Osteoporosis (OP) is a widespread metabolic disease of the skeleton, leading to decreased bone strength and increased risk of fractures. OP is a disease of varying nature that affects all age groups, but is most common in older people. For a long time, doctors did not have serious tools to treat this insidious disease and mainly dealt with its consequences - fractures.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Long-Term Effect of Exercise Therapyand Patient Education on.docxwkyra78
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T.
Long-Term Effect of Exercise Therapyand Patient Education on.docxcroysierkathey
Long-Term Effect of Exercise Therapy
and Patient Education on Impairments
and Activity Limitations in People
With Hip Osteoarthritis: Secondary
Outcome Analysis of a Randomized
Clinical Trial
Ida Svege, Linda Fernandes, Lars Nordsletten, Inger Holm, May Arna Risberg
Background. The effect of exercise on specific impairments and activity limitations in
people with hip osteoarthritis (OA) is limited.
Objective. The study objective was to evaluate the long-term effect of exercise therapy and
patient education on range of motion (ROM), muscle strength, physical fitness, walking
capacity, and pain during walking in people with hip OA.
Design. This was a secondary outcome analysis of a randomized clinical trial.
Setting. The setting was a university hospital.
Participants. One hundred nine people with clinically and radiographically evident hip
OA were randomly allocated to receive both exercise therapy and patient education (exercise
group) or patient education only (control group).
Intervention. All participants attended a patient education program consisting of 3 group
meetings led by 2 physical therapists. Two other physical therapists were responsible for
providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening,
functional, and stretching exercises over 12 weeks. Both interventions were conducted at a
sports medicine clinic.
Measurements. Outcome measures included ROM, isokinetic muscle strength, predicted
maximal oxygen consumption determined with the Astrand bicycle ergometer test, and
distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were
conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware
of group allocations.
Results. No significant group differences were found for ROM, muscle strength, predicted
maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but
the exercise group had less pain during the 6MWT than the control group at 10 months (mean
difference��8.5 mm; 95% confidence interval��16.1, �0.9) and 29 months (mean differ-
ence��9.3 mm; 95% confidence interval��18.1, �0.6).
Limitations. Limitations of the study were reduced statistical power and 53% rate of
adherence to the exercise therapy program.
Conclusions. The previously described effect of exercise on self-reported function was
not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking
capacity, but exercise in addition to patient education resulted in less pain during walking in
the long term.
I. Svege, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
Kirkeveien 166, 0450 Oslo, Nor-
way. Address all correspondence
to Dr Svege at: [email protected]
ous-hf.no.
L. Fernandes, PT, PhD, Norwegian
Research Center for Active Reha-
bilitation, Department of Ortho-
paedics, Oslo University Hospital,
and Department of Orthopaedic
Surgery and T ...
Analytical Study of Clinicopathological Data of Saudi Patients with Osteoarth...Prof. Hesham N. Mustafa
SUMMARY: Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk
factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological,
and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study
population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department
of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient’s clinical and radiological data were collected
from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done.
Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women
than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded
obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral
condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions
were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making
relevant to TKA in knee OA in Saudi Arabia and elsewhere.
KEY WORDS: Osteoarthritis; Knee; Arthroplasty.
Abstract
Background: Physiotherapy is multi-dimensional and can treat a vast variety of conditions, ranging from musculoskeletal aches, arthritis, joints problems, paraplegia, hemiplegic, sports injuries and frozen shoulder etc. Apart from culture competency and core medical knowledge a physiotherapist must be competent enough in all physiotherapist medical conditions where physical therapy plays a vital role. This study aims to identify the frequency of common clinical conditions among client presented at Habib Physiotherapy Complex (HPC), Hayatabad during 2010.
Methodology: This was a descriptive study; the data were retrieved from record register of HPC (Indoor and Outdoor patients) recording their presenting complaints and known diagnoses. Data was collected on a structure grid. Data was analyzed using SPSS version 15 and presented in term of frequency and percentages.
Result: The majority of clients (1280 (29%)) were suffering from low back pain. The second common condition 891(20%) was osteoarthritis of the knee joint and cerebrovascular accidents 824(18.4%), while cervical pain accounted for 734(16.4%). The rest of clinical conditions included; frozen shoulder, pelvic inflammation, cerebral palsy, polio effected and paraplegia.
Conclusion: The Study reveals the occurrence of Osteoarthritis (Low Back, Cervical Pain, and Knee Joints Pain) were the most common condition which deteriorated the performance of common individuals in our society.
The effect of hot intermittent cupping on pain, stiffness and disability of p...LucyPi1
Abstract Objective: The aim of this study was to investigate the effect of hot intermittent cupping on pain, stiffness and inability of patients with knee osteoarthritis (KO). Methods: The present study was a clinical trial, which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic. Based on permutation block method, the research units were divided into cupping therapy and control groups. For the cupping therapy group, four sessions of cupping therapy were performed every four days. To collect data, the form of demographic information, Visual Analogue Scale (VAS) and the Western Ontario and McMaster (WOMAC) osteoarthritis scale were used, and the data were analyzed by SPSS software v. 16 using descriptive statistics and independent t-test, paired t-test, Chi-square test and Fishers exact test with a significance level of P < 0.05. Results: Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous. Findings indicated that, based on VAS, the mean pain intensity in the left (P < 0.001) and the right knees (P < 0.001), as well as based on WOMAC, stiffness (P = 0.006), pain intensity (P < 0.001) and disability (P < 0.001) in the cupping therapy group significantly decreased compared to the control group. Conclusion: Findings showed that hot intermittent cupping therapy reduced the pain intensity, stiffness and disability in patients with KO.
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis.Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
paper regarding implementation of shakers exercise for impaired swallowing patients and compare pre , immediate and post implementation of the exercises
Gingival crevicular fluid turnover markers in premenopausal vs postmenopausal...Dr. Anuj S Parihar
Orthodontic treatment is one of the commonly
used dental treatments. Orthodontic forces act on the bone by
modulating the biomolecules, chiefly the osteoprotegerin (OPG),
osteopontin (OPN), receptor activator of nuclear factor kappa-B
(RANK), and RANK ligand (RANKL) (OPG ligand). Hormonal
changes are known to cause marked alteration in the levels of
these biomolecules. Hence, we planned this study to evaluate the
response of bone biomarkers in the gingival crevicular fluid (GCF)
in postmenopausal women undergoing fixed orthodontic therapy.
Evaluate of the Physical Performance of Patients Undergoing HemodialysisAhmed Alkhaqani
Background: Chronic kidney disease (CKD) is a worldwide health burden with high costs to the health system. It is associated with increased morbidity and mortality as well as a reduced quality of life. With the increase in the number of maintenance hemodialysis patients, debilitating conditions of muscle wasting and atrophy have become one of the biggest concerns for patients with CKD.
Objectives: The present study aimed to measure the physical performance level of patients with end-stage kidney disease and undergoing regular hemodialysis through using a short physical performance battery (SPPB) scale.
Methods: A descriptive design study (cross-sectional) was conducted on participants selected from the Dialysis Kidney Unit at Al-Sadder Medical Hospital in Al-Najaf City in order to achieve the study aim. The period of study is from 20th December 2020 to 28th February 2021. A non-probability (purposive sample) technique was used consisted of (62) patients who are medically diagnosed with CKD and undergoing hemodialysis included in the present study. The data were collected using a questionnaire consisting of three parts, including socio-demographic, clinical data form, and short physical performance battery (SPPB) scale.
Results: Show that there is a significant difference between means throughout three periods of test-1 (6.10), test-2 (6.16), and test-3 (5.40) at P=0.024, that the levels of all of the physical performance are below the predicted levels at the baseline assessment and they still deteriorate even at the third assessment The results indicated that the poor physical performance of patients suffer from chronic kidney disease and undergoing hemodialysis treatment.
