Author: Dr. Vikram Chauhan

April 20, 2021

Treatment of Strongyloides stercoralis hyperinfection syndrome

Abstract

Strongyloides stercoralis is a very small nematode which parasites the mucosa of the upper part of the small intestine, often in large numbers.the eggs hatch in the bowel but only larvae are passed in the feces. In moist soil they moult and become the infective filariform larvae. After penetrating human skin they undergo a development cycle similar to that of hookworms but the female worms burrow into the mucosa and submucosa. Some larvae in the intestine may develop into filariform larvae which may then penetrate the mucosa or perianal skin and lead to auto infection and a very persistent infection. In this article we will mainly discuss the hyperinfection due to  Strongyloides stercoralis and what symptoms it creates along with its Ayurvedic management.

Introduction

Strongyloides is the parasite that has more prevalence in the tropical and subtropical regions of the world. Hyperinfection syndrome due to these parasites is ensured in patients that are having imapired cell mediated immunity. Imapaired cell mediated immunity is common in patients who are being administered with steroidal treatment and with drugs which are responsible for immune system suppression. Hyperinfection syndrome only happens when there is acceleration of the normal life cycle of S. stercoralis increasing the worm burden within the reproductive route.Then wide spread of the larvae of this parasite takes place out of the gut area involving organs like heart, liver, brain and urinary tract.

Strongyloides stercoralis hyperinfection syndrome

Clinical manifestation of Strongyloides stercoralis hyperinfection syndrome

The symptoms are similar to classic strongyloidiasis which includes nausea, vomiting, diarrhea, abdominal pain, weight loss, GI hemorrhage, cough, fever and difficulty in breathing. But in case of hyperinfection with accelerated life cycle of parasite catastrophic clinical manifestations like shock, intravascular coagulation, meningitis, respiratory and renal failure.

Moreover, major anatomical changes take place in the duodenum and jejunum. The parasites can be identified in the crypts of lieberkuhn and in mucosa and deposited eggs are sometimes present in the depths of these burrows. The inflammatory action is quite variable and only in the more severe instances is there a mixed leukocytic infiltration, characteristically containing many eosinophils. Much of this infiltration may be attributable to secondary infection.

Diagnosis

The diagnosis of this condition is usually done after examining the stool. Sterile slides are made for filariform larvae. Due to accelerated activity usually parasites are being diagnosed in the stool test. Moreover, a complete blood count is done to take a complete idea of infection and its severity. Urine tests can also be advised.

Treatment

The first line of treatment for strongyloides include ivermectin which eradicated around 80% of parasites. Other agents include thiabendazole and albendazole. In case of shock patients need in door admission along with fluid replacement therapy. Administration of antibiotics through intravenous routes can also be done. If patients have low hemoglobin levels immediate administration of blood units is required.

Herbal Remedies by Planet Ayurveda

Planet Ayurveda is a leading herbal manufacturing unit which manufactures herbal products that are very effective in managing multiple conditions. These products are manufactured using potent herbs and are prepared under the guidance of expert Ayurvedic doctors. The manufacturing team works under their guidance to avoid any kind of compromise with product quality. Our products do not contain any kind of fillers, additives, adulterants and are totally safe to use without any side effects. The herbal products are manufactured using potent and efficient herbs.

Herbal Remedies for Strongyloides stercoralis hyperinfection syndrome

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Following are the products offered by Planet Ayurveda for the management of Strongyloides stercoralis hyperinfection syndrome

  1.  Wormistop capsules
  2.  Sanjivani Vati
  3.  Mahashankh Vati
  4.  Digesto plan syrup
  5.  Giloy Capsules
  6.  Curcumin capsules

Products Description

1. Wormistop capsules

Wormistop has constituents like palash (Butea monosperma), tulsi (Ocimum sanctum),  sonth (Zingiber officinale) and vidang (Piper retrofractum). As the product name suggests it is very effective in removing parasites from the intestine and eradicates around 80-90% of worms from the human intestine. It also improves digestion and soothes the mucosa of the intestine.

