New Concepts Research Articles

Surgical strategies to improve visual outcomes in corneal transplantation

The recent years have brought about a sea change in the field of corneal transplantation with penetrating keratoplasty being phased to newer lamellar keratoplasty techniques for a variety of corneal pathology. Improved and innovative surgical techniques have allowed selective replacement of diseased host corneal layers with pre-prepared healthy donor corneal lamellae for anterior corneal disorders such as keratoconus and posterior corneal disorders such as Fuch's corneal endothelial dystrophy. The results of lamellar techniques are encouraging, with rapid visual rehabilitation and vastly reduced risk of immune-mediated transplant rejection. The techniques of deep anterior lamellar keratoplasty and Descemet's stripping endothelial keratoplasty (DSAEK) continue to evolve with advent of femtosecond lasers and newer concepts such as pre-conditioned donor corneas for Microthin DSAEK and Descemet's membrane keratoplasty. This review describes the current developments in lamellar keratoplasty, including the futuristic approach using cell therapy to restore vision in corneal blindness.

Diabetic Foot Salvage by Limited Access Dressing (LAD)

Moist wound healing and Negative pressure wound therapy (NPWT) are newer concepts in wound management. NPWT has been shown to be a safe and effective treatment for complex diabetic foot wounds. Limited Access Dressing (LAD) combines the principles of moist wound healing and NPWT along with a provision of two additional ports (1216Frtube) for instilling antimicrobial solution of choice and alters the wound environment without any need to change the dressing. LAD utilizes definite intermittent negative pressure schedule (30 minutes of negative suction and 3½ hours of rest period; minimum 30mmHg of negative pressure). Intermittent negative pressure regimen of LAD reduces the total duration of negative pressure and need for specially designed suction devices. The LAD design has notable advantages, while avoiding some major disadvantages such as an inaccessible offensive smelling wound environment and relatively high treatment cost. Neuropathy, angiopathy, skin changes (cracks), callosities, and foot deformities leads to nonhealing ulcers followed by infection. Non healing ulcers and infection are major reasons for progressive tissue destruction in diabetic patients. Repeated radical debridement leads to loss of certain amount of viable tissue exposing vital structures, bone, ligaments and subsequent desiccation of exposed tissues and infection starts avicious cycle of debridement and further tissue destruction leading to amputation. LAD has been proved to control wound infection, and help in separation of dead tissue from living tissue by autolytic and mechanical debridement while preserving viable tissue as compared to that by surgical debridement. By virtue of better control of infection and systemic inflammatory response syndrome (SIRS), early physiotherapy (minimizing stiffness and deformity), advantages over other modern methods of dressings and ultra conservative debridement (minimal damage to viable tissue by safer intra LAD natural separation of necrotic tissue), LAD acts as a reliable and effective method of limb salvage in diabetic patients.

Effect of commercially available probiotic product on the level of salivary microflora in children of West Bengal

Context: Newer concepts and methods are being researched and being implemented every day. One such newest variety of preventive measure is the use of probiotics. Aims: This study tries to explore the effect of commercially available probiotic product on the level of the salivary microflora in children of West Bengal in a specific period. Materials and Methods: The study was of a randomized, placebo-controlled design. The total of 90 children between age group 6 and 14 years were selected at random, as study and control group. The study group was provided with the commercially available probiotic product Eugi sachet with milk as a vehicle for 21 days, whereas control group is provided with only plain milk. Salivary concentration of few specific cariogenic bacteria was measured in both study and control group in the beginning and at the interval at 0, 1, 3, and 5 months. Statistical Analysis Used: Average, standard deviation for a varied comparison was calculated. Student's t-test and probability test were performed. Results: The significant difference in between control and study group only existed at 1-month interval and difference again became insignificant in respective intervals ahead. Conclusions: The study concluded that, (1) there was significant reduction of Gram-positive colony (GPC) counts after 1 month in the probiotic consumed group. (2) During the interval of 1 to 3 months, the GPC counts showed increase in a number and they were restored to the baseline concentration which was maintained till the 5 th month. (3) There was no significant variation in GPC count between different age groups at all intervals.

Newer concepts in neural anatomy and neurovascular preservation in robotic radical prostatectomy.

