Besides other Signs, Can a 6-min Walk Test be Applied as a Criterion for Going to the Hospital with a Diagnosis of COVID-19?

Recently the pandemic of Covid-19 challenges countries’ medical health services systems. While some patients experience acute and devastating symptoms, others may only have mild myalgia and fever. Due to the high amounts of hospital referrals, some countries’ health systems have asked patients to stay at home and go to the hospital when they feel that the symptoms are severe. Some symptoms, such as fever, myalgia, diarrhea, and headache, have been offered as Covid-19 symptoms. However, is there any clinical test that helps patients themselves to detect the severity of symptoms? A six-minute walk test is a clinical test to investigate the function of the cardiorespiratory system. In this test, a physician asks a patient to walk for 6 minutes in a 30-meter walking course. Some studies have shown its relation with short term survival, especially in patients who complete less than 300 meters. Based on the walked distance, results can be used in the two following formats. First, the Vo2 max could be estimated via an equation; second, the distance can be compared at different times. Considering that Covid-19 affects the respiratory tract, it seems that it could affect 6-min walk test results. Due to the particular situation, the health system can ask people who have mild symptoms to check their 6-min walk test results for several consecutive days besides the other symptoms. If patients’ walking distance decreased due to breath shortness at this time, they should go to the hospital. Even if their walking distance is less than 300 meters, maybe they need a chest CT scan. With the application of this approach, we can decrease the load of referrals to the hospitals and also prevent patients with mild symptoms from being contacted to the high load of virus in the hospitals

Multimodal impact of acupuncture, exercise therapy, and concurrent functional electrical stimulation on osteoarthritis of the knee: a case report

Knee osteoarthritis (OA) causes functional limitation in weight-bearing activities including walking. To investigate the multimodal impact of acupuncture, exercise therapy, and concurrent functional electrical stimulation (FES) on knee osteoarthritis. We designed a multidisciplinary treatment package including acupuncture; home based exercise therapy, and concurrent functional electrical stimulation during treadmill walking. Outcomes measurements included the numerical rating scale (NRS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tampa Scale of Kinesiophobia (TSK). Measurements were completed at baseline and following the treatment phase which consisted of six individual sessions. A 48-year-old male, office worker presented with a history of chronic right knee. During the previous year, he was diagnosed with knee osteoarthritis after clinical physical examination by a sports medicine physician. Following our novel training intervention, the patient reported a reduction in pain intensity from 8 to 2 on the NRS, improved in all KOOS subscale scores, and improved in the TSK scale (reduction from 15 to 11). In addition, the patient reported that he was able to return to work and undertake normal activities of daily living with reduced knee pain. This case report showed that our novel multimodal intervention including six sessions of acupuncture, exercise therapy, and treadmill walking with functional electrical stimulation (FES) had a positive impact on knee pain and function in a middle-aged male with knee osteoarthritis

Prevalence of Neck Pain among Athletes: A Systematic Review

Many studies have investigated the prevalence of neck pain (NP) and its risk factors in the general population. However, the prevalence of NP among athletes has not yet been systematically investigated. We aimed to systematically review the prevalence of NP in athletes. A comprehensive search was conducted in September 2015 using PubMed, Ovid SP Medline, ISI, and Google Scholar. We included studies in English that reported the prevalence of NP in an athletic population during a defined period of time. We assessed the risk of bias in studies due to various definitions of NP, response rates, and reliability of the study instruments. Two reviewers independently assessed the studies’ quality and performed data extraction. Of 1,675 titles identified, eight articles were assessed for risk of bias, and six with low or moderate risk were included. NP was shown to be prevalent in athletes, with a 1-week prevalence ranging from 8% to 45%, a 1-year prevalence ranging from 38% to 73%, and a lifetime prevalence of about 48%. The prevalence of NP in athletes is high. More studies regarding the prevalence and risk factors of NP may be useful for planning educational programs and developing appropriate rehabilitation protocols and preventive guidelines. Researchers are encouraged to perform epidemiologic studies in athletes with a low risk of bias

A double-blind randomized controlled trial for the effects of dry needling on upper limb dysfunction in patients with stroke

Spasticity is one of the main complications of a stroke. This double-blind, randomized controlled trial aimed to compare the result of three sessions of dry needling (DN) versus sham DN on the affected upper limbs in post-stroke survivors. We recruited 24 patients (age 57.0 ± 9.6 years; male 71%). Patients were randomly allocated to two groups: a DN group and a sham DN group. The primary outcome measures were the Modified Modified Ashworth Scale (MMAS) and the Box and Block Test (BBT). Secondary outcome measures included active and passive wrist range of motion (AROM and PROM). All assessments were measured at baseline, immediately after the last session of the intervention, and one month later. Patients in the DN group had improved upper limb spasticity and passive wrist range of motion compared to control group (P0.05). Dry needling is a useful method for improving muscle spasticity in the upper limbs of patients with stroke

