Significant Symptomatic Relief Research Articles

Comparison of Treatment Outcome of Ganciclovir Ophthalmic Gel and Moxifloxacin Eye Drop in Acute Adenoviral Keratoconjunctivitis

Adenoviral ophthalmic infection is a self-limiting, highly contagious, very frequent infectious process. It can present in three acute clinical forms: nonspecific acute follicular conjunctivitis, pharyngo-conjunctival fever and epidemic keratoconjunctivitis. This study aims to assess and compare the efficacy of 0.15% ganciclovir gel with Moxifloxacin eye drop in the treatment of acute adenoviral keratoconjunctivitis.This longitudinal prospective study was conducted among 40 patients of acute adenoviral keratoconjuctivitis attending in the cornea clinic of National Institute of Ophthalmology & Hospital (NIOH), Dhaka, Bangladesh. They were randomly divided into two groups: group-I (study group) with 20 patients who used 0.15% ganciclovir gel and group-ii (control group) with 20 patients who used artificial tear and 0.5% moxifloxacin eye drop. Diagnosis was confirmed by expert cornea specialist by methodical ophthalmic examination. They were followed-up on 1,2,4 and 6 weekly. Mean score of symptoms and signs were calculated in every follow-up and compared between two groups. Unpaired t test and chi square test were done in applicable cases with statistical significance p<0.05. This study showed that in study group mean age of the respondents were 36.4±9.59 years and in control group 37±11.02 years. Most of them were male (82.5%). In study group, mean score of symptoms at the beginning of the study was 1.4. It was 1.14, 0.64, 0.20 and 0.04 after1,2,4,6 weeks respectively after starting treatment and in control group mean score of symptoms at the beginning of the study was 1.48. It was 1.46, 1.125,0.59 and 0.23 after1,2,4,6weeks respectively after starting treatment. A trend towards better response was observed in the treatment group and the difference was statically significant. The mean score of signs after starting treatment in group-iwas 1.8.It was 1.35, 0.775, 0.30 and 0.175 after ,2,4,6weeks respectively and in group-ii, mean score of signs at the beginning of the study was 1.675. It was 1.725,1.35,0.725 and 0.300 after 1,2,4,6 weeks respectively after starting treatment. A trend towards improved sings were observed in the study group and the difference was statistically significant at 1 week (p=0.0283), 2 week (p= 0.0003), 4 week (p=0.0016) except 6 week (p=0.1524). At 6th week of treatment improvement of signs occur but not statistically significant because of persistence of some corneal lesion. The significant symptomatic relief and clinical improvement was found in the study group treated with Ganciclovir ophthalmic gel suggesting an effective method for treatment of acute adenoviral keratoconjunctivitis. Mugda Med Coll J. 2024; 7(1): 9-13

Robot-assisted Exploration of the Alcock Canal: A Novel Surgical Technique

ObjectiveTo demonstrate a safe and reproducible surgical approach to the Alcock canal with a full decompression of the pudendal nerve. SettingPudendal neuralgia, a condition causing debilitating pelvic pain, is traditionally managed through a trans-gluteal incision.1-2 This surgical approach offers limited visualization and ability for nerve decompression.3 With the current technique, a full exposure and decompression of the pudendal nerve was achieved. ParticipantsA 44-year-old para 2 with symptoms of left pudendal neuralgia. InterventionsA 44-year-old para 2 presented with burning vaginal pain radiating to the left groin that was aggravated with sitting. She underwent a robotic-assisted left sacrospinous ligament transection and fasciotomy of the obturator internus muscle for suspected pudendal neuralgia. The surgery was performed with three robotic ports using the daVinci® Xi robotic system. ConclusionWith the enhanced access to the pudendal nerve provided by the novel surgical technique demonstrated in this study, a more comprehensive nerve decompression can be performed. This technique was successfully applied to a patient with pudendal neuralgia. There were no immediate intra-operative or post-operative complications. In short-term follow-up, the patient had significant relief of preoperative symptoms. While all surgical procedures for pudendal neuralgia have a risk of pudendal nerve and vessel injury,4 the presented technique has the potential to limit these risks by providing an enhanced view of the relevant anatomy. Future adaptation and refinement of this technique may contribute to the advancement of the surgical management of pudendal neuralgia.

