Effects of phantom exercises on pain, mobility, and quality of life among lower limb amputees; a randomized controlled trial.

BACKGROUND: The objective of the current study is to evaluate the effects of phantom exercises on phantom limb pain, mobility status, and quality of life in lower limb amputees treated with mirror therapy and routine physiotherapy. METHODS: It is a randomized controlled trial in which 24 unilateral lower limb amputees (above and below the knee) were randomly assigned to two equal groups i.e., control group (mirror therapy and conventional physical therapy) and experimental group in which, phantom exercises were given, additionally. Physical therapy included conventional therapeutic exercises while phantom exercises include imagining the movement of the phantom limb and attempting to execute these movements Data were collected at baseline, after 2 and 4 weeks of intervention using VAS (pain), AMP (mobility) and RAND SF-36 Version 1.0 (QOL) questionnaires. All statistical analyses were done with IBM SPSS 25.0 with 95% CI. RESULTS: Twenty-four amputees (17 males and 7 females) participated in this trial. The Mean age of the participants in experimental and control groups was 45.3 ± 11.1 years and 40.5 ± 12.5 years respectively. After the intervention, the pain (VAS score) was significantly lower in the experimental group (p = 0.003). Similarly, the experimental group demonstrated a significantly better score in the "bodily pain" domain of SF-36 (p = 0.012). Both groups significantly (p < 0.05) improved in other domains of SF-36 and ambulatory potential with no significant (p > 0.05) between-group differences. CONCLUSIONS: The Addition of phantom exercises resulted in significantly better pain management in lower limb amputees treated with mirror therapy and routine physiotherapy. TRIAL REGISTRATION: This study is registered in the U.S National Library of Medicine. The clinical trials registration number for this study is NCT04285138 ( ClinicalTrials.gov Identifier) (Date: 26/02/2020).

Effectiveness of Physical Therapy for Improving Constipation In Spastic Cerebral Palsy.

BACKGROUND: Bowel and bladder problems in children with cerebral palsy (CP) negatively affect both the children and their families. Routine physical therapy (PT) may contribute to relieving constipation in children with CP by reducing spasticity. OBJECTIVE: To determine the effectiveness of PT in relieving constipation in children with spastic CP. DESIGN: This was a single-blinded randomized crossover trial (Clinical Trail # NCT03379038) that included 35 children with spastic CP. The children who fulfilled the inclusion criteria were randomly assigned to one of two groups: the progressive physical therapy (PPT) or the maintenance physical therapy (MPT) group. METHODS: Data was collected via general demographic questionnaire, defecation frequency (DF) questionnaire, Constipation Assessment Scale (CAS) and the Modified Ashworth Scale (MAS) at baseline and at the 2nd, 4th, and 6th week before and after crossover. The Mann Whitney U-test was used for between-group comparisons and the Friedman and Wilcoxon signed-rank test for post hoc analysis tests were used for within-group changes. To determine the relationship between spasticity and constipation, simple linear regression was used. SETTING: National Institute of Rehabilitation Medicine, Islamabad, Pakistan. RESULTS: Neither group showed a significant difference in spasticity level or DF at baseline or at the end of the 2nd week. However, at the end of the 4th week (PPT = 4[1] vs MPT = 2[1]; U = 192; P < .001) and 6th week (PPT = 4[1] vs 3(1); U = 158; P < .001) DF was significantly better in the PPT group than in the MPT group. Regarding constipation severity, the PPT group showed significantly better results on all items of the Constipation Assessment Scale (CAS) compared with the MPT group after intervention (P < .001). The results showed that spasticity was significantly correlated with DF (r = -0.81; P < .001) and constipation severity (r = 0.45; P < .001). CONCLUSION: Physical therapy significantly improves DF and reduces constipation severity in children with spastic CP.

Task-oriented training and exer-gaming for improving mobility after stroke: A randomized trial.