With more than 60% of radical prostatectomies being performed robotically, robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced the open and laparoscopic approaches and has become the standard of care surgical treatment option for localized prostate cancer in the United States. Accomplishing negative surgical margins while preserving functional outcomes of sexual function and continence play a significant role in determining the success of surgical intervention, particularly since the advent of nerve-sparing (NS) robotic prostatectomy. Recent evidence suggests that NS surgery improves continence in addition to sexual function. In this review, we describe the neuroanatomical concepts and recent developments in the NS technique of RALP with a view to improving the “trifecta” outcomes.

Current understanding on the neurobiology of sleep and wakefulness

The modern concept of sleep and wakefulness has evolved from the landmark discovery of ascending reticular activating system by Moruzzi and Magoun in 1949. The other major contributions have come from the electrophysiological studies of sleep-wake states following the discovery of electroencephalogram by Hans Berger in 1929. Research studies over the past 60 years have provided us an enormous understanding on the neural basis of sleep-wake states and their regulatory mechanisms. By shuttling through the two behavioral states of sleep and wake, brain coordinates many complex functions essential for cellular homeostasis and adaptation to environment. This review briefly summarizes the current awareness on the dynamicity of brain mechanisms of sleep and wakefulness as well as the newer concepts of the biological functions of sleep.

A New Classification (Grading System) of Debridement in Diabetic Lower Limbs - an Improvization and Standardization in Practice of Diabetic Lower Limb Salvage Around the World

Debridement is one of the most common and also a most underestimated surgical procedure performed by surgeons. For specialist like Podiatric surgeons and qualified wound care nurses, debridement of diabetic foot wounds has been an essential day to day common surgical practice. Inspite of being such a common procedure, there is no classification of debridement when it comes to diabetic limb salvage practice till date. The word debridement is used loosely and equally for all diabetic foot lesions without specification. The author, being one of the few handful specialist podiatric surgeons in India, proposes a new simple classification [grading system] for surgical debridement of diabetic lower limb wounds which could be used in day to day practice and which will help in standardizing the practice of diabetic lower limb salvage in developed, developing and underdeveloped countries and thus can form a language of medical communication in field of diabetic limb salvage. There is currently an urgent need for newer concepts, standardization and recent advances in diabetic foot practice in developing countries where this speciality is neglected. This new grading system is one such novel step by the author towards improvisation of diabetic foot practice.

The Relationship between Quality of Work Life and Socio-Economic Status of Employees in Private Sector Commercial Banks in Virudhunagar District

The role of banking sector continuous to grow in a developing economy like India. The productivity of banking industry is associated with the efficiency of the employees. Quality of work life is one of the newer concepts experimenting how to make effective utilization of human resources. The purpose of this study is to measure the level of quality work life of employees in private sector commercial banks in virudhunagar district, and to investigate the relationship between quality of work life and some socio-economic status among them.

Evaluation and assessment of bonding of heat cure acrylic resin to cobalt-chromium alloy: Old ideas employing newer concepts

Literature has evidenced marvelous work on increasing bond strength between acrylic resin and partial denture casting alloys in past by various pioneer workers. Several systems have been employed to increase the bond strength between acrylic resin and partial denture casting alloys. Some of the popular methods were silicate layer silane coupling agents, active acrylate monomers: Polyfluormetacrylate bonding agents, tin oxide layer, and bifunctional monomer (dual function group). With the exception of air abrasion, most techniques are associated with expensive equipment, technique sensitivity, and harmful chemicals. Air abrasion, however, consistently has been associated with improved bond strengths. Traditionally, denture base acrylic resin is attached to the metal framework by three types of retentive aids: Mechanical, chemical, or combination of both. Advantage of retentive elements weakens the acrylic resin base by creating stress and by replacing its bulk on which resin depends for strength. Failure of the resin at the interface is a common source of problems when forces exceed the capacity of the retentive mechanisms. Here, authors have sought to review the bonding strength between acrylic resin and partial denture casting alloys along with their clinical applicability that can best retain the said prosthesis with minimal failure.

Small Cell Ovarian Carcinomas - Characterisation of Two Rare Tumor Entities.

