Everybody hurts - What can physical health professionals learn about how mental health professionals support their own emotional resilience and mental health?

The physical aspects of ultrasonography, difficult posture with prolonged pressure exertion, have been extensively researched and addressed with advances in machine ergonomics, operator awareness of posture and positioning and workplace tools to identify musculoskeletal problems. The mental stresses are less well recognized and have only recently started getting investigated. Ultrasonography is a mentally challenging activity requiring long periods of intense concentration, empathy and communication of complex and often difficult information to patients and clinicians, all of which carries an emotional toll. Practitioners are also under increasing time and caseload pressures exacerbated by COVID recovery and chronic fatigue from two years of pandemic. A survey of UK obstetric sonographers showed 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively).1 While many Trusts provide training to support physical health, few radiology departments educate their staff on emotional resilience or offer regular support to either promote or maintain mental wellbeing. Training, when available, is often focused on the receiver and not on the impact of vicarious traumas experienced as a result of repeatedly discovering/delivering difficult outcomes to patients on a regular and prolonged basis. Few health professionals are face-to-face with their patient at point of significant discovery whether that information is imparted to the patient or not. Mental health professionals have adopted a traumainformed stance into their working practices. This has not only informed the direct clinical work with patients but is also evident in the way the workforce is supported by the trust. Regular supervision, reflective practice and debriefs are required and monitored by the trust, based on research in clinical psychology to inform best practice. Some of these practices could be applied to physical health professionals to address some of the emotional burdens experienced as part of day-to-day delivery of care.

Idiopathic anomalous congenital band causing small intestinal obstruction in a 5-month-old dog

A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature.Copyright © 2022 Canadian Veterinary Medical Association. All rights reserved.

Analysis Factors that Affect Low Back Pain in Medical Students during the Study from Home

Low Back Pain (LBP) is a health problem that affects performance in working. Indonesia is a country affected by the COVID-19 pandemic, so a study from the home policy has been issued. This study aimed to determine the association between the factors that affect LBP in Medical Students at the Faculty of Medicine, University of Mataram during the study from home. This study is an observational analytic study design with the cross-sectional approach. The population of this study is Medical Students, Faculty of Medicine, University of Mataram with total sample of 185 people. Collecting data using questionnaires and analyzed using univariate, bivariate, and multivariate analysis. According to univariate analysis, amount of LBP complaints (53 people). Based on bivariate analysis, the p-value of gender factor (0.000);body mass index factor (0.840);social-economy status factor (0.499);sitting position factors (sitting position while studying factor (0.008), sitting location while studying factor (0.046), chair shape while studying factor (0.286), body position while studying factor (0.037), legs position while studying factor (0.339), back support use while studying factor (0.455), table use while studying factor (0.010), elbows position while studying factor (0.627), stretching between study time factor (0.372), duration in each stretch factor (0.389), time range between stretch factor (0.311)), and sitting duration factor (0.011). Based on multivariate analysis, the strength of the association (OR) to LBP are sitting position factor (sitting position while studying factor) (8.232), sitting duration factor (1.956), and gender factor (0.187). The dominant factors to LBP are gender factor, sitting position factor (sitting position while studying factor), and sitting duration factor. The factor that has the strongest association with LBP is sitting position factor (sitting position while studying factor).Copyright Published by Oriental Scientific Publishing Company © 2023.

The Devil in the Details: Looking for Tough Moments in Unusual Places

Critical moments from a youth transitions' point of view, narrative turning points from a life course perspective, and biographical crisis from a subjective and reflexivity approach have been of interest for those concerned in biographical approaches, life histories, and social trajectories. It has been rightfully associated with qualitative approaches: the life stories that are told are the channel for researchers to identify and analyze the role of these specific moments in the course of lives. But is this the only route to identify, tackle and understand these moments of life? In this article we argue there are other means to analyze them. Using data from the longitudinal project "Linked Lives", where 15 family histories (with a sum of 15 young people from 18 to 25 years of age) were collected through individual interviews, and qualitative oriented surveys were applied during and after the 2020 and the 2021 pandemic lockdowns;we explore two additional avenues. One is through the interaction during the interview. Based on ethnographic notes on postures, emotions, and interactions, during the interview as a whole, and in the moments where those tough life moments were shared, another layer of understanding is achievable. Not only regarding how these moments impact the lives of young people, but also in relation to the way they are capable and willing to express them. In another approach, we suggest that qualitative-driven surveys are capable of providing stories of tough moments. Using the collected information on self-reported wellbeing and reflections of the several phases of COVID-19 lockdowns, we are able to uncover differences and oscillations of young people in difficult contexts. This may also be an ante-camera of Pandemic long lasting hardship stories. These arguments are contextualized in longitudinal, intergenerational and household scopes, since tough moments are a result of accumulated and inter-personal dynamics.Copyright © 2023 The Child Care in Practice Group.

