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Aparna Sharma A Prospective Randomized Comparative Clinical Assistant Professor Study to evaluate the efficacy of Saindhavadi Lepa and Shunthyadi Pratisarana in the management of Klinnavartma w. Shamsa Fiaz To Evaluate the Efficacy of Netrashani Rasa and Associate Professor Shigruvadi Pindi and Aschyotana in Kaphaja Adhimantha w. Shamsa Fiaz Clinical Evaluation of the Role of Basti and Tarpana Associate Professor in the Management of Kaphaja Adhimanta w. Shamsa Fiaz Comparative Evaluation of Tarpana and Basti Associate Professor Karma in Management of Age Related Macular Degeneration(Non Exudative) w. Shamsa Fiaz Ayurvedic Management of Retinal Hemorrhages Associate Professor with Vasakadi Basti and Ghana Vati. Shamsa Fiaz Comparative Study of Virechana Karma and Basti Associate Professor Karma in Timir w. Shamsa Fiaz Concept of Adhimantha: Choukhamba Publication, Associate Professor Glaucoma in Ayurveda and Varanasi Modern Aspect (B) Articles Published in Journals/Magazines: Sl. Shamsa Fiaz Role of Pathadi Taila Nasya and Journal of Ayurveda, Dept of Associate Professor Vyaghree Haritaki Rasayana in Vataja Ayush, Delhi. Shamsa Fiaz Effect of Madhukadi Taila Karnapichu & Journal of Ayurveda, Dept of Dr. Shamsa Fiaz Role of Tarpana with Triphala Ghrita in International Journal of Multi Dr. Shamsa Fiaz Ocular Manifestations and Their World Journal of Associate Professor Management in Diabetisc w. Gulab Pamnani A Clinical Study on Karna Badhirya Journal of Ayurveda, Dept of Assistant Professor w. Vijay Vagh with Nagaradi Taila, Gudadi Nasya and 2321-0435 Scholar Arogya Rasayana. Gulab Pamnani Clinical Evaluation on the Effect of Journal of Ayurveda Assistant Professor Lodhradi Churna and Dept of Ayush, Delhi. Prabhakar An Ayurveda Approach in the World Journal of Vardhan Management of Giant Papillary Pharmaceutical Research Lecturer Conjunctivitis A Case Study. Prabhakar A Concise Review of Apanavaigunya and World Journal of Vardhan its Management by Anulomana. Patel Ayurveda Hospital, Nadiad, Gujarat and demonstrated the techniques of Ent Kriya Kalpas. Shamsa Fiaz 2nd International Conference on Shalakya Tantra organized by J S Associate Professor Ayurveda Mahavidhyalaya & P D Patil Ayurveda College, Nadiad on 2-3 September 2016. Shamsa Fiaz One Day Conference organised by Jaypee Brothers Medical Publishers and Associate Professor presented a Paper on Future Scope of Ayurveda as a Streamline in Comparison to Allopathy on 25th February 2017. Dr Gulab Pamnani, 3rd National Hindi Vigyana Sammelana at Rajasthan University on 16-18 Assistant Professor December 2016 at Jaipur. Shamsa Fiaz A Program organised by Jaypee Future Scope of Ayurveda as a Associate Professor Brothers on 25 February 2017. Shamsa Fiaz 7th World Ayurveda Congress held on 4th Management of Allergic Associate Professor December at Kolkata. Gulab Pamnani Short Term Training Program for Diseases related to Eye, Ear, Assistant Professor Foreign Nationals held in the Institute Nose and Their Management. Pratibha Natural Medicaments in Ophthalmology: World Journal of Potent and Hidden Source for Ocular Pharmaceutical Research Disorders. Pratibha Rationale of Tarpana Therapy as World Journal of Emerging Innovation in Ophthalmology. Pratibha Role of Vasakadi Kwath in Diabetic International Journal of Retinal Hemorrhages A Case Study. Pratibha Understanding Diabetic Retinopathy: A World Journal of Pharmacy Lifestyle Disorder from Ayurvedic and Pharmaceutical Sciences Perspective. Pratibha Role of Tarpana Ghrita in Myopia: A International Journal of Case Study. Pratibha Treatment of Glaucomatous Optic British Journal of Atrophy Through Ayurveda.

