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   2018| April-June  | Volume 7 | Issue 2  
    Online since May 2, 2018

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Ayurvedic management of cervical spondylosis radiculopathy
Archana Kushwaha, Sarvesh Kumar Singh, Kshipra Rajoria
April-June 2018, 7(2):104-109
Radiculopathy, commonly referred as pinched nerve, refers to a set of conditions in which one or more nerves are affected and their functioning is hampered. This phenomenon is termed as neuropathy. This can result in pain or more precisely in radicular pain. In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. The management available in the current era of medicine is not satisfactory. Here, we are presenting a case of cervical spondylosis (CS) radiculopathy which was treated with a combination of Panchkarma procedures and Ayurvedic oral drugs. Greeva stambh was considered as the Ayurvedic diagnosis for the case. The treatment protocol designed for the particular case was Panchatikta ksheera Basti (enema with medicated milk) for 16 days along with Shalishastic pind sweda. The oral medication prescribed was Ashwagandha churna (Withania somnifera Dunal), Shatavari churna (Asparagus recemosus Wild), Gokshur churna (Tribulus terrestris L.) each in a dose of 2 g, Sarpgandha churna (Rauvolfia serpentina (L) Benth. Ex Kurz) 1 grms, Shankha bhasma 500 mg with Luke warm water, Yograj guggulu-3 tablet with Dashmool kwath in a dose of 40 ml, Ashwagandha avaleha 10 g with lukewarm water. All these drugs were prescribed for twice a day. Visual analog scale and range of motion were the parameter used to assess patient and considerable improvement was noticed in the case after a month of treatment which sustained in follow-up duration of 2 months. The case study demonstrate that CS radiculopathy may be successfully managed with Ayurvedic treatment.
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Role of medical and psychiatric social workers in improving follow-up care in surgical settings: Medical and psychiatric social work perspective
Raju Birudu, Krishna N Reddy
April-June 2018, 7(2):120-122
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Laser versus electrocautery: A split-mouth study to evaluate depigmentation
Arnav Mukherji
April-June 2018, 7(2):117-119
Oral melanin pigmentation is considered to be multifactorial, which can be physiological or pathological and can be caused by a variety of local and/or systemic factors. Improved esthetics is the first and foremost indication for depigmentation. The selection of the technique should be based on clinical expertise and individuals' preferences, which give better results. This is a case report on comparative evaluation between electrocautery and laser for depigmentation.
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Comparative nutritional evaluation of four botanical source plants of jīvantī: A classical Ayurvedic drug
Raghavendra Naik, Rabinarayan Acharya
April-June 2018, 7(2):69-74
CONTEXT: Jīvantī is one among the best vegetable drugs to be consumed according to classical texts of āyurveda. As a single drug it is used as jīvanīya (longevity promoter), snehopaga (oleating), śvāsahara (anti-asthmatic), vayasthāpana (anti-aging), rasāyana (rejuvenator) and cakṣuṣya (eye tonic). It is also included as an ingredient of many polyherbal formulations. AIMS: The present study was carried out to evaluate the comparative nutritional values of aerial parts of Leptadenia reticulata (Retz.), Holostemma ada-kodien Schult., Wattakaka volubilis (Linn. f.) Stapf., and Dendrobium macraei Lindl., four claimed botanical source plants of jīvanti. MATERIALS AND METHODS: Different nutritional parameters like carbohydrate, fat, protein energy value, calcium, iron, zinc, manganese, phosphorus, Vitamin A, and Vitamin C were evaluated following the standard guidelines. RESULTS: Among the four plants, L. reticulata is found more nutritious by having the highest content of protein, fat, energy value phosphorus, and Vitamin A, compared to other three source drugs of jīvanti. Micronutrients such as zinc, manganese and calcium are more in W. volubilis. Holostemma ada-kodien Schult. Is having more amount of carbohydrate and Vitamin C while iron content is high in D. macraei Lindl. CONCLUSIONS: Among the four different source plants used in the name of classical drug jīvantī, L. reticulata is found more nutritious with the highest content of protein, fat, energy value phosphorus, and Vitamin A. Micronutrients such as zinc, manganese, and calcium are more in Wattakaka volubilis.
