The effect of different positions during non-stress test on maternal hemodynamic parameters, satisfaction, and fetal cardiotocographic patterns

Maternal position is one of the most important factors to be considered during Non-Stress Test (NST). It should be a part of practice guidelines, where the appropriate maternal position reduces test-related errors and false-positive results. This study aimed to investigate the effect of different maternal positions during NST on maternal hemodynamic parameters, satisfaction, and fetal Cardiotocographic (CTG) pattern. A quasi-experimental research design was conducted at NST clinic, outpatient department/ Maternal and Children hospital at Najran city, Saudi Arabia. The study comprised a convenience sample of 118 low-risk pregnant women in their third trimester of pregnancy. Data was collected from January to June 2020. All women were assessed in the three different positions; supine, left lateral, and semi-fowler position concerning CTG pattern, maternal hemodynamic parameters, and satisfaction. The study results indicated a higher Fetal Heart Rate (FHR), increased accelerations, and fetal movement in the left lateral position, followed by a semi-fowler position compared to the supine position with statistically significant differences. No statistically significant differences (P>0.05) were observed regarding FHR variability and NST reactivity in the three positions. In addition, there were statistically significant differences (P<0.05) between the different maternal positions regarding maternal heart rate, systolic Blood pressure (BP), diastolic BP, and maternal satisfaction. The current study concluded that left lateral and semi-fowler positions were associated with a more favorable CTG pattern, maternal hemodynamic parameters, and satisfaction than the supine position. Left lateral and semi-fowler positions during the NST test should be standardized to reduce practical variations among health care providers, which, in turn, may reduce the need for unnecessary, expensive, and even hazardous interventions. La position de la mère est l'un des facteurs les plus importants à prendre en compte lors du test sans stress (NST). Cela devrait faire partie des directives de pratique, où la position maternelle appropriée réduit les erreurs liées aux tests et les résultats faussement positifs. Cette étude visait à étudier l'effet de différentes positions maternelles pendant le NST sur les paramètres hémodynamiques maternels, la satisfaction et le schéma cardiotocographique fœtal (CTG). Une conception de recherche quasi-expérimentale a été menée à la clinique du NST, au service de consultation externe / à l'hôpital maternel et infantile de la ville de Najran, en Arabie saoudite. L'étude comprenait un échantillon de convenance de 118 femmes enceintes à faible risque dans leur troisième trimestre de grossesse. Les données ont été recueillies de janvier à juin 2020. Toutes les femmes ont été évaluées dans les trois postes différents; position couchée, latérale gauche et semi-fowler concernant le schéma CTG, les paramètres hémodynamiques maternels et la satisfaction. Les résultats de l'étude ont indiqué une fréquence cardiaque fœtale (FCF) plus élevée, des accélérations accrues et des mouvements fœtaux en position latérale gauche, suivis d'une position semi-fowler par rapport à la position couchée avec des différences statistiquement significatives. Aucune différence statistiquement significative (P> 0,05) n'a été observée concernant la variabilité FHR et la réactivité du NST dans les trois positions. De plus, il y avait des différences statistiquement significatives (P <0,05) entre les différentes positions maternelles concernant la fréquence cardiaque maternelle, la tension artérielle systolique (TA), la TA diastolique et la satisfaction maternelle. L'étude actuelle a conclu que les positions latérales gauches et semi-fowler étaient associées à un modèle CTG plus favorable, des paramètres hémodynamiques maternels et une satisfaction que la position couchée. Les positions latérales gauche et semi-fowler pendant le test NST doivent être standardisées pour réduire les variations pratiques entre les prestataires de soins de santé, ce qui, à son tour, peut réduire le besoin d'interventions inutiles, coûteuses et même dangereuses

The Role of Presence /Absence of Palmaris Longus and Fifth Flexor Digitorum Superfiscialis Tendons in Carpal Tunnel Syndrome

