Effects of Physical Activity on Thyroid Stimulating Hormone Levels in Obese Metabolic Syndrome Patients: A Meta-Analysis.

Metabolic syndrome is a combination of multiple disorders that predispose an individual to risk of diabetes, obesity, cardiovascular diseases (CVDs), cerebrovascular accidents (CVAs), and insulin-resistance. Hypothyroidism is the most prevalent metabolic disorder causing obesity, followed by hypercortisolism and hypogonadism. Hence, this study aimed to determine the effects of various exercises on thyroid stimulating hormone (TSH) levels in obese patients with metabolic syndrome. The study conformed to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) standards. The PubMed, Cochrane, Google Scholar, Medline, and Biomed Central databases were searched using the keywords exercise, aerobic, rehabilitation, etabolic syndrome, and thyroid stimulating hormone. Studies in English language published between 2010 and 2021 and that examined the efficacy of physical therapy management with sham treatment on TSH levels in patients with obesity were included. The meta-analysis comprised of 526 patients with metabolic obesity from 10 randomised controlled trials. The analysis revealed that when compared with the control group, exercise had a moderate pooled effect on lowering TSH levels, with an effect size standardised mean difference (SMD) of -0.56 (95% Confidence Interval (CI), -1.09-0.02) estimated using a random effects model, with an I2 of 86.61% (95% CI, 77.31-92.10) in the interventional group. It was concluded that although a pooled moderate effect of training on TSH levels was observed when all the studies were analysed using a continuous measure analysis SMD model, an individual analysis of the studies revealed a mild effect, with many studies also revealing the negative impact of training on TSH levels. Nonetheless, exercise-based intervention strategies are safe and effective as a management strategy for hypothyroidism and obesity due to hypothyroidism. Key Words: Thyroid hormone, Exercise, Metabolic syndrome, Obesity, TSH level.

Effects of Exercise-based Management on Motor Symptoms in Parkinson's Disease - A Meta-analysis.

Parkinson's disease (PD) is the second most common neurological illness after Alzheimer's disease. According to research, medication alone can give palliative alleviation; however, freezing of gait (FOG) and balance can be treated with physical therapy. This meta-analysis aims to bridge gaps about exercise-based therapy's impact on balance and FOG in patients with PD. Google Scholar, CINHAL, Medline, PubMed, and PEDro were searched for 2016-2021 citations using the PIOD paradigm. Pooled effect size mean and SD were analysed using a fixed and random effects model. A total of 21 trials were included in this review, with SMD=0.60 and p=0.0007 utilising BBS. The pooled analysis revealed statistically significant impacts on exercise-based management in the experimental group. With SMD=0.87 and p<0.00001 using Mini-BESTest, the pooled analysis revealed that exercise-based management was also effective on balance in the experimental group. The fixed effect model of FOG in terms of SMD was used to draw the pooled effects of FOG in terms of SMD and FOG in terms of SMD (0.21; 95 percent CI -0.01 to 0.44; p=0.06). According to this research, several physiotherapy approaches such as exergaming, gamepad systems, virtual reality, gait exercises, and core training, help Parkinson's patients regain balance and FOG. Key Words: Parkinson's disease, Physical therapy techniques, Neurological rehabilitation, Balance, Freezing of gait, Motor symptoms.

Mixed Connective Tissue Disease with Severe Axonal Polyneuropathy: A Case Report.

Mixed connective tissue disease (MCTD) is a unique disorder characterized by the presence of a high titer of anti-U1 ribonucloprotein antibody with overlapping features of various connective tissue disorders including systemic lupus erythematosus, scleroderma, and myositis. Severe renal or neurological involvement is unusual with this disorder. We describe a case of biopsy-confirmed severe sensorimotor axonal polyneuropathy in a middle-aged gentleman as his first presentation for MCTD.

Exercise response on dose curve among class I obese young adult population.

Objectives: To identify exercise regimes having a short duration and yet incorporating the effects of both aerobic and resistance exercises. METHODS: The randomised study was conducted from December 1, 2019, to April 31, 2020, at Ziauddin Hospital, Karachi, and comprised individuals of either gender aged 20-40 years with class-I obesity. All participants were initially screened using a physical activity and readiness questionnaire to determine if they were fit to perform the exercises. Subsequently, dynamic exercises were introduced based on the guidelines of the American College of Sports Medicine. The subjects were randomised into aerobic group A, resistance group B and dynamic resistance group C. The intervention lasted 12 weeks. The quantification of exercises was done using the frequency, intensity, time, and type protocol. RESULTS: The results were analysed on MedCalc statistical software. Out of the 102 participants, 51(50%) each were males and females. Each of the three groups had 34(33.3%) subjects; 17(50%) males and as many females. The impact was significant in all the three groups (p<0.05). The effect was significantly better in group C than groups A and B. CONCLUSIONS: Body mass index and body fat percentage values improved through aerobic, resistance and dynamic resistance exercises.

Pregnancy Outcomes in Systemic Lupus Erythematosus Women: A single tertiary centre experience.

