Lasunadi Agada in Lootha Visha Chikitsa - A Review

Agadatantra had a golden time period in Kerala, and was known in the name of Visha chikitsa. There were excellent Visha vaidhyas who used to treat extreme venomous conditions and even predict the condition of patient just through the Dootha lakshana. As a part of these practices, there were numerous textbooks on Visha chikitsa with unique and exclusive Yogas. Some of the books got maintained, and many got ruined. Among those only few practices are still in use in the management if Visha and still many are untouched. Prayoga samucchaya is a well-known traditional Keraleeya Visha chikitsa textbook written by renowned King Kochunni thamburan, which explains the concepts of Visha and its detail management. Lootha visha is a most frequent and important clinical condition that which a physician encounters in their daily practice. It has got importance in all the time, as its manifestation is in such a way that improper handling of the case may worsen the presentation. There many Agada yogas mentioned in the management of Lootha visha. Lasunadi Agada is a simple yoga explained in Prayoga samucchaya, which contains only 6 drugs, explained in the context of Lootha samanya chikitsa as Pana and Nasya. Presently this yoga is practicing in the name of Lasunadi gulika. So this paper is an attempt to review on the formulation Lasunadi Agada.

INFLUENCE OF GENDER IN HEMIPLEGIC GAIT - A KINEMATIC ANALYSIS

Background: Gait is considered as a factor of high quality in?uencing rehabilitation and quality of life. Hemiplegics show asymmetric gait pattern and return of walking ability is an important indicator of successful rehabilitation. Gender based differences exist in hemiplegic gait. This can impact the outcome of rehabilitation. Though gait analyses have been carried out in different settings, there are very little studies regarding the in?uence of gender in gait in hemiplegia. Hence our study, comparing the kinematics of hip, knee and ankle of the hemiplegic limb is carried out. Aims and Objectives: The objective of the study is a comparison of gait analysis parameters of stroke survivors based on gender using Instrumental Gait Analysis (IGA) system. The present study is the outcome of an observational study Methods: conducted in the Gait Laboratory of Department of Physical Medicine and Rehabilitation, Medical College Kottayam. 100 subjects were selected for the study ful?lling the inclusion criteria. ISen3.08 system and STT-IWS sensors were used to carry out the Gait analysis and kinematic data was collected. Quantitative data was analyzed by descriptive statistical analysis. Qualitative data was expressed as frequency and percentage. The mid stance knee and ankle and terminal stance Results: knee were statistically signi?cant. In mid stance, mean knee angle in males was -1.90 whereas in females it was 0.26. In terminal stance, males showed 9.08 and females 12.28. The ankle in midstance showed a value of -0.33 in males and 1.30 in females. This study con?rms that there are gender based variations in the angular kinematic parameters in Conclusion: hemiplegic gait. Females are more severely affected in various phases of gait cycle with signi?cant involvement in the mid stance and terminal stance phases

Analytical Study of Ocular Surface Changes in Patients of Chronic Kidney Disease undergoing Hemodialysis and Peritoneal Dialysis

Objectives?The idiopathic group is a significant cause of chronic kidney disease (CKD) in developing countries. Literature available on ocular surface changes has predominantly been reported in patients undergoing hemodialysis. Little is known about the changes in patients undergoing peritoneal dialysis. The present study aimed to identify ocular surface changes in an idiopathic group of CKD undergoing dialysis. Aim?To compare tear film disorders and the severity of ocular surface changes (goblet cell density, squamous metaplasia, and corneoconjunctival calcification) in patients of idiopathic etiology with CKD undergoing hemodialysis and peritoneal dialysis. This is an analytical study. Materials and Methods?Asymptomatic adult patients of idiopathic CKD, on treatment with dialysis underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, and a dilated fundus examination. Dry eye assessment was done by ocular surface staining score, Schirmer test, and tear breakup time (TBUT). Conjunctival impression cytology was studied to assess changes on ocular surface. Chest X-rays for aortic calcification were reviewed and data analyzed. Results?Both eyes of 76 patients of hemodialysis and 32 patients of peritoneal dialysis were studied. Ocular surface staining (OSS) scores were low. Impression cytology showed a drop in goblet cell density, presence of squamous metaplasia, and conjunctival keratinization significantly more in the hemodialysis group. No correlation was seen between the presence of conjunctival calcification and aortic calcification. Conclusion?The hemodialysis group had mild subclinical dry eye but keratinization of conjunctiva was seen. Similarly, advanced squamous metaplasia was seen in the peritoneal dialysis group. These changes were positively correlated to decrease in goblet cell density.

