CRITIQUE ON JALODARARI RASA - A MIGHTY HEPATOPROTECTOR

Ayurveda is the oldest methodical branch of knowledge that speaks its reality in the sketch of philosophy. It comprises most scientific milieu of derivation. As per ancient Ayurveda scholars for getting a desirable outcome of any medication, it should be precisely analysed before prescribing to the patient. There are several classical formulations successfully practised by Ayurveda physicians for treating various ailments, and also there are few unexplored but potent formulations that need the attention of practitioners to come to light. The present study is based to collaborate various references as well as the Pharmacological importance and mechanism of action of a distinctive hepatoprotection Jalodarari Rasa. The most common manifestation of liver dysfunction is ascites, and the most common cause of ascites is liver disease. Ascites is the accumulation of fluid in the peritoneum. Despite advanced medical facilities still, there is no definite treatment that cures a patient of ascites completely. The modern treatments only provide provisional relief with time dependant recurrence but, the fluid gets collected in the abdominal cavity repeatedly. In such cases, Ayurvedic treatment gives relief without any side effects and can be correlated with Jalodara, mentioned in Ayurvedic medical science. Jalodarari Rasa is a herbomineral preparation that is depicted in Bhaishajya Ratnavali Udararogaprakarana, its fundamental constitution being Jayapala, Tamra bhasma, pippali, maricha which are all having lekhana- pachana-bhedana action and thereby useful to evacuate the excess accumulated fluid which is needed to counteract Jalodara. Hence, here an attempt has been made to address the detailed review of Jalodarari rasa. Keywords: Ascites, hepatoprotective, Ayurveda

Management strategies for acutely decompensated aortic stenosis

Background Uncertainty exists over the optimal treatment strategy for patients presenting with acutely decompensated severe aortic stenosis (AS). The available options include a bridging balloon aortic valvuloplasty (BAV) or a direct transcatheter aortic valve implantation (TAVI). Purpose Our study compares TAVI outcomes in patients treated with two different strategies in acutely decompensated severe AS: bridged TAVI vs direct TAVI. Methods In this observational study all patients admitted with decompensated severe AS who underwent balloon aortic balloon valvuloplasty (BAV) and/or TAVI on the index admission were included. Comparison was made between bridged TAVI group (defined as initial BAV followed by TAVI) and direct TAVI group (TAVI on the index admission without bridging BAV). For this analysis we excluded patients in cardiogenic shock. Baseline characteristics, echocardiographic and periprocedural data were recorded in hospital database. Major adverse cardiovascular events (MACE) were defined as death, major bleeding, rehospitalisation for heart failure, or stroke). The follow-up data was obtained by outpatient visits and/or telephone calls. Results 178 patients with acutely decompensated AS were analysed: 58 bridged TAVI, 23 direct TAVI, 9 bridged SAVR and 88 destination BAV (defined as BAV non followed by a definite treatment). There was no statistically significant difference between bridged TAVI and direct TAVI group in mean age (83.6±6.6 vs 80.4±8.3 years), the prevalence major comorbidities (coronary, respiratory, neurological or peripheral vascular disease), renal function (eGFR 43.4±18.9 vs 45.2±20.9 ml/min/m2), the mean LV ejection fraction (53.4±13.8 vs 48.6±14.6%) or aortic valve gradient (39.4±13.0 vs 34.1±12.3mmHg), respectively. Direct TAVI patients had a higher mean surgical risk scores (STS 6.1±3.7 vs 9.1±7.0%, logES 18.8±11.5 vs 30.8±20.9%, p=0.01) and higher prevalence of significant aortic regurgitation (5% vs 43%, p=0.0001). The femoral TAVI access was used in 98% of bridged and 78% of direct TAVI patients (p=0.006). The estimated 1-year survival and 1-year MACE-free survival did not differ significantly between the bridged TAVI and direct TAVI groups (86.8% vs 78.3%, p=0.20 and 79.7% vs 64.2%, p=0.11, respectively). Conclusions A large proportion of patients admitted with acutely decompensated AS were not eligible for definite treatment. There is no difference in procedural success, 1-year all-cause mortality and 1-year major adverse cardiovascular events between the bridged TAVI or direct TAVI strategies in acute decompensated aortic stenosis allowing to personalize treatment strategy for individual patient. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Clinical and procedural data

