Level Of Evidence 1b Research Articles

Effectiveness of an On-Field Rehabilitation framework for return to sports in injured male professional football players: a single-blinded, prospective, randomised controlled trial

ObjectivesIn football, on-field rehabilitation (OFR) is critical during injury recovery for a player’s safe return to sports (RTS). The study aimed to evaluate the effectiveness of an OFR framework for...

Pioneering Non-Invasive Neuromodulatory Techniques for Amelioration of Radiculopathic Pain: A Systematic Review of Randomized Trials

Radiculopathy refers to spinal nerve root issues causing pain, numbness, weakness, or reflex problems along specific nerve pathways. Numerous research endeavors have delved into the potential of non-invasive neuromodulation (NINM) for alleviating neuropathic pain stemming from diverse causes; however, its efficacy specifically in addressing radiculopathic pain remains under-explored. This systematic review offers an exhaustive synthesis of existing literature concerning the application of NINM in managing radiculopathy-induced pain. A meticulous search was conducted across four databases namely Scopus, PubMed, PEDro and The Cochrane Library up to September 2023 in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. which yielded six pertinent studies out of 75,182 studies that met the predefined inclusion criteria and underwent rigorous evaluation. Employing assessment tools such as PEDro, GRADE, and Level of Evidence, the quality and findings of these studies were critically appraised. Out of 75182 studies that were initially found, six studies (PEDro score 3-9, GRADE scores very low-high and 1B level of evidence) were found to be eligible. Three out of six studies have low bias across all domains, while one study has concerns about outcome measurement. Another study lacks information about the randomization process, and one indicates high bias in randomization and some concerns about missing outcome data bias. Although some variations existed among the research outcomes, a predominant trend highlighted a notable decrease in pain severity on Visual Analog Scale (VAS)/numeric pain rating scale with the adoption of diverse NINM methodologies. As per the inferences drawn from the review, two out of six studies exhibited highest quality followed by other studies demonstrating moderate to low quality as a whole. In summation, integrating these NINM approaches alongside conventional therapeutic strategies appears promising for enhancing the efficacy and sustainability of radiculopathic pain management.

A new treatment for cervical dizziness

ObjectivesTo verify the rates of heat effectiveness generated by Carbon Nanotubes (CNT) in the resolution of dizziness in individuals diagnosed with Cervical Dizziness (CD). MethodsRandomized clinical trial was performed and samples from volunteers diagnosed with CD, divided into a Study Group (SG) and Control Group (CG). Patches containing CNT with thermotherapeutic effect were used in SG and inert patches in the CG. Treatment was performed over 30 days and measures of pain, dizziness and asymmetry of cervical muscle tension were evaluated over 60 days. ResultsPain, dizziness and asymmetry of cervical muscle tension were reduced in the SG. The variables analyzed in this study did not change in the CG. ConclusionOur results show that the therapeutic effect of heat was effective in the treatment of patients diagnosed with CD. We could also observe a clear interrelationship between pain and dizziness symptoms with the asymmetry of cervical muscle tension. Level of evidence1B.

Urinary Incontinence: evidence on conservative management

Urinary incontinence in women is a condition of high incidence and is associated with an impact on quality of life. Conservative treatment modalities are an important resource in the management of this condition, since they can be prescribed based on the clinical diagnosis without the need for additional tests. The present study aims to gather current evidence on conservative treatment modalities available for female incontinence published in the last 5 years. Conducting the search in the Medline and LILACS databases, 28 articles were identified, categorized with level of evidence 1b and 2b by the Oxford classification, which present original results on physical therapy, medication and behavioral modalities in the non-community treatment of female incontinence. The current state of the art demonstrates a domain of studies with a high degree of evidence involving the treatment modalities associated with the physical therapy practice of pelvic floor muscle training. Evidence from 5 analyzed studies statistically demonstrated the superiority of this method in relation to control groups, or to groups submitted to other interventions. Positive evidence related to transcutaneous electrical stimulation therapies, intravaginal electrical stimulation, duloxetine, noradrenaline receptor inhibitors, continence pessaries, and lifestyle changes was also observed.

