RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE …



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

COMPLETED PROFORMA FOR REGISTRATION OF TOPIC FOR DISSERTATION

“THE STUDY OF ASTHI DHATU WITH SPECIAL REFERENCE TO RELATION BETWEEN BONE MINERAL DENSITY AND CHRONIC TAMAKA SWASA”

By

DR SAJIN. c. p.

MD (AY) SCHOLAR

DEPT OF P.G. STUDIES IN SHAREERA RACHANA

S.D.M. COLLEGE OF AYURVEDA

HASSAN

Guide

Dr. B.G.KULKARNI M.D (AyU)

Dept.of P.G.Studies in shareera rachana

S.D.M.College of Ayurveda

HASSAN

2012 – 2013

S.D.M.COLLEGE OF AYURVEDA

THANNIRUHALLA, HASSAN-573201

From-

Dr SAJIN. C. P.

1st Year M.D. Scholar

Dept. of P.G.Studies in Shareera Rachana

S.D.M.C.A. HASSAN

To-

The Registrar

Rajiv Gandhi University of Health Sciences

Karnataka, Bangalore

Through-

The Principal & Head of The Department (Shareera Rachana)

S.D.M. College of Ayurveda

Thanniruhalla, Hassan-573201.

Subject: Submission of completed proforma for registration of topic for

Dissertation.

Respected sir,

I request you to kindly register the below mentioned topic against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bangalore for the partial fulfillment of M.D.(AYU) in Shareera Rachana.

Title of Dissertation:

The study of Asthi Dhatu with special reference to relation between bone mineral density and chronic Tamaka Swasa

Herewith I am enclosing completed Proforma for registration of topic for dissertation.

Thanking you

Date: Yours Sincerely

Place: Hassan Dr.Sajin.C.P.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

ANNEXURE-II.

COMPLETED PROFORMA FOR REGISTRATION OF TOPIC FOR DISSERTATION

1. NAME OF THE : DR. SAJIN. C. P.

CANDIDATE

ADDRESS

(IN BLOCK LETTERS) PRELIMINARY M.D (AYU) SCHOLAR Dept.of P.G.Studies in SHAREERA

RACHANA. S.D.M.C.a

THANNIRUHALLA,HASSan

PERMANENT ADDRESS : CHAKKALAKKAL HOUSE

PALISSERY PO

PALAKKAL, THRISSUR

KERaLA-680027

2. NAME OF THE : SRI DHARMASTHALA MANJUNATHESHWARA

INSTITUTION COLLEGE OF AYURVEDA HASSAN-573201

3. COURSE OF STUDY : M.D (AYURVEDA)

AND SUBJECT SHAREERA RACHANA

4. DATE OF ADMISSION : 14/7/2012

TO COURSE

5. TITLE OF THE TOPIC : “The study of Asthi Dhatu with special reference to relation between bone mineral density and chronic Tamaka Swasa”

6. BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED OF THE STUDY

Asthi is the fifth Dathu as per Ayurveda classics.1 It gives support and is responsible for appropriate posture of body. Total number of Asthi and its types are explained in classics.2In Samhita a detailed explanation of Asthi and it’s Vikara are mentioned,3 but microscopic changes related to Asthi are not mentioned. According to Ashraya Ashrayi Bhava, Asthi is the seat of Vayu and increase of Vayu in Shareera leads to the Kshaya of Asthi Dathu.4 The homeostasis of body mainly depends upon Vata and as it is residing within the Asthi, the structural and functional status of its Upadathus will also be affected. Vriddi and Kshaya Lakshana of Asthi are mentioned in classics and are expressed in terms of Danta, Nakha, Kesha and Asthi Vikara., 5 In Bhagna Nidanam while explaining about the Sadhyaasadhyata of Bhagna, it is mentioned that in Swasa the Bhagna is Krichrasadhya .6Tamaka Swasa is caused due to the Margavarodha of Vayu by Kapha,so Vayu also plays an important role in Swasa.7

