Journal of clinical and diagnostic research

Advanced Kienbock’s Disease with Chronic Regional Pain Syndrome: A Case Report

V Sheshagiri, CS Sujan Theja, BM Pramod, CS Vidya

Kienbock’s disease is a rare and painful disorder of the wrist, of unknown etiology, characterised by osteonecrosis of the lunate bone visible on wrist radiographs. It is typically seen in individuals aged 20-40 years, often in the dominant wrist, with a history of trauma. If left untreated, it can lead to fragmentation of the lunate, collapse and shortening of the carpus, and secondary arthritic changes throughout the proximal carpal area. We present a case of Kienbock’s disease Lichtman stage IV with Chronic Regional Pain Syndrome (CRPS) in a 53-year-old female who presented with right wrist pain and swelling persisting for one month, alongside a loss of range of motion of about 20 degrees in palmar and dorsal flexion, following a fall on an outstretched hand one year prior. Initially, the patient was managed conservatively with splinting, physiotherapy, and pharmacotherapy (Vitamin C, Vitamin D, Diclofenac) until the CRPS subsided. Subsequently, the patient underwent total wrist arthrodesis with bone grafting, resulting in pain relief and a satisfactory pain score.

Ocular findings in a Case of Tuberous Sclerosis Complex: A Classic Posterior Segment Presentation

Aishwarya M Angadi, Shikha Rai

Tuberous Sclerosis Complex (TSC) is a genetic condition caused by autosomal dominant mutations in the tumour suppressor genes TSC1 and TSC2. The most frequent manifestations of this disorder involve benign tumours affecting multiple systems, including neurological, dermatological, renal, cardiac, pulmonary and ocular systems. The classic symptom triad consists of seizures, intellectual disability and cutaneous angiofibromas. Ocular involvement, though often asymptomatic, can reveal characteristic retinal lesions that are valuable for diagnosis and monitoring. A 23-year-old female with a recent diagnosis of TSC was referred to the Department of Ophthalmology for evaluation. She had no visual complaints. Examination revealed characteristic facial angiofibromas and bilateral Retinal Astrocytic Hamartomas (RAH) without any visual impairment. Computed Tomography (CT) imaging also showed bilateral renal angiomyolipomas. Ocular involvement in TSC is common but often asymptomatic. RAH are the most frequent ocular manifestations and are usually stable over time. Recognising these findings can support diagnosis and systemic evaluation, especially in undiagnosed patients. Ocular examination plays an essential role in the multidisciplinary assessment of TSC, aiding in both diagnosis and monitoring. Awareness of these subtle but significant findings is important for early and holistic management.

A Rare Case of Cavernous Haemangioma Mimicking Arteriovenous Malformation of the Arm

Cavernous haemangiomas are venous malformations that are commonly localised defects in the vasculature. These haemangiomas are typically asymptomatic but can adversely affect Quality of Life (QoL). Arteriovenous Malformations (AVMs) are also vascular defects with a congenital origin. AVMs are characterised by direct abnormal connections with high blood flow. Cavernous haemangiomas and AVMs can be differentiated using diagnostic modalities such as Magnetic Resonance Imaging (MRI) and computed tomography angiography. This case report aims to document a rare clinical presentation of cavernous venous malformations in a 30-year-old female presenting with swelling of the arm and intermittent pain for the past two years. This case illustrates an atypical presentation of cavernous haemangioma, which initially appeared as an AVM but was gradually confirmed to be a ‘cavernous haemangioma’. A 30-year-old female presented with complaints of swelling in her upper arm, which was managed by embolisation followed by surgical resection. The diagnosis was confirmed through histopathology. Histopathological examination played a crucial role in the definitive diagnosis. This case highlights a rare diagnostic challenge where imaging findings initially suggested an AVM, but histopathology confirmed a cavernous haemangioma, emphasising the importance of thorough diagnostic workup in vascular anomalies.

Ileo-ileal Knotting in a Postoperative Chronic Calcific Pancreatitis Patient: A Case Report

Ileo-ileal knotting is an exceptionally rare and potentially fatal cause of Small Bowel Obstruction (SBO), often leading to rapid vascular compromise, bowel ischaemia, and eventual gangrene if not promptly managed. The present case report describes a 43-year-old female with a prior history of Chronic Calcific Pancreatitis (CCP) who had underwent Frey’s procedure one year earlier. She presenting with acute abdominal pain, bilious vomiting, distension, and obstipation. Imaging was indicative of mechanical obstruction. Emergency exploratory laparotomy revealed a tightly knotted ileo-ileal loop located approximately four feet from the ileocecal junction. Remarkably, the bowel appeared viable, and the knot was successfully untied without requiring resection. The present patient experienced a smooth and uneventful recovery period following the surgical procedure and was subsequently discharged on the sixth day. The present case is clinically significant as it represents a rare non-resectional outcome of ileo-ileal knotting in a postoperative abdomen, a scenario scarcely reported in current literature. Prior abdominal surgeries may predispose patients to altered bowel motility or mesenteric dynamics, increasing the likelihood of such complications. The rarity associated with diagnosing this condition underscore the significance of sustaining a keen awareness among healthcare professionals, particularly for patients in the postoperative phase who show indications of bowel obstruction. Prompt surgical intervention is essential not only for preserving life but also for ensuring the ongoing functionality of the bowel. Reporting such rare entities contributes meaningfully to surgical literature, enhances clinician awareness, and may improve diagnostic accuracy and patient outcomes in future presentations.

Defying Expectations: A Rare Case of Hypergonadotropic Hypogonadic Pregnancy

Sridivya Cherukuri, Kamlesh Chaudhari, Apoorva Dave, Sravya Gudapati

Amenorrhoea, hypoestrogenism, and hypergonadotropinism are the hallmarks of premature ovarian failure, affecting primary fertility in young females. Hypergonadotropic hypogonadism is a gonadal disorder that delays the onset of puberty in both males and females. In females, hypergonadotropic hypogonadism is also termed ‘Primary Ovarian Insufficiency’ (POI), which is characterised by premature ovarian failure. This is a rare case of a 27-year-old pregnant female with hypergonadotropic hypogonadism. She presented with primary infertility, and her laboratory investigations suggested hypergonadotropic hypogonadism or POI. Ultrasound imaging depicted a hypoplastic uterus with streak ovaries. She was treated with In-Vitro Fertilisation (IVF), which was successful on the second attempt. Hence, based on the findings of this case, it is recommended that females with POI should be counselled and informed about the small but real possibility of pregnancy.

Diabetic Mastopathy Mimicking Malignancy: A Surgical Perspective on Diagnosis and Management

Nandhini Ganesh, Athira Gopinathan, Vindu Srivastava, Imran Thariq Ajmal

Diabetic Mastopathy (DMP) is an uncommon benign fibroinflammatory condition of the breast, predominantly seen in individuals with long-standing diabetes mellitus. It often mimics malignancy on clinical and radiological examination, leading to diagnostic uncertainty. DMP accounts for 0.5-13.5% of all benign breast lesions. Here, authors present the case of a 48-year-old postmenopausal female who presented with complaints of serous, cheesy discharge of minimal quantity from the right nipple, intermittently for the past 10 years, along with pain over the right breast for the last four weeks. Clinical evaluation revealed a firm, tender subareolar mass with nipple-areola distortion and cheesy discharge. Imaging via sonomammography revealed a Breast Imaging Reporting and Data System 3 (BIRADS 3) hypoechoic lesion with cystic areas and ductal dilatation. A wide local excision, including the removal of the distorted nipple-areola complex, was performed. Gross and histopathological examination showed fibrocystic changes with dense fibrous stroma, lymphoplasmacytic infiltration and giant cells, consistent with DMP. Close clinical follow-up is essential. Heightened clinical awareness and individualised treatment strategies can help minimise unnecessary surgeries while ensuring patient safety and reassurance.

Uterine Dehiscence Presenting as Postpartum Puerperal Sepsis Mimicking Abdominal Tuberculosis

Vaishnavi Lakkireddy, Manjusha Agrawal, Smruti Mapari, Aishwarya Beedkar

Uterine dehiscence, characterised by the partial or complete separation of a previous uterine scar, is a rare but potentially life-threatening complication following Caesarean Section (CS). This condition often presents with non-specific symptoms and may mimic other diseases, delaying diagnosis and increasing morbidity. A 24-year-old postpartum female presented with abdominal distension, fever, vomiting, and purulent discharge from the surgical site. The initial diagnosis of abdominal tuberculosis was based on ascitic fluid analysis and elevated Adenosine Deaminase (ADA) levels. Imaging and further evaluations confirmed uterine scar dehiscence. Management included relaparotomy, debridement, and resuturing of the uterine scar, followed by antibiotic therapy. The patient improved significantly postoperatively, with resolution of symptoms and normalisation of laboratory parameters. She was discharged in stable condition 14 days after surgery. This case underscores the importance of considering uterine dehiscence in postpartum patients with sepsis and abdominal distension. Early diagnosis through imaging and timely surgical intervention is critical in improving outcomes and preventing long-term complications.

Successful Management of Cardiotoxic Manifestation following Krait Snake Bite in a Child: A Case Report

Sham Lohiya, Shahzad Ahmad, Jayant Vagha, Keta Vagha

Krait (Bungarus) envenomation is typically associated with neurotoxic symptoms, while isolated cardiotoxicity without neurological or haemotoxic features is exceptionally rare. This report describes the case of a nine-year-old child who presented with cardiorespiratory symptoms following a krait snakebite. Notably, the child exhibited no neurological deficits, coagulopathy, or systemic envenomation markers typically associated with krait bites. The clinical presentation was dominated exclusively by cardiotoxic manifestations, including cardiac rhythm abnormalities and respiratory distress. Timely administration of Anti-Snake Venom (ASV) resulted in the complete resolution of symptoms, underscoring the potential efficacy of ASV even in cases of isolated cardiotoxicity. This case highlights the importance of considering atypical presentations in snakebite cases, particularly in paediatric patients, where initial symptoms may mimic primary cardiac or respiratory conditions. Early recognition and intervention, including appropriate ASV administration, play a crucial role in preventing potential morbidity and mortality. To the best of our knowledge, this represents the first documented paediatric case of isolated cardiotoxicity following krait envenomation that was successfully managed with ASV therapy. This case adds to the growing body of literature emphasising the spectrum of krait envenomation presentations and reinforces the need for maintaining a high index of suspicion for snakebites in endemic areas, even when classical neurotoxic features are absent.

Right Inguinoscrotal Swelling Revealing Classic Seminoma: A Case Report

Satish Surapureddy, Pankaj Gharde, Dheeraj Surya, Bhagyesh Sapkale

There are many causes of inguinoscrotal swelling, but common causes include hydrocele, tumours, and infections. The presented case involves a 40-year-old male who presented with an inguinoscrotal mass on the right side that developed over the past year, accompanied by painful episodes. Physical examination revealed a 5×6 cm tense swelling with positive transillumination. Investigations showed a right-sided chronic hydrocele, funiculitis, varicocele, and epididymo-orchitis. Dissection for the hydrocele at the onset led to the identification of a right testicular mass, necessitating a high inguinal orchidectomy. Histopathological examination confirmed classic seminoma with capsular and lymphovascular invasion. This case highlights the diagnostic difficulty of inguinoscrotal swellings, particularly when hydrocele obscures an underlying tumour. The unexpected intraoperative findings underscore the importance of flexibility in surgical planning to address potential malignancy concerns. The report emphasises the necessity of a proper histopathological assessment to determine the nature of the testicular mass for appropriate management in future cases.

Anaesthetic Management of a Retroperitoneal Paraganglioma: A Case Report

Vinit Sunil Dhanure, Nikhil Bhalerao, Amaresh Paul, Saurabh Prakash

Retroperitoneal tumours, especially paragangliomas, pose peculiar challenges in their surgical and anaesthetic management, as they are hormonally active due to the release of catecholamines. These tumours are typically located adjacent to critical structures, particularly the Inferior Vena Cava (IVC), aorta, and celiac trunk, making their resection hard, due to the risk of haemodynamic instability in the course of surgery. This case report of a 47-year-old male epitomises the importance of a multidisciplinary approach in the management of a retroperitoneal paraganglioma. He had a history of neurogenic bladder and had undergone embolisation of the retroperitoneal mass previously. General Anaesthesia (GA) with thoracic epidural catheterisation was employed as the anaesthetic modality for the surgical removal of the tumour. Invasive monitoring techniques, such as arterial lines and central venous catheters, were used to manage possible surges in catecholamines, haemodynamic shifts, and substantial blood loss during resection of this tumour. The intraoperative hypertensive crisis was managed with nitroglycerine and continuous monitoring and epidural analgesia ensured smooth recovery in the postoperative period. The case points out the necessity of careful preoperative evaluation, advanced intraoperative techniques, and alert postoperative care in handling complex retroperitoneal tumours like paragangliomas.

Unique Manifestation of Hirayama Disease: Bilateral Radial and Ulnar Nerve Palsy with Hypothenar Atrophy, and Atypical Snake Eye Appearance

Viraj Gupta, Gaurav Mishra, Ravishankar Patil, Shubhi Gaur, Mrunali S Bhosale

A rare cervical myelopathy called Hirayama disease usually manifests as muscle atrophy and distal upper limb weakness that develops gradually in young males. A 42-year-old male presented with progressive weakness and atrophy in both upper limbs for over 12 years, accompanied by fine tremors. Neurological examination revealed weakness in wrist extension and finger movements, profound atrophy of the hypothenar and interosseous muscles, and sensory deficits consistent with radial and ulnar nerve involvement. Cervical spine Magnetic Resonance Imaging (MRI) in a flexed position revealed anterior displacement of the posterior dural sac (from C3 to C7 level), with compression of the lower cervical cord, confirming the diagnosis of Hirayama disease. This case highlights a rare and severe manifestation of Hirayama disease, emphasising the bilateral involvement of multiple peripheral nerves, a finding uncommon in classical presentations. Early diagnosis, aided by dynamic MRI imaging, is crucial to prevent further neurological deterioration. Treatment options, including cervical collar immobilisation, aim to halt disease progression. This report underscores the importance of considering Hirayama disease in the differential diagnosis of atypical peripheral neuropathy presentations, particularly in young patients and, in this case, in an older age group (40-45 years). It also provides insight into the varied clinical spectrum of this condition.

Visual Loss and Rhabdomyolysis: A Case of Acute Methanol Intoxication

Methanol toxicity is a rare but potentially fatal condition, often associated with accidental or intentional ingestion of adulterated alcohol. Complications include high anion gap metabolic acidosis, visual disturbances, central nervous system involvement, and multi-organ dysfunction. Rhabdomyolysis, though less commonly reported, can be a serious sequel leading to Acute Renal Failure (ARF) and significant morbidity. We report the case of a 40-year-old male with chronic alcohol use who presented to the Emergency Department (ED) with bilateral lower limb weakness, pain, dark urine, abdominal discomfort, and visual blurring. He was in shock, with severe lactic acidosis (pH <6.8, lactate >15 mmol/L, a non-recordable bicarbonate (HCO₃) level, and high anion gap of 40) and required immediate Intensive Care Unit (ICU) stabilisation. Laboratory investigations were deranged, including Creatine Kinase (CK) 39,000 IU/L, Lactate Dehydrogenase (LDH) 1738 IU/L, acute kidney injury, dyselectrolytaemia including refractory hyperkalaemia, hypocalcaemia, hyperphosphataemia, deranged liver enzymes, and an osmolar gap of 72, suggestive of toxic alcohol ingestion-induced rhabdomyolysis and visual loss. Further history revealed binge consumption of locally brewed alcohol (“tadi”), raising strong suspicion of methanol poisoning. Oral ethanol therapy was initiated, followed by multiple sessions of haemodialysis due to persistent acidosis, renal failure, and electrolyte imbalance. The patient showed gradual clinical improvement and was discharged with near-complete recovery. Methanol toxicity-induced rhabdomyolysis is a medical emergency that demands prompt recognition and intervention. This case underscores the importance of clinical vigilance and early empiric treatment in patients with suggestive history and biochemical findings, even before confirmatory tests are available. Timely haemodialysis and supportive care can significantly improve patient outcomes.

Unmasking the Silent Bleed: Subclavian Artery Puncture and Mediastinal Haematoma during Minimally Invasive Oesophagectomy

Sharada M Adiga

Video-Assisted Thoracoscopic Oesophagectomy (VATS-E) is a minimally invasive procedure increasingly used for managing oesophageal cancer due to its reduced postoperative morbidity and shorter recovery times. However, it is not without risks, particularly in the perioperative management of patients requiring central venous access. Complications associated with central line placement, such as vascular injuries, can lead to significant morbidity, including rare but life-threatening conditions like mediastinal haematomas. This case report presents an unusual complication encountered during VATS-E. During the insertion of a subclavian central venous line, an inadvertent puncture of the subclavian artery occurred, resulting in the formation of a large mediastinal haematoma. The patient exhibited symptoms of haemodynamic instability, including tachycardia and hypotension, which necessitated urgent intervention. Advanced imaging revealed a localised haematoma compressing mediastinal structures. Management of this critical situation required a multidisciplinary approach involving thoracic surgeons, anaesthesiologists, and interventional radiologists. The haematoma was managed conservatively with continuous haemodynamic monitoring while ensuring that no further vascular compromise or compression occurred. The patient recovered without requiring surgical evacuation of the haematoma, highlighting the potential for non-operative management in selected cases. This report underscores the importance of prompt diagnosis, careful assessment, and collaborative management in addressing such rare complications. By sharing this case, we aim to raise awareness of this potential risk and emphasise strategies to mitigate complications during central line placement in patients undergoing oesophagectomy.

Metastatic Breast Cancer in a Patient with Neurofibromatosis Type I: A Rare Case Report Highlighting Aggressive Disease and Management Challenges

Karan Sood, Aman Sondoule, Amol Dongre, Tanuja Bhutekar, Juliana Paonam

Neurofibromatosis Type 1 (NF1) is a genetic condition caused by a mutation in the NF1 tumour suppressor gene and is associated with a high risk of malignancies, especially breast cancer. Individuals with NF1 face an exceptionally high burden of cancer. Breast cancer is of special concern in NF1, with the risk being increased in women younger than 50 years. NF1-associated breast cancer appears to be more aggressive, often presenting as the basal subtype, and has been noted to occur at an earlier age. This case report describes a 45-year-old female with NF1 who was diagnosed with right-sided triple-negative breast cancer. She received adjuvant chemotherapy and radiotherapy but did not follow-up regularly. Two years later, she developed widespread metastatic disease in her liver, bones, lungs, and pleura, with imaging revealing extensive metastases and lymphangitic carcinomatosis. Breast cancer in NF1 patients usually develops at a younger age and is more aggressive, as illustrated in this case. Patients with confirmed NF1 should undergo regular screening starting at the age of 30 years, and any suspicious mass should be biopsied. Most cases are basal; hence, discussions in a multidisciplinary tumour board are essential. Neoadjuvant chemotherapy can provide a survival advantage. Given that radiation therapy in NF1 can cause fibrosis and lead to secondary malignancies, its use should be limited wherever possible. This report emphasises the high risk of breast cancer in NF1, the management of the disease, and the necessity of early detection to improve patient outcomes.

Endometrioid Borderline Tumour of the Ovary: Pathological Analysis of a Rare Case

Srinivasan Raman, Meethu Rappai, Kalaivani Amitkumar, Balaji Radhakrishnan

Endometrioid Borderline Ovarian Tumours (EBOTs) are rare epithelial tumours with low malignant potential, also referred to as atypical proliferative endometrioid tumours. EBOTs exhibit glandular proliferation and nuclear abnormalities without invading surrounding tissue, which distinguishes them from invasive endometrioid carcinomas. The endometrioid subtype represents a rare category of Borderline Ovarian Tumours (BOTs). We present a case of a 45-year-old woman who had a right ovarian haemorrhagic cyst discovered during a routine ultrasound. The diagnostic workup included a pelvic Magnetic Resonance Imaging (MRI) scan, which showed a complex ovarian cyst with solid components, suggesting a neoplasm. Serum tumour markers, including Cancer Antigen (CA)-125, Carcinoembryonic Antigen (CEA), and CA 19-9, were all normal. Given the imaging results and clinical analysis, the patient underwent a Total Laparoscopic Hysterectomy (TLH) along with a Bilateral Salpingo-Oophorectomy (BSO). Histopathological Examination (HPE) of the removed ovary revealed glandular proliferation lined by stratified columnar cells with mild to moderate nuclear atypia and no stromal invasion. Immunohistochemistry (IHC) supported the diagnosis by showing positive results for Estrogen Receptor (ER), Progesterone Receptor (PR), and Cytokeratin 7 (CK7) with a lower proliferation index (Ki-67), which helped rule out invasive carcinoma and similar conditions. This case emphasises the need for a thorough diagnostic process, including imaging, tumour markers, HPE, and IHC for accurate classification. While EBOTs are less aggressive, careful pathological interpretation is necessary to prevent misdiagnosis and unnecessary treatment. Ongoing clinical monitoring is important due to the potential for recurrence or progression. Recognising EBOTs as a separate group allows for better patient management and improved outcomes.

Congenitally Corrected Transposition of Great Arteries in a Young Adult: A Case Report

Congenitally Corrected Transposition of the Great Arteries (ccTGA) is a rare congenital cardiac anomaly characterised by atrioventricular and ventriculoarterial discordance, comprising less than 0.05% of all congenital heart diseases. While often associated with abnormalities such as Ventricular Septal Defect (VSD), pulmonary obstruction, coarctation, and Ebstein anomaly, ccTGA can also occur as an isolated defect. Such cases may remain asymptomatic for decades and are sometimes discovered incidentally. We present a case of a 26-year-old asymptomatic male diagnosed with ccTGA during an evaluation for inguinal hernia surgery. The patient’s only complaint was occasional palpitations. Electrocardiography revealed Complete Heart Block (CHB), which was confirmed by echocardiography and coronary Computed Tomography (CT) angiography, showing typical findings of ccTGA. The Right Ventricle (RV) had a reduced ejection fraction of 40-45%, with mild regurgitation of the tricuspid and aortic valves. Pacemaker implantation was recommended for the management of CHB. This case highlights the importance of early recognition of ccTGA-associated complications such as CHB and underscores the need for regular follow-up to monitor for Heart Failure (HF) and other late sequelae.

Efficacy of Polyherbal Ayurvedic Formulations in the Management of Endometrial Polyp and Associated Menorrhagia: A Case Report

The management of endometrial polyps, benign uterine growths commonly manifesting with abnormal uterine bleeding, has traditionally relied on hysteroscopic polypectomy as the gold standard intervention. This case report aims to demonstrate the remarkable efficacy of Ayurvedic medicine as a compelling alternative therapeutic approach. A 41-year-old multiparous woman suffering from persistent menorrhagia and intermenstrual bleeding for three months underwent an ultrasonographic evaluation, which revealed a substantial endometrial polyp measuring 41×20×13 mm and a concurrent simple left ovarian cyst. After a comprehensive assessment confirmed menorrhagia and constipation as the primary clinical manifestations, the patient embarked on a holistic Ayurvedic treatment protocol. The regimen consisted of sophisticated polyherbal formulations, including Kanchanar Guggul, Ashokarishta, Chandraprabha Vati, Arshakuthar Ras, and Mamsa Pachak Vati, administered over 90 days, complemented by tailored dietary modifications. The therapeutic response was profound and progressive; menstrual bleeding diminished significantly from 5-6 pads per day to 3-4 pads per day within just 30 days, normalising to two pads per day with regular cycling by day 60. By the conclusion of the treatment period, the patient experienced complete resolution of both menorrhagia and constipation, with follow-up imaging confirming normal pelvic architecture. This compelling case illustrates how Ayurvedic intervention, focussed on restoring dosha (body humor) equilibrium through carefully selected herbal compounds, successfully resolved a symptomatic endometrial polyp, thereby circumventing surgical intervention entirely. The results underscore the significant therapeutic potential of traditional Ayurvedic approaches in addressing endometrial pathologies, particularly in early-stage presentations.

Successful Spinal Anaesthesia in Severe Kyphoscoliosis Patient for Knee Surgery: A Case Report

Bhagyashri Soor, M Sharan, Abhijit Namdev More, Supriya Gholap

Kyphoscoliosis, a complex spinal deformity, presents unique challenges in the perioperative management of patients requiring general anaesthesia as well as neuraxial anaesthesia. General anaesthesia in patients with kyphoscoliosis is challenging due to difficult airway management, reduced lung capacity, and altered pulmonary and cardiovascular mechanics, all of which increase the risk of respiratory and haemodynamic complications. Moreover, the spinal deformity complicates positioning and affects the administration of neuraxial anaesthesia, requiring careful preoperative planning and close intraoperative monitoring. We discuss a case involving a 32-year-old male with a history of childhood kyphoscoliosis, diagnosed with a left Anterior Cruciate Ligament (ACL) tear. He had no neurological abnormalities and no other complaints apart from localised pruritus in the lower abdomen. Upon evaluation, the Cobb angle measured 80º on the X-ray of the spine, and he had moderate pulmonary hypertension observed in a Two-Dimensional (2D) echocardiogram, along with restrictive lung disease without obstruction noted on spirometry. After this assessment, ACL repair under spinal anaesthesia was planned. The common problems faced during the procedure included the identification of intervertebral spaces and unpredictable spread of the spinal anaesthetic. We report the successful anaesthetic management of an adult male with severe kyphoscoliosis scheduled for left arthroscopic knee surgery under spinal anaesthesia.

Management of Fourth Degree Perineal Tear: A Case Report

Apoorva Dhankhar, Shankar Burute

Perineal trauma, particularly third- and fourth-degree tears, poses a significant concern in obstetric care due to its association with short- and long-term morbidities, including faecal incontinence, pain, dyspareunia, and social and psychological complications like depression. The risk of severe perineal tears increases with factors such as large birth weight, instrumental deliveries, and prolonged labour. Accurate diagnosis, effective management, and appropriate repair techniques are crucial for preventing complications and promoting recovery. This report discusses a case of a 33-year-old woman who presented with a 10-year history of faecal and flatus incontinence, with faeces passing through the vagina. Her obstetric history included three full-term home vaginal deliveries, marked by significant blood loss in the last two deliveries. Examination revealed a fourth-degree perineal tear with the absence of a separate anal opening and significant fibrosis, highlighting the complexities of managing such injuries. Surgical repair was performed using the Warren flap method. Postoperative management involved a liquid diet, antibiotics, and careful monitoring to prevent complications like wound dehiscence and delayed complications such as rectovaginal fistula. The patient’s postoperative course was uneventful, and follow-up assessments showed marked improvement, with complete healing at three months. The case emphasises the importance of skilled surgical intervention, tailored postoperative care, and comprehensive follow-up in optimising outcomes for patients suffering from severe perineal trauma.

Primary Hyperparathyroidism Presenting with Multiple Lytic Lesions: A Case Report

Primary Hyperparathyroidism (PHPT) is a condition characterised by elevated serum calcium levels along with elevated serum Parathyroid Hormone (PTH). The main cause of PHPT is parathyroid adenoma or parathyroid gland hyperplasia. Symptoms and signs of this condition may mimic those of the first differential diagnoses, such as multiple myeloma or metastatic disease from a primary source. In this case, a lady presented with progressively increasing lower back pain and difficulty walking. Initially, the clinical diagnosis leaned towards multiple myeloma or metastatic disease of unknown origin based on Positron Emission Tomography-Computed Tomography (PET-CT) findings. However, her serum calcium levels remained persistently elevated, while her serum phosphorus levels were normal. Consequently, a serum PTH level test indicated elevated levels. A biopsy from an Fluorodeoxyglucose (FDG)-avid lytic lesion in the left iliac bone showed a giant cell-rich lesion that was positive for CD 163 and Vimentin by Immunohistochemistry (IHC), favouring a diagnosis of brown tumour of the bone. A subsequent surgical excision of the adenoma, along with the parathyroid gland, was performed. The patient received intravenous bisphosphonate therapy for the lytic lesion and was advised to follow-up every three months with serum calcium and PTH levels monitored.

Rare Case of Large Arteriovenous Malformations Arising after a Parotid Tumour Excision

Sagar Sanjay Rane, Nitin Dharampal Bhola, Sanjana Wadewale

Arteriovenous Malformations (AVMs) of the head and neck are uncommon vascular anomalies characterised by high-flow shunting between arteries and veins without an intervening capillary bed. Among these, AVMs involving the parotid region are exceedingly rare and are often misdiagnosed or mistaken for more common salivary gland tumours. Their presentation may vary from painless swelling to disfiguring facial masses with the potential for life-threatening bleeding. Accurate diagnosis typically requires advanced imaging such as contrast-enhanced Computed Tomography (CT) or Digital Subtraction Angiography (DSA), as clinical signs may be subtle or absent. Management of craniofacial AVMs remains challenging due to complex vascular anatomy, the potential for recurrence, and the risks associated with surgical or endovascular interventions. A multidisciplinary approach involving interventional radiology, surgery, and supportive specialties is essential for optimal outcomes. This report highlights the diagnostic and therapeutic complexities of a large facial AVM discovered in an adult decades after parotid surgery, emphasising the importance of considering vascular anomalies in the differential diagnosis of longstanding facial swellings. The case reinforces the need for early recognition and careful planning in managing such lesions to reduce morbidity and improve prognosis. Given their rarity, each case contributes valuable insights to the evolving understanding and management of parotid and craniofacial AVMs.

MRI in the Evaluation of Accessory Cavitated Uterine Mass: A Case Report

Laxman Chhabhadiya, Kunal Solanki, Ashutosh Patel, Parth Nikhil Doshi

Accessory Cavitated Uterine Mass (ACUM) is a rare Müllerian anomaly typically seen in adolescents or young women presenting with severe dysmenorrhoea. It can mimic other pelvic pathologies such as adenomyosis or endometriosis. Magnetic Resonance Imaging (MRI) plays a pivotal role in identifying and characterising the lesion preoperatively. The present case report includes a case of a 21-year-old unmarried woman presenting with severe dysmenorrhoea since menarche. MRI revealed a well-defined intramyometrial cystic lesion near the right uterine cornua, which was mildly hyperintense on T1 and heterogeneously hyperintense on T2, without communication to the endometrial cavity-findings consistent with ACUM. The diagnosis was confirmed after laparoscopic excision and histopathological analysis, resulting in complete postoperative symptom relief. ACUM is a rare but treatable cause of severe dysmenorrhoea in young females. MRI offers crucial diagnostic clarity, allowing for early surgical intervention and improved quality of life.

Beyond the Norm: A Unique Case Report of Traumatic Fibroma Excision and Management of Mucosal Fenestration

V Pooja, S Senthilnathan, H Gayathri, Giftlin Denny Xavier, K Gowtham

Mucosal fenestration is a clinical condition in which the surrounding mucosa (or gingiva) is compromised, exposing the root of the tooth to the surrounding oral cavity. This condition is most commonly observed in the anterior region of the dentition due to a thin labial cortex. “Traumatic fibroma” is a common benign exophytic lesion that develops in the oral cavity as a result of tissue injury, often referred to as an irritation fibroma. The lower labial mucosa, buccal mucosa, and tongue are the most frequently affected areas. A 52-year-old female presented with a traumatic fibroma and a mucosal fenestration defect in the lower front tooth region. The lesion had progressively enlarged over the course of one year, necessitating a multidisciplinary therapeutic approach. The root apex was exposed through the defect and exhibited a distinctly darker colouration, resembling that of a non-vital tooth. A comprehensive treatment strategy was designed, consisting of endodontic therapy, fibroma excision, root resection, regenerative periodontal surgery with bone grafts, and Guided Tissue Regeneration (GTR) to correct the mucosal fenestration. A three-month follow-up revealed satisfactory healing and closure of the defect.

Perioperative Anaesthesia Challenges in a Difficult Airway Case of a Turricephaly Child Posted for Fronto-orbital Advancement and Remodelling: A Case Report

Priya Kishnani, Vishwa Shah, Kartik H Sangam, Tejash H Sharma, Pooja Shah

Turricephaly is a rare craniosynostosis characterised by premature fusion of the coronal sutures, resulting in a tower-shaped, elongated skull. This abnormal skull morphology presents anaesthetic concerns due to associated craniofacial deformities that complicate airway management, increase the risk of raised intracranial pressure and pose challenges in vascular access, fluid management and control of intraoperative blood loss. Present case is of a 13-year-old girl with turricephaly who underwent fronto-orbital advancement and cranial remodelling. An anticipated difficult airway was encountered, requiring multiple intubation attempts. Intraoperative anaesthesia care focused on securing the airway, maintaining normocapnia, invasive monitoring, proper fluid management, prevention of hypothermia and management of intraoperative blood loss with transfusion of blood products. Postoperatively, the patient was electively intubated and transferred to the Paediatric Intensive Care Unit (PICU) and kept on a ventilator overnight with appropriate sedation and analgesia. The patient was extubated the next day. This case highlights the importance of thorough preoperative assessment, vigilant intraoperative management including fluid management and transfusion strategies, maintenance of normothermia and meticulous postoperative care in achieving a successful outcome in such complex craniofacial surgical cases.

The Lateral Periodontal Cyst: Report of a Rare Developmental Anomaly with Literature Review

Laboni Ghorai, Surajit Bose, Jayanta Chattopadhyay

The Lateral Periodontal Cyst (LPC) is a relatively rare odontogenic cyst of developmental origin that accounts for less than 2% of all cysts of the jawbone. It is characterised by its location on the lateral root surface of vital permanent mandibular canines and premolars in individuals between the fifth and seventh decades of life. The cyst is typically asymptomatic and exhibits a characteristic incidental radiographic finding of a well-circumscribed round or ovoid unilocular radiolucency with minimal effect on surrounding structures. Clinically, it poses a diagnostic challenge in differentiating it from other entities that present similar clinico-radiographic pictures, such as gingival cysts, odontogenic keratocysts, lateral radicular cysts, and lesions of endodontic and periodontal origin. Although the occurrence of LPC is rare, precise diagnosis is essential to provide appropriate treatment. Hereby, the authors present a case report of a 24-year-old male patient of LPC and review the pertinent literature.

Management of Oligospermia (Kshina Shukra) by Ayurvedic Therapy: A Case Report

Mahesh Sharma, Sourabh Deshmukh, Nitika Senger

Male infertility is a widespread issue, often resulting from low sperm count (oligospermia) and poor sperm motility (asthenospermia). According to the World Health Organisation (WHO), a sperm concentration of less than 15 million sperm per milliliter of semen is classified as oligospermia. Oligospermia can be associated with Shukravaha Srotas Dushti in Ayurveda. Globally, infertility impacts approximately 8-12% of couples. Shukra Dhatu primarily refers to semen and its role in determining reproductive potential. A decline in Shukra Dhatu leading to Shukra Kshaya can be correlated with oligospermia. A 30-year-old male patient presented with general debility and fatigue for one year. He was married and, along with his wife, had been trying to conceive for the past four years without success. He was advised to undergo a semen analysis, which confirmed a diagnosis of oligospermia. The treatment approach emphasised Aamapachana (toxin elimination) and rejuvenation of Shukra Dhatu through Shodhan (bio-purification) and Shaman (curative) treatment to address the root cause of infertility. The outcome demonstrated notable improvements in both sperm count and motility, indicating the effectiveness of Ayurvedic therapies in managing oligospermia (Shukra Kshaya). This report underscores the potential of Ayurvedic interventions as a holistic approach to treating oligospermia and improving male fertility.

