RESUMO
Acute prolapsed inter-vertebral disc (IVDP) is a painful condition that requires immediate treatment by conservative or surgical management. Though majority of patients show remission in symptoms with conservative treatment, regression of herniated disc with non-surgical management has been rarely reported. A 46 years old female patient with acute and severe low back pain, disability and radiating pain towards right lower extremity came to our hospital. Oswestry Disability Index (ODI) score of the patient was 94% indicating bed-ridden condition. MRI of lumbar spine showed diffuse posterior disc bulge between fourth and fifth lumbar vertebra indenting right traversing nerve root and inferior displacement of extruded disc along the body of fifth lumbar vertebra. She was treated according to treatment explained in Ayurveda. She received oral medications, application of medicated oils, fomentation and medicated enema (Basti). After treatment of seven and half months, the patient showed good remission in pain, stiffness and radiculopathy. ODI score reduced to 9% that indicates minimal disability. Follow up MRI showed non significant compression of the nerve root and gross reduction in the inferior displacement of extruded disc. Acute IVDP can be successfully conserved using Ayurveda treatment. The Panchakarma procedures and medicines used in the treatment need further evaluation.
RESUMO
Reconstruction of post-traumatic large bone defect in tibia is a surgical challenge. Masquelet technique is a two stage procedure to achieve bone union. After cement spacer implantation in defect, optimal time for 2nd stage bone grafting is at 1 month. After 2 months, osteoinductive property of induced membrane is doubtful. We managed a post- traumatic tibial defect of 10 cm with cement spacer as 1st stage of Masquelet procedure. But 2nd stage was delayed for 6 months at which time osteoinductive property of induced membrane was doubtful. Osteopenia, pin track infection with stiff knee and ankle made 2nd stage surgery more challenging. We reconstructed 6 months old induced membrane with 12 cm non-vascularised fibula autograft in combination of cancellous autograft from iliac crest. The construct was fixed with locking compression plate on medial side. Patient achieved bone consolidation and successful union at 9 months with knee flexion of 100 degrees. This case demonstrated that induced membrane is able to preserve osteoinduction property even up to 6 months and with good structural support like fibula strut graft, successful reconstruction is possible in delayed 2nd stage of Masquelet technique.
RESUMO
BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis with unsatisfactory treatment outcomes. OBJECTIVES: To evaluate efficacy and safety of AHPL/AYTAB/0313 tablet in subjects with OA of knee joint. STUDY DESIGN: Prospective, open-label, single-arm clinical study conducted in daily clinical practice setting. METHOD: Subjects were advised to take 2 AHPL/AYTAB/0313 tablets twice daily orally after meals for 180 days. 48 subjects completed the study. The primary endpoints were changes in mean visual analogue scale (VAS) pain score and WOMAC score. Secondary endpoints were quality of life, time to walk 50 feet, knee joint swelling, use of analgesic drug as rescue medicine, and safety parameters. RESULTS: At baseline visit, the mean index knee joint pain (VAS) score was 82.29 ± 15.19, which reduced significantly to 19.38 ± 13.75 on day 180. The mean WOMAC combined score at baseline was 39.94 ± 11.67, which reduced significantly to 09.58 ± 05.77 (76.0%) on day 180. The mean WOMAC pain score at baseline was 09.65 ± 02.91, which reduced significantly to 02.06 ± 01.46 on day 180. The mean WOMAC stiffness score at baseline was 03.48 ± 01.58, which reduced significantly to 00.63 ± 01.08 on day 180. The mean WOMAC difficulty score at baseline was 26.81 ± 09.63, which reduced significantly to 06.90 ± 04.78 on day 180. The mean walking time to walk 50 feet reduced significantly by 40% on day 180. Not a single subject was known to have knee joint swelling from 150 days onwards. Only 5 subjects were using analgesic as rescue medicine on day 180. Twenty-six subjects had adverse events (AEs). Most of the AEs were not associated with the study medication. Vitals and all the safety laboratory parameters were within normal limits both at baseline and on day 180. CONCLUSION: "AHPL/AYTOP/0113" tablet is safe and significantly effective in reducing pain, swelling, and stiffness of knee joints and improving mobility of knee joints in patients with OA. CTRI registration No. is CTRI/2015/09/006177.
