Effectiveness of home-based conventional exercise and cryotherapy on daily living activities in patients with knee osteoarthritis: A randomized controlled clinical trial.

BACKGROUND: Knee osteoarthritis (KOA) is a prevalent joint condition associated with aging that causes pain, disability, loss of function, and a decline in quality of life. This study aimed to evaluate the effectiveness of home-based conventional exercise and cryotherapy on daily living activities in patients with KOA. METHODS: In this randomized controlled clinical trial, the patients who were diagnosed with KOA were assigned to 3 groups: an experimental group (n = 18), the control group 1 (n = 16), and the control group 2 (n = 15). Control and experimental groups engaged in a 2-month home-based exercise (HBE) program. The experimental group received cryotherapy along with HBE. In contrast, the patients in the second control group received regular therapeutic and physiotherapeutic services at the center. The patients were recruited from the Specialized Center for Rheumatic and Medical Rehabilitation in Duhok, Iraq. RESULTS: The patients in the experimental group had statistically significant better daily activity functions compared to the first and second control groups in pain (2.22 vs 4.81 and 12.7; P < .0001), stiffness (0.39 vs 1.56 and 4.33; P < .0001), physical function (5.72 vs 13.31 and 38.13; P < .0001), and the total score (8.33 vs 19.69 and 55.33; P < .0001) at 2 months. The patients in the experimental and the first control groups had statistically significantly lower balance scores compared to the second control group at 2 months, 8.56 versus 9.30. At 3 months, similar patterns were observed for the daily activity function and balance. CONCLUSIONS: This study showed that combining HBE and cryotherapy may be an effective technique to improve function among patients with KOA. Cryotherapy could be suggested as a complementary therapy for KOA patients.

Assessing in-hospital mortality and predictors in Patients with contrast-induced nephropathy Following primary percutaneous coronary Intervention.

BACKGROUND: The contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (PCI) it has been reported to be associated with an increased risk of mortality. The study reported the in-hospital mortality among patients who developed CIN after primary PCI. METHODS: This descriptive cross-sectional study was conducted on a sample of consecutive who developed CIN after primary PCI at a tertiary care cardiac hospital in Karachi, Pakistan. The CIN was defined as either a relative increase of 25% or an absolute increase of 0.5 mg/dL in post -procedure serum creatinine within 72 hours. The in-hospital mortality status was recorded and clinical and demographic predictors of in-hospital mortality were identified with the help of binary logistic regression analysis. RESULTS: In the study sample of 402 patients, 74.1% (298) were male and the mean age of the study sample was 59.4±11.5 years. The in-hospital mortality rate was 9.7% (39). On multivar iable analysis, an increased risk of mortality was found to be independently associated with inferior wall myocardial infarction (IWMI) with right ventricular (RV) infarction, intra-procedure arrhythmias, and pump failure with an adjusted odds ratio of 3.63 [95% CI: 1.31-10.08; p=0.013], 5.53 [95% CI: 1.39-22.06; p=0.015], and 8.94 [95% CI: 3.99-20.02; p<0.001], respectively. CONCLUSIONS: In conclusion, there is a high rate of mortality for patients who develop CIN after primary PCI, and the risk of mortality is further aggravated by the presence of IWMI with RV infarction, intra-procedure arrhythmias, and pump failure.

Capturing Initial Understanding and Impressions of Surgical Therapy for Parkinson's Disease.

Background: Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson's Disease (PD). Both physician and patient hesitancies have been described as potential barriers to DBS, but the specifics of patient perceptions of DBS have not been well-characterized in the general PD population. Objective: To characterize the understanding and impressions of surgical therapy in PD patients prior to formal surgical evaluation. Methods: A 30-question survey assessing impressions of surgical therapy for PD and understanding of DBS for PD was administered to PD patients seen at an urban movement disorders clinic. Results: One hundred and two patients completed the survey. When asked if they would undergo a hypothetical risk-free, curative brain surgery for PD, 98 patients responded "yes." Patients were more agreeable to "reversible," "minimally-invasive," and "incisionless" surgery. 51.2% thought DBS is an "effective" treatment for PD, 76.6% thought it was "invasive," and 18.3% thought it was "reversible." 45.2% reported fear of being awake during DBS surgery. Regarding costs, 52.4% were concerned that DBS was "very expensive" or "not covered by insurance." Initial source of information and perceived treatment effectiveness were not associated with concerns about DBS effectiveness or threats to normality. Negative perceptions of past surgery were associated with concerns about DBS altering mood and personality. Conclusion: Overall, patients expressed concerns regarding procedural efficacy, invasiveness, cost, and irreversibility-independent of the original source of information. Future studies are required to allow us to better understand the impact of these initial findings on DBS hesitancy and underutilization.

