MEDICATED THREAD KSHARA SUTRA- A PHARMACOECONOMIC DRUG DELIVERY SYSTEM OF COSMETIC POTENTIAL IN FISTULA-IN-ANO

abstract 

Kshara sutra is basically a medicated thread prepared by repeated coatings of latex from Euphorbia nerrifolia, water extract of powder ashes of Achyranthes aspera and powder of Curcuma longa in a definite fashion. This communication intends to highlight the pharmacoeconomic as well as cosmetic potentials of medicated thread kshara sutra over modern surgery. This also highlights the zenith of research in ancient times on designing of drug delivery systems with nobility.

PARVEEN BANSAL, RAJESH SANND, SANJIV KUMAR, VIKAS GUPTA, SAVITA SHARMA ,japs,vol-1,issue-1,22-27

Management of Pilonidal sinus by kshara sutra a minimally invasive treatment

A Pilonidal sinus (PNS) occurs in the cleavage between the buttocks (natal cleft) and can cause discomfort,embarrassment and absence from work. It is more common in men (as they have more hair) than in women. Themost commonly used surgical techniques for this disorder include excision and primary closure and excision with reconstructive procedure. However, the risk of recurrence or of developing an infection of the wound after the operation is very high. Also, the patient requires longer hospitalization, and the procedure is expensive. There is a similarity between  Nadi Vrana described in Sushruta Samhita and pilonidal sinus. Sushruta has advocated a minimally invasive para-surgical treatment,viz.,Kshara Sutra procedure, for nadi vran.Hence this therapy was tried in pilonidal sinus, Kshara Sutra treatment not only minimizes complications and recurrence but also enables the patient to resume work quicker and with less discomfort, impact upon body image and self-esteem as wellas reduced cost.

A comparative study of Barron's rubber band ligation with Kshar Sutra ligation in hemorrhoids

Despite a long medical history of identification and treatment, hemorrhoids still pose a challenge to the medical fraternity in terms of finding satisfactory cure of the disease. In this study, Kshar Sutra Ligation (KSL), a modality of treatment described in Ayurveda, was compared with Barron's Rubber Band Ligation (RBL) for grade II and grade III hemorrhoids. This study was conducted in 20 adult patients of either sex with grade II and grade III hemorrhoids at two different hospitals. Patients were randomly allotted to two groups of 10 patients each. Group I patients underwent RBL, whereas patients of group II underwent KSL. Guggul-based Apamarga Kshar Sutra was prepared according to the principles laid down in ancient Ayurvedic texts and methodology standardized by IIIM, Jammu and CDRI, Lucknow. Comparative assessment of RBL and KSL was done according to 16 criteria. Although the two procedures were compared on 15 criteria, treatment outcome of grade II and grade III hemorrhoids was decided chiefly on the basis of patient satisfaction index (subjective criterion) and ability of each procedure to deal with prolapse of internal hemorrhoidal masses (objective criterion): Findings in each case were recorded over a follow-up of four weeks (postoperative days 1, 3, 7, 15 and 30). Statistical analysis was done using Student's t test for parametric data and Chi square test & Mann-Whitney test for non-parametric data. P < 0.05 was considered significant. RBL had the advantages of being an OPD procedure requiring no anesthesia and was attended by significantly lesser postoperative recumbency ( P < 0.001 ) and significantly lesser pain ( P < 0.005 on day 1) as compared to KSL. However, Group II (KSL) scored better in terms of treatment outcome. In Group II, there was significantly high (P < 0.05) patient satisfaction index as compared to Group I. Group II reported 100% 'cure' (absence of hemorrhoidal masses even on proctoscopy) of internal hemorrhoidal prolapse as against 80% in Group I (RBL); however, this difference was statistically insignificant (P > 0.05). Both the groups were comparable statistically on all other grounds. Kshar Sutra Ligation is a useful form of treatment for Grades II and III internal hemorrhoids.

Singh R, Arya RC, Minhas SS, Dutt A. A comparative study of Barron's rubber band ligation with Kshar Sutra ligation in hemorrhoids. Int J Ayurveda Res 2010;1:73-81

THE MANAGEMENT OF FISTULA-IN- ANO WITH TILADI KSHARA SUTRA AND AMRITA GUGGULU

Abstract

Most of the kshara sutra researches are carried on ksheera (like snuhi, karkati etc) based kshara sutra. The present study is carried on a kalka (Tiladi) based Apamarga kshara sutra along with oral administration of Amrita guggulu (Bhava prakasha, Vatarakta adhikarana).

