Evaluation of Punarnavadi Mandura for haematinic activity against mercuric chloride-induced anemia in albino rats.

Background: Punarnavadi Mandura, a compound Ayurvedic formulation, is one of the most commonly used medicine in the treatment of anemia (Pandu) in Ayurveda. The safety profile of this formulation is well established; however, no pharmacological study has been reported to provide the scientific basis for its use in the treatment of anemia. Aim: To evaluate the hematinic effect of Punarnavadi Mandura against mercuric chloride-induced anemia in albino rats. Materials and methods: The test drug (Punarnavadi Mandura) was suspended in distilled water and administered orally in a dose of 450 mg/kg for 30 days in rats. Anemia was induced by simultaneous administration of mercuric chloride (9 mg/kg) for 30 consecutive days. Body weight was noted for each animals. At the end, haematological parameters, anaemia markers like serum iron, ferritin, and total iron binding capacity (TIBC), as well as relative weight of organs and histopathology investigation, were examined. Results: Exposure of mercuric chloride to rats for 30 days resulted in a significant decrease of body weight, an increase in the weight of the liver and kidney and a decrease in hemoglobin content. It also decreased serum ferritin to a significant extent and increased serum TIBC. Histopathology of the liver shows macro fatty changes, vacuolization, marked necrosis, and severe degenerative changes, while the kidney shows cell infiltration. All these changes were significantly attenuated by the administration of Punarnavadi Mandura. Conclusion: The present data indicate that Punarnavadi Mandura has possessing marked cytoprotective activity, significantly attenuated the HgCl2-induced adverse changes on red blood cell related parameters, and showing hematinic activity in albino rats.

Efficacy of Pandughni Vati & Punarnavadi Mandura Vati in the managment of Pandu w.s.r. iron deficiency anemia in children- An open labelled comparative clinical trial.

Background: Anemia is a public health problem worldwide, and its prevalence in India is higher than any other south asian countries. Iron deficiency anemia (IDA) is having larger share out of all types of anaemia's. Symptomatology of IDA resembles with Kapha dominant variety of Pandu. Pandughni Vati (PV) and Punarnavadi Mandura (PM) Vati mentioned in Ayurveda are being used in clinical practice since long. Aim: To assess the efficacy of Pandughni Vati and compare its clinical efficacy with Punarnavadi Mandura Vati in the management of Pandu ws.r. iron deficiency anemia in children. Materials and methods: Present clinical study was a randomized trial for management of iron deficiency anemia aged 2-16 years. Out of total 91 patients enrolled, 60 completed the study and divided into two groups. In group A, Pandughni Vati (trial drug) and in group B, Punarnavadi Mandura Vati in the management of Pandu ws.r. iron deficiency anemia in children. (standard drug) were given to 30-30 patients respectively for a duration of 90 days in age specific doses. Patients were assessed by clinical signs and symptoms of Pandu and investigation parameters like complete blood count, serum iron, serum ferritin and total iron binding capacity (TIBC) on baseline and after 90 days of treatment. Statistical analysis was carried out by Sigma Stat software. Results: On comparison, highly significant difference was found between two groups in subjective parameters such as Panduta (pallor), Daurbalya (weakness), Hriddrava (palpitation), Akshikuta Shotha (periorbital oedema), Pindikodweshtana (leg cramps) and Shwasa (breathlessness) whereas objective and saturation percentage except serum ferritin. Conclusion: The study revealed that, both the drugs; Pandughni Vati and Punarnavadi Mandura Vati were equally effective in the management of IDA so, it could be concluded that Pandughni Vati, can be used as mineral-free, safe, easily obtainable, palatable, cost-effective alternative drug of choice in alternative of Punarnavadi Mandura in iron deficiency anemia in children.

Risk factors associated with Clostridium difficile infection in kidney transplant recipients.

