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 of Subacute Combined Degeneration as a Manifestation of Pernicious Anaemia

Vitamin B12 deficiency affects multiple systems, including the central and peripheral nervous systems, producing a vast spectrum of neurological symptoms. It is particularly important due to its insidious presentation and because it can evolve to spastic paraplegia with permanent sequelae. The authors describe a case of a woman with asthenia, bilateral lower limb weakness, urinary retention, and faecal incontinence, with no structural cause on imaging studies. Blood tests showed anaemia (haemoglobin: 6.8 g/dL) and vitamin B12 deficiency (<100 pg/mL). After upper digestive endoscopy compatible with chronic atrophic gastritis and positive for anti-intrinsic factor antibodies was obtained, the diagnosis of subacute combined degeneration due to vitamin B12 deficiency in the context of pernicious anaemia was admitted. Although this entity is a rare cause of myelopathy, it is a frequent manifestation of vitamin B12 deficiency. Clinical suspicion is fundamental since the reversibility of the neurological lesion is dependent on early treatment.

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.

Pernicious anaemia: cause of recurrent cerebral venous thrombosis

This case of recurrent cerebral venous thrombosis (CVT) highlights hyperhomocysteinemia in pernicious anemia due to vitamin B12 deficiency. No other risk factors such as trauma, infections, coagulation disorders or autoimmune diseases were present. The patient was cured with vitamin B12 and anticoagulation therapy. So, it is worthwhile and important to investigate levels of vitamin B12 and homocysteine in CVT.

Autoimmune gastritis concomitant with gastric adenoma and subacute combined degeneration of the spinal cord

A 62-year-old woman was referred to our department for further investigation of anaemia. Blood test showed macrocytic anaemia. Oesophagogastroduodenoscopy (OGD) revealed proximal-predominant gastric atrophy and flat elevated lesion in the gastric body. Several days after OGD, she complained of gait disturbance and was diagnosed with subacute combined degeneration of the spinal cord. Furthermore, laboratory tests showed positive for both anti-parietal cell and anti-intrinsic factor antibodies, as well as increased serum gastrin level and decreased pepsinogen I level, which confirmed the diagnosis of autoimmune gastritis (AIG). Anaemia and neurological symptoms were improved after vitamin B12 supplementation. Subsequently, the patient underwent gastric endoscopic submucosal dissection; histopathological examination revealed gastric adenoma. AIG can cause gastric neoplasms and vitamin B12 deficiency, with the latter resulting in pernicious anaemia and neurological disorders. These diseases are treatable but potentially life-threatening. This case highlights the importance of early diagnosis of AIG and proper management of its comorbidities.

Use of hyperbaric oxygenation as an adjunctive treatment for severe pernicious anaemia in a bloodless medicine patient

Severe anaemia in patients who cannot receive blood transfusion is an indication for the use of hyperbaric oxygen therapy (HBO). Most reports of the use of HBO for anaemia involve patients with acute blood loss. This report details a case of HBO used for a patient with severe pernicious anaemia. A 35-year-old Jehovah’s Witnesses believer presented to a hospital with fatigue, dyspnoea and haemoglobin of 26 g/L. She was diagnosed with pernicious anaemia. As she could not receive blood transfusion due to her religious beliefs, vitamin B12 supplementation and HBO were administered and resulted in significant improvement in her condition. The mechanisms of action of HBO, including increased systemic plasma oxygenation, can alleviate signs and symptoms of anaemia regardless of its aetiology. HBO administration can greatly enhance the plasma arterial oxygen content, leading to clinical improvement in patients with anaemia who cannot receive blood transfusion.

P77 Management of vitamin B12 deficiency in primary care during the COVID-19 pandemic: Do all patients need to come in?

Introduction Not all causes of vitamin B12 deficiency require intramuscular hydroxocobalamin (IMH). NICE guidance states that diet-related deficiency can be treated orally, but pernicious anaemia must be excluded via anti-intrinsic factor antibodies (anti-IFAB). Our aim was to audit the management of B12 deficiency during the COVID-19 pandemic when reducing footfall is vital. Then, implement staff education strategies to improve adherence to guidance. Methods Data for patients who received IMH from March-June 2020 was retrospectively analysed for: full blood count (FBC), B12, folate and anti-IFAB levels. These patients were sent letters to have blood tests for the missing investigations. Results were presented at meetings and flowchart-posters were distributed. Audit was closed with prospective data for patients who requested IMH from September-October 2020. Results From 46 patients identified, 82.6% had B12 and folate checked prior to therapy commencement, but 23.7% had an untreated folate deficiency. 79.3% of patients receiving IMH had never been tested for anti-IFAB; none of those tested were positive. A lack of awareness of the NICE guidance was identified as a key cause for non-adherence. Following the intervention, all 34 patients were appropriately investigated. Out of these, 8.8% had positive anti-IFAB levels and following a review of their clinical histories, all patients were commenced on appropriate therapy. Discussion IMH can have great benefit; but it is invasive, has financial and nursing-time implications, and increases the risk of contagion via footfall in the practice. Thus, this multi-cycle audit shows that appropriate investigations prior to commencing therapy is key.