Systematic literature review informing the 2022 update of the EULAR recommendations for the management of ANCA-associated vasculitis (AAV): part 1—treatment of granulomatosis with polyangiitis and microscopic polyangiitis

ObjectiveTo summarise and update evidence to inform the 2022 update of the EULAR recommendations for the management of antineutrophil cytoplasm antibody-associated vasculitis (AAV).MethodsA systematic literature review (SLR) was performed to...

Changes in olfaction and taste in patients hospitalized for COVID-19 and their relationship to patient evolution during hospitalization

ObjectivesDuring the COVID-19 pandemic, several cases of changes in olfaction and taste associated with the infection have been reported. Therefore, otolaryngologists are frequently the first medical professionals sought by patients. The aim of this study was to evaluate the frequency of olfaction and taste disorders in patients hospitalized with COVID-19, and their association with other clinical manifestations and patient evolution during hospitalization. Methods248 patients, admitted to three public hospitals in Belo Horizonte, Minas Gerais, Brazil, were prospectively included: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), Hospital Júlia Kubitschek (HJK) and Hospital Eduardo de Menezes (HEM), who, upon admission to hospital, presented with Severe Acute Respiratory Syndrome due to COVID-19. Clinical and laboratory variables and outcomes during hospitalization were prospectively collected from the electronic medical records. The collection of sociodemographic and symptomatology data during the acute phase was carried out prospectively in electronic medical records and confirmed with the patients at a subsequent outpatient visit. ResultsThe most frequently reported symptoms were dyspnea (77.4%), cough (69.8%) and fever (55.2%). During the acute phase of the disease, 95 (38.3%) and 87 (35.1%) patients reported taste and olfaction disorders, respectively. There was a lower prevalence of dysosmia among patients with previous comorbidities (p < 0.05). Both symptoms were associated with less need for intensive care admission (p = 0.001 for dysgeusia and p = 0.021 for dysosmia) and a negative correlation with length of hospital stay (dysosmia: r = −0.175, p < 0.05; dysgeusia: r = −0.29, p < 0.001) and length of stay in the ICU (dysosmia: r = −0.136, p < 0.05; dysgeusia: r = −0.215, p < 0.05). The absence of taste disorders was also associated with a greater need for mechanical ventilation (p < 0.001). ConclusionChanges in taste and olfaction were reported by a large number of patients in the acute phase of COVID-19. In this study, both were markers of better clinical patient evolution. Level of evidence1B.

Adaptation of the Pediatric Smell WheelTM to evaluate olfactory function in Brazilian children

ObjectiveOlfaction influences nutrition, safety, and the cognitive development of children. Presently there are few olfactory tests for children, and normative reference values are generally lacking. In this study, we validate the Pediatric Smell WheelTM (PSW) to evaluate olfactory function in Brazilian children. MethodsWe modified and validated the PSW, a test developed in the United States, for administration in Brazil, and established normative data for Brazilian children. The validation process consisted of five phases. First, we identified odorants familiar to Brazilian children. Second, we established the test-retest reliability of the Brazilian PSW test that employed these odorants. Third, we compared the test scores of healthy children to those microsmic from adenoid hypertrophy. Fourth, we examined the test’s ability to detect improvement in olfactory function before and after adenoidectomy. Finally, we determined a normative 10th percentile cut point for defining microsmia in a sample of 169 healthy Brazilian children between 5 and 12 years of age. ResultsEleven odors were identified for inclusion in the test. The test-retest reliability was modest (r = 0.54, p < 0.001), although likely attenuated based on the inclusion of only data from children with normal function. The test clearly differentiated the olfactory function of children with adenoid hypertrophy from that of healthy children and demonstrated the return of function after adenoidectomy. An overall score <7 was found useful in defining hyposmia, although additional age-related cut-points were also defined. ConclusionA Brazilian version of the PSW was developed and validated and found to be efficacious in detecting smell dysfunction in children ranging in age from 5 to 12 years. Level of evidence1b (Diagnosis).

Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity.

BackgroundDeficits in dynamic neuromuscular control have been associated with post-injury sequelae and increased injury risk. The Y-Balance Test Lower Quarter (YBT-LQ) has emerged as a tool to identify these deficits.PurposeTo review the reliability of the YBT-LQ, determine if performance on the YBT-LQ varies among populations (i.e., sex, sport/activity, and competition level), and to determine the injury risk identification validity of the YBT-LQ based on asymmetry, individual reach direction performance, or composite score.Study DesignSystematic ReviewMethodsA comprehensive search was performed of 10 online databases from inception to October 30, 2019. Only studies that tested dynamic single leg balance using the YBT-LQ were included. Studies were excluded if the Y-Balance Test kit was not utilized during testing or if there was a major deviation from the Y-Balance test procedure. For methodological quality assessment, the modified Downs and Black scale and the Newcastle-Ottawa Scale were used.ResultsFifty-seven studies (four in multiple categories) were included with nine studies assessing reliability, 36 assessing population differences, and 16 assessing injury prediction were included. Intra-rater reliability ranged from 0.85-0.91. Sex differences were observed in the posteromedial direction (males: 109.6 [95%CI 107.4-111.8]; females: 102.3 [95%CI 97.2-107.4; p = 0.01]) and posterolateral direction (males: 107.0 [95%CI 105.0-109.1]; females: 102.0 [95%CI 97.8-106.2]). However, no difference was observed between sexes in the anterior reach direction (males: 71.9 [95%CI 69.5-74.5]; females: 70.8 [95%CI 65.7-75.9]; p=0.708). Differences in composite score were noted between soccer (97.6; 95%CI 95.9-99.3) and basketball (92.8; 95%CI 90.4-95.3; p <0.01), and baseball (97.4; 95%CI 94.6-100.2) and basketball (92.8; 95%CI 90.4-95.3; p=0.02). Given the heterogeneity of injury prediction studies, a meta-analysis of these data was not possible. Three of the 13 studies reported a relationship between anterior reach asymmetry reach and injury risk, three of 10 studies for posteromedial and posterolateral reach asymmetry, and one of 13 studies reported relationship with composite reach asymmetry.ConclusionsThere was moderate to high quality evidence demonstrating that the YBT-LQ is a reliable dynamic neuromuscular control test. Significant differences in sex and sport were observed. If general cut points (i.e., not population specific) are used, the YBT-LQ may not be predictive of injury. Clinical population specific requirements (e.g., age, sex, sport/activity) should be considered when interpreting YBT-LQ performance, particularly when used to identify risk factors for injury.Level of Evidence1b

The Neuromuscular Effects of the Copenhagen Adductor Exercise: A Systematic Review.

BackgroundGroin strains are one of the most common time-loss injuries in athletes. The Copenhagen Adductor Exercise (CAE) eccentrically strengthens the adductors and may function to prevent adductor strains, similar to the eccentric mechanism in which the Nordic Hamstrings exercise acts to prevent hamstring strains.ObjectiveThe purpose of this study was to systematically review the literature on the CAE and its effects on adductor muscle strength and muscle activity in athletes.Study DesignSystematic ReviewMethodsA systematic search of the literature was performed in the following databases: Pubmed; Medline (EBSCO); Sportdiscus; Scopus; Web of Science; CINAHL; Proquest; Cochrane Library; Physiotherapy Evidence Database (PEDro). Inclusion criteria consisted of 1) implements CAE, 2) includes athletes of any age participating in at least one sport, 3) study type is a cohort study or randomized control trial. Studies were excluded if they were not written in English or did not measure strength as an outcome. Data were extracted on eccentric hip adductor strength (EHAD), eccentric hip abductor strength (EHAB), EHAD:EHAB ratio, and electromyography (EMG) activity of the adductor muscles. Quality assessment was performed on all included studies using Quality Assessment Tool for Quantitative Studies.ResultsFive articles were identified for inclusion, four of which received a strong rating, and one a moderate rating on the Quality Assessment Tool for Quantitative Studies. The CAE significantly increased EHAD in four of the four studies that examined it; significantly increased EHAB and EHAD:EHAB in three of the three studies that examined them, and increased the EMG activity of the adductors in the dominant leg 108%.ConclusionOverall, the CAE increases EHAD, EHAB, EHAD:EHAB, and EMG activity in the hip adductors in male soccer players. The increase in strength may reduce adductor muscle injuries, although more research needs to be done in this area to identify a clear relationship between the CAE and groin injury prevention.Level of Evidence1b