BACKGROUND: Solid organ transplant recipients are especially vulnerable to Clostridium difficile infection (CDI) due to cumulative risk factors including increased exposure to healthcare settings, persistent immunosuppression, and higher rates of antimicrobial exposure. We aimed to identify risk factors associated with CDI development in kidney transplant recipients including implications of immunosuppressive therapies and acid-suppressing agents. METHODS: This was a single-center, non-interventional, retrospective case-control study of adult subjects between June 1, 2009 and June 30, 2013. During this time, 728 patients underwent kidney transplantation. Overall, 22 developed CDI (cases) and were matched 1:3 with 66 controls. Cases and controls were also matched for induction agent, kidney allograft type (living or deceased), and time from transplant to CDI result (±60 days). RESULTS: The majority of subjects received a deceased donor kidney (77.3%) and basiliximab induction therapy (86.4%). The overall CDI incidence was 3%. Factors independently associated with CDI were average tacrolimus trough (AOR = 1.25, 95% CI = 1.00-1.56, P = .048) and antibiotic exposure for urinary tract infections (UTI) (AOR = 4.17, 95% CI = 1.12-15.54, P = .034). Proton pump inhibitor use was not associated with CDI (OR = 0.81, 95% CI = 0.29-2.29, P = .691). CONCLUSION: Maintaining a clinically appropriate tacrolimus trough and judicious antibiotic use and selection for UTI treatment could potentially reduce CDI in the kidney transplant population.

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.

Cardiac amyloidosis: where are we today?

Systemic amyloidosis is generally considered to be rare, but the heart is frequently involved and is a major determinant of prognosis. New diagnostic imaging methods have recently been developed with the capacity to enhance the accuracy of diagnosis, which will be ever more important with the variety of new treatments on the near horizon. Most cases of cardiac amyloidosis are of either monoclonal immunoglobulin light chain (AL) type, which can occur at any age from young adulthood onwards, or transthyretin (ATTR) type, which can be acquired in elderly individuals or inherited at a younger age. Cardiac involvement is the most serious manifestation of AL amyloidosis, and serum cardiac biomarkers have proved to be of great value in staging disease severity and response to an ever increasing array of chemotherapy agents. Cardiac involvement is the dominant manifestation of nonhereditary ATTR amyloidosis, also known as senile cardiac amyloidosis, the prevalence of which is not known but is probably much greater than currently recognized. A genetic variant in the gene for transthyretin (TTR), which is present in 3-4% of African Americans and probably a similar proportion of black individuals of African descent generally, appears to be associated with increased susceptibility to developing cardiac ATTR amyloidosis in older age. Several novel therapies are in the advanced stages of development for ATTR amyloidosis including TTR protein stabilizers and RNA inhibitors that greatly diminish TTR production. Here, we will review recent developments in the diagnosis and management of cardiac amyloidosis.

Iterative probabilistic voxel labeling: automated segmentation for analysis of The Cancer Imaging Archive glioblastoma images.

BACKGROUND AND PURPOSE: Robust, automated segmentation algorithms are required for quantitative analysis of large imaging datasets. We developed an automated method that identifies and labels brain tumor-associated pathology by using an iterative probabilistic voxel labeling using k-nearest neighbor and Gaussian mixture model classification. Our purpose was to develop a segmentation method which could be applied to a variety of imaging from The Cancer Imaging Archive. MATERIALS AND METHODS: Images from 2 sets of 15 randomly selected subjects with glioblastoma from The Cancer Imaging Archive were processed by using the automated algorithm. The algorithm-defined tumor volumes were compared with those segmented by trained operators by using the Dice similarity coefficient. RESULTS: Compared with operator volumes, algorithm-generated segmentations yielded mean Dice similarities of 0.92 ± 0.03 for contrast-enhancing volumes and 0.84 ± 0.09 for FLAIR hyperintensity volumes. These values compared favorably with the means of Dice similarity coefficients between the operator-defined segmentations: 0.92 ± 0.03 for contrast-enhancing volumes and 0.92 ± 0.05 for FLAIR hyperintensity volumes. Robust segmentations can be achieved when only postcontrast T1WI and FLAIR images are available. CONCLUSIONS: Iterative probabilistic voxel labeling defined tumor volumes that were highly consistent with operator-defined volumes. Application of this algorithm could facilitate quantitative assessment of neuroimaging from patients with glioblastoma for both research and clinical indications.

