How does exercise influence fatigue in people with multiple sclerosis?

Purpose. This study explored the influence of an 8-week exercise programme on fatigue perceptions in people with multiple sclerosis (MS).

Method. Eight women and two men with a confirmed diagnosis of MS participated three times a week in an 8-week exercise programme at a physiotherapy gymnasium. Participants were interviewed at three defined time points. Interviews were transcribed, analysed, and emergent categories were subject to verification by three independent sources.

Results. Five interrelated categories were identified from the data. The category, ‘listening to your body’ evolved from the participants' ‘perceived control over fatigue’, which subsequently defined the ‘reaching the edge’; a critical point at which the ‘nature of tiredness' perceived by participants following exercise was either healthy or unhealthy. This critical point consequently explained either perceived positive ‘exercise outcomes' outcomes of physical improvement and wellbeing or perceived physical deterioration and negative feelings.

Conclusion. This study details the positive and negative influences of exercise on fatigue perceptions in people with MS. Healthcare professionals therefore, need to be cognisant of strategies which may enhance ‘perceived control over fatigue’ and promote ‘listening to your body’, in order to maximise the benefits of exercise intervention for individuals with MS-related fatigue.     

Is there a relationship between wound infections and laceration closure times?

Background

Lacerations account for a large number of ED visits. Is there a ??golden period?? beyond which lacerations should not be repaired primarily? What type of relationship exists between time of repair and wound infection rates? Is it linear or exponential? Currently, the influence of laceration age on the risk of infection in simple lacerations repaired is not clearly defined. We conducted this study to determine the influence of time of primary wound closure on the infection rate.

Methods

This is a prospective observational study of patients who presented to the Emergency Department (ED) with a laceration requiring closure from April 2009 to November 2010. The wound closure time was defined as the time interval from when the patient reported laceration occurred until the time of the start of the wound repair procedure. Univariate analysis was performed to determine the factors predictive of infection. A non-parametric Wilcoxon rank-sum test was performed to compare the median differences of time of laceration repair. Chi-square (Fisher's exact) tests were performed to test for infection differences with regard to gender, race, location of laceration, mechanism of injury, co-morbidities, type of anesthesia and type of suture material used.

Results

Over the study period, 297 participants met the inclusion criteria and were followed. Of the included participants, 224 (75.4%) were male and 73 (24.6%) were female. Ten patients (3.4%) developed a wound infection. Of these infections, five occurred on hands, four on extremities (not hands) and one on the face. One of these patients was African American, seven were Hispanic and two were Caucasian (p?=?0.0005). Median wound closure time in the infection group was 867?min and in the non-infection group 330?min (p?=?0.03).

Conclusions

Without controlling various confounding factors, the median wound closure time for the lacerations in the wound infection group was statistically significantly longer than in the non-infection group.     

Is there a relationship between light touch-pressure sensation and functional hand ability?

Purpose. To investigate and compare the level of light touch-pressure sensation as tested via the Semmes Weinstein monofilament (SWM) test with the level of functional hand ability.

Methods. Twenty-seven persons with isolated sensory deficit due to leprosy and 31 healthy controls were tested in the Occupational Therapy department of a hospital for patients with Hansen's disease. Palmar light touch thresholds were determined by SMW testing. Functional hand ability was tested via the Jebsen-Taylor Hand Function Test (JTHFT) and the Functional Dexterity Test (FDT). All participants were measured by manual muscle testing (MMT) to exclude any motor impairment. Data analysis compared sensory thresholds and level of functional hand ability between the two groups and examined the relationship between the variables.

Results. In the group with sensory deficit, the sensory thresholds were significantly higher than in the control group. Significant correlations were found between the sensory thresholds measured by the SWM test and the FDT and JTHFT scores, with higher correlations found for tasks entailing manipulation of small objects.

Conclusions. The findings support the existence of a relationship between sensory light touch thresholds tested by the Semmes Weinstein monofilaments (SWMs) and hand function. However, the SWM test alone is not sufficient as an indicator of hand function and must therefore be supplemented with other hand function tests.     

Is there a relationship between the blood cholinesterase and QTc interval in the patients with acute organophosphate poisoning?

