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   Table of Contents - Current issue
May-June 2017
Volume 10 | Issue 3
Page Nos. 219-322

Online since Friday, May 19, 2017

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Beall's list vanishes into the blue… what next? Highly accessed article p. 219
Amitav Banerjee
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Evidence-based safety and efficacy of Ayurvedic herbo-metallic preparations containing gold, iron, and mercury with special reference to pediatrics p. 222
Rahul K Shingadiya, Suhas Chaudhary, Krutika Joshi, Prashant Bedarkar, BJ Patgiri, PK Prajapati
Background: Safety and efficacy of herbo- metallic or mineral formulations in Ayurvedic therapeutics is subject of great concern in present era. Especially in paediatrics in which, a number of herbo-metallic formulations are found in practice for prevention as well as for the treatment of paediatric disorders. Among various herbo-metallic preparations mentioned in Ayurveda, gold, iron and mercurial formulations are more popular in paediatric practices. Present study has been conducted to highlight an evidence based safety and efficacy of metallic preparations in paediatrics. Material and Method: Subject related published research articles from reputed journals were searched through four online search engines Pubmed, Google scholar and Ayush research portal and DHARA online. The data of the articles were analysed to confirm their safety and efficacy in paediatrics. Results: Total 10 clinical studies showing safety and efficacy of Ayurvedic herbo-metallic preparations in paediatric disorders were compiled, which included 3 formulations of gold, 4 of iron and 3 mercurial formulations. Children suffering from Chronic tonsillitis, Iron deficiency anaemia, Sickle cell anaemia and Bronchial asthma were treated with significant effect and positive changes in haematological parameters. No any adverse or toxic effect of any of these formulations was noticed. Conclusion: Metallic preparations of gold, iron and mercury are found quite safe to the use in pediatric disorders with proper dose and adjuvant. They are also found effective in the diseases which are chronic and diffi cult to treat such as sickle cell anemia, seizure, and acute lymphoblastic leukemia.
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Pharmacists' knowledge and perceptions about herbal medicines: A case study of Jos and environs p. 229
Nanloh S Jimam, Benjamin N Joseph, Dooshima C Agba
Background: Due to increased health consciousness among the public, the use of herbal products are on the increase on a daily basis. To achieve optimal benefits, there is a need for pharmacists who are the custodians of knowledge on drugs and drugs-related products to have more understanding and interest in herbal medicine for effective counseling on the products. The purpose of this study was to assess Pharmacists' knowledge and perceptions regarding herbal medicine use. Methods: Self-administered questionnaires were administered to 200 pharmacists working within the study areas to fill; after which the collected data were statistically analyzed using IBM SPSS software programmer, version 20. Results: Only 88.5% of the respondents responded on the questionnaires, and their mean age was 34 years; median year of experience in practice was 8.2 years; and their areas of practice included hospital (56.1%), community (28.1%), academic (8.47%), and industries (4.52%). More than half (76.27%) of them believed that herbal products were more efficacious and safer (61.02%) than orthodox medicines; with almost all of them (94.92%) acknowledging the beneficial effects of incorporating herbal medicines into orthodox medicine practice. However, most of them (72.88%) confessed having little knowledge on herbal remedies, especially drug-herbs interactions (81.36%), and their main source of information on herbs was from school (56.50%). Conclusions: The result showed poor level of pharmacists' knowledge on herbal medicine; which might result in poor patients' counseling on herbal therapy, especially regarding their safety and potential interaction with orthodox medicine.
