Journal of clinical and diagnostic research

Diagnostic Utility of Dermoscopy in Angiokeratoma of Fordyce: A Case Report

Angiokeratomas are benign, rarely occurring vascular lesions characterised by marked ectasia of thin-walled blood vessels in the superficial dermis. Angiokeratoma of Fordyce is the second most common type. It is more frequent in men and usually presents as multiple bright red papules on the scrotum, occasionally on the penis, buttocks, and abdomen; it can also occur in females mainly over the vulvar region. Here, a case of a 70-year-old patient who presented with multiple asymptomatic elevated skin-coloured lesions over the scrotal region for six months is presented. Based on the clinical and dermoscopic findings, a diagnosis of angiokeratoma of Fordyce was made. Treatment involved proper counselling and reassurance about the benign nature of Angiokeratoma.

An Intricate Case of Pyopneumothorax with Trapped Right Lung Requiring Swift Adaptation and Multidisciplinary Collaboration

Vipul Sharma, Jayant Bhatia, Preeti Raj

Pulmonary Tuberculosis (PTB) is a significant cause of morbidity, especially in patients with underlying health conditions. The present case highlights the complex management in a patient with intricate medical history, marked by tuberculosis, multiple Intercostal Chest Drain (ICD) procedures, and pyopneumothorax with long-standing diabetes mellitus and a history of smoking, adding to the uniqueness of the case. The authors present a case of a 67-year-old male, admitted for a right Pneumonectomy (PE) due to a complex combination of pyopneumothorax, right trapped lung and post-decortication status. However, due to the fragile nature of the tissue and the existence of vascular adhesions, it was decided to choose “physiological lung exclusion” by separating the affected lung from the tracheobronchial tree by cutting the bronchus and tying off the pulmonary artery, without removing any lung tissue, while keeping the pulmonary veins intact. The present report highlights the challenges faced, the multidisciplinary approach employed, and the successful surgical outcome, underscoring the importance of collaborative management.

Progressive Paraparesis due to Extramedullary Haematopoiesis in Thalassaemia Intermedia Treated Successfully with Radiotherapy: A Case Report

Bithi Pal, Debottam Barman, Bodhiswatta Dutta

Extramedullary Haematopoiesis (EMH), a rare complication of Thalassaemia Intermedia (TI), can present with pressure symptoms including Spinal Cord Compression (SCC) and can be treated using surgery, radiotherapy, hypertransfusion, or hydroxyurea. Hereby, the authors present a case report of a 20-year-old male young thalassaemic patient presented with progressive paraparesis. Neurological examination suggested SCC, and Magnetic Resonance Imaging (MRI) of the spine revealed paravertebral masses due to EMH. The patient was treated with radiotherapy to a dose of 30 Gy over three weeks. There was immediate, near-complete resolution of symptoms, and the patient could walk without assistance. He has been doing well since 1.5 years of treatment. So, in cases of TI, one should think of EMH as a differential diagnosis for paraparesis. Early clinicoradiological diagnosis of EMH-induced SCC is necessary and possible, as there is a high chance of complete remission of symptoms with radiotherapy, which is a non invasive and effective treatment option.

Successful Management of Rituximab Refractory Warm Autoimmune Haemolytic Anaemia with Splenectomy: A Case Report

Zuber Ansari, Suhail Akhtar, Anas Ahmed, Sumera Bhati

Autoimmune Haemolytic Anaemia (AIHA) is a rare haematological disorder characterised by autoantibodies directed against autologous red blood cells. It can be idiopathic or secondary and classified as Warm type AIHA (WAIHA), cold, or mixed. The primary treatment for WAIHA is a long course of steroid administration, which has an early response rate of 80-90%. However, up to 20-30% of patients require second-line therapy. In the last decade, rituximab has replaced splenectomy as the first-choice therapy for refractory WAIHA patients due to its efficacy and safety. There is a paucity of reported cases of WAIHA refractory to both steroids and rituximab that have responded to splenectomy. This is a case of a 35-year-old female with a history of jaundice and anaemia for the past two years. The patient was diagnosed with WAIHA with a Direct Antibody Test (DAT) positive, IgG positive, and C3d negative results, and massive splenomegaly that was initially refractory to steroids and rituximab but responded to splenectomy. Significant splenomegaly may be an indication for choosing splenectomy over rituximab as a second-line treatment in steroid-refractory WAIHA.

A Case of Persistent Headache Leading to Diagnosis of Lung Adenocarcinoma: An Atypical Presentation

Manasi Harale, Arun Biju, Bhavya Sri Yammanuru, Sreevidya Yekkaluru

Lung adenocarcinoma is a primary type of lung cancer and is classified as a non small cell lung carcinoma. Headache is a rare presentation of lung carcinoma. This case report found that early diagnosis and proper treatment can improve disease outcomes. The case describes a 36-year-old woman presenting with a persistent left-sided headache and non radiating pain. Despite normal vital signs and laboratory results, an Magnetic Resonance Imaging (MRI) revealed multifocal abnormalities in the brain, suggesting neoplastic metastasis. Further investigations, including Computed Tomography (CT) scans and Positron Emission Tomography-Computed Tomography PET-CT scans, confirmed lung adenocarcinoma with metastases to the brain, bone, and liver. Histopathology revealed an invasive, moderately-differentiated adenocarcinoma. The patient was recommended palliative radiation therapy, and after compliance with treatment, she was discharged. The present case underscores the importance of thorough diagnostic evaluation in unexplained symptoms, leading to the identification of advanced-stage lung adenocarcinoma with multiple metastases.

Cytodiagnosis of Spindle Cell Squamous Cell Carcinoma presenting as a Metastatic Lesion to Chest Wall: A Case Report

Garima Akhilesh Chandrakar, Arvind Bhake, Simran Khan

Spindle cell carcinoma is a rare biphasic tumour composed of squamous cell epithelial and spindle cell mesenchymal components. This variant of squamous cell carcinoma masquerades as sarcoma with a high-risk of recurrence and metastasis. Metastatic lesions to the chest wall of squamous cell carcinoma from a distant primary are rare. The most common sites for metastasis from head and neck cancers are usually seen in the lungs, liver, bone, and brain. In this present case, the patient presented with complaints of an ulcerated mass on the left buccal mucosa with limited mouth opening. Despite wide excision of the mass and postoperative radiation, it resulted in distant metastases to the chest wall after a disease-free survival of four months. The metastasis of the chest wall appearing as red, inflamed, small, multiple, subcutaneous nodules is even rarer. The diagnosis of subcutaneous metastatic nodules of squamous cell carcinoma on Fine Needle Aspiration Cytology (FNAC) appearing in the literature is infrequent. The primary in this case was oral squamous cell carcinoma, which in follow-up after wide local excision of the mass with marginal mandibulectomy, presented as multiple inflamed appearing nodules on the chest wall. The primary site of the tumour showing classical squamous cell carcinoma and its metastatic lesion appearing on morphology as the spindle cell variant of squamous cell carcinoma are also infrequently reported in the literature. Herein, one such unusual case of subcutaneous metastasis on the chest wall cytodiagnosed on FNAC is reported.

Isolation of Salmonella Kentucky from Scrotal Abscess: A Rare Case Report

Parul Garg, Bani Rai, Rakesh Kumar Mahajan

Infections due to Non Typhoidal Salmonella (NTS) are emerging as a major health problem for both humans and animals worldwide including in India. In humans, NTS infections routinely remain restricted to the intestinal tract and may or may not manifest as a clinical illness but in immunocompromised patients systemic involvement may result in frank bacteraemia or focal involvement depending on the site of localisation. A 70-year-old, male presented to the Emergency Department with complaints of pain for about five days, on the right side of the scrotum. A drained pus sample was received at the Department of Microbiology for culture and sensitivity. Salmonella kentucky was identified by standard microbiological techniques. Here the authors present a case of scrotal abscess caused by Salmonella kentucky in an old immunocompromised patient and this possibly appears to be the first case report of scrotal involvement from India. No single diagnostic approach may be able to identify the NTS up to the species level. To determine the identity of organisms in cases where individual labs may not have the necessary capacity to produce the results, it would be extremely sensible from a scientific standpoint to create a network of cooperating labs with varying diagnostic capacities.

Navigating Postcaesarean Challenges: A Case Report on Bladder Flap Haematoma with Haematuria

Khushboo Singh, Vaishali Korde Nayak, Priyanka Prashant Kamdar, Jaya Barla

A less common puerperal complication following a caesarean section is a bladder flap haematoma, characterised by the accumulation of blood in the vesico-uterine space. A young, unregistered primigravida was referred from a peripheral facility with preeclampsia and obstructed labour. Signs of obstructed labour were observed both before and intraoperatively, like dehydration, foetal distress, a stretched lower uterine segment, and oedematous bladder. The uterus was sutured in two layers to control bleeding, and the patient was closely monitored postoperatively. The diagnosis of haematoma was made by the increasing height of the uterus and a suprapubic bulge anterior to the uterus, along with postoperative haematuria. Imaging with ultrasonography and Computed Tomography (CT) helped to decide the management. The patient improved after exploratory laparotomy with haematoma drainage. No bladder injury was found during the cystoscopy. Early diagnosis and treatment were important in preventing complications such as haemodynamic instability, abscess formation, and sepsis. Authors present their experience in this patient with postcaesarean vesico-uterine haematoma, with frank haematuria, without an obvious bladder injury, who required re-exploration. The clinical presentation, course, and sonographic findings of this patient form the basis of this report.

Superficial Partial Thickness Burns Treated using Theruptor Novo, a Novel Antimicrobial Dressing: A Case Report

Jayanthinathan Sampath

Burns are assessed by total body surface area and wound depth. Burn depth can range from Superficial Partial Thickness (SPT) to full thickness, where the epidermis, dermis, and sometimes underlying structures are involved. Scalds usually cause superficial or partial burns, which can blister and cause pain as well. A moist, pink, and shiny surface with brisk capillary refill times forms the basis for the clinical diagnosis of SPT. The goal of burn wound management is to minimise the formation of scars by adhering to fundamental principles. It is mandated that dressings be used on all occasions except for superficial burns. In the management of a patient with a history of accidental boiling water spillage over the left lower limb resulting in SPT burns, with complaints of pain and burning sensation for one month, Theruptor Novo (Healthium Medtech, India) dressing was utilised. The treatment aimed to protect the wound, maintain a moist setting, counteract burn wound infection, promote epithelisation, and minimise pain and discomfort. Theruptor Novo prevented infection, promoted wound healing, with good moisture effectively, and provided patient comfort.

Ayurveda Principles and Formulations in the Management of Alopecia Areata: A Case Report

Punam Sawarkar, Gaurav Sawarkar, Gauri Boharupi

Alopecia Areata, known as Indralupta in Ayurveda, involves abrupt hair loss from various scalp regions, attributed to an imbalance of Vata, Pitta, Kapha, and Rakta (bio-humours involving blood). This condition is increasingly prevalent due to contemporary lifestyle factors. Conventional medical treatments typically involve steroids and antifungal shampoos, which, despite their efficacy, can lead to undesirable side-effects, prompting the need for alternative treatments in Ayurveda. This case report examines the effectiveness of specific Ayurvedic treatment modalities for a 25-year-old female patient presenting with 2-3 bald spots on her scalp’s parietal and occipital regions, enduring for 6-7 months without associated symptoms of itching or burning. The patient underwent a combination of internal and external Ayurvedic therapies. Internally, she was treated with Panchatikta Ksheer Vasti (a medicated enema prepared with milk and five herbal drugs) and oral medications, including Aampachak Vati, Rasapachak Vati, Panchtikta Ghrita Guggulu, Krumikuthar Rasa, and Panchtikta Ghrita. Externally, herbal head packs were applied, supplemented by dietary and lifestyle modifications recommended by Ayurvedic traditions. After three months of continuous treatment, the patient exhibited significant hair regrowth on the bald patches without any adverse effects or recurrence to date. This case report highlights the potential of both internal and external Ayurvedic treatments to effectively manage Alopecia Areata, offering a viable alternative to conventional therapies with minimal side-effects.

Unveiling the Uncommon: A Case of Parietal Rhabdomyosarcoma in a 60-year-old Woman

Jayashree Bhawani, Samarth Shukla, Sourya Acharya

Malignant mesenchymal tumours are rare, aggressive neoplasms originating from mesenchymal tissues. These tumours are characterised by a high metastatic potential and pose significant diagnostic and therapeutic challenges. Mesenchymal tumours are of interest to oncologists because of their comparatively low occurrence, especially those with a high proliferation index. Authors report a case of a 60-year-old female who presented to the tertiary care rural hospital with persistent headaches, dizziness, and respiratory distress. Imaging studies revealed a heterogeneously enhancing soft-tissue density lesion in the right parietal region with extensive metastasis to both lungs. Histopathological analysis of the parietal lesion indicated features suspicious of a high-grade malignant tumour of muscular origin. Immunohistochemistry results were conclusive for Rhabdomyosarcoma. The patient was treated with radiation therapy for the primary tumour site and systemic chemotherapy, including doxorubicin and ifosfamide, for the metastasis. This case highlights the aggressive nature of malignant mesenchymal tumours and the complexities involved in their management. The high Ki-67 index and extensive metastasis indicate a poor prognosis. A multidisciplinary approach is crucial for symptom management and improving quality of life. Early detection, accurate diagnosis, and a comprehensive, multidisciplinary treatment strategy are essential for managing these challenging cases. Patients with such tumours typically have a bad prognosis since they have a significant chance of the tumour spreading to other organs, such as the liver, lungs, and bones. This case report aims to highlight the clinical presentation, diagnostic process, and therapeutic challenges associated with this aggressive tumour type, contributing to the limited but growing body of literature on rhabdomyosarcoma.

Wernicke Encephalopathy in a Patient of Acute Gastroenteritis: A Case Report

Jagannath Dhadwad, Anish Chitnis, Ramiz Kadiwala, Kunal Modi

An acute neurological disease known as Wernicke Encephalopathy (WE) is characterised by the clinical triad of symptoms: ophthalmoparesis with nystagmus, ataxia, and disorientation. Thiamine deficiency is the underlying cause of this potentially fatal condition, which mainly affects the central and peripheral nervous systems. Hereby, the authors present a case of a 47-year-old male who presented with multiple episodes of loose stools and altered consciousness to the emergency ward. He had hyperchloremic metabolic acidosis suspected to be due to acute gastroenteritis, which may have caused his altered consciousness. Despite correction of his metabolic acidosis, his sensorium did not improve. Later, he was diagnosed with WE using Magnetic Resonance Imaging (MRI) brain findings, which showed symmetrical subtle hyperintensities in the medial part of the thalami and periaqueductal grey matter, suggestive of WE; his consciousness improved after thiamine supplementation. There should be a high suspicion of WE for timely diagnosis and treatment. Prompt treatment would be rewarding as WE is reversible, if treated in time.

Anaesthetic Challenges in Paediatric Hepatoblastoma Resection: A Case Report

The most common primary liver tumour in children is hepatoblastoma, which is often diagnosed in the first three years of life. While the majority of hepatoblastomas are sporadic, some associations are reported with genetic disorders like Beckwith-Wiedemann syndrome and familial adenomatous polyposis. The annual incidence of hepatoblastoma in children has gradually increased during the past three decades. Babies born prematurely, weighing <1 kg, have been found to be significantly more likely to acquire hepatoblastoma. The most common symptoms with which children present are abdominal discomfort, easy fatigability, loss of appetite, and anaemia. The choice of treatment is surgical resection of the mass or surgical resection coupled with chemotherapy. Present case is of a seven-month-old, 7 kg infant who presented with a gradually increasing abdominal mass diagnosed as hepatoblastoma. Left hepatectomy was done under general anaesthesia and epidural analgesia. Liver resection is one of the major surgical procedures that carries a risk of blood loss and pulmonary embolism, but improved expertise in paediatric anaesthesia and surgical skills have reduced operative risk. The challenges in this case were securing vascular access, maintaining blood volume with considerable fluid and blood loss, and assuring haemodynamic stability. Maintenance of normothermia, glucose levels, and effective pain management were all crucial, necessitating careful planning and a multidisciplinary approach to maximise results and guarantee patient safety.

Parasurgical Management of Indralupta (Alopecia Areata) by Jalaukavcharana (Leech Therapy): A Case Report

Riya Rajendra Rathor, Renu Bharat Rathi

Urdhwajatrugata Vyadhi (disease of the supra clavicular region) and Indralupta {Alopecia Areata (AA)} are characterised by patchy hair loss in the area that bears hair, such as the beard and scalp. According to Sushruta Acharya, vitiated pitta and vitiated vata together cause Indralupta (AA), leading to scalp hair loss. Additionally, vitiated Rakta and Kapha obstruct the hair follicles openings, limiting the growth of new hair. In contemporary science, these conditions are related to the clinical features of AA. A five-year-old female child presented to the Department of Kaumarbhritya with complaints of hair falling out in patches on the scalp gradually over six months. In her condition, the Raktamokshana therapy by using the jalaukavcharan vidhi technique was adopted for effective results. This age-old procedure described by Acharya Sushrut in Sushrut Samhita is still beneficial in treating the above aforementioned condition. The patient experienced relief from her symptoms after eight sessions and is continuing treatment. Raktamokshana, or therapeutic bloodletting, is one of the Ayurvedic therapy methods for Raktapradoshaja Vikara. Raktamokshana (Bloodletting) through leech treatment is one of the easiest methods to administer, especially for elderly patients, female patients, paediatric patients, individuals who are extremely shy, and those with sensitive constitutions like children. It resulted in fewer complications postprocedure and reduced the risk of symptom recurrence. The therapy was cost-effective, and within short span of three months, it produced positive outcomes in patients.

Paget’s Disease of Maxilla with Paranasal Sinuses: A Case Report

Paget’s disease of bone is a chronic skeletal disorder affecting predominantly elderly individuals. The pelvic girdle is the most common site to be affected; however, other sites such as long bones, spine, and skull are also frequently affected. The diagnosis of Paget’s disease is made through careful radiographic, biochemical and histopathological analysis. Although involvement of the maxilla is common, the involvement of the paranasal sinuses is comparatively rare. Radiographic presentation of skull lesions ranges from osteolysis to cortical thickening, with characteristic cotton-wool radiopacities and diploe thickening. A rise in serum alkaline phosphatase without a significant elevation in serum calcium and vitamin D levels is regarded as a typical biochemical sign of the disease. Paget’s disease of bone often presents asymptomatically in most cases until deformity becomes apparent. It is successfully treated with bisphosphonates, a group of anti-resorptive drugs, thereby reducing the associated morbidity and mortality. In the present case, Paget’s disease of the skull involving the maxilla with obliteration of the paranasal sinuses was diagnosed in an elderly female who presented with swelling in the posterior maxillary region and markedly elevated serum alkaline phosphatase and parathyroid hormone levels, while calcium and phosphate levels are typically within normal limits. Hereby, the authors present a case report of 64-year-old female patient with Paget’s disease of bone with craniofacial involvement resulting in cotton-wool radiopacities of the skull and elevated serum alkaline phosphatase. The patient was under pharmacological management with bisphosphonates and calcium supplements.

Diving Deep into Diagnosis: Unveiling High Grade B-cell Lymphoma

Madhulika Laxmikant Mahashabde, Yash Rameshbhai Bhimani, Gaurav Ashok Chaudhary

The term “lymphoma” comprises a heterogeneous group of biologically and clinically distinct neoplasms that arise from cells in the lymphoid organs. Based on the identification of Reed-Sternberg cells (RS cells), it is divided into Hodgkin and Non-Hodgkin’s Lymphoma (NHL). Lymphadenopathy is a common presenting feature of lymphoma. Extranodal involvement may show gastrointestinal, cutaneous, neurological, or other symptoms. Hereby, the authors present a case report of 76-year-old male with non-Hodgkin’s lymphoma whose symptoms were masked by the abdominal pain of emphysematous pyelonephritis. Although the infection was treated, the patient continued to complain of dull, aching, persistent abdominal pain. As a result, the patient underwent additional radiological examinations, including a contrast-enhanced Computed Tomography (CT) scan of the abdomen-pelvis, which disclosed multiple lymphadenopathies. Hence, an endoscopic ultrasound-guided biopsy was performed from the lymph node between the portal vein and inferior vena cava, revealed High-grade B-cell Lymphoma (HGBL). The prognosis for HGBL with double- and triple-hit lymphomas is extremely bad. The patient that came to us had an early diagnosis of HGBL, which led to a favourable prognosis, in contrast to most cases of the disease, which usually manifest late in the course and are linked with a very grave prognosis.

Minimally Invasive Approach to Epiphrenic Oesophageal Diverticulum: A Case Report

An oesophageal diverticulum is a relatively rare disorder of the oesophagus which results in the outpouching of the oesophageal mucosa through a weak portion within the oesophageal lining. Oesophageal diverticula occur in <1% of the population and are found in approximately 1-3% of those presenting with dysphagia. A 75-year-old male patient came to the surgical Outpatient Department (OPD) with chief complaints of difficulty in swallowing for 2-3 months, initially with solids which later progressed to difficulty in swallowing liquids. He was diagnosed on a Contrast-Enhanced Computed Tomography (CECT) scan with a large oesophageal diverticulum arising from the right lower lateral thoracic oesophagus just proximal to the oesophagogastric junction in the retrocardiac region with no filling defect or mucosal thickening. The patient was treated with transhiatal laparoscopic oesophageal diverticulectomy with cardiomyotomy and Dor fundoplication. For symptomatic patients, most often, minimally invasive myotomy and removal of the pouch endoscopically are advised, which may pose a surgical challenge due to the rarity of the disease.

Malignant Eccrine Tumours at Unusual Locations: A Report of Two Cases

Neha Singh, Rupinder Kaur, Fiza Chopra

Eccrine carcinoma is a rare skin adnexal tumour that presents significant diagnostic challenges due to its uncommon occurrence and varied clinical presentations. This report discusses two unique cases of eccrine carcinoma in middle-aged females, occurring at atypical locations: the thigh and the anal region. It emphasises the importance of recognising such tumours for appropriate management. The first case describes a 53-year-old woman with a chronic, non healing thigh ulcer that was initially suspected to be a benign lesion but was later identified as spiradenocarcinoma through histopathological examination. This highlights the potential for benign eccrine lesions to undergo malignant transformation. The second case involves a 50-year-old woman presenting with rectal bleeding and a malignant growth at the anal verge, which was confirmed as eccrine carcinoma through comprehensive pathological analysis, including immunohistochemical staining. Both cases underline the crucial role of detailed clinical observation and advanced histopathological evaluation in diagnosing and managing eccrine carcinoma, particularly when presented in non traditional sites. This approach guides effective treatment strategies and improves patient outcomes.

An Atypical Midline Anterior Torus Mandibularis: A Case Report

Ranjan Rashmi Behera, Mohammad Jalaluddin, Bandana Panda

Benign bony growths called tori can develop in various places throughout the mandible and maxilla, although their exact origin is still unknown. There have been numerous reports of unilateral or bilateral Mandibular Tori (MT); however, no reports of a midline anterior mandibular tori have been made yet. A 27-year-old female patient reported with a complaint of a bony growth on her lower jaw below the tongue. The tori are unusually situated at the midline on the lingual side of the mandibular central incisor. The elements shown to be causal were the gender of the male, the ethnicity of Asians, and developmental in origin. The cornerstone of treatment for Tori is surgical resection. After a year of follow-up, there was no recurrence. The present case highlighted the significance of etiological factors for bony exostosis management and recurrence, which, in conjunction with origin, gender, ethnic and racial factors, may account for the patient’s lack of recurrence.

Propanil Poisoning Presenting with Methaemoglobinemia: A Case Report

Propanil is an uncommon cause of poisoning, and the incidence of it in India is unknown. It is a low to medium toxicity agent; however, severe poisoning can lead to death, especially in areas with limited medical facilities. Hereby, the authors present a case of 15-year-old girl who presented to Emergency Department after 72 hours of ingesting an unknown quantity of propanil. She was noted to have peripheral cyanosis, laboured breathing, and a room air saturation of 62%, for which she was intubated and ventilated. Methaemoglobinemia was suspected in the child, which is considered a complication of propanil poisoning, and methylene blue was administered within six hours of admission. Exchange transfusion was performed via a femoral central line catheter when there was no improvement with methylene blue. Sulfhaemoglobinemia was also considered as a differential diagnosis. On day 4 of the hospital stay, her saturation improved to 80%. She experienced complications of haemolysis, which were managed conservatively. She improved clinically and was extubated on day 5. Her room air saturation was 93% on day 9, and she was discharged. She had a follow-up appointment in the outpatient clinic after two weeks, where her saturation on room air was recorded as 97%, and her methaemoglobin levels were 8.7% in the postexchange transfusion sample. Propanil has the potential to cause severe, life-threatening clinical symptoms. Exchange transfusions can be lifesaving in situations of severe poisoning. Early transfer of patients to tertiary care Institutions should be considered as peripheral hospitals may lack intensive care facilities and exchange transfusion capabilities.

Paediatric Autoimmune Haemolytic Anaemia Presenting with Acute Kidney Injury: A Case Report

Anuj Barot, Aashna Verma, Dhara Gosai, Gargi Pathak

Autoimmune Haemolytic Anaemia (AIHA) occurs when an individual’s immune system produces autoantibodies against antigens on Red Blood Cells (RBCs). It is a relatively rare haematological disease in the paediatric population. Case reports of paediatric warm AIHA are rare in general and are usually associated with other underlying conditions like haematological neoplasms, viral infections, and drug-induced conditions. This is a case report of a three-year-old male child with warm AIHA who presented with dark urine and decreased urine output for one day. Through laboratory and radiological investigations, it was found that this patient developed acute haemolysis following a bacterial lower respiratory tract infection. The patient was treated with corticosteroids, antibiotics, and Intravenous Immunoglobulins (IVIg). Peritoneal dialysis was also done. The patient was eventually discharged from the hospital on a maintenance dose of oral steroids, which was gradually tapered off. It was concluded that a bacterial lower respiratory tract infection can lead to warm AIHA in children. Even though this illness is rare, it may cause life-threatening complications if prompt treatment is delayed.

Anaesthetic Management of a Patient with Solitary Fibrous Tumour of Pleura with Postoperative Diagnosis of Doege Potter Syndrome: A Case Report

Bhavini Shah, Shilpa Kore, Pallavi Pratap Jagtap, Krusha Shah

Pleural tumours represent a small yet significant subset of thoracic malignancies. Solitary Fibrous Tumours of the Pleura (SFTPs) are typically benign and account for 5% of all pleural tumours. Authors report a case of SFTPs excision with a postoperative diagnosis of Doege Potter Syndrome (DPS) in a 63-year-old male patient who was referred with complaints of chronic productive cough and breathlessness. Upon clinical and radiological evaluation, he was diagnosed with SFTPs. The patient experienced preoperative and intraoperative hypoglycaemic episodes, which were diagnosed as DPS during postoperative evaluation. This syndrome is a paraneoplastic condition associated with the secretion of Insulin-like growth factor-2 (IGF-II), observed in less than 5% of patients with SFTPs, with hypoglycaemia being a major symptom. Awake intubation and other procedures were performed with the patient in a propped-up position as he was unable to lie supine, which caused dyspnoea.

An Unusual Presentation of Cemento-ossifying Fibroma in the Anterior Maxilla: A Case Report

Ankita Chavhan, Swati Patil, Alka Hande, Archana Sonone, Aayushi Pakhale

Cementifying Fibroma (CF) is a benign fibro-osseous lesion with sharply defined and well-confined edges. It is slow-growing and has a radiolucent peripheral component. It is mostly seen in the mandible in the 20-39 years age group with a female predilection. Hereby, the authors present a case report of a 60-year-old woman who had a painless growth in the upper front region of her jaw for two months and visited Outpatient Department (OPD). Extraoral examination revealed facial asymmetry due to swelling in the upper front region of the jaw. Intraoral examination showed round to oval swelling in the 11 and 21 regions. On radiographic examination, a round radiolucency in the 11 region was appreciated. After excision, the tissue was sent to the laboratory, and histopathologically the diagnosis was confirmed as peripheral CF. The patient was kept in a 12-month follow-up postoperatively, which reported no recurrence.

Intra-rater Agreement of One Foot Balance Test to Identify Balance among Female Collegiates

Kriti Arya, Sunanda Bhowmik

Introduction: Static balance is relying on intact sensory systems and is crucial for preventing falls, especially in populations with neurological or musculoskeletal issues. The One-foot Balance Test (OFBT) is one of the common assessment tools of static balance. Previous Researches have highlighted the importance of reliable assessments like OFBT in identifying balance issues. But there is a dearth in literature regarding the intra-rater reliability of OFBT among female collegiates aged between 19-22 years. Aim: To establish the intra-rater reliability of OFBT among collegiate students. Materials and Methods: This was an observational study with a cross-sectional design. The sample size for this study was estimated to be 120. Participants were asked to stand on their right foot followed by the left leg. Three readings for each were taken with both eyes open and eyes closed. After two days one reading for each was taken for both legs with Eyes Open (EO) and Eyes Closed (EC) to check the intra-rater reliability of one foot balance test at same suitable conditions. Results: The value of Cronbach’s alpha was 0.31 and the Intra-class Correlation Coefficient (ICC) value of EC (R) and EC (L) was 0.18. The value of Cronbach’s alpha was 0.27 and the Intraclass Correlation Coefficient (ICC) value for EO (R) and EO (L) was 0.15. Conclusion: The intra-rater reliability of OFBT found to be very poor in female collegiate. This may be due to poor proprioception of the students, sedentary lifestyles more indulging in indoor activities of the collegiate.

Postoperative Rare Presentation of Ventral Cervical Cord Herniation: A Case Report

Silky Taya, Vinod Chaudhary, Ullas V Acharya

Cervical spinal cord herniation is a rare occurrence and is usually seen after C3-C5 fusion with C4 corpectomy using a posterior approach. Herniation in the cervical spine with an anterior approach is unusual and has only been reported in a few cases. Hereby, a case of a 53-year-old male who underwent C3-C5 fusion with C4 corpectomy for Ossification of the Posterior Longitudinal Ligament (OPLL) of the cervical spine is reported. Following surgery, the patient deteriorated, leading to re-exploration. Delayed postoperative Magnetic Resonance Imaging (MRI) shows ventral cord herniation with an anterior pseudo meningocele. Spinal cord herniation should be considered if neurological deficits occur after C3-C5 fusion with C4 corpectomy.

Management of Mandibular Anterior Demineralisation Associated with Myofunctional Appliance: A Case Report

S Advaitha Narayan, K Madhuram, K Shanmugapriya, Ashok Leburu, V Naveen Kumar

Myofunctional appliances encompass a diverse range of intraoral devices that rely on the intrinsic forces of the orofacial musculature for their functionality. These appliances are typically designed to be removable and exhibit a passive mechanism of action. Caries and demineralisation are well known adverse side effects of myofunctional orthodontic appliances, with the most frequent reports relating to fixed appliance treatment. Hereby, the authors present a case report of a 12-year-old male patient with a slight neuromotor defect who developed significant caries and demineralisation of the permanent mandibular anteriors due to the consumption of large quantities of carbonated drinks and acidic fruits while wearing a twin block appliance for eight months and failing to return for regular orthodontic follow-ups. The patient was provided with strategies for oral health training and diet modification. Fluoride varnish was applied to treat the caries and pain caused by hypersensitivity. Additionally, at-home application of GC Tooth Mousse Plus, which is rich in Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CCP-ACPF), was utilised for remineralisation and dentinal tubule occlusion. The mandibular anteriors were restored with composite resin using an ultra-conservative 3D guided technique, alongside preventive care during the fluoride varnish application. The present case report emphasises the risk of decalcification of teeth during orthodontic treatment and the importance of regular dental check-ups.

Anaesthesia Management in Case of Placenta Accreta undergoing Caesarean Delivery with Internal Iliac Artery Balloon Catheterisation and Embolisation

Monica Pandey, Shiv Mohan Chopra, Mona Bana, Madhuri Agrawal

Abnormal invasion of the placenta into the uterine tissue during pregnancy is one of the most common causes of peripartum hysterectomy, as well as morbidity and mortality. A multidisciplinary approach is the best way to manage such cases in order to maintain perioperative haemodynamic stability, which leads to lower rates of complications and shorter hospital stays for both the parturient and the newborn. The authors hereby report the case of a 27-year-old female {Gravidity and Parity (G1P2)} at 36 weeks of gestation, diagnosed with central placenta accreta with bladder invasion. In the present case, authors performed a balloon-assisted caesarean delivery under general anaesthesia while avoiding hysterectomy. The patient had a history of a previous caesarean delivery 1.5 years prior. Placenta accreta was diagnosed during her ultrasound. All routine laboratory results were within the normal range, except for haemoglobin, which was 10.1 g/dL. An elective caesarean section with a consented hysterectomy under general anaesthesia was planned. Adequate blood and blood products (4 units of packed red blood cells and 2 units of fresh frozen plasma) were arranged before surgery. Bilateral internal iliac artery embolisation was performed to reduce perioperative bleeding. Flexible cystoscopy was conducted prior to surgery to confirm the extent of bladder invasion. The caesarean section was successfully carried out with the multidisciplinary team approach under general anaesthesia, and hysterectomy was not performed, allowing for a successful fertility-sparing caesarean delivery by our team. The patient was transferred to the Intensive Care Unit (ICU) after the surgery for proper vital monitoring and adequate pain management. She was moved to the ward on day 2 and discharged on day 3. In conclusion, balloon occlusion of the internal iliac artery is effective for haemostasis in most cases of patients with placenta previa.

Role of Phenol Epidural Neurolysis in Pain Management of Patient with Myxofibrosarcoma: A Case Report

Myxofibrosarcoma is an aggressively malignant soft-tissue neoplasm of the upper or lower extremities that occurs in adults. At the time of diagnosis, upto 73% of cancer patients complain of varying degrees of pain. The ultimate goal of treatment is pain relief and functional recovery. The authors describe the case of a 59-year-old female patient who presented with complaints of excruciating brachialgia of the right upper limb. She had a pain score of 10 based on the Visual Analogue Scale (VAS 0-10). Her pain was initially managed conservatively with systemic analgesics but it failed to offer adequate relief. Often, there is an inadequate response to conservative treatment. These patients may benefit from various interventional modalities. Hence, epidural neurolysis with phenol was done by slowly injecting 2 mL of 6% aqueous phenol into the epidural space under Computed Tomography (CT) and fluoroscopy guidance. Upon follow-up, the patient’s Visual Analog Scale (VAS) was recorded as one, morphine consumption decreased with eventual discontinuation, and paraesthesia had reduced by 50%. This patient was suffering from chronic pain, which significantly reduced her Quality of Life (QoL). The injection of phenol into the appropriate space resulted in satisfactory sustained analgesia. She did not have any sensory or motor loss. Her pain was adequately controlled by paracetamol 500 mg as needed. The patient remained pain-free for five months after the procedure but eventually succumbed to her illness.

Spontaneous Unilateral Anterior Corneal Mosaic in Orbital Apex Syndrome: A Case Report

Harshita Moond, Twinkle Gupta, Neha K Sethi, Ashu Dihana, Neeru Bhutta

Cornea is the transparent, avascular, outermost fibrous coat of the eyeball. Fluorescein dye is used to detect epithelial discontinuities in the cornea. In a normal cornea, there is no uptake of stain after fluorescein instillation. However, a distinct honeycomb or mosaic pattern is often observed after massaging the cornea through the lids with fluorescein staining. This pattern is known as Anterior Corneal Mosaic (ACM) and is characterised by a polygonal/honeycomb pattern on the cornea. Present case is the first case of spontaneous unilateral ACM in an eye with orbital cellulitis and orbital apex syndrome, displaying a ‘guitar-pick’ sign on Magnetic Resonance Imaging (MRI) and B-scan. In this case, a 65-year-old female patient complained of a sudden onset of decreased vision in her left eye that began one week ago. Slit lamp examination revealed chemosis and a spontaneous mosaic pattern on the cornea. Pus culture from an upper lid abscess identified Methicillin Resistant Staphylococcus aureus (MRSA). Treatment with intravenous antibiotics, abscess drainage, and topical antibiotics resulted in clinical improvement, although vision remained poor after one month. Authors hypothesise that the ACM was spontaneously induced in the absence of external pressure from the eyelids. It was likely caused by pressure on the cornea from lid swelling and increased posterior pressure due to orbital soft-tissue inflammation. Thus, it may serve as a clinical indicator of elevated orbital pressure.

Hodgkin’s Lymphoma Concurrent with Amyloidosis: A Rare Case Report

Ketki Rajesh Wajpeyi, Sunita Jayant Vagha, Kaustubh Vilasrao Kharche

Hodgkin’s lymphoma is a neoplasm of lymphoid tissue. Histopathological examination with evidence of Reed-Sternberg cells in the background of inflammatory cells combined with immunohistochemistry for specific markers is confirmatory in order to diagnose Hodgkin’s lymphoma. Amyloidosis is a protein misfolding disorder characterised by amyloid deposition in various organs. Diagnosis involves histochemical examination using Congo red, which is a special stain. It is a rare phenomenon to witness both pathologies concurrently in a single patient. It is very challenging as it involves intricate diagnostic, therapeutic, as well as prognostic implications for the patient. Here, a case of a 45-year-old female who presented clinically with a painful swelling on the right-side of the neck. Thorough investigations confirmed the diagnosis of Hodgkin’s lymphoma coupled with amyloidosis. The patient was given chemotherapy for Hodgkin’s lymphoma but was simultaneously closely monitored for any complications or side-effects related to amyloidosis. Additionally, a novel therapy approach was structured for treating amyloidosis. Thus, it highlights the importance of a multidisciplinary approach for the diagnosis, management, and prognosis for such patients. To gain a deeper understanding of this specific relationship and ultimately improve the prognosis of the patients, additional research is extremely crucial.

Evaluation and Quantifying the Difference between Male and Female Agility in Football Players: A Cross-sectional Pilot Study

Varsha Chattanta, Nitesh Verma, Pooja Mehra

Introduction: Football is an intermittent sport which requires agility as essential trait for player conditioning, selection and prevention of injury. Agility is a conditional motoric attribute classified as a locomotor skill combining both a muscular and cognitive component. Previous study, revealed that Illinois and T-test were most significant tests to evaluate agility. Aim: To evaluate and quantify the difference in agility between male and female footballers. Materials and Methods: Purposive sampling was used in this cross-sectional study. 30 professional football players, aged between 18-25 years with normal BMI and had atleast 3 years of systematic football training with 3-4 training sessions weekly and 8 hours of football training per week were included. Those players who had visual/hearing impairments, history of lower limb fractures, Anterior Cruciate Ligament (ACL) reconstruction and meniscectomy were excluded from the study. Illinois and T-test was used to access agility of football players. Normality of data was checked using Shapiro-Wilk test. Descriptive statistics in form of Mean±SD were used to find normative value and Independent T-test was utilised to quantify the difference. Results: Reference value of male and female player’s agility in T-test was 10.35±0.58 and 14.52±0.50 whereas for Illinois test it is 16.34±0.79 and 18.12±1.02 respectively. Independent T-test showed significant difference in male and female agility for both Illinois and T-test (p<0.001). Conclusion: Normative values are established for both genders. It is concluded that female players are clinically and statistically less agile when compared to male players (p-value <0.001).

Exploring the Impact of Office Syndrome on Employee Productivity: A Literature Review

Md Sajid Raza Khan, Simranjeet Kaur, Nidhi Sharma

Introduction: Physiotherapy helps employees prevent injuries at work by improving workspaces and everyday routines, with a focus on acoustics and body mechanics. Working in a situation where every employee is aware of their individual physical needs, understands how to improve their posture, and takes regular pauses to stretch out decreases the likelihood of accidents while increasing productivity. Aim: To explore the impact of office syndrome on employee productivity. Materials and Methods: A total of twenty articles were reviewed in this narrative review. Twenty publications were evaluated, including 8 reviews, 2 experimental studies, 3 observational studies, 5 cross-sectional studies, and 2 surveys. Results: According to the studies and publications included, the most common occupations with an increased risk of upper limb injuries were office workers. Workers reported increased weariness, upper backache, and neck discomfort after commencing work. Neck and back pain have been shown to interfere with participants' normal activities. We discovered a positive correlation between computer usage on a regular basis. Conclusion: The majority of research participants experienced symptoms of office syndrome, mostly related to stiffness in their upper extremities and back. Employees working in offices who are older, female, have more experience, and put in longer hours are at a higher risk of developing these problems and need extra care. Ergonomic modifications, such as adjustable workstations and raised desks; behavioural cures, such as regular stretch breaks and postural awareness training.

Reference Value of Heel on Shin Test in Young Adolescents

Rohit Kumar, Sunanda Bhowmik

Introduction: Co-ordination assessment plays a pivotal role in evaluating motor function, particularly in adolescents, where impairments can have significant implications for daily activities and overall well-being. By providing standardised benchmarks, the reference value may have a potential effect to identify the optimal co-ordination among ideally developing young adolescents. Aim: To establish normative reference values for the Heel on Shin Test (HST) among healthy young adolescents aged 12-19 years. Materials and Methods: Weighing machine (healthgenie®), Anthropometer, Measuring tape, Stopwatch, other stationary items. The sample size for this test was 110 according to the formula: N=[(1.96*0.13)/(0.025)]2=110. The anthropometric measurement was then taken for the selected participants. The selected participants were asked to be in supine lying position to perform “heel on shin test”, with eyes open and close for each side simultaneously with both limbs right limb following the left limb. They were instructed to place the heel of one foot onto the knee of the other leg and then slide the heel down the shin from the knee to the ankle and back up to the knee respectively. Results: The mean±SD, GM for HTS_R_EO was (2.39±0.17,2.39), HTS_R_EC was (2.36±0.16,2.35) and for left side mean±SD, GM is HTS_L_EO was (2.44±0.19,2.41), HTS_L_EC was (2.42±0.18,2.41) respectively. Conclusion: The normative values for the HST in adolescents provide crucial benchmarks for assessing motor function. These findings aid in identifying co-ordination impairments.

Effects of Exercise and Lifestyle Modifications in Sarcopenia Affected Elders: A Literature Review

Nilesh Bhargava, Smriti Bhatia, Sunita Kumari, Sarvotam Chauhan

Introduction: Sarcopenia is a condition in which the loss of muscle mass and strength occurs. Which leads to difficulty in daily activities it has negative impact on physical health and quality of life among geriatric population. Studies showed 25% of elders aged 65+ elders affected by sarcopenia and 60% of 80+ elders are affected by sarcopenia. Studies show the role of exercise in improving muscle mass and function in Geriatric population with sarcopenia, and the duration and frequency of exercise needed to manage sarcopenia in this age group. Aim: To find positive impact of exercise on elders and create awareness about exercises has numerous benefits in sarcopenia management. Materials and Methods: Data has been sourced from google scholar, PubMed, ResearchGate and various journals. A total of 9 out of 10 studies are selected and have been reviewed and concluded in this article. Results: A total of 7 out of 9 papers showed that Resistance exercise, aerobic exercise, combined exercise has positive effect. Resistance exercise shows efficacy in improving muscle strength and muscle mass in individuals at various stages of life. A total of 5 papers also says it improves the structural function of the neuromuscular system as it also slows down the chronic inflammatory response caused from aging and regulate hormone secretion. Conclusion: People with sarcopenia, muscle strength and function can be enhanced through physical activity. The review also identified some gaps in the current research, like the need for more studies to evaluate the long-term effects of exercise.

Physiotherapy as Holistic Care in Pregnancy: A Literature Review

Smriti Bhatia, Nilesh Bhargava, Pooja Sharma, Sarvotam Chauhan

Introduction: Physiotherapy deals with the overall physical development of an individual. In pregnancy, there are pregnancy related disorders, such as gestational weight gain, gestational diabetes, pelvic muscle dysfunction and incontinence. Regular physical exercise during pregnancy is associated with numerous benefits. Aim: To gather best evidence about the effectiveness of exercise and modalities during pregnancy. Materials and Methods: Random controlled trails and studies from Google scholar, Pubmed and Physiotherapy Evidence Database (PEDro) that were published from 2019-2023 were reviewed. These studies included the trail of modalities during parturition and various forms of exercises during pregnancy. After reviews from these studies, a concise review has been formed suggesting the effectiveness of physiotherapy in pregnancy. Results: Out of 15 papers that were selected 13 showed a positive impact of exercise and TENS in pregnancy and parturition respectively. Physiotherapy in case of pregnancy had shown a significant impact on gestational period, parturition Pelvic floor strengthening held in easy carrying of the foetus and exercises were found to prevent the gestational weight gain along with it, Pelvic floor strengthening helped in management of stress incontinence. Conclusion: The whole study showed a positive impact of physiotherapy during pregnancy. The implementation of physiotherapy and modalities has the potential to reduce labor pain. Pregnant women who exercise have been shown to have a shorter labor and easier deliveries and possesses greater self-esteem.

Impact of Aerobic Exercise Training on Sleep Quality in Adults with Somatic Dysfunction

Aryan Batra, Kanu Goyal, Manu Goyal

Introduction: It has been demonstrated that aerobic exercise improves cardiovascular health and endurance. Patients with somatic dysfunction have low quality sleep, and training in aerobic exercise is important for enhancing the quality of the patients’ sleep. Training with aerobic exercises includes cycling, running, and brisk walking. Aim: To study that aerobic exercise improves sleep quality in adults with somatic dysfunction. Materials and Methods: Databases such as PubMed/Medline, Google Scholar, Scopus, Cochrane were explored to uncover full-text publications authored in English and were searched to retrieve desired articles. In addition, reference list of the retrieved article were searched in the analysis process. Result: A total 278 articles are retrieved after removing duplicates articles, only 3 articles were evaluated in this literature review. Conclusion: It has been concluded that aerobic exercise training improves sleep quality in adults with somatic dysfunction. Aerobic exercise training has shown promising effects on sleep quality among adults with somatic dysfunction. Research indicates that regular aerobic activity can improve sleep duration, efficiency, and overall quality. By reducing stress and promoting relaxation, aerobic exercise contributes to better sleep patterns, potentially enhancing the well-being of individuals with somatic dysfunction. Implementation: Aerobic exercise protocols are employed to raise physical health and improve sleep quality in adults.

Development and Content Validation of Iliotibial Band Friction Syndrome Index (IBFS-I)

Ritika, Sandeep, Joydip Saha, Lalit Mishra, Sunanda Bhowmik

Introduction: Activity-related lateral knee discomfort is a common symptom of Iliotibial Band Friction Syndrome (ITBFS), a condition characterised by excessive friction between the iliotibial band and the lateral femoral condyle. Literature indicates that ITBFS is highly prevalent in road cyclists, military recruits, and habitual runners respectively. But there is scarcity of readily usable tool to identify the extent of ITBS. This study was designed to develop and validate the content of a scale for ITBFS diagnosis. Aim: To develop and content validate of the developed tool which will help the physiotherapist to asses easier and earlier. Materials and Methods: This study involves expert opinions from seven different physiotherapy experts in an offline mode. Study was done in 3 phases: Phase 1: The extensive literature exploration Phase 2: Development of questionnaire Phase 3: Content validation of the developed questionnaire. The Delphi method was used to validate the content, which involves expert review panel, examining the domain and its items, assigning a score to each item, and computing the scale level content validity index (S-CVI) and item content validity index (I-CVI). It was performed using Delphi method which includes seeking expert opinion from 7 different expert from the field of physiotherapy on an offline mode, selecting expert review panel, reviewing domain and items, providing score to each item and calculating I-CVI (item content validity index) and scale level content validity index (S-CVI). Results: I-CVI was calculated using (I-CVI= agreed item/number of expert) and found to be 0.98 and S-CVI using (S-CVI=sum of I-CVI scores/Number of items) and found to be 0.9. This developed questionnaire is having excellent I-CVI and S-CVI. The physiotherapists may use the IBFS-I scale for the early identification of ITBFS. Conclusion: The IBFS-I scale may help physiotherapists diagnose ITBFS early. This scale may prove to be an effective tool in assisting the therapist in determining the degree of ITBFS in individuals.

Normative Reference Value of Four Square Step Test among School-going Children

Shiwangi Garg, Sunanda Bhowmik

Introduction: Dynamic Balance (DB) is the ability to maintain balance while the body is moving. The Four-Square Step Test (FSST) is a reliable and valid tool to assess DB in older populations. Previous research demonstrated the normative score of FSST for the community-dwelling older population. Aim: To estimate the reference score of FSST among 8 to 15-year-olds. Materials and Methods: FSST is a test that can be used for both therapeutic and diagnostic purposes to evaluate an individual’s dynamic standing balance. A total of 90 School goers were recruited for this research. Participants had to cross the four sticks in a predetermined order. The sticks were each 90 cm long and were positioned in a cross pattern on the ground. They were instructed not to touch any sticks when they were crossing them. The amount of time it took to complete the test was recorded. Results: The normative value of FSST was (mean±SD 11.43±1.24) Geometric mean (11.37), skewness (0.30), kurtosis (0.65), median (25, 75 IQR) 11.25 (11.25,12.07), range (8.00-15.00). Conclusion: The total time taken by the participants to finish the test was 9 to 12 seconds. Analysing these results against findings to previous research, children between the ages of 8 and 15 were found to finish the FSST faster than average adults. In clinical practice, the standard reference score may be employed to rule out abnormalities related to children’s DB.

Reference Score of C7 Angle among College Students of North India

Subhi Kumari, Joydip Saha

Introduction: The sagittal shoulder C7 angle is specialised to analyse shoulder posture in the sagittal plane. the curvature of the cervical spine can influence the location and movement of the shoulder girdle like, a higher C7 angle leads to greater cervical lordosis, whereas a lower C7 angle leads to forward head posture and changes in shoulder blade position, affecting shoulder function and biomechanics. Aim: To establish normative score of C7 angle among college-going students of North India. Materials and Methods: A total 57 college-going male students with any musculo-skeletal condition in neck and head are included in this study to establish the normative score of C7 angle. The C7 angle was calculated in two phases. Firstly, the authors here took photographs of neck and head of participants in sagittal plane and angle was calculated by Kinovea software which were reliable methods. Results: Normative was establish for the participants which came to be abmormal. The p-value obtained was less than 0.05. Hence the normative value is represented in terms of median and IQR. The p-value <0.05 indicates a non-normal distribution. The researchers most likely performed a normality test on the C7 angle measurements collected from the individuals. A p-value <0.05 indicates that the data deviates from a normal distribution. To put it simply, the C7 angle scores were not distributed uniformly, as a conventional bell curve would be. Traditionally, the average (mean) serves as the normative value. However, extreme values in non-normal distributions have a significant influence on the mean. Because the C7 angle scores were not normally distributed, taking the mean as the normative value could be deceptive. It may be skewed to greater or lower values based on the data. Conclusion: The analysis was successful and normative score for C7 angle was 55.03 as well as results will help to determine normal value of C7 angle among college-going students.

Unwind the Prevalence of Caffeine Intake and Risk of Hypertension among Indian Healthcare Professionals

Simran Kaur, Neha Kashyap

Introduction: The most widely used psycho-stimulant substance with a lengthy history of use across the globe is caffeine. In general, consuming little to moderate amounts of caffeine is safe and advantageous. Health care being a demanding job, requires one to be awake and diligent all the time, hence a lot of health care professional resort to caffeine to combat long shifts and heavy workload. Aim: To unravel the prevalence of caffeine consumption and risk of hypertension among Indian health care professionals. Materials and Methods: This study recruited 245 Indian health care professionals aged 19 to 45 years. The data was procured using a questionnaire directed to test their addiction to caffeine and their awareness to risk of Hypertension (HTN). Results: A total of 54.2% healthcare professionals consume caffeine on regular basis. It was observed that more than 34% health care professionals consume more than four drinks and unaware of the negative effects of caffeine despite experiencing symptoms of excessive caffeine consumption. Conclusion: In the present study, the authors concluded that more awareness of the harmful effects of drinking caffeine and the likelihood of getting hypertension is desperately needed to reduce the risk of acquiring any of the numerous cardiovascular conditions.

Review on Prevalence of Musculoskeletal Disorders in Nurses and Sweepers

Harman, Neha, Gurleen Kaur, Arpit Bansal

Introduction: Studying the prevalence of musculoskeletal disorders in health care professionals like nurses and sweepers is important because it helps us to understand the impact of their work on their physical health by identifying the common disorders and risk factors. Aim: To find out prevalence of musculoskeletal disorders in nurses and sweepers. Materials and Methods: This research was conducted on nurses and sweepers. We searched PubMed, Google-Scholar and selected cross-sectional population- based or cohort study that provide a view on work-related musculoskeletal disorders among nurses and sweepers. Results: Work Related musculoskeletal disorders prevalence augmenting. The occupational activities such as lifting, carrying, pulling and pushing the dustbin (cleaners) leads to muscular strain. Female sweepers complaints of body pain (93.33%), pain in shoulder (91.67%), arm (85%), hand/wrist (83.33%) due to repetitive job which require heavy physical effort needed in carrying out. In nurses, most vulnerable anatomical sites of WRMSD are vertebral column (45.70%), followed by shoulder (23.50%), neck (28.50%), knee, ankle and feet (20%). Physical demand of nursing profession are bending and twisting movement. Conclusion: Description of the 15 studies located during this review had either measured the prevalence of MSD or reported on the possible risk factors for the MSD among nurses and sweepers. Implication: It is important to raise awareness about ergonomics, provide training on proper body mechanics.

Factors Contributing to Abdominal Obesity among Young Adults

Hemlata, Nidhi Sharma, Simranjeet Kaur

Introduction: In general obesity, adipose tissue increases in the overall body, and it is generally represented by BMI while in abdominal obesity fat accumulates specifically in the abdomen and is measured such as waist circumference, waist-to-hip ratio, and waist-to-height ratio (WHtR). Aim: This study aims to gather all the factors that can contribute to abdominal obesity. Materials and Methods: The literature search was conducted in the electronic database (PubMed and Google Scholar). By using the key terms risk factor, abdominal obesity, genetic traits, and young adults, factor affecting. The search was made between 2002 and 2023. Therefore, the inclusion and exclusion criteria are young adults, both males and females were recruited, and metabolic disorder, and abdominal surgery respectively. Result: By using key terms, found 1195 articles, out of these 20 articles were included (5 Reviews, 9 Observational studies, 3 Surveys, 1 RCT, 1 Cohort study). These are the common factors that prompt the abdominal obesity such as physical inactivity, insulin resistance, eating disorders, increased testosterone levels, signal transducer and activation of transcription 3 genes (STAT3 Gene) and low altitude. Conclusion: The study indicates that a sedentary lifestyle and genetic mutations significantly contribute to the development of abdominal obesity. The physiotherapy program for abdominal obesity involves personalised exercise regimens, regular progress monitoring, and lifestyle education, focusing on strength training, core stability, and aerobic activities.

Association between Body Mass Index and Heart Rate in School-going Children

Tanishak, Sunanda Bhowmik

Introduction: The link between Body Mass Index (BMI) and Heart Rate (HR) in school-age children is an important area of study due to its potential impact on health fitness. BMI, a measure of body fat based on height and weight, and heart rate, an indicator of cardiovascular health, are being investigated together to gain a better understanding of children’s overall well-being and potential risks for heart-related issues. Aim: To determine if there is association between body mass index and Heart Rate (HR) in School-going children. Materials and Methods: This was a correlation study, 284 school-going children aged between 6 to 12 years were selected according to the inclusion criteria, and categorised into underweight (uwBMI), normal weight (nBMI), and overweight (owBMI). Their age, height, and weight, gender also was recorded. They underwent a Modified Shuttle Test Paeds (MSTP) procedure three trials each for 3 minute, Pre and Post intervention HR was recorded through a pulse oximeter. Results: The findings of this study suggest poor association for HR Pre_uwBMI was (r=0.38); HR Post_uwBMI was (r=0.71), HR pre_nBMI was (r=0.55), HR post_nBMI was (r=0.44), HR pre_owBMI was (r=0.17); HR post_owBMI was (r=0.28) respectively (p-value_<0.005). Conclusion: This study concludes that, there was no association among different BMI on heart rate of students aged between 06-12 years.

Effect of Conservative Management of Sacroiliac Joint Dysfunction in a Patient with Posteromedial Knee Pain: A Case Report

Mansi Dewan, Deepak Tyagi, Nitin Sharma, Harsh Raj

Over the world, knee discomfort is a major problem. Since this discomfort is mostly associated with muscular dysfunction, it has been suggested that early in the rehabilitation process, efforts should be made to reduce muscle inhibition as this can postpone functional recovery. Studies have shown that a patient may only suffer knee pain in some circumstances, if a more proximal structure such as the hip or sacroiliac joint is impacted. This necessitates assessing pain referral from a proximal structure. The purpose of the present case study was to assess whether conservative treatment for sacroiliac joint improves the muscular dysfunction and functional abilities at the knee joint. A case study of a 27-year-old male who experienced excruciating knee pain during squats and runs is documented. Antalgic gait and decreased left SI hypomobility were seen throughout the examination accompanied by muscular imbalance. The patient reported a significant improvement in knee discomfort after the SI manipulation (VAS-4/10). The deep squat pain subsided and the gait showed signs of recovery. These symptoms improved in the ensuing sessions. When the LEFS was administered on the tenth day of the rehabilitation, the findings showed a significant improvement (LEFS 41 to 56). This case study discusses the connection between sacroiliac joint dysfunction and knee function. The present case study serves as additional evidence of the importance of a thorough regional assessment in preserving the equilibrium between the proximal and distal portions of the kinetic chain. Therefore, sacroiliac joint exams can be beneficial for patients and therapists when performed on individuals who are having knee pain.

Can Neurobic Exercises be used as an Efficacious Approach to Improve Reaction Time among Runner? A Case Report

Pooja Sunil Patil, Amit Kumar, Shashi Prakash Sharma

To find the effectiveness of Neurobic exercises, recreational runner, male, aged 23 years was selected for this case reported on the basis of inclusion criteria. A planned five weeks Neurobic exercises protocol was created with an emphasis on reaction time improvement. This protocol included: Lazy eights, backward walking, cross crawls, ankle touch, brain buttons, and trace X. For the quantification of improvement three outcome measures were used; Sprint with 90 degrees turn, sprint 9-3-6-3-9 meters with 180 degrees turn, sprint 9-3-6-3-9 meters with backward and forward running. Neurobic exercises work as an effective treatment for efficient and quick decision making while creating new associative patterns using neuroplastic approach. This case report demonstrates how a runner can benefit and improve his reaction time and boost his field performance. Positive results emphasise how crucial Neurobic exercises are for supporting sports players for their betterment on field.

Testing the Significance of Backward Drill Exercise Protocol in Alleviating Pain and Enhancing Strength in Patello-femoral Pain Syndrome Patients

Aniruddha Ratnaparkhi, Sakshi Sadhu

Introduction: Patello-femoral Pain Syndrome (PFPS) is a common musculoskeletal disorder characterised by anterior knee pain, particularly during activities like climbing stairs and squatting and long running. Despite its prevalence, effective rehabilitation strategies for PFPS remain a topic of research. Aim: To assess the significance of a novel backward drill exercise protocol in reducing pain and improving strength among PFPS patients. Materials and Methods: A randomised controlled trial will be conducted with 40 PFPS patients aged 18-30 years. Participants will be randomly assigned to either the backward drill exercise group or a control group (receive standard physiotherapy treatment protocol). Both groups will undergo a 6-week interventional program. Pain levels will be assessed by using the Visual Analog Scale (VAS), and muscle strength will be measured using a dynamometer, EMG study will be done for Vastus Medialis Obliquus muscle to check its activation before and after the intervention. Discussion: This study will test whether backward drill exercise protocol is a significant intervention for PFPS patients to effectively reduce pain, enhancing quadriceps strength and activation of the Vastus medialis obliquus muscle. Implementing this exercise protocol in the rehabilitation of PFPS patients may offer a promising alternative to standard physiotherapy approaches, potentially improving patient outcomes and quality of life.