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Pharmaceutical standardization and preliminary quality control parameters of Shirishavaleha prepared from two different liquid media
Harmeet B Kaur, Galib Ruknuddin, Biswajyoti Patgiri, Prashant Bedarkar, Pradeep Kumar Prajapati
April-June 2018, 7(2):89-97
CONTEXT: The different dosage forms of Ayurveda are mostly prepared in the presence of Jala (water) as Drava dravya (extracting medium). Transfer of the medicinal properties of any Dravya (drug) is done on the virtue of Drava dravya (liquid medium). Screening through the classics reveal that seers used Drava such as Kshira (cow's milk), Gomutra (cow's urine) and Kanji (sour gruel) in preparing different formulations based on the necessity. These media are either used to get more extraction from the raw material or according to suitability and hence to increase the efficacy of the finished formulation. However, information on comparative profiles of a formulation prepared in the presence of different media is not available till date. AIM: Considering this, it is aimed to develop standard manufacturing procedure and possible analytical profiles of Shirishavaleha prepared from Kanji and water as media. MATERIALS AND METHODS: The formulation was prepared in the presence of water and Kanji with the usage of Twak (bark) of Shirisha (Albizia lebbeck Benth.) in eight batches. The quality control parameters such as determination of pH, moisture, total ash, acid-insoluble ash value, alcohol-soluble extractive value, water-soluble extractive value, total fat, total solid content, total sugar estimation, total saponin, total alkaloids, total tannin estimation, microbial limit test and determination of heavy metals (Cd, Pb, Hg, and As) to develop preliminary analytical profiles and qualitative test for various functional groups and high-performance thin layer chromatography profile were also carried out by following the standard guidelines. RESULTS: No significant differences were found in pharmaceutical and analytical aspects of both the samples of Shirishavaleha. CONCLUSION: The current methods of preparation can be considered as standard in further studies. The absence of microbial contamination and heavy metals reflects the quality and safety aspects of both the formulations.
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A study on etiological spectrum of hypoglycemia in nondiabetic patients in a rural medical teaching institution
Gouranga Santra, Dipu Roy
April-June 2018, 7(2):83-88
INTRODUCTION: Awareness regarding etiological distribution of nondiabetic hypoglycemia is poor among physicians. No study of etiological spectrum of hypoglycemia is found in rural West Bengal. We conducted this study to identify different causes of hypoglycemia in nondiabetics in a rural area of the western part of West Bengal. METHODS: Nondiabetic patients admitted in general medical ward with clinical or laboratory features of hypoglycemia with blood sugar level <70 mg/dl were evaluated clinically and from laboratory investigations to identify the underlying disorders. Relationship with food intake and recurrence of hypoglycemia were assessed. RESULTS: A total of 55 patients were included in this study. The most common cause of hypoglycemia was alcoholism (27.27%). Next common cause was steroid withdrawal (18.18%), especially in rheumatic patients. The third common cause was sepsis (12.73%), followed by panhypopituitarism (10.91%). Sheehan syndrome was seen in three cases. Hypoglycemia was detected in one chronic kidney disease (CKD) patient after hemodialysis (HD) and two CKD patients without HD. Hypoglycemia developed in one case of fulminant hepatitis, two cases of decompensated cirrhosis (hepatitis B and alcoholic), and two cases of congestive cardiac failure. Hypoglycemia developed in two cases of primary adrenocortical insufficiency due to tuberculosis and histoplasmosis of bilateral adrenal glands. All patients had fasting hypoglycemia except one case of dumping syndrome due to Billroth II gastrojejunostomy surgery. Other rare causes were insulinoma, malnutrition, and malignancy. CONCLUSION: Knowledge regarding different causes of hypoglycemia will increase the alertness and suspicion of possible hypoglycemia in appropriate situations. It will also help to identify underlying disorders in cases of hypoglycemia.
