Normal Daily Activities Research Articles

Effect of Jambira Pinda Sweda in the Management of Avabahuka

Ayurveda is boon for mankind. Panchakarma is the most important part of Ayurveda to uproot the disease as well as achieving the perfect balance of vitiated Doshas, Dhatus and Agni. Avabahuka is a disease that affects the day to day activities like cooking, dressing, bathing, eating etc. Shoulder pain is a common clinical symptom of Avabahuka. The symptom of Avabahuka may be correlated with frozen shoulder because symptoms as well as pathogenesis are more or less similar to Avabahuka. Acharya Vangasena had mentioned Swedana Karma for Avabahuka. Aim: To evaluate the effectiveness of Jambira Pinda Sweda in the management of Avabahuka. Method: In our Panchakarma OPD 56 years old female patient came with complain of pain in the right shoulder joint and unable to perform her normal daily activities. Patient was admitted to the Panchakrma IPD of R.A.M&H and she had been treated with Jambira Pinda Sweda for 15 days. Result: After taking Panchakarma therapy, patient showed marked improvement of the symptoms like Shula (Pain), Sthambha (Stiffness) etc. Conclusion: It was found that Jambira Pinda Sweda had significant role in the management of Avabahuka.

Effect of Paribhadra Paneeyakshara in Mutraghata Caused by Benign Prostatic Hyperplasia- A Case Report

Benign Prostatic Hyperplasia is a troublesome disease that bothers the population of ageing men by decreasing their quality of life. It is an abnormal growth involving the submucosal glands of prostate. The disease interferes with the normal daily activities and sleep pattern and hence is a matter of concern to the medical field. The symptoms of Benign Prostatic Hyperplasia closely coincide with the symptoms of Mutraghata (urinary obstruction) explained in Ayurveda. When taking the obstructive pathology into consideration, Paneeyakshara Prayoga (alkali for internal administration) is classically mentioned as a treatment option. This work is a case study on the effect of Paneeyakshara prepared out of Paribhadra (Erythrina indica) which is a drug possessing Vatakaphahara (alleviate Vata and Kapha Dosha) and Shophahara Karma (pacify inflammatory swellings) in Mutraghata caused by Benign Prostatic Hyperplasia. A 66-year-old male who presented with the signs and symptoms of Benign Prostatic Hyperplasia was administered with 500 mg of Paribhadra Paneeyakshara with 1 gram of Guda (jaggery), morning and evening, half an hour before food for a period of 45 days. Assessment was done before and after treatment based on the IPSS (International Prostate Symptom Score) of the American Urological Association and the Ultrasound abdomen findings. The post- interventional assessment showed a lowered IPS Score and reduced USG parameters indicating the efficacy of Paribhadra Paneeyakshara in reducing Mutraghata caused by Benign Prostatic Hyperplasia.

Semitendinosus and Gracilis Autograft for Neglected Patellar Tendon Rupture: A Surgical Reconstruction

BACKGROUND: Neglected patellar tendon rupture is an extremely rare case among orthopedic injuries that severely compromises the function of the extensor mechanism of the knee. Therefore, a prompt and accurate diagnosis of a ruptured patellar tendon are a key to efficacious management, because a treatment delay is often associated with unsatisfactory functional outcomes. CASE PRESENTATION: We report the case of an adult male patient with traumatic patellar tendon rupture after 9 months of a motorcycle accident. The patient underwent reconstruction surgery using semitendinosus and gracilis tendon augmentation. This procedure restores the anatomical position of the patella and prevents extensor lag. At a 3-month follow-up, a full recovery of the structure and function of the extensor mechanism was perceived. The patient could return to normal daily activities following rehabilitation protocol. CONCLUSION: Semitendinosus and gracilis tendon autograft is the technique of choice to be applied in the surgical reconstruction of neglected patellar tendon rupture.

