scholarly journals The Valid Diagnostic Parameters in Bilateral CT Scan to Predict Unstable Syndesmotic Injury with Ankle Fracture

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 812
Author(s):  
Si-Wook Lee ◽  
Kyung-Jae Lee ◽  
Chul Hyun Park ◽  
Hyuk-Jun Kwon ◽  
Beom-Soo Kim
Keyword(s):  
Ct Scan ◽  
Ankle Fracture ◽  
Operating Characteristic ◽  
Stress Test ◽  
Roc Curve Analysis ◽  
Posterior Translation ◽  
Preoperative Ct ◽  
Group A ◽  
Group B ◽  
Anterior Posterior

The purpose of this study is to evaluate the reasonable parameters to predict unstable syndesmotic injuries in ankle fractures. Seventy consecutive patients who underwent preoperative bilateral computed tomography (CT) scans were enrolled. Group A consisted of 20 patients intraoperatively diagnosed with syndesmotic injuries according to an intraoperative stress test and group B consisted of 50 patients who had nosyndesmotic injuries. The tibiofibular overlap (TFO) and tibiofibular clear space (TFCS) were measured using preoperative ankle radiographs. Measuring the anterior fibular distance (AFD), posterior fibular distance (PFD), anterior translation distance (AT), fibular diastasis (FD), anterior-posterior translation (APT), fibular length (FL), and surface area of syndesmosis (SAS) 1.0 and 1.5 which 1.0 cm and 1.5 cm above the tibial plafond was done via preoperative CT scan. The ratio of measurements (Injured/Intact) of the TFO, PFD, APD, and SAS 1.0 showed statistically significant differences. The researchers identified the SAS 1.0 as the most reasonable parameter to predict transfixation using receiver-operating characteristic (ROC) curve analysis. The SAS 1.0 is most valid parameter to predict syndesmotic injuries in this study and these results show that performing a bilateral CT scan on an ankle fracture may provide substantial information in measuring valid parameters.

scholarly journals The valid diagnostic parameters in static bilateral CT scan to predict unstable syndesmotic injury with ankle fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Si Wook Lee
Keyword(s):  
Ct Scan ◽  
Surface Area ◽  
Ankle Fracture ◽  
Ct Scans ◽  
Syndesmotic Injury ◽  
Roc Curve Analysis ◽  
Uninjured Side ◽  
Significant Difference ◽  
Posterior Translation ◽  
Preoperative Ct

Category: Trauma Introduction/Purpose: The purpose of this study is to evaluate valid and reasonable parameters to predict syndesmotic injury in ankle fracture. Methods: Seventy patients who underwent preoperative bilateral CT scans were enrolled retrospectively. On preoperative x-ray, tibiofibular overlap (TFO) and tibiofibular clear space (TFCS) were measured. On preoperative CT scan, anterior fibular distance (AFD), posterior fibular distance (PFD), anterior translation distance (AT), fibular diastasis (FD), anterior-posterior translation (APT), fibular length (FL), surface area of syndesmosis (SAS), surface area of syndesmosis of 1.5 cm above the ankle joint line (SAS1.5) were measured. Those measured values were divided with those of uninjured side, in order to minimize the differences among the individuals. Results: Statistically significant differences has been shown between The measurements of ratio (Injured/Uninjured) of TFO, PFD, APT, Diastasis, and SAS of groups which required transfixation have shown statistically significant difference, compared to those of groups which did not require transfixation. Other measurements were not showing significant difference. Furthermore, using ROC curve analysis, a ratio of measurement which is the most reasonable to predict transfixation was SAS (95% confidence interval = 0.598 – 0.869, cut of value = 1.555) Conclusion: Measuring TFO, PFD, APT, Diastasis, and SAS from CT scans and comparing with uninjured side preoperatively can provide surgeon an reasonable evidence to perform transfixation intraoperatively

scholarly journals Evaluation of Two Shaping Systems and Two Ultrasonic Irrigation Devices in Removing Root Canal Filling Material from Mesial Roots of Mandibular Molars: A Micro CT Study

2019 ◽  
Vol 7 (1) ◽  
pp. 2 ◽  
Author(s):  
Marc Krikor Kaloustian ◽  
Walid Nehme ◽  
Claire El Hachem ◽  
Carla Zogheib ◽  
Nabil Ghosn ◽  
...  
Keyword(s):  
Ct Scan ◽  
Filling Material ◽  
Micro Ct ◽  
Micro Computed Tomography ◽  
Root Canal Filling ◽  
Mandibular Molars ◽  
Group A ◽  
Ultrasonic Irrigation ◽  
Group B ◽  
Group D

We assessed the efficiency of two shaping file systems and two passive ultrasonic irrigation (PUI) devices for removing filling material during retreatment. The mesial canals from 44 extracted mandibular molars were prepared and obturated. The teeth were randomly divided into two groups, and then one group was retreated with Reciproc R25 (VDW, Munich, Germany) (n = 44) and the other group was retreated with 2Shape (TS, Micro Mega, Besançon, France) (n = 44). A micro-computed tomography (CT) scan was taken before and after the retreatment to assess the volume of the filling material remnants. The teeth were then randomly divided into four groups to test two different PUI devices: Irrisafe (Satelec Acteon Group, Merignac, France) and Endo Ultra (Vista Dental Products, Racine, WI, USA). The teeth in Group A were retreated with 2Shape to test the Endo Ultra (n = 22) device, the teeth in Group B were retreated with 2Shape in order to test the Irrisafe (n = 22) device, the teeth in Group C were retreated with Reciproc to test the Endo Ultra (n = 22) device, and Group D was retreated with Reciproc to test the Irrisafe (n = 22) device. A third micro-CT scan was taken after the retreatment to test the PUIs. The percentage of Gutta-Percha (GP) and sealer removed was 94.75% for TS2 (p < 0.001) and 89.3% for R25 (p < 0.001). The PUI significantly enhanced the removal of the filling material by 0.76% for Group A (p < 0.001), 1.47% for Group B (p < 0.001), 2.61% for Group C (p < 0.001), and by 1.66% for Group D (p < 0.001). 2Shape was more effective at removing the GP and sealer during retreatment (p = 0.018). The supplementary approach with PUI significantly improved filling material removal, with no statistical difference between the four groups (p = 0.106).

Value of multimodality imaging in the diagnosis of breast lesions with calcification: A retrospective study

2020 ◽  
Vol 76 (1) ◽  
pp. 85-98 ◽  
Author(s):  
Wenjuan Tong ◽  
Xiaoling Zhang ◽  
Jia Luo ◽  
Fushun Pan ◽  
Jinyu Liang ◽  
...  
Keyword(s):  
Roc Curve ◽  
Operating Characteristic ◽  
Multimodality Imaging ◽  
Curve Analysis ◽  
Breast Lesions ◽  
Roc Curve Analysis ◽  
Diagnostic Efficacy ◽  
Contrast Enhanced ◽  
Conventional Ultrasound ◽  
Group A

PURPOSE: To assess the value of conventional ultrasound (US), contrast-enhanced ultrasound (CEUS) and mammography in the diagnosis of breast lesions with calcifications. METHODS: A total of 87 breast lesions with calcification were subjected to US, CEUS and mammography and divided into 3 groups: Group A (all cases), Group A1 (31 cases who underwent US and CEUS first followed by mammography), and Group A2 (56 cases who underwent mammography first followed by US and CEUS). A receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic efficacy of different methods in different groups. RESULTS: In Group A, the area under the ROC curve (AUROC) of CEUS were 0.937, which were significantly higher than that of mammography (p < 0.05). In Group A1, the AUROC of CEUS were 0.842, which were not significantly different from that of US and mammography (p > 0.05). In Group A2, the AUROC of CEUS were 0.987, which were significantly higher than that of mammography and US (p < 0.05). CONCLUSION: Based on the mammography results, the combination of US and CEUS might improve the diagnostic efficacy in breast lesions with calcification.

scholarly journals Diagnostic performances and clinical usefulness of comprehensive non-commercial software for renogram analysis: Values of renal output efficiency and normalized residual activity in suspected kidney outflow obstruction

2021 ◽  
pp. 3-3
Author(s):  
Slobodanka Beatovic ◽  
Marija Radulovic ◽  
Otas Durutovic ◽  
Milos Veljkovic ◽  
Jelena Saponjski ◽  
...  
Keyword(s):  
Residual Activity ◽  
Area Under The Curve ◽  
Normal Subjects ◽  
Roc Curve Analysis ◽  
Output Efficiency ◽  
Group A ◽  
Group B ◽  
Sensitivity Specificity ◽  
Furosemide Test ◽  
One Way Anova

Introduction/Objective. Nuclear Medicine Section of IAEA has developed the software for dynamic renal scintigraphy, which allows calculation of advanced parameters of drainage: renal output efficiency (OE) and normalized residual activity (NORA). The aim of this study was to validate IAEA software by comparing results of parameters of renal drainage in normal subjects against their established reference values and to assess diagnostic accuracy of OE and NORA in distinguishing between obstruction/unobstruction. Methods. 55 patients with suspected obstruction and 36 kidney donors were investigated. Group A consisted of 24 obstructed kidneys, Group B of 37 kidneys with dilated urinary tract and Group C of 72 normal kidneys. 40min acquisition was applied. Furosemide was administered after 20min. Post-micturition image was acquired at 50min. Parameters analyzed were: OE at 20min (OE20) and at the end of furosemide test (OE40), NORA at 20min (NORA20) and after micturition (NORAPM). One-way ANOVA was used for evaluating differences between Groups. Ability of OE40 and NORAPM to distinguish between obstruction/unobstruction was determined by ROC curve analysis. The sensitivity, specificity, area under the curve and cutoff values were analyzed. Results. Excellent agreement of our results with established OE and NORA values was found. Difference between Groups was significant for OE20, OE40 NORA20 and NORAPM (p < 0.001). Cut-off values for obstruction were 82% and 0.11 for OE40 and NORAPM, respectively. Conclusion. IAEA software gives reliable analysis of diuretic renography and helps to better diagnose obstruction. IAEA should be encouraged to produce final version of the software and to release it through Web site.

scholarly journals Comparison of below knee cast and elasticated support bandage treatment foe an isolated fracture of the lateral malleolus

2017 ◽  
Vol 17 (2) ◽  
pp. 12-17
Author(s):  
Rajram Maharjan
Keyword(s):  
Ankle Fracture ◽  
External Rotation ◽  
Lateral Malleolus ◽  
Stage Ii ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Rotation Stage ◽  
Supination External Rotation

Introduction: Ankle fractures are the most common type of fractures treated in orthopaedics with isolated malleolar fractures, accounting for two-thirds of fractures. The most common injury mechanism is supination external rotation, which accounts for the majority of all ankle fracture patterns. Supination external rotation stage II is the classic short oblique fracture of the distal fibula without a medial side injury, which responds well to non-operative treatment as it is a stable fracture. The purpose of this study is to compare efficacy of elasticated support bandage versus plaster cast in the patient with isolated lateral malleolus fracture (Lauge-Hansen supination- eversion external stage II.)Method: A prospective comparative study was carried out in the Department of Orthopaedics in Bir Hospital from February 2007 to January 2009. Patients with ankle fracture were initially treated by below knee posterior slab for seven days to allow the swelling to subside and on seventh day follow-up they were grouped in two groups. Group A were patients with below knee cast and Group B were elasticated support bandage. Both groups were followed-up in the 5th week for cast or elasticated bandage removal and were evaluated after a week, thereafter, every monthly for 3 months and finally at 6 month.Result: Of the 48 cases enrolled, the mean age of the patients was 38.85 years. The common mode of injury was fall from height followed by road traffic accident. The modified subjective ankle score of Olerud and Molander (1984) was found more in group B in comparison to group A in all follow ups. In initial three successive follow ups at 6 week, 12 week and at 3 month subjective score was found statistically significant (p> 0.05) however, it was not significant at 6 month follow up. The range of motion was significantly improved in group B in all follow ups but the difference between the two groups at 6 weeks and 10 weeks follow ups was statistically significant. Immobilized group required less analgesic but the difference was not significant statistically.Conclusion: Both below knee cast and elasticated support bandage treatment methods are safe, satisfactory and equally effective with a better early result in elasticated support bandage. Supination External Rotation stage II type fracture can be treated conservatively, if there is no medial tenderness.Journal of Society of Surgeons of NepalVol. 17, No. 2, 2014, Page: 7-11

LDH serum levels as a predictive factor for global outcome in pretreated colorectal cancer patients receiving regorafenib: Implications for clinical management.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 497-497 ◽  
Author(s):  
Michela Del Prete ◽  
Mario Scartozzi ◽  
Tiziana Prochilo ◽  
Luca Faloppi ◽  
Riccardo Giampieri ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Progression Free Survival ◽  
Serum Levels ◽  
Roc Curve Analysis ◽  
Group A ◽  
Group B ◽  
Colorectal Cancer Patients

497 Background: Although a demonstrated clinical efficacy, a non negligible proportion of colorectal cancer patients does not seem to benefit from regorafenib and are consequently exposed to unnecessary toxicity. LDH serum levels represent an indirect marker of tumour hypoxia, neo-angiogenesis and worse prognosis in many tumour types. In colorectal cancer LDH showed a correlation with treatment outcome for patients receiving antiangiogenetic treatment, thus suggesting a possible interaction with the activity profile of these drugs. We analyzed the role of LDH serum levels in predicting clinical outcome for pre-treated metastatic colorectal cancer patients receiving regorafenib. The final aim was to individuate a potentially reliable and easy to use marker for patients stratification. Methods: 118 colorectal cancer patients treated with regorafenib were available for our analysis. For all patients, LDH values were collected within one month before the procedure and after treatment end. LDH cutoff value was determined by ROC curve analysis, patients were then divided into two groups (A and B, below and above cut-off level respectively). Patients were also classified according to the variation in LDH serum levels pre- and post-treatment (increased patients vs. decreased patients). Results: Patients in group A and B proved homogeneous for all clinical characteristics analyzed. In group A patients median progression free survival (PFS) was 3.18 months, whereas it was 1.87 months in group B patients (p = 0.0018). Median overall survival (OS) was 6.23 months and 3.28 months in group A and B respectively (p = 0.048). Significant differences were not noted among the 2 groups for response rate. All the other clinical variables analyzed failed to show any correlation with patients outcome. Conclusions: Our observations seem to suggest a role of LDH as a marker of clinical outcome in colorectal cancer patients receiving regorafenib. We can then speculate that high LDH patients may not be optimal candidates for regorafenib. After further confirmation in larger trial, these findings may be relevant for a better patients stratification and selection.

External validation of the prognostic index in acute paraquat poisoning

2015 ◽  
Vol 35 (4) ◽  
pp. 366-370 ◽  
Author(s):  
DS Kim ◽  
C Kang ◽  
DH Kim ◽  
SC Kim ◽  
SH Lee ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Characteristic Curve ◽  
External Validation ◽  
Prognostic Index ◽  
Mortality Rates ◽  
Prognostic Indicators ◽  
Group A ◽  
Operating Characteristic Curve ◽  
Group B ◽  
Overall Mortality

Objective: Some studies have evaluated the prognostic indicators associated with acute paraquat (PQ) poisoning. In this study, we externally validated the Yamaguchi index, which showed a good prognostic relevance in predicting the outcome of PQ poisoning. Methods: A retrospective analysis of 297 patients was performed. The Yamaguchi index was calculated using the following equation: Eq1 = (K+ × HCO3−)/(Creatinine × 0.088)(mEq/L) against time from PQ ingestion ( T). The patients were divided into three groups: group A: Eq1 > 1500 − 399 × log T, group B: 930 − 399 × log T < Eq1 ≤ 1500 − 399 × log T, and group C: Eq1 ≤ 930 − 399 × log T). Results: The overall mortality rate was 65.3% (194 of 297). The mortality rates of the three groups stratified by the Yamaguchi index were 7.1% (2 of 28), 22.4% (15 of 67), and 87.6% (177 of 202). The area under the receiver–operating characteristic curve for predicting mortality from the external validation of the Yamaguchi index was 0.842 (95% confidence interval: 0.795–0.882). Conclusion: The Yamaguchi index is a reliable prognostic factor and could be helpful in predicting mortality due to PQ poisoning.

scholarly journals Evaluation of Volumetric Change of Intracerebral Hemorrhage in Patients Treated with Thrombolysis for Intraventricular Hemorrhage

2020 ◽  
Author(s):  
Franziska Staub-Bartelt ◽  
Jasper Hans van Lieshout ◽  
Thomas Beez ◽  
Rainer Kram ◽  
Daniel Hänggi ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Intraventricular Hemorrhage ◽  
Volume Reduction ◽  
Percentage Reduction ◽  
Hematoma Volume ◽  
Group A ◽  
Group B ◽  
Lysis Therapy

Abstract Background Intraventricular hemorrhage (IVH) is often caused by irruption of intracerebral hemorrhage (ICH) of basal ganglia or thalamus into the ventricular system. Instillation of recombinant tissue plasminogen activator (rtPA) via an external ventricular drainage (EVD) has been shown to effectively decrease IVH volumes while the impact of rtPA instillation on ICH volumes remains unclear. In this series, we analyzed volumetric changes of ICH in patients with and without intrathecal lysis therapy. Methods Between 01/2013 and 01/2019, 36 patients with IVH caused by hemorrhage of basal ganglia, thalamus or brain stem were treated with rtPA via an EVD (Group A). Initial volumes were determined in the first available computed tomography (CT) scan, final volumes in the last CT scan before discharge. During the same period, 41 patients with ICH without relevant IVH were treated without intrathecal lysis therapy at our neurocritical care unit (Group B). Serial CT scans were evaluated separately for changes in ICH volumes for both cohorts using OsiriX DICOM viewer. The Wilcoxon signed-rank test was performed for statistical analysis in not normally distributed variables. Results Median initial volume of ICH for treatment Group A was 6.5 ml and was reduced to 5.0 ml after first instillation of rtPA (p < 0.01). Twenty-six patients received a second treatment with rtPA (ICH volume reduction 4.5 to 3.3 ml, p < 0.01) and of this cohort further 16 patients underwent a third treatment (ICH volume reduction 3.0 ml to 1.5 ml, p < 0.01). Comparison of first and last CT scan in Group A confirmed an overall median percentage reduction of 91.7% (n = 36, p < 0.01) of ICH volumes and hematoma resolution in Group A was significantly more effective compared to non-rtPA group, Group B (percentage reduction = 68%) independent of initial hematoma volume in the regression analysis (p = 0.07, mean 11.1, 95%CI 7.7–14.5). There were no adverse events in Group A related to rtPA instillation. Conclusion Intrathecal lysis therapy leads to a significant reduction in the intraparenchymal hematoma volume with faster clot resolution compared to the spontaneous hematoma resorption. Furthermore, intrathecal rtPA application had no adverse effect on ICH volume.

scholarly journals Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease?

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Faiza Sadaqat Ali ◽  
Nimrah Bader ◽  
Bader Faiyaz Zuberi ◽  
Tazeen Rasheed
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Liver Stiffness Measurement ◽  
Stiffness Measurement ◽  
Group A ◽  
Group B

Objectives: This study aimed to validate Baveno-VI recommendations for variceal screening in cACLD in our region and proposed our own cutoff values. Methods: Prospective cross-sectional study was conducted on cACLD patients from August 2020 till April 2021. Patients segregated into Group-A, having Liver stiffness measurement (LSM) of ≥ 20 kPa and platelet of ≤ 150 × 109 cells/L; and Group-B having LSM of < 20 kPa and PLT of > 150 × 109 cells/L. Gastroscopic findings were segregated into three categories, VNT, Varices Not Needing Treatment (VNNT) and No Varix (NV). ROC plots were generated for LSM and Platelet for VNT for sensitivity, specificity, Negative and Positive Predictive Values were calculated. Results: A total of 134 patients of cACLD were included. Group-A had 72 (53.7%) patients and Group-B had 62 (46.3%) patients. Group-A had 6 (8.3%) NV; 18 (25.0%) VNNT and 48 (66.7%) VNT. Group-B had 26 (41.9%) NV, 24 (38.7%) VNNT and 12 (19.4%) VNT. The sensitivity of 66.7%, specificity of 80.6% and NPV of 67.56% was obtained. Thus 19.4% VNT were missed on following Baveno VI recommendations. ROC in our study suggested cutoff value of 11.5 kPa with sensitivity of 100% and 1-sepcifity pf 78% (AUROC = 0.865; p < .001) of LSM below which screening gastroscopy could be avoided. The positive and negative predicted values for 84.85% and 100% respectively. Cut off value of platelet count for VNNT came out to be ≥ 97.5 × 109 cells/L with AUROC 0.891 (p < .001), having sensitivity of 100 % and 1-specificity of 83.3%. Conclusions: Substantial number of VNT in cACLD patients are missed by following Baveno-VI recommendations and these needs to be revised on regional basis. List If Abbreviations: AASLD: American Association for Study of Liver Diseases (AASLD), AUROC: Area Under Receiver Operating Characteristic, cACLD: Compensated Advance Chronic Liver Disease (cACLD), CTP: Child-Turcotte-Pugh, DCLD: Decompensated Chronic Liver Disease (DCLD), EV: Esophageal Varices, KPa: Kilo Pascal, LSM: Liver stiffness measurement (LSM), NPV: Negative Predictive Value, NV: No Varix (NV)., PPV: Positive Predictive Value, ROC: Receiver Operating Characteristic, VNNT: Varices Not Needing Treatment (VNNT) and VNT: Varices Needing Treatment (VNT). How to cite this:Ali FS, Bader N, Zuberi BF, Rasheed T. Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease? Pak J Med Sci. 2022;38(1):---------.  doi: https://doi.org/10.12669/pjms.38.1.4796 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals EVALUATE THE EFFICACY OF SHASHTIK-SHALI PINDA SWEDA AND ABHYANGA IN MANAGEMENT OF PAKSHAGHATA ALONG WITH VIRECHANA W.S.R. TO HEMIPLEGIA

2020 ◽  
pp. 1-12
Author(s):  
Nisha Singh ◽  
Sriyash Dubey
Keyword(s):  
Early Diagnosis ◽  
Ct Scan ◽  
The Body ◽  
Healthy Life ◽  
Applied Aspect ◽  
Group A ◽  
Group B

Body is assembled by Vata Pitta and Kapha Dosha each assigned to do its Kshaya, Poshana and Dharana Karma. Vata dominates both because of its Yogavahi Guna. Pakshaghata is one of the grievous Vata Vyadhi in Ayurveda. Sansarga of other Dosha and Dhatu leads to involvement of Shodhana and Shaman Chikitsa. Snehana therapy, Bahya and Abhyantar are well known for its treatment in Vata Vyadhi. Inclination towards modernization and deviation from basic healthy life make the body vulnerable for disease especially Vata Vyadhi. We know Vata Vyadhi are fulminate in nature but early diagnosis with the help of investigation tools like CT scan, MRI etc; we can prevent from further damage caused by previous pathology. Sansarga of other Dosha and Dhatu leads to involvement of Shodhana and Shaman Chikitsa. In terms of treatment Virechana had been mentioned as Shodhana Chikitsa in our Samhita. Here an attempt was made to apply Virechana treatment with two different Poorva karma and to evaluate the efficacy with an applied aspect. The study had been conducted on 30 patients of Pakshaghata (Hemiplegia) who were divided in two groups and were given below treatments nearly for 1 month. Group A: Virechana followed by Shashtik-Shali Pindasweda. Group B: Virechana followed by Abhyanga. It was observed that both groups are effective in Ruja, Gauravta and Cheshtanivriti in the management of Pakshaghata (Hemiplegia) but Group A is more effective in comparison to Group B.

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