit,
Jawaharlal Nehru Centre for Advanced Scientific Research,
Bangalore, INDIA.
E-mail: sheeba@jncasr.ac.in
I will introduce the basic features of rhythms that would allow us to consider them as
being driven by endogenous circadian clocks. The underlying genetic basis of
circadian clocks was unraveled by researchers using classic genetic approaches and
many critical genes that are involved in the functioning of the circadian clock were
first discovered in fruit flies. These findings paved the way for studies in mammals
and several other organisms. The anatomical and cellular identities of the circadian
pacemakers were also investigated in parallel in many organisms. I will describe some
studies from our own research group and that of others which showed that behavior of
animals in more natural settings can reveal features not detected in standard
laboratory studies. The characteristic features of circadian rhythms and their
molecular, genetic and cellular basis will be discussed. Rhythms under natural
conditions and behaviors underlying molecular clock will be explained.

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Blood pressure variability as a risk factor for cardiovascular
diseases: chronobiological perspective
Dr. Narsingh Verma. MD
Professor of Physiology & Vice Dean, KGMU, Lucknow
Blood pressure measurement by sphygmomanometer or automated devices is the
routine approach for diagnosing hypertension in clinics, but patients may be
misclassified due to masked hypertension or “white coat” hypertension. The addition
of ambulatory blood pressure monitoring (ABPM), has helped in improving the
diagnosis and treatment decisions. ABPM is not new as more than 50 years have
passed since first attempt for ABPM was made by Hinman et al. in 1962. The potential
of this technique was not recognized that time and nobody expected that it will soon
become indispensable tool in day to day practice. Its recognition and acceptance in
clinical practice took little time and now there is overflow of data using ABPM from
different groups around the world. Study of circadian pattern of blood pressure has
provided several insights into the patho-physiology of target organ damage in
hypertensives. With identification of dipping and non dipping patterns among
hypertensives the treatment goals have observed a paradigm shift from correcting the
average blood pressure values to restoring the dipping pattern. Chronomics now
guiding the drug therapy in such patients have made ABPM indispensible tool not only
in diagnosing but overall management of hypertension. Recently several studies have
increasingly demonstrated its application in identifying risk of target organ damage in
Type 2 Diabetes and Kidney transplant patients. In this context our group is working
on investigating circadian pattern of Blood Pressures among normal subjects,
hypertensive patients, Type-2 Diabetes Patients and pregnancy induced hypertension.
Some of the interesting findings from our group will be discussed during the meeting.

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Dr. Biju Vishwanath. MD, PhD
Assistant Professor (DST INSPIRE),
Dept. of Psychiatry,
National Institute of Mental Health and Neuro Sciences
(NIMHANS), Bangalore.
Bipolar disorder is a chronic severe neuropsychiatric illness with high rate of suicide.
The exact biological basis of bipolar disorder or its pharmacological treatment is
unknown. Over the last decade, circadian rhythm abnormalities in this disorder have
been studied increasingly. Clinical, neuro-endo-phenotype and genetic studies in the
field need to be highlighted. Recent studies of cell models offer exciting avenues to
integrate the biology of this complex disorder along these lines of research.

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Nasal cycle and its therapeutic applications: a yogic perspective
Yogacharya Dr Ananda Balayogi Bhavanani. MBBS, MD (AM).
Deputy Director,
Centre for Yoga Therapy, Education and Research (CYTER),
Sri Balaji Vidyapeeth University,
MGMC&RI Campus, Pondicherry.
Yogachemmal Dr Meena Ramanathan. PhD (Yoga).
Coordinator-cum-Yoga therapist,
Introduction: The nasal cycle is an ultradian rhythm of nasal congestion and
decongestion with a quasi-periodicity of 60 to 240 minutes.(1) Keyser made the first
formal description and the use of the term nasal cycle in 1895.(2) However the concept
of the nasal cycle and an understanding of its role in our life had existed for long in
Indian thought. The Vedic science of understanding the function of the nasal cycle
was known as Swarodaya Vigjnan (swara = sonorous sound produced by the airflow
through the nostrils in the nasal cycle, udaya = functioning state, and vigjnan =
knowledge).(3) The Shivaswarodaya, an ancient treatise in Sanskrit literature advises
the Yogi to undertake quieter, passive activities (soumyakarya) when the left nostril
flow is dominant (ida / chandraswara), to engage in challenging and exertional
activities (roudrakarya) when right nostril is dominant (pingala / suryaswara) and to
relax or meditate when the bilateral nasal flow is operational (sushumnaswara) as it
was considered to be unsuitable for performance of worldly activities. Ida swara (left
nostril dominance) was described as feminine, Shakti and moon-like (chandra) while
the pingalaswara (right nostril dominance) was described as masculine, Shiva and
sun-like (surya). Traditional Indian description of Ardhanarishwara consists
of Shakti (the female element) being depicted on the left and Shiva (the male element)
on the right side of the body. Such a notion of left-right, female-male duality was
common in oriental traditional medicine as also in western alchemy. (1)
Postulated mechanisms: Various mechanisms were postulated for the occurrence of
the nasal cycle and a great amount of research work has been done in this field. It has
been seen that the use of Yoga Danda (T-shaped wooden implement used by
the Yogis to regulate differential breathing patterns), pressure of a crutch in the axilla,

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pressure on the thorax while sitting and also the act of lying down on the side, can
affect pattern of nasal dominance. (4-7)The nasal cycle is dependent upon the tonic
activity of the limbic autonomic nervous system, the levels of circulating
catecholamines and other neuro-hormones. Nasal congestion correlates with low
sympathetic-high parasympathetic activity whereas decongestion is directly related
to high sympathetic-low parasympathetic activity mode.(8) Compression of the hemi
thorax from any surface lateral, anterior, posterior or superior leads to congestion of
the ipsilateral nostril with simultaneous decongestion of the opposite nostril. (9) Eccles
proposed that the hypothalamus was the centre for the sympathetic effects on the
nasal mucosa and the nasal cycle.(10)
Therapeutic applications: A group of pranayama, namely chandra and suryanadi
(CN and SN, respectively) and chandrabhedana and suryabhedana (CB and SB,
respectively) have uninostril breathing (UNB) and alternate nostril breathing (ANB)
patterns using left and/or right nostrils, respectively. This type of yogic nostril
manipulation is also furthered in nadishuddhi (NS), a specific technique involving
alternate use of both nostrils in a specific pattern. It has been previously suggested
that right nostril dominance in the nasal cycle as well as right UNB may be correlated
with the “activity phase” of the basic rest-activity cycle, the time during which
sympathetic activity in general exceeds parasympathetic activity throughout the body.
(11)
These yogic UNB and ANB techniques have captured the imagination of researchers
worldwide and recent studies have reported their differential physiological and
psychological effects including effects on O2 consumption, metabolism and body
weight,(12) blood glucose,(11)involuntary blink rates(11) and intraocular pressure, (13) heart
rate (HR), stroke volume and end diastolic volume(14)as well as skin resistance, digit
pulse volume, and blood pressure (BP).(15)ANB (as done in NS pattern) has been
reported to rapidly alter cardiopulmonary responses and improve simple problem
solving. (16)Yogic breathing through right, left, or through both nostrils alternately
produce distinct autonomic changes: right UNB increased systolic pressure (SP) and
diastolic pressure (DP), whereas left UNB resulted in significant reduction in SP and
mean pressure (MP).(17)
Shannahoff-Khalsa suggested that mechanical receptors in the nasal mucosa register
flow of air across membranes (unilaterally) and transmit this signal ipsilaterally to the
hypothalamus, the highest center for autonomic regulation. (11) Even alternating left-
right levels of catecholamines have been found to occur in peripheral circulation of
resting humans with rhythms coupled to the nasal cycle. (18)It is possible that the right
nostril initiated techniques are producing such a state of autonomic arousal, whereas
left nostril initiated techniques are inducing autonomic relaxation/balance in our
subjects.