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Stride, energy expenditure, and user's satisfaction in person with postpolio residual paralysis: A comparative study between pneumatic control and drop-lock knee joint using knee-ankle-foot orthosis
Prachi Prava Pattnaik, Ranjeet Kumar, Pooja Kumari
April-June 2018, 7(2):75-79
BACKGROUND: Persons with postpolio residual paralysis (PPRP) present gait abnormalities due to residual lower extremity pareses and joint deformities.[1,2] An increase in energy cost results from lower extremity muscle weakness. Lower extremity orthoses are prescribed to reduce gait abnormalities, to enable standing and walking, and to maintain or improve physical performance. The present study is to determine the effectiveness of the newly designed pneumatic control knee joint [Figure 2] with respect to stride parameter, energy expenditure, and user's satisfaction in comparison to drop-lock knee joint [Figure 1] in knee-ankle-foot orthosis (KAFO) in a patient with PPRP.{Figure 1}{Figure 2} METHODS: Purposive sampling was done for the study, and thirty patients were recruited. The stride parameter, energy expenditure, and user's satisfaction were measured between drop-lock knee joint KAFO and pneumatic control knee joint KAFO. An adaptation period of 1 h was provided with pneumatic control KAFO. RESULTS: A paired t-test was conducted for estimating step length and stride length for subjects using drop-lock KAFO and Pnuematic control KAFO. Pneumatic Control KAFO showed a higher significance in both step length with (t = −5.150, P = 0.000) and Stride length (t = −5.026, P = 0.000). A paired t-test conducted for cadence shows a signifi cant difference (t = 1.066, P = 0.295) in favor of drop-lock KAFO. The speed shows a signifi cant difference (t = −4.704, P = 0.000) in favor of pneumatic control KAFO. Physiological cost index while walking with pneumatic control KAFO was signifi cantly lower than those walking with drop-lock KAFO (t = −5.575, P value = 0.000). The user's satisfaction for the subjects using the drop-lock KAFO and the pneumatic control KAFO shows a significant difference (t = −9.798, P = 0.000) in favor of pneumatic control KAFO. CONCLUSION: The study concludes the pneumatic control KAFO to have significantly greater value as compared to drop-lock KAFO in terms of stride parameter and energy expenditure and user's satisfaction in subjects with PPRP.
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Fetal hemoglobin gene expression in patients with sickle cell disease in North Central Nigeria
Amos Dangana, Idris Abdullahi Nasir, Jessy Thomas Medugu, Felix O Emelike, BO Oluwatayo, Abubakar Shehu Haruna
April-June 2018, 7(2):98-103
BACKGROUND: Fetal hemoglobin (HbF) plays a dominant role in ameliorating morbidity and mortality associated with sickle cell disease (SCD). OBJECTIVE: This study evaluated the distribution pattern of HbF and total Hb concentration among 75 participants with homozygous sickle cell trait (HbSHbS) as test cases and 71 with homozygous normal trait (HbAHbA) as controls. MATERIALS AND METHODS: Ethylenediaminetetraacetic acid-anticoagulated blood samples were collected from all participants. They were tested for HbF and HbA fractions using high-performance liquid chromatography, while total Hb concentration was determined by cynomethemoglobin technique. RESULTS: Participants with HbSHbS genotype showed mean ± standard error of mean (SEM) of HbF levels of 6.5 ± 0.8%, HbA1 showed mean ± SEM of 2.6 ± 0.3%, and HbA2 showed mean ± SEM of 4.9 ± 0.1%. Those with HbAHbA (control participants) genotype showed mean ± SEM of HbF levels of 0.5 ± 0.04%, HbA1 showed mean ± SEM of 87.3 ± 0.4%, and HbA2 showed mean ± SEM of 3.2 ± 0.1%, while the mean ± SEM Hb concentration of test cases was 6.5 ± 0.16 g/dl and that of controls was 12.32 ± 0.13 g/dl. The total Hb concentration of sickle cell patients was significantly lower than that of nonsickle cell patients. There was a positive correlation of Hb concentration (g/dl) with HbSHbS gene expression. CONCLUSION: Findings from this study revealed that the lesser episodes of sickle cell crisis, the lower the HbF expression and higher the total Hb concentration. Hence, it is recommended that the determination of HbF, HbA1, and HbA2 levels be considered in conjunction with other routine complete blood count and hematology tests in the diagnosis and clinical management of SCD.
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Mortality trends in a tertiary care hospital in Mysore
C Deepak, Ravi V Krishna Kishore, M Suresh Babu
April-June 2018, 7(2):80-82
AIM: The aim of this study is to find out the various causes of mortality in a tertiary care hospital over a 1-year period. MATERIALS AND METHODS: All deaths occurring in the study period were retrospectively analyzed by analyzing the hospital records from the Medical Records Department for causes of death and various epidemiological parameters such as age and sex. RESULTS: A total of 1028 deaths were included the study. Deaths were more in males than females. More deaths were observed in the fifth and sixth decades of life. The maximum deaths, i.e., 356 were due to sepsis (34.6%) of which pneumonia was the cause in a majority of sepsis-related deaths (36.51%). Cardiovascular causes of death were 184 (17.89%) of which a majority of 130 (70.65%) were related to ischemic heart disease. The other causes of deaths included 137 (13.3%) from road traffic accidents, 117 (11.3%) due to cerebrovascular accidents, 73 (7.1%) due to gastrointestinal tract-related causes, 58 (5.64%) due to primary renal diseases, 45 (4.37%) from chronic respiratory ailments, 32 (3.11%) due to malignancies, 18 (1.75%) due to poisonings, and 4 (0.38%) deaths due to hematological disorders. CONCLUSION: The most common cause of overall mortality was sepsis followed by cardiac causes. Road traffic accidents also significantly contributed to the overall mortality. Steps are needed to be taken to educate the medical fraternity and the people about the prevalence and preventive strategies for communicable and noncommunicable diseases.
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Role of yoga and naturopathy in a patient with left ovarian malignancy and nonalcoholic fatty liver with ascites
M Fathima-Jebin, ST Venkateswaran, N Manavalan, A Mooventhan
April-June 2018, 7(2):110-113
A 70-year-old married woman diagnosed with left ovarian malignancy and nonalcoholic fatty liver with ascites in November 2016 underwent conventional management. In February 2017, the patient developed abdominal discomfort, bloatedness, nausea, and vomiting and underwent conventional management first in a government hospital, followed by in a private hospital, South India. Since no improvements were noted in any of the symptoms except vomiting, in March 2017, the patient was admitted to our hospital. The patient was advised to undergo yoga and naturopathy treatments for 30 days. Results showed a better improvement in weight, body mass index (BMI), abdominal girth, blood pressure (BP), plasma glucose, liver function test (LFT), and renal function test (RFT) along with very mild reduction in the size of left ovarian cancer. It suggests that yoga and naturopathic treatments may be effective in improving weight, BMI, BP, plasma glucose level, LFT, and RFT in patients with left ovarian malignancy and nonalcoholic fatty liver with ascites. Further studies are required to warrant the results.
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Primary hyperparathyroidism presenting as bilateral genu valgum
Sowmini P Kamath, Janardhan Shenoy, K Prashant Kini, Kishan B Shetty, K Anand Pai
April-June 2018, 7(2):114-116
We present two children with bilateral knock-knee. Both of them had hypercalcemia, hypophosphatemia, raised alkaline phosphatase and parathormone, normal renal function, and deficient serum vitamin D levels. Sestamibi scintigraphy showed a parathyroid adenoma in both children, which was removed surgically with improvement. Primary hyperparathyroidism should be a differential diagnosis for bilateral genu valgum.
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Young minds: A proposed model for students' well-being in educational institutions
M Kishor, HR Vinay, KS Kusuma, Pratibha Kantanavar
April-June 2018, 7(2):123-125
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