A Study on Azhal Keel Vayu (அழல் கீல் வாயு)

AIM AND OBJECTIVES: The disease “Azhal Keel Vayu” is a major ailment of the elderly. This produces pain and discomfort to the patients. The purpose of author’s work is to elucidate a good medicine from ancient Siddha literatures and to create hope and faith in their treatment. Their being a preliminary endeavour by the author, as if it would be a helping hand to the sufferers. With this view this dissertation subject was undertaken. 1. To prove the efficacy of our Siddha Medicine to the world. 2. To study the clinical cause of the disease “Azhal Keel Vayu” with keen observation on the Aetiology, Pathology, Diagnosis, Prognosis, Complications and the Treatment by making use of Siddha aspect. 3. To expose the unique diagnostic methods mentioned by Siddhars, to know the disease “Azhal Keel Vayu” alters the normal condition under the topic Mukkutram, Poripulangal, Ezhu Udal Kattukkal and Envagai thervugal. 4. To know the extent of correlation of Aetiology, Classification, Signs and Symptoms of Azhal Keel Vayu in Siddha aspect with Osteo arthritis in Modern medicine. 5. To have an idea about the incidence of the disease with age, sex, socio-economic status and climatic conditions. 6. To have a detailed clinical investigations. 7. To have a clinical trial on Azhal Keel Vayu with the medicines named NANNARIVER CHOORNAM as internal medicine and SANGANKUPPI VER ENNAI as external medicine. 8. To evaluate the Bio-chemical and Pharmacological effects of trial medicine. 9. To use modern parameters to confirm the diagnosis and prognosis of the disease. 10. To insist Thokkanam (Massage) and Asanas along with medicines to achieve the good results, which are the salient features of Sirappu Maruthuvam. SUMMARY: 1. Fifty Five cases of Azhal Keelvayu, diagnosed clinically. Out of them Thirty Cases were admitted in the in-patient PG Sirappu Maruthuvam Ward, Govt. Siddha Medical College Hospital, Palayamkottai were observed for clinical diagnosis, lab diagnosis and treatment by the trial medicines. Out of them Twenty Cases were selected for study. Twenty Five Cases were treated as out patients. 2. Clinical diagnosis of Azhal Keel vayu was done on the basis of clinical features described in the siddha text books. 3. Laboratory diagnosis of Azhal Keelvayu was done by modern methods of examination in the Govt. Siddha Medical College Hospital, Palayamkottai. 4. The various siddha aspects of examination of the disease were carried out and recorded in a proforma. 5. The trial medicines choosed for both internal and external treatment and the management of Azhal Keelavayu • Nannariver Choornam as per the severity of the complaints, the dosage was given 1 gm three times a day with white sugar for fifteen days and above. • Sangan kuppi ver ennai (Externally). 6. Before starting the treatment, careful detailed history was carried out and recorded from the twenty selected patients. 7. During the period of treatment, all the patients were put under strict pathiyam-a specific dietary regimen. 8. The observation made during the clinical study shows that the main drug Nannariver Choornam (Internally) is clinically effective. It has moderate analgesic action and significant anti inflammatory action. 9. The action of Sangan kuppi ver ennai (Externally) over the affected joint was also clinically effective. It has Significant anti inflammatory action. 10. A periodical laboratory investigation were made for all the case for blood, urine and motion test etc., along with radiological reports. 11. Since Azhal Keel vayu is a chronic disease, it required minimum treatment for twenty days, treated both internally and externally to minimize the severe pain, tenderness and Swelling, but also slight disappearance of the crepitation. CONCLUSION: All the twenty patients, selected for this Study were treated with Nannariver Choornam (Internal 1gm tds with white sugar) and Sangan kuppi ver ennai (Externally). Clinical results show improvement in large number of the cases that is 50%. During the meantime of treatment, under admission all the Azhal Keel vayu patients were instructed and guided to follow the following asanas. a) Komugaasana - The Cow head Posture b) Padmasana - The Lotus Posture c) Vajraasana - The Adamant posture It was sure that no one had any remission up to 6 months. If any further recurrence or no satisfied improvement, the individuals were instructed to follow up treatment both internally and externally. It is very pleasurable to say here, the author highlights the trial medicines are found effective just relieved from pain and tenderness, severe morning stiffness, severe crepitation, arresting of marked swelling and so on. It was noted that the internal drug Nannariver Choornam was free from adverse side effects, i.e. no cases were reported either nausea or vomiting and the external application Sangan kuppi ver ennai was not irritant, i.e. no cases were reported itching or inflammation or eruption wherever massaged. Meanwhile it gave good soothing effect to the affected part

Assessment of Left Main Coronary Stenosis by Transesophageal Echocardiography

INTRODUCTION: Quantitative evaluation of coronary stenosis is clinically important. Quantitative coronary angiography is usually performed for estimating the severity of coronary stenosis. Intracoronary blood flow velocity measurements using Doppler catheters or Doppler ultrasound guide systems have also been proposed as an alternative method for evaluating the functional severity of coronary stenosis at baseline as well as for assessing the results of interventional procedures . Johnson et al. demonstrated, in a canine model, that the crosssectional area (CSA) of the coronary stenosis can be calculated with a Doppler catheter using the continuity equation, which was originally introduced for measuring stenotic valve area More recently, Nakatani et al. showed, in 13 patients with mild to moderate stenosis, that application of the continuity equation to Doppler catheter measurement of coronary flow velocity can be used to successfully compute the severity of coronary stenosis. These methods, however, remain invasive, requiring cardiac catheterization, and cannot be repeated without risk during serial follow-up studies. Furthermore, in a consecutive series of 52 patients undergoing percutaneous transluminal coronary angioplasty, Di Mario et al. found that, although the percent CSA stenosis derived from the intracoronary guide wire Doppler measurements based on the continuity equation were significantly correlated with the corresponding quantitative angiographic measurements, this determination could be achieved in only 16% of cases. Recently, it has been demonstrated that coronary blood flow velocity can be recorded in the proximal part of the left coronary artery (LCA) with the use of transesophageal Doppler echocardiography (TEDE). In the present study, we tested whether the percent reduction of CSA of the stenosis can be quantitated by TEDE using the continuity equation. AIM AND OBJECTIVES: The purpose of the study was the utility of transesophageal echocardiography in assessing left main coronary artery stenosis. MATERIALS AND METHODS: The study was conducted in the department of cardiology Government Rajaji Hospital Madurai between Jan 2009 to April 2010.All patients underwent Coronary angiogram & Transesophageal echocardiography was done and left main coronary artery visualized at midesophageal transverse view at base of the heart and at the level of left sinus of valsalva and flow was recorded with pulsed wave Doppler. METHODS: Fifty patients with a left main coronary artery (LMCA) stenosis were prospectively studied from January 2009 to April 2010. We chose patients with LMCA because, TEDE recordings are easier to obtain in these portions of the LCA. A high quality TEDE signal was obtained in 50 patients (45 men and 5 women, mean age 53 years [range 36 to 70]). Written informed consent for TEDE examination was obtained in all patients. Statistical Analysis: All data are expressed as the mean value ± SD. The information collected regarding all the selected cases were recorded in a Master Chart. Data analysis was done with the help of computer using Epidemiological Information Package (EPI 2008) developed by Center for Disease Control, Atlanta. Using this software, range, frequencies, percentages, means, standard deviations and ‘p’ values were calculated. A ‘p’ value less than 0.05 is taken to denote significant relationship. CONCLUSION: Transoesophageal Doppler assessment of coronary blood flow is a highly sensitive and specific non invasive method in the diagnostics of stenotic and occlusive atherosclerosis of the main coronary arteries. A modified continuity equation is haemodynamically correct and allows with application of Transoesophageal Doppler allows the accurate calculation of the coronary artery stenosis percentage. The peak diastolic velocity of coronary blood flow (equal to 1.4 m.s -1 in the LMCA,0.9 m.s-1 in the LAD, and 1.1 m.s-1 in the LCX) alongside the aliasing phenomenon is a Doppler criterion of haemodynamically significant stenosis. Break of colour mapping,absence of Doppler spectrum and registration of retrograde blood flow during late diastole are Doppler echocardiographic criteria for coronary coronary artery occlusion

Complete Identification of a Dynamic Fractional Order System Under Non-ideal Conditions Using Fractional Differintegral Definitions

This contribution deals with identification of fractional-order dynamical systems. System identification, which refers to estimation of process parameters, is a necessity in control theory. Real processes are usually of fractional order as opposed to the ideal integral order models. A simple and elegant scheme of estimating the parameters for such a fractional order process is proposed. This method employs fractional calculus theory to find equations relating the parameters that are to be estimated, and then estimates the process parameters after solving the simultaneous equations. The data used for the calculations are intentionally corrupted to simulate real-life conditions. Results show that the proposed scheme offers a very high degree of accuracy even for erroneous data.Comment: 16th IEEE International Conference on Advanced Computing and Communication, 200

Extension of Max-Min Ant System with Exponential Pheromone Deposition Rule

The paper presents an exponential pheromone deposition approach to improve the performance of classical Ant System algorithm which employs uniform deposition rule. A simplified analysis using differential equations is carried out to study the stability of basic ant system dynamics with both exponential and constant deposition rules. A roadmap of connected cities, where the shortest path between two specified cities are to be found out, is taken as a platform to compare Max-Min Ant System model (an improved and popular model of Ant System algorithm) with exponential and constant deposition rules. Extensive simulations are performed to find the best parameter settings for non-uniform deposition approach and experiments with these parameter settings revealed that the above approach outstripped the traditional one by a large extent in terms of both solution quality and convergence time.Comment: 16th IEEE International Conference on Advanced Computing and Communication, 200

A bacterial foraging optimization and learning automata based feature selection for motor imagery EEG classification

Selection of relevant features is an open problem in Brain-computer interfacing (BCI) research. Sometimes, features extracted from brain signals are high dimensional which in turn affects the accuracy of the classifier. Selection of the most relevant features improves the performance of the classifier and reduces the computational cost of the system. In this study, we have used a combination of Bacterial Foraging Optimization and Learning Automata to determine the best subset of features from a given motor imagery electroencephalography (EEG) based BCI dataset. Here, we have employed Discrete Wavelet Transform to obtain a high dimensional feature set and classified it by Distance Likelihood Ratio Test. Our proposed feature selector produced an accuracy of 80.291% in 216 seconds

Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.

Abstract Introduction Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI). Methods Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings. Results We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I2 = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26–1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year. Conclusions In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship