Objective: This study aimed to emphasize facilitation training and strengthening of abdominal and core muscles in improving the inter-recti distance (IRD) and associated low back pain (LBP) among young postpartum females. Materials and methods: A single-blinded randomized controlled trial, among forty young postpartum females, was conducted at a community health center. The females were divided into two equal groups through the envelope method where Group A received abdominal crunch training protocol whereas group B received double straight leg raise (DSLR) exercise protocol for 6 weeks and pre and post IRD and Oswestry disability index (ODI) scores were recorded. Results: Group A showed improvement in IRD with a mean difference of 1.95±0.4 whereas in group B it was found to be 2.85±0.35 when assessed through finger palpation method.  The mean difference of IRD, when measured through digital nylon caliper method in abdominal crunch and DSLR exercise group was 4.06±0.74 and 1.2±0.49 respectively. Moreover, ODI scores of group A were 2.70±1.05 whereas, group B scores were found to be 1.1±0.06 showing that LBP reduced in participants who performed abdominal crunch exercise. Conclusion: This study reveals that 6 weeks of exercise protocol was observed to be effective in the management of DRA. Thus, abdominal crunch exercise seemed to produce promising results in a reduction of IRD and associated LBP.

Study design: A cross-sectional survey. Objectives: To document bowel care practices of chronic spinal cord injury (SCI) patients in Pakistan. Settings: Outpatient Department, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan. Methods: A total of 50 adult patients (18-65 years) with SCI of duration 412 months were sampled by convenience sampling. Medical record was reviewed, detailed neurological examination was performed and face-to-face semistructured interviews were conducted. Data were collected and analysed using SPSS v10. Frequencies and descriptive statistics were calculated for the various variables. Results: Most of the patients (29) were males. The mean age was 33 ± 11 years. Majority of the patients (76%) had thoracic-level injury. In all, 43 patients gave a history of occasional or regular faecal incontinence. In addition, 17 patients reported the regular use of laxatives whereas 22 used bulkforming agents on a regular basis. Majority of the patients (56%) had at least one bowel evacuation daily. In addition, 31 patients required 16-30 min to complete the bowel evacuation. Approximately half (54%) required assistance in bowel evacuation. Conclusion: A large number of patients with chronic SCI in Pakistan had faecal incontinence. A majority of patients used methods such as suppositories, laxatives and bulk-forming agents to control the frequency and duration of the bowel programme. Adherence to standard bowel care programme and practices are influenced by sociocultural factors and lack of education on the part of the patients.

An isolated musculocutaneous nerve (MCN) injury is a rare condition that can be easily missed if it presents late. A 28-year-old man reported painless and progressive wasting of the right arm for 6 months. On examination, there was visible wasting of the right biceps brachii muscle along with its slight weakness, depressed biceps jerk, and an impaired pinprick sensation in the lateral antebrachial cutaneous nerve distribution. He described a history of a road traffic accident 14 months beforehand. Based on the history and clinical examination, the differential diagnosis included an isolated MCN injury, upper trunk plexopathy, lateral cord plexopathy, C5/6 radiculopathy, and monomelic amyotrophy involving the C5/6 myotomes on the right side. The results of nerve conduction studies and electromyography were consistent with chronic proximal MCN neuropathy (right). In cases of arm wasting without pain or numbness, MCN injury should be included in the differential diagnosis, even in the presence of good power of the elbow flexors. The importance of detailed history-taking and clinical correlation cannot be over-emphasized in such cases.

Objectives: To evaluate the functional status of Pakistani patients with non-cancerous end-stage liver disease selected for liver transplant, and to compare results acquired through various assessment tools. Methods: The study was conducted at the Rehabilitation Medicine Department, Shifa International Hospital, Islamabad, Pakistan, from August 2017 to November 2019, and comprised end-stage liver disease patients of either gender who had been selected for liver transplant.  Assessment tools included the Six-Minute Walk Distance, Eastern Cooperative Oncology Group Performance Status and Modified Borg Scale across age, gender, ethnicity, primary aetiology, and Model for end-stage liver disease scores. Data was analysed using SPSS 20. Results: Of the 172 patients, 143(83%) were males; 99(58%) hailed from the Punjab province; and 118(71%) had hepatitis C as the most common aetiology. The overall mean age was 46.1±10.5 years (range: 14–70 years). The mean Six-Minute Walk Distance was 291.9±67.2m. Model for end-stage liver disease scores had a significant inverse correlation with Six-Minute Walk Distance (p<0.01) and a significant positive correlation with Modified Borg Scale (p=0.02) and Eastern Cooperative Oncology Group Performance Status scores (p<0.01). Age and ethnicity had no correlation with the variables (p>0.05). Conclusions: The Six-Minute Walk Distance score was significantly low.  The Model for end-stage liver disease scores were inversely correlated with Six-Minute Walk Distance scores, and positively correlated with Eastern Cooperative Oncology Group Performance Status and Modified Borg Scale scores. Continuous...