Experiences of water immersion during childbirth: a qualitative thematic synthesis.

BACKGROUND: The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence-based care aimed at promoting women's participation in informed decision-making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women's autonomy and well-being during childbirth. Currently, water immersion is used as a non-pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women's and midwives' experiences, values, and preferences regarding water immersion during childbirth. METHODS: A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non-qualitative studies, mixed-methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. RESULTS: Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. CONCLUSIONS: The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rigorous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results.

Role of Vitamin K in Bone and Muscle Metabolism.

Vitamin K, a cofactor for the γ-glutamyl carboxylase enzyme, is required for the post-translational activation of osteocalcin and matrix Gla protein, which play a key role in bone and muscle homeostasis. In vivo and in vitro models for osteoporosis and sarcopenia suggest the vitamin K could exert a positive effect in both conditions. In bone, it increases osteoblastogenesis, whilst decreases osteoclast formation and function. In muscle, it is associated with increased satellite cell proliferation and migration and might play a role in energy metabolism. Observational trials suggest that high levels of vitamin K are associated with increased bone mineral density and reduced fracture risk. However, interventional studies for vitamin K supplementation yielded conflicting results. Clinical trials in sarcopenia suggest that vitamin K supplementation could improve muscle mass and function. One of the main limitations on the vitamin K studies are the technical challenges to measure its levels in serum. Thus, they are obtained from indirect sources like food questionnaires, or levels of undercarboxylated proteins, which can be affected by other environmental or biological processes. Although current research appoints to a beneficial effect of vitamin K in bone and muscle, further studies overcoming the current limitations are required in order to incorporate this supplementation in the clinical management of patients with osteosarcopenia.

Case report of visual biofeedback-driven, magnetic resonance-guided single-fraction SABR in breath hold for early stage non-small-cell lung cancer.

Stereotactic ablative body radiation therapy (SABR) is a well-established alternative to surgery for early stage non-small-cell lung cancer (NSCLC). While SABR is typically delivered in 3 to 5 fractions, randomized trials have shown single-fraction SABR to be a reasonable alternative. We present the case of a 66-year-old male with history of cholangiocarcinoma who was subsequently diagnosed with peripheral early stage NSCLC and treated in mid-inspiration breath hold (BH) to 34 Gy in 1 fraction on a magnetic resonance (MR)-guided linear accelerator, with treatment delivery completed in 17 minutes. Visual biofeedback was utilized to maximize patient compliance with appropriate depth of inspiration BH and improve overall treatment delivery time efficiency. The benefits of single- vs multifraction SABR and unique advantages of MR guidance that are particularly well-suited for single-fraction SABR are reviewed.

Eficacia del tratamiento con férula tipo INMOYBA en niños con torsión tibial interna y externa / Efficacy of treatment with INMOYBA type splint in children with internal and external tibial torsion

Introducción. Los problemas rotacionales de los miembros inferiores son una de las causas más frecuentes de consulta de ortopedia pediátrica. Existe una gran controversia en cuanto al tratamiento conservador. El objetivo de nuestro estudio es valorar la eficacia de la férula tipo INMOYBA para el tratamiento de la torsión tibial. Material y método. Estudio descriptivo retrospectivo donde hemos evaluado a los pacientes remitidos a nuestra Unidad de Rehabilitación Infantil, con diagnóstico de torsión tibial patológica, tratados con férula tipo INMOYBA de uso nocturno. Recogimos variables sociodemográficas y perfil rotacional. Las medidas se realizaron justo antes de comenzar el tratamiento con la férula y seis meses después de su retirada. El ángulo muslo-pie (AMP) también fue recogido en el momento de retirada de la ortesis. Resultados. La corrección producida en el AMP inicial con respecto al de la retirada fue de media 14,38° en el izquierdo y de 13,08° en el derecho siendo esto estadísticamente significativo. Al comparar el AMP de la retirada con el valor final, la corrección aumentó aún más. Al correlacionar las rotaciones interna y externa de cadera previa y posterior al tratamiento así como la flexión dorsal y plantar se obtuvo una disminución de las mismas, siendo esta última estadísticamente significativa. Conclusión. El uso de la férula tipo INMOYBA nocturna parece eficaz para el tratamiento tanto de la torsión tibial interna como externa. Sería recomendable dilucidar si la disminución producida en la flexión plantar se debe al empleo de este tipo de ortesis o si va vinculado a la evolución natural (AU)