Exploring the Efficacy of Constraint-induced Movement Therapy on Hand Function Rehabilitation in Stroke Survivors: A Review

Simran, Aman Kanda, Neha Kashyap

Introduction: Stroke is the abrupt loss of neurological function caused by an arrest of the blood flow to the brain which deprives brain tissue of oxygen and nutrients. Majority of people with stroke experience some degree of motor impairment in their upper extremities. Constraint-Induced Movement Therapy (CIMT) is a multi-faceted intervention which promotes affected upper extremity. It involves constraining the movement of unaffected limb while synchronously engaging in intensive training and exercises with the affected limb. Aim: To emphasise the effect of CIMT on hand function rehabilitation in stroke patients. Materials and Methods: An extensive search on various databases was carried out including Ovid, Google Scholar, Medline, PubMed, Research gate and Scopus. Studies done in last 15 years were included in the review. Results: CIMT showed significant improvements in grip strength, dexterity and overall functional use of the affected hand and with long lasting effects, indicating the enduring effectiveness in facilitating hand function recovery. Conclusion: CIMT is an effective intervention for improving hand function among stroke patients.

Study Over Factors Leading to ACL Injuries in Female Athletes

Archisman Mitra

Introduction: There has been some past physiotherapeutic interventions for ACL injury management by compiling every factor that contributes to such injuries and proposing further areas of research. Aim: To understand the factors leading to such increased amount of ACL injuries in female athletes and also suggest role of physiotherapy in dealing such injuries. Materials and Methods: Cases of professional female athletes in ball playing sports from the age of 18 to 32 years were studied. An exploratory review of relevant articles were done. All articles explicitly explaining the factors for increased risk of ACL injuries in female athletes were included. Articles in english language were only considered. Results: The major factors playing role in increased ACL injuries in female athletes can be categorised into, structural (comprising Q angle and valgus tendency, smaller inter-condylar fossa, quadriceps dominance, reconstruction problems), hormonal (oestrogen Increase effects), biomechanical (poor landing mechanics) factors. Conclusion: The found factors help us better understand the problems to tackle to effectively rehabilitate female athletes and reduce their injury probability. Implication: These findings can guide further research efforts aimed at enhancing evidence-based practices in physiotherapy for ACL rupture in female athletes.

Role of Physical Therapy in Treating Infertility- Beyond Basic Physical Therapy

Mansi Dewan, Kangana Juneja, Ankita Samuel, Mehak, Monika, Aryan Gupta

Introduction: Infertility is defined as the inability of a sexually active, non-contraceptive couple to conceive within a year of one another. There is scarcity of literature to evaluate the effects of manual therapy in combating infertility. Aim: To address the possible outcomes of various manual therapy techniques and the data that currently supports their efficacy. Materials and Methods: The extant literature supports the efficaciousness of manual therapy as a treatment for female infertility. This narrative review looks at the results that can be obtained from a number of manual treatment methods as well as the evidence that currently supports their effectiveness. Results: The use of osteopathic care illustrated a variety of concepts and techniques for diagnosis and treatment. Osteopathy may be able to reverse infertility, despite the scant evidence supporting this theory. It is highly recommended to do more research with more thorough descriptions of the intervention and different study designs. Conclusion: The range of manual therapy techniques is indicative of several scopes that provide encouraging options for infertility treatment. Infertility serves as a subtle stigma for couples. The creation of innovative therapy strategies can help the infertile couple live happy, full lives and overcome this stigma.

Effectiveness of Dynamic and Rigid Taping in Subacromial Impingement Syndrome: A Review

Muskan Manaktala, Kanu Goyal, Manu Goyal

Introduction: Subacromial Impingement Syndrome (SIS) is a condition characterised by the narrowing of the shoulder complex between the acromion and the humeral head. It is caused by entrapment of the subacromial bursa, biceps tendon, teres minor muscle, supraspinatus, and infraspinatus between the humeral head and coracoacromial arch. This entrapment results in shoulder pain and inflammation. Physiotherapy is frequently regarded as the initial course of treatment for SIS. Theories have suggested that taping corrects alignment through dynamic motions or induces proprioceptive input. Taping procedures increase the strength of muscles, improve function, and lessen pain. Aim: The aim of this review is to ascertain daily physical activities in subacromial impingement syndrome. Materials and Methods: This review utilised PubMed, Cochrane, Google Scholar, and ProQuest to search relevant literature, and identified 7430 studies from the last 10 years. After removing duplicates, 5470 titles and abstracts were screened, with 11 studies assessed. Results: The study found that dynamic and rigid taping significantly improved pain and physical activity ratings in subacromial impingement syndrome patients, but not recommended for long-term effects. Further high-quality research is still required to confirm these results. Conclusion: Dynamic and Rigid Taping improves physical activity, reduces pain, and decreases myoelectric activity in specific muscles, but may not be a standalone alternative for treating Subacromial Impingement Syndrome.

Physiotherapy Intervention in Nocturnal Leg Cramps: A Review

Niyti, Kanu Goyal, Manu Goyal

Introduction: Nocturnal Leg Cramps (NLC) are painful, involuntary spasms of the calf, hamstring, or foot muscles at night, causing severe pain and disrupting sleep. Through physiotherapy interventions, we can prevent the nocturnal leg cramps. In NLC, on palpation muscle became tender or hard and affect or disturb the sleep. The study is done to know about the various physiotherapy intervention and its effectiveness in nocturnal leg cramps, based on various articles. Aim: To identify the most effective physiotherapy intervention for reducing or preventing nocturnal leg cramps, based on various articles. Materials and Methods: This review utilised PubMed, Cochrane, MEDLINE databases are searched to find the desired articles. In addition, physiotherapy interventions of the desired articles were checked to conduct the study. Older adults (above 55 yrs. of age), Pregnant female and patient with lumbar degenerative disorder were included. Results: Eight articles highlight the effectiveness of various physiotherapy interventions, including tendoachilles, hamstring and calf stretching, moist heat pack, cryotherapy, self-myofascial technique in reducing nocturnal leg cramps, including in pregnant females. Conclusion: The stretching is the more effective in reducing the nocturnal leg cramps as compared to other physiotherapy interventions but further high-quality research is still required to confirm these results.

Normative Reference Score of 6×10 M Shuttle Run Test among North Indian Collegiates Athlete

Sujan Gharti Chhetri, Joydip Saha

Introduction: The 6×10 M shuttle run test is a widely used measure of agility, speed, and anaerobic performance among athletes. Agility is a crucial component of athletic performance, particularly among collegiate athletes who compete at high levels of intensity and skill across various sports. Understanding the significance of agility in this population is essential for optimising training strategies, injury prevention, and overall athletic success. Aim: To establish a normative reference score of a 6×10 M shuttle run test among college-going students. Materials and Methods: A Total of 43 college-going male and female students between 18-26 years are included in this study through convenient sampling technique to establish the normative score of the 6×10 M shuttle run test. A total of three repetitions of running back and forth over a 10 M distance, with their times recorded. Results: Normality of the data was calculated by using Shapiro-wilk test as the present sample size was less then 50 and the data came out to be normal. Hence their normative value is represented in terms of mean with standard deviation. Conclusion: The analysis of the study established a normative reference score of 6×10 M shuttle run test is 22.87 with a standard deviation of 2.304. Implications: This result will help to determine the normal value of agility among college-going students.

Development of Self-administrative Questionnaire to Assess Shin Pain among College-going Students

Vikash Chahal, Joydip Saha

Introduction: Shin pain, or shin splints, is mainly an overuse injury in athletes that occurs mainly in the anterior aspect of the tibia. It commonly occurs in athletes who are involved in activities like running and jumping and in military personnel who perform drills as part of their daily routine. The main causes of shin pain are not known yet, but there are many studies that show different views on its occurrence. Aim: To develop a self-administrative questionnaire to assess shin pain among collage going students. Materials and Methods: A total of six experts from physiotherapy profession and currently working as an assistant and associate professor in different universities from India were included in this study for content validation of the questionnaire. Three stages went into developing the questionnaire. We do a thorough literature review to determine the questionnaire’s domain in the first phase. Subsequently, the domain was examined to identify the questionnaire items by means of participant interviews and expert judgments. Subsequently, the questionnaire is sent to six experts for content evaluation using Delphi methodologies. Results: The newly developed questionnaire has CV-I index of 0.98. Conclusion: The self-administrate questionnaire used in the present study is highly validate tool.

Is there any Correlation between Knowledge Level, Health Protective Practice, and Depression among Physiotherapists Working in Intensive Care Units?

Manisha, Sunanda Bhowmik

Introduction: The correlation between knowledge level, health-protective practice, and depression among physiotherapists in Intensive Care Units (ICUs) is a significant area of inquiry. Understanding this relationship is vital for optimising healthcare delivery and ensuring the well-being of healthcare professionals. This study aims to explore the interplay between these variables to enhance support mechanisms and improve overall ICU working conditions. Aim: To examine the correlation between, the level of health-protective practices, depression, and knowledge level among physiotherapists working in ICU. Materials and Methods: The material required includes, good network service, and an online Google form. Circulate the Google form and complete the data collection within 3 to 4 days which includes 18 questions and then go for the data analysis for the same. The participants were identified from different medical hospitals equipped with ICUs, and an online survey was done to assess their knowledge levels, health-protective practices, and depression levels. Hundred forty-eight Physiotherapists working in ICUs aged between 20-40 years. Results: There were 54% of physiotherapists had >15 days posting duration 46% of physiotherapists had <15 days posting duration 64% had a high knowledge level of ICU training. 61.78% of physiotherapists suffered from depression. A total of 94.28% of physiotherapists used health-protective practices in work life. Conclusion: The study concludes female physiotherapists had very high knowledge levels of ICU training and most of them suffered from depression. Females are more affected in comparison with the male.

Virtual Reality: A Game Changer in Cardiac Rehabilitation

Simran Kaur, Neha Kashyap

Introduction: Virtual Reality (VR) technology creates a three-dimensional virtual environment that mimics the actual world, allowing users to interact with its features and engage in variable exercise where essential components include intensity, repetition, and feedback. It is a computer-generated simulation consisting of sounds and visuals that mimic an actual location or circumstance. Aim: To determine whether VR balance or gait training is superior to traditional balance or gait training for patients. Materials and Methods: An extensive search on various databases was carried out including Ovid, Google Scholar, Medline, PubMed, ResearchGate and Scopus. Researches, RCT’s and reviews done in last 10 year were included for this review. Conclusion: It has been discovered that virtual reality can evoke acute stress reactions accompanied by the activation of the sympathetic nervous system and a decrease in the activity of the parasympathetic nervous system. It is a powerful tool for individual to acquire new learning for the benefit of their psychological well-being.

Effect of Active, Passive and Non-smoking on Aerobic Capacity among Young Collegiates

Aakrit Sharma, Mandeep Kumar Jangra

Introduction: The Cardiopulmonary health of young collegiates is important, especially considering the prevalence of smoking within this demographic. Despite widespread awareness of risks, many college students still smoke actively or are exposed to second hand smoke. Understanding these effects on young adults is vital for targeted interventions to reduce risks. This study aimed to explore how various smoking statuses affect the Cardiopulmonary health of young college students, to provide strategies to promote healthier lifestyles and lessen the burden of smoking-related diseases in this demographic. Aim: To investigate the effects of active and passive smoking on aerobic capacity among young collegiates. Materials and Methods: A total of 60 participants with a mean age of 21.7±1.4 years were randomly divided into three groups: active, passive, and non-smokers. Aerobic capacity was assessed using the Queen’s College step test. Participants stepped for threeÂ minutes with a cadence of 22 steps/minute for females and 24 steps/minute for males. Heart rate was recorded immediately after the test for 15 seconds and multiplied by 4 to obtain the rate per minute. Results: Active smokers exhibited the lowest VO2 max, followed by passive smokers, while non-smokers demonstrated the highest aerobic capacity. But there was no statistically significant difference in VO2 max among the groups; active-passive (p=1.000), passive and non-smokers (p=0.299), active and non-smokers (p=0.113). Conclusion: Although there was no significant change in aerobic capacity, lower VO2 max was observed among active smokers followed by passive smokers.

Development of Self-administrate Questionnaire to Check the Effect of Prolong Standing on Fatigue among Healthcare Professionals

Sonam, Joydip Saha

Introduction: Fatigue is commonly characterised as an extreme state of being tired and feeling exhausted. There are two types of fatigue: Mental which leads to reduced concentration and Physical which leads to decrease in performance. One of the major occupational risk factors that lead to fatigue is prolonged standing. Healthcare professionals are also affected by this issue as they have to stand prolong time in their duty hours. Aim: To find the effect of prolong standing on fatigue in the healthcare professionals. Materials and Methods: The Questionnaire was developed in three phases. In first phase we identify the domain of the questionnaire by doing intense literature survey. Then items of the questionnaire were identified from the domain by taking interview from the participants and taking expert opinion. Then we send the questionnaire through Delphi methods to 9 experts for content validation of questionnaire. All the experts are from physiotherapy profession and currently working as an assistant and associate professor in different universities from India. Results: Newly developed questionnaire has content validity index of 1 for all the items included. Conclusion: The developed questionnaire has the significant content validity to check the fatigue among healthcare professionals. The questionnaire was designed to capture the specific type of fatigue that is most relevant to prolonged standing.

Development of Self-administrative Questionnaire to Check Effect of Menstrual Cycle on Physical Activity

Dilrose Kaur Toor, Joydip Saha

Introduction: The menstrual cycle is a crucial biological rhythm typically lasting 21 to 35 days, averaging 28 days, is vital for female athletes. Increasingly, women in sports are recognising menstrual cycle impact on performance due to hormonal fluctuations. Sensitivity to these changes varies, potentially affecting exercise tolerance and energy levels during training and competition. Recognising these dynamics is crucial in physiotherapy to optimise athletic performance with tailored interventions, considering the menstrual cycle’s impact on the female body. Aim: To develop a questionnaire to examine the influence of the menstrual cycle on physical activity. Materials and Methods: To evaluate the impact of the menstrual cycle on physical activity, a self-administrative questionnaire was formulated in three stages: establishing the questionnaire’s scope through reviewing literature, determining questionnaire components by consulting participants and experts feedback, and verifying its content validity with the input of eight experts using Delphi method. These eight physiotherapy experts are serving as assistant and associate professors at various universities in India, contributed to this validation process. Results: Newly developed questionnaire has content validity index of 0.98 for all the items included. Conclusion: This questionnaire is a valid tool for assessing the impact of menstrual cycle phases on physical activity of young adult.

Analysing the Impact of Work-related Musculoskeletal Disorder among Chefs in Different Categories: A Narrative Review

Sourabh Kaushal, Nidhi Sharma, Simranjeet Kaur

Introduction: Chefs are essential contributors to the culinary industry, yet they face unique challenges in their work environment that predispose them to Work-Related Musculoskeletal Disorders (WRMSDs). Aim: This study examines the influence of work-related musculoskeletal disorders on chefs across various categories. Materials and Methods: This review studies chefs in various culinary fields, including cooks, pastry chefs, and sous chefs within the age range of 25 to 45 in both commercial and restaurant settings. A comprehensive literature search was conducted utilising electronic databases like PubMed, Google Scholar, and Scopus. By using the key terms work-related musculoskeletal disorders, chefs, and culinary industry articles were searched from the year 1998 to 2023 based on the impact of WRMSDs on diverse categories of chefs, and published within the last 25 years. Results: By using key terms, 675 articles were retrieved related to WRMSDs, out of which 16 articles (6 cross-sectional studies, 4 observational studies, 2 reviews, 2 surveys, and 2 experimental studies) were included for the review that assessed the prevalence, risk factors, consequences, management strategies, and interventions related to WRMSDs. Conclusion: WRMSDs are prevalent and affecting chefs. Risk factors include physical workload, prolonged standing, awkward posture, repetitive movement, and workplace stress. Interventions include ergonomic improvements, workplace modifications, and lifestyle changes.

A Review of Latest Guidelines to Treat Lymphoedema Post Vulva Cancer

Janvi, Suruchi Shreya, Eishika Bloreya, Shweta Kumar

Introduction: The “stages” of Vulva Cancer that describes the size of cancer and how far it has grown and “grades” that describe how abnormal the cell look under the microscope. Vulva is the outer layer of urethra, where cancer cells rapidly spread to skin that often gets associated with poor prognosis. Aim: To create a database of information on vulva cancer led Lymphoedema and to create collection of guidelines on current available literature on rehabilitation of lymphoedema post-vulva cancer. Materials and Methods: The guidelines were searched using the PubMed database. Embase database will be used for literature search using PICOT table. Results: A literature survey table ruled out the guidelines required to be incorporated in the management of lymphoedema cases. Conclusion: This literature review will interpret the guidelines already stated using evidence-based searches and highlight it at one place for the benefit of clinicians. This study will establish clinical guidelines to effectively manage lymphoedema bilateral or unilateral extremities post vulva cancer. Lymphoedema post vulva cancer suffers from poor prognosis due to skin related cancerous changes that usually are malignant in nature. Physiotherapists in this field work towards good quality of life for these patients with effective communication and using short stretch bandages.

Physiotherapy Strategies for Improved Hygiene and Quality of Life in Wheelchair-bound Women: A Narrative Review

Diksha, Sunita Sharma

Introduction: Wheelchairs offer increased mobility and freedom, their usage may introduce supplementary obstacles to engage in daily activities, potentially impact an individual’s overall quality of life adversely. Studies demonstrate that women with disabilities are subjected to emotional, physical, and sexual abuse at notable frequencies and these disabilities frequently result in individuals using wheelchairs. The analysis indicates that girls with disabilities rely on caregivers and family members for mobility, facing difficulties in maintaining hygiene and accessing safe, disability-friendly washrooms. Aim: To investigate the potential benefits of physiotherapy interventions in enhancing hygiene management and overall well-being among women who rely on wheelchairs. Materials and Methods: We conducted searches in English across databases including PubMed, Scopus, and Google Scholar using the keywords “physiotherapy strategies”, “hygiene care”, “quality of life” and “wheelchair-bound women”. For this review, a total 16 articles were selected, comprising 6 narrative reviews, 3 systematic reviews, 4 Randomised Clinical Trials (RCTs), and 3 experimental studies and excludes studies not written in English, conference abstracts, and those lacking relevance to the topic. Results: Physiotherapy interventions for wheelchair-bound women enhance hygiene and quality of life, emphasising personalised approaches and inter-disciplinary collaboration for optimisation. Conclusion: Physiotherapy treatments, such as targeted exercises and instruction, have the potential to alter hygiene care and quality of life for wheelchair-using women, promoting independence and well-being.

Effectiveness of Physiotherapy Intervention in Meralgia Paresthetica in Females: A Literature Review

Nidhi Mor, Kanu Goyal

Introduction: The studies suggest that physiotherapy interventions improve the condition of meralgia paresthetica in females. Aim: To analyse the literature present on the physiotherapy treatment intervention of meralgia paresthetica in females. Materials and Methods: The review utilised PubMed, Google scholar to search relevant and identified 776 studies from last 10 years. After removing duplicates, titles and abstracts were screened, from the literature involving females patients of 30-40 years of age group, and finally 11 were assessed. Results: We included studies consisting of RCTs, Systematic review, clinical trials, correlation studies and meta-analysis. All studies included physiotherapy treatments and interventions. Conclusion: The study concluded that manual therapy, kinesio-taping, PNF, TENS and PFR all extremely effective treatment interventions to manage meralgia paresthetica in females. Implications: The results can be used to conduct further studies to add evidence-based literature in physiotherapy practice.

Development and Content Validation of Survey Questionnaire to Evaluate the Awareness of Alternative Menstrual Care Devices among University Female Students

Navneet Kaur, Sandeep Pattnaik

Introduction: Menstrual care products that are most used in India have historically been sanitary pads for menstrual hygiene and analgesics for period pain. Alternative menstruation care products are, nevertheless, the subject of a growing discourse. Informed decisions about menstrual hygiene and period pain management are being hampered by ignorance about these alternative menstrual care options. Aim: To develop and validate a survey questionnaire to evaluate university female students’ awareness of alternative menstrual care devices for menstrual hygiene and pain relief compared to conventionally used products. Materials and Methods: The study describes two phases of questionnaire development and its validation. At first, an extensive literature review was conducted to frame the 23-item survey questionnaire, which was later validated in the later phase. For content validation, a panel of 9 experts, including gynaecologists, physiotherapists who specialise in menstrual rehabilitation, and social activists, was formed. They were prompted to validate the questionnaire produced in Google Forms after providing their consent. Results: The Content Validation Index (CVI) was used to quantitatively assess the questionnaire’s content validity. The I-CVI score was calculated to be 0.97, which exceeds 0.83, suggesting an excellent content validity. Conclusion: This study successfully developed and validated a survey questionnaire with strong assessment attributes. The developed questionnaire can be used to carry out surveys among females in the menstrual age and based on the results, modifications can be made to menstrual rehabilitation, its implication policies and awareness programs related to it.

Mysophobia and its Impact on General Wellbeing of Physiotherapists attending IPD Duties

Yachika Tyagi, Kanika, Rittu Sharma

Introduction: Mysophobia, or germaphobia, is a pathological fear of germs and poor cleanliness, ranked fifth among all phobias by the Diagnostic and Statistical Manual of Mental Disorders (DSM). The term was coined by William Alexander Hamilton. Its causes are thought to be a mix of psychological, environmental, and genetic factors, impacting mental health and well-being significantly. Aim: To ascertain how mysophobia impact the overall health of physiotherapists who perform IPD duties. Materials and Methods: A total of 300 physiotherapists working in IPD set-ups of different secondary and tertiary health care centres in Haryana, India. A self-administered questionnaire with an item contentÂ validity (I-CVI) of 0.8 and scale content validity (S-CVI) of 0.9 was circulated among physiotherapists working in a tertiary healthcare hospital. Results: This study found that 79.3% of individuals experience anxiety due to germs exposure. This fear affects work performance for 57.9% and leads to excessive hand hygiene practices and affecting their skin integrity and hindering their ability to attend to more patient. Healthcare professionals, especially students, show heightened mysophobic behaviours, impacting patient care and mental well-being. Interventions like therapy and education are needed to address these concerns effectively. Conclusion: Mysophobia impairs general health and limits interactions with patients, which in turn affects their rehabilitation.

Prevalence of Tokophobia among Pregnant Women Electing for Normal Vaginal Delivery and Caesarean-section: A Cross-sectional Study

Isha Walia, Pooja Mehra, Geetanjali Kaul, Varsha Chattanta

Introduction: Normal Vaginal Delivery (NVD) and CaesareanÂ (C)- section are two different mode of delivery that are opted in pregnant women and each method has its own advantages and disadvantages. The pathological dread of child-birth known as “tokophobia” has an impact on women’s health by increasing their risk of physical and psychological morbidity. It includes fear for the infant's life, genital tract, and injuries. Early tokophobia detection is crucial since it can result in long-term anxiety and make daily tasks challenging. Aim: To evaluate the Prevalence of Tokophobia among Pregnant women electing for Normal Vaginal Delivery and Caesarean-section. Materials and Methods: A total of 230 pregnant women (115-NVD, 115- c-section), aged between 18 to 45 years, convenience sampling were enrolled in the study. Kolmogorov Smirnov’s test showed data was normally distributed and was expressed mean (range) and 95% CI. Chi-square test was used to check association of tokophobia with mode of delivery and gravida. Results: Intense fear (35.65%) was observed in women electing for NVD than caesarean section (28%). There was a significant association between mode of delivery and tokophobia (<0.05) and in-significant association between gravida and tokophobia (>0.05). Phi-crammer’s v criteria shows that mode of delivery and tokophobia has strong association (p-value 0.015) and gravida and tokophobia has moderate association (p-value 0.149) respectively. Conclusion: Intense fear was found to be more prevalent among primigravida women opting for NVD.

Impact of Music Therapy on Psychological Health during Pregnancy: A Literature Review

Neha, Rittu Sharma, Jahanvi Dave

Introduction: Pregnancy is a crucial phase for maternal mental health. Pregnancy is a significant period marked by profound physiological and psychological changes in women. While it’s a time of anticipation and joy, it can also be accompanied by various stressors, anxieties, and emotional challenges. Recognising the importance of supporting maternal psychological well-being during this critical phase, researchers and healthcare professionals have explored various interventions, including music therapy. Music therapy has emerged as a promising intervention to support psychological well-being during this period. This paper examines the impact of music therapy on a pregnant mother’s mental health, highlighting its potential as a valuable aspect of prenatal care. Aim: The aim is to explore how music therapy can positively impact the psychological well-being of pregnant women. Materials and Methods: PubMed/Medline and Google Scholar wereÂ searched together recently published articles. By using key terms, music therapy, during pregnancy, and psychological health. This approach includes 11 articles (7 RCT, 3 Reviews, 1Â Observational) from (2007-2021) which showed the effect of music therapy during pregnancy are included and excluded from post-partum women studies. Results: Music therapy is a cost-effective, non-pharmacological intervention, that has been shown to quantifiably decrease postpartum anxiety, pain, and depression while increasing the tolerance for pain and helping to maintain maternal and fetal parameters, promoting safe maternal-fetal bonding, and reducing blood pressure. Conclusion: This study concludes that music therapy is free of cost with very effective treatment during pregnancy to maintain psychological well-being for the mother and foetus.

Managing Myofascial Pain Syndrome: A Multi-disciplinary Approach

Akash Rajput, Manish, Charu Chhabra

Myofascial Pain Syndrome (MPS), a pain originating from muscle and fascia is present with localised tenderness and discomfort in a restricted area or referred pain of different patterns. According to recent studies, there exists a myofascial component of pain in 30% of patients in an internal medicine practice, 55% of those in a head and neck pain clinic, and up to 85% to 95% of cases in a clinic. With a prevalence rate of 30% to 85% amongst patients with musculoskeletal pain, this syndrome is usually found in the population aged from 27 to 50 years with greater incidences in females than males. Although the cause is unclear, repetitive, prolonged tasks, cause increase in stress of the muscle fibers leading to muscle strain, fatigue, hypoxia and ischemia.it is believed that intracellular calcium pumps, which are responsible for inducing sustained muscle contraction, are dysfunctional due to energy depletion, resulting in the development of taut bands. In conservative physical therapy practice, emphasis is laid on the use of electro-therapeutic modalities such as ultrasound, transcutaneous electric nerve stimulation, and therapeutic massage or soft tissue manipulation for symptomatic relief in patients with MPS. Although these non invasive techniques, have a temporary effect, but the root cause of the problem is not rectified. With the advent of technology, low-level laser therapy has proved to provide tremendous benefits when used with stretching techniques, post-isometric relaxation, active release techniques, trigger point pressure release, muscle energy techniques, massage. Latest researches lay emphasis on the use of dry needling and cupping therapy as individual therapies, and as combination therapy in patients with MPS. These approaches are not only time saving and effective; these have minimal risk of dependence and are easy for use for the therapist with considerable expertise in the field.

Questionnaire to Assess the Influence of Short-form Videos on University Students’ Attention Span and Concentration: Development and Content Validation

Shashank Malhotra, Sandeep Pattnaik

Introduction: The attention span and concentration of students are often hypothesised to be influenced by the addiction to Short-Form Videos (SFVs). Although the idea about such impact of SFVs has suddenly boomed across the globe, the earlier literature lacks a valid self-administered questionnaire to assess people’s perceptions of the impact of SFVs on their attention span and concentration. Aim: To develop and validate a survey questionnaire that can be used to assess the impact of addiction to SFVs browsing on the attention span and concentration of university students. Materials and Methods: The study describes two phases of questionnaire development and its validation. At first, an extensive literature review was conducted to frame the 26-item survey questionnaire. For content validation in the second phase, a panel of 8 experts, including physiotherapists, psychologists and psychiatrists who specialise in neuro-psychological rehabilitation with a minimum of 5 years of relevant experience was formed. After giving their consent, they were asked to validate the Google Forms questionnaire. Results: The Content Validation Index (CVI) was used to quantitatively assess the questionnaire’s content validity. The I-CVI score was calculatedÂ to be 0.94 (>0.83), thus suggesting excellent content validity. Conclusion: This study successfully developed and validated a survey questionnaire with strong assessment attributes, that offers a valuable tool for researchers investigating the relationship between SFVs use and students’ cognitive abilities, paving the way for a deeper understanding of the potential influence of these popular media platforms on academic performance.

To Check Aerobic Capacity and Fatigue Index of Asymptomatic Young Adults: A Pilot Study

Neetu Swami, Arihant Pandey, Shweta Kumar

Introduction: The 6-minute walk test is a submaximal exercise test used to assess aerobic capacity and endurance. This test helps the researchers understand the importance of physical activity and exercise tolerance. It is very useful in elderly and frail patients, but the present study will establish data for young asymptomatic individuals. Aim: To assess the utility of 6-minute walk test to monitor the progress of functional capacity, aerobic capacity and endurance of the asymptomatic individual. Methods: Instruct the patient to walk as far as they can without running in a 30 m long hallway. If a subject stopped before the 6thÂ minute were up operator decided that he\she should not continue the reason for stopping was recorded. Results: The participants in the study were analysed based on pre-post values of SpO2, fatigue and heart rate. Statistical Package for Social Sciences (SPSS) version 21.0 was used to analyse the data and paired test was used to analyse the results further. Conclusion: 6-minute walk test is a submaximal exercise assessment tool to gauge a person’s endurance and functional capacity. This test is mild to moderate activity and can be used to determine the exercise tolerance and cardio-respiratory fitness. The test can be used to evaluate the physical performance of asymptomatic young adults’ young individuals.

A Comprehensive Review to Determine the Effect of Dehydration on Various Health Conditions

Luckshita, Nidhi Sharma, Simranjeet Kaur

Introduction: The effects of dehydration on medical ailments have significant relevance to physiotherapy, as it impacts multiple facets of patient care including pain management, joint health, muscular function, recuperation, and cognitive function. To enhance patient results and promote overall well-being, physiotherapists need to incorporate considerations of hydration status into their therapy approach. Dehydration is the state in which the body loses more fluid than it takes in, which throws off electrolyte balance and impairs biological processes. Aim: To review the imbalance which may cause minor to severe health consequences depending on the level of dehydration and personal variables. Materials and Methods: Commencing with PubMed, and Google Scholar, the authors here looked through the databases. key terms were used such as dehydration, health effects etc. Those with dehydration-related disorders were included in this group. Results: Out of 201 Nine studies in total, including three cross-sectional, four case studies, one longitudinal, one retrospective, and one stating the impact of dehydration on health. Conclusion: Dehydration can have complex effects on various health parameters, such as exercise tolerance, cardiovascular health, cognitive function, and musculoskeletal function. In physiotherapy, where the main goals are movement retraining, functional restoration, and rehabilitation, taking hydration into account is critical.

Leveraging Physiotherapy to Combat Children’s Mental Health

Anshika Goel, Shweta Sharma

Introduction: In the realms of mental health, psychiatry physiotherapy has evolved as a renowned specialisation. In the backdrop of mental health, human mobility, functioning, physical activity, and exercise were all addressed in physiotherapy both individually as well as collaborative sessions. For managing children’s psychological disorders (attention deficit hyperactivity disorder, cerebral palsy) multiple physiotherapy regimen serves, including pilates and relaxation techniques, as well as to foster their mental health. In the arena of pediatric psychiatry, physiotherapy possesses a lot of space to evolve. Aim: To map out the synergies between children’s mental health and physiotherapy. Materials and Methods: To retrieve full-text publications, we commenced by digging through databases, notably PubMed, Google Scholar, and Scopus. For this narrative review, 20 publications were scrutinised. This encompasses publications or articles that dealt with pediatric population to gauge the sanctity of their perturbed mental health, which incorporates 8 reviews, 5 experimental, 2 observational, 2 cross-sectional, and 3 survey studies. Results: To ascertain the result, 20 articles were screened for the analysis, which states that integrating the practice of physiotherapy into the oversight of children’s mental health unveils an extensive approach. As reported by many studies, consistent engaging in exercise overcomes anxiety and depression. Furthermore, the mental health evaluations demonstrated substantial variation between the low, medium, and high physical activity groups; these disparities indicate, level of higher physical activity possess better mental health. Conclusion: This study concludes that engaging in physical activity has the potential to contribute for pleasant psychological ramifications.

Breast Distension and Mastitis Amid Lactation: An Obligation for Physical Rehabilitation- A Narrative Review

Sandhya Sharma, Shweta Sharma

Introduction: Physical therapy targets posture, muscle tension, and lymphatic drainage, among other aspects, and can be effective for preventing breast mastitis during lactation. Therapeutic ultrasonography, massage, and exercise are a few of the techniques that can help minimise pain, enhance circulation, and promote the healing process. In scenarios of mastitis and breast apprehension, comprehensive physical therapy indicated worth it. Aim: To figure out the efficacy of physiotherapeutic intervention to supervise breast mastitis in lactating mothers. Materials and Methods: For determining full text publications, we pursued by browsing databases comprising PubMed, Cochrane, Google Scholar, and Scopus. In the context of the analysis, the reference outlines of the retrieved articles were also assessed. This narrative review entailed 20 publications in all, representing 7Â reviews, 3 experimental investigations, 4 cross-sectional studies, 3Â randomised control trials, 1 retrospective study and 2 case report. Results: The analysis covered 15 publications in order to acquire the outcome, which anticipated that conservative management is likely to be productive. Breast-feeding mothers can encounter re-assurance from breast discomfort via physical therapy interventions. There were statistically significant drops in challenges with breast-feeding and pain. Conclusion: It’s concluded that physiotherapy is a key component of breast mastitis treatment. A comprehensive physical therapy strategy involving ultrasonography, specialised manual techniques, and patient education has been demonstrated to be quite helpful in mastitis in feeding women.

Physiotherapy in Prevention and Management of Herniated Disc

Chetna Chaprana, Smriti Bhatia, Nilesh Bhargava

Introduction: A herniated disk is also known as a slipped, ruptured or bulging disk. It’s one of the most common causes of neck, back and leg pain. Every year, up to 2% of people get a herniated disk. Herniated disks are a leading cause of neck, back and leg pain. Aim: To discuss role of physiotherapy in prevention and management of herniated discs. Materials and Methods: Data was collected from Pubmed, Physiotherapy Evidence Database (PEDro) and Google Scholar. Results: Most of the papers were in the favor of physiotherapy in management of herniated disc. Physiotherapy helps in managing pain and prevents this problem by maintaining a good posture. It also helped in increasing range of motion by performing specific exercises. It was found that core strengthening and exercises can help surrounding muscles of spine and hip and pelvis. Physiotherapy also helps in regaining muscle endurance. Conclusion: The provision of physiotherapy programs and form of infrared, tens, stretching hamstrings and core exercises performed two times a week for four weeks helped in reducing pain and improve functional ability in patients.

Exploring the Efficacy of Ultrasonic Therapy for Ankle Sprains: A Narrative Review

Sejal, Sunita Sharma

Introduction: Ankle sprains are musculoskeletal ailments resulting in discomfort, oedema, and functional impairment. Ultrasound has been used extensively to treat a wide range of musculoskeletal conditions including ankle sprains by reducing pain, swelling and improving joint motion. Aim: To determine if ultrasonic therapy is effective in alleviating the symptoms of ankle sprain. Materials and Methods: We started by looking through the databases, which included Google Scholar, PubMed, and Scopus and as per the inclusion criteria. A total of 7 articles were reviewed out of which there were 3 RCTs, 2 case series assessing ultrasonic treatment for ankle sprains, investigations examining pain severity, and 2 systematic reviews were all considered. Results: The outcomes showed conflicting results. Following ultrasonic treatment intervention, limited studies found significant improvements in pain relief and swelling reduction however, others in majority did not discover any appreciable variations. It is possible that differences in treatment parameters, like the frequency and intensity of ultrasonic therapy, played a role in the inconsistent studyÂ results. Conclusion: Ultrasonic therapy appears to be a supplementary treatment option for ankle sprains but it is less effective. Clinicians can maximise the therapeutic potential of ultrasound to improve functional outcomes and speed up recovery for patients by clarifying the treatment parameters.

Effectiveness of Physiotherapy Intervention following ACL Reconstruction of Grade 3 ACL Tear: A Case Report

Mohit Bansal, Rittu Sharma, Abhishek Kori, Kanika

Individuals with third grade Acute Cruciate Ligament (ACL) tear commonly face lower limb function impairments like pain, difficulty in prolong standing and reduced Range of Motion (ROM). The prevalence of ACL tear is approximately 87% for both males and females who are engaged in sports. Hence, effectiveness of physiotherapy for post-ACL surgery patients of ACL tear to bring them to their optimal level of functioning needs to be checked. A 27-year old male patient with grade 3 ACL tear reconstruction was recruited and given physiotherapy intervention for 5 weeks. Pre-Post (after surgery) intervention changes were recorded by Visual Analog Scale (VAS), ACl-Return to Sport after Injury (ACL-RSI) and ROM of left Knee. After 5 weeks of intervention, pre-post-intervention changes were as VAS (7 to 1), ACL-RSI (39 to 67/100) and ROM (active Knee flexion 35° to 74°). The results suggest that physiotherapy intervention is much beneficial approach for better recovery or to maintain the optimise level of functioning in individual with ACL grade 3 reconstruction. Post surgery Physiotherapy intervention program can be the beneficial approach for better and early recovery in grade 3 ACL tear reconstruction.

Knowledge, Attitude and Practice of Tele-rehabilitation among Physiotherapists Working in Haryana

Vishaka, Kanika, Rituraj Mandal

Introduction: In this burgeoning epoch, tele-rehabilitation represents an emerging method to rehabilitate patients without the necessity of commuting. Tele-rehabilitation facilitates un-interrupted service provision throughout the entire rehabilitation process, encompassing assessment, intervention, consultation, and education. Aim: To find out the knowledge, practice, and attitudes towards TR among physiotherapists working in various settings. Materials and Methods: A self-administered questionnaire, withÂ an Item Content Validity Index (I-CVI) of 0.78 and a Scale Content Validity Index (S-CVI) of 0.84, was distributed among physiotherapists workingÂ in a tertiary healthcare hospital. Results: The study showed that out of 365 participants, 69.4% were aware of TR. 64.2% reported using TR in conjunction with physical rehabilitation for patients who are unable to commute daily, aiming to enhance their recovery. Surprisingly, 71% of physiotherapists displayed a negative attitude toward TR and considered it a waste of time, citing the inability to achieve recovery without physical contact, 64.3% expressed concerns that TR hinders the recovery process by impeding the assessment of muscle recruitment. A total of 77.3% of physiotherapists reported not utilising any applications for tele-rehabilitation. Additionally, 72.7% identified network errors as the primary distraction during tele rehabilitation sessions. Conclusion: Although the knowledge and practice of tele-marketing among physiotherapists are relatively high, there is a pressing need to address and alter their negative attitudes toward tele-rehabilitation practice. The findings of this study will assist physiotherapists to have extended knowledge of tele-rehabilitation use so that they can implement in their clinical settings and larger number of patients having various impairments can be benefitted from the same.

Unravelling the Evidence: Craniosacral Therapy for Migraine Relief- A Review

Jasleen Kaur Grover, Subhasish Chatterjee, Mousumi Saha

Introduction: Cranio-sacral Therapy (CST) is a non invasive method which can help patients with migraine. Reviews are needed to explore the effectiveness of the same and also the most effective treatment frequency and duration need to be recommend. Aim: To evaluate the effectiveness of CST in managing pain and migraine attack frequency among migraineurs. Methodology: Relevant articles were identified by searching major databases (PubMed, Physiotherapy Evidence Database, Cochrane Library) published between 2000 and 2023 on adult participants who received CST with a history of migraine for atleast one year. The focus was to find whether effectiveness of CST was superior to sham interventions in participants with migraines. A standardised approach was used to assess the quality and potential biases within each study using Physiotherapy Evidence Database (PEDro) scale and robvis tool, followed by an evaluation of the overall strength of the evidence using a recognised framework. Results: The present search identified 38 studies, of which only 5 trials met the strict criteria for inclusion in this review. These studies consistently showed that CST was more effective than sham therapy in reducing both migraine frequency and pain intensity. Additionally, the results suggested that CST may not only decrease migraine frequency but also improve overall quality of life. Conclusion: CST is a gentle and safe approach and can be a valuable complementary therapy that may help reduce both the frequency andÂ intensity of migraine episodes compared to other interventions. Implications: It’s crucial to seek treatment from a qualified cranio-sacral therapist for optimal safety and effectiveness.

Reliability and Validity of 3-Meter Backward Walk Test in Individuals with Balance Impairments: A Literature Review

Palkin Arora, Kanu Goyal, Manu Goyal

Introduction: Balance tests are helpful in assessing a population with variety of conditions. Computerised dynamic posturography, and other tools for balance assessment are expensive, difficult to handle/use and also not readily available. Thus, basic screening exams like 3-Meter Backward Walk Test (3MBWT) are developed. The 3MBWT is used to assess backward walking mobility, balance, and risk of fall.3-meter backward walk test (3MBWT) is a quick, easy, and clinically standardised way to evaluate backward walking and is therefore a tool for balance assessment. Aim: The study aims to review the validity and reliability of 3MBWT in individuals with balance impairments. Materials and Methods: The study commenced by exploring the databases including PubMed/Medline, Google Scholar, and Scopus to uncover full text publications authored in English. A total of 34 articles were retrieved after extensive data search, which were evaluated and only 13 articles met the inclusion criteria and were reviewed. Young adults, older adults and older populations with neurological and musculoskeletal impairments were included. Results: 3MBWT shows excellent intrarater, interrater and test-retest reliability (ICC >0.80) and moderate to strong co-relations with already established tools for balance assessment therefore is having good concurrent validity. Conclusion: 3MBWT is a reliable, valid and user-friendly tool for assessment of balance and fall risk and should therefore be included in the series of tests while assessing patients with neurological or musculoskeletal conditions. Implications: The findings may be administered in assessment of balance and risk of fall.

Effect of Side Dominance on Range of Motion at Different Joints of the Body in Adults: A Literature Review

Mohit Kumar Siradhana, Aditi Popli

Introduction: Side dominance decides the involvement of bodies’ side during activities of daily living therefore each side of the body undergoes different amounts of stress and load which leads to varying degenerative changes. When diagnosing musculoskeletal problems and tracking prognosis, Range of Motion (ROM) assessments are frequently used. Therefore, ROM is a helpful clinical indicator of tailored treatment plans. Current rehabilitation literature suggests to goal for equal ROM at the effected joint as contralateral side which may differs greatly based on the dominance of the extremity. Aim: The study aims to assess the effects of side dominance on ROM at different joints of the body in adults. Materials and Methods: The study commenced by exploring the databases including PubMed/Medline, Google Scholar and Scopus to uncover full text publications authored in English. A total of 38 articles were retrieved after extensive data search, which were evaluated and only 5 articles met the inclusion criteria and were reviewed. Adult Males and Females (18-59 years) were included. Results: It was found out that there is significant difference between ROM measurements of dominant and non-dominant sides of the body. Conclusion: ROM measurements of dominant and non-dominant sides is found different which should be considered while planning rehabilitation goals. Implication: The findings may be administered in assessing difference in ROM in dominant and non-dominant sides of body.

Optimising Navicular Height: A Narrative Review of Physiotherapy Interventions Focused on the Medial Longitudinal Arch

Ruchi Bohra, Subhashish Chatterjee, Mousumi Saha

Introduction: The Medial Longitudinal Arch (MLA), specifically the navicular height, is vital for foot biomechanics and overall lower limb function. Physiotherapy interventions focused on improving Navicular Height (NVH) are important for foot health and movement efficiency. This review aims to examine different physiotherapy methods which enhance navicular height, providing insights into their effectiveness and clinical significance. This understanding is crucial for clinicians looking for evidence-based techniques to manage foot-related issues and enhance patient well-being. Aim: To evaluate and synthesise existing literature on physiotherapy interventions targeting the medial longitudinal arch with the goal of optimising navicular height. Materials and Methods: A literature search using electronic databases (Google Scholar and PubMed) identified relevant articles on medial longitudinal arch, navicular height, and physiotherapy intervention, including randomised controlled trials, cohort studies, and case series. Results: Using key terms found a total article 1567 on MLA and NV height which 13 articles (7 Experimental studies, 2 cross-sectional studies, 2 reviews, and 1 case study) included Interventions like strengthening exercises, stretching techniques, orthotic support, and manual therapy have shown promising results in enhancing NV height and improving foot functions. Conclusion: This study examines the effectiveness of physiotherapy interventions in modifying MLA and NV height, identifying gaps, and improving foot biomechanics and function, with multi-modal approaches tailored to individual needs potentially achieving optimal outcomes in managing foot pathologies, and suggesting future research directions for foot deformity management.

To Assess the Effect of Physiotherapy Management in Osteoarthritis Knee: A Case Report

Prachi Sharma, Vanshika Chouhan, Aditi Popli

Introduction: Osteoarthritis (OA) is the most common degenerative joint condition, characterised by joint pain and dysfunction caused by joint destruction. There is strong evidence to show short-term beneficial effects of exercise on pain and function. Physiotherapy treatments aim to dissipate knee joint load, alter lower limb alignment, improve range of motion and restore normal neuromuscular function. Aim: To check if physiotherapy helps in improving joint function in patients with OA. Methodology: A 27-year-old male patient diagnosed with osteoarthritis knee were recruited and given physiotherapy intervention for 4 weeks. On the basis radiological examination and Kellgren and Lawerence Scale patient is classified as OA knee. Results: Physiotherapy in combination with other management strategies, such as weight loss and attention to psychological factors may provide more significant outcomes than any one of these in isolation. Conclusion: Physiotherapy plays a crucial role in managing Osteoarthritis Knee. Implication: Physiotherapy interventions can reduce knee pain and improve function in those with knee OA.

Emotional Competence and Cognitive Abilities: A Comparative Survey Study of Active and Sedentary College Students

S Choudhary, P Siwach, A Choudhury, S Verma, H Sehrawat

Introduction: College students are prone to physical inactivity resulting in sedentary behaviour which may closely linked to their lower levels of cognitive function and emotional intelligence. The purpose is to compare the cognitive function and emotional intelligence among physically active versus sedentary college students. As physical activity is crucial for physical as well as psychological health of students that can help students to achieve better academically. Aim: To compare the cognitive function and emotional competence in college students. Materials and Methods: A total of 400 college students, aged 18-30 years of either gender, were included in this questionnaire-based survey. The subjects were asked to fill google form regarding their activity level on Sedentary Behaviour Questionnaire, The Cognitive Assessment Questionnaire for cognitive competency and Wong and Law Emotional Intelligence Scale for Emotional Intelligence. Participants were grouped into Group A (Sedentary) and Group B (Active), findings of both groups were compared. Results: Mean with SD for cognitive competency were 47.83±17.3 for Group A and 35.59±19.36 for Group B. Mean with SD for Emotional Intelligence four sub-domain SEA, ROE, UOE and OEA (Group A: 4.07±1.3, 4.29±1.3, 4.11±1.3, 4.08±1.3) (Group B: 4.75±1.7, 4.82±1.6, 4.71±1.6, 4.58±1.6) respectively. Results of Cognitive and Emotional Intelligence of Group B were found highly significant with p-value <0.05 than inactive subjects. Conclusion: Physical activity can help in better cognition and emotional intelligence among collegiate students. Implications: Some amount of physical activity is necessary to improve one’s emotional competence and cognitive function.

Cognitive Resilience in Willis Ekbom Disease: Enhancing Functionality through Neurophysiotherapy Interventions

Muskan Dani, Shweta Sharma

Introduction: The neurological condition known as Restless Legs Syndrome (RLS), or Willis-Ekbom disease, is epitomised by unintentional movement of the legs that predominantly unfold during sleep. RLS is accompanied by leg discomfort. RLS management is multi-faceted because of its heterogeneous causes and varying treatment outcomes. Dopamine agonists are the primary treatment, however some individuals may have augmentation-paradoxical worsening of symptoms. Aim: To explore the potential of neuro-physiotherapy to further dignify cognitive resilience among individuals grappling with Willis Ekbom Disease (WED). Materials and Methods: An exhaustive review of the literature, encompassing several full-text published studies, was carried out using key databases such as PubMed/Medline, Google Scholar, and Scopus to uncover cognitive-focused approaches that could potentially be incorporated into neuro-physiotherapy for WED. This review stipulated a comprehensive examination of individuals aged 18 and above who experienced sleeplessness, apprehension and neuromuscular diseases. Results: Enhancements in cognitive function, including attention, memory, and executive function, can result from neuro-physiotherapy therapies such as cognitive training, psychoeducation, and interdisciplinary teamwork which ultimately mitigate WED. Conclusion: This study concludes that inclusion of cognitive resilience-focused therapies into neuro-physiotherapy for WED proves essential for holistic care, resulting in enhanced patient outcomes and prevention of disease.

Enhancing Rehabilitation through Pilates: A Comprehensive Approach

Shreya, Aditi Popli

Introduction: Pilates is a type of exercise treatment that strengthen the deep torso muscles, increase breathing awareness, and improve spine alignment. The Pilates mat exercises use limb motions to change the torque applied to the trunk muscles when standing, supine, prone, or side lying. Pilates is an effective tool for rehabilitation. Pilates was discovered to be an appropriate and successful movement-based rehabilitation method, particularly because of its exercises’ safety and individual adaptability. Aim: To bring attention to possible advantages of integrating movements, exercises, and mindfulness practices of Pilates into conventional rehabilitation treatments. Materials and Methods: Several researches were carried out using databases such as Google Scholar and Pubmed to review full text published articles in relevance with Pilates. Results: Pilates works well for treating back pain, scoliosis, ankylosing spondylitis, and breast cancer. It significantly improves neuromotor fitness, especially balance both dynamically and statically. On the otherÂ hand, data for other components of fitness are contradictory. Pilates is a useful technique for enhancing balance, particularly in olderÂ persons. Conclusion: Pilates can be a useful addition to conventional rehabilitation techniques, with possible advantages for both injury prevention and general physical well-being.

Effects of Blood Flow Restriction Technique in Patients with Knee Osteoarthritis: A Narrative Review

Anuj Chhabra, Aditi Popli, Akanksha Saxena, Anmol Ratna

Introduction: Compressive neuropathy of the common peroneal nerve occurs when it’s trapped, often around the fibular head which causes symptoms like foot drop, sensory loss, and pain in the leg. Therefore, this study aimed to assess the effectiveness of a newly developed physiotherapy intervention for foot drop resulting from nerve entrapment. Case Report: A 37-year-old male patient presented to the physiotherapy OPD with complaints of weakness, tingling, and numbness in the left lower limb, along with difficulty walking over the past month. The patient underwent pre and post intervention assessment using the Stanmore Assessment Questionnaire (SAQ), Foot Ankle Disability Index (FADI), Dynamic Gait Index (DGI), Manual Muscle Testing (MMT), Motor Nerve Conduction Velocity (MNCV), and F-wave study of the peroneal and tibial nerves. The patient underwent a regimen that included Intermittent Galvanic Stimulation, passive dorsiflexion and weight-bearing exercises initially of left lower limb. After that Functional Electrical Stimulation coupled with gait training, as well as active-assisted to active-resisted range of motion exercises targeting ankle dorsiflexors evertors and thera-band exercises were administrated. Significant improvements were observed in SAQ scores (from 21 to 74), FADI (from 66 to 85), DGI (from 8 to 22), MMT of ankle dorsiflexors (from grade 1 to grade 4), MNCV (from non-recordable to 35.3 m/sec), and F-wave latency (from non-recordable to 32 m/sec). The provided treatment demonstrates effectiveness in improving foot drop due to compressive neuropathy. This treatment protocol enables physiotherapists to evaluate the effectiveness of the newly developed intervention on a larger sample size, thereby enhancing patient care.

Efficacy of Physiotherapeutic Intervention in the Improvement of Lower Limb Impairments following Injection Palsy

Nishu, Kanika, Yukta Sharma, Rittu Sharma

A 36-year-old male patient presented to the neuro-physiotherapy Outpatient Department (OPD) with the complaint of pain in left lower limb and difficulty in weight-bearing on left lower limb from the past two weeks. Patient had a history of accidental trauma to sciatic nerve while taking an injection on the gluteal region. The patient underwent lower limb function assessment using motor and sensory examinations, Foot and Ankle Disability Index (FADI), Stanmore Assessment Questionnaire (SAQ), and Visual Analogue Scale (VAS) and Nerve Conduction Velocity testing (NCV). Patient was having intact myotomes and dermatomes on both lower limbs. The Manual Muscle Testing (MMT) of left lower limb was found to be affected. A physiotherapy protocol including electrical stimulation, application of Transcutaneous Electrical Nerve Stimulation (TENS) over the distribution of sciatic nerve and strengthening of foot muscles was given for a duration of 5 times a week for 8-weeks. The given treatment showed improvement in MMT scores from 3 to 4 for hip flexors, 3- to 3+ for hip extensors, 3 to 3+ for knee flexors, 2- to 3 for ankle plantar flexion, 2+ to 3 for dorsiflexion, 2 to 3- for eversion and from +1 to 2+ for inversion, FADI scores decreased from 104 to 16, SAQ scores improved from 100 to 61 and VAS scores decreased from 9 to 3. Additionally, the motor nerve conduction velocity (MNCV) of the sciatic nerve increased from 42.4 ms to 43.7 ms in the left lower limb and tibial nerve from 36.3ms to 37.07. The provided treatment demonstrated effectiveness in alleviating the patient’s symptoms.

Enhancing Maternal Health: Physiotherapy Rehabilitation Approaches for Gestational Diabetes in Pregnant Women: A Narrative Review

Vanshika Agarwal, Simranjeet Kaur, Nidhi Sharma

Introduction: According to a Diabetes Prevention Program (DPP) study, patients with gestational diabetes mellites may experience a lower risk of acquiring diabetes if they implement lifestyle modifications. Physical activity is regarded as a crucial element in the treatment of gestational diabetes mellites. For people with insulin resistance, systematic exercise is beneficial in improving diabetes management outside of pregnancy. Aim: To summarise all the existing literature to learn about the physiotherapy rehabilitation of expectant mothers with gestational diabetes mellitus. Materials and Methods: A This narrative review included articles from the databases PubMed, Cochrane Library and Physiotherapy Evidence Database (PEDro) databases have been utilised to search articles with search terms which includes, REHAB “GBM”, exercise, hydrotherapy AND aerobic using Boolean operators AND, OR. The search yield 156 results in the PubMed Database and few articles results in the GOOGLE SCHOLAR database. various studies that analyses effect of physical activity, resistance training exercise, aerobic exercise, to improve strength, cardiovascular activity and functional reduction in the weight at the time of pregnancy 8 articles fulfilled the eligibility criteria and were included for the present review in which total participants with diabetes were allocated to experimental and control group. Results: The blood glucose level in the resistance exercise group and the aerobic exercise group were lower after the intervention than before the intervention. Conclusion: Exercise is essential for managing GDM, although there is currently little data to support its medium to long-term benefits.

Holistic Review of Epley Maneuver for Posterior Canal Benign Paroxysmal Positional Vertigo

Vankita Tandon, Shweta Sharma

Introduction: Vertigo is a prevalent medical manifestation with multiple diagnoses that need to be addressed through a thorough clinical assessment and physical examination. The predominant reason behind vertigo is particularly Benign Paroxysmal Positional Vertigo (BPPV) in primary healthcare settings are confirmed through a positive Dix Hallpike positional test and addressed through repositioning training session. Aim: The primary focus of this study centred on evaluating the efficacy of Epley manoeuvres for addressing patients afflicted with Posterior Canal Benign Paroxysmal Positional Vertigo (PC-BPPV). Materials and Methods: Research articles from PubMed, Cochrane library, Scopus and Google Scholar databases were reviewed. Approximately, 20 articles were reviewed in total in this literature review. Fourteen publications were assessed including 14 randomised control studies, two observational studies and four reviews. Results: In order to attain the result, 20 articles were featured in the analysis which stated that the Epley Manoeuvre improves quality of life in both the global and disease-specific domains for older patients with BPPV. When used in primary care, this manoeuvre can effectively reverse a positive Dix Hallpike Test and lessen the extent of vertigo in individuals in the Dix Hallpike Test who had baseline nystagmus. Conclusion: The administration of self-Epley manoeuvre twice a day has a good success rate and can be used for patients who are unable to perform the Epley manoeuvre after the Dix Hallpike Test.

Recent Physiotherapy Management of Peripheral Vascular Disease: A Review

Purvanshi, Mandeep K Jangra, Akanksha Saxena

Introduction: Peripheral vascular disease commonly called Varicose vein and Deep Vein Thrombosis (DVT) are abnormal conditions affecting 20% to 40% of adults, causing venous dilatation and twisting in the legs. These veins are caused by valve malfunctions in the great saphenous vein, small saphenous vein, and perforator vein artery. Pulmonary embolism and deep vein thrombosis are major causes of morbidity and death. Factors like obesity, inactivity, hormonal changes, smoking, constipation, and prolonged standing can weaken veins. Aim: To known the efficacy of physiotherapy treatment in peripheral vascular disease. Materials and Methods: A total of 15 articles were analysed from various databases PubMed, Google Scholar focus on physiotherapy treatment of Peripheral vascular disease. Results: The review of articles on physiotherapy for Peripheral Vascular Disease (PVD) reveals promising strategies for pain reduction and symptom management. Techniques like Neuromuscular Electrical Stimulation and Hydrotherapy show efficacy in improving venous blood flow and alleviating discomfort. Additionally, exercises, Transcutaneous Electrical Nerve Stimulation (TENS), and therapeutic ultrasound exhibit positive outcomes. Strengthening calf muscles emerges as a key approach for managing varicose veins. Overall, physiotherapy offers diverse interventions to improve symptoms and enhance venous function in PVD patients. Conclusion: Advanced physiotherapy modalities and techniques offer a multifaceted approach to rehabilitation and pain management across various conditions and populations. Electrotherapy modalities such as Neuromuscular Electrical Stimulation (NMES), Transcutaneous Electrical Nerve Stimulation (TENS), and Low Intensity Laser Therapy (LILT) provide effective pain relief, while manual therapy techniques like joint mobilisations and myofascial release restore mobility and function.

Electrotherapeutic Interventions in Diabetic Peripheral Neuropathy: A Narrative Review

Sakshi Thakur, Kirti Chhabra

Introduction: Diabetic peripheral neuropathy presents a significant clinical challenge, often resulting in chronic pain and sensory deficits. Electrotherapy offers a non-pharmacological approach to alleviate symptoms, presenting potential benefits for pain management and functional improvement. Aim: To explore the efficacy, mechanisms, and clinical relevance of electrotherapeutic interventions Transcutaneous Electrical Nerve Stimulation (TENS), Precutaneous Electrical Nerve Stimulation (PENS), low frequency pulse electromagnetic field in the management of diabetic neuropathy of peripheral extremities. Materials and Methods: Searches were conducted in English across databases including PubMed, Scopus, and Google Scholar using the keywords “electrotherapy” and “diabetic peripheral neuropathy.” For this review, a total of 21 articles were selected, comprising six narrative reviews, three systematic reviews, nine Randomised Control Trial (RCT) and three experimental studies. Results: Electrotherapy has been shown to effectively decrease pain levels, enhance sensory function, and improve the overall well-being of individuals suffering from diabetic peripheral neuropathy. Conclusion: Electrotherapy represents a valuable adjunctive treatment for diabetic neuropathy, warranting consideration in clinical practice for enhanced patient care and treatment outcomes. Implementation: Clinicians should consider incorporating electrotherapeutic interventions into comprehensive treatmentÂ plans for diabetic neuropathy, taking into account individual patient characteristics, preferences, and treatment goals. Multidisciplinary collaboration and patient education are essential for maximising the potential benefits of electrotherapy in clinical practice.

Evaluation of Psychometric Properties across Translated Variants of the Tinetti Performance-oriented Mobility Assessment (POMA) Scale: A Narrative Review

Sukhpal Singh, Nidhi Sharma, Simranjeet Kaur

Introduction: The Tinetti POMA Scale evaluates balance and gait in the elderly. It’s commonly used by healthcare professionals who work with the elderly and those with neurological disabilities. Each component is scored separately, with higher scores indicating better balance and gait function. The overall score ranges from 0 to 28. Aim: To evaluate the psychometric properties across different translated variants of the Tinetti Performance-Oriented Mobility Assessment (POMA) scale. Materials and Methods: Authors searched electronic databases from inception to March 2024, including studies on translation procedures, validity, reliability, and responsiveness of the scale in non-english languages. We assessed quality using predetermined standards. Results: A total of four studies met the inclusion criteria, it was found that the Korean adaptation of the Tinetti mobility test exhibited superior psychometric properties compared to the Turkish, Persian, and Gujarati versions. The test demonstrated a strong level of concurrent validity, displaying a negative correlation to the 10-meter walk test and the TUG test, while displaying a positive correlation to the BBS. Additionally, the Tinetti balance and gait scale showed high levels of test-retest, internal consistency, intra-rater, and inter-rater reliability. The gait and balance sensitivity and specificity were also found to be high. Conclusion: The study found that translated versions of Tinetti POMA are reliable, valid, and sensitive. Hence, they are suitable for use in the target population or language group. This supports the use of Tinetti POMA in clinical practice and research across different linguistic and cultural settings.

Efficacy of Physiotherapy Intervention in the Symptomatic Management of Foot Drop due to Compressive Neuropathy of the Common Peroneal Nerve: A Case Report

Chhavi, Rituraj Mandal, Kanika, Rittu Sharma

Impact of Physical Activity on Functional Independence among Elderly Population Residing in Old Age Homes

Sanjana Panchal, Kanika, Nidhi Sharma

Introduction: Ageing is a global phenomenon. Age-related physiological changes result in a decline in functional skills as the population ages. Reduced functional abilities result in issues with everyday living, self-care, and psychosocial issues. Regular physical activity is known to enhance functional ability, physical fitness, and well-being and to mitigate the adverse effects of aging. Aim: Evaluate the impact of physical activity on the functional independence in daily living of the elderly residing in old age homes. Materials and Methods: A total of 100 elderly individuals aged 60-80 years were recruited using purposive sampling based on selection criteria. The Global Physical Activity Questionnaire (GPAQ) was employed to assess the level of physical activity and Functional Independence Measure (FIM) was evaluated to determine the participants’ level of independence. Results: The study comprised 52 male participants with a mean age of 70.26±7.61 and 48 female participants with a mean age of 68.91±2.34. The data exhibited normal distribution, therefore pearson correlation was used for data analysis. The findings revealed a strong positive correlation between physical activity and functional independence (r=0.9, p>0.05). Conclusion: This study found a strong positive correlation between physical activity and functional independence. This shows that affected physical activity can be major contributing factor in the level of independence. It has been proven that higher disability was found to be associated with lower physical activity.

The Impact of Menopause on Rheumatoid Arthritis and Role of Physiotherapy: A Narrative Review

Lavanya, Mandeep Jangra

Introduction: Rheumatoid Arthritis (RA) is a chronic autoimmune disease characterised by inflammation of the synovium, leading to joint pain, stiffness, and progressive joint destruction. It predominantly affects women, with a peak onset around the age of menopause. Menopause, a physiological milestone marking the cessation of ovarian function and reproductive capability, brings about hormonal changes, particularly a decline in oestrogen levels, which have been implicated in the pathogenesis and progression of RA. Aim: To investigate the impact of menopause on rheumatoid arthritis and elucidate the potential role of physiotherapy interventions in managing the symptoms and improving the quality of life in postmenopausal women with RA. Materials and Methods: This review utilised PubMed, Google Scholar, to search relevant literature, and identified 20123 studies from 2011 to 2024 years. After removing duplicates 10215, 9908 titles and abstracts were screened for eligibility criteria, out of these 11 articles were included in this review. Results: This review has synthesised the result that the lowered levels of oestrogen in women after the menopause modifies the immune response of the body to inflammation. This altered response coupled with age related changes in the joints not only makes females vulnerable to arthritic conditions but also accelerates the progression of joint related conditions such as rheumatoid arthritis. Conclusion: Menopause has a significant impact on RA among postmenopausal women, and physiotherapeutic treatment has been proven efficient in dealing with it.

Virtual Reality in Neurorehabilitation

Lavisha, Kuljeet Singh, Taniya Chandel, Cherry Sharma, Agam Nischey Singh

Introduction: Virtual Reality (VR) is revolutionising neurorehabilitation by providing interactive and captivating approaches to enhance the treatment and recovery of patients with neurological disorders. Traditional techniques for neurorehabilitation offer effective therapies, but often face challenges with patient motivation and the ability to create safe and engaging training environments. Virtual Reality addresses these limitations. Aim: To explore the potential of VR in neurorehabilitation by examining its impact on motor, sensory and cognitive rehabilitation. Materials and Methods: Literature on use of Virtual Reality in various neurological rehabilitation were studied in order to find out the effectiveness of VR in neurological rehabilitation. Results: Virtual Reality is a promising avenue in rehabilitation nowadays, it can be beneficial in a variety of neurological disorder. It can create safe and engaging training environment that ultimately enhances the rehabilitation of patients. Conclusion: Integration of Virtual Reality into neurorehabilitation offers exciting possibilities such as improving movement, boosting motivation, managing pain, and enhancing cognitive skills. This can lead to a better quality of life for patients recovering from neurological conditions.

Effect of Stress and Behaviour on Working Memory and Psychosocial Status among Healthy College-going Medical Laboratory Technician Student

Janki Kumari, Sunanda Bhowmik

Introduction: This study might have a potential input about the behaviour, anxiety and working memory of college-going students stress can significantly impact working memory and psychosocial status among college students. Understanding the mechanisms through which stress affects cognitive function and behaviour is crucial for developing interventions to support students in managing stress effectively and promoting their overall well-being. Aim: To determine the effect of stress and behaviour on health stress can significantly impact working memory and psychosocial status among college students. Understanding the mechanisms through which stress affects cognitive function and behaviour is crucial for developing interventions to support students in managing stress effectively and promoting their overall well-being. Materials and Methods: The study included 100 sample from college-going healthy students aged between 19-25 years. The participants were selected from several MLT department colleges, and an online survey was used to evaluate their behaviour and the impact of stress on their working memory and psychosocial status. Results: Women are more impacted than men. It was discovered how frequently stressed and behaved college-bound students were in good health. Of the MLT students, 38.9% and 61.1% were most affected. Conclusion: The MLT students were frequent affected with stress and anxiety mostly the females were affected rather than male.

Effect of Core Stimulation and Hamstring Release on Pain and Disability among Male Adults with Chronic Low Back Pain

Devansh Sharma, Rabab Kaur, Krishan Mohan

Introduction: Chronic Low Back Pain (CLBP) is a prevalent condition affecting a substantial portion of the adult population, particularly males. Conventional therapies used for treating CLBP are mostly targeting symptomatic treatment. Core muscles help to provide stability to the spine as well as help in maintaining good posture, if these muscles are weak then this stability and posture is lost. Core stimulation aims to increase the strength and stability of core musculature which in turn willÂ help to stabilise the lower back area. Tight hamstring muscles produce an increased load on the pelvis leading to posterior pelvic tilt which in turn causes increased stress on the lower back, hamstring release aims to decrease this load from the lower back area. Aim: This study aims to find out the effect of core stimulation combined with hamstring release in pain, and disability among male adults with CLBP. Materials and Methods: 60 male individuals with CLBP were selected from NEURO REHAB, Amity Institute of Health Allied Sciences, Amity University, Noida, Uttar Pradesh; the subjects had to be male, aged 25-60, have an NPRS of <7/10, and have a Core Strength MMT of >3. Patients have no past surgical history and have suffered low back discomfort for atleast 3 months. Subjects were excluded on the grounds of osteoporosis, using painkillers, having any co-morbidities, neurological impairments, and obesity. Baseline assessment was done on day 1 using the Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI). Subjects were randomly assigned in two groups: Group A was given Conventional therapy and Group B was given Conventional therapy, Hamstring Release along with Core stimulation. Subjects were reassessed after 2 weeks and results were analysed using paired and unpaired t-tests. The significance level was kept at 95% (p<0.05). Results: In this study, authors found significant improvement in pain and disability in both groups (p<0.05). A significant reduction in pain and disability was found in Group B as compared to GroupÂ A (p<0.05). Conclusion: The finding of this study concludes that core stimulation and hamstring release reduce pain and disability among males with CLBP.

Physiotherapeutic Assessment and Treatment Strategy in Gymnastic Athletes: An Update

Riya Mittal, Himani Kaushik, Avi Choudhary

Introduction: Gymnastics is a sports that require early specialisation and high-intensity training. Training programs at a young age help to develop power and strength, as the sport demands explosive lower-body power and control of the body. Physiotherapy rehabilitation protocols can be incorporated to improve the athletic performance of the gymnasts. Aim: To identify the impact of physiotherapy protocols on the subjective and objective physical fitness parameters of gymnastic athletes. Materials and Methods: The authors carried out a comprehensive literature search using different databases: PUBMED, ResearchGate, Cochrane Library, and Scopus using MESH terms rehabilitation, physiotherapy, physical fitness, gymnastics, and training. Full-text articles written in the English language from 2013-2023 were considered, and gymnastic athletes of any gender and age group were included in the study. Results: The study included eight articles on physiotherapy rehabilitation in gymnasts, based on specific inclusion and exclusion criteria. The studies show that various types of physiotherapy rehabilitation protocols can be included in gymnasts’ training programs, leading to significant improvements in both subjective and objective physical fitness outcome measures related to athletic performance. These protocols may involve plyometric training, core training, and neuromuscular training all of which can enhance the power, agility, strength, endurance, flexibility, and balance of the gymnastic athletes. Conclusion: This review shows that different physiotherapy rehabilitation programs can lead to significant improvement in the physical fitness and overall performance of gymnastic athletes. Further studies should be conducted in this area to identify the most challenging situations of gymnastic athletes, enhance performance, and develop effective rehabilitation protocols.

Impact of Aquatic Therapy for Patients with Multiple Sclerosis: A Systematic Review

Himani Chauhan, Avi Choudhary, CS Ram, Himani Kaushik

A Comprehensive Review of Cranial Electrical Stimulation on Cognitive Enhancement among Adults

Naveeta Thakur, Nidhi Sharma, Simranjeet Kaur

Introduction: Cranial Electrotherapy Stimulation (CES) is a U.S. Food and Drug Administration approved non invasive neuromodulation method used for treating insomnia, anxiety, depression, pain and cognition. Aim: To provide an insight on the effect of Cranial Electrotherapy Stimulation on cognition among adults. Materials and Methods: A literature search was performed using the PubMed, Scopus and Google Scholar databases for relevant research published from inception to February 2024. The search terms like “Cranial Electrotherapy Stimulation”, “Cognition”, “Attention” and “Memory” using Boolean operators AND, OR were used. 4,593 articles were retrieved, out of which only 6 articles met the eligibility criteria, in which186 participants with cognitive dysfunction were included. Adult population, randomised controlled trials, case series and complete text papers written in english were included and preliminary reviews, book chapters and thesis and dissertations were excluded. Results: All articles included for the review examined the impact of CES on cognition and out of those, three randomised controlled trials and one case series showed statistically significant improvement in all aspect of cognition among normal adults and in clinical population. However, two randomised controlled trials showed no significant improvement on cognition among clinical population, potential reasons for not observing positive effects from the intervention include missed CES treatments and a small sample size. Conclusion: CES is a safe neuromodulation method that appears to have the potential to enhance cognitive performance among normal adults and in clinical population. However, further research is needed to confirm these conclusions.

Impact of Extracorporeal Shockwave Therapy on Quadratus Lumborum Trigger Point Associated with Chronic Low Back Pain: A Scoping Review

Riya Kalra, Manu Goyal, Kanu Goyal

Introduction: Chronic Low Back Pain (CLBP), a well-known public health burden which progressively increased with time and development of trigger points in Quadratus Lumborum (QL) is frequently the cause of CLBP. Extracorporeal Shockwave Therapy (ESWT) is an entirely novel and effective non invasive therapy for treating myofascial trigger points. Aim: There is no comprehensive analysis which assess the effect of ESWT on QL trigger points associated with CLBP. As a result, aim of this review is to outlined the existing evidence available. Materials and Methods: Electronic databases which include PubMed/Medline, Scopus, Physiotherapy Evidence Database (PEDro), and Cochrane were searched. Searches were limited to full-text english language and publication between Jan 2000 to Jan 2024. In addition, reference list of the retrieved articles was also explored. A total of 678 relevant articles which includes 142 participants were identified in which participants were included. After duplicates were removed, articles were assessed for eligibility criteria. Five (n=5) articles met all criteria and were included in the final data synthesis. Results: The results shows that patients treated with ESWT shows statistically significant improvement in pain (p<0.05) for Visual Analogue Scale (VAS). Also, some studies show statistically significant improvement (p<0.05) in ODI (Oswestry Disability Index) and SF-36 (Short Form Health survey). Conclusion: ESWT leads to significant pain reduction, improve Quality of Life (QOL) of patients having QL Trigger points associated with CLBP.

Effects of Instrument Assisted Soft Tissue Mobilisation on Pain in Patients with Plantar Fasciitis: A Literature Review

Prachi Ranjan, Simranjeet Kaur, Nidhi Sharma

Introduction: Plantar Fasciitis (PF), with a 10% lifetime prevalence, is often attributed to biomechanical issues. Instrument Assisted Soft Tissue Mobilisation (IASTM) is a therapeutic technique that involves using specialised tools to manipulate soft tissue, such as muscles and tendons, to help reduce pain, improve mobility, and promote healing. Aim: To provide an insight on the effect of Instrument Assisted Soft Tissue Mobilisation on pain in patients with PF. Materials and Methods: A literature search was conducted on PubMed, Scopus, and Google Scholar from inception to January 2024 using keywords like “Instrument Assisted Soft Tissue Mobilisation,” “Pain,” and “Plantar fasciitis” with Boolean operators. 4,551 articles were retrieved, out of which only 6 articles met the eligibility criteria, in which 223 participants on plantar fasciitis population were included. Randomised controlled trials, case series and complete text papers written in English were included while preliminary reviews, book chapters, thesis, and dissertations were excluded. Results: Following a standardised literature search, authors identified four randomised controlled trials, one quasi-experimental study and one case series. All the studies showed significant improvement on pain reduction, improve strength and functional mobility of the foot and ankle. Therefore, all the studies suggested that IASTM used alone or in combination with other techniques or exercises, give positive effect for managing chronic heel pain. Conclusion: IASTM is a safe manual therapy technique used to treat the plantar-fascia pain and to improve foot and ankle function in patients with plantar fasciitis. However, this further research is needed to confirm these conclusions.

Joint Effectiveness of Dry Needling and Neurodynamic Mobilisation in Patients Suffering from Piriformis Syndrome: A Case Series

Alisha Jaiswal, Akanksha Saxena, Yashleen Kaur Sandhu, Mandeep Kumar Jangra

Introduction: Piriformis Syndrome (PS) is a neuromuscular condition caused due to tightness of piriformis muscle along with the irritation of the sciatic nerve. Management of PS so far involved only musculoskeletal component with none working on the neural component. So, authors intent to work on combined effectiveness of Dry Needling (DN) and Neurodynamic Mobilisation (NDS) as a new emerging technique for better management of PS. Case Report: Four patients were involved (3 females and 1 male) who experienced untreated and recurrent PS for a prolonged period (1-2 years) during their fourth decade. After reassessment of the patients, PS was confirmed by Flexion Adduction and internal rotation (FAIR), Beatty maneuver, and Straight Leg Raise (SLR). Baseline and post measurements were taken using outcome variables VAS, Pain Pressure Threshold, h-reflex, hip rotations range of motion, and Lower Extremity Functional Scale (LEFS). Patients recruited were given a 10-days treatment with dry needling for 10 minutes on alternate days and continuous neurodynamic mobilisation (sliders and tensioners) comprising 30 repetitions/minute for 2 sets with a 1-minute rest in between, in addition to conventional therapy. The study revealed substantial improvement in pain scores, pressure threshold, h-latency, hip rotations and functional capabilities of the lower extremities. A study demonstrated a notably substantial enhancement in addressing symptoms associated with both the muscular and neural aspects, along with the overall improvement in quality of life. Addressing to it neural and muscular with NDS and DN has long lasting effects and reduced frequency of reoccurrence of PS symptoms.

Combined Effect of Class IV Laser Therapy with Neural Mobilisation on Improving Vibration and Sensory Function in Individuals with Diabetic Peripheral Neuropathy: A Case Series

Rohan Sood, Akanksha Saxena, Mandeep Jangra

Introduction: Diabetic peripheral neuropathy is a complication of type 2 diabetes mellitus that can lead to altered sensation, muscular weakness, and neuropathic pain in affected individuals. Limited literature exists on the effectiveness of the Neural mobilisation on diabetic peripheral neuropathy but there is no literature available on which the combine effect of class IV laser therapy and neural mobilisation on this condition. Case Series: This study aimed to assess the combined effectiveness of these treatments on vibration and sensory functions in individuals with diabetic peripheral neuropathy. Three participants, with an average age of 53 years (2 females and 1 male), diagnosed 8 years ago, were recruited for the study. The participants were given neural mobilisation of tibial and peroneal nerve and Class IV Laser therapy regular for 6 days followed by alternate days in next consecutive week. At baseline, scores of outcome parameter such as vibration sense was assessed by biothesiometry, light touch sensation by monofilament, assessment of sensory functions of patients by the help of Michigan Neuropathy Screening Instrument (MNSI) testing. After intervention mean score value of right foot changes from 38.7 to 36.3, and left foot changes from 40.3 to 37 along with changes observed in MNSI value from 7 to 5.3. Result of the current study shows the substantial significant improvement on sensory functions and vibration sense. This treatment overlooks the, sensory functions and motor functions. Class IV laser combined with neural mobilisation is an effective treatment in diabetic peripheral neuropathy.

Effect of Pilate Breathing on the Pulmonary Functions in Chronic Obstructive Pulmonary Disease: A Review

Urvashi, Mandeep Kumar Jangra

Introduction: Chronic Obstructive Pulmonary Disease (COPD) ranks third globally in causing mortality. It not only affects lungs but overall bodily systems. A novel and impactful treatment approach needs to be summoned in managing and improving quality of life in individuals with COPD. Pilates breathing presents a cost-effective solution for enhancing fitness and rehabilitation in COPD by improving strength, endurance, and breathing efficiency. This review aims to unveil Pilate breathing effect on pulmonary functions in COPD. Aim: To determine the effect of Pilate breathing on pulmonary function among COPD. Materials and Methods: The following searches were performed in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane and Google Scholar from years 2014-2024 with the keywords, “Pilates”, “COPD” and “Pulmonary Function” which resulted in 1284 articles. After removal of duplicates only three Randomised Control Trails (RCTs) were included, the patients with moderate to severe COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria from age groups 40 to 80 years. A total of 104 participants participated in the three recruited RCTs with the outcome measures of chest expansion, Modified Medical Research Council Dyspnea scale, Modified Borg Dyspnea scale, FEV1/FVC by spirometer, respirator pattern measurement and saturation measurement. Results: Three RCTs with an average 5 weeks intervention. The findings indicated that Pilate breathing enhances pulmonary function, increases the FEV1/FVC ratio and reduces dyspnea. Conclusion: Pilates breathing proved to be effective in enhancing chest expansion, alleviating breathlessness, and boosting functional capacity among individuals with COPD. Integrating Pilates breathing into the rehabilitation process of COPD facilitates early and effective patient recovery.

To Analyse the Effect of Sliders Neural Mobilisation on F wave Latency in Lumbar Radiculopathy Patients: A Pilot Study

Nitya Chophla, Divya Aggarwal

Introduction: Lumbar radiculopathy is second leading cause of disability globally, characterised pain, weakness, and sensory changes due to nerve compression. Sliders neural mobilisation, involves neural structure movement and helps relieve pain and improve nerve excursion. F wave latency serves as an electrophysiological marker of nerve function in this condition. Aim: This pilot study aimed to evaluate the effect of sliders neural mobilisation on F wave latency. Materials and Methods: Twelve participants (25-50 years) diagnosed with Lumbar Radiculopathy (L4-L5 and L5-S1) having unilateral symptoms for more than 3 months were enrolled, excluding recent spinal trauma or surgery and diabetic neuropathy. They were divided into two groups: A (Sliders Neural Mobilisation) and B (Sham Mobilisation). Both groups received hot pack application (10 minutes), mobilisation (5 sets, 1.5 minutes each), and core exercises thrice weekly for two weeks. Pre- and post-intervention, Numeric Pain Rating Scale (NPRS) and F wave latencies of Tibial and Common Peroneal Nerves were measured. Results: Results showed that decrease in NPRS scores and F wave latency was more in sliders neural mobilisation group (p<0.05) after 2 weeks, indicating pain reduction and improved nerve conduction. Conclusion: The study suggests that sliders neural mobilisation positively affect nerve function in lumbar radiculopathy patients. Further research with larger sample sizes and randomised controlled designs is necessary to validate these initial findings.

Electromyographical Analysis on Combined Effect of Breathing Exercise and Core Stabilisation Exercise along with Breathing Cadence in Runner’s Stitch in Recreational Runner’s: A Randomised Controlled Trial

Pinku Kumari, Jaganjyoti Das, Pooja Bhati

Introduction: Runner’s stitch is a painful sharp or stabbing or cramping sensation that is experienced by a runner during the course of the activity. Pain is localised, prevalent in young people due to larger peritoneal space but it is not related to gender. The main function of the core is to maintain postural alignment during functional activity. Core stability is the muscular capacity of the lumbopelvic-hip complex. Breathing exercises is a process of moving air into and from lungs to facilitate gas exchange. Aim: To compare the effect of breathing exercise, core stabilisation exercise along with breathing cadence on onset latency of stitch, severity, location, muscle activation pattern, muscle co-activation ratio and lower limb power in runner’s stitch. Materials and Methods: A total of 15 subjects were randomly allocated to three groups. Group A consisted of core stabilisation exercises along with active stretching, group B performed core stabilisation exercises along with breathing exercises breathing cadence and active stretching, group C only performed active stretching as a controlled measured. The players were asked to perform the dynamic exercises desuring which amplitude of muscle activation pattern, onset, severity, location of side stitch, muscle co-activation ratio with surface electrode using four channel electromyographical system were measured for 12 muscles. Result: Data were significantly analysed by one-way ANOVA for within the group analysis and post hoc test used for multiple comparison. Group B showed significant improvement in mean amplitude, co-contraction of muscles with p value (p<0.05). Conclusion: Core stability along with breathing exercise and breathing cadence help delay runner’s stitch in runners and can be implemented in athletes for better results.

Comparative Study of the Effectiveness of Fartlek Training and High-intensity Interval Training on VO₂max and Power on Volleyball Players: A Pilot Study

Nikita Gautam, Sajjan Pal, Himanshu Rakheja

Introduction: Volleyball is an Intermittent sport that requires players to compete in frequent short bouts of high-intensity exercise, which is followed by periods of low-intensity activity. Fartlek training is a very efficient cardiovascular interval training technique which is utilised by endurance athletes. The Fartlek exercise training that delivers both aerobic conditioning and strength and endurance is converging. High-intensity Interval Training (HIIT) is one form of technique and the appropriate form of exercise since it is very effective and efficient approach to enhance the desired of physical components of volleyball sports. Aim: To compare the effectiveness of the 6-week Fartlek Training and High-Intensity Interval Training program. Materials and Methods: A total of 15 national volleyball players were divided into three groups; Experiment one consisted of fartlek training, Experiment two consisted of high-intensity interval training, and a control group was given conventional training. The outcome variables measured were VO₂ max and Power which was calculated before and after training. Fartlek training sessions include jogging, sand running, and sprinting whereas HIIT includes several exercises. Results: Data were significantly analysed by one-way ANOVA for within the group analysis and post hoc test were used for multiple comparison. Group A showed significance than group C in terms of VO₂ max and power (p=0.003 and p=0.001) Group B showed significance than group C in VO₂ max and power (both p=0.001). Conclusion: Group B, which underwent HIIT, demonstrated higher improvement in VO₂ max compared to Group A, which underwent Fartlek training. However, both Group A (Fartlek training) and Group B (HIIT) showed significant improvements in terms of power.

Effect of High-intensity Interval Training in Perimenopausal Women on Sleep and Different Level of Psychological Health Problem: A Pilot Study

Shweta Yadav, Vinika Chaudhary, Sonia Pawaria

Introduction: Sleep related issues ranges from 40% to 50% in perimenopausal women. Women’s Health Across the Nation (SWAN), longitudinal examination of 8 years’ worth of data from more than 3000 women revealed that the most prevalent issue was difficulty sleeping owing to frequent awakenings, which worsened as women enter menopause. A history of perimenopausal phase indicates the symptoms of sleep issues, Hot Flashes (HFs), depression, and stress, resulting from a differential susceptibility to hormonal changes in the body. Aim: To find out the effect of High-intensity Interval Training (HIIT) in premenopausal women on sleep difficulties and different levels of psychological health problems. Materials and Methods: The subjects were taken from SGT Hospital and were treated in the Physiotherapy Department of the Hospital. Total 20 subjects were randomly allocated in two groups, one was experimental i.e. group A and other was the control group B, the treatment session was 3 days in a week for 3 weeks. The patient underwent baseline measurement through Pittsburgh Sleep Quality Index (PSQI) and Depression, Anxiety and Stress (DASS) scale. The Follicle-Stimulating Hormone (FSH) test helps identify the stages of the shift and to more clearly understand how and when changes in the parameters of perimenopausal phase. Results: For all the variable (PSQI and DASS) between group analysis was done using Mann whitney test and within group analysis was done using Wilcoxon test, the Group A showed a significant change (p=0.005) when compared to Pre and post value, at p<0.05, the results were considered statistically significant. Conclusion: The study suggests that HIIT has a positive result in sleep problems and psychological mental health problems compared to the control group. HIIT will prove their effectiveness in improving sleep difficulties and associated mental health during the perimenopause phase and provide better therapeutic options to improve the quality of life.

Parkinson’s New Advancements in Diagnosis and Treatment: A Review

Sakshi, Pooja Anand

Parkinsonism Disease (PD) is a progressive neurological disorder. Although PD is associated with a variety of Non-motor symptoms (NMS) in virtually all patients including hyposmia, constipation, pain and sleep disturbances. It is age related disorder and affects more than 6 million population every year. It is associated with neuronal degeneration in substantia nigra and to lesser extent, in the globus pallidus, putamen and caudate nucleus. The degeneration of the neurons of the substantia nigra that send their axons to the corpus striatum results in reduction in the release of neurotransmitter dopamine with in corpus striatum. This leads to hypersensitivity of the dopamine receptors in the post synaptic neurons in the striatum. Individuals have characteristics signs and symptoms tremors, bradykinesia, postural instabilities, rigidity. Neither loss of sense nor muscle power is usually seen in such cases. Deep tendon, Superficial and Abdominal reflexes are well retained on evaluation. There has been various types of classification in Parkinsonism which are described later. Together with aging, genetics, environment and the role of biological sex as important factor in development of PD has been widely discussed in the past decade. Investigations in PD remains a challenge, recent studies included 7 Tesla MRI, PET and SPECT have proved to be confirmatory in diagnosis of PD. Parkinsonism disease treatment includes increasing the levels of dopamine in brain by giving its immediate precursor L-dopa which can easily cross blood brain barrier unlike dopamine. Evidence of slowing the process of degeneration has been seen with drug selegiline. Other than drugs surgical options include pallidotomy.

Effect of Quality of Sleep on Choice Reaction Time, Coordination and Fatigue Level in Football Players

Dimple, Roopika Sabharwal, A Sahana

Introduction: The relationship between sleep quality and athletic performance is an important but little-researched topic in the immense world of football. This study aims to provide insight into how sleep quality affect football players’ choice reaction time, coordination, and fatigue levels, providing important information for training optimisation and improving on-field performance. Aim: To examine the effects of sleep quality on the athletic performance of young football players. Materials and Methods: A total of 40, (U-17)-developmental stage male football players who were able to perform functional keys for choice reaction time task from Chandigarh Football Association were recruited using non-probability convenience sampling. Correlational design was employed to assess sleep quality and fatigue levels using Sleep Quality Scale-(SQS) and Fatigue Assessment Scale-(FAS). Choice reaction time and coordination was determined via Deary liewald reaction time task software and Hand-eye coordination test respectively. Quantitative analysis was conducted by Karl Pearson’s coefficient correlation. Results: Study found a non significant weak positive relationship between sleep quality and choice reaction time, [r (40)=0.025, p=0.881], significant moderate positive relationship between sleep quality and coordination, [r (40)=0.433, p=0.005], and significant moderate negative relationship between sleep quality and fatigue level, [r (40)=-0.517, p=0.001]. Increased sleep quality improved coordination and reduced fatigue levels, while choice reaction time showed no significant improvements. Conclusion: Sleep quality significantly impacts coordination and fatigue levels, but no effect was observed on choice reaction time. Future research should explore various sports with a larger sample size.

Combined Effect of Transcutaneous Electrical Nerve Stimulation and Yoga on Pain and Discomfort Associated with Dysmenorrhea

Devanshi, Amandeep Singh, Shalika Pathania, Monika Rani

Introduction: Dysmenorrhea is a common problem with almost 50 to 90% of women affected worldwide. Transcutaneous Electrical Nerve Stimulation (TENS) and yoga is frequently used to treat dysmenorrhic pain and discomfort. Aim: To assess the combined effect of transcutaneous electrical nerve stimulation and yoga on pain and discomfort associated with dysmenorrhea in university students. Materials and Methods: The study involved 60 subjects aged 18-25 years female students divided into three groups via using chit box approach by using simple random sampling. An experimental design was employed to assess pain and discomfort through numeric pain rating scale. Quality of life was assessed by using EQ-5D-5L questionnaire. The necessary permission to use the questionnaire was also obtained. Results: Wilcoxon sign rank showed statistically significant difference between pre and post data for pain (<0.001) and quality of life (<0.001) in both first and second months. Kruskal-Wallis test showed non significant difference between groups for pain (mean difference of 5.32 in 1^st month and 2.62 in 2^nd month) and quality of life (mean difference of 5.4 in 1^st month and 1.15 in 2^nd month) indicating that all three groups were equally effective in reducing pain and improving quality of life. Conclusion: All three groups have shown statistically significant improvement among dysmenorrhic females but clinically more improvement was found out in group three that received combination of TENS and yoga.

Empowering Women: Pilates as a Holistic Approach to Alleviate Dysmenorrhea Symptoms: A Systemic Review

Palak Chaudhary, Neha Upadhyay, Ankita Sharma

Introduction: Dysmenorrhea, characterised by painful menstrual cramps, is a prevalent condition affecting a significant portion of the female population worldwide. Despite its common occurrence, the management of dysmenorrhea often remains inadequate, with reliance on pharmacological interventions that may offer temporary relief but come with potential side effects and long-term consequences. Aim: To evaluate the effectiveness of pilates as a holistic approach to alleviate dysmenorrhea symptoms, with the goal of empowering women in managing their menstrual health more effectively. Materials and Methods: The study’s literature review spanned several databases—PubMed, Scopus, Web of Science, and Google Scholar—complemented by manual reference list searches. The search strategy incorporated keywords such as “Pilates,” “dysmenorrhea,” “menstrual pain management,” and “non-pharmacological interventions for dysmenorrhea.” This approach yielded 98 articles, from which six full-text available articles, published from 2014 to January 2024, were selected for their insights into the pilates-dysmenorrhea nexus. This research engaged women diagnosed with dysmenorrhea, with pre- and post-intervention assessments measuring pain levels and physical function using standardised tools. Results: Preliminary outcomes indicate a marked reduction in menstrual pain and an enhancement in physical function among participants undertaking pilates exercises, compared to those in the control group. Conclusion: Pilates exercises offer a holistic and comprehensive management strategy for dysmenorrhea, addressing both its physical and psychological dimensions. The study affirms pilates as an effective, non invasive way to ease dysmenorrhea symptoms.

A Study Protocol to Investigate the Influence of Shoe Collar Height on Coordination and Plantar Pressure Distribution during Locomotion in Young Adults

Gargi Sahu, Nidhi Sharma, Simranjeet Kaur

Introduction: Higher collar heights are often associated with increased ankle support and stability while lower collar heights may allow for greater ankle flexibility. The design of footwear, particularly the height of the collar, plays a crucial role in influencing how individuals move and distribute pressure on their feet during various activities. Aim: To investigate how high-cut, low-cut and mid-cut shoes affects coordination and plantar pressure distribution during walking in young adults. Materials and Methods: Ninety-five healthy college-going students aged between 18-25 years wearing casual shoes for atleast six hours a day for 5 days a week for more than 6 months will be recruited through convenience sampling method. Participants shall be grouped based on the design and cut height of their shoes into high-cut, low-cut and mid-cut categories. Coordination tests under barefoot and shod conditions will be used to assess coordination. Plantar pressure in barefoot condition for different foot regions will be determined through Harris mat and Podia Scan^® software. Results: Kolmogorov-Smirnov test will be used to determine normality (n>50). Parametric (Paired t-test) or non-parametric test (Wilcoxon-Signed Rank Test) will be used for within-group analysis. For between-group analysis, parametric (One-way ANOVA) or non-parametric test (Kruskal-Wallis H test) will be used. Conclusion: Understanding the relationship between shoe collar height and lower extremity coordination as well as foot pressure distribution is crucial for designing footwear that optimises performance, minimises injury risk, and enhances overall movement efficiency across various physical activities.

Effectiveness of X-box Gaming on Balance using One Leg Standing among Older Adults: A Mini Systematic Review

Mayuri Thakur, Nidhi Sharma, Simranjeet Kaur

Introduction: The predominant challenge encountered by the elderly and older people is balance. This concern is not only affecting the quality of life for individuals but increasing their risk of falling. Literatures available determined the effect of various gaming apparatus on balance in older adults but these evidences need to be reviewed systematically to determine their overall effect. There is no systematic review assessing the effectiveness of X-box gaming on balance among older adults. Aim: To assess X-box gaming effectiveness on older adults balance. Materials and Methods: Searches in PUBMED, Physiotherapy Evidence Database (PEDro), and SCOPUS (2015-2023) included randomised controlled trials featuring participants, aged more than 55 years, using one-legged stance test as outcome measure, as assessing one’s balance through single-leg standing on various surfaces aids in determining the Center of Pressure (CoP). Greater variability in CoP measurements suggests poor overall balance control and an elevated risk of falls among individual. X-box gaming interventions were included. Results: Initially, 432 studies were screened; after eliminating duplicates and applying inclusion criteria, 2 eligible studies were selected for review. Conclusion: The reviewed trials showed diverse X-box and exercise intervention parameters. Future research should explore different treatment protocols for balance re-education and exercise therapy in older adults to establish optimal guidelines for enhancing balance and reducing fall risk.

Physiotherapy Intervention for Cervical Radiculopathy: A Case Report

Mehak Harjai, Simranjeet Kaur, Nidhi Sharma

Introduction: The objective of this study is to determine the efficacy of physiotherapy on pain and quality of life in cervical radiculopathy. Cervical Radiculopathy is characterised by compression of the nerves by either arthritic bone spurs or herniated disc material. Usually, this impingement causes motor dysfunction in the upper extremities and neck, as well as sensory impairments, numbness, or discomfort extending to the arms. Pathologies affecting the nerve roots might result in cervical radiculopathy. Case Report: This case report focuses on a 31-year-old female patient who has been diagnosed with cervical radiculopathy. She had tingling and numbness in her hands, particularly in right arm shows (median nerve distribution). Patient was recruited on the basis of special test: Spurling Test, Distraction Test, and Upper Limb Tension Test. After 2 week of intervention significant improvement was shown by using- Numeric pain Rating scale for pain, Neck Disability Index for Disability, and SF_12 for quality of life, patient reported less symptomatic and symptoms reduction during work and exercise. This case report demonstrates an effective, evidence based approach to physical therapy treatment for patients in cervical radiculopathy.

Reaping Metabolic Benefits of Blood Flow Restriction Training (BFRT): A Boon for Diabetes and Hypertension- A Narrative Review

Arghya Mondal, Mandeep Kumar Jangra, Muskaan Banyal, Akanksha Saxena

Introduction: Blood Flow Restriction Training (BFRT) is an emerging tool that not only works on musculoskeletal conditions but also improve vascular and metabolic health by using controlled exercise with blood flow occlusion. Research findings suggest that lowering blood pressure and maintaining glycaemic control can decrease the likelihood of complications related to diabetes. BFR combined with exercise is studied for its positive effects on managing diabetes and hypertension due to its impact on metabolism and hemodynamic. BFRT can thus be viewed as an upcoming novel technique for treating metabolic conditions like diabetes and hypertension for reaping better results. Aim: The current narrative review aims on exploring the effects of Blood flow restriction training BFRT for managing diabetes and hypertension. Materials and Methods: The databases probed were Google scholar, PubMed, Physiotherapy Evidence Database (PEDro) and Ovid from 2015-2024. The studies with both male and female individuals, age ranging from 18 to 75 and diagnosed with type 1/type 2 diabetes mellitus and hypertension, using BFRT as a treatment technique were included. The selected studies were segregated and analysed further. Results: From 9997 initial studies, seven relevant ones were selected after duplicate removal. Among them, six studies focused on hypertension and one on diabetes mellitus and hypertension both collectively indicating a significant positive impact of BFRT on these conditions. Conclusion: BFRT has an effect on both systemic and metabolic parameters and hence can be looked up to as an advanced tool for treating both the conditions and managing diabetes and hypertension in a better way.

The Effectiveness and Adherence of Postural Hygiene on Chronic Neck Pain: A Narrative Review

Sneha Mittal, Sunita Sharma

Introduction: One important condition that causes disability in people is chronic neck pain. Most people agree that this aberrant posture is linked to the onset and duration of numerous forms of neck pain as well as other biomechanically driven illnesses. Aim: The effectiveness of posture correction advice for persistent neck pain is highlighted in this review. Through the use of longer active postures and enhanced antagonist muscle activation, posture re-education seeks to lengthen and stretch these shortened muscles, promoting greater muscular balance and postural symmetry. Materials and Methods: The following researches were performed in PubMed, Cochrane and Scopus from year 2015-2024 with the keywords “Chronic neck pain and postural re-education”. The searches yielded 1,320 studies, out of which four randomised controlled trials met the inclusion criteria and were include in the narrative review. Results: This review includes four articles, summarises the literature of postural re-education used in the treatment of neck pain. Research indicates that postural advice is a clinically useful treatment for a variety of musculoskeletal conditions and limitations. Discussion: This review has outlined the potentially beneficial effects of preserving posture in cases of neck pain, including pain reduction and improved neck impairment. Postural education has shown to be effective than manual therapy interventions. Conclusion: The review will help clinicians to incorporate postural hygiene as a part of their treatment plan in patients with chronic neck pain.

Unveiling the Impact and Innovations of Physiotherapy Intervention in Patients with Neuropathic Pain: A Narrative Review

Yashica Sharma, Sunita Sharma

Introduction: Neuropathic pain, as characterised by the International Association for the Study of Pain, results from abnormalities or injuries that affect the somatosensory system. Physiotherapy Interventions like heat and cold, manual therapy, electrotherapy with exercise therapy can help improve physical function, reduce pain intensity, and enhance overall quality of life. Aim: To assess the impact of physiotherapy interventions in patients with neuropathic pain. Materials and Methods: Searches in PubMed, Scopus, Cochrane and Google scholar (2015- 2023) included Randomised Controlled Trials (RCTs) featuring participants aged 40+ (both male and female), using Neuropathic pain Scale and Visual Analog Scale as an outcome measure, which assessed patients with Neuropathic pain and manual therapy, electrotherapy with exercises interventions were included. Results: Initially, a total of 5,740 studies were screened. After removing duplicate entries and applying the inclusion criteria, 5 studies meeting the eligibility requirements were chosen for review. These selected studies provide a valuable summary of the efficacy of physiotherapy intervention in managing neuropathic pain and highlight various interventions that hold clinical utility for treatment. Conclusion: Physiotherapy interventions hold promise as valuable components of neuropathic pain management, offering multifaceted approaches to symptom relief and functional improvement. However, further research is needed to elucidate optimal intervention strategies and address existing gaps in knowledge.

Improving Respiratory Outcomes: The Role of Soft Tissue Manipulation in Enhancing Pulmonary Function for COPD Patients: A Narrative Review

Deepika, Mandeep Kumar Jangra, Sarvotam Chauhan

Introduction: COPD is the most prevalent respiratory disease to be studied and employing a variety of treatment techniques to deal with. Soft tissue manipulation is one such technique which decreases muscle tone that helps to achieve better compliance and hence improved respiratory functions and functional capacity in COPD patients. Aim: To determine effect of soft tissue manipulation on pulmonary function among Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: The following searches were performed in PubMed, Physiotherapy Evidence Database (PEDro), Cochrane and Google Scholar from years 2015-2024 with the keywords, “Soft tissue manipulation”, “COPD”, “Visceral manipulation” and “Pulmonary Function”. After probing these databases out of 5,240 articles only five studies were found to be in line with the aim, where the participants were both male and female with moderate to severe COPD according to GOLD criteria, aged from 45 to 80 years. Results: One pilot study and four randomised controlled trials were included in this review. These studies employed soft tissue manipulation over Diaphragm, Costal, Pectoralis, Scalene, Trapezius muscles ranging from 4 weeks to 24 weeks intervention for COPD patients and the results so reaped were that the technique helps improve pulmonary functions (Residual volume, Forced vital capacity, Forced expiratory volume, Total lung capacity, Functional exercise capacity, FEV1/FVC ratio) in COPD patients. Conclusion: Soft tissue manipulation has been proven to have a positive impact on the pulmonary functions in COPD patients.

Efficacy of Plyometric Warm Up Exercises on Aerobic Capacity and Anaerobic Capacity in Palestrato Population: A Pilot Study

Deeksha Pokhrel, Joydip Saha

Introduction: Plyometric training should be a fundamental part of any plan, whether it is used for performance enhancement, strength and conditioning, or later phases of rehabilitation. Plyometric training, also known as jump-based strength training, is a popular approach to enhancing neuromuscular strength. It utilises the Stretch-Shortening Cycle (SSC) in muscle contractions. This method can improve running economy and reactive strength index, potentially enhancing aerobic performance. Aim: To observe and compare the efficacy of plyometric warm up exercises on aerobic and anaerobic capacity in palestrato population. Materials and Methods: The participants were randomly assigned to two groups using convenience sampling; plyometric warm up group (n=6): Non-plyometric warm up group (n=6), a four week warm up intervention was given to the Plyometric group. Outcome measures included push-ups, squat thrusts, abdominal curls, and a 20-meter shuttle run test. Results: The experimental group (plyometric) showed significant improvement in all four measures: 20 m shuttle run test: Pre (30.7±2.7) and post (34.6±2.8) with p=0.02. Push-up test: Pre (32.8±9.3), post (35.5±8.4) with p=0.042. Abdominal curl: Pre (31.2±8.9), post (35.3±8.3) with p=0.042. Squat thrust: Pre (12.8±4.2), post (17.5±2.1) with p=0.027. Conclusion: Strength athletes can benefit from plyometrics to increase their muscle strength and power as well as their aerobic capacity.

Effectiveness of Concurrent Training in Improving Lipid Profiles among Hypertensive Individuals: A Review

Priyanka Tah, Mandeep K Jangra, Akanksha Saxena

Introduction: Hypertension is the elevated blood pressure and most common risk factor of Cardiovascular Disease (CVD). Dyslipidaemia, is the imbalance of lipids such as liproprotein cholesterol, triglycerides, and high-density lipoproteins that increases the CVD risk. Concurrent training proves to be efficacious in improving lipid profiles, it could serve as a valuable adjunctive therapy in the management of hypertension and associated metabolic abnormalities. Aim: This review aims to critically examine the existing literature to explain the effects of concurrent training on lipid profiles in hypertensive individuals. Materials and Methods: A comprehensive literature search was conducted using PubMed and Google Scholar to identify relevant studies published from 2009 to February 2024. Keywords used for the search included “hypertension,” “concurrent training,” “lipid profile” employing Boolean query. Full text experimental studies using concurrent training as an intervention on individuals with controlled hypertension were included whereas congestive heart failure, recent myocardial infarction, musculoskeletal disorder were excluded. Results: The search revealed 1133 articles from which seven full text articles met the selection criteria. Concurrent training elicits favourable effects on lipid profiles in hypertensive individuals. Specifically, improvements in total cholesterol, LDL-cholesterol, triglycerides, an HDL-cholesterol levels have been observed following concurrent training interventions of varied intervals. These beneficial effects are attributed to the combined impact of aerobic and resistance exercises on lipid metabolism and cardiovascular health. Conclusion: Concurrent training (combining aerobic and resistance exercises) offers promising benefits for cardiovascular health in improving lipid profiles in hypertensive individuals.

Integrating Suboccipital Muscle Inhibition Techniques with Adjunctive Therapies for Tension-type Headache: A Narrative Review

Sandhya, Sunita Sharma

Objective: Tension Type Headache (TTH) recounted as ‘a band encircling the head’ which is mild to moderate in intensity and bilateral in location. Suboccipital Muscle Inhibition Technique (SMIT) is one of the manual therapy procedures utilised for treating myofascial areas that have been compromised due to restriction. Aim: To determine the effect of SMI combined with other therapeutic approaches in patients with. Materials and Methods: The following researches were performed in PubMed, Cochrane and google scholar from year 2015-2024 with the keywords “Suboccipital Muscle Inhibition” and “Tension Type Headache”. The searches yielded 1,630 studies, out of which four randomised controlled trials met the inclusion criteria and were include in the narrative review. Results: This review summarise the literature of SMI technique, spinal manipulation and electrotherapy intervention in reducing headache intensity, disability and pericranial tenderness and increase in craniocervical flexion and extension in individuals with TTH. Conclusion: Integrating SMI techniques with adjunctive therapies holds great promise for the management of TTH. Clinicians should consider this multimodal approach in their treatment plans. TTH is a chronic condition and on amalgamating this technique with other therapeutic intervention shows better improvement in pain management.

A Compressive Review to Evaluate the Modifications while Translating Lower Extremity Functional Scale into Various Languages

Yashleen Kaur Sandhu, Simranjeet Kaur, Nidhi Sharma, Alisha Jaiswal

Introduction: Ability to locomote heavily relies on the effectiveness of one’s lower limbs. In contemporary society, due to sedentary lifestyles and inadequate nutritional habits, individuals as young as 40 years old often present to outpatient departments with complaints of lower extremity pain, which is most of the time miscellaneous in nature. Therefore, an outcome measure such as Lower Extremity Functional Scale (LEFS) that completely assesses functional status and thus help in planning perfect treatment protocol gets ideal for use. Aim: To gather information regarding the problems faced by authors while getting final translated version of LEFS in the desired language. This is done in order to understand the diversity present in different cultures. Materials and Methods: Multiple databases like PubMed, Google Scholar and Cochrane Library were searched to gather all available translations to date. Various terms were used so that no article gets skipped, like ‘LEFS’, ‘translations’, ‘adaptation’, ‘LEFS and validity’ and ‘Reliability’ with the help of Boolean operation like ‘AND’ and ‘OF’. Articles published between 1999 and 2023 were systematically gathered. Following extensive screening, a total of 20 translations were gathered out of which 17 were included. Results: It was observed that native individuals embraced the adaptation of LEFS; however, several modifications, including alterations to specific items, were necessary to enhance its level of acceptance among people. Conclusion: For better cultural adaptation, translated versions had slight modifications in them. But item no. 12 out of all the items was the one to undergo maximum modifications followed by item no. 11.

Advancement in Balance Training among Individuals with Chronic Obstructive Pulmonary Disease

Simran Chawla, Mandeep Kumar Jangra, Akanksha Saxena, Sarvotam Chauhan

Introduction: Individuals with Chronic Obstructive Pulmonary Disease (COPD) face not only respiratory challenges, but also posture issues, leading to compromised balance, increased fall risk, and activities limitations. As traditional pulmonary rehabilitation lacks global accessibility, alternative approaches like Virtual Reality (VR) technologies and Sensamove with biofeedback have been explored offering benefits such as adjustable difficulty levels, performance monitoring, and movement guidance. Aim: To highlight the advancement in balance training among individuals with COPD. Materials and Methods: Authors conducted a recent literature review (2019 to 2024) utilising databases including Cochrane, PubMed, and Google Scholar, focusing on interventions for moderate to severe COPD based on GOLD criteria (FEV1/FVC <0.7) aged between 40-70 years. Results: A total of 24,300 articles were retrieved, out of which only eight articles were found relevant that met our inclusion criteria and directly related to our research objectives in which four RCT study’s using X-box 360 and Kinect adventures software and there were four systematic reviews. With VR and sensa move authors found that patients with COPD improve physical fitness, lungs function, quality of life, exercise capacity and dyspnea. Conclusion: The integration of innovative tools such as VR and sensamove alongside established interventions holds potential for more comprehensive and effective approach to COPD rehabilitation.

Pelvic Floor Training, a Silent Enhancer of Pulmonary Function: An Integrative Literature Review

Sadikshya Mulepati, Akanksha Saxena, Mandeep Kumar Jangra

Objective: This review delves into the intricate relationship between pelvic floor training and its potential to enhance lung function across diverse health conditions. While the coordination between the pelvic floor and diaphragm is well-established, the specific advantages of pelvic floor strengthening in bolstering pulmonary health necessitate deeper investigation. Despite indications of pelvic floor training’s potential benefits for pulmonary issues, a comprehensive review is imperative to consolidate understanding. Aim: This review attempts to shed light on how pelvic floor activation influences various parameters of pulmonary function. Articles analysing pulmonary function improvements post pelvic floor activation constituted the participant pool for this review. Materials and Methods: An extensive search spanning from 2001 to 2024 across databases like PubMed, Ovid, Cochrane Review, and Physiotherapy Evidence Database (PEDro) unearthed experimental and observational studies. Primary outcome measures included forced expiratory volume in 1 second, forced vital capacity, Peak expiratory flow rate, forced expiratory flow, maximum voluntary ventilation and others. Results: Ten studies meeting inclusion criteria involved healthy subjects, individuals with pelvic floor weakness, and pulmonary impairment. Exercises like Kegels, hypopressive techniques and electrical stimulation, demonstrated positive impacts on pulmonary function parameters. Conclusion: This review underscores the significance of pelvic floor exercises in augmenting lung function. By exploring diverse interventions and their effects on pulmonary health outcomes, it addresses a critical gap in research, potentially informing recommendations for respiratory rehabilitation programs. Insights gleaned from this review hold promise for enhancing pulmonary rehabilitation programs by integrating pelvic floor exercises. Clinical recommendations could benefit from incorporating these findings, thereby optimising patient outcomes.

Outcome Measures for Shoulder Joint Assessment in Patients with Stroke: A Narrative Review

Jatin Sangwan, Subhasish Chatterjee, Mousumi Saha

Objective: Understanding the influence of evidence-based practice on rehabilitating patients with stroke can be achieved through the use of suitable outcome measures. Aim: The purpose of this study is to consolidate the existing outcome measures related to the Shoulder Joint assessment in patients with stroke. This review aims to provide education to neurologists, physiotherapists, academics, and researchers regarding available resources for diagnosing, prognosing, and rehabilitating shoulder joint in stroke patients. Materials and Methods: Electronic searches were performed on databases including Medline, PubMed, Cochrane, Physiotherapy Evidence Database (PEDro) and Google Scholar using terms related to outcome measures utilised in the diagnosis, prognosis, and rehabilitation of shoulder joint in stroke patients. Results: Total seven outcome measures {Stroke Specific Shoulder Disability Index (SSSDI), Fugl Meyer Assessment of Upper Extremity, Motor Assessment Scale, Chedoke-McMaster Stroke Assessment, Orpington Prognostic Scale, Motricity Index, and Stroke Rehabilitation Assessment of Movement} were included in this study used in the diagnosis, prognosis, and rehabilitation of upper extremity in shoulder joints having shoulder domains were identified. SSSDI and Fugl Meyer Assessment of Upper Extremity (FMA-UE) have excellent reliability and good validity among them. But, FMA-UE does not measure the functional assessment of shoulder joint. Currently, among the scales used for shoulder assessment in stroke patients, only the SSSDI covers all domains comprehensively, setting it apart from other scales. Conclusion: The SSSDI is a single tool available for assessing the shoulder domains in stroke patients having excellent reliability.

Effectiveness of Power Exercises vs Plyometric Training in Athletes: An Electromyographical Analysis

Hetashri Upadhyay, Jaganjyoti Das, Neha Reyalch

Introduction: Power training and Plyometric training exercises are recommended to improve the power of the upper and lower extremities. Research is necessary to provide coaches and practitioners with more information to plan their General power training and Plyometric training programs on various biomechanical and fitness measures. Aim: To compare the effect of General Power training vs Plyometric training on electromyographical parameter in athletes. Materials and Methods: A total of 15 subjects were divided into three groups: Power training group, Plyometric group, Control group. A total of 15 young athletes were randomly allocated to experimental and control group (N=15, n=5). Participants of three groups were asked to perform the dynamic activities during which amplitude of muscle activation with surface electrodes using four channel Electromyographic system were measured. Average of three trials were considered. Initially 16 muscles of both the sides were assessed. The intervention of Group A consisted of Power training exercises, Group B consisted of Plyometric drills and the control group performed regular training exercises. The intervention was given for 3 days a week for 6 weeks. All the outcome variables were recorded for baseline and after 6 weeks. Results: Within group analysis for both experimental groups were found to be statistically significant for Rectus femoris and Vastus Lateralis muscles whereas between group analysis revealed general power training group to offer statistically significant improvement with p-value <0.05. Conclusion: There was a significant improvement in in both the groups in terms of muscle activation; however, General Power training shows effective outcome than the Plyometric training.

Problems Associated with Persisting Primitive Reflex in Healthy School-going Children

Yukta Sharma, Akanksha Saxena

Introduction: Primitive reflexes, originating in the brainstem, develop in utero and vanish within six months post-birth, aiding infant motor milestones. Integration relies on cortical maturation inhibiting them via basal ganglia pathways. Persistence may indicate neurological issues lead to motor, balance, and learning difficulties. Aim: This scoping review explored the persistence of primitive reflexes and determined the problems associated with their persistence in healthy school-going children. Materials and Methods: A total of 3988 full-text published articles were identified from PubMed, Ovid-SP and Physiotherapy Evidence Database (PEDro) from 2004-2024 year. Only full text prevalence/incidence and observational studies on children between 4-12 years are included. After duplicate deletion 3614 articles were left at abstract level, finally 63 full text articles related to research topic were further analysed and only nine articles were included in review for analysis. Results: Within group analysis for both experimental groups were found to be statistically significant for Rectus femoris and Vastus Lateralis muscles whereas between group analysis revealed general power training group to offer statistically significant improvement with p-value <0.05. Conclusion: Majority of articles show that persistence of ATNR (Asymmetrical Tonic Neck Reflex) reflex shows neurological impairments like attention and reading difficulties while persistence of spinal galant may lead to scoliosis. In articles assessing the persistence of all primitive reflexes like ATNR/STNR (Symmetrical Tonic Neck Reflex)/TLR (Tonic Labyrinthine Reflex) may cause gait impairments and development delay. Boys exhibit higher reflex activity and attention deficits, correlating with diminished reading proficiency, emphasising the link between neuromotor maturity and academic achievement. The prevalence of primary reflexes like ATNR and TLR in preschoolers, impact attention, neuromotor development and gait. Early detection of persisting primitive reflex, and managing them with reflex integration therapy in children can help mitigate neurological development delay.

A Review on the Finger-to-Nose Test for Assessing Coordination in Children with Developmental Coordination Disorder

Priyanka Negi, Nidhi Sharma, Simranjeet Kaur

Introduction: Developmental Coordination Disorder (DCD) affects around 5-6% of school-aged children and is characterised by impairments in motor coordination that significantly interfere with daily activities. Various assessment tools have been explored to evaluate coordination difficulties in children with DCD. This review focuses on the Finger-to-Nose Test (FNT), examining its utility in diagnosing and monitoring coordination impairments in this population. Aim: To provide a comprehensive analysis and purposeful evaluation of the FNT in this specific population. Materials and Methods: A literature search was conducted using the PubMed, Scopus, and Google Scholar databases for relevant studies published from inception to February 2024. The keywords including “Finger-to-Nose Test”, “Developmental Coordination Disorder,” “pediatric population,” using Boolean operators AND, OR were used. Based on inclusion criteria Developmental coordination disorder with pediatric population, Observational and RCTs studies included. Results: A total of 532 articles were found from different databases, out of which only five articles fulfilled the eligibility criteria. Findings from the reviewed studies demonstrate that finger-to-nose test alone is not very promising evidence to assess children with DCD from healthy controls. Conclusion: This review concluded that FTN test remains a valuable tool in assessing motor coordination disorders, its optimal use lies in conjunction with other assessment measures to enhance diagnostic accuracy and treatment planning. Continuous research efforts aimed at refining its utility and exploring its implications in therapeutic interventions will contribute to better understanding and management of motor coordination disorders in children.

Efficacy of Sustained Natural Apophyseal Glides in Improving Pain, Cervical Range of Motion, and Enhancing Quality of Life in Cervicogenic Headache: A Systematic Review

Sukhpreet Kaur, Akanksha Saxena

Introduction: Cervicogenic headaches originates from cervical region issues, causing one-sided head pain, neck stiffness, and shoulder discomfort worsened by movement. Sustained Natural Apophyseal Glides (SNAG) mobilisation, a manual therapy technique, applies targeted pressure to dysfunctional spinal segments, aiming to alleviate pain and enhance cervical mobility, potentially offering relief and restoring normal function. Aim: To systematically review the existing literature to determine the efficacy of SNAGs as a treatment intervention for cervicogenic headache, with a focus on evaluating their impact on pain severity, cervical range of motion, and quality of life outcomes. Materials and Methods: A systematic litertaure search was performed using PubMed, Physiotherapy Evidence Database (PEDro) AND Ovid, from 2014 to February 2024. The search terms “SNAG” OR “Sustained Natural Apophyseal Glides” OR “Mulligan” AND “Cervicogenic headache” AND “pain” OR “range of motion” OR “disability” OR “quality of life” were used according to PRISMA guidelines. The study included total 1757 articles, from which eight articles met the inclusion criteria which includes 432 participants with cervicogenic headache. The methodological quality of the included studies were analysed using the PEDro scale. Results: Majority of the articles provide evidence that SNAG has a significant positive effect on the cervicogenic headache. A total of six studies shows positive effect of SNAG on ROM and pain, two studies showed significant improvement in improving quality of life and ROM. Conclusion: SNAG is safe and effective technique that manages cervicogenic headaches.