Objective: Small cell ovarian carcinomas (SCOC) are differentiated into two types: hypercalcaemic (SCOCHT) and pulmonary (SCOCPT). Unfortunately, little is known about pulmonary-type small cell ovarian carcinoma. Study Design: We carried out a systematic analysis of all available reports in the literature on individual cases of SCOCHT and SCOCPT. Results: We found that patients with SCOCPT were significantly older than those with SCOCHT. Vimentin and chromogranin detection by immunohistochemistry allow good differentiation between the two types. Interestingly, SCOCPT but not SCOCHT was found to be associated with other benign and malignant ovarian tumours in about 44 % of cases. Although the percentage of R0/R1 resections was high (~ 74 %), survival was poor; even in patients with disease limited to the ovaries (stage Ia and Ib) the recurrence rate was 40 %. Chemotherapy with etoposide or anthracyclines could be useful. Conclusion: Taking the limitations of our study such as its retrospective nature into account and based on the results from studies of small cell carcinomas originating from other tumour sites, we conclude that treatment of SCOCPT should be based on the therapies used to treat other small cell carcinomas. Surgery is appropriate, especially in very early stages of disease, but chemotherapy should not be omitted. Newer concepts such as treatment with somatostatin analogues could help to control symptoms and stabilise some slow-growing tumours.

Retainment, Recovery and Recycling: A Swedish Success Story of ECO-Steelmaking

With a view to optimize the environmental aspects of steelmaking, the Swedish Steel Producers Association took the initiative to start a national project on ECO-steelmaking with financial support from Swedish Foundation for Strategic Environmental Research. The Division of Materials Process Science at the Royal Institute of Technology has an important part of the project, viz. “Retention, Recovery and Recycling”, with emphasis on the retention of metal values in the steel bath without loss to the slag or gas phases, to recover the metal values that are lost to the slag phase by the development of new or optimized process concepts and aim at a total recycling of the metal values as well as the slag components within or outside the steel sector. The present paper describes the optimization of existing process concepts as well as evolving newer concepts to meet the above project goals. The use of CO2–O2–Ar gas mixtures for the decarburization of high-alloyed steels, development of a low cost precursor for the addition of molybdenum to steel in EAF, direct alloying in EAF are some of the concepts initiated in the present work. Successful recovery of iron and manganese values by oxidation of the slag and separation of the magnetite or manganese ferrate by electromagnetic separation formed part of the recovery part. As part of the project, a salt extraction process was developed by which the metal values in slags could be extracted into a chloride phase followed by electrolysis in fused chloride medium. This method was found to be successful in the recovery of metal values from slags. This process could be extended to the recovery of a variety of metal values from a variety of secondary sources. The salient features of the process designs and the results are presented in this paper.

Diagnostic utility of PETCT in thyroid malignancies: an update

The primary clinical application of (18)F FDG PET/CT ((18)Fluorine labeled flurodeoxyglucose positron emission tomography/computed tomography) in differentiated thyroid carcinoma is in the identification of active disease in thyroglobulin (Tg) positive (>10 ng/ml), whole body iodine scan negative patients. The impact of FDG PET/CT in diagnosis, surveillance, cure, and progression-free survival of differentiated thyroid carcinoma patients remains to be seen. Five main indications of FDG PET/CT in thyroid cancer have been recommended by revised American thyroid association guidelines 2009. This review aims to provide a complete picture of PET imaging in thyroid malignancies and enumerates each indication with literature review. This review also highlights recent advances in targeted molecular imaging. Currently differentiated thyroid cancer is best imaged using conventional single photon emission computed tomography-based radioiodine tracers ((123)I/(131)I). Although the utility of FDG PET in well differentiated thyroid cancer patients who are iodine negative but with raised Tg is well established, evidence is emerging on the advantages of FDG PET/CT in other histological types of thyroid malignancy, such as Hurthle cell, medullary, and the anaplastic malignancies. Novel PET radiotracers, such as (124)Iodine ((124)I), (18)F-DOPA (3,4-dihydroxy-L-phenylalanine), and (68)Ga-DOTA peptides are revolutionizing the way thyroid malignancies are imaged. Newer concepts on targeted molecular imaging and theranostics are ushering in new possibilities for imaging and treating thyroid cancer.

