Comparative effect of composite management of type II diabetes mellitus with induced emesis and Varadi Ghanavati: A pilot clinical study.

INTRODUCTION: Ayurveda offers a rational view in the management of Prameha. Shodhana (∼bio-purification) is advocated as the first line of treatment to eliminate Kapha, which is followed by palliative treatment to further control disease pathology. Evaluation of such composite treatment has rarely been published. The present study was conducted to assess the comparative efficacy and safety of three interventions in the management of Prameha (Diabetes mellitus type II (T2DM)) - (a) Vamana (induced emesis) and Varadi Ghanavati (oral Ayurvedic medication), (b) Varadi Ghanavati, and (c) glibenclamide. METHODS: It was open labelled, comparative, randomised, prospective, three arm pilot study. A total 49 patients, newly diagnosed or known cases of Prameha (T2DM) were randomised in three groups. The first group (Vamana) received Vamana followed by Varadi Ghanavati (500 mg (mg) thrice daily before food for 12 weeks). The second (Varadi) group received Varadi Ghanavati without prior Vamana, while, the control group received glibenclamide 5 mg twice daily before food for 12 weeks. Patients were evaluated at intervals of each four weeks. Assessment was done on changes seen in blood sugar (BSL) fasting (F), postprandial (PP), glycosylated haemoglobin, lipid profile, body mass index (BMI) and clinical symptoms. RESULTS: Patients in all groups showed better glycaemic control as compared to baseline. Mean BSLF before and after treatment were 166.20 ± 78.39 mg/dL and 125.00 ± 58.77 mg/dL in Vamana group (p < 0.01), 163.60 ± 59.34 mg/dL and 127.73 ± 37.94 mg/dL in Varadi group (p < 0.05), while 163.00 ± 59.03 mg/dL and 129.40 ± 41.91 mg/dL in control (p < 0.05). Similarly, BSL PP values before and after treatment were 254.47 ± 99.59 mg/dL and 178.47 ± 68.45 mg/dL in Vamana group (p < 0.01), 233.93 ± 68.95 mg/dL and 185.20 ± 56.73 mg/dL in Varadi group (p < 0.05), 239.80 ± 77.10 mg/dL and 182.53 ± 42.14 mg/dL in control (p < 0.05). Glycosylated haemoglobin, mean values before and after treatment were 8.23 ± 1.71% and 7.18 ± 1.96% in Vamana group (p < 0.05), 7.83 ± 1.21% and 6.75 ± 1.13% in Varadi group (p < 0.05), 7.17 ± 1.12% and 6.60 ± 0.65% in glibenclamide group (p < 0.05). Comparative evaluation in the three groups showed that there was a statistically significant reduction (p < 0.001) in total cholesterol, low-density lipoproteins (LDL) and BMI in Vamana group as compared the other groups. No adverse event was observed. CONCLUSION: Along with better glycaemic control, composite treatment can reduce deranged lipids and BMI, which can help in better management of Prameha (T2DM). Vamana and Varadi Ghanavati can be administered safely. CLINICAL TRIAL REGISTRATION NO: CTRI/2017/10/010127.

Conservative management of acute prolapsed inter-vertebral disc with ayurveda: A case report.

Acute prolapsed inter-vertebral disc (IVDP) is a painful condition that requires immediate treatment by conservative or surgical management. Though majority of patients show remission in symptoms with conservative treatment, regression of herniated disc with non-surgical management has been rarely reported. A 46 years old female patient with acute and severe low back pain, disability and radiating pain towards right lower extremity came to our hospital. Oswestry Disability Index (ODI) score of the patient was 94% indicating bed-ridden condition. MRI of lumbar spine showed diffuse posterior disc bulge between fourth and fifth lumbar vertebra indenting right traversing nerve root and inferior displacement of extruded disc along the body of fifth lumbar vertebra. She was treated according to treatment explained in Ayurveda. She received oral medications, application of medicated oils, fomentation and medicated enema (Basti). After treatment of seven and half months, the patient showed good remission in pain, stiffness and radiculopathy. ODI score reduced to 9% that indicates minimal disability. Follow up MRI showed non significant compression of the nerve root and gross reduction in the inferior displacement of extruded disc. Acute IVDP can be successfully conserved using Ayurveda treatment. The Panchakarma procedures and medicines used in the treatment need further evaluation.

Evaluation of Cyavanaprasa on Health and Immunity related Parameters in Healthy Children: A Two Arm, Randomized, Open Labeled, Prospective, Multicenter, Clinical Study.

CONTEXT: Cyavanaprasa (CP) is an Ayurvedic immune booster formulation that confers vigor and vitality while delaying the ageing process. Benefits of CP have been studied widely in adult population. OBJECTIVES: Current study assessed beneficial effects of CP on health and immunity related parameters in healthy children. METHODS: This study was a 6 month long two armed, randomized, open labeled, prospective clinical study. School going healthy children between ages of 5-12 years were randomized to receive orally daily either CP (approx. 6 g) followed by a cup of milk (100 - 200 ml) or cup of milk only twice a day while continuing with their normal/routine diet. Results were analyzed based on number of episodes, severity, duration of illness (infections and allergies) and number of absent days due to illness during the study duration and changes in levels of energy, physical fitness, strength, stamina and quality of life in children which were recorded in subject diary by their parents/Legally Acceptable Representative (LAR). RESULTS: 702 participants were randomized, out of which 627 completed the study (CP n = 313; Control n = 314). Results of immunity (episodes of infections or allergy related conditions) showed more than 2 times protection from immunity related illness in CP Group as compared to the control. CP also showed better percentage improvement in energy levels, physical fitness, strength, stamina and quality of life assessed through KIDSCREEN QOL-27 questionnaires in children. CONCLUSION: Regular consumption of CP for a period of six months could significantly improve immunity, energy levels, physical fitness, strength, stamina and quality of life in school going healthy children. STUDY REGISTRATION: Clinical Trail Registry of India vide CTRI/2015/02/005574, Dated 24 February 2015.

