The prevalence of trunk asymmetries in the small island state of Malta

Background: Malta, the smallest member state of the European Union is constituted of two inhabited islands Malta and Gozo. In the Maltese islands there has not been any large population size definitive study concerning the incidence of trunk asymmetries that may indicate Adolescent Idiopathic Scoliosis (AIS) amongst the general population. Scoliosis is one of the most deforming orthopaedic conditions confronting children. To confirm the orthopaedic condition of scoliosis one has to carry out a visual examination that usually consists of the Adam’s Forward Bend test, this is followed by the measurement of trunk rotation with the use of a Bunnell Scoliometer. Should the angle of trunk rotation be more than five degrees then the positively screened student be referred for x-Rays and a 10 degree Cobb angle taken as being required to confirm the diagnosis of Scoliosis. The lack of a full scale study together with the apparent lack of awareness regarding the condition has prompted the authors to research the situation on all Gozitan children aged between 13 and 15 years of age. It was decided to measure Trunk Asymmetry and the aim of the study was to obtain statistical data on the occurrence of trunk asymmetries amongst the Gozitan population, to further analyse the ratio of distribution of trunk asymmetries between female and male students and finally to refer the positively screened students to the relevant medical authorities for x-ray to confirm a scoliosis diagnosis. Methods: This quantitative study design was carried out on all children aged between 13 to 15 years old over a five-month period. An Adam’s forward bend test and Scoliometer reading were taken for each participant consenting to this study. To minimse bias a qualified full time Physiotherapist graduated with a Bachelor of Science Honours degree in Physiotherapy since 2012, carried out these tests in the selected schools. Results: The results of the study concluded that 5.3% of the adolescent population in Gozo suffer from trunk asymmetries (13 out of 245). Prevalence of trunk asymmetry was calculated using the 95% confidence interval and the Chi square tests had a significant p-value. Further analysis showed that 69% of these were female and 31% were male. These results demonstrate that the prevalence of trunk asymmetries in Gozitan adolescents is comparable to that stated within the current literature. Conclusions: Results from the study confirms that trunk asymmetry is relatively common within the Maltese population. This might be indicative that a significant portion of the Maltese adolescent population might suffer from Adolescent Idiopathic Scoliosis. The intention of this research is to increase the general public’s awareness of the condition AIS, to make this condition more prominent to members of the allied professions, to reinforce the need for school screening projects and finally to ensure that the condition Trunk Asymmetry and Scoliosis is given the importance that it requires in the curriculum of study for physiotherapists.peer-reviewe

Low back pain : a comparative study on the value of core training versus traditional strengthening exercises

This randomised controlled trial (RCT) employed a pre-test/post-test design to compare the effects of core training (Pilates method) and traditional back exercises on a population with low back pain (LBP). Therapeutic intervention related to the Pilates method has recently become popular, but there is little evidence to prove it works. In this study, 120 individuals with LBP were allocated to three different groups. Group A was the control group, Group B was given modified Pilates intervention and Group C received traditional back exercises. All three groups were given a posture re-education session and back-care advice. After the initial session, the control group had individual sessions on posture re-education. The other groups undertook a six-week course of either modified Pilates or general back exercise classes. The modified Pilates group was taught how to use the core muscles, incorporating stabilisation with increasing functional movements. The back exercise group did similar exercises without learning to specifically stabilise. The Oswestry Low Back Pain Disability Questionnaire (ODQ) and the Visual Analogue Scale (VAS) were used as measures for pain and functional disability. Post-test ODQ readings showed no significant difference for pain-related function whilst VAS readings revealed a significant improvement in pain levels in all three groups, with the control group showing the best scores. However, the six-month follow-up scores showed that only the modified Pilates group continued to improve. At this stage, the control group was beginning to regress and the back exercise group was almost back to baseline measures. It was therefore concluded that core stability exercises have better long-term effects than traditional back exercisespeer-reviewe