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Herbal medicines: knowledge, perception, and usage p. 233
Viroj Wiwanitkit
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Antihyperlipidemic activity of Navaka Guggulu prepared with fresh (Naveena) and old (Purana) Guggulu: A randomized clinical trial Highly accessed article p. 235
Kruti Yagneshkumar Vyas, Prashant Bedarkar, R Galib, Pradeep Kumar Prajapati
Introduction: Navaka Guggulu is a well-known polyherbal formulation containing Guggulu (Commiphora wightii Arn. Bhandari) as main ingredient. It is effectively used in Medoroga (hyperlipidemia), Sthaulya (obesity), and other Kaphaja roga. In classics, fresh (Naveena) Guggulu is attributed with Brimhana (body mass increasing) effect while old (Purana) with Atilekhana (scrapping). Earlier studies reported that 1-year-old Guggulu possesses better effect on body weight, body mass index, and cardinal symptoms of Medoroga along with significant lipid lowering effect against fresh Guggulu. It infers that old sample of Guggulu is beneficial. Aim: Considering the results of 1-year-old sample, an attempt has been made to evaluate comparative antihyperlipidemic effect of Navaka Guggulu prepared by old (3-year-old-Purana) Guggulu and fresh (Naveena) Guggulu. Materials and Methods: Navaka Guggulu was prepared by freshly collected and 3-year-old samples of Guggulu. Patients who satisfied inclusion criteria of hyperlipidemia were randomly allocated into two groups, namely, A and B and Navaka Guggulu was administrated at a dose of 2 g twice daily with lukewarm water during Prabhata and Nishi kala (1 h before meal) for 8 weeks. Results: Navaka Guggulu prepared from 3-year-old sample exhibited better results in reducing serum cholesterol (8.94%), serum triglycerides (22.76%), and very low-density lipoprotein (VLDL) level (23.10%), wherein Navaka Guggulu prepared from Naveena sample, reduction was found 4.58% in serum cholesterol, 17.26% in serum triglycerides, and 17.76% in VLDL level. Conclusion: Navaka Guggulu prepared from 3-year-old (Purana) sample is better antihyperlipidemic agent against fresh (Naveena) sample.
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Prosthetic valve obstruction: Redo surgery or fibrinolysis? p. 246
Avinash Inamdar, Shweta Pralhad Shende, Sanjeevini Inamdar
Objective: The aim of this study was to compare the efficacy and safety of surgery versus fibrinolytic therapy in patients with prosthetic valve obstruction. Materials and Methods: We compared 15 patients of prosthetic valve thrombosis treated by surgical line of management and another 15 patients treated by thrombolysis. All patients were initially assessed by clinical evaluation and diagnosis confirmed by transthoracic and transesophageal two-dimensional echocardiography. Depending on hemodynamic stability, pannus, or thrombus on transesophageal echocardiography, the patients were assigned surgical or medical line of management. Results: Patients mortality rate was 40% in fibrinolytic group and 13.33% in surgical group. Recurrence was 40% in fibrinolytic group while there was no recurrence till date in surgery group. Complications were more in fibrinolytic group as opposed to surgery group patient. Conclusion: From our experience, we conclude that redo surgery is effective and definitive treatment, especially in patients with stable hemodynamic conditions.
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Surgery or thrombolysis for prosthetic valve obstruction, the debate is going on p. 250
A.K. M. Monwarul Islam
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Comparative study for the treatment of plantar fasciitis by corticosteroids versus platelet rich plasma p. 252
Tarun Kukreja, Tushar Agarwal, Ashutosh Singh, Himanshu Bhugra
Purpose: The purpose of this study to compare the efficiency of corticosteroid and platelet rich plasma (PRP) for the treatment of chronic plantar fasciitis. Materials and Methods: The present study was conducted in Department of Orthopaedics at Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune from June 2013 to September 2015. In this series, forty patients having chronic plantar fasciitis were treated with PRP and corticosteroid injection. The results were evaluated prospectively to compare the efficacy of both the procedures. One group of twenty patients received an injection of corticosteroid and the second group of twenty patients received an injection of PRP. Patients were selected if they fit into the inclusion criteria of the study after random selection. Results: Both groups initially performed well. The patients were followed up at 3, 6, and 12 months interval and were analyzed with the scoring systems (American Orthopedic Foot and Ankle Society [AOFAS], visual analog scale and Roles and Maudsley system). The average pretreatment AOFAS score at 3 months after treatment in the steroid group was 45 and improved to 82 and in the PRP group was 44 and improved to 90. However, the steroid group scores degraded with a sharp drop in the AOFAS rating to 74 at 6 months and 62 at 12 months after treatment. In stark contrast, the PRP group scores remained high with AOFAS scores of 87 at 6 month and 85 at 12 months after treatment. Conclusion: This study confirms the long-term superiority of PRP over corticosteroid injection for chronic planter fasciitis.