Diaphragm dysfunctions among patients recovered from COVID

Introduction: Due to the presence of ACE 2 receptors in the diaphragm, its involvement is likely among patients with Covid 19. This study aimed to describe the presence of diaphragm dysfunction among patients who have recovered from Covid 19. Method(s): The thickness fraction (TF) of the diaphragm was assessed via ultrasonography in supine or semirecumbent posture in the right hemidiaphragm in the zone of apposition. A TF of less than 20% was classified as diaphragm dysfunction. Result(s): A total of 50 (males 34) with a mean age of 49.36 years and recovered from acute Covid were enrolled in the study. Among these 50 participants, 11, 12, and 27 had recovered from mild, moderate, severe Covid, respectively. Overall, 37(74%) subjects were hospitalized, 13 (26%) cases were home quarantined;30 (60%) subjects required oxygen during the course of illness. The average weeks from the onset of symptoms to enrolment was 7.1 weeks. Among the study participants, 9 (18%) subjects (8 males and 1 female) had diaphragm dysfunction (thickness fraction less than 20%). Among subjects who were managed at the hospital (n=37), diaphragm dysfunction was observed in 8 (21.6%). Of patients who had diaphragm dysfunction, 3 out of 9 had mild disease, whereas 6 of 9 (66.6%) subjects had severe illness. sub7 out of 9 (77.7%) subjects were hospitalized and 6 required oxygen during the illness. Conclusion. A significant percentage of COVID-19 survivors had diaphragm dysfunction which may also attribute to the persistent shortness of breath. There is an urgent need for large-scale (nationwide) assessment of diaphragm function among the survivors.

Prevalence of Musculoskeletal Disorders among Nursing Personnel

Background: Health sectors can be listed under the high-risk work areas. As we all know, in this COVID 19 pandemic, doctors, nurses, health workers are the front line warriors. If we consider only the nursing personnel here, their tasks alone are prone to occupational hazards. Musculoskeletal disorders (MSDs) are most common among the self-reported occupational diseases. In previous studies, a significantly large number of participants reported musculoskeletal symptoms faced at least once. Insufficiency of ergonomic expertise is one of the most important recognizable risk factors as well as the shortage of staff in hospitals. MSDs are caused due to stressful physical work, static work postures, frequent bending, and twisting, lifting, pushing, and pulling of heavy objects, vibrations, localized mechanical pressure, etc. Various studies have shown that the daily chores of nursing personnel put them at high risk of MSDs. Methods : The study areas were different hospitals and nursing homes in West Bengal. Only the female, registered nurses working in different wards are chosen for this study. The study's inclusion criteria were only the female, registered nurses and the absence of any chronic disease in them. The exclusion criteria were the nursing students, nurses having histories of recent or previous major accidents/injuries or chronic diseases. The study population was interviewed on a one-to-one basis by means of a questionnaire based on Modified Nordic Musculoskeletal Questionnaire. Result(s): Among the total study population, 67.5% of subjects reported low back pain (LBP). 22.5% reported upper back, knee, and ankle discomfort. 27.5%, 15%, and 12.5% reported neck, shoulder, and wrist/hand discomfort, respectively. Conclusion(s): The results of this study have revealed that MSDs are a common phenomenon among nursing personnel. LBP is the most familiar among them, 67.5% of subjects have reported the presence of discomfort. Not only LBP, subjects reported neck, shoulder, knee, and upper back discomfort along with ankle and wrist symptoms. In this COVID-19 scenario, their jobs have become more strenuous than usual. It is found that tasks requiring continuous long hours to perform are causing symptoms to appear. Shift rotations, splitting of shifts, using more ergonomically designed tools, knowledge of ergonomic skills are required in this situation to avoid the aggravation of symptoms.

