Satisfactory Relief Research Articles

A service evaluation of FODMAP restriction, FODMAP reintroduction and long-term follow-up in the dietary management of irritable bowel syndrome.

The dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), called the low-FODMAP diet (LFD), is frequently used to manage irritable bowel syndrome (IBS). This service evaluation aimed to assess the long-term effectiveness of the LFD in managing IBS symptoms and whether symptom response and dietary adherence to the LFD were associated. This observational service evaluation collected data via questionnaires during clinical dietetic appointments for IBS management. Symptom severity was reported at baseline, short term (following FODMAP restriction) and long term (following FODMAP reintroduction). Additional data that captured experiences following the LFD were collected at long-term follow-up. Of 184 patients, 14% reported satisfactory relief from global symptoms at baseline, which increased to 69% at short-term follow-up and 57% at long-term follow-up (p < 0.001). The most notable improvements in individual symptoms between baseline and long-term follow-up were abdominal bloating (72% baseline, 48% long term, p < 0.001), abdominal pain (61% baseline, 30% long term, p < 0.001) and flatulence (71% baseline, 40% long term, p < 0.001). High adherence with the LFD at short-term follow-up was not associated with long-term symptom improvement, but there was an association between long-term adherence and global symptom severity (p = 0.032). Completion of FODMAP reintroduction as per protocol was associated with long-term symptom improvement (p = 0.049). The LFD is an effective treatment for managing IBS symptoms in the long term, particularly, when the diet is adhered to and reintroduction is completed as per dietetic education. Further randomised-controlled trials are required to explore the cause-and-effect relationship between LFD and IBS symptom management.

Higher skin sympathetic nerve activity as a potential predictor of overactive bladder in females refractory to oral monotherapy.

This study investigates predictors of unsatisfactory outcomes in female overactive bladder (OAB) patients treated with oral monotherapy by analyzing skin sympathetic nerve activity (SKNA) using a novel "neuECG" method. The study included 55 newly diagnosed female patients with idiopathic OAB, autonomic function was evaluated using neuECG before treatment initiation, and validated OAB questionnaires and urodynamic studies were administered. Initial monotherapy was administered for the first 4 weeks, with non-responders defined as patients not achieving satisfactory symptom relief and requiring further treatment. Responders (n = 32) and non-responders (n = 23) had no significant differences in baseline characteristics or urodynamic parameters; however, non-responders exhibited significantly higher baseline average SKNA (aSKNA) (1.36 ± 0.49 vs. 0.97 ± 0.29 μV, p = 0.001), higher recovery aSKNA (1.28 ± 0.46 vs. 0.97 ± 0.35 μV, p = 0.007), and a lower stress/baseline ratio of aSKNA (1.05 ± 0.42 vs. 1.26 ± 0.26, p = 0.029). Baseline aSKNA had the highest predictive value for monotherapy refractoriness in OAB (AUROC = 0.759, p = 0.001), with an optimal cut-off point of >1.032 μV. These findings suggest that elevated pre-treatment aSKNA can predict resistance to oral monotherapy in OAB, warranting close monitoring and proactive treatment strategies for patients with high aSKNA.

Comparison of 4-week versus 8-week dietitian-led FODMAP diet group education sessions in tertiary care clinical practice for irritable bowel syndrome: A service evaluation.

