Association of breastfeeding related musculoskeletal pain, sleep quality and physical activity among postpartum women: a literature review

Women often report musculoskeletal ailments during perinatal period resulting in less sleep hours and decline in physical activity. It has been speculated that physical activity can lower the frequency of muscular pain and enhance good quality sleep among women. Hence, the review aimed to investigate the association of breastfeeding related musculoskeletal pain, sleep quality and physical activity thus refining quality of life among women. Literature search was performed using search strategy on PubMed, Scopus and Pedro databases during 2019-2023. A total 54,037 articles were found via database searching out of which only 16 studies were relevant meeting the inclusion criteria. All the studies found that breastfeeding related musculoskeletal pain, sleep quality and physical activity are associated with each other. To lower the incidence of muscular pain and improve sleep quality, physical activity can be incorporated thus preventing occurrence of future complications. Hence, it has been suggested that physical activity is key solution of emerging musculoskeletal pain and broken sleep quality. Evidence from this literature supports that prenatal education emphasizing necessity of physical activity should be routinely integrated into maternal care in an effort to reduce chances of future complications.

Platelet count and its indices as diagnostic markers of neonatal sepsis: a cross-sectional study

Background: Neonatal sepsis is a critical condition posing a significant threat to newborns globally, particularly in developing countries. The non-specific symptoms and time-consuming traditional diagnostic methods highlight the need for rapid and reliable biomarkers. Recent studies suggest platelet count and indices such as mean platelet volume (MPV) and platelet distribution width (PDW) as potential indicators for early diagnosis of neonatal sepsis. This study aimed to assess the correlation between platelet count and its indices and neonatal sepsis.Methods: A hospital-based cross- sectional study was conducted at NICU of tertiary care hospital involving 80 neonates with suspected sepsis. Platelet count, PDW, and MPV were measured and correlated with neonatal sepsis. Statistical analyses were performed using SPSS software, with a significance set at p<0.05.Results: Of the 80 neonates studied, 22.5% exhibited thrombocytopenia. There was a noteworthy inverse relationship discovered between platelet count and sepsis, while MPV and PDW were higher. Gram-negative organisms were the most common cause of sepsis, out of which E. Coli (63.64%) was the most common.Conclusions: The study confirmed a significant association between platelet count and indices with neonatal sepsis. Platelet count, MPV, and PDW can serve as effective, rapid diagnostic markers, potentially improving early detection and outcomes in neonatal sepsis.

Physical rehabilitation of the visually impaired and its implications for tactile modelling

The aim of this study is to investigate the effect of tactile models in improving the health of visually impaired people. The main objective of the intervention is to improve mobility, muscle strength, flexibility and physical fitness. Longitudinal study, this study was approved by the research ethics committee “Naraina Medical College and Research Centre (NMCRC)” Kanpur, Uttar Pradesh. Convenience sampling was conducted over a three-week period from December 2021 to January 2022. The physical rehabilitation of the visually impaired (PP-PVI) process includes physical assessment, language selection, design structure and visually impaired language. A longitudinal study was conducted with youth and young adults with visual impairment. They received treatment twice a week for 12 months and their quality of life was assessed before and after treatment. Quality of life was assessed using the 30-item short form health questionnaire (SF-30). Mean scores improved in all domains except the quality of life questionnaire after PP-PVI. PP-PVI has proven to be a valuable, easy-to-understand, and reliable clinical tool. This product is for people with visual impairment. Implications for Professionals: PP-PVI exercise improves many aspects of your body and performance. This plays an important role in ensuring independence for people with low vision. Physical therapy is effective in improving visual and tactile motor skills. Physical therapists can help improve the overall function and quality of life of people with these problems through targeted exercises and activities.

