Sowa-Rigpa (Amchi/Buddhist Medicine): A Review

Sowa-rigpa is known as Amchi or Buddhist medicine or Tibetan system of medicine which is primarily based on Buddhist philosophy. It is the fact that basic concepts of Sowa-Rigpa and Ayurveda are almost same and it seems that there is inter-relation among these two traditional systems of Indian Medicine. The description of Tridosha, Panchamahabhuta, seven Dhatus, three Malas, week wise embryological development are same. In Sowa-Rigpa, it has been mentioned that we all are sick due to ignorance as according to Buddhist philosophy, Ignorance is the cause of sufferings. The relation between ignorance and suffering as per the Sowa-Rigpa may be the unique concept which may show the path for human-beings to eradicate all human sufferings i.e., ultimately to walk on the path of Nirvana which is the goal of Buddhist philosophy and Moksha according to Ayurveda.

Usefulness of the outer membrane proteins of Shigella sonnei in developing an antibody-based immunoassay for the diagnosis of shigellosis

@#Conventional culture method and biochemical tests remain as the ‘gold standard’ method for the identification of S. sonnei which are time-consuming. We have discovered previously the potential of three OMPs of S. sonnei (33.3 kDa, 43.8 kDa and 100.3 kDa) as biomarkers in the diagnostic test for shigellosis. Here, we evaluated the performance of the outer membrane proteins of S. sonnei for the development of an antibody-based immunoassay for the detection of S. sonnei infections. All threetarget proteins were specifically recognized when probed with S. sonnei sera. In addition, another two potential proteins of molecular weight 29.0 kDa and 88.2 kDa in size were also exclusively recognized by the IgA when probed with S. sonnei sera. The optimized ELISA demonstrated higher sensitivity and specificity which exceeded 86.0%. In conclusion, the identified target proteins showed great potential as diagnostic biomarkers for the detection of S. sonnei infections in patients.

Result and outcome of shorter fractionation schedule for post-operative cancer breast patients.

Background: The purpose of this prospective study is to determine the effectiveness and cosmetic outcome of shorter fractionated radiotherapy in post-operative invasive breast cancer patients. Methods: Between July 2009 and June 2011, 216 post-operative cancer breast patients were treated with this regimen on cobalt60. The chest wall and supraclavicular area were treated using a tangential parallel pair, & direct supraclavicular portal with wedges as necessary, to a dose of 40 Gy / 15 fractions (study group) (133 cGy for tangential and 266 cGy for supraclavicular field each). (Control Group received 50 Gy / 25#) No additional boost was given. The median duration of follow-up surviving patients are 3 years. Results: From July 2009 to July 2011 (2 years), 216 histopathologically proven cases of Invasive ductal carcinoma of Breast were included in this study. All patients with early and locally advanced stage breast cancer were treated with hypofractionated and conventional schedule of radiotherapy. At baseline 80.19% in the study and 75.45% of patients in the control group were being rated as excellent or good. At 2 years, the percentages of patients with an excellent or good cosmetic outcome were 75.80% in the study and 73% in the control group. Grade II skin reactions were more in control (60%) as compared to study group (49%). A radiation schedule delivering 40 Gy / 15 # seems to offer control rates of locoregional tumour relapse & late adverse effects at least as favourable as the standard schedule of 50 Gy / 25#. Conclusion: Shorter fractionation schedule is very much effective in preventing recurrent breast cancer and it provides a high level of patient satisfaction as well as reduce money and overall treatment time. Its shorter duration offers the added advantage of a more efficient use of resources and greater patient convenience.

Evaluation of multiplex Polymerase chain reaction utilising multiple targets in Mycobacterium tuberculosis direct test negative but culture positive cases: A potential method for enhancing the diagnosis of tuberculosis.