The Effect of Dry Needling on Lower Limb Dysfunction in Poststroke Survivors

Background: Spasticity is one of the main complications in poststroke survivors leading to difficulties in walking and standing resulting in high levels of disability. Objective: The aim of the study was to investigate the effects of deep dry needling on lower limb dysfunction in poststroke spastic patients. Methods: A randomized clinical trial conducted in poststroke survivors who were assigned to one of 2 groups: Deep dry needling (intervention group) and sham dry needling (control group). The primary outcome measures were Modified Modified Ashworth Scale (MMAS) and functional tests (timed up and go test, 10-meter walk test). Secondary outcome measures were active ankle dorsiflexion range of motion (AROM), passive ankle dorsiflexion range of motion (PROM), single leg stance test, and Barthel index. All measurements were assessed at baseline (T0), immediately after the third session 1 week later (T1), and 1 month after the end of the intervention (T2). Results: We recruited 24 patients (71% male; mean age 57 ± 10 years; 26.4 ± 1.8 kg•m−2; time since event: 25.2 ± 12.5 months). There were significant improvements in MMAS, timed up and go test, 10-meter walk test, Barthel scale, and PROM (P . 05). Conclusions: Deep dry needling decreases muscle spasticity and improves lower limb function and gait speed in poststroke survivors

The Role of a Multi-Step Core Stability Exercise Program in the Treatment of Nurses with Chronic Low Back Pain: A Single-Blinded Randomized Controlled Trial

Study Design Single-blinded randomized controlled trial. Purpose To evaluate the effects of a multi-step core stability exercise program in nurses with chronic low back pain (CLBP). Overview of Literature CLBP is a common disorder among nurses. Considering that patient-handling activities predispose nurses to CLBP, core stability exercises suggested for managing CLBP in the general population may also be helpful in nurses. However, sufficient evidence is not available on whether a multi-step core stability exercise program affects pain, disability, quality of life, and the diameter of lateral abdominal muscles in nurses with CLBP. Methods In this single-blinded randomized controlled trial, 36 female nurses with CLBP were recruited. The sample was divided into two groups of 18 patients (intervention and control). Nurses in the intervention group performed core stability exercises for 8 weeks, based on a progressive pattern over time. Roland–Morris Disability Questionnaire (RDQ), quality of life (36-item Short Form Health Survey [SF-36]), ultrasound assessment of the diameter of lateral abdominal muscles, and Visual Analog Scale (VAS) score for pain were evaluated in the participants before and after the trial. Sixteen nurses (eight from each group) dropped out of the study, and analysis of covariance was used to compare outcomes for the remaining nurses in the intervention (10 nurses) and control (10 nurses) groups. Results The results after the trial showed significant improvements in RDQ, SF-36, and VAS score in the intervention group compared with that in the control group (p <0.005). Furthermore, the ultrasound data showed a significant increase in the left and right muscle diameter of all three abdominal muscles during the abdominal drawing-in maneuver in the intervention group compared with that in the control group (p <0.05). Conclusions This study showed that a multi-step core stability exercise program is a helpful treatment option for improving quality of life and reducing disability and pain in female nurses with CLBP

Lipoma as Potential Delayed Side Effect of Anabolic Steroids Abuse in an Athlete

Androgenic-anabolic steroids (AAS) are a subset of testosterone. They are widely used by athletes and, specifically, bodybuilders to improve strength and performance. They are classified based on their chemical structures and have a variety of side effects that impact different organs, especially the cardiovascular system, liver, and kidney. Skin changes, such as acne, striae, hirsutism, and alopecia, are common side effects of AAS abuse. They can even lead to other complications, such as shrinking testicles, breast enlargement, hair loss, and a decrease in the number of sperm and infertility in males. Studies have shown that AAS can be a risk factor in human cancers, such as prostate cancer, and this might be the result of the effect on cellular changes associated with high-density lipoprotein (HDL) and positive effects on muscle lean mass and strength. Undeniable connections between steroid abuse among bodybuilders and their side effects necessitate the need for further investigations

The Effect of School-Based Physical Activity Interventions on Body Mass Index Among ‎Adolescents: A Systematic Review of Randomised Trials

