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Menopause is the period in women’s life when menstruation ceases for atleast 12 months. Perimenopause refers to the time during which body makes the natural transition to menopause. M Majority women attain menopause without having adequate knowledge and approaches to cope with the menopausal changes. So, they face many physical and psychological disorders during their menopause. So knowledge and awareness regarding it is very necessary.: To study knowledge, attitude and perception of perimenopausal and menopausal changes in middle age women of 40-45years of urban population.: It was a cross-sectional study in urban population (community set-up).: 100 female participants between the age group 40-45 years having regular or irregular menstrual cycle were asked to fill a self-made questionnaire which was face validated. : Descriptive analysis.: 99% women have heard about the term perimenopause and menopause of which 96% women have knowledge about it. 46% were aware about the physical symptoms, 84% about the emotional/psychological symptoms, 78% about the hormonal deficiency related symptoms and 92% about the bone and muscle related problems. 41% of women had knowledge about Hormonal Replacement Therapy. 51% of the women have knowledge about the exercise which helps cope with perimenopause and menopause symptoms.: More efforts are needed for creating awareness about symptoms, complication and risk factors associated with perimenopause and menopause and importance of exercise as the first line of treatment option to cure the symptoms.

Adult degenerative scoliosis presents with various symptoms, including back pain, leg pain, claudication, and radiological findings like coronal / sagittal imbalance. So In our study, we have put forth an algorithm to categorise the patients for suitable operative management. This was prospective study of 30 patients. Patients with age 50 and above and ones who had no relief/worsening of symptoms after 6 months of conservative management were included. Patients were categorised into 3 groups. Patients were either treated with Focal Decompression / Decompression and long instrumented fusion with correction of deformity /Decompression only. MODI and SF36 scores were compared at the end of 2 years.11 patients were categorised into group A, 15 into group B and, 4 patients who had significant co-morbidities and had very high risk for surgery were categorised into group 3. There was significant (p Not every case needs long stabilization, focal decompression only also gives satisfactory outcome in properly selected patients. In patients operated by Instrumented fusion, Sagittal balance also plays a crucial role in functional outcome.

The Thoracic Erector spinae plane block (ESPB) has been incorporated in multimodal analgesia protocols since 2016. In a series of 20 Total Hip Arthroplasty (THA) patients, done under spinal anaesthesia, we studied the efficacy of Lumbar Erector spinae plane block (L-ESPB) for post operative analgesia. L-ESPB was administered at L4 with Ropivacaine 0.2% (0.4 mg/kg). Time to first analgesia (TTFA) request (mean 15.03 hours) and total opioid consumption in first 24 hours (mean 27.5 mg Tramadol) was noted. A median NRS at TTFA was 3.5. Our study demonstrates L-ESPB as an effective alternate technique for postoperative analgesia in THA patients. Keywords: Lumber ESP block, Hip Arthroplasty

This case series describes the use of ultrasound (US)-guided dorsal sacral foraminal block (DSFB) for providing postoperative analgesia in six patients who underwent foot and ankle surgeries under spinal anesthesia. Postoperatively, all of them received a US-guided DSFB at the level of the brim of the second sacral foramina (SF2). Needle placements were confirmed with fluoroscopic (FL) images and injected radiocontrast defined the diffusion with a postoperative CT scan. The images obtained depicted ipsilateral spread in the sacral epidural space, sacral nerve roots, and plexus. The US-guided DSFB could be effectively used as an alternative method for postoperative pain relief after foot and ankle surgery.

To the Editor: Acute kidney injury (AKI) is a lesser-known complication of hip fracture that may come about owing to decreased kidney perfusion and heightened inflammation from trauma, pain, bleeding, and fasting. Approximately 15%-20% of patients undergoing surgery for a hip fracture develop AKI, with 0.5%-1.8% receiving dialysis. [...]