The Emerging Role of Vitamin D3 in Women’s Health

Vitamin D3, often called the “sunshine Vitamin,” is a very important nutrient for women’s health. Despite its discovery 100 years ago, Vit D has emerged as one of the most controversial nutrients and prohormones of the 21st century, and a lot of research has been in place on this molecule. The research leads us to newer therapies with newer concepts. Research has now shown Vit D’s indisputable role in both inherent and adaptive immunity. This editorial will take an account of the current view on the impact of vitamin D deficiency on women’s health. We already know that Vit D is a Steroid prohormone (“conditional” Vitamin); it is synthesized in skin under ultra-violet light exposure. 7-Dehydrocholesterol present in the skin absorbs UV light over wavelengths of 290–300 nm [UVB ] to synthesize Vit D3. Synthesis in the skin epidermis takes place over several days; the quantity (intensity) and quality (appropriate wavelength) of sunlight are both important This biosynthesis can be inadequate due to poor dietary intake, absorption, or poor exposure to sunlight [UVB]. The deficiency can occur because of fat malabsorption, anticonvulsant use, chronic kidney disease, and obesity and is seen in high-risk groups like elderly women, dark-skinned people, people from areas with a thick layer of ozone, women using sunscreen lotions, and people from urban areas. In urban and polluted areas, the UV light of 290–300-nm wave length gets filtered out; hence, skin may not get enough of this light. Therefore, there is a high rate of Vit D deficiency even among the urban population. Hence, foods and dietary supplements are necessary. There are two major forms of dietary Vit D: Cholecalciferol (Vit D3) and Ergocalciferol (Vit D2). Cod liver oil, salmon and sardines, fortified milk, egg, fortified yogurt, mushrooms, fortified soy products, oysters, and fortified cereals are rich sources of Vit D. Under situations of minimal exposure to sunlight, a specific recommendation of a daily supplement of 400 IU (10 μg) is retained for the Indian population. RDA for pregnant women is 200 IU per day and the maximum safe daily dose is 2,000 IU. Due to widespread deficiency, testing for vitamin D levels is important for most individuals. A serum concentration of 25-hydroxyvitamin D is the best indicator of vitamin D status as it is the major circulating form of the vitamin in the body.

Cardiology for Anesthesiologists (International Anesthesiology Clinics 50, Number 2, Spring 2012).

Advances in pharmacologic and invasive techniques have vastly transformed the general practice of cardiology into one with very focused subspecialties. Anesthesiologists must adapt to these advances, as our patients present to us with treatment modalities that are ever changing. Cardiology for Anesthesiologists explores several advances and describes their corresponding anesthetic considerations.In the tradition of International Anesthesiology Clinics, Cardiology for Anesthesiologists is not a comprehensive conglomerate of all things cardiology. Rather, it is an assortment of independent topics, each written by its own group of authors. The reader should not expect to learn how to interpret an electrocardiogram or how to treat new onset atrial fibrillation. The preface explains this by describing this text as one that stays off the “beaten path” and attempts to introduce fresher topics.The book succeeds in this goal by presenting several topics that are not commonly covered in current anesthesiology texts, such as “When Cardiac Patients Need ECT” and “Inflammatory Diseases and the Heart.” “Perioperative Hypertensive Crisis: Newer Concepts” describes current literature and pharmacologic treatments and emphasizes the importance of evaluating pulse pressure rather than just suggesting a threshold for treating systolic or diastolic hypertension. In “Robotic-Assisted Cardiac Surgery,” the text leaves its strict cardiology theme. It presents a history of robotic surgery and current cardiothoracic techniques. The chapter “Congenital Heart Disease in the Adult” includes an eight-page table that briefly describes the anatomy and perioperative considerations for caring for these patients. It is a solid review, but it is not likely to be enough of a resource to help practitioners who seldom anesthetize this population formulate an anesthetic plan.A thorough discussion of modern monitoring techniques is presented in the chapter entitled “Monitoring Hemodynamic Risk in Remote Locations.” This chapter is disguised as an overview of treating ill patients outside the operating room, but is actually a review of modern invasive and noninvasive monitors, including the physics behind them. The chapter provides good descriptions of the technologies, but the devices would be better introduced in the operating room until a comfort level is achieved to allow their employment in remote locations. “Severe Heart Failure and Mechanical Circulatory Support” presents current data on the efficacy of commonly used monitors, such as pulmonary artery catheters, and describes newer treatments, including percutaneously placed ventricular assist devices.“Cardiac Electrophysiology Procedures in Clinical Practice” should not be considered to be a review of how to care for a patient with a pacemaker or automatic implantable cardiac defibrillator. The reader will not find an answer to the question, “To magnet or not to magnet?” Instead, the chapter presents an excellent review of the anatomy and physiology of arrhythmias, the electrophysiology procedures used to treat them, and suggestions for corresponding anesthetic plans.While the topic of anticoagulation therapy in the patient with a recent history of primary coronary intervention is widely available for review, there is no discussion in the text contrasting the algorithm for withholding anticoagulants perioperatively in patients with bare metal versus drug-eluding stents. When selecting a text entitled Cardiology for Anesthesiologists, the audience would likely expect a discussion of this topic. However, because these algorithms change regularly, as they have recently, they quickly become outdated and are not included here.In summary, Cardiology for Anesthesiologists is a text that will be of greatest interest to the anesthesiologist who wishes to learn about several focused topics in cardiology without having to read through well-covered themes, such as treatments for coronary artery disease and chronic hypertension. It is not written as a reference book for all cardiology topics. Instead, it introduces new topics and covers some less-discussed pathologies that are still of importance, including a great discussion of the treatment of patients with cardiac tamponade. I would highly recommend this book as an adjunct to traditional anesthesiology texts.

