Effect of Snehadahana in the Management of Kadara - A Case Report

Kadara is a Kshudra Roga, first mentioned by Acharya Sushruta. It is a condition which causes extreme pain and discomfort to the affected person. Kadara may be correlated to Corn based on the causative factors, site of the swelling, clinical and other features. The incidence of corn in India is more than 10 million cases per year. The treatment modalities available at present in the modern science are the usage of corn caps, salicylic acid paints, cryotherapy and surgical excision. All theses modalities are associated with a high rate of recurrence. Snehadahana is mentioned as the line of management in Kadara after Utkarthana by all the Acharyas. Acharya Bhoja specifically mentions Tila Thaila as the Sneha dravya to be used for Agnikarma. In the present study, a 53 year old female patient, who visited the OPD of Sri Jayendra Saraswathi Ayurveda College and Hospital with a case of Kadara, was selected for Snehadahana. Chedana was done prior to Snehadahana. The procedure was carried out as 4 sittings, once a week, for a period of 4 weeks. Two follow ups were done at an interval of 14 days, after the fourth sitting of Snehadahana. There was complete healing of the wound and no recurrence seen until the follow up period.

BUCKLING REGIMES IN BINGHAM PLASTICS FLOW IN AN ECCENTRIC INNER PIPE INSIDE A VERTICAL CLOSED-END OUTER PIPE

We develop a lubrication approximation model, using the Herschel–Bulkley constitutive equation, with dimensionless flow parameters including the Bingham number, the power-law index, the buoyancy number, the viscosity ratio, the diameter ratio, the eccentricity and the aspect ratio. Based on a reasonable prediction to the yielding onset, the model allows us to classify the flow regimes versus an elegant combination of the dimensionless numbers. We study the injection flow of a heavy viscoplastic fiuid into a light Newtonian fiuid, via modelling and experiments. The injection is carried out downward, via an eccentric inner pipe inside a vertical closed-end outer pipe. This configuration results in a core viscoplastic fiuid surrounded by an annular Newtonian fiuid. The flow is structured and mixing is negligible. As the injection rate increases in a typical experiment, we observe three distinct flow regimes, associated with the core fiuid behavior, namely the breakup, coiling and buckling (bulging) regimes

A rare case of osteonecrosis of hip in sickle cell disease

Avascular necrosis of bone is a severe complication of sickle cell disease (SCD) and Management of these problems is often difficult because of the diagnostic imprecision of most laboratory and imaging investigations and because of the lack of evidence for most surgical procedures in sickle cell disease. Its treatment is not standardized. The objective in this case is to determine the impact of core decompression and PRP infusion in the management of Avascular necrosis of hip. In this case, a young Indian male with a known history of sickle cell disease presented to the clinic with severe bilateral hip pain. The pain had lasted for several months and had not improved with anti- inflammatory medication and starting on alandronate. There was severe pain with internal and external rotation of the hip. MRI of the femur showed stage 2 or 3 avascular necrosis of the femoral head, while X-rays of the femur were unremarkable. Patient managed conservatively by Non weight- bearing for several weeks and oral medication shortly thereafter, the patient underwent core decompression of the bilateral femoral head as well as continuing on Alendronate, a bisphosphonate. The patient improved temporarily but regressed shortly thereafter. His avascular necrosis worsened radiographically over the next several months. At this point, the only other option would be to do a total hip arthroplasty, but the patient may need several more throughout his lifetime due to the lifespan of the artificial replacement. There have only been scarce reports of avascular necrosis in patients with sickle cell trait. This manuscript presents such a case and includes the trials and tribulations associated with its management.

A case of superior vena cava syndrome

Superior Vena Cava Syndrome is the clinical manifestation of the Superior Vena Cava obstruction, with severe reduction in venous return from the head, neck and upper extremities. More than 80% cases of SVCS is nearly attributable to advanced malignancy, most commonly lung cancer. SVC syndrome is characterized by congestion and swelling of the face and upper thorax, with distended superficial chest veins. The most severe complications of SVC syndrome include Glottic edema and venous thrombosis in the central nervous system. We represent a case SVC syndrome due to Small Cell Cancer of the lung.

