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Ian McClurg Group

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Hamlet Nekrasov
Hamlet Nekrasov

A Yat Tha Mar

Where to start? On top of a X% discount off all orders above $X, you'll also be able to give teams individual allowances and order from thousands of the best restaurants in the city. If you ever encounter a problem, you'll also have a dedicated account manager to answer your enquiries.

A Yat Tha Mar

With this foodpanda for business, we know our team can enjoy healthy and interesting meals delivered without having to rush out of the office to grab food. They can spend time eating together, which improved the workplace experience.

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The Burmese Kitchen Combo Fried Platter is a great introduction to some of our most popular vegan starters. The platter features classic Burmese fried samosas, Burmese style falafels, and our famous Golden Tofu made from chick peas served with a spicy tamarind dipping sauce. This wide variety of authentic tastes and textures make it a perfect dish for sharing amongst friends.

Move over Tea Leaf Salad, the Burmese Kitchen has a new original dish that is soon to be a classic. What Chef Dennis has named Pal Kyak Thok or Crispy Fried Pea Salad is an unique blend of classic Burmese Flavors.

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Hyperthermia, phototherapy and magnetic therapy: (1) Low frequency electrotherapy: Use pulse current with frequency less than 1000 Hz to treat; (2) Medium frequency electrotherapy: Use sinusoidal alternating current with frequency between 1000-100000 Hz to treat; (3) High frequency electrotherapy: The oscillatory current with frequency above 100 kHz and the electromagnetic field are used for treatment, which has no exciting effect on nerve and muscle; (4) Phototherapy: Use all kinds of light radiation to treat; and (5) Magnetic therapy: It is a kind of physical therapy that uses the magnetic field on the human body to treat diseases with the effect of analgesia, detumescence and pain relief.

Nonsteroidal anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) mainly have antipyretic, analgesic, anti-inflammatory and antirheumatic effects (such as ibuprofen injection, loxoprofen sodium cataplasms, etc.), which can effectively relieve pain. It is the most commonly used medicine to cure chronic pain diseases. Nonselective NSAIDs have strong anti-inflammatory and analgesic effects but also have obvious gastrointestinal side effects. The selective COX-2 inhibitors (such as celecoxib, etocoxib, etc.) can significantly reduce the occurrence of gastrointestinal adverse reactions. Factors that may increase the risk of NSAID related upper gastrointestinal adverse events (gastrointestinal ulcer, bleeding, perforation) old age, history of severe upper gastrointestinal ulcer or hemorrhagic disease, concurrent use of warfarin or other anticoagulants, use of oral corticosteroids or high dose NSAIDs, etc. Therefore, it is recommended to prescribe such drugs at the lowest effective dosage and shortest course of treatment as possible. It is forbidden for patients to take two NSAIDs at the same time[32,33].

Ion channel regulators: Sodium channel blockers (such as bulleyaconitine) and calcium channel blockers (such as gabapentin and pregabalin) are commonly used ion channel regulators and are used as the first-line drugs for neuropathic pain and for the treatment of MPS. The common side effects include drowsiness, dizziness and edema. Such drugs should be given at lower doses and increased slowly[35].

Central muscle relaxant: Such drugs are mainly used to cure spasm or musculoskeletal related diseases by blocking the vicious cycle of skeletal muscle tension, i.e. hyperactivity of muscle tension, circulatory disorder, muscle pain and hyperactivity of muscle. Such drugs include tizanidine, chlorzoxazone, eperisone, baclofen, etc. It is recommended to treat patients with myofascial pain when NSAIDs are not effective alone or with muscle spasm[36].

Silver needle puncture: The treatment of silver needle combined with heat conduction is an effective method for the treatment of intractable MPS. The diameter of soft silver needle body is 1.1 mm, and the tip is blunt, which increases the difficulty of scratching blood vessels and nerves making the treatment relatively safe. The operator inserts the silver needle into the tenderness point (area), then a small range of thrusting, lysis, separation and heat conduction are performed. The aseptic inflammation at the attachment of soft tissue was eliminated due to the deep heat effect in the myofascial membrane of the diseased tissue and periosteum. The silver needle acupuncture has been widely applied and popularized in the clinic for the high safety, simple operation, wide range of indication and excellent long-term effectiveness. The newly developed thin silver needle (0.6 mm in diameter) in the treatment of the small joints of the limbs and maxillofacial region gains some advantages, but the clinical report of long-term outcomes is lacking.