The Systemic Effects of Blood Flow Restriction Training: A Systematic Review.

BackgroundBlood flow restriction (BFR) training has been reported to have significant benefits on local skeletal muscle including increasing local muscle mass, strength, and endurance while exercising with lower resistance. As a result, patients unable to perform traditional resistance training may benefit from this technique. However, it is unclear what effects BFR may have on other body systems, such as the cardiovascular and pulmonary systems. It is important to explore the systemic effects of BFR training to ensure it is safe for use in physical therapy.PurposeThe purpose of this study was to systematically review the systemic effects of blood flow restriction training when combined with exercise intervention.Study DesignSystematic review.MethodsThree literature searches were performed: June 2019, September 2019, and January 2020; using MedLine, ScienceDirect, PubMed, Cochrane Reviews and CINAHL Complete. Inclusion criteria included: at least one outcome measure addressing a cardiovascular, endocrinological, systemic or proximal musculoskeletal, or psychosocial outcome, use of clinically available blood flow restriction equipment, use of either resistance or aerobic training in combination with BFR, and use of quantitative measures. Exclusion criteria for articles included only measuring local or distal musculoskeletal changes due to BFR training, examining only passive BFR or ischemic preconditioning, articles not originating from a scholarly peer-reviewed journal, CEBM level of evidence less than two, or PEDro score less than four. Articles included in this review were analyzed with the CEBM levels of evidence hierarchy and PEDro scale.ResultsThirty-five articles were included in the review. PEDro scores ranged between 4 and 8, and had CEBM levels of evidence of 1 and 2. Common systems studied included cardiovascular, musculoskeletal, endocrine, and psychosocial. This review found positive or neutral effects of blood flow restriction training on cardiovascular, endocrinological, musculoskeletal, and psychosocial outcomes.ConclusionsAlthough BFR prescription parameters and exercise interventions varied, the majority of included articles reported BFR training to produce favorable or non-detrimental effects to the cardiovascular, endocrine, and musculoskeletal systems. This review also found mixed effects on psychosocial outcomes when using BFR. Additionally, this review found no detrimental outcomes directly attributed to blood flow restriction training on the test subjects or outcomes tested. Thus, BFR training may be an effective intervention for patient populations that are unable to perform traditional exercise training with positive effects other than traditional distal muscle hypertrophy and strength and without significant drawbacks to the individual.Level of Evidence1b

Effect of Lumbar Stabilization Exercises on Stable versus Unstable Surface on Pain and Function in Mechanical Low Back Pain-an Evidence Based Study

Background: Low back pain is the most common complaint all over the world. Lumbar instability is an important causative factor for low back pain. Lumbar stabilization exercises are helpful in reducing and preventing its recurrence. Purpose: To study the evidences regarding effect of lumbar stabilization exercises on stable versus unstable surface on pain and function in mechanical low back pain. Methodology: The study was conducted according to Preferred Reporting Items for systematic reviews and meta-analysis guidelines. Evidences selected since year 2010-February 2020 from PubMed, Google Scholar, Physiotherapy Evidence Database (PEDro), Research Gate, Science Direct and Cumulative Index of Nursing and Allied Health Literature. Key words used were: Lumbar stabilization exercise, Core stability exercise, Pain and Function. Analysis was done using 2 scales: PEDro scale and Centre for Evidence-Based Medicine Levels of Evidence Scale. Total 202 articles were found, out of which 22 articles were relevant and from those 17 articles were included in the study and other articles were excluded as per eligibility criteria. Results: 11 studies were shown that core stability exercise is effective treatment for reducing pain and improving disability. (Level of evidence-1a,1b,2b). 2 studies were showed that motor control exercise was more effective than core stability exercise. (Level of evidence-1b). 4 studies shown that lumbar stabilization exercise performed on unstable surfaces showed significant improvement in back pain and disability (Level of evidence-1b, 2b). Conclusion: Lumbar stabilization exercise performed on unstable surface provide significant benefit in reducing pain and improving function in patients with mechanical low back pain. Keywords: Lumbar stabilization exercise, Core stability exercise, Pain and Function Low Back Pain.