The implementation of the fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet for irritable bowel syndrome (IBS) can be effectively delivered by dietitians in group settings. The initial FODMAP restriction phase is recommended to be followed for 4 weeks; however, limited efficacy data exist for 4-week FODMAP restriction in group education clinical practice. We aimed to compare 4-week versus 8-week FODMAP group treatment pathways on clinical outcomes using a prospective service evaluation design of IBS patients attending FODMAP restriction (baseline) and reintroduction (follow-up) group sessions (between 2015 and 2019). Clinical outcomes included global symptom question (GSQ) measuring satisfactory relief, gastrointestinal symptom rating scale (GSRS), stool frequency (SF), stool consistency using Bristol stool form scale (BSFS), diet acceptability, patient satisfaction with group sessions and dietary adherence. Logistic regression was used to test for differences in treatment effects when clinical outcomes were compared between groups. Patients (n = 284) included were aged 18 to 86 years (mean ± SD [standard deviation], 44.6 ± 15.5), 80% female, and were split into 4-week (41%, 117/284) versus 8-week (59%, 167/284) pathways with no differences in baseline characteristics. Mean ± SD time gap between baseline and follow-up was 4.6 ± 0.9 weeks in the 4-week pathway and 9.6 ± 3.3 weeks in the 8-week pathway. When groups were compared at follow-up, no statistical differences were observed in any measures (GSQ, GSRS, SF, BSFS, dietary adherence, diet acceptability and patient satisfaction). A 4-week dietitian-led group FODMAP treatment pathway is as clinically effective and maintains patient acceptability when compared to 8-weeks and should be considered as part of routine clinical practice.

Frequency-Selective Suppression of Essential Tremor via Transcutaneous Spinal Cord Stimulation.

Essential tremor (ET) is a common debilitating condition, yet current treatments often fail to provide satisfactory relief. Transcutaneous spinal cord electrical stimulation (tSCS) has emerged as a potential noninvasive neuromodulation technique capable of disrupting the oscillatory activity underlying tremors. This study aimed to investigate the potential of tSCS to disrupt tremor in a frequency-dependent manner in a cohort of patients with ET. Eighteen patients with ET completed the study. The experiment consisted of 60-s postural tremor recording, during tSCS at tremor frequency, at 1 Hz, at 21 Hz, no stimulation, and trapezius stimulation. Tremor frequency and amplitude were analyzed and compared across the conditions. We found tremor amplitude reduction at tremor frequency stimulation significant only during the second half of the stimulation. The same stimulation resulted in the highest number of responders. tSCS at 1 Hz showed a trend toward decreased tremor amplitude in the latter half of stimulation. tSCS at 21 Hz did not produce any significant alterations in tremor, whereas trapezius stimulation exacerbated it. Notably, during tremor frequency stimulation, a subgroup of responders exhibited consistent synchronization between tremor phase and delivered stimulation, indicating tremor entrainment. Cervical tSCS holds promise for alleviating postural tremor in patients with ET when delivered at the subject's tremor frequency. The observed changes in tremor amplitude likely result from the modulation of spinal cord circuits by tSCS, which disrupts the oscillatory drive to muscles by affecting afferent pathways or spinal reflexes. However, the possibility of an interplay between spinal and supraspinal centers cannot be discounted. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Tendon transfers for the management of irreparable subscapularis tears.

Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the subscapularis tendon, the symptoms are usually more severe and the prognosis after surgery must be guarded. Isolated subscapularis tears represent 18% of all rotator cuff tears and arthroscopic repair is a good alternative primary treatment. However, when the tendon is deemed irreparable, tendon transfers are the only option for younger or high-functioning patients. The aim of this review is to describe the indications, biomechanical principles, and outcomes which have been reported for tendon transfers, which are available for the treatment of irreparable subscapularis tears. The best tendon to be transferred remains controversial. Pectoralis major transfer was described more than 30 years ago to treat patients with failed surgery for instability of the shoulder. It has subsequently been used extensively to manage irreparable subscapularis tendon tears in many clinical settings. Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its position in the axial plane - anterior to the rib cage - is clearly different and does not allow it to function as an ideal transfer. Consistent relief of pain and moderate recovery of strength and function have been reported following the use of this transfer. In an attempt to improve on these results, latissimus dorsi tendon transfer was proposed as an alternative and the technique has evolved from an open to an arthroscopic procedure. Satisfactory relief of pain and improvements in functional shoulder scores have recently been reported following its use. Both pectoralis minor and upper trapezius transfers have also been used in these patients, but the outcomes that have been reported do not support their widespread use.

