As people get older, chronic diseases become an important reason of disability while a decline in physical functions is related to aging among the elders, which may lead to dependency and isolation of the older adults. Body asymmetry and imbalance body alignment can bring added stress to the joint structures that can cause dysfunction of the joint, ligaments, tendons, bursas, and related muscles, which in return brings about problem while walking or during activities of daily living. Joint Functional Screening (JFS) is a systemic clinical examination with clinical reasoning of the entire human joints body, with or without causative limitation to derive a holistic analysis of musculoskeletal system. JFS profile helps to assess body disorder of older people. This clinical screening include documentation of balance of the body, lower and upper body strength, joints flexibility, body composition, and body alignment. This is an innovation build to profile a normal musculoskeletal state to decode any anomaly in an otherwise a normal subject, who might be preparing to take up any activities in one’s lifespan that could elicit an injury which could be prevented. JFS could be a useful tool for physiotherapists, exercise therapist or even the personal trainers to screen a body prior to rehabilitative or an exercise program; and this clinical screening is presently a best guidance to prevent risk of fall or injury among individual healthy people and older adult.
Hand-to-hand bioelectrical impedance (HH BIA) is a low-cost method to estimate percent body fat (%BF). The BIA method is consistently reliable, but questions on validity remain. We have observed anecdotally that elbow position can render consistently different measures of %BF while using HH BIA, thus leading to the question: Does elbow angle influence the validity of measures derived using HH BIA? The purpose of this study was to assess the effect of elbow position (i.e., IN=flexed to 90° versus OUT=fully extended) on the reliability of HH BIA on 44 male and 24 female healthy adults (age=21±2 yrs, BMI=23±3). An additional aim was to assess the validity of the HH BIA %BF on a subset of subjects (n=12) using air displacement plethysmography (BOD POD®) as the criterion measure. The IN position was ~4%BF lower than the OUT position for HH BIA (p=0.05, effect size=0.67). Measures of %BF for both trials for the IN [intraclass correlation coefficient (ICC)=0.99, coefficient of variation (CV)=2.99%] and OUT (ICC=0.99, CV=1.48%) conditions were highly reliable. On the subsample, the OUT (18.3±6.7 %BF) position exceeded both the IN (14.5±7.4 %BF) and the BOD POD® (16.1±7.8 %BF) measures (p<0.05); however, IN and BOD POD® measures of %BF did not differ (p=0.21). These findings support that HH BIA is a reliable measure at both elbow positions; however, %BF estimations vary considerably (~4%) with respect to the criterion measure depending on elbow position. The OUT position was found to overestimate criteria %BF. Further research may reveal an optimum elbow angle position for HH BIA estimates of %BF.
Arlene Silverio, Scott Briggs, Lisena Hasanaj, Jeffrey Hurd Jr, Max Lahn, Liliana Serrano, Lucy Cobbs, Jenelle Raynowska, Rachel Nolan, Joel Birkemeier, Dennis Cardone, Steven L Galetta and Laura J Balcer*
Identifying concussion and initiating removal from play is challenging for even the most diligent youth sports organizations. Empowering parents to implement removal from play protocols and sideline testing may be the most practical plan at community levels to protect young athletes. We developed paradigms for community-based youth sports teams that incorporated both standard concussion protocols and research investigations. The research studies were designed to determine how sideline tests of vision, cognition and balance augment the capacity for parents and other responsible adults to identify youth athletes with concussion in ice hockey, football, lacrosse and cheerleading. Research-based sideline tests were performed at pre-season baseline sessions and during the season at the time of injury or as soon as symptoms were recognized by trained volunteer parent team testers. The combination of standard concussion protocols and research studies were performed for 510 athletes, aged 5-17 years, over 2.5 years through 5 athletic seasons. To implement the protocols and studies, approximately 80 student volunteers and parents were educated and trained on early concussion recognition and on baseline and sideline test administration. Over 80% of parent-identified head injuries were physician-confirmed concussions. Of the sideline tests performed, over two-thirds were administered within 24 hours of injury; the rest were performed within an average of 2.6 days post-injury since some athletes had delayed development of symptoms. Removal from play guidelines and standard concussion evaluation protocols were maintained in the context of the sideline testing research investigations. Based on this observational study, parents of youth athletes can be successfully empowered to perform rapid sideline tests in the context of existing concussion protocols. Implementation of objective testing may improve concussion identification and shift the culture of advocacy and responsibility towards parent groups to promote safety of young athletes. Ongoing investigations will further examine the impact of these programs on concussion management in youth sports.
