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Home > Effect of Additional Lumbosacral Corset on the Outcome of Patients With Non-Specific Acute Low Back Pain at the Aga Khan University Hospital, Nairobi

Effect of Additional Lumbosacral Corset on the Outcome of Patients With Non-Specific Acute Low Back Pain at the Aga Khan University Hospital, Nairobi

Thesis Info

Author

Mwenda, Stanley Aruyaru

Department

General Surgery (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2016

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728046520

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Introduction: Low back pain (LBP) is a common problem world over affecting 60-90% of the population in their lifetime. It is a leading reason for hospital admission, healthcare spending, workplace absenteeism and years lived with disability. Up to 90% of patients suffering from low back pain do not have a serious pathology warranting imaging or further intervention besides symptom relief. These are categorized as having non- specific low back pain. This has a good prognosis running a short course of 3 to 6 weeks. The management of non-specific acute LBP entails analgesia and non-pharmacologic interventions (back school and physical therapy). Many modalities of physical therapy are often employed for non-specific acute LBP. The use of lumbosacral corset as a physical therapy for non-specific acute LBP has not been clearly supported with scientific evidence. However, it is commonly prescribed for this category of patients. It is important to assess the effect of this modality on the outcome of patients with non- specific acute LBP. Objective: To assess the outcome (change in back specific disability) of patients with non-specific acute low back pain treated with a lumbosacral corset in addition to a standard analgesic protocol compared to those on a standard analgesic protocol alone over a 3- week duration at the Aga Khan University Hospital, Nairobi, Kenya. Methods: A two-arm single blinded randomized controlled trial was carried out involving 82 consecutively sampled patients. Patients were randomized to analgesic protocol alone or analgesic protocol and a lumbosacral corset and followed up weekly for three weeks. Back specific disability was assessed using the Oswestry Disability Index (ODI). The primary outcome was the mean change in the ODI score between the two arms. We analyzed the data by use of repeated masures ANOVA. Results: Seventy-nine patients were analysed. The baseline characteristics were similar. There was a significant effect of time on the ODI (F=(1.38, 106.56)=207.89, P=.000). There was a statistically significant difference in ODI score between the two arms favouring the intervention arm ( F (1, 27)=4.23, p=.043). The difference in pain score and days off duty was not statistically significant. The number of days off duty was comparable between the two arms. Compliance to use of lumbosacral corset was good with mean of 1 day off the corset. The maximal change in both ODI and pain score occurred between the first and second reviews indicating maximum clinical improvement with the first week. Conclusion: Compared
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وسدی جھوک دے لوگ

وسدی جھوک دے لوگ

اساں وسدی جھوک دے لوگ ھاسے

 

ساڈیاں جھمراں میلے جاگے ہن

ساڈے سارے بھاگ سھاگے ہن

 

ایں ہسدے وسدے ویلے وچ

ہک دھرتی جایا آیا ھا

 

ساکوں نندروں آنڑ جگایا ھا

او روشن سجھ امیدیں دا

 

او نور ھا ساڈیاں دیدیں دا

پر وقت دے اندھے آمر کوں

 

اونھ ویلھے دے ہک جابر کوں

ساڈا رل کے جیونڑ نی بھانڑاں

 

ساڈا سانجھا تھیونڑ نی بھانڑاں

او غاصب روح دیاں فصلاں دا

 

او قاتل ساڈیاں نسلاں دا

اونھ خوشبو کو زنجیر کیتا

 

ساڈے سجھ کوں آنڑ اسیر کیتا

پچھیں رات اندھاری ڈھک گئی اے

 

اوندیں نانویں وینڑ کریندے ھویں

اونھ نسل دی کمر وی جھک گئی اے

 

رل سانجھا تھیو مڑ چاھندے ہن

متاں وستیاں ساڈیاں وس پوون

 

متاں وستیاں ساڈیاں وس پوون

متاں جھوک تے ساول ول آوے

 

اینہ آس تے ھنڑ پئے جیندے ھیں

اوندا لعل بلاول ول آوے

                                                                                                                جیے بھٹوجیے، جہانگیر مخلص

 

 