The role of inflammation and oxidative stress in the pathophysiology of depressions: time to consider vitamin C deficiency

Depression is on the rise and medication does not always provide satisfactory relief. This raises the question of a treatment gap that has not yet been (sufficiently) addressed. Inflammation and oxidative stress play an important pathophysiological role, which also leads to a deficiency of antioxidants such as vitamin C. This perspective mini-review reflects the results of a PubMed search combining the search terms depression with inflammation, oxidative stress and vitamin C. Vitamin C is an important antioxidant and co-factor for many neuronal metabolic and epigenetic pathways, and a deficiency is associated with depression and cognitive disorders. Inadequate vitamin C blood levels that do not yet result in somatic symptoms may induce neuropsychiatric scurvy, which is associated with increased neuroinflammation and characterized by depression and cognitive impairment. Experimental studies show that vitamin C has multifactorial effects on metabolic pathways relevant to depression. Treatment of vitamin C deficiency, which is more common than appreciated, should be considered in the management of depressed patients. Further studies should investigate whether the pharmacological administration of vitamin C has additional effects beyond the correction of deficiency.

Protocol of a randomized controlled study to evaluate the efficacy of Shwadanshtradi Taila Abhyanga in pain management of Janusandhigata Vata vis-à-vis knee osteoarthritis

Abstract BACKGROUND: Knee osteoarthritis (OA) is one of the leading causes of disability globally and is generally managed by various pharmacological modalities like analgesics, supplementations, intra-articular injections, physiotherapy, and self-management strategies. Ayurveda offers numerous interventions for the management of symptoms of OA. Abhyanga (massage with oil) is one of the clinically effective modalities for pain management in Janu Sandhigata Vata which is similar to the presentation of OA. However, the effect of Abhyanga with Shwadanshtradi Taila alone (without any internal medication), in reducing the severity of pain due to knee OA, in a specified duration, needs to be evaluated. OBJECTIVE: To evaluate the efficacy of Abhyanga with Shwadanshtradi Taila for seven days in relieving pain due to Janusandhigata Vata vis-à-vis knee OA. MATERIALS AND METHODS: This study is a single center, prospective, parallel arm, exploratory, single-blind, and randomized controlled clinical trial. Patients aged 35–70 years with persistent knee pain, morning stiffness under 30 min, and suspected or diagnosed unilateral or bilateral knee OA, those who are not taking regular anti-inflammatory/analgesic drugs or are not finding satisfactory relief with conventional treatments, are being included in the study. A total of 62 participants fulfilling the selection criteria will be enrolled in the study and allocated randomly to one of the two study arms. Participants are administered either Shwadanshtradi Taila or Tila Taila for Abhyanga (external oil massage) on the affected Janu Sandhi (knee joint) twice daily for seven days. The outcomes of the study include the severity of pain assessed by the visual analog scale (VAS) and change in functional disability assessed by the WOMAC scale and improvement in symptoms of Janu Sandhigata Vata. The outcomes are assessed at baseline, 7th day and 14th day. DISCUSSION: The outcomes of this study will inform about the efficacy of Abhyanga in the management of symptoms especially pain of knee OA in a specified duration of seven days without any internal medication. The study can generate leads for larger studies to prove the effectiveness of this simple and commonly practiced Ayurveda procedure in pain management in various musculoskeletal painful conditions.

Surgical Treatment Outcomes of Anterior-Only Correction and Reconstruction for Severe Cervical Kyphotic Deformity with Neurofibromatosis-1: A Retrospective Study with a 5-Year Follow-Up.

