Features of diagnosis and treatment of a patient with functional dyspepsia on the example of clinical case

Today, the diagnosis of functional dyspepsia is quite common and is very common in the practice of a physician, family doctor and gastroenterologist. Functional dyspepsia is the presence of symptoms in the gastroduodenal area without the presence of organic, systemic or metabolic disorders. This condition is defined as a feeling of discomfort and pain in the epigastric region in the absence of symptoms of reflux. Symptoms of dyspepsia are found in many patients, but not all of them seek medical attention. To date, the issues of etiology and pathogenesis remain unexplored. But much of the role is given to genetic factors, the polymorphism of some genes. Lifestyle, eating fatty, fried, spicy foods, smoking, drinking alcohol, infections, and psychogenic factors are also likely to be important. These factors include the characteristics of the patient’s character, the presence of chronic stress, psychological states accompanied by depression, anxi-ety and others. Patients with functional dyspepsia have the following complaints: epigastric pain, early satiety, burning in the epigastrium, postprandial overflow. But keep in mind that this diagnosis is an exclusion diagnosis. That is, it is necessary to make sure that the patient has no symptoms of anxiety (progressive dysphagia, unmotivated weight loss, anemia, fever, etc.), that the patient does not take nonsteroidal anti-inflammatory drugs, no Helicobacter pylori infection, endoscopy, which revealed no abnormalities. Patients with prolonged symptoms should be excluded from the psychological connection with the disease or the possible presence of food intolerance.

Effect of Ksheera Vaitarana Vasti, Janu Vasti along with Adjuvant Ayurveda Drugs in the management of Sandhigatavata (Osteoarthritis in knee joint)- A case study

Sandhigatavata is a disease with Shoola (pain), Shotha (swelling) and Hanti Sandhi Gatah Sandhi (impairment of the functions of joints). This can be correlated with osteoarthritis. Osteoarthritis is a degenerative arthritis. While any joint can be affected in osteoarthritis, knee joint is most commonly affected. Vangasena Samhitha mentions Ksheera Vaitarana Vasti as a treatment for Janu Sankocha (stiffness of joint), Kati Prushta Shoola Shotha (swelling and pain in waist, knee and back). Prasarana Akunchanayoh Pravrutthishca Savedana (pain during contraction and extension of limbs) is described as a symptom of Sandhigatavata and stiffness in joint is a symptom of osteoarthritis. Sri Lankan traditional physician family ‘Weerasinghe’ treat Sandhigatavata with Belimul Thippilimul Amu Inguru Kashaya with effective results. Gugguladi Thaila is described in Sri Lankan Ayurveda Pharmacopeia in treatment of Vata Roga. Susruta advises to conduct Snehana in treatment of Vata Roga. Janu Vasti is one method of administering Bhahya Snehana to Janu Sandhi (knee joint). A 65 years old female with an 8 years history of Sandhigatavata Ayurveda treatments for 21 days. Ksheera Vaitarana Vasti was conducted for seven days and from Day 8 to 21, with oral administration of Belimul Thippilimul Amu Inguru Kashaya along with Janu Vasti using Gugguladi Thaila. After completion of treatment, it was observed that swelling, tenderness and pain during contraction and extension of limbs were completely relived. It is concluded that above treatment regimen is effective in treatment of Sandhigatavata (osteoarthritis).

Family Conference In Primary Care Practice

From the Epidemiology Triangle, we can see that a person’s health status is influenced by 3 factors: host, agent, and the environment. The environment plays the biggest role as the cause of health problems, one of which is the family environment. Family can become a supporting factor or inhibiting factor in the successful management of patient’s cases. Therefore, a primary care physician/family physician needs to conduct family meetings to discuss and agree on solutions with the patient’s family by paying attention to inhibiting and supporting factors and find common solutions for the benefit of the patient.

A Phase II Trial of Decitabine and Vorinostat in Combination with Chemotherapy for Relapsed/Refractory Acute Lymphoblastic Leukemia

Abstract 4307 DNA hypermethylation and histone de-acetylation are mechanisms involved in gene expression silencing and subsequent drug resistance in leukemia. Agents which target these mechanisms have been investigated in myeloid malignancies but few studies have addressed whether they have a role in lymphoid leukemia. We conducted a clinical trial evaluating the tolerability and efficacy of Decitabine and Vorinostat followed by chemotherapy for relapsed/refractory acute lymphoblastic leukemia (ALL). Patients 0–60 years of age were eligible. Protocol therapy included Decitabine (15mg/m2 iv) and Vorinostat (230mg/m2 PO div BID) days 1–4 followed by vincristine, prednisone, PEG-Asparaginase and doxorubicin. Fourteen patients with a median age of 16 (range, 3 – 54) years have been enrolled to date. Five patients failed prior allogeneic transplantation. The most common non-hematological toxicities (grade >3) at least possibly related to Decitabine and/or Vorinostat were infection (grade 3; n=6) and fever (grade 3; n=3). There was a single grade 5 toxicity related to the chemotherapy backbone. Bone marrow samples (n=11) were evaluated using the DNA LINE global methylation analysis. A decrease in total methylation was found in 10 patients comparing baseline and day 5 (4/10 showing significant reductions in hypermethylation (T-test p<0.01). Eight patients were evaluable for response. Complete remission without platelet recovery (CRp) was achieved in 4 patients, PR in 2 patients, SD and PD in 1 patient each for an overall response rate (CRp + PR) of 75%. Six patients were inevaluable for response based on not having an end of treatment marrow evaluation due to disease progression (n=2; days 4 and 16), toxic death (n=1), ineligibility (n=1) and physician/family request (n=2). The combination of Decitabine and Vorinostat for patients with relapsed ALL leads to changes in methylation patterns in the leukemic blasts. The use of these agents followed by chemotherapy appears tolerable and efficacious in patients with relapsed ALL. This study is continuing to accrual and is registered at www.clinicaltrials.gov as NCT00882206. Disclosures: Off Label Use: decitabine for relapsed ALL vorinostat for relapsed ALL.