Lateropulsion After Hemispheric Stroke: A Form of Spatial Neglect Involving Graviception

ObjectiveTo test the hypothesis that lateropulsion is an entity expressing an impaired body orientation with respect to gravity, in relation to a biased graviception and spatial neglect.MethodsData from the DOBRAS cohort (ClinicalTrials.gov:NCT03203109), were collected 30 days after a first hemisphere stroke. Lateral body tilt, pushing and resistance were assessed with the Scale for Contraversive Pushing.ResultsAmong 220 individuals, 72% were Upright and 28% showed lateropulsion (Tilters=14% less severe than Pushers=14%). The three signs had very high factor loadings (>0.90) on a same dimension, demonstrating that lateropulsion was effectively an entity comprising body tilt (cardinal sign), pushing and resistance. The factorial analyses also showed that lateropulsion was inseparable from the visual vertical (VV), a criterion referring to vertical orientation (graviception). Contralesional VV biases were frequent (44%), with a magnitude related to lateropulsion severity: Upright -0.6°(-2.9;2.4), Tilters -2.9°(-7;0.8), Pushers -12.3°(-15.4;-8.5). Ipsilesional VV biases were less frequent and milder (p<0.001). They did not deal with graviception, 84% being found in upright individuals. Multivariate, factorial, contingency, and prediction analyses congruently showed strong similarities between lateropulsion and spatial neglect, the latter encompassing the former.ConclusionsLateropulsion (pusher syndrome) is a trinity constituted by body tilt, pushing and resistance. It is a way to adjust the body orientation in the roll plane to a wrong reference of verticality. Referring to straight above, lateropulsion might correspond to a form of spatial neglect (referring to straight ahead), which would advocate for 3-D maps in the human brain involving the internal model of verticality.

PERILAKU SANTRIWAN YANG BARU MONDOK DI PESANTREN K-K KECAMATAN SAKO TERHADAP KEJADIAN PENYAKIT KULIT SKABIES

Sekitar 300 juta kasus skabies per tahunnya dilaporkan di seluruh dunia dan di Indonesia 3,9-9% penduduk. Faktor-faktor yang berhubungan dengan risiko infestasi tungau antara lain higienitas pribadi yang buruk, kontak dengan penderita, kelembapan, kepadatan hunian yang tinggi dan pengetahuan yang rendah. Faktor risiko tersebut tinggi pada santri penghuni asrama pesantren. Kegiatan penelitian bertujuan untuk menentukan faktor risiko dan hubungannya penyakit kulit kudis pada Pondok Pesantren K-K di Kecamatan Sako Kota Palembang. Penelitian dilakukan melalui metode observasi dengan menggunakan pendekatan desain potong lintang pada 114 santri dengan prosedur pemeriksaan klinis (cardinal sign) gejala skabies dan mikroskopis serta kuesioner. Hasil menunjukkan bahwa subjek penelitian yang terkena skabies sebanyak 37% didominasi oleh jenis kelamin laki-laki (53%), berada pada tingkat tsanawiyah (63%) kelas VII (40%), memiliki tingkat pengetahuan sedang (49%), tingkat sikap sedang (48%), tingkat perilaku baik (52%). Analisis bivariat dan logistik regresi multivariat menunjukkan hubungan antara kejadian skabies dengan pengetahuan, sikap, perilaku, dengan pengaruh paling besar pada perilaku (OR 8,24). Disarankan untuk tidak menggunakan barang pribadi secara bersama. Penyuluhan terutama pada santri yang baru masuk asrama harus lebih digalakkan dengan melibatkan pihak puskesmas untuk sosialisasi penyakit terutama bagi santriwan kelas VII tsanawiyah.

Complex dystonias: an update on diagnosis and care

Complex dystonias are defined as dystonias that are accompanied by neurologic or systemic manifestations beyond movement disorders. Many syndromes or diseases can present with complex dystonia, either as the cardinal sign or as part of a multi-systemic manifestation. Complex dystonia often gradually develops in the disease course, but can also be present from the outset. If available, the diagnostic workup, disease-specific treatment, and management of patients with complex dystonias require a multi-disciplinary approach. This article summarizes current knowledge on complex dystonias with a particular view of recent developments with respect to advances in diagnosis and management, including causative treatments.

Clinical study to evaluate the effectiveness of Gavakshi Moola (Citrullus colocynthis) Draava with Ksheera in Kamala (hepatocellular jaundice)

Hepatocellular jaundice is a sign that usually accompanies diseases of liver, the organ that detoxifies metabolites, synthesizes proteins, produces biochemicals necessary for digestion, decomposes red blood cells and produces hormones,[1] hence is constantly under the risk of various diseases. Causes of hepatocellular jaundice are numerous with the most common being viral hepatitis, alcohol and drug toxicity. Kamala described among the Pittaja Nanatmaja Vyadhi has Haridra Varna of Netra, Twak, Nakha, Anana, Mutra as the cardinal sign, hence analogous to jaundice. The administration of Gavakshimoola Draava for 3 days is described in the management of Kamala. A clinical trial was conducted on 15 subjects and the results obtained were statistically analysed. Statistically significant reduction of Lakshana of Kamala and serum levels of bilirubin with p-value less than 0.05 was noted.

