Srivastava Rn

Levamisole therapy in corticosteroid-dependent nephrotic syndrome

Abstract. The effect of prolonged treatment with levamisole was examined in 43 patients (30 boys) with steroid-dependent nephrotic syndrome (SDNS). The mean age at institution of treatment was 4.0±2.0 years. Fourteen patients had previously received cyclophosphamide with an ensuing remission of 8.5±10 months. Following induction of remission with prednisolone, levamisole was administered at a dose of 2.5 mg/kg body weight on alternate days. Prednisolone was tapered by 2.5 – 5 mg every 4 weeks to 0.5 mg/kg on alternate days. The duration of levamisole therapy ranged from 6 to 31 months (mean 17.4±8.4 months); 15 patients received levamisole for more than 18 months and 10 for more than 24 months. Prednisolone was discontinued in 18 patients after a mean duration of 11.7±7.1 months, whereas in 21 patients its dose was reduced to 0.2 – 0.4 mg/kg on alternate days. The mean relapse rate prior to levamisole therapy was 3.0±1.5 relapses/year, which reduced to 0.9±0.7 relapses/year during levamisole treatment (P <0.001). A comparison of the response in 14 patients who had previously received cyclophosphamide with the other 29 patients did not show any significant difference. There were no side effects of levamisole therapy. Our findings suggest that prolonged treatment with levamisole is beneficial and safe in SDNS, with a marked steroid-sparing effect. A significant proportion of these patients can be kept in remission on levamisole alone.

Urinary excretion of minerals, oxalate, and uric acid in north Indian children

Abstract. Urinary excretion of calcium, magnesium, phosphate, uric acid, oxalate, and creatinine was measured in 208 children (aged 8 – 15 years, 124 boys, 84 girls), living in a residential school near New Delhi. Levels were reduced compared with those reported from developed countries. The 95th percentile value of 24-h creatinine excretion was 33.4 mg/kg, calcium 2.2 mg/kg, magnesium 2.9 mg/kg, phosphate 9.4 mg/kg, uric acid 4.4 mg/kg, and oxalate 1.5 mg/kg. The 95th percentile value of the urine calcium/creatinine ratio was 0.15 and oxalate/creatinine 0.06. The dietary intake of proteins, calcium, and other nutrients in these children was less than recommended and explained the reduced urinary excretion observed. Physicians need to be aware of the regional patterns of normal urinary excretion of these constituents.

Single- versus divided-dose prednisolone therapy for relapses of nephrotic syndrome

Abstract. Relapses of nephrotic syndrome are usually treated with prednisolone, initially in three to four daily divided doses. The divided-dose regimen may cause poor patient compliance and greater adrenal suppression. In a prospective randomized controlled trial, we compared the efficacy of prednisolone in inducing remission of nephrotic syndrome, when given either as a single dose or in divided doses. Patients with steroid-responsive nephrotic syndrome with relapse were randomized to receive prednisolone 2 mg/kg per day, either as a single morning dose or in three divided doses for 2 weeks, followed by 1.5 mg/kg on every alternate day for 4 weeks. Parents tested the urine for protein daily until remission (nil proteinuria for 3 consecutive days). The duration between initiation of treatment and achievement of remission was recorded. Of 106 patients, 94 (47 each in single-dose and divided-dose groups) completed the study. The patients in the two groups were similar in relation to age, sex, number of relapses in the preceding year, and blood levels of creatinine, albumin, and cholesterol. The mean time for achievement of remission in the single- and divided-dose groups was 8.6 and 8.5 days, respectively (P = 0.94, power 96%). After 9 months’ follow-up, there were no differences in the frequency of relapses and cumulative dose of prednisolone received in the two groups. The observations suggest that prednisolone administered in a single daily dose or in divided doses is equally effective in inducing remission in patients with relapsing nephrotic syndrome.

Outcome of pediatric renal transplantation in north India.

Sinha A, Hari P, Guleria S, Gulati A, Dinda AK, Mehra NK, Srivastava RN, Bagga A. Outcome of pediatric renal transplantation in north India.
Pediatr Transplantation 2010: 14:836–843.

Itracranial Calcifilcation in Nephrogenic Diabetes Insipidus

Patient 1 A 5-month-old girl was admitted with a 3-month history ofunexplained fever that ranged from 37EC39.6EC. She was born at term after an uncomplicated pregnancy and normal delivery. Her weight at birth was 3,200 g. There was no family history of renal disease or parental consanguinity. She had continued to feed normally but failed to thrive. Social smile appeared at 4 months, but she was unable to hold her head up or turn from prone to supine position. On examination she was alert and did not appear ill. Weight was 4,200 g, length 56 cm, and head circumfer-

Quantification of Immunity Status of Dabur Chyawanprash - A Review Part- 2 (Clinical Studies)