Background: Venous thromboembolism is a significant source of morbidity and mortality following total hip replacement and total knee replacement. Apixaban has been proven to be efficacious without increased risk of bleeding in phase-III trials in patients undergoing total knee replacement and total hip replacement. Due to paucity of data on safety of apixaban in Indian patients, this phase-IV study was conducted to evaluate safety of apixaban in patients undergoing total knee replacement and total hip replacement. Methods: In this non-comparative phase-IV clinical trial, patients undergoing elective total knee replacement or total hip replacement surgery, or a revision of at least one component of total knee replacement or total hip replacement, were enrolled. The eligible patients were given the approved dosage of apixaban 12 to 24 h after completing the skin wound closure. The primary safety outcome was the composite of the International Society on Thrombosis and Haemostasis–defined major bleeding and clinically relevant non-major bleeding events at the end of the treatment. The secondary efficacy endpoint was the composite of venous thromboembolism/all-cause death at the end of the treatment. Results: A total of 498 patients received apixaban prophylaxis therapy. Six (1.2%) bleeding adverse events were observed during the treatment period. Only one bleeding event was adjudicated as an International Society on Thrombosis and Haemostasis–defined clinically relevant non-major bleeding event (moderate severity). There were no fatal bleeding events and no deaths following the treatment. One venous thromboembolism event, that is, symptomatic distal left leg DVT, was reported in a total knee replacement patient and was adjudicated during the treatment period. Conclusion: Apixaban demonstrated a favorable safety profile for venous thromboembolism prevention in Indian patients undergoing total knee replacement or total hip replacement.

Background: In majority of heavy industries and factories safety footwear is a mandatory safety obligation, thus a necessity for workers in industrial settings, contributing to foot problems, interfering with work capacity. Therefore, there is an urgent need to find prevalence of foot problems occurring due to safety footwear. To find the prevalence of foot problem associated with wearing safety footwear in factory employees.Methods: Factory employees working in industrial setting wearing safety footwear for prolonged duration on regular basis were included in the study. Subjects having any recent ankle and below knee fractures in last 6 months were excluded. Samples were collected from different industrial settings, with the help of a self-made questionnaire. Descriptive analysis of the data collected was done and the responses were converted into percentiles and represented in graphical form.Results: 62.50% subjects complain pain in the heel and bottom of the foot (plantar fasciitis), 50.83% pain in the foot (radiating up to calf), 47.50% excessive heat/wet condition, 30.83% hard dead skin on the pressure areas of the foot (foot corn), 12.50% blisters/swelling on the foot, bump/bulge on the joint at the base of the big toe (bunion), numbness of great toe, 10.83% interference with blood circulation. 43.34% employees the intensity of pain caused by wearing safety footwear interfere with their working capacity. For 43.34% employees the intensity of pain caused by wearing safety footwear interferes with their working capacity.Conclusions: It can be concluded that there is significant prevalence of foot problems caused due to wearing safety footwear. These foot problems limit the working capacity of the individual.

Existing literature is varied in the methods used to make this determination in the treatment of athletes who have undergone recent anterior cruciate ligament (ACL) reconstruction. Some authors report using primarily time-based criteria, while others advocate for physical measures and kinematic testing to inform decision-making. The goal of this paper is to elucidate the most current medical evidence regarding identification of the earliest point at which a patient may safely return to sport. The present review therefore seeks to examine the evidence from a critical perspective-breaking down the biology of graft maturation, effect of graft choice, potential for image-guided monitoring of progression and results associated with time-based versus functional criteria-based return to play-to justify a multifactorial approach to effectively advance athletes to return to sport. The findings of the present study reaffirm that time is a prerequisite for the biological progression that must occur for a reconstructed ligament to withstand loads demanded by athletes during sport. Modifications of surgical techniques and graft selection may positively impact the rate of graft maturation, and evidence suggests that imaging studies may offer informative data to enhance monitoring of this process. Aspects of both functional and cognitive testing have also demonstrated utility in prior studies and consequently have been factored into modern proposed methods of determining the athlete's readiness for sport. Further work is needed to definitively determine the optimal method of clearing an athlete to return to sport after ACL reconstruction. Evidence to date strongly suggests a role of a multimodal algorithmic approach that factors in time, graft biology and functional testing in return-to-play decision-making after ACL reconstruction.Level of evidence: level V.

Introduction: Removal of the elastic stable intramedullary nail (ESIN) after the union is routinely performed in the pediatric population. However, ESIN removal can be lengthy and difficult due to the strong bonding between nail and bone. Technique: We preferred keeping the nail tip tangentially flush (

Background: Knowledge about risk factors and early signs of stroke helps in early intervention and may lead to a better functional outcome for the patient. This study was conducted to assess awareness about stroke in the high risk population of Pune region.Methods: Ethical committee clearance was taken. A total of 180 samples were recruited and written consent was obtained. Data was collected using a close-ended, self made questionnaire, which was face validated, in an interview based format. Collected data was analysed using descriptive statistics.Results: 43.3% participants were fully aware about stroke. 24.2% participants couldn’t identify a single risk factor.79% participants did not have self risk perception about stroke. Only 2.2% participants identified all the signs and symptoms of stroke correctly. 85.4% participants believed that early treatment of stroke increases chances of recovery. Only 32.5% participants would call the ambulance on occurrence of stroke. Awareness about risk factors and early signs of stroke seems to be higher among high risk population belonging to urban areas of Pune region, with higher literacy levels.Conclusions: There is significant lack of awareness about risk factors and early signs of stroke. Public health education seminars should be conducted to increase awareness, especially targeting population at high risk. Outreach to the rural population should be improved.

