Standardisation of Various Processes in the Preparation of Kousheyashma Bhasma Accounting its Clinical Utility

Asbestos, one among the inosilicate group of minerals is listed under the Sikatha varga (Silicate compounds) in the Rasasastra treatises, in the name, Kousheyashma. Though the asbestos is vastly used for commercial purposes, it is not found to be used in clinical practices owing to its toxicity. But in Ayurveda, Acharyas have opined that by the judicious usage, even the poison can be bestowed medicinal value. And hence, after undergoing appropriate pharmaceutical processes as mentioned in the treatises, Kousheyashma can be effectively administered in Bhasma (after incineration) form in the treatment of various ailments like leucorrhoea, painful micturition, inflammation of urinary tract, menorrhagia. In this work, an attempt is made to expose the hidden medicinal values of asbestos by converting it into Bhasma form. Kousheyashma is a very cost effective and potent medicine which could be effectively used by Ayurvedic practitioners. In the present work, conversion of raw Kousheyashma into medicinal Bhasma form is discussed elaborately. The processes involved includes Sodhana and Marana of Kousheyashma. The liquid media used for the purpose of Sodhana was Gomutra and for Marana purpose, Harithamanjari swarasa was used. Three Putas were required to obtain Kousheyashma bhasma which satisfied the Bhasma pareekshas.

Idiopathic abdominal cocoon: An enigma

Abdominal cocoon is often described by various terminologies like encapsulating peritoneal sclerosis (EPS) or sclerosing encapsulating peritonitis or peritonitis chronica fibrosa incapsulata is defined as syndromes associated with symptoms due to formation of a fibro-collagenous peritoneal membrane involving commonly the small intestinal loop. Clinical presentation ranges from abdominal pain to features of intestinal obstruction which may be acute or sub-acute. It is believed to be mesenchymal transition of mesothelial cells. This condition is commonly associated with tuberculosis, peritoneal dialysis and previous abdominal surgeries but may also be idiopathic. Though a wide range of medical management has been tried for conservative management of the patient, surgery is the preferred choice of treatment to alleviate the persisting symptoms. This is one condition where on table intra op diagnosis supersedes the imaging and histological diagnosis. Here, we discuss the case report of 32 year old male, known diabetic for 4 years, who presented with complaints of abdominal pain, intermittent for over 5 years, with no evidence of intestinal obstruction. Imaging showed abdominal cocoon of small bowel loops and mid gut rotation anomaly with internal hernia. Laparoscopically the cocoon sac was removed and adhesiolysis was done. This case report is to add richness to limited amount literary resources available about abdominal cocoon syndrome.

Clinical characteristics and prognostic analysis of triple-negative breast cancer: single institute experience

Background: Triple-negative breast cancer [TNBC] is a poor prognostic subset of breast cancer that lacks the benefit of specific targeted therapy

Materials and Methods: A prospective study of the clinical profile of triple negative breast cancer cases at a tertiary referral centre. The duration of the study period was 26 months and the median follow up period was ten months. A total of 111 invasive breast cancer patients were evaluated from 1st August 2009 to 31st October 2011. We examined TNBC patients with respect to clinicopathological parameters, adjuvant chemotherapy regimens and relapse free survival

Results: In our study, patients were young [median age at presentation, 47 yrs], premenopausal [54%], tumour size was discordant with lymph node positivity, the histology was predominantly intraductal carcinoma [90%], histological grade higher than two [90%]. Relapses were early and preferential visceral [32%] and CNS metastasises [11.7%]. 91% of patients were eligible for adjuvant therapy but only 80% of the patients could complete full course of adjuvant chemotherapy. Anthracycline-based regimens [43%], sequential anthracycline and taxane-based regimen [24%] and other regimes like CMF [13%] were used as adjuvant chemotherapy in eligible TNBC patients. Median relapse free survival in patients following adjuvant chemotherapy was around 10 months at last follow-up

Conclusions: Patients with TNBC have aggressive clinicopathological characteristics with early and higher rate of disease relapse and therefore derive inadequate benefit from current adjuvant chemotherapy. So, new treatment strategies in adjuvant chemotherapy for TNBC are needed

Platinum-based chemotherapy in metastatic triple negative breast cancer: experience of a tertiary referral centre in India

Experimental data suggest that triple-negative breast cancer [TNBC] may have increased sensitivity to platinum-based chemotherapy but there is lack of relevant clinical data. Clinical outcomes in patients with metastatic TNBC treated with Platinum-based chemotherapy were evaluated in this prospective study. 21 selected patients with metastatic TNBC presenting at GCRI during the study period from 1[st] August 2009 to 31[st] October 2011 formed the study group with median follow up period of 10 months. They were given palliative chemotherapy based upon prior adjuvant chemotherapy along with an additional platinum compound. Response rates, response duration and toxicities of platinum-based chemotherapy were recorded and analyzed. In evaluable TNBC patients, overall response rate and complete clinical response were 72% and 38% with median response duration of four months. Response could not be assessed in three patients due to patient refusal for evaluation, lost to follow up and toxicities. In three TNBC patients after completion of platinum based chemotherapy have early isolated CNS relapse with systemic disease in remission. Haematological adverse effects were febrile neutropenia in 19% of patients, and grade 3-4 neutropenia [9%] thrombocytopenia and anaemia [7%]. The main non-hematological adverse effects reported in the present study were peripheral neuropathy [14%] and severe emesis [9%]. The most common Platinum-based chemotherapy combination was carboplatin and paclitaxel in 11 patients [52%] of evaluable patients. Patients who received this regime have complete response rate, overall response rate and toxicity was 45%, 65% and 10%. TNBC patients with platinum-based chemotherapy have better overall response rates, higher complete clinical response rates, prolonged response duration and acceptable safety profile. The results of the present study need to be confirmed with a larger randomized study with a longer follow up

Atypical Presentation of Multiorgan Failure Leptospirosis (Weil’s Disease) without Fever.

