One hundred and eighty-two cases of abdominal tuberculosis admitted to Swaroop Rani Nehri (SRN) Hospital, Allahabad, in the past 7 years have been reviewed. The clinical diagnosis of abdominal tuberculosis was made correctly only in 50 per cent of cases. About half the cases presented with chronic or acute on chronic intestinal obstruction. The remaining patients had vague pains, tender abdomen, constitutional symptoms or a mass in the abdomen. Diarrhoea was not frequent and fistula formation was rare. A chronic obstructive type of lesion was found not only in cases with a bowel lesion but also in patients with chronic miliary peritonitis and tuberculous mesenteric adenitis. Similarly, a lump was present not only in hypertrophic bowel tuberculosis but also in chronic miliary peritonitis and tuberculous mesenteric adenitis. On radiological examination false positive features such as fluid levels, bowel dilatation or even the 'string' sign were encountered. Liver and endometrial biopsies were positive in only a very few cases. Peritoneal biopsy was of considerable help, being positive in 88 per cent of ascitic cases and in 42-1 per cent of non-ascitic cases. Open peritoneal biopsy obtained after making a small incision in the right iliac fossa was found to be the most useful investigation in the diagnosis of abdominal tuberculosis. An ascitic fluid protein content of 2-5 g or more and a predominantly lymphocytic count of over 100/mm3 are diagnostic, but a cell count of 10/mm3 was recorded in one tuberculous case.
Introduction Increased physical activity and functional ability are the goals of total knee replacement surgery. Therefore, adequate rehabilitation is required for the recovery of patients after discharge from hospital following total knee arthroplasty (TKA). This systematic literature review aimed to evaluate the effectiveness of home telerehabilitation in patients who underwent TKA. Methods Studies published in the English language between 2000 and 2014 were retrieved from Embase, PubMed, and Cochrane databases using relevant search strategies. Two researchers independently reviewed the studies as per the Cochrane methodology for systematic literature review. We considered telerehabilitation sessions as those that were conducted by experienced physiotherapists, using videoconferencing to patients' homes via an internet connection. The outcomes assessed included: knee movement (knee extension and flexion); quadriceps muscle strength; functional assessment (the timed up-and-go test); and assessment of pain, stiffness, and functional capacity using the Western Ontario and McMaster Universities Osteoarthritis Index and visual analogue scale for pain. Results In total, 160 potentially relevant studies were screened. Following the screening of studies as abstracts and full-text publications, six primary publications (four randomized controlled trials, one non-randomized controlled trial, and one single-arm trial) were included in the review. Patients experienced high levels of satisfaction with the use of telerehabilitation alone. There was no significant difference in change in active knee extension and flexion in the home telerehabilitation group as compared to the control group (mean difference (MD) -0.52, 95% CI -1.39 to 0.35, p = 0.24 and MD 1.14, 95% CI -0.61 to 2.89, p = 0.20, respectively). The patients in the home telerehabilitation group showed improvement in physical activity and functional status similar to patients in the conventional therapy group. Discussion The evidence from this systematic literature review demonstrated that telerehabilitation is a practical alternative to conventional face-to-face rehabilitation therapy in patients who underwent TKA.
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