Mortality post inpatient alcohol detoxification: a descriptive case series

<br>Background: Individuals with alcohol dependence often die prematurely. Scotland in particular has high rates of alcohol misuse compared to the rest of the UK and Europe. Although there is some evidence that rates of alcoholrelated harm and alcohol-related deaths are reducing in Europe, there is little evidence of this trend occurring in Scotland. Inpatient detoxification is an important, but expensive, option in the management of alcohol dependence. Little work has been done with regard possible clinical characteristics associated with mortality post discharge in this cohort of patients.</br> <br>Methods: Retrospective electronic records were used to identify patients admitted electively for alcohol detoxification into a psychiatric ward in a district general hospital under the care of a single consultant addiction psychiatrist between 1/1/05 and 31/12/07 inclusively. Demographic and clinical factors were recorded. 5-year mortality data was obtained by linkage to the National Records of Scotland.</br> <br>Results: 25.2% of patients admitted for elective alcohol detoxification died during the 5-year follow up period. 42.9% of deaths (n=12) were due to alcoholic liver disease, one death (3.6%) was of undetermined intent. A higher proportion of the deceased cohort was likely to have continued disulfiram (93% vs. 80%) and acamprosate (81% vs. 60%) than those surviving. There was no statistically significant difference in survival between individuals on medication and those not on medications in our cohort. The average consumption of units of alcohol per week in the deceased cohort was significantly higher than that calculated for the surviving cohort (298.8 units vs. 233.3 units p=0.0137).</br> <br>Conclusion: Inpatient detoxification was associated with significant mortality at 5-year follow up post- discharge. The majority of deaths were due to liver disease while deaths due to accidents and of undetermined intent were relatively infrequent. Increased education and practical strategies such as “space and pace” aimed both at an individual and societal level to reduce alcohol consumption may help to reduce mortality associated with alcohol dependence post inpatient detoxification.</br&gt

Histochemical localization of cytokinin oxidase/dehydrogenase during the developmental stages of Withania somnifera (L.) Dunal

Withania somnifera (L.) Dunal is a promising herb that has been used as both traditional and modern therapeutic agent by virtue of its bioactive compounds especially withanolides. Earlier in vitro studies revealed the relation between cytokinin (CK) level and biogeneration of withanolides. The information on the cytokinin metabolism in W. somnifera is lacking. The role of enzymes involved in cytokinin metabolism can provide the link between the level of cytokinin and withanolide production. CK is a plant growth regulator playing crucial role in almost all the developmental processes. It is agreed that, the oxidative breakdown of CK by cytokinin oxidase (CKX) is an important process by which plant tissues control the levels and distribution of CK. This paper reports histochemical localization of CKX at various developmental stages of W. somnifera.Key words: Cytokinin oxidase/dehydrogenase, Withania somnifera, CKX localization

A REVIEW ON THE ROLE OF AVARANA (OCCLUSION OF BODY CHANNELS) IN METABOLIC SYNDROME

In Ayurvedic classics, the diseases caused by Vatha are considered as very serious diseases (Mahagada). One of the two pathological processes for the vitiation of Vatha is Avarana. Avarana is the disturbed movement of Vatha due to obstruction by other factors in the body. In the present social scenario, majority of diseases of Vatha are the result of Avarana, but the pathogenesis related to Avarana is least explored. Metabolic syndrome is one such lifestyle disease comprised of obesity, hyperglycemia, hypertension, hyper triglyceridemia and low HDL level. Majority of the symptoms of different Avarana conditions can be identified in patients presenting with metabolic syndrome. The general treatment protocol for Avarana is pacification of Vatha along with cleansing of channels and treatment of encroaching Dosha. Since metabolic syndrome is a disease with Avarana as the main pathophysiology, the treatment proposed by Acharyas for Avarana will be useful in metabolic syndrome. Since the vitiation is predominantly of Kapha and Meda, the drugs pacifying Kapha and Meda, cleansing of the channels, strengthening the tissues and not vitiating Vatha will be beneficial. The drugs may also be disease specific, like Pramehahara and Medodoshahara. Tinospora cordifolia (Guduchi) and Commiphora mukul (Guggulu) may be effective in metabolic syndrome since they are satisfying the above properties. Serious disease will develop, if the Avarana pathology is left untreated as evident in coronary artery disease.