Laparoscopic intraperitoneal onlay mesh repair for ventral hernia: our experience

Background: Ventral hernia is one of the most common pathologic conditions encountered with an estimated prevalence of one-fourth of individuals being born with it, developing, or acquiring a ventral hernia in their lifetime. Ventral hernias include both primary abdominal wall hernia and incisional hernia. Numerous studies indicate that the laparoscopic approach is safe and effective, and may be superior to open repair with regard to lower rates of recurrence and wound infection, greater patient acceptance, shorter hospital stay and early return to work. Aim of the study was to analyse the outcome, complications, postoperative pain and patient compliance in laparoscopic ventral hernia repair by intraperitoneal onlay mesh (IPOM) technique, using composite mesh.Methods: This was a prospective study conducted in the department of general surgery, MVJ medical college, Bangalore from December 2020 to August 2021. There were 100 cases operated by experienced surgeons. All patients posted electively for laparoscopic repair of ventral hernia on an intention to treat basis were included in the study. The immediate complications of pain, perioperative bleeding and major visceral injury were noted in all cases. We then followed up each patient prospectively in the postoperative period at 1 month, 3 months and 6 months to assess the incidence of port-site hernia and recurrence.Results: Of the 100 patients, 63 had an umbilical hernia, 33 had incisional hernias and 4 had an epigastric hernia. The mean age of the patients was 44.7 years. Female to male ratio of 2.25:1. The average defect width was 1.3 cm for umbilical hernias and 2.4 cm for incisional hernias. The mean operating time was 38 min for umbilical hernias and 61 min for incisional hernias. The mean postoperative hospital stay was 4.7 days. The mean duration of return to normal daily activity was 6.4 days. The average duration for which postoperative pain lasted was 4.6 days. No conversion to open laparotomy was required in any of the cases. The only short complication reported was postoperative pain. No case of postoperative ileus/seroma/port site infection/mesh displacement/infection or port site hernia and recurrence was reported over one year of follow up.Conclusions: IPOM technique is safe, feasible and effective technique for treatment of ventral abdominal wall hernias.

Asymptomatic inguinal hernia: does it need surgical repair? A systematic review and meta-analysis.

The aim of this review is to compare the outcomes of surgical repair versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias. Preferred reporting items for systematic reviews and meta-analyses guidelines were employed. We analysed primary outcomes: pain, quality of life, pain during daily activities and visual analogue scale (VAS that measures pain at rest and on movement) and secondary outcomes: postoperative complications and recurrence. Pain and quality of life were not comparable due to differences in the parameters used in different articles. Pain interfering with normal daily activity was evaluated in one study and appears more favourable in the post-repair group respect to the watchful waiting (WW) group (5.1% versus 2.2%). VAS, measured in one study, at 6months was more favourable in the surgery group (37% versus 44%). After 12 months the outcome was better in the control group than in the repair group (28% versus 30%). Conversion rate of the patient cohorts from watchful waiting to elective surgery was between 35.03% and 57.8%. The meta-analysis did not find significant statistical differences in the two groups examined for postoperative complications [RR=0.95, 95% CI (0.50, 1.80), P=0.88], as for hernia recurrence [RR=1.01, 95% CI (0.50, 2.02), P=0.98]. WW seems to be an acceptable option for the patient with asymptomatic or minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms appear is safe. Acute hernia incarcerations are not particularly frequent. The incidence of chronic pain after the repair is high. Physicians must select patients carefully and explain to them the risks and benefits of surgery.

Living Lab Experience in Turin: Lifestyles and Exposure to Black Carbon.

State-of-the-art, continuous personal monitoring is a reference point for assessing exposure to air pollution. European air-quality standards for particulate matter (PM) use mass concentration of PM (PM with aerodynamic diameters ≤ 10 μm (PM10) or ≤2.5 μm (PM2.5)) as the metric. It would be desirable to determine whether black carbon (BC) can be used as a better, newer indicator than PM10 and PM2.5. This article discusses the preliminary results of one of the three living laboratories developed in the project “Combination of traditional air quality indicators with an additional traffic proxy: Black Carbon (BC)”. The Living Lab#1 (LL#1) involved 15 users in the city of Turin, Italy. Three portable aethalometers (AE51) were used to detect personal equivalent black carbon (eBC) concentrations in the respiratory area of volunteers at 10-s intervals as they went about their normal daily activities. The Geo-Tracker App and a longitudinal temporal activity diary were used to track users’ movements. The sampling campaign was performed in November for one week. and each user was investigated for 24 h. A total of 8640 eBC measurements were obtained with an average daily personal exposure of 3.1 µg/m3 (±SD 1.3). The change in movement patterns and the variability of microenvironments were decisive determinants of exposure. Preliminary results highlight the potential utility of Living Labs to promote innovative approaches to design an urban-scale air-quality management plan which also includes BC as a new indicator.

Safety of mRNA vaccines administered during the initial 6 months of the US COVID-19 vaccination programme: an observational study of reports to the Vaccine Adverse Event Reporting System and v-safe

BackgroundIn December, 2020, two mRNA-based COVID-19 vaccines were authorised for use in the USA. We aimed to describe US surveillance data collected through the Vaccine Adverse Event Reporting System (VAERS), a passive system, and v-safe, a new active system, during the first 6 months of the US COVID-19 vaccination programme.MethodsIn this observational study, we analysed data reported to VAERS and v-safe during Dec 14, 2020, to June 14, 2021. VAERS reports were categorised as non-serious, serious, or death. Reporting rates were calculated using numbers of COVID-19 doses administered as the denominator. We analysed v-safe survey reports from days 0–7 after vaccination for reactogenicity, severity (mild, moderate, or severe), and health impacts (ie, unable to perform normal daily activities, unable to work, or received care from a medical professional).FindingsDuring the study period, 298 792 852 doses of mRNA vaccines were administered in the USA. VAERS processed 340 522 reports: 313 499 (92·1%) were non-serious, 22 527 (6·6%) were serious (non-death), and 4496 (1·3%) were deaths. Over half of 7 914 583 v-safe participants self-reported local and systemic reactogenicity, more frequently after dose two (4 068 447 [71·7%] of 5 674 420 participants for local reactogenicity and 4 018 920 [70·8%] for systemic) than after dose one (4 644 989 [68·6%] of 6 775 515 participants for local reactogenicity and 3 573 429 [52·7%] for systemic). Injection-site pain (4 488 402 [66·2%] of 6 775 515 participants after dose one and 3 890 848 [68·6%] of 5 674 420 participants after dose two), fatigue (2 295 205 [33·9%] participants after dose one and 3 158 299 participants [55·7%] after dose two), and headache (1 831 471 [27·0%] participants after dose one and 2 623 721 [46·2%] participants after dose two) were commonly reported during days 0–7 following vaccination. Reactogenicity was reported most frequently the day after vaccination; most reactions were mild. More reports of being unable to work, do normal activities, or of seeking medical care occurred after dose two (1 821 421 [32·1%]) than after dose one (808 963 [11·9%]); less than 1% of participants reported seeking medical care after vaccination (56 647 [0·8%] after dose one and 53 077 [0·9%] after dose two).InterpretationSafety data from more than 298 million doses of mRNA COVID-19 vaccine administered in the first 6 months of the US vaccination programme show that most reported adverse events were mild and short in duration.FundingUS Centers for Disease Control and Prevention.

