A Systematic Review of Radiological Diagnosis and Management of May-Thurner Syndrome.

May-Thurner syndrome (MTS) is an anatomical condition of external luminal compression of common iliac vein due to a partial obstruction of the common iliac vein between common iliac artery and lumbar vertebra causes deep-vein thrombosis, venous hypertension, and chronic venous insufficiencies. In this article, we review present evidence of the clinical diagnosis and management of MTS. Here, we conducted a literature review of studies on MTS. We also reviewed different clinical features, presentation, diagnostic methods, and therapeutic procedure for this condition. Most studies mentioned the diagnosis of this condition is performed by color Doppler, computed tomographic angiography, venography, and problem-solving cases by intravascular ultrasound technique. Nonsurgical methods of management are first line, and vascular surgery is reserved for refractory cases. Multiple modalities are required to reach the diagnosis of MTS, and noninvasive intervention radiology methods are the first line of management. This review highlights the presentations of MTS and outlines diagnostic procedure and management.

Evaluation of Shoulder Injuries: A Comparative Study of Imaging by Magnetic Resonance Imaging (MRI) and Magnetic Resonance Arthrography (MRA).

Background: In contrast to the standard shoulder arthroscopy, current radio-diagnostic techniques like magnetic resonance arthrography (MRA), and magnetic resonance imaging (MRI) provide less invasive intricate structural detail of shoulder anatomy. Objectives: Comparison of efficacy of MRA and MRI for diagnosing suspected rotator cuff injury. Materials and Methods: Over the course of 4 years (from June 2017 to June 2021), a comparative study, including 100 individuals with suspected rotator cuff pathology, was conducted. For the evaluation of shoulder injuries, the assessment and comparison of MRA and MRI were done in terms of sensitivity (Sn), positive predictive value (PPV), and diagnostic accuracy (DA). Results: MRI and MRA were positive in 76 (76%) and 98 (98%) patients, respectively. The Sn and PPV of MRI for diagnosing the shoulder injury were 76% and 100%, respectively, whereas the Sn and PPV of MRA were 98% and 100%, respectively. MRA was better than MRI in terms of diagnostic accuracy (98% vs. 76%, P = 0.03). Conclusion: MRA is a nonsurgical effective method in evaluating and diagnosing rotator cuff injuries in comparison to MRI.

Utility of Pulmonary Angiography by 128-Slice Computed Tomographic Scanner in Diagnosis of Tetralogy of Fallot Cases.

Tetralogy of Fallot (TOF) is a significant cause of cyanotic congenital heart disease (CHD) encountered in childhood with few cases manifesting in adulthood. It has four classical features (ventricular septal defect, overriding of aorta, hypertrophy of right ventricular hypertrophy, and right ventricular outflow tract obstruction), but the clinical presentation and course can be variable. Due to various anatomical variations and complex anatomy, presurgical planning and postoperative follow-up by pulmonary computed tomographic angiography (CTA) have a very important role. With continued technological advances and the availability of 128-slice computed tomographic (CT) scans, they now play an important role in TOF preoperative evaluation and workup, assisting by minimizing routine invasive digital subtraction catheter angiography. The fast scan of a 128-slice CTA with very sensitive detectors is a very useful modality for studying the complex anatomy and variations as well as its utilization for postoperative management. In this article, we report four cases of TOF where we used a 128-slice scan for performing pulmonary angiography (Optima 660, GE 128, 2180 Premier Row, Orlando, FL 32809, U.S.A.) for preoperative diagnosis and management of three cases and work up for revision surgery for an already operated case with a nonfunctional modified Blalock-Taussig shunt with additional lung parenchymal findings simultaneously. This study will explain the advantageous role of the 128-slice CT scanner over the lesser-slice CT scanners with the ability of pulmonary CTA to facilitate accurate diagnosis and postoperative management.

Impact of Climate Change, Food Insecurity, and COVID-19 on the Health of Neonates and Children: A Narrative Review.

Climate change, food insecurity, and epidemics affect all population sub-groups. This article reviews the current evidence on the relationships between climate change, food insecurity, and the COVID-19 pandemic in the context of newborn and child health. The authors searched Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases using a structured approach. Food insecurity, particularly from the lack of food access and affordability, increased amidst the COVID-19 pandemic. Factors such as nationwide lockdowns, increased unemployment and financial instability, and school closures precipitated food insecurity. Children born to immigrant parents, belonging to racial and ethnic minority groupsor low-income families, and those who were Autistic were highly vulnerable. Climate change also contributes to food insecurity, with increased susceptibility among neonates and children compared to adults. There is a need for further research on the relationships between climate-linked exposures and COVID-19 transmission. Multisectoral collaborations and multilevel interventions are necessary to mobilize local and national resources for mitigating and preventing the synergistic effects of the three concurrent crises. The evidence-informed discourse on this topic can help in improved preparedness and response for future outbreaks and epidemics. The policy interventions for newborn and child survival need to factor in climate change, food insecurity, and emerging diseases.

Selecting a thesis topic: A postgraduate's dilemma.

It is said that well begun is half done. Choosing a thesis topic and submitting a research protocol is an essential step in the life cycle of a postgraduate resident. National Medical Commission of India mandates that all postgraduate trainees must submit at least one original research work (dissertation), one oral paper, one poster, and one publication to be eligible for final year examination. It is the duty of the faculty to ensure that trainees take active interest and submit their theses on time. However, their journey is often marred by multiple challenges and hurdles. The literature was searched from year 2000 onwards till 2011 using Pubmed, ResearchGate, MEDLINE, and the Education Resources Information Centre databases with terms related to residency training, selecting thesis topic, challenges or hurdles, and conversion of thesis into journal article. Existing literature on the subject matter is sparse. Current article advocates promotion of ethical and original research during postgraduation and proposes a checklist for residents before submission of their proposals.

de Quervain's Disease among Patients Visiting the Orthopaedic Outpatient Department of Tertiary Care Center: A Descriptive Cross- sectional Study.

Introduction: de Quervain's disease is one of the common causes of wrist pain. It can cause serious disability and absence from work due to impaired functioning of the wrist and hand. The aim of this study is to find out the prevalence of de Quervain's disease among patients visiting the orthopaedic outpatient department of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among patients visiting the orthopaedic outpatient department of a tertiary care centre after receiving ethical approval (IRC KAHS Reference: 078/079/56). This study was conducted from 1 January 2021 to 30 December 2021 from hospital medical records. A convenience sampling method was used. Patients with de Quervain's disease from 16 to 60 years were included in this study. Clinically diagnosis of de Quervain's disease was based on the tenderness of the radial styloid process, tenderness over the first extensor compartment on resisted thumb abduction or extension and positive Finkelstein test. Point estimate and 95% Confidence Interval were calculated. Results: Out of 9600 orthopaedic outpatients, de Quervain's disease was seen in 128 (1.33%) (2.68-4.52, 95% Confidence Interval). Conclusions: The prevalence of de Quervain's disease was similar when compared to other studies conducted in similar settings. Keywords: de Quervain's disease; surgery; tenosynovitis.

Neighborhood violence and socioeconomic deprivation influence associations between acute air pollution and temperature on childhood asthma in New York city.

Ambient air pollution, temperature, and social stressor exposures are linked with asthma risk, with potential synergistic effects. We examined associations for acute pollution and temperature exposures, with modification by neighborhood violent crime and socioeconomic deprivation, on asthma morbidity among children aged 5-17 years year-round in New York City. Using conditional logistic regression in a time-stratified, case-crossover design, we quantified percent excess risk of asthma event per 10-unit increase in daily, residence-specific exposures to PM2.5, NO2, SO2, O3, and minimum daily temperature (Tmin). Data on 145,834 asthma cases presenting to NYC emergency departments from 2005 to 2011 were obtained from the New York Statewide Planning and Research Cooperative System (SPARCS). Residence- and day-specific spatiotemporal exposures were assigned using the NYC Community Air Survey (NYCCAS) spatial data and daily EPA pollution and NOAA weather data. Point-level NYPD violent crime data for 2009 (study midpoint) was aggregated, and Socioeconomic Deprivation Index (SDI) scores assigned, by census tract. Separate models were fit for each pollutant or temperature exposure for lag days 0-6, controlling for co-exposures and humidity, and mutually-adjusted interactions (modification) by quintile of violent crime and SDI were assessed. We observed stronger main effects for PM2.5 and SO2 in the cold season on lag day 1 [4.90% (95% CI: 3.77-6.04) and 8.57% (5.99-11.21), respectively]; Tmin in the cold season on lag day 0 [2.26% (1.25-3.28)]; and NO2 and O3 in the warm season on lag days 1 [7.86% (6.66-9.07)] and 2 [4.75% (3.53-5.97)], respectively. Violence and SDI modified the main effects in a non-linear manner; contrary to hypotheses, we found stronger associations in lower-violence and -deprivation quintiles. At very high stressor exposures, although asthma exacerbations were highly prevalent, pollution effects were less apparent-suggesting potential saturation effects in socio-environmental synergism.

Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial.

