An Evidence-Based Review on Shirodhara: A Unique Panchakarma Therapy

Shirodhara is a procedure consisting of continuous pouring of a stream of medicated oil, milk, buttermilk, etc. on the forehead of the patient from a specific height for a specified period. Acharya Vagbhatta has described four types of Murdha Tail i.e., Abhyanga, Parishek, Pichu, and Shirobasti, which is successively more beneficial than the previous one. Shirodhara or Shiroparishechan is one of them. Indication of Shirodhara was found in our ancient textbooks in various diseases like Ardhavabhedaka, Suryavarta, Ardita, Pakshaghata, Hanugraha, Akshishula, Nidranasha, Shirogata Vata and Shirahkampa. In the modern era, it is a very widely used Panchakarma therapy and in this review article, an evidence-based approach is used to define the type, procedure, indication contraindication, mode of action, complications and management and evidence of efficacy etc. of Shirodhara. Based on evidence Shirodhara has been found effective in various disorders like Insomnia, Psoriasis, ADHD in children, Shirah Shoola, essential hypertension, cerebral ischemic stroke and premature ejaculation when accompanied with other treatment modalities. Shirodhara was found effective on subjective as well as scientific parameters or modern biochemical markers parameters in various studies.

Triancinolona intra-vítrea e clorpromazina retrobulbar como alternativas ao manejo do olho cego doloroso / Intravietrea trianciclone and retotubulbar chlorpromazine as alternative to blind paintful eye manegement

RESUMO Objetivo: O objetivo desde estudo foi avaliar a efetividade da triancinolona intra-vítrea e da clorpromazina retrobulbar como alternativas no manejo da dor ocular em olhos cegos. Métodos: Este foi um estudo prospectivo intervencionista não-randomizado de pacientes com olho cego doloroso não responsivo ao tratamento tópico e sem indicação de evisceração atendidos no Serviço de Oftalmologia do Hospital Governador Celso Ramos no ano de 2010. Após exame oftalmológico e ultrassonografia ocular modo B, os pacientes foram divididos em dois grupos. Pacientes do Grupo 1 possuíam glaucoma intratável e receberam injeção retrobulbar de clorpromazina 2,5ml, e pacientes do Grupo 2 possuíam olhos phthisicos com componente inflamatório e receberam injeção intra-vítrea de triancinolona 0,3ml. Foram realizadas avaliações com 1, 3 e 6 meses após o procedimento e a dor quantificada de forma subjetiva em uma escala de 0 a 10 (sem dor e com o máximo de dor, respectivamente). Resultados: Foram incluídos 38 olhos, sendo 15 no Grupo 1 e 21 no Grupo 2. Houve predomínio do sexo masculino e idade média de 54 anos. A causa mais prevalente de olho cego doloroso foi o glaucoma neovascular. Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram-se eficazes no controle da dor ocular em olhos cegos no período do estudo (p<0,001). Ocorreu uma redução de 77,1% no uso de colírios (p<0,01) após a aplicação das medicações. Conclusão: Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram resultados significativos no controle da dor ocular em olhos cegos, além de uma redução no uso de colírios. A clorpromazina é um medicamento de baixo custo, com melhor perfil de efeitos adversos e mostrou resultados discretamente melhores relação à triancinolona. Possíveis viéses identificados no estudo são o de tempo e seleção.

ABSTRACT Objective: The objective of this study was to evaluate the efficacy of intravitreal triamcinolone and retrobulbar chlorpromazine as alternatives in the management of ocular pain in blind eyes. Methods: This was a non-randomized interventional prospective study of patients with painful blind eye unresponsive to topical treatment and without indication of evisceration treated at the Hospital Governador Celso Ramos Ophthalmology Service in 2010. After ocular examination and ocular B mode ultrasound, patients were divided into two groups. Group 1 patients had intractable glaucoma and received retrobulbar injection of chlorpromazine 2.5ml, and Group 2 patients had phthisics eyes with inflammatory component and received intravitreal triamcinolone injection 0.3ml. Evaluations were performed at 1, 3 and 6 months after the procedure and quantified pain subjectively on a scale from 0 to 10 (no pain and maximum pain, respectively). Results: 38 eyes were included, 15 in Group 1 and 21 in Group 2. There was a predominance of males with a mean age of 54 years. The most prevalent cause of painful blind eye was the neovascular glaucoma. Any retrobulbar injection of chlorpromazine as the intravitreal triamcinolone shown to be effective in the control of ocular pain in the eye blind study period (p <0.001). There was a 77.1% reduction in eye drops (p <0.01) after application of medication. Conclusion: Both the retrobulbar injection chlorpromazine as the intravitreal triamcinolone showed significant results in the control of ocular pain in blind eyes, and a reduction in the use of eye drops. Chlorpromazine is a low cost product, with a better adverse effect profile and showed slightly better results compared to triamcinolone. Potential bias identified in the study are the time and selection.