Early administration of tocilizumab in hospitalized COVID-19 patients with elevated inflammatory markers; COVIDSTORM—a prospective, randomized, single-centre, open-label study

ObjectivesSevere COVID-19 is associated with an imbalanced immune response. We hypothesized that patients with enhanced inflammation, as demonstrated by increased levels of certain inflammatory biomarkers, would benefit from interleukin-6 blockage. MethodsPatients hospitalized with COVID-19, hypoxemia, and at least two of four markedly elevated markers of inflammation (interleukin-6, C-reactive protein, ferritin, and/or D-dimer) were randomized for tocilizumab (TCZ) plus standard of care (SoC) or SoC alone. The primary endpoint was clinical status at day 28 assessed using a seven-category ordinal scale, and the secondary endpoints included intensive care unit admission, respiratory support, and duration of hospital admission. ResultsClinical status at day 28 was significantly better in patients who received TCZ in addition to SoC compared with those who received SoC alone (p = 0.037). By then, 93% of patients who received TCZ (n = 53 of 57) and 86% of control patients (n = 25 of 29) had been discharged from the hospital. In addition, 47% of TCZ patients (n = 27 of 57) and 24% of control patients (n = 7 of 29) had resumed normal daily activities. The median length of hospitalization was 9 days (interquartile range, 7–12) in the TCZ group and 12 days (interquartile range, 9–15) in the control group (p = 0.014). DiscussionIn patients hospitalized with COVID-19, hypoxemia, and elevated inflammation markers, administration of TCZ in addition to SoC was associated with significantly better clinical recovery by day 28 and a shorter hospitalization compared with SoC alone.

PEDIATRIC PELVIC FRACTURES: AREVIEW ARTICLE AND A CASE REPORT

Introduction:Pediatric pelvic fractures are most commonly associated with high energy fractures, mostly due to motor vehicle accidents. Children poorly tolerate any significant blood loss, so, any child presents with a pelvic fracture must be investigated for multi-organ injury, or possible life -threatening retroperitoneal hemorrhage, with an increased potential for death. Method: A literature search was conducted to included articles from 2001 till 2017on pediatric pelvic fracture, including stable and unstable fractures, acetabular, and sacroiliac joint injuries, and excluded adult population. Results: Conservative management is the main treatment in hemodynamically stable patients, with good anatomical reduction, however , in a hemodynamically unstable patients, external fixator is the gold standard as a temporary management.This, most often is followed by open or closed reduction with internal fixation by screws only or plates and screws, which is consistent with achieving early stability, better union rates and hence early return to normal daily activities.

Changes in Fat Oxidation and Body Composition after Combined Exercise Intervention in Sedentary Obese Chinese Adults.

(1) Background: Evidence suggests that aerobic exercise and high-intensity interval training (HIIT) might increase fat oxidation and reduce fat. However, limited research has examined the effects of combining progressive aerobic exercise and HIIT interventions in sedentary adults with overweight and obesity, and differences in its effects between men and women remain unclear. The purpose of this study was to investigate the effects of combined progressive aerobic exercise and HIIT (CAEH) on fat oxidation and fat reduction in sedentary Chinese adults and compare sex differences in sedentary adults after seven weeks. (2) Methods: Eighty-four sedentary obese adults were enrolled and allocated to two groups in baseline (experimental (EXP) group:42; control (CON) group:42), and fifty-six subjects (EXP:31; CON:25) completed the experiments and were included in the final analysis. Subjects in the EXP group performed CAEH three times per week for seven weeks. Subjects in the CON group were advised to continue with their normal daily activities. Anthropometric, lipid profile, cardiorespiratory fitness, and fat oxidation outcomes were assessed before and after the intervention. (3) Results: After seven weeks of the CAEH intervention, compared with the CON group, the EXP group showed significant increases in fat oxidation at rest (FO_rest) (+0.03 g/min, p < 0.01), maximal fat oxidation (MFO) (+0.05 g/min, p < 0.01), and maximal oxygen intake (VO2max) (+3.2 mL/kg/min, p < 0.01). The changes in the percentages of the FO_rest (+57%) and the VO2max (+16%) were significantly greater (+20%, +6%) in males than in females (p < 0.05, p < 0.05). The body mass index (BMI) (−1.2 kg/m2, p < 0.01), body fat percentage (−3.2%, p < 0.001), visceral fat area (−12.8 cm2, p < 0.001), and total cholesterol (TC) levels (−0.4 mmol/L, p < 0.05) were significantly decreased in the EXP group. (4) Conclusions: Seven weeks of the CAEH intervention effectively improved FO_rest, MFO, and VO2max in sedentary obese adults, and the improvements in FO_rest and VO2max were more pronounced in males than in females. CAEH also improved body composition and TC levels in sedentary obese adults.

