Electromyographic activity of selected shoulder muscles in commonly used therapeutic exercises

BACKGROUND AND PURPOSE

The purpose of this study was to evaluate and compare the muscle activity of the supraspinatus, infraspinatus, teres minor, and lower trapezius muscles during commonly prescribed therapeutic exercises in subjects with and without shoulder pathology.

SUBJECTS

Twenty healthy subjects (9 male, 11 female) and 20 subjects with recurrent unilateral shoulder pain and weakness (14 male, 6 female), aged 18 to 40 years (mean = 28, SD = 5.8), participated in this study.

METHODS

Subjects performed each of the following exercises using a hand-held weight: prone lateral (external) rotation, sidelying lateral rotation, and arm elevation in the scapular plane. Indwelling fine-wire electrodes recorded electromyographic (EMG) activity during each exercise. The EMG activity in five phases of concentric contraction of each exercise was averaged and divided into three equal time intervals. Mean EMG values normalized to maximal activity for the entire phase of concentric contraction and for each of the three intervals were used in subsequent analyses.

RESULTS

Two-way repeated-measures analyses of variance (ANOVAs) revealed between-group differences only in the prone lateral rotation exercise. Compared with subjects without shoulder pathology, subjects with shoulder pain showed significantly greater EMG activity in the infraspinatus muscle and less activity in the supraspinatus muscle during this exercise.

CONCLUSION AND DISCUSSION

These results suggest that the pattern of muscle activation during specific shoulder movements in patients with shoulder pain may be related to pathology. Future studies are needed to determine whether an imbalance in neuromuscular control is a factor contributing directly to shoulder dysfunction or whether such an imbalance is secondary to some pathology.

Antimicrobial activity of bismuth subsalicylate on Clostridium difficile, Escherichia coli O157:H7, norovirus, and other common enteric pathogens

Previous studies have shown bismuth subsalicylate (BSS) has antimicrobial properties, but few studies have addressed the mechanism of action. Furthermore, following BSS ingestion other bismuth salts form throughout the gastrointestinal tract including bismuth oxychloride (BiOCl) that also act upon enteric pathogens. To further understand the antimicrobial activity of bismuth in infectious diarrhea, the antimicrobial effect of BSS and BiOCl on Clostridium difficile, Salmonella, Shigella, Shiga toxin-producing Escherichia coli strains and norovirus (NoV) were measured. Bacterial enteric pathogens in pure culture or in human fecal material were exposed to 35mg/ml BSS or BiOCl with or without a vehicle suspension. BSS and BiOCl treated samples were quantified and visualized by transmission electron microscopy. To measure the effect on NoV, reduction of infectious murine NoV (MNV), a surrogate for human NoV, and Norwalk virus RNA levels were measured by viral plaque assay and RT-qPCR, respectively. BSS and BiOCl reduced bacterial growth by 3-9 logs in all strains with majority resulting in populations of <10 cfu/ml within 24 h. Similar results were found when fecal material was included. Microscopy images detected bismuth on bacterial membranes and within the bacterial organisms at 30 min post-treatment. At 8.8mg/ml BSS and BiOCl reduced infectivity of MNV significantly by 2.7 and 2.0 log after 24 h of exposure. In addition, both BSS and BiOCl slightly reduced the level of Norwalk replicon-bearing cells suggesting that bismuth may inhibit NoV in vivo. Collectively, our results confirm and build on existing data that BSS has antimicrobial properties against a wide-range of diarrhea-causing pathogens.

What Happens When "Germs Don't Get Killed and They Attack Again and Again": Perceptions of Antimicrobial Resistance in the Context of Diarrheal Disease Treatment Among Laypersons and Health-Care Providers in Karachi, Pakistan

In south Asia, where diarrhea is common and antibiotics are accessible without prescription, antimicrobial resistance is an emerging and serious problem. However, beliefs and behaviors related to antimicrobial resistance are poorly understood. We explored laypersons' and health-care providers' (HCP) awareness and perceptions of antimicrobial resistance in the context of treatment of adult diarrheal disease in Karachi, Pakistan. In-depth, open-ended interviews were conducted with 40 laypersons and 45 HCPs in a lower-middle-class urban neighborhood. Interviews conducted in Urdu were audiotaped, transcribed, translated, and coded using applied thematic analysis. Slightly over half of laypersons and two-thirds of HCPs were aware that antimicrobial medication could lose effectiveness, but misperceptions were common. Laypersons and HCPs often believed that "the body becomes immune" or "bacteria attack more strongly" if medications are taken "improperly." Another prevalent theme was that causes and effects of antimicrobial resistance are limited to the individual taking the antimicrobial medication and to the specific diarrheal episode. Participants often attributed antimicrobial resistance to patient behaviors; HCP behavior was rarely discussed. Less than half of the HCPs were aware of treatment guidelines. To combat antimicrobial resistance in urban Pakistan, a health systems strategy and community-supported outreach campaigns on appropriate antimicrobial use are needed.