Organophosphates cause poisoning as a result of the excessive accumulation of acetylcholine at the cholinergic synapses due to inhibition of acetylcholinesterase (ChE). In the literature, it has been reported that there have been electrocardiographic abnormalities, including QT-interval prolongation in most patients with acute organophosphate poisoning (OPP), and a relation between blood ChE level and clinical severity in acute OPP. The aim of this study is to assess the relationship between blood ChE level and QTc interval in the patients with acute OPP. This retrospective study consists of 20 patients admitted to the emergency intensive care unit. A total of 93 QTc interval and blood ChE measures obtained on the same day from 20 cases were compared for their correlation. There were prolonged QTc intervals in 35.4% of the ECGs. There was a negative correlation between QTc interval and blood ChE measures. In following up the patients with acute OPP, QTc interval may be useful when blood ChE levels are low and may provide complementary information concerning the severity of poisoning. However, further prospective studies, supporting the present results, are needed.     

Is there a relationship between plasma phenylalanine and cholesterol in phenylketonuric patients under dietary treatment?

OBJECTIVES: To study the lipid profile in a group of treated phenylketonuric patients (PKU; n = 61) compared with a group of inborn error of intermediary metabolism patients (IEM; n = 22), a group of hyperphenylalaninemic children (HPA; n = 37), and a control group without dietary restriction (n = 41). DESIGN AND METHODS: Phenylalanine was analyzed by ion exchange chromatography and triglycerides, cholesterol and HDL were determined by standard procedures with the Cobas Integra analyzer. RESULTS: Serum total cholesterol concentrations were significantly lower in PKU patients compared with IEM patients (whose cholesterol daily intake was similar to those of PKU patients), HPA children and the control group. A negative correlation was observed between cholesterol and phenylalanine concentrations in the PKU patients. CONCLUSIONS: Our findings support the hypothesis of a relationship between high plasma phenylalanine levels and an inhibition of cholesterogenesis, although the low cholesterol intake of the special diets may also decrease serum cholesterol values.     

How are cognitive impairment,fatigue and signs of depression related to participation in daily life among persons with multiple sclerosis?

Abstract

Purpose: Factors that impact participation are of scientific and clinical importance. Participation in everyday activities among persons with multiple sclerosis (MS) can be compromised by various factors however the combined contribution of these factors to participation has not been explored. The aim of this study was to describe the relationship between cognitive impairment, physical disability and signs of depression and participation in daily life among persons with MS. Methods: Data from 200 participants were collected in an observational, prospective study. The majority was female, had mild physical disability, and an average age of 48.7. The impact of independent variables, including demographic and disease related data, levels of cognitive impairment, signs of depression and fatigue, on participation was investigated using path analysis. Results: Cognitive impairment was associated with restricted participation in domestic, leisure and outdoor domains. Restrictions in leisure and outdoor activities, but not domestic activities were related to signs of depression. Cognitive impairment was associated with the level of education and the level of physical disability. Conclusions: Increasing participation is an important outcome of rehabilitation. The results of this study suggest a multifactorial approach to intervention that considers physical, mental and emotional component to maximize participation among persons with MS.

• Implications for Rehabilitation

• Rehabilitation for persons living with multiple sclerosis (MS) should incorporate careful evaluation of physical disability, cognitive impairment and depression and their impact on participation.

• Clinicians need to evaluate participation in a variety of daily activities, including activities within and outside of the home, and leisure activities.

• Signs of depression may have a greater impact on participation in outdoor and leisure activities then on other activities.

     

Care without coverage: Is there a relationship between insurance and ED care?

The Institute of Medicine (IOM) has concluded that differences in care exist for hospitalized patients on the basis of insurance; we attempted to determine if these differences begin in the emergency department (ED). We retrospectively studied high-acuity adult visits to one ED over 6 months, utilizing electronic databases. Uninsured patients were more often younger, male, and non-white (n = 3899 visits; 468 uninsured, 3431 insured). Fewer uninsured patients were admitted (9.8% vs. 27.2% insured; p < 0.001). Comparing patients by admission status, there was no evidence of difference for most measures, excepting radiographic studies (admitted patients: 78.3% uninsured vs. 90.5% insured, p = 0.007; treated-and-released patients: 62.3% uninsured vs. 69.4% insured, p = 0.004). In a subset of trauma patients for whom acuity could be evaluated with Injury Severity Scores (ISS), admission rates were similar. In this pilot study of high-acuity patients, there was limited evidence of differences in most measures of ED-based patient care on the basis of insurance status.     

Gestational diabetes: Is there a relationship between leg length and glucose tolerance?

