Main Clinical Finding Research Articles

EFFICACY OF PHALAGHRITA UTTARABASTI IN THE MANAGEMENT Of VANDHYATWA WITH SPECIAL REFERENCE TO TUBAL BLOCKAGE- A CASE STUDY

Introduction: Vandhyatwa has been mentioned by various Acharyas in Ayurvedic classics using multiple terms. Acharya Charak explained factors responsible for Vandhyatwa (infertility), such as yoni dosha (gynaecological disorders), Mansika-Abhitapa (mental stress), Shukra-Artavadosha (disorders of sperm and ovum), Ahara-Vihara Dosha (food- and lifestyle-related disorders), Akalyoga (inappropriate timing), Bala-Kshaya (decreased strength). Two major factors which are associated with fertility problems are anovulation and defects in tubal patency. In the present article, there is a case study of ayurvedic management of infertility due to bilateral tubal blockage. Main Clinical Finding: A 29-year-old female patient reached the hospital complaining of a wants issue for five years. Diagnosis: Her hysterosalpingiography findings showed a bilateral fallopian tubal block. Interventions: 3 consecutive cycles of Uttarabasti were given with Phalaghrita for 3months along with oral medications (Tab. Shebless forte, Phalaghrita) and Anu taila nasya application. Outcome: The patient missed her period after four months of treatment, and the urine pregnancy test was found to be positive. Conclusions: Tubal patency (Kshetra) is an essential factor for conception.

Revamping the Peg Smile with Composites

Abstract Patient’s expectations for esthetic dentistry have risen in recent years. Having the perfect smile is becoming a goal, as celebrities and public figure’s appearances have undoubtedly improved as a result of smile correction. This case report is unique, as this type of restoration enhances smiles by a conservative and economic approach. The main clinical finding of the present case was smaller shape and size of medially inclined laterals when compared to other teeth, so the diagnosis was peg-shaped laterals, which are the most common but rare too dental form aberration that can distort the harmony of smile and affect patient psychology. Treatment options can vary depending on no prep or prep type of modification. Composites are of no preparation type of restoration, that can easily solve the esthetic issue of peg-shaped teeth, and boost up the patient satisfaction level for the treatment. The present case involves bilateral peg-shaped lateral incisors as a developmental anomaly treated with composites.

ROLE OF TRIVIDHA AUSHADHA IN THE MANAGEMENT OF INFERTILITY DUE TO BILATERAL TUBAL BLOCKAGE AND ABNORMAL ENDOMETRIUM RECEPTIVITY ALONG WITH THE PREVENTION OF CONGENITAL ANOMALY: A CASE STUDY

Introduction: Infertility is the failure to naturally conceive a child even after one or more years of regular unpro-tected coitus. Primary infertility (absence of prior conception) and secondary infertility (infertility following at least one previous conception) are two categories under which infertility can be classified. Here, it is the case of secondary infertility caused by tubal and endometrial factors. Tubal factor and Endometrial factor come under four essential factors for conception described by Acharya Sushruta, i.e. Ritu, Kshetra, Ambu, Beeja as if the Kshetra is not formed correctly, it causes vandhyatva. In this case study, Ayurvedic management successfully treated secondary infertility caused by tubal and endometrial factors. Main clinical finding: A married Hindu female patient of 29 years of age visited OPD of the National Institute of Ayurveda, Jaipur, on 3 March 2021 with a chief complaint of wants issue since 1-year Diagnosis: Her HSG scan on 25 Feb 2021 suggestive of bilateral fallopian tube blockage. Her USG scan is suggestive of a simple cyst in her right ovary of size 31x19mm and endometrium thickness of 4mm on the 12th day of menses. Inter-ventions: Treatment given was Daivavyapashraya, Yuktivyapashraya (Ksheera basti, Uttarbasti and Yoga basti along with oral medication), and Satvavajaya. Outcome: She conceives after taking 20 months of treatment and delivered a healthy male child of weight 3.04kg on 21 July 2023 without any congenital anomaly. Conclusion: This case study shows the efficacy of Uttar Basti for treating bilateral tubal blockage and Ksheera Basti for en-hancing endometrial receptivity. It also highlights the significance of Daivavyapashraya, Yuktivyapashraya, and Satvavajaya Chikitsa in the management of infertility and the prevention of congenital anomalies.

