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.

Gender-based Variations in Trunk Motion and Isometric Strength in Young Adults with Low Back Pain: A Prospective Case-control Study / Variações baseadas em gênero no movimento e na força isométrica do tronco em jovens adultos com dor lombar: Um estudo de caso-controle prospectivo

Abstract Objective To determine gender-based variations in trunk range of motion (RoM) and isometric strength (IS) in symptomatic and asymptomatic young adults. Methods In this prospective case-control study, 73 subjects with low back pain (LBP) and 80 asymptomatic subjects were analyzed. Dynamometer-based device trunk RoM and IS measurements in extension, flexion, and rotation were compared in both groups and gender-based subgroups. Multivariate analysis was used to determine factors influencing trunk RoM and IS. Results Symptomatic males had significantly less extension RoM and extension, flexion, and rotation isometric trunk strength (ITS) (p < 0.0001) compared with asymptomatic males, whereas no significant difference was found between asymptomatic and symptomatic females. However, the mean extension-flexion RoM and mean extension-flexion ITS ratios were significantly lower (p = 0.04) in asymptomatic females compared with symptomatic females. Female gender was significantly associated with less extension and flexion ITS in both asymptomatic and symptomatic subjects. Conclusion Males with LBP had significant global ITS weakness when compared with asymptomatic males. Despite no significant ITS difference in symptomatic versus asymptomatic females, LBP caused significant extension-flexion RoM and ITS imbalance in females. These gender-based variations in trunk RoM and IS, especially the extensor-flexor IS imbalance in females, must be considered while designing rehabilitation treatment protocols for LBP.

Resumo Objetivo Determinar as variações na amplitude de movimento (ADM) do tronco e na força isométrica do tronco (FIT) em jovens adultos sintomáticos e assintomáticos baseadas no gênero dos indivíduos. Métodos Neste estudo caso-controle prospectivo, 73 indivíduos com dor lombar (DL) e 80 indivíduos assintomáticos foram analisados. As medidas de ADM do tronco e FIT de extensão, flexão e rotação foram comparadas em ambos os grupos e em subgrupos organizados por gênero. A análise multivariada foi usada para determinar os fatores que influenciam a ADM do tronco e a FIT. Results Symptomatic males had significantly less extension RoM and extension, flexion, and rotation isometric trunk strength (ITS) (p < 0.0001) compared with asymptomatic males, whereas no significant difference was found between asymptomatic and symptomatic females. However, the mean extension-flexion RoM and mean extension-flexion ITS ratios were significantly lower (p = 0.04) in asymptomatic females compared with symptomatic females. Female gender was significantly associated with less extension and flexion ITS in both asymptomatic and symptomatic subjects. Conclusão Indivíduos do sexo masculino com DL apresentaram significativa fraqueza global relacionada à FIT quando comparados com indivíduos do sexo masculino assintomáticos. Apesar de não haver diferença significativa de FIT em indivíduos do sexo feminino sintomáticos versus assintomáticos, a DL impactou a ADM e a FIT de extensão-flexão em indivíduos do sexo feminino. Essas variações de ADM do tronco e FIT baseadas no sexo, especialmente o desequilíbrio extensor-flexor de força isométrica em indivíduos do sexo feminino, devem ser consideradas ao projetar-se protocolos de tratamento de reabilitação para lombalgia.

Trend and Epidemiological Profile of Dengue Fever/Dengue Haemorrhagic Fever in Ahmedabad City, Gujarat, India

Introduction: Correct perceptions of young Dental and Unani students towards Reproductive and Sexually Transmitted Infections (RTIs and STIs) Management are not only essential; for the prevention of Occupational Exposures to RTIs and STIs( including HIV/AIDS) to them from their Clinical Practice, but also for effective management of such cases in their future clinical practice as evident from their Improper attitudes currently existing in literature. Objective: To understand In-depth about perceptions towards RTI and STI Management among Dental Students and Unani Medical College students in their colleges study curriculums. Method : A Cross sectional Bi-centric Study was done at 2 Institutions on 1000 Students (500 Dental( BDS) and 500 Unani(BUMS) students of all batches for 7 months from Jan 2018 to July 2018. The Students Qualitative data was obtained by Semi-structured E-questionnaire sent to them via emails. Key RTIs and STIs were included in this study such as: HIV, Hepatitis B, Hepatitis C , Human Pappiloma Virus (HPV), Chlamydia, Gonorrhoea etc. The data were analyzed by software Epi-info(version 7.2.2.2). Results: The Dental students of (BDS) had significantly better knowledge and attitudes as to compared Unani (BUMS ) students( p< 0.001) in both the understanding of importance of socio-cultural factors in RTI/STI causation and key diseases management strategy towards RTI/STI in their respective setups. Conclusion: RTI and STI management needs priority both in BDS as well as BUMS courses. However BUMS-Unani students needs improvement knowledge and proper attitudes towards RTI/ STI management from their Study Curriculum. This attitude issue needs more consideration in their clinical teaching.

Obstructive Sleep Apnea in Children with Nocturnal Enuresis

There is increasing evidence on the association ofmonosymptomatic nocturnal enuresis (MNE) with obstructivesleep apnea. In this communication, we share our experience offour patients with Primary monosymptomatic nocturnal enuresis(PMNE) with positive Sleep-related breathing disorder (SRBD)score who underwent detailed polysomnography, and were eitherrefractory to desmopressin treatment or relapsed ondiscontinuation of desmopressin.