OBJECTIVE: To assess the relationship between leg length and glucose tolerance in pregnancy. RESEARCH DESIGN AND METHODS: The leg length and leg-to-height percentage were prospectively determined on 161 glucose-tolerant women during pregnancy and 61 women with gestational diabetes mellitus (GDM). RESULTS: Women with GDM were a mean of 2.8 cm shorter than women who were glucose tolerant, due entirely to their leg lengths being a mean of 3.2 cm shorter. With respect to the 2-h result on the glucose tolerance test (GTT), there were negative correlations for height (r = -0.161, P = 0.017), leg length (r = -0.266, P < 0.0005), and the leg-to-height percentage (r = -0.294, P < 0.0005). The correlation between the leg-to-height percentage and the 2-h result on the GTT remained significant after adjustment for age (r = -0.252, P < 0.0005) and for age and BMI (r = -0.224, P = 0.001). CONCLUSIONS: Women with GDM are shorter than glucose-tolerant women and have a lower leg-to-height percentage. Consideration of short stature as a risk factor for GDM is not valid without taking into account the leg-to-height percentage.     

Is there a link between dementia and phenylketonuria?

This study searches for causes of dementia by posing the hypothesis that the natural decline in the metabolic functioning associated with aging may mimic the specific "error in metabolism" present in some children at birth that leads to phenylketonuria. Although the Guthrie Test is adequate for children, perhaps a quantitative test is needed for the elderly to detect minute elevations of serum phenylalanine. If a positive relationship could be documented between elevated serum phenylalanine in the elderly and dementia, would a diet low in phenylalanine help prevent some of the manifestations seen in the elderly with dementia? By carefully following these dietary restrictions, would more of the elderly be able to "age in place" in the community and not have to be institutionalized?     

Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia?

BackgroundCurrent clinical guidelines do not support the use of manual therapy (MT) interventions for Fibromyalgia (FM) patients, despite evidence of positive biochemical, mechanical and psychological effects, and the popularity of hands-on treatments amongst patients. An optimal dose for MT has not been established; this may explain the discrepancies found within the published literature. The aim of this systematic review was to determine whether there is a dose response relationship for MT leading to improvements in core domains of FM symptomology; Pain, Mood, Sleep, Global Measure of Impact (Functional Status & Quality of Life).MethodsWe searched six databases from 1990 to January 2018; studies were evaluated using the PEDro scale. Within-group (ESd) and between-group (ESg) Effect Sizes were calculated.ResultsWe identified and screened 4012 articles, 12 articles were critically appraised. Overall, there is moderate evidence that MT has positive effects on the four clinical outcomes investigated. However, there was no consistent dose response relationship observed across all studies.ConclusionsA dose of approximately 45 min MT, three to five times per week, for three to five weeks, totalling 11 h 15 min, should be considered a baseline generic protocol for treatment delivery and research trials. Further research is necessary to confirm domain specific, or patient specific optimal doses. Moderator variables such as treatment time, frequency, duration; and MT type also need to be explored to ensure optimal delivery of MT in future research and clinical care provision.     

Is there a causal relationship between stress and migraine? Current evidence and implications for management

BackgroundThe purpose of this narrative review is to examine the literature investigating a causal relationship between stress and migraine and evaluate its implications for managing migraine.MethodsPubMed, PsycINFO and CINAHL were searched from 1988 to August 2021, identifying 2223 records evaluating the relationship between stress and migraine. Records were systematically screened. All potentially relevant records were thematically categorized into six mechanistic groups. Within each group the most recent reports providing new insights were cited.ResultsFirst, studies have demonstrated an association of uncertain causality between high stress loads from stressful life events, daily hassles or other sources, and the incidence of new-onset migraine. Second, major stressful life events seem to precede the transformation from episodic to chronic migraine. Third, there is some evidence for changes in levels of stress as a risk factor for migraine attacks. Research also suggests there may be a reversed causality or that stress-trigger patterns are too individually heterogeneous for any generalized causality. Fourth, migraine symptom burden seems to increase in a setting of stress, partially driven by psychiatric comorbidity. Fifth, stress may induce sensitization and altered cortical excitability, partially explaining attack triggering, development of chronic migraine, and increased symptom burden including interictal symptom burden such as allodynia, photophobia or anxiety. Finally, behavioral interventions and forecasting models including stress variables seem to be useful in managing migraine.ConclusionThe exact causal relationships in which stress causes incidence, chronification, migraine attacks, or increased burden of migraine remains unclear. Several individuals benefit from stress-oriented therapies, and such therapies should be offered as an adjuvant to conventional treatment and to those with a preference. Further understanding the relationship between stress, migraine and effective therapeutic options is likely to be improved by characterizing individual patterns of stress and migraine, and may in turn improve therapeutics.