Endoscopically Assisted Intraoral Coronoidectomy for Treatment of Coronoid Hyperplasia

Hyperplasia of the coronoid process of the mandible is a rare condition defined as an abnormal and progressive elongation of the coronoid process (unilateral or bilateral). Jacob disease is the name given to a pseudo-joint formation between the coronoid process and the zygomatic bone. The main clinical finding is a progressive, painless difficulty in opening the mouth, due to contact of the coronoid process with the posterior surface of the zygomatic bone or the medial surface of the zygomatic arch. To restore the mouth opening in a stable manner, resection of the elongated coronoid process followed by physiotherapy is the only effective treatment. Surgery (coronoidetomy or coronoidectomy) can be performed through intraoral or extraoral access. Intraoral coronoidectomy is the best surgical choice for most of the cases. However, in some cases, the intraoral surgical field prevents an adequate visualization of the osteotomy line. The authors present 5 consecutive clinical cases of hyperplasia of the coronoid process treated with an endoscopically assisted coronoidectomy using ultrasound bone-cutting instruments.

Epistaxis associated with Angiostrongylus vasorum infection in a dog

AbstractA 9‐month‐old, female, entire border collie was presented as an emergency for unilateral epistaxis, rapidly evolving to bilateral, and lethargy of sudden onset. A moderate broncho‐interstitial pattern was present on thoracic radiographs, particularly in the caudo‐dorsal lung lobes. Haematology and coagulation parameters (prothrombin time, partial thromboplastin time, fibrinogen) were within normal range. Multiple larvae (L1) of Angiostrongylus vasorum were identified both on flotation (Ovassay technique) and sedimentation (McKenna technique). The dog was treated with fenbendazole (50 mg/kg) for 15 days. On re‐examination, 4 days after completion of treatment, faecal analysis was negative and thoracic radiographs were improved. This case reports epistaxis as the main clinical finding in a young dog infested with A. vasorum, in the southwest of France, where this parasite is endemic. If bleeding diatheses are increasingly reported in angiostrongylosis, epistaxis is an unusual presentation, especially as the sole clinical sign of bleeding, in a dog with normal coagulation parameters.

Femoral B‐cell neurolymphomatosis in a horse with multicentric lymphoma

SummaryAn 18‐year‐old Freiberger gelding was presented with a history of intermittent left hindlimb lameness after an acute onset 2 weeks prior to referral. The lameness had not responded to anti‐inflammatory therapy prescribed by the referring veterinarian. Physical, orthopaedic and neurological examinations revealed signs compatible with ipsilateral femoral nerve dysfunction. Transrectal sonographic examination showed a marked increase in the diameter of the left femoral nerve. The results of electromyography of the left hind quadriceps muscle were compatible with denervation attributable to neuropathy. Evaluation of cerebral spinal fluid (CSF) revealed pleocytosis consisting of medium‐sized lymphocytes, 5%–10% of which were positive for CD3 and CD79a. Neoplasia was suspected and steroid therapy was started. However, exacerbation of the clinical signs occurred and the horse was euthanised. Histopathological evaluation showed neurolymphomatosis of the left femoral nerve as the cause of the lameness. Infiltration of tumour cells was also seen to a lesser extent in the right femoral nerve, spinal cord, various parts of the cardiovascular system, renal capsules, an abdominal lymph node and the subcutis of the left stifle and upper lip. Histochemical evaluation revealed 60%–70% of the neoplastic lymphocytes were positive for CD20 and CD79a and up to 40% were positive for CD3. This report describes the uniqueness of a femoral mononeuropathy as the main clinical finding of B‐cell neurolymphomatosis and multicentric lymphoma.