Diabetes and the retinal changes in the eye: a threat to the sight

This article discusses the importance of diabetic retinopathy, an eye disease associated with diabetes, which is a systemic disease. The research question addresses the impact of diabetes on the retina of the eye through infection and clinical features. This approach is designed to improve the relationship between early diagnosis and treatment of disease, including laser surgery, corticosteroid injections, and vitrectomy. This article focuses on chronic diabetic retinopathy and eye examination recommendations in the United States and the United Kingdom. To prevent and manage diabetic retinopathy, it is recommended that diabetic patients have regular eye examinations. The results of this study include the importance of good glycaemic control, injections, photocoagulation, and vitrectomy as treatment options. Intravitreal long-acting steroids may also temporarily improve visual acuity by reducing macular oedema. However, long-term use of the drug may cause side effects and may lead to cataracts, steroid glaucoma, and endophthalmitis. It may cause reasons. A recent study of the disease in India shows that the incidence of high blood sugar and its effects on the eye is mainly diabetic retinopathy, including cataracts, neovascular glaucoma and even retinal detachment, which are very dangerous for eye health. Therefore, it is important to inform patients about this disease and perform timely screening because patients need to be informed carefully.

Study to assess incidence and type of congenital heart defect in children with down syndrome presenting to tertiary care teaching hospital of Southern Rajasthan

Background: Down syndrome occurs in people of all races and economic levels. Cardiac anomalies with a prevalence of about 50% are the most common anomaly responsible for death during the 1st two years of life in children with down syndrome. Objective of the study was to Assess the incidence and type of congenital heart disease in children with down syndrome presenting to a tertiary care hospital.Methods: Hospital based descriptive study. Participants: All children (0 to 18 years) diagnosed (clinically or on karyotyping) with Down syndrome, presenting in RNT Medical College, Udaipur Each patient was evaluated with a pre-set Performa which contained detailed sociodemographic profile, maternal and clinical history including age of conception, detailed physical examination to look for features of down syndrome. Degree of Intellectual / Developmental retardation was assessed by Vineland Social Maturity Scale. 2D- echo, karyotyping was done in all patient. CBC, thyroid profile, CXR, USG- abdomen, Invertogram were done as per need.Results: Out of 57 Down syndrome children, 32(56.1%) were males and 25(43.9%) were females. Congenital heart defect was found in 35 out of 57 Down syndrome children (61.4%). Among 35 cases 82.2% had Acyanotic CHD and 17.1% had Cyanotic CHD. Ventricular Septal defect (31.4%) was the most common Congenital heart defect followed by Atrial Septal defect in 20% cases. Trisomy 21 was observed among 94.7% cases.Conclusions: More than half of children with Down syndrome have congenital heart disease, mostly Acyanotic, more specifically VSD. Early screening and diagnosis re the key to avoid irreversible hemodynamic consequences.

Manual jet ventilation to rescue a patient with pinhole tracheal stenosis: A case report

Background: Airway management of patients with tracheal stenosis is highly challenging and even establishing a surgical airway may be difficult in these patients. Case: A 24 year old female developed pinhole tracheal restenosis after undergoing tracheal web resection and reconstruction. After other modes of ventilation had failed, we used the Manual jet ventilator endotracheal tube assembly as a rescue device and performed intermittent low-frequency jet ventilation until a definitive surgical airway could be established. Conclusion: Central airway obstruction in severe tracheal stenosis can cause life-threatening hypoxia. Jet ventilation through the pin hole opening buys some time for the surgeon to secure the airway.

Krukenberg tumor

Krukenberg tumor is a rare form of metastatic ovarian cancer which accounts for less than 2% of all ovarian tumor. Krukenberg tumor mostly occurs after the age of 40 years and is rarely found in younger age group. It usually presents with bilateral involvement of ovaries. It presents when the primary is already advanced. Here we are presenting a rare case of Krukenberg tumor in a 22 years old female with primary from stomach.