Kshara sutra is prepared with tiladi kalka (Tilakalka sa madhukoghritaka vranaropana su.sU.11/29) as base, Apamarga kshara is applied over it as a 3 to 6 layers and lastly 5 coatings of Haridra powder is given.

Study of thirty cases done according to age, sex, occupation, type of fistula-in-ano, type of bhagandhara, chronicity, food habits, and unit cutting time in relation to diet, gender, diabetic, operative and non operative case, out of which 26 (83.34 %) are males and 4 (16.66%) are females. Vegetarians are 5(15%), non- Vegetarians are 25(85%). Most of patients i.e. 36.67% have chronicity of more than four years. Out of thirty patients, 4 (20%) are Shataponaka, 6 (26.7%) are Ushtragreeva, 19 (50%) are Parisravi, 1 (3.3%) is Shambukavarta and no patient is observed as Unmargi.

         High anal fistulas are observed in 6 (20%) patients and low anal fistulas in 24 (80%) patients. Recurrent fistula in ano after fistulotomy cases are 5 (15%).

          In present clinical study, the efficacy of Tiladi kshara sutra and Amrita guggulu was observed in 35 fistula tracks of 30 patients. The assessment of the results is mainly based on unit cutting time (U.C.T.) and unit cutting length (U.C.L).

          After calculating the unit cutting time separately for all the 30 cases the average unit cutting time was evaluated. The average unit cutting time in present study of 35 tracks of 30 cases was 7.55 days/cm and average unit cutting length was 9.26 mm per week.

             There was lot of relief in the symptomatic para meters- like dramatic relief in pain, inflammation and burning sensation and also there was lot of difference in pus discharge and bad smell before and after treatment with Tiladi kshara sutra.

No recurrence was found after 6 months of follow up in all thirty cases.

         This clinical study proves beyond doubt that the appreciable result obtained from this combination is an effective, economical and uncomplicated management for bhagandara.

        In comparison to previous works of efficacy of different kshara sutras in Fistula in Ano, the results observed in the present study with Tiladi kshara sutra are quite encouraging.


Dr.R.KrishnaKumar M.D(ayu), SRF(NIIMH)
mailto:kitsdr@gmail.com,

Pomegranate ellagitannin-derived compounds exhibit antiproliferative and antiaromatase activity in breast cancer cells in vitro.

Abstract

Estrogen stimulates the proliferation of breast cancer cells and the growth of estrogen-responsive tumors. The aromatase enzyme, which converts androgen to estrogen, plays a key role in breast carcinogenesis. The pomegranate fruit, a rich source of ellagitannins (ET), has attracted recent attention due to its anticancer and antiatherosclerotic properties. On consumption, pomegranate ETs hydrolyze, releasing ellagic acid, which is then converted to 3,8-dihydroxy-6H-dibenzo[b,d]pyran-6-one ("urolithin") derivatives by gut microflora. The purpose of this study was to investigate the antiaromatase activity and inhibition of testosterone-induced breast cancer cell proliferation by ET-derived compounds isolated from pomegranates. A panel of 10 ET-derived compounds including ellagic acid, gallagic acid, and urolithins A and B (and their acetylated, methylated, and sulfated analogues prepared in our laboratory) were examined for their ability to inhibit aromatase activity and testosterone-induced breast cancer cell proliferation. Using a microsomal aromatase assay, we screened the panel of ET-derived compounds and identified six with antiaromatase activity. Among these, urolithin B (UB) was shown to most effectively inhibit aromatase activity in a live cell assay. Kinetic analysis of UB showed mixed inhibition, suggesting more than one inhibitory mechanism. Proliferation assays also determined that UB significantly inhibited testosterone-induced MCF-7aro cell proliferation. The remaining test compounds also exhibited antiproliferative activity, but to a lesser degree than UB. These studies suggest that pomegranate ET-derived compounds have potential for the prevention of estrogen-responsive breast cancers.

Adams LS, Zhang Y, Seeram NP, Heber D, Chen S, Pomegranate ellagitannin-derived compounds exhibit antiproliferative and antiaromatase activity in breast cancer cells in vitro, Cancer Prev Res (Phila). 2010 Jan;3(1):108-13.