Integrated management of diabetic foot ulcers (DFU) using a smartphone - A case report.

INTRODUCTION AND IMPORTANCE: DFU care in India is expensive. Cost-effective integrated care approaches for diabetic wounds are a necessity. CASE PRESENTATION: A 54-year-old, type 2 diabetic male patient presented with bilateral Grade Four compound DFUs. He also had a peculiar pattern of progressive gangrenous lesions on both toes of his limbs. He was on medication for schizophrenia for 20 years. Doppler studies of both limbs revealed extensive atherosclerotic changes with no flow in the mid and very low flow in the distal left anterior tibial artery. CLINICAL DISCUSSION: Along with Ayurvedic internal medication, in-home wound care was advised. Wound cleaning (shodhana) was done with Triphala decoction, gauze packing (ropana) with Gandhak druti, and application of Jatyadi oil (snehana) was done daily. The wound inspection was done using a smartphone. Out of six wounds, one infected wound measuring (8 cm-3 cm), one tunnelling wound measuring (9 cm-3 cm), one neuro-ischemic, Grade 4 planter wound, and other non-infected wounds healed within four to ten weeks. It has been observed that all the toes with progressive ischemic black spot on the proximal interphalangeal joint had deteriorated within 20-35 days. CONCLUSION: Gandhak druti may be effective for progressive wounds. Jatyadi oil application to enhance microcirculation as a preventive therapy should be investigated. Wound dressing guidelines recommended in Ayurveda classics can be followed at diabetic wound in-home care using a smartphone. Correlative timeframe of pathophysiological signs and anatomical site of dermopathy patches can add value to the non-invasive microcirculation detection tests.

Ayurveda management of large endometrioma - A case report.

Endometriosis is an unusual feature of retrograde menstruation that affects nearly every woman of reproductive age. Endometrioma, a severe form of endometriosis, is a common cause of infertility. Surgery is the recommended treatment for large endometrioma, which most women prefer to avoid. A 23-year-old unmarried patient had right side rapidly enlarging endometrioma measuring 6.9 × 5 cm with acute intermittent abdominal pain diagnosed as udavarta yonivyapada. Yoga basti (eight medicated enemas) and Kuberaksha vati were the primary treatments. Yoga basti is the treatment of choice for pain, inflammation and all the pelvic diseases related to fertility caused by vata aggravation. Alleviation of pain avoided the surgery. After discontinuation of medicines, the endometrioma size increased to 10.3 × 5.5 cm The second Yoga basti was administered before wedding. The patient conceived within four months after the marriage and had a full-term normal delivery with no acute pain episodes. The endometrioma size was reduced by 2 cm within one year and further reduced to 7.6 × 5.2 cm in the first trimester. Ayurvedic conservative treatment for endometriosis can manage pain and may also prevent retrograde menstruation. It can be a minimally invasive alternative prior to surgical removal, that has long-term beneficiary effects. As a seasonal regimen, yoga basti can also help fertile women with primary and secondary dysmenorrhea enhance the quality of life.

Phenyltins in surface sediments of the Visakhapatnam harbour, India.

Twenty-two surface sediment samples were collected from Visakhapatnam harbour, east coast of India, and analysed for monophenyltin (MPT), diphenyltin (DPT), triphenyltin (TPT), total bacteria, and TPT tolerant bacteria. Concentrations of MPT, DPT and TPT varied between 1-26, 3-28, and 0.31-145 ng Sn g(-1) dry wt, respectively. Phenyltin concentrations were influenced by ship related activities, agricultural waste and sewage. These phenyltin concentrations indicate sediments are contaminated. Abundance of TPT tolerant bacteria was strongly influenced by the levels of phenyltins.

Ayurveda in the management of infant hyperlipidemia: A case report.

