The dorsal root ganglion (DRG) serves as a pivotal site for managing chronic pain through dorsal root ganglion stimulation (DRG-S). In recent years, the DRG-S has emerged as an attractive modality in ...the armamentarium of neuromodulation therapy due to its accessibility and efficacy in alleviating chronic pain refractory to conventional treatments. Despite its therapeutic advantages, the precise mechanisms underlying DRG-S-induced analgesia remain elusive, attributed in part to the diverse sensory neuron population within the DRG and its modulation of both peripheral and central sensory processing pathways. Emerging evidence suggests that DRG-S may alleviate pain by several mechanisms, including the reduction of nociceptive signals at the T-junction of sensory neurons, modulation of pain gating pathways within the dorsal horn, and regulation of neuronal excitability within the DRG itself. However, elucidating the full extent of DRG-S mechanisms necessitates further exploration, particularly regarding its supraspinal effects and its interactions with cognitive and affective networks. Understanding these mechanisms is crucial for optimizing neurostimulation technologies and improving clinical outcomes of DRG-S for chronic pain management. This review provides a comprehensive overview of the DRG anatomy, mechanisms of action of the DRG-S, and its significance in neuromodulation therapy for chronic pain.
Background: India has over 50 million workers employed in industries with exposure to very high sound levels, predisposing them to noise-induced hearing loss (NIHL). Methods: We conducted a ...systematic review and meta-analysis by using the following criteria: (1) Observational or experimental studies conducted in India; (2) English language studies; (3) Published during January 2010-December 2019; (4) Primary outcome: proportion of participants detected with NIHL. We reviewed bibliographic databases (PubMed, Scopus, and DOAJ) and Google Scholar, and extracted the relevant data. Results: A total of 160 documents were identified after removing duplicates, and 33 full texts were screened, of which 22 studies were included. The mean (SD) effective sample size of the studies was 107.1 (78.9). The pooled proportion of participants with NIHL irrespective of the category was 0.49 (95%CI: 0.22-0.76) and that of hearing loss was 0.53 (95%CI: 0.28- 0.78). Most studies reported that none of the workers, especially in the informal sectors, used auditory protection. Conclusions: NIHL is a major neglected public health occupational health challenge in India linked with adverse social determinants of health. Sustained advocacy for implementation of legislative and behavior change communication for protecting the hearing of workers is warranted.
Abstract
Lymphatic system imaging has been a challenging field in Radiology. We here describe a case of a 26-year-old male who presented with complaints of left-sided inguinoscrotal swelling and was ...subsequently diagnosed with abdomino-thoracic cystic lymphangiomatosis. Detailed imaging evaluation across the modalities of ultrasonography, computed tomography scan and magnetic resonance imaging evaluation revealed extensive involvement and diagnostic imaging appearance of the unique lymphatic system abnormality. Imaging findings were confirmed on histopathology.
The relationship between skin diseases and psychiatric illnesses is bi-directional and is manifested as cause and effect. Psychiatric disorders such as stress, anxiety, and depression are seen to be ...instrumental in the development and progression of dermatological diseases on one hand, while on the other hand, cosmetic disfigurement caused by dermatological diseases is responsible for psychological distress in patients. The present study was conducted to investigate the spectrum of dermatological disorders in psychiatric patients to offer them holistic treatment and provide them with a better quality of life.
This cross-sectional, observational study was conducted at a tertiary medical care center. A total of 170 psychiatric patients referred to the dermatology department for different dermatological manifestations were enrolled in the study. A demographic profile of the patients was done, and an association between dermatological diseases and psychiatric illnesses was done.
Out of 170 study participants, 88 (51.8%) were females, and the rest (82, 48.2%) were males. A total of 13 major types of dermatological conditions were noted; among them, fungal infection (43, 25.3%) was the most common, followed by eczema (18, 10.6%), parasitic infestation (17, 10.0%), pigmentary disorder (13, 7.6%), acne (11, 6.5%), bacterial infection (11, 6.5%), pruritic disorder (11, 6.5%), hair disorder (9, 5.3%), drug reaction (9, 5.3%), papulosquamous disorder (7, 4.1%), and viral infection (6, 3.5%). Skin conditions other than the above-mentioned were present in 15 (8.8%) patients. The most common psychiatric illness in the present study was major depressive disorder (41, 24.1%), followed by generalized anxiety disorder (38, 22.4%) and psychosis not otherwise specified (34, 20.0%). Other psychiatric illnesses included in the study were bipolar affective disorder (22, 12.9%), schizophrenia (18, 10.6%), obsessive-compulsive disorder (12, 7.1%), and mixed anxiety depressive disorder (5, 2.9%).
The findings of the present study depict that psychiatric patients with dermatological manifestations show a spectrum of dermatological conditions, primarily of infectious (fungal, parasitic, or viral) nature. This might be associated with a relatively poor hygienic status of psychiatric patients and thus their increased susceptibility to these disorders. Most of the time, the susceptibility to these skin conditions seemed to be opportunistic and unaffected by the type, duration, and level of control of psychiatric illness.
