Burning Sensation Research Articles

Understanding Diabetic Peripheral Neuropathy in Ayurvedic perspective

Diabetes mellitus is rising to an alarming epidemic level especially in India and more than the Diabetes itself the complications caused by the long-term suffering of Diabetes are creating a great havoc. Diabetic peripheral neuropathy is one among the complications of Diabetes that accounts for more hospitalizations than all other diabetic complications combined. It is a nerve damaging disorder and is a result of diabetic microvascular injury involving small blood vessels that supply to nerves. Prameha is a disease described in the ancient ayurvedic scriptures, mostly correlated with Diabetes mellitus. Its inclusion in the astamahagadas by the three bruhattrayeekaras itself reflects its significance. May be the disease was considered important because of its incurability and the different upadravas (complications) caused by the long-term suffering from Prameha like daha (burning sensation), dourbalya (weakness), sula (pricking pain), suptata (numbness) etc. The symptoms of DPN can be found mentioned under the headings of upadrava as well as poorva rupa of Prameha. The main aim of this article is to review the concept of Diabetic peripheral neuropathy and to understand it in ayurvedic aspect.

Evaluation of patients presenting with headache to the emergency outpatient clinic

Aims: This study aimed to explore the factors contributing to headache presentation in patients by recognizing headache as a symptom of various potential ailments. It is crucial to understand these factors for appropriate assessment and treatment planning in patients with headaches. Additionally, this study investigated patients' preferences for headache management, which is an understudied aspect in the field. Methods: In 2012, a two-month study was conducted at an emergency department outpatient clinic to assess the general characteristics, severity, frequency, duration, and location of headache episodes among patients presenting with headache complaints. The study analyzed various parameters, including the different types of pain, such as throbbing, stabbing, and burning, as well as the impact of headaches on daily performance, medication use, specific medications taken, and alternative treatment methods via a headache questionnaire. Results: The survey results revealed that 21.7% of the patients described their pain as extremely severe, 52.2% as severe, and 26.1% as distressing. Pain descriptions were predominantly throbbing (79.4%) and pain (62.2%), with sensations of pressure (20%), stabbing (18.3%), pulsating (13.3%), burning (10.6%), and constriction-like a band (2.8%). The localization of pain was bilateral in 15.0% of patients, unilateral in 18.3%, around or behind the eyes in 28.3%, and in the neck or back of the head in 38.3%. Headaches were found to affect the work life of 40.6% of patients, 20% reported no impact, and 39.4% experienced occasional interference. No significant statistical difference was observed regarding the intensity, frequency, and duration of pain, and its impact on work life with respect to sex. The usage of non-prescription medication was high (92.8 %), whereas prescription medication usage was 57.8%. Regarding alternative treatment methods, massage therapy was used by 53.6% of the patients and herbal treatments by 17.8%. Conclusion: This study examined the frequency and handling of headaches among patients visiting an emergency department. The results indicate that headaches affect both sexes equally, with a marginal prevalence in females. To provide better care, addressing patients’ preferences and experiences is important. As patients rely on non-prescription medications and alternative therapies, concerns regarding healthcare accessibility arise. A combination of medication management, patient education, and non-pharmacological therapies is necessary to achieve better outcomes and decrease the burden on healthcare systems.

Rebamipide gargle and benzydamine gargle in prevention and management of chemo-radiotherapy and radiotherapy-induced oral mucositis in head and neck cancer patients (randomized clinical trial)

ObjectivesThis study aimed to evaluate the preventive and therapeutic effects of rebamipide gargle in comparison with benzydamine in head and neck cancer patients undergoing radiotherapy with or without chemotherapy.Materials and methodsPhase III randomized clinical trial was conducted from January 2021 till August 2022 on one hundred patients with head and neck cancer receiving high doses of radiotherapy. These patients were equally allocated into either rebamipide group or benzydamine group, The measured outcomes were the incidence of oral mucositis ≥ grade1, according to the WHO mucositis scale, in addition to the duration, and the onset of oral mucositis.ResultsThere was no statistically significant difference between the two groups, regarding the incidence of a severe grade of oral mucositis (WHO grades 3), as well as the onset and duration of oral mucositis. Both gargles succeeded to prevent the development of WHO grade 4 oral mucositis. Side effects reported were mainly burning sensation in benzydamine group and nausea in rebamipide group.ConclusionRebamipide mouthwash was as beneficial as benzydamine mouthwash in minimizing the incidence of severe oral mucositis induced by treatment of head and neck cancer. However, rebamipide gargle proved to be superior to benzydamine in terms of reduction in the severity of the radiation-induced oral mucositis.Trial registrationThe trial was registered in the protocol Registration and Result system of Clinical Trials (Registration ID: NCT04685395)0.28-12-2020.

MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE THROUGH AYURVEDA: A CASE STUDY

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal ailment. Its symptoms include heartburn and regurgitation, epigastric pain, dysphagia, belching, nausea, bloating, etc.General line of treatment includes antacids, histamine-receptor antagonists (H2RAs), and proton-pump inhibitors (PPIs). If medication treatment fails, patients may require surgical intervention, such as anti-reflux surgery, with varying outcomes for long-term care. This condition can be co-related with Amlapitta described in Ayurveda text. In present case study a 48-year-old patient having chief complaints as acid eructation, burning sensation in the chest (retrosternal burning), episodes of pain in the chest and nauseawere clinically diagnosed as case of amlapitta(corelated with GERD). The patient was treated with specific regimen - Tab Pittashamak, Tab Gulkacid, Tab Vruddhihar and mahatiktaghrita in prescribed dose. Therapeutic evaluation of treatment was done based on improvement in sign & symptoms. Patient was cured completely with no reoccurrence of symptomseven after 3 months. A chronic case of GERD was successfully treated with ayurvedic medicine along with diet and lifestyle modification.

Do milk proteins relieve capsaicin‐induced burning sensation in the oral cavity?

AbstractMilk has a soothing effect on the capsaicin‐induced burning sensation in the mouth. This double‐blinded, placebo‐controlled, cross‐over study aimed to investigate if milk proteins could relieve the capsaicin‐induced burning sensation. During each session, the tongue of each participant was exposed to capsaicin twice for 8 min in total. Subsequently, the participants rinsed the mouth with one of three solutions: 5% casein, 5% whey protein, or water. The participants rated the perceived unpleasantness and burning sensation during capsaicin exposure and after rinsing on numerical rating scales. Thermographic imaging and semi‐quantitative sensory testing were performed at baseline, after capsaicin exposure, and after rinsing. No significant differences were observed between sessions in any of the measured parameters (p ≥ .053). Scores for unpleasantness and burning sensation varied over time (p ≤ .006). Heat and mechanical sensitivity changed over time (p < .001). In conclusion, rinsing with milk protein solutions did not have any robust effect in this study design.Practical ApplicationsIt has been suggested that milk proteins could be responsible for the soothing effect milk has on the capsaicin‐induced burning sensation in the mouth. The present results indicate that milk proteins are not solely responsible for this effect. Shedding light on the effects milk and its constituents have on the oral mucosa during a state of burning sensation or pain is of importance. This can help determining if specific constituents of milk could be used to relieve meal‐related burning sensations as well as illness‐related acute or chronic pain in the oral mucosa.

Efficacy and safety of topical capsaicin in the treatment of osteoarthritis pain: A systematic review and meta-analysis.

Osteoarthritis (OA) affects hundreds of millions of people worldwide. The objective was to critically appraise the efficacy and safety of topical capsaicin in reducing pain in OA. MEDLINE (PubMed) and Embase (Ebsco) were searched from inceptions until February 2023. The eligibility criteria included randomized controlled trials (RCTs), evaluating topical capsaicin in OA patients. Standard Cochrane methods were used to extract data and to appraise eligible studies. Eight double-blind RCTs involving 498 patients were included. Five trials (62.5%) were at an overall low risk of bias, and three (37.5%) were at a high risk of bias. Meta-analysis showed that, in various OA patients, compared with placebo, topical capsaicin (0.0125%-5%) may reduce pain severity measured with visual analog scale (standardized mean difference = -0.84, 95% confidence intervals [CIs] = -1.48 to -0.19, p = 0.01; eight studies). However, topical capsaicin may increase burning sensation at the application site (risk ratio = 5.56, 95% CI = 1.75-17.69, p = 0.004, numbers needed to harm = 3; five studies) when compared with placebo. Limitations include short study durations, small sample sizes, high heterogeneity, and overall low-to-very-low certainty of the evidence. Topical capsaicin may reduce OA pain at follow-ups of up to 3 months. Larger trials, potentially evaluating capsaicin in combination with phytopharmaceuticals having anti-inflammatory effects, with longer follow-ups might be needed to reduce the existing uncertainties. Topical capsaicin might be recommended for short-term management of pain in OA patients intolerant to nonsteroidal anti-inflammatory drugs.

