An observational study to evaluate the efficacy Pachana Poorvaka Shodhana i.e. Agnilepa Chikitsa followed by Virechana Karma in the management of Amavata w.s.r. to Rheumatoid Arthritis

The change in life style, food habits have contributed to a number of new diseases which have become a challenge for the human race, one among such diseases is Rheumatoid arthritis which is the commonest joint disorder. It is a systemic inflammatory disease of undetermined aetiology involving primarily the synovial membrane and articular structures of multiple joint. The disease is often progressive and result in pain, stiffness and swelling of joint. In India the prevalence rate is 0.1-0.4%. The symptoms of Rheumatoid arthritis are parallel with Amavata, as the name suggests Amavata is comprise of two terms, Ama and Vata. The Nidanas such as Viruddhaahara, Viruddhacheshta, Mandagni, Nischalatva etc. due to consumption of Viruddahara and indulging in Viruddhacheshta the Ama will be manifested. The manifested ama is carried by vata and circulates throughout the body and takes ashraya in Sandhis. Commonly affecting the joints of Hasta, Pada, Shira, Gulpha, Trika, Janu and Uru and characterized by pain similar to vrischika damshtra. In this present clinical trial, 10 diagnosed patients of Amavata / Rheumatoid arthritis were selected randomly to evaluate the efficacy of Pachana Poorvaka Shodhana that is Agnilepa Chikitsa followed by Virechana Karma in Amavata w.s.r. to Rheumatoid Arthritis. Statistical analysis showed highly significant results p value (<0.0001) in almost all subjective and objective parameters of Amavata

Unsuspected multiples myeloma presenting as bilateral pleural effusion – a cytological diagnosis

<b>Background:</b> Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis. <b>Case Presentation:</b> A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin&#x2032;s Lymphoma deposit (Immunoblastic type). Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type). <b>Conclusion: </b> Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age

Postoperative sore throat with 0.05% betamethasone gel and 2% lignocaine jelly used as a lubricant for ProSeal LMA (PLMA) insertion

AbstractPostoperative sore throat (POST) is a minor complication after general anaesthesia. Many agents have been used as lubricant to reduce the incidence of POST with variable efficacy. We conducted a study to compare the incidence of POST with 0.05% betamethasone gel and 2% lignocaine jelly as a lubricant for PLMA insertion in patients undergoing general anaesthesia.Sixty subjects were divided randomly into two groups. Patients in Group I (n=30) had 2.5ml of 0.05% of betamethasone gel while the Group II had 2.5ml of 2% lignocaine jelly applied on the cuff of PLMA. After standard induction and insertion of PLMA cuff inflated to 60cm of H2O and was maintained at the same throughout the surgery. In PACU, patients were inquired about sore throat at immediate and 24h post operative period.POST was not observed in any of the patients of Group I. In group II 33% of the patients had 1st degree and 10% had 2nd degree of sore-throat in immediate post-operative period. After 24h 16% patients had 1st degree sore-throat and 3% patients had 2nd degree of sore-throat in Group II patients. We conclude that lubricating cuff of PLMA with 0.05% of betamethasone gel is effective in reducing the incidence of POST

A CLINICAL STUDY TO EVALUATE THE EFFECT OF SARVANGA UDVARTANA FOLLOWED BY VIRECHANA KARMA AS ROOKSHA POORVAKA SHODHANA IN AMAVATA W.S.R TO RHEUMATOID ARTHRITIS

The change in the classification of Rheumatoid Arthritis under various headings over the past few decades gives an insight to the pathology that requires a deeper understanding.  Considering the role of immune mediating cells, progressive involvement of multiple joints &amp; other systems, reduction in functional capacity, no other group of diseases is responsible for greater loss of earnings. The incidence of Rheumatoid Arthritis increases between 25 and 55years of age, after which it plateaus until the age of 75 and then decreases.Ayurveda understands this disease on the lines of Ama formation, Agni mandhya in rasa vaha srotas primarily, which over time dysfunctions all the 3 Agni (Jatharagni, Dhatwagni, Bhootagni) resulting in Sthabdham kurute gatram. The mainstay of treatment in Rheumatoid Arthritis comprises the early use of Disease Modifying Anti Rheumatic Drugs &amp; Corticosteroids for induction of remission. As Amavata is an Abhishyandha pradhana vyadhi, adopting any snigdha modality of treatment will cause complications, hence identifying the degree of Sama - Nirama avastha in Amavata, Rookshana is to be done prior to any Snigdha chikitsa. Hence, the aim of this study was to evaluate the effect of Rookshana before Virechana Karma in the management of Amavata / Rheumatoid Arthritis. In this present clinical trial conducted in Varsha rtu, 10 diagnosed patients of Amavata / Rheumatoid Arthritis were selected. Statistical analysis showed highly significant improvement p &lt;0.001 in almost all subjective &amp; objective parameters of Amavata