Pleural Involvement and True Hyponatraemia in Multiple Myeloma: A Report of Two Rare Cases

KJ Rajaprasath, V Keshavprakash, TA Vidya, D Reena Jose, JS Kumar

Multiple Myeloma (MM) is a plasma cell proliferative malignancy that produces monoclonal immunoglobulin. Pleural effusion in MM, caused by the direct infiltration of the pleural space by plasmacytes, leading to true myelomatous pleural effusion, is rare. Patients with MM often exhibit pseudohyponatraemia due to high serum paraprotein levels; a far less common occurrence is true hyponatraemia resulting from the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH). This report presents two such cases. In Case 1, a 45-year-old woman with no known co-morbidities presented with complaints of shortness of breath and pain in both hips. Investigations revealed anaemia, renal impairment, a reversed albumin-to-globulin ratio and the presence of an M band on serum electrophoresis. Imaging showed lytic lesions and minimal pleural effusion. A bone marrow biopsy confirmed plasmacytosis and diagnostic pleural tapping was performed, revealing malignant myelomatous pleural effusion. The pleural effusion progressed to a massive effusion, necessitating therapeutic tapping. Despite treatment with dexamethasone, cyclophosphamide and bortezomib, the patient eventually succumbed. In Case 2, a 56-year-old man, previously treated for MM, presented with complaints of back pain, giddiness and vomiting. Investigations revealed anaemia, hyponatraemia and elevated globulin levels. A Positron Emission Tomography-Computed Tomography (PET-CT) scan indicated the possibility of relapse. The patient exhibited low serum osmolality alongside high urine spot sodium and urine osmolality, while renal, adrenal and thyroid functions were normal, pointing towards SIADH. He responded well to fluid restriction, salt supplementation, tolvaptan and chemotherapy, resulting in the resolution of hyponatraemia. These cases are reported to shed light on the various presentations of MM that may be overlooked during patient evaluation.

Junctional Epidermolysis Bullosa In-utero with Pyloric Atresia and Aplasia Cutis Congenita (Carmi Syndrome): A Case Report

Samuel Jeyaraj Daniel, J Balaji Ganesh, S Saranya, K Desingh

Carmi Syndrome (CS) is an extremely rare autosomal recessive genetic disorder characterised by the co-existence of Junctional Epidermolysis Bullosa (JEB), Pyloric Atresia (PA), and Aplasia Cutis Congenita (ACC). Globally, very few cases have been reported. CS is often fatal in neonates. Authors present the case of a two-day-old male preterm newborn who exhibited widespread absence of skin, especially over the lower limbs, associated with scarring skin lesions and extensive milia from birth. Other findings included bilateral microtia, nail dystrophy in the fingernails, absence of toenails, fusion of toes, corneal opacity, and a broad nasal root. Additionally, systemic involvement included PA and congenital joint contractures (arthrogryposis). The newborn was diagnosed with CS based on clinical characteristics and X-ray results. The condition was managed using a multidisciplinary approach. Unfortunately, the neonate succumbed to death on the fourth day of life due to sepsis.

Uncommon Presentation of Dengue Fever in a G6PD-Deficient Adult: A Case Report

Dengue fever presents a diverse clinical spectrum which can lead to many complications. The outcome of these presentations predominantly depends on early diagnosis and judicious management. While complications involving the haematological system, such as cytopenia and bleeding, are well-known in severe dengue infections due to various factors, the occurrence of haemolytic anaemia in dengue fever is rare. An alteration in the redox state of immune cells due to Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency may lead to atypical presentations of dengue infection, such as intravascular haemolysis. A 37-year-old male initially presented to the emergency department with a 6-day history of fever, red-colored urine and severe shortness of breath. Routine tropical fever work-up detected an infection with the dengue virus, while severe enzyme deficiency was attributed as the cause of haemolysis. The presence of splenomegaly, haematuria, hyperferritinaemia, transaminitis and raised triglycerides was suggestive of Macrophage Activation Syndrome (MAS), which was confirmed through a bone marrow biopsy. He was diagnosed with dengue fever, complicated by MAS and haemolytic anaemia due to G6PD deficiency.

Oral Manifestations and Conservative Clinical Management of a 2-year-old Child with Congenital Ichthyosis: A Case Report

Jaya Agali Ramachandra, Pradnya Dhamnekar, Ganavi G Nayak

Congenital Ichthyosis (CI) is an uncommon genetic condition affecting tissues of ectodermal origin, including the skin, nails and tooth enamel. The thickening of the stratum corneum impairs the skin’s ability to act as a protective barrier due to aberrant epidermal cell differentiation, as well as lipid synthesis, metabolism and transport. This set of keratinisation disorders is clinically and etiologically diverse, with severe forms characterised by skin dryness, flaking and peeling, leading to a wide range of complications. CI involves mutations in various genes and presents with different symptoms that can significantly affect the patient’s quality of life. Although it affects tissues of ectodermal origin, little is known about its oral manifestations. Lamellar Ichthyosis (LI) is a type of CI that typically manifests at birth, with the infant found to be covered in a membrane. Xerostomia is one oral symptom that may increase the risk of dental caries. While many individuals with CI may present with normal dentition, some may experience dental defects, delayed tooth eruption and a higher risk of dental caries. In the context of CI, the primary consideration in dental care should include the presence of friable and tender skin, which necessitates extra caution during handling. It is crucial to ensure that any procedure minimises irritation and injury to the skin, as it is more vulnerable than usual. The present case report highlights a case of a two-year-old female child diagnosed with CI who presented with early childhood caries. Management may include a conservative approach for rehabilitation, utilising delicate handling of soft tissues to reduce patient discomfort and facilitate successful treatment.

Clinical Implication and Ontological Basis of Bilobed Spleen: A Rare Case Report

Chaitanya Singh, Neelesh Kanaskar

Anatomical knowledge regarding the external morphology of the spleen is essential for surgical intervention and radiological diagnosis. A characteristic feature of the spleen is the presence of splenic notches at the superior border; however, such notches rarely extend deep enough to be considered fissures or to separate the spleen into multiple lobes. To date, there are very few cadaveric reports of complete splenic fissures. During a routine dissection class of the abdominal region, the spleen removed from the abdominal cavity exhibited a morphological variation in the form of a complete fissure. The spleen showed a complete notch extending as a fissure from the superior to the inferior border, dividing the spleen into two lobes. This study provides valuable information regarding the anatomy and prevalence of splenic fissures and bilobed spleens. A bilobed spleen is a rare congenital malformation that should be considered distinct from other known splenic anomalies. The presence of splenic fissures in bilobed spleens can serve as a guide for surgeons during conservative splenectomy procedures.

Uncommon Presentation of Adenoid Cystic Carcinoma in the Parotid Gland: A Case Report

Adenoid cystic carcinoma is a rare form of cancer that primarily affects the salivary glands, although it can also occur in various other tissues, including the breast, skin, cervix and prostate. This malignancy is characterised by its slow growth and distinctive histological patterns, often presenting as a painless mass in the affected area. It is most commonly diagnosed in adults aged 40 to 60 years, with a slight predominance in females. The tumour is known for its potential to recur locally and metastasise, primarily to the lungs, although it rarely spreads to regional lymph nodes. Diagnosis typically involves a combination of medical history review, physical examination, imaging studies such as ultrasound, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and biopsy of the tumour tissue. The biopsy reveals the tumour’s histological characteristics, which are crucial for diagnosis. This is a case of a 65-year-old male who presented with a primary complaint of preauricular swelling for two months. The swelling was diagnosed as a low-grade malignant tumour of adenoid cystic carcinoma based on Fine Needle Aspiration Cytology (FNAC). The patient was managed with surgical excision followed by adjuvant chemotherapy and radiotherapy.

A Rare Case of Heterotopic Pregnancy in a Unicornuate Uterus

Shabista Shaikh, Prashansa Gupta, Harshad Patel, Janvi Patel, Varshini Vadithala

Heterotopic pregnancy, a condition involving simultaneous intrauterine and extrauterine pregnancies, is a rare clinical scenario, particularly when associated with a unicornuate uterus. This rarity underscores the importance of recognising and managing such cases promptly. A 24-year-old primigravida presented at 10 weeks of gestation with per vaginal spotting and abdominal pain, along with a history of ovulation induction. Pelvic ultrasound showed a heterotopic pregnancy in a unicornuate uterus, with a possible pseudo-gestational sac and a left ruptured tubal ectopic pregnancy. The combination of a ruptured ectopic pregnancy and an intrauterine pregnancy highlights the importance of early detection and surgical management. This case emphasises the rarity of heterotopic pregnancy in a unicornuate uterus. A unicornuate uterus with rudimentary horns results from incomplete Müllerian duct fusion and carries significant risks, including rupture during pregnancy. Early diagnosis and surgical intervention are essential to prevent life-threatening complications, with treatment options varying based on the patient’s condition and gestational age.

A Rare Paediatric Case of Double Appendix Anomaly with Appendiceal Neuroendocrine Neoplasm

Kovuri Umadevi, Bhavani Shanker Nityananda, Zuafshan Sultana, Mahendra J Parage

This case report presents a rare congenital anomaly: the presence of a double appendix, a condition observed in approximately 1 in 25,000 appendectomy cases. The discovery of a neuroendocrine tumour in one of the appendices further underscores the exceptional nature of this case. Present case is of an eight-year-old boy who was admitted with acute abdominal pain, during which emergency surgery revealed a double appendix. While one appendix appeared normal, the other exhibited a yellow nodular lesion suggestive of malignancy. Histopathological evaluation confirmed a Grade I well-differentiated neuroendocrine tumour measuring 1.2 cm. The tumour had invaded the serosa and the proximal surgical margin but showed no lymphovascular invasion. Immunohistochemical analysis demonstrated strong positivity for chromogranin and negativity for synaptophysin, with a low Ki-67 index of 3%, corroborating the diagnosis. Following National Comprehensive Cancer Network (NCCN) guidelines, the patient underwent a right hemicolectomy to ensure complete tumour removal and minimise the risk of recurrence. Subsequent histological examination showed no residual tumour or lymph node metastases. The patient recovered well, with no recurrence noted during follow-up. This case highlights the need for careful intraoperative exploration and thorough pathological assessment, particularly when rare anatomical anomalies are encountered. Documenting such unique findings enriches medical knowledge, raises clinical awareness and underscores the value of evidence-based surgical management in achieving optimal outcomes.

Impact of Inspiratory Muscle Training on Functional Capacity in a Patient with Interstitial Lung Disease and Right-sided Pleural Effusion: A Case Report

Shivani Dey, Vishnu Vardhan, Chitrakshi Choubisa

Interstitial Lung Disease (ILD) is a term for a collection of conditions that impact the lung parenchyma. Notable features include inflammation and fibrosis. The prognosis of ILD varies, largely depending on the severity and specific subtype of the disease. Pleural effusion can trigger further dyspnoea and lead to a decrease in functional capacity. Pulmonary Rehabilitation (PR), along with Inspiratory Muscle Training (IMT) through specific disease-focussed exercise techniques, can help address these symptoms while improving general well-being by enhancing exercise capacity and respiratory dynamics. This case describes a 56-year-old male farmer who came to our hospital with complaints of breathlessness during routine activities over the past month. He reported experiencing a productive cough for two months, alongside two days of dysuria, haemoptysis, loss of appetite, and weight loss. The patient was initially treated conservatively and underwent fibre optic endoscopy, physical therapy, and IMT, which showed significant improvement. The levels of breathlessness, exercise tolerance, and quality of life improved for the patient within two weeks following multidisciplinary care.

Forward Head Posture Adaptation Correlated with Scapular Dyskinesia Type1: A Case Study

Md Akhlaque, Shanthakumar Kalimuthu, Jahanvi Dave

People adapt poor posture particularly in the head and neck region, as a result of their sedentary lifestyles and use of technology. Forward head posture is most frequently, the most prevalent deviation from the natural bend of the cervical spine. Changes from the normal posture pattern led to pathological issues, which affect the surrounding muscles and joints. While forward head posture is also associated with Scapular Dyskinesia (SD) type 1, it is more observed in people who have forward head posture. SD type 1 is defined as the prominence of the inferior medial scapular border and its unusual rotation around a transverse axis. It is an uncommon type of SD that can occur in the aftermath of surgery or trauma. The outcomes are Scapular Dyskinesis Test, Numerical Pain Rating Scale, Neck Disability Index, Manual Muscle Testing, Shoulder range of motion, Lateral Scapular Slide Test and Posture Assessment. A 20-year-old male student with limited range of motion, forward head posture, and mild shoulder pain was the subject of this case study. The goal was to use physical therapy techniques to reduce pain, enhance scapular function, and correct posture. Exercises for strengthening and mobilising the scapular joint or shoulder joint were used, which decreased discomfort, improved shoulder joint range of motion and correct forward head posture. The results of the study showed that SD type 1, forward head posture, and shoulder pain were all improved by advance manual therapy of the shoulder girdle joints and muscles. Improving shoulder function requires addressing scapular problems. In addition to advocating for holistic management measures to aid in their recovery, this research emphasises the significance of acknowledging SD as a major contributor to forward head posture.

A Rare Co-existence of POLR1C-related Hypomyelinating Leukodystrophy and Congenital Pulmonary Adenomatoid Malformation in a Child: A Case Report

Rohan Acharya, Kumud Pahwa, Hunny Verma, Dinkar Yadav, Kapil Bhalla

Hypomyelinating Leukodystrophy 11 (HL-11) and Congenital Pulmonary Adenomatoid Malformation (CPAM) are rare conditions, and their co-occurrence is exceptionally uncommon. The co-occurrence of HL-11 and CPAM in a single patient has not been previously reported in the literature. A seven-year-old boy presented with progressive weakness, tremors, and developmental delay since the age of four and a half years. Developmental milestones, such as independent walking and fine motor skills, like grasping objects, were achieved later than expected for his age. Physically, the child exhibited a lean build, with height and weight in the 25th percentile for his age, and no dysmorphic features. Neuroimaging studies conducted at seven years of age revealed periventricular white matter abnormalities consistent with leukodystrophy. Genetic analysis using whole-exome sequencing identified a heterozygous mutation in the POLR1C gene, confirming HL-11. Due to recurrent pneumonia, High-Resolution Computed Tomography (HRCT) of the chest revealed a CPAM in the right lung. The index case was managed with levetiracetam, pacitane, baclofen, propranolol, occupational therapy, and supportive care. This case underscores the need to consider coexisting diagnoses in children with complex neurological symptoms and atypical respiratory findings, even when a neurological condition has been established, emphasising the importance of comprehensive evaluation for optimised patient management.

The Efficacy of Janda Approach for the Treatment of Text Neck Syndrome: A Case Report

Shavez Mansoori, Sunita Sharma, Sanam Maurya

Text neck is an overuse syndrome which affects the head, neck and shoulders, usually resulting from excessive strain on the cervical spine from looking in a forward and downward position at any hand held devices over long period of time. This may result in headache as well as arm, shoulder and neck pain. Treatment usually consists of a combination of pharmacological, nonpharmacological, and physiotherapeutic interventions such as Kendal exercise, mobilisation, myofascial release, muscle energy technique, proprioceptive neuromuscular facilitation technique, neck stabilisation exercises, and electrotherapy. Janda approach is a treatment technique which helps in reducing pain, restoring mobility, enhancing muscle strength, and functions of the cervical spine. This case report aims to evaluate the therapeutic effects of Janda approach along with conventional treatment on pain, Cervical Range of Motion (CROM) and overall function of the cervical spine in Text Neck Syndrome. This is a case of 24-year-old male suffering from Text Neck Syndrome since 1 year. He had a complaint of pain and stiffness in the neck.The aggravating factors were reading, writing, and using a mobile phone, while relieving factors were rest or sitting with neck extension on chair. Janda approach along with conventional treatment was given for 5 days per week for 2 weeks. visual analogue scale, pressure biofeedback, CROM and Neck Disability Index were used as an outcome measures.After 2 weeks of intervention, there were significant decrease in pain and neck disability, and improved muscle strength and range of motion in cervical spine. This case report concluded that Janda approach along with conventional treatment can be used as an effective intervention protocol for reducing pain, increasing range of motion, enhancing muscle strength and reducing neck disability in patients with Text Neck Syndrome.

Integrating Pain Neuroscience Education in Managing Chronic Plantar Fasciitis: A Case Report

Riya Kalra, Kanu Goyal, Manu Goyal

Chronic Plantar Fasciitis (CPF) is an inflammation of the plantar fascia that lasts for more than 3 months and is caused by repetitive stress on the plantar fascia. Chronic pain patients develop central sensitivity, which means that treatment given on the periphery is insufficient to manage their symptoms.Pain Neuroscience Education (PNE) may help to reduce anxiety and catastrophic thinking related to pain. Currently, there are insufficient data on the effects of PNE as an adjunct to physiotherapy in CPF patients. This case study involves a 26-year-old woman who was diagnosed with CPF and who experienced heel discomfort with her first few steps in the morning and during prolonged standing for the past five years.To measure pain, Numeric Rating Scale (NRS) and to measure ankle dysfunction, Foot and Ankle Disability Index (FADI) was taken,to measure pain Catastrophisation, Pain Catastrophising Scale (PCS) and to measure Kinesiophobia, Tampa Scale for Kinesiophobia (TSK) was taken at baseline, 3rd and on 6th week.Physiotherapy treatment included Plantar fascia release, Plantar fascia stretching, and strengthening of intrinsic muscle of foot and PNE includes metaphors and storytelling. The patient demonstrated significant improvement in pain and activity limitations along with significant improvement in Pain Catastrophization and Kinesiophobia. This case study illustrates that integrating PNE along with physiotherapy treatment is an effective strategy for treating individuals with CPF.

Efficacy of Low-frequency Repetitive Transcranial Magnetic Stimulation, along with Conventional Rehabilitation on Functional Independence in an Individual with Spinocerebellar Ataxia: A Case Report

Akshata Shinde, Divya Midha, Narkeesh Arumugam, Priyanka Dangi

Spinocerebellar Ataxia (SCA) is a progressive, autosomal dominant, neurodegenerative disorder distinguished by deficits in motor-coordination and balance. It significantly impairs daily functioning, leading to increased reliance on assistance. Contemporary therapeutic strategies primarily emphasise symptomatic management aimed at enhancing functional independence. Therefore, early intervention is crucial to decelerate progression of the condition. The case-report aimed to evaluate the efficacy of low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) combined with conventional rehabilitation in improving motor-coordination, balance, and quality of life in an individual with SCA. This study describes a case of a 56-year-old female diagnosed with SCA who presented with a history of balance impairment, mild incoordination, slowness in gait and difficulties with activities of daily living since 8 years. The participant underwent low-frequency rTMS (over the inion, bilateral cerebellar hemispheres) at 90% Resting Motor Threshold (RMT), 900 trains at 1 Hz, for 15 minutes/session, combined with conventional rehabilitation, including virtual reality and dual-task on treadmill. The participant was intervened for 5 days/week for the duration of 4-week. Progress was monitored using the Scale for the Assessment and Rating of Ataxia (SARA), Modified Clinical Test for Sensory Interaction on Balance (mCTSIB) and Quality of Life Scale (QOLS). Pre-intervention and post-intervention scores at Day 0 and Day 30 of SARA and mCTSIB were 13/40 to 5/40 and 46/120 to 97/120, respectively, indicating a marked improvement in motor-coordination and balance. The QOLS score also improved from 70/112 to 92/112, indicating enhanced overall health status, selfsufficiency and independence in daily activities. The case study indicated that integrated effects of rTMS with conventional rehabilitation could offer a viable therapeutic strategy for improving the symptoms of SCA, emphasising the need for further research to explore its long-term efficacy and applicability across larger populations.

Effectiveness of Constraint induced Movement Therapy on Lower Limb Function in Monoplegia: A Case Study

Paulraj Manickavelu, J Subapradha

Introduction: Stroke is one of the leading causes of motor impairments, which significantly impact an individual's functional mobility and quality of life. While much attention has been directed towards upper limb rehabilitation, the importance of lower limb recovery is equally critical in improving overall mobility and independence. Constraint-Induced Movement Therapy (CIMT) has demonstrated substantial effectiveness in enhancing motor function in the upper limbs of stroke survivors. However, its application to the lower limbs, particularly in cases of monoplegia, is less understood and has not been as extensively researched. This case study explores the potential impact of CIMT on improving the function of the paretic lower limb in a patient with monoplegia following a stroke. Aim: The effectiveness of CIMT for improving lower limb function and voluntary muscle control in monoplegia. Materials and Methods: The case study involved a 48-year-old female patient who presented with monoplegia following an ischemic stroke. The patient had a medical history of diabetes mellitus and hypertension and displayed significant motor deficits in the left lower limb, which required 75% assistance for mobility. CIMT protocol was implemented for a duration of 4 weeks, where the patient’s unaffected limb was constrained, forcing the use of the paretic lower limb during daily functional tasks and therapy sessions. Results: After completing the 4-week CIMT , notable improvements were observed in the patient’s gait quality, muscle strength, voluntary muscle control, and overall mobility. The statistical analysis of pre- and post-treatment assessments demonstrated significant improvements. Conclusion: This case study indicates that CIMT has the potential to improve lower limb function in monoplegia, particularly in enhancing voluntary control and mobility. However, further research involving larger sample sizes and longer treatment durations is needed to confirm the broader applicability and long-term benefits of CIMT in lower limb rehabilitation.

Role of Physiotherapy Management in Tennis Elbow: A Case Report

Sushma Singh Chauhan

Repetitive hand movements in daily activities or work can lead to arm discomfort, particularly in the elbow, increasing the risk of tennis elbow. Tennis elbow is a condition characterised by reduced joint mobility, impaired muscle performance, and inflammation of the wrist extensor tendon at the lateral epicondyle, resulting in pain and disability. It affects approximately 40% of the population, particularly individuals aged 35–54 years, and is common among tennis players, with 75–80% experiencing elbow pain due to this condition. Physiotherapy modalities, including LASER and exercise therapy, play a significant role in its management. A 45-year-old male sportsperson from Bundelkhanduniversity, Jhansi presented with left elbow pain persisting since August 2024, following table tennis sport. The pain interfered with daily tasks such as personal hygiene, playing game, lifting objects, motorcycle riding, and office typing. The patient underwent three physiotherapy sessions, each lasting 60 minutes, incorporating Transcutaneous Electrical Nerve Stimulation (TENS), LASER, and exercise therapy. Outcomes were assessed using the Numerical Rating Scale (NRS) for pain, Manual Muscle Testing (MMT) for muscle strength, goniometry for range of motion, and the Patient-Rated Tennis Elbow Evaluation (PRTEE) for functional ability. Significant improvements were noted in pain reduction, muscle strength, joint mobility, and functional performance. The primary goal of the physiotherapy program for tennis elbow is to alleviate pain, enhance muscle strength, restore joint range of motion, and improve functional capabilities. Exercise therapy was particularly effective in promoting muscle contraction and relaxation, aiding precise movement control. A comprehensive physiotherapy program, including TENS, LASER, and structured exercise therapy, effectively reduced pain and enhanced range of motion, muscle strength, and overall functional ability in a patient with tennis elbow.

Novel Cervical Pillow: A Case Series on its Effectiveness in Alleviating Pain and Enhancing Sleep in Patients with Cervical Spondylosis

Swarup Ghosh, Kanu Goyal, Manu Goyal

Cervical spondylosis, a degenerative condition of the cervical spine, significantly impacts quality of life through debilitating neck pain, stiffness, and disrupted sleep. While various treatments exist, the role of pillow selection in maintaining cervical lordosis during sleep remains under-explored and often overlooked by most healthcare practitioners. This study investigates the efficacy of a novel cervical pillow designed with optimal parameters, in conjunction with postural reeducation exercises only, in improving pain, disability, and sleep quality in individuals with cervical spondylosis. Four patients (three females and one male) with confirmed radiological evidence of cervical spine degeneration and clinical symptoms of neck pain and disturbed sleep persisting for over three months were recruited for the study.Outcome measures, including pain, disability, and sleep quality, were evaluated using the Numeric Pain Rating Scale (NPRS), the Neck Disability Index (NDI), and the Pittsburgh Sleep Quality Index (PSQI), respectively, with baseline and post-intervention scores recorded after a four-week period. During the intervention, patients were provided with a novel cervical firm pillow, measuring 10–12 cm in height, to use exclusively during sleep. Additionally, self-directed postural re-education exercises were demonstrated, with specified repetitions and sets prescribed for practice throughout the study duration.The study demonstrated statistically significant improvements across all outcome measures compared to baseline. The Numerical Pain Rating Scale (NPRS) showed a reduction from 7.33±0.51 to 2.17±0.40 (p<0.01, 95% CI), the Neck Disability Index (NDI) decreased from 55.68±5.78 to 10.54±1.11 (p<0.01, 95% CI), and the Pittsburgh Sleep Quality Index (PSQI) improved from 12.17±0.40 to 4.67±1.36 (p<0.01, 95% CI). This study underscores the clinical significance of appropriate pillow selection in managing the multifaceted symptoms of chronic cervical spine degeneration, including pain, disability, and disrupted sleep.

Effects of Blood Flow Restriction Training on Glycated Haemoglobin and Lipid Profiles among Individuals with Type 2 Diabetes Mellitus: A Case Series

Type 2 Diabetes Mellitus (T2DM) is a complex multifactorial polygenetic disease also known as “noninsulin-dependent diabetes” or “adult-onset diabetes” (due to a progressive loss of adequate beta-cell insulin secretion frequently on the background of insulin resistance). Hyperglycaemia (indication of elevated HbA1c) drives microvascular complications, while diabetic dyslipidaemia (high triglycerides and low-density lipoprotein, and low high-density lipoprotein, etc.) heightens cardiovascular risk in T2DM. Controlling HbA1c and lipid levels among individuals with T2DM is a significant challenge for a multidisciplinary team. This case series aimed to determine the effects of BFRT on glycated hemoglobin and lipid profiles among individuals with T2DM.The study included 4 patients having a history of T2DM from 3 to 8 years. The intervention consists of three phases: warm-up, Blood Flow Restriction training programme, and cool-down. The BFRT protocol used 80% arterial pressure for lower-limb exercises (leg curls, leg extensions, hip flexion) and 50% for upper-limb exercises (arm curls, triceps extensions). Training began at 20% of 1Rep Max (RM), with lower-limb intensity increasing to 30% in the final two weeks and the training was at 20%of 1 RM for the upper extremity. Each session included four sets (30 reps in the first set, 15 in the next three) with 30-second breaks. The cool-down phase repeats the warm-up exercises. The treatment was given for 3 days a week for 4 weeks.HbA1c and lipid parameters (Total Cholesterol (TC), High-density Lipoprotein (HDL), Low-density Lipoprotein (LDL), Very-low Density Lipoprotein (VLDL), and Triglycerides (TGs)) were measured at baseline and after 4 weeks of intervention. The result showed significant improvement in all the outcome variables, HbA1c (p=0.003), TC (p=0.01), HDL (p=0.008), TG (p=0.051), VLDL (p=0.002), and LDL (p=0.04).. This study concluded that BFRTis effective in improving HbA1C and lipid profiles suggesting its potential to reduce cardiovascular as well as metabolic risks. Through the principle of peripheral vascular occlusion, BFRT promotes muscle hypertrophy by enhancing mechanotransduction, hormonal responses, reactive oxygen species generation, and cell swelling. It also stimulatesglucose transporter 4(GLUT4) translocation via calmodulin-dependent protein kinase (Ca2+/CAMKII) pathway and activates AMP-activated protein kinase, improving glucose uptake and metabolic regulationand may improve metabolic regulation in individuals with T2DM.

Unusual and Uncommon Presentations of Extrapulmonary Tuberculosis: A Case Series

Pooja Shah, Sae Pol, Abhilasha Belpatre, Tejaswini Olambe, Rajesh Karyakarte

Tuberculosis (TB) is primarily a disease of the lungs; however, Extrapulmonary TB (EPTB) mainly affects the lymph nodes, pleural cavity and spine. Other sites are considered rare and uncommon. Authors present five interesting cases of EPTB from different sites. The first case involved thyroid TB that had spread to the neck. The Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) test was positive. The patient was started on antitubercular treatment and was discharged after undergoing incision and drainage. The second case is of an immunocompetent patient with disseminated TB, which spread from the lungs to the pleura, muscles, subcutaneous tissue and skin, resulting in fistula formation. The CBNAAT was positive, and the Line Probe Assay (LPA) indicated that the strains were sensitive to rifampicin and isoniazid. The third case details a female patient with genital TB who was unable to conceive. An ultrasound examination revealed issues in the adnexa. The CBNAAT was positive (with low levels of Mycobacterium tuberculosis detected, and rifampicin was found to be sensitive), but her sputum sample was negative. The fourth case describes disseminated TB in a seropositive female, where her synovial fluid tested positive and her Computed Tomography (CT) chest findings were suggestive of TB. The fifth case is of abdominal TB in a patient with a history of previous abdominal surgery. Her CBNAAT was positive and she recovered following treatment. In present study, all the cases presented unusual manifestations and the diagnosis was made based on radiological findings combined with microbiological laboratory investigations. Therefore, clinically suspecting these cases and confirming the diagnosis through microbiological tests is critically important.

Cytomegalovirus Infection in Infants: A Case Series on Varied Clinical Manifestations

Caroline D Shira, Emjaj Rahman

Cytomegalovirus (CMV) is a common cause of congenital infection, presenting a wide spectrum of clinical manifestations and varying grades of severity. In the neonatal period, CMV infection may manifest as jaundice, hepatosplenomegaly, petechiae, microcephaly, and chorioretinitis. Nonetheless, congenital CMV infection may be asymptomatic in 90% of infants at birth. Late diagnosis of congenital infection can significantly affect the quality of life for children due to neurodevelopmental delays and sensorineural hearing loss. Globally, people are more informed about neural tube defects, foetal alcohol syndrome, and toxoplasmosis than about congenital CMV, even though congenital CMV infection poses a greater threat to newborns. Hence, understanding the clinical manifestations and treatment modalities for CMV infection is paramount for effective management and prevention strategies.In this case series, the authors present seven cases of congenital CMV infection, with presentations varying from cirrhosis to subarachnoid haemorrhage, aiming to shed light on the varied clinical presentations, diagnostic challenges, and management strategies for CMV infections in infants.

Embolia Cutis Medicamentosa Secondary to Commonly used Drugs: A Series of Four Cases

S Akshata Yadav, TS Rajashekar, K Sureshkumar

Nicolau syndrome, also referred to as Embolia Cutis Medicamentosa, is a rare iatrogenic complication typically following intramuscular, subcutaneous, or intra-articular drug administration. It is characterised by the sudden onset of severe pain, followed by erythema, violaceous discoloration, and skin necrosis at the injection site. This report presents a case series of four patients aged 13, 30, 43, and 56 years, who developed Nicolau syndrome after intramuscular injections of commonly used drugs such as Deriphyllin, Diclofenac, Tramadol, and Betamethasone. The clinical presentation in all cases involved acute pain followed by ulceration or necrosis over the gluteal region. Diagnosis was primarily clinical, supported by normal laboratory parameters and ultrasonographic findings showing subcutaneous tissue changes. Management included conservative approaches such as wound care with topical antibiotics, systemic analgesics, and oral antibiotics as needed. All patients recovered with residual scarring and post-inflammatory hyperpigmentation. This case series emphasises the importance of correct injection techniques, including appropriate site selection (upper outer quadrant of the buttock), using the Z-track method, aspirating before injection, and employing appropriate needle lengths to minimise risk. Given that Embolia Cutis Medicamentosa is preventable, reporting such cases is crucial to raise awareness among healthcare professionals. Early diagnosis and appropriate intervention can significantly reduce the complications and morbidity associated with this condition.

Neutrophilic Dermatoses: A Case Series of Unusual Adverse Effects with Commonly Administered Drugs

Yeragonda Susmitha, TS Rajashekar, K Suresh Kumar

Neutrophilic Dermatoses (NDs) are inflammatory conditions characterised by sterile neutrophilic infiltrates on histopathology. Multiple clinical presentations can occur in a single patient with ND. The location of the neutrophilic infiltrate (in the skin’s superficial, deeper, or subcutaneous layers), the clinical features, and the duration of the disease help to identify ND. Robert Douglas Sweet introduced the term neutrophilic dermatoses in 1964 to describe febrile neutrophilic dermatoses, now known as Sweet syndrome. The major conditions in this group include Pyoderma Gangrenosum (PG), Sweet Syndrome (SS), subcorneal pustular dermatoses, Generalised Pustular Psoriasis (GPP), and Inflammatory Bowel Disease (IBD)-associated neutrophilic dermatoses. The present case series described five female patients, aged 32 to 85, who developed painful, red, pus-filled skin lesions after taking common medications such as aceclofenac, diclofenac, and isotretinoin. The cases included Neutrophilic Eccrine Hidradenitis (NEH), Sweet syndrome, and PG, with symptoms such as fever, sore throat, and arthralgia. Skin biopsies confirmed the diagnoses, showing inflammatory changes, dermal oedema, and features such as vascular injury. Blood tests consistently showed neutrophilia and elevated inflammatory markers {Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP)}. Management consisted of stopping the suspected offending medications and initiating corticosteroid therapy, which led to improvement in symptoms. This case series highlights the importance of promptly identifying drug-induced neutrophilic disorders to avoid misdiagnosis, inappropriate treatment, and potential complications. Heightened awareness among clinicians is essential to facilitate timely diagnosis and effective management of these rare yet significant dermatological reactions. Hence, the case series aimed to summarise therapeutic innovations related to the principal neutrophilic dermatoses.

The Fungal Footprint: Radiologic Spectrum in Pulmonary, Paranasal Sinus and CNS Infections

P Jenikar, MG Sai Shankar, B Harshavardhan, Sachin Virmani

Fungal infections can involve multiple organ systems, with imaging playing a pivotal role in their diagnosis and management. Fungal infections of Paranasal Sinuses (PNS) can be classified into invasive and non-invasive forms. Invasive fungal infections can be further divided into acute, chronic, or chronic granulomatous entities. It mainly affects immunocompromised patients with uncontrolled diabetes mellitus, Human Immunodeficiency Virus (HIV), and those on chemotherapy or chronic oral corticosteroids. Computed tomography remains the gold standard for sinonasal imaging while Magnetic Resonance Imaging (MRI) excels in assessing intraorbital and intracranial extensions. It is important to know and identify the characteristic imaging patterns of invasive and non-invasive fungal rhinosinusitis, and the radiologist is very important in refining the diagnosis to prevent a possible fatal outcome. This case series highlights the radiologic manifestations of fungal infections affecting the pulmonary system, Central Nervous System (CNS), and peripheral nervous system with characteristic imaging features ranging from invasive aspergillosis and mucormycosis to allergic fungal disease and rhinosporidiosis. Imaging findings includes sinus opacification, bony erosion, cavernous sinus invasion, orbital involvement, and cavitary lung lesions with Monod sign, ground-glass opacities and hyperdense mucus played a crucial role in diagnosis. By presenting a range of cases, this series aims to provide a comprehensive understanding of the imaging features associated with these infections, facilitating accurate diagnosis and treatment planning for radiologists and clinicians.

The Relevance of Follow-up after Primary Management of Omphalocele in Beckwith-Wiedemann Syndrome: A Series of Five Cases

Santosh B Kurbet, Rami Reddy

Omphalocoele, also called exomphalos, though a large disease by itself, can just be one part of association of much broader growth disorder of Beckwith-Wiedemann Syndrome (BWS), which one needs to be familiar with primarily. The omphalocoele is amenable to primary surgical correction in neonatal period. With the successful treatment of omphalocoele in the spectrum of BWS does not conclude the management, as the literature suggests the follow-up is imperative as there is increased incidence of visceral malignancy and blood cancers in these patients over the years of life. Present series is of five cases of BWS treated at birth for omphalocoele by surgery successfully, kept on regular follow-up, with one child developing leukaemia and loss of life due to the disease. The emphasis thus is on the need identification of the syndrome of BWS in a case of omphalocoele and also elaborating on their follow-up, long enough after surgery because of the risk of development of various malignancies.

