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Aim The development of lymphedema post-breast-cancer surgery has been identified as a significant burden worldwide, with nurses at the forefront of prevention and risk reduction practices. Prevention is of crucial importance to avoid lymphedema formation and its complications. This study aims to assess the knowledge gained through an educational session regarding risk reduction and prevention of breast cancer-related lymphedema (BCRL) among nursing professionals and compare the pre-test and post-test knowledge. Methods and material The research approach was quantitative in nature, and the design adopted was a pre-experimental, one-group pre-test post-test design. The study was conducted in a 400-bed multispecialty teaching hospital in Bangalore, Karnataka. After obtaining formal permission from the authorities, the participants were approached and informed about the purpose of the study. Eighty-four staff nurses working with breast cancer-related lymphedema (BCRL) patients participated in the study. The data for the study was collected using a validated questionnaire based on the National Lymphedema Network's (NLN) breast cancer-related lymphedema (BCRL) risk reduction and preventive guidelines. The questionnaire consisted of two sections. Section A consisted of the staff nurses' demographic data, and Section B consisted of questions on risk reduction and prevention of lymphedema. The pre-test was conducted, followed by a structured teaching session on risk reduction and prevention of lymphedema among 84 staff nurses working with BCRL patients. After the teaching session, the post-test was conducted. Results Descriptive and inferential statistics were used for analysis in this study. The t-test determined the statistical significance using the software SPSS (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). The result showed that the mean knowledge score was 4.286 with SD 0.97 in the pre-test, which increased to 4.452 with SD 1.511 with a significant p-value (<0.001). Conclusion According to the study's findings, nurses must get standardized lymphedema training in order to prevent lymphedema from developing in patients having breast cancer surgery. The study's outcome has implications on the focus areas for nurses in the context of the team's adoption and dissemination of breast cancer-related lymphedema preventive measures. Key messages of this study are - 1) BCRL is an irreversible, progressive complication with no cure if not diagnosed early. 2) Poor knowledge of lymphedema prevention among nurses leads to frustration for BCRL patients. 3) Risk reduction and prevention education enable the patient to reduce BCRL complications, minimize the severity of the condition, and improve the quality of life. 4) Pre-habilitation - patient education on early diagnosis and risk reduction/prevention of BCRL reduces the cost, time, and energy for the patient and health care delivery system.
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Ectopic pregnancy in the scar of a previous cesarean section contributes to significant maternal morbidity in the first trimester due to a significantly higher risk of uterine rupture if left undetected. The routine scans done in the first trimester serve as an important screening tool in the detection of such an ectopic pregnancy. Early detection can aid in making a paradigm shift from a surgical to a more conservative approach for the management of such pregnancies. Here, we report a case of a cesarean scar pregnancy diagnosed in the sixth week of gestation which was managed non-surgically with methotrexate and intracardiac potassium chloride injection.
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BACKGROUND: Lymphedema is a severe post-mastectomy complication that still causes much morbidity in breast cancer patients with axillary lymph node dissection. Therefore, after mastectomy, lymphedema prevention is crucial for long-term survival and an increase in quality of life. AIM: The study's primary objective was to determine whether pre-discharge educational intervention sessions for post-mastectomy women effectively improve the knowledge in preventing arm lymphedema. METHODOLOGY: A quasi-experimental research study, one-group pretest-posttest design, was conducted in a teaching hospital in Bangalore. The sample included 80 females who were diagnosed with breast cancer, had recently undergone mastectomy, and had chemo and radiation therapy plans. Questions were based on the knowledge of lymphedema preventive concepts, including the definition of the lymphatic system and lymphedema, its causes, symptoms, prevention, and management, and were included in a structured self-administered questionnaire. Convenience sampling was used among women who had undergone mastectomy for breast cancer. The pre-discharge educational interventions session included instructions on a self or simple lymphatic drainage technique demonstration, arm exercises, and an e-brochure on risk reduction strategies and arm lymphedema prevention. The knowledge of pre-discharge educational intervention sessions highlighting risk reduction/prevention strategies among post-mastectomy women was evaluated using the self-structured knowledge questionnaire pretest and posttest data. RESULTS: The entire study population comprised women who had undergone mastectomy. Almost half of the subjects were older than 55 years. Prior to the intervention, the majority of patients (58) had poor knowledge (72%) about preventing lymphedema, whereas nearly all patients (80) had good knowledge (100%) after the intervention sessions. All participants felt comfortable using the treatment plan to avoid arm lymphedema. The knowledge gain was statistically significant at the 0.05 level. CONCLUSIONS: It was determined that pre-discharge educational intervention sessions enhanced post-mastectomy women's awareness and risk reduction behaviors toward preventing arm lymphedema and reducing arm morbidity. Therefore, it is suggested that women who have had breast cancer surgery participate in a pre-discharge educational intervention program. This will guarantee that all mastectomy patients have access to educational information/materials and that risk reduction strategies are followed to prevent lymphedema.
