Extracorporeal Shock Wave Therapy and Dry Needling in Myofascial Trigger Points

Randomized Trial on Comparison of the Efficacy of Extracorporeal Shock Wave Therapy and Dry Needling in Myofascial Trigger Points
Objectives To compare the efficacy of radial extracorporeal shock wave therapy (ESWT) and dry needling (DN) in the treatment of myofascial trigger points (MTrPs) in the upper trapezius muscle. Design A total of 65 patients with MTrPs were randomly divided into ESWT group (n=32) and DN group (n=33). Patients received 3 weeks of treatment at one-week intervals in both groups Visual analogue scale (VAS), pressure pain threshold (PPT), Neck Disability Index (NDI) and shear modulus were evaluated pre-treatment, immediately post the first therapy, 1-month and 3-month after the completion of the third therapy. Results Significant improvements of VAS, PPT, NDI scores were observed at all time points post-treatment (p<0.01) in both treatment groups. The shear modulus of MTrPs was reduced in both DN group (p<0.05) and ESWT group (p<0.01) immediately after the first treatment. Significant reductions in shear modulus were maintained up to 3-month post-treatment in both groups (p<0.01). There were no significant differences between the radial ESWT group and DN group. Conclusions The ESWT is as effective as DN for relieving pain, improving function and reducing shear modulus for patients with MTrPs following a series of three treatments. Shuo Luan and Zhi-min Zhu contributed equally to this work. Co-Corresponding authors: Chao Ma and Shaoling Wu are both corresponding authors of this article. All correspondence should be addressed to: Chao Ma, MD, PhD and Shaoling Wu, MD, PhD, Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, No.107 Yanjiang West Road, Guangzhou, 510120, China Disclosures: This study was supported by a grant from National Natural Science Foundation of China (81771201, 81671088), Natural Science Foundation of Guangdong (2016A030311045), Guangzhou science and technology plan projects (201807010050) and Sun Yat-Sen Clinical Research Cultivating Program (SYS-C-201704). Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Exercise training guidelines for multiple sclerosis, stroke, and Parkinson’s disease

: Rapid review and synthesis
The translation of knowledge from exercise training research into the clinical management of multiple sclerosis (MS), stroke, and Parkinson's disease (PD) requires evidence-based guidelines that are uniformly recognizable by healthcare practitioners and patients/clients with these diseases. This paper synthesized resources that reported aerobic and resistance training guidelines for people with MS, stroke, and PD. Systematic searches yielded 25 eligible resources from electronic databases and websites or textbooks of major organizations. Data were extracted (exercise frequency, intensity, time, and type) and synthesized into recommendations per disease. Exercise guidelines for MS consistently recommended 2-3 days/week of aerobic training (10-30 minutes at moderate-intensity) and 2-3 days/week of resistance training (1-3 sets between 8-15 repetition maximum (RM)). Exercise guidelines for stroke recommended 3-5 days/week of aerobic training (20-40 minutes at moderate-intensity) and 2-3 days/week of resistance training (1-3 sets between 8-15 repetitions between 30-50% 1-RM). Exercise guidelines for PD recommended 3-5 days/week of aerobic training (20-60 minutes at moderate-intensity), and 2-3 days/week of resistance training (1-3 sets of 8-12 repetitions between 40-50% of 1-RM). This harmonization of exercise guidelines provides a prescriptive basis for healthcare providers, exercise professionals, and people with these diseases regarding disease-specific exercise programming. Correspondence to: Yumi Kim, MS, University of Alabama at Birmingham/Lakeshore Foundation Research Collaborative, 4000 Ridgeway Drive, Birmingham, AL 35209, USA; email: yumikim@uab.edu Authorship: YK: Article selection/screening, data extraction/synthesis, writing, editing, BL: Data cross-check, exercise guideline summary, writing, editing, TM: Reviewing, editing, MT: Reviewing, editing, SP: Reviewing, editing, JH: Exercise guideline summary, reviewing, writing, editing, RM: Exercise guideline summary, reviewing, writing, editing All the authors approved and critically revised the manuscript. FUNDING: This work was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant number 90REGE0002-01-00). The National Institute on Disability, Independent Living, and Rehabilitation Research is a Centre within the Administration for Community Living, Department of Health and Human Services. The contents of this manuscript do not necessarily represent the policy of these groups and you should not assume endorsement by the US Federal Government. CONFLICT OF INTEREST: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Serum and intranodular VEGF (nVEGF) and VEGF receptor-1 (VEGFR-1) levels in patients with thyroid nodules

Correlation of vascular endothelial growth factor and vascular endothelial growth factor receptor-1 levels in serum and thyroid nodules with histopathological and radiological variables Gurkan Haytaoglu, Fatih Kuzu, Dilek Arpaci, Ayfer Altas, Murat Can, Figen Barut, Furuzan Kokturk, Sevil Uygun Ilikhan, Taner Bayraktaroglu Journal of Laboratory Physicians 2019 11(1):51-57 BACKGROUND/AIM: Vascular endothelial growth factor (VEGF) is a major cytokine in angiogenesis and has a role on aggressivity of various tumors. The expression of VEGF has been shown to increase in differential thyroid cancer. The aim of the study was to evaluate serum and intranodular VEGF (nVEGF) and VEGF receptor-1 (VEGFR-1) levels in patients with thyroid nodules and their relevance to ultrasonographic and pathological results. MATERIALS AND METHODS: A total of eighty patients were included in the study. Thyroid fine-needle aspiration biopsies were performed, and the levels of serum and nVEGF and VEGFR-1 were measured. Any possible correlations between serum and nVEGF, VEGFR-1, and biochemical/radiological variables were investigated. RESULTS: There were no significant differences between serum VEGF (sVEGF), nVEGF, sVEGFR-1, nVEGFR-1 levels, number of nodules, size of nodules, and benign and malignant ultrasonographic features. sVEGF and nVEGF were higher in malignant or suspicious nodules than that in benign nodules, but did not reach statistical significance (P > 0.05). sVEGFR-1 and nVEGFR-1 levels were higher in hyperthyroid patients than that in euthyroid patients (P < 0.05 and P = 0.003, respectively). nVEGFR-1 level was higher in hypothyroid patients than that in euthyroid patients (P = 0.016). sVEGF level was found to be higher in hyperactive nodules than that in others. Both sVEGFR-1 (P = 0.008) and nVEGF levels (P = 0.01) significantly increased with increasing age. nVEGFR-1 decreased with increasing body mass index (BMI) (P = 0.004). CONCLUSIONS: Our study showed the relationships of sVEGF, nVEGF, sVEGFR-1, and nVEGFR-1 levels with age, gender, BMI, and hyperthyroidism. To determine the role of VEGF/VEGFR-1 in thyroid nodules, further studies are required with a large number of patients.

Antimicrobial resistance of Acinetobacter isolates

A 5-year surveillance on antimicrobial resistance of Acinetobacter isolates at a level-I trauma centre of India
Minu Kumari, Priyam Batra, Rajesh Malhotra, Purva Mathur

Journal of Laboratory Physicians 2019 11(1):34-38

INTRODUCTION: Acinetobacter spp. has emerged as a major cause of nosocomial outbreaks. Multiple antibiotic resistance is an important problem in Acinetobacter isolates in recent years. The aim of this study was to evaluate the rate of antimicrobial resistance and changes in resistance pattern over a period of 5 years (2012&#8211;2016) in Acinetobacter spp. isolated from trauma patients. MATERIALS AND METHODS: Acinetobacter spp. was identified by VITEK 2 and antibiotic susceptibility of isolates was investigated by disc-diffusion method and VITEK 2 automated system. Interpretation of susceptibility results was based on the Clinical and Laboratory Standards Institute guidelines. RESULTS: Out of the total 16,210 isolates obtained throughout the period of 5 years, Acinetobacter spp. accounted for 3744 (28.9&#37;). Out of which, the species which was maximally isolated was Acinetobacter baumannii (98.5&#37;), followed by Acinetobacter lwoffii (1.4&#37;) and Acinetobacter hemolyticus (0.1&#37;). The highest number of clinical isolates of Acinetobacter were recovered from neurosurgical ward (n &#61; 1210), followed by the neurosurgical intensive care unit (ICU) (n &#61; 1000) and surgical ICU (n &#61; 948) and the most common sample of Acinetobacter isolation was from tracheal aspirate (37.1&#37;), followed by wound swab (18.8&#37;). The highest level of resistance was observed against ciprofloxacin (96&#37;), followed by cefepime (95&#37;), ceftazidime (95&#37;), piperacillin (95&#37;), and amikacin (92&#37;). The trend of antibiotic resistance was found to be statistically significant (P &#60; 0.001) for most of the antibiotics being tested such as amikacin and carbapenems. CONCLUSION: The high rate of antibiotic resistance of the Acinetobacter strains indicated that there is an urgent need for controlled antibiotic usage and appliance of hospital infection control measures. 

Volume, conductivity, and scatter parameters of leukocytes as early markers of sepsis and treatment response

Volume, conductivity, and scatter parameters of leukocytes as early markers of sepsis and treatment response
Parul Arora, Praveen Kumar Gupta, Raghavendra Lingaiah, Asok Kumar Mukhopadhyay

