Early Detection of Exercise - Associated Muscle cramp

One of the deep and painful involuntary contractions of skeletal muscle is muscle cramp which takes place during various other conditions. The origin for the cramps that occur during or soon after exercise and the appropriate remedies continue to prove uncertain. Soon after an implant process and forceful workout, past voluntary dehydration cramps occur at many sections. The process of identifying the type of cramp is time consuming and treatment process to cramps is also quite tedious. If not treated at the right time, Muscle cramps may cause vigorous side effects and worsening in day to day physiological activities. The main motive of this vest is to locate and identify the cramp and alert so that further injury can be detected. It would also be helpful in preventing the person from further muscular cramps and other complications. EMG signals which are obtained from adhesive electrodes are amplified by using IC741 (op-amp) with instrumentation amplifier configuration.LM35 temperature sensor is used to monitor the temperature at specified locations. Wherever the cramp occurring possibilities are high. Flex sensor is used to identify the abnormal contraction and relaxation muscles in upper limbs. The three input bio potential signals are fed to the micro controller (Arduino UNO). The main objective of this system is to provide a comfortable vest which would monitor the cramps occurring in athletes whenever it occurs. Therefore with the help of this wearable device muscle cramps occurring at upper limbs can be detected and further injuries, complications such as fractures can be reduced.

Effectiveness of Mouth Rinsing versus Ingesting Pickle Juice for Alleviating Electrically Induced Cramp in Physically Active Adults

(1) Background: Stimulating oropharyngeal transient receptor potential (TRP) channels inhibits muscle cramping by triggering a supraspinal reflex to reduce α-motor neuron hyperexcitability. This study investigated whether the longer stimulation of the TRP channels via mouth rinsing with PJ is more effective than drinking PJ at inhibiting an electrically induced muscle cramp (EIMC). Both conditions were compared to the control (water). (2) Methods: The tibial nerves in 11 cramp-prone adults were percutaneously stimulated to elicit an EIMC of the flexor hallucis brevis in three trials that took place one week apart from each other. At cramp onset, the participants received mouth rinsing and expelling PJ (25 mL), ingesting PJ (1 mL∙kg−1 body-mass (BM)), or ingesting water (1 mL∙kg−1 BM). Cramp onset and offset were induced by electromyography, and the severity of discomfort was recorded using a visual analogue scale (VAS). (3) Results: The median time to cramp cessation as a percentage of water was 82.8 ± 14.63% and 68.6 ± 47.78% for PJ ingestion and PJ mouth rinsing, respectively. These results had large variability, and no statistically significant differences were observed. There were also no differences in perceived cramp discomfort between conditions, despite the hazard ratios for the time taken to reach VAS = 0, which was higher than water (control) for PJ ingestion (22%) and mouth rinsing (35%) (p = 0.66 and 0.51, respectively). (4) Conclusions: The data suggest no difference in cramp duration and perceived discomfort between PJ and water.

Benefit of an Internet-Based Management System among Hemodialysis Patients at the Risk of Intradialytic Hypotension and Muscle Cramps: A Controlled before and after Study

<b><i>Background:</i></b> The purpose of this study was to observe the impact of an internet-based management system on the incidence of intradialytic hypotension (IDH) and muscle cramps in hemodialysis patients. <b><i>Methods:</i></b> The patients, who underwent maintenance hemodialysis in the center from January 2018 to June 2020, were recruited and divided into the pre-intervention group (before operation of the internet-based hemodialysis management system, from January 2018 to December 2018) and intervention group (after operation of the system, from June 2019 to June 2020). The clinical outcomes were compared between groups. <b><i>Results:</i></b> The compound endpoint of &#x3e;1 IDH or muscle cramps happened in 182 patients (61.7%) in the pre-intervention group and 99 participants (30.8%) in the intervention group (relative risk [RR] = 0.50 [95% confidence interval [CI], 0.42; 0.60]). IDH occurred in 122 patients (1–5 episodes in 47 patients, 6–10 episodes in 25 patients, and &#x3e;10 episodes in 50 patients) and 33 patients (30 patients had 1–5 episodes and 3 patients had 6–10 episodes) before and after execution of the internet-based management system, respectively (RR = 0.25 [95% CI, 0.18; 0.35]). The incidence of muscle cramps was significantly decreased (RR = 0.57 [95% CI, 0.45; 0.73]) after the implementation of the system, and the number of patients with 6–10 episodes dropped from 10 to 1. Multivariate analyses also showed significantly lower RRs in the intervention group: 0.29 ([95% CI, 0.20; 0.41]) for IDH and 0.58 ([95% CI, 0.45; 0.74]) for muscle cramps. Compared with the pre-intervention, participants in the intervention group had a large improvement in self-management (<i>p</i> &#x3c; 0.001) and self-efficacy (<i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> The study found that the internet-based hemodialysis management system was effective in reducing the IDH and muscle cramp events and improving self-management. It provided a significant implication for the development and application of internet-based programs in hemodialysis management.

