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Incidence of diabetes is significantly increasing day by day in last two decades. Around 422 million people were said to be diabetic in 2014 according to a data published by WHO. The prime cause for globally increasing rate of diabetes is the changed lifestyle of the people like sedentary lifestyle, fast foods, junk foods, lack of exercise, mental factors like stress etc. All the patients with increased glycemic index may not be established diabetes. It may be simple Ajeerna, Grahani dosha or Amapradoshaja vikara also. Diabetes is compared with the near similar condition in Ayurveda called as Prameha. Incidence of diabetes is increasing day by day globally. Ayurveda being the oldest medicinal system of the mankind, states this unique condition since the time immemorial. It is said to be one of the Santarpanajanya vyadhi. Even though the explanation of Prameha is found in scattered manner in Brihatrayee and Laghutrayee, here we have considered Charaka samhita as a base to the present article. The aim of article is not to prove Prameha as diabetes or vice versa, instead explain a different approach towards treatment of Prameha based on Hetu (cause), Linga (symptoms) and Aushadha (medicine) triad. It is not important to name a disease, but to treat based on the Dosha vitiated and Samprapti involved
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Background:Pulmonary artery hypertension (PAH) dreadful complication in bronchiectasis. The 6thworld symposium on pulmonary hypertension have taken mPAPof 20 mmHg as normal. Not much studies have been done based on the current cut off values, so we have incorporated values based on the new guidelines and made following observations. Methods: Thisstudy was designed as an observational cross-sectional study consisting of 27 patients, who were admitted in Pulmonary medicine department. Results:Out of 27 study subjects 15 were female抯 and 12 were males. It was found that 70.3% had less than 5 segments involved and 29.6% had more than 5 segments involved. Mean value of PAH was 34.48�.06 mmHg. Analysis showed a significant correlation (r=0.67) between number of segments involved and incidence of pulmonary hypertension. Conclusions: Itis essential to evaluate the cardiac status of bronchiectasis patients at the time of diagnosis as cardiac manifestations are one of the dreadful complications.
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We present a 60 years old patient who presented to us with history of domestic fall and sustained injury to the right hip and was diagnosed with trochanteric fracture right side. As closed reduction was not acceptable and bone spike was not available in the set, we designed our own technique of using a bone lever introduced from the same incision from where reaming/nail insertion was done. To the best of our knowledge this technique has never been described before in english literature.Since our first case we have tried it in 6 other patients and without any issues
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Bilateral olecranon fractures are a rare occurrence. Direct trauma usually results in comminuted fractures and indirect trauma in transverse fractures. We describe a case of bilateral olecranon fracture with a radial head comminuted fracture with coronoid fracture without the involvement of collaterals. Olecranon fractures are usually a result of direct trauma (fall from height/motor vehicle accidents) or indirect trauma. A 22year old male patient presented to the emergency department with complaints of pain and swelling around both elbows following a motor vehicle accident. The patient also sustained trauma to the head and had a history of transient loss of consciousness. CT brain at the time of presentation was normal and the patient was conscious. The Olecranon Fracture was fixed with a pre-contoured olecranon locking compression plate (Synthes, USA). In our case, the collaterals were intact and as the radial head was comminuted, we excised the radial head. The radial head being secondary stabilizer of the elbow in injuries to the medial collateral ligament complex. The excision of the radial head would not cause any instability. Bilateral olecranon fractures need to be fixed anatomically, the comminuted radial head was excised and the anterior capsule was repaired
