Pricking Sensation Research Articles

AYURVEDIC APPROACH IN THE MANAGEMENT OF STYE: A CASE REPORT

Stye is an infection of the sebaceous glands of Zeis located at the base of the eyelashes or the apocrine glands of Moll. Stye can be correlated to Anjananamika in Ayurveda. Signs and symptoms such as a boil with a red (Tamra varna) appearance and burning and pricking sensations around the eyelid (Vartma pradesha) will be present. Additionally, the condition is marked by mild pain with a soft, swollen eyelid (Mridvimandaruja). The treatment in Ayurveda involves various therapies like Swedana (hot compress), Nishpidana (applying pressure to drain pus), Bhedana (incision), Pratisarana (rubbing medicaments on the eyelids) and Anjana (collyrium). The main objective of this study is to assess the efficacy of Bidalaka (local application) and Ashchyotana (eye drops) along with oral medicines in treating the disease Anjananamika. A 26-year-old female patient presented at the Shalakya Tantra outpatient department of Jeevan Jyoti Ayurveda Medical College and Hospital, Aligarh, with complaints of multiple swelling in the right eyelid for eight days, pain and redness. Upon examination, the right eyelid showed oedema along the entire edge, with an abscess at the apanga desha (outer canthus). Based on these clinical signs and symptoms, the patient was diagnosed with Anjananamika and treated with Kriyakalpas tailored to the roga Bala-condition's severity. After a week of treatment, the symptoms entirely resolved, emphasising the effectiveness of the Ayurvedic approach in managing Anjananamika.

Safety and Efficacy of Charakokta Raktapachak Yoga in Patients of Urticaria (Kotha) Caused Due to Dooshivisha – A Randomized Controlled Trial

This controlled clinical study aimed to assess the safety and efficacy of Charkokta Raktapachak Yoga in treating DooshivishajanyaKotha (urticaria), a condition known for its challenging recurrence. Two groups, each comprising 30 patients, were formed: a standard groupreceiving Tab. Cetrizine 10mg OD, and an experimental group receiving Tab. Raktapchak Yoga 500mg/day in two divided doses for 42 days.Follow-ups occurred every 7 days. The study evaluated manifestations such as raised edematous swelling (kotha), itching (kandu), burningsensation (daha), and pricking sensation (toda). Objective parameters like Hb, ESR, AEC, and stool examination were assessed before andafter the study. Statistical analysis revealed significant inter-group differences after treatment for urticaria (p = 0.0047), itching (p < 0.0001),pricking sensation (p = 0.0025), and burning sensation (p = 0.0018). In the experimental group, significant improvements were observed inobjective parameters: hemoglobin levels (p = 0.0026), ESR (p < 0.0001), AEC levels (p < 0.0001), and stool examination (p = 0.0176).Symptoms such as the urticarial wheel, itching, pricking, and burning sensation were alleviated more in the experimental group than in thecontrol group. Recurrence of symptoms was reduced in the experimental group post-treatment compared to the standard group. Objectiveparameters improved in the experimental group, affirms the safety and efficacy of Charkokta Raktapachak Yoga in treating urticaria caused byDooshivisha.

The revised zone of partial preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury: ZPP applicability in incomplete injuries

Study designConsensus process.ObjectivesTo provide a reference for the Zone(s) of Partial Preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and analyze the initial impact of applicability of the revised ZPPs. Revisions include the use of ZPPs in selected incomplete injuries (in addition to prior use in sensorimotor complete injuries). Specifically, the revised motor ZPPs are applicable bilaterally in injuries with absent voluntary anal contraction (VAC) and the revised sensory ZPP for a given side is applicable if deep anal pressure (DAP), light touch and pin prick sensation in S4-5 are absent on that side.SettingCommittee with 16 ISNCSCI experts and datasets from the European Multicenter Study about Spinal Cord Injury (EMSCI).MethodsOccurrence frequencies of applicable ZPPs were determined in an EMSCI cohort consisting of two ISNCSCI examinations from 665 individuals with traumatic SCI.ResultsMotor ZPPs were derived in 35.2% of all datasets of incomplete injuries, while sensory ZPPs are much less frequent (1.0%). Motor ZPPs are applicable in all American Spinal Injury Association Impairment Scale (AIS) B datasets (mean ZPP length: 0.9 ± 1.0 segments), in 55.4% of all AIS C datasets (ZPP length: 11.8 ± 8.2 segments) and in 9.9% of the AIS D datasets (ZPP length: 15.4 ± 7.9 segments).ConclusionsThe revised ZPP allows for determining motor ZPPs in approximately 1/3 of all incomplete injuries. The broadened applicability enables the use of ZPPs beyond complete injuries for complementary description of residual functions in more individuals.SponsorshipN/A

