A Case Study of Furunculosis following an Ayurvedic Oil Massage, Sudation Therapy, and Lessons to Learn

India has a long history of using sudation therapy and oil massage as Ayurvedic treatments. However, nothing is known about its side effects, and just two studies have identified side effects as cutaneous adverse drug reactions brought on by Ayurvedic oil massage. We are presenting the example of a 72-year-old adult man who visited our hospital and had his right knee massaged with Nirgudi oil followed by sudation therapy. Erythema, papules, itchiness, and scorching pain were some of his symptoms. However, these sensations only partially abated once we quit sudation therapy. Our investigation demonstrates that a Nirgudi oil massage or sudation causes the skin reaction associated with furunculosis. This case report illustrates the necessity of being aware of Panchakarma-related consequences and suggests that medical practitioners, patients, and product makers take into account the likelihood of such a reaction following Nirgudi oil massage and sudation therapy as a precaution.

Pain Management by Ayurveda in Lumbar Spondylosis– A Case Study and Selective Review of Literature

Introduction: In Ayurveda, Snehana is an important method of treatment for diseases of the spine. As per Ayurveda, fatty substances are having properties opposite to that of Vata Dosha which is the root of many diseases. Therefore, Sneha (fatty substances) have an important position in Ayurvedic treatment. Fatty substances are of 4 types of Ghrita (Ghee), Taila (oil), Vasa (muscle fat), and Majja (bone marrow fat). Among these types, the literature is available about Ghrita (ghee), Taila (oil), and Majja (bone marrow fat) only, but Vasa (muscle fat) is not currently practiced. We got a case study, in which cod liver oil capsules were used as a representative of Vasa Sneha. A male of 35 suffering from lumbar spondylosis approached for moderate to severe low back pain. We successfully used cod liver oil capsules as representative of Vasa Sneha in this case. Study Design:  A single case study and selective review of the literature. Place and Duration of Study: Panchakarma OPD, Yashwant Ayurvedic medical college, PGTRC, Kodoli, 416114, Dist. – Kolhapur, Maharashtra, India. Presentation of Case: This is a single case study in which a male of 35 years was suffering from chronic low back pain (CLBP) due to lumbar spondylosis The patient had chronic low back pain which was aggravated for 3 months. We prescribed him Ayurvedic medicines and cod liver oil capsules orally. The patient was followed for 16 months. Results: The outcome measure was assessed by the Oswestry low back pain disability questionnaire. The low back pain score was measured in different positions. The before treatment value was 36 (median ẋ = 3.5) and the score was 72, and after treatment value was 2 (median ẋ = 0) and the score was 4. The Mann Whitney U test was performed. The p was 0.00009 (<0.05). Conclusion: It is concluded that cod liver oil can be successfully used as a representative of vasa Sneha, and it is very effective in relieving chronic low back pain in lumbar spondylosis along with other ayurvedic preparations.

Regulatory T cells and IL-10 as modulators of chikungunya disease outcome: a preliminary study

Regulatory T (Treg) cells hold centre stage in regulating the immune responses in most viral infections. However, their involvement in chikungunya infection is unexplored. In the current study, the frequencies and functionality of peripheral Treg and T effector (Teff) cells were assessed during different phases of chikungunya by flow cytometry and in-vitro cytokine assays. Treg cells were also studied in rheumatoid arthritis (RA) patients, whose symptoms closely mimic chronic chikungunya arthritis patients. Frequency of Treg cells was lower in acute and chronic chikungunya arthritis patients than in recovered individuals and controls, and comparable among recovered individuals and controls. Treg/Teff ratio was lower in acute than in chronic chikungunya arthritis patients, recovered individuals and controls. Higher secretion of CHIKV specific IL-10 was observed in recovered individuals than in acute, chronic chikungunya arthritis patients and controls. Frequencies of Treg and Teff cells were higher and Treg/Teff ratio was lower in RA patients than in chronic chikungunya arthritis patients. The results indicate that reduction of Treg cells was associated with ongoing CHIKV infection and normalization of Treg cells with resolution of disease. Contrasting phenotypic data in RA and chronic chikungunya arthritis suggest an altogether different mechanism of Treg-mediated pathology in both arthritis conditions. Overall, our preliminary study, suggesting an association of peripheral Treg cells and IL-10 with recovery from chikungunya, may provide insight into chikungunya disease prognosis and warrants further study.

