scholarly journals Subcutaneous Suppressive Antibiotic Therapy for Bone and Joints Infections: Safety and Outcome in a Cohort of 10 Patients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S98-S99
Author(s):  
Tristan Ferry ◽  
Cecile Pouderoux ◽  
Sylvain Goutelle ◽  
Sébastien Lustig ◽  
Claire Triffault-Fillit ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Oral Treatment ◽  
Clinical Signs ◽  
Treatment Discontinuation ◽  
Treatment Modalities ◽  
Induction Phase ◽  
Prosthesis Loosening ◽  
Duration Of Treatment ◽  
Suppressive Antibiotic Therapy

Abstract Background Optimal surgical therapy could be sometimes non-feasible, especially in the elderly population. Therefore, a medical therapy with oral prolonged suppressive antibiotic therapy (PSAT) seems to be an option to prevent recurrence and prosthesis loosening. Subcutaneous (SC) administration of injectable intravenous antibiotics as PSAT could be a convenient way when oral treatment is not available to facilitate ambulatory care, even if this practice is considered as an “off-label” practice. Methods All patients receiving SC PSAT since 2010 were prospectively enrolled in a cohort study evaluating treatment modalities, efficacy, and safety. Success was defined by the absence of clinical signs of infection at the time of last follow-up. Results We included 10 patients (median age of 79 years): seven had PJI and three chronic osteomyelitis. Six had plurimicrobial infections and four had infections due to multidrug-resistant Gram-negative pathogens. Suboptimal surgery was performed in seven patients, and three received only antibiotics. All patients received an induction-phase therapy with conventional antibiotic treatment before SC PSAT. For nine patients, SC injections were delivered by a 50 mlml 30 minute gravity infusion of the antibiotic, using butterfly disposable needle. One patient received direct flash SC administration. The most frequent drug used was ertapenem (n = 7; 1–2 g/day), followed by ceftriaxone (n = 2; 1 g/day), and ceftazidime (n = 1; 2 g/day). The dose was adjusted depending on the results of trough residual blood concentration. Median duration of treatment was 6 months (from 1 to 58 months), corresponding to a total of about 5,000 SC injections. SC PSAT had to be discontinued for side effects in only two patients, including skin necrosis in the patient receiving direct SC infusion (lost to follow-up after treatment discontinuation) and epilepsy under ertapenem therapy (with relapse of the BJI after the treatment discontinuation). One other patient experienced a relapse despite the SC PSAT. Finally, SC PSAT was still ongoing in seven patients with a favorable outcome at the last follow-up. Conclusion SC PSAT appears to be a safe and effective alternative therapy when optimal surgical strategy is not feasible and when oral treatment is not available. Disclosures T. Ferry, HERAEUS: Consultant, Speaker honorarium. S. Lustig, Heraeus: Consultant, Consulting fee

scholarly journals Brain Abscess Caused by Nocardia: Case Report and Literature Review

2020 ◽  
Author(s):  
Guilherme Finger ◽  
Maria Eduarda Conte Gripa ◽  
Tiago Paczko Bozko Cecchini ◽  
Tobias Ludwig do Nascimento
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Brain Abscess ◽  
Clinical Signs ◽  
Occipital Lobe ◽  
High Morbidity ◽  
Rare Clinical Entity ◽  
Brain Abscesses

AbstractNocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and a mortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a long-term antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up.

scholarly journals Subcutaneous suppressive antibiotic therapy for bone and joint infections: safety and outcome in a cohort of 10 patients

2019 ◽  
Vol 74 (7) ◽  
pp. 2060-2064 ◽  
Author(s):  
Cécile Pouderoux ◽  
Agathe Becker ◽  
Sylvain Goutelle ◽  
Sébastien Lustig ◽  
Claire Triffault-Fillit ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Salvage Therapy ◽  
Chronic Osteomyelitis ◽  
Joint Infection ◽  
Intensive Therapy ◽  
Treatment Modalities ◽  
Surgical Removal ◽  
Prosthetic Joint ◽  
Suppressive Antibiotic Therapy

Abstract Background Optimal treatment of prosthetic joint infection and chronic osteomyelitis consists of surgical removal of biofilm-embedded bacteria, followed by a 6–12 week course of antimicrobial therapy. However, when optimal surgery is not feasible, oral prolonged suppressive antibiotic therapy (PSAT) is recommended to prevent prosthesis loosening and/or relapse of infection. Since 2010, we have used infection salvage therapy using off-label subcutaneous (sc) injection of a β-lactam as PSAT for patients in whom oral PSAT is not possible. Methods A single-centre prospective cohort study (2010–18) reporting treatment modalities, efficacy and safety in all patients receiving sc PSAT. NCT03403608. Results The 10 included patients (median age 79 years) had polymicrobial (n = 5) or MDR bacterial (n = 4) prosthetic joint infection (knee, n = 4; hip, n = 3) or chronic osteomyelitis (n = 3). After initial intensive therapy, seven patients received ertapenem, three patients received ceftriaxone and one patient received ceftazidime by sc injection (one patient received 8 days of ceftriaxone before receiving ertapenem). In one patient, sc PSAT failed with recurrent signs of infection under treatment. In three patients, sc PSAT had to be discontinued due to side effects; in only one of these was the sc route implicated (skin necrosis following direct sc injection and not gravity infusion). Median treatment duration was 433 days. In six patients, sc PSAT was successful with favourable outcome at the time of writing. Interestingly, three patients with MDR bacterial carriage at baseline lost this under PSAT during follow-up. Conclusions As salvage therapy, sc PSAT delivered by gravity infusion is a safe and interesting alternative when an optimal surgical strategy is not feasible and no oral treatment is available.

scholarly journals 814. Successful Treatment of Cutibacterium acnes (CA) Prosthetic Device Infection (PDI) with Oral Linezolid and Rifampin (LR)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S500-S500
Author(s):  
Ronald G Nahass ◽  
Maalikat Esquivel ◽  
Krystle Smith ◽  
Danielle Heinemann ◽  
Kathleen H Seneca
Keyword(s):  
Low Cost ◽  
Oral Treatment ◽  
Prosthetic Device ◽  
Research Support ◽  
Duration Of Treatment ◽  
Slime Layer ◽  
Device Infection ◽  
Cutibacterium Acnes ◽  
Research Grant

Abstract Background CA PDI is increasingly recognized. CA is felt to create a slime layer that makes infection more likely and treatment more difficult in this setting. Traditional management has included prosthetic device explantation (PDE), prolonged antibiotic treatment, and delayed reimplantation. Recent interest in the use of oral treatment regimens and single stage procedures with long duration antibiotic therapy led us to treat a series of patients with oral treatment and retained prosthesis after debridement. We report those results. Methods Sequential patients with CA PDI treated with oral therapy were identified. All patients underwent debridement of the tissue, exchange of components and/or reimplantation of the prosthetic device. Only patients with exchanges were included. PDE was excluded. MIC testing for CA isolates was obtained when possible. Initial treatment was recorded at time of surgery. LR was the treatment of choice unless toxicity developed. A minimum of a 3-month follow-up post treatment was required to be included. 6 and 12 month follow up were obtained for all patients but 1 at this time. Results 10 patients were treated (Table 1). Shoulder joint infections were most common. All patients were treated with LR. All completed a minimum of 42 days of treatment (Table 2). The medication was well tolerated. The most common adverse events were nausea. 9/10 patients with 12 month follow up had no evidence of relapse. 1/10 had no relapse at 3 months. Typical for CA infection laboratory markers for infection were not markedly elevated. Notably thrombocytopenia did not occur (Table 3). Table 1. Distribution of Prosthetic Device Infections Table 2. Duration of Treatment Table 3. Selected Laboratory Results Conclusion We demonstrated the ability to successfully treat 10/10 patients with CA PDI without explantation using prolonged oral treatment with LR after debridement. This combination should be considered a treatment option and explored further as a low cost, well tolerated, high value treatment approach to this difficult infection. Disclosures Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker’s Bureau)Merck (Grant/Research Support, Speaker’s Bureau) Kathleen H. Seneca, MSN, Abbvie (Research Grant or Support)Alkermes (Research Grant or Support)Gilead (Speaker’s Bureau)

Systematic Review of Pharmacologic and Compression Therapies for Treatment of Post-Thrombotic Syndrome

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4207-4207
Author(s):  
Jacqueline M. Cohen ◽  
Elie A. Akl ◽  
Susan R. Kahn
Keyword(s):  
Quality Of Life ◽  
Venous Insufficiency ◽  
Conflicts Of Interest ◽  
Treatment Success ◽  
Clinical Signs ◽  
Duration Of Treatment ◽  
Post Thrombotic Syndrome ◽  
Quality Evidence

Abstract Abstract 4207 Background: Post-thrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT) characterized by chronic pain, swelling and other signs in the affected limb that can severely impact individuals' quality of life. There are no widely accepted treatments for PTS, although varied treatment strategies have been proposed. Objective: To systematically review evidence for the effectiveness and safety of pharmacologic and compression therapies for treatment of PTS. Methods: Randomized controlled trials (RCTs) of PTS treatments were sought in a search of PubMed and by reverse citation searches. Results: A total of 121 titles were reviewed and 12 full-text publications were assessed for inclusion. Seven trials were selected for inclusion in the review. Four trials (3 parallel RCTs, 1 crossover RCT) including 521 patients assessed the effectiveness of various drugs for treatment of PTS. These pharmacotherapies included rutosides, hidrosmin, and defibrotide and treatment durations ranged from 2–12 months. Three trials (1 parallel RCT, 2 crossover RCTs) including 82 patients assessed compression therapies. Two used intermittent pneumatic compression (IPC) devices worn for 4–8 weeks, while one used continuous compression in the form of graduated compression stockings (GCS) worn for at least 1 year. Follow-up in these studies ranged from 8 weeks to over 1 year. All studies identified PTS as occurring after DVT in the same leg, often requiring objective diagnosis of DVT. One study used CEAP criteria for venous insufficiency, including patients classified as C2, C3 or C4. Another required participants to have had deep venous insufficiency (not further defined) for at least 12 months. Two studies used the Villalta scale to classify patients as having PTS, while one study only included patients with a score >14, corresponding to severe PTS. Another study defined PTS as the presence of chronic and typical pain and swelling 1 year post-DVT, and another defined it as intractable symptoms causing significant limitations of lifestyle and/or morbidity. In one study, PTS was not defined. Indicators used to assess the success of the interventions varied. Clinical signs and symptoms were often assessed with a quantitative scoring system. Validated scales used included Kakkar & Lawrence, Villalta, and VEINES-Sym. Calf and ankle circumference were often measured, where significant differences in these measures were used to attest to the success of an intervention; however, the clinical significance of these changes may be questionable. The IPC studies defined treatment success based on factors such as perceived benefit, patient preference for the active treatment, and willingness to continue to use the intervention. The GCS study defined treatment failure based on symptom deterioration, work absences, and development of venous ulcer. Only 1 study assessed the effect on quality of life, using the VEINES-QOL questionnaire. Studies of pharmacotherapies demonstrated minimal benefit on symptom scores, reduced calf and ankle circumference, and ulcer healing. In one study that continued to follow-up subjects for 6 months after treatment was terminated, the effect of drug treatment was not sustained (50% of ulcers returned). Studies of compression therapy did not convincingly demonstrate benefits of GCS; but for the IPC devices, treatment success was more likely than on the placebo devices. None of these treatments were associated with any important side effects and hence, compliance was acceptable in all studies that reported it. Studies of pharmacologic and compression therapies for treatment of PTS suffer from study design limitations including lack of blinding and wash-out periods that have the potential to introduce bias. Short duration of treatment in some studies may limit the extent to which the interventions were found to be effective. Sustained effectiveness was not assessed except for one study. Conclusions: There is limited and low quality evidence for the effectiveness of rutosides, hidrosmin, and defibrotide to treat PTS. There is also limited and low quality evidence for the effectiveness of GCS, but IPC devices seem to provide at least short term relief from PTS. More rigorous studies are needed to assess the effectiveness and sustainability of pharmacologic and compression treatments for PTS, and study endpoints should focus on clinically important improvements in patient condition. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Patterns of Ibrutinib Use, Discontinuation, and Hospitalization Among Patients with Chronic Lymphocytic Leukemia (CLL) in a US Healthcare Claims Database

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5909-5909 ◽  
Author(s):  
Tu My To ◽  
Wei-Shi Yeh ◽  
Juliana Biondo ◽  
Anthony S Masaquel
Keyword(s):  
Disease Progression ◽  
Median Time ◽  
Stock Options ◽  
Cancer Biology ◽  
Oral Treatment ◽  
Treatment Discontinuation ◽  
Lymphocytic Leukemia ◽  
Claims Database ◽  
Oral Agents

Abstract Introduction : Current treatment options for CLL or small lymphocytic leukemia (SLL) include novel oral therapies that are taken until disease progression. Ibrutinib is approved in frontline and relapsed/refractory CLL and is the most common oral treatment since Food and Drug Administration approval in 2014. Despite favorable responses with ibrutinib, treatment discontinuation occurs (41-50%) (Mato et al. Haematologica 2018; Sharman et al. Blood 2017) and increases the risk of poor overall survival (Follows GA and UK CLL Forum. Poster Presentation 14th International Conference on Malignant Lymphoma Palazzo dei Congressi, Lugano Switzerland, 2017). Previous studies have reported that in addition to disease progression, intolerance and toxicity were primary reasons for discontinuation. However, hospitalizations have not been explored to date. This study used a large US claims database to evaluate ibrutinib treatment patterns and toxicity-related hospitalizations among patients with CLL. Methods : A retrospective analysis of Truven Health MarketScan® Commercial Claims Database was conducted. Patients were included if they initiated ibrutinib treatment (index) between 2/12/2014 and 3/31/2017 and were diagnosed with CLL or CLL along with SLL. Patients were excluded if they had other cancers, did not have at least 180 days of continuous enrollment pre-index (baseline), were treated with ibrutinib within this baseline period, or had less than 180 days of observation after ibrutinib initiation. Patients were categorized into 1 of 3 treatment cohorts: (1) those who had continuous ibrutinib claims without any gap (Users), (2) those who had a treatment gap, but had at least 1 ibrutinib claim after the gap (Retreated), and (3) those who completely discontinued ibrutinib treatment or switched to another treatment (Discontinued/Switched). A gap in treatment was defined as a period of ≥60 days after the end of treatment exposure (Mato et al. Cancer Biology & Therapy 2018). Patient demographics, time to first treatment discontinuation, and frequency of hospital-related adverse events (AEs) were determined for each cohort. AEs were obtained in the 60 days prior to the last ibrutinib claim (pre-discontinuation) and in the exposure period for the last claim plus 60 days after (post-discontinuation). AEs were assessed for the User cohort based on a proxy derived from a median time from initial treatment to discontinuation in the Retreated and Discontinued groups and using the +/- 60-day time window. Results : There were 714 patients included in the analyses. Most patients were male (69%) and the average age at CLL diagnosis was 55.8 years. There were 451 (63%) in the User cohort, 96 (13%) in the Retreated cohort, and 167 (24%) in the Discontinued/Switched cohort. The median time from ibrutinib initiation to end of study observation was 16.8 (6.0-44.2) months. The median time to ibrutinib discontinuation was 4.9 (1.0-40.4) and 6.0 (1.0-34.1) months for the Retreated and Discontinued/Switched cohorts, respectively. For the Retreated cohort, patients were off ibrutinib treatment for a median of 3.2 (2.0-32.0) months before restarting ibrutinib again. Among the Discontinued/Switched cohort, 61% discontinued ibrutinib treatment without receiving any further treatment and 39% switched to another treatment. Retreated and Discontinued/Switched cohorts had higher hospitalization rates compared to the User cohort. The 5 most common inpatient diagnoses were pneumonia, pancytopenia/neutropenia, fever, sepsis, and atrial fibrillation across both the Retreated and Discontinued/Switched cohorts (Table 1). Discontinued/Switched cohort were more likely to have any hemorrhage diagnosis for hospitalization (6%). Conclusion : Consistent with other studies (median follow-up of 17-20 months) (Mato et al. Haematologica 2018; Sharman et al. Blood 2017), the overall treatment discontinuation with ibrutinib in our study was approximately 37% with a median follow-up of 16.8 months. A limitation is that exact reasons for stopping treatment cannot be ascertained from claims data. However, patients who paused or stopped ibrutinib were more likely to have higher rates of hospital-related AEs than those who continued treatment. As treatment discontinuation is likely to occur during a long treatment exposure, oral agents with a finite duration of treatment and with better tolerability are needed for patients with CLL. Disclosures To: Genentech, Inc.: Employment, Other: May own stocks/stock options at Roche. Yeh:Genentech, Inc.: Employment, Other: May own stock/stock options at Roche. Biondo:Roche: Equity Ownership; Genentech, Inc.: Employment, Other: May own stocks/stock options at Roche. Masaquel:Genentech, Inc.: Employment, Other: May own stocks/stock options at Roche.

Intraocular tuberculosis, a challenge in diagnosis and treatment

2020 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Martina Larroude ◽  
Gustavo Ariel Budmann
Keyword(s):  
Developing Countries ◽  
Clinical Signs ◽  
Steady Increase ◽  
Ocular Tuberculosis ◽  
Industrial Countries ◽  
Choroidal Granuloma ◽  
History Of ◽  
And Migration ◽  
Ocular Tb

Ocular tuberculosis (TB) is an extrapulmonary tuberculous condition and has variable manifestations. The incidence of TB is still high in developing countries, and a steady increase in new cases has been observed in industrial countries as a result of the growing number of immunodeficient patients and migration from developing countries. Choroidal granuloma is a rare and atypical location of TB. We present a case of a presumptive choroidal granuloma. This case exposes that diagnosis can be remarkably challenging when there is no history of pulmonary TB. The recognition of clinical signs of ocular TB is extremely important since it provides a clinical pathway toward tailored investigations and decision making for initiating anti-TB therapy and to ensure a close follow-up to detect the development of any complication.

Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 9-20 ◽  
Author(s):  
Hung-Chuan Pan ◽  
Ming-Hsi Sun ◽  
Jason Sheehan ◽  
Meei-Ling Sheu ◽  
Clayton Chi-Chang Chen ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Gamma Knife ◽  
Temporal Lobe ◽  
Treatment Modalities ◽  
Conformity Index ◽  
Index Number ◽  
The Mean ◽  
Instrument Accuracy ◽  
Group 1

Object In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF. Methods Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test. Results The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife). Conclusions Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.

Thyroidectomy in a patient with a giant multinodular nontoxic cervical retrosternal goiter

2020 ◽  
pp. 97-99
Author(s):  
U. V. Kukhtenko ◽  
O. A. Kosivtsov ◽  
L. A. Ryaskov ◽  
E. I. Abramian
Keyword(s):  
Surgical Treatment ◽  
Clinical Case ◽  
Clinical Signs ◽  
Disease Relapse ◽  
Cardiac Pathology ◽  
Nontoxic Goiter ◽  
Retrosternal Goiter

A clinical case of successful surgical treatment of a patient with a giant cervical retrosternal nontoxic goiter with severe cardiac pathology is presented. Thyroidectomy from cervical access without sternotomy was performed. At the follow-up examination 5 months after the operation, instrumental and clinical signs of disease relapse were not detected.

Persistent Apical Periodontitis: Bacterial Taxonomic Analysis and Treatment Through Intentional Replantation

2020 ◽  
Author(s):  
Fernando Eduardo Coria-Valdiosera
Keyword(s):  
Antibiotic Therapy ◽  
Root Canal ◽  
Resistance Mechanisms ◽  
Apical Periodontitis ◽  
Infectious Process ◽  
Identification Of Bacteria ◽  
The Right ◽  
Apical Lesions ◽  
Endodontic Retreatment

Introduction: The microorganisms own different resistance mechanisms that allow them to resist the chemo-mechanical cleanliness of root canal and antibiotic therapies causing the persistence of apical lesions. Methods: This clinical case describes a male patient diagnosed with pulp necrosis in the right lower central incisor due to trauma, which developed apical periodontitis manifesting itself extra orally. Root canal treatment along with antibiotic therapy was performed, but because the infectious process persisted, endodontic retreatment and a new antibiotic therapy were carried out, however, the clinical evolution was not favorable. For this reason, the intentional replantation was chosen as the outright treatment, performing apicectomy and curettage of the periapical lesion, from which the isolation and taxonomic study of microorganisms were carried out, with the respective antibiogram. Results: In the 10-day clinical follow-up, the extraoral infectious process disappeared almost completely and 6 months later, a complete repair of the bone tissue was observed on the tomography. Conclusion: A better understanding of the persistence of apical periodontitis was achieved by taxonomic identification of bacteria and the intentional replantation allowed to remove the apical biofilm gaining an excellent wound healing.

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

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