OBJECTIVES: This study was conducted to assess pregnancy outcomes in women with systemic lupus erythematosus (SLE) in Oman. METHODS: A retrospective cohort study of 149 pregnancies in 98 women with SLE was conducted over 10 years to evaluate the impact of clinical and laboratory parameters in predicting adverse pregnancy outcomes. RESULTS: Mean maternal age was 30.6 ± 5 years ranging from 20-44 years, and the mean disease duration was 10 ± 5 years, ranging from 2-27 years. The most common maternal manifestations were joint pain in 36 (24.2%), lupus nephritis (LN) in 18 (12.08%), preeclampsia in 11 (7.4%), eclampsia in three (2%) and lupus flare in one pregnancy. The live birth rate was 139 (93.3%) with a mean gestational age of 36 ± 2 weeks ranging from 26-40 weeks. In total, 55 (39.6%) were preterm deliveries, six (4%) pregnancies ended in miscarriage, and four (2.7%) resulted in intrauterine fetal death. Intrauterine growth restriction was observed in 49 babies (35%). A significant association was found between hypertension (HTN) and miscarriage (P = 0.024) and preterm birth (P = 0.019). In addition, HTN was positively associated with preeclampsia (P = 0.004) and LN (P = 0.048). Antiphospholipid syndrome impacted preterm birth (P = 0.013) and postpartem haemorrhage (PPH) (P = 0.027) and was found to be a significant predictor for women developing deep vein thrombosis and pulmonary embolism (P <0.001 for both). CONCLUSION: Despite potential complications, most pregnancies complicated by SLE in Oman result in good outcomes. Adverse pregnancy outcomes, however, may still occur in women with SLE. In women with SLE, pregnancy planning, careful antenatal monitoring and efficient SLE treatment need to be undertaken for successful pregnancy outcomes.

Impact on Mental Health of Families during Covid-19: A Cross-Sectional Survey.

Background: The global pandemic of novel coronavirus outbreaks threatens the general public and health care workers' physical, social and mental well-being. Therefore, the current study is aimed to highlight the status of mental health of families suffering from the COVID-19 pandemic. Methods: An online cross-sectional survey was conducted on 560 families through Google Form distributed via email, Whatsapp groups, Facebook, and LinkedIn from November 2020 to January 2021 during the pandemic period in Karachi through the snowball sampling technique. The status of COVID-19 patients was assessed through demographics information and contextual factors questions whereas impact on mental health was assessed through Depression Anxiety Stress Scale (DASS-21). Results: A total number of 536 participated in the study. The prevalence of depression, anxiety and stress was found to be 38.99%, 26.67%, and 15.48% respectively included 31% of males and 69% where the highest number of respondents belonged to district Central (37.8%). Chi square estimation was found to be significant among both the gender and in between all the age group ranges from 20 to 60 years. Moreover, significant association among categorical division of demography and DASS-21 p<0.05 was observed. Conclusion: The results of our study indicated high rate of depression and anxiety in majority of families; in particular females. Consistent with these symptoms, significant association was found between gender and age from high to low socioeconomic status.

Effects of Mode and Duration of Exercises on Fat Mass of Obese Population.

A meta-analysis was performed to determine impact of resistance and aerobic exercise on body fat of obese population. Database of Google Scholar, BioMed Central, and Medline was reconnoitered for the purpose of research article of interest. Inclusion criteria encompass all those studies in which effects of aerobic and resistance exercise were determined on body fat mass of obese participants. Studies in which combination of aerobic and resistance exercise were used, or outcome measures were other than body fat mass or studies conducted before 2010 were excluded from this review. A total of 805 obese participants were included in 10 randomized controlled trials (RCT) including 401 in resistance training protocol and 404 in aerobic training protocol were part of this meta-analysis. Results revealed that resistance exercise had a mild pool affect in increasing weight of participants with an effect size (SMD) of 0.26 (95% of CI -0.09 to 0.63) calculated at random effect model, I2 83.80% (95% of CI 71.76 to 90.71) in comparison to aerobic exercises performed during the duration of two to eight weeks of training protocol. The meta-analysis concluded that resistance exercises had a mild pool effect in increasing the weight of the participants in comparison to aerobic exercises. Key Words: Aerobic exercises, Resistance exercises, Obesity, Fat mass, Body fat index and body fat composition.

Recurrent miscalling of missense variation from short-read genome sequence data.

