Ayurvedic management of alopecia areata: A case report

Índralupta is a disease characterized by patches of hair loss spread throughout the body and scalp. It can be considered alopecia areata according to conventional medical care. The present case report is on the effectiveness of shodhana (treatment in which aggravated doshas are expelled from the body) and shamana (treatment that pacifies the aggravated doshas) in the patient of índralupta. A patient 25 years old, had hair loss patches on the scalp and many other areas of the body. The patient took conventional modern medicine as well as ayurveda treatment but didn't get a satisfactory result. The patient was hospitalized and treated with vamana (medicated emesis), virechana (medicated purgation), basti (administration of medicine through procto-colonic route), raktamokshana (blood-letting), and nasya (medicine administered through nasal route) along with shamana treatment for more than 6 weeks. The hair eruption started from many patches of the scalp and whole body. In this case, regrowth of hair from hair follicles was evident within 15 days of treatment. The collected data of this study suggest that shodhana and shamana treatment can provide noteworthy relief in índralupta.

Effect of Nadi svedana with simultaneous passive stretching on correction of sandhijadya

Severe knee flexion contracture greater than 80° is rare and challenging to manage. It is a common complication which occurs after a prolonged course of the rheumatoid arthritis. The case was a 45 year old female patient of Ama vata (rheumatoid arthritis) with sandhijadya and sankoca (contracture deformity) who was hospitalized for 2 months. She was unable to walk since 1 year due to contracture of both knee joints. The patient came on a wheel chair and was unable to walk even with support. She was advised for contracture repair surgery which she refused. After hospitalization she was treated with Nadi svedana twice a day for 20 min each. Simultaneously, passive stretching for 45 s in every 5 min interval was done. She was treated for 2 months. The patient was instructed to continue other Ayurvedic remedies given as the Ama vata (rheumatoid arthritis) treatment. After Nadi svedana, goniometric assessment of the knees contracture was performed every week. She got satisfactory result in stiffness and pain and has been able to walk with support. Extension of both knee joints has improved up to 20° with increased range of motion. Her height has also been increased up to 1.5 cm due to improvement in the extension of the knee joints with better feeling in daily activities during 3 months of follow-up period.

Vaginal Cuff Dehiscence after Hysterectomy and One Minute Technique of Laparoscopic Vault Closure

Aims: This study was done to observe the rate of vaginal cuff dehiscence of one minute technique of laparoscopic vault closure in laparoscopic hysterectomy.Methods: It was a descriptive study performed in Birat Hospital among 1012 patients undergoing total laparoscopic hysterectomy for both benign and malignant gynaecological conditions between 2012 to 2013. Monopolar cautery was used for laparoscopic colpotomy and vault was closed by laparoscopic single running suture, that is, one-minute laparoscopic vault closure technique. Patients were followed up for vaginal cuff dehiscence and the dehiscence rate was compared with other techniques of laparoscopic vault closure in laparoscopic hysterectomy.Results: This study showed that the rate of vaginal cuff dehiscence after one minute technique of laparoscopic vault closure in laparoscopic hysterectomy was 1/1012 patients (0.09%) which was significantly less as compared to other techniques of laparoscopic vault closure in laparoscopic hysterectomy quoted in the literature.Conclusions: One minute technique of laparoscopic vault closure after colpotomy with monopolar cautery using single running suture has encouraging results. It is a noble technique of laparoscopic vault closure with excellent support. It can be practiced in low resource setting also.

