Prevalence, associated factors and predictors of post stroke pneumonia in a Nigerian population: A retrospective study.

OBJECTIVES: Stroke can trigger an immune response that can raise the risk of infection, alter tracheal epithelium, reduce pulmonary clearance and impair secretions drainage capacity. Infection, altered tracheal epithelium, reduced pulmonary clearance, impaired secretions drainage capacity and aspiration can cause pneumonia after stroke. The aim of this study is to find out the prevalence of post stroke pneumonia in a Nigerian population and factors that are associated with it. MATERIALS AND METHOD: Study data was extracted from the case files of patients with stroke who were managed between 1st January, 2011 and 1st February, 2021 in the study setting. RESULTS: The result showed that, there was a record of only 591 patients with stroke (mean age, 62.78 ± 14.86 years) who were managed in the two hospitals during the period of the study. Out of this number, only 102 (17.3 %) had pneumonia. Presence of the pneumonia was only significantly (p < 0.05) associated with sex, type of stroke, lower limb muscle power, and outcome (died or alive). However, only those with ischaemic stroke are less likely to have pneumonia (Odds ratio=  0.467; CI: 0.275 to 0.791, p=  0.005), and patients who survived the stroke and are alive are less likely to develop pneumonia (Odds ratio=  0.150; CI: 0.092 to 0.245, p < 0.001). CONCLUSIONS: Pneumonia occurs to a large extent after stroke. Therefore, it is important measures are taken to prevent it or complications arising from it especially in those with a hemorrhagic stroke.

Effectiveness of lumbar stabilization exercise with real-time ultrasound imaging biofeedback on lumbar multifidus muscle cross-sectional area in individuals with non-specific chronic low back pain: a study protocol for a randomized controlled trial.

BACKGROUND: Structural impairment of the lumbar multifidus muscle, such as reduced cross-sectional area, is evident among individuals with chronic low back pain. Real-time ultrasound imaging (RUSI) biofeedback has been reported to improve preferential activation of as well as retention in the ability to activate the lumbar multifidus muscle during lumbar stabilization exercises (LSE). However, evidence of the effectiveness of this treatment approach in individuals with non-specific chronic low back pain (NCLBP) is still limited. The purpose of this study is, therefore, to determine the effectiveness of LSE with RUSI biofeedback on lumbar multifidus muscle cross-sectional area in individuals with NCLBP. METHODS/DESIGN: This study is a prospective, single-center, assessor-blind, three-arm, parallel randomized controlled trial to be conducted at National Orthopedic Hospital, Kano State, Nigeria. Ninety individuals with NCLBP will be randomized in a 1:1:1: ratio to receive LSE, LSE with RUSI biofeedback, or minimal intervention. All participants will receive treatment twice weekly for 8 weeks. The primary outcome will be the lumbar multifidus muscle cross-sectional area. The secondary outcomes will include pain (Numerical Pain Rating Scale), functional disability (Roland-Morris Disability Questionnaire), and quality of life (12-Item Short-Form Health Survey). All outcomes will be assessed at baseline, 8 weeks post-intervention,  and 3 months follow-up. DISCUSSION: To our knowledge, this study will be the first powered randomized controlled trial to compare the effectiveness of LSE training with and without RUSI biofeedback in individuals with NCLBP. The outcome of the study may provide evidence for the effectiveness of LSE with RUSI biofeedback on enhancing the recovery of the lumbar multifidus muscle in individuals with NCLBP. TRIAL REGISTRATION: Pan African Clinical Trials Registry ( PACTR201801002980602) . Registered on January 16, 2018.

Prevalence and Correlates of Musculoskeletal Pain in Adults with Type 2 Diabetes in Populations with Low-Risk of Obesity: A Cross-Sectional Study.