Rhythm and Response: Examining the Effects of Music on Reaction Time: A Comprehensive Review

Preeti Kapri, Nidhi Sharma, Simranjeet Kaur

Introduction: A reaction time test measures a person’s response time to stimuli. There has been a noticeable increase in exposure to loud music, which is generally believed to result in functional aberrations over time in healthy individuals. Loud music can improve alertness and arousal in certain situations, but it can also slow down cognitive processes and impede reaction time, especially when it serves as a stressor or distraction. Aim: To offer insights into investigating how music affects reaction time in adults. Materials and Methods: A literature search was conducted from PubMed, The Cochrane Library, and Google Scholar database from February 2000 to February 2024. The search utilised terms such as “music”, “high volume”, “adult”, “reaction time” and “noise” employing Boolean operators (AND, OR). Articles in which reaction time was measured included in this review, non-english articles were excluded. Results: A total of 2392 articles found from different database, out of which only seven met the inclusion criteria. These studies suggest that listening to loud music may have a negative impact on reaction time. Conclusion: The varying outcomes observed may suggest that the selection of music could have influenced alertness levels, while the presence of different distraction levels might have contributed to neurocognitive alterations, such as delayed responses and impaired bodily functions.

Current Trends in Physiotherapy Treatment Protocols in Parkinson’s Disease

Syed Tashbeeba, Meenakshi Verma

Objective: Physiotherapy is prescribed for individuals with Parkinson’s Disease (PD). Conventional forms of physiotherapy have been studied extensively, however effectiveness of recent physiotherapy interventions for PD are being evaluated and assessed. Aim: To evaluate the efficacy of conventional and recent physiotherapy interventions for people with Parkinson’s disease. Materials and Methods: A systematic search using CINAHL, Embase, and PubMed, that contrasted physiotherapy with no intervention or sham treatment. Resistance training, treadmill training, strategy training, dance, martial arts, aerobic exercises, hydrotherapy, balance, gait training, dual tasking, exergaming, and Nordic walking, were twelve categories into which trials were divided. Motor symptoms, balance, gait, and quality of life were among the outcomes. To evaluate methodological quality, GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used. A total of 191 trials, with 7998 participants were taken. Active therapy was included, irrespective of the severity or stage of the disease. Results: Physiotherapy enhanced gait, quality of life, and motor symptoms. Resistance and treadmill training improved gait. Training strategies enhanced gait and balance. Nordic walking, balance and gait training, and others improved gait, balance and motor symptoms. Exergaming and hydrotherapy enhanced life quality and balance. However, none of the outcomes significantly improved by dual task training. Conclusion: This review offers data supporting the efficacy of physiotherapy treatment in Parkinson’s disease, empowering medical professionals to choose treatment based on the best available research. PD affects balance, mobility, gait, fall susceptibility. Conventional and advanced physiotherapy improves these motor symptoms, and augment quality of life.

Agility among College-going Students: A Literature Review

Tanbeer Hassan, Joydip Saha

Introduction: Agility is the ability to rapidly alter direction or speed of whole-body in response to a stimulus. Agility is correlated with several trainable physical attributes, including technique, strength, endurance, power and cognitive components. Aim: To provide an insight on agility testing among college-going students. Materials and Methods: A literature search was performed using the PubMed, Scopus and Ovid Medline databases for relevant research published from 2012 to 2022. Articles including participant with age group 18-25 year are included. The search terms such as “Agility”, “Agility test”, “Youth”, “Students” using Boolean operators AND, OR were used. All the free full original English articles inexplicitly explaining the role of agility in the different sport were included, irrespective of the type of the study. Results: A total of 3045 articles were retrieved from different databases, out of which only nine articles fulfilled the inclusion criteria and were included for the present review. These studies revealed that several Agility Test (AT) were developed such as Y-shaped AT, 505 AT, Illinois AT, zigzag run AT, T drill AT, 5-20-30m sprint AT, pro AT, repetitive AT, Butterfly AT and Hexagonal AT, which were used among similar population. Conclusion: Although there are multiple valid agility tests which can be performed among college student. Illinois AT and T drill AT are considered to be most effective test and helps to improve the agility among college students. This review will aware about the implication of different agility test among college-going students.

Comparative Evaluation of the Impact of Anodal Transcranial Direct Current Stimulation (TDCS) Targeting the Cerebrum versus the Cerebellum on Balance Function in Individuals with Chronic Stroke: A Pilot Randomised Clinical Trial

Rituraj Mandal, Subhasish Chatterjee

Introduction: Balance impairment significantly impact the daily activities of individuals with chronic stroke, often stemming from issues like spasticity, muscle weakness, and other neurological symptoms. tDCS has shown promise in enhancing both balance and walking abilities among chronic stroke patients. Aim: To evaluate the efficacy of anodal tDCS in enhancing balance performance among chronic stroke patients, comparing its effectiveness between stimulation of the cerebellum and the primary motor cortex region. Materials and Methods: The study aimed to evaluate the efficacy of anodal tDCS in enhancing balance performance among chronic stroke patients, comparing its effectiveness between stimulation of the cerebellum and the primary motor cortex region. Results: Both groups showed significant improvement in all outcome measures (TUG, BESS, MRMI, DGI) (p<0.05). Between-group analysis revealed significant changes in TUG, BESS, and DGI (p=0.0016, 0.019, 0.003 respectively). However, there was no significant change between groups in MRMI (p=0.528). Conclusion: Anodal cerebellar tDCS is more effective to improve balance and gait than Cerebral tDCS.

Effect of Aerobic Exercises on Abdominal Strength, Sexual Dysfunction, Pain and Menstrual Parameters in Women with Caesarean Section Delivery Suffering from Primary Dysmenorrhea: A Pilot Study

Nisha, Jaganjyoti Das, Aditi

Aim: To find out the effect of aerobic exercise on abdominal strength, sexual dysfunction, pain and menstrual parameters in women with caesarean section delivery suffering from primary dysmenorrhea.This will help effective management of patients suffering from dysmenorrhea after caesarean section delivery. Materials and Methods: A total of 16 subjects were divided into 2 groups (i.e., aerobic exercise, control group). 16 subjects with diagnosed dysmenorrhea after caesarean section delivery were randomly allocated to experimental and control groups (N=16; n=8) participants of both groups were asked to perform a set of exercises. The intervention of the experimental group consisted of aerobic exercise along with stretching and hot packs whereas the control group was given only stretching exercise and hot pack. The intervention was prescribed 4 days a week for 6 weeks. All the outcome variables were recorded at the baseline and the end of 6 weeks. The mean and standard deviation of all dependent variables of both groups were calculated. For all the variables within group analysis was done using paired sample T-test and between group analysis was done by independent sample T-test. The significance level was set at 95% (p≤0.05). Results: Statistically, a significant difference (p≤0.05) was found in the mean amplitude of pre- and post-values of the experimental group as well as between the groups were found to be significantly improved, whereas, in the experimental group, difference is found to more than the control group in abdominal strength, sexual dysfunction, pain and menstrual parameters. Conclusion: There was a significant improvement in abdominal strength, sexual dysfunction, pain and menstrual parameters in the aerobic exercise group in the experimental group. A focused rehabilitation program for dysmenorrhic females after caesarean section delivery will help in improving the quality of life and functional efficacy.

Effects of Pillow and it’s Types in Individuals with Chronic Neck Pain: A Literature Review

Swarup Ghosh, Manu Goyal

Introduction: Chronic neck pain has become a significant burden, exacerbating disability and disrupting sleep quality in contemporary society. Besides various treatment approaches, selecting an appropriate pillow is crucial for promoting spinal alignment, relieving strain on neck muscles, and enhancing overall sleep quality. Aim: Thoroughly synthesise and summarise current research on the influence of diverse pillow characteristics in individuals with chronic neck pain. Materials and Methods: A comprehensive search from the year 2014-2024 retrieved 15,258 articles through electronic databases like PubMed, Google Scholar, and Cochrane Library. Studies incorporating pillow interventions alongside physiotherapy treatment in symptomatic individuals, aged 18 years and older, who presented symptoms of chronic neck pain were included. Only, seven pertinent studies, following the removal of duplicates were selected for inclusion in this review and subjected to further analysis. Results: The reviewed literature primarily employed outcome measures like Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Numerical Pain Rating Scale (NPRS), and Neck Disability Index (NDI), with only 2 studies investigating sleep quality using the PSQI. Limited studies indicate pillow efficacy as adjuncts, with minimal evidence favoring latex or foam pillows over regular ones, showing statistical significance in NRS (p=0.015) but no statistical significance in NDI (p=0.195). Conclusion: The heterogeneity of outcome measures and the diversity of pillows assessed hinder a conclusive determination of pillow effectiveness in managing chronic neck pain. Hence, it is imperative for future research to prioritise conducting rigorous randomised trials to ascertain the effectiveness of pillows in individuals with this widespread condition.

Hindi Translation, Validation and Test-retest Reliability of The Fugl Meyer Assessment Upper Extremity Scale: A Cross-sectional Study Protocol

Etika Rana, Subhashish Chatterjee

Introduction: Stroke, a global health concern, causes substantial mortality and disability. The Fugl Meyer Assessment Upper Extremity (FMA-UE) scale evaluates sensorimotor impairment in stroke patients. Despite Hindi’s widespread use, with over 609 million speakers worldwide, the scale lacks a Hindi version. Bridging this gap could significantly enhance stroke rehabilitation outcomes. Aim: This study aims to translate the FMA-UE scale into Hindi, validate the translated version, and determine its test-retest reliability in Hindi-speaking stroke patients. Materials and Methods: Permission from the author is required before meticulously translating the FMA-UE scale into Hindi by bilingual experts. This process will involve, combining perspectives from a medical expert and a linguistic specialist. Merged translations will be back-translated into English for accuracy. Content validation via the Delphi method by an expert panel will ensure linguistic equivalence. Pretesting will gauge comprehensibility and appropriateness. Test-retest reliability will be determined through correlation coefficient calculations on patients, assessed twice with an interval. Results: Study anticipates successful translation of FMA-UE scale into Hindi with robust linguistic translation. Delphi method will be used for item assessment, calculating Item-level Content Validity Index (I-CVI). Scale-level Content Validity Index Average (S-CVI/Ave) ensures unanimity. Test-retest reliability evaluated through ICCs and Bland-Altman plots, illustrating mean scores and standard deviations across sessions, with ICC values indicating reliability and Bland-Altman plots confirming score agreement visually. Conclusion: The Hindi FMA-UE scale will aid assessment in Hindi-speaking stroke populations. This protocol ensures linguistic adequacy, enhancing clinical assessment and rehabilitation strategies.

Efficacy of Spencer’s Technique in Adhesive Capsulitis: A Literature Review

Krishnagopal Mondal, Sunita Sharma

Introduction: Adhesive capsulitis, characterised by escalating pain and gradual joint mobility restriction of uncertain origin, poses significant challenges in daily activities over months to years. Among numerous treatment modalities, the Spencer technique emerges as a distinctive and highly promising approach, offering notable improvements in pain relief, reduction of disability, and enhancement of range of motion for individuals afflicted with this condition. Aim: To provide a comprehensive summary of the current body of literature pertaining to the efficacy of Spencer’s technique in patients diagnosed with adhesive capsulitis. Materials and Methods: A total of 2,788 articles were initially collected from electronic search engines like PubMed and Google Scholar. Studies incorporating individuals aged 30 years or older, diagnosed with frozen shoulder, and utilising Spencer’s technique as an intervention were included. However, only 10 relevant articles were included in this review and analysed further, following removal of duplication. Results: While most the studies demonstrated significant findings of Spencer’s technique on ROM (p<0.05), they presented diverse results concerning pain levels and SPADI scores. Also, 3 articles have indicated that Mulligan mobilisation exhibits greater efficacy compared to the Spencer technique in adhesive capsulitis patients. Conclusion: Spencer’s technique demonstrates significant differences in pre-post outcomes versus conventional methods but lacks superiority over Mulligan mobilisation, supported by moderate evidence. Additionally, other manual therapy techniques’ efficacy remains scarce or limited in comparison.

A Literature Review on Maximising Pain Management in Low Back Pain: A Combined Approach of High-intensity LASER Therapy and Exercise Therapy

Divya Chauhan, Sunita Sharma, Mandeep Kumar Jangra

Introduction: Low Back Pain (LBP) is one of the most common musculoskeletal conditions in the world which impairs one’s ability to move, and their general quality of life. In modern medicine, High-intensity Light Amplification by Stimulated Emission of Radiation (LASER) Therapy (HILT) in particular, is commonly used in conjunction with exercise therapy to enhance the effectiveness of treating musculoskeletal complaints. However, there is insufficient data to support the combined therapeutic efficacy of HILT and exercise therapy in treatment of LBP. Aim: To investigate several databases to find out the effectiveness of combined approach of HILT and exercise therapy in pain alleviation in LBP. Materials and Methods: Using Medical Subject Headings (MeSH) keywords, authors searched across various electronic databases such as PubMed, Cochrane Library, Google Scholar, Medline, and Physiotherapy Evidence Database (PEDro). Full text randomised clinical and controlled studies were included from last 15 years. After an initial screening of 3,913 records and the removal of articles whose title and abstract didn’t meet the inclusion criteria, 54 records were considered for eligibility. Among these, the review incorporated three articles focusing on the treatment of LBP using a combination of HILT and exercise therapy. Results: The findings demonstrated the advantages of HILT, especially in terms of pain relief, may improve exercise compliance by lessening limitations brought on by pain and permitting more thorough low back rehabilitation. Conclusion: The current literature analysis showed that treating individuals with LBP with a combination of HILT and exercise therapy is more effective in reducing pain.

A Comparison of Myofascial Release and Positional Release in Conjunction with Static Stretching for Treatment of Upper Trapezius Trigger Points among University Students: A Pilot Study

Rubi Yadav, Sunita Sharma

Introduction: Myofascial trigger points are considered to be a major cause of neck pain and shoulder muscle tenderness among the working population. Aim: To investigate the efficacy of combining Myofascial Release Therapy (MFR) and Positional Release Therapy (PRT) on pain intensity and pain tolerance for managing neck pain caused by Myofascial Trigger Points (MTrPs) of the upper trapezius muscle. Materials and Methods: A pilot study was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India on a total of 16 participants were randomly assigned to Group A (MFR)and Group B (PRT), receiving treatment 3 days a week for two weeks. Both groups also received conventional treatment (such as static stretching of the upper trapezius along with a cold pack). The Numeric Pain Rating Scale (NPRS) and the Pain Pressure Threshold (PPT) were employed to compare the pre- and post-intervention assessment of the participants. Results: As the baseline data were normally distributed, the statistical analysis used independent t-tests for between-group comparisons and paired t-tests for within-group analysis. For within-group analysis, both groups revealed highly significant improvement (p<0.05) in all the outcome measures such as (NPRS and PPT). However, upon comparing both groups, the between-group analysis showed significant improvement across all parameters (p<0.05). Conclusion: Both PRT and MFR combined with static stretching were found to be effective in reducing pain and raising the pain threshold; however, comparing patients who received MFR combined with static stretching had more significant results.

A Literature Review on Graston-assisted Soft Tissue Mobilisation Technique in Patients with Plantar Fasciitis

Sanam Maurya, Sunita Sharma

Introduction: Plantar fasciitis is a common condition characterised by inflammation and microtears of the plantar-fascia, resulting in heel pain and impaired foot function. Traditional treatments include stretching, orthotics and physical therapy. Graston-assisted soft tissue mobilisation has emerged as a promising adjunctive therapy for plantar fasciitis, aiming to improve outcomes through targeted tissue manipulation. Aim: To critically evaluate existing research on the effectiveness of Graston-assisted Soft Tissue Mobilisation (GASTM) techniques in treating patients with plantar fasciitis. Materials and Methods: A literature search was conducted from Pubmed, Cochrane Library, and Google Scholar from year February 2014 to February 2024. The search utilised MeSH key terms such as “Plantar fasciitis”, “Graston technique”, “Soft tissue mobilisation”, “Quality of life”, “Range of motion” employing Boolean operators (AND, OR). A total of 2642 articles were found from different databases. Duplicate articles was removed. A total of six articles fulfilled the eligibility criteria and were included for the present review. Results: The reviewed literature primarily employed outcome measures like Numeric Pain Rating Scale (NPRS), Visual Analogue Scale (VAS), Foot and Ankle Disability Index (FADI) and Foot Function Index (FFI). Out of 2642 articles, only six met the criteria in which Graston technique effect on plantar fasciitis was evaluated and were included in the review. The review demonstrated that the Graston therapy significantly improves plantar fasciitis. Conclusion: The GASTM can effectively reduce soft tissue restriction, alleviate plantar-fascia pain, increase dorsiflexion range, and improve foot and ankle function.

Development and Validation of a Multidimensional Rehabilitation Protocol for Postmenopausal Women: A Cross-sectional Study

Poornima Maurya, Akanksha Saxena

Introduction: Menopause is a normal aging phenomenon in women. The overall prevalence of menopausal symptoms in all domains was reported as 87.7% which includes hot flushes, cognition, autonomic nervous disorders, sleep disturbances, mood changes, anxiety, etc. Therefore, it is necessary to manage these symptoms to improve the quality of life. Aim: To develop and validate a multidimensional rehabilitation protocol for Postmenopausal women. Materials and Methods: A cross-sectional study was conducted from December 2023 to February 2024 after thorough literature review, a 45-50 minute protocol was developed which included warm-up, resistance training, cognition training followed by a cool down session. After which a Delphi survey method was employed to evaluate the content validity of the formed protocol by a multidisciplinary expert panel on the basis of relevancy. Then I-CVI (Item-level Content Validity Index) and S-CVI (Scale- level Content Validity Index) of the developed protocol was calculated. Results: The protocol has been validated by a group of multidisciplinary experts with an average experience of 9.5 years working in Department of Obstetrics and Gynaecology/Women’s Health. A total of seven experts responded and evaluated each item of the protocol and suggested modifications. The I-CVI of each item was found to be between 0.86 and 1 whereas the S-CVI by average method was found to be 0.93 which was above the satisfactory level as suggested by Lynn i.e. above 0.83. Conclusion: The above generated multidimensional rehabilitation protocol for Postmenopausal women is valid.

Impact of Manual Therapy Techniques in Individuals with Text Neck Syndrome: A Narrative Review

Shavez, Sunita Sharma

Introduction: Manual therapy can help to improve pain, range of motion, strength, functional disability etc. Techniques like Elongation Longitudinaux Avec Decoaption Osteo-articulaire (ELDOA), Myofascial release, Muscle Energy Technique (MET), Neck Stabilisation exercises etc, targets specific areas affected by text neck syndrome and provide valuable management strategies. Aim: To summarise all the available evidences on how manual therapy techniques can help individuals with Text neck syndrome. Materials and Methods: A narrative review search was conducted using PubMed, Cochrane library, Physiotherapy Evidence Database (PEDro) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from year 2019 to January 2024. The search terms- “Text neck syndrome”, “Manual therapy”, “Physiotherapy” were used. The studies which included both males and females aged 18-35 years with text neck syndrome, full text Randomised Controlled Trials (RCTs) and Quasi-experimental studies were included. Results: Total 1,464 articles were found on different databases. A total of nine articles which met the inclusion criteria were included in this narrative review, out of which seven were randomised trials and two were quasi-experimental studies. Most of the manual therapy techniques found to be significantly effective in reducing pain, functional disability, improving Range of Motion (ROM) and strength while the cervical stabilisation exercise with visual feedback was effective for the proprioception and the neck stabilisation and contrology training increased Craniovertebral Angle (CVA) in individuals with text neck syndrome. Conclusion: The present review concluded that manual therapy techniques which authors reviewed were safe and effective in reducing pain, functional disability, improving ROM and strength in individuals with text neck syndrome.

Impact of Body Composition on Dynamic Balance in School-going Children: A Comprehensive Literature Review

Suraya Niyaz, Kanu Goyal

Introduction: The primary goal is to provide insights into the mechanisms underlying this relationship and to highlight the relevance of understanding body composition for balance-related interventions. Dynamic balance is crucial for daily activities, and understanding how body composition affects balance can inform strategies to improve balance control and reduce the risk of falls and injuries in children. The present review addresses the gap in knowledge regarding the specific impact of body composition on dynamic balance and its implications for school-going children. Aim: To investigate the relationship between body composition and dynamic balance to elucidate how body composition influence balance performance in school-going children. Materials and Methods: A comprehensive literature search included school-going children from the age 5 to 19 years and was conducted using PubMed, Cochrane, Scopus and Web of Science databases to identify relevant studies published up to the present date. Articles investigating the association between body composition and dynamic balance in school-going children were included. Results: A total of 913 articles were retrieved for the present study. After removing duplicate articles only 9 articles were evaluated in this literature review. The aim was to explore the relationship between body composition and dynamic balance in school going children. All the 9 articles showed a relatively high proportion of children with overweight and obesity exhibit impairment of dynamic balance. Conclusion: The present review concluded that Body Mass Index (BMI) affects dynamic balance in school-going children. These effects can increase risk of falls and injuries among children. Overall, further research is required to elucidate the precise mechanisms underlying how body composition affects dynamic balance and to develop targeted interventions for improving balance for school-going children. This review will increase awareness about the implication of different balance test among school-going students.

Effect of Soft Tissue Mobilisation on Somatic Symptoms in Chronic Low Back Pain Patients: A Pilot Pretest Post-test Randomised Clinical Trial

Sourabh Kumar, Manu Goyal

Introduction: Numerous studies suggest a significant correlation between Chronic Low Back Pain (CLBP) and somatic symptoms. These symptoms often stem from altered fascial biomechanics. Implementing Soft Tissue Mobilisation (STM) techniques aimed at restoring fascial biomechanics can markedly alleviate somatic symptoms associated with CLBP. Aim: To assess the efficacy of STM in alleviating somatic symptoms in patients with Chronic Low Back Pain (CLBP). Materials and Methods: A pilot pretest post-test randomised clinical trial was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from July 2023 to December 2023, on participants diagnosed with Non Specific Chronic Low Back Pain (NSCLBP) accompanied by somatic symptoms. The experimental group (Group 1), n=6 (41.00±6.29 years), received myofascial unwinding and myofascial release. In contrast, the clinical group (Group 2), n=6 (43.83±11.20 years), received conventional physiotherapy care, including structured exercises and electrophysical modalities, over 4 weeks. Both groups underwent three sessions per week, amounting to 12 sessions in total. The evaluation of somatic symptoms was conducted using the Hamilton Depression Rating Scale (HDRS) at baseline and after the 4 weeks. Results: The statistical analysis demonstrated significant within-group differences in HDRS (p-value=0.002) in Group 1, and no statistically significant difference in Group 2 (p-value=0.749). The between-group analysis demonstrated a statistically significant difference in HDRS (p=0.035) with a large effect size (d=1.4). Conclusion: STM effectively improves somatic symptoms in NSCLBP patients. The beneficial effect of STM on somatic symptoms can be translated into clinical practice after strengthening results in the larger population.

Establishing the Normative Reference Values of Timed Up and Go Test among Normal Weight and Overweight School-age Children: A Study Protocol

KC Sushma, Kanu Goyal, Manu Goyal

Introduction: The dynamics of body posture to avoid falling are generally referred to as balance. It has been shown that child developmental skills are influenced by their body compositions. When compared to their peers who are at a healthy weight, children who are overweight or obese frequently show poorer levels of motor proficiency including balance, mobility and related features. Need of the study: The protocol will determine the typical TUG test results in children relative to their body composition, enabling clinicians to effectively screen for balance deficits in children and will enable timely interventions to prevent falls, accidents, and sports injuries in children. Aim: To find the reference values of Timed Up and Go (TUG) test in normal weight and overweight children and compare the values between them. Materials and Methods: A study protocol on school-going children aged 5 to 15 years will be recruited using convenience sampling and divided into two groups based on their Body Mass Index (BMI): normal weight and overweight. The procedure for performing TUG test will be taught to the children, and the time taken for completion will be recorded using a stopwatch. To check the normality, Kolmogorov test will be applied as sample size estimated is above 50. Parametric or non parametric tests will be used for between group analyses.

Correlation between Hamstrings-quadriceps Strength Ratio and Lumbar Flexibility of College-going Students: A Pilot Study

Abhishek Kori, Joydip Saha

Introduction: The concept of myofascial chains or meridians emphasises the interconnectedness of the musculoskeletal system. There is a correlation between the counteracting forces applied by the knee and lower back regions. Fatigue in the quadriceps femoris muscle can lead to increased activation of the lumbar muscles. Accelerated exhaustion of the lumbar muscles during isometric trunk extension correlates with heightened suppression of the quadriceps muscles. The strength of the quadriceps muscles sets a limit on the ability to lift objects or sustain back injuries. Aim: To establish relationship between hamstring-quadriceps strength ratio and lumbar flexibility among college going individuals. Materials and Methods: A pilot study was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from October 2023 to November 2023. The study comprised 15 volunteers, aged 18 to 25, who were regular college-going students with a normal Body Mass Index (BMI) and have no active cardiovascular or musculoskeletal conditions. An evaluation was made that included isokinetic dynamometer strength ratio (duration for strength ratio evaluation was 10 minutes for each subject) and Schober test (duration for flexibility evaluation was 5 minutes for each subject). Participants followed test thrice at the same time. Results: Normality of data was determined by using Shapiro–Wilk test which showed not normal distribution. The peak hamstring-quadriceps ratio was generated from bilateral limb, which showed fair correlation to performance of composite score of Schober test in individuals going college regularly (r=-0.594; p<0.05). Conclusion: Lumbar flexibility can be dependent on Hamstring and quadriceps strength ratio among healthy individuals. The clinical implication of the present study is improving strength ratio of Hamstring and quadriceps can be an effective measure to increase lumbar flexibility and reduce low back injuries.

Effectiveness of Physiotherapy Intervention in the Symptomatic Management of Hirayama Disease: A Case Report

Bhumika Kashyap, Kanika, Subhasish Chatterjee

Hirayama Disease (HD) is an infrequent condition. Due to its rarity and misdiagnosed nature, epidemiological data is limited. Therefore, the present study aimed to find the effectiveness of physiotherapy intervention in the symptomatic management of HD. The results of the present study provided evidence for the development of standardised protocol for treatment to manage the symptoms of HD. Hereby. the authors present a case of a 20-year-old male, who presented with the chief complaint of weakness in bilateral hands for the past 3 years. The patient was examined for upper limb motor functions using Nerve Conduction Velocity (NCV), Manual Muscle Testing (MMT), Patient-related Wrist Evaluation (PRWE) and Patient-related Hand Evaluation, Quality of Life (QoL) Scale, Handheld Dynamometer (HHD) and Pinchmeter. Pre and post-intervention analysis of outcome measures were used to show the differences in the improvement of the patient’s symptoms. There was a clinical and symptomatic improvement in the scoring of PRWE from 29 to 6, NCV (30.17 m/s to 35.80 m/s on right side median nerve, 28.23 m/s to 32.06 m/s on right side ulnar nerve, 32.87 m/s to 37.23 m/s on left side median nerve, 32.13 m/s to 40.12 m/s on left ulnar nerve), MMT (from grade 2 or 3 to grade 3, 4 or 4+), QOL (72 to 99), HHD (0.3 lb to 0.5 lb of left side and 0.1 lb to 0.5 lb of right side) and Pinchmeter (0.5 lb to 3 lb of left and 0.2 lb to 1 lb of right side). The treatment given was effective in improving the patient’s symptoms. The results can be used to conduct further studies to add evidence-based literature in physiotherapy practice.

Experience of Physical Rehabilitation in Empowering Individuals Living with Parkinson’s Disease: A Qualitative Study Protocol

Simran Saini, Akanksha Saxena, Mandeep Kumar Jangra

Introduction: Life expectancy is good, patients live with certain problems (tremors, difficulty in activities of daily living, cognitive impairment, lack of balance etc). Although mainstay treatment requires pharmacological treatment and regular physiotherapy. So, the first-hand experience of physiotherapy matters in these individuals. Need of the study: The present protocol will explore the experience of individuals with Parkinson’s Disease (PD). It will help in exploring the patients’ physical and emotional experiences as they return to the community, their barriers, facilitators and also gaps they experience in their rehabilitation journey. Aim: To explore the experience of physical rehabilitation in empowering individuals with Parkinson’s Disease (PD). Materials and Methods: An open-ended interview guide was formed and validated by multidisciplinary experts. Both male and female above the age of 40 years, undergoing rehabilitation for atleast 6 months and having mild and moderate PD (Hoehn and Yahr stage I-III). No depression and anxiety is assessed on Hospital Anxiety and Depression scale (HADS); HADS-depression score=9, HAD-anxiety=8 will be recruited. It will have 17 open ended questions regarding the experiences after Physical Rehabilitation, Cognitive impairment’s, Activities of Daily Living (ADLs), Freezing, Balance, Facilitators, Barriers. Semi-structured interviews will be conducted and transcribed verbatim into English language, then entered into Qualitative Data Analysis (QDA) miner software for analysis. The interview guide is validated by the experts and obtained an Item-level Content Validity Index (I-CVI) of all items/questions of 0.84-1 while Scale-level Content Validity Index (S-CVI) by Average method and Universal agreement is 0.914 and 0.647, respectively. Results will be depicted in form of word clouds and code tree.

Transcranial Direct Current Stimulation as a Modulator of Autonomic Functions: A Narrative Review

Muskaan Banyal, Mandeep Kumar Jangra, Akanksha Saxena

Introduction: The transcranial Direct Current Stimulation (tDCS) has been explored for its benefits in a variety of conditions, and has been reported to have significant impact on the autonomic functions such as heart rate, heart rate variability, sympathetic and parasympathetic outflow via the neural modulation. Aim: To study the potential effects tDCS on the autonomic functions. Materials and Methods: A narrative review was conducted on healthy young adults with age ranging from 18 to 35 years. For the studies to be segregated, a plethora of studies were looked up the databases PubMed, Google Scholar, Cochrane, Ovid and Physiotherapy Evidence Database (PEDro). As a result of search, 1007 studies were found out of which 22 experimental studies were found to justify the aim chosen for current study and hence were scrutinised for yielding the result. Results: The scrutiny of the included literature resulted in yielding the nuances that stimulation by tDCS has improved the parameters determined by autonomic nervous system. A total of nine out of 22 studies talked about the cathode placed extra-cephalous, having no statistically appreciable results however, rest 13 studies had the anode and cathode both placed cephalic and had significant impact on heart rate variability, baro-reception and sympathetic and parasympathetic outflow. Though on comparison of the type of tDCS stimulation, stimulation via anode had much pronounced beneficial changes than cathode or sham stimulation. Conclusion: The tDCS is a novel technique that impact-fully deals with impairment in autonomic functions incorporation with the conventional treatment techniques, tDCS can be adjunctively used to deal with autonomic impairments and help achieve better quality at life.

Exploring the Psychometric Properties of Upper Extremity Functional Scale: A Narrative Review

Rubina Nazz, Simranjeet Kaur, Nidhi Sharma

Introduction: The Upper Extremity Functional Scale (UEFS) is a 20-item, region-specific, patient-reported outcome measure developed by Glenn Pransky and colleagues in 1997. The UEFS is used to measure upper extremity function in individuals with hand and upper extremity disorders. Patients rate their function on a 0 to 4 Likert scale, where 0 indicates extreme difficulty and 4 indicates no difficulty performing the task. This translates into a maximum possible score of 80, which indicates excellent function. The UEFS takes about 5 minutes to complete and is easy to administer and score with minimal training. The total score is computed by adding up individual item scores. Aim: To examine the psychometric properties of the UEFS. Materials and Methods: A narrative review was conducted from August 2023 to February 2024 and included searches in PubMed, Physiotherapy Evidence Database (PEDro), and Scopus (2015-2023) The search strategy included keywords such as “Upper Extremity Functional Scale,” “psychometric properties,” “reliability” “validity,” and “responsiveness.” There were 10 articles investigating the psychometric properties of the UEFS in individuals with upper extremity musculoskeletal disorders were included. Results: The summary of the psychometric evidence of the Upper Extremity Functional Index (UEFI) available version in terms of reliability, validity and responsiveness. The UEFI and UEFI-15 versions showed consistent test-retest reliability results {Intraclass Correlation Coefficient (ICC)=0.94}. Convergent validity for both the UEFI and UEFI-15 versions was supported by their strong correlation with the Upper Extremity Functional Scale (UEFS) ≥0.6. Conclusion: The UEFS exhibits strong psychometric properties. It is widely used in clinical practice and research, with solid evidence supporting its usefulness in measuring upper extremity function in people with musculoskeletal diseases.

Impact of Stationary Cycling on Clinical Outcomes in Patients with Tibiofemoral Osteoarthrosis: A Pilot Study

Akash Chatterjee, Manu Goyal

Introduction: Knee osteoarthrosis (tibiofemoral) is one of the most common forms of arthritis and a significant contributor to disability in the elderly. It has a notable impact on the muscle strength and lower limb biomechanics. The pain and stiffness associated with osteoarthrosis knee can significantly hinder daily activities and work potential in affected individuals. Aerobic exercises have demonstrated positive outcomes for these patients. Aim: To evaluate the effectiveness of forward and backward cycling with knee osteoarthrosis ranging from grade 1-3. Materials and Methods: A prospective, randomised clinical trial and single-blind pilot study was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India. The compared two groups: one adding static cycling to regular treatment, the other receiving only regular treatment. Both groups got treatment three times a week for four weeks. Quality of Life (QoL) and pain were assessed using the Comprehensive Knee Osteoarthritis Index (CKOAI) scale, while isokinetic strength was measured with an isokinetic dynamometer. Evaluation at both baseline and endpoint was conducted by the same assessor. Results: Significant improvements were shown at the 4-week follow up for QOL, pain and isokinetic strength (p<0.02) with stationary cycling. The CKOAI, an indicator of pain intensity and QOL showed significant improvement (p=0.02). Conclusion: The research affirms the findings from the earlier Randomised Controlled Trials (RCTs) and indicated that engaging in stationary cycling leads to significant enhancement in individuals with osteoarthrosis knee. Participants expressed their appreciation for the program and proved to be safe, effective and feasible in primary care.

Effectiveness of Myofascial Release on Respiratory Muscle in COPD Patients: A Narrative Review

Yuvraj Rana, Manu Goyal

Introduction: The Chronic Obstructive Pulmonary Disease (COPD) can stiffen the diaphragm, limiting its movement and compliance. Myofascial Release (MFR) techniques may help loosen restrictions in the fascia surrounding the diaphragm, allowing for better mobility and more efficient breathing. While some studies suggest benefits of MFR for COPD patients, the overall research base is limited. Aim: To evaluate the current evidence on effectiveness of MFR techni-ques in improving respiratory muscle function in patients with COPD. Materials and Methods: A narrative review was conducted from September 2023 to January 2024 and following searches were performed in PubMed, Physiotherapy Evidence Database (PEDro) and Cochrane using keywords like “manual diaphragm release”, “respiratory muscles”, “COPD” and “diaphragmatic myofascial release”. After probing the databases only four studies were found to be in line with the aim, where the participants were both male and female with COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Results: Findings of the Randomised Controlled Trials (RCTs) were included in the present review. The studies employed Myofascial release over Respiratory muscles which shows that MFR have beneficial effects on respiratory muscle functions in COPD patients, potentially improving breathing mechanics, muscle strength and exercise tolerance. Conclusion: The review supports the potential effectiveness of myofascial release as a complementary therapy for improving respiratory muscle function in individuals with COPD. The MFR could be a valuable non invasive and drug-free technique to complement existing COPD management strategies like medication and pulmonary rehabilitation. It might offer additional benefits for symptom management and overall well-being.

Role of Core Muscle Strengthening Exercises in Rehabilitation of Knee Osteoarthritis in Obese Patients: A Narrative Review

Manalisa, Sunita Sharma

Introduction: Knee Osteoarthritis (OA), is a common cause of disability. It normally affects women more often than men, and as people age, it becomes more prevalent. Obese individuals are more prone to develop knee OA. Regular exercise has been demonstrated to lessen knee OA discomfort. Exercises that strengthen the core muscles are very beneficial for people with osteoarthritis in the knee, particularly those who are obese. Aim: To determine whether core muscle-strengthening exercises have been beneficial in the rehabilitation of knee osteoarthritis patients with obesity. Materials and Methods: Electronic searches were conducted using PubMed, Scopus, and Google Scholar databases to get information that was relevant from years 2012-2024 with the keywords, “Knee Osteoarthritis”, “Obesity”, “Regular Exercise”, “Quality of Life”. An unbiased selection, evaluation, and extraction of data were carried out in the present review. Complete text papers, written in English, published within 2007 and 2023 and knee OA with core strengthening studies were included in the review. Results: The present review included a total of five articles that emphasise the use of the photogrammetric method in the evaluation of forward head posture, particularly the craniovertebral angle. The angular and linear values are commonly utilised by using posture analysis software to evaluate changes in the frontal and sagittal planes of the spine. The photogrammetric method can be recommended as a reliable tool for evaluation of forward head posture. Conclusion: Exercises that strengthen the core muscles are very beneficial for people with osteoarthritis in the knee. Strengthening the core muscles is a very effective physical treatment for knee osteoarthritis patients, as it dramatically improves their functional status, discomfort, range of motion and Quality of Life (QoL).

Evaluation of Forward Head Posture using Photogrammetric Method: A Literature Review

Anamika Kundu, Simranjeet Kaur, Nidhi Sharma

Introduction: Photogrammetry is a technological space, innovations in electronics and computer science had an enormous effect on it and continues to be greatly impacted by the expanding use of technology. This particular area is perpetually progressing and the transition from analog to statistical and digitised approaches emphasises this aspect well. The photogrammetric method is comprehensively being used in the healthcare system for the assessment of forward head postural evaluation. Aim: To determine the efficacy of photogrammetry for the assessment of forward head posture in frontal and sagittal planes. Materials and Methods: Electronic databases such as PubMed, Google Scholar, and Cochrane Library to acquire essential information on photogrammetric methods for evaluating forward head posture were used. Studies including evaluation of the forward head posture utilising the photogrammetric method as an outcome measure, full-text articles, written in English language, published between 2010 to 2023 were included. The review performed an objective process, evaluation, and selection of data extraction. Results: This review included a total of five articles that emphasised the use of the photogrammetric method in the evaluation of forward head posture, particularly the craniovertebral angle. Conclusion: The photogrammetric method has shown consistency for the evaluation of forward head posture, particularly the craniovertebral angle, and therefore is a cost-effective approach in the field of postural evaluation and it would be worth considering for evaluating forward head posture.

Impact of Class IV LASER Therapy and Conventional Exercise on Young Adults with Cervicogenic Headache: A Randomised Clinical Trial Protocol

Anjuman Sahani, Sunita Sharma

Introduction: A Cervicogenic Headache (CGH) is characterised by unilateral neck pain that originates in the bony or soft tissues of the neck and refers to the head. Light Amplification by Stimulated Emission of Radiation (LASER) therapy is frequently employed in clinical settings to treat musculoskeletal diseases. Need for the study: Authors anticipate cervicogenic headache (CGH) treatment with Class IV LASER therapy will lead to statistically significant reduction in both neck pain and headache compared to baseline measurement. Adverse events related to Class IV LASER on CGH is minimal. The anticipated result of the present protocol will provide valuable insight into the efficacy and safety of Class IV LASER in the management of headache and neck pain. Aim: To determine the efficacy of Class IV LASER therapy in young adults with CGH. Materials and Methods: A randomised clinical trial protocol will be conducted on a total of 44 patients having age range between 20-39 years with cervicogenic headache were recruited by convenience sampling method. Recruited individuals with cervicogenic headache will be randomly divided into two groups: Treatment Group A (Class IV LASER therapy with conventional exercises) and Treatment Group B (Conventional exercises). Treatment time for group A will be calculated by dividing the total energy delivered by the average total output. Each patient received six sessions in total alternative days. Group B also received same session as group A. The visual analogue scale, neck disability index, algometer, and headache impact test are outcome measures that will be recorded as a baseline and of the two-week post-intervention period.

Effect of Soft Tissue Mobilisation in Patients with Oral Submucous Fibrosis: A Case Series

Rohan Kumar Sahu, Manu Goyal

Oral Submucous Fibrosis (OSMF) is a chronic, premalignant disorder of oral cavity, marked by limited mouth opening (trismus) and burning sensation in the mouth. Purpose of the present case series was to evaluate the effect of Soft Tissue Mobilisation (STM) in patients with OSMF. Individuals with history of trismus with histopathological confirmation of OSMF who volunteered for the study. STM is a manual therapy technique and is widely used in soft tissue conditions. In this study STM was used to treat fibrous band which are present in the buccal mucosa of the OSMF patients. Mouth opening range was taken as an outcome measure, assessed using vernier caliper at the baseline and after six weeks from the baseline. Treatment duration was once in a week for 6 weeks. The patients showed significant increase in the mouth opening range (1.5±0.14 inches), at the end of 6 weeks. The present case series has delineated the promising contribution of STM in OSMF by improving mouth opening. The effect of STM has shown, this helps clinicians to incorporate STM as a part of their treatment plan in patients with OSMF.

Visual Biofeedback Assisted Lower Limb Balance Training in Chronic Stroke: A Pilot Study

Satemrenla Ao, Neha Gupta, Ankur Mittal

Introduction: Stroke is one of the significant long-term impairments and it results in the inability to carry out many activities due to balance issues leading to increased risk of falls. A rehabilitation technique called Visual Biofeedback (VBF) may be applied to provide the patient with visual cues and are given more knowledge to modify their behaviour and achieve improved performance. Aim: To investigate the effectiveness of lower limb balance training interventions using VBF (Togu Challenge Disc 2.0) in improving balance in hemiplegic patients following a stroke. Materials and Methods: A pilot study was conducted in Xcell Physiocare, Greater Kailash 1, New Delhi, India for 3 weeks, from 27 February, 2024 to 14 March, 2024. In the present study, a total five chronic stroke patients were included and the selection criteria were as: able to tolerate standing, Berg Balance Scale (BBS) score >20 to <41, Brunnstrom score between stage I and IV. For the training, subjects were made to perform activities standing on a platform known as Togu challenge disc 2.0 where there were various levels and patient had to move their COG in the directions as displayed on the screen and recorded in a software named Body Teamwork. A total of nine sessions (30 min/day, 3 times per week for 3 weeks) were given. Pre- and post-intervention assessment was carried out using Berg Balance Scale and Lower Extremity Motor Coordination Test (LEMOCOT). Intervention effects were evaluated with the Wilcoxon’s matched paired test. Results: After training, the group showed significant improvement and increase in BBS median score from 34 (range=32-39) to 38 (35-42) (p>0.05) and LEMOCOT median score from 13 (range=11.33-14.63) to 16 (range=15-16.66) (p>0.05). Conclusion: The VBF improved both the balance and coordination.

Efficacy of Pilates Training on Balance in Spastic Cerebral Palsy Children: A Pilot Study

Shyamoli Sharma, Neha Gupta, Ankur Mittal

Introduction: Impaired postural and reactive balance control is a substantial challenge for children with Cerebral Palsy (CP). Evidence states that Pilates Training (PT) increases strength, endurance and flexibility of the trunk and abdominals, and demonstrates improvement in the deep core muscles which helps body’s ability to relax and improve balance in Spastic Cerebral palsy (SCP) children. Aim: To measure the efficacy of PT on improving balance in SCP children. Materials and Methods: A quasi-experimental pilot study with convenient sampling was conducted for 2 weeks, from March 6, 2024 to March 21, 2024 in Xcell Physiocare, Greater Kailash-I, New Delhi, India among children aged between 5 to 9 years, who were able to understand Hindi and English, with spasticity ranging from 1 to 1+ (Modified Ashworth Scale), level 3 and 4 (Gross Motor Function Classification System) and normal flexibility of lower back muscle. They received 10 minutes of stretching, followed by 45 minutes of PT, 10 repetition each, 4 times a week for 2 weeks. The measurement was performed at baseline and post-treatment using Pediatric Balance Scale (PBS), modified Timed Up and Go (mTUG). Data was analysed using Wilcoxon’s Signed-rank test. Results: The measured variables before and after therapy showed a significant improvement (p<0.05) in both PBS and mTUG. Conclusion: PT is an effective treatment program for improving balance in SCP children.

Balance Training for Improving Equilibrium in Patients with Chronic Ankle Instability: A Literature Review

Deepshikha, Simranjeet Kaur, Nidhi Sharma

Introduction: Balance training refers to a type of exercise or physical activity that focuses on improving an individual’s ability to maintain stability and equilibrium. For those with recurrent balance problems, balance training is a specific method to increase stability and decrease the chance of falls or injury. Aim: To find out the effectiveness of balance training among individuals with chronic ankle instability. Materials and Methods: A literature review with a total of nine randomised controlled trial and one cohort study were included which emphasised on balance training and addressed the treatment of chronic ankle instability. Electronic searches were performed through databases PubMed, Google scholar and Cochrane library were used to acquire the relevant studies from the last 10 years from 2014 to 2024. The keywords like “Balance training”, “Chronic ankle instability”, ‘Equilibrium’ and ‘Posture’ were used. An impartial selection, evaluation and data extraction procedure were carried out by the reviewer. Results: Balance training through physical therapy involved specific treatment plans which aimed at strengthening areas of weakness that led to balance and coordination issues and proven significant results for the management of the chronic ankle instability. Conclusion: Balance training was better treatment for the improvement in the dynamic as well as static balance, gait patterns, functional improvement and postural control in the individuals having chronic ankle instability.

Impact of Ladder Training on Lower Limb Power, Strength and Agility in Collegiate Badminton Players: A Pilot Study

Baishali Singha, Pooja Anand, Himanshu Rakheja

Introduction: Badminton is a highly explosive, intermittent sport that requires quick anticipation and response to opponent movements. To execute advanced strokes and compete against stronger opponents, players must improve their basic physical parameters-strength, power and agility, otherwise due to physical demands on the lower limbs, leads to frequent injuries among players. Ladder training, type of strength and sports training, involves performing one or more exercises with an ascending and falling repetition pattern for building muscular endurance and conditioning, to assist players to increase their overall training volume. Aim: To study the impact of ladder training on lower limb power, strength and agility in collegiate badminton players. Materials and Methods: A pilot study was conducted in the Department of Physiotherapy, SGT University, Gurugram, Haryana, India, from December 2023 to January 2024. In the present study, 10 collegiate badminton players were selected according to the inclusion and exclusion criteria with informed consent signed. The players were further divided into two groups: experimental group (n=5) underwent ladder training for 3 days/week, 6 weeks. and control group (n=5) underwent conventional training for 3 days/week, 6 weeks. The outcome measures for both groups were: Y-shaped agility test, standing broad jump test and Triple hop distance test, taken before and after training session. Results: The data was statistically analysed by paired and unpaired t-test, the agility performance of Group A compared to Group B with p-value=0.001 was considered highly significant and the data between pre and post training the group A was highly significant (p=0.001) in strength, power and agility of the players.

Exploring the Viability of Neurobic Exercises as an Intervention for Cognitive Impairment: A Literature Review

Pooja Purendra Chandrakar, Sunita Kumari

Aim: To investigate the viability of implementing neurobic exercise interventions among adults diagnosed with Mild Cognitive Impairment (MCI). Materials and Methods: A comprehensive search of electronic databases PubMed, Google Scholar, Medline, was done for relevant studies, including randomised controlled trials, observational studies. Inclusion criteria were both male and female with cognitive impairment, implementation of neurobic programme and their follow ups. A total of four articles were synthesised out of 12, for the review based on the inclusion criteria. Results: All the four studies yielded positive results. Firstly, use of neurobic exercises exhibited a significant decrease in Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) relative change scores, indicating cognitive decline improvement, and significantly higher Catechol-O-methyltransferase (COMT) relative change scores, reflecting enhanced cognitive performance at 3^rd and 6^th weeks. Secondly, serum Brain-derived Neurotrophic Factor (BDNF) level in the neurobic group was slightly higher than pretest. There was change in Montreal Cognitive Assessment (MoCA) scale in post treatment experimental group as compared to conventional group. Participants expressed high satisfaction with the activities and perceived the intervention as helpful. Conclusion: The implementation of neurobic exercise interventions proved to be both feasible and was well-received by people with cognitive impairment. It also proved to improve quality of life. Neurobic exercises suggest future research avenues demonstrating a forward looking approach to address existing research gaps.

Exploring Non Invasive Neuromodulation to Ameliorate Radiculopathic Pain: A Systematic Review of Randomised Controlled Trials

Sidharth Bansal, Nidhi Sharma, Simranjeet Kaur

Introduction: Despite numerous investigations has delved into Non invasive Neuromodulation (NINM) for alleviating neuropathic pain from various origins, its efficacy in addressing radiculopathic pain specifically remains inadequately explored. Aim: To comprehensively synthesise existing literature on the use of NINM in managing radiculopathy-induced pain. Materials and Methods: A thorough search of four databases—Scopus, PubMed, Physiotherapy Evidence Database (PEDro), and Cochrane Library was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines from October 2023 to January 2024. Included articles in the study must have patients with cervical or lumbar radiculopathy, aged over 18 years, and included atleast one non invasive neuromodulation intervention, with outcomes measuring pain. Case reports, reviews, and meta-analyses were reviewed for additional references. “Radiculopathy” and “Neuromodulation” were the primary keywords used to extract data and the studies’ quality and findings were critically appraised using tools such as PEDro, Grading of Recommendations, Assessment, Development and Evaluations (GRADE), Level of Evidence, and Risk of Bias. Results: Six out of 75,182 studies that were identified met the inclusion criteria and underwent thorough evaluation. The remaining 75,176 articles were excluded for reasons such as duplicates (32,156), patients not related to radiculopathy (15,637), lack of the desired intervention or outcome (27,094), and various other reasons (289). NINM methods showed a significant reduction in pain severity for radiculopathy patients, with no reported adverse effects. Conclusion: In summary, integrating NINM approaches alongside conventional therapeutic strategies showed promising effects in enhancing the efficacy and sustainability of pain management for radiculopathy.

Effect of High-intensity LASER Therapy, Kinesio-taping and Plantar-fascia Stretching on Patients with Plantar Fasciitis: A Study Protocol

Sarita Yadav, Sunita Sharma, Mandeep K Jangra, Sandeep Pattnaik

Introduction: Plantar Fasciitis (PF) is the most frequent musculoskeletal condition that primarily affects the foot, causing tenderness and disturbed foot function. Need of the study: The planned clinical trial will proceed with the aim of ensuring that the intervention is accessible to the general public, irrespective of the outcomes. This study will help in exploring the effect of HILT, KT and plantar-fascia stretching and to add this method as adjunct to conventional physiotherapy approach in plantar fasciitis sufferers. Aim: To evaluate the effect of combination of {High-Intensity Light Amplification by Stimulated Emission of Radiation (LASER) Therapy HILT)} with Kinesio-taping (KT), and plantar-fascia stretching in improving pain pressure threshold and foot function in individuals suffering from PF. Materials and Methods: A single-blinded randomised clinical trial design will be employed to enroll both male and female participants aged >18 years, with plantar heel pain lasting more than 4 weeks and will be randomly divided into two groups. The experimental group will receive HILT along with KT using the low-dye taping technique, while the comparator group will receive HILT along with plantar-fascia stretching. A power analysis will be conducted to determine the appropriate sample size based on the findings of a pilot study. Outcome measures will include pressure algometry to assess pressure pain threshold and the foot function index to evaluate disability. The study outcomes could either indicate a meaningful difference between the groups or not. This will confirm the practical relevance of the intervention for individuals suffering from plantar fasciitis.

A Review on Optimising Limb Function with Inspiratory Muscle Training: Unlocking Potential with Enhanced Performance

Deepa Sharma, Mandeep K Jangra

Introduction: The potential of Inspiratory Muscle Training (IMT) to enhance limb function holds broad significance across sports science, rehabilitation, and physical therapy. The present review elucidates the link between respiratory muscle function and limb performance, suggesting that integrating IMT into training protocols and rehabilitation programs, particularly in sports and preventive healthcare, could yield improved outcomes. Recognising the vital role of respiratory muscle function in overall performance may inspire innovative approaches to training and rehabilitation strategies. Aim: To investigate the effect of inspiratory muscle training in optimising limb function and its impact on overall performance enhancement. Materials and Methods: Full text published articles from year 2004 to 2024 from different databases like Google Scholar, PubMed, Physiotherapy Evidence Database (PEDro) and Cochrane library were included. The search items like “Inspiratory muscle training,” “Limb function”, “Respiratory muscle strength” using Boolean operators AND, OR were used. The study involving both male and female individuals were included. Results: From a total of 345 studies, seven full text studies were relevant and meeting the inclusion criteria were selected. IMT was proven to improve limb function especially in athletes. Conclusion: The findings are expected to provide valuable insights into the potential of IMT as a novel intervention for optimising limb function and enhancing overall performance. The conclusion drawn will contribute to the body of knowledge in sports science, rehabilitation and physical therapy, prepare the way for clinical applications.

Comprehensive Therapeutic Approach for Obstetric Brachial Plexus Injuries: A Scoping Review

Payal Mehta, Shweta Sharma

Introduction: About 1.4 out of 1000 deliveries of live babies result in Obstetric Brachial Plexus Injury (OBPI), which is characterised by flaccid paralysis of the arm due to brachial plexus damage to the nerve following birth. Shoulder dystocia, maternal hyperglycemia, instrumental delivery, and breech delivery are the primary risk factors. Repercussions are seen in the form of muscle weakness, and activity limitations. Thus, early intervention is a necessity here. Aim: To highlight all the therapeutic interventions that are exercised in children with brachial plexus injury. Materials and Methods: To retrieve literature about obstetric brachial plexus injury, the Cochrane Library and PubMed databases were accessed for this scoping review. A total of 256 articles were determined to be pertinent to the investigation. In summary, 40 met the review’s inclusion specifications, so they had been thoroughly reviewed. Results: There is unanimous agreement that principles of Modified Constraint-induced Movement Therapy is the main treatment option for the rehabilitation of OBPI. The disparities have been identified and the need for further research has been highlighted. Conclusion: The present study concludes that Modified constraint-induced Movement Therapy (mCIMT) has found to be effective for upper limb function and strength in cases of OBPI. However, efficacy of other techniques like Kinesio-taping and dynamic orthosis in combination with mCIMT needs more clarity, in terms of literatures and evidences. Also, emerging source of virtual rehabilitation in terms of Erb’s Palsy requires justifications. Implication: The present scoping review provides an insight of all the techniques which shall be administered while treating cases of OBPI in clinical practice.

Enhancing Sensory Disparities: A Case Report on Structured Exercise Protocol in Diabetic Peripheral Neuropathy Management

Khushboo Kumari, Subhasish Chatterjee, Manu Goyal

Diabetes encompasses a spectrum of metabolic disorders marked by elevated blood sugar levels due to issues with insulin secretion, its effectiveness, or both. Despite numerous investigations into managing symptoms of Diabetic Peripheral Neuropathy (DPN), a structured protocol has yet to be established. The present study aimed to shed light on the impact of a structured exercise protocol on symptom management and the enhancement of superficial and deep sensations. Specifically, the study explores the effectiveness of a Structured Exercise Program in addressing symptoms of DPN, with a focus on improving both superficial and deep sensations to enhance overall quality of life. The case report involved a participant diagnosed with DPN. Following a comprehensive clinical assessment and diagnostic tests, specific predetermined criteria were established to confirm the alleviation of symptoms. Physiotherapy interventions were employed to address various symptoms, with superficial and deep vibratory sensation serving as indicators of progress. Over the 30-day monitoring period, the patient showed improvements in light touch and pressure sensations during everyday activities. The treatment strategies effectively addressed the specific challenges associated with enhancing the patient’s quality of life and functional abilities. In conclusion, this case study highlights the complexities of managing DPN and the effectiveness of combining physiotherapy interventions. The enhancements in sensory functions and daily activities underscore the potential of exercise therapy in improving the quality of life for individuals with DPN.

Evidence of Disability and Quality of Life-related Outcome Measures in Postpartum Women with Pelvic Girdle Pain: A Literature Review

Devendra Kumar Dhruv, Manu Goyal

Introduction: Pelvic girdle pain is a common musculoskeletal complaint in pregnant or postpartum women. This pain is experienced between the posterior iliac crest and the gluteal fold. Various assessment tools are used for assessing Disability and Quality of life in postpartum women with pelvic girdle pain. Aim: To provide suggestions based on evidence, for the assessment tools used in postpartum women with pelvic girdle pain. Materials and Methods: In the present review, MEDLINE (via PubMed), Scopus, Google Scholar, Physiotherapy Evidence Database (PEDro) were searched using Boolean operators to identify existing relevant studies from September 2023 to February 2024. The studies that assessed the measurement properties of tools used to measure outcomes relevant to populations experiencing Pelvic Girdle Pain (PGP) and/or Lumbar Pelvic Pain (LPP) were included. Results: The existing evidence suggested reliability of tools for Pelvic Girdle Questionnaire {Intraclass Correlation Coefficient (ICC)=0.98} Oswestry Disability Index (0.94); Roland Morris Disability Questionnaire (0.91); Disability Rating Index (ICC=0.90); Short Form-8 (ICC=0.85). Conclusion: All the instruments showed excellent reliability and the Pelvic Girdle Questionnaire (PGQ) is the most assessed instrument in the literature. It is suggested that PGQ can be utilised to assess disability in postpartum women with pelvic girdle pain and is the only condition-specific tool for pelvic girdle pain. By employing these assessment instruments in clinical setting would assist in diagnosing and monitoring prognosis during subsequent evaluations.

Normative Reference Value of Proprioception and Reaction Time among Females with PMS- A Cross-sectional Study

Anshu Sharma, Nidhi Sharma, Simranjeet Kaur

Introduction: Premenstrual Syndrome (PMS) encompasses physical, emotional, and behavioral changes prior to menstruation. While hormonal fluctuations during PMS may affect neurological processes, direct links to alterations in proprioception and reaction time are not firmly established. Normative reference scores have not been established for proprioception and reaction time among females with premenstrual syndrome. Aim: To determine the normative reference score of proprioception and reaction time among females with PMS using the Sensbalance MiniBoard. Materials and Methods: A cross-sectional study was conducted at the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, recruited females aged 18 to 40 years, with regular menstrual cycle, and with Premenstrual Syndrome (PMS), diagnosed according to Premenstrual Dysphoric Disorder (PMDD) criteria (≥5 out of 11 symptoms). The study aimed to establish normative values for these measures in PMDD individuals. Results: The normative data for proprioception in four directions i.e. front, back, left, and right were 19.47±18.26°, 7.59±3.66°, 11.94±12.93°, 10.99±8.02°. The normative data for the reaction time in front, back, left and right was obtained as 0.94±0.32 s, 0.79±0.16 s, 0.91±0.27 s and 0.93±0.50 s, respectively. Conclusion: The results suggest the feasibility of conducting an extensive study with a larger sample size to facilitate the generalisation of data to a global population.

Interpretation of Normative Score of Hamstring and Quadriceps Isokinetic Peak Torque among University Students: A Pilot Study

Nandni Goel, Sunanda Bhowmik

Introduction: Understanding normative scores can help in identifying individuals who may be at risk of injury due to muscle imbalances or weakness. By comparing an individual’s scores to the normal, interventions can be implemented to address any deficits and reduce the risk of injuries, particularly in physically active populations like college students involved in sports or physical activities. Aim: To evaluate the normative reference score of isokinetic peak torque of hamstring and quadriceps muscles among healthy college-going students from the age group 18-25 years. Materials and Methods: This pilot study was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India and enrolled 50 healthy college-going students. Permission was taken from participants in the Institutional Research Laboratory for data collection. Students aged 18 to 25 years were enlisted for the research. All participants were sensitised about the procedure before they participated in the study. The participants were provided consent form. Results: The normative reference value of RHq_R was mean±SD 1.18±0.61, median (IQR) was 1.07(0.76, 1.43), skewness was 1.26, kurtosis was 1.37 and for the LHq_L mean±SD was 1.35± 0.71, median {Interquartile Range (IQL)} was 1.21(0.83, 1.80) and the skewness, kurtosis was 1.18 and 0.97, respectively. Conclusion: The study found that college students had weak quadriceps and hamstring strength. It also revealed that these students had a bad Hamstring:Quadriceps strength (H:Q) ratio and were more likely to have hamstring injuries.

