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Gautam A.P.,Manipal University India | Fernandes D.J.,Manipal University India | Vidyasagar M.S.,Father Muller Medical College | Maiya A.G.,Manipal University India | Vadhiraja B.M.,Manipal Multispecialty Hospital
Radiotherapy and Oncology | Year: 2012

Background and purpose: Oral mucositis (OM) is most cumbersome acute side effect of concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC). OM associated pain affects oral functions and nutrition of the patient that may result in discontinuity of treatment. Several modalities have been tried to prevent and treat OM, but none proved completely successful until date. We used prophylactic low level laser therapy (LLLT) for the prevention and treatment of CCRT induced OM. Materials and methods: In this triple blinded study, 221 HNC patients scheduled to undergo CCRT (Cisplatin (1, 22, 43 day) + RT = 66 Grays (2 Gy/fraction), 33 fractions, 5 fractions/week, for 45 days) were block randomized into laser (n = 111) and placebo (n = 110) group. Laser group received LLLT (HeNe, λ = 632.8 nm, power-density = 24 mW, dosage = 3.0 J/point, total dosage/session = 36-40 J, spot-size = 1 cm2, 5 sessions/week) while placebo received sham treatment daily prior to radiation. OM (RTOG/EORTC Scale), oral pain (VAS), dysphagia (FIS), weight loss and CCRT break were assessed. Data were analyzed using frequencies and percentage, generalized estimating equations (GEE) and odds ratio. Results: There was significant reduction in incidence of severe OM (F = 16.64, df = 8876, p < 0.0001) and its associated pain (F = 25.06, df = 8876, p < 0.0001), dysphagia (F = 20.17, df = 8876, p < 0.0001) and opioid analgesics use (p < 0.0001) in laser than placebo group patients. Conclusions: LLLT decreased the incidence of CCRT induced severe OM and its associated pain, dysphagia and opioid analgesics use. © 2012 Elsevier Ireland Ltd. All rights reserved. Source


Prabhu R.K.,Father Muller Medical College
The Cochrane database of systematic reviews | Year: 2013

Contractures, a common complication following immobility, lead to restricted joint range of motion. Passive movements (PMs) are widely used for the treatment and prevention of contractures; however, it is not clear whether they are effective. The aim of this review was to determine the effects of PMs on persons with contractures or at risk of developing contractures. Specifically, the aim was to determine whether PMs increase joint mobility. We searched the Cochrane Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid SP), EMBASE (Ovid SP), ISI Web of Science (SCI-EXPANDED; SSCI; CPCI-S; CPCI-SSH), PEDro and PsycINFO (Ovid SP). The search was run on 21 November 2013. Randomised controlled trials of PMs administered for the treatment or prevention of contractures were included. Studies were included if they compared the effectiveness of PMs versus no intervention, sham intervention or placebo in people with or at risk of contracture. Studies that involved other co-interventions were included, provided the co-interventions were administered in the same way to all groups. Interventions administered through mechanical devices and interventions that involved sustained stretch were excluded. Three independent review authors screened studies for inclusion. Two review authors then extracted data and assessed risk of bias. Primary outcomes were joint mobility and occurrence of adverse events such as joint subluxations or dislocations, heterotopic ossification, autonomic dysreflexia and fractures or muscle tears. Secondary outcomes were quality of life, pain, spasticity, activity limitations and participation restrictions. We used standard methodological procedures as advocated by the Cochrane Handbook for Systematic Reviews of Interventions. Two identified studies randomly assigned a total of 122 participants with neurological conditions comparing PMs versus no PMs. Data from 121 participants were available for analysis. Both studies had a low risk of bias. One within-participant study involving 20 participants (40 limbs) measured ankle joint mobility and reported a mean between-group difference of four degrees (95% confidence interval (CI), two to six degrees) favouring the experimental group. Both studies measured spasticity with the Modified Ashworth Scale, but the results were not pooled because of clinical heterogeneity. Neither study reported a clinically or statistically relevant reduction in spasticity with PMs. In one study, the mean difference on a tallied 48-point Modified Ashworth Scale for the upper limbs was one of 48 points (95% CI minus two to four points), and in the other study, the median difference on a six-point Modified Ashworth Scale for the ankle plantar flexor muscles was zero points (95% CI minus one to zero points). In both studies, a negative between-group difference indicated a reduction in spasticity in the experimental group compared with the control group. One study with a total of 102 participants investigated the short-term effects on pain. The mean difference on a zero to 24-point pain scale was -0.4 points in favour of the control group (95% CI -1.4 to 0.6 points). The GRADE level of evidence about the effects of PMs on joint mobility, spasticity and pain is very low. Neither study examined quality of life, activity limitations or participation restrictions or reported any adverse events. It is not clear whether PMs are effective for the treatment and prevention of contractures. Source


