Common Complain Research Articles

Efficacy of McKenzie, Maitland Mobilisation and Myofascial Release in Chronic Low Back Pain

Objective: To compare the effectiveness of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain and find out the effects of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain. Background: Low back pain is defined as the pain that occurs in an area with boundaries between the lowest rib and the crease of the buttocks. It is one of the most common complain of working-age population. Low back pain is associated with deconditioning of spine and trunk due to lack of core strength and stability in which 60-80% of general population suffer with high recurrence rates of 60 - 85% within following three years. The global prevalence of LBP as 7.3%. Activities that are required for daily living are affected because of LBP. The significance of disability is created because of LBP. The lumbosacral, sacroiliac and lumbar regions are the main regions of LBP. Pain in the back region that lasts for more than three months is called chronic lower back pain (CLBP). Lower?back pain (LBP) is seen in all age groups. Half of the people encounter back pain in a year and nearly three-fourths of the population account for LBP in their lifetimes. It is one of the most disabling factors often preventing sports person for participation in sporting activities. In United States, the workers compensation claims account for about one fourth of all claims and one third of total compensation costs. It results in about 40% of absences from work. In total spinal pain cases low back pain accounts for 60-70%.Chronic Low back pain is the pain that persists longer than the expected time period for healing, with a duration of more than three months. The natural course of most low back pain is of self-limiting in nature, with vast majority of individuals improving within six weeks or less. Study design: Experimental study Methods: 51 subjects were selected through convenient sampling. All the subjects who were diagnosed with chronic low back pain from Orthopaedics OPD was referred to physiotherapy department and was screened and assessed according to inclusion and exclusion criteria. The eligible subjects were approached with proposal of the study. Aim and procedure of the study was explained to the subject and a written informed consent was taken from them in their preferred language. At first the demographic data (age, sex, duration) was collected forever subject. Then the baseline data (pre intervention) of CLP intensity, functional disability was taken before commencement of the study. Then the subjects were randomly allocated each 17 subjects. A final data of pain intensity, functional disability was recorded. Results: For all the outcome measures, no significant difference results were found for all three techniques. Whereas, Mc Kenzie techniques is the most effective and the least effective is Maitland Mobilisation. Mean Improvement calculated as Pre- post values of VAS and RMQ scores at follow-up on 7th and 14th day was compared between the 3 techniques. Its significance was tested by testing whether the 95% CI of the mean improvement included 0 or not. Mckenzie techniques howed maximum improvement 4.68 (2.29, 7.07) on Day 7th and Maitland mobilisation the least improvement, 1.56(0.95, 2.93). Improvement by all techniques was significant at 95% CI using paired t test. However, on day 14th McKenzie showed maximum improvement 5.56(2.72, 7.07)) Maitland mobilization remaining the least effective. Conclusion: LBP is a common condition and all age groups are facing it. Pain can be due to various causes and the line of treatment depends upon the cause of pain. In this review, we found out that LBP is a condition everyone is facing. Mc Kenzie is a better treatment approach over other two techniques to reduce chronic LBP. Pain and disability were the points considered while concluding. LBP affects the quality of life and to maintain or improve the quality of life strengthening the muscles plays an important role. This review gives a brief about the treatment methods available for treating CLBP clinically. Hence physiotherapy treating subjects with chronic low back pain may choose any one technique but Mc Kenzie Technique is the most effective technique for pain and for functional disability in CLBPis the most effective. However sufficient experience and expertise is necessary. Key words: Chronic Low Back Pain, Mc Kenzie, Maitland Mobilisation, Myofascial Release, VAS, RMQ

Abstract PO3-11-09: Cross-cultural adaptation and psychometric validation of lymphedema patient-reported outcome measurements in Chinese breast cancer patients