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Clinicohistopathological correlation and Helicobacter pylori status in patients with functional dyspepsia p. 257
Anita Basavaraj, Rahul S Kulkarni, Dilip B Kadam, Vinay Thorat
Background: Functional dyspepsia (FD) is a condition of immense clinical significance. Helicobacter pylori may be responsible for FD in a subset of patients. Materials and Methods: Upper gastrointestinal endoscopy was done in sixty patients of FD fulfilling ROME III criteria, and gastric and duodenal biopsies were taken. Duodenal histopathological findings and H. pylori status were correlated with the symptomatology. Standard treatment was given according to the H. pylori status, and the response was analyzed using 6-point Likert scale. Results: Sixty percent of cases were infected with H. pylori. 72.5% of cases with predominant epigastric pain were H. pylori-positive. 96.5% patients with early satiety had duodenal eosinophilia and duodenitis. Epigastric pain was significantly associated with H. pylori, and early satiety was associated with duodenal eosinophilia and duodenitis. Sixty-five percent of cases had increased duodenal intraepithelial lymphocyte count. 88.8% cases showing no response to treatment had duodenal eosinophilia. Conclusion: H. pylori infection constitutes an important subset of FD patients. H. pylori infection, duodenitis, and duodenal eosinophilia contribute to symptom generation. H. pylori eradication can provide symptomatic relief. A duodenal biopsy can identify an important subset of patients with duodenal eosinophilia and duodenitis which can be a contributor for poor treatment response and can be clinically amenable to new treatment avenues.
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The accuracy of polyuria, polydipsia, polyphagia, and Indian Diabetes Risk Score in adults screened for diabetes mellitus type-II p. 263
Shivshakti D Pawar, Poonam Thakur, BK Radhe, Harshal Jadhav, Vivek Behere, Vikrant Pagar
Context: The World Health Organization report suggests that over 19% of the world's diabetic population currently resides in India. Unfortunately, >50% of the diabetics in India are unaware about their diabetic status. In the poor income country like India, it is essential to use cost-effective methods for screening for diabetes, and traditionally using three classical symptoms and Indian Diabetes Risk Score (IDRS) tool is helpful but, data regarding their diagnostic accuracy is very less. Objective: (1) To assess the diagnostic accuracy of polyuria, polydipsia, polyphagia, and IDRS for detecting diabetes. Settings and Design: Six hundred and seventy-seven adult individuals >20 years of age were screened for diabetes and assessed polyuria, polydipsia, polyphagia, and IDRS score. All were subjected for postprandial blood glucose level. Subjects and Methods: For diagnostic accuracy sensitivity, specificity, positive and negative predictive values, likelihood ratios (LRs, for positive and negative tests), and accuracy was calculated for each symptom. Similarly, by receiver operative curve (ROC) curve analysis, we carried out sensitivity and specificity of IDRS. Results: There was statistically significant association between these three classical symptoms and diabetes status of individuals. When present, all these three symptoms carried 7.34% sensitivity and 98.42% specificity with positive predictive value 47.06% and NPV 84.70%, LR+4.36, LR−0.94 with accuracy of 85%. The optimum cutoff value of IDRS score was >50, which carried sensitivity 73%, specificity 58.7%, and area under curve for ROC was 68% (P < 0.001). Conclusions: This study has shown highest specificity for these three classical symptoms in diagnosing diabetes, but these symptoms were insensitive to detect all diabetic subjects.
