91 research outputs found
Osmolarity of the tear film in healthy subjects and patients with dry eyes eye
Das Trockene Auge ist typischerweise mit einem hyperosmolaren TrĂ€nenfilm assoziiert. Dementsprechend stellt die Messung der TrĂ€nenfilmosmolaritĂ€t ein wichtiges Kriterium in der Diagnostik des Trockenen Auges dar. Von manchen Autoren wird sie sogar als Goldstandard diskutiert. Bis vor kurzem konnte die OsmolariĂ€t des TrĂ€nenfilms nur durch komplexe Laborverfahren wie Gefrierpunktserniedrigung oder Dampfdrucktechnik gemessen werden. Wir hatten die Möglichkeit ein tragbares, einfach zu bedienendes Osmometer (Tearlabtm, Fa. Ocusense) kurz nach der MarkteinfĂŒhrung zu testen.
Wir untersuchten 200 augengesunde Probanden und Patienten mit trockenem Auge. Anhand der subjektiven Beschwerden (Ocular Surface Disease Index-Fragebogen), der TrĂ€nenfilmstabilitĂ€t (TrĂ€nenfilmaufreiĂzeit), der OberflĂ€chenanfĂ€rbung, der TrĂ€nenproduktion (Schirmertest) und dem Vorhandensein einer Blepharitis wurden die Studienteilnehmer in eine Siccagruppe (n=129) und eine Kontrollgruppe (n=71) eingeteilt. Die Messung der TrĂ€nenfilmosmolaritĂ€t erfolgte mit dem TearlabTM-Osmometer am schlechteren oder â bei seitengleichem Befund - am linken Auge.
Die TrÀnenfilmosmolaritÀt betrug bei Patienten mit Trockenem Auge 308,9 ± 14,0 mOsml/L, in der Kontrollgruppe 307,1 ± 11,3 mOsml/L. Somit konnten wir anhand der OsmolaritÀtsdaten nicht zwischen Siccapatienten und augengesunden Probanden unterscheiden. Zudem korrelierte die OsmolaritÀtsmessung nicht mit den subjektiven Beschwerden der Patienten und den objektiven Zeichen des Trockenen Auges, evaluiert mit etablierten klinischen Tests. Die erhobenen TrÀnenfilmosmolaritÀten korrelierten allerdings eindeutig mit dem Schweregrad des Trockenen Auges.
Seit der Beendigung unserer Messungen sind einige Studien zur Tearlab-Osmometrie publiziert worden. Sie demonstrieren die Relevanz der TrĂ€nenfilmosmolaritĂ€t als Einzeltest, zeigen jedoch meist nur beim moderaten bis schweren Trockenen Auge sinnvolle Ergebnisse. Einige Autoren konnten- wie wir - in einem inhomogenen, aber klinisch typischen Patientengut die TrĂ€nenfilmosmolaritĂ€t nicht zur Diskriminierung der Gruppen nutzen. Viele Faktoren scheinen die ZuverlĂ€ssigkeit der Messungen zu beeinflussen wie Umweltfaktoren, ReflextrĂ€nen, und eine Augentropfentherapie vor der Messung. Die Testtrennwerte werden nach wie vor diskutiert und wurden vom Hersteller zwischenzeitlich von 316mOsm/L auf 312 mOsm/L gesenkt. Auch ist mittlerweile klar, dass aufgrund der interindividuellen VariabilitĂ€t und des Messrauschens mehrere Messungen an beiden Augen fĂŒr ein zuverlĂ€ssiges Ergebnis notwendig sind.
Leider haben sich somit die Hoffnungen auf einen einfachen, spezifischen und sensiblen Einzeltest in der Diagnostik des Trockenen Auges nicht erfĂŒllt. Die Diagnosestellung bei Trockenem Auge bleibt daher komplex und ist nur nach spezifischer Anamnese in Kombination mit mehreren klinischen Testen zu stellen. Es bleibt zu eruieren, ob Patienten mit stark erhöhter TrĂ€nenfilmosmolaritĂ€t eine Subgruppe im Krankheitsspektrum des Trockenen Auges, z.B. mit erhöhter entzĂŒndlicher AktivitĂ€t darstellen
Hydrodilatation, corticosteroids and adhesive capsulitis: A randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>Hydrodilatation of the glenohumeral joint is by several authors reported to improve shoulder pain and range of motion for patients with adhesive capsulitis. Procedures described often involve the injection of corticosteroids, to which the reported treatment effects may be attributed. Any important contribution arising from the hydrodilatation procedure itself remains to be demonstrated.</p> <p>Methods</p> <p>In this randomized trial, a hydrodilatation procedure including corticosteroids was compared with the injection of corticosteroids without dilatation. Patients were given three injections with two-week intervals, and all injections were given under fluoroscopic guidance. Outcome measures were the Shoulder Pain and Disability Index (SPADI) and measures of active and passive range of motion. Seventy-six patients were included and groups were compared six weeks after treatment. The study was designed as an open trial.</p> <p>Results</p> <p>The groups showed a rather similar degree of improvement from baseline. According to a multiple regression analysis, the effect of dilatation was a mean improvement of 3 points (confidence interval: -5 to 11) on the SPADI 0â100 scale. T-tests did not demonstrate any significant between-group differences in range of motion.</p> <p>Conclusion</p> <p>This study did not identify any important treatment effects resulting from three hydrodilatations that included steroid compared with three steroid injections alone.</p> <p>Trial registration</p> <p>The study is registered in Current Controlled Trials with the registration number ISRCTN90567697.</p
Intelligent framework for diagnosis of frozen shoulder using cross sectional survey and case studies
Diagnosis and management of adhesive capsulitis
Adhesive capsulitis is a musculoskeletal condition that has a disabling capability. This review discusses the diagnosis and both operative and nonoperative management of this shoulder condition that causes significant morbidity. Issues related to medications, rehabilitation, and post surgical considerations are discussed
Effectiveness of manual therapies: the UK evidence report
<p>Abstract</p> <p>Background</p> <p>The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions.</p> <p>Methods</p> <p>The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs.</p> <p>Results</p> <p>By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.</p> <p>Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments.</p> <p>Conclusions</p> <p>Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.</p> <p>Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.</p
GĂŒncel kelam tartıĆmaları
Ä°slĂąm dininin inanç, ibadet ve davranıĆlara dĂąir genel esaslarını tespit, temellendirme ve savunma görevini ĂŒstlenen kelĂąm ilminin gĂŒnĂŒmĂŒzde bu fonksiyonunu ne ölĂ§ĂŒde yerine getirdiÄi tartıĆma konusudur. Bu baÄlamda kelĂąmın kendini yenilemediÄi, çaÄımızda ortaya çıkan inanç problemlerine çözĂŒm ĂŒretemediÄi, bugĂŒnĂŒn insanına rehberlikte bulunacak bir dĂŒnya görĂŒĆĂŒ ortaya koyamadıÄı, çeĆitli dĂŒĆĂŒnce ve ideolojiler karĆısında Ä°slĂąmâı yeterince savunamadıÄı gibi eleĆtiriler söz konusudur. Benzer eleĆtirileri Ä°slĂąmĂź ilimlerin her birine yöneltmek mĂŒmkĂŒndĂŒr..
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