Platelet-Rich Plasma Releasate versus Corticosteroid for the Treatment of Discogenic Low Back Pain: A Double-Blind Randomized Controlled Trial

Clinical application of platelet-rich plasma is gaining popularity in treating low back pain (LBP). This study investigated the efficacy and safety of platelet-rich plasma releasate (PRPr) injection into degenerated discs of patients with discogenic LBP. A randomized, double-blind, active-controlled clinical trial was conducted. Sixteen patients with discogenic LBP received an intradiscal injection of either autologous PRPr or corticosteroid (CS). Patients in both groups who wished to have PRPr treatment received an optional injection of PRPr eight weeks later. The primary outcome was change in VAS from baseline at eight weeks. Secondary outcomes were pain, disability, quality of life (QOL), image analyses of disc degeneration, and safety for up to 60 weeks. The VAS change at eight weeks did not significantly differ between the two groups. Fifteen patients received the optional injection. Compared to the CS group, the PRPr group had a significantly improved disability score at 26 weeks and walking ability scores at four and eight weeks. Radiographic disc height and MRI grading score were unchanged from baseline. PRPr caused no clinically important adverse events. PRPr injection showed clinically significant improvements in LBP intensity equal to that of CS. PRPr treatment relieved pain, and improved disability and QOL during 60 weeks of observation.

Effect of Foot Orthoses in Children With Symptomatic Flexible Flatfoot Based on Ultrasonography of the Ankle Invertor and Evertor Muscles

Objective To examine the changes in the cross-sectional area (CSA) ratio of the ankle invertors and evertors following rigid foot orthosis (RFO) application in children with symptomatic flexible flatfoot and to determine the correlation between the degree of change in CSA ratio and pain-severity after RFO application.Methods We included 24 children with symptomatic flexible flatfoot without comorbidities and measured the CSAs of tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) using ultrasonography, resting calcaneal stance position (RCSP) angle, calcaneal pitch (CP), Meary’s angle, talonavicular coverage angle, and talocalcaneal angle using radiography, and foot function index (FFI) at baseline and 12 months after RFO application. We analyzed 48 data by measuring both feet of 24 children. The CSA ratios, the ratio of CSA of each muscle to the sum of CSA of TA, TP, and PL, were also compared. Correlations between the degree of change in FFI, each muscle’s CSA ratio, RCSP angle, and radiographic measurements were investigated.Results Following RFO application, significant increase in the PL ratio and CP and significant decrease in the RCSP angle, FFI total, pain, and disability scores were observed. The degree of change in the total score, pain, and disability score of FFI were significantly correlated with the degree of change in the PL ratio and RCSP angle.Conclusion RFOs applied to children with symptomatic flexible flatfoot might reduce the compensatory activities of the ankle invertors, thereby increasing the PL ratio, and pain decreases as the PL ratio increases.

Immediate Vs. Early Loading of Bone Level Tapered Dental Implants with Hydrophilic Surface in Fully Edentulous Maxilla:Clinical and Patient-Centered Outcomes

ABSTRACT The aim was to: (i) compare changes among primary and secondary implant stability between immediate and early loaded implants in edentulous maxilla, (ii) evaluate oral health related quality of life (OHRQoL) and (iii) determine patient satisfaction with 6-implant supported fixed full-arch dentures. A prospective, randomized controlled clinical trial was conducted on 24 edentulous maxilla patients. The BLT SLActive® implants in 12 patients were immediately loaded with temporary restorations while12 patients did not receive temporary restorations. Definitive (final) dentures were delivered to all patients after 6 weeks. Stability of the implants were assessed by Insertion Torque (IT) and Resonance Frequency Analysis (RFA). Oral Health Impact Profile-19 ( OHIP-19) questionnaire was used to evaluate OHRQoL and a Visual Analogue Scale (VAS) for patient satisfaction. The IT value of implants assigned for immediate and early loading group was 27.17±9.55Ncm and 25.01±11.06Ncm, respectively. Changes in implant stability from baseline to week 6 were similar in both groups when measured by Penguin ® (p=0.881) and Ostell ® (p= 0.828). Patients in the immediate load group reported significantly lower OHIP physical pain scores (p=0.016), OHIP psychological disability score (p=0.046) and significantly higher VAS function score (p=0.009) and VAS aesthetics score (p=0.009). Implant loading protocols don’t have a significant effect on the change in implant stability 6 weeks after implantation, however, immediate loading significantly improves OHRQoL and satisfaction of patients with maxillary edentulism treated by fixed full-arch dentures. Future trials will determine the role of immediate loading protocol in clinical scenarios with various amounts of available jaw bone using different numbers of implants to retain a fixed prosthetic restoration in the edentulous maxilla.

