A CLINICAL STUDY OF PANDUGHNI VATI ON PANDU W.S.R. To IRON DEFICIENCY ANEMIA IN CHILDREN Prof.. K. S. PATEL HOD Dr. V. K. KORI Asst. Professor Institute for Post Graduate Teaching And Research in Ayurveda Gujarat Ayurved University, Jamnagar-361008 DEPARTMENT OF KAUMARABHRITYA
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A PHARMACO-CLINICAL STUDY OF PANDUGHNI VATI ON PANDU …
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A CLINICAL STUDY OF PANDUGHNI VATI ON PANDU W.S.R. To IRON DEFICIENCY ANEMIA IN CHILDREN
Prof.. K. S. PATELHODDr. V. K. KORI
Asst. Professor
Institute for Post Graduate Teaching And Research in AyurvedaGujarat Ayurved University,
Jamnagar-361008
DEPARTMENT OF KAUMARABHRITYA
• With a global population of 6,700 million, at least 3,600
million people have iron deficiency and 2000 million out of
these suffer from iron deficiency anemia.
• South East Asia contributes to 1/5th of population living with
Iron deficiency anemia*.
• Prevalence of anemia in India to be higher than other south
Asian countries**.
• The Third National Family Health Survey (NFHS 3)
reported that prevalence of anemia to be 70-80% in
children. ****GBD 2000 WHO estimates.
** Lancet study rings alarm over anaemia prevalence in India, Indian Express, August 11, 2011.
****National Family Health Survey-III (NFHS-III) 2005-06,Delhi
• Indian Govt. started a National Anemia Prophylaxis Programme in1970.
• Recently Government of India in collaboration with WHO*,UNICEF* and FOGSI* launched the 12 by 12 initiative, on 23 April2007**.
• Several other programmes focusing on issue of anemia include:
1. Mid-day meal programme
2. Kishori Swasthya Yojna,
3. Matri Suraksha Abhiyan
4. ICDS (Integrated Child Development Services), IMA (IndianMedical Association) Anemia free India, as a Public PrivatePartnership and Anemia Chale Jao etc.
• However, most of these programmes have not had anticipatedsuccess and anemia prevalence goes on increasing.
*World Health Organization, United Nations Children’s Fund, Federation of obstetric and Gynecology Society of India**Suneeta Mittal , FCH news and workshop 12 by 12 initiative booklet, , July, 2007, All India Institute of Medical Sciences, New Delhi
Anemia is defined as the reduction of hemoglobinconcentration or the hematocrit below the range ofvalues occurring in healthy persons.*
IRON DEFICIENCY ANEMIA (IDA)
Iron deficiency anemia (IDA) is defined as the depletion of
iron stores in the body where iron loss exceeds iron intake
for a long time and insufficient iron is available for normal
hemoglobin production.
*Bertil Glader, The Anemias. In Nelson Text Book of Pediatrics, Ed Behrman RE et al. 17th Edition, Saunders, Philadelphia, 2004: 1604-1632.
2. Marker Compounds- S. Iron, S. ferritin, TIBC, Transferrin
Saturation
No Pallor 0Pallor hard palate 2Pallor of hard palate, palms/tongue 4Pallor of hard palate, palms/tongue, conjunctiva. 6Pallor of hard palate, palms/tongue ,conjunctiva ,nails and skin
8
Panduta
No palpitation 0Palpitation on heavy exertion 1Palpitation on moderate exertion 2Palpitation on mild exertion. 3
Hriddrava
Edema occational. 1Periorbital edema only in the morning hours. 2Periorbital edema present throughout the day. 3
Akshikuta Shotha
No leg cramps 0Mild leg cramps only at night. 1Leg cramps present in night or on exertion. 2Leg cramps present in night or on exertion, needs medication.
3
Leg cramps present throughout the day. 4
Pindikodveshtana
No dyspnoea 0Dyspnoea on heavy work or play. 2Dyspnoea on moderate work or play. 4Dyspnoea on light work or play. 6Dyspnoea on routine activities. 8
Shwasa
No weakness. 0Weakness present, routines not hampered. 1Weakness present, routines hampered. 2Weakness present, routines hampered, school absenteeism
3
Always sleepy. 4
Daurbalya
No H/O RURTI 0RURTI one episode /month. 1RURTI two episode /month 2RURTI three episodes /month. 3RURTI > three episode /month 4
Recurrent URTI
No Weight Gain 0Weight Gain 1kg in three months. 2Weight Gain 2 kg in three months 4Weight Gain 3 kg in three months. 6Weight Gain >3 kg in three months 8
Weight Gain
Presence of all (Utsah/Laghuta/Udgarshuddhi/Kshut/Trishna/Yathochit malpravrutti)
0
Any 4 2Any 3 3Any 2 4Any 1 5
Jarana Shakti
Good quantity thrice a day 0Reduction up to 25% 2Reduction up to 50% 3Reduction upto 75%, on IV fluids 4Only on IV Fluids 5
Abhyaharana Shakti
Equally willing towards all the Bhojyapadarth(sarva rasa)
0
Willing towards some specific Ahara/Rasavishesha 1Willing towards only one among Katu/Amla/Madhura food
2
Only most liking, not to others 3Unwilling for food but could take the meal 4Totally unwilling for food 5
Ruchi Aharakale
Easily in normal routine 0In normal routine but with difficulty/after meals 1Alternate day/1-2 times ,not well formed 3Every 2nd day/2-3 times, semi liquid, with food particles
4
Every 3rd day/3-4 times ,liquid stools 5
Vata Mutra Purisha Retasam mukti (esp. bowel)
No Irritability , always cheerful 0Occasional irritability. 1Frequent irritability 2Irritability throughout the day 4
Kopanatva
Sound sleep (Deep, unbroken) 0Delayed onset of sleep, gets disturbed at night 1Sleep only for 3-4 hrs at night/day 2No sleep at all at night/some hrs in day time only 3
Nidra labho yathakalam
Enthusiastic and having concentration, interest in routine
0
Less enthusiastic, not able to concentrate but interested in routine
1
Less enthusiastic and not interested in work 2Loss of enthusiasm and concentration 3
Overall effect of therapy on various parameters of Pandu
87.03%84.8%
61.62%
1.82%
-7.87%
-20
0
20
40
60
80
100
Cardinal features Associated features
Bala (Deha,Agni,Satva)
Hematological Specific markers
0% 3.33%
80%
13.33%
0
10
20
30
40
50
60
70
80
90
Cured Marked Imp. Moderate Imp. Mild Ipm.
Discussion
Basic difference in the management – Pandu / IDA
• Correction of Metabolism Vs Nutritional Deficiency
• Pandu – A Santarpanottha Vyadhi
• Correctors of Agni Vs Role of iron containing compounds
• Charaka Samhita: 108 preparations are indicated but only 13 preparations
contain iron.
• AFI:102 preparations are indicated but only 30 preparations contain iron.
• Administration of metallic preparations require special cautions in children.*
• * Masawe MJ. The adverse effect of iron retention on the course of certain infections. British medical journal, 1987, 2:1113–15.
Discontinued patients = 21
8 : Non-cooperative (fear of injection)
2 : laboratory personal were unable to take sample even after several pricks
6 : Irregular
1 : URTI Infections
1 : vomiting
1 : diarrhea
1 : Refusal of intake due to Heavy dose of PV
1 : Move other place
• A study stated that pooreducation is the common cause ofanemia. Because it is responsiblefor lack of knowledge aboutbalanced and nutritiousdiet, faulty dietary habits etc.which may lead to nutritionalanemia.
• Parents had little knowledge ofthe symptoms, causes andprevention of anemia.
Maternal edu. Secondary (33.33%)
Paternal edu. Secondary (35.29%)
www.jiag org, www.ijag.org,
Lillian Mwanri, Anthony W, Joseph M, School and anaemia prevention: current reality and opportunities—a Tanzanian case study, Oxford
Journal, health promotion International, Vol 16, issue4, pg 321-331.
• Various studies proved that patients fromlower SES have higher grades of anemiathan higher SES.
Socio-economic
status
74.50% lower SES
• Vegetarians are more likely to developiron deficiency, it may be due to the factthat availability of iron in plants rangesfrom only 1-10%, while that in meet, fishetc, is 20-30%. Animal products aresource of haem iron and its absorption isusually high compared to non haemiron.
Dietary pattern 64.70%
Vegetarian
Sanjeev M Chaudhry, Vasant R Dhage, A study of anemia among adolescent female in the urban area of Nagpur , IJCM, Vol33, issue
4, oct.2008, pg243-245.
Devidsons principle and practice of medicine, 20th ed. 2006, Elsevier ltd., editors Nicholas Boon, Nicki college, Brain walker John Hunter, pg126.
• PV shown significant increase (P<0.01) in Hemoglobin level.
• MCH was significantly increased (P< 0.05) MCH, Theabsorption of iron and improvement in hematologicalparameters depends on availability of enhancers and quantityof iron*.
• PV revealed highly significant result on all cardinal andassociated features.
PV, All biochemical parameters shown insignificant result
Finding are suggestive of normal functioning of liver and
kidney and normal metabolism of body. Various studies
revealed that vitamin C may lower the serum uric acid level*.
*Arthritis Rheum. 2005. Johns Hopkins University, Baltimore, Maryland 21205, USA.
• S. ferritin was significantly decreased (P<0.05) High
S. ferritin reflects high stores of iron in the body.
• S. iron and Transferrin saturation shown insignificant
result. Iron is transported in blood by the protein
transferrin High iron intake may increase S. iron and
transferrin saturation and helpful in correcting IDA
because *.*Centers for Disease Control and Prevention (CDC), Recommendations to Prevent and Control Iron Deficiency in the United States, MMWR, April 3, 1998 / Vol. 47 / No. RR-3
• increase in hemoglobin level was highly significantly
in 2-6 yrs children, but insignificant change was
noticed in 7-11yrs aged children
• Some dissimilarity was noted between the present study and
the previous research. Previous research work on Pandughni
Vati shown insignificant result in adult*. But in present
research work insignificant result was noticed in 7-11yrs aged
children while highly significant result shown in 2-6yrs aged