Role of glycated hemoglobin in microvascular complications in type 2 diabetes mellitus: cross sectional study

Background. Diabetes mellitus (DM) is a complex disorder which defects mainly vascular complications. Complications increase the morbidity and mortality associated with the disease, reducing life expectancy by 10–15 years. Diabetic neuropathy (DN) is a frequent complication of DM and is defined as the presence of peripheral nerve dysfunction after exclusion of other causes. Poor glycaemic control and chronic hyperglycaemia are the major risk factors for DN. Most important treatment of DN remains good glucose control generally noted as HbA1c ≤ 7.5 %. The purpose of this cross-sectional study is to investigate the role of glycated hemoglobin in microvascular complications in type 2 diabetes mellitus. Materials and methods. This cross-sectional study was carried out in Teerthanker Mahaveer Medical College and Research Center, Moradabad from Jan 2016 to December 2016 in which 100 type 2 diabetic mellitus (T2DM) patients in the age group of 35–69 years were included. Patients were divided into 2 groups of 50 each. Group 1 constituted of T2DM patients without any microvascular complication and group 2 includes T2DM patients with microvascular complications. Examination of patients included recording of medical history, pulse rate and blood pressure. Neuropathy was assessed by clinical examination based on modified NDS procedure, which included examination of vibration, pin prick sensation, temperature sensation on dorsum of foot and Achilles tendon reflex. Blood samples were collected by venepuncture and accordingly biochemistry analysis was carried out (Fasting Blood Glucose, post prandial blood glucose and HbA1c were recorded). HbA1c estimation was done by using COBAS fully automated analyser. Results. Among recruited patients, Mean fasting, PPBS level, HbA1c among test group was significantly more than control group. In control group significant correlation of HbA1c is found with age, weight and BMI and in test group significant correlation of HbA1c is observed with age and duration of DM. Significant correlation of HbA1c with FBS and PPBS seen in both control group and in test group. Among test group, 19 patients were found to have DN and significant correlation of HbA1c is observed with NDS score. Conclusions. Increased HbA1c is closely associated with DN in T2DM patients and could be considered as a potent indicator for DN in these patients.

Safety and efficacy for hair removal in dark skin types III and IV with a high-powered, combined wavelength (810, 940 and 1060 nm) diode laser: A single-site pilot study.

Previous studies have demonstrated the superior efficacy of a high-power diode laser (4800W) with a wavelength of 810nm over others with less power and the same wavelength, while also being safe and comfortable for the patient. However, the use of this laser is limited on dark skin. This study aims to compare the efficacy, safety, and comfort of a 4800W diode laser (810nm) with that of the new Blend diode laser (810nm, 940nm, and 1064nm). Furthermore, the study aims to demonstrate that the Blend diode laser delivers better results on darker skin. A 810nm diode laser was compared with the Blend diode laser (810, 940 and 1064nm) (Primelase, Cocoon Medical). A side-by-side comparative study was carried out over three sessions involving fourteen participants with skin types III and IV, with evaluation of the results 6months after treatment. The study was performed at the Tennessee Clinical Research Center, Nashville, Tennessee, USA. This evaluation was based on efficacy, safety, comfort, and participant satisfaction. Blend diode laser treatments were performed with fluences 40% (SE=0.04%) higher than those of the 810nm. Besides mild-to-moderate transient discomfort during the procedure, the Blend diode laser also produced an increased pricking sensation that was 1.8 points higher on a 10-point scale (p<0.05), due to the higher fluence used. Hair reduction was 12% higher with the Blend diode laser, with a confidence level of 70%. Moreover, participants were more satisfied with the results of the Blend diode laser than with the diode laser (50% very satisfied vs. 36%, respectively). No long-term adverse effects were observed. The new Blend diode laser has been shown to be more effective and satisfactory than 810nm diode laser on dark skin types III and IV, while also being safe and comfortable for participants.