Abstract Background: Lymphedema is one of the most common complains reported by breast cancer survivors, which negatively affects the quality of life (QoL). Various internationally recognized patient-reported outcome measurements (PROMs), such as the Upper Limb Lymphedema 27 (ULL-27), Lymphoedema Functioning, Disability and Health questionnaire (Lymph-ICF), Lymphedema Quality of Life Questionnaire for upper limbs (LYMQOL-ARM), and Lymphedema Life Impact Scale Version 2 (LLIS), have been translated into different languages and widely used to assess QoL in patients with breast cancer-related lymphedema (BCRL). However, limited evidence has proved the efficiency of these tools in Chinese patients. In this study, we performed cross-cultural adaptation and psychometric validation of these four PROMs within the Chinese context. Additionally, we also compared the accuracy in detecting BCRL for early diagnosis. Methods: A process of forward–backward translation and cultural adaptation was conducted based on international standards. Content validity was assessed through patient interviews. Internal consistency was evaluated by Cronbach’s alpha coefficient. The correlation analysis of the MOS item short from health survey (SF-36) and each BCRL QoL questionnaires was utilized to indicate the convergent and divergent validity. Clinical validity was assessed by comparing scores among patients with different BCRL stages. Furthermore, questionnaires scores and the known group of lymphedema or not were compared to generate receiver operator characteristic (ROC) curves of these instruments. Results: A total of 204 female breast cancer patients were recruited in this study. Among them, 104 patients (61 with lymphedema and 43 without lymphedema) finished LYMQOL-ARM and ULL-27 questionnaire, while 100 patients (59 with lymphedema and 41 without lymphedema) were assessed by Lymph-ICF and LLIS. The internal consistency was high, with Cronbach's alpha coefficients above 0.9 for all subscales and global scales. The content validity was generally good, except for a few issues reported by the patients. Convergent and divergent validity confirmed the hypotheses of correlation between the tested questionnaire and SF-36 to varying degrees: 100% for ULL-27, 80% for Lymph-ICF, nearly 70% for LLIS, and only 50% for LYMQOL-ARM. LLIS and Lymph-ICF demonstrated strong clinical validity, with significant differences found in total and subscale scores among participants in different BCRL stages (P< 0.05). There were no significant differences between stages for the mood dimension (P=0.132) of LYMQOL-ARM, psychological dimension (P=0.506), social dimension (P=0.083), and total score (P=0.057) of ULL-27. Only the physical concerns and global scale of LLIS and the symptom subscale of Lymph-ICF exhibited acceptable AUC values near 0.7 (AUC 0.725, 95% CI 0.625-0.825, p< 0.029; AUC 0.680, 95% CI 0.573-0.787, p< 0.002; AUC 0.734, 95% CI 0.633-0.834, p< 0.001, respectively). In contrast, other subscales and questionnaires displayed lower AUC values. Conclusion: Lymphedema is a chronic disease that has a relatively low mortality risk but significantly affects the quality of life. Therefore, it is crucial to prioritize patient-reported outcomes in the assessment of lymphedema. Among the four PROMs, LLIS not only showed high internal consistency and content validity more suitable for Chinese patients, but also exhibited better performance in reflecting the presence and severity of lymphedema patients. Consequently, the validated and reliable Chinese version of LLIS is recommended for clinical and scientific practices in the assessment of BCRL, which will help to provide better interventions with a patient-centered focus. Citation Format: Yue Zhou, Bingqiu Xiu, Qi Zhang, Jiong Wu. Cross-cultural adaptation and psychometric validation of lymphedema patient-reported outcome measurements in Chinese breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-11-09.

Psychometric evaluation of the Bengali brief pain inventory in a sample of Bangladeshi cancer patients

Pain is a common complain among oncology patients, and success of its management requires accurate assessment. However, the status of pain treatment in Bangladesh is largely undocumented. The purpose of this study was to evaluate the psychometric properties of the Bengali version of Brief Pain Inventory (BPI-Bengali) in a Bangladeshi sample of cancer patients. BPI-Bengali and the Questionnaire on Stress in Cancer Patients Revised (QSC-R 23) were administered to a convenience sample of 60 adult oncology patients receiving pain treatment. Cronbach alpha coefficients were 0.89 and 0.94 for the severity and interference items respectively. The Pearson correlation coefficients for the test-retest stability were 0.65 (p<0.01) for the pain intensity scale and 0.88 (p<0.01) for the pain interference scale. Exploratory factor analysis (EFA) yielded two components, indicating pain severity and interference clusters by explaining 75% of the variance. The confirmatory factor analysis indicated the model as moderate fit to the data (CFI=0.89, RMSEA=0.16). Convergent validity of the pain severity and interference was demonstrated by significant correlations with stress level (r=0.67, p<0.01), (r=0.66, p<0.01). The findings of this study support the psychometric properties of Bengali BPI among cancer population in terms of validity, reliability and factor structure. Dhaka Univ. J. Biol. Sci. 33(1): 99-108, 2024 (January)

