Comparison of spinal manipulation and short-wave diathermy on patients with chronic postural low back pain, in department of physical medicine at teaching hospital, Kandy, Sri Lanka

Background: Chronic postural low back pain (CPLBP) is one of the common health problems worldwide. The aim of the study was to compare the spinal manipulation (SM) and short-wave diathermy (SWD) in patients with CPLBP in department of physical medicine at teaching hospital, Kandy, Sri Lanka.Methods: Observational study was conducted. Patients diagnosed as CPLBP, who referred to the department of physical medicine (DPM), teaching hospital Kandy, were observed in the study (n=140). Seventy (70) patients were allocated for SWD and 70 for SM by the consultant. Two physiotherapists were routinely appointed for the treatments and SWD treatment by group 1 and SM was carried out by group 2. The two treatment sessions were continued once a week through four weeks. Outcomes were measured by numerical pain scale to compare with initial pain.Results: Group 1, SM consisted 39 females and 31 males, group 2, SWD 40 females and 30 males. After 4 sessions, the mean value of pain reduction from initial pain was significantly high (p<0.001) in SM group than the short-wave diathermy group in both genders. (Female: 6.410 (SM) and 4.625 (SWD), Male:6.710 (SM) and 4.333 (SWD). Further the mean values showed that there was a significant pain reduction during the initial treatment session than 2nd, 3rdand final sessions in both treatment groups.Conclusions: Pain reduction was more pronounced in the first treatment session in both methods. SM is more effective for the treatment of CPLBP irrespectively the age and gender when compare to the SWD in the study population. Therefore, SM could apply on CPLBP patients with higher effective treatment

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

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