|Lifestyle intervention: A preventive approach for non-communicable diseases|
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):119-120
|Significance of Shringagrahika Nyaya (maxim) in understanding Charaka Samhita in context to commentary of Chakrapani|
Rajkumar Chinthala, Shubhangi Kamble, AS Baghel, N N L Bhagavathi
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):121-126
Background: Ancient Ayurveda seers presented the knowledge in coded language, in the form of Sutras (verses). These verses are characterized by Padairalpam, Matimbuddhwa, i.e. having few words with concealed meaning with larger applications which can be explored with the help of Sanskrit grammar. Sometimes, just translation of the original verses might not convey the authentic and primary aim of the author as it depends on various factors such as the context, time and place. For this purpose, various commentators have adopted the methodology of integrating Nyayas (maxims) in their respective commentaries. Shringagrahika Nyaya (SGN) also belongs to the same category as it has been mentioned in several contexts in Chakrapani's Ayurveda Dipika (AD) commentary on Charaka Samhita. It is the maxim of seizing the ox by its horns. The present work is an attempt to explore the different contexts of SGN in AD commentary. Aim and Objective: To explore the significance of SGN in understanding Charaka Samhita in context to AD commentary of Chakrapani. Materials and Methods: Original text of Charaka Samhita along with Chakrapani's commentary, other available translations and published articles in peer-reviewed journals, published books and subject-related material available online have been thoroughly screened, compiled, organized and described in a systematic manner. Observations: Thorough screening of AD commentary of Charaka Samhita revealed that SGN has been mentioned in 12 different contexts out of which some are in positive and some are in negative sense. In a group of similar objects to indicate a particular one, this maxim has been used. Conclusion: To get authentic apprehension of Ayurvedic treatises, the knowledge of SGN is essential for the physicians, especially for better understanding of Charaka Samhita as well as successful implementation of fundamental concepts for the management of various disease conditions.
|Variation in skin hydration on the basis of Deha Prakriti (body constitution): A cross-sectional observational study|
Umarkar V Suwarna, Vyas M Deepak, Kulkarni B Sheela, Sathe D Kalpana
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):127-131
Background: Prakriti (body constitution) is an important concept of Ayurveda which is decided at the time of birth. It shows differences in physical, physiological and psychological characteristics of an individual. Variation in skin characteristics is found as per Prakriti. Aim: The aim of the present work was to study hydration of skin over volar forearm in people with different Prakriti with the help of skin diagnostic SD 27 instrument. Subjects and Methods: This was a cross-sectional study conducted at Cosmetic Technology Department in unmarried healthy female students of (18–30 years). A total of 904 volunteers were screened, of which 621 volunteers were further examined for Deha Prakriti for screening of single Dosha dominant Prakriti. 58 Vata, 70 Pitta and 61 Kapha dominant Prakriti were eligible for further study, but on actual day of skin examination, 50 volunteers in each group completed the study. Skin hydration was measured by skin diagnostic SD 27 instrument. Results: It was found that maximum people with Vata (92%) and Pitta dominantPrakriti (70%) had less hydration while (48%) Kapha dominant Prakriti volunteers had normal to dehydrated skin. Chi-square test was used for analysis. The Chi-square value is 45.9 and P= 0.0001, which is highly significant. Conclusion: The skin of Vata and Pitta dominant Prakriti had less hydration while hydration was well maintained in Kapha dominant Prakriti than that of Vata and Pitta Prakriti people.
|A descriptive cross-sectional study on various uses and outcomes of Garcinia kola among people of Oshimili North in the Delta State of Nigeria|
Vincent Icheku, Ifeanyichukwu Fidelis Onianwah, Augustine Nwulia
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):132-138
Background: A preliminary review of literature for this study shows that the use of Garcinia kola (bitter kola) as plant medicine is common among Africans but there are no scientific evidence to support its uses to prevent or treat common medical conditions. The main purpose of this study, therefore, is to examine the various uses and outcomes of Garcinia kola (G. kola) among people of Oshimili North in the Delta State of Nigeria. Methodology: This descriptive cross-sectional quantitative study was based on a structured questionnaire for adults aged 18 and above (n = 274) in Oshimili North local government area of Delta State of Nigeria. Likert scale data were coded as follows: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree and 5 = strongly agree. As Likert-type data are usually ordinal data, which make more sense when converted to interval data. The converted ordinal data were analyzed using SPSS computer software. Ethical requirement including the administration of information sheet, written informed consent, and the provision of confidentiality was ensured. Results: The analysis of results show that the benefits derived from ingesting bitter kola were rated high for cough, bacterial or viral infection and anticancer. The results also show that most of the respondents consider bitter kola having low benefits for relieving food poison, diarrhea or stomach upset. Chi-square results show no association between gender and perceived benefits of bitter kola for relieving these conditions. In addition, results show that females perceive benefits derive from ingesting bitter kola as low as an aphrodisiac whereas males consider it as average. Chi-square results show significant association between gender and perceived benefits of bitter kola as an aphrodisiac. Conclusion: The study found that Garcinia kola acts as anti-bacteria, anti-virus and provides protection against cancer. However, this study could not find any conclusive evidence to support the age long claim of bitter kola as treatment for food poison, diarrhea or stomach upset and aphrodisiac (libido).
|Linking Prameha etiology with diabetes mellitus: Inferences from a matched case–control study|
Sanjeev Rastogi, Nripendra Pandey, Kamal Sachdev
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):139-145
Background: Diabetes is one of the most rapidly increasing disease in the contemporary context. Its rapid global rise indicates that its cause are possibly closely associated with the routine lifestyle and eating habits. Diabetes is also possibly the medical condition, which presents with a preclinical phase having a possibility of reversal if its possible causes can be seriously understood and eliminated. Experiences of diabetes management so far had not been very promising either in prevention of its incidence or spread and prevention of its complications. Aims and Objective: In this case, preventing diabetes by attempting to identify the risk factors and then proposing the ways to avoid them could be a most pragmatic way forward. Material and Methods: This study has attempted to associate Ayurvedic causes of Prameha with diabetes in a matched case–control manner (n = 24) and has shown the high association of diabetes with a few relatively less known causes such as stress (odds ratio [OR]: 7.86:1), anger (OR: 5.9:1), and excessive exposure to high ambient temperature (OR: 4.6:1). Results: Among the causative factors showing a high OR, stress and anger were particularly found statistically significant (P = 0.0173 and 0.0145, respectively). Conclusion: On the basis of these results, this can be proposed that if such studies are done on larger basis and possibly in a prospective cohort manner, it can open a completely new area of identifying the risk factors to diabetes. Such revealing knowledge will not only help us knowing about diabetes better but also definitely help us to prevent diabetes to a large extent.
|Association of Kaphaja and Kapha-Pittaja Prakriti and methylenetetrahydrofolate reductase C677T allele with type 2 diabetes|
Archana Gupta, Akhtar Ali, Priyadarshini Tewari, Neeraj Kumar Agrawal, Rashmi Patel, Parameswarappa Shivappa Byadgi
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):146-150
Background and Objectives: Type 2 diabetes is a multifactorial disorder that results from the interaction between genetic predisposition and environmental factors. Different Prakriti (body constitution) individuals have different susceptibility for the diseases, and this Prakriti is determined by both genetic and environmental factor. This study was undertaken to determine the association status of Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C with type 2 diabetes and Prakriti. Materials and Methods: After informed consent, 54 patients with type 2 diabetes and 56 individuals as normal controls were analyzed. Their constitution and pathological data were collected and MTHFR C677T and A1298C genotypes were determined. Results: Kapha/Kapha-Pittaja Prakriti were associated and found to be strong risk factors (Chi-square test = 39.67, P < 0.00001, odds ratio [OR] = 16.133, 95% confidence interval [CI] = 6.32–41.20) for type 2 diabetes. MTHFR C677T was associated (Chi-square test = 7.743, P= 0.02) with type 2 diabetes where the major CC genotype was found to be a risk for type 2 diabetes (OR = 3.78, 95% CI = 1.14–12.45). A1298C was not associated with type 2 diabetes (Chi-square test = 2.264,P= 0.322). None of the Prakriti was associated with C677T and A1298C variants. Interpretation and Conclusion: In the present study, an extremely strong association between Prakriti (Kaphaja/Kapha-Pittaja) and type 2 diabetes (P < 0.00001) was detected. The present study gives a strong clue for the association of Prakriti (body constitutional) and clinical phenotype.