A comparative study on efficacy of Bharangyadi Avaleha and Vasa Avaleha in the management of Tamaka Shwasa with reference to childhood asthma.

Ayurvedic concept is of the opinion that Tamaka Shwasa (Bronchial Asthma) is a Yapya Vyadhi. The etiopathogenesis, signs, and symptoms of Tamaka Shwasa may be correlated with Bronchial Asthma. Each child reacts differently to the factors that trigger asthma and treated symptomatically. Asthma is the most common chronic allergic disorder in childhood and third leading cause of hospitalization under the age of 15 years. As it is a Kapha-Vata predominant disorder, Ayurvedic medicine may help to decrease the recurrence, improve immunity, and check symptoms naturally. With this aim, a clinical study was undertaken on two groups for duration of 6 weeks. The drugs Bharangyadi Avaleha and Vasa Avaleha were given orally, separately in both the groups. All the patients were kept under strict dietary control during the treatment. The observation on effect of therapy was encouraging and showed less recurrence.

A clinical study of Devadarvyadi-Vati on Grahani Dosha in children.

Childhood period is considered as the period of rapid growth and development, as it is the crucial stage of establishing future. Gastro-intestinal disorders show high prevalence in pediatric practice. These conditions generally produce chronic illness. Grahanidosha is a disease related with Agnidushti. This condition is seen more in childhood period due to faulty dietary habit and changing lifestyle. The present paper deals with study on etiopathogenesis of Grahanidosha and evaluates the efficacy of Deavadarvyadi-Vati. The etiological factors and symptoms were observed carefully to make clear etiopathogenesis. Total 32 patients (3-12 years) were registered and randomly divided into two groups. In Group A Devadarvyadi-Vati (treated group) and in Group B Bhunimbadi-Vati (control group) given for 4 weeks with Koshna Jala. In Group A (Devadarvyadi-Vati), marked improvement was observed in 21.43% of the patients, moderate improvement was observed in 57.14% of patients and mild improvement was observed in 21.43% of patients.

Evaluation of Dhatri Avaleha as adjuvant therapy in Thalassemia (Anukta Vyadhi in Ayurveda).

Thalassemia is the commonest single gene disorder in India. About 10,000 infants with Thalassemia major are born every year. The present study was under taken with a hope to prevail better quality of life to the Thalassemic patients. Pallor being the chief complaint, a randomized controlled trial was undertaken with Dhatri Avaleha as it is specially mentioned for Pandu, Kamala & Haleemaka Roga. Children between age group of 1 to 15 years were randomly divided in two groups: Drug treated group (Group A) and Control group (Group B). Assessment was done on subjective and objective parameters after 30 and 60 days of treatment with follow up of two month. Statistically significant (P<0.01) result was obtained in Blood transfusion interval in group 'A' in comparison to group 'B'. Dhatri Avaleha may have a potential to increase blood transfusion interval and decrease secondary infection and thus it can be used as supportive therapy with modern medical management.

Effect of Triphaladi Avaleha as an adjuvant therapy in the management of Thalassemia.

Thalassemia is the most common inherited single-gene (autosomal recessive) disorder in the world. Scientists worldwide predict that thalassemia will become a considerable health issue in the next century. It is a new disease entity for Ayurvedic medicine, and hence, it is called Anukta Vyadhi in Ayurveda; but we can understand it by careful scrutiny of the clinical presentation and the investigation results described in the available literature. Modern medical management is aimed at maintaining the hemoglobin level at 10 - 12 g/dl. A post-transfusion hemoglobin level of 9.5 g/dl is said to be sufficient to maintain active life. Thus, blood transfusion therapy is the only treatment, but it can result in hemosiderosis (iron overload), a complication with a fatal outcome. The transfusional iron overload is compounded by increased intestinal absorption of iron. The most important factors associated with survival, and also those deciding the outcome of bone marrow transplant (the only curative therapy) are, age at which chelation therapy is introduced and the success with which serum ferritin is maintained below 2500 ng/ml. Iron chelators used in modern medicine to achieve this goal are expensive and associated with side effects, and hence, associated with poor adherence to the treatment. The present study is an endeavor to explore the efficacy of Triphaladi Avaleha as an iron chelator in the management of thalassemia, in comparison to a control group managed by routine modern therapy.