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Research studies at CYTER: Our studies at CYTER have demonstrated that right and
left yogic UNB and ANB techniques have differential physiological effects.(19-21) Right
nostril initiated UNB and ANB techniques (SB and SN) induce a state of arousal
through sympathetic activation and/through increased ascending reticular activity
and/or by central action at the primary thalamo-cortical level. On the other hand, left
nostril initiated UNB and ANB techniques (CB, CN, NS) delay reactivity of the subjects
by inducing a sense of inert lethargy and may induce a state of parasympathetic
dominance as seen in CV parameters. This finding is in tune with the traditional
swara yoga concept that air flow through right nostril (SN and pingalaswara) is
activatory in nature, whereas the flow through left nostril (chandranadi and idaswara)
is relaxatory. Further studies in different populations and in patients of different
conditions, as well as over different periods of time, may provide a more detailed
understanding of the therapeutic potential of these simple and effective pranayama
techniques.
References:
1. Bhavanani AB. Swarodaya vigjnan. A scientific study of the nasal cycle. Yoga Mimamsa.2007; 39: 32–38.
2. Kayser R. Die exakte Messung der Luftdurchgängigkeit der Nase. Arch. Laryng. Rhinol (Berl.) 1895; 3: 101-210.
3. Giri R, Shankar G. Swara Yoga - an introduction and its applications. Nisargopachar Varta 2001; 1: 18-20.
4. Rao S, Potdar A. Nasal airflow with body in various positions. J Appl Physiol 1970; 28:162-65.
5. Block RA, Arnott DP, Quigley B, Lynch WC. Unilateral nostril breathing influences lateralised cognitive
performance. Brain Cognit 1989; 9:181-90.
6. Davies AM, Eccles R. Reciprocal changes in nasal resistance to air flow caused by pressure applied to the axilla.
Acta Otolaryngol (Stockh) 1985; 99:154-59.
7. Mitti Mohan S. Reflex reversal of nostril dominance by application of pressure to the axilla by a crutch. Indian J of
Physiol Pharmacol 1993; 37: 147-50.
8. Deshmukh VD. Limbic autonomic arousal: its physiological classification and review of the literature. Clinical
Electroencephalography 1991; 22: 46-60.
9. Singh V. Thoracic pressure and nasal patency. J Appl Physiol 1987; 62: 91-94.
10. Eccles R. The Central Rhythm of the Nasal Cycle. Acta Oto-Laryngologica 1978; 86: 464-68.
11. Shannahoff-Khalsa DS. Unilateral forced nostril breathing: Basic science, clinical trials, and selected advanced
techniques. Subtle Energies and Energy Med J. 2002; 12: 79–106.
12. Telles S, Nagarathna R, Nagendra HR. Breathing through a particular nostril can alter metabolism and autonomic
activities. Indian J Physiol Pharmacol 1994; 38: 133–37.
13. Mohan SM, Reddy SC, Wei LY. Modulation of intraocular pressure by unilateral and forced unilateral nostril
breathing in young healthy human subjects. Int Ophthalmol 2001;24: 305–11.
14. Shannahoff-Khalsa DS, Kennedy B. The effects of unilateral forced nostril breathing on the heart. Int J Neurosci
1993; 73: 47–60.
15. Telles S, Nagarathna R, Nagendra HR. Physiological measures of right nostril breathing. J Altern Complement Med
1996; 2: 479–84.
16. Subbalakshmi NK, Saxena SK, Urmimala, D'Souza UJ. Immediate effect of „Nadi-shodhana Pranayama‟ on
selected parameters of cardiovascular, pulmonary, and higher functions of brain. Thai J Physiol Sci 2005; 18: 10–
16.
17. Raghuraj P, Telles S. Immediate effect of specific nostril manipulating yoga breathing practices on autonomic and
respiratory variables. Appl Psychophysiol Biofeedback 2008; 33: 65–75.
18. Kennedy B, Ziegler MG, Shannahoff-Khalsa DS. Alternating lateralization of plasma catecholamines and nasal
patency in humans. Life Sci 1986; 38: 1203–14.
19. Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Differential effects of uninostril and alternate nostril
pranayamas on cardiovascular parameters and reaction time. Int J Yoga 2014; 7: 60-65.
20. Bhavanani AB, Ramanathan M, Madanmohan. Immediate effect of alternate nostril breathing on cardiovascular
parameters and reaction time. Online International Interdisciplinary Research Journal 2014; 4: 297-302.
21. Ramanathan M and Bhavanani AB. Immediate effect of chandra and suryanadi pranayamas on cardiovascular
parameters and reaction time in a geriatric population. International Journal of Physiology 2014; 2: 59-63.

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Chronobiology of ageing: role of telomere and lifestyle intervention
Dr. Vivek Kumar Sharma. MD
Additional Professor of Physiology,
Jawaharlal Institute of Postgraduate Medical Education &
Research,Pondicherry-605006
Contact No: 04132296849; 9442529673.
Email: drviveksharma@yahoo.com
Recent studies document that telomere length and telomerase cellular are not only
associated with chronobiology of ageing but also accelerated ageing in various cardio-
metabolic disorders like coronary artery disease, diabetes, hypertension etc and their
associated complications. Telomeres are “expendable” repetitive (TTAGGG) sequences
at the end of chromosomes.
Telomere length-telomerase enzyme activities are affected by oxidative stress,
inflammation and cellular proliferation, and thus form an association with
chronobiology of ageing and related diseases. Recent research in the field of telomere
length dynamics documents that chronobiology of ageing and age-related diseases
have a synergistic effect on telomere length-telomerase activity and as well as effect
telomere length independently also. Reports suggest decreased telomerase activity that
reflects greater tissue ageing and prevalence of senescent phenotypes in various
tissues marking the progression of the accelerated chronobiology of aging.
There has been an alarming increase in non-communicable diseases worldwide
including India in recent decades due to the adoption of modern lifestyle, unplanned
urbanization, dietary changes, physical inactivity, socio-economic changes and
accompanied stress. By 2015, 50-60 % of deaths in India will be attributed to lifestyle
related disorders including obesity, coronary artery disease and diabetes mellitus.
Benefits of life-style intervention including yoga, meditation and increased physical
activity are universally known and recent studies indicate higher levels of telomere-
telomerase system activity in subjects participating in these interventions thereby,
suggesting subcellular changes and delayed chronobiology of aging in the practicants.
Therefore, Telomere-Telomerase system may be considered as a potential therapeutic
target for life-style modification related interventions in studying the chronobiology of
accelerated aging conditions.
Two recent western studies have documented that 12 weeks of intensive meditation
and lifestyle changes significantly increased peripheral blood telomerase activity,
immune function, reduced stress parameters and promoted more meaningful life in
the participants. There is paucity of data on studying the relationship of life-style
interventions with chronobiology of aging in healthy and diseased Indian population
and this can be contemplated by the scientific community.

30
Prof. PN Ravindra. MD, PhD (Neurophysiology)
Professor and Head,
Dept of Physiology
Akash Institute of Medical Sciences and Research Centre,
Bangalore.
Melatonin is evolutionarily highly conserved molecule present in a spectrum of plant
and animal species that play a major role in circadian rhythm regulation. Melatonin is
a central time keeper (Zeitgeber) synthesized and secreted by pineal gland, a central
structure in the circadian system. Pineal gland was considered as a functionless
rudimentary organ until 1958 when Aaron Lerner and colleagues (Lerner, 1958)
isolated pineal active substance . They (Lerner, 1959) named this compound as
melatonin, a „hormone of darkness‟ and described its chemical structure as N-acetyl-
5-methoxytryptamine. Light is the most dominant powerful environmental source that
regulates melatonin synthesis. Photic stimuli through retina are transmitted to
suprachiasmatic nucleus (SCN), the master circadian clock. SCN in turn conveys the
signal to pineal gland for melatonin synthesis. In this process, noradrenergic fibers of
cervical ganglion, is the one that ensures proper translation of photic information into
melatonin synthesis. Therefore, in addition to light, the levels of noradrenalin in these
neurons also play important role in synthesis of melatonin. It is to be noted that the
photoreceptors (melanospin containing retinal ganglion cells) that are sensitive to light
in the range between 446-484 nm (blue light) are primarily involved in stimulating
melatonin synthesis (Lewy and Sack, 1989). Therefore, visual blindness doesn‟t
necessarily cause circadian misalignment but for the absence of melanospin or its
connection to SCN if not intact. However, with development of cataract and
constriction of pupil with age, the transmission of light waves of shorter wave length
may be impeded, thereby, causing alteration in melatonin rhythm and ensuing sleep
problems.
The most striking feature of melatonin is its daily variations that are sensitive to light–
dark cycle and its release is at peak towards darkness. These circadian variations in
melatonin play major role in bringing about normal daily rhythms in hormonal
secretion, temperature variations, sleep-wake cycle etc. Melatonin peak is followed by
drop in the core body temperature; these two factors play important role in inducing
sleep (Karasek and Winczyk, 2006). This relationship between melatonin and core
body temperature follows even during therapeutic administration of melatonin