Exercise-associated Muscle Cramps in Runners: A Review

Objective: Exercise-associated Muscle Cramp (EAMC) is an intense, painful, and involuntary contraction of skeletal muscles during a physical activity. Runners are more prone to this syndrome than other athletes. The present paper aims to review of the literature on EAMC in runners to determine the reasons and nature of EAMC in this sports field. Methods: A search was conducted for related studies from 1997 to 2021 in MEDLINE/PubMed, EMBASE/SCOPUS, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, Google Scholar as well as MagIran, IranDoc, IranMedex, MedLib using MeSH Keywords. The reference section of the studies were also checked to find more studies. Finally, 15 eligible papers on EAMC in runners were reviewed and findings were reported. Results: Several factors were found to be effective in EAMC among runners, including dehydration, electrolyte deficit, cold, long training or competition period, increased body temperature during training or competition, history of injury or muscle cramp, increased training intensity in short time, and dietary restrictions. Conclusion: The cause of EAMC in runners seems to be multifactorial.

Evidence-based clinical practice guidelines for Liver Cirrhosis 2020

The first edition of the clinical practice guidelines for liver cirrhosis was published in 2010, and the second edition was published in 2015 by the Japanese Society of Gastroenterology (JSGE). The revised third edition was recently published in 2020. This version has become a joint guideline by the JSGE and the Japan Society of Hepatology (JSH). In addition to the clinical questions (CQs), background questions (BQs) are new items for basic clinical knowledge, and future research questions (FRQs) are newly added clinically important items. Concerning the clinical treatment of liver cirrhosis, new findings have been reported over the past 5 years since the second edition. In this revision, we decided to match the international standards as much as possible by referring to the latest international guidelines. Newly developed agents for various complications have also made great progress. In comparison with the latest global guidelines, such as the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD), we are introducing data based on the evidence for clinical practice in Japan. The flowchart for nutrition therapy was reviewed to be useful for daily medical care by referring to overseas guidelines. We also explain several clinically important items that have recently received focus and were not mentioned in the last editions. This digest version describes the issues related to the management of liver cirrhosis and several complications in clinical practice. The content begins with a diagnostic algorithm, the revised flowchart for nutritional therapy, and refracted ascites, which are of great importance to patients with cirrhosis. In addition to the updated antiviral therapy for hepatitis B and C liver cirrhosis, the latest treatments for non-viral cirrhosis, such as alcoholic steatohepatitis/non-alcoholic steatohepatitis (ASH/NASH) and autoimmune-related cirrhosis, are also described. It also covers the latest evidence regarding the diagnosis and treatment of liver cirrhosis complications, namely gastrointestinal bleeding, ascites, hepatorenal syndrome and acute kidney injury, hepatic encephalopathy, portal thrombus, sarcopenia, muscle cramp, thrombocytopenia, pruritus, hepatopulmonary syndrome, portopulmonary hypertension, and vitamin D deficiency, including BQ, CQ and FRQ. Finally, this guideline covers prognosis prediction and liver transplantation, especially focusing on several new findings since the last version. Since this revision is a joint guideline by both societies, the same content is published simultaneously in the official English journal of JSGE and JSH.

EFEKTIVITAS TERAPI LEG EXERCISE INTRADIALYTIC TERHADAP PENURUNAN MUSCLE CRAMP PADA PASIEN CHRONIC KIDNEY DISEASE YANG MENJALANI HEMODIALISIS

Pendahuluan: Chronic Kidney Disease (CKD) yang terjadi > 3 bulan dan ditunjukan oleh nilai laju filtrasi glomerulus (GFR) < 15 ml/menit/1,73m2 pada tahap stadium akhir (End Stage Renal Disease (ESRD)) diperlukan terapi pengganti ginjal, yaitu salah satunya hemodialisis. Salah satu permasalahan yang sering dikeluhkan pasien hemodialisis rutin adalah muscle cramp, yang biasanya dirasakan satu jam sebelum hemodialisis selesai dilakukan. Untuk mengatasi gejala tersebut dilakukan leg exercise intradialytic. Tujuan penelitian untuk mengidentifikasi pengaruh terapi leg exercise intradialytic terhadap penurunan muscle cramp pada pasien CKD yang menjalani hemodialisis. Metode: Metode penelitian: penelitian bersifat kuantitatif dengan desain quasi eksperimental one group pre-post test design. Sampel ditentukan dengan metode purposive sampling. Hasil: Hasil penelitian menunjukkan bahwa terjadi perubahan yang signifikan muscle cramp sebelum dan sesudah dilakukan terapi leg exercise intradialytic dengan p value = 0,000. Kesimpulan: Terapi leg exercise intradialytic selama hemodialisis dapat menurunkan muscle cramp pada pasien CKD yang menjalani hemodialisis.