GUT BRAIN AXIS IN AUTISM SPECTRUM DISORDERS - AYURVEDIC PERSPECTIVE

Autism spectrum disorder (ASD) constitutes a group of brain developmental disorders, and it is defined by stereotyped behaviour and deficits in communication and social interaction. The prevalence of ASD has shown an alarming increase in the recent decades ending up to 1 in 90 children. The exact cause of ASD is still not known. Research studies have focused on genetic causes, dysregulation of the immune system, inflammation, exposure to environmental toxicants, and the defective gut microbiota. Accumulating evidence demonstrates that gastrointestinal symptoms, such as abdominal pain, gaseousness, diarrhea, constipation and flatulence, are a common comorbidity in patients with ASD. The gut consists of millions of microbiota, and we hypothesize that the microbiota and its metabolites might be involved in the pathophysiology of ASD. In Ayurveda all Psycho social abnormalities have been included under the category of Unmada. A defective digestive and metabolic function is postulated as the root cause of Unmada, leading to systemic accumulation of metabolic wastes (Dhatugataama). The metabolic wastes act as systemic toxins and impair the functional integrity of brain. An observational study was carried out in the outpatient section of the Department of Kaumarabhrithya, Govt. Ayurveda College Hospital for Women and Children, Poojappura, Thiruvananthapuram in 122 children with ASD. Data pertaining to Socio demographic aspects and clinical manifestations were recorded and its prevalence rate was calculated. It was noted that 54% of the cases showed an evident disturbance in the digestive mechanism. Constipation was complained by 28% of cases, bloated abdomen by 16%, irritable bowel by 8%, increased flatulence by 7% and recurrent diarrhoea by 3%. Although these studies did not show a cause-effect relationship between GI symptoms and ASD, the findings suggest that the gut plays an important role in the etiology of ASD. Ayurvedic treatment strategies that modulate the gut microbiota might constitute a potential therapy for patients with ASD

EFFECT OF RASAPRAVICHARANA CIKITSA (TASTE SPECIFIC DRUG THERAPY) IN KAPHA DOMINANCE OF TAMAKA SWASA (ASTHMA) - A CASE SERIES

Rasapravicharana cikitsa is the administration of drugs in accordance with the Rasam (taste) after assessing the Doshic imbalance in diseases. The basic approach of Ayurveda is to normalize the Doshas in aggravated or depleted conditions occurred in the manifestation of disease. The objective of the study was to assess the effect of Rasapravicharana cikitsa (taste specific drug therapy) in aggravated Kapha dosha of Kapha dominant Tamaka swasa (asthma). The study was conducted on 10 patients between the age group 16 to 70 yrs of both the sexes. The patients were administered with Katu (pungent) rasa drug ie, powder of the dried fruit of Maricham (Piper nigrum Linn) at the dose of 500 mg, Tikta (bitter) rasa drug i.e., dried Vasa leaf powder (Adhatoda vasica Nees) at the dose of 3gm, and Kashaya (astringent) rasa drug i.e., powder of the dried fruit pericarp of Haritaki (Terminalia chebula (Gaertn.) Retz.) at the dose of 3gm, 8 AM and 8 PM after food daily in luke warm water respectively for a period of two weeks each. The Katu rasa drug administered for 14 days produced highly significant reduction in dyspnoea, cough bout frequency, wheeze, expectoration of sputum and quantity of sputum, and significant improvement in PEFRate. But no significant improvement was observed in PEF%. The administration of Tikta rasa drug in the next 14 days resulted in highly significant reduction in cough bout frequency and expectoration of sputum and significant reduction in dyspnoea. The reduction was maintained in other signs and symptoms. The Kashaya rasa drug used in the last 14 days significantly improved PEFRate. Reduction in other signs and symptoms was maintained. The management according to Rasapravicharana cikitsa has a significant role in the pacification of Doshas involved in the manifestation of diseases. &nbsp

STUDY OF ANATOMY AND POWDER MICROSCOPIC CHARACTERS OF SWETA SARIVA (HEMIDESMUS INDICUS (L.) R.Br)

