Validation of the Ayurvedic construct, Rasadhatudushti, in adults at risk of cardiovascular diseases - A mixed-method study.

BACKGROUND: Rasadhatudushti (RD), the deranged state of Rasadhatu, is a construct in Ayurveda mentioned as the cause of diseases affecting the circulatory channels and the heart, collectively called cardiovascular diseases (CVD). It is a morbid condition generic to some other disorders, hence is non-specific to CVD. It was observed that RD was present in majority of acute coronary artery disease in a cross-sectional, descriptive study in 250 patients stabilized after an acute episode. OBJECTIVES: To validate the available scale for assessing RD in the context of CVD risk. To study the prevalence of RD in participants at risk of cardiovascular diseases. METHOD: In the first part, validation of the scale for assessing RD, as mentioned in the texts, was done through standard steps for scale validation in the context of CVD risk. Psychometric analysis was done after administering the draft scale of 39 items in 218 participants above the age of 40 years who were not yet diagnosed with overt CVD conditions. Construct validation was done by comparing mean score of Framingham global risk score in high and low RD scores and comparing the reduction in CVD risk score assessed by Qrisk®2-2017 by life style modification and a conventional RD correction as add on. Second part was a cross sectional survey study to estimate the prevalence of RD in a specific population vulnerable to CVD. This was done in a sample of 160 sedentary government employees of Thiruvananthapuram District, Kerala, aged above 40, using the validated RD assessment scale. RESULT: -The final scale to assess RD, 'RAS-RCVD', with 25 symptoms was found to have concurrent validity using WHO/ISH risk prediction as the reference standard. Framingham global risk score also showed significant but low positive correlation with eight as the cut off for RD score. The reduction in mean (SD) Qrisk score was 2.53 (3.22) in the trial group receiving RD correction drug and 0.30 (3.43) in the control with statistical significance (p < 0.05). The prevalence of RD as assessed by RD score above the cut off in the second part of the study was 49.4%. The prevalence of RD was significantly high in participants with moderate to high risk for CVD (61.3%). CONCLUSION: - The construct RD was observed to be valid in pre-clinical states of CVD. There was a high prevalence of this morbid construct in moderate to high-risk individuals. Ayurvedic CVD prevention strategies need to target on correction of RD along with individual risk factor management.

Mortality and associated risk factors of COVID-19 infection in dialysis patients in Qatar: A nationwide cohort study.

CONTEXT: Patients on maintenance dialysis are more susceptible to COVID-19 and its severe form. We studied the mortality and associated risks of COVID-19 infection in dialysis patients in the state of Qatar. METHODS: This was an observational, analytical, retrospective, nationwide study. We included all adult patients on maintenance dialysis therapy who tested positive for COVID-19 (PCR assay of the nasopharyngeal swab) during the period from February 1, 2020, to July 19, 2020. Our primary outcome was to study the mortality of COVID-19 in dialysis patients in Qatar and risk factors associated with it. Our secondary objectives were to study incidence and severity of COVID-19 in dialysis patients and comparing outcomes between hemodialysis and peritoneal dialysis patients. Patient demographics and clinical features were collected from a national electronic medical record. Univariate Cox regression analysis was performed to evaluate potential risk factors for mortality in our cohort. RESULTS: 76 out of 1064 dialysis patients were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). During the study period, 7.1% of all dialysis patients contracted COVID-19. Male dialysis patients had double the incidence of COVID-19 than females (9% versus 4.5% respectively; p<0.01). The most common symptoms on presentation were fever (57.9%), cough (56.6%), and shortness of breath (25%). Pneumonia was diagnosed in 72% of dialysis patients with COVID-19. High severity manifested as 25% of patients requiring admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes. The mean length of hospital stay was 19.2 ± -12 days. Mortality due to COVID-19 among our dialysis cohort was 15%. Univariate Cox regression analysis for risk factors associated with COVID-19-related death in dialysis patients showed significant increases in risks with age (OR 1.077, CI 95%(1.018-1.139), p = 0.01), CHF and COPD (both same OR 8.974, CI 95% (1.039-77.5), p = 0.046), history of DVT (OR 5.762, CI 95% (1.227-27.057), p = 0.026), Atrial fibrillation (OR 7.285, CI 95%(2.029-26.150), p = 0.002), hypoxia (OR: 16.6; CI 95%(3.574-77.715), p = <0.001), ICU admission (HR30.8, CI 95% (3.9-241.2), p = 0.001), Mechanical ventilation (HR 50.07 CI 95% (6.4-391.2)), p<0.001) and using inotropes(HR 19.17, CI 95% (11.57-718.5), p<0.001). In a multivariate analysis, only ICU admission was found to be significantly associated with death [OR = 32.8 (3.5-305.4), p = 0.002)]. CONCLUSION: This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high incidence of COVID-19 infection and related mortality compared to previous reports of the general population in the state of Qatar (7.1% versus 4% and 15% versus 0.15% respectively). We also observed a strong association between death related to COVID-19 infection in dialysis patients and admission to ICU.

A comparative diuretic evaluation of fruit and root of Gokshura (Tribulus terrestris Linn.) in albino rats.