Anesthetic Consideration in Patient posted for LSCS with RHD with Severe MS

Introduction: Rheumatic mitral stenosis forms 88% of the heart diseases complicating pregnancy in the tertiary referral centre in India. Case report: 27 year old G4P2L2A1 with 39 weeks of gestation with Rheumatic Heart Disease with severe Mitral stenosis with moderate mitral regurgitation and tricuspid regurgitation was posted for elective caesarean delivery. After doing preanaesthetic evaluation patient was managed conservatively with iv diuretics and inj metoprolol and patient status improved from nyha iv to ii. After taking written high risk consent,the patient was taken on OT table with Pre op vitals PR-84/min, BP =110/67mmhg, Sp02=99% in room air and during Intraop course Induction was done after premedication with Inj Etomidate 12 mg IV and scoline 75mg IV and was intubated orotrachealy with RSI technique with ETT of 7.0mm Bilateral air entry confirmed and fixed at 19 cm at corner of mouth. Anaesthesia was maintained with O2 at 100%@5L/min and isoflurane at 0.4-0.6 and inj Atracurium 15+5+5 mg IV and Inj Fentanyl 40 µg IV. Inj.Esmolol 5 mg IV was given at regular intervals to control tachycardia. Tab sildenafil was given via ryles tube.After delivery of the baby,20 IU of oxytocin was given via IV infusion and Inj. Furosemide 40 mg IV was also given.Total fluid input was 300 ml and she had an output of 250 ml.She was also given usg guided b/l TAP block using 40 ml of 0.25% Ropivacaine.She was extubated after giving neostigmine 2.5mg and glycopyrrolate 0.5mg IV.she maintained SPO2 of 99% on room air and was shifted to recovery room and oxygen supplemented pos operatively @6L/minPost op vitals:PR=89/min,BP=120/74mmhg and SPO2=100% Conclusion: Rheumatic mitral stenosis complicating pregnancy is still a frequent cause of maternal death. A better understanding of the physiological changes in pregnancy and the pathological impact of mitral stenosis over pregnancy and a multidisciplinary approach in diagnosis and management reduce the mortality and morbidity

Genetic Clarification of Auricularia heimuer Strains Bred and Cultivated in Korea Using the ITS and IGS1 rDNA Region Sequences

Auricularia is one of the broadly cultivated edible mushrooms in Korea. Most of the Korean Auricularia strains used for cultivation and breeding are known as A. auricula-judae. Recently, this species has been reported to belong to a species complex. Therefore, this study was carried out to genetically clarify the bred and cultivated Korean A. auricula-judae strains. The internal transcribed spacer (ITS) and IGS1 rDNA region sequences were determined from 10 A. auricula-judae strains by PCR and sequencing. Variation in the nucleotide sequence and sequence length of the two rDNA regions were found among the seven A. auricula-judae strains. A maximum-likelihood (ML) phylogenetic tree based on the ITS sequences clearly placed all the 10 Korean A. auricula-judae strains in the A. heimuer clade of the A. auriculajudae complex. A. heimuer is diverged from A. auricula-judae. An ML phylogenetic tree based on the IGS1 sequences revealed the close relationship between Korean A. heimuer strains to Chinese A. heimuer strains. But each strain could be distinguishable by the IGS1 sequence. Furthermore, progeny strains in the seven Korean strains could be differentiated from their parental strains by the IGS1 sequence based phylogenetic tree. Our results are expected to be used to complement the distinction of domestic Auricularia cultivars.