Leptospirosis is a zoonotic disease of sporadic occurrence caused by bacteria that belongs to the genus Leptospira. Here we report a case of rare form of leptospirosis with multiorgan failure called Weil’s disease. This patient did not have a fever which is the most common presentation of leptospirosis.

Biological evaluation of [3[beta]-STIGMAST-5-EN-3-OL as potent anti-diabetic agent in regulating glucose transport using in vitro model

Insulin resistance is characterized by alterations in insulin signaling components thereby resulting in reduced glucose uptake. The mechanistic role of [3beta]-stigmast-5-en-3-ol in augmenting glucose uptake to overcome insulin resistance is deciphered in this study. 16 myotubes, rat skeletal muscle model have been used to check the effect of [3beta]-stig-mast-5-en-3-ol, a plant phytosterol isolated from the ethyl acetate extract of Adathoda vasica on glucose transport. The influence of [3beta]-stigmast-5-en-3-ol on various cellular targets of insulin signaling cascade has been evaluated using inhibitors on glucose uptake as well as gene and protein expression to unravel the mechanistic action in triggering glucose uptake. [3beta]-stigmast-5-en-3-ol promoted glucose uptake in a dose dependent manner under insulin resistant condition. As assessed by inhibitor studies using Genistein [IRTK inhibitor] and Wortmannin [PI3K inhibitor], gene expression and protein expression studies using specific primers and antibodies, an activation of IR-[3, IRS-1, PI3K, AKT/PKB, PKC by both the crude and [3beta] stigmast-5-en-3-ol were observed. This suggested that [3beta]-stigmast-5-en-3-ol induced glucose uptake functions through the PI3K dependent pathway in L6 myotubes. Both, the crude and [3beta]-stigmast-5-en-3-ol activates GLUT 4 transport [evident from increased mRNA levels and redistribution of GLUT4 from intracellular membrane to plasma membrane through translocation studies]. Confocal microscopy revealed a substantial increase in redistribution of FITC tagged GLUT4 throughout the cells. Our results emphasize the insulin-like effect of [3beta]-stigmast-5-en-3-ol in stimulating glucose transport in vitro and provide evidence in its beneficial role possessing antidiabetic property apart from its existing cholesterol lowering efficacy

In vitro safety evaluation and anticlastogenic effect of BacoMind on human lymphocytes / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>BacoMind (BM) is a standardized extract of Bacopa monnieri, which belongs to the family Scrophulariaceae and is a creeping annual plant found throughout the Indian subcontinent. It has been used by Ayurvedic medicinal practitioners in India for almost 3000 years and is classified as a medharasayana, a substance which improves memory and intellect. With the widespread traditional use as well as scientific validation of Bacopa monnieri for nootropic activity, a bioactive-rich unique phytochemical composition-BacoMind was developed from B. monnieri for use as a cognition and memory enhancing agent. The present study aimed to investigate the in vitro toxicity of this formulation of BacoMind on human lymphocytes and to rule out its possible contribution to mutagenicity.</p><p><b>METHODS</b>In the present investigation the active ingredients present in BM were identified and quantified by high performance liquid chromatography (HPLC) and high performance thin-layer chromatography (HPTLC). Antioxidant and anticlastogenic properties of BM were studied in vitro with and without metabolic activation. Doses of BM were chosen on the basis of mitotic index (MI) and cytokinesis-block proliferation index (CBPI). Clastogenicity assays were performed at 31.2 microg/mL, 62.5 microg/mL, and 125 microg/mL, while the Salmonella reverse mutation assay (Ames test) was performed at doses of 61.72, 185.18, 555.55, 1666.67, and 5000.00 microg/plate.</p><p><b>RESULTS</b>HPLC and HPTLC analysis of BM revealed the presence of bacoside A3, bacopaside I, bacopaside II, jujubogenin isomer of bacopasaponin C, bacosine, luteolin, apigenin, bacosine, and beta-sitosterol D glucoside. BM demonstrated significant antioxidant activity. The number of chromosomal aberrations and the frequency of micronuclei induced by BM were not statistically significant up to a dose of 62.5 microg/mL. A subsequent dose of 125 microg/mL prior to metabolic activation induced mild clastogenicity, but it was found to be biologically insignificant as this effect was not seen post metabolic activation. BM also demonstrated a dose-dependent protection against the clastogens used in this study using the above tests for clastogenicity. Maximum protection was observed in presence of metabolic activation. Moreover, BM demonstrated no mutagenic effect on the tested strains, as observed in the Ames test.</p><p><b>CONCLUSION</b>BM protected human lymphocytes against various clastogens. BM also exhibited high antioxidant activity which might be responsible for the observed protective effects against the clastogens since the used clastogens are known to induce their clastogenic effects via production of oxidative radicals.</p>

Sporadic paroxysmal non-kinesigenic dyskinesia: a frequently-misdiagnosed movement disorder

Paroxysmal non-kinesigenic dyskinesia is a very rare movement disorder. Few cases have been reported in the literature so far. We present a 40-year-old man with non-kinesigenic paroxysmal dyskinesia, which was initially diagnosed as a psychogenic disorder. This case highlights the varied presentation of this condition and an excellent response to clonazepam.