BACKGROUND: Pain and functional limitation affect the quality of life in piriformis syndrome. Stretching of piriformis is essential in the treatment protocols in physiotherapy, however, which sequence of stretching provides optimal improvement is only determined by trial and error. The purpose of this study was to compare the effects of specific stretching technique in terms of functional outcome in female with piriformis syndrome and to determine the normative length of piriformis at different reference points in females.

METHODS: This study was a randomized controlled trial that was conducted in the Physiotherapy Department of the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan between July to December, 2015. This study enrolled 30 patients with piriformis syndrome at outpatient department between the ages of 20 and 50 years. These patients were randomly assigned into two groups. In one group, external rotator sequence of self-stretching (ERS) was practiced while in the second group, adductor sequence of passive stretching (APS) was performed. Each group was treated for two weeks. Pre and post intervention, the assessment was made on Numerical Pain Rating Scale (NPRS), Functional Performance of Lower Extremity Scale (FPLE) and by measured length at three reference positions. Independent T-test was used for statistical analysis.

RESULTS: Both groups showed improvement in outcome in term of a decrease in pain score on NRPS, FPLES and measured reference lengths at all three positions (p-value < 0.05). Adductor pattern of stretching was as effective as external rotator pattern of stretching (p-value> 0.05) when results of pain score and measured reference length at three different positions were compared. However, on the FPLES, external rotator stretching technique was more effective than adductor stretching technique (p value < 0.05).

CONCLUSION: The two studied sequence of piriformis stretching exercises have the same effect on outcomes in terms of clinically measured referenced length and decrease in pain score. Future studies will highlight which subgroups patients are more likely to get greater benefit for a given technique.

BACKGROUND: Antibacterial resistance is a major concern in healthcare associated infections. Longer hospital stay, empirical treatment without antimicrobial stewardship policy and ineffective infection control practices are making it difficult to treat infections. Kashmir valley lacks surveillance data and awareness about antibiotic resistance among clinicians, thus complicating patient care. The aim of this study was to investigate the prevalence of antibacterial resistance among various clinical isolates.

 METHODS: The study was conducted between February 2013 and April 2014 in the Srinagar city. Samples of urine, pus, and other body fluids (N=500) were examined for clinically important pathogens. Standard laboratory protocols were followed for the isolation, identification and susceptibility tests. Recent CLSI guidelines for antimicrobial susceptibility were followed using Kirby-Bauer method.

RESULTS: Predominant pathogens identified in urine cultures were Escherichia coli (42.1%), Klebsiella pneumoniae (31.57%), Proteus species (7.8%), Pseudomonas aeruginosa (13.1%) and Enterococcus faecalis (5.26%). Methicillin resistant Staphylocoocus aureus (14.8%) and Methicillin sensitive Staphylococcus aureus (22.2%) were common isolates found in pus. Other frequent clinical isolates found in pus cultures were Proteus species (28.1%), Enterococcus faecalis (18.5%) and Pseudomonas aeruginosa (14.8%). Klebsiella pneumoniae and Staphylococcus aureus were prevalent isolates in semen cultures. All clinical isolates screened in this study were resistant to quinolones, aminoglycosides, cephalosporins, carbepenems and sulphonamides. Glycopeptide resistance was observed in one of the urinary isolates. All clinical isolates were sensitive to fosfomycin.

CONCLUSION: We found high quinolone resistance in pathogens isolated from community acquired urinary tract infection (UTI) and nosocomial infections. Fosfomycin can be a good alternative choice in the treatment of urinary tract infection with greater efficacy & lesser antibiotic resistance. The drug has not been so far prescribed in routine clinical practice in the valley.