Do Improved Trunk Mobility and Isometric Strength Correlate with Improved Pain and Disability after Multimodal Rehabilitation for Low Back Pain? / A melhora da mobilidade e da força isométrica do tronco se correlacionam com a melhora da dor e da incapacidade após a reabilitação multimodal para dor lombar?

Abstract Objective To determine the correlation between posttreatment trunk range of motion (ROM) and isometric strength (TIS) and pain and disability in patients who underwent multimodal rehabilitation for low back pain (LBP). Methods In this prospective cohort study, 122 patients undergoing multimodal rehabilitation for LBP were analyzed. The pre- and posttreatment numerical pain rating scale (NPRS) and the Oswestry disability index (ODI) scores, as well as trunk ROM and TIS were compared. The Pearson correlation was used to determine correlation between posttreatment clinical outcomes and ROM and TIS. Results At the end of treatment, the mean NPRS (p< 0.0001) and ODI (p< 0.0001) scores, mean trunk extension (p< 0.0001), and flexion (p< 0.0001) ROMs improved significantly. Similarly, posttreatment, the mean extension (p< 0.0001) and flexion (p< 0.0001) TISs improved significantly. There was a weak correlation between the NPRS score and ROM extension (r = -0.24, p= 0.006) and flexion strength (r = -0.28, p= 0.001), as well as between the ODI score and TIS extension (r = -0.30, p= 0.0007) and flexion (r = -0.28, p= 0.001). Conclusion Despite significant improvement in pain, disability, trunk ROM, and TIS with multimodal treatment, there was a weak correlation between posttreatment pain and function and trunk ROM and TIS. Improvement in pain and function with physical rehabilitation treatment for LBP is a complex phenomenon and needs further investigation.

Resumo Objetivo Determinar a correlação entre a amplitude de movimento (ADM) do tronco pós-tratamento e a força isométrica do tronco (FIT) e a dor e a incapacidade em pacientes submetidos à reabilitação multimodal para dor lombar (DL). Métodos Neste estudo de coorte prospectiva, 122 pacientes submetidos à reabilitação multimodal para DL foram analisados. Foram comparados os escores de escala numérica de dor pré- e pós-tratamento (END) e do índice de incapacidade Oswestry (Oswestry disability index - ODI), a ADM do tronco e a FIT. A correlação de Pearson foi utilizada para determinar a correlação entre desfechos clínicos e a ADM e a FIT pós-tratamento. Resultados Ao final do tratamento, as médias de ADM (p< 0,0001) e ODI (p< 0,0001), as ADMs médias de extensão (p< 0,0001) e a flexão (p< 0,0001) do tronco melhoraram significativamente. Da mesma forma, a FIT pós-tratamento, as FITs médias de extensão (p< 0,0001) e flexão (p< 0,0001) melhoraram significativamente. Houve uma correlação fraca entre o escore do END e a ADM de extensão (r = -0,24, p= 0,006) e força de flexão (r = -0,28, p= 0,001) pós-tratamento, assim como entre o escore de ODI e FIT de extensão (r = -0,30, p= 0,0007) e flexão (r = -0,28, p= 0,001) pós-tratamento. Conclusão Apesar da melhora significativa da dor, capacidade, ADM do tronco e FIT com tratamento multimodal, houve uma fraca correlação entre dor pós-tratamento e função e ADM e FIT de tronco. A melhora da dor e da função com o tratamento de reabilitação física para DL é um fenômeno complexo e precisa de uma investigação mais aprofundada.

Management of Hypertension in Patients with Diabetes: A Comprehensive Review of the Perceptions and Practices of Health Care Providers in India

Objectives: This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Methods: Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). Results: The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31–50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin–angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Conclusion: Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

The Deadly Duo of Hypertension and Diabetes in India: Further Affirmation from a New Epidemiological Study