31
agonists, wherein, temperature drops down within 2-3 hours after administration
(Verster, 2009). Alterations in normal circadian variations of melatonin either due to
exposure to bright light during biological night (as in shift work, late night work etc) or
pathological conditions tends to misalign the circadian rhythm thereby bringing
various sleep related problems. The classical circadian rhythm disorders include
delayed sleep phase syndrome, advanced sleep phase syndrome, jet lag, shift work,
and free running type as seen in the visually challenged people (Martinez and Lenz,
2010). However, there can be circadian disorder due to genetic mutations of circadian
genes, medical conditions (insulin resistance, parkinsonism, cirrhosis, renal failure
etc.), medications and drug abuse as well. Few common circadian sleep disorders are
explained briefly here (Phyllis et al 2013, L Sack et al, 2007).
Delayed sleep phase disorder (DSPD): This is characterized by recurrent difficulty in
falling asleep or wakeup in socially acceptable time. There will be a delay of more than
two hours than conventional acceptable time to bed and waking up. However, the
important characteristic of this disorder is that the circadian rhythm of the person will
get persistently be delayed that brings about significant impairment in individuals
social life. DPSD is most commonly observed in adolescent primarily due to socially
enforced alterations in sleep-wake scheduled associated with late night social
activities. The symptoms exacerbate with decreased light exposure in the morning and
bright light exposure in late evening hours. However, genetic basis with polymorphism
of circadian clock gene is also implicated in developing DPSD. It has been reported
that DPSD patients have diminished ability to compensate for the sleep loss in spite of
having high homeostatic drive.
In managing DPSD, chronotherapy, secluding the timing of sleep, would
synchronize circadian rhythm. Sleep scheduled is delayed gradually for several hours
a day until the target time is reached. After reaching the target time patients are
advised to keep the regular sleep-wake scheduled. In addition to this, bright light
exposure during morning hours with evening melatonin administration is known to
realign the circadian rhythm in DPSD patients.
Advanced sleep phase disorder (ASPD): characterized with early sleep time than the
conventional socially acceptable timings i.e. feeling extremely sleepy in late afternoon
and evening hours and earlier wake up time (between 2 - 5 am) than desired. This is
generally found with aging. Shortened circadian time due to mutation of circadian
clock gene is one of the causes for ASPD. The most reported complications of this are
alcoholism, sedative and other drug abuse. The usual treatment is exposure to light in
evening so as to suppress their melatonin secretion and postpone the sleep. Patients
are encouraged to take melatonin supplements in early morning hours so that sleep is
continued and wake up after sunrise.

32
Jet lag disorder: Is a temporary misalignment of circadian clock due to travel across
at least two different time zones. The symptoms like disturbed sleep, generalized
weakness, decreased day time attention, mood disturbance etc occurs with one or two
days of travel. The severity of symptoms depends on the number of time zones and the
direction of travel. Travelling from east to west is less severe than travelling from west
to east ward. The sleep problems parse with eastward travel include difficulty in falling
asleep and awakening next day, whereas, with west bound travel individual
experiences excessive sleepiness in evening and early morning awakening. The
treatment of jet lag syndromes is focused bringing desired sleep and wake time in
accordance to destination travelled with improving nocturnal sleep and increasing day
time alertness. However, if the stay in the destination is for 2 days and less, then
measures taken for circadian adaptation will be counterproductive. In the measures to
be taken, planned exposure or avoidance to light is advised. Travelers towards east,
are advised to avoid light exposure in early morning (enhance melatonin secretion) and
expose to bright light in late morning and afternoon (decrease melatonin secretion). In
west ward travel, expose to light during afternoon and early evening, not to go to sleep
till nighttime of the place. However, with melatonin (0.5 to 10mg) administration
during early evening hours well in advance before the travel towards east and during
night time at the destination, the severity of jet lag syndromes can be minimized.
Shift work disorder: Characterized by history of excessive sleepiness during the day
and insomnia during sleep period at least for one month due to unconventional work
secludes. This will bring impaired work performance, decreased alertness and
cognition there by increasing the risk of accidents in the work place. This is associated
with higher incidence of cardiovascular comorbid conditions, metabolic syndromes,
endometrial and breast cancer etc., Exposure to intense light during night work and
avoiding light during day respectively will help to reduce sleepiness during work and
to induce sleep in the day. Exposure to light during night works hours should be to
1000 -10,000 lux until 2 hours prior to end of the shift. Melatonin consumption before
bed will enable good sleep, but, do not improve the alertness during work. Therefore,
melatonin and light therapy should be combined in individuals with shift work
disorder.
In addition to these circadian rhythm disorders, melatonin administration in old
age aids in preventing many neurodegenerative conditions, insomnia, neuropsychiatric
conditions like depression as mentioned above, in schizophrenia, eating disorders,
intractable epilepsy etc., Interestingly, meditation (Vipassana) is known to enhance
endogenous melatonin levels across age groups in experienced practitioners (Ravindra
et al, 2012). Apart from therapeutic potential, melatonin role as an antioxidant,
immune enhancing, oncostatic; hence, its supplement has positive role in maintaining
general health and wellbeing as well.

33
References:
1. Lerner. Isolation of melatonin,pinalfactorthat lightens melanocytes. J Am
Chem Soc.1958; 80:2587.
2. Lerner. Structure of mealtonin. J Am Chem Soc.1959; 81:6084.
3. Lewy AJ, Sack RL. The dim light melatonin onset as a marker for circadian
phase position. Chronobiol Int. 1989; 6:93-102.
4. Karasek M, Winczyk K (2006) Melatonin in humans. J Physiol
Pharmacol.2006; 57 Suppl 5:19-39.
5. GC Verster .Melatonin and its Agonists, Circadian Rhythms and Psychiatry.
Afr J Psychiatry.2009;12:42-46,.
6. Denis Martinez & Maria do CarmoSfreddo Lenz. Circadian rhythm
sleep disorders. Indian J Med Res.2010; February 131, pp 141-149,
7. Phyllis C. Zee,HrayrAttarian,AleksandarVidenovic. Circadian
Rhythm Abnormalities. Continuum (MinneapMinn).2013;19(1):132–147.
8. Robert L Sack, Robert L Sack, Dennis Auckley, R. Robert Auger,
Mary A. Carskadon, Kenneth P. Wright Jr, Michael V. Vitiello,
Irina V. Zhdanova.An American Academy of Sleep Medicine Review
Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work
and Jet Lag Disorders. SLEEP.2007; 30( 11): 1460-1483.
9. Robert L Sack, Robert L Sack, Dennis Auckley, R. Robert Auger,
Mary A. Carskadon, Kenneth P. Wright Jr, Michael V. Vitiello,
Irina V. Zhdanova.An American Academy of Sleep Medicine Review
Circadian Rhythm Sleep Disorders: Part II, Advanced Sleep Phase
Disorder, Delayed Sleep Phase Disorder, Free-Running Disorder, and
Irregular Sleep-Wake Rhythm SLEEP.2007a; 30( 11):1484-1501.
10. Ravindra P.N, NirmalaMathurai,Bindu M Kutty „ Meditation
its regulatory effect on sleep‟ Frontiers in Neurology.
April 2012; 3(54): 1-3.

