Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects

Introduction: Osteoarthritis (OA) is a common degenerative joint disease particularly in older subjects. It is usually associated with pain, restricted range of motion, muscle weakness, difficulties in daily living activities and impaired quality of life. To determine the effects of adding two different intensities of low-level laser therapy (LLLT) to exercise training program on pain severity, joint stiffness, physical function, isometric muscle strength, range of motion of the knee, and quality of life in older subjects with knee OA.Methods: Patients were randomly assigned into three groups. They received 16 sessions, 2 sessions/week for 8 weeks. Group-I: 18 patients were treated with a laser dose of 6 J/cm2 with a total dose of 48 J. Group-II: 18 patients were treated with a laser dose of 3 J/cm2 with a total dose of 27 J. Group-III: 15 patients were treated with laser without emission as a placebo. All patients received same exercise training program including stretching and strengthening exercises. Patients were evaluated before and after intervention by visual analogue scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index for quality of life, handheld dynamometer and universal goniometer.Results: T test revealed that there was a significant reduction in VAS and pain intensity, an increase in isometric muscle strength and range of motion of the knee as well as increase in physical functional ability in three treatment groups. Also analysis of variance (ANOVA) proved significant differences among them and the post hoc tests (LSD) test showed the best improvements for patients of the first group.Conclusion: It can be concluded that addition of LLLT to exercise training program is more effective than exercise training alone in the treatment of older patients with chronic knee OA and the rate of improvement may be dose dependent, as with 6 J/cm2 or 3 J/cm2

Long-term effect of non-severe COVID-19 on pulmonary function, exercise capacities and physical activities: a cross-section study in Sakaka Aljouf [version 5; peer review: 2 approved]

Background COVID-19 has serious consequences on different body systems particularly the respiratory system with its impact on pulmonary function, exercise capacities, and physical activities. This study aimed to investigate the long-term effect of COVID-19 on pulmonary function, exercise capacities, and physical activities in patients with non-severe COVID-19. Methods 160 individuals were selected to participate in a cross-section study. Group-I: 80 male and female patients with non-severe COVID-19 at least 3 months after the recovery time. Group-II: 80 male and female matched (non-infected with COVID-19) participants. The spirometer, six-minute walk test (6MWT), and International Physical Activity Questionnaire (IPAQ) were used to assess pulmonary function, exercise capacities, and physical activities respectively. The Kolmogorov-Smirnov test was used to test normality of data. The Mann–Whitney and independent t-tests were used to compare the significant differences between both groups. Results The results show significant differences in FVC & FEV1 of the pulmonary function, exercise capacities, and physical activities of the work & transportations between both COVID-19 and matched groups p-value = (0.001 & 0.001, 0.001 and 0.005 & 0.012) respectively. Conclusion Pulmonary function, exercise capacities, and physical activities are negatively influenced by COVID-19 as long-term consequences indicating the need for extended health care, and prescription of proper rehabilitative training programs for non- severe COVID-19 patients whatever their severity degree of infection or history of hospitalization. Outcome reflections of the current results raise awareness of physical therapists to the importance of the proper rehabilitative training programs for non-severe COVID-19 patients

The Efficacy of Adding Electromagnetic Therapy or Laser Therapy to Medications in Patients With Diabetic Peripheral Neuropathy

Introduction: Diabetes mellitus (DM) is a common disease with a highly significant burden among the Saudi population. This study aimed to investigate the effects of adding either magnetic or laser therapy to medications in patients with diabetic peripheral neuropathy (DPN).Methods: Seventy-one medically controlled diabetic patients were randomly assigned to 1) Magnetic group: 26 patients were exposed to magnetic therapy for 20 minutes/session, 2 sessions/week, for 3 months 2) Laser group: 25 patients were exposed to laser therapy with intensity 5.7 J/cm2 for 30 minutes/session, 2 times/week, for 3 months. 3) Drug group: 20 patients received only the regular medications for diabetic control and pain analgesia. Pain and neuropathy were assessed by the visual analog scale (VAS) and the Toronto Clinical Neuropath Scoring System (TRCNSS). Conduction velocities and amplitudes of peroneal and sural nerves were measured by electromyography.Results: The results showed significant increases in conduction velocities and amplitudes in both magnetic and laser groups in parallel with significant reductions in TRCNSS. Non-significant changes were obtained only after using only medications (P > 0.05). The mean values of VAS reduced significantly in the three groups. The least significant differences showed significant changes among the three groups, whereas non-significant differences were obtained between both magnetic and laser groups.Conclusion: There were non-significant differences between both magnetic and laser therapy groups. Addition of either magnetic or laser therapy to medications could bring extra positive benefits to patients with DPN. Both magnetic and laser therapy can be applied with medications for the treatment of patients with DPN.