Effect of heating on the ESR signal of human fingernails

The potential confounding influence of heat on the electron spin resonance (ESR) spectra of fingernails has been studied in irradiated and unirradiated samples. The samples were heated at different temperatures between 20 and 160 °C for 1 h. The experimental temperature range was selected considering that the fingernails may be accidentally exposed to heat during normal daily activities or in a certain working environment. Changes in the overall visual shape of the ESR spectra were observed in the γ-ray irradiated and unirradiated samples heated above 100 °C, thereby showing that a heat-induced signal was present in the fingernail spectrum. The effect of heating showed an evident bulge in the spectra (between g = 2.014 and 2.024), which was more pronounced in both the irradiated and unirradiated samples heated at higher temperatures, with reduced peak-to-peak intensities and broadened spectra. The heat-induced signal was unstable, decayed for about a few days, and was easily removed upon treatment with water. While the radiation-induced signal (RIS) was stable up to 160 °C, our results also suggest that heating up to 160 °C did not affect the sensitivity of the RIS, but the heat-induced signal was still observed after irradiation. Similar thermal stability was also found in both the irradiated and unirradiated samples, suggesting that the heat-induced signal and RIS were overlapped, but probably independent. Overall, these findings will be useful to obtain a more reliable radiation dose assessment using fingernails that could be accidentally exposed to heat in various situations.

Recent Technical Developments in the Field of Laparoscopic Surgery: A Literature Review.

The benefits of laparoscopic surgery (LS) include a speedy recovery, shorter duration of hospital stay, minimal postoperative pain, discomfort and disabilities, and better cosmetic outcomes (less scarring) that help an individual to resume normal daily activities and return to work. A comprehensive literature search on laparoscopic surgeries was conducted using different Internet-based search engines and databases from August 2021 to October 2021. The search was limited to articles published in the English language and those published between years 2005 and 2021. A total of 126 articles were initially identified. Two independent reviewers thoroughly examined the quality and content of the articles. Articles with duplicate data were excluded, and the remaining articles were screened and assessed by the titles and abstracts. After a vigorous assessment, we included data from 49 articles for this review process. Bibliographic management was done using the software “EndNote” (Thomson Reuters, New York, NY, USA).It was concluded that LS has become the technique of choice for virtually every kind of abdominal surgery, evident by numerous scholarly publications in this field. Level I evidence demonstrating the advantage of LS over open surgery has been reported for numerous operations, including fundoplication for gastroesophageal regurgitation disease, bariatric surgery for weight loss, and cancer resection. Advanced LS has subsequently been expanded to include hepatectomy, pancreatectomy, urology, and gynecology. Patients who are at risk of having elevated abdominal pressure during LS, however, should proceed with care. Recent advances in natural orifice transluminal endoscopic surgery, single-incision laparoscopic surgery, and robot-assisted laparoscopic surgery are promising.

Minimally invasive fasciotomy for symptomatic tibialis anterior muscle hernia

BackgroundSymptomatic muscle herniae are an uncommon cause of chronic exercise induced leg pain. The most common site for muscle hernia is the tibialis anterior muscle. This study evaluates the outcome of a minimal incision fasciotomy in patients with a symptomatic muscle hernia of the tibialis anterior muscle, and their return to normal daily activities including sport. MethodsThe study reports mid-term results in a series of 22 consecutive patients (17 males and 5 females, median age: 22 years) with a unilateral tibialis anterior MH who had undergone minimally invasive fasciotomy between 2008 and 2019. Clinical outcomes were assessed with SF-36 and European Quality of Life-5 Dimensions scale (EQ-5D). The ability to participate in sport before and after surgery, and the time to return to training (RTT) and to sport (RTS) were recorded. ResultsAt a median follow up after surgery of 23 months, both questionnaires showed a statistically significant improvement (P < 0.005). At the latest follow up, 16 of patients (73%) had returned to pre-injury or higher levels of sport/activity. The median time to return to training and to return to sport was 7 and 11 weeks respectively. No severe complications and no recurrence of symptoms were recorded. ConclusionMinimally invasive fasciotomy is effective and safe for patients suffering from muscle hernia of the tibialis anterior muscle with good results in the mid-term. Level of EvidenceIV.

