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Background: Protein intake and physical activity have a substantial impact on body composition and weight loss outcomes after bariatric surgery. The 24-h dietary recall and 6-min walk test (6mWT) are frequently used to monitor protein intake and physical activity, respectively. Despite its frequent use, it is unknown whether these tests can predict long-term weight loss. Methods: This retrospective study included 85 patients who underwent laparoscopic Roux-en-Y gastric bypass. Protein intake was recorded using the 24-h dietary recall and physical function was measured using the 6mWT. Data about total weight loss (TWL) and nonresponse (i.e., insufficient weight loss and weight regain) were collected up to 5 years. Multiple regression analyses were performed to examine the predictive value of the 24-h dietary recall and 6mWT on weight loss outcomes. Results: The mean protein intake 1 year postoperatively was 68.1 +/- 15.0 g/day and the mean distance covered during the 6mWT was 591.7 +/- 67.9 m. Both the 24-h dietary recall and 6mWT were not significantly associated with TWL and neither with nonresponse. Conclusions: The 24-h dietary recall and 6mWT are poor predictors for long-term weight loss outcomes after gastric bypass. Despite the well-known advantages of these clinical tests, other monitoring tests are suggested for future research.

OBJECTIVE Identifying roots available for grafting is of paramount importance prior to reconstructing complex injuries involving the brachial plexus. This is traditionally achieved by combining input from both clinical examinations and imaging studies. In this paper, the authors describe and evaluate two new clinical tests to study long thoracic nerve function and, consequently, to predict the status of the C5 and C6 roots after global brachial plexus injuries. METHODS From March 2020 to December 2020, in 41 patients undergoing brachial plexus repair, preoperative clinical assessments were performed using modified C5 and C6 protraction tests, C5 and C6 Tinel’s signs, and MRI findings to predict whether graft-eligible C5 and C6 roots would be identified intraoperatively. Findings from these three assessments were then combined in a logistic regression model to predict graft eligibility, with overall predictive accuracies calculated as areas under receiver operating characteristic curves. RESULTS In the 41 patients, the pretest probability of C5 root availability for grafting was 85% but increased to 92% with a positive C5 protraction test and to 100% when that finding was combined with a positive C5 Tinel’s sign and favorable MRI findings. The pretest probability of C6 root availability was 40%, which increased to 84% after a positive C6 protraction test and to 93% when the protraction test result concurred with Tinel’s test and MRI findings. CONCLUSIONS Combining observations of the protraction tests with Tinel’s sign and MRI findings accurately predicts C5 and C6 root graft eligibility.

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly affecting the axial skeleton. axSpA includes radiographic (i.e., ankylosing spondylitis (AS)) and non-radiographic forms (nr-axSpA). Although recent studies have reported that patients with AS have impaired gait, axSpA’s consequences on gait remain unknown. The present review’s objectives were to identify: 1) how gait is assessed in patients with axSpA, and 2) what the gait characteristics are of patients with axSpA. This systematic review’s protocol was registered in the Prospero database (CRD42020128509). Three databases were systematically searched using keywords related to axSpA and gait. Two independent reviewers selected the articles and extracted the data. The search revealed two hundred titles and abstracts, and two articles were finally included in this review, comprising a total of 132 patients with axSpA. One of the included studies used the 6 m maximum gait velocity test (axSpA: 2.2 ± 0.5 m/s), and the other used the six-minute walk test (axSpA: 414 ± 106 m). Neither study involved a control group to compare gait. Only two published studies assessed the gait performance of patients with axSpA using clinical tests. Furthermore, neither of them compared gait performance to healthy controls or differentiated gait between the AS and nr-axSpA forms of axSPA. The present literature review highlights the need for future research to learn more about how gait is impaired in different types of patients with axSpA.

Academic health centers and health systems increasingly ask patients to enroll in research biobanks as part of standard care, raising important practical and ethical questions for integrating biobank consent processes into health care settings. This article aims to assist academic health centers and health systems considering implementing these integrated consent processes by outlining the 5 main issues-and the key practical and ethical considerations for each issue-that Indiana University Health and the Indiana Biobank faced when integrating biobank consent into their health system, as well as the key obstacles encountered. The 5 main issues to consider include the specimen to collect (leftover, new collection, or add-ons to clinical tests), whether to use opt-in or opt-out consent, where to approach patients, how to effectively use digital tools for consent, and how to appropriately simplify consent information.

Made available in DSpace on 2022-05-01T09:31:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-11-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objectives: To compare trunk muscle endurance among females and males with and without patellofemoral pain (PFP), and to investigate the correlations between trunk muscle endurance and performance of the single leg hop test (SLHT) and forward step-down test (FSDT). Design: Cross-sectional. Setting: Laboratory-based study. Participants: 110 females and 38 males with PFP, 61 females and 31males without PFP. Main outcome measures: Anterior and lateral trunk muscle endurance were assessed with the prone and bilateral side-bridge tests, respectively. Performance during the SLHT and FSDT was also assessed. Results: Lower anterior and lateral trunk muscle endurance were identified in females (p

There are few instruments available for evaluating functional mobility during multitasking in people with Parkinson’s Disease (PD). Virtual Reality is a potentially tool capable of aiding in the evaluation of functional mobility. The purpose of this study is to verify the potential of the Virtual Functional Mobility Test (VFMT) as a clinical tool to assess functional mobility of people with PD during multitasking condition. 25 people with PD and 25 people without PD, matched for age and sex, were recruited. Participants were evaluated through the Trail Making Test, Timed “UP and GO” test, Timed “UP and GO” test in dual task condition and through the VFMT, composed of 1) a simple task, and 2) a complex task. The VFMT and clinical tests were sensitive to differentiate the groups, except the trail making test part B (p = 0.332) and complex task (p = 0.052). Strong correlations were observed between parts A and B of the trail making test (r = 0.75) and complex task (r = 0.72); Moderate correlations between Timed Up and Go test and Timed Up and Go test in dual task condition with simple task (r = 0.47) and complex task (r = 0.55), respectively, were found. The complex task and simple task showed excellent and moderate reliability intra-rater, respectively. It was concluded that the novel VFMT is feasible, sensible, reliable and has potential as an instrument for the evaluation of functional mobility during multitasking in people with PD.

Cannabis spp. are some of the most controversial medicinal plants in the world. They contain great amounts of biologically active secondary metabolites, including the typical phenolic compounds called cannabinoids. Because of their low toxicity and complex biological activities, cannabinoids can be useful in the therapy of various diseases, but adverse psychological effects (of Δ9-THC in particular) raise concerns. This review summarizes the current knowledge of selected active C. indica compounds and their therapeutic potential. We summarize the main compounds contained in cannabis, the mechanisms of their effects, and their potential therapeutic applications. Further, we mention some of the clinical tests used to evaluate the efficacy of cannabinoids in therapy.

OBJECTIVES: The accuracy of clinical tests (Lachman, McMurray, Anterior Drawer) in the diagnosis of knee joint injuries in comparison to arthroscopy taken as gold standard. METHODOLOGY: This cross-sectional study was conducted at the Department of Orthopedic Surgery, Khyber Teaching Hospital, Peshawar for 3 years. Total of 48 patients were recruited in the study. Data was collected after ethical approval from the hospital ethical committee using consecutive non-probability sampling techniques. Written informed consent was obtained from the patients. Arthroscopy examination was taken as a gold standard. Data analysis was performed using statistical software SPSS 21 and MEDCALC online software for calculating sensitivity and specificities of the clinical tests. RESULTS: Mean age was 26.4+6.5 years. Lachman and Anterior Drawer tests were noted to have 91.67% and 66.67% sensitivity for anterior cruciate ligament while McMurray test was noted only 66.67% sensitive for both meniscal injuries. On the other hand, Lachman was 95.8% specific, McMurray was 77.78%, and Anterior Drawer was 79.2% specific. Regarding accuracy, Lachman was 93.7%, McMurray 70.8% and Anterior Drawer was 72.9% accurate. CONCLUSION: Among clinical examination and specific examination tests, Lachman has high sensitivity, specificity and accuracy followed by Anterior Drawer test and MacMurray for diagnosing anterior cruciate ligament and meniscal injuries of knee joint.

Objective To synthesize available evidence about diagnostic accuracy of clinical tests and imaging examinations for femoroacetabular impingement (FAI) syndrome. Design Umbrella review. Setting N/A. Participants N/A. Interventions N/A. Main outcome measures Systematic reviews (SR) indexed in Embase, LIVIVO, PubMed, SCOPUS, the Cochrane Library, and Web of Science were searched in a 2-phase process. SR assessing diagnostic accuracy were considered eligible. Results From 1520 studies, 6 SR were included, which evaluated 24 primary studies related to FAI syndrome. Of these, 5 SR assessed clinical tests, and a substantial heterogeneity was found concerning reference standards adopted across primary studies, which included arthroscopy, clinical examination (associated or not with imaging exams), intra-articular injections, and open surgery. Most clinical tests presented higher values of sensitivity compared with specificity, although evidence was considered limited because the same primary studies were often included across SR. Nonetheless, evidence around the flexion adduction internal rotation (FADIR) test was considered stronger and its use as a screening tool was consistently supported. Only one SR assessed the accuracy of imaging examinations, which adopted open surgery as the sole reference standard. Most imaging exams presented considerably high values of sensitivity, although specificity values were notably lower. Conclusions No robust recommendations can be provided for most clinical tests, although the FADIR test, in particular, was consistently supported as a screening tool. Moreover, although imaging examinations showed considerably high sensitivity values, evidence was considered sparse and further research is strongly recommended to validate its use as reference standards for diagnostic accuracy data.

With aging, regular changes develop in metabolism, first of all, these are changes in lipid and carbohydrate metabolism. With accelerated aging, metabolic disorders are more expressed, which leads to the development of metabolic syndrome. The purpose of the work was to develop a method for calculating metabolic age using available clinical tests and to assess the rate of metabolic aging in people with metabolic syndrome. Materials and methods. The study involved 283 apparently healthy people aged 20 to 80 years and 82 people with metabolic syndrome. Anthropometric parameters and biochemical tests were measured for all people included in the study. The formula for calculating metabolic age was obtained by the method of stepwise multiple regression.Results. The calculation of the metabolic age in healthy people according to the formula we obtained showed that the average absolute error is 6.01 years. In 20.5% of people with metabolic syndrome, metabolic age exceeds chronological age by more than 10 years. At the same time, in the group of healthy people, the share of such people was only 4.2%. Conclusions. The method we have developed for assessing the rate of metabolic aging has a sufficiently high accuracy and can be used to assess the risk of developing metabolic syndrome and other agerelated pathology.

Background: Ulnar-sided wrist pain is a common cause of upper- extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Carful clinical examination should be done, there are some provocative tests for some pathologies which induce pain when the patient has the specific pathology for the test. MRI of the wrist is often challenging because the components of the wrist have complex anatomy of bone and soft tissues, with ligaments and cartilage which are small sized structures measuring millimeters. MRI is a one of advanced imaging techniques that play an important role in evaluating the wrist and is a useful examination modality because of its multiplanar, multisequence capability and its excellent resolution of soft tissue structures. MRI is particularly advantageous for assessing occult bone lesions and soft tissue structures around the wrist such as cartilages, tendons, ligaments and nerves. Aim: The aim of this study is to assess the role and accuracy of clinical tests and MRI in diagnosis of chronic ulnar-sided wrist pain causes. Patients and Methods: This is a prospective study and was conducted on a 50 adult patients complaining from chronic ulnar side wrist pain. They were attended to Orthopedic Department of Tanta University Hospitals over a period of 6 months starting from November 2019 till May 2020. Results: MRI gave positive finding in most of patients (92%), while negative in about (8%) of cases, this means that there are some pathologies need more investigations to be diagnosed. Most of Clinical tests also gave a help in diagnosis of the cause of the pain especially ulnocarpal stress test, fovea sign test, ECU synergy test and piano key test which by statistics showed significant results but LT ballottement test had insignificant results so LTL pathology can't be diagnosed by clinical tests only but needs more investigations as MRI. So some pathologies can be diagnosed clinically as ECU tenosynovitis, but other pathologies need more investigations like MRI like LTL tear, also some pathologies need more investigations. Conclusion: Most of clinical tests give significant results in diagnosis of chronic ulnar-sided wrist pain except for some pathologies like LTL tear needs more investigations, also MRI has important role and gives significant results in diagnosis.

Fetal movement (FM) is one of the important indexes of clinical observations on fetal activities (such as the position, duration and relative force of FM), and as demand for the home monitoring of pregnant women grows increasingly, a wearable device for the long-term monitoring of fetal movement has drawn more and more attention. This study integrated multi-point IMU sensing with an innovative real-time classification method to build a device for the long-term monitoring of fetal movement, including the evaluation of the relative position, force and duration. In order to validate the sensitivity and clinical feasibility of the device, this study performed phantom simulation tests and clinical tests on 13 pregnant women. The phantom test results showed that the device had high accuracy (>90.3%) in recognizing 12 FM positions, the relative force had high correlation ( ${R}^{2}>0.98$ ), and the duration of FM had a low error percentage (