Abstract: Background & Aims: Etiologically the causing factor of carpal tunnel syndrome is not clear and multiple contributing factors such as the presence or absence of Palmaris longus tendon have been cited. The aim of the present study was to compare patients with carpal tunnel syndrome and healthy individuals in regard to the absence and presence of Palmaris longus and fifth flexor digitarum superficialis tendons. Methods: This prospective study was performed on 60 diseased and 180 normal hands. Presence or absence of each tendon was determined carefully by the same examiner in both groups. Data were compared by Chi-square test. Results: The relationship between carpal tunnel syndrome and the absence of Palmaris longus tendon and fifth flexor digitorum superficialis was significant (P=0.041 & P=0.05 respectively). Carpal tunnel syndrome group compared to the control group had higher rate of the absence of both tendons in one hand (P=0.017) and lower rate of the presence of both tendons in one hand (P=0.005). By considering only the hands with Palmaris longus tendon, there were more cases of absence of fifth flexor digitorum superficialis in carpal tunnel syndrome group (P=0.048), but by considering only the hands with fifth flexor superficialis, there was no significant difference between the two groups in regard to the presence of Palmaris longus tendone. Conclusion: It seems that the absence of Palmaris longus tendon and fifth superficial flexor each alone and in combination is a risk factor for development of carpal tunnel syndrome. Probably the absence of superficial flexor is a greater risk factor than the absence of Palmaris longus. Keywords: Carpal Tunnel Syndrome, Palmaris Longus, Fifth Flexor Digitorum Superficiali

The Effect of Presence of Palmaris Longus and Fifth Superficial Flexor Tendons on Median Nerve Surface Area; A Cross-sectional Study with Sonography

Abstract: Background & Aims: Sonography has enjoyed much attention as a noninvasive diagnostic tool for carpal tunnel syndrome in recent years. The aim of the present study was to assess the effect of anatomic variations of existence or absence of palmaris longus and fifth superficial flexor tendons on the sonographic measurement of median nerve surface area in healthy individuals’ wrists. Methods: 93 volunteers without any symptoms related to carpal tunnel syndrome underwent clinical evaluation for determining presence of tendons in both wrists and also, sonographic measurement of median nerve surface area. Results: In 22 of 186 hands (11.82%), there was absence of the palmaris longus tendon and absence of the fifth flexor was noted in 8 (4.30%). The median nerve surface area in the hands without palmaris longus was meaningfully less than the hands with it (P = 0.025), while the difference in the median nerve surface area was not statistically significant regarding the presence of the fifth flexor (P = 0.324). Conclusion: Based on the findings of the present study, it seems that the median nerve surface, area as a sonographic finding, is probably related to presence or absence of the palmaris Longus tendon. So, those hands with the tendon present have larger surface areas. Also, it seems that this sonographic finding is not dependent on the presence of fifth superficial flexor tendon. Keywords: Carpal tunnel syndrome, Ultraonography, Tendon variatio

Bilateral Simultaneous Posterior Elbow Fracture / dislocation: a Case Report

Abstract: Elbow dislocation, though not a rare injury has been only occasionally reported to occur bilaterally. An extremely rare case of upper extremity trauma is reported in which bilateral simultaneous posterior elbow dislocation associated with bilateral radial neck fractures had occurred. To the best of our knowledge, this hasn't been reported previously. Although radial head excision has been reported to be associated with good outcome in cases of elbow dislocations with fracture of radial neck, the trend has been toward preservation of the head and it seems that this is a more logical approach. Keywords: Elbow, Dislocation, Fracture, Radial nec

An assessment of the effects of variations in the Palmaris longus tendon and the fifth superficial flexor digitorum on pinch and grip strength

INTRODUCTION: The effect of the absence or presence of the Palmaris longus tendon on pinch and grip strength was investigated in this study. Similarly, the effect of the presence or absence of the fifth superficial flexor digitorum on grip strength in the hand was studied. The aim of the present study was to assess the combined effect of these anatomical variations on pinch and grip strength. MATERIALS AND METHODS: In this cross-sectional study, 523 volunteers and their 1046 hands were enrolled. Each hand was assessed for the presence or absence of the Palmaris longus tendon and for variations in the fifth superficial flexor digitorum function. Then the grip and pinch power of the hands were measured with the Jammar Dynamometer. RESULTS: The presence or absence of Palmaris longus had no effect on grip strength in the individuals studied. Likewise, variations in fifth superficial flexor digitorum function had no effect on grip and pinch strengths. But the results of statistical testing showed the effect of the presence of Palmaris longus on pinch strength (25.38 lbs in hands with Palmaris present vs 24.43 lbs in hands without Palmaris). Pinch and grip power was higher in men than in women and in the right hand than in the left. CONCLUSION: Based on the findings of the present study, it seems that absence of the Palmaris longus tendon is associated with a reduction in pinch strength but has no effect on grip strength, and the variations in the fifth superficial flexor digitorum (flexor digitorum superficialis, or FDS) have no effect on pinch and grip strengths. © 2020 - IOS Press and the authors. All rights reserved