Drainage versus no Drainage after Elective Laparoscopic Cholecystectomy

Background Laparoscopic cholecystectomy is the gold standard for the surgical treatment of cholelithiasis. Routine drainage after elective LC is an issue of considerable debate. Objective To evaluate the advantages and disadvantages of drainage in patients undergoing Laparoscopic cholecystectomy. Method The study was conducted at the department of surgery in Nepalgunj Medical College and Teaching Hospital, Kohalpur between March 2013 and May 2014. During the period of study, sixty patients underwent laparoscopic cholecystectomy for symptomatic gall stone. Sixty patients were randomized before surgical procedure into two groups. Group A consisted 30 patients in whom a drain was placed in subhepatic space and group B consisted 30 patients without drain. Postoperative pain was assessed using a 10-point visual analog scale. The two groups were evaluated and compared regarding postoperative pain, the time needed for surgery, length of postoperative hospital stay and the incidence of postoperative complications. Result The mean operative time in group A was 6.16 minutes longer when compared with group B (p>0.05). Although the postoperative mean pain score was same at 6 hours after surgery in both groups (7.53 vs 7.23), the postoperative pain was higher in the group A by more than two points on the average in VAS (visual analogue score) at 24 hours and 48 hours. The proportion of the patients staying in the hospital for more than two days was higher in group A, 14 (46.66%) and 8 (26.66%) in group B (p < 0.05). There was no statistical difference in the rate of wound infections, shoulder pain, nausea, vomiting, and respiratory infections between the two groups. Conclusion The routine drainage of gallbladder bed after elective laparoscopic cholecystectomy may not be justified and appears to cause more postoperative pain and more postoperative complications and prolongs the hospital stay.

Clinical evaluation of Vardhamana Pippali Rasayana in the management of Amavata (Rheumatoid Arthritis)

Amavata is described as a difficult to cure (Krichhrasadhya) disease in Ayurveda. Pain in joints with swelling is a cardinal feature of this disease. It can be correlated with rheumatoid arthritis described in modern medical science. In conventional medical science, steroids and some nonsteroidal anti-inflammatory drugs are used for its management, but they cause certain dangerous side effects in the patients. Ayurveda promises an excellent therapy for it. The present clinical trial was conducted with the same objective to provide a safe, economical and effective therapy to the patients of Amavata. The present study was conducted in 73 patients having classical symptoms of Amavata. The patients were given Vardhamana Pippali Rasayana for 15 days. Patients with any other acute or chronic systemic illness or infection were excluded from the study. The observations and results obtained were analyzed statistically applying the "t" test. All the patients experienced up to 50% relief from the signs and symptoms of Amavata after the therapy. The drug might have produced its beneficial effects in the patients of Amavata due to its Agnideepana, Amapachana, Vatashamaka and Rasayana effects in the body. A significant decrease in the erythrocyte sedimentation rate in all the patients was also noticed. All the results obtained were highly significant statistically. Thus, it can be implicated that the Vardhamana Pippali Rasayana has a lot of beneficial effects in the patients of Amavata.

Effect of Atibalamula and Bhumyamalaki on thirty-three patients of diabetic neuropathy

Diabetic neuropathy is a relatively early and common complication affecting approximately 30% of diabetic patients. According to Ayurvedic principles there is involvement of Vata and Pitta Dosa in diabetic neuropathy. Bhumyamalaki (Phyllanthus niruri) is a plant which shows possibility to pacify these two Dosas. Another plant Atibala (Abutilon indicum) has also Vata pacifying qualities. Present study has been carried out to study the effects of Bhumyamalaki and Atibala on 33 patients of diabetic neuropathy. All the patients have been given Bhumyamalaki Churna 3 g twice a day and decoction of 10 g of Atibala-mula twice a day for 30 days. Neuropathy analyzer machine has been used for exact recording of sensory perception of vibration, cold and hot sensations before and after treatment. Changes in numbness, tingling, burning sensation and pain in lower limbs have also been assessed before and after treatment. Results have been analyzed statistically by applying the ‘t’ test. It can be stated from the results that use of Bhumyamalaki and Atibalamula in the patients of diabetic neuropathy can revert the diminished sensory perception and can reduce the symptoms significantly.

Effects of Ayurvedic treatment on 100 patients of chronic renal failure (other than diabetic nephropathy)

Chronic renal failure (CRF) refers to an irreversible deterioration in renal function, which develops over a period of years. This initially manifests only as a biochemical abnormality. CRF is considered when glomerular filtration rate (GFR) falls below 30 ml/min. The conventional approach of management includes dialysis and renal transplantation, which are not affordable by Indian population mainly due to economic reasons. Therefore, exploration of a safe and alternative therapy is needed, which proves to be helpful in reducing the requirement of dialysis and in postponing the renal transplantation. A clinical study of 100 patients of CRF was conducted at OPD and IPD of PD Patel Ayurved Hospital, Nadiad. They were given Niruha basti of Punarnavadi kvatha daily with oral medicaments including Goksuradi guggulu, Rasayana churna, and Varunadi kvatha for 1 month period. The patients of CRF, having diabetic nephropathy as a cause, were excluded since a separate study for diabetic nephropathy is being conducted. Results were analyzed statistically using the “t” test. The symptoms and signs, serum creatinine, blood urea, urine albumin level were reduced, which were found to be statistically highly significant on “t” test.

