Ayurvedic management of Ruddhapatha Kamala (Obstructive Jaundice) - A Case Study

Biliary obstruction[1] refers to blockage of any duct that carries bile from the liver to the gallbladder or from the gallbladder to the small intestine. The clinical setting of the failure of biliary flow may be due to obstruction by mechanical means or by metabolic factors in the hepatic cells. The discussion of metabolic causes of biliary obstruction is very complex; the pathogenesis is not always clearly defined. While on the other hand, the condition Ruddha Patha Kamala in Ayurveda is the nearest possible clinical correlation to biliary obstruction wherein the flow of Pitta is obstructed by Kapha.[2] A structural / physical complete blockage of biliary flow needs a surgical intervention while if the cause is due to metabolic compromise or a partial block, the condition can be reversed effectively through Ayurvedic medications. Here is a case of obstructive jaundice, with a h/o cholecystectomy 20y back and H/O ERCP 5y back, treated successfully with Ayurvedic medications and some diet modifications for about 42 days. A combination of Avipatthikara Churna, Shweta Parpati, Yava Kshara and Katuki Churna was the intervention given. Mulaka Yusha twice a day along with bland diet was advised as Pathya. By the end of 42 days, the LFT report turned completely normal and the patient felt very healthy subjectively. There exists a need in the current times to critically understand the treatment techniques and principles of traditional medicine systems and to make use of them in treating certain conditions where the other conventional medicine systems fail

Width of margins in phyllodes tumors of the breast: the controversy drags on?—a systematic review and meta-analysis

Phyllodes tumors (PT) of the breast are rare fibroepithelial neoplasms. Information is controversial in the literature regarding to the optimal surgical management. Most studies suggested margins of at least 10 mm while some recent studies suggested narrower margins without an increased risk of local recurrences (LR) and distant metastases (DM). The objective of this systematic review was to identify and compare studies that assessed these different practices. A systematic review was performed through five databases up to April 2019. Studies exploring the association between the width of margins, subtypes of PT, and the LR and DM rates were considered for inclusion. A statistical model for analyzing sparse data and rare events was used. Thirteen studies met eligibility criteria and were selected. Considering a threshold of 10 mm (margins < 10 vs margins ≥ 10 mm), the 5-year incidence rate of LR was estimated to be 5.22 vs. 3.63 (diff. -1.59) per 100 person-years for benign PT, 9.60 vs. 7.33 (diff. -2.27) for borderline PT, and 28.58 vs. 21.84 (diff. -6.74) for malignant PT. For DM, it was estimated to be 0.88 vs. 0.86 (diff. -0.02) for benign PT, 1.61 vs. 1.74 (diff. 0.13) for borderline PT, and 4.80 vs 5.18 (diff. 0.38) for malignant PT. The data for a threshold of 1 mm were not sufficient to draw any conclusions. Irrespective of tumor grade, we found that DM was a rarer event than LR. Malignant PT had the highest incidence rate of LR and DM. This meta-analysis found a clear association between width of margins and LR rates. Whatever the tumor grade, surgical margins ≥ 10 mm guaranteed a lower risk of LR than margins < 10 mm. On the other hand, the width of margin did not influence the apparition of DM

Polyvinyl Alcohol/EuBa2Ca2Cu3O9−x Composites: Dielectric and Mechanical Properties

In the present work, the influence of EuBa2Ca2Cu3O9-x (coded as Eu-1223) ceramic additive on the mechanical and dielectric properties of poly(vinyl alcohol) (PVA) polymer were investigated for the first time. PVA/Eu-1223 polymer-ceramic thick film composites were prepared by solution casting method with different ceramic contents varying from 1 to 5%. The surface morphology of the samples were studied with scanning electron microscope revealed that adding higher concentration of Eu-1223 increases the roughness of the surface as well as the fragility of the PVA. Thermogravimetric analyses results revealed that the increasing Eu-1223 additive enhances slightly both the thermal and oxidative stability of the PVA. Furthermore, FTIR analysis of the composite displayed new FTIR transmittance peaks that can be attributed to the formation of a reaction between the PVA polymer chain and the ceramic additive. The mechanical properties in the context of stress-strain curves of the samples unveiled that increasing ceramic doping improves the Young's modulus of PVA films. The impedance and dielectric properties of the samples recorded at room temperature indicated a space charge polarization regardless of the doping concentration. The complex electrical modulus analysis also pointed out a pure conduction process. The Nyquist and phase angle plots defined the grain and grain boundary properties along with the ideal capacitor ability of the composites. Especially, the lower epsilon' and epsilon aEuro(3) values were achieved for the 5% Eu-1223 additive level concentration. This work brings out that 5% Eu-1223 added PVA thick film may be suggested as a low dielectric loss dielectric material for supercapacitor applications

Noncirrhotic portal fibrosis/idiopathic portal hypertension: APASL recommendations for diagnosis and treatment

The Asian Pacific Association for the Study of the Liver (APASL) Working Party on Portal Hypertension has developed consensus guidelines on the disease profile, diagnosis, and management of noncirrhotic portal fibrosis and idiopathic portal hypertension. The consensus statements, prepared and deliberated at length by the experts in this field, were presented at the annual meeting of the APASL at Kyoto in March 2007. This article includes the statements approved by the APASL along with brief backgrounds of various aspects of the disease

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. Methods: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Findings: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). Interpretation: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. Funding: None