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Ayurveda is a science that focuses on both well-being and disease treatment. Many surgical and para-surgical procedures have been described by Acharya Sushruta for the management of various diseases; among these, Raktamokshana is popularly used for the management of various pathologies occurring due to Rakta Dushti (blood-borne disorders). It is derived from two words i.e., ‘Rakta’ which means blood & ‘Mokshana’ which means leave. Hence, Raktamokshana means to let the vitiated blood out. It is one of the five purification therapies by Acharya Sushruta. There are two ways to do Raktamokshana i.e., Shastra Visravana (using sharp instruments) and Anushastra Visravana (without using sharp instruments). Furthermore, it is said that Siravedha is ‘Chikitsaardha’ i.e., half of the treatment described in Shalya Tantra is similar to a well-performed Basti karma (Therapeutic Medicated Enema) advocated in Kaya-Chikitsa. However, there are relatively limited recommendations or use of Raktamokshana in clinical practices nowadays which may be due to fear associated with the procedure, lack of skillfulness, and unawareness about the efficacy of Raktamokshana in various diseases. This review article is specifically intended to assemble the usefulness of numerous modes of Raktamokshana based on Ayurvedic parameters with its detailed procedure
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Introduction: Breast cancer is the most common cancer of women worldwide. Early diagnosis of it has a very important role in its management. Breast self-examination (BSE) is a key to the early diagnosis of breast cancer. Materials and Methods: A community-based cross-sectional study was conducted on 300 females of Jaipur city. This study was conducted by a house-to-house survey through a systematic random sampling technique in the field practice area of the Urban Health Training Centre (UHTC) of SMS medical college, Jaipur (Rajasthan), India. A predesigned semi-structured questionnaire containing predesigned questions regarding knowledge and practice of BSE was used to collect data. A Chi-square test was used to find out associations. Results: Only 18% of females were aware of BSE and 5.7% of the females were practicing BSE. Health professionals (31.03%) were the main source of knowledge. Only 50% of females who have heard the name of BSE, knew that it is performed by self. Awareness and practice of BSE both were found to be associated with religion, education, socioeconomic status, and occupation and there was no association with age and marital status. Females with higher education and socioeconomic status were more aware of BSE. The most common (94.69%) reason for not practicing BSE was the lack of awareness of steps followed by ‘find it unnecessary’. Conclusion: As knowledge and practice of BSE were observed very poor and considering the important role that can be played by BSE in the early diagnosis and management of breast cancer, there is an urgent need to implement and reinforce BSE in the existing cancer awareness and screening programs. IEC activities regarding BSE also motivated proper knowledge of BSE.
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Diagnosis of central diabetes insipidus (CDI) requires a high index of clinical suspicion, especially when it manifests as a coexisting condition like traumatic brain injury or following neurosurgery. We would like to report a rare case of necrotizing infundibulohypophysitis (NIH) as a cause of CDI in a 21-year-young male who presented with a severe progressive headache not responding to routine analgesics followed by vomiting, altered sensorium. His baseline blood investigations were normal including his cerebrospinal fluid examination, plain and contrast magnetic resonance imaging (MRI) scan. The patient partially responded to the treatment of headache and after 2 days, complained of polyuria with severely reduced serum sodium level. A repeat plain and MRI of the brain was done which showed classical findings of NIH with CDI which we discuss along with the differential diagnosis and its prognosis
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Background: Tacrolimus (Tac) a calcineurin inhibitor (CNI), is a potent immunosuppressive drug which is widely used in organ transplant recipients. The drug has a narrow therapeutic window and high inter-individual pharmacokinetic variability. Tac is metabolized by cytochrome P450 3A (CYP3A) enzymes. The CYP3A5 activity is largely determined by the single nucleotide variant (SNV) CYP3A5*3 (c.219-237A>G; rs776746), which results in alternate mRNA splicing and a non-functional protein.Methods: An observational prospective study was carried out at nephrology centre of army hospital where the consenting patients were enrolled in the study. The whole blood sample drawn was utilized to analyze for plasma drug concentration of Tac and genotyping for the CYP3A*5 polymorphism by the method as described by Cheung et al.Results: 100 patients participated with an average of 98±8 days after transplantation. Recipients having heterozygous CYP3A5*1 genotype manifested 70% lower mean steady state concentration of Tac (C0/D ratio) 1.67±0.43 ?g*l-1/mg in comparison to homozygote carriers of CYP3A5*3 5.60±1.94 ?g*l-1/mg p<0.001.Conclusions: Study suggested that Indian sub population closely mimics Caucasian population in terms of genotype expression for CYP3A5*3, who are expressing a non-functional enzyme for metabolism. Also, this study reinforces that population genotype CYP3A5*1 is significantly associated with lower C0/D ratio for Tac than the ones expressing homozygous CYP3A5*3 genotype. It also established the importance of pre-transplant genotyping, for better individualization of Tac doses. Further studies are suggested for population pharmacokinetic modelling study in future to derive starting dosage of Tac based on profiling of CYP3 genetics in recipients.