A Survey on Current Methods of Carpal Height Ratio Measurement and Suggestion of a New Method

Abstract: Background & Aims: Two famous methods are commonly used for the measurement of carpal height ratio. Both methods are performed on anteroposterior radiogram and have some shortcomings. We are going to introduce a new method for measuring this index in lateral view of the wrist radiogram. Methods: This cross-sectional and case-control study was conducted on 100 anteroposterior and lateral radiograms of asymptomatic individuals and then 20 radiograms of patients with Kienbock disease in various stages of the disease. After determining new reference points on the radiograms of the “normal” group, it was tried to define the ratio by new method. In the next stage the interobserver and intraobserver agreement of the new index was assessed along with previous defined indices. Results: All three methods had some limitations, but overall it seems that the new method has more precise reference points. With regard to inter and intraobserver variability the new index was better than the Natrass group index, but not than the Youm group index. Conclusion: The new index can be used as a substitute or an alternative in carpal height measurement. Keywords: Wrist, Radiography, Capitate bon

Variations of Plantaris, Palmaris Longus, and Fifth Superficial Flexor Tendons: a Cadaver Study

Abstract: Background & Aims: The Plantaris muscle is located in the superficial posterior compartment of the leg and is absent in some individuals. The present study was undertaken to evaluate the absence variation of Plantaris muscle and its possible relation with Palmaris longus and fifth superficial flexor digitorum of the hand. Methods: 83 fresh cadavers, referred to legal medicine center, Kerman, Iran from April 2010 to November 2011 were enrolled in the study. Dissection was performed using mini incisions and the results were recorded in a questionnaire including presence or absence, length and width of the Plantaris and Palmaris longus tendons, and the presence or absence of the fifth superficial flexor. The suitability of the Palmaris and Plantaris tendons was assessed using the previously described criteria and according to the criteria that are proposed by us. Results: 8 of the 83 cadavers showed variations. Plantaris tendon was present in 80 (96.3%) and absent in 3 (3.7%), of which was absent bilaterally in two (2.3%) and unilaterally in one (1.2%). 6 cadavers (7.2%) were deficient in Palmaris longus tendon, 4 bilateral (4.8%) and 2 (2.3%) unilateral. Bilateral absence of fifth flexor digitorum superficialis was observed in 2 cadavers (2.3%) and one showed unilateral absence (1.2%). There was no statistically significant relationship (p<0.05) among the presence of Palmaris longus, plantaris and fifth superficial flexor. The plantaris tendon by far showed better characteristics for graft than the Palmaris tendon. Conclusion: According to the results of the present study, considering the Plantaris tendon for graft harvest seems logic, noting its high percentage of presence and better characteristics Keywords: Plantaris Tendon, Palmaris Longus Tendon, Fifth Superficial flexor Tendon, Graf

Evaluation the Grain-Filling Duration and Yield of Triticale Cultivars on Different Sowing Dates in Ahvaz Region

In order to study the effect of sowing date on grain yield and grain-filling duration of triticale cultivars, an experiment was conducted based on strip-plot experiment with four replicates at Ramin Agricultural Research and Educational Center (RAREC) during 2009-10. The sowing date treatments were November, 10th (Aban, 20th) and December, 4th (Azar, 14th) and the cultivars include: ET.79-3،ET.79-4،ET.79-17،ET.82-8،ET.82-15،ET.82-1،ET.83-20،ET.84-5،ET.84-8،ET.84-15،ET.85-7، ET.85-9, and Govanilo -91. Results showed that the sowing date had significant effect on the duration from planting to tillering, the duration from planting to spiking, and the amount of chlorophyll. There were significant differences between the cultivars for plant height, spike height, the duration from planting to spiking, and the amount of chlorophyll. The first sowing date with 34.13-day duration of grain-filling had lower filling rate in comparison to the second sowing date. In the second planting date, due to more heat, the during of grain-filling period was reduced to 25.5 days. Nevertheless, as a result of the proper temperature at the region, grain-filling rate increased to 1.51 mg/day. Therefore, in order to increase the grain-yield and 1000 –seed-weight, one possible way is to use the cultivars which, along with the heat-stress tolerance, are capable of increasing the duration of grain-filling through increasing their photosynthesis. As a result, ET.79-3, ET.82-16, and Javanilo-92 cultivars in late-sowing time (Dec, 4th) and ET.84-5 and ET.79-17 in early-sowing (Nov, 10th) showed to have maximum grain yield