Raktamokshana- Ancient Blood Letting Technique: A Review

Ayurveda is a science that focuses on both well-being and disease treatment. Many surgical and para-surgical procedures have been described by Acharya Sushruta for the management of various diseases; among these, Raktamokshana is popularly used for the management of various pathologies occurring due to Rakta Dushti (blood-borne disorders). It is derived from two words i.e., ‘Rakta’ which means blood & ‘Mokshana’ which means leave. Hence, Raktamokshana means to let the vitiated blood out. It is one of the five purification therapies by Acharya Sushruta. There are two ways to do Raktamokshana i.e., Shastra Visravana (using sharp instruments) and Anushastra Visravana (without using sharp instruments). Furthermore, it is said that Siravedha is ‘Chikitsaardha’ i.e., half of the treatment described in Shalya Tantra is similar to a well-performed Basti karma (Therapeutic Medicated Enema) advocated in Kaya-Chikitsa. However, there are relatively limited recommendations or use of Raktamokshana in clinical practices nowadays which may be due to fear associated with the procedure, lack of skillfulness, and unawareness about the efficacy of Raktamokshana in various diseases. This review article is specifically intended to assemble the usefulness of numerous modes of Raktamokshana based on Ayurvedic parameters with its detailed procedure

Genetic variation of CYP3A and its influence on the pharmacokinetics of tacrolimus, a calcineurin inhibitor

Background: Tacrolimus (Tac) a calcineurin inhibitor (CNI), is a potent immunosuppressive drug which is widely used in organ transplant recipients. The drug has a narrow therapeutic window and high inter-individual pharmacokinetic variability. Tac is metabolized by cytochrome P450 3A (CYP3A) enzymes. The CYP3A5 activity is largely determined by the single nucleotide variant (SNV) CYP3A5*3 (c.219-237A>G; rs776746), which results in alternate mRNA splicing and a non-functional protein.Methods: An observational prospective study was carried out at nephrology centre of army hospital where the consenting patients were enrolled in the study. The whole blood sample drawn was utilized to analyze for plasma drug concentration of Tac and genotyping for the CYP3A*5 polymorphism by the method as described by Cheung et al.Results: 100 patients participated with an average of 98±8 days after transplantation. Recipients having heterozygous CYP3A5*1 genotype manifested 70% lower mean steady state concentration of Tac (C0/D ratio) 1.67±0.43 ?g*l-1/mg in comparison to homozygote carriers of CYP3A5*3 5.60±1.94 ?g*l-1/mg p<0.001.Conclusions: Study suggested that Indian sub population closely mimics Caucasian population in terms of genotype expression for CYP3A5*3, who are expressing a non-functional enzyme for metabolism. Also, this study reinforces that population genotype CYP3A5*1 is significantly associated with lower C0/D ratio for Tac than the ones expressing homozygous CYP3A5*3 genotype. It also established the importance of pre-transplant genotyping, for better individualization of Tac doses. Further studies are suggested for population pharmacokinetic modelling study in future to derive starting dosage of Tac based on profiling of CYP3 genetics in recipients.

Correlation between Fasting Blood Sugar Level, HbA1C Level and Serum Lipid Levels in Type 2 Diabetes Mellitus Patients

Introduction: Diabetes Mellitus is one of the most commonendocrinal diseases in the world. Incidences of this disease areincreasing worldwide and this disease is called disease of thismillennium. This study was undertaken to correlate fastingblood sugar level, Glycosylated haemoglobin (HbA1C) leveland serum lipid levels in patients with diabetes mellitus.Material and Methods: This study was a cross sectionalstudy conducted on 100 patients of diabetes mellitus came toM.B Govt. Hospital, Udaipur. The fasting blood sugar (FBS)levels, HbA1C levels and serum lipid levels were performedand then correlated fasting blood sugar level with HbA1Clevels and FBS and HbA1C with serum lipid levels. There wasa significant positive correlation between FBS and HbA1C,and FBS and HbA1C with serum cholesterol and serumtriglycerides level and negative correlation with serum HDLcholesterol levels.Results: This study demonstrated that HbA1C level wasincreased in diabetics and it showed correlation with the statusof control of diabetes.Conclusion: Diabetics have got increased level of serumcholesterol, triglycerides and decreased levels of serumHDL-cholesterol. HbA1C showed stronger correlation withserum cholesterol and triglycerides as compared to FBS.HDL-cholesterol showed stronger correlation with FBS thanHbA1C.

