THE CONCEPT OF IMMUNOMODULATION IN AYURVEDA W.S.R. TO ITS SIGNIFICANCE IN PREVENTING EMERGING INFECTIONS LIKE COVID 2019

Ayurveda is one of the most renowned traditional systems of medicine that has survived and flourished from ages till date. The two basic aims of Ayurvedic science is to maintain the health of healthy person and curing the ill health of the diseased. Here is a comprehensive review of the Ayurvedic classical texts, to understand the Ayurvedic perspectives of immunomodulation w.s.r. to its significance in preventing emerging infections like COVID 2019 pandemic. Background: The review is prepared based on the Ayurvedic perspectives and practices of immunity described in various classical Ayurvedic text books like Brhitrayis, Laghutrayis, their commentaries and published research articles. Review Results: Ayurveda enlists various enhancers of immunity, which include Dinacharya (daily regimen), Ritucharya (seasonal regimen), proper diet, exercise, specific foods like milk, Rasayanas like Guduchi (Tinospora cordifolia), meditation, Yoga-pranayama, Achara Rasayana (good conduct of behaviour). The concept of Vyaadhiksamatva is not merely immunity against a specific infectious agent or disease like the concept of modern medicine. Rather, it denotes resistance against the loss of integrity, proportion and inter-relationship amongst the individual’s Doshas (biohumours) and Dhatus (tissues), which can be increased by various methods mentioned in Ayurveda. Conclusion: New infections are emerging which are not manageable by conventional medicine like the COVID 2019 pandemic. Soit is high time to educate people about the valuable teachings on leading a healthy and subsequently a happier life with the help of the immunomodulatory techniques described in Ayurveda.

Bilateral Idiopathic Neuroretinitis

BACKGROUND: Neuroretinitis is a clinical entity characterized by an acute loss of vision associated with disc edema and a star pattern of exudates in the macula. It can be divided into two, those with a specific infectious agent or idiopathic. Most infectious cases are due to cat-scratch disease caused by Bartonella species and other infectious agents. Case with a clear infectious is categorized as idiopathic. Most patients with idiopathic neuroretinitis recover excellent visual acuity with or without intervention. Although the presentation is most often unilateral, bilateral cases of neuroretinitis have been reported. CASE REPORT: A 20-year-old woman with a 2-weeks history of sudden progressive visual loss both eyes (visual acuity: RE 3/60; LE 20/200). The optic disc was edema and the hard exudate on the macular area. Two weeks follow-up, funduscopic shows a macular star and the optic disc’s edema was reduced. Perimetric test shows general depressed in both eyes. The blood tests and the brain computed tomography scan were normal. She received methyl prednisolone 48 mg for 2 weeks. Eight months follow-up, VA: RE 20/50, LE 20/40 with the pinhole 20/15 in both eyes. The funduscopic still showed edema and slight paling. There was an improvement in central visual acuity after steroid treatment but leave residual abnormal funduscopic. CONCLUSION: Neuroretinitis is generally self-limited. The visual acuity recovers excellent with the steroid, but the abnormal disc in this case related to a vaso-occlusive mechanism of prelamin arterioles with subsequent disc infraction.

Equine Recurrent Uveitis: a review

Equine recurrent uveitis (ERU), also known as "periodic ophthalmia" or "moon blindness", is one of the most serious and vision-threatening disorders worldwide. The pathogenesis of the disease is only partially understood, although it is confidently immune mediated, where bacterial {Leptospira, interrogans), viral and parasitic infections, trauma and systemic diseases have been implicated. The clinical manifestations of ERU vary considerably depending on the stage of the disease. The ocular lesions are usually unilateral, whereas in approximately 20% of the cases they are seen in both eyes. Diagnosis is based on ophthalmologic examination along with specific serology, aiming at the detection of any specific infectious agent. Aggressive and early undertaken treatment is of paramount importance in an attempt to preserve vision, decrease ocular pain and prevent or minimize further relapses. The conventional treatment includes the use of glucocorticosteroids or non-steroidal anti-inflammatory drugs along with mydriatics-cycloplegics, while pars plana vitrectomy and cyclosporine A intra-ocular implants may also give encouraging results. Recendy, alternative therapeutic methods (homeopathy, acupuncture) have also been used. Prognosis in ERU is always guarded to poor, because the severity and frequency of the future episodes is unpredictable.

