Cortical and STN spectral changes during limb movements in PD patients with and without dystonia

Background: Dystonia is a prevalent yet under-studied motor feature of Parkinson disease (PD). Although considerable efforts have focused on brain oscillations related to the cardinal symptoms of PD, whether dystonia is associated with specific electrophysiological features is unclear. Objectives: To investigate subcortical and cortical field potentials at rest and during contralateral hand and foot movements in PD patients with versus without dystonia. Methods: We examined the prevalence and somatotopy of dystonia in PD patients undergoing deep brain stimulation (DBS) surgery. We recorded intracranial electrophysiology from sensorimotor cortex and directional DBS electrodes in subthalamic nucleus (STN), during both rest and voluntary contralateral limb movements. We used wavelet transforms and linear mixed models to characterize spectral content in patients with and without dystonia (n=25). Results: Dystonia was highly prevalent at enrollment (61%) and most common in the foot (78%). PD patients with dystonia display greater subthalamic theta and alpha power during movement (p < 0.05) but not at rest. Regardless of dystonia status, cortical recordings display prominent beta desynchronization (13-30 Hz) during movement, whereas STN signals show increases in spectral power at lower frequencies (4-20 Hz), with peaks at 6.0 +/- 3.3 and 4.2 +/- 2.9 Hz during hand and foot movements, respectively (p < 0.03). Conclusions: Whereas cortex was characterized by beta desynchronization during hand and foot movements similarly, STN showed limb-specific low frequency activity which was increased in PD patients with dystonia. These findings may help elucidate why PD-related dystonia is most common in the foot and help guide future closed-loop DBS devices.

A Multiscale, Systems-Level, Neuropharmacological Model of Cortico-Basal Ganglia System for Arm Reaching Under Normal, Parkinsonian, and Levodopa Medication Conditions

In order to understand the link between substantia nigra pars compacta (SNc) cell loss and Parkinson's disease (PD) symptoms, we developed a multiscale computational model that can replicate the symptoms at the behavioural level by incorporating the key cellular and molecular mechanisms underlying PD pathology. There is a modelling tradition that links dopamine to reward and uses reinforcement learning (RL) concepts to model the basal ganglia. In our model, we replace the abstract representations of reward with the realistic variable of extracellular DA released by a network of SNc cells and incorporate it in the RL-based behavioural model, which simulates the arm reaching task. Our results successfully replicated the impact of SNc cell loss and levodopa (L-DOPA) medication on reaching performance. It also shows the side effects of medication, such as wearing off and peak dosage dyskinesias. The model demonstrates how differential dopaminergic axonal degeneration in basal ganglia results in various cardinal symptoms of PD. It was able to predict the optimum L-DOPA medication dosage for varying degrees of cell loss. The proposed model has a potential clinical application where drug dosage can be optimised as per patient characteristics.

EFFECT OF KUNJAL KRIYA AND AGASTYA HARITKI RASAYANA IN TAMAKA SHWASA W.S.R BRONCHIAL ASTHMA: A CASE STUDY

Tamaka Shwasa (Bronchial asthma) is one of the stressful medical conditions of today's era and is well known for its episodic and chronic course which affects the whole human race. Tamaka shwasa is a disease in which the pa- tient experiences severe symptoms of respiratory distress with extreme weakness, fatigue and mental glooming. Tamaka Shwasa can be correlated with the disease Bronchial Asthma based on its features & etiopathogenesis. Here the sincere effort has been made using Kunjal kriya a shodhana chikitsa and Agastya Haritaki as Rasayana. Rasayana plays an important role in the rejuvenation of body tissues and providing strength to patients. A male patient of Age 40 years with a history of Tamaka shwasa from last 5 years. The Patient has all classical symptoms like Shwasakashtata, Kasa, Kaphashteevan, Aruchi, Parshvashula, Asino Labhate Saukhyam, Ghurghuraka comes at O.P.D of Govt. Ayurvedic Hospital Model Gram Ludhiana, On Auscultation of chest wheezing present bilater- ally in lungs. The patient was using short-acting Bronchodilator puffs almost 3-4 puffs in a day. So, this case of Tamaka shwasa is treated with Kunjal Kriya a Yogic Shodhana Karma once a week followed by Rasayana for four weeks. All this was done after examination of Bala of the Patient. In this case, it was observed patient got good relief in all cardinal symptoms of Tamaka shwasa. Keywords: Rasayana, Kunjal Kriya, Tamaka Shwasa

PHARMACEUTICO-ANALYTICAL STUDY OF MALATYADI TAILA

Analytical study of Ayurvedic preparations is the need of the present scientific era. Though the Ayurvedic drugs are time tested and have been used successfully in the management of various ailments it is now necessary to prove their quality, efficacy and safety to the scientific world through various modern analytical parameters. The Sneha Kalpa is par excellent to other dosage forms due to their wider advantages like increased absorption and extraction of fat-soluble active principles Sneha Kalpa is the only dosage form that can be administered conveniently both internally as well as externally. Malatyadi Taila is an important herbal formulation mentioned in Chakradutta for the management of the disease Darunaka. Dandruff is an irritative disease of the scalp in which shedding of dead tissue from the scalp with itching sensation is the cardinal feature. It can be correlated to Darunaka the cardinal symptoms of the disease Darunaka are Kandu (itching), Kesha Chyuti (falling of hair), Swapa (abnormalities of touch sensation), Rukshata (roughness or dryness of the skin) and Twak Sputana (breaking or cracking of the skin). Chakradutta has mentioned the application of Malatyadi Taila in the treatment of Darunaka. An attempt has been made in the present study to prepare Malatyadi Taila and standardise it through analytical parameters like organoleptic properties, refractive index, acid value, saponification value, iodine value, loss on drying for developing standards. All the parameters were found to be good and within the standards. Keywords: analytical standardization, Malatyadi Taila, saponification value, HPTLC.

“A STUDY OF CORRELATION BETWEEN CLINICAL FEATURES, RADIOLOGICAL FINDINGS AND SPIROMETRY PARAMETERS IN PATIENTS OF BRONCHIECTASIS”

INTRODUCTION: Bronchiectasis is dened as an irreversible dilation and destruction of one or more bronchi with a reduction in clearance of secretions and in the expiratory airow. Etiologies include prior lung infection, systemic inammatory disorders, and genetic disorders of host defense. METHODOLOGY: This is an Observational study of 160 patients patient who were diagnosed with Bronchiectasis in tertiary health care centre over a period of 15 months. Data was collected and analyzed for correlation between clinical features, radiological ndings and spirometry parameters. RESULT: Mean age of presentation was 21-30 years. Most important etiology was post-infections, pulmonary tuberculosis followed by pneumonia. The cardinal symptoms of bronchiectasis were productive cough followed by dyspnoea on exertion. The most common bacteria isolated from sputum culture was Haemophilus Inuenzae. The commonest radiological pattern of bronchiectasis was cylindrical followed by cystic and varicose. Most of the patients had obstructive pattern in spirometry tests. CONCLUSION: Radiological ndings and spirometry test are more valuable for early and accurate diagnosis of bronchiectasis which help in early and prompt management. Cases of bronchiectasis have repeated history of admissions in the hospital thus all options of treatment including surgical intervention must be taken into consideration for good quality life and healthy.

The impact of the COVID-19 pandemic on child health

Most Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections in children are mild or asymptomatic. Severe Coronavirus Disease 2019 (COVID-19) in children is infrequent. An estimated 0.3–1.3% of children with SARS-CoV-2 infection were admitted to hospital, and of these 13–23% needed critical care. SARS-CoV-2 related deaths were very rare in children, estimated at 2 per million. The vast majority of admitted children had one of shortness of breath, fever, and cough, but atypical symptoms are more common in children. Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) have been linked to SARS-CoV-2 infection. Cardinal symptoms include prolonged fever, clinical signs of inflammation, gastro-intestinal symptoms, and cardiac dysfunction. Twenty two to 80% of patients with MIS-C needed critical care; mortality of MIS-C is around 2%. Six to 24% of children with MIS-C had coronary artery dilatation or cardiac aneurysms. Equipoise still exists between first-line treatment with immunoglobulins and steroids. Outcomes for children with MIS-C are generally very good in those recognised early and started on appropriate treatment. Vaccination schemes for children are rapidly expanding, with the benefits of preventing severe COVID-19 disease and MIS-C and reducing community transmission outweighing the risks of adverse events of, amongst others, myocarditis temporally related to COVID-19 vaccination in children and young adults. The imposed social distancing measures reduced the overall number of children with acute illness or injury presenting to urgent and emergency care facilities worldwide. No clear signal was seen that large numbers of children had a delayed presentation to emergency care departments with a serious illness. The social distancing measures negatively impacted the mental health of children.

The The role of Sarvang sundar rasa Orally and Mahamash tail locally in the management of Amavata WSR to Rheumatoid Arthritis –A case study.

Amavata is term derives from the word as Ama and vata.Ama is a type of metabolic toxin; it is an essential factor in development of pathology.Mandagni (low digestive fire) produce Ama in the body,when ama get associated with vitiated vata and starts circulating in the body accupies in shleshmal sthana(asthi sandhi) results in painful disease Amavata. Madhavakara (900 AD) has identified first time the disease.Amavata as seprate entity and discribed the disease in detail.Madhavakara describes etiopathology of amavata that the person with weak digestion (Mandagni) if he is posseses a secondary life (nishchalasya)or if he indulges into virrudha aaharaand vihara e.g.excessive exercise after taking heavy and fatty food,ama is produced and vata get vitiated. This ama provoks by vata (Vayuna preritah),Circulates in the body especially towards shleshmal sthanas. the resultant of cardinal symptoms of amvata are painful swelling of the joints (sarujashotham ) of hands,feet,ankle,knee,hip,Spinal column,and stiffness(jadyata),fever( Jwara),loss of appetite (aruchi),indigestion (apaka),Constipation(vibandhata),gurguling(antrakujanam)etc. this impairs the day to day functions of person.in spite of presence of NSAID,DMRD,steroids etc. the rheumatology remains refractory to treatment but Ayurvedic drug which are therapeutically safe and effectiveness.

Comparative study on efficacy of SNOT 22 outcome in nasal surgery using teflon splinting for chronic rhinosinusitis

<p><strong>Background:</strong> CRS is defined as inflammation in the nose and paranasal sinus and it is characterized by two or more cardinal symptoms. There is a growing need for a simple, reliable, system-specific standardized outcome measure that can help us explore CRS in a more uniform way and help us to take into account patients’ HRQoL. SNOT covers a broad range of health and health-related quality of life problems including physical problems, functional limitations, and emotional consequences.</p><p><strong>Methods:</strong> we report a case series of 60 patients, divided into 2 groups of 30 each. 1^st group underwent FESS+septoturbinoplasty while the 2^nd group underwent FESS+septoturbinoplasty with teflon splinting. Patients were asked to score their symptoms on SNOT 22 questionnaire pre-operatively and post-operatively.</p><p><strong>Results:</strong> Significant changes were noted in nasal related and quality of life domain and less significant changes noted in ear/facial related and psychological domains in group 2.</p><p><strong>Conclusions:</strong> patient-based outcome measures like SNOT 22, is helpful tool for quantifying changes in symptoms and useful for predicting post-operative improvement. It is both patient and researcher-friendly.</p>

Acceptability of and symptom findings from an online symptom check-in tool for COVID-19 outpatient follow-up among a predominantly healthcare worker population

IntroductionHealth systems worldwide have had to prepare for a surge in volume in both the outpatient and inpatient settings since the emergence of COVID-19. Early international healthcare experiences showed approximately 80% of patients with COVID-19 had mild disease and therfore could be managed as outpatients. However, SARS-CoV-2 can cause a biphasic illness with those affected experiencing a clinical deterioration usually seen after day 4 of illness.ObjectiveWe created an online tool with the primary objective of allowing for virtual disease triage among the increasing number of outpatients diagnosed with COVID-19 at our hospital. Secondary aims included COVID-19 education and the promotion of official COVID-19 information among these outpatients, and analysis of reported symptomatology.MethodsOutpatients with acute COVID-19 disease received text messages from the hospital containing a link to an online symptom check-in tool which they were invited to complete.Results296 unique participants (72%) from 413 contacted by text completed the online check-in tool at least once, generating 831 responses from 1324 texts sent. 83% of text recipients and 91% of unique participants were healthcare workers. 7% of responses to the tool were from participants who admitted to a slight worsening of their symptoms during follow-up. Fatigue was the most commonly reported symptom overall (79%), followed by headache (72%). Fatigue, headache and myalgia were the most frequently reported symptoms in the first 3 days of illness. 8% of responses generated in the first 7 days of illness did not report any of the cardinal symptoms (fever, cough, dyspnoea, taste/smell disturbance) of COVID-19. Participants found the tool to be useful and easy to use, describing it as ‘helpful’ and ‘reassuring’ in a follow-up feedback survey (n=140). 93% said they would use such a tool in the future. 39% reported ongoing fatigue, 16% reported ongoing smell disturbance and 14% reported ongoing dyspnoea after 6 months.ConclusionThe online symptom check-in tool was found to be acceptable to participants and saw high levels of engagement and satisfaction. Symptomatology findings highlight the variety and persistence of symptoms experienced by those with confirmed COVID-19 disease