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Polycystic ovary syndrome (PCOS) is a common condition with a multifactorial aetiology. Chronic periodontitis (CP) is an immunoinflammatory disease that is linked to PCOS via the excessive production of reactive oxygen species (ROS), which leads to an imbalance in the antioxidant system. However, limited studies have evaluated the relationship between these diseases. The current study aims to evaluate the levels of advanced oxidation protein products (AOPP) in patients with periodontitis and PCOS. Four groups, each consisting of 12 patients, with both PCOS and CP (PCOSCP), systemically healthy women with CP, periodontally healthy women with PCOS (PCOSPH), and periodontally and systemically healthy women (PH) were included in the study. Clinical parameters such as clinical attachment loss, bleeding on probing (BOP), and periodontal inflamed surface area (PISA) index were noted. AOPP were evaluated in the saliva and serum samples by spectrophotometric detection. Salivary and serum AOPP levels were highest in the PCOSCP group (75.16 ± 7.50 µmol/l, 97.92 ± 6.50 µmol/l, respectively). Statistical significance (P<0.05) was noted between the salivary AOPP levels of the PCOSCP group and PCOS group. PISA was greatest in the PCOSCP group (1338.40 ± 285.96 mm2 ) followed by the PCOS group (680.33 ± 79.49 mm2 ), which showed the impact of PCOS on gingival inflammation. According to the results of this study, increased levels of advanced oxidative protein products appeared to show the effect of CP on worsening PCOS.
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Complete heart block is seldom seen in pregnant women and poses a challenge for further management. The available literature on this is scarce, and the management usually varies as per the discretion of the obstetrician and severity of the presenting symptoms. Here, we report a case of a G2P0 primi with a high-degree AV block that was managed with a temporary cardiac pacemaker, which resulted in the successful delivery of twins. Clinically, we suspected a mitochondrial genetic defect to be the underlying cause of the conduction defect. Through this case, we would like to emphasize on the involvement of a multidisciplinary approach for the management of every pregnancy complicated by a medical disorder and the provision of timely interventions to reduce maternal and perinatal mortality.
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BACKGROUND AND AIM: The study assessed the impact of continuous patient education on Knowledge, Attitude, Practice (KAP), medication adherence and extent of glycemic control in pregnant women with gestational diabetes on insulin or metformin therapy. METHODS: 81 women with gestational diabetes (37 on insulin and 44 on metformin) were assessed for KAP using a validated questionnaire and medication adherence using the 8-items Morisky medication adherence scale, fasting, and postprandial blood glucose levels at the baseline and after two education sessions on drug therapy at one and three months intervals. The difference in mean KAP, medication adherence scores, fasting, and postprandial blood glucose levels and the extent of glycemic control with insulin or metformin therapy were assessed statistically. RESULTS: There was a highly significant difference in the mean KAP, medication adherence scores, fasting and postprandial blood glucose levels from baseline to follow-up after three months, (P < 0.0001) indicating that continuous patient education had a positive impact on their KAP, medication adherence, blood glucose levels. CONCLUSION: The study identified that continuous patient education improved their knowledge and practice of medication adherence which reflected on lowered fasting and postprandial blood glucose levels. Glycemic control was found to be the same with metformin and insulin in gestational diabetes.