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The present study compares the effects of dexmedetomidine and esmolol on cardiovascular responseoccurring due to laryngoscopy and endotracheal intubation. A randomised controlled study was carried outon 90 healthy adult patients (ASA I and ASA II) under general anaesthesia. Patients were randomlyallocated into two groups i.e group E and group D. Group D received dexmedetomidine 0.6 µg/kg andgroup E received esmolol 1 mg/kg. Heart rate, systolic blood pressure and diastolic blood pressure wererecorded at baseline, at induction and at 1, 3, 5 and 10 minutes after intubation. This study showed thatdexmedetomidine (0.6 µg/kg) was more effective than esmolol (1mg/kg) for attenuating the cardiovascularresponse to laryngoscopy and intubation
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Introduction: Diabetes Mellitus is one of the most commonendocrinal diseases in the world. Incidences of this disease areincreasing worldwide and this disease is called disease of thismillennium. This study was undertaken to correlate fastingblood sugar level, Glycosylated haemoglobin (HbA1C) leveland serum lipid levels in patients with diabetes mellitus.Material and Methods: This study was a cross sectionalstudy conducted on 100 patients of diabetes mellitus came toM.B Govt. Hospital, Udaipur. The fasting blood sugar (FBS)levels, HbA1C levels and serum lipid levels were performedand then correlated fasting blood sugar level with HbA1Clevels and FBS and HbA1C with serum lipid levels. There wasa significant positive correlation between FBS and HbA1C,and FBS and HbA1C with serum cholesterol and serumtriglycerides level and negative correlation with serum HDLcholesterol levels.Results: This study demonstrated that HbA1C level wasincreased in diabetics and it showed correlation with the statusof control of diabetes.Conclusion: Diabetics have got increased level of serumcholesterol, triglycerides and decreased levels of serumHDL-cholesterol. HbA1C showed stronger correlation withserum cholesterol and triglycerides as compared to FBS.HDL-cholesterol showed stronger correlation with FBS thanHbA1C.
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Corneal ulcers in dogs usually have a traumatic origin. They cause a break in the continuity of underlying corneal stroma and become rapidly contaminated with bacteria. Twenty eight clinical samples were obtained from corneal ulcer affected dogs for bacterial isolation and anti-microbial susceptibility. Bacterial growth was observed in 100% of the samples (n=28) and Staphylococcus spp. was isolated and characterized by culture, gram staining and various biochemical tests. Antibiogram pattern revealed that gatifloxacin and moxifloxacin antibiotics were found to be highly effective in the treatment of corneal ulcers in dogs. Corneal culture and sensitivity testing provided useful information for the diagnosis, determination of appropriate treatment and antimicrobial therapy for corneal diseases in dogs
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Background: Kasni (Cichorium intybus L.) reported to play an important role in the effective management of serum liver enzymes SGPT & SGOT in various animal models and this study is extension to newly diagnosed patients of type 2 diabetes mellitus. Methods: Newly diagnosed 90 patients of Type2 DM, age 35-65years, of either sex were divided into 3 groups. In group I only Metformin sustained release once a day and in group II/III 6 grams crude seed powder or 50 ml decoction of crude seed powder was given twice a day for 90 days in combination with Metformin sustained release orally once in a day. Serum liver enzyme levels of SGPT & SGOT were measured at zero, 30th, 60th and 90th day. Results: All the three groups showed a significant reduction in SGPT & SGOT across the four time periods. Post hoc Tukey HSD test shown that there was a significant difference between group I & II (p=0.011) and group I & III (p=0.000) for SGPT and group I & II (p=0.012) and group I & III (p=0.000) for SGOT. Conclusions: The add on therapy with Kasni seed preparations is more effective for the management of altered SGPT and SGOT levels in Type2 diabetes mellitus patients than only oral hypoglycaemic agent in decreasing SGPT & SGOT of selected patients. Among Kasni seed preparation treated groups, decoction was found more effective than crude seed powder.
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A selective and rapid high-performance liquid chromatography–tandem mass spectrometry method was developed and validated for the quantification of raltegravir using raltegravir-d3 as an internal standard (IS). The analyte and IS were extracted with methylene chloride and n-hexane solvent mixture from 100 mL human plasma. The chromatographic separation was achieved on a Chromolith RP-18e endcapped C18 (100 mm ? 4.6 mm) column in a run time of 2.0 min. Quantitation was performed in the negative ionization mode using the transitions of m/z 443.1-316.1 for raltegravir and m/z 446.1-319.0 for IS. The linearity of the method was established in the concentration range of 2.0–6000 ng/mL. The mean extraction recovery for raltegravir and IS was 92.6% and 91.8%, respectively, and the IS-normalized matrix factors for raltegravir ranged from 0.992 to 0.999. The application of this method was demonstrated by a bioequivalence study on 18 healthy subjects.