The Effect of two Schedules of Intermittent Enteral Feeding on the Development of Gastric Colonization

Nutritional support is an important aspect of the care of traumatized patients and it can result in improving wound healing, decreasing catabolic response to injury, enhancing immune system function, improving gastrointestinal structure and function, and improving clinical outcomes. However, many complications are associated with enteral feeding including gastric colonization. Routine enteral feeding schedule is not allowing time to acidify stomach with gastric pH. This may predispose the traumatized patients to acquire gastric colonization which may predispose to aspiration pneumonia. Aim: this study was carried out to investigate the effect of two schedules of intermittent enteral feeding on the development of gastric colonization Design: a quasi-experimental design. Setting: trauma ICU at Assiut University Hospitals, Egypt. Patients: A convenience sample of 80 adults' traumatized patients on enteral feeding constituted the study sample. The patients were assigned into two equal groups (group 1 and group 2, 40 patients each). Methods: The only manipulation was in the rest period and time interval in which the group 1 patients were rested 8hours at night as compared to 6hours for the group 2 ones, as well group 1 patients were having 4hours time interval between each two consecutive feeding as compared to 2hours for group 2 patients. Results: ninety percent of group 2 patients developed gastric colonization as compared to 40% of the group 1 patients with a highly significant statistical difference between both groups in this regard (p= 0.000).Conclusion: intermittent 4-hour interval enteral feeding schedule inhibit the development of gastric colonization. Keywords: intermittent enteral feeding, gastric colonization

Effect of ultrasound on subserosal and intramural fibroids in vitro: A quasi-experimental study of physical therapy

The aim of this study was to determine the effect of ultrasound (US) on extra subserosal and intramural uterine fibroids in vitro. A quasi-experimental, randomized, pre-post intervention study of physical therapy was conducted. Thirty women, who underwent myomectomy for subserosal or intramural fibroids with any leiomyomas' volumes in the operating room of Bab El-Sharia Hospital, participated in the study. Thirty uterine fibroids whose were collected from participants were randomly divided into three groups (I, II and III), and exposed to ultrasound therapy for 15, 30, and 45 minutes respectively. Leiomyomas volumes were measured using the fluid displacement method before and after the application of US. The samples were kept in saline solution immediately after their excision from operating room to be transferred to physical therapy department in same hospital to apply ultrasound therapy. Results of all study groups (I, II, and III) showed a statistically significant decrease in the volume of subserosal and intramural leiomyoma post US application (p>0.05). However, there was no statistically significant difference in the size of the subserosal and intramural leiomyoma between study groups (p<0.05). In conclusion, the ultrasound therapy is effective in shrinking the volume of subserosal and intramural leiomyomas without effect of long duration ultrasound therapy.

Oxidative stress and S-100B protein in children with bacterial meningitis

<p>Abstract</p> <p>Background</p> <p>Bacterial meningitis is often associated with cerebral compromise which may be responsible for neurological sequelae in nearly half of the survivors. Little is known about the mechanisms of CNS involvement in bacterial meningitis. Several studies have provided substantial evidence for the key role of nitric oxide (NO) and reactive oxygen species in the complex pathophysiology of bacterial meningitis.</p> <p>Methods</p> <p>In the present study, serum and CSF levels of NO, lipid peroxide (LPO) (mediators for oxidative stress and lipid peroxidation); total thiol, superoxide dismutase (SOD) (antioxidant mediators) and S-100B protein (mediator of astrocytes activation and injury), were investigated in children with bacterial meningitis (n = 40). Albumin ratio (CSF/serum) is a marker of blood-CSF barriers integrity, while mediator index (mediator ratio/albumin ratio) is indicative of intrathecal synthesis.</p> <p>Results</p> <p>Compared to normal children (n = 20), patients had lower serum albumin but higher NO, LPO, total thiol, SOD and S-100B. The ratios and indices of NO and LPO indicate blood-CSF barriers dysfunction, while the ratio of S-100B indicates intrathecal synthesis. Changes were marked among patients with positive culture and those with neurological complications. Positive correlation was found between NO index with CSF WBCs (r = 0.319, p < 0.05); CSF-LPO with CSF-protein (r = 0.423, p < 0.01); total thiol with LPO indices (r = 0.725, p < 0.0001); S-100B and Pediatric Glasow Coma Scores (0.608, p < 0.0001); CSF-LPO with CSF-S-100B (r = 0.482, p < 0.002); serum-total thiol with serum S-100B (r = 0.423, p < 0.01).</p> <p>Conclusion</p> <p>This study suggests that loss of integrity of brain-CSF barriers, oxidative stress and S-100B may contribute to the severity and neurological complications of bacterial meningitis.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

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

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat