A Clinical Case Study on Pittaja Atisara with reference to Ulcerative Colitis

The symptomatology of Ulcerative Colitis (UC) presents from irregular, incomplete bowel evacuation to mucous and bloody defecation. Direct correlation of UC in Ayurvedic literature is not possible, may be correlated to Pittaja Atisara, Rakthaja Atisara, Kshataja Grahani, Samgrahini Grahani. This case report shows diagnosed case of Ulcerative Colitis with nidana (etiology), Samprapti (pathophysiology) and Rupa (clinical presentation) similar to Pittaja Atisara. Signs and symptoms observed were stools mixed with blood & mucous (Pita-Haridra-Saraktha-Sadavalaprabham), Udarashula (abdominal pain), Payusanthapa (burning sensation in anal region) and showed Rupa that of Pittaja Atisara. Treatment was given according treatment approach of Pittaja Atisara viz., Langhana, Pachana and Picha Vasthi. Initially patient general condition was worst, managed under the guidance of modern medicine consultation and gradually tapered to Ayurvedic medicines. Oral medicines chosen were based on Rakthasthambaka, Vranaropana, Agni deepana and Grahi action, the drugs used for Pichha vasti are Madhu, Charngeryadi ghritam, Murivenna, Yashtimadhu kalka, Shalmali kwatha. A 45-day course of treatment was given, during which 30 Picha Vasthi were administered, includes 14 days of solely Vasthi and the final 11 days of Samsarjana Kala. Treatment outcomes were evaluated using partial Mayo scores and through routine blood tests and colonoscopy. Partial Mayo score was evaluated at 0th, 15th, 30th, and 45th day of the treatment cycle. Total partial Mayo Index score went from Severe Disease (9) to Remission (1). Total Leucocyte Count (TLC) and indices for hemoglobin and RBC returned to normal range after treatment. The patient got improvement and Ayurveda treatment protocol was successful.

Unilateral Vocal Cord Paralysis In Gastrointestinal Malignancies- A Rare Presentation

Background Advancements in diagnostic modalities have brought many hidden etiological causes of unilateral vocal cord paralysis (UVCP) to light. Here we are presenting two cases of gastrointestinal (GI) malignancies with metastases causing UVCP which can further add to another rare cause of UVCP. Case summary We are presenting a case of 40 year male with metastatic periampullary carcinoma leading to UVCP and another case of 45 year female with rectal carcinoma further causing UVCP. Both patients were under treatment while during follow-up, symptoms of UVCP were observed which changed our perspective towards cases of UVCP. Conclusion Vocal cord palsy is a symptom of an underlying disorder and not a disease. In above case reports metastases are the commonest etiology for vocal cord palsy. Relevant investigations have to be conducted in order to diagnose the etiology and the modality of treatment varies depending on the etiology of the condition.

Quantitative Assessment of Muscle Activity and Joint Load in Braced and Unbraced Osteoarthritis Knee by External Strain Gauge Sensor.

Objectives: Altered biomechanics leads to the development of degenerative joint disease. The joint pressure and dynamic loading varies during activities of daily living. The study was undertaken to assess the muscle activation pattern of the medial and lateral knee compartments (tibiofemoral joint) during gait in osteoarthritis subjects without and with knee brace undergoing either exercise therapy or balance therapy. The joint load was assessed by the strain gauge transducer and the weight shift pattern is taken as an indicator for the muscle activation pattern. Methods: In a prospective design study on 57 male subjects diagnosed osteoarthritis knee with KellagrenLawrennce scale walked barefooted with and without designed offloader knee brace on a level surface for three minutes. The subjects were allocated in two different study groups i.e. Conventional (exercise therapy) (Control Group, n=31) and Structured Neuromuscular Postural Training (SNPT) group (Balance therapy) (Study Group, n=26). The subjects were sub grouped as pre-elderly (40-60 Years) and elderly (>61 years) group in both. The quantitative assessment of muscle activity and joint loading with and without knee brace was done using designed strain gauge sensor instrument. The pressure changes of strain gauges of muscles around the knee joint viz. vastus medialis (VM), vastus lateralis (VL), semi membranosus / tendinosus (Medial Hamstring) (MH), Biceps Femoris (Lateral Hamstring) (LH), gastro-soleus (GS) and tibialis anterior (TA) muscles during normal gait were observed at baseline and 6 weeks follow up after undergoing exercise therapy or balance therapy treatment as per allocation of study groups. The digital values from MATLAB were recorded and analyzed. Results: At the end of 6 weeks conventional / SNPT (structured neuromuscular postural training) treatments, medial hamstring muscle activity showed significant difference (p<0.001) in pre-elderly subgroup, while significant difference was seen in vastus laterals (VL), medial hamstring (MH) (p<0.005) and lateral hamstring (LH) muscles (p<0.001) in elderly subgroup