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BackgroundSubacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of children and young adults that affects the central nervous system (CNS). It is a slow, but persistent, viral infection caused by defective measles virus. Dissociation in a case of SSPE is rare, so is very difficult to diagnose as the symptoms mimics neurobehavioural changes often seen in SSPE.Case PresentationThe child, 11yrs old girl, student, brought with complaints of pain in lower limbs from last 4 months and 3 episodes of unconsciousness & abnormal behaviour from last 3 months. Semiology- pain in lower limbs→ pricking sensation in LL→whole body→loss of consciousness→tightening of all 4 limbs. All episodes were precipitated by some stress at home. Also she had become irritable and there were multiple spells of anger outburst from last 3 months. There is a past h/o measles at 4 yrs. of age and fever f/b 1 episode of fits at 5 yrs. of age. EEG showed rademaker complexes & Antinuclear antibody IIF was positive both s/o SSPE.ResultsChild has been prescribed Tab Sodium Valproate 400mg and Tab. Aripiprazole 5mg along with JPMR exercises and coping skill training. Parents were taught contingency management principles after which she showed good improvement.DiscussionWill be done at the time of presentation.

Deciphering the Action of Perfluorohexyloctane Eye Drops to Reduce Ocular Discomfort and Pain.

Perfluorohexyloctane (F6H8) eyedrops have been recently introduced in Europe as a product to treat dry eye disease, based on its ability to reduce tear film instability in Meibomian gland dysfunction and evaporative dry eye disease, although its mechanism of action is still unknown. In the present pilot study, we evaluated the effects of the ocular instillation of a single drop of commercial F6H8 eyedrops in 20 healthy humans (9 women/11 men), measuring: (a) Corneal surface temperature (CST) from infrared video images; (b) tear volume using phenol red threads; (c) blinking frequency; and (d) ocular surface sensations (cold, dryness, pricking, foreign body, burning, itching, gritty, eye fatigue, watering eyes, and light-evoked discomfort sensations; scored using 10 cm Visual Analog Scales), before and 5–60 min after F6H8 or saline treatment. CST decreased and tearing and blinking frequency increased significantly after F6H8 but not after saline solution. When applied unilaterally, CST decreased only in the F6H8-treated eye. No sensations were evoked after F6H8 or saline. The corneal surface temperature reduction produced by topical F6H8 does not evoke conscious ocular sensations but is sufficient to increase the activity of corneal cold thermoreceptors, leading to an increased reflex lacrimation and blinking that may relieve dry eye condition thus reducing ocular discomfort and pain.

COMPARISON BETWEEN PERINEURAL DEXAMETHASONE AND INTRAVENOUS MAGNESIUM SULPHATE AS ADJUVANT IN SUPRACLAVICULAR BLOCK

Abstract Background: Upper extremity surgeries are commonly performed under regional anaesthesia. Regional anaesthesia of the upper extremity has several advantages over general anaesthesia such as improved postoperative pain management, decreased postoperative narcotic consumption, and reduced recovery time. Objectives: The aim of the study was to compare between dexamethasone and magnesium sulphate as adjuvants in supraclavicular brachial plexus block as regards the onset and duration of sensory and motor block as well as side effects. Patients and Methods: This prospective double-blinded comparative study was carried out in Faculty of Medicine, Ain-Shams University Hospital on 120 adult patients between 21-50 years of both sexes with ASA classification 1&amp;2 who were scheduled for elective upper limb orthopaedic surgeries. A written informed consent was obtained from all patients. Every patient received an explanation about the purpose of the study. Procedures had been approved by the institutional and the regional ethical committee. Total 120 patients are enrolled in the study and divided into 3 groups A and B and C (40 for each one). Results From aspect of increasing the duration of sensory &amp;motor block magnesium sulphate group (group A) showed higher prolongation of sensory &amp; motor block with recovery of pin prick sensation in median time 313 mins ± when compared with group B &amp;C even with longer time taken for patient to request rescue analgesia after 5 hours. In group (B) by adding dexamethasone with bupivacaine the blood pressure rate are increased after 20 min of injection and return normal after 240 min, heart rate are normal, but in case of sensory and motor block about 77.5% of study patient in this group have full motor and sensory block, in case of increasing time of motor and sensory block the dexamethasone success increasing time for motor and sensory block to reach 278 min sensory and 314 min in motor block, first call of Analgesic are after 4 hr. Conclusion: Group A (Magnesium sulphate with bupivacaine) were more effective and increasing affected time in motor and sensory block than Group B (Dexamethasone with Bupivacaine) and Group C (Control).