Atopic Dermatitis and Abrocitinib: Unraveling the Therapeutic Potential

Abstract: Atopic dermatitis (AD) is a chronic immune-mediated skin condition seriously affecting both children and adults and impacting their quality of life. This complex condition involves genetic predisposition, immune system impairment, and environmental factors. The Janus kinase signal transducer and activator of transcription (JAK-STAT) pathway plays a key role in AD pathogenesis and progression. Abrocitinib presents a hopeful avenue for managing moderate to severe AD, offering significant symptom relief and potential long-term benefits. Its targeted approach to modulating the JAK-STAT pathway holds promise for improved AD management. This comprehensive review explores AD pathogenesis, the chemistry and clinical pharmacology of Abrocitinib, and its safety and efficacy in various trials.

Analysis of Clinical Features and Treatment of Patients Presenting Dyspepsia Related to COVID-19: Retrospective Chart Review

Objectives: The main purpose of this study is to investigate the clinical characteristics of patients complaining of indigestion after COVID-19 infection (CI) or COVID-19 vaccination (CV) and to confirm the effectiveness and safety of Korean medical treatment.Methods: We retrospectively collected and investigated the medical records of 39 patients admitted to the Kyung Hee University Korean Medicine Hospital with a chief complaint of dyspepsia from January 1, 2020 to February 29, 2024 who reported the onset or significant exacerbation of dyspepsia after CV or CI. Patients were divided into vaccination and infection groups, and their demographic characteristics, Ryodoraku results, presenting symptoms, traditional Korean medicine treatments, and treatment outcomes were analyzed.Results: When comparing the groups with dyspepsia after CV and after CI, it was observed that the CI group had significantly lower average body weight, and the measurements of LH6, LF1, and LF6 in the Ryodoraku test were significantly lower. Additionally, compared to the CV group, the CI group showed significantly more abdominal distension, nausea, and abdominal pain. Significant relief of upper gastrointestinal symptoms was observed in both the CV and CI groups after treatment. No adverse reactions were observed during the course of treatment.Conclusion: The CI group tended to complain more severely of various dyspeptic symptoms and had a tendency to lower body weight than the CV group, as was also reflected in the results of the Ryodoraku test. Korean medical treatment can be effective and safe in treating these patients.

Successful treatment of severe hepatic impairment in erythropoietic protoporphyria: A case report and review of literature

BACKGROUND Erythropoietic protoporphyria (EPP) is a rare genetic disorder stemming from ferrochelatase gene mutations, which leads to abnormal accumulation of protoporphyrin IX primarily in erythrocytes, skin, bone marrow and liver. Although porphyria-related severe liver damage is rare, its consequences can be severe with limited treatment options. CASE SUMMARY This case study highlights a successful intervention for a 35-year-old male with EPP-related liver impairment, employing a combination of red blood cell (RBC) exchange and therapeutic plasma exchange (TPE). The patient experienced significant symptom relief and a decrease in bilirubin levels following multiple PE sessions and an RBC exchange. CONCLUSION The findings suggest that this combined approach holds promise for managing severe hepatic impairment in EPP.

Successful Treatment using OMT for Chronic GERD in a Pediatric Patient

Abstract Gastroesophageal Reflux Disease (GERD) is a highly prevalent gastrointestinal motility disorder affecting 10% to 20% of children in the United States. Many patients affected by this disorder are medically managed with proton pump inhibitors (PPI) and H2 receptor antagonists for prolonged durations. Here we present a pediatric patient with GERD refractory to chronic use of PPI. The patient received Osteopathic Manipulative Treatment (OMT) and had close follow-ups over 5 years. The patient reported significant relief in symptoms and improved daily performance within weeks of treatment. His symptoms are now being fully controlled by OMT without regular medication. This case report illustrates the advantages of utilizing OMT in the pediatric population.