OBJECTIVE: To evaluate the effects of task-oriented training and to compare it with virtual reality training on the mobility, physical performance and balance in stroke patients. METHODS: The randomised controlled trial was conducted from January 2016 to March 2017 at the Physical Rehabilitation Department of Pakistan Railways General Hospital, Rawalpindi, Pakistan, and comprised patients 40-70 years with stroke history of at least 3 months who had the ability to stand unaided. The subjects were randomised into virtual reality training group A and task-oriented training group B. Task oriented training was provided for 3 days per week over 8 weeks to both groups with each session lasting 40-45 minutes, while additional 15-20 minutes of exer-gaming was provided only to group A. Fugl-Meyer Assessment-Lower Extremity, Berg Balance Test, Timed Up and Go Test and Dynamic Gait Index were used for assessment which was done at baseline, and at 2, 4, 6 and 8 weeks of training. Data was analysed using SPSS 21. RESULTS: Of the 52 subjects, there were 26(50%) in each of the two groups. The overall sample had 36(69.2%) males and 16(30.7%) females. Group A showed significant difference in Fugl-Meyer Assessment-Lower Extremity and Berg Balance Test scores at 04 weeks of training compared to group B (p<0.05). Timed Up and Go Test significantly improved in group A at 6 weeks (p<0.05). Both groups showed significant improvement in Dynamic Gait Index after 8 weeks of training (p>0.05). CONCLUSIONS: Virtual reality combined with task-oriented training improved the physical performance, mobility and balance outcome in stroke patients. However, virtual reality and task-oriented trainings had similar effect on gait performance of the patients.

Effects of eccentric muscle energy technique versus static stretching exercises in the management of cervical dysfunction in upper cross syndrome: a randomized control trial.

OBJECTIVE: To compare the effects of eccentric muscle energy technique versus static stretching exercises combined with cervical segmental mobilisation in the management of upper cross syndrome in patients having neck pain. METHODS: The randomised controlled trial was conducted at the Khan Kinetic Treatment Canada Orthopaedic and Rehabilitation Centre, Rawalpindi, Pakistan, from August 2017 to January 2018, and comprised patients of upper cross syndrome who were randomized into two equal groups using lottery method. Patients in Group-A were treated with eccentric muscle energy technique with cervical segmental mobilisation, while those in Group-B received static stretching exercises with cervical segmental mobilisation. Two sessions per week for 3 weeks were given to each patient who were analysed by measuring tragus-to-wall distance, visual analogue scale and neck disability index. Cervical passive range of motion was measured using inclinometer. Data was recorded at baseline and after 3 weeks of treatment. Data was analysed using SPSS 21. RESULTS: Of the 40 subjects, 20(50%) each were in the two groups. In Group-A mean age was 42.75±11.13 years. In Group-B, it was 40.50±9.14 years. Eccentric muscle energy technique and static stretching technique both showed significant results (p<0.05) for within group analysis, but comparison across groups showed non-significant results (p>0.05 each) on all parameters. CONCLUSIONS: Both the techniques used were found to be equally effective in decreasing pain, improving cervical range of motion and reducing neck disability.

Comparison between Manual Traction, Manual Opening technique and Combination in Patients with cervical radiculopathy: Randomized Control Trial.

OBJECTIVE: To compare the effects of manual traction, manual intervertebral foramen opening technique and combination of the two techniques in patients with cervical radiculopathy. METHODS: The single-blind randomised control trial was conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan, from July 2017 to January 2018, and comprised patients of either gender having unilateral upper extremity pain, paresthesia or numbness. The subjects were placed into groups I, II and III using sealed envelope method. Group I was treated with the opening of intervertebral foramen technique, while group II received manual traction of cervical spine, and group III received both techniques. Three sessions were conducted per week for 3 weeks. The outcome measures were neck disability index, Numeric pain rating scale, patient-specific functional scale, and range of motions of cervical spine. SPSS 21 was used for data analysis. RESULTS: Of the 40 patients, 17(30%) were males and 23(70%) were females. There were 13(32.5%)patients each in groups I and II, while group III had 14(35%). Mean age in group I was 42.41±6.86 years, in group II 40.95±7 .32 years and in group III 42.50±5.77 years. There was no statisticallysignificant difference among the three groups with respect to any parameter (p>0.05). Individual group analysis showed significant improvement (p<0.05) in all parameters . CONCLUSIONS: Manual intervertebral foramen opening technique, manual traction, and combination of both techniques were equally effective in decreasing pain, level of disability and improved cervical mobility in patients with cervical radiculopathy.

Common balance measures and fall risk scores among older adults in Pakistan: Normative values and correlation.