Pelvik kuşak ağrısı (PKA) yaygın olarak görülen bir kas-iskelet sistemi hastalığıdır. Gebelik, travma, artrit ve osteoartrit ile ilişkili olarak artan PKA, hormonal, biyomekanik, travmatik, metabolik, genetik, psikolojik, nörofizyolojik ve dejeneratif faktörlere bağlı olarak ortaya çıkmaktadır. PKA ağrı ve aktivite limitasyonu gibi durumlara yol açarak yaşam kalitesinde azalmaya yol açmaktadır. PKA’lı bireylerde açığa çıkan bu durumların hasta bildirimli ve performansa yönelik sonuç ölçümleriyle değerlendirilmesi, tedavi programının planlaması ve etkinliğinin gösterilmesi açısından önemli rol oynamaktadır. Bu çalışmanın amacı PKA’lı bireylerin tanı ve değerlendirilmesinde kullanılan klinik testleri ile hasta bildirimli ve performansa dayalı sonuç ölçümlerini derlemektir. Bu amaçla PubMed, Google Scholar ve ScienceDirect veri tabanlarında ilgili anahtar sözcükler kullanılarak 1 Aralık 2020 tarihine kadar yayımlanmış olan çalışmalarda tarama yapılmıştır. PKA’lı bireylerin tanısında kullanılan klinik testler ve değerlendirilmesinde kullanılan hasta bildirimli ve performansa dayalı sonuç ölçümleri psikometrik analizlerle sunulmuş, gerek performansa dayalı sonuç ölçümleri ve gerekse bunların karşılaştırıldığı çalışmaların oldukça az sayıda olduğu görülmüştür. Bu derlemenin bulgularının PKA’lı bireylerle çalışan tüm sağlık profesyonelleri ve araştırmacılar için yol gösterici olacağı düşünülmektedir., Pelvic girdle pain (PGP) is a common musculoskeletal disease. PGP, which increases in relation to pregnancy, trauma, arthritis and osteoarthritis, arises due to hormonal, biomechanical, traumatic, metabolic, genetic, psychological, neurophysiological and degenerative factors. PGP causes a decrease in quality of life by causing conditions such as pain and activity limitation. Assessment of these conditions in individuals with PGP by patient notification and performance-based outcome measurements play an important role in terms of planning the treatment program and its effectiveness. This study aimed to compile clinical tests and outcome measures used in the diagnosis and evaluation of individuals with PGP. For this aim, the studies published in PubMed, Google Scholar, and ScienceDirect databases were searched using the relevant keywords 1 December 2020. The clinical tests used for diagnosis and patient-reported and performance-based outcome measures used in the evaluation of individuals with PGP have been presented with psychometric analysis, and it has been observed that there are very few studies that compared both performance-based outcome measures and these. It is thought that the findings of this review will be a guide for all health professionals and researchers working with individuals with PGP.

Background. Dry eye disease (DED) is a multifactorial and one of the most common problems treated in an ophthalmic outpatient clinic. Due to the variability in presentation, diagnosis of DED consists of a combination of subjective and objective clinical tests. The purpose of this study was to assess the effectiveness of a handheld smartphone-based infrared thermal (IRT) camera for screening symptomatic evaporative DED. Methods. This observational sex-matched control study assessed IRT images of 184 right eyes (46 normal and 138 DED) of 184 participants. Evaporative DED was assessed using noninvasive tear breakup time, fluorescein staining, and the Chinese version of the ocular surface disease index (C-OSDI) questionnaire and categorized into their respective dry eye symptomology group (none, mild, moderate, or severe). The ocular surface temperature (OST) at 8 anatomical regions of interest (ROI) (nasal conjunctiva, nasal limbus, nasal cornea, central cornea, inferior cornea, temporal limbus, temporal cornea, and temporal conjunctiva) were measured and compared using a handheld smartphone-based IRT camera. The effectiveness of these 8 ROIs OST in detecting varying severity of DED was evaluated in terms of correlations with severity of DED and their area under the curve (AUC). Results. OST at the 8 anatomical ROI was significantly higher in DED participants than in the non-DED group ( p < 0.05 ) except for inferior cornea, temporal limbus, and temporal conjunctival regions (>0.05). Analyzing 8 anatomical ROIs revealed that the nasal limbus had the highest Pearson correlation with the severity of DED (0.64, p < 0.001 ). Additionally, the nasal limbus ROI achieved the highest AUC of 0.79 (CI: 0.73–0.85; p < 0.05 ), sensitivity, and specificity (0.96 and 0.91) when comparing its ability to discriminated DED vs. non-DED eyes. Conclusions. Rather than a diagnostic tool, handheld smartphone-based IRT images can be considered as a rapid, noninvasive, and hygienic screening tool in discriminating DED and non-DED and potentially alleviating inconvenience experienced during conventional tests.

Adherence to antiretroviral therapy (ART) is a prerequisite to improve immunity and reduce the morbidity and mortality of people living with HIV (PLWH). To describe ART adherence and associated factors among PLWH, patients who initiated ART in Liuzhou between 1998 and 2013 were recruited. Socio-demographic characteristics, HIV infection-related characteristics and clinical tests were analyzed. Both descriptive and multi-level analyses were used to explore factors related to ART adherence of PLWH who initiated ART in Liuzhou. A total of 8433 patients were recruited in this study. The rate of adherence to ART was 84.9% in PLWH who initiated ART in Liuzhou between 1998 and 2013. The female sex, WHO clinical stage III or IV before ART initiation, longer treatment duration and higher triglyceride were positively associated with ART adherence. Meanwhile, HIV acquired by intravenous drug use, co-infection with tuberculosis and other opportunistic infections were negatively associated with ART adherence. Measures should be adopted to improve the ART adherence of PLWH who are male, acquired HIV by intravenous drug use, and are co-infected with tuberculosis and other opportunistic infections.

In the era of healthcare digitalization, automation of some medical processes becomes extremely crucial, especially in situations where it is not possible to receive support quickly enough, for example, due to long wait for a specialist (queues) or absence of the needed specialist. This approach will help to use healthcare resources effectively. Automated audiometry is an example of automated diagnostic procedure based on algorithms and technical means for recording acoustic threshold in order to determine the hearing conditions. This review describes the process of automated hearing testing technology development in detail and several other system components (software, equipment, acoustic stimulation sources). The authors describe their own experience of using the automatic audiometry system. The results of comparative study of automated and clinical tests are presented.

To assess muscular abnormalities related to systemic sclerosis (SSc) using shear wave elastography and correlate results with those of clinical tests.We evaluated 55 patients (mean age: 50.4 years; range: 18-88; 34 female) with SSc before treatment and choose muscle groups based on cutaneous involvement and functional impairment [forearms (9); thighs (41); thenar/hypothenar (5)]. We performed shear wave elastography in two orientations to access heterogeneity using virtual touch IQ and mean shear wave velocity values (SWV) and measured skin and fascia thickness. We compared SWVs to the modified Rodnan skin score (mRSS). Twenty-two healthy controls (mean age: 52.0; range: 19-88; 7 female) underwent the same protocol.SWV pattern analysis (homogeneous vs heterogeneous) detected SSc with sensitivity/specificity/negative predictive value/positive predictive value0.79/0.81/0.91/0.62 in transverse and 0.75/0.18/0.91/0.56 in longitudinal orientation. In patients we found poor correlation between SWVs and mRSS but a cutoff of mRSSE = 20 separated them significantly (p0.01). Skin and muscle fascia were significantly thicker in patients vs. controls (p0.001).SSc involves more than increased skin and fascial thickness which is not fully represented by mRSS. Elasticity differs in muscles with and without SSc. The former shows higher SWV and increased heterogeneity in transversal planes of muscular fibers.

Objectives: To evaluate 20 Kampo medicines, which comprised 6 formulas, Otsujito, Junchoto, Tokakujokito, Bofutsushosan, Mashiningan, and Keishikashakuyakudaioto, from 7 brands, to create a ranking of Kampo medicines for appropriate selection of laxatives. Methods: The amounts of sennosides A and B, the important components showing laxative effects contained in Kampo medicines, were analysed using High Performance Liquid Chromatography. Results: We found that the amounts of sennosides A and B were different among brands, even when they had the same formula. Furthermore, the amounts of sennosides differed when the same amounts of rhubarb were used. Conclusions: These results suggest that the differences in amounts of sennosides are caused by the quality of the rhubarb used. Kampo medicines containing laxatives other than rhubarb, including disodium sulphate and hemp seed, had synergistic laxative effects. Thus, in the future, it may be possible to adjust laxative potency of Kampo medicines through further clinical tests.

