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In the present modern day's world, anorectal disorders are increasing in number due to sedentary lifestyle. They cause great discomfort and make one’s life miserable. Among these fistula in ano is most common. It is challenging to treat due to its recurrent nature. Fistula-in-ano is an inflammatory tract that is lined by unhealthy granulation tissue and has two openings, an external opening present in perianal skin and an internal opening in the anal canal or rectum. Fistula in ano is correlated with Bhagandara in Ayurveda. Acharya Sushruta has mentioned it among Ashta Mahagada and explained five types of Bhagandara. Many treatment modalities have been given for the treatment of fistula in ano, Ksharasutra application is one of them. It is a minimally invasive para-surgical procedure and induces both mechanical as well as chemical cutting and healing of the fistulous tract. This technique has a high success rate but it is time-consuming and causes minimal complication. A 73 years old male patient came to RGGPG Ayurvedic College and Hospital, with a complaint of pain and pus discharge from his left thigh for 7-8 years, he has been diagnosed with a case of recurrent fistula in ano. The patient was treated with partial fistulectomy along with Ksharsutra application and recovered well with complete excision of the tract.

Non-healing ulcers are a serious health issue that affects people all over the world. They are expensive in terms of both human and material resources. Unavoidable and harmful to the lower limb, non-healing ulcers are a leading factor in non-traumatic lower limb amputations. Numerous studies have examined the potential effects of medicinal leech therapy (MLT), also known as hirudotherapy or Jalaukavcharan in Ayurveda on a variety of illnesses, including Skin disorders and inflammatory diseases, as well as various surgical ailments. Despite the lengthy history of complementary health practises, contemporary medicine has only recently focused on their potential mechanisms of action. Many bioactive compounds, including antistasin, eglins, guamerin, hirudin, saratin, and bdellins, as well as complement and carboxypeptidase inhibitors, are secreted by leeches. In addition to extracellular matrix degradative and antibacterial actions, they exhibit analgesic, anti-inflammatory, platelet inhibitory, anticoagulant, and thrombin regulating properties. However, with more research, the range of effects may broaden. The method has been shown to be affordable, efficient, simple to use, and effective. The aim of this study to evaluate the effectiveness of Jalaukavcharan to promote the healing processes in non-healing ulcer. The study was an observational single case design without control group; it was carried out in department of Shalya of Rajiv Gandhi Post Graduate Ayurvedic College, Paprola

Ancient Indian medicine has a long and wide history but modern medicine has just recently emerged with focusing on their possible modes of action. Jalaukavacharna or Medicinal Leech Therapy or Hirudotherapy is an old technique of bloodletting and is being widey studied by many researchers for possible effects on numerous diseases as Dushta Vrana Ropana, inflammatory diseases, osteoarthritis, various diseases according to different Doshas etc. Detailed description of the Jalaukavacharna and Jalauka is given in Sushruta Sutra Sthana Thirteen. Researchers have described various properties of leech therapy like anti-inflammatory, analgesics, platelet inhibitory, anticoagulant etc. A 61 years old male patient with history of DMII since 10 years came to RGGPG Ayurvedic College and Hospital, Paprola, Himachal Pradesh with the complaints of wound over left foot with pustular discharge and smell accompanied by fever. After thorough debridement, leech therapy was done for 4 weeks, twice per week followed by once every week for 6 weeks. Strict limb elevation was advised along with strict diabetic management. The treatment followed may be adopted in the future for various cases.

Intervertebral disc herniation is common condition, with majority occurring in lumbar and cervical spine. Most lumbar disk herniations occur within the spinal canal, with approximately 7%-10% identified within the foramen or extraforaminal location. Extraforaminal disc herniation in extreme lateral, retroperitoneal or anterior terms are used when disc material is seen towards anterolateral or anterior to the spine. Disc herniation in these locations is easily mistaken for an abscess or a neoplasm especially when it is not connected to the parent disc (sequestered disc). We describe a case of 60-year male who initially was misdiagnosed as psoas abscess and subjected to invasive investigation which later turned out to be histologically confirmed disc sequestration in the retroperitoneum. Thus, knowledge of this condition is essential in avoiding unnecessary workup and treatment.

