The Study On Range Of Motion Of Hip And Knee In Prayer By Adult Muslim Males. A Preliminary Report

Introduction: Praying represents a fundamental activity of daily living in Muslim community. Muslims need to adopt several postures that require deep flexion of the knee and hip to perform this daily obligation. This is a preliminary report of the study on hip and knee range of motion conducted to obtain normative passive and functional range of flexion data during Muslim prayers in both weight-bearing joints of normal Muslim adults. Methods: A cohort of Malay men aged between 20 to 30 years was recruited in this cross-sectional study. Passive range of motion and flexion angles of the joints in various postures during prayer were measured using a standard goniometer. The difference against existing normative range of motion database available and the influence of various factors were analysed. Factors analysed include body mass index and other anthropometric measurements. Results: Sixty participants recruited for the preliminary phase of this study. The mean (SD) of passive hip and knee flexions were higher compared to other existing normative range of motion database. A unit increase in body mass index will have 0.782 units lower of knee range of motion. The hip and knee flexion arc were from 74.1° to 119.0° and from 3.3° to 119.7° respectively. Conclusion: The range of motion involved for prayers was more for the knee but less for the hip as compared to the measured passive range of motion. Body mass index has a significant linear negative relationship with the passive range of motion of the knee, but not the hip

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Porous plga sheet and acellularized muscle stuffed vein seeded with neural- differentiated mscs are potential scaffolds for nerve regeneration

Numerous studies on bridging a nerve gap without using autologous nerve graft have been reported. Our study compares two models of nerve conduit; a porous PLGA sheet and acellular muscle stuffed vein with both models seeded with mesenchymal stem cells. The micro-porous PLGA sheet was fabricated by solvent casting/salt leaching technique using methylene chloride as the solvent. Both PLGA and muscle stuffed vein was decellularized by liquid nitrogen immersion and the latter further hydrolyzed by soaking in HCl for 24 hours. Neural-differentiated mesenchymal stem cells (MSCs) were seeded and cultured on the surface of both conduits. We studied the seeded constructs for their surface morphology by scanning electron microscope and biocompatibility assessment. Both models of nerve conduit had good distribution and proliferation of seeded cells. For the PLGA sheet, pores had extensive interconnections, excellent for allowing nerve growth. For the muscle stuffed vein, cells were successfully embedded within the hydrolyzed fraction of muscle and ultra structural analysis showed healthy cells attached to the surface of a cellular muscle. In conclusion, both PLGA and muscle stuffed vein seeded with neural-differentiated MSCs are suitable scaffolds for nerve tissue engineerin

The Study On Range Of Motion Of Hip And Knee In Prayer By Adult Muslim Males. A Preliminary Report

Introduction: Praying represents a fundamental activity of daily living in Muslim community. Muslims need to adopt several postures that require deep flexion of the knee and hip to perform this daily obligation. This is a preliminary report of the study on hip and knee range of motion conducted to obtain normative passive and functional range of flexion data during Muslim prayers in both weight-bearing joints of normal Muslim adults. Methods: A cohort of Malay men aged between 20 to 30 years was recruited in this cross-sectional study. Passive range of motion and flexion angles of the joints in various postures during prayer were measured using a standard goniometer. The difference against existing normative range of motion database available and the influence of various factors were analysed. Factors analysed include body mass index and other anthropometric measurements. Results: Sixty participants recruited for the preliminary phase of this study. The mean (SD) of passive hip and knee flexions were higher compared to other existing normative range of motion database. A unit increase in body mass index will have 0.782 units lower of knee range of motion. The hip and knee flexion arc were from 74.1° to 119.0° and from 3.3° to 119.7° respectively. Conclusion: The range of motion involved for prayers was more for the knee but less for the hip as compared to the measured passive range of motion. Body mass index has a significant linear negative relationship with the passive range of motion of the knee, but not the hip.</jats:p

Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone

BACKGROUND: The safe and appropriate use of long-acting beta-agonists (LABAs) for the treatment of asthma has been widely debated. In two large clinical trials, investigators found a potential risk of serious asthma-related events associated with LABAs. This study was designed to evaluate the risk of administering the LABA salmeterol in combination with an inhaled glucocorticoid, fluticasone propionate. METHODS: In this multicenter, randomized, double-blind trial, adolescent and adult patients (age, ≥12 years) with persistent asthma were assigned to receive either fluticasone with salmeterol or fluticasone alone for 26 weeks. All the patients had a history of a severe asthma exacerbation in the year before randomization but not during the previous month. Patients were excluded from the trial if they had a history of life-threatening or unstable asthma. The primary safety end point was the first serious asthma-related event (death, endotracheal intubation, or hospitalization). Noninferiority of fluticasone-salmeterol to fluticasone alone was defined as an upper boundary of the 95% confidence interval for the risk of the primary safety end point of less than 2.0. The efficacy end point was the first severe asthma exacerbation. RESULTS: Of 11,679 patients who were enrolled, 67 had 74 serious asthma-related events, with 36 events in 34 patients in the fluticasone-salmeterol group and 38 events in 33 patients in the fluticasone-only group. The hazard ratio for a serious asthma-related event in the fluticasone-salmeterol group was 1.03 (95% confidence interval [CI], 0.64 to 1.66), and noninferiority was achieved (P=0.003). There were no asthma-related deaths; 2 patients in the fluticasone-only group underwent asthma-related intubation. The risk of a severe asthma exacerbation was 21% lower in the fluticasone-salmeterol group than in the fluticasone-only group (hazard ratio, 0.79; 95% CI, 0.70 to 0.89), with at least one severe asthma exacerbation occurring in 480 of 5834 patients (8%) in the fluticasone-salmeterol group, as compared with 597 of 5845 patients (10%) in the fluticasone-only group (P<0.001). CONCLUSIONS: Patients who received salmeterol in a fixed-dose combination with fluticasone did not have a significantly higher risk of serious asthma-related events than did those who received fluticasone alone. Patients receiving fluticasone-salmeterol had fewer severe asthma exacerbations than did those in the fluticasone-only group

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

1013 Preoperative Nasopharyngeal Swab Testing and Postoperative Pulmonary Complications in Patients Undergoing Elective Surgery During The SARS-Cov-2 Pandemic

Abstract Introduction This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Method International cohort study including adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020 (NCT04384926). Patients suspected preoperatively of SARS-CoV-2 infection were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Results Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2%) underwent preoperative testing: 1458 (16.6%) had a swab test, 521 (5.9%) CT only, and 324 (3.7%) swab and CT. The overall pulmonary complication rate was 3.9% and SARS-CoV-2 infection rate was 2.6%. After risk adjustment, only a nasopharyngeal swab test (adjusted odds ratio 0.68, 95% confidence interval 0.68-0.98, p = 0.040) was associated with lower rates of pulmonary complications. Swab testing remained beneficial before major surgery and in high SARS-CoV-2 population risk areas but not before minor surgery in low incidence areas. Conclusions Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 incidence areas. There was no proven benefit of swab testing before minor surgery in low incidence areas. </jats:sec