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Functional paradox of leptin and adiponectin in diabetes patients and controls in the Cape Coast Metropolis of Ghana p. 268
Samuel Acquah, Johnson Nyarko Boampong, Benjamin Ackon Eghan Jnr
Aim: To investigate the concept of obesity paradox in diabetes patients and nondiabetic control in the Cape Coast Metropolis of Ghana. Materials and Methods: Levels of leptin, adiponectin, total antioxidant power (TAP), lipid peroxides, and C-reactive protein (CRP) were assessed in 115 diabetics and an equal number of control respondents. Furthermore, various anthropometric indices and blood pressure were measured using standard methods. Levels of biomarkers were compared between groups based on body mass index or blood pressure classifications. Results: Control respondents exhibited higher (P < 0.05) levels of leptin, adiponectin, and TAP but lower levels of CRP and peroxides than diabetes patients. In each study group, overweight/obese respondents exhibited higher (P < 0.05) leptin level but comparable (P > 0.05) mean levels of the various biomarkers, except TAP level which was higher (P < 0.05) in the overweight/obese diabetic respondents only. Mean level of adiponectin was lower (P < 0.05) only in systolic diabetic hypertensives with comparable (P > 0.05) levels of the other biomarkers between diabetes patients and their control counterpart. Irrespective of diabetes, obesity, or hypertensive status, leptin associated positively with various measures of adiposity. Adiponectin correlated positively with leptin (R > 0.38; P< 0.05) only in the control respondents, suggesting a possible functional paradox of the adipocytokines in this group of respondents. Conclusion: Overweight/obese respondents appear metabolically healthier than their normal-weight counterparts. However, further studies are needed for proper understanding of this concept in the Ghanaian context.
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Medical students' attitude toward suicide prevention: An exploratory study from North India p. 277
Naresh Nebhinani, Amit Jagtiani, Savita Chahal, Mamta Nebhinani, Rajiv Gupta
Background and Objectives: Although medical students are the future physicians and their attitudes toward suicide attempters may impact upon the quality of care, literature is not available on their attitude toward suicide prevention. This study was aimed to assess medical students' attitudes toward suicide prevention. Materials and Methods: This cross-sectional study was conducted in an apex medical institute of Haryana. Totally 205 final-year medical students were recruited through total enumeration method. Attitude toward suicide prevention scale was administered. Results: Nearly half of the students' opined lack of disclosure of suicidal intent by suicide attempters and one-third of the students considered unemployment and poverty as the main causes of suicide. Half of the students were not comfortable in suicide risk assessment (girls > boys). More than half of the students acknowledged their role for suicide prevention. However, only half of them had positive attitude toward working with suicidal patients. Minority of students had clinical exposure of managing any suicidal patient and attending suicide prevention programs. Conclusions: Merely half of the medical students had a positive attitude toward working with suicidal patients. To make them more equipped, medical curriculum should incorporate regular programs on assessment and management of suicidal patients and multipronged approach for suicide prevention.
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Suicide in a patient of rectal carcinoma: Exploration of psychodynamics from the suicide note p. 281
Rajanikanta Swain, Shashank Pooniya, Sujita Kumar Kar, Shivani Dhaka
Distress related with cancer not only impairs the quality of life and accelerates disease progression, but also causes noncancer mortality including suicide. The physical and psychological sufferings in a cancer patient are the major causes of suicide. Financial burden related to the expensive treatment of cancer further add up to the suffering of the patients as well as their family. We reported a case of rectal carcinoma, who committed suicide inside the hospital premises leaving behind a suicide note. Patient's clinical history, sociodemographic profile, and the suicide note were analyzed. The content analysis of the suicide note has been described along with an analysis of different factors associated with suicide in cancer patients in an Indian scenario. Suicide note may show the reflections of psychodynamics of suicide, hence, it needs to be included routinely during psychiatric evaluation.
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Uncommon associations of Hepatitis A in children: Acute respiratory distress syndrome and erosive gastritis p. 284
Shefali Parikh, Ira Shah, Sushmita Bhatnagar
Hepatitis A is a common cause of acute hepatitis in children and usually has a benign self-limiting course, moreover so in young children. We report two exceptional cases of erosive gastritis and acute respiratory distress syndrome, respectively, as rare associations of hepatitis A in children. Both children were <5 years of age and eventually recovered.
