Prevalence and Characteristics of Low Back Pain in a Rural Ghana Primary Care Clinic Population.

INTRODUCTION: Low back pain (LBP) is the leading cause of disability in the developed world. Less is known about the impact of LBP in the developing world, and particularly the rural developing world. In 2015, the World Health Organization (WHO) issued an urgent call for additional research into the prevalence and effect of LBP on developing world populations. OBJECTIVE: To calculate the prevalence of LBP in a rural Ghana primary care clinic population. DESIGN: Survey of LBP prevalence and severity. SETTING: Primary care mission clinic in rural Southeastern Ghana. PARTICIPANTS: Six hundred eighty-four adult patients. METHODS: All adult patients were screened for LBP using the definition "any pain occurring within the region between the lower margin of the 12th ribs and the gluteal folds." The Oswestry Disability Index (ODI) was used to further characterize LBP in those screening positive. Chi-square test was used to assess statistical significance of difference in prevalence between groups, and ordinary least squares regression was used to assess the relationship between LBP severity and gender and age. MAIN OUTCOME MEASUREMENTS: LBP prevalence and LBP severity as assessed using the ODI. RESULTS: Overall LBP prevalence was 15.7%, with no statistically significant differences observed by age or gender. The activities of standing, traveling, and walking were most severely affected. Of those with LBP, 10.3% were considered "crippled" based on ODI responses, whereas a further 31.8% were "severely disabled." No statistically significant relationship between LBP severity and age or gender was found. CONCLUSIONS: LBP is a cause of significant disability within this region of rural Ghana; however, prevalence appears to be lower than in the developed world and parts of the urbanized developing world. Increased attention to screening and treatment of LBP represents an opportunity to improve the health of rural Africans. LEVEL OF EVIDENCE: IV.

Sleeping beauties in the otolaryngology-head & neck surgery literature.

INTRODUCTION: "Sleeping Beauties" (SBs) are articles that receive little attention in the literature for many years after publication but suddenly "awaken" at a later date to greatly increased relevance. This effort represents the first attempt at identifying SBs within the otolaryngology literature. METHODS: The Web of Science Database was queried for all papers under the section "Otolaryngology" between 1945 and 2007. All papers were assigned a "Beauty Coefficient" (B), based on an a priori formula. Three groups were analyzed: 1) highest overall SBs, 2) clinically significant SBs (papers with greater than 100 total citations), and 3) modern SBs (published 1988 and later). RESULTS: 80,532 papers were identified, with SB able to be calculated in 79,523. Papers spanned a wide array of topics within the Otolaryngology literature. Unlike analysis of SBs in other disciplines, no obvious patterns or themes appeared consistently within or between any of the three groups. CONCLUSIONS: This study represents the first known analysis of SBs in our field. While no obvious patterns or unifying themes were observed, this analysis highlights the clinical impact of SBs and underscores the idea that in this surgical field, important ideas may be proposed "ahead of their time." LEVEL OF EVIDENCE: NA Laryngoscope, 130:609-614, 2020.

Disruption of peripheral nerve development in a zebrafish model of hyperglycemia.

Diabetes mellitus-induced hyperglycemia is associated with a number of pathologies such as retinopathy, nephropathy, delayed wound healing, and diabetic peripheral neuropathy (DPN). Approximately 50% of patients with diabetes mellitus will develop DPN, which is characterized by disrupted sensory and/or motor functioning, with treatment limited to pain management. Zebrafish (Danio rerio) are an emerging animal model used to study a number of metabolic disorders, including diabetes. Diabetic retinopathy, nephropathy, and delayed wound healing have all been demonstrated in zebrafish. Recently, our laboratory has demonstrated that following the ablation of the insulin-producing ß-cells of the pancreas (and subsequent hyperglycemia), the peripheral nerves begin to show signs of dysregulation. In this study, we take a different approach, taking advantage of the transdermal absorption abilities of zebrafish larvae to extend the period of hyperglycemia. Following 5 days of 60 mM d-glucose treatment, we observed motor axon defasciculation, disturbances in perineurial glia sheath formation, decreased myelination of motor axons, and sensory neuron mislocalization. This study extends our understanding of the structural changes of the peripheral nerve following induction of hyperglycemia and does so in an animal model capable of potential DPN drug discovery in the future.NEW & NOTEWORTHY Zebrafish are emerging as a robust model system for the study of diabetic complications such as retinopathy, nephropathy, and impaired wound healing. We present a novel model of diabetic peripheral neuropathy in zebrafish in which the integrity of the peripheral nerve is dysregulated following the induction of hyperglycemia. By using this model, future studies can focus on elucidating the underlying molecular mechanisms currently unknown.