ABSTRACT
Ayurveda is a science that focuses on both well-being and disease treatment. Many surgical and para-surgical procedures have been described by Acharya Sushruta for the management of various diseases; among these, Raktamokshana is popularly used for the management of various pathologies occurring due to Rakta Dushti (blood-borne disorders). It is derived from two words i.e., ‘Rakta’ which means blood & ‘Mokshana’ which means leave. Hence, Raktamokshana means to let the vitiated blood out. It is one of the five purification therapies by Acharya Sushruta. There are two ways to do Raktamokshana i.e., Shastra Visravana (using sharp instruments) and Anushastra Visravana (without using sharp instruments). Furthermore, it is said that Siravedha is ‘Chikitsaardha’ i.e., half of the treatment described in Shalya Tantra is similar to a well-performed Basti karma (Therapeutic Medicated Enema) advocated in Kaya-Chikitsa. However, there are relatively limited recommendations or use of Raktamokshana in clinical practices nowadays which may be due to fear associated with the procedure, lack of skillfulness, and unawareness about the efficacy of Raktamokshana in various diseases. This review article is specifically intended to assemble the usefulness of numerous modes of Raktamokshana based on Ayurvedic parameters with its detailed procedure
ABSTRACT
Background: Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. NAFLD is considered a disease of no consequence. Data on the effect of NAFLD on renal dysfunction in T2DM is sparse. Author aimed to study the association of NAFLD with CKD in Indian T2DM subjects.Methods: In an observational cross-sectional study at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India from February 2017 to March 2018. 197 out of 268 randomly selected type 2 diabetes mellitus (T2DM) subjects were selected for the study after considering the inclusion and exclusion criteria. CKD was defined as estimated GFR <60 ml/min per 1.73 m2 and/or albumin to creatinine ratio ≥30 mg/g. NAFLD was diagnosed using ultrasonography. The association between NAFLD and CKD was analyzed using SPSS (version 24.0).Results: On ultrasonography 133 (67.5%) T2DM subjects had NAFLD. Diabetic with NAFLD (133, 67.51%) had significantly more history of hypertension (p 0.006), higher systolic (p 0.03) and diastolic BP (p 0.009), higher BMI (p <0.001), waist circumference (p <0.001), fasting glucose (p 0.03), triglyceride (p<0.001) and higher urinary albumin-to-creatinine ratio (p <0.001). Diabetics with CKD (61, 30.96%), were older (p 0.03), hypertensive (p <0.001) and had higher fasting glucose (p 0.003). Subjects with CKD had a higher prevalence of underlying NAFLD (78.69% vs 62.5%, p 0.03) as compared with diabetics with no CKD. T2DM subjects with NAFLD had more than two times (OR 2.88 (1.1-6.78), p 0.03) the risk of developing CKD after multivariate analysis as compared to subjects without NAFLD.Conclusions: NAFLD is a risk factor for development of CKD in patients of type 2 diabetes mellitus. Screening and early preventive measures may go long way in reducing morbidity.
ABSTRACT
Background: Fascia iliaca is one of the most commonly performed and safest block. Local anaesthetic diffuses under the fascia ilIiaca to block femoral nerve, lateral cutaneous femoral nerve, and obturator nerves. Clonidine, α2-adrenergic receptor agonist, has potent central and peripheral antinociceptive properties. Dexmedetomidine, is a potent α2-adrenoceptor agonist with dose dependent α2 receptor sensitivity. Receptors for α2 are found in the peripheral and central nervous system, platelets, and a variety of organs, such as the liver, pancreas, kidney, and eye. It exhibited dose dependent protection against brain matter loss in vivo and improved the neurologic functional deficit induced by the hypoxic ischemic insult. Aim: To compare clonidine and dexmedetomidine as an adjuvant to ropivacaine under ultrasound guided fascia iliaca for post-operative analgesia scheduled for hip and femur surgeries under subarachnoid block. Methods: It was a Randomized controlled trial study. The patients were allocated one of the three groups which are group R (n=30), Control group – 40 ml of 0.25% Ropivacaine in fascia iliaca compartment block, group RC (n=30) Clonidine group– 40ml of 0.25% Ropivacaine+ 0.5μg/kg Clonidine in fascia iliaca compartment block and group RD (n=30) Dexmedetomidine group – 40ml of 0.25% Ropivacaine + 0.5μg/kg Dexmedetomidine in fascia iliaca block by random number chart. 90 patients of both sexes in the age group of 20-60 years were taken in the study. This study was conducted in the department of Anesthesiology, Dr. R.P.G.M.C, Tanda at Kangra, Himachal Pradesh. Results: Time to first rescue analgesia was maximum in RD group as compared to RC group followed by R group and it was statistically significant amongst groups. Mean of total number of rescue analgesic i.e. inj. diclofenac required was 2.60 ± 0.50 (dose) in R group as compared to 1.50 ± 0.51 in RC group and 1.03 ± 0.18 in (RD) group. There was statistically significant difference in need for analgesia amongst R, RC and RD groups (P<.001). Conclusion: It is recommended that dexmedetomidine in a dose of 0.5μgm/kg can be used as an adjunct to ropivacaine (less cardio toxic) under ultrasound guided fascia iliaca compartment block, for better postoperative pain relief and prolonged duration of postoperative analgesia. It reduces the postoperative rescue analgesic requirement with arousable sedation and without any adverse effect.