To assess and compare all current computed tomography angiography (CTA) scoring systems for the diagnostic workup of brain death (BD) to digital subtraction angiography (DSA) and clinical tests. Fifty-two patients with a clinical suspicion of BD underwent CTA and subsequently DSA. The diagnostic performance of all current CTA scoring systems was compared to that of DSA, in all patients with a suspicion of BD. A comparison to clinical tests was made only in DSA-positive for BD patients (n = 49), since in DSA-negative BD patients (n = 3) clinical tests were not performed. Further subgroup analysis was performed in relation to skull defects (SDs) stratification. Statistical analysis was conducted by applying statistics-contingency tables, Cochran’s-Q test and McNemar’s test. The CTA -10, and -7- and all 4-point scoring systems, showed overall sensitivities of 81,6%, 87.8% and 95.9% respectively and 100% specificity, when compared to DSA. In patients with a clinical verification of BD, the CTA -10 and -7-point scoring systems were significantly inferior to clinical tests (p = 0.004 and p = 0.031), while the 4-point scoring systems showed no such difference (p = 0.5). All 4-point scoring systems showed 100% sensitivity in patients with a minor SD or no SD. In patients with a major SD, all CTA scoring systems (− 10, − 7- and all 4-point) were less sensitive (62.5%, 62.5% and 75% respectively). The presence of a major SD was associated with an 8 × relative risk for false negative results in all 4-point scoring systems. CTA showed excellent diagnostic performance in patients with a suspicion of BD. The 4-point CTA scoring systems are the most sensitive for the diagnosis of BD, although in patients with a major SD patient, the role of CTA is ambiguous.

The purpose of this systematic literature review is to analyse the role of the iliofemoral ligament (ILFL) as a hip joint stabilizer in the current literature. A total of 26 articles were included in the review. The ILFL is the largest hip ligament consisting of two distinct arms and is highly variable, both in its location and overall size, and plays a primary role in hip stability; in the case of hip dislocation, the iliofemoral ligament tear does not heal, resulting in a persistent anterior capsule defect. Clinically, the ILFL is felt to limit external rotation in flexion and both internal and external rotation in extension. The abduction–hyperextension–external rotation (AB-HEER) test is overall the most accurate test to detect ILFL lesions. Injuries of the ILFL could be iatrogenic or a consequence of traumatic hip instability, and can be accurately studied with magnetic resonance imaging. Different arthroscopic and open techniques have been described in order to preserve the ILFL during surgery and, in case of lesions, several procedures with good to excellent results have been reported in the existing literature. The current systematic review, focusing only on the ILFL of the hip, summarizes the existing knowledge on anatomy, imaging and function and contributes to the further understanding of the ILFL, confirming its key role in anterior hip stability. Future studies will have to develop clinical tests to evaluate the functionality and stability of the ILFL. Cite this article: EFORT Open Rev 2021;6:545-555. DOI: 10.1302/2058-5241.6.200112

Perturbation-based balance training (PBT) has been shown to improve reactive balancing abilities in chronic stroke. To inform future investigations in the subacute phase of stroke, the objective of this series of N-of-1 studies was to investigate the range of balancing responses to unexpected mechanical perturbations applied to the pelvis during walking on an instrumented treadmill before and after PBT training. Three subacute stroke subjects were assessed on each occasion with clinical tests and biomechanical measurements following perturbations applied in forward, backward, inward and outward directions. After 15 daily sessions of PBT, most clinical mobility outcomes showed improvements in all three subjects. Assessment of reactive balancing also showed improvements in all subjects when responding to perturbations in backward and inward directions whereas the changes following perturbations in forward and outward directions were subject-specific. The results suggest that PBT should be individually tailored to target balance deficiencies identified through a serial biomechanical assessment.

Introduction. Chronic recurrent instability of the shoulder joint is a frequent outcome of conservative treatment oftraumatic dislocation of the shoulder (2.8–30 % of cases). Preoperative examination largely determines the outcome of surgical treatment of this pathology.The aim of the study was to provide a clinical assessment of the developed algorithm for the surgical treatment of patients with recurrent anterior shoulder joint instability. Materials and methods. The results of treatment of 98 patients with recurrent anterior shoulder joint instability were studied. Preoperative examination included clinical tests, MRI or CT with calculation of bone loss. Fifty-six patients (57.1 %) underwent Bankart operation, 14 patients (14.3 %) – Latarjet operation. Twenty-three patients (23.5 %) underwent Bankart + Remplissage surgery, and 5 (5.1 %) – Latarjet + remplissage. The result was assessed on the ROWE scale.Results. Bone defects significant in the formation of instability (“glenoid off track”) were found in 19.4 % of patients, and “glenoid on track” – in 80.6 %. According to the proposed algorithm for treating patients with anterior recurrent instability of the shoulder joint, the “glenoid off track” state was an indication for Latarjet surgery. When “glenoid on track” was used, indications for Bankart operation were displayed. The remplissage procedure was indicated in case of the presence of a Hill-Sachs grade 3 defect or the presence of hyperelasticity of the tissues of the shoulder joint. The mean ROWE score for the entire group of patients before surgery was 41.5 ± 12.8 points, and 15 months after sur gery – 94.9 ± 3.4 points. Two recurrent dislocations were revealed, one of which was associated with repeated trauma, and the other – with an incorrect choice of stabilization technique. One complication (axillary nerve neuropathy) was observed, which was arrested conservatively.Conclusions. The proposed algorithm allowed us to obtain positive results in 97.9 % of cases.

Brain death (irreversible loss of brain function), according to German regulations, is investigated exclusively by qualified specialists in a strictly hierarchical three-step pattern and a four-eyes principle. In step 1 all necessary prerequisites are to be checked and the pathophysiology of brain damage has to be classified. Step 2 comprises the clinical investigation of reactivity to external stimuli and the upper, middle and lower brain stem reflexes including apnea testing. Step 3 exclusively checks for irreversibility of this condition. The latter is achieved by appropriate technical investigations or by repeated clinical examinations within context-specified intervals (range 12-72 h). However, exclusion of contributing primarily infratentorial pathologies is necessary to avoid limitations of the clinical findings. In this paper, both the initiation of brain death diagnostics and the approved clinical tests regarding to their execution, their alternatives and limits are presented and special situations like conditions with extracorporeal membrane oxygenation (ECMO) are also examined.

The management of SARS-CoV-2 has not yet been clearly determined and is based on potential therapies evaluated during the SARS-CoV and MERS-CoV outbreaks. An emerging potential therapeutic approach currently being evaluated in numerous clinical trials is the remdesivir agent, which acts on COVID-19 by interfering with key steps in the virus replication cycle. It is considered a therapeutic option to be evaluated against COVID-19, based on data on its in vitro and in vivo activity against MERS-CoV and SARS-CoV coronaviruses. In this work, we provide an overview of remdesivir's discovery, mechanism of action, and the current studies exploring its clinical effectiveness. Recommendations for its use against COVID-19 infection are also summarized.