Conclusion: Patients with end-stage kidney disease and undergoing hemodialysis have a low level of physical performance. This result is related to the physical activity regarding the population on hemodialysis, not being related to the demographic and clinical data evaluated.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Validity of Clinical Attachment Loss for Diagnosis of Osteoporosis in Postmen...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
UNRAVELLING THE MENTAL HEALTH LANDSCAPE: EXPLORING DEPRESSION AND ASSOCIATED ...indexPub
Introduction: The prevalence of depression and its correlates in Bangladeshi rural university students have been rarely investigated. We draw a literature review, a cross-sectional study and analysis of the rural students’ depression natures and mechanisms that influence their academic performance and health and well-being. Methods: A cross-sectional research was conducted during the period august 2019 to January 2020 in a university. We employed Beck Depression Inventory scale to collect data from 200 undergraduate and graduate students. Data were analysed using chi-square association test and ordinal logistic regression. Results: We discovered that mild to severe depression affected 60% of rural students [mild (16%), borderline (10%), moderate (12%), severe (11.5%), and extreme (10.5%)]. Family expectations, smoking, bad academic achievement, inability to enroll in a particular program, and inadequate household finances were significant risk factors for depression. When it comes to depression, male students scored noticeably higher than female pupils. The decreased depression was linked to both strong household economics and intellectual achievement. Conclusions: The intricate interactions among the risk factors influence the character and processes of depression in rural students.
IMPACT OF PERFORMANCE MANAGEMENT ON SUCCESSION PLANNINGindexPub
Motivation: HR in an organization faces various challenges in business environment, such as Building Capabilities, Improving Productivity, Building Performance Culture, Talent Management, Succession Planning for Key Leadership and Critical Roles, Developing Accountability and Ownership, Human Capital Management and transforming HR function into developmental Role from the legacy driven HR, etc. Succession Planning is the process of identifying and developing individuals, who have potential to hold the key leadership position in an Organization, whereas Performance Management includes assessing and improving upon the performance of an employee to meet the organizational goals. There are several Management Practices, which are adopted widely in Industry to make a successful Succession Planning. Workforce and Talent Management is one of them. The health of an organization majorly depends on the proper placement of people, which is a combined outcome of Talent Identification, Talent Development and Talent Retention. Performance Management plays a vital role in Talent Identification. It also has an impact on Talent Development and Talent Retention. The key idea of succession planning suggests that the right person to be placed at the right position at the right time. Succession planning is becoming a challenge these days in the corporate world. Organizations are often not found prepared with their successors to occupy the key positions as and when required. The positions are either kept vacant for a substantial period or more than one role is assigned to a single person. Identifying the right talent for the key positions from outside the organization and recruiting them is a much more difficult task at the eleventh hour. This has a significant impact on organizational health and in turn to organizational sustainability. Organizations must last longer than people. Role of organization continues even when the people move out. Employees must superannuate after attaining a certain age. Also, organizations must have a contingency plan for sudden vacancy arises out of attrition, health hazards and death of employee. Succession planning is the strategy to ensure that a suitable person is made available during exigencies. Employees are developed for taking on higher responsibilities and for the new roles that may emerge in future. The placement of Key Leadership positions can be executed either by inviting the talent from outside or developing the talent in-house. The latter is always in demand keeping in view the core values of the organization and the impact on loyalty and organizational culture in a long run. It is preferable to develop the in-house talent pool to reduce dependency on recruitment of experienced people from outside for the critical roles. It brings the talent acquisition cost low and contributes as a motivating factor for the team as well. The acceptability of a person placed at Top / Key Leadership Positions is high when these are occupied
More Related Content
Similar to EVALUATION OF THE EFFICIENCY OF BISPHOSPHONATES IN THE TREATMENT OF OSTEOPOROSIS IN THE CLIMACTERIC PERIOD
Abstract
Background: Physiotherapy is multi-dimensional and can treat a vast variety of conditions, ranging from musculoskeletal aches, arthritis, joints problems, paraplegia, hemiplegic, sports injuries and frozen shoulder etc. Apart from culture competency and core medical knowledge a physiotherapist must be competent enough in all physiotherapist medical conditions where physical therapy plays a vital role. This study aims to identify the frequency of common clinical conditions among client presented at Habib Physiotherapy Complex (HPC), Hayatabad during 2010.
Methodology: This was a descriptive study; the data were retrieved from record register of HPC (Indoor and Outdoor patients) recording their presenting complaints and known diagnoses. Data was collected on a structure grid. Data was analyzed using SPSS version 15 and presented in term of frequency and percentages.
Result: The majority of clients (1280 (29%)) were suffering from low back pain. The second common condition 891(20%) was osteoarthritis of the knee joint and cerebrovascular accidents 824(18.4%), while cervical pain accounted for 734(16.4%). The rest of clinical conditions included; frozen shoulder, pelvic inflammation, cerebral palsy, polio effected and paraplegia.
Conclusion: The Study reveals the occurrence of Osteoarthritis (Low Back, Cervical Pain, and Knee Joints Pain) were the most common condition which deteriorated the performance of common individuals in our society.
The effect of hot intermittent cupping on pain, stiffness and disability of p...LucyPi1
Abstract Objective: The aim of this study was to investigate the effect of hot intermittent cupping on pain, stiffness and inability of patients with knee osteoarthritis (KO). Methods: The present study was a clinical trial, which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic. Based on permutation block method, the research units were divided into cupping therapy and control groups. For the cupping therapy group, four sessions of cupping therapy were performed every four days. To collect data, the form of demographic information, Visual Analogue Scale (VAS) and the Western Ontario and McMaster (WOMAC) osteoarthritis scale were used, and the data were analyzed by SPSS software v. 16 using descriptive statistics and independent t-test, paired t-test, Chi-square test and Fishers exact test with a significance level of P < 0.05. Results: Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous. Findings indicated that, based on VAS, the mean pain intensity in the left (P < 0.001) and the right knees (P < 0.001), as well as based on WOMAC, stiffness (P = 0.006), pain intensity (P < 0.001) and disability (P < 0.001) in the cupping therapy group significantly decreased compared to the control group. Conclusion: Findings showed that hot intermittent cupping therapy reduced the pain intensity, stiffness and disability in patients with KO.
Sub153105.pdf my article Outcome Measurement of Electrical Stimulation on Qua...jayanta Jayanta0074U
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis
Jayanta Nath
Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
Outcome Measurement of Electrical Stimulation on
Quadriceps Muscles for Knee Osteoarthritis.Abstract: Introduction: Outcome measurement is very essential part to assess efficacy of treatment intervention. The first objective
was to perform a review of all outcome measurement used in manangement of knee OA. Secondly to know if there was any difference
of outcome measurement of electrical stimulation on quadriceps muscle based on collected review article. Question: What were the
various outcome measurement used for assessment of knee osteoarthritis specially when used electrical stimulation? Design: Review of
literature. Participant: reviewer. Adults with osteoarthritis of the knee. Intervention: Electrical stimulation for quadriceps. Outcome
measure : VAS, WOMAC, dynamometer,MMT,EMG etc Development: Literature searches were made in these databases: Medline
(Ovid), Pedro, SCOPUS, PsycINFO, Web of knowledge, CINAHL (EBSCOHost), SportDicus (EBSCOHost), DOAJ, Cochrane,
EMBASE, Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), and MedicLatina (EBSCOHost). A
retrospective search of 13 years was used until February 2015. 33 records were selected based on the affinity with the subject of the
review and their internal validity according to the PEDro scale. Conclusions: WOMAC, VAS, were most commonly used outcome
measurement for OA knee. recommend further research on ES and outcome measurement.There were many outcome measure for knee
OA based on literature search .The review evidence suggest that VAS,WOMAC,were useful for assessing quality of management.Out of
all outcome measurement tool the WOMAC,PPT, EMG were most valid and reliable tool.
paper regarding implementation of shakers exercise for impaired swallowing patients and compare pre , immediate and post implementation of the exercises
Gingival crevicular fluid turnover markers in premenopausal vs postmenopausal...Dr. Anuj S Parihar
Orthodontic treatment is one of the commonly
used dental treatments. Orthodontic forces act on the bone by
modulating the biomolecules, chiefly the osteoprotegerin (OPG),
osteopontin (OPN), receptor activator of nuclear factor kappa-B
(RANK), and RANK ligand (RANKL) (OPG ligand). Hormonal
changes are known to cause marked alteration in the levels of
these biomolecules. Hence, we planned this study to evaluate the
response of bone biomarkers in the gingival crevicular fluid (GCF)
in postmenopausal women undergoing fixed orthodontic therapy.