Purpose: To evaluate multiplex Polymerase Chain Reaction (MPCR) utilising multiple targets (IS6110, Protein b [Pab] and MPB64 genes) in Mycobacterium tuberculosis Direct Test (MTD) negative but culture positive cases and comparison of MPCR with Real-Time polymerase chain reaction (RT-PCR) for diagnosis of tuberculosis. Materials and Methods: MPCR was carried out on 28 culture positive sputum samples. Out of 28 culture positive samples, 17 were originally reported, as MTD test negative and 11 were MTD test positive, respectively. The results of MPCR were compared with RT-PCR. To check the specifi city of the tests, MPCR and RT-PCR were also evaluated with 16 non-tuberculous mycobacterial (NTM) isolates. Results: Out of 28 culture positive sputum samples, MPCR was positive in all 28/28 samples, whereas RT-PCR was positive in 27/28 samples and MTD test was originally tested positive in six sputum samples and on repeating MTD testing, fi ve more sputum samples were positive and thus total number of MTD positive were 11/28 sputum samples, respectively. All the tests were negative on evaluation with all the 16 NTMs, thus giving specifi city of 100% to all the tests; sensitivity of MPCR, RT-PCR and MTD tests were 100%, 96.42% and 39.28%, respectively, in these specifi cally selected samples. Conclusions: MPCR may be an important tool in the rapid diagnosis of tuberculosis especially in disease endemic, resource limited countries.

Concurrent radiotherapy and weekly gemcitabine treatment of locally advanced squamous cell carcinoma of head and neck.

Head and neck cancers are not curable yet but survival and local control has been increased due to concurrent treatment approach. Study was conducted to assess the role of concurrent Gemcitabine (2'2' Difluro Deoxycytidine) along with radiotherapy in treatment of Head and Neck cancers and to assess local control as well as disease free survival achieved due to chemoradiation. 100 patients were enrolled in this study, 50 patients received Radiotherapy (Group A- Control group) alone and 50 patients received Concurrent Chemoradiotherapy (Group B- Study group). Patients in study group received Gemcitabine 200mg/m2 on weekly basis for 5-7 cycles over 30 mins. Radiation delivered after 2 hours of IV infusion. Conventional radiotherapy was given in dose ranging from 66-70Gy in 33-37# for 6-7weeks. In this study, Grade 3 mucositis and Grade 2 pharyngeal toxicity were common i.e, 56% and 54% respectively in study group and 30% and 38% respectively in control group. Hematological toxicity i.e., Grade 1 leucopenia was seen in 28%. Even though the toxicities were high in study group compare to control group but they were tolerable and acceptable. The response was better in concurrent group than radiotherapy alone (Control group) CR 52% vs 40%, PR 34% vs 36% and SD 14% vs 24%. Concurrent use of gemcitabine and radiotherapy is a effective modality in treatment of head and neck cancers with acceptable toxicity. Improved local control shows that Gemcitabine acts as a sensitizers and has synergistic action along with radiotherapy.

Phalange metastasis from carcinoma of alveolus.

Metastatic involvement of a phalanx by head and neck cancers is rare. We report a case of a 66-year-old man with squamous cell carcinoma of the alveolus who had no residual disease or local recurrence after treatment but presented with metastasis to the middle phalanx of the middle finger.

Curcuma longa as feed additive in broiler birds and its patho-physiological effects.

Broiler birds (Vencob chicken of 3 days old) when given feed mixed with powdered rhizome of Curcuma longa (CL; @ 1 g/kg) for 42 days of age, showed significant decrease in serum uric acid and albumin as compared to control, whereas significant increase was recorded in the level of serum total protein and globulin. Level of serum glucose, alkaline phosphatase, aspartate amino transferase and calcium showed no significant variation between the two groups. Micronutrient assay revealed significantly higher level of manganese, zinc, iron and copper in treated group as compared to control group. HA/HI test revealed better humoral response against RD vaccine in CL administered birds. Haematological study showed significantly higher haemoglobin and absolute neutrophil count in treated group. Addition of CL as feed additive also resulted in better growth rate, feed consumption and F:C efficiency in the treated birds. Thus, it could be concluded that powdered CL might be a useful feed additive, since it enhanced the F:C efficiency and had nephroprotective properties.