Effect of Paribhadra Paneeyakshara in Mutraghata Caused by Benign Prostatic Hyperplasia- A Case Report

Benign Prostatic Hyperplasia is a troublesome disease that bothers the population of ageing men by decreasing their quality of life. It is an abnormal growth involving the submucosal glands of prostate. The disease interferes with the normal daily activities and sleep pattern and hence is a matter of concern to the medical field. The symptoms of Benign Prostatic Hyperplasia closely coincide with the symptoms of Mutraghata (urinary obstruction) explained in Ayurveda. When taking the obstructive pathology into consideration, Paneeyakshara Prayoga (alkali for internal administration) is classically mentioned as a treatment option. This work is a case study on the effect of Paneeyakshara prepared out of Paribhadra (Erythrina indica) which is a drug possessing Vatakaphahara (alleviate Vata and Kapha Dosha) and Shophahara Karma (pacify inflammatory swellings) in Mutraghata caused by Benign Prostatic Hyperplasia. A 66-year-old male who presented with the signs and symptoms of Benign Prostatic Hyperplasia was administered with 500 mg of Paribhadra Paneeyakshara with 1 gram of Guda (jaggery), morning and evening, half an hour before food for a period of 45 days. Assessment was done before and after treatment based on the IPSS (International Prostate Symptom Score) of the American Urological Association and the Ultrasound abdomen findings. The post- interventional assessment showed a lowered IPS Score and reduced USG parameters indicating the efficacy of Paribhadra Paneeyakshara in reducing Mutraghata caused by Benign Prostatic Hyperplasia.

Prevalence and determinants of sarcopenia in Indian patients with chronic kidney disease stage 3 & 4

Objectives@#There is limited literature on the prevalence and determinants of sarcopenia in the Indian predialysis chronic kidney disease (CKD) population. The current study attempts to characterize sarcopenia in CKD stages 3 & 4 using 3-compartment model dual-energy X-ray absorptiometry (DXA). @*Methods@#This is secondary data from a randomized trial on bicarbonate supplementation for preserving muscle mass. A 3-compartment DXA was done to assess body composition in 188 subjects aged 18 to 65, with stable kidney function. Sarcopenia was defined by Asian Working Group criteria - appendicular skeletal mass index < 5.4 kg/m2 in women and < 7 kg/m2 in men. @*Results@#Sarcopenia was present in 69.1% (n = 130). There was no difference in the prevalence of sarcopenia in CKD stage 3 (n = 62; 72.1%) vs CKD stage 4 (n = 68, 66.7%); P = 0.434. A lower body mass index (BMI) (OR 1.69; 95% CI 1.43, 2.01) and lower bicarbonate levels (OR 1.22; 95% CI 1.02, 1.47), and age (OR 0.95; 95% CI 0.91, 0.98) was independently associated with the muscle mass. A BMI cut-off of 18 failed to identify sarcopenia in 78.4% (n = 102) subjects (Kappa statistic 0.396). The receiver operating characteristic curve for mid-arm muscle circumference for identifying sarcopenia was 0.651 (95% CI 0.561, 0.740). @*Conclusions@#Sarcopenia is highly prevalent in CKD 3 and 4. Sarcopenic individuals are older, with a low BMI and lower bicarbonate levels. The anthropometric parameters and biochemical parameters did not help identify sarcopenia in the predialysis population.

Primary hydatid cyst of the pterygomandibular region: an unusual cyst, location and case report

Hydatid disease is a zoonotic infection in humans. The disease is endemic in some parts of the world, including Africa, Australia, and Asia, where cattle grazing is common; the disease is spread by an enteric route following the consumption of food contaminated with the eggs of the parasite. Failure to identify this parasite results in delayed diagnosis and increased morbidity to the patient. Upon diagnosis, every possible step should be taken, both surgical and medical, to prevent anaphylactic reactions from the cystic fluid. Postsurgical long-term follow up along with periodical ultrasonography of the liver and computed tomography scan of the abdomen is essential to rule out possible recurrence.