Evaluate of the Physical Performance of Patients Undergoing HemodialysisAhmed Alkhaqani
Background: Chronic kidney disease (CKD) is a worldwide health burden with high costs to the health system. It is associated with increased morbidity and mortality as well as a reduced quality of life. With the increase in the number of maintenance hemodialysis patients, debilitating conditions of muscle wasting and atrophy have become one of the biggest concerns for patients with CKD.
Objectives: The present study aimed to measure the physical performance level of patients with end-stage kidney disease and undergoing regular hemodialysis through using a short physical performance battery (SPPB) scale.
Methods: A descriptive design study (cross-sectional) was conducted on participants selected from the Dialysis Kidney Unit at Al-Sadder Medical Hospital in Al-Najaf City in order to achieve the study aim. The period of study is from 20th December 2020 to 28th February 2021. A non-probability (purposive sample) technique was used consisted of (62) patients who are medically diagnosed with CKD and undergoing hemodialysis included in the present study. The data were collected using a questionnaire consisting of three parts, including socio-demographic, clinical data form, and short physical performance battery (SPPB) scale.
Results: Show that there is a significant difference between means throughout three periods of test-1 (6.10), test-2 (6.16), and test-3 (5.40) at P=0.024, that the levels of all of the physical performance are below the predicted levels at the baseline assessment and they still deteriorate even at the third assessment The results indicated that the poor physical performance of patients suffer from chronic kidney disease and undergoing hemodialysis treatment.
Conclusion: Patients with end-stage kidney disease and undergoing hemodialysis have a low level of physical performance. This result is related to the physical activity regarding the population on hemodialysis, not being related to the demographic and clinical data evaluated.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Validity of Clinical Attachment Loss for Diagnosis of Osteoporosis in Postmen...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Similar to EVALUATION OF THE EFFICIENCY OF BISPHOSPHONATES IN THE TREATMENT OF OSTEOPOROSIS IN THE CLIMACTERIC PERIOD (20)
UNRAVELLING THE MENTAL HEALTH LANDSCAPE: EXPLORING DEPRESSION AND ASSOCIATED ...indexPub
Introduction: The prevalence of depression and its correlates in Bangladeshi rural university students have been rarely investigated. We draw a literature review, a cross-sectional study and analysis of the rural students’ depression natures and mechanisms that influence their academic performance and health and well-being. Methods: A cross-sectional research was conducted during the period august 2019 to January 2020 in a university. We employed Beck Depression Inventory scale to collect data from 200 undergraduate and graduate students. Data were analysed using chi-square association test and ordinal logistic regression. Results: We discovered that mild to severe depression affected 60% of rural students [mild (16%), borderline (10%), moderate (12%), severe (11.5%), and extreme (10.5%)]. Family expectations, smoking, bad academic achievement, inability to enroll in a particular program, and inadequate household finances were significant risk factors for depression. When it comes to depression, male students scored noticeably higher than female pupils. The decreased depression was linked to both strong household economics and intellectual achievement. Conclusions: The intricate interactions among the risk factors influence the character and processes of depression in rural students.
IMPACT OF PERFORMANCE MANAGEMENT ON SUCCESSION PLANNINGindexPub
Motivation: HR in an organization faces various challenges in business environment, such as Building Capabilities, Improving Productivity, Building Performance Culture, Talent Management, Succession Planning for Key Leadership and Critical Roles, Developing Accountability and Ownership, Human Capital Management and transforming HR function into developmental Role from the legacy driven HR, etc. Succession Planning is the process of identifying and developing individuals, who have potential to hold the key leadership position in an Organization, whereas Performance Management includes assessing and improving upon the performance of an employee to meet the organizational goals. There are several Management Practices, which are adopted widely in Industry to make a successful Succession Planning. Workforce and Talent Management is one of them. The health of an organization majorly depends on the proper placement of people, which is a combined outcome of Talent Identification, Talent Development and Talent Retention. Performance Management plays a vital role in Talent Identification. It also has an impact on Talent Development and Talent Retention. The key idea of succession planning suggests that the right person to be placed at the right position at the right time. Succession planning is becoming a challenge these days in the corporate world. Organizations are often not found prepared with their successors to occupy the key positions as and when required. The positions are either kept vacant for a substantial period or more than one role is assigned to a single person. Identifying the right talent for the key positions from outside the organization and recruiting them is a much more difficult task at the eleventh hour. This has a significant impact on organizational health and in turn to organizational sustainability. Organizations must last longer than people. Role of organization continues even when the people move out. Employees must superannuate after attaining a certain age. Also, organizations must have a contingency plan for sudden vacancy arises out of attrition, health hazards and death of employee. Succession planning is the strategy to ensure that a suitable person is made available during exigencies. Employees are developed for taking on higher responsibilities and for the new roles that may emerge in future. The placement of Key Leadership positions can be executed either by inviting the talent from outside or developing the talent in-house. The latter is always in demand keeping in view the core values of the organization and the impact on loyalty and organizational culture in a long run. It is preferable to develop the in-house talent pool to reduce dependency on recruitment of experienced people from outside for the critical roles. It brings the talent acquisition cost low and contributes as a motivating factor for the team as well. The acceptability of a person placed at Top / Key Leadership Positions is high when these are occupied
EXTERNAL BEHAVIOURAL FACTORS IMPACT ON INVESTMENT DECISIONS OF INDIVIDUAL INV...indexPub
The study collects data from a sample of individual investors and analyses their responses to recent financial events, changes in market trends, and economic forecasts. By examining factors such as demographic profiles, financial literacy, risk tolerance, and market perceptions, the research aims to identify significant predictors of investment decisions in this demographic. The findings suggest that investors are predominantly influenced by financial news, peer influence, past investment performance, and the economic stability of the region. This study contributes to the field by highlighting the localized factors impacting investment choices and providing insights for financial advisors and investment firms to tailor their strategies according to investor needs and regional specifics.
GLOBAL RESEARCH TREND AND FUTURISTIC RESEARCH DIRECTION VISUALIZATION OF WORK...indexPub
Purpose – The purpose of this research is to undertake a bibliometric analysis of working capital management. The study examines papers from time period 1974-2023and performed performance analysis, co-citation analysis, bibliographic coupling and scientific mapping. Design/methodology/approach – The study examines 174 articles retrieved from the Scopus database using bibliometric analysis, performance analysis and thematic clustering. The study looked at the scientific productivity of papers, prolific authors, most influencing papers, institutions and nations, keyword co-occurrence, thematic mapping, co-citations and authorship and country collaborations. VOSviewer was as a tool in the research to conduct the performance analysis and thematic clustering.The watchword "Working Capital Management" was used to include only English-language articles. Findings – The most productive year was 2022 with 26 publications. Martínez and García- are the most protuberant authors with 708 citations. The findings of the study shows that the most influential institutions are ‘The Department of Management and Finance, Faculty of Economy andBusiness and Department of Management and Finance, Faculty of Economics and Business, The University of Murcia, Spain with 381 & 297 citations. Among,thecountry analysis,Spain with 744 citations stands first of all other nations for publication on Working Capital Management. Kärri is the most productive author with 7 documents. Country-wise analysis reveals that the United States is the most productive country for Working Capital Management research with 40 documents.The authors also identified seven thematic clusters of Working Capital Management. Research limitations/implications – It informs and directs researchers on the current state of study in the field of Working Capital Management.The present study has quite a few implications forSmall & Medium enterprise managers, entrepreneurs, financial managers, academicians and scholars. It also outlines future research directions in this field.Present study provides an inclusive acquaintance about the working capital management till date. Originality/value – This is the first study which provides the performance analysis and scientific mapping of the all published documents on working capital management between the time periods 1974-2023
A SOCIAL CAPITAL APPROACH TO ENTREPRENEURIAL ECOSYSTEM AND INNOVATION: CASE S...indexPub
Despite being recognised as drivers of innovative development, Micro, Small, and Medium-Sized Enterprises (MSMEs) frequently confront resource limitations. Therefore, enhancing the ecosystem is contingent on the entrepreneurs’ social capital, which is crucial for the success of MSMEs. This study applies the social capital approach to analyse the entrepreneurial ecosystem enrichment and its impact on the innovation process of cosmetics MSMEs. The qualitative case study of six cosmetic manufacturing MSMEs explores that social capital is a multifaceted asset to MSMEs. Through an in-depth thematic analysis of three dimensions of social capital (structural, relational, and cognitive), this study states that the innovation process is supported by the synergistic transformation of one dimension of social capital into another. Entrepreneurs sharing the common norms, rules, and language enrich their cognitive as well as relational aspects of ecosystem. The study suggests that as network ties, trust, and norms collectively influence innovation in firms, hence, social capital needs to be studied with its contextualization in the ecosystem.
