Anjan Adhikari

Adjunct therapy of Ayurvedic medicine with anti tubercular drugs on the therapeutic management of pulmonary tuberculosis

Background: Pulmonary tuberculosis (PTB) is an age old disease described in Vedic Medicine as ‘Yakshma’. Later on, in Ayurveda it earned a prefix and found way into mythology as ‘Rajayakshma’. After the discovery of streptomycin, the therapeutic management of PTB received a major breakthrough. The treatment module changed remarkably with the formulation of newer anti-tubercular drugs (ATD) with appreciable success. Recent resurgence of PTB in developed countries like United States posed a threat to the medical community due to resistant strains. Consequently, WHO looked toward traditional medicine. Literature reveals that Ayurvedic treatment of PTB was in vogue in India before the introduction of ATD with limited success. Records show that 2766 patients of PTB were treated with Ayurvedic drugs in a tertiary care hospital in Kolkata in the year 1933-1947. Objectives: To evaluate the toxicity reduction and early restoration by adjunct therapy of Ayurvedic drugs by increasing the bio-availability of ATDs. Materials and Methods: In the present study, treatment response of 99 patients treated with ATD as an adjunct with Aswagandha (Withania somnifera) and a multi-herbal formulation described in Chikitsa-sthana of Charaka samhita i.e. Chyawanprash were investigated. Hematological profile, sputum bacterial load count, immunoglobulin IgA and IgM, blood sugar, liver function test, serum creatinine were the assessed parameters besides blood isoniazid and pyrazinamide, repeated after 28 days of treatment. Results: The symptoms abated, body weight showed improvement, ESR values were normal, there was appreciable change in IgA and IgM patterns and significantly increased bioavailability of isoniazid and pyrazinamide were recorded. Conclusion: This innovative clinical study coupled with empowered research may turn out to be promising in finding a solution for the treatment of PTB.

Variation of Origin of Obturator Artery in Eastern Indian Population - A Study

Abstract Obturator artery is a medium-calibre parietal branch of internal iliac artery having wide variations in its origin. Since there was no previous investigation of variations of origin of obturator artery in a large series of eastern Indian subjects, it was decided to undertake this study. 56 pelvic halves from formaldehyde preserved cadavers were dissected in Calcutta National Medical College, Kolkata and B.S. Medical College, Bankura over a period of 3 years. Obturator artery originated in maximum number (44.6%) of cases from the anterior division of the internal iliac artery, the next common site (23.2%) being the inferior epigastric artery. Relatively late appearance of the obturator artery amongst the branches of internal iliac artery is most likely to be the cause of such a wide variation.

A questionnaire-based survey to ascertain the views of clinicians regarding rational use of antibiotics in teaching hospitals of Kolkata

Objectives: The objective was to assess the views of clinicians in teaching hospitals of Kolkata regarding the use of antibiotics in their own hospitals, focusing on perceived misuse, reasons behind such misuse and feasible remedial measures. Materials and Methods: A total of 200 clinicians from core clinical disciplines was approached in six teaching hospitals of Kolkata through purposive sampling. A structured, validated questionnaire adopted from published studies and modified to suit the responding population was completed by consenting respondents through face-to-face interaction with a single interviewer. Respondents were free to leave out questions they did not wish to answer. Results: Among 130 participating clinicians (65% of approached), all felt that antibiotic misuse occurs in various hospital settings; 72 (55.4% of the respondents) felt it was a frequent occurrence and needed major rectification. Cough and cold (78.5%), fever (65.4%), and diarrhea (62.3%) were perceived to be the commonest conditions of antibiotic misuse. About half (50.76%) felt that oral preparations were more misused compared to injectable or topical ones. Among oral antibiotics, co-amoxiclav (66.9%) and cefpodoxime (63.07%) whereas among parenteral ones, ceftriaxone and other third generation cephalosporins (74.6%) followed by piperacillin-tazobactam (61.5%) were selected as the most misused ones. Deficient training in rational use of medicines (70.7%) and absence of institutional antibiotic policy (67.7%) were listed as the two most important predisposing factors. Training of medical students and interns in rational antibiotic use (78.5%), implementation of antibiotic policy (76.9%), improvement in microbiology support (70.7%), and regular surveillance on this issue (64.6%) were cited as the principal remedial measures. Conclusions: Clinicians acknowledge that the misuse of antibiotics is an important problem in their hospitals. A system of clinical audit of antibiotic usage, improved microbiology support and implementation of antibiotic policy can help to promote rational use of antimicrobial agents.

Histologic and morphometric study of human placenta in gestational diabetes mellitus.

AIMS The aim was to study morphometry, site of umbilical cord insertion and histological changes in placentae of women with gestational diabetes mellitus and compare the results with those of normal pregnancies and observe the perinatal outcome. METHODS It was an observational, correlational study of 130 placenta specimens collected from labour room and operation theatre of Department of Gynaecology & Obstetrics, Institute of Post Graduate Medical Education and Research, Kolkata. The subjects were mothers who attended antenatal clinic of the hospital regularly and delivered their babies in the same hospital. Cases were selected randomly, and divided in two groups: group A consisted of mothers having normal, uncomplicated pregnancy, group B consisted of mothers whose pregnancies were complicated by gestational diabetes mellitus. Morphometry, site of umbilical cord insertion and histological changes in placentae of all women were recorded. Perinatal outcome of the cases were also registered. The statistical methods used were chi-square test and Mann-Whitney U test. RESULTS It was observed that the placentae of diabetic mothers were significantly bigger in size, weight, volume, area, thickness, diameter and circumference than those of normal mothers. Also, in diabetic mothers, there was significant increase in villous oedema, fibrin deposition, calcification and congestion of blood vessels. These placental changes were significantly correlated with birth weights of babies. Out of 70 mothers in Group B, 65 had live births, 5 had stillborn babies. CONCLUSIONS Placentae of women with GDM showed several changes that may be associated with impaired functioning, leading to bad perinatal outcome.

Quality of Life and Treatment Satisfaction Observed Among Indians With Diabetes Foot Ulcers Undergoing Ayurvedic Adjunct Therapy

The purpose of the study was to assess the health-related quality of life and treatment satisfaction of diabetes patients (n = 36) with foot ulcers undergoing insulin and ayurvedic adjunct therapy. Retrospective hospital based cross-sectional design considered patients with diabetes foot ulcers undergoing 4-week treatment with insulin and ayurvedic combinatorial therapy. The Audit of Diabetes Dependent Quality of Life Questionnaire and Diabetes Treatment Satisfaction Questionnaire were completed for the assessment. The mean duration of diabetes among participants was 9.32 ± 5.3 years. Assessment of Diabetes Treatment Satisfaction Questionnaire (total treatment satisfaction) score was found to be 26.0139 ± 5.20369, and Audit of Diabetes Dependent Quality of Life Questionnaire (average weighted impact) score was −3.0819 ± 1.83003. Relationship with diabetes complications showed that Audit of Diabetes Dependent Quality of Life Questionnaire score (P = .383) had no relationship, but Diabetes Treatment Satisfaction Questionnaire score (P = .039) showed significance. Integrated approaches for diabetes foot ulcer management with insulin and ayurvedic management have a favorable impact on patient-perceived quality of life.

Exploratory study on the ayurvedic therapeutic management of cerebral palsy in children at a tertiary care hospital of karnataka, India.

Cerebral palsy (CP) is the leading cause of childhood disability affecting cognitive function and developments in approximately 1.5 to 3 cases per 1000 live births. Based on Ayurvedic therapeutic principles, CP patients were subjected to Abhyanga (massage) with Moorchita Tila Taila (processed sesame oil) and Svedana (fomentation) with Shastikashali Pinda Sveda (fomentation with bolus of drugs prepared with boiled rice). Study group received Mustadi Rajayapana Basti (enema with herbal decoction) and Baladi Yoga (a poly-herbo-mineral formulation), while the placebo group received Godhuma Vati (tablet prepared with wheat powder) and saline water as enema. Treatment with Mustadi Rajayapana Basti and Baladi Yoga improved the activities of daily life by 8.79%, gross motor functions by 19.76%, and fine motor functions 15.05%, and mental functions like memory retention got improved by 15.43%. The placebo group showed an improvement of 0.21% in daily life activities, 2.8% in gross motor, and 2.4% in fine motor functions. Mustadi Rajayapana Basti and Baladi Yoga proved to be more supportive in improving the motor activities and gross behavioral pattern. Further clinical trials are required to evaluate and validate the maximum effect of the combination therapy in a large sample with repetition of the courses for longer duration.

Detection of arecoline by simple high-performance thin-layer chromatographic method in Indian nontobacco pan masala.

Chewing the habit of blended pan masala containing areca nut with or without tobacco is a common practice in the Indian subcontinent. Arecoline, a pyridine alkaloid presence in areca nut alarmed for oral carcinogenesis and strictly prohibited in the western world. However, in India using blended pan masala is very popular among young and old individuals. In this context, we aimed to detect arecoline in Indian blended nontobacco pan masala sold in Kolkata using a simple densitometric high-performance thin-layer chromatographic (HPTLC) method and for alarming their use in common people. Eleven popularly Indian blended nontobacco pan masala were collected from the territory of Kolkata and isolated arecoline, following solvent extraction method derived for pyridine alkaloid. The quantitative analysis of arecoline was measured using automated software-based HPTLC instruments and validated the method according to International Conference on Harmonization guidelines. Arecoline was detected in all 11 blended nontobacco pan masala samples in a range of minimum 130 to maximum 415 μg/g dry samples. Arecoline is hazardous carcinogenic compound, so the use of Indian blended nontobacco pan masala should be restricted. Further, the method was found suitable for routine quantitative analysis of arecoline in areca nut containing substances.

Ayurveda in changing scenario of diabetes management for developing safe and effective treatment choices for the future

Abstract Ayurveda described diabetes mellitus (DM) as Madhumeha. This ancient evidence-based system of medicine enumerated various herbs and formulations for its management, which needs scientific validation. Whereas translational “bedside to bench” approach in biomedical research is an upcoming concept, its application in traditional and complementary medicine can be interesting. The intersecting concepts in the field Ayurveda and translational research needs “omics” approach. The Ayurvedic biology concepts about DM have its close relations with present systems biology approach. Metabolic changes causing tissue damage connected with genetic and immunological irregularities leading to insulin resistance coincide with ancient knowledge. Combinatorial therapy according to Prakriti type as elucidated by Ayurgenomics should be carried on for further research. “Bedside to bench” approaches in research utilizing metabolomics and pharmacogenomics approach can be a major step towards changing the therapeutic strategy towards diabetes. Prameha which is described as the pre-diabetic state is a novel concept in Ayurvedic etiopathogenesis, while metabolomic parameters like lipid level in urine can be a thrust area of research to have a pre-diabetic screening method in high-risk populations. This tradition-guided research paradigm can open up novel opportunities in traditional knowledge-inspired systems biology and drug discovery against diabetes.

DRUG PRESCRIPTION PATTERN OF BREAST CANCER PATIENTS IN A TERTIARY CARE HOSPITAL IN WEST BENGAL: A CROSS-SECTIONAL AND QUESTIONNAIRE-BASED STUDY

Objective: Cancer is a disease of uncontrolled division of cells in any part of the body. Breast cancer most common in women accounts for 13% of the death worldwide. The objective of the present study was to evaluate the drug prescription pattern of breast carcinoma patients in a tertiary care hospital of West Bengal. Methods: This was a cross-sectional observational questionnaire-based study done for a period of 6 months at the Department of Pharmacology in Collaboration with the Department of Surgery and Department of Radiotherapy of a Tertiary Care Hospital at Kolkata, West Bengal, India. Female patients with breast cancer (originated from epithelial tissues) of different types and grade attending surgery outdoor patient department were taken as subjects for the study, after signing informed consent. Results: The present study evaluated 28 patients (n=28) diagnosed as breast cancer by the physicians of the department of surgery and radiotherapy. It was observed that breast cancer was mostly found in the middle age group. Breast carcinoma in postmenopausal women accounted to 75%. The most prevalent breast cancer was invasive ductal carcinoma, accounting to 75% of the study population. 5-Fluorouracil, epirubicin, doxorubicin, cyclophosphamide, docetaxel/paclitaxel, and carboplatin were mostly used as chemotherapeutic agent. Conclusion: Breast carcinoma being a prevalent type of cancer in females, the present study tried to evaluate the pattern of prescribing chemotherapeutic agents for breast cancer patients in a tertiary care hospital. Such study is essential to evaluate and refine the therapeutic regimen of the cancer patients to reduce their sufferings.

Risk of Betel Nut Chewing: Chemical and Toxicological Studies

Last few decades epidemiological reports warn that the development of oral submucous fibrosis − a precancerous state, is universal among betel nut or areca nut users. Betel nut contains arecoline and other microelements which are released into the buccal cavity during the process of areca nut chewing. The present effort was undertaken to find out the correlations between chemical ingredients, like arecoline, magnesium, iron and copper present in betel nut with toxicological incidences in experimental animals. Arecoline was estimated by HPLC (Perkin Elmer, USA) and other micronutrients like magnesium, iron and copper was assessed by AAS (Perkin Elmer, USA). Repeated dose 90-day sub-acute oral toxicity of betel nut water extract (BNE) at the dose of 0.5X10-2 ml/g/day and 1.0X10-2 ml/g/day was performed on Wistar rats as per the Organization for Economic Co-operation and Development (OECD) guidelines No. 408. The result indicates that betel nut contains Group 1 human carcinogen arecoline with significant high level of magnesium, iron and copper. Moreover, consumption of betel nut induces liver damage in rats by indicating significant enhancement of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP). It may conclude that chemical ingredients presences in betel nut are harmful for health and it should be restricted.