Significant Improvement In Overall Symptoms Research Articles

A Comprehensive Ayurvedic Management of Amavata

Amavata is an Ama pradoshaja vikara, caused by Agnimandya, which leads to accumulation of Ama in Shleshmasthana and Prakopa of Vata dosha, resulting in pain, stiffness and swelling of joints, which closely resembles the chronic inflammatory autoimmune disorder called Rheumatoid arthritis. Prevalence of rheumatoid arthritis is approximately 0.8% worldwide and 0.5-0.75% in India. Materials and Methods: A 44 years female presented with pain in multiple joints associated with swelling and stiffness since 2 years was diagnosed as Amavata. The patient was treated with Kottamachukkadi lepa, Dashamoola kashaya and Dhanyamla Kayaseka, Vaitarana basti followed by Guduchyadi kashaya basti along with Rasayana and oral medications. Results: There was a significant improvement in overall symptoms. Conclusion: Contemporary medicine offers DMARDS and steroid medications for very long time as it is Auto immune condition. Whereas on other hand Panchakarma therapies can target on root cause of the Vyadhi and provide more promising results.

S125 Oral and Esophageal Manifestations in a Patient With Severe Ulcerative Colitis

Case: Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon with a growing prevalence. Traditionally, UC is thought to affect the rectum and colon exclusively, and spare the remainder of the gastrointestinal (GI) tract. The course of illness can range from mild colitis to full blown toxic megacolon requiring complete colonic resection. While various treatment options are available, total colectomy is viewed as potentially curative since it has been shown to result in complete cessation of symptoms. We report an unusual case of UC in a patient who presented with oral and esophageal ulcers that resolved completely following total colectomy. A 26-year-old male with no significant past medical history presented with a 1-week history of severe oral ulceration, odynophagia and fevers along with a 4-month history of intermittent bloody diarrhea. Infectious workup was negative. CT scan of the abdomen and pelvis showed evidence of pancolitis concerning for inflammatory bowel disease (IBD). An upper endoscopy (UE) showed multiple clear base, non-bleeding esophageal ulcers and a colonoscopy revealed severe ulceration spanning the entire colon. Patient’s hospital course was complicated by development of toxic megacolon requiring urgent total colectomy with end ileostomy. Following surgery patient reported significant improvement in overall symptoms. Biopsies from the colon revealed evidence of mucosal inflammation with crypt abscesses and absence of granulomas. Biopsies from the esophagus revealed acute esophagitis with no evidence of viral or fungal infection. Patient was discharged with 4 weeks of pantoprazole therapy and inhaled budesonide however no treatment for IBD was started. A follow up magnetic resonance enterography was obtained which showed no evidence of small bowel inflammation. Postoperatively patient continued to have improvement in symptoms with adequate weight gain. His budesonide and pantoprazole therapy was discontinued. An UE was repeated 5 months later which showed normal esophageal mucosa and no evidence of ulceration. Biopsies from the esophagus showed normal mucosa with no signs of inflammation. An ileoscopy was performed which was unremarkable and biopsies showed no evidence of small intestinal inflammation. Patient continues to do well off therapy with plans of undergoing a proctocolectomy with ileal pouch-anal anastomosis. There have been approximately 20 case reports that describe upper gastrointestinal (GI) involvement in patients with UC. These patients tend to be young and have evidence of severe UC. Clean base esophageal ulcers were observed in majority of these cases. Significant advances have been made in the treatment of UC however total proctocolectomy with ileo-anal anastomosis remains as a last resort therapy which can alleviate all symptoms including extraintestinal manifestations in up to 58% of UC patients. We therefore describe a rare case of UC that presented with primarily upper GI manifestations and emphasize the notion that UC may not be restricted to the colon only and that a total colectomy can serve as a treatment option for resolution of these symptoms.

