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Background The role of breastfeeding in childhood asthma has long been controversial. The majority of research pertains to developed countries with scant literature available in a developing country like India, where a different asthma phenotype is prevalent. This study examined the association of breastfeeding duration and exclusiveness with childhood asthma and its severity, as measured by peak expiratory flow rate (PEFR) in India. Methodology We conducted a matched case-control study in Pune, India. A total of 180 children with asthma (cases) and 180 without the disease (controls) were included. A standardized questionnaire recorded demographics and medical and breastfeeding history. PEFR readings were obtained from each child. Conditional logistic regression and linear regression were used to explore the association of breastfeeding with asthma and PEFR, respectively. Results The median duration of breastfeeding among cases was [5 (2.5-10)] months as compared to controls [9 (3.5-16.8)] months. The prevalence of exclusive breastfeeding among mothers was 60% (50% among cases and 69% among controls). Exclusive breastfeeding was associated with a 46% lower likelihood of having asthma with a probability (p-value) of 0.025 where the odds ratio (OR) was 1.85, with a 95% confidence interval (CI) of 1.08 to 3.16. Breastfeeding duration was significantly associated with a lower likelihood of having asthma (p = 0.001) (OR 0.87; 95% CI 0.79-0.94). One-month increase in the duration of breastfeeding was associated with a 23% reduced risk of the disease. The odds of maternal asthma [21.4 (4.22-109.36)], paternal smoking [1.44 (0.22-0.86)], and maternal smoking [5.14 (1.78-14.80)] were higher among children with asthma as compared to children without asthma. The weight of the child and duration of breastfeeding were negatively associated with PEFR. Maternal asthmatic history, associated allergies, paternal smoking, and parents' education were positively associated with PEFR for the overall sample. Conclusion Prolonged and exclusive breastfeeding was found to be a protective factor against the development of asthma. Promotion of breastfeeding and smoking cessation should be a priority in the control of childhood asthma. Further research should be conducted to explore the negative correlation between duration and frequency of breastfeeding and PEFR.
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BACKGROUND: Laparotomy (open surgery) is considered the standard approach for acute small bowel obstruction (ASBO). However, with the advent of minimally invasive surgery, the laparoscopic approach is gaining popularity. There is no consensus on the appropriate setting for laparoscopic therapy for small bowel obstruction (SBO). AIM AND OBJECTIVES: The purpose of this study is to evaluate the outcomes of laparoscopic surgery for ASBO. PATIENTS AND METHODS: We retrospectively evaluated the prospectively collected data of all the 38 patients who had undergone laparoscopy for ASBO, performed by a single surgeon at our institution, due to adhesions (30 patients), internal hernias (five patients), midgut malrotation (one patient), ileo-ileal intussusception (one patient), and superior mesenteric artery (SMA) syndrome (one patient) from 2012 to 2020. Data were extracted from the hospital electronic medical records (EMR) for the following parameters of each individual patient: age, sex, clinical presentation, preoperative investigation findings, final diagnosis, surgical details, operating time, time to postoperative oral feeds, length of hospital stay, complications, recurrences, and time taken to resume normal activity. A preoperative abdominal contrast-enhanced computed tomography (CECT) was performed in all the cases. Patients with peritonitis and septic shock were excluded from the study. Results: The mean age of the 38 patients was 58 years (ranged between 33 and 83 years) with a standard deviation (SD) of 16.5. The mean age of the female patients in the study was 60.5 years with an SD of 16.6, while the mean age of the male patients was 54.9 years (SD = 16.2). The age difference between male and female patients in the study was not statistically significant (p = 0.36). The mean operating time was 74.4 minutes (range: 60-90 minutes, with an SD of 7.2). The mean time to oral liquid/soft diet was 2.5 days. The mean postoperative stay was 5.7 days. Three patients (8%) underwent conversion to open surgery, out of which two patients had multiple complex bowel-to-bowel and bowel-to-parietes adhesions, and in one patient, massive distension of small bowel caused technical difficulties. CONCLUSION: Laparoscopic management of ASBO is feasible, effective, and safe. Optimum surgical techniques, the surgeon's experience with the procedure, and stringent patient selection criteria enable a high probability of success.
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The present study aimed to compare the clinical effects of image-guided versus blind steroid injection to treat shoulder pain, which is always debatable. An electronic search of credible databases was conducted for randomized controlled trials (RCTs) comparing image-guided versus blind steroid injections. The continuous data were pooled as mean difference (MD) or standardized mean difference (SMD), and dichotomous data were grouped as odds ratio (OR) with 95% confidence interval (CI). Sensitivity analysis and leave-one-out analysis were performed. The meta-analysis of 20 RCTs comprising 1136 patients favored image-guided injection based on the MD of the visual analog score (VAS) and shoulder function scores, measured between six weeks follow-up and baseline (MD=0.63, 95% CI [0.13, 1.12], p=0.01 and SMD=0.35, 95% CI [0.05, 0.65], p=0.02, respectively). Meta-analysis did not favor either group regarding the shoulder disability scores or side effects (MD=-2.18, 95% CI [-12.19, 7.83], p=0.67, and OR=0.40, 95% CI [0.14, 1.15], p=0.09, respectively). The image-guided approach was associated with significant improvement in pain and shoulder functionality. However, no significant difference was observed between the two approaches in terms of disability scores and side effects.