Further, there is a clear association between Chronic Obstructive Pulmonary Disease and excessive bone loss/risk of fractures.8 Little is known about the pathophysiological processes involved in the bone loss. The release of inflammatory cytokines in all respiratory disorders like tumour necrosis factor alfa and interleukin-1 along with catalytic enzymes (matrix metalloprotienases etc)which are the end products of protein catabolic process, induces bone resorption might be a reason.9Interleukin-6 is involved in regulation of bone turnover and Osteoporosis development which is also seen in these patients.10In Bone Mineral Density Test (BMD), the T-score less than -2.5 comes under Osteoporosis and - 2.5 to -1 is Osteopenia and above -1 is healthy bone with sufficient minerals.11

By the above references it is revealed that there may be some significant role of BMD(bone mineral density) in healing process of fracture (Bhagna). That is why Sushruta might have told about poor prognosis of fracture in Swasa Rogi. To substantiate this thought, there is a need to analyze quantitative and qualitative status of Asthi Dhatu by measuring the bone mineral density in Swasa Rogi. This study will be helpful for Ayurvedic physicians to manage the disorders of bone in Swasa Rogi.

6.2 REVIEW OF LITERATURE:

Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis, the bone mineral density (BMD) is reduced, bone microarchitecture deteriorates, and the amount and variety of proteins in bone are altered. Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density of 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by dual-energy X-ray absorptiometry; the term "established osteoporosis" includes the presence of a fragility fracture. The disease may be classified as primary type 1, primary type 2, or secondary. The form of osteoporosis most common in women after menopause is referred to as primary type 1 or postmenopausal osteoporosis. Primary type 2 osteoporosis or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of 2:1. Secondary osteoporosis may arise at any age and affect men and women equally.12

Osteoporosis itself has no symptoms, its main consequence is the increased risk of bone fractures. Osteoporotic fractures occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, rib, hip and wrist.13The underlying mechanism in all cases of osteoporosis is an imbalance between bone resorption and bone formation. In normal bone, matrix remodeling of bone is constant; up to 10% of all bone mass may be undergoing remodeling at any point in time. The process takes place in bone multicellular units (BMUs) as first described by Frost in 1963. Bone is resorbed by osteoclast cells (which derive from the bone marrow), after which new bone is deposited by osteoblast cells.14

The diagnosis of osteoporosis can be made using conventional radiography and by measuring the bone mineral density (BMD). The most popular method of measuring BMD is dual-energy x-ray absorptiometry. Dual-energy X-ray absorptiometry (DXA) is considered the gold standard for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30–40-year-old), healthy adult women reference population. This is translated as a T-score. But because bone density decreases with age, more people become osteoporotic with increasing age. The World Health Organization has established the following diagnostic guidelines.15

Bone density testing can be done several different ways. The most common and accurate way uses a dual-energy x-ray absorptiometry (DEXA) scan. It uses low-dose x-rays. (You receive more radiation with a chest x-ray.)There are two different types of DEXA scans:

• Central DEXA. You lay on a soft table, and the scanner passes over your lower spine and hip. Usually you do not need to undress.

• Peripheral DEXA (p-DEXA). These smaller machines measure the bone density in your wrist, fingers, leg or heel.

• The results of your test are usually reported as a T-score and Z-score.

T-score compares your bone density with that of healthy young women. Z-score compares your bone density with that of other people of your age, gender, and race. With either score, a negative number means you have thinner bones than the standard. The more negative the number, the higher your risk of a bone fracture. T-score is within the normal range if it is -1.0 or above.17

Asthi Kshaya Lakshanas like Asthithoda, Nakha and Kesha Sathana etc are explained in classics.18.