Navigating the Dual Challenge of Difficult Airway and Low Cardiac Reserve in Oral Cancer Surgery: A Case Series

Shilpa Sarang Kore, Dipti Rana, Amita Vishal Sale

Oral cancers, particularly Squamous Cell Carcinomas (SCCs), cause fibrosis and structural changes within the oral cavity, creating complex airway management challenges. These cases often present anaesthetic difficulties, including restricted access for instrumentation, distorted anatomy that increases the difficulty of ventilation and intubation, and a heightened risk of bleeding or airway obstruction. Postoperative concerns, such as airway oedema, respiratory compromise, and pain management, further complicate the perioperative period. This case series explores the anaesthetic management of three patients with oral cancer and significant cardiovascular comorbidities. Two key factors that created anaesthetic challenges were restricted mouth opening of less than 2 cm (less than two finger breadths) and compromised cardiac function, which carries risks of haemodynamic instability and arrhythmias. Awake Fiberoptic Intubation (AFO) was chosen to secure the airway and avoid a situation where ventilation or intubation would be impossible. The nasal cavities were instilled with xylometazoline drops. Additionally, a transtracheal block was performed in the sitting position, using 4 mL of 4% topical lignocaine to anaesthetise the trachea, significantly reducing the cough reflex and discomfort during intubation. Sedation was provided with midazolam and fentanyl after the administration of supplementary oxygen. Fiberoptic intubation was carried out, and the airway was secured by railroading a flexometallic tube over the bronchoscope. Induction was performed with midazolam (0.04 mg/kg), fentanyl (2 mcg/kg), and vecuronium (0.1 mg/kg). Anaesthesia was maintained using sevoflurane, nitrous oxide, and oxygen. Haemodynamic monitoring was conducted with Central Venous Pressure (CVP) and Arterial Blood Pressure (ABP) measurements. The surgical procedure went uneventfully. After surgery, the patients were kept on a T-piece in the Post-Anesthesia Care Unit (PACU) and were closely monitored for airway patency, respiratory effort, and haemodynamic stability. This case series emphasises anesthetic strategies that manage complex airway and cardiovascular issues in high-risk oral cancer surgery while addressing critical postoperative considerations.

The Cryptococcus neoformans Challenge in Immunocompromised Patients: A Two Year Case Series from Western Rajasthan with Review of Literature

Cryptococcosis is a severe opportunistic fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii (critical fungal pathogens), primarily affecting immunocompromised individuals such as those with Human Immunodeficiency Virus (HIV), postorgan transplant patients, or those on prolonged immunosuppressive therapy. Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. This case series highlights five patients with varied clinical presentations, including postrenal transplant complications, co-infection with TB and disseminated disease in HIV-positive individuals. Diagnosis relied on cerebrospinal fluid analysis, cryptococcal antigen testing and advanced imaging techniques. Treatment included liposomal amphotericin-B, fluconazole and supportive therapies. Despite aggressive management, outcomes varied, with some patients surviving while others succumbed to the infection. The series underscores the challenges in diagnosing and managing cryptococcosis, particularly in resource-limited settings, as well as the increased mortality associated with co-infection, which is a public health concern. Therefore, authors emphasise the need for improved diagnostic tools and integrated management strategies for better patient outcomes. With the rise in case studies of cryptococcosis, there is an increase in awareness; however, to control this menace, a high level of alertness and surveillance must be maintained at both clinical and laboratory levels. Only then can this “awakening giant” be contained.

Blunt Ocular Trauma Commonly Presenting to the Emergency Department: A Case Series from a Tertiary Care Hospital in Banaskantha, Gujarat, India

Rahul Navinchandra Bakhda

Blunt ocular trauma is a leading cause of ocular morbidity and visual impairment. Blunt ocular trauma is also involved with trauma to other parts of the body. Head injury is commonly accompanied with blunt ocular trauma. Common causes of blunt ocular trauma are road traffic accidents, assault, alcohol-related incidents and workplace injuries. This case series includes some common ocular manifestations of blunt ocular trauma, like lid oedema, periorbital ecchymosis, subconjunctival haemorrhage and chemosis, that commonly present to the emergency department along with trauma to other parts of the body. Common presenting symptoms include pain, loss of vision, blurring of vision, redness, increased watering, swelling around the eye and bleeding. This case series mainly deals with anterior segment manifestations of blunt ocular trauma that are frequent in the emergency department. Ocular trauma can significantly affect the future quality of life. Ocular trauma is a preventable public health problem worldwide. Preventive measures should be taken by the government to educate people regarding safety precautions in the workplace, better vehicular safety measures and prevention of blunt ocular trauma. Community education is an essential part in prevention. Early diagnosis and prompt intervention can help prevent visual impairment.

Rare Clinical Image of Cutaneous Mastocytosis

Shubham Khanke, Mujahid Khan, Keyur Dudhat, Pratiksha Mahure

Mastocytosis, a rare condition also referred to as a clonal bone marrow disorder, is characterised by an excessive presence of CD34+ mast cell progenitors and functionally impaired mast cells. This disorder can affect both adults and children, leading to symptoms such as hives, itching, and potentially life-threatening anaphylactic shock. Often misdiagnosed, mastocytosis is frequently associated with other underlying conditions, indicating that its prevalence may be underestimated. The disease can present in two distinct forms: Cutaneous Mastocytosis (CM) and systemic mastocytosis. These conditions impact multiple bodily systems, leading to a diverse array of symptoms and clinical manifestations (1). An 18-year-old male presented with a one-year history of pruritus and discolouration affecting his legs. Upon examination, pigmented lesions were observed, some of which were elevated and exhibited red or brown hues, as seen in (Table/Fig 1). These lesions were prone to blistering when subjected to friction, and no systemic abnormalities were noted. Accompanying symptoms, including pruritus, erythema, musculoskeletal pain, and fatigue, were discovered. The diagnosis was made based on a Complete Blood Count (CBC), serum tryptase, and skin biopsy confirming mastocytosis, as shown in (Table/Fig 2). The serum tryptase level was 16 ng/mL. The histopathological findings revealed a mild to moderate perivascular and interstitial infiltrate of mast cells in the dermis. The mast cells were round to oval in shape with granular cytoplasm. No significant atypia was observed in the mast cell morphology. There was an absence of epidermal involvement, and the overlying epidermis appeared unremarkable. Dermal collagen appeared intact with no evidence of fibrosis. Blood vessels within the dermis were unremarkable, without evidence of vasculitis. Toluidine Blue Stain highlighted positive for metachromatic granules, confirming the presence of mast cells. The differential diagnosis for mastocytosis includes urticaria, pruritic skin disorders, melanocytic nevi, autoimmune bullous skin disorders, and Langerhans cell histiocytosis (2). The treatment was administered as Gandhak Rasayan 250 mg, two tablets BD after food, Panchatikta Ghrita one teaspoon in the morning, Arogyavardhini Vati 250 mg BD, and Cutis ointment for local application for fifteen days. The skin is the organ most commonly affected by mastocytosis. CM is categorised based on its clinical manifestations and is also characterised by the timing of disease onset. Typically, CM manifests during early childhood; however, cases of adult-onset CM are also observed (3). In pediatric patients, the likelihood of systemic involvement is relatively low. Childhood-onset mastocytosis shows spontaneous, partial, or complete remission in 67% of cases, whereas in adults, systemic mastocytosis is present in more than 25% of CM cases (4). Mastocytosis is defined by the clonal expansion of mast cells across multiple organs. In the case of childhood-onset mastocytosis, approximately 90% of instances manifest before the age of 2, with a minority presenting at birth (5). Adult-onset mastocytosis typically manifests between the ages of 20 and 35 years and is frequently linked to mutations in the c-KIT gene, particularly in exon 17. In 2-4% of instances, mastocytosis may present as a familial condition, with at least one first-degree relative also exhibiting the disorder. There are three forms of CM, with Maculopapular Cutaneous Mastocytosis (MPCM) and Urticaria Pigmentosa (UP) being the most prevalent, accounting for 70-90% of cases (6). This is followed by mastocytoma of the skin, which occurs primarily in children and represents 10-30% of cases. Diffuse CM is exceedingly uncommon, typically presenting at birth or during early infancy, with an incidence of 1-3%. The main objective of the treatment for mastocytosis is to manage symptoms associated with mast cell mediators. The therapeutic foundation lies in antagonists of the histamine receptor and short-term topical corticosteroids. First-generation and second-generation H1 antihistamines can effectively manage skin manifestations, including pruritus, flushing, and a burning sensation on the skin. The first-line drugs are nonsedating H1 antihistamines (7). Phototherapy serves as a secondary treatment option that may be utilised when antihistamines fail to yield the anticipated benefits. Emerging therapeutic alternatives encompass omalizumab and agents that target KIT (8). In recent years, omalizumab, a monoclonal antibody that specifically targets human IgE, has emerged as a promising treatment alternative for mastocytosis linked to recurrent anaphylaxis (9).

Trichoepithelioma: A Rare Skin Condition with Significant Psychosocial Burden

Rohit Arun Waskar, Dipika Chakole, Bhagyashri Chaudhari, Sourabh Deshmukh

Trichoepithelioma is a rare, benign tumour originating from hair follicles. These tumours are generally presented as small, firm papules or nodules that often match the skin colour or appear yellowish. They are predominantly found on the face, especially around the nose and forehead (1),(2). This case details a 58-year-old female presenting with multiple papules on her face, accompanied by mild, intermittent itchiness and dryness that persisted for the past 20-25 years. The condition significantly impacted her quality of life both socially and mentally. Despite consulting various dermatologists, the patient did not receive effective treatment. Histopathological examination of the lesions showed no evidence of malignancy. A family history was noted, as the patient’s mother also had a few similar lesions around her nose. Differential diagnoses included Basal Cell Carcinoma (BCC), syringoma, and fibrous papules of the face, which were ruled out based on clinical presentation and pathophysiological differences. BCC was excluded due to its malignant nature, syringomas were ruled out as they are typically found around the eyes, and fibrous papules are mainly confined to the nose. Therefore, the diagnosis of multiple familial trichoepithelioma, a hereditary form of benign trichoepithelioma, was confirmed (Table/Fig 1), (Table/Fig 2), (Table/Fig 3). Genetic analysis revealed that mutations in the CYLD gene on chromosome 16q12-q13 are the primary cause of multiple familial trichoepithelioma. The CYLD gene encodes a protein that negatively regulates cell proliferation and inflammation, including the Wnt/β-catenin and NF-κB pathways. A mutation in CYLD leads to uncontrolled cell growth, contributing to tumour formation (3). Histologically, trichoepitheliomas differ from BCCs by the presence of basaloid cells surrounded by fibrous stroma and keratin-filled horn cysts (4). Treatment for trichoepithelioma typically involves surgical excision or ablative laser therapy. However, these treatments may result in unsatisfactory outcomes and tumour recurrence. Pharmacological interventions, when used alone or in combination with traditional methods, may offer partial responses, but evidence supporting their efficacy remains largely anecdotal (5). In this case, the patient was treated with Ayurvedic remedies, including Tab Neem 500 mg twice daily (BD) with Haridra Jal as anupan, and local application of coconut oil to soothe dryness and provide a cooling effect. These treatments were intended as supportive care to reduce inflammation and alleviate symptoms, though their ability to fully resolve the condition is limited.

Solitary Myocysticercosis of Sternocleidomastoid Muscle

Agrawal Shilpi, Ravanagomagan

An eight-year-old female child presented to the paediatric outpatient department with a complaint of swelling in the neck on the right side. Her mother noticed the swelling six weeks ago, and it has been progressively increasing in size. The patient is a pure vegetarian and has a history of regularly eating vegetable and fruit salads. Additionally, there was a history of consuming salad from a hotel 10 weeks prior. Upon examination, the swelling measured approximately 2×3 cm (Table/Fig 1). The extent of the swelling was as follows: anteriorly, it was located 5 cm from the midline; posteriorly, it was just on the anterior border of the right sternocleidomastoid muscle; superiorly, it was 7 cm down from the right angle of the mandible; and inferiorly, it was 5 cm from the mid-part of the right clavicle. Blood investigations revealed nothing significant. An ultrasonography of the neck region showed a well-defined hypoechoic lesion measuring 17.4×5.7×20.7 mm in the right sternocleidomastoid muscle, with an eccentric mural nodule in its distal part and no evidence of vascularity. Fine Needle Aspiration Cytology (FNAC) was performed. In the cytology slides, we observed a mixed inflammatory infiltrate comprising polymorphs, eosinophils, histiocytes, lymphocytes, and phagocytes (Table/Fig 2), along with a loose aggregate of histiocytes containing admixed inflammatory cells. These histiocytes exhibited abundant pale cytoplasm and a large vesicular nucleus with a prominent nucleolus, with some displaying epithelioid morphology (Table/Fig 3). A fragment of the bladder wall from a cysticercus larva was noted. The larval tissue exhibited a fibrillary stroma with interspersed, minute parasitic nuclei. Additionally, scattered phagocytes with intracytoplasmic nuclear debris were observed in the background (Table/Fig 4). (Table/Fig 5) shows a higher magnification view of the same specimen. The patient was started on a tablet of albendazole at a dosage of 15 mg/kg/day for 28 days. Two weeks after starting the treatment, the swelling began to reduce in size and resolved completely by four weeks of therapy (Table/Fig 6). During regular follow-up for two months after the therapy, there was no recurrence of the swelling. Cysticercosis, caused by Taenia solium in humans, is a type of parasitic infection. The larval cyst of this tapeworm leads to this infection, which is most common in developing countries like India due to poor hygiene, sanitation, and open-air defaecation. It is endemic in certain developing regions of Africa, Eastern Europe, Mexico, and Southeast Asia (1). Our patient presented with an isolated, painless, non-erythematous swelling in the sternocleidomastoid region. Notably, she denied any neck stiffness or warmth, which differs from the presentations described by Gunasekaran PK et al., (2). The patient was a lifelong vegetarian with no history of pork consumption, consistent with observations by Chennamanen V, which suggest alternative routes of infection (3). The location of the swelling within the sternocleidomastoid muscle mirrored cases reported by Singh R et al., (4). The patient was treated medically with albendazole at a dosage of 15 mg/kg/day for 28 days, a regimen commonly employed and supported by recent literature, such as that by Lahel RS et al., (5). After two weeks of therapy, the swelling reduced. Surgical intervention for myocysticercosis is typically reserved for cases that are unresponsive to medical therapy or those involving ocular cysticercosis.

Iatrogenic Carotid-jugular AV Fistula in a Patient with Polycystic Kidney Disease and Mitral Valve Prolapse: A Case of Diagnostic Complexity

Poonam Hannurkar, Jekha Mary Babu

Dear Editor, Autosomal Dominant Polycystic Kidney Disease (ADPKD) is characterised by multiple renal cysts, progressive kidney enlargement, and dysfunction (1), eventually leading to End-Stage Renal Disease (ESRD). Extrarenal manifestations include hepatic cysts, hypertension, Left Ventricular Hypertrophy (LVH), valvular heart disease, intracranial and extracranial aneurysms, pancreatic cysts, and diverticulosis (2). Arteriovenous fistulae (AV fistulas) can be congenital, idiopathic, or acquired following trauma or iatrogenic procedures, such as Internal Jugular Vein (IJV) catheterisation [3,4]. This report highlights the need for clinician awareness and routine vascular imaging in high-risk ADPKD patients with a history of jugular catheterisation. A 46-year-old male presented with bilateral leg swelling, oliguria, exertional dyspnoea, and fatigue. He was a known case of ADPKD and had been on maintenance haemodialysis for the past 10 years. His last session was two days prior to surgery via a right forearm AV fistula. A right internal jugular permanent catheter, which is a tunneled central venous catheter used for long-term haemodialysis access, had been placed eight years prior. There was no significant dental history. On examination, he exhibited moderate anaemia with facial puffiness, grade 3 pitting oedema, mild ascites, a heart rate of 105 beats/min, and blood pressure of 168/97 mmHg. An Electrocardiogram (ECG) revealed sinus tachycardia, tall T waves in leads V3-V5, and LVH (Table/Fig 1). A chest X-ray showed right lung consolidation, pleural effusion, and cardiomegaly (Table/Fig 2). Echocardiography demonstrated a left ventricular ejection fraction of 50%, LVH, dilated left atrium, Mitral Valve Prolapse (MVP) with moderate Mitral Regurgitation (MR), moderate pulmonary artery hypertension, and mild tricuspid regurgitation (Table/Fig 3). Auscultation revealed a systolic murmur and basal crepitations. Ongoing medications included ramipril 2.5 mg once daily, metoprolol 25 mg once daily, tolvaptan 45 mg in the morning and 15 mg in the evening, lasilactone 50 mg once daily, torsemide 5 mg+spironolactone 50 mg, and aspirin 75 mg at night. Based on clinical and imaging findings, a provisional diagnosis of chronic kidney disease stage 5 on regular haemodialysis and underlying valvular heart disease was made. The treatment plan involved immediate dialysis, adjustment of cardiac and antihypertensive medications, and close haemodynamic monitoring. He was scheduled for right deceased-donor renal transplantation following standard preoperative clearance. On the day of surgery, Transesophageal Echocardiography (TEE) was used in addition to standard intraoperative monitoring (Table/Fig 4), (Table/Fig 5). A left radial artery line was cannulated under local anaesthesia. General anesthesia was induced with intravenous midazolam 0.02 mg/kg, fentanyl 2 μg/kg, etomidate 0.3 mg/kg, and cisatracurium 0.15 mg/kg, followed by intubation with an 8.0 mm cuffed endotracheal tube. While preparing for right IJV cannulation, a pulsatile neck swelling with engorged veins was observed. Ultrasound and color Doppler confirmed a high-flow AV fistula between the right common carotid artery and IJV (Table/Fig 6), (Table/Fig 7). It was presumed that the permanent catheterisation of the right IJV performed eight years earlier caused the AV fistula. Cannulation was safely planned on the left side, and the transplant surgery proceeded uneventfully. To manage hypotension and blood loss, volume resuscitation was initiated along with phenylephrine infusion at 1 μg/kg/min to maintain Mean Arterial Pressure (MAP), control tachycardia, and ensure adequate tissue perfusion. The transplanted kidney produced 250 mL of urine within four hours after ureteric anastomosis and reperfusion. Intraoperative analgesia included intravenous paracetamol 15 mg/kg and fentanyl boluses of 0.5 μg/kg twice in response to tachycardia and a rise in blood pressure. The patient was transferred intubated to the transplant recovery unit, with extubation planned for the next morning. Multidisciplinary consultation with a cardiologist, vascular surgeon, interventional radiologist, and the consulting nephrologist was initiated, and the patient was informed about the AV fistula postoperatively. Endovascular closure with a covered stent was scheduled at another hospital following discharge. While many iatrogenic AV fistulas remain asymptomatic, larger fistulas can cause significant haemodynamic instability and may be fatal without timely detection. A carotid-internal jugular fistula leads to high-output heart failure due to direct arterial flow into the vein, which increases venous return and cardiac workload over time (5). Clinical signs include pulsatile neck swelling, bruit, tachycardia, palpitations, arrhythmias, elevated jugular venous pressure, fatigue, pulmonary congestion, peripheral oedema, orthopnoea, and paroxysmal nocturnal dyspnoea. Pulmonary congestion may present as basal crepitations. To maintain perfusion, the heart compensates by increasing heart rate and stroke volume (6). However, blood diversion into the venous system may impair cerebral circulation, causing syncope or stroke. In patients with pre-existing MVP, a fistula can worsen MR, increasing preload and afterload, leading to left atrial dilation, ventricular overload, and eventually systolic dysfunction, which clinically presents as worsening heart failure and a new or louder systolic murmur (7). Essential investigations include echocardiography to assess MR severity and ventricular function, ECG for arrhythmias, chest X-ray for pulmonary oedema, and Brain Natriuretic Peptide (BNP) levels as a marker for heart failure. First-line therapy includes Angiotensin-Converting Enzyme (ACE) inhibitors, with Angiotensin Receptor Blockers (ARBs) as alternatives (2), followed by diuretics to manage volume overload. If blood pressure remains uncontrolled, calcium channel blockers or beta-blockers may be added (2). Sacubitril/valsartan, an Angiotensin Receptor-Neprilysin Inhibitor (ARNI), has shown benefits in heart failure, while ivabradine is beneficial for patients with sinus rhythm and a resting heart rate >70 beats/min (8). In MVP with MR, bradycardia should be avoided to prevent worsening of regurgitation. Anaesthetic goals include maintaining haemodynamic stability by cautiously titrating anesthetic agents, balancing fluid management to optimise preload without causing pulmonary congestion, and using invasive monitoring and intraoperative TEE guidance (8). Endovascular closure with a covered stent or coil embolisation is the first-line treatment for AV fistulas; surgical repair is reserved for cases deemed unsuitable for endovascular approaches (9). MVP requires ongoing monitoring, with echocardiography every 6-12 months if MR remains mild to moderate. Surgical intervention is indicated for severe MR or if ventricular dysfunction develops (7). In this case, an undetected carotid-internal jugular AV fistula compounded the cardiovascular burden in a patient predisposed to ADPKD and MVP. Similar conclusions were made in other studies, stating that MVP is an established cardiac manifestation in ADPKD and contributes to the overall cardiovascular burden in affected individuals by compounding risks already elevated by hypertension and other structural heart changes (10),(11). This incident prompted a revision of our institutional protocols to mandate Doppler ultrasonography of the neck and peripheral vessels in transplant recipients with prior central venous access. Essential investigations, including echocardiography and Doppler ultrasound, are crucial for assessing haemodynamic status and detecting abnormal flow patterns (12). Therefore, routine preoperative vascular imaging should be emphasised, particularly in transplant recipients, to identify undetected anomalies, minimise intraoperative risk, and optimise anesthetic and surgical planning. Additionally, we recommend heightened awareness among anaesthesiologists, nephrologists, surgeons, radiologists, and cardiologists to anticipate such findings and communicate them effectively with the multidisciplinary team and patients.

Major Anaesthetic Challenges during Minor Surgery: A Case of Ventricular Thrombus

Shilpa Deshmukh, Avirneni Vaishnavi

Dear Editor, Ventricular thrombi can develop more frequently in individuals with certain underlying conditions, the most common being post-myocardial infarction and dilated cardiomyopathy (1). Their occurrence without underlying cardiac disease is unusual, and these thrombi are often identified incidentally (2). We present the anaesthetic approach for a 48-year-old male undergoing emergency incision and drainage of a 5×5 cm carbuncle on the back of the neck, who was incidentally diagnosed with a large Left Ventricular (LV) thrombus. The patient had a 10-year history of poorly controlled diabetes {Glycosylated Haemoglobin (HbA1c) 13.8%, blood glucose 234 mg/dL}. There were no other significant findings in his history or examination. Investigations revealed an Electrocardiogram (ECG) showing global T wave inversions and transthoracic echocardiography demonstrating a reduced ejection fraction (40%) with an apical thrombus in the LV measuring 37×29 mm. Counselling regarding the preoperative high risk of thromboembolic phenomena and stroke was provided. Emergency drugs, including amiodarone, were prepared in advance along with a defibrillator. Although Cardiopulmonary Bypass (CPB) was not directly accessible, we discussed escalation strategies with the cardiac surgery team and prepared for emergency intervention. General anaesthesia was induced using graded doses of fentanyl (2 mcg/kg), etomidate (0.3 mg/kg), and vecuronium (0.1 mg/kg). Lignocaine (1.5 mg/kg) was administered to suppress the laryngoscopy-induced sympathetic response. An 8-sized endotracheal tube was used for intubation. Maintenance of anaesthesia was achieved with sevoflurane along with air and oxygen. The surgical procedure was conducted in a semi-prone (lateral) position instead of the prone position to reduce cardiac load, lower the risk of embolisation, support haemodynamic stability, and ensure access for resuscitative measures if needed. The surgeon was advised to perform local infiltration with 10 mL of 1% lignocaine without adrenaline. Intraoperatively, the haemodynamic parameters remained stable. A brief episode of atrial flutter occurred just before extubation; however, it resolved without any intervention. Reversal of neuromuscular blockade was achieved with sugammadex (2 mg/kg), and the patient was extubated uneventfully. Postoperatively, the patient was monitored in recovery for one hour before being transferred to the ward. He was advised to follow-up with cardiology for anticoagulant therapy. Patients with LV thrombi are at heightened risk for embolic complications, particularly during anaesthetic-related haemodynamic shifts (2). Key anaesthetic goals include maintaining sinus rhythm and preventing tachycardia, excessive contractility, and hypotension (3). We prioritised agents and techniques that provided cardiovascular stability, such as etomidate for induction, lignocaine to mitigate sympathetic responses, and the exclusion of stimulatory agents like adrenaline and ketamine. If an embolus is large enough to obstruct the LV outflow tract, on-table cardiac arrest may occur. Performing cardiopulmonary resuscitation or defibrillation in such a situation can increase the risk of further embolisation (4). Therefore, pharmacologic management was planned to take precedence over mechanical resuscitation. Literature supports the use of CPB as a contingency in such cases when available (5). Such cases presenting for noncardiac surgery in emergency settings are uncommon and pose significant management challenges due to the complexities involved in decision-making for an anaesthesiologist. Anaesthetic management in these scenarios necessitates a careful balance of strategies to minimise the risk of systemic embolisation while ensuring optimal blood pressure for adequate organ perfusion.

Obturator Hernia Unveiled: A Silent Threat with Surgical Urgency

Chaitanya Mahajan, Varun S Shetty, Iqbal M Ali

Dear Editor, We read with keen interest the article titled “Unilateral Obturator Hernia (OH) in an Elderly Male: A Case Report” by Sharma PK et al., which adeptly addresses the diagnostic complexity and clinical implications of OH. The authors have aptly highlighted the subtlety of its presentation, the indispensable role of imaging in its identification and the elevated risk of morbidity associated with delayed surgical intervention (1). In continuation of this pertinent discussion, authors wish to share their experience in managing a comparable case at our tertiary care institution. A 42-year-old, moderately built female (BMI: 28 kg/m²) presented with a long-standing, painless swelling along the medial aspect of her right thigh, associated with intermittent constipation and absence of a cough impulse. The deep pelvic location of the OH contributed to subtle functional limitations, including mild discomfort during ambulation and prolonged standing. She had no known co-morbidities. Despite the long-standing nature of her symptoms, she had previously deferred medical evaluation due to financial constraints. However, the sudden onset of acute pain in the preceding 48 hours prompted urgent presentation to our centre. A Contrast-Enhanced Computed Tomography (CECT) scan confirmed a strangulated right obturator hernia with a defect measuring 2.5×2 cm and incarcerated small bowel as content. The patient underwent a laparoscopic Transabdominal Preperitoneal (TAPP) repair under American Society of Anaesthesiologists (ASA) II status. A standard three-port TAPP configuration (2) was employed to ensure optimal access and visualisation of the obturator canal and associated pelvic structures (Table/Fig 1). Upon entering the preperitoneal space, a right-sided obturator hernial defect measuring approximately 2.5×2 cm was identified, containing a segment of incarcerated small bowel (Table/Fig 2). The herniated contents were carefully reduced, revealing a 5-cm segment of ischaemic ileum that necessitated resection after intraoperative assessment of viability. A primary end-to-end anastomosis was performed laparoscopically. Given the risk of contamination, mesh placement was deferred and the hernia defect was closed anatomically using interrupted intracorporeal sutures. Adequate peritoneal lavage was performed and a drain was placed in the pelvis. The procedure lasted 138 minutes and was technically demanding due to the deep pelvic location of the obturator canal and the friability of the incarcerated bowel segment. Postoperative recovery was guided by the Enhanced Recovery After Surgery (ERAS) Protocol, emphasising early ambulation, adequate analgesia and deep vein thrombosis prophylaxis using pneumatic compression devices and subcutaneous low-molecular-weight heparin (3). Nil Per Os (NPO) status was maintained for the initial 24-48 hours postresection, after which oral liquids were cautiously reintroduced once bowel sounds returned. The patient was then started on a soft diet by postoperative day 4. The postoperative course was uneventful and the patient was discharged after eight days of hospital stay. During follow-up at six months postoperatively, the patient demonstrated no clinical or radiological evidence of recurrence and had fully regained functional capacity, with no residual pain or limitation in activity. Owing to its concealed pelvic location and insidious onset, obturator hernia is often misdiagnosed or mistaken for more common groin pathologies. Among these, femoral hernia presents the most frequent diagnostic dilemma due to its anatomical proximity and shared demographic profile, particularly in elderly, emaciated females. However, unlike femoral hernias, OH often remains clinically silent until complications such as bowel obstruction or strangulation emerge. In such cases, especially when no overt groin bulge is noted, cross-sectional imaging plays a decisive role in establishing the diagnosis (4). Clinical recognition of subtle signs such as the Howship-Romberg sign and the Hannington-Kiff sign may offer additional diagnostic insight in select cases (5). Present case further emphasises the evolving role of laparoscopy in the management of both elective and emergency presentations of OH. While open surgery has historically been the standard surgical approach, several studies, including those by Burla MM et al., Sun Z et al., and Schizas D et al., have demonstrated that minimally invasive repair yields equivalent outcomes with comparable morbidity and significantly lower recurrence rates (Table/Fig 3) (6),(7),(8). The laparoscopic approach offers significant advantages, including superior visualisation, reduced postoperative morbidity and the opportunity to assess the contralateral obturator canal. It enables both bowel resection and hernia defect closure through a single access route, thereby streamlining intraoperative workflow (9),(10). On the other hand, laparoscopic repair of obturator hernia is limited by a steep learning curve, primarily due to the rarity of the condition, its deep pelvic location and the advanced technical expertise required for navigating complex pelvic anatomy, performing bowel resection, identifying the obturator canal with precision and executing intracorporeal suturing. Moreover, the increased cost associated with laparoscopic instrumentation and prolonged operative time may further restrict its applicability in resource-limited healthcare settings (11). Authors commend the Sharma PK et al., (1) for shedding light on this rare yet clinically significant condition and endorse their emphasis on early recognition and timely surgical management. In our view, continued awareness, combined with heightened clinical suspicion and advanced imaging, remains central to improving outcomes in patients with obturator hernia.

A Rare Case Report of Odontogenic Keratocyst in a 2-year-old Child

Kundan Shibjee Jha, Nitin Bhola, Sanjana Wadewale

Odontogenic Keratocyst (OKC) is a distinct developmental odontogenic cyst with an aggressive behaviour, a high recurrence potential and association with Nevoid Basal Cell Carcinoma Syndrome (NBCCS). The present case involves a two-year-old male who presented with a progressive, painless swelling in the left anterior mandible, first noticed at one month of age. Clinical examination revealed a firm, non tender swelling and Computed Tomography (CT) demonstrated a well-defined unilocular radiolucency with buccal cortical expansion but no root resorption or perforation. Aspiration yielded straw-coloured keratinaceous fluid and subsequent histopathological analysis confirmed the diagnosis of a parakeratinised OKC. The lesion was managed with complete enucleation under general anaesthesia, while preserving adjacent developing tooth buds and avoiding adjunctive chemical cauterisation to minimise potential harm due to the child’s young age. The present case is rare primarily due to the exceptionally early age of presentation—a two-year-old—which is well below the typical age range reported for OKCs in the paediatric population, generally 6 to 12 years or older. Additionally, the anterior mandibular location is less commonly reported compared with the more frequent posterior mandibular involvement.

Effectiveness of Lagos Neuropathy Protocol, Proprioceptive Neuromuscular Facilitation and Neuromuscular Taping on Sensorimotor Functions in Patients with Diabetic Peripheral Neuropathy: A Study Protocol

Adarsh Sharma, Shantha Kumar, Manu Goyal

Introduction: The management of Diabetic Peripheral Neuropathy (DPN) consists of multidirectional interventions. Physiotherapy, in addition to the pharmacological approach, has achieved appreciable popularity in ameliorating the symptoms of DPN. Lagos Neuropathy Protocol (LNP), Proprioceptive Neuromuscular Facilitation (PNF), and Neuromuscular Taping (NMT), have shown remarkable improvements in sensorimotor impairments in various neuromuscular and musculoskeletal disorders but no research has been established to compare the effectiveness of LNP, PNF and NMT on sensorimotor functions in individuals with DPN. Need for this study: This study may provide the comparative significant differences between the LNP, PNF and NMT interventions among DPN patients. Aim: To compare the effectiveness of LNP, PNF and NMT on sensorimotor functions in patients with DPN. Materials and Methods: Sixty DPN subjects 60-75 years of age both male and female will be divided into 3 groups, scoring ≥2/13 on physical appearance and ≥1/10 on physical examination of the Michigan Neuropathy Screening Instrument (MNSI), <45 on Berg Balance Scale (BBS) and >12 on Leeds Assessment of Neuropathic Symptom and Sign (LANSS) scale will be included in the study. All three groups (LNP, PNF, and NMT) will receive an intervention for 3 days/week for 10 weeks respectively. Outcome measures will be assessed at baseline and post-intervention, respectively.

Development, Validation and Reliability of Workrelated Low Back Pain Questionnaire for Nursing Professionals: A Questionnaire-based Study

Arushi Mishra

Introduction: Multiple risk factors induce Work-related Musculoskeletal Disorders (WMSDs), resulting in a higher prevalence of work-related low back pain among nurses. Aim: The present study aimed to develop and establish the validity and reliability of Work-related Low Back Pain Questionnaires (WRLBPQ) for nursing professionals. Materials and Methods: This study employed a methodology centered on the development, reliability, and validation of a scale. Five experts with a master's degree in the relevant subject and a minimum of 10 years of academic experience participated in the first focal group discussion. Subsequently, 35 specialists engaged in the evaluation of content validity for the WRLBP questionnaire. To assess reliability, a sample of 200 staff nurses employed in hospitals was chosen to participate in this questionnaire. Results: The newly developed WRLBPQ tool demonstrates strong scale-level content validity, achieving a score exceeding 0.78 for each item. The kappa values for each item ranged from 0.97 for item quality to 1 for item content, indicating excellent agreement. The universal acceptance of each item was 0.91 for quality and 1 for content. The Pearson correlation coefficient was employed to determine test-retest reliability, yielding a result of rho=1 for session 1 and rho=0.82 for session 2. Inter-rater reliability was determined using the Intra-rater Correlation Coefficient (ICC), with values of 0.76 for rater A and 0.86 for rater B, alongside a Cronbach’s alpha of 0.98. Conclusion: The WRLBP questionnaire, the first measurement tool among nursing professionals, is a reliable and valid tool for evaluating WRLBP among nursing professionals.