BACKGROUND: There are few data concerning the prevalence and predictors of musculoskeletal pain among adults with type 2 diabetes in population with low-risk of obesity. Our objective was to describe the point prevalence and factors associated with increased risk of musculoskeletal pain in this population. METHODS: A cross-sectional data of 200 adults with type 2 diabetes, aged ≥ 18 years who were attending two tertiary hospitals were examined. Musculoskeletal pain and physical activity were collected with Nordic Musculoskeletal Questionnaire (NMQ) and International Physical Activity Questionnaire (IPAQ-SF) respectively. We used logistic regression to examine the risks associated with musculoskeletal pain. RESULTS: The point prevalence of musculoskeletal pain was 72.7% and similar between men (72.3%) and women (73.1%). In the last 7days, advancing age (odds ratio=1.09;95%CI:1.02-1.16) and comorbidity (odds ratio=3.0;95%CI:1.07-8.39) were risk factors associated with musculoskeletal pain. In the last 12 months, only comorbidity (odds ratio=5.57;95%CI:1.62-19.17) was a risk factor for increasing musculoskeletal pain. However, a unit increase in physical activity level (odds ratio=0.06;95%CI:0.008-0.51) was associated with decreased odds of musculoskeletal pain. CONCLUSIONS: The prevalence of musculoskeletal pain was high and physical activity was associated with a decreased risk thereof. A further research should be evaluated on the influence of physical activity on musculoskeletal pain.

Does Low-level Laser Therapy Provide Additional Benefits to Exercise in Patients with Shoulder Musculoskeletal Disorders? A Meta-analysis of Randomised Controlled Trials.

BACKGROUND: Low-level laser therapy as an adjunct to exercise is common in clinical practice; however, existing evidence for its recommendation is low. To determine whether low-level laser therapy provides additional benefits to exercise in patients with various shoulder musculoskeletal disorders. MATERIAL AND METHODS: An electronic search was conducted on seven databases, including The Cochrane Library, MEDLINE, and CINAH as well as grey literatures, for randomised controlled trials published in English from 1996 to 2018. Selected studies were independently screened and assessed for quality according to the Cochrane Grade of Recommendations, Assessment, Development and Evaluation. RESULTS: Eleven studies met the inclusion criteria for this review. Moderate evidence indicates that low-level laser therapy provides additional short-term benefit to exercise in improving overall pain (10cm-VAS) (6 RCTs, GRADE quality moderate) (WMD: 1.75; 95% CI: 1.43 to 2.07). However, low evidence indicates that low-level laser therapy provides no additional benefit to exercise for shoulder function [5 RCTs; SWMD: -0.14; 95% CI: -0.79 to 0.25] and range of motions. CONCLUSIONS: 1. Physiotherapists may consider the use of low-laser therapy as an adjunct to exercise in the short run to improve pain in patients with shoulder musculoskeletal disorders. 2. However, low-laser therapy with exercise in the short-term is no more effective than exercise alone in improving shoulder function and range of motions.

Relationship between Physical Activity and Health Related Quality of Life among Pregnant Women.

The study aimed to investigate the association between health-related quality of life (HQoL) and physical activity (PA) among pregnant women. Sample of pregnant women (N= 398; mean age=27.86±5.15 years) were surveyed using the Pregnancy Physical Activity and Health Related Quality of Life (SF 12) Questionnaires. Spearman correlation coefficient and logistic regression analyses were used to determine the bivariate relationship and association between HQoL and PA intensities and domain respectively. Overall, sedentary behaviour was positively albeit tenuously related to HQoL (r=0.111, P <0.01) whereas sport/exercise was the only domain of PA tenuously associated with the Physical health of HQoL (r=0.142, p <0.01). Also, pregnant women with sufficient PA were 4 times likely to report good quality of life in physical component not in the mental component of HQoL (OR: 4.33, 95% CI: 1.36-13.80). In conclusion, sports/exercise may be an important domain of PA to target when delivering interventions to improve the physical wellbeing among pregnant women in Maiduguri, Nigeria.

Low-level laser therapy and exercise for patients with shoulder disorders in physiotherapy practice (a systematic review protocol).

