AYURVEDIC MANAGEMENT OF AMLAPITTA (GASTRITIS) - A CASE REPORT

Amlapitta is the most typical illness in the present era. In a rapidly growing civilization, Amlapitta is the outer- most common disorder within the current society, because of indulgence in incompatible food habits and activi- ties. Materialistic lifestyle provokes people to run behind a busy, tremendous stressful life which is the least con- cern towards proper food habits. "Hurry", “Worry” & “Curry” are the main causes of Amlapitta disease. The us- age of synthetic drugs like H2 receptor blockers & proton pump inhibitors has decreased due to their side effects. The signs and symptoms of Amlapitta are very comparable to Gastritis or Hyperacidity. The ruling features of Amlapitta are Avipaka (indigestion), Urodaha (Burning in the chest), Utklesha (Nausea) Aruchi (Anorexia) and Tikta-Amlodgara (sour and bitter belching) have been described in Ayurvedic classical texts. A 42-year-old male patient came in OPD with the following complaints Tikta-Amlodgara, Urodaha, Utklesha, Aruchi, Praseka. Dur- ing Examination, the vitals are normal. The patient was treated with Sutshekar rasa 1 tab. BD, Avipattikar chura- na 3gm BD, Drakshavaleha 5gm BD on the basis. The patient was advised to follow up every 15th day. Along with medication, the patient was also advised to follow diet and lifestyle restrictions. Keywords: Agni, Amlapitta, Annavahasrotas, Hyperacidity.

Evaluation of the Effectiveness of the use of Pantoprazole and the Risks

Drug use evaluation (DUE) is a systematic approach to study the utilization of marketed drugs. These studies are proved invaluable for policy makers to get inputs on the use of drugs so that they can review their strategies. In this prospective observational study, we have conducted a DUE of Acid suppressant drugs in Outpatient department (OPD) of a tertiary care teaching hospital in Kadapa, Andhra Pradesh. In the armamentarium of acid suppressants Proton pump inhibitors (PPIs) occupied a special space owing to their superiority to others like H2 receptor blockers. PPIs are in the market for the last 40 years and their safety and efficacy is impeccable till now. These are the most commonly used drugs and tend to be used for long-term to manage acidity problems. But unregulated usage of PPIs over long term could pose very significant health problems ranging from electrolyte imbalance to cognitive impairment. Our study identified some issues in prescribing PPIs suggesting there is generous use of PPIs without considering their risks. And their safety also taken for granted, it appears.

Clinical evaluation, management and outcome of hollow viscus perforations

Background: Gastrointestinal perforation is the third most common cause for exploratory laparotomy as an emergency. With the advent of drugs against acid peptic disease the incidence of peptic ulcer perforations is on decline. The advent of laparoscopy and endoscopy has played decisive role in the diagnosis and management of gastric and colorectal perforations. Aim of the study is to study the clinical outcome, surgical management and postoperative complication of peritonitis secondary to hollow viscus perforation.Methods: This was prospective study of 50 cases. All patients admitted and treated with perforation secondary to Hollow viscus perforations in surgical wards of M S Ramaiah Medical College, Bangalore, during the period of April 2016 to October 2017. Patients with peritonitis secondary to hollow viscus perforation admitted was evaluated and the diagnosis was made.Results: Out of 50 patients, most were male patients between 30-50 years age group. Duodenal ulcer perforation led the list. 4 were gastric, 37 were duodenal, 3 were jejunal, 6 cases were ileal. However colonic perforations were not observed. Wound infection leads the list of postoperative complications with faecal leak and burst abdomen following residual abscess. Almost all perforations were treated surgically.Conclusions: It was thought that with the introduction of better H2 receptor blockers and proton pump inhibitors, incidence of peptic perforations would decrease. Early recognition of perforations, prompt surgical intervention, adequate drainage, recognition of co-morbid conditions and complications would help in reduction of morbidity and mortality.

To study the cost variation analysis of oral H2 receptor blockers available in different brands in Indian pharmaceutical market

Background: Aim of the study was to study percentage price variations among different brands of the commonly prescribed H2 receptor blockers.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition, Drug Today April to June 2018 Vol-1. The price ratio and the percentage price variation for individual drug brands was calculated. The price of 10 tablets/capsules were calculated. At last the price ratio and percentage price variation of various brands were compared.Results: Percentage variation in price for H2 receptor blockers marketed in India was found to be tablet cimetidine 200mg:81.89, tablet cimetidine 400mg:91.27, tablet ranitidine 150mg:295.64, tablet ranitidine 300mg:123.19, tablet famotidine 20mg:939.62, tablet famotidine 40mg:1110.09, tablet roxatidine 75mg:38.65, tablet roxatidine 150mg:21.85.Conclusions: H2 receptor blocker is the most common drug prescribed for prolonged period in case of gastritis, Gastro-Esophageal Reflux Disease (GERD), peptic ulcer. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. The doctors prescribing these drugs should be aware of these variations in price to reduce the price of drug therapy.

Anaesthetic antacids: a review of its pharmacological properties and therapeutic efficacy

Anaesthetic antacids, combination of antacids (Aluminium hydroxide, Magnesium hydroxide) with an anaesthetic (oxethazaine), is becoming a choice of physicians and is re-emerging across all types of GI disorders (esophagitis, peptic ulcer, duodenal ulcer, heartburn, gastritis, functional dyspepsia), despite the discovery of potent and efficacious acid suppressants like H2 receptor blockers and proton pump inhibitors (PPIs). The reason being that anaesthetic antacids increase the gastric pH and provide relief from pain for a longer period of duration at considerably a lower dosage. Furthermore, it significantly increases the duration between the time of medication and the peak pH as compared to antacid alone. Oxethazaine, an anaesthetic component, produces a reversible loss of sensation and provides a prompt and prolonged relief of pain, thereby broadening the therapeutic spectrum of antacids. Antacids vary widely in their in vitro acid neutralizing capacity (ANC), which measures the potency. Among marketed brands in India, Digecaine has shown the highest potency with maximum mean ANC value (28.84 mEq). The expert panel has recommended the inclusion of oxethazaine-antacid/alginate-antacid as complementary to the proton pump inhibitors in the management algorithm of gastroesophageal reflux disease. The present review summarizes the pharmacokinetic and pharmacodynamic of different components of anaesthetic antacids and its clinical use across different gastrointestinal indications, for generalists and specialists, based on existing evidences.

Histamine Poisoning from Ingestion of Fish or Scombroid Syndrome

The scombroid poisoning is due to the ingestion of poorly preserved fish (especially tuna, sardines, and mackerel) out of the cold chain. Under the influence of the proliferation of gram negative bacteria that occurs for heating, the histidine content in the muscle of the fish is converted into histamine, by the action of the enzyme histidine decarboxylase. If the histamine is ingested in large quantities, it causes an anaphylactoid reaction with a variety of symptoms from moderate to severe to life-threating. We will describe two cases that came under our observation after consuming a meal of bluefin tuna. The diagnosis of scombroid syndrome was made on the basis of the anamnestic data and the clinical one. The rapid resolution of the signs and symptoms after treatment with histamines H1-H2 receptor blockers confirmed the suspected diagnosis.