Cerebrospinal fluid free sialic acid and aspartate transaminase levels in meningitis

BACKGROUND

Sialic acid (SA) is a nine carbon sugar derived from mannosamine and pyruvate. High levels of sialic acid and aspartate transaminase (AST) levels in cerebrospinal fluid have been described in pyogenic meningitis (PM) compared to tubercular meningitis (TBM).

OBJECTIVES

To evaluate the levels of CSF free SA in PM and TBM and to assess the correlation between CSF free SA and CSF glucose or total protein levels.

PATIENTS AND METHODS

A total of 122 subjects were studied and divided into children and adults. Further, these have been subdivided into controls, PM and TBM. CSF free SA was estimated by thiobarbituric acid assay of Warren and AST by Reitmann and Frankel method.

RESULTS

CSF free SA and AST levels in children and adults were significantly high in PM (p<0.001) as compared to TBM and controls.

CONCLUSION

A very high CSF free SA and AST were found to be characteristic of PM, making them useful parameters to differentiate PM from TBM.

Application of the polymerase chain reaction on formalin-fixed, paraffin-embedded tissue in the recognition of tuberculous osteomyelitis

A retrospective series of 45 cases of chronic osteomyelitis collected over a period of 14 years was histologically classified into tuberculous osteomyelitis (25) and chronic non-granulomatous osteomyelitis (20). The tuberculous osteomyelitis group was divided into three subgroups: a) typical granulomas (13 cases); b) ill-defined granulomas (seven cases), and c) suspected granulomas (five cases). An in-house polymerase chain reaction amplifying the 245 bp nucleotide sequence, and capable of detecting 10 fg of DNA of Mycobacterium tuberculosis, was used on the DNA extracted from the paraffin blocks. The polymerase chain reaction was positive in 72% of cases (18) of tuberculous osteomyelitis, but when typical cases of tuberculous osteomyelitis with confirmed granulomas were considered (13), this increased to 84.6% (11). The chronic non-granulomatous osteomyelitis group gave positive polymerase chain reaction results in 20% of the cases (4).

Our preliminary study on tuberculous osteomyelitis shows that the polymerase chain reaction can be a very useful diagnostic tool, since a good correlation was seen between typical granulomas and polymerase chain reaction with a sensitivity of 84.6% and a specificity of 80%. In addition, our study shows that tuberculous osteomyelitis can be diagnosed in formalin-fixed paraffin-embedded tissues in the absence of typical granulomas.

Evaluation of an in-house-developed PCR for the diagnosis of tuberculous meningitis in Indian children

Early and rapid detection of the causative organism is necessary in tuberculosis, particularly tuberculous meningitis, as the disease affects mainly children and if untreated or improperly treated can cause severe central nervous system disorders and can often be fatal. An in-house-developed PCR technique was developed for the detection ofMycobacterium tuberculosisDNA, in which the target for amplification was a 340 bp nucleotide sequence located within the 38 kDa protein gene. The test can detect as small an amount of DNA as 10 fg, which is equivalent to two to three organisms, and is highly specific. Amplified product was detected by ethidium bromide staining after electrophoresis and Southern hybridization. Evaluation of test sensitivity and specificity was carried out using acid-fast bacilli-positive sputum samples from patients with pulmonary tuberculosis and an equal number of non-tuberculosis patient samples as negative controls. In a double-masked study 30 cerebrospinal fluid samples from tuberculous meningitis patients and 30 samples from non-tuberculous meningitis patients were investigated. Out of the 30 samples 22 were positive by ethidium bromide-stained gel electrophoresis and 27 gave positive results by Southern hybridization. All of the 30 control samples showed negative results. The sensitivity of this PCR was 90 % and specificity, 100 %.

Detection of campylobacter species: a comparison of culture and polymerase chain reaction based methods

AIMS

To investigate the optimal method for the detection of campylobacters from stool samples by comparing selective culture with membrane filtration and the polymerase chain reaction (PCR).

METHODS

Three hundred and forty three stool samples were investigated by each of the three methods mentioned above. Selective culture was performed with charcoal cefoperazone desoxycholate agar plates. Membrane filtration was performed using cellulose triacetate membranes with 0.45 micro m pores placed on blood agar plates. Enteropathogenic campylobacters were detected using a PCR identification algorithm, consisting of screening PCRs and species identification using a PCR enzyme linked immunosorbent assay (PCR-ELISA), both based on the 16S rRNA gene.