Evaluating the Role of the Buteyko Breathing Technique in Asthma Management: A Narrative Review

Salim Akhtar, Sunita Sharma, Subhasish Chatterjee, Yashasvi Parmar

Asthma is a chronic respiratory condition characterised by airway inflammation, hyperresponsiveness, and recurring symptoms. The Buteyko Breathing Technique (BBT) is an eminent technique that helps to improve asthma control. This narrative review aims to consolidate existing evidence on the efficacy and safety of BBT in managing asthma symptoms, focussing on its impact on symptom severity, asthma control, pulmonary function, and medication use. A comprehensive literature search was conducted in PubMed, Google Scholar, and other relevant databases to identify studies investigating the effects of BBT on asthma. Studies included randomised controlled trials, observational studies, and case reports. The evidence consistently demonstrated that BBT significantly improves asthma symptoms and control. Pulmonary function improvements, such as increased FEV1 and PEFR, were noted in some studies, while others showed no significant changes. Comparative studies highlighted the superiority of BBT over other techniques in improving asthma control and quality of life. Methodological limitations, such as small sample sizes and short durations, were noted across several studies.BBT shows promise as an adjunct therapy for asthma, improving symptoms and reducing medication use. Larger, long-term trials are needed to confirm its efficacy and uncover its mechanisms.

The Effect of Blood Flow Restriction Training on Quadriceps Strength Recovery in Postsurgical Rehabilitation after Knee Joint Surgeries: A Systematic Review Protocol

Shivam Attri, Kanika Bhatia, Rittu Sharma

Introduction: Blood Flow Restriction Training (BFRT) and exercises are a training method that is characterised by the use of specialised tourniquets and cuffs to restrict venous blood flow during the exercise in the working limb to increase metabolic stress. Traditional high-load resistance training may not be appropriate in the early phases of recovery because of joint stress, although it is beneficial in regaining muscle strength. This problem is addressed by BFRT, which enables patients to develop their muscles significantly at lower loads, lowering the mechanical stress on healing tissues and accelerating recovery. Need for this study: This review will synthesise current literature to provide evidence-based recommendations for integrating BFRT into clinical rehabilitation protocols, ultimately enhancing recovery outcomes for knee surgery patents. Aim: This review aims to consolidate existing evidence on the effectiveness of BFR training in post-knee joint surgery rehabilitation. Materials and Methods: This systematic review is formally registered within the PROSPERO Database (PROSPERO ID CRD42024621803) and aims to consolidate existing evidence on the effectiveness of BFR training in post-knee joint surgery rehabilitation. Observing PRISMA guidelines, a structured search will be conducted across databases like PubMed to identify randomised controlled trials comparing BFRT to standard rehabilitation protocols in knee surgery patients.The data extraction will primarily focus on strength improvements assessed through functional tests, such as terminal knee extension and sit-to-stand performance and also considering secondary outcomes, including thigh circumference, range of motion, and pain levels while evaluating the impact of BFRT by specifically examining quadriceps strength, pain management, functional performance, and quality of life, postoperatively.

Ergonomic Interventions and Technologyassisted Physiotherapy for Text Neck Syndrome: A Synergistic Approach

Vankita Tandon, Shweta Sharma

The appellation “text neck” refers to the discomfort and distress to the neck that results from staring down at a cell phone and excessive use of tablets or other wireless devices for too long. Recent analysis indicates that among 18- to 44-year-olds, 79% are almost always within reach of their mobile phones, with only about two hours daily spent apart from them. In order to enhance patients' emotional responses, body image, and physical function, Virtual Reality (VR) and Augmented Reality (AR) have been integrated with psychological and physical rehabilitation therapies. The main emphasis of the present investigation is on scrutinising the efficacy of ergonomics and physiotherapeutic interventions abetted by technology for addressing patients affected with Text Neck Syndrome.In order to retrieve literature about Text Neck Syndrome, the Cochrane library, PubMed, and Google Scholar databases were reviewed. From an initial pool of 157 potentially relevant articles, forty met the established inclusion criteria for this review and were therefore subjected to in-depth analysis.Combining ergonomic adjustments with motor control exercises proved as effective as pain relief and general exercise in reducing pain and improving function. However, a year later, this combined approach led to significantly greater overall recovery as reported by individuals with Text Neck Syndrome. The discrepancies have been observed, thus underscoring the necessity for further investigation.The present study concludes that providing office workers with highly adaptable seating and ergonomic education is predicted to enhance their ergonomic awareness and abilities, lessen physical burdens and discomfort, and optimize well-being and efficiency. The available evidence strongly suggests that combining Manual Therapies (MTs) with VR and AR has the ability to augment the quality and comprehensiveness of patient care provided by manual therapists.

Efficiacy of Virtual-based Physiotherapy for Chronic Pain Management in Marfan Syndrome: A Systematic Review

Nandani Dhiman, Urvashi Chauhan

Introduction: Marfan syndrome (MFS) is a genetic connective tissue disorder characterised by cardiovascular, musculoskeletal, and ocular complications, often leading to the chronic pain and reduced quality of life. Traditional physiotherapy plays a critical role in managing these symptoms, but virtual-based physiotherapy has emerged as a convenient and accessible alternative. Aim: This review evaluates the efficacy of virtual physiotherapy in managing chronic pain and improving physical function in individuals with MFS. Materials and Methods: A systematic review of studies from databases such as PubMed, and Google Scholar was conducted using keywords like this “Marfan syndrome,” “Virtual physiotherapy,” and “Chronic pain”. Inclusion criteria comprised studies that examined virtual interventions for pain management in MFS, while non-virtual or non-MFS studies were excluded. Results: Virtual physiotherapy interventions demonstrated significant improvements in quality of life, pain reduction, and physical function. Key outcomes included enhanced cardiorespiratory fitness, muscle strength, and flexibility. The programmes were safe, with no adverse effects reported, and facilitated better adherence due to their accessibility and personalisation. Conclusion: Virtual physiotherapy is a promising approach for managing chronic pain in MFS patients, offering a safe, effective, and flexible alternative to traditional methods. Further large-scale research is necessary to validate its long-term benefits and establish standardised protocols.

Establishing Normative Reference Score of Foot Tapping Test among Healthy College going Students: A Cross-sectional Study

Palak Bansal, Aditi Popli

Introduction: The Foot Tapping Test (FTT) is an assessment tool used to evaluate Upper Motor Neuron (UMN) function, particularly in individuals with neurological conditions affecting gait and mobility. However, there is lack of normative values in both healthy and clinical populations regarding the FTT. Aim: This study aimed to establish normative reference values for the FTT in healthy young adults. Materials and Methods: A total of 226 healthy individuals (113 males, 113 females) aged 19-24 years were recruited in the study. Participants were asked to perform the FTT in a short sitting position, and anthropometric measurements were recorded. Results: Data was analysed using IBM SPSS Statistics 26.0. Normality tests were conducted using the Kolmogorov-Smirnov test.Significant variability in foot tap performance was observed across age groups. Those aged 19 years had foot taps range for dominant foot, 12 (14-26) and 9 (17-26) individuals had foot taps range for non-dominant foot, those aged 20 years had 16 (14-30) and 15 (14-29) individuals, those aged 21 years had 18 (20-38) and 23 (17-40) individuals, those aged 22 years had 22 (20-42) and 21 (20-41) individuals, those aged 23 years had 22 (18-40) and 23 (17-40) individuals, while those aged 24 years had 14 (22- 36) and 19 (21-40) individuals. While younger participants (19-20 years) exhibited more consistent performance, greater variability was observed in the 21-23-year-old age group. Conclusion: This study established a normative reference values for the FTT in a healthy young adult population (19-24 years).The findings demonstrate significant variability in foot tap performance across this age group. The findings highlight the importance of considering age-related variability when interpreting FTT results.

Gut Microbiota and its Influence on Obesity: Physiotherapy as a Nonpharmacological Strategy

Shital, Neha Kashyap, Shikha Singh

Due to its ability to alter adiposity and glucose metabolism, the human gut microbiota has been involved in obesity and related comorbidities. The development of obesity is significantly impacted by gut microbiota metabolites, which are produced by fermentation of food ingredients and bacterial alteration of host molecules. These metabolites play a role in a number of processes that lead to obesity, such as inflammation, altered energy metabolism, and altered gut barrier function. The management of obesity still mostly involves pharmacological and dietary interventions, but physiotherapy provides an additional, non-pharmacological strategy that can use the gut-muscle axis to enhance metabolic results. The aim of this study is to investigate the mechanisms by which gut microbiota contribute to obesity and how physiotherapy can help to curb it. A comprehensive literature search was conducted in which the articles from 2014 to 2024 were included using the search terms “Gut microbiota,” “Obesity,” and “Rehabilitation,” which yielded 11,300 results from various digital databases like PubMed, Google Scholar, Ovid, Web of Science and the Cochrane Library. The search is then further filtered through the inclusion and exclusion criteria. It has been demonstrated that regular exercise, an important component of physical therapy, which can alter the composition of the gut microbiota, and the target physical therapy interventions such as resistance training, aerobic exercise, and core-strengthening regimens, improve gastrointestinal motility, lower visceral fat, and improve insulin sensitivity. While examining the possibility of physical therapy as a therapeutic tool, this review emphasises the dynamic interaction between gut microbes and obesity.

Effectiveness of Kinesiotaping in Managing Medial Tibial Stress Syndrome in Athletes: A Literature Review

Sharmishtha, Rittu Sharma, Swarup Ghosh, Jahanvi Dave, Kanika Bhatia, Kanika

Medial Tibial Stress Syndrome (MTSS) is a common overuse injury affecting athletes, particularly those involved in running and jumping activities. Characterised by pain along the inner edge of the shin bone, they impact the muscles, tendons, and bone tissue in the area. Prevalent among runners and young athletes aged 20 to 30 years, with studies reporting a prevalence rate of 13.6% to 20% in runners, shin splints can significantly hinder performance and overall well-being. This study seeks to review and summarise the current evidence base regarding the effectiveness of kinesiotaping as an adjunct to other interventions, compared to other taping methods, sham taping, or alternative treatments in athletes. A comprehensive search of PubMed, Google Scholar, Scopus and Cochrane Library from 2014 to 2024, using the keywords “kinesiotaping,” “shin splints,” and “medial tibial stress syndrome” with Boolean operators AND and OR, initially retrieved 492 articles. After removing duplicates, six relevant articles were identified and analysed for further review. Kinesiotaping demonstrated statistically significant improvements (p<0.05) on outcome measures such as pain (assessed using Visual Analogue Scale [VAS] and Numerical Pain Rating Scale [NPRS]), navicular heightor drop, plantar pressure distribution (measured using specific foot scan platforms), static balance (using single leg balance tests), dynamic balance (using Y-balance test), postural control, single leg hop tests and sprint tests when compared to sham or placebo taping. However, two studies reported no superior benefits of kinesiotaping over rigid taping. Preliminary evidence suggests that kinesiotaping is effective for managing MTSS. The heterogeneity of outcome measures and the focus on short-term effects limit the ability to draw conclusive evidence on its overall effectiveness. Further, high-quality trials are needed to evaluate the long-term effects of kinesiotaping and compare it with rigid taping or other treatments to provide definitive conclusions.

Predicting and Modulating Cardiac Autonomic Dysfunction: A Review of Interventions in Hypertensive Patient

Rohit Gupta, Shilpa Jain, Urvashi Sinha, Charu Chhabra

Significant health risks are posed by hypertension which is an elevated blood pressure against arterial walls and further influenced by autonomic nervous system. This review aims to address a lacuna in the literature concerning the predictors and modulators of CAF (cardiac autonomic dysfunction) in patients with hypertension, particularly focusing on physiotherapeutic interventions. Taking into account of high prevalence of hypertension and its associated complications, autonomic dysfunction would be manageable by understanding the crucial role of exercises. Databases such as Google Scholar, PubMed, and PEDro were utilised to gather the Randomised Controlled Trials (RCTs) related to prediction and modulation of CAF and related anomalies using the boolean operators to refine the search results, and pertinent studies were selected using a rigorous criteria. After exhaustive search four RCTs involving 364 participants, revealed that various exercise approaches specifically Circuit Weight Training (CT), Aerobic Exercise Training (AExT) and Resistance Training are helpful in modulating cardiac autonomic function in hypertensive individuals and also indicated in the studies that Heart Rate Variability (HRV), sedentary behavior and obesity provide as independent predictors of CAF related anomalies. Particularly, combination of HRV and sedentary lifestyle factors further emphasise their role in autonomic dysfunction. While Breathe-Humming Breathing (BHB) exercises were not observed to have a direct significant effect on CAF, but they may put forth an indirect sway over modulation of HRV. In conclusion, exercise therapy emerges as a promising approach for positively influencing cardiac autonomic function in hypertensive patients. This review warrants inevitability for further such research studies to describe the mechanisms underlying these effects and to optimise the strategies for managing better health outcomes in this population.

Clinicoepidemiological Profile of Non Venereal Urogenital Dermatoses among Males: A Cross-sectional Study from Southern India

Introduction: Diseases that affect the male external genitalia can be divided into venereal and non venereal dermatoses. Non venereal dermatoses are a cause of great concern and anxiety to the patient, significantly affecting their quality of life. Hence, understanding the non sexual nature and varied presentations of these diseases may provide clues for diagnosing major systemic and generalised cutaneous diseases at the earliest. Aim: To study the clinical pattern of Non Venereal Urogenital Dermatoses (NVUD) and assess the frequency of various dermatoses, their presenting complaints and different sites of genital involvement. Materials and Methods: A cross-sectional study was conducted in the Department of Dermatology at an urban-based tertiary care hospital in Chennai, Tamil Nadu, India, from November 2023 to October 2024. All male patients aged 18 years and above who attended the dermatology outpatient department with complaints of skin lesions in the genital area were screened for NVUD and were included in the study after obtaining informed consent. Most of them were examined clinically and diagnosed; in case of diagnostic dilemma, tests and investigations were done to confirm the diagnoses. Detailed demographic data and medical and sexual history were collected from all participants. Results: The study included 125 male patients with NVUD who presented over a 12-month period. The majority were from urban areas (72%; 90/125) and were married (82.4%; 103/125). The most common complaints were pruritus and dyspigmentation (each 22.4%). Vitiligo (23.2%) was the most common urogenital dermatosis encountered in the study, followed by balanoposthitis (14.4%). Conclusion: NVUD are often overlooked rather than noticed. Genital dermatoses are perceived as stigmatised by a majority of the population, considerably delaying their presentation to a dermatologist or urologist.

Effectiveness of Stabilisation Exercise along with Conventional Therapy on Pain, ROM, Muscle Strength, JPS and QOL in Diabetic Frozen Shoulder

Niraj Kumar, Siddhartha Sen, Navneet Badoni, Sobhit Garg

Introduction: Diabetic Frozen Shoulder (DFS) is characterised by pain and severe limited active and passive range of motion of the glenohumeral joint, particularly external rotation. Diabetes is frozen shoulder is due to the effects on collagen in the shoulder, which holds the bones together in a joint. Collagen gets triggered by the presence of high blood sugars.Interestingly, collagen gets sticky when sugar molecules become attached, leading to restricted movements and shoulder starting to stiffen. The prevalence of adhesive capsulitis in patients with diabetes in India was reported to be 11% - 29.61 %, in Saudia Arabia 6.7%, in Iran 13.30%, in Finland 14%, in UK around 10.8%. Whereas other studies identified around 20% Australians, 38.6% Americans, 27% Indians and around 40% British reported diabetes in patients with adhesive capsulitis. Aim: To evaluate the effectiveness of stabilisation exercise along with moist heat therapy on pain, Range of Motion (ROM), proprioception, muscle strength and Quality of Life (QOL) in patients with DFS. Materials and Methods: This article has been approved by the Institutional Ethics Committee (IEC).The confidence level – 95% and confidence interval - 5% were used to calculate sample size. Thirty-one patients were treated with stabilisation exercise and moist heat therapy. The patients were assessed in 0 (zero) week and reassessed in 4 (four) weeks and 8 (eight) weeks of treatment. These treatment protocols will be given five days per week for eight weeks. Result and Conclusion: The data were analysed using the statistical software SPSS 15 version. Analysis of the Numerical Pain Rating Scale (NPRS), ROM, Shoulder Strength, Joint Position Sense (JPS) score & the World Health Organisation QOL (WHOQOL) was done using repeated measure ANOVA test. In 4 and 8 weeks of treatment, significant results were observed (p=0.05). Our study concluded that stabilisation exercise along with conventional therapy in patients with DFS showed significant improvement in reducing pain, improving ROM, increasing muscle strength, improving JPS and improving quality of life in 4th & 8th weeks of treatment.

Age-associated Changes in Adiposity and Impact on Insomnia Severity in Women with Polycystic Ovary Syndrome: A Pilot Observational Study

Aakanksha Bajpai, Digvijay Sharma

Introduction: Polycystic Ovary Syndrome (PCOS) is frequently manifested by metabolic abnormalities and increased adiposity. However, the influence of age on regional fat accumulation and how this relates to sleep disturbances remains unexplored. Aim: This study aimed to examine the relationships between age, specific anthropometric measures, and insomnia severity in women diagnosed with PCOS. Materials and Methods: A total of 30 women aged between 18-34 years, with clinically confirmed PCOS were enrolled in this cross-sectional study. Comprehensive anthropometric assessments were conducted, including waist circumference, arm circumference, and skinfold thickness (triceps, subscapular, supra-iliac, calf) and Body Mass Index (BMI). Insomnia was evaluated using the Insomnia Severity Index (ISI). Spearman’s rank correlation was applied to identify statistically significant associations (p<0.05). Results: The results of the study indicated that the adiposity of the upper body in women with PCOS increased with age, as demonstrated by the higher BMI (ρ = 0.497, p = 0.011), waist circumference (ρ = 0.498, p = 0.011), arm circumference (ρ = 0.475, p = 0.016), and triceps (ρ = 0.446, p = 0.025) and subscapular (ρ = 0.497, p = 0.011) skinfold thicknesses. The skinfolds around the supra-iliac (ρ = 0.590, p = 0.002) and calf (ρ = 0.618, p = 0.001) were most strongly linked to worse insomnia, while BMI alone had lower associations with insomnia. Conclusion: In women with PCOS, increasing age is strongly associated with increased levels of upper-body fat, although supra-iliac and calf adiposity appear to be more predictive of sleep difficulties than overall obesity measurements. These findings highlight the significance of accounting for age-related body composition changes and targeted fat deposition when treating insomnia in PCOS patients.

Effects of Pelvic Floor Exercises and Core Muscle Exercises on Scar Pain and Pelvic Floor Muscle Strength in Abdominal Hysterectomy Patients: An Observational Study

Kirti Chouhan, Aishwarya Rai

Introduction: Abdominal hysterectomy is the surgical method when the abdomenis exposed via Pfannenstiel incision. Abdominal surgeries may downgrade abdominal muscle power, efficiency of intra-abdominal pressure. Aim: This study determined the effects of pelvic floor and core muscle exercise sons carpain and pelvic floor muscle strength in abdominal hysterectomy patients. Materials and Methods: Thirty post hysterectomy females were randomly assigned to group A (core muscle exercise group, n=15) and group B (pelvic floor muscle exercise group n=15). The group A performed core muscle exercises (Dead bug exercise, bridging exercise, concentric curl-up exercise, a Straight Leg Raise [ASLR]) and Group B performed pelvic floor muscle exercises (abdominal isometric exercise, pelvic adductor exercise, Ball Bridge exercise, ball leg lifts) both for 30 minutes once in a day for 2 weeks (6 days). Pelvic floor muscle strength (measured by perineometer) and scar pain {measured with the Numeric Pain Rating Scale (NPRS)} were evaluated pre and post of the intervention. Results: Significant changes showed in both the groups but group A showed highly significant improvement in scar pain compared to group B. The group B showed highly significant improvement in pelvic floor muscle strength compared to group A. Conclusion: Pelvic floor exercise training is recommended to improve pelvic floor muscle strength and core muscle exercise is recommended to improve scar pain in abdominal hysterectomy patients.

Exploring Experiences, Satisfaction, and Quality of Life with Physiotherapy One Month after Total Knee Arthroplasty in Low- and Middleincome Countries: A Qualitative Study

Saloni Shetty, Asir John Samuel

Introduction: Total Knee Arthroplasty (TKA) has been a widely practiced procedure, with its popularity steadily growing globally, particularly in India. TKA is primarily performed for osteoarthritis, which affects millions in India.Research highlights the role of physiotherapy rehabilitation in improving pain, range of motion, and daily function post-TKA, yet limited studies have explored patients' satisfaction and perspectives during rehabilitation. This qualitative phenomenological study addresses this gap by examining the lived experiences, satisfaction levels, and quality of life of patients undergoing physiotherapy rehabilitation post TKA. Aim: To explore the patients' perspective about the satisfaction and experiences post rehabilitation and to also explore the factors influencing quality of life with physiotherapy after 1st month of TKA. Materials and Methods: Six participants participated in semi-structured face-to-face interviews. The participants are recruited using criterion-based purposive sampling. The interviews were audio-recorded and transcribed. Familiarisation with the data, generating initial codes, constructing themes, reviewing and refining themes, defining and naming themes and writing the report stages of Braun and Clarke,2024 reflexive deductive- inductive thematic analysis were performed using NVivo 15. Credibility, transferability, dependability and confirmability were also ensured. Results: Age ranging from 45 to 60 years, predominantly female,mostly upper middle class socioeconomic status who had undergone TKA were interviewed which lasted for about 15 min one month after their surgery. Four main themes with 12 subthemes emerged influencing quality of life: (i) Pain and the recovery experience; (ii) Functional abilities and limitations; (iii) Satisfaction with recovery and Physiotherapy; and (iv) Psychological impacts and emotional aspects. Conclusion: The study reveals reduction in pain, mobility enhancement over time, satisfaction and quality of life.

A Study on Domain Identification for Physical Performance Assessment Tools in Children with Developmental Disorders

Kayinat Hassan, Jasmine Anandabai, Shikha Singh

Introduction: Children with developmental disorders, such as Cerebral Palsy (CP), Attention-Deficit Hyperactivity Disorder (ADHD), and Autism Spectrum Disorder (ASD), may struggle with physical performance, including strength, balance, and motor coordination. The diagnosis, monitoring, and development of customised therapeutic programmes, depend on a thorough Physical Performance Assessment Instrument (PPAT). Nevertheless, it is unclear which domains ought to be covered by these technologies. Aim: The purpose of this study is to describe and identify the major areas of physical performance that are pertinent to children with developmental disorders and to create a framework for incorporating these domains into assessment instruments. Materials and Methods: The study used a mixed-methods approach, consulting paediatric specialists, clinicians, and therapists in addition to conducting a systematic evaluation of the assessment instruments currently in use. Clinical observations were also made in order to assess the functional and motor difficulties that children with different developmental problems encounter. The most relevant and consistent domains across various settings were found by analysing the data. Results: The study found that motor coordination, balance, strength, endurance, and flexibility are the five main domains that are crucial for evaluating physical performance in children with developmental problems. These domains were found to be extremely relevant to the needs of children with ASD, ADHD, and CP and crucial for comprehending general physical function. There are currently very few instruments that target strength, endurance, and flexibility in this population; instead, they primarily concentrate on motor coordination and balance. Conclusion: The key dimensions of physical performance for children with developmental problems are clearly defined by the study's findings. To ensure thorough and useful assessments, these domains must be included in the next physical performance evaluation instruments. The foundation for creating a standardised assessment Tool that can direct intervention tactics and monitor developmental progress is laid by this framework.

Neural Coefficient Theory: A Key to Unlock Neuro-recovery’s Missing Link

Sharanjeet Kaur, Narkeesh Arumugam, HS Chhabra

Introduction: The complexity of neuro-rehabilitation necessitates a deeper understanding of neural dynamics and their role in functional recovery. This study introduces the Neural Coefficient Theory, a novel framework that quantifies the relationship between Autonomic Nervous System (ANS), Peripheral Nervous System (PNS) and Central Nervous System (CNS). By proposing ANS as a key factor, the theory bridges the gap between theoretical neuroscience and clinical application. The Neural Coefficient Theory states that, “Autonomic Nervous System acts as the coefficient in the recovery of nervous system related diseases or disorders”. Aim: The study aimed to establish that the ANS rehabilitation along with standard rehabilitation protocols in CNS and PNS lesions is vital for improving neurological patient’s outcomes and quality of life. Methodology: Nature of study: The study was an innovative and qualitative study to demonstrate the conceptual framework of Neural Coefficient theory approved by IEC, Punjabi University, Patiala (Ref Number: 28/55/IEC/PUP/2022) Funding: The study was funded by INSPIRE-DST (FELLOWSHIP) Implications: By addressing both the primary and secondary effects of these lesions on the ANS, healthcare professionals can help individuals with nervous system related disorders to achieve better functional outcomes and enhanced overall well-being. Conclusion: Preliminary analysis and clinical observations suggested that the ANS could serve as a predictive tool to customise rehabilitation protocols, enhancing outcomes for neurological patients. This theory not only advances the scientific understanding of role of ANS in the recovery of CNS or PNS-based disorders but also lays the groundwork for personalised medicine in neurorehabilitation. Further studies are required to validate its efficacy and develop clinical models for its application.

Prevalence of Tennis Elbow in Gym going Young Adults: An Observational Study

Jasmanveer Kaur

Introduction: Lateral epicondylalgia, also known as tennis elbow, is a prevalent condition that has a substantial impact on the population. There is little disagreement about the clinical manifestations of this illness. It is typically defined as pain over the lateral epicondyle that is reproduced by digital palpation, resisted wrist extension, middle finger extension, and gripping. Lateral epicondylitis is pain in the lateral epicondyle caused by misuse of the forearm extensor muscles. Chronic tears in the origin of the extensor carpi radialis brevis and degenerative alterations are related with the disorder. Lateral epicondylitis is a serious disorder that causes loss of limb function by damaging the tendinous tissue of the wrist extensor muscles' origins at the lateral epicondyle of the humerus. As a result, the patient's social and professional life may be negatively impacted. The lateral elbow is made up of bony and ligamentous elements that maintain the joint and act as the origin of the musculotendinous attachments on the dorsal forearm. Aim: The aim of the study is to estimate the prevalence of tennis elbow or lateral epicondylitis in gym going young adults. Materials and Methods: An observational study was performed on gym going population. Overall 100 participants were enrolled in the study with 97 males and 3 females. Age of the participants was between 18 to 28 years. Participants were screened according to selection criteria and then were asked to sign a written consent form, Demographic data was taken that included the type of exercise which is being performed, such as weight training and cardio. Data were collected and analysed to check the prevalence of tennis elbow on in healthy gym going young Adults. Results: The prevalence of tennis elbow in gym going healthy individuals was calculated in 97% men and 3% women with a median age of 23 years. We found a prevalence of 3%. Conclusion: The study concluded that tennis elbow is not prevalent among young adults going to gym.

Ten-meter Walk Test with Motor and Cognitive Dual-task Activities in Overweight Individuals: An Observational Study

Urvashi, Sandhya, Jatin Sangwan

Introduction: A certain amount of body fat is essential for functions like energy storage, heat insulation, and shock absorption. However, an excessive or abnormal accumulation of body fat, which can negatively affect health, is categorised as overweight or obesity. In daily life, individuals often engage in tasks that require simultaneous processing of both motor (balance) and cognitive functions, commonly referred to as "dual task situations." A dual task involves performing two tasks; one motor and one cognitive at the same time, which typically leads to a decline in performance in at least one of the tasks. Aim: To determine the short term effects of motor and cognitive dual tasks on the walking speed of overweight individuals. Materials and Methods: In this observational study, total of 100 participants were enrolled. They performed dual task activities along a 10-meter path. The subjects walked at their usual pace while the time was measured with a stopwatch, and three readings were recorded. Afterward, they repeated the task while performing a cognitive dual task (counting backwards) and then a motor dual task (walking while carrying a tray with a bottle). Three readings were taken for each condition to calculate the mean for further analysis. Results: The Kolmogorov-Smirnov test was applied to check for normality in the data. Since the data was not normally distributed, the Mann-Whitney test, a non-parametric test, was used to analyse the data and calculate the p-value for the demographic variables. For the outcome measures, the mean, median, range, and p-values were computed using the Friedman test, which showed significant results with a p-value of <0.001. Conclusion: The study provided valuable insights into the short-term effects of motor and cognitive dual tasks on the walking speed of overweight individuals. It concluded that cognitive dual tasks had a greater impact on speed compared to motor dual tasks, as compared to walking at a normal pace.

Effect of Early Mobilisation in Mechanically Ventilated Acquired Brain Injury Patients: An Observational Study

Aishwarya Rai, Kirti Chouhan, Shikha Singh

Introduction: Acquired Brain Injuries (ABIs) often render patients bed-ridden for longer durations with associated impairments. Mechanical ventilation however necessary has distinct risks and adverse effects such as Ventilator-associated Pneumonia (VAP), Intensive Care Unit-Acquired Weakness (ICU-AW), and an increased Length of Stay (LOS) in the hospital including depression and anxiety in affected individuals. Early rehabilitation of patients has often been said to be the key in swift recovery of patients. However, the onset of interventions has been varying across various studies. Aim: This study aims to pin point as to whether mobilisation of patients affected with ABI with a the Glasgow Coma Scale (GCS) between 8-12 at the time of admission that underwent conservative management, out of bed as soon as Day 3 leads to better outcomes or not. Materials and Methods: A sample of 30 patients affected with ABI were incorporated in the study whose mean age was 33.7 years. The patients were divided into groups A and B. Group-A underwent mobilisation starting post-op day 3 along with various physiotherapeutic interventions, whereas patients of group B were not mobilised until day 7. Each patient underwent a carefully constructed treatment protocol that comprised interventions such as Neurophysiological Facilitation of Respiration (NPF), manual techniques as well as limb physiotherapy along with hourly positioning of the patient. Outcome scores were recorded on Day 1 and 30 of the treatment. Results: Patients belonging to group A showed better outcomes when compared with patients of group B. Conclusion: The study concludes that patients that are mobilised out of bed on Day 3 during their stay in the hospital show better recovery in various aspects when compared to patients that do not undergo early mobilisation. Patients of group A also showed lesser incidences of ICU-AW.

Prevalence and Symptomatology of Cervical Spondylosis in Computer Professionals: A Cross-sectional Study

Anupam Garg, Jasmine Anandabai, Shikha Singh

Introduction: Computer workers are more likely to develop cervical spondylosis, a degenerative disorder of the cervical spine, as a result of sedentary work habits, poor posture, and extended screen time. For the purpose of prevention and management, it is essential to identify certain symptoms and related risk factors in this population. Aim: To investigate the influence of ergonomic and occupational factors, as well as the prevalence and symptomatology of cervical spondylosis among computer professionals Materials and Methods: A cross-sectional study with 300 computer experts was carried out. Using a standardised questionnaire, information about common symptoms, work patterns, and demographics was gathered. Headaches, disorientation, numb hands, stiffness, radiating arm discomfort, and neck pain were among the main symptoms evaluated. To find correlations, daily computer use and ergonomic aspects were examined. Results: According to the study, 68% of participants had symptoms that were typical of cervical spondylosis. The most often reported symptoms were radiating arm pain (52%), stiffness (76%), and neck pain (85%). Increased symptom severity was substantially correlated with ergonomic issues, such as prolonged work hours (≥8 hours/ day), improper chair height, and lack of lumbar support. Conclusion: Cervical spondylosis is highly prevalent among computer professionals, with neck pain and stiffness being the most common symptoms. Addressing ergonomic risk factors and promoting awareness of preventive strategies, including regular physical activity and workplace modifications, is crucial for reducing the burden of this condition in the workplace.

Exploring the Effect of Extracorporeal Shockwave Therapy in Managing Chronic Ankle Instability and Achilles Tendinopathy: A Narrative Review

Kamalpreet Kaur, Shivangi Palsra

Introduction: Chronic Ankle Instability (CAI), is characterised by recurring sprains and persisting symptoms following the injury, can result from ankle re-injuries, which occur at a rate of 28.3%. CAI has distinctive characteristics based on contributory variables, including mechanical and functional instability caused by trauma-induced laxity and by neuromuscular insufficiencies, muscle weakness, and proprioceptive shocks respectively.Ankle sprains are the most frequently persisting ankle injuries, accounting for around 80% of instances. However, only about 20% of ankle sprain patients develop CAI. The Achilles Tendon (AT) is a structure made up primarily of collagen fibers that are oriented in the direction of tensile stresses transmitted through the tendons. CAI, particularly affects functional capability, that can be triggered by ankle sprains. The prevalence of CAI would be higher and functional abilities would be lower in those with disorganised AT structure than in those with organised structure. Extracorporeal Shockwave Therapy (ESWT), a non-invasive treatment for musculoskeletal conditions, has shown success rates of 65% to 91% in improving discomfort and functionality in individuals with ankle joint soft tissue disorders. The treatment focusses on preserving dorsiflexion and avoiding excessive plantar flexion, enhancing blood flow, bone and tendon regeneration through biological responses like bone morphogenic proteins, nitric oxide synthesis, and neovascularisation and preventing recurring ankle sprains in CAI patients. Despite its growing clinical use, no comprehensive reviews currently analyse ESWT’s effects on chronic ankle instability and Achilles tendinopathy. To bridge this gap, databases such as PubMed and PEDro were searched for studies published between 2014-2024. A total of 209 articles were retrieved out of which 87 duplicated were removed via Mendeley. The remaining 111 articles were screened and based on selection criteria only 4 articles were reviewed of full text English publication. The outcome measures were VAS for pain and ROM for ankle dorsiflexion function. The intervention period ranged between 3-24 weeks. The results shows that there was significant improvement in ROM and pain score VAS (p<0.05). To conclude ESWT is a effective measure for Achilles tendinopathy and ankle instability.

Relationship between Cervical Flexor Strength and Endurance in Patients with Chronic Neck Pain: An Observational Study

Aryan Dharmaik, Jatin Sangwan, Urvashi, Aditi Popli, Shivangi Palsra

Introduction: The global prevalence of neck pain was estimated at 288.7 million cases in 2017. Neck pain is often described as a condition with recurring episodes throughout life, with varying recovery levels between episodes. Studies on the effects of neck pain on the cervical motor system, posture, and movement have increased significantly, especially in the last 20 years.Decrease in cervical flexor endurance can lead to cervical dysfunction, tissue overload, trauma, and discomfort since it is connected with cervical spine function. Aim: The aim of the study is to examine the relationship between cervical flexor strength and endurance in patients with chronic neck pain. Materials and Methods: A total of 156 patients with chronic neck pain were recruited from Physiotherapy OPD, MM Superspeciality Hospital; the participants were male or female, aged 25-40 years and Visual Analogue Scale (VAS) 3.5-7.4 using convenient sampling method. Participants were excluded if they have acute neck pain, radicular pathology, cervical trauma within last six months and severe neck pain on VAS. Demographic data was recorded after taking consent from the participants. Based on the requirements, cervical flexor strength and endurance were assessed with two test which are pressure biofeedback test and neck Neck flexor endurance test. Results: Statistical analysis was done using SPSS version 22.0. Kolmogorov Smirnov test was used for assessing normality. As the data was not normally distributed, Mann-Whitney U test was used for data analysis by comparing the values of strength and endurance of the cervical flexors muscles. The statistical significant result was set if p-value ≤0.05. Conclusion: There was a statistical significant difference in the strength and endurance of cervical muscles in chronic neck pain patients. The finding of this study suggests that decreasing strength and endurance of neck flexor muscle will contribute to the neck pain and disability.Avoiding fear response commonly seen in the neck pain patients which leads to reduction of muscle strength and endurance.