The objective of this study was to assess the balance and fall risk among the community dwelling healthy older adults in Pakistan and to determine the correlation between balance measures and fall risk, for which a crosssectional correlation study was conducted at Foundation University Islamabad and Fauji Foundation Hospital from March 2016 to February 2017. A total of 77 individuals over 50 years were included via convenience sampling. I n di vi d u al s w i t h he a r i ng /v is ua l an d c o gn it ive impairments, infections, and orthopaedic and severe comorbid conditions were excluded. Data collection tools included Berg Balance Scale (BBS), Timed Up and Go (TUG) test, Functional Reach Test (FRT) and Fall Risk Score (FRS). Independent t-test and Bivariate Pearson Correlation (CI=95%, P<0.05) were used for analysis. Mean value of the BBS, FRS, TUG and FRT was 41.36±2.96, 3.40±1.47, 15.90±2.68 and 13.34±3.45 respectively. Age had a significant (p<0.05) positive correlation with FRS and negative correlation with BBS. A significant correlation (P<0.05) was found only between FRT & TUG and TUG & BBS.

Training on Biodex balance system improves balance and mobility in the elderly.

OBJECTIVE: To determine the effects of balance training with visual feedback using static and dynamic Biodex balance system for fall risk and mobility.. METHODS: The two-arm pilot randomised controlled trial was conducted from July to October 2016 at Fauji Foundation Hospital Rawalpindi and comprised community-dwelling elderly individuals. Subjects having no major co-morbid conditions were recruited via non-probability purposive sampling. Subjects were randomly divided in two equal groups. The intervention group received 8-week training on Biodex balance system and the control group received no intervention. Data was collected using Biodex fall risk score, Berg balance scale and Timed Up and Go Test before and after the treatment. Data was analysed using SPSS 20. RESULTS: There were 18 subjects in two groups of 9(50%) each. Analysis within the groups showed significant improvement in the intervention group (p<0.001) while no significant improvement (p>0.05) was observed in the control group. Post-intervention the result remained unchanged while comparing the two groups (p<0.05). CONCLUSIONS: Dynamic postural training using static and dynamic Biodex balance system had a positive effect on mobility and balance in the elderly.

The effectiveness of an incentivized physical activity programme (Active Student) among female medical students in Pakistan: A Randomized Controlled Trial.

OBJECTIVE: To determine the efficacy of an incentive-based approach combined with a smartphone application in promoting physical activity and weight-loss among female medical students, and to explore among them psychological effects pertaining to self-esteem, guilt, body-shaming, and perception of physical beauty. METHODS: The pilot, randomised controlled trial was conducted at the Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan, from March to May 2017, and comprised female students who were randomly allocated to either the incentivized or the non-incentivized group. The incentivized group was given a weekly financial incentive based on the required level of physical activity, measured each week for five weeks using Moves application. All subjects completed several questionnaires covering secondary outcomes at the end of the trial. SPSS 20 was used for data analysis. RESULTS: Of the 56 subjects, there were 28(50%) in each of the two groups. The use of financial incentives combined with the smartphone application did not result in a significant increase in physical activity (p>0.05). However, within-group weight-loss at the end of intervention was significant for both the groups (p<0.05). There was no significant change in the number of steps in the control group during the course of intervention (p>0.05), but there was a significant decline in the number of steps in intervention group from weeks 4 and 5 compared to the baseline physical activity (p<0.05). CONCLUSIONS: Financial incentives combined with a smartphone app designed to track physical activity did not promote physical activity or decrease obesity.

Effect of botulinum toxin A & task-specific training on upper limb function in post-stroke focal dystonia.

OBJECTIVE: To determine the effect of botulinum toxin A and task-specific training on upper limb function in post-stroke focal dystonia patients. METHODS: A randomised control trial was conducted at hospitals in Rawalpindi and Islamabad, Pakistan, from October 2015 to September 2016. The subjects were recruited using non-probability purposive sampling and were divided equally into control and experimental groups by sealed envelope method. The experimental group received botulinum toxin A followed by task-specific training, while the control group received only task-specific training for 8 weeks. Data was collected at baseline, after 4 weeks and 8 weeks by using upper extremity items of Motor Assessment Scale and Fugl-Meyer Assessment scale of upper limb. RESULTS: There were 43 subjects divided into two equal groups of 23(50%) each. In the experimental group, mean age of patients was 43.57±10.94 years while in the control group it was 48.75±10.75 years (p=0.135). There were 15(71.4%) male and 6(28.6%) female patients in the experimental group and 9(45%) were male and 11(55%) were female in the control group. Both groups showed significant improvements on the Motor Assessment Scale and Fugl-Meyer Assessment scale (p<0.01), but no significant differences were observed between the groups at baseline, after 4 and 8 weeks of intervention (p>0.05). CONCLUSIONS: Eight weeks of task-specific training improved upper limb function in post-stroke focal dystonia patients.