According to Samhita, Asthi resides in the Vayu, the intimate relation as the Ashraya and Ashrayi respectively, increase of Vata Dosha leads to decrease of Asthi Dhatu and causes Asthi Kshaya.19

According to Susrutha Samhitha, in Swasa Rogi, Bhagna is Krichrasadhya.20

In Swasa ,Vayu is blocked by Kapha and the vitiated Dosha effects Pranavaha Srotas.21Vitiation of Pranavayu occurs in Swasa.22

6.3 AIMS & OBJECTIVES

1. Study of Asthi Dhatu in the perspective of Ayurvedic and contemporary science.

2. To establish the relation between the status of Asthi Dhatu in Swasa Rogi.

7 MATERIALS & METHODS:

Study type: Observational study

Study design: Cross sectional study

Time perspective: Retrospective

Method of sampling: Convenient sampling method

Apparently 30 subjects ,diagnosed with chronic Tamaka Swasa ( >2years of occurrence) will be selected, including both sex from SDMCAH, Hassan of age group 18 to 45years who have not undergone glucocorticoid therapy or with a gap of one and half years. Along with this 30 healthy individuals are also selected of same age group, irrespective of sex.

Above -1 means bones are normal,-1 to -2.5 means Osteopenia or low bone density, -2.5 or lower means Osteoporosis. Each decrease by one point indicates bone loss of 10 to 15 percent.

Appropriate case format will be prepared for Swasa Rogi indicating name of the individual, age, sex, occupation and associated lakshanas.

A database will be created for the medical information about the patients, which will be analysed retrospectively.

Both the groups of chronic Tamaka Swasa and healthy individuals are then send for

p-DEXA (Dual-energy X-ray absorptiometry) scan to assess the bone mineral density (BMD).

By using BMD reading scale, T-score value for 30 chronic Tamaka Swasa patients and healthy individuals are recorded and compared with the normal values of BMD chart. .

By the aid of Statistical tests like cross tabulation and correlation analysis test, the relationship between Asthi Dhatu depreciation in Swasa Rogi is established.

Inclusion criteria

Both sex

Age group between 18 and 45years

Chronic Tamaka Swasa (>2 years of occurrence)

Exclusion criteria

Cardiovascular diseases

Bone related metabolic disorders

Persons with lower limb amputated

Congenital anomalies

Cancer patients

ASSESSMENT CRITERIA

Assessment will be done by subjective and objective criteria

Subjective criteria

Difficulty in breathing, cough, headache, sleeping difficulty etc for Swasa patients.

Objective criteria

BMD test will be done to assess the osteoporotic and osteopeniac cases.

.

7.1 Does this study requires any investigations or intervention to be

Conducted on patients or other humans or animals?

Yes

7.2 Has the ethical clearance is obtained from your institution:

Yes

8. LIST OF REFERENCES:

1. Paradakara HSS. Ashtanga Hrudayam with Sarvanga Sundaram of Arunadutta and Ayurveda Rasayana of Hemadri. 9th ed. Varanasi (India): Chaukhambha Sanskrit Orientalia; 2005. p. 10.

2. Acharya Y T. Sushruta Samhita with Nibhandhasangraha commentary of Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya on Nidanasthana. Reprinted ed. Varanasi (India): Chaukambha Sankrit Sansthan; 2010. p. 365-66.

3. Acharya JT. Charaka Samhita Ayurveda Deepika commentary of Chakrapani Datta. Reprint ed. Varanasi (India): Chaukhambha Krishnadas Academy; 2010. p. 179.

4. Paradakara HSS. Ashtanga Hrudayam with Sarvanga Sundaram of Arunadutta and Ayurveda Rasayana of Hemadri. 9th ed. Varanasi (India): Chaukhambha Sanskrit Orientalia; 2005. p.186-87.

5. Paradakara HSS. Ashtanga Hrudayam with Sarvanga Sundaram of Arunadutta and Ayurveda Rasayana of Hemadri. 9th ed. Varanasi (India): Chaukhambha Sanskrit Orientalia; 2005. p.184-85.