Role of Combined Agility and Balance Training on Reducing Injury Risk in Basketball Players: A Systematic Review

Vaseem Akhtar, Probhjot Singh Nalwa

Introduction: Basketball is a fast-paced game that requires extreme physical activity including quick movements, sharp direction changes and frequent jumps. These physical demands results in various injuries specially in ankle and knee joints. To reduce the risk of these injuries, combined agility and balance training is seen highly effective. Agility is the ability to move quickly and change direction easily, Agility is correlated with several trainable physical attributes, including technique, strength, endurance, power and cognitive components. Balance is defined as ability to maintain stability and control of the body, especially while performing movements or standing.Balance refers to maintaining the body's centre of gravity over the base of support by neuromuscular responses in response to continuous visual, vestibular, and somatosensory feedback. Aim: The aim of this study is to discover the role of combined agility and balance training to prevent injuries and other musculoskeletal impairments among basketball players. Improving balance and agility contributes in improving stability, functions and athletic performance. Materials and Methods: Online databases like PubMed, Google Scholar and Cochrane were searched for articles published between 2010 to 2024. The search term such as “Agility: Balance training, Basketball player,reducing injury on basketball, using Boolean operators AND, OR. All the articles were randomised controlled trial, and were included in English language and other language were excluded. Results: A total of 58 articles were revived from different sites, out of which only 10 articles were found to meet the inclusion criteria. The results showed a significant decrease in rates of injuries and marked enhancements in performance among the basketball players who underwent combined agility and balance training. It also showed overall improved balance and agility in subsequent tests. Conclusion: This review concludes that combined agility and balance training plays a pivotal role in preventing injuries and enhancing performance in basketball players. By focusing on these skills’ basketball players can improve their physical resilience, enhance their performance, and remain healthier throughout the sports season.

Role of Transverse Abdominis Muscle in Trunk Biomechanics: A Critical Review

GC Sujan, Sandeep Pattnaik

The Transverse Abdominis (TrA) is the deep abdominal muscle with a transverse fiber arrangement, known to have an anticipatory activation before any bodily movement, and has a role in the stabilisation of the lumbar and pelvic area. Although we have a general understanding of the abdominal muscle in the biomechanical component of the trunk, the role of TrA is not completely understood. This critical review thus aims to exploreand outline the role of TrA in various biomechanical functions of the trunk including trunk rotation,inter-abdominal pressure, stability, and respiration. A comprehensive literature search was conducted to identify full-text articles exploring the role of TrA in trunk biomechanics, published in English across PubMed, EMBASE, EBSCOhost, and Cochrane Library between 2014 and 2024. Keywords like ‘Transverse Abdominis’, ‘Trunk Rotation’, ‘Trunk Motion’, and ‘Electromyography” were used as the search terms along with Boolean operators (AND, OR). Eligibility for inclusion was not restricted by any demographic or study design considerations. A total of 6 studies were identified and analysed to summarise the role of TrA. The review found that the TrA activation increases ipsilateral trunk rotation and helps in thoracolumbar and pelvic stability rather than initiation of the movement. During the perturbation and limb movement, through various reflexive mechanisms, TrA acts as a respiratory muscle and spinal stabilisation is secondary to it. The selective exercise for deep abdominal muscle and lumbar stabilisation exercise help in improving the thickness of TrA resulting in stabilisation of the lumbar region and posture. The TrA increases intra-abdominal pressure resulting in the extension of the lumbar vertebrae resulting in increased chest mobility as well. To conclude, findings suggest that TrA plays a crucial role in trunk rotation, stability, and respiration. While this review highlighted the multifaceted role of the TrA in trunk biomechanics, further research is warranted.

Influence of Leg Length, Trunk Length and Hydration Levels on Hamstring Flexibility among School going Adolescents: An Observational Study

Luckshita, Sukhpal Singh, Simranjeet Kaur, Nidhi Sharma

Introduction: Hamstring flexibility is an essential component of physical fitness that contributes to posture, reduces musculoskeletal injury risk, and enhances athletic performance in adolescents. While age and physical activity levels are known to affect flexibility, the impact of leg length, trunk length and hydration levels is secondary understood in this population. Aim: This study aims to investigate the influence of leg length, trunk length and hydration levels on hamstring flexibility among school-going adolescents aged 13 to 17 years. Materials and Methods: A cross-sectional study was conducted with 250 adolescents (131 males, 119 females). Hamstring flexibility was assessed using the V Sit and Reach Test. Body proportions, including leg and trunk lengths, were measured using standard anthropometric techniques. Hydration status was evaluated with the NIRUDAK scale, which considers fluid intake, urine colour, and physiological markers. Descriptive statistics and Spearman correlation analysis were used to explore relationships between these variables. Results: There were weak and non-significant correlations between hamstring flexibility and body proportions, such as leg length and trunk length (Rho=-0.107) and (Rho=-0.108). However, a significant positive correlation was found between daily water intake and hamstring flexibility (Rho = 0.474, p = 0.001). Dehydration showed a strong negative correlation with flexibility (Rho = -0.776, p = 0.001), indicating that increased dehydration levels are associated with reduced hamstring flexibility. Conclusion: Hydration has a notable impact on hamstring flexibility in adolescents, while leg and trunk length show no significant effect. These findings highlight the importance of adequate hydration for maintaining optimal flexibility and provide insights for educators and clinicians to design effective physical education and rehabilitation programmes.

Need of Establishing Translation and Crosscultural Adaptation of Questionnaires/Scales in Hindi: A Study Protocol

Anshika, Aditi Popli, Jatin Sangwan

Introduction: Translation and cross-cultural adaptation are essential in India due to its linguistic and cultural diversities which makes it crucial. As most of the outcome measures are of English origin, to guarantee that people receive the right information and treatment, validated and reliable medical outcome measures must be accurately translated and culturally adapted according to their needs.India holds officially 22 languages and Hindi is the most outspoken language. Need for this study: The translation and cross-cultural adaptation research will provide a valid and reliable tool for assessing outcomes in patients, improving accessibility and its clinical implication to reduce health disparities, and fosters education and empowerment. Aim: To establish the importance of translation and cross-cultural adaptation of various assessment questionnaires/scales in Hindi language for population in India. Methodology: Guidelines given by Beaton's are recommended as a core guide for translation process where an assessment questionnaire/scale is translated into the target language by the 2 translators during the first stage of forward translation (R1 and R2). A common translation, R-12 will be synthesised, and is sent for backward translation. The Draft R-12 will be forwarded for Delphi survey. This questionnaire/scale will further proceed for pretesting and final testing. Cross-cultural adaptation enables therapist to modify the cultural behaviours according to the need of the people to perform better. As it improves validity and dependability. Additionally, it is designed for culturally appropriate intervention and successful communication.

Study Protocol for Efficacy of Medicine Ball Exercise on Throwing Performance in Racket Sports

Shrishti, Nitin Kumar Indora

Introduction: Racket sports, including racquetball, badminton, table tennis, squash, and tennis, have experienced global popularity and are still growing. These sports demand a variety of skills, including power, strength, agility, and coordination, particularly while throwing or hitting.Practicing with medicine balls allows players to mimic strong, sequential, and rotating motions like striking and throwing during a game.Medicine ball workouts include twisting, turning, and bending motions that are not typically included in regular strength exercises. Medicine balls can weigh anywhere from 1 to 30 pounds. Need for this study: The study will assist in assessment of the medicine ball exercise efficacy using speed, smash velocity and accuracy. Aim: The aim of this study is to evaluate the efficacy of medicine ball exercise on throwing performance in racket sports. Methodology: In this study, badminton players aged 18-25 years, both male and female, with 1-2 years of experience will be included. Players will be excluded with recent fractures, surgery before 6 months, and with any musculoskeletal injury. The MCID score and the standard deviation from the pilot experiment will be used to determine the study's sample size. Simple random sampling will be performed for sampling. Selected players will be included for medicine ball exercises such as one-handed medicine slams, medicine ball squats and throws, standing side throws, chest passes, back throws, and frontal or side reaches. The outcome variables are speed, smash velocity, and accuracy.

Physiotherapy Approaches for Managing Shin Splint in Marathon Runners: A Narrative Review

Prateek Singh, Jatin Sangwan, Himanshi Arora, Urvashi

Medial Tibial Stress Syndrome (MTSS), often known as shin splints, is a common injury among marathon runners that is characterised by pain along the tibia, or inner part of the shinbone and now a days shin splints are common in marathon runners. It occurs due to overuse injury among marathon runners, and characterised by pain and discomfort along the medial tibial border (lower leg). In this injury, physiotherapy plays an important and crucial role to manage the shin splints. This narrative review explores various physiotherapy approaches for managing shin splints, generally focussing on conservative and evidence-based interventions. Key strategies include activity modification, cryotherapy, and Kinesio taping, which provide pain relief and improve postural control. Biomechanics adjustments, such as the use of orthotics and transitioning to a heel-toe running style, are shown to reduce tibial stress. Strengthening and stretching exercises target the tibialis posterior and anterior muscles to enhance flexibility and prevent recurrence. Novel techniques, such as cupping therapy, improve circulation and reduce muscle tightness, while Transcutaneous Electrical Nerve Stimulation (TENS) aids in pain management. Although shock-absorbing insoles and supportive footwear show promise, evidence for their long-term efficacy remains inconclusive. Combining modalities, such as kinesio taping and structured training programmes, offers a comprehensive management strategy. This review highlights the importance of a tailored, multidisciplinary approach to alleviate symptoms, prevent recurrence, and optimise performance in marathon runners with shin splints. Further research is needed to evaluate the long-term benefits of these interventions.

Physiotherapy to Reduce the Sarcopenia in Patient with Type Ii Diabetes Mellitus: A Narrative Review

Manvi Devi, Urvashi, Jatin Sangwan, Lakshay Panchal

In 2019, International Diabetes Federation (IDF) was estimated that 77 million persons suffered with Type 2 Diabetes Mellitus (T2DM) in India and according to the Asian Working Group for Sarcopenia (AWGS) criteria, a 22% prevalence of sarcopenia has been reported. Sarcopenia and T2DM, both are more prevalent with aging which increasing the chances of long term complications, hospitalisations, frality and premature death. The risk of developing sarcopenia is 3 to 16 times more in patients with T2DM diabetes. Sarcopenia refers to the declining in skeletal muscle mass and muscle function with age. Approximately, 80% glucose clearance is primarily done by glucose transporter 4 (GLUT 4) which is present in skeletal muscles. The chance of developing T2DM is increased due to decreased efficiency of glucose uptake with age. The aim of this study is to synthesise and outline the current research studies using physiotherapy interventions to decrease the sarcopenia in patients with T2DM. A literature from 2015 to 2024 was searched on PubMed, Google Scholar, Scopus and PEDro with the keywords like “Physiotherapy AND Sarcopenia”, “Type II diabetes mellitus AND sarcopenia”, “Body composition and sarcopenia”, “Exercise AND sarcopenia” which resulted in 671 Articles were retrieved, and from this 31 Articles we have include in our study. Exercises include strengthening exercise, sandbag exercises helps in increasing muscle mass, strength, functional capacity; and aerobic exercises will enhance the physical performance by improving cardiovascular health, metabolic function, and endurance in T2DM patients with sarcopenia. Blood Flow Restriction (BFR) training shows more significant result as compare to resistance exercises. BFR a promising approach which restrict flow of blood to the muscle during low intensity exercise; helps in improving muscle growth and strength. Pilates is an innovative version of exercises and Virtual Reality (VR) engage patient in immersive environment; shown to be beneficial in reducing sarcopenia by improving strength, balance, coordination and muscle stability. Neuromuscular Electrical Stimulation (NMES) can be used as adjunct to strength training in patients who are unable to perform exercises due to mobility issues. This review highlighting the significance of personalised, evidence based exercise programme customised according to the patient’s need.

Effect of Shockwave Therapy on Neck Pain in Patients with Levator Scapulae Syndrome: A Pilot Study

Heman Devi, Jatin Sangwan, Urvashi, Aditi Popli

Introduction: Levator Scapula Syndrome (LSS) can be defined as motor, sensory, and autonomic symptoms that cause by Myofascial Trigger Points (MTrPs) in levator scapulae muscle that are associated with a hypersensitive palpable nodule in taut bands. The prevalence of LSS among beauticians is 38.5%. LSS is characterised by pain, stiffness in cervical and upper thoracic region, with decreased Range of Motion (ROM) and tenderness on palpation of superior angle of scapula. Aim: To examine the effect of shockwave therapy on neck pain in patients with LSS. Materials and Methods: Twelve patients with neck pain due to trigger point in levator scapulae muscle will be recruited by convenient sampling method. The patients aged between 20 to 40 years with trigger point in levator scapulae muscle were included in this study. The exclusion criteria include: epilepsy, traumatic injury of cervical vertebra, surgery affecting the cervical spine, cervical herniated discs, ankylosing spondylitis and rheumatoid arthritis. The participants were divided into two groups, Group A received shock wave therapy and Group B received conventional Transcutaneous Electrical Nerve Stimulation (TENS) therapy. Pain intensity was measured by NPRS scale, Pressure Pain Threshold (PPT) by algometer and quality of life by Neck Disability Index before and after the intervention. Results: The results were analysed based on the pre and post values of the outcome measure i.e. NPRS, PPT and Neck Disability Index.Shapiro-wilk test was used as a normality test as total number of participants will be less than 50. SPSS version 22.0 was used for data analysis and paired t-test was used for within group analysis and unpaired test was used for between group analysis. Conclusion: The findings of the study conclude that shock wave therapy reduce pain, tenderness and improve quality of life in patients with LSS. Group A showed statistical significant results as compare to Group B. The pain pressure threshold was also reduced after the four weeks shock wave intervention protocol.

Prevalence of Obstructive Sleep Apnoea among College going Students: A Study Protocol

Harpreet Kaur, Mousumi Saha, Subhashish Chatterjee

Introduction: Obstructive Sleep Apnoea (OSA) is a sleep disorder defined by partial or complete obstruction of the upper airway during sleeping. Occasional episodes of hypopnoea and/or apnoea are caused by the upper airways collapsing due to the change in airway muscle tone during sleep, which primarily occurs during the inspiratory phase of breathing. Snoring, sleep problems, and exhaustion during the day are common symptoms. The majorities of OSA patients are obese, at high cardiovascular risk, and have other cardio metabolic co morbidities. OSA is most commonly treated with Continuous Positive Airway Pressure (CPAP). Other treatments for OSA include positional therapy, aerobic exercise, Orofacial Myofunctional Therapy (OMT), lifestyle modifications, and Transcutaneous Electrical Nerve Stimulation (TENS). Need for this study: This simple and user-friendly tool aims to effectively evaluate individuals who could be at risk for OSA. It offers a rapid and accurate way to find people who can benefit from additional assessment or intervention. Aim: The aim of the study is to assess the prevalence of OSA among overweight college going students using STOP-BANG questionnaire. Materials and Methods: Students from university having Body Mass Index (BMI) more than 25 kg will be participating in this study. The STOP-BANG questionnaire will be used as the outcome measure. Those who meet the inclusion criteria will be given OMT, TENS, aerobic exercise, positional therapy, CPAP, and lifestyle change.

Revolutionising Cancer Cachexia Care: Virtual Reality Interventions for Enhanced Patient Outcomes

Kajal, Shweta Sharma

Cancer cachexia is a debilitating condition which leads to wasting of muscles, weight loss, and a decline in quality of life. Cancer cachexia is a multifactorial condition that leads to enhanced functional impairment and is defined by an ongoing loss in skeletal muscle mass that is not fully reversed by conventional nutritional treatment. It is necessary to diagnose or treat refractory cachexia early as associated muscle wasting is not completely understood. This highly impacts the patients’ Quality of Life (QoL). Exercise Rehabilitation proves to be an effective management strategy to improve QoL. This includes aerobic, resistance, flexibility, and neuromuscular training. Exercise rehabilitation has been shown to significantly improve Cancer-Related Dysfunctions (CRDs). Virtual Reality (VR) is a software application that allows users to navigate through and interact with a virtual environment nearly in real time. Virtual Reality (VR), exercise, nutritional therapy, psychosocial assistance, and pharmacological therapy are the interventions involved in cancer cachexia intervention. The aim of the study is to figure out the impact of VR based interventions on improvement of outcomes of patients suffering from cancer cachexia. This review utilised PubMed, Google Scholar, and Cochrane to search relevant full texts literature and identified 30 studies from the last 10 years comprising randomised controlled trials, qualitative studies, and systematic reviews. After removing duplicates, 15 articles were found to be pertinent to the review.Patients who went through VR based intervention showed a significant improvement in muscle strength, functional ability and overall QoL. This review finds that interventions using VR gave significant promise to the intervention of cancer cachexia, the condition that severely affects cancer patients' quality of life by causing fatigue, muscle wasting.

Effect of Physical Activity on Modulation of Gut Microbiome in Patients with Alzheimer’s Disorder

Waniya Sawhney, Lakshay Panchal, Manu Goyal, Aditi Popli

Alzheimer's Disease (AD) is a neurodegenerative disorder with the hallmark of neuropsychiatric symptoms and neurodegenerative dysregulation. Recent researches have suggested that gut microbiome can influence the pathological pathways and progression of AD. All qualitative and quantitative alteration in gut microbial composition can potentially contribute in progression of the AD. Physical Activity (PA) has become a potent strategy for preventing cognitive decline and lowering chronic inflammation. PA also causes notable alterations in gut microbiota composition, functionality, diversity, and Short-chain Fatty Acid (SCFA) production. Physical stress and cognitive abilities are positively correlated in both AD patients and the elderly. Physical activities can be carried out with relatively easy and affordable methods, and even brief interventions that occur seldom appear to have beneficial effects. This review aims to examine the existing evidence to find the effect of physical activity on modulating gut microbiome and its implication for the progression of AD. The literature search was conducted from various databases including PubMed, PEDro, and Cochrane. This review includes findings from 8 studies which suggest that exercise-induced alterations for the treatment of gut dysbiosis can alleviate the symptoms of AD and improves physical health and psychological wellbeing of patient. Furthermore, exercise has a major impact on gut microbiota.

Review of Various Tools Available to Assess Sleep Quality

Sundar Kumar, Neha Kashyap, Sikha Singh, Md Sajid Raza Khan

Sleep quality is a crucial clinical concept since people frequently report poor sleep quality and its impact on daily functioning. Poor sleep quality is a common sign of various medical and sleep disorders. Objective measures of sleep quality, such as polysomnography, are costly, time-consuming, and unsuitable for epidemiology and research studies, making them inaccessible to many practitioners. However, a number of self-report questionnaires have been developed. This review focusses on the psychometric qualities, concept validity, and factorial structure of sleep quality questionnaires. It compares and discusses their measuring features. This narrative review covered a total of 20 articles. Article were searched from PubMed(12), Scopus(4), PEDro(2), Cochrane library(2). Twenty papers were examined, comprising eight reviews, two experimental studies, three observational studies, five cross-sectional studies, and two surveys. An evaluation of 20 studies that used Polysomnography (PSG), Electroencephalogram (EEG)- based methods, actigraphy, clinician observation, and patient-reported questionnaires was performed. Key findings include the need for standardised criteria for scoring PSG in patient, who commonly have aberrant brain wave patterns. The quantity, sample size, and duration of existing research limit the ability to provide meaningful recommendations for EEG-based measurements and actigraphy. Clinicians should use the Sleep Observation Tool to monitor sleep, and the Richards Campbell Sleep Questionnaire to measure patients' views of sleep quality. To assess the success of programmes to prevent sleep loss, sleep assessment instruments must be trustworthy and valid. There has been significant progress in creating, testing, and applying these techniques in the people. We advocate doing large, multicentre intervention studies to assess many components of sleep and provide additional information on the instruments' reliability, validity, feasibility, and sensitivity. In addition, we support the development of new technologies to improve the functionality and precision of existing tools.

Circular Training’s Function in Post-anterior Cruciate Ligament Tear Rehabilitation: Evaluating how well it Restores Strength, Mobility, and Endurance

Shreya, Aditi Popli, Jatin Sangwan, Urvashi Chauhan

An Anterior Cruciate Ligament (ACL) tear is a potentially fatal injury that frequently necessitates surgery and prolonged recovery. Strength, mobility, and endurance exercises are all part of circular training, a planned programme that has gained popularity as a successful recovery technique. Circular training incorporates several rehabilitation objectives into dynamic, time-efficient sessions, in contrast to standard therapy procedures. The aim of the study is to assess the role that circular training plays in helping people who have had ACL repair regain their strength, mobility, and endurance. By combining previous research and methods, this investigated the function of circular training in the recovery process following an ACL tear. It included activities like resistance training (leg presses, squats), dynamic stretches, and low-impact cardio (cycling, elliptical) and concentrated on how well circular training restored strength, mobility, and endurance. With consideration for patient-reported adherence and difficulties, the review focused on important results, such as increased cardiovascular endurance, knee Range of Motion (ROM), and quadriceps and hamstring strength.Circular training considerably enhanced post-ACL tear healing, according to the review. Through low-impact aerobics, participants saw improvements in knee range of motion, increased muscle strength, particularly in the quadriceps and hamstrings, and greater endurance. Strength, mobility, and endurance were successfully restored by the organised exercise. Strength, mobility, and endurance are all improved by circular training, which is a successful rehabilitation technique for recovering from an ACL damage. It offers a thorough approach to healing by combining low-impact cardio, mobility work, and resistance workouts.

Comparative Effectiveness of Viddha-agnikarma in Managing Lower Back and Knee Joint Pain: A Pilot Study

Yogesh Yadav, Sheetal Asutkar

Introduction: Viddha-agnikarma is a novel Ayurvedic method that combines Viddhkarma (piercing therapy) and Agnikarma (thermal cautery) to alleviate pain through targeted thermal stimulation. It offers an alternative pain management approach, particularly for chronic musculoskeletal conditions, by delivering localised relief without reliance on pharmacological treatments. Aim: To evaluate the efficacy of Viddha-agnikarma in managing chronic pain associated with the lower back and knee joints in patients unresponsive to conventional therapies. Materials and Methods: This was a prospective intervention pilot study conducted at Department of Shalya Tantra, Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Wardha, Maharashtra, India, from February 2024 to July 2024. It included 12 patients with persistent lower back or knee pain resistant to standard treatments. Each patient received Viddha-agnikarma therapy every three days, totaling seven sessions, with follow-up evaluations on day 21. Pain levels were assessed using the Visual Analog Scale (VAS) at baseline, immediately post-treatment, and during follow-up. A comparison of the differences in initial and final mean scores was conducted, and the percentage improvement in pain scores was calculated to evaluate therapeutic efficacy. Results: The study included 12 patients: seven males and five females, all from rural areas, with a mean age of 58±5.9 in Group A and 54.8±8.4 in Group B. VAS scores indicated a reduction from 8 to 0.33 for Lower Back Pain (LBP), and from 8 to 4 for knee pain. Although patients experienced some improvement in knee pain, the outcomes were less consistent and varied across individuals, indicating a need for further research into Viddha-agnikarma’s efficacy for knee pain. Conclusion: Viddha-agnikarma emerged as a promising non pharmacological alternative for chronic pain management, particularly effective for LBP, with potential benefits over conventional treatments. This pilot study supports the integration of Viddha-agnikarma into Ayurvedic pain management practices. However, larger, randomised controlled trials are necessary to validate these findings and further explore its effectiveness, especially for knee pain management.

Transurethral Pneumatic Cystolithotripsy under Local Anaesthesia as a Day-care Procedure: A Retrospective Descriptive Study from North-east India

Stephen Lalfakzuala Sailo, Cornerstone V Wann, Laltanpuii Sailo, Rajini Thabah

Introduction: Urinary bladder stones comprise only 5% of all urinary stones but are responsible for 14% of hospital admissions. Various types of treatment for bladder stones include open cystolithotomy, extracorporeal shock wave lithotripsy, cystolitholapaxy, and percutaneous suprapubic or transurethral cystolithotripsy. Aim: To report the safety and intensity of pain associated with transurethral pneumatic cystolithotripsy under local anaesthesia in adult patients as a day-care procedure. Materials and Methods: This retrospective hospital-based descriptive study was conducted in the Department of Urology at the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, India, from June 2022 to January 2024, 34 patients (33 men and 1 woman) with symptomatic urinary bladder stones underwent transurethral pneumatic cystolithotripsy under local anaesthesia as a day-care procedure. Patient’s sex, age, symptoms, complete blood count, kidney function tests, random blood sugar, Glycated Haemoglobin (HbA1c), coagulation profile and urine analysis were collected from hospital records. Stone size and number were collected from Kidney, Ureter and Bladder (KUB) X-ray, ultrasonography and in some cases, intravenous urography and CT scan (non-contrast) reports. Ten minutes after the instillation of 10 mL of 2% lignocaine jelly into the urethra, pneumatic energy was delivered using a 9.5 F semi-rigid ureteroscope (Karl Storz, Germany). Pain during the procedure was assessed using the Visual Analogue Scale (VAS). The operating time and status of fragmentation and clearance of the stone were also recorded. These data were entered and analysed using Microsoft Excel Software version 2019. Continuous variables were presented as mean and standard deviation or range, while categorical variables were expressed as frequencies and percentages. Results: The mean patient age was 38 years, and the mean stone size was 13.9 mm. The mean operating time was 15.4 minutes. Complete stone fragmentation and clearance were achieved in 30 out of 34 patients (88.2%), with a mean VAS score of 2.5. All patients who had a successful procedure had stones ≤20 mm. Mild haematuria was observed in 25 patients (73.5%). There were no bladder perforations and no mortality. The procedure failed in four patients, who subsequently underwent cystolithotripsy under spinal anaesthesia. Conclusion: Transurethral pneumatic cystolithotripsy under local anaesthesia as a day-care procedure was safe and effective. Adult patients tolerated the procedure well. Therefore, it is a viable treatment option for urinary bladder stones of size up to 20 mm in adult patients.

Evaluation of Bolton Anterior and Overall Tooth Size Discrepancy among Different Malocclusion Groups in Southern Indian Population: A Retrospective Study

Sandiya Rajavelu, Thirunavukkarasu Ramanathan, Muralidharan

Introduction: Orthodontic treatment involves distinct phases, each with unique traits and challenges. In particular, the “Finishing” stage is renowned for the fine corrections needed to achieve optimal results. Discrepancies in tooth size contribute significantly to the difficulties encountered during this stage. Aim: To assess differences in maxillary and mandibular tooth size discrepancies among different sagittal malocclusion groups in a South Indian population using the derived Bolton formula. Materials and Methods: A retrospective study was conducted in the Department of Orthodontics at Karpaga Vinayaga Institute of Dental Sciences, Kanchipuram, Tamil Nadu, India, over three months, from July to September 2024. A total of 120 high-quality pretreatment orthodontic study models were selected. The inclusion criteria comprised patients aged 16 to 25 years with full permanent dentition up to the first molars in both arches. The models were categorised into three groups based on Angle’s classification of anteroposterior malocclusion: Class I (n=40), Class II (n=40), and Class III (n=40). The mesiodistal width of each tooth up to the first molar on both sides was measured at the interproximal contact points using a digital caliper. Bolton’s anterior and overall ratios were calculated using the measured values. Statistical analysis included one-way ANOVA to evaluate differences in mean Bolton ratios across groups, and the Chi-square test to assess the distribution of anterior and overall Bolton discrepancies among the malocclusion types. A p-value of <0.05 was considered statistically significant. Results: The prevalence rate of tooth material discrepancies in the anterior region for Angle Class I and Class III groups was significantly greater than that for Class II groups. The mean overall and anterior ratios were not significantly different between the malocclusion groups (p=0.13 and p=0.72, respectively). Conclusion: The present study indicated that Class I and Class III show an increased frequency of tooth material discrepancies compared with Class II.

Impact of Verbal and Visual Training on Amount of Toothpaste Dispensed by Parents and Children: A Quasi Experimental Study

Arwa Soni, J Jasmin Winnier, Shilpa S Naik, Sonal Tandel, Diksha Patil, Kruti

Introduction: Fluoride prevents dental caries however excessive utilisation of fluoridated toothpastes can lead to dental fluorosis. Hence, parents and children should be instructed regarding toothpaste dispensing quantities. Aim: To determine the effectiveness of visual and verbal aids in instructing parent-child dyad regarding toothpaste dispensing patterns. Materials and Methods: A pretest-post-test quasi experimental study was conducted comprising of 70 parents and children aged 3-6 years in the Department of Paediatric and Preventive Dentistry, DY Patil University of Dentistry, Navi Mumbai, India from September to December 2023. Data on toothpaste and toothbrush type were collected. Toothpaste dispensing was assessed at baseline, after parental counselling with visual and verbal aids (T0) and after atleast three months (T1). One-way ANOVA and Tukey HSD post-hoc test was used to compare difference in weight of toothpaste dispensed at all time intervals. Unpaired t-test was used to compare amount of toothpaste dispensed by parent and child at all time intervals. Results: A total of 44 (62.9%) of parents utilised adult toothpaste and 7 (10%) used adult toothbrushes while brushing their child’s teeth. Parents and children dispensed an average 0.62±0.29 mg and 0.74±0.34 mg, respectively. However, a noticeable reduction in usage from baseline to T0 and T1 was observed in both parent and child groups (p<0.001*). Conclusion: Parents and children dispensed beyond recommended amount. Children, dispensed more toothpaste than their parents at baseline, immediately after counselling and after three months, emphasising need to monitor toothpaste use in preschoolers to avert dental caries and fluorosis. The noticeable reduction in parental usage shows positive impact of visual and verbal guidance in their dispensing habits.

Dosage of Local Anaesthetic Drug in Spinal Anaesthesia Based on Dural Sac Cross-sectional Area Measured using Ultrasound for Transurethral Resection and Inguinal Hernia Surgeries: A Double-blinded, Randomised Controlled Study

Sandip Baheti, Tharun Dasarath Perni, Sravya Bejugama, Vaishnavi Avirneni

Introduction: Geriatric patients undergoing surgical procedures such as Transurethral Resection of the Prostate (TURP) and inguinal hernia repair often face an increased risk of complications due to age-related anatomical and physiological changes. The Dural Sac Cross-sectional Area (DSCSA) has been proposed as a parameter to optimise the dosage of local anesthetics in spinal anaesthesia, aiming to achieve effective sensory blockade while minimising haemodynamic instability. Aim: To determine the minimum required dose of intrathecal bupivacaine based on DSCSA for achieving a T10 sensory blockade in elderly patients undergoing TURP and inguinal hernia repair. Materials and Methods: This was a double-blinded, randomised controlled study conducted on 70 geriatric patients {American Society of Anaesthesiology (ASA) I and II} undergoing TURP or inguinal hernia repair at Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India from July to November 2024. Patients were randomly allocated into two groups: the Control (C) group, which received a fixed dose of 10 mg hyperbaric bupivacaine, and the Ultrasound (U) group, where DSCSA was measured using ultrasound at the L3-L4 level, and the bupivacaine dosage was adjusted accordingly. Haemodynamic parameters, sensory blockade levels, motor block duration, and two-segment regression times were analysed. Data normality was assessed using the Shapiro-Wilk test, with quantitative variables compared using the independent t-test, qualitative variables analysed using the Chi-square test or Fisher’s exact test, and a p-value <0.05 considered statistically significant. Results: Baseline characteristics such as age, height, weight, ASA grade, and surgery duration were comparable between groups (p>0.05). The mean DSCSA in the U group was 120.03±12 mm², with a calculated mean dose of 7.99±0.77 mg bupivacaine, significantly lower than the fixed 10 mg in the C group (p<0.0001). The highest sensory level reached was T8 in the U group and T4 in the C group (p=0.004). The U group had a significantly shorter motor block duration (157.23±11.92 min vs. 199±21.86 min, p<0.0001) and two-segment regression time (52.5±13.44 min vs. 62.64±14.49 min, p=0.003). The C group experienced a greater decrease in Mean Arterial Pressure (MAP) (p<0.0001) with a higher need for vasopressor support. Conclusion: Tailoring the intrathecal bupivacaine dosage based on DSCSA significantly reduces the risk of excessive cephalad spread, minimising haemodynamic fluctuations while maintaining adequate anaesthesia. Ultrasound-guided DSCSA measurement can serve as a valuable tool for optimising spinal anaesthesia in geriatric patients.

Comparative Evaluation of Fragment Reattachment and Fracture Resistance of Tooth Stored in Different Hydration Media when Reattached with Different Materials: An In-vitro Study

Introduction: Different methods have been developed to restore an uncomplicated crown fracture, varying from less invasive procedures to aesthetic restorations. Fragment reattachment has been established as a better alternative for restoring aesthetics, anatomy, and improved function. The rationale of the study lies in the fact that the materials used in the study are readily available and has proved beneficial in many literatures. Aim: To compare the tooth reattachment success and fracture resistance between tooth remnant and reattached part using different reattachment materials when the fragments were in different storage conditions. Materials and Methods: The present in-vitro, experimental study was conducted at Guru Nanak Institute of Dental and Research, Panihati, West Bengal, India, Indian Institute of Engineering Science and Technology, Shibpur and Narula Institute of Technology, Agarpara for one and half years, July 2022 to December 2023. A total of 96 Maxillary permanent central incisors extracted due to periodontal problems with approximately similar dimensions, mesiodistal width at the junction of middle and incisal third approximately between 8.4 to 8.7 mm were included in the study. Sample was divided into four groups: 1 positive control (A) and 3 experimental, based on storage media (B- Normal Saline, C- Fat-free milk, D- Stored Dry). Each experimental group was further subdivided into three sub-groups according to the different reattachment material (1- Light cure GIC; 2- Nano-filled packable Composite; 3- Flowable Composite). Tooth fracture was simulated and then the fracture fragments were stored as per the standard rehydration protocol for each group and reattached accordingly. The samples were then mounted on a Universal Testing Machine (UTM) to evaluate fracture resistance. The tooth reattachment success was noted by calculating the distance between the reattached tooth fragment from the reattachment material using Scanning Electron Microscopy. One-way Analysis of Variance (ANOVA) and Tuckey’s post-hoc tests were used for intergroup and intragroup comparisons. The level of significance was fixed at p=0.05 and any value ≤0.05 was considered to be statistically significant. Results: It was seen that significant differences were seen in fracture resistance based on different storage media and different reattachment materials. Among the samples, it was found that the fracture resistance is the highest in packable composite in the fat-free milk media with a mean value of 278.09 (SD 9.54). Also, it was found that distance between restoration and tooth surface is the smallest in packable composite in the fat-free media with a mean value of 1.4131 μm (SD 0.12880). These differences were statistically significant. Conclusion: The success of reattachment of a fractured anterior tooth with its fractured fragment was affected greatly by the rehydration of the fragments and also by the type of reattachment material used.