Objective To synthesize and appraise the evidence on the diagnostic accuracy of the clinical examination tests and questionnaires for screening carpal tunnel syndrome (CTS) among workers. Design Systematic review of diagnostic test accuracy Methods Electronic search of 3 online databases (CINAHL, Embase, Medline) was done on August 31, 2020. Studies reporting the diagnostic accuracy of clinical examination tests in workers, compared to a reference standard test, were included. Diagnostic accuracy measures such as sensitivity (Sn) and specificity (Sp) were extracted and reported for different clinical examination tests. The risk of bias and applicability concerns were rated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool by 2 independent reviewers. Diagnostic tests accuracy extension of the PRISMA guidelines were followed. Results Twelve studies reporting on the diagnostic accuracy of the clinical examination tests for workers suspected of CTS were included. Fourteen different clinical examination tests were evaluated in the studies, including sensorimotor, provocative maneuvers, questionnaires, and hand symptom diagrams (HSD). Ten of the included studies had an either unclear or high risk of bias. The most accurate tests to diagnose CTS in workers were the Katz HSD (with Sn ranging from 38%-93%, and Sp ranging from 25%-89%) and Kamath and Stothard questionnaire (Sn and Sp = 100%). Combination of Katz HSD with either the Phalen’s maneuver or the Tinel’s sign resulted in excellent Sp (83% and 89%, respectively). Conclusions Low to moderate quality evidence indicates variability in individual clinical examination tests used to screen for CTS in workers. Diagnostic self-report tools consisting of hand diagrams and/or diagnostic questions provide low burden and high accuracy. Still, they require more rigorous investigation about their value alone or in combination with clinical assessment tests.

Weam Mohamed Ebeid,1 Mahmoud Adel Kenny,2 Tamer AbdelFattah Badran1 1Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 2Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, EgyptCorrespondence: Weam Mohamed EbeidFaculty of Medicine, Ain Shams University, 78 First District, Fifth Settlement, Cairo, 11861, EgyptTel +20 1003785838Email weam.ebeid@med.asu.edu.egPurpose: To assess dry eye disease (DED) in thalassemic adolescents by evaluating corneal epithelial thickness (CET) and various dry eye clinical tests and correlate them to tissue iron overload.Methods: The study included 120 Beta-thalassemia patients (11 to 18 years) and 120 matched controls. CET maps were captured using anterior segment optical coherence tomography. OSDI questionnaire was completed. Dry eye tests included Schirmer test, tear film breakup time ‎‎ (TBUT), and ocular surface staining (OSS) with fluorescein and lissamine green. We recorded serum ferritin ‎level, and liver iron concentration (LIC) measured by magnetic resonance imaging.Results: Superior and inferior CET was thinner, while map standard deviation (MSD) was higher in thalassemics compared to controls (all P‎< 0.001‎). Thalassemic group also showed higher OSDI scores‎ (P‎< 0.001), shorter TBUT ‎‎(P‎< 0.001‎), and higher OSS grades (P‎< 0.001‎). Both superior and inferior CET was correlated positively with TBUT, and negatively with OSS (all P < 0.001). Serum ferritin and LIC showed negative correlations with CET (superior and inferior, both P< 0.001), positive correlations with MSD, P< 0.001, as well as with TBUT (P< 0.001), OSS ‎(P< 0.001), and OSDI scores (P< 0.001).Conclusion: Thalassemic adolescents had thinner CET with higher thickness’ variability, shorter TBUT and more marked OSS‎ than controls. Correlation of higher serum ferritin and hepatic iron overload with irregular epithelial thinning and more affected dry eye tests results supports our hypothesis that high tissue iron levels could play a pivotal role in DED pathogenesis in thalassemic patients.Keywords: dry eye, thalassemia major, corneal epithelial map, OSDI questionnaire, anterior segment optic coherence tomography

Objectives: This study aimed to explore whether certain clinical tests or a rapid improvement in lateral hip pain following periarticular injection are predictive of subsequent efficacy of local glucocorticoid (GC) injection in greater trochanteric pain syndrome (GTPS).

The aim of the present study was to compare the diagnostic values of clinical tests and magnetic resonance imaging (MRI) which used for the diagnosis of subscapularis (SSc) tears in the patients who underwent arthroscopic rotator cuff surgery. Two-hundred and nine consecutive patients who underwent arthroscopic rotator cuff surgery between 2015 and 2019 were analyzed. The lift-off test, belly-press test and bear-hug test were performed preoperatively. 1.5 T MRI scans of all patients were evaluated for SSc integrity. The diagnostic values of both clinical tests and MRI were calculated. SSc tears were graded according to Fox and Romeo. Arthroscopic findings were used as the gold standard for diagnosis of SSc tears. There were 54 SSc tears accounting for an prevalence of 29%. The BHT showed the greatest sensitivity for both type II–II–IV (73.3%) and all types of (68.5%) SSc tears. The sensitivity and specificity of the combined test and MRI were 91.1–87.2% and 93.3–90.8% in Type II–III–IV SSc tears, respectively, and 81.5–88.6% and 88.9–94.7% in all SSc tears, respectively. There were no statistically significant difference between combined test and MRI in terms of sensitivity and specificity (n.s.). The present study is the first that compared both clinical tests and MRI with arthroscopic findings in terms of sensitivity and specificity in the same patient group. A combination of clinical tests increases their diagnostic values and shows similar sensitivity and specificity as MRI. I.

We studied rates of cadaveric organ donation on transition from apnoeic-oxygenation to radioisotope brain perfusion scanning to diagnose brain death. We studied records of children who were organ donors and/or had Technetium Tc99m Exametazine brain scans over 1989-2018. Donation after Brain Death (DBD) commenced in 1989, Donation after Circulatory Death (DCD) in 2011. Brain scanning was adopted in 2002 and apnoeic-oxygenation abandoned in 2007. In total, 95 of 1930 children (4.9%) donated organs (81 DBD, 14 DCD). During 1989-2001, with brain death diagnosed by clinical tests including apnoeic-oxygenation, 40 of 1059 children (3.8%) donated organs at average 3.1/annum. During 2002-2007 when either apnoeic-oxygenation or scanning was used, 18 of 351 children (5.1%) donated organs at average 3.0/year. During 2008-2018 with scanning in lieu of apnoeic-oxygenation, 23 of 520 children (4.4%) donated organs at average 2.1/annum. The difference in DBD rate between eras was not significant (P=0.52). Of 77 children scanned, 65(84%) were diagnosed brain dead after 1 or 2 scans, and 29 (45%) of these donated organs. Of 12 children with limited brain perfusion (not brain dead), DCD proceeded in 8 (67%). DCD or DBD (death diagnosed by scanning) was performed during 2011-2018 in 35 of 370 children (9.5%) which is significantly more (P

The aim of this study was to investigate the feasibility and preliminary validity and reliability of remote sitting balance assessment. Seven wheelchair users (mean age: 42.7 ± 19.74 years) participated in an in-person and remote sitting balance assessment. The assessments were compared to investigate the concurrent validity of the remote assessment. Reliability of remote assessment was evaluated using intraclass coefficient correlation (ICC) and the Bland-Altman. No significant differences were observed between the mean scores of in-person and remote administrations of the clinical tests (P's > 0.05). High to very high agreement was found between in-person and remote assessments (ICC = 0.88-0.982, P < 0.05). The agreement was confirmed by Bland-Altman graph analysis. Preliminary results indicate remote sitting balance assessment is feasible to perform, valid, and reliable.

Study Objective: To analyse parasitic GIT damage in children in Astrakhan Region as exemplified by Lamblia intestinalis invasion. Study Design: real-time epidemiological analysis. Materials and Methods. Follow-up enrolled 131 children aged 2.5 to 17 years with lambliosis, including 55 (42.0%) school children. Parasitic GIT damage was diagnosed in 33 (60.0%) school children. The highest percentage of subjects with GIT damage and lambliosis was recorded in children aged 7 to 14 years — 21 out of 33 (63.6%) children. Study Results. All children came from organised groups (school children). All followed up children had clinical signs of GIT damage (ultrasound imaging results): reactive pancreas changes — 2 (6.1%), reactive liver changes — 5 (15.2%), signs of biliary dyskinesia — 12 (36.3%), a combination of liver and pancreas damage — 4 (12.1%), a combination of liver, pancreas damage and signs of biliary dyskinesia — 5 (15.2%), liver damage and signs of biliary dyskinesia — 3 (9%), and pancreas damage and signs of biliary dyskinesia — 2 (6.1%). In the majority of cases (n = 25; 75.8%), children were treated with Nifuratel 15 mg/kg twice daily for 7 days. Albendazole 12 mg/kg once daily for 5-7 days was prescribed to 8 (24.2%) children. Conclusion. Lambliosis was more common in primary school children; it can be indicative of inadequate knowledge of personal hygiene routine. The main causes of disease are poor personal hygiene and contact with pets, mostly with cats. Key complaints are abdominal pain, nausea, loss of appetite, loose stool and skin allergies. Keywords: lambliosis, geography, onychophagy, personal hygiene, reactive liver changes, reactive pancreas changes.

Introduction The red reflex examination (RRE) and visual acuity testing (VA) is a mandatory part of the examination during the well-child visits (WCV) in primary health care centres of the public system of health in Chile. The eye examination is aimed at the early detection of severe eye diseases in children, such as retinoblastoma, congenital cataracts, and amblyopia. The knowledge and difficulties experienced by health workers in primary care health centres for evaluating the red reflex during WCV in Chile is unknown. Material and methods A survey was performed in primary community health centres of XXX Santiago de Chile. Results The WCV were mainly performed by physicians (45.2%) and nurses (35.8%). Only 34% of health workers performed the red reflex test, and 42.3% checked VA during the WCV. The main reasons for not doing it include the lack of direct ophthalmoscopes and VA charts (55.2% and 43.9%, respectively) at their centres, and not having the knowledge or skills (29.3% and 22%, respectively) to properly perform these clinical tests. Conclusion In this series, the eye examination of children attending WCV was unfrequently performed. A better implementation of the health centres and training of the health workers are needed in order to improve the access and quality of the paediatric eye examination in primary health care institutions in Chile.

Introduction: Injuries to the posterolateral structures of the knee are commonly caused by sports injuries, falls, and vehicle accidents. A direct hit on the proximal tibia when the knee is in stretched condition may cause an isolated posterolateral injury. The PLC is primarily responsible for resisting varus angulation and external rotation in addition to posterior displacement of the tibia. It is extremely important that the functionality of the PLC and tibiofibular joint be checked along with other clinical tests when diagnosing a knee injury. Aim of the study is to know the clinical outcome ofLaprade technique for posteriolateral corner injury of the knee.Materials and Methods: A total of 20 patients were included in this study with posterolateral corner injury and were operated by La Prade technique. Results: In this study, the preoperative range of motion was measured with goniometer. Normal range of motion (0-1400) was seen in 8 patients (40%), 6 patients (30%) had good range of motion (0-1200). 2 patients (10%) had range of motion (0-1100), 2 patients (10%) had range of motion (0-1000), 2 patients (10%) had (0-900) range of motion. Post operatively 15 patients (75%) had full range of motion (0-1400).1 patient (5%) had (0-1300) range of motion, and 4 patients (20%) had range of motion (0-1200).Conclusion: The posterolateral knee reconstruction technique or La Prade technique presented here significantly improved objective stability in patients with a chronic posterolateral knee injury.

Background The changes in morphology of hair follicle and aberrant cycling of hair follicle are the main reasons of the most common forms of hair loss (alopecia). However, existing alopecia treatments do not specifically target these processes. Aims Autologous whole fat injection suggests a paradigm shift that may offer alternative therapies that can be used to prevent hair loss. This study aimed to present clinical cases for the treatment of androgenetic alopecia by autologous whole fat injection in the scalp. Methods Nine patients with androgenetic alopecia (7 women and 2 men) were enrolled to our study. After lipoaspiration, autologous whole fat was injected into the patient's scalp. Hair regeneration was evaluated by three clinical tests: the pull test, hair quality, and hair density. Results For all patients, before and after treatment, the number (density) and diameter of hair were calculated using trichograms. The pull test was also performed. The pictures were obtained before after treatment. Conclusion Our results showed that whole fat injection enormously can increase the level of hair growth.

Pediatric ocular myasthenia gravis (OMG) is difficult to diagnose and manage, owing to its rarity and low index of suspicion in the early stage of the disease. Also, many other conditions having similar presentation cause a further delay in diagnosis. In this review, we highlighted various pointers in history and described bedside clinical tests that can aid in its timely diagnosis. The antibody spectrum in myasthenia is ever increasing and includes anti-muscle specific kinase and low-density lipoprotein-receptor related protein 4 antibodies in addition to acetylcholine receptor antibodies besides many others. However, pediatric OMG patients often test negative for all three antibodies, making the diagnosis even more difficult in triple seronegative patients. Edrophonium and electrophysiological tests, which help in confirming myasthenia in adults, have a limited utility in diagnosing pediatric ocular myasthenia cases. Various practical difficulties are encountered like nonavailability of edrophonium, risk of bradycardia associated with neostigmine use and its lower sensitivity, noncooperative children, and limited technical expertise in performing electrophysiological tests in children. In this article, we described a pragmatic approach to diagnose pediatric OMG along with the important aspects of its management.

Developmental encephalopathies, including intellectual disability and autistic spectrum disorder, are frequently associated with infant epilepsy. Epileptic encephalopathy is used to describe an assumed causal relationship between epilepsy and developmental delay. Developmental encephalopathies pathogenesis more independent from epilepsy is supported by the identification of several gene variants associated with both developmental encephalopathies and epilepsy, the possibility for gene-associated developmental encephalopathies without epilepsy, and the continued development of developmental encephalopathies even when seizures are controlled. Hence, ‘developmental and epileptic encephalopathy’ may be a more appropriate term than epileptic encephalopathy. This update considers the best studied ‘developmental and epileptic encephalopathy’ gene variants for illustrative support for ‘developmental and epileptic encephalopathy’ over epileptic encephalopathy. Moreover, the interaction between epilepsy and developmental encephalopathies is considered with respect to influence on treatment decisions. Continued research in genetic testing will increase access to clinical tests, earlier diagnosis, better application of current treatments, and potentially provide new molecular-investigated treatments.

Up to now, coronavirus infection that causes an acute respiratory syndrome has been detected almost in all countries worldwide Global spread of SARS-CoV-2 virus has become a world pandemic and there is no efficient and commonly accepted conventional therapy against COVID-19 Due to the existing emergency most drugs that can potentially be used to treat COVID-19 are allowed to be applied only basing on certain data probing their safety and efficiency against SARS-CoV At present only Lopinavir/Ritonavir and Remdesivir are the only anti-virus drugs that are included into well-recognized management procedures for COVID-19 treatment;an acceptable alternative could probably be combined therapy that includes Hydroxychloroquine and Azithromycin Given the existing situation, a lot of drugs that are usually used to treat other diseases are now being suggested as probable ways to treat COVID-19 taking into account all the available knowledge on pathophysiology of the infection In this review, basing on available data on how SARA-CoV-2 virus enters a cell and pathophysiological aspects of cytokine storm development, we have strived to highlight certain prospects related to applying anti-viral medications, antiinflammatory and immune-suppressing drugs, vitamins and microelements that are widely used to treat and prevent various diseases Most tested drugs as well as zinc preparations, and vitamins С and D3 turned out to have not only immunemodulating but also anti-inflammatory properties;or either they were able to block ways for the virus to enter a cell or disrupt SARS-CoV-2 intracellular replication Having leant from previous experience in fighting against SARS and MERS, doctors have applied some existing drugs to treat COVID-19 infections in their clinical practices;clinical tests aimed at confirming their safety and efficiency in treating COVID-19 are still being performed at the moment Although a lot of various treatment procedures have been suggested, it is necessary to perform specifically planned randomized clinical trials based on evidence-based medicine principles, if we want to determine the most suitable ones © Ashirmetov A Kh , Mavlyanov I R , Mavlyanov Z I , Zharylkasynova G Zh , 2020

Purpose Although there have been multiple clinical studies evaluating the accuracy of physical examination tests used to diagnose anterior cruciate ligament (ACL) injury, there are no data to date evaluating the accuracy of these tests in diagnosing re-injury after prior ACL reconstruction. We compared the sensitivity of three clinical tests — Lachman, anterior drawer, and pivot shift — in diagnosing initial ACL tears versus graft re-tears following a prior ACL reconstruction. Methods Twenty consecutive adult patients who had undergone primary ACL reconstruction and 20 consecutive adult patients who had undergone revision ACL reconstruction by a single surgeon at a tertiary care center from November 2011 to December 2017 were included in this study. Results The sensitivity of the Lachman test was 95.0% in diagnosing ACL tears in patients with native ACL versus 85.0% in patients with prior ACL reconstruction with allograft or autograft. The sensitivity of the anterior drawer test was 80.0% in patients with native ACL compared to 77.8% in patients with prior ACL reconstructions. The sensitivity of the pivot shift test could not be accurately assessed because pain and swelling prevented the physician from performing this test in most patients on their initial presentation to the clinic. Conclusions This study suggests that a clinician may need to have a lower threshold to perform advanced imaging or diagnostic arthroscopic evaluation in a patient with prior ACL reconstruction with a suspected re-injury even if the physical examination tests are not immediately positive.

The review presents the characteristics of modern biocompatible and biodegradable wound dressings on the basis of seaweed polysaccharides (carrageenans of red algae, fucoidans and alginates of brown algae, ulvans of green algae) and notes the key physicochemical and biological properties that are important for constructing wounds dressings. There are information on various types of wound dressings and results of experimental and clinical tests of dressings in the treatment of wounds of various origins. Particular attention is paid to hydrogel dressings, since hydrogels meet the basic requirements for an ideal wound dressing, and many marine polysaccharides are able to form hydrogels.

Aim In our work we seek to develop new approaches for treating patients with COVID-19 The first reports about new coronavirus infection, COVID-19, came out in China in 2019 It was recognized by WHO as a pandemic crisis on March 11, 2020 Currently, there is no standard therapy protocol for COVID-19 and the drugs are used off label Materials and methods We have implemented ozone therapy into clinical practice as an adjuvant treatment regimen for patients with SARS-CoV-2 infection In our study, 19 patients received ozone therapy and 18 patients were members of the control group All patients had a positive PCR test for SARS-CoV-2 infection and were matched by the following features: sex, age, severity of symptoms, imaging data and clinical history Patients in the study group received ozone therapy in the form of daily intravenous infusions of ozonized physiological solution (concentration: 2 2-2 4 mg/l) Conclusion We observed a statistically significant improvement in laboratory, radiological and clinical tests of patients in the study group compared to the control group on the 14th day Thus, we have demonstrated the benefits of using ozone therapy in patients with the new coronavirus infection COVID-19 Taking into consideration the physiological processes underlying such approach, ozone therapy should be justified for both phases: the beginning and at the peak of the disease Цель Поиск новых направлений в терапии COVID-19 Новая коронавирусная инфекция COVID-19, возникшая в конце 2019 г в Китайской Народной Республике, признана ВОЗ пандемией 11 марта 2020 г В настоящее время не разработана этиотропная терапия данной инфекции Препараты в протоколах лечения используются off label Материалы и методы Нами была использована озонотерапия в качестве адъювантной у пациентов с SARS-CoV-2-инфекцией Озонотерапия проводилась 19-ти пациентам, 18 больных составили контрольную группу Все пациенты имели положительный ПЦР-тест на инфекцию SARS-CoV-2, были сопоставимы по полу, возрасту, степени тяжести, учитывая данные МСКТ и клинической картины Пациентам в изучаемой группе проводилась озонотерапия в виде ежедневных внутривенных инфузий озонированного физиологического раствора в концентрации 2 2-2 4 мг/л Выводы По результатам проведённого исследования мы получили статистически значимое улучшение лабораторных, рентгенологических, клинических данных на 14-й день исследования у пациентов в изучаемой группе, по сравнению с контрольной Таким образом, нами продемонстрирована эффективность озонотерапии у пациентов с новой коронавирусной инфекцией COVID-19 С учетом механизмов действия данного метода, его применение обосновано как в начале, так и в разгаре заболевания

The phenomenal commercial success of many nutraceutical products, dietary and health supplements indicate increasing levels of consumer acceptance to the usage of health supplements in Malaysia. As much as these products are consumed for health purposes, lack of effective control by drug authority leaves much to be desired. Legal issues such as marketing approval, product liability, safety, advertising, trade description (nutrition labelling & health claims) would undoubtedly emerge as direct implications from widespread sales and consumption of such products. Consumers' health and safety are at risk where nutraceuticals can easily penetrate into the market without any need of undergoing clinical studies, as opposed to pharmaceuticals. This article was written based on research that has identified several causal factors to the above-mentioned issues. First, nutraceuticals are loosely classified as in between food and drugs. Due to the loose classification scheme, manufacturers tend to opt that their products be classified as food to escape strict clinical evaluations. This leads to the issue of misleading health claims made on its labels and advertisements. The article examines regulation of nutraceuticals in Malaysia and identifies significant issues therein. Comparative analysis with Japanese nutraceutical regulations was made to learn how Japanese classifies its nutraceuticals under specific categories known as ‘Food for Specified Health Uses (FOSHU)’. Products bearing the FOSHU logo went through strict clinical tests and are allowed to make health claims on their labels – and were proven effective and safe for consumption as claimed. The article made several recommendations for the establishment of a legal framework to regulate nutraceutical products in Malaysia.