Perioperative Nutritional Optimization in Spine Surgery.

Nutritional optimization in patients undergoing spine surgery is important as improved surgical outcomes and decreased rates of complications have been noted in optimized patients. With the increasingly high numbers of elderly patient and patients with metabolic comorbidities undergoing spine procedures, perioperative nutritional status should be enhanced for the best possible surgical outcomes. Methods of optimization include preoperative screening with Nutritional Risk Score or other scoring systems, looking for changes in body mass index, detecting sarcopenia, and screening for metabolic abnormalities. Assessment of blood glucose, electrolytes, cholesterol, vitamin levels, visceral proteins, and lean body mass must be done preoperatively and close monitoring should be continued postoperatively. Albumin helps to determine the health status of patients before surgery and prealbumin as a predictor of surgical outcomes is being investigated. Malnourished patients should be given balanced diets replenishing key nutrient deficits, glucose should be maintained with sliding scale insulin or continuous infusions and immunonutrition may be implemented. Postoperatively, patients should initiate a diet as soon as possible to decrease overall length of stay and complication rates, facilitating return to normal activities.

Using VARK Approach for Assessing Preferred Learning Styles of First Year Medical Sciences Students: A Survey from Iran.

BACKGROUND: Preferred learning styles of learners are different, which depend on tastes, mentality preparedness, as well as physical condition, in terms of sensory modalities. Identifying and employing appropriate learning styles could play an important role in selecting teaching styles, which can improve education ultimately. AIM: The present study aimed to assess the diversity of learning styles amongst medical students of a medical sciences university which was located west of Iran, in 2010. METHODS: A cross-sectional study which employed VARK learning style's questionnaire was done on 141 first year medical sciences students at Ilam University of Medical Sciences in 2010. Data was collected with use of VARK questionnaire. The validity of the questionnaire was assessed on basis of experts' views and its reliability was calculated by using Cronbach's alpha coefficients (α=0.86). Data were analysed by using SPSS software and Chi-square test. RESULTS: Overall, 41.6% of the samples preferred to use a single learning style (Uni-modal). Of these, 17.7% preferred the Aural style, 17% preferred Reading and Writing, 6.4% preferred Kinesthetic style and 0.7% preferred Visual styles. Among the rest of the 82 students who preferred more than one style (multimodal), 17% chose two modes (bimodal), 13.5% chose three modes (tri-modal), and 27.6% chose four modes (quad-modal). There was a significant difference between educational levels and majors on one hand and choice of quad modal of VARK styles on the other hand (p=0.008). A significant association was also found between participants' genders and selection of visual and reading/writing styles (p=0.03). CONCLUSION: The preferred learning styles of medical students in the present study were aural and reading/writing. It is suggested that all medical students must be tested to determine their desired learning styles by using VARK questionnaire, also to choose appropriate teaching methods and to improve educational goals.

HLA-DR/DQ Genotypes in Kurd Patients with Rheumatoid Arthritis: Relation to Disease Activity.

BACKGROUND: Specific alleles present at the HLA-DR/DQ loci seem to be associated with disease activity of rheumatoid arthritis. AIM: In the present study, our aim was to investigate the distribution of HLA-DR/DQ alleles among Kurd patients with rheumatoid arthritis and to ascertain their relationship with disease activity. MATERIALS AND METHODS: Sixty five patients with rheumatoid arthritis (RA) and 65 apparently healthy subjects participated in the study. Diagnosis and disease activity were confirmed. Blood analyses, including those of laboratory markers of disease activity, were done. The 28 joint disease activity score (DAS-28) was calculated. HLA-DR/DQ typing was performed by polymerase chain reaction (PCR).The association between HLA-DR/DQ genotypes and disease activity was determined. RESULTS: The most frequent alleles which were identified in RA patients were HLA-DRBI*01(23.1%) and HLA-DQBI*6(34.6%), whereas in healthy subjects, they were HLA-DRBI*11(17.7%) and HLA-DQBI*03(35.4%). Patients with active disease had high frequencies of HLA-DQBI*6 (40.0%) as compared to those with moderate disease activity (16.7%); OR=3.33. Patients with severe RA had increased frequencies of HLA-DQBI*6 (56.3%) as compared to those with mild RA (10.0%); OR = 11.57. Patients with positive rheumatoid factor (RF) and positive Anti-citrullinated peptide antibody (Anti-CCP), also had high frequencies of HLA-DQBI*06 (38.4% and 39.4%) as compared to frequencies of 11.1% and 15.4% which were seen in patients with negative rheumatoid factor and negative anti-CCP (OR= 4.98 and3.10) respectively. CONCLUSION: HLA-DQBI*06 was found to be more common in Kurd patients and it was significantly associated with disease activity; this may indicate a high risk for developing a more progressive type of the disease.