Effect of Ayurvedic management in 130 patients of diabetic nephropathy

Diabetic nephropathy is a specific form of renal disease. It is a major cause of renal insufficiency and ultimately of death. The present study has been carried out to prove the efficacy of Ayurvedic drugs in the management of diabetic nephropathy, which can be helpful in reducing the need of dialysis and avoiding or delaying renal transplantation. A total of 130 patients of this disease were treated in IPD (Group A) and OPD (Group B). Ayurvedic formulations including Gokshuradi Guggulu, Bhumyamalaki, Vasa and Shilajatvadi Vati were given to all the patients for 2 months. Group A patients were given special planned food. Results were analyzed statistically using “t” test. In group A patients, highly significant reduction was found in the values of serum creatinine, blood urea and urinary excretion of albumin. Marked improvement was found in the patients’ general physical well-being, together with reduction in symptoms, in group A patients. This shows the importance of Pathyapathya in Ayurvedic management of the disease. This management may bring some new hope to the patients of diabetic nephropathy, which usually terminates to chronic renal failure and ultimately to death. Further studies are being carried out in this regard.

Effects of Ayurvedic treatment on forty-three patients of ulcerative colitis

Ulcerative colitis is a chronic idiopathic inflammatory bowel disease with a relapsing nature. It is a very challenging disease affecting a patient during the most active period of his life i.e. 20 to 40 years of age. The main features are ano-rectal bleeding with increased frequency of bowel evacuation, general debility and with abnormal structural pathology in the descending colon, particularly sigmoid colon. In modern medical science, there is no permanent curative and safe treatment for this disease. This study can be helpful for reducing the need of steroids and surgical processes in the patients of ulcerative colitis. A clinical study of 43 patients of ulcerative colitis has been conducted at the O.P.D. (outdoor patient department) and I.P.D. (indoor patient department) of the P D Patel Ayurveda Hospital, Nadiad. They were given Udumbara kvatha basti with oral Ayurveda medicaments including Kutaj ghan vati, Udumbara kvatha, and combination of Musta, Nagakesara, Lodhra, Mukta panchamrut rasa for a one-month period. Results were analyzed statistically by using the 't' test. In this study, it was observed that the symptoms and signs, daily dose of steroids and other anti-inflammatory drugs were reduced by more than 75% with a highly significant result. The hemoglobin level was also increased.

A clinical comparative study of the management of chronic renal failure with Punarnavadi compound

India like any other country is facing a silent epidemic of chronic renal failure (CRF)- a facet of the health transition associated with industrialization partly fuelled by increase in sedentary lifestyle, low birth weight and malnutrition. Increasing figures by many folds seen is posing a difficult situation to overcome with respect to economy and health of the working and earning population of the nation. There is an urgent need to explore, highlight new interventions and modify modifiable risk factors as a basis for treatment strategies to prevent the development and progression of CRF. The present study was taken up to evaluate the role of trial formulation tab. Punarnavadi compound in the management of chronic renal failure. This was an open clinical comparative study in controlled circumstances wherein 67 patients were studied for two months in three groups- Group A (allopathic control), Group B (ayurvedic control) and Group C (ayurvedic test). It was a multi-centric study; patients were registered from Anandababa charitable dialysis centre, Jamnagar, Kayachikitsa O.P.D. of I.P.G.T. and R.A. Jamnagar and P. D. Patel Ayurveda hospital, Nadiad. Results were assessed on 15 parameters using Students (paired) 't' test. Group A patients showed comparatively better results in eight parameters- weight, platelet count, serum urea, serum uric acid, serum sodium, potassium, chloride and total proteins. Parameter Hemoglobin% showed better results in Group B patients and in Group C patients comparatively better results in six parameters viz.- quality of life (breathlessness, weakness, general functional capacity), total count, serum creatinine and serum calcium - were observed. Throughout the study, trial drug tab. Punarnavadi compound did not show any adverse drug reaction. The results of this study will help in developing a cheap and safe treatment for the management of CRF.