A survey of lead pollution in Chhattisgarh State, central India.

Lead (Pb) is of major environmental concern due to its toxicological importance. The anthropogenic emission of Pb is at least 100 times higher than natural emissions. Soil and dust are significant sources of Pb exposure. Lead is generally immobile in soil and accumulates in the upper layers. Lead particles may enter homes via shoes, clothes, pets, and windows. Central India is rich in deposits of natural resource materials such as coal, pyrite, dolomite, and alumina that contain Pb and other heavy metals at the trace levels, and the substantial exploitation of these materials has tended to increased contamination of water and geological formations. Here we present data on Pb concentrations in the water, soil and sediment samples (n=158) collected from 70 locations in Chhattisgarh state, Raipur region. Lead concentrations in the surface water (n=44), groundwater (n=44), soils (n=60) and sediments (n=10) ranged from 6 to 1410, 3 to 52, 12.8 to 545, and 31 to 423 microg g(-1), with mean values of 305, 16, 102 and 190 microg g(-1), respectively. Most of the Pb fractions of >80% can be leached out with the chemical extractants EDTA, acetic acid, and hydroxylamine hydrochloride. Lead has accumulated in the soil clay fraction due to its relatively large surface area and decreases with increasing depth in the soil profile.

Arsenic contamination in water, soil, sediment and rice of central India.

Arsenic contamination in the environment (i.e. surface, well and tube-well water, soil, sediment and rice samples) of central India (i.e. Ambagarh Chauki, Chhattisgarh) is reported. The concentration of the total arsenic in the samples i.e. water (n = 64), soil (n = 30), sediment (n = 27) and rice grain (n = 10) were ranged from 15 to 825 microg L(-1), 9 to 390 mg kg(-1), 19 to 489 mg kg(-1) and 0.018 to 0.446 mg kg(-1), respectively. In all type of waters, the arsenic levels exceeded the permissible limit, 10 microg L(-1). The most toxic and mobile inorganic species i.e. As(III) and As(V) are predominantly present in water of this region. The soils have relatively higher contents of arsenic and other elements i.e. Mg, Al, Si, K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Ga, Zr, Sn, Sb, Pb and U. The mean arsenic contents in soil of this region are much higher than in arsenic soil of West Bengal and Bangladesh. The lowest level of arsenic in the soil of this region is 3.7 mg kg(-1) with median value of 9.5 mg kg(-1). The arsenic contents in the sediments are at least 2-folds higher than in the soil. The sources of arsenic contamination in the soil of this region are expected from the rock weathering as well as the atmospheric deposition. The environmental samples i.e. water, soil dust, food, etc. are expected the major exposure for the arsenic contamination. The most of people living in this region are suffering with arsenic borne diseases (i.e. melanosis, keratosis, skin cancer, etc.).

A new spectrophotometric method for the determination of total and ferric iron in rain water at the ppb level.

A new, simple, selective and sensitive spectrophotometric procedure for the on-site quantification of iron at nano-gram levels in atmospheric precipitations, i.e. rain as sample source is described. It is based on the color reaction of Fe3+ with SCN- ions in the presence of a cationic surfactant, i.e. cetylpyridinium chloride (CPC), in strong HCl solution, and subsequent extraction of the complex with N-octylacetamide into toluene or chloroform. The apparent molar absorptivity of the complex is 2.60 x 10(5) L mol(-1) cm(-1) at lambdamax = 480 nm at an enrichment factor (EF) of 10. The detection limit (causing higher absorbance than the sum of the blank absorbance (0.009) and 3 SD) is 5 ng mL(-1) Fe. Ions commonly associated with iron did not interfere in the present method. The effect of analytical variables, i.e. amount and type of the reagents, acidity, solvent, temperature, dilution, etc., in the determination of iron are discussed. The validity of the present method is checked with GF-AAS. The method has been applied to the determination of iron at the ppb level in rain water samples.

