EFFECT OF VISCERAL MANIPULATION ON CHILDREN WITH REFRACTORY CHRONIC FUNCTIONAL CONSTIPATION: A RANDOMIZED CONTROLLED TRIAL.

BACKGROUND: Functional constipation (FC) is a common global high prevalence issue in children. OBJECTIVE: The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment. METHODS: This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report. RESULTS: At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P<0.05). The dose of oral laxative in the intervention group decreased significantly (P<0.05), however, no significant change was observed in the control group (P>0.05). In the intervention group comparison, statistically significant differences were found in all va-riables except the Bristol stool form scale (P<0.05). The Bristol stool form scale after treatments was not different when the groups were compared (P=0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (P<0.05). CONCLUSION: VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.

Post-COVID-19 physical and cognitive impairments and associations with quality of life: a cross-sectional study.

Background and objective: This study aimed to compare physical and cognitive functions between post-coronavirus disease 2019 (COVID-19) participants and healthy matched controls and investigate associations between physical and cognitive impairments with quality of life. Methods: Twenty-three post-COVID-19 participants and 23 age and sex-matched healthy people without a history of COVID-19 were included. Physical function was assessed using the Medical Research Council Sum Score (MRC-SS), 2 min Step Test, Modified Borg Scale, and Short Physical Performance Battery (SPPB) Test. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), and Stroop test, and the quality of life was evaluated using the Euro Quality of Life-5 Dimensions-3 Levels (EQ-5D-3l) questionnaire. Assessments were performed by a physical therapist in one session. Results: Mann-Whitney U test showed that in the post-COVID-19 group, compared to the control group, the number of steps in the 2 min Step Test (p < 0.001, ES = 0.57) and the scores of the SPPB (p = 0.03, ES = 0.32), MoCA (p = 0.003, ES = 0.44), Stroop test (p < 0.001, ES = 0.75), and the EQ-5D-3l visual analog scale (p = 0.027, ES = 0.32) were significantly lower. In addition, the Modified Borg Scale score (p < 0.001, ES = 0.6), TMT-A (p = 0.013, ES = 0.36) and TMT-B (p = 0.016, ES = 0.35) times, and the Stroop time (p < 0.001, ES = 0.61) were significantly higher in the post-COVID-19 group. There were no significant between-group differences in the MRC-SS score (p = 0.055, ES = 0.28). Furthermore, there were significant moderate to high associations between physical and cognitive functions and the quality of life in post-COVID-19 participants. Conclusions: On average 4 months after symptomatic COVID-19, post-COVID-19 participants had significant impairments in physical and cognitive functions compared to healthy matched controls that were significantly correlated with the quality of life. These findings highlight the need for a comprehensive assessment to plan appropriate management strategies.

Efeito da manipulação visceral em crianças com constipação crônica funcional refratária: um ensaio clínico randomizado controlado / Effect of visceral manipulation on children with refractory chronic functional constipation: a randomized controlled trial

ABSTRACT Background: Functional constipation (FC) is a common global high prevalence issue in children. Objective: The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment. Methods: This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report. Results: At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P<0.05). The dose of oral laxative in the intervention group decreased significantly (P<0.05), however, no significant change was observed in the control group (P>0.05). In the intervention group comparison, statistically significant differences were found in all va­riables except the Bristol stool form scale (P<0.05). The Bristol stool form scale after treatments was not different when the groups were compared (P=0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (P<0.05). Conclusion: VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.