The kynurenine pathway in Alzheimer's disease: a meta-analysis of central and peripheral levels

Objective: Changes in the kynurenine pathway are recognized in psychiatric disorders, but their role in Alzheimer's disease (AD) is less clear. We aimed to conduct a systematic review and meta-analysis to determine whether tryptophan and kynurenine pathway metabolites are altered in AD. Methods: We performed a systematic review and random-effects meta-analyses. Inclusion criteria were studies that compared AD and cognitively normal (CN) groups and assessed tryptophan or kynurenine pathway metabolites in cerebrospinal fluid or peripheral blood. Results: Twenty-two studies with a total of 1,356 participants (664 with AD and 692 CN individuals) were included. Tryptophan was decreased only in peripheral blood. The kynurenine-to-tryptophan ratio was only increased in peripheral blood of the AD group. 3-Hydroxykynurenine was decreased only in cerebrospinal fluid and showed higher variability in the CN group than the AD group. Kynurenic acid was increased in cerebrospinal fluid and decreased in peripheral blood. Finally, there were no changes in kynurenine and quinolinic acid between the groups. Conclusions: Our results suggested a shift toward the kynurenine pathway in both the brain and in the periphery, as well as a shift towards increased kynurenic acid production in the brain but decreased production in peripheral blood. In addition, our analysis indicated dissociation between the central and peripheral levels, as well as between plasma and serum for some of these metabolites. Finally, changes in the kynurenine pathway are suggested to be a core component of AD. More studies are warranted to verify and consolidate our results.

A cross-sectional study of musculoskeletal disorder and their environmental determinants among cycle rickshaw pullers of Delhi: A geographical information system-based analysis

Introduction: Rickshaw pulling is among the major activities in the informal sector. Cycle rickshaw pulling involves the task of prolonged sitting, fixed posture, and vibrations which could increase the risk of developing many health problems including one of the major problems of musculoskeletal disorder (MSD). Rickshaw pulling remains important for urban transport system, and such activities contribute in terms of employment and transportation services. The injury and illness resulting from work leads to lower productivity and quality employment which force them to increase their daily hours of working. The work environment and various other environmental determinants for MSD were assessed. The spatial variability of these environmental determinants and MSDs of cycle rickshaw pullers was studied in Delhi. Material and Methods: A cross-sectional study was conducted among cycle rickshaw pullers of Delhi. Five districts were randomly selected, and out of 448 study subjects, a total of 425 were included in the study. Consent was obtained before the study. The Nordic Musculoskeletal Questionnaire instrument for MSDs was used. The spatial distribution of MSD and risk factors was studied using QGIS software. Results: MSD was observed in 51.5% of the cycle rickshaw pullers and the prevalence increased with age from 9.6% to 34.7%. A statistically significant association of MSD with duration of work, sleeping hour, and sleeping place was observed. Poor road condition and posture were also having an association with MSD. Conclusion: Every second cycle rickshaw puller was having MSD. Lifestyle, road conditions, harsh environmental condition, strenuous physical exertion, and ergonomics of the cycle rickshaw were important factors contributing for MSD.

Immediately sequential bilateral cataract surgery in Down syndrome

The exponential increase in world population and average human lifespan is expected to result in geriatric population globally. The problem of preventable blindness due to cataract will increase manifold. Simultaneous Bilateral cataract surgery (SBCS) is a viable option in such subset of patients. Despite faster visual recovery, economic benefits to patients and health care providers, decreased risk of complications associated with General anaesthesia, there is significant resistance in accepting SBCS as a routine procedure. Bilateral endophthalmitis is the main deterrent in performing ISBCS. This case highlights successful ISBCS in 36 years old female patient with Down抯 syndrome.

Emphysematous pancreatitis presenting as new-onset diabetes mellitus with multi-organ dysfunction: Managed successfully with medical management alone

Emphysematous pancreatitis is one of the rare and potentially fatal complications of acute pancreatitis. We present here the case of a 69-year-old man who presented with abdominal discomfort, vomiting, and constipation with features of sepsis due to Klebsiella pneumoniae bacteremia and new-onset diabetes mellitus. Elevated serum lipase levels and abdominal computed tomography scan showing pancreatic necrosis with air bubbles suggestive of emphysematous pancreatitis. He was managed conservatively as the surgical intervention was differed in view of unstable hemodynamics and thrombocytopenia. The entire emphysematous pancreatitis and sepsis resolved with medical management alone although surgical necrosectomy may be indicated at presentation.