BACKGROUND: Plantar fasciitis (PF) is a common orthopaedic problem, with heel pain worsening the quality of life. Although steroid injection is often used if the conservative treatment fails, Platelet-Rich Plasma (PRP) injection is gaining popularity due to its safety and long-lasting effect. However, the effect of PRP versus steroid injection in PF has not been studied yet in Nepal. Therefore, this study aimed to assess the effect of PRP compared with steroid injection in the treatment of PF. METHODS: This study was a single-center, hospital-based, open-label, parallel-group randomized clinical trial to compare the effect of PRP injection with steroid injection in plantar fasciitis between August 2020 and March 2022. A total of 90 randomly selected participants aged 18 to 60 years suffering from plantar fasciitis with failed conservative treatment were intervened. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Visual Analog Scale (VAS) scoring system were used to evaluate functional mobility and pain before and after the intervention for three and six months, respectively. Statistical analyses were performed using a Student's two-sample t-test. P-value < 0.05 was considered statistically significant. RESULTS: The PRP injection showed a better outcome than the steroid injection in six months follow-up. The mean (± SD) VAS score was significantly decreased in the PRP group (1.97 + 1.13) than in the steroid group (2.71 ± 0.94) with the group difference of -0.73 (95% CI: -1.18 to -0.28) at six months. Similarly, there was a significant increase in the AOFAS scores in the PRP group (86.04 ± 7.45) compared to the steroid group (81.23 ± 9.60) at six months of follow-up with a group difference of 4.80 (95% CI: 1.15 to 8.45). There was also a significant reduction of plantar fascia thickness in the PRP group compared to that of the steroid group (3.53 ± 0.81 versus 4.58 ± 1.02) at six months of follow-up with the group difference of -1.04 (95% CI: -1.44 to -0.65). CONCLUSION: The PRP injection showed better outcomes than steroid injection in plantar fasciitis treatment over the course of six months. Further research with a larger population and longer follow-up than six months is needed to generalize the findings and their long-term efficacy. TRIAL REGISTRATION: NCT04985396. First registered on 02 August 2021. ( https://clinicaltrials.gov/ct2/show/NCT04985396 ).

Adding pre-emptive anticholinergics to antipsychotics: Is it justified?

Anti-psychotics are the mainstay of treatment for Schizophrenia and psychotic disorders. Historically, anticholinergics have been prescribed to prevent or treat extrapyramidal side effects (EPS) associated with first-generation antipsychotics (FGAs). Even though newer antipsychotics are associated with markedly lower rates of EPS, concurrent anticholinergic use remains high. Use of these medications has potential for long-term side effects, worsening of EPS and poor adherence. We have briefly discussed the limited association between second-generation antipsychotics (SGAs) and EPS, the efficacy of anticholinergics for different types of EPS, and summarized various national and international guidelines on the subject. In conclusion, there is no evidence for prophylactic use of anticholinergics with antipsychotics. Clinicians need to guard against this tendency to be unduly cautious.

The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial.

BACKGROUND: Femur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery. METHODS: This study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student's two-sample t-test to compare the outcomes between the two groups. RESULTS: All the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7-5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3-6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1-9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8-7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2-13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6-12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group. CONCLUSIONS: The uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting. TRIAL REGISTRATION: NCT04838366, first registered on 09/042021 ( https://clinicaltrials.gov/ct2/show/NCT04838366 ).

Identifying entrustable professional activities for postgraduation in psychiatry: What should a psychiatrist be able to do?

Background: Competency-based medical education (CBME) has been the mandate by regulatory bodies of medical education in India, and implementation is an evolving process. This study aimed to identify and propose a set of entrustable professional activities (EPAs) for a master's degree in psychiatry. An attempt has been made to present it in the form of a portfolio. Methodology: Faculty experts in psychiatry went through phases of review to select appropriate EPAs for postgraduate residents from divergent thinking to development of portfolio. Results: One hundred and sixty-seven EPAs were identified and are presented. These were divided according to expertise required. Of these, 54% were considered vital, 30% essential, and 16% desirable. Conclusion: It is envisaged that the use of EPAs and portfolios will be instrumental in implementation and success of CBME in psychiatry. It is expected that medical universities will incorporate them in their curricula. It is also expected that data will be generated to identify challenges, which shall guide future refinement of the EPAs.

Association of ambient extreme heat with pediatric morbidity: a scoping review.

