Prevalence of Lower Cross Syndrome in Housemaids

Introduction  Lower cross syndrome, also known as pelvic crossed syndrome, occurs if there is inadequate muscle strength, leading to an imbalance in the lower extremities. This condition is characterized by the weakening and tightening of muscle groups on the anterior and posterior aspects of the body. Mostly, there is weakness in the abdominal muscles, gluteus maximus, and gluteus medius, while there is tightness in the hip flexor muscle groups. There are various studies investigating musculoskeletal disorders across different professions, but there is no research on the prevalence of lower cross syndrome among housemaids. Housemaids frequently report complaints of joint pain and exhibit specific postural changes such as anterior pelvic tilt, increased lumbar lordosis, and lower back pain. Therefore, this research aims to fill this gap by determining the prevalence of lower cross syndrome within the housemaid profession. The study aims to find out the prevalence of lower cross syndrome among housemaids. Methodology A total of 75 housemaids between the ages of 35 and 50 years complaining of pain in the lower back were included in the study, and the housemaids with recent surgical histories and cognitive impairments were excluded. The evaluation was done by measuring the strength and range of motion (ROM) of the affected muscles. Outcome measures include the length of the iliopsoas muscle, measurement of the spinal extensor muscle, and strength of the gluteus maximus muscle to identify which structures are tight or weak.  Result Statistical changes were observed in the housemaids' population to check tight and weak structures using all outcome measures. According to the visual analogue scale (VAS), the pain was found to have a standard deviation of 5.39 ± 1.26 (3-8). The length of the iliopsoas muscle on the right and left sides had a t-value of 1.51 (p = 0.13), and the length of lumbar extensors had a standard deviation of 5.39 ± 1.26 (3-8). Conclusion In our study, the conclusion was found that housemaids who are working continuously for long periods without maintaining good ergonomics are prone to lower cross syndrome. It indicates a strong need for further research on the management of symptoms in such a population (housemaids) to prevent chronic musculoskeletal illness.

Glycemic control and neonatal outcomes in twin pregnancies with gestational diabetes mellitus

BACKGROUND

Preliminary data suggest that strict glycemic control in twin pregnancies with gestational diabetes mellitus may not improve outcomes but might increase the risk of fetal growth restriction.

OBJECTIVE

This study aimed to investigate the association of maternal glycemic control with the risk of gestational diabetes mellitus-related complications and small for gestational age in twin pregnancies complicated by gestational diabetes mellitus.

STUDY DESIGN

This was a retrospective cohort study of all patients with a twin pregnancy complicated by gestational diabetes mellitus in a single tertiary center between 2011 and 2020, and a matched control group of patients with a twin pregnancy without gestational diabetes mellitus in a 1:3 ratio. The exposure was the level of glycemic control, described as the proportion of fasting, postprandial, and overall glucose values within target. Good glycemic control was defined as a proportion of values within target above the 50th percentile. The first coprimary outcome was a composite variable of neonatal morbidity, defined as at least 1 of the following: birthweight >90th centile for gestational age, hypoglycemia requiring treatment, jaundice requiring phototherapy, birth trauma, or admission to the neonatal intensive care unit at term. A second coprimary outcome was small for gestational age, defined as birthweight <10th centile or <3rd centile for gestational age. Associations between the level of glycemic control and the study outcomes were estimated using logistic regression analysis and were expressed as adjusted odds ratio with 95% confidence interval.

RESULTS

A total of 105 patients with gestational diabetes mellitus in a twin pregnancy met the study criteria. The overall rate of the primary outcome was 32.4% (34/105), and the overall proportion of pregnancies with a small for gestational age newborn at birth was 43.8% (46/105). Good glycemic control was not associated with a reduction in the risk of composite neonatal morbidity when compared with suboptimal glycemic control (32.1% vs 32.7%; adjusted odds ratio, 2.06 [95% confidence interval, 0.77-5.49]). However, good glycemic control was associated with higher odds of small for gestational age compared with nongestational diabetes mellitus pregnancies, especially in the subgroup of diet-treated gestational diabetes mellitus (65.5% vs 34.0%, respectively; adjusted odds ratio, 4.17 [95% confidence interval, 1.74-10.01] for small for gestational age <10th centile; and 24.1% vs 7.0%, respectively; adjusted odds ratio, 3.97 [95% confidence interval, 1.42-11.10] for small for gestational age <3rd centile). In contrast, the rate of small for gestational age in gestational diabetes mellitus pregnancies with suboptimal control was not considerably different when compared with non-gestational diabetes mellitus pregnancies. In addition, in cases of diet-treated gestational diabetes mellitus, good glycemic control was associated with a left-shift of the distribution of birthweight centiles, whereas the distribution of birthweight centiles among gestational diabetes mellitus pregnancies with suboptimal control was similar to that of nongestational diabetes mellitus pregnancies.