34
Chronotherapeutics
Prof. K Manimekalai. MD
Professor Head, Department of Pharmacology,
Mahatma Gandhi Medical College & Research Institute,
Sri Balaji Vidyapeeth Deemed University, Pondicherry
Chronotherapeutics is the delivery of medications in the right concentration to the
right targeted tissues at the right time to meet biological rhythm-determined needs,
e.g., rhythms in the mechanisms of disease, symptom intensity, and/ or patient
tolerance, to optimize desired and minimize and avert adverse effects. The following
are the diseases with established oscillatory rhythm in their pathogenesis
1. Asthma
Symptoms of asthma occur 50 to 100 times more often at night than during the day.
Cortisol levels were highest at the time of awakening and lowest in the middle of the
night, and histamine (a mediator of broncho constriction) concentrations peaked at a
level that coincided with the greatest degree of bronchoconstriction at 4:00 am.
2. Pain
The sensitivity threshold of the gingiva to a cold stimulus was maximal at 18:00 h and
reached a peak at 03:00 h (35% difference). Tooth sensitivity was lowest between
15:00 and 18:00 h; with a peak in pain intensity at 08:00 h (160% increase).The peak
of morphine use occurred at 09:00 h and was the least at 15:00 h in patients
undergoing elective surgery. The peak demand for morphine or hydromorphone
occurred in the early morning and was lowest during the night in postoperative
gynecologic patients.
3. Arthritis
Patients with osteoarthritis tend to have less pain in the morning and more at night;
while those with rheumatoid arthritis, have pain that usually peaks in the morning
and decreases throughout the day. Chronotherapy for all forms of arthritis using
NSAID‟s such as ibuprofen should be timed to ensure that the highest blood levels of
the drug coincide with peak pain. For osteoarthritis sufferers, the optimal time for a
non-steroidal anti-inflammatory drug such as ibuprofen would be around noon or
mid-afternoon. The same drug would be more effective for people with rheumatoid
arthritis when taken after the evening meal.

35
4. Cardiovascular diseases
Several functions (e.g. BP, heart rate, stroke volume, cardiac output, blood flow) of the
cardiovascular system are subject to circadian rhythms. For instance, capillary
resistance and vascular reactivity are higher in the morning and decrease later in the
day. Platelet aggregability is increased and fibrinolytic activity is decreased in the
morning, leading to a state of relative hypercoagulability of the blood. Numerous
studies have shown an increase in the incidence of early-morning myocardial
infarction, sudden cardiac death, stroke, and episodes of ischemia. BP is at its lowest
during the sleep cycle and rises steeply during the early morning awakening period.
5. Duodenal ulcer
In peptic ulcer patients, gastric acid secretion is highest during the night. Suppression
of nocturnal acid is an important factor in duodenal ulcer healing. Therefore, for active
duodenal ulcer, once daily at bed time is the recommended dosage regimen for
H2antagonists. At nighttime, when gastric motility and emptying are slower, drug
disintegration, dissolution, and absorption may be slower.
6. Hypercholesterolemia
Cholesterol is synthesized during the night as well as during daylight; however the
maximal production occurs early in the morning, i.e. 12 h after the last meal. Studies
with HMG CoA reductase inhibitors have suggested that evening dosing was more
effective than morning dosing.
7. Diabetes
The goal of insulin therapy is to mimic the normal physiologic pattern of endogenous
insulin secretion in healthy individuals, with continuous basal secretion as well as
meal-stimulated secretion. Providing basal insulin exogenously to patients with Type 1
diabetes inhibits hepatic glucose production. Exogenous administration of mealtime
doses promotes peripheral glucose uptake (i.e. it prevents postprandial increases in
blood glucose concentration) as well as reducing hepatic glucose release.

36
Therapeutic potential of music: chrono-biological and traditional
perspectives
Prof. Sumathy Sundar. PhD
Director, Centre for Music Therapy Education and Research
(CMTER),
Mahatma Gandhi Medical College and Research Institute,
Pondicherry
Chronobiology is the science of understanding of biological rhythms in respect of life,
health and disease observing the cyclical repeated variation in a biological function
that gives a time sense to every living organism. However the roots of chronobiology
can be traced back even in the Vedic traditions in Indian culture roughly 4000 to 4500
years ago. Ayurvedic physicians of the Vedic period indicated three phases in which
the activation of certain bodily functions is sometimes stronger, sometimes weaker
and coined the terms vata, pitta and kapha to express this phenomenon. Evidences
have also been documented linking cycles of time with musical performances in
ancient times and recorded relation between scales and the different bodily functions.
Time theory of ragas prescribes specific time to perform specific Indian ragas
according to the tonal characteristics corresponding to vata, pitta and kapha biological
cycles in the human body. This presentation deals in detail with the ancient wisdom
or the art of understanding the biological rhythms, entraining and resetting them
through music as an external stimulus and how far these ideas are explored and
integrated in the modern music therapy, clinical practice and research and integrative
medicine. This paves way for deep understanding of the patterns of biological rhythms
and the mutual relationships between music, health and illness and also preserve the
health and promote healing under integrative medicine.

37
Adaptive resilience exercises as envisioned in yoga
Yogachemmal Dr Meena Ramanathan. PhD (Yoga).
Coordinator-cum-Yoga therapist,
Yogacharya Dr Ananda Balayogi Bhavanani. MBBS, MD
(AM).
Deputy Director,
The tree that bends doesn’t break!
As human beings, it is inevitable that we have our share of ups and downs. Something
always pushes us down, throws us off-balance and makes us uneasy. During such
moments, it is imperative that we stop, take a step back and observe ourselves
objectively to understand how long it takes us to bounce back to normalcy once again.
The faster we can disentangle ourselves from events of the past, the faster we begin
experiencing freedom in the present.
This is where Yoga comes in, to rescue us from this vicious negative spiral of mental
and emotional whirlpools that suck us down into the depths of despair. Yoga may be
understood as a conscious and evolutionary path that enables us to break free from
our conditioned patterns (samskara) that take us nowhere.
Yoga teaches us that we need to make conscious choices to do the following:
1. Let go of the negativities beseeching us (doshanivarana),
2. Regain our balance, equipoise (samatvam) at the earliest,
3. Relax ourselves so that we can rebuild and replenish our resources (nishpanda
kaya kalpaanukrama).
4. Empower ourselves to efficiently face „repeat challenges‟ by:
a. Adopting healthy attitudes (pratipakshabhavanam, maitri-karuna et al),

38
b. Enhancing flexibility of body, mind, emotions and spirit (hatha yoga),
c. Developing objective self-awareness (vairagya, swadhyaya)
d. Creating positive relationships through acceptance (samabhavabhavana).
Mind, body and emotions of the individual are harmonised and brought into a state of
balance by the various Yoga techniques. The practice of jathis and kriyas helps loosen
up inherent tensions, stresses, and regressed emotions. They can be then thrown out
through conscious breath-body-mind workouts such as nasargamukhabhastrika and
the pawanmukta series. Nada Yoga techniques that utilise sound power like the
hakarakriya, brahma mudra and bhramari pranayama are efficient methods to release
pent-up tensions. These practices produce psycho-somatic energisation and create a
beautiful mind-body harmony, stabilising emotions thus teaching us to „let go and be
free‟. Through Yogic relaxation techniques such as shavasana, we consciously
overcome our self-defeating tendencies and re-invigorate ourselves physically,
mentally, and emotionally.
Many studies have reported that Yoga reduces allostatic load and induces balance of
autonomic nervous system. This is the keystone in developing adaptive resilience. The
very sound of the word resilience captures its bouncy, rubbery quality. Yoga enables
an alignment of panchakosha, the five sheaths of existence - the body, breath,
emotions, intellect and spirit. Jnana yoga kriya-s and prakriya-s enable inherent
healing energies to integrate, reunite and bring together fragmented parts of the
individual thereby enhancing such adaptive resilience.
Yoga also empowers the spirit, developing a deep and subtle adaptive resilience that
promotes the skilful stepping beyond of one‟s limitations, enabling self-transformation
(atmabhavabhavana). This facilitates insight, empathy and an ability to calm and
focus the mind, thus ultimately transcending all limiting traits of the individual. Such
a transformation of the individual until they manifest their fullest potential, and live
life as it is meant to be, is truly the goal of Yoga itself.

