Comparative Evaluation of the Efficacy of Hydrocortisone Suppository and Durvadi gudavarti in Raktarsha: A Management Protocol

The most common diagnosis for any anorectal complaint particularly of rectal bleeding in adults is haemorrhoidal disease. Regardless of grading conservative treatment is used primarily in symptomatic haemorrhoids. In Ayurveda, Sthanik Chikitsa (Local application) in the management of Arsha (Hemorrhoids) includes pralepa/pratisaran (Paste application). Instead of applying the lepa in the clinics by the clinician/proctologist, those formulations could be developed into Gudavarti (traditional suppository) & used in the management of Raktarsha (bleeding piles) for better compliance. Hence, development of ‘Durvadi Gudavarti’ using the indigenous medicinal herbs mentioned in Charaka Sanhita (Classical Ayurveda text) for pratisaran/pralepa in Raktarsha & its efficacy will be evaluated. Objectives: To study & compare the efficacy in patient treated with standard- Hydrocortisone suppository group & interventional- Durvadi Gudavarti group in the management of Raktarsha (Bleeding piles). Methodology: 130 patients of 2nd grade hemorrhoids will be selected and will be allocated into two equal groups by computer randomization. Experimental group will be treated with Durvadi Gudavarti & control group with Hydrocortisone based suppository for 2 weeks. Following Symptoms- PR Bleeding, Anal Pain, Prolapse of Pile mass/Lump, Anal pruritus, Mucous discharge & Constipation will be assessed subjectively and Size/ (Volume in cubic millimeter) of pile mass will be the objective parameter for study. Clinical evaluation will be done at Baseline and 3rd, 5th, 10th, 15th day after treatment onset. Proportion of patients that would respond clinically on 10th day will be the main end point, determined via disappearance of the clinical symptoms & more than or equal to 50 % reduction in the initial size of pile mass/lump. Time to response & need for any oral/ parenteral medication for pain, bleeding and constipation would be the secondary variables. Side effects (type, duration & severity) will be registered carefully. Expected Results: Durvadi Gudavarti contains indigenous herbs having anti-inflammatory, analgesic, haemostatic, wound healing, astringent, & laxative properties. Hence, it is expected to be as efficacious as Hydrocortisone suppository with lesser side effect in the management of Raktarsha. Results will be assessed on the basis of clinical assessment criteria using proper statistical values and tools. Changes will be observed in objective outcomes. Conclusion: Durvadi Gudavarti will be efficacious in the management of Raktarsha.

The association between the initial outcomes of COVID-19 and the human development index: An ecological study

BACKGROUND & OBJECTIVE: Outcomes of the pandemic COVID-19 varied from one country to another. We aimed to describe the association between the global recovery and mortality rates of COVID-19 cases in different countries and the Human Development Index (HDI) as a socioeconomic indicator. METHODS: A correlational (ecological) study design is used. The analysis used data from 173 countries. Poisson regression models were applied to study the relationship between HDI and pandemic recovery and mortality rates, adjusting for country median age and country male to female sex ratio. RESULTS: During the first three months, the global pooled recovery rate was 32.4%(95%CI 32.3%–32.5%), and the pooled mortality rate was 6.95%(95%CI 6.94%–6.99%). Regression models revealed that HDI was positively associated with recovery β= 1.37, p = 0.016. HDI was also positively associated with the mortality outcome β= 1.79, p = 0.016. CONCLUSIONS: Our findings imply that the positive association between the HDI and recovery rates is reflective of the pandemics’ preparedness. The positive association between the HDI and mortality rates points to vulnerabilities in approaches to tackle health crises. It is critical to better understand the connection between nations’ socioeconomic factors and their readiness for future pandemics in order to strengthen public health policies.

Testing how different narrative perspectives achieve communication objectives and goals in online natural science videos

Communication of science through online media has become a primary means of disseminating and connecting science with a public audience. However, online media can come in many forms and stories of scientific discovery can be told by many individuals. We tested whether the relationship of a spokesperson to the science story being told (i.e., the narrative perspective) influences how people react and respond to online science media. We created five video stimuli that fell into three treatments: a scientist presenting their own research (male or female), a third-party summarizing research (male or female), and an infographic-like video with no on-screen presenter. Each of these videos presented the same fabricated science story about the discovery of a new ant species (Formicidae). We used Qualtrics to administer and obtain survey responses from 515 participants (~100 per video). Participants were randomly assigned to one of the videos and after viewing the stimulus answered questions assessing their perceptions of the video (trustworthiness and enjoyment), the spokesperson (trustworthiness and competence), scientists in general (competence and warmth), and attitudes towards the research topic and funding. Participants were also asked to recall what they had seen and heard. We determined that when participants watched a video in which a scientist presented their own research, participants perceived the spokesperson as having more expertise than a third-party presenter, and as more trustworthy and having more expertise than the no-spokesperson stimuli. Viewing a scientist presenting their own work also humanized the research, with participants more often including a person in their answer to the recall question. Overall, manipulating the narrative perspective of the source of a single online video communication effort is effective at impacting immediate objective outcomes related to spokesperson perceptions, but whether those objectives can positively influence long-term goals requires more investigation.

Multiple ligament anatomic-based reconstructions of the knee: State- of-the-art

Multiple knee ligament injuries are defined as a disruption of any combination of the four main ligament complexes; the cruciate ligaments, posterolateral corner, and posteromedial corner. Evaluation requires consideration of the entire clinical picture, including injury to associated structures, directions and degree of instability, neurovascular compromise and appropriate imaging, and physical examination. Reconstruction is favored over repair and anatomic- based reconstruction techniques have been validated to restore the native biomechanics of the knee and lead to successful patient-reported and objective outcomes. Anatomic-based reconstruction of many knee ligaments simultaneously requires precise knowledge of the relevant anatomical landmarks, careful planning of reconstruction tunnel positions, and orientations to avoid tunnel convergence, and employment of immediate early motion in the post-operative rehabilitation regimen to provide the patient the best chance for relatively normal use of the affected limb.

