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Objective: Chronic hand eczema (CHE) is a common inflammatory skin disease with a major psychological and socioeconomic impacts on patients' quality of life (QoL) and work ability. To the best of k...

Objectives. Congenital diaphragmatic hernia (CDH) is a birth defect affecting the respiratory functions, functional performance, and quality of life (QOL) in school-aged children. Rarely have studies been conducted to evaluate the impacts of respiratory muscle training on school-aged children with postoperative CDH. The current study was designed to evaluate the impacts of respiratory muscle training on respiratory function, maximal exercise capacity, functional performance, and QOL in these children. Methods. This study is a randomized control study. 40 children with CDH (age: 9-11 years) were assigned randomly into two groups. The first group conducted an incentive spirometer exercise combined with inspiratory muscle training (study group, n=20), whereas the second group conducted only incentive spirometer exercise (control group, n=20), thrice weekly for twelve consecutive weeks. Respiratory functions, maximal exercise capacity, functional performance, and pediatric quality of life inventory (PedsQL) were assessed before and after the treatment program. Results. Regarding the posttreatment analysis, the study group showed significant improvements in all outcome measures (FVC%, p<0.001; FEV1%, p=0.002; VO2max, p=0.008; VE/VCO2 slope, p=0.002; 6-MWT, p<0.001; and PedsQL, p<0.001), whereas the control group did not show significant changes (p>0.05). Conclusion. Respiratory muscle training may improve respiratory functions, maximal exercise capacities, functional performance, and QOL in children with postoperative CDH. Clinical commendations have to be considered to include respiratory muscle training in pulmonary rehabilitation programs in children with a history of CDH.

BACKGROUND: Hypoxemia and pulmonary complications are common after upper abdominal surgery (UAS). OBJECTIVE: To examine whether inclusion of autogenic drainage (AD) in chest physiotherapy after UAS confers additional benefits in improving blood gases and reducing postoperative pulmonary complications (PPCs). DESIGN AND SETTING: Randomized controlled study conducted at Kasr Al-Ainy teaching hospital, Egypt. METHODS: A randomized controlled trial was conducted on 48 subjects undergoing elective UAS with high risk of developing PPCs. The study group received AD plus routine chest physiotherapy (deep diaphragmatic breathing, localized breathing and splinted coughing) and the control group received routine chest physiotherapy only. The outcomes included arterial blood gases measured at the first and seventh postoperative days, incidence of PPCs within the first seven days and length of hospital stay. RESULTS: Baseline characteristics were similar between groups. In the AD group, SaO2, PaO2, PaCO2 and HCO3 significantly improved (P < 0.05) while in the physiotherapy group, only SaO2 and PaO2 significantly improved (P < 0.05). Nonetheless, significant differences in post-treatment SaO2 and PaO2 between the groups were observed. The overall incidence of PPCs was 16.66% (12.5% in the AD group and 20.8% in the physiotherapy group) (absolute risk reduction -8.3%; 95% confidence interval, CI, -13.5 to 29.6%), with no significant difference between the groups. The AD group had a significantly shorter hospital stay (P = 0.0001). CONCLUSION: Adding AD to routine chest physiotherapy after UAS provided a favorable blood gas outcome and reduced the length of hospital stay. It tended to reduce the incidence of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04446520.

Objective: To compare the efficacy of negative pressure wound therapy (NPWT) with that of microcurrent electrical stimulation (MES) on wound surface area, length of stay (LoS) and colony count of wounds in patients with burns. Method: Patients with thermal dermal burn injuries covering 25–40% of total body surface area were enrolled in this clinical trial. Participants were randomly allocated into three, equal-sized groups: patients receiving NPWT, patients receiving MES and a control group which received standard wound care. All groups received the same traditional physical therapy programme in addition to the same nursing and medical care. In all groups, wound surface area, colony count and LoS were measured 72 hours after thermal burn injury (pre), after 10 days and again at 21 days from the beginning of the study. Results: A total of 45 patients took part in the study. There were statistically significant decreases in wound surface area observed in all groups (pConclusion: From the findings of this study, MES was more effective in decreasing wound surface area in burn wounds while NPWT was more effective in reducing bacterial growth.