CSM 2023 Cardiovascular and Pulmonary Platform Abstracts

The proceedings contain 63 papers. The topics discussed include: the CAT is significantly correlated to DLCO and 6-minute walk test in patients with long-COVID;cardiac and non-cardiac pain and sleep in patients participating in outpatient cardiac rehabilitation;the PEM/PESE activity questionnaire: a novel health-related quality of life measure for post-exertional disablement;comparison of AM-PAC and FSS-ICU in patients recovering from open heart surgery in ICU;assessment of physical therapy students' self-efficacy and accuracy measuring blood pressure using a task trainer;functional improvements observed in long-covid patients following participation in pulmonary rehabilitation;effects of a virtually-delivered program on breathing strength and lung function - a retrospective study;the influence of kinesiology tape on posture and breathing mechanics in healthy individuals;is there a role for increasing daily lifestyle walking bouts in asymptomatic peripheral arterial disease?;and impact of standard vs. modified sternal precautions on function following median sternotomy: a systematic review.

Motor and Sensory Balance Deficits Seen in People Immediately Following Covid-19

PURPOSE/HYPOTHESIS: Patients with cardiorespiratory dysfunction, such as COPD, have postural instability and increased risk of falls compared to age matched controls. Given that COVID-19 is defined as a respiratory condition, it could be presumed that these patients may demonstrate the same balance deficits. Ninety percent of patients with a history of COVID-19 report at least one neurological symptom, and these neurological symptoms could potentially result in alterations in balance. The act of maintaining upright posture or balance depends on both sensory and motor responses. It has been previously demonstrated that people post-COVID have motor and sensory balance deficits including vestibular dysfunction after leaving the acute care institution. The purpose of this study was to determine and characterize balance in patients COVID recovered (off airborne isolation but not discharged from the hospital). NUMBER OF SUBJECTS: Twenty-five subjects were recruited. Mean age was 55.6 +/- 11.3 years, 17 males, 8 females, mean length of time since diagnosed with COVID-19 was 34 +/- 15 days. All subjects had a primary or secondary diagnosis of COVID-19 during hospitalization and were considered COVID recovered (off-airborne isolation but not discharged from the hospital) and were receiving care in an acute inpatient hospital. MATERIALS AND METHODS: Following consent, subjects completed the Activityspecific Balance Confidence Scale (ABC), a questionnaire about symptoms of dizziness, the Timed Up&Go (TUG) and the modified Clinical Test of Sensory Interaction and Balance (mCTSIB). Subjects had vital signs monitored before, during, and after the examination. RESULT(S): There were no differences in clinical test scores based on age (<65 or >=65) or order of testing. Using age appropriate normative scores, all subjects had abnormal scores on the TUG indicating difficulty with motor balance, 88% had abnormal scores on the ABC indicating low confidence in performing balance activities, and 48% of the subjects had abnormal scores on Condition 4 of the mCTSIB indicating difficulty using vestibular information for balance. There was no correlation between the clinical test scores and age, length of time with COVID-19, or O2changes during testing. Surprisingly, there was no correlation between the scores on the clinical balance tests. CONCLUSION(S): Both young and older adults present with motor and sensory balance deficits acutely following a COVID-19 infection. Subjects have low perceptions of their ability to balance that may impact their function as they are discharged. CLINICAL RELEVANCE: People acutely post-COVID-19 may have balance deficits. These deficits may be due to immobility and deconditioning. It is recommended that people acutely post COVID-19 receive education and interventions to increase mobility, improve balance, and specifically receive activities that stimulate the vestibular system. It is also recommended that people acutely post-COVID-19 have these balance deficits and perceptions of balance function be considered in discharge planning.

CSM 2023 Cardiovascular and Pulmonary Platform Abstracts

The proceedings contain 63 papers. The topics discussed include: the CAT is significantly correlated to DLCO and 6-minute walk test in patients with long-COVID;cardiac and non-cardiac pain and sleep in patients participating in outpatient cardiac rehabilitation;the PEM/PESE activity questionnaire: a novel health-related quality of life measure for post-exertional disablement;comparison of AM-PAC and FSS-ICU in patients recovering from open heart surgery in ICU;assessment of physical therapy students' self-efficacy and accuracy measuring blood pressure using a task trainer;functional improvements observed in long-covid patients following participation in pulmonary rehabilitation;effects of a virtually-delivered program on breathing strength and lung function - a retrospective study;the influence of kinesiology tape on posture and breathing mechanics in healthy individuals;is there a role for increasing daily lifestyle walking bouts in asymptomatic peripheral arterial disease?;and impact of standard vs. modified sternal precautions on function following median sternotomy: a systematic review.