|Phytopharmacognostical investigations on root and stem of Dalbergia volubilis Roxb.: An extrapharmacopoeial plant of Ayurveda|
Rabinarayan Acharya, Switu V Jani, CR Harisha, Vinay J Shukla
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):151-158
Introduction: The roots and stem of Dalbergia volubilis Roxb. are used by tribals for management of various ailments. Aims: The aim was to study the macro- and microscopic characters, physiochemical and preliminary phytochemical parameters including high-performance thin-layer chromatography (HPTLC) of D. volubilis root and stem. Materials and Methods: Experiments were performed on authenticated plant materials, following standard procedures and standard deviation was calculated using Microsoft Excel. Results: Externally, the root is creamish to dark brown in color and internally creamish, and its transverse section reveals general anatomy of dicot root. Young greenish stem, on drying, turns maroon or dark brown in color and microscopy shows dicot stem anatomy with secondary growth. Powder microscopy of root and stem reveals the presence of starch grains and rhomboidal crystals. Physicochemical parameters reveal that loss on drying of root is 10.02% w/w and stem is 7.51% w/w. Spectral comparison of similar Rfis 0.95, 0.82, 0.94 and 0.95 at short and long ultraviolet, respectively. Conclusion: D. volubilis root can be identified by the presence of abundance of starch grain, brown content and intraxylary pitting. Presence of hooks, interxylary phloem and crystal fiber are one of the rare anomalous growth patterns in stem. Results of preliminary phytochemical analysis including HPTLC on root and stem will help in further standardization.
|Comparative pharmacognostical analysis through quantitative micrometry and analytical study on Mridu and Tikshna Apamarga Kshara|
Monica Shrestha, CR Harisha, Tukaram S Dudhamal, Riddhi Kanakhara
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):159-164
Introduction: Kshara is derived from the word “Ksharana” that means as something that mobilizes and removes the deformed flesh, skin, tissue, etc., due to its corrosive nature (Ksharanata). Pratisarniya Kshara has been further classified into three types on the basis of its potency – Mridu (mild), Madhyama (moderate) and Tikshna (strong). This study aims at comparison between (Mridu and Tikshna) Apamarga Kshara on the basis of pharmacognostical and pharmaceutical evaluation. Materials and Methods: Apamarga Panchanga (whole plant of Achyranthes aspera Linn.) was collected, and authentication was done by the expert. Mridu Apamarga Kshara (MAK) andTikshna Apamarga Kshara (TAK) were prepared as proposed by Sushruta Samhita. Pharmacognostical and pharmaceutical analyses were carried out according to standard protocol. Observation and Results: Both the Kshara showed their own peculiar crystal system and analytical findings showed higher pH value (10.65) and calcium content (6.1%) in TAK as compared to MAK. Discussion: Quantitative micrometric microscopy showed more amount of crystals in TAK (13/mm2) than MAK (6/mm2), which may be due to Kapardika and Chitrakamoola (roots of Plumbago zeylenica Linn.). pH of MAK and TAK was 10.2 and 10.65, respectively. This result showed that TAK is more alkaline, which may be also due to Kapardika and Chitrakamoola. Conclusion: Sodium and potassium ion concentration was higher in MAK (Na+ = 26%, K+ = 45%) as compared to TAK (Na+ = 12.6%, K+ = 32.5%). Calcium ion estimation was lower (2.31%) in MAK and higher (6.1%) in TAK. These findings can be further used for the standardization purpose of Tikshna Kshara which may enrich the Ayurvedic Pharmacopoeia of India.
|Antibacterial activity of garlic extract on cariogenic bacteria: An in vitro study|
Minal Madhukar Kshirsagar, Arun Suresh Dodamani, Gundbakhta Nagappa Karibasappa, Prashanth K Vishwakarma, Jagdishchandra Bheemasain Vathar, Kapil Ramesh Sonawane, Harish Chaitram Jadhav, Vrushali Ramdas Khobragade
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):165-168
Background: Garlic (Allium Sativum) is ubiquitous, small and commonly used spice for processing food. There are many types of garlic and differ in shape, size, color, taste, number of cloves per bulb and storability. Objectives: To determine and compare the antibacterial activity of soft neck and hard neck species of garlic against cariogenic bacteria (Streptococcus mutans and Lactobacillus acidophilus). Materials and Methods: The well diffusion method was used to evaluate the antibacterial activity of garlic against Streptococcus mutans and Lactobacillus acidophilus. After incubation in an appropriate culture medium, diameter of zone of inhibition was measured to assess the antibacterial efficacy of garlic extract. Chlorhexidine mouthwash (ICPA HEALTH PRODUCTS LTD.) was kept as control group. Results were statistically analyzed using Kruskal Wallis test and independent 't' test. Thus, zone of inhibition (in mm) was analyzed using mean of all the readings obtained and the level of significance at <0.05 was considered statistically significant at 5% of level of significance. Results: Maximum zone of inhibition was found with hard neck garlic extract (24mm) followed by soft neck garlic extract (18mm) and Chlorhexidine (17mm) against Streptococcus mutans and Lactobacillus acidophilus. Conclusion: Action of garlic against Streptococcus mutans and Lactobacillus acidophilus raises the possibility that it can be used for dental caries and other oral infections possibly.
|Influence of intrinsic microbes on phytochemical changes and antioxidant activity of the Ayurvedic fermented medicines: Balarishta and Chandanasava|
Annadurai Vinothkanna, Soundarapandian Sekar
AYU (An international quarterly journal of research in Ayurveda) 2018 39(3):169-181
Background: Balarishta and Chandanasava are polyherbal-fermented medicines of Ayurveda. Objective: Investigation of native microbes, understanding phytochemical changes and antioxidant activities in these medicines. Methods: Microbial populations were enumerated using selective media and standard plating methods. Yeast and bacteria were identified using classical and molecular methods. Qualitative phytochemical and gas chromatography-mass spectrometry (GC-MS) analyses were carried out.In vitro antioxidant assays were performed with different assay systems. Results: Balarishta and Chandanasava possess two yeasts (Saccharomyces cerevisiae and Schizosaccharomyces pombe) and six bacteria that are species of Bacillus, Paenibacillus, and Brevibacillus. These microbes identified biochemically were authenticated with 16S and 18S rDNA sequence analysis and NCBI accession numbers. GC-MS analysis indicated that several compounds disappear as a result of fermentation while many are retained. The presence of new phytochemical compounds in the final stages of fermentation could be ascribed from the parent molecules that either disappeared or retained during fermentation. It suggests the biotransformation of phytochemicals by the mediation of intrinsic microbes. These medicines possess antioxidant activities by the presence of phytochemicals such as phenolics, flavonoids, tannins and phytosterols, wherein bacteria also contribute. Conclusion: The role of native microbial consortium in fermentation, biotransformation and antioxidant activity of these Arishta and Asava is demonstrated.
Παρασκευή, 29 Μαρτίου 2019
|A new beginning|
Indian Journal of Radiology and Imaging 2019 29(1):1-1
|Is next-generation radiologist ready for the challenges?|
Indian Journal of Radiology and Imaging 2019 29(1):2-3
Indian Journal of Radiology and Imaging 2019 29(1):4-5
|Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features|
Rohan Kamat, Pankaj Gupta, Yalaka Rami Reddy, Suman Kochhar, Birinder Nagi, Rakesh Kochhar
Indian Journal of Radiology and Imaging 2019 29(1):6-13
Corrosive ingestion is a common form of poisoning. Corrosive agents cause severe damage to the gastrointestinal (GI) tract. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury is life-long morbidity. Upper GI endoscopy is the test of choice for assessing severity in the acute phase of the disease. The long-term management is based on the site, length, number, location, and tightness of the stricture. This information is best provided by the barium contrast studies. In this pictorial review, a spectrum of findings in patients with corrosive injuries of the esophagus and stomach is illustrated. The role of various imaging modalities including barium studies, endoscopic ultrasound, computed tomography, and magnetic resonance imaging is discussed.
