Observational research on the effect of an Ayurvedic treatment protocol in patients of hereditary pancreatitis

BACKGROUND

Hereditary pancreatitis (HP) is a chronic and recurrent inflammatory disorder caused by genetic abnormalities, often accompanied by severe symptoms and complications. Conventional treatments offer limited relief but fail to halt disease progression. An Ayurvedic Treatment Protocol has been reported to be effective in treating various types of pancreatitis.

OBJECTIVES

This observational clinical study is aimed at assessing the efficacy of a year long Ayurvedic treatment protocol (ATP) in mitigating attack frequency and intensity in Hereditary Pancreatitis patients.

MATERIALS & METHODS

The study enrolled 151 patients across diverse age groups and genders, subjecting them to a comprehensive Ayurvedic treatment protocol at a specialized center. The protocol incorporated Metal-Based Ayurvedic Formulation (MBAF) named Amar, alongside supportive Ayurvedic compounds and dietary adjustments. Patients underwent pre- and post-treatment evaluations involving interviews, medical records, blood tests, radiological imaging, and symptom assessments. Notably, pancreatic enzyme use was discontinued prior to initiating Ayurvedic treatment.

RESULTS

Among 151 patients, 88 completed the year long ATP, resulting in significant enhancement of their quality of life. There was a marked 98.7% reduction in emergency hospitalizations and a notable 92.8% decrease in attack frequency (p < 0.0001). Radiological assessments indicated pancreatic health stabilization, while no adverse effects were reported, highlighting the intervention's safety and tolerability.

CONCLUSION

The study furnishes promising evidence supporting the efficacy and safety of ATP, especially the MBAF, in managing Hereditary Pancreatitis. The observed decline in attack frequency, absence of adverse effects, and stabilization of pancreatic health underscore the potential of Ayurvedic medicine. Subsequent research, including randomized controlled trials, is warranted to substantiate these findings and elucidate underlying mechanisms.

Proof of Efficacy Study to Evaluate an Ayurvedic Formulation in the Treatment of Allergic Rhinitis: An Open Label Randomized Controlled Clinical Trial

BACKGROUND

Allergic rhinitis is largely treated by using antihistamines and nasal sprays, either alone or in combination. However, these measures ease out the symptoms but do not address causative factors, and have their share of side effects and limitations. An Ayurvedic herbo-mineral formulation, IMMBO, has been reported to be effective in treating allergic rhinitis.

OBJECTIVE

The present study was carried out to evaluate the efficacy, safety, and tolerability of the Ayurvedic herbo-mineral formulation in comparison with a fixed-dose combination of levocetirizine and montelukast.

METHOD

This was a randomized, comparative, clinical study carried out on 250 patients at a medical college in India. The patients were enrolled according to the eligibility criteria of the study and randomized into two groups, to receive either Ayurvedic herbo-mineral formulation, IMMBO, or a combination of levocetirizine and montelukast for 28 days. Total nasal symptom score (TNSS) and Immunoglobulin E (IgE) were calculated for evaluation of efficacy parameters.  Result: At the end of therapy both IMMBO and levocetirizine and montelukast combination showed significant improvement in TNSS in both treated population and per protocol population. The IMMBO group had a statistically higher reduction in TNSSs compared to the levocetirizine + montelukast group (-5.70 vs. -3.31; p<0.01). There was a statistically significant difference in the reduction of IgE levels between the groups (-351.54 vs. -208.79; p<0.05).  Conclusion: The findings of this study establish prima facie evidence about the efficacy and safety of Ayurvedic formulation. However, the said Ayurvedic formulation needs to be further developed scientifically.