Background: Gokshura Moola (root of Tribulus terrestris Linn.) is one among the ingredients of Dashamoola, a group of ten medicinal plants principally comprising roots as the useful part. In practice instead of root, fruit of Gokshura is widely used in most of the preparations of Dashamoola in Kerala. Dashamoola occupies a significant role in a wide range of Ayurvedic formulations and holds a major share in the drug manufacturing industry. This high demand of Dashamoola, leads the use of fruit instead of its root and implies the need to compare the efficacy of root and fruit of Gokshura. Aim: This study is planned to assess whether fruit of Gokshura can be substituted for its root using the parameter of diuretic activity in Wistar albino rats. Materials and methods: Wistar albino rats were divided in to four groups. The group I control group and group II standard group was orally administered with carboxymethyl cellulose 2% in normal saline and furosemide (20 mg/kg) respectively. Group III was administered orally with decoction of Gokshura root and groups IV with Gokshura fruit decoction, with a dose of 8.64 ml/kg. The diuretic effect was evaluated by measuring urine volume, Na+, K+ and Cl- ion content in urine. The results were analyzed by applying one-way ANOVA and LSD Post hoc pairwise comparison test. Results: Both test drugs in group III and group IV provided significant increase in urine output when compared to the control group (P < 0.001). Decoction of Gokshura root provided a significant increase in comparison to decoction of Gokshura fruit in regards of sodium (P < 0.01), potassium (P < 0.001), and chloride ion (P < 0.05) excretion. Conclusion: Diuretic action of both root and fruit of Gokshura is similar in terms of urine volume, but root is more effective in the basis of ionic excretion. Hence, while treating patients suffering from ionic imbalance, it is better to use fruit of Gokshura for protecting the ionic balance during diuresis. In all other conditions, root can be used for a better diuretic activity.

Hepatoprotective effect of Lobelia alsinoides Lam. in Wistar rats.

BACKGROUND: Traditional healing practitioners of South India use fine paste (an Ayurvedic dosage form known as 'kalka') of Lobelia alsinoides Lam., an ethno medicinal plant for curing hepatic diseases. OBJECTIVE: To evaluate in-vivo hepatoprotective effect of a candidate formulation viz. kalka containing whole plant (L. alsinoides Lam.) in rat model of Carbon-tetrachloride (CCl4) induced hepatotoxicity. MATERIALS & METHODS: Hepatotoxicity was induced in Wistar albino rats by oral administration of 1.25 ml/kg CCl4 once every day for 7 consecutive days. A candidate kalka formulation (fine paste) was prepared and administered to rats at different dose rates of 0.54 g/kg, 1.08 g/kg and 2.16 g/kg daily. At the end of the study-period, the serum levels of aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (ALP), total bilirubin, total protein, albumin and total cholesterol were monitored. Further, the hepatic pathology was evaluated for assessing the extent of hepatotoxicity in the control and hepatoprotective effect in treatment groups. Meanwhile in-vitro antioxidant activity of kalka was evaluated by hydroxy radical, nitric oxide and DPPH (2, 2 diphenyl-1-picrylhydrazil) radical scavenging assays. Further, a 'limit test' was done in accordance with OECD Guidelines 425 (acute toxicity). RESULTS: The animals treated with the fine paste of L. alsinoides did not show an elevation in the biochemical values compared to CCl4 treated rats and during histomorphologic evaluation, hepatoprotective effect was evident with scattered mitotic figures in the parenchyma. Acute toxicity evaluation indicated that doses up to 2500 mg/kg are not toxic to rats. It has a good anti-oxidant activity also. CONCLUSIONS: From the study, it was obvious that L. alsinoides had significant hepatoprotective effect in CCl4 induced liver toxicity in rats. This ethno medicinal plant is certainly a promising hepatoprotective drug in liver disorders.

Performance Evaluation of Algorithms in Lung IMRT: A comparison of Monte Carlo, Pencil Beam, Superposition, Fast Superposition and Convolution Algorithms.

BACKGROUND: Inclusion of inhomogeneity corrections in intensity modulated small fields always makes conformal irradiation of lung tumor very complicated in accurate dose delivery. OBJECTIVE: In the present study, the performance of five algorithms via Monte Carlo, Pencil Beam, Convolution, Fast Superposition and Superposition were evaluated in lung cancer Intensity Modulated Radiotherapy planning. MATERIALS AND METHODS: Treatment plans for ten lung cancer patients previously planned on Monte Carlo algorithm were re-planned using same treatment planning indices (gantry angel, rank, power etc.) in other four algorithms. RESULTS: The values of radiotherapy planning parameters such as Mean dose, volume of 95% isodose line, Conformity Index, Homogeneity Index for target, Maximum dose, Mean dose; %Volume receiving 20Gy or more by contralateral lung; % volume receiving 30 Gy or more; % volume receiving 25 Gy or more, Mean dose received by heart; %volume receiving 35Gy or more; %volume receiving 50Gy or more, Mean dose to Easophagous; % Volume receiving 45Gy or more, Maximum dose received by Spinal cord and Total monitor unit, Volume of 50 % isodose lines were recorded for all ten patients. Performance of different algorithms was also evaluated statistically. CONCLUSION: MC and PB algorithms found better as for tumor coverage, dose distribution homogeneity in Planning Target Volume and minimal dose to organ at risks are concerned. Superposition algorithms found to be better than convolution and fast superposition. In the case of tumors located centrally, it is recommended to use Monte Carlo algorithms for the optimal use of radiotherapy.