Currently, anterior-only (AO), posterior-only, and combined anterior-posterior spinal fusions are common strategies for treating cervical kyphosis in patients with neurofibromatosis-1 NF-1. Nevertheless, the choice of surgical strategy remains a topic of controversy. The aim of our study is to evaluate the safety and effectiveness of anterior decompression and spinal reconstruction for the treatment of cervical kyphosis in patients with NF-1. Twelve patients with NF-1-associated cervical kyphotic deformity were reviewed retrospectively between January 2010 and April 2020. All patients underwent AO correction and reconstruction. The X-ray was followed up in all these patients to assess the preoperative and postoperative local kyphosis angle (LKA), the global kyphosis angle (GKA), the sagittal vertical axis, and the T1 slope. The visual analog scale score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI) score were used to evaluate the improvement inclinical symptoms. The results of the difference in improvement from preoperatively to the final follow-up assessment were assessed using a paired t-test or Mann-Whitney U-test. The LKA and GKA decreased from the preoperative average of 64.42 (range, 38-86) and 35.50 (range, 10-81) to an average of 16.83 (range, -2 to 46) and 4.25 (range, -22 to 39) postoperatively, respectively. The average correction rates of the LKA and GKA were 76.11% and 111.97%, respectively. All patients had achieved satisfactory relief of neurological symptoms (p < 0.01). JOA scores were improved from 10.42 (range, 8-16) preoperatively to 15.25 (range, 11-18) at final follow-up (p < 0.01). NDI scores were decreased from an average of 23.25 (range, 16-34) preoperatively to an average of 7.08 (range, 3-15) at the final follow-up (p < 0.01). Anterior-only correction and reconstruction is a safe and effective method for correcting cervical kyphosis in NF-1 patients. In fixed cervical kyphosis cases, preoperative skull traction should also be considered.

Efficacy of Tegoprazan in Patients With Functional Dyspepsia: A Prospective, Multicenter, Single-arm Study.

Acid-suppressive drugs, such as proton pump inhibitors (PPIs), are treatment options for functional dyspepsia (FD). However, the efficacy of potassium-competitive acid blockers (P-CABs) in treating FD has not yet been established. This prospective multicenter clinical trial-based study aimed to assess the efficacy and safety of tegoprazan as a P-CAB treatment in patients with FD. FD was diagnosed using the Rome IV criteria. All patients received tegoprazan 50 mg once daily for 8 weeks. Dyspeptic symptoms were assessed using a dyspepsia symptom questionnaire (5-point Likert scale, Nepean Dyspepsia Index-Korean [NDI-K], and gastroesophageal reflux disease-health-related quality of life [GERD-HRQL]). The main outcome was satisfactory symptom relief rates at 8 weeks. In this study, from the initial screening of 209 patients, 173 were included in the per-protocol set analysis. Satisfactory symptom relief rates at 8 and 4 weeks were 86.7% and 74.6%, respectively. In addition, the NDI-K and GERD-HRQL scores significantly improved at 8 and 4 weeks compared with the baseline scores. The efficacy of tegoprazan was not influenced by the FD subtype or Helicobacter pylori status. In patients with overlapping FD and GERD, there was a greater improvement in the NDI-K and GERD-HRQL scores than in patients with FD symptoms only. No serious drug-related adverse events occurred during this study. Tegoprazan (50 mg) administered once daily provided satisfactory symptom relief for FD.

The influence of depression on clinical outcomes of total shoulder arthroplasty: a systematic Review.

Much of the current literature on total shoulder arthroplasty (TSA) has assessed the impact of preoperative medical comorbidities on postoperative clinical outcomes. The literature concerning the impact of psychological disorders such as depression on TSA has increased in popularity in recent years, but there lacks a thorough review of the influence of depression on postoperative pain and functional outcomes. We queried PubMed/MEDLINE and identified six clinical studies that evaluated the influence of a psychiatric diagnosis of depression on patient outcomes after TSA. Studies that discussed the impacts of depression on TSA, including PROs or adverse events in adults, were included. Studies focused on other psychologic pathology, non-TSA shoulder treatments, or TSA not for primary osteoarthritis were excluded. Non-clinical studies, systematic reviews, letters to the editor, commentaries, dissertations, books, and book chapters were excluded. Three cohort studies described patient-reported pain and functional outcomes and three database studies assessed the risk of postoperative complications. Cohort studies demonstrated that the prevalence of depression in patients undergoing TSA decreased from preoperatively to 12-months postoperatively. Two studies demonstrated that depression is an independent predictor of less pre- to postoperative improvement in the ASES score at minimum 2-year follow-up; however, one study found the difference between patients with and without depression did not exceed the minimum clinically important difference. Database studies demonstrated that depression was associated with higher rates of blood transfusion (n = 1, OR = 1.8), anemia (n = 1, OR = 1.65), wound infection (n = 2, OR = 1.41-2.09), prosthetic revision (n = 1, OR = 1.92), and length of hospital stay (n = 3, LOS = 2.5-3days). Although patients with a preoperative diagnosis of depression undergoing TSA can achieve satisfactory relief of shoulder pain and restoration of function, they may experience poorer patient-reported outcomes and a higher risk of postoperative adverse events compared to their peers. Surgeons should be cognizant of the influence of depression in their patients to facilitate proper patient selection that maximizes patient satisfaction, function, and minimizes the risk of adverse events following TSA. Level IV.