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If you think this is a thyroid lump, ask relevant questions about hypo or hyperthyroidism. If he has had this before, what happened to it the last time, and what did the doctor say it was You may Surgical Talk 9 be able to reassure the patient even if you do not know the exact diagnosis. For example, you may be able to reassure a 20-year-old girl with a painful breast lump that breast cancer is rare at her age and usually is not painful, etc. As seen with the history of a lump, this set of questions can apply to any pain, whether cardiac in origin or due to appendicitis. Remember that visceral pain is referred along the somatic nerves; for example, diaphragmatic irritation is felt at the shoulder, and early appendicitis is felt around the umbilicus. Colicky pains feel like the contents of a tube are being squashed or pushed forward. They originate from a hollow viscus, and usually come and go in a reg ular pattern. It is sometimes helpful to get the patient to draw a graph of the pain against time. Asking the patient for aggravating or relieving factors often leads to a blank and you may have to ask more 10 Surgical Talk: Revision in Surgery direct questions in this context. This distinction is helpful in differentiating biliary colic, where the patient may be moving about during an episode, from chole cystitis, where the patient will tend to lie still. For example, nausea, vomiting and signs of sympathetic stimulation all go with cardiac pain. Anorexia, weight loss, change in the bowel habit and, perhaps, rectal bleeding would be suggestive of a bowel cancer, etc. A better approach which will make you stand out from the rest of the candidates is to apply your answer directly to the question. On examination I would inspect the breasts, followed by palpation, examining the normal side first, etc. The patient would then require counselling about the disease, and treatment could be divided into medical and surgi cal options (which can be subdivided into curative and palliative). It is clear that this answer shows that you are thinking properly and not merely giving stereotypical responses. It may be possible to give an adequate performance even when you are unsure of the exact diagnosis. A clear history or good clinical examination technique will go a long way towards persuading the examiners that you should pass. Often, if you have accurately reported the history and physi cal signs, the examiners will give you a hint towards the correct diagnosis if you do not get it immediately. Sadly, however, it is a subject that is poorly covered in most textbooks and so in this chapter we start from first principles to help you understand and remember the topic. The con tribution of water to body weight depends on how much fat you carry, because fat contains very little water. Women also tend to have a greater proportion of fat and so females and the elderly will have a smaller proportion of total body water. If we assume body water is 60% of our weight, then a 70 kg man will carry 42 l water. Osmotic pressure is the pressure needed to reverse osmosis (through a semipermeable membrane, i. Oncotic pressure on the other hand is the pressure exerted by proteins to draw fluids back in.

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Defining inappropriate practices in prescribing for elderly people: a national consensus panel. Medical treatment, management of property and personal care are areas where capacity assessment is often necessary. There are many dilemmas and ethical questions surrounding matters of competency and capacity. Formal assessors can be available (for a steep fee) to help make this determination, and they can be arranged via the Capacity Assessment Office of the Ontario Ministry of the Attorney General. The analogy is that of a person living in a condemned house: if they know that the place may fall about their head any moment, while we may not agree with their living situation, we must abide by it. In contrast, if one is living in a condemned house but denies that there is anything wrong with such an unsafe living arrangement and denies that they may come to harm, in this instance they are not capable of understanding the risks of their current situation and are therefore not capable of making such living decisions on their own. Take it in your right hand, use both hands to fold it in half, and then put it on the floor. If a person is blind, cannot read or write, or has aphasia, note their deficits and provide scores out of this new denominator. While there are 4 point scales and 30 point scales in circulation, there is no advantage in having more questions asked than on the 15 item version below (Pomeroy et al, Int J. Ask the person you are screening to choose the best answer for how they have felt over the past week or so: 1. Scoring: For most clinical purposes a score > 5 points is suggestive of depression and warrant a follow-up interview. Occurs when bilateral occipital strokes are combined with lesions in the parietal lobes. Charles Bonnet Syndrome: Vivid cinematic hallucinations in older adults with normal cognition. Diogenes Syndrome: A syndrome characterized by 1) Extreme self neglect 2) domestic squalor 3) syllogomania (excessive hoarding) 4) social withdrawal and 5) lack of concern/shame about living conditions. Not a well understood entity, and covers a mixed bag of possible diagnoses ranging from dementia, late onset psychosis to simple eccentricity. Seen in lesions of the association area of the dominant parietal lobe of the brain. Wernickes Syndrome: Thiamine deficiency leading to an encephalopathy characterized by a triad of confusion, ocular dyskinesias (diplopia and nystagnus), and ataxia. Current management of acutely agitated patients involves the use of neuroleptics and benzodiazepines either alone or in combination. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. Can J Neurol Sci 2001-28 (Supplement 1) S I -S 123 (Supplement on Dementing Disorders) 5. Clinical and Neuropathological criteria for frontotemporal dementia, consensus statement. Frontotemporal lobar degeneration: A consensus on clinical diagnostic criteria Neary et al, Neurology 1998; 51: 1546-1554 10. A multifactorial intervention to reduce the risk of falling among elderly people living in the community.