Management of yovanpidaka by vaman karma

Introduction: Yovanpidaka, also known as Mukhadushika, is described under Kshudra Rogas in Ayurveda Samhitas. It can be compared with acne vulgaris. It is self-limiting in the majority but severe forms, however, lead to disfiguring scars, which can be prevented. Hence, it is essential to look out for treatment modalities which would help prevent the disfigurement caused by acne. Main Clinical Finding: A 20-year-old female presented with eruptions, pain, closed comedones, whiteheads, itching, and redness over her face for the past 2 years. Diagnosis: Yovanpidaka. Interventions: Administered Vaman with Madanphal Yoga along with milk and Yashtimadhu Phanta after proper internal oleation with Panchatikta Ghruta. Outcome and Conclusions: Marked improvement after Vaman in the signs and symptoms of the patient. Improvement in complexion was also seen.Significant result was seen in Yovanpidaka after Vaman. In cases where local treatments prove to be futile, Shodhan Chikitsa can deliver wonderful results.

Post-Metachronous Cancer of the Ampulla of Vater after Gastric Cancer Surgery: An Overview

Post-metachronous ampulla of Vater carcinoma after gastric cancer is an extremely rare between multiple primary cancers. The published literature contains only a few cases. Among the cases males are found more frequently. The majority of the cases reported after early gastric cancer. The main problem is to distinguish between new cancer and metastasis in gastric cancer patients. Early onset of jaundice, which is the main clinical finding, is important in diagnosis. The main type of surgery is pancreaticoduodenectomy. In this study, the clinic, diagnosis, and treatment of the post-metachronal ampulla of Vater cancer and the highlights of management options reviewed.

Management of Infertility due to Bilateral Tubal Blockage, PCOD & Endometrial Polyp by Ayurvedic Regime: A Case Study

Infertility is one of the predominant health issues, affecting 10-15% of reproductive- aged couples. An infertility evaluation should be considered in any couple that has failed to conceive in one year. Infertility can be subdivided into primary infertility (no prior conception) and secondary infertility (infertility following at least 1 prior conception). Here it is the case of primary infertility. In Ayurveda it can be correlated with Anaptaya Vandhya (that is who never has conceived) and Apraja Vandhya (that lady who never have conceived but can conceive by eliminating the underlying cause). In this case study, Ayurvedic management successfully treat the primary infertility. Main clinical finding: A married Hindu female patient of 28 years of age visited to OPD of National institute of Ayurveda, Jaipur on 24 October 2020 with chief complaint of wants issue since 3 years. She had associated complaint of sometimes milk like discharge from breast since 3 years. Diagnosis: Her HSG scan suggestive of right fallopian tube fimbrial block & left fallopian tube cornual blockage. Her USG scan suggestive of bilateral polycystic ovary & a tiny echogenic polyp of size 3.7x2.3mm in mid part of endometrial cavity. Her prolactin level was found elevated. Interventions: Treatment given was Beejasamskara, Uttarbasti with Apamarga kshara tail & Shudah bala tail along with oral medication. Outcome: She conceived after taking 6 months of treatment. She was given proper antenatal care along with garbhsamskara. She delivered a healthy female baby of weight 3.03kg on 7th Jan 2022. Conclusion: This case study shows the potential of Beejasamskara, Uttarbasti in the management of infertility and the role of Garbhsamskara during the antenatal period.

Ayurvedic Approach for Management of Ulcerative Colitis- A Case Report

Introduction: Ulcerative colitis (UC) is related to chronic mucosal inflammation and manifestations such as bloody diarrhea and abdominal cramps, tenesmus and urgency. Main Clinical Finding: A 63-year-old male patient, known case of ulcerative colitis under regular allopathic treatment for 16 years had recurrent symptoms of blood and mucous mixed stool (2-3 times/day) with abdominal tenesmus and urgency to defecate. Diagnosis: Based on the clinical features like tenesmus, increased frequency of blood mixed mucoid defecation, and decreased volume of faeces, this case of UC was diagnosed as Raktaja Pravahika. Interventions and Outcome: The combinations of medicines based on Ayurvedic principles were intervened. Significant result was observed in signs and symptoms with Grade I UC impression within 15 months without recurrence of any signs symptoms for about 6 months. Conclusions: This treatment was found effective for this case. It could be a valuable intellectual addition to researchers and to the medical field.

Ayurvedic management of renal cyst – A case study

Introduction: Renal cysts are detected more easily in elderly people due to the widespread use of abdominal computed tomography (CT), abdominal ultrasonography (USG), and magnetic resonance imaging. The importance of renal cysts arises from their augmented detection in elderly populations with the pervasive use of CT and abdominal USG. In Ayurveda, renal cyst has been interpreted with the name of Granthi where Vata-Kapha dominant Tridosha is involved. Very less scientific data is available depicting the effect of Ayurvedic intervention in such cases. Main Clinical Finding: A confirmed case of renal cyst of size 15 mm × 16 mm was seen in the lower calyx of the left kidney, a calculus of size 2.3 mm with mild upper hydroureteronephrosis, increased parenchymal echogenicity suggestive of Grade 1 fatty liver and gallbladder is distended with multiple hyperechogenic foci suggestive of calculus largest measuring of 13mm. Diagnosis: The patient was a diagnosed case of a renal cyst of size 15 mm × 16 mm in the lower calyx of the left kidney with a calculus of size 2.3 mm with mild upper hydroureteronephrosis with Grade 1 fatty liver and calculus largest measuring of 13 mm in the gallbladder based on USG findings. Interventions: The patient was treated with Ayurvedic medicines such as Chandraprabha Vati, Kanchnara Guggulu, Lavan Bhaskara Churna, Samsamani Vati, Kumaryasava, and Gokshuradi Guggulu. Outcome: Complete remission of the renal cyst with calculi along with Grade 1 fatty liver was observed after 6 months of treatment. Conclusion: This case study demonstrates the potential and usefulness of Ayurveda in the management of renal cysts.

Acute subdural hemorrhage accompanied with rupture of the inferior vena cava: a case report

Introduction: One of the main causes of mortality and morbidity with physical and mental disabilities is traumatic brain injury (TBI). Apart from that, TBI also causes huge socio-economic burdens around the world. About 60% of TBI cases reported are caused by traffic accidents. Acute subdural hemorrhage (ASDH) is the main clinical finding in TBI cases. Blunt abdominal trauma associated with TBI accounts for 14% of cases. Inferior vena cava (IVC) injury is the most common vessel injured in a blunt (0.6-1%) and penetrating abdominal trauma (0.5-5%). Injury of the IVC can lead to a very high mortality rate.Case description: Male patient, 15 years old, presented to the emergency department 30 minutes after a traffic accident with decreased consciousness with the Glasgow Coma Scale score of 11. The patient’s chest was clear, abrasions were found on the left hypochondrium. Head CT scan represented acute subdural hemorrhage in the left frontotemporoparietal region was accompanied by midline shift more than 0,5cm. Hemicraniectomy decompression was performed. After decompression was done, the patient was unstable, blood pressure down to 70/50 mmHg and weak peripheral pulses with 140 beats per minute. Fluid and blood resuscitation have been performed but not responding. The patient remained hemodynamically unstable with minimal urine output. Physical examination reveals a tense abdomen. Diagnostic peritoneal lavage (DPL) was performed, blood was obtained. Exploration laparotomy was done by a midline incision, and IVC injury was found. The blood was removed, then packing on IVC with gauze, observation, and no blood comes out. The packing was opened, the patient stable, the operation was complete.Conclusion: Case of severe head injury with acute SDH, then a craniectomy was performed, in the abdomen had a ruptured inferior vena cava, an exploratory laparotomy was done. Currently, the patient has recovered well without deficits.

Eye care and ocular findings at the Olympic and Paralympic Games Rio 2016

ObjectivesTo describe the attendance and ocular profile of competitors and members of delegations who attended the Polyclinic Ophthalmology Division during the Olympic and Paralympic Games Rio 2016.MethodsThe eye clinic was...

