Impact of antenatal corticosteroids on frequency and mortality due to respiratory distress syndrome in preterm neonates.

BACKGROUND: Prematurity is still a major problem for health care services throughout the world. Before the late 1980s, respiratory distress syndrome (RDS) was the primary cause of morbidity and mortality in preterm new-borns. Frequency of RDS and ensuing mortality in infants treated with antenatal steroid is less than those delivered without this therapy. Many pregnant females deliver before term or 37 weeks, hence may be advised this prophylactic therapy without creating significant maternal or foetal side effects. METHODS: It was a descriptive case-series conducted in the department of obstetrics and gynaecology, unit II of Jinnah Hospital Lahore for a period of 6 months. RESULTS: The study sample of 230 was divided into two groups on the basis of exposure to dexamethasone. RDS was reported 76 (33.0%) cases (preterm neonates) in the study, out of these 26 (22.4%) cases belonged to exposed group and 50 (43.9%) cases belonged to non-exposed group. Mortality due to RDS among all preterm neonates with RDS occurred in total 29 (12.6%) preterm neonates in the study, out of these 5 (4.3%) cases belonged to exposed group and 24 (21.1%) belonged to non-exposed group. CONCLUSIONS: Frequency of RDS and mortality due to this disease in group of infants treated with antenatal steroid is far less than the group of preterm new-borns delivered without this therapy.

Effect of constraint-induced movement therapy on persons-reported outcomes of health status after stroke: a systematic review and meta-analysis.

Constraint-induced movement therapy (CIMT) is used for the rehabilitation of motor function after stroke. The aim of this review was to investigate its effect on persons-reported outcomes of health status (PROsHS) compared with conventional therapy. The study was a systematic review and meta-analysis registered in PROSPERO (CRD42019142279). Five databases PubMED, PEDro, OTSeeker, CENTRAL and Web of Science were searched. Randomized controlled trials were included if they assessed PROsHS. Mean scores of PROsHS, sample size and dose of CIMT and control groups interventions were extracted. The result was analyzed using qualitative and quantitative syntheses. Nine studies (n = 558) were included in the review. From the result, CIMT significantly improved PROsHS postintervention. However, postintervention, there was no statistically significant difference between groups for the upper limb [Mean difference (MD) = 6.67, 95% confidence interval (CI) = -2.09 to 15.44, P = 0.14] and the lower limb (MD = -1.86, 95% CI = -16.29 to 12.57, P = 0.80). Similarly, there was no statistically significant percentage of variation across studies, upper limb (I2 = 0%, P = 0.92) and lower limb (I2 = 0%, P = 0.86). For the lower limb at follow-up, there was no statistically significant difference between groups (MD = 0.97, 95% CI = -13.59 to 15.53, P = 0.90). When upper and lower limbs studies were pooled, there was no statistically significant difference between groups postintervention (MD = 0.22, 95% CI = -0.15 to 0.58, P = 0.24) and at follow-up (MD = 0.03, 95% CI = -0.43 to 0.49, P = 0.90). CIMT improves PROsHS after stroke. However, it is not superior to conventional therapy based on the current literature.

Effects of Lower Limb Constraint Induced Movement Therapy in People With Stroke: A Systematic Review and Meta-Analysis.

Background: Constraint induced movement therapy (CIMT) is effective at improving upper limb outcomes after stroke. Aim: The aim of this study was to carry out a systematic review and meta-analysis of the effects of lower limb CIMT studies of any design in people with stroke. Materials/ Method: PubMED, PEDro, OTSeeker, CENTRAL, and Web of Science were searched from their earliest dates to February 2021. Lower limbs CIMT studies that measured outcomes at baseline and post-intervention were selected. Sample size, mean, and standard deviation on the outcomes of interest and the protocols of both the experimental and control groups were extracted. McMaster Critical Review Form was used to assess the methodological quality of the studies. Result: Sixteen studies with different designs were included in this review. The result showed that lower limb CIMT improves functional, physiological and person's reported outcomes including motor function, balance, mobility, gait speed, oxygen uptake, exertion before and after commencement of activities, knee extensor spasticity, weight bearing, lower limb kinematics and quality of life in people with stroke post intervention. However, there were only significant differences in quality of life in favor of CIMT post-intervention [mean difference (MD) = 16.20, 95% CI = 3.30-29.10, p = 0.01]; and at follow-up [mean difference (MD) = 14.10, 95% CI = 2.07-26.13, p = 0.02] between CIMT and the control group. Even for the quality of life, there was significant heterogeneity in the studies post intervention (I 2 = 84%, p = 0.01). Conclusion: Lower limb CIMT improves motor function, balance, functional mobility, gait speed, oxygen uptake, weigh bearing, lower limb kinematics, and quality of life. However, it is only superior to the control at improving quality of life after stroke based on the current literature.

Neurological and Musculoskeletal Features of COVID-19: A Systematic Review and Meta-Analysis.