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Background: In 1996, WHO recognized the need to develop and use the anatomical therapeutic chemical (ATC) and defined daily dose (DDD) as an international standard for utilization studies wherein it appointed experts in clinical pharmacology, drug utilization, drug regulation, drug evaluation, statistics, and medicine to monitor drug utilization on a standard and uniform pattern around the world. Methods: All the prescriptions presented to main dispensary of the hospital from January-December 2013 in mid-month period of 10 days were taken for the analysis in terms of pharmacovigilance, polypharmacy, drug usage group wise, pharmacoeconomics, and drug utilization in DDD/1000/day along with ATC classification using customized software. Results: 35,808 prescription forms containing 121,303 drugs were presented to main dispensary of the hospital across which medicines were dispensed. Polypharmacy was calculated to be 3.27±0.44 standard deviation. Approximately, 60% of total prescription forms analyzed were lacking essential and basic such information as age, gender, or diagnosis. Pharmacoeconomics of this study indicates that a major budget was mainly spent on drug groups belonging to - metabolic, antibiotics, hormones, and related drugs. A voluminous consumption of drugs belonged to drug groups - metabolic drugs like statins, hormones, and related drugs such as various oral hypoglycemics, anti-hypertensives, psychotropics, and proton pump inhibitors or H2 blockers, all indicative toward stressful and sedentary lifestyle of modern era and unhealthy lifestyles, a trend of increasing morbidity and mortality, reducing significantly the productive man-hours. Conclusions: This study was undertaken in a government tertiary care hospital which gives insight into the day to day functioning status of our health care delivery system. It is an opportunity on self-assessment in further improving the health care delivery by implementing measures which economizes on scarce health care budget as well as minimizing the common prescription errors.
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Background: The management of ventricular electrical storm can prove to be a challenge for the clinician given its complexity and life threatening consequences. Case characteristics: 8-year-old boy with repeated life-threatening polymorphic ventricular tachycardia following aortic valve replacement surgery. Intervention: Defibrillated 45 times in addition to multiple antiarrhythmic drugs. Outcome: Conversion to stable sinus rhythm with normal neurological outcome. Message: Electric storm can be controlled by combination of multiple intravenous antiarrhythmic drugs.
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Seizure is the most common and serious neurological emergency seen in clinical practice. A detailed evaluation of every patient with first onset seizure is mandatory to determine seizure type, precipitating events, underlying etiology. There is no reliable diagnostic test and so its diagnosis and management requires clinical acumen and experience If the event is an epileptic seizure, the seizure type and associated clinical, electroencephalographic (EEG) and neuroimaging findings assist in determining the risk of seizure recurrence and the possible need to begin anticonvulsant therapy.
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Granulocytic sarcoma (GS) usually presents concomitantly with or after the onset of acute myeloid leukemia, blastic phase of chronic myeloid leukemia (CML), or myelodysplastic syndromes. Rarely, it may present even before the onset of overt leukemia and when so, it is often misdiagnosed. We are reporting a case of GS of kidney presenting as an isolated renal mass with normal laboratory investigations including a normal peripheral blood smear. It was initially misdiagnosed as lymphoma as the blasts, in addition to the morphological similarity with lymphoma cells, also showed positive immunohistochemistry for B cell markers. Based on further investigations including immunophenotyping and cytogenetic studies, a final diagnosis of CML-blast crisis (mixed phenotype) presenting initially as GS was made. To the best of our knowledge, this is the first antemortem report of nonleukemic GS presenting as kidney mass that later on progressed to CML-blast crisis with mixed phenotype blasts.
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Facioscapulo humeral muscular dystrophy (FSHD) is a rare type of myopathy and differs clinically and genetically from Duchenne muscular dystrophy. It is an autosomal dominant disorder and as the name designates it has the characteristic distribution of the weakness. The face is almost always affected. Progression of the disease is slow and symptoms begin in adolescence but signs may be evident in children. We present a case of facioscapulo humeral muscular dystrophy in a 14 year old girl & the case was sporadic in nature.
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Direct laryngoscopy and endotracheal intubation frequently induces a cardiovascular stress response due to reflex symbathetic stimulation. This response may be hazardous in patients with Hypertension, Coronary artery disease, Myocardial disease, cerebrovascular disease. Numerous agents have therefore been utilized to blunt this response. The present study was undertaken in view of above mentioned facts, to compare effectiveness of intravenous esmolol and lignocaine in suppressing the cardiovascular stress response. Patients were divided in to three groups of 20 patients each. Group-C did not receive any drug under study. Group-L received lignocaine and Group-E received esmolol three minutes before intubation. All the groups were observed for changes in haemodynamic parameters i.e. heart rate (HR) systolic and diastolic blood pressure every minute after intubation till 5 minutes post intubation. It was found that patients given esmolol had better attenuation of stress response to laryngoscopy and intubation than patients given lignocaine.
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Tuberculosis rarely involves wrist joint and is usually diagnosed in arthritic stage. Early presentations are easily confused with traumatic event and commonly missed. We describe a case presenting with scapholunate dissociation initially, which later progressed to full blown arthritis. Similar presentation has never been documented.