Pathology of benzalkonium chloride toxicity and its effect on body weight gain in broiler birds.

Four groups comprising 16 broiler birds each were given benzalkonium chloride (BC) at 100, 300, 500 and 700 ppm in drinking water for 40 days and one group of 16 birds (control) was kept on plain water. Clinical signs in higher dose groups were respiratory distress, drooling of saliva, difficulty in deglutition, inappetence, apathy, lethargy and loss of body weight. Better body weight gain was recorded in 100 ppm dose rate. At 300 ppm, no significant body weight variation was recorded, whereas, at 500 and 700 ppm dose rates, significantly poor body weight gain was recorded. Major pathological changes were seen in 500 and 700 ppm groups, which exhibited formation of yellow diphtheritic plaques in the buccal cavity, swollen and pale commissures of beak and shortening of tongue. Minute necrotic and ulcerative foci were seen in oesophagus and crop. Hyperplastic and hypertrophic alterations were seen in mucosa of the upper digestive tract. Crop of 300 ppm group revealed formation of well developed epithelial nest with pseudoepitheliomatous hyperplasia at the margin of the lesion. Serum alanine transaminase, urea and uric acid in 500 and 700 ppm groups were elevated whereas no significant variations were observed in the 100 and 300 ppm groups. BC could enhance performance of broiler birds at 100 ppm dose rate. It should not be used beyond 300 ppm.

Studies on persistence of temephos in sandy loam soil under field and laboratory conditions.

Persistence of temephos was studied in soils under field and laboratory conditions in sandy loam soil to evaluate the effect of moisture and formulations on persistence. The insecticide was applied as 50 EC and 1 % S.G. granules @1 kg a.i. ha-1 on surface of the soil' and residues were determined spectrophotometrically. The soil was fortified separately with dilute emulsion of EC and suspension of granular formulation at 5 ppm level and incubated at different moisture levels at 25:1:1 degrees C for 90 days. The residues of temephos from both the formulations persisted upto 55 days in soil when applied @1 kg a.i. ha(-1). In 40 days 92 and 91.43 per cent temephos was dissipated from soil treated with EC and granular formulations, respectively. There was no leaching or downward movement of the toxicant beyond 7.5 cm. The half-life of temephos under field condition for EC and granular formulations were 18.14 and 20.44 days, respectively. Statistically, there was no significant effect of two formulations of temephos on its persistence. But at three different moisture conditions viz. airdry, field capacity and sub-merged, the difference was significant at 5% level.

Germ cell tumour of testis.

Germ cell tumour, though rare, represents most common malignancy among young men aged between 15 to 35 years. In 1990's dramatic improvement has taken place in survival rate of testicular tumours (from 10% in 1970's and 90% in 1990's). This has been possible because of effective diagnostic techniques, accurate monitoring with biological markers and use of effective platinum based combination chemotherapy in its management. The most significant improvement in survival rate has occurred in advanced stage germ-cell tumours. Seminomas are sensitive to radiation therapy and NSGCT (Non Seminomatous Germ Cell Tumours). are effectively treated by combination chemotherapy of 3 drugs of which Bleomycin is most expensive and many patient can not afford it and so compliance is poor. In the present series we have tried only 2 drug regimen consisting of Platinum and Etoposide (PE). Since January 1992 to December 1994, 40 cases of testicular tumours were treated. 16 cases received PEB regimen and 24 cases were treated by PE regimen of which only 6 cases in the former and 20 cases in the later group completed the scheduled course. Patients were given 6 cycles of PE regimen (inj. Platinum 20 mg/m2 D1-D5, VP-16 (ETOPOSIDE), 100 MG/M2 1.V. D1-D5) repeated every three weeks. Final evaluation was done in June 1996. 17/20 (85%) patients on PE regiment exhibited complete regression of the disease by the end of June 1996, I was lost to follow up, and 2 of them had the disease in progressive stage and were considered for another regimen. 18 months disease free survival was 85%. Table I. Royal Marsden Staging System Stage I: Disease econfined to testes Stage II: Intradiaphragmatic node involvement A: Less than 2 cm B: 2-5 cm C: Greater than 5 cm Stage III: Supradiaphragmatic node involvement Stage IV: Extralymphatic disease Lung, Liver, Bone etc.