A Multicenter Randomized Controlled Trial of Microbiome-Based Artificial Intelligence-Assisted Personalized Diet vs Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet: A Novel Approach for the Management of Irritable Bowel Syndrome.

Personalized management strategies are pivotal in addressing irritable bowel syndrome (IBS). This multicenter randomized controlled trial focuses on comparing the efficacy of a microbiome-based artificial intelligence-assisted personalized diet (PD) with a low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet (FODMAP) for IBS management. One hundred twenty-one patients participated, with 70 assigned to the PD group and 51 to the FODMAP diet group. IBS subtypes, demographics, symptom severity (IBS-SSS), anxiety, depression, and quality of life (IBS-QOL) were evaluated. Both interventions spanned 6 weeks. The trial's primary outcome was the within-individual difference in IBS-SSS compared between intervention groups. For the primary outcome, there was a change in IBS-SSS of -112.7 for those in the PD group vs -99.9 for those in the FODMAP diet group ( P = 0.29). Significant improvement occurred in IBS-SSS scores ( P < 0.001), frequency ( P < 0.001), abdominal distension ( P < 0.001), and life interference ( P < 0.001) in both groups. In addition, there were significant improvements in anxiety levels and IBS-QOL scores for both groups ( P < 0.001). Importantly, PD was effective in reducing IBS SSS scores across all IBS subtypes IBS-Constipation (IBS-C; P < 0.001), IBS-Diarrhea (IBS-D; P = 0.01), and IBS-Mixed (IBS-M; P < 0.001) while FODMAP diet exhibited comparable improvements in IBS-C ( P = 0.004) and IBS-M ( P < 0.001). PD intervention significantly improved IBS-QOL scores for all subtypes (IBS-C [ P < 0.001], IBS-D [ P < 0.001], and IBS-M [ P = 0.008]) while the FODMAP diet did so for the IBS-C ( P = 0.004) and IBS-D ( P = 0.022). Notably, PD intervention led to significant microbiome diversity shifts ( P < 0.05) and taxa alterations compared with FODMAP diet. The artificial intelligence-assisted PD emerges as a promising approach for comprehensive IBS management. With its ability to address individual variation, the PD approach demonstrates significant symptom relief, enhanced QOL, and notable diversity shifts in the gut microbiome, making it a valuable strategy in the evolving landscape of IBS care.

Supplementation of Amra Beej Majja Churna in Vitamin B12 Deficiency - A Case Study

B12 is an important vitamin needed by red blood cells for maturation and DNA synthesis of myelin- producing oligodendrocytes. It remarkably supports the regeneration of nerves after injury. B12 is also involved in Hcy metabolism, transmethylation processes, fatty acid and nucleic acid synthesis, energy production etc. The symptoms of its deficiency range from glossitis to severe demyelination of nervous tissue. Indian population, with largely vegetarian food habit, is prone to harbor Vitamin B12 deficiency. There’s a general belief that vegan diet is devoid of Vitamin B12 but a few recent researches have shown that the Amra Beej Majja can act as a cost effective food supplement not just for calcium, vitamin A and C but also for Vitamin B12. So, there’s a felt need to evaluate therapeutically, the acclaimed role of Amra Beej Majja Churna as a supplement in people with Vitamin B12 deficiency. This paper presents a clinical study on the administration of Amra Beej Majja Churna in a patient with vegan dietary habits having Vitamin B12 deficiency which was clinically verified with low serum levels of the same. She presented with symptoms like hair loss, fatigue, tingling sensation in lower limbs and pain in calf muscles. The study was conducted for 2 months after which blood tests revealed increased serum Vitamin B12 levels from 189pg/ml to 217pg/ml along with significant symptomatic relief especially in tingling sensation and hair loss.