To describe the pattern of hand functional recovery in the first six months following the discharge of children with burn injury, and to identify the predictors affecting this recovery.This was a prospective, comparative, follow-up cohort study in which hand functional outcome, was assessed during 9 months follow-up on 37 children with burn injuries involving the upper extremity with total body service area (TBSA35%). Thirty-six matched healthy children were participated to compare the differences between children with burn and healthy children regarding the hand functional outcome. Hand function assessments included total active motion (TAM), grip strength and Jebsen Hand Function Test (JHFT) were conducted at hospital discharge, 3, and 6 months follow-up after discharge.We found a trend towards an increase in the TAM scores over time (P0.001), and were excellent in 5.41%, at discharge and increased to 18.92% and 40.54% at 3 and 6-month following discharge. The hand grip strength and JHFT showed significant improvement over time after 6 months (P0.001). Regression analysis revealed that time to surgery, engagement in rehabilitation services, hand dominance, age and TBSA were the predictors of hand functional recovery and accounted 74% for TAM, 0.79 and 0.86 for total JHFT scores and grip strength.the TAM, grip strength and JHFT were significantly improved after 3-month and these improvements were more evident at 6-month following discharge. Identification of the predictors may help therapists in the development of an effective rehabilitation programs.

Zizi M Ibrahim,1,2 Olfat Ibrahim Ali,3 Samah A Moawd,4,5 Marwa M Eid,2,6 Mona Mohamed Taha1,5 1Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 3Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 4Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabi; 5Department of Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 6Department of Physical Therapy, Faculty of Applied Medical Science, Taif University, Taif, Saudi ArabiaCorrespondence: Zizi M Ibrahim Email Zizikahla@yahoo.comPurpose: Burn injury with pre-existing diabetes has poorer outcomes and complications. Balance and functional mobility are disturbed in diabetic patients with burn injury which increase the risk of total morbidity. The aim of the current study was to evaluate the impact of vibrational training as an additional intervention on postural balance, balance confidence and functional mobility in type 2 diabetic patients with lower limb burn injury.Patients and Methods: Thirty-eight type 2 diabetic patients of both sexes with healed lower limb burn were randomly assigned into two equal groups: the vibration group and the control group. The vibration group received whole body vibration (WBV), 3 sessions a week for 8 weeks, in addition to the selected exercise program (balance exercises and resisted exercises), while the control group only received the selected exercise program. Biodex Balance System was used to assess the dynamic balance score, the Activities-specific Balance Scale to assess balance confidence and the timed up and go test to assess the functional mobility. All measurements were obtained before and at the end of the study after 8 weeks of treatment.Results: Marked improvement in all dynamic balance indices; overall stability index, antero-posterior stability index and medio-lateral stability index, balance confidence and the functional mobility were obtained in both the vibration and the control groups (P< 0.05), whereas post-treatment comparison between groups revealed a statistically significant difference in favor of the vibration group in all measured variables.Conclusion: Based on the results of the current study, it is possible to conclude that adding WBV training for an 8-week duration to a selected exercise program (balancing and resisted exercises) seems to be effective; in improving postural balance, balance confidence, as well as improving the functional mobility in type 2 diabetic patients with lower limb burn injury.Keywords: burn injury, postural balance, vibrational training, functional mobility, resisted exercises

Background: Lipodermatosclerosis (LDS) is considered a type of panniculitis (inflammation of subcutaneous fat). Patient experiences severe pain, increased stress, swelling, walking problems and decreased quality of life. The end result of untreated LDS is ulcer formation with high incidence of delayed healing and infection. In addition to psychological problem, the financial costs can be significant. Aim of the study: To evaluate the efficacy of ultrasonic waves (U.S.) in the treatment of lipodermatosclerosis. Methods: Forty patients with lipodermatosclerosis from both sexes aged from 42 to 65 years were assigned into two groups of equal number. The study group (group A) received continuous U.S. three times/week at frequency of 3 MHz in addition to routine treatment which consisted of wearing grade 2 compression stocking (30–40 mmHg) during weight bearing conditions, patients were advised to try to decrease weight bearing as much as possible during the treatment period and circulatory exercise for 15 min at least 5 times/day, control group (group B) received placebo U.S. plus routine treatment. Pain sensation and skin hardness were assessed in both groups using numeric rating scale (NRS) and durometer. Results: The results revealed a significant decrease in mean values of pain sensation and skin hardness in the study group compared to the control group after treatment. To conclude that therapeutic ultrasound was effective in controlling of lipodermatosclerosis disease as regards, decreasing pain sensation and skin hardness. Keywords: Lipodermatosclerosis; Pain; Skin hardness; Ultrasonic waves

[Purpose] This study aimed to determine the impact of aerobic exercise on aerobic capacity, balance, and treadmill time in patients with thermal burn injury. [Subjects and Methods] Burned adult patients, aged 20–40 years (n=30), from both sexes, with second degree thermal burn injuries covering 20–40% of the total body surface area (TBSA), were enrolled in this trial for 3 months. Patients were randomly divided into; group A (n=15), which performed an aerobic exercise program 3 days/week for 60 min and participated in a traditional physical therapy program, and group B (n=15), which only participated in a traditional exercise program 3 days/week. Maximal aerobic capacity, treadmill time, and Berg balance scale were measured before and after the study. [Results] In both groups, the results revealed significant improvements after treatment in all measurements; however, the improvement in group A was superior to that in group B. [Conclusion] The results provide evidence that aerobic exercises for adults with healed burn injuries improve aerobic physical fitness and balance.

Introduction: Background. Upper abdominal surgery alters postoperative pulmonary function, as observed by impairment of lung volumes such as total lung capacity, vital capacity. Impaired clearance of sputum results in a vicious cycle of colonization and infection of bronchi with pathogenic organisms, dilation of bronchi and further production of sputum. The aim was to investigate the effect of combination of Acapella device and breathing exercises on treatment of post operative pulmonary complications after upper abdominal surgeries. Subjects and methods: Sixty patients underwent upper abdominal surgery were assigned randomly into two equal groups; their ages ranged from 20-50 years. The study group received breathing exercises, Acapella device and traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). Control group received traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). All groups received three sessions per week for four successful weeks. The data were collected before and after the same period of treatment for both groups. Evaluation procedures were carried out to measure pulmonary function: Forced vital capacity (FVC) and Forced expiratory volume in one second (FEV1) using electronic spirometer. Results: Post treatment results showed that there was a significant improvement difference in FVC and FEV1 in both groups in favor of the study group. Percentage of improvement of FVC in the study group was 42.28%, while it was 16.31%in the control group. Percentage of improvement of FEV1 in the study group was 49.05%, while it was 20.79%in the control group. Conclusion: Combination of Acapella device and breathing exercises were considered to be an effective modality for treatment of postoperative pulmonary complications and removal of secretions after upper abdominal surgeries.

Background: A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The aim was to compare the effect of Acapella device and breathing exercises with traditional chest physiotherapy program on forced expiratory volume/ forced vital capacity ratio after upper abdominal surgeries. Subjects and methods: Thirty patients underwent upper abdominal surgery were assigned randomly into two equal groups; their ages ranged from 20-50 years. The study group received breathing exercises, Acapella device and traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). Control group received traditional chest physical therapy program (postural drainage. percussion, vibration, cough training and early ambulation). All groups received three sessions per week for four successful weeks. The data were collected before and after the same period of treatment for both groups. Evaluation procedures were carried out to measure forced expiratory volume/ forced vital capacity ratio (FEV1/ FVC ratio) using electronic spirometer. Results: Post treatment results showed that there was a significant difference in FEV1/ FVC ratio in both groups in favor of the study group. Percentage of improvement of FEV1/ FVC ratio in the study group was 10.17%, while it was 2.96% in the control group. Conclusion: Acapella device and breathing exercises were more effective in improvement of FEV1/FVC % than traditional chest physical therapy after upper abdominal surgeries.