Primary hydatid cyst of the pterygomandibular region: an unusual cyst, location and case report

Hydatid disease is a zoonotic infection in humans. The disease is endemic in some parts of the world, including Africa, Australia, and Asia, where cattle grazing is common; the disease is spread by an enteric route following the consumption of food contaminated with the eggs of the parasite. Failure to identify this parasite results in delayed diagnosis and increased morbidity to the patient. Upon diagnosis, every possible step should be taken, both surgical and medical, to prevent anaphylactic reactions from the cystic fluid. Postsurgical long-term follow up along with periodical ultrasonography of the liver and computed tomography scan of the abdomen is essential to rule out possible recurrence.

Primary hydatid cyst of the pterygomandibular region: an unusual cyst, location and case report

Hydatid disease is a zoonotic infection in humans. The disease is endemic in some parts of the world, including Africa, Australia, and Asia, where cattle grazing is common; the disease is spread by an enteric route following the consumption of food contaminated with the eggs of the parasite. Failure to identify this parasite results in delayed diagnosis and increased morbidity to the patient. Upon diagnosis, every possible step should be taken, both surgical and medical, to prevent anaphylactic reactions from the cystic fluid. Postsurgical long-term follow up along with periodical ultrasonography of the liver and computed tomography scan of the abdomen is essential to rule out possible recurrence.

Demographic profile, host, disease & viral predictive factors of response in patients with chronic hepatitis C virus infection at a tertiary care hospital in north India.

Background & objectives: Standard of care for chronic hepatitis C (CHC) in India is peginterferon and ribavirin (RBV). The response to treatment in real life stetting is unclear. The objectives of this study were to evaluate the demographic profile and assess the virological response and predictors of response in CHC patients. Methods: Consecutive patients with CHC were included in this study. Detailed clinical history, risk factors, and predictive factors of response were noted. Patients were treated with peginterferon α2b (1.5 μg/kg/wk) and RBV (12 mg/kg/day) for 6 to 18 months based on response. Results: A total of 211 patients were included in the analysis, mean age 40.6±12.3 yr, 144 (68%) were males and 71 (34%) had compensated cirrhosis. Commonest risk factor for acquiring CHC was previous transfusion and surgery (51%). Genotype 3 (72%) was most common followed by genotype 1 (23%). Overall sustained virologic response (SVR) was 64 per cent [95% CI 57.1%-70.4%]. The SVR was 66.5 per cent [95% CI 58.34-73.89%] for genotype 3 and 61.2 per cent [95% CI 46.23 to 74.80%] for genotype 1. Non-cirrhotics had better SVR rates compared to cirrhotics (76 vs 41%, P<0.001). On multivariate analysis, BMI ≥23 kg/m2, HOMA-IR ≥2, compliance (≤80%), and fibrosis >2 were predictors of low SVR. Interpretation & conclusions: Genotype 3 was the commonest HCV genotype. The commonest source of infection was previous transfusion and surgery. SVR rates for genotypes 3 were better than genotype 1 patients. Predictors of non-response were high BMI, insulin resistance, significant fibrosis and inadequate compliance.

Cowden syndrome with Lhermitte–Duclos disease presenting as ataxia.

Cowden syndrome or multiple hamartoma syndrome is a rare genodermatosis of autosomal dominant inheritance characterized by multiple hamartomatous lesions of ectodermal, mesodermal and endodermal origin. A 45-year-old man presented to us with a history of dural arteriovenous fistula and intracerebral bleed in the past with gradually progressive difficulty in walking. Magnetic resonance imaging (MRI) of the brain showed a heterogeneous lesion in the cerebellum which was diagnosed as adult Lhermitte–Duclos disease which is considered a component of Cowden syndrome. On examination we found florid skin and mucosal manifestations of Cowden syndrome. A family history of thyroid malignancy was also present. Using the Cleveland Clinic web calculator, the patient had an 82% chance of having a phosphatase and tensin homologue (PTEN) mutation.