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Is this 4-year-old female child suffering from a forme fruste of hypomelanosis of Ito? p. 287
Ibrahim Aliyu, Zainab F Ibrahim, Godpower Chinedu Michael
Hypomelanosis of ito (HI) is a multisystemic disorder characterized by cutaneous, neurologic disorder, and musculoskeletal disorder. However, there may be isolated cutaneous manifestation, resulting in diagnostic overlap with other hypopigmentary lesions such as nevus depigmentosus and hypopigmentation along the lines of Blaschko. Therefore, there is the need for generally acceptable diagnostic criteria avoiding these ambiguities. Hence, the case of a 4-year-old female child with isolated hypopigmentations characterized as whorls on the torso and as linear distribution along the lines of Blaschko is reported.
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Graves' disease and idiopathic intracranial hypertension p. 290
Manish Gutch, Annesh Bhattacharjee, Sukriti Kumar, Durgesh Pushkar
Idiopathic intracranial hypertension (IIH) is a central nervous system disorder characterized by raised intracranial pressure with normal cerebrospinal fluid composition and absence of any structural anomaly on neuroimaging. Among all endocrine disorders associated with the development of IIH, the association of hyperthyroidism and IIH is very rare with few cases reported till date. Thyroid disturbances have a unique association with IIH. Hypo- and hyper-thyroidism have been reported in association with this disorder. We present a rare case of a 25-year-old man with Graves' disease with intractable headache that was later investigated and attributed to development of IIH.
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Waldenstrom's macroglobulinemia: An unusual cause of nonhealing leg ulcers p. 293
Navjyot Kaur, Sanjeevan Sharma, Abhish Mohan, Pankaj Puri
Waldenstrom's macroglobulinemia (WM) is one of the rare hematological malignancies and accounts for 1%–2% of all blood cancers. While fatigue is the most common presentation; hyperviscosity syndrome, symptomatic cryoglobulinemia, and cold agglutinin disease (CAD) are the characteristic symptoms. However, they occur only in 5%–15% of all patients of WM. We discuss a 63-year-old patient who presented with nonhealing ulcers on both lower limbs and severe anemia. His blood clotted in ethylenediaminetetraacetic acid sample tubes, and there was difficulty in getting blood cross matched for transfusing him. During evaluation, he was found to have high erythrocyte sedimentation rate, albumin globulin reversal with serum protein electrophoresis, and immunofixation suggestive of immunoglobulin M monoclonal gammopathy. There was evidence of autoimmune hemolytic anemia and skin biopsy from ulcers revealed hyaline thrombosis and deposition of cryoglobulins. He was diagnosed to have WM with cryoglobulinemia and CAD.
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Ruptured intracranial dermoid: Case report and literature review p. 297
Pravin Tukaram Survashe, Sachin Parshuram Guthe, Vernon Velho, Anuj Bhide
Intracranial dermoid cysts are nonneoplastic, ectodermal inclusion cysts of embryological origin. They contain various ectodermal derivatives including apocrine glands, sebaceous glands, hairs, squamous epithelium, and occasionally teeth. Spontaneous rupture of these cysts is uncommon, and so far very few cases have been reported in the literature. Hereby, we report a case of young male presenting with ruptured intracranial dermoid cyst managed surgically.
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A case report of emergency cesarean section in parturient with kyphoscoliosis p. 300
Raghavendra Vagyannavar, Rekha Devi
Anesthesia for emergency cesarean section for the pregnancy with kyphoscoliosis is associated with potential risks for both mother and fetus due to alterations in maternal physiology and the pathological changes seen in kyphoscoliosis. The anesthetic management must include the well-being of both mother and fetus. The need of anesthesia for delivery in pregnant women with kyphoscoliosis is more than the normal parturient. We report the case of a 23-year-old female, full-term primigravida with kyphoscoliosis who was posted for emergency caesarean section. The anesthetic management of this patient is presented here.