Discovery of highly potent small molecule kallikrein inhibitors

Uncontrolled kallikrein activation is involved in diseases such as hereditary angioedema, bacterial septic shock and procedures such as cardiopulmonary bypass. Here we report a series of small molecule compounds that potently inhibit kallikrein activity in vitro. Kinetic studies indicate that some of these compounds are slow binding inhibitors of kallikrein with Ki final less than a nanomolar. The ability of these compounds to inhibit the activity of kallikrein was further confirmed in a plasma model by quantitating the release of bradykinin, an endogenous cleavage product of plasma kallikrein. To understand the inhibitory mechanism of the selected compounds toward kallikrein, the interactions between the selected compounds and kallikrein was explored using molecular modeling based on the information of crystal structures of TF/FVIIa and kallikrein. The information presented in the current study provides an initial approach to develop more selective and therapeutically useful small molecule inhibitors.

Cervical spinal cord neurapraxia in the setting of Klippel–Feil anomaly: a diagnostic and therapeutic challenge

STUDY DESIGN

Case report.

SETTING

Temple University Children's Medical Center in USA.

OBJECTIVES

To report a patient whose recurrent and transient episodes of quadriplegia mimicked cervical cord neurapraxia. Cervical spine neuroimaging revealed congenital intersegmental fusion of C5 through C7 (consistent with Klippel-Feil anomaly), corresponding abnormal spinal cord signals on T2-weighted images and enhancing focal lesion opposite the C4 vertebral body. A posterior cervical decompression at C4-C5 and lateral mass fixation was performed, and the episodic quadriplegia has not recurred.

CONCLUSION

Understanding of the biomechanics of Klippel-Feil anomaly may facilitate prompt referral for surgical management and avoidance of permanent disability.

Study on the anatomical dimensions of the human sigmoid colon

Although the sigmoid colon is commonly afflicted with disease, studies on its anatomical dimensions are scarce. It is suspected that dimensions of the sigmoid colon change with age. This study documents data on the anatomical measurements of the sigmoid colon in 70 Indian subjects (51 live and 19 cadavers). Seven parameters of sigmoid colon anatomy measured included length and width of the sigmoid colon and mesocolon at specific points. Three mesocolic indices (width to length ratios) were calculated. Comparisons of measurements in the live and cadaver subjects and in the two sexes were made. The relationship of change in parameters with age was assessed. Appropriate statistical methods were used and the differences were considered significant at P < or = 0.05. The study showed wide ranging variations in the values of various measured parameters of the sigmoid colon. Seven patterns of the shape of the sigmoid loop were identified. In the commonest pattern the sigmoid mesocolon was vertically longer than wide (dolichomesocolic), the sigmoid loop having its maximum convexity located just a little proximal to the apex. Patterns where the width of the mesocolon was greater than the vertical length (brachymesocolic) were also observed. The gender analysis showed that the sigmoid mesocolon of the female was brachymesocolic (wider than long), whereas that of the male was dolichomesocolic (longer than wide). This might explain the higher incidence of sigmoid volvulus in the male. This study also showed that the measurements of the sigmoid colon and its mesocolon do not change significantly within the age range of 16-60 years in the two sexes. Also noteworthy is the observation that in the cadaver the sigmoid colon shows considerable shrinkage, particularly of its mesocolon; consequently the data from cadaver subjects, though valuable for anthropometric use, have limitations when used for clinical applications.

Attenuated myocardial vasodilator response in patients with hypertensive hypertrophy revealed by oxygenation-dependent magnetic resonance imaging

BACKGROUND

Oxygen (O(2)) homeostasis is central to myocardial tissue functioning, and increased O(2) demand is thought to be satisfied by a vasodilatory mechanism that results in increased blood and O(2) delivery. We applied blood oxygenation level-dependent (BOLD) MRI in conjunction with vasodilatory stress to index the ability to augment intramyocardial oxygenation in hypertensive hypertrophy, the primary cause of heart failure.