Spontaneous pneumomediastinum and subcutaneous emphysema in asthma exacerbation: an unusual presentation

Pneumomediastinum is defi ned as presence of air in mediastinum. Spontaneous pneumomediastinum [SPM] incidence ranges from 1:800 to 1:42000. It is more common in the young, tall males. Here we present a female aged 22 years, who presented to the casualty with sudden onset of breathlessness followed by pain around the neck and chest associated with dysphagia. She was a known asthmatic since several years on regular treatment. Respiratory system examination revealed bilateral polyphonic rhonchi. Chest radiograph revealed features of subcutaneous emphysema and pneumomediastinum. Computed tomography of the thorax confi rmed the fi ndings. She was diagnosed to have an exacerbation of bronchial asthma complicated by pneumomediastinum, probably due to alveolar rupture. She was managed with oxygen, bronchodilators, steroids and other supportive measures following which she improved. This case is being presented to emphasize the possibility of SPM as a rare complication of asthma exacerbation, showing good response to conservative management

Hepatoprotective activity of Oxalis corniculata L. ethanolic extract against paracetamol induced hepatotoxicity in Wistar rats and its in vitro antioxidant effects.

Oxalis corniculata is well known for its medicinal properties like anti-inflammatory, digestive, diuretic, antibacterial, antiseptic etc. The present study focuses on the ability of O. corniculata to alleviate liver damage caused by over dose of paracetamol. Antioxidant activity of O. corniculata was evaluated using the free radical scavenging activity of 1, 1-diphenyl-2- picrylhydrazyl radicals, total anti oxidant capacity by phosphomolybdenum method and total phenolic content was also evaluated. The ethanolic extract of whole plant of O. corniculata (OC, 500 µg/mL, po) significantly reduced 1, 1-diphenyl-2- picrylhydrazyl radicals. This dose also caused significant reduction (62.67%) in malondialdehyde levels of murine hepatic tissues. The antioxidant capacity of OC was comparable to that of standard ascorbic acid and showed 53.5 µg of phenol/mg OC. Rats pre-treated with OC for 4 days showed significant reduction in the serum enzymes such as glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, alkaline phosphatase, serum bilirubin and showed almost normal histological liver architecture of the treated groups compared to paracetamol induced hepatic damage group, indicating its hepatoprotective and antioxidant potential.

Reviewing host proteins of Rhabdoviridae: Possible leads for lesser studied viruses.

Rhabdoviridae, characterized by bullet-shaped viruses, is known for its diverse host range, which includes plants, arthropods, fishes and humans. Understanding the viral–host interactions of this family can prove beneficial in developing effective therapeutic strategies. The host proteins interacting with animal rhabdoviruses have been reviewed in this report. Several important host proteins commonly interacting with animal rhabdoviruses are being reported, some of which, interestingly, have molecular features, which can serve as potential antiviral targets. This review not only provides the generalized importance of the functions of animal rhabdovirus-associated host proteins for the first time but also compares them among the two most studied viruses, i.e. Rabies virus (RV) and Vesicular Stomatitis virus (VSV). The comparative data can be used for studying emerging viruses such as Chandipura virus (CHPV) and the lesser studied viruses such as Piry virus (PIRYV) and Isfahan virus (ISFV) of the Rhabdoviridae family.

Referral pattern of patients with end-stage renal disease at a public sector hospital and its impact on outcome.

