Ayurvedic clinical decision-making methods to predict, prevent and manage childhood allergic disorders.

Allergy is a conundrum lacking satisfactory answers despite its global prevalence. Traditional systems of medicine may contain sustainable and effective solutions for the same. For mainstreaming them, an evaluation based on the system's own methods is inevitable rather than symptom-based correlations. Atopy is a novel entity in Ayurveda, but the methods of tripartite delineation (disease pattern, disease targets and influencing factors) of novel diseases and multifactorial approach to diagnosis and management in Ayurveda can bring about comprehensiveness in collection and categorization of data regarding the entity. This in turn can make the prediction, prevention and management of the same more precise, effective and sustainable. The article provides a template for the application of Ayurvedic biological framework in the diagnosis and management of novel diseases, with special reference to childhood allergic disorders.

An unusual cause of respiratory distress.

Exogenous lipoid pneumonia is a rare alveolar-filling disorder characterized by foreign body reaction to inhaled/aspirated hydrocarbon that may be vegetable oil, animal fat, or mineral oil. It is vanishingly rare and often missed except in the classical clinical settings of acute aspiration of petroleum products. We present a toddler with iatrogenic exogenous lipoid pneumonia and highlight clinical and radiological clues that can prompt early recognition of this entity.

The Protein Interactome of Streptococcus pneumoniae and Bacterial Meta-interactomes Improve Function Predictions.

The functions of roughly a third of all proteins in Streptococcus pneumoniae, a significant human-pathogenic bacterium, are unknown. Using a yeast two-hybrid approach, we have determined more than 2,000 novel protein interactions in this organism. We augmented this network with meta-interactome data that we defined as the pool of all interactions between evolutionarily conserved proteins in other bacteria. We found that such interactions significantly improved our ability to predict a protein's function, allowing us to provide functional predictions for 299 S. pneumoniae proteins with previously unknown functions. IMPORTANCE Identification of protein interactions in bacterial species can help define the individual roles that proteins play in cellular pathways and pathogenesis. Very few protein interactions have been identified for the important human pathogen S. pneumoniae. We used an experimental approach to identify over 2,000 new protein interactions for S. pneumoniae, the most extensive interactome data for this bacterium to date. To predict protein function, we used our interactome data augmented with interactions from other closely related bacteria. The combination of the experimental data and meta-interactome data significantly improved the prediction results, allowing us to assign possible functions to a large number of poorly characterized proteins.

Future Research Priorities for Morbidity Control of Lymphedema.

BACKGROUND: Innovation in the treatment of lower extremity lymphedema has received low priority from the governments and pharmaceutical industry. Advancing lymphedema is irreversible and initiates fibrosis in the dermis, reactive changes in the epidermis and subcutis. Most medical treatments offered for lymphedema are either too demanding with a less than satisfactory response or patients have low concordance due to complex schedules. A priority setting partnership (PSP) was established to decide on the future priorities in lymphedema research. METHODS: A table of abstracts following a literature search was published in workshop website. Stake holders were requested to upload their priorities. Their questions were listed, randomized, and sent to lymphologists for ranking. High ranked ten research priorities, obtained through median score, were presented in final prioritization work shop attended by invited stake holders. A free medical camp was organized during workshop to understand patients' priorities. RESULTS: One hundred research priorities were selected from priorities uploaded to website. Ten priorities were short listed through a peer review process involving 12 lymphologists, for final discussion. They were related to simplification of integrative treatment for lymphedema, cellular changes in lymphedema and mechanisms of its reversal, eliminating bacterial entry lesions to reduce cellulitis episodes, exploring evidence for therapies in traditional medicine, improving patient concordance to compression therapy, epidemiology of lymphatic filariasis (LF), and economic benefit of integrative treatments of lymphedema. CONCLUSION: A robust research priority setting process, organized as described in James Lind Alliance guidebook, identified seven priority areas to achieve effective morbidity control of lymphedema including LF. All stake holders including Department of Health Research, Government of India, participated in the PSP.

Evaluation of the effect of Kanchnara Guggulu and Tankana-Madhu Pratisarana in the management of Tundikeri (tonsillitis) in children.