Effects of Compressive Myofascial Release of Vastus Lateralis on Lateral Patellar Tracking in Patients with Knee Osteoarthritis

Knee osteoarthritis is highly prevalent around the world and 4th leading cause of disability. Lateral patellar tracking is a common complain of knee osteoarthritis. It causes Q-angle at knee joint to increase that further leads to gait abnormalities. Objective: To determine the effect of compressive myofascial release of vastus lateralis on lateral patellar tracking in terms of pain, range of motion, and functional disability in patients with knee OA. Methods: This Randomized controlled trial was conducted at the Ahad Medicare Clinic and Physiotherapy Centre, Rawalpindi, spanning from December 2020 to June 2021. In this study, 52 participants were carefully selected using the Open Epi software. These individuals were aged 50 years and above and had previously been diagnosed with Grade 2-3 knee osteoarthritis. Participants were then evaluated for the presence of lateral patellar tracking by measuring Q-angle. After meeting eligibility criteria participants were divided into two groups: the Experimental group (n=26) and the Control group (n=26). Numeric Pain Rating Scale (NPRS), Goniometer, and Western Ontario and McMaster Universities Arthrosis Index (WOMAC) were used to take measurements at baseline and at 15 days follow-up. Results: Statistical analysis revealed a significant difference (p<0.05) between the Experimental and Control groups in terms of pain reduction and knee extension range of motion (ROM). Conclusions: The study's findings revealed that the experimental group exhibited more significant improvements in pain reduction and knee extension compared to the conventional treatment group.

Ultrasonographic Characters of Uterine Myoma as Predictors for Successful Laparoscopic Myomectomy at Mansoura University Hospital

Background: Myomectomy is the surgical procedure of choice for symptomatic myoma in the reproductive age, especially if future fertility is desired. LM is the surgical removal of uterine myoma through small incisions in the abdomen. It is an appropriate, if not preferred, alternative to abdominal myomectomy in well-selected patients since it offers shorter hospitalization, short recovery period and resumption of activities within 1–2 weeks, reduced risk of blood transfusion, and intraoperative adhesions. Aim: The aim of the current study was to determine the diagnostic accuracy of different ultrasonographic characters of uterine myoma in predicting success of laparoscopic myomectomy. Methods: The present study was prospective interventional study that was carried out on 35 cases with Chronic pelvic pain. All patients had radiological evaluation by TVS and TAS. All Laparoscopic myomectomies done under general anaesthesia. Outcomes included determining ultra-sonographic predictors for successful laparoscopic myomectomy as regards site, size, and character of Myoma, presence of capsule and line of separation around myoma. Results: The most common complain among the studied cases was bleeding followed by pain and lastly infertility. Regarding location, the most common site was posterior followed by fundal, then anterior and lastly at the cornu. Operative times, blood loss amount, method of extraction, need laparoscopic suturing, complications during surgery recovery and hospital stay after operation demonstrated significant relation with outcomes. Myoma characters, numbers and type demonstrated insignificant relation with outcomes. Conclusion: The current study concluded that, myoma characters, numbers and type could not be used as predictors for successful LM; outcomes. However, operative times, blood loss amount, complications during surgery recovery and hospital stay after operation were less in successful LM than in LAM; and laparoscopic suturing and morcellation have less time consumption and better results than LAM.

Ozone treatment combined with sodium fluoride for the treatment of dentin hypersensitivity: an exploratory study.

