Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care.

BACKGROUND: Since the contribution of the lumbar multifidus(LM) is not well understood in relation to non-specific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. OBJECTIVES: This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. DESIGN: Multicenter case control study. METHOD: Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, p-values<0.05, with Tukey's HSD post-hoc test were considered significant. RESULTS: A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11-0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10-0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). CONCLUSIONS: Trunk ROM and LM thickness show differences between LBP patients and healthy controls.

Does obesity influence the outcome after the operative treatment of ankle fractures?

Many orthopaedic surgeons believe that obese patients have a higher rate of peri-operative complications and a worse functional outcome than non-obese patients. There is, however, inconsistency in the literature supporting this notion. This study was performed to evaluate the effect of body mass index (BMI) on injury characteristics, the incidence of complications, and the functional outcome after the operative management of unstable ankle fractures. We retrospectively reviewed 279 patients (99 obese (BMI > or = 30) and 180 non-obese (BMI < 30) patients who underwent surgical fixation of an unstable fracture of the ankle. We found that obese patients had a higher number of medical co-morbidities, and more Orthopaedic Trauma Association type B and C fracture types than non-obese patients. At two years from the time of injury, however, the presence of obesity did not affect the incidence of complications, the time to fracture union or the level of function. These findings suggest that obese patients should be treated in line with standard procedures, keeping in mind any known associated medical co-morbidities.

A model for the RecA protein of Mycoplasma synoviae

In this work, we predict a structural model for the RecA protein from M. synoviae (MsRecA) by theoretical homology modeling and evaluate the occurrence of polymorphisms in this protein within several isolates of this species. The structural model suggested for MsRecA conserves the main domains present in MtRecA and EcRecA. The L1 and L2 regions showed six and three amino acid substitutions, respectively, which apparently do not affect the conformation and function of MsRecA. The C-terminal domain is shorter than that found in EcRecA and MtRecA, which may increase its capacity to bind dsDNA and displace SSB, compensating the absence of recombination initiation enzymes. The MS59 isolate RecA sequence showed one polymorphism which does not affect its functions since these belong to the same physical-chemical group.

Review of psychological issues in victims of domestic violence seen in emergency settings.

When a history of domestic violence is discovered during a universal screening in the emergency department, emergency staff typically feel ill equipped to address the underlying psychological, behavioral, and health problems of the victim. This article reviews the known characteristics of ongoing relationships in which one partner exerts coercive control over another, with emphasis on the effects of abuse on the victim's physical and mental health. These effects include actual injury, multiple stress-related physical conditions, substance abuse, and a variety of psychiatric problems, including depression, anxiety and anxiety disorders, dissociation and dissociative disorders, and post-traumatic stress disorder. A patient-centered approach allows emergency response staff to tailor intervention to victims' real and perceived needs, fulfilling their professional obligation to provide meaningful help to female victims of domestic violence seen in emergency settings.

Women's mental health in primary care. Depression, anxiety, somatization, eating disorders, and substance abuse.

Primary care physicians can improve the care of women patients by applying new concepts of women's physiology and psychosocial development. New developmental models that emphasize the importance of relationships in women's self-concept and well-being have led to effective psychotherapies for depression, eating disorders, anxiety and substance abuse. Many of these therapies can be offered in brief formats suitable to primary care settings. New biological treatments including the use of estrogen, thyroid hormone and bright light for depression and refeeding to increase metabolic rate in eating disorders also promise to expand the range of mental health problems that generalist physicians can treat successfully.

Increased incidence of aberrant morphological phenotypes in human embryogenesis--an association with endometriosis.

PURPOSE: After noticing specific aberrant forms of development in preimplantation embryos from women with endometriosis, we embarked upon this study in order to examine the frequency of these events as compared with controls. METHODS: A total of 235 embryos representing 30 women undergoing 56 cycles of in vitro fertilization were retrospectively analyzed on videotape and placed into categories based upon the incidence of specific morphological criteria found during observations made on the first and second days following oocyte retrieval. RESULTS: Several of the aberrant nuclear and cytoplasmic events were found to be statistically increased in the group of embryos from women with endometriosis. CONCLUSIONS: The incidence of defined aberrant phenotypes in embryos from women with laparoscopically documented endometriosis may allow us to identify specific embryotoxic events with reference to endometriosis and other diagnoses.