Botulinum Toxin A and Task-Specific Training for Hand Dystonia due to 5 Year Old Stroke.

Focal hand dystonia after stroke, a result of maladaptive plasticity, impairs hand function, affects daily activities, and undermines independence. A 59-year male patient, who had developed focal hand dystonia after suffering from ischemic stroke 5 years ago, received training following an injection of Botulinum Toxin A (BoNTA). Task-specific training for a duration of 60 minutes per day for 3 days per week was provided for 12 weeks. Assessments were done by using arm dystonia disability scale, action research arm test, Fugl-Meyer assessment of upper extremity, and stroke-specific quality of life. Substantial improvement was observed in all the parameters, at short-term follow-up.

Effects of virtual reality training on mobility and physical function in stroke.

Stroke is a common disabling condition which declines the functional and mobility level. The purpose of the case series was to determine the effect of virtual reality training on sensorimotor function and mobility level in stroke patients. Ten male (40-60 year) patients of stroke (08 Infarction, 02 Haemorrhagic) were selected from Physiotherapy department of Pakistan Railway Hospital, Rawalpindi. The additional virtual reality training (15-20 minutes) was provided 03 days per week for 06weeks along with task oriented training. All patients were assessed through Fugl-Meyer Assessment-Lower Extremity (FMA-LE) and Timed Get Up and Go Test (TUG) at baseline and after 06 weeks of training. The results showed that there was significant improvement in mobility level of stroke patients. It is concluded that combination of task oriented and virtual reality training considerably improves the physical performance and mobility level in stroke patients.

A randomized controlled trial of intermittent Cervical Traction in sitting Vs. Supine position for the management of Cervical Radiculopathy.

OBJECTIVE: To compare the effectiveness of intermittent cervical Traction in sitting vs. supine position for the management of cervical radiculopathy. METHODS: A randomized clinical trial was done to compare pain and disability modification of cervical radiculopathy patients by using cervical traction in sitting and supine positions. Forty patients (males and females aged between 18-60 years with chronic cervical radiculopathy) were recruited for the trial. Participants were randomized into two homogeneous groups by dice method. The Group-A (n=20) received 3-weeks of intermittent cervical traction in sitting position along with Transcutaneous Electric Nerve Stimulation (TENS) and hot pack. The Group-B (n=20) received the same treatment except the intermittent cervical traction that was applied in supine position. Participants were assessed two times: at baseline (week 0) and at the termination of rehabilitation (week 3). Neck disability index was used to collect the data before and after the treatment. RESULTS: The mean age of the patients was 43.15±8.99 vs. 48.80±6.89 years in Group-A vs. Group-B respectively. Mean (±S.D.) weight of the patients was 74.75±12.11 vs. 74.60±11.24 kg in Group-A vs. Group-B respectively. Mean Neck Disability Index score at start of treatment was 30.30±7.46 vs. 30.75±7.85 in Group-A and Group-B respectively. There was a significant difference in Group-A and Group-B regarding aggregate NDI score at the end of treatment (19.45±7.12 vs. 11.05±4.40; p<0.0001). CONCLUSION: Supine position is better choice for applying cervical traction as compared to sitting position for the management of cervical radiculopathy comparing post interventional NDI score.

Effectiveness of therapeutic ultrasound with or without thumb spica splint in the management of De Quervain's disease.