Association Between Pain with Disability in the Elderly with Dementia

Background: Elderly is one of the most important and critical periods of life, and paying attention to the issues and problems of this period is very important. Objectives: The present study was performed to investigate the relationship between pain and disability in the elderly with dementia in 2021. Methods: In the present cross-sectional descriptive study, 120 elderly people with dementia were included. The instruments used in the four sections were the demographic profile form, the P-APS pain observation tool, and Stanford Disability Questionnaire questions. the researcher identified the elderly with dementia by available sampling method and if the elderly with dementia were eligible and written informed consent was obtained from the elderly and their primary caregivers, the questionnaires were completed. Conditions of pain and disability were described by descriptive tests, and then the relationship between pain and the degree of disability in patients was analyzed by statistical analysis using SPSS16 software. Results: The results showed mean (SD) pain score was 14.45 (4.23), disability score was 12.75 (3.09), and fall score was 37 (30.8%). According to pain score status classification, 4 (3.3%) of the elderly had no pain, 8 (6.7%) had mild pain, 27 (22.5%) had moderate pain, and 81 (67.5%) had severe pain. There is a significant relationship between pain status and disability in the elderly with dementia. By increase in pain, the patients had more disability (P = 0.000, F = 79.971). Conclusions: As the pain increased, the disability of the elderly with dementia decreased. For this reason, preventive interventions are explained in this field.

CONSERVATIVE MANAGEMENT OF ACUTE LUMBAR DISC HERNIATION WITH ASSOCIATED RADICULOPATHY: A STUDY

Objective: Acute disc herniation (DH) is a common cause of low back pain (LBP). It ranks fifth in the category of diseases in terms of cost of hospital care. It has higher indirect costs due to absenteeism from work and disability than any other disease. The present study was performed to assess the clinical outcomes of non-surgically treated LBP patients after 6 months of follow-up. Methods: The present study was prospective study which was performed on 450 lumbar radicular patients visiting the neurosurgery outpatient department having clinical signs and symptoms of acute lumbar DH of less than 3 month duration. Their diagnosis was confirmed by magnetic resonance imaging. The patients were treated conservatively during 6 months. Pain and disability were assessed by visual analog scale (VAS) and Oswestry disability questionnaire, respectively. Results: About 135 (30%) female and 315 (70%) male participated in the study. During the follow-up period, 27 (06%) patients (21 male and 6 female) showed poor response to conservative treatment and motor weakness and underwent surgical intervention. A significant improvement in the VAS Score was seen after 6 months of conservative treatment than initial evaluation of patients (3.12±1.84, 7.1±1.43, p=0.00). Furthermore, significant improvement in disability score of patients was seen in follow-up period (25.82±16.92, 53.66±17.66; p=0.00). Conclusion: Results of our study showed that conservative treatment in patients of acute lumbar DH have significant improvement in pain relief and disability without any notable side effect.