Dose: Two capsules twice  a day after meals.

2. Sanjivani Vati

Sanjivani vati is known as a medication that infuses life. This is a classical ayurvedic formulation consisting of sonth (Zingiber officinale), haritaki (Termenalia chebula), giloy (Tinospora cordifolia) and many others. It helps in getting rid of accumulated endotoxins and also helps in removing worms from intestines. It creates such an environment in the bowel which is not fit for the survival parasite hence leading to parasite free bowel.

Dose: Two tablets twice a day after meals.

3. Mahashankh Vati

This is a classical formulation having constituents like pancha lavana (five types of salts), shankh bhasma (ashes of pearl), pippali (Piper longum)  and many others. These Help in reducing symptoms related to the digestive system like pain in abdomen, indigestion, worms in intestine, acidity and gastritis. Shankh bhasma in this is very effective in treating chronic constipation and also helps in removal of parasites from intestine by creating a non favourable environment.

Dose: Two tablets twice a day after meals.

4. Digesto plan syrup

Digesto plan syrup is an ultimate composition of herbs like amalaki (Emblica officinalis), haritaki (Terminalia chebula), bibhitaki (Terminalia bellerica) and others. This syrup is potent in reducing anorexia, indigestion and abdominal pain. It improves digestion and has abundant healing features. It helps in balancing toxins in the digestive system which creates a favorable environment for parasite growth.

Dose: Two tsp twice a day after meals.

5. Giloy Capsules

Giloy (Tinospora cordifolia) is an amazing herb that helps in improving the immunity of the body. It also behaves as an immunomodulator in immune-compromised cases. Giloy is an amazing herb that works according to the way your body needs it due to its vichitra pratya rabdha property. Giloy is very much safe to use in any age group.

Dose: Two capsules twice a day after meals.

6. Curcumin capsules

Curcumin capsules are made from the curmin extract of haridra (Curcuma longa). Haridra has amazing properties like it behaves as an antibacterial, anthelmintic, and also bears analgesic features. This formulation is very effective in dragging out worms from the intestine and also helps in enhancing the immunity of the body.

Dose: Two capsules a day after meals.

Contact Planet Ayurveda to provide you the costing / ordering and delivery information at – costing.planetayurveda@gmail.com or call at +91-172-5214030 Or Check Website – www.PlanetAyurveda.com

Conclusion

Strongyloides stercoralis hyperinfection syndrome is a condition which ultimately is the result of strongyloides infection ignorance. Patients must stay alert and should notice general symptoms related to worm infestation because long term ignorance can be deadly.

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April 13, 2021

What is Fasting Insulin and its significance for Diabetic patients?

Abstract

Diabetes mellitus is a non communicable disease but is spreading like a pandemic all over the world. Each and every house is having at least two members who are diagnosed with diabetes. The commonest type of diabetes is diabetes mellitus type 2 but the patients of diabetes type 1 are also increasing day by day. Diabetes mellitus is a clinical syndrome that is characterized by hyperglycemia due to absolute or relative deficiency of insulin. In this article we will mainly discuss the significance of fasting insulin with respect to insulin dependent Diabetes Mellitus or diabetes type 1 and also non insulin dependent diabetes or diabetes type 2.

Introduction

Diabetes is worldwide in distribution and the incidence of both types of primary diabetes, i.e insulin dependent diabetes mellitus (IDDM) or diabetes mellitus type 1 and non insulin dependent diabetes (NIDDM) or also known as diabetes mellitus type 2. However prevalence of both varieties varies considerably in both parts of the world. This Seems to be due to differences in both genetic and environmental factors. To Begin with almost certainly the term diabetes mellitus embraces a heterogenous group of disorders having differing modes of inheritance. Agreement appears to be near at hand that IDDM and NIDDM exhibit substantial genetic differences.

Diabetes mellitus

Stages of Diabetes

1. Overt or manifest diabetes

It refers to the fully expressed clinical syndrome. This stage of disease is characterized by fasting hyperglycemia, glucosuria and usually three p’s that are polyuria, polydipsia and polyphagia.

