Ahmad H. Alghadir

Role of cellular oxidative stress and cytochrome c in the pathogenesis of psoriasis.

Oxidative-free radicals and apoptosis have linked to chronic skin diseases. Higher levels of oxidative radicals and the release of mitochondrial cytochrome c may have a role in the pathogenesis of psoriasis. We investigated the possible role of cellular oxidative stress and release of cytochrome c of mitochondria in the pathogenesis of psoriasis. Disease severity was assessed by psoriasis area severity index score (PASI) of 55 psoriasis patients, they grouped as mild (11), moderate (20) and severe (24), also 20 healthy individuals used as controls. All groups were subjected for serum malondialdehyde (MDA), nitric oxide (NO·), superoxide dismutase (SOD), catalase (CAT), total antioxidant status (TAS) and serum cytochrome c concentrations. We found that, (1) Severity wise increase in MDA and NO·, and decrease in SOD, CAT and TAS levels in all patients with different degrees of psoriasis; (2) PASI showed positive correlation with the increase in MDA and NO·, and negatively with decreased SOD, CAT and TAS levels; (3) significant increase in cytochrome c level was observed among psoriasis patients which showed negative correlation to MDA and NO· levels in mild and positively with moderate and severe groups. The release of mitochondrial cytochrome c indicates the induction of apoptosis mediated via oxidative stress which ultimately plays role in the pathogenesis of psoriasis.

Effect of Isometric Quadriceps Exercise on Muscle Strength, Pain, and Function in Patients with Knee Osteoarthritis: A Randomized Controlled Study

[Purpose] The aim of present study was to investigate the effects of isometric quadriceps exercise on muscle strength, pain, and function in knee osteoarthritis. [Subjects and Methods] Outpatients (N=42, 21 per group; age range 40–65 years; 13 men and 29 women) with osteoarthritis of the knee participated in the study. The experimental group performed isometric exercises including isometric quadriceps, straight leg raising, and isometric hip adduction exercise 5 days a week for 5 weeks, whereas the control group did not performed any exercise program. The outcome measures or dependent variables selected for this study were pain intensity, isometric quadriceps strength, and knee function. These variables were measured using the Numerical Rating Scale (NRS), strength gauge device, and reduced WOMAC index, respectively. All the measurements were taken at baseline (week 0) and at the end of the trial at week 5. [Results] In between-group comparisons, the maximum isometric quadriceps strength, reduction in pain intensity, and improvement in function in the isometric exercise group at the end of the 5th week were significantly greater than those of the control group (p<0.05). [Conclusion] The 5-week isometric quadriceps exercise program showed beneficial effects on quadriceps muscle strength, pain, and functional disability in patients with osteoarthritis of the knee.

Efficacy of shock wave therapy on chronic diabetic foot ulcer: A single-blinded randomized controlled clinical trial

OBJECTIVE This study was conducted to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) on the healing rate, wound surface area and wound bed preparation in chronic diabetic foot ulcers (DFU). METHODS Thirty eight patients with 45 chronic DFU were randomly assigned into; the ESWT-group (19 patients/24 ulcers) and the control-group (19 patients/21 ulcers). Blinded therapist measured wound surface area (WSA), the percentage of reduction in the WSA, rate of healing and wound bed preparation at baseline, after the end of the interventions (W8), and at 20-week follow-up (W20). The ESWT group received shock wave therapy twice per week for a total of eight treatments. Each ulcer was received ESWT at a frequency of 100 pulse/cm(2), and energy flux density of 0.11mJ/cm(2). All patients received standardized wound care consisting of debridement, blood-glucose control agents, and footwear modification for pressure reduction. RESULTS The overall clinical results showed completely healed ulcers in 33.3% and 54% in ESWT-groups and 14.28% and 28.5% in the control group after intervention (W8), and at follow-up (W20) respectively. The average healing time was significantly lower (64.5 ± 8.06 days vs 81.17 ± 4.35 days, p<0.05) in the ESWT-group compared with the control group. CONCLUSION ESWT-treated ulcers had a significant reduction in wound size and median time required for ulcer healing, with no adverse reactions. So, the ESWT is advocated as an adjunctive therapy in chronic diabetic wound.

Effect of Deep Cervical Flexor Muscles Training Using Pressure Biofeedback on Pain and Disability of School Teachers with Neck Pain

[Purpose] The job of secondary school teachers involves a lot of head down posture as frequent reading, assignment correction, computer use and writing on a board put them at risk of developing occupational related neck pain. Available studies of neck pain experienced by teachers are limited. The purpose of this study was to determine whether training of deep cervical flexor muscles with pressure biofeedback has any significant advantage over conventional training for pain and disability experienced by school teachers with neck pain. [Subjects] Thirty teachers aged 25–45 years with neck pain and poor craniocervical flexion test participated in this study. [Methods] A pretest posttest experimental group design was used in which experimental group has received training with pressure biofeedback and conventional exercises while control group received conventional exercises only. Measurements of dependent variables were taken at baseline, and after 2 and 4 weeks of training. Pain intensity was assessed using a numeric pain rating scale and functional disability was assessed using the neck disability index. [Results] The data analysis revealed that there was significant improvement in pain and disability in both the groups and the results were better in the experimental group. [Conclusion] Addition of pressure biofeedback for deep cervical flexor muscles training gave a better result than conventional exercises alone. Feedback helps motor learning which is the set of processes associated with practice or experience leading to permanent changes in ability to respond.