Dentin hypersensitivity is one of the most common complains faced by dental professionals, and there is still lack of consensus for the most effective treatment approaches. The aim of the present study was to evaluate the efficacy of ozone therapy combined with sodium fluoride in reducing pain associated with dental hypersensitivity, compared to a paint-on adhesive desensitizing agent. The study included 20 patients (131 teeth), selected according to specific inclusion criteria and divided into two groups according to the type of desensitizing therapy (ozone with sodium fluoride or paint-on adhesive). The efficacy of both treatments were evaluated recording pain for each treated tooth immediately after treatment, after 1 month and after 6 months using a Numeric Rating Scale (NRS). Subjective parameters were also recorded: patients were asked to report whether they experienced pain caused by air, teeth brushing, cold and hot topical stimuli (present/absent). In both groups, pain values significantly decreased over time. Six months after treatment we registered significantly lower pain values in the ozone-treated group compared with the adhesive group and the mean percentage of NRS reduction from was significantly higher in the ozone-treated group. We did not register significant differences in subjective pain-related parameters between groups. The results of this exploratory study were aimed at exploring the combined effect of ozone with natrium fluoride, which was before described only in vitro. With the limitation of the sample size, our results suggest that this approach provides a pain reduction that was comparable to the paint-on adhesive.

CLINICAL PRESENTATION OF TRICHOMONAS VAGINITIS IN TERTIARY CARE CENTRE IN KATHMANDU

Background: Cervical-vaginal infections are common problems in women of reproductive age groups. Trichomonas vaginalis is one of the major organisms causing vaginitis. Trichomonas vaginalis is an anerobic, flagellated protozoan. The main objective of this study was to study the clinical findings of women with Trichomonas vaginitis.
 Methods: This was a hospital based descriptive study carried out in the Department of Pathology and Gynaecology of Nepal Medical College Teaching Hospital in one year (January- December 2020). A total of 163 Pap smear examination were included in study. Specimen were stained using conventional Papanicolaou method. After staining, slides were examined under the light microscopy. The cytological diagnosis was correlated with the clinical findings. The collected data was analyzed using SPSS software version 16. Mean, Standard deviation, frequencies and percentages were calculated.
 Results: A total of 163 cases were evaluated. The mean age of women who underwent Pap smear examination was 37.5 10.5 years. Out of 163 cases, there were 42 cases of Trichomonas vaginitis. The prevalence of Trichomonas vaginalis was 25.8%. The common age group was 20 to 40 years. Most of the women were symptomatic (64.3%) while rest were asymptomatic (35.7%). Per vaginal discharge (35.7%) was the most common complain followed by vulval itching (16.7%).
 Conclusions: Trichomonas vaginalis are commonly found in reproductive age group presented with clinical manifestations or may be asymptomatic at all too. Vaginal discharge is the commonest presentation.

Vitreous floaters – etiology, diagnostics and treatment

Vitreous floaters are one of the most common complain of ophthalmological patients. The aetiology of floaters includes pathological process (vitreous haemorrhages, injuries, diabetics or uveitis) and also natural age-related changes in vitreous body. Diagnosis and treatment depends on the severity of the symptoms. Process of posterior vitreous detachment requires particularly careful monitoring, because of potential complications such as retinal tears or retinal detachment. Supplementation with anti-glycation and antioxidant substances allows to reduce complains of patients with vitreous floaters.

Clinical profile and etiology of children presenting with prolonged fever in tertiary care centre of Southern Rajasthan

Background: Fever is the most common complain of a child presenting to a health care setting. A prolonged fever however, is an intriguing challenge for clinicians and remains overly medicated and inappropriately worked up, provided a systemic approach is not followed. Our study aims to find the etiologic diagnosis in these cases of prolonged fever. Methods: The present study was conducted in a tertiary care hospital in southern Rajasthan over a period of 12 months from November 2021 to October 2022. Our descriptive, observational study enrolled 150 children who were prospectively followed during their stay in hospital. Each patient was subjected to a set of mandatory investigations followed by other investigations as per the diagnostic clues. Patients were monitored closely during their course of stay until discharge, at which the final diagnosis was charted. Results: A diagnosis could be reached for 138 patients (92%) and in 12 patients (8%), the cause of fever remained undiagnosed until discharge/death. Out of the 138 patients diagnosed, 118 patients (85.5%, 78.6% overall) had an infection as the cause of fever and 20 cases (14.49%,13.3% overall) had a non-infective etiology. Conclusions: Infections are the most common cause of prolonged fever in pediatric population - tuberculosis being the most frequent infection. Hematological malignancies were found as an emerging cause of prolonged fever in our study.