Obesity and Diabetes: Newer Concepts in Imaging

Quantifying body fat is currently an area of active research. Recent studies have shown that the quantity and location of fat in different compartments have varying clinical significance. This information can now be obtained from computed tomography (CT) or magnetic resonance (MR), and it can inform clinical decision making for patient management. Diabetes patients with insulin resistance and hyperinsulinemia have nonalcoholic fatty liver disease (NAFLD) ranging from steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis, typically diagnosed by liver biopsy or serum markers. There is now an emerging role of noninvasive imaging tests such as MR imaging or MR spectroscopy or elastography, which can provide quantitative information and have potential to avoid biopsy. Obese patients with diabetes are also at risk for cardiovascular disease and cancer. There is an emerging role for imaging in early detection of not only structural but also functional abnormalities of myocardium at a subclinical stage. Screening for cancer is currently recommended only for breast, colon, prostate, and cervix. Given wider availability and advances in imaging techniques such as positron emission tomography/CT (faster scans with higher resolution and less ionizing radiation) and better understanding of molecular biology and risk-stratification, more and more cancers are being detected in early stages with better clinical outcomes. Concerns related to cost, overdiagnosis, and unnecessary interventions must be addressed before population-based screening for other cancers is recommended. Based on ongoing imaging research, it is expected that it will be possible to provide more precise measurement of body fat and detect cardiovascular disease and cancers earlier in their course.

Evolution of energy metabolism, stem cells and cancer stem cells: how the Warburg and Barker hypothesis might be linked.

Evolution of energy metabolism, stem cells and cancer stem cells: how the Warburg and Barker hypothesis might be linked.

Cardiac Remodeling in Obesity

Obesity has generated much interest within the cardiovascular community within the past 2 decades.1 It is now recognized that obesity is an important contributor to cardiac and all-cause mortality,1,2 independent of its association with other cardiovascular risk factors and increases the risk for cardiovascular morbidity, including heart failure (Figure 1).2–4 The malefic consequences of obesity are due both to the associated structural and functional cardiac alterations as well as the high prevalence of coexisting conditions, such as coronary artery disease, hypertension, sleep–disordered breathing (SDB), and diabetes mellitus.1–7 To better understand the relationship between obesity and heart failure, we will review what is known about cardiac structural remodeling in obesity as well as the evidence for preclinical abnormalities in left-ventricular (LV) systolic and diastolic functions. We will place particular emphasis on newer concepts and findings suggested by contemporary imaging methods. Figure 1. The population attributable risk of heart failure because of overweight is 14% in women and 8.8% in men. In obesity, the corresponding population attributable risks in women and men are 13.9 and 10.9%, respectively. From Kenchaiah et al,4 used with permission. By National Institutes of Health criteria, obesity is defined as a body mass index (BMI) ≥30 kg/m2 and severe obesity as a BMI≥40 kg/m2.8 Obesity involves the growth of both lean body mass and adipose tissue and is characterized by a disproportionate growth of adipose tissue in relationship to lean body mass.9 It is now recognized that adipose tissue is not a homogeneous organ, but is differentiated in relation to its metabolic activity. Whereas fat accumulating in the subcutaneous region does not require substantial blood supply,10 fat surrounding organs (abdominal, epicardial) is metabolically active, requires energy, and produces a number of compounds …

Doctors and #8217; role in long-term care: How do students learn about it?