Prevention of Hepatitis B-Knowledge and Practices Among Medical Students.

Background: Hepatitis B is the major infectious disease of mankind. It is the most common cause of chronic hepatitis, liver cirrhosis and hepato-cellular carcinoma world wide .The health professionals are at the most risk. Vaccination against Hepatitis B can prevent this deadly disease. This survey was conducted to assess the knowledge and status of Hepatitis B vaccination among the medical students of B.J. Medical College, Ahmedabad. Methods: A cross-sectional study was conducted among 150 medical students of II, III/I and III/II year .Pre-tested questionnaire were administered to 50 students of each semester. Data was analyzed using SPSS version 16.0. Results: 86.7 % of the medical students had correct knowledge about Hepatitis B virus, though only 66 % of II year students knew about the virus. Majority of the medical students had correct knowledge regarding mode of transmission however, the knowledge was found to be less among II year students. Only 20% of the II year students had the correct knowledge regarding Post Exposure Prophylaxis for hepatitis B. 29.3% of the medical students were not vaccinated for Hepatitis B. Conclusion: The present study concludes that there is a lack of awareness among the medical students entering into the profession about Hepatitis B, its route of transmission and modes of prevention .Similarly all the students were not vaccinated against Hepatitis B, which makes them vulnerable to the disease.

Predictors of metabolic syndrome in Asian north Indians with newly detected type 2 diabetes.

Background & objectives: The identifi cation of metabolic syndrome (MS) among patients with type 2 diabetes (T2DM) is of great importance, since those with MS carry a cluster of cardiovascular risk factors. This study evaluates suitable criteria with high effi ciency in diagnosing MS and to identify the strongest predictors of MS in newly detected type 2 diabetes individuals. Methods: Newly detected type 2 diabetes (<6 months) patients were assessed. The MS was assessed by WHO, National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), modifi ed NCEP-ATP-III and International Diabetes Federation (IDF) criteria. Receiver operating characteristics (ROC) curves of serum triglycerides, HDL, and waist circumference were created for the prediction of MS and the area under the corresponding curves (AUC) were used to evaluate the predictive effi ciency of each MS parameter. Different cut points in the selected variables and the corresponding sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) were estimated. Results: Among the 563 newly detected T2DM individuals, the presence of MS ranged from 57 to 68 per cent according to the different criteria. The higher percentage of MS was observed in modifi ed NCEPATP III criteria. In comparison to men, presence of MS was higher in women in all the four criteria [198 (67%) vs. 165 (62%); 209 (70%) vs. 111 (42%); 231 (78%) vs. 151 (57%); 222 (75%) vs. 129 (49%)] by modifi ed WHO, NCEP-ATP III, modifi ed NCEP-ATP III, and IDF, respectively. The predictive ability to diagnose MS was highest with modifi ed NCEP-ATP III and lowest with IDF criteria. The optimal cut-off of waist circumference in men and women were 90 and 88 cm respectively. Serum triglyceride in men effectively indicated the presence of MS in newly detected T2DM individuals, whereas, in women the HDL-C was the stronger predictor of MS. Interpretation & conclusions: The study results show that modifi ed NCEP-ATP III criteria predict highest occurrence of MS in newly detected T2DM patients. Elevated serum triglyceride for men and decreased serum HDL-C in women were the strongest single predictors, effectively indicating presence of MS in newly detected T2DM.

Prevalence and predictors of metabolic syndrome in non-obese Asian Indians with newly detected type 2 diabetes mellitus.

We measured the prevalence and have evaluated the sensitivity, specificity, positive and negative predictive value of different predictors according to different standard criteria for metabolic syndrome in non-obese newly detected type 2 diabetes. Two hundred and fifteen patients of BMI <25 kg/m2 were studied. Metabolic syndrome prevalence was high in non-obese newly detected type 2 diabetes mellitus individuals. Greater prevalence of metabolic syndrome was observed in modified WHO (50.23%) and lesser in IDF (30.69%) classification. Non-obese metabolic syndrome individuals display significantly higher BMI, per cent body fat, waist circumference, hip circumference, waist hip ratio, blood pressure, triglyceride and a lower high density lipopratein than non-obese individuals without metabolic syndrome. The cut-off point for waist circumference in men was 86 cm and 79.7 cm for women (modified ATP III). Elevated serum triglyceride for men and low serum high density lipoprotein in women were the strongest predictors that effectively indicated the presence of metabolic syndrome in non-obese individuals.

Morphological and biochemical studies on the different developmental stages of a fresh water snail, Lymnaea stagnalis (Lymnaeidae) after treatment with some pesticides.

In the present study when the egg masses of Lymnaea stagnalis showing different developmental stages were introduced with the sub lethal concentrations of baygon and nuvan from cleavage to before hatching stages exhibited the development arrest in most of the egg capsules due to deviation in protein fractions in the corresponding development stages in comparison to control groups resulted into high percentage of mortality and low percentage of hatchability in treated groups. Another potent cause of low percentage of hatchability of young snails from their corresponding egg capsules was the phenomenon of polyembryony in nuvan treated egg masses which showed the high rate of mortality due to the lack of metabolites for their progressive development in comparison to control groups. Teratogenesis and deformities in larval stages were also observed in most of the egg capsules which could be correlated with the depletion of most of the protein fractions in the present investigation.