Varus stress MRI in diagnosis of medial meniscal posterior root tear

BackgroundEarly and accurate diagnosis of medial meniscal posterior root tear (MMPRT) via magnetic resonance imaging (MRI) is crucial to prevent the development of medial meniscus extrusion (MME) and subsequent osteoarthritic changes. The study aims to assess the role of MRI in diagnosing the medial meniscal posterior root tear (MMPRT) as well as to investigate the additive value of a new MRI technique (varus stress position technique) in measuring the accurate degree of a truly extruded meniscus, during normal daily activities like standing or walking. This prospective study included 70 patients who had an episode of posteromedial knee pain. All patients underwent conventional MRI, whereas only 35 of them underwent MRI with varus stress loading position.ResultsThe study included 70 patients, of which 56 were female (80.0%), with a mean age of 49.1 ± 8.5 years. According to duration onset of MMPRT, 39 patients were in the chronic stage (4–12 months), 16 patients were in the acute stage (early < 1 month), and 15 patients were in the subacute stage (1–3 months). It was found that varus stress position could detect 100% of the patients (35/35) with positive medial meniscus extrusion (MME) (≥ 3 mm), whereas the MRI with the traditional position could detect only 62.9% of the cases (22/35) (P < 0.000). Regarding the chronicity of MMPRT, a significant increase was observed in the amount of MME in post-varus MRI compared with that in pre-varus MRI for each stage (acute, subacute, and chronic) (P < 0.000).ConclusionMRI is considered a superior imaging modality in diagnosing MMPRT through several characteristic MRI findings. The varus stress position showed a valuable role in assessing the presence and degree of severity of true extruded meniscus using positional varus stress load.

Retinal Detachment Repair With Vitrectomy: Air Tamponade Integration to a Vitreoretinal Service, Comparison With Gas Tamponade, and Literature Review.

Rhegmatogenous retinal detachment (RRD) repair by pars plana vitrectomy and gas tamponade (GT) has significant clinical and quality-of-life impacts compared with repair by short-acting air tamponade (AT). With AT, most authors minimize cryotherapy because of prolonged chorioretinal scar formation and use perfluorocarbon to maximize subretinal fluid drainage; this deviates from traditional technique, which discourages popularization of AT. Prospective 12-month study from January to December 2019 of all primary macula-on RRD cases. Patients fulfilling the inclusion criteria for the Pneumatic Retinopexy Versus Vitrectomy for Retinal Detachment Trial received AT and otherwise were assigned to receive GT. Forty-six patients were enrolled: 22 (48%) receiving AT and 24 (52%) receiving GT. The primary success rate of AT was 21 (95%) and the primary success rate of GT was 23 (96%), with 100% final success. Cryopexy was used in 64% of AT cases and 58% of GT cases. Cataract surgery was required less when AT was used (1 [6%]) than when GT was used (3 [21%]). AT was used in 48% of primary macula-on RRD and 27% of all primary RRD cases. AT has visual and anatomical outcomes comparable to those of GT with conventional vitrectomy techniques, with faster postoperative rehabilitation enabling a swift return to normal daily activities. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:87-95.].

Colonic stenting as a bridge to surgery for obstructive colon cancer: is it safe in the long term?