Effectiveness of Biodentine in Apexification of Immature Teeth: A Prospective Clinical Study

Debjani Saha, Nandita Goyal, Haridas Das Adhikari, Snigdho Das, Ankit Chanani

Introduction: Apical periodontitis results from microbial infection in the root canal system, prompting endodontic treatment to eliminate infection and prevent reinfection. Apexification addresses the cessation of root development in teeth with incomplete formation and pulpal necrosis, using materials such as Calcium Hydroxide (CH), Mineral Trioxide Aggregate (MTA), or Biodentine. By utilising Biodentine’s unique properties in a single-step apexification approach, this study seeks to provide evidence-based insights into its efficacy in reducing lesion size, promoting apical healing, and minimising procedural complexities. The findings will contribute to the growing body of literature supporting Biodentine as a viable alternative to traditional apexification techniques, potentially influencing future clinical protocols for managing immature teeth with open apices. Aim: To assess the effectiveness of Biodentine as a material in the apexification of immature teeth with periapical lesions. Materials and Methods: This prospective clinical study, approved by the Institutional Ethics Committee, was conducted at Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India, from March 2014 to February 2016. Forty healthy patients aged 14 to 50 years, with traumatised maxillary incisors exhibiting incomplete root development and open apices, were included in the study. The inclusion criteria specified teeth with chronic apical periodontitis or wide apical foramina. Preoperative evaluations included clinical assessments and radiographic examinations. The apexification procedures involved thorough canal preparation, disinfection, application of Biodentine, and subsequent obturation with gutta percha. Follow-ups were scheduled at 1, 3, 6, 9, 12, and 18 months. Friedman’s ANOVA with post-hoc Dunn’s test and the Binomial test were employed for statistical analysis at an alpha level of 5%. Results: Initially, although 40 patients were recruited, only 33 completed all follow-ups and were included in the final analysis. After accounting for dropouts, the median age of participants was 29 years (IQR: 19-39.5), with an age range of 14-47 years. The study included 19 males (57.6%) and 14 females (42.4%), with no significant gender association across groups (p=0.49). The median lesion size (IQR) decreased progressively: preoperative 21 mm² (10-40), 18 mm² (9-33.5) at one month, 15 mm² (7-22) at three months, 7 mm² (3.5-16) at six months, 4 mm² (0.5-12) at nine months, 1 mm² (0-7) at 12 months, and 0 mm² (0-2.5) at 18 months, reflecting reductions of 13.44-88.91%. Younger patients (<20 years) showed greater lesion reduction at 18 months compared to older patients (33 mm² vs. 14 mm², p=0.03), with no gender differences (p=0.86). At the 18-month follow-up, pain or discomfort was absent in 29 (87.9%) patients (p<0.001). Tenderness on palpation was absent in 30 (90.9%) (p<0.001), and tenderness on percussion was absent in 29 (87.9%) (p<0.001). An abscess or sinus was not observed in any patient (33 [100%]). Clinical and radiographic success was achieved in 29 (87.9%) cases, while 4 (12.1%) cases were classified as failures (p<0.001). Conclusion: Apexification using Biodentine shows promising outcomes; however, its efficacy relative to conventional methods could not be definitively established. Comparative studies with traditional materials, larger cohorts, and extended follow-ups are needed to validate its potential as an alternative for managing immature teeth with open apices.

Association of Serum Magnesium and Cardiovascular Events in End Stage Renal Disease Patients: A Prospective Cohort Study

Arya Vijayan, Ajumala M Basheer, KS Shajidha, Arun Mathew Chacko, A Geetha

Introduction: End Stage Renal Disease (ESRD) patients display cardiovascular complications which is a significant feature for surge in death rate and morbidity. Vascular calcification manifests prematurely in renal failure patients and progresses often in an enhanced manner in subjects with hypomagnesaemia in comparison to the common herd. Aim: The aim of the study was to evaluate if there is any association with serum Magnesium (Mg) levels and future cardiovascular events in Chronic Kidney Disease (CKD) stage-5 patients. Materials and Methods: The present prospective cohort study was conducted on 60 CKD patients presenting to the Department of Nephrology at Government Medical College, Kottayam, Kerala, India, from 6th May 2016 to 5th May 2017. 5 mL of venous blood samples were collected and separated serum was used to determine Mg using the Xylidyl blue method in a fully automated clinical chemistry analyser, the Beckman Coulter AU 480. The study subjects were also grouped based on all causes of mortality due to cardiovascular events after follow-up for one year. Statistical analysis was performed by using Fischer’s-exact test, Pearson’s Chi-square, and Pearson’s correlation test. The p-value <0.05 was considered statistically significant. Results: Sixty subjects study population were in the age group ranging from 20-79 years, including 47 (78.3%) males and 13 (21.7%) females. The mean Mg level in those who developed an event was 2.32±0.41 mg/dL and in those who did not develop an event was 2.41±0.45. This difference in mean was not statistically significant with independent t test with t value=-0.69 and p-value=0.49. There was no significant association between low serum Mg levels and occurrence of cardiovascular event with p-value >0.05. Conclusion: Although Mg has been shown to effectively slow down calcification in controlled settings, additional elements impacting calcium deposition in CKD individuals must not be overlooked.

Association of hsCRP Levels with Microvascular Complications in Prediabetics, Newly Diagnosed and on Treatment Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Jagannath Dhadwad, Prince Yadav

Introduction: Low-grade chronic inflammation is recognised as the predominant cause of the pathogenesis and progression of Type 2 Diabetes Mellitus (T2DM) and its microvascular complications. High-sensitivity C-Reactive Protein (hsCRP) is a biomarker for inflammation that may indicate the underlying mechanisms of diabetes, such as insulin resistance and vascular damage. Aim: To compare hsCRP levels across three glycaemic categories- prediabetes, newly diagnosed T2DM, and on-treatment T2DM- and to determine its correlation with glycaemic control measures Glycated Haemoglobin (HbA1c), Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS) and microvascular complications such as diabetic retinopathy, nephropathy, and neuropathy. Materials and Methods: The present hospital-based, cross-sectional, analytical study was conducted over 18 months (October 2023 to March 2025) at Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Pimpri, Pune, Maharashtra, India. One hundred fifty participants aged ≥18 years were randomly assigned to three groups: prediabetics, newly diagnosed T2DM (≤18 months), and T2DM under treatment. Measurements included FBS, PPBS, HbA1c, and hsCRP using an immunoturbidimetric assay. Diabetic retinopathy was diagnosed via fundoscopy, nephropathy was assessed through the urine albumin-creatinine ratio, and peripheral neuropathy was screened using a 10 g monofilament and sensory examination. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) v20. Comparisons between groups were conducted with One-way Analysis of Variance (ANOVA) and the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Mean hsCRP values were significantly higher in newly diagnosed (7.87±1.26 mg/L) and on-treatment diabetics (7.26±2.30 mg/L) compared with pre-diabetics (2.72±2.80 mg/L; p<0.001). hsCRP exhibited a strongly positive correlation with HbA1c (r=0.616), FBS (r=0.223), and PPBS (r=0.461). Patients with diabetic retinopathy, nephropathy, and neuropathy had significantly elevated hsCRP levels compared to those without complications (p<0.001). Conclusion: hsCRP is a valuable marker of inflammation associated with poor glucose control and the development of diabetic microvascular complications. Regular monitoring can aid in the early detection of risk, facilitating targeted anti-inflammatory therapy and strict glycaemic control.

Management of Binge Eating Disorder in Polycystic Ovarian Syndrome using Different Modalities: A Randomised Controlled Trial

Renuka Jakhar, Elina Dewanji Sen, Preeti Rastogi

Introduction: Difficulty in losing weight is a major problem in binge eaters. It becomes catastrophic when it is concurrent with Polycystic Ovarian Syndrome (PCOS). Weight loss programs don’t benefit to cope with binge eating disorder and vice-versa; which is the most challenging component of weight management in PCOS females that manifest binge eating also. Aim: To develop a management strategy which can address binge eating and weight management in PCOS females. Materials and Methods: The present randomised, parallel group, active controlled trial was conducted from december 2021 to december 2022 in non-pregnant females of 18-45 years of age satisfying Rotterdam criteria of PCOS having BMI ≥18.5. Eating Disorder Diagnostic Scale (EDDS) was used as a screening tool. A total of 114 participants were randomised into two groups of 57 females each ,experimental group and control group control group (n=57). Experimental group performed aerobic exercises, resistance exercises, diet modifications and Rajyoga meditation while control group performed only diet modifications and Rajyoga meditation. Eligible and willing participants visiting Weight, height, waist circumference, hip circumference, Body-Mass Index (BMI), Waist-Hip Ratio (WHR), Eating Attitudes Test (EAT) score, Bulimic Investigatory Test, Edinburgh (BITE) severity score and BITE symptom score were assessed before start of intervention and after 12 weeks of intervention. Shapiro-Wilk test indicated data were non-normally distributed. Within group analysis (pretest vs post-test) was performed using Wilcoxon signed-rank test. The between group differences were compared (experimental vs. control) using Mann-Whitney U test. IBM Statistical Package for Social Sciences (SPSS) Statistics 22.0 was used for analysis with p<0.05 statistically significant. Results: The mean ageof the participants was 26.35±4.97 years, mean weight was 73.53±16.73 kg, mean WHR 0.88±0.04 and mean BMI 28.81±5.90 kg/m2 Reduction in weight, BMI, waist circumference, EAT score, BITE severity score and BITE symptom score were statistically significant within both groups (pre-test and post-test, p<0.001) while reductions in hip circumference and WHR were statistically significant only in experimental group (pre-test and post-test, p<0.001). Conclusion: the present study results highlights the significant weight BMI binge eating symptoms in the intervention group.further researches can help the profeSsionalS in healthcare in treatment of pcos.

Nerve Conduction among Middle-aged Indian Diabetic Males without Clinical Neurodeficit: A Cross-sectional Study

Andrevich Saha, Piyali Das, Sujoy Ghosh

Introduction: Peripheral neuropathy is one of the dreaded complications of diabetes mellitus. Data pertaining to subclinical neuropathies among diabetics are deficient, especially in the Indian context. Aim: The aim of this study is to evaluate the Nerve Conduction Study (NCS) parameters in middle-aged Indian males with diabetes who do not exhibit any clinical neurodeficits, and to compare the findings with age-matched, non diabetic healthy controls. The present study also explores the correlations between NCS parameters and glycaemic control (HbA1c) in the study population. Materials and Methods: This cross-sectional study was conducted at IPGME&R Kolkata, West Bengal, India from February 2021 to July 2022. A total of 165 diabetic males without any neurological symptoms and 54 age-matched non diabetic controls were included in this study. Onset latencies, amplitudes, and conduction velocities of the median, ulnar, tibial, peroneal, and sural nerves were compared between the groups using an unpaired Student’s t-test. The correlation between NCS parameters and HbA1c levels among diabetics was checked using the Pearson correlation coefficient. A p-value of <0.05 was considered significant. Results: In the present study, 165 diabetic individuals and 54 non diabetic controls were included. When comparing the nerve conduction parameters, the diabetic individuals showed significant delays in sensory and motor nerve conduction across all peripheral nerves examined. For instance, the conduction velocities (m/s) of the motor and sensory components of the median nerve were found to be 56.73±4.96 and 65.85±9.84 in the non diabetic controls, whereas they were 53.71±7.23 and 59.71±11.87 in the diabetic patients (p<0.05 in each case). Except for the motor amplitudes of the tibial and ulnar nerves, all other peripheral nerves in both the upper and lower limbs showed significantly higher amplitudes of motor and sensory action potentials among the non diabetic controls. HbA1c was found to have significant positive correlations with NCS parameters, including the motor onset latencies of the median, ulnar, tibial, and peroneal nerves, as well as the sensory onset latencies of the median, ulnar, and sural nerves. Conclusion: Peripheral neuronal conduction is affected in diabetic patients even before any neurological symptoms appear, and the degree of neurodeficit is dependent on glycaemic control.

Serum Levels of MicroRNA-210 as a Pathogenic Factor in Patients with Diabetes and Diabetic Nephropathy: A Cross-sectional Study

Divya Singh, Ivvala Anand Shaker, Ashishkumar Agravatt

Introduction: Diabetes Mellitus (DM) is a foremost global health challenge, causing disability and premature death. It leads to severe micro and macrovascular complications, including Diabetic Nephropathy (DN), which affects 20% of patients worldwide. Up to 50% of Chronic DM (CDM) patients get end-stage DN and then require Renal Replacement Therapy (RRT). DN develops gradually and causes proteinuria and glomerulopathy. Oxidative stress, Reactive Oxygen Species (ROS), and abnormal microRibonucleic Acid (miRNAs) are involved in DM progression and complications. Aim: The study aimed to assess serum miRNA-210 levels in DM patients and those with diabetes nephropathy, as it plays a crucial role in DM along with endothelial cell function. Materials and Methods: The present Cross-Sectional Study (CSS) included 400 participants, grouped into healthy controls, diabetic patients having nephropathy, and diabetic patients not having nephropathy, matched by age and sex. Inclusion criteria covered adults with known diabetes or DN, while individuals with infections, inflammatory or haematological diseases, and pregnant women were excluded. Ethical clearance was obtained, and informed consent was secured from all participants. Biochemical, renal, inflammatory, and epigenetic markers (including miRNA-210) were measured utilising standard laboratory techniques. Also, statistical analysis was performed using MedCalc, with significance value of p<0.05. Results: Of the 400 study participants, 192 (48.0%) were female and 208 (52.0%) were male. This study discovered noteworthy differences in glycaemic, renal, inflammatory, and epigenetic markers among control, diabetic, and DN groups. C-Reactive Protein (CRP) levels were elevated in both diabetic groups 10.591±7.175 mg/L (diabetic mellitus), and 18.710±7.406 mg/L (DN) (p<0.001). IL-10 levels were low in the diabetic mellitus group (8.380±0.801 pg/mL) (p<0.001). Fetuin-A levels were 186.90±35.913 in diabetic mellitus (p<0.001). Adiponectin levels were highest in the nephropathy group (21.340±7.193 μg/mL), compared to controls (p<0.001). Conclusion: These findings highlight reduced serum miRNAs’ potential as a biomarker for early detection and disease progression.

Secretory Carcinoma of Salivary Gland: A Single-centre Cohort Study Highlighting Histomorphologic and Immunohistochemical Characteristics

KR Anila, Rutuja Karbhari Narwade, PK Pravanya, Malu Rafi, Bipin T Varghese

Introduction: Secretory carcinoma of the salivary gland is a distinct subtype of salivary gland carcinoma that was first described by Skalova A et al., in 2010. It is characterised by the ETV6-NTRK3 translocation. Before the recognition of this entity, most cases of secretory carcinoma were misdiagnosed as acinic cell carcinoma. The accurate diagnosis of secretory carcinoma is important as inhibiting the active Ets-leukemia Virus-Neurotrophic tropomyosin Receptor Kinase 3 (ETV6-NTRK3) is highly efficient in the treatment of this carcinoma. Aim: To evaluate the clinical, histomorphological, and Immunohistochemical (IHC) characteristics of secretory carcinoma diagnosed at a tertiary care centre. Materials and Methods: This cohort study was conducted in the Department of Pathology at the Regional Cancer Centre, Thiruvananthapuram, Kerala, India (a tertiary cancer centre), from June 2021 to December 2021, after approval from the scientific review committee. A total of 13 cases diagnosed as secretory carcinoma from January 2016 to December 2020 were reviewed. Histomorphological features analysed included growth pattern, cytoplasmic vacuolisation, presence of secretion, hobnailing, nuclear shape, presence of nucleoli, chromatin characteristics, presence of necrosis, lymphovascular invasion, and perineural invasion. Clinical characteristics such as age, gender, tumour site, size, and clinical presentation were documented. Furthermore, an IHC panel of S100, DOG-1, and mammaglobin was studied, and results were interpreted as positive or negative to support the diagnosis. Follow-up details of the patients concerning local or distal recurrences and terminal events, if any, were updated from the medical records as of December 2021. An analysis of the common histopathological characteristics and immunoprofile in these cases was conducted. Results: A total of 13 cases of secretory carcinoma were identified, with a mean age of 44 years and a male-to-female ratio of 12:1. The parotid gland was the most commonly affected site, observed in eight cases. The most frequent histopathological pattern was papillary cystic, seen in nine cases. The presence of luminal secretion was consistently observed in all thirteen cases. Intracytoplasmic vacuolation was seen in three cases, and hobnailing was present in five cases. The nuclei were round to oval with vesicular chromatin and prominent nucleoli in all 13 cases (100%). Aggressive histopathological features were present in only a few cases, with perineural invasion in one case, lymphovascular invasion in two cases, and necrosis in two cases. High-grade transformation was present in one case. All cases showed positive staining with S100 and negative reaction with the DOG-1 immunomarker. Among the seven cases where mammaglobin was tested, all showed a positive reaction. All patients underwent surgery, with seven cases also requiring radiotherapy. Conclusion: Secretory carcinoma of the salivary gland is relatively rare. Histopathological features are helpful in making a diagnosis. A limited IHC panel comprising S100, DOG-1, and mammaglobin helps in narrowing down the differentials and differentiating it from acinic cell carcinoma, which is the closest differential. The diagnosis of secretory carcinoma has therapeutic implications due to the availability of targeted therapy. Multicentric studies including a greater number of cases can help in better characterising this entity.

Physio Research Summit '25 25th January, 2025

Shubhashish Chatterjee

MM(DU) is a premier Indian University with a diverse courses in campus with NAAC Accrediation, UGC category, NIRF ranking, QS World University rankings etc. The MM(DU) provides a comprehensive range of academic programs that equip students with the knowledge and skills necessary to succeed at global level. University’s intellectually stimulating environment, coupled with our globally-focused faculty, creates an ideal setting for personal and professional development.

Effect of Time Under Tension on Strength in Athletes: A Narrative Review

Vikas Kumar, Kanika Bhatia

Correlation between Work Stress and Social Media Addiction in Patients with Depressive Disorder: A Cross-sectional Study

Maria Dominic Raj, Shabeeba Z Kailash, Kailash Suresh Kumar, PR Sobia

Introduction: Depression is a leading global health concern, contributing significantly to disability and economic burden worldwide. Work stress and Social Media Addiction (SMA) have been identified as critical factors influencing mental health, often interacting to exacerbate depressive symptoms. However, the combined impact of these variables on patients with depressive disorders remains underexplored. Aim: To study the relationship between work stress and SMA in patients with depressive disorders. Materials and Methods: This cross-sectional study was conducted in the Department of Psychiatry at Chettinad Hospital and Research Institute, Chengalpattu, Tamil Nadu, India, among 96 patients aged 18-64 years diagnosed with depressive disorder according to International Classification of Diseases (ICD)-11 criteria. Participants were assessed using the Hamilton Depression Rating Scale (HDRS) for depression, the Tool for Assessment of Work Stress (TAWS-16) for work stress and the Bergen Social Media Addiction Scale (BSMAS) for SMA. Data were analysed using descriptive statistics, Pearson’s correlation, and multivariate linear regression, with significance set at p-value <0.05. Results: Among the participants, 33 individuals (34.37%) exhibited SMA, while 37 individuals (38.54%) reported mild work stress, 38 individuals (39.58%) reported moderate work stress, and 21 individuals (21.87%) reported severe work stress. Significant positive correlations were observed between HDRS and BSMAS scores (r-value=0.571, p-value <0.001), HDRS and TAWS-16 scores (r-value=0.418, p-value <0.001), and BSMAS and TAWS-16 scores (r-value=0.347, p-value <0.001). However, Chi-square analysis revealed no significant association between SMA and work stress categories (p-value=0.437). Regression analysis identified HDRS scores (p-value <0.001) as the only significant predictor of SMA severity. Conclusion: This study highlights the significant interplay between work stress, SMA and depression severity in patients with depressive disorders. The prevalence of SMA among individuals with depressive disorder was 34.4%. Addressing both occupational stressors and problematic social media use could be pivotal in managing depressive symptoms effectively.

Comparison of Tightrope versus Syndesmotic Screw Fixation for Functional and Radiological Outcomes in Patients with Ankle Syndesmosis Injuries: A Prospective Interventional Study from Southern India

Introduction: Ankle syndesmosis injuries often occur due to high-energy trauma or distal fibular fractures, disrupting the stabilising ligament complex. Conventional screw fixation, while effective, requires implant removal and may be associated with complications. Tightrope fixation offers dynamic stabilisation, allowing early mobilisation with potentially fewer complications. Aim: To evaluate and compare clinical and radiological outcomes of Tightrope fixation and syndesmotic screw fixation in patients with ankle syndesmosis injuries. Materials and Methods: The present prospective interventional study conducted in the Department of Orthopaedics at SRM Medical College Hospital and Research Centre, Tamil Nadu, India over a period of 18 months (September 2023 - February 2025). A total of 60 patients with ankle syndesmosis injuries were enrolled and allocated into two groups based on clinical judgment: group A (Tightrope fixation, n=30) and group B (syndesmotic screw fixation, n=30). All patients underwent open reduction and internal fixation of the ankle fracture followed by either Tightrope or syndesmotic screw fixation for stabilisation of the syndesmosis, depending on group allocation. Functional outcomes were assessed using the Olerud-Molander Ankle Score (OMAS) and the Foot and Ankle Outcome Score (FAOS). Pain was evaluated using the Visual Analog Scale (VAS). Radiological parameters included tibiofibular clear space, tibiofibular overlap, and medial clear space. Postoperative follow-up was conducted at three weeks, six weeks, three months, and six months, with a total follow-up duration of six months. Complications were also recorded. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 29, with a p-value <0.05 considered significant. Results: Mean age of participants in groups A and B were 43.2±18.3 years and 42.8±16.2 years, respectively. Gender distribution was also comparable across both groups (p=0.793). Regarding co-morbidities, Diabetes Mellitus (DM) was present in 8 (13.3%) of participants overall and Hypertension (HTN) was seen in 11 (18.3%), with similar distribution across groups. Smoking habits were nearly evenly distributed, with 40 (66.7%) of participants being non-smokers. OMAS and FAOS scores were significantly higher in the Tightrope group across all follow-up intervals (p<0.001). At six months, the mean VAS score was significantly lower in group A compared to group B (1.6±0.9 vs. 3.3±1.6; p<0.001). Radiological outcomes, including tibiofibular clear space and overlap, also significantly favoured group A (p<0.001). The rate of infection was lower in the Tightrope group (3.3% vs. 20%), and there were no cases of malreduction, compared to 6.7% in the screw fixation group. Conclusion: The present study demonstrates that Tightrope fixation offers superior functional recovery, pain relief, and radiological outcomes compared to syndesmotic screw fixation in ankle syndesmosis injuries treatment. Additionally, it results in fewer postoperative complications, allowing it a more feasible and efficient surgical choice for treating such injuries.

A Cross-sectional Study of Ventilator-associated Pneumonia between Pulmonary and Non Pulmonary Indications of Mechanical Ventilation

Introduction: Ventilator-associated Pneumonia (VAP) is defined as pneumonia occurring 48-72 hours after the initiation of invasive Mechanical Ventilation (MV). It is diagnosed based on positive endotracheal tube or tracheostomy secretions culture and new or worsening infiltrates on a chest X-ray after 48 hours of MV. The incidence and severity of VAP may differ between pulmonary and non pulmonary groups due to variations in underlying diseases, immune responses, and duration of ventilation. Aim: To compare the incidence and other parameters of VAP between pulmonary and non pulmonary indications of MV. Materials and Methods: This cross-sectional study was conducted from April 2023 to December 2024 on 126 VAP patients who were on mechanical ventilation for different indications in the RICU, MICU, and SICU at BLDE (Deemed to be University) Shri B M Patil Medical College, Hospital, and Research Centre, Vijayapura, Karnataka, India. Primarily, this study included all patients who were on MV due to pulmonary and non pulmonary indications during the study period. Inclusion criteria included patients aged over 18 years, of either sex, and willing to provide informed consent. A total of 254 patients who were on MV for more than 48 hours were screened for VAP based on clinical, microbiological, and radiological criteria for diagnosis. Out of these, 126 patients were diagnosed with VAP, 63 due to pulmonary indications and 63 due to non pulmonary indications. A chest X-ray was done immediately after intubation and repeated after 48 hours of MV for comparison. Endotracheal/tracheostomy tube secretions were sent for culture and sensitivity testing to isolate the organism and determine the resistance pattern. Demographic factors such as age and sex were studied and compared. Predictors of severity, such as the Acute Physiology and Chronic Health Evaluation (APACHE II score) and Sequential Organ Failure Assessment (SOFA) score, were calculated using ROC analysis and compared between pulmonary and non pulmonary indications of MV. Results: The mean age was significantly higher in the pulmonary group (58±16.4 years) compared to the non pulmonary group (49±18.0 years), and both groups showed a male predominance, with 45 (71.4%) in the pulmonary group and 48 (76.2%) in the non pulmonary group. The incidence of VAP in pulmonary indications was 63/134 (47%), whereas for non pulmonary indications, it was 63/120 (52.5%). The most common organisms causing VAP are Acinetobacter baumannii complex, followed by Klebsiella pneumoniae. Overall mortality and improvement are higher in pulmonary cases compared to non pulmonary cases. SOFA and APACHE II scores are strong predictors of mortality. Conclusion: VAP is one of the most common ICU-acquired infections and is associated with increased mortality and morbidity. The data from this study can provide a reference for the management of VAP and the early detection of high-risk patients.

Correlation of Visual Field Parameters with Optic Disc and OCT findings in Primary Open-angle Glaucoma: A Cross-sectional Study

Introduction: Primary Open-Angle Glaucoma (POAG) is a chronic, progressive optic neuropathy characterised by optic disc changes and corresponding Visual Field (VF) loss. This study aimed to evaluate the pattern of VF defects and correlate them with optic disc and Optical Coherence Tomography (OCT) parameters in patients diagnosed with POAG. Aim: This study aimed to evaluate the pattern of VF defects and correlate VF parameters with optic disc and OCT parameters in patients diagnosed with POAG. Materials and Methods: The present cross-sectional study included a total of 76 eyes from 38 patients with POAG attending a tertiary healthcare center in Western Maharashtra, India between September 2023 and March 2025. All 38 patients were diagnosed with bilateral POAG, and both eyes met the eligibility criteria of reliable VF and OCT data. Therefore, all 76 eyes included in the study were from bilateral cases. There were no unilateral cases in the final dataset. Complete ophthalmic examination including Goldmann Applanation Tonometry (GAT), fundus evaluation, Humphrey VF testing and spectral-domain OCT {Retinal Nerve Fiber Layer (RNFL) and Ganglion Cell-Inner Plexiform Layer (GCL-IPL)} analysis were performed. VF patterns were classified and correlated with Neuroretinal Rim (NRR) thinning and OCT-based parameters. Results: The most common VF defect was tunnel vision, observed in 21 eyes (27.6%), followed by 18 eyes (23.7%) and with superior paracentral scotomas and 11 eyes (14.5%) with inferior paracentral scotomas. Optic disc analysis showed Neuroretinal Rim (NRR) thinning in all quadrants in 27.6% and inferior quadrant alone in 26.3%. OCT revealed an average RNFL thickness of 61.9 μm and GCL+IPL thickness of 71.9 μm. Significant correlations were observed between VF indices Mean Deviation (MD), Pattern Standard Deviation (PSD), and Visual Field Index (VFI) with both RNFL and GCL+IPL thickness. Additionally, inverse correlations were found between Vertical Cup-Disc Ratio (VCDR) and these OCT and VF parameters. VF loss patterns corresponded topographically to optic disc thinning. Conclusion: Tunnel vision and paracentral scotomas were common in moderate to advanced POAG. Structural changes in RNFL and GCL+IPL showed strong correlation with functional VF defects. OCT-based metrics, particularly GCL+IPL thickness, are valuable tools for assessing glaucomatous progression.

Effect of Lower Limb Strengthening Exercises and Motor Dual Task Training in Elderly People with Impaired Balance: An Experimental Study

Sarulatha Haridass, Manikumar Muthaiah, R Vijayaraghavan, Ramesh Kumar Jeyaraman

Introduction: Ageing progressively declines movements and functions, thereby impacting muscle strength, endurance, and power. Impaired mobility and muscle strength gradually lead to loss of balance, instability, and an increased risk of falls. The declines in these physical components must be identified early to prevent and control activity loss. Aim: To compare the efficacy of Progressive Resistance Exercises (PRE) and Motor Dual Task (MDT) on balance, gait, functional performance, self-confidence, and Health Related Quality of Life (HRQOL) in elderly people with impaired balance. Materials and Methods: This experimental study was conducted at selected elderly care homes at Bangalore, from November 2016 to May 2020. A total of 69 elderly individuals aged between 60 and 75 years were recruited according to the inclusion criteria from three residential homes in East Bangalore (Sarjapur), Karnataka. Participants included in the study were cognitively intact with a minimum Performance Oriented Mobility Assessment score (POMA) score of 24 and an Activity Specific Balance Confidence (ABC) scale score of 70% or less. Baseline data on age, sex, Body Mass Index (BMI), number of falls, and presence of physical discomfort were recorded and preserved for data analysis. Pre and post-test measures of balance and lower limb mobility, functional independence, balance confidence, and HRQOL were measured using the POMA, Short Physical Performance Battery (SPPB), ABC scale, and Euro Quality of Life (EQOL), respectively. Participants in all groups underwent eight weeks of supervised exercise training, with each exercise group performing three sessions per week for a total of 24 sessions. Each session consisted of 10 minutes of warm-up exercises, followed by main exercises (MDT training/PRE/conventional exercises) specific to their assigned groups for approximately 40 minutes, and concluded with 10 minutes of cool down exercises similar to the warm-up session. The data were analysed using Systat SigmaPlot software. A probability of 0.05 or less was considered statistically significant. Results: The between-group analysis of the POMA and SPPB was analysed using Kruskal-Wallis one-way analysis of variance, while within-group analysis used the Wilcoxon signed rank test, revealing significance in the conventional, PRE, and MDT groups (p<0.001). ABC and EQOL scores were analysed using 2-way RM ANOVA. The results showed statistically significant differences in the post-test scores of all three groups. Among the three groups, the improvement in balance (50%), functional performance (42.8%), balance confidence (24.8%), and QOL (28%) was highest in the MDT group (n=2). Conclusion: MDT training is more effective than PRE and conventional balance exercises, leading to improvements in balance, walking ability, functional performance, balance-related self-confidence, and HRQOL in elderly participants with impaired balance.

Relationship between Physical Fitness, History of Falls and Depression with Fear of Falls among Institutionalised Elderly Population: A Cross-sectional Study

Sheetal Khanderao Aurangabadkar, Sandip Kumar Parekh

Introduction: Institutionalised elderly are more prone to falls and depression due to their functional dependence and social isolation. Physical fitness plays an important role in falls prevention. Fear of Falls (FoF) can be described as an anxiety or a patient’s concern about falling that can lead an individual to avoid activities that they are capable of performing, thus reducing their physical activity and overall fitness. The consequences of FoF include an increased risk of falling, reduced physical activity, decreased social interaction and lower quality of life. FoF is one of the potentially modifiable risk factors where intervention could be effective in preventing falls. Knowledge of and relationships between risk factors and FoF will be useful in developing strategies to reduce FoF and improve the quality of life in the elderly population. Aim: To explore the relationship between physical fitness, history of falls and depression with FoF in the institutionalised elderly population. Materials and Methods: This cross-sectional study was carried out at institutional old-age homes in the Kalyan-Dombivli area, Mumbai, Maharashtra, India. The total duration of the study was four months, from August 2024 to November 2024. After obtaining permission from the old-age homes, participants were approached and screened according to inclusion criteria. The inclusion criteria were institutionalised elderly aged 60-85 years, ambulatory with or without an assistive device, both male and female. Those participants who voluntarily agreed to participate were recruited by convenience sampling. After screening 130 participants according to the inclusion criteria, 124 participants agreed to be part of the study. Demographic data such as age, gender, education, number of years residing in the old-age home, number of co-morbidities, medical and surgical history and medication history were collected. History of falls in the last 12 months was also documented. The outcome measures assessed were the Senior Fitness Test for physical fitness, history of falls, Falls Efficacy Scale-International (FoF) and Geriatric Depression Scale. Spearman correlation was used to assess the relationships between physical fitness, depression and FoF. The Chi-square test (p-value ≤0.05) was used to determine whether there was a significant difference between the history of falls and FoF. Results: The mean age of the participants was 71.4±5.8 years. Of the 124 participants, 64 had a history of falls. Concerns about falls were higher among fallers than among non fallers. The Chi-square test showed no significant difference between these two groups (p-value=0.843). Among physical fitness parameters, there was a negative correlation between the arm curl test (upper limb strength) and FoF in the fallers group. There was a significant positive correlation between the back-scratch test (left side) and FoF score (p-value=0.0156). There was no correlation between lower-limb strength, agility, or aerobic capacity and FoF. There was no significant correlation between depression and FoF among study participants (p-value=0.5879). Conclusion: There was no correlation between physical fitness parameters and history of falls except for upper-limb flexibility and strength. All participants, irrespective of fall history, showed high concerns about falls. Depression in the participants also showed no significant relationship with FoF.

Interleukin-6 as a Diagnostic Salivary Biomarker in Oral Squamous Cell Carcinoma and Oral Potentially Premalignant Disorders: A Cross-sectional Pilot Study

Introduction: Worldwide, Oral Squamous Cell Carcinoma (OSCC) is the 6^th major cancer and 2^nd major in India. This high prevalence is linked to carcinogens, particularly smoking tobacco and chewing betel nuts and due to lack of a quick, accurate, and cost-effective screening diagnostic tool. Immunological biomarkers have the potential to identify and offer a prognostic assessment of this condition. Interleukin-6 (IL-6) is a significant salivary marker among the many other inflammatory markers. Aim: To assess the level of IL-6 in OSCC and Oral Premalignant Diseases (OPMD). Materials and Methods: The present cross-sectional pilot study was conducted at Pathology department of Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India for detection of IL-6 level in OSCC and OPMD saliva samples. A total of 30 patients from each group diagnosed with OPMD and OSCC were recruited consecutively over the period of two years (June 2022-May 2024). Demographic features such as age, gender, habit of tobacco chewing and site of lesion on buccal mucosa were recorded. The level of IL-6 was determined from saliva sample in each group and was compared with healthy control by using Enzyme-Linked Immunosorbent Assay. Kruskal Wallis test was applied for comparison between medians of two groups. IBM Statistical Package for Social Sciences (SPSS) version 25 was used for statistical analysis. Results: The clinicodemographic features revealed that tobacco chewing was the most common aetiology in 80% of OSCC diagnosed cases and 90% in OPMD cases. The median and Interquartile Range (IQR) of salivary IL-6 in OSCC was 138.28 pg/mL (IQR 44.21-254.69), OPMD’s 24.81 pg/mL (IQR 13.69-53.38) in comparison to healthy controls, 8.71 pg/mL (IQR 5.10-13.08). Conclusion: The findings of this study demonstrate that salivary IL-6 level is higher in OSCC cases than OPMD cases and both have potential in early diagnosis. Due to wide array of functional characterisation saliva biomarkers, it can be a potential non invasive biomarker to differentiate the OSCC and OPMD cases.

Superior Mesenteric Artery First Approach versus Conventional Pancreaticoduodenectomy in Periampullary Adenocarcinomas: A Single Institutional Observational Study

Dwaipayan Samaddar, Jaya Bagchi Samaddar, Bibaswan Chakrabarty, Gautam Das

Introduction: Periampullary malignancies represent a group of malignancies at and around the ampulla of Vater, whose clinical features and management are similar, with Pancreaticoduodenectomy (PD, Whipple procedure) being the standard surgical treatment. Superior Mesenteric Artery (SMA) first approach to PD (smaPD) is a modification of conventional PD (cPD) in which the SMA is assessed early in the surgery. This improves the assessment of intraoperative resectability, reduces bleeding during surgery and enhances the dissection of retroportal tissues, resulting in a greater number of resections with no residual tumour (R0). Aim: To compare smaPD with cPD with respect to clinical, perioperative, histological, oncological and survival outcomes. Materials and Methods: This was a retrospective observational study conducted at the Department of General Surgery at North Bengal Medical College and Hospital, West Bengal, India. A total of 58 patients with periampullary adenocarcinomas who had undergone PD from 1 May 2018 to 30 November 2023 were studied. The retrospective data of 58 matched patients (smaPD vs cPD) with n=29 in each group were retrieved from the records. They were compared with respect to clinical and intraoperative findings, postoperative complications, in-hospital mortality, Overall Survival (OS) and pathology parameters. Continuous data were analysed using Student’s t-test and categorical data using the Chi-square test. OS was plotted using Kaplan-Meier survival curves and compared using the log-rank test. Results were considered statistically significant when p-value <0.05. Statistical software used: GraphPad Prism 10 (San Diego, USA) and Epi Info version 7.4.6 (Atlanta, Georgia, USA). Results: The mean operative time in group A (smaPD) was 391.74±32.15 minutes whereas in group B (cPD) it was 306.55±39.57 minutes (p-value <0.0001). The mean blood loss in group A was 365.52±108.97 mL and in group B 424.14±58.34 mL (p-value=0.0162). R0 resection was higher in smaPD but this was not statistically significant (p-value=0.315). There was not much difference in terms of postoperative complications, length of hospital stay, pathology and OS (p-value=0.4034). Vascular anomalies were observed in four patients in group A. Conclusion: The operative time was significantly longer in group A, but intraoperative blood loss was significantly lower, with more R0 resections. Advanced Multidetector Computed Tomography (MDCT) can accurately predict resectability preoperatively. In a rural setup, pursuing the smaPD technique for intraoperative assessment appears useful.