E-Learning and Body Aches among Palestinian University Students during Covid-19 Pandemic: The Effects of Several Behavioural Changes

Background/Objective: COVID-19 pandemic has changed our lives in the current century. During the COVID-19 lockdown, most countries switched their education methods to e-learning. The use of different electronic devices for e-learning for long hours is associated with several musculoskeletal pain that varies based on the sitting position the students use during e-learning. The aim of our study is to examine the association between different body position used during the e-learning and the different body aches experienced by the students. We also aimed to examine if several types of behavioral modifications and/or exercise practices by the students might minimize body aches associated with e-learning. Method(s): The subjects of this study were students from An-Najah university in Palestine. 385 questionnaires were filled using Google forms questionnaire and all subjects were using e-learning due to COVID-19 pandemic. Result(s): Our study showed that a large percentage of participants experienced musculoskeletal pain during the use of electronic devices for e-learning. The location and severity of pain was correlated with the sitting position used during e-learning. Furthermore, behavioral changes during e-learning like taking breaks and changing sitting position minimized the experienced pain during e-learning but no significant decrease in pain was observed by engaging in several exercise practices. Conclusion(s): The university students that participated in this study had an increase in body aches during the e-learning process that is associated with their sitting position. Awareness programs should be lunched to university students to help them minimize this pain based on behavioral changes and proper exercise training during the e-learning. Copyright © 2022, Anka Publishers. All rights reserved.

Effect of Suryanamaskar on the Sleep Quality and General Well-being among Young Adults: A Quasi-experimental Study

Introduction: Rapid decline in physical functionality has an adverse impact on both physical and psychological health. Deteriorating sleep quality during the pandemic is one such common manifestation, that further affects the general well-being. Therefore, safe non pharmacological treatments are warranted, and the practice of suryanamaskar is one such intervention. Aim(s): To find the effectiveness of suryanamaskar on sleep quality and general well-being among young adults. Material(s) and Method(s): This quasi-experimental study was conducted in Physiotherapy Department at Ashirwad Bhagwat Multispecialty Clinic, Sonipat, Haryana, from March 2021 to July 2021. A total of 30 young adults were enrolled in the study and randomly divided into two groups of 15 participants each. The experimental group practiced 8 weeks of suryanamaskar yogic exercise, also known as sun salutations, which comprises of 12 different postures performed with controlled breathing. The control group performed 20 mins of walk. Sleep quality and General Well-being (GWB) were evaluated preintervention and postintervention using the Pittsburgh Sleep Quality Index (PSQI) and Psychological General Well-Being Index (PGWBI) respectively, along with the resting Heart Rate (HR) and Blood Pressure (BP). A higher PGWBI score denotes greater psychological well-being and a total PSQI score of 5 or more indicates poor sleep quality. The effect of the intervention on GWB, sleep quality, BP and HR were assessed using Wilcoxon signed-rank test within the group and the Mann-Whitney test was used to find a statistical difference between the two groups. Result(s): After 8 weeks of yoga training, a significant difference was found in the overall sleep quality (9.53+/-1.68, p-value=0.001), GWB (78.33+/-14.76, p-value=0.001), HR (77.07+/-5.48, p-value=0.001), SBP (116.67+/-2.99, p-value=0.001) and BMI (23.01+/-3.17, p-value=0.019) in the experimental group. However, the control group revealed a significant difference only in the GWB (50.80+/-13.87, p-value=0.019) postintervention. Additionally, when compared to the control group, the experimental group revealed statistically significant results for sleep quality (p-value=0.001), GWB (p-value <0.001) and HR (p-value=0.007). Conclusion(s): The study suggests, that yoga training comprising suryanamaskar has positive effects on sleep quality and general well-being. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

Proton pump inhibitors in systemic sclerosis: a reappraisal to optimise treatment of gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GERD) is associated with substantial morbidity in patients with systemic sclerosis. Although the introduction of proton pump inhibitors (PPIs) into clinical care represents a major achievement in the management of gastro-oesophageal problems in systemic sclerosis, PPIs are seldom fully effective in patients with systemic sclerosis, and the use of maximum PPI doses is a very frequent clinical practice. However, there is little evidence to support the empirical use of PPIs in systemic sclerosis. This scarcity of evidence is especially relevant with regards to the safety concerns of long-term exposure, which have been raised in the general population. The purpose of this Viewpoint is to highlight the substantial beneficial impact of PPIs on GERD in patients with systemic sclerosis, while considering the potential adverse effects in this patient population. Furthermore, we highlight the unmet needs of people with systemic sclerosis and GERD and propose an agenda for future research to optimise the safe and effective use of PPIs in systemic sclerosis. Copyright © 2022 Elsevier Ltd