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Adult zebrafsh should be acceptable or acceptable-with-conditions, frst-step exposed for a minimum of 10 minutes and fry 4 to 7 method. If necessary to ensure death, rapid chilling for dpf for at least 20 minutes following loss of operculum specifed groups may be followed by either an approved movement. Use of a dilute sodium hypochlorite or calci sia methods for zebrafsh embryos < 3 dpf. To ensure um hypochlorite solution may be an adjunctive method embryonic lethality these methods should be followed for early life stages of fnfsh, including embryos and with an adjunctive method such as use of diluate sodi larvae. Flushing of fnfsh into sewer, sep Until further research is conducted, rapid chilling is ac tic, or other types of outfow systems is unacceptable for ceptable with conditions for other small-bodied, simi many reasons. Water chemistry and quality may delay larly sized tropical and subtropical stenothermic spe time to death and result in exposure to noxious com cies. For systems in close proximity to and/or con will determine the appropriateness and effectiveness nected to natural waterways, pathogen release or trans of rapid chilling for euthanasia of fnfsh. Based on these 2 factors, it has been suggested that thesia, is also an unacceptable method. Similarly death rapid chilling in water associated with an ice slurry is a by anoxia and dessication after removal from the water suitable killing method for small tropical and subtropi or by anoxia in water; any death due to exposure to caus cal fnfsh species 3. While metomidate has been used for euthanasia of To ensure optimal hypothermal shock (ie, rapid some fnfsh species, its listing in the Index of Legally killing), transfer of fnfsh into ice water must be com Marketed Unapproved New Animal Drugs for Minor pleted as quickly as possible. Full contact with cold water ensures op embryos and larvae, may require higher concentrations timal exposure and rapid chilling of the fnfsh. Tropical aquarium fnfsh are sold at retail pet often value them as companion animals and share a shops and fnfsh stores from systems housing one or human-animal bond similar to that seen between cli more species of fnfsh per tank. Therefore, populations of fnfsh may become injured or diseased it is important to consider the perception of the client and require euthanasia. Clients should this environment need to be applicable to individual be offered the opportunity to be present during eutha fnfsh, to all fnfsh in an aquarium, to fnfsh held in nasia whenever feasible; however, clients also should be multiple aquariums on a central fltration system, or for educated as to what method will be used and what they fnfsh kept in ponds. For example, clients may not be feasible and depopulation methods may be may believe the excitement phase of anesthesia, which required. Owners should be advised applied blunt force trauma as step 1 of a 2-step method, about the possibility of ketamine-induced muscle followed by pithing. Therefore, od may become hyperactive, which can be disconcert unless a veterinarian is available on-site to oversee use ing for staff and owners. The large number of fnfsh, limited boat space, and species should be sought as necessary. Similarly, fsheries biologists may be faced quinaldine sulfate, and 2-phenoxyethanol. Finfsh eu with situations involving numerous fnfsh requiring de thanized with these methods must not enter the food population (eg, invasive species) rather than euthanasia. Fieldwork on fnfsh may also be conducted on a (2) Rapid chilling (hypothermic shock) is accept smaller scale under conditions that make euthanasia able for zebrafsh (D rerio) and Australian river gizzard feasible. Although a gen exposed to this method may exhibit hyperactivity and eral concern for all environments and situations, the appears to be in distress), eugenol, isoeugenol, or clove potential effects of drug residues and proper disposal of oil. Although a general concern for erator designed for the size of fnfsh being euthanized. Decapitation potential carcinogen318 so human safety in the applica alone is not considered a humane form of euthanasia, tion of that agent is of concern. The pared with concentrations of > 70% used for preser rationale for this approach is similar to that for decapi vation), and acts by inhibiting neuronal sodium and tation and pithing, except that the head is still physi calcium channels in molluscs. Other agents for euthanasia, while less common, (6) Rapid chilling (hypothermic shock) in water have been described and may be useful for specifc ap plications. These agents are not acceptable, however, for 222 solution having a concentration > 1 g/L is not a immersion as a single-step procedure, nor as the frst reliable method for killing some fnfsh in early life step of a 2-step procedure.