|"Honeycomb" pattern of gallbladder wall thickening – A forward step in early diagnosis of "Severe Dengue Fever"|
Jitendra Parmar, Maulik Vora, Chander Mohan, Sandip Shah, Harsh Mahajan, Tapan Patel
Indian Journal of Radiology and Imaging 2019 29(1):14-18
Aims and Objectives: To study “Honeycomb” pattern of gallbladder wall thickening (GBWT) in dengue fever (DF) and to assess its clinical significance in early diagnosis of severe DF. Materials and Methods: A total 244 patients of DF were studied, 84 patients were classified as severe DF, 61 patients as DF with warning signs, and 99 patients as DF without warning signs. Abdominal ultrasound was performed for assessment of GBWT patterns, hepatomegaly, splenomegaly, pancreatic enlargement, ascites, pleural effusion, and other additional findings were recorded in severe DF cases. Statistical comparison between “Honeycomb” pattern of GBWT and clinically severe DF was done using Pearson correlation test. Results: Out of 244 patients, 145 patients were males and 99 patients were females, belonging to various age groups ranging from 1 to 81 years and 14.34% (35 patients) among them included in pediatric group. In total, 65.57% (160 patients) were non-severe DF cases and 34.42% (84 patients) were severe DF cases. A total of 84 patients of severe DF, 92.85% patients showed GBWT, and out of which, 71.42% patients had “Honeycomb” pattern, whereas a total of 160 patients of non-severe DF patients, 45% patients had GBWT and out of which, only 5.6% patients showed “Honeycomb” pattern.”Honeycomb” pattern of GBWT shows sensitivity of 71.4%, 94.37%, Positive predictive value of 86.95%, and Negative predictive value of 86.28% in severe DF. Conclusion:”Honeycomb” pattern of GBWT is significant finding in severe DF. Its sensitivity and specificity are high in severe DF with significant statistical correlation. It can aid in early diagnosis of severe DF.
|Adhesive capsulitis: MRI correlation with clinical stages and proposal of MRI staging|
Amarnath Chellathurai, Komalavalli Subbiah, Atchaya Elangovan, Sivakumar Kannappan
Indian Journal of Radiology and Imaging 2019 29(1):19-24
Objective: The purpose of this study was to correlate the magnetic resonance imaging (MRI) findings of adhesive capsulitis with clinical stages and thereby propose a MR staging system. Materials and Methods: This study consisted of 74 patients with clinically diagnosed adhesive capsulitis. The edema of the inferior glenohumeral ligament (IGHL), pericapsular edema, thickness of anterior band of IGHL, axillary pouch, thickness of coracohumeral ligament, and obliteration of fat in the subcoracoid triangle were evaluated by MRI. Results: Thickening of the anterior band of IGHL showed most significant correlation with the clinical stages. The distribution of edema of IGHL and pericapsular edema also showed significant correlation with the clinical stages of adhesive capsulitis. Pericapsular edema and IGHL edema was not observed in stage IV. Conclusion: MR is a useful tool for evaluation and prediction of clinical stage of adhesive capsulitis.
|Role of apparent diffusion coefficient as a biomarker in the evaluation of cervical cancer|
Sunita Dashottar, T Preeth Pany, Nishant Lohia
Indian Journal of Radiology and Imaging 2019 29(1):25-32
Background: Diffusion-weighted magnetic resonance imaging (DW-MRI) has evolved as a major diagnostic and prognostic tool in cervical cancer. The aim of our study was to compare the change in mean apparent diffusion coefficient (ADC) value before and after concurrent chemoradiation therapy (CCRT) in carcinoma cervix thereby establishing its role as a cancer biomarker. Materials and Methods: A hospital-based prospective study was conducted in 35 patients diagnosed with cervical cancer. All 35 patients underwent pelvic MRI before and after 6 months of CCRT. The study was done over a period of 12 months. Conventional axial and sagittal T2 imaging was followed by DW-MRI. In the axial DW/ADC images at “b-value” of 800 s/mm2, a circular region of interest was drawn covering more than 60% of the tumor volume to calculate the ADC values. Statistical Package for the Social Sciences (version 21.0) was used for statistical evaluation. Chi-square test, independent samples t-test, and analysis of variance were used to analyze the data. The results are depicted as frequencies (number), proportion (percentages), and mean ± standard deviation. Results: Pre-CCRT mean ADC value was 0.814 × 10−3 mm2/s. Post-CCRT mean ADC value was 1.294 × 10−3 mm2/s. Mean ADC value of patients having lymph node involvement and parametrial extension was significantly lower when compared with those without lymph node involvement and parametrial extension (P = 0.001). Nonresponders with residual lesion had lower ADC values than responders with no residual lesion. An interesting and unique observation was that pre-CCRT mean ADC value of responders was higher than nonresponders. Conclusion: An increase in mean ADC value of 0.480 × 10−3 mm2/s after CCRT was found to be statistically significant (P < 0.001) thereby proving its role as an imaging biomarker in cancer cervix.
|Cardiac T2* magnetic resonance analysis of membranous interventricular septum in assessment of cardiac iron overload in pediatric thalassemia patients: A pilot study|
Ishan Kumar, Priyanka Aggarwal, Vineeta Gupta, Ashish Verma, Suwen Kumar, Ram C Shukla
Indian Journal of Radiology and Imaging 2019 29(1):33-39
Background: Cardiac iron deposition in transfusion-dependent thalassemia patients is patchy in distribution. Purpose: The purpose of this study is to assess the correlation between T2* matrices of membranous interventricular septum (MIVS) and T2* values of muscular interventricular septum (IVS) on magnetic resonance imaging (MRI) and to evaluate the relationship of myocardial T2* at these two locations with MRI-estimated liver iron concentrations (LIC) and electrocardiographic (ECG) parameters. Material and Methods: MRI of heart and liver was performed in 16 consecutive pediatric patients of transfusion-dependent thalassemia major to calculate liver iron concentration and T2* time of membranous and muscular IVS. ECG parameters of these patients were charted and correlated with MRI parameters. Results: No significant correlation between T2* values of muscular IVS and MIVS was observed. Mean T2* of MIVS (9.8 ms) was significantly lower than that of muscular IVS (26.9 ms). T2* of MIVS correlated strongly with LIC where as a weak correlation was observed between T2* of IVS and LIC. Significantly higher mean QTc (corrected QT interval) value (439.86 ms) was seen in patients with T2* IVS <20 ms. Conclusion: Addition of T2* analysis of MIVS to the existing MRI protocol, consisting of muscular IVS analysis, may offer a more sensitive estimation of cardiac iron overload.
|Safety and outcomes of pre-operative portal vein embolization using N-butyl cyanoacrylate (Glue) in hepatobiliary malignancies: A single center retrospective analysis|
Amar Mukund, Aniket Mondal, Yashwant Patidar, Senthil Kumar
Indian Journal of Radiology and Imaging 2019 29(1):40-46
Aims and Objectives: To evaluate the outcome of preoperative portal vein embolization (PVE) using N-butyl cyanoacrylate (NBCA) for change in future liver remnant (FLR) volume, biochemical changes, and procedure-related complications. The factors affecting FLR hypertrophy and the rate of resection was also evaluated for this cohort. Materials and Methods: From 2012 to 2017, PVE utilizing NBCA mixed with lipiodol (1:4) was performed using percutaneous approach in 28 patients with hepatobiliary malignancies with low FLR. All patients underwent volumetric computed tomography (CT) assessment before and at 3–5 weeks after PVE and total liver volume (TLV), FLR volume, and FLR/TLV ratio, changes in portal vein diameter and factors affecting FLR were evaluated. Complications and the resectability rate were recorded and analyzed. Result: PVE was successful in all 28 patients. The mean FLR increased by 52% ± 32% after PVE (P < 0.0001). The FLR/TLV ratio was increased by 14.2% ± 2.8% (P < 0.001). Two major complications were encountered without any impact on surgery. There was no significant change seen in liver function test and complete blood counts after PVE. Eighteen patients (64.28%) underwent hepatic resection without any liver failure, and only three patients developed major complication after surgery. Remaining ten patients did not undergo surgery because of extrahepatic metastasis detected either on follow-up imaging or staging laparotomy. Patients with diabetes showed a lower rate of hypertrophy (P < 0.05). Conclusion: Preoperative PVE with NBCA is safe and effective for increasing FLR volume in patients of all age group and even in patients with an underlying liver parenchymal disease with hepatobiliary malignancy. Lesser hypertrophy was noted in patients with diabetes. A reasonable resectability was achieved despite having a high rejection in gall bladder cancer subgroup due to rapid disease progression.