Quadricuspid aortic valve (QAV) is rare congenital malformation of the aortic valve with estimated prevalence of 0.013% to 0.043% [1-4]. QAV is most commonly associated with aortic insufficiency (AI), which is found in almost 75% of cases . QAV can also be associated with other cardiac defects such as ventricular or atrial septal defects, patent ductus arteriosus, subaortic fibromuscular stenosis, malformation of the mitral valve, and coronary anomalies . Up to 40% of all patients with QAV undergo aortic valve replacement surgery most commonly due to progressive AI in 88% of case [2,3,6]. Here we report a case from our institution of a woman with QAV with severe AI and anomalous origin of the right coronary artery.
Coactivation of agonist and antagonist muscles participates in the regulation of joint stiffness and postural instability. Alterations on muscle activity have been revealed as an important falling risk factor. It is unclear the effects, and age-related differences, of a prolonged demanding task on the muscular coactivation levels. We compared muscle activation amplitude and coactivation of the vastus medialis, biceps femoris, tibialis anterior, and gastrocnemius medialis from surface EMG in 16 young adults (age 21-33) and 8 elderly adults (age 66-72) while fast-walking at 70% of their maximum heart rate. Overall, the elderly demonstrated higher coactivation indexes than the young individuals. Ankle coactivation decreased in the first half of the swing phase, while coactivation at the knee increased in the latter half of the swing phase in our elders. Alterations of muscle activation and coactivation on the knee and ankle were more prominent close to landing and in the swing phase. Our results suggest that these alterations may suggest potential concerns with respect to the risk of falls.
Rohit Kulshrestha*, Vinay V Umale, Kamlesh Singh, Aftab Azam and Madhvi Bhardwaj
Published on: 10th March, 2017
Aim: To evaluate sexual dimorphism in horizontal lip position in adults with different skeletal patterns.
Material and Methods: The sample comprised of 120 patients (Females 18 years and above, Males 21 years and above) with no history of previous orthodontic treatment or functional jaw orthopaedic treatment. They were divided into different groups based on the ANB angle and gender. Group I and II included 30 males and 30 females with skeletal class I malocclusion (ANB 0-4 degree). Group III and IV included 30 males and 30 females with skeletal class II malocclusion respectively (ANB above 4 degree).
Results: When comparison between males and females (Class I+Class II) was done S-line (p<0.001), B-line (p<0.001), E-line (p<0.001), Holdaways angle (p<0.001) and Merrifield angle (p<0.001) were found to be statistically significant. S-line (p<0.001), E-line (p<0.001) and Holdaways angle (p<0.001) were found to be statistically significant when comparison was done between males and females (Class I). When comparison was done between males and females (Class II) only Holdaways angle (p<0.001) showed a significant statistical difference.
Conclusion: Sexual dimorphism was found in various lip parameters. Significant amount of differences were found between Class I and Class II (male and female) subjects.
Purpose: To determine the normal value of basal angle measured using the modified MR imaging technique in Thai population compared with the standard value obtained from the Western population.
Material and Methods: We retrospectively evaluated midline sagittal SE T1 weighted MR images in 200 adults and 50 children. The basal angle of the skull base was measured using the modified MR imaging technique described by Koenigsberg et al. The angle was formed by a line extending across the anterior cranial fossa to the tip of the dorsum sellae and another line drawn along the posterior margin of the clivus. The mean values of the basal angles among different age groups and sex were calculated and analyzed.
Results: The mean skull base angle of our adult population was 115° (range 100.5°-130°, SD=5.7) with an inter-observer agreement of 0.85, slightly smaller than the previous study from the USA which was 117°. There was no significant difference between the male and female groups. The mean skull base angle in our children population was 114.7° (range 102- 130.5°, SD=6.3) with an inter-observer agreement of 0.89, quite similar to the previous USA study which was 114°. There was no significant difference between adult and children.
Conclusion: The mean adult skull base angle measured using the modified MR imaging technique in Thai population was slightly smaller than the Western population, while the mean skull base angle of children was quite similar. The basal angle range of 103.6°-126.4° may be used as a guide for the potential range of normal skull base angles in Thai population and possibly also the Southeast Asian population.
Background: Proximal humerus fractures (PHFs) are common injuries particularly in older adults. Evidence-based protocols for PHF rehabilitation are lacking and physiotherapists use a variety of interventions.
Purpose: To determine practice patterns and perceptions of physiotherapists who treat adults with PHF in Ontario, Canada.