Radiotherapy plays an important role in the treatment of localized primary malignancies involving the chest wall or intrathoracic malignancies. Secondary effects of radiotherapy on the lung result in radiation-induced lung disease. The phases of lung injury from radiation range from acute pneumonitis to chronic pulmonary fibrosis. Radiation pneumonitis is a clinical diagnosis based on the history of radiation, imaging findings, and the presence of classic symptoms after exclusion of infection, pulmonary embolism, heart failure, drug-induced pneumonitis, and progression of the primary tumor. Computed tomography (CT) is the preferred imaging modality as it provides a better picture of parenchymal changes. Lung biopsy is rarely required for the diagnosis. Treatment is necessary only for symptomatic patients. Mild symptoms can be treated with inhaled steroids while subacute to moderate symptoms with impaired lung function require oral corticosteroids. Patients who do not tolerate or are refractory to steroids can be considered for treatment with immunosuppressive agents such as azathioprine and cyclosporine. Improvements in radiation technique, as well as early diagnosis and appropriate treatment with high-dose steroids, will lead to lower rates of pneumonitis and an overall good prognosis.

In this research, 25 medicinally used Lamiaceae species belonging to 20 genera have been studied and identified for the nine disorders. We used scanning electron microscopy (SEM) for qualitative and quantitative morphological character identification. The micromorphological characters observed here were important for distinguishing the studied taxa. The highest medicinal values were reported for Vitex negundo and Scutellaria baicalensis for all considered categories except urinary and otorhinolaryngology disorders. The foliar epidermal anatomical characteristics revealed that the micromorphological features of the Lamiaceae species provide taxonomically significant and accurate identification information to delimitate the family species. Moreover, we focused on both qualitative (epidermal cell shape, stomata type, stomatal pore shape, subsidiary cell shape, glandular trichomes, and non-glandular trichome shape) as well as quantitative features (epidermal cell size, stomata size, stomatal pore size, subsidiary cell size, and trichomes size). The trichomes diversity was different in most species' on adaxial and abaxial surfaces. In most species, anomocytic stomata were observed, but other types such as diacytic, paracytic, and tetracytic type stomata were also examined. The diverse pattern of anatomical characters suggests that the studied taxa provide insight evidence for the taxonomic observation of the Traditional Chinese Medicinal plants from the Lamiaceae. This work sets an avenue for future research and taxonomic exploration of medicinal flora through microscopic investigations. RESEARCH HIGHLIGHTS: This research offers a thorough microscopic identification of the family Lamiaceae. Taxonomic information on the trichome characters and types for the accurate authentication. Qualitative and quantitative characterization of 25 medicinally used Lamiaceae taxa.

Introduction: Racial disparities exist in patients with peripheral artery disease (PAD), with Black individuals having worse PAD-specific outcomes. However, mortality risk in this population has been mixed. As such, we sought to evaluate all-cause mortality by race among individuals with PAD. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Baseline data were obtained from 1999 to 2004. Patients with PAD were grouped according to self-reported race. Multivariable Cox proportional hazards regression was performed to calculate adjusted hazard ratios (HR) by race. A separate analysis was performed to study the effect of burden of social determinants of health (SDoH) on all-cause mortality. Results: Of 647 individuals identified, 130 were Black and 323 were White. Black individuals had more premature PAD (30% vs 20%, p < 0.001) and a higher burden of SDoH compared to White individuals. Crude mortality rates were higher in Black individuals in the 40–49-year and 50–69-year age groups compared to White individuals (6.7% vs 6.1% and 8.8% vs 7.8%, respectively). Multivariable analysis demonstrated that Black individuals with both PAD and coronary artery disease (CAD) had a 30% higher hazard of death over 20 years compared to White individuals (HR = 1.3, 95% CI: 1.0–2.1). The cumulative burden of SDoH marginally (10–20%) increased the risk of all-cause mortality. Conclusions: In a nationally representative sample, Black individuals with PAD and CAD had higher rates of mortality compared to their White counterparts. These findings add further proof to the ongoing racial disparities among Black individuals with PAD and highlight the necessity to identify ways to mitigate these differences.

