Effect of lumbar traction on discogenic low back pain using variable forces.

OBJECTIVE: To determine the effect of variable traction forces on discogenic low back pain. METHODS: The experimental study was conducted at the Department of Physical Medicine and Rehabilitation at the Combined Military Hospital, Okara, Pakistan, from July to December 2018, and comprised patients of low back pain who were randomised into group 1 treated with high-force lumbar traction, hot pack and lumbar stabilisation exercises, and group 2 treated with low-force lumbar traction, hot pack and lumbar stabilisation exercises. There were a 3 sessions per week for 3 weeks for a total of 9 sessions. Modified Oswestry disability index and visual analogue scale were used to measure outcomes. Data was analysed using SPSS 20. RESULTS: Of the 30 patients, there were 15(50%) in each of the two groups. There were 18(60%) females and 12(40%) males, with an overall mean age of 30±5.5 years. Also 18(60%) subjects were obese on the basis of body mass index.There was significant improvement in pain in both groups (p<0.05), while disability scores in group 1 showed more improvement compared to group 2 (p<0.05). Young age was significantly associated with better results (p<0.05). CONCLUSIONS: Use of variable force lumbar traction improved pain in discogenic low back pain, while high-force lumbar traction also reduced functional disability.

Motor impairment and skeletal mineralization in children with cerebral palsy.

OBJECTIVE: To evaluate the bone mineral density and the effect of motor impairment on bone mineral density in children with cerebral palsy. METHODS: The cross-sectional study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from January 2013 to January 2015. Children diagnosed with cerebral palsy were sampled by non-probability purposive sampling from the Cerebral Palsy clinic. On the basis of Gross Motor Function Classification level of motor impairment, the children were divided into mild Cerebral Palsy (level 1 & 2) and moderate to severe Cerebral Palsy (level 3-5) groups. Bone mineral density z-score was measured at lumbar spine with Dual Energy X-Ray Absorptiometry at L1-L4 lumbar vertebra. Data was analysed using SPSS 20. RESULTS: Of the total 108 children selected, 18(16.6%) had to be excluded due to poor nutrition status or deranged serum chemistry, while in 4(3.7%) children Dual Energy X-ray Absorptiometry scan was not done on technical grounds. Of the remaining 86(79.6%) children, 39(45.3%) were males and 47(54.7%) were females. The overall mean age was 6.08±2.89 years and mean bone mineral density z-score was -2.16±0.62. Statistically significant difference was found in bone mineral density z-scores of moderate to severe compared to mild Cerebral Palsy group (p<0.05). Significant difference in bone mineral density z-scores was also found among different levels of Gross Motor Function Classification system of motor impairment (p<0.05). CONCLUSIONS: Cerebral Palsy children had low bone mineral density z-score, especially those who were non-ambulatory.

The diagnostic dilemma of progressive muscular atrophy.

Progressive muscle atrophy is a rare subtype of motor neuron disease that affects only the lower motor neurons and presents as asymmetrical rapidly progressive muscle weakness, atrophy and normal sensations. The diagnostic electrophysiological findings are denervation potentials in three out of four body segments (bulbar, cervical, thoracic and lumbosacral). The disease is fatal and the management is supportive. We present the report of a 45-year-old female patient who presented with unilateral foot drop and rapidly progressed to profound weakness in muscles of all limbs, neck and back along with dysarthria and dysphagia. She had been operated twice for suspected cervical and lumbosacral intervertebral disc herniations and ultimately guided in right direction after muscle biopsy, nerve conduction studies and electromyography.

Higher stress scores for female medical students measured by the Kessler Psychological Distress Scale (K10) in Pakistan.

The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).