RESUMO Contexto: A constipação funcional (CF) é um problema comum de alta prevalência global em crianças. Objetivo: O objetivo do presente estudo é avaliar o efeito da manipulação visceral (MV) em crianças com CF crônica intratável, não responsiva ao tratamento padrão. Métodos: Este estudo foi conduzido como um ensaio clínico randomizado, controlado e cego. Cinquenta e duas crianças com CF crônica refratária, não responsivas ao tratamento médico padrão, foram randomicamente alocadas em dois grupos de 26 controle (cuidados médicos padrão (CMP)) e 26 intervenção (CMP com MV) por 4 semanas. Dor abdominal, defecação dolorosa, consistência das fezes, frequência de defecação e dose de laxante oral foram avaliadas antes e após o período de tratamento usando a Escala de Avaliação da Dor, Escala de Forma das Fezes de Bristol e relato do paciente/pais. Resultados: No final do tratamento, exceto pela dose de laxante oral no grupo controle, todos os resultados mostraram uma diferença significativa em ambos os grupos (P<0,05). A dose de laxante oral no grupo de intervenção diminuiu significativamente (P<0,05), entretanto, nenhuma mudança significativa foi observada no grupo controle (P>0,05). Na comparação do grupo de intervenção, diferenças estatisticamente significativas foram encontradas em todas as variáveis, exceto na Escala de Forma das Fezes de Bristol (P<0,05). A Escala de Forma das Fezes de Bristol após os tratamentos não foi diferente quando os grupos foram comparados (P=0,32), mas o número de indivíduos com consistência fecal normal aumentou significativamente no grupo de intervenção em comparação com o grupo controle (P<0,05). Conclusão: A MV pode ser considerada como um possível tratamento sem efeitos colaterais além dos CMP para o manejo da CF crônica. Mais estudos são necessários para investigar o efeito de longo prazo da MV.

Effect of breathing exercises on respiratory indices and anxiety level in individuals with generalized anxiety disorder: a randomized double-blind clinical trial.

[Purpose] The purpose of this study was to assess the efficacy of breathing exercises alongside traditional therapy on respiratory indexes and the level of anxiety of generalized anxiety disorder patients. [Participants and Methods] Forty-one patients were assigned a study group undergoing medication and routine counselling plus breathing exercises (EXS), and a control group received medication and routine counselling only (Non-EXS). Every two weeks, patients are called (weeks 2, 4, 6, and 8) to monitor their schedule adherence. [Results] This study's results showed FEV1/FVC ratio significantly increased in the EXS group in the second study follow-up period after two months. Anxiety, FVC, FEV1, Etco2, respiration, and pulse rate over time have tended towards desirable results in the exercise group than control groups, especially after two months, but significant differences not seen. [Conclusion] This study's findings indicated that breathing exercises could improve generalized anxiety disorder's pharmacotherapy and psychotherapy. Our data bring up this hypothesis that longer follow up, increasing breathing period, and more exercising is associated with higher outcome.

The synergic effects of alpha-lipoic acid supplementation and electrical isotonic contraction on anthropometric measurements and the serum levels of VEGF, NO, sirtuin-1, and PGC1-α in obese people undergoing a weight loss diet.

Background: The anti-obesity effects of Alpha-lipoic acid (α-LA) and isotonic contraction has been reported. However, the underlying mechanism is not fully understood. This study aimed to investigate the effect of 1200 mg/day α-LA supplementation and 3 sessions per week of Faradic (an electrical stimulating system) on anthropometric parameters, body composition, VEGF, Sirtuin-1, nitric oxide (NO), and PGC1-α in obese people undergoing a weight loss regime.Methods: This randomised clinical trial was carried out on 100 obese adults. The subjects were randomly assigned to four groups of 25 subjects including Faradic, α-LA, α-LA + Faradic, and control. A Bio Impedance Analyser (BIA) was used to estimate anthropometric measurements including weight, body mass index (BMI), fat mass, and fat free mass. The serum levels of Sirtuin-1, PGC1-α, VEGF, and NO levels were measured. All measurements were done at baseline and after 8 weeks of the intervention.Results: A significant weight reduction was observed in all four groups compared to baseline (p<.01). The placebo group had significantly higher weight, BMI, weight circumstance (WC), and body fat (BF) compared with the other groups. The α-LA + Faradic group had significantly lower weight, BMI, BF, WC than control, faradic, and α-LA groups and higher, Sirtuin and PGC than the control group (all p < .05).Conclusions: The findings indicated that the α-LA and Faradic interventions may have a synergistic effect on weight, BMI, BF, WC, and SLM, possibly through changes in serum level of VEGF, NO, and PGC. Further studies are warranted to clarify the mutual effects of -α-LA and Faradic on obesity and its molecular mechanisms. Name of the registry: Iranian Registry of Clinical TrialsTrial registration number: IRCT20131117015424N2Date of registration: 04/04/2018URL of trial registry record: https://www.irct.ir/search/result?query=IRCT20131117015424N2.