Role of Jaloukavacharana in Management of Raktharshas (Thrombosed Hemorrhoids)

Arsha's is one among the Astamahagada, and a commonest ano-rectal disease with a wide range of symptoms. It affects all economic groups of the population. In Ayurveda, Arsha's is a growth of Mamsa with obstructs the anal opening. Anatomically anal canal is 51/2 Angula's length. A faulty lifestyle and dietary habits along with occupational and physical stress triggers the pathology of Arsha's. Doshic involvement includes Rakta along with Mamsa dhatu at Rakthavaha Dahmanis of Guda, which forms as Mamsa Ankura. Acharya Susrutha mentioned 4 curative measures for the treatment, they are Bhesaja, Kshara karma, Agni karma, Shastra karma. Hemorrhoids are dilated rectal veins. Thrombosed piles occur where there is high venous pressure, which is associated with severe pain, which hampers their daily routine, thereby they avoid defecation which leads to hardening of stool, constipation and rectal bleeding. The treatment includes the surgical excision of the thrombosed pile mass. A case study of thrombosed pile treated with Jaloukavacharana (leech therapy) has been recorded which has reduced the mass, pain, bleeding per rectum

Management of parapneumonic effusion and thoracic empyema with intrapleural instillation of 2-mercaptoethane sulfonate sodium and conservative approach – A comparative study

Background: The aim of pleural effusion management is to provide symptomatic relief by draining excessive fluid in the pleural space and stable the patient before the surgical and therapeutic intervention of underlying disease. Intrapleural fibrinolytic therapy is an effectively adjunct to improve the drainage of loculated effusion in complicated empyema especially in cases who fail chest tube drainage. Aim and Objectives: The aim of the study was to compare the efficacy of intrapleural instillation of 2-mercaptoethane sulfonate sodium (MESNA) and conservative approach in the management of loculated parapneumonic effusion and thoracic empyema. Materials and Methods: A total of 50 cases with loculated parapneumonic effusion and empyema above 21 years of age were recruited. Cases were randomly divided into two groups, that is, Group 1 managed with intrapleural instillation of MESNA for adhesiolysis of loculations through tube thoracostomy and Group 2 managed with conservative approach through tube thoracostomy. Results: Effusion in 84–80% and empyema in 16–20% were observed in Group 1 and Group 2, respectively. The mean value of number of days in ICD was 14.98 days in Group 1 and 19.5 days in Group 2. The amount of fluid drained (125.3–95.6 ml) and mean duration of hospital stay (22.2–28.5) was statistically significant between study groups. No adverse complications were noticed; however, cough and pain at the site of injection were reported in two cases each. Around, 32–64% cases required surgical intervention in Group 1 and Group 2, respectively. Conclusion: The intrapleural fibrinolytic therapy by 2-MESNA has better efficacy than conservative thoracostomy. The MENSA has better outcome in regard to breaking loculations, limited requirement of surgical intervention, less duration of hospital stay, and faster absorption of pleural fluid in effusion and empyema.

Diabetes among pulmonary tuberculosis cases – An impact of glycemic control on clinic-radiological profile

Background: Pulmonary tuberculosis and diabetes mellitus are major public health concerns in India. Pulmonary tuberculosis in cases with diabetes shows an unusual radiographic pattern and higher frequency for cavitation. Aim and Objectives: To evaluate the impact of glycemic control on the clinico-radiological profile of pulmonary tuberculosis in cases with diabetes mellitus. Materials and Methods: A total of 126 cases clinically confirmed and microbiologically diagnosed as pulmonary tuberculosis above 21 years of age were recruited. Based on the blood glucose levels cases were divided into prediabetics, newly diagnosed diabetics, and known diabetics. Clinical and radiological examinations were conducted. Results: Cough was the most prevalent clinical symptom followed by fever, loss of appetite, loss of weight, and dyspnea. In the radiographic examination, lower lung field was most commonly involved in newly diagnosed and known diabetes cases. Cavitary lesions were commonly noticed in multiple zone implication, multiple cavities, and bilateral cavity involvement was observed more often in newly diagnosed and known diabetic cases. Among the diabetic cases (94), satisfactory glycemic control was observed in 39 cases and poor glycemic control was seen in 55 cases. The mean symptom score in the cases with satisfactory glycemic control was 3.87 and in poor glycemic control was 3.99. Conclusion: Diabetic cases with lower lung field lesions may be an indication of tuberculosis which needs immediate diagnosis and management. In this study, poor glycemic control influence the radiological manifestations of pulmonary tuberculosis cases with diabetes.