Clinical evaluation of the role of tulsi and turmeric in the management of oral submucous fibrosis: A pilot, prospective observational study.

The aim of the present study was to investigate the clinical efficacy of herbal medicines (1 gm tulsi and 1 gm turmeric mixed in glycerine base) for the treatment of oral submucous fibrosis (OSMF). Forty‑one patients in the age group of 17- 56 years without any systemic complications were included in the study. The patients were treated with medicines, which were to be applied 3-4 times a day. Blood samples were collected before and after treatment to screen for any systemic changes due to these medications. Burning sensation and mouth opening were recorded before and after treatment. Patients were followed up on monthly subsequent visits for three months. Changes in the burning sensation on visual analogue scale (VAS) scale and difference in the mouth opening were analyzed statistically. A statistically significant improvement was seen in both burning sensation and mouth opening. Tulsi and turmeric offers a safe and efficacious combination of natural products available for symptomatic treatment of OSMF.

Comparison of Low- and High-dose Rate Brachytherapy in Carcinoma Cervix: Results From a Randomized Study.

Purpose: We are reporting results of a randomized study with the aim to compare the results of low-dose rate (LDR) versus high-dose rate (HDR) brachytherapy in locally advanced carcinoma cervix patients. Material and methods: Sixty cases of carcinoma of uterine cervix in Stage IIB-IIIB (FIGO) were included from a period of January 2002 to March 2003 and were randomized into HDR brachytherapy (6 Gy/fraction for 4 sessions) or LDR brachytherapy (27 Gy/single session) arm after completion of external beam radiotherapy (50 Gy/25#/5 weeks). Results: In HDR arm, 16/30 (53.33%) patients experienced complete response. In LDR arm, complete response was experienced by 13/30 (43.33%) of patients. Locoregional control in HDR group was 54.54%, 57.14% and 71.42% at 6, 9 and 12 months, respectively. Locoregional control in LDR group at 6, 9 and 12 months was 45%, 63.63% and 42.85%, respectively. Conclusion: The results of our study indicate that LDR and HDR groups are similar in locoregional control in the management of carcinoma uterine cervix. HDR brachytherapy can safely substitute LDR brachytherapy applications.

On the conspecificity of Anopheles fluviatilis species S with Anopheles minimus species C.

Anopheles fluviatilis and An. minimus complexes,each comprising of at least three sibling species, are closely related and important malaria vectors in Oriental Region. Recently An. fluviatilis species S, which is a highly efficient malaria vector in India, has been made conspecific with An. minimus species C (senior synonym) on the basis of homology in 335 base pair nucleotide sequence of D3 domain of 28S ribosomal DNA (rDNA). We examined the conspecificity of these two nominal species by obtaining and analysing the DNA sequences of nuclear ribosomal loci internal transcribed spacer 2 (ITS2) and D2-D3 domain of 28S rDNA (28S-D2/D3) from those of An. fluviatilis S and An. minimus C. We found that the sequences of An. fluviatilis S are appreciably different from those of An. minimus C with pair-wise distance (Kimura-2-parametre model)of 3.6 and 0.7%for loci ITS2 and 28S-D2/D3, respectively. Pair-wise distance and phylogenetic analyses using ITS2 sequences of members of Minimus and Fluviatilis Complexes revealed that An. fluviatilis S is distantly related to An. minimus C as compared to any other members of the Fluviatilis Complex. These findings suggest that the two nominal species, An. fluviatilis S and An. minimus C, do not merit synonymy. The study also confirms that the reported species An. fluviatilis X is synonym with species S.