The associations between screen time and mental health in adolescents: a systematic review

BackgroundAdolescents have extensive use of screens and, they have common complains related to mental health. Here a systematic review was done to understand the association between screen time and adolescent’s mental health.MethodThis review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses – PRISMA. An update search was performed in January 2023 with the following keywords: “screen time,“ “adolescent,“ and “mental health” on PubMed, PsycINFO and Scopus databases.Results50 articles were included, most have found associations between screen exposure and mental health in adolescents. The most used device by adolescents was the smartphone and the use on weekdays was associated with diminished mental well-being. Social media use was negatively associated with mental well-being and, in girls, associated at higher risk for depression.ConclusionExcessive screen time in adolescents seems associated with mental health problems. Given the profusion and disparity of the results, additional studies are needed to clarify elements such as the screen content or the interaction of adolescents with different screen devices.Systematic review registration:PROSPERO CRD42022302817.

A correlation study of cervical cytology on pap smear with cervical biopsy in a tertiary care hospital (1 Year Study)

Introduction: Cervical cancer is the second most common cancer in women worldwide after breast cancer, and in developing countries, the leading cause of death by cancer. It is one of the most preventable and curable of all cancers. The Pap smear is the standard screening tool used to test for the presence of abnormal cells that could become cancerous. A regular Pap smear provides an opportunity to detect pre-cancerous cells in the cervix. The simplicity, effectiveness and versatility of Pap test have made it an integral part of routine clinical examination and large chunk of workload in gynaecological and pathological practice is due to this test. Aims and Objectives: To establish usefulness of pap smears examination as a diagnostic tool for detection of cervical lesions. Material and Method: In present study results of 400 PAP smears are analysed, which had been examined in cytology section (Department Of Pathology, M.P. Shah Medical College, Jamnagar) during 1 years (July 2021 to July 2022). Out of 400 pap smear 250 patients were undergone cervical biopsy or hysterectomy. So the final sample size is 250. The conventional cervical smears were fixed by 100% methanol and stained by Pap method (RAPID-PAP). The cytological smears were reported using Bethesda System 2001. The cervical biopsies or hysterectomy specimens received from the same patients were fixed in 10% neutral buffered formalin solution and processed with embedding in paraffin blocks and stained with haematoxylin and eosin (H and E) stain. The histopathological findings and Pap smear findings were correlated and histopathological diagnosis of biopsies were taken as the gold standard. Result: In present study most common complain was irregular menstrual bleeding followed by lower abdominal pain. Out of 250 pap smears maximum patient belong to 41-50 years and were multipara. Maximum cases were reported as NILM (60%), followed by ASCUS (15.2%), LSIL (12%), HSIL (8%), squamous cell carcinoma (4.8%). On histopathology, 47.6% cases were diagnosed as chronic cervicitis, 23.2% cases as chronic cervicitis with squamous metaplasia, CIN I (17.2%), CIN II (4.4%), CIN III (2.8%), squamous cell carcinoma (4.8%). Overall sensitivity, specificity, positive predictive value and negative predictive value is 95.8%, 83%, 70%, 98% respectively. Conclusion: Pap smear is a simple cheap safe and practical diagnostic tool for early detection of cervical cancer in high risk group population and therefore should be established as a routine screening procedure.

High Altitude Illness among Rapidly Ascending Pilgrims to Kailash Mansarovar.

High altitude pilgrims typically ascend rapidly, are not well prepared for the austere environment and tend to have multiple co-morbidities. Here, we list the trend of altitude and other illnesses who visited Humla district hospital (2,950 meters) following very rapid ascent to Kailash Mansarovar (4,500 meters). A prospective study was conducted among 55 patients at the Humla District Hospital from September 2019 - August 2022. Patients who fell ill during pilgrimage and brought to the hospital were included. The patients were assessed with medical history and clinical examination. Lake Louise Score Acute Mountain Sickness Score (2018) was used for the diagnosis of Acute Mountain Sickness. A total of 56 evacuees visited the hospital which included 55 patients and 1 brought dead. The mean age was 50.63 ±10.91 years. Sixteen patients (29.1%) developed symptoms within 24 hours and 15 patients (27.3%) within 48 hours of ascent. Headache 42 (76.4%) was the most common complain. Mild acute mountain sickness (30.9%; 17 patients) was the most common altitude related illness while 14 patients (25.4%) were diagnosed with non-altitude related illnesses. Twelve patients (21.8%) had co-morbidities like hypertension and diabetes mellitus. In the rapidly ascending pilgrims, majority of travelers requiring medical attention are suffering from some form of altitude illnesses. Hence, proper planning and public awareness about slow and gradual ascent profile is necessary to make the travel safer.