Method: A paper and pencil survey asking about respondent demographics and management of Neer Group 1 (minimally/nondisplaced) and complex (displaced 3- and 4-part) PHF was mailed to 875 randomly selected physiotherapists who were registered with the College of Physiotherapists of Ontario in 2013/2014 and working in practice areas likely to be accessed by adults with PHF.
Results: The response rate was low (10%); 83 physiotherapists completed the survey - 80% had experience managing PHF. Respondents treated 1-5 individuals with PHF annually; more treated Neer Group 1 PHF (89%) than complex PHF (68%). Most individuals with PHF were older than 60 years (64%), female (76%) and accessed physiotherapy through a doctor’s referral (91%) more than 1 month post injury (33%).
Main findings: Physiotherapists manage PHF using multi-component interventions and a minimum of 76% include the following elements: education and progression of passive, active assisted, active range of motion exercises and muscle retraining to build coordination and strength. Use of other elements was variable. The main factors influencing the treatment plan were the ability of the individual with PHF to comply, bone quality, and fracture type. Most respondents were unsure that there is sufficient PHF rehabilitation literature to guide treatment.
Conclusions:This environmental scan is the first North American study to document practice patterns and attitudes of physiotherapists providing PHF rehabilitation. Elements used by physiotherapists in Ontario treating small numbers of individuals with Neer Group 1 or complex PHFs each year align well with the limited PHF rehabilitation literature available.
Potential implications:Multi-disciplinary collaborations to design and conduct large, high quality, multi-centre prognostic studies and RCTs that evaluate the effectiveness of key aspects of non-surgical PHF rehabilitation in various patient groups are needed. Meanwhile, consensus guidelines should be developed in the context of region-specific physiotherapy service models to inform best practice in PHF rehabilitation management.
Introduction: Chronic kidney disease is a costly and burdensome public health concern. Delayed recognition and treatment of CKD may predispose patients to unfavorable future outcomes and burden the healthcare services. The early detection of disease via screening programs is widely recommended. The present study is a hospital camp-based screening for detecting patients with chronic kidney disease in Varanasi from 2014-18.
Methods: The study subjects constituted 436 apparently healthy adults (age ≥18 years) of Varanasi. Information on socio-demographic profile, personal characteristics and clinical investigations were recorded. Stepwise binary logistic regression analysis was applied to find the significant predictors of chronic kidney disease.
Results: Median age of the study subjects was 40.5 years. There were 39.7% males and 60.3% females. Chronic kidney disease was found in 23.9% subjects. Underweight, diabetes mellitus, hypertension, smoking status and higher creatinine levels came out as significant predictors of chronic kidney disease.
Conclusion: We screened apparently healthy individuals and found very high percentages of chronic kidney disease and its predictors. Henceforth, understanding the preventable and modifiable risk factors of chronic kidney disease becomes a prerequisite to intervene before risk populations reaches to irreversible stages of adverse future outcomes.
Functional dyspepsia (FD) is a prevalent global health concern increasing with years. Inspired by the Traditional Chinese Medicine (TCM) liver-stomach disharmony syndrome in order to find a quick natural alternative treatment, a Ferula asafoetida-Silybum marianum (Asdamarin™) combined extract has been developed and proved its rapid efficiency and its safety with a 7-day randomized, double-blind, placebo-controlled pilot study (CTRI/2018/05/013993 dated 21/05/2018) conducted on 70 healthy human volunteers (aged 18–60 years) supplemented with 250 mg / twice a day of either a placebo or Asdamarin™. Subjects were evaluated from baseline to the end of the study (EOS) through changes in Gastrointestinal Symptom Rating Scale (GSRS), changes in Glasgow Dyspepsia Severity Score (GDSS) and changes in the short form of Nepean Dyspepsia Index (NDI-SF) for Quality of Life. Compared to the baseline a significant reduction (p < 0.001) of GDSS questionnaire score was noted in the Asdamarin™ group (from 5.66 ± 3.1 at baseline to 5.09 ± 2.8 at the End Of Study (EOS)) compared to placebo group (from 2.77 ± 1.3 baseline to 2.69 ± 1.3 EOS), a significant decrease (p < 0.001) of GSRS score noted in the Asdamarin™ group (from 32.11 ± 8.6 baseline to 19.11 ± 5.4 EOS) compared to the placebo group (from 25.23 ± 3.6 baseline to 23.2 ± 4.9 EOS), and a significant reduction (p < 0.001) of NDI-SF scoring was noted in the Asdamarin™ group (from 15.74 ± 4.1 baseline to 11.54 ± 2.1 EOS) compared to placebo group (from 12.54 ± 3.2 baseline to 11.63 ± 2.6 EOS). Asdamarin™ has been found safe and very well tolerated during the study.