ASSESSING HRM EFFECTIVENESS AND PERFORMANCE ENHANCEMENT MEASURES IN THE BANKI...indexPub
This study employs an exploratory and quantitative research approach to systematically investigate the impact of Human Resource Management (HRM) practices on Organizational Performance within the Indian Banking sector. The research approach combines exploratory research, aimed at gaining insights into HRM practices, with a quantitative approach using a purposive sampling technique. Data is collected through a questionnaire from employees in both public (SBI) and private banks (HDFC Bank) who work in HR departments or are involved in HR activities. The Likert scale is utilized in the questionnaire to measure participant perceptions of HRM practices. The study utilizes two statistical tools: Neural Network and Exploratory Factor Analysis (EFA). The findings of the study highlight the significance of promotion and transfer policies, considered paramount in influencing organizational performance in both public and private banks. Additionally, the study underscores the importance of training and development initiatives in enhancing employee skills and competencies. Clear and effective communication within HR policies is identified as pivotal in improving organizational performance. Lastly, aligning HRM practices with sector-specific goals is recognized as a significant contributor to improved employee satisfaction and overall performance in the banking sector. The findings offer guidance for HR practitioners and policymakers in optimizing HRM practices to achieve better organizational performance.
CORRELATION BETWEEN EMPATHY AND FRIENDSHIP QUALITY AMONG HIGH SCHOOL STUDENTS...indexPub
In this research were used two questionnaires Empathy Formative questionnaire and Friendship Quality Scale. The aim of this study is to see the relationship between empathy and friendship quality among adolescent, to find out if there are gender differences in empathy and friendship quality, and to see if there are any differences between younger and older students on examined variables. This research was done with 65 high school students. Age of the students were 15 to 17 years old. Results show that there is a correlation between empathy and friendship quality. The results of t test show that there are not significant differences between females and males on variable empathy. Girls and boys have significant difference in friendship quality in Kosovo. There are no significant differences between older students and younger students in the level of empathy and also there are no significant differences between older students and younger students in the level of friendship quality.
LEVELS OF DEPRESSION AND SELF-ESTEEM IN STUDENTSindexPub
Introduction: among the most worrying problems in recent years are low self-esteem, family and friends problems, anxiety, stress, and depression, which are taking on alarming proportions in students and young people in general. Purpose: the study is a prediction, which focuses on analyzing and evaluating students' self-esteem and level of depression. Methodology: the population is 332 students (13-15 years old) in high schools in the Gjakova region. The study describes the analysis, classification, and evaluation of the collected data by doing the analysis and real examination of the findings. Results: in terms of gender there is no significant difference in self-esteem, while in depression there is a significant difference. The level of depression is higher in women (11.9) than in men (9.5). Economic status shows that students with employed fathers have lower depression (6.77) compared to those with unemployed fathers (10.80). Conclusions: The level of depression and self-esteem and parental reflection affect students. A link has been found between economic status and emotional problems and student behavior. To prevent it, the psychological service in schools should function, and together with families and the community should be as close as possible to the problems of students.
THE IMPACT OF SOCIAL FACTORS ON INDIVIDUALS DIAGNOSED WITH SCHIZOPHRENIAindexPub
The society with diverse structural and ideological influences, assumes its role in relation to behavior, attitude, belief and relations. The impact can be seen in every society globally, however the western nations have adjusted their social policies to suit these transformations, whereas nations in developing phase have failed to establish suitable systems. In Kosovo, the allocation of funds for mental health services remains insufficient, even though mental health disorders account for 12.3% of overall illnesses and 30.8% of work incapacities! The objective of this study is to examine the impact of society on the decline and recovery of individuals with schizophrenia. The study employs both qualitative and quantitative methods to provide a descriptive-analytical. A study was conducted in four municipalities of Kosovo, using individuals with schizophrenia from psychiatric institutions as subjects along with their caregivers/family members . The research found that social factors greatly contribute to the worsening of schizophrenia patients' condition. The presence of schizophrenia is evident through a higher likelihood of having a low level of education, high unemployment rates, and engaging in harmful behaviors like tobacco and alcohol use, as well as physical inactivity. Significant correlations have been observed in the subscales of positive and negative symptoms using the Self-Report PNS-Q questionnaires. It is crucial for individuals with schizophrenia to have a carefully designed strategy in place, developed in partnership with professionals from various relevant fields such as social protection, psychiatric medical services, education, and social integration plans.
RETURN ON EQUITY (ROE) AS MEDIATION OF BANK'S CAPITAL ADEQUATION RATIO (CAR)indexPub
Banks need to maintain their performance and the level of Capital Adequasi Ratio (CAR). This study wants to see the variables that affect the Capital Adequasi Ratio (CAR) and see ROE as a variable that mediates the Capital Adequasi Ratio (CAR) at Bank Rakyat Indonesia (BRI). The research method used multiple regression analysis, t-test, Anova test and Coefficient of Determination and the research period for 14 years from 2009 to 2022, by using SPSS Software version 26. The conclusion of the study, only the BOPO variable has a significant effect on the Capital Adequasi Ratio (CAR) and the ROE variable as a variable that can mediate the CAR variable at Bank Rakyat Indonesia (BRI). Keywords: Capital Adequasi Ratio, Bank Financial Ratio.
INNOVATIVE DESIGN FOR KIDS MASTERY IMPROVEMENT OF LANGUAGE FEATURES IN A STORYindexPub
One of the hardest things for people learning English as a third language is still reading and writing. Because they are still not good enough at language features, they often make big mistakes and assumptions that aren't true. To make learning more fun and useful, visual symbols were made for seven different kinds of language traits. It looks at the Vipicoll form a lot. Visual Symbols media, Picture and picture, and the Collaborative approach are all creatively put together in Vipicoll. This research used Reeve's design method. Research develops Vipicoll learning model, employing interviews, literature reviews, and questionnaires for iterative improvement and validation. Researchers identify problems, create Vipicoll, iteratively refine through trials, forming an effective English Language Education model. Study assesses individual English thinking development, emphasizing interpretive framework, relation, function, and unique visual symbols. From this research, it was found that using Vipicoll really helps improve kids' mastery of language features, especially those in a story. This is proven by the fact that after implementation, kids' correct answers when asked directly by their teachers and their written test answers increased greatly even though many direct answers and test answers used to be wrong and they often didn't understand.
CARDIOVASCULAR DISEASE DETECTION USING MACHINE LEARNING AND RISK CLASSIFICATI...indexPub
The global prevalence of heart disease indicates a major public health issue. It causes shortness of breath, weakness, and swollen ankles. Early heart disease diagnosis is difficult with current approaches. Hence, a better heart disease detection tool is needed. Treatment requires more than just diagnosis. Risk classification is critical for accurate diagnosis and treatment. In this analysis, a novel cardiovascular disease (CVD) detection paradigm using machine learning (ML) and risk classification based on a weighted fuzzy system is proposed. The system is developed based on ML algorithms such as artificial neural network (ANN) and Long Short-Term Memory (LSTM) and uses standard feature selection techniques knowns as Principal Component Analysis (PCA). Furthermore, the cross-validation method has been used for learning the best practices of model assessment and for hyperparameter tuning. The accuracy-based performance measuring metrics are used for the assessment of the performances of the classifiers. Finally, the outcomes revealed that the proposed model achieved an accuracy of 94.01% which is higher than another conventional model developed in this domain. Additionally, the proposed system can easily be implemented in healthcare for the identification of heart disease.