Pharmacotherapy for posttraumatic stress disorder using phenelzine or imipramine.

Sixty male veterans with posttraumatic stress disorder (PTSD) participated in an 8-week, randomized trial comparing phenelzine (N = 19), imipramine (N = 23), and placebo (N = 18). Mean treatment retention was better on phenelzine (7.4 weeks) than on imipramine (5.6 weeks) or placebo (5.5 weeks). By week 5, both medications significantly reduced PTSD symptoms, as assessed by the Impact of Events Scale (IES), but the 44% improvement on phenelzine was greater than the 25% improvement on imipramine. The intrusion, but not the avoidance, subscale of the IES showed significant improvement, and the initial mild to moderate depressive symptoms did not significantly improve.

Pregnancy and leadership: case study from an inpatient unit.

A psychiatrist's pregnancy creates different problems and opportunities, depending upon the professional role(s) that she occupies. In previous reports, authors have described the impact of a psychiatrist's pregnancy in private or subordinate roles such as therapist (Lax 1969; Nadelson et al. 1974), resident (Butts and Cavenar 1979), or supervisee (Baum and Herring 1975). Here I discuss additional complexities that may occur when the pregnant woman occupies a position of leadership.

A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder.

In a double-blind, randomized clinical trial, the efficacy of imipramine and of phenelzine was compared with that of placebo in 34 male veterans with posttraumatic stress disorder (PTSD). Both medications reduced PTSD symptoms.

Depressed mood during pregnancy and the puerperium: clinical recognition and implications for clinical practice.

Mild to moderate depression is common among women during the first 3 months postpartum. The authors studied 20 normal pregnant women in the hope of finding valid predictors of postpartum mood disorder. The subjects rated their level of emotions and various depressive symptoms at 26 and 36 weeks of pregnancy and filled out a brief questionnaire about the emotional circumstances of their pregnancy. The mood scales were repeated at 2 days and 6 weeks postpartum, along with a clinical interview. The antepartum mood scale identified women with postpartum depression and differentiated this condition from the more common, transient postpartum blues. Certain psychosocial variables also predicted postpartum distress. The authors discuss the implications of these findings, emphasizing the feasibility and necessity of routine screening for mood disturbances in prenatal and puerperal women.

Clinical assessment of the Kobayashi vacuum extractor.

Four hundred and thirty-one vacuum extraction deliveries were reviewed during a five-year period from 1978 to 1983. All cases involved the use of the Kobayashi silastic cup vacuum extractor with nine participating obstetricians performing the procedures. Specific attention was directed toward maternal and fetal morbidity associated with the use of the silastic cup extractor. No maternal or fetal deaths occurred. Vaginal and cervical lacerations accounted for a 4% maternal morbidity rate. Seventy-five percent of the infants had Apgar scores greater than 7 at one minute, and 97% had scores greater than 7 at five minutes. Fetal morbidity was impressively low, with a cephalohematoma rate of 6% and only two instances of major fetal cranial hemorrhages. In comparison with the reported morbidity sited by other authors using the metal cup extractor, less fetal scalp trauma may be anticipated with the judicious use of the Kobayashi silastic cup vacuum extractor.

Moses Maimonides: rabbi or medicine.

The great medieval Jewish philosopher Moses Maimonides was also a practicing physician who contributed a number of important works to medical literature. Modern students of these treatises have made extravagant claims about Maimonides' scientific outlook and have attributed to him important discoveries and innovations. Viewed in its historical and religious content, Maimonides' medical work appears more explanatory than exploratory, though still of considerable interest to students of both the philosophy of science and the history of medicine.