Ayurvedic Approach for Shwitra- A Case Study

Skin is one of the most important and visible organ of our body. Skin anomalies create physical as well as psychological problems in an individual. Among different variety of Kustha, Shwitra is considered as one of them in the Ayurvedic classics which occur due to vitiation of Tridoshas and Dhatus like Rakta, Mamsa and Meda. Shwitra can be correlated with vitiligo or leucoderma, where it manifest as white patch on the skin due to partial or complete loss of skin pigmentation and causes cosmetic imbalance of the body. Vitiligo is an autoimmune disease and it may be associated with other autoimmune diseases such as pernicious anaemia, addison disease and diabetes mellitus results in destruction of melanocytes thus causing depigmentation. A female patient, aged 36 years suffering from white patches in left forehead region for last 2 years and she was treated with both Sodhan and Shaman Chikitsa for a period of 3 months. Result was assessed from the changes in the size of patch and photographs. Proper written consent was taken from the patient prior to the study. Follow up was done at 1 month interval and after 3 months there was marked improvement seen in patch and colour. The present study indicates different prospective of treatment for Shwitra kustha and it provides cost effective as well as safe treatment of the disease. This study shows a new dimension in the treatment for Shwitra and could be carried out for statistical significant study.

A Case Study on Ayurveda Management of Shwitra

Shwitra is a condition characterised by white patches on the body. It's possible that it's linked to Vitiligo in modern science. In Ayurveda, all skin illnesses are classified as Kustha Roga. It is caused by Tridosha vitiation. It is an autoimmune disease that can be linked to other autoimmune diseases such as diabetes mellitus, pernicious anaemia, and Addison disease. Leukoderma affects one percent of the population. For the patient, this sickness becomes a source of social disgrace as well as a financial hardship. Aim: To Evaluate The Efficacy of Ayurvedic Treatment In Shwitra. Study Design: Simple Single Arm Study Place: Parul Ayurved Hospital, Parul University,Limda, Vadodara, Gujarat. Duration of study: 2 Months Methodology: Kosthashuddhi With Internal Medication And Rasaaushidhi For External Medication. Which provides a fresh hope for providing efficient and safe treatment. It was in much better shape than before.

Adrenal Involvement in an SLE Patient with Antiphospholipid Syndrome

Addison disease related to SLE and mostly to Antiphospholipid Syndrome (APS) is a rare condition that should be suspected in patients presenting with abdominal complaints, fever, hypotension and hyponatremia [1-3]. Its prevalence remains unknown such as its time of onset once SLE or APS are diagnosed [3]. Nowadays, there is not enough evidence for recommending systematic screening regarding this involvement. Its estimated mortality is 3.81% [1]. Nevertheless, under correct treatment, long-term survival is quite favourable [4]. Our main objective is to remind a very uncommon but life-threatening complication that might affect patients with Antiphospholipid Syndrome (APS) associated to SLE.

Audit on Steroid Replacement in Confirmed or Suspected COVID-19 Patients With Adrenal Insufficiency or Adrenal Suppression in a District General Hospital

