Effect of Ultrasound Cavitation on lumbar hyperlordosis in Obese Postnatal Women with Diastasis Recti: A randomized controlled trial

Objective: This study was conducted to determine the effect of ultrasound cavitation (UC) on lumbar hyperlordosis in obese postnatal women with diastasis recti. Subjects and Methods: Sixty obese multiparous women with diastasis rectus abdominis (DRA), their ages ranged from 25 to 35 years, their BMI was more than 30 Kg/ m2. All women had lumbar hyper lordosis, and their mode of delivery was normal vaginal delivery. All women were divided randomly into two equal groups (A & B). Each group consist of 30 women, Group A (control group) treated by low caloric diet regimen only (1600- 2000 Kcal/ day) designed by nutritionist throughout the whole treatment program for two months. Group B (study group) treated by ultrasound cavitation on the abdominal area for 30 minutes, twice weekly for two months in addition to low caloric diet regimen   for two months. The lumbar lordotic angle was measured using the spinal mouse before and after two months of treatment for each woman in both groups (A & B). Results: Within groups, there was statistically significant improvement post-treatment versus pre-treatment in lumbar lordotic angle) (p < 0.05), between groups; pre-treatment, there was no significant difference between both groups (A & B) in lumbar lordotic angle. While, post treatment, there was a significant difference between both groups (A & B) in lumbar lordotic angle (more decrease in group B). Conclusion: Using UC on the abdominal area was effective on reducing lumbar hyper lordosis in obese postnatal women with diastasis recti

The sensitivity and specificity of the conventional symptoms and signs in making a diagnosis of acute appendicitis

Introduction: Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. Objective: This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis.Methods: The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation (signs and symptoms) and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous.Results: Clinical diagnosis was made correctly in 807 (93.2%) of the patients. White blood cells count ranged from 3.70 to 45.30 /mm3 (mean 17.5353 /mm3). It wa

Effect of Aerobic Exercise Versus Vestibular Stimulation on Lipid Profile in Premenstrual Syndrome

Objective:  To determine the effect of aerobic exercise versus vestibular stimulation on lipid profile in premenstrual syndrome. Subjects and Methods: Sixty patients with premenstrual syndrome had regular menstrual cycles were participated in this study. Their ages were ranged between 23-30 year. Their body mass index did not exceed 30 kg/ m2. They were not participating in physical therapy exercise program at the last 3 months. Patients with cardiovascular problems, pulmonary problems and endometriosis are excluded from the study. All patients were divided randomly into two equal groups (A&B). Group A: It consisted of thirty patients with premenstrual syndrome. They were treated by aerobic exercises in the form of treadmill training at moderate intensity of 60- 70% of the maximum heart rate, 3 times per week for 2 months. Group B: It consisted of thirty patients with premenstrual syndrome. They were treated by vestibular stimulation, 3 times per week for 2 months. Outcome measures: Total cholesterol level, HDL, LDL, triglycerides were assessed for all patients before and after treatment in both groups (A&B). Premenstrual syndrome scale was used to confirm the diagnosis of PMS before study and to evaluate the severity of PMS symptoms for all patients in both groups (A&B) before and after treatment. Results:  Results revealed that, between groups; pretreatment, there was no significant difference between both groups A and B in total cholesterol, triglycerides, HDL, LDL and premenstrual syndrome scale. While post treatment, there was significant difference between both groups A and B in total cholesterol, triglycerides, HDL, LDL and premenstrual syndrome scale (with favour of group A; more decrease in total cholesterol, triglycerides, LDL and premenstrual syndrome scale and more increase in HDL). Conclusion: Aerobic exercise was found to be effective more than vestibular stimulation on lipid profile in premenstrual syndrome, in relieving stress and symptoms of PMS

Tendinopathy—from basic science to treatment

Chronic tendon pathology (tendinopathy), although common, is difficult to treat. Tendons possess a highly organized fibrillar matrix, consisting of type I collagen and various 'minor' collagens, proteoglycans and glycoproteins. The tendon matrix is maintained by the resident tenocytes, and there is evidence of a continuous process of matrix remodeling, although the rate of turnover varies at different sites. A change in remodeling activity is associated with the onset of tendinopathy. Major molecular changes include increased expression of type III collagen, fibronectin, tenascin C, aggrecan and biglycan. These changes are consistent with repair, but they might also be an adaptive response to changes in mechanical loading. Repeated minor strain is thought to be the major precipitating factor in tendinopathy, although further work is required to determine whether it is mechanical overstimulation or understimulation that leads to the change in tenocyte activity. Metalloproteinase enzymes have an important role in the tendon matrix, being responsible for the degradation of collagen and proteoglycan in both healthy patients and those with disease. Metalloproteinases that show increased expression in painful tendinopathy include ADAM (a disintegrin and metalloproteinase)-12 and MMP (matrix metalloproteinase)-23. The role of these enzymes in tendon pathology is unknown, and further work is required to identify novel and specific molecular targets for therapy

Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.

OBJECTIVE: Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. METHODS: The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit ? (2) Should we monitor preload and fluid responsiveness in shock ? (3) How and when should we monitor stroke volume or cardiac output in shock ? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock ? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock ? Four types of statements were used: definition, recommendation, best practice and statement of fact. RESULTS: Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. CONCLUSIONS: This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock

Effect of Foot Refelexology on Preeclampsia

Purpose: This study was conducted to investigate the effect of foot reflexology on mean arterial blood pressure, Serum Cortisol level, proteinuria and quality of life in pregnant women suffering from mild preeclampsia. Subjects and Methods: Sixty mild preeclamptic pregnant women were selected randomly from Out Patient Clinic of Obstetrics Department in Minia University Hospital in Minia to participate in this study. Their ages were between 20-36 years old. Their body mass index less than 35 kg/m2. They were divided randomly into two equal groups (A & B); Group A (control group): It comprised thirty pregnant women with mild preeclampsia who were treated by antihypertensive drugs only while group B (study group): It comprised thirty pregnant women with mild preeclampsia who were treated by antihypertensive drugs and foot reflexology sessions (25 minutes, 2 sessions weekly for 8 weeks). Assessment: Mean arterial blood pressure (MABP), Serum Cortisol level and proteinuria were assessed before and after treatment for all patients in both groups (A&B), as well as quality of life was evaluated through World Health Organization quality of Life Questionnaire (WHOQOL). Results: revealed that, between groups; pretreatment, there was insignificant difference between both groups A & B in MABP, serum cortisol level, proteinuria and WHOQOL questionnaire scores. While post treatment, there was significant difference between both groups A &B in MABP, serum cortisol level, proteinuria and WHOQOL questionnaire scores [in favor of group B (more decrease in MABP, serum cortisol level and proteinuria; and more increase in WHOQOL questionnaire scores)]. Conclusion: Foot reflexology is an effective modality in decreasing MABP, serum cortisol level and proteinuria, as well as enhancing the quality of life of mild preeclamptic pregnant women

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Clostridium difficile infection.

Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis - the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota

Search for Dark Matter and Supersymmetry with a Compressed Mass Spectrum in the Vector Boson Fusion Topology in Proton-Proton Collisions at root s=8 TeV

Peer reviewe