Review on Shatkriyakala – A way to know and treat diseases

Ayurveda is a science of life. It is a system of traditional medicine native to Indian subcontinent but now days its knowledge is accepted worldwide. In Ayurveda prevention of all types of diseases is known as a prominent part of treatment which includes restructuring human lifestyle aligns with the course of nature. Kriyakala means the time of treatment or interception in the process of disease manifestation. These six stages mentioned by Acharya Sushruta gives an idea regarding the state of the disease in the body and it guides us when to intervene or where to inter intervene. Early diagnosis of diseases helps to cure the diseases successfully without much discomfort in planning treatment. The concept is traced in ancient Ayurvedic books. This is an objective approach of ancient scientists helping for the clinical practice. Apart from that the Kriyakala give us the knowledge of diagnosis, prognosis and the level of intervention and so that to prevent the establishment of a disease

STUDY ON AGE RELATED MACULAR DEGENERATION (DRY TYPE) IN CONTEXT TO PITTA VIDAGDHA DRISHTI AND ITS AYURVEDIC MANAGEMENT

Age Related Macular Degeneration (ARMD) is the leading cause of the vision loss and blindness in people above 50 years of age. ARMD is characterised by central vision loss, distorted or blurred vision, decreased visual acuity, Central or para-central blind spot (scotoma). An almost similar clinical condition to ARMD is seen in Pitta Vidagdha Dristi. Dry ARMD is more prevalent (90%) and slower in progress than Wet ARMD. The Ayurvedic management of Pitta Vidagdha Drishti is similar to Pittaja Abhishyanda. With this background a specific line of treatment for the Pitta Vidagdha Drisht in Sushruta Samhita is adopted. In this study, total 22 patients, 12 in group A (Triphala Ghrita, Saptamrita Lauha, Rasayana Churna and Shatavari etc.) & 10 in Group B (Control) were registered. The duration of therapy was of 3 months in both the groups. Group A showed better results on ARMD when compared with that of Group B especially on perception of flashes of light (72.23%) & dim light adaptation problem (45.23%). So ARMD (Dry type) can be better managed by Ayurvedic treatment group than the Modern multivitamin group

Management of Diabetic Macular Edema Through Ayurveda: A Single Case Study

Diabetic macular edema is one of the leading causes of visual acuity loss in people with diabetes. It produces blurry vision, particularly in the centre of the vision field, floaters and black spots in front of the eyes etc. The treatment recommended by modern science is laser photocoagulation and anti-VEGF injection, which is pricey and does not ensure visual reversal in the patient. In Ayurveda text, diabetic retinopathy and diabetic macular edema are not directly described but etiopathogenesis of eye diseases and Prameha gives an idea of possible correlation between these two diseases. So, DME resembles Timira (Pramehajanya). In Ayurveda, Timira has been explained in detail by our Acharyas. Clinical manifestations of Timira are Vihwal Drishti (blurred vision), Makshika Mashaka Kesha Jaala Pashyati (floaters), Tamasa Darshanam (Scotoma- black spots in front of eyes) and Nasa Akshi Yuktani Vipritani Vikshate (Metamorphopsia or distorted vision) which has similarity with features of DME. Material & Methods: In the present study, a female patient aged 51 years, visited the Shalakya Tantra OPD of National Institute of Ayurveda, Jaipur, with complaining of Blurriness of vision since 6 months and uncontrolled blood sugar level. Result: Blood sugar level was controlled and saw reduction in subjective and objective parameters. Discussion: Following an Ayurvedic drugs and routine will assist to slow the advancement of the condition, prevent further diabetes complications, and improve quality of life

Situs inversus totalis associated with cancer: Report of three rare cases and review of literature

Situs inversus totalis (SIT) is rare congenital recessively inherited condition in which there occurs transposition of all viscera in a mirror image form. The relationship between SIT and neoplasia is still unclear. We hereby report three rare cases (carcinoma esophagus, carcinoma lung, and non-Hodgkin lymphoma thyroid) associated with SIT. We report the first case in world literature of primary esophageal carcinoma associated with HIV and SIT

Comparative Study between conventional EBRT alone and EBRT followed by intraluminal brachytherapy in local advanced cancer esophagus

Aim: The purpose of this study is to compare local tumor control, dysphagia-free survival, and complication in patients with locally advanced carcinoma esophagus using external beam radiotherapy (EBRT) alone (Arm A) and EBRT followed by intraluminal brachytherapy (ILBT) (Arm B). Materials and Methods: A total of 50 histopathologically proven patients of locally advanced unresectable cancer esophagus were taken for the study from March 2019 to February 2020 and were divided into two arms, 25 patients each. Arm A was treated by standard concurrent chemotherapy–radiotherapy (CTRT) alone (a total dose of 50 Gray (Gy) in 25 fractions (fr), 2 Gy/fr administered daily 5 days per week with weekly injection cisplatin 40 mg/m2) and Arm B received 44 Gy through two definitive radiation therapies along with computed tomography followed by ILBT (5 Gy/fr; 2 fr 1 week apart). Assessment was done weekly during RT and 3 and 6 months post treatment for local control of disease and dysphagia-free survival and complication. Results: The local tumor control was observed 80% and 84% at 6 months in Arm A and Arm B, respectively (P = 0.82). Six-month dysphagia-free survival was 52% versus 68% (P = 0.248) and stricture formation was found 16% and 24% (P = 0.479) in Arm A and Arm B, respectively. Conclusion: This study shows comparable results of CTRT-ILBT over CTRT alone in locally advanced esophageal cancer patients

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research