Obesity has become a global health concern among the child and adolescent populations. We performed a systematic review for an indirect comparison of the effectiveness of aerobic exercise (AE) school-based physical activity (SBPA) interventions versus resistance training (RT) SBPA interventions in changing adolescent body mass index (BMI). OVID Medline, Cochrane Library, and Embase were searched. All English-language, peer-reviewed randomized control trials (RCTs) that examined SBPA inter- ventions and objectively measured BMI as an outcome in adolescents aged 10-18 were eligible for inclusion. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Of the 355 records identified, 10 met the eligibility criteria and 5 were included in the best evidence synthesis (BES). Five studies had a high risk of bias, two had some concerns and three had a low risk of bias. In the BES, this study found that both types of interventions reported either decreases or maintenance in BMI. However, due to the limited number of included studies, this review was unable to conduct an indirect comparison of the effects of AE and RT on changes in BMI. This finding could be beneficial in the planning of strategies to address overweight and obesity in adolescents. Further RCTs with a low risk of bias are required to compare the effects of AE and RT SBPA on BMI in adolescents

The use of machine learning on administrative and survey data to predict suicidal thoughts and behaviors: a systematic review

BackgroundMachine learning is a promising tool in the area of suicide prevention due to its ability to combine the effects of multiple risk factors and complex interactions. The power of machine learning has led to an influx of studies on suicide prediction, as well as a few recent reviews. Our study distinguished between data sources and reported the most important predictors of suicide outcomes identified in the literature.ObjectiveOur study aimed to identify studies that applied machine learning techniques to administrative and survey data, summarize performance metrics reported in those studies, and enumerate the important risk factors of suicidal thoughts and behaviors identified.MethodsA systematic literature search of PubMed, Medline, Embase, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Allied and Complementary Medicine Database (AMED) to identify all studies that have used machine learning to predict suicidal thoughts and behaviors using administrative and survey data was performed. The search was conducted for articles published between January 1, 2019 and May 11, 2022. In addition, all articles identified in three recently published systematic reviews (the last of which included studies up until January 1, 2019) were retained if they met our inclusion criteria. The predictive power of machine learning methods in predicting suicidal thoughts and behaviors was explored using box plots to summarize the distribution of the area under the receiver operating characteristic curve (AUC) values by machine learning method and suicide outcome (i.e., suicidal thoughts, suicide attempt, and death by suicide). Mean AUCs with 95% confidence intervals (CIs) were computed for each suicide outcome by study design, data source, total sample size, sample size of cases, and machine learning methods employed. The most important risk factors were listed.ResultsThe search strategy identified 2,200 unique records, of which 104 articles met the inclusion criteria. Machine learning algorithms achieved good prediction of suicidal thoughts and behaviors (i.e., an AUC between 0.80 and 0.89); however, their predictive power appears to differ across suicide outcomes. The boosting algorithms achieved good prediction of suicidal thoughts, death by suicide, and all suicide outcomes combined, while neural network algorithms achieved good prediction of suicide attempts. The risk factors for suicidal thoughts and behaviors differed depending on the data source and the population under study.ConclusionThe predictive utility of machine learning for suicidal thoughts and behaviors largely depends on the approach used. The findings of the current review should prove helpful in preparing future machine learning models using administrative and survey data.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022333454 identifier CRD42022333454

The Role of Ultrasound in Diagnosis of the Causes of Low Back Pain: a Review of the Literature

Context: Low back pain (LBP) is among the most prevalent musculoskeletal conditions in the developed countries. It is a common problem causing disability and imposing a huge economic burden to individuals and state organizations. Imaging plays an important role in diagnosis of the etiology of LBP. Evidence Acquisition: The electronic databases included: PubMed (1950 to present), Ovid SP Medline (1950 to present) and ISI (1982 to present) and Google Scholar. In every search engine another search was performed using various permutations of the following keywords: ultrasonography, ultrasound imaging, low back pain, back muscles, paraspinal muscles, multifidus, transverse abdominis, muscle size, spinal canal, sacroiliac joint and spondylolisthesis. Results: Magnetic resonance imaging (MRI) is widely used in evaluation of patients with LBP; however, high costs, limited availability and contraindications for its use have restricted MRI utilization. In a quest for a less expensive and readily available tool to investigate LBP, clinicians and researchers found ultrasonography (US) as an alternative. In this review we discuss the US application in diagnosis of some common causes of non-specific chronic LBP. Discussed topics include evaluation of spinal canal diameter, paraspinal and transabdominal muscles, sacroiliac joint laxity, pregnancy related LBP, sacroiliitis, and spondylolisthesis using US in patients with LBP. Conclusions: While the first researches on employing ultrasound in diagnosis of patients with LBP had been focused on spinal canal diameter, recent studies have been mostly performed to evaluate the role of transabdominal and paraspinal muscles on core stability and thereby LBP occurrence. On the other side, Doppler ultrasonography has recently played an important role in objective measurement of joint laxity as a common etiology for LBP. Doppler imaging also in pregnant patients with LBP has been recommended as a safe and sensitive method. As conclusion, according to recent and most prestigious studies, focusing more on transabdominal muscle thickness can be considered as future approach in investigations