Scoliosis : lower limb asymmetries during the gait cycle

This research was presented in the form of a poster presentation at the National Symposium of Health Sciences organised by the University of Malta, on the 24th April 2014.Several studies indicate that the gait pattern of subjects suffering from scoliosis differs from the norm. However, there is conflicting evidence regarding the source of this discrepancy. The objective of this study is to evaluate lower limb asymmetries in selected gait variables. Study design: A case–control study on lower limb asymmetries during gait which can be related to scoliosis. 31 subjects with scoliosis (Study Group - SG) and an equal comparative control sample (Control Group – CG) of subjects underwent objective gait analysis with the Vicon® motion caption system whilst walking at a comfortable speed along the gait laboratory walkway. Analysis was performed at three levels: (1) Asymmetry in the SG against asymmetry in the CG, (2) Difference in magnitude of asymmetry between the SG and CG, and (3) Global mean values in the SG vs. CG. The Paired Student T-Test was used for intra-group analysis whilst the Independent Student T-Test was used for inter-group analysis of the selected parameters, which include temporal parameters (stride length, stride time, step length, individual step speed, speed of gait, cadence, swing-to-stance ratio), ground reaction force (peak GRF values during Loading and Propulsion phases, vertical component only) and electromyography (peak EMG values and their time of onset, as a percentage of the gait cycle) of two lower limb muscles (Gastronemius and Vastus Medialis). No intra-group variation was found to be significant. However, the speed of gait was found to be significantly slower (p = 0.03) in scoliotic subjects when compared to the norm, as a result of the shorter stride length (p = 0.002 and longer stride time (p = 0.001) in the SG. Furthermore, there was statistical significance in the time of onset of EMG peaks for the Lateral Gastrocnemius (p = 0.02) with regards to inter-group difference in magnitude of lower limb asymmetry and global mean values. Scoliosis is a tri-planar deformity which has some impact on the gait pattern. This research study concludes that scoliotic subjects have a slower speed of gait due to a shorter stride length and a longer stride time, together with variations in the timing of muscle activation.peer-reviewe

Modernising the Maltese physiotherapy curriculum : An empirical study.

Following a poliomyelitis epidemic, physiotherapy was introduced to Malta in 1943 based on the curriculum of the English Chartered Society of Physiotherapy and has remained the core of Maltese physiotherapy courses. However, health services in Malta are undergoing major changes in policy and resources cumulating with the development of a new teaching hospital. The need was felt both from the clinical and academic perspectives that the inherited curriculum needed review to ensure it meets the current requirements of local stakeholders including those of overseas authorities. Various research methodologies were examined and a qualitative approach using an 'Action Research' paradigm was identified as the most appropriate. Seven cycles of planning, action and evaluation using documentary research and interviews with: educators, students, practitioners, patients, management as well as the professional body were undertaken. 'Thematic Analysis' was used to interpret and analyse the data. To triangulate the data collected during the previous cycles, Q Methodology was applied as a means to offer an empirical explanation to the qualitative data collected previously. During the early stages of the study the data indicated that both students and academia were not content with the curriculum and expressed scepticism that the study will result in change. As the study developed their interest increased, becoming actively involved in the research process resulting in the empowerment of the primary stakeholders to ameliorate their curriculum, work and working environment. Throughout the study changes to the course design, content, teaching and assessment methods of the curriculum have occurred, encouraging students to become critical and reflective practitioners. The study resulted in two curricula being designed; a workable curriculum acceptable to the University which would satisfy the needs of both local and foreign requirements and an 'ideal' curriculum for future implementation.Importantly this study offers a model and methodology for designing professional curricula that could be utilised by other professions, both locally and abroad. Finally, suggestions for further and future considerations are presented

IGF-I increases bone marrow contribution to adult skeletal muscle and enhances the fusion of myelomonocytic precursors

Muscle damage has been shown to enhance the contribution of bone marrow–derived cells (BMDCs) to regenerating skeletal muscle. One responsible cell type involved in this process is a hematopoietic stem cell derivative, the myelomonocytic precursor (MMC). However, the molecular components responsible for this injury-related response remain largely unknown. In this paper, we show that delivery of insulin-like growth factor I (IGF-I) to adult skeletal muscle by three different methods—plasmid electroporation, injection of genetically engineered myoblasts, and recombinant protein injection—increases the integration of BMDCs up to fourfold. To investigate the underlying mechanism, we developed an in vitro fusion assay in which co-cultures of MMCs and myotubes were exposed to IGF-I. The number of fusion events was substantially augmented by IGF-I, independent of its effect on cell survival. These results provide novel evidence that a single factor, IGF-I, is sufficient to enhance the fusion of bone marrow derivatives with adult skeletal muscle

European Headache Federation (EHF) consensus on the definition of effective treatment of a migraine attack and of triptan failure