Exploring New Trends in Physiotherapy for Optimising Recovery in Patients with Spinal Cord Injury: A Narrative Review

Akanksha Nagar, Jaspreet Singh Vij

Introduction: The present study provides up-to-date insights for healthcare professionals and aim for the improvement in patient outcomes and enhanced recovery. It also focuses on recent advancements in physiotherapy techniques tailored for spinal surgery recovery. Aim: To explore emerging trends and innovative approaches in physiotherapy interventions for patients with Spinal Cord Injury (SCI). Materials and Methods: Relevant literature published from January 2019 to March 2024 searched. MeSH terms and keywords were combined in a search strategy. The included studies comprised of patients aged 19-44 years with spinal cord injury. Primary intervention were of new technologies in physiotherapy. Results: A total of 573 studies were found through search and out of them 18 were selected. A total of seven studies were included. Conclusion: The ultimate goal of these interventions is to achieve patient’s societal reintegration and become independent in most of the activities according to the severity of their condition; therefore, improving and updating these strategies create opportunities for innovative research, as well as implementing rehabilitation strategies as a complement for non pharmacological strategies for the SCI patient.

Effectiveness of Bobath-based Rehabilitation Program and Conventional Physiotherapy on Motor Function in Children with Hydrocephalus

Tanpreet Kaur Bakshi, Jaspreet Singh Vij, Ashish Chhabra

Introduction: Hydrocephalus is the most common childhood brain disorder and among the most common entities addressed by neurosurgeons. Disabilities of hydrocephalus are dependent on the patient’s age. Aim: To determine the efficacy of bobath-based rehabilitation program and conventional physiotherapy in improving motor function in children with hydrocephalus and levels of anxiety of parents of children with hydrocephalus. Materials and Methods: A study was conducted in the Department of Physiotherapy, University College of Physiotherapy, Baba Farid University of Health Sciences, Faridkot, Punjab, India, with a total of 20 subjects of hydrocephalus, aged 3 months to 8 years, both males and females, who were included as per the selection criteria, after their parents’ written consent. These subjects were randomly divided into two groups, Group A (n=10) and Group B (n=10). All the subjects were assessed for motor function using Gross Motor Function Measure (GMFM-88 scoring). The anxiety level of parents was assessed using State-trait Anxiety Inventory (STAI). Group A was administered bobath-based rehabilitation program whereas Group B received conventional physiotherapy. In both the groups the specific interventions were given for a total of 8 weeks, with 1 session per week. Subjects were reassessed after completion of the interventions. Statistical analysis was done using paired t-test and unpaired t-test. Results: The results showed statistically significant difference in the scores of GMFM, STAI-State (S) and STAI-Trait (T) in Group A (p-value=0.0030, 0.0001,0.0009) and Group B (p-value=0.0234, 0.0013,0.0005), respectively. Conclusion: Thus, both bobath-based rehabilitation program and conventional physiotherapy are efficacious for enhancing motor function and in improving level of anxiety of parents of children with hydrocephalus.

Virtual Reality’s Influence on Eye Sightedness: A Review

Jay Shankar Choudhary, Nidhi Sharma, Simranjeet Kaur

Introduction: Virtual Reality (VR) is an innovative tool for treating a range of childhood and adult illnesses, improving motor skills across ages. The use of VR therapies is expanding, particularly in serious VR games that may influence vision. VR’s immersive environments, tracked by headsets and sensors, raise concerns for eye health, affecting user experience and potentially creating visual challenges. Aim: To provide perspectives on exploring the influence of virtual reality on the eye sightedness. Materials and Methods: A search of literature was carried out on databases including PubMed, Cochrane, Physiotherapy Evidence Database (PEDro), Ovid-SP, and Google Scholar from their beginnings until February 2024. The search involved using terms such as “Virtual Reality,” “Eye,” “vision,” “effects,” and “physiotherapy,” with the use of Boolean operators AND and OR. Out of 3549 articles found in different databases, only four met the criteria and were included in this review. Results: The findings of the present review indicated that prolonged virtual reality use can strain the eyes, leading to discomfort, dryness, and visual fatigue. Over time, this strain may cause more significant issues such as the progression of myopia, digital eye strain, and potential long-term impacts on vision clarity and eye health. Conclusion: Concerns about the impact of extended VR use on eyes are valid, with evidence suggesting it could lead to the development of heterophoria—a condition where eyes point in different directions at rest. This condition may result in long-term vision issues. However, enjoying the benefits of VR (such as education, therapy, and entertainment) while being mindful of eye health is still feasible.

Efficacy of TheraTogs on Biomechanical Variables in Spastic Diplegic Cerebral Palsy Children: A Literature Review

Payal Mehta, Shweta Sharma

Introduction: TheraTogs are specialised orthotic garments which is highly used for rehabilitation purpose for improving postural control, alignment and stability, especially in case of spastic diplegic cerebral palsy children. This poster highlights all the therapeutic benefits that has been thoroughly examined with the use of TheraTogs. Selected published literatures that has featured the efficacy of theratogs on various parameters in children with cerebral palsy are evaluated here. Aim: To study the efficacy of TheraTogs on biochemical variables in spastic diplegic cerebral palsy children. Materials and Methods: To access literature about TheraTogs, the Cochrane Library and PubMed databases were accessed for the present literature review from December, 2023 to February 2024. Twenty-five articles were determined to be pertinent to the investigation. In summary, 20 met the review’s inclusion specifications, so they had been selected and thoroughly reviewed. Results: When compared to the control group (the Conventional Physiotherapy), children in the experimental group (using TheraTogs) demonstrated statistically significant improvements in all primary and secondary measure scores after treatment (p<0.05). Conclusion: The present review concluded that TheraTogs orthotic undergarments have been found to be a potentially helpful tool for enhancing spinal geometry, improving gait and postural control in children with diplegic cerebral palsy. This literature review provides an insight of all the benefits which can be forecasted with the use of TheraTogs in clinical practice.

The Use of Robotic Devices in Knee Rehabilitation: A Literature Review

Neha Upadhyay, Pooja Sharma, Palak Chaudhary

Introduction: Total Knee Replacement (TKR) surgery rehabilitation presents significant challenges, necessitating effective interventions to restore function and mobility. Robotic devices have emerged as promising tools for enhancing knee rehabilitation outcomes. Robotic-Assisted Rehabilitation (RAR) systems offer unique capabilities that may address some of the challenges associated with traditional methods, robotic devices can facilitate early mobilisation and functional training, potentially leading to faster recovery, improved joint function, and enhanced patient satisfaction. Aim: To provide a comprehensive overview of the current state of research on the use of robotic devices in knee rehabilitation. Materials and Methods: A thorough search of databases, including PubMed, Google Scholar, Science Direct, and Medical Literature Analysis and Retrieval System Online (MEDLINE) was conducted by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the terms “rehabilitation”, “robot”, and “total knee replacement”. This approach yielded 37 articles of which six full-text available articles, from 2014 and 2024 were included in the present review. Studies were selected based on predefined inclusion criteria. Pertinent reference lists were examined. Results: The review identified various types of robotic devices utilised in knee rehabilitation, including exoskeletons, robotic-assisted therapy systems, and rehabilitation platforms. Comparative effectiveness studies indicated potential benefits of robotic-assisted rehabilitation in improving range of motion, muscle strength, functional performance and patient satisfaction. Conclusion: It can be concluded that RAR may be an effective treatment in TKR patients. Future research should focus on personalised rehabilitation protocols, longitudinal outcomes assessment and innovative technologies to optimise patient care and rehabilitation efficacy in knee injuries and surgeries.

Impact of Gamification on Undergraduate Physiotherapy and Occupational Therapy Pedagogy: A Comprehensive Review and Quality Analysis using MERSQI

Rohi Kumar, Nitya Chophla

Introduction: In the realms of physiotherapy and occupational therapy pedagogy, a notable shift towards student-centered approaches has been witnessed, with gamification emerging as a pivotal tool for fostering teaching methodology and motivating learners. This study helped to explore innovative educational gamification methods and assessed the quality of the evidence which could help in incorporating this approach in undergraduate teaching. Aim: To evaluate the impact of gamification on undergraduate pedagogy in physiotherapy and occupational therapy. Additionally, it aimed to analyse the quality of evidence of research using the Medical Education Research Study Quality Instrument (MERSQI) scale. Materials and Methods: Employing a systematic approach, a thorough search was conducted across various electronic databases including Google Scholar, PubMed, Science Direct, etc. The search strategy used a combination of keywords like: “gamification”, “physiotherapy”, etc. Quality of evidence was assessed using the MERSQI scale. A total of 679 articles were screened, ultimately leading to the inclusion of 12 studies. Results: The review included 12 Studies with 1348 Students of UG programs. Quality assessment, measured via the MERSQI scale, yielded scores ranging from 8 to 13.5 out of 18. Key gamification strategies such as Kahoot! and Escape Room puzzles were observed to significantly enhance active learning, bolster retention rates and foster critical problem-solving skills among students. Conclusion: It was found that gamification had a positive impact on the motivation, learning outcomes, and professional development of students and holds immense potential for revolutionising pedagogical practices and fostering a dynamic and engaging learning environment.

Pontic Site Development using Soft-tissue Augmentation with Connective Tissue Graft in Maxillary Anterior Region: A Case Report

Restoring a localised alveolar ridge defect in the anterior aesthetic zone poses the greatest challenge in the field of Perio-aesthetics. Various soft-tissue augmentation techniques have been recommended for soft-tissue augmentation. The present case report shows treatment of a Siebert’s Class-III ridge defect using an interpositional connective tissue augmentation technique and restoration with an ovate pontic design to achieve an increase in soft-tissue volume and aesthetic outcome. A 58-year-old male patient was referred to the Department of Periodontics for the replacement of a missing tooth at position 11. The patient was given two treatment options: Guided Bone Regeneration (GBR) followed by the placement of an implant or Soft-tissue augmentation with Connective Tissue Graft (CTG) and restoration with a Fixed Dental Prosthesis (FDP). The patient opted for soft-tissue augmentation along with FDP, and the procedure was carried out. The results showed that this technique improved the soft-tissue quality and quantity without the use of any hard-tissue grafts. The soft-tissue augmentation mimicked the natural healthy emergence profile in a Siebert’s Class-III ridge defect. The use of subepithelial CTG gives a predictable results in FDP as a prosthetic option and is cost-effective compared to other synthetic graft materials. The technique used in the present case report is simpler, predictable and less invasive compared to the morbidity associated with the harvesting of an autogenous bone graft for augmentation.

Gallbladder Ascariasis in a Young Adult: Not that Scary After All

Raja Kumaran Rajamanickam, Shivani Tyagi

Hepatobiliary and Pancreatic Ascariasis (HPA) is an uncommon manifestation of Ascariasis. Hereby, authors report a case of a 35-year-old female who presented with two days of acute onset epigastric pain. It was associated with nausea and non bilious emesis. She had a similar episode about a week back that spontaneously subsided. The abdominal examination was benign and non contributory. Laboratory reports showed raised serum amylase and lipase levels, with other biochemical parameters within normal limits. She had no eosinophilia. Transabdominal Ultrasonography (USG) picked up a moving linear hyperechoic structure within the gallbladder with a bulky heterogeneous pancreas. The stool sample confirmed the presence of a fertilised Ascaris lumbricoides egg. The patient was admitted with the diagnosis of mild acute interstitial pancreatitis secondary to gallbladder and intestinal ascariasis. She was followed with serial abdominal scans, and on the third day, she had a spontaneous expulsion of the worm from the gallbladder. She was treated with a single dose of oral albendazole. She was later discharged on day six of admission in a stable condition. In endemic areas, patients presenting with hepatobiliary and pancreatic symptoms should consider ascariasis in the differential diagnosis. The management is largely non operative, with good clinical outcomes when diagnosed early. Efforts should be made to reduce the burden of ascariasis in the community with a focus on public health awareness.

Transient Abnormal Myelopoiesis in a Down Syndrome Baby: A Case Report

Vani Krishnamurthy, KR Shouree

Transient Abnormal Myelopoiesis (TAM) is a transient haematological condition observed in children with Down syndrome during their neonatal period. Spontaneous resolution without any specific treatment is the rule, and the condition is known to occur exclusively in association with trisomy 21. Around 10% of Down syndrome babies are known to be affected by TAM, and 20-30% of these babies are known to develop acute myeloid leukaemia, of the megakaryoblastic type, in their later lives. Multisystem involvement is known in this condition. The present case of TAM is a two-day-old newborn female baby, born out of full-term gestation, presented with respiratory distress along with congenital pneumonia, hepatosplenomegaly, and mild ascites. The baby also had significant pulmonary hypertension, an Atrial Septal Defect (ASD), and non restrictive Patent Ductus Arteriosus (PDA). A significant increase in the total leukocyte count was seen, accompanied by thrombocytosis and 72% blastoid cells. Then, using karyotyping, Trisomy 21 was verified. 35% of the blasts had megakaryoblastic differentiation, according to flow cytometry. Hence, before diagnosing congenital leukaemia based on finding excess blasts in the peripheral smear of a newborn, karyotyping has to be done to look for possible trisomy 21. It can be an incidental finding, as in the present case, without prior clinical suspicion of Down syndrome.

A Holistic Accelerated Approach in the Acute Phase for ACL Sprain: A Case Report

Saurabh Puri, Swapnil Ramteke, Ashish Keoliya

To manage acute Anterior Cruciate Ligament (ACL) sprains, this case report suggests a comprehensive, accelerated method that incorporates cutting-edge diagnostics, personalised rehabilitation, and new approaches like Kinesio Taping. The technique works for rapid return to activities, pain relief, and knee stability rehabilitation. Kinesio Taping offers dynamic support, improves circulation, and lowers oedema. It is recognised for its proprioceptive benefits. The recovery process is maximised by taking a holistic approach that considers lifestyle, psychological, and physical aspects. The case report advances the treatment of ACL injuries by stressing an accelerated, multifaceted approach and the combined advantages of including Kinesio Taping into the regimen. This explores the case of a 28-year-old male Kabaddi player who, after suffering a grade 1 ACL tear, facing persistent pain, swelling, and anxiety. The traditional approach offered limited relief. However, a new, multifaceted treatment plan incorporating physical therapy, Cognitive Behavioural Therapy (CBT), and Kinesio Taping brought remarkable results.

Prosthetic Rehabilitation of a Three-year-old Child with Ectodermal Dysplasia: A Case Report

Yashshwini Shroff, Brahmananda Dutta, S Bhuvaneshwari, Varsha Sharma

Ectodermal Dysplasia (ED) is a rare congenital syndrome that exhibits defects in two or more ectodermal tissues. Dental manifestations include delayed eruption of permanent dentition, complete absence of teeth or absence of a few teeth, and peg-shaped teeth. This condition is typically diagnosed by a dentist when parents bring their child with complaints of absent/delayed eruption of primary teeth. Hypohidrotic ED with true anodontia is an extremely rare condition, particularly in females. Over the past 50 years, only 11 cases have been reported involving anodontia of primary and permanent dentition in ED. The current report describes a case of a three-year-old female child diagnosed with hypohidrotic ED with anodontia, successfully treated by fabricating complete dentures with proper retention to restore function and aesthetics.

A Case Report of Two Malignancies in Breast with Short Review of Literature: Phyllodes and Ductal Type

A 54-year-old female presented with a recurrent mass in the right breast for eight months, associated with pain and discolouration of the skin for two weeks. Past history revealed a wide local excision of a tumour in the same breast 10 months ago, which was reported as a benign phyllodes tumour. Local examination revealed a bosselated mass of size 20×20×10 cm occupying all four quadrants of the right breast, along with another firm lump of size 3×3 cm in the lower inner quadrant. Magnetic Resonance Imaging (MRI) of the breast showed two separate lumps: the large lump involved all four quadrants of the right breast and was suggestive of malignant transformation of a recurrent phyllodes tumour-BIRADS V (Breast Imaging-Reporting and Data System), and another smaller lump was noted in the lower inner quadrant. A Tru-cut biopsy of the larger lesion was reported as a possibility of a phyllodes tumour with mild nuclear atypia. The total mastectomy specimen showed both solid and cystic areas with necrotic material, haemorrhagic fluid, and blood clots in the larger lump. A separate lump from the lower inner quadrant of the ipsilateral breast showed a firm, solid lesion. Microscopic examination of both lesions revealed the simultaneous presentation of a malignant phyllodes tumour with chondrosarcomatous differentiation and infiltrating ductal carcinoma. This case highlights the unpredictable co-existence of two separate malignant lumps in the ipsilateral breast, which is an extremely rare event.

The Profile of Cypermethrin Intoxication as Differential Diagnosis of Organophosphate Poisoning: A Case Report

Ananta Kumar Bora, Amrit Jyoti Sonowal, Ananya Barman, Sneha Gang

Cypermethrin, a type II pyrethroid, is easily available over the counter, increasing the possibility of accidental and intentional exposures. Severe Cypermethrin exposure is rare but may lead to an organophosphate-like toxidrome, posing a diagnostic quandary to the critical care personnel. The authors present a case of a 25-year-old lady patient, who intentionally ingested a toxin or poison. On repeated investigation by medical personnel and family members, it eventually turned out to be cyperhit. On, immediate shifting to the Intensive Care Unit (ICU) following acute poisoning, her vital signs were more or less stable, but with mouth filled with copious mouth secretions and mild bronchorrhoea. An intravenous dose of 1.2 mg of atropine sulfate was administered because of bronchorrhoea, which led to satisfactory improvement, except for hypoglycaemia {(Random Blood Sugar (RBS): 67 mg/dL}. To address hypoglycaemia, an initial bolus of 25% dextrose (IV)/100 mL was injected followed by an infusion of 25% dextrose at a rate of 10 ml/hr. At the end of three days of close monitoring and psychiatric counseling sessions, she was fully alert, oriented, afebrile, and had stable vital signs. The present case suggests that Cypermethrin poisoning should be considered a differential diagnosis of patients presenting with classical features of organophosphorus poisoning. Inadvertent administration of pralidoxime and atropine can be avoided if emergency physicians are aware of this entity. Optimum Atropine administration is useful when the dose is adjusted as per the patient’s response.

A Case Report on Management of Paraquat Poisoning Associated with Oral Fibrosis and Lung Fibrosis

P Karthick, E Arun, R Nandakumar, S Sarumathy

Paraquat, a brown, viscous liquid herbicide known as “N, N’-dimethyl-4,4’-bipyridinium dichloride,” rapidly deactivates upon contact with soil, making it an efficient herbicide with minimal chronic toxicity. However, the prognosis is poor for acute poisoning or high doses of paraquat. Since, there is currently no effective treatment for paraquat poisoning, preventative efforts must be prioritised. A 31-year-old male patient was brought to the Emergency Department after ingesting around 10 mL of paraquat while under the influence of alcohol. He complained of vomiting, throat pain, mouth ulcers, and difficulty swallowing and speaking. Upon oral examination, erosions were observed on the upper and lower lips, with erythema present on the tongue. The patient was diagnosed with deliberate self-harm paraquat poisoning-induced oral fibrosis. Computed Tomography (CT) chest scan revealed no fibrosis except for a few paraseptal emphysematous changes in the apical segments of the bilateral upper lobes. Gastric lavage was performed, and activated charcoal (60 mg) was administered as initial treatment. The patient was then treated with choline salicylate gel, dexamethasone, and acetylcysteine as an anti-inflammatory measure for oral fibrosis before being discharged. However, the patient returned with complaints of dysphagia, worsened oral ulcers, and an inability to take oral fluids, leading to readmission for these issues. A follow-up CT chest scan revealed patchy ground glass consolidatory changes with surrounding minimal fibrotic changes in the bilateral upper lobe. The patient exhibited elevated levels of White Blood Cells (WBC), neutrophils, Erythrocyte Sedimentation Rate (ESR), urea, Blood Urea Nitrogen (BUN), and C-reactive Protein (CRP), which were continuously monitored. Due to the oral ulcers and lung fibrosis, the patient was treated with methylprednisolone, acetylcysteine, povidone iodine mouthwash, and clotrimazole mouth paint. The patient was managed conservatively, and there was an improvement in symptoms.

EMG Activity of Core and Global Muscles of Spine during Functional Exercises in Basketball Players with Chronic Ankle Instability: A Pilot Study

Anuj Sehrawat, Pooja Bhati, Pooja Anand

Introduction: Assessing the Electromyography (EMG) activity of core muscles during various exercises might be extremely important to understand the neuro-muscular strategies used by basketball athletes with Chronic Ankle Instability (CAI). Aim: To compare the EMG activity of the core/global muscles during different functional exercises in basketball athletes with versus without CAI. Materials and Methods: A pilot study was conducted in the Department of Physiotherapy, SGT University, Gurugram, Haryana, India. A total of eight basketball players subjects aged 18-30 years with (n=4) and without CAI (n=4) were recruited using convenience sampling. Players with atleast 2 years of competitive experience were enrolled. CAI was diagnosed if there was a history of atleast two ankle inversion injuries in the same ankle for the past 2 years, which had required a period of protected weight bearing or immobilisation or any complaint of giving way of the ankle during functional activities and score of less than 24 on the Cumberland ankle instability tool. Surface EMG was recorded for multifidus, rectus abdominis, transverse abdominis and erector spinae during six functional exercises (single leg squat, Y balance exercise, quadrant hop, toe touch down, box jump and medicine ball slams). 2×5×4 repeated measures Analysis of Variance (ANOVA) was employed to test the study hypothesis. Results: A significant difference was found between the activation patterns of the core and global muscles in basketball players with CAI and without CAI. Conclusion: It can be concluded that CAI alters the activation of core and global spinal muscles significantly. CAI is not restricted to distal joint but has an impact on proximal muscles as well. Neuromuscular training for the muscles, which alters motor control strategy because of CAI, could be taken into consideration when planning rehabilitation for CAI.

Sleep Disturbance among Chronic Low Back Patients: A Short Survey

Shivangi, Manu Goyal

Introduction: In the realm of modern health challenges, Chronic Low Back Pain (CLBP) and sleep disturbances is an issue of concern, casting a shadow over millions worldwide CLBP has a direct impact on the sleep disturbance leading to physical and mental disabilities. Physiotherapy is pivotal in management of Primary and secondary complications like sleep disturbances associated with CLBP. Aim: To evaluate and analyse various domains of sleep hygiene among CLBP patients through Pittsburgh Sleep Quality Index (PSQI). Materials and Methods: A survey using the gold standard method was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, among 8 patients with CLBP and the sleep was evaluated through PSQI which serves as a seven component subjective questionnaire that evaluated the state of sleep and interruptions during a one-month period. Results: Data analysis showed that PSQI has significant improvements (p<0.05) after manual and conventional physiotherapy. Conclusion: Physiotherapy plays a crucial role in management of chronic low back pain and secondary complications such as sleep disturbance associated with it. Using both manual and conventional physiotherapy techniques greatly improves the outcome of treating CLBP.

Efficacy of Integrated Neuromuscular Inhibition Technique on Pain and Range of Motion in Patients with Upper Trapezius Triggers Point: A Literature Review

Shivani Chauhan, Simranjeet Kaur, Nidhi Sharma

Introduction: Myofascial Pain Syndrome (MPS) is current musculoskeletal pain disorder that affects the majority of chronic pain population. Myofascial Trigger Points (MTrPs) are hyperexcitable spots in a tight band within the skeletal muscle, which ache upon shortening, elongating and manifest referred pain. Integrated Neuromuscular Inhibition Technique (INIT) is a single coordinated technique, which is used to decrease the pain intensity, increase the function and range of motion due to the increased blood supply by intermittent pressure, muscle relaxation by strain-counter strain and tone reduction by muscle energy technique. Thus, the review of literature was suggested to explore the efficacy of techniques like INIT on pain and range of motion parameters. Aim: To evaluate the current literatures on the efficacy of INIT on pain and range of motion in patients with upper trapezius trigger point. Materials and Methods: A literature review was conducted from December 2023 to February 2024, using PubMed, the Cochrane Library, and PEDro databases to identify studies on the Integrated Neuromuscular Inhibition Technique (INIT) in patients with upper trapezius trigger points. Seven articles meeting inclusion criteria were selected for detailed analysis to evaluate INIT’s effects on pain and range of motion in this population. Results: From the initial search of PubMed, the Cochrane Library, and PEDro databases, seven articles met inclusion criteria for analysis. Among these, four studies reported positive outcomes for the Integrated Neuromuscular Inhibition Technique (INIT) in treating upper trapezius trigger points. INIT interventions consistently improved pain levels and range of motion, indicating its efficacy in managing myofascial pain syndromes in this muscle group. Conclusion: An integrated strategy, INIT is proved to be effective in reducing pain and improving quality of life in patients with non specific neck pain, stiffness, and enhancing functionality.

Prevalence of Neck and Shoulder Pain among Teaching Professionals: A Cross-sectional Study

Simran Kaur Mohi, Sahana, Ravia, Amandeep Singh

Introduction: Teachers are more susceptible to neck and shoulder pain due to their daily tasks and regular employment, making it the most prevalent occupational health issue contributing to morbidity and absence among teachers globally. Neck and/or shoulder pain in working population such as in teachers is increasing day by day. Incidence of shoulder pain is 73.4% and neck pain is 68.9%. Aim: To find out the prevalence of neck and shoulder pain among the teaching professionals. Materials and Methods: A cross-sectional study was conducted in the Department of Physiotherapy, CSHS, Chitkara University, Punjab, India. Atotal of 207 educators teaching in colleges and universities completed a questionnaire. Sampling method used was convenient sampling method. The data collection was done using a questionnaire which was circulated through Google form. Results: Out of 207 subjects, 125 teaching professionals were found to have neck and shoulder pain. Among them, 57.1% females and 42.9% males of which, 48.3% reported neck pain, 21.3% radiating pain and 38.4% describe it as dull aching, whereas 39.6% reported shoulder pain. The screen usage per day: 79.7% reported >3 hours, 10.6% with 3 hours, 4.8% with 2 hours, and 4.8% with 0-1 hours. Conclusion: The incidence of neck pain and shoulder pain was found to be quite high among teaching professionals. They need to be administered regular postural advices so as to maximise their outputs.

Effectiveness of Blood Flow Restriction Training on Functional Mobility and Strength in Neurological Disorders: A Review

Sudhir Kumar, Aarti Gupta, Saurabh

Introduction: Research indicates that Blood Flow Restriction (BFR) offers advantages for individuals in good health, older populations, and those experiencing musculoskeletal issues. A comprehensive analysis was carried out to explore the efficacy of BFR in improving functional mobility and strength among individuals with neurological disorders. In recent times, there has been a surge in interest towards BFR research, which entails the regulation of blood flow to the muscles during physical activity, partly for arterial circulation and fully for venous circulation, aiming to optimise training outcomes. Aim: To ascertain how blood flow restriction training affects strength and functional mobility in neurological diseases. Materials and Methods: A comprehensive analysis was conducted. PubMed, Web of Science (WOS), Physiotherapy Evidence Database (PEDro), Google Scholar, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), the Cochrane Library, and Research Gate were the databases that were searched for literature between January 2003 and October 2023. The risk of bias in the research was assessed using the Cochrane Collaboration tool, and the methodological quality of the studies was assessed using the PEDro scale. Total 278 articles were found through literature search, after filtration for all years through 2003 to 2023 yielded (278) articles and removing duplicates yielded 238 articles. Reports assessed for eligibility (N=15). A total of 10 articles were included based on the inclusion criteria. Results: There were no unfavourable results from any of the trials that we reviewed. However, we found out significant improvement in increasing muscular strength and functional mobility among neurological patients. Due to the substantial diversity and small number of publications, the results should be interpreted with caution. Further clinical study ought to be conducted. These studies should improve the methodological quality as well as the consistency of the procedures used in larger samples. Conclusion: Blood flow restriction therapy appears to be helpful in treating neurological problems without having negative side effects, according to the reviews in this study. Progress has been observed in walking endurance, strength, muscle thickness, gluteus density, and step length symmetry, and gait speed. There have also been improvements to the balance.

Effectiveness of Mulligan Therapy in Patients with Cervicogenic Headache: A Systematic Review of Randomised Control Trials

Shruti Tamhankar, Vaneet Kumar

Introduction: Cervicogenic headache is a type of headache that presents as unilateral pain which starts in neck. It originates from C1-C2 zygapophyseal joints. Mulligan therapy is a technique that utilises pain-free low velocity joint mobilisations that includes active component. Aim: To find out effectiveness of mulligan therapy in patients with cervicogenic headache. Materials and Methods: A systematic review of articles searched from PubMed central, Google scholar, ResearchGate until 2023 were undertaken. Among 70 articles, only 10 articles which were according to inclusion and exclusion criteria, were reviewed. The article was reviewed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Physiotherapy Evidence Database (PEDro) guidelines. Patients with cervicogenic headache, studies reporting influence of mulligan therapy, study design including only randomised control trials were included. Conclusion: Mulligan therapy specifically Natural Apophyseal Glides (NAGs) and Sustained Natural Apophyseal Glides (SNAGs) had an effect on decreasing pain intensity level, improving functional cervical range of motion in patients with cervicogenic headache.

Physical Functional Limitations in Breast Cancer: A Case Series

Suman Mehra, Pragya Kumar, Abhishek Soni

Multidisciplinary approach, to Breast Cancer (BC) has significantly improved patient survival time, but the patients suffer from adverse effects of cancer and anti-cancer treatment affecting their functionality and overall quality of life. This case series aimed to identify limitations in physical functioning among patients with breast cancer. An interview guide was developed on the basis of literature definition of ‘physical function’, its determinants, International Classification of Functioning, Disability and Health criteria on functioning, and literature published on relevant factors in BC. Fifteen women diagnosed with BC, who were either undergoing active treatment or completed it, with age ranging between 26-75 years, were included. Semi-structured interviews were conducted using interview guide and responses were audio-recorded. The responses obtained were then coded and analysed using thematic analysis. Out of total 15 participants, three were on ongoing active treatment and 12 had completed it (nine were within one year of completion of active treatment). Thematic analysis revealed that the subjects experienced impairments in upper quarter flexibility (n=7), upper limb functional strength (n=9), limitations in basic (n=5) and instrumental activities of daily living (n=12) and many had done changes in performing activities at home or workplace (n=12). Many women had pain (n=13) in neck or arm after sustained activity, swelling in arm, cording, fatigue, impairment of balance (n=6) and negative body image perception. Such limitations were more prevalent among old and frail. Limitations in physical functioning were found prevalent among participants in the present case series which points out the need for long term surveillance of women with breast cancer for physical functional limitations.

Physiotherapy Interventions for the Management of Treatment-related Complications in Breast Cancer: Systematic Literature Review

Neelam Kumari, Suresh Mani, Kalaivani Chellappan

Introduction: The prevalence of treatment-related complications remains high throughout the course of cancer treatment resulting a decline in quality of life. Physiotherapy can have a positive influence on various domains of Quality of Life (QoL), potentially alleviating the severity of perceived complications. \ Aim: To evaluate the physiotherapy interventions used for managing treatment-related complications among breast cancer patients. Materials and Methods: Databases including Medical Literature Analysis and Retrieval System Online (MEDLINE), Science Direct, Cochrane Library, and Scopus from year 2000 to 2022 was searched with Mesh terms for trials with breast cancer patients >18 years of age participating in physiotherapy program. The primary outcome measure of interest was a significant improvement in treatment-related complications from pre- to post intervention. Change in quality of life was evaluated as secondary outcome measure. Cochrane risk of bias tool was used to assess the risk of bias and quality of included studies. Results: A total of 20 randomised controlled trials with 2019 patients incorporated various physiotherapy interventions to manage and alleviate treatment-related complications. For physical functioning (p=0.04) and the pain-sleep-fatigue cluster (p=0.006 to 0.044) different types of exercises were included. Complex Decongestive Therapy (CDT) combined with other electrotherapy modalities was embraced to manage lymphedema (p<0.05). For shoulder and arm dysfunction (p<0.05) passive stretching, mobilisation and strengthening exercises were incorporated. Furthermore, regular practice of exercise and physiotherapy exhibited positive impacts on overall health-related quality of life (p=0.0001 to 0.01) along with improvements in anxiety, depression, self-esteem and emotional function. Conclusion: Physiotherapy interventions are exceedingly effective in managing and providing relief from breast cancer treatment-related complications. Consequently, the integration of physiotherapy into cancer treatment protocols has the potential to enhance the overall QoL of patients.

Management of Pain and Inflammation in Knee Osteoarthritis using Class IV LASER: An Experimental Study

Anupma, Jasobanta Sethi, Rajeev Aggrawal

Introduction: Knee osteoarthritis is a degenerative inflammatory disease affecting the entire joint and is characterised by progressive loss of cartilage and associated with pain. The tissue cells absorbs a certain wavelength of Light Amplification by Stimulated Emission of Radiation (LASER) which triggers a number of chemical responses in the cells that promote healing and reduce inflammation. Aim: To find the effect of Class IV LASER on pain and inflammation in knee osteoarthritis of older adults. Materials and Methods: This study utilised an experimental controlled design with pre and post comparison. The study was conducted from March 2023 to January 2024 at Jindal Physio Care, New Delhi, India, with the sample size of 36 subjects (18 each group). Participants were recruited based upon a predefined selection criterion. After signing the informed consent, all the subjects were randomly distributed among two groups (Group A and Group B). Outcome variables were inflammatory biomarkers Interleukins 6 (IL 6), Interleukins 1β (IL 1β), C-Reactive Protein (CRP) and NumericÂ Pain Rating Scale (NPRS), which were assessed in the beginning and at the end of study period of 10 weeks. Group A was given Placebo LASER along with moist heat, exercises and knee brace while GroupÂ B was given Class IV high-intensity LASER along with moist heat, exercises and knee brace. Data were analysed using the Student’s t-test and significance level was kept 95% (p<0.05). Results: There was a significant decrease in NPRS score, IL 6, IL 1β and CRP levels in both the groups at the end of the study. AÂ substantial reduction was found in group B compared to groupÂ A (p<0.001). Conclusion: Class IV LASER treatment has been found satisfactory in alleviating pain and inflammation, which may be a promising treatment method for knee osteoarthritis.

Effectiveness of Kabat Rehabilitation, Kinesio-taping Combined with Neuromuscular Facilitation Techniques in Management of Subacute Bell’s Palsy: A Case Report

Adarsh Sharma, S Jeyanthi

A comprehensive physiotherapy protocol for treating individuals with Bell’s palsy including neuromuscular facilitation techniques is essential to enhance therapeutic effects and significant outcomes for individuals with subacute Bell’s palsy. The purpose of the present case report was to explore the distinct effects of Kabat rehabilitation, Kinesio-taping, and neuromuscular facilitation techniques for treating Bell’s palsy. It underscores the necessity for additional integrated research in this domain. Hereby, the authors present a case of a 34-year-old male suffering from Bell’s palsy with a history of left ear pain and heaviness on the left side of the face for 1.5 months. The patient reported to Neurophysiotherapy Outpatient Department (OPD) and was recruited after thorough assessment and screening followed by informed consent and was given an intervention of 40 minutes per session, 5 times per week for 4 weeks. Baseline and post-assessments were done for facial functions with the House-Brackmann Facial Outcome Scale (HBFS) and Facial Disability Index (FDI). After 4 weeks of intervention, there were significant improvements between baseline and post-intervention scores on the HBFS and FDI. The result of the present report was to provide a more potentiate intervention to improve facial outcomes in individuals with Bell’s Palsy. Emphasis should be placed on experimental studies with larger sample sizes to observe more significant results.

Comparative Study of Blood Flow Restriction Therapy and Weight Training on the Knee Flexors Strength among Recreational Cricket Players: A Randomised Controlled Trial

Radha Mittal, Nikki, Pragnya Jyoti Dash, Tanya Gujral, Richa Hirendra Rai

Introduction: Cricket was once regarded as a “moderate injury risk” sport, However, there has been a continual increase in injury rates in cricket, with Hamstring Strain Injuries (HSIs) being the most prominent. More recent research suggests that the injury rate in cricket is rising, with HSIs one of the most common and severe injuries. Aim: To investigate the impact of Blood Flow Restriction Therapy (BFRT) and traditional resistance training on knee flexor strength and squat test among cricket players. Materials and Methods: This was a single-blinded, randomised controlled trial on 39 cricket players conducted in the Department of Physiotherapy, Galgotias University (GU), Greater Noida, Uttar Pradesh, India. Subjects aged between 18-25 years were randomly divided in a 1:1 ratio. Group A underwent BFRT combined with low-resistance training, and Group B underwent traditional resistance training. A four-week intervention, comprising two sessions weekly was administered. Results: For within-group comparisons, the paired t-test was used and for between-group comparisons, the independent t-test was used using Statistical Package for the Social Sciences (SPSS), version 25.0. Group A demonstrated a statistically significant increase in squat test scores from pre- to post-intervention compared to Group B after 4 weeks. No significant difference in muscle strength was observed among the two groups. Conclusion: Combining BFRT with low-resistance training significantly enhances knee flexor endurance, as evidenced by superior performance in the squat test compared to traditional resistance training alone. These findings suggest the potential of BFRT as a valuable adjunct to rehabilitation and performance enhancement strategies for lower limb injuries in athletes.

Management of Pain and Improvement in Quality of Life in Lumbar Disc Herniation using Class IV LASER- A Placebo-controlled Study

Dinesh Kumar, Jasobanta Sethi, Rajeev Aggrawal

Introduction: Intervertebral disc herniation is the most common cause of spine related disability in working-age individuals. Class IV high-intensity Light Amplification by Stimulated Emission of Radiation (LASER) therapy can help in reducing inflammation, pain and improve function with increasing microcirculation, activating angiogenesis. Aim: To find the effect of Class IV LASER on pain and Quality of Life (QoL) in patients with herniated lumbar disc. Materials and Methods: This placebo-controlled pre- and post-comparison study conducted at Jindal Physio Care, New Delhi with the sample size of 34 subjects. Participants were recruited based upon a predefined selection criteria. After signing the informed consent, all the subjects were randomly distributed among two groups. Outcome variables were Numeric Pain Rating Scale (NPRS), and QOL 36-Item Short Form Survey Instrument (SF-36) questionnaire which were assessed in the beginning and at the end of study period of 10 weeks. Control group was given placebo LASER whereas the study group was treated with high-intensity LASER. Moist heat, core strengthening exercise and use of lumbar corset was advised for both the groups. Results: There was a significant (p<0.05) decrease in NPRS and SF-36 score in both the groups at the end of the study. However, study group showed significant improvement compared to control group (p<0.001). Conclusion: Class IV LASER treatment has been found more effective reducing pain and improving QoL. This can be a better choice of treatment in patients with lumbar disc herniation.

Understanding the Risk Factors for Cardiac Arrest in Young Adults: A Systematic Review

Kalindi Dev

Introduction: Cardiac arrest, once largely associated with older individuals, is increasingly affecting young adults, necessitating a deeper understanding of its risk factors in this demographic. Aim: To identify and analyse relevant literature to uncover the risk factors contributing to cardiac arrest among young adults. Materials and Methods: A comprehensive search of databases using specific keywords related to cardiac arrest, risk factors, and young adults was conducted. Out of 573 studies initially identified, 245 duplicates were removed, and 328 were screened based on eligibility criteria. After further assessment, 123 records were rejected, leaving 205 full-text papers for review. Ultimately, eight studies were included in the qualitative analysis. Results: The review highlighted modifiable lifestyle factors, cardiovascular conditions, genetic predisposition and environmental influences as significant contributors to cardiac arrest risk in young adults. Specifically, obesity, smoking, physical inactivity, and substance abuse emerged as prominent modifiable risk factors. Predisposing factors such as inherited cardiac conditions, structural heart abnormalities, and acquired cardiac disorders were also identified. Environmental factors, including air pollution and socioeconomic status, were found to play a role in shaping the risk profile of young adults. Conclusion: The review concludes by emphasising the importance of addressing modifiable risk factors and promoting cardiovascular health awareness to mitigate the incidence of cardiac arrest in young adults. By addressing these factors, healthcare providers can work towards reducing the burden of cardiac arrest and improving outcomes in this vulnerable population. The present systematic review provides valuable insights into the risk factors contributing to cardiac arrest in young adults and lays a foundation for evidence-based preventive measures.

Effect of Isometric and Eccentric Exercises on Pain and Jump Performance in Indian Male Volleyball Players with Patellar Tendinopathy

Monika, Kalindi Dev

Aim: To find out which exercise, isometric or eccentric is the best intervention to reduce the patellar tendon pain and maximise the jump performance. Materials and Methods: The participants were screened and selected according to the inclusion and exclusion criteria. The demographic data, pain and Victorian Institute of Sport Assessment–Patella (VISA-P) scale were measured pre-intervention and post-intervention. A total of 25 players of mean age 17.00±16.54 years, mean weight 67.76±60.84 kg and 89.63±17.67 cm mean height were taken through the single-blinded randomised sampling and were allocated into two groups Group A (n=12) of isometric exercise intervention and Group B (n=13) of Eccentric (EC) exercise intervention for 12 weeks. Results: There was a statistically non significant difference seen for the demographic values between the groups (p>0.05) for all the variables. There was a statistically highly significant difference seen for the values between the groups (p<0.01) for post VISA-P with higher values in EC group. There was a statistically non significant difference seen for the values between the groups (p>0.05) for preÂ VISA-P. Conclusion: In this trial, among volleyball players with chronic patellar tendinopathy, treatment with eccentric exercise is superior to isometric. Coaches, sport scientists and volleyball players may use the eccentric exercise as a training protocol to improve the game skills. This could aid coaches in planning and controlling training, making appropriate performance enhancement decisions, and avoiding hand injuries.

Normative Reference Value of Hop Test and its Association with Body Mass Index in Football Players: A Cross-sectional Study

Nitesh Verma, Pooja Mehra, Shweta

Introduction: Football is a highly regarded and widely appreciated sport that is played throughout the globe. It is a quick game that involves continuous running and jumping activities as per game demands. Hop tests are functional test that can be used to assess power and strength of lower limbs and helps to decide fitness level of a player. In most studies this test is used after Anterior Cruciate Ligament (ACL) reconstruction for return to sport and comparison between dominant and non dominant leg. Aim: To establish a normative value of hop test {Single Leg Hop Test (SLHT), Triple Leg Hop Test (TLHT) and 6-minute Timed Hop Test (6-mHT)} and its association with Body Mass Index (BMI). Materials and Methods: A cross-sectional study was conducted from December 2023 to February 2024 in the Department of Physiotherapy, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India, from December 2023 to February 2024. Convenience sampling was used to recruit 280Â players, aged between 18-25 years. Inclusion criteria was 3Â years ofÂ systematic football training with 3-4 training sessions weekly and 8 hour of football training per week. The SLHT, TLHT and 6-mHT were used to assess functional testing of players. Kolmogorov Smirnov test showed data was non normal, expressed in the form ofÂ Median {Interquartile Range (IQR)} and Median (Range). Pearson’sÂ Chi-square test was used to check association between BMI and hop test. Results: Normative values were established for SLHT 150 (25), 153.64 (127-177); TLHT 448 (101.25), 446.88 (368-522); 6-mHT 2.45 (1.49), 2.84 (1.95-4.30). Phi-Cramer’s test showed that SLHT and 6-mHT have a very weak association with BMI having p-value=0.047 and <0.001 respectively. Conclusion: Normative values were established for hop test and it showed a very strong association between BMI and TLHT.

Identification of Barriers and Facilitators towards Diabetic Peripheral Neuropathy Patients’ Experiences about Physiotherapy Intervention: A Step-wise Interview Guide Protocol

Rittu Sharma, Manu Goyal

Introduction: Diabetic Peripheral Neuropathy (DPN) is the most common complication of diabetes. Qualitative study includes patients experiences in detail which are not covered under quantitative study. This interview guide will collect broad information about the facilitators and barriers of DPN patients about the physiotherapy intervention which is helpful for decision makers to solve the challenges experienced by the patients. Need of the study: The present study is based on the experiences of DPN patients to identify their facilitators and barriers for physiotherapy intervention. It will provide broad information about the facilitators and barriers for physiotherapy intervention and will be helpful for decision makers and policy formulators to plan and implement evidence-based strategies to solve the challenges experienced by DPN patients. Aim: To cater the experiences of the DPN patients to identify facilitators and barriers of the physiotherapy intervention through an interview guide to solve the treatment challenges experienced by them. Materials and Methods: This phenomenological study will recruit 5-25 DPN participants (Acc. to Polkinghorne, 1989) till data saturation. An interview guide is prepared through the Delphi method. In depth face to face semi-structured interview will be conducted after the physiotherapy intervention of 4 times/week for 6 weeks. All the interviews will be video recorded and transcripts will be prepared in English. After that interview, transcripts will be analysed through thematic analysis by the Qualitative Data Analysis (QDA) Miner-lite software. QDA Miner-lite software will be used to describe the results i.e., facilitators and barriers in the form of word-cloud, bar graph, pie-chart and code tree which will highlights the description of the patients’ experiences about the physiotherapy intervention.

Predicting the Aerobic Capacity in Chronic Obstructive Pulmonary Disease Patients with Infection: A Study Protocol

Prachi Rana, Subhasish Chatterjee, Sameer Singhal

Introduction: Chronic Obstructive Pulmonary Disease (COPD),Â a prevalent respiratory condition, can be prevented and treated. Among various triggers, infections are a leading cause of COPD exacerbations. Assessing aerobic capacity is essential in COPD management, as it serves as a fundamental indicator of both quality of life and mortality. However, determining this target value necessitates the estimation of a gender-specific predictive aerobic capacity value for each individual. Need of the study: The newly developed gender-based reference equation for aerobic capacity may have the potential to accurately calculate predicted values that assess the individual patient and aerobic capacity. Aim: To develop a gender-based prediction equation to assess aerobic capacity in COPD patients with infection. Materials and Methods: A cross-sectional study will be conducted at a tertiary care super specialty hospital, analysing various parameters including anthropometric data and pulmonary function tests to identify factors related to aerobic capacity. The Forced Expiration Volume in 1 second/Forced Vital Capacity (FEV1/FVC) ratio will be documented using the post-bronchodilator Pulmonary Function Test (PFT) report, while aerobic capacity will be evaluated through the Six-Minute Walk Test (6MWT). The sample size will be calculated with G*Power 3.1.9.7 software. Data will be analysed using IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Demographics and outcomes will be checked for normality using the Shapiro–Wilk test. Depending on data type, Chi-square, Spearman’s or Pearson’s tests will be used to assess the correlations between FEV1/FVC and 6MWT. Multivariate linear regression with a step-wise approach will create a predictive equation for aerobic capacity. Subsequently, a standardised equation for aerobic capacity will be derived.

Identifying Clinical Determinants for Artificial Intelligence-based Diagnosis of Lumbar Prolapsed Intervertebral Disc: A Prospective Cross-sectional Study

Sandeep Pattnaik, Manu Goyal, Rajneesh Kumar

Introduction: For the clinical diagnosis of lumbar Prolapsed Intervertebral Disc Disease (PIVD), an Artificial Intelligence (AI)-based diagnostic tool may prove to be a productive substitute for the widely accepted gold standard diagnostic technique of magnetic resonance imaging. Development of such an AI-based diagnostic tool requires a dataset framed around the clinical findings that are most accurate to diagnose lumbar PIVD. Aim: To identify the important clinical determinants for the dataset to be used for the development of an AI-based lumbar PIVD diagnosis tool. Materials and Methods: A two-phase prospective cross-sectional study was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from July 2023 to December 2023. Phase 1 involved a thorough review of the literature to identify the most prevalent clinical determinants linked to the incidence of lumbar PIVD, and phase 2 involved an online expert opinion survey to get physiotherapist; opinions on the most suitable clinical determinants among these identified findings that lead to the diagnosis of the condition. Results: A total of 67% of the experts identified age between 25 to 50 years, low back pain, and radiating pain as the most common clinical determinants. Other identified determinants included height, body mass index, prolonged sitting job and heavy lifting job. Conclusion: The findings of the literature review and online expert opinion survey assisted in determining and identifying clinical characteristics that can be best used to create a dataset for the development of an AI-based diagnostic tool for lumbar PIVD.

Effect of Video-assisted Neurobics Training on Sustained Attention in Rural and Urban School Goers: A Pilot Feasibility Trial

Sunanda Bhowmik, Manu Goyal

Introduction: The primary cause of healthy children’s decreased cognitive performance is lack of focused attention, as well as the lack of attention of parents and educators, The ability to pay attention is a critical skill for learning. Sustained attention allows students to focus on a task for an extended period without getting distracted. There is a growing body of research on the benefits of neurobics, which are exercises designed to improve cognitive function. Some studies have shown that neurobics can improve attention, memory, and processing speed. Aim: To determine the effect of video-assisted neurobics activities on children’s attention. Materials and Methods: A pilot feasibility trial was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from September 2023 to January 2024 among school-going children. A total of 31 school goers were recruited for the study. Participants were screened according to selection criteria. After all the anthropometrics, baseline data were taken using Trial Making Test (TMT), seven interventions wereÂ than, given to the participants one after another for 3 session/week/4 week. Following this, the participants were then assessed using TMT. Results: As the data doesn’t follows a normal distribution, the Wilcoxon’s ranked test was employed to analyse the differences between the pre and post-intervention periods. The results suggested that, for all age groups except 13 and 14 years, the median difference between the pre and post TMT data was significant (p<0.05) for all subdomains. Moreover, the gender-specific pre and post intervention data showed significant changes in all TMT subdomains (p<0.05). Conclusion: Neurobics program may have a potential to maximise sustained attention among school goers.

Effect of Comprehensive Physiotherapy Protocol on Muscle Mass, Strength, Functional Ability and Quality of Life in Postmenopausal Women with Type-2 Diabetes Mellitus: A Study Protocol

Sonali Guliya, Subhasish Chatterjee

Introduction: Postmenopausal women with Type-2 Diabetes Mellitus (T2DM) are at five-fold higher risk of muscle mass and strength loss compared to those without diabetes. This poses serious health concerns necessitating effective management. Need of the study: The present protocol may provide evidence of the efficacy of a comprehensive physiotherapy protocol on muscle mass, strength, functional ability and quality of life in postmenopausal women with T2DM and also integrate specialised physiotherapy programs into standard care. Aim: To design and test a comprehensive physiotherapy protocol for muscle mass, strength, functional ability and quality of life in postmenopausal women with T2DM. Materials and Methods: The study will be conducted in a tertiary care superspeciality hospital, and the procedure will be divided into two phases. Phase I includes formulation and validation of a comprehensive physiotherapy protocol. For validation, A panel of 10 experts in the relevant field will be formed. Phase II includes testing the effectiveness of protocol by performing Randomised Controlled Trial (RCT) on Postmenopausal women with T2DM. All participants will be assessed pre- and post-treatment with outcome measures such as musculoskeletal ultrasonography, isokinetic dynamometer, and Sarcopenia Quality of Life (SarQoL) questionnaire. The duration of the intervention would be three days a week for six weeks. Results: Content validation will be determined according to the Content Validity Index (CVI) values. Data analysis will be done using the Wilcoxon’s signed-rank test/paired t-test and Mann Whitney U-test/Independent t-test. The significance level will be set at p-value <0.05.

Correlation between Body Mass Index and Body Fat Percentage in Patients Suffering from Diabetes Mellitus with Normal Healthy People

Amita, Shabnam Joshi, Deepika

Introduction: Diabetes Mellitus (DM) is a metabolic disorder in which body is unable to produce or respond to the insulin and unable to maintain the proper blood sugar levels. Diabetes is the most common non communicable disease globally. It has been predicted by World Health Organisation (WHO) that, by 2030, DM will become one of the leading cause of death. Type 2 diabetes constitutes about 85% to 95% of all diabetes in developed countries. Aim: To find the correlation between the Body Mass Index (BMI) andÂ and Body Fat Percentage (BF%) of patients suffering from diabetes in comparison with normal healthy people. Materials and Methods: A study was conducted in the Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India, on a total of 400 subjects were included divided in two groups out of which, Group A (Diabetes) and Group B (Normal). Only those patients were included who were diagnosed by physician. The demographic data was taken from every subject regarding the study. At last the height, weight and BF% were noted down. Results: The obese individuals showed higher value of BMI and BF%, therefore, increase in BMI and BF% associated with higher risk of diabetes. The patients suffering from diabetes mellitus showed higher BMI and BF% as compared to the normal ones. The BF% is different for every individual due to variety in body weight and fat deposition. The body fat percentage depends upon various factors such as: Age, Weight, Height and Sex. Conclusion: The current study showed that the BMI and BF% are strongly correlates with each other and showed positive relationship, respectively among patients having diabetes with normal healthy individuals.

Additive Effect of Neuromuscular Taping to Conventional Physiotherapy on Sensorimotor Complications in Patients with Diabetic Peripheral Neuropathy

Kanika, Manu Goyal

Introduction: Neuromuscular Taping (NMT) is the application of elastic adhesive tape to the skin without any tension over the target area. NMT has demonstrated the ability to induce a dilation effect on underlying body tissues, leading to pain relief, improved lymphatic flow, and increased vascularity. The outcomes of the present study will provide evidence regarding the effectiveness of NMT in alleviating sensorimotor symptoms associated with Diabetic Peripheral Neuropathy (DPN). Aim: To assess the effectiveness of NMT in addition to conventional treatment among patients with DPN. Materials and Methods: This pilot feasibility trial was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from January 2023 to January 2024. A total of 12 participants were recruited and were divided into two groups: Experimental Group (EG) (n=6) and Control Group (CG) (n=6). An 8-weeks physiotherapy intervention was given. EG group received NMT on bilateral tibialis anterior, tibialis posterior, peroneus longus muscles and transverse arch of foot and Transcutaneous Electrical Nerve Stimulation (TENS) on the course of bilateral tibial and peroneal nerves. CG received sham taping and TENS as EG group. Patients were assessed for pre and post intervention using the outcomes; Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) and Nerve Conduction Velocity (NCV) of tibial, peroneal and sural nerves. Results: There was significant improvement in the LAANS scores; p=0.03 and NCV tibial right; p=0.01, NCV tibial left; p=0.01, NCV peroneal right; p=0.04 and NCV peroneal left; p=0.03, NCV sural right; p=0.03 and NCV sural left; p=0.01 at p>0.05. Conclusion: The present study suggested that NMT in conjunction with conventional treatment can be an effective approach for managing sensorimotor symptoms of DPN.

Efficacy of Scapular Stabilisation Exercise Program in Patients with Subacromial Impingement Syndrome: A Systematic Review

Deepika, Shabnam Joshi, Amita

Introduction: Subacromial Impingement Syndrome (SIS) is compression and mechanical abrasion of the rotator cuff structures as they pass beneath the coracoacromial arch during elevation of the arm. Aim: To study the efficacy of scapular stabilisation exercise program in patients with subacromial impingement syndrome. Materials and Methods: The electronic databases such as PubMed and Cochrane Library, Physiotherapy Evidence Database (PEDro) and additional articles were searched according to Patient/Population, Intervention, Comparison and Outcomes (PICO) strategies and references of the relevant articles from 2011 till date. The appropriate keywords were used relevant to the condition and outcome measures. Fourteen Randomised Controlled Trial (RCTs) were selected based on the inclusion and exclusion criteria in which scapular stabilisation exercises alone or with conventional treatment were used for management of subacromial impingement syndrome. Results: According to PEDro soring, one study was of excellent quality, 10 of good quality and three were fair in quality. The sample size in these studies ranged from 7 to 120 participants from different countries. Following this, full-text screening of 942 articles was performed, out of which 13 were finally included. Finally, 14 articles consisting of 630 participants who had subacromial impingement syndrome were selected for analysis. Conclusion: Scapular oriented exercise is effective in reducing pain and disability for patients with shoulder impingement syndrome.

Effectiveness of Isometric Neck Exercises versus Dynamic Neck Exercises in Chronic Neck Pain among University Students: A Randomised Controlled Trial

Chanchal, Sujata Sharma, Shabnam Joshi

Introduction: Neck pain can be characterised as “the tenderness inÂ any space joined to nuchal line from the upper and lower edge”. It is becoming a very common health problem throughout the worldÂ and affects almost two-thirds of the general population. Aim: To find out the effectiveness of isometric neck exercises and dynamic neck exercises in management of chronic neck pain among university students. Materials and Methods: This was a randomised controlled trial conducted in the Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India and a total of 60 subjects were included in the study. The outcome measures were pain, disability, depression and anxiety. The students had non specific neck pain for more than 3 months with the age above 18-40Â years and both males and females were included. Participants were randomly assigned to two groups (Group A and Group B). Isometric neck exercises were given to the patients in group A and dynamic neck exercises to the group B. Outcomes were assessed at baseline and at the end of the intervention program (post-intervention). Results: There was a statistically significant difference (p<0.01) found between the Group A and Group B. Group A (19.8±8.22) showed greater effect than Group B (13.7±5.96). There was a significant reduction in the anxiety and depression after performing the dynamic and isometric neck exercises. Conclusion: The present study concluded that isometric and dynamic neck exercises both are effective in management of chronic neck pain but dynamic neck exercises are more effective than isometric and can be used for the management of chronic neck pain and reduction of anxiety and depression among university students.

Physical Fitness Evaluation among Young Adults: A Literature Review

Joydip Saha, Manu Goyal

Introduction: Everyone engages in physical activity to stay healthy, however, the amount is primarily a matter of personal preference and can differ significantly across individuals as well as throughout a person lifespan. Fitness is a collection of two traits, general health attributes and specialised sport-based skill attributes where fitness measurement should involve all the attributes. Aim: To provide an insight into a comprehensive overview of physical fitness evaluation among healthy adults. Materials and Methods: A literature search was performed to identify English-language peer -reviewed articles on healthy adults using the PubMed, Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE) and Scopus databases from 2014-2024. With Boolean operators AND and OR, the search terms utilised were “Physical Fitness test battery”, “Fitness evaluation”, “Physical Fitness” and “Healthy adults”. Results: After retrieving 122 articles from various databases, only eight of them met the inclusion criteria and were part of the current review. According to these investigations, several fitness test batteries had been developed involving questionnaires and On-Field assessments. The most widely utilised options are modifiable activity questionnaires, health fitness measurement scale, vitalityÂ test battery, senior test battery {Intraclass Correlation Coefficient (ICC) from 0.93 to 0.98} and Preschoolers Fitness (PREFIT) (ICC from 0.73 to 0.99). Conclusion: The study concluded that, although there are several fitness test batteries present to assess physical fitness in healthy novices, the PREFIT and Senior test batteries are the most helpful since they cover most fitness components they are found to be reliable to assess physical fitness. The information might assist health educators or physiotherapists in selecting the most efficient fitness assessment tool.

Tele-rehabilitation in Physiotherapy for Low Back Pain: A Scoping Review of Patient Satisfaction

Nishchint Banga, Pallavi Prakash, Supriya Awasthi

Introduction: Tele-rehabilitation has been shown to be highly relevant in the field of physiotherapy for low back pain, offering significant benefits in terms of effectiveness, efficiency, and patient satisfaction. Studies have demonstrated tele-rehabilitation has proven to be efficient, requiring fewer visits and potentially providing more cost-effective care options for both patients and payers. Aim: To evaluate how well tele-rehabilitation enhances the functional status of individuals with low back pain compared to traditional in-person care. Additionally, to comprehend the level of patient contentment with tele-rehabilitation in contrast to satisfaction levels from in-person clinic visits. Materials and Methods: The participants were individuals with low back pain who received care through tele-rehabilitation, allowing for the comparison of outcomes between those who received traditional in-person care and those who received care through tele-rehabilitation. A scoping review conducted for three months duration i.e. December 2023 to February 2024 in Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, Scopus, and Web of Science (WOS), Google Scholar, Cochrane Library, Physiotherapy Evidence Database (PEDro) using terms like tele-rehabilitation, satisfaction, low back pain, telehealth, patient experience, and pain. The criteria for inclusion were studies that evaluated patient or professional satisfaction as an outcome of tele-rehabilitation interventions, focused on low back pain, and utilised a qualitative and quantitative research approach. Results: A total of 14 articles were included, Randomised Controlled Trials (RCTs) (n=8), systematic reviews (n=2), case studies (n=1), survey study (n=2), and case series (n=1). PEDro rating scale was used to evaluate the quality of included studies but for non randomised clinical trials, assessed using the Methodological Index for Non randomised Studies (MINORS). Patients experiencing low back pain expressed satisfaction with the communication, technical aspects, and overall experience of their physiotherapy treatment through tele-rehabilitation. However, the review highlighted a mix of study quality, which posed challenges in making direct comparisons and broad generalisations. Conclusion: Patient satisfaction is attributed to effective communication and interactions between physiotherapists and patients, which include involving patients in treatment decisions, ensuring understanding of their conditions, empowering patients to manage their issues, and supporting their return to normal activities.

Relationship of Forward Head Posture and Kinesthesia with Electromyographical Parameters in Upper Cross Syndrome: A Correlational Cross-sectional Study

Jaganjyoti Das, Pooja Anand, Pooja Bhati

Introduction: Forward Head Posture is a functional ailment observed due to alterations in cervical and shoulder muscular function. Kinesthesia is an objective measure of cervical proprioception. It has been observed that muscle functions do affect the joint proprioception and function. There are no studies focused on electromyographic parameters of Forward Head Posture and kinesthesia. Aim: To identify electromyographical parameters and its correlation with forward head posture and kinesthesia in Upper Crossed Syndrome (UCS) patients. Materials and Methods: A correlational cross-sectional study was conducted in the Department of Physiotherapy, SGT University, Gurugram, Haryana, India was conducted for three months on a total number of 45 subjects with UCS who had undergone electromyographical testing for 12 muscles of both side (Upper, middle and lower trapezius, serratus anterior, pectoralis major, anterior scalene). Participants were asked to perform a set of dynamic exercise (Y and W exercise) post familiarisation using elastic resistance band during which Root-mean-square (RMS) value for muscle activation and activation ratio were calculated by surface electrodes using 4-channel electromyographic system (26T PowerLab, ADInstruments Inc.). Average of three trial were considered. Kinesthesia of neck position was measured using Joint Position Sense Error (JPSE) test. Forward Head Posture (FHP) was measured using photogrammetric and ruler method. Mean and standard deviation of all dependent variables of both the groups were calculated. Correlation between all the variables were done by using Pearson’s correlation test. The significance level was set at 95% (p≤0.05). Results: A statistical significant correlation was found between average amplitude of Upper Trapezius (UT), Lower Trapezius (LT) and Serratus Anterior (SA) with both FHP and kinesthetic sense (p≤0.05). Muscle activation ratio of UT:LT and UT:SA also found to be significantly correlated to FHP (p≤0.05). Conclusion: Altered muscle activation in UCS patients is strongly correlated with forward head posture and joint position sense.

Prevalence of Crossed Syndrome among College-going Students: An Observational Study

Amit Kumar, Mahima Guleria

Introduction: Backpack carriage is a common practice among collegiate students. There is evidence that students carry heavy backpacks weighing beyond the recommended safe limits of 10% of their body weight and this has potential consequences such as musculoskeletal discomfort leads to crossed syndrome. For best of authors’ knowledge, there is scarcity of researches in this field of study showing a positive perspective of specific outcome measures related to crossed syndrome. Aim: To identify the prevalence of crossed syndrome among college-going students using backpacks. Materials and Methods: An observational study was conducted in the Department of Physiotherapy, School of Allied Medical Sciences, Lovely Professional University, Phagwara, Punjab, India between January 2024 and March 2024. A total 12 college-going students were recruited based on Researcher-designed Questionnaire as primary outcome measure. Secondary outcome measures were Neck Flexor Endurance Test (to check strength), Flexi Curve Ruler (to check kyphotic angle), and GaitON (to check static posture). On the basis of readings of all the outcome measures, data was analysed using Statistical Package for the Social Sciences (SPSS), version 20.0 software. Results: A total of 83.5% of participants had the symptoms of crossed syndrome and 93.9% of participants failed to demonstrate Neck Flexor Endurance test within normative range (Males: 38.9 secs, females: 28.7 secs). A total of 67.8% of participants had disturbed normative ranges of angles and alignment measured by GaitON. Conclusion: A total of 81.7% of participants were suffering from crossed syndrome according to the present study. It can be concluded that there existed a positive perspective of specific outcome measures related to crossed syndrome, among college-going students using backpacks.

Establishing Normative Values of Star Excursion Balance Test and its Relationship with Age and Gender in Older Adults: An Observational Study

Sharnpreet Kaur, Sarika

Introduction: Balance and gait are key factors in healthy aging. Existing research indicates that the Star Excursion Balance Test (SEBT) can offer objective measures to distinguish between deficits and improvements in dynamic postural-control related to lower extremity injury and induced fatigue. Therefore, SEBT is taken into consideration due to its low cost, ease of use, validity, and reliability. Additionally, the testing pattern is reflected in daily activities that are comparable. The research that is currently available indicates that no study has utilised or employed the SEBT with an older population. Furthermore, neither the reference value nor the normalised data for this test are available. Aim: To establish and provide a reference value of SEBT and its relationship with age and gender in older adults. Materials and Methods: This cross-sectional study was conducted in MYAS-GNDU, Department of Sports Sciences and Medicine, Amritsar, Punjab, India, and a convenience sample of 139 subjects were included after obtaining written informed consent and screening through inclusion and exclusion criteria. The sample consisted of 70 men and 69 women, age 55-65 years. The subjects were approached from the different locations of the Punjab. Following the documentation of subject characteristics and subjective data sheet, each participants limb length was measured. Afterward in each of the test directions, each participant completed four practice and three recorded reaches. Testing was done in each of the eight directions. Results: The mean age and height of participants was 60.78±2.70 years and 167.64±9.86 cm. The normative values of the SEBT among older age adults were represented in mean scores and standard deviations. The different reach distances recorded for each direction were expressed as a percentage of leg length. The maximum reach distance was observed on posteromedial direction for both right and left side. Conversely, the shortest reach distance is observed on lateral and posterolateral directions in both the sides. Conclusion: The present study has established normative performance values for the SEBT in older adults. These values can be used to identify the balance deficits among older adults. Normative data are crucial for researchers and physicians alike. It may be easier to identify and treat balance issues of a person or group of people who have much poorer balance than a healthy individual of the same age.

Efficacy of Exercise Therapy on Fatigue Levels of Patients with Multiple Sclerosis: A Literature Review

Avi Choudhary, Himani Kaushik

Introduction: Multiple sclerosis is a disease of the central nervous system caused by the immune system and it affects people all over theÂ world. It is characterised by a variety of symptoms. Excessive fatigue is the most prevalent and debilitating symptom in individuals with multiple sclerosis, significantly impacting their lives. Several factors contribute to the disease and physical inactivity, which have been suggested to impact fatigue levels. Regular exercise therapy hasÂ the potential to alter psychological and physiological functions that can significantly improve fatigue in multiple sclerosis patients. Aim: To review the existing literature on the efficacy of exercise therapy on fatigue levels of multiple sclerosis patients. Materials and Methods: The authors conducted a literature search from 2014-2024 using different search engines such as Google Scholar, PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library and Scopus. The search utilised MeSH (Medical Subject Headings) keywords including exercise, multiple sclerosis, and fatigue. The authors included all types of studies that examined the efficacy of exercise interventions on fatigue outcome measures. Results: Exercise therapy was a safe intervention for multiple sclerosis patients and did not cause any harm. A combination of exercise programs were used to improve fatigue levels and the quality of life of multiple sclerosis patients. Both subjective and objective outcome measures showed significant changes in fatigue levels. Conclusion: Exercise therapy has shown promising results in improving the overall health of multiple sclerosis patients, particularly in reducing fatigue levels. There is a need for more focus on designing non stereotypical treatment protocols and evaluating them using gold-standard tools. The International Classification of Functioning, Disability and Health (ICF) model can be incorporated to identify more effective treatment and assessment methods.

An Interesting Case Series of Neuropsychiatric Lupus: A Combination of Inflammatory and Thrombotic Origin

Rajkumar Kannan, Balaji Ganesh, Abirami Thangaraj, Rosemin Jose Meleth

Systemic Lupus Erythematosus (SLE) is a versatile autoimmune disorder with multisystem organ involvement, most commonly involving the skin, joints, vasculature, and associated immunological abnormalities. The hallmark of SLE is the presence of circulating non organ specific humoral autoantibodies synthesised by so-called T cell-dependent B cells, which are germline encoded. Patients with SLE can exhibit symptoms of Central Nervous System (CNS) involvement, termed CNS Lupus, which may also have associated psychiatric manifestations, where the entity gets the designation of Neuropsychiatric SLE (NPSLE). CNS Lupus is often a diagnosis of exclusion, as there are many other aetiological factors that could result in seizures and encephalitis picture. A detailed examination of patients presenting with isolated late-onset seizures is very helpful in uncovering Connective Tissue Disorder (CTD) as the cause of seizures. The manifestations of NPSLE (19 Neuropsychiatric syndromes) can be focal and diffuse, ranging from non specific symptoms such as headache and cognitive impairment to severe manifestations such as memory loss, seizures, stroke, and suicidal intentions. Neuropsychiatric symptoms often occur during the first year of SLE but can rarely also be the presenting symptom of the disease. Antiphospholipid antibodies (Anticardiolipin, Lupus anticoagulant, Anti β2 glycoprotein) and Anti Ribosomal P antibodies are among the frequently associated antibodies in NPSLE, which, in turn, increase the risk of both focal and diffuse neurological complications. A single episode of abortion or miscarriage is a vital clue for a detailed work-up of female patients for the possibility of an underlying occult potential of CNS Lupus in the absence of seizures. The present case series focuses on five female patients who presented with NP symptoms, and finally, the cause was attributed to the involvement of CNS in SLE after excluding other possible organic causes.

Appendicular Gastralgia Revisited: A Case Series of this Rare Presentations

Shreyasi Jha, Ameet Kumar

In the myriad of clinical presentations of acute appendicitis, appendicular gastralgia remains a poorly researched entity. In this article, authors present a series of three cases of acute appendicitis that initially presented as appendicular gastralgia. A 35-year-old gentleman initially presented with complaints of epigastric pain of six hours’ duration with an Alvarado score of 3/10 and was managed medically. Re-examination after six hours of unresolved pain revealed Right Iliac Fossa (RIF) tenderness. Similarly, a 13-year-old boy presented with epigastric pain of 12 hours’ duration with a normal clinical examination and an Alvarado score of 5/10. The pain radiated to RIF after 12 hours with RIF tenderness. A 58-year-old lady presented with pain in the epigastrium of six hours’ duration and had a normal clinical examination, haematological and radiological parameters. She was initially managed medically. However, due to the non resolution of symptoms despite treatment, she underwent Contrast Enhanced Computed Tomography (CECT) Abdomen, which revealed a localised appendicular perforation with appendicoliths. All three patients underwent emergency laparoscopic appendectomy and had an uneventful postoperative recovery with no recurrence of epigastric pain. Low Alvarado scores, non specific clinical findings and equivocal imaging delay diagnosis in these cases. Through this article, attempt was made to enhance awareness of this entity amongst clinicians.

Androgen Insensitivity Syndrome: A Rare Cause of Primary Amenorrhoea

Androgen Insensitivity Syndrome (AIS) is a rare X-linked Disorder of Sexual Differentiation (DSD) caused by a mutation in the Androgen Receptor (AR) gene, which is located on the X chromosome (Xq11-q12). It can present with a wide spectrum of phenotypes depending on different mutations of the AR gene. It is classified into mild, partial, and complete AIS. In this series of cases, authors describe patients who presented to tertiary hospitals over several years. Case 1 presented with inguinal masses and primary amenorrhoea, which upon investigations revealed complete AIS. Case 2 was a young child who underwent surgery for an inguinal hernia, and later histopathology and karyotype revealed a diagnosis of complete AIS. Case 3 presented with large adnexal masses to oncology, where intraoperatively absent Mullerian structures, histopathology, and karyotype gave the diagnosis of Complete AIS. Case 4 presented with hirsutism, primary amenorrhoea, and clitoromegaly. Upon investigation, imaging and karyotype with virilising features led to the diagnosis of partial AIS. The absence of Mullerian structures on imaging, chromosomal analysis, and the finding of undescended testicular masses in inguinal regions clinch the diagnosis. These patients should undergo gonadectomy after puberty to decrease the chances of malignancy. Therefore, when investigating the cases of primary amenorrhoea, patients with absent pubic/axillary hair and absent uterus/ovaries should raise suspicion of AIS. Also, any young female child with an inguinal hernia should be investigated for AIS.

Cutaneous and Nodal Histiocytic Sarcoma: A Series of Five Cases

Geeta Yadav, Manish Kumar, Kusum Yadav, Shalini Bhalla, Rashmi Kushwaha

Histiocytic Sarcoma (HS) is an extremely rare haematolymphoid neoplasm that exhibits morphological and immunophenotypic features indicative of histiocytic differentiation. In most cases, it is misdiagnosed as Diffuse Large B-Cell Lymphoma (DLBCL) or anaplastic large cell lymphoma. HS is a diagnosis of exclusion, necessitating extensive immunophenotypic analysis to finalise the diagnosis. Hereby, authors present a case series of five cases diagnosed as HS based on histomorphology and an extensive Immunohistochemistry (IHC) panel. A total of five cases reported as HS over a five-year period (2018 to 2023) were diagnosed at the Department of Pathology. All demographic and clinical data, as well as treatment history, were collected from the patients and their family members. Paraffin-embedded blocks were retrieved from the archive, and routine Haematoxylin and Eosin (H&E) and special stains like Periodic Acid-Schiff (PAS) were performed. Microscopy revealed sheets of round to oval tumour cells with small round nuclei, inconspicuous nucleoli, and moderately microvacuolated cytoplasm. An extended IHC panel was applied to confirm the microscopic findings. All five cases exhibited intense immunoreactivity for Leukocyte Common Antigen (LCA) and showed strong positivity for the histiocytic marker CD68, while CD163 demonstrated variable cytoplasmic positivity. Dako R antibody at a dilution of 1:100 was used for the IHC analysis. This case series aims to highlight the importance of clinical, radiological, histological, and immunohistochemical properties of this rare neoplasm for early diagnosis and proper management.

Unveiling the Intricacies of Acute Aortic Syndromes through Imaging: A Case Series

Madhu Shankar Kikkeri, R Vidhya Rani, D Naveen, MR Akshay, S Leelashree

Acute Aortic Syndrome (AAS) comprises of three distinct pathological conditions: Aortic Dissection (AD), Penetrating Atherosclerotic Ulcer (PAU), and Intramural Haematoma (IMH). Although AAS and its emergencies are not common occurrences, they are considered highly dangerous and potentially fatal. Clinically, differentiating between the various types of aortic syndromes can be challenging. The prognosis of these conditions significantly depends on speedy and precise analysis. Therefore, present study emphasised the critical role of radiology in the diagnosis of AASs, with Contrast-Enhanced Computed Tomography (CECT) being the quickest and most consistent imaging modality. In this case series, four cases of AASs are presented, comprising three cases of AD and a case of PAU in a patient with infrarenal aortic occlusion. Notably, one of the dissection cases was accompanied by renal ischaemia. Recognising acute aortic emergencies promptly is essential for saving lives.

Efficacy of Chandan Bala Lakshadi Tail Matra Basti as Adjuvant Therapy in the Anorectal Ailments: A Case Series

Abhishek Dattatray Mavale, Devyani Dasar, Naveen Singh

Ayurveda mentions several anorectal ailments, among which are Bhagandara (Anal Fistula), Guda vidhradhi (Rectal Abscess), Parikartika (Anal Fissure), and Arsha (Haemorrhoid), which are the most common. These illnesses may have several underlying causes and may result in a wide variety of symptoms. Present case series discusses a total of five instances in which majority of the patients were between the ages of 20 and 80 years. Pain and burning sensations during and after defecation, as well as perineal haemorrhage and hard stools, were prevalent complaints among these patients. Through local and physical examination, three anorectal ailments were detected: Arsha (internal external haemorrhoids), Bhagandara (anal fissure), and Parikartika (fissure in ano). Ultimately, anorectal procedures were carried, such as haemorrhoidectomy and Lord’s anal dilatation with Kshara Sutra ligation. Anorectal concerns might impact a person’s quality of life as they are unsettling, painful, and occasionally even life-altering. In the early stages, current therapy includes the use of soothing creams, gels, oral analgesics, and stool softeners, as well as surgical interventions such as sphincterotomy, fissurectomy, and Lord’s dilatation. In anorectal conditions like Parikartika (anorectal fissure), Bhagandara (anorectal fistula), and Arsha (haemorrhoids), a more effective alternative treatment must be developed. Chandan bala Lakshadi Tail Matra Basti is beneficial in reducing irritation, spasm, and the perception of pain as well as bleeding per rectum and anal inflammation.

Multiple Coagulation Factor Deficiency: A Series of Eight Cases

Abhijith Lakshman, Febe Renjitha Suman, Gramani Arumugam Vasugi

Multiple Coagulation Factor Deficiency (MCFD) is an uncommon haematological disorder characterised by simultaneous deficiency of multiple clotting factors, which leads to an increased risk of bleeding and compromised haemostasis. The present series aimed to provide a comprehensive analysis of MCFD, shedding light on its aetiology, clinical manifestations, and potential therapeutic interventions in a case-by-case manner, highlighting the individualised treatment options that are needed for many of these cases. A prospective combined clinical and laboratory study was performed on all patients who presented with bleeding tendencies and were subsequently diagnosed with MCFD. Clinical records and laboratory data of all these patients were reviewed to identify commonalities and variations among affected individuals. Haematological assays were performed to quantify the extent of coagulation factor deficiencies. The present series identified a diverse cohort of eight individuals (2 females and 6 males) with MCFD, showcasing variability in age of onset, severity of symptoms, and potential underlying genetic mutations. Clotting factor assays revealed deficiencies of Factor V and Factor VIII (F5F8D), Vitamin K-dependent clotting factor deficiency, and failure of synthesis of clotting factors of hepatic origin. Clinically, patients presented with a spectrum of bleeding phenotypes, ranging from mild to severe, requiring tailored therapeutic strategies. The present series provides an overview of some of the presentations of MCFD, emphasising the need for a multidisciplinary approach in its diagnosis and management. Clinicians should be vigilant in recognising the varied clinical presentations of MCFD and consider genetic testing for precise diagnosis and management.

Insights from Magnetic Resonance Imaging in Diagnosis of Marjolins Ulcer

Saraswathula Bharadwaj, Nunna Bhagyasri, Ravishankar Patil, Pratap Singh Parihar

A 62-year-old female presented to the Surgery Outpatient Department with a four-month history of a wound on the lateral aspect of her right thigh, with an underlying history of trauma a few days prior. She had suffered a flame burn injury 50 years ago. There was a progressive increase in the size of the wound over the past four months, with an associated pricking type of pain. The patient denied other symptoms such as fever or discharge. Local examination revealed a 14×12 cm solitary ulcer on the posterolateral aspect of the right thigh with irregular margins and rolled-out edges (Table/Fig 1). The base was formed by muscle induration, associated with slough and an absence of any discharge or bleeding. Multiple wedge biopsies from the wound margins and base were performed, revealing moderately differentiated Squamous Cell Carcinoma (SCC). The patient was advised to undergo an Magnetic Resonance Imaging (MRI) of the thigh for further management planning. The MRI revealed heterogeneously enhancing soft-tissue thickening at the ulcer margins, approximately 13.3×4.1×1.5 cm in size, involving the skin and subcutaneous tissue in the posterolateral aspect of the thigh (Table/Fig 2). The lesion appeared heterogeneously hyperintense (Table/Fig 3), showing diffusion restriction and no blooming on Susceptibility Weighted Imaging (SWI). Hyperintensity was seen deep in the lesion in the subcutaneous plane and showed mild postcontrast enhancement (Table/Fig 4). The underlying bones and muscles appeared normal. Mild inguinal lymph nodes on the right-side appeared rounded and showed postcontrast enhancement. The differentials that were considered for this case were actinic keratosis, allergic contact dermatitis, atopic dermatitis, atypical fibroxanthoma, limbal dermoid, osteomyelitis, ulcer osteoma, and basal cell carcinoma. The MRI findings, along with histopathological examination, confirmed the diagnosis. The patient was initially treated with vinegar dressing, followed by wide local excision of the Marjolin ulcer (Table/Fig 5) and Vacuum- Assisted Closure (VAC). After two weeks, the VAC dressing was removed, and the patient was managed with a sterile dressing with gentamicin for a few weeks. The patient was referred to a plastic surgeon, and a thick skin graft was placed over the excised ulcer (Table/Fig 6). A frozen section was sent when the ulcer was excised, which suggested no infiltration of malignant cells, and Histopathological Examination (HPE) revealed SCC (PT3Mx) (Stage IB). A Marjolin ulcer is the unusual occurrence of cutaneous SCC in the presence of a scar or ulcer. It typically arises at an old thermal burn scar (1). Marjolin ulcers generally appear 30 years after a skin injury. They can afflict persons of all ages, with males diagnosed 2-3 times more frequently than women (2). They can affect the legs, feet, head, and neck, lasting from six weeks to a year after the incident. Marjolin ulcers are most commonly found on the legs and feet but can also develop on the head and neck. The incidence is around 1-2% of all burn scars (3),(4). Radiologically, MRI is vital for the assessment of the involvement of underlying soft tissue structures and bony involvement. Marjolin ulcer presents as a soft tissue mass in MRI. On contrast enhancement, the ulcer shows avid enhancement due to increased vascularity. As the ulcer progresses, MRI helps determine the extent of invasion of the ulcer and underlying structures such as muscle, bone, and deeper layers. In chronic cases, regional lymphadenopathy suggests the possibility of metastasis (5). Due to the destructive and progressive nature of the ulcer, MRI is essential in identifying bony destruction, marrow involvement, and periosteal reaction. Marjolin ulcer is a rare malignant tumour that requires prompt discovery, proper diagnosis, and treatment. Histopathology supports the diagnosis, and MRI is essential for determining the size and extension of the lesion, underlying muscle and bone involvement, and metastasis.

Anomalous Origin of Right Coronary Artery from Ascending Aorta: MDCT Coronary Angiography Depiction Images

A 46-year-old male presented with complaints of chest pain and dyspnoea on moderate exertion for the past month. The patient was a known case of type 2 diabetes mellitus and hypertension, and has been on treatment for the past five years. He was not a smoker or alcoholic. Suspecting coronary artery disease, a diagnostic work-up was performed. Blood investigations revealed dyslipidaemia. Electrocardiography (ECG) showed sinus rhythm with a limited right bundle branch block with ST-T changes. Echocardiogram showed biventricular dysfunction. Since the patient was reluctant to undergo catheter coronary angiography, a Computed Tomography (CT) Coronary angiogram was performed first. A 128-slice Multidetector Computed Tomography (MDCT) coronary angiography revealed an anomalous high origin of the Right Coronary Artery (RCA) arising from the anterior wall of the ascending aorta approximately 2 cm above the sinotubular junction at an acute angle of 45° (Table/Fig 1),(Table/Fig 2) [Video-1]. The anomalous RCA followed its normal course without any intramural course noted. Mixed plaques were observed in the RCA, with involvement distal to the acute marginal artery, causing a maximum of 90% stenosis or complete occlusion. The Left Coronary Artery (LCA) was found to be normal, arising from the left cusp of the coronary sinus and dividing into the left anterior descending artery and left circumflex artery. The left anterior descending artery showed significant stenosis in its proximal third. The left circumflex artery exhibited minimal coronary artery disease with no significant stenosis. Therefore, double-vessel coronary artery disease was diagnosed, and the patient was advised to undergo a revascularisation procedure. Currently, the patient is on medication and undergoing follow-up. The anomalous origin of the RCA was first described by White and Edwards in 1948 (1). The incidence of an anomalous RCA varies from 0.026 to 0.25% (1). Patients with an anomalous origin of the RCA can be asymptomatic or may present with angina, myocardial ischaemia, or sudden cardiac death (1),(2). Possible causes can include narrow ostia, a malignant course leading to its compression between the aorta and pulmonary artery, or spasm due to compression in its malignant course. In index case, the patient’s symptoms were due to coronary artery disease and not an anomalous RCA. Anomalous RCA origin from the ascending aorta is an extremely rare anomaly comprising only 0.04 to 0.15% of all reported anomalies (3). In a case reported by Ramirez Damera R et al., there was an anomalous origin of the RCA from the ascending aorta above the left sinus of Valsalva; however, in index case, it arose from the anterior wall of the ascending aorta above the sinotubular junction (3). In a recent case reported by Mutluoglu M et al., the anomalous RCA had a high origin from the ascending thoracic aorta above the sinotubular junction, similar to index case (4). Cannulation of the anomalous RCA can be difficult and requires extra effort during catheter coronary angiogram. If found incidentally and asymptomatic, only careful follow-up is recommended.

Acute Subdural Haematoma due to Ruptured Posterior Communicating Artery Aneurysm: A Rare Presentation

Sambhaji Pawal, Riteshkumar Sahu, Rahul Arkar

Acute Subdural Haemorrhage (SDH) frequently arises as a complication after head trauma, often resulting in sudden loss of consciousness and neurological impairments in an individual who was previously healthy (1). Uncommonly, a ruptured aneurysm may present with SDH. Among these cases, a ruptured aneurysm at the junction of the Internal Carotid Artery (ICA) and the Posterior Communicating Artery (Pcom) stands out as the most common site associated with this uncommon spontaneous acute SDH (2). This manuscript documents imaging and endovascular management of a rare case of a ruptured Pcom aneurysm presenting as acute SDH. The purpose of presenting this case was to underscore awareness of this condition, helping to prevent diagnostic and therapeutic errors (3). A 51-year-old woman came to the emergency department with a history of right eye ptosis, retro-orbital pain, and headache for 15 days. She had no other focal neurological deficits. A Computed Tomography (CT) scan of the brain (Table/Fig 1) revealed SDH along the tentorium and right cerebral convexity due to a ruptured right PCoM artery aneurysm. Blood investigations revealed normal parameters with haemoglobin level of 11.40 gm/dL, platelet count of 2.52 lac/mm³, serum creatinine of 0.75 mg/dL, and normal coagulation parameters. She underwent urgent cerebral Digital Subtraction Angiography (DSA) on the same day. DSA revealed a large (approximately 17.0×9.5 mm size) postero inferiorly projecting wide-neck PCoM artery aneurysm on the right-side. The ruptured PCoM aneurysm was treated with balloon-assisted coiling (Table/Fig 2) on the next consecutive day. A postprocedure CT scan of the brain (Table/Fig 3) did not reveal any cerebral infarction or fresh intracranial bleed. The patient was electively ventilated for 24 hours in the Intensive Care Unit (ICU) post-procedure . She was observed in the ICU for any evidence of cerebral vasospasm, electrolyte imbalance, hydrocephalous, or any neurological deficit. She received intravenous antibiotics, antiepileptics, analgesic medications, and intravenous fluids during her stay in the ICU and ward. Follow-up cerebral angiography (Table/Fig 4) after one week showed stable occlusion of the coiled PCoM aneurysm. She was discharged after 15 days without any fresh focal neurological deficits, reduced pain, and mild improvement in right eye ptosis. On discharge, she was advised to take oral analgesics and cerebral vasodilator medications. Follow-up after three months showed no fresh neurological complaints.

Massive Facial Plexiform Neurofibroma: An Unusual Presentation

Jasleen Kaur, Prasad Deshmukh, Sagar Gaurkar

A 45-year-old male patient presented to the department with the chief complaint of overhanging folds of loose skin over the nose and left eye, and various round swellings on the face and throughout the body. The swelling had appeared 15-20 years ago and had gradually worsened over time. The patient reported suffering socially because of his condition. There was no relevant personal or family history, and he had no history of any co-morbidities. On examination, the swellings were of variable size, soft to firm, and non tender, located on the face and body. A colossal lesion originated from the left frontal region, with an overhanging skin mass concealing the left eye, nose, and maxillary area of his face, creating a disfiguring appearance (Table/Fig 1)a. However, upon elevation of the mass, the eye and nose were revealed to be perfectly normal, with unimpaired visual acuity, although the visual field was hampered (Table/Fig 1)b. A similar massive swelling was noted on the lateral aspect of the forehead (Table/Fig 1)c. The loose folds presented a staggering facial plexiform soft-tissue lesion, which is a hallmark of Neurofibromatosis Type 1 (NF1). Further examination unveiled the classic cutaneous manifestations of NF1, including café-au-lait macules, axillary freckling, and a multitude of cutaneous neurofibromas of varying sizes (Table/Fig 1)d, with the largest measuring an astonishing 3×3 cm. The clinical diagnosis was Neurofibromatosis (NF) which was confirmed histopathologically. The patient was scheduled for excision, but they were not willing to undergo surgical intervention. The complications were explained to the patient and their relatives, but the patient refused the procedure. Plexiform Neurofibromas (NF) are potentially devastating manifestations of Von Recklinghausen’s NF1. They are benign tumours that originate from nerve sheath cells or subcutaneous peripheral nerves and can involve multiple fascicles, occurring anywhere along the nerve, including the face, orbit, and globe. These tumours frequently involve the cranial and upper cervical nerves (1). Histologically, plexiform NF contain all elements of peripheral nerves and are characterised by an increase in the endoneural matrix, which leads to the separation of nerve fascicles and proliferation of Schwann cells (2),(3). Cutaneous manifestations of NF1 are among the imperative diagnostic criteria, along with café-au-lait spots, freckles, and neurofibromas (4). Dogra BB and Rana KS presented two cases of facial NF treated at their hospital. The first patient, a female, had an overhanging mass of skin folds on the right side of her face, completely covering her right eye. The second patient, a young male, had a large, unsightly swelling on his right cheek that was pulling down his right eyelids and pinna. Both patients exhibited café-au-lait macules, axillary freckling, and multiple NF on their trunks. They underwent reconstructive surgery, which involved subtotal excision of the tumour mass and re-draping of the facial skin. Six months postsurgery, there was evidence of tumour regrowth in both cases (5). Fadda MT et al., studied rare primary neurogenic tumours of the facial nerve, which are typically found intratemporally, with few cases involving the intracranial and intraparotid regions (6). They reported on a 10-year-old with NF1, who had a slowly growing cheek swelling diagnosed as a plexiform NF at age three. The patient had multiple nodular lesions without facial nerve impairment. A superficial parotidectomy was performed, preserving the facial nerve. Postoperatively, significant swelling was noted, and ultrasonography at three months showed recurrence. Plexiform NF, seen in up to 15% of NF1 patients, carry a risk of malignant transformation. Surgery is the only effective treatment, but it has a high recurrence rate due to the tumours’ infiltrative nature. Recurrence rates are higher in patients operated on before age 10; therefore, it is advisable to delay surgery for asymptomatic paediatric patients to minimise physical and psychological impact (7). The differential diagnosis considered included schwannoma, lipoma, haemangioma, Proteus Syndrome (PS), and Bannayan-Riley-Ruvalcaba syndrome. Schwannoma was ruled out based on the appearance of the lesions, as in schwannomas, the Schwann cells grow as a mass that pushes the nerve aside and may compress it. NF, on the other hand, often comprise a heterogeneous collection of blood cells, connective tissue cells, and other cell types from the nerve sheath that surrounds the nerve without displacing it. Lipomas appear as lumps, while haemangiomas are usually located in the skin and subcutaneous tissues. Bannayan-Riley-Ruvalcaba syndrome was ruled out due to the absence of macrocephaly (large head size). PS was excluded as a diagnosis because there were no malignancies or pulmonary conditions present, which are generally associated with this condition (8). The patient presented here exhibits a highly characteristic example of NF1, which is of significant interest due to the pronounced distortion of their facial features. In such cases, a thorough examination of the patient is necessary because of the potential for widespread involvement of underlying anatomical areas.

Use of Modified Acrylic Stent in the Management of Radicular Cyst in a Paediatric Patient: Images in Medicine

Ashwin Harekal, Prithi Shenoy, Joyce Sequeira, Sharan Sargod

A nine-year-old female patient reported to the Department of Paediatric and Preventive Dentistry with a chief complaint of pain in the lower left back tooth region for two months. The patient experienced dull achy pain, which aggravated over two weeks and gradually progressed. The patient reported a history of nocturnal pain and previous dental treatment in the area of concern. On extraoral examination, facial asymmetry was seen (Table/Fig 1). Upon inspection, mild diffuse swelling 2×3 cm in size was noted on the left lower third of the face, extending across the lower border of the mandible. On palpation, an oval swelling, firm in consistency with a smooth surface and a diffuse edge, was noted in the lower border of the mandible. It was non compressible, non reducible, tender, and febrile. Upon intraoral examination, buccal expansion with vestibular obliteration was noted (Table/Fig 2). On palpation, diffuse bony hard swelling was noted between 34 to 36. On the panoramic radiograph (Table/Fig 3), a well-defined unilocular radiolucency with a sclerotic border was noted, extending anteroposteriorly from the distal aspect of 33 up to the mesial aspect of the distal root of 36. Inferiorly, the radiolucency was associated with impacted tooth 35. The root formation appeared to be incomplete. Superiorly, with respect to 75, an ill-defined radiolucency involving pulp with external root resorption was noted. Medial displacement of the root of 34 was noted. On Cone Beam Computed Tomography (CBCT) examination, inferior displacement of the inferior alveolar nerve canal with decortication of the roof was noted (Table/Fig 4). Expansion of the buccal cortical plate with extreme thinning and mild expansion was noted at the lingual cortical plate (Table/Fig 5),(Table/Fig 6),(Table/Fig 7),(Table/Fig 8). The differential diagnosis based on clinical examination was radicular cyst or dentigerous cyst. Based on the diagnosis made, treatment options were enucleation or a two-staged procedure- Marsupialisation followed by enucleation and decompression. However, as the patient was in the mixed dentition phase, Marsupialisation and decompression with cystic enucleation was considered the most beneficial treatment. The mucoperiosteal flap was reflected under local anaesthesia. Retained deciduous 75 was extracted. An incision was made at the site of the extracted primary tooth to unroof the cystic lining (Table/Fig 9)a. The cystic fluid was then evacuated, and the cavity was irrigated with normal saline. The margin of the cystic lining was sutured to the adjacent gingival margin of the wound (Table/Fig 9)b. The patency of the cystic lesion within the extraction socket was preserved by employing a customised appliance. This adaptation was designed to enhance the child’s comfort and minimise the need for frequent follow-ups. A removable appliance was fabricated using acrylic resin and C clasps on 34 and 36 for retention and a projection into the cystic cavity, which would help in preventing food seepage and help the patient avoid frequent multiple visits to the hospital (Table/Fig 10)a,b,(Table/Fig 11)a,b. The patient’s parents were taught to irrigate the cavity thrice a day by removing the appliance and irrigating with copious amounts of diluted betadine solution to reduce surgical site infection. Hence, 35 was retained. The patient reported to the hospital once every 10 days for two months. Later, the visit was reduced to once a month for radiographic assessment and appliance trimming. Radiographically, 2-3 mm of the eruption of 35 was noted in comparison to the first serial radiograph. This was a much lesser frequency compared to alternate-day visits required for the medicated gauze packing method. Once 35 was closer to eruption (Nollas stage 8), the patient discontinued wearing the appliance, and cystic enucleation was planned. The patient was recalled one month later for cystic enucleation under local anaesthesia. The mucoperiosteal flap was reflected from the 1st molar to the canine, the cystic cavity was approached from the healing socket, and the cystic lining was removed in toto and sent for biopsy (Table/Fig 12)a-d. The histopathological feature showed an arcading pattern of non keratinised stratified squamous epithelium with chronic inflammatory cell infiltration, confirming the diagnosis as a radicular cyst. A series of radiographs were used to monitor the patient for a total of six months (Table/Fig 13) until the first permanent premolar 35 was extruded orthodontically.

Nodular Reverse Halo Sign: An Imaging Feature of Active Pulmonary Tuberculosis

Varsha Rangankar, Ankita Pandey

A 19-year-old female presented with complaints of cough and fever persisting for one month. The patient also gave a history of loss of appetite and significant weight loss within the same timeframe. There were no complaints of chest pain, breathlessness, or shortness of breath. Upon examination, the patient was febrile with a temperature of 100.4 degrees Fahrenheit and had wheezing with bilateral crepitations on respiratory examination. The rest of the vital parameters and systemic examinations were within normal limits. The High-resolution Computed Tomography (HRCT) of the lungs revealed a Reverse Halo Sign (RHS) with larger nodules peripherally and smaller ones centrally, resembling a Nodular Reverse Halo Sign (NRHS) (Table/Fig 1)a-c. Additionally, thick-walled cavities were observed in the superior segment of the left lower lobe, along with patchy consolidation and bronchiectasis in the left upper lobe (Table/Fig 1)a-c. Centrilobular nodules exhibiting a tree-in-bud appearance were noted in both lungs. These findings were consistent with post-primary pulmonary Tuberculosis (TB), which was confirmed by sputum examination. The RHS, also known as the atoll sign or target sign, is a radiological finding typically associated with certain pulmonary diseases. RHS is described as having a central focal area of Ground-glass Opacity (GGO) or lucency on the CT scan, surrounded by a well-defined, nearly complete ring or crescent-shaped denser consolidation (1). It was initially described as a characteristic finding in Cryptogenic Organising Pneumonia (COP), but it has been associated with various other infectious pulmonary diseases, such as invasive fungal infections, TB, pneumocystis pneumonia, community-acquired pneumonia, as well as non infectious conditions like sarcoidosis, granulomatosis with polyangiitis, pulmonary infarction, lung neoplasms and following radiofrequency ablation or radiation therapy for lung cancers (1),(2). The presence of RHS on CT imaging can aid radiologists in narrowing down the potential causes of pulmonary pathologies, but it is important to consider clinical history, laboratory findings and other imaging features to differentiate between infectious and non infectious causes for appropriate treatment and management (1),(2). The distinctive “nodular reverse halo appearance” is strongly associated with active granulomatous infections, specifically pulmonary TB (2). HRCT lung images (Table/Fig 1)a-c typically show areas of nodular densities along the bronchovascular bundle, with multiple slightly larger nodules in the periphery and smaller ones in the center, giving the appearance of NRHS. Granulomatous diseases typically involve the formation of granulomas, which are small nodules of immune cells and fibrosis (2). The multiple small nodules at the peripheral halo and in the center seen in the NRHS correspond to these multiple granulomas (2),(3). Marchiori E et al., in their study of RHS in active TB and COP, reported solitary and multiple lesions exhibiting the RHS pattern in cases of TB as well as COP with associated abnormalities such as consolidation, multifocal ground-glass opacities, or linear opacities in lung parenchyma (2). The authors found a classical morphological pattern of the nodular walls and nodules inside the reverse halos, giving an NRHS appearance only in cases of active TB and in none of the COP cases (2). This finding of NRHS in active TB helps in the differentiation of classical RHS of COP, which is a specific type of lung inflammation characterised by granulation tissue plugs in the small airways lacking pulmonary granuloma formation and nodular lesions. The NRHS, though more commonly seen in active TB, has also been reported in sarcoidosis and other granulomatous infections like cryptococcosis and schistosomiasis (2),(4). However, NRHS with other findings such as cavities, the endobronchial pattern of disease spread with centrilobular nodules and tree-in-bud appearance are highly suggestive of active pulmonary TB, as seen in the present case (1),(2). After a sputum examination confirmed the diagnosis of pulmonary TB, the patient was started on anti-TB medication. Radiologists should be aware of NRHS, which can aid in the early diagnosis and effective management of active TB.

Social Workers and Communication Barriers in a Community: The Story so Far

Rajendra Satish Devkar, Payal Dattatray Waghmare

Dear Editor, Successful communication helps us better understand people, their situations, and celebrate diversities, build respect and trust, solve problems, and share creative ideas. Social workers are professionals dedicated to improving the well-being of individuals, families, and communities. They work in various settings such as schools, hospitals, and community centers, helping people overcome social challenges and access necessary support services. Communicating effectively is essential for social workers to build trust, establish relationships, and ultimately make a positive impact in their communities. Lack of effective communication between social workers and the community might have serious implications. Furthermore, poor communication skills among social workers can contribute to harm and a lack of care in the community. Communication can take various forms such as face-to-face interactions, online communication, sharing photos and notes, and using sign language. In situations, where there is no common language, people can resort to communication through touch or with the help of interpreters. Additionally, technology and media are increasingly being used to complement traditional methods like letters, documents, and formal reports, according to Vaccelerate Consortium (1). Consequently, social workers need to be cautious when using E-blogs and social networking sites, as they are bound by professional codes of conduct (2). Juliet Koprowska’s book ‘Communication and Interpersonal Skills in Social Work (2008)’ discusses communication as an interactive process that is influenced by the context, necessitating careful evaluation. However, various obstacles may hinder effective communication, such as issues of authority, language barriers, differences in skills and personalities, as well as factors like gender, age, and social class (3). This letter to the editor aims to highlight the communication challenges that social workers often face when engaging with communities and proposes strategies to overcome these obstacles. Communication Challenges Faced by Social Workers Lack of clear communication channels within the community: Communities may lack established communication infrastructure, making it challenging for social workers to disseminate information effectively. This can lead to information gaps, confusion, and decreased community engagement (4). Language and cultural barriers affecting effective communication: Social workers often work with diverse populations, including immigrants and minority communities. Language barriers and cultural differences can hinder effective communication, leading to misunderstandings, misinterpretations, and limited access to services (4). Limited resources and time constraints for effective communication: Like other things in life, money is a barrier to communication in the health and social care sectors. The means of communication with the community can be restricted by financial resources. Social workers often operate within limited budgets and face time constraints due to heavy workloads. These constraints hinder their ability to invest adequately in communication tools, training, and outreach efforts, resulting in communication gaps and reduced community engagement (4). Emotional barriers and resistance to change: Social work involves addressing sensitive issues, such as child abuse, addiction, or poverty, which can evoke strong emotions. Overcoming resistance to change and facilitating effective communication becomes challenging when individuals or communities are resistant or defensive (4). Limited access to socio-economic factors: Socio-economic factors contribute to communication barriers. Limited access to resources, education, and technology hampers the dissemination of information. Social workers are confronted with the task of finding innovative ways to reach all members of the community, ensuring that vital messages are not lost during these disparities (4). Lack of digital technology awareness: The digital divide poses another significant challenge. While technology has revolutionised communication, not everyone within the community has equal access. Social workers are faced with the task of balancing traditional communication methods with digital ones, ensuring that no one is left uninformed or isolated (4). Personal Viewpoint on Strategies to Overcome Communication Challenges Establishing trust and rapport with the community: Building relationships based on trust and respect is crucial for effective communication. Social workers should invest time in understanding the community’s culture, values, and norms, demonstrating a genuine interest in their well-being. Adapting communication styles to meet the needs of diverse populations: Recognising and adjusting communication styles to match the cultural and linguistic preferences of the community can foster better understanding. Social workers should employ tools like interpreters, translation services, or cultural mediators to bridge language and cultural gaps. Additionally, leveraging various communication channels, both digital and traditional, has helped in reaching a broader audience. Active listening and empathy in understanding the community’s concerns: Social workers should practice active listening, which involves fully focusing on the speaker, understanding their perspective, and validating their feelings. Demonstrating empathy and acknowledging the community’s concerns helps build trust and fosters open communication. Utilising technology and social media for efficient communication: Social workers should leverage technology and social media platforms to reach a broader audience. Utilising these tools helps disseminate information, engage the community, and provide support even when face-to-face interactions are limited. Building partnerships and collaborating with other organisations: Partnering with community organisations, local leaders, and stakeholders can enhance communication efforts. Collaborative initiatives can pool resources, increase community reach, and foster a holistic approach to addressing social issues. Effective communication is a cornerstone of successful social work practice. By addressing the communication challenges faced by social workers in interacting with communities, the authors can enhance community engagement, access to services, and overall social well-being. Community workshops, cultural sensitivity training, and collaboration with local leaders have proven effective in breaking down communication barriers. Let us work together to ensure effective communication becomes an integral part of social work practice.

A Letter to Editor Regarding Efficacy of Salivary Urea and Creatinine Compared to Serum Levels in Chronic Kidney Disease Patients: A Cross-sectional Study

Geeta Bhatia, Vaishali Dhat

Dear Editor, The article in your issue 2024 Jan; Vol 18(1): BC05-BC08, titled “Efficacy of Salivary Urea and Creatinine Compared to Serum Levels in Chronic Kidney Disease Patients: A Cross-sectional Study”. We read this article with great interest. In this study, the authors tried to explore the use of saliva as a non invasive tool for evaluation of Chronic Kidney Disease (CKD). Salivomics is a rapidly developing diagnostic field, in which saliva is used as a tool for evaluating systemic diseases like CKD, diabetes mellitus and rheumatoid arthritis (1). In this study, the authors focussed on application of salivary urea and creatnine compared to their serum counterparts in CKD patients. The Glomerular Filtration Rate (GFR) is estimated for diagnosis and staging of CKD. In routine clinical practice, serum creatinine is used to estimate GFR using prediction equations with the Modification of Diet in Renal Disease (MDRD) (2). We wanted to point out certain facts- The stages of CKD in the procedure should have mentioned estimated GFR (eGFR) as it is the parameter followed in the Kidney Disease: Improving Global Outcomes (KDIGO) classification (3). As per the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) CKD is categorised on the basis of eGFR, which is as follows: G1- ≥90, G2- 60-89, G3a- 45-59, G3b- 30-44, G4- 15-29, G5- ‹15 mL/min/1.73 m². This recent classification, particularly stages 3a and 3b, is not mentioned in your article, which is essential as this classification is followed worldwide. The eGFR is a crucial measure used to assess the functioning of the kidneys. The main difference between GFR and eGFR is that GFR describes the flow rate of the filtered fluid through the kidneys whereas eGFR is a number that estimates the GFR (4). GFR can be measured by plasma or urinary clearance of ideal filtration markers such as inulin, while eGFR can be calculated from a single blood test such as serum creatinine. Compared to measured GFR (mGFR) or GFR, eGFR is widely available, less expensive, and requires less time. Though GFR and eGFR are used interchangeably to be more precise, eGFR is the right terminology used by researchers worldwide. In this article, the authors work is on CKD (1-3) stages patients, so it is very essential to mention the term eGFR and CKD classification as per KDOQI. These points should have been mentioned in the article, hence pointed out. Authors’ response In the “Letter to the Editor” the reader has mentioned that the CKD classification (3a and 3b) classification has not been elaborated. However, it is brought to light that the article focused on the role of saliva as a tool for CKD prognosis monitoring rather than CKD as a disease with its complete classification and diagnosis. Hence, it was not considered. But for future studies, this classification can be included.

Antimicrobial Efficacy of Calcium Hydroxide with Different Herbal Additives: An In-vitro Study

Shakuntala Bethur Siddaiah, Pragna S Vijaya

Introduction: Microorganisms such as Enterococcus faecalis, Enterobacteriaceae, and Candida albicans are associated with persisting infections and can cause endodontic failure. The addition of herbal additives such as Triphala, Clove, and Activated charcoal to Calcium hydroxide enhances the microbial efficacy within the root canal. Aim: To evaluate and compare the anti-microbial efficacy of calcium hydroxide with various herbal additives against E. faecalis and C. albicans using Agar Diffusion Test (ADT) and Direct Contact Test (DCT). Materials and Methods: The present in-vitro study was conducted in Bangalore, Karnataka, between July 2023 and September 2023. Ethical clearance was obtained from the institution. Sabouraud Dextrose Agar (SDA) and Mueller-Hinton Agar were prepared and used to culture C. albicans and E. faecalis, respectively. In each plate, four wells were filled with groups (n=10): Group-I: Nanocalcium hydroxide (NCH)+sterile distilled water, Group-II: NCH+Nanoparticle Clove, Group-III: NCH+Nanoparticle Triphala, Group-IV: NCH+nanoparticle activated charcoal. The plates were incubated at 37°C, and zones of inhibition around the wells were measured on the first, third, and seventh day. DCT was evaluated in Colony Forming Units (CFUs)/ml by adding each bacterial suspension to four groups and inoculating on blood agar plates. One-way ANOVA test followed by Tukey’s post-hoc analysis was used to compare the mean Zone Of Inhibition (ZOI). Kruskal-Wallis Test followed by Mann-Whitney post-hoc test was used to compare the mean CFUs. Results: One-way ANOVA test showed that there was a significant difference in the mean ZOI between the four groups at p=0.005. The maximum mean ZOI against C. albicans was achieved by the combination of calcium hydroxide and clove with an average mean of 22.20±1.92 mm, 20±1.87 mm, and 17.20±2.28 mm on the 1st, 3rd, and 7th day, respectively. Calcium hydroxide with distilled water combination showed the highest mean ZOI against E. faecalis with an average mean of 18.20±0.84 mm on day 1, 17±1 mm on the 3rd and 7th day. The mean CFUs of E. faecalis and C. albicans showed a significant difference between the four groups at p<0.001. Conclusion: The addition of herbals to Calcium hydroxide increased anti-microbial activity against Candida albicans and Enterococcus faecalis.

Quality of Life among Haemophilic Children in Central Madhya Pradesh, India: A Cross-sectional Study

Madhuri Tejwani, Pankaj Pal, Gaurav Kumar Prajapati, Vipin Thakur, Shweta Sharma

Introduction: Quality of Life (QoL) has recently become a focus of research in haemophilia, as children with haemophilia miss out on opportunities to reach their full potential during school and later in life. This leads to emotional and behavioural problems, family issues, and a decrease in Health-related Quality of Life (HRQoL). There is very limited data from the state of Madhya Pradesh, India, to assess the QoL in haemophilia patients. Aim: To study the clinical profile of haemophilic children and assess their QoL. Materials and Methods: The present hospital-based cross-sectional study was conducted in the Department of Paediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from January 2019 to December 2019. A total of 49 children (Institutional incidence), aged from 4-12 years, with factor VIII/IX deficiency who presented in the Paediatric ward of the study Institution for factor transfusion, were included in the study. The study population was divided into two groups with children aged (group ) and children aged 8-12 years (group II). A detailed clinical history was obtained from the accompanying parent/guardian, and QoL was measured using the Haemophilia QoL (Haemo-QoL) questionnaire. Scores achieved in each dimension, as well as, the total score were combined on a scale ranging from 0 to 100. High values indicate high impairment in QoL. The observations of different scales like Standardised and Transformed Scale Scores (TSS) of Haemo-QoL were analysed using the student’s t-test. Results: In the present study, haemophilia A was more common than haemophilia B. All patients who attended the paediatric ward for factor transfusion were males, with a mean age of 8.37±2.56 years. It was also observed that the proportion of patients who were diagnosed early was significantly higher in the 4-7 years age group compared to the 8-12 years age group of patients (p-value <0.05). The present study revealed that the mean overall scores on the Haemo-QoL for the age groups 4-7 years and 8-12 years were 41.92±17.95 and 51.84±16.36, respectively. The highest impairment was in the physical health, school and sports, and family dimensions of QoL. Conclusion: The QoL is poor among children in both age groups. The current study also showed that as age advances, the QoL of haemophilia patients becomes poorer.

A Clinicopathological Evaluation of Oral Cavity Lesions and the Role of Cytokeratin 8/18 as a Marker in Oral Premalignant and Malignant Lesions: A Hospital-based Cross-sectional Study

Nirmali Mattack, Balmiki Datta, Barnali Das, Gitali Devi

Introduction: The oral cavity is affected by a wide range of pathologic lesions that may originate from squamous mucosa, salivary glands, mesenchymal structures and lymphoid tissue. Alterations in Cytokeratin (CK) patterns have been reported in oral potentially malignant and malignant lesions, and its expression is a hallmark of tumour progression. Aim: To evaluate different oral cavity lesions, with an emphasis on using Cytokeratin 8/18 (CK8/18) to differentiate between benign, premalignant and malignant lesions. Materials and Methods: The present hospital-based cross-sectional observational study was conducted in the Departments of Pathology and Otorhinolaryngology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Guwahati, Assam, India, from September 2020 to August 2021. A total of 93 biopsied or resected specimens clinically presenting in the Otorhinolaryngology Department with oral cavity lesions were submitted to the Department of Pathology, Fakhruddin Ali Ahmed Medical College and Hospital for histopathological examination followed by Immunohistochemistry (IHC) with CK8/18 in all the tissue samples as per IHC protocol. Age, gender, clinical presentation and sites of lesions were also assessed, as well as, histopathological evaluation and IHC. All data were collected, compiled and subjected to suitable statistical analysis, such as one-way Analysis of Variance (ANOVA) and Fisher’s exact tests using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 28.0. Microsoft Office Word and Excel 2019 were used to generate graphs and tables. Results: The age of the patients ranged from 9-90 years and mean±Standard Deviation (SD) age was 52.69±15.81 years. Males, 59 (63.4%), were more commonly affected than females 34 (36.6%), with a male-to-female ratio of 1.73:1. Among the 93 various oral cavity lesions, 24 were located on the buccal mucosa, making it the most common site in our study. Of the 42 malignant oral cavity lesions, the most frequent was moderately differentiated Squamous Cell Carcinoma (SCC) with a frequency of 21 cases (50%), followed by well-differentiated SCC with 18 cases, including one case of Verrucous carcinoma. Poorly differentiated SCC was the least frequent, with three cases (7.14%). CK8/18 was positive in 33 of the 42 malignant cases, four out of the 20 dysplasia cases, and all the benign cases were negative for IHC of CK8/18. The maximal intensity of CK8/18 was seen in 13/21 (62%) cases of moderately differentiated oral SCC. Conclusion: In conclusion, the present study on oral cavity lesions in the lower Assam region highlighted the significance of clinical, histopathological and immunohistochemical evaluations, particularly with CK8/18 staining. A predominance of lesions on the buccal mucosa was found, with moderately differentiated SCC being the most common malignant type. CK8/18 expression showed a notable association with malignant lesions, especially in moderately differentiated SCC, suggesting its potential as a diagnostic marker. These findings contribute to a better understanding of oral cavity pathologies and may aid in early detection and management strategies.

Correlation between Ankylosing Spondylitis Disease Activity Score and MRI Scoring in Patients with Ankylosing Spondylitis: A Cross-sectional Study

Binay Kumar Singh, Mohan Tiwari, Pavan Kumar Meena

Introduction: Ankylosing Spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton, peripheral joints, and extra-articular structures. Typically, the condition starts in the second or third decade. Lower back pain lasting longer than three months, morning stiffness lasting more than 30 minutes, relieved by daily activities, are signs of disease onset. Aim: To establish a correlation between disease severity score Ankylosing Spondylitis Disease Activity Score (ASDAS) and Magnetic Resonance Imaging (MRI) scoring in patients with AS. Materials and Methods: This cross-sectional study was conducted on 66 patients attending the Medicine Emergency/Outpatient Department (OPD)/ward of ESIPGIMSR and ESI Hospital, Basaidarapur, New Delhi, India, who were diagonsed with AS based on the modified New York Criteria. Clinical assessments included ASDAS based on Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP), while MRI disease activity scores were determined using the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI scoring. The sample size was calculated with a coefficient limit of 10% and a confidence level of 95%. Data analysis was performed using Statistical Packages for Social Sciences (SPSS) version 21.0, a widely used statistical computing and graphics tool. Pearson’s correlation coefficients were computed to explore relationships between variables, including age, disease duration, ASDAS-ESR, and MRI changes. Results: In present study, a total of 66 patients were included, out of which 51 (77.3%) were males and 15 (22.7%) were females. The age group of patients included in present study was 33 years to 44 years with a mean of 37.96 years. In present study, the disease duration ranged from a minimum of two years to a maximum of 10 years with a mean of 5.4 years. The mean ASDAS CRP was 3.687 (minimum-2.80, maximum-4.60), and the disease activity as assessed by MRI score (SPARCC) had a minimum value of 8.85 and a maximum value of 26.2 with a mean of 16.359. In present study, the X-ray grading of sacroiliitis revealed that 19.7% of the subjects were classified as Grade-2, 60.6% as Grade-3, and 19.7% as Grade-4. Conclusion: The clinical disease activity index may not always reflect active inflammation, which is detectable by MRI. Incorporating MRI into diagnostic and treatment strategies for AS is crucial for the accurate assessment of disease severity and better patient outcomes.

Prevalence of Depression in Schizophrenic Remission Patients and its Impact on their QoL: A Cross-sectional Study

T Pallavi, Shabeeba Z Kailash, Kailash Sureshkumar, M Aravindh

Introduction: Schizophrenia is a major mental illness and a significant contributor to the global burden of disease. Around one-fifth of patients with Schizophrenia have significant depression during the phase of clinical remission. Aim: To evaluate the prevalence of depression in patients with Schizophrenia, the Quality of Life (QoL) of patients with depression in Schizophrenia, and to study the relationship between the two. Materials and Methods: This cross-sectional study was conducted at the Department of Psychiatry, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India. One hundred patients aged 18 to 59 years diagnosed with Schizophrenia as per International Classification of Diseases (ICD-11), operationally in remission for a minimum of one month, were included. The Calgary Depression Scale for Schizophrenia (CDSS) and the World Health Organisation Quality of Life Brief version (WHOQoL-BREF) scale were used to measure the presence of depression and QoL in patients with Schizophrenia. Data were analysed with t-test, Chi-square tests, and Pearson correlation using Statistical Package for Social Sciences (SPSS) software version 21.0. Results: The mean age of the study participants was 31.6±5.1 years. Of the total study population, 72% were male, 31% had a high school level education, 20% were unemployed, 64% were married, 46% were from a semi-urban background, and 45% belonged to a lower-middle socio-economic background. Twenty-two percent of patients with Schizophrenia in remission were found to have depression. A longer duration of untreated psychosis (mean=9.14±2.83 years) was significantly associated with the development of depression in patients with Schizophrenia. Patients with Schizophrenia and depression had significantly poorer QoL in all domains (physical, psychological, social, environmental; p<0.001). Conclusion: This study helps us understand the importance of monitoring for depression in at-risk patients with Schizophrenia in remission. Doing so can pave the way for early intervention, thus improving their overall QoL.

Cervical Cytology-Histopathology Concordance and Role of Dual Immunomarkers in Biopsy Samples of Uterine Cervix: A Cross-sectional Study from a Tertiary Care Hospital of West Bengal, India

Srimoyee Sen, Esha Mondal, Nazir Abdul Wasim, Manisha Sarkar, Asim Kumar Manna

Introduction: Cervical cancer is one of the leading causes of cancer deaths. Liquid-based cervical cytology enables the detection and diagnosis of the disease at an early stage. p40 is a specific immunomarker that distinguishes squamous cell carcinomas from other cervical carcinomas with glandular and neuroendocrine differentiation. Aim: To determine the role of Liquid-based Cytology (LBC) in the early detection of premalignant and malignant lesions of the uterine cervix and its concordance with histopathological findings. Materials and Methods: This cross-sectional study was conducted at the Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India, over a period of one year and six months (from October 2020 to March 2022). Cervical samples were collected from a total of 200 females, and the materials were processed using the BD SurePath™ LBC method. The cytologically confirmed cases were biopsied, and histopathological concordance was established. Immunohistochemical (IHC) staining for p40 and p63 was performed using the peroxidase-antiperoxidase method to differentiate between premalignant, malignant squamous, and glandular lesions of the uterine cervix. For quantitative analysis, all cells were counted in 10 random fields at 400x magnification, and p63 and p40 were expressed as a percentage of positive cells per the total number of counted cells. Cases were considered positive if 5% or more of the tumour cell nuclei showed brown nuclear staining. The mean percentage positivity of p63 and p40 nuclear staining of all the cases in each category was calculated for non neoplastic and precursor/neoplastic lesions of the cervix. Results: Among the 200 cases evaluated by LBC, 169 (84.5%) were non neoplastic, and the remaining 31 (15.5%) were precursor/neoplastic lesions. The vast majority (126 cases, 63%) were inflammatory smears, followed by 20 cases (10%) that were Negative for Intraepithelial Lesion or Malignancy (NILM). Total of 40 cases were followed-up with biopsy and histopathology, and concordance with the cytological diagnosis was evaluated. Among 40 cases, 23 were precursor/neoplastic on histopathology, and seven cases that were non neoplastic on Histopathological Examination (HPE) had been correctly diagnosed on LBC, giving a concordance rate of 75%. The overall sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of LBC were 92%, 46.6%, 74.1%, and 77.7%, respectively, considering histological diagnosis as the gold standard. Regarding IHC expression on histopathology, the mean positivity of p40 and p63 for non neoplastic lesions was 9.40% and 10.06%, and for precursor/neoplastic lesions, 47.44% and 46.4%, respectively. Adenocarcinoma-in-situ and adenocarcinoma were negative for both p40 and p63. Conclusion: Cervical cytology is a less invasive, cost-effective, and simple procedure to diagnose cervical epithelial cell abnormalities. Cytological-histopathological concordance revealed that LBC is a sensitive diagnostic method. The comparison between non neoplastic and neoplastic lesions of the cervix revealed a statistically significant difference with respect to the mean percent positivity of p40 and p63 IHC staining. Both of these markers can be used to differentiate squamous cell carcinoma from adenocarcinoma of the cervix.

Diagnostic Accuracy of Tissue Transglutaminase and Combined Assay of Tissue Transglutaminase and Deamidated Gliadin Peptide in Children with Coeliac Disease: A Cross-sectional Study

Pankaj Kumar Yadav, Nisha Attri, Lalit Bharadia, Rajiv Kumar Bansal

Introduction: Coeliac Disease (CD) is a systemic immune disorder caused by gluten in genetically susceptible individuals. A serological screening assay for CD has been designed to detect Immunoglobulin A (IgA) and IgG anti-tissue Transglutaminase (a-tTG) and IgA and IgG Deamidated Gliadin Peptide antibodies (a-DGP) simultaneously. The seronegative gap can be closed when these two antigens are combined on a single solid phase. This is primarily because untreated CD children who are negative for antibodies of one of the antigens may exhibit a positive result for the other. Aim: To determine the diagnostic parameters {sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV)} of tTG-IgA and htTG-DGP (Coeliac fusion- a combination of IgA and IgG to human tTG and synthetic DGP) for the diagnosis of CD in clinically symptomatic children. Materials and Methods: This cross-sectional study was conducted at the Paediatric Outpatient Department (OPD) of Santokhba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India from April 2023 to November 2023. The study population comprised 45 children (age >6 months and <18 years) showing clinical features of CD. Considering biopsy as the gold standard, the diagnostic parameters (sensitivity, specificity, PPV, NPV) of tTG-IgA and htTG-DGP were calculated with a 95% confidence interval for both tests. To determine the agreement between the two tests, Cohen’s kappa was calculated. A p-value less than 0.05 was considered statistically significant. Results: Out of the study population, 23 (46%) CD patients were in the age group of 3-6 years, while 13 (26%) patients were in the age group of 6-9 years. A total of 24 (53.3%) CD patients were males, and 21 (46.7%) were females. Chronic diarrhoea was the most common clinical feature in 31 (62%) patients. Considering duodenal biopsy as the gold standard, the study results showed that the anti tTG-IgA antibody test had a sensitivity of 91.1%, specificity of 80%, PPV of 97.6, and NPV of 50%. In comparison, the htTG-DGP antibody test had a sensitivity of 95.6%, specificity of 100%, PPV of 100%, and NPV of 71.43%. Conclusion: Currently, tTG-IgA is considered the best CD screening test. However, the inclusion of DGP IgG could increase diagnostic sensitivity, and a Combined IgA/G-DGP/tTG assay could be even better than tTG-IgA for the diagnosis of childhood CD.

Comparison of Physiochemical Properties and Biocompatiblity of Two Commercially Available Natural Xenogeneic Collagen Membranes: In-vitro Study

A Gnanamani, Vamsi Lavu, Reshma Achu Joseph, R Thilagam, SK Balaji

Introduction: Physical factors like stiffness and surface features are among the characteristics that affect the performance of barrier membranes and determine the results of regenerative processes. A perfect equilibrium between the membrane’s rigidity and mechanical stability guarantees effective periodontal regeneration. The study’s novelty lies in comparing the physical characteristics, namely morphology, tensile strength, wettability, and biological characteristics, namely biocompatibility and enzyme resistance properties, of the Fix-GideTM membrane against the gold standard membrane, Bio-Gide®. Aim: To explore the physical and biological properties of two commercially available barrier membranes in oral tissue regeneration. Materials and Methods: The present in-vitro study compared two commercially available membranes, namely Bio-Gide® and Fix-GideTM. Both membranes are bilayered resorbable membranes, with Bio-Gide composed of porcine dermis Type-I and III collagen and Fix-GideTM of bovine origin. The study was conducted at the Central Leather Research Institute, and the membranes were procured from Sri Ramachandra Institute of Higher Education and Research. Morphological characterisation was done using Scanning Electron Microscopy (SEM). Physical properties were evaluated using a tensile strength test, enzyme resistance test, and wettability measurement. Biocompatibility assessment was also performed. The Statistical Package for Social Sciences (SPSS) software was used to run the Mann-Whitney U test to analyse the statistical data obtained in the enzyme resistance test. Results: Biocompatibility assessment showed no cytotoxic profile of both membranes, portraying their biocompatible nature. Morphological analysis using SEM showed the surface of the Bio-Gide® membrane to be considerably smoother than the Fix-GideTM membrane. Both membranes, however, have fibrous and porous features on their inner surfaces. Tensile strength assessment found that the percentage of elongation was better with Bio-Gide (1.7±0.4 and 4.8±0.4) when compared to Fix-Gide (15.8±0.2 and 2.2±0.2) in both wet and dry states, respectively. The enzyme resistance test evaluated in dry and wet settings showed that the membranes, namely, Bio-Gide^® membrane exhibited around 29±2% of degradation, whereas the Fix-GideTM exhibited only 18±2%. These mechanical profiles exhibited that the membranes has appreciable differences, although there wasn’t a statistically significant difference between them (p=0.68). According to wettability studies, Bio-Gide is hydrophilic, but Fix-GideTM is hydrophobic. Conclusion: The observations of the present study showed that Fix-Gide had comparable physio-biological properties to that of the Bio-Gide membrane. This supports the suitability of the use of both membranes for various oral tissue regeneration procedures.

Ligasure versus Traditional Suturing in Total Abdominal Hysterectomy: A Retrospective Observational Study

Introduction: Gynaecological procedures may be performed via vaginal, abdominal, or minimally invasive approaches, such as laparoscopy, hysteroscopy, and robotic surgery. Abdominal hysterectomy, a prevalent major surgical intervention, is linked to significant complications, notably bleeding and postoperative pain. The invention of Ligasure represents a pivotal milestone in the field of gynaecology. Aim: To compare the effectiveness of Ligasure and traditional suturing during total abdominal hysterectomy. Materials and Methods: A retrospective observational study was conducted in Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India, from March 2022 to September 2023. A total of 34 patients scheduled for elective abdominal hysterectomy were enrolled and divided into two equivalent groups comprising Ligasure (group A) and conventional suturing (group B). Comprehensive preoperative assessments and preparations were done for all participants. Subsequent documentation and comparison of operative and postoperative outcomes, focusing primarily on parameters such as surgical duration, blood loss, and postoperative complications, were done between the two groups. Student’s t-test was used to compare surgical time and blood loss between group A and group B. Results: The mean age of participants in the Ligasure group was 43±4.5 years, and in the suture group was 45±5 years. The difference in BMI between the two groups was not significant. The surgical duration in the Ligasure group was significantly shorter (p-value=0.0002) compared to the conventional suturing group (53.8±6.7 minutes and 64.3±7.62 minutes, respectively). Furthermore, the Ligasure group showed a significant reduction (p-value<0.0001) in blood loss (156.4±31.3 mL and 261.6±36.8 mL, respectively). There was no significant difference (p-value=0.2990) in postoperative haemoglobin levels (11.6±1.2 g/dL and 11.2±1 g/dL, respectively). Conclusion: The use of Ligasure proves to be an efficient approach in abdominal hysterectomy. A reduced duration of surgery and a significant decrease in blood loss were observed with this procedure.

Salivary Levels of S100A8, S100A9 and S100A8/9 in Periodontal Health and Disease: A Cross-sectional Study

Introduction: Damage Associated Molecular Patterns (DAMPs) can initiate and amplify immune responses and can play an important role in the sustenance and progression of periodontal diseases. S100A8, S100A9 and their heterodimer, S100A8/9, are DAMPs or alarmins currently being evaluated for their potential as biomarkers in periodontal diseases. Aim: To quantify and compare salivary levels of S100A8, S100A9 and S100A8/9 in periodontal health, gingivitis or stage 1 periodontitis and stages 3 or 4 periodontitis. Materials and Methods: A cross-sectional analytical study was carried out in the Department of Periodontics, Saveetha Dental College and Hospital, Chennai, India, from December 2022 to February 2023. Periodontal examination and saliva sample collection were done for sixty-eight consecutively enrolled subjects who met the inclusion and exclusion criteria. Study subjects were categorised as group 1, which comprised participants with clinical periodontal health (n=20), group 2, subjects with gingivitis or stage 1 periodontitis (n=20), and group 3, which included patients with stages 3 or 4 periodontitis (n=28). Detailed clinical examination and periodontal charting were done in all study subjects. Saliva samples were processed and stored at -80°C, and enzyme-linked immunosorbent assay was done to quantify S100A8, S100A9 and S100A8/9. Data were analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 25.0. Salivary levels of S100A8, S100A9 and S100A8/9 were expressed as mean and standard deviation values. Mean values of the three salivary proteins were compared using the non parametric Kruskal-Wallis test. Bonferroni adjusted pairwise comparisons were also done. The p-values less than 0.05 were considered statistically significant. Results: The mean age of study participants was 38.97±7.62 years. Salivary levels of S100A8 were 41.34±14.34, 141.95± 185.25 and 901.37±65.60 pg/mL in groups 1, 2 and 3, respectively. A statistically significant difference was present among the three groups for mean salivary levels of S100A8 (p-value<0.001). Pairwise comparisons showed that salivary S100A8 values in group 3 were significantly higher than the values observed in clinical health (group 1) (p-value<0.001) and those seen in the gingivitis or stage 1 periodontitis group (group 2) (p-value<0.001). Mean salivary levels of S100A9 and S100A8/9 did not show any statistically significant differences between the groups. Conclusion: There is an altered expression of S100A8, S100A9 and S100A8/9 in periodontal diseases compared to clinical health. Salivary levels of S100A8 are markedly different in cases of advanced periodontal destruction than in periodontal health and early stages of periodontal disease. Salivary S100A8 merits potential as a biomarker for periodontal diseases.

Histopathology and Immunohistochemical Profile of Breast Cancer amongst Young Females below 40 years of Age: A Cross-sectional Study

Introduction: Breast cancer is a diverse and heterogeneous disease affecting women in both developing and developed countries. In 2022, Global Cancer Observatory (GLOBOCAN) reported 2.3 million cases of breast carcinoma, which accounted for 11.6% of all cancer cases worldwide. The incidence of breast cancer in India has been steadily rising and has surpassed cervical cancer as the most common cancer in women. Invasive ductal carcinoma is the most common histologic type found in all age groups. Grading is done according to Elston Ellis’s modification of the Scarff Bloom Richardson Scoring system. Hormonal {Estrogen Receptor (ER), Progesterone Receptor (PR)} and Human Epidermal growth factor Receptor-2 (HER2/neu) immunohistochemical expression are used for molecular typing of breast carcinoma. Young women account for up to 25% of all breast carcinoma cases in India. Aim: To assess the clinical symptoms, histological type, grade, Immunohistochemistry (IHC) profile (ER, PR, HER2neu), and their relationships in females below 40 years of age with breast carcinoma. Materials and Methods: An ambispective cross-sectional study with a total of 99 cases of breast carcinoma in young females were included in the study, which was conducted in the Department of Pathology at Sri Aurobindo Medical College and PG Institute in Indore, Madhya Pradesh, India, between April 2022 and March 2024. Biopsies, lumpectomy, and total or modified mastectomy specimens were fixed in formalin and paraffin embedded. Sections were stained with Haematoxylin and Eosin (H&E) and IHC markers ER, PR, and HER2neu using Estrogen Receptor Alpha Antibody (EP1), EP2, and EP3 antibodies, respectively, on a fully automated workstation. Carcinomas were classified according to the World Health Organisation (WHO) classification and graded based on Elston Ellis’s modification of the Scarff Bloom Richardson System Scoring. The proportion of tumour cells and intensity were studied, and evaluation was done with appropriate controls. Results: The most common symptom was a breast lump (84.84%), while Invasive breast cancer of {No Special Type (NST)} was the most common histologic type (96.96%) and histological Grade III was predominant (53.53%) in the majority of patients. ER, PR, and HER2neu were positive in 57.57%, 51.51%, and 33.33% of cases, respectively. HER2neu expression was negative in the majority of cases (66.66%). The most common molecular subtype was Luminal A (35.35%), followed by Triple-negative Breast Cancer (TNBC) (29.29%), Luminal B (22.22%), and the least common was the HER2neu enriched subtype (13.13%). Conclusion: Invasive breast carcinoma (NST) is the most common histologic type, with higher histologic grade and a greater number of triple-negative cases seen in young females (<40 years).

Role of Serial Serum Cholinesterase Levels in Clinical Outcomes of Patients with Organophosphorus Compound Poisoning: A Cohort Study

GN Swapna, T Neeraja

Introduction: Poisoning is caused, when a poisonous material is consumed, inhaled, or comes into contact with the skin, eyes, or mucous membranes like the mouth or nose. Poisoning by pesticides has long been considered a serious public health issue. The majority of poisoning cases reported to hospitals involve either an unknown type and quantity of Organophosphorus (OP) poisoning taken by the patient, which makes repeated serum Acetylcholinesterase measurements. Few studies have done the serial Serum Cholinesterase (SChE) tests in the early stages of poisoning. Aim: To evaluate the prognostic value of measuring serial SChE levels in patients with OP poisoning to predict clinical outcomes. Materials and Methods: This cohort study was conducted in the Department of Biochemistry and Therapeutics at Hassan Institute of Medical Sciences, Karnataka, India. Medical records of OP poisoning cases admitted during September 2023 and December 2023. A total of 40 patients were included in the study. Detailed demographic and clinical data, along with serial SChE levels at admission, day 2, and day 4, were recorded in the case record forms. Results: The mean age of the patients was 43.38±16.46 years. There was a significant decrease in serum SChE levels from day 1 to day 4 (p<0.0001). Furthermore, the mean SChE levels at admission in patients who survived were significantly higher (p<0.00001) than those in the group that expired. Conclusion: Significantly higher SChE levels were found to be associated with improved clinical outcomes, as indicated by improvements in mechanical ventilation and lower fatality rates after acute OP poisoning.

Dentinal Tubule Occluding Efficacy of Three Nano Biomaterials Containing Toothpastes on Simulated Hypersensitive Dentin: An SEM and EDX In-vitro Analysis

Neha Mundhada, Chetana Makade, Pratima Shenoi, Deepashri Tekam, Simran Gupta

Introduction: Dentin Hypersensitivity (DH) is a common dental issue characterised by sharp pain in response to stimuli. Desensitising toothpastes provide lasting relief by sealing dentinal tubules. In recent years, new home-use desensitising products incorporating nano biomaterials have been developed. Aim: To evaluate the efficacy of nano biomaterials such as Nano-hydroxyapatite (n-HAp), Novamin, and Pro-Argin in occluding dentinal tubules for the treatment of DH. Materials and Methods: An in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India, from October 2017 to April 2019. A total of 105 extracted maxillary premolars were divided into five groups: a no-treatment group (n=5), a control group (Sodium Fluoride) (n=25), and three experimental groups (n=25) using n-HAp, Novamin, and Pro-Argin, respectively. An Oral B cross-action toothbrush with a customised jig machine was used along with the experimental toothpaste for two minutes daily for two months. All samples were sectioned and subjected to Scanning Electron Microscope (SEM) and Energy Dispersive X-ray Spectroscopy (EDS) for chemical characterisation. The data were subjected to statistical analysis using one-way Analysis of Variance (ANOVA) for comparison of the mean number of dentinal tubules and Calcium to Phosphorous (Ca/P) ratio. Paired comparisons were carried out using Tukey’s post-hoc test. Results: It was observed that the n-HAp-containing toothpaste had the highest number of completely occluded tubules (546.00±49.96), and the Ca/P ratio of enamel (1.87±0.41) was higher than that of the other experimental groups (p<0.0001). Conclusion: The n-HAp-containing toothpaste reported the highest efficacy in occluding dentinal tubules followed by Novamin, Pro-Argin, and regular toothpaste at the end of two months. All three tested toothpastes containing nano biomaterials had remineralisation potential.

Comparative Evaluation of Solubility of a Single Shade Resin Composite with Conventional Composite: An In-vitro Study

Pranauti Sonaje, Farhin Katge, Shilpa Shetty, Devendra Patil, Trisha Patel

Introduction: Resin composites have been commonly used in restorative dentistry over the years. The longevity of restorations depends upon various physical properties like as solubility. Composite solubility can lead to deleterious effects on the polymer structure. Aim: To evaluate and compare the solubility of a single shade resin composite in comparison to a conventional resin composite in artificial saliva. Materials and Methods: In the present in-vitro study, 44 pellets (10 mm × 1 mm) were prepared from each material. The pellets were divided into two groups (n=22) based on the immersion period of two days and seven days. They were incubated, weighed using an analytical balance, and then immersed in artificial saliva. Weighing was done again after the completion of the immersion period, and solubility was calculated. Paired and independent sample t-tests were used to compare the solubility of both materials after two days and seven days. Results: The differences of solubility values for the single shade composite and conventional composite at two and seven-day intervals were (p=0.031) and (p=0.019), respectively, which were statistically significant. On inter-group comparison, the difference in solubility of the single shade composite at two days was significantly lower compared to conventional composites (p=0.024). Whereas, no significant difference was observed in solubility values between both groups at seven days (p=0.102). Conclusion: The performance of the single shade composite in terms of solubility was better in comparison with conventional composite.

Comparison of Fracture Resistance of Endodontically Treated Human Mandibular Molars Restored with Paracore Dual-cure Composite and EverX Posterior Composite: An In-vitro Study

Rupankar Dey, Raghunath Sil, Priti Desai, Laboni Ghorai

Introduction: Endodontic treatment is an elective dental procedure that is performed when the dental pulp becomes irreversibly damaged or necrotic due to dental caries or trauma. Considerable loss of coronal tooth structure together with large cavity designs and access cavities compromise the mechanical behaviour of endodontically treated teeth, making them more susceptible to catastrophic fracture. Hence, following endodontic treatment, it is imperative to provide a suitable restorative material to avoid subsequent tooth fracture following occlusal loading. Aim: To assess and compare the fracture resistance of endodontically treated human mandibular first molars restored with dual-cure composite (Paracore) and newer short fibre-reinforced composite (EverX Posterior) in occlusal (Class-I) cavities. Materials and Methods: The in-vitro study was performed in January 2023 to February 2023 using 30 freshly extracted sound adult human mandibular first molars (divided in three groups) at Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India. A total of 10 intact teeth served as positive controls (Group-1). Class-I access cavity preparation followed by endodontic therapy was performed on the remaining 20 teeth, which were randomly divided into two groups (Group-2 and 3), which were coronally restored with Paracore dual-cure composite and EverX posterior composite, respectively. Teeth were mounted in acrylic resin, and subsequently, measurements of fracture strength were performed using a universal testing machine. Data were analysed statistically using One-way Analysis of Variance (ANOVA), Post-Hoc Tukey, and Chi-square tests, with a p-value of ≤0.05 considered as the level of significance. Results: The mean fracture resistance values (in kilonewtons) were as follows: Group-1 (1.5750 kN) > Group-3 (1.0450 kN) > Group-2 (0.6350 kN). Group-3 showed a significantly higher mean fracture resistance value (p=0.035) than the other experimental group. The levels of fractures were also evaluated, and a significant difference between the groups was noted (p=0.001), concluding that the frequencies of unfavourable fractures were significantly higher in Group-2 than in the other groups. Conclusion: Short fibre-reinforced composite (EverX) showed fracture resistance similar to that of a natural tooth and hence can be used as a direct core build-up material to reinforce the remaining tooth structure in endodontically treated teeth.

Fluid Electrophoresis as a Tool for Diagnosis in Ascitic Patients: A Cross-sectional Study

Yassir OA Sidahmed, Aimun AE Ahmed, Rehab OE Elhewaig, Yasir S Kaloda

Introduction: Ascites is a condition in which there is accumulation of pathological fluid within the abdominal cavity. It is a challenging problem for healthcare personnel due to different pathological causes. To make a differential diagnosis, many investigations are needed. These investigations mainly depend on the analysis of ascitic fluids. Aim: To determine electrophoresis patterns in ascitic fluid and to relate the findings to each established diagnosis. Materials and Methods: This was a cross-sectional hospital-based study conducted at Khartoum and Alshaab Teaching Hospitals in Khartoum state, Sudan, from May 2018 to August 2018. The study population included all patients who were confirmed to have ascites using ultrasound. Fresh ascitic fluid samples were obtained from a total of 35 patients. All safety and aseptic conditions were applied. Immediately after collection, the samples were brought to the laboratory for electrophoresis of ascitic fluids. Data were analysed using descriptive statistics in terms of frequency and percentage. Results: The study findings revealed that most of the patients were men 26 (74.3%) and were over 50 years old 16 (45.7%). The majority of them were diagnosed with Liver Cirrhosis (LC) (28.6%), while a few (5.7%) suffered from Periportal Fibrosis (PF), Hepatocarcinoma (HC), Ovarian Carcinoma (OC), Heart Failure (HF), or Peritonitis (PT). Different patterns of ascitic electrophoresis were detected in diagnosed patients with ascites. About 29 (82.9%) patients had specific electrophoresis patterns that helped with diagnosis, while only 6 (17.1%) did not. Conclusion: Liver cirrhosis, hepatocellular carcinoma, and hepatitis B bands were specific compared to normal serum patterns, while no changes in ascitic fluid electrophoresis were observed in HF.

Ultrasound-guided Transversus Abdominis Plane Block and Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia in Caesarean Section: A Randomised Clinical Study

Sukhmanpreet Kaur, Amrita Ghosh, Manasij Mitra, Ranabir Pal, Maitraye Basu

Introduction: Pain is the most unpleasant subjective feeling comprising of innumerable emotional and psychological components that require medical advice for relief, regardless of the cause. Transversus Abdominis Plane (TAP) block and Erector Spinae Plane (ESP) block are effectively studied blocks that provide adequate pain control. Aim: To compare postoperative analgesic efficacy in pregnant women undergoing caesarean section under spinal anaesthesia with Ultrasound (USG)-guided TAP block and USG-guided ESP block. Materials and Methods: In this institution-based interventional randomised clinical study, two categories comprising 30 subjects in group I with USG-guided bilateral TAP block and group II with USG-guided bilateral ESP block using Ropivacaine were involved. Visual Analogue Scale (VAS) was used to compare analgesic efficacy. Other parameters for analysis included time of first rescue analgesia, total number of administrations of rescue analgesia within 24 hours, together with Adverse Drug Reactions (ADRs). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0. Student’s t-test and Chi-square test were used for data analysis. Results: Subjects in group I had a mean age of 24.9±4.66 years while those in group II were 25.5±3.99 years. The VAS score at 24 hours in group I was 7.22±0.89 and in group II was 6.8±0.83, which was statistically significant with a p-value of 0.0241. USG-guided ESP block was superior to USG-guided TAP block, providing analgesia for 24 hours. Following the first dose, there was a significant delay in rescue analgesia and a reduction in the total administration of rescue analgesia within 24 hours. The first rescue analgesia in group I was at 10.66±2.32 hours and in group II was at 16.66±2.53 hours, with a p-value of 0.0001 indicating a statistically significant difference. No ADRs were reported in either group of participants. Conclusion: ESP block provided a prolonged duration of analgesia, as shown by a decrease in the total VAS score. There was also a significant reduction in the total number of administrations of rescue analgesia within 24 hours when compared to TAP block, suggesting that ESP block provides superior analgesia. Hence, for pain relief in postcaesarean section individuals, ESP block can be regarded as a novel potent option.

Comparison of Balance between Badminton and Volleyball Recreational Players with Chronic Ankle Instability: A Cross-sectional Study

Yashwitha Shetty, Saumya Srivastava

Introduction: Chronic Ankle Instability (CAI) is an injury that presents persistent instability and “giving way” symptoms. The higher rate of reinjury following an initial Lateral Ankle Sprain (LAS) is associated with the development of CAI, which affects athletic and functional performance. Impairment of musculotendinous receptors following an initial ankle sprain may result in recurrent ankle instability. Some studies have suggested an association between CAI and issues with static and dynamic balance. Comparisons of static balance between recreational badminton and volleyball players and dynamic balance between recreational badminton and volleyball players with CAI are required to provide athletes with the proper balance training exercises. Aim: To analyse the static balance of badminton and volleyball recreational players with CAI using the Balance Error Scoring System (BESS) and a Plantar Pressure Analysis System (PPAS), as well as the dynamic balance of those players using the Y Balance Test (YBT). Materials and Methods: A cross-sectional study was conducted where recreational players with CAI who play badminton and volleyball were screened using the Cumberland Ankle Instability Tool (CAIT), and 46 participants were selected based on inclusion and exclusion criteria. The study was conducted in the indoor and outdoor stadiums of NITTE (Deemed to be University), Mangaluru, Karnataka, India. The study duration was from March 2023 to March 2024. Ethical clearance was obtained from the same university for the study. Following this, static and dynamic balance of each group was assessed using BESS (number of errors), PPAS (sway velocity), and YBT (distance reached by the limb). The static balance between the groups and dynamic balance between the groups were analysed in Jamovi software using independent sample t-test. Results: Following the analysis, static balance between badminton and volleyball recreational players using BESS showed a non significant difference with a p-value of 0.282, while PPAS showed non significant differences with p-values of 0.174 for double leg stance and 0.063 for single leg stance. Similarly, dynamic balance between badminton and volleyball recreational players using YBT showed non significant differences with p-values of 0.467, 0.768, and 0.299 for anterior, posteromedial, and posterolateral directions, respectively. Conclusion: The study concluded that there was no significant difference in static as well as dynamic balance between badminton and volleyball recreational players with CAI. However, it is important to evaluate the static and dynamic balance of recreational players to enhance performance and prevent injuries.

Knowledge, Attitude, and Practice of Ethical Social Media Usage amongst Dentists: A Cross-sectional Questionnaire-based Study

Introduction: Social Media (SM) has proven to be a valuable tool in various fields, including healthcare. However, its improper use can result in several ethical problems. Aim: To evaluate the knowledge, attitude, and practice of ethical SM usage for professional purposes. Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics and Crown and Bridge at K.M. Shah Dental College and Hospital Vadodara, Gujarat, India between October 2022 and March 2023. A total of 319 respondents, including dental postgraduates, academicians, and dental practitioners, participated in the survey online through various SM groups. The questionnaire was created by analysing previous literature and reviewed by experts for accuracy. The survey comprised nine questions with three subsections to evaluate knowledge, attitude, and practice of ethical SM usage The survey was distributed through Google Forms, and the statistical analysis of the results was conducted using the Chi-square test (p<0.05). Results: A survey found that 238 (75.3%) of users have used SM for over five years. The most commonly used platforms are WhatsApp, Instagram, and Facebook. A total of 153 (48.4%) knew about electronic protected health information, 156 (49.4%) knew about Digital Information Security in Health Care Act (DISHA), and 264 (83.5%) knew about consent’s importance. A total of 227 (71.8% ) of dentists saw SM as a potential risk to patient privacy, but 248 (78.5%) took consent before sharing and 252 (79.7%) used de-identification measures before posting images. A total of 197 (62.3%) of individuals have not participated in any awareness or sensitisation programs regarding the ethical implications of SM usage. Conclusion: The study found dentists understand and prioritise patient privacy on SM. Regular training and policy updates are crucial for sensitising them regarding ethical use.

Comparative Evaluation of Anti-bacterial, Anti-inflammatory Efficacy and Cytotoxicity of Triple Antibiotic Paste Modified Soft Liners with Conventional Soft Liners: An In-vitro Study

Dnyaneshwar Parekar, Sahana Selvaganesh, Thiyaneswaran Nesappan

Introduction: Soft-Liner is an acrylic temporary relining material for the temporary rebasing (relining) of acrylic dentures and tissue conditioning. The use of soft liner as a medium to deliver anti-bacterial and anti-inflammatory medications locally to the site enhances the healing of the soft tissues, further maintaining the mucosa healthy in the transitional healing period. Soft liners modified with Triple Antibiotic Paste (TAP) help in soft tissue healing and reduce post-surgical inflammation. Aim: To evaluate the anti-bacterial, anti-inflammatory efficacy, and cytotoxicity of TAP modified soft liners with conventional soft liners. Materials and Methods: The in-vitro study was conducted in the Gold Laboratory at Saveetha Dental College, Chennai, Tamil Nadu, India, in March 2023. A solution of TAP was prepared and mixed with Gas Chromatography (GC) soft liner material. The antibacterial efficacy against the strains of Staphylococcus aureus, Pseudomonas, and E. faecalis was assessed, and Mueller Hinton Agar was used to identify the zone of inhibition. The Kolmogorov-Smirnov test was conducted to assess the normality of the distribution, and non-parametric tests were performed for further analysis. A chi-square test was used to compare the cytotoxicity of TAP modified soft liners, which was assessed by a Lethality assay for brine shrimps over 24 hours. The Egg albumin denaturation assay was used to assess anti-inflammatory properties, with different concentrations of 10 μL, 20 μL, 30 μL, 40 μL, and 50 μL. Human Gingival Fibroblast (HGF) was used for the cell line study, and the isolation of HGF was performed by enzymatic digestion subjected to collagenase (900 u/mL) and dispase (400 u/mL) digestion at 37°C for one hour. Results: In comparing the modified TAP liners to commercially available liners on the basis of antibacterial efficacy, there was increased anti-bacterial efficacy in the TAP modified liners, which increased with increasing concentration, with the maximum being 40.25±14.87 mm for a 1:3 concentration against S. aureus and the least being 23±1.3 mm of unmodified soft liners against Pseudomonas and S. aureus. Different concentrations of 10 μL, 20 μL, 30 μL, 40 μL were used for the anti-inflammatory test, and as the concentration increased, anti-inflammatory activity also increased. The cytotoxicity of the material increased from 10% to 40% as the concentration of TAP rose from 5 μL to 80 μL. Conclusion: TAP shows a better response in managing postoperative inflammation and better soft tissue healing when incorporated into the soft liners. More precise studies are needed to understand the exact mechanism of TAP.

Unveiling the Promise of Bioactive Alkaloid Compound from Catharanthus Roseus: An In-vitro Computational Exploration of their Molecular Docking against a Target Protein for Type-2 Diabetes

A Mariappan, PK Jabir, D Alfred Solomon, Shyamaladevi Babu, Madhan Krishnan

Introduction: Molecular docking facilitates the exploration of interactions between bioactive alkaloid compounds and target proteins, offering insights into potential binding modes and affinity, crucial for drug discovery and understanding molecular mechanisms. Catharanthus roseus (C. roseus), renowned for its bioactive alkaloid compounds, emerges as a promising candidate for novel agents in diabetes management. Aim: To study the computational methods, including in-silico molecular docking, to elucidate the interactions between bioactive alkaloids from C. roseus and a Type-2 diabetic target protein. Materials and Methods: In this in-vitro study conducted in 2022 at the Department of Research, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Tamil Nadu, India. The research took place from July to October 2022. Computational techniques, particularly in-silico molecular docking, were utilised to analyse the binding affinities and potential mechanisms of action of bioactive alkaloids from C. roseus against a target protein associated with Type-2 diabetes. The study employed established computational protocols and software tools to predict and evaluate the binding interactions between the alkaloids and the target protein. Results: The analysis suggests Vinblastine, Ajmalicine, and Vindolinine from C. roseus as potential diabetes therapeutics. Vinblastine binds strongly to Human Pancreatic Alpha-Amylase (HPA), hinting at glucose metabolism regulation. Ajmalicine and Vindolinine also interact significantly with HPA, implying antidiabetic potential. Additionally, the present study findings suggest a potential role of Reserpine in modulating HPA activity and supporting its antihypertensive effects. Conclusion: In conclusion, the analysis highlights the potential of C. roseus compounds like Vinblastine, Ajmalicine, and Vindolinine in managing diabetes by interacting with HPA, indicating their potential as antidiabetic agents. Additionally, Reserpine’s effect on HPA activity suggests a role in hypertension management. These findings emphasise the therapeutic potential of natural compounds from C. roseus for diabetes and related conditions, warranting further clinical investigation.

Evaluation of Elastic Recovery of Elastomeric Impression Materials Subjected to Various Disinfection Methods: An In-vitro Study

Introduction: Disinfection of impressions is essential to prevent cross-contamination from the operatory to the laboratory. Various methods have been employed to disinfect the impressions. These disinfection methods should not alter the physical and mechanical properties of impression materials. Aim: To evaluate the Elastic Recovery (ER) of elastomeric impression materials subjected to different disinfection methods. Materials and Methods: This was an in-vitro study conducted at KIMS Dental College and Hospital, Amalapuram, Andhra Pradesh, India and Vishnu Dental College, Bhimavaram, Andhra Pradesh, India over a period of 5 months from August 2022 to December 2022. A total of 120 impressions were made using three different types of elastomeric impression materials: Poly Vinyl Siloxane (PVS), Vinyl Poly Ether Siloxane (VPES), and Poly Ether (PE). A metal die was made as per American Society for Testing and Materials (ASTM) D412 and International Organisation for Standardisation (ISO) Specification 4823, containing a lower and upper member. These impressions were trimmed to the dimensions of a stainless steel stencil, measuring at points with uniform thickness. The impressions were then subjected to autoclave and chemical disinfection using 5% Glutaraldehyde (Korsolex) and Ethanol-2-Propanol (Bacillol). The samples prepared were fixed in the tensile grips of a Universal Testing Machine (UTM) and subjected to tensile loading at a crosshead speed of 10 mm/minute until tearing. The distance between the break ends was measured using a digital Vernier Callipers, and ER was measured. One-way Analysis of Variance (ANOVA) followed by Tukey’s post-hoc tests were used to analyse the obtained study data. Results: The PE impression material demonstrated more ER when subjected to different disinfection methods compared to the other materials. Significant differences were observed between the ER of impression materials with different disinfection methods (Autoclave: p<0.001, Korsolex: p<0.001, and Bacillol: p=0.007). Conclusion: For better ER, PVS can be sterilised with Bacillol and Korsolex. Korsolex should be avoided for disinfecting PE. VPES performed better with autoclave and Korsolex.

Oral Health-Related Quality of Life after Dental Treatment among Disabled and Non Disabled Individuals in Saudi Arabia: A Cross-sectional Study

Abdullah Ali H Alzahrani, Nagesh Bhat

Introduction: The quality of life based on oral health has been a vital factor affecting health outcomes. It is an overall factor that influences functional well-being, as disabled individuals may have predisposing factors that could impact their quality of life. Aim: To assess Oral Health-Related Quality of Life (OHrQoL) in disabled and non-disabled individuals after receiving dental treatment in the Al-Baha region, Kingdom of Saudi Arabia. Materials and Methods: A cross-sectional study was conducted between September and December 2023. A total of 86 disabled and 129 non-disabled participants underwent clinical examinations, and dental treatments were performed. The Oral Health Impact Profile (OHIP-14) was utilised to evaluate OHrQoL using a validated Arabic version of the questionnaire. Data related to all variables in OHIP-14 were analysed in association with oral diseases using Statistical Package for Social Sciences (SPSS) Software version 20.0. Results: A total of 215 patients with and without disabilities were included in the study. Among these, 124 (57.5%) were females and 91 (42.3%) were males. Females reported significantly higher OHrQoL scores than males after dental therapy (p-value<0.001). No significant differences in OHrQoL were observed between patients with and without disabilities (p-value 0.389). However, quality of life significantly improved after dental treatment in disabled and non-disabled individuals across all sections or domains (p-value<0.05). Conclusion: Oral disorders had a negative impact on quality of life, as post-treatment OHrQoL scores were significantly lower than pre-treatment scores.

Correlation between Visceral Fat with Pulse Pressure in Young Offsprings of Hypertensive and Normotensive Parents: A Cross-sectional Observational Study

Arti Choubey, Vivek Verma, Sumit Kumar

Introduction: Increased Pulse Pressure (PP) and arterial stiffness are both associated with an elevated risk of Cardiovascular Disease (CVD). Raised PP is an independent prognostic marker for CVD not only in adults but also in young normotensive subjects. Normotensive Offspring of Hypertensive Parents (OHP) are more likely to develop future hypertension. Visceral obesity, closely tied to endocrine activity, magnifies susceptibility to hypertension and CVD development in young adults. Thus, understanding the association between visceral fat and PP assumes paramount importance in young adults. Aim: To study the correlation between visceral fat and PP in young offspring of hypertensive and normotensive parents. Materials and Methods: The cross-sectional study was conducted in the Department of Physiology, Government Medical College, Datia, Madhya Pradesh, India for eight months from June 2023 to January 2024 among 140 healthy young participants aged 18-25 years. The subjects were divided into two groups: Group-1 {Offspring of Normotensive Parents (ONP)} and Group-2 offsprings of Hypertensive Parents (OHPs). Body composition parameters and visceral fat levels were measured using a calibrated Karada scan. Detailed information regarding the history of hypertension in the family, alcohol intake, etc., was collected in a pre-defined proforma. Blood pressure measurements of subjects were taken using a standard electronic sphygmomanometer. Statistical analysis of the data was conducted using Statistical Package for Social Sciences (SPSS) Version 28.0 software. For correlational analysis, Pearson correlation test was used and a p-value <0.05 considered significant. Results: The findings revealed a significant positive correlation between visceral fat levels and PP levels (p<0.05, r=0.58 and 0.57) in the two groups. Visceral fat levels were significantly higher in OHPs than in ONPs. Conclusion: Visceral fat and PP showed a correlation within the young population, irrespective of hypertensive or normotensive parents. However, visceral fat and PP levels were higher in the OHPs. This study suggests that maintaining a healthy body fat composition rather than just body weight might be pivotal for long-term hypertension prevention.

Effect of Mulligan Calcaneal Taping on Dynamic Balance and Functional Performance in Subjects with Plantar Fasciitis: A Prospective Cohort Study

Chetna Jakhotiya, Riddhi Ashish Shroff, Pranita Ganjave

Introduction: Plantar fasciitis is the most common cause of heel and foot pain, leading individuals to use compensatory techniques to alleviate their pain, resulting in an antalgic gait. These compensations alter the feeling of joint position and muscle activation, making it challenging to maintain an upright posture within the base of support. According to Mulligan’s concept, rigid tape allows painful or restricted movements with quick pain relief and increased range of motion while correcting positional faults and reducing tensile tension on the fascia, thereby decreasing inflammation and microscopic tears. Currently, there is a scarcity of data studying the effect of Mulligan’s calcaneal taping on dynamic balance. Aim: To evaluate the effect of Mulligan’s calcaneal taping on dynamic balance and functional performance in subjects with plantar fasciitis. Materials and Methods: The study was a prospective cohort study conducted at D.Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India. It began in March 2023 and concluded in March 2024, spanning one year. Thirty-six subjects were randomly divided into group A (n=18) and group B (n=18). Subjects experiencing pain for more than six weeks, aged between 18-60 years, with a positive Windlass test, plantar medial heel pain, and abnormal foot posture index (between +6 to +9) were included in the study. The experimental group received Mulligan’s calcaneal taping along with conventional physiotherapy exercises, while the control group received only conventional physiotherapy exercises. Pre-post assessments were conducted using the star excursion balance test for dynamic balance assessment and the Foot Function Index (FFI) for functional performance. Results: Statistically significant differences were found among the medial (p-value=0.0212), posteromedial (p-value=0.0199), and posterior (p-value=0.0091) directions of the star excursion balance test. Both groups did not show statistically significant differences in the FFI score. However, with effect size, there was good clinical significance for the FFI score and all directions of the star excursion balance test except the posterolateral direction. Conclusion: Mulligan calcaneal taping has been shown to be more effective in improving dynamic balance in subjects with plantar fasciitis.

Comparison of Cognitive Performance, Stress, Body Mass Index, and Lung Functions in Exercising and Non Exercising Medical Students: A Cross-sectional Study

Ritish Reddy Ankireddy, T Bharath, Vijaya Vageesh

Introduction: Stress is an inherent part of the human experience, especially among medical students, due to academic pursuits and social commitments. The present study explores the intricate relationship of cognition with perceived stress levels, lung function, and Body Mass Index (BMI) in exercising and non exercising medical students. Aim: To find out and compare the levels of stress, cognition, BMI, and lung function in exercising and non exercising medical students. Materials and Methods: This cross-sectional study was conducted at the Department of Physiology, JSS Medical College, Constituent College of JSSAHER, Mysuru, Karnataka, India over a span of two months from February 2021 to April 2021. It included 110 participants categorised into an exercising group and a non exercising group. Stress and cognition were measured using the Perceived Stress Scale 10 (PSS-10) and the Modified Mini-mental State Examination (3MS), respectively. The BMI was calculated using Quetelet’s index. Pulmonary function was measured using a computerised spirometer. Associations were determined using a Student’s t-test, with p<0.05 considered significant. Results: The mean PSS-10 score for exercising students (11.36±3.67) was significantly lower compared to non exercising students (20.71±4.61). The 3MS score of exercisers (97.33±1.73) was significantly higher compared to non-exercisers (94.02±1.40). The mean values of pulmonary functions namely Forced Expiratory Volume 1 (FEV1) (3.43±0.71 L), Forced Vital Capacity (FVC) (3.88±0.76 L), and FEV1/FVC (87.94±2.73%) in exercisers, were significantly better than the values for non-exercisers: FEV1 (3.00±0.67 L), FVC (3.48±0.71 L), and FEV1/FVC (85.86±2.75%). The mean BMI of exercisers (21.45±1.43 kg/m²) was significantly lower than that of non-exercisers (23.03±1.35 kg/m²). Conclusion: Participants who exercise regularly have better cognition, lower stress levels, a healthier BMI, and better lung function than their non exercising counterparts.

Comparative Analysis of Musculoskeletal Responses in Patellofemoral Osteoarthritis Patients: A Study on Retro-walking Treadmill Protocols using an Experimental Design

Chhavi Chaturvedi, Priyanka Rishi, Snigdha Tiwari, Saurabh Kumar

Introduction: Knee Osteoarthritis (OA) is a significant cause of disability globally and is rapidly becoming a major health issue. The part of the knee most affected by OA is the patellofemoral joint. This type of arthritis poses challenges for both patients and healthcare providers in managing symptoms and improving the quality of life for those affected. However, there’s a lack of data on specific therapies for the patellofemoral joint. Aim: To investigate if a varied frequency treadmill exercises protocol involving retro-walking has a greater impact on musculoskeletal responses, leading to better improvements in individuals with symptomatic Patellofemoral Joint Osteoarthritis (PFOA). Materials and Methods: The present study was an experimental research design i.e., between -subjects experimental design in which 60 participants with patellofemoral arthritis were enrolled based on the inclusion criteria. The study was conducted in the Department of Orthopaedics, SGT Medical College Hospital and Research Institute in Gurugram, Haryana, India for a duration of one year (May 2022- May 2023). Participants were randomly randomised to three distinct exercise program groups with varying intensity levels for retro-walking on a treadmill for six weeks, and all three groups received conventional treatment six days/week for six weeks. All participants were evaluated at three-time intervals of baseline, at the end of the third week, and after intervention (end of the sixth week) for the evaluation of several musculoskeletal parameters affecting patellofemoral arthritis. Statistical analysis was carried out using the IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Comparison for within group differences between various outcome measures at various intervals of time was done using repeated measures of Analysis of Variance (ANOVA) and post-hoc analysis for mean values with Least Significant Difference (LSD) whereas for between group analysis One-way ANOVA and post-hoc Analysis for mean values was done with p-value set at <0.05. Result: Significant statistical and clinical differences were observed in musculoskeletal responses, Q-angle (p-value=0.001) and popliteal angle (p-value=0.001) in the high frequency group (group C) performing the protocol five times a week for six weeks leading to a better quality of life followed by group B and group A, respectively. Conclusion: The main finding of the present study suggested that the dosage for retro-walking on treadmill among patients with patellofemoral arthritis requires at least walking for five times/week for six weeks to get more clinical improvement in Musculoskeletal Disorders (MSD).

Knowledge, Attitude and Practices Regarding Marijuana usage among Medical Students: A Descriptive Cross-sectional Study

Introduction: The increment in marijuana use across the world is concerning and needs to be addressed. There has been a cultural change regarding the perception and use of marijuana medicinally and recreationally, even among medical students. This needs to be studied to understand the outlook towards marijuana among young adults, including future doctors, to help improve their awareness of the risks and pitfalls of marijuana usage. Aim: To evaluate the knowledge, attitude, and practices regarding marijuana usage among medical students. Materials and Methods: This cross sectional study recruited 159 medical undergraduate students from the tertiary healthcare institute, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India via an online, anonymised, semistructured, self-designed questionnaire that was circulated over social media. The duration of the study was from October 2023 to February 2024. The study population was grouped into first-year and final-year MBBS students to identify differences, if any, in knowledge, attitude, and practices regarding marijuana usage among students between the start and end of their MBBS training. The responses to questions were compared to establish any statistical significance. Results: Out of the total 159 participants, 106 (66.67%) were first-year MBBS students, and 53 (33.33%) were final-year MBBS students. Most students from both groups reported that marijuana was illegal in India. Both groups responded affirmatively to questions regarding their awareness of the effects of marijuana and whether it could be used as a medical therapeutic drug. The majority of students, 81 (76.42%) and 32 (60.38%), respectively in both groups, agreed with the statement that marijuana impairs concentration and movement. A total of 88 (83.02%) and 41 (77.36%) participants, respectively, were largely in favour of legalising marijuana, with a greater proportion of respondents from both groups opining that marijuana should be legalised, be it for medical therapeutic use or as a recreational drug. Conclusion: Study results showed that the majority of students from both groups responded positively to the question about the legalisation of marijuana in India. Some interesting differences were found between the two groups with respect to marijuana use and the perceptions about its positive or negative effects. It is essential to educate medical students, as future physicians, on the adverse effects and implications of marijuana use.

Foetal Pulmonary Artery Derived Doppler Parameters for Foetal Lung Maturity Assessment: An Observational Study

Namdev Seth, Saumya Verma

Introduction: Neonatal Respiratory Distress Syndrome (RDS) is a major cause of foetal mortality and morbidity, especially in preterm labour because of concerns about foetal lung maturity. One of the method to assess foetal lung maturity is the Doppler assessment of the foetal Pulmonary Artery. Aim: To assess the accuracy of Doppler findings of the foetal Main Pulmonary Artery (MPA) in foetal lung maturity assessment and prediction of the development of neonatal RDS in preterm deliveries. Materials and Methods: A prospective observational study was conducted in the Department of Radiology, along with the Departments of Obstetrics and the Department of Paediatrics of Rama Medical College, Hospital, and Research Institute in Kanpur, India from May 2022 to December 2022. A total of 76 pregnant women with singleton pregnancies and gestational age <37 weeks were included. Clinical history and relevant clinical examination data were collected from the patients. Ultrasound examination began with a general survey of the gestational sac, foetal biometry, detailed anatomical evaluation for any evident anomalies, and then cardiac evaluation. The Doppler waveform of the MPA was confirmed by its characteristic ‘spike and dome pattern’. It was distinguished from the ductus arteriosus waveform, as it shows a triangular waveform with increased diastolic flow. Acceleration Time (AT) was measured from the start of the systolic wave to the first systolic peak. Ejection Time (ET) measurement included the entire systolic wave. The diagnosis of RDS was made by the paediatrician, who was blinded to the Doppler findings. Receiver Operating Characteristic (ROC) curves were drawn using Statistical Package for the Social Sciences (SPSS) software to assess the diagnostic ability of the Doppler findings and to find the cut-off values with maximum sensitivity and specificity. Results: Out of the 76 pregnant women included in this study, 14 were excluded due to inadequate Doppler measurements and not being able to give birth within one week of Doppler evaluation. The study assessed a total of 62 pregnant females who underwent preterm delivery following the Doppler study. In total, 28 neonates developed RDS. Doppler parameters of both groups were compared (the first group included pregnant women whose neonates developed RDS after birth, and the second group included pregnant women whose neonates didn’t develop RDS after birth) with the help of the ROC curve. The AT/ET ratio achieved the highest sensitivity and specificity, both at 82%. Conclusion: The AT/ET ratio has produced the best results among all foetal pulmonary artery-derived Doppler parameters and is a promising non invasive method for assessing foetal lung maturity.

Correlation between Abdominal Girth and Skin to Epidural Space Distance of Thoracic and Lumbar Spine: A Cross-sectional Study

Nikitha Agarwal, Prachi Kar, Archana Pathy, Dudala Sai Apoorva Reddy

Introduction: The Skin-to-Epidural Space Distance (SESD) is likely to be different at two different parts of the spine in the same individual and also in the same part of the spine in two different individuals. The knowledge of the expected depth of the epidural space can be very useful in placing the epidural needle appropriately and avoiding unwanted dural puncture. Although many studies have been conducted to study the relation of lumbar SESD with various physical and anthropometric parameters, the literature on thoracic SESD is scant. Aim: To determine the correlation between SESD and Abdominal Girth (AG) in the mid-thoracic, lower thoracic, and lumbar regions of the spine in adult patients scheduled for elective surgical procedures. Materials and Methods: After obtaining Ethics Committee clearance (EC/NIMS/2671/2020, 51st ESGS No: 1082/2020), this prospective observational study was carried out at Nizam’s Institute of Medical Sciences, Hyderabad, India, from October 2021 to February 2022. The study recruited 202 patients, and data from 194 patients was analysed. During the preoperative visit, all physical parameters, including AG, were noted. Using an 18G Tuohy needle, the epidural space was identified, and SESD was measured. Its correlation with AG, age, height, weight, and body mass index was studied. The data was analysed using the Statistical Pacakge for Social Sciences Software (SPSS) (2011, IBM, Armonk, NY, United States of America) version 20.0. Results: The mean SESD was 4.7±1.09 cm in the mid-thoracic region, 4.71±0.98 cm in the lower thoracic region, and 4.8±0.82 cm in the lumbar region. The correlation coefficient of SESD with AG was 0.42, 0.44, and 0.78 in the mid-thoracic, lower thoracic, and lumbar regions, respectively, and the significance level was <0.001 in all three regions. Body weight had a good correlation (r-values of 0.56, 0.66, 0.53 in mid-thoracic, lower thoracic, and lumbar areas, respectively, and p-value of <0.001 in all three anatomical regions of the spine) with SESD. All other physical parameters were correlated weakly with SESD. Conclusion: AG has a strong correlation with SESD in the lumbar area but a moderate correlation in the thoracic spine. SESD in the lumbar, mid, and lower thoracic regions have a good correlation with weight.

Global Research Trends on Use of VELScope for Diagnosis of Oral Mucosal Lesions: A Bibliometric Analysis

Subhashree Mohapatra, Rahul Mohandas

Introduction: The Visually Enhanced Lesion Scope (VELscope®) is a handheld medical device that can be used to clinically visualise and diagnose oral mucosal lesions. It works by the application of direct fluorescence and the loss of fluorescence in visible and non visible high-risk oral lesions. Numerous publications have offered insights on the possible use of VELscope® for identifying oral mucosal lesions. By analysing patterns in publication outputs, citation metrics and collaborative networks, researchers can gain insights into the development, influence and key contributors in the field of VELscope®, guiding future research directions and policy decisions. Aim: To track down and analyse all studies published on the application of VELscope® in the diagnosis of oral mucosal lesions and to assist future researchers by highlighting the most cited earlier publications. Materials and Methods: This bibliometric analysis was conducted using articles published on the applications of VELscope® in detecting oral mucosal lesions between 2006 and 2022. In December 2023, a comprehensive search was performed on PubMed and Scopus databases using medical subject heading terms like “VELscope®,” “Autofluorescence imaging system,” and “Oral” in several combinations. Bibliographic data regarding the top 100 most cited articles were extracted and collated. Results: The analysis showed that the most contributions came from the journals “Oral Oncology,” “Oral Diseases,” and “Photodiagnosis and Photodynamic Therapy,” with significant contributions from researchers in the USA and India. The highest number of publications occurred in 2015, with a notable peak in the decade 2011-2020. The articles were cumulatively cited 4,559 times. Conclusion: The current bibliographic analysis provided valuable insights into the development and impact of research on the applications of VELscope® in dentistry by highlighting publication trends, influential works, leading authors and collaborative networks. These insights can guide future research directions, inform policy decisions and enhance understanding of the evolution and scholarly influence.

Correlation of Serum Vaspin Level with the Severity of Cardiovascular Risk in Patients with Acute Coronary Syndrome: A Cross-sectional Study

S Harshitha, P Renuka, M Vengatesh, V Sriram, RB Pavithra, VM Vinodhini

Introduction: Acute Coronary Syndrome (ACS) describes a range of myocardial ischaemic states that includes Unstable Angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI), or ST-Elevation Myocardial Infarction (STEMI). Vaspin is an emerging adipokine, and low vaspin concentrations are found to be correlated with the severity of cardiovascular events. The Global Registry of Acute Coronary Events (GRACE) score is widely used to assess early risk stratification among ACS patients. Aim: To evaluate the severity of cardiovascular risk in patients with ACS using GRACE risk score and to study the correlation of serum vaspin levels with the risk score. Materials and Methods: This analytical cross-sectional study was conducted at the Intensive Care Unit (ICU) of the Cardiology Department at SRM Medical College, Tamil Nadu, India, from June 2023 to October 2023. A total of 89 patients diagnosed with ACS were included and stratified into three groups based on the GRACE score. Lipid profiles were assessed using a Beckman Coulter autoanalyser, while serum vaspin levels were measured using Enzyme Linked Immuno Sorbent Assay (ELISA). Statistical analyses including Kruskal-Wallis test, Spearman’s correlation, and Receiver Operating Characteristic (ROC) curve analysis were performed. Results: Among the study participants, 65.2% were males, and 34.8% were females, with mean ages of 56±8.8 years and 56±11.8 years, respectively. Out of the 89 participants, 32 (36%) were categorised as high-risk, 31 (34.8%) as intermediate risk, and 26 (29.2%) as low risk. Serum vaspin levels were observed to be lower in the high-risk group compared to the low and intermediate risk groups. A cut-off value for serum vaspin level was determined as ≤0.610 pg/mL in ACS, indicating an increased risk for complications. Conclusion: The levels of serum vaspin are decreased in ACS patients presenting with a greater degree of cardiovascular complications. These findings enhance the comprehension of vaspin’s role in the pathophysiology of ACS and its relevance in risk assessment.

Stability of Nasoendotracheal Tube with Transeptal Flower Stitch versus Simple Surgical Knot in Patients undergoing Maxillofacial Trauma Surgery: A Cross-sectional Study

Riddhi H Mahalle, Nitin Bhola, Anchal Agarwal, Swapnil Jain, Shrenik Chouradiya

Introduction: Nasoendotracheal (NET) tubes are exposed to various external forces, handling, slippage, and accidental extubation, with the potential for fatal complications. In the modern era, several techniques have been developed to reduce the complication rate of Nasoendotracheal Intubation (NTI). NET tubes can be secured using twill or cotton tape, adhesive tape, gauze, or a manufactured device, either individually or in combination. In present study, a transcolumellar stitch and transeptal stitch were designed with 2-0 silk suture material and utilised by many anaesthetists and surgeons to secure the NET, providing good stability but sometimes leading to columellar ischaemia and cutting through. Aim: To compare the intraoperative stability of Nasoendotracheal Tubes (NETT) secured by a transept flower stitch with those secured using a simple surgical knot in patients undergoing NET Intubation (NETI) for open reduction and internal fixation of maxillofacial trauma. Materials and Methods: This cross-sectional study was conducted in the Department of Oral and Maxillofacial Surgery at Sharad Pawar Dental College and Hospital and Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, over a period of six months from March 2023 to August 2023. The study involved 30 patients with maxillofacial fractures who were divided into two groups. Preoperative assessments included case history, physical examinations, and maxillofacial evaluations. Patients were divided into two groups: Group A underwent simple surgical knot using 2-0 silk suture (odd-numbered patients), while patients in Group B underwent transseptal flower stitch using 2-0 silk suture (even-numbered patients). All parameters were recorded by the same surgeon at the beginning and end of the procedure. The data was collected, tabulated, and statistically analysed using Statistical Package for the Social Sciences (SPSS) statistical software version 23.0. Results: Out of the total 30 patients enrolled in the study, 24 (80%) were male and 6 (20%) were female. The comparison between the two groups regarding the duration of surgery showed no statistically significant difference. Three parameters, namely the amount of NETT displacement, nasal tip laceration, and tip ischaemia, were evaluated and recorded both preoperatively and immediately after extubation. The amount of NETT displacement (p-value=0.031) and nasal tip laceration, haemorrhage, or necrosis (p-value=0.049) were shown to differ statistically significantly between the groups. Conclusion: The present study highlighted that the flower stitch method is an extremely beneficial approach. It offers advantages in terms of better stability and is associated with fewer complications and lower morbidity when compared to the simple surgical knot group.

Variations in the Size and Shape of Left Atrial Appendage: A Cross-sectional Study-based on Autopsy Specimens and their Endocasts

Cheravalloor Sukumaran Sapna, Kaumari Jayasree

Introduction: Atrial appendages are recognised as structures with implications in cardiac thromboembolism and arrhythmogenesis. Variations in the shape and size of atrial appendages, especially the Left Atrial Appendage (LAA), have been found to impact these pathological conditions. Knowledge about the variations in the relationship of the LAA to its nearby structures is important in planning interventional and surgical procedures in and around the LAA. Most of the studies on variations in LAA morphology are image-based, with only a few anatomical studies available. Aim: To investigate the variations in the shape and size of the LAA using autopsy specimens. Materials and Methods: This cross-sectional study examined LAA specimens from 50 autopsies conducted in a tertiary care teaching hospital. Observations were made on the shape of LAA, the shape of LAA orifice, and its relationship with the Pulmonary Vein (PV) orifice. Measurements were taken of the LAA’s length, external diameter, and LAA orifice’s diameter. Endocasts were prepared from 30 specimens to estimate internal volume. The shape classification system proposed by Wang Y et al., was used. Categorical variables were expressed as percentages, and continuous variables as mean and standard deviation. Results: The windsock type was the most common seen in 29 (58%), followed by the chicken wing type in 15 (30%). The majority 30 (60%) of LAA orifices were oval. In 27 cases (54%), the Left Superior Pulmonary Vein (LSPV) orifice was at a higher level than LAA orifice and in 20 (40%), both orifices were at same level, with a prominent ridge between the orifices in all patients. The majority of appendages were bilobed 22 (44%). There was considerable variation in the length, diameter, and internal volume of the LAA appendage. Specimens from females were found to have smaller external diameters. One patient with an accessory LAA was identified. Conclusion: The shape variations observed in this study were similar to findings in some earlier studies but in contrast to others. Variations in the shape and size of the LAA orifice and the size of the LAA were consistent with those reported in earlier studies. Larger studies exploring these anatomical variations in specimens will be valuable for designing and developing therapeutic interventions in and around the LAA.