Microneedle patch designs to increase dose administered to human subjects

Microneedle (MN) patches are being developed for many different kinds of drugs, but are often limited to delivering sub-milligram doses. This is because larger patches can be more difficult to apply to the skin, and acceptability of larger MN patches by human subjects has received limited study. Here, we fabricated 18 different large MN patch designs by laser microfabrication with different MN length (800–1500 μm), number of MNs (225 to 900 MNs per patch), space between MNs (600–1100 μm), and MN base diameter (200–250 μm). After manual application of these patches to human participants, we assessed dose delivery efficiency, total dose delivered, dose delivered per MN, depth of MN penetration and whole-MN delivery efficiency. We found that all of these parameters generally increased with decreased MN length, increased number of MNs (among those ≤1000 μm in length) and increased MN-MN spacing. All MN patch designs caused less pain than a pin prick sensation and were generally considered acceptable by the study participants. The MN patches induced mild, or sometimes moderate, transient erythema on skin. Study participants showed higher preference for MN patches for long-acting contraception compared with conventional options, indicating strong interest and acceptability of MN patches in this study.

Small nerve fiber selectivity of laser and intraepidermal electrical stimulation: A comparative study between glabrous and hairy skin

ObjectivesIn clinical neurophysiology practice, various methods of stimulation can be used to activate small-diameter nociceptive cutaneous afferents located in the epidermis. These methods include different types of laser and intraepidermal electrical stimulation techniques. The diffusion of the stimulation in the skin, inside or under the epidermis, depends on laser wavelength and electrode design, in particular. The aim of this study was to compare several of these techniques in their ability to selectively stimulate small nerve fibers. MethodsIn 8 healthy subjects, laser stimulation (using a CO2 or Nd:YAP laser) and intraepidermal electrical stimulation (using a micropatterned, concentric planar, or concentric needle electrode), were applied at increasing energy or intensity on the dorsal or volar aspect of the right hand or foot. The subjects were asked to define the perceived sensation (warm, pinprick, or electric shock sensation, corresponding to the activation of C fibers, Aδ fibers, or Aβ fibers, respectively) after each stimulation. Depending on the difference in the sensations perceived between dorsal (hairy skin with thin stratum corneum) and volar (glabrous skin with thick stratum corneum) stimulations, the diffusion of the stimulation inside or under the epidermis and the nature of the activated afferents were determined. ResultsRegarding laser stimulation, the perceived sensations turned from warm to pinprick with increasing energies of stimulation, in particular with the Nd:YAP laser, of which pulse could penetrate deep in the skin according to its short wavelength. In contrast, CO2 laser stimulation produced only warm sensations and no pricking sensation when applied to the glabrous skin, perhaps due to a thicker stratum corneum and the shallow penetration of the CO2 laser pulse. Regarding intraepidermal electrical stimulation using concentric electrodes, the perceived sensations turned from pinprick to a combination of pinprick and electrical shocks with increasing intensities. Using the concentric planar electrode, the sensations perceived at high stimulation intensity even consisted of electric shocks without concomitant pinprick. In contrast, using the micropatterned electrode, only pinprick sensations were produced by the stimulation of the hairy skin, while the stimulation of the glabrous skin produced no sensation at all within the limits of stimulation intensities used in this study. ConclusionsUsing the CO2 laser or the micropatterned electrode, pinprick sensations were selectively produced by the stimulation of hairy skin, while only warm sensation or no sensation at all were produced by the stimulation of glabrous skin. These two techniques appear to be more selective with a limited diffusion of the stimulation into the skin, restricting the activation of sensory afferents to the most superficial and smallest intraepidermal nerve fibers.

