Background Yoga as alternative form of therapy has shown positive impact on pulmonary functions, exercise capacity, behavioral changes, and inflammation in non-trauma patients. However, the efficacy of Yoga has not been studied in chest trauma patients. Methods This randomized controlled trial was conducted at level-1 Trauma Centre. Isolated chest injury patients were randomized into either standard physiotherapy or Yogatherapy groups. Patients in physiotherapy group received conventional chest physiotherapy and Yogatherapy group received a set of Yogic exercises in addition to conventional chest physiotherapy. Primary outcome measure was changes in pulmonary function tests (PFT) at 4 weeks of discharge. Secondary outcomes were changes in quality of life (QoL), respiratory muscle strength and endurance, chest wall mobility, and levels of cytokines at 4 weeks. Data were analyzed using STATA v14.0. Results A total of 89 eligible patients were randomized to physiotherapy ( n = 46) and Yoga therapy ( n = 43) groups. Demographic characteristics were comparable in both the groups. There were statistically significant improvements in PFT in the Yogatherapy group compared with physiotherapy with an increase in Forced vital capacity ( p = 0.02) and Forced expiratory volume ( p = 0.01) at 4 weeks. In addition, there were significant improvement in physical component of QoL, respiratory muscle endurance ( p = 0.003) and axillary cirtometry ( p = 0.009) in the Yogatherapy group. However, no statistically significant difference in the trends of cytokine markers seen between the groups. Conclusion Yoga was found to be effective in improving pulmonary functions and QoL in patients with chest trauma. (Trial registered at ctri.nic.in/clinicaltrials/login.php, numberREF/2016/05/011,287).

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A 60-year-old male patient presented with history of passing black coloured stool for 15 days. Clinically, there was pallor with documented haemoglobin of 5.9 gm%. Patient was resuscitated with intravenous fluids and two units of packed red blood cells. Other routine blood investigations were normal. Once the patient was haemodynamically stable, EGD was performed which revealed normal esophagus and stomach, and a 1cm sessile polyp in the first part of the duodenum [Table/ Fig-1]. Endoscopic polypectomy was performed and specimen was subjected to the histopathological examination (HPE). Colonoscopy didnot reveal any significant pathology. Upper gastrointestinal endoscopic re-assesment was done three hours after polypectomy to confirm haemostasis at the polypectomy site. Postprocedure pneumoperitoneum was ruled out by abdominal imaging.HPE of excised specimen showed tubular adenomatous polyp with mildly distorted villous structure and tubular hyperplasia of the glands, focal mild dysplasia of the glandular epithelium and mild inflammatory cell infiltration in the lamina propria [ DIsCUssIoNDuodenal polyps are rare lesions with different pathological manifestations. Varieties include adenomas, submucosal tumours (lipomas, endocrine tumours and gastrointestinal tumours), Brunner's gland hyperplasia and hamartomas. The prevalence of duodenal polyps, as detected during EGD performed for other reasons, ranges from 0.3-4.6% [1]. Around 20% of small bowel adenomas occur in the duodenum. The malignant potential of these lesions is reportedly between 35% and 55%. These adenomas may produce symptoms mimicking those of ulcer disease, although majority of the patients are asymptomatic at the time of diagnosis.Adenomas can occur sporadically or as part of a polyposis syndrome with FAP or Gardner's syndrome. Both groups carry malignant potential but polyposis syndrome scores higher among the two. The majority of the sporadic duodenal adenomas are flat and sessile and occur in the 2 nd part of the duodenum. Patients with sporadic duodenal adenomas carry an increased risk of colonic neoplasia and should be offered colonoscopy [2]. Sporadic duodenal adenomas are found in only 0.3% of upper GI endoscopies performed, usually for other reasons [3]. The peak incidence of duodenal adenoma is between 6 th and 8 th decades of life.Surgery Section aBstRaCt Duodenal polyps are rare lesions in patients undergoing Esophago gastro duodenoscopy (EGD), and the prevalence varies widely with range of 0.3-4.6% of cases. Duodenal adenomas most commonly occur in association with familial adenomatous polyposis. Isolated occurrence of such adenomas is very rare and presentation as upper gastrointestinal (GI) haemorrhage is even rarer. We herein report a case of elderly male patient presenting to emergency department with features of upper GI bleeding. Patient was resuscitated followed by EGD was done. On EGD bleeding duodenal polyp was found and endoscopic polypectomy was done to control the bleeding. Subsequent colonoscopy was done and was normal. T...