BACKGROUND: The management of De Quervain's disease is determined more by Intuition than scientific data. The choice of first line conservative option for the management of De Quervain's disease is still a topic of debate. AIM: To evaluate the effectiveness of therapeutic ultrasound with or without spica splint in the management of De Quervain's disease (DQD). DESIGN: Randomized controlled trial (RCT). SETTING: Outpatient department of Al-Nafees Medical College Hospital, Islamabad, Pakistan. POPULATION: Thirty patients who had the history of the De Quervain's disease for at least 6 months were enrolled in the study. The ages of the patient were 30-50 year. The population included housewives, maids, painters, and teachers. METHODS: Thirty patients were divided into two groups. The control group was treated with therapeutic ultrasound while in the experimental group thumb spica splitting was also added. The data was collected from the subjects through Quick Disabilities of the Arm, Shoulder and Hand questionnaire. The demographic data was presented in the form of tables. Intervention-induced changes within the groups were investigated using paired sample t-test while independent sample t-test was used to compare the two groups. RESULTS: Significant changes within both groups (p ≤ 0.05) were observed as a result of intervention. Additionally, significant differences in some instrument items were found between experimental and control group (p ≤ 0.05) after intervention. However, some items did not demonstrate significant changes in both groups likely because there was no effect of De Quervain's disease on those items before the intervention. CONCLUSION: The results showed that the use of therapeutic ultrasound and spica splint together is more effective than using therapeutic ultrasound alone in the conservative management of De Quervain's disease. CLINICAL REHABILITATION IMPACT: This study provides evidence to the relevant clinicians and professionals on the utility of therapeutic ultrasound combined with thumb spica splint in the conservative management of DQD.

Muscle-tendon glucose uptake in Achilles tendon rupture and tendinopathy before and after eccentric rehabilitation: Comparative case reports.

Achilles tendon rupture (ATR) is the most common tendon rupture injury. The consequences of ATR on metabolic activity of the Achilles tendon and ankle plantarflexors are unknown. Furthermore, the effects of eccentric rehabilitation on metabolic activity patterns of Achilles tendon and ankle plantarflexors in ATR patients have not been reported thus far. We present a case study demonstrating glucose uptake (GU) in the Achilles tendon, the triceps surae, and the flexor hallucis longus of a post-surgical ATR patient before and after a 5-month eccentric rehabilitation. At baseline, three months post-surgery, all muscles and Achilles tendon displayed much higher GU in the ATR patient compared to a healthy individual despite lower plantarflexion force. After the rehabilitation, plantarflexion force increased in the operated leg while muscle GU was considerably reduced. The triceps surae muscles showed similar values to the healthy control. When compared to the healthy or a matched patient with Achilles tendon pain after 12 weeks of rehabilitation, Achilles tendon GU levels of ATR patient remained greater after the rehabilitation. Past studies have shown a shift in the metabolic fuel utilization towards glycolysis due to immobilization. Further research, combined with immuno-histological investigation, is needed to fully understand the mechanism behind excessive glucose uptake in ATR cases.

Role Of Stretching Exercises In The Management Of Constipation In Spastic Cerebral Palsy.

BACKGROUND: Constipation is considered as one of the most common non-motor manifestations in cerebral palsy (CP). Along with other reasons, spasticity also contributes in developing constipation in CP, by decreasing mobility of trunk and lower extremities and abdominal viscera. Stretching exercises of upper extremities, trunk and lower extremities are routine management of spasticity in CP children. The objective of the study was to determine the role of stretching exercises in improving constipation symptoms in children with spastic cerebral palsy and to explore the association between spasticity and constipation among cerebral palsy children. METHODS: Single-group Pretest-Posttest Design (Quasi Experimental Study Design). The study was conducted at Physiotherapy Department of National Institute of Rehabilitation Medicine (NIRM) Islamabad. Thirty spastic CP children - both male and female - with complaints of constipation were recruited through non-probability, convenience sampling. The mean age of the children was 7.55±1.33 years. Each child was assessed for defecation frequency (DF), constipation severity by constipation assessment scale (CAS) and level of spasticity by modified ash worth scale for spasticity (MASS) at baseline. Stretching exercises were performed for 30 seconds with five repetitions and at least once a day for six week, followed by positioning of patients in reflex inhibiting posture. Final data was collected using the same tools as done at the baseline. Paired samples t-test was used to analyse the rehabilitation-induced changes after 6 weeks. To determine association between spasticity and constipation Pearson product-moment correlation coefficient was used. The data was analysed through SPSS 20. RESULTS: Significant changes, compared to the baseline scores, were observed after 6 weeks of stretching exercises in MASS (2.53±0.62 Vs 1.53±0.77), DF (2.43±0.67 Vs 3.70±1.02) and CAS (7.23±1.50 Vs 5.43±1.73) with p≤0.05. The results also showed significant correlation between changes in levels of spasticity and severity of constipation (r = 0.37; p=0.04). Finally, significant correlation was present between improvement in spasticity and defecation frequency (r =-0.39; p=0.02). CONCLUSIONS: Stretching exercises administered for the management of spasticity in CP can significantly improve the symptoms of constipation in such children. The results of the study showed that constipation is strongly associated with level of spasticity in CP children.