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p

Playing guitar can cause adoption of asymmetric postures and affect the shoulder's stability.To assess the presence of scapular dysfunction in professional guitar players.A lateral scapular slide test was performed at the level of the spine of the scapula and at the inferior angle of the scapula in 20 professional guitar players (age: 18-40 years) and was compared with 20 age-matched non-players at angles of 0°, 45° and 90° of shoulder abduction with both limbs loaded with 0.5-kg weights. Analysis was done by unpaired t test.Scapular dysfunction in guitar players was seen in the form of asymmetric scapula at rest in 25% and dyskinetic scapula in 20% of players. 100% of non-players had normal scapular positioning. Comparison at the level of the spine of the scapula showed no significant difference (p 0.05), but the inferior angle showed a significant difference at 0° (1.37 cm), 45° (1.93 cm) and 90° (2.15 cm) which was more in the player's category (p 0.05).There exists a marked dysfunction of scapular stabilizers in professional guitar players at the level of the inferior angle of the scapula.

Acetabulum fractures require systematic approach for understanding the fracture pattern and also for planning the treatment plan. The fractures have to be correctly identified radiologically and clear definition of fracture patterns should be made before planning. The radiological parameters must be kept in mind in planning of surgical approach and also the fixation method. This may require a long learning curve but these basics have to be kept in mind while dealing with acetabulum fractures. There are new techniques like 3d CT, virtual assessment of the fracture, 3D print modelling of the fractures that may help in complex fractures, but the basic principles remain the same. Advancements in technology simply refines the ways and means of interpretation and implementation of the basic principles. The current article is compilation of experience gathered over a period of time. The entire article emphasizes on the basics of understanding and managing acetabular fractures and also includes important tips and tricks that facilitate the treatment. Keywords: Acetabulum fractures, surgical management, Letournal and judet.

Background: Racquet sports, especially lawn tennis and badminton have been gaining popularity in Asian countries like India. With this increase in popularity, the injury rate in the sport has also increased. Objectives: The study will help detect the presence of gleno-humeral movement dysfunction and scapular resting position abnormality in asymptomatic racquet players, thus providing basis for screening the players and allow the clinician to determine if the asymmetry is a normal adaptation in the player or an abnormal change associated with injury. Materials and Methods: 46 asymptomatic professional players were divided into a study group of 23 players (16 tennis and 7 badminton) and control group of 23 football players. Assessment of passive gleno-humeral range of motion and distance of spine and inferior angle of scapula from corresponding spinous process were measured bilaterally and between groups. Results: There was statistically significant reduction in range of internal rotation (62.17 ± 8.09), extension (39.78 ± 4.12) and an increase in the external rotation (106.95 ± 7.49) of dominant compared to non-dominant arm of racquet players and a statistically significant decrease in internal rotation (78.69 ± 10.24), extension (44.78 ± 3.19), adduction (37.39 ± 6.54) and an increase in external rotation (102.6 ± 5.19) of dominant arm of racquet players compared to football players. Study also showed statistically significant increase in the spino-scapular distance at the level of inferior angle of scapula (10.23 ± 1.43) on dominant side compared to non-dominant. Conclusions: The dominant side scapula of asymptomatic racquet players showed increased external rotation and elevation as compared to the non-dominant side. Also, reduced shoulder internal rotation, extension and adduction and gain in shoulder external rotation was observed on the dominant side of racquet players when compared to the control group.