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe hereditary arrhythmia syndrome predominantly affecting children and young adults. It manifests through bidirectional or ...polymorphic ventricular arrhythmia, often culminating in syncope triggered by physical exertion or emotional stress which can lead to sudden cardiac death. Most cases stem from mutations in the gene responsible for encoding the cardiac ryanodine receptor (
), or in the Calsequestrin 2 gene (
), disrupting the handling of calcium ions within the cardiac myocyte sarcoplasmic reticulum. Diagnosing CPVT typically involves unmasking the arrhythmia through exercise stress testing. This diagnosis emerges in the absence of structural heart disease by cardiac imaging and with a normal baseline electrocardiogram. Traditional first-line treatment primarily involves β-blocker therapy, significantly reducing CPVT-associated mortality. Adjunctive therapies such as moderate exercise training, flecainide, left cardiac sympathetic denervation and implantable cardioverter-defibrillators have been utilized with reasonable success. However, the spectrum of options for managing CPVT has expanded over time, demonstrating decreased rates of arrhythmic events. Furthermore, ongoing research into potential new therapies including gene therapies has the potential to further enhance treatment paradigms. This review aims to succinctly encapsulate the contemporary understanding of the clinical characteristics, diagnostic approach, established therapeutic interventions and the promising future directions in managing CPVT.
Hypothenar hammer syndrome (HHS) is a rare vascular disorder leading to ulnar artery thrombosis or aneurysm and causing acute or chronic limb ischemia. The optimal approaches to managing this ...condition lack a definitive consensus and are essentially empirical, typically necessitating conservative methods for symptomatic relief, with surgical intervention reserved for cases for which conservative measures prove inadequate or when acute limb ischemia ensues. Limited data are available on percutaneous management for this condition. We present the case of a 36-year-old male powerlifter who developed acute digital ischemia due to HHS in the left hand that was managed successfully through an innovative approach using antegrade left brachial artery access and combining percutaneous thrombosuction and intra-arterial thrombolysis. This comprehensive approach resulted in restoration of blood flow and resolution of acute limb ischemia. The patient was subsequently prescribed short-term anticoagulation therapy and remained symptom free at 3 months of follow-up. This innovative strategy challenges traditional surgical approaches in HHS management, underscoring the importance of using minimally invasive techniques as a promising alternative and highlighting potential avenues for further research.
Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India as well as worldwide and last decade has seen a steep rise in incidence of CAD in India. Direct ...visualization of the coronary arteries by invasive catheterization still represents the cornerstone of the evaluation of CAD. Cardiac imaging is a challenge of 21 (st) century and is being answered by 128 slice dual source CT as it has good temporal resolution, high scanning speed as well as low radiation dose.
To assess the diagnostic accuracy of 128-slice dual source CT Cardiac Angiography in comparison with Conventional Catheter Cardiac Angiography.
Forty patients attending the cardiology OPD with complaint of chest pain and suspected of having CAD were evaluated by CT coronary angiography and conventional invasive Catheter coronary angiography and the results were compared. All patients were checked for serum creatinine and ECG before the angiography. Computed Tomography (CT) coronary angiography was done using SIEMENS 128-slice Dual Source Flash Definition CT Scanner under either Retrospective or Prospective mode depending on the heart rate of the patient. Oral/IV beta-blocker were used whenever required.
Coronary arteries were assessed as per 17- segment AHA model. A total of 600/ 609 segments were evaluable in 40 suspected patients on CT coronary angiography, of which 21 were false positives and 8 were false negatives with specificity of 95.12% and sensitivity and positive predictive value of 95.26% & 88.46% respectively.
Non-invasive assessment of CAD is now possible with high accuracy on 128-slice dual source CT scanner.
Abstract
Organ transplant has, arguably, been the pinnacle of the advancement in medical science so far and vascularized composite allotransplantation has been the most recent addition to it. The ...scope of vascularized tissue allotransplantation has been widening with each passing day and more and more reports regarding the safety and efficacy of the procedure have been described.
Due to the limited available literature on the management of the complications and implications of the hand transplant, the importance of each report on the procedure is paramount.
A mid-arm allotransplant is a challenge in terms of expected motor recovery, and many controversies exist over the efficacy of the procedure altogether. Moreover, our case was complicated by a long ischemia time due to logistic reasons.
We share our experience of a transhumeral upper limb allotransplantation, the complications associated with it along with the early postoperative results at 10 months follow up.
Role of burn blister fluid in wound healing Gupta, Saurabh; Chittoria, Ravi; Chavan, Vinayak ...
Journal of cutaneous and aesthetic surgery,
07/2021, Letnik:
14, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Blisters are characteristic finding of second-degree superficial burns. Varied opinions for the management of burn blisters are available in literature. Most accepted one is to puncture it in a ...sterile way, keep the overlying skin as a biological cover, and over that put a moist sterile biological dressing. Fluid in the blister is ultrafiltrate of the plasma, which is rich in proteins such as immunoglobulins, various cytokines, prostaglandins, and interleukins. This fluid is pro-inflammatory, and the evidence regarding its effect on wound healing is varied. Instead of drainage, the burn blister fluid can be aspirated and immediately sprayed over the other areas of the same wound. We found this method feasible as an adjuvant therapy for second-degree superficial burn wounds. In this case report, we share our experience of the same.
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