A RANDOMIZED CONTROLLED TRIAL TO COMPARE THE EFFECT OF JATHYADI GHRITA WITH POVIDONE IODINE OINTMENT IN DUSHTAVRANA

Dushtavrana is a commonly encountered problem faced in surgical practice. The presence of Dushtavrana worsens the condition of the patient with different complications which may become fatal and life-threatening. Good wound healing with minimal scar formation and pain is the prime motto of every surgeon. Many formula-tions have been in use for centuries. One of these is a polyherbal drug, Jathyadi Ghrita. The present study com-pares the effect of Jathyadi Ghrita and Povidone Iodine ointment on relief in signs and symptoms of Dushtav-rana. Clinically diagnosed 34 Dushtavrana patients were divided into groups A and B. Group A (Trial group) managed with Jathyadi Ghrita. Group B (the control group) was managed using the Povidone Iodine ointment application. The study duration was 28 days in both groups, with 17 participants in each group. Assessment was done on 0th, 7th,14th ,21st and 28th day. The data obtained was statistically analysed and interpreted. The assess-ment was done on the 0th,7th,14th,21st and 28th day. The collected data were subjected to statistical analysis using appropriate statistical methods. Frequency and percentages were calculated for qualitative variables, while mean and SD were calculated for quantitative variables. Nonparametric methods were employed to analyse the data. The Wilcoxon signed-rank test was used to assess the significant effect before and after treatment within each group. The Mann Whitney U test was used to compare two groups based on before and after treatment values. P value less than 0.05 is statistically significant. All analyses were carried out with the help of the software SPSS 23.0. Statistically significant changes were noted in pain and itching sensation by management with Jathyadi Ghrita in Dushtavrana compared to Povidone Iodine ointment. Considering all observations, statistical analysis was done, and conclusions were drawn. The study results statistically reveal that Jathyadi Ghrita shows better results than Povidone Iodine ointment in managing pain, itching sensation, burning sensation, ulcer size, and discharge. Thus, the null hypothesis is rejected, and the alternate hypothesis is accepted.

A descriptive phenomenological study of critically ill elderly patients’ experiences of treatment using high-flow nasal cannula after extubation

PurposeThis study aims to describe the experiences of critically ill elderly patients (CIEPs) who were treated using the high-flow nasal cannula (HFNC) after extubation.Design/methodology/approachA descriptive phenomenological approach was conducted to interview eleven CIEPs using face-to-face semi-unstructured interviews. Participants were selected through purposive sampling. Data were analyzed using Giorgi’s method.FindingsExperiences of CIEPs included their fears of failure, getting comfortable and uncomfortable, as well as asking for assistance. Fears of failure were described as involving worsening symptoms related to their diseases and failure of HFNC leading to the need for reintubation. While receiving HFNC, their breathing was comfortable, and they were free from intubation. However, they were uncomfortable because of the sensation of burning in the nasal passages. Additionally, they asked for assistance from nurses in managing their symptoms, and the alarms of HFNC oxygen therapy devices resulted in fears of HFNC failure.Originality/valueThe paper indicates that CIEPs experienced physical and psychological impacts from HFNC oxygen therapy (e.g. burning sensation in the nose and fear of failure). Although they had comfortable breathing, being uncomfortable also occurred. Therefore, health-care professionals should support what CIEPs need and develop a program or guidelines for managing the complications of HFNC – neither burning noses nor psychological issues enhance the comfort of CIEPs – by considering age-related changes.

Relationship Between Clinical Course of Treatment for Burning Mouth Syndrome in Early Period and Aggression Using Rosenzweig Picture Frustration Study: A Retrospective Observational Study.