|Early experience of combination therapy of transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma measuring 3–7 cm|
Yashwant Patidar, Lalit Garg, Amar Mukund, Shiv Kumar Sarin
Indian Journal of Radiology and Imaging 2019 29(1):47-52
Background of the Article: Hepatocellular carcinoma (HCC) is one of the most common human malignancies worldwide. Radiofrequency ablation (RFA) is considered curative option in selected patients; efficacy is severely limited by lesion size and lesions bordering a large vessel. On the other hand, transarterial chemoembolization (TACE) is not limited by lesion size and arterial occlusion of the tumor feeding vessels leads to increase the volume of the ablative zone. Combination treatments using both intraarterial liver-directed therapy and percutaneous ablation seek to overcome the disadvantages of the individual treatments alone, theoretically improving response to therapy and survival. Material and Methods: This is a single-center retrospectively study in which patients who received TACE plus RFA for HCC were evaluated for technical success, local tumor progression rates, distant intra and extrahepatic recurrences and survival. Results: The study included 22 patients, 21 patients had a solitary HCC of size 3–7 cm and one patient had three target lesions. Technical success achieved after first session of combination treatment was 100% (24/24). At 1 and 3 months follow-up 100% patients (24 target lesions) had complete response and at 6 months; 21 (87.5%) had complete response, one (4.2%) had local tumor progression and two patients (8.3%) developed progressive disease. No major difference in complication was noted. The event-free survival as shown by Kaplan–Meier graph analysis at 6 and 12 months were 90.7% and 66.4% with mean time to event-free survival was 11.1 months. Conclusion: The combined use of TACE and RFA is a safe and effective option in the treatment of patients with single large or multinodular HCC when surgical resection is not feasible and this approach provides better results than RFA or TACE alone.
|Urinary tract infection in renal transplant recipients: A clinical conundrum|
Praveen Kumar Etta
Indian Journal of Transplantation 2019 13(1):1-4
|World of omics in transplantation – "Transplantomics"|
Indian Journal of Transplantation 2019 13(1):5-8
Over recent years, the transplantation outcomes have improved dramatically. However, rejections still occur despite potent immunosuppression. Furthermore, long-term transplant complications affect outcomes, for example, new-onset diabetes after transplantation (NODAT) or cancers worsen outcomes. The science of transplantomics is a relatively novel science directed at further improving short- and long-term outcomes after transplantation. Hence, nephrologists need to be aware of potential applications of omics in transplantation.
|Chronic antibody rejection in renal allograft: An underestimated cause of renal allograft dysfunction|
Nishika Madireddy, Megha S Uppin, Swarnalatha Guditi, Gangadhar Taduri, Sree Bhushan Raju
Indian Journal of Transplantation 2019 13(1):9-14
Introduction: Chronic antibody-mediated rejection (CAMR) has now emerged as one of the most common causes of chronic graft failure. In this study, we tried to study the clinical details, morphological features, risk factors, and outcome of biopsy-proven CAMR. Materials and Methods: This was a retrospective study including 14 patients' with biopsy-proven CAMR. The clinical details, posttransplantation duration, risk factors, histomorphological features, immunohistochemical features, treatment protocol, and graft outcome of all the patients were studied. Results: There were 11 male and 3 female patients and the mean age at biopsy was 33 ± 10 years. The mean transplant duration to the diagnosis of CAMR was 61 months. The mean serum creatinine levels and 24-h proteinuria at the time of biopsy were 5.3 ± 4.5 mg/dl and 3.4 ± 0.9 g/24 h, respectively. Four patients had a previous episode of rejection and three patients had a concurrent hepatitis C virus (HCV) infection. Transplant glomerulopathy (TG) was seen in all 14 biopsies and all were positive for C4D in the peritubular capillaries. Twelve of these progressed to graft failure. Conclusion: CAMR is an important cause of chronic graft rejection, with a majority of cases progressing to graft failure. TG is the most commonly observed histomorphological pattern and the severity of TG seems to be associated with poor graft survival. An associated HCV infection further hinders the graft survival.
|Knowledge, attitude, and practice regarding organ donation among adult Population of an Urban field practice area of a medical college in Durgapur, West Bengal, India|
Sourabh Paul, Tapas K Som, Indranil Saha, Gautam Ghose, Arpan Bera, Akansha Singh
Indian Journal of Transplantation 2019 13(1):15-19
Background: Organ donation is either when a person allows healthy transplantable organs/tissues to be removed, after death, or when the donor is alive and transplanted into other persons. Common transplantations include eyes, kidneys, liver, heart, skin, and bone marrow. The present study was conducted to understand the knowledge, attitude, and practice pattern of organ donation among the participants and to find out the association between the knowledge of organ donation with selected variables of interest. Methods: The present study was a cross-sectional study conducted among adult participants of an urban area of Durgapur from October 18, 2016, to November 5, 2016. A predesigned and pretested pro forma was used for data collection. Results: About 73.3% of the participants had heard about organ donation. Majority of the participants were female, aged 31–40 years, illiterate, and with a monthly income less than Rs. 5000/month. Eye was the most common donatable organ identified by the participants. Majority of the participants were unaware about the existing law in India about organ donation. Not a single participant had donated any organ, but 6% of them had signed form for cadaveric donation. Participants those who have educational status above high school had better knowledge compared to those who have lesser educational qualification (P = 0.001). Similarly, participants with monthly family income ≥10,000 also had better knowledge compared to other groups (P = 0.029), and this relation was statistically significant. Conclusion: Awareness about organ donation is not satisfactory, but the community had a positive attitude toward organ donation.
|Spectrum of asymptomatic bacteriuria in renal allograft recipients and its short-term effect on graft outcome: Experience of a Tertiary Care Center from Northwest India|
Gaurav Shekhar Sharma, Dhananjay Agarwal, Vinay Rathore, Alok Kumar Pandey, Rajesh Jhorawat, Sanjeev Kumar Sharma, Pankaj Beniwal, Vinay Malhotra
Indian Journal of Transplantation 2019 13(1):20-24
Introduction: Asymptomatic bacteriuria (AB) is not uncommon after renal transplantation with limited data from developing countries; we did this study to assess the microbiological spectrum and its short-term graft outcome in our tertiary care center. Materials and Methods: It is a prospective observational study. We included all the patients who underwent renal transplantation over a period of 18 months, from January 2016 to June 2017. Patients who had indwelling urinary catheter beyond 5 days posttransplant and those with persistent graft dysfunction within 6 months of transplant were excluded from the study. Results: A total of 67 patients were included in the study with a mean age of 33.78 ± 8.91 years and a male-to-female ratio of 7:1; live-related donors were 36 (53.73%), live unrelated were 19 (28.35%), and 12 (17.91%) were cadaveric renal allograft recipients (RARs). Twenty-eight (41.79%) patients had 42 episodes of AB over 6 months of follow-up. The maximum episodes occurred within 1 month of postrenal transplantation, and 42 out of 67 (62.68%) RARs had bacterial growth in their double-J ureteral stents (USs). The most frequently isolated pathogen from urine was Escherichia coli (n = 14, 33.33%), whereas Pseudomonas aeruginosa (n = 10, 23.80%) was in US culture (USC). The prevalence of AB was higher in cadaveric RARs compared to live RARs (83.33% vs. 32.72%, P = 0.001) and with bacterial growth in the USC compared to those who did not show any growth in USs (57.14% vs. 16.0%, P = 0.001). However, the estimated glomerular filtration rate between those with AB and those without at 6 months of follow-up (66.36 ± 14.98 vs. 66.10 ± 13.83 ml/min/1.73 m2, P = 0.943) was not different. Conclusion: AB is not uncommon in RARs and it is more common in cadaveric RARs and those with growth in US culture without compromise in allograft function at 6 months postrenal transplant.
|A leap toward brighter future – deceased-donor renal transplantation: Three years of experience in Sawai Man Singh Hospital, Jaipur, India|
Harshal Joshi, Dhananjai Agarwal, Vinay Malhotra, Vinay Rathore, Pankaj Beniwal, Nishad Raveendran, Sanjeev Sharma, Rajesh Jhorawat, Nisha Gaur, Shailendra Kumar
Indian Journal of Transplantation 2019 13(1):25-30
Background: With an increase in the prevalence of risk factors for chronic kidney disease, the prevalence of end-stage renal disease (ESRD) is increasing in India, adding 1.75 lakh ESRD patients each year. Renal transplant is one of the best modalities of renal replacement therapy; however, it is available only in a few centers. Despite an increase in trend, deceased-donor renal transplant (DDRT) rate is only 0.34/million populations, one of the lowest rates in the world. Materials and Methods: We analyzed 25 DDRT recipients transplanted in the last 3 years. The patients were followed till death or graft loss whichever was earlier. Posttransplant outcome and complications were evaluated. Results: The patient survival was 84% (21/25), and death-censored graft survival was 84% (21/25). 16% (4/25) had the second renal transplant with a history of failed previous live renal transplant. Delayed graft function (DGF) and biopsy-proven acute rejection were seen in 16% and 12%, respectively. The mean posttransplant creatinine in recipients with functioning graft on the last follow-up was 1.14 ± 0.2 mg/dl. The most common medical complication was sepsis (40%, 10/25). Conclusion: The short-term outcome of DDRT in our center is comparable to other centers in India. DGF was the most important determinant of graft survival.