ADAPTATION AND TRANSCULTURAL VALIDATION OF THE BRAZILIAN VERSION OF THE BACK PAIN FUNCTIONAL SCALE

ABSTRACT Objective: The Back Pain Functional Scale (BPFS) was designed to evaluate the functional state of individuals with low back pain. The scale consists of twelve items, covering functional aspects of the daily life activities of these individuals. The final score is calculated by summing the responses to each item, the values of which range from 0 to 5, obtaining a total result of 0 to 60 points. Methods: The validation process was developed in accordance with the World Health Organization (WHO) protocol, covering translation, back translation, semantic equivalence, evaluation by specialists from previous stages, pre-test of the tool, and final version. Subsequently, the final version was applied in a sample of 90 individuals and the data obtained were subjected to descriptive statistical analysis, factorial analysis, evaluation of internal consistency, and correlation with other validated tools. Results: The tool was adapted to Brazilian Portuguese, making use of terms to approximate the language of everyday expressions. The final version presented results similar to those from the original version, as demonstrated by the factorial analysis, the internal consistency (Cronbach's alpha: 0.990), and the strong correlation with tools validated for the Portuguese language. Conclusion: The Brazilian version of BPFS proved to be easy to apply and understand, and presented high internal consistency and construct validity similar to that of the original instrument. Level of evidence 1B; Study of adaptation of a valid score.

Topical treatment for plantar warts: A systematic review.

There are a wide variety of treatments for plantar warts, but none has been shown to be effective in all patients. We aimed to perform a systematic review of the efficacy of different topical treatments on plantar warts. Systematic electronic searches (Pubmed, Cochrane Library, Embase, and Web of Science) were conducted in April 2020. Meta-analyses, systematic reviews, and retrospective or prospective clinical trials of the effects of topical and nonsurgical treatments of plantar warts were included. Two authors performed the study selection and data extraction. Any discrepancies between the two reviewers were discussed with a third reviewer. Forty-four studies were included. The average cure rates of the most frequent treatments were variable across the studies: cryotherapy (45.61%), salicylic acid (13.6%), cantharidin-podophyllin-salicylic acid formulation (97.82%), laser (79.36%), topical antivirals (72.45%), intralesional bleomycin (83.37%), and intralesional immunotherapy (68.14%). Twenty-two studies (50%) had a level of evidence 1b and grade of recommendation A, five studies (11.4%) had a level of evidence 2b and grade of recommendation B, two studies (4.5%) had a level of evidence 3b and grade of recommendation B, and 15 studies (34,1%) with a level of evidence 4 and grade of recommendation C. First-choice treatments for common warts, such as cryotherapy and salicylic acid, have low-cure rates for plantar warts. Other treatments, such as CPA formulation, immunotherapy, and intralesional bleomycin, which have compassionate use, have higher cure rates. This review should stimulate future high-quality research to evaluate these specialized treatments.

Circulating tumor cell analysis in locally advanced and metastatic squamous cell carcinoma of the head and neck.