A PROSPECTIVE STUDY OF EFFICACY OF DEXAMETHASONE USED AS ADJUVANT TO LEVOBUPIVACAINE ADMINISTERED FOR BRACHIAL PLEXUS BLOCK BY SUPRACLAVICULAR APPROACH FOR UPPER LIMB SURGERY

Many studies have been done on the adjuvants used along with local anaesthetics for Brachial Plexus block. The drug Levobupivacaine has wider margin of safety and has been used in our study along with Dexamethasone as adjuvant. Method: We performed a prospective, randomized, controlled, single blinded study on a total of 70 patients who were randomly allocated into two groups namely Group N (Normal Saline) and Group D (Dexamethasone). Both groups received 28 ml 0.5% Levobupivacaine. Group D received 2 ml (8 mg) Dexamethasone as adjuvant while Group N received 2 ml Normal Saline. Onset of Sensory blockade and motor blockade were measured, respectively, by time taken to loss of pin prick sensation and loss of muscle movement, after administration of drug. Duration of sensory block was measured by time till patient rst reported pain after sensory blockade. Result:The onset time of sensory block was 10.2 ± 1.67 minutes in Group D compared to 12.3 ± 1.88 minutes in Group N (p value &lt;0.0001). The onset time of motor block in Group D was 14.4 ± 1.73 minutes and in Group N 16.3 ± 1.97 min (p value = 0.0002). The duration of sensory block was 944.1± 64.79 minutes in Group D versus 654.7 ± 71.61 min in Group N (p value &lt; 0.0001). Conclusion: It was observed that Group D had signicantly faster onset of sensory and motor blockade while also experiencing longer duration of analgesia.

Role of Pharmacological Therapy and Surgical Intervention in Breast Carcinoma

Objective: To determine the Role of medical therapy and surgical intervention in carcinoma of breast.&#x0D; Study Design: Prospective observational study.&#x0D; Place and Duration: Two years study from January 2018 to December 2020 was conducted at Liaquat university of Medical and Health Sciences Jamshoro.&#x0D; Methods: The study comprises 50 patients. Data was collected from all who were admitted at OPD. The patients were evaluated fully after history &amp; Clinical examinations and Specific investigations of Fine Needle Aspiration Cytology (FNAC), Tru cut biopsy for Histology ERPR Receptor and Herceptin receptor, ultra sound of breast, and Abdomen, Mammography, C T scan, M R I, Tumor marker CA15.3. CA 125 for ovary and breast, X ray chest and Bone scan. Sentinel lymph node biopsy for lymphatic involvement, Liver Function Test, serum calcium, Complete Blood Picture (CBP), blood sugar, blood urea. HBSAG, HCV, HIV and COVID-19 Evaluated patients were evaluated fully after history, clinical examinations &amp; specific investigations.&#x0D; Results: In this study 50 patients of Carcinoma of breast. The maximum numbers of patients were in age group 20 to 80 years. 15 patients were in age group 20 to 39 year, 24 patients were in age group 40 to 59 years, 11 patients were in age group 60 to 80 year. Out of 50 patients 29 patients were presented with breast lump, 8 patients were presented with bloody discharge, 7 patients were presented with nipple destruction and 6 Patients were presented with pricking sensation Out of 50 patients 21 patients were presented with stage I, 13 Patients presented with stage II, 9 patients were presented with stage III and 7 patients were presented with stage IV. Out of 50 patients 22 Patients were diagnosed duct cell carcinoma, 11 patients were diagnosed Phyllodes tumor, 9 patients were diagnosed lobular cell carcinoma, 5 patient were diagnosed tubular cell carcinoma and 3 patients were diagnosed Paget’s type of carcinoma .Out of 50 patients 25 patients were ERPR positive treated by Nolvadex (tamoxifeen) 16 Patients were ERPR negative treated by chemotherapy drugs and Aromatase inhibitors, 9 Patients were Her2neu receptor positive treated by Herceptin (Trastuzumab) Out of 50 patients 34 patients were treated by Modified radical mastectomy, 16 patients were initially were treated neo adjuvant therapy. Then Modified Radical Mastectomy, Out of 50 patients 25 patients were treated with Nolvadex (tamoxifeen) after Modified Radical Mastectomy better outcome seen in those patients.&#x0D; Conclusion: Carcinoma of breast is a common problem all over the word, patient can present with lump over the breast, bloody discharge, destruction of nipple or areola if not diagnosed and treat early stage, patient can die within a year without Medical and surgical treatment.