Assessment of disability in idiopathic inflammatory myopathy: a call for linearity

Objectives To evaluate the clinimetric properties of the Academic Medical Centre Disability Score (ALDS) in patients with idiopathic inflammatory myopathy (IIM). Methods We used prospectively collected data of IIM patients who completed a phase-2 study with first-line IVIg monotherapy. The ALDS is a patient reported questionnaire which contains 25 items relevant for disability in myositis. ALDS and all core set measures (CSMs) for myositis (including Health Assessment Questionnaire-Disability Index (HAQ-DI)) were evaluated at baseline and 9 weeks follow-up. In addition, the 2016 ACR/EULAR myositis response criteria outcome called Total Improvement Score (TIS) was evaluated at 9 weeks. We examined floor/ceiling effects, reliability and construct validity of the ALDS. To examine known-group validity, ALDS change scores over time were compared with TIS and physician impression of clinical response (PICR). Results Nineteen patients with IIM (median age 59 years, 12 (63%) female) were enrolled. At baseline, ALDS showed a median score of 65.4 (IQR 58.2–73.5), good Cronbach’s alpha (α = 0.84) and a small ceiling effect (11%). Construct validity was confirmed by moderate to strong correlations between ALDS and HAQ-DI (rs=-0.57 (baseline); -0.86 (follow-up)). ALDS change score correlated with TIS (rs=0.70), discriminated between responders and non-responders (TIS ≥ 40; p= 0.001), between groups based on PICR (p= 0.03), and detected deterioration. Conclusion The ALDS showed promising clinimetric properties and detected relevant changes in disability in patients with myositis. These results warrant further investigations.

Skin Advanced Glycation End Products among Subjects with Type 2 Diabetes Mellitus with or without Distal Sensorimotor Polyneuropathy

Aim of the Study. To examine the correlation between skin AGEs and parameters of distal sensorimotor polyneuropathy (DSPN) in type 2 diabetes mellitus (T2DM). Materials and Methods. We included 132 subjects (88 men) with a mean age of 64.57 years and median T2DM duration of 14.5 years. Skin AGEs were measured with AGE reader mu connect (Diagnoptics) on the dominant arm. The device enables single and automated triplicate measurements: both of these were performed. DSPN was diagnosed through the neuropathy disability score (NDS). Small nerve fibre function was assessed by temperature and pinprick sensation on the foot. Bilateral measurement of the vibration perception threshold (VPT) on the hallux was carried out by using a neurothesiometer (Horwell Scientific Laboratory Supplies). Results. Single and triplicate AGE measurements were positively correlated with each other (Pearson’s correlation coefficient r = 0.991 , 95 % CI = 0.987 -0.994, p < 0.001 ). AGEs were higher among subjects with vs. those without DSPN ( p < 0.001 ). Furthermore, they were higher among subjects with reduced vs. normal temperature sensation ( p < 0.001 ), among subjects with reduced vs. normal pinprick sensation ( p = 0.002 ), among those with abnormal vs. normal monofilament examination ( p < 0.001 ), and among those with abnormal vs. normal VPT ( p < 0.001 ). AGEs were correlated with NDS, VPT, and monofilament score. Conclusions. In T2DM, skin AGEs are increased in the presence of DSPN. This holds true both for large and for small nerve function impairment. Moreover, AGEs are correlated with DSPN severity.

Canine Mesenchymal Cell Lyosecretome Production and Safety Evaluation after Allogenic Intraarticular Injection in Osteoarthritic Dogs