Validity of MDCT cholangiography in differentiating benign and malignant biliary obstruction

BackgroundMDCT cholangiography can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary surgery, and determine the cause and level of biliary obstruction. Early tumor detection and staging of biliary cancer are key factors for a possible cure by surgical resection. Between December 2019 and October 2020, 69 patients with clinically suspected biliary obstruction were enrolled in the study, subjected to clinical assessment (full history taking and clinical examination) and imaging assessment by MDCT cholangiography. Our findings were correlated to standard reference examinations including operative/ERCP/biopsy and histopathology findings.ResultsThe most affected age was between 60 and 70 years old, and males were more affected. The commonest clinical presentation was yellowish discoloration of the skin and sclera followed by biliary colic. Right hypochondrial tenderness was the main clinical finding on clinical examination. Our patients were categorized according to the etiology of biliary obstruction into 7 groups: malignant stricture 52.2% (36 patients), calcular 24.6% (17 patients), iatrogenic 5.8% (4 patients), portahepatis lesions 5.8% (4 patients), benign stricture 4.3% (3 patients), inflammatory 4.3% (3 patients), and congenital 1.4% (1 patient). The malignant group shows dominant mass, moderate biliary obstruction, and arterial and venous enhancement. The overall sensitivity was 94% for malignancy.ConclusionMDCT cholangiography is non-invasive, fast, and highly sensitive and specific in the diagnosis of different causes and levels of biliary obstruction and is useful in the characterization of the lesion in cases of malignant obstruction and differentiating it from benign stricture. It can be used as an effective alternative to ERCP or PTC.

AIDS-related progressive multifocal leukoencephalopathy.

INTRODUCTION: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by reactivation of JC virus (JCV). METHODS: We described the profile of laboratory-confirmed PML cases among AIDS patients. RESULTS: A total of 43 HIV patients with clinical conditions compatible with PML were obtained; 5 cases were confirmed by JCV testing. The main clinical finding was mental confusion. Median CD4 count was 54 cells/mm³. CONCLUSIONS: Three of the five confirmed PML cases died; the time between diagnosis and death was 2, 5, and 6 months. It is important to consider JCV infection as a differential diagnosis.

Ayurvedic management of vitiligo (Shvitra)

Introduction: Vitiligo is a common autoimmune disorder in which the destruction of melanocytes occurs, resulting in the formation of white spots on the skin. It has a major impact on the quality of life of patients, as they feel distressed and stigmatized by their condition. Treatment available in contemporary medicine has its own limitations and side effects. In Ayurveda, Shvitra is the term employed for the hypopigmentation disorders of the skin. Due to the holistic approach, Ayurveda has the vast potential to treat such autoimmune skin diseases. Here, a case study of chronic vitiligo treated successfully with ayurvedic interventions is reported. Main Clinical Finding: There were white patches measuring about 7x5 cm, 4x3 cm, 3x3 cm and 4x2 cm on right and left arm, neck, chest, forehead region respectively. There were multiple small patches on fingers of hand also. The spots and patches were asymmetric, well defined whitish-pink and without scaling and discharge. Diagnosis: The patches were spread on large area (bahala), colour of patches was white/whitish pink (tvaka vaivarnyata), no secretion from lesion (aparisravi) ,with no itching (kandu) and loss of hair (romavidhvamsha) on affected area, so the case was diagnosed as Shvitra kustha on the bases of observed sign and symptoms. Intervention: The management approach was personalized and holistic in nature incorporating Ahara,vihara and Aushadha. In Sanshamana chikitsa Pitta-kapha shamaka and Vyadhi pratyanika line of treatment including internal administration of Khadira sara, decotition of Amla and Udumbara Chhala and Shashilekha Vati with external application of Chakramarda beeja, Muli beeja and Vakuchi beeja lepa was incorporated. Outcome: After 3 months of interventions, skinny spots appeared between the white patches. After six months, patches of chest, neck and forehead almost disappeared and that of arms significantly decreased with no recurrence. No adverse effect was seen during treatment and in follow up period

New Classification and Management of Abetalipoproteinemia and Related Disorders

New Classification and Management of Abetalipoproteinemia and Related Disorders

Gestational outcomes in women infected by Zika virus during pregnancy in Mato Grosso do Sul, Brazil: A cross-sectional study