The COVID-19 pandemic has led to a surge of mental health disturbances and the subsequent use of various mind-body therapies. Although evidence supports the benefits of yoga for mental health in a variety of disease states, information on its effects among healthcare workers during the COVID-19 epidemic is scarce. Therefore, this study evaluated and compared the efficacy of relaxation to music and yoga nidra on the mental health of frontline healthcare workers during the pandemic. This open-label randomized trial was conducted at a Level III COVID-19 care center. In the Relaxation-to-Music Group, participants received deep relaxation music, whereas those in the Yoga Nidra Group performed yoga nidra practices; both interventions were delivered through a YouTube platform and were to be done daily for 30 minutes during the healthcare workers’ 2-week duty periods. The primary outcomes were measured using scores of the Patient Health Questionnaire (PHQ)–9, Generalized Anxiety Disorder (GAD)–7 scale, and Insomnia Severity Index (ISI) at the end of the duty period. A total of 79 healthcare workers were randomly divided into two groups: (1) Relaxation-to-Music (n = 40) and (2) Yoga Nidra (n = 39). Demographics; clinical characteristics; and PHQ-9, GAD-7, and ISI scores of the two groups were comparable at baseline. In the Yoga Nidra Group, PHQ-9 scores decreased significantly (5.17 ± 4.25 to 3.03 ± 2.40, p = 0.002) compared to the Relaxation-to-Music Group (5.68 ± 4.73 to 4.34 ± 2.90, p = 0.064). Similarly, GAD-7 scores decreased significantly in the Yoga Nidra Group (4.93 ± 3.27 to 2.33 ± 2.56, p < 0.001) compared to the Relaxation-to-Music Group (4.84 ± 3.94 to 4.03 ± 3.56, p = 0.123). ISI scores also decreased significantly in the Yoga Nidra Group (6.10 ± 3.53 to 3.03 ± 2.88, p < 0.001) compared to the Relaxation-to-Music Group (6.09 ± 5.37 to 5.93 ± 5.95, p = 0.828). In this study, yoga nidra practice was more helpful than relaxation to music in reducing depression, anxiety, and insomnia among frontline COVID-19 healthcare workers during their duty periods.

INTRODUCTIONPrimary gallbladder carcinoma is a rare aggressive neoplasm of elderly with poor prognosis. The tumour is often unresectable at the time of diagnosis. Metastasis to heart is rare and only 6 cases have been reported in the indexed literature. We herein report a case of gallbladder carcinoma metastasizing to heart.PRESENTATION OF CASEA 54 year old female presented with dyspnoea and chest pain with past history of radical cholecystectomy and palliative chemotherapy for adenocarcinoma of gallbladder. Chest X-ray showed cardiomegaly and 2-D ECHO revealed features of tumour deposits on the surface of myocardium and malignant pericardial effusion. Mini-thoracotomy and pericardial window procedure was done to relieve distressing symptoms and biopsy of pericardial tissue revealed metastatic adenocarcinoma. In spite of intensive care, patient succumbed to disease in the post-operative period.DISCUSSIONPrimary adenocarcinoma of gallbladder is the most common malignancy of biliary tract and fifth most common malignancy of gastro-intestinal system with dismal prognosis. It most commonly spreads to liver and regional lymph nodes, very rarely distant metastasis occurs to kidney, adrenal, thyroid and bones as reported in the literature. Metastasis to heart presents with symptoms of cardiac failure due to pericardial effusion. Even with intensive care patients will invariably succumb to the disease.CONCLUSIONMetastatic spread to heart from carcinoma of gallbladder is very rare. Should a patient be suspected of or an operated case of gallbladder carcinoma present with symptoms of congestive heart failure and massive pericardial effusion, cardiac metastasis should be considered.