Estudo da topografia do músculo esfenomandibular / Topographic study of the sphenomandibular muscle

The temporal muscle is housed in the fossa of the bone bearing its name – the temporal bone. Its origin, body, and insertion have been well studied, and it has been described as a muscle consisting of three bundles and responsible for various functions. The advancement of technology has allowed the observation of yet another muscle next to this bundle of fibers and above the temporal muscle, namely the sphenomandibular muscle. The present study was designed to study the topography of the sphenomandibular muscle. Ten anatomical sets (five cadavers) were dissected with the intention of displaying the topography of the temporal and sphenomandibular muscles using the techniques of cutting and folding and conventional cross cuts. The folding of the structures and mapping of the muscles was carried out on four cadavers, analyzing their origins and describing their bodies and insertions. On another cadaver, cross-sectional (horizontal), 2 mm-thick slices were made in a sequential manner. We observed the topography of the muscle and its relationship with adjacent structures. The sphenomandibular muscle was found to be independent of the temporal muscle, for its origin is in the zygomatic-frontal complex, lateral to the orbit and overlaying the fiber of the anterior bundle of the temporal muscle. Its body is separated from the body of the temporal muscle by a thin fascia and is inserted on an oblique line external to the mandible presenting, therefore, its origin, body, and insertion independent of the origin, body, and insertion of the temporal muscle.

O músculo temporal fica alojado na fossa temporal do osso de mesmo nome. Sua origem, corpo e inserção são bem estudados, e ele tem sido descrito como um músculo constituído por três feixes e responsável por várias funções. O avanço da tecnologia permitiu a constatação da existência de outro músculo junto ao feixe anterior do músculo temporal, a saber, o músculo esfenomandibular. O presente trabalho, que teve por objetivo estudar a topografia dos músculos esfenomandibulares em 10 peças anatômicas (cinco cadáveres) humanas. Os cadáveres foram dissecados buscando evidenciar a topografia dos músculos temporal e esfenomandibular, através das técnicas de rebatimento ou convencional em quatro cadáveres e de cortes transversais, em um. Em oito peças foi realizado rebatimento das estruturas e mapeamento dos músculos, analisando-se sua origem, descrevendo-se o seu corpo e suas inserções. Em outro espécime foram feitos cortes transversais (horizontais), em fatias de 2 mm de espessura, peças estas que foram estudadas de forma sequencial, do primeiro corte até o ultimo. Observou-se a topografia e a relação com estruturas contiguas. Verificou-se que o músculo esfenomandibular é uma entidade muscular independente do músculo temporal, pois apresenta origem no complexo zigomático-frontal, lateral da órbita e sobrepondo às fibras do feixe anterior do músculo temporal. Seu corpo apresenta separado do corpo do músculo temporal por uma fina fáscia e inserção na borda anterior do processo coronoide (linha oblíqua externa da mandíbula), apresenta portando, origem, corpo e inserção independente da origem, corpo e inserção do músculo temporal.

Formas de presentación de dengue clásico en lactantes preescolares y escolares: hospital León Becerra 2001 / Classic dengue in Infants, preschoolers, and school children at Leon Becerra hospital 2001

Hablar de dengue es hablar de una de las enfermedades más frecuentes en nuestro medio; es transmitida por mosquitos Aedes Aegypti y afecta al ser humano; constituye un severo problema de salud pública, especialmente en la mayoría de países tropicales como el nuestro, donde las condiciones del medio favorecen el desarrollo y proliferación del vector biológico causal.Se realizó un estudio retrospectivo, longitudinal, descriptivo desde enero a diciembre de 2001 que tuvo como objetivo conocer la incidencia, los síntomas y signos que presentaron, cuales son los meses del año mas afectados, determinar si la prueba de lazo establece diagnóstico definitivo para dengue clásico y unificar criterios de diagnóstico. Se obtuvieron 86 pacientes diagnosticados de dengue clásico, de los casos estudiados el 15% presentaron la enfermedad en los meses de invierno y el 85% en los meses de verano. El sexo y la edad predominante fueron las niñas escolares. La fiebre fue el principal síntoma en todos los niños del estudio.

Dengue is one of the most frequent illnesses in our society. It is transmitted by the Aedes Aegypti mosquito and affects the human being. It is a serious health problem especially in tropical countries like ours where the environment promotes the development and proliferation of this biological vector.A Retrospective, longitudinal and descriptive study was done between the months of January thru December of 2001. The objective of this study is to find out the incidence, symptoms that these illnesses produce, when are the month where the population is most affected and how to diagnose dengue. We obtained 86 patients that had the diagnosis of dengue. 15% of them had this illness thru the winter months and 85% had it thru the summer months.The sex and age that was predominant were school girls. Fever was the primary symptom of all the children in this study.