SETTING PRIORITIES IN PUBLIC HEALTH EMERGENCIES: THE PLACE OF TRIAGE IN THE DISTRIBUTION OF COVID-19 VACCINES

Just as it is the case in other issues in clinical ethics, the discourse on COVID-19 has been dominantly preoccupied with the difficulty in taking urgent decision on who gets access to scarce medical resources when demand outstrips supply. The emergence of COVID-19 in the late 2019 and its attendant consequences has created global tension and anxiety. The debate on addressing the ravaging COVID-19 pandemic has gone on at professional and policy levels. It has taken international, intercontinental and inter-racial tones. Critical in this debate are issues of vaccine production, distribution and consumption. Conspiratorial theorists are up in arms against not only the production but also distribution and consumption of the vaccine. The nationalists are taking a hardline posture against free flows of the vaccines across national boundaries while the globalists are pushing for universal access. As this debate continues to inform and enlarge scholarly and policy perspectives, issues of priority in the distribution and consumption still loom large in successes and failures across both the nationalist and globalist paradigms. The nationalists are at the crossroad with respect to prioritizing the distribution and consumption needs of rural dwellers over those of their urban counterparts. The globalists are also confronting priority challenges not only across geographies but also genders. This paper interrogates these dilemmas, with a view to articulating ways in which market and moral dynamics as well as placespecific factors might be mobilized as a game changer in the context of priority in the distribution and consumption of COVID-19 vaccine in Africa. The paper uses conceptual clarification, philosophical argumentation and analysis, to explore the commercial and charity features of the vaccine and demonstrates how some elements within African cosmology may become precursors in the emergence of effective triage system for addressing the nationalist and globalist priority dilemmas in Africa.

A Fatal Case of Intraparenchymal Hemorrhage Masquerading as Central Diabetes Insipidus

This is 32-year-old women presented to us on postpartum day 10 with severe covid-19 pneumonia. Hercomplaints were dyspnea and headache which she described as, frontally located, 8/10 in intensity, non-radiating and not associated with any posture. She had no prior history of migraines. She was afebrile, tachycardiac and hypoxic on exam. Physical examination was unremarkable. Patient failed trial of non-invasive ventilation following which she was intubated. CT head on admission was unremarkable.For COVID 19 ARDS, she was started on dexamethasone, tocilizumab, paralysis was achieved withcisatracurium and prone protocol was followed for refractory hypoxia. Patient was placed on DVTprophylaxis with heparin. Her pneumonia and oxygenation improved. However, on hospital day 8, herlab results were suspicious of Diabetes insipidus (DI). Her serum sodium was 152mEq/L with serumosmolarity of 360 and polyuria (more than 2L of urine in one hour). A full neurological examinationcould not be obtained as she was paralyzed, however, pupils were equal in size and reactive to light. With high clinical suspicions of diabetes insipidus she received a one-time dose of 16mcg of DDAVP andMRI of pituitary gland was ordered to delineate etiology. Subsequent improvement in polyuria wasnoted. Despite DDAVP her serum sodium continued to worsen. We continued to monitor serumsodium levels every four hours. Her serum sodium levels remained labile with a precipitous drop notedfrom 174mEq/L to 152mEq/L. Review of Pituitary MRI revealed multiple intraparenchymal hemorrhageson bilateral frontal lobes along with trans tentorial and cerebellar tonsillar herniation. Subsequently, patient underwent a brain death exam and declared brain dead. We suspect the development of intracranial hemorrhage in our patient was secondary to covid-19. Onliterature review, an incidence of 0.2% in covid-19 patients with a mortality of 48% is reported. In ourpatient, inability to perform a full neurological exam due to paralysis limited early recognition andintervention. This case highlights the need for increased awareness in patients with features of central diabetesinsipidus and the urgency to obtain CT head immediately after a diagnosis has been established. Promptconsideration of neuroimaging should be made when features of central diabetes mellitus are noted with limited neurological exam.

