Effect of exercise on renal function in diabetic nephropathy-a systematic review and meta-analysis.

Diabetic nephropathy causes cardiovascular complications among individuals with diabetes which results in decreased kidney function and overall physical decline. The objective of this systematic review was to determine effects of exercise on various renal function parameters amond individuals with type 2 diabetes and nephropathy. It was registered with PROSPERO (CRD42020198754). Total 6 databases (PubMed/Medline, Scopus, Web of Science, CINAHL, ProQuest, and Cochrane) were searched. Among 1734 records, only four randomized controlled trials were included. The review included a total of 203 participants (103 in the intervention group and 100 in the control/standard group) with type 2 diabetic nephropathy or stage 2,3, or 4 of chronic kidney disease. The meta-analysis showed no effects of exercise on serum creatinine, serum cystatin c and varied eGFR equations. However, exercise decreased urinary albumin to creatinine ratio, urinary protein to creatinine ratio, serum urea nitrogen, creatinine clearance, and urinary protein excretion while increasing urea clearance. Limited evidence on the reno-protective role of exercise demands future research in this direction.

Effects of Aerobic Exercise on Vibration Perception Threshold in Type 2 Diabetic Peripheral Neuropathy Population Using 3-sites Method: Single-blind Randomized Controlled Trial.

OBJECTIVEST: The purpose of this study was to examine the effects of 8 wk of moderate intensity aerobic exercise on vibration perception threshold (VPT) in type 2 diabetic peripheral neuropathy (DPN). METHODS: Single blind parallel group randomized controlled trial was done in a tertiary center. Stratified block randomization was used for selecting participants. A total of 87 individuals participated in the study. After final randomization, there were only 47 individuals in the control group and 37 in the study group. The exercise group training was carried out in the range of 40% to 60% of heart rate reserve as an adjunct to this rating of perceived exertion (scale ranging from 6 to 20) before, during, and postexercise. For the control group, standard medical care, education for foot care, and diet (same as the experimental group) were given. Both the groups were assessed at baseline and wk 8. RESULTS: On comparison of results for control and study group using repeated measures of analysis of variance for VPT measures for 3 sites (great toe, medial malleoli, first metatarsal phalanx), there was a significant difference between the 2 groups (df1, df2 = 1,63; F = 8.56; P < .001) for both lower limbs. CONCLUSIONS: Aerobic exercises have an augmentative effect on vibratory sensations of the peripheral nerves, which implicates an attenuating effect on DPN in type 2 diabetes.

Use of corticosteroids in acute respiratory distress syndrome: Perspective from an Indian intensive care unit.

BACKGROUND: Acute respiratory distress syndrome (ARDS) causes overwhelming inflammation, which serves as a potential target for corticosteroids. Despite extensive Western literature, there are no Indian studies evaluating steroids in ARDS. METHODS: This was a retrospective study at an Indian intensive care unit (ICU) on ARDS patients. Demographic, clinical, laboratory, and imaging parameters were collected. Patients were divided into cohorts based on steroid use, and some received high-dose (2 mg/kg/day), whereas others received low-dose (1 mg/kg/day) steroids. Primary outcomes were in-hospital mortality and secondary outcomes included need for and duration of invasive mechanical ventilation (IMV), IMV-free days, ICU length of stay (LOS), and total LOS. Two-tailed p < 0.05 was considered statistically significant. RESULTS: During the 20-month period, 95 patients [median age 37 (30-47) years; 48 (50.5%) males] met our inclusion criteria. Steroid use was noted in 48 (50.5%) patients [11 (22.9%) low-dose and 37 (77.1%) high-dose]. Baseline characteristics of the cohorts, including ARDS severity indices, were comparable. Of these 95 patients, 70 (73.7%) had sepsis, but microbiological diagnosis was positive only in 17 (17.9%) patients. Steroid use did not significantly influence mortality [odds ratio (OR) 0.6 (0.3-1.4)] or need for IMV [OR 1.0 (0.4-2.6)]. There were no differences in outcomes of IMV-free days, ICU LOS, or total LOS. These outcomes were comparable between the high-dose and low-dose steroid users. CONCLUSIONS: Steroid use and comparison of low-dose vs. high-dose steroids did not influence outcomes associated with ARDS in the Indian population.

Analysis of Postural Control During Quiet Standing in a Population with Diabetic Peripheral Neuropathy Undergoing Moderate Intensity Aerobic Exercise Training: A Single Blind, Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to investigate the effect of 8 wks of moderate-intensity aerobic exercise on postural control during quiet standing in type 2 diabetic peripheral neuropathy. METHODS: Individuals were included in the study if they had type 2 diabetes with clinical neuropathy, defined by a minimum score of 7 on the Michigan Diabetic Neuropathy Score, following which the patients were randomly assigned to an 8-wk program by computer-generated random number tables to study or control group. Repeated-measures analysis of variance was used for data analysis (P < 0.05 was considered significant). RESULTS: After final randomization, there were 36 patients in the study group and 45 in the control group. On comparison of results for control and study groups using repeated-measures analysis of variance only in the eyes closed on foam condition was there was a significant difference between the two groups for sway velocity along the x-axis (df1, df2 = 1, 18, F = 3.86, P = 0.04) and mediolateral displacement (df1, df2 = 1, 18, F = 4.04, P = 0.03). CONCLUSION: Aerobic exercise training could exert a therapeutic effect on center of pressure movement only along the x-axis in the eyes closed condition on foam surface during quiet standing.

Closure of non-healing chronic ulcer in Klippel-Trenaunay syndrome using low-level laser therapy.

A 69-year-old man diagnosed with Klippel-Trenaunay syndrome (KTS) reported to the physiotherapy outpatient clinic with the complaint of a non-healing ulcer over the right medial malleolus, for a 6-month duration, that was non-granulating and had moderate pus discharge with foul odour at initial assessment. There was a decrease in scores of the Pressure Ulcer Scale of Healing, a significant increase in granulation tissue, a decrease in the amount of discharge and foul odour along with complete closure of the chronic wound after irradiation with a light-emitting diode (LED). This is a novel case study analysing the possible effect of a helium-neon laser  and LEDs on non-healing chronic ulcers associated with KTS, where the complete closure of the chronic ulcer that was initially not responsive to standard medical care was observed.