Gastric per-oral endoscopic myotomy for refractory gastroparesis: a detailed description of the procedure, our experience, and review of the literature

Gastric per-oral endoscopic myotomy (G-POEM) was introduced four years ago as an investigational procedure for refractory gastroparesis. The safety and efficacy were currently evaluated. With our recent studies on G-POEM, we share our experience and knowledge through the discussion of a detailed description of the procedure and review of the literature. To our knowledge, this is the first systemic review on this new therapeutic endoscopic procedure. The indications and contraindications, various aspects of the procedure, and efficacy assessment are discussed based on our experience and current available data. Preoperative preparation, detailed description of the procedure, post-procedural care, and results in the literature are presented. The procedure is safe and effective. 70-80% of patients have significant improvement in overall symptoms and quality of life in short-term (6months) follow-up, as assessed by Gastric Cardinal Symptom Index and Short Form 36. G-POEM is a feasible and effective procedure for refractory gastroparesis based on early and limited data. Well-designed prospective studies are expected to advance and evaluate this new procedure in the future.

Vortioxetine: Atypical antidepressant

Although its mechanism of action is not fully understood, vortioxetine is an inhibitor of serotonin (5-hydroxytryptamine [5-HT]) reuptake and an agonist at 5-HT1A receptors; a partial agonist at 5-HT1B receptors; and an antagonist at 5-HT3, 5-HT1D, and 5-HT7 receptors. According to Takeda, it is the fi rst and only antidepressant that increases the availability of serotonin by this unique combination of pharmacodynamic activity. The contribution of each of these mechanisms of action to vortioxetine’s antidepressant effect has not been established; however, they may represent an improvement over other antidepressants currently on the market, said Takeda.

Case studies on prophylactic ayurvedic therapy in migraine patients

Ayurveda is a nearly 3000 years old traditional medical system of India. Most of the time, people turn to ayurvedic physicians in desperate conditions. Here clinical practices of Ayurveda were initially found effective in the management of migraine among few patients. Later, it was developed as an ayurvedic treatment protocol (ATP) which consists of four herbo-mineral formulations (HMF), three meals and three snacks in a day with eight hours sleep at night. ATP brought significant relief in reducing the frequency, intensity of pain and associated symptoms in the migraine patients. IHS diagnostic criteria was followed to establish the diagnosis of migraine and uniform ATP was prescribed to each patient who were primarily treated by the ayurvedic physicians at their respective clinics. Such observations were presented at appropriate international forums. In an effort to validate the above, the present study carries the details of nine migraine patients who were first diagnosed and treated for migraine by a leading headache expert at Mumbai in India and were then referred to receive ATP. A total number of nine subjects volunteered to this program. Out of those, seven subjects completed 120 days of ATP. Five subjects reported significant improvement in overall symptoms of migraine. All subjects were followed up periodically for four years. No Grade II side effects were observed in any treated case. HMF has also been proved to be safe in experimental studies. Further pharmacological and randomized controlled clinical studies are in progress at the respective departments of a premier medical institute in India.

One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients

Objectives This study investigated the ongoing effects of participation in a mindfulness-based stress reduction (MBSR) program on quality of life (QL), symptoms of stress, mood and endocrine, immune and autonomic parameters in early stage breast and prostate cancer patients. Methods Forty-nine patients with breast cancer and 10 with prostate cancer enrolled in an eight-week MBSR program that incorporated relaxation, meditation, gentle yoga and daily home practice. Demographic and health behaviors, QL, mood, stress symptoms, salivary cortisol levels, immune cell counts, intracellular cytokine production, blood pressure (BP) and heart rate (HR) were assessed pre- and post-intervention, and at 6- and 12-month follow-up. Results Fifty-nine, 51, 47 and 41 patients were assessed pre- and post-intervention and at 6- and 12-month follow-up, respectively, although not all participants provided data on all outcomes at each time point. Linear mixed modeling showed significant improvements in overall symptoms of stress which were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up. Immune patterns over the year supported a continued reduction in Th1 (pro-inflammatory) cytokines. Systolic blood pressure (SBP) decreased from pre- to post-intervention and HR was positively associated with self-reported symptoms of stress. Conclusions MBSR program participation was associated with enhanced quality of life and decreased stress symptoms, altered cortisol and immune patterns consistent with less stress and mood disturbance, and decreased blood pressure. These pilot data represent a preliminary investigation of the longer-term relationships between MBSR program participation and a range of potentially important biomarkers.