“AN APPRAISAL ON PREVENTIVE ASPECT OF ARSHA WRT TO EXTERNAL HEMORRHOIDS.”

The Shalya tantra prime branch of Astanga Ayurveda is rich in much aspect of modern surgical concepts. Sushruta elaborately described the advances of Tantra in various Ano-rectal diseases, as Arsha is one among them. Arsha is a common problem related to sedentary life style, age occupation and dietary factors where anal pain, anal lump and rectal bleeding are very common complain. Arsharogain his treatise and considered as one among the Mahagada and indefinitely curable. Arsha as the dreadful disease can affect anyone, anytime, anywhere. Nidanas (causes) mentioned are mandagni (irregularities of digestive process), adyashana (improper diet) and mithya vihara (lifestyle) leads to six types of Arshas (hemorrhoidal diseases), classified as per symptoms. Arsha is a Tridoshaj disease that arises from Mandagni and Ama formation. In respect with the Bheshaj Chikitsa of Arsha, the Vatanuloman effect is desired, the principle of treatment of Arsha includes three chief clinical effects Agni Deepan, Vatanuloman and Raktasthambhan. Normal diet, appropriate digestion and to avoid seating on hard place helpful in preventing the condition of Arsha. Ayurveda has ultimate management modalities to get rid of that kind of crippling conditions, which are already described in various classical texts.

Evaluation of Clinical , Laboratory and Genetic Parameters in Patients with Primary Myelofibrosis in Nineveh province

Background :Primary myelofibrosis is a Philadelphia-negative myeloproliferative neoplasm(MPN) with predominant proliferation of megakaryocytes and granulocytes in the bone marrow characterized by initial proliferative phase, followed by a reactive deposition of fibrous connective tissue in the bone marrow. Objectives : To evaluate the clinical and laboratory data in primary myellofibrosis and to correlate the genetic disorders with clinical and other laboratory parameters. Setting : This case series study conducted at Ibn-Sina Teaching Hospital/Outpatients Hematology Department from November 2019 to April 2020. Patients and method : Total fifteen patients with primary myelofibrosis included in this case series (retrospective and prospective) study. The records of old cases were reviewed from patients for clinical history, clinical examination, previous blood counts, bone marrow study and genetic study. For new cases clinical history and physical examinations were noted, ten mls of venous blood were aspirated from patients (new cases) by clean venipuncture and delivered into sterile EDTA and gel tubes for doing complete blood pictures, genetic study (JAK2) and biochemical tests. Data were collected and analyzed by using SPSS software version 24. Result : The males were (60%) of patients and females were (40%) with male to female ratio was 1.5:1, their age ranged from 43-75 years with a mean of 59.3 years. The most common complains were fatigue (86.7%), fullness in the abdomen (73.3%) and constitutional symptoms (66.7-80%). All patients(100%) had splenomegaly at presentation. The total mean Hb was 8.2 g/dl with a range of 4.7-12.5 g/dl. Leukocytosis had been observed in (40%) of patients, while thrombocytosis was found in (26.6%) of patients. Compared in hematological parameters in PMF patients with JAK2 Positive and JAK2 Negative, it was found that MPV significantly increased in JAK2 positive patients with p-value 0.03 . Conclusion : old age groups (55-64 years) were commonly affected by primary myelofibrosis and males were predominance over females. The most common complains were fatigue and constitutional symptoms, while splenomegaly was the most common clinical sign. The mean platelets volume (MPV) significantly increased in JAK2 positive patients with p-value 0.03.