Effects of 12-wk eccentric calf muscle training on muscle-tendon glucose uptake and SEMG in patients with chronic Achilles tendon pain.

High-load eccentric exercises have been a key component in the conservative management of chronic Achilles tendinopathy. This study investigated the effects of a 12-wk progressive, home-based eccentric rehabilitation program on ankle plantar flexors' glucose uptake (GU) and myoelectric activity and Achilles tendon GU. A longitudinal study design with control (n = 10) and patient (n = 10) groups was used. Surface electromyography (SEMG) from four ankle plantar flexors and GU from the same muscles and the Achilles tendon were measured during submaximal intermittent isometric plantar flexion task. The results indicated that the symptomatic leg was weaker (P < 0.05) than the asymptomatic leg at baseline, but improved (P < 0.001) with eccentric rehabilitation. Additionally, the rehabilitation resulted in greater GU in both soleus (P < 0.01) and lateral gastrocnemius (P < 0.001) in the symptomatic leg, while the asymptomatic leg displayed higher uptake for medial gastrocnemius and flexor hallucis longus (P < 0.05). While both patient legs had higher tendon GU than the controls (P < 0.05), there was no rehabilitation effect on the tendon GU. Concerning SEMG, at baseline, soleus showed more relative activity in the symptomatic leg compared with both the asymptomatic and control legs (P < 0.05), probably reflecting an effort to compensate for the decreased force potential. The rehabilitation resulted in greater SEMG activity in the lateral gastrocnemius (P < 0.01) of the symptomatic leg with no other within- or between-group differences. Eccentric rehabilitation was effective in decreasing subjective severity of Achilles tendinopathy. It also resulted in redistribution of relative electrical activity, but not metabolic activity, within the triceps surae muscle.

Differential contributions of ankle plantarflexors during submaximal isometric muscle action: a PET and EMG study.

The objective of this study was to investigate the relative contributions of superficial and deep ankle plantarflexors during repetitive submaximal isometric contractions using surface electromyography (SEMG) and positron emission tomography (PET). Myoelectric signals were obtained from twelve healthy volunteers (27.3±4.2yrs). A tracer ([(18)F]-FDG) was injected during the exercise and PET scanning was done immediately afterwards. The examined muscles included soleus (Sol), medial gastrocnemius (MG), lateral gastrocnemius (LG), and flexor hallucis longus (FHL). It was found that isometric maximal voluntary contraction (MVC) force, muscle glucose uptake (GU) rate, and SEMG of various plantarflexors were comparable bilaterally. In terms of %EMG MVC, FHL and MG displayed the highest activity (∼34%), while LG (∼21%) had the lowest activity. Cumulative SEMG from all parts of the triceps surae (TS) muscle accounted for ∼70% of the combined EMG signal of all four plantarflexors. As for GU, the highest quantity was observed in MG (2.4±0.8µmol*100g(-1)*min(-1)), whereas FHL (1.8±0.6µmol*100g(-1)*min(-1)) had the lowest uptake. Cumulative GU of TS constituted nearly 80% of the combined GU. The findings of this study provide valuable reference for studies where individual muscle contributions are estimated using models and simulations.

Plantarflexor muscle function in healthy and chronic Achilles tendon pain subjects evaluated by the use of EMG and PET imaging.