BACKGROUND: Low-level laser therapy is one of the adjunct treatments of choice with exercise therapy for shoulder rehabilitation in physiotherapy clinical practices. Although previous reviews have found little use of low-level laser therapy, there are recent trials whose findings are yet to be systematically reviewed. METHODS: We plan to do a systematic review to assess the effects of low-level laser therapy with exercise and exercise alone in participants who are 18 years and above, with a clinical or radiological diagnosis of various shoulder pathologies. We will search CENTRAL, MEDLINE, CINAHL, PEDro, Science Direct, Scopus and Physiotherapy Choices regardless of publication status. We will hand search for subject-specific journals (PhotoMedicine and Laser Surgery, Lasers in Surgery and Medicine and Journals of Lasers in Medical Science) and conference proceedings of World Association for Laser Therapy. Two review authors will independently screen, select studies, extract data and assess the risk of bias based on a priori criteria. Disagreements between review authors will be resolved either through discussion or consultation with a third review author. If there are at least two clinically homogeneous studies, we will perform meta-analysis. DISCUSSION: The findings will shed more light on the benefit of low-level laser therapy as an adjunct treatment to exercise in the management of shoulder disorders. The findings may also inform decision makers in the review and development of guidelines for shoulder rehabilitation in physiotherapy practices. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014013691.

The challenges of underweight and overweight in South African children: are we winning or losing the battle? A systematic review.

Underweight and overweight are adverse effects of malnutrition and both are associated with negative health consequences in children and adolescents. In South Africa, the burden of economic and social disparity coexists with malnutrition in children. The purpose of this study was to review available South Africa studies regarding the comprehensive summary of prevalence of underweight and overweight and evaluates government policies in addressing undernutrition and overnutrition in South African children and adolescents. We searched subject-specific electronic bibliographic databases of observational studies published on malnutrition, undernutrition, overnutrition, underweight and overweight in South African boys and girls from birth to 20 years of age in studies published on or after 1990. A total of sixteen cross-sectional, three longitudinal studies and one report met the criteria for inclusion in this review. Descriptive data synthesis revealed the small number of longitudinal studies highlights the dearth of research in tracking undernutrition and overnutrition in South African children. In this review, 0.7%-66% of underweight was reported among children in rural areas compared to a 3.1%-32.4% of overweight in urban areas. All studies reported a higher rate of underweight in boys than girls who were significantly more likely to have higher body fat. The data indicated that both underweight and overweight were positively related with health-related physical activity and psychological health problems such as low activity, low fitness, low self-image and self-esteem. Numerous recommendations were made in the reviewed studies, however effective strategic programs in eradicating both underweight and overweight are minimal. It is evident from the reviewed studies that the burden of underweight and overweight are still a problem in South African children. The most highly affected by underweight are rural children, while children in urban areas in transition are faced with burden of overweight. There is little evidence to suggest that government strategic programs are effective in addressing underweight and overweight in South African children. Based on these findings, sustainable school-based feeding schemes and physical education programmes are needed for optimal benefits in children and adolescents.

Factors contributing to the risk of HIV infection in rural school-going adolescents.

The objective of this study was to determine the factors that increase the risk of HIV infection in rural school-going adolescents and young adults. This was a cross-sectional study of 430 secondary school students (47.4% boys and 52.6% girls) from two rural schools in South Africa. Data were collected with a self-administered questionnaire on demographic information, sources of HIV/AIDS information, HIV knowledge, sexual behaviors, communication and negotiation skills, self-efficacy to refuse sex, peer influence and time perspective. Out of 113 (27.2%) participants who reported being sexually active, about 48% reported having had sex before the age of 15 and 42.2% reported penetrative sex with more than one partner in their lifetime. Only 44.8% of them reported consistent and regular use of condoms for every sexual encounter. Peer influence (OR = 3.01 (95% CI = 1.97-4.60)), gender difference (OR = 6.60 (95% CI = 1.62-26.84)) and lack of HIV information (OR = 1.22 (95% CI = 1.03-1.44)) influenced the sexual risk behaviors of the adolescents. Greater numbers of school-going adolescents in rural areas are sexually active. Peer influence, especially in boys, is a factor that increases the preponderance of risky sexual behaviors in adolescents. Positively, adolescents with high knowledge of HIV infection are more likely to use condoms for every sexual encounter. There is a need to strengthen comprehensive sexual health education and youth-friendly HIV prevention strategies to promote abstinence and safe sexual behaviors, especially among boys.