Visible spectrophotometric determination of tantalum in soil, sediment, minerals, and alloys.

A new, sensitive, and selective method is described for the spectrophotometric determination of Ta(V). The method is based on the extraction of the Ta(V)-F-CV+ complex (CV+ = crystal violet cation) with a benzene solution of imidoyl derivatives (ID), i.e., N,N'-diphenylbenzamidine (DPBA), N-hydroxy-N,N'-diphenylbenzamidine, and N-(2,5-dimethyl)phenyl-p-tolylimidoylphenylhydrazine, from sulfuric acid solution; DPBA was selected for detailed study. The molar absorptivities of the Ta(V)-F-CV+-ID complexes in the benzene solution were in the range of (1.00-1.65) x 10(5) L/mol x cm at 600 nm. The limit of detection was 7 ng Ta/mL (which had an absorbance greater than that of the blank + 3 standard deviations). The optimization of the analytical variables, the composition of the complex, and the effect of diverse ions in the determination of Ta are discussed. The present method was applied to the determination of Ta in environmental samples, i.e., soil, sediment, minerals, and alloys.

Mean nuclear area of squamous cell carcinomas of the head and neck using image cytometry.

OBJECTIVE: To determine if mean nuclear area (MNA) in squamous cell carcinomas of the head and neck (SCCHN) correlate with the TNM system and histologic grade. STUDY DESIGN: We measured MNA by image cytometry on 74 primary SCCHN. Fify-five had primary surgery, 16 had radiotherapy, and 3 and both as their primary treatment. RESULTS: The mean MNA was 47.85 microm2 (range, 20.5-84.8). Tumor size, nodal status and histologic grade were, respectively: T1 = 13, T2 = 29, T3 = 18, T4 = 14; N0 = 53, N1 = 15, N2 = 5, N3 = 1; 17 = well, 38 = moderate, 19 = poorly differentiated. Spearman rank and Kruskal-Wallis tests for MNA/histologic grade, MNA/tumor size, MNA/nodal status and MNA/site were calculated; only MNA/node was statistically significant (P<.05). CONCLUSION: MNA increases in primary SCCHN as nodal involvement increases. This may reflect that high MNA may be a biologic marker of primary SCCHN with a poorer prognosis.

Graphite furnace-atomic absorption spectrophotometric determination of palladium in soil.

A new and sensitive procedure for the graphite furnace-atomic absorption spectrophotometric (GF-AAS) determination of Pd in soil at nanogram level is described. The method is based on prior separation and enrichment of the metal as Pd(II)-SnCl3- -N-butylacetamide (BAA) complex into 1-pentanol (PN) by solvent extraction method. The value of the molar absorptivity of the complex in three solvents, i.e. ethyl acetate, 1-pentanol, chloroform, lie in the range of (0.70-2.75) x 10(4) L mol(-1) cm(-1) at lambda(max) 360-440 nm. The metal could be enriched into organic solvent, i.e. PN, up to 10-folds. The sensitivity (A = 0.0044) of the method in the term of the peak height was 0.5 ng Pd/mL of the aqueous solution at an enrichment factor (EF) of 5. Optimization of analytical variables during enrichment and GF-AAS determination of the metal are discussed. The method has been applied for the analysis of Pd to soil samples derived from roads and highways in Germany.

Kikuchi-Fujimoto's syndrome masquerading as tuberculosis.

We report a case of a 27-year-old Asian man presenting with the typical features of tuberculous cervical lymphadenitis who was commenced on anti-tuberculous therapy on the strength of the clinical presentation. Histological examination of an excised cervical lymph node however, revealed the diagnosis of Kikuchi's syndrome; a histiocytic necrotizing lymphadenitis which is usually self-limiting.