|Nutrition status and its impact on quality of life and performance status in end-stage liver disease|
Neha Bakshi, Kalyani Singh
Indian Journal of Transplantation 2019 13(1):31-37
Aim: Malnutrition in end-stage liver disease (ESLD) patients has been associated with various prognostic factors. However, its effect on nonconventional parameters is least studied. The present exploratory study analyzes the impact of malnutrition on quality of life (QoL) and performance status (PS) in ESLD. Methods: We recruited 54 adult ESLD patients. Nutrition status assessment was performed by different validated tools such as subjective global assessment (SGA), mid-upper arm circumference, triceps skinfold measurements, mid-arm muscle circumference, and body mass index (BMI) for ascites. QoL and PS were assessed by Short Form-36 Interview and Eastern Cooperative Oncology Group-PS, respectively. Results: Malnutrition in patients ranged from 24.1% to 88.9% by various nutrition assessment techniques. ESLD patients showed lower levels of QoL and PS. SGA showed that malnourished patients had significantly lower PS grades than normal patients (P < 0.05). The Chi-square adjusted Z-scores showed that moderately malnourished patients had significantly higher PS-Grade-3 (capable of only limited self-care); further, severely malnourished patients had significantly higher PS-Grade-4 (completely disabled) (P < 0.004). Furthermore, malnutrition also showed lower QoL scores. After Bonferroni correction, SGA showed significantly lower emotional well-being scores of QoL in severely malnourished patients. BMI for ascites also showed significantly lower physical functioning and physical component summary scores of QoL among severely malnourished patients. Albumin level showed a significant positive correlation with emotional well-being of the patients.Conclusion: Hence, higher degree malnutrition among ESLD is associated with lower QoL and PS. The data addresses the need for planning nutrition interventions to ameliorate malnutrition in ESLD patients to improve QoL and PS for better prognosis.
|Hepatic mucormycosis in a renal transplant recipient: A rare presentation|
Sai Chandana Gali, N Rukmangadha, Aruna Prayaga, V Siva Kumar
Indian Journal of Transplantation 2019 13(1):38-41
Fungal infections account for 5% of all infections in renal transplant recipients. Mucormycosis has emerged as an important invasive fungal infection in transplant recipients associated with aggressive clinical course and substantial rates of death. A 28-year-old male with chronic kidney disease underwent renal transplantation from a deceased brain-dead donor. Implantation kidney biopsy showed features of acute tubular necrosis. On follow-up, the patient had progressive renal failure. The patient expired 3 months after transplantation due to sepsis with refractory shock. Postmortem needle biopsy done on the liver showed areas of necrosis with broad, aseptate filamentous fungal hyphae stained positive with Gomori methenamine silver stain favoring mucormycosis. Mucormycosis is a fatal mycosis in transplant recipient due to its angiophilic and thrombosis/hemorrhage-oriented characteristics. The overall mortality rate among solid-organ transplant recipients with mucormycosis is 38%–48%. Early detection and appropriate timely management of fungal infections play a decisive role in improving the survival and reducing the mortality.
|Deep vein thrombosis occurring early postrenal transplant|
Vamsi Krishna Makkena, Manikantan Shekar, Varun Mamidi, Varun Kumar Bandi, Jayakumar Matcha
Indian Journal of Transplantation 2019 13(1):42-45
In kidney transplant recipients (KTRs), there can be an increased risk of thrombotic diseases. Here, we report a case of KTR, who developed ipsilateral acute iliofemoral deep vein thrombosis (DVT). A 38-year-old male with end-stage renal disease underwent deceased donor renal transplantation. He received antithymocyte globulin induction (2 mg/kg) and was maintained on tacrolimus, mycophenolate mofetil, and steroids. He had delayed graft function. One month posttransplant, the patient presented with right lower limb edema, with Doppler showing DVT of the right external iliac, common femoral, and proximal superficial femoral veins. He was treated with unfractionated heparin and underwent placement of retrieval filter in the infrarenal inferior vena cava (IVC) through the right internal jugular vein approach. Heparin was overlapped and switched to oral acenocoumarol. At 3 months postoperative, the patient is stable with no limb edema and serum creatinine of 0.8 mg/dl. A follow-up venous Doppler demonstrated the resolution of the thrombus. In conclusion, our patient developed DVT within 30-day postoperative period with no apparent risk factor and was successfully treated with anticoagulation and placement of IVC filter. Venography, thrombolysis, and thrombectomy pose challenges in the KTRs because of increased risk of adverse effects such as bleeding, contrast-induced nephropathy, and pulmonary embolism.
|Pancreatic transplant associated tuberculosis diagnosed and followed up on whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography|
Indian Journal of Transplantation 2019 13(1):46-49
Infection attributable to impaired host immunity is the most commonly reported cause of morbidity and mortality among pancreatic transplant recipients. Among these, tuberculosis (TB) has been reported sporadically. Herein, we present a case illustrating the role of whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosis and follow-up of peripancreatic abdominal TB in a pancreas-only transplant recipient who presented with unexplained fever.
|Preface to the first issue of Heart India 2019|
Alok Kumar Singh
Heart India 2019 7(1):1-2
|Aspirin for primary prevention: The changing paradigms!|
Akshyaya Kumar Pradhan, Vikas Gupta, Pravesh Vishwakarma
Heart India 2019 7(1):3-7
Aspirin has been a widely used antiplatelet drug for management of cardiovascular disease for last five decades. Multiple studies have established its role in secondary prevention of cardiovascular diseases. For primary prevention, the situation is not so simple. Initial studies (though large and with long follow up) performed two decades ago suggested an impressive positive risk -benefit profile. But such benefits could not be replicated in subsequent studies performed in the new millennium. Recently, three back to back studies of aspirin in primary prevention in contemporary era failed to demonstrate any benefits or the benefits were counterbalanced by bleeding events. Hence, the role of aspirin for primary prevention of cardiovascular disease is under intense scrutiny.
|Efficacy of heart failure reversal therapy program in post-menopausal females with reduced ejection fraction: An observational study|
Rohit M Sane, Snehal A Kholapure, Rahul S Mandole
Heart India 2019 7(1):8-13
Background: Heart failure with reduced ejection fraction (HFrEF) has growing prevalence, especially in postmenopausal females. Heart failure reversal therapy (HFRT) is a combination of Panchakarma and allied therapies used by Ayurveda physicians for chronic heart failure patients. This observational study was done to evaluate HFRT in HFrEF-affected postmenopausal females. Materials and Methods: The study was conducted between January 2015 and December 2017 at a Madhavbaug Hospital in Khopoli, India. The data of HFrEF patients who were administered HFRT twice over 7 days in hospital were considered. VO2 max, distance covered on 6-min walk test (6MWT), weight, body mass index (BMI), abdominal girth, heart rate (HR), and blood pressure (BP) were compared to day 1 and 90 of HFRT. Results: Twenty females were enrolled with a mean age of 64.2 ± 4.38 years. There was a significant improvement in mean VO2 max (12.30 ± 2.12 vs. 13.45 ± 2.10, P < 0.05) and mean distance covered after 6MWT (319.5 ± 92.1 vs. 369.5 ± 91.39 m, P < 0.05) of patients on day 90, when compared to day 1 of HFRT. Mean weight (55.20 ± 7.23 vs. 51.48 ± 6.70 kg, P < 0.05), mean BMI (22.51 ± 3.10 vs. 21.45 ± 2.47 kg/m2, P < 0.05), and mean abdominal girth (86.05 ± 8.57 vs. 81 ± 8.65 cm, P < 0.05) were decreased at 90 days after HFRT therapy initiation. BP and HR were reduced but not significantly (P > 0.05). Conclusion: HFRT effectively increases the VO2 max, distance walked on 6MWT and decreases metabolic parameters in postmenopausal HFrEF patients.