INTRODUCTION: Tonsillitis is a common illness in the childhood period. There are about 7,455,494 cases of tonsillitis in India per year. Tonsillitis can be compared with Tundikeri in Ayurveda. In the present study, Kanchnara Guggulu tablets and Pratisarana of Tankana-Madhu were selected. AIM: To evaluate the effect of Kanchnar Guggulu and Tankana-Madhu Pratisarana in the management of Tundikeri in children. MATERIALS AND METHODS: In the present study, a total of 31 patients aged between 5 and 16 years attending the outpatient department of Kaumarbhritya Department and Shalakya Tantra Department were registered. Among them, 26 patients completed the treatment. Kanchnara Guggulu tablets were administered orally in Group A and in Group B, Pratisarana with Tankana-Madhu was done along with the oral administration of Kanchnara Guggulu tablets. RESULTS: The results showed that in Group A, 21.43% of patients got complete remission, 42.86% of patients got marked improvement and 35.71% of patients got moderate improvement. In Group B, 25% of patients got complete remission, 58.33% of patients got marked improvement and 16.67% of patients got moderate improvement. CONCLUSION: Both the groups showed highly significant results in all cardinal and associated features of Tundikeri. Kanchnara Guggulu and Tankana-Madhu Pratisarana are a safe and effective modality for the treatment of Tundikeri.

Evaluation of Gandhakadi Yoga as an adjuvant therapy in the management of Beejadushtijanya Pandu (thalassemia major).

INTRODUCTION: Thalassemia major is a malignant type of genetic disorder and iron overload is the main complication of the disease which results due to frequent blood transfusions. Gandhakadi Yoga has been proved effective against iron overload in experimental studies and pilot voluntary study, hence, taken for clinical evaluation in the present study. AIM: The aim of this study is to evaluate the efficacy of Gandhakadi Yoga as an adjuvant therapy in the management of thalassemia major. MATERIALS AND METHODS: A total of 46 patients of age group 2-12 years were registered and randomly divided into two groups. Group A (trial group-Gandhakadi Yoga with blood transfision (BT)) and Group B (control Group-with BT and iron chelation therapy). The assessment was done based on the subjective and objective parameters after12 weeks of treatment, with a follow-up of 12 weeks. The data obtained in clinical study was analyzed using Student's "t" test. RESULTS: Trial drug provided highly significant result (P < 0.001) in most of the subjective parameters and BT interval was prolonged. In Group A, the maximum improvement was found in three patients (13.04%); moderate improvement in 15 patients (65.22%) and mild improvement in five patients (21.74%). No adverse drug reaction was reported during the clinical study. CONCLUSION: Gandhakadi Yoga provided better results than control in subjective and objective parameters, BT interval and general health status, hence, has an effective role as an adjuvant in the management of thalassemia major.

Acute hypopituitarism complicating Russell's viper envenomation: case series and systematic review.

BACKGROUND: Chronic hypopituitarism following Russell viper envenomation (RVE) is a rare but well-recognized syndrome. The clinical features, associations, management and outcomes of RVE associated-acute hypopituitarism (AHP) are not well described. AIMS: To describe the clinical features, intensive care unit (ICU) management and outcomes of a series of patients with RVE-AHP and identify the clinical associations of RVE-AHP. METHODS: We describe a series of patients with prospectively identified AHP related to RVE and describe our findings comparing RVE with and without AHP and a systematic search of literature on AHP related to RVE. RESULTS: We identified nine cases of AHP related to RVE. Unexplained hypoglycemia (100%) and hypotension (66.7%) were the most common findings at presentation. AHP occurred after a median of 9 (range, 2-14) days after severe envenomation and was associated with multi-organ dysfunction, lower platelet counts, more bleeding and transfusions when compared to patients with RVE alone. The presence of clinically defined capillary leak syndrome, disseminated intravascular coagulation and mortality were not different from those without AHP. Our systematic search yielded 12 cases of AHP related to RVE; data on associated clinical manifestations, therapy and ASV administration were not available in most reports. CONCLUSION: AHP is a very rare complication of RVE. Unexplained hypoglycemia and hypotension should prompt evaluation for AHP in RVE. AHP is associated with severe RVE, multi-organ dysfunction, bleeding and need for transfusion. Prompt treatment with steroids may reduce mortality related to AHP in RVE.

Randomized placebo-controlled clinical study on enhancement of Medha (intelligence quotient) in school going children with Yahstimadhu granules.