This paper is an attempt to answer the question of how to help undergraduate medical students learn about the principles of long-term healthcare management. The authors are concerned that undergraduate medical students are often not formally taught about this matter except from the purely technical aspects of longitudinal healthcare provision, and that it is necessary to be aware of certain issues as undergraduate students to facilitate improved expertise as they become qualified doctors. The authors suggest that the topic requires consideration in light of newer concepts of the role and value of long-term health care for patients in general. The authors propose several ideas about how to achieve this in small group settings, and this paper includes a series of points for discussion within these groups. The list of issues to be discussed includes encouragement for all teachers to discuss long-term healthcare issues with undergraduate medical students, how to develop and maintain positive working relationships over multiple clinical encounters, to be aware of the overall concepts of doctoring, holding relationships, spiritual values within long-term healthcare, and heartsink. The authors hope this novel addition to the curriculum will prove useful as an adjunct to student learning about professional roles.

Ways To Reduce Cardiovascular Disease in Diabetes

Diabetes Technology & TherapeuticsVol. 14, No. S1 Cardiovascular Disease and DiabetesEditorialWays To Reduce Cardiovascular Disease in DiabetesSatish K. Garg, Dominic DiDomenico, and Sean SwitzerSatish K. GargBarbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado.School of Medicine, University of Colorado Denver, Aurora, Colorado.Search for more papers by this author, Dominic DiDomenicoBarbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado.Search for more papers by this author, and Sean SwitzerBarbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado.Search for more papers by this authorPublished Online:31 May 2012https://doi.org/10.1089/dia.2012.0100AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Ways To Reduce Cardiovascular Disease in Diabetes." , 14(S1), pp. S-1–S-2FiguresReferencesRelatedDetailsCited byObesity and Diabetes: Newer Concepts in Imaging Kavita Garg, Samuel Chang, and Ann Scherzinger1 May 2013 | Diabetes Technology & Therapeutics, Vol. 15, No. 5Current Knowledge and Future Directions on Cardiovascular Disease in Diabetes David M. Maahs and Janet K. Snell-Bergeon31 May 2012 | Diabetes Technology & Therapeutics, Vol. 14, No. S1 Volume 14Issue S1Jun 2012 InformationCopyright 2012, Mary Ann Liebert, Inc.To cite this article:Satish K. Garg, Dominic DiDomenico, and Sean Switzer.Ways To Reduce Cardiovascular Disease in Diabetes.Diabetes Technology & Therapeutics.Jun 2012.S-1-S-2.http://doi.org/10.1089/dia.2012.0100Published in Volume: 14 Issue S1: May 31, 2012PDF download

Cardiac Actions of Protein Kinase C Isoforms

Protein kinase C (PKC) isoforms have emerged as important regulators of cardiac contraction, hypertrophy, and signaling pathways that influence ischemic/reperfusion injury. This review focuses on newer concepts regarding PKC isoform-specific activation mechanisms and actions that have implications for the development of PKC-targeted therapeutics.

Chiropractic care in women's health: A midwifery perspective

Introduction: Chiropractic care is one of the newer concepts and treatment modalities available to women in coping with the physical stresses of pregnancy, other than pharmacotherapy. Chiropractic care can help to increase the chances of a healthy pregnancy and can ease labour. Therefore midwives in clinical practice may find it useful to know the basic facts about chiropractic care in order to increase awareness of options in midwifery and inter-professional acceptance of chiropractors. Methods: An integrative review was conducted using a multimodal search of databases such as CINAHL, Science Direct, SCOPUS, PubMed and Cochrane. Results: Twelve studies met the inclusion criteria and findings suggest that chiropractic care is beneficial to pregnant women with back pain and mal-presentation during labour. Conclusion: Although there is still limited empirical research about chiropractic care in midwifery practice, the available studies showed that chiropractic treatment can offer women relief from musculoskeletal complaints. To this end, midwives should be educated and given opportunities to learn chiropractic skills to aid the comfort of mothers during pregnancy.