54 years male patient complains of pain and swelling in the right lower thumb. since 6 months he is a diabetic patient hba1c is 8.3 cbc is normal uric acid is increased a bit no other systemic disease he is a driver by occupation doppler reports are attached. he is a chronic smoker. there is change in colour at the thumb region compared to the normal side what cud be the provisional diagnosis

20 year old male presented to orthopedic opd for evaluation of joint pain and swelling for last 3 years , started with left elbow joint and resulted in severe pain swelling and later a flexion deformity.Following this, bilateral great toes got affected with pain and swelling following which there was discharge of chalky white material from the toes later it progressed to bilateral knee and then to hips and then to bilateral wrist joints and small joints of hand.The patient's CBC shows decreased hemoglobin levels , platelets , TLC within normal limits , LFT , KFT normal with increased uric acid levels only around 16.14 serum calcium was normal and PTH was also normal , RA Factor slightly elevated at 12 , Anti ccp awaited. Xray as follows@

50yrs old female pt presnts wd joints pain since last 3 yrs . pt is non diabetic .pt fingers is twisted . uric acid ++ wat is most likely dx nd Rx ...

World Arthritis Day 2018 World Arthritis Day (WAD) was established in 1996 by Arthritis and Rheumatism International (ARI) to raise awareness of issues affecting people with rheumatic and musculoskeletal diseases (RMDs). It is celebrated every year on 12th October. 'Don't Delay, Connect Today' theme initiated in 2017 by the European League Against Rheumatism (EULAR) continues to give importance on early diagnosis and access to care in 2018. ‘Don’t Delay, Connect Today’ campaign calls on people including the public, physicians, health professionals and policy-makers to connect early for earlier diagnosis of RMDs and timely access to evidence-based treatment. The overall goal is to highlight RMDs as major public health problem globally and that early diagnosis and timely access to treatment can prevent further damage and burden on the individual and society. Why is early diagnosis important? Early diagnosis is important to prevent further damage, if not treated early daily activities are affected, reducing the quality of peoples' life and affecting physical abilities. Delay is often due to a lack of awareness hence it’s important to know the symptoms of RMDs and consult a healthcare professional early. RMDs are commonly divided into inflammatory and non-inflammatory types: Common non-inflammatory RMDs are degenerative spine diseases, osteoarthritis, osteoporosis and fibromyalgia Common inflammatory RMDs are rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, connective tissue diseases and polymyalgia rheumatica. RMDs can be hereditary; can also be triggered by lifestyle factors such as smoking, excessive weight, sedentary lifestyles, increasing age and having occupations that lead to injury and overuse of joints/muscles; however, in some cases the causes are unknown. Early medical treatment of inflammatory RMDs, particularly in the first 12 weeks, can prevent joint and organ damage and improve long-term function. What is Arthritis? The word arthritis actually means joint inflammation; in public health arthritis is used as a shorthand term for arthritis and other rheumatic conditions. What are the most common types of arthritis? The most common forms of arthritis are osteoarthritis, gout, fibromyalgia, and rheumatoid arthritis. What are the symptoms of arthritis? Symptoms of arthritis in affected joint are- swelling, pain, stiffness, decreased range of movements. How does body weight influence arthritis? Maintaining a healthy weight reduces the risk of developing osteoarthritis. Health tips for living with RMDs/Arthritis- (a)Healthy living- Improve your wellbeing by keeping high on emotional wellbeing, self-management and motivation and by making healthy life style choices such as: Don't smoke. Avoid stress- As stress can alter behaviour, affect sleep patterns, change appetite and increase muscle tension therefore use relaxation techniques to help manage stress. Get adequate sleep- Get enough quality sleep to protect your mental and physical wellbeing and quality of life. Reduce alcohol intake (b) Healthy eating- Healthy and balanced diet is important for people with rheumatic and musculoskeletal diseases (RMDs). Control your salt and sugar intake: Try to reduce sugar intake as it is high in calories especially in soft drinks, ready meals and confectionery foods. Salt intake should be less than 5 grams per day for adults. Too much salt can cause high blood pressure, an increased risk of heart disease and osteoporosis. (c) Physical activity and fitness- Being physically active is good for general health and can have specific benefits for people with RMD/Arthritis. Consult your doctor or physiotherapist about the type of exercise most appropriate for your condition. Exercise may be in the form of cycling, dancing, walking, gardening, swimming, yoga etc. Source : NHP

THE ROLE OF HIJAMAH IN RAKTAMOKHSHANA IN THE PRACTICE OF AYURVEDA. Although i am not a VEYD but i take a very keen interest in the medical modus of Ayurveda. It is one of the oldest forms of medicinal and therapeutic methods of healing the human body. Known to be more than 12000 years old as stated by some historians. It has the most closest relationship to Tibb E Nabwi in terms of healing by herbs as well as other healing aspects of its liniments. There are many principles that lie within this modus. However i wish to highlight the concepts of blood letting and Wet cupping in relation to this wonderful ancient therapy. Raktamokshana is one of the Panchakarma Ayurvedic treatments or the 5 basic techniques of detoxification. It is made of two words – Rakta i.e blood and Mokshana i.e to leave, and combining both these words makes the word Raktamokshana which means ‘to let out blood’. Raktamokshana is an effective blood purification therapy, in which carefully controlled removal of small quantities of blood is conducted to neutralize accumulated Pitta toxins of many blood borne diseases. This is because Raktamokshana decreases the quantum of enhanced Pitta dosha and thus the diseases caused by Pitta are also relieved. 2 Main Types of Raktamokshana : 1) Shastra Visravana : This procedure of bloodletting is performed by using metal instruments . It is further of two types Pracchana ( Bloodletting through multiple incisions ) Siravyadha ( Venepuncture ) 2) Anushastra Visravana : This raktamokshana is performed without the use of metal instruments. This is of three types – Jalaukavacharana ( Application of Leeches ) – This is indicated for Pitta dosha diseases. Shrungavacharana ( Sucking through cow’s horn ) – This is indicated for Vata dosha diseases. Alabu ( Vacuum extraction by using vegetable called Alabu / Bottle Gourd ) This is indicated for Kapha dosha diseases. ( 1) Of all these types, Siravyadha or the Venepuncture is regarded as the best. Indications of Raktamokshana: Raktamokshana or the technique of bloodletting Ayurvedic treatment is mainly advised for Pitta dosha (fire body humor) and Rakta (blood tissue) imbalance and toxicity. This is highly effective in diseases like skin diseases, edema, abscess, inflammations, dullness, uremia and pericarditis. At Indus Valley Ayurvedic Centre, we have found favorable result with Raktamokshana in Allergies, Skin disorders such as Eczema, Allergic Dermatitis, Tonsillitis and Sciatica. This procedure also decreases the load on the vital organs of heart and liver. Benefits of Raktamokshana: It has been specified in Ayurveda text that Raktamokshana Ayurvedic treatment of Panchakarma works both as curative as well as preventive therapy. As in Ayurvedic medicine, the Basti Karma is regarded as partial or even the complete treatment method, similarly in the Ayurveda surgery text, Raktamokshana is considered as the partial or complete treatment in itself. Jalaukavacharana ( Leech Therapy ) Leech is water living animal used for blood detoxification purpose. The Leech therapy ( Jalaukavacharana ) is another form of Raktamokshana practiced since ancient times in the Ayurvedic treatment of blood letting. Leech used in Therapy There near about 600-650 species found around the world. Out of this variety, only 15-20 are used for treatment purpose. Hirudo ventralis (Indian cattle leech) is used in India for treatment purpose. The size of the leech varies from half inch to eighteen inches. And the Leeches may be found in a variety of colors like black, brown, yellowish maroon etc. Procedure of Leech Therapy of Raktamokshana: Leech therapy is safe, painless & doesn’t require any change in routine life style. In this therapy after diagnosing a person, leech is applied to specific body part and is made to stay there. Once the leech finishes sucking blood from the site, then either the leech separates itself or may be separated manually by sprinkling of some herbal medicine. Proper dressing is done after the procedure. At a time single leech can suck 10-60ml blood . One session of leech therapy requires about 20- 60 min. Benefits of Leech Therapy: When the leech is used for bloodletting in the technique of Raktamokshana, as the leech sucks impure blood from the body, this helps to provide considerable detoxification, immunity boosting and also improves the blood circulation in the body. This particular variety procedure of Raktamokshana Panchakarma is highly recommended for ailments like pigmentation, scar, wound , Osteoarthritis, Rheumatoid arthritis, Gouty arthritis, Psoriatic arthritis, Atopic dermatitis, pain , edema ,itching , burning on skin etc. Procedure of Raktamokshana Panchakarma : Since Raktamokshana is a specialized procedure , Purva karma , Pradhan karma and Paschat karma or (the Pre, Main and Post procedures) are explained. Purva Karma ( Pre procedure ) of Raktamokshana : Indications for Raktamokshana : In healthy persons , if , it is done at regular intervals diseases arising from blood does not occur .(2) Diseases such as oedema , gout , psoriasis , filariasis , tumours , glaucoma , trachoma , erysipelas, diseases of liver and spleen etc . ( 3) Contraindications : Anemia , generalized oedema , emaciation , ascites , pregnancy etc . Proper instruments , herbs , tourniquet , gauze pieces , cotton swabs , bandages etc . Take informed consent . Pradhana Karma ( Main procedure ) of Raktamokshana: PRACCHANA : The part should be tied with tourniquet to dilate the vessels . Then without injuring Marmas , tendons multiple incisions are given parallel to the local blood vessels . By this method, the superficial doshas are removed and also relieves tension on that part . SIRAVYADHA : The vein is selected according to the disease . After proper oleation and sudation , liquid gruel is given .Then patient sits in erect position or lies down . SIZE OF PUNTURE : In muscular areas puncture should be the size of yava ( barley grain ) and in other areas it should be ½ barley or 1 brihi ( rice grain ). JALAUKAVACHARANA : Small nicks are given around the diseased part . When blood starts oozing , leech is applied .When it starts sucking mouth takes the shape of horse’s hoof and lift it’s neck . Then cover its neck with wet cotton . When leech has sucked enough blood , it leaves that spot and drops down . If it doesn’t leave , turmeric powder is sprinkled around the mouth .( 4, 5 ) SHRINGA YANTRA : It is applied on a flat , round , fleshy part of the body . 2 – 3 nicks are given on the site of blood letting . Horn is applied and air is sucked out from narrow part creating a vacuum . The blood comes out . (6 ) ALABU YANTRA (Cupping): A small nick is given on the skin . Put a leaf by the side of nick . Keep a cotton ball dipped in spirit and light it . Immediately put Alabu on that . As fire extinguishes the skin edges are caught tight with margins of Alabu yantra .When blood letting completes , the base gets slackened .( 7 ) Paschat Karma ( Post Procedure ) of Raktamokshana : After completion of procedures , whenever blood flow stops tourniquet and instruments are removed . Tight dressing is applied and gentle massage around the wound with medicated oil is done . The above information in relation to Ayurveda practice was taken from:- INDUS VALLEY AYURVEDIC CENTER ....By Dr. Sonica Krishen.