BackgroundCirculating tumors cells (CTCs) are considered an early step towards metastasis and have been linked to poor prognosis in several types of cancer. CTCs in squamous cell carcinoma of the head and neck (SCCHN) have an unclear role.MethodsIn this prospective study, patients with locally advanced or metastatic SCCHN had CTC counts assessed before starting systemic treatment using the CellSearch System. Select cases also had sequential CTC evaluation. Presence of CTCs was correlated with patient characteristics and outcomes.ResultsForty‐eight patients enrolled, and 36 had evaluable clinical data and baseline CTC counts. Twenty‐five patients had locally advanced disease (LAD) and 11 had metastatic disease. ≥1 CTCs were detected in six patients with LAD (24%) and four with metastatic disease (36%). On univariate analysis, smoking was associated with CTCs.ConclusionCTCs are not associated with prognosis in patients with LAD and metastatic disease; however, they are present in this patient population, and ≥1 CTCs is associated with a history of smoking.Level of evidence1b; individual prospective cohort study.

Phytoneering medicines in the treatment of acute rhinosinusitis: an emphasis on effectiveness and safety of application

The choice of an optimal drug is only one of the components of high-quality pharmacotherapy of acute rhinosinusitis, which is supplemented by providing a patient with full information about the action of the drug selected, its rational use and duration of drug administration, possible side effects, as well as drug and food interactions. There are no “good” or “bad” medicines because even the most effective drug can prove to be ineffective precisely through the wrong choice and insufficient information about its use. The solution to this problem will allow increasing not only the effectiveness, but also the safety of acute rhinosinusitis treatment. Today, phytoneering drugs occupy an important place in the treatment of patients with acute rhinosinusitis and have evidence-based effectiveness and safety. Thus, according to the EPOS 2020 recommendations, some herbal medicines are included into the treatment regimens for acute viral and post-viral rhinosinusitis with the level of evidence 1b by the GRADE methodology. A special place is occupied by the Sinupret products line manufactured by “BIONORIKA СE” company, Germany. All Sinupret drugs are related to the original plant raw material, the qualitative composition of the active substances that determine their pharmacological activity. “Sinupret®” contains standardized extracts of 5 plants: elder flowers (Sambucus nigra), primrose flowers (Primula versis), sorrel herb (Rumex acetosa), verbena herb (Verbena officinalis) and gentian root (Gentiana lutea). The high efficiency of each of the plants was confirmed by practical experience, and the therapeutic combination subsequently received a strong scientific basis. Due to the unique combination of biologically active substances of 5 medicinal plants “Sinupret®” exerts a versatile complex effect, breaking the “vicious circle” in rhinosinusitis. The pharmacodynamics of “Sinupret®” includes the following main effects: secretolytic and secretomotor, anti-inflammatory, anti-infective and immunomodulative. The administration of “Sinupret®” (taking into account the available pharmacodynamic effects) allows avoiding potentially problematic polypragmasia – simultaneous indication (in this context – unjustified) of several medicines to a patient, often for the treatment of the same symptom. This is especially true for the uncontrolled use of antibiotics without indications, and it has already led to the spread of such a dangerous phenomenon as antibiotic resistance all over the world.Conclusions. Considering the weighty data of evidence-based medicine the “Sinupret®” line medicines is an alternative choice for the treatment of persons with non-complicated acute rhinosinusitis.

450P - Supportive care to control nausea and dizziness in malignant tumours: A systematic review

