The effectiveness of radial extracorporeal shock wave therapy vs transcutaneous electrical nerve stimulation in the management of upper limb spasticity in chronic-post stroke hemiplegia-A randomized controlled trial.

BACKGROUND: Traditionally both rESWT and TENS are used in treating post-stroke upper limb spasticity over years and their effectiveness had been assessed disjointedly. However, these methods were not yet compared for superiority. OBJECTIVES: To compare rESWT vs TENS to assess their effectiveness in different parameters of stroke such as stroke type, gender, and the affected side. METHODS: The experimental group was treated with rESWT application to the middle of the muscle belly of Teres major, Brachialis, Flexor carpi ulnaris, and Flexor digitorum profundus muscles using 1500 shots per muscle, frequency of 5Hz, energy of 0.030 mJ/mm. The TENS was applied to the same muscles in the control group using 100 Hz for 15 minutes. Assessments were taken at the baseline (T0), immediately after first application (T1), and at the end of four-week protocol (T2). RESULTS: Patients 106 with a mean age of 63.87±7.052 years were equally divided into rESWT (53) and TENS (53) groups including 62 males, 44 females, 74 ischemic, 32 hemorrhagic, affecting 68 right, and 38 left. Statistical analysis has revealed significant differences at T1 and T2 in both groups. But at T2 compared to T0; the rESWT group has reduced spasticity 4.8 times (95% CI 1.956 to 2.195) while TENS reduced by 2.6 times (95% CI 1.351 to 1.668), improved voluntary control by 3.9 times (95% CI 2.314 to 2.667) and it was 3.2 times (95% CI 1.829 to 2.171) in TENS group. Improvement of the hand functions of the rESWT group was 3.8 times in FMA-UL (95% CI 19.549 to 22.602) and 5.5 times in ARAT (95% CI 22.453 to 24.792) while thrice (95% CI 14.587 to 17.488) and 4.1 times (95% CI 16.019 to 18.283) in TENS group respectively. CONCLUSION: The rESWT modality is superior compared to the TENS modality for treating chronic post-stroke spastic upper limb.

Bartter syndrome-like phenotype in a patient with diabetes: a case report.

BACKGROUND: Bartter's syndrome is a rare genetic tubulopathy affecting the loop of Henle leading to salt wasting. It is commonly seen in utero or in early neonatal period. Rare cases of acquired Bartter's syndrome are reported in association with infections like tuberculosis, granulomatous conditions like sarcoidosis, autoimmune diseases, and drugs. The mainstay of management includes potassium, calcium, and magnesium supplementation. CASE PRESENTATION: We report the case of a 62-year-old Sri Lankan Sinhalese man with diabetes and hypertension presenting with generalized weakness with clinical evidence of proximal myopathy. He was severely hypokalemic with high urinary potassium excretion and hypochloremic metabolic alkalosis. He poorly responded to intravenously administered potassium supplements. A diagnosis of idiopathic Bartter-like phenotype was made. He responded well to spironolactone and indomethacin. CONCLUSIONS: Patients presenting with body weakness need serum potassium estimation. Acquired Bartter's syndrome although rare, should be ruled out in those with hypokalemia and metabolic alkalosis with increased urinary potassium loss with poor response to potassium replacement.