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The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle. Achilles tendon ruptures: A new method repair, early range of motion, and functional rehabilitation. Achilles tendon rupture: Avoiding tendon lengthening during surgical repair and rehabilitation. Recovery of calf muscle strength following acute Achilles tendon rupture treatment: A comparison between minimally invasive surgery and conservative treatment. Posterior tibial tendon dysfunction: Its association with seronegative inflammatory disease. Eccentric training in patients with chronic Achilles tendinosis: Normalized tendon structure and decreased thickness at follow up. Rehabilitationafterhalluxvalgus surgery:Importance ofphysicaltherapy torestore weight bearing of the first rayduringthe stance phase. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: A meta-analysis of randomized trials. Effectivenessof theAlfredsonprotocol compared with alower repetition-volume protocol for midportion Achilles tendinopathy: A randomized controlled trial. The influence of early weight-bearing compared with non-weightbearing after surgical repair of the Achilles tendon. Operative versus nonoperative treatment of acute Achilles tendon ruptures: A multicenter randomized trial using accelerated functional rehabilitation. Which is the most appropriate intervention during the first 4 months after Achilles tendon repair Resisted foot adduction with the foot in contact with the floor, in a windshield-wiper type of motion c. Fractures are classified to dictate treatment, simplify communication between medical personnel treating the fracture, and predict outcome. The ankle is a hinge joint in which the malleoli are connected to the talus through the collateral ligaments. A fibularfracture combinedwith a deltoid ligament tear is a bimalleolar equivalent fracture and also requires surgery. Ankle fractures that involve only one malleolar disruption and do not disturb the stability of the ankle mortise are treated nonoperatively; the patient wears a short-leg walking cast or fracture boot for 4 to 6 weeks. Describe the radiographic views and alignment guides used in assessing ankle fractures. It is performed to test deepdeltoidligamentstability ina patient with a distalfibular fracture. If the medial tibiotalar space widens more than 4 mm with this test, then the deep deltoid ligament is torn and surgical stabilization of the distal fibula is warranted. Talar neck fractures usually result from hyperdorsiflexion injury, as in a motor vehicle accident or fall from a height. Treatment is usually surgical in light of problems with late displacement and prolonged immobilization. The radiograph is taken with the foot in maximal plantar flexion and pronated at 15 degrees; the x-ray tube is directed 15 degrees cephalad to the vertical. Surgical treatment generally provides better outcomes than nonoperative treatment. Approximately 65% of patients are limited in vigorous or sports activities, 50% are able to ambulate over any surface, and 40% are unable to return to previous employment. Bipartite sesamoids occur in 10% to 30% of the population and may be easily confused with an acute fracture. Bipartite sesamoids are bilateral in 85% of cases, have smooth sclerotic borders, and exhibit no callus after several weeks of immobilization. A bone scan will show increased uptake of technetium in a fractured sesamoid but will be normal in the case of a bipartite sesamoid.