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Klippel–Feil syndrome with inherited coagulopathy: A rare case report p. 303
Sameer Bansal, Ketaki Utpat, Jyotsna M Joshi
Klippel–Feil syndrome is a rare disease known to be associated with many musculoskeletal as well as somatic diseases. Thromboembolism is one of the complications, which although rarely described earlier with this syndrome, can be life-threatening. Earlier case reports have attributed it to structural abnormalities seen in this syndrome. We, however, report a rare instance of inherited coagulopathy seen with Klippel–Feil syndrome, leading to pulmonary thromboembolism.
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Median arcuate ligament syndrome diagnosed on multi-detector computed tomographic angiography p. 307
Amit Kharat, Vigyat Kamal, Mansi Sidharth Dhende, Anubhav Kamal
Median arcuate ligament syndrome or coeliac artery compression syndrome is one of the abdominal vascular compression syndromes characterized by postprandial intestinal angina in the expiratory phase of respiration due to focal proximal coeliac root compression by a fibrous ligamentous band with resultant inadequate blood supply to the respectively supplied part of the gastrointestinal tract. Multi-detector computed tomography is extremely useful noninvasive modality in differentiating the cause of compression of the coeliac artery along with evaluation of collaterals due to multiplanar imaging capability.
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T-cell lymphoblastic lymphoma infiltration into the thyroid gland: A rare case report p. 311
HB Rakshitha, M Usha, Aneesha Asok, Prasanna Shetty
Lymphomas account for approximately 2% of all malignancies of the thyroid gland. Infiltration of T-cell lymphoblastic lymphoma (T-LBL) into the thyroid gland is rare. This case is presented on account of the rarity of T-LBL infiltration into the thyroid gland. A 22-year-old male, diagnosed case of T-LBL by left cervical lymph node biopsy and immunohistochemistry (IHC) and on chemotherapy, presented with a thyroid swelling after 6 months of diagnosis of T-LBL. Ultrasound imaging of the neck showed symmetrically enlarged thyroid gland. Fine needle aspiration cytology of the thyroid swelling showed infiltration of lymphoma cells into the thyroid gland, which was confirmed with IHC. T-LBL is a high-grade lymphoma which rarely infiltrates the thyroid gland. Intensive chemotherapy regimens and long-term maintenance therapy improve the prognosis of T-LBL.
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Value of transcutaneous electric nerve stimulation in the treatment of myofascial pain dysfunction syndrome p. 314
Hina Handa, Ashwini Deshpande, Silky Punyani
Pain in facial region originating from both temporomandibular joint (TMJ) and jaw muscles is a common clinical problem and is a diagnostic dilemma till today. There are many synonyms for this condition including myofascial pain dysfunction syndrome, mandibular dysfunction syndrome, and the TMJ dysfunction syndrome. With change in time, advances and new diagnostic criteria have been made in the diagnosis of myofascial pain syndrome, its epidemiology, clinical characteristics, and etiopathogenesis, but many unknowns remain. An integrated hypothesis has provided a greater understanding of the physiopathology of trigger points, which may allow the development of new diagnostic criteria and treatment of this chronic disease and combined pharmacological as well as physical therapy for the management of the disease. The purpose of this paper is to describe the multidisciplinary approach highlighting the effect of transcutaneous electric nerve stimulation (TENS) for the treatment of a 60-year-old female who suffered from myofascial pain and 5-day TENS therapy for management of pain.
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Outcomes in multidrug-resistant tuberculosis p. 319
Manas Pratim Roy
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Authors Response: Outcomes in multidrug resistant tuberculosis p. 319
Manoj Waghmare, Ketaki Utpat, Jyotsna M Joshi
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The knotted complication of a nasogastric tube p. 320
Ritu Aggarwal
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Revisiting the contrecoup extradural hematoma p. 321
Sushanta Kumar Sahoo, Chhitij Srivastava, Sidharth Vankipuram
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