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Context: Head-and-neck cancer patients undergoing chemoradiation. Aims: The aim of the study was to see if there is any correlation between the planning target volume (PTV) and mucositis. Settings and Design: This was a single-arm prospective study. Subjects and Methods: A total of forty head-and-neck cancer patients undergoing chemoradiation were assessed for mucositis at the 5th week. The grades of mucositis were correlated with PTVs of low risk (54 Gy) and high risk (60–66 Gy). Statistical Analysis Used: The data were analyzed using the statistical software, SPSS Inc. Release 2009, predictive analytics software statistics for windows version 20.0, Chicago. Log transformation was done as the data were skewed. Independent t-test was used to compare between the two grades of toxicity. P <0.01 was considered for statistical significance. Results: The mean PTVlow risk was 522cc (228–771) and PTVhigh risk was 254cc (20–780). Grade II mucositis was seen in 27 (67%) patients and Grade III in 11 (28%) patients. The mean PTVlow risk was higher for patients, who had Grade III compared to Grade II mucositis (571 vs. 517 cc, P = 0.052). Conclusions: The same was seen for PTVhigh risk(367 vs. 222 cc, P = 0.017). PTV is a better predictor of mucositis, and those patients with larger PTV require close monitoring and early intervention of mucositis
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Dengue is a mosquito-borne viral infection found in tropical and sub-tropical regions around the world and has emerged as a significant threat and burden to public health systems. The infection is transmitted by the bite of an infected female mosquito- Aedes aegypti. Dengue viral infection may be asymptomatic or may give rise to undifferentiated fever with or without other associated clinical manifestations, namely, Dengue Fever (DF), Dengue Haemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS). The present study is conducted to evaluate the prevalence and serodiagnosis of Dengue fever among patients with acute febrile illness, provide useful guidance to clinicians for early diagnosis and prevention of untoward complications of dengueMETHODSThis was a retrospective descriptive study conducted for a period of one year in a tertiary care hospital from January 2019- December 2019. Blood samples collected from 1905 clinically suspected cases of dengue fever and serum were separated and tested for detection of Dengue NS1 antigen, Dengue specific IgM antibody and IgG antibody by using Dengue Day 1 test kit (procured from J. Mitra & Co. Ltd, India). Test was performed and results were interpreted as per manufacturer manual.RESULTSOut of 1905 serum samples tested, 273 were positive for dengue and 1632 were negative, with seropositivity was 14.33%. Out of 273 dengue positives, 202 (73.6%) were positives for dengue specific NS1 Antigen, 50 (18.3%) were positives for dengue specific IgM and 14 (5.12%) were positives for dengue specific IgG and 8 (2.93%) were positives for both IgM and IgG. Out of 273 positives cases of dengue, 158 (57.8%) were males and 115 (42.12%) were females. Majority of the patients tested positive were in the age group of 21-30 yrs. (28.2%).CONCLUSIONSDengue cases occur throughout the year with more positives in Jun-October. The incidence of dengue cases was higher in males and in children and in young adults. Early laboratory diagnosis of dengue fever among patients with acute febrile illness is essential to prevent dengue related complications.
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The authors report a rare case of bilateral elbow dislocation with associated radial head fractures in a 33 year male who presented to our hospital following a road traffic accident. The elbow dislocations were reduced in the emergency room, the left radial head fracture was treated conservatively in an above elbow slab for four weeks and the right radial head and neck fracture was treated operatively with Herbert screw fixation for the radial head fracture andbuttress plating for the radial neck fracture. At six months follow-up, the patient was pain free and had functional range of flexion and extension of both elbows with pronation and supination of the right elbow up to 50°and 40° and that of the left elbow up to 60° and 45° respectively.
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Background: Feeding infants with cleft lip and palate is one of the most challenging and worrying events in a mother’s life. When the baby fails to thrive, the mother becomes anxious as the effort goes futile which may inhibit maternal bonding with the child leading to other consequences. Hence, our aim was to assess the attitudes of mothers towards feeding their babies with cleft lip and palate.Methods: A cross sectional study was conducted among mothers of children with cleft lip and palate at a cleft center in Hyderabad city. The mothers were interviewed using a self-administered questionnaire on a 3-point Likert scale. The collected data were subjected to statistical analysis using SPSS version 22.Results: A total of 96 mothers participated in the study. Among them a majority of them bottle fed their baby (85%). Escape of milk through nostrils was reported to be the most common problem faced by the child (30%). The attitudes of mothers were categorized into good (29%), moderate (62.5%) and poor (28%). Also there was a significant difference between the educational qualification, household income and clinical diagnosis with the attitude of mothers.Conclusions: In the present study, a majority of them had moderate attitude. Personal and professional care and support are the key factors influencing the mothers’ attitude.