Burning mouth syndrome (BMS) is characterized by a chronic, ongoing sensation of intraoral burning or discomfort without causative lesions. This study sought to examine the relationship between personality traits in patients with BMS using the Rosenzweig Picture Frustration (PF) study, a projective psychological test, and their progress in treatment. Data were collected from outpatients diagnosed with BMS at our clinic between April 2017 and March 2021. The data were analyzed for 28 patients with BMS, of which nine showed improvement earlier than three months (early responders; ER), and the others did not (non-early responders; NER). The mean visual analog scale (VAS scores for BMS pain at the first visit were 52.8 in the ER and 59.6 in NER (n.s.). No significant differences were detected in the type and direction of aggression between ER and NER in the PF study. In contrast, the group conformity score of the ER (63.7%) was significantly higher than that of the NER (51.4%). Personal traits reflected in the PF study may have affected the course of improvement in the BMS. To understand the characteristics of patients with BMS and achieve more favorable treatment outcomes, further study on their personality organization is necessary.

The effect of antiresorptive therapy on the prevalence and severity of oral lichen planus: a retrospective study

BackgroundAntiresorptive therapy (AR) disrupts osseous homeostasis and can induce direct irritation over the gastrointestinal mucosa; however, its possible erosive effects on the oral epithelium have not been totally described. Among the most frequent oral erosive lesions, oral lichen planus (OLP) frequently presents as painful mucosal ulcerations, arising from basal membrane inflammatory damage. Thus, the aim of this retrospective study was to describe the association between AR and the incidence of OLP.MethodsThis case-control study included data from 148 patients (17 patients undergoing AR therapy (AR group) / 131 without AR therapy (Control group)). Each patient record was systematically processed and the association between AR drugs and OLP clinical characteristics within both groups was assessed.ResultsThe erosive form of OLP was significantly more frequent in the AR group than in the Control group (p = 0.029). Indeed, the AR treatment using alendronic acid (41.2%) was the most frequently reported. Additionally, the erosive form of OLP showed the strongest association with pain and burning sensation among the OLP types (p < 0.050). However, disease worsening and AR consumption were not significantly associated (p = 0.150).ConclusionsPatients under AR therapy show more clinical symptoms associated to the erosive type of OLP. Regardless of the AR therapy, the erosive type of OLP is associated with more severe symptoms.

Burning Mouth Syndrome Treated with Low-Level Laser and Clonazepam: A Randomized, Single-Blind Clinical Trial.

Burning mouth syndrome (BMS) is a chronic pain disorder characterized by intraoral burning or dysaesthetic sensation, with the absence of any identifiable lesions. Numerous treatments for BMS have been investigated, though without conclusive results. An analysis was conducted of the efficacy of treatment with a low-level diode laser and clonazepam in patients with BMS, and a study was carried out on the levels of different salivary biomarkers before and after treatment. A randomized, single-blind clinical trial was carried out involving 89 patients divided into the following groups: group 1 (laser, The Helbo® Theralite Laser 3D Pocket Probe + clonazepam) (n = 20), group 2 (sham laser placebo) (n = 19), group 3 (laser) (n = 21) and group 4 (clonazepam) (n = 18). Symptom intensity was scored based on a visual analogue scale (VAS). Sialometry was performed before and after treatment, and the Xerostomia Inventory, Oral Health Impact Profile-14 (OHIP-14) and Mini-Nutritional Assessment (MNA) questionnaires were administered. The following markers were measured in saliva samples: interleukins (IL2, IL4, IL5, IL6, IL7, IL8, IL1β, IL10, IL12, IL13, IL17, IL21 and IL23), proteins (MIP-3α, MIP-1α and MIP-1β), GM-CSF, interferon gamma (IFNγ), interferon-inducible T-cell alpha chemoattractant (ITAC), fractalkine and tumor necrosis factor α (TNFα). A significant decrease in the VAS scores was observed after treatment in group 1 (laser + clonazepam) (p = 0.029) and group 3 (laser) (p = 0.005). In turn, group 3 (laser) showed a decrease in the salivary concentration of fractalkine (p = 0.025); interleukins IL12 (p = 0.048), IL17 (p = 0.020), IL21 (p = 0.008), IL7 (p = 0.001) and IL8 (p = 0.007); proteins MIP1α (p = 0.048) and MIP1β (p = 0.047); and TNFα (p = 0.047) versus baseline. Following treatment, group 1 (laser + clonazepam) showed significant differences in IL21 (p = 0.045) and IL7 (p = 0.009) versus baseline, while group 4 (clonazepam) showed significant differences in IL13 (p = 0.036), IL2 (p = 0.020) and IL4 (p = 0.001). No significant differences were recorded in group 2 (sham laser placebo). The low-level diode laser is a good treatment option in BMS, resulting in a decrease in patient symptoms and in salivary biomarkers. However, standardization of the intervention protocols and laser intensity parameters is needed in order to draw more firm conclusions.

