BackgroundLimited treatment options, long duration of treatment and associated toxicity adversely impact the physical and mental well-being of multidrug-resistant tuberculosis (MDR-TB) patients. Despite research advances in the microbiological and clinical aspects of MDR-TB, research on the psychosocial context of MDR-TB is limited and less understood.MethodologyWe searched the databases of PubMed, MEDLINE, Embase and Google Scholar to retrieve all published articles. The final manuscripts included in the review were those with a primary focus on psychosocial issues of MDR-TB patients. These were assessed and the information was thematically extracted on the study objective, methodology used, key findings, and their implications. Intervention studies were evaluated using components of the methodological and quality rating scale. Due to the limited number of studies and the multiple methodologies employed in the observational studies, we summarized these studies using a narrative approach, rather than conducting a formal meta-analysis. We used ‘thematic synthesis’ method for extracting qualitative evidences and systematically organised to broader descriptive themes.ResultsA total of 282 published articles were retrieved, of which 15 articles were chosen for full text review based on the inclusion criteria. Six were qualitative studies; one was a mixed methods study; and eight were quantitative studies. The included studies were divided into the following issues affecting MDR-TB patients: a) psychological issues b) social issues and economic issues c) psychosocial interventions. It was found that all studies have documented range of psychosocial and economic challenges experienced by MDR-TB patients. Depression, stigma, discrimination, side effects of the drugs causing psychological distress, and the financial constraints due to MDR-TB were some of the common issues reported in the studies. There were few intervention studies which addressed these psychosocial issues most of which were small pilot studies. There is dearth of large scale randomized psychosocial intervention studies that can be scaled up to strengthen management of MDR-TB patients which is crucial for the TB control programme.ConclusionThis review has captured the psychosocial and economic issues challenging MDR patients. However there is urgent need for feasible, innovative psychosocial and economic intervention studies that help to equip MDR-TB patients cope with their illness, improve treatment adherence, treatment outcomes and the overall quality of life of MDR-TB patients.

BackgroundPranayama, a branch of yoga practice is extremely beneficial to mankind in maintaining sound physical and mental health and this article aims to attain an insight on the studies conducted on the effectiveness of Bhramari Pranayama (Bhr.P) on health. The studies done until May 2016 were found using Medline, Embase, Google scholar and manual search. Studies conducted on the health effectiveness of Bhr.P specifically were included on the basis of prisma guidelines. The data were defined by their objectives, methodology, study setting, findings, interventions done and implications suggested in the study. Methodological Quality Rating Scale (MQRS) and Newcastle-Ottawa Scale (NOS) were used in reviewing and reporting results of the included studies. 6 studies satisfied the inclusion criteria; 2 studies were done on the cold pressor test, one on heart rate and BP, one on EEG changes, one each on the inhibitory response and tinnitus condition. In the included studies, the Bhr.P practices have shown para-sympathetic dominance. There are some encouraging effects of Bhr.P on various physiological systems. Methodological quality of the included studies was evaluated to be very low and none of them were RCTs. Yet the available studies are heterogeneous, dealing in different grounds and this heterogeneity serves as a resource for the limited scope of studies on Bhr.P. Therefore, further large-scale, properly designed, randomized trials of Bhr.P on various systems have to be done to justify these effects efficiently.

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Prevalence of Non-communicable Diseases (NCDs) are on the increase and there is an urgent need for novel and effective treatment modalities in the management of NCDs. Objective of the current study is to understand the success of one such 'novel' Yoga and Naturopathy based 'Lifestyle clinic' model, executed at various government rural and urban settings in Tamil Nadu, South India. The patient trends and health conditions with which they had visited these Yoga and Naturopathy centers are presented in this article. Method: We retrospectively analyzed the data abstracted from various government Yoga & Naturopathy centers/ Lifestyle clinics in Tamil Nadu, which includes the total number of outpatients, name and frequency of diseases diagnosed and treatments offered. Results: Total number of outpatients who had approached the centers/Lifestyle clinics between the period of 2015 and 2018 was 8,914,820. There was a positive increase in the trend of the number of patients who visited various Yoga and Naturopathy centers on a year-on-year basis since 2015. Of the patients identified, most patients visited the rural centers-National Rural Health Mission (NRHM) (44%). Patients who had visited other centers like District Headquarters Hospital (DHQHpl) and Medical College Hospitals (MCH) were 31% and 25% respectively. Conclusion: Our study suggests that the Yoga and Naturopathy based 'Lifestyle clinic model' is successful in the community and there is a positive increase in trend among patients for utilizing these government centers. Further analysis of the characteristics of patients getting treated would help future researchers to implement stronger clinical evidence and its implementation on a larger scale.