Effectiveness and Safety of Oral Triamcinolone in the Management of Acute Exacerbations of Asthma: A Prospective Interventional Study

Santhalingam Balamurugan

Introduction: Acute exacerbation of asthma leads to increased morbidity, mortality, and healthcare costs. Oral Corticosteroids (OCS) are critical in the management of asthma exacerbations; however, the response varies between patients. While there are some studies about a good response to Intramuscular (IM) triamcinolone, there is no data about the effect of oral triamcinolone on objective parameters during asthma exacerbations. Aim: To evaluate the effectiveness and safety of oral triamcinolone as an adjunct to Standard-Of-Care (SOC) comprising Inhaled Corticosteroids (ICS) with or without Long-Acting β2-Agonist (LABA) in treating mild-to-moderate exacerbations of asthma. Materials and Methods: This was a prospective, interventional, single-arm, single-centre, open-label study. Adults with bronchial asthma on stable doses of asthma medications for at least three months and presenting with mild-to-moderate exacerbation were recruited. Oral triamcinolone 4-16 mg/day for seven days was prescribed depending on exacerbation severity. Improvements in the Asthma Control Questionnaire (ACQ-6) score, Forced Expiratory Volume in 1 second (FEV1), and Peak Expiratory Flow Rate (PEFR) were evaluated. All patients in the study who had taken at least one dose of the study medication were included in the Intention-To-Treat (ITT) set. All patients in the ITT set who completed the study as Per Protocol (PP) were included in the PP set and considered for effectiveness analysis. Qualitative data are presented as numbers (n) and percentages (%), and quantitative data as n, mean, and Standard Deviation (SD). Quantitative variables were further evaluated using paired t-test at a 5% level of significance. Results: A total of 100 (38 males and 62 females) patients with a mean±SD age of 45.2±12.7 years were enrolled. The mean ACQ score decreased from 2.2 to 1.4 (p-value<0.001), mean FEV1 increased from 1.6 to 1.7 L/s (p-value<0.001), and the mean±SD PEFR increased significantly from 251.5±90.0 to 270.4±88.3 L/min (p-value<0.001) on day 7. Overall, triamcinolone was well-tolerated with no serious Adverse Events (AE). Conclusion: In patients with mild-to-moderate asthma exacerbations, oral triamcinolone as an adjunct to SOC improved ACQ-6 score, FEV1, and PEFR with a favourable safety profile. These findings support the use of oral triamcinolone for treating acute exacerbations of asthma.

Prevalence of Elevated Blood Lead Levels and Factors Contributing to the Risk of Lead Poisoning among 1-5-year-old Children: A Cross-sectional Study

Introduction: Lead is a well-documented potent environmental toxin that has various harmful effects on the body, growth, and development noticed since, birth. Despite notable advancements in the decrease of lead exposure, researchers found environmental, socioeconomic, and demographic factors associated with elevated blood lead levels in children in Chennai, India, aged 1-5 years. This underscores the necessity for additional research on correlated risk factors. Aim: To assess the prevalence of elevated blood lead levels in children and estimate its values while identifying potential sources of lead exposure to the children. Materials and Methods: The cross-sectional analytical research was conducted at SRM Medical College, Hospital, and Research Centre, Kattankulathur, Tamil Nadu, India, from July 2019 to July 2022. A total of 92 children aged 1-5 years attending the Paediatric Outpatient Department (OPD) and inpatients at the same hospital were included in the study. This study was conducted to examine the impact of lead exposure on children aged one to five years by using a lead exposure risk assessment questionnaire by World Health Organisation (WHO). Blood lead levels were measured using Lead Care II analyser equipment and lead care blood lead testing kits. Chi-square test and Fisher’s exact test were applied to statistically analyse the data. Results: The majority, 48 (52.17%), were boys, while 44 (47.83%) were girls. The study found that 8 (8.7%) out of all the children had lead toxicity. Thumb sucking was associated with higher lead toxicity, while frequent waste material combustion was linked to higher lead toxicity. Other risk factors like age, gender, residence conditions, recent renovations, and exposure to smoke or dust were not significantly associated with increased blood lead levels. Food prepared in metal vessels, water sources, canned food, traffic near home, imported food, cosmetics, home remedies usage, and parental education status were not significantly associated with increased blood lead levels. Conclusion: Among the study population of 92 children, the prevalence of lead toxicity (>5 μg/dL) was found in 8 (8.7%) children. The results of present study point towards a significant association of lead toxicity in children with thumb sucking and combustion of waste material in surroundings. To fully understand lead exposure in primary and secondary care settings, greater sample sizes and additional research on confounding factors are required.

Effects of Subarachnoid Block vs General Anaesthesia on Intraoperative Blood Glucose Levels in Non Diabetic Patients undergoing Elective Surgeries: A Prospective Interventional Study

Bharati N Ganar, MG Nandini, S Puneeth Kumar, Raghvi Vijyeta

Introduction: The inhibition of the pituitary gland, an increase in the production of catabolic hormones, and the stimulation of the sympathetic nervous system culminate in surgical stress. These factors result in elevated hepatic glycogenesis and gluconeogenesis, decreased skeletal muscle glucose uptake and glycogen synthesis, and hyperglycaemia. Aim: To examine the effects of Subarachnoid Block (SAB) and General Anaesthesia (GA) on perioperative Capillary Blood Glucose (CBG) levels in individuals undergoing surgery lasting 1-3 hours. Materials and Methods: This prospective interventional study included 100 non diabetic patients undergoing surgery of 1-3 hours duration with 50 patients in each group (GA and SAB). CBG was checked 30 minutes before the administration of anaesthesia, 30 and 60 minutes after the induction of anaesthesia, and 30 minutes after shifting to the Post Anaesthesia Care Unit (PACU) in both the GA and SAB groups. Differences in participant characteristics, such as age and CBG levels in the two groups (SAB and GA), were examined using the two-tailed Independent samples t-test and the Chi-square/Fisher’s exact test. Results: The mean CBG levels measured 30 minutes before anaesthesia in the GA group were 105.50±21.13 mg/dL, while in the SAB group they were 99.67±19.04 mg/dL, with a p-value of 0.330. However, CBG levels measured 30 minutes after anaesthesia in the GA group were 125.69±22.95 mg/dL, compared to 104.67±20.94 mg/dL in the SAB group, with a p-value of 0.001. At 60 minutes after anaesthesia, CBG levels in the GA group were 152.41±28.97 mg/dL, while in the SAB group they were 99.65±22.69 mg/dL, with a p-value of 0.003. Finally, 30 minutes after shifting to PACU, CBG levels in the GA group were 147.49±27.20 mg/dL, compared to 92.86±24.35 mg/dL in the SAB group, with a p-value of 0.002. Conclusion: CBG levels significantly increased in individuals receiving GA for surgery. This indicates that the hormonal stress response is greater during GA compared to SAB.

Evaluation of Thyroid Lesions by Fine-Needle Aspiration Cytology: A Cross-sectional Study

Siddaganga Santosh Mangshetty, Rajashree Jagadish Ingin, Sudharani Sudheer

Introduction: Thyroid diseases are the most common endocrine disorders treated by physicians in their routine practice. Fine Needle Aspiration Cytology (FNAC) plays a dominant role in managing thyroid lesions. Aim: To determine the utility of FNAC in diagnosing various thyroid lesions and to categorise them according to the Bethesda system of reporting. Materials and Methods: This retrospective cross-sectional study was conducted in the pathology department of a tertiary care hospital from July 1, 2016, to June 30, 2021. FNA specimens obtained from 540 patients presenting with thyroid swelling were analysed, classified using the Bethesda system, and the distribution of cases in each category was studied. Results: The age of the patients ranged from 8 years to 74 years, with a mean age of 41 years. The majority of patients were in their third and fourth decades. There was a female preponderance, with a female-to-male ratio of 11:1. Out of 540 cases, 476 (88.15%) were benign lesions, six (1.11%) were Follicular Lesion of Undetermined Significance (FLUS), 22 (4.07%) were Follicular Neoplasm (FN)/Suspicious for FN, three (0.56%) were suspicious of malignancy, 14 (2.59%) were malignant, and 19 (3.52%) were non-diagnostic/unsatisfactory. Cytohistopathological correlation was performed in 52 benign and nine malignant lesions in this study. The sensitivity of FNAC was 94.7%, specificity was 97.6%, and diagnostic accuracy was 96.7%. Conclusion: FNAC is a rapid and minimally invasive procedure used in preoperative screening to distinguish between benign and malignant thyroid lesions. It has high sensitivity and specificity. The Bethesda system allows for precise cytological diagnosis, standardisation in reporting, improved clinical significance, and leads to the best management approaches.

Comparison of Doppler Flow Parameters of Foetal Middle Cerebral Artery in Pregnancy with Gestational Diabetes versus Normal Pregnancy: A Cohort Study

Introduction: Gestational Diabetes Mellitus (GDM) affects maternal placental blood flow. As a compensatory mechanism for placental haemodynamic changes, blood flow is redistributed from peripheral vessels to the brain. This re-distribution can be evaluated using doppler Ultrasonography (USG) measurements of the umbilical arteries and foetal middle cerebral arteries. Aim: To compare doppler flow parameters {Pulsatility Index (PI), Resistance Index (RI), Peak Systolic Velocity (PSV), Systolic-To-Diastolic (S/D)} of the foetal Middle Cerebral Artery (MCA) in pregnancy with gestational diabetes versus normal pregnancy, and to compare pregnancy outcomes in GDM versus non-GDM women. Materials and Methods: A prospective cohort study was conducted from November 2019 to November 2021 at the Department of Obstetrics and Gynaecology, Department of Radiology, and Department of Paediatrics in Tertiary care centre of New Delhi, India. All pregnant women attending the Antenatal Care Outpatient Department (ANC OPD) upto 34 weeks with an Oral Glucose Tolerance Test (OGTT) ≥140 mg/dL were defined as cases, and those with OGTT <140 mg/dL were taken as controls. All patients underwent doppler USG after 34 completed weeks, and doppler flow parameters (PI, RI, PSV, S/D ratio) were noted. Patient outcomes were recorded, including maternal outcomes such as mode of delivery, pregnancy-induced hypertension, polyhydramnios, stillbirth, and Intrauterine Death (IUD). Foetal outcomes such as APGAR (Activity Pulse Grimace Appearance Respiration) score, hypoglycemia, hyperbilirubinemia, admission to the Neonatal Intensive Care Unit (NICU), Respiratory Distress Syndrome (RDS), and neonatal death were also documented. Appropriate statistical tests were used for the statistical analysis (Chi-square test, Fisher’s exact test and Wilcoxon-Mann-Whitney test). Results: The mean age of GDM and non-GDM women was 27.40±3.57 years and 26.20±3.29 years, respectively. Among GDM women, 14 patients (31.1%) were primigravida, while there were 15 patients (33.3%) who were primigravida among non-GDM women. MCA PI was significantly higher in cases (1.79±0.36) compared to controls (1.65±0.19) (p-value=0.023), whereas MCA PSV was significantly lower in cases (45.86±2.17) than in controls (50.10±1.62) (p-value=0.001). Pregnancy-induced hypertension was observed in 28.9% of GDM women and 6.7% of non-GDM women, with the difference being statistically significant (p-value=0.006). There was a statistically significant difference between APGAR scores at 1 minute (p-value=0.030). However, there was no statistically significant difference in the APGAR scores at 5 minutes (p-value=0.242). Conclusion: Foetal MCA PI on doppler velocimetry was significantly higher in the GDM group, and MCA PSV was significantly lower in the study group, while MCA RI and MCA S/D ratio were not significantly different. Maternal complications were more common in GDM compared to non-GDM.

Diagnostic Role of The Bethesda System of Reporting Thyroid Cytopathology and Immunohistochemistry as an Adjunct to Fine Needle Aspiration Cytology in Differentiating Benign and Malignant Thyroid Lesions: A Cross-sectional Study

Swati Rao, Prajwala Gupta, Nishi Sharma, Minakshi Bhardwaj

Introduction: Fine Needle Aspiration Cytology (FNAC) plays a crucial role in the preoperative assessment of thyroid nodules. The Bethesda System of Reporting Thyroid Cytopathology (TBSRTC; 2023) is a standardised system for reporting thyroid FNAC. However, diagnostic challenges can occur in each category of TBSRTC. Aim: To categorise thyroid FNAC according to TBSRTC and revisit the challenges of cytological diagnosis in each category. Materials and Methods: A cross-sectional, observational study was conducted from November 2018 to April 2020 (18 months) in the Department of Pathology at ABVIMS and Dr. RML Hospital in New Delhi, India. The study included all 470 thyroid FNA cases received in the department from patients presenting with palpable thyroid nodules or ultrasonographically detected solid thyroid lesions, regardless of their age or sex. The cases were classified according to TBSRTC. Diagnostic tests were used to calculate sensitivity, specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV), and diagnostic accuracy of TBSRTC. Immunoexpression for Human Bone Marrow Endothelium marker-1 (HBME-1) and p63 was studied in Bethesda III to VI category cases, i.e., atypia of undetermined significance (AUS), Suspicious for Malignancy (SFM) and malignant cases only, and not in categories I and II. Results: The study included 470 thyroid FNA cases with a mean age of 39.72 years. Cytohistological follow-up was available for 50 cases, of which six cases were discordant and the remaining 44 cases were concordant. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of TBSRTC were calculated as 50%, 97.06%, 32%, 80.49%, and 82%, respectively. Three cases with diagnostic challenges were revisited and discussed. Immunohistochemistry was performed on a total of 33 FNAC cases. However, histological follow-up was available for only 18 cases, of which seven cases were diagnosed as Papillary Thyroid Carcinoma (PTC) on histological follow-up. HBME-1 and p63 were positive in 57.14% and 42.86% of these cases, respectively. Conclusion: The TBSRTC, 2023, is an excellent reporting system for thyroid FNA and serves as an initial investigative tool for thyroid lesions. Present study findings reveal that it has high specificity and diagnostic accuracy. The Risk of Malignancy (ROM) was comparable to other studies, except for the Bethesda II category. Immunoexpression of HBME-1 and p63 was useful in isolated cases; however, it is not sufficient for cytological diagnosis.

Seroprevalence of Hepatitis B and Hepatitis C in People with Haemophilia at a Tertiary Care Centre, Assam, India: A Cross-sectional Study

Anupam Dutta, Luish Borboruah, Papori Gogoi

Introduction: Prior to the advent of recombinant factor products, the treatment of haemophilia was mainly based on the administration of direct blood products like whole blood, Fresh Frozen Plasma (FFP), and cryoprecipitates. This led to a high incidence of transfusion-transmitted infections like Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus (HIV) . Aim: To study the seroprevalence of Hepatitis B and Hepatitis C in people with haemophilia at Assam Medical College. Materials and Methods: This cross-sectional observational study was conducted at Assam Medical College, Dibrugarh, Assam on 73 haemophilia patients in the month of November 2023. Ethical clearance and informed consent were obtained. Demographic details and treatment-related history were taken, and blood samples were analysed to assess the seroprevalence of Australian antigen (HBsAg) and anti-HCV. The prevalence of Hepatitis B and C was studied with respect to the severity of the disease and treatment received. Statistical analysis was performed using Statistical Packages for Social Sciences (SPSS) version 17.0, and the level of significance was set at (p<0.05). Results: Out of the 73 patients included in the study, 62 participants (84.9%) had haemophilia A, while rest 11 (15.1%) had haemophilia B. The participants were distributed based on the severity of the disease into mild, moderate, and severe categories. Out of the 73 patients, 14 patients (19.2%), 20 patients (27.4%), and 39 patients (53.4%) belonged to the mild, moderate, and severe categories, respectively. Most of the patients belonged to the age of less than 30 years and highest number of patients in the age group of 11-20 years (35.7%). The overall positivity for Hepatitis B and C among all haemophilia patients was 1.4% and 5.5%, respectively. The prevalence of both Hepatitis B and C was higher in patients who had the severe form of haemophilia. Out of the 35 patients who received only recombinant factors, only one showed seropositivity for anti-HCV, whereas three patients were detected to be anti-HCV positive and one patient to be HBsAg positive among 38 patients who received both factors and FFP/cryoprecipitates in their lifetime. Conclusion: Haemophilia patients are at a higher risk of developing transfusion-transmitted infections, which can cause multiple life-threatening complications. These complications can be easily prevented by early screening and early initiation of treatment. People with the severe form of the disease, especially those with a history of receiving direct blood products, are more prone to developing these infections. However, with the advent of recombinant factors, the incidence has come down.

Extended Spectrum Beta Lactamase Profile of Citrobacter Species Isolated from Various Samples in the North East Coast of Tamil Nadu, India: A Cross-sectional Study

Introduction: Citrobacter species play a significant role in causing hospital-acquired infections, especially those affecting the urinary and respiratory systems, and they are commonly present in faeces. Healthcare systems are facing a major challenge due to the rise of antibiotic-resistant Gram-negative infections resistant to antibiotics. Aim: To identify the genotypic characterisation of the resistant gene blaTEM-1 in Citrobacter spp. obtained from a range of clinical samples. This investigation seeks to provide insights into the patterns of antibiotic resistance exhibited by these bacteria. Materials and Methods: This cross-sectional study was conducted between August 2021 and February 2022. Preliminary examinations included screening as well as confirmatory tests for Extended Spectrum Beta Lactamase (ESBL) production, which were confirmed by the combination disk method and double disc synergy test. Genotypic detection of the blaTEM-1 gene was done using the Polymerase Chain Reaction (PCR) technique. Demographic parameters like gender and age were assessed. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) Software version 21.0. Results: Citrobacter koseri (66 isolates, 54.5%) was found to be the predominant species among the Citrobacter spp., followed by Citrobacter freundii (55 isolates, 45.5%). Urine samples were the primary source of Citrobacter spp. isolates, comprising 52 isolates (43%) of the total. In this study, the prevalence of ESBL producers was reported to be 49 isolates (77.8%) identified as ESBL producers. Tigecycline demonstrated a 100% effectiveness rate, followed by Piperacillin-Tazobactam (96% sensitivity) and Amikacin (95% sensitivity). Out of the 20 Citrobacter spp. isolates that tested positive for ESBL, 15 isolates (75%) were found to be positive for blaTEM-1. Conclusion: The results of this study provide insight into the changing patterns of antibiotic resistance in Citrobacter spp., with particular emphasis on ESBL profiles. Thus, it is imperative to implement intervention techniques to reduce the ongoing selection and spread of these more resistant bacteria, as well as efficient infection-control measures to manage epidemics. These results advance the comprehension of antibiotic resistance patterns and guide initiatives to combat the increasing threat of antibiotic resistance.

Comparative Evaluation of Gingival Displacement and Patient Outcomes with Different Gingival Retraction Techniques: A Cross-over Clinical Trial

Pooja Nilesh Singh, Suresh Venugopal, Amrutha Shenoy

Introduction: The success of fixed restorations depends on marginal integrity, particularly in subgingival areas. Gingival retraction facilitates proper placement of impression material in the displaced gingival sulcus; however, a lack of consensus on evaluation criteria hinders comparative studies of gingival retraction systems. Aim: To evaluate the effectiveness of mechanical retraction cord and chemical gingival retraction paste compared to a control group with no retraction. Materials and Methods: This study was a cross-over clinical trial conducted at Saveetha Dental College and Hospitals in Chennai, Tamil Nadu, India, involving 20 patients requiring single crowns from May 2024 and June 2024. Patients were allocated into three groups-no retraction, chemical retraction, and mechanical retraction-based on randomisation. Patients with healthy gingival and periodontal status, exhibiting no bleeding on probing, were included in the study. Impressions were taken at baseline, and subsequent gingival displacements on days 7 and 27 were performed using chemical and mechanical methods according to random allocation. A Visual Analogue Scale (VAS) score was used to analyse post-operative comfort. Gingival displacement was measured with a stereomicroscope, and results were tabulated. Data analyses were performed using Statistical Package for Social Sciences (SPSS) software (version 26.0). Statistical significance was set at a threshold of p<0.05, employing one-way analysis of variance and Tukey post-hoc tests for gingival retraction and Visual Analog Scale (VAS) scores. Results: Among the 60 tested samples, significant differences in gingival retraction were noted (p<0.05). Both experimental groups (Mechanical gingival retraction=698.53±43.276 μm, Chemical retraction=509.33±29.405 μm) exhibited more gingival displacement than the control group (mean gingival retraction=164.8±15.725 μm), with mechanical retraction cord displaying the highest value. The mean gingival displacement rankings were as follows: mechanical retraction > chemical retraction > no retraction. For VAS scores, statistically significant results were observed for mechanical retraction compared to no retraction (0.9±0.052) and mechanical retraction (3.40±0.049), as well as between no retraction and chemical retraction (2.6±0.057) (p<0.05). However, the differences between mechanical and chemical retraction were not statistically significant (p>0.05). Conclusion: Although there was a statistically significant difference in the amount of displacement between the chemical and mechanical systems, both were within the clinically acceptable range (220 microns). Hence, chemical retraction can be used as a substitute for mechanical retraction techniques.

Gastric Volume in Diabetic Patients after Overnight Fasting vs Clear Liquid Ingestion Two Hours before Surgery using Ultrasonography: A Randomised Clinical Trial

S Koushallya Sri, S Anand

Introduction: Perioperative gastric aspiration poses risks such as aspiration pneumonia, prolonged hospital stays, and increased mortality. Fasting guidelines may not adequately address the needs of diabetic patients due to the delayed gastric emptying often observed in this population. Aim: To assess residual gastric volume in diabetic patients who fasted overnight versus those who ingested water preoperatively using ultrasound. Materials and Methods: A randomised clinical trial enrolled 50 diabetic patients undergoing elective surgery. Patients were randomised into two groups: fasting overnight or receiving water preoperatively. Gastric ultrasound was used to measure antral dimensions and calculate gastric volume. The parameters studied included residual gastric volume in diabetic patients in the Right Lateral Decubitus (RLD) position, antral Cross-Sectional Area (CSA) in the semi-sitting position among diabetic patients, and antral CSA in the RLD position among diabetic patients. Statistical analysis involved descriptive statistics for continuous variables and Chi-square tests for categorical variables, with significance set at p-value <0.05. Results: The study enrolled 50 diabetic patients, with 25 in group A and 25 in group B. The mean age of patients in group A was 49.3±11.7 years, while in group B, it was 58.6±9.8 years. In the RLD position, the mean Craniocaudal (CC) diameter showed no significant difference between the two groups. However, the mean Anteroposterior (AP) diameter was higher in group B compared to group A, showing a statistically significant difference (p-value=0.012). Similarly, the mean CSA was significantly higher in group B compared to group A. Regarding gastric volume in the RLD position, the mean volume showed no significant difference between the two groups (p-value=0.342). In the semi-sitting position, the mean CC diameter and AP diameter between the two groups, although not statistically significant, were slightly higher in group B. The mean CSA in group A and group B showed a statistically significant difference. Conclusion: Preoperative intake of clear fluids two hours before surgery showed no significant increase in gastric volume in diabetic patients compared to overnight fasting, as evidenced by ultrasound measurements.

Prevalence of Iron Deficiency Anaemia and the Diagnostic Utility of Soluble Transferrin Receptor and sTfR/Log Ferritin Index among Pregnant Women: A Cross-sectional Study

Introduction: Anaemia is a significant global health concern, particularly among pregnant women. This condition, primarily caused by Iron Deficiency (ID), poses risks to both maternal and foetal health. However, interpreting iron status through biochemical tests faces challenges. While serum ferritin concentration is a specific indicator of ID, its accuracy can be compromised by factors like inflammation. Serum Soluble Transferrin Receptor (sTfR) has shown promise in accurately diagnosing anaemia, especially in pregnant women, as it remains unaffected by pregnancy-related changes. Nonetheless, studies on its efficiency have yielded mixed results. Aim: To study the prevalence of Iron Deficiency Anaemia (IDA) among pregnant women and also to evaluate the accuracy of sTfR levels and the sTfR/Log Ferritin Index as diagnostic markers in predicting IDA among pregnant women. Materials and Methods: This cross-sectional study was conducted at NEIGRIHMS, Shillong, Meghalaya, India, between April 2021 and November 2022. A total of 92 pregnant women in their first trimester were included in the study. An automated clinical chemistry analyser measured serum iron and high-sensitivity C-Reactive Protein (hsCRP). Serum ferritin and sTfR levels were assessed via chemiluminescence assay. Sensitivity and specificity of sTfR levels and the sTfR/Log Ferritin Index in predicting IDA were determined utilising the Receiver Operating Characteristic (ROC) curve. Results: Most participants, 38 individuals (41.3%), were aged 20 to 25 years. The prevalence of anaemia was observed in eight individuals, comprising 8.7%, with sTfR proving highly sensitive (87.5%) and specific (75%) for IDA at 25.24 nmol/L. Both sTfR (r=-0.360) and sTfR-ferritin Index (r=-0.344) had significant negative correlations with Haemoglobin (Hb) (p-value<0.001), while ferritin (r=0.156) didn’t correlate significantly with Hb (p-value=0.136). Notably, CRP didn’t affect sTfR levels, enhancing its reliability. Conclusion: sTfR levels and the sTfR-Ferritin index were significantly higher in pregnant women with IDA. They exhibited greater sensitivity and specificity compared to serum ferritin in detecting IDA.

Comparative Analysis of Peak Inspiratory Flow Rate at Discharge and Three-month Follow-up in Severe Acute Exacerbation of COPD Patients using Metered Dose Inhalers versus Dry Powder Inhalers: A Prospective Observational Study

Lalita Fernandes, Manu Siva, Durga Lawande

Introduction: Patients discharged following hospitalisation for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) are prescribed Metered Dose Inhalers (MDI), Dry Powder Inhalers (DPI), or nebulisers. Drug dispersion from the inhaler and deposition in the lung depends on Peak Inspiratory Flow Rate (PIFR) among other factors. A low PIFR results in suboptimal drug delivery and is a risk factor for readmission. Aim: To estimate PIFR at discharge following AECOPD, assess the type of inhalers prescribed at discharge, and estimate the mean change in PIFR at three months follow-up in patients using MDI and DPI. Materials and Methods: A prospective observational study was conducted at a tertiary care hospital, Goa Medical College, Goa, India on 138 patients over 15 months from November 2018 to February 2020. A sample size of 138 was calculated, and the study duration was 15 months. Patients admitted with AECOPD were enrolled in the study after obtaining informed consent. At discharge, baseline characteristics and co-morbidities were recorded, and PIFR was measured using an in-check dial peak inspiratory flow meter without resistance. Inhalers prescribed by the treating physician were verified and checked for errors. PIFR was measured at three months of follow-up. Optimal PIFR was defined as PIFR of ≥60 L/min. Statistical analysis was performed using the Statistical Package for Social Science Programs (SPSS) version 24.0 (IBM Corp, SPSS Inc, Chicago, IL). A paired t-test assessed the change in PIFR at discharge and three months follow-up, and Pearson’s correlation test was used to assess the correlation between continuous variables. Results: Total 138 were enrolled with a mean age of 69.8±7.5 years, 87 (63%) were males. The mean PIFR at discharge was 58.9±24.7 L/min. 85 (61.6%) had suboptimal PIFR and were older {71.9±7.8 versus 66.3±5.6, p-value=0.01}. A total of 59 (69.4%) with suboptimal PIFR received MDI. At three months, the suboptimal PIFR group receiving MDI showed a mean change in PIFR of 18.6±7.7, p-value<0.001 while with DPI mean change was -3.8±6.3, p-value=0.005. Conclusion: 61.6% had suboptimal PIFR at discharge following hospitalisation with AECOPD. Patients with suboptimal PIFR receiving MDI showed improvement in PIFR at three months, while those with suboptimal PIFR using DPI showed significant deterioration. Identifying patients with suboptimal PIFR will aid appropriate prescription of inhaler devices.

An Observational Study on Impact of COVID-19 in Pregnancy: Clinical Profiles and Foetomaternal Outcomes in Caesarean Section Cases at a Tertiary Care Centre, Gujarat, India

Vijyeta Ravindra Jagtap, Ragini Nimesh Verma

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has resulted in a crippled healthcare system worldwide. In this unprecedented situation, it is important to analyse the impact on the vulnerable population of pregnant women, especially those with high-risk pregnancies and those undergoing a Caesarean section (CS). Aim: To analyse the clinical profile, foetomaternal outcomes, and co-morbidities in COVID-19-affected pregnancy cases undergoing a CS. Materials and Methods: This was a retrospective observational study conducted at the Department of Obstetrics and Gynaecology, Government Medical College, and New Civil Hospital in Surat, Gujarat, India during the first wave of the COVID-19 pandemic from April 2020 to December 2020. The study included a total of 65 cases of COVID-19-positive mothers undergoing a C-section. Demographic parameters such as age, obstetric history, details of the C-section (like gestational age at the time of the procedure, indication, and category of the C-section), associated co-morbidities, severity of COVID-19-related symptoms and treatment, neonatal parameters {such as birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, and COVID-19 status of the baby at birth} were analysed. Additionally, a comparison of the C-section rate and complications such as the development of severe anaemia requiring blood transfusion, postoperative development of urinary tract infections, surgical site infections, and the association of hypertensive disorders of pregnancy was conducted between COVID-19-affected and unaffected pregnancies undergoing a C-section during the study period. Data on COVID-19 negative cases were obtained from the monthly labour room statistics submitted to the department. The Chi-square test and Fisher’s-exact test were used to compare parameters of the COVID-19 positive and negative groups and a p-value of less than 0.05 was considered statistically significant. Results: Out of a total of 6246 deliveries conducted at the institute during the study period, the CS rate among affected and non affected women was 44.5% (65 out of 146) vs. 32.8% (2006 out of 6100) {p=0.003, Relative Risk (RR) 1.3, 95% Confidence Interval (CI) 1.12-1.62}. The mean age of women with COVID-19 undergoing a CS was 25.3 years. The difference in the rate of blood transfusion requirement in COVID-19-affected cases was 9 out of 65 (13.8%) vs. 120 out of 2006 (6%) in COVID-19 negative pregnancies (RR 2.3, 95% CI: 1.2-4.3). The difference in the rate of urinary tract infections in the postoperative period was statistically significant in COVID-19-infected patients, 5 out of 65 (7.7%) vs. 58 out of 2006 (2.9%) in non infected patients (p=0.0451, RR 2.6, 95% CI 1.1-6.4). The prevalence of hypertensive disorders among COVID-19 positive and negative mothers undergoing CS was very high in the present study (16 out of 65, 24.6% vs. 160 out of 2006, 8.1%, RR 3.08, 95% CI 1.9-4.8). Neonatal parameters like low APGAR score at birth were seen in 5 cases (8%), low birth weight in 20 cases (30%), and 3 babies (4.5%) were COVID-19 positive at birth. Conclusion: Higher rates of caesarean sections, increased prevalence of hypertensive disorders of pregnancy, anaemia requiring blood transfusion, and postoperative development of urinary tract infections among COVID-19-affected mothers undergoing a caesarean section.

Quantitative Analysis of Phytocompounds and Gas Chromatography Mass Spectrometry Profiling of Methanolic Extract of Citrus Limon Peel: An Experimental Study

N Anuradha, S Saravana Kumar, N Himabindu, A Gnanavel, S Karthick

Introduction: All citrus plants are rich sources of phytochemicals that have many beneficial effects on human health. Different parts of the Citrus Limon plant, such as fruits, leaves, seeds, stems, and peels, also contain a wide spectrum of phytochemicals with therapeutic effects. Aim: The present study focused on phytochemical analysis and Gas Chromatography Mass Spectrometry (GCMS) profiling of limon peel. Materials and Methods: An experimental qualitative analysis was conducted at Systemic Life Sciences and Research in Hyderabad, Telangana, India from April 2023 to April 2024. Fresh Citrus Limon fruits were collected from an authorised vendor, identified, and authenticated. The peels were dried, coarse powdered, and a methanolic extract was prepared using the Soxhlet extraction method. An experimental qualitative analysis GCMS was performed to identify the chemical compounds present in the Citrus Limon peel extract. Results: Phytochemical analysis of Citrus Limon peel showed the presence of various metabolites such as carbohydrates, proteins, alkaloids, tannins, flavonoids, saponins, steroids, terpenoids, and glycosides. The GCMS profiling identified 13 chemical compounds, most notably Pentamethoxyflavone, Tetramethoxyflavone, and 2-Methoxy-4-vinylphenol in the methanolic extract of Citrus Limon peel. Conclusion: It was concluded that the bioactive phytocomponents are abundant in Citrus Limon peel extract.

Clinical Profile of Acute Neurological Emergencies in Postpartum Mothers: A Hospital-based Descriptive Study

R Selvi, A Beatrice Joan, S Vennila

Introduction: Neurological disorders in pregnancy pose a major diagnostic challenge as they are a significant contributor to mortality and morbidity in pregnancy. Neurological complications may manifest at any time during pregnancy or puerperium even after what seemed to be a normal pregnancy. A thorough understanding of the patterns of these diseases is essential for prediction and early identification. Aim: To study the aetiology, clinical profile, morbidity and mortality patterns of acute neurological emergencies in postpartum women. Materials and Methods: This hospital- based descriptive study was conducted in the Department of Obstetrics and Gynaecology at Government Vellore Medical College and Hospital, Vellore, Tamil Nadu, India between February 2021 and August 2022. A total of 76 postnatal mothers who met the inclusion criteria were selected using consecutive sampling. Details pertaining to personal, demographic, antenatal risk factors, labour/delivery and postnatal events were recorded using a pretested semi-structured questionnaire. The data were entered into Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) 21.0, with the data expressed as frequency and proportion. Results: Among the 76 women included in the study, more than half were multiparous women 42 (55%) and the majority were young adults aged <25 years 48 (63.1%). The majority belonged to a low socioeconomic status (57, 75%), with headache 46 (60.5%) being the most common presenting complaint followed by seizures 45 (59%). The most common diagnosis observed was postpartum eclampsia 37 (48%). Around 34 (44.7%) of the women had associated anaemia, followed by hypertensive disorders of pregnancy including Gestational Hypertension (GHTN) and severe pre-eclampsia together 33 (42%). Long-term residual morbidity was observed only in five of the survivors, two with fine motor weakness, two with remote amnesia and one with speech defects mainly attributable to irreversible damage to motor nuclei and hypoxic ischaemic encephalopathy. Seven out of the 76 affected individuals succumbed to death during the hospital stay, all within seven days of admission. Conclusion: Neurological disorders in the postpartum period are a major contributor to maternal mortality, with eclampsia topping the list as the most common cause of seizures in the postpartum period.

Comparative Evaluation of Three-dimensional Skeletal and Dentoalveolar Effects of Sawangi Flexiforce Expander and NiTi Expander in Class II (vertical) Cases with Maxillary Constriction: A Research Protocol

Srushti Atole, Ranjit Kamble

Introduction: Maxillary constriction is a very common type of malocclusion found at any age. It is recommended to treat it as early as possible to avoid the worsening of the situation and to re-establish optimal function and aesthetics. Expansion of the maxillary arch is considered the best treatment procedure in a growing child. There are various appliances used for the expansion of the arch. The Nickel Titanium (NiTi) expander is considered the hallmark in orthodontics, but it has a few drawbacks. To overcome these drawbacks, the Sawangi Flexiforce Expander (SFE) has been introduced. The present study aims to evaluate and compare the effects of SFE against NiTi expander. Need for the study: The commercially available NiTi expander is very expensive. As most dental practices are located in rural areas, not every patient requiring arch expansion can afford it. Therefore, there is a need for an appliance that is as effective as the NiTi expander but affordable for everyone. Aim: To evaluate and compare the three-dimensional skeletal and dentoalveolar effects of SFE against the NiTi expander in class II (vertical) cases with maxillary constriction using the Finite Element Method (FEM). Materials and Methods: The present FEM study will be conducted in the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College in Wardha, Maharashtra, India. The study will take place from November 2023 to October 2024. A single patient with a vertically growing pattern will be selected for a Computed Tomography scan (CT scan) of the Nasomaxillary complex based on inclusion and exclusion criteria. The CT scan of the patient will then be converted into a 3D finite element model. The 3D models of the NiTi expander, SFE, and nasomaxillary complex will be studied to evaluate and compare the three-dimensional effects. Parameters such as stress distribution and displacement at skeletal, dental, and dentoalveolar landmarks of the nasomaxillary complex in three directions due to both expanders will be evaluated. An unpaired t-test will be used to determine significant differences between the two expanders and to compare the outcomes. The displacement at each landmark due to 1 mm of activation of both expanders will be correlated using the Pearson’s correlation test. A p-value <0.05 will be considered significant.

A Narrative Review on Jerusalem Syndrome: Exploring Diagnosis, Treatment and Cultural Impacts

Truptesh Patil, Bhagyesh Sapkale, Anjali Vagga, Sachin R Gedam

Visitors to Jerusalem who are not religious may experience “Jerusalem Syndrome,” characterised by obsessive religious ideas and delusions that can lead to psychosis. There are three varieties of this disorder. However, it is not officially recognised: Type-I affects individuals who have already experienced psychosis; Type-II affects persons who held unusual ideas before travelling to Jerusalem; and Type-III affects people who were initially mentally stable but developed psychosis while in Jerusalem. The review explores the effects of Jerusalem Syndrome on mental health, drawing comparisons with “Paris Syndrome.” Notable similarities with schizophrenia point to different initiators related to Jerusalem’s significance. Jerusalem Syndrome is treated with individualised mental care that combines medication and psychotherapy.

Development of Interprofessional Education and its Implementation in Global and Indian Context: A Literature Review

Integration of Interprofessional Education (IPE) into the health sciences curriculum has been recommended over the past several decades to prepare healthcare professionals for future collaborative practice. However, due to the disparity in the adoption of IPE, this literature review attempted to examine the development of IPE and its implementation in global and Indian contexts. IPE has evolved from being fragmented and isolated initiatives to entering into the mainstream of professional education. In terms of IPE implementation, the global scan revealed that IPE was implemented in several countries to varying degrees; however, developing countries lagged behind developed countries in implementing and sustaining IPE. Scarce evidence was found regarding the implementation of IPE in India. The literature review elaborates on the transformation of health professions education from the traditional system to IPE and discusses the gap in the adoption and implementation of IPE in developing countries, including India.

Applicability of Various Intelligence Scales Utilised in Paediatric Population: An Overview

Anuja Satish Handargule, Amar Taksande, Revat Meshram, Poonam Uke

Due to the imperfect development of the brain and the varied biological, environmental, and experiential elements that arise during childhood and adolescence, paediatric neuropsychology differs from adult neuropsychology. According to current theories, certain brain regions have a reciprocal effect on various neuro functioning systems, which, in turn, affects the child’s ability to think and perceive. The interaction of functioning systems most likely affects the child’s behavioural, psychological, and cognitive manifestation of a childhood condition. These days, parents worry about their children doing well in school. A variety of intelligence scores are utilised to evaluate children’s cognitive abilities. Intelligence research is important since it sheds light on the individual’s qualities, shortcomings, and special talents. Currently, a large number of standardised tests are used since intelligence is seen as a measurable commodity. When diagnosing dyslexia, attention-deficit/hyperactivity disorder, autism spectrum disorders, intellectual disability, and other problems in the paediatric population, intelligence scales play a critical role. It is vital to recognise that every exam has a unique set of constraints. This paper explores the benefits and drawbacks of the currently utilised intelligence measures while offering an overview of each. The goal of this evaluation is to make it easier to analyse different intelligence measures and decide which ones are applicable for what circumstances and needs.

Management of Pain in Children through Ayurveda: A Review of Literature

Prasad Gajanan Yewale, Swapnali Prabhakar Mate, Mohan Sahebrao Raut

Pain is the feeling of discomfort, most of the time, it refers to physical discomfort. Children often suffer from various kinds of pain, including abdominal pain and pain due to sports injuries. Unrelieved pain may be detrimental psychologically and physically from the start. A child’s quality of life can be significantly impacted by pain if it is not addressed and treated at an early age, affecting their mood, sleep, hunger, attendance at school, academic performance, and extracurricular activities. Pain management in paediatric populations poses unique challenges, necessitating a comprehensive and holistic approach. However, the use of Ayurvedic therapies can be very effective in the management of pain in children, though it is not specifically defined by any authors or researchers. This paper offers a review of the literature with a particular focus on how Ayurveda, an ancient Indian medical system that emphasizes the harmony of the body, mind, and spirit, might be utilised to treat paediatric pain. This study includes the exploration of the historical roots of Ayurveda and its traditional applications for managing pain in children, including dietary guidelines and non pharmacological interventions like Abhyanga (oil massage) and Swedana (sudation therapy).

Dentinal Fluid: Unravelling the Mysteries Beneath the Surface

The Dentinal Fluid (DF), often referred to as dentinal microcirculation, represents the interstitial fluid within the Dentinal Tubules (DT). Understanding the dynamics of DF is pivotal in comprehending the physiology and pathology of the dental pulp. The composition of the DF, including ions, proteins, and growth factors, plays a critical role in maintaining pulp vitality, but imbalances can lead to various pathological conditions, such as dental hypersensitivity, pulpitis and pulp necrosis. The present review provides insight into the multifaceted role of DF in endodontics, highlighting its significance in pulp nutrition, defense mechanisms, and the mediation of inflammatory responses. Furthermore, it explores the various pathologies that can disrupt the delicate balance of DF, leading to adverse clinical outcomes.

Role of Radiotherapy Technologists in Clinical Radiation Therapy Practices: A Comprehensive Review

Manishimwe Jules, Anurag Luharia, Shweta Dahake

Radiation therapists, also known as radiotherapy technologists, are allied health professionals who specialise in providing high doses of radiation to patients with malignant growths. High-energy radiation damages cells’ genetic material {Deoxyribonucleic Acid (DNA)}, stopping them from replicating and multiplying further. Radiation can be used to treat cancer or as a highly effective palliative therapy to alleviate cancer-related pain in patients. Radiation therapy can be used in conjunction with other treatments, including surgery, chemotherapy, and immunotherapy. Because radiation harms both healthy tissues and malignant cells, the primary objective of radiation therapy is to optimise radiation exposure to abnormal cancer cells while avoiding irradiation of healthy tissues adjacent to or in the path of radiation. Remarkable precision is required to provide ionising radiation to patients and target specific cells for consistent, accurate, and successful radiation treatment. A team consisting of radiation oncologists, medical physicists, radiation therapists, medical dosimetrists, and nurses work together to achieve this goal. Radiation therapists are responsible for delivering radiation treatment, as well as maintaining and testing the equipment used to monitor and administer the treatment. The radiation therapist administers the patient’s treatment dose according to the prescription plan made by the radiation oncologists and medical physicists. Radiation therapists must communicate with patients and their families, respond to their inquiries, and clarify the radiation treatment plan. They must also track the patient’s progress and report any changes to their seniors. Radiation therapists must maintain high levels of precision while administering therapy, think critically, and exercise autonomous, professional, and ethical judgment in all aspects of their work. The field of radiotherapy is continuously evolving with new advancements in technology and treatment delivery techniques that maximise patient satisfaction and treatment delivery efficacy. Radiation therapists undergo continuing education and training to broaden their knowledge of the field and stay current with standard practice. This review addresses the critical role of radiation therapists in clinical radiation therapy practices. It highlights their significance in delivering safe and effective treatment to radiotherapy patients. The review covers various aspects, including the responsibilities of technologists in treatment planning, equipment operation, patient care and safety, quality assurance, and research. This present review provides a comprehensive understanding of the importance of well-trained and skilled radiation therapists in ensuring the success of radiation therapy treatments.

Early Identification and Management of Ulcerative Colitis: A Narrative Review

Ulcerative Colitis (UC) is a chronic Inflammatory Bowel Disease (IBD) that affects the inner lining of the colon, imposing a significant burden on healthcare systems worldwide. Symptoms include bloody stools and abdominal pain. The prevalence of UC is increasing, particularly among young adults. The pathogenesis involves immune responses, genetics and environmental factors. Diagnostic delays are common, leading to complications and increased costs. Early diagnosis is crucial for preventing complications. Endoscopy is the primary diagnostic tool. Treatment aims to reduce inflammation and achieve remission. Delayed diagnosis can lead to long-term complications such as Colorectal Cancer (CRC) and bowel stenosis. Prompt recognition and management are essential for minimising the disease burden and optimising care. The present study delves into the complex nature of UC, a chronic IBD, revealing its epidemiology, pathogenesis, diagnostic challenges, treatment strategies, prognosis, complications and the impact of delayed diagnosis on patients’ quality of life. The study highlights the evolving understanding of UC pathogenesis, incorporating immune responses, genetics, environmental factors and biomarkers. It also discusses diagnostic delays due to symptom similarities and the need for increased awareness among healthcare providers and the public. The study also discusses advanced diagnostic methods and therapeutic approaches, including novel drug targets and surgical interventions. It also highlights the negative consequences of delayed diagnosis, including increased morbidity, psychological distress and socioeconomic burden. The study emphasises the need for collaborative efforts to ensure timely and appropriate care for UC patients.

Sample Size Determination in Randomised Controlled Clinical Trials: A Narrative Review

This article summarises efforts towards understanding the calculation of sample size determination in Randomised controlled Clinical Trials (RCTs). Readers would gain insight into the procedures behind sample size calculation in RCTs and its significance. Additionally, researchers, including residents, will learn to calculate sample sizes independently, aiding in their postgraduate thesis or dissertation work, especially for straightforward projects. The determination of sample size depends on various factors, several of which are discussed in this article. The concepts of biostatistics, which underpin sample size calculations and other statistical computations, are also elucidated. Examples are provided to illustrate how formula variations correspond to changes in influencing factors. Furthermore, a list of relevant software tools is included.

Effect of Respiratory Muscle Training on Improving Respiratory Muscle Strength in Younger Population: A Systematic Review

Chitrakshi Ashish Chobisa, Lajwanti Lalwani, Vishnu Vardhan, Harsh Nathani

Introduction: Inspiratory Muscle Training (IMT) is an integral part of pulmonary rehabilitation. It is a therapeutic modality that has demonstrated considerable promise in augmenting respiratory muscle function and overall pulmonary well-being in a range of clinical cohorts. While IMT has been extensively scrutinised in the adult demographic, its efficacy in paediatric populations has remained a relatively underexplored realm. Aim: This systematic review seeks to undertake a meticulous assessment of the existing literature to gauge the potential of IMT in ameliorating respiratory function in children and adolescents. Materials and Methods: The present systematic review includes seven pertinent studies, comprising randomised controlled trials, cohort investigations, and pilot studies published in English from 2018-2023 from the Cochrane Library, PubMed, Google Scholar, and ScienceDirect. The keywords used were paediatric, restrictive lung diseases, obstructive lung diseases, IMT, obesity, neuromuscular disorders, thoracic surgeries, and advanced physiotherapy. Risk of bias assessment was done using the Cochrane risk-of-bias assessment tool. Results: These studies have investigated the impact of IMT on various paediatric cohorts, from athletic populations to those afflicted with neuromuscular disorders, cystic fibrosis, and other respiratory pathologies. Collectively, the findings offer compelling evidence that IMT has the potential to enhance inspiratory muscle strength, endurance, and overall respiratory function in paediatric populations. Conclusion: In light of the findings gleaned from this systematic review, it is evident that IMT possesses the potential to be an efficacious intervention for enhancing respiratory function in the paediatric population and offering the prospect of improved clinical outcomes and an enhanced quality of life for this vulnerable cohort.

Oral Epithelial Dysplasia: A Narrative Review on Histological Grading, Computer-aided Diagnostics and Treatment Approaches

Taibur Rahman, Lipi B Mahanta

Head and Neck (H&N) cancer represents a significant global health burden, ranking sixth among all cancer types worldwide, with a particularly high prevalence in developing countries. Oral cancer, a subset of H&N cancer, encompasses malignant growths within the oral cavity region. Oral Epithelial Dysplasia (OED) serves as a precursor lesion to oral cancer and is identifiable through histological examination by pathologists. While histological grading correlates with progression cancer risk, accurately predicting lesion advancement remains challenging due to limited research and study. Despite established grading criteria based on architectural and cytological changes in the oral cavity histological images, variability exists among pathologists in assessing OED presence and grade. The present article explores OED as a precancerous lesion, delving into various histological grading systems based on architectural and cytological changes. Additionally, it examines the role of Computer-aided Diagnostics (CAD) leveraging Artificial Intelligence (AI) in OED detection. Lastly, the paper discusses treatment modalities for oral cavity cancers.

Assessment of the Effect of Moringa Oleifera Leaves Extract on Angiogenesis using the Novel Yolk Sac Model: An In-ovo Experimental Study

Amita Aditya, Sunil Mishra, Ramesh Bhonde

Introduction: In recent times, the focus of cancer research has shifted to naturally occurring compounds derived from plants that may have the potential for anticancer activity. Moringa oleifera is a softwood tree whose fruits, roots, and leaves have been advocated for medicinal and industrial uses. Angiogenesis plays an important role in many physiological and pathological conditions and is considered a hallmark of tumour development and progression. An efficient anticancer drug is expected to have a significant inhibitory effect on angiogenesis. However, there are a limited number of studies reported to explore the anti-angiogenic activities of Moringa Oleifera Leaf extract (MOL). Aim: To assess the effect of MOL on angiogenesis using the Yolk Sac Model (YSM). Materials and Methods: A preliminary in-ovo study was conducted in the in the specialised Regenerative laboratory of Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune, Maharashtra, India, between September 2022 and February 2023 after obtaining necessary scientific and ethical permissions. The calculated sample size for YSM analysis was seven in each study and control group (total of 14); however, the authors used a total of 28 YSMs (seven in each of the three study concentration groups and seven in the control group). In this method, freshly fertilised White Leghorn chicken (Gallus domesticus) eggs, procured from the hatchery, were incubated and treated with different concentrations (10 μg/mL, 100 μg/mL, and 500 μg/mL) of the treatment substance (MOL) along with a control group (Avastin). The anti-angiogenic effect of MOL extract was determined by calculating vessel density, total vessel network length, total branching points, total segments, mean segment length, and width in the three groups compared to Avastin after 48 hours of treatment using WimCam software for analysing the images. Descriptive statistical analysis and one-way Analysis of Variance (ANOVA) were then applied to compare the parameters in the four groups. Results: Statistical analysis by one-way ANOVA showed a significant (p<0.05) percentage reduction in the number of blood vessels in each treatment group after 48 hours of treatment. Among the different concentrations of MOL used, 500 μg/mL showed greater anti-angiogenic capacity. Conclusion: The results indicate that MOL could suppress abnormal angiogenesis in a dose-dependent manner and may be considered a potential anti-angiogenic agent in various diseases, including cancer.

Effect of Stretching and Strengthening Exercises on Thenar Muscles of Hands on Smartphone Users

Ritu Sinha, Taruna Verma

Introduction: Musculoskeletal issues are more likely to develop while using a smartphone because of the time spent in a stooping posture. Long-term use of a smartphone may lead to bad posture and numbness and discomfort in the hands, arms, shoulders, and elbows. Aim: To find out the effectiveness of hand muscle strengthening exercises and stretching exercise with home management program on dominant hand grip strength and hand function in smartphone addicted healthy Indian population. Materials and Methods: A total of 30 subjects between the age 18-30 who met inclusion and exclusion criteria were selected. They were then randomly assigned to one of the two treatments groups: Group A (Hand strengthening and stretching activities) or GroupÂ B (only stretching exercises) were assigned with home exercise program to their respective treatment programs for a period of 4Â weeks. The VAS scale, the Duruöz Hand Index (DHI), and the SAS-SV scale test were administered to all of the individuals before and after the intervention programmed. Results: In comparison, Group A DHI score was 25 points lower than Group B, while Group B was 16 points lower. Both Group A and Group B had decreased levels of pain as measured by the Visual Analogue Scale (VAS). A p-value of p=0.05 revealed statistically significant variations in test results between the two groups. Conclusion: Hand muscle strengthening exercises and stretching exercise with home management program have significant effect on dominant hand grip strength and hand function in smartphone addicted healthy Indian population.

Effect of Knee Isokinetic Strength Ratio on Foot Arch Index In College-going Students: A Cross-sectional Study

Dikshita Kabba, Joydip Saha

Introduction: Knee isokinetic refers to the dynamic knee muscles contraction with constant velocity. Hamstring-to-Quadriceps (H:Q) ratio data for several knee isokinetic parameters are essential as they are primary dynamic frontal-plane knee stabilizers. Multiple researches had confirmed that altered frontal knee alignment is highly correlated with the foot posture. Foot arch is biomechanically linked with the knee by kinematic chain which may influence the knee alignments. Aim: To find the effect and relation of knee isokinetic strength on foot arch index in college-going students. Materials and Methods: The 200 college-going students (age: 22.08±1.36 years) were recruited in this study using convenient sampling method. Informed consent and demographic details were obtained from each individual. H:Q ratio with five repetitions of maximal knee concentric flexion and extension were performed on an isokinetic dynamometer. Harris mat was used to obtain the foot print and arch index was calculated using Staheli’s arch index. Results: The mean H:Q ratio was 66.94±27.791 (p>0.05). The foot arch index was normally distributed (left=0.682±0.172, right=0.680±0.169). There was no significant relationship between left (r=-0.044) and right (r=-0.062) foot arch index with the H:Q ratio. Conclusion: The study concluded that there was no effect and correlation of knee isokinetic strength ratio on foot arch in college-going students.

Effectualness of Dry Needling: A Review

Tamanna Sharma, Navjyot S Trivedi

Trigger point Dry Needling (TDN) is a therapeutic intervention for Musculoskeletal (MSK) pain, encompassing various body areas. TDN, involving the insertion of fine needles into muscles, connective tissues, and myofascial trigger points, has gained popularity as a treatment for MSK pain. The review aimed to consolidate evidence from published Systematic Reviews (SRs) on the efficacy of TDN in managing myofascial pain syndrome across different MSK disorders. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement, evaluating SRs of Randomised Controlled Trials (RCTs) published after 2000. The search strategy encompassed databases such as Web of Science, Excerpta Medica DataBASE (EMBASE) and Medical Literature Analysis and Retrieval System Online (MEDLINE), with keywords including “dry needling,” “acupuncture,” and “physical therapy.” Nineteen SRs met the inclusion criteria, focusing on TDN efficacy across various body regions. TDN was found to be effective in reducing pain and tenderness in regions including the temporomandibular joint, cervical spine and shoulder, upper extremities, lumbar spine, and lower extremities. The review suggests that TDN may offer temporary relief for trigger point-related pain and tenderness, with outcomes comparable to or better than other interventions such as manual therapy, stretching, and pharmaceutical injections. However, the review acknowledges limitations in the available evidence, including variations in study protocols, methodologies, and outcome measures across publications. While TDN shows promise in reducing myofascial pain across different body regions, further high-quality research is needed to confirm its efficacy and inform clinical decision-making. The review emphasises the importance of standardised protocols and comprehensive outcome assessments in future research to better understand the potential benefits of TDN for MSK pain management.

Microcrack Formation after Root Canal Instrumentation: A Narrative Review

The development of rotary files and other endodontic instrument techniques have revolutionised treatment by enhancing canal preparation and producing rounder, smoother canals that are constructed of Nickel-Titanium (NiTi) alloy. There are two types of movements in these instruments: rotary continuous and reciprocating. Rotary continuous movements involve torsion and flexion, and can cause instrument fractures. An alternative approach to avoid the issue is proposed, which involves reciprocating movement. The present literature review compares the incidence of dentinal crack formation in root canal walls when using stainless steel and NiTi rotary systems. It highlights the potential complications, such as tooth fracture and increased bacterial susceptibility due to contact between instruments and dentinal walls.

Effect of Callisthenic Exercises vs Yoga on Health Related Quality of Life, Lipid Profile, Anthropometric Measurements and ultrasonography Findings in Polycystic Ovarian Syndrome: A Research Protocol

Ashwini Bulbuli, Vijay Kage, Manjunath Hukkeri, MB Bellad

Introduction: Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder, and individuals with this condition are at a risk of developing complications like metabolic syndromes throughout their lifetime. Not much is known about studies reporting the combined effects of calisthenic exercise with either aerobic exercise or progressive resistive exercises that have shown positive outcomes in PCOS. Need for the study: Extensive literature search has revealed gaps in reporting the individualised effects of calisthenic exercise in PCOS and its comparative effects with yoga. The present research article presents a study protocol comparing calisthenic exercises and yoga protocols prescribed for women with PCOS. Aim of the study: To evaluate and compare the effects of calisthenic exercises and yoga in women with PCOS. Materials and Methods: This research protocol is planned to conduct a randomised clinical trial in Belagavi, Karnataka, India, and will employ a randomised, open-label, parallel-armed, double-blinded clinical experimental design. The duration of the study will be near bout four years, from June 2022 to August 2026. A total of 102 females with PCOS, aged between 18 and 35, will be randomly allocated to either a yoga group (N=51) or a calisthenic exercise group (N=51). For a period of 1½ months (i.e., six weeks), group therapy sessions will be held five times a week. Ultrasonography scans, which will assess ovarian cyst count and size, ovarian volume, and total lipid profile, will be conducted twice (pre- and post-intervention). The PCOS Questionnaire (PCOSQ-26) will be utilised to assess health-related quality of life, as well as anthropometric measurements such as waist-hip ratio and Body Mass Index (BMI). These measurements will be assessed prior to the intervention, six weeks following the intervention, and at the 12-week follow-up. Inferential as well as statistical methods will be used to analyse the gathered data. A test for normal distribution will be conducted, depending on whether parametric tests (Z test and/or ANOVA) or non-parametric tests (Mann-Whitney U test or Wilcoxon signed-rank test) will be performed. A probability value of less than 0.05 will be considered statistically significant.

Effect of Plyometric Training versus Swiss Ball Training on Core Strength, Agility and Dynamic Balance in Recreational Badminton Players: A Research Protocol

Saylee Sunil Shedge, Swapnil Ulhas Ramteke

Introduction: Badminton is a recreational, versatile, explosive sprint sport. The player needs core strength, agility, and dynamic balance. Resistance training used in plyometric activities helps to improve the athlete’s strength and fitness. Swiss ball training, a widely embraced method of functional exercise, enhances balance, core stability, flexibility, and overall strength. Need of the study: This study fills a gap in knowledge by exploring the effects of plyometric training and Swiss ball training on core strength, agility, and dynamic balance in recreational badminton players. It seeks to enhance on-court performance and prevent injuries by determining, which method is more effective. Tailored training programs can then be developed further based on individual responses to these methods. By providing evidence-based data, the study aims to support and guide the strength and conditioning coaches, trainers, and players in making appropriate decision about training approaches, ensuring optimal results and minimising injury risks in badminton. Aim: To find out the effect of Plyometric training versus Swiss Ball training on core strength, agility, and dynamic balance in recreational badminton players. Methodology: A non-blinded, randomised controlled parallel-group trial will be conducted for a period of one year from January 2024 to December 2024. Participants will be recruited from Wardha’s District Badminton Stadium and will sign a consent form after meeting inclusion or exclusion criteria. They will be randomly divided into Group-A- Plyometric training and Group-B-Swiss ball training by the primary researcher. Outcome measures will be assessed pre and post-intervention. The analysis will be conducted using the free version of R-software. Significance in mean baseline variables will be assessed using either the t-test or Mann-Whitney test for the two assessment periods. Pairwise comparisons between the two groups for significant differences will be conducted using either the paired t-test or Wilcoxon test. The p-value will be evaluated at a 5% level of significance (p≤0.05).