Yuna Gloves, Sarung Tangan Anti Carpal Tunnel Syndrome (CTS)

<em>Carpal Tunnel Syndrome (CTS) is a symptom of compression neuropathy of the median nerve at the wrist. Characterized by increassed pressure in the carpal tunnel and decreased nerve function. The Most Common Complain are pain, numbness and tingling along the distribution of the median nerve. The prevalence of carpal tunel syndrome in the adult population ranges from 0.7 – 9.2%, 0.4% in women and 2.1% in men. Women have a riskof developing CTS 3 times higher in pregnant women then in non-pregnant women. The purpose of this study was tu produce yuna gloves which were effective in reducing the incidence of CTS in pregnant women at the Cipanas Health Center in 2021. This study was conducted using the case control method, which is to campare existing Products with research products. This researche process lasted for 3 months. The population in this study were all pregnant women in the third trimester at the Cipanas Public Health, which amaunted to 150 people, the sample in this study amounted 33 people. From the results of the case study, its expected to further improve the quality of service delivery for health workers, aspecially in handling cases of CTS in pregnant women at the Cipanas Health Center.</em>

Abstract 14547: A Rare Case of Pericardial Effusion Causing Cardiac Tamponade in Preeclampsia

Background: Cardiovascular manifestations of preeclampsia are caused by increased peripheral vascular resistance and systemic endothelial damage causing third spacing of fluids. Usually this presents as lower extremity edema or non-cardiogenic pulmonary edema. Here we report a rare case of third spacing into pericardial space causing cardiac tamponade in a patient with severe pre-eclampsia. To our knowledge, only 2 similar cases have been reported so far. Case presentation: 35-year-old female G1P0A0 presented to the hospital at 36 weeks and 6 days of gestation with complaints of elevated blood pressure, headache, blurring of vision, and shortness of breath. On physical exam, she had blood pressure of 170/85, 3+ bilateral lower extremity edema and labs showed urine protein to creatinine ratio of 13,962. She was diagnosed with severe pre-eclampsia and underwent emergent C-section without any complications. On postoperative day 1, patient continued to complain of shortness of breath and became hypoxic requiring 2 to 3 L of supplemental oxygen. Chest x-ray showed slight pulmonary edema but BNP was 49. She had persistent lower extremity swelling and was empirically diuresed with IV Lasix with some improvement in her symptoms. An echocardiogram showed large circumferential pericardial effusion with early right ventricular diastolic collapse consistent with cardiac tamponade. Her LV function was normal with an EF of 70% without any wall motion abnormalities. She was taken to the Cath Lab for pericardiocentesis and underwent drainage of almost 650 cc of yellowish clear-colored fluid. Analysis of the fluid showed 1186 nucleated cells, pH 7.5, and protein of 2.9 mg/dl. Her ANA and Rheumatoid factor were negative. The pericardial drain was removed after 5 days with no evidence of recurrence of tamponade on repeat echo. Conclusion: Peripartum shortness of breath with leg swelling is a common complain among pregnant women with pre-eclampsia. Although peripartum cardiomyopathy is more common, pericardial effusion with cardiac tamponade is also a potential diagnosis and should be kept in the differential. Echocardiography can differentiate these entities.

Self-perceived cognitive function and neuropsychological performance in women with fibromyalgia.

Cognitive dysfunction is a common complain in patients with fibromyalgia (FM). To assess the perceived cognitive function and cognitive performance in women with FM. Cross-sectional study including 100 women with FM (FMG) and 100 healthy controls (CG). Self-perceived cognitive functioning was evaluated using the Functional Assessment of Cancer Therapy Cognition scale (FACT-Cogv3). The neuropsychological performance was assessed with the Trail Making Test (TMT-A, TMT-B), Digit Span test (DS), Barcelona test (DS-F/B) and the Frontal Assessment Battery (FAB-E), Spanish version test. The mean scores of all cognitive self-perception factors and all neuropsychological tests were lower in the FMG (p < 0.001). Over 90% of the FMG took longer than the population mean (P50) to complete the TMT-A and TMT-B tests, while in the CG, 1/3 took longer than the P50 in both tests. The minimum expected scores for the DS-F and DS-B tests were not achieved by 40 and 9% of FMG participants, respectively. According to FAB-E, 54% and 24% of FMG were categorized as fronto-subcortical deficit and fronto-subcortical dementia, respectively. Women with FM have a higher perception of cognitive dysfunction and lower cognitive performance in objective tests than healthy women. More research is needed to explore the clinical, psychosocial, and sociodemographic characteristics that predispose to cognitive deficits in this group of patients.