|Spontaneous coronary artery dissection in acute coronary syndromes: A single-center experience|
Suresh Madhavan, Jayaprasad Narayanapillai
Heart India 2019 7(1):14-20
Aim: Incidence, diagnosis, and management of spontaneous coronary artery dissection (SCAD) in the Indian subcontinent are less well understood. The present study is to find the incidence and clinical features of SCAD in acute coronary syndrome (ACS) patients undergoing coronary angiography in acute coronary settings. Subjects and Methods: This is a prospective and retrospective analysis conducted on ACS patients who underwent emergency angiogram in the Department of Cardiology, Government Medical College, Kottayam, India, from February 19, 2008, to December 31, 2017. Those without SCAD were kept as control. Results: Out of 3708 patients studied, SCAD was seen in 5.9% patients with 78.8% females and was responsible for 31.4% and 6% of ACS in females aged <50 and >50 years, respectively. The mean age of presentation was 47.2 years. Age <50 years, female sex, emotional and physical stress, and fibromuscular dysplasia (FMD) were the risk factors identified. In-hospital and 6-month mortality rate was 3.1% and 6.3%. 31.9% of SCAD patients were diagnosed to have FMD on follow-up. Only 4.1% of patients belonged to peripartum period. Medical management is superior in hemodynamically stable SCAD patients compared to invasive strategies. Conclusions: SCAD is far more common than expected in this part of the world, and the awareness regarding the diagnosis, treatment, and follow-up has to be improved.
|Does hypertension deteriorate the health-related quality of life (HRQoL)? A matched cross-sectional analytical study in an urban area of Puducherry, South India|
Bijaya Nanda Naik, Srikanta Kanungo, T Mahalakshmy
Heart India 2019 7(1):21-25
Introduction: Hypertension is a chronic disease which necessitates daily medication intake and changes in the lifestyles. This may influence the quality of life. Aims and Objective: The aim of the study was to compare the health-related quality life of hypertensive individuals and age- and gender-matched nonhypertensive individuals in an urban area of Puducherry. Setting and Design: The cross-sectional analytical study was conducted as facility as well as community-based study. Methodology: The study involved 101 hypertensive patients attending the outpatient department of an Urban Health Training Center and 101 age- and gender-matched nonhypertensive individuals recruited from the community. The health-related quality of life (HRQoL) was measured using Short Form-12 (SF-12) questionnaire. The HRQoL was expressed in eight domains: physical functioning, physical role play, bodily pain, general health, vitality, emotional role play, social functioning, and mental health. The data were entered in Epidata software, and analysis with unpaired t-test was done using SPSS software for comparison of scores between the two groups. Results: The hypertensive individuals were found to have lower quality of life in both physical and mental domains compared to nonhypertensive individuals. The physical functioning, bodily pain, and general health domains of physical component recorded statistically significant difference. Conclusion: Hypertensive individuals have poor quality of life, especially in physical component domain in our study population. Hypertensive individuals merit a vulnerable population and need special focus by health-care providers in the context of achieving universal health coverage and sustainable goals.
|Echocardiographic abnormalities in patients with cirrhosis and relation to disease severity|
PG Anish, Narayanapillai Jayaprasad, Suresh Madhavan, Raju George
Heart India 2019 7(1):26-30
Context: Cirrhosis is the leading cause for hepatic transplantation worldwide. Heart is one of the most adversely affected organs in cirrhosis and it increases morbidity and mortality in these patients. Aims: The objective of this study is to identify the echocardiographic abnormalities in patients with cirrhosis and their relation to severity of cirrhosis. Subjects and Methods: An observational study was done on patients with cirrhosis (n = 55) and age- and sex-matched controls (n = 30). Detailed echocardiographic examination including 2D, M-mode, pulsed-wave Doppler, tissue Doppler, and 2D speckle-tracking imaging was performed. Severity of cirrhosis was defined by model for end-stage liver disease (MELD) score. Comparison of various echo parameters among cases and controls and among the two groups with MELD score >12 and <12 was made. Results: The major echocardiographic abnormalities noticed were left ventricular hypertrophy in 47.3%, diastolic dysfunction in 40%, pulmonary artery hypertension in 32.7%, and pericardial effusion in 3.6% of patients. Among the various echocardiographic parameters, mitral annular velocity, deceleration time, isovolumetric relaxation time (IVRT), Sm velocity, e' velocity, E/e' ratio, and average global longitudinal strain (GLS) were significantly different in cirrhosis patients compared to the control population. Mitral annular a velocity and IVRT were significantly more in cirrhotic patients with MELD score >12. Conclusions: Cirrhosis is associated with increased LV mass and cardiac output. Diastolic dysfunction was present in 40% of patients. Although systolic function by ejection fraction was normal in cirrhotic patients, GLS was less compared to controls.
|Which strategy for bifurcation lesions? Provisional or two stent: A dilemma|
Heart India 2019 7(1):31-33
Bifurcation lesions are synonymous with unfavorable angiographic and clinical outcomes. We present a case of a bifurcated lesion in the left anterior descending artery diagonal. She was managed by implanting a single stent using the proximal optimizing technique (POT), side branch inflation, and final POT (POT-side-POT technique), without final kissing balloon.
|Year in cardiology 2018|
Alok Kumar Singh
Heart India 2019 7(1):34-40
|Prevention of atopic dermatitis: Etiological considerations and identification of potential strategies|
John C Su, Adrian J Lowe
Indian Journal of Paediatric Dermatology 2019 20(2):93-100
Research during the last decade has given many new insights into factors contributing to the development and evolution of atopic dermatitis (AD). Factors identified include skin barrier defects, proinflammatory predispositions, anomalies in the microbiome, and some environmental influences. There is now the possibility of personalizing therapy and potentially, of disease prevention. However, discerning the respective roles of early factors leading to AD development is complex. Stringent analysis for confounders must precede attribution of causality to any factor. This review examines current understandings of AD pathogenesis and related research approaches in AD primary prevention.
|Disorders of nail in infants and children|
Archana Singal, Kavita Bisherwal
Indian Journal of Paediatric Dermatology 2019 20(2):101-111
Nail disorders in infants and children do not contribute to substantial pediatric consultations as they are relatively uncommon. Nail changes are often missed as specific nail examination is not routinely done in this age group. The presentation and management of nail disorders in children are different from adults; few being specific to the children. Physiological alterations are common in infants and pediatric age. These should be known to a clinician so as to differentiate from pathological conditions, to reassure parents, and to avoid unnecessary medical intervention. The congenital nail disorders can be a part of major hereditary syndromes requiring further evaluation. Several acquired causes may cause nail dystrophy. Some of them are self-limiting while others may require long-term management. Meticulous and careful nail examination is, therefore, important in neonates, infants and children for early diagnoses, management and to prevent complications. There are few epidemiological studies delineating nail changes in infants and children. In this script, we have comprehensively reviewed nail conditions seen in pediatric population through all stages, i.e., neonates, infants, and children.
|Childhood leprosy: A review|
Swetalina Pradhan, Bibhu Prasad Nayak, Gaurav Dash
Indian Journal of Paediatric Dermatology 2019 20(2):112-116
Leprosy in children is of special importance as it is the indicator of transmission in community. It affects both the child and family members psychologically and functionally. In this review, we will discuss regarding epidemiology of childhood leprosy in detail, types of leprosy in children, diagnostic difficulties in children, prevention of disabilities in children, and effect of childhood leprosy on the community.
|Hot Topics in Paediatric Dermatology|
Vishal Thakur, Dipankar De
Indian Journal of Paediatric Dermatology 2019 20(2):117-121
|A study assessing the knowledge, attitude, and practices of parents regarding childhood hypopigmented lesions|
Akila Ravindra, Veranna Shastry, Chetana Prakash, Jaydev Betkerur
Indian Journal of Paediatric Dermatology 2019 20(2):122-127
Background: Pigmentary disorders are believed to be the most common group of dermatoses in the pediatric age group. Loss of pigment can have a profound psychological impact on parents of the affected child. There are few studies available in India about the evaluation of hypopigmented lesions in the pediatric age group. Objectives: The objective of this study was conducted to assess the knowledge and attitude and various practices of parents toward hypopigmented disorders. Materials and Methods: A total of 130 pediatric patients were evaluated for hypopigmented lesions. Parent of each child was given a preformed questionnaire for the assessment of knowledge and attitude and various practices of their skin condition. Results: The frequency of hypopigmentary disorders among children was 3.28/1000. The mean age was 8.41 years. Nearly 9.33% of patients had onset at birth. In the study of 130 parents, 82 had low, 32 had moderate, and 14 had high knowledge levels, and 84 had unfavorable, and 46 had favorable attitudes. The parents, who had incorrect practices, were 53% and 35.67% had correct practices. Conclusion: The most common hypopigmentary conditions are benign and self-limiting, which requires proper counseling of the parents. A good knowledge and attitude will not only liberate them from traditional beliefs and home remedies that have been used in most of the Indian households but will also make them understand the magnitude of the problem their child could face if they do not seek proper advice from a doctor at the right time.