Modified Cantwel-Ransley Reconstruction of Continent Penile Epispadias In Children: A Case Report

Epispadias as an isolated embryologic defect is a rare anomaly, with an incidence of 1 in 117.000 males. Isolated epispadias with continence is a very rare condition comprising less than 10% of all epispadias cases. Epispadias is a closure defect of the dorsal wall of the urethra. The biggest challenges for epispadias treatment are creating adequate penile length, straightening the severely curved penis, and creating a penopubic angle for allowing comfortable penetration of the penis. An 11-year-old boy underwent surgery for his continent penile epispadias in Dr. Soetomo General Academic Hospital. The surgical technique chosen for this patient was Modified Cantwell-Ransley repair. The dressing was opened on the 3rd day after the operation. The urethral catheter was removed on the 10th day. The patients underwent regular follow-up examinations for 6 months and were evaluated for subjective and objective outcomes. There was no post-operative fistula or urethral narrowing requiring urethral dilatation. The Uroflowmetry and post voiding residual ultrasound result was good. The cosmetic appearance of the penis was satisfying. Outcomes related to sexual activity were not evaluated because the patient had no sexual activity yet.

Milestones 2.0: Otolaryngology Resident Competency in the Postpandemic Era

The Accreditation Council for Graduate Medical Education and the American Board of Otolaryngology–Head and Neck Surgery Milestones Project grew out of a continued need to document objective outcomes within resident education. Milestones 2.0 began its work in 2016, with an intent to resolve inconsistencies in the original milestones based on an iterative process. Milestones 2.0 retains the original 5 levels of achievement but includes a “not yet assessable” option as well. In addition, Milestones 2.0 has added harmonized milestones across all specialties. Each specialty has incorporated a supplemental guide with examples and resources to improve facility with the tool. There will be further refinement of the Milestones as new research emerges with the ultimate goal of providing programs and trainees with a reliable roadmap that can be used to direct and assess learning.

Objective Measurement of Impact of Bench Laparoscopic Training in Novices

Background: We are currently in the era of laparoscopic surgery. It has gained popularity in the last few decades because of its well- known advantages. Laparoscopy requires different skills from those of open surgery. In a paradigm shift, learning basic surgical skills is now performed more in the skills laboratory than in the operation theater. However, there is a lack of reliable training and assessment tools for laparoscopic surgical skills. This study aimed to objectively assess the effect of bench laparoscopic training in novices. Methods: This prospective study was conducted at the Clinical Skills Centre of Bangalore Medical College and Research Institute (BMCRI) in Bangalore, India. Sixty interns with no previous experience in laparoscopy were included. They underwent supervised training on the box trainer for 3 days, 2 hours a day, in basic surgical tasks, including pointing dots, joining straight lines, joining curved lines, picking objects, peg transfer, and circle cut. All participants were assessed objectively in a virtual reality (VR) simulator before and after training. The objective outcomes measured were time taken, distance traveled, and error scores given by the VR simulator metrics. Results: The novices showed statistically significant improvement in all the tasks after the training compared with their skill levels before the training. Conclusion: Structured short-term training significantly improves basic laparoscopic surgery skills.

COMPARATIVE CLINICAL STUDY OF AMSABASTI AND SNEHAN – SWEDAN THERAPY BY LAGHUVISHGARBHA TAIL ALONG WITH TRAYODASHANGGUGGULU IN AVABAHUKA (FROZEN SHOULDER)

Avabahuka is caused mainly by vitiated vata. Avabahuka is not mentioned in nanatmajvatavyadhi but acharya sushruta and other acharyas considered avabahuka as vatavyadhi. Avabahuka is a disease that affects amsa sandhi. Avabahuka is correlated with frozen shoulder of modern science. It is also known as adhesive capsulitis, or stiff shoulder where joint pain and stiffness of shoulder joint both occur. Therefore as avabahuka causes major limitations in activities of daily living casting a negative influence on the quality of life as well as long-term or even permanent disability in a few of the patients, proper treatment is needed for the problem. In ayurveda basic principle of avabahuka treatment is vata shaman chikitsa. The general line of treatment for vatavyadhi issnehana, swedana, mrudusamshodhan, basti, nasya, and so on. Snehana – swedana for the treatment of avabahuka which is generally given in vatavyadhichikitsa has gained popularity for its efficacy. Evaluation of the utility, safety, and efficacy of laghuvishagarbha tail amsabasti by amsabasti yantra along with trayodashangguggulu as compare to laghuvishagarbha tail snehana – swedana along with trayodashangguggulu in the management of avbahuka (frozen shoulder). In this study, 140 patients will be divided randomly into 2 groups (70 in each). In group a (experimental) –amsabasti of laghuvishgarbha tail and oral drug trayodashangguggulu (500 mg thrice a day) after meals with plain water will be given for 21 days and group b (control) –snehana of laghuvishgarbha tail, swedana of by plain water and oral drug trayodashangguggulu (500 mg thrice a day) after meals with plain water will be given for 21 days. Assessment of avabahuka will be recorded on day 0, on 7th day, on 14th day and on 21st day. Changes will be observed in objective outcomes. Amsa basti will be more efficacious thansnehana -swedana in the management of avabahuka.