A Study To Analyse The Effects Of Fascial Manipulation On The Lateral Thigh Region In Mechanical Low Back Pain

Background: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders, affecting up to 90% of people at some point in their lifetime. Up to 50% will have more than one episode of back pain. Previous studies have highlighted the benefits of fascial manipulation for chronic low back pain over manual therapy alone. But early detection of densification of specific points in the lateral thigh region in low back pain subjects in an acute phase itself will be of benefit in resolving the back pain as the deep friction on these points aims at restoring the physiological gliding properties of the fascia and lead to immediate pain relief in the low back, increased range of motion and improved functions. Methods: Sixty individuals were enrolled for the study and were randomly allotted to two groups using a simple random method, were samples were randomly allocated by the primary investigator before baseline assessment. Control group subjects in Group A received conventional exercises, including core stability exercises. Experimental group subjects in Group B received Fascial manipulation to the lateral aspect of the thigh region in the lower limb. Both the groups received interferential therapy for 20 minutes as a part of conventional treatment for low back pain for 15 days. The subjects were assessed for their pain level, using NPRS score, and range of motion (ROM) was assessed to find any restriction in the lumbar region due to fascial densification. The functional activities of daily life were assessed using the ODI scale. The above scores were recorded before and after the interventions for both the groups. Results: The pre-test and post-test results were analyzed using a Paired and Unpaired t-test. The outcome measures of the Numeric Pain Rating Scale, Modified Schober's test, the Oswestry Disability Index were used for the study. A comparison of post-test values between Group A and Group B using unpaired t-test revealed a significant difference of p<0.001 in terms of pain relief, improved Range of motion, and functional ability of subjects in Group B than subjects in Group A. Conclusion: Fascial manipulation technique on lateral thigh region proved to be effective than conventional exercises as it showed a clinical and significant effect in decreasing pain and disability and improving the range of motion and functional activities of daily living in subjects with mechanical low back pain.

Gender Oriented Variations In The Finger Flexion Cascade In Normal Individuals

Background: A normal Finger Flexion Cascade (FFC) is formed by the fingers of the hand when the hand in a relaxed position. Usually, the fingers of the hand assume a flexed position; gender may influence the normative values of the resting hand due to differences in the anatomical structure of hand and frequency of usage of joints of hand in their respective occupation and habitual activities of daily living. Hence the study aims to find the difference in the FFC between men and women in power grip and nonpower grip occupational activities. Methods: A cross-sectional study was conducted in a mixed population of five hundred active individuals aged between 25 and 40 years belonging to various occupations of industrial work and individuals working with software companies. Individuals who fulfilled the inclusion criteria participated in the study. After completing a questionnaire based on occupation, the subjects were grouped into power grip users and nonpower grip users. The range of motion of the joints of all the fingers, namely, metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of both dominant hand and nondominant hand was measured using universal finger goniometer, and the composite finger flexion was recorded using a geometric ruler. The results were analyzed, and Un-paired T-test was used to compare the FFC between the power grip and the nonpower grip group. Results: The FFC variations in both the hands of male and female subjects in power grip users (PGU) and nonpower grip users(NPGU) were recorded. In the dominant hand, it was found that the DIP joint of 5th digit in female subjects had a greater ROM values than male subjects, but greater ROM values in MCP joints of the hand in males were found. The comparison between the range of values of both groups revealed that the values in the PGU group were more than the NPGU group with a statistical significance of p<0.001. Conclusion: The finger flexion cascade was found to be more closed in female subjects than males in both the dominant and nondominant hands of in the power grip users than in the nonpower grip users.

Antidiarrheal Activity of Methanolic Extract of Leaves of Gymnosporia Emerginata.

The methanolic leaf extract of Gymnosporia emerginata showed significant antidiarrheal activity on castor oil induced diarrheal model in rats. These results obtained revealed that the leaf extract possess pharmacological activity against diarrhea and may possibly explain the use of the plants in traditional medicine.

Effect of oral or pulse cyclosphosphamide in recalcitrant pemphigus: an audit of eighteen patients