Background: Skin diseases is a common worldwide problem. It affected every aspect of patients’ quality of life (QOL) mainly physically, socially and psychologically.
Objectives: to assess the impact of skin disorders on patients’ quality of life and to identify factors associated with it.
Methodology: This cross-sectional study was conducted in outpatient dermatology clinic of a tertiary hospital in Malaysia. A random sample of 145 patients with acne, psoriasis and atopic dermatitis (AD) were interviewed using DLQI questionnaire during their scheduled follow-up appointments at dermatology clinic.
Main outcome measure: Self-reported patients’ QOL due to their skin diseases.
Results and discussion: Out of three skin diseases psoriasis patients had the highest prevalence (39.3%) followed by AD (34.5%) and acne (26.2%). Patients’ QOL was highly influenced by their skin conditions especially on working/schooling domain. Furthermore, several factors were identified, namely age, working environment, concurrent skin diseases, usage of supplement for skin diseases and type of food as aggravating factors—that may influence patients’ QOL. QOL among females and younger adults was found to be more significantly influenced as compared to males and elderly. With respect to working environment, those who had both indoor and outdoor working environment showed the highest impact of their skin conditions on their QOL. Single patients were more influenced by their skin conditions when compared to those who are married, however it was not significant.
Conclusion: Our findings revealed skin disease had negatively impacted individual QOL with different level of aspects. Among the three diseases, AD patients had the worst impact on QOL. Significant predictors of QOL did not relate solely to skin diseases but also other factors such as type of food and working environment.
Objectives: As the cancer patients are at higher risk of premature deaths due to candidemia. So, the present study aims to evaluate the predictors of candidemia along with its outcomes among hospitalized adults and pediatric cancer patients.
Methods: A retrospective study was conducted at a tertiary care cancer hospital in Lahore, Pakistan. The data was collected from the medical records of all the patients who were found positive for Candida species between 1st January 2017 and 31st June 2017. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) and Microsoft Excel (MS Office 2010).
Results: Overall, 135 patients were detected with candidemia. Based on blood culture test results, it was found that out of 100 cultures positive for any microorganism there were 2 cases of candidemia. Multivariate analysis revealed that hematological malignancies (AOR: 2.1), and shock (AOR: 9.1) were significantly associated with high risk of mortalities during the index hospitalization, while risk of mortality among cancer patients suffering from Candida albican infection (AOR: 0.47) and those who were administered with antifungal agent after sensitivity report of the fungal culture (AOR: 0.2) was significantly less. Also, there was no significant association of empiric therapy of antifungal agent with the risk of mortality before a positive culture found (p>0.05).
Conclusion: Although, no risk factor was found to be associated significantly with candidemia among cancer patients. But hematological malignancies, non-albican candidemia and shock were predictors of higher risk mortality during index hospitalization.
Introduction: Necrotizing Fasciitis (NF) is a rapidly progressing, severe suppurative infection of the superficial fascia and the sorrounding tissues that may lead to necrosis, septic shock and death if left untreated. Facial NF is rarely seen and symptoms may be non-specific at the onset and depend on the origin site and the stage of the disease, making it difficult for diagnosis.
Materials and Methods: A systematic review was done following the PRISMA guidance. PubMed database was searched for case reports published between January 2007 and March 2017. Full text articles were obtained and assesed for relevance. Data extraction was performed as an iterative process.
Results: A total of 24 articles, describing 29 adult patients with facial NF were included. Facial NF was more common in males. Skin trauma was the most frequent mechanism of lesion and diabetes mellitus was the most common associated systemic disorder. Periorbital area was the most affected area. In order of appereance, swelling and pain were the most common initial clinical manifestations. Group A Streptococcus was the most frequent microorganism isolated. Advanced airway management was needed in more than 50% of the cases and surgical management was done in 90% of the cases.
Conclusions: Practitioners should be aware of its existance, epidemiology, etiology, risk factors and initial clinical manifestations to develop a high index of suspicion, to order studies that may discard or confirm the diagnosis, and to offer prompt treatment to preserve patient’s life and reduce the disfigurement and disability that it may cause.
Between 2013 and 2016 the main tasks for the German public health care departments were mainly related to medical support in terms of the management of outbreaks of infectious diseases, physical examinations of children and adults to exclude tuberculosis ore other infectious diseases, the administration of vaccinations and medical acute care.