The placement of a self-expanding metal stent in patients with obstructive colon cancer is used as a bridge to surgery. However, due to a lack of consensus and insufficient data, the long-term oncologic outcomes after colonic SEMS placement remain unclear. We assessed the long-term oncologic outcomes and adverse effects of colonic stenting for malignant colonic obstruction. We included 198 patients admitted to Korea University Anam Hospital between 2006 and 2014 for obstructive colon cancer, of whom 98 underwent SEMS placement as a bridge to surgery and 100 underwent direct surgery without stenting. The clinicopathologic characteristics, overall survival, and disease-free survival were compared. There were no significant differences in long-term oncologic outcomes between the two groups. The median follow-up durations were 61.55 and 58.64months in the SEMS and DS groups, respectively. There were also no significant differences in the 5-year OS (77.4% vs. 74.2%, p = 0.691) and 5-year DFS (61.7% vs. 71.0%, p = 0.194) rates between the groups. However, the DS group had significantly more early postoperative complications (p = 0.002). Colonic SEMS deployment as a bridge to surgery did not negatively affect long-term oncologic outcomes when compared with DS. In addition, colonic stenting decreased early postoperative complications and reduced the time for patients to return to normal daily activities.

Postoperative pain and pain-related health-care contacts after open inguinal hernia repair with Adhesix™ and Progrip™: a randomized controlled trial

PurposeSelf-fixed mesh is an alternative to suture mesh fixation in inguinal hernia repair. The aim of this study was to evaluate postoperative pain after open inguinal hernia surgery using self-fixed meshes.MethodsA randomized clinical trial comparing self-adhesive mesh (Adhesix™) and self-gripping mesh (Progrip™) was conducted from November 2018 through March 2021. Patients included were male, 18–85 years old, and suitable for day case surgery. The primary endpoint was the number of patients needing follow-up visits due to postoperative pain during the first 3 postoperative months. Secondary endpoints included the intensity of pain, the time of return to work and normal daily activities, quality of life measures and postoperative complications.Results270 patients were enrolled, 132 received Adhesix™ mesh (A group) and 138 Progrip™ mesh (P group), 231 (85.6%) completed 1- or 3-month follow-up. The number of patients needing follow-up for postoperative pain was significantly higher in the P group (19 vs. 4, p = 0.001). The P group had higher numeric rating scale of pain while coughing (P 0.50 vs. A 0.20, p = 0.024) and during exercise (P 1.02 vs. A 0.60, p = 0.057) at 3 months postoperatively. The time of return to normal activity was 16.6 days in the A group and 22.9 days in the P group, (p = 0.004). The postoperative day being fit for work was sooner for the A group (14.3 days vs 17.8 days, p = 0.009).ConclusionThis study demonstrated an advantage of self-adhesive mesh over self-gripping mesh with respect to acute postoperative pain and thus faster recovery after surgery.

Alteration in Activity Patterns of Cows as a Result of Pain Due to Health Conditions

Simple SummaryThere are several conditions and diseases considered painful to cattle. One reason for the inconsistency in pain recognition and thus pain relief in cattle is the inadequate ability to identify and assess pain. In fact, both increased and/or reduced daily lying time can be indicative of pain in cattle. This review helps to properly interpret pain in cows through behavioural activity patterns and explores whether pain relief is capable to restore their normal activity.The main conditions and diseases considered painful in dairy cows are mastitis, lameness, calving (including dystocia and caesarean section) and metritis. The cattle literature reports that deviation from normal daily activity patterns (both increased and/or reduced daily lying time) can be indicative of painful conditions and diseases in cows. This narrative review discusses on how pain due to several health conditions in dairy cows modifies its activity pattern and explores if non-steroidal anti-inflammatory drugs (NSAIDs) are capable of restoring it. Divergent outcomes may differ depending upon the painful cause, the severity and the moment, and consequently its interpretation should be properly explained. For instance, cows with clinical mastitis reduced their time lying and increased the number of lying bouts and stepping due to pain caused by the swollen udder when cows are lying. However, lame cows show longer lying times, with a lower number of lying bouts and longer and more variable lying bouts duration, as compared to non-lame cows. When the relationship between painful disorders and daily activity patterns is studied, factors such as parity, bedding type and severity of disease are important factors to take into consideration. The potential benefits of the NSAIDs treatment in painful health disorders depend upon the type of drug administered, its dosage and administration mode, and the time of administration relative to the painful health disorder. This narrative review can be used as a tool to properly interpret and grade pain in cows through behavioural activity patterns and proposes directions for future investigations.