Ayurvedic Treatment Protocol for Hereditary Pancreatitis: A Case Report Demonstrating Disease Arrestation

The case report presented here highlights the use of an Ayurvedic treatment protocol (ATP) in managing hereditary pancreatitis (HP) in a 14-year-old boy. HP is a rare form of pancreatitis caused by specific gene mutations that are inherited within families. It is known to be aggressive and can lead to pancreatic cancer in later stages. The boy, in this case, experienced multiple episodes of pancreatitis and required several hospitalizations despite following a conventional treatment approach, which included a dairy-free, protein and fat-restricted diet, and pancreatic enzyme supplementation. However, after starting the ATP in February 2022, which involved a modified diet and the use of herbo-mineral Ayurvedic formulations, the boy reported significant improvement in his general well-being and was able to lead a normal life without experiencing any discomfort. The ATP included a customized diet comprising dairy products with moderate amounts of fat and protein, along with specific herbo-mineral formulations and the withdrawal of pancreatic enzymes. The boy also received vitamin D3 supplementation. After approximately one year of following the ATP, the disease progression was arrested, as indicated by follow-up images and investigations. The size of the pancreatic duct decreased from 8 mm to 2.8 mm. This case report suggests that the ATP may have potential efficacy in managing hereditary pancreatitis and halting disease progression. However, it is important to note that this is a single case report, and further research and clinical studies are needed to validate the long-term benefits and understand the underlying mechanisms of Ayurvedic interventions in hereditary pancreatitis.

Optimization of instant foxtail millet based khichdi by using response surface methodology and evaluation of its shelf stability

Instant foods are a great convenience in today's fast moving world, aiding to reduce the time spent on the cooking process, along with the added advantage of long shelf life and ease to carry. Ingredient composition was finalized by optimizing the design variables (instantised foxtail millet, instantised green gram dal and oat flakes) using Central Composite Rotatable Design besides suitable fat and spices for the development of instant foxtail millet khichdi. Over all acceptability and water holding capacity were considered as the responses for the experimental design. The developed quick cooking (jiffy) product possessed calorific value of 525.11 kcal/100 g with good rehydration/ reconstitution properties within 4 min. Shelf stability of the khichdi packed in polypropylene (75µ) and metallised polyester (90µ) pouches was evaluated in terms of chemical, microbiological and sensorial changes. The product was found to be shelf stable for 6 months of storage in metallised polyester.

Variability of bioactive properties and antioxidant activity in commercially grown cherry tomato (Solanum lycopersicum var. cerasiforme) cultivars grown in India

In this study, six commercial cherry tomato cultivars were analysed for variations in biochemical and technological parameters. Significant differences were observed among cultivars with respect to their technological and functional quality attributes. About 2.48-fold variation in titratable acidity, 2.47-fold variation in total phenolics, 4.13-fold variation in total carotenoid and 7.68-fold variation in lycopene contents were recorded. The total antioxidant activity and respiration rate were also found to vary about 1.85-fold and 1.48-fold, respectively. The highest antioxidant activity and total phenolic content were found in the Cherry tomato hybrid no.1 followed by Pusa cherry tomato-1. Hierarchical cluster analysis revealed that Cherry tomato hybrid no. 1, Pusa cherry tomato-1, and Nagmoti cultivars were abundantly rich in phytochemical and bioactive compounds.

Clinical Outcome Analysis and Correlation of Reproductive Outcome with Endometriosis Fertility Index in Laparoscopically Managed Endometriosis Patients: A Retrospective Cohort Study

Background:

Laparoscopy is important for management of endometriosis patients with estimation of endometriosis fertility index (EFI) which can predict reproductive outcome.

Aims:

This study aims to evaluate clinical outcome in laparoscopically managed pelvic endometriosis and correlation of reproductive outcome with EFI.

Setting and Design:

Retrospective cohort study carried out in the Department of Obstetrics and Gynecology.

Materials and Methods:

Our study included 123 patients who had undergone laparoscopic management of endometriosis from January 2017 to March 2018. Case files were retrieved and meticulously analyzed. All patients were contacted and interviewed. Symptomatic relief and pregnancy in infertility patients were recorded. EFI was calculated.