Adapting an in-person cognitive embodiment course to online delivery for people living with Parkinson's disease and their care partners

Objective: Alexander technique (AT) is a cognitive embodiment approach applied during daily life. We tested the feasibility and potential of online AT-based group courses for people living with PD (PwP) and included care partners to enhance dyadic relationship and retention of benefits. Background: An RCT showed that 1:1 AT sessions reduced motor symptoms in PwP with retention of benefits at 6 months [1-2]. Recent data suggest in-person AT-based group courses also hold promise. The COVID-19 pandemic gave an opportunity to test synchronous online AT-based courses. Methods: Design: Uncontrolled feasibility trial;3 groups met for 105 min, twice/wk, for 8 or 9 wks. Participants: 16 PwP and 14 care partners began the course. Intervention: Courses were delivered in-home via Zoom. Coursework included functional anatomy and self-management strategies via verbal instruction, anatomical models and images, demonstration, and activities. AT principles were embedded in everyday acts such as gait, sit-to-stand, speech, and IADLs. Review handouts and session recordings were provided. Outcome Measures: Functional reach, one-leg stance, TUG, 7-item Physical Performance Test, symptommanagement self-report, anonymous course evaluations, posture photos, audio interviews. Results: 94% of PwP completed the course (c.f. 65% for in-person course). Average course attendance by PwP was 86% (c.f. 91% in-person). PwP improved functional reach (p = .03) and simulated eating (p = .06). Subjectively, PWP reported improved physical self-control and ability to manage falls, shuffling gait, upright posture, garbled speech, and anxiety (all p < .05). On a 0-10 scale, evaluations averaged >9 for novelty of ideas and practicality of tools for physical symptom-management and for care partners' likelihood to remember and use what they had learned, and > 8.5 for everyone feeling better prepared to meet the daily demands of living with PD. Conclusion: AT training shows promise to improve selfmanagement of PD motor and non-motor symptoms. Online classes can increase accessibility and retention for PwP and their care partners. Larger RCTs are needed to statistically verify improvement, optimize delivery, compare to other approaches, and investigate AT combined with exercise. Six-month follow-up data are being collected for presentation, along with subjective data from care partners about their partners' symptom management.

Management of Chronic Spine Pain for U.S. Military Veterans during the COVID-19 Pandemic: Development of Virtual Chiropractic and Yoga Group Education

Methods: An experienced yoga therapist and chiropractor collaborated to develop a manualized series of 4 virtual combination yoga and chiropractic classes tailored to the needs of primarily older veterans with chronic back pain. The sessions emphasized education about spine health with practical exercises and other self-care strategies to decrease back pain. Over 4 onehour sessions, a cohort of two to six veterans practiced these chiropractic principles (e.g. postural correction, abdominal bracing, spine sparing strategies), gentle yoga postures, and relaxation and mindfulness exercises, each class building on the one before. Results: Four veteran cohorts were conducted from February 2021 through August 2021. Veterans reported feeling better equipped to manage their back pain and were more active after engaging in these classes. Delivering the classes via telehealth not only facilitated veterans' participation during COVID-19, but also allowed for the inclusion of some rural veterans who often lack access to integrative pain management resources. Other veterans struggled to participate virtually however due to lack of comfort with technology, or not having adequate equipment, or bandwidth. Background: The COVID-19 pandemic has severely limited patients' access to in-person manual (e.g. chiropractic) and complementary and integrative therapies, such as yoga, to manage chronic back pain. We sought to pilot a series of virtual classes combining yoga therapy with education and exercises to improve spine health and increase veterans' selfmanagement of chronic back pain. Conclusion: Challenges in providing in-person spine care during COVID-19 have been overcome by this novel collaboration between chiropractic care and yoga therapy, emphasizing patient education, active care strategies and empowerment of veterans. Future courses will need to consider recruitment efforts as well as providing enhanced technical support to help close the digital divide.

COVID-19 Infection Induced Mania

Coronavirus Disease 2019 (COVID-19) infection or Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, is associated with various psychiatric consequences, which are because of various types of stressors, may be fear of infection or social isolation, hospitalization, death and so on. In the present case report, a 44-year-old female with a history of pentazocine addiction and no known history of previous psychiatric illness was admitted to the Emergency Ward with vacant, withdrawn look, unnatural fixed posture, mutism, refusal to eat. These symptoms developed after discharge from another hospital where she was treated for COVID-19 induced severe pneumonia (resolving). The very next day, the patient demonstrated excessive talkativeness and jovial mood with echolalia. The patient was treated symptomatically and recovered without the use of any antipsychotics. This report highlights the probability of the mania like symptoms being linked to COVID-19 (SARS-CoV-2 infection) highlighting the need for assessment of various psychiatric manifestations during COVID-19 infection.

