IntroductionInflammatory mediators are key players in the pathogenesis of osteoarthritis (OA) and bone destruction. Conventional drugs suppress symptomatic activity and have no therapeutic influence on disease. Cissus quadrangularis and Withania somnifera are widely used for the treatment of bone fractures and wounds; however, the cellular and molecular mechanisms regulated by these herbals are still unclear.MethodsWe established an in vitro OA culture model by exposing human chondrocytes to proinflammatory cytokine and interleukin (IL)-1β for 36 hours prior to treatment with the herbals: C. quadrangularis, W. somnifera, and the combination of the two herbals. Cell viability, toxicity, and gene expression of OA modifying agents were examined. In addition, expression of survivin, which is crucial for cell growth, was analyzed. In vivo work on osteotomized rats studied the bone and cartilage regenerative effects of C. quadrangularis, W. somnifera, and the combination therapy.ResultsExposure of chondrocytes to IL-1β induced significant toxicity and cell death. However, herbal treatment alleviated IL-1β induced cell toxicity and upregulated cell growth and proliferation. C. quadrangularis inhibited gene expression of cytokines and matrix metalloproteinases, known to aggravate cartilage and bone destruction, and augmented expression of survivin by inhibiting p38 MAPK. Interestingly, osteotomized rats treated with C. quadrangularis drastically enhanced alkaline phosphatase and cartilage tissue formation as compared to untreated, W. somnifera only, or the combination of both herbals.ConclusionOur findings demonstrate for the first time the signaling mechanisms regulated by C. quadrangularis and W. somnifera in OA and osteogenesis. We suggest that the chondroprotective effects and regenerative ability of these herbals are via the upregulation of survivin that exerts inhibitory effects on the p38 MAPK signaling pathway. These findings thus validate C. quadrangularis as a potential therapeutic for rheumatic disorders.

Despite a long medical history of identification and treatment, hemorrhoids still pose a challenge to the medical fraternity in terms of finding satisfactory cure of the disease. In this study, Kshar Sutra Ligation (KSL), a modality of treatment described in Ayurveda, was compared with Barron's Rubber Band Ligation (RBL) for grade II and grade III hemorrhoids. This study was conducted in 20 adult patients of either sex with grade II and grade III hemorrhoids at two different hospitals. Patients were randomly allotted to two groups of 10 patients each. Group I patients underwent RBL, whereas patients of group II underwent KSL. Guggul-based Apamarga Kshar Sutra was prepared according to the principles laid down in ancient Ayurvedic texts and methodology standardized by IIIM, Jammu and CDRI, Lucknow. Comparative assessment of RBL and KSL was done according to 16 criteria. Although the two procedures were compared on 15 criteria, treatment outcome of grade II and grade III hemorrhoids was decided chiefly on the basis of patient satisfaction index (subjective criterion) and ability of each procedure to deal with prolapse of internal hemorrhoidal masses (objective criterion): Findings in each case were recorded over a follow-up of four weeks (postoperative days 1, 3, 7, 15 and 30). Statistical analysis was done using Student's t test for parametric data and Chi square test & Mann-Whitney test for non-parametric data. P < 0.05 was considered significant. RBL had the advantages of being an OPD procedure requiring no anesthesia and was attended by significantly lesser postoperative recumbency (P < 0.001 ) and significantly lesser pain (P < 0.005 on day 1) as compared to KSL. However, Group II (KSL) scored better in terms of treatment outcome. In Group II, there was significantly high (P < 0.05) patient satisfaction index as compared to Group I. Group II reported 100% 'cure' (absence of hemorrhoidal masses even on proctoscopy) of internal hemorrhoidal prolapse as against 80% in Group I (RBL); however, this difference was statistically insignificant (P > 0.05). Both the groups were comparable statistically on all other grounds. Kshar Sutra Ligation is a useful form of treatment for Grades II and III internal hemorrhoids.

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BACKGROUND Bear injuries are unusual, but a trend is often observed in areas of bear habitats. Northern part of Chhattisgarh, a tribal belt is surrounded by bear habitat dense tropical moist deciduous forest. Industrialization and human invasion in their habitats resulting in frequent attacks by bear and victims present to the health care center with grievous injuries and psychological trauma. METHODS Present study included 50 victims of bear attacks admitted in the Department of Surgery, Government Medical College, Ambikapur, Surguja, Chhattisgarh, from 2016 to 2018. Data included are age, sex, precision time of attack, seasons, body parts involved, types of injuries and activity of victims during attack including the course of management. RESULTS In our study of 50 cases, most of the victims were attacked early in the morning and most of the attacks were in winter and monsoon. Common age group encountered was young adults to middle age ranging from 21-40 years. Out of 50 cases studied, 31 (62%) were males and 19 (38%) were females with a male: female ratio of 1.63:1. Attacked victims were usually engaged in cattle grazing activity (40%) and common tendency of attack observed was on face in 46%, followed by scalp in 24% and upper limb in 14%. Commonest injuries made in chronological order were laceration 76% followed by punctured wound in 48%, and avulsion injuries in 16%. Common major complications observed were wound infections 26%, followed by wound dehiscence 10%, with a fatality rate of 4%. CONCLUSIONS Human and bear interactions are accidental and unusual, but frequency is found to be increasing due to encroachment of forest by humans. Victims are usually villagers of near forest. Face and scalp are most commonly attacked body parts but no part is spared and the attack is sometimes fatal. Laceration injury was most common, and mostly on the face and scalp. Management of bear injury required multispecialty approach due to the variety of injuries with involvement of eye, ear, fractures, head injury including reconstruction surgery, to minimise complications.