Comparative Evaluation of the Efficacy of Hydrocortisone Suppository and Durvadi gudavarti in Raktarsha: A Management Protocol

The most common diagnosis for any anorectal complaint particularly of rectal bleeding in adults is haemorrhoidal disease. Regardless of grading conservative treatment is used primarily in symptomatic haemorrhoids. In Ayurveda, Sthanik Chikitsa (Local application) in the management of Arsha (Hemorrhoids) includes pralepa/pratisaran (Paste application). Instead of applying the lepa in the clinics by the clinician/proctologist, those formulations could be developed into Gudavarti (traditional suppository) & used in the management of Raktarsha (bleeding piles) for better compliance. Hence, development of ‘Durvadi Gudavarti’ using the indigenous medicinal herbs mentioned in Charaka Sanhita (Classical Ayurveda text) for pratisaran/pralepa in Raktarsha & its efficacy will be evaluated. Objectives: To study & compare the efficacy in patient treated with standard- Hydrocortisone suppository group & interventional- Durvadi Gudavarti group in the management of Raktarsha (Bleeding piles). Methodology: 130 patients of 2nd grade hemorrhoids will be selected and will be allocated into two equal groups by computer randomization. Experimental group will be treated with Durvadi Gudavarti & control group with Hydrocortisone based suppository for 2 weeks. Following Symptoms- PR Bleeding, Anal Pain, Prolapse of Pile mass/Lump, Anal pruritus, Mucous discharge & Constipation will be assessed subjectively and Size/ (Volume in cubic millimeter) of pile mass will be the objective parameter for study. Clinical evaluation will be done at Baseline and 3rd, 5th, 10th, 15th day after treatment onset. Proportion of patients that would respond clinically on 10th day will be the main end point, determined via disappearance of the clinical symptoms & more than or equal to 50 % reduction in the initial size of pile mass/lump. Time to response & need for any oral/ parenteral medication for pain, bleeding and constipation would be the secondary variables. Side effects (type, duration & severity) will be registered carefully. Expected Results: Durvadi Gudavarti contains indigenous herbs having anti-inflammatory, analgesic, haemostatic, wound healing, astringent, & laxative properties. Hence, it is expected to be as efficacious as Hydrocortisone suppository with lesser side effect in the management of Raktarsha. Results will be assessed on the basis of clinical assessment criteria using proper statistical values and tools. Changes will be observed in objective outcomes. Conclusion: Durvadi Gudavarti will be efficacious in the management of Raktarsha.

Application Value of the Motor Unit Number Index in Patients With Kennedy Disease

The aim of this study was to evaluate the usefulness of the motor unit number index (MUNIX) technique in Kennedy disease (KD) and test the correlation between the MUNIX and other clinical parameters. The MUNIX values of the bilateral deltoid, abductor digiti minimi (ADM), quadriceps femoris (QF), and tibialis anterior (TA) were determined and compared with the course of the disease. The MUNIX sum score was calculated by adding the MUNIX values of these 8 muscles. Disability was evaluated using the spinal and bulbar muscular atrophy functional rating scale (SBMAFRS). The MUNIX scores of patients with KD were negatively correlated with the course of the disease (p < 0.05), whereas their motor unit size index (MUSIX) scores were positively correlated with the course the of disease (p < 0.05). MUNIX sum scores were correlated with SBMAFRS scores (r = 0.714, p < 0.05). MUNIX was more sensitive than compound muscle action potentials or muscle strength as an indicator of neuron loss and axonal collateral reinnervation. The MUNIX sum score is an objective and a reliable indicator of disease progression, and it is a potential choice for therapeutic clinical trials. The MUNIX can assess the functional loss of motor axons and is correlated with disability. The MUNIX sum score may be especially suitable as an objective parameter.

Left Ventricular Lead Placement Guided by Reduction in QRS Area

Background: Reduction in QRS area after cardiac resynchronization therapy (CRT) is associated with improved long-term clinical outcome. The aim of this study was to investigate whether the reduction in QRS area is associated with hemodynamic improvement by pacing different LV sites and can be used to guide LV lead placement. Methods: Patients with a class Ia/IIa CRT indication were prospectively included from three hospitals. Acute hemodynamic response was assessed as the relative change in maximum rate of rise of left ventricular (LV) pressure (%∆LVdP/dtmax). Change in QRS area (∆QRS area), in QRS duration (∆QRS duration), and %∆LVdP/dtmax were studied in relation to different LV pacing locations within a patient. Results: Data from 52 patients paced at 188 different LV pacing sites were investigated. Lateral LV pacing resulted in a larger %∆LVdP/dtmax than anterior or posterior pacing (p = 0.0007). A similar trend was found for ∆QRS area (p = 0.001) but not for ∆QRS duration (p = 0.23). Pacing from the proximal electrode pair resulted in a larger %∆LVdP/dtmax (p = 0.004), and ∆QRS area (p = 0.003) but not ∆QRS duration (p = 0.77). Within patients, correlation between ∆QRS area and %∆LVdP/dtmax was 0.76 (median, IQR 0.35; 0,89). Conclusion: Within patients, ∆QRS area is associated with %∆LVdP/dtmax at different LV pacing locations. Therefore, QRS area, which is an easily, noninvasively obtainable and objective parameter, may be useful to guide LV lead placement in CRT.

AMA FROM AYURVEDIC AND MODERN PERSPECTIVE

Agni is one of most powerful transformative principles of Ayurveda. Deranged Agni leads to the formation of Ama. Ama is responsible for causing most of the diseases in human beings. The disease produced, clinically mani- fests itself in form of various signs and symptoms. These signs and symptoms are the principal tools for a physi- cian to diagnose the disease and treat it promptly. On the basis of these symptoms, all diseases can be classified in Samavastha and Niramavastha. If an objective Parameter that could measure the severity of Ama is searched, it will prove to be an advantage for the physician, who could then catch the cause (Ama) and save patients from this harmful disease entity. A definite line of treatment of Ama can be planned after considering the symptoms and severity of the condition. Keeping this approach, the review is carried out to understand Ama from Ayurvedic and Modern perspectives. After reviewing it can be concluded that Ama has no direct correlation in modern science but can best be equated to 'toxins'. They may be endotoxins like enzymes, hormones, catalysts, etc. when these are unable to function properly or entirely, different metabolites are formed which are not acquired by the body. On further process these go on accumulating in different systems, affecting the normal mechanism of that respective system or exotoxins produced by some bacteria or micro-organism when they enter into the body. Keyword: Agni, Ama, Toxin

Emulator-based Bayesian optimization for efficient multi-objective calibration of an individual-based model of malaria

Individual-based models have become important tools in the global battle against infectious diseases, yet model complexity can make calibration to biological and epidemiological data challenging. We propose using a Bayesian optimization framework employing Gaussian process or machine learning emulator functions to calibrate a complex malaria transmission simulator. We demonstrate our approach by optimizing over a high-dimensional parameter space with respect to a portfolio of multiple fitting objectives built from datasets capturing the natural history of malaria transmission and disease progression. Our approach quickly outperforms previous calibrations, yielding an improved final goodness of fit. Per-objective parameter importance and sensitivity diagnostics provided by our approach offer epidemiological insights and enhance trust in predictions through greater interpretability.

A CLINICAL STUDY OF SHILAJEET VATI IN PRAMEHA PURVARUPA (PRE-DIABETIC STATE)

Introduction- The incidence of Prameha is increasing rapidly because of changes in dietetic habits and lifestyle. If the Prameha Purvarupa (Pre-diabetic) clinical features are treated by formulation Shilajeet is recommended in Ayurvedic Classics, proven efficacious and widely practised in the management of Prameha (Diabetes). Materi- als and methods- 30 patients from OPD and IPD of Govt. Ayurvedic College & Hospital, Balangir, fulfilling the Subjective and Objective Parameters were registered for the clinical trial. After diagnosis, they were under trial with Ayurvedic formulation Shilajeet Vati treated in a dose of 2 Vati (500mg each) twice daily empty stomach, for a period of 30 days with Ushna Jala. The assessment of subjective and objective parameters was evaluated on the 10th, 20th and 30th day from the day of initiation of trial up to 30 days in order to find the efficacy of the trial by statistical paired ‘t’ test. Observation and results- The average percentage of improvement in subjective parame- ter Prabhuta Mutrata (quantity) 71.43%, Prabhuta Mutrata (frequency) 77.78%, Pipasa (increased thirst) 72.73%, Kshudha (excessive appetite) 72.22%, Kara-pada Daha (burning sensation in hand and feet) 73.81%,Kara-pada Suptata (numbness of hand and feet) 80%, Sweda Pravritti (excessive sweating) 83.33%, Mukha Sho- sha (dry mouth) 79.17%, Mukha Madhurya (sweetness in mouth) 77.78%, Sheeta Priyata (liking for cold things) 80% and Madhura Shukla Mutrata (sweetness in urine) 100% and in objective Parameter fasting plasma glucose 68.89%, postprandial glucose 81.11%, HbA1c 73.33%. It has been observed that the trial drug patients are highly significant (p<0.001) to reduce both Subjective and Objective parameters after 30 days of treatment. Discussion and Conclusion- Prameha is a Kapha Pradhana Tridoshaja Vyadhi in which Meda is a Pradhana Dushya. The drug showed a potent Pramehahar effect which is evident from the reduction in the Subjective Parameter of Prameha and objective parameter of the levels of FBS, PPBS and HbA1c in patients. No side effect was noticed during the clinical study of Shilajeet Vati. Keywords: Prameha, Diabetes, Shilajeet Vati.