Baliga M.S.,Father Muller Medical College | Kurian P.J.,University Road
Chinese Journal of Integrative Medicine | Year: 2012

Ixora coccinea Linn., (Rubiaceae) commonly known as jungle of geranium and red ixora, is an evergreen shrub found throughout India. Depending on the medical condition, the flowers, leaves, roots, and the stem are used to treat various ailments in the Indian traditional system of medicine, the Ayurveda, and also in various folk medicines. The fruits, when fully ripe, are used as a dietary source. Phytochemical studies indicate that the plant contains important phytochemicals such as lupeol, ursolic acid, oleanolic acid, sitosterol, rutin, lecocyanadin, anthocyanins, proanthocyanidins, glycosides of kaempferol and quercetin. Pharmacological studies suggest that the plant possesses antioxidative, antibacterial, gastroprotective, hepatoprotective, antidiarrhoeal, antinociceptive, antimutagenic, antineoplastic and chemopreventive effects, thus lending scientific support to the plant's ethnomedicinal uses. In the present review, efforts are made in addressing its ethnomedicinal uses, chemical constituents, and validated pharmacological observations. © 2011 Chinese Association of the Integration of Traditional and Western Medicine and Springer-Verlag Berlin Heidelberg. Source


Baliga M.,Research and Development | Rao S.,Father Muller Medical College
Journal of Cancer Research and Therapeutics | Year: 2010

Radiation is an important modality in cancer treatment and estimates are that between one third and one half of all patients will require ionizing irradiation therapy during some point in their clinical management. However, the radiation-induced damage to the normal tissues restricts the therapeutic doses of radiation that can be delivered to tumors and thereby limits the effectiveness of the treatment. The use of chemical compounds (radioprotectors) represents an obvious strategy to improve the therapeutic index in radiotherapy. However, most of the synthetic radioprotective compounds studied have shown inadequate clinical application owing to their inherent toxicity and high cost. These observations necessitated a search for alternative agents that are less toxic and highly effective. Studies in the recent past have shown that some medicinal plants possess radioprotective effects. Two species of the commonly used aromatic herb mint, Mentha piperita and M. arvensis protected mice against the γ-radiation-induced sickness and mortality. Detail investigations have also shown that the aqueous extract of M. piperita protected the vital radiosensitive organs: the testis, gastrointestinal and hemopoetic systems in mice. The radioprotective effects are possibly due to free radical scavenging, antioxidant, metal chelating, anti-inflammatory, antimutagenic, and enhancement of the DNA repair processes. This review for the first time summarizes the observations and elucidates the possible mechanisms responsible for the beneficial effects. The lacunae in the existing knowledge and directions for future research are also addressed. Source


Baliga M.S.,Father Muller Medical College
Integrative Cancer Therapies | Year: 2010

Alstonia scholaris, commonly known as devil's tree is an important medicinal plant in the various folk and traditional systems of medicine in Asia, Australia, and Africa. The decoction, mostly prepared from the bark, is used to treat a variety of diseases of which the most important is malaria. Furthermore, ethnomedicinal practices also suggest it to be of use in treating cancer, and preclinical studies performed with cultured neoplastic cells and tumor-bearing animals having validated these observations. Additionally, the phytochemicals like echitamine, alstonine, pleiocarpamine, O- methylmacralstonine, macralstonine, and lupeol are also reported to possess antineoplastic effects. In addition to the cytotoxic effects, A scholaris is also observed to possess radiomodulatory, chemomodulatory, and chemopreventive effects and free-radical scavenging, antioxidant, anti-inflammatory, antimutagenic, and immunomodulatory activities, all of which are properties efficacious in the treatment and prevention of cancer. The current review for the first time summarizes the results related to these properties. An attempt is also made to address the lacunae in these published studies and emphasize aspects that need further investigations for it to be of use in clinics in the future. © The Author(s) 2010. Source

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