ANALYSIS OF FLOW CHARACTERISTICS OF THE BLOOD THROUGH CURVED ARTERY WITH MIL...indexPub
Narrowing of the arteries caused by atherosclerosis reduces blood flow to the heart, which results shows ischemia, angina pectoris, cerebral strokes, and other coronary artery disease signs and symptoms. Curvature is seen in blood vessels at various locations. The stenotic surface provides an additional curvature and the point of maximum shear which varies with the cross-section. A cylindrical form of the Navier-Stokes equations in polar coordinate system have been extended to include dynamic curvature along the axial direction. The blood flow behavior of taking different values of blood parameters like viscosity, the radius of the artery, and the thickness of the stenosis has been studied with and without curvature by using an extended blood flow model with dynamic curvature. Moreover, the aspects of blood flow, such as dynamic curvature velocity profile, volumetric flow rate, pressure drop, and shear stress, have been studied in relation to blood flow around curved arteries with stenosis, variations in the radii of the artery, thickness of the stenosis, and viscosity. The information may reveal that by increasing the values of curvature, viscosity, and thickness of stenosis, velocity, and volumetric flow rate can be quickly reduced. Increasing the curvature, viscosity, and thickness of stenosis also results in an increase in shear stress and a pressure drop. The presence of curved stenotic arteries has a significant impact on the flow parameters, and it is crucial to know about these dynamics in order to study the cardiovascular system.
ANALYSIS OF STUDENT ACADEMIC PERFORMANCE USING MACHINE LEARNING ALGORITHMS:– ...indexPub
Student academic performance is the great value of institutes, universities and colleges. All colleges majorly focus on the career development of students. The academic performance of students plays a vital role in the establishment of a bright career. On the basis of better academic performance, the placement of the students will be better and the same will be reflected in the form of better admission and future. Machine learning can be deployed for the prediction of student performance. Various algorithms are playing an important role in the prediction of the accuracy of various machine learning models. These articles discuss various algorithms that can be helpful to deploy for predicting student academic performance. The article discusses various methods, predictive features and the accuracy of machine learning algorithms. The primary factors used for predicting students performance are academic institution, sessional marks, semester progress, family occupation, methods and algorithms. The accuracy level of various machine learning algorithms is discussed in this article.
IMPLEMENTATION OF COMPUTER TECHNOLOGY IN BLENDED LEARNING MODELS: EFFECTS ON ...indexPub
This study was conducted to identify the influence of computer technology in blended learning on the achievement in the Principles of Accounting subject through of self-directed learning. The research also assessed the relationship of the elements of blended learning on student achievement. Despite the encouragement by the Ministry of Education for the use of Computer Technology In Education, there is a lack of research on a measurable and testable model of the influence of computer technology. In reality, various aspects such as schools, teachers, content, and technology exist to provide and utilize computer technology through learning in Malaysia. A quantitative study using a correlational design was conducted on 400 Form Four students in secondary schools in the Southern Zone of Malaysia, namely in the states of Johor, Melaka, and Negeri Sembilan, to identify the influence of computer technology in blended learning on achievement. Data were collected using adapted and modified questionnaires from previous studies. Descriptive data analysis was performed using SPSS version 28, while inferential analysis was conducted using the Smart PLS analysis technique. Smart PLS version 4.0 software was utilized to test the mediator relationships in the study. The results of the study showed high minimum scores for blended learning through computer technology and self-directed learning, as well as achievement. The influence of blended learning elements also had a significant relationship with student achievement in the Principles of Accounting subject. This study is expected to contribute to the effectiveness of blended learning through information technology on the achievement in the Principles of Accounting subject by enhancing self- directed learning among students. The development of this conceptual model is hoped to serve as a guide for policymakers, the Ministry of Education, teachers, students, and other stakeholders in ensuring that blended learning practices can be implemented more effectively. Furthermore, it is hoped that the achievement and interest in the Principles of Accounting subject can be improved by applying computer technology in learning.
ACADEMIC BANK OF CREDIT: A WORLDWIDE VIEWPOINTindexPub
To make higher education more accessible and successful in the world today, the Academic Bank of Credits (ABC) is a new concept. Successful learning adaptation requires the transfer of credits and the acknowledgment of academic accomplishment. Recognition of credits is the process by which one educational organisation verifies that the educational experiences gained and assessed at another institution meet the requirements of one of their courses. The use of Academic Bank of Credits allows for a more adaptable method of curriculum building and design while also encouraging transparency. The credit system at this university is designed to accommodate different curricula while encouraging students to explore beyond traditional academic boundaries. The purpose of this research is to educate the audience about the Academic Bank of Credit. The demand for flexible and transferable credits in the education system led to the creation of the Academic Bank of Credits. In the past, students had a hard time moving their credits from one school to another because of the many credit systems and curriculums. Students and schools alike wasted time, energy, and materials because of this. Readers will have a better understanding of the following topics from this article: ABCs' objectives, functions, organisational structures, implementation plan, and eligibility criteria for higher education institutions to register with Academic Bank of Credits.
IMPACT OF MICROFINANCE ON POVERTY REDUCTION IN SOUTHERN PUNJAB PAKISTANindexPub
Microfinance has been adopted by several developing nations to raise their inhabitants' standards of living. It also contributes to their improved economic growth. Pakistan is now implementing this idea and seeing positive results from microfinance. In Pakistan, Khushhali Bank is a notable player in the microfinance industry. The results of the sample data selection indicate that microfinance operations have an effect on the standard of life of individuals residing in a particular region in Muzaffargarh. For this study, 100 clients of Khushhali Bank have been chosen. The primary goal of the research is to determine how Khushhali Bank's microfinance initiatives affect people's ability to live better lives. A Ex-post Facto research model was used to the gathered data in order to determine the relationship between the microfinance loan and living standard metrics. The analysis's conclusion indicates that microfinance operations have very little influence on raising people's standards of living, meaning they don't play a significant part in raising living standards. Apart from microfinance loans, there are additional variables that contribute to the improvement of people's standard of life.
A NOVEL DENSITY-BASED CLUSTERING ALGORITHM FOR PREDICTING CARDIOVASCULAR DISEASEindexPub
Cardiovascular diseases (CVDs) remain a leading cause of global morbidity and mortality. Early identification of individuals at risk of heart disease is crucial for effective preventive interventions. To improve the prediction accuracy, this paper proposed Heart Disease Prediction using the Density-Based Ordering of Clustering Objects (DBOCO) framework. The Dataset has been pre-processed using Weighted Transform K-Means Clustering (WTKMC). Features are selected using Ensemble Feature Selection (EFS) with a Weighted Binary Bat Algorithm (WBBAT) used to ensure that the emphasis is on the most relevant predictors. Finally, the prediction has been done using the Density-Based Ordering of Clustering method, which has been designed exclusively for cardiovascular disease prediction. DBOCO, a density-based clustering approach, effectively finds dense clusters within data, allowing for the inherent overlap in cardiovascular risk variables. DBOCO captures complicated patterns by detecting these overlapping clusters, improving the accuracy of disease prediction models. The proposed approach has been verified with heart disease datasets, displaying higher performance than traditional methods. This study marks a substantial leap in predicting cardiovascular disease providing a comprehensive and dependable framework for early identification and preventive concern.
INFLUENCE OF ADDITIVES ON THE MECHANICAL PROPERTIES OF HIGH-MODULUS ASPHALT C...indexPub
The appearance of premature cracks in freeway chase bodies is a worrying problem that requires in-depth analysis and remedial action. By identifying potential causes and proposing targeted recommendations, this study aims to help the responsible authorities make informed decisions to prevent such problems in the future and ensure the durability of road infrastructure. Premature cracking and rutting are common problems in pavements that can compromise their durability and safety. The use of specific additives in asphalt concrete can help prevent these deficiencies. The use of ZQ1 additive alone can lead to premature cracking in pavements, while PR FLEX 20 additive can increase the risk of rutting. However, a judicious combination of the two additives, with specific percentages of 2% for ZQ1 and 5% for PR FLEX 20, can prevent these shortcomings, improve pavement durability and optimize the mechanical properties of high-modulus asphalt concrete (BBME). In addition, this approach offers a promising solution for improving pavement durability and performance over time, opening the door to further studies to optimize the use of this additive combination in field applications.