Correlation between Emotional Labour and Job Satisfaction among Physiotherapists: A Cross-sectional Survey in Multispecialty Hospitals of Delhi NCR, India

Megha Yadav, Vajrala Krishna Reddy, Anamika Pandey

Introduction: Healthcare delivery has undergone significant changes, making Emotional Labour (EL) a key factor contributing to worker wellbeing and service quality. Physiotherapists often navigate patients’ pain, fear and expectations during treatment, leading to emotional strain. Aim: To quantify the relationship between EL dimensions (surface acting, deep acting, suppression and emotional consonance) and job satisfaction to guide strategies for improving the workplace experience. Materials and Methods: A cross-sectional design was used to measure the relationships among 400 physiotherapists in direct patient care at public and private multispecialty hospitals in Delhi-NCR, India between January 2023 and January 2024. Data were collected using standardised questionnaires: the Dutch Questionnaire on Emotional Labour (D-QEL), which includes four EL dimensions and the Minnesota Satisfaction Scale, which measures general, intrinsic and extrinsic job satisfaction. Comprehensive statistical analyses determined the strength and direction of these associations. Results: General satisfaction was negatively correlated with surface acting (r-value=-0.917, p-value <0.001), deep acting (r-value=-0.896, p-value <0.001), and suppression (r-value=-0.910, p-value <0.001), whereas emotional consonance showed a positive correlation (r-value=0.870, p-value <0.001). Intrinsic satisfaction, reflecting personal fulfilment, also negatively correlated with surface acting (r-value=-0.935, p-value <0.001), deep acting (r-value=-0.918, p-value <0.001), and suppression (r-value=-0.926, p-value <0.001), but was positively correlated with emotional consonance (r-value=0.879, p-value <0.001). Similarly, extrinsic satisfaction, linked to external job factors, showed strong negative correlations with surface acting (r-value=-0.921, p-value <0.001), deep acting (r-value=-0.903, p-value <0.001), and suppression (r-value=-0.916, p-value <0.001), but a positive correlation with emotional consonance (r-value=0.872, p-value <0.001). Conclusion: Higher emotional consonance significantly improves job satisfaction, whereas surface acting and suppression contribute to dissatisfaction. Training in emotional intelligence can enhance physiotherapists’ wellbeing and overall job satisfaction, ultimately improving healthcare service quality.

Association of Pre Pregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes in Women with Gestational Diabetes: A Retrospective Observational Study

Introduction: The incidence of obesity and gestational diabetes is increasing globally. Gestational diabetes and obesity are known to be independently associated with adverse perinatal outcomes. Gaining excess weight in pregnancy, especially in obese and overweight women appears to increase the risk of maternal and neonatal complications. Aim: To evaluate the association of maternal Body Mass Index (BMI) and Gestational Weight Gain (GWG) with pregnancy outcomes in women with Gestational Diabetes Mellitus (GDM). Materials and Methods: The present retrospective observational study was conducted at Fernandez Hospital, Hyderabad, Telangana, India from January 2017 to December 2019. Singleton pregnancies with gestational diabetes were included. Those booked after first trimester or with pregestational diabetes or hyperthyroidism were excluded. Based on BMI, participants were categorised into lean (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (>30 kg/m2) groups. Based on recommended weight gain for each BMI category, Institute of Medicine (IOM) has laid specific ranges. GWG in each group was divided into inadequate, adequate and excessive weight gain as per these recommendations. Maternal and perinatal outcomes were compared between groups. Regression analysis was carried out and adjusted odds ratio, along with their 95% CI was presented. The p-value <0.05 was considered statistically significant. Statistical Package for the Social Sciences (SPSS) version 25 was used for analysis. Results: Total of 2626 pregnant women were included. Obese and overweight population was 575 (21.9%) and 1095 (41.7%), respectively. Based on GWG, 1042 (39.7%) and 633 (24.1%) had inadequate and excessive weight gain respectively in the entire study population. Both obese and overweight groups had higher caesarean section rates compared to the other two groups. As per regression analysis, obese women had significant adjusted odds ratio {2.32 (95% CI 1.6-3.31)} for gestational hypertension and need for Induction of Labour (IOL) {1.48 (95% CI 1.11-1.97)}. Women with inadequate weight gain had less gestational hypertension {0.68 (95% CI 0.49-0.95)}, need for IOL {1.28 (95% CI 1.001-1.64)}, and less chance for large for gestation age babies {0.67 (95% CI 0.51-0.89)} and more preterm deliveries {1.63 (95% CI 1.20-2.20)} as compared to other groups. In excessive weight gain, odds ratio for large for gestation age babies was found to be significant (p-values <0.001), Adjusted OR {(2.01 (95% CI 1.54-2.64)}. Conclusion: Obese women had higher rate of IOL and caesarean section rate, excess GWG group had higher incidence of large for gestation age neonate.

Functional Outcome and Quality of Life after Prosthetic Rehabilitation in Patients with Maxillofacial Defects: A Systematic Review

Srushti Ravindra Ghagas, Saee Deshpande, Neelam Pande

Introduction: Maxillofacial prosthetics is a branch of dentistry focused on addressing congenital or acquired defects of the maxillofacial region. These defects may result from trauma, cancer, or other conditions, impacting speech, chewing, facial appearance, and overall quality of life. The field aims to restore both function and aesthetics, improving patients’ well-being. Aim: To evaluate the functional outcome and Quality of Life (QoL) after prosthetic rehabilitation in patients having maxillofacial defects. Materials and Methods: An electronic search was carried out across PubMed and Google Scholar to identify relevant articles published up to November 2023. Based on the framework of Population, Intervention, Control, and Outcomes (PICO), the main research question for this study was, “Does prosthetic rehabilitation improve functional outcome and QoL in patients with maxillofacial defects?” By looking at the titles, abstracts, and full texts of the articles, it was possible to verify their relevance and see if they met the inclusion criteria. This systematic review comprised Randomised Controlled Trials (RCTs), cross-sectional studies, retrospective studies, and prospective studies on patients receiving prosthetic rehabilitation for maxillofacial defects published between 1990 and 2023. Only English-language articles were considered. Studies on congenital maxillofacial defects were excluded. A quality assessment of the listed studies was conducted using the Joanna Briggs Institute (JBI) tool. Results: Out of the 155 results returned by the database search, 128 were removed due to incomplete, inconsistent, or missing information. Three additional papers were removed after evaluating 27 full text papers for eligibility. For that reason, the current systematic review includes a total of 24 papers. Nineteen studies included in this review were on maxillary defects with a total of 798 participants. Three studies addressed mandibular defects with 267 participants, and the remaining two covered facial defects with a total of 93 participants. A quality assessment of studies was done. Meta-analysis was not possible due to diversity of the data. Conclusion: Individuals with maxillofacial abnormalities experience significantly better functional outcomes and a higher QoL after maxillofacial prosthetic rehabilitation. However, using standardised evaluation instruments is crucial to guarantee consistent results and make it easier to compare results across various cases. By doing this, we can keep enhance patient well-being and more accurately assess the long term effects of prosthetic therapies.

Tweets, Tissues and #Trends: Analysis of Pathology Related Tweets on Social Media

Introduction: The social media platform X/Twitter is very active, with participants posting and discussing political topics and other issues. Pathologists have also utilised X/Twitter to share interesting cases and discuss various issues about pathology. However, awareness regarding the use of X/Twitter for pathology education was limited. Aim: To collect and analyse eight months of pathology-related posts on Twitter/X. Materials and Methods: This was a retrospective observational study conducted over a duration of eight months, from May 2023 to December 2023, in the Pathology Department of MGM Medical College, Aurangabad, Maharashtra, India. One of the authors, a junior resident in the department of Pathology, manually searched for tweets containing the hashtags #PathTwitter and #PathXterms. Data with full text links were extracted and analysed for the number of cases with images per month. The diagnostic categorisation of cases was done as benign, malignant, or non-neoplastic, and the authors independently validated the diagnoses. An organ-wise analysis of the posted cases was also carried out. The ‘Like’ count and number of ‘Retweets’ for each tweet were noted to ascertain the popularity of the topic and its author. Statistical analysis was performed by collecting the data in Microsoft Excel, and the data was presented in the form of bar diagrams, pie charts, etc. Results: A total of 600 pathology cases were posted on X/Twitter, with an average of 75 cases per month, ranging from a minimum of 38 to a maximum of 136 cases per month. Among these, benign tumours comprised 136 cases, malignant accounted for 277, and non-neoplastic cases numbered 187, as per their given diagnosis. There were 38 haematology-related and six cytology-related non-neoplastic cases. The maximum number of retweets were 398, and the maximum number of likes were 1500, both for a post on eosinophilia. Based on the 'like' count and the number of retweets, the most popular posts were related to haematology, with the most popular author on X/Twitter being Dr Nihar Desai (@nihardesai) in this study. Conclusion: The social media platform X/Twitter features a rich variety of benign and malignant pathology cases from different parts of the world. Reviewing such cases is useful for students and consultants to enhance their pathology knowledge. Twitter/X can provide networking opportunities, enabling the formation of new connections across countries and continents. It can also lead to career enhancement through academic improvement or networking.

Utilisation Pattern of Rh-D Negative Packed Red Blood Cells Inventory at a Tertiary Care Referral Teaching Hospital Blood Centre in Southern India: An Observational Study

Saddala Prashanth, MD Praveen, Bandi Suresh Babu, KV Sreedhar Babu

Introduction: Rh-D negative Packed Red Blood Cells ( PRBCs) are used in a variety of situations like emergency transfusions, exchange transfusions, intrauterine transfusions and for neonatal transfusions. The availability of Rh-D negative blood can vary by region and ethnicity and the demand for Rh-D negative blood is high. Aim: The present study aimed to evaluate the utilisation patterns of all Rh-D negative PRBCs as part of inventory management. Materials and Methods: The present cross-sectional observational study was conducted at the Department of Immuno Haematology and Blood Transfusion (IHBT) attached to Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India which is a tertiary care referral teaching hospital in South India. The data has been collected and analysed from July, 2021 to December, 2022. Data of Rh-D negative PRBC units including recipient blood groups, age of the unit at the time of issue, and Quality Control (QC) assessments were reviewed. Data has been analysed using Statistical Package for Social Sciences (SPSS) version 21.0. The Chi-square test of independence was applied for analysing categorical data which is represented as percentages. Results: During the study period a total of 15,322 blood units were collected. Among these 972 (6.34%) were Rh-D negative. After excluding 15 units reactive for different Transfusion Transmissible Infectious diseases (TTIs) and 1 under-collection unit, 956 (6.24%) units were included in the analysis. Majority of the PRBCs were O Rh-D negative 453 (47.39%) units. A total of 908 (94.98%) units were issued to Rh-D negative recipients, 33 (3.45%) units to Rh-D positive recipients and 15 (1.57%) units were subjected for QC. Conclusion: Effective inventory management of Rh-D negative PRBCs will ensure their optimal utilisation and will prevent the wastage. The study highlighted the importance of strategic transfusion practices to maintain a balance between availability and demand for this scarce resource.

Expression of CK20 and Ki-67 in Colon Carcinoma and their Association with Various Histopathological Parameters: A Cross-sectional Study

Asmita Mitra, Sarmila Sen, Dipan Mukhopadhyay

Introduction: According to 2022 data, globally colon carcinoma ranks 4th. In India, colon carcinoma ranks 6th in incidence and 7th in mortality. It is the 4th most common cancer in males and 5th in females. Diagnosis of colon carcinoma in recent times has been largely depended on Immunohistochemical (IHC) markers such as Cytokeratin 20 (CK20), CDX2, Ki-67, Cadherin 17, etc., alongside histopathology. Aim: To study the association of histological parameters with IHC expression of Ki-67 and CK20 in predicting the behaviour of colon carcinoma. Materials and Methods: This was a cross-sectional study conducted in the Department of Pathology in association with the Department of General Surgery, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India on patients clinically diagnosed with colon cancer who underwent surgery (n=44). Data were collected from October 2022 to March 2024 (17 months) and analysed in April 2024. Microscopic examination was performed using Haematoxylin and Eosin (H&E) to assess histological features such as tumour grading and staging, margin status, Lymphovascular Invasion (LVI) and lymph node metastasis. IHC staining was performed with ready-to-use antibodies against CK20 and Ki-67 and the staining was recorded. For statistical analysis, the Fisher-Freeman-Halton test and Fisher’s exact test were used, with Statistical Package for the Social Sciences (SPSS) version 26.0. Statistical significance was set at p-value <0.05. Results: In this study, there were 44 cases and the ages of the patients ranged from 12 to 89 years. The male-to-female ratio was 1.4:1. 20 (45.5%) of the tumours were moderately-differentiated adenocarcinomas, followed by 13 (29.6%) well-differentiated and 5 (11.4%) poorly differentiated. Cytokeratin 20 (CK20) expression was observed in 35 (79.6%) of cases. Ki-67 expression was categorised as grade 1 (≤25%), grade 2 (26-50%) and grade 3 (≥51%). A statistically significant association was found between CK20 expression and increased tumour differentiation (p-value <0.001), absence of LVI (p-value=0.006) and decreased margin involvement (p-value=0.007). Ki-67 expression showed association with decreased tumour differentiation (p-value <0.001), higher stage (p-value=0.032), increased LVI (p-value <0.001), lymph node metastasis (p-value=0.005) and increased margin involvement (p-value <0.001). CK20 and Ki-67 expression also showed a significant inverse association with each other (p-value <0.001) based on histological differentiation. CK20 expression was gradually lost in higher Ki-67-expressing tumours. Conclusion: The most prevalent colon carcinoma was adenocarcinoma; the majority were moderately-differentiated adenocarcinomas. CK20 expression was higher in well-differentiated tumours and those without LVI, while Ki-67 expression increased with poorer differentiation, higher stage, more LVI and lymph node metastasis. An inverse relationship was observed between CK20 and Ki-67 expression based on histological parameters.

Effects of Balance Training on Chronic Ankle Instability in Athletes: A Systematic Review

Aditya Bhardwaj, Aditi Popli, Lakshay Panchal

After an initial ankle sprain or injury it is followed by Chronic Ankle Instability (CAI), which is characterised by recurring feeling of the ankle giving away. While performing this study the effects of balance training on athletes’ (CAI), two different training programmes were utilised: the Progressive Hop-to-Stabilisation Balance (PHSB) and the classic Single-limb Balance (SLB). Athletes commonly go through injury such as lateral ankle sprain, which can result in CAI, which is characterised by a continuous sensation of the ankle “giving way”. Due to this injury decline in athletes performance can be observed and neuromuscular control in also effected by this condition. We are aiming to find out how the balance training can effect athletes who have CAI. Databases such as Cochrane Library, and PubMed were utilised for this literature review. Articles between December 2004 -2024 were taken.Interestingly, the SLB group showed larger gains in self-reported sports function than the PHSB group, even though both training regimens were beneficial. This implies that dynamic postural control can be enhanced by both strategies, SLB can provide further benefits for particular functional outcomes. However, further research is warranted to explore long-term effects and potential variations in training intensity and frequency. In conclusion, this study contributes valuable insights into rehabilitation strategies for CAI among athletes. By comparing PHSB and SLB programmes it highlights their effectiveness in enhancing balance, stability, and overall athletic performance and reduce and ankle “giving away”. The implications of this research extend to improving recovery outcomes for athletes dealing with chronic ankle instability.

Effectiveness of Myofascial Release for Management of Lateral Epicondylitis: A Systematic Review Protocol

Balpreet Kaur, Kanika Bhatia, Rittu Sharma

Lateral Epicondylitis (LE) is one of the most prevalent elbow tendinopathies, characterised by pain at the humeral lateral epicondyle when the wrist is dorsiflexed against resistance. Individuals with LE report pain and functional difficulties that impact their everyday activities, particularly those involving wrist and forearm movements. Rest, non-steroidal anti-inflammatory medications, stretching, strengthening, and ultrasound are all conservative treatment options for LE, but Myofascial Release Technique (MFR), a soft tissue mobilisation method, has emerged as a promising intervention for LE management. MFR techniques relieve tension in the forearm muscles and fascia, enhancing blood circulation and diminishing inflammation. This may ease symptoms related to tennis elbow, including pain and restricted motion. However, there are considerable differences in the evidence for MFR’s effectiveness in minimising pain and associated symptoms. This systematic review protocol was created to give a mechanism for conducting research to evaluate the efficiency of the MFR in relieving patient discomfort. A comprehensive search of electronic databases, including PubMed and Scopus will be performed to locate studies published up to the current date. Keywords such as “Myofascial Release”, “Lateral Epicondylitis”, “Tennis Elbow” will be used to construct search queries. Following a thorough examination of the titles and abstracts of these studies, along with removal of any duplicates, Randomised Controlled Trials (RCT) will be referred. Non-RCT studies and non- English papers will be excluded. This review will provide analysis of understanding of Myofascial Release and its positive effect in the treatment of LE. All the RCTs demonstrate that in individuals with LE, myofascial release has an important beneficial impact on reducing pain and impairment as well as pain-related symptoms and hand grip. It improves the quality of life of the patients as their pain levels will significantly decrease while doing daily life activities. Although additional studies are required regarding the duration of the technique to be performed.

Optimising Maternal Health in Third Trimester Pregnancy: Evidence Based Benefits of Pranayama

Kanishka, Neha Kashyap, Shikha Singh

Third trimester of pregnancy presents with exclusive psychological, physiological challenges, comprising heightened stress, discomfort, increased physical discomfort and preparation of labour. Pranayama being a primordial practice of controlled breathing offers a non-invasive and evidence based method to enrich health by improving oxygen supply, enhancing relaxation, and reducing stress contributing to overall well-being. Pranayam is thought to regulate autonomic nervous system, promoting relaxation, reducing stress levels and also increases O2 delivery. This review aims to find out the role of different pranayams specifically in third pregnancy in optimising overall maternal health. A comprehensive literature search was conducted wherein the articles from 2010 to 2024 were included using the search terms “Optimising Maternal Health”, “Third Trimester Pregnancy” results from various digital databases like PubMed, Google Scholar, Ovid, Web of Science and the Cochrane Library. The search is then further filtered through the inclusion and exclusion criteria. It was found that pranayamas (AnulomVilom (Alternate Nostril Breathing), Bhramari (Bee Breath), Ujjayi (Ocean Breath or Victorious Breath), NadiShodhana (Channel-Cleansing Breath), Dirga Pranayama (Three-Part Breath), Sheetali and Sheetkari (Cooling Breaths) during the third trimester of pregnancy offers a range of benefits for both mother and baby. Additionally, it strengthens lung capacity, refines breathing control, and prepares the body for the physical demands of childbirth. The study concludes that among pregnancy exercises, Pranayama is highly recommended. Pranayama yoga techniques are also believed to increase the chances of a natural and uncomplicated childbirth. Pranayama can be considered a valuable secondary supplementary therapy for enhancing health and well-being due to its affordability, ease of use and minimal risk profile.

Impact of Aquatic Therapy in Improving Balance and Postural Control in Children with Spastic Cerebral Palsy: A Review

Khoolood Intkhab, Manu Goyal, Kanu Goyal

Cerebral palsy, a global movement disorder impacting 18 million individuals, particularly children, is characterised by intellectual impairments, seizures, speech, hearing, vision challenges, and physical contractures. Among therapeutic interventions, aquatic therapy has emerged as a promising approach to enhance physical abilities in children with cerebral palsy. By utilising water’s unique properties, such as buoyancy, resistance, and hydrostatic pressure, aquatic therapy improves joint mobility, range of motion, muscle flexibility, tone management, motor coordination, and balance. This systematic review evaluated the efficacy of aquatic therapy in children with cerebral palsy and identified future research directions. Following PRISMA guidelines for methodological quality, a comprehensive search of databases including PEDro, Cochrane, and PubMed was conducted to analyse studies published between 2015 and 2023. Seven studies met the inclusion criteria, encompassing 298 participants. The interventions ranged from 6 to 12 weeks, with sessions occurring one to three times per week. Outcome measures included the Gross Motor Functional Classification System and the Paediatric Balance Scale. Results demonstrated significant improvements in balance and postural control among participants, particularly those with spastic cerebral palsy. These benefits highlight aquatic therapy’s potential as an effective intervention to enhance physical function and quality of life in children with cerebral palsy. By leveraging water-based exercises, this therapeutic approach offers a holistic pathway for improved motor outcomes and greater independence.

Common Musculoskeletal Complaints Arising among Women after Caesarean Section Delivery

Pari Sharma, Jahanvi Dave, Rittu Sharma

Musculoskeletal complaints are commonly observed in women after cesarean section delivery, primarily due to physiological, hormonal, and biomechanical changes occurring during pregnancy and the postpartum. These issues include low back pain, poor posture, pelvic pain, extremity pain, DeQuervain’s tenosynovitis, abdominal muscle weakness, ligament laxity, and trunk flexor deficits. Hormonal fluctuations during and after pregnancy often lead to excessive joint mobility and postural challenges, while physical demands such as breastfeeding, lifting, carrying the infant, and managing household tasks exacerbate musculoskeletal discomfort. Sleep deprivation and muscle fatigue further complicate recovery during the early postpartum period. According to study findings, 81.2% of women experienced musculoskeletal complaints following cesarean delivery, with low back pain accounting for 75.3% of these complaints. Physiotherapeutic approaches such as manual therapy, electrotherapy and ergonomic advice aims to restore functions and decrease the discomfort. Early and advance physiotherapeutic approaches are essential to treat all these musculoskeletal conditions effectively. A comprehensive review was conducted to evaluate the prevalence and impact of musculoskeletal issues following cesarean delivery, utilising Google Scholar and PubMed as primary databases. Keywords such as cesarean section, postpartum period, muscle fatigue, and musculoskeletal, were employed to construct search queries. The findings underscore the significant impact of these complaints on postpartum recovery and maternal well-being. In conclusion, addressing musculoskeletal issues through early detection, physiotherapy interventions, and patient education is imperative to promote postpartum recovery, enhance functionality, and improve overall quality of life for mothers after cesarean section.

Effectiveness of Spinal Manipulation in Cervicogenic Headache: A Scoping Review

Nitish Kumar, Nidhi Sharma, Preeti Kapri

Millions of individuals throughout the world suffer from headache, which are common and incapacitating conditions that reduce productivity, cause severe discomfort, and impair quality of life. Although there are other choices for treatment, spinal manipulation has become a viable substitute. By critically assessing the body of research on spinal manipulation’s efficacy in treating headache disorders. The aim of the review was to assess the efficacy of spinal manipulation in reducing cervicogenic headache frequency, severity, and duration. A literature search was conducted from PubMed, The Cochrane Library, and Google Scholar database from December 2000 to December 2024. The search utilised terms such as “headache,” “spinal manipulation” and “adult” employing Boolean operators (AND, OR). Articles in which spinal manipulation was treated in this review, non-English articles were excluded. A total of 1943 articles were found from different databases, out of which only six met the inclusion criteria. These studies suggest that spinal manipulation an effective treatment for reducing pain intensity, headache frequency, and headache duration in patients with headaches. The varying outcomes observed may suggest that patients with tension-type headaches, migraines, and cervicogenic headaches may find that spine manipulation is a useful treatment for lowering headache frequency, duration, and pain severity. The quality of the included research varied, and several had methodological problems, despite the encouraging data.

Summarising the Effect of Management Strategies in Pedal Oedema: A Systematic Review

Abhijit Kumar Jha, Nidhi Sharma, Preeti Kapri

Pedal oedema, sometimes referred to as peripheral oedema, is a common ailment that causes swelling in the tissues of the feet and ankles due to a buildup of extra fluid. Gravitational pressure, lymphatic blockage, cardiovascular illness, and renal failure are some of the causes of this disorder. Untreated pedal oedema can cause pain, discomfort, and reduced mobility, all of which can have a major negative influence on a person’s quality of life. Moreover, chronic oedema can lead to infection, delayed wound healing, and skin deterioration, which highlights the significance of timely interventions. Therefore, in order to reduce symptoms, avoid problems, and enhance general health, pedal oedema management is essential. The aim of the review was to determine the most effective management strategies for the pedal oedema in middle-aged office employees. A literature search was conducted from PubMed, The Cochrane Library, and Google Scholar database from December 2000 to December 2024. The search utilised terms such as “Pedal oedema”, “Treatment outcome”, “Peripheral oedema”, “Swelling reduction” and “Quality of life” employing Boolean operators (AND, OR). Articles in which treatment outcome was measured add were included in this summary, non-english articles were excluded. A total of 1236 articles add were found from different database out of which only 6 met the inclusive criteria. The majority of the adults having pedal oedema had shown significant reduction in pedal oedema through Buerger Allen exercise. Also, diuretics showed some effectiveness in case of pedal oedema and intermittent pneumatic pedal compression also helped to reduce signs and symptoms. In addition, kinesiology tape was found to be an effective method for reducing pedal oedema. Overall findings suggest that kinesiology tape was found to be the most effective method for reducing pedal oedema.

Criteria-based Return to Sports Decisionmaking following Lateral Ankle Sprain Injury: A Narrative Review

Aditi Sen, Kanika Bhatia

One of the most common musculoskeletal injuries suffered by athletes competing in both recreational and competitive sports is Lateral Ankle Sprain (LAS).After suffering a LAS injury, over half of Add the people choose not to seek official medical attention and many Return To Sports (RTS) before the impairments caused by the injury are healed. The main objective of this review is to identify prospective studies that used a criteria-based RTS decision-making process for patients with LAS injury. For determining full-text publications, PubMed, Cochrane, Google Scholar, and Scopus add databases searched for article published between the 2015 to 2024, an evidence-based review, follow up study and a prospective randomised trial studies in English567 papers that were first discovered were qualified for full textand 319articles were eliminated because they contained duplicates.248 abstract and titles were assessed, out of those167 were removed due to other treatment. In this review entailed 9 published articles. This study found that, if the athlete is cleared too early or skips critical rehabilitation steps, there is a higher risk of re-injury, particularly in cases where joint instability or strength deficits remain unresolved. This may result in chronic ankle instability or long-term functional impairments. In various studies this has been demonstrated that full recovery of athletes across the criteria’,(e.g., strength deficits, balance issues, or psychological concerns)they have safely return to sport following a graded re-entry, starting with non-contact practice and gradually increasing intensity. Further rehabilitation is necessary for the athletes who have not met these criteria should not return to the sports and after full recovery with proper training regimes they can resume the sports. Attention should be given to strengthening, enhancing balance, reestablishing functional movement patterns, and resolving any psychological obstacles.

Effectiveness of Kinesiotaping and Shockwave Therapy in Managing Osgood’s Schlatter Disease: A Literature Review

Garvit Kumar, Rittu Sharma, Swarup Ghosh, Jahanvi Dave, Kanika, Kanika Bhatia

Osgood-Schlatter disease, characterised by apophysitis of the tibial tubercle, is a prevalent condition affecting physically active adolescents during periods of rapid growth, particularly boys aged 8 to 15 years. This condition is a leading cause of knee pain in this population. It often arises from repetitive sprinting and jumping activities. Physiotherapeutic interventions, including kinesiology taping for pain management, and emerging modalities such as Extracorporeal Shockwave Therapy (ESWT), have demonstrated promising outcomes in the management of this condition.This study aims to evaluate and summarize the existing evidence on the clinical effectiveness of kinesiotaping and shockwave therapy in managing Osgood-Schlatter disease.A comprehensive literature search spanning 2015 to 2024 across electronic databases, including PubMed, Google Scholar, Scopus, and the Cochrane Library, yielded 3,967 articles using the keywords “kinesiotaping,” “extracorporeal shockwave therapy,” and “Osgood-Schlatter disease” with Boolean operators AND and OR. After eliminating duplicates, only five articles were deemed eligible for further analysis.The reviewed literature primarily assessed pain using the Visual Analogue Scale with some studies also examining return-to-sports timelines. Three studies evaluated kinesiotaping as an adjunct to conservative treatments, such as quadriceps stretching and eccentric strengthening, demonstrating statistically significant improvements (p<0.05). Only two studies assessed ESWT, which demonstrated statistically significant changes in pain reduction after the treatment sessions. Preliminary evidence suggests that both kinesiotaping and ESWT may offer pain reduction when integrated into conservative exercise programmes for Osgood-Schlatter disease. However, to draw definitive conclusions, further high-quality randomised controlled trials are necessary. These trials should evaluate the efficacy of these interventions, both as standalone treatments and as adjuncts to conservative management, utilising reliable and standardised outcome measures.

Calcaneal Eversion as a Predictor of Knee Conditions: A Narrative Review

Anjali, Kanika Bhatia, Rittu Sharma

Calcaneal eversion refers to the outward rotation of the calcaneus away from the midline of the body, which is a critical movement in the biomechanics of the foot and ankle. The significance of calcaneal eversion on the knee is multifaceted, influencing knee alignment, rotational dynamics, and potential injury mechanisms. Understanding calcaneal eversion is essential for assessing its impact on injuries and rehabilitation. To explore the impact of calcaneal eversion on knee injuries, we conducted a literature search in databases such as PubMed and Google Scholar focussing on publications from 2014 to 2024. Search terms included “calcaneal eversion”, “kneeinjury”, “ankle biomechanics”, “athletes”, “alignment”. This review entailed 9 publications comprising randomised controlled trials, systematic reviews, cross-sectional surveys, observational studies and scoping reviews. This review showed that overweight individuals exhibit greater calcaneal eversion. Also, excessive calcaneal eversion can lead to abnormal tibial rotation, leading to increased risk of knee injuries due to the mechanical coupling at the ankle joint complex. Increased hindfoot and forefoot eversion correlates with medial knee displacement and lead to exacerbation of knee conditions. The review also revealed that calcaneal eversion has a coupling coefficient of 0.68, indicating a significant relationship with tibial movement. Conversely, while calcaneal eversion is linked to knee conditions, some studies suggest that not all individuals with eversion experience knee issues, indicating that other factors, such as muscle strength and overall biomechanics, act as an important marker in knee health. The study concluded that calcaneal eversion plays a crucial role in knee joint mechanics, with its impact evident in various knee pathologies.

Hindi Translation and Validation of the London Chest Activity of Daily Living Scale (LCADL)

Atreyee Sharma, Mousumi Saha, Subhashish Chatterjee

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition leading to airflow limitation, disability, and reduced independence, particularly in older adults. Many severe COPD patients experience breathlessness during daily activities, significantly affecting their ability to perform Activities of Daily Living (ADL). However, tools to assess ADL limitations in advanced COPD are scarce. Existing tools, such as the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ) and Nottingham Extended Activities of Daily Living Scale (EADL), are either too lengthy or fail to detect changes after pulmonary rehabilitation. The London Chest Activity of Daily Living (LCADL) Scale, developed by Garrodetal., is a validated tool to assess ADL impairment in COPD, covering personal care, household tasks, physical activities, and leisure activities. However, cultural and linguistic adaptations are necessary for its effective use across diverse populations. This study focusses on translating and validating the LCADL Scale into Hindi for North Indian patients with severe COPD to ensure cultural relevance and clarity for better patient assessment. Aim: To develop and validate a Hindi version of the LCADL Scale, ensuring its cultural and linguistic appropriateness for evaluating activity limitations in North Indian patients with COPD. Materials and Methods: The translation process included forward translation by two bilingual translators—one with a medical background and the other a linguist. The synthesised version was back-translated into English by two independent translators. The final version was reviewed by a panel of cardiothoracic physiotherapists with at least three years of clinical experience. Results: The Hindi version of the LCADL Scale was adapted using standardised cross-cultural guidelines. Content validity was confirmed by experts, ensuring the scale effectively captured dyspnoea’s impact on daily activities and was relevant to the experiences of COPD patients in North India. Conclusion: The Hindi LCADL Scale is a valid, culturally appropriate tool for assessing activity limitations due to dyspnoea in North Indian COPD patients. It can be used in clinical practice and research to improve interventions and quality of life for COPD patients.

Enhancing Physiotherapy Outcomes in Cystic Fibrosis: The Role of Gamification in Rehabilitation

Ashish Kumar, Neha Kashyap, Urvashi

Cystic fibrosis (CF) being a multifarious genetic disorder is characterised by chronic pulmonary complications and systemic involvement. Physiotherapy has played a key role in managing CF complications on routine basis for chronic patients. Techniques like bronchial toileting, active cycle of breathing technique, spirometry etc are a part of the routine regimens of patients with CF but adherence to same, monotonous, mundane exercises is challenging. Gamification, the application of game design principles in non gaming contexts, has emerged as a promising approach to address this issue by increasing patient engagement and motivation. This review was taken up to find out the effect of gamification in long term illness like CF in improving lung function. An exhausting data search was carried out on various databases like Ovid, Scopus, Pubmed, Cochrane etc to filter out the studies done on CF using gamification as a long term rehabilitation tool. Keywords like cystic fibrosis, virtual reality, rehabilitation were used. Through this review of existing literature and pilot interventions, this research finds crucial parameters determining the success of gamified physiotherapy, including age, disease severity, and technology accessibility. According to preliminary research, gamification greatly increases patient motivation, creates a feeling of accomplishment, and promotes exercise tolerance and pulmonary function when used in physiotherapy regimens. Additionally, the study emphasises how crucial it is for behavioural psychologists, software engineers, and physicians to work together across academic boundaries in order to enhance gamified designs for this particular patient population.

Effectiveness of Transcranial Direct Current Stimulation along with Body Weight Supported Overground Gait Training on Central Pattern Generator of Locomotion in Individual with Incomplete Spinal Cord Injury: A Case Report

Bhavya Kapoor, Narkeesh Arumugam, Sharanjeet Kaur

Spinal cord injury (SCI) results from disruption of neural elements of the spinal cord, leading to loss of motor and sensory function below the level of injury. Walking and functional independence remain pivotal goals for individuals with SCI. Central pattern generators (CPGs) are specialized neural circuits within the spinal cord that generate rhythmic, instinctive, and repetitive motor patterns autonomously, independent of continuous sensory inputs or supra-spinal inputs allowing for coordinated movement. The combination of tDCS and body weight-supported overground training is a cutting-edge approach being researched for enhancing motor recovery in individuals with spinal cord injury (SCI). To evaluate the effectiveness of trans-cranial direct current stimulation and body weight supported overground gait training on CPG of locomotion in individual with incomplete spinal cord injury. A 37-year-old male was diagnosed with traumatic incomplete spinal cord injury (D12-L1) with ASIA B in August 2023. On neurological examination, the bilateral lower limb had sensory and motor impairment. The participant was not able to walk with assistive devices and was wheelchair dependent. The participant was intervened with tDCS (anode over the M1 region corresponding to the dominant leg, cathode over the contralateral supraorbital region, intensity= 2mA,20 minutes) with body weight supported overground gait training along with conventional rehabilitation for 5 days per week for the duration of 4 weeks. Pre-intervention and post-intervention assessment was done on Day 0 and Day 30 respectively. ASIA Impairment Score, Walking Index for spinal cord injury-II and Spinal cord independence measure-III were selected as desired outcome measures. There was significant improvement in the motor scores of ASIA-Score (1/50 to 3/50), sensory scores of ASIA-Score (LT= 72/112, PP=72/112 to LT=80/112, PP=80/112), the scores of WISCI-II (0/20 to 6/20) AND SCIM-III (42/100 to 54/100). Significant improvement was shown in all outcome measures, and the participant was able to initiate a walk with KAFO and assistive devices. tDCS, a non-invasive brain stimulation technique, has emerged as a potential therapeutic intervention that can promote neuroplasticity and enhance motor spinal connectivity thereby activating the CPG of Locomotion in spinal cord injury survivors.

