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Introduction One of the global concerns regarding use of electronic nicotine delivery systems (ENDS) among young adults is like another pandemic which has caused associated lung injuries and cardiogenic effects on human body. Even though the product is not approved by FDA and is also banned in India, the rapid evolution of ENDS has led to an urgent need to study the prevalence of these products and its effect on the different cardiovascular parameters. Methodology Thirty-four subjects, who endorsed use of vapes with nicotine containing liquids since last 2 months for alternate days a week and a minimum of 25 min a day, were assessed for their blood pressure, heart rate, double product, and 6MWD. It was ensured that they were “low dependence” as on the Penn State E-Cigarette Dependence Index (PSECDI) and also scored less than 10 on Beck Depression Inventory (BDI). They were then subjected to breathing exercise intervention for 28 sessions every day for 20 min. The observed mean values of all parameters were compared pre and postintervention for vapers. Results There was statistically significant change in blood pressure, heart rate, double product but not in 6MWD after the breathing exercise intervention. At baseline, both groups had similar demographic profile; however, the control group had significantly different and better cardiovascular parameters than the ones who vaped. Conclusion There was statistically significant improvement in the cardiovascular parameters in vapers after telephysiotherapeutic pranayam intervention in vapers.

Background: Aerobics exercise training and kettlebell training is recommended to prevent and control overweight/obesity. Purpose: The aim of the this research is to assess the improvement in various variables related to health fitness among obese adults on administrating a twelve weeks aerobics exercise training and kettlebell training. Materials and Methods: Total sixty male adults with obese (Mean ± SD; age: 18.92 ± 1.54 yrs.; height: 172.4 ± 5.4 cm.; weight: 84.4 ± 6.3 kg) were randomly allocated into three equal (n = 20) groups: Aerobic Exercise Training (AET), Kettlebell Training (KBT) and a control group. The AET & KBT training protocol was performed three days per week for 12 weeks. All the selected variables of physical fitness has been examined at baseline and 12 weeks. Control group does not perform any exercise. Analysis and findings: There were significant difference in terms of Flexibility (F), Muscular Endurance (ME), Muscular Strength (MS) and Cardiovascular Endurance (CE), between the AETG & KBTG have been compared with control group (p < 0.05). Body Composition (BF) significant reductions in AET & KBT groups have been compared with control group (p < 0.05). Conclusion: Our findings suggest that AET & KBT protocols have greater effects than control group on health related physical fitness variables in obese male adult individuals. It is recommended that schools and colleges should administrate the aerobic exercise session and kettlebell training among adults for better health perspectives.

Background and Study Aim: Hematological investigation plays a meaningful role in determining the physical standard and performance of the athletes in various games. It is a measure for an athlete’s health and physical gesture. The present study portrays the platelet count analysis of university-level female athletes playing volleyball, judo, and football respectively. Material and Methods: 54 female athletes (18 from each game) were selected for the study. The platelet count relationship was the criterion for the present study to differentiate the physical standards of the female players among three different games. To obtain the statistical analysis, one-way ANOVA and posthoc Tukey’s HSD test were used to set the significance level of p < 0.05. Results: We found the present results displayed the platelet counts of the players participating in Judo are comparatively higher as compared to football and volleyball. Conclusions: It was observed that there was no correlation between platelet counts between the players participating in three games. No relationship exists between the players from different games concerning their platelet counts. No significant correlation between the three games existed pair-wise individually for comparative statistical analysis as their p > 0.05.

Purpose. The novel coronavirus is the recently emerged disease of the respiratory system for which various national and international research agencies are putting joint efforts towards finding a permanent cure. Recently, the vaccine against coronavirus has been designed by various pharmaceutical agencies that are currently undergoing clinical trials. Since vaccines prevent infection by strengthening the defense system of the body, we proposed that yoga and physical exercises could act as an integrative approach to synergize the immunogenic response of the coronavirus vaccine. Yoga and physical exercises are already known to boost immunity against several other infections. Materials and Methods. In the present review article, we aimed towards exploring the role of yoga and physical exercise as an immunity booster against coronavirus infection. Being India is a low-income country, yoga and physical exercises could be an excellent cost-effective strategy that could be administrated along with vaccine trials to enhance immunity against virus infection. Results. In the present review, we analyze the studies conducted to date focusing on finding the role of yoga and physical exercises to prevent coronavirus infection. We also described the potential exercises, which are already known to enhance the immunity of the body by particularly targeting respiratory disease. Conclusion. The present review article will help in providing the health agencies potential targets, which could further be explored to established a standard exercise module to enhance the vaccine-mediated immunity against coronavirus infection.

