COMPARISON OF ISOCONAZOLE NITRATE VERSUS NYSTATIN FOR TREATMENT OF OTOMYCOSIS

Objective: To compare isoconazole nitrate versus nystatin for treatment of otomycosis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Bahawalpur and Combined Military Hospital Mardan, from Jan to Dec 2018. Methodology: Total 204 cases fulfilling the inclusion criteria were selected from outpatient department of Combined Military Hospital Bahawalpur and Mardan. They were divided into 2 groups of 102 each using random number tables. Group A cases were given Isocona-zole nitrate for application in external auditory meatus and group B cases were given Nystatin. All the cases were examined two weeks later and outcome was compared in terms of clinical improvement and symptoms resolution. Results: Out of 204, 125 patients were females and rest 79 were males. Age range was from 12-87 years with mean age 31 ± 2.4. Both groups were identical in terms of gender. In group A patients, 74 (72.5%) showed marked improvement after two week, 15 (14.7%) showed moderate improvement and 13 (12.7%) showed minor improvement. However, in group B, 55 (53.9%) showed marked improvement after two week, 23 (22.5%) showed moderate improvement and 24 (23.5%) showed minor improvement. Group A treatment was found significantly better than group B treatment (p=0.021). Conclusion: Isoconazole nitrate ointment was found significantly more effective for treating otomycosis than nystatin.

Syndromic Craniosynostosis: Objective and Parent-Reported Outcome Measurements after Cranio-Facial Remodelling Surgeries

<b><i>Introduction:</i></b> Syndromic craniosynostosis (SC) is a rare entity compared to the non-syndromic variant. Treatment involves a multidisciplinary approach towards a multitude of problems. Early intervention is known to be better for optimum results. We reviewed outcomes of children with SC who underwent reconstructive cranio-facial surgery. <b><i>Materials and Methods:</i></b> A retrospective study was conducted using data from hospital case files and the picture archival communication system. Objective data like the cephalic index (CI), both preoperatively and post-operatively, were compared. Subjective data for the cosmesis outcome – “Sloan and Whitaker outcome class” – following surgery were assessed. Also, parent-reported outcome measurement (PROM) was performed with various parameters to assess quality of life (QOL). <b><i>Results:</i></b> We had 21 operated cases of SC, with 19 needing cranio-facial remodelling. The male to female ratio was 11:10. Crouzon’s syndrome was the most common syndromic association followed by Apert’s syndrome. Nineteen patients underwent cranio-facial remodelling surgeries and 2 underwent the ventriculo-peritoneal shunt only – for raised intracranial pressure (ICP). Nine patients underwent cranial remodelling with fronto-orbital advancements, and 3 of these patients also received le-fort’s type 3 osteotomy and advancement later. Ten patients underwent fronto-orbital advancement with parieto-occipital barrel-stave osteotomies. <b><i>Outcomes:</i></b> Improvement in the CI was maximum at the 6-month follow-up. Six (37.5%) cases had Sloan class 1 outcome, 9 (56.25%) had class 2 outcomes, and 1 patient had a class 6 outcome. Whitaker cosmesis outcomes – 14 out of 16 cases (87.5%) had Category 1 outcomes. PROM was assessed. All parents reported at least a moderate improvement in cosmesis following surgery. Out of 15 cases, 10 (66%) reported significant improvement, while 4 (26.6%) cases reported moderate improvement with respect to eye and visual problems. Four parents reported snoring as a significant problem even after surgery. Most parents felt that the children were doing well, attending regular school, and social well-being was normal and had an overall good QOL. <b><i>Conclusions:</i></b> SC cases may have a multitude of other problems like raised ICP, ophthalmological problems, poor intelligence, and cognition apart from cosmetic concerns. PROMs revealed good outcomes in terms of cosmesis, cognition, and ophthalmological and oral cavity-related problems. Significant improvement in overall QOL was seen in most patients following cranio-facial remodelling surgery.

Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain

Objectives. To evaluate the evidence on benefits and harms of cannabinoids and similar plant-based compounds to treat chronic pain. Data sources. Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Library, and SCOPUS® databases, reference lists of included studies, submissions received after Federal Register request were searched to July 2021. Review methods. Using dual review, we screened search results for randomized controlled trials (RCTs) and observational studies of patients with chronic pain evaluating cannabis, kratom, and similar compounds with any comparison group and at least 1 month of treatment or followup. Dual review was used to abstract study data, assess study-level risk of bias, and rate the strength of evidence. Prioritized outcomes included pain, overall function, and adverse events. We grouped studies that assessed tetrahydrocannabinol (THC) and/or cannabidiol (CBD) based on their THC to CBD ratio and categorized them as high-THC to CBD ratio, comparable THC to CBD ratio, and low-THC to CBD ratio. We also grouped studies by whether the product was a whole-plant product (cannabis), cannabinoids extracted or purified from a whole plant, or synthetic. We conducted meta-analyses using the profile likelihood random effects model and assessed between-study heterogeneity using Cochran’s Q statistic chi square and the I2 test for inconsistency. Magnitude of benefit was categorized into no effect or small, moderate, and large effects. Results. From 2,850 abstracts, 20 RCTs (N=1,776) and 7 observational studies (N=13,095) assessing different cannabinoids were included; none of kratom. Studies were primarily short term, and 75 percent enrolled patients with a variety of neuropathic pain. Comparators were primarily placebo or usual care. The strength of evidence (SOE) was low, unless otherwise noted. Compared with placebo, comparable THC to CBD ratio oral spray was associated with a small benefit in change in pain severity (7 RCTs, N=632, 0 to10 scale, mean difference [MD] −0.54, 95% confidence interval [CI] −0.95 to −0.19, I2=28%; SOE: moderate) and overall function (6 RCTs, N=616, 0 to 10 scale, MD −0.42, 95% CI −0.73 to −0.16, I2=24%). There was no effect on study withdrawals due to adverse events. There was a large increased risk of dizziness and sedation and a moderate increased risk of nausea (dizziness: 6 RCTs, N=866, 30% vs. 8%, relative risk [RR] 3.57, 95% CI 2.42 to 5.60, I2=0%; sedation: 6 RCTs, N=866, 22% vs. 16%, RR 5.04, 95% CI 2.10 to 11.89, I2=0%; and nausea: 6 RCTs, N=866, 13% vs. 7.5%, RR 1.79, 95% CI 1.20 to 2.78, I2=0%). Synthetic products with high-THC to CBD ratios were associated with a moderate improvement in pain severity, a moderate increase in sedation, and a large increase in nausea (pain: 6 RCTs, N=390 to 10 scale, MD −1.15, 95% CI −1.99 to −0.54, I2=39%; sedation: 3 RCTs, N=335, 19% vs. 10%, RR 1.73, 95% CI 1.03 to 4.63, I2=0%; nausea: 2 RCTs, N=302, 12% vs. 6%, RR 2.19, 95% CI 0.77 to 5.39; I²=0%). We found moderate SOE for a large increased risk of dizziness (2 RCTs, 32% vs. 11%, RR 2.74, 95% CI 1.47 to 6.86, I2=0%). Extracted whole-plant products with high-THC to CBD ratios (oral) were associated with a large increased risk of study withdrawal due to adverse events (1 RCT, 13.9% vs. 5.7%, RR 3.12, 95% CI 1.54 to 6.33) and dizziness (1 RCT, 62.2% vs. 7.5%, RR 8.34, 95% CI 4.53 to 15.34). We observed a moderate improvement in pain severity when combining all studies of high-THC to CBD ratio (8 RCTs, N=684, MD −1.25, 95% CI −2.09 to −0.71, I2=50%; SOE: moderate). Evidence on whole-plant cannabis, topical CBD, low-THC to CBD, other cannabinoids, comparisons with active products, and impact on use of opioids was insufficient to draw conclusions. Other important harms (psychosis, cannabis use disorder, and cognitive effects) were not reported. Conclusions. Low to moderate strength evidence suggests small to moderate improvements in pain (mostly neuropathic), and moderate to large increases in common adverse events (dizziness, sedation, nausea) and study withdrawal due to adverse events with high- and comparable THC to CBD ratio extracted cannabinoids and synthetic products in short-term treatment (1 to 6 months). Evidence for whole-plant cannabis, and other comparisons, outcomes, and PBCs were unavailable or insufficient to draw conclusions. Small sample sizes, lack of evidence for moderate and long-term use and other key outcomes, such as other adverse events and impact on use of opioids during treatment, indicate that more research is needed.

ORIGINAL RESEARCH ARTICLE: EXPRESSION OF SYCOSIS MIASM IN TODAY’S ERA

Background: The word miasm means an infection. Hippocrates was the first who use the term "miasm" which has its origins in the Greek word for taint or fault. He anticipated that certain infectious diseases were transmitted to humans by air and water tainted by miasms. Hahnemann thought that the life power is infected by certain factors and this infection creates the disease. Dr. Hahnemann has recognized three special forms which he has designated as PSORA, SYCOSIS AND SYPHILIS. Which are recognized as ‘Miasm’ Objectives: The objective of the study is to understand the Expression of Sycosis miasm in Today’s Era. Methods: This Prospective study includes 50 cases that were randomly selected which had predominantly sycotic expression irrespective of age, sex and religion. The symptoms in the case were analyzed for the sycosis expressions. Investigation was carried out as and when required as per the case. The remedy was selected on the basis of totality of symptoms. The remedies were used in various potencies with repetition of doses as per the requirement of the case. The Homoeopathic remedies were selected from Standard Homoeopathic Pharmacy, Response was analyzed into 3 criteria: Mild Improvement, Moderate Improvement, Status quo, Left the treatment. Results: 50 cases of sycosis expression, both the genders of different age and different family background were analyzed and examined for response the homeopathic treatment. Expression of sycosis miasm was observed more in 31-40 years of age group. In general, sycosis predominantly seen in Male 26 cases. The common mental expression which was easily found out was dominating nature and desire for company and most peculiar was anger, which was expressed in different-different ways e.g., Anger at trifles, anger when contradicted, with abusive language or even throwing things when angry. In physical expression craving for such as sweets and spices. This miasm has aggravation at night in the research it is observed majority complaints of sycosis aggravated at night. The prominent disease conditions observed were hypertension 16%, renal calculi 12%, and diabetes mellitus 9%, hemorrhoids and hypothyroidism 7%, and gout, BPH, DNS, ovarian cyst, fibroids 5% respectively. The medicines selected on the totality of symptoms including miasmatic expression gave moderate improvement in 32% of cases where as mild improvement was observed in 40% of cases. The medicine found to be effective were anti-sycotic medicines like Medorrhinum, Nat. mur, Calc.carb, Apis etc. Lycopodium was prescribed in 20% of cases. Conclusion: From our study we would like to conclude that sycosis is flourishing miasm in many directions in this world. Along with it, it is most mischievous and difficult to conclude on mental aspect. Because we cannot grab sycotic person from their mind. Here I have made an effort to find out the common features of sycosis in this era which we can effortlessly find out and get from people. Keywords: miasm, sycosis

TO STUDY THE EFFICACY OF NISHAKANAK KALKA LEPA IN STANPEEDA W.S.R. TO CYCLIC MASTALGIA

Stanpeeda (Mastalgia) is a commonly occurred breast pain that a female suffers from during her lifetime. Approximately two-thirds of women develop this pain during their reproductive life and may seek medical attention when it adversely affects their daily life. The breast pain may vary from mild to severe, could be intermittent or constant. According to Ayurveda, Stanpeeda can be correlated with Mastalgia. The objectives are to study of Stanpeeda with reference to cyclic mastalgia and to study the effect of Nisha kanak kalka lepa in Stanpeeda for 7 days, when cyclic mastalgia occurs. The study was conducted at Stree Rog prasuti tantra department, Hon. Shri. Annasaheb Dange Ayurved Medical College, Post Graduate & Research Center, Sangli, Maharashtra. Total number of 60 patients of 18-35 years age group having Stanapeeda were selected and treated with Nisha Kanak Kalka lepa. In this study the importance of Nisha (Rhizome of Haridra) and Kanak (Dhatura patra) and its possible action on each symptom was explained. Out of 60 patients studied, 21 patients (35%) showed marked improvement, 36 patients (60%) showed moderate improvement while 3 patients (5%) were mildly improved. Hence Nisha and Kanak Kalka lepa had significant result in Stana Peeda.

Impact of cardiovascular health status on the association between changes in physical activity and major cardiovascular events and mortality among 88,320 adults: outcomes of the Lifelines Cohort Study

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Lifelines Biobank initiative received funding from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen [UMCG], University Groningen and the Northern Provinces of the Netherlands. The work of T.M.H.E is supported by the Netherlands Heart Foundation [Senior E-Dekker grant #2017T051]. Background. Regular physical activity (PA) improves health. Many observational studies investigated the association between PA and health at a single time-point, but PA might change over time. Purpose. To examine the association between change in PA and major adverse cardiovascular events (MACE) and all-cause mortality, and to investigate the impact of cardiovascular health status at baseline on these outcomes. Methods. This study used data from the Lifelines Cohort Study (N = 88,320). Self-reported PA volumes were presented as Metabolic Equivalent of Task (MET) min/week. Change in PA was calculated by subtracting MET-min/week at the first assessment from the second assessment (median interval: 4 yrs), and 5 groups were created; large reduction (&lt; -1500), moderate reduction (-1500 to -250), no change (-250 to 250), moderate improvement (-250 to 250) and large improvement (&gt;1500). The outcome was a combination of MACE and all-cause mortality. Results. During a median follow-up of 7 years, 667 events occurred among healthy individuals (43 ± 12 yrs, 1% of 69,818) and 599 in individuals with CVRF (55 ± 11 yrs, 3% of 18,502). Adjusted for confounders and baseline PA, healthy individuals with a large reduction in PA had a greater risk of incident MACE and mortality (Table). In CVRF, moderate to large improvements in PA were associated with reductions in adverse outcomes. Risk estimates became stronger in individuals with lower baseline PA (&lt;2000 MET-min/week), Table). Conclusions. Maintaining PA in healthy individuals and increasing PA in individuals with CVRF over time is important to prevent MACE and mortality. The impact of changes in PA was stronger for individuals with lower baseline PA. Table. Change of PA, MACE and mortality. Changes in PA Healthy CVRF Large reduction 1.40 [1.02;1.93] 1.27 [0.95;1.70] Moderate reduction 1.22 [0.89;1.68] 0.97 [0.72;1.30] No changes Ref Ref Moderate improvement 1.04 [0.74;1.44] 0.65 [0.47;0.91] Large improvement 0.96 [0.71;1.31] 0.69 [0.51; 0.94] Individuals with lower baseline PA Large reduction 2.24 [0.96;5.21] 2.85 [1.44;5.63] Moderate reduction 1.77 [1.10;2.84] 1.33 [0.89;1.98] No changes Ref Ref Moderate improvement 1.16 [0.73;1.83] 0.49 [0.31;0.76] Large improvement 0.77 [0.48;1.23] 0.58 [0.39;0.86]

THE MANAGEMENT OF AMAVATA (RHEUMATOID ARTHRITIS) WITH VATARI GUGGULU AND BRIHAT SIMHANADA GUGGULU

The detail knowledge on Amavata was first explained by Madhavakar, whereas Chakrapani Dutta first gave knowledge about principle and management of the disease. Amavata is a clinical entity very much similar to the chronic but active inflammatory arthropathy, the Rheumatoid arthritis. Till now, the etio-pathogenesis of Rheumatoid arthritis is not known precisely but among the hypothesis, entero-pathy along with autoimmune have important role regarding this disease. In Amavata, due to impaired functioning of 'Kayagni' the anna-rasa undergoes fermentation resulted formation of ama (biotoxin) which combines with vitiated Vata (biophysical force for movement) to form Amavata.(1) So, two important entities one is toxin and other is movement, when comes together kha vaigunya concept the disease formed which is worst one. That’s why swelling, severe pain, and restricted movements are the main features of Amavata. Severe pain, difficulty in movements, and swelling on the joints along with fever etc makes the patient’s life miserable. Although Ama and Vata are chiefly pathogenic factors, Kapha and Pitta are also invariably involved in its pathogenesis (Samprapti). The therapeutic approach should be on Vata dosha, Kapha dosha and correction of Amadosha and of Agni viz. Pitta. The line of treatment for amavata also includes langhanam, swedanam, tiktam, deepana, katu drugs and sodhana treatment like virechana, basti etc. The shamana drugs which are having Vatashamaka, Amapachaka, Ama Shoshaka, and Deepniya properties can be used in the treatment of this disease. Vatari Guggulu and Brihat simhanada guggulu carries indication for Amavata according to Bhaisajya Ratnavali. The compositions in it are approachable lieu of principles of treatment of Amavata. The clinical research shows that in TG I, 7 (46.67%) patients were got Moderate im-provement while 8 (53.33%) patients were got Mild improvement. In TG II 10 (66.67%) patients were get Moderate improvement while 5 (33.33%) patients were got Mild improvement.

A Comparative Clinical Evaluation of Agnikarma and Raktamokshana in Management of Gridhrasi (Sciatica)”

Background: Gridhrasi can be correlated with sciatica which is a severe painful condition where back pain and radiating pain of the legs are found together on the basis of symptoms. In the treatment of sciatica only symptomatic management and a very few surgical procedures are available in conventional medical science with their own limits. Various methods used for Gridhrasi treatment in Ayurveda but para-surgical methods i.e. Agnikarma & Raktamokshana are more beneficial. Aim & objective: To compare the efficacy of Agnikarma and Raktamokshana (Cupping) in the management of Gridhrasi (Sciatica). Materials & Methods: Total 32 diagnosed cases of sciatica were registered, from which 29 patients completed the study. In group A, 4 sittings of Agnikarma were done in 16 patients with Panchadhatu Shalaka at lumbosacral region and achilles tendon region. In group B, 2 sittings of Raktamokshana was performed in 16 patients by using modified Shringa Yantra at lumbo-sacral region and four angula above Janu sandhi (Knee joint).. Result: The result was assessed by using wilcoxon signed rank test within the group and Mann whitney test between the group. Stastically significant relief was observed in both groups on cardinal symptoms of Gridhrasi. In Agnikarma group, 26.67% patients had got complete remission, 20% patients had marked improvement whereas 40% had moderate improvement in the symptoms of Gridhrasi. In group, Raktamokshana 50% had moderate improvement, 42.85% had marked improvement. Conclusion: Both para-surgical modalities have definite role in treating sciatica but Agnikarma has shown better result in comparison of Raktamokshana in the management of Gridhrasi (Sciatica).

Chronic Fatigue After Thyroidectomy: A Patient-Centered Survey

Background Fatigue after thyroidectomy is common, but there is a paucity of data regarding its prevalence and duration. We hypothesized that total thyroidectomy (TT) patients would have more long-term fatigue than thyroid lobectomy (TL) patients. Methods Statewide survey of thyroidectomy patients (2004-2017) was carried out. Results 281 patients completed the survey. 216 respondents (77%) had TT and 65 (23%) had TL. Within one year of surgery, 172 (61%) respondents recalled being troubled by new fatigue all, most, or some of the time. Total thyroidectomy patients were more likely to report new fatigue (69% vs. 44%, aOR 2.72, 95% CI 1.44 to 5.18). Of patients ( n = 172) reporting new fatigue, 67 (39%) reported at least moderate improvement. Nineteen (28%) saw improvement within 1 year, 35 (52%) saw improvement in 1-2 years, and 11 (16%) saw improvement after 2 years. Conclusion Long-term fatigue after TT can be debilitating, long-lasting, and less prevalent after TL.

CLINICAL EVALUATION OF ANUBHUTA YOGA (INGUDI) IN THE MANAGEMENT OF KAMALA

The present study is to establish the efficacy of folklore medicine Ingudi in the management of Kamala. The methods are Subjects presenting with classical symptoms of Kamala taken for the study. Total 30 subjects were selected randomly. Gradations were given to subjective parameters actual test values were given to objective parameters. Test values of LFT were recorded before and after the treatment. Patients were administered Anubhuta yoga(Ingudi Kalka) 5 gm bid for 14 days. The obtained subjective and objective data was statistically analyzed to determine the significance of treatment. In the subjects treated 55% of marked improvement was found, 36% moderate improvement was found. 2% of subjects had no relief. This shamana line of treatment has succeeded in reducing the signs and symptoms along with LFT values which reduced within the time period of 14 days.