Statin use is recommended in all patients with peripheral arterial disease (PAD) owing to its morbidity and mortality benefits. However, the effect of statin use on limb salvage in patients with PAD after intervention is unclear. We examined the effect of statin use on limb salvage and survival among patients with PAD undergoing surgical or endovascular intervention.A total of 488 patients with PAD were identified who underwent surgical (n = 297) or endovascular (n = 191) intervention between 2009 and 2010. Information was collected from electronic medical records and the Social Security Death Index. Predictors of ongoing statin use were identified first by univariate analysis and then via multivariable logistic regression. Survival and freedom from amputation were identified using Kaplan-Meier plots and adjusted hazard ratios by Cox regression.Of the 488 patients with PAD with intervention, 39% were non-whites, 44% were females, 41% received statins, 56% received antiplatelets, 26% received oral anticoagulants, 9% required a major amputation, and 11% died during follow-up of up to 88 months. Statin users were more often male (P = .03), white (P = .03), smokers (P .01), and had higher comorbidities such as coronary artery disease (P .01), hypertension (P .01), and diabetes (P .01). Antiplatelet use was not associated with limb salvage (P = .13), but did improve survival (P .01). Dual antiplatelet therapy did not show any benefit over monotherapy for limb salvage (P = .4) or survival (P = .3). Statin use was associated with improved survival (P = .04), and improved limb salvage (hazard ratio, 0.3; 95% confidence interval, 0.1-0.7) after adjusting for severity of disease, traditional risk factors, and concurrent antiplatelet use.Statin use in patients with PAD with interventions was associated with improved limb salvage and survival. Despite existing guidelines, statin therapy was low in our PAD population, and efforts are ongoing to increase their use across the health care system.

Spontaneous intercostal artery bleeding is a rare disease seen in cirrhosis and can present with hemodynamically significant blood loss anemia, hypotension, and shock. Transcatheter arterial embolization is an effective treatment for severe cases.

In the Indian context, the formal description of wound care has been widely elaborated in the three great treaties (Brahatrayi) of Ayurveda i.e., Charak Samhita, Sushruta Samhita, Ashtang Sangrah. Madhu has been described by them as Vrana Ropaka. A 42-year-old patient came to us with Ignored 10 days old open fracture of the Base 2nd Metatarsal with an infected wound right foot. After debridement of the wound and application of Madhu was done for 3 weeks, and B/K POP Slab applied. The treatment plan followed may be adopted in the future for cases.

The family Scrophulariaceae consists of taxonomically complex genera and species. The delimitation of the taxa within this family is always challenging. In this paper, we studied leaf epidermis anatomical characteristics and its taxonomic significance of four species belonging to four genera of the family Scrophulariaceae collected from northern Pakistan. The species were examined under light and scanning electron microscopes (LM and SEM). Qualitative and quantitative foliar epidermal anatomical features were examined for both adaxial and abaxial surfaces. Qualitative characters like epidermal cell shape, epidermal cell cover, anticlinal wall, trichomes type, stomata type and stomata position were examined. Quantitative characters like the length and width of leaf epidermis, stomata, stomatal pore, subsidiary cell and trichomes for both adaxial and abaxial surfaces were studied and measured. Stomatal index within the species and between the species was found to be different on adaxial and abaxial surfaces. Diacytic stomata and glandular trichomes on epidermis were only found in Anticharis glandulosa while rest of the taxa has anomocytic type stomata and dendroid trichomes on both surfaces. Based on the micromorphological characters, we did principal component analysis (PCA), and cluster analysis for the species delimitation and identification. A taxonomic key has been provided to delimit and identify the studied taxa based on foliar epidermal characters. The aim of the present research was to elucidate the micromorphological characters to distinguish the studied taxa for taxonomic purposes.

We propose an algorithm, guided variational autoencoder (Guided-VAE), that is able to learn a controllable generative model by performing latent representation disentanglement learning. The learning objective is achieved by providing signals to the latent encoding/embedding in VAE without changing its main backbone architecture, hence retaining the desirable properties of the VAE. We design an unsupervised strategy and a supervised strategy in Guided-VAE and observe enhanced modeling and controlling capability over the vanilla VAE. In the unsupervised strategy, we guide the VAE learning by introducing a lightweight decoder that learns latent geometric transformation and principal components; in the supervised strategy, we use an adversarial excitation and inhibition mechanism to encourage the disentanglement of the latent variables. Guided-VAE enjoys its transparency and simplicity for the general representation learning task, as well as disentanglement learning. On a number of experiments for representation learning, improved synthesis/sampling, better disentanglement for classification, and reduced classification errors in meta-learning have been observed., Comment: Accepted to CVPR 2020

We present a new generative autoencoder model with dual contradistinctive losses to improve generative autoencoder that performs simultaneous inference (reconstruction) and synthesis (sampling). Our model, named dual contradistinctive generative autoencoder (DC-VAE), integrates an instance-level discriminative loss (maintaining the instance-level fidelity for the reconstruction/synthesis) with a set-level adversarial loss (encouraging the set-level fidelity for the reconstruction/synthesis), both being contradistinctive. Extensive experimental results by DC-VAE across different resolutions including 32×32, 64×64, 128×128, and 512×512 are reported. The two contradistinctive losses in VAE work harmoniously in DC-VAE leading to a significant qualitative and quantitative performance enhancement over the baseline VAEs without architectural changes. State-of-the-art or competitive results among generative autoencoders for image reconstruction, image synthesis, image interpolation, and representation learning are observed. DC-VAE is a general-purpose VAE model, applicable to a wide variety of downstream tasks in computer vision and machine learning.