DETECTION OF SUCCESSFUL SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK BY PULSE OXIMETER PERFUSION INDEX

Background: Early and accurate detection of failure of supraclavicular brachial plexus block helps to take early corrective measures and thus to save the operating room time and improve patient satisfaction. Aims: To assess the efcacy of perfusion index and perfusion index ratio in prediction of success or failure of brachial plexus block by supraclavicular approach. Methods: Ninety adult patients scheduled for upper limb surgery under supraclavicular brachial plexus block were recruited in this study. Success of brachial plexus was assessed by using traditional methods such as loss of pin prick and thermal sensation. Perfusion index and perfusion index ratio was monitored in both limbs at baseline, 3, 6, 9, 12, 15, 18 and, 21 minutes after block. Changes in PI and PI ratio were measured in successful as well as failure cases of brachial plexus block. Results: Signicant increase in perfusion index (1.60 Vs 7.65) and perfusion index ratio (1.00±0.00 Vs 4.78±2.7) was noticed following successful block. PI and PI ratio may be an important tool for early prediction of success rate of brachial plexus block. Failure or partial block was noticed in eight patients.

A study of intrathecal low dose bupivacaine and fentanyl versus conventional dose of bupivacaine alone for elective caesarean section

Background: Spinal anesthesia is the most common method of the regional block in cesarean section, because it is easy to perform, economical produces rapid onset of anesthesia, and good muscle relaxation, and most importantly, it gives immense pleasure to the conscious mother. To improve the quality of subarachnoid block, intrathecal opioids are used as adjuvants to Bupivacaine. Fentanyl has a rapid onset of action as a lipophilic opioid following intrathecal administration. Because of high lipid solubility, it undergoes rapid uptake by the spinal cord, and hence the chances of delayed respiratory depression are less. Methods: We randomly selected 60 patients belonging to the American Society of Anesthesiologists (ASA) class I and II, who are scheduled for elective LSCS. These patients were divided randomly into two groups of 30 each. Group B received 10mg of 0.5% hyperbaric bupivacaine (2ml). Group BF received 7.5mg of 0.5% hyperbaric bupivacaine (1.5ml) with 25mcg of Fentanyl (0.5ml). Lumbar puncture was performed at the level of L3-L4 with 23 Guage Quincke Babcock's needle with the patient in the right lateral position. The sensory block was assessed with the loss of pin prick sensation, and the motor block was set using the Bromage scale technique. We also recorded the hemodynamic parameters like pulse rate, blood pressure, oxygen saturation. Results: No significant statistical difference was found in demographic data between the two groups. Group BF showed early onset of the sensory block with a P value of 0.001. Time taken to attain peak sensory level was early in the BF group with a P value of 0.001. The total duration of sensory block and duration of effective analgesia was longer in the BF group with a P value of 0.001. The onset of motor blockade was early in the bupivacaine only group with a P value of 0.02. Conclusion: The intrathecal fentanyl 25mcg reduces the dose of 7.5 mg of 0.5% hyperbaric Bupivacaine for spinal anesthesia in cesarean section, thus reducing the incidence of side effects associated with it. By its synergistic effect with 0.5% hyperbaric bupivacaine, it provides better excellent sensory blockade and postoperative analgesia, good hemodynamic stability, less incidence of complications like Nausea, vomiting, and shivering without compromising the safety of mother and fetus in comparison to intrathecal 10mg of 0.5% hyperbaric Bupivacaine alone.

Application of Gunja (Abrus precatorius Linn.) Beeja lepa: An Ayurvedic protocol for the treatment of Gridhrasi (sciatica)