DOES LIPOSUCTION FOR LYMPHEDEMA WORSEN LYMPHATIC INJURY?

Liposuction for treatment of lymphedema is an effective and time-tested treatment. However, as there is a fear regarding further lymphatic damage caused by liposuction, we objectively compared lymphatic function pre- and post-liposuction. All patients with solid-predominant lymphedema who were treated during the study period of June 2014 and November 2018 were included. Patients were assessed using patient-reported baselines/outcomes, lymphedema- specific quality of life scale (LYMQOL), limb circumference/volume measurements, and indocyanine green lymphography (ICGL) preoperatively and at predefined postoperative time intervals. Fifty-seven limbs from 41 patients were included. Mean lipoaspirate volumes were 2035 mL, 5385 mL, and 3106 mL for the arm, thigh, and leg, respectively with a mean adipose fraction of the lipoaspirate of 71%. All patients underwent redundant skin excision with the “flying squirrel” technique. The mean follow-up was 10.7 months (range 3 – 48 months) with a mean limb volume reduction of 32.2% and all patients reporting satisfactory relief of symptoms. All showed statistically significant improvement in LYMQOL in symptoms, appearance, and function. On ICGL, none showed worsened lymphatic drainage, rather, all showed improved lymph drainage. Furthermore, the improved lymph drainage was found to be progressive during the study period in all patients. Our study results demonstrate that treating extremity lymphedema with liposuction does not worsen lymphatic function and in fact, paradoxically, it induces progressive improvement in lymph drainage.

A dietitian-led low-FODMAP diet webinar: a pre-post study evaluating its impact on symptoms of irritable bowel syndrome.

Evidence suggests that the low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet improves irritable bowel syndrome (IBS) symptoms when delivered by a dietitian. However, demand for dietetic appointments exceeds supply. Prerecorded webinars are acceptable and cost-effective for delivering first-line IBS dietary advice. This study, using a pre-post design, aimed to evaluate the effectiveness of a low-FODMAP diet restriction phase webinar at improving IBS symptoms. Participants with self-reported IBS symptoms were asked to report their IBS symptoms, stool frequency, stool consistency and IBS medication use, before and 8 weeks postwebinar via an online questionnaire. The presence and severity of participants' symptoms and bowel habits were captured using validated tools and a global symptom question. In total 228 participants responded to both pre- and postsurveys. A statistically significant improvement in all symptoms was observed 8 weeks postwebinar (p < 0.05). The proportion of participants rating their overall symptoms as moderate-to-severe reduced from 85.5% at baseline to 34.6% postwebinar (50.9% reduction [p < 0.001]). The proportion of participants reporting normal stool consistency and frequency significantly increased postwebinar (23.2%-39.9% [p < 0.001] and 76.3%-89% [p < 0.001], respectively). Satisfactory relief of symptoms increased from 16.7% to 53.1%, (p < 0.001) 8 weeks postwebinar. These results are comparable with literature on the efficacy of face-to-face delivery of low-FODMAP diet education. Dietitians should consider directing triaged patients with IBS, who have tried first-line dietary advice, to this webinar as an alternative or alongside current practice.