A flow cytometric assay to quantify in vivo bacterial uptake by alveolar macrophages

Our laboratory has developed a flow cytometric assay to quantify alveolar macrophage (Mcapital EF, Cyrillic) phagocytosis of bacteria within a live animal. Mcapital EF, Cyrillics collected by bronchoalveolar lavage from rats infected transtracheally with Syto 9-labeled bacteria are fluorescently labeled for identification and analyzed by flow cytometry to quantify their bacterial uptake.

[Recommended actions: Reinforcing clinicians' resilience and supporting second victims during the COVID-19 pandemic to maintain capacity in the healthcare system]

Der Begriff Second Victim beschreibt eine an der Patientenversorgung beteiligte Person, die durch eine außergewöhnliche Situation in der Patientenversorgung selbst traumatisiert wird. Dieses in der Öffentlichkeit noch weitgehend unbekannte, aber weit verbreitete Phänomen wird durch die COVID-19-Pandemie verschärft und birgt das Risiko, durch eine ausgeprägte psychische Überlastung der Behandelnden Gesundheitssysteme zusätzlich unter Druck zu setzen. Dies stellt sowohl für die Patienten als auch für die Mitarbeitersicherheit eine ernstzunehmende Gefahr dar. Das Second-Victim-Phänomen ist gut erforscht und bedarf einer zweigleisigen Strategie. Einerseits müssen Second Victims in einem flächendeckenden, möglichst niederschwellig erreichbaren gestuften System schnell, persönlich und vertraulich unterstützt werden. Andererseits kommt der Stärkung der Resilienz aller Behandelnden besondere Bedeutung zu. Die Resilienz und damit die langfristige Leistungsfähigkeit der Behandelnden kann durch eine besondere Berücksichtigung im Führungsverhalten und in der Krisenkommunikation nachhaltig unterstützt werden. Sie leistet somit sowohl kurzfristig als auch nachhaltig einen positiven Beitrag für die Patientensicherheit und damit die Überlebenschancen vieler Patienten während und nach der COVID-19-Pandemie.

Effect of Bismuth Subsalicylate vs Placebo on Use of Antibiotics Among Adult Outpatients With Diarrhea in Pakistan: A Randomized Clinical Trial

IMPORTANCE

Many of the 4.5 billion annual episodes of diarrhea are treated unnecessarily with antibiotics; prevalence of antibiotic resistance among diarrheal pathogens is increasing. Knowledge-based antibiotic stewardship interventions typically yield little change in antibiotic use.

OBJECTIVE

To compare antibiotic use among adult outpatients with diarrhea given bismuth subsalicylate (BSS) or placebo.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial took place from April to October 2014. Participants were patients aged 15 to 65 years with acute, nonbloody diarrhea from 22 outpatient clinics in Karachi, Pakistan. Participants were interviewed about symptoms and health care utilization during the 5 days after enrollment. Group assignment was concealed from participants, field staff, and the statistician. Primary analysis occurred from August to September 2015.

INTERVENTIONS

Participants were randomly assigned (1:1) to receive BSS or placebo for 48 hours or less.

MAIN OUTCOMES AND MEASURES

Use of systemic antibiotics within 5 days of enrollment. Secondary outcomes included measures of duration and severity of illness.

RESULTS

Among eligible patients, 39 declined to participate, 440 enrolled, and 1 enrolled participant was lost to follow-up, for a total of 439 patients included in the analysis. Median (interquartile range) participant age was 32 (23-45) years and 187 (43%) were male. Two hundred twenty patients were randomized to BSS and 220 were randomized to placebo. Overall, 54 participants (12%) used systemic antibiotics (16% in the placebo group and 9% in the BSS group); all antibiotic use followed consultation with a physician. Use of any antibiotic was significantly lower in the BSS group (20 of 220 vs 34 of 219 patients; odds ratio [OR], 0.54; 95% CI, 0.30-0.98), as was use of fluoroquinolones (8 of 220 vs 20 of 219 patients; OR, 0.38; 95% CI, 0.16-0.88). Rates of care seeking and hospitalization were similar between groups and no difference was detected in timing of diarrhea resolution. However, those in the BSS group less commonly received intravenous rehydration (14 of 220 vs 27 of 219 patients; OR, 0.48; 95% CI, 0.25-0.95) and missed less work (median [interquartile range], 0 [0-1] vs 1 [0-1] day; P = .04) during follow-up.

CONCLUSIONS AND RELEVANCE

This study found less antibiotic use among participants given BSS for acute diarrhea in a setting where antibiotics are commonly used to treat diarrhea. Encouraging health care professionals in such settings to recommend BSS as frontline treatment for adults with diarrhea, and promoting BSS for diarrhea self-management, may reduce antibiotic use and rates of antibiotic resistance globally.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02047162.