Global climate change is leading to higher ambient temperatures and more frequent heatwaves. To date, impacts of ambient extreme heat on childhood morbidity have been understudied, although-given children's physiologic susceptibility, with smaller body surface-to-mass ratios, and many years of increasing temperatures ahead-there is an urgent need for better information to inform public health policies and clinical approaches. In this review, we aim to (1) identify pediatric morbidity outcomes previously associated with extreme heat, (2) to identify predisposing co-morbidities which may make children more susceptible to heat-related outcomes, and (3) to map the current body of available literature. A scoping review of the current full-text literature was conducted using the Arksey and O'Malley framework Int J Soc Res Methodol 8:19-32, (2015). Search terms for (1) pediatric population, (2) heat exposures, (3) ambient conditions, and (4) adverse outcomes were combined into a comprehensive PubMed and Medline literature search. Of the 1753 publications identified, a total of 20 relevant studies were ultimately selected based on selection criteria of relevance to US urban populations. Most identified studies supported positive associations between high extreme temperature exposures and heat-related illness, dehydration/electrolyte imbalance, general symptoms, diarrhea and digestion disorders, infectious diseases/infections, asthma/wheeze, and injury. Most studies found no association with renal disease, cardiovascular diseases, or diabetes mellitus. Results were mixed for other respiratory diseases and mental health/psychological disorders. Very few of the identified studies examined susceptibility to pre-existing conditions; Cystic Fibrosis was the only co-morbidity for which we found significant evidence. Further research is needed to understand the nuances of associations between extreme heat and specific outcomes-particularly how associations may vary by child age, sex, race/ ethnicity, community characteristics, and other pre-existing conditions.

Psychosocial Challenges in Palliative Care: Bridging the Gaps Using Digital Health.

Psychosocial health is a major palliative care concern globally. Patients and caregivers engaged in palliative care may experience deteriorated mental and social health conditions. Global evidence informs a high burden of depression, anxiety, psychological distress and other mental health problems among the palliative care populations. Those challenges aggravate the preexisting palliative care issues, such as lack of access and suboptimal quality of care. Palliative caregiving, both in the institutional and community settings, should be strengthened, incorporating psychosocial support for the patients and their caregivers. The recent advancements in digital health technologies have shown promising impacts in facilitating health communication, decision-making and delivering psychosocial interventions using digital devices and platforms. Adopting evidence-based interventions can help the users to access mental health resources and communicate with each other to promote shared decision-making and management of health problems. Health-care organisations and systems may explore opportunities to advance psychosocial care using digital technologies. Leveraging advanced technologies in palliative caregiving may require multifaceted research exploring potential barriers and opportunities at the user, institutional and systems levels. Nonetheless, palliative care policies and health systems measures should be strengthened to develop and implement digital support systems that may improve psychosocial health and overall palliative care outcome.

Risk factors of postpartum depression.

BACKGROUND: Postpartum depression (PPD) is one of the most common puerperal psychiatric illnesses impairing quality of life and mental health of the mother and also the child. AIM: The aim is to study the prevalence and risk factors of PPD. MATERIALS AND METHODS: This cross-sectional observational study was done on a sample of 295 mothers who delivered and were followed up at a tertiary care hospital. The mothers were administered Edinburgh Postnatal Depression Scale, and demographic, psychosocial, and clinical data were collected. RESULTS: The age of the participant mothers ranged from 18 to 35 years and age at marriage ranged from 21 to 24 years. In most of the mothers, the parity was 2 and they had institutional vaginal delivery. The prevalence of PPD in this population of mothers was 30.84%. The factors that had a statistically significant association with PPD included: lower educational status of mother, lower family income, rural place of residence, higher parity, preterm delivery, and adverse events in newborn. CONCLUSION: PPD is a common mental health problem in the postpartum period. Sociodemographic factors such as low educational status of mothers, rural population, and low monthly family income were found to be associated with PPD. Primipara status, preterm delivery, and adverse events in newborn were also significantly associated.

Neurobiological underpinnings of emotions.

Emotion is a stirred-up state caused by physiological changes occurring as a response to some event and which tends to maintain or abolish the causative event. Understanding the neuroanatomical basis of the genesis and control of emotions is quintessential in understanding how biology affects the mind and in turn, helps in understanding our own nature. We present a short communication explaining the neurological basis of emotions.

Magnetic seizure therapy.

Magnetic seizure therapy is a novel form of focal convulsive treatment wherein magnetic field passes through the scalp and skull without impedance. In many ways, it has the potential to be superior to electroconvulsive therapy (ECT) as the anesthesia-associated side effects and cognitive impairments are less. It also may be an alternative for those who do not opt for ECT because of the stigma associated with it.

Cannabis-induced psychosis masquerading schizophrenia or vice-versa? A diagnostic dilemma.

Clinical features of schizophrenia and cannabis-induced psychosis (CIP) share many overlapping characteristics. We present a case of Cannabis Dependence Syndrome, whose first presentation was with first-rank symptoms of schizophrenia in the form of thought insertion, withdrawal and delusion of control.

COVID-19 pneumonia in kyphoscoliosis: The success stories.

Coronavirus disease (COVID-19) pandemic has led to millions of deaths worldwide. Old age, immunocompromised state and multiple comorbidities are described as risk factors. Kyphoscoliosis (KS) is the most common spine abnormality and a risk factor of respiratory failure. Management of pneumonia in a patient with severe kyphoscoliosis is challenging to the intensivist. We report successful management of two patients with severe kyphoscoliosis who developed severe COVID-19 pneumonia.