BACKGROUND: Short-read resequencing of genomes produces abundant information of the genetic variation of individuals. Due to their numerous nature, these variants are rarely exhaustively validated. Furthermore, low levels of undetected variant miscalling will have a systematic and disproportionate impact on the interpretation of individual genome sequence information, especially should these also be carried through into in reference databases of genomic variation. RESULTS: We find that sequence variation from short-read sequence data is subject to recurrent-yet-intermittent miscalling that occurs in a sequence intrinsic manner and is very sensitive to sequence read length. The miscalls arise from difficulties aligning short reads to redundant genomic regions, where the rate of sequencing error approaches the sequence diversity between redundant regions. We find the resultant miscalled variants to be sensitive to small sequence variations between genomes, and thereby are often intrinsic to an individual, pedigree, strain or human ethnic group. In human exome sequences, we identify 2-300 recurrent false positive variants per individual, almost all of which are present in public databases of human genomic variation. From the exomes of non-reference strains of inbred mice, we identify 3-5000 recurrent false positive variants per mouse - the number of which increasing with greater distance between an individual mouse strain and the reference C57BL6 mouse genome. We show that recurrently miscalled variants may be reproduced for a given genome from repeated simulation rounds of read resampling, realignment and recalling. As such, it is possible to identify more than two-thirds of false positive variation from only ten rounds of simulation. CONCLUSION: Identification and removal of recurrent false positive variants from specific individual variant sets will improve overall data quality. Variant miscalls arising are highly sequence intrinsic and are often specific to an individual, pedigree or ethnicity. Further, read length is a strong determinant of whether given false variants will be called for any given genome - which has profound significance for cohort studies that pool datasets collected and sequenced at different points in time.

Seat belt syndrome: Delayed or missed intestinal injuries, a case report and review of literature.

INTRODUCTION: Seat belt injuries are not uncommon. The use of seat belts is associated with a unique injury profile collectively termed "the seat belt syndrome". The aim is to aid in the early diagnosis of seat belt injuries. CASE PRESENTATION: Two different patients presented to the emergency after sustaining a motor vehicle accident. Both were the drivers, restrained and had a frontal impact. On presentation they were hemodynamically stable with mild tenderness on the abdomen and the abdominal computed tomography (CT) did not show any signs of bowel or mesenteric injuries. The signs of peritonitis became obvious after 24h in one case and after 3 days in the other. DISCUSSION: Early diagnosis provides better outcomes for patients with seat belt injuries, but this remains a challenge to trauma surgeons. The typical findings of peritonitis might not be present initially. The presence of abdominal wall ecchymosis (seat belt sign) increases the chance of intraabdominal injuries by eight folds. CONCLUSION: Clinical signs of intestinal injuries might not be obvious on presentation. In the presence of seat belt sign the possibility of bowl injury must be suspected. Admit the patient for observation even if no clinical or radiological findings are present at presentation.

Genotype at the sIL-6R A358C polymorphism does not influence response to anti-TNF therapy in patients with rheumatoid arthritis.

OBJECTIVES: To investigate the association between genotype at the soluble interleukin 6 receptor (sIL-6R) A358C single nucleotide polymorphism (SNP, rs8192284), previously reported to correlate with soluble receptor levels, and response to anti-TNF therapy in subjects with RA. METHODS: In a large cohort of Caucasian RA patients treated with anti-TNF medications (total, n = 1050; etanercept, n = 455; infliximab, n = 450; and adalimumab, n = 142), the sIL-6R A358C polymorphism was genotyped using a Taqman 5'-allelic discrimination assay. Linear regression analysis adjusted for baseline 28 joint disease activity score (DAS28), baseline HAQ score, gender and use of concurrent DMARDs was used to assess the association of genotype at this polymorphism with response to anti-TNF therapy, defined by change in DAS28 after 6 months of treatment. Analyses were performed in the entire cohort, and also stratified by an anti-TNF agent. Additional analysis according to the EULAR response criteria was also performed, with the chi-squared test used to compare genotype groups. RESULTS: No association between genotype at sIL-6R A358C and response to anti-TNF treatment was detected either in the cohort as a whole or after stratification by anti-TNF agent, in either the linear regression analysis or with response segregated according to EULAR criteria. CONCLUSIONS: This study shows that genotype at the functional sIL-6R A358C SNP is not associated with response to anti-TNF treatment in patients with RA.

A comparative study of interleukin-1beta production and p2x7 expression after ATP stimulation by peripheral blood mononuclear cells isolated from rheumatoid arthritis patients and normal healthy controls.

Interleukin 1 beta (IL-1beta) is a proinflammatory cytokine that is considered to play an important role in the progression of rheumatoid arthritis (RA). A stimulus such as ATP is necessary to cause the release of mature IL-1beta, via activation of the P2X(7) receptor on monocytes. In this study, the production of IL-1beta in whole blood after ATP stimulation and expression of P2X(7) receptors in RA and healthy subjects were examined. Blood samples from RA patients or healthy controls were stimulated with ATP in the presence of lipopolysaccharide (LPS). Supernatants were harvested and IL-1beta levels were measured by enzyme-linked immunosorbent assay (ELISA). Expression of P2X(7) receptors was measured using flow cytometry. ATP induced significantly higher levels of IL-1beta in LPS-activated RA blood samples compared to controls. A significant up-regulation of P2X(7) receptor expression on mononuclear cells was observed after overnight incubation with ATP without any significant differences between RA patients and normals. These data suggest that RA patient mononuclear cells are more sensitive to ATP stimulation than healthy individuals perhaps due to genetic polymorphism in the P2X(7) gene.