Purpose: Several studies have shown that platelet size is a reliable indicator of platelet activity and, therefore, a valuable biomarker for cardiovascular events. Many inflammatory and prothrombotic disorders have been linked to it. As a biomarker for inflammation and neoplastic disease, This study aims to examine existing research on changes to mean platelet volume (MPV). Materials and methods: The present study portrays MPV comparison among the female players who participated in three games viz Yoga, Volleyball, and Rugby conducted at the university level throughout India with age groups ranging from 17 to 25 years in the sample. The sample size is 45, with 15 players chosen from each game Yoga, Volleyball, and Rugby. Results: The results mean, standard deviation (SD), standard error of the mean (SEM), and lowest and maximum scores were used to examine the data. SPSS software was used to do the One-Way Analysis of variance. It was observed that there is a significant difference in the MPV of players from three distinct sports. Furthermore, there exists a one-to-one correspondence between the MPV between the players participating in individual games. The present results displayed the values of MPV among players from different games are independent of one another and unaffected by one another. Conclusion: The study's findings indicate a significant difference in the MPV of players from three distinct sports. However, when MPV of Volleyball and rugby players were compared, it was discovered that they were connected. In conclusion, MPV among players from different games are independent of one another and unaffected by one another. Variability in MPV was also observed across all sample sizes in the study.

Aerobic exercise training is recommended to prevent and control obesity. The present study aimed to evaluate the effectiveness of a twelve-week step aerobics or floor aerobics exercise program in improving the physical and psychophysiological health of obese men. Sixty male adults of mean age 18.92 (SD 1.54 years) and Body Mass Index (BMI) ≥ 30 kg/m2 were randomly allocated into three equal (n = 20) groups: Step Aerobics Exercise Training (SAET), Floor Aerobic Exercise Training (FAET), and a control group (which did not perform any exercise). The SAET and FAET training protocols were performed three days per week for 12 weeks. Health-related physical fitness, biochemical, physiological, and psychological variables were used as outcome measures and measured at baseline and at 12 weeks. There were significant differences in terms of physical and psychophysiological health parameters in participants who underwent SAET and FAET training compared with the control group (p < 0.05). SAET and FAET proved to be helpful in managing the physical and psychological health of obese adults. Schools and colleges should administer aerobic exercise sessions to adults for better health perspectives.

Introduction: Ovarian cancer is associated with high morbidity and mortality. This is due to the nonspecific symptoms and no effective screening methods. Currently, carbohydrate antigen-125 (CA125) is used as a tumor biomarker for the diagnosis of ovarian cancer, but it has its own limitations. Hence, there is a need for other tumor biomarkers for the diagnosis of ovarian cancer. Objective of the study was to evaluate the diagnostic test characteristics of plasma osteopontin (OPN) in detecting ovarian malignancy and comparing its performance with CA125. Materials and Methods: This is a prospective cross-sectional diagnostic test evaluation. Women with adnexal mass detected by clinical or radiological examination were enrolled as suspected cases. Women who presented with other gynecological conditions were enrolled as controls. OPN and CA125 levels were measured in all enrolled subjects. Results: Among 106 women enrolled, 26 were ovarian cancer, 31 had benign ovarian masses, and 49 were controls. Median plasma CA125 levels were higher in subjects with ovarian cancer (298 U/ml; interquartile range [IQR]: 84–1082 U/ml vs. 37.5U/ml; IQR: 17.6–82.9U/ml; P < 0.001). CA125 sensitivity, specificity, positive, and negative likelihood ratios were 88.5%, 61.3%, 2.10, and 0.19, respectively. Median plasma OPN levels were higher in subjects with ovarian cancer (63.1 ng/ml; IQR: 39.3–137 ng/ml vs. 27 ng/ml; IQR: 20–52 ng/ml; P = 0.001). Sensitivity, specificity, positive, and negative likelihood ratios of OPN were 50%, 87%, 2.58, and 0.62, respectively. Conclusion: OPN levels were higher in ovarian cancer than in the benign ovarian mass and had better specificity than CA125. OPN can better differentiate between benign and malignant ovarian mass as compared to CA125.