Importance: Some of the symptoms of COVID-19 are fever, cough, and breathing difficulty. However, the mechanism of the disease, including some of the symptoms such as the neurological and musculoskeletal symptoms, is still poorly understood. Objective: The aim of this review is to summarize the evidence on the neurological and musculoskeletal symptoms of the disease. This may help with early diagnosis, prevention of disease spread, and treatment planning. Data Sources: MEDLINE, EMBASE, Web of Science, and Google Scholar (first 100 hits) were searched until April 17, 2020. The key search terms used were "coronavirus" and "signs and symptoms." Only studies written in English were included. Study Selection: The selection was performed by two independent reviewers using EndNote and Rayyan software. Any disagreement was resolved by consensus or by a third reviewer. Data Extraction and Synthesis: PRISMA guidelines were followed for abstracting data and assessing the quality of the studies. These were carried out by two and three independent reviewers, respectively. Any disagreement was resolved by consensus or by a third reviewer. The data were analyzed using qualitative synthesis and pooled using a random-effect model. Main Outcome(s) and Measure(s): The outcomes in the study include country, study design, participant details (sex, age, sample size), and neurological and musculoskeletal features. Result: Sixty studies (n = 11, 069) were included in the review, and 51 studies were used in the meta-analysis. The median or mean age ranged from 24 to 95 years. The prevalence of neurological and musculoskeletal manifestations was 35% for smell impairment (95% CI 0-94%; I 2 99.63%), 33% for taste impairment (95% CI 0-91%; I 2 99.58%), 19% for myalgia (95% CI 16-23; I 2 95%), 12% for headache (95% CI 9-15; I 2 93.12%), 10% for back pain (95% CI 1-23%; I 2 80.20%), 10% for dizziness (95% CI 3-19%; I 2 86.74%), 3% for acute cerebrovascular disease (95% CI 1-5%; I 2 0%), and 2% for impaired consciousness (95% CI 1-2%; I 2 0%). Conclusion and Relevance: Patients with COVID-19 present with neurological and musculoskeletal symptoms. Therefore, clinicians need to be vigilant in the diagnosis and treatment of these patients.

Interleukin-10 as a Marker of Disease Progression in Dengue Hemorrhagic Fever.

OBJECTIVE: To evaluate the plasma interleukin-10 (IL-10) levels in patients suffering from dengue hemorrhagic fever between 4 to 7 days of onset of disease and 24 hours after the first sample, to find out the association of plasma IL-10 levels with the outcome. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: All major hospitals of Lahore, Pakistan, from August to November 2012. METHODOLOGY: Participants included 50 registered patients of dengue hemorrhagic fever (DHF) aged between 15 - 50 years. Plasma IL-10 concentrations were measured on above stated day. Outcome was described as recovery and shock. Platelet count and hematocrit percentages were also recorded. Statistical analyses were done using SPSS version 19. Ap-value ≤0.05 was considered significant. RESULTS: Plasma IL-10 levels were found to be raised in DHF patients and were associated with fatal outcome (p=0.004). In recovered DHF patients, plasma IL-10 levels decreased after 24 hours (mean 26.54 ± 16.03 pg/ml) as compared to admission time (mean 74.39 ± 61.69 pg/ml) but in case of DHF patients suffering from shock, plasma IL-10 was found to be higher after 24 hours (mean 87.69 ± 7.77 pg/ml) as compared to levels at admission time (mean 42.56 ± 28.09 pg/ml). ROC curve analysis revealed a change (30 units pg/ml) of plasma IL-10 concentration, within 24 hours of admission, raised from the base line to be 105 times more critical for shock in DHF patients (100% sensitivity and 71.4% specificity, p < 0.001). CONCLUSION: Elevated plasma IL-10 is a potential predictor of disease severity and fatal outcome in DHF patients.

Serum 25-Hydroxy Vitamin D Level in Preeclamptic and Normotensive Pregnancies.

OBJECTIVE: To compare serum 25-hydroxy vitamin D level between preeclamptic and normotensive pregnancies. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Department of Physiology, Federal Postgraduate Medical Institute, Shaikh Zayed Hospital, Lahore, in collaboration with Sir Ganga Ram Hospital and Lady Willingdon Hospital, Lahore, from March 2012 to April 2012. METHODOLOGY: Thirty registered preeclamptic patients with systolic and diastolic blood pressure > 140/90 mm Hg on more than two occasions, 6 hours apart, and proteinuria at least 300 mg in 24-hour urine collection; and 30 normotensive uncomplicated pregnant women matched for age, gestational age, parity and BMI were included by convenient sampling technique. Vitamin D levels of less than 50 n mol/l (< 20 ng/ml) was the cutoff point. Spearman's rank correlation of vitamin D with systolic blood pressure and arterial pressure in both preeclamptic and normotensive pregnant women was presented in a tabulated form. RESULTS: Vitamin D deficiency was found in 95% of preeclamptic and normotensive pregnant women. The difference of vitamin D level between the two groups was not found significant. Although there was an inverse correlation between serum vitamin D and systolic blood pressure and arterial pressure in preeclamptic group, but this was not statistically significant. CONCLUSION: Vitamin D deficiency does not seem to be affected by the state of preeclamptic and normotensive pregnancy. The correlation of systolic blood pressure and arterial pressure and vitamin D needs to be explored further by increasing the sample size.