Ashtvidha Shastra Karma With Suturing In Detail

Ayurveda is considered by many scholars to be the oldest healing science. In sanskrit, Ayurveda means "The Science of life". Ayurvedic knowledge originated in India more than 5000 years ago and is often called the "Mother of healing". Ancient surgical science- Shalya Tantra is one of the vital components of Ayurveda science which involves surgical and para-surgical interventions. The Shalya chikitsa deals with different surgical approaches for the management of various diseases such as Bhagandra, Pilonidal sinus, Arshas etc. Shalya Tantra embraces all processes aiming at the removal of factors responsible for producing pain or misery to the body or mind. Acharya sushruta has mentioned "Trividha Karma" and "Ashtavidha Shastra Karma" as versatile approaches for therapeutic purposes. The concept of Ashtavidha karma is a unique contribution of Acharya Sushruta. These eight specific surgical procedures are useful in the management of all the diseases which require surgical intervention. In the present time though modern surgery has developed a lot but the basic procedures used in major conditions remained same. These eight basic surgical procedures mentioned by Sushruta are equally applied even today with required modifications to manage the diseases which require surgery including surgical emergency conditions. This article summarizes role of Ashtvidha Shastra Karma in Shalya karma for the management of various surgical problems.

Picroside II attenuates fatty acid accumulation in HepG2 cells via modulation of fatty acid uptake and synthesis

BACKGROUND/AIMS: Hepatic steatosis is caused by an imbalance between free fatty acids (FFAs) uptake, utilization, storage, and disposal. Understanding the molecular mechanisms involved in FFAs accumulation and its modulation could drive the development of potential therapies for Nonalcoholic fatty liver disease. The aim of the current study was to explore the effects of picroside II, a phytoactive found in Picrorhiza kurroa, on fatty acid accumulation vis-à-vis silibinin, a known hepatoprotective phytoactive from Silybum marianum. METHODS: HepG2 cells were loaded with FFAs (oleic acid:palmitic acid/2:1) for 20 hours to mimic hepatic steatosis. The FFAs concentration achieving maximum fat accumulation and minimal cytotoxicity (500 μM) was standardized. HepG2 cells were exposed to the standardized FFAs concentration with and without picroside II pretreatment. RESULTS: Picroside II pretreatment inhibited FFAs-induced lipid accumulation by attenuating the expression of fatty acid transport protein 5, sterol regulatory element binding protein 1 and stearoyl CoA desaturase. Preatreatment with picroside II was also found to decrease the expression of forkhead box protein O1 and phosphoenolpyruvate carboxykinase. CONCLUSIONS: These findings suggest that picroside II effectively attenuated fatty acid accumulation by decreasing FFAs uptake and lipogenesis. Picroside II also decreased the expression of gluconeogenic genes.

Intravenous dexmedetomidine vs. lignocaine in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation: a randomized double blind study

Background: The stress response to laryngoscopy and endotracheal intubation is a commonly encountered physiological phenomenon. Though the response can be transient and harmless in normotensive healthy patients, but it may prove hazardous amongst patient with underlying cardiac disease, or hypertensive disease and its sequelae. Present study was planned to evaluate the efficacy of IV dexmedetomidine infusion and IV lignocaine in attenuating the hemodynamic responses during laryngoscopy and intubation

Methodology: On approval from hospital ethical committee, 120 ASA grade I and II, normotensive patients in the age group of 18-60 years, planned for elective surgery under general anesthesia were enrolled in the study. Patients were divided into 3 equal groups of 40 each; Group A [Lignocaine group] received lignocaine 1.5 mg/kg IV 2 min before induction, Group B [dexmedetomidine group ] received dexmedetomidine 1 micro /kg IV infusion with syringe pump 10 min before induction, and Group C [control group] received normal saline before induction. Heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], oxygen saturation of arterial blood [SpO2] and electrocardiogram [ECG] were monitored at induction, intubation and post intubation at one minute interval till 10th minute

Results: A better control of stress response was observed in patients receiving dexmedetomidine infusion. More decrease in HR was noted in Group B as compared to Group A [9.28 % vs. 13.40%] respectively. The decrease in MAP was also more in Group B as compared to group receiving lignocaine [5.49 % vs. 10.72%] respectively

Conclusion: Dexmedetomidine 1 micro g/kg IV is more effective in blunting stress response to laryngoscopy and endotracheal intubation as compared to lignocaine 1.5 mg/kg IV

Is dexmedetomidine a better sedative agent than clonidine in spinal anesthesia?

Background and Aims: Regional anesthesia offers benefits to patients and anesthetists by keeping the patients awake, preserving the airway reflexes, by providing cardiovascular stability during the procedure and fast postoperative recovery. Patients are often uncomfortable, because of pain at puncture site, recall of procedure and limited duration of blockade. Alpha-2 adrenoreceptor agonists were introduced in anesthesia for their sedative and analgesic effects. The aim of this study was to compare the effects of intravenous dexmedetomidine or clonidine as adjuvants during bupivacaine spinal anesthesia

Methodology: A prospective, randomized study was conducted involving 120 patients scheduled for elective infraumbilical surgery under spinal anesthesia. Patients were randomly divided into three groups [n = 40] and were given the following drugs intravenously as per group allocation: Group A received 1 microg/kg of dexmedetomidine, followed by an infusion at the rate of 0.5 microg/kg/h; Group B received 1 microg/ kg of clonidine, followed by an infusion at rate of 1 microg/kg/h and Group C received normal saline bolus and infusion. Loading dose was given over 10 min, prior to [SAB], followed by a maintenance infusion. Ramsay sedation score of 3-4 was considered as target sedation. Patients were assessed for time required to achieve target sedation, prolongation of analgesia and motor blockade. The hemodynamic parameters and side effects were also observed

Results: The target sedation was achieved significantly earlier in Group A [14.32 +/- 5.25 min] as compared to Group B [30.01 +/- 2.33 min] [P = 0.001]. In Group A, the mean duration of analgesia was 208.25 +/- 28.29 min as compared to 169.75 +/- 20.15 min in Group B and 135.25 +/- 22.60 min in Group C [P < 0.05]. Duration of motor blockade was increased in Group A [217 +/- 24.697 min] as compared to Group B and C

Conclusion: Intravenous dexmedetomidine infusion is better than intravenous clonidine as it provides earlier onset of adequate sedation along with prolongation of analgesia and motor blockade during bupivacaine spinal anesthesia

PCI in a case of dual [type IV] LAD with anomalous origin of the LCx from RCA

Dual left anterior descending coronary artery [LAD] originating from the left main stem and the right coronary artery [type IV LAD] is a rare congenital anomaly. Its association with an anomalous origin of the left circumflex [LCx] from RCA is even rarer. We describe a patient presenting with acute inferior wall myocardial infarction, who was subsequently found to have this coronary anomaly. He underwent staged PCI of the dominant RCA and anomalous LCx successfully through the radial route. We conclude that anomalous coronaries can be safely and successfully treated through the radial route after careful evaluation of origin and course of the anomalous vessels. CT coronary angiography is extremely useful in delineating the vessel course and particularly their relation to great arteries