Role of Radiotherapy in Improving Quality of Life in Patients with Hepatocellular Carcinoma and Liver Metastasis

Background: Hepatocellular carcinoma (HCC) and liver metastases (LM) are often associated with significant symptoms such as pain and abdominal discomfort, impacting the quality of life (QoL) of affected patients. Current treatments vary in effectiveness and often leave a substantial unmet medical need in symptom management. Objective: This study aimed to assess the efficacy of external radiation therapy (ERT) in alleviating symptoms and improving the QoL in patients with HCC and LM, focusing on those presenting primarily with pain or abdominal discomfort. Methods: After institutional review board approval, patients with HCC or painful LM, not previously treated with tumor resection, radiofrequency ablation, or systemic therapy, were included. Eligible participants exhibited symptoms such as pain, nausea, and fatigue, and had a performance status of 0-2. A single fraction dose of ERT was administered, and symptom relief was evaluated using the Brief Pain Inventory (BPI) and QoL using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30). Completion rates of these questionnaires were tracked at baseline, one week, and one month post-treatment. Results: Of the 43 patients enrolled (23 HCC, 20 LM), significant improvement in the FACT-G TOI was observed in 34% of patients at one month post-ERT. When focusing on those with pain or abdominal discomfort, 59% reported clinically significant symptom relief. However, QoL improvement was noted in only about one quarter of patients, with one third experiencing worsening QoL at one month. Questionnaire completion rates were high initially but decreased over time, reflecting the challenging nature of the patient population. Conclusion: ERT demonstrated potential benefits in symptom relief, particularly for pain and abdominal discomfort in patients with HCC and LM. Nonetheless, the impact on overall QoL was mixed, highlighting the need for further research into optimizing therapeutic strategies for this patient group.

General Treatments Promoting Independent Living in Parkinson's Patients and Physical Therapy Approaches for Improving Gait-A Comprehensive Review.

This study delves into the multifaceted approaches to treating Parkinson's disease (PD), a neurodegenerative disorder primarily affecting motor function but also manifesting in a variety of symptoms that vary greatly among individuals. The complexity of PD symptoms necessitates a comprehensive treatment strategy that integrates surgical interventions, pharmacotherapy, and physical therapy to tailor to the unique needs of each patient. Surgical options, such as deep brain stimulation (DBS), have been pivotal for patients not responding adequately to medication, offering significant symptom relief. Pharmacotherapy remains a cornerstone of PD management, utilizing drugs like levodopa, dopamine agonists, and others to manage symptoms and, in some cases, slow down disease progression. However, these treatments often lead to complications over time, such as motor fluctuations and dyskinesias, highlighting the need for precise dosage adjustments and sometimes combination therapies to optimize patient outcomes. Physical therapy plays a critical role in addressing the motor symptoms of PD, including bradykinesia, muscle rigidity, tremors, postural instability, and akinesia. PT techniques are tailored to improve mobility, balance, strength, and overall quality of life. Strategies such as gait and balance training, strengthening exercises, stretching, and functional training are employed to mitigate symptoms and enhance functional independence. Specialized approaches like proprioceptive neuromuscular facilitation (PNF), the Bobath concept, and the use of assistive devices are also integral to the rehabilitation process, aimed at improving patients' ability to perform daily activities and reducing the risk of falls. Innovations in technology have introduced robotic-assisted gait training (RAGT) and other assistive devices, offering new possibilities for patient care. These tools provide targeted support and feedback, allowing for more intensive and personalized rehabilitation sessions. Despite these advancements, high costs and accessibility issues remain challenges that need addressing. The inclusion of exercise and activity beyond structured PT sessions is encouraged, with evidence suggesting that regular physical activity can have neuroprotective effects, potentially slowing disease progression. Activities such as treadmill walking, cycling, and aquatic exercises not only improve physical symptoms but also contribute to emotional well-being and social interactions. In conclusion, treating PD requires a holistic approach that combines medical, surgical, and therapeutic strategies. While there is no cure, the goal is to maximize patients' functional abilities and quality of life through personalized treatment plans. This integrated approach, along with ongoing research and development of new therapies, offers hope for improving the management of PD and the lives of those affected by this challenging disease.