Background: Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed. Materials and Methods: Parturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery (n = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 μg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD. Results: Incidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact P = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86–43.55; P = 0.001). Conclusion: CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.

Abstract Objective The emergence of distraction‐based growing rods has provided the means to reduce the progression of spinal deformity in early onset scoliosis (EOS). The current protocols for evaluating spinal implants (ie, ASTM‐F1717 and ISO‐12189) were developed for fusion/dynamic devices. These protocols do not feature long unsupported rod lengths subjected to distraction. Due to the unsuitability of the existing guidelines for the evaluation of growing rods, a new distraction‐based finite element protocol is presented herein for the first time. Method A vertebrectomy (VO) model from current protocols was modified to accommodate multi‐spinal segments (ie, MS model) in which springs with appropriate stiffness were simulated in between the plastic blocks. To assess the efficacy of the protocol, two different computational studies were conducted: (a) compression‐bending (MS‐CB) with no distraction, and (b) distraction followed by compression‐bending (MS‐D + CB). In each study, the model with no axial connector (rods‐only) was modified to include a) 80‐mm long tandem (LT) connectors, and b) side‐by‐side (SBS) connectors. Stiffness and yield loads were calculated as per ASTM‐F1717 guidelines and compared with the corresponding VO models with no distraction. In the MS‐D + CB models, distraction was applied at the top block, stretching the spring‐block construct in a simulation of scoliosis surgery prior to locking the construct at the connector‐rods' interface. Results MS‐CB models predicted higher stiffness and yield loads, compared to the VO models. The locking mechanism produced pre‐existing stresses on the rod‐connector interface, which caused a shift in the location of high‐stress regions to the distraction site. Distraction led to a decrease in the construct's stiffness and yield load. Discussion The proposed protocol enables the simulation of clinical parameters that are not feasible in the F1717 models and predicted stress patterns in the hardware consistent with observed clinical failures.

Introduction: With the advent of technology, medical education has been transformed to the extent that internet has become a necessary part of it. The use of Internet ranges from purely academic purposes like acquisition of knowledge and research to completely leisure activities. While proper use of internet has its own benefits, problematic internet use can disrupt occupational and social life. It has been reported to be allied with anxiety disorders, introversion, pathological gambling, personality disorders, bipolar disorder and depression in young people. DSM-V classifies Internet Gaming Disorder in Section III and in the beta draft of ICD-11 it is included as a diagnosis under disorders due to addictive behaviours (6C51). Aim: To study the prevalence of internet addiction and its association with Depression and Anxiety among Medical Students. Materials and Methods: Cross sectional study involving 700 medical students who were using internet for more than 6 months duration was conducted. A pretested self-reported questionnaire, Young’s Internet Addiction Test, Beck’s Anxiety Inventory and Beck’s Depression scale were administered. Statistical analysis was done using latest IBM SPSS 2.0 Software. Results: Majority of the students 51.8 % belonged to 21-25 years age group. The prevalence of Internet Addiction was found out to be 19.1% with moderate addiction of 17.4%, and severe addiction of 1.7%. Among the internet addicts, 58.9% reported anxiety symptoms and 32.8% scored high on Becks Depression Scale. Conclusion: Around 1/5th of our sample had internet addiction which had positive correlation with Depression & Anxiety, indicating need for preventive measures like proper education, support groups and physical activities etc.

Context: Atypia of undetermined significance/Follicular lesion of undetermined significance [AUS/FLUS] is a heterogeneous category with a wide range of risk of malignancy [ROM] reported in the literature. The Bethesda system for reporting thyroid cytopathology [TBSRTC], 2017 has recommended subcategorization of AUS/FLUS. Aims: To evaluate the ROM in thyroid nodules categorized as AUS/FLUS, as well as separate ROM for each of the five subcategories. Settings and Design: Retrospective analytic study. Methods and Materials: A retrospective audit was conducted for all thyroid fine-needle aspiration cytology (FNAC) from January 2013 to December 2017. Slides for cases with follow-up histopathology were reviewed, classified into the five recommended subcategories, and differential ROM was calculated. Statistical Analysis Used: z test for comparison of proportions was done to evaluate the difference in ROM among different subcategories of AUS/FLUS. The P value of less than 0.05 was taken as statistically significant. Results: Total number of thyroid FNACs reported was 1,630, of which 122 were AUS/FLUS (7.5%). Histopathology was available in 49 cases, out of which 18 were malignant (ROM = 36.7%). The risk of malignancy (ROM) for nodules with architectural and cytologic atypia was higher (43.8%) than ROM for nodules with only architectural atypia (16.7%). Conclusions: The sub-classification of AUS/FLUS into subcategories as recommended by TBSRTC, 2017 may better stratify the malignancy risk and guide future management guidelines.

Of the most prevalent issues surrounding long-term spaceflight, the sustainability of human life and the maintenance of homeostasis in an extreme environment are of utmost concern. It has been observed that the human immune system is dysregulated in space as a result of gravitational unloading at the cellular level, leading to potential complications in astronaut health. A plethora of studies demonstrate intracellular changes that occur due to microgravity; however, these ultimately fall short of identifying the underlying mechanisms and dysfunctions that cause such changes. This comprehensive review covers the changes in human adaptive immunity due to microgravity. Specifically, there is a focus on uncovering the gravisensitive steps in T cell signaling pathways. Changes in gravitational force may lead to interrupted immune signaling cascades at specific junctions, particularly membrane and surface receptor-proximal molecules. Holistically studying the interplay of signaling with morphological changes in cytoskeleton and other cell components may yield answers to what in the T cell specifically experiences the consequences of microgravity. Fully understanding the nature of this problem is essential in order to develop proper countermeasures before long-term space flight is conducted.

Basal cell carcinoma (BCC) commonly affects the elderly and is mostly confined to the head and neck region. Only 10% of all cases occur on the trunk. We presented a case of bullous lesion on the abdomen in a young male, initially diagnosed by clinicians as a vascular nevus. Histopathological examination and immunohistochemistry (IHC) revealed it to be Nodular cystic variant of BCC. This rare variant of BCC morphologically resembles benign skin adnexal tumor of Eccrine syringofibroadenoma. Ber Ep4 positivity on IHC established the correct diagnosis. This case highlights that nodular cystic variant of BCC can be a diagnostic dilemma for clinicians and pathologists.

Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Transvaginal ultrasound and color flow Doppler provides a high diagnostic accuracy. A delay in diagnosis and treatment can lead to uterine rupture, major hemorrhage, hysterectomy and serious maternal morbidity and mortality. Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus preserving the uterus and future fertility. Primary health care provider should know about this rare entity, because if diagnosed timely, and referral to specialized centre is done without delay will definitely save maternal morbidity and mortality. Management plan should be individualized. Termination of pregnancy is the treatment of choice in the first trimester. Expectant treatment has a poor prognosis because of risk of rupture. In this case report we aim to discuss the associated diagnostic dilemma, most appropriate methods of diagnosis and management, with their implications in clinical practice. Keywords: scar pregnancy; caesarian section; methotrexate. | PubMed

Introduction: Vaginal vault prolapse is one of the distressing conditions which occur after hysterectomy. This is due to the weakness or detachment of sacrouterine cardinal ligament complex from the vaginal cuff. Till now, the most accepted procedure for this condition is sacrocolpopexy. Materials and Methods: We present a cohort of patients who underwent abdominal sacrocolpopexy (ASC) from April 2009 to August 2013. These patients were followed till April 2014 and were evaluated for subjective and objective outcomes following ASC. Results: One patient had intraoperative hemorrhage and postoperative hematoma formation. One patient had vault abscess which was managed conservatively. Hundred percent success rate was noted at 1 year. Long-term patient satisfaction score was 85 (70-90).

Introduction: Puerperal genital haematomas although an uncommon entity but is elusive. This painful condition is not only distressing and dangerous to patient but is embarrassing to the obstetrician who has conducted the delivery. Aim: This study has been planned to evaluate the incidence and risk factors for puerperal genital haematomas. Materials and Methods: A case control study was done from August 2005 to August 2015, of all puerperal genital haematomas. All patients, who had undergone drainage for the puerperal genital haematoma, were enrolled as cases. Two controls were chosen for each case, who had delivered immediately after the case. All the patients were evaluated for the characteristics of haematoma and the management of the same. Cases and controls were compared for the evaluation of risk factors for puerperal genital haematoma. Results: During the study period 27,826 vaginal deliveries were performed in our institute. Thirty nine haematomas were drained during this period. Incidence of haematomas was one in 1,113 deliveries, in our institute. Among the puerperal haematomas, vulvovaginal was the most common type. Perineal pain was the most common complaint. To evaluate the risk factors, 77 controls were enrolled. Primigravida, hypertensive disease of pregnancy and coagulopathy were the significant risk factors with p-value of

Climate change is a reality, and the modern healthcare sector not just contributes towards this grave phenomenon but is itself being affected by it. The present review was thus conducted to understand the meaning of ‘Green Hospital’, to identify the many ways in which health sector is contributing towards climate change, to explore possibilities for countering this grave trend and last of all to look for institutions that are pioneering change. Data for the review was extracted from multiple online sources using the Google search engine. It was found that hospitals, being resource intensive establishments, consume vast amounts of electricity, water, food and construction materials to provide high quality care. It was also found that certain healthcare institutions, by employing simple, smart and sustainable measures can greatly reduce their environmental footprint. But constructing Green Hospitals can be a challenge considering the local conditions and growing customer expectations.

Background: Decreased core stability displaces center of gravity away from base of support reducing activity participation of athlete. Present study was conducted to study the effect of core stabilization exercises after reconstruction surgery of ACL on functional outcomes. Methods: 30 subjects following 5 months of ACL reconstruction were randomly assigned to either group that performed (study group) or did not performed (control group) additional core stabilization exercises in conjugation with standard rehabilitation protocol. Outcome measures were: activity level using Tegnar activity level scale and functional performance using triple hop test. Outcome measures were compared at day 1 and day 42 of the treatment. Result: Significant improvement was seen in the study group for Tegnar score with mean difference changing from 4.5 to 1.5 from day 1 to day 42 of treatment (p=0.039) while the control group showed improvement in mean difference changing from 3.8 to 1.4 (p=.045) from day 1 to day 42 of treatment. Highly significant improvement was seen in the study group for triple hop test with mean difference changing from 25 to 6.7 (p

Although traditional approaches like root canal therapy and apexification procedures have been successful in treating diseased or infected root canals, but these modalities fail to re-establish healthy pulp tissue in treated teeth. Regeneration-based approaches aims to offer high levels of success by replacing diseased or necrotic pulp tissues with healthy pulp tissue to revitalize teeth. The applications of regenerative approaches in dental clinics have potential to dramatically improve patients’ quality of life. This review article offers a detailed overview of present regenerative endodontic approaches aiming to revitalize teeth and also outlines the problems to be dealt before this emerging field contributes to clinical treatment protocols. It conjointly covers the basic trilogy elements of tissue engineering.

This document discusses the barriers to accessing fertility preservation in adolescents with Hodgkin lymphoma in India. The study found that only a small percentage of patients were offered fertility preservation, with affordability and accessibility being the main barriers in public and trust hospitals. In private hospitals, cultural acceptance and concerns about time involved were the main barriers. The study highlights the need for increased awareness and access to fertility preservation services in India, as well as the importance of counseling patients and their families about the potential impact of cancer treatment on fertility. [Extracted from the article]