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There is no clear consensus on when asymptomatic hyperparathyroidism requires surgery. Female heterozygotes have a dual population of red cells and, depending on the proportion, may develop symptoms. During hemolysis, older red cells with the lowest enzyme levels are destroyed, and diagnostic tests done at this time may be falsely normal. Other commonly used drugs for community-acquired pneumonia are high-dose amoxicillin, cefuroxime, trimethoprim-sulfamethoxazole, and doxycycline. Theoretically, empiric therapy should be guided by knowledge of local resistance patterns. Categories of tubulointerstitial kidney disease include toxins (exogenous and metabolic), neoplasia, immune diseases, vascular disorders, infections, and hereditary renal diseases. Defects in urinary acidification and concentrating ability are frequently the most troublesome manifestations of tubulointerstitial kidney disease. Antacids, sucralfate, and H2-blockers are all useful in less severe reflux disease. If vasculitis occurs, purpura, urticaria, skin ulcers, and mononeuropathy are its most common manifestations. Generally, however, crystalloid or colloid solutions are sufficient for volume replacement until properly matched blood is available. Severe disease can cause pulmonary congestion (Kerley B lines) and enlargement of the right ventricle, right atrium, and superior vena cava. Women are more frequently affected than men (3:2 ratio), and the age for peak incidence in women is in the third or fourth decade. Risk of breast cancer is increased in women with a family history, early menarche, late menopause, nulliparity, and late age at first pregnancy. Cardiac catheterization and angiography may be followed by bypass surgery or angioplasty. It is difficult to provide precise recommendations for their use, and a wide range of systemic and inhaled doses are used. By electron microscopy, focal basement membrane collapse and denudation of epithelial surfaces are noted. It is believed that remission of proteinuria with steroid therapy will improve the prognosis. The degree of proteinuria correlates with the likelihood of developing renal failure. The disease recurs rapidly in transplanted kidneys, suggesting a humoral factor in pathogenesis. Surgical sympathectomy usually provides only temporary improvement and does not prevent progression of the vascular lesion. Nifedipine is now the drug of choice for treating symptoms not responding to local warming measures (gloves, mitts) and avoidance of smoking and cold. It can also occur after myocardial infarction (Dressler syndrome) or after trauma to the heart (stab wound, blunt trauma). The clinical symptoms and signs suggest pericarditis is the diagnosis and rule out myocardial infarction, and pulmonary embolism. Iron deficiency, thalassemia, chronic inflammation, or sideroblastic anemia do not cause macrocytosis. Relatively few of such patients have a large pituitary tumor that affects the visual pathways. When vertebral collapse occurs, the anterior height of the vertebra is usually decreased. Plain x-rays are insensitive diagnostic tools because up to 30% of bone mass can be lost without any apparent x-ray changes. In the elderly, hypothyroidism can be misdiagnosed as due to aging or to other diseases such as Parkinson disease, Alzheimer disease, or depression. Mantle irradiation can result acutely in transient dry mouth, pharyngitis, fatigue, and weight loss.