Acupotomy: Acupotomy is a blade shaped like a silver needle with a thick needle body and a needle tip of 0.8 cm wide, which can incise or peel off adhesion and small nodules of local soft tissues. For MPS, the mechanical stimulation and separation of acupotomy could enhance the activity of local tissues and accelerate the lymphatic circulation. The incision of scar tissue leads to the reduction of local pressure and pain. Because of its accessibility and convenience, it is widely used in China. However, the acupotomy should be utilized with caution or prohibited in some areas containing major nerves, vessels or organs due to the invisible operation with a sharp needle tip.

The major complication of MPS injection is infection. Accidental puncture into a blood vessel or spinal canal can cause nerve injury to occur. A transient fever or pain can occur following this injection technique, and the patient should be warned of this possibility prior to the procedure. The process of injection should be entirely aseptic, and the vital signs of the patient should be monitored[41].

Injection of local trigger points: Palpation with finger pressure prior to the procedure may find points inducing cord sensation and radiating pain. Injection would function better at the points where muscle twitching is induced during puncture[42]. Then treating the scheduled area by means of typical MTrPs with careful palpation rather than on the basis of soft-tissue anatomy will result in a positive effect[40].

In recent years, ultrasound-guided therapies for MTrPs have been widely used. Ultrasound guidance can improve the therapeutic success of injections in MPS-related cervical headache, shoulder pain, chest wall pain, back pain, etc[43]. Ultrasound assists to identify deep MTrPs that cannot be observed by the naked eye. Observing local convulsive responses under the help of ultrasound supports positioning accuracy and improving efficiency[44]. Puncture in this area with an in-plane or out-of-plane approach under ultrasound guidance to elicit a local convulsive response can locate the trigger point to perform precise ultrasound-guided injection. Furthermore, injury to normal tissues can be avoided by the visibly real-time punctures, which eventually reduces incidents of complications[45].

Neural blockade: Neural blockade is aimed at the myofascial areas of important nerve distribution. By inhibiting aseptic inflammation of peripheral nerves and separating and loosening local soft tissues, a therapeutic effect is produced. The procedure must be performed under ultrasound or X-ray guidance[46].

In combination with acupuncture and stretch therapy, a total of 0.1 mL to 0.5 mL of local anesthetic is drawn up as long as the puncture induces intolerable soreness or twitching in the patient. The stretch therapy should also be followed gradually and slowly as the puncture is completed. The most common dose of local anesthetics is 0.5% to 1% of lidocaine or 0.1% to 0.5% of ropivacaine. An additional small dose of corticosteroid may be needed in severe cases[48].

RF thermal coagulation treatment: RF thermal coagulation of myofascial pain is applied to the muscle fascia without important nerves around, such as the trapezius, supraspinatus, gastrocnemius, etc. The main targets of treatment are the MTrP and the fascia. The MTrP is determined physically upon palpitation. After that, the skin over the MTrP is marked and sterilized, a sterile surgical towel is placed, and a local anesthetic is administered with 0.5% lidocaine. Then, the RF cannula is inserted into the fascia under the guidance of ultrasound. The output temperature is set to be 75 C and duration of 15-30 s. Thermal coagulation RF therapy can be performed at the same time for different MTrPs, while the same point can only be treated once a week.

Pulsed RF treatment: The energy output mode of pulsed RF is intermittent and of high intensity, which produces high voltage with low temperature. Therefore, it can avoid the damage of nerves around the needle tip. Pulsed RF of myofascial pain is applied to the muscle fascia with important nerves around, such as the scalenus, piriformis, gluteus medius, etc. During the procedure of local anesthesia, we should avoid injecting local anesthetics into the muscle layer near the treatment points. When the needle reaches the target fascia under the guidance of ultrasound, the parameters should be set to 42 C for 120 s. Similarly, pulsed RF therapy can be performed at the same time for different points of myofascial. 041b061a72


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