Bacterial Investigation and Antibiogram in Corneal Ulcers in Dogs

Corneal ulcers in dogs usually have a traumatic origin. They cause a break in the continuity of underlying corneal stroma and become rapidly contaminated with bacteria. Twenty eight clinical samples were obtained from corneal ulcer affected dogs for bacterial isolation and anti-microbial susceptibility. Bacterial growth was observed in 100% of the samples (n=28) and Staphylococcus spp. was isolated and characterized by culture, gram staining and various biochemical tests. Antibiogram pattern revealed that gatifloxacin and moxifloxacin antibiotics were found to be highly effective in the treatment of corneal ulcers in dogs. Corneal culture and sensitivity testing provided useful information for the diagnosis, determination of appropriate treatment and antimicrobial therapy for corneal diseases in dogs

Prescription audit study in a tertiary care hospital using the anatomical therapeutic chemical and defined daily dose classification concept.

Background: In 1996, WHO recognized the need to develop and use the anatomical therapeutic chemical (ATC) and defined daily dose (DDD) as an international standard for utilization studies wherein it appointed experts in clinical pharmacology, drug utilization, drug regulation, drug evaluation, statistics, and medicine to monitor drug utilization on a standard and uniform pattern around the world. Methods: All the prescriptions presented to main dispensary of the hospital from January-December 2013 in mid-month period of 10 days were taken for the analysis in terms of pharmacovigilance, polypharmacy, drug usage group wise, pharmacoeconomics, and drug utilization in DDD/1000/day along with ATC classification using customized software. Results: 35,808 prescription forms containing 121,303 drugs were presented to main dispensary of the hospital across which medicines were dispensed. Polypharmacy was calculated to be 3.27±0.44 standard deviation. Approximately, 60% of total prescription forms analyzed were lacking essential and basic such information as age, gender, or diagnosis. Pharmacoeconomics of this study indicates that a major budget was mainly spent on drug groups belonging to - metabolic, antibiotics, hormones, and related drugs. A voluminous consumption of drugs belonged to drug groups - metabolic drugs like statins, hormones, and related drugs such as various oral hypoglycemics, anti-hypertensives, psychotropics, and proton pump inhibitors or H2 blockers, all indicative toward stressful and sedentary lifestyle of modern era and unhealthy lifestyles, a trend of increasing morbidity and mortality, reducing significantly the productive man-hours. Conclusions: This study was undertaken in a government tertiary care hospital which gives insight into the day to day functioning status of our health care delivery system. It is an opportunity on self-assessment in further improving the health care delivery by implementing measures which economizes on scarce health care budget as well as minimizing the common prescription errors.

Bilateral adrenal abscess in a neonate.

A 23-day-old male baby with a history of perinatal hypoxia presented with refusal of feeds and abdominal distension. The child had a right-sided cystic upper abdominal mass and features of neonatal septicemia. Abdominal ultrasound (US) and contrast-enhanced CT scan showed bilateral adrenal abscesses. Laparotomy with drainage of the abscesses successfully treated the condition. The literature on the subject is reviewed.

Pharmacoeconomics.

Pharmacoeconomics focuses on the costs and benefits of drug therapy and pharmacoeconomic evaluations provide a basis for resource allocation and utilization. It is increasingly becoming important for health policy decision-making. A pharmacoeconomic evaluation may be conducted as an economic assessment incorporated into clinical trials. Such trials should compare the new drug/procedure with an older drug or existing intervention. Four techniques are used for economic evaluation, namely, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The choice of the evaluation method depends on the nature of outcomes and the context in which the choices need to be made. Pharmacoeconomics is a young science that will improve with application. Its need is undeniable, especially in developing countries.

Hypertriglyceridemia-induced acute pancreatitis--treatment with heparin and insulin.

Heparin and insulin stimulate lipoprotein lipase and are known to decrease serum triglyceride levels. However, their efficacy in hypertriglyceridemia-induced acute pancreatitis is not well documented. We report a 51-year-old man in whom treatment with heparin and insulin was accompanied by reduction in serum triglyceride levels and resolution of pancreatitis.