Psoriasis and Covid-19: A Precise Survey and Metaanalysis

Introduction: Psoriasis influences around 2% of the grown-up populace. Systemic treatments for direct to serious psoriasis have been connected to an expanded chance of upper respiratory viral tract disease. It is undetermined in the event that having psoriasis itself, having comorbidities related with psoriasis, or efficient medications for psoriasis clarify this relationship with COVID-19. Method: This precise survey incorporates looking the Google Scholar, PubMed and Web of Science databases utilizing the catchphrases psoriasis, coronavirus and COVID-19. The look was supplemented by manual looking of reference records of included articles. The look was upgraded in December 2019. Result: the current writing may give a few clues for security contemplations. Ordinary immunosuppressive treatments like anti-tumor corruption and cyclosporine and methotrexate calculate specialists ought to not be favored due to expanded hazard of contamination, particularly in regions of high-risk. Due to the side impact of hypertension, which has been detailed to be related with defenselessness to serious COVID-19 utilize of cyclosporine might posture extra hazard. Conclusion: the present writing has given no final prove that increment in biologics the chance of COVID-19, extraction of these operators ought to be saved with COVID-19 side effects for patients. The approach of treatment ought to be modified, seeing the points of interest and drawbacks for each case independently.

MINDFUL WALKING IN KNEE OSTEOARTHRITIS: A FEASIBILITY RANDOMIZED CONTROLLED TRIAL

Purpose: Current walking interventions for people with knee osteoarthritis (OA) focus on either reducing knee joint loading or on increasing physical activity. There is a need for interventions that could address both quality and quantity of walking for people with knee OA. The goal of this randomized controlled trial (clinicaltrials.gov # NCT03064139) was to determine the feasibility of a mindful walking intervention to improve quality and quantity of walking in people with knee OA. Methods: Individuals with symptomatic knee OA were recruited from the community using advertisements. Study criteria are shown in Table 1. [Formula presented] During enrollment, the more symptomatic knee, or a knee selected at random in case of equal symptoms, was designated as the study knee. After the baseline visit, participants were randomized to either a mindful walking group (MWG) or an attention-matched self-management group (SMG). Participants in both groups received 11 intervention sessions delivered over a 6-month period (4 in 1 st month, 2 each in 2nd and 3rd months, 1 each in 4th, 5th, and 6th months). Interventions were delivered via in-person groups (4-10 in each group) and each session was 1.5-3 hours in duration. For MWG, a certified instructor provided training in mindful walking that includes whole-body movement retraining and mindful body-awareness skill building. Biomechanical elements include: shorter stride length, higher cadence, greater toe-in, and more aligned posture. Participants were coached to progressively increase their mindful walking activity each week. Mindfulness elements include mindful body-awareness skills to increase sensitivity and awareness of deviations from the taught techniques. The approach is based on “ChiWalking®” so called because the movement approaches are drawn in part from T’ai Chi. For SMG, a researcher delivered a curriculum consisting of education and self-management techniques (e.g., importance of physical activity and exercise, nutrition, weight-management, etc.). This information was also provided to MWG in a condensed form. Gait analyses and physical performance tests were completed at baseline and 6-months. Physical activity was assessed using a commercial wrist-worn activity monitor (Charge 3, Fitbit Inc, San Francisco, CA). Participant-reported outcomes (PROs) were completed at baseline and every 3-months. Participants were remotely followed for an additional 6-months after the end of the intervention. Given the feasibility nature of the study, primary outcomes included recruitment, adherence, retention and number of adverse events. Secondary outcomes included peak external knee adduction moment [KAM], daily step count, Knee injury and osteoarthritis outcome score (KOOS) Pain, Five Facet Mindfulness Questionnaire (FFMQ), Arthritis Self-Efficacy Scale (ASES), 30-second chair stand test (30STS), 40-meter fast paced walk test (40FPW), and Stair Climbing Test (SCT). Analyses were conducted on intention-to-treat basis with all randomized participants included and missing values were not imputed. Results: Participants were recruited between March 2019 and January 2020. During this period, ∼450 individuals completed pre-screening questionnaires (∼41 per month), 66 completed in-person screening visits, 47 were enrolled, and 44 were randomized (Table 2). Interventions for 19 participants were interrupted, delayed for 3-months, and then transitioned to virtual format due to the COVID-19 pandemic. While the original recruitment goal was 62, the trial was halted earlier due to COVID-19. [Formula presented] Attendance is shown in Table 3. On average, MWG group attended 63% of the sessions vs. 70% in the SMG group. Among those who attended at least 1 session, MWG group attended 69% vs. 77% for SMG. Among those who attended at least 3 sessions, MWG group attended 75% vs. 84% for SMG. Post-intervention, 65% (n=15) and 87% (n=20) of MWG completed the in-person visits and PROs, respectively. In SMG, 81% (n=17) completed in-person visits and PROs. At 12-months, 91% (n=21) and 71% (n 15) completed the PROs for MWG and SMG, respectively. [Formula presented] Participant feedback at 6- and 12-months showed that the intervention was acceptable (Table 4). There were no serious adverse events related to the intervention in either group. Within group and between group differences for secondary outcomes are shown in Table 5. [Formula presented] [Formula presented] Conclusions: Our benchmarks were recruitment over 1.5 years, attendance of 75% in MWG group, and retention of 80% of participants at 6-months. While all of these benchmarks were negatively impacted by COVID-19, the recruitment rates over the period studied, adherence in those who attended at least 3 sessions, and retention for some secondary outcomes were acceptable. Participants in both groups found the interventions helpful, enjoyable, and rated it highly. At 12-month follow-up, MWG participants continued to practice mindful walking 1-2 days a week. Between group differences for secondary outcomes were small. Given the feasibility nature of the study, conclusions regarding efficacy cannot be made and larger trial would be needed. Our results show that our methods are appropriate for conducting such a larger trial.