Proper identification and quality assurance of the raw material is an essential prerequisite to ensure reproducible quality of Ayurvedic medicines. Sweta Sariva (Hemidesmus indicus), commonly known as Indian Sarsaparilla is a well-known drug and is reputed for its Dahaprasamana (alleviates burning sensations), Deepana (appetizing) and Raktashodaka (blood purifying) properties. Root is the official part of Sweta Sariva. It is very popular in Kerala as a medicine and as a health drink. Hemidesmus indicus of Periplocaceae family is considered to be the genuine source plant of Sweta Sariva, but survey of commercial samples from various states of India reveal that at present root and root-stalk of five different botanically identified plants from dissimilar families are being sold as Sariva in different parts of the country. Here a study on the anatomical and powder characters of Sweta Sariva was done so that people can easily identify the Sweta Sariva from its adulterants. The genuine Hemidesmus indicus roots are very slender with a diameter less than 1cm and they possess a characteristic pleasant smell with a sweetish taste. In the transverse section there are plenty of starch grains, prismatic crystals of calcium oxalate crystals and lactiferous ducts are seen in the cortex portion which forms the major identifying features. Three types of vessels are found in the powder microscopy

THE ROLE OF AIRWAY MUCUS HYPER SECRETION DUE TO KAPHA VITIATION IN TAMAKA SVASA (ASTHMA): PATHOPHYSIOLOGY AND PHARMACOTHERAPEUTIC APPROACH

Tamakasvasa (asthma) is a mucous hypersecretory respiratory disease. The inspissated mucus produced by vitiated Kapha obstructs the bronchi and other small air passages in the pathological development of the disease. Physiologically Kapha dosa provides strength (Bala) to the body due to the intrinsic qualities unctuousness (Snigda), coldness (Sita), heaviness (Guru), slowness (Manda), smoothness (Slasna), softness (Mrisna), stability (Sthira) etc. Being an organ in the specific site of Kapha dosha i.e., thorax (Uras), production of mucus in lungs is normal. Etiological factors that irritate respiratory tract stimulate inflammatory process and due to this, mucus is produced in excess. Due to the excessive vitiation of qualities of Kapha the mucus turns highly viscous and the normal clearance of mucus by airflow and ciliary function is hampered. Thus gelatinous mucus plugs tend to develop in the airways. The gel-forming MUC genes MUC2, MUC5AC and MUC5B commonly seen in respiratory secretions and stomach, duodenum, gall bladder etc have major role in the formation of airway mucus. Due to the ingestion of unwholesome food stomach (Amasaya) where Kapha reside, act as the organ of origin of the disease. The main pharmacotherapeutic objective in the management of Tamakasvasa is reduction of airway obstruction and airflow limitation by enhancing mucus clearance. This can be achieved by altering the rheological properties of bronchial mucus and inhibition of mucus hyper secretion and airway hyper responsiveness by procedure based therapies and pharmacological methods of Sleshmavilayana, Srotomardavakarana and rationale use of taste specific drug therapy (Rasapravicarana chikitsa)

DEVELOPMENT OF A MEASUREMENT TOOL WITH SPECIAL REFERENCE TO AVARANA IN METABOLIC SYNDROME

In many instances the researcher cannot find an adequate or appropriate existing tool to measure an important construct- the theoretical variable that is supposed to measure. In these situations it will become necessary to develop a new instrument for measuring the particular construct. Failure to carefully develop a measurement instrument can result in invalid data. The steps involved in the development of such tools are complex and unknown to many. Hence, the systematic development of a reliable and valid instrument for measuring subjective states is outlined here to assist researchers in devising usable instruments.According to Ayurveda, the diseases are caused by derangement of Tridoshas- the dynamic force (Vatha), the transformation factor (Pitha) and the anabolic factor (Kapha). Avarana is the disturbances in the movement of Vathadosha by other factors in the body. In the present social scenario, majority of diseases of Vatha are the result of Avarana. Metabolic syndrome is one such lifestyle disease comprised of obesity, hyperglycemia, hypertension, hyper triglyceridemia and low HDL level. Majority of the symptoms of Avarana can be identified in patients presenting with Metabolic syndrome. This article outlines the methodology involved in the development and validation of a measurement tool, taking into consideration of Avarana in Metabolic Syndrome.