Pharmaceutical Preparation of Amrita Guggulu and its Clinical Efficacy on Vatarakta

This study scrabbles about into the pharmaceutical preparation of Amrita Guggulu, a traditional Ayurvedic formulation known for its therapeutic properties. The focus of the research is on assessing the clinical efficacy of Amrita Guggulu in managing Vatarakta, a condition characterized by vitiated Vata as well as Pitta and associated with inflammatory joint disorders. The pharmaceutical preparation involves meticulous formulation techniques, ensuring the quality and potency of the final product. Standardization parameters include the selection of authentic raw materials, adherence to traditional preparation methods and quality control measures. Clinical Trial Design: The clinical trial was designed as a randomized, double-blind study to assess the efficacy of Amrita Guggulu in patients diagnosed with Vatarakta. Participants were randomly assigned to either the treatment group receiving Amrita Guggulu group A or group B. A comprehensive clinical trial was conducted to evaluate the efficacy of Amrita Guggulu in patients diagnosed with Vatarakta. Key parameters such as joint pain, inflammation in joint, tenderness, burning sensation in affected area, skin rashes and tingling sensation were selected for the study. Overall improvement was assessed using standardized tools and patient-reported outcomes. Result: Preliminary findings indicate promising results, suggesting that Amrita Guggulu may play a significant role in alleviating symptoms associated with Vatarakta. The observed effects include a reduction in joint pain, improved joint function, and decreased inflammatory markers. Conclusion: This research contributes valuable insights into the pharmaceutical preparation of Amrita Guggulu and highlights its potential as an effective intervention for Vatarakta. On the basis of this clinical trial, we can say that S. Uric acid is not the confirmatory parameter for the decision of Vatarakta (gout). Further studies and long-term observations are recommended to solidify these findings and establish Amrita Guggulu as a viable therapeutic option in managing inflammatory joint disorders.

Peculiar Pattern of Irritant Contact Dermatitis to Semecarpus anacardium

Abstract Semecarpus anacardium (Family: Anacardiaceae), is a frequently used medicinal plant in alternative medicine. There has been few case reports suggesting the role of marking nut extract in allergic contact dermatitis. Case one presented with vesicles coalescing to form bullae with surrounding necrotic epidermis accompanied by itching and burning sensation over nape of neck. He developed recurrent urticarial episodes post treatment. Case two reported similar lesions over beard region after 2 weeks of our index case in addition to diffuse erythematous maculopapular pruritic rash over upper chest, face and anterior shoulder. Case three, four and five reported with similar kind of lesions over various body parts. Case six presented with targetoid lesion with central bullae over upper torso. Case seven reported with bizarre lesions like splattering of chemical which were morphologically similar as the other cases, over left popliteal fossa and calf area. Our cases were from the same geographic area and were in the same profession. On evaluation of the pattern and morphology of lesions and careful investigation, it was concluded that it was an irritant reaction to Semicarpus nut extract which was supported by histopathology findings. On further probing, it was observed that the individuals inflicted the injury in order to avoid some strenuous work. All were evaluated and none of them were found to be suffering from any psychiatric ailment. We reported this case series because of unique morphological presentation which has not yet been reported in the literature to the best of our knowledge.

Role of Ayurveda medicine in the management of Amashaya Arbhuda w.s.r. to Carcinoma of Stomach

Due to faulty lifestyle, altered food habits and chronic psychological stress and mental depression, the incidence of Malignancy has been raised. Carcinoma of stomach is one such disorder which is commonly seen in Indian population. Symptoms like pain abdomen, burning sensation of the stomach, malena, weight loss, loss of appetite and anaemia are the common clinical features of this disease. Ayurveda medicine is beneficial in the cases with early diagnosis. After radical excision of the active lesion, palliative treatment can be given by using Ayurveda medicine. In Ayurveda, Vyadhi Pratyanika Aushadhi Prayoga, Yogasana and Pranayama, Assurance, changes in food and life style and Pathapathya Prayoga are advised. Medicines having actions like Anticancer, cytotoxic, Shoolahara, Antacid, antispasmodics, antidepressant, anxiolytic, antistress, adaptogenic, CNS depressant, Balya, Brimhala, Ojaskara, immunomodulator and cytoprotective actions are used as palliative measures. In this paper, the role of Ayurveda medicines in the management of Amashaya Arbhuda w.s.r. to carcinoma of stomach is discussed elaborately.