39
Pranayam and its physiological basis
Prof. Madanmohan. MD, DSc, FIAY
Professor & Head, Department of Physiology, MGMC& RI
&
Director, Center for Yoga Therapy, Education & Research
(CYTER),
Vedic concept of universal, divine pran occurs in many ancient scriptures. Pran is the
omnipresent energy whose Divine source Paramatma is called as pranasyapranah
(Ken Upanishad, 1:2). On the physical plane, pran manifests as physical energy like
light and heat and this whole universe vibrates with pran (Kath Upanishad, 6:2). On
the biological plane, pran manifests as life energy (“ki” in reiki) and acts as a catalyst
in our all activities. In Bhagavadgita (15:14), YogeshwarKrishn says that “Pran
manifested as digestive power, it is I who digests the food”. Being superior, holy and
higher power (Brhdaranyak Upanishad, 6:1:1), pran should be used only for higher,
noble purposes and never for lower pursuits.
Breathing is the most tangible expression of pran and pranayam is an ingenious
method for enhancing our vitality by drawing pran from inexhaustible and
omnipresent universal source. Pranayam means conscious expansion of pran (the life
force) and is the 4th limb of Patanjali‟sashtang (8-limbed) yoga. Yoga is holistic and
pranayam is best practiced as a component of full, holistic yoga discipline. There are
many types of pranayams. Some involve rapid breathing whereas others involve slow,
uniform breathing, with or without ratio between the phases of respiration. Yoga is a
psychosomatic technique. Pranayam breathing should be uniform and with meditative
awareness. Thus performed, pranayam enhances one‟s ability to combat physical as
well as psychological stress.
From the physiological point of view, pranayam is of great significance. Deep breathing
with maximum contraction of diaphragm and intercostal muscles results in:
1. Massage of abdominal viscera and improved venous return.
2. Stretching of all parts of thorax and lungs with resultant increase in compliance
and vital capacity.
3. A definite pattern of proprioceptive input from thorax and abdomen. This, along
with a pattern of activity in respiratory center may modulate the neuronal
activity of other medullary centers/brain areas.

40
4. Fluctuations in blood gas content and altered proprioceptive input may alter
the sensitivity and activity of chemo reflex and other neuronal circuits.
5. Breathing meditatively with full concentration results in conscious alteration of
cerebral activity and improves mind-body coordination, the goal of yoga.
Rhythmic breathing in a relaxed state of mind (e.g. savitri pranayam) can produce
deep psychosomatic relaxation and significant decrease in oxygen consumption within
a few minutes. (Madanmohan et al. The Yoga Review, 3: 25-34, 1983).

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Melatonin & chronobiology
Dr. Suchitra B Parkhad
Assistant Professor, Department of Physiology
Mahatma Gandhi Medical College & Research Institute
Melatonin, also known as the “mother hormone of chronobiology,” is a hormone made
in the pineal gland due to cues from the supra-chiasmatic nucleus of the
hypothalamus, which regulates the circadian rhythm. When the retinas stop sensing
as much blue wavelength light, the supra-chiasmatic nucleus senses this and induces
the pineal gland to begin making melatonin. When early morning light is sensed by the
retinas, melatonin production is ceased and hormones associated with wakefulness
are made instead. This cycle helps to create a circadian rhythm, or 24-hour sleep-
wake cycle.
Melatonin has a very short half-life of about 30 minutes. Because it breaks down so
quickly, it must be made continuously throughout the night in order to sustain restful
sleep. In people with a healthy circadian rhythm, melatonin levels rise rapidly after
dark and plateau throughout the night until early morning. These high levels are
essential not just for falling asleep, but for sleeping deeply and restfully. Melatonin
levels then drop sharply in the early morning to allow people to wake up in response to
increasing light levels.
The dangers of sleep disturbances & melatonin deficiencies
Chronic sleep disturbance in an average of three out of seven nights raises the
likelihood of heart attack, stroke, diabetes, vascular disease, and medically
problematic obesity considerably.
A team at the University of Pennsylvania is analyzing the huge data collection from
more than 130,000 people (average age of 46) for the first time, and was able to draw
the following conclusion: Even minimal interference with sleeping in, sleeping soundly,
as well as sleeping too much can make a big difference. The risk for obesity increased
by 35%, for diabetes by 54%, and for cardiovascular illness by 98%, and the risk for
stroke doubled.
Researchers of the Harvard Medical School are concentrating on the 90 to 120
minutes every night that provide healthy people with actual deep sleep. They recruited
784 men with normal blood pressure who allowed their sleep cycles to be monitored at
home with the help of a small machine. This was done for 42 months.

42
Normally deep sleep makes up about 25 percent of one night. In this phase brain
activity is weakened and the heartbeat and the disbursement of stress hormones are
reduced. Blood pressure readings during this time are typically 10 points lower than
normal. Nightly pressure decline is seen as very positive. However, a condition in
which the pressure stays low is seen as a risk factor for heart conditions.
The results were, that those men who had a noticeably shorter regeneration phase,
reacted with increased blood pressure of dangerous proportions (several of those
monitored only reached four percent of deep sleep, or fifteen minutes). Most of these
generally had interrupted and shortened sleep.
As mother hormone of chronobiology, melatonin not only directs sleep patterns, but
also the activity of all organs. One consequence is that with age the frequent lack of
melatonin affects the liver negatively by leaving it without a sense of direction at night,
which in turn impacts the glycol-metabolism.
Aging &melatonin production
Not only are modern humans the only living creatures who diverge from their rhythms
and turn night into day – the older we get, the lower the nightly production of
melatonin becomes, and the shorter the signal it transmits to the other glands
becomes. Often, it does not become active until well after midnight. At daybreak,
however, the secretion of this hormone continues to stop on time. The result is that
older people are exposed to the sleep hormone for a time span that is much too short,
and the hormone becomes available less and less overall.
For the older pineal gland sufficient nighttime production of melatonin is no longer
possible, even when the body is exposed to complete darkness. The pineal gland is
heavily supplied with blood and like other areas with vessels, it is predestined to suffer
from calcification–this leads to pronounced insomnia.
Melatonin deficiency is also reflected in the disrupted rhythmicity of the downstream
hormone systems. A decrease in female sex hormones may be a factor in the early
onset of menopause. It also threatens to slow down the production of the growth
hormone HGH, also called the “vitality hormone.” Insufficient melatonin also affects
the liver, when it is not effectively programmed at night. This can cause insulin
resistance, which can lead to diabetes. In addition, the urge to urinate at night
remains at a daytime level when a special anti-hormone (ADH) is missing due to a lack
of melatonin.
Melatonin deficiency has particular effects directly on the brain. All nightly repair
mechanisms become diminished. The storing of information into long-term memory,
which takes place at night, is impeded. This increases the susceptibility to early-onset
dementia and neurodegenerative processes.
The British Journal of Ophthalmology recently published an alarming connection
between aging eyes and the production of melatonin. Measurements demonstrate that
after 45 years of age less rays of sunlight reach the inner eye. This is a result of subtle
yellowing of the ocular lens and narrowing of the pupil. Because of this, less light
particles reach the key cells of the retina which are dependent on the day and night

43
rhythm to regulate our internal clocks. Studies show that the changes in the aging eye
lead to a number of typical eye ailments, for which the cause is not searched for in the
eye itself. Consequences of the deterioration of eye performance include cognitive
deficiencies (especially memory capacity), sleeplessness, depression, and lengthened
reaction times.
Our internal clocks react to the changes in light and dark, and manage our circadian
rhythms. They give each organ an impulse for daily and nightly tasks. The brain, for
example, saves the information gathered during the day as long-term memory, or
deletes it entirely. These trigger signals are transferred especially through the mother
hormone of chronobiology, melatonin. Older people, however, only have a fraction of
this neurotransmitter available. This leads not only to widespread problems of staying
asleep in the morning and throughout the night, but also to impairment of the correct
daytime activities of major organs, for example the liver or nerves, in the course of a
24 hour day.
Melatonin supplements
Recent studies in chronobiology have indicated that melatonin supplements can help
treat circadian sleep disorders as well as a variety of sleep-related issues. However, not
all melatonin supplements are created equal. The way melatonin supplements are
metabolized can have a huge effect on physiological levels and effects of this hormone.
Studies in circadian biology have shown how important melatonin levels are to
maintaining a natural human sleep-wake pattern. In fact, studies have found that
many sleep disorders improve significantly with melatonin supplementation. However,
some people find that melatonin doesn‟t work as dramatically as they expected. They
may assume that melatonin is not a useful treatment for their sleep issues when, in
fact, they could be simply taking the wrong kind of melatonin supplement.
The most common types of melatonin supplements are fast release and slow release.
Fast release melatonin causes a sharp spike in melatonin levels that drops off after an
hour. People who use this type of melatonin supplement may find that they are
immediately sleepy but have trouble remaining asleep or do not get high quality sleep.
Slow-release melatonin, on the other hand, takes hours to build up to sleep-inducing
levels and then does not wear off in the early morning. People who take slow release
melatonin may have trouble falling asleep due to low melatonin levels, followed by
difficulty waking up because the levels are unnaturally high.