CONCLUSION

In patients with gestational diabetes mellitus in a twin pregnancy, good glycemic control is not associated with a reduction in the risk of gestational diabetes mellitus-related complications but may increase the risk of a small for gestational age newborn in the subgroup of patients with mild (diet-treated) gestational diabetes mellitus. These findings further question whether the gestational diabetes mellitus glycemic targets used in singleton pregnancies also apply to twin pregnancies and support the concern that applying the same diagnostic criteria and glycemic targets in twin pregnancies may result in overdiagnosis and overtreatment of gestational diabetes mellitus and potential neonatal harm.

Four-dimensional aspects of tight contact 3-manifolds

We conjecture a four-dimensional characterization of tightness: A contact structure on a 3-manifold Y is tight if and only if a slice-Bennequin inequality holds for smoothly embedded surfaces in [Formula: see text] An affirmative answer to our conjecture would imply an analogue of the Milnor conjecture for torus knots: If a fibered link L induces a tight contact structure on Y, then its fiber surface maximizes the Euler characteristic among all surfaces in [Formula: see text] with boundary L. We provide evidence for both conjectures by proving them for contact structures with nonvanishing Ozsváth-Szabó contact invariant.

Systematic Construction of Real Lapped Tight Frame Transforms

We present a constructive algorithm for the design of real lapped equal-norm tight frame transforms. These transforms can be efficiently implemented through filter banks and have recently been proposed as a redundant counterpart to lapped orthogonal transforms, as well as an infinite-dimensional counterpart to harmonic tight frames. The proposed construction consists of two parts: First, we design a large class of new real lapped orthogonal transforms derived from submatrices of the discrete Fourier transform. Then, we seed these to obtain real lapped tight frame transforms corresponding to tight, equal-norm frames. We identify those frames that are maximally robust to erasures, and show that our construction leads to a large class of new lapped orthogonal transforms as well as new lapped tight frame transforms.

The outer limiting membrane (OLM) revisited: clinical implications

Purpose

The outer limiting membrane (OLM) is considered to play a role in maintaining the structure of the retina through mechanical strength. However, the observation of junction proteins located at the OLM and its barrier permeability properties may suggest that the OLM may be part of the retinal barrier.

Material and methods

Normal and diabetic rat, monkey, and human retinas were used to analyze junction proteins at the OLM. Proteome analyses were performed using immunohistochemistry on sections and flat-mounted retinas and western blotting on protein extracts obtained from laser microdissection of the photoreceptor layers. Semi-thin and ultrastructure analyses were also reported.

Results

In the rat retina, in the subapical region zonula occludens-1 (ZO-1), junction adhesion molecule (JAM), an atypical protein kinase C, is present and the OLM shows dense labeling of occludin, JAM, and ZO-1. The presence of occludin has been confirmed using western blot analysis of the microdissected OLM region. In diabetic rats, occludin expression is decreased and glial cells junctions are dissociated. In the monkey retina, occludin, JAM, and ZO-1 are also found in the OLM. Junction proteins have a specific distribution around cone photoreceptors and Müller glia. Ultrastructural analyses suggest that structures like tight junctions may exist between retinal glial Müller cells and photoreceptors.

Conclusions

In the OLM, heterotypic junctions contain proteins from both adherent and tight junctions. Their structure suggests that tight junctions may exist in the OLM. Occludin is present in the OLM of the rat and monkey retina and it is decreased in diabetes. The OLM should be considered as part of the retinal barrier that can be disrupted in pathological conditions contributing to fluid accumulation in the macula.