Introduction. Rotational problems of the lower limbs are one of the most common causes of pediatric orthopedics consultation. There is considerable controversy regarding conservative treatment. The aim of our study is to assess the effectiveness of the INMOYBA type brace for the treatment of tibial torsion. Material and methods. A retrospective descriptive study was performed including the patients referred to our Child Rehabilitation Unit who were diagnosed with pathological tibial torsion and treated with INMOYBA type splint for nighttime use. We collected sociodemographic variables and rotational profile. Measurements were made just before starting treatment with the splint and six months after its removal. Thigh-foot angle (TFA) was also obtained on removal of the splint. Results. The correction produced in the initial TFA compared to the removal one was 14.38° on the left and 13.08° on the right, this being statistically significant. When the removal TFA was compared with the final value, correction was even greater. A reduction was obtained when the internal and external rotation of the hip was correlated before and after treatment as well as dorsal and plantar flexion. The latter was statistically significant. Conclusion. The use of INMOYBA-type night splint appears to be effective for the treatment of both internal and external tibial torsion. It would be advisable to ascertain whether the decrease in plantar flexion produced is due to the use of this type of brace or if it is associated to the natural evolution (AU)

Enfermedad de Addison. Tratamiento sustitutivo con glucocorticoides y su monitorización / Addison´s disease. Hydrocortisone replacement therapy and its monitoring

En esta revisión se repasan algunos aspectos del tratamiento sustitutivo con glucocorticoides en pacientes con enfermedad de Addison. Según opinión de algunos autores, la dosis tradicional de 30 mg/día de hidrocortisona, repartida en dos tomas, podría ser excesiva para la mayoría de los enfermos, por lo que debería administrarse en tres tomas. Así, se ha señalado que la sobreexposición prolongada a los glucocorticoides podría aumentar el riesgo de padecer osteoporosis. Por otra parte, aunque los pacientes con enfermedad de Addison tratados pueden llevar una vida normal, muchos de ellos aquejan fatiga, cansancio y disminución de la tolerancia al estrés, y en varios estudios se demuestra que presentan una alteración significativa de la calidad de vida relacionada con la salud (CVRS). Una explicación para este hallazgo podría ser el déficit de deshidroepiandrosterona (DHEA) que presentan y que también justificaría, al menos en parte, la peor CVRS observada en las mujeres. El tratamiento de este déficit de DHEA mejora algunos aspectos psicológicos. Tampoco resulta fácil establecer una pauta de tratamiento que imite el perfil fisiológico de secreción de cortisol, en los pacientes con enfermedad de Addison, si se consideran criterios bioquímicos. Por todo ello, como recomendación general proponemos iniciar el tratamiento sustitutivo de estos enfermos con 10-5-5 mg/día de hidrocortisona y aumentar esta dosis en los casos en que se detecte alteración de la CVRS (AU)

Screening of medicinal plants for induction of somatic segregation activity in Aspergillus nidulans.

Knowledge about mutagenic properties of plants commonly used in traditional medicine is limited. A screening for genotoxic activity was carried out in aqueous or alcoholic extracts prepared from 13 medicinal plants widely used as folk medicine in Cuba: Lepidium virginicum L. (Brassicaceae): Plantago major L. and Plantago lanceolata L. (Plantaginaceae); Ortosiphon aristatus Blume, Mentha x piperita L., Melissa officinalis L. and Plectranthus amboinicus (Lour.) Spreng. (Lamiaceae); Cymbopogon citratus (DC.) Stapf (Poaceae); Passiflora incarnata L. (Passifloraceae); Zingiber officinale Roscoe (Zingiberaceae); Piper auritum HBK. (Piperaceae); Schinus terebinthifolius Raddi (Anacardeaceae) and Momordica charantia L. (Cucurbitaceae). A plate incorporation assay with Aspergillus nidulans was employed, allowing detection of somatic segregation as a result of mitotic crossing-over, chromosome malsegregation or clastogenic effects. Aspergillus nidulans D-30, a well-marked strain carrying four recessive mutations for conidial color in heterozygosity, which permitted the direct visual detection of segregants, was used throughout this study. As a result, only in the aqueous extract of one of the plants screened (Momordica charantia) a statistical significant increase in the frequency of segregant sectors per colony was observed, and consequently, a genotoxic effect is postulated.