Induction followed with concurrent chemo radiotherapy in advanced head & neck cancer.

BACKGROUND: The need for effective, well tolerated, and convenient therapies for inoperable Head and Neck cancer has led researchers to continually refine chemotherapeutic regimens with radiotherapy to balance efficacy with safety and tolerability in order to maintain or improve quality of life and chemotherapy either induction or concurrent with radiation have emerged as a viable alternative. AIM: This study was performed to analyze the efficacy and safety of induction chemotherapy with radiotherapy and concurrent radiotherapy on survival, functional and quality of life outcomes. MATERIAL AND METHOD: From Dec. 2001 to July 2003, hundred inoperable Head & Neck cancer patients were planned to be treated with methotrexate, Bleocin and cisplatin. On Completion of 3 cycles at 21 days interval, after 2 weeks of last cycles, fifty patients were planned to receive only radiotherapy (Group A) and rest 50 patients (Group B) were given cisplatin 50 mg weekly before Rt. on every Monday. All 100 patients received radiotherapy (66-70 cGy) to the locoregional sites by cobalt 60 units. RESULT: After completion of therapy in group A complete response was observed in 56% patients which was 68% in group B. After 2 years of follow up only 54% patient alive and 34% patients were disease free in group A where as in group B. 60% patient alive in which 42% were disease free. The survived patient enjoyed good quality of life. CONCLUSION: Patients responded better with induction chemotherapy can be treated with radiotherapy and those who failed to show satisfactory response may be treated with concurrent chemo radiotherapy to get additional benefit in term of survival with good organ preservation along with acceptable and manageable occurrence of schedule & dose related adverse events.

Evaluation of bifenthrin treated mosquito nets against anopheline and culicine mosquitoes.

BACKGROUND AND OBJECTIVES: The main rural malaria vector Anopheles culicifacies has developed resistance to dichloro diphenyl trichloroethane (DDT), hexachloro cyclo hexane (HCH) and malathion in the state of Haryana in northern India. An alternative synthetic pyrethroid insecticide bifenthrin was therefore evaluated on mosquito nets against anopheline and culicine mosquitoes, in two villages Jagdishpur and Garh Mirakpur of Community Health Center (CHC) Badhkhalsa in district Sonipat, Haryana state. METHODS: Two formulations of bifenthrin, suspension concentrate (SC) and micro-emulsion (ME) were compared with micro-capsule suspension (CS) of lambdacyhalothrin. The impact of three doses of bifenthrin (10, 25 and 50 mg/m(2)) impregnated on mosquito nets was compared with lambdacyhalothrin (25 mg/m(2)) and untreated control. Quality assessment of treatment on treated nets was carried out by residue analysis and the persistence of the insecticide on nets was determined by contact bioassays. Efficacy of treated nets on mosquito density was assessed by calculating mosquito entry rate, immediate mortality, delayed mortality and excito-repellency to the insecticides. RESULTS: In susceptibility tests An. culicifacies was susceptible to bifenthrin (0.1% test papers) and to lambdacyhalothrin (0.05% test papers). Bioassays on treated nets against A. culicifacies recorded 100 per cent mortality up to tenth fortnight for all the doses of impregnation with bifenthrin (SC and ME) and lambdacyhalothrin (CS). Ring-net bioassays against An. culicifacies showed median knock-down time between 3.1 to 11.4 min. Behavioural indices were also studied for anopheline and culicine mosquitoes. The reduction in entry rates of anopheline and culicine mosquitoes into the rooms with treated nets compared to control indicated good efficacy with all the formulations and doses of the insecticides. INTERPRETAION AND CONCLUSION: Indoor (immediate) mortality of mosquitoes with bifenthrin ME formulation was relatively lower compared to SC fomulation of bifenthrin and based on delayed mortility and continued susceptibility in bioassays, bifenthrin ME at the rate of 10 mg/m(2) dose was found suitable for the impregnation of mosquito nets for phase III trial.

An allele-specific polymerase chain reaction assay for the differentiation of members of the Anopheles culicifacies complex.

Anopheles culicifacies, the principal vector of malaria in India, is a complex of five cryptic species which are morphologically indistinguishable at any stage of life. In view of the practical difficulties associated with classical cytotaxonomic method for the identification of members of the complex, an allele-specific polymerase chain reaction (ASPCR) assay targeted to the D3 domain of 28S ribosomal DNA was developed. The assay discriminates An. culicifacies species A and D from species B, C and E. The assay was validated using chromosomally identified specimens of An. culicifacies from different geographical regions of India representing different sympatric associations. The assay correctly differentiates species A and D from species B, C and E. The possible use of this diagnostic assay in disease vector control programmes is discussed.

Peripheral nerve complications in hemophilia.

AIM: Muscle bleed in hemophilics can result in compressive neuropathy and permanent disability if not treated properly in time. Twenty cases of peripheral nerve involvement in hemophilics are presented with an aim to highlight its features and the role of pulsed ultrasound in the management. METHODOLOGY: Between January, 1999 and 2000 June, 134 patients of bleeding disorders were examined. Twenty of them presented with features of nerve palsy. In addition to usual conservative treatment, pulse ultrasound electrotherapy of 10-15 sittings was used in all the cases. RESULTS: Femoral nerve was involved in majority (15), followed by sciatic (4) and peroneal nerve in one case. Femoral nerve involvement was associated with iliacus bleed in 13 patients and inguinal bleed in two cases. All the four cases of sciatic nerve palsy were associated with gluteal hematoma. Only case of peroneal nerve palsy was associated with hematoma at upper leg and calf. Twelve cases improved completely within six months whereas another four recovered around 10 months. Remaining four showed only partial recovery even when followed up to 12 months. CONCLUSIONS: Recognition of nerve complications in hemophilics is important to avoid long-term disability. Conservative therapy starting early was associated with favourable results. Pulsed ultrasound therapy at the site of haematoma helped in early regression of hematoma and neural recovery.

Kushtha (skin disorders) in vedic and other religious literatures - A review.

In view of the description of Medical citations; Vedic literature, Buddhist literature, Jain literature, Mahabharat, Ramayan etc. have also got significant importance. Like other diseases, the description regarding Kushtha (different skin disorders) is also available in all these treatises. These are akin to the description available in Ayurveda. From the above, it is apparent that description of different diseases mentioned in Ayurveda are also available in religious literatures.

Functional diversity of hnRNP proteins.

The hnRNP proteins bind to pre-mRNA concomitant with transcription and form ribonucleoprotein complex essential for post-transcriptional events. More than 20 different groups of hnRNP proteins are known in humans. The number seems to be similar in other organisms too. The hnRNP proteins possess different types of RNA binding domains which directly interact with RNA, most likely in a sequence specific manner. The functions of hnRNP proteins range from mRNA packaging and transport, to mRNA splicing and silencing. Further, indirectly, their role has also been implicated in oogenesis. Hence, hnRNP proteins play diversified roles both in nucleus and cytoplasm, and regulate the gene expression at various levels.

Bacteriology of pyoderma including anaerobes.

Of 100 pus samples cultured from pyodermal lesions, 99 yielded positive cultures. Staphylococcus aureus alone (45%) or with beta-haemolytic streptococci (BHS, 32%) was the commonest isolate. Antimicrobial sensitivity of 71 Staph. aureus strains tested showed high degree of resistance to erythromycin (38.3%). BHS was the second common pathogen encountered. T-agglutination patterns studied in BHS group A could type 85.7 per cent of the isolates. Non-group A BHS isolated were of group G (3) and group D (1). Five pus specimens yielded obligate anaerobes mixed with aerobes. Bacteroides melaninogenicus/asacchrolyticus was isolated in 4 of 5 samples.