Are health professionals vulnerable to workrelated musculoskeletal disorders

Introduction: Work-related musculoskeletal disorders (MSDs) are a group of disorders confined basicly to muscles, tendons, ligaments, nerves, joints, and bones and occur in relation to occupational activities. These disorders are reported to be common in health professionals and affect their quality of life. Carpal tunnel syndrome, tendinitis, degenerative spine disease, thoracic outlet syndrome, and strained neck syndrome are common in health workers. These problems often arise due to nonneutral postures, unsuitable instruments, nonergonomic working conditions. In addition, repetitive challenging activities are common risk factors. Medical students: MSDs can begin in medical students at even educational stage, especially during laboratory studies. Researches showed that the most common sites of problems are;lower back, neck, and upper back. Lower back, neck, and upper back prevented daily activities in the majority of cases. Strategies are suggested to address ergonomic and postural training, as part of university curriculums, including the identification of problems for early intervention to facilitate sustainable workforces. Health professionals: Work-related MSDs were found to be relatively highly prevalent among health care and hospital workers in general and nurses in particular. Both disorders were reported to be largely workrelated and stress-related. Moreover, they were found to be a result of both psychological stress and physical strain from work. Surgeons: Compared with disease estimates in the general population, surgeons have a higher prevalence of MSDs. Surgeons, hospital administrations, surgical material designers, and health insurance schemes have a role to play in taking action to protect surgeons from this potential burden and occupational health hazard. Dentistry: Professional practice and dental training have many risk factors, and the dental team should be able to recognize these factors to protect themselves. The most common sites for MSDs are neck, lower back, and shoulders. Women show a higher frequency of intense pain involving the cervical, lumbar, dorsal, and wrist areas placing them at a higher risk of injury. Nurses: Because of the specificity of their work tasks and the long duration of tasks in health institutions, nurses are quite vulnerable to various occupational risk factors. In addition to the physical risk factors connected to the work tasks, there are also individual risk factors, related to each individual's susceptibility and organizational/psychosocial risk factors (although these occupational risk factors are often addressed separately), whose control is critical. During the pandemic: Physicians and nurses can be considered to have MSDs because of: (1) the difficulties they experience, especially while using Personal Protective Equipment for Covid-19 in Intensive Care Unit/Settings. (2) the difficulties they experience by having to spend a long time at the computer to provide telemedicine services to the patients they monitor. Long and intensive studies leading up to these periods may have also caused MSDs. Conclusion: Areas of action can be ergonomic equipment, training, and consulting for workplaces at home and ergonomic risk assessments. In cases where protection is not provided and early treatment is not performed, they can cause temporary or permanent work disability.