BACKGROUND: Patients with peripheral arterial disease (PAD) often have walking impairment due to insufficient oxygen supply to skeletal muscle. In aged rats, we have shown that daily stretching of calf muscles improves endothelium-dependent dilation of arterioles from the soleus muscle and increases capillarity and muscle blood flow during exercise. Therefore, we hypothesized that daily muscle stretching of calf muscles would improve endothelium-dependent vasodilation of the popliteal artery and walking function in PAD patients. METHODS: We performed a randomized, non-blinded, crossover study whereby 13 patients with stable symptomatic PAD were randomized to undergo either 4 weeks of passive calf muscle stretching (ankle dorsiflexion applied 30 min/d, 5 days/wk) followed by 4 weeks of no muscle stretching and vice versa. Endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin-induced dilation of the popliteal artery and 6 minute walk test (6MWT) were evaluated at baseline and after each 4 week interval. RESULTS: After 4 weeks of muscle stretching, FMD and 6MWT improved significantly in the muscle stretching group vs. the control (FMD: 5.1 ± 0.5 % vs. 3.7 ± 0.3 %, P=0.005; 6MWT continuous walking distance: 304 ± 43m vs. 182 ± 34m; P=0.0006). No difference in nitroglycerin-induced dilation was found between groups (10.9 ± 1.2 vs. 9.9 ± 0.4 %, P=0.48). Post-stretching, 6MWT total walking distance was positively correlated with normalized FMD (R=0.645, P=0.02). CONCLUSIONS: Passive calf muscle stretching enhanced vascular endothelial function and improved walking function in elderly patients with stable symptomatic PAD. These findings merit further investigation in a prospective randomized trial.

OBJECTIVE We assessed the influence of age on warfarin dose, percentage time in target range (PTTR), and risk of major hemorrhage. DESIGN Warfarin users recruited into a large prospective inception cohort study were categorized into three age groups: young (younger than 50 yrs), middle aged (50-70 yrs), and elderly (older than 70 yrs). The influence of age on warfarin dose and PTTR was assessed using regression analysis; risk of major hemorrhage was assessed using proportional hazards analysis. Models were adjusted for demographic, clinical, and genetic factors. SETTING Two outpatient anticoagulation clinics. PARTICIPANTS A total of 1498 anticoagulated patients. OUTCOMES Warfarin dose (mg/day), PTTR, major hemorrhage. RESULTS Of the 1498 patients, 22.8% were young, 44.1% were middle aged, and 33.1% were elderly. After accounting for clinical and genetic factors, compared with young warfarin users, warfarin dose requirements were 10.6% lower among the middle aged and an additional 10.6% lower for the elderly. Compared with young patients, middle-aged and elderly patients spent more time in target international normalized ratio (INR) range (p

Background: Statin use is recommended in patients with peripheral arterial disease (PAD) due to its morbidity and mortality benefits. However, the effect of statins on limb salvage in PAD is unclear. We examined the effect of statins on survival and limb salvage among PAD patients undergoing surgical or endovascular intervention. Methods: PAD patients were identified who underwent intervention between 2009 and 2010. Information was collected from electronic medical records and the Social Security Death Index. Univariate analysis was used to determine predictors of ongoing statin use. Survival and freedom from amputation were determined using KM plots and adjusted hazard ratios by Cox regression. Results: A total of 488 PAD patients underwent surgical (n=297) or endovascular (n=191) intervention. 39% were African-American, 44% were female, 41% received statins, 56% received antiplatelet medications, 26% received oral anticoagulants, 9% required a major amputation, and 11% died during follow-up of up to 88 months. Statin users were more often male (p=0.03), caucasian (p=0.03), smokers (p Conclusion: Statin use in PAD patients with interventions was associated with improved limb-salvage and survival. Despite existing guidelines, statin therapy was disappointingly low in our PAD population, and efforts will be made to increase use across our health system.