To evaluate the efficacy of Nasya Karma in Manyasthamba

In modern era, the people adopt mechanical type of lifestyle who don’t follow the proper regimen will suffer from disorders like Manyastambha. A major part of global population experiences Manyastambha atleast once in their lifetime. Manyastambha is one of the important vataja urdhvajatrugata roga the cardinal sign of Manyastambha is stiffness of neck with or without pain. Present work was undertaken to evaluate the efficacy of Nasya Karma on Manyastambha i.e. Brumhana and Shodhana therapy of mashataila is used in the Nasya Karma. In present study 30 patients are undertaken for clinical trial from Shri Mallikarjuna Swamiji Post Graduate and Research Center Bijapur. The result of Nasya Karma was having a prolonged significant results during, after and post followup of the treatment.

Knowledge on leprosy and its management among primary healthcare providers in two districts of Bangladesh

Background In 2013, Lepra Bangladesh (a non-government organization) and the National Leprosy Programme of the Directorate General of Health Services under the Ministry of Health and Family Welfare, Bangladesh implemented a 3 years project entitled “2015 and Beyond: Poverty Reduction through Strengthened Health Systems”. The aims of this Health System Strengthening (HSS) project were to improve quality of leprosy services through service delivery, capacity development, curriculum development, improved collaboration, coordination, operational research and knowledge sharing to identify and treat leprosy in order to contribute to strengthen existing health systems. We evaluated the changes in knowledge of primary and community level healthcare providers about cardinal signs, course of leprosy treatment, and drug use for paucibacillary (PB) and multibacillary (MB) leprosy cases. Methods We conducted two surveys using purposive sampling technique in two pilot districts: Bogra and Moulvibazar. The first survey was conducted before implementing the HSS project from March to June 2014 among 98 providers. The end-line survey was conducted in November 2015 and included 49 providers. The interview was conducted using the same pre-tested structured questionnaire. Descriptive statistics followed by further analysis was done including proportions, 90% confidence intervals, and p values were calculated for the selected variables. Results The primary and community level healthcare providers demonstrated significant increases in knowledge on one cardinal sign (definite loss of sensation in a pale -hypopigmented- or reddish skin patch), doses and courses for the adult PB and MB cases and duration of Multi-Drug Therapy (MDT) course at the end line compared to the beginning of the project. All the providers except TB and Leprosy Control Assistants demonstrated statistically significant decreases in knowledge at the end-line compared to the baseline about supportive counseling. Conclusions HSS activities including training and capacity building of the providers recorded significant increase of knowledge on types of leprosy, one cardinal sign, courses of MDT and drug use for the adult PB and MB cases and use MDT for leprosy treatment among the service providers at the end-line. Any health systems strengthening project should incorporate a capacity building approach within the programme all through.

Isolated corpus spongiosum injury after sexual intercourse

Penile fractures are generally rare and underreported. The mechanism of injury is due to a rupture of the corpora cavernosa following blunt or sexual trauma to the penis when fully erect. Penile fractures usually present with a ‘popping’ sound with concomitant sudden swelling and ecchymosis of the penis followed by rapid detumescence. Urethral involvement occurs only in a small part of the cases. Isolated spongiosal injury after sexual intercourse is also extremely rare. The cardinal sign of urethral injury is blood at the meatus. A small laceration can be repaired by simple closure with absorbable sutures, while a complete rupture requires a more complex anastomotic repair. We report a case of a typically presenting penile fracture that was eventually proven to be an isolated corpus spongiosum injury, with no corpora cavernosa involvement.

Clinical Approach to Vrana Shopha w.s.r. to Inflammatory Swelling

Inflammation in Ayurveda is known by different names in different contexts namely Shotha, Shopha, Svayatu, Utsedha and Samhata. Chronic inflammation is a cardinal sign of chronic degenerative disorders. Inflammation and oedema associated with it is duly recognised in Ayurveda as a pathological manifestation. While modern medicine considers inflammation as a symptom or rather as a healing response of the body in wounds. Ayurveda treats the concept of inflammation as symptom of a disease, an independent disease and complication of diseases. Degenerative diseases share a common pathological feature of inflammation. The disturbances in micro channel circulation in inflammation are due to Srotodushti (clogging of channels) by Aama (toxic waste of metabolism). The proper clinical approach to Vrana Shopha with Modern concept is an key role in management and preventing complication of Vrana Shopha.