Stereotactic Drainage of Brainstem Abscess With the BrainLab Varioguide™ System and the Airo™ Intraoperative CT Scanner: Technical Case Report

BACKGROUND AND IMPORTANCE Stereotactic biopsies or needle aspirations of posterior fossa lesions are technically challenging. Here we report a novel technique for performing these procedures employing the Airo™ intraoperative computed tomographic (CT) scanner and the VarioGuide™ articulated arm (BrainLab, Munich, Germany). CLINICAL PRESENTATION A 62-yr-old woman presented with an irregularly shaped, enhancing lesion of the left pons/middle cerebellar peduncle. Slowed diffusion on magnetic resonance imaging suggested an abscess, but no definitive infectious agent/source could be identified. When the patient deteriorated despite broad-spectrum antibiotic therapy, she was taken to the operating room for stereotactic drainage of the abscess employing the described technique. A specific infectious agent (Eikenella corrodens) was identified from the aspirate, allowing for tailored antibiotic therapy. The procedure was well tolerated and the patient made a full recovery with minimal neurological sequelae. CONCLUSION The combination of the Airo™ intraoperative CT and the Varioguide™ articulated arm allows for safe, accurate, and efficient targeting of posterior fossa lesions.

Detection of agents associated with respiratory diseases of swine by real time PCR

Porcine Respiratory Disease Complex (PRDC) is a group of diseases that cause high losses in the swine industry. Several infectious agents are related to PRDC including porcine circovirus 2 (PCV-2), pseudorabies virus (SuHV-1),Haemophilus parasuis (HP), Mycoplasma hypneumoniae (MH) and Pasteurela multocida (PM). The aim of this study was to develop real-time PCRs (qPCR) for the detection of these infectious agents. Oligonucleotides were designed for each specific infectious agent and labeled with different fluorophores to amplify specific parts of the genome. This was done in two groups of reactions—a duplex qPCR for SuHV-1 and PCV-2 and a multiplex qPCR to detect the three bacteria simultaneously. The reactions were tested in 142 pooled samples of swine lymph nodes and lungs with clinical signs of PRDC. There were 135 samples that tested positive for PCV-2, 61 for HP, 29 for PM, 30 for MH and zero for SuHV-1. We recorded 76 cases of co-infection. The qPCRs developed in this study are useful tools in the diagnosis of PRDC.

Fever in the returned traveller

The diagnosis of fever in the returned traveller is an important challenge to the physician. An accurate travel history and knowledge of the incubation period of common diseases is required to assess the risk of infection with a specific infectious agent. Although many febrile illnesses are benign and self-limiting, failure to diagnose malaria and enteric fevers may have disastrous consequences. All patients returning with fever should have thick and thin blood films for malaria and blood cultures performed. Other haematological and biochemical tests are useful in identifying a group of patients in whom empirical anti-microbial therapy is indicated. Thought must be given to the isolation of patients and notification of certain suspected or proven diseases to the local Consultant for Communicable Disease Control. Preventative measures in those likely to travel again should be discussed.

STUDIES ON THE ETIOLOGY OF SPONTANEOUS CONJUNCTIVAL FOLLICULOSIS OF MONKEYS

Spontaneous folliculosis of Macacus rhesus monkeys—a type of follicular conjunctivitis associated with marked, local, inflammatory reactions—is apparently a disease sui generis, due to a specific infectious agent. It can be transmitted from monkey to monkey by means of subconjunctival injection of suspensions, and by conjunctival swabbing of the secretions, of affected tissues, or by contact of normal animals with folliculosis monkeys. The agent causing folliculosis has failed in our hands to pass through Berkefeld and Seitz filters, even those of an unusual degree of permeability; and the lesions that it causes show no cellular inclusions suggestive of the action of a virus. The condition is due apparently to an organism of low grade pathogenicity. The essential histopathological structure corresponds to that of a folliculoma (16) which, while not identical with a granuloma, bears certain resemblances to the latter. The studies here reported concern only one species of monkey, Macacus rhesus. Further investigations will be carried out on different species of Anthropoidea and other animals.