In recent years, mesenchymal stromal cells (MSCs) have shown promise as a therapy in treating musculoskeletal diseases, and it is currently believed that their therapeutic effect is mainly related to the release of proteins and extracellular vesicles (EVs), known as secretome. In this work, three batches of canine MSC-secretome were prepared by standardized processes according to the current standard ISO9001 and formulated as a freeze-dried powder named Lyosecretome. The final products were characterized in protein and lipid content, EV size distribution and tested to ensure the microbiological safety required for intraarticular injection. Lyosecretome induced the proliferation of adipose tissue-derived canine MSCs, tenocytes, and chondrocytes in a dose-dependent manner and showed anti-elastase activity, reaching 85% of inhibitory activity at a 20 mg/mL concentration. Finally, to evaluate the safety of the preparation, three patients affected by bilateral knee or elbow osteoarthritis were treated with two intra-articular injections (t = 0 and t = 40 days) of the allogeneic Lyosecretome (20 mg corresponding 2 × 106 cell equivalents) resuspended in hyaluronic acid in one joint and placebo (mannitol resuspended in hyaluronic acid) in the other joint. To establish the safety of the treatment, the follow-up included a questionnaire addressed to the owner and orthopaedic examinations to assess lameness grade, pain score, functional disability score and range of motion up to day 80 post-treatment. Overall, the collected data suggest that intra-articular injection of allogeneic Lyosecretome is safe and does not induce a clinically significant local or systemic adverse response.

Enlightening the Brahmamudra- As Per Yogmimansa in Management of Manyastambh w.s.r. to Cervical Spondylosis

Cervical spondylosis (CS) is a degenerative and age-related condition affecting neck joints. It is also known as cervical osteoporosis. This is usually found in men and women at the age of 40 years or above. The aim of present study to reduces the symptoms and increases in functional activities of elderly patients with spondylosis before and after Bramhamudra.(Yoga posture) In this clinical study, total 30 patients were enrolled. All patients were treated on Brahmamudra fallowed by micro exercise and diet on the day of enrollment and after 30 day with the schedule as 0th 7th 15th 30th day fallow up. There is no drop out. Clinical assessment done on day 1st and 30th day of fallow up, shows results of improvement in all the assessment criteria in neck region. Neck pain and the symptoms was assessed examination (X-ray, MRI) by symptomatic score used by VAS (Visual analog scale), physical examination through ROM (range of movement), cervical disability score questionnaire, radiological and examination by pathological test (uric acid, ESR, RA factor, BMD in the patient willing to do) on the day of enrollment. Then after fallow up the neck pain was examination by symptomatic score used by VAS, physical examination through ROM, cervical disability score questionnaire (radiological and examination by pathological test if required). In conclusion, a combination of Yoga with diet control is found to be effective in reducing pain, and facilitating improvement in functional status of elderly people suffering from CS.

Hereditary transthyretin-mediated amyloidosis with polyneuropathy: baseline anthropometric, demographic and disease characteristics of patients from a reference center

ABSTRACT Background: Hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy is a rare, inherited, multisystem, and often fatal disease caused by a variant in transthyretin (TTR) gene. Baseline characteristics of patients, especially anthropometric data, are scarce in the literature, and they are relevant to define effective treatment strategies. Objective: This study aimed to describe baseline demographic, anthropometric, and disease characteristics in a cohort of patients from a reference center in Brazil. Methods: Symptomatic patients not previously included in clinical trials and eligible for treatment were enrolled. Ethnicity, state of residence, age, sex, weight, height, body mass index (BMI), TTR variant, and Polyneuropathy Disability Score (PND) at diagnosis were analyzed. Results: Among the 108 patients enrolled, 58.33% were male, 60.19% were Caucasian, and 83.33% lived in the Southeast region. Mean age was 51.61 (±16.37) years, mean weight was 65.76 (±15.16) kg, mean height was 168.33 (±10.26) cm, and mean BMI was 23.11 (±4.45) kg/m2. The most prevalent variant was V30M (86.11%). Patients with PND score 0 presenting autonomic neuropathy were 14.81%. Patients with PND score I-II and III-IV were 52.78 and 32.41%, respectively. Mean weight and BMI were significantly lower in patients with sensory-motor manifestations. Conclusions: This is the largest cohort of patients in Brazil for whom anthropometric characteristics have been described. Baseline demographic, anthropometric, and disease data indicate that delay in diagnosis of hATTR amyloidosis with polyneuropathy is still a problem and that efforts must be made to expedite diagnosis and maximize opportunities for new disease-modifying treatments.