Electromyography Analysis of the Masseter Muscle's Activity in the Management of Oral Submucous Fibrosis.

Introduction Oral submucous fibrosis (OSMF) is a persistent, collagen metabolic disorder distinguished by the presence of fibrosis of the connective tissue stroma in the oral mucosa with a higher malignant potential rate for oral cancer. This study aimed to analyze the utility of electromyography (EMG) as the prognostic assessment tool in the management of OSMF with conventional intralesional corticosteroid therapy. Materials and methods This study included 20 OSMF cases of age range 20 to 80 years without systemic comorbidities to assess pre-treatment and post-treatment changes with intralesional corticosteroid therapy as an intervention and to determine if it could be assessed using electromyographic study. Clinical and histopathological grading of OSMF was done. The five clinical parameters were evaluated for measuring treatment prognosis. Among them, mouth opening, tongue protrusion, and burning sensation assessments were quantitative parameters, and palpable fibrotic bands and mucosa colour were qualitative parameters. As OSMF involves changes in muscle plane in moderately advanced and advanced cases, EMG was used as an assessment tool for measuring muscle activity. Among the muscles of mastication, the masseterand temporalis were selected for evaluation. Twenty age and gender-matched healthy controls were required for this study as there are no standardized normal values for amplitude and onset of activity in muscle analysis. The EMG activity of the right and left temporalis and masseter muscles were recorded using surface electrodes and were correlated with five clinical assessment parameters. Results In the right masseter, the rest amplitude of 1.6010 µV of the OSMFwas statistically significant (p-value: 0.050) when compared with 4.1275 µV of the control. The clench amplitude of 133.370 µV of the OSMFwas statistically significant (p-value: 0.062) when compared with 94.310 µV of the control. In the left masseter, the rest amplitude of 1.6695 µV of the OSMFwas statistically significant (p-value 0.066) when compared with 2.5735 µV of the control. In the left masseter, the onset of muscle action of 62.670 ms of the OSMFwas statistically significant (p-value: 0.017) when compared with 131.835 ms of the control. The clench amplitude differences in the right masseter of 133.370 µV pre-treatment, and 102.775 µV post-treatment were statistically significant (p-value: 0.007). The clench amplitude in the left masseter of 102.535 µV pre-treatment, and 92.090 µV post-treatment were statistically significant (p-value: 0.036). The correlation was seen between tongue protrusion and rest amplitude in the right masseter in OSMF (r = 0.376, p-value: 0.023). Conclusion There was a correlation between tongue protrusion and rest amplitude in the right masseter muscle in OSMF patients before treatment. In the right and left masseter, during rest, the amplitude of the OSMF group was lesser than that of the control group. During clench, in the right masseter, the amplitude of the OSMF group was higher than that of the control group. During clench in the left masseter, the onset of muscle action was lesser in the OSMF group than in the control group. After treatment, there was a reduction in clench amplitude in OSMF patients from their pretreatment values signifying muscle relaxation and a better onset of muscle action.

Examination of Ulcero-Proliferative Lesions of Oropharynx and Oral Cavity- A Clinical Perspective