Management of human epidermal growth factor receptor 2杗egative metastatic breast cancer: Role of poly adenosine diphosphate (ADP?ribose) polymerase inhibitors

Human epidermal growth factor receptor 2 (HER2)?negative subset is the most heterogeneous group of metastatic breast cancers (MBCs) as it includes both hormone receptor (HR)?positive and HR?negative breast cancer (or TNBC), which have different therapies and treatment challenges. Though endocrine therapy (ET) remains the treatment backbone in HR?positive HER2?negative cases, about 40% of the patients show intrinsic or acquired resistance to ET due to multiple mechanisms. Combining different therapies such as ET and other targeted therapies with or without chemotherapy fails to give continued benefit, unlike cyclin?dependent kinase (CDK) 4/6 inhibitors that have shown a great benefit. TNBC has conventionally been treated ineffectively with systemic chemotherapy. Recently, poly (ADP?ribose) polymerase inhibitors (PARPi) have emerged for HER2?negative breast cancer (BC) patients, including TNBC. Olaparib and talazoparib have recently been approved in germline BRCA?mutated (gBRCAm) HER2?negative MBC. Additionally, ongoing trials of PARPi in combination with various therapies are expected to provide more and better treatment options for gBRCAm HER2?negative breast cancer.

Constant score in asymptomatic shoulders varies with different demographic populations: derivation of adjusted score equation

Background@#In the present study, the age- and sex-adjusted Constant score (CS) in a normal Indian population was calculated and any differences with other population cohorts assessed. @*Methods@#The study participants were patients who visited the outpatient department for problems other than shoulder and healthy volunteers from the local population. Patients without shoulder pain/discomfort during activity were included in the study. Subjects with any problem that might affect shoulder function (e.g., cervical, thoracic spine, rib cage deformity, inflammatory arthritis) were excluded. Constant scoring of all participants was performed by trained senior residents under the supervision of the senior faculty. Shoulder range of movement and strength were measured following recommendations given by the research and Development Committee of the European Society for Shoulder and Elbow Surgery (2008). A fixed spring balance was used for strength measurement; one end was fixed on the floor and the other end tied with a strap to the wrist of the participant, arm in 90° abduction in scapular plane with palm facing down. @*Results@#Among the 248 subjects (496 shoulders), the average age was 37 years (range, 18–78 years), 65.7% were males (326 shoulders) and 34.3% females (170 shoulders). The mean CS was 84.6±2.9 (males, 86.1±3.0; females, 81.8±2.9). CS decreased significantly after 50 years of age in males and 40 years of age in females (p<0.05). The mean CS was lower than in previous studies for both males and females. Heavy occupation workers had higher mean CS (p<0.05). A linear standardized equation was estimated for calculating the adjusted CS for any age. @*Conclusions@#Mean CS and its change with age differed from previous studies among various population cohorts.

Comparative evaluation of diode laser and simvastatin gel in pulpotomy of primary molars A randomized clinical trial

Background: Pulpotomy is a vital pulp therapy performed in carious pulp exposures in teeth in which the inflamed coronal pulp is removed and medicament is placed to conserve the vital root pulps. Recently, simvastatin which is a cholesterol-lowering drug has been found to be associated with the pulp regenerative potential. Aim: The aim of this parallel two-arm randomized control trial was to evaluate and compare the clinical and radiographic efficacy of diode laser (DL) and simvastatin gel (SG) in pulpotomy of carious primary molars. Methods: Hundred primary molars (in 98 children, 65 males, 33 females with age 4–8 years) requiring pulpotomy were randomized into the DL or SG group. Pulpotomy was performed as per the standardized protocol; thereafter, all teeth were restored with resin modified glass ionomer cement followed by stainless steel crowns. Follow-up evaluations were done at 3 and 12 months using clinical and radiographic criteria. Statistical analysis was done using Chi-square test at a significance level of 0.05. Results: At 12 months, out of 92 teeth available for clinical and radiographic evaluation by blinded evaluators, DL group showed clinical and radiographic success rates of 76.1% and 52.1%, while SG group showed 80.4% and 65.2% success rates, respectively. There was no statistically significant difference between the efficacy of two techniques clinically (P = 0.49) or radiographically (P = 0.30). Conclusions: Both SG and DL had similar efficacy for primary tooth pulpotomy, clinically and radiographically after 12 months. Considering its ease of application and low-cost, SG can be recommended as a potential pulpotomy medicament in primary molars.