We report a series of 10 patients with unilateral, dynamic, winged scapula (WS), without cause, that was diagnosed as voluntary winging of the scapula (VWS). We compared clinical, electrodiagnostic, and other examination data for 10 patients with VWS and 146 with dynamic WS-related neuromuscular disorders, to establish a detailed pattern of the VWS subtype. In VWS, electrodiagnostic and other examinations did not reveal any neuromuscular or orthopedic cause. Winging was dynamic, obvious, neither medial nor lateral, and mainly involved the inferior angle of the scapula, in young patients. VWS never appeared during floor push-ups. Patients could produce WS at will with the index and healthy shoulder, between 25° and 65° of anterior elevation, or with shoulder internal rotation. VWS is a benign disorder that can be distinguished from neuromuscular WS by normal electrodiagnostic results for muscles and nerves of both shoulders and two specific clinical tests.

Objectives The main objective was to determine the trajectory of instrumental activities of daily living (iADL) decline in persons with mild cognitive impairment (MCI) who progressed towards dementia relative to persons with MCI who remained stable. Methods/Design At study entry, 121 participants met criteria for MCI. Based on the follow‐up, 47 participants later converted to dementia and were identified as progressors. Sixteen participants, identified as decliners, presented a significant cognitive decline but did not reach the criteria for dementia within the study timeframe. Stable MCI remained cognitively stable during the 5‐year follow‐up; n = 58. Participants completed a yearly assessment using clinical tests/questionnaires, neuropsychological measures, and functional autonomy assessment until they met criteria for dementia. The average number of months for the follow‐up was 34. Results Many years of stable performance followed by an accelerated decline just prior to diagnosis, was observed for complex activities for progressors. No change was found for stable MCI and a gradual linear decline characterized decliners. The housekeeping‐related activities component showed a linear decline in progressors and did not change in stable and decliner MCI. We found a predictive model that includes significant predictors of dementia conversion with a high diagnostic accuracy the following year (area under the curve = 0.94 [95% confidence level; lower bound: 0.87, upper bound: 1]). Conclusions It is critical to assess iADL that reflect complex activities in the evaluation of MCI individuals as their impairment, combined with change on cognitive markers, indicates a higher risk of dementia progression 1 or 2 years later.

Gastroparesis presents with nausea, vomiting, and other upper gut symptoms, and is diagnosed by confirming delayed gastric emptying. A related condition, chronic unexplained nausea and vomiting, has similar symptoms but with normal emptying. Both conditions are managed using therapies with diverse mechanisms of action. Even though prokinetic treatments are proposed to improve gastroparesis by accelerating gastric emptying, there is limited evidence that they provide benefit by virtue of transit stimulating effects. Other tests can delineate alterations in other gut sensorimotor parameters in patients with suspected gastroparesis, but their relation to symptoms and their capability to guide treatment are largely unproved.

Introduction: Meniscal injuries of the knee are common indications for arthroscopic knee surgery. Most of the meniscal tears can be diagnosed by clinical evaluation alone. This study aims to test the accuracy of the commonly performed tests for meniscal tears in our set up. Method: This was a prospective observational study of 32 symptomatic knees that underwent clinical evaluation followed by arthroscopy. The sensitivity, specificity and diagnostic accuracy of three clinical tests (McMurray’s test, Apley’s compression test and Joint line tenderness) were calculated against arthroscopic findings. Result: Among clinical tests, maximum sensitivity (94.44%) was with Joint Line Tenderness for Medial Meniscus Tear (MMT) and minimum (54.54%) with Apley’s Compression Test for Lateral meniscus Tear (LMT). Specificity was maximum (90.48%) with Joint Line Tenderness for LMT and minimum (64.28%) with Apley’s Compression Test for MMT. Diagnostic accuracy was maximum (90.6%) with McMurray’s test for LMT and minimum (75%) with Apley’s Compression Test for MMT and LMT. Conclusion: All three clinical tests (McMurray’s, Apley’s compression and Joint line tenderness) were found reliable for diagnosing meniscus tears. Joint Line Tenderness had the best diagnostic accuracy followed by McMurray’s test.

This retrospective case study aims to evaluate the accuracy of menace response, response to nasal stimulation and proprioceptive placing in diagnosing forebrain lesion in dogs. A total of 145 client-owned dogs investigated by magnetic resonance imaging study of the brain between December 2017 and June 2019 were evaluated. Seventy-one dogs with no magnetic resonance imaging-detectable intracranial and significant cerebrospinal fluid abnormality or recent history of seizure (

Background Unilateral muscular deficits have been identified in individuals with neck pain, although no unilateral clinical tests have been described in the literature. Assessment of lateral neck flexor endurance may allow identification of abnormal unilateral muscle function. The lateral neck flexor (LNF) endurance test, where an individual holds their head parallel to the ground while side-lying, may be a clinical option. We sought to (1) determine inter-rater reliability of the LNF endurance test and (2) establish normative LNF values in healthy individuals. Methods Inter-rater reliability was assessed for four raters, working in pairs to assess a pilot sample of 20 individuals. Normative data was subsequently collected for 60 healthy adults, age 20–40. All participants completed the International Physical Activity Questionnaire to assess physical activity and the LNF endurance test was assessed once per side. Results The LNF endurance test demonstrated excellent inter-rater reliability: ICC(2,1) = 0.972 [0.941–0.987]. Left and right median LNF hold times were 122.0, 133.94 s for males and 97.42, 93.73 s for females, respectively. Individual median hold time ratios were 72.1% for males and 68.7% for females. There were no meaningful correlations between reported physical activity and LNF endurance. Conclusion The LNF endurance test is a reliable measure. Males generally displayed greater LNF endurance than females, although variability within groups was high. Based on the observed values in this healthy population, 120 s for males and 90 s for females with a 70% side:side ratio appear to be useful normative benchmarks although further research is required including clinical populations.

Objectives: the work was to determine the maxillary tissue changes under acrylic and flexible lower tooth supported overdentures. Methods: The study was accomplished on 20 patients; the selected cases were upper completely edentulous and lower tooth supported one. lower overdenture supported with canines bilaterally. The cases randomly split into two groups: Group I; ten patients wear acrylic complete upper denture and acrylic mandibular tooth supported overdenture Group II; ten patients wear flexible complete upper denture and flexible lower tooth supported overdenture. Clinical tests were performed by measuring the soft tissue thickness of superimpose the anterior upper ridge at 2 dots 1 cm and 2 cm on each hand to the midline at time of prosthesis delivery and at 12 months. Also, radiographic evaluations of upper edentulous area estimated at time of prosthesis delivery and at 12 months. Results: there was non-significant increase in upper mucosa thickness in both groups at both points of measurements. Also, both groups showed radiographic bony changes in maxillary ridge. There was significant increase in maxillary bony changes in Group I in compare to Group II. Conclusion: it was concluded that there was slight increase in the thickness of soft tissue above the anterior upper ridge in each sequence. More bone resorption allover region of maxilla was observed in Group I, but there was slight decrease in Group II more than Group I.