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Introduction: Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases include lung, liver and bones. Bone involvement in cases of carcinoma of cervix is low and the estimates range from 0.8-16 % according to various series.Several patterns of bone involvement are observed in cases of carcinoma of cervix including, (1) direct extension into bone, either from the parametrial extensions of the primary or recurrent pelvic tumor, (2) direct extension into adjacent bone from the pelvic or distant lymph node metastasis (3) regional or systemic haematogenous metastasis to bones. Aims: To evaluate the pattern of metastases in patients of carcinoma of uterine cervix, with particular emphasis on the pattern of bone involvement on contrast enhanced CT. Settings and Design: Retrospective study. Materials and Methods: This was a retrospective study, where we reviewed the hospital records and data of patients of cervical cancer who underwent contrast enhanced CT (CECT) of the chest and abdomen over a period of one year between January and December 2016. A total of 100 patients of carcinoma cervix were included. CT images were reviewed by two experienced radiologists. The bony erosion due to pelvic mass or lymphadenopathy was classified as subtle or gross. Results: Bone involvement was seen in 11 out of 100 cases (11% cases). Among 13 cases direct bone involvement by the pelvic mass/recurrence and metastatic lymph nodes (8/11; 72.7%) was slightly more common than thehematogenous bone metastasis (5/11; 45.4% cases). Among the direct bone involvement direct erosion of the underlying bone by the nodal metastasis (6/8; 75%) was twice more common than the direct bone involvement by the pelvic mass/recurrence(2/8; 25%). Conclusions: Direct bone involvement by erosion of adjacent bone by nodal metastasis is the most common mechanism of bone involvement in cases of carcinoma of cervix signifying the high propensity of lymph nodal deposits to erode the underlying bone. This finding of direct bone erosion is not seen in any other gynaecological malignancy and should be promptly looked for in all cases of carcinoma of cervix
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An Os acromiale is a condition that results from the failure of fusion of the anterior acromial apophysis. It can be asymptomatic. It can also result in subacromial impingement and rotator cuff tear. In this case report of a 39year-old lady we would like to present the management of the painful bursitis and spur formation on the superior surface of a meso-type of os acromiale. Conservative management in the form of rest, anti-inflammatory drugs and physiotherapy did not provide symptomatic relief. Patient then underwent surgical excision of the superior spur. Open reduction and internal fixation was not carried out. Patient had resolution of pain and no recurrence of symptoms or features of impingement at 6 months follow up. To the best of our knowledge there are limited reportsin English literature about this rare subset of patients with symptomatic os acromiale with superior spur formation and with no features of impingement or cuff pathology.
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Coronal shear fractures of the distal humerusare rare, complex fractures that can be technically challenging even in the best of hands. Their peak incidence is seen in elderly females and is usually the result of low energy fall. The injury is usually part of complex elbow injury and in rare instances can be isolated entity. Complex injury pattern is characterized by shear fracture combined with fracture of radial head and collateral ligament injury. The preferred treatment for this complex fracture is Open reduction and internal fixation. The usual recommendation is a two-incision approach. We report a rare case in which fracture could not be classified using the traditional classification systems and in which entire fracture was managed via a single approach
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Sacrum is an extremely rare site for osteoid osteoma. We present a 25 year-old male, a computer operator who presented with chronic back pain of 4 years duration. He was initially investigated with routine x-rays and lab investigations and was treated for chronic back pain at another facility. Extensive work up at our clinic revealed a diagnosis of Osteoid Osteoma of Right 2ndSacral vertebral arch Interlesionalresection of the tumor was done and this was verified on histopathology. The patient had complete relief of pain following surgery. Repeat CT scan done at one year follow up. It showed complete removal of the Nidus. To the best of our knowledge there have not been many case reports in English Literature from the Indian subcontinent. There are many studies in which tumor of lumbar region is one of the causes of radiating pain in lower extremities but to the best of our knowledge this finding is unique and can also be an important cause of radicular pain
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Introduction: Solitary thyroid nodule (STN) presents a challenge in their diagnosis, evaluations, and management. Often,these abnormal growths/lumps are large in size and develop at the edge of the thyroid gland so that they are felt or seen as alump in front of the neck.Materials and Methods: The study is carried out in upgraded Department of General Surgery, Kakatiya Medical College andMahatma Gandhi Memorial Hospital, during the period of February 2017–October 2018.Results: Among the 62 patients studied in this research, 52 were female and there were 10 males. Females accounted for83.9% of the cases while males accounted for 16.1%. The male-to-female ratio was 5.2:1.Conclusions: Incidence of STN is common in the age group of 18–30 years. Hemithyroidectomy was commonly performedon maximum cases.