Aim: In response to new updated guidance from Society For Endocrinology April 2020, this Audit was conduct to assess the adequacy of steroid replacement in confirmed or suspected COVID-19 patients with adrenal insufficiency or adrenal suppression admitted to Bedford District General Hospital. In steroid dependent patients (Addison’s disease, adrenal insufficiency, pituitary steroid insufficiency, use of long term steroids for other conditions - 5mg or more of prednisolone (or equivalent doses) daily for longer than 4 weeks) admitted to hospital very unwell with confirmed or suspected COVID recommendations is to start on Hydrocortisone 100 mg per IV injection followed by continuous IV infusion of 200 mg hydrocortisone/24h (alternatively 50 mg every 6 h per intravenous or IM bolus injection). Method: Retrospect data collection on Patients admitted in May 2020 to Bedford Hospital with suspected or confirmed COVID 19 disease with adrenal insufficiency or on long term steroid use. Those patients should be started on Hydrocortisone 100 mg per IV injection followed by continuous IV infusion of 200 mg hydrocortisone/24h (alternatively 50 mg every 6 h per intravenous or IM bolus injection). Results: In May 2020, 295 patients admitted under the medical team in Bedford Hospital with confirmed or suspected COVID-19. Only 12 patients met the inclusion criteria, one patient with a diagnosis of Addison disease and the remaining 11 patients on long term steroids. None of these patients were managed as per updated guidelines. 6 patients had less than the adequate dose, they were started on prednisolone 30-40mg. 4 patients dose of oral steroids was only doubled, 1 patient received the same dose of oral steroid and the only confirmed Addison had higher dose of hydrocortisone. Moreover, In June 2020, The RECOVERY Outcome trial results showed that Dexamethasone 6mg for 10 days reduces the death by one third in hospitalised patient with severe respiratory complications of COVID-19. Dexamethasone 6mg is 12 times the physiological required steroid dose, this is equivalent to 240mg hydrocortisone, which is adequate for steroid replacement in patients with adrenal insufficiency or suppression. Conclusion: In view of these results and the outcome of the RECOVERY Trial, Local trust guidelines updated, indicated that any patient with Adrenal insufficiency or suppression including those on long term steroids very unwell admitted to the hospital should receive Dexamethasone if requiring oxygen or Hydrocortisone if not requiring oxygen. Recommendation of changes included teaching sessions delivered to doctors, posters on updated guidelines distributed in major areas in hospital and trust guidelines updated on the intranet.

Hyperpigmentation with Vitamin B12 Deficiency in an Adolescent Girl

Hyperpigmentation as primary symptom is rare in vitamin B12 deficiency. This adolescent non vegetarian girl presented with hyperpigmentation, anaemia, glossitis and weight loss. She was worked up to find out the cause of anemia and hyperpigmentation. Addison disease was a strong provisional diagnosis. Her cortisol level was normal and megaloblastic anemia due to vitamin B12 deficiency was found. All of her symptoms were dramatically improved by injectable cobalamin. As vitamin B12 deficiency is a treatable condition so it should be ruled out in patient presenting with hyperpigmentation. Early replacement therapy also prevents multisystem involvement like bone marrow failure and demyelinating neurological disease. J Bangladesh Coll Phys Surg 2021; 39(1): 62-67

Coeliac disease is a risk factor for the development of seronegative arthritis in patients with autoimmune thyroid disease

Objective Hashimoto’s thyroiditis is known to cluster with other systemic autoimmune disorders. Rheumatic manifestations, such as a seronegative non-erosive polyarthritis have been described. The aim of this study was to evaluate the characteristics and the prevalence of rheumatic features in thyroiditis patients, and to ascertain whether the association with systemic autoimmune disorders improved the arthritis manifestations. Methods In total, 180 thyroiditis patients were enrolled. Major clinical and demographic characteristics have been recorded. Patients underwent a rheumatological clinical assessment and extra-articular manifestations allowing for a differential diagnosis with systemic autoimmune diseases and spondyloarthropathy. Presence of systemic autoimmune diseases was recorded. Results A total of 8.33% of thyroiditis patients shown a peripheral inflammatory arthritis (P = 0.002). Female gender (P = 0.042) and thyroid peroxidase (TPOAbs) positivity (P = 0.001) were more frequent. In total, 37 patients had systemic autoimmune diseases (P = 0.0003). A significant high prevalence of coeliac disease and Addison disease was found (P = 0.034 and P = 0.049, respectively). In patients with coeliac disease, the articular manifestations were more frequent (21.21%) (P = 0.001) and the risk to develop joint involvement was 2.96. Conclusion Although we found an articular involvement in about one-third of thyroiditis patients, the prevalence of inflammatory arthropathy was only 8.33%. The prevalence of other coexisting autoimmune disorders was 34.26% with a significant prevalence of coeliac disease (7.41%). Thyroiditis patients with coeliac disease have an articular involvement more frequently than those without. In these patients, we have found a high risk of developing arthritis than patients with only thyroiditis, suggesting cumulative autoimmune effects in the developing articular involvement.