Trends of Proton Pump Inhibitor Uses among Pharmaceutical Promotional Workers

Background: Proton pump inhibitors (PPIs) are one of the most frequently used drugs in the world for the management of gastric- acid related diseases. The aim of this study was to assess the trend of PPIs uses among the pharmaceutical promotional workers in Bangladesh. Methods: A questionnaire-based survey was conducted on pharmaceutical promotional workers from different regions in Bangladesh. The study data were collected which includes demographics, PPIs uses in terms of duration, dose, generics, symptoms for which they took PPIs and effects of PPIs on symptoms. Drugs or diseases that influenced the intake of PPIs were also recorded. Results: Among six hundred surveys issued for the study, 581 valid questionnaires were returned. Among the respondents 520 individuals (89.5%) were male and 61 individuals (10.5%) were female. Common indications for taking PPIs were abdominal discomfort (51.5%), vomiting (34.1%) and abdominal pain (24.6%). Two hundred seventy (48.56%) respondents had satisfactory relief of symptoms, 125 (22.48%) had symptoms reappeared after stopping PPIs and 77 (13.85%) had complete cure of symptoms. Most of the participants (42.60%) were on PPIs therapy for up to one year. Most of the participants (64.49%) took PPI once daily. Most of the participants (60.75%) started PPI by themselves. Esomeprazole (40.1%) and rabeprazole (30.1%) were the most frequently used PPIs. Conclusion: PPI is found to be a frequently used medication among pharmaceutical promotional workers. Further well-designed study with adequate work up may be designed to see misuse and overuse of PPI among workers of pharmaceutical sector as well as general population. Sir Salimullah Med Coll J 2023; 31: 41-46

Ayurvedic Management of Hypothyroidism - A Case Report

Hypothyroidism is the significant endocrine problem found in general public. It is characterized by insufficient production of thyroid hormones, leading to abnormal levels. This condition prompts the decrease in Basal metabolic rate of the body. Ayurveda places a significant part to preclude the basic reason and to treat it. In Ayurveda, it tends to be associated with Kapha-vata dosha dushti, Rasavaha Strotasadushti, Medadushti and Agnimandya. In present study, a 22 years old female patient suffering from Sthaulya (~Weight gain), Duarbalya (~Weakness), Twak rukshata (~Dry skin), Kesh patana (hair loss), puffiness around eyes, mood swings, impaired memory, emotional depression, drowsiness, headache, Amalapitta (~Hyperacidity) and lethargy from last three years. She had been taking allopathic medicine without experiencing any satisfactory relief in her symptoms. In the present study, group of Herbo-mineral preparation was prescribed to the patient for a period of 4 months. After four months patient experienced relief, and her allopathic medicine was completely stopped. Keywords: Hypothyroidism, Agnimandya, Sthaulya

Hearing Results after Transmastoid Superior Semicircular Canal Plugging for Superior Semicircular Canal Dehiscence: A Meta-Analysis.

The transmastoid plugging of a superior semicircular canal is considered a safe and effective technique for the management of superior semicircular canal dehiscence (SSCD). The aim of this meta-analysis is to assess the postoperative hearing outcomes after the transmastoid plugging of the superior semicircular canal. Search method and data sources: A systematic database search was performed on the following databases until 30 January 2023: MEDLINE, Embase, Cochrane Library, Web of Science, CINAHL, ICTRP, and clinicaltrials.gov. A systematic literature review and meta-analysis of the pooled data were conducted. We also included a consecutive case series with SCDS for those who underwent transmastoid plugging treatment at our clinic. We identified 643 citations and examined 358 full abstracts and 88 full manuscripts. A total of 16 studies were eligible for the systematic review and 11 studies for the meta-analysis. Furthermore, 159 ears (152 patients) were included. The postoperative mean air conduction threshold remained unchanged (mean difference, 2.89 dB; 95% CI: -0.05, 5.84 dB, p = 0.58), while the mean bone conduction threshold was significantly worse (mean difference, -3.53 dB; 95% CI, -6.1, -0.95 dB, p = 0.9). The transmastoid plugging technique for superior semicircular canal dehiscence syndrome, although minimally worsening the inner ear threshold, is a safe procedure in terms of hearing preservation and satisfactory symptom relief.