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It is a nodular erythematous eruption, usually on the extensor aspects of the legs, less commonly on the thighs and forearms. A Tzanck smear is a cytologic technique for the diagnosis of herpes virus infection from vesicles, and diascopy is to assess whether a skin lesion will blanch with pressure. It is characterized by superficial pustules that rupture, resulting in a honey-colored crust. Treatment requires improving hygiene and soaking the crust, as well as oral antibiotics. It can also be caused by systemic disorders such as sarcoidosis and tuberculoid leprosy. In the latter disorder, there is associated anesthesia, anhidrosis, and alopecia of the lesions. These lesions may be periungual telangiectasias that are found in lupus erythematosus and dermatomyositis. The nail beds of scleroderma patients often reveal loss of capillary loops, with dilatation of the remaining loops when examined under magnification. Other drugs commonly implicated include penicillins, gold, allopurinol, captopril, phenytoin, and carbamazepine. Fever, eosinophilia, and interstitial nephritis frequently accompany the erythroderma. Xanthomas associated with hypertriglyceridemia are frequently eruptive; these yellow papules have an erythematous halo and are most frequently found on extensor surfaces of the extremities and buttocks. Associated findings that help make the diagnosis include annular plaques on the face, nonscarring alopecia, condylomata lata, mucous patches, lymphadenopathy, malaise, fever, headache, and myalgia. Other skin manifestations of cancer drugs include sterile cellulitis, phlebitis, ulceration of pressure areas, urticaria, angioedema, and exfoliative dermatitis. Black pigmentation can involve the face, mucous membrane, and pretibial and subungual areas. This is a panniculitis characterized by tender, subcutaneous, erythematous nodules characteristically found on the anterior portion of the legs. However, the drug is contraindicated in children under 8 years of age because of the risk of discoloring permanent teeth. A 42-year-old woman presents to the clinic complaining of dry skin, fatigue, and weight gain over the past 3 months. On physical examination, her blood pressure is 110/70 mm Hg, pulse 52/min, and heart and lungs are normal. On physical examination, there are no active joints presently, but he does have some tophaceous deposits on his left hand. As part of his complete evaluation, screening for renal complications of gout is performed. Which of the following findings is most likely compatible with chronic gouty nephropathy A screen for clinical depression is negative and she has no constitutional symptoms. On physical examination, the blood pressure is 104/68mm Hg, and heart rate is 56/min. Which of the following is the most common presentation of anterior pituitary hyposecretion Her physical examination is normal, and she has female sex characteristics and breast development. Which of the following mechanisms is most likely to explain her phenotypic pattern and amenorrhea

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Lipid peroxidation and antioxidant enzymes in synovial fluid of patients with primary and secondary osteoarthritis of the knee joint. Protein profile of osteoarthritic human articular cartilage using tandem mass spectrometry. Comparative proteomic characterization of articular cartilage tissue from normal 66 donors and patients with osteoarthritis. Cartilage markers and their association with cartilage loss on magnetic resonance imaging in knee osteoarthritis: the Boston Osteoarthritis Knee Study. Joint fluid antioxidants are decreased in osteoarthritic joints compared to joints with macroscopically intact cartilage and subacute injury. Interleukin-6 is a significant predictor of radiographic knee osteoarthritis: the Chingford study. Synovial fluid proteomic fingerprint: S100A8, S100A9 and S100A12 proteins discriminate rheumatoid arthritis from other inflammatory joint diseases. Discovery and biochemical characterisation of four novel biomarkers for osteoarthritis. The human synovial fluid proteome: A key factor in the pathology of joint disease. Comparison of different depletion strategies for improved resolution in proteomic analysis of human serum samples. Assessment of albumin removal from an immunoaffinity spin column: Critical implications for proteomic examination of the albuminome and albumin-depleted samples. Sample preparation of human serum for the analysis of tumor markers: Comparison of different approaches for albumin and -globulin depletion. Depletion of the highly abundant protein albumin from human plasma using the Gradiflow. Development of Mammalian Serum Albumin Affinity Purification Media by Peptide Phage Display. Proteomic analysis of human plasma: Failure of centrifugal ultrafiltration to remove albumin and other high molecular weight proteins. Multi component immunoaffinity subtraction chromatography: An innovative step towards a comprehensive survey of the human plasma proteome. Evaluation of Multiprotein Immunoaffinity Subtraction for Plasma Proteomics and Candidate Biomarker Discovery Using Mass Spectrometry. Depletion efficiency and recovery of trace markers from a multiparameter immunodepletion column. In Role of Reversed-phase High-performance Liquid Chromatography in Protein Isolation and Purification; Richard J. Enhanced stability of surfactant-based semipermanent wall coatings in capillary electrophoresis using oppositely charged surfactant. Separation, detection and quantitation of peptides by liquid chromatography and capillary electrochromatography. Capillary Electrophoresis of naormal human synovial fluid: comparasion with fluid from disease states of osteoarthritis and rheumatoid arthritis. Quantitative analysis of hyaluronan in human synovial fluid using capillary electrophoresis. Identification of 1-acid glycoprotein (orosomucoid) in human synovial fluid by capillary electrophoresis. Methodological Challenges of Protein Analysis in Blood Serum and Cerebrospinal Fluid by Capillary Electrophoresis.

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