Nuclear structure and chromosome segregation in Drosophila male meiosis depend on the ubiquitin ligase dTopors.

In many organisms, homolog pairing and synapsis at meiotic prophase depend on interactions between chromosomes and the nuclear membrane. Male Drosophila lack synapsis, but nonetheless, their chromosomes closely associate with the nuclear periphery at prophase I. To explore the functional significance of this association, we characterize mutations in nuclear blebber (nbl), a gene required for both spermatocyte nuclear shape and meiotic chromosome transmission. We demonstrate that nbl corresponds to dtopors, the Drosophila homolog of the mammalian dual ubiquitin/small ubiquitin-related modifier (SUMO) ligase Topors. We show that mutations in dtopors cause abnormalities in lamin localizations, centriole separation, and prophase I chromatin condensation and also cause anaphase I bridges that likely result from unresolved homolog connections. Bridge formation does not require mod(mdg4) in meiosis, suggesting that bridges do not result from misregulation of the male homolog conjunction complex. At the ultrastructural level, we observe disruption of nuclear shape, an uneven perinuclear space, and excess membranous structures. We show that dTopors localizes to the nuclear lamina at prophase, and also transiently to intranuclear foci. As a role of dtopors at gypsy insulator has been reported, we also asked whether these new alleles affected expression of the gypsy-induced mutation ct(6) and found that it was unaltered in dtopors homozygotes. Our results indicate that dTopors is required for germline nuclear structure and meiotic chromosome segregation, but in contrast, is not necessary for gypsy insulator function. We suggest that dtopors plays a structural role in spermatocyte lamina that is critical for multiple aspects of meiotic chromosome transmission.

Clinical and molecular diagnosis of Familial Mediterranean Fever in Egyptian children.

BACKGROUND: Familial Mediterranean Fever (FMF) is an autosomal inherited disorder affecting certain races including Arabs. Diagnosis depends mainly on clinical basis, but mild forms may remain undiagnosed. OBJECTIVES: This study aims at an accurate diagnosis of FMF in Egyptian children by detection of genetic mutations in addition to clinical assessment. SUBJECTS AND METHODS: Subjects included 66 Egyptian cases (37 males and 29 females) with a mean age of onset of 6.9 years. They had been referred from health centers and hospitals of the Delta region, Egypt. Analysis of the clinical manifestations was performed using Tel-Hashomer criteria in addition to 10 items clinical score system. For all these cases, DNA analysis was made for three common mutations M680I, M694V, and V726A using amplification refractory mutation system (ARMS-PCR) technique. RESULTS: Most of the cases had attacks ranging from 3-5 days duration with the mean of 3.6 days. Their rate of recurrence was variable but 47 % of them had suffered attacks 10-30 times/year. Abdominal pain was the most common symptom (87.9%) followed by fever (82%), arthritis or arthralgia (56.1%), chest pain (45%) and myalgia (6%). Laparotomy had been done during attacks for exploration or appen-dectomy in 27.7% of cases. Positive mutations were detected among 42 cases (63.6%), of them 14 (21.2%) were compound heterozygotes, 7 (10.6%) were had homozygotes while 21 (31.8%) were simple heterozygotes. Allele M694V was the most frequent one (18.8%) followed by V726A (17.4%) and M680I (12.1%). Taking positive mutation as a guide for diagnosis, a cutoff clinical score level was determined with =15 for unlikely, =20 for definite and 15-20 for probable diagnosis. CONCLUSION: Diagnosis of FMF among Egyptian children cases although based mainly on clinical suspicion requires to be confirmed through detection of the corresponding mutation which can be easily made using the simple ARMS-PCR technique.