Price discovery mechanism and volatility spillover between national agriculture market and national commodity and derivatives exchange : the study of the Indian agricultural commodity market

Agricultural commodity markets are critical to the global economy. This study investigates the price discovery mechanism, lead-lag relationship, and volatility spillover between spot prices on the National Agriculture Market (E-NAM) and futures and spot prices on the National Commodity and Derivative Exchange (NCDEX) in the Indian agricultural commodity market. The Johansen Cointegration, Vector Error Correction (VEC), Granger causality tests, and bivariate GARCH models were applied to daily data from April 2016 to December 2020 for twelve agricultural commodities traded on the E-NAM and NCDEX. We discovered the long-run relationship using the Johansen Cointegration test and concluded that the NCDEX spot and futures market is dominant in the price discovery mechanism, and the NCDEX futures and spot markets lead the E-NAM spot prices having a unidirectional or bidirectional relationship. Furthermore, the bivariate GARCH model suggested a volatility spillover from E-NAM spot prices to NCDEX futures and spot markets for most commodities, except for bajra, barley, and jeera, which have no volatility spillover. The study’s findings have important implications for various stakeholders, including policymakers, farmers, investors, traders, and others who want to reduce price risks by using information from the E-NAM market’s spot prices.peer-reviewe

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

Purpose Endotracheal intubation is the gold standard for securing the airway before surgery. Nevertheless, this procedure can produce an activation of the sympathetic nervous system and result in a hemodynamic response which, in high-risk patients, may lead to cardiovascular instability and myocardial ischemia. The aim of this review was to evaluate whether gabapentin can attenuate this response and whether such an attenuation could translate into reduced myocardial ischemia and mortality. Source We searched MEDLINE®, EMBASE™, CINAHL, AMED, and unpublished clinical trial databases for randomized-controlled trials that compared gabapentin with control, fentanyl, clonidine, or beta blockers for attenuating the hemodynamic response to intubation. Primary outcomes were mortality, myocardial infarction, and myocardial ischemia. Secondary outcomes were hemodynamic changes following intubation. Principal findings We included 29 randomized trials with only two studies at low risk of bias. No data were provided for the primary outcomes and no studies included high-risk patients. The use of gabapentin resulted in attenuation in the rise in mean arterial blood pressure [mean difference (MD), −12 mmHg; 95% confidence interval (CI), −17 to −8] and heart rate (MD, −8 beats·min−1; 95% CI, −11 to −5) one minute after intubation. Gabapentin also reduced the risk of hypertension or tachycardia requiring treatment (risk ratio, 0.15; 95% CI, 0.05 to 0.48). Data were limited on adverse hemodynamic events such as bradycardia and hypotension. Conclusion It remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations

Large-scale unit commitment under uncertainty: an updated literature survey

The Unit Commitment problem in energy management aims at finding the optimal production schedule of a set of generation units, while meeting various system-wide constraints. It has always been a large-scale, non-convex, difficult problem, especially in view of the fact that, due to operational requirements, it has to be solved in an unreasonably small time for its size. Recently, growing renewable energy shares have strongly increased the level of uncertainty in the system, making the (ideal) Unit Commitment model a large-scale, non-convex and uncertain (stochastic, robust, chance-constrained) program. We provide a survey of the literature on methods for the Uncertain Unit Commitment problem, in all its variants. We start with a review of the main contributions on solution methods for the deterministic versions of the problem, focussing on those based on mathematical programming techniques that are more relevant for the uncertain versions of the problem. We then present and categorize the approaches to the latter, while providing entry points to the relevant literature on optimization under uncertainty. This is an updated version of the paper "Large-scale Unit Commitment under uncertainty: a literature survey" that appeared in 4OR 13(2), 115--171 (2015); this version has over 170 more citations, most of which appeared in the last three years, proving how fast the literature on uncertain Unit Commitment evolves, and therefore the interest in this subject