BackgroundPatients with malignant tumours may suffer from nausea as a side-effect of chemo-/radiotherapy. Antiemetic drugs can cause dizziness, which may lead to falls and decrease quality of life. Complementing research on painkiller-associated dizziness [1], we now focus on dizziness in association with antiemetic drugs. MethodsA systematic review is provided on dizziness in association with antiemetic drugs. A PubMed literature search was carried out for all articles in core clinical journals until 30 June 2019. ResultsA total of 411 articles were identified. No study evaluated dizziness caused by antiemetic drugs as a primary endpoint. A focus on dizziness as a secondary endpoint revealed four studies with class 1a (meta-analysis) or 1b (randomized controlled trial) level of evidence (LoE). In cisplatin-based chemotherapy, there is LoE 1b that the 5-hydroxytryptamine 3 receptor antagonists (5-HT(3)RA) ondansetron [2] or the combination of tropisetron and dexamethasone [3] are better in terms of antiemetic potential and dizziness than metoclopramide [2] or metoclopramide plus dexamethasone plus diphenhydramine [3]. Among 5-HT(3)RAs, a meta-analysis with over 6000 patients [4] revealed that palonosetron had the lowest incidence of nausea and dizziness (LoE 1a). The neurokinin-1 receptor rolapitant was associated with less nausea than ondansetron plus dexamethasone in a randomized controlled trial (LoE 1b) including 454 patients and had a descriptively but not significantly higher incidence of dizziness [5]. Conclusions5-HT(3)RAs, particularly palonosetron, have an advantage with regard to antiemetic efficacy and frequency of reported dizziness when compared to metoclopramide [2-4]. The neurokinin-1 receptor rolapitant is a possible alternative [5].

Actionable Pharmacogenetic Variation in the Slovenian Genomic Database.

Background: Genetic variability in some of the genes that affect absorption, distribution, metabolism, and elimination (“pharmacogenes”) can significantly influence an individual’s response to the drug and consequently the effectiveness of treatment and possible adverse drug events. The rapid development of sequencing methods in recent years and consequently the increased integration of next-generation sequencing technologies into the clinical settings has enabled extensive genotyping of pharmacogenes for personalized treatment. The aim of the present study was to investigate the frequency and variety of potentially actionable pharmacogenetic findings in the Slovenian population.Methods: De-identified data from diagnostic exome sequencing in 1904 cases submitted to our institution were analyzed for variants within 293 genes associated with drug response. Filtered variants were classified according to population frequency, variant type, the functional impact of the variant, pathogenicity predictions and characterization in the Pharmacogenomics Knowledgebase (PharmGKB) and ClinVar.Results: We observed a total of 24 known actionable pharmacogenetic variants (PharmGKB 1A or 1B level of evidence), comprising approximately 26 drugs, of which, 12 were rare, with the population frequency below 1%. Furthermore, we identified an additional 61 variants with PharmGKB 2A or 2B clinical annotations. We detected 308 novel/rare potentially actionable variants: 177 protein-truncating variants and 131 missense variants predicted to be pathogenic based on several pathogenicity predictions.Conclusion: In the present study, we estimated the burden of pharmacogenetic variants in nationally based exome sequencing data and investigated the potential clinical usefulness of detected findings for personalized treatment. We provide the first comprehensive overview of known pharmacogenetic variants in the Slovenian population, as well as reveal a great proportion of novel/rare variants with a potential to influence drug response.

1793P - Painkiller-related dizziness in malignant tumors: A systematic review

Background: To our knowledge, there is no systematic review on painkiller-related dizziness, which often occurs. Methods: Papers from core clinical journals on PubMed-database resulted in 340 articles on dizziness in malignant tumors until 31st Dec 2017. Eight studies with level of evidence (LoE) 1 focused on dizziness as a side effect of painkillers. Results: In a meta-analysis on codeine, dizziness was reported in 18.06 % of patients (LoE 1a) [1]. In randomized controlled trials (LoE 1b), oxycodone-associated dizziness was only seen in controlled release (8.3 %) and not in immediate release oxycodone [2]. In a systematic review (LoE 1a) [3], controlled release oxycodone was associated with 11.9 % of dizziness reports. A meta-analysis on immediate release morphine and transmucosal fentanyl (7 % dizziness) favoured transmucosal fentanyl for breakthrough cancer pain, but did not differentiate between the painkillers for dizziness [4]. Effective analgesia with rare (1.8 to 7.5 %) events of dizziness was reported for intranasal fentanyl spray (LoE 1b) [5]. For long-acting analgesia, a systematic review favoured transdermal fentanyl over sustained release oral morphine (LoE 1a) [6]. A randomized controlled trial in bone metastases favoured the combination of two nonsteroidal anti-inflammatory drugs (NSAIDs) plus morphine (10.3 % dizziness reports) over one NSAID plus morphine (> 25 %), presumably due to lower morphine need in two NSAIDs (LoE 1b) [7]. Finally, both hydromorphone and morphine had at least 15 % of dizziness reports in a systematic review (LoE 1a) [8]. Conclusions: There is level of evidence 1a to 1b that immediate release oxycodone, transmucosal or intranasal fentanyl are associated with the lowest incidence of dizziness. For long-acting analgesia, transdermal fentanyl is a promising option.