Real-world experience of water vapour therapy (Rezum) in patients with benign prostatic enlargement: a retrospective single-center study.

Water vapor thermal therapy (Rezum) is a minimally invasive treatment for benign prostatic enlargement (BPE). Studies reporting urodynamic results regarding the procedure are rare. Our study aimed to assess the effectiveness of Rezum on urinary outcome parameters in a consecutive series of patients and compare urodynamic data before and after treatment. We retrospectively evaluated all the patients treated with Rezum between 07/2017 and 12/2023 at our institution. Patients who had more than one Rezum intervention, those who were unable to void (i.e., catheter-dependent patients), and those with insufficient data were excluded from the data analysis. Descriptive outcomes, such as symptom scores (IPSS, IPSS-QoL), peak flow in uroflowmetry (Qmax), post-micturition residual urine volume (PVR), and prostate volume (PVol), were analyzed. If available, preoperative and postoperative urodynamic results were evaluated. In total, 250 Rezum procedures were performed during the observational period. After applying the exclusion criteria, the data from 193 patients were included in the analysis. Patients achieved significant symptom relief as measured using the IPSS (46% reduction) and IPSS-QoL scores (41% reduction). Qmax improved by 4.8 ml/s, as the mean PVR significantly decreased by 50%. PVol and PSA values decreased by 30% and 27.5%, respectively. In 19/193 patients with a urodynamic evaluation, pre- and postoperative data analysis showed a significant reduction in the bladder outlet obstruction index (BOOI) by approximately 70%. Rezum is effective and can improve urinary symptoms. In appropriate patients, Rezum can significantly reduce the bladder outlet obstruction (BOO).

A Case Study on Ayurvedic management of Mutrashmari (Urolithiasis)

Background: Mutrashmari is disease classified as Asthamahagada which means "difficult to cure." It is Kapha Pradhana Tridoshaja Vyadhi. Due to resemblance in clinical manifestations, Mutrashmari is compared to urolithiasis. Urolithiasis, a pathological condition of the urinary system where aggregation of urinary crystalloids takes place anywhere in the urinary tract, i.e., from the kidney to urinary bladder showing male predominance (Male: female = 3:1) and currently becoming a medico‑surgical and economical challenge for entire health‑care systems. Objectives: The aim of this study was to evaluate the efficacy of Viddhakarma and Shamana Chikitsa in Mutrashmari (Urolithiasis). Materials and Methods: It is a single case study. A 52 years old male patient who was clinically diagnosed case of Urolithiasis before 3 years visited to OPD with complaints of Vrikka Parshava Shoola (Pain in bilateral kidney and b/l flanks region) which was radiating from loin to groin region in late night usually, Mutrakriccha (difficulty in maturation) and Mutradaha (Burning micturition) from last 2 months. The patient was treated with total 4 sittings of Viddhakarma were given at the lateral border of the thumb of the bilateral legs on same day of every week along with Shamana Chikitsa. Results: The patient was showed highly significant results before and after the completion of treatment. All sign and symptoms of patient resolved and there was no trace of calculi in the both kidneys, according to the USG report after 1 month. Conclusion: Highly significant relief in symptoms was seen in patient after 1 month of Ayurvedic treatment.