Effect of Pilates in Breast Cancer Patients Undergoing Hormonal Therapy: A Systematic Review of RCTs

Jasleen Kaur Grover, Sandeep Pattnaik, Nitin Bhardwaj, Akshat Sehgal

Breast cancer is a prevalent form of cancer that primarily originates in breast tissue, affecting women predominantly. It is characterized by the uncontrolled growth of cells, which may metastasize to other body parts if untreated. Hormonal therapy is a crucial treatment, by blocking or reducing the production of hormones like estrogen and progesterone, It prevents cancer cells from growing and spreading. Post-treatment complications following hormonal therapy can significantly impact a patient’s quality of life and overall well-being. Pilates focuses on physical fitness including core strength, flexibility, posture, muscle tone, balance, and mental well-being. It emphasizes on strength, flexibility, and mind-body integration, and presents a promising intervention to address these challenges. Database including PubMed, Cochrane Library, PEDro, and Google Scholar using keywords related to “plantar fasciitis,”“Breast Cancer”, “Hormonal therapy” and “Pilates” from 2018 till date.Included RCTs involved adults (11-80 years) with breast cancer stage 0-III breast cancer undergoing hormonal therapy. excluding those with active cancer or limitations that could hinder physical activity.The outcomes considered in the study were related to the Quality of life, Physical fitness, Self-esteem, Depression, Pain, Disability, and Balance of the women having breast cancer. Data from all databases 2852 initially searched articles including 963 duplicates, only 79 were screened based on titles and abstracts. Amongst them based on the area of interest, few articles were excluded as 71 were irrelevant to breast cancer or Pilates or didn’t include hormonal therapy as a treatment option,1 was a pilot study and 2 were just the abstract. Therefore, upon scrutiny only 5 articles are included in this systematic review Following PRISMA guidelines, study quality was evaluated using CONSORT, PEDro, and ROB 2. PROSPERO registration was done with ID CRD42024568245.As a result,Pilates was found to have positive effects on physical function, mental health, and symptom management in breast cancer patients undergoing hormonal therapy. However, the studies varied regarding Pilates programmes design and sample size. Pilates may be a beneficial intervention for breast cancer patients undergoing hormonal therapy. Further research is needed to confirm the long-term benefits and develop evidence-based implementation guidelines.

The Impact of Workplace Ergonomics on Musculoskeletal Disorders in Office Workers: A Literature Review

Jaspreet Kaur, Supreet Bindra

Occupational health and safety are critical factors for ensuring long-term organisational success and employee well-being. As workplaces increasingly prioritise productivity, quality, and efficiency, it becomes essential to focus on creating environments conducive to physical and psychological health. Adverse working conditions, such as inadequate lighting, extreme work environments, or prolonged static postures – can result in reduced motivation, impaired performance, and musculoskeletal disorders. By addressing these challenges, organizations can foster healthier and more efficient workforces, ensuring sustained productivity and employee satisfaction. This study aims to evaluate the impact of workplace ergonomic advices based on musculoskeletal disorders among office workers. A computer search of peer reviewed articles from database such as PubMed (National Library of Medicine), Google scholar Medline, Research Gate, add and Science Direct, was conducted focussing on studies published from 2011 to 2024.The findings demonstrate that ergonomic solutions, such as adjustable furniture, properly aligned equipment, and workplace designs that encourage movement, play a critical role in reducing physical strain and promoting proper posture. Additionally, practices like regular breaks and stretching exercises further reduce fatigue and prevent injury. The review highlights that implementing effective ergonomic strategies enhances workplace safety, minimises the risk of MSDs, and supports sustained productivity and employee well-being. These insights underscore the importance of prioritising workplace ergonomics in organisational health and safety policies.

Recent Advancement of 3d-motion Analysis in Sports Rehabilitation: A Narrative Review

Aashu, Bhawna Vats

In sports rehabilitation, 3D motion analysis involves tracking and analysing an athlete’s movement in three dimensions using cutting-edge technology, such as wearable sensors, motion capture structures, and biomechanical modelling. The aim of this review is to quantify the effective use of motion capture and 3D modelling technology to facilitate sports training. Sports rehabilitation has been modified by recent advances in 3D motion analysis, which provide comprehensive view of athletic movement patterns. Therapists may create specialised rehabilitation plans with this technology, which speeds up recovery and decreases the chance of injuries. In the clinic, the Inertial Measurement Unit (IMU) sensors are used together with tests and outcome measurements. The most widely used techniques include smartphones with standard optical cameras and IMUs. Artifical Intelligence (AI) recently emerged as one of the most researched areas of motion analysis technologies in health. It is evident that AI has several types of benefits, such as reductions in time and money and the ability for better patient care, as Machine Learning (ML) reduces illnesses, decision-making, and analysis. ML has been shown to be more effective in medical imaging, wearable technologies, risk prediction, pain phenotype prediction, and decision support when it involves sports injuries and conditions. In sports biomechanics and rehabilitation, the marker-less motion analysis system gives a fast, entirely automatic, and noninvasive technique that can significantly improve research and application From December 2020 to December 2025, a literature search was done using the PubMed, Scopus, and Embase databases. Boolean operators (AND, OR) were used in the search, which included terms like "3D motion," "wearable motion" and "biofeedback." Articles in which recent advancement in 3D motion analysis was discussed or used were included in this review. Non-English and non peer reviewed articles were excluded. 2367 articles found from different database, out of which only five met the inclusion criteria. A comprehensive study proved that motion capture and 3D modelling technologies had a beneficial impact on sports training. According to our findings, the motion recognition methodology of the suggested system can be utilised to monitor the patient’s rehabilitation progress and confirm that the physiotherapy exercises are of high quality.

To Examine The Effect of Physiotherapy Intervention in Pelvic Floor Weakness in Women with Post-Ovarian Cystectomy: A Study Protocol

Himanshi Arora, Jatin Sangwan, Urvashi

Introduction: Ovarian cyst is a common gynaecological problem, which is generally present in the ovaries on either side. These ovarian cysts are the fluid-filled sacs present in the ovary in the form of simple or complex cysts, if the cyst is larger than 5 mm in diameter, surgical removal of the ovarian cyst is prescribed and this procedure is called ovarian cystectomy. It can lead to many complications such as pelvic pain, dyspareunia, incontinence, inflammation, injury, and damage to the skeletal and renal system, which can lead to pelvic floor muscle weakness. Aim: This study aims to examine the effectiveness of physiotherapy interventions on pelvic floor weakness in women following ovarian cystectomy. Materials and Methods: In this experimental study patients with post-ovarian cystectomy after 5 days of surgery will be recruited by purposive sampling method with consent. Participants will be randomly assigned to either a physiotherapy intervention group or a control group receiving standard post-operative care. The intervention will consist of pelvic floor muscle training and education on bladder management. Outcome measures will include pelvic floor muscle strength (assessed by perineometer), urinary incontinence severity assessed by the Incontinence Impact Questionnaire-7 and quality of life (using the SF-36). Assessments will be made at baseline, post-intervention, and a 3-month follow-up. Results: The main focus in data analysis will be the comparison of pre-and post-intervention outcomes between the experimental and control groups. Statistical analysis will be performed using paired t-tests for continuous variables and chi-square tests for categorical outcomes. Conclusion: It is anticipated that women in the physiotherapy group will show significant improvements in pelvic floor strength, urinary function, and overall quality of life compared to the control group. This study will provide evidence regarding the role of physiotherapy in managing pelvic floor dysfunction after ovarian cystectomy.

Clinical and Functional Outcome of Infected Non Union of the Femur Managed with Monolateral External Fixator: A Prospective Interventional Study

Ishan Rajendra Shevate, Selvi Ashishkumar Khajanchi, Rahul Salunkhe

Introduction: The treatment of infected non unions of long bones is one of the most challenging tasks in modern orthopaedic trauma practice. With the increasing prevalence of Road Traffic Accidents (RTAs) and associated high-energy trauma, primary fractures are often presented with gross contamination, soft-tissue degloving, bone loss and vascular compromise. Infected non unions of the femur are managed through debridement, external fixation, bone grafting, microvascular composite tissue transfer, bone transport via an external fixator over a nail and Ilizarov circular or monolateral fixators. Aim: To evaluate the clinical and functional outcomes in infected non unions of the femur treated with a monolateral external fixator. Materials and Methods: This study was a prospective interventional study that included 17 males and one female patient, with a mean age of 35 years, who were treated at Dr. D. Y. Patil Tertiary Care Hospital in Pune city, Maharashtra, India with a monolateral external fixator between January 2021 and January 2024. All patients had high-energy RTAs, compound fractures and gross contamination initially. Implant removal was performed, followed by radical debridement and stabilisation with the rail fixator. The mean duration of non union was 13 months (range: 4-24 months). The mean number of previous surgical procedures was 3.4 (range: 1-4). Corticotomy and bone transport were performed in six patients who had shortening or bone loss of more than 2 cm. Distraction of the corticotomy was initiated one week later at a rate of 1 mm per day until lengthening was achieved. Monthly outpatient department follow-ups, with X-rays, were conducted and the fixator was maintained until the healing of three cortices and eradication of infection were confirmed. The average follow-up duration was 2.3 years (range: 1-4 years). A paired t-test was used for statistical analysis during follow-up. Results: Union was achieved in 17 out of 18 patients, resulting in a union rate of 94.4%. The mean time to bony union was 7±2 months (range: 4-12 months). Infection was eradicated in all but one patient, who continued to experience a discharging sinus. The mean length achieved in the corticotomy and lengthening group was 4±0.75 cm. According to Paley’s bone and functional outcome scoring, all but one patient had excellent to good results at the one-year follow-up. Significant improvement was observed in the Lower Extremity Functional Score (LEFS) and in the Physical Component Score (PCS) of the 36-Item Short Form Health Survey questionnaire (SF-36) at the one-year follow-up (p-value <0.05); however, there was no improvement in the Mental Component Score (MCS) of the SF-36. Conclusion: A monolateral external fixator can provide stable fixation for the management of infected non unions of the femur and is an effective method for eradicating infection.

Assessment of Pressure Support Ventilation versus T-Piece Ventilation in Spontaneous Breathing Trials for Successful Extubation in Mechanically Ventilated Patients: An Open-labelled Block Randomised Controlled Trial

O Johnson, Vikas Raj, Ali Hasan Faiz Karnam, Sivakumar Segaran, Nayyar Iqbal

Introduction: Spontaneous Breathing Trials (SBTs) are vital in determining readiness for extubation in patients undergoing mechanical ventilation. Pressure Support Ventilation (PSV) and T-piece ventilation are two commonly used methods for conducting SBTs. Aim: To compare the rates of weaning failure, extubation failure, reintubation, and 28-day mortality between patients undergoing SBT using PSV and those using T-piece ventilation. Materials and Methods: A randomised controlled trial with an open-label design was conducted at the Department of General Medicine, PIMS, Pondicherry, Tamil Nadu, india, from from 11 Nov 2019 to 20 Oct 2021. A total of 160 patients requiring mechanical ventilation were randomly allocated into two groups using block randomisation. One group underwent SBT with PSV, while the other group used T-piece ventilation. Ethical approval was obtained, and informed consent was secured from all participants. Primary outcome measures included rates of weaning failure, extubation failure, reintubation, and 28-day mortality. Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 26, with a p-value below 0.05 considered statistically significant. Results: The study included 64 patients, predominantly male (79.69%) and aged 51-60 years (23.4%), with 45.31% reporting smoking habits and 42.18% consuming alcohol. The mean systolic blood pressure was 130.94±20.69 mmHg, the mean diastolic blood pressure was 80.00±12.55 mmHg, and the mean pulse rate was 99.41±20.78 beats/min. The mean APACHE II score was 16.29±7.85. The weaning failure rate was 42.9% in the PSV group and 57.1% in the T-piece group, a difference that was not statistically significant (p=0.38). Extubation failure was observed in 14.07% of patients, with no significant difference between groups (p=0.24). Similarly, the reintubation rates (p=0.098) and 28-day mortality rates (p=1.000) were comparable. Conclusion: Both PSV and T-piece ventilation were equally effective for SBTs, with no significant differences in weaning failure, extubation failure, reintubation, or 28-day mortality. The findings suggest that either approach can be utilised effectively based on patient-specific considerations.

Different Positioning Practices in Neonatal Intensive Care Unit and their Effects on Neuromotor Development of Preterm Neonates: A Systematic Review

Dhwani Chanpura, Neha Mukkamala, Nalina Gupta

Introduction: Advances in neonatal intensive care have markedly improved the survival of preterm infants. However, without appropriate interventions, many preterm infants face long-term disabilities. Preterm infants often adopt postures that differ from those they would typically develop in utero. Therapeutic positioning is among the earliest neurodevelopmental interventions implemented in the Neonatal Intensive Care Unit (NICU). The primary goals of positioning are to provide support, facilitate movement and optimise neurodevelopment. Aim: To examine various positioning practices and their effects on neuromotor development in preterm infants admitted to the NICU. Materials and Methods: A literature search of PubMed, MEDLINE, CINAHL, DARE, ScienceDirect and Embase was conducted covering from January 2000 to June 2024, focusing on studies that examined different positioning techniques and their effects on posture and neuromotor development. Articles were screened against predefined inclusion and exclusion criteria. Eligible studies were identified and the methodological quality of the included studies was assessed. A qualitative synthesis of the findings was performed. Results: Eleven studies were included in this review. The included studies employed various postural strategies, such as different types of nests, mattresses and postural support devices (rolls or diapers) and assessed their effects on posture and neuromotor development. Conclusion: Positioning strategies for preterm infants are diverse. By adopting specific positions or using particular equipment, NICU care can address some of the unique needs of preterm infants during their stay. Positioning in certain positions may be associated with pain relief, improved flexion posture, enhanced neuromotor development and shorter lengths of hospital stay.

Frequency of spaP Genetic Determinants in Streptococcus mutans Isolated from Patients with Oral Premalignant Disorders: A Cross-sectional Study

Introduction: The surface-associated Protein (spaP) of Streptococcus mutans is crucial for its virulence, aiding in adherence and biofilm formation. This study explores the prevalence of the spaP gene in clinical strains of S. mutans to understand its potential role in the progression of Oral Premalignant Disorders (OPMD). Aim: To phenotypically characterise S. mutans from clinical samples of patients with OPMD and to assess the frequency of spaP genes in clinical strains of S. mutans. Materials and Methods: This cross-sectional study was conducted at the Department of Microbiology, Saveetha Dental College and Hospitals, Chennai, India, from January 2023 to April 2023. A total of 60 saliva samples were randomly collected from three groups: Group 1 (OPMD, n=20), Group 2 (healthy individuals with dental caries, n=20), and Group 3 (healthy individuals without caries, n=20). The primary inclusion criteria were participants within these three groups, with exclusions for those with systemic diseases, ongoing infections, or recent antibiotic/antifungal use (within the last three months). Saliva samples were cultured on Mutans Sanguis Agar (MSA), and colonies were characterised through Gram staining and catalase testing. Genomic Deoxyribonucleic Acid (DNA) was extracted, and Polymerase Chain Reaction (PCR) was performed to detect the spaP gene. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) v25.0, with significance considered at p<0.05. Demographic parameters such as age, sex, and clinical status were analysed. Results: The prevalence of S. mutans was found to be 45% (n=9) in OPMD patients, 40% (n=8) in healthy individuals with caries, and 15% (n=3) in healthy individuals without caries. The frequency of the spaP gene was found to be 88% (n=8) in OPMD patients and 75% (n=6) in healthy individuals with caries. Conclusion: The comparative evaluation of the prevalence of S. mutans and the frequency of the spaP gene among the strains suggests a significant role of the spaP gene in association with both caries and OPMD conditions.

Association of Premenstrual Dysphoric Disorder with Depression and Anxiety in Women of Reproductive Age Group: A Cross-sectional Study

Manisha Upadhyay, Saurav Kumar, Meenu Saini, Priya Kumari

Introduction: Premenstrual Dysphoric Disorder (PMDD) is a mood disorder affecting women during the luteal phase of the menstrual cycle. Its association with depression and anxiety has been documented. Despite of its significant impact on women’s quality of life, physical and mental health, PMDD remains under evaluated and under researched in the Indian population. Aim: To evaluate the association of PMDD with depression and anxiety. Materials and Methods: The present cross-sectional study was conducted from August 2024 to January 2025 among 100 women aged 15-49 years presenting to Outpatient Department of Gynaecology in GS Medical College, Hapur, Uttar Pradesh, India with PMDD like symptoms. The Premenstrual Symptom Screening Tool (PSST) was applied to all these women and PSST score was calculated some other variables like age, education, occupation, length of menstrual cycle, duration and amount of menstrual flow was also recorded. All 100 patients diagnosed with PMDD and those who were having mild premenstrual symptoms were further screened and scored for anxiety and depression by using Beck’s Anxiety Inventory (BAI) and Beck’s Depression Inventory (BDI) scale. Association of PMDD with severity of anxiety and depression was analysed using Chi-square test. The difference in PSST score among various categorical groups like education, occupation, marital status and amount of menstrual flow was analysed using F-test of Analysis of Variance (ANOVA). Regression analysis was run to identify the significant predictors of PMDD. Results: Out of 100, 65 women were diagnosed to have PMDD using PSST and 35 women had mild Premenstrual Syndrome (PMS). Significant differences in PSST Score were observed among groups categorised by education (p=0.01) and menstrual flow (p=0.006) implying that these factors influence PSST scores. Duration of menstrual flow found to be a significant predictor of PSST Score (p=0.04). The results showed a significant association between PSST score and both depression (χ²=84.22, p<0.001) and anxiety (χ²=64.84, p<0.001). Most women with PMDD experienced severe depression and moderate-to-high anxiety levels. Conclusion: PMDD was significantly associated with increased severity of depression and anxiety. Low education levels and heavier or prolonged menstrual bleeding were the contributing factors.

Functional Outcome of High Energy Schatzker Type V and VI Tibial Plateau Fractures Treated with Hybrid External Fixator: A Prospective Interventional Study

Akshat Mittal, Aditya Kumar Singh, Manvendra Singh Rawat, Chandra Shekhar

Introduction: High-energy Schatzker type V and VI tibial plateau fractures are severely injured intra-articular fractures commonly accompanied by serious soft-tissue injury and instability. Conventional internal fixation may be problematic because of the serious risk of infection and soft-tissue complications. Hybrid external fixators provide a less invasive option, hoping to stabilise the fracture without compromising soft-tissue integrity and facilitating functional recovery. Aim: To evaluate the functional results of hybrid external fixation of bicondylar tibial plateau fractures. Materials and Methods: The present prospective interventional study was conducted at Government Doon Medical College, Dehradun, Uttarakhand, India over a period of 12 months from September 2021 to August 2023, focusing on high-energy Schatzker type V and VI tibial plateau fractures. A total of 41 patients were treated using a hybrid external fixator; however, three patients were lost to follow-up. Two-plane radiographs were taken in all the cases, and radiographs taken immediately after surgery were assessed to check the quality of fixation and reduction. All the patients were checked at six weeks, six months, and twelve months, and functional results were scored by the Modified Hospital for Special Surgery (MHSS) knee scoring system. Removal of the fixator was done at a mean of 2.5±0.5 months from the time of surgery. Data were analysed via statistical tests used Chi-square test or Analysis of Variance (ANOVA), with significance at p<0.05. Results: Thirty-eight patients (31 men, 7 women) who had follow-up were included in the study. There were 13 Schatzker V fractures and 25 Schatzker VI fractures. All patients exhibited good coronal and sagittal plane alignment and preserved articular width on supine X-rays of the knee in Anteroposterior (AP) and lateral views. Good to excellent results were achieved in 36 (94.73%) patients based on the MHSS knee score. The average range of knee flexion was 115.79±21.29 degrees, and the average MHSS score was 80.34±10.30 at final follow-up. 2 (5.26%) patients got superficial infections after external fixation whereas 1 (2.63%) patients had nonunion, and another (2.63%) developed varus deformity. A total of 36 (94.74%) patients went back to their previous level of work and activity. No cases of deep infection were observed. Conclusion: Hybrid external fixator in Bicondylar tibial plateau fractures gives a favourable functional outcome as it provides rigid fixation and allows immediate knee mobilisation.

Salivary Metallothionein Level in Type 2 Diabetes Mellitus Patients with and without Chronic Periodontitis: A Cross-sectional Study

EN Keerthi, Supraja Ajitkumar, Muthukumar Santhanakrishnan, Sathya Selvarajan

Introduction: Metallothionein (MT) is a cysteine-rich protein involved in cellular defence mechanisms, including the regulation of oxidative stress and immune responses. Oxidative stress is a common link between Diabetes Mellitus (DM) and periodontitis, two chronic inflammatory conditions with a bidirectional relationship. Although MT has been widely studied in diabetes, its role in periodontal disease and the combined impact of both conditions on MT expression remain unclear. Aim: To evaluate the levels of MT in the saliva of diabetic patients with and without periodontitis. Materials and Methods: The present cross-sectional study was conducted at Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu India, over two months (February to March 2021), involving 76 participants divided equally into four groups (n=19): healthy controls, Chronic Periodontitis (CP), Type 2 Diabetes Mellitus (T2DM), and T2DM with periodontitis (T2DM+CP). Clinical periodontal parameters-gingival bleeding index, Plaque Index (PI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), and Periodontal Inflamed Surface Area (PISA)-were recorded. Salivary metallothionein levels were measured using Enzyme-Linked Immunosorbent Assay (ELISA). Data were analysed using Statistical Package for Social Sciences (SPSS) software with the Shapiro-Wilk test, one-way Analysis of Variance, Dunn’s post-hoc test, and Spearman’s correlation (p<0.05). Results: The T2DM+CP group showed significantly higher periodontal parameters and glycaemic levels compared to the other groups (p<0.05). Salivary MT levels were also highest in this group and were statistically significant, with a p-value of <0.05 when compared to the other groups. A positive correlation was observed between MT and glycaemic levels, and a moderately positive correlation (r-value of 0.507) was noted between MT levels in patients with T2DM and periodontitis. Conclusion: Elevated salivary MT levels in diabetic patients with periodontitis suggest a potential role as a biomarker of oxidative stress and disease activity. Further longitudinal and interventional studies are needed to validate MT as a diagnostic and prognostic marker.

Diastolic Dysfunction in Patients with Hypertension Assessed by 2D Echo and Doppler Imaging and its Association with Clinical Profile and ECG Findings: A Cross-sectional Study

Vikram Vikhe, Diksha Sabharwal, Asmita Samal

Introduction: Hypertension is a major risk factor for cardiovascular diseases and is strongly associated with Diastolic Dysfunction (DD), which can lead to Heart Failure with preserved Ejection Fraction (HFpEF). Despite its clinical significance, DD often remains underdiagnosed, necessitating routine echocardiographic screening for early detection. Aim: To evaluate the prevalence of DD in hypertensive patients using 2 Dimensional (2D) echocardiography and doppler imaging, along with its association with clinical characteristics and Electrocardiogram (ECG) findings. Materials and Methods: The present cross-sectional analytical study was conducted at Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India from February 2023 to September 2025. A total of 100 hypertensive patients were recruited using a purposive sampling method. Each participant underwent clinical assessment, Blood Pressure (BP) measurement, ECG, and (2D echo and doppler imaging). The prevalence and severity of DD were analysed, and its associations with age, duration of hypertension, severity of hypertension, and ECG findings were evaluated. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20, with a p-value <0.05 considered significant. Results: DD was detected in 46% of hypertensive patients, with 19% having grade 1 DD, 11% grade 2, and 16% grade 3. The prevalence of DD increased with age, from 25% in patients below 40 years to 62.5% in those aged 71-80 years. A significant association was found between hypertension duration and DD (p=0.023*), with 26.1% of patients with 1-5 years of hypertension exhibiting DD, increasing to 66.7% in those with more than 15 years. Among patients with grade 3 hypertension, 75% had DD confirming that worsening hypertension increases DD risk. On ECG analysis, 17% of patients had Left Ventricular Hypertrophy (LVH), and 70.6% of them had DD (p=0.026*), indicating a strong association between LVH and DD. Echocardiographic findings showed 46% had impaired LV relaxation, and 27% had elevated Left Atrial Pressure (LAP). Comparative analysis revealed that patients with DD had significantly higher mean age, longer hypertension duration, and higher Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) (p<0.05), whereas Body Mass Index (BMI), Blood Sugar Levels (BSL), and lipid profiles did not show significant differences. Conclusion: The study found that DD is prevalent in nearly half of hypertensive patients, with its prevalence increasing with age, hypertension severity, and duration. Significant associations were observed between LVH on ECG and echocardiographic evidence of DD, reinforcing the need for early screening and stringent BP control to prevent progression to heart failure. Routine echocardiographic assessment of hypertensive patients should be emphasised to detect and manage DD at an early stage.

Management and Outcomes in Head and Neck Cancer Patients with Malignancy Related Hypercalcaemia, an Oncological Emergency: A Cohort Study from a Tertiary Care Hospital in Tamil Nadu

Introduction: Malignancy-Related Hypercalcaemia (MRH) is a paraneoplastic syndrome often associated with various malignancies but has limited evidence available Head and Neck Cancers (HNC). Head and neck squamous cell carcinomas with MRH is rare but it has a unique propensity to induce hypercalcaemia, even in the absence of bone metastases. Despite its clinical significance, hypercalcaemia in this patient population is frequently missed, as its symptoms are often attributed to the underlying malignancy or its treatment. Aim: The present study aimed to analyse data on patterns of care, define the clinical profile of hypercalcaemia in HNC patients, evaluate treatment strategies employed during hospitalisation, and assess survival outcomes. Materials and Methods: The present cohort study was done and analysis was conducted on HNC patients hospitalised at Department of Radiation Oncology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India between January 2014 to July 2024 with symptomatic hypercalcaemia (serum total calcium >10.5 mg/dL) based on inpatient medical records. Data were extracted for the clinical profile, patterns of management and survival follow-up was from electronic medical records and telephonic follow-ups. Based on the serum total calcium levels, hypercalcaemia was categorised as mild, moderate and severe for the ranges, 10.5-11.9 mg/dL, 12-13.9 mg/dL; and more than 14 mg/dL, respectively. Descriptive statistics were used for categorical and continuous variables. Survival was analysed using Kaplan-Meier estimates using stata version 16.1 and python version 3.9.21. Results: Total of 19 patients was included in the study. The cohort was predominantly men 17 (89.47%), with median age of 51 years. 17 (89.47%) of patients had oral cavity cancers as the primary site of malignancy, with 9 (52.94%) originating from the tongue and 8 (47.05%) buccal mucosa. Most common presenting symptom was bone pain 13 (68.42%). Hypercalcaemia management included 14 (73.68%) of patients receiving a combination of hydration and bisphosphonates like zoledronic acid, 5 (26.31%) received hydration alone and 2 (10.52%) hydration and bisphosphonates patients were administered calcitonin also. Of the 19 patients, four were lost to follow-up, Overall mortality rate in the followed-up patients (n=15) was 100%, with 8 (53.3%) of deaths occurring during the hospitalisation within seven days. Median survival was seven days and 11 (73.3%) of patients succumbed within 30 days of hypercalcaemia diagnosis. Conclusion: MRH remains a significant marker of poor prognosis. HNC patients who present with symptoms such as fatigue, lethargy, bone pain, or altered mental status should be evaluated for hypercalcaemia. Despite aggressive management, survival remains limited, emphasising the need for improved preventive and therapeutic strategies in future and necessity of early integration of palliative care team and psychological support in these patients.

A Longitudinal Study on Antimicrobial Resistance Dynamics in Pseudomonas aeruginosa at a Government Superspeciality Hospital

Harika Kanugula, Swathi Suravaram

Introduction: Pseudomonas aeruginosa, primarily an opportunistic hospital pathogen, has now become an increasing cause of infections in the community as well. It significantly contributes to the rising burden of Antimicrobial Resistance (AMR), making treatment challenging. In high-risk settings such as superspeciality hospitals, the impact of AMR is magnified, necessitating continuous surveillance of susceptibility patterns to guide empirical therapy and escalation/de-escalation strategies for definitive treatment as part of antimicrobial stewardship. Aim: To analyse the Antimicrobial Susceptibility Testing (AST) patterns of Pseudomonas aeruginosa isolates at a government superspeciality hospital. Materials and Methods: This longitudinal study analysed data from three years (January 2021 - January 2024) at the 250-bedded ESIC super-speciality government teaching hospital, Hyderabad, Telangana, India. Adhering to Clinical and Laboratory Standards Institute (CLSI) M-100 guidelines, samples were collected and processed on clinical requests; those showing growth were analysed using an automated identification and AST analyser. Among all the samples received in the microbiology laboratory, 517 samples with growth of Pseudomonas aeruginosa were included. Colistin resistance was confirmed using Colistin Broth Disc Elution (CBDE) and compared with automated analyser results to assess the difference between both methods. Suitable antibiotics with potential for treatment were evaluated based on CLSI M39 guidelines. Demographic parameters such as age groups (paediatric and adult), gender distribution and sample types (urine, blood, respiratory specimens and exudates) were considered to evaluate resistance patterns. Descriptive statistics were used and presented in terms of percentages. Results: In the current study, among the 517 isolates of Pseudomonas aeruginosa, 440 (85%) were from adults and 77 (15%) from paediatric population. Pseudomonas aeruginosa showed varying susceptibility rates to different antibiotics, ranging from 193 (43.8%) to 276 (62.7%) in adults and 32 (41.5%) to 38 (49.3%) in paediatric population. Multidrug Resistant (MDR) isolates totalled 170 (32.8%), with 123 (43.2%), 6 (12.5%), 20 (22.1%) and 21 (22.5%) among the received urine, blood, respiratory and exudate samples, respectively. MDR Pseudomonas aeruginosa rates increased from 2021 to 2023, reaching 68 (43.6%). Colistin susceptibility rates were relatively better, with 371 (84.3%) in adults and 70 (90.9%) in the paediatric population. Colistin susceptibility ranged from 38 (79%) to 83 (93%) across samples. A discrepancy of 76 (14.7%) was observed between the CBDE and automated methods for detecting colistin resistance. Conclusion: This study highlights the increase in MDR Pseudomonas aeruginosa, with higher resistant rates observed among paediatric population. While colistin remains effective, its resistance requires ongoing monitoring, necessitating the need for alternative strategies, enhanced infection control measures and antimicrobial stewardship to effectively combat the growing threat of AMR in Pseudomonas aeruginosa.

Comparative Analysis of Conventional and Rapid Antimicrobial Susceptibility Testing in Patients with Gram-negative Bacteraemia Directly from Blood Culture in a Tertiary Care Hospital: A Cross-sectional Study

S Shanmugapriya, S Alagammai, B Appalaraju

Introduction: Early administration of appropriate antimicrobial therapy in Gram-negative bacteraemia would influence the patient’s prognosis. Conventional Antibiotic Susceptibility Testing (AST)- disk diffusion and VITEK-2 rely on bacterial isolates obtained from subculturing positive blood cultures. Direct AST done from positive blood culture fluid would reduce subculturing time. Aim: To compare rapid AST directly from the positive blood culture with the conventional method of performing in isolated colonies obtained from positive blood cultures. Materials and Methods: The present cross-sectional study was done on 350 blood culture samples received at the diagnostic Microbiological laboratory of PSG hospital, Coimbatore, Tamil Nadu, India from August 2024 to October 2024. Consecutive positive blood cultures received during the study period showing monomicrobial (gram negative bacilli identified by doing gram stain of culture fluid) was included in the study. Blood culture samples were subjected simultaneously to susceptibility testing by Direct Sensitivity Test (DST) by Kirby bauer disk diffusion method (CLSI recommended) and Antibiotic Sensitivity Test (AST) by Vitek-2 Compact which is an automated (BioMerieux) reference method from positive blood cultures flagged by BacT/ALER3D System. AST was done directly from the positive blood culture fluids and on sub cultures by disc diffusion and VITEK 2 method. Data analysed using Statistical Package for Social Sciences (SPSS) v.28.0 and p-value less than 0.05 was considered statistically significant. Results: Antibiotic susceptibility test results of Klebsiella pneumoniae and E.Coli between direct and conventional disc diffusion method showed complete agreement in 98% of the samples in total. More than 95% samples showed complete agreement for all the antibiotics. On comparison between direct and conventional VITEK 2 method, 99% of the samples showed complete agreement between two tests in total. A 100% of samples showed complete agreement for the antibiotics like ceftazidime, ceftazidime+clavulanic acid, cefoxitin, cotrimoxazole, meropenem, ertapenem, piperacillin-tazobactam, cefaperazone-sulbactam, colistin. 91.25 and 90.7% samples showed complete agreement for amikacin and Ciprofloxacin. Conclusion: The therapeutic value of this approach is underlined by the excellent agreement rates obtained for antibiotics of critical importance. This may contribute to improved outcomes through earlier directed therapy.

Assessment of Processed Food Consumption and Eating Habits among Medical Students: A Cross-sectional Study

Introduction: The consumption of processed foods has emerged as a significant public health concern, particularly among medical students who represent future healthcare providers. The demanding nature of medical education often leads students to rely on convenient yet nutritionally inferior food options, potentially affecting both their personal health and their future ability to counsel patients effectively. Aim: To assess the consumption patterns of processed foods and eating habits among medical sciences students to identify factors influencing these patterns. Materials and Methods: A cross-sectional study was conducted among 536 medical students at Dr. D. Y. Patil School of Allied Health Sciences, Pimpri, Pune, Maharashtra, India, from September to November 2023, using a self-structured questionnaire. Data were collected on the frequency and types of processed foods consumed, eating habits, factors influencing food choices, and awareness of health risks. Chi-square tests and t-tests were used for statistical analysis, with p<0.05 considered statistically significant. Results: Among participants, 179 (33.4%) consumed processed foods several times a week, and 74 (13.8%) consumed them daily. Packaged snacks (319, 59.5%) and fast food (227, 42.4%) were the most commonly consumed items. Taste preference (310, 57.8%), convenience (231, 43.1%), and availability (217, 40.5%) were the primary drivers of consumption. Notably, 416 (77.6%) participants reported receiving education on the associated health risks through their academic curriculum, and 424 (79.1%) expressed concern about these risks; however, a significant knowledge-behavior gap was observed. Encouragingly, 295 (55.0%) consumed breakfast daily, and 379 (70.7%) ate home-cooked meals regularly. Conclusion: This study reveals the high prevalence of processed food consumption among medical students, despite their awareness of its health risks. The findings highlight the importance of targeted interventions at the medical school level, including improved nutrition education within the curriculum, institutional efforts to provide healthier food choices, and initiatives that encourage time management strategies to promