ROLE OF PATHYA-APATHYA AND YOGIC PROCEDURES IN THE MANAGEMENT OF COPD

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease that is often preventable and treatable. In Ayurvedic texts Shwasa Roga has been described having symptomatology close to COPD. COPD damages the airways in lungs and leads to shortness of breath, impacting patient`s work, exercise, sleep and other everyday activities. More than 11 million people in the U. S. suffer from COPD and its prevalence has been increasing steadily over the past 20 years. It causes serious long-term disability and early death. COPD includes both chronic bronchitis and emphysema. Risk factor includes exposure to air pollution, second-hand smoke and occupational dusts and chemicals, smoking, cold weather etc. which are also mentioned in Ayurvedic classics. Identification, reduction and control of risk factors to prevent the onset of COPD are important steps towards developing strategies for prevention of COPD. The aims and objectives of Ayurveda are to maintain the health of a healthy person and to cure the diseases of the patients. It is signifies that “prevention is better than cure.” To maintain the health, Ayurveda laid many basic principles like Ritucharya (seasonal regime), Dincharya (diumal regime) etc. The Yogic procedures and the concept of Pathya (wholesome) and Apathya (unwholesome) is the peculiarity of Ayurveda for the management of COPD and the treatment module includes- Panchakarma (Vamana, Virechana, Dhumapana and Nasya), external therapies (Lepas, Dhara, Sthanika Abhayanga and Swedana) and internal medications are very effective in COPD

A RAY OF HOPE THROUGH AYURVEDIC MANAGEMENT IN OSTEOARTHRITIS: A CASE STUDY

Osteoarthritis (OA) is degenerative condition, increasing due to today’s life style and age related changes. It mostly affects woman. A 70 years female patient, housewife by occupation, known case of osteoarthritis since 30 years was admitted in IPD of Panchkarma department with following presenting complaints: continuous pain in both knee joints and pain in lower back and hands. On the basis of strong similarity between etiological factor, symptoms, and Doshika involvement in the etiopathology and complication, OA can be correlated with Sandhigata Vata. There is need to search a safe, effective and less-expensive treatment that can alter the course of the disease. In this condition, Ayurveda is a ray of hope to stop disease progression. Considering these points in mind, Sarvang Abhyang with Narayan Tail, Swedana, Matra vasti with Panchguna Tail was administered in patient for 10 days. After this, Sarvang Patra Pottali Swedana was given for 7 days along with oral medication like Tryodashang Gugglu 2 tablets thrice a day, Tablet Neo 2 tablets twice in day after meal. Activities which were hampered due to symptoms and after 45 days of treatment, patient can perform daily tasks easily with mild pain in some joints and complete relief in others. Ayurvedic management provides better result within limited time periods with least oral medications

EFFICACY OF DHANYAMLA SARVANGA DHARA IN THE MANAGEMENT OF OBESITY: AN ANALYTICAL REVIEW

Obesity consist a major nutritional health problem in developed and developing countries, which has reached epidemic proportions. It is a medical condition of excessive fat accumulation to the extent that it may have negative effect on health. Obesity are major causes of co-morbidities, including type 2 diabetes, cardiovascular disease, various cancer and other health problem like obstructive sleep apnea, osteoarthritis and depression. Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity. Leptin enzyme is responsible for controlling appetite through its action on CNS, TNF alpha is also link factor between fat accumulation and metabolic disorders. The body mass index (BMI) is an internationally accepted index to estimate body weight. Taking medication like Sibutramine, Orlistat as an option for treatment of obesity can be given, because it is associated with many side effects. Bariatric surgery may be performed to reduce weight, but it is not very useful treatment. Diet, life style modification, physical activity can achieve the desired loss of body fat. In Ayurveda best treatment for Sthaulya defined by Acharyacharak and Sushruta and Vagbhatt. Dhanyamalasarvangadhara is highly effective in Vata associated with Ama and Kapha. Dhanyamla sarvanga dhara eliminates the body toxins, establishes health and tones up the joints and soft tissues. The drug will act soon as the medicine touches the skin surface. Due to Vasodilation property blood flow will increase through the area, increasing metabolism further eliminating the toxins, which will help in reducing the obesity. Dhanyamala sarvanga dhara controls the disease process and may cause long lasting relief

A retrospective analysis of ectopic pregnancy at a tertiary care centre: one year study

Background: Ectopic pregnancy is an important cause of maternal morbidity and mortality especially in developing countries where the majority of patients present late with rupture and hemodynamic compromise. The aim of this study was to determine the risk factors, clinical profile of the patients and management options for ruptured ectopic pregnancies.Methods: We conducted a retrospective study about ectopic pregnancy at obstetrics and gynaecology department over a period of one year, from 01 January 2015 to 31 December 2015. Information on the biosocial data, clinical symptoms and signs, risk factors for the disease, site of ectopic pregnancy and treatment options, quantity of hemoperitoneum and need for blood transfusion was extracted. The data was analyzed and presented in frequency tables and charts.Results: Frequency of ectopic pregnancy was 1.6% of total 10235 deliveries. 131 (89.1%) cases were of ruptured ectopic pregnancy. 147 patients underwent laparotomy while 22 patients were managed conservatively. All patients were symptomatic at presentation. Majority (86, 50.8%) of the patients were in the age group of 20-24 years. 33 (19.5%) patients were nulliparous. Risk factors were found in 86 (50.8%) patients. Majority (38, 44.1%) had history of previous tubal surgery (tubal sterilization and/or recanalisation) as risk factor. The highest number of ruptured ectopic occurred between 7-12 weeks of gestation. Most common surgical procedure employed was salpingectomy in 140 (95.2%) patients.  There was no maternal mortality due to ectopic pregnancy.Conclusions: Ectopic pregnancy is still a major life threatening emergency condition which if treated early has good prognosis. Most cases present late making tubal conservation inapplicable. Efforts should be made towards woman education, improved hospital accessibility and better diagnostic skills

STUDIES ON ENDOPHYTES AND ANTIBACTERIAL ACTIVITY OF SAUSSUREA COSTUS (FALC.)

Different plant parts (root, stem, leaf) of Saussurea costus were used to isolate and investigate endophytic fungal species in summer, rainy and winter seasons. Total ten species of endophytic fungi belonging to seven genera (Aspergillus, Cunninghamella, Myrothecium, Penicillium, Pythium, Rhizopus and Trichoderma) were isolated from the root, stem and leaf in different seasons. The genus Aspergillus was found to be dominant with three species (A. nustus, A. wentii and A. niger). The genus Rhizopus was represented by two species (R. oryzae, R. nigricans).The genera Cunninghamella, Myrothecium, Penicillium, Trichoderma and Pythium were represented by one species each i.e. Cunninghamella elegans, Myrothecium roridum, Penicillium chrysogenum, Trichoderma viride and Pythium sp. respectively. Antibacterial activity of root of Saussurea costus has been investigated using different solvents (methanol, ethanol and acetone) at different concentrations (25%, 50%, 75% and 100%) against three test bacteria namely S. aureus, E. coli and Y. pestis. Root extract of S. costus showed greater antibacterial activity using methanol as solvent followed by acetone and ethanol solvent. In case of methanol extract, maximum inhibition activity was shown against S. aureus and minimum against E. coli. Maximum inhibition was shown against Y. pestis and minimum against E. coli in case of acetone extract whereas ethanol extract exhibited highest inhibitory activity against E. coli and lowest against Y. pestis. On the basis of results compiled above, it is evident that S. costus exhibited antibacterial activity against all the test bacteria in all the solvents used in this study thereby conforming it a good antibacterial agent for future study.   KEY WORDS: Saussurea costus, endophyte isolation, a

Caesarean scar pregnancy: a case report with review of management options

Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology

Maternal and neonatal outcome in pregnancy with previous lower segment caesarean section undergoing trial of scar

Background: Women with previous LSCS often have to make a decision about mode of delivery of their second baby. As the rate of caesarean section is continuously increasing, vaginal birth after caesarean section (VBAC) is a good strategy to decrease caesarean rate. The present study was planned to assess the fetomaternal outcome in pregnancies with previous lower segment caesarean section undergoing trial of scar and to identify the factors, which can influence the outcome of trial of scar.Methods: This was a prospective observational study on 100 patients at a tertiary care institute. Pregnant women with previous LSCS were selected randomly for the study on the basis of the inclusion and exclusion criteria. Each labor monitored closely using a partogram. Decision for repeat emergency caesarean was taken by consultant. All women included in the study were followed through delivery and till discharge.Results: Out of 100 pregnant women 49 % cases had successful VBAC, 50% had emergency caesarean and one patient had laparotomy for rupture uterus. In women, who also had a prior vaginal delivery, 72% delivered vaginally, as compared to 40% of the women who did not undergo prior vaginal delivery (p value=0.003). Women who were in spontaneous labor, 59.21% delivered vaginally, whereas women who were induced, 16.6% delivered vaginally. The rate of perinatal complication was more in the patients who required an emergency CS after a failed trial. Conclusions: Our findings may encourage obstetricians to encourage VBAC in the properly screened ANC patients and decrease the rate of recommending caesarean section

Prophylactic and Therapeutic Role of Human Breast Milk Proteins and Bioactive Peptides against Neonatal Bacterial Infections

Breast milk represents nature’s best mechanism to provide complete nourishment and protection to the newborn. Human breast milk acts as a store house of an array of bioactive factors, which includes antimicrobial proteins and antimicrobial peptides that confer early protection while lowering the incidence of developing various infections and exhibiting immune modulation property to activate the immune cells to fight against the invading pathogens. Among the bioactive peptides, endogenous peptides present in breast milk have opened a new window of research on studying their unique mechanisms of action. This will help in incorporating these peptides in formula milk for meeting special needs where breastfeeding is not possible. The present chapter aims to give a deep insight into the various antimicrobial peptides and the newly reported endogenous peptides in human breast milk with emphasis on their levels and activity in preterm milk as data related to this is lacking and preterm newborns are highly vulnerable to acquire infections. Further, the chapter focuses on highlighting the antibacterial mechanisms adopted by the bioactive peptides for protection against the neonatal bacterial pathogens with special emphasis on the infections caused by resistant bacterial strains in hospital settings (neonatal wards) and their future implications

Tumor-induced osteomalacia: experience from three tertiary care centers in India

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by recalcitrant hypophosphatemia. Reports from the Indian subcontinent are scarce, with most being single center experiences involving few patients. Herein, we conducted a retrospective analysis of 30 patients of TIO diagnosed at three tertiary care hospitals in India. Patients with persistent hypophosphatemia (despite correction of hypovitaminosis D), normocalcemia, elevated alkaline phosphatase, low TmP/GFR and elevated or ‘inappropriately normal’ FGF23 levels were labeled as having TIO. They were sequentially subjected to functional followed by anatomical imaging. Patients with a well-localized tumor underwent excision; others were put on phosphorous and calcitriol supplementation. The mean age at presentation was 39.6 years with female:male ratio of 3:2. Bone pain (83.3%) and proximal myopathy (70%) were the chief complaints; 40% of cases had fractures. The mean delay in diagnosis was 3.8 years. Tumors were clinically detectable in four patients (13.3%). The mean serum phosphate was 0.50 mmol/L with a median serum FGF23 level of 518 RU/mL. Somatostatin receptor-based scintigraphy was found to be superior to FDG-PET in tumor localization. Lower extremities were the most common site of the tumor (72%). Tumor size was positively correlated with serum FGF23 levels. Twenty-two patients underwent tumor resection and 16 of them had phosphaturic mesenchymal tumors. Surgical excision led to cure in 72.7% of patients whereas disease persistence and disease recurrence were seen in 18.2% and 9.1% of cases, respectively. At the last follow-up, serum phosphate in the surgically treated group was significantly higher than in the medically managed group

An Isolated Conjunctival Capillary Hemangioma Masquerading as Ocular Surface Squamous Neoplasia

The purpose of this article is to report a case of isolated subconjunctival capillary hemangioma, masquerading as ocular surface squamous neoplasia (OSSN) in a 58-year-old lady. Conjunctival hemangioma over the age of 58 is rare, with few cases reported in the literature. Here, we present an interesting case of spontaneous development of this tumor at age 58, without associated systemic disease process or cutaneous manifestations. This female presented with complaints of isolated elevated vascular nodular lesions with feeder vessels in superior-temporal bulbar portion of left eye. Provisional diagnosis of left eye OSSN was made. Wide excisional biopsy with cryotherapy was performed for the left eye. Histopathology report of the lesion showed subconjunctival capillary hemangioma with no malignancy. The patient did not show any recurrence of lesion in the left eye at 2-month follow-up