 Introduction Patients often present with ulcero-proliferative lesions of the oropharynx and oral cavity in the outpatient department (OPD). These lesions have a negative impact on the patients' health, so it's critical to make an accurate diagnosis and administer the right care.  Aim of the Study: To determine the proportion of patients who exhibit different ulcero-proliferative lesions clinical characteristics in the oropharynx and oral cavity.  Patients and Methodology: This is prospective study done at Department of ENT, Guntur Medical College, spanning a period of 18 months. This study included patients with ulcero- membranous lesions in the oropharynx and oral cavity, regardless of age. This study excluded Patients who had radiation therapy soon before developing the illness and who had traumatic injuries but no infection. Detailed history including personal, family and medical history were noted. Local and general examination was done. Selected patients were subjected to investigations like routine blood investigations, gram stain, albert’s stain, KOH mount, culture and sensitivity, peripheral smear, serology, FNAC, HPE, USG, chest x ray, CT neck, MRI.  Results In the current study, men dominated women (65.69%) and the most prevalent age group participating was 41–60 years old (45.09%). The most typical symptoms of the throat were odynophagia, burning sensation, dysphagia, and throat pain. 5.9% of the patients had nose issues and 14.7% had associated ear complaints. General symptoms included fever in 10.7% of cases, weight loss in 23.5%, general weakness in 15.6% of cases, and skin lesions in 6.9% of cases. Systemic disorders such as HIV was present in 3.9%, hypertension in 25.4%, and diabetes in 34.3% of cases. Risk factors include chewing tobacco (17.6%), drinking alcohol (14.7%), smoking (43.1%), and having previously been exposed to radiation (0.9%). The tongue was the most frequently afflicted site in this study (44.1%), followed by the palate (29.4%), the buccal mucosa (15.6%), the tonsils (8.8%), the lips (7.8%), the alveolus (2.9%), and the RMT (1.9%). Neoplastic etiology accounted for 41.1% of the total etiology discovered. It was followed by inflammatory (31.3%), infectious (20.5%), and miscellaneous (6.8%) etiologies. 52.9% of patients had conservative care, 36.2% had oncosurgery team treatment through surgery, and 10.7% had radiation therapy. Of the patients with neoplastic etiology, 10.7% had radiation therapy.  Conclusion: The incidence of cancers rises in the adult population with increased habits like smoking and chewing nicotine in any form. A high degree of suspicion is required when treating oral ulcers, particularly those that are chronic. The gold standard for confirming the diagnosis is always a biopsy and a histopathological examination.

Management of Ahiputana (Diaper Rash) though Triphala Khadir Yog (TKY) Avachoornan

Ayurveda is an ancient medical system that addresses both the state of Swasthya, or optimal human health, and a broad range of illnesses and associated therapies. One of the most frequent issues in pediatric OPD is diaper rash. According to Ashang Hridaya, Maloplep (contained faeces) and Sweda (sweat/perspiration) both causes Kandu (irritability), Daha (burning sensation) and Tamra Varna (redness), Strava (discharge), Vrana (wound formation around the perianal region), Pidika (papulovesicular lesion) around the Guda area (napkin area). In Ahiputana there is Pitta, Kapha and Rakta Dosha Prakop (increase). In present case report, a 11-month-old female baby patient presented in Balrog OPD 13 of Sane Guruji Rugnalaya, Hadapsar, Pune, with complaints of loose motion episodes, itching and redness associated with discharge and burning sensation for 3 days and was treated with external application of Triphala Khadir Yoga. After complete treatment of 10 days, there was complete remission in the symptoms and there is no recurrence till date. From the current case report, it can be inferred that Ahiputana (diaper rash) can be successfully treated with the appropriate Ayurveda medications.

How side effects can improve treatment efficacy: a randomized trial.

While treatment side effects may adversely impact patients, they could also potentially function as indicators for effective treatment. In this study, we investigated whether and how side effects can trigger positive treatment expectations and enhance treatment outcomes. In this pre-registered trial (DRKS00026648), 77 healthy participants were made to believe that they will receive fentanyl nasal sprays before receiving thermal pain in a controlled experimental setting. However, nasal sprays did not contain fentanyl, rather they either contained capsaicin to induce a side effect (mild burning sensation) or saline (inert). After the first session, participants were randomized to two groups and underwent functional MRI. One group continued to believe that the nasal sprays could contain fentanyl while the other group was explicitly informed that no fentanyl was included. This allowed for the independent manipulation of the side effects and the expectation of pain relief. Our results revealed that nasal sprays with a side effect lead to lower pain than inert nasal sprays without side effects. The influence of side effects on pain was dependent on individual beliefs about how side effects are related to treatment outcome, as well as on expectations about received treatment. Functional MRI data indicated an involvement of the descending pain modulatory system including the anterior cingulate cortex and the periaqueductal gray during pain after experiencing a nasal spray with side effects. In summary, our data show that mild side effects can serve as a signal for effective treatment thereby influencing treatment expectations and outcomes, which is mediated by the descending pain modulatory system. Using these mechanisms in clinical practice could provide an efficient way to optimize treatment outcome. In addition, our results indicate an important confound in clinical trials, where a treatment (with potential side effects) is compared to placebo.