Atypical lipoma of the right piriformis muscle: a case report and review of the literature

BackgroundPiriformis muscle mass is rare, which is particular for intrapiriformis lipoma. Thus far, only 11 cases of piriformis muscle mass have been reported in the English literature. Herein, we encountered one patient with intrapiriformis lipoma who was initially misdiagnosed.Case presentationThe patient is a 50-year-old Chinese man. He complained of osphyalgia, right buttock pain, and radiating pain from the right buttock to the back of the right leg. Both ultrasound and magnetic resonance imaging demonstrated a cyst-like mass in the right piriformis muscle. Ultrasonography-guided aspiration was performed on this patient first, but failed. He was then recommended to undergo mass resection and neurolysis of sciatic nerve. Surprisingly, final histology revealed the diagnosis of intrapiriformis lipoma. The patient exhibited significant relief of symptoms 3 days post-surgery.ConclusionDiagnosis and differential diagnosis of radicular pain are potentially challenging but necessary. Atypical lipoma is prone to be misdiagnosed, especially in rare sites. It is notable for clinicians to be aware of the presence of intrapiriformis lipoma to avoid misdiagnosis and inappropriate treatment.

Improvement of Dyspnea and Palpitations of Cardiac Origin Using Comprehensive Traditional Korean Medicine Treatment Including &lt;italic&gt;Bangibokryeong-tang&lt;/italic&gt; (&lt;italic&gt;Fangji Fuling&lt;/italic&gt; Decoction) : A Case Report

This case report demonstrates the effect of modified &lt;i&gt;Bangibokryeong-tang&lt;/i&gt; (&lt;i&gt;Fangji Fuling&lt;/i&gt; Decoction), a traditional herbal prescription in treating dyspnea and palpitations, symptoms that often lead to anxiety and reduced quality of life of cardiac patients. A female patient in her late 70s with congenital valve malformation and atrial fibrillation presented with dyspnea and palpitations, each rated at a severity of 8 on a numeric rating scale (NRS). After voluntarily discontinuing Western medication, she received modified BGBRT for 25 days, leading to significant symptom relief and NRS improvement to 0-2. The patient reported maintaining an improved condition and showed a significant increase in vitality. This improvement was sustained for 7 months, but the symptoms recurred; thus, modified BGBRT was restarted. Modified BGBRT showed substantial effects on persistent cardiac-origin dyspnea and palpitations. Thus, this TKM has the potential to manage symptoms and enhance the quality of life of cardiac patients.

Licorice extract inhibits porcine epidemic diarrhea virus in vitro and in vivo.

Porcine epidemic diarrhea virus (PEDV) causes severe diarrhea and even death in piglets, resulting in significant economic losses to the pig industry. Because of the ongoing mutation of PEDV, there might be variations between the vaccine strain and the prevailing strain, causing the vaccine to not offer full protection against different PEDV variant strains. Therefore, it is necessary to develop anti-PEDV drugs to compensate for vaccines. This study confirmed the anti-PEDV effect of licorice extract (Le) in vitro and in vivo. Le inhibited PEDV replication in a dose-dependent manner in vitro. By exploring the effect of Le on the life cycle of PEDV, we found that Le inhibited the attachment, internalization, and replication stages of the virus. In vivo, all five piglets in the PEDV-infected group died within 72 h. In comparison, the Le-treated group had a survival rate of 80 % at the same time, with significant relief of clinical symptoms, pathological damage, and viral loads in the jejunum and ileum. Our results suggested that Le can exert anti-PEDV effects in vitro and in vivo. Le is effective and inexpensive; therefore it has the potential to be developed as a new anti-PEDV drug.

Augmented reality-assisted microvascular decompression for glossopharyngeal neuralgia: a case report

Abstract Glossopharyngeal neuralgia is a rare condition characterized by pain along the distribution of the glossopharyngeal nerve. Surgical approaches via microvascular decompression represent a common treatment strategy. For this procedure, an understanding of the location of the cranial nerve and the offending vasculature is critically important. A mixed reality system was used to register patient-specific 3D models onto the patients head for operative planning and anatomical visualization. A 58-year-old female presented to neurosurgery with severe right-sided facial, tongue, and jaw pain unresponsive to multiple conservative therapies including medication. T2-weighted MRI with FIESTA sequence demonstrated right posterior inferior communicating artery compression of the right glossopharyngeal nerve entry zone. An augmented reality system was used to visualize the patients’ anatomy overlaid onto the patients’ head. A microvascular decompression of Cranial Nerves IX and X was performed via a retrosigmoid approach. Patient obtained significant relief of preoperative pain symptoms without complications.