EFFECT OF INTRADIALYTIC EXERCISES ON CLINICAL OUTCOME AMONG PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS

Background- Although it is widely accepted that exercise is beneficial in patients with end-stage renal disease as in the general population, it is not easy to incorporate exercise programs into routine clinical practice. objectives: To determine the effect of intradialytic exercises on clinical outcome among patients undergoing maintenance hemodialysis and to find the association of clinical outcome with selected socio personal and clinical variables. Material and Method: One group pretest posttest design carried out among 30 patients who fulfilled the selection criteria were consecutively selected from dialysis unit of a tertiary care unit. The tools used were socio personal and clinical data sheet, Urea reduction ratio sheet, Pittsburgh sleep quality index, fatigue severity rating scale and muscle cramp assessment tool.Results:After intradialytic exercises urea reduction ratio was improved significantly from 64.27 ± 9.10 to 68.47 ±7.33, Pittsburgh sleep quality index score decreased significantly from 10.40 ± 4.17 to 8.43 ± 4.67, fatigue severity score decreased significantly from 43.03 ± 15.14 to 28.93± 16.56 and muscle cramp severity score significantly decreased from 2.13± 1.33 to 1.77±1.35. Intradialytic exercises were found to be effective in improving clinical outcome of patients undergoing maintenance hemodialysis. No statistically significant association was found between clinical outcome of dialysis and selected socio personal and clinical variables.

Effect of oral rehydration solution versus spring water intake during exercise in the heat on muscle cramp susceptibility of young men

Background Muscle cramp is a painful, involuntary muscle contraction, and that occurs during or following exercise is referred to as exercise-associated muscle cramp (EAMC). The causes of EAMC are likely to be multifactorial, but dehydration and electrolytes deficits are considered to be factors. This study tested the hypothesis that post-exercise muscle cramp susceptibility would be increased with spring water ingestion, but reduced with oral rehydration solution (ORS) ingestion during exercise. Methods Ten men performed downhill running (DHR) in the heat (35–36 °C) for 40–60 min to reduce 1.5–2% of their body mass in two conditions (spring water vs ORS) in a cross-over design. The body mass was measured at 20 min and every 10 min thereafter during DHR, and 30 min post-DHR. The participants ingested either spring water or ORS for the body mass loss in each period. The two conditions were counter-balanced among the participants and separated by a week. Calf muscle cramp susceptibility was assessed by a threshold frequency (TF) of an electrical train stimulation to induce cramp before, immediately after, 30 and 65 min post-DHR. Blood samples were taken before, immediately after and 65 min after DHR to measure serum sodium, potassium, magnesium and chroride concentrations, hematocrit (Hct), hemoglobin (Hb), and serum osmolarity. Changes in these varaibles over time were compared between conditions by two-way repeated measures of analysis of variance. Results The average (±SD) baseline TF (25.6 ± 0.7 Hz) was the same between conditions. TF decreased 3.8 ± 2.7 to 4.5 ± 1.7 Hz from the baseline value immediately to 65 min post-DHR for the spring water condition, but increased 6.5 ± 4.9 to 13.6 ± 6.0 Hz in the same time period for the ORS condition (P < 0.05). Hct and Hb did not change significantly (P > 0.05) for both conditions, but osmolarity decreased (P < 0.05) only for the spring water condition. Serum sodium and chloride concentrations decreased (< 2%) at immediately post-DHR for the spring water condition only (P < 0.05). Conclusions These results suggest that ORS intake during exercise decreased muscle cramp susceptibility. It was concluded that ingesting ORS appeared to be effective for preventing EAMC.

Model of skeletal muscle cramp and its reversal

In an accompanying paper [2], we developed the Shorten [3] model of skeletal muscle by incorporating equations such as surface calcium fluxes. In further research in this paper, we succeeded in reproducing muscle cramp, as well as its prevention and reversal, by investigating muscle contraction and cramp, in which calcium regulatory networks are involved, using the extended model in comparison with the original model. Incorporation of data from a traditional medicine from root extracts of paeony and licorice and one of its pure chemicals was modeled. The sensitivity analysis of the extended model shows the robustness of the calcium regulatory networks. Muscle cramp, in the extended model, requires calcium influx via the L-type calcium channel and it will not occur without calcium influx. Reduced calcium influx can delay or prevent cramp. Increased interstitial potassium is implicated in developing and maintaining cramp. Mechanism of reversal of cramp requires wash-out of extracellular potassium via increased blood flow, followed by calcium efflux via sodium-calcium exchange. This paper shows the first successful quantitative electrophysiological and mechanical model of cramp and of its reversal.