Vulvar melanoma with multisystemic metastases: A rare case presentation

Malignant melanoma is the second most common vulvar malignancy which occurs in elderly females. In advanced stages of the disease, distant metastases can occur to any organ; hence, comprehensive radiological evaluation is necessary. We report a case of a 45-year-old female who presented with progressively increasing growth over the vulva for 6 months. On detailed clinical, pathological, and radiological workup, multiple metastases were found in the brain, liver, pancreas, peritoneum, lungs, and pleura. The final diagnosis of vulvar melanoma with multisystemic metastases was made after the histopathological examination

A comparative study in the outcome between the two fixed doses of polyvalent anti snake venom, 10 vials versus 20 vials, with mechanical ventilation in children with severe neurotoxic snake envenomation

Background: Every year about 50,000, people die of snake bites in India. Anti-snake venom and mechanical ventilation is mainstay of treatment in cases with severe neurotoxic envenomation. ASV is costly and scarce resource. There is lack of universal consensus towards the optimal dose of ASV in management protocol for children with severe neurotoxic snake envenomation. Objective was to compare the difference in outcome between two fixed doses of ASV, 10vials versus 20 vials, in children with severe neurotoxic snake envenomationMethods: This comparative observational study was carried out for a period of 3 years in Department of Pediatrics of SVS Medical College, Mahabubnagar, Telangana, India. Children with history of snake bite and clinical evidence of neuroparalysis were included. In addition to the mechanical ventilation and other supportive measures, every alternate patient was administered with 10vials (low dose) and 20 vials (high dose) of ASV over 1 hour. Outcome was compared between the two groups.Results: Of the 62 patients, 32 were in each group. The median time to extubation was 41 hours and 39.5 hours and mean duration of the hospital stay was 4.6 days and 4.5 days among the low dose and high dose groups, respectively. There were three deaths, one from low dose group and two from high dose group.Conclusions: There was no significant difference in outcome between the 10 vials vs 20 vials of ASV in addition to mechanical ventilation in treatment of children with severe neurotoxic snake envenomation. So, 10 vials of ASV can be utilized to reduce the cost of treatment.

Two cases with pycnodysostosis in a family: a case report

Pycnodysostosis (Greek, pycnos - density, dys - defect, ostosis - bone) is a rare inherited disorder of the bone, first described by Maroteaux and Lamy. Pycnodysostosis is an autosomal recessive disorder, with incidence estimated to be 1.7 per 1 million births. Clinical presentation of this disorder include short stature, dolichocephalic skull, frontal bossing, obtuse mandibular angle, dysplastic clavicles, and short hands and feet, diffuse osteosclerosis, acro-osteolysis along with the finger and nail abnormalities. The main oral aspects are midfacial hypoplasia, a grooved palate, and dental abnormalities include double row of teeth, delayed eruption of permanent dentition, multiple caries. Pathological fractures of the bones occur due to sclerosis. Radiologically, skull bones appear thickened with open fontanels which look like 'lakes of bones', hypoplasia of facial bones, generalized osteosclerosis, open fontanels and cranial sutures, non pneumotization of paranasal sinuses, and fractures commonly in lower limbs.