Hypertriglyceridemia is a rare disorder in childhood. Familial Chylomicronemia Syndrome (FCS) is a rare genetic disease that leads to severe hypertriglyceridemia, often associated with recurrent episodes of pancreatitis. In this syndrome, traditional lipid-lowering drugs are marginally effective. A 6-months-old infant with complaints of recurrent episodes of abdominal colic and pancreatitis, with S. Cholesterol 552 mg% and Triglycerides 6400 mg%, was treated with Ayurvedic medicines. After six months of medication, Serum Cholesterol levels were within normal limits, and within the three years of regular treatment, S. Triglycerides was under 2000 mg%. Recurrent episodes of acute abdominal colic and vomiting reduced significantly. The patient was treated for Kapha Pitta dushti in Rasa and Raktavah srotas (deformity of the Kapha Pitta humors in the tissue nourishment pathway of the first and the second tissue respectively). Laghoo Sootshekhar, Arogyavardhini, Tinospora cordifolia, Cyprus rotundus, Aegle marmelos, Berberis aristata, Vettiveria zizanioides, and Triphala were the medicines used frequently. The three years treatment was safe and effective. Cost-effectiveness was an added feature of this treatment. Clinical experience of this case shows that congenital hyperlipidemia can manage by Ayurvedic medicine.

Seasonal variation in organotins in the waters of the Dona Paula Bay, west coast of India.

Surface seawaters from the Dona Paula Bay, were collected at weekly intervals during March 2007 to March 2008, and analyzed for butyltins (BT) such as tributyltin (TBT), dibutyltin (DBT), monobutyltin (MBT) using a GC-MS system. The mean concentrations of TBT, DBT, MBT and total BT varied from <1-37, 4-19, 6-28 and 21-84 ng Sn L(-1), respectively. Highest levels of BTs were recorded during May followed by April 2007 and March 2007 probably because the shipping and tourism activities are very high during these months.

Butyltins in the sediments of Kochi and Mumbai harbours, west coast of India.

Surface sediment samples were collected from various locations in the Mumbai and Kochi harbours, west coast of India, to assess the presence of butyltin compounds. Tributyltin (TBT) and dibutyltin (DBT) varied from 16 to 16,816 ng/g dry wt. and from undetected to 469 ng/g dry wt., respectively, of the sediment in Kochi harbour. In Mumbai harbour, the values of TBT and DBT ranged between 4.5 and 1193 ng/g dry wt. and from undetected to 131 ng/g dry wt. of the sediments, respectively. The concentrations of both TBT and DBT showed strong seasonal variation probably due to the effect of tides and currents. Nevertheless, the levels of butyltin compounds were generally higher at sites influenced by shipping activities such as navigation, dry dock and ship-building activities. The presence of DBT indicates the abiotic or microbiological degradation of TBT. Compared to TBT, DBT was relatively less abundant, suggesting either fresh inputs of TBT and/or less degradation of TBT. The concentrations of TBT showed significant positive relationships with organic carbon and lipid, implying that both lipophilic and ionic interactions were probably involved in controlling the abundance of TBT at these sediments. The observed levels of butyltin compounds are much higher than those required to induce toxic effects on marine organisms, suggesting that these sediments were contaminated with butyltin compounds.

Butyltins in water, biofilm, animals and sediments of the west coast of India.

