Effect Of Chest Binder On Kinesiophobia In Coronary Artery Bypass Grafting Patients, Over A Period Of One Month: A Prospective Experimental Study

Background: Kinesiophobia has been reported as one of the most common factors that hinder the exercise based cardiac rehabilitation. According to the evidences in the literature and clinical observations, chest binder is prescribed post median sternotomy to reduce the postoperative complaints and complications. Till date no sufficient evidence has been reported regarding effectiveness of chest binder on kinesiophobia in CABG patients post median sternotomy. Purpose: To assess the effect of chest binder on the level of kinesiophobia; in CABG patients over a period of one month. Participants: Total 70 (50 – males; 20 – females) post CABG via median sternotomy, hemodynamically stable patients, aged between 40 – 70 years, with Tampa Scale for kinesiophobia – short version (TSK – SV) Heart scores > 37 were included. Methods: On the 4th post operative day, patients were assessed for level of kinesiophobia using TSK – SV Heart. The patients were divided in to two groups depending on the prescription of chest binder by their surgeons as Group A (with binder), Group B (without binder). One month post CABG, the patients in both the groups were asked to fill the TSK – SV Heart, via telephonic conversation. Analysis: Comparison of TSK – SV Heart score at baseline and after one month within Group A and Group B was done using Wilcoxon signed rank test with continuity correction. Comparison of difference of TSK – SV Heart score at baseline and after one month between Group A and Group B was done using Mann – Whitney test. The p value < 0.05 was considered to be statistically significant. Results: The mean of TSK –SV Heart score on 4th day post CABG in group A and group B was 43.42 (±7.717) and 43.45 (±4.64) respectively. The mean of TSK –SV Heart score on one month post CABG in group A and group B was 35.82 (±8.372) and 39.51 (± 6.03) respectively. A significant reduction in kinesiophobia was observed in group A and group B, p-value 0.00001188 and 0.00007886 respectively. The 95% Confidence Interval (CI) median estimate of group A and group B was 7.9 (5.0 – 10.5) and 4.5 (3.0 – 6.0) respectively. The mean of difference of TSK – SV Heart score in group A and group B was 7.6 (±8.24) and 3.94 (±4.82) respectively. The reduction in kinesiophobia in group A was significantly more than in group B, p-value = 0.00792. The 95% Confidence Interval (CI) median estimate of the mean of difference of TSK – SV Heart score in group A and group B was 3.7 (2.48 – 4.92) Conclusion: There was significant reduction in kinesiophobia irrespective of the use of chest binder post CABG via median sternotomy over a period of one month. There was marked reduction in kinesiophobia in patients who were using chest binder. Implications: Use of chest binder is recommended in patients who have kinesiophobia to encourage their participation in exercise based cardiac rehabilitation.

Core biopsies of the breast: Diagnostic pitfalls.

The incidence of breast cancer is increasing worldwide. In this review article, the authors compare and contrast the incidence of breast cancer, and the inherent differences in the United States (US) and India in screening techniques used for diagnosing breast cancer. In spite of these differences, core biopsies of the breast are common for diagnosis of breast cancer in both countries. The authors describe "Best Practices" in the reporting and processing of core biopsies and in the analysis of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor Receptor 2 (Her2/neu). The pitfalls in the diagnosis of fibroepithelial lesions of the breast on core biopsy are discussed, as also the significance of pseudoangiomatous stromal hyperplasia of the breast (PASH) is discussed in core biopsy. In this review, the management and diagnosis of flat epithelial atypia and radiation atypia are elaborated and the use of immunohistochemistry (IHC) in papillary lesions, phyllodes tumor, and complex sclerosing lesions (radial scars) is illustrated. Rarer lesions such as mucinous and histiocytoid carcinoma are also discussed.

Approach to diagnosis of auto-immune hepatitis.

Auto-immune hepatitis (AIH) is one of the chronic liver diseases, seen predominantly in women, resulting from dysregulated immune mechanisms not yet clearly defined. Based on a combination of clinical and laboratory parameters with both positive and negative weights, the International AIH Group devised a scoring system in 1993. The system was modified in 1999 and has proven useful for both diagnostic and research purposes. This review deliberates on the clinical, immunological and histological features of this entity.