2. Subclinical diabetes

Subclinical diabetes is understood when the patient is completely asymptomatic and fasting blood glucose level is usually normal but the post prandial level (glucose levels after two hours of meal) is frequently elevated.

3. Latent or stress diabetes

These patients are at the risk of developing overt diabetes. It basically refers to a person who is completely asymptomatic and under ordinary condition is normoglycemic and has a normal glucose tolerance. But under stress like pregnancy, infection and other serious conditions temporary carbohydrate intolerance develops.

4. Prediabetes or potential diabetes

This is a conceptual state which can be applied only retrospectively to the period of time preceding carbohydrate intolerance.

Pancreatic pathology for insulin dependent diabetes mellitus

Three outstanding features characterise the pathological picture of prediabetic pancreas in IDDM

  1. ‘Insulitis’ which  is the infiltration of the islets with mononuclear cells.
  2. The initial patchiness of this lesion with, until a very late stage, lobules containing heavily infiltrated islets commonly seen immediately adjacent to unaffected lobules.
  3. The striking beta cell specificity of the destructive process within infiltrated islets where the glucagon and other hormone secreting cells invariably remain intact.

Things about insulin

Insulin is a peptide hormone secreted by beta cells in pancreatic islets of langerhans and its main function is to lower the serum glucose levels and hence promote anabolism. It is a normal growth factor required for development.  Glucose production and secretion by the liver is strongly inhibited by high concentration of insulin in the blood. Decrease or absence of insulin activity results in diabetes mellitus of either type 1 or type 2. Human insulin protein is composed of 51 amino acids and has a heterodimer of an A- chain and a B-chain which are linked together by disulfide bonds.

Fasting insulin

What is fasting insulin?

Fasting insulin is the name given to a diagnostic test which is used to measure the amount of insulin in blood. As mentioned before insulin is very much important for utilization of blood glucose and hence maintaining rights levels of it. In absence of insulin a condition called hyperglycemia usually occurs. So determining correct levels of insulin in blood is necessary so as to evaluate what exactly is the condition.

Insulin test preparation

Fasting insulin requires at least 8 hours of fasting. This means that before giving a blood sample, a patient should have not eaten anything for around 8 or more than 8 hours.

Purpose of fasting insulin

  1. To find reasons for hypoglycemia
  2. Diagnosing insulin resistance
  3. To find out tumors on the pancreases.
  4. This tumor is called insulinoma.

Test results showing insulin resistance or no insulin resistance

  1. If your body cells have developed insulin resistance then fasting insulin is more than 48pmol/L.  
  2. If your body cells are not having any kind of insulin resistance then fasting insulin is 18-48 pmol/L.

Importance of fasting insulin with respect to hyperglycemia or both form of diabetes

Insulin as mentioned earlier is very important as it is responsible for glucose take up by the cells. Our body cells like cells of muscle tissue, cells of various organs use glucose as a source of energy. They are having specific insulin receptors. Insulin is attached to these receptors and hence the glucose is binded to it. Then this glucose is taken up by the cells which then convert it into energy or store it for later use as a source of energy. But if these receptors do not determine insulin than glucose uptake by the cells does not take place or in other scenarios due to pancreatic cell destruction as a result of the autoimmune process there is absolute deficiency of insulin resulting in hyperglycemia.

So, advising fasting insulin is of great importance in both above mentioned cases. Reason is, this test help in determining:

  1. The exact levels of insulin in body
  2. Determining the type of diabetes especially in case of children
  3. Deciding the type of diet which can be followed
  4. Determining the units of insulin which are to be administered.

Conclusion

Diabetes is no doubt setting its roots deep and deeper into our society. Though we have many effective ways to deal with this group of conditions but still it becomes challenging with each and every patient diagnosed. It is very important to understand that this condition is related to both genetic and environmental factors along with some personal habits. Moreover insulin, whose deficiency is the main reason for hyperglycemia cannot be generated through medicines but its requirement is fulfilled by administration of synthetic insulin.

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