COVID-19 and lung pathologies

COVID-19 is a global emergency with over 10 million cases and over 500, 000 deaths worldwide. The SARS CoV-2 is a RNA virus belonging to the family coronaviridae. It has high infectivity. The manifestations of the disease range from asymptomatic or mild symptoms to severe pneumonia and ARDS. The CT scan of lung shows consolidation and “Ground Glass Opacities”. The persons with other comorbidities are considered to be at a higher rate of acquiring the infection. Asthma and other allergies have not been identified as major risk factors for COVID-19 as the number of asthmatic patients having COVID-19 is not high enough for it to be considered so. The occurrence of COVID-19 in COPD patients can be related with smoking. The ACE-2 expression in such patients was considerably high. The relation between COVID-19 and Tuberculosis can also be reflected in terms of the stigma associated with diagnosis and treatment of such diseases in some communities, eventually increasing the chances of people's reluctance to seek medical help. Cancer patients are usually more susceptible to infections. Lung cancer is no different. Additionally, lung cancer also has strong association with smoking further increasing the risk. The risk of getting infection and its severity is high for autoimmune disorders as well as fungal infections. Currently there is no definite treatment of COVID-19. However, some of the currently used modalities are hydroxychloroquine and antiviral drugs.

COVID-19: sudden and dramatic upsurge in the number of cases in India

The second wave of coronavirus disease 2019 (COVID-19) in India, which commenced in March’21, continues to create a major crisis of medications, hospital beds, oxygen, and Intensive Care Units at very rapid rate which has placed the country on the verge of a humanitarian crisis. While no definite treatment for SARS-CoV-2 has been found, different types of vaccines have been manufactured which have shown some effectiveness in preventing disease progression and severity. The objective of this manuscript is to review the available data from the pandemic and highlight the factors that have contributed to the development of second wave in India which has led to crisis. In this review, using available scientific literature on various indexes such as PubMed, Google Scholar, Medline and news articles- where appropriate, we dive into understanding newer virus variants, vaccines and their effectiveness against new strains, overwhelming burden on the Indian healthcare system and socio-politico-environmental factors responsible for upsurge. The sudden upsurge in the number of cases is multifactorial, which includes virus variants, complacency in following COVID-19 appropriate behaviour, burden over the health care system, various socio-politico-environmental factors. As the definitive treatment is yet to be discovered, vaccination remains at the top.

Middle Ear Adenomatous Neuroendocrine Tumor: A Rare Entity

Middle ear adenomatous neuroendocrine tumors (MEANT) are rare, mainly benign neoplasms and account for less than 2% of the middle and inner ear neoplasms. There are no specific radiological or clinical findings; therefore, the diagnosis is often difficult. Biopsy prior to surgery is often proposed. The definite treatment is the complete surgical resection. We present an uncommon clinical report of a MEANT, which was treated successfully with surgical excision.

Detailed analysis of recovery process of cranial nerve palsy after IMRT-based comprehensive treatment in nasopharyngeal carcinoma

Background cranial nerve (CN) palsy in nasopharyngeal carcinoma with cancer-related involvement of cranial nerve has been considered as an unfavorable prognostic factor for NPC. We assessed the role of IMRT based treatment modality on the recovery of CN and investigated the prognostic value of CN palsy recovery. Methods A total of 115 NPC patients with CN palsy were included in the study. We referred CTCAE version 5.0 to evaluate the grade of CN palsy. Results All patients with grade 1 CN palsy recovered completely during the 2 years of follow-up after definite treatment. Most grade 2 palsy could change gradually to grade 1 palsy or complete recovery during two years of follow-up. The 3-year DFS were 84.9% in patients experienced 1 or 2 symptom of CN palsy compared with 60.3% in patients with more than 2 symptoms of CN palsy (HR: 0.25, 95%CI: 0.07–0.89, P = 0.001). Conclusions IMRT based comprehensive treatment could effectively promote the recovery of tumor-related CN palsy in locoregionally advanced NPC.

Clinicogenetic Profile, Treatment Modalities, and Mortality Predictors of Gaucher Disease: A 15-Year Retrospective Study