BACKGROUND: Achilles tendon pathologies may alter the coordinative strategies of synergistic calf muscles. We hypothesized that both surface electromyography and positron emission tomography would reveal differences between symptomatic and asymptomatic legs in Achilles tendinopathy patients and between healthy controls. METHODS: Eleven subjects with unilateral chronic Achilles tendon pain (28 years) and eleven matched controls (28 years) were studied for triceps surae and flexor hallucis longus muscle activity in response to repetitive isometric plantarflexion tasks performed at 30% of maximal voluntary contraction using surface electromyography and glucose uptake using positron emission tomography. Additionally, Achilles tendon glucose uptake was quantified. FINDINGS: Normalized myoelectric activity of soleus was higher (P<0.05) in the symptomatic leg versus the contralateral and control legs despite lower absolute force level maintained (P<0.005). Electromyography amplitude of flexor hallucis longus was also greater on the symptomatic side compared to the healthy leg (P<0.05). Both the symptomatic and asymptomatic legs tended to have higher glucose uptake compared to the control legs (overall effect size: 0.9 and 1.3, respectively). Achilles tendon glucose uptake was greater in both legs of the patient group (P<0.05) compared to controls. Maximal plantarflexion force was ~14% greater in the healthier leg compared to the injured leg in the patient group. INTERPRETATIONS: While the electromyography showed greater relative amplitude in the symptomatic leg, the results based on muscle glucose uptake suggested relatively similar behavior of both legs in the patient group. Higher glucose uptake in the symptomatic Achilles tendon suggests a higher metabolic demand.

A spectrum of novel NPHS1 and NPHS2 gene mutations in pediatric nephrotic syndrome patients from Pakistan.

BACKGROUND: Mutations in the NPHS1 and NPHS2 genes are among the main causes of early-onset and familial steroid resistant nephrotic syndrome respectively. This study was carried out to assess the frequencies of mutations in these two genes in a cohort of Pakistani pediatric NS patients. METHODS: Mutation analysis was carried out by direct sequencing of the NPHS1 and NPHS2 genes in 145 nephrotic syndrome (NS) patients. This cohort included 36 samples of congenital or infantile onset NS cases and 39 samples of familial cases obtained from 30 families. RESULTS: A total of 7 homozygous (6 novel) mutations were found in the NPHS1 gene and 4 homozygous mutations in the NPHS2 gene. All mutations in the NPHS1 gene were found in the early onset cases. Of these, one patient has a family history of NS. Homozygous p.R229Q mutation in the NPHS2 gene was found in two children with childhood-onset NS. CONCLUSIONS: Our results show a low prevalence of disease causing mutations in the NPHS1 (22% early onset, 5.5% overall) and NPHS2 (3.3% early onset and 3.4% overall) genes in the Pakistani NS children as compared to the European populations. In contrast to the high frequency of the NPHS2 gene mutations reported for familial SRNS in Europe, no mutation was found in the familial Pakistani cases. To our knowledge, this is the first comprehensive screening of the NPHS1 and NPHS2 gene mutations in sporadic and familial NS cases from South Asia.

Comparison of oral amoxicillin with placebo for the treatment of world health organization-defined nonsevere pneumonia in children aged 2-59 months: a multicenter, double-blind, randomized, placebo-controlled trial in pakistan.

BACKGROUND: world Health Organization (WHO) acute respiratory illness case management guidelines classify children with fast breathing as having pneumonia and recommend treatment with an antibiotic. There is concern that many of these children may not have pneumonia and are receiving antibiotics unnecessarily. This could increase antibiotic resistance in the community. The aim was to compare the clinical outcome at 72 h in children with WHO-defined nonsevere pneumonia when treated with amoxicillin, compared with placebo. METHODS: we performed a double-blind, randomized, equivalence trial in 4 tertiary hospitals in Pakistan. Nine hundred children aged 2-59 months with WHO defined nonsevere pneumonia were randomized to receive either 3 days of oral amoxicillin (45mg/kg/day) or placebo; 873 children completed the study. All children were followed up on days 3, 5, and 14. The primary outcome was therapy failure defined a priori at 72 h. RESULTS: in per-protocol analysis at day 3, 31 (7.2%) of the 431 children in the amoxicillin arm and 37 (8.3%) of the 442 in placebo group had therapy failure. This difference was not statistically significant (odds ratio [OR], .85; 95%CI, .50-1.43; P = .60). The multivariate analysis identified history of difficult breathing (OR, 2.86; 95% CI, 1.29-7.23; P = .027) and temperature >37.5°C 100°F at presentation (OR, 1.99; 95% CI, 1.37-2.90; P = .0001) as risk factors for treatment failure by day 5. CONCLUSION: clinical outcome in children aged 2-59 months with WHO-defined nonsevere pneumonia is not different when treated with an antibiotic or placebo. Similar trials are needed in countries with a high burden of pneumonia to rationalize the use of antibiotics in these communities.