The most common musculoskeletal disorder affecting the movement of legs is low back pain. Among the affected patients, 40% have ridiculer pain, and these cases can be classified under the umbrella of the sciatic syndrome. Low back pain is extraordinarily common, frequently resulting from degenerative arthritis of the lumbosacral spine. The annual prevalence of disc-related sciatica in the general population is estimated at 2.2%. Sciatica is characterised by constant aching pain which felt in the lumbar region may radiate to the buttock, thigh, calf and foot. Acharaya Charaka explained Gridhrasi in eighty types of nanatmaja Vata vikara. The present study is aimed at evaluating the effect of Gunja (Abrus precatorius Linn.) Beeja lepa in the management of Gridhrasi (Sciatica) and thereby assessing the changes in quality life. The present study is designed as a Non-randomized controlled clinical study, in which a minimum of 30 patients will be enrolled. Gunja beej lepa will be administered external application two times in a day with lukewarm water. Assessment will be recorded on the 3rd, 5th, 7th, 14th and 28th day. Changes will be observed in subjective parameters such as Ruk (pain) Toda (pin pricking sensation) Stambha (Stiffness), Spandana (Fasciculation) and objective parameters such as measuring the changes in the angle of elevation of the leg by SLR Test, Sciatica Bothersomeness Index and Sciatica Frequency Index before and after the treatment. Suitable conclusion will be drawn post completion of the trial.

Cyberchondria: Technology-mediated expression of hypochondriasis

Cyberchondria involves excessive indulgence in online health-related platforms for information. This trend becomes more due to the presence of easy access to Internet and availability of health portals. A 34-year-old male presented with the complaints of pricking and spasm-like sensation in his throat and fear of developing cancer of the mouth or throat for the past year and excessive use of Internet. The case was assessed using clinical interview and Cyberchondria Severity Scale. It revealed the presence of excessiveness, distress, and reassurance related to online health research. These characteristics are being seen in cases with hypochondriasis. The case implies for screening and evolving psychoeducational approach to manage cyberchondria.

Effect of Panchatikta Panchaprasritika Basti (Medicated Enema Therapy) in the Management of Photodermatoses: A Case Study

Photodermatoses is a skin disease that is caused by exposure to sunlight. People with photodermatoses may develop skin rashes following exposure to the sun. This manifestation is most likely due to an abnormal immune system reaction to the sun. There is no exclusive description for this condition in Ayurveda, but all pathological skin manifestations are described under the heading of Kustha (~skin diseases). As, the symptoms of photodermatoses are predominant in Vata pitta, the condition can be managed accordingly. The present case of Photodermatoses is treated with Panchatikta pancha prasratika basti, topical application of Go-ghrita, and internal administration of Kaishor guggulu and Manjistadi kwatha. Significant relief was found in Kandu (~itching), Daha (~burning sensation), Toda (~pricking sensation), Shyava aruna varnata (~blackish red hyper pigmentation), Rukshata (~dryness), Utsedha (~skin thickening), Srava (~discharge) and Twak nirmochana (~scaling of skin). Considering the satisfactory results in the present case; similar strategies can be adopted in suitable cases of photodermatoses in larger sample size to generate evidences and disseminate usefulness of traditional interventions in the management of photodermatoses.

T26. Clinical, neurophysiological features of neuropathies induced by abuse of nitrous oxide

Introduction Nitrous Oxide (N2O) is a kind of oxidant, which has been used as an inhalation anesthetic agent for pain and surgery. It is usually inhaled from a balloon and it’s known to precipitate vitamin B12 deficiency and may cause neurologic, hematologic and reproductive disorders. Methods Two cases with neuropathies induced by abuse of N2O admitted to our hospital were studied. The clinical and neurophysiological data were analyzed. Results Case 1: A 21 years old male patient developed lower limb weakness and numbness in both feet with walking unsteadily, following twice a week inhalation of N2O for one month. Neurological examination demonstrated both lower extremities weakness, left more than right, distal more than proximal. Sensory disturbances were found at below the ankles. Ankle reflexes were absent on both sides. Blood routine was normal; folic acid: 7.07 ng/ml, Vitamin B12: 116 pg/ml; CSF analysis and Immune tests were normal, MRI of lumbar and thoracic was normal. EMG showed denervation potentials in both TA and MG muscles; NCS showed the amplitudes of CMAPs of peroneal and tibial nerves were reduced, but MCV and distal latencies were normal. SCS and F waves were within normal ranges. H reflexes were absent bilaterally. He was treated with mecobalamin for 2 weeks and fully recovered. Case 2: A 17 years old female patient developed weakness and paresthesias in both legs and numbness in both hands following intermittent inhalation of N2O for 6 months. On examinations the muscle strength of ankle dorsal and planter flexions were 1/5, knee flexions and extensions were 4/5 pin prick sensation was reduced at below knees. Knee and ankle reflexes were absent bilaterally. Blood routine was normal. Vitamin B12 was at subnormal lever. CSF analysis and GM1 and GQ1b tests were normal. NCS showed absent of CMAP of both peroneal and tibial nerves. F waves were absent and sensory nerve conduction studies were normal. H reflexes were absent bilaterally. She was also treated with mecobalamin for one month with substantial clinical improvement. Conclusion The distinctive clinical and neurophysiology pattern of N2O induced neuropathies demonstrate an acute, motor severer than sensory, length dependent, axonal polyneuropathy. Its severity is related to the amount of N2O abused. The patients improved substantially after vitamin B12 supplement when the patients abstained from further nitrous oxide abuse.