Diagnosis and surgical treatment of high-risk anomalous aortic origin of coronary artery

Objective: To analyze the diagnosis and surgical treatment of high-risk anomalous aortic origin of coronary artery (AAOCA). Methods: This is a retrospective case series study. From January 2016 to July 2023, 24 cases of high-risk AAOCA underwent surgical treatment in Department of Cardiac Surgery, Guangdong Provincial People's Hospital. There were 18 males and 6 females, operatively aged (M (IQR)) 13 (26) years (range: 0.3 to 57.0 years). They were confirmed by cardiac ultrasound and cardiac CT, all of which had anomalous coronary running between the aorta and the pulmonary artery. There were 15 cases of the right coronary artery from the left aortic sinus of Valsalva, 6 cases of left coronary artery from the right aortic sinus of Valsalva, 3 cases of the sigle coronary artery. Only 3 patients had no obvious related symptoms (2 cases were complicated with a positive exercise stress test and 1 case with other intracardiac malformations), 21 cases had a history of chest tightness, chest pain, or syncope after exercise. Three patients suffered syncope after exercise and underwent cardiopulmonary resuscitation (2 cases were treated with an extracorporeal membrane oxygenerator (ECMO)). The gap from the first symptom to the diagnosis was 4.0 (11.5) months (range: 0.2 to 84.0 months). The detection rate of coronary artery abnormalities suggested by the first cardiac ultrasound was only 37.5% (9/24). Seven patients were complicated with other cardiac diseases (4 cases with congenital heart defects, 2 cases with coronary atherosclerotic heart disease, 1 case with mitral valve disease). Results: All 24 patients underwent surgical treatment (23 cases underwent abnormal coronary artery unroofing, 1 case underwent coronary artery bypass grafting), and 5 patients underwent other intracardiac malformation correction at the same time. There were no death or surgery related complications in the hospital for 30 days after the operation. A patient with preoperative extracorporeal cardiopulmonary resuscitation was continuously assisted by ECMO after emergency AAOCA correction and had complications such as limb ischemia necrosis and renal dysfunction after the operation. During the follow-up of 2.2 (3.3) years (range: 1 month to 7.2 years), one patient who previously underwent percutaneous transluminal coronary angioplasty with a stent implant experienced significant postoperative symptomatic relief, and the other discharged patients had no related symptoms. Conclusions: The accurate rate of initial diagnosis for high-risk AAOCA is still low, but the risk of cardiovascular accidents is high. For sports-related chest pain and other symptoms, more attention should be paid to the detection of AAOCA, especially for adolescents. Exercise stress testing can be helpful in evaluating the cardiovascular risk of asymptomatic AAOCA. Instant surgical treatment can achieve satisfactory curative effects.

Understanding to Concept of Jarajanya Vyadhi (ageing related diseases) w.s.r. to Sandhigatavata (osteo arthritis)

As age advances Vata Dosha increases in an individual. This increasing Vata trigger and accelerates Dhatu Kshaya (depletion of tissues) and Bala Kshaya (diminished the body strength). Hence advancing age makes man prone to many diseases especially degenerative disorders. Asthis (bones) are the main seat of Vata Dosha and Sandhis (joints) is the main seat of Kapha Dosha. Vata Dosha is responsible for different body movements like Prasaarana and Akunchana of Sandhi (flexion and extension of joints), whereas Shleshaka Kapha located in Sandhi (joints) is provides nutrition, protection and to minimize the friction during the movement. Sandhigatavata is Vata pradhana vyadhi. It is quite similar to osteoarthritis, a degenerative joint disease stand in modern medical science. Sandhigatavata is Vata dominating disorder which result in inflammatory and degenerative changes in joints. Osteoarthritis is a disease of musculoskeletal system, affecting the joints mostly in elderly population and in weight bearing joints (particularly knee joint). The current standard modern medical pharmacological management of osteoarthritis includes the administration of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). However, their use neither provides adequate and significant relief in symptoms nor deceleration in disease process. Therefore, Vata shamaka aushadhis along with local application e.g. Abhyanga, different form of Swedana are beneficial. As Sandhigatavata is ageing related heath condition, Rasayana chikitsa can also be helpful in the management of Sandhigatavata (Osteoarthritis). This article enlighten the knowledge about Jarajanya vyadhi especially Sandhigatavata.