METHODS AND RESULTS

Nine healthy controls and 10 hypertensive subjects with moderate-to-severe hypertrophy underwent imaging on a 1.5 T clinical scanner. The dipyridamole-induced change in the apparent transverse relaxation rate, R2*, which correlates with hemoglobin oxygenation, was -5.4+/-2.2 s(-1) (95% CI, -4.0 to -6.8 s(-1)) in controls compared with -1.7+/-1.4 s(-1) (95% CI, -0.8 to -2.6 s(-1)) in hypertensive patients (P=0.0003).

CONCLUSIONS

Patients with hypertensive hypertrophy demonstrate an impaired ability to increase intramyocardial oxygenation during vasodilatory stress, as indexed by BOLD MRI. The capacity to image vascular function with BOLD MRI may advance the understanding of the development of ventricular dysfunction in hypertension.

First-pass myocardial perfusion MR imaging with interleaved notched saturation: feasibility study

The authors evaluated a magnetization preparation scheme with a "notched" section profile for T1-weighted first-pass myocardial perfusion magnetic resonance (MR) imaging at 1.5 T. The pulse sequence consisted of a preparation sequence followed by an interleaved gradient-echo echo-planar sequence. Image contrast was evaluated in a feasibility study in 12 adult patients. The notched saturation pulse allowed long magnetization recovery times without sacrificing section coverage. Image contrast between normal and ischemic myocardium was excellent.

Bandpass optical flow for tagged MRI

MR tagging has shown great promise for detailed noninvasive cardiac motion imaging. Our research uses low-frequency tags coupled with gradient-based optical flow estimation to compute cardiac motion. We develop here a novel, fast, fully automated optical flow method for tagged MRI by exploiting the Fourier content of the tagged images. This new method, called bandpass optical flow, works by extracting various subband images from tagged cardiac data, and then formulating multiple optical flow constraints for each subband. The resulting system is solved by least squares pseudo-inversion. The proposed method is validated on simulated and real tagged data.

A vector Wiener filter for dual-radionuclide imaging

The routine use of a single radionuclide for patient imaging in nuclear medicine can be complemented by studies employing two tracers to examine two different processes in a single organ, most frequently by simultaneous imaging of both radionuclides in two different energy windows. In addition, simultaneous transmission/emission imaging with dual-radionuclides has been described, with one radionuclide used for the transmission study and a second for the emission study. There is thus currently considerable interest in dual-radionuclide imaging. A major problem with all dual-radionuclide imaging is the "crosstalk" between the two radionuclides. Such crosstalk frequently occurs, because scattered radiation from the higher energy radionuclide is detected in the lower energy window, and because the lower energy radionuclide may have higher energy emissions which are detected in the higher energy window. The authors have previously described the use of Fourier-based restoration filtering in single photon emission computed tomography (SPECT) and positron emission tomography (PET) to improve quantitative accuracy by designing a Wiener or other Fourier filter to partially restore the loss of contrast due to scatter and finite spatial resolution effects. The authors describe here the derivation and initial validation of an extension of such filtering for dual-radionuclide imaging that simultaneously 1) improves contrast in each radionuclide's "direct" image, 2) reduces image noise, and 3) reduces the crosstalk contribution from the other radionuclide. This filter is based on a vector version of the Wiener filter, which is shown to be superior [in the minimum mean square error (MMSE) sense] to the sequential application of separate crosstalk and restoration filters.

Carcinoma penis

In the present study 90 cases of carcinoma penis were studied. The disease is more common after the age of 40 years; phimosis was found to be most important predisposing factor. Most common presentation was proliferative lesion with commonest involvement of glans penis. All the cases were of squamous cell carcinoma except one case of malignant melanoma. Clinical determination of lymph node metastasis is falacious as there was discrepancy between clinical and histopathological stage of the disease in 26.67% of cases. Therefore lymph node biopsy at the time of primary surgery is advocated. The result of total amputation is better than other mode of treatment.

Frontal bone osteomyelitis causing recurrent meningitis

A case of recurrent pyogenic meningitis is reported. The focus for recurrent meningeal infection was frontal bone osteomyelitis secondary to a road accident which the patient sustained ten years earlier.