ObjectivesThis study aimed to describe the demographic and clinical parameters of women infected by Zika virus who had infants with stigmata of Congenital Zika Syndrome (CZS) versus those who had normal-appearing infants at birth, thereby providing further details on the clinical caveats of neonatal ZIKV infection. MethodologyThis cross-sectional study was performed in the state of Mato Grosso do Sul, Central-West region of Brazil, and included 117 mother-infant pairs who were interviewed and 120 gestational outcomes. All mothers had laboratory confirmation by qRT-PCR of ZIKV infection during pregnancy. ResultsThe prevalence of congenital abnormalities related to ZIKV was 2.69 cases per 10,000 live births during this period. Exanthem was the main clinical finding, observed in 92.5% of the mothers in this study. Regarding the timing of ZIKV infection, the first trimester was the most frequent time of infection among mothers of infants with CZS (54.55%) (p=0.0007). The case fatality rate was 5% (n=6).Among the 23 children who were classified as having CZS, 13 (56.52%) of them presented with microcephaly. Only 13 (56.52%) children with CZS were tested by qRT-PCR for ZIKV infection at birth, five (38%) were positive. ConclusionsThis study highlights the congenital alterations of ZIKV infection during pregnancy in an epidemic burst, demonstrating that the alterations found in other studies are similar to the present research.

Acute Kidney Injury in Hospitalized Kidney Transplant Recipients

BackgroundAcute kidney injury (AKI) is a main cause of morbidity, hospitalization, and hospital readmission in kidney transplant recipients. We aimed to determine AKI incidence and risk factors following kidney transplant to assess outcomes such as renal function and graft loss after AKI. MethodsWe conducted a retrospective cohort study with hospitalized kidney transplant recipients during 2016 to 2017. Clinical data of 179 patients were reviewed. The primary outcome was AKI incidence and risk factors. To determine AKI occurrence, we based it on creatinine criteria from Acute Kidney Injury Network classification. ResultsWe documented a total of 179 hospital admissions; AKI was diagnosed in 104 patients (58.1%). Recipients with higher baseline serum creatinine (odds ratio, 2.6; confidence interval [CI], 1.5-4.5; P < .001) and hospital admission because of infections (odds ratio, 2.4; CI, 1.1-5.2; P = .020) were more likely to experience AKI. A total of 19 recipients (10.6%) had graft loss with a significant AKI association (P = .003) at 12 months after admission. Intensive care unit length of stay (P = .63) and hospital stay (P = .55) were not different in patients with AKI compared with the control group. ConclusionsAs a main clinical finding, we concluded that infections and higher serum creatinine baseline level were associated with the development of AKI.

Double pituitary adenomas in a large surgical series

PurposeTo explore the incidence of double pituitary adenomas in a tertiary center for pituitary surgery and asses their clinical, imaging and histopathological features.MethodsThe medical records of the patients operated on for pituitary tumors at the Department of Neurosurgery of Military Institute of Medicine in Warsaw, Poland between the years 2003 and 2018 were retrospectively analyzed. Among the 3270 treated patients, the diagnosis of double pituitary adenoma was established in 22 patients. Clinical, laboratory, detailed histopathological and diagnostics imaging data were collected and analyzed.ResultsThere were 21 cases of synchronous and one case of asynchronous double pituitary adenoma. The main clinical finding was acromegaly (12/22) followed by Cushing’s disease (3/22). The diagnosis of synchronous double pituitary adenoma was suspected in the preoperative MRI in 11 patients. In the remaining patients the diagnosis of contiguous double pituitary adenoma was confirmed in the histopathological examination. There was no predilection for gender and the mean observation time was 74.2 months. In one case of Cushing’s disease the occurrence of double pituitary adenoma led to the initial failure of achieving hormonal remission. One patient presented with double pituitary adenomas as a manifestation of Carney complex.ConclusionsDouble pituitary adenoma is a rare entity that can pose a significant challenge especially in the setting of Cushing’s disease. Careful inspection of preoperative MRI and diagnostic work-up before transsphenoidal surgery and thorough histopathological microscopic examinations with immunohistochemical staining for all pituitary hormones is essential for establishing the diagnosis of double pituitary adenoma.