|Childhood vitiligo: A hospital-based study on 200 patients in Northeast India|
NA Bishurul Hafi, Nandakishore Singh Thokchom, Shyamsunder Ch Singh, Romita Bachaspatimayum
Indian Journal of Paediatric Dermatology 2019 20(2):128-133
Background: Vitiligo is a depigmenting disorder which can be psychologically devastating. Childhood-onset vitiligo has different epidemiological and clinical characteristics as compared to adults. Aims and Objectives: The aim was to study the clinico-epidemiological and hematologic investigation profiles of childhood vitiligo. Materials and Methods: First 200 pediatric patients younger than 18 years, with vitiligo who attended the dermatology outpatient department of a tertiary center in Northeast India, between September 2015 and August 2017 were included in the study. A detailed history and examination along with autoimmune diseases and laboratory parameters were recorded. Results: Among the 200 patients, 62% were girls. The mean age was 10.3 ± 4.9 years. The mean age at onset was 9.1 ± 4.9 years (ranging 2 months–17 years), with duration of disease varying from 1 month to 8 years with mean duration of 1.39 ± 1.63 years. Most common pattern of vitiligo was vulgaris (39.5%) followed by focal (25%), segmental (15.5%) genital (10%), acral and lateral lip (8%), and acrofacial (4%). Family history of vitiligo was seen in 12% of patients. In 96% patients, only <5% of body surface area was affected. Nearly 8.5% had Koebnerization while 9% showed leukotrichia. Thyroid-stimulating hormone and antithyroid peroxidase abnormalities were seen in 4.5% and 1% patients, respectively. Low Vitamin D level was seen in 21.5%. Conclusion: Any depigmented lesion in children should be evaluated and followed up properly to rule out vitiligo. Dermatologists and pediatricians should understand the characteristics of childhood vitiligo properly since it behave differently from adult-onset disease.
|Factitious disorders in children: A diagnostic labyrinth of cases|
Chinmoy Raj, Maitreyee Panda, Debasmita Behera, Bikash Ranjan Kar
Indian Journal of Paediatric Dermatology 2019 20(2):134-137
Factitious disorders are among the most underdiagnosed and less explored group of disorders in pediatric patients. Studies from different parts of the world have reported varying prevalence rates. In this article, we present a series of nine cases of factitious disorders that we encountered in the pediatric age group. Factitious disorder remains highly elusive in developing countries like India. It is highly necessary to remain vigilant to clinch an early diagnosis and manage appropriately.
|A rare early presentation of staphylococcal scalded skin syndrome in a Neonate|
Srinivas Abhishek Gaddam, Srinidhi Thirunagari
Indian Journal of Paediatric Dermatology 2019 20(2):138-140
Staphylococcal Scalded Skin Syndrome (SSSS) is caused by the exfoliative toxins (ETs) of Staphylococcus aureus. We present a case of a 3 days old infant with complaints of fever and diffuse erythematous exfoliation all over the body with bilateral conjunctivitis. The diagnosis of SSSS was reached based on clinical features and positive blood culture report. He responded well to the antibiotics paracetamol, and intravenous fluids for rehydration. He was discharged after 14 days, with complete resolution of symptoms. Having a high clinical suspicion for SSSS, early diagnosis/treatment, and following strict aseptic measures in neonatal intensive care unit are important.
|Congenital erythropoietic porphyria in an Indian Child|
Archana Singal, MN Kayarkatte, Deepika Pandhi
Indian Journal of Paediatric Dermatology 2019 20(2):141-144
Congenital Erythropoetic Porphyria (CEP) also called the “Günther disease”, is a rare variant of porphyria. It is caused by the deficiency of uroporphyrinogen III synthase (URO-III-synthase), an enzyme in the heme biosynthetic pathway. Clinically, CEP presents with blistering over face and extremities, scarring, hypertrichosis and dyspigmentation. Acral blistering leads to mutilation of the fingers with acro-osteolysis of distal phalanx We, hereby, report an 8-years-old boy with classical clinical features and porphyrin assays.
|Vincristine, aspirin, and prednisolone therapy in Kasabach–Merritt phenomenon: Response in 2 cases|
Shikha Gupta, Subhash Bharti, Niyaz Ahmed Khan, Lavleen Singh
Indian Journal of Paediatric Dermatology 2019 20(2):145-147
Kasabach–Merritt phenomenon (KMP) is a severe thrombocytopenic coagulopathy which usually occurs in the presence of enlarging vascular tumors such as kaposiform hemangioendothelioma (KHE) and tufted angioma. The treatment for this potentially fatal condition is challenging without a consensus on appropriate management. The authors report two cases of KHE with KMP, wherein improvement in size of tumor and coagulopathy occurred after treatment with prednisolone, vincristine, and aspirin.
|Research implementation in Education and clinical practice|
Raj K Manchanda
Indian Journal of Research in Homoeopathy 2019 13(1):1-3
|Exploring the predictive value of specific symptom as prognostic factor: Assessment of group-confined likelihood ratio for symptom 'Headache' in 20 lesser-known drugs|
Jaya Gupta, Suhana P Azis, Lex Rutten, Raj K Manchanda, Abhishek Pramanik, Partha Sarathi Chakraborty, Pramodji Singh, JP Singh, Mahesh Sah, G R. C. Reddy, Manas Sarangi, Abhijit Chakma, Sunil Ramteke, PK Pradhan, P Devi, Ojit Singh, AR Sahoo, KK Avinash, Navin Kumar Singh, Siva Prasad Goli
Indian Journal of Research in Homoeopathy 2019 13(1):4-11
Aim: Assessment of group-confined likelihood ratio (GCLR) for the symptom ‘Headache’ from among 20 lesser-known remedies clinically verified by the Central Council for Research in Homoeopathy during the period 2012–2018. Materials and Methods: Analysis of data of the clinical verification study, which was a multicentric, open-label, observational clinical study conducted at 13 study sites of the council. The 50 medicines that completed the drug proving programme of the council were clinically verified in ascending potencies of 6C, 30C and 200C. Of these, 20 lesser-known medicines allowed analysis of the prevalence and LR of the symptom ‘Headache'. These 20 medicines were ordered according to the prevalence of headache, and LR >1 gave an indication what medicines were more related to headache than others. Results: The symptom ‘Headache’ was recorded in a part of the population: 4582 patients where 20 lesser-known medicines were prescribed. Of these medicines, 8 have a GCLR >1, indicating that the symptom headache could indicate these medicines out of the assessed group of 20. Only 5 had statistically significant confidence interval: Allium sativum, Formicum acidum, Gymnema sylvestre, Avena sativa and Persea americana. Among these, two medicines, Allium sativum and Formicum acidum, have significantly higher GCLR. Conclusion: Of 20 lesser-known homeopathic medicines, two could be considered for the further evaluation of the relationship with headache. These findings should be confirmed in properly organised prognostic factor research in a larger population, not restricted to specific medicines, that enables proper comparison.
|A survey regarding awareness and beliefs about Homoeopathy among general population during Magh Mela at Allahabad, Uttar Pradesh, India|
Manas Ranjan Sarangi, Abhishek Pramanik, Jaya Gupta, Ramesh Prasad, Pramodji Singh, Mahesh Shah, Alok Kumar Upadhyay, Saurabh Jain, Ambreesh Pandey, Arvind Kumar, Goutam Rakshit, Anil Khurana, Raj K Manchanda
Indian Journal of Research in Homoeopathy 2019 13(1):12-21
Background and Objective: Homoeopathy is one of the various alternative systems of medicine prevalent in India. A survey was conducted during the month of January–February 2017 in a congregation at Sangam, Allahabad, to know about the awareness of general population about Homoeopathy. Methods: A cross-sectional survey was conducted on patients and people visiting the health check-up camp and exhibition stall set-up during Magh Mela at Sangam, Allahabad. A self-administered questionnaire was used during the survey, devised by the Central Council for Research in Homoeopathy. Results: Of 1144 total respondents, 68.1% had knowledge about Homoeopathy. About 46.6% of respondents believed that it has no side effects and 15.1% believed that it is cost-effective. The diseases for which most of the participants have taken homoeopathic treatment were fever, common cold, constipation and diarrhoea. Conclusion: General population has knowledge about Homoeopathy, but various misconceptions are also prevalent. Awareness campaigns are needed to make people more aware about Homoeopathy and its effectiveness in various disorders.