The Management of Katishoola (vertebral Compression fracture) through Panchakarma- A case study

Background: In present era low backache (Katishoola) is a common complain among the patients visiting hospital for treatment. There are various causes for low backache like compression fracture, inter vertebral disc prolapse [IVDP], Lumbar spondylosis, tuberculosis of spine etc. About 39% of the population present complaints of low back pain at some point in their lives, Incidence is more in females aged between 40 and 80 years. vertebral compression fracture (VCF) are one of the cause of severe low backache. VCF is a common fracture of the spine. The symptoms of VCF are back pain, numbness, tingling, and weakness and intensity of pain increase while standing or walking. It can be correlated with Katishoola in Ayurveda. In contemporary science there is no treatment except some invasive procedure like vertebroplasty. Here in this case pain in lower backache associated with tingling sensation managed with Ayurveda Panchakarma treatment like Matra Basti, Katibasti, Pinda Swedana. The collected data shows that Panchakarma therapy along with oral medicine gave encouraging effect in low backache. Material and method: In this study the patient with complaint of pain in lower back, tingling sensation, unable to stand for long duration approached to the OPD of Panchakarma, AIIA hospital. He was managed with Panchakarma therapies along with oral medicines. Effect of treatment was assessed before and after the treatment on presenting complaints. Result and observation: Significant improvement was noticed after the treatment. Pain was reduced significantly. There was reduction in VAS scale, SLR, Marked improvement was noticed in Score of Oswestry low back pain index, Low back outcome score (LBOS). Discussion: In this case study we are focusing in the management of low backache due to wedge compression fracture through Ayurveda oral medicine along with Panchakarma to further deterioration of the condition of the patient.

Social Service of Pain Management for Patients Unresponsive to Conservative Treatment

Pain is one of the most common complain encountered in outpatient clinic. Inadequate pain management has been widely reported. As an anesthesiologist and pain physician, we perform a social service of pain management for patients unresponsive to conservative treatment. The social service was held from April - June 2022. We enrolled thirty-two patients from other physician reference and Primary Health Care in several districts around Malang city to come to Brawijaya University Hospital with the age range of 30-80 years old. The pain interventions given to the participants mainly include prolotherapy, pulsed radiofrequency (PRF), and others. The pain measurement of the patients were assessed with Numerical Rating Scale (NRS), pre and post-intervention. The social service is performed on 32 patients (male 34,37%, female 65.62%), majority aged 60 years od and older (34.37%) with low back pain become the major complaint (43.75%). The majority of patients receive prolotherapy (68%). The mean NRS decrease from 6.19 ± 0.18 (before treatment) to 2.69 ± 0.10 (after treatment). After this social service, most patients (96.875%) have obtained better pain control after given pain interventions.

Mammographic Trends of Pakistani Women Single Institutional Study

Background: Breast carcinoma is the most common cancer and leading cause of cancer related death in women world wide.Mammography is currently the gold standard method to screen &amp; diagnose the breast carcinoma at early stage. Materials and Methods: This retrospective cross sectional study is conducted in department of Diagnostic Radiology PUMHSW.SBA. Mammography examination including MLO &amp; CCviews performed between 1January to 31st December 2020 are included in the study Results:Total of 579 women were referred for mammogram in the department in this 12 month duration.Of these 225 ladies had no breast related complains while 354 women complained of breast symptoms. The mean age of the patients was 46 years and the most common complain was mastalgia (44%). Total 2316 mammogram examinations of 1158 breasts was performed including 900 &amp; 1416 in screening and diagnostic settings respectively.Out of 900 screening mammogram 58 (6.4%) patients are reported BIRADS IV. Conclusions:Our study noted reduce trend of screening mammogram in Pakistan women and 6.4% potential breast cancer can be detected in asymptomatic patients by screening mammogram.