6. Acharya Y T. Sushruta Samhita with Nibhandhasangraha commentary of Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya on Nidanasthana. Reprinted ed. Varanasi (India): Chaukambha Sankrit Sansthan; 2010.. p.330.

7. Acharya Y T. Sushruta Samhita with Nibhandhasangraha commentary of Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya on Nidanasthana. Reprinted ed. Varanasi (India): Chaukambha Sankrit Sansthan; 2010. p.761.

8. Kearney DM, Lockey RF. Division of Allergy and Immunology, University of South Florida College of Medicine and James A. Haley Veterans' Hospital, Tampa, Florida 33612-4745, USA.

9. Lehouck A, Boonen S, Decramer M, Janssens W. Respiratory Division, Center of Metabolic Bone Diseases, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium.

10. Graat-Verboom L, Wouters EF, Smeenk FW, van den Borne BE, Lunde R, Spruit MA. Department of Respiratory Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.

11.  Brian K Alldredge; Koda-Kimble, Mary Anne; Young, Lloyd Y.; Wayne A Kradjan; B. Joseph Guglielmo (2009).Applied therapeutics: the clinical use of drugs. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. pp. 101–3.

12. WHO (1994). "Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group". World Health Organization technical report series 843: 1–129. PMID 7941614.

13.  Ojo F, Al Snih S, Ray LA, Raji MA, Markides KS (2007). "History of fractures as predictor of subsequent hip and nonhip fractures among older Mexican Americans". Journal of the National Medical Association 99 (4): 412–8. PMC 2569658.PMID 17444431.

14. Lim LS, Hoeksema LJ, Sherin K; ACPM Prevention Practice Committee. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med. 2009;36:366-375.

15. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2008.

16. Old, JL; Calvert, M (2004). "Vertebral compression fractures in the elderly". American Family Physician 69 (1): 111–6.PMID 14727827. Retrieved 31 March 2011.

17. Kim DH, Vaccaro AR (2006). "Osteoporotic compression fractures of the spine; current options and considerations for treatment". The spine journal : official journal of the North American Spine Society 6 (5): 479–87.doi:10.1016/j.spinee.2006.04.013. PMID 16934715.

18. Paradakara HSS. Ashtanga Hrudayam with Sarvanga Sundaram of Arunadutta and Ayurveda Rasayana of Hemadri. 9th ed. Varanasi (India): Chaukhambha Sanskrit Orientalia; 2005. p.185.

19. Paradakara HSS. Ashtanga Hrudayam with Sarvanga Sundaram of Arunadutta and Ayurveda Rasayana of Hemadri. 9th ed. Varanasi (India): Chaukhambha Sanskrit Orientalia; 2005. p.186.

20. Acharya Y T. Sushruta Samhita with Nibhandhasangraha commentary of Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya on Nidanasthana. Reprinted ed. Varanasi (India): Chaukambha Sankrit Sansthan; 2010.. p.330.

21. Acharya Y T. Sushruta Samhita with Nibhandhasangraha commentary of Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya on Nidanasthana. Reprinted ed. Varanasi (India): Chaukambha Sankrit Sansthan; 2010. p.761.

22. Acharya Y T. Sushruta Samhita with Nibhandhasangraha commentary of Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya on Nidanasthana. Reprinted ed. Varanasi (India): Chaukambha Sankrit Sansthan; 2010. p.761.

9 Signature of candidate :

10 Remarks of the Guide :

11 Name and designation of Guide : DR. B. G. KULKARNI M D (AYU)

READER

DEPARTMENT OF P.G. STUDIES IN

SHAREERA RACHANA

S.D.M.C.A., HASSAN

Signature of Guide :

12 Name and designation of H.O.D. DR. B. G. KULKARNI M D (AYU)

READER AND HOD

DEPARTMENT OF P.G. STUDIES IN

SHAREERA RACHANA

S.D.M.C.A., HASSAN

Signature of H.O.D. :

13 Remarks of the Chairman :

And Principal

13.1 Signature with seal :

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