COMPARISON OF BILATERAL AND UNILATERAL SQUAT EXERCISES ON BARBELL KINEMATICS AND MUSCLE ACTIVATION

Bilateral squats are commonly used in lower body strength training programs, while unilateral squats are mainly used as additional or rehabilitative exercises. Little has been reported regarding the kinetics, kinematics and muscle activation in unilateral squats in comparison to bilateral squats. Therefore, the purpose of this study was to compare muscle activity, kinetics, and barbell kinematics between unilateral and bilateral squats with the same external load per leg in experienced resistance-trained participants. Fourteen resistance-trained males (age 23 ± 4years, body mass 80.5 ± 8.5kg and height 1.81 ± 0.06m) participated. Barbell kinematics and surface electromyography (EMG) activity of eleven muscles were measured during the descending and ascending phase of each repetition of the squat exercises. Total lifting time was longer and average and peak velocity were lower for the bilateral squat (p<0.001). Furthermore, higher muscle activity was found in the three quadriceps muscles, biceps femoris (ascending phase) and the erector spinae (ascending phase) in the bilateral squat, while greater activation for the semitendinosis (descending phase) (p=0.003) was observed for the unilateral squat with foot forwards. In the ascending phase, the prime movers showed increased muscle activity with repetition from repetition 1 to 4 (p≤0.034). Unilateral squats with the same external load per leg produced greater peak vertical ground reaction forces than bilateral squats, as well as higher barbell velocity, which is associated with strength development and rate of force development, respectively. The authors suggest using unilateral rather than bilateral squats for people with low back pain and those enrolled in rehabilitation programs after ACL ruptures, as unilateral squats are performed with small loads (28 vs. 135 kg) but achieve similar magnitude of muscle activity in the hamstring, calf, hip and abdominal muscles and create less load on the spine. 1b.

A randomized study of four different types of tympanostomy ventilation tubes – Full-term follow-up

ObjectiveTo evaluate the impact of tympanostomy ventilation tube material (silicone vs fluoroplastic) and shape (short vs long) regarding time to extrusion, occurrence of otorrhea, occlusion, tube removal and occurrence of persistent perforation. Methods and materialFour different types of ventilation tubes were used; Long Armstrong tubes, Donaldson tubes, Shepard tubes and straight tubes, representing four specific combinations of VT material (silicone or fluoroplastic) and shape (short, double flanged or long, single flanged). Four hundred children scheduled for bilateral tube insertion were included in a randomized trial. The patients received one type of tube in the right ear and another type in the left ear. The incidence of tube extrusion and complications were monitored postoperatively every third month by an otolaryngologist. ResultsTwenty-two children were excluded during surgery. Out of the studied 378 children the mean age was 35.3 months. 63.8% were boys. Short tubes extruded earlier than long tubes; hazard ratio (HR) 4.84 (95% CI 3.50–6.69, p < 0.001). Long Armstrong tubes were least prone to extrude. Silicone tubes resulted in significantly longer time to first infection in a VT ear, HR 1.68 (95% CI 1.03–2.76, p = 0.039). Donaldson tubes rendered the longest mean time to first infection (p = 0.025). Infections did not affect tube extrusion rates significantly (p = 0.879). No significant differences were found regarding tube occlusion, tube extraction or persistent perforation. ConclusionsLong tubes are less prone to extrude early. Long Armstrong tubes have the least propensity to extrude early. Silicone tubes render significantly longer time to first infection. Donaldson tubes result in least infections. Infection does not affect extrusion rates significantly. Level of evidence1b