Results of neck-specific exercise for altered postural sway in individuals with chronic whiplash-associated disorders: a longitudinal case-control study.

Postural sway has not been investigated before or after a neck exercise intervention in individuals with chronic whiplash-associated disorders (WAD). The aim of the study was to investigate postural sway in individuals with chronic WAD grades 2 and 3: (a) compared with healthy matched controls at baseline; (b) after three months of neck-specific exercise and (c) to investigate the correlation between postural sway with self-reported dizziness during motion and balance problems/unsteadiness. This is a longitudinal prospective experimental case-control intervention study. Individuals with WAD (n = 30) and age- and gender-matched healthy volunteers (n = 30) participated. Postural sway was assessed using an iPhone application. Measurements were carried out at baseline, and for those with WAD a second measurement was performed at the three-month follow-up when neck-specific exercise intervention ended. The WAD group performed significantly worse than the healthy group in both pathway and ellipse area double stance eyes closed at baseline (main outcome), but not at the three-month follow-up. The WAD group significantly improved after rehabilitation in both pathway double stance eyes closed and pathway single stance eyes open. The correlation between postural sway and self-rated dizziness during motion and balance problems was low to moderate. One may conclude that postural sway was improved after a neck-specific exercise programme. The study results strengthen earlier findings that individuals with WAD have worse balance outcome when they have to rely on neck proprioception (eyes closed). The study results may be important for the development of improved rehabilitation methods for WAD.

Acute Kidney and Liver Injury Associated With Low-Dose Liraglutide in an Obese Adolescent Patient.

In 2020, the US Food and Drug Administration approved liraglutide (glucagon-like-peptide-1-receptor-agonist) as an adjunctive therapy for weight management in adolescents aged 12 to 18 years in combination with a reduced-calorie diet and increased physical activity. The 2023 American Academy of Pediatrics guidelines recommend pharmacotherapy with glucagon-like-peptide-1-receptor-agonist as a second-line therapy in obesity management. Although reports in adults have suggested a link between liraglutide and adverse effects including hepatic injury and acute kidney injury (AKI), these effects have not previously been reported among adolescents treated with liraglutide for weight loss. We present a 17-year-old male who developed AKI and evidence of hepatic injury (significant elevation of hepatic transaminases) after 3 months administration of the lowest dosage of liraglutide (0.6 mg/day) for management of class III obesity. The patient experienced significant loss of appetite, weight loss, and melancholy during the treatment period. One month after discontinuing liraglutide, his mood had improved, his liver enzymes had returned to normal, and AKI had resolved. The Adverse Drug Reaction Probability Scale suggested a high likelihood of a causative association between liraglutide and his symptoms. Our report highlights the importance of vigilance in monitoring for these potential adverse effects among adolescents treated for obesity with any dose of liraglutide.

Remote versus face-to-face fall risk assessment in home dwelling older adults: a reliability study.

BACKGROUND: Falls are a leading cause of severe injury and death in older adults. Remote screening of fall risk may prevent falls and hence, advance health and wellness of older adults. While remote health care is becoming a common practice, we question if remote evaluation of fall risk is as reliable as face-to-face (FTF). OBJECTIVE: To assess the inter-tester reliability of synchronized remote and FTF fall risk assessment. METHODS: This inter-format, inter-rater reliability study included 48 home dwelling older adults aged 65 and over. Five valid functional and balance tests were conducted: 30 Second Sit-to-Stand (STS), MiniBESTest, Timed up and go (TUG), 4-Meter Walk (4MWT), and Berg Balance Scale (BBS). Instructions were provided via videoconferencing, and two physiotherapists scored performance simultaneously, one remotely, and one in the room. Inter-rater reliability between remote and FTF scores was analyzed using intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimal detectable change (MDC95) and Bland and Altman analysis. RESULTS: Excellent ICCs were found for STS, MiniBESTest, TUG, and BBS (0.90-0.99), and moderate for 4MWT (0.74). SEM and MDC95 values were STS (0.37,1.03 repetitions), MiniBESTest (1.43,3.97 scores), TUG (1.22,3.37 seconds), 4MWT (0.17,0.47 m/second), and BBS (1.79,4.95 scores). The Bland and Altman analysis showed excellent agreement between remote and FTF assessments of the STS. All other tests showed low to moderate agreement. Mean difference ± SD and 95%LOA were as follows: STS (-0.11 ± 0.52), (-1.13,0.91) repetitions, MiniBESTest (0.45 ± 1.98), (-3.43,4.32) scores, TUG (-0.35 ± 1.54), (-3.37,2.67) seconds, 4MWT (-0.08 ± 0.22), (-0.35,0.51) meter/second, and BBS (0.04 ± 2.53), (-4.93,5.01) scores. CONCLUSIONS: The findings support the responsible integration of remote fall risk assessment in clinical practice, enabling large-scale screenings and referrals for early intervention to promote healthy aging and fall prevention.

Urinary tract infections in young infants with a normal urine dipstick.

AIM: To assess missed urinary tract infections (UTI) in febrile infants ≤2 months when adhering to recent guidelines suggesting not to send a urine culture with a negative dipstick. METHODS: A retrospective cohort study of 308 infants ≤2 months with a positive urine culture admitted in 2013-2023, divided into subgroups without exposure to urine dipstick results: 'urosepsis' (UTI with bacteraemia), 'UTI' (positive urine culture, elevated inflammatory markers, no other cause of fever) and 'bacteriuria' (positive urine culture, not meeting the above-mentioned criteria). After retrieving the dipstick results, the 'missed UTI' group (UTI+ negative dipstick) was described. RESULTS: A negative dipstick was found in 2/20 (10%), 32/127 (25%) and 126/161 (78%) of infants with 'urosepsis', 'UTI' and 'bacteriuria', respectively. In the 'missed UTI' group (n = 34), there were more non-Escherichia coli UTI (68% vs. 9% with positive dipstick, p < 0.001), and lower inflammatory markers (leukocytes 15.5 vs. 17.2 k/µL, p = 0.007, C-reactive protein 21 vs. 58 mg/L, p < 0.001). Three infants had high-grade vesicoureteral reflux (VUR) and renal scarring. CONCLUSIONS: There is a non-negligible rate of infants ≤2 months with UTI and without pyuria, including those with urosepsis, VUR and renal scarring. We suggest obtaining a urine culture regardless of dipstick results.