A Pocket-Friendly and Sustainable Iontophoresis Apparatus for Palmoplantar Hyperhidrosis: Advancement over a Previously Described Homemade Design.

Introduction and Objectives:Tap water iontophoresis is a promising therapy for palmoplantar hyperhidrosis. Non-affordability and nonavailability of the marketed device restrict its usage for many patients hailing from villages or small cities.Materials and Methods:In an article named “A simple user-made iontophoresis device for palmoplantar hyperhidrosis” published previously in this journal, a simple inexpensive homemade device that runs on 12 V direct current battery was described. We made a small modification by using a 220–12 V alternate current to direct current semiconductor diode–based transformer for the current supply.Results:The added innovation made the device lightweight, cheaper, and usable with domestic electric supply at home/clinic. Sustained supply of current at same voltage without dip and non-requirement to change/replace battery are added advantages. Cost of the whole assembly is ₹310. Working and clinical efficacy of our device were comparable to the commercially available apparatus as reported by 13 patients who received thrice a week of 15min sessions with our device. Mild electric pricking sensation was felt by all patients. Four of thirteen reported that pricking sensation was a bit more with our device as compared to the marketed device. No calibration for intensity is available in our device.Conclusion:This simple to assemble and inexpensive device makes iontophoresis applicable in many needy patients with similar efficacy and few limitations compared to expensive marketed devices.

Nekritična primena nesteroidnih antinflamatornih lekova u terapiji hroničnog nemalignog bola - nekritična primena Nsail

Introduction: Pain is a subjective experience. Perception of the pain intensity is influenced by multiple factors including genetic, socio-economic and psychological factors. Chronic non-cancer pain represents the socioeconomic burden. In adolescent population, osteoid osteoma has an incidence of 10-12% in all symptomatic benign bone tumors. Nonsteroid anti-inflammatory drugs (NSAIDs) are the most frequently used medications for non-cancer pain treatment. Case report: Male, 17 years old, complained about moderate low back pain. Clinical examination was performed and subsequent diagnostic procedures (ultrasound examination of abdomen, nuclear magnetic resonance examination, and radiographic examination of lumbal spine) revealed discopathia and left leg sensory neuropathy. After examination by a pediatrician, physical medicine specialist and an orthopedic surgeon, he started using analgesic (ibuprofen 600 mg), vitamins and physical treatment. Diclofenac 75 mg was added for severe pain management. Haematuria, eosinophylia, decreased creatinine clearance were consequences of NSAIDs toxic nephritis. NSAIDs were stopped and patient reffered to pain specialist - different focuses of pain were suspected. Subspecialist verified pricking and heating sensation in upper leg, severe hip pain without functional deficit and dominating neuropathic pain originating from spinal nerve compression. New radiography reveiled presence of osteoid osteoma of the hip, and after orthopedic consultation, surgery (biopsy of tumor and tumor extirpation) was performed. In the postoperative period, strong pain disappeared, pregabalin was introduced and neuropathic pain was reduced by 20% and low back pain by 30%. Discussion: NSAIDs are the first line treatment of wide range of pain states. NSAIDs can cause numerous serious side effects including acute interstitial nephritis. Conclusion: Multiple causes and types of pain can exist simultaneously, therefore detailed physical examination, followed by other diagnostic Pre primene analgetika, neophodno je izvršiti detaljan klinički pregled i dijagnostičke pretrage, čime bi se smanjila nekritična primena NSAIL.