Repeated Thoracic Paravertebral Blocking to Alleviate Pain Symptoms in 66-years-old Man with Post-herpetic Neuralgia: A Case Report

Introduction Post-herpetic Neuralgia (PHN) is a neuropathic pain syndrome resulting from the sequelae of Herpes Zoster (HZ). Case Report Therefore, this study aimed to report a case of a 66-year-old male who presented with chronic pain characterized by a burning sensation in the right chest region, specifically at the areola level. The patient had been experiencing these symptoms for a year, which progressed to the severe stage over the past few months. To mitigate pain, a Thoracic Paravertebral Block (TPVB) procedure was proposed and conducted 3 times, with a solution containing levobupivacaine 0.25% and dexamethasone 10 mg in 5 ml. Conclusion The procedure was replicated three times. After two weeks, the pain had almost subsided, showing less need for further analgesia.

Abstract PO4-17-12: Early adherence to adjuvant abemaciclib: Data from the Belgian Medical Need Program

Abstract Patient adherence profiles for adjuvant hormonal therapy combined with abemaciclib in HR+/HER2- High Risk EBC based on real world evidence (RWE) from a Medical Need Program in Belgium Background Following results of MonarchE, demonstrating clinically meaningful improvement in invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS), a 2-year treatment with abemaciclib has been reimbursed in Belgium since May 1st, 2023 for the adjuvant treatment of HR+, HER2–, lymph node-positive (&amp;gt;3 or 1-3 if pT3 or grade 3) early breast cancer (EBC). In this trial, adverse event related treatment discontinuation was reported in 18,5% (8.9% after dose reduction) of which 10.1% in the first 5 months after starting this CDK 4/6 inhibitor. Prior to reimbursement, an early access program was initiated in Belgium on June 28 2022. We studied the proportion of patients estimated to be eligible for the program nationwide who effectively started adjuvant abemaciclib, as well as early treatment discontinuation and dose reductions. Methods The number of eligible patients for the adjuvant abemaciclib Medical Need Program (MNP) was estimated by the Belgian Cancer Registry based on the above mentioned reimbursement criteria for patients registered during the incidence year 2018. The MNP was active in Belgium from June 28 2022 until May 1 2023. Discontinuation rate and proportion with dose reductions were calculated using a nationwide prospective managed monthly updated register of participating patients including information on age at diagnosis, time since therapy start, delivered doses and patient reported adverse events (AE). They all signed an informed consent and agreed to share their registered data after anonymization. Data analysis was retrospective. Descriptive statistics were used. Results In this 10-month period, 840 patients were estimated to be eligible to receive adjuvant abemaciclib in Belgium. A total of 311 patients (309 women, 2 men) were included in the program, 37% of the estimated number of patients. Median age at initiation was 57 y. Median time on treatment was 4.5 months (156 patients &amp;gt;4.5 months on treatment). 21/311 (6.7%) patients discontinued (all causes). 2 patients never started. 10 patients (3.2%) discontinued their therapy without dose reduction. 12/311 (3.8%) had a starting dose of 2 × 100 mg/d. 128/311 (41.1%) had a dose reduction, 96/128 (75%) before 3 months of therapy. In the subgroup of 156 patients starting treatment &amp;gt;4.5 months ago, 16/156 (10.2%) discontinued treatment, 13 patients have not yet been reported. 79/156 (50.6%) required a dose reduction, of which 7 (4.5%) discontinued after dose reduction. The reasons for discontinuation reported: 8/21 (38%) gastro-intestinal intolerance, 3/21 (14.2%) real deterioration in renal function, 8/21 quality of life issues (not specified), 1/21 anal burning sensation and anal fistula, 3/21 asthenia and fatigue. Conclusion Of the estimated eligible patients in Belgium 37 % started with adjuvant abemaciclib. These results illustrate that there is a need to further improve implementation of adjuvant abemaciclib. Early results show that 89.8% of patients receiving adjuvant abemaciclib therapy in Belgium continued their treatment after 4.5 months and 50% of patients needed a dose reduction. Longer follow-up will be needed. Understanding the reasons of discontinuation and early dose adjustments can enable better patient support on adherence. This is a critical capability to ensure optimal patient compliance. Citation Format: Maxime Van Houdt, Marc Michaux, Sevilay Altintas, Ahmad Awada, Jean-Luc Canon, Hannelore Denys, François Duhoux, Guy Jerusalem, Jeroen Mebis, Rosanne Janssens, Isabelle Huys, Barbier Liese, Charlotte Verbeke, Sileny Han, Hans Wildiers, Patrick Neven. Early adherence to adjuvant abemaciclib: Data from the Belgian Medical Need Program [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-17-12.