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Introduction: Fistula-in-ano form a good majority of treatable benign lesions of the rectum and anal canal. About 90% or soof these cases are end results of crypto glandular infections.Materials and Methods: Patient placed in the lateral position and the external opening of the fistula is identified and cannulated,and saline is injected. The patient is then placed in a supine position in magnetic resonance (MR) gantry.Results: Clinical examination less accurate to detect internal opening while MR fistulogram could detect most of the internalopenings which were confirmed in surgical findings.
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Objectives: To document the dose received by brachial plexus (BP) in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck squamous cell carcinoma (HNSCC) and report the incidence of brachial plexopathy. Methods: Newly diagnosed patients of HNSCC treated with radical or adjuvant IMRT were included in this retrospective study. No dosimetric constraints were applied for BP maximum dose equivalent dose (EQD2 α/β = 3). Patients with minimum 6-month follow-up were included and patients with suspicion of plexopathy were evaluated further. Results: Sixty-seven patients were eligible and 127 BP were analyzed. The mean BP maximum dose (BPmax) was 62.4 Gy (+6.9), while mean BP volume was 28.1 cc (+4.1). Proportion of patients receiving BPmax >66 and >70 Gy were 34.7% and 14.2%. The mean BPmax for T4 tumors was significantly higher than T1 tumors (65 vs. 57.5 Gy, P = 0.005) but when adjusted for N-category, T-category was not independently significant in accounting for BPmax >66 or >70 Gy. Mean BPmax for N0 versus N2+ was 59.8 versus 65.6 Gy (P = 0.0001) and N1 versus N2+ was 61.6 versus 65.6 Gy (P = 0.018). After adjusting for T-category, patients with N2+ had a mean 4.2 Gy higher BPmax than N0-N1 (P = 0.0001). Stage III–IV patients had a mean six Gy higher BPmax doses than Stage I–II disease (P = 0.0001). With a median follow-up of 28 months (interquartile range 16–42), no patient had brachial plexopathy. Conclusion: Clinically significant plexopathy was not seen in spite of majority having over 2-years follow-up and a third of patients having dose above the recommended tolerance. Only nodal category independently influenced dose to the brachial plexii
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Background: The objective of this study is to know the gender variation in number of admissions, severity of malnutrition at the time of admission, gaining of weight and adherence to follow up in children admitted to nutrition rehabilitation center and during follow up.Methods: This is a retrospective study involving the review of existing programme records. Children who were admitted to nutrition rehabilitation centre, district hospital, Chamarajanagar, Karnataka, India, between January 2017 to December 2017 with severe acute malnutrition were involved in the study. The programme included 2 weeks of in-patient care, and four follow-up visits to the NRC subsequently as follows; 1st visit at 7 days, 2nd at 14 days, 3rd at 1 month and 4th at 2 months after discharge.Results: Among 57 children who admitted to NRC females were 30 (52.6%) and males 27 47.4%). 25 among 57 children (43.9%) could sustain weight gain of >5grams/kg/day as per one of the discharge criteria. 13 (52%) were females and 12 (48%) were males. 32(56%) among 57 admitted children to NRC, could achieve <-1SD during entire programmed. 15(46.8%) were females and 17 (53.1%) were males.Conclusions: There was no gender variation in either number of admission or severity of malnutrition at the time of admission or weight gain during NRC programme.
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PURPOSE@#The purpose of this study was to determine the effect of the weave technique for hamstring graft preparation on the diameter of the prepared graft, functional outcome, and need for harvesting of semitendinosus and gracilis (ST + G) or semitendinosus alone (ST).@*MATERIALS AND METHODS@#This retrospective study evaluated 340 patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction from January 2013 to December 2015. Our protocol for graft preparation is that the graft length must be a minimum of 8 cm and the diameter must be between 7 and 10 mm. The parallel-graft preparation technique was used in 189 patient and the weave technique was used in 151 patients. Outcome was measured by using stress radiographs and International Knee Documentation Committee (IKDC) 2000 score.@*RESULTS@#In the parallel-graft preparation group, ST + G was used in 99 patients and ST was used in 90 patients. In the weave-graft preparation group, ST + G was used in 38 patients and ST alone was sufficient in 113 patients. The need for G harvest was less in the weave-technique group (p < 0.0001). There was no statistically significant difference at 2 years of follow-up in stress laxiometry, IKDC 2000 scores and rerupture rates between the two groups.@*CONCLUSION@#The weave technique helps to reduce the need for G harvest without compromising functional outcome. Level of evidence IV.