CLINICAL STUDY TO EVALUATE THE EFFICACY OF YAVAKSHARA PRATISARANA IN THE MANAGEMENT OF TUNDIKERI (CHRONIC TONSILLITIS)

Introduction: The symptoms of Tundikeri resembles with Chronic Tonsillitis. This disease is more frequent in young and middle aged adults. If not treated in time, chronic tonsillitis may lead to Middle ear infection, Rheumatic fever, Nephritis, Rheumatic heart disease and many other systemic complications.Looking into above facts there is a need of treatment which can prevent complications of the disease as well as reduces the recurrence effectively. In this study an effort has been made to evaluate the efficacy of Yavakshara pratisarana in Tundikeri (Chronic Tonsillitis). Materials and methods: The present study was an open labelled, single arm, clinical study in Tundikeri (Chronic Tonsillitis) (n=30) selected using convenience sampling technique with pre and post design conducted in a tertiary Ayurveda healthcare centre attached to a teaching institute, situated at the district headquarters in South India. 31 patients fulfilling the inclusion criteria suffering from Tundikeri w s r to Chronic Tonsillitis were selected with the intervention of Yavakshara pratisarana in single sitting. Results: The effect of therapy was assessed before and after treatment, the results were statistically analyzed; it showed significant changes in subjective parameters like Katina shopha,Mandaruk ,Galaragata,Galoparodha ,Halitosis,Enlarged Jugulodigastric lymph nodes, and Objective parameter- ESR Conclusion: Yavakshara pratisarana has shown better efficacy in subjective parameters likeKatinashopha,Mandaruk,Galaragata,Galoparodha,Halitosis,EnlargedJugulodaigastric lymph nodes , and Objective parameter like- ESR KEY WORDS: Tundikeri, Yava kshara, Pratisarana.

A Comparative Clinical Study in the Management of Vataja Kasa w.s.r. to Tropical Pulmonary Eosinophilia by Shringarabhra Rasa and Shwasakasa Chintamani along with Mridu Virechana

Vataja kasa vis-à-vis T.P.E is a disease of Swasanavaha samsthana, is one of the commonest problem in tropical countries like India. India being a tropical country the prevalence of TPE is remarkable. Vatajakasa presents with symptoms like Shuska kasa, Prasakta vega, Uraha shoola, Ksheena bala, Ksheena oja, Kshamana etc. In Ayurveda, researches have been done and Vataja kasa can be compared with TPE. TPE symptoms such as repeated bouts of dry cough, chest pain, weight loss, and Malaise etc may continue for weeks or months with remission and reoccurrence. Methods: Classical signs and symptoms of Vataja kasa and raised esinophil count >500cells/cumm and 30 patients were selected and randomly allocated in two groups. Firstly, Shunti churna with hot water was given for Amapachana, later patients were given Kantakari ghrita for Snehapana prior to Virechana with Eranda taila in both the groups followed by Shringarabhra rasa in Group A and Shwasa kasa chintamani in Group B for 21 days with follow up of 1 month. Results: Both Group A and Group B provided highly significant results in all parameters of assessment but group B showed better improvement in the symptoms of the disease Vataja kasa in the present study. Interpretation and Conclusion: 15 subjects (50%) got marked relief, 5 subjects (16.66%) got moderate relief in subjective parameters; 20 subjects (66.66%) got mild relief and 5 (16.66%) subjects got moderate relief in objective parameter. Hence, the modalities of our treatment can be recommended to all the patients of Vataja kasa without any hesitation.