<b><i>Introduction:</i></b> Gaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder, in which biallelic pathogenic variants in the Glucosidase beta acid (<i>GBA</i>) gene result in defective functioning of glucosylceramidase that causes deposition of glucocerebroside in cells. GD has 3 major types namely, non-neuronopathic (type I), acute neuronopathic (type II), and chronic neuronopathic (type III). Definite treatment options are limited and expensive. They succumb early to the disease, if untreated. There is paucity of studies from the Indian subcontinent, which elicit the factors resulting in their premature mortality. <b><i>Materials and Methods:</i></b> A retrospective study was carried out in a tertiary care setting of South India to assess the clinical profile, mutation spectrum, and various management strategies (only supportive therapy, enzyme replacement therapy [ERT], substrate reduction therapy [SRT] haematopoietic stem cell transplant [HSCT]), and mortality predictors of patients with GD from 2004 to 2019. A Kaplan-Meier survival curve was plotted. In silico predictions were performed for novel variants. <b><i>Results:</i></b> There were 60 patients with all types of GD seen over the study period of 15 years. Their median age at diagnosis was 2 years. The median follow-up was for 5 years (interquartile range [IQR] = 2–8). The overall mortality rate was 35%; however, it was only 10% in those receiving definite treatment. Mortality was higher (47.5%) by more than 4 folds in those only on supportive therapy. The median survival from the time of diagnosis was 6.3 years (IQR = 3.5–10.8) in the definite treatment group and 3.5 years (IQR = 1–5) in those on supportive therapy. The Kaplan-Meier survival analysis showed significant (<i>p</i> value 0.001) mortality difference between these groups. The multiple logistic regression analysis found the neuronopathic type (OR = 5) and only supportive therapy (OR = 6.3) to be the independent risk factors for premature mortality. <b><i>Conclusion:</i></b> GD is a rare disease with a high mortality rate, if left untreated. ERT and SRT are the definitive treatments which increase the survival. In resource-limited settings like India, with higher prevalence of the neuronopathic type, HSCT may be a more suitable definitive treatment option, due to its one-time intervention and cost, assuming similar efficacy to ERT. However, the efficacy and safety of HSCT in GD needs to be established further by substantial patient numbers undergoing it.

Role of Phage Therapy in COVID-19 Infection: Future Prospects

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan City, China, in 2019. After that, the outbreak has grown into a global pandemic and definite treatment for the disease, termed coronavirus disease 2019 (COVID-19), is currently unavailable. The slow translational progress in the field of research suggests that a large number of studies are urgently required for targeted therapy. In this context, this hypothesis explores the role of bacteriophages on SARS-CoV-2, especially concerning phage therapy (PT). Several studies have confirmed that in addition to their antibacterial abilities, phages also show antiviral properties. It has also been shown that PT is effective for building immunity against viral pathogens by reducing the activation of NF kappa B; additionally, phages produce the antiviral protein phagicin. Phages can also induce antiviral immunity by upregulating expression of defensin 2. Phages may protect eukaryotic cells by competing with viral adsorption and viral penetration of cells, virus mediated cell apoptosis as well as replication. Moreover, by inhibiting activation of NF-κB and ROS production, phages can down regulate excessive inflammatory reactions relevant in clinical course of COVID-19. In this chapter, we hypothesize that the PT may play a therapeutic role in the treatment of COVID-19.

LONG TERM COMPLICATIONS OF COVID-19

SARS-CoV-2 pandemic started in December 2019. Some countries have seen second and even third wave of infection. Unlike in the beginning of the pandemic, the management of the infection has improved over the period resulting in less morbidity and mortality. This is because of improved knowledge of the disease due to several studies that are conducted during last one year. However, of late what is worrying is the long-term complications of the disease. The most common being the post covid fatigue, which lasts more than six months in some patients resulting in not able to carry out routine work as well as earning livelihood. Other common complications are pulmonary, cardiac, renal and neurological. The exact mechanism of these complications are not known. The real problem is that there is no definite treatment for these complications. Resting, relaxing and reassurance are the treatment practiced now apart from organ/system specific management. Since the pandemic is recent one we may have wait for some more time to get more information of long-term sequelae of COVID19.

Micronutrients and Soil Microorganisms in the Suppression of Potato Common Scab

Nature-friendly approaches for crop protection are sought after in the effort to reduce the use of agrochemicals. However, the transfer of scientific findings to agriculture practice is relatively slow because research results are sometimes contradictory or do not clearly lead to applicable approaches. Common scab of potatoes is a disease affecting potatoes worldwide, for which no definite treatment is available. That is due to many complex interactions affecting its incidence and severity. The review aims to determine options for the control of the disease using additions of micronutrients and modification of microbial communities. We propose three approaches for the improvement by (1) supplying soils with limiting nutrients, (2) supporting microbial communities with high mineral solubilization capabilities or (3) applying communities antagonistic to the pathogen. The procedures for the disease control may include fertilization with micronutrients and appropriate organic matter or inoculation with beneficial strains selected according to local environmental conditions. Further research is proposed to use metagenomics/metabolomics to identify key soil–plant–microbe interactions in comparisons of disease-suppressive and -conducive soils.