Effect of panchakarma and Ayurvedic treatment in postpartum rheumatoid arthritis (amavata): A case study.

Dream of a mother is to get involved actively in upbringing of child, which is impeded if she is suffering from painful condition like rheumatoid arthritis (RA) in postpartum phase. It causes physical incapacity and psychological trauma as well. Present case is a patient who developed RA one month after full term delivery by caesarean section. In view of symptoms, she was diagnosed as case of amavata. She received Ayurvedic treatment - Simhanada guggulu, Pratapalankeshwara rasa, Dashamoola katutraya kashaya and combination of Swarnabhupati rasa, Tapyadi loha, Mahavatavidhvansa, Chopachini (Smilax china), Shunthi (Zinziber officinale) and Guduchi (Tinospora cordifolia) for four months and course of kala basti (medicated enema) along with application of medicated oil (Vishagharbha taila abhyanga) and sudation (bashpa sweda) for ten days. Complete remission was seen after treatment for four months. The patient was free from oral analgesics. RA test titer that was 160 international units per milliliter (IU/ml) before treatment showed marked reduction (28.12 IU/ml) after 75 days of treatment and later dropped in normal range (6.1 IU/ml). Normal milestones were seen in the child receiving breast feeding. Application of Ayurvedic principles showed excellent results in this case where modern medical management options were limited due to lactation.

Gallbladder cancer revealed by an endobiliary tumor thrombus.

Common bile duct neoplastic thrombosis is rare and can cause jaundice in case of gallbladder cancer (GBC). We report the case of a 45-year-old man with GBC located in the fundus associated with a malignant endobiliary thrombus. A surgical procedure has been performed, including segmentectomy 4b+5 with common bile duct resection with Roux-en-Y hepaticojejunostomy. Postoperative courses were uneventful and the patient is alive at 15 months.

Determinants of incident hyperglycemia 6 years after delivery in young rural Indian mothers: the Pune Maternal Nutrition Study (PMNS).

OBJECTIVE: To study determinants of incident hyperglycemia in rural Indian mothers 6 years after delivery. RESEARCH DESIGN AND METHODS: The Pune Maternal Nutrition Study collected information in six villages near Pune on prepregnant characteristics and nutrition, physical activity, and glucose tolerance during pregnancy. An oral glucose tolerance test (OGTT) was repeated 6 years after delivery. RESULTS: A total of 597 mothers had an OGTT at 28 weeks' gestation; 3 had gestational diabetes (by World Health Organization 1999 criteria). Six years later, 42 of 509 originally normal glucose-tolerant mothers were hyperglycemic (8 diabetic, 20 with impaired glucose tolerance, and 14 with impaired fasting glucose). The hyperglycemic women had shorter legs and thicker skinfolds before pregnancy (P < 0.01, both), were less active and more hyperglycemic (2-h plasma glucose 4.8 vs. 4.4 mmol/l, P < 0.001) during pregnancy, and gained more weight during follow-up (6.0 vs. 2.7 kg, P < 0.001). Multivariate analysis revealed that total leukocyte count and blood pressure during pregnancy were additional independent predictors of 2-h glucose concentration at follow-up. CONCLUSIONS: Our results suggest that compromised linear growth, adiposity, inflammation, and less physical activity predispose to hyperglycemia in young rural Indian women. International cut points of diabetes risk factors are largely irrelevant in these women.

Oral vitamin B12 supplementation reduces plasma total homocysteine concentration in women in India.

People in India have a high prevalence of low vitamin B12 status and high plasma total homocysteine (tHcy) concentrations. In a proof of principle trial, we studied the effect of oral vitamin B12 (500 microg) and/or 100 g cooked green leafy vegetables (GLV) every alternate day in a 2x2 factorial design over a 6-week period. Forty-two non-pregnant vegetarian women (age 20-50 years) were randomly allocated to four study groups. Clinical measurements were made at the beginning and at the end of the study, and blood samples were collected before, and 2 and 6 weeks after commencement of intervention. Forty women completed the trial. Twenty-six women had low vitamin B12 status (<150 pmol/L) and 24 had hyperhomocysteinemia (>15 micromol/L). GLV supplementation did not alter plasma folate or tHcy. Vitamin B12 supplementation increased plasma vitamin B12 concentration (125 to 215 pmol/L, p <0.05) and reduced tHcy concentration (18.0 to 13.0 micromol/L, p <0.05) within first 2 weeks, both of which remained stable for the next 4 weeks. Plasma vitamin B12 and tHcy concentrations did not change in those who did not receive vitamin B12, and there was no change in plasma folate concentration in any of the groups. Blood haemoglobin concentration increased marginally within first two weeks in those women who received vitamin B12 (by 3 g/L, p <0.05) and the number of women with macrocytosis decreased from 2 to zero. There was no change in vibration sensory threshold during the period of the study. High-dose per oral vitamin B12 supplementation significantly reduced plasma tHcy within 2 weeks but did not achieve normal plasma tHcy concentration even after 6 weeks. People in India have a high prevalence of low vitamin B12 status and high plasma total homocysteine (tHcy) concentrations.