INTRODUCTION: Optimal intelligence is a vital essentiality in day-to-day life, especially in children who have to build up their life in an apt manner. Yashtimadhu (Glycyrrhiza glabra Linn) is a time tested classical drug indicated for promotion of mental health mentioned in Ayurveda which may also help children to attain optimal intelligence. AIM: To evaluate the role of Yashtimadhu (Glycyrrhiza glabra Linn.) granules in enhancement of Medha (intelligence quotient [IQ]). MATERIALS AND METHODS: The study was conducted on healthy school going children aged 14-16 years. Total 94 children were registered and divided into two groups. Yashtimadhu granules was administered in Group A and Wheat flour in the form of granules in Group B, the duration of treatment was 12 weeks with follow up of additional 12 weeks. Objective parameters included assessment of functional aspects of Buddhi (psychological faculty for reasoning and logic) along with the assessment of IQ, Quality of life parameters and general health condition. RESULTS: Yashtimadhu granules showed statistically highly significant results in improving functional aspects of Buddhi, IQ, several aspects of quality of life parameters and health. The number needed to treat (NNT) with Yashtimadhu granules for children achieving an IQ score of 90 and above was 3.38, suggesting one in every 3.38 patients had achieved this target and for children achieving an IQ score of 110 and above the NNT was 6.66. CONCLUSION: Yashtimadhu granules was safe throughout the course of study and indeed possessed a significant efficacy in improving Medha (IQ).

Efficacy of triphaladi avaleha on beejadushtijanya pandu (thalassemia).

BACKGROUND: Hemoglobinopathies constitute a major public health problem internationally, particularly in the developing world as it has the least resources for coping with the problem. Thalassemia is an inherited single-gene autosomal recessive disorder of the Red Blood Corpuscles (RBCs). Life becomes miserable due to blood transfusion every fortnight, recurrent infections, stunted growth, problems of iron overload, splenectomy, and decreased school performance. Nearly Rs. 1000 Crore is being spent in the treatment of thalassemia per annum. AIM: To evaluate the efficacy of Triphaladi Avaleha in Beejadushtijanya Pandu (thalassemia). MATERIALS AND METHODS: Total 32 patients of age group 1-15 years were registered and randomly divided into two groups. Group A (test drug treated group) and Group B (control group). In Group A, Triphaladi Avaleha was given with Godugdha, and in Group B, Deferiprone was administered. Assessment was done based on the subjective and objective parameters after 12 weeks of treatment, with a follow-up of 8 weeks. RESULTS: The trial drug proved better than the standard control in Paandutaa and Sandhishoola at a highly significant level and in Jwara, Akshikootashotha and Pindikodweshtana at a significant level. In Group A, five patients (38.46%) showed maximum improvement, five patients (38.46%) showed moderate improvement, two patients (15.38%) had mild improvement. CONCLUSION: Triphaladi Avaleha has various properties which help to relieve the signs and symptoms of the disease, as well as decrease the iron overload.

A critical appraisal on Swarnaprashana in children.

Administration of processed gold in children is a unique practice mentioned in Ayurveda as "Swarnaprashana" by Acharya Kashyapa thousands of years back. He explained evidently the administration of Swarna (gold) in children for the benefits of improving intellect, digestion and metabolism, physical strength, immunity, complexion, fertility, and life span. There are various formulations of gold and even along with herbal drugs explained by different Acharya for prolonged usage in children. Swarnaprashana in children can be mainly implicated in two contexts of Ayurveda; Lehana (supplementary feeds) and Jatakarma Samskara (newborn care). This review is an effort to critically evaluate the available data, which may be helpful in clearing some of the existing fallacies on the topic. The age and method of administration, benefits and dosage as per various classical textbooks of Ayurveda are discussed here along with the reports of related scientific studies. This review proposes that the benefits of Swarnaprashana can be achieved at multiple levels like as a general health promoter and in specific to enhancement of intelligence, digestion, metabolism, immunity, physical strength, complexion, or fertility. Ayurveda recommends only purified and processed form of gold for internal administration. The age at which Swarnaprashana should be administered and its duration can be determined depending upon the desired effect in children as a positive health care program.

Comparative clinical efficacy of Ashtangavaleha and Vyaghreehareetakee Avaleha on Tamaka Shwasa (bronchial asthma) in children.