Statistical Analysis:

Data analyses were carried out using statistical software STATA version 12.0. P < 0.05 was considered statistically significant.

Results and Conclusions:

A total of 123 cases were enrolled; the most common complaint was infertility 107 (86.99%); the mean age was 32.4 years. EFI was found to be (6 to 10) in 28(26.2%) patients, EFI of (4 to 5) in 49 (45.8%) and EFI of (0 to 3) in 30 (28.0%). Post surgery, dysmenorrhoea was relieved in 56 (65.88%) patients, menstrual irregularities were relieved in 45 (76.27 %) patients, dyspareunia in 32 (54.24%) and chronic pelvic pain in 24 (40.5%) patients. 8 (40%) patients with low EFI conceived, 20 (58.82%) with moderate, and 26 (96.29%) with high EFI conceived. EFI score showed statistically significant positive correlation with pregnancy outcome P = 0.001, higher the EFI score, better the reproductive outcome. Laparoscopic surgeries are important for managing patients of endometriosis. It provides significant symptomatic relief, and EFI estimation can be done, which is a good tool to predict reproductive outcome of infertility patients with endometriosis.

Effect of Germination on Nutritional, Antinutritional and Rheological Characteristics of Quinoa (Chenopodium quinoa)

White and red varieties of quinoa were germinated and studied for the changes in nutritional, anti-nutritional and rheological characteristics. Germination has significantly (p≤0.05) enhanced protein and crude fibre with the significant (p≤0.05) reduction in carbohydrate contents in both the varieties. Anti-nutritional factor like phytic acid was decreased by 8.56 and 18.80 units in white and red varieties respectively. Total phenols, total flavonoids enhanced significantly (p≤0.05) in both the varieties, showing more in red variety exhibiting comparatively higher antioxidant activity. After 48 hr of germination, vitamin ‘C’ in both the varieties enhanced between the range of 10.56 and 13.23 mg/100g. Linoleic acid was the major fatty acid identified in both the varieties constituting more than 50 per cent of total fatty acids. Germination has reduced linoleic, linolenic and palmitic acids with the increase in stearic and oleic acids. Germination also caused significant (p≤0.05) decrement in breakdown, set back and final viscosities in both the varieties without much affecting their pasting temperature.

Comparative study between liquid-based cytology & conventional Pap smear for cytological follow up of treated patients of cancer cervix

Background & objectives:

Cancer cervix is one of the most common forms of genital malignancy among Indian women. Recurrence is seen in a significant number of cases. The conventional cervical smear technique has inherent problems and screening and interpretation errors. This study was undertaken to assess the efficacy of liquid-based cytology (LBC) as a method for cytological follow up and detection of recurrence in treated cases of cancer cervix and to compare it with conventional Pap smear technique to find the best screening method for detection of recurrence in these patients.

Methods:

This cross-sectional study was conducted over a period of one year. Patients attending Gynecology and Radiotherapy outpatient departments for follow up after treatment of cancer cervix were included. Pap smear and LBC were taken in all cases. Colposcopy and biopsy were done for those having epithelial cell abnormality in cytology report. Colposcopy and biopsy were taken as gold standard for diagnosis of cancer cervix recurrence.

Results:

Ninety four treated patients of carcinoma cervix were studied. The diagnostic accuracy for detection of recurrence of conventional Pap smear was 79.16 per cent, and that of LBC was 97.6 per cent. The difference between the two methods was significant (P<0.001).

Interpretation & conclusions:

Our findings showed that LBC performed better than the conventional method of cytology to detect recurrence of squamous cell carcinoma. Its sensitivity, specificity as well as accuracy were much higher than conventional method. LBC can be a better method of cytological follow up of post-treated patients of cancer cervix.

A cohort study of vulvar cancer over a period of 10 years and review of literature

OBJECTIVE

The objective of this study was to study the risk factors, management protocols, and the outcome of vulvar cancer cases over a period of 10 years in a tertiary care hospital.