Clinical Outcome and Patterns of Failure in Patients with Solitary Plasmacytoma Treated with Radical Radiotherapy

We intended to assess the patterns of care and failure in patients with solitary plasmacytoma (SP), treated at our institute from 2011-21. Data pertaining to the management of patients with SP was abstracted by retrospective chart review. Progression free survival (PFS) and overall survival (OS) were defined as the time intervals from the date of diagnosis to the date of progression (local, systemic or both) and death or last follow up, respectively. PFS and OS were analyzed by Kaplan Meier method. Atotal of 72 patients were diagnosed with SP (61-bone plasmacytoma; 11-extramedullary plasmacytoma) in between 2011 and 2021. The median age at diagnosis was 52 years. The male: female ratio was 2.27. The ECOG PS were 0, 1, 2, 3, and 4 in 1, 46, 11, 10, and 3 patients, respectively. The median diameter of the lesion was 6.7 cm (range 2.3-18.4 cm). The median M protein was 0.375 g/dl (range 0.63-5.3 g/dl). On bone marrow examination, 8 and 64 patients had no and minimal marrow involvement, respectively (median bone marrow plasma cells 4%). Radical radiotherapy (RT) was administered in 71 patients, the techniques being 2D-conventional in 35, 3D-conformal in 14, IMRT in 8 and VMAT in 5 patients (details not available in 9). The median RT dose was 45 Gy in 25 fractions over 5 weeks (range 45-50 Gy). In addition, 5(7%) patients underwent surgery prior to RT and 6(8.5%) patients received systemic chemotherapy. After RT, the median quantum of symptom relief was 75% (range 0-100%). The best response to RT was CR, PR, SD and PD in 41(57.7%),18(25.4%),3(4.2%) and 4(5.6%) patients, respectively (response assessment could not be done in 5). Local control with primary RT was achieved in 58(81.7%) patients. No RT related grade 3/4 acute or late toxicity was reported. The median follow up was 48.3 months (range 1.3-141.6 months). A total of 28(39.4%) patients experienced disease progression (systemic in 15, local in 7 and both in 6), out of which 13 could be successfully salvaged with further systemic chemotherapy (mostly bortezomib, lenalidomide/pomalidomide and dexamethasone based) with or without local treatment. On progression to multiple myeloma, 9 patients underwent high dose chemotherapy(melphalan) followed by autologous stem cell transplant. Nine (12.7%) patients died, the causes being COVID-19 infection in 1, surgical complications in 1, PD in 2, second malignancies in 3 and unknown in 2. The actuarial rates of PFS & OS were 58.4% & 92.5% at 3 years and 50.3% & 89.4% at 5 years, respectively. Metachronous second malignancies were noted in 4 patients (B-ALL-1, lung cancer-1, metastatic carcinoma cervix-1, metastatic carcinoma gall bladder-1). In patients with SP, radical RT with a modest dose (45-50 Gy) leads to satisfactory symptom relief, response and local control. Close to 40% patients eventually progress to multiple myeloma, out of which 50% can be successfully salvaged with further systemic chemotherapy. The 5-year OS approaches 90% in this cohort.

Outcome of Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) with Doppler Guidance for Symptomatic Grade-II, III and IV Internal Haemorrhoids

Background: Internal haemorrhoids are very common all around the world and the classical surgical treatment is open haemorrhoidectomy for a long time. This procedure has a lot of complications and is very painful for the patient. Doppler guided HAL-RAR has shown satisfactory results in the literature with minimal pain and a significantly lower rate of complications compared to open haemorrhoidectomy .&#x0D; Objective: To assess the outcome of a relatively new surgical procedure (HAL-RAR) using doppler guidance for the treatment of grade-II, III and IV internal haemorrhoids.&#x0D; Methods: This case series was conducted at Surgimed hospital, Lahore, Pakistan, between May 2015 to December 2021. One hundred patients who attended the outpatient department of the hospital were recruited for this study. These patients presented with grade-II, III or IV symptomatic internal haemorrhoids. Surgical intervention in the form of HAL-RAR was performed in all patients and outcome was measured in terms of mean operating time, length of hospital stays, post-operative pain, recurrence of prolapse and bleeding, and early and late post-operative complications with one year follow up for all patients. &#x0D; Results: Out of these 100 patients, 72 were males and 28 were females. On average, seven haemorrhoidal artery ligations and three recto anal repairs were performed in each patient. The average hospital stay was 31 hours with a range between 24 hours to 72 hours. Early post-operative pain was minimum and only twelve patients required narcotic analgesics. Three patients complained of excessive pain lasting for five days. Seven patients had self-limiting bleeding, two patients had post-operative bleeding which was controlled by re-ligation of the bleeding point and one patient developed a perianal fistula. In the long term follow up, one patient had recurrence of prolapse six months after the surgery. &#x0D; Conclusion: HAL-RAR with doppler was a safe and efficient method for treatment of grade-II, III and IV internal haemorrhoids, with very low post-operative pain scores, satisfactory relief of symptoms, and low recurrence rates.&#x0D;

