Successful pregnancy outcome in a rare case of complete situs inversus in a primigravida

Complete situs inversus is a rare syndrome, of autosomal recessive inheritance, resulting from inversion of rotation of the cardiac tube during embryogenesis. It occurs in 1 in 10,000 births. We report here an interesting case where situs inversus was diagnosed during pregnancy followed by uneventful course of pregnancy. A 28 year old primigravida, presented to our hospital for first antenatal visit at 16 weeks of gestation. On physical examination she was found to have her cardiac apex on the right side in right 5th intercostal space. Presence of dextrocardia prompted a thorough physical examination, with other findings raising suspicion of total situs inversus. Confirmation of situs inversus was done by ultrasound imaging of abdomen and transthoracic echocardiography. Her obstetric ultrasonographic examination was unremarkable and showed a single alive intrauterine gestation 14 weeks gestation. She was regularly followed up & her pregnancy course was uneventful. She was admitted at term gestation, with premature rupture of membranes. An attempt to induce labour was done with four doses of oral misoprostol. Eventually she underwent emergency cesarean section due to failure of induction and an alive term female baby of weight 2.7 kg was delivered . Intra and post-operative period was uneventful. She was discharged on sixth post-operative day. Her six week postpartum follow up was uneventful. Situs inversus with pregnancy is a rare clinical entity. However, these patients are likely to have uneventful course during pregnancy

Kepemimpinan Lembaga Pendidikan Islam di MAN 2 Model Medan

Leadership developed by individuals in leading Islamic educational institutions will have a significant impact on improving the quality of these institutions. Leaders of Islamic educational institutions can use some of the characteristics of Islamic leadership to carry out leadership tasks. Islamic leadership strikes a balance between worldly and spiritual leadership by prioritizing long-term goals over short-term organizational goals, requiring a strong commitment to Islamic principles, and treating leadership responsibilities not only as a human responsibility that is only accountable to members but also to God. SWT. Leadership developed by individuals in leading Islamic educational institutions will have a significant impact on improving the quality of these institutions

Design and manufacture of a novel system to simulate the biomechanics of basic and pitching shoulder motion

Objectives: Cadaveric models of the shoulder evaluate discrete motion segments using the glenohumeral joint in isolation over a defined trajectory. The aim of this study was to design, manufacture and validate a robotic system to accurately create three-dimensional movement of the upper body and capture it using high-speed motion cameras. Methods: In particular, we intended to use the robotic system to simulate the normal throwing motion in an intact cadaver. The robotic system consists of a lower frame (to move the torso) and an upper frame (to move an arm) using seven actuators. The actuators accurately reproduced planned trajectories. The marker setup used for motion capture was able to determine the six degrees of freedom of all involved joints during the planned motion of the end effector. Results: The testing system demonstrated high precision and accuracy based on the expected versus observed displacements of individual axes. The maximum coefficient of variation for displacement of unloaded axes was less than 0.5% for all axes. The expected and observed actual displacements had a high level of correlation with coefficients of determination of 1.0 for all axes. Conclusions: Given that this system can accurately simulate and track simple and complex motion, there is a new opportunity to study kinematics of the shoulder under normal and pathological conditions in a cadaveric shoulder model

An exploratory qualitative study of the prevention of road traffic collisions and neurotrauma in India: perspectives from key informants in an Indian industrial city (Visakhapatnam).

BACKGROUND: Despite current preventative strategies, road traffic collisions (RTCs) and resultant neurotrauma remain a major problem in India. This study seeks to explore local perspectives in the context within which RTCs take place and identify potential suggestions for improving the current status. METHODS: Ten semi-structured interviews were carried out with purposively selected key informants from the city of Visakhapatnam, Andhra Pradesh. Participants were from one of the following categories: commissioning stakeholders; service providers; community or local patient group/advocacy group representatives. Transcripts from these interviews were analysed qualitatively using the Framework Method. RESULTS: Participants felt RTCs are a serious problem in India and a leading cause of neurotrauma. Major risk factors identified related to user behaviour such as speeding and not using personal safety equipment, and the user state, namely drink driving and underage driving. Other reported risk factors included poor infrastructure, moving obstacles on the road such as other vehicles, pedestrians and animals, overloaded vehicles and substandard safety equipment. Participants discussed how RTCs affect not only the health of the casualty, but are also a burden to the healthcare system, families, and the national economy. Although there are ongoing preventative strategies being carried out by both the government and the community, challenges to successful prevention emerged from the interviews which included resource deficiencies, inconsistent implementation, lack of appropriate action, poor governance, lack of knowledge and the mindset of the community and entities involved in prevention. Recommendations were given on how prevention of RTCs and neurotrauma might be improved, addressing the areas of education and awareness, research, the pre-hospital and trauma systems, enforcement and legislation, and road engineering, in addition to building collaborations and changing mindsets. CONCLUSIONS: RTCs remain a major problem in India and a significant cause of neurotrauma. Addressing the identified gaps and shortfalls in current approaches and reinforcing collective responsibility towards road safety would be the way forward in improving prevention and reducing the burden

Recommendations for a core outcome set for measuring standing balance in adult populations: a consensus-based approach

Standing balance is imperative for mobility and avoiding falls. Use of an excessive number of standing balance measures has limited the synthesis of balance intervention data and hampered consistent clinical practice.To develop recommendations for a core outcome set (COS) of standing balance measures for research and practice among adults.A combination of scoping reviews, literature appraisal, anonymous voting and face-to-face meetings with fourteen invited experts from a range of disciplines with international recognition in balance measurement and falls prevention. Consensus was sought over three rounds using pre-established criteria.The scoping review identified 56 existing standing balance measures validated in adult populations with evidence of use in the past five years, and these were considered for inclusion in the COS.Fifteen measures were excluded after the first round of scoring and a further 36 after round two. Five measures were considered in round three. Two measures reached consensus for recommendation, and the expert panel recommended that at a minimum, either the Berg Balance Scale or Mini Balance Evaluation Systems Test be used when measuring standing balance in adult populations.Inclusion of two measures in the COS may increase the feasibility of potential uptake, but poses challenges for data synthesis. Adoption of the standing balance COS does not constitute a comprehensive balance assessment for any population, and users should include additional validated measures as appropriate.The absence of a gold standard for measuring standing balance has contributed to the proliferation of outcome measures. These recommendations represent an important first step towards greater standardization in the assessment and measurement of this critical skill and will inform clinical research and practice internationally