Tinnitus-derived from the Latin “tinnire” meaning “to ring” is a perceived ringing, buzzing, or hissing in the ear(s) or around the head-which has multiple etiologies and is sometimes idiopathic. As of 2009 in the United States, approximately 50 million Americans were affected for six months or greater, while a United Kingdom study in 2000 reported a 10% prevalence in the adult population . Tinnitus may vary widely with regard to pitch, loudness, description of sound, special localization, and temporal pattern . Most often, tinnitus is associated with other aural symptoms, such as hearing loss and hyperacusis . Tinnitus may result in sleep disturbances, work impairments, and distress. The severity varies within this cohort of chronic sufferers, with some unable to fulfill daily activities. Though tinnitus is more likely to affect adults and the incidence increases with age, children can experience tinnitus as well . Males are more likely to suffer as are individuals who smoke .
Clinical applications of Artificial Intelligence (AI) in healthcare are relatively rare. The high expectations in relation to data analysis influencing general healthcare have not materialized, with few exceptions, and then predominantly in the field of rare diseases, oncology and pathology, and interpretation of laboratory results. While electronic health records, introduced over the last decade or so in the UK have increased access to medical and treatment histories of patients, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, laboratory and test results, these have potential for evidence-based tools that providers can use to make decisions about a patient’s care, as well as streamline workflow. In the following text, we review the advances achieved using machine learning and deep learning technology, as well as robot use and telemedicine in the healthcare of older people.
1. Artificial Intelligence use is extensively explored in prevention, diagnosis, novel drug designs and after-care.
2. AI studies on older adults include a small number of patients and lack reproducibility needed for their wider clinical use in different clinical settings and larger populations.
3. Telemedicine and robot assisted technology are well received by older service users.
4. Ethical concerns need to be resolved prior to wider AI use in routine clinical setting.
Aim and objective: Dentistry for children is not difficult but is different from what is practiced for adults. The children reacts to differently to people and places around them. Anxiety is an emotional state that helps normal individual defend themselves against a variety of threats and Dental anxiety refers to patients specific response towards dental suitation-associated stress. so the aim is to evaluate the anxiety related management of the children using intellectual mind game of the individual
Study design: The background of the study is to evaluate and study the effectiveness of anxiety control of children using colour distraction between 5 and 12 yrs of age group as one part and the intellectual distraction of children between the same age group using buchanan facial imaging scale and intellectual coloured game chart
Results and conclusion: lowering of anxiety was noticed in the children obtained the favorite colours in the dental environment and easy distraction can be achieved using intellectual gamings.
Lipomas are the most common type of soft tissue tumor occurring in the subcutaneous tissue. Rarely, lipomas present in the deep soft tissue such as intermuscular, intramuscular, and parosteal sites. When they occur within a skeletal muscle they are called intramuscular lipomas. Intramuscular lipomas may involve both children and adults. They are benign, nontender, deep located, circumscribed but unencapsulated lesions. Intramuscular lipomas account less than 1% of all lipomas. Most are located within a single muscle (solitary), while cases involving two or more muscles are very rare. They present with typical histological features. They may be divided into the infiltrative, the well-circumscribed and the mixed type. Differential diagnosis of the infiltrative type from liposarcoma is very difficult. Local recurrence may be evident if the surgical margin is not clear. They can occur in almost any anatomical site [1-15].
The use of cell phones has remarkably increased in the last two decades with several pros and cons. The negative consequences of cell phones on mental health have not been studied widely. Aggression, in this regard was a completely neglected area. The present study, therefore, was carried out to investigate the relationship between cell phone use and aggression and to further identify the moderating roles of gender and marital status between cell phone use and aggression. The inquiry included 500 young adults from Rawalpindi, Pakistan. Buss and Perry Aggression Questionnaire was administered. It was hypothesized that there would be a strong positive relationship between cell phone use and aggression. It was further hypothesized that gender and marital status would be significant moderators between cell phone use and aggression. The results supported the hypotheses on significant differences and made a significant contribution in the existing scientific literature.
Subungual exostosis (SUE) is a benign phalangeal tumor of an osteocartilaginous nature . SUE is most commonly diagnosed in children and young adults; most of these lesions are located in the big toe, although they can occur (albeit infrequently) in other toes. We report five observations of SUE described in young children under 10 years and discuss the particularities of this pathology in the pediatric population.
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Dr. Shuaib Kayode Aremu
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