Diagnosis In Ayurveda With Special Reference To Trividha Bodhya Samgraha

Ayurveda is comprehensive in its approach which emphasizes naming a disease is not necessary rather knowledge about Nidana (Etiological Factors), Dosha, Dushya and Samprapti of disease (Pathology) are crucial. Several diseases mentioned in the Samhitas (Classical texts) does not match with clinical presentation of disease thus in order to ascertain a working diagnosis clinical history and detailed physical examination are critical to the diagnostic process. Based on the ‘Purush Purush Veekshya Nyaya’, various Siddhantas (principles) ought to be adopted to diagnose the disease, as diagnosis is always individual to each patient. Acharya Charaka has mentioned the concept of Trividha Bodhya Samgraha (Vikara Samuthana, Vikara Adhishtana and Vikara Prakruti Vishesha that deals with the principles of etiology and different stages of pathology of a disease. This concept holds basis for Ukta Gada (listed diseases) as well as for Anukta Gada (unlisted diseases). Thus it can be applied to diagnose any of the disease. If accurate diagnosis is made in proper and sequential manner it provides the best outcome by assessing the response to multimodal approach of Ayurveda through treatment modality. This present article aims to provide an insight to develop a clinical approach to Ayurveda diagnosis enunciated in Samhitas in context of Trividha Bodhya Samgraha underneath the spectrum of Anukta Vyadhi.

Management of rectal prolapse (Guda Bhramsa) through Kshara Karma (chemical cauterisation): a case study / Manejo do prolapso retal (Guda Bhramsa) usando Kshara Karma(cauterização química): um estudo de caso

Abstract Rectal Prolapse is a condition where the rectum protrudes beyond the anus. The explanation of this condition can be traced back to ancient Ayurveda text like Susruta Samhita, Ebers Pappyrus of 1500 B.C., etc. The exact cause of rectal prolapse is unclear but it is predominant on female gender and on people having constipation, previous anorectal surgeries etc. Both partial and complete varieties of rectal prolapse are extremely debilitating because of the discomfort of the prolapsing mass and variety of symptoms like rectal bleed, intermittent constipation or fecal incontinence. Although, diverse modalities of surgical management of rectal prolapse are present, no single optimal procedure is proved and the choice of operation is determined by the patient's age, sex, degree of incontinence, operative risk, as well as by the surgeon's experience. In Ayurveda, Guda Bhramsa (Rectal prolapse) is explained by Acharya Susruta under Kshudra Rogas (chapter of minor diseases) and has elaborated it's conservative management very beautifully. In this case, a female with partial rectal prolapse was treated with Kshara application and managed without complications. So, Kshara application can be a safe and effective alternative for the management of rectal prolapse.

Resumo O prolapso retal é uma condição em que o reto se projeta para além do ânus. A explicação desta condição foi relatada em antigos textos Ayurveda como Susruta Samhita e Ebers Pappyrus, datados de 1500 aC. A causa exata do prolapso retal não é clara, mas essa condição é predominante no sexo feminino e nas pessoas com constipação e histórico de cirurgias anorretais anteriores. Tanto o prolapso retal parcial quanto total são extremamente debilitantes devido ao desconforto da massa prolapsante e da variedade de sintomas como sangramento retal, constipação intermitente ou incontinência fecal. Embora diversas modalidades de tratamento cirúrgico para corrigir o prolapso retal tenham sido relatadas na literatura, nenhum procedimento é consensual; a escolha da operação é determinada pela idade, sexo, grau de incontinência, risco operatório e experiência do cirurgião. Na Ayurveda, Guda Bhramsa (prolapso retal) é explicado por Acharya Susruta no Kshudra Rogas (capítulo de doenças menores) e seu manejo conservador é descrito de forma bastante completa. No presente caso, uma paciente do sexo feminino com prolapso retal parcial foi tratada com aplicação de Kshara e administrada sem complicações. Assim, a aplicação de Kshara pode ser uma alternativa segura e eficaz para o manejo do prolapso retal.

The association between new generation oral contraceptive pill and the development of inflammatory bowel diseases

BACKGROUND/AIMS: To examine the association between use of oral contraceptive pills (OCPs) and the risk of developing inflammatory bowel diseases (IBD), in a modern cohort. METHODS: A prospective nested case-control study across sites in the Asia-Pacific region was conducted; involving female IBD cases and asymptomatic controls. Subjects completed a questionnaire addressing questions related to OCP use. Primary outcome was the risk of development of IBD of those exposed to OCP versus non-exposure. Secondary outcomes were development of Crohn's disease (CD) versus ulcerative colitis (UC), and whether age of first use of OCP use may be associated with risk of IBD. RESULTS: Three hundred and forty-eight female IBD cases (41% CD, median age: 43 years) and 590 female age-matched controls were recruited. No significant association was found between OCP use and the risk of IBD (odds ratio [OR], 1.65; 95% confidence interval, 0.77–3.13; P=0.22), CD (OR, 1.55) or UC (OR, 1.01). The lack of association persisted when results were adjusted for age and smoking. IBD cases commenced OCP use at a younger age than controls (18 years vs. 20 years, P=0.049). CONCLUSIONS: In this large cohort of subjects from the Asia-Pacific region, we found a modest but not significantly increased risk of developing IBD amongst OCP users.

Effects of multiple root canal usage on the surface topography and fracture of two different Ni-Ti rotary file systems.

Aim: The purpose of this study was to evaluate the effect of multiple root canal usage on the surface topography and fracture of Twisted File (TF) and ProTaper (PT) rotary Ni-Ti file systems, using scanning electron microscope (SEM). Materials and Methods: Ten sets of PT and TF instruments were used to prepare the mesial canals of mandibular first molars. TF 25, 0.06 taper and PT F1 instruments were analyzed by SEM when new and thereafter every three root canal usages. This sequence was repeated for both the TF and PT groups until 12 uses. Two images of the instrument were recorded, one of the instrument tip and the other 5 mm from the tip, both at ×100 magnification. The sequential use was continued till the instrument fractured and the number of root canal usages for the file to fracture was noted. All fracture surfaces were examined under the SEM. Results: Fresh TF instruments showed no surface wear when compared to PT instruments (P < 0.05). Spiral distortion scores remained the same for both the groups till the 6 th usage (P > 0.05), while at the 9 th usage TF showed a steep increase in the spiral distortion score when compared to PT (P < 0.05). PT instruments fractured at a mean root canal usage of 17.4, while TF instruments showed a mean root canal usage of 11.8. Fractographically, all the TF instruments failed due to torsion, while all the PT instruments failed because of cyclic fatigue. Conclusion: PT instruments showed more resistance to fracture than TF instruments.

Fatal re-expansion pulmonary oedema in a mechanically ventilated patient.

Fatal course of re-expansion pulmonary oedema (REPO) is infrequent and very rarely documented in mechanically ventilated patients. We report a case of fatal REPO following tube thoracostomy for a right-sided pneumothorax in an elderly patient of chronic obstructive pulmonary disease (COPD) with respiratory failure on mechanical ventilation.

Carpal tunnel syndrome: survey of an occupational hazard.

Carpal tunnel syndrome (CTS) is one of a number of muscle-tendon and nerve related disorders that affect people performing intensive work with their hands. Hand and wrist disorders are receiving most of the attention although their symptoms are reported less often by dental workers than symptoms of neck/back disorders. The lack of data pertaining to the behaviour of Indian general dental practitioners towards carpal tunnel syndrome was the basis behind this descriptive study to evaluate the prevalence of carpal tunnel syndrome symptoms.

Criteria for management of calcific metamorphosis: review with a case report.

