Management of Diabetic Macular Edema Through Ayurveda: A Single Case Study

Diabetic macular edema is one of the leading causes of visual acuity loss in people with diabetes. It produces blurry vision, particularly in the centre of the vision field, floaters and black spots in front of the eyes etc. The treatment recommended by modern science is laser photocoagulation and anti-VEGF injection, which is pricey and does not ensure visual reversal in the patient. In Ayurveda text, diabetic retinopathy and diabetic macular edema are not directly described but etiopathogenesis of eye diseases and Prameha gives an idea of possible correlation between these two diseases. So, DME resembles Timira (Pramehajanya). In Ayurveda, Timira has been explained in detail by our Acharyas. Clinical manifestations of Timira are Vihwal Drishti (blurred vision), Makshika Mashaka Kesha Jaala Pashyati (floaters), Tamasa Darshanam (Scotoma- black spots in front of eyes) and Nasa Akshi Yuktani Vipritani Vikshate (Metamorphopsia or distorted vision) which has similarity with features of DME. Material & Methods: In the present study, a female patient aged 51 years, visited the Shalakya Tantra OPD of National Institute of Ayurveda, Jaipur, with complaining of Blurriness of vision since 6 months and uncontrolled blood sugar level. Result: Blood sugar level was controlled and saw reduction in subjective and objective parameters. Discussion: Following an Ayurvedic drugs and routine will assist to slow the advancement of the condition, prevent further diabetes complications, and improve quality of life.

Association of mood disorder and modifiable life-style risk factors in medical students: a cross-sectional study

Background: Bipolar disorder is one of the common chronic serious mental illness affecting 7 billion people in the world associated with significant morbidity which goes unrecognized. After extensive literature search, it was found that there is paucity of studies from the Indian setting that have addressed the issue of bipolar disorder.Methods: The present study was carried out to screen for bipolar disorder among medical undergraduate students and its correlates.  Due to non-availability of many studies from India, the proportion of 50% was taken as prevalence to calculate the sample size. With 95% confidence interval and 8% absolute error, a sample size of 126 was calculated using Epi Info. Study tools used were a semi structured questionnaire on socio-demographic profile of participants, Global Physical Activity Questionnaire (GPAQ) and Mood Disorder Questionnaire (MDQ). MDQ is a self-reporting screening instrument for bipolar disorder having a Cronbach’s alpha coefficient of 0.83. Data was analyzed using chi-square test with p value <0.05 considered statistically significant.Results: The study included 87.3% males and 12.7% females with mean age 21.26±1.23 years. Out of 126 participants, 17 (13.5%) were screened positive for bipolar disorder. Factors found to have statistically significant association with bipolar disorder were number of siblings, type of family, migration status of family, living in hostel, body mass index and physical activity of the participant.  Conclusions: The results suggest that medical students constitute a vulnerable group and there are certain risk factors other than academic stressors which predispose a medical student to mental illness.

Audit into stillbirths: a tertiary hospital experience.

Background: The objective of the study was to evaluate the prevalence, risk factors and causes of stillbirth. Methods: A retrospective cohort study was conducted from January 2014 until December 2014 in a tertiary referral teaching hospital in Punjab. The 2014 birth register from the department of Obstetrics and Gynecology was reviewed and the data was collected. The results were tabulated and data was analyzed as frequencies, percentages and descriptive statistics. Results: During the one-year study period, there were 1528 registered pregnancies in the hospital and 64 pregnant women were diagnosed to have stillbirth resulting in a stillbirth rate of 40.63 / 1000 live births. More than 75% of the stillbirths were noted in women between 21 to 30 years of age. Pregnant women who were unbooked (72.5%) had higher rates of stillbirths. More than 80% of the stillbirths were preterm. Anaemia (41.93%), pre-eclampsia (25.8%) and antepartum hemorrhage (24.19%) were the most common maternal risk factors noted in these patients. Maternal factors contributed to 37.5% of the causes of stillbirths. The other causes for stillbirths were placental factors (32.8%) and fetal factors (6.2%). In 23.43% of the cases the cause was unknown. Conclusions: India shares a high burden of stillbirths with priority gaps in reporting and recognizing at the health policy level. Better counting of stillbirths and improved cause-of-death data can advocate child survival strategies.

FNAC of Head and Neck Swellings.

Background : Fine Needle Aspiration Cytology is simple, quick, inexpensive, majority are on OPD basis and minimally invasive technique used to diagnose different types of swellings located in the head and neck commonly originate from cervical lymph node, thyroid, salivary glands and soft tissues. Aim : To assess the frequency of incidences at different sites of head and neck region, and amongst the sex group. To assess distribution amongst inflammatory and neoplastic lesions. Methodology: A retrospective study was conducted at a tertiary care hospital, Ahmedabad from October 2013 to January 2014. Patients between the ages of 1 to 80 years were enrolled into the study. A total of 146 patients with a head and neck swelling underwent FNAC. Fine needle aspiration diagnosis was correlated with detail of relevant clinical findings and investigations. Results : Out of 146 fine needle aspiration procedures, 107 (73.29%) were of lymph nodes, 25 (17.12%) were of thyroid gland, 08 (5.48%) from soft tissue and 06 (4.11%) from salivary glands. Amongst lymph node swellings (73.29%), tuberculous involvement was seen in 73 cases (68.22%) with a female preponderance. Out of total 146 lesions, 109 (74.66%) were inflammatory, 29 (19.86%) were benign and 08 (5.48%) were malignant. Conclusions : The head and neck swellings are very common conditions encountered, with most of them being on OPD basis. Our study found that FNAC is simple, quick, inexpensive and minimally invasive technique to diagnose different types of head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. In case of neoplastic conditions, patient may be referred to Regional Cancer Centre.