EFFECTS OF PHYSICAL THERAPY-BASED MANAGEMENT APPROACHES FOR TENSION TYPE HEADACHE

Background of the Study: Multiple Physical Therapy approaches have recently been developed and reported in the literature for providing better results in the treatment regimens of tension-type headaches. The advancement in the field of Physical therapy towards the treatment approaches of tension-type headaches has become the driving force for writing this article. Methodology: Studies comparing the effects of physical therapy management with conventional treatment approaches are included in the meta-analysis. PRISMA guidelines were used for performing the qualitative analysis and assessment of risk of biases. Results: According to the findings of nine randomized controlled trials, the analysis of the results had revealed that physical therapy intervention demonstrated a significant improvement in reducing headache severity. In a random effect model, the pool effects of physical therapy strategies in terms of Standardized Mean Difference had an impact of 1.41, which according to a Cohen rule of thumb displays a larger effect of physical therapy management in significant decrease in pain intensity among tension-type headache patients Conclusion: The study has concluded that physical therapy-based management strategies as provided in several RCTs analyzed in this review article revealed a pool effect of moderate size in managing the frequency of pain and a larger effect size in managing pain intensity and duration. Further, it was concluded that tension-type headaches can be effectively managed through physical therapy-based approaches.

Prevalence of Urinary Tract Infections in Febrile Children and Role of Urine Interleukins in Diagnosis

Background: Urinary tract infections (UTI) are common in the paediatric age group and can contribute to permanent renal damage. Urine culture takes a minimum of 48 hours, thus delaying treatment in suspect cases. It is also expensive and requires training of laboratory technologists. Early diagnosis is important in prevention of serious sequelae such as hypertension and end stage renal disease. Determination of burden of the problem within a population allows appropriate allocation of diagnostic and management resources. Urine interleukins are postulated to be useful adjuncts in diagnosis of UTI. Objectives: The primary objective was to determine the prevalence of UTI in febrile children aged 12yrs and below, at theAga KhanUniversityHospital. The secondary objective was to determine the diagnostic utility of urine interleukin 8 (IL-8) and interleukin 6 (IL-6), in detection of UTI using urine culture as the gold standard. Methodology: This was a cross-sectional survey conducted at the Aga Khan University Hospital,Nairobi between March and August 2010. All patients ≤12 years of age with fever presenting at theAga KhanUniversityHospital were enrolled .The minimum sample size was 92. Consecutive sampling was carried out until sample size was achieved. Urine samples were collected as mid stream for toilet trained children and urethral catheterization for children ≤two years of age after consent was obtained. Prevalence of UTIs was determined and a 2 by 2 contingency table was used in the calculation of the diagnostic utility of urine IL-6 and IL-8.ROC curves were plotted to illustrate sensitivity and specificity of IL-6 & 8 cut offs. Results: A total of 98 patients were enrolled, 52% were male and the mean age of patients recruited was 57.6 months (range 0-144 months). Prevalence of UTI was 13.3% (95%CI 7.95-21.4) and 69% of patients with UTI were female. The sensitivity, specificity, positive and negative predictive values of IL-6 were 50% (18.7-81.3%), 69.2% (57.8-79.2%), 17.2% (5.85-35.8%) and 91.5% (81.3-97.2%) while for IL-8 they were 20% (2.52-55.6%), 98.7% (93.1-100%), 66.7% (9.43-99.2%) and 90.6% (82.3-95.8%) respectively. Likelihood ratio for urine IL-6 was 1.6 at >1.8pg/ml (.794-3.24) and 15.6 (1.55-157) for IL-8 at >200pg/ml. Confidence intervals (95%) are shown in brackets. Conclusion: The overall prevalence of UTI in febrile children at the Aga Khan University Hospital, Nairobi was noted to be similar to that reported in Kenya and higher than that in developed countries. The diagnostic utility of urine interleukins was found to be poor and unsuitable as screening tests but useful