44
Timed-Release Melatonin: A Better Option for Maintaining Natural Circadian
Rhythms
Timed-release melatonin is a supplement that is formulated to be released in amounts
that mimic healthy, natural melatonin levels. It is metabolized so that levels rise
sharply after the supplement is taken and then remain at a high plateau for several
hours. Levels then drop sharply to allow for waking. This mimics the healthy, normal
circadian rhythm cycles that are linked to restful sleep.
Research in chronobiology has shown that maintaining melatonin cycles is important
not just to restful sleep but also to overall health. For this reason, an increasing
number of health experts are recommending timed-release melatonin as the ideal
melatonin supplement. It more closely correlates to the natural levels of melatonin in a
healthy brain. Maintaining a healthy circadian rhythm is important to health, so
timed-release melatonin supplements are usually the best option.

45
POSTERS

46
Physiological significance of retinal melatonin
Qurratul Ain Sayeed
Dept. of Physiology, DCMS, Hyderabad
The circadian signaling molecule, melatonin, is secreted into the circulation from the
pineal gland, and is also produced within specific ocular cells such as retinal
photoreceptors, ciliary epithelial cells, and perhaps cells of the lens.In addition many
ocular tissues themselves exhibit circadian rhythm activity to optimize specific
processes which require coordination with the light-dark cycle.Melatonin receptors
have been identified in many ocular tissues, including the neural retina, retinal
pigment epithelium, ciliary body, cornea, sclera, and lens.
This mini paper tries to review physiological significance of ocular melatonin in a very
brief manner including following points.
1. Melatonin causes aggregation of melanin in RPE and clumping of pigment granules
in the chromatophores in choroid. It activates disc shedding in rod photoreceptors,
and elongation of cone photoreceptors. Melatonin blocks apoptosis after
experimentally induced RPE cell ischemia.
2. Synthesis and diurnal rhythm of retinal melatonin are independent of the pineal
gland. Pinealectomy had no effect on ocular melatonin levels and a diurnal rhythm
continued.
3. Retinal melatonin synthesis is elevated at night and decreased during day as a
result of rhythmic regulation by a circadian oscillator, or clock
4. Retinal dopamine appears to act through D2 receptors to suppress melatonin
synthesis and to entrain ocular circadian oscillator.
5. Light inhibits melatonin synthesis and entrains circadian rhythms.
6. Pineal melatonin (but not retinal) has an important role in the control of circadian
rhythms.
7. Retinal melatonin may be a modulator of intraocular pressure and melatonergic
mechanisms in the eye could be responsible for the diurnal rhythm in IOP.
8. Studies show an Inhibitory effect of melatonin on cataract formation in newborn
rats and may be an evidence for anti-oxidative role for melatonin.

47
Virgin olive oil reduces dental plaque formation
Mahantayya V Math1, Rohit B Gadda 2, PradnyaJadhav 3, NehaPatil 4, Yashoda
R Kattimani 5, RS Inamdar 6
1, 5, 6 Department of Physiology, MGM Medical College, 2, 3, 4 Department of Oral Medicine
and Radiology, MGM Dental College, Navi Mumbai
Introduction: Oral cavity has a complex and changing environment. Dental diseases
are affecting a large number of people in both the developed and developing countries.
Diurnal variation is seen in salivary osmolality. Salivary secretion is reduced at night
and salivary osmolality is highest at 7 am in the morning. Mild dehydration is a risk
factor for dental disease. Virgin olive oil has low surface tension and is rich in
monounsaturated fatty acids, phenolics and antioxidants.
Objectives: This study was done to determine the plaque inhibitory action of virgin
olive oil using a plaque re-growth model and compare the effect of virgin olive oil with
distilled water on plaque index
Materials and methods: 17 healthy young volunteers participated in this study A
randomized, controlled, cross-over design was used. The subjects were asked to swish
thoroughly for 5 minutes with 3 ml of virgin olive oil or distilled water in the morning
and at night before going to sleep and then swallow. They were told to use water or
olive oil from Monday to Friday twice daily (10 swishing in total), and were instructed
not to use any other oral hygiene product during this period. Dental plaque was
assessed with plaque disclosing agent (Alphaplac).at the beginning and end of the
study.
Results: The mean plaque index with virgin olive oil use was (mean ± SD) 1.476 ± 0.36
and with use of distilled water 2.3±0.386 (p<0.001)
Conclusion: Use of virgin olive oil twice a day (in the morning and at night) is effective
in decreasing dental plaque compared to that observed with distilled water.

48
Comparative study of pulmonary function tests in early smokers,
chronic smokers and non-smokers
Manjushree R, Suresh Y, Bondade, Smilee Johncy S
Department of Physiology, JJM Medical College, Davangere
Introduction: Smoking is the malicious curse of world today. Smoking related
diseases kill one in ten adults globally. Smoking is the main risk factor in the
development of Chronic obstructive pulmonary disease (COPD), and smoking
cessation is the only effective treatment for avoiding or reducing the progression of this
disease.
Objective: To study the differences in pulmonary function test values in early-
smokers, chronic-smokers and non-smokers.
Materials and methods: In cross sectional study, spirometry data were collected by
RMS Helios 401 computerized spirometer. Expiratory flow volume curves were
recorded and FVC, FEV1, FEV1/FVC ratio, PEFR, FEF25-75%were obtained. The data
were compared between early smokers, chronic smokers and non-smokers group
&statistically analyzed usingSPSS software and ANOVAtest
Results: Pulmonary function test(PFT) parameters FVC,FEV1, PEFR, FEF25-75% and
MVV were significantly reduced in chronic smokers group compared to non-smokers
group (p<0.05).FEV1was the initial parameter to be declined in early smokers. The PFT
parameters markedly decrease with increase number of cigarette smoked per day as
well as increase duration of smoking.
Conclusion: The present study brings out substantial variation in most of the
parameters of PFTs between early smokers, chronic smokers and non-smokers
confirming PFT values are less in chronic smokers due to toxic effects of tobacco
smoking on respiratory system & is the major cause of obstructive lung disease in
Indian population. It also reveals that smoking cessation improves the accelerated
decline in FEV1which indicates that smoking cessation positively influences
remodeling processes in lungs. These results can be used to convince people to quit
smoking.

49
Depression, anxiety and stress among junior science college
students
Sanghamitra Panda, Ashok Kumar Dash
Shadan Institute of Medical Sciences, Hyderabad
Introduction:Adolescence is a transitional stage marked by rapid changes in physical,
cognitive and emotionaldevelopment. Presence of conditions like depression, anxiety
and stress at this age is a matter of concern. Teen stress is an important health issue.
Objective: To study the depression, anxiety and stress among adolescent junior
college girls.
Material and method: A cross sectional study was conducted in a junior science
college, 240 girl students belonging to class 11th and 12th were recruited for the study.
Among them 87 students were day scholars and 153 students were staying in the
hostel. DASS 21 questionnaire was used to assess depression, anxiety and stress
among the students. Sleep pattern of all the students were sought and it was found
that average sleep duration was less than 7 hours per day.
Results: The scores in the three domains were found to be remarkably high. It was
found that depression and anxiety was more in students in comparison to stress.
DASS score was found to be more in students residing in the hostel viz. depression
(77.125%), anxiety (75.164%), stress (45.099%) in comparison to day scholars viz.
depression (72.414%), anxiety (67.817%), stress (40.230%).
Conclusion: Depression, anxiety and stress among the students were found to be
quite high. Educational institutions need to identify the prevalence of negative mental
health states among students especially high risk students and preventive measures
should be undertaken to reduce the mental stress.

50
Chronobiology and irritable bowel syndrome
Prabhavathi K, Hemamalini RV, Thamaraiselvi K, Christy A, Saravanan A
SRM MCH & RC, Potheri
Chronobiology is one of most studied topics in modern medicine as it links between
the body‟s internal clock and health almost every day. Studies in circadian biology
showed a link between disrupted sleep cycles and irritable bowel syndrome (IBS).
Supra-chiasmatic nucleus the central pacemaker of our brain is known to dictate a
variety of hormonal processes and physiological activities of GIT explaining the fact
“We are what and when we eat”. Around 10% of our genes fluctuate in activity
according to the time of day which is involved in the health and function of the
digestive tract. Research has found that Non-REM sleep enhances the
parasympathetic nervous system to aid in the digestion of food and sympathetic
nervous system slows the digestion during REM sleep. This balance is crucial for
sustaining good gut health. Also hormones associated with digestion like ghrelin,
insulin, leptin, orexins, neuropeptide Y, VIP, serotonins are released periodically
throughout the day. Thus the molecular basis for circadian timing in GIT involves
transcriptional /translational feedback loop which culminate in rhythmic expression
and activity of a set of clock genes and related hormones which is responsible for
periodic activity of various segments and transit along GIT. In IBS there may be a lack
of hormonal regulation along with the alternating cycles of autonomic activity. People
with diarrhea predominant type of IBS, have very different autonomic activity from the
normal people during sleep. Also melatonin produced by neuroendocrine cells of GIT
mucosa, plays an important role in the internal biological clock. Clinical studies have
demonstrated that administration of melatonin improve symptoms with IBS.
Thus Mind-brain-body-gene frame work, including the role of chrono-nutrition is
probably implicated in the genesis of IBS, which may further help in diagnosis and
treatment of IBS in shift duty workers with impaired circadian rhythm.

51
Sleep deprivation and disruption of bio-clock in medical students
Madhuri Taranikanti, Sanghamitra Panda, Nikhat Yasmeem, Siddique A R O
Department of Physiology, Shadan Institute of Medical Sciences, Hyderabad
Introduction: One of the major problems in today‟s modern world is the component of
artificial light and working hours during the night time. Also, urban lifestyle involves
sleeping late in the night and exposure to bright lights contributing to derangement of
the normal bio-clock. Medical students are faced with the problem of managing time
with the hectic schedule in order to cover the vast syllabus and are often under stress
to reach their targets with changes in their lifestyle acting against the normal
circadian rhythm. The aim of the present study is to look for pathophysiology of
diseases if any caused by sleep deprivation in medical students as understanding this
mechanism seems to be the present major challenge. The objectives of the study are to
see the association between duration of sleep and levels of blood pressure and blood
sugar.
Material and Methods: I MBBS students, both male and female were included in the
study. They were asked to fill out a form about their sleep pattern like time of sleeping
and waking up and the reason for sleeping late. Anthropometric measurements, blood
pressure and blood sugar were recorded twice in the day.
Results: Students with reduced hours of sleep had changes in BP and blood sugars
from morning to evening and their BMI was higher. The values were close to pre-
hypertensive and pre-diabetic ranges. Students who maintained regular timings for
sleep and waking up had less or no changes.
Discussion: It is seen that sleep deprivation can lead to a variety of metabolic
derangements including fluctuation in blood pressure and blood sugar levels. Medical
students who slept late in the night were exposed to artificial light for a longer
duration which may cause suppression of melatonin and disruption of bio-clock of the
body. Also, there is scope for eating late into the night causing weight gain and obesity
which further causes sleep disruption forming a vicious cycle.
Conclusion: There is a need to intervene and sensitize medical students about the
need to maintain a disciplined lifestyle by including techniques that relieve stress into
the hectic curriculum.

52
Therapeutic implications of the circadian clock on skin function
Amal Philip, Ashwini Dhandayutham
Government Villupuram Medical College,Villupuram
Introduction: Circadian rhythm is any biological process that displays an
endogenous oscillation of about 24 hours. The human circadian clock ensures that
biochemical and physiological processes occur at the optimal time of day.
Circadian pacemaker in skin: Like the central circadian pacemaker, some rhythmic
oscillations are there for the functioning for peripheral tissues like skin. The skin's
chronobiologic functioning influences i) skin aging ii) cell repair (iii) development of
skin cancers iv) DNA repair and copying
Circadian rhythm in skin:The skin is uniquely positioned at the interface between
body and external environment. Predictable daily periodicity has been reported in i)
skin cell proliferation rates ii) hydration and trans-epidermal water loss iii) capillary
blood flow iv) temperature v) surface pH
Therapeutic implications:
Skin Cancer: Stem cells in epidermis reproduce mainly at night. Hence skin cancer
treatments involving chemotherapy is most effective when planned to coincide with
skin cell cycle.
Role of melatonin: Melatonin acts as a potent antioxidant and anti-aging substance
and plays a role in controlling hair growth, development of melanoma, suppression of
UV light induced damage. Lower melatonin levels during the day may inhibit the skins
ability to repair UV rays induced DNA damage and the harmful effects of reactive
oxygen species.
Conclusion: Chronobiology is an emerging field that is proving to be more and more
important in human health. Understanding CLOCK (Circadian Loco motor Output
Cycles Kaput) genes and their effects on skin cells may be an important way of
preventing skin cancer, premature aging, and a variety of skin disorders.

53
Effect of work shift timings and sleep pattern on circadian rhythm
in urban population of Hyderabad
Anuradha G, Joya Rani D
Gandhi Medical College, Secunderabad
Introduction: Sleep is an important regulator of circadian rhythm. Changes in
working timings of individuals may affect the normal sleep pattern. Reaction time is an
important aspect of circadian rhythm. Reaction time plays important role in our day to
day activities like driving, crossing a road, working in industries etc.
Materials and methods: A total 40 subjects are divided in to two groups of 20 each.
Group A includes day shift and Group B includes night shift workers. Test for simple
visual reaction time was conducted at 9 am and 9 pm for both the groups using
garydar computer software. Females between 20-25 years of age were included in the
study. Participants with hypertension, diabetes mellitus, visual and hearing problems,
alcoholics, smokers, yoga practitioners & regular sports persons were excluded.
Results: Mean simple visual reaction time for group A and group B (mean ± SD) are
0.32±0.08 and 0.44±0.14 which was statistically significant.
Conclusion: Simple visual reaction time is prolonged in night shift workers than day
shift workers. There is more sleepiness in night shift workers at the end of the work
shift than day shift workers.

54
Assessment of cardiac sympatho-vagal activity of sedentary
overweight and obese young females
Latha Ramalingam1, Rajalakshmi R2
1.Department of Physiology, Shri Sathya Sai Medical College and Research Institute,
Kanchipuram2.Department of Physiology, Indira Gandhi Medical College and Research
Institute, Puducherry
Introduction: Heart rate variability (HRV), also known as R-R interval variability,
represents the cardiac autonomic status of the individual. Several factors are known
to affect the HRV and reduced HRV is associated with increased risk of cardiovascular
morbidity and mortality. In today‟s world, increase in the standard of living,
consumption of junk food and sedentary lifestyle are emerging as major risk factors for
cardiovascular disorders among the young population. Several studies have shown
that young sedentary obese males have reduced HRV. However, there are not many
studies which have explored the changes in HRV indices in young sedentary females
with BMI above the normal range.
Objective: The aim of this study was to assess the cardiac sympatho-vagal status of
young sedentary overweight and obese females.
Materials and methods: A total of forty females aged 18 to 25 years were recruited in
the study. Categorization of sedentary behavior was done using the IPAQ
questionnaire. Based on the BMI (WHO guidelines for Asian population), subjects were
divided into test group (BMI >23 Kg/m2 & W/H ratio>0.8, N=20) and control group
(BMI = 18 to 23 Kg/m2, W/H ratio<0.8 N=20). Subjects were asked to rest in supine
posture for 10 minutes after which a 5 minute ECG was acquired in lead II
configuration. R-R intervals were acquired from the ECG data and were fed into the
Kubios HRV analysis software to obtain the time domain and frequency domain
indices of HRV.
Results: There was no significant difference between the test and control group with
respect to time domain indices. With respect to frequency domain indices, LF power,
HF power and total power did not show significant differences. However, LF nu was
significantly high (p=0.043), HF nu was significantly low (0.043) and LF/HF ratio was
significantly high (p=0.05) among the test group individuals.
Conclusion: Apparently healthy young sedentary overweight and obese females have
increased cardiac sympathetic activity and reduced cardiac parasympathetic activity.
This will lead to reduced HRV in these individuals which in turn may predispose them
to the risk of various cardiovascular disorders at an earlier age. Hence, appropriate
lifestyle modifications need to be adopted to prevent the progress of impending
alterations in the cardiovascular status of these young women.

55
Global warming and its effect on health
Thamaraiselvi K1, S.Jayaraman S2, Saravanan A1
1Department of Physiology, SRM Medical College Hospital & Research Centre,
Kattankulathur, 2Department of Economics, Presidency College, Chennai
In the theory of evolution Darwin said that nature selects only the fittest. But human
through their economic activities and indiscriminate use of natural resources have
endangered many species of animals, flora and fauna by destroying their habitats and
consuming them. These activities have created a kind of situations unacceptable to
the nature. This situation is collectively called global warming. This is unsuitable to
the very survival of the human being. Many of the human activities have created non
conducive atmosphere for the survival of the human being itself. The globe which
includes the atmosphere, lithosphere and hydrosphere has been polluted by the gases
and particles either by their presence or excess quantity. Since the industrial
revolution, atmospheric pollution have increased many fold and in faster rate than
which the nature can handle. There is an excess quantity of CO2, CO, Methane,
sulphur, nitrogen, water particles, dust particles in the atmosphere and the
hydrosphere. The causes have been overexploitation of natural resources,
deforestation, and excessive use of fossil fuels, industrial wastages and domestic
wastages both non-biodegradable and excessive biodegradable. In the past fifty years
the atmospheric temperature has increased by 0.75°degree Celsius. This has
increased sea level by melting of the glaciers in the Polar Regions and many climatic
and seasonal changes like abnormal rain fall and cyclones. The ocean‟s surface
temperature has increased by 0.50° C in the last fifty years. By 2100 this may be
increased to 1°C to 3.5° C, the highest increase will result in the increase of sea level
by 7 meters and cause the inundation of many low lying areas.
The health effect of the global warming is very severe in widespread sparing nobody.
Global warming have created conducive atmosphere for host of vectors that carry
disease causing bacteria, viruses, parasites etc. There are frequent outbreaks of
Malaria, yellow fever, dengue, chickengunya etc. There is decrease in productivity,
mental health and above all the reproductive capacity and ability. This has rendered
many infertile and impotent. The future of human being is at the mercy of nature and
technology advancement.
Unless due care is taken to correct the past mistakes and steps taken to prevent
further degradation. Not only the economic sustainability but also the very survival
and the affordability of survival will be at stake, which is in the hands of human
beings.

56
Peripheral blood mononuclear cells: an immune marker
Ihsan V P, Balanaga Nandhini D
Department of Physiology, Government Villupuram Medical College, Villupuram
Introduction: In humans, most physiological and behavioral functions are expressed
rhythmically across days and nights.
Central clock: The circadian rhythms are controlled by a central self-sustained
biological oscillator organized in transcriptional/translational feedback loops involving
several clock genes. Central component of this complex oscillatory system resides in
the suprachiasmatic nuclei (SCN) of the anterior hypothalamus.
Peripheral clock: Molecular clock mechanisms oscillate also in peripheral organs,
such as the liver, kidney, and fibroblast cells. Many immune parameters such as
cytokine synthesis and white blood cell counts fluctuate in a circadian fashion.
Peak clock expression: Peak clock gene expression was observed mostly during the
usual time of activity and light exposure. Peak melatonin concentration is followedby
peak clock gene expression. The oscillation of clock genes in peripheral tissues often
lags several hours behind oscillation of the supra-chiasmatic nuclei.
Immune clock: Circadian clock keeps immune system more active during day time.
The sympathetic autonomic nerves keep them activated during habitual time of
activity. Circadian clock genes are expressed in a circadian manner in human
peripheral blood mononuclear cells (PBMCs), with the peak level occurring during the
habitual time of activity. Oscillation of clock genes in PBMC takes place even in
absence of sleep/darkness which suggests an endogenous nature for this oscillation.
Hence PBMC is an accessible surrogate for the identification of rhythmic clock gene
expression in humans.
Conclusion: Functional circadian machinery in human PBMCs suggests that
peripheral blood cells may be useful for the investigation of human circadian rhythms
and their associated disorders.

57
Gut clock: the implications of circadian rhythm on GIT
Nandagopal S S, Senthilkumari K R
Department of Physiology, Government Villupuram Medical College, Villupuram
Introduction: Circadian and seasonal rhythms are a fundamental feature of all living
organisms and their organelles. Biological rhythms are responsible for daily food
intake. The period of hunger and satiety is controlled by the central pacemaker, which
resides in the supra-chiasmatic nucleus (SCN) of the hypothalamus. Clocks in the GIT
are responsible for the periodic activities which transit along the GIT. They are
localized in special interstitial cells.
Endocrine encoding: Melatonin, produced by neuro-endocrine cells of the
gastrointestinal mucosa, plays an important role in the internal biological clock,
related to food intake and the myoelectric rhythm. This appears to be an endocrine
encoding of the light-dark cycle, conveying photic information.
Effect of disruption of circadian physiology: i) irritable bowel syndrome (IBS) ii)
gastroesophageal reflux disease (GERD) and iii) peptic ulcer disease. It also accelerates
aging, and promotes tumor genesis in the liver and GIT. Disruption of circadian
regulation may also lead to obesity by shifting food intake schedules.
Role of melatonin: The role of melatonin in the regulation of circadian rhythm allows
researchers and clinicians to approach gastrointestinal diseases from a
chronobiological perspective. Clinical studies have demonstrated that the
administration of melatonin improves symptoms in patients with IBS and GERD.
Melatonin significantly protects gastrointestinal mucosa, and has strong protective
effects on the liver in patients with non-alcoholic steatohepatitis (NASH).
Conclusion: Hence the role of clock genes in the pathophysiology of the GIT and liver
is a probe to be discussed in this modern day scenario.

58
Inadequate sleep as a risk factor for neurodegenerative diseases
Hemamalini R V, Prabhavathi K, Thamaraiselvi K, Christy A, Saravanan A
SRM Medical College Hospital & Research Center, Kattankulathur
Inadequate sleep refers to sleep of shorter duration than the average need of seven to
eight hours per night. The cumulative effects of sleep loss have been associated with a
wide range of deleterious health consequences including an increased risk of
hypertension, diabetes, obesity, depression, heart attack, and stroke. Recently it has
also been considered as serious risk factor for neurodegerative diseases like
Alzheimer‟s, Parkinsons disease, Lewy body dementia.
Studies have shown that in those who carried the APOE-E4 gene and who slept most
soundly showed the greatest preservation of memory and thinking skills. Among study
participants who died, the poor sleepers were more likely to exhibit the characteristic
brain plaques and tangles of Alzheimer‟s disease. It was found that those getting less
sleep or sleeping poorly was tied to an increase in brain levels of beta-amyloid, a toxic
protein that builds up and forms plaques in the brains of those with Alzheimer‟s.
Brain scans revealed that individual who slept less than five hours a night had higher
levels of beta-amyloid in the brain than those who slept over seven hours a night.
A SPECT study showed a trend towards decreased dopamine transporter density in
the nigrostriatal regions of the brain and Parkinsonism in the follow-up data of
patients with REM sleep disturbance who had no previous evidence of
neurodegenerative disease. A lack of tracer binding in these regions of the brain is
closely linked to neuronal degeneration and the development of dementia and
movement disorders.REM sleep disturbances also results in Lewy body dementia.
There is an increasing amount of research linking sleep disturbance resulting in
inadequate sleep with increased risk of dementia.
It is extremely important to identify the individuals at risk such as night shift workers
who are sleep deprived, those with sleep apnea which causes them to awaken several
times during the night and those with various sleep disorders. As early detection and
adequate treatment of their sleep problems may reduce the risk of developing neuro-
degenerative diseases.

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