Background. Late referral of patients with chronic kidney disease (CKD) to a nephrologist has been shown to be associated with greater morbidity and adverse clinical outcomes. Methods. We did a prospective cross-sectional study of 2490 consecutive, newly diagnosed patients with end-stage renal disease (ESRD) referred to the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh over 2 years. The referral pattern was classified on the basis of the interval between first visit to a nephrologist and initiation of renal replacement therapy (RRT). If the patient reported later to a nephrologist, the disease would have progressed more, and the time interval to initiation of RRT would thus be shorter. A time interval of <3 months was classified as late referral (LR), 3–12 months as intermediate referral (IR) and >12 months as early referral (ER). The demographic and clinical characteristics and co-morbid conditions were compared, and factors associated with LR and outcomes were evaluated. Results. About 75% of patients were referred late. Poor socioeconomic status, low level of education and reduced access to reimbursement of treatment costs contributed to LR. The aetiology of ESRD could not be established in a larger number of LR patients as compared to the other groups. LR patients had a higher prevalence of uraemic complications and required emergency dialysis more frequently. A higher proportion of LR patients were lost to follow up because they could not afford to continue dialysis. Early mortality was higher in the ER group than in the other groups. ER patients were older, more likely to have diabetic nephropathy and a higher burden of co-morbid conditions. They were also more likely to choose continuous ambulatory peritoneal dialysis or undergo transplantation. Only 28% of all patients continued RRT beyond 3 months. Conclusion. A large majority of patients with ESRD in India seek medical attention late, usually in advanced stages of CKD with uraemic complications. LR is more frequent in younger patients and those with non-diabetic kidney disease, and is associated with poor socioeconomic status, lack of education and poor outcomes.

Effect of Added Brine on Polymer-surfactant interaction.

Effect of added brine on the structural transitions of SDS, in different compositions of gelatin has been investigated by viscosity, conductivity, circular dichroism, FTIR Spectroscopy, TGA and DSC. The slow and steady growth of the normal spherical micelles to the higher order aggregates were predicted by viscosity and conductivity measurements. The large negative value for ellipticity observed from CD measurements indicated absence of any conformational change for gelatin. Other measurements were used to study the molecular packing in the micellar aggregates. The complex formed exhibits fantastic properties to be explored in the field of smart gels.

Primary haemophagocytic syndrome in a young girl.

Haemophagocytic syndrome is a life-threatening systemic illness characterized by an uncontrolled inflammatory response. Patients present with fever, hepatosplenomegaly, jaundice and liver dysfunction, neurological manifestations and often pancytopenia. Bone marrow, lymph node, hepatic or splenic biopsy shows macrophages with ingested blood cells or their precursors. Laboratory markers include elevated triglycerides and ferritin, low fibrinogen with normal or low erythrocyte sedimentation rate (ESR). Familial haemophagocytic lymphohistiocytosis (HLH) is an autosomal recessive disorder. Secondary haemophagocytic syndrome results from infections, malignancy and collagen vascular disorders. We describe a young girl with primary haemophagocytic syndrome.

Oestrus ovis ophthalmomyiasis with keratitis.

A 35-year-old male patient presented with complaints of redness, swelling around the eyelids, watering, and irritation in the right eye. At presentation his best-corrected visual acuity was 20/20 partial in the right eye. The tarsal conjunctiva of the upper eyelid showed injection with pseudomembrane. Underneath the pseudomembrane we noticed four motile larvae. The cornea showed an irregular cobweb-like mucous plaque adherent to the epithelium, with a clear stroma. The pseudomembrane was easily peeled-off under topical anaesthesia. The organisms were removed and identified as Oestrus ovis. Three days later the patient was comfortable and his visual acuity was 20/20 in the right eye.

Anti-allergic, anti-inflammatory and anti-lipidperoxidant effects of Cassia occidentalis Linn.

Cassia occidentalis Linn. mast cell degranulation at a dose of 250 mg/kg, showed dose dependent stabilizing activity towards human RBC, with is widely used in traditional medicine of India to treat a number of clinical conditions including allergy and inflammatory manifestations. In the present study anti-allergic, anti-inflammatory and anti-oxidant properties of C. occidentalis whole plant ethanolic extract (CO) was investigated. Effects of CO on rat mast cell degranulation inhibition and human red blood cell (HRBC) membrane stabilization were studied in vitro following standard methods. The anti lipidperoxidant effects of CO were also studied in vitro. Effect of CO on carrageenan-induced mouse paw oedema inhibition was also assessed. CO significantly decreased maximum protection of 80.8% at 15 μg/ml. The extract also caused significant reduction in malondialdehyde (MDA) levels of murine hepatic microsomes at 100 μg/ml (56%) and significantly reduced carrageenan induced inflammation in mice at a dose of 250 mg/kg. Results of the present study indicated that CO inhibited mast cell degranulation, stabilized HRBC membrane thereby alleviating immediate hypersensitivity besides showing anti oxidant activity.