Introduction: Hypertension is highly prevalent in patients with type II diabetes mellitus. India has some of the highest rates of diabetes and hypertension worldwide, but there is a lack of local data on the coexistence of these two risk factors. This study determined the prevalence of hypertension in patients with, or at high risk of, type II diabetes mellitus from across India. Methods: Data came from a nationwide trial evaluating the effects of yoga-based lifestyle modification for the prevention/management of type II diabetes. Participants were recruited based on randomized house-to-house screening in urban and rural areas from 65 districts of 29 states/union territories. Eligible individuals were aged 20–80 years and had diabetes or were at high risk of diabetes (IDRS ? 60). Anthropometric and demographic data were obtained, and resting blood pressure and blood glucose levels were recorded. Results: This analysis included data from 14,135 individuals. Of these, 25% had self-reported diabetes, 19% were diagnosed with diabetes during the trial, and 26.8% were at high risk for type II diabetes. In these three patient groups, hypertension prevalence rates were 58%, 41.0%, and 35.8%, respectively. The prevalence of hypertension was highest in the North East region and lowest in the North West. Conclusion: The high prevalence of hypertension in patients with, or at risk of diabetes, highlights the urgent need for policies to manage this population, who are at high risk of cardiovascular disease and death.

Isolated diastolic hypertension and its risk factors in semi-rural population of South India

Background Isolated diastolic hypertension (IDH) has been actively discussed for the last two decades because of its prevalence in a younger population and its association with cardiovascular disease. Furthermore, the association of IDH is significant in South Asian Countries such as India because relatively younger populations are known to have a higher risk of cardiovascular events. Objective The objective of this study is to find prevalence of IDH and its risk correlates in a semiurban population of South Indian state of Andhra Pradesh. Methods Data were collected using the modified World Health Organization - STEPwise approach to Surveillance (WHO STEPS) questionnaire for 16,636 individuals from a group of villages under Thavanampalle Mandal. Collated data were analyzed for prevalence and risk factors of IDH. Results Prevalence of IDH was found to be 4.0% with mean age of 46.0 (±SD 13.6) years and a relatively higher prevalence in men (5.3%) as compared with women (3.2%). The prevalence of IDH peaked in the fifth decade of life (40–49 years of age) and declined thereafter. Among various risk factors that were analyzed for their association with IDH, only age, body weight, and body mass index retained their significance in multivariate binary logistic regression analysis. Conclusion There is a significant prevalence of IDH below 50 years of age in the semiurban population of South India. As IDH in young and middle age is known to be associated with increased risk of cardiovascular events and end organ involvement, it highlights need for study and development of effective IDH management strategies to reduce associated morbidity and mortality.

Neuronal Remodeling and Dendritic Spines: A Review

The neurons show remodeling in their dendritic arbor and spine/synapsenumber in many brain regions including the hippocampus, amygdala and the prefrontalcortex. The dendritic spine density is reported to be changed due to experiences andstressful conditions. The dendritic spines are the small protrusions arising from thedendritic shaft of the neurons. They have basic shapes as large mushroom spines, shortstubby spines and thin spines. The morphology of spines changes rapidly in response tovarious stimuli that may be internal such as hormones and external such as environmentalchanges. Dendritic spine density plays a major role in classification of principal neuronsi.e. multipolar and pyramidal neurons. The principal neurons may be classified as sparselyspinous, moderately spinous and heavily spinous on the basis of density of spine over thedendritic branches. In response to environment dendritic remodeling takes place in theform of spine shapes, spine turnover and spine density etc. Synaptic plasticity primarilytakes place in dendritic spines and enriched environment have positive effect while socialisolation have negative effect on synapse formation. Exposure of animals to environmentalcomplexity may improve the learning and memory by providing adaptive changes in thedendritic spine density.

High-risk Hypertension and Its Clinical Implications.

Hypertension (HT) is a well-established risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD). Only <50% of treated hypertensive patients have a BP of <140/90 mmHg, which is a cause for much concern. These treated but inadequately controlled hypertensive patients are at significant risk for developing CVD and other complications. Telmisartan is a long-acting angiotensin receptor blocker (ARB), which has multiple positive effects aside from its antihypertensive efficacy. It reduces CV events in high-risk patients, has favorable effects on endothelial function including renoprotective effects. Trials like the MAPHY and BCAP have shown that β blockers (metoprolol) have beneficial effects on outcomes and survival along with reduction in BP. Most hypertensives need combination approach to control their high BP. Being cardioprotective drugs, combination of telmisartan and metoprolol is beneficial for secondary prevention of cardiovascular events in high-risk patients with HT.

Assessment of precipitate formation on interaction of irrigants used in different combinations: An in vitro study.