METHODOLOGY

It is a retrospective cohort study. The hospital records of 41 patients with histologically proven vulvar cancer were studied from the Department of Obstetrics and Gynaecology and the Department of Radiotherapy (RT). The presence of risk factors, stage of disease, treatment modalities used, and disease outcomes in terms of survival were studied. The data collected were analyzed and compared with the published literature.

RESULTS

The mean age for the diagnosis of vulvar cancer was 52 years and the peak incidence was seen in the age group of 50-70 years. Incidence was significantly more in multiparous (P = 0.001) and postmenopausal women (P = 0.007). An average of 4.1 cases were seen per year. Nearly, 97.56% of the cases were squamous cell carcinomas. Twenty cases belonged to the early stage of the disease (Stage I and II) whereas 21 cases had advanced disease (Stage III and IV). Nearly, 48.78% of the cases were primarily treated with surgery, 26.83% with RT, 7.3% with chemotherapy, and 17.07% with combined chemoradiation. Seventy-eight percent of the surgically treated cases had a mean survival of 5 years. Mean survival of 1 year was recorded in advanced disease cases. Limitation of the study was poor follow-up after treatment.

CONCLUSION

Incidence of vulvar cancer is significantly high in multiparous and postmenopausal women. Conservative surgical treatment is the best option in the early stage of the disease (Stage I and II) and gives high survival rates whereas advanced disease treated with chemoradiation has a poor survival.

Innovative non-surgical management of pelvic and anterior vaginal wall abscess following vaginal surgery

Surgical site infections remain a common cause of morbidity following gynaecological surgery. The widespread implementation of antibiotic prophylaxis prior to surgery, as well as cognizance of modifiable risk factors for postoperative infection, has led to a significant reduction in postoperative infection rates. However, in low resource settings where sepsis and infections are common, surgical site infections following vaginal hysterectomy are sometimes encountered. It is a challenge to treat these infections with minimal intervention avoiding repeat surgery. We report here a unique situation following vaginal hysterectomy and then laparotomy; where a pelvic abscess communicated with the vesicovaginal space and drained through an opening into the anterior vaginal wall. An innovative technique was used to drain this anterior vaginal wall abscess connecting to pelvic cavity using a 40 cm long disposable urinary catheter (made of polyvinyl chloride), which was inserted into the vaginal opening under ultrasound guidance.

Bone-Subtracted Spinal CT Angiography Using Nonrigid Registration for Better Visualization of Arterial Feeders in Spinal Arteriovenous Fistulas

BACKGROUND AND PURPOSE

Pretreatment diagnosis for the location of shunts and arterial feeders of spinal arteriovenous fistulas is crucial. This study aimed to evaluate the utility of subtracted CT angiography imaging by using nonrigid registration (R-CTA) in patients with spinal arteriovenous fistulas compared with conventional CTA imaging.

MATERIALS AND METHODS

The records of 15 consecutive subjects (mean age, 65 years; 2 women) who had undergone CTA and digital subtraction angiography for clinically suspected spinal arteriovenous fistula were reviewed. From CTA images obtained at the arterial and late arterial phases, warped images of the late arterial phase were obtained by using nonrigid registration that was adjusted to the arterial phase images. R-CTA images were then obtained by subtracting the warped images from the arterial phase images. The accuracies of using nonrigid registration and conventional spinal CTA and the time required for detecting arterial feeders in spinal arteriovenous fistulas were analyzed for each patient with DSA results as a standard reference. The difference between R-CTA and conventional spinal CTA was assessed by the Welch test and the McNemar χ(2) test.

RESULTS

R-CTA had a higher accuracy compared with conventional spinal CTA (80% versus 47%, P = .025). The time for interpretation was reduced in R-CTA compared with conventional spinal CTA (45.1 versus 97.1 seconds, P = .002).

CONCLUSIONS

Our subtracted CTA imaging by using nonrigid registration detects feeders of spinal arteriovenous fistulas more accurately and quickly than conventional CTA.

Pregnancy with portal hypertension

Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of non-cirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes.

Newer innovations in treatment of retracted nipple

OBJECTIVES

To compare the efficacy, merits and demerits of various methods for the treatment of retracted nipple, i.e., two new innovative methods (rubber band method and sucking by the husband) with the in-use syringe method.

METHODS

A prospective study on 213 women having retracted nipple, 71 in each of the three groups was carried out. Group A included patients in which syringe method was used; Group B comprised of woman in which rubber band method was used and Group C included patients with vigorous sucking by the husband.

RESULTS

Highest success rates were seen in Group C (vigorous sucking by the husband), being 52, 88 and 94 % on days 3, 7 and 14 respectively. Success rates in Group B (rubber band method) were lower, being 43, 66 and 74 % respectively and lowest in Group A (syringe method), i.e., 33, 47 and 64 %, respectively on corresponding days. Problem of difficulty in applying technique were common in Group B (38 %), less common in Group A (22 %) and nil in Group C. The incidence of local pain had the same trend i.e., 48 and 30 % in Group B and A, respectively, and nil in Group C. Disliking taste of milk in mouth and problem of privacy were highest in Group C i.e., 28 % and 100 % respectively.

CONCLUSIONS

Although syringe method is well established, sucking by husband is definitely superior and a boon for difficult cases too. Rubber band method is a bit inferior due to complicated technique, local pain and no lactation stimulation.

Human fascioliasis with biliary complications

We report a case of human fascioliasis adding to the few of the previously reported cases in India. A young boy from rural background in Bihar presented with diarrhea, vomiting, hepatic tenderness, jaundice and fever along with peripheral eosinophilia. Examination of stool revealed yellow-brown eggs of Fasciola hepatica. Human fascioliasis should be kept in mind in patients with cholangitis and eosinophilia especially in areas of sporadic occurrence.

Analysis and comparison of clinicohematological parameters and molecular and cytogenetic response of two Bcr/Abl fusion transcripts

Different forms of p210 are produced by alternative splicing, namely b2a2 and b3a2. There have been many contrasting data establishing a relationship between the two Bcr/Abl transcripts and platelet counts and also response to treatment. However, the data published to date have been on a small group of patients. The aim of the present study was to determine whether there was any difference between clinical and hematological parameters at diagnosis between the two Bcr/Abl fusion transcripts in our population, and whether the two transcripts responded differently or similarly to imatinib treatment. RT-PCR was performed in 202 cases for detection of Bcr/Abl transcripts in newly diagnosed chronic myelogenous leukemia cases in one year. The two transcripts were compared and correlated with clinical, hematological and FISH data and with response to treatment. A total of 138 cases were of b3a2 and 64 were of b2a2 transcript. There was no correlation between the hematological parameters and the type of transcript. There was a significant association of blast crisis with b2a2, especially with myeloid blast crisis. When compared to FISH results, 10% of b3a2 were found to have a significant association with 5'Abl deletion as compared to 3% of b2a2. On analyzing the therapeutic response, we did not find any difference between the two transcripts. In conclusion, our findings confirm that the b3a2 type transcript is not significantly associated with thrombocytosis, that the short transcript, b2a2, occurs with acute phase, i.e., blast crisis, and that there is no difference in treatment response between the two transcripts. However, further studies are required to understand the molecular pathways involved in the Bcr/Abl mechanism.

Ocular Tuberculosis

Ocular tuberculosis is a challenge in ophthalmic practice because it is extremely difficult to diagnose it.The term ocular tuberculosis indicates any infection by Mycobacterium tuberculosis in, on, or around theeye. It tends to affect all the structures of the eye. Clinical manifestations of ocular tuberculosis depends onthe site and severity of its infection. Diagnosis of ocular tuberculosis is entirely clinical, thoughinvestigation should be made to confirm the diagnosis. Treatment of ocular tuberculosis is the same as forthat of pulmonary tuberculosis.