Calcific metamorphosis is seen commonly in the dental pulp after traumatic tooth injuries and is characterized by deposition of hard tissue within the root canal space. Opinion differs among practitioners as to whether to treat these cases upon early detection of calcific metamorphosis or to observe them until symptoms or radiographic signs of pulpal necrosis are detected. In this article, the clinical, radiographic, and histopathologic appearance of calcific metamorphosis is described; a review of the literature is presented to address these issues in an attempt to establish sound rationale for treatment. Approximately 3.8% to 24% of traumatized teeth develop varying degrees of calcific metamorphosis. Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis. Most of the literature does not support endodontic intervention unless periradicular pathoses is detected or the involved tooth becomes syptomatic. It may be advisable to manage cases demonstrating calcific metamorphosis through observation and periodic examination. A report of a case where in non-surgical endodontic intervention was successfully carried out a patient suffering from calcific metamorphosis with periapical pathoses is also presented.

Clinical profile of carcinoma stomach at a tertiary care hospital in south India.

Carcinoma of the stomach is an important cause of mortality due to cancer. Carcinoma of the stomach is common in the southern region of India. We conducted a retrospective study on the epidemiological, clinical and survival patterns among the patients with carcinoma of the stomach, attending our hospital from June 19, 1995 to 1st January 2003. All the patients had histopathological confirmation of malignancy. Patients with gastrooesophageal junction lesions were excluded. Surgery was performed with curative as well as palliative intent in suitable patients. Chemotherapy has been incorporated in to the combined modality treatment in our hospital since July 2000. Postoperative chemotherapy comprised commonly used intravenous chemotherapy regimens, while oral chemotherapy (etoposide) was given to patients with disease not amenable to surgery, and those having poor performance and nutritional status. Oral etoposide was given in a dose of 50 mg/day for 14 days, in a 28 day cycle. Quality of life was assessed in the oral chemotherapy group. Out of the 1749 cancer patients seen during the period, 151 had gastric malignancy (8.6%). The median age was 55 years (range 15-84 years). The male to female ratio was 4:1. Adenocarcinoma was found in 148 patients, 2 had stromal tumours and 1 had non-Hodgkin lymphoma. Stage disribution was as follows; stage 2-1 patient , stage 3a-25, stage3b-49, stage4-3 1, Metastatic-28. Staging was not completed in 17 patients. Eighty-nine patients underwent surgery. Fifty-nine patients (39%) did not have surgery. One patient underwent polypectomy. Curative gastrectomy was performed in 11 patients. Thirty-nine patients underwent palliative tumour resection. Palliative gastro-jejunostomy for relief of symptoms was performed in 26 patients and exploratory laparotomy alone was perforaied in 13. Thirty-eight patients received chemotherapy. Out of these, only 2 patients had prior complete resection of the tumour and 36 received palliative chemotherapy. Intravenous chemotherapy was given to 17 patients and oral chemotherapy to 19; All the patients who received oral etoposide did not experience any toxicity. Patients who received intravenous chemotherapy (n=17) had the following toxicities: grade 3 emesis in 4 (20%), discoloration of the skin and nails in 6(31%), alopecia in 8 (50%), grade 3 diarrhoea in 3 (15%) and neutropenic fever in 4 patients (20%). Median survival for the cohort was 10.4 months. Quality of life parameters, such as sleep, appetite, weight, pain, work and general sense of ill health showed improvement. In conclusion, 8.6% of all cancers at our hospital were due to cancer of stomach, in whom distal gastric tumor were more frequent and most were non-resectable. Median survival was 10.4 months. Oral etoposide was found to be safe, improved the quality of life and may play a role in the palliative management of advanced carcinoma of the stomach.

Acute mesenteric venous thrombosis complicating endoscopic variceal sclerotherapy with absolute alcohol.

We report two patients, one with liver cirrhosis and another with extrahepatic portal vein obstruction, who developed acute mesenteric vein thrombosis following endoscopic variceal sclerotherapy with absolute alcohol. Both patients recovered after emergency laparotomy and resection of gangrenous bowel loop.