Clinical and etiological profile of ataxic hemiparesis.

We studied the clinical profile and etiology of 28 cases of ataxic hemiparesis. After a detailed neurological examination, CT scan brain (plain and after IV contrast) was done in all. Age ranged from 18 to 80 years. Acute onset of symptoms was in 22, while 6 had insidious onset. 18 patients had major infarct, while 4 patients had lacunar infarct. 2 patients were found to have haematoma (1 following head injury) and 1 each had tuberculoma, meningioma, glioma and toxoplasma granuloma. The lesions were seen in various parts of brain stem, thalamus, basal ganglion, internal capsule and frontal, parietal and temporal region. Heterogeneity as regards to etiology and localisation is being highlighted.

Vasopressor responses in autosomal dominant cerebellar ataxia.

Thirteen patients with autosomal dominant cerebellar ataxia were investigated for autonomic functions using standard tests. Patients showed no significant reduction in parasympathetic responses as measured by heart rate response to slow breathing and Valsalva manoeuvre. Measurement of blood pressure response to isometric exercise, cold exposure and 70 degrees head-up tilt showed a significant decrease in sympathetic pressor response.

Ring enhancing CT lesions--a diagnostic dilemma.

We studied 68 such cases of RECTL with follow up ranging from 3 months to 3 years. Patients were divided into 3 groups depending on the size of ring ie. Group I (less than 5 mm), Group II (5-10 mm), Group III (10-20 mm). Maximum cases were in Group II (42), in the age group 20-40 years. 60 cases presented with seizures. Single ring was seen in 46 cases and multiple rings in remaining 22 cases. There were 22 cases of tuberculoma, 15 neurocysticercosis, 15 disappearing lesions, 4 malignancy, 2 abscess, 1 each showing infarction and gliosis and 8 of unknown etiology. Partial or total excision biopsy was done in 18 cases of which 3 were due to tuberculoma, 7 neurocysticercosis, 4 tumours, 2 abscess and 1 each due to infarction and gliosis. We found that RECTL could be a real diagnostic problem, which could be solved only be repeated clinical examination and CT Scan with excision biopsy in some selected cases.

Phenol block in the management of spastic cerebral palsy.

In the present series 116 cases of spastic cerebral palsy were selected; in whom perineal care and ambulation was affected. These cases were given peripheral nerve block (obturator 110, posterior tibial 134 and median nerve 2) with 6% aqueous phenol solution. The block relieved the spastic condition, allowed better nursing care, freed the patient from the embarrassment of a contorted limb, allowed voluntary movement to take place and eased in fitment of caliper to aid further ambulation. The period of effectiveness ranged from 3 months to 18 months, with an average of 13 months. Paraesthesia occurred following 5 nerve blocks. Eleven nerve blocks had to be repeated. Ease, simplicity, safety, therapeutic benefits and economic advantages of peripheral nerve block using phenol in cerebral palsy warrant its more widespread use.

Botulinum toxin A in blepharospasm and hemifacial spasm.

We report the first Indian experience of botulinum toxin A in the treatment of blepharospasm and hemifacial spasm. Sixteen patients, 7 with essential blepharospasm, 5 with Meige syndrome and 4 with hemifacial spasm received botulinum toxin A injection. One patient received 3 courses of injections, 2 received 2 courses and the rest received only one course. The effect was observed after a latent period of less than 48 hours in all patients and lasted for a mean of 16.65 weeks. More than 70% improvement occurred after 17/20 injections (85%). Poor response was more often seen when blepharospasm was associated with oromandibular dystonia (2/5 injections). Though the duration of response and subjective score of improvement was best in patients with hemifacial spasm, the numbers were very small for any statistical evaluation. The side effects were local, transient, mild and well tolerated. The commonest side effect was blepharoptosis.