Quality of life and challenges experienced by the surviving adults with transfusion dependent thalassaemia in Malaysia: a cross sectional study

BackgroundImprovement in medical management has enabled transfusion dependent thalassaemia (TDT) patients to survive beyond childhood, building families, and contributing to the labour force and society. Knowledge about their adult life would provide guidance on how to support their needs. This study aims to explore the general well-being of adults with TDT, their employment status and challenges.MethodsThis study recruited 450 people with TDT, aged 18 and above, of both genders through all regional Thalassaemia societies in Malaysia and from the two participating hospitals, over five months in year 2016. A self-administered questionnaire including ‘Healthy Days Core Module’, WHOQOL-BREF and employment measurements was used. Multiple linear regression models were fitted with associations adjusted for several potential confounders.ResultsA total of 196 adults with TDT responded to the survey (43.6% response rate). Almost half (45%) had comorbidities and 9% suffered multiple complications: bone-related (13%), hormonal (12%), cardiac (3%) and infections (2%), resulting in 23% seeking treatment more than twice monthly. Within a month, they suffered from at least three days with poor physical and or mental health and their normal daily activities were disrupted up to three days. 36% were jobless and 38% of those with a job were receiving salaries below RM1000. The mean WHOQOL-BREF score (mean (SD)) was: physical health 62.6 (15.5), psychological health 64.7 (15.7), social relationship 64 (15.9), environmental health 60.8 (16.7). Having days with mental issues, financial status, education level, ethnic and marital status were main factors affecting QOL scores. Open questions showed dissatisfaction with health service provision, conflicting judgement in prioritising between health and job, and poor public empathy.ConclusionThe adults with TDT perceived their health as good and had less unhealthy days when compared with people with other chronic diseases. However, some perceived themselves to be facing more life disruption in a rather non-supportive community and that health services do not meet their needs. Future qualitative studies are needed to focus on their perceived needs and to look for more tailored supportive approaches.

Standardization and Validation of the Flash Visual Evoked Potential-P2 Conversion Scores in the Diagnosis of Amnestic Mild Cognitive Impairment and Alzheimer's Dementia.

Amnestic mild cognitive impairment (aMCI), which is characterized by normal daily activity, but a significant decline in episodic memory, is now widely accepted as a risk factor for the development of Alzheimer's dementia (AD). Research suggests that many of the same neuropathological changes associated with AD also occur in patients diagnosed with aMCI. A recent review of the literature revealed that the latency of the flash visual-evoked potential-P2 (FVEP-P2) may possess pathognomonic information that may assist in the early detection of aMCI. While standards exist for the recording of FVEP-P2, individual clinics often use recording parameters that may differ, resulting in latencies that may not generalize beyond the clinic that produced them. The present article illustrates the process by which the FVEP-P2 latency can be standardized across clinics using FVEP-P2 Conversion Scores. We then demonstrate the diagnostic accuracy of the newly developed scores. Method: In the present investigation, we used the previously unpublished data containing the FVEP-P2 latencies of 45 AD and 60 controls. Result: We were able to demonstrate the process by which individual clinics may first standardize FVEP-P2 latencies and then examine patient performance using FVEP-P2 Conversion Scores, providing clinicians with a richer context from which to examine the patient performance. Conclusion: Consistent with the findings of previous research, the findings of the present investigation support the use of the FVEP-P2 Conversion Scores in the diagnosis of AD. Future directions, including the modification of recording parameters associated with the FVEP-P2, are also discussed.