Prevalence of rickets: a clinical study

Background: Rickets is a growing bone disease that is common in children and adolescents. It is triggered by the inability of the osteoid to calcify in a growing individual. Even in countries with ample sun exposure, rickets is a common health problem which leads to frequent morbidities. Inadequate information on its prevalence and risk factors is available. For the study of prevalence and prominence of clinical characteristics of rickets in children aged between 0 - 10 years.Methods: The present research was a cross-sectional analysis. This study was conducted over a period of one year' from June 2018 to June 2019. Department of Pediatrics, Malla Reddy Medical College, Hyderabad, India. This prospective study was conducted on 100 children presenting with signs of rickets in the pediatric department of Malla Reddy Medical College, Hyderabad. The detailed history thorough clinical examination, anthropometric measurements and ratios of each child enrolled in the study was taken. The social and demographic data was also obtained through a structured questionnaire.Results: The prevalence of rickets was found to be more prevalent in males with (70%) than in females (30%). Rickets prevalence was around 46% in the study which is higher compared to other studies. Most of the cases around 85% belonged to the age group of 0-5 years. Rachitic rosaries were the most prominent sign amongst all.Conclusions: Because of its greater prevalence among infants, Rickets continue to be a major health problem. Rachitic rosaries and thickened epiphysis are the most common clinical signs. Since Rickets are a disease which can be prevented, vitamin D should be supplemented.

A cross sectional, analytical study of personal hygiene related morbidities of children residing in welfare hostels, Tirupati town, Andhra Pradesh, India

Background: The objective of the study was to find out the personal hygiene status among boys residing in social welfare hostels by class and age and type of hostel.Methods: Cross sectional study, analytical study, social welfare hostels in Tirupati town of Andhra Pradesh. Participants was 524 boys. Statistical analysis are percentages and Chi-square test.Results: The prevalence of scabies was found to be significantly higher in those children with poor personal hygiene (35.7%) compared to average level (18.8%) and good (14.4%) of personal hygiene. The prevalence of other specific morbid conditions was found to be similar in all the three levels of personal hygiene and the differences were not statistically significant.Conclusions: The prevalence of scabies was found to be significantly higher in those children with poor personal hygiene compared to average level and good of personal hygiene. In view of higher proportion of children with poor level of personal hygiene of children in scheduled tribe hostel, there is a need to sensitize and give health education on personal hygiene related diseases and take necessary preventive steps and supervision by hostel staff especially in scheduled tribe hostel. Hand washing with soap can protect about one out of every three young children.

A Cross Sectional, Analytical Study of the Morbidity Pattern among Boys Residing in Social Welfare Hostels in Tirupati Town, A. P..

The role of hostels in the educational advancement of backward classes is long recognized. In closed homes like hostels, the morbid conditions especially infectious diseases like skin diseases and respiratory diseases tend to rapidly spread among others and become difficult to control. There is increased nutritional demand in this age group because of pubertal changes. It has been found that several school children especially from socially backward sections of the community suffer from nutritional health problems as well as other physical health problems. We wanted to evaluate the morbidity pattern among boys residing in social welfare hostels.METHODSThis is a cross sectional, analytical study to determine the morbidity pattern among boys residing in social welfare hostels. This present study was conducted from August 2013 to July 2014 among boys residing in three welfare hostels, one each for scheduled castes, scheduled tribes and backward classes in Tirupati town.RESULTSThe common prevalent morbid conditions found were skin disorders (46.4%), nutritional disorders (43.1%), eye diseases (29.0%), respiratory diseases (15.3%) gastrointestinal diseases (13.6%), ENT diseases (9.5%,), musculoskeletal conditions (1.0%), and other diseases (5.7%).CONCLUSIONSHealth education and increasing the nutritional supplements improve the health of children with regard to personal hygiene and common diseases. Provision of necessary materials like soaps, oils etc., under supervision of hostel staff will go a long way in controlling these infections.