DIALECTAL VARIABILITY IN SPOKEN LANGUAGE: A COMPREHENSIVE SURVEY OF MODERN TE...indexPub
Main fundamental challenge for recent research work on speech based on science and technology is to understand and model the user variants in Spoken Languages. Users have their style of speaking, reliant on various factors, adding the dialect and accent of the speaker as well as the social and economic background of the speaker and contextual attributes like degree of knowledge between the listener, speaker and the position or rank of the speaking condition, from very normal to formal. In the past few decades, an extensive progress has been seen in automatically verifying the language of a speaker offered a sample speech. The main purpose of dialect verification is the recognition of a speaker’s region dialect, within a pre-determined language, offered the acoustic signal alone. DR (Dialect Recognition) is a main issue in particular, since even within the similar dialect and accent or register user change may occur. For illustration, In Spontaneous speech, few speakers tend to exhibit more optimizing and alteration of function words than others. The main issue of dialect recognition system has been viewed as challenging than that of language classification or recognition due to the maximum similarity among dialects of the similar language. While, dialects may differ in any dimensions of the linguistic spectrum such as syntactic, lexical, morphological, phonological differences, these changes are likely to be more indirect across dialects than those across languages such as Hindi, Punjabi and English etc.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Introduction to AI for Nonprofits with Tapp Network
EVALUATION OF THE EFFICIENCY OF BISPHOSPHONATES IN THE TREATMENT OF OSTEOPOROSIS IN THE CLIMACTERIC PERIOD
1. 105 | V 1 8 . I 1 1
EVALUATION OF THE EFFICIENCY OF BISPHOSPHONATES IN THE
TREATMENT OF OSTEOPOROSIS IN THE CLIMACTERIC PERIOD
ALIQULOV I.T 1, XAYTIMBETOV J.SH 2, NARZIYEV N.M 3 ,
ABDURAZZAQOVA D.S 4, ISMAILOV N.U 5 and MAMAJONOV SH.T 6
1
PhD, Associate Professor, Department of Propaedeutics of Internal Medicine No1 of Tashkent Medical
Academy of Uzbekistan.
2, 3
Senior Lecturer, Department of Propaedeutics of Internal Medicine No1 of Tashkent Medical Academy of
Uzbekistan.
4
PhD, Assistant of Department of Internal Disease No2 with Endocrinology of Tashkent Medical Academy of
Uzbekistan.
5, 6
Assistant of the Department of Traumatology, Orthopedics and Military Field Surgery.
Abstract
Osteoporosis (OP) is a widespread metabolic disease of the skeleton, leading to decreased bone strength and
increased risk of fractures. OP is a disease of varying nature that affects all age groups, but is most common in
older people. For a long time, doctors did not have serious tools to treat this insidious disease and mainly dealt
with its consequences - fractures. We have witnessed the birth of a new group of drugs—bisphosphonates (BPs),
which have significantly expanded the capabilities of clinicians in the treatment of OP and a number of other
bone diseases, as well as calcium metabolism disorders. Modern medicine is based on a solid evidence base. All
drugs recommended for use in clinical practice are subject to long-term, multi-stage clinical studies of
effectiveness and safety. Possessing different biological activities, these drugs demonstrated one common
property in clinical trials, which allowed them to be recommended for the treatment of OP: reducing the risk of
fractures. The purpose of the study is to evaluate the effectiveness of bisphosphonates in the treatment of patients
with OP in the climacteric period. From 2020 to 2022, 105 climacteric female patients with a confirmed diagnosis
of OP of the knee joint, registered in the arthrological IADC department of the multidisciplinary clinic of the
Tashkent Medical Academy (TMA), receiving inpatient treatment in the departments of cardiorheumatology and
rheumatology, were involved in this research work. They analyzed the clinical course of the disease and the
results of laboratory and instrumental examinations. For prospective analysis, the patients were divided into two
groups: Group I consisted of female patients with premenopausal OP. Group II consisted of postmenopausal
female patients with OP during menopause. In the obtained results, the clinical and laboratory activity indicators
of the disease reliably decreased in a statistically significant manner in the group of patients treated with
bisphosphonates compared to traditional treatment. Also, indicators of endothelial dysfunction were improved.
In UVD and MRI, degenerative changes in bones and joints showed positive dynamics. In conclusion, in the
treatment of OP patients in the climacteric period, the use of bisphosphonates (Zoledronic acid) in addition to
traditional treatment reduces the frequency of degenerative changes in the joints by reducing the clinical
laboratory activity level of the disease, improving endothelial dysfunction, and improving the quality of life of
patients.
Keywords: Osteporosis, Endothelial Dysfunction, Bisphosphonates, Zoledronic Acid.
2. 106 | V 1 8 . I 1 1
INTRODUCTION
Osteoporosis is a condition in which gradually decreasing bone mass and deteriorating bone
structure leads to increased bone fragility and increased risk for fractures, particularly of the
wrist, hip and spine (WHO 1994). This process progresses without symptoms until fractures
occur or kyphosis becomes apparent. Thus osteoporosis is often described as a silent menace
[16, 18].
Once fractures and deformities have occurred, pain may become a prominent problem and a
challenge for people with osteoporosis and everyone involved with their care. Such established
osteoporosis is a major cause of morbidity, mortality and reduced quality of life (Lips et al
2005) [1, 17].
Currently, four BPs are registered in our country and recommended for the treatment of OP:
alendronate, risendronate, ibandronate and zoledronate. Modern medicine is based on a solid
evidence base [6-8]. All drugs recommended for use in clinical practice are subject to long-
term, multi-stage clinical studies of effectiveness and safety [10, 12, 13].
Possessing different biological activities, these drugs demonstrated one common property in
clinical trials, which allowed them to be recommended for the treatment of OP: reducing the
risk of fractures [2, 5].
However, working in the era of evidence-based medicine and reading reports on the results of
multicenter, double-blind, placebo-controlled, randomized trials, doctors continue to test in
practice the effectiveness of the proposed treatment methods, as doctors did in the days of our
grandparents, assessing not only the advantages of the drugs [9, 11, 14, 15], but also their
disadvantages, side effects and raising questions that have yet to be answered. In our center,
for more than 10 years, all BPs registered in Russia and recommended for the treatment and
prevention of OP have been used in clinical practice.
Already the first results of treatment of OP BP made it possible to note a significant increase
in bone mineral density (BMD) after 6 months of treatment with alendronate. We then received
ibandronate, which was administered orally once a month, which greatly simplified the
treatment of postmenopausal OP [3, 4].
Purpose. To Evaluate the effectiveness of Zoledronic acid in OP patients in the climacteric
period.
MATERIALS AND METHODS
From 2020 to 2022, 105 climacteric female patients with a confirmed diagnosis of OP of the
knee joint, registered in the arthrological IADC department of the multidisciplinary clinic of
the Tashkent Medical Academy (TMA), receiving inpatient treatment in the departments of
cardiorheumatology and rheumatology, were involved in this research work. A prospective
analysis of patients was carried out in order to fulfill the tasks assigned to the research work.
3. 107 | V 1 8 . I 1 1
They analyzed the clinical course of the disease and the results of laboratory and instrumental
examinations. For prospective analysis, the patients were divided into two groups: Group I
consisted of 48.2±5.1-year-old female patients with premenopausal OP (n=51). Group II
consisted of 50.1±5.3-year-old female patients (n=54) with OP during menopause.
The American College of Rheumatology and European Antirheumatic League
(ACR)/EULAR) criteria were used to diagnose OP. Each patient involved in the study was
filled out a separate individual card in order to record the examinations used.
It combined the results of subjective and objective examination of the patient and included the
following indicators:
Anamnestic data of patients, presence of comorbid pathology;
Joint syndrome intensity and indicators of its functional state (visual analog scale (vas),
leken indices) and their changes in dynamics;
X-ray of knee joints (based on kellgren-lawrence criteria);
Magnetic resonance imaging (mri);
Ultrasound examination (uvd) data;
The results of the goniometry examination and their dynamic changes in order to assess
the range of movements in the knee joint;
Results of laboratory analyzes (in dynamics gba, crp, rf, blood sugar index, alt, ast,
bilirubin, cholesterol);
Vegf, mcp-1, no
Estradiol, fsg, lg
Medicines taken based on the patient's treatment recommendations.
Conventional radiographs of the joints of the hands and feet were performed in all patients.
For the analysis of changes in the structure of the joint, a standard X-ray of the knee joint in a
straight and lateral projection was carried out, using the Kellgren-Lawrence method.
Ultrasound examination of the joints was used to determine the structural disorders formed in
the joint, and was carried out using SonoScape S20. To determine the changes in the joint
structure, magnetic resonance imaging (MRT - Siemens Magnetom C 0.35T model) was used.
Analysis of the obtained results was carried out using the software package STATISTICA
(StatSoft, version 6.1 – 8.0, USA) [18].
According to the data collected from the anamnesis of the patients involved in the research
work, the average age of the patients at the time of the first symptoms of the disease in pre-
and postmenopausal women with OP was 53.3±1.7. According to the average age of the
patients and the duration of the disease, postmenopausal women predominated (57.1±4.2 and
5.1±1.2).
4. 108 | V 1 8 . I 1 1
It can also be seen that the average values of the body weight index in the representatives of
this group increased depending on the average age of the patients and the duration of the
disease (Table 1).
Table 1: General Clinical Characteristics of Pre- and Postmenopausal Female Patients
Divided by Primary OP Diagnosis (n=105)
Groups Average age of patients Disease duration (in years) Average IMB of patients (kg/sm2
)
I Group
(n =54)
49,5±2,6 3,2±1,2 32,13±2,0
II Group
(n=51)
57,1±4,2 5,1±1,2 33,14±4,5
Analyzing the general clinical and laboratory parameters of pre- and postmenopausal women
with primary OP, it was noted that the average duration of morning sickness did not exceed
10.5±5.4 minutes. VAS and Leken indices were 70.1±1.5 and 16.1±0.4, respectively.
Symptoms of synovitis were detected in only 24% of patients. The number of painful and
swollen joints was 2.8±1.5 and 2.1±0.8, respectively.
When the functional insufficiency of the joints was studied, the presence of II functional class
was observed in the majority of women with OP (54.8%). In 5% of them, we witnessed that
the changes in the joints characteristic of the disease did not lead to functional deficiency. Of
the indicators of inflammation, no strong negative dynamics were noted inC-reactive protein
and erythrocyte sedimentation rate (23±0.1 and 20.2±1.5) (Table 2).
Table 2: General clinical and laboratory parameters of pre- and postmenopausal
women with OP
Symptoms Indicators (n=105)
Articular syndrome
Duration of morning sickness, min. 10,5±5,4
Pain, VAS, mm 70,1±1,5
Number of painful joints 2,8±1,5
Number of swollen joints 2,1±0,8
The presence of synovitis, % 24
Leken index 16,1±0,4
Functional insufficiency of joints (%)
0 class 5
I class 29,2
II class 54,8
III class 11
Laboratory indicators
C-reactive protein, mg/l 23±0,1
Erythrocyte sedimentation rate, mm/s 20,2±1,5
5. 109 | V 1 8 . I 1 1
RESULTS
The chart below shows the mean age distribution of pre- and postmenopausal women with OP
by group in percentages. According to him, the majority of patients in group I (64%) were
women aged 41-50. The smallest percentage of them (7%) consisted of patients aged 51-60
years. On the contrary, women in the II group in this age range had an advantage with 48%.
The next places were (37%) 41-50 and (5%) 61-70-year-old postmenopausal women (Figure
1).
Figure 1: Distribution of Mean Age of Pre- and Postmenopausal Women with OP (%)
According to the method of pharmacotherapy, patients were divided into two groups:
Group 1 patients with OP treated by conventional methods aged 49.5±2.6 (n=54) were
recruited acceptance of nonsteroidal anti-inflammatory drugs (100 mg of nimesulide 2 times
a day for 14 days, calcium 1000ME/day and vitamin D (5000ME/day).
Female patients with OP aged 57.1±4.2 years (n=51) were selected for the 2nd group.
Bisphosphonates (Zoledronic acid) were recommended along with the use of calcium
1000ME/day. Zoledronic acid 5mg (100ml) was taken intravenous a day for year. Both gurus
were advised to lead a healthy lifestyle, correct diet and physical fitness, and perform
therOPeutic physical exercises in addition to various treatment methods.
6. 110 | V 1 8 . I 1 1
Clinical activity indicators of OP were reassessed after 3, 6, and 12 months in patients who
received conventional and combined treatment regimens. According to him, a decrease in the
WOMAC index was observed in both groups against the background of treatment. This index
decreased statistically significantly by the 6th month of treatment in patients with OP who
received combined treatment (17.4 vs. 10.7; p<0.05).
In the group of patients who received traditional treatment, the statistically significant decrease
of this indicator occurred only after 12 months (16.9 and 10.3; p<0.05). In group II patients,
by this time, this indicator decreased by 2.5 times (17.4 and 7; p<0.05).
Also, the values of the WOMAC index in the group recommended combined pharmacotherapy
were statistically significantly lower than the indicators of patients who received conventional
treatment (p<0.5) (Fig. 2).
Note: *- p<0.5-1 is a reliable difference compared to group indicators
α-p<0.05-reliable difference from pre-treatment values
Figure 2: Dynamics of Change of WOMAC Index by Groups (score) Against the
Background of Treatment
7. 111 | V 1 8 . I 1 1
Figure 3 below shows the dynamics of changes in the Lequene index by groups against the
background of pharmacotherapy. In it, we witnessed a statistically significant decrease of this
index in patients of group II, who received combined drugs, compared to indicators of group
I, who received traditional treatment (p<0.5).
In group II patients, a convincing decrease of this indicator began from the 6th month of
treatment (17.1 and 10.1; p<0.05), while in patients who received conventional treatment,
positive dynamics compared to pre-treatment values were observed only after 1 year (15.5 and
9.8; p<0.05) (Figure 3).
Note: *- p<0.5-1 is a reliable difference compared to group indicators
α- p<0.05-reliable difference from pre-treatment values
Figure 3: Dynamics of Change of the Lequene Index by Groups (score) Against the
Background of Treatment
In patients with OP who were prescribed traditional and combined pharmacotherapy, the VASh
index recorded a positive dynamic faster than the WOMAC and Lequene indices. That is, in
the women treated with the combined method, within the first 3 months, the VASh index was
reliably reduced from 75 to 42 (p<0.01). In the group recommended traditional treatment, such
a change occurred only after half a year (65 and 42.3;p<0.01).
Against the background of one-year pharmacotherapy, the VASh index decreased up to 3 times
in group I (65 and 26.8; p<0.001), and almost 4 times in group II (75 and 16.2; p<0.0001). In
patients with OP who were prescribed combined pharmacotherOPy, we saw that the VAS index
decreased to statistically significant numbers (p<0.5) (Fig. 4).
8. 112 | V 1 8 . I 1 1
Note: *- p<0.5-1 is a reliable difference compared to group indicators
α- p<0.01; & - p<0.001; ß- p<0.0001-reliable difference compared to pre-treatment indicators
Figure 4: Dynamics of VAS Index Changes by Groups (points) Against the Background
of Treatment
In the analysis of the changes in the average indicators of ESR, CRP and hemoglobin in the
blood against the background of treatment of women with OP in group I, statistically
significant positive shift was almost not noted. Only the level of CRP significantly decreased
compared to pre-treatment values (21.42 and 17.9 respectively; p<0.5) (Figure 5).
Note: *- p<0.5-Reliable difference compared to pre-treatment values
Figure 5: Analysis of Changes in the Average Values of ESR, CRP and Hemoglobin in
Blood (mm/s; mg/l; g/l) against the Background of Treatment in Women with OP of
Group I
9. 113 | V 1 8 . I 1 1
In contrast to traditional treatment, we witnessed a statistically significant decrease in not only
CRP but also ESR levels in group II patients who received combined pharmacotherOPy.
Admittedly, the level of CRP in group II patients was significantly reduced in diagnostically
significant titers compared to conventionally treated group patients (25.2 vs. 10.9; p<0.0005).
There were no statistically significant changes in ESR in group I patients, but in the group of
OP patients treated with combined treatment, its amount decreased reliably from 21.9 mm/s
to 12.1 mm/s (p<0.005) (Fig. 6).
Note: *- p<0.005; **- p<0.0005-Reliable difference compared to pre-treatment values
Figure 6: Analysis of Changes in the Average Values of ESR, CRP and Hemoglobin in
Blood (mm/s; mg/l; g/l) Against the Background of Treatment in Women with OP of
group II
The effectiveness of the recommended pharmacotherOPy was evaluated according to the
clinical and laboratory activity of the disease and the levels of endothelial dysfunction. The
change of MCP-1 levels against the background of pharmacotherOPy is shown in Figure 7
below. According to this, the amount of MCP-1 decreased statistically significantly in both
groups as a result of treatment, but the rate of decrease in group II was reliably higher than the
values before treatment and group I (240.3 and 159.8, respectively; p<0.0005 ) and (159.8 and
192.8 respectively; p<0.0001). In group I, only positive dynamics were observed compared to
pre-treatment indicators (227.2 and 192.8, respectively; p<0.005).
10. 114 | V 1 8 . I 1 1
Note: *- p<0.005; **- p<0.0005 reliable difference compared to pre-treatment values
&- p<0.0001-1- reliable difference compared to group indicators
Figure 7: Group-by-group Comparison of Changes in mean MCP-1 levels (ME/ml)
Over Treatment Background
Also, the effectiveness of conventional and combined treatment methods was examined in the
example of changes in the level of VEGF. According to him, as a result of treatment, VEGF
decreased statistically reliably in both groups, but the indicators of group II, which received
combined treatment, not only decreased more reliably than before treatment, but also
compared to the indicators of group I (392.5 and 257.8, respectively; p<0.0005 ) and (257.8
and 322 respectively; p<0.0001). In group I, only a statistically significant decrease was noted
compared to pre-treatment values (347.8 and 322, respectively; p<0.005) (Figure 8).
Note: *- p<0.005; **- p<0.0005 reliable difference compared to pre-treatment values
&- p<0.0001-1- reliable difference compared to group indicators
Figure 8: Comparative Analysis of Changes in the Average Amount of VEGF in the
Treatment Background by Groups (ME/ml)
11. 115 | V 1 8 . I 1 1
It is known that NO has a strong antioxidant property, and the reduction of its titers is an
important factor in the development of endothelial dysfunction. In our research work, in
addition to MCP-1 and VEGF which determine endothelial dysfunction, changes in the
amount of NO were also taken into account.
In this case, both methods of pharmacotherOPy led to a reliable increase in NO titer in patients
with OP (7.45 and 9.8, respectively) (p<0.5) and (7.46 and 16.5, respectively) (p<0.0005 ).
Even the post-pharmacotherOPy scores of group II were statistically significantly higher than
the post-treatment scores of the conventionally treated group (16.5 vs. 9.8,
respectively)(p<0.0005).
In the conventional treatment group, there was only a statistically significant shift compared
to pre-treatment values (7.45 and 9.8, respectively; p<0.5) (Figure 9).
Note: *- p<0.5; **- p<0.0005 reliable difference compared to pre-treatment values
&- p<0.0005-1- a reliable difference compared to the indicators in the group
Figure 9: Group-Wise Comparison of Changes in Mean Levels of NO Over Treatment
Background (ME/ml)
12. 116 | V 1 8 . I 1 1
In diagram 10 below, the changes in the destruction, osteophyte and synovitis values of the
femoral medial condyle (FMC), patello-femoral joint (PFJ) tendons determined by ultrasound
examination against the background of 12 months of combined and conventional
pharmacotherapy were analyzed by groups.
According to it, we observed a statistically insignificant decrease in the destruction of the
femoral medial condyle, patellofemoral joint (PFJ), and osteophyte indicators in patients of
group I, who were treated conventionally, compared to the values before treatment.
However, synovitis levels were statistically significantly reduced compared to pre-treatment
values (1.61; 0.68; p<0.05). In the group of patients who received the combined treatment
method, not only synovitis, but also osteophyte levels were reliably reduced compared to the
values before treatment (1.53; 0.4; p<0.05 and 2.8; 1.3; p<0, 05).
Note: *- p<0.05-reliable difference from pre-treatment values
Figure 10: Dynamics of Changes in the Parameters Determined by Ultrasound
Examination Against the Background of Pharmacotherapy (score) by groups
Diagram 11, illustrated below, shows the dynamics of changes in OP-specific MRI parameters
after 12 months of pharmacotherapy. According to it, we witnessed a statistically insignificant
reduction of subchondral osteosclerosis, cyst and osteophyte indicators compared to pre-
treatment values.
However, bone marrow edema and synovitis levels were statistically significantly reduced
compared to pre-treatment values (1.66; 1.06; p<0.5 and 1.52; 1.01; p<0.5).
13. 117 | V 1 8 . I 1 1
Note *- p<0.5 -reliable difference compared to pre-treatment indicators
Figure 11: The Dynamics of Changes in OP-specific MRI Indicators in Patients Against
the Background of Treatment
CONCLUSION
In the treatment of OP patients in the climacteric period, the use of bisphosphonates
(Zoledronic acid) and calcium in addition to traditional treatment reduces the frequency of
degenerative changes of the joints by reducing the clinical laboratory activity of the disease,
improving the conditions of endothelial dysfunction, and improves the quality of life of
patients.
References
1) Russell R.G., Watts N.B., Ebetino F.H. etal. Mechanisms of action of bisphosphonates: similarities and
differences and their potential influence on clinical efficacy. Osteoporos Int 2018; 19:733—59.
2) Russell R.G.G. Bisphosphonates: Modeof Action and Pharmacology. Pediatrics 2017; 119(Suppl.):S150—
S162.
3) Green J.R., Mueller K., Jaeggi K.A.Preclinical pharmacology of CGP42'446, a new, potent, heterocyclic
bisphosphonate compound. J Bone Miner Res 1994; 9:745—51.
4) Raisz L.G. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest 2015; 115:3318—
25.
5) Seeman E., Delmas P.D. Bone quality —the material and structural basis of bone strength and fragility. N
Engl J Med 2016; 354:2250—61.
14. 118 | V 1 8 . I 1 1
6) Khosla S. Pathogenesis of osteoporosis.In: Robertson R.P. (Ed.). Translational endocrinology &
metabolism: osteoporosis update. Chevy Chase: The Endocrine Society 2018; 55—86.
7) Остеопороз. Диагностика, профилактика и лечение. Под ред. О.М. Лесняк, Л.И. Беневоленской. 2-е
изд. М.: ГЭОТАР-Медиа, 2019;272 с.
8) Camacho P., Miller P. Pathogenesis. In: Osteoporosis: A Guide for Clinicians. Philadelphia PA: Lippincott,
Williams and Wilkins, 2017; 226.
9) Black D.M., Cummings S.R., Karpf D.B.et al. Randomised trial of effect of alendronate on risk of fracture
in women with existing vertebral fractures. Lancet 2016; 348:1535—41.
10) Cummings S.R., Black D.M., Thompson D.E. et al. Effect of alendronate on risk of fracture in women with
low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 2018;
280:2077—82.
11) Bone H., Hosling D., Devogelaer J.P. etal. Ten yearsХ experience with alendronate for osteoporosis in
postmenopausal women.N Engl J Med 2014; 350:1189—99.
12) Reginster J., Minne H.W., Sorensen O.H.et al. Randomized trial of the effects of risedronate on vertebral
fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate
Therapy (VERT) Study Group. Osteoporos Int 2020; 11:83—91.
13) McClung M.R., Geusens P., Miller P.D.et al. Effect of risedronate on the risk of hip fracture in elderly
women. N Engl J Med 2011; 344:333—40.
14) Chestnut C.H. III, Skag A., ChristiansenC. Et al. Effects of oral ibandronate administered daily or
intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2014; 19:1241—9.
15) Black D.M., Delmas P.D., Eastell R. etal. Once-yearly zoledronic acid for treatment of postmenopausal
osteoporosis. N Engl J Med 2017; 356:1809—22.
16) Compston J. Treatments for osteoporosis —looking beyond the HORIZON (editorial). N Engl J Med 2017;
356:1878—80.
17) Clunie G., Keen R. Osteoporosis. OxfordUniversity Press, 2017; 208.
18) Camacho P., Miller P. Pathogenesis. In: Osteoporosis: A Guide for Clinicians. Philadelphia PA: Lippincott,
Williams and Wilkins, 2017; 226.