A case of adrenal cortical carcinoma with inferior vena cava thrombus extending into the right atrium: a two staged procedure

We present a case of adrenal cortical carcinoma (ACC) with tumor thrombus involving the inferior vena cava (IVC) and right atrium in a morbidly obese, middle-aged female. ACC is a rare type of cancer with a poor outcome. Most cases present with metastasis at the time of initial presentation. This patient presented with breathing difficulty and flank pain. With endocrinology evaluation and collaborative effort of multidisciplinary teams, the patient successfully underwent staged procedures of atrial clot evacuation after thoracotomy with cardiopulmonary bypass (CBP) along with inferior vena cava thrombectomy (IVCT) and left radical nephroadrenalectomy. The two staged procedure reduces the mortality when compared with a single staged procedure. The patient underwent atrial clot evacuation, performed by cardiothoracic surgery team under CBP and deployment of IVC filter by interventional radiologist as a first staged procedure. At six months of follow-up, the patient had locoregional disease spread but with good functional status. This case report highlights that even a high-volume disease, with proper planning by an experienced surgical team, can be operated successfully with an acceptable post-surgery quality of life for the patients.

Laparoscopic Paediatric Hernia Repair Using Tuohy Needle - Our Preliminary Experience of 100 Cases

Congenital inguinal hernia repair is one of the most commonly encountered paediatric surgical procedures. With advancements in minimal access surgery, there is an increasing inclination towards the repair of paediatric inguinal hernia (PIH) laparoscopically over an open procedure. Currently, a single port laparoscopic percutaneous extraperitoneal closure, a simple and reliable method, is being used widely. METHODS100 patients with PIH were treated using a single port LPEC technique from August 2014 to July 2018. The study was conducted with a modified LPEC technique using a Tuohy needle. The deep ring was encircled with the help of Tuohy needle under laparoscopic visualization and a suture was passed through it. The needle was then used to encircle the ring from the opposite side and the initial suture was retrieved with the help of a loop, and a purse string was created to obliterate the deep ring with extracorporeal knotting. RESULTS100 congenital hernias were repaired by LPEC method. Mean age was 5.85 ± 2 years. Male to female ratio was 7.3 : 1. 96% of cases were unilateral and 4 % were bilateral preoperatively. PPV was found in 8% of cases intraoperatively. Mean operating time was 22.08 ± 10.2 and 27.6 ± 11.47 minutes for unilateral and bilateral cases respectively. There were no intraoperative complications and no recurrences. Only one patient developed wound infection. CONCLUSIONSLPEC of hernial sac using a Tuohy needle is a safe and effective method for the repair of PIH. It is easy to perform, faster, and offers good cosmesis with cure for imminent contralateral hernias.

A curious case of electric wire in urethra

We present a case of discharging urethral fistula in a sexually active young male, who was found to have an impacted electrical wire in the urethra. Polyembolokoilamania is a condition, where one inserts foreign bodies via natural orifices, either for autoerotism, in inebriated states or due to psychological conditions. A wire was inserted into the patient’s urethra and it remained impacted for a year, leading to pain, dysuria and discharging urethral fistula. The wire was removed and the fistulous tract was excised. Patients, if diagnosed with autoerotism needs follow up with psychiatrist to address the underlying condition.