Background: In India, obesity is highly prevalent in women as compared to men. As the obesity epidemic spreads, there are growing concerns about efficient obesity management. Aims: To compare between circuit training (CT), treadmill (TM) walking and suryanamaskar (SN) training in weight management and physical fitness enhancement in obese females. Settings and Designs: Comparative controlled study conducted in a community setting. Materials and Methods: 119 females of age between 20 and 40 years of body mass index (BMI) between 25.1 and 34.9 kg/m 2 . 87 participants completed the study. Group 1: CT; group 2: TM walking; group 3: Modified SN; group 4: Control. Outcome Measures: Body composition, cardio-respiratory and muscle endurance, flexibility. Statistical Analysis : Within-group data was analyzed with the paired t-test. P =0.05. Analysis between the groups was done using one way ANOVA test. Analysis between the groups was done using ANCOVA test controlling for baseline differences only for those variables that have significant differences at baseline. For those which do not have significant difference at baseline, RMANOVA was done at end of 8 weeks. Results: Reducation in mean body weight in CT group (2.2%), TM (1.7%) and SN (1.6%), (P < 0.05), BMI in all the three groups (P < 0.01), total body fat % in the CT (5%) and SN (3.7%), (P < 0.01), metabolic age with CT (2%) and TM (2%), (P = 0.001). Improvement in muscle mass in CT (4%, P = 0.009), VO 2max in CT group by 17.2%, SN (14%), TM group (8%) (P < 0.05). Upper limb Muscle endurance in CT (51.3%), SN group (51.24%) and in TM group (40%), (P = 0.05), in lower limb TM (21.2%) and SN (24.5%) (P = 0.05), flexibility in SN (12.4%, P = 0.0001). Conclusions: All three methods were effective in weight and physical fitness management. CT and SN were more effective in improving cardio-respiratory fitness and upper limb muscle endurance while only SN was effective in improving body flexibility.

Background : Balance is the ability to maintain proper alignment of body segments with respect to each other. Muscular fatigue is a key factor which can influence performance via impaired joint proprioception and postural control. Fatigue alters the force generation capacity of the muscle and ultimately leads to task failure. The relationship between fatigue and balance is poorly understood. The purpose of the present study was to assess if fatigue had an immediate effect on balance and core strength in healthy individuals, by checking the static and dynamic stability and the core muscle strength for spinal stability. Aim : To find the effect of Induced muscular fatigue on Balance and Core strength in Normal Individuals. Methodology: Functional reach tests, Single Leg Stance, Core strength were measured Pre and post Fatigue, which was induced by squats performed till RPE of 10. The data obtained was statistically analyzed using paired 't' test. Results : A significant reduction was found in the mean single leg stance time from 10.05 seconds pre-fatigue, to 3.01s post fatigue (p

Objective : The purpose of the study was to compare the values of ankle brachial index (ABI) measured by Doppler and by sphygmomanometer. Method : Thirty people were assessed for the ABI measurement through Doppler method by one investigator and by sphygmomanometer method done by another investigator. Results : The correlation between the ABI taken with sphygmomanometer and with Doppler was 0.745. The value suggests positive correlation between the two. But kappa score was 0.267 with p value 0.143 implied that ABI measurement with Doppler could not be replaced with measurement with help of sphygmomanometer. Conclusion : Best method of measuring ABI is with Doppler. ABI Measurement with sphygmomanometer does not give good result as compared to Doppler.

Background: Persistent infection, soft-tissue fibrosis, and damage to periosteum compound the treatment of children with a bone defect following osteomyelitis. We report on a series of twenty-six patients treated with nonvascularized fibular graft and intramedullary fixation. Methods: The series included eleven boys and fifteen girls (mean age, 6.8 years; range, three to twelve years) with gap nonunion after osteomyelitis. Initial treatment involved thorough debridement and sequestrectomy. When the infection was quiescent as indicated by inflammatory parameters, nonvascular fibular grafting with intramedullary Kirschner wire fixation (with or without additional external fixation) was performed. The time to union was noted, and a subgroup analysis was performed to correlate the size of the bone defect with the time to union. Results: The mean duration of follow-up was 3.02 ± 0.74 years (range, 1.3 to 4.2 years), and the mean time to union was 38.76 ± 12.02 weeks (range, fifteen to sixty weeks). There was a weak positive correlation between the time to union and the preoperative bone defect size (Pearson correlation coefficient, 0.699). The mean time to union was 31.7 ± 11.5 weeks for a defect of 6 cm. Delayed union was seen at one end of the fibular graft in four (15%) of the patients and was treated with plate fixation. One patient had recurrence of infection. Limb-length discrepancy (range, 2 to 5 cm) was seen in all patients in whom the lower limb was involved and was treated with a shoe lift. Conclusions: This series illustrates the potential benefits of staged sequestrectomy and nonvascular fibular grafting for the treatment of gap nonunion following osteomyelitis in children. The procedure is simple, does not require specialized training or equipment, and has a low complication rate. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.