Kuttner’s tumour: chronic sclerosing sialadenitis- a mimicker of malignancy

Background: Kuttner’s tumour is a condition of the submandibular gland which is underreported as a distinct entity. Also called as the chronic sclerosing sialadenitis it resembles a plasmocytic and lymphocytic inflammatory process and presents as a hard and painful mass which clinically mimics a malignancy and raises significant concerns. The objective of the present study was to evaluate cases of Kuttner’s tumor and discuss its clinical and pathological aspects to distinguish it from a definite malignancy and create a grown acceptance of the presence of such an entity in our setting.Methods: We collected 170 cases of submandibular swellings and evaluated in detail the clinical and pathological aspects of eight cases out of them which were later diagnosed to as Kuttner’s tumour.Results: The age of the patients varied between 23 to 61 years (mean age 42.5 years) with 3 males and 5 females. 6 patients reported with a firm to hard painless submandibular mass (5 left sided; 3 right sided) while 2 patients experienced intermittent discomfort. The mean duration of presentation of symptoms was 5.3 months. Fine needle aspiration cytology was done in 6 cases preoperatively. Following submandibular sialadenectomy histopathology showed salivary gland tissue with preserved lobular architecture, but with marked fibrosis, acinar atrophy, and a dense lymphoplasmacytic infiltrates.Conclusions: Kuttner’s tumor may be pre operatively distinguished from a malignancy with improved imaging and a good image guided FNA Cytology saving the clinician and the patient from a lot of dilemma. However, histopathology and immunohistochemistry would be the key in establishing the diagnosis.

Clinico-laboratory profile and outcome of dengue fever among children attending a tertiary care hospital of rural Telangana, India

Background: Dengue is a self-limiting, vector-borne disease transmitted by Aedes mosquito, causing a major public health threat globally. The objective of this study is to assess the clinical profile and outcome of the dengue infection in children less than 14 years of age September 2018 to August 2019 at the Pediatric Department of S.V.S. Medical College, the tertiary care hospital in Mahabubnagar, Telanagana.Methods: Prospective study of 82 hospitalized children of <14 years with the diagnosis of dengue illness. Children with diagnosis of dengue were classified further in to two groups as per WHO guidelines, Non-severe dengue fever (probable dengue, dengue with warning signs) and 'Severe Dengue' (Dengue Haemorrhagic Fever and/or Dengue Shock Syndrome (DHF/DSS). A separate questionnaire form used for documenting clinical history, laboratory parameters. Haematological parameters were noted, chest x-ray, ultra-sonogram in required cases was done. Children were managed as per WHO protocol. The outcomes of the cases were mentioned as discharge, left against medical advice and death.Results: A total of 82 children with dengue were divided in to 55(67%) non severe dengue and 27(33%) severe dengue with males 56(68.2%) and females 26(31.7%). The most common age of presentation was between 6-10 years 34(41.5%). Fever 73(89%) was the most common presenting symptoms. Pleural effusion and hepatomegaly were the commonest clinical findings 28(34.1%) each, which were more among the severe dengue patients. Gall bladder edema 29(35.3%) was the most common ultra-sonogram finding. Significant elevation of transaminases (SGOP, SGPT) was seen in 39(47.5%). Severe thrombocytopenia was observed in 22(26.8%) children. Management was by administration of colloids and crystalloids.Conclusions: Dengue is a global problem. Presenting features include high grade fever, vomiting, abdominal pain, skin rash. Early recognition of symptoms and proper management can reduce the mortality.

Occurrence of Intestinal and Caecal Coccidiosis in Rajasri Birds

Coccidiosis in poultry is still considered as one of the main diseases affecting performance of poultry reared under intensive production systems. Coccidiosis was diagnosed in Rajasri birds upon routine postmortem examination conducted at Department of Veterinary Pathology, College of Veterinary Science, Hyderabad. PM examination of 423 birds conducted during a period of one month, out of which 136 birds were diagnosed with intestinal coccidiosis (32.15%) and 120 birds with caecal coccidiosis (28.36%). Clinically birds showed weakness, somnolence, ruffled feathers, pale comb, mucoid bloody diarrhea and death. Coccidiosis was initially diagnosed on the basis of faecal smear examination and histopathological alterations in intestines. Gross examination of birds showed pale muscle, dehydrated and emaciated carcass. Extremely ballooned intestine and caeca and haemorrhages in intestinal mucosa were seen. Upon opening of the small intestines and caeca, watery ingesta mixed with mucus and blood was observed. Faecal smears made from duodenum, jejunum, ileum and caecum revealed coccidial oocysts. Histopathological examination of intestine and caecum revealed coccidia lifecycle stages with destruction of different layers of the intestine and caecum with infiltration of heterophils and mononuclear cells (MNC)

Fatty Liver Haemorrhagic Syndrome (FLHS) in Broilers

Fatty liver haemorrhagic syndrome (FLHS) in poultry is a metabolic disease. An outbreak of fatty liver haemorrhagic syndrome (FLHS) was detected by post mortem examination of broilers in a commercial farm. There was severe loss of production and sudden deaths with moderate mortality. Post mortem of the dead birds were performed and histopathological examination was done as per standard procedure. At necropsy, dead birds had pale combs and wattles with significant liver lesions. The liver was enlarged, friable and greasy, yellowish brown with firm fatty layer deposits and haematoma was noticed in abdominal cavity. Fat vacuoles were seen in liver sections which was also confirmed by special stain. Multiple factors like high dietary energy and stress of production may have precipitated the FLHS in broilers

A Comparative Study to Evaluate Efficacy of Fentanyl Transdermal Patch VS Ketoprofen Patch in Pain Control after Mandibular Third Molar Surgery

Background: Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. Aims and Objectives: to evaluate and compare the degree of post-operative analgesia, patient compliance and frequency of adverse events between transdermal ketoprofen patch and transdermal fentanyl patch following third molar extraction. Methods: Total 7 patients aged 18-65 years with impacted mandibular third molar teeth were included in the study. The study drugs transdermal patches of fentanyl and ketoprofen was applied one hour before the surgical procedure on the skin, preferably in an area devoid of any hair. The selected mandibular third molar tooth of either of the side was extracted in the first appointment using an aseptic protocol. Every patient was given a Verbal Pain Intensity and Pain Relief chart ( both 5- point scales with values 0-4 ) for assessing pain intensity and pain relief for all the three post-operative days. Results: During the first four hours of operative day, the difference observed between the two groups was not found to be statistically significant (p=0.881). Whereas during the first eight hours of operative day the difference observed between the two groups was not found to be statistically significant (p=0.141). During the first twelve hours of operative day, the difference observed between the two groups was not found to be statistically significant (p=0.276). At the end of operative day, the difference observed between the two groups was found to be statistically significant (p=0.048). Conclusion: Transdermal fentanyl patch was more effective for immediate pain relief than transdermal ketoprofen patch for pain control following removal of mandibular impacted third molars.

Prevalence of obesity and diabetes among health care physicians in Pondicherry, India

Background: Non communicable diseases like obesity and diabetes are increasing worldwide, healthcare physicians are also not immune to this morbidity. The objective of this study is to find the prevalence of obesity and diabetes among healthcare physicians.Methods: The study was done at a tertiary care hospital in Pondicherry. All adult health care physicians of both sexes working in the hospital and giving informed consent to participate in the study were included. Pregnant physicians and those who are not willing to give written consent for participation in the study were excluded from the study. The study was done as a cross sectional study using a pretested standardized questionnaire. Age, sex, demographic data, height, weight, diet habits, family history of diabetes, exercise, medication in all the health care physicians were recorded and studied.Results: Of the total one hundred health care physicians, there were 50 male and 50 female physicians. Among the female physicians, there were 17 of age 41 to 50 years. There were 27 male and 34 female physicians with body mass index of 25 to 29.9. Six males and four females had diabetes mellitus. Six physicians were doing regular exercise. Four physicians were taking both oral anti hyperglycemic drugs and insulin.Conclusions: Doctors are aware and educated part of the society but there is high prevalence of obesity and diabetes mellitus among healthcare physicians. Doctor have to be motivated to take care of their health and to prevent lifestyle disease complication. Further regular screening for diabetes and obesity has to be done for doctors.