عرب عہد جاہلیت میں ’’طلاق‘‘ کا تصور: تحقیقی جائزہ

Conjugal life is an important aspect of human society, on which a prosperous life depends. Almost every Culture, civilization and religion Legislate for family life. There is a part of these laws to end the marital relationship which is denoted by "DIVORCE". Divorce is mentioned in detail in Islamic Sharia, in order to understand them truly one has to genuinely consider and understand the concept of divorce in Pre-Islamic period of ignorance. There were several specific terms for divorce that were used in the Arab culture for example Talᾱq, Īela and Khula etc. But generally decent people use the word "طلاق"(Talᾱq) to end the marital relationship. There were some common causes and reasons for divorce in Arabs before Islam for example lack of mental harmony, infertility, bigotry, family feud and apostasy etc. The divorced women become more and more vulnerable socially and economically in ancient Arab and consequently their children less attention, love and affection of their mothers turning them into rebellious, nonconformist and ruthless individuals crossing all limits of oppression and we often see examples of such incidents in Arabs before dawn of Islam. These cruel customs and practices were uprooted through teachings of Islam which is based on justice, equality and basic human rights.

Dose Distribution of Hdr Brachytherapy Using Different Sources, Treatment Planning Systems and Applicators

Three dimensional radiotherapy techniques propose the opportunity of delivering the dose distribution which is well conformed to target volume while minimizing the exposure by radiations to nearby organs. However, second cancer incidences from the radiations are rare and much late effects after radiotherapy techniques. The purpose of dose distribution is vital as imprecision in dose parameters can produce further complications. The critical organs of the patients are usually received low radiations due to the complex radiation fields which are close or relatively far from target and may be a cause to produce secondary cancer risk. Therefore, numerous parameters regarding to the radiotherapy treatment planning must be discussed. This study aims to calculate the dose distribution, dose volume histograms (DVHs), life time secondary cancer risk, solid cancer risk or excess absolute risk (EAR) using the different modalities of radiotherapy (APBI – accelerated partial breast irradiation, EBRT – external beam radiotherapy). Breast cancer is global dilemma and considerable improvements have been made in the outcomes with early stage breast cancer patients. In our analysis, due to the steep dose gradient and the prescription to 10 mm tissue depth, Accelerated partial breast irradiation (APBI) with 50 kV x-ray miniature source and MammoSite brachytherapy with Ir-192 Source delivered the highest maximal dose to the ipsilateral breast. MammoSite brachytherapy delivered higher maximal dose to heart than after three dimensional conformal radiotherapy (3D-CRT) and significantly lower using the tangential IMRT. The risk of solid cancer is generally related to radiotherapy. In general, the incidences of secondary cancers are related to the actual dose received by the irradiated organ. In our study, secondary cancer risk is estimated from the breast radiotherapy techniques. IORT associated with less second cancer risk (0.02%) for ipsilateral lung in comparison to APBI and EBRT. Second cancer risk observed by IORT for contralateral breast is less in comparison to APBI and EBRT. The risk calculated from EBRT for the ipsilateral lung (2.9%) and contralateral lung (0.2%). Tangential IMRT and 3D-CRT irradiated the higher volume of contralateral breast and ipsilateral lung for the dose (<1 Gy). EAR decreased for contralateral breast, ipsilateral lung and contralateral lung for 3D-CRT and tangential IMRT viiiin comparison to multibeam IMRT and VMAT by using linear, linear-exponential and plateau models. In order to get better accuracy in dose distribution, it is point of interest to compare the dose distribution by treatment planning system, applicators and sources. High dose-rate (HDR) brachytherapy techniques are commonly used to treat the tumours such as the breast, cervix and prostate. In these brachytherapy techniques, applicators are inserted close to tumours while the radioactive sources are adjusted at suitable position for the desired delivery of dose. Intracavitary brachytherapy (ICBT) constitutes an essential component in the radiation therapy of cervical cancer. With high-dose-rate (HDR) afterloading units, ICBT procedures require multiple applications spread over time. In our study, The GammaMedplus HDR remote brachytherapy afterloading system with single high active (usually about 10 Ci) cylindrical 192 Ir source having active dimensions of 0.6 mm diameter and 3.6 mm length was used. The planning was done using treatment planning software (ABACUS 3.1). It is noted that total average dose and standard deviation of dose for nine patients by Ring applicator at bladder, rectum, RPWRP and LPWRP was of 4.26 ± 0.35 Gy, 2.72 ± 0.29 Gy, 0.98 ± 0.11 Gy and 0.83 ± 0.16 Gy respectively whereas total average dose and standard deviation of dose for five patients by Fletcher applicator at bladder, rectum, RPWRP and LPWRP was of 4.05 ±0.73 Gy, 3.02 ± 0.76 Gy, 1.22 ± 0.25 Gy and 1.23 ±0.38 Gy respectively.