Attack; Migraine; TriptanAtaque; Migraña; TriptánAtac; Migranya; TriptanBackground Triptans are migraine-specific acute treatments. A well-accepted definition of triptan failure is needed in clinical practice and for research. The primary aim of the present Consensus was to provide a definition of triptan failure. To develop this definition, we deemed necessary to develop as first a consensus definition of effective treatment of an acute migraine attack and of triptan-responder. Main body The Consensus process included a preliminary literature review, a Delphi round and a subsequent open discussion. According to the Consensus Panel, effective treatment of a migraine attack is to be defined on patient well-being featured by a) improvement of headache, b) relief of non-pain symptoms and c) absence of adverse events. An attack is considered effectively treated if patient’s well-being, as defined above, is restored within 2 hours and for at least 24 hours. An individual with migraine is considered as triptan-responder when the given triptan leads to effective acute attack treatment in at least three out of four migraine attacks. On the other hand, an individual with migraine is considered triptan non-responder in the presence of failure of a single triptan (not matching the definition of triptan-responder). The Consensus Panel defined an individual with migraine as triptan-resistant in the presence of failure of at least 2 triptans; triptan refractory, in the presence of failure to at least 3 triptans, including subcutaneous formulation; triptan ineligibile in the presence of an acknowledged contraindication to triptan use, as specified in the summary of product characteristics. Conclusions The novel definitions can be useful in clinical practice for the assessment of acute attack treatments patients with migraine. They may be helpful in identifying people not responding to triptans and in need for novel acute migraine treatments. The definitions will also be of help in standardizing research on migraine acute care.This work is supported by a grant from the European Headache Federation to cover publication fees

Neonatal Ovine Pulmonary Dendritic Cells Support Bovine Respiratory Syncytial Virus Replication with Enhanced Interleukin (IL)-4 And IL-10 Gene Transcripts

The lung microenvironment is constantly exposed to microorganisms and particulate matter. Lung dendritic cells (DCs) play a crucial role in the uptake and processing of antigens found within the respiratory tract. Respiratory syncytial virus (RSV) is a common respiratory tract pathogen in children that induces an influx of DCs to the mucosal surfaces of the lung. Using a neonatal lamb model, we examined the in vivo permissiveness of DCs to RSV infection, as well as overall cell surface changes and cytokine responses of isolated lung DCs after bovine RSV (BRSV) infection. We report that isolated lung DCs and alveolar macrophages support BRSV replication. Isolated lung DCs were determined to be susceptible to BRSV infection as demonstrated by quantification of BRSV non-structural protein 2 mRNA. BRSV infection induced an initial upregulation of CD14 expression on lung DCs, but by 5 d postinfection expression was similar to that on control cells. No significant changes in CD80/86 or MHC class I expression were seen on lung DCs after BRSV infection. Low to moderate expression of MHC class II and DEC-205 was detected by day 5 postinfection. Initially, on day 3 postinfection, lung DCs from BRSV-infected lambs had decreased endocytosis of fluorescein isothiocyanate (FITC)–ovalbumin (OVA). The amount of FITC–OVA endocytosed by lung DCs isolated on day 5 postinfection was similar to that of controls. The most interesting observation was the induction of immunomodulatory interleukin (IL)-4 and IL-10 cytokine gene transcription in lung DCs and alveolar macrophages after in vivo infection with BRSV. Overall, these findings are the first to demonstrate that neonatal lung DCs support in vivo BRSV replication and produce type II cytokines after viral infection

Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance

Cura de migranya; Migranya refractària; Migranya resistentMigraine care; Refractory migraine; Resistant migraineCuidado de la migraña; Migraña refractaria; Migraña resistenteBackground New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts). The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions. Methods We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. Results There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care. Conclusions This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities.Publication fees for this publication were covered by the European Headache Federation

Human Respiratory Syncytial Virus Memphis 37 Grown in HEp-2 Cells Causes more Severe Disease in Lambs than Virus Grown in Vero Cells

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in infants and young children. A small percentage of these individuals develop severe and even fatal disease. To better understand the pathogenesis of severe disease and develop therapies unique to the less-developed infant immune system, a model of infant disease is needed. The neonatal lamb pulmonary development and physiology is similar to that of infants, and sheep are susceptible to ovine, bovine, or human strains of RSV. RSV grown in Vero (African green monkey) cells has a truncated attachment G glycoprotein as compared to that grown in HEp-2 cells. We hypothesized that the virus grown in HEp-2 cells would cause more severe clinical symptoms and cause more severe pathology. To confirm the hypothesis, lambs were inoculated simultaneously by two different delivery methods (intranasal and nebulized inoculation) with either Vero-grown or HEp-2-grown RSV Memphis 37 (M37) strain of virus to compare viral infection and disease symptoms. Lambs infected with HEp-2 cell-derived virus by either intranasal or nebulization inoculation had significantly higher levels of viral RNA in lungs as well as greater clinical disease including both gross and histopathologic lesions compared to lambs similarly inoculated with Vero-grown virus. Thus, our results provide convincing in vivo evidence for differences in viral infectivity that corroborate previous in vitro mechanistic studies demonstrating differences in the G glycoprotein expression by RSV grown in Vero cells