Journal of Laboratory Physicians 2019 11(1):29-33

INTRODUCTION: Morphologic changes in the size and granularity of leukocytes seen in sepsis could be measured using the volume, conductivity, and scatter (VCS parameters) from the automated hematology analyzers. The objective of this study is to find the clinical usefulness of VCS parameters as possible indicators of sepsis and to determine the effect of treatment on these parameters. METHODS: This observational study was conducted in a tertiary level hospital in India. Hemogram and VCS parameters obtained from LH 750 (Beckman coulter, Fullerton, CA) from 134 proven blood culture-positive cases of sepsis were reviewed on the day of culture positivity (day 0), day 3, and day 7 were analyzed and compared with those of samples from otherwise healthy 100 participants. Statistical analysis of data was done, and cutoff value was established using receiver-operator characteristic curve. RESULTS: Out of 134 culture-positive cases, 55.2&#37; (n &#61; 74) Gram-negative and 44.8&#37; (n &#61; 60) Gram-positive bacteria were isolated. The mean neutrophil volume (MNV) and mean monocyte volume (MMV) were higher in the sepsis group compared to that of the control group (165.43 &#177; 18.21 vs. 140.59 &#177; 7.6, P &#61; 0.001 for MNV and 179.8 &#177; 14.16 vs. 164.54 &#177; 9.6, P &#61; 0.001 for MMV). A significant decrease in MNV and MMV was observed with the initiation of the treatment. Significant changes in scatter and conductivity parameters were also noticed. A cutoff value of 150.2 for MNV gave a sensitivity and specificity of 79.1&#37; and 95&#37;, respectively, with an area under the curve (AUC) of 92.3&#37;. With a cutoff of 168.3, MMV had a sensitivity of 80.6&#37; and specificity of 77.5&#37;, AUC of 83&#37;. CONCLUSION: VCS parameters such as MNV and MMV can be easily obtained by an automated hematology analyzer and could be used for early detection and therapeutic response in sepsis. 

Multidrug-resistant Acinetobacter septicemia in neonates

: A study from a teaching hospital of Northern India
Asifa Nazir

Journal of Laboratory Physicians 2019 11(1):23-28

BACKGROUND: Acinetobacter species are typical nosocomial pathogens causing infections and high mortality, almost exclusively in compromised hospitalized patients. Acinetobacter sp. are intrinsically less susceptible to antibiotics and have propensity to acquire resistance. Multidrug-resistant (MDR) Acinetobacter sp. blood infection in the neonatal intensive care unit patients create a great problem in hospital settings. AIMS: A prospective data analysis was performed over a one year period of all neonates admitted with sepsis who developed Acinetobacter infection and their antibiotic susceptibility pattern was carried out. MATERIALS AND METHODS: Blood samples of infected neonates were collected aseptically and cases of Acinetobacter septicemia were identified. Speciation of Acinetobacter species was done. Various risk factors were identified and their drug-sensitivity test was performed. RESULTS: The incidence of neonatal septicemia due to Acinetobacter species was 13.7&#37; (49/357). Predominant species isolated was Acinetobacter baumannii (98&#37;). The major symptoms were lethargy and poor feeding. The major signs were tachypnea, intercostal retraction, and respiratory distress. The major fetal risk factors were low birth weight and prematurity. High degree of resistance was observed to the various antibiotics used. Majority of the isolates (95.9&#37;) were MDR while 93.68&#37; were resistant to carbapenems as well as extensively drug resistant. However, all the strains were sensitive to colistin. CONCLUSION: MDR Acinetobacter septicemia in neonatal patients is becoming alarmingly frequent and is associated with significant mortality and morbidity. Therefore, rational antibiotic use is mandatory along with an effective infection control policy in neonatal intensive care areas of each hospital to control Acinetobacter infection and improve outcome. 

Acute undifferentiated febrile illness

Serological evidence of human leptospirosis in patients with acute undifferentiated febrile illness from Uttarakhand, India: A pilot study
Mohit Bhatia, Pradeep Kumar, Pratima Gupta, Puneet Kumar Gupta, Minakshi Dhar, Deepjyoti Kalita

Journal of Laboratory Physicians 2019 11(1):11-16

CONTEXT: To the best of our knowledge, there are no reports of serological evidence of human leptospirosis from Uttarakhand state in India. AIMS: The aim of this study was to screen for serological evidence of leptospirosis in patients with acute undifferentiated febrile illness at a tertiary care teaching hospital in Uttarakhand. SETTINGS AND DESIGN: A pilot study was conducted from March to November 2017. SUBJECTS AND METHODS: Fifty-three adult patients who presented in Medicine outpatient Department with a history of fever of &#8805;7 up to 14 days duration with or without other associated symptoms such as a headache, rashes, myalgia, arthralgia, and conjunctival suffusion were enrolled in the study using convenience sampling technique. Blood samples of these patients were collected and subjected to peripheral smear examination for malaria parasites, dengue immunoglobulin M (IgM) immunochromatographic card test, IgM Typhidot, Leptospira and Scrub typhus IgM ELISA, respectively. Aerobic blood culture was performed in 24 cases. Relevant clinico-epidemiological details were obtained as per the pro forma formulated in accordance with the modified Faine&#39;s criteria. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: The study population consisted of 50.94&#37; of males and 49.06&#37; of females with a mean age &#177; standard deviation of 34.2 &#177; 15.2 years. Fifty febrile patients had additional symptoms of which myalgia was the most common (81.1&#37;) followed by arthralgia (22.6&#37;). Peripheral smears of all patients were negative for malaria parasites. Dengue and Typhidot IgM positivity was observed in two and eight patients, respectively. Six and five patients were tested positive by leptospira and scrub typhus IgM ELISA, respectively. Salmonella Typhi was isolated from blood sample of only one patient. Serum samples of two patients showed dual positivity. All six leptospira seropositive patients satisfied modified Faine&#39;s criteria. CONCLUSIONS: Leptospirosis is a seemingly unexplored infection in Uttarakhand and should be considered as a differential diagnosis in patients with acute undifferentiated febrile illness.