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Relatively Myasthenia gravis is an uncommon disorder with an annual incidence of 10-20 new cases per million. Diagnosis follows a bimodal distribution with a predominantly female peak in the second and third decade of life and a predominantly male peak in the fourth to eighth decades. It presents with fluctuating skeletal muscle weakness and fatigue most commonly affecting the ocular muscles, although any muscle may be affected. MG affects 50 to 200 per million people. It is newly diagnosed in three to 30 per million people each year. Diagnosis is becoming more common due to increased awareness. Although there is still no cure for myasthenia gravis in modern sciences other than symptomatic management, Ayurvedic therapies can give much more promising results. Comparison between myasthenia gravis and diseases explained in Ayurveda is difficult and exact correlation is not possible. But based on Nidana, Roopa, Upashaya, and Anupashaya, a probable diagnosis can be made and treated accordingly. When aggravated, a single Dosha may cause manifold diseases depending upon the various etiological factors and the sites of manifestations. Hence nomenclature of all types of diseases in definite terms is not always possible. If a physician is not able to name a particular disease, he should not feel ashamed on that account. In the present study, Vatavyadhi chikitsa, Asthimajjagata vata chikitsa, Arditavat chikitsa and Avarana concepts were applied for diagnosis and treatment. Nasya, Nasapana, Basti chikitsa were planned accordingly. Vatakaphahara, Dhatvagni vardhana, Brimhana and Snehana dravyas were used in the management.
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BACKGROUND: Neck and back pain are leading sources of disability placing substantial burden on health care systems. Surgical interventions in managing chronic neck pain secondary to various disorders continue to increase. Even though surgical interventions are effective, a significant proportion of patients continue to have symptomatology and develop cervical post-surgery syndrome. This study was performed to know the effectiveness of cervical interlaminar epidural injections with or without steroids. METHODS: The effectiveness of fluoroscopic cervical interlaminar epidural injections in post-surgery syndrome was evaluated in a randomized, active controlled trial. The study population included 116 patients assigned to 2 groups. Group 1 received cervical interlaminar epidural injections with local anesthetic alone and Group 2 received injection with local anesthetic and steroids. The main outcomes were defined as significant improvement (greater than 50%) of pain relief using the numeric rating scale and/or functional status improvement using the Neck Disability Index (NDI). RESULTS: Both groups had similar results with significant improvement (≥ 50% pain relief and functional status improvement) in 69% of the patients in Group I, whereas, in Group II, 71% of the patients showed significant improvement at the end of 2 years. During a 2-year period, the average number of procedures was 5 to 6, with an average of approximately 12 weeks of significant improvement per procedure. CONCLUSIONS: Fluoroscopic cervical interlaminar epidural injections administered in cervical post-surgery syndrome using local anesthetic, regardless of the use of steroids, may be effective in approximately 70% of the patients at 2-year follow-up.
Subject(s)
Female , Humans , Anesthetics, Local , Back Pain , Cervical Vertebrae , Chronic Pain , Delivery of Health Care , Follow-Up Studies , Injections, Epidural , Neck , Neck Pain , Postoperative Complications , Reoperation , SteroidsABSTRACT
BACKGROUND: Related to escalating health care costs and the questionable effectiveness of multiple interventions including lumbar facet joint interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine influencing coverage decisions. METHODS: Cost utility of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain was performed utilizing data from a randomized, double-blind, controlled trial with a 2-year follow-up, with direct payment data from 2016. Based on the data from surgical interventions, utilizing the lowest proportion of direct procedural costs of 60%, total cost utility per quality adjusted life year (QALY) was determined by multiplying the derived direct cost at 1.67. RESULTS: Patients in this trial on average received 5.6 ± 2.6 procedures over a period of 2 years, with average relief over a period of 2 years of 82.8 ± 29.6 weeks with 19 ± 18.77 weeks of improvement per procedure. Procedural cost for one-year improvement in quality of life showed USD $2,654.08. Estimated total costs, including indirect costs and drugs with multiplication of direct costs at 1.67, showed a cost of USD $4,432 per QALY. CONCLUSIONS: The analysis of therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain shows clinical effectiveness and cost utility at USD $2,654.08 for the direct costs of the procedures, and USD $4,432 for the estimated overall cost per one year of QALY, in chronic persistent low back pain non-responsive to conservative management.