BACKGROUND: Tamaka Shwasa is a chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction. This disease is more predominant in children and aged population. Apart from being the leading cause of hospitalization for children, it is one of the most important chronic conditions causing elementary school absenteeism. The parallel disease entity in contemporary medical science to this disorder is Bronchial Asthma. AIM: This study was aimed to evaluate the clinical efficacy of Ashtangavaleha and Vyaghreehareetakee Avaleha on Tamaka Shwasa (Bronchial Asthma) in Children. MATERIALS AND METHODS: The study was therapeutic interventional randomized clinical trial. Totally 100 patients suffering from Tamaka Shwasa were selected, and 74 patients completed the course of treatment. Patients were divided into two groups. Ashtangavaleha was administered in group AG and Vyaghreehareetakee Avaleha was administerd in group VG (5-15g in divided doses) for 8 weeks duration. Comaprative assesment of both the drugs was done on the signs and symptoms of the disease, pulmonary function test and quality of life parameters. RESULTS: When the individualized overall effect of therapy was considered, more number of patients treated with Ashtangavaleha reached moderate improvement zone than the patients treated with Vyaghreehareetakee Avaleha. CONCLUSIONS: The trial showed a marginal better efficacy of Ashtangavaleha (66.66%) in comparison to Vyaghreehareetakee Avaleha (63.15%) on the overall condition of the patients even though the superiority was statistically insignificant (>0.05).

Management of spastic cerebral palsy through multiple Ayurveda treatment modalities.

BACKGROUND: Cerebral palsy (CP) is a leading cause of childhood disability affecting function and development. The global incidence of CP is 2:1000. It has been reported that children with CP and their caretaker have impaired health-related quality of life (QOL). Of the many types and subtypes of CP, none has any known cure. For a detailed description of the disease CP, though, there is no one to one correlation in Ayurvedic classics; it can be taken as Vata Vyadhi as far as its etiology and symptomatology are concerned. AIM: To assess the effect of certain Panchakarma procedures in the management of CP. MATERIALS AND METHODS: Total 8 patients were registered and treated with 5 days of Udvartana, 5 days of Abhyanga followed by Sarvanga Swedana and then 8 days of Yoga Basti. The same course of treatment has been repeated for 3 times with an interval of 14 days. Ashtanga Ghrita was given during whole procedures as internal medication. Results of treatment were assessed with anthropometrical measurement, developmental milestone, Modified Ashworth Scale, spasm scale, reflex scale, and muscle power grading. RESULT: This Ayurvedic management shows good result in CP patients, especially by improving growth (height, weight, chest circumference) and development (head holding and sitting), reducing spasticity of left upper limb and muscle spasm. CONCLUSION: Multisystem approach is needed to improve the condition of the patient. Panchakarma along with internal medication should be given to improve all the facets of spastic CP. Yoga Basti acts by their own mode of action and can be used freely for such disease conditions.

Etiopathological study on cerebral palsy and its management by Shashtika Shali Pinda Sweda and Samvardhana Ghrita.

According to World Health Organization (WHO) estimation, 10% of the global population has some form of disability due to different causes; in India, it is 3.8% of the population. Nearly 15-20% of the total physically handicapped children suffer from Cerebral Palsy (CP). For India, the estimated incidence is around 3/1000 live births; however, being a developing country, the expected actual figure may be much higher. Despite the advancement in modern technology and improved neonatal care, stagnant or increasing incidence of CP has been observed, which is of great concern. As far as management or preventive aspect is concerned, no satisfactory criteria have been developed to date. The present study is based on a positive hypothesis for the efficacy of Ayurvedic treatment. The study was carried out in 16 patients, 8 in each group, namely group A (Shashtika Shali Pinda Sweda externally and Samvardhana Ghrita internally) and group B (Samvardhana Ghrita internally) for 35 days duration. In group A, moderate improvement, mild improvement, and no improvement were observed in 50%, 37.5% and 12.5% of patients respectively. In group B, moderate improvement and mild improvement were observed in 75% and 25% of the patients respectively. Statistical significance of results on selected criteria showed the efficacy of the selected Ayurvedic treatment modality in relieving the signs and symptoms of CP. Although it is incurable, Ayurvedic science can provide a better direction by improving the quality of life of children with CP with better life expectancy.

Immunomodulatory activity of Vachadhatryadi Avaleha in albino rats.

The present study is carried out to evaluate the immuno-modulatory activity of Vacha Dhatryadi Avaleha in albino rats. Vacha Dhatryadi Avaleha was prepared by classical method and evaluated for humoral antibody formation and cell-medicated immunity in established experimental models. Test formulation was administered at the dose of 900 mg/kg and parameters like hemagglutination titer, ponderal changes, histopathology of immunological organs and immunological paw edema were recorded. Vacha Dhatryadi Avaleha significantly enhanced antibody formation and moderately suppressed the immunological edema. The present study concludes that Vachadhatryadi Avaleha has immunopotentiating activity.