Efficacy of Quadruple-coated Probiotics in Patients With Irritable Bowel Syndrome: A Randomized, Double-blind, Placebo-controlled, Parallel-group Study.

To evaluate the efficacy of quadruple-coated probiotics (gQlab) in patients with irritable bowel syndrome (IBS), focusing on sex differences and IBS subtypes. One hundred and nine Rome III-diagnosed IBS patients were randomized into either a gQlab or placebo group and received either gQlab or a placebo for 4 weeks. Participants replied to questionnaires assessing compliance, symptoms, and safety. Fecal samples were collected at 0 and 4 weeks to measure the probiotic levels using real-time quantitative polymerase chain reaction (qPCR) and to perform metagenomic analysis via 16S ribosomal DNA sequencing. The primary endpoint was the change in the overall IBS symptoms after 4 weeks of treatment. Ninety-two subjects (47 and 45 in the gQlab and placebo groups, respectively) completed the study protocol. At week 4, there was a higher relief of the overall IBS symptoms in the gQlab group (P = 0.005). The overall IBS symptom improvement was statistically significant (P = 0.017) in female patients of the gQlab group compared with the placebo group. Among the IBS subtypes, constipation-predominant IBS patients showed significant relief of the overall IBS symptoms (P = 0.002). At week 4, the fecal microbiome profiles between the 2 groups did not differ, but the qPCR levels of Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus helveticus, Bifidobacterium longum, and Bifidobacterium breve were increased in the gQlab group (P < 0.05 by repeated measures ANOVA). gQlab administration can improve the overall IBS symptoms, especially in female and constipation-predominant IBS patients. Further research is necessary to clarify the pathophysiology behind sex-related treatment responses in IBS patients.

Cerebrospinal fluid–lymphatic fistula in a child with generalized lymphatic anomaly treated with targeted blood patch — a rare case report and review of the literature

Spontaneous intracranial hypotension may result in debilitating postural headaches and severe neurological symptoms due to secondary cerebellar sagging. The most common cause is the cerebrospinal fluid (CSF) leak within the spinal canal. Although previously reported in only a few cases, also paraspinal lymphatic malformations causing vertebral bone destruction may occasionally result in CSF leak to these pathological formations. Here, we present a case of a 9-year-old girl with generalized lymphatic anomaly (GLA) presenting with severe postural headache. Radiological imaging revealed a typical feature of cerebellar sagging. Myelography localized the CSF leakage into vertebral bodies of C7 and Th1, which both were partly involved in pathological paravertebral masses of known lymphatic anomaly, and from there along the right C8 nerve root sleeve into the anomaly. As the C8-nerve root could not be ligated due to the risk of significant neurological injury, we attempted image-guided targeted percutaneous epidural placement of a blood patch directly into the foramen at the affected level. The procedure resulted in obliteration of the fistula and regression of cerebellar sagging, with significant relief of symptoms. Although it is an extremely rare coincidence, patients with paraspinal lymphatic malformations may develop intraspinal CSF leak into these pathological formations. The present case report suggests that besides a direct surgical obliteration of the fistula and sacrificing the nerve root, a targeted percutaneous epidural blood patch may be a possible alternative in the case of a functionally important nerve root.