The aim of this work was to evaluate the efficacy of Helium Neon (He–Ne) laser therapy on post mastectomy lymphedema and shoulder mobility. Thirty female patients with axillary lymph node dissection (ALND), with or without radiotherapy had been participated in this study. The patients were randomly divided into two groups of equal numbers. Group A received He–Ne laser therapy and decongestive lymphatic therapy. Group B received placebo laser therapy in addition to decongestive lymphatic therapy. Measurements of limb volume and shoulder mobility (by tape measurement and standard goniometer) were collected before treatment and after six months of treatment. The mean values of limb volume and Shoulder mobility after 6 months of treatment showed a significant improvement ( p < 0.05) for the two groups of the study with a greater improvement for patients in group A. Conclusion : Helium Neon laser therapy has a positive effect in reducing post mastectomy lymphedema and increasing range of motion of shoulder joint. Keywords: Helium Neon laser; Lymphedema; Mastectomy; Shoulder mobility The Egyptian Journal of Medical Human Genetics (2013) 14, 195–199

Introduction: A large portion of the Italian built heritage is characterized by a significant seismic vulnerability since many structures were designed with outdated criteria, i.e., without accounting for seismic actions. This aspect is particularly relevant for strategic structures and infrastructures, whose functionalities are crucial in case of seismic events. Objective: The main aim of the present paper is to share the key findings related to the seismic vulnerability assessment of the National Institute for the Study and Treatment of Cancer (IRCCS) “Giovanni Pascale Foundation” in Naples. In particular, the main evidences could be easily extended to existing hospitals realized in the last century, with the main reference to: construction techniques, quality of constructional material, overt and convert seismic vulnerabilities and possible intervention strategies for risk mitigation. Methods: In the present paper, the assessment methodologies adopted for such a strategic hospital complex are provided, focusing in particular on: i. preliminary research of original design documents and on-site investigation for determining constructional details; ii. material tests on structural elements; iii. vulnerability seismic assessment by means of non-linear FE analyses (push-over and capacity spectrum method); iv. recommendations on retrofitting measures and cost estimations. Results: The conducted study puts into clear evidence the inadequacy of the investigated buildings to face the design seismic actions provided by the current Italian code and thus showed the significant seismic vulnerabilities affecting the Institute “G. Pascale Foundation” of Naples. Among these, particular attention has also been focused on the so-called intrinsic vulnerabilities, namely the ones not measurable explicitly and interesting non-structural elements (e.g., connection of shelves, stained glass windows, facilities, etc.). Conclusion: The presented case study highlights the strong seismic vulnerability affecting structures realized in the past century, despite their strategic functions. On the whole, the examined structures can be considered as representative of this building typology, and the adopted calculation criteria, as well as the assumptions of the assessment process, could be easily extended to similar case studies.

Simulating the mechanical behavior of masonry structures with reasonable approximation using numerical models is a complex issue, mainly due to the uncertainties affecting the selection of mechanical parameters. Since destructive testing is in some cases impossible, the Italian building code provides ranges for the parameters based on masonry type to be used in numerical and analytical estimations of the capacity curves of masonry panels, suggesting the Equivalent Frame Method approach for the numerical modelling. In this paper, the application of these ranges to three more sophisticated material descriptions to be used in 3D representations (i.e. Double Drucker Prager, Total strain crack and Concrete damage plasticitymodels) is investigated, with reference to a heterogeneous set of experimental tests performed in the past. In particular, numerical, analytical and experimental results are compared with the aim, on the one hand, of examining the suitability of such ranges when a macroscale approach is adopted, while, on the other, investigating their capability in predicting the real behavior of masonry structures. The comparisons are performed in terms of failure mode, initial stiffness, maximum horizontal load and ultimate drift. The results provide a critical appraisal of the predictive capability of the considered models. They also show that the application of material parameter ranges based on typological features to numerical models may be problematic and entails a limited improvement in the predictions compared to the analytical formulations.