Responsiveness and minimal detectable change of the dynamic gait index and functional gait index in persons with balance and vestibular disorders.

Background and Purpose: We performed a retrospective chart review to determine the responsiveness and minimal detectable change (MDC95) in persons with balance and vestibular disorders with the dynamic gait index (DGI) and the functional gait assessment (FGA). Methods: The study cohort consisted of 326 patients with a mean age of 60 ± 18.3 years (range, 18-95 years; 69% female). The DGI, FGA, Activities-Specific Balance Confidence (ABC) scale, and the dizziness handicap inventory (DHI) were collected at intake and discharge. Results: The standardized response mean as an index of responsiveness was greater for the FGA (1.25) than for the DGI (0.72). Both measures demonstrated good internal consistency with baseline measures. The amount of pre- to posttreatment change that exceeds chance variation was estimated at 4 points for the DGI and 6 points for the FGA. In both the DGI and the FGA, a magnitude of change equivalent to the respective MDC95 was significantly associated with improvements in self-reported disability as measured by the ABC and DHI. Discussion and Conclusions: The DGI and the FGA are responsive to change over time in persons with balance and vestibular disorders. More complex gait measures need to be developed, as close to 50% of the subjects received optimal scores at discharge from a physical therapy exercise program, indicating that these measures have a ceiling effect. Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A70 for more insights from the authors).

Physical activity and lifestyle effects on bone mineral density among young adults: sociodemographic and biochemical analysis.

[Purpose] The purpose of this study was to assess the possible role of physical activities, calcium consumption and lifestyle factors in both bone mineral density and bone metabolism indices in 350 young adult volunteers. [Subjects and Methods] All volunteers were recruited for the assessment of lifestyle behaviors and physical activity traits using validated questioners, and bone mineral density (BMD), serum osteocalcin (s-OC), bone-specific alkaline phosphatase (BAP), and calcium were estimated using dual-energy X-ray absorptiometry analysis, and immunoassay techniques. [Results] Male participants showed a significant increase in BMD along with an increase in bone metabolism markers compared with females in all groups. However, younger subjects showed a significant increase in BMD, OC, BAP, and calcium compared with older subjects. Osteoporosis was more common in older subjects linked with abnormal body mass index and waist circumference. Bone metabolism markers correlated positively with BMD, physically activity and negatively with osteoporosis in all stages. Also, moderate to higher calcium and milk intake correlated positively with higher BMD. However, low calcium and milk intake along with higher caffeine, and carbonated beverage consumption, and heavy cigarette smoking showed a negative effect on the status of bone mineral density. Stepwise regression analysis showed that life style factors including physical activity and demographic parameters explained around 58–69.8% of the bone mineral density variation in young adults especially females. [Conclusion] body mass index, physical activity, low calcium consumption, and abnormal lifestyle have role in bone mineral density and prognosis of osteoporosis in young adults.

Work-related musculoskeletal disorders among dental professionals in Saudi Arabia.

[Purpose] Musculoskeletal disorders are common causes of work-related disability in different professions involving the frequent practice of lifting, stooping, twisting, prolonged sitting, or standing. The dental profession is one such profession. Our aim was to determine the prevalence of work-related musculoskeletal disorders among dental professionals in Saudi Arabia, the factors associated with them, and their consequences and to propose preventive measures for them. [Subjects and Methods] A self-administered online questionnaire was sent to 225 members of the Saudi Dental Association. It included questions on demographic and professional characteristics, general medical history, and history of work-related musculoskeletal disorders before and after joining the dental profession. [Results] The questionnaire was completed by 65% of the respondents. Among them 85% reported that they had developed some pain due to work after joining the dental profession, and 42% reported that they were suffering pain at the time of the survey. Besides lower back, shoulder, and neck regions, the hands, upper back, and other regions like the elbows, buttocks, thighs, leg, and feet were areas in which they pain. [Conclusion] The prevalence of work-related musculoskeletal disorders among dental professionals in Saudi Arabia is high, affecting their daily activities, sometimes even forcing them to change their work setting. Age, gender, specialty of work, work setting, number of contact hours with patients, etc., were all found to be related to their work-related pain. We need to emphasize the role of ergonomics, counseling, proper techniques of patient handling, etc., during the training of dental professionals so that they can work efficiently.

Therapeutic Effects of Whole-Body Vibration Training in Knee Osteoarthritis: A Systematic Review and Meta-Analysis

OBJECTIVE To examine the current evidence regarding the effects of whole-body vibration (WBV) training in individuals with knee osteoarthritis (OA). DATA SOURCES We searched PubMed, CINAHL, Embase, Scopus, Physiotherapy Evidence Database (PEDro), and Science Citation Index for research articles published prior to January 2015 using the keywords whole body vibration, vibration training, and vibratory exercise in combination with the Medical Subject Heading osteoarthritis knee. STUDY SELECTION This meta-analysis was restricted to randomized controlled trials published in the English language. The quality of the selected studies was assessed by the PEDro Scale. The risk of bias was assessed using the Cochrane collaborations tool in the domain-based evaluation. We also evaluated the quality of each study based on the criteria given by the International Society of Musculoskeletal and Neuronal Interactions for reporting WBV intervention studies, consisting of 13 factors. DATA EXTRACTION Descriptive data regarding subjects, design, intervention, WBV parameters, outcomes, and conclusions were collected from each study by 2 independent evaluators. The mean and SD of the baseline and final endpoint scores for pain, stiffness, and function were extracted from the included studies. DATA SYNTHESIS A total of 83 studies were found in the search. Of these, 5 studies met the inclusion criteria and were further analyzed. Four of these 5 studies reached high methodologic quality on the PEDro Scale. Overall, studies demonstrated mixed results in favor of additive effects of WBV for reducing pain and improving function in knee OA. There was considerable variation in the parameters of the WBV included in this systematic review. CONCLUSIONS WBV training reduces pain and improves function in individuals with knee OA.

Correlation between vitamin D levels and muscle fatigue risk factors based on physical activity in healthy older adults

Purpose The purpose of this study was to investigate the relationship of serum vitamin D levels with physical activity, obesity, muscle fatigue biomarkers, and total antioxidant capacity (TAC) in healthy older adults. Methods A total of 85 healthy older subjects aged 64–96 years were recruited in this study. Based on estimated energy expenditure scores, the participants were classified into three groups: inactive (n=25), moderate (n=20), and physically active (n=35). Serum 25(OH)D (25-hydroxy vitamin D) levels, metabolic syndrome parameters, TAC activity, muscle fatigue biomarkers (Ca, creatine kinase, lactic acid dehydrogenase, troponin I, hydroxyproline), physical activity, body fatness, and fatigue score (visual analog scale) were estimated using immunoassay techniques and prevalidated questionnaires, respectively. Results Physical activity was estimated in 64.6% of the participants. Males showed higher physical activity (42.5%) compared to females (26.25%). Compared to participants with lower activity, significant reduction in body mass index, waist circumference, hips, fasting blood sugar, triglycerides, total cholesterol, HDL-cholesterol, and LDL-cholesterol were observed in moderate and physically active participants. Also, significant increase in the levels of serum 25(OH)D concentrations, calcium, and TAC activity along with reduction in the levels of muscle fatigue biomarkers: creatine kinase, lactic acid dehydrogenase, troponin I, hydroxyproline, and fatigue scores (visual analog scale) were reported in physically active participants compared to those of lower physical activity. In all participants, serum 25(OH)D concentrations correlated positively with Ca, TAC, physical activity scores, and negatively with body mass index, lipid profile, fatigue scores (visual analog scale), and muscle fatigue biomarkers. Stepwise regression analysis showed that serum 25(OH)D concentrations, physical activity, Ca, TAC, and demographic parameters explained approximately 61.4%–85.8% of reduction in both fatigue scores and muscle fatigue biomarkers with substantial improvement in muscle performance in healthy older adults. Conclusion The data showed that considerable levels of 25(OH)D concentrations, calcium intake, and lower obesity positively correlated with the improvement in the muscle relief and performance of physically active participants. These results demonstrate that 25(OH)D concentrations and calcium might prevent muscle fatigue by regulation of the biosynthesis of creatine kinase, lactic acid dehydrogenase, troponin I, and hydroxyproline via a proposed antifree radical mechanism reported by higher TAC activity. It was suggested that vitamin D status could be reported as a marker of the improvement of muscle performance, especially in healthy older adults with lower physical activity.

Effect of Locomotor Training on Motor Recovery and Walking Ability in Patients with Incomplete Spinal Cord Injury: A Case Series

[Purpose] The aim of this study was to describe the effect of locomotor training on a treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated in this prospective case series. All subjects participated in locomotor training for a maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy program. The lower extremity strength and walking capabilities were used as the outcome measures of this study. Lower extremity strength was measured by lower extremity motor score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord Injury (WISCI II). [Results] An increase in lower extremity motor score and walking capabilities at the end of training program was found. [Conclusion] Gait training on a treadmill can enhance motor recovery and walking capabilities in subjects with incomplete SCI. Further research is needed to generalize these findings and to identify which patients might benefit from locomotor training.