Introduction: Irrigants play an essential role in the successful debridement and disinfection of pulp space. Various combination of irrigants used during root canal treatment enhance their efficacy, but some form precipitates which affects the diffusion of intracanal medicaments and the seal of the obturated root canal. Aim: To evaluate the combination of various irrigants whether it forms the precipitate and also to quantify the amount of precipitate formed. Materials and Methods: Five different irrigants were taken in ten test tubes each having the combination of two irrigants and observed for 2 min for precipitate formation. Results: One-way-ANOVA test revealed more amounts of precipitate with 2% Chlorhexidine (CHX) 5% Tulsi followed by 2% CHX, 5% Neem and 3% Sodium hypochlorite 2% CHX. Conclusion: Precipitate formation is seen more with the 2% CHX-5% Neem followed by 2% CHX-5% Tulsi when compared with the control group. When these combinations of irrigants were used, intermediate flushes of saline or distilled water reduced the amount of precipitate.

Breastfeeding practices: positioning, attachment [latch-on] and effective suckling - a hospital-based study in Libya

To assess the correct position, attachment and effective suckling in the breastfeeding of infants as practiced by mothers attending hospitals at Benghazi. An observational, descriptive, cross-sectional study was done at AlJamahiriya and AlFateh Hospital in Benghazi, Libya, from November 2009 to February 2010. One hundred ninety-two mother-neonate units were observed for mother's and baby's position, attachment and effective suckling using WHO B-R-E-A-S-T- Feed observation form. Grading of positioning, attachment and suckling was done according to the score of various characteristics. Data thus collected were analyzed using software SPSS 11.5 version. About 15% of the infants were about a week old [early neonatal period] and 85% were in the late neonatal period. There was poorer positioning among primipara [24.0%] than multipara [8.9-12.5%] mothers. Poorer attachment was also more evident among primipara [30.0%] compared to multipara [20.9%] mothers. Parity was significantly associated with poor position [P = 0.028] and attachment [P = 0.002]. Poor attachment was related to cracked nipples and mastitis. Preterm and low birth weight were significantly associated with poor attachment and poor effective suckling. Poor suckling was more [42.8%] in the early neonatal period than late neonatal period [32.9%]. Young [<20 years] and primipara mothers were more in need of support and guidance for appropriate breastfeeding techniques. It is recommended that each mother should be observed for mother's and infant's positioning and attachment at the onset of breastfeeding and if needed subsequent counseling should be given on correct positioning and attachment

A study on the comparison between clinical and microbiological diagnoses of sexually transmitted diseases.

The efficacy of microbiological diagnosis in sexually transmitted diseases (STDs) has been evaluated in comparison with the clinical diagnosis. Amongst the clinical diagnoses of single STDs, syphilis, genital warts, gonorrhoea and herpes genitalis were the predominant ones. Syphilis was the most predominant infection in both the single and mixed STD infections in Chennai. Clinical diagnoses of trichomoniasis, genital chlamydiasis and genital herpes were more accurate and correlated well with laboratory investigations. On the other hand, clinical diagnoses of gonorrhoea, candidiasis and syphilis were less accurate. More over many of these cases, clinically diagnosed as single, infection, were also positive for other STDs in the laboratory investigations. Double infections were clinically diagnosed only in 7 cases as against 11 cases in microbiological tests and one triple infection diagnosed in microbiological tests was diagnosed only as single disease clinically. Therefore, the laboratory/microbiological investigations have been emphasised to have better accuracy of diagnosis of STDs.

Adrenergic mechanisms in left ventricular hypertrophy: significance and clinical implications.

Emerging consensus indicates that the goal of antihypertensive therapy is not merely a reduction in the level of systemic arterial blood pressure; rather, it is prevention of target organ damage and reversal of complications. Among the clinical consequences of hypertension, left ventricular hypertrophy (LVH) is a prominent manifestation. Initially the left ventricle (LV) hypertrophies as an adaptive physiological response to an increase in afterload. However, persistence of LVH can cause a number of cardiac complications. Reversal of LVH is, therefore, likely to be of immense therapeutic benefit. A number of clinical and experimental observations have shown a close correlation between level of adrenergic activity and the development of LVH; adrenergic blockade has been shown to cause regression of LVH. Recent studies have demonstrated that post-synaptic alpha-blockers cause a reduction of LV mass. Terazosin, by virtue of its long duration of action, may attenuate the pathologic adrenergic pathways in the myocardium. These observations suggest the possible role of adrenergic mechanisms in the complex multifactorial pathogenesis of LVH and suggest the therapeutic impact of alpha-adrenergic blockade in promoting regression of LVH.