Now it's 2014

Yes it has been 2 years since I open this blog.

It's 2012

Lahawla wa laquwata illa billah

This is what they are saying. Too many blogs. Too little time. Its a year less two months since I visited my own blog - blogging about my work and general scientific interest.

Insha Allah I'll do better this year.

See you.

Physionotes 1: Heterotrophic Ossification

Physionotes 1

Heterotrophic Ossifications: Current concepts. (Pape et. al. 2004)

• No clear mechanism
• Multifactorial with several risk factors
• Trauma is a Constant Feature
• Risk factors for TBI
• Spasticity of Limbs (Garland et. al. 1988)
• Decebrate posture (Flin et al 2002)
• Diffuse Axonal Injury (Gennarelli et al 1988)
• Prolonged Immobilization (Mielants et al 1975)
• Respiratory ventilation (Newman et al 1987)
• Risk factors after THR
• Male (Ahrengart et al 1989)
• Previous history of HO (Ritter et al 1977)
• OA with pre-existing heterotrophic bone (DeLee et al 1976)
• Ankylosing spondylitis (Sundaram et al 1986)
• Diffuse idiopathic skeletal hyperostosis (Fahrer et al 1988)
• Clinical features
• Accelerated bone healing
• Biochemical changes – Serunm alkaline phosphatase levels, Prostaglandin E2 (PGE2)
• Radiological Changes
• X-ray: extent of ossification (6 weeks to 2 months)
• Three-phase bone scintigraphy
• Flow studies
• Blood pool image
• Bone scan
• Pathophysiology
• Mesenchymal stem cells – ability to generate cartilage, bone, muscle, tendon, ligament and fat.
• Stimulating Events – proteins presents in soft tissues.
• Interleukin-1ß
• Many others
• Poorly understood
• Stimulating factors related to injury
• Serum of TBI patients promoted mitogenesis and cell division in a rat osteoblast cell culture.
• Local tissue environment
• Microvascular changes → hypoxemia paraarticular soft tissue → Metabolic changes → HO
• Mechanical Ventilation → local PH from acid to alkaline → systemic alkalosis → HO
• Treatment
• PT (Ellerin et al 1999)
• Assisted ROM with gentle stretch and terminal resistance training not beyond Pain-free range of movements. (Evans et al 1991)
• Medical Management
• No conclusive evidence for etidronate
• Radiotherapy
• Prophylactic – effective in preventing HO in arthroplasty
• Surgical Incision
• Timings of Surgery
• Traumatic HO – 6 months
• SCI – 12 months
• TBI – 18 months
• Better neuromuscular control = better outcomes
• CPM is beneficial after surgery
• HO continues to be poorly understood. Prevention is better than cure.

Evidence-based Work and Faith

The first thing I do when I arrived at work is to put my coffee thermo-mug on a shared desk (virtually by everyone including our Aides). Sitting atop this desk is a corporate computer that allows multiple user accounts. As soon as I settle on a synthetic coated cushioning seat of a steel chair, my right hand inavertently reach towards the waiting mouse automatically navigating it on a padless surface and consequently dragging the cursor towards logging into my account. With the username and password logged in, the familiar opening scene of Windows OS appears before me revealing the desktop and its innumerable shortcuts that have been sitting there unused for months.

I find opening my corporate email exciting because of the regular updates I receive from several online research websites like medscape and pubmed. Thus without much effort the exciting new world of medical and scientific updates are there ready to be explored with a single click of the unwary mouse.

Randomized-controlled trials or RCT's are all I'm looking for in a new research. I tend to ask all the basic assumptions of Physiotherapy practice most especially in treatment prescriptions. If I have only enough time in the world, I'd read about every single issue that's affecting my patients. Just recently I have a traumatic brain injury patient with heterotrophic ossification on his right knee just slightly above the medial epcondyle. I couldn't help myself but consult Shaikh Google for a medical fatwa on the subject. Just kidding actually, Google has a 'Scholar' tab where one is supposed to go if one wants to 'stand on the shoulders of the Giants ( I think it was Sir Isaac Newton who said this) and look for Systematic Reviews, Meta analysis, Cochrane Reviews and RCT's. But I don't have all the time in the world to do this to all my patients in all of their concerns.

Is it wrong to feel elation - well not really elation - but some kind of inexplicable happiness or satisfaction when I get to download free articles in PDF formats (considering that it took at least 3 years for the publishers of these papers to study and write them)? Thus stacks and stacks of unread papers are just piling up on my shelves waiting to be bound according to their year of publishing and topics.

Then I go home...and here is when the crossing over happens; when I enter my car, start its engine, I get reminded that I have to prepare for my Friday lecture at Fanar.

Teaching Islam to new Muslims may sound easy but if one wants to teach properly according to the standards set by the scholars from the days of old up until now, one has to choice but to read about the topics in more scholarly details. If reading about Salah in Fiqhus Sunnah doesn't sound hard enough, what about going deeper and read about it in Bidaayatul Mujtahid written by Ibn Rushd (Averroes). Although there is a standard manual used in the organization, I cannot but help to look for the Takhreej of the Hadeeth mentioned therein in order to ascertain for sure their authencity or not. Good thing alhamdulillah because of this cyber-digital-revolution, one can find thousands of classical books in Arabic packed in a three gigabyte file with a search function in it. This is not called Al Maktabah Ash Shamilah (The Complete Library) for nothing.

Evidence base science is not only in medical practice but also in Religion. Allah repeatedly said in the Qur'an "Haatoo burhanakum in kuntum saadiqeen". "Bring forth your proofs if you are truthful". Thus in Islam, every minute point of belief, every single action of worship, has to have an evidence from the Qur'an and Sunnah and its derivatives (Ijmaa, Qiyas, 'Urf etc).

I guess this insatiable search of mine of truth - whether it is emperical truth or truth by revelation that drives me to dig and delve deep if possible to the bedrock of things. I maybe exploring two separate directions in terms of inquiry, nevertheless I now realize that they are actually one. There is no conflict between science and religion because all the truths came from the same source. One of the names of God is Al Haqq - the Truth.

God told us to say this when we ask Him for something:

Rabbana atina fiddunya hasana wa fil akhirati hasana wa qina adhabannar. O Our Lord give us the best of this life and the next life and save us from the punishment of the fire.

Also in Soorah al Mulk (67) He said, "Alladhee khalaqal mawta wal hayata liyabluwakum ayyukum ahsanu amala'". He it is who has created death and life so that He will test you which of you is the best in Deeds."


Barakallah feekum

I missed hummus from Damascus Restaurant

The Mediterranean diet has a beneficial effect on abdominal obesity, lipid levels, glucose metabolism, and blood-pressure levels, all the components of the metabolic syndrome, which are also risk factors for the development of cardiovascular disease, insulin resistance, and diabetes."

Speaking more than 2 languages protects brain

Hi there. I used to complain that I don't have a primary language stored in my brain. I mean I write efficiently in English and not in any other language but I speak fluently in Tagalog more than any other language. When I get really mad I speak Tausug. I speak Arabic when I pray. I do smutter Hindi/Urdu (depends on whom you are talking to) to most of my patients. Alhamdulillah I can say the equivalent of 'how are you - I'm fine' in other languages as well like Croatias, Thailand, Mandarin, Romania, Korean, Tamil, Malayalam, Nepalese, Swede, Japanese, Nigerian, Bangali and Vietnamese and others I forgot now. I guess I shouldn't complain now.

Care to read about the story?

March 7, 2011 — Compared with bilingual seniors, those who speak more than 2 languages appear to be protected from cognitive impairment according to a longitudinal study.

Other Links:

Do you have fatty Liver like me? Asians with lower BMI 23 kg/M2 have the same amount of VISCERAL fat with whites at 27 kg/M2. This means that even though I have a normal BMI and yet having a fatty liver, I'm still considered having excess fats and hence more susceptible to Diabetes Type II and other metabolic abnormalities.

Read on...

"It's clear that Asians cannot afford to gain weight because they will put on more visceral fat, more liver fat, and, as a consequence, they will be at greater risk of developing type 2 diabetes than whites with the same BMI."

More Links:

Kid's Asthma control

Physical Therapists Use A Split-belt Treadmill To Help Stroke Patients Walk More Easily

Hi. Good Morning. This is very interesting. A split belt treadmill allowing different speed between the two lower extremities. Read on...

"Physical therapists used motion detector cameras to analyze how patients move on a specially designed split-belt treadmill--the belt is divided to move together or at independent speeds. When the legs move at speeds different from one another, the brain receives an error signal and the brain and nervous system use the feedback to adjust. The cerebellum recalls this message even after the treadmill stops and for a few minutes, stroke patients can walk easier."

http://www.sciencedaily.com/videos/2008/1207-retrain_your_brain_after_stroke.htm

Here is the PUBMED link and abstract:

http://www.ncbi.nlm.nih.gov/pubmed/21084921

J Neurol Phys Ther. 2010 Dec;34(4):202-7.

Split-belt treadmill training poststroke: a case study.

Reisman DS, McLean H, Bastian AJ.

Department of Physical Therapy, University of Delaware, Newark, Delaware 19716, USA. dreisman@udel.edu

Abstract

BACKGROUND AND PURPOSE: Even after rehabilitation, many individuals with strokes have residual gait deviations and limitations in functional walking. Applying the principles of motor adaptation through a split-belt treadmill walking paradigm can lead to short-term improvements in step length asymmetry after stroke. The focus of this case study was to determine whether it is possible to capitalize on these improvements for long-term gain.

CASE DESCRIPTION: The participant was a 36-year-old woman who was 1.6 years poststroke. She had a slow walking speed and multiple specific gait deviations, including step length asymmetry.

INTERVENTION: The participant walked on a split-belt treadmill 3 d/wk for 4 weeks, with the paretic leg on the slower of the two treadmill belts. The goal was 30 minutes of split-belt treadmill walking each day, followed by overground walking practice to reinforce improvements in step length symmetry.

OUTCOMES: With training, step length asymmetry decreased from 21% to 9% and decreased further to 7% asymmetry 1 month after training. Self-selected walking speed increased from 0.71 m/s to 0.81 m/s after training and 0.86 m/s 1 month later. Percent recovery, measured by the Stroke Impact Scale (SIS), increased from 40% to 50% posttraining and to 60% 1 month later.

DISCUSSION: Improvements in step length symmetry were observed following training and these improvements were maintained 1 month later. Concomitant changes in clinical measures were also observed, although these improvements were modest. The outcomes for this participant are encouraging given the relatively small dose of training. They suggest that after stroke, short-term adaptation can be capitalized on through repetitive practice and can lead to longer-term improvements stroke.

PMID: 21084921 [PubMed - indexed for MEDLINE]