The use of crossword puzzles as an educational tool.

INTRODUCTION: Instruction in teacher-centered formats may lead to early learning fatigue, which in turn, decelerates students' knowledge retrieval. Presently, teachers try to increase students' participation and their active attention to course content by incorporating effective, applicable, low-cost, and enjoyable teaching apparatuses. METHODS: The participants of this quasi-experimental study were the students of speech therapy in 4th semester (n=83) at Ahvaz Jundishapur University of Medical Sciences. They were simple-randomly divided into two groups of experimental (who received the crossword puzzle accompanied by lecture or the hybrid method as Group A) and control (who received the traditional method as Group B). The students' knowledge level and students' satisfaction with their received instruction methods were assessed as outcome measures throughout the experiment for both groups. The test score of students' initial knowledge of the concepts in Speech Therapy, the score from the semester final exam of the courses in forms of multiple choice questions, and the retained learning score were calculated as the pre-test, post-test and a follow-up measurement, respectively. Independent-samples T-test for comparative analyses of students' satisfaction between the pre-test and post-test, and multivariate repeated measures ANOVA test were used to analyze the students' knowledge level at three time-points (before, immediately after, and one month after the trainings). The data were analyzed using SPSS ver. 18.0 software, and at the level of statistical significance of P≤0.05. RESULTS: Both educational methods significantly improved the students' knowledge level after the trainings (P=0.030); however, the mean score of knowledge and learning of Group A (mean=17.14) were significantly higher than that of Group B (mean=16.02) immediately after (P=0.036) and one month after the trainings (mean=18.26 vs. 16.10) (P=0.001). The mean score of students' satisfaction in Group A was also significantly higher than that in Group B (P=0.010). CONCLUSION: Utilizing the crossword puzzle as an enjoyable and participatory teaching tool accompanied by lecture could improve management quality in Speech Therapy sessions.

The effect of alpha-lipoic acid supplementation and electrical isotonic contraction on anthropometric parameters, body composition and angiogenesis factor, sirtunin-1 and peroxisome proliferator-activated receptor-γ coactivator-1α in obese people under a weight loss regime: A study protocol for a randomized controlled clinical trial.

BACKGROUND: Obesity is defined as a chronic disease, and is known as a public health problem in developed and developing countries. Several studies have shown the effects of anti-obesity of α-lactalbumin. AIM: This study was designed to investigate the effect of alpha-lipoic acid supplementation and electrical isotonic contraction on anthropometric parameters, body composition and angiogenesis factor, sirtunin-1 and peroxisome proliferator-activated receptor-γ coactivator-1α (PGC1α) in obese people under a weight loss regime. METHODS: Obese people who meet the inclusion criteria are included. Participants are randomly divided into four groups (alpha-lipoic (1200 mg) +weight loss regime group; Faradic (three 1 hour sessions) + weight loss regime group; alpha-lipoic (1200 mg) + Faradic (three 1 hour sessions) + weight loss regime group; control group (1200 mg placebo) for 2 months. At the beginning and the end of the study, demographic information, dietary intake, anthropometric parameters, body composition and serum levels of the angiogenesis factor (sirtunin-1, PGC1α and nitric oxide) are measured. CONCLUSION: Recent studies reported the anti-obesity effects of alpha-lipoic acid. This study is novel, since a similar study has not yet been carried out. This study evaluates the effect of 600 mg of alpha-lipoic acid supplementation or having three sessions of 1 hour per week electrical isotonic contraction induced by Faradic for 2 months alone or in combination in obese people that are undergoing a weight loss regime. TRIAL REGISTRATION: Iran Clinical Trials Registry, ID: IRCT20131117015424N2. Registered 2018-04-02.