Background Autoimmune pemphigus is a potentially life threatening bullous disease. The cornerstone of treatment is systemic corticosteroids. However, adjuvant therapy with immunosuppressant drugs is commonly used to improve disease control and alleviate the high morbidity and mortality associated with the use of corticosteroids. Adjunctive treatment with pulse intravenous cyclophosphamide may be more efficacious and less toxic than other immunosuppressants. Objective To retrospectively review the clinical outcome of 18 patients with recalcitrant pemphigus who were treated with cyclophosphamide over the past 10 years. Methodology A retrospective study was conducted between 1985 and 2009 in thirteen Malaysian dermatology centres. Data collected were analysed for comparison of relapse rates, compliance rates and adverse drug effects between the 2 regimes. Results Eighteen patients were included in this audit of which 12 patients had pemphigus vulgaris and 6 patients had pemphigus foliaceous. Prior to treatment with cyclophosphamide, fourteen patients were on azathioprine, three were given intravenous immunoglobulin, and two were prescribed dapsone; however all these patients were either unresponsive, intolerant or suffered serious side-effects with these drugs. Subsequently, 7 patients (median age: 31 years) received a combination of pulse intravenous cyclophosphamide and either intravenous dexamethasone or methylprednisolone. These seven patients received between 2 to 21 pulses of intravenous cyclophosphamide and steroids at monthly intervals with oral prednisolone and cyclophosphamide (50-100mg) in between pulses. The remaining 11 patients (median age: 46 years) received oral cyclophosphamide and corticosteroids. Of the 18 patients in our cohort, 15 achieved control and consolidation of disease activity at an average of 4 weeks and 10 weeks respectively. The remaining three patients are yet to achieve disease control. The total duration of treatment with cyclophosphamide ranged from 2 to 62 months with a cumulative dose ranging from 2.95g to 93.55g. Four patients achieved partial remission on minimal therapy and 3 achieved complete remission. None of patients experienced serious side effects. Conclusion Cyclophosphamide may be an alternative treatment option in patients in patients with pemphigus who fail to respond to standard therapy. Controlled trials are needed to further evaluate the efficacy and safety of this therapy.

Severe adverse cutaneous drug reactions: The 5 year Kuala Lumpur Hospital experience

Introduction: Stevens Johnson syndrome (SJS), Stevens Johnson Syndrome - toxic epidermal necrolysis overlap syndrome (SJS-TEN overlap), toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome (DHS) are well known severe adverse cutaneous drug reactions (SACDRs). All clinicians are responsible for the diagnosis and management of SACDR. Objective: To retrospectively review the clinical patterns, management strategies and outcome of 134 patients with severe adverse cutaneous drug reactions managed at the Department of Dermatology, Kuala Lumpur Hospital between 2006 and 2010. Results: The mean age of presentation was 44.8 years (13-83). The male: female ratio was 1:1. There were 68 cases (50.7%) of SJS, 10 cases (7.5%) SJS-TEN overlap, 32 cases (23.9%) TEN and 24 cases (17.9%) DHS. The five commonest drugs associated with SACDRs were allopurinol (26.9%), carbamazepine (13.4%), phenytoin (9.7%), non-steroidal anti-inflammatory drugs (11.2%) and co-trimoxazole (7.5%). The mean duration of drug exposure before the onset of reaction was 2.8 weeks. A hundred and thirty patients (97%) were managed as in-patient. The mean duration of in-patient stay was 12.4 days. All identified culprit drugs were withheld. Systemic corticosteroids was given to 96% cases of DHS with mean duration of 9.7 weeks; 52.9% of SJS with mean duration of 2.8 weeks; 60% of SJS-TEN overlap with mean duration of 2.3 weeks; and 62.5% of TEN with mean duration of 3.3 weeks. Thirteen patients (42%) with TEN were treated with intravenous immunoglobulin. Eight patients (6%) died, of which 7 were TEN and one DHS. Conclusion: SACDRs are life-threatening emergencies which not only results in significant morbidity and mortality; but also potentially increases the health care cost and burden. Clinicians should recognize high risk medications and prescribe them with great caution.

Trends in human birth weight across two successive generations.

OBJECTIVE: To determine the correlation between parental and offspring birthweight (BW) in India. METHODS: The study involved two birth cohorts of successive generations. The parental cohort comprised of 472 fathers and 422 mothers from an earlier study. Details of their anthropometry at birth and in adulthood were available. 1525 children born to them comprised the offspring cohort. BW was obtained from hospital records for the offspring cohort. Odds ratios and regression coefficients were calculated to estimate the risks of a low birth weight (LBW) parent producing a LBW baby and quantitate the effects after adjusting for confounders. RESULTS: A LBW mother had a 2.8 times risk (95%CI 1.2-6.4) of delivering a LBW baby (p=0.02) and a LBW father was twice as likely to produce a LBW baby (OR 2.2; 95%CI 1.0 - 4.8; p=0.05). Every 100g increase in maternal BW was associated with an increase in offspring BW of 14 g; the equivalent figure for paternal BW was 18.1g (p< 0.001 for both). Between the generations, the incidence of LBW decreased from 19.7% to 17.2% (p=0.1). Mean BW increased in males (2846 g vs 2861 g; p=0.59) but not in females (2790 g vs 2743 g; p=0.08). CONCLUSION: Both maternal and paternal BW are strong determinants of offspring BW. The effect of mothers' BW on offspring BW is weaker than that seen in developed nations. Stronger intrauterine constraint exhibited by Indian women secondary to a higher prevalence of growth restriction in utero may be responsible. Paternal effects may be governed by paternal genes inherited by the offspring.