Biofilm, fish, oyster, mussel, clam, surface seawater, suspended particulate matter (SPM), and sediment samples were collected from marine and/or estuarine waters of the west coast of India. These samples were analysed for butyltin derivatives such as dibutyltin (DBT) and tributyltin (TBT). The concentrations DBT plus TBT varied between 2.4 and 8.3, 163 and 363 ng/l, 5 and 2853 ng/g dry wt in the SPM, seawater and sediment samples, respectively, of the Marmugao harbour. The values of DBT plus TBT ranged between 0.60 and 29, 123 and 242 ng/l and 1.4 and 65 ng/g dry wt in SPM, water and sediment samples, respectively, collected from the Mandovi estuary. In the Dona Paula Bay the DBT plus TBT varied from 10 to 89 ng/l in surface seawater, and TBT from 10 to 513 ng/g in biofilm samples. For the coastal sediment samples the concentration of DBT plus TBT ranged between 36 and 133 ng/g dry wt of sediment. For the animal samples the DBT plus TBT ranged between 58 and 825 ng/g dry wt of the tissue. Mussel tissues contained the highest amount of DBT plus TBT (825 ng/g dry wt tissue), whereas highest TBT concentration was recorded in the oyster (732 ng/g dry wt). TBT was generally the most abundant butyltin compound in most of the samples suggesting fresh inputs and/or less degradation of TBT. A wide range of the observed butyltin concentrations suggests the presence of localized areas of contamination. Leaching of tributyltin-containing antifouling paints from the ocean going ships, fishing and recreational boats, barges, and the inputs of TBT from the Goa shipyard and dry dock facility situated in the harbour are the probable sources of the DBT and TBT in the samples of the west coast of India. Higher levels of TBT were observed in biofilm relative to that in the surrounding seawater. When fed on TBT contaminated biofilm of the diatom Navicula subinflata, butyltin concentrations in the clam Paphia malabarica increased over the period of feeding suggesting the importance of biofilm in the transfer of butyltins to higher group of organisms.

Baseline of organotin pollution in fishes, clams, shrimps, squids and crabs collected from the west coast of India.

Organotins, especially tributyltins (TBT) are highly toxic to many marine organisms. These compounds are introduced in marine waters by ship trafficking, ship scrapping activities, as antifouling compounds and sewage disposal. Marine fishes, crustaceans and molluscans are easily prone to organotins contamination. In view of this, a baseline monitoring study was conducted in order to establish the levels of organotins in edible marine fishes, bivalves, shrimps, squids and crabs collected from Mumbai, Goa and Karwar on the west coast of India. At these locations average organotin concentration found in fishes, clams, shrimps, squids and crabs was 108, 852, 179, 70 and 89 ng Sn g(-1)dw, respectively. In all the samples butyltins dominated over phenyltins. The levels of organotins suggest that all the organisms were contaminated with organotins and their consumption may pose health problems to humans.

Distribution of butyltins in the waters and sediments along the coast of India.

Water and surface sediment samples were analyzed for butyltins (TBT, DBT, MBT) from various ports along the east and west coast of India. The total butyltin (TB) in water samples varied between ~1.7 and 342 ng S nl⁻¹, whereas for sediments it varied between below detection limit to 14861 ng S ng⁻¹ dry weight of sediment. On an average Chennai port recorded the highest level of butyltins in the sediments while Paradip recorded the highest level of butylins in the waters. A fairly good relationship between the TB in the sediment and overlying water samples, as well as between organic carbon and TB, implicates the importance of adsorption/desorption process in controlling the levels of TBT in these port areas. In India the data on organotin pollution is very sparse; most of the port areas have been surveyed for butyltins for the first time during this study.

Organotins in the sediments of the Zuari estuary, west coast of India.

Industrial use of organotins such as butyltins and phenyltins has increased several folds during the last two decades. Butyltins and phenyltins are synthetic, multipurpose chemicals, which have been extensively used in marine antifouling paints. They have been known to be extremely poisonous to mollusc fishery resources (oysters, clams, etc.). Contamination of Zuari estuary sediments was assessed by quantitative determination of butyltins and phenyltins by using GC-MS using the electron ionization mode. Butyltins predominated in the whole area over phenyltins. Butyltins contributed about 70-90% of the organotins in general. The concentration of butyltins in sediments ranged from 20 to 7621 ng Sn/g. The concentration of phenyltins in sediments ranged from 0 to 46 ng Sn/g. Degradation indices for butyltins and phenyltins were calculated. The Butyltin degradation index (BDI) for the Zuari sediments ranged from 0 to 2.7 indicating a lot of fresh input of butyltins in the estuary and a lower degradation rate. The phenyltin degradation index (PhDI) ranged from 1 to 10 implying that different processes were prevalent at different stations. The observed organotin levels in the Zuari estuary indicate some highly localized areas of contamination which are severe enough to cause harmful effects on marine flora and fauna. Therefore, there is a need to regulate the use of butyltins and phenyltins as biocides in marine antifouling paints.