STUDY DESIGN: Cross-sectional study. PURPOSE: The aim of the study was to determine relationship between the degrees of radiologically demonstrated anatomical lumbar canal stenosis using magnetic resonance imaging (MRI) and its correlation with the patient's disability level, using the Oswestry Disability Index (ODI). OVERVIEW OF LITERATURE: The relationship between the imaging studies and clinical symptoms has been uncertain in patients suffering from symptomatic lumbar canal stenosis. There is a limited number of studies which correlates the degree of stenosis with simple reproducible scoring methods. METHODS: Fifty patients were selected from 350 patients who fulfilled the inclusion criteria. The patients answered the national-language translated form of ODI. The ratio of disability was interpreted, and the patients were grouped accordingly. They were subjected to MRI; and the anteroposterior diameters of the lumbar intervertebral disc spaces and the thecal sac cross sectional area were measured. Comparison was performed between the subdivisions of the degree of lumbar canal stenosis, based on the following: anteroposterior diameter (three groups: normal, relative stenosis and absolute stenosis); subdivisions of the degree of central canal stenosis, based on the thecal sac cross-sectional area, measured on axial views (three groups: normal, moderately stenotic and severely stenotic); and the ODI outcome, which was also presented in 20 percentiles. RESULTS: No significant correlation was established between the radiologically depicted anatomical lumbar stenosis and the Oswestry Disability scores. CONCLUSIONS: Magnetic resonance imaging alone should not be considered in isolation when assessing and treating patients diagnosed with lumbar canal stenosis.
Constriction, Pathologic* ; Cross-Sectional Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Lumbar Vertebrae ; Magnetic Resonance Imaging* ; Methods ; Observational Study* ; Radiculopathy ; Research Design

Purpose: The burden of influenza on primary healthcare services is not well-established in tropical countries where there are no clearly defined influenza seasons. We aimed to estimate the association between influenza infection activity and polyclinic attendance rates for upper respiratory tract infections (URTI) in the Singapore population. Methods: We used generalized additive time series models to estimate the association between the proportion of respiratory tests positive for influenza infection in Singapore reported to the World Health Organization every week, and the population rate of polyclinic attendances in Singapore for physician-diagnosed URTI, which includes influenza-like illness (ILI), for a total of 6 years from 2012 through 2017. Where data were available, we controlled for other infections that can cause fever or respiratory symptoms. Results: Influenza, dengue fever and chickenpox (varicella) were positively associated with acute URTI polyclinic attendances. The estimated URTI polyclinic attendance rates attributable to influenza, dengue fever and chickenpox were 618.9 (95% confidence interval [CI] 501.6, 736.3), 153.3 (95% CI 16.5, 290.2) and 1751.5 (95% CI: 1246.3, 2256.8) per 100,000 population per year, respectively. Conclusions Influenza poses a considerable burden on primary healthcare services in Singapore. However, a substantial number of polyclinic attendances due to febrile infections such as dengue fever and chickenpox appear to be recorded as URTI in the polyclinic database. These associations require further investigation.

[Objective] To explore the application of Quality by Design (QbD) tools in assessing geographical variations of Phyllanthus emblica (P. emblica) from five distinct Indian states. [Methods] In the current experiment, the Box-Behnken design with a reduced quartic model and 105 runs was employed with the use of the Design Expert software for randomized response surface mapping. Three different extraction methods (Soxhlet, maceration, and sonication) along with three solventst [distilled water, methanol, and water-methanol mixture (50 : 50 v/v)] were considered in the present study. The anti-oxidant activities, total flavonoid content (TFC), and total phenolic content (TPC) in the P. emblica were determined and analysed by gas chromatography-mass spectrometry (GC-MS) to identify the major components. [Results] The QbD overlay plot showed that the extractive value of the P. emblica was no less than 30% w/w, 2,2-diphenyl-1-picrylhydrazyl (DPPH) no less than 60% mcg/mL (micrograms per millilitre), TFC no less than 75 mg QE/g (milligrams of quercetin equivalents per gram), and TPC no less than 80 mg GAE/g (milligrams of gallic acid equivalents per gram). Moreover, the GC-MS data confirmed the presence of variation in the bioactives of P. emblica extracts. [Conclusion] The model was significant in describing the variation in extractive value, DPPH, TFC, and TPC. The QbD approach may tend to prioritize thoroughness in the extraction process, ultimately resulting in improved quality in the extracted products.