A study on Charakokta Ahara Vidhi Vidhana w.s.r. to physiology of Digestive System

Ahara being one of the Upasthambha supports our Shareera for day to day activities and acts as Bala and Prakriti Dayaka, When it is consumed by following the rules and regulations. Wrong diet methods which are widely followed in this modern era result into Ajirna (Indigestion) which is the source of many diseases. Charakokta Ahara Vidhi Vidhana is not only a scientific method to maintain physical health but also to Maintain good mental health which results into proper digestion of the food which inturn promotes health and prevents many diseases. An attempt is made here to understand the physiology behind these rules and regulations and how they affect the process of digestion

Study of Upamana Pramana with special reference to Indriyasthana

Ayurveda, the diagnosis and the treatment of a disease is based on Nidana Pancaka, Atura Pariksha and these inturn depend upon Pramanas, as other Pramanas like Pratyaksha, Aptopadesha, Anumana are already elaborately mentioned, Upamana has also shown great utility in Jnanotpatti along with other Pramanas, so this study is planned to understand the concept of Upamana Pramana and also the contribution cannot be ignored as it is equally important like other Pramanas and should be given separate place and accepted as an independent Pramana. Charaka Samhita is the base of Chikitsa, so before starting the treatment portion Acharya Charaka has explained the symptoms and sign by which a vaidya can examine the diseases properly and in Indriyasthana it is clearly indicated that after seeing some signs and symptoms a Vaidya can deny for treatment. Such signs and symptoms which indicate mortality are called as Arista Lakshanas. As science has grown it is necessary to know and correlate these Arista Laksanas on modern clinical parameter also. Here the Upamana Pramana plays an important role. Hence the study is carried out to know the importance of Upamana Pramana, its applicability in clinical and literary field, also the importance of Indriyasthana, utility of Upamana Pramana in Indriyasthana in understanding various Arista Lakshanas and their comparision in modern medical science so that our Samhitas are accurate till today

Study on Prevalence of Enteric Parasitic Infections in HIV Infected Patients in Chennai.

INTRODUCTION : Human Immunodeficiency Virus (HIV) infection is a global pandemic and an Extremely serious worldwide problem. According to the 2006 report on the global AIDS Pandemic by UNAIDS, the total number of persons living with HIV is 39.5 million . India is on the verge of having the greatest increase in the estimated number of People living with HIV/AIDS (PLHA) in the world in the coming decades. Nationally, the HIV prevalence among adults (aged 15 – 49 years) is less than 1%, but with a population of more than 100 crores, estimated population of PLHA is 51.34 lakhs by the end of 2004 (NACO 2005 b). According to the UNAIDS statistics there were estimated 1,60,000 AIDS Cases in India in 2006.65 India is second only to South Africa in terms of the overall number of people living with the disease. In some north-eastern states and southern states of India, including Tamil Nadu, the HIV epidemic is classified as a generalized one, with more than 1% of women attending Antenatal clinics (ancs) being infected and an HIV prevalence among sexually transmitted Infection (STI) clinic patients of more than 5%. The first AIDS case in India was discovered In a female commercial sex worker in Tamil Nadu in 1986.53 According to the UNAIDS’ Statistics there were estimated 58,000 AIDS cases in Tamil Nadu in 2006; HIV infection Rates in STD patients being 9.2%. The type of pathogen responsible for morbidity and mortality vary from region to Region and it also varies with time. Therefore, identification of specific pathogen(s) is Important for management of such cases. Infections caused by these parasites can not be Differentiated clinically unless specific faecal examination is carried out. Since the enteric Illness due to parasitic aetiology among HIV patients is on the rise during recent times, the Present study was undertaken to study the status among HIV patients in Chennai. AIMS AND OBJECTIVES : 1. To identify parasites causing intestinal infection in HIV seropositive patients. 2. To compare various methods for detection of intestinal parasites. 3. To estimate the prevalence of opportunistic intestinal parasites in HIV infected patients in Chennai. 4. To correlate opportunistic intestinal parasitic infections with immune status of the patients (CD4 T lymphocyte counts). 5. To correlate opportunistic intestinal parasitic infections with duration of diarrhoea. CONCLUSION : Individuals with HIV/AIDS, because of their compromised immune status are at a higher risk of infections and especially opportunistic enteric intracellular parasites affect the small intestine and produce overwhelming results with grave prognosis. As parasites cause prolonged, life-threatening diarrhoea in AIDS patients, identification of these opportunistic parasites at the earliest will enable the clinician to give effective treatment and save the patient from increasing mortality. Protozoan parasites were found to be more common than helminths in HIV patients, of which coccidia comprised the major portion. Isospora was the commonest parasite detected. In the control group helminths were more common than protozoa and coccidian parasites and Stongyloides were not detected. HIV-infected individuals with lower immunity, as indicated by CD4 counts, suffered more with diarrhea, especially in chronic form. Parasites were common in lower immune status. Isospora was detected in a wide range of immune status including those without diarrhea, but highest rate of infection was seen with CD4 counts 100-200 cells/mm3. In the present study, simple techniques like wet mounts and modified acid fast staining could successfully identify a variety of enteric parasites in HIV patients. Formalin ether concentration procedure increased the sensitivity of detection

A study of knowledge, attitude and practice on use of antibiotics and its resistance among the doctors and interns at urban tertiary care hospital: an interventional study

Background: Infections due to resistant micro-organisms considerably increase the mortality rate, treatment cost, disease spread and duration of illness. The development of antibiotic resistance (AMR) is increasing steadily increasing over the last 10-15 years, which is a real threat to disease management. Many studies states that about 20-50% of antibiotic use unnecessary so decreasing the use of antibiotics is the first step to curb the AMR.Methods: A questionnaire based prospective interventional study among the doctors. Systemic random sampling was applied. The pre tested structured questionnaire was used. Data’s were summarised in the excel sheet, analysed by proportions, percentages and other statistical methods like Student t test, Fisher test and Chi square test were used to check the association. The p>0.05 was considered as significant.Results: Out of 200 doctors, preliminary screening of 170 was included in the study and finally 156 participants were actively selected for analysis of results. Out of 156 participants, 55.1% were MBBS Intern and 44.9% were doctors. High significance (p=0.0001) were found between pre and post knowledge, attitude and practice of doctors.Conclusions: Further modes of studies have to perform to identify the determinants of attitude behaviour and motivation that lead people to use and misuse antibiotics. For effective outcome many more qualitative and quantitative studies are required. In addition, health care system should follow proper regulation and prescription policy as well as controls for prescription of antibiotic drugs

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Background: Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective: To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources: Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods: Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results: Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations: The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions: The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. Study registration: This study is registered as PROSPERO CRD42016039494. Funding: The National Institute for Health Research Health Technology Assessment programme

Biologicals in the treatment of psoriasis: The Indian perspective

Psoriasis is a common inflammatory skin disorder characterized by itchy erythematous papules and plaques topped with silvery white scales. It has a chronic relapsing course and is associated with significant morbidity and reduction in the quality of life. Therapy of psoriasis is challenging. Topical therapy forms the first line of treatment for stable plaque psoriasis affecting a limited body surface area and in extensive disease systemic agents are indicated. All these drugs have inherent side effects, and none bring prolonged remission of the disease. The other therapeutic modality for psoriasis is phototherapy, but it is delivered through a specialized machine which can be available only at referral centers. Biologics have revolutionized the management of psoriasis as they can bring a remission of disease up to several years. Although limited availability and high cost prohibit their regular usage, Indian dermatologists are rapidly adopting biologics in the treatment of psoriasis

Analyzing the Predictability of an Artificial Intelligence App (Tibot) in the Diagnosis of Dermatological Conditions: A Cross-sectional Study

BackgroundArtificial intelligence (AI) aims to create programs that reproduce human cognition and processes involved in interpreting complex data. Dermatology relies on morphological features and is ideal for applying AI image recognition for assisted diagnosis. Tibot is an AI app that analyzes skin conditions and works on the principle of a convolutional neural network. Appropriate research analyzing the accuracy of such apps is necessary. ObjectiveThis study aims to analyze the predictability of the Tibot AI app in the identification of dermatological diseases as compared to a dermatologist. MethodsThis is a cross-sectional study. After taking informed consent, photographs of lesions of patients with different skin conditions were uploaded to the app. In every condition, the AI predicted three diagnoses based on probability, and these were compared with that by a dermatologist. The ability of the AI app to predict the actual diagnosis in the top one and top three anticipated diagnoses (prediction accuracy) was used to evaluate the app’s effectiveness. Sensitivity, specificity, and positive predictive value were also used to assess the app’s performance. Chi-square test was used to contrast categorical variables. P<.05 was considered statistically significant. ResultsA total of 600 patients were included. Clinical conditions included alopecia, acne, eczema, immunological disorders, pigmentary disorders, psoriasis, infestation, tumors, and infections. In the anticipated top three diagnoses, the app’s mean prediction accuracy was 96.1% (95% CI 94.3%-97.5%), while for the exact diagnosis, it was 80.6% (95% CI 77.2%-83.7%). The prediction accuracy (top one) for alopecia, acne, pigmentary disorders, and fungal infections was 97.7%, 91.7%, 88.5%, and 82.9%, respectively. Prediction accuracy (top three) for alopecia, eczema, and tumors was 100%. The sensitivity and specificity of the app were 97% (95% CI 95%-98%) and 98% (95% CI 98%-99%), respectively. There is a statistically significant association between clinical and AI-predicted diagnoses in all conditions (P<.001). ConclusionsThe AI app has shown promising results in diagnosing various dermatological conditions, and there is great potential for practical applicability