RESULTS

Of the 343 samples tested, 23 were positive by one or more method. Of these, 17 were positive by selective culture, 12 by membrane filtration, and 20 by the PCR identification algorithm. A total of 18 of 23 positives were identified as C jejuni and/or C coli by the PCR identification algorithm, compared with 14 identified to the genus level by selective culture, and 10 by membrane filtration. Among the remaining five positive samples, one C hyointestinalis was detected only by the PCR identification algorithm; one C upsaliensis was detected only by the PCR identification algorithm; one Campylobacter sp was detected by membrane filtration and selective culture and later identified as C concisus; one Campylobacter sp was detected by membrane filtration alone and later identified as Arcobacter sp; and one Campylobacter sp detected only by selective culture was lost to study and therefore not speciated. There was no significant difference between detection by selective culture and the other two methods. However, detection by PCR was significantly better than by membrane filtration (0.05 > p > 0.02).

CONCLUSION

The PCR identification algorithm can detect and identify Campylobacter spp to the species level and the result is obtained on the same day. However, PCR is expensive, labour intensive, and does not provide an isolate for further identification or typing. Selective culture is as good as the PCR identification algorithm for the detection of the two most common species, C jejuni and C coli, and it is cheap and practical. However, it does miss the less common species, results take 48 hours, and identification is only to the genus level. Membrane filtration showed a low sensitivity compared with the other methods and is not appropriate for the diagnostic laboratory, although it was the only method to detect the Arcobacter sp. The optimum method for the detection of campylobacters from stool samples in the diagnostic laboratory remains selective culture.

Stability indicating HPTLC determination of timolol maleate as bulk drug and in pharmaceutical preparations

Timolol was the first beta blocker to be used as an anti-glaucoma agent and to date remains as the standard because none of the newer beta blockers were found to be more effective. The high performance thin layer chromatographic method of analysis of timolol maleate is reported. The mobile phase selected was ethyl acetate-methanol-isopropyl alcohol-ammonia (25%) (80:20:2:1, v/v/v/v). The calibration curve of the drug was linear in the range of 100-600 ng. The spectrodensitometric analysis was carried out at 294 nm. The mean (+/- RSD) values of slope, correlation coefficient and intercept were 2487.5 (+/- 0.9), 0.996 (+/- 0.081) and 90463 (+/- 1.1), respectively. The system precision and the method precision were excellent with an RSD of 2.8 and 1.004, respectively. The limits of detection and quantitation were 10 and 40 ng, respectively. The mean percent recovery was found to be 98.6. Timolol maleate was degraded by exposing the drug to heat, acid and base. The degraded products were found to be well separated from the pure drug with significantly different Rf values suggesting a stability indicating analysis method for quantification of timolol maleate in pharmaceutical preparations and as bulk drug. The method was utilized to analyze timolol maleate from conventional eye drops and novel sustained release solid polymeric ocular inserts and oral preparations. The reported method is simple, selective, precise, accurate, time saving and economic as compared to reported HPLC methods.

Alterations in total iron, zinc, and calcium levels and their influence on the hepatic activities of gamma-glutamyl transferase and glucose-6-phosphatase in the host bearing transplantable murine lymphoma

The levels of iron, zinc, and calcium in liver as well as serum, together with the enzymatic activities of gamma-glutamyl transferase (GGT, EC 2.3.2.2) and glucose-6-phosphatase (G-6-Pase, EC 3.1.3.9) in liver, were critically monitored over various periods in male Swiss albino mice bearing Dalton's lymphoma (DL), a transplantable ascites-producing tumor. Both hepatic and serum contents of iron, zinc, and calcium were found to be maximally elevated (p < 0.001) on day 15 after tumor transplantation as compared with their contents in normal animals. There was a gradual increase in the activity of GGT in liver in lymphoma-bearing mice in comparison with their normal counterparts, which showed a maximum peak (p < 0.001) on day 15, followed by a continuous and sharp fall. Hepatic G-6-Pase activity was found to decrease continuously throughout the progression of lymphoma as compared with its levels to normal animals. Tumor-cell counts in peritoneal lymph fluids of mice containing DL yielded a maximum count of 155.7 x 10(3) cells/mm3 on day 15. A significant correlation was observed among the levels of different metals, enzymatic activities, and tumor-cell counts at different periods of study. From these results, it can be concluded that the metals studied may have a role in initiating and controlling cellular proliferations, through their effects on modulating the activities of the possibly preneoplastic and neoplastic marker enzymes named above.

Study of reaction time in smokers

A significant decrease in the visual and auditory reaction times (VRT and ART) was found in 50 smokers as compared to healthy controls of the same age group (P less than 0.001). The acute effect of smoking one cigarette was also studied in the same group of smokers and a statistically significant reduction was found (P less than 0.001) as compared to their basal VRT and ART.