Attention-demand effects on respiration in chronic low back pain patients.

Increasing attention is being drawn towards the involvement of systems other than the musculoskeletal one in the presence of low back pain (LBP). Recent evidence suggests both cognitive and respiratory functions to be affected in LBP patients. The aim of this study was to compare the effect of performance of a cognitive task on the respiratory function in LBP patients with that in control participants. Capnography and spirometry parameters of 48 participants (24 in each group) were assessed under 3 cognitive loading conditions (no, easy and difficult cognitive task). The results showed that in both groups the respiratory function was significantly affected by the introduction of the cognitive task (p < 0.05) and in the same manner (p > 0.05). Capnography and spirometry variables alterations were significantly correlated in the no-LBP group (p < 0.05) but there was no significant relationship between respiratory parameters and capnography and disability indices in the LBP group (p > 0.05). The findings of the current study suggest that while performing a cognitive task affects respiratory function, the possible differences of LBP patients and control participants may not be elicited under simple non-physically demanding postural conditions.

Effect(s) of Language Tasks on Severity of Disfluencies in Preschool Children with Stuttering.

Speech disfluency in children can be increased or decreased depending on the type of linguistic task presented to them. In this study, the effect of sentence imitation and sentence modeling on severity of speech disfluencies in preschool children with stuttering is investigated. In this cross-sectional descriptive analytical study, 58 children with stuttering (29 with mild stuttering and 29 with moderate stuttering) and 58 typical children aged between 4 and 6 years old participated. The severity of speech disfluencies was assessed by SSI-3 and TOCS before and after offering each task. In boys with mild stuttering, The mean stuttering severity scores in two tasks of sentence imitation and sentence modeling were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). But, in boys with moderate stuttering the stuttering severity in the both tasks were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). In girls with mild stuttering, the stuttering severity in two tasks of sentence imitation and sentence modeling were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). But, in girls with moderate stuttering the mean stuttering severity in the both tasks were [Formula: see text] and [Formula: see text] respectively ([Formula: see text]). In both gender of typical children, the score of speech disfluencies had no significant difference between two tasks ([Formula: see text]). In preschool children with mild stuttering and peer non-stutters, performing the tasks of sentence imitation and sentence modeling could not increase the severity of stuttering. But, in preschool children with moderate stuttering, doing the task of sentence modeling increased the stuttering severity score.

Reliability and Validity of the Iranian Version of Nijmegen Questionnaire in Iranians with Asthma.

BACKGROUND: The aim of this study was to assess the validity and reliability of Nijmegen questionnaire (NQ) translated to Farsi for diagnosis of the hyperventilation syndrome (HVS) in patients with asthma. MATERIALS AND METHODS: The original version of NQ was translated to Farsi and then back-translated to English again to assess its agreement with the original version. To determine its cultural adaptation, a pilot study was carried out. The mean score of the questionnaire and the mean pressure of end tidal carbon dioxide (PETCO2) were compared in 100 asthmatic patients to determine the validity of the questionnaire. For reliability, 52 out of 100 patients randomly filled out the questionnaire with an interval of 5 to 10 days. Internal consistency and content validity of the questionnaire were assessed by Cronbach's alpha coefficient and by calculating floor and ceiling effects respectively. The exploratory factor analysis was used to assess the factor structure. RESULTS: There was a significant inverse correlation between NQ scores and PETCO2 (P=-0.783). Cronbach's alpha coefficient was greater than 0.7, indicating good internal consistency of the questionnaire (P=0.702). The questionnaire had a good stability in an interval of 5 to 10 days (P=0.826). The NQ had no floor and ceiling effect. and also factor analysis of 16 scales showed that this questionnaire has a five-factor structure, which can describe 55% of data variance. CONCLUSION: The Iranian version of the Nijmegen questionnaire is a valid and reliable tool for detection of patients with HVS. In addition, the questionnaire can be used to evaluate the condition of respiratory function in people with asthma.