Therapeutic Effect of Polyherbal Formulation in The Management of Tamaka Śwāsa (Bronchial Asthma)

Tamaka Śwāsa is one among the 5 different respiratory disorders described elaborately in classics of Ayurveda having close resemblance to Bronchial Asthma. With time several polyherbal formulation modalities are found to be well-accepted, safe and effective in asthma due to multiple blocking and homeostasis of very complex, interdependent cellular, mediator networks supporting and involved in the inflammatory process. An open clinical trial was conducted with polyherbal formulation on 100 patients at Government Ayurvedic College &amp; Hospital, Guwahati, Assam-781014,India to assist the therapeutic effect in the management of Tamaka Śwāsa (Bronchial Asthma). The therapeutic effect showed statistically extremely satisfactory relief symptomatically along with improvement in Peak Expiratory Flow Rate, Breath Holding Time to be statistically highly significant suggestive of bronchodilator effect and statistically reduction in ESR, AEC showed anti-allergic, anti-inflammatory effect. During the course of the clinical study of the trial drug no adverse reaction or side effect was observed in any of the patients and overall therapeutic response was encouraging. Thus, it is found that the polyherbal formulation is safe and ideal in the management of Tamaka Śwāsa (Bronchial Asthma).

An ayurvedic management of Tamakshwasa with special reference to bronchial asthma: A case study

Bronchial asthma is a chronic inflammatory disease of respiratory tract with airway hyper responsiveness producing symptoms such as wheezing, cough and dyspnea. Exposure to the dust, smoke, respiratory infections, new dietic preparation, stress and change in climate are some of the causative factors of Bronchial Asthma. In Modern medicine there is no permanent cure for asthma, only symptoms can be. If it is left untreated or not treated in time,it is fatal in nature. Although various studies have been performed across the globe in last few decades and some good drugs are discovered. Due to changes in life style and change in environment, mainly pollution, study shows clear indication that the prevalence of Shwasa (Bronchial Asthma) has increased significantly in all age groups. Tamakshwasa is of 5 types of Shwasa , which is said to be Kashtasadhya or Yapya by Madhavnidan. Presently, nebulization is the fastest way of relieving the symptom of Shwaskashtata in Bronchial Asthma, for which bronchodilator and steroidal preparations are widely used. But they have some ill effects when used for prolonged period. A 40-year-old female having increase in symptoms of Shortness of breath, Expiratory wheezes, Chest pressure sensation, Patient had taken allopathic medicine for 1 month, but she had no satisfactory relief. Shaman and Shodhan as ApunarbhavChikitsa is given. Significant improvement observed in subjective and objective parameters.

Arthroscopic debridement of the extensor carpi radialis brevis

Surgical treatment of lateral epicondylitis is reserved for patients who, despite extensive conservative therapy, do not experience satisfactory relief of symptoms. As an alternative to the open procedure, arthroscopic debridement of the extensor carpi radialis brevis (ECRB) muscle is asimple and standardized procedure. The arthroscopic approach also enables the additional treatment of intra-articular pathologies such as loose bodies or osteochondral lesions. After diagnostic arthroscopy, the attachment of the ECRB is visualized via the anteromedial portal, so that under visual control the debridement of the tendon fibers of the ECRB and its bony insertion site can be performed via the anterolateral portal. Postoperatively, there is no restriction of movement of the elbow joint. The outcome after arthroscopic ECRB debridement described in the literature is equivalent to that of other surgical techniques.