|Homoeopathic drug proving of Mangolia grandiflora: A randomised double blind placebo-controlled trial|
Goutam Rakshit, AK Vichitra, Rajpal Singh, Amulya Ratna Sahoo, Sujata Kumari Choudhury, Vinay Kumar Singh
Indian Journal of Research in Homoeopathy 2019 13(1):22-36
Objective: This study was carried out to elicit the pathogenetic response of the drug Magnolia grandiflora in homoeopathic potencies on apparently healthy human beings. Materials and Methods: Drug Magnolia grandiflora was proved by the Central Council for Research in Homoeopathy (CCRH) through a double-blind placebo-controlled method. The study was conducted at three centres. The drug was proved in two potencies (6C and 30C) on 48 apparently healthy volunteers who were selected after conducting pre-trial medical examinations by the medical specialists and routine laboratory investigations. In the first phase, volunteers were given 56 doses (4 doses per day for 14 days) of placebo. In the next two phases, 56 doses (4 doses per day for 14 days) of each potency or placebo were consumed. Out of 48 provers, 32 were given the actual drug and 16 were given placebo. The symptoms generated during the trial period were noted by the volunteers and elaborated by the proving masters. The data obtained from all the three centres were compiled at the Proving-Cum-Data Processing Cell at CCRH headquarters after decoding. Results: Out of the 32 provers who were on the actual drug trial, 21 manifested symptoms. The drug was able to produce symptoms in each potency in most of the parts of the body. Conclusion: New and proved pathogenetic responses elicited during the proving trial expand the scope of use of the drug Magnolia grandiflora and will benefit the research scholars and clinicians. These symptoms will carry more value when verified clinically.
|Evaluation of qualitative phytochemical analysis of water extract of Achyranthes aspera and Achyranthes aspera 30|
Indian Journal of Research in Homoeopathy 2019 13(1):37-40
Introduction: Plant sources are a valuable starting material for drug development. These plants are the potential therapeutic agents, which provide maximum benefits with minimum adverse effects. Objective: The objective of the study is to evaluate the qualitative phytochemical analysis of water extract of whole plant excluding root of Achyranthes aspera and 30 potency of the same drug. Methodology: The qualitative phytochemical analysis of water extract of whole plant excluding root of Achyranthes aspera and Achyranthes aspera 30 has been performed to confirm the presence of alkaloid, saponin, phenolic compound, carbohydrate and proteins. Physicochemical constants such as ash, extractive values and moisture content were also determined. Results: The physicochemical analysis showed that the parts of this plant contained total ash value of 9.59% in which the acid-insoluble ash is 2.27%. The extractive values percentage of water-soluble extract is 20.91%. The qualitative phytochemical analysis reveals the presence of carbohydrates, protein, alkaloids, saponins and phenolic compounds in water extract of Achyranthes aspera and Achyranthes aspera 30. The analysis also shows that various bioactive phytochemicals are retained with dilution while preparation of Homoeopathic medicines. Conclusion: Achyranthes aspera in homoeopathic potency 30 contains its bioactive phytochemicals even after being a high dilution (with alcohol) of the original plant.
|Efficacy of predefined homoeopathic medicines in the treatment of warts: Study protocol of double blind randomised placebo controlled trial|
Central Council for Research in Homoeopathy
Indian Journal of Research in Homoeopathy 2019 13(1):41-47
Background and Objectives: The literature cites a large number of homoeopathic medicines for the treatment of warts. Studies on warts are based on experiences of individual practitioners and do not give specific factors, which are responsible for making a successful prescription for the treatment of warts. The present study was designed as a multicentric randomised, double-blind, placebo-controlled trial to evaluate response to homoeopathic treatment for the disappearance or resolution of warts and to validate the symptoms of the pre-identified 09 drugs (Antimonium crudum, Calcarea carbonicum, Causticum, Dulcamara, Natrum muriaticum, Nitric acidicum, Ruta graveolens, Sulphur and Thuja occidentalis) on clinical outcome in warts. Materials and Methods: The study would be conducted at eight centres of the Central Council for Research in Homoeopathy, where patients requiring any of the predefined medicines for warts would be randomised to Homoeopathy or placebo group using a computer-generated randomisation chart. The selected medicine would be prescribed first in 6C potency and dosage and subsequent potency as per the requirement of the case. Outcome is based on the percentage of warts completely disappeared assessed fortnightly for 6 months. Discussion: The study intends to combine randomised controlled trial with validation of symptoms of the pre-identified drugs in warts. The symptoms of verum group in each case successfully treated would be compared with that in the control group. The study would aid in assessing treatment efficacy and identifying the symptomatology on the basis of which successful prescriptions have been made.
|Resolution of lacrimal gland tumour by Homoeopathic medicines - A case report|
Partha Pratim Pal
Indian Journal of Research in Homoeopathy 2019 13(1):48-54
Lacrimal glands are exclusive structures possessing both epithelial and lymphoid tissue and may produce a variable range of pathologies such as neoplastic, infective, infiltrative, inflammatory and structural. Treatment is either anti-inflammatory in the form of corticosteroids, radiotherapy or complete excision in the field of modern medicine. A female patient named IB, aged 35 years, came with bilateral firm swelling of the lacrimal gland. She started treatment under modern medicine doctors; however, when she was advised for biopsy, for histopathological examination, she preferred to go for Homoeopathy. The swelling was developing gradually for 2 months – painless, no fluctuation, no fixity to skin and underlying structures. After thorough case-taking followed by repertorisation, Calcarea carbonica 1M, two doses were prescribed. The patient reported after 2 months with zero Outcome in Relation to Impact on Daily Living instrument score. Further modification was done in repertorisation, and now Silicea 1M, two doses was prescribed. Treatment continued for 4 more months and no new medicine or further repetition was required. Documentation was done in the form of photographs of the patient from the same angle under similar light exposure in every follow-up.
|Role of homoeopathic medicine in the treatment of infantile haemangioma|
Md Ismail Shaikh
Indian Journal of Research in Homoeopathy 2019 13(1):55-61
Infantile haemangioma is a benign vascular tumour of childhood, characterised by endothelial cell proliferation. It usually develops shortly after birth and grows most rapidly over the first 6 months. However, it may keep growing for up to 12–18 months. After that, it undergoes regression or involution, and 50% of all infantile haemangiomas have completed involution by the age of 5 years, 70% by the age of 7 years and 90% by the age of 9–12 years. However, in a small percentage of patients in whom haemangioma is not disappearing completely, residual fatty tissue or superficial skin telangiectasias remains. These patients may require drug therapy (propranolol/timolol/steroids/vincristine), surgery and/or laser therapy often during childhood involving certain risks or side effects. However, homoeopathic medicine can quickly, safely and effectively diminish proliferative growth and hasten resolution without any side effects. Two children with infantile haemangioma were treated with homoeopathic medicines, selected on the basis of their totality of symptoms and repertorisation. Each child was followed up every 2–4 weeks’ interval, and photographs were taken to assess/compare the vascularity, height (thickness), pliability and pigmentation according to the Vancouver Scar Scale chart. In the 1st case, the score reduced from 9 to 1 in about 10 months of follow-up and showed 88.8% improvement. In the 2nd case, the score reduced from 9 to 0 in about 10 months of follow-up and showed 100% improvement. These case reports show that early treatment of infantile haemangioma with Homoeopathy medicine can diminish proliferative growth and hasten resolution as early as possible without any side effects.
|Research Highlights (January–March 2019)|
Indian Journal of Research in Homoeopathy 2019 13(1):62-65
|Dr Paras Nath Varma|
Indian Journal of Research in Homoeopathy 2019 13(1):66-67
Dr. P. N. Varma, the ‘Grandmaster’ of Homoeopathy, left for his heavenly abode on 5th November 2018. The entire homoeopathic fraternity pays tributes to the legendary homeopath. Dr. P.N. Varma has made unique contributions to the homoeopathic manufacturing industry and scientific homoeopathy.
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