Ayurveda, the oldest Indian system of medicine, recommends the administration of a specified group of for - mulations known as Rasayana for preventing occurrence of diseases. Ayurvedic scholars like Caraka (500 BC) have mentioned that, the use of Rasayana would impart a long, healthy and a disease free life while promoting intelligence, memory and lustre. Chyawanprash (CP) is a well-known Ayurvedic Rasayana formulation and studies have indicated that they act as immunomodulators. In review part - 1, experimental studies (in vivo and in vitro), conducted by Dabur Research and Development Centre in evaluating the immunity benefits of Dabur Chyawanprash were reviewed. In the present review, Clinical Studies on Dabur Chyawanprash in establishing its beneficial effects on immunity have been reviewed. The criteria of assessment in the clinical studies was based on clinical symptoms, IgE, IgG, C3, C4, respiratory performance test, plasma cortisol levels and haematological parameters.

Quantification of Immunity Status of Dabur Chyawanprash - A Review Part-1 (Experimental Studies)

Ayurveda, the oldest Indian system of medicine, recommends the administration of a specified group of formulations known as Rasayana for preventing occurrence of diseases. Ancient scholars like Caraka (500 BC) have mentioned that, the use of Rasayana would impart a long, healthy and a disease free life while promoting intelligence, memory and lustre. Chyawanprash is a well-known Ayurvedic Rasayana formulation. In the present review, the preclinical studies conducted by Dabur Research and Development Centre in quantifying the immunity benefits of Dabur Chyawanprash (DCP) are reviewed. Details of studies to establish the safety and efficacy, the anabolic effect as also the anti-allergic and Immunomodulatory activities of NK and Dendritic Cells are elaborated.

Clinical validation of efficacy and safety of herbal cough formulation “Honitus syrup” for symptomatic relief of acute non-productive cough and throat irritation

Background: Acute cough represents the most common illness evaluated in the outpatient settings. Available remedies for its management are generally allopathic combinations of antihistamines and decongestants that achieve antitussive activity, but often with unpleasant side effects prompting the need to explore safer and effective options. Honitus is an Ayurvedic proprietary herbal cough syrup with benefits of honey, intended to provide relief in acute nonproductive cough and throat irritation without causing drowsiness. This study investigated the safety and efficacy of Honitus in reducing acute nonproductive cough and throat irritation in comparison to a standard marketed allopathic cough syrup intended for use in similar conditions. Materials and Methods: This was a randomized double-blind study conducted in 105 individuals who received orally 2 tsp (10 ml) of either Honitus or marketed cough syrup (MCS) four times a day for 3 days. Response to treatment was evaluated from baseline to the end of treatment period on the basis of changes in day and night frequencies of cough, throat irritation and development of adverse events (AEs). Results: Honitus was found safe and effective in reducing symptoms of acute nonproductive cough, throat irritation, and comparable to MCS in reducing day and night frequencies of cough, the time to relief from cough and throat irritation and the Physicians Global Assessment of cough. Honitus showed comparably better results than MCS on throat irritation, the duration of relief from cough and throat irritation without causing drowsiness. No AEs related to study or study products were reported. Conclusion: Honitus Syrup is safe and effective in reducing the symptoms of acute nonproductive cough and throat irritation without causing drowsiness.

Evaluation of Ratnaprash for its effect on strength, stamina and fatigue using swim endurance test and biochemical estimation in swiss albino mice.

Context: Traditional medicines have been considered as important resources for postponing fatigue, accelerating elimination of fatigue related metabolites and improving physical ability. Rasāyanās or rejuvenative therapies are mentioned as one of the eight clinical specialties in Ayurveda for attaining longevity, healthy life and regulation of bodily balance. Eventhough more detailed studies are needed to confirm the claims of benefits in the light of evidence based research, Ratnaprash, a herbo-mineral rasāyana formulation, is proposed here to be an antifatigue supplement that is good in promoting strength and stamina. Materials and Methods: In the present study, anti fatigue, strength and stamina enhancing properties of Ratnaprash were examined based on swim endurance capacity and the change in biochemical parameters in Swiss Albino mice. Treatment groups were orally administered Ratnaprash at various test doses (500, 1000, 2000 mg/Kg per day), while the control group received distilled water at similar dose volumes. Effect of therapy was evaluated after 28 days of treatment. Results: At the end of study period, the swimming times to exhaustion were longer in the treated groups than in the control group. Plasma lactate levels of treated groups were lower than those of the control group (P < 0.05) while tissue ATP levels were higher. These effects were dose dependent and the strongest effect was seen in groups treated at 1000 mg/Kg. Conclusion: Ratnaprash enhanced the forced swimming capacity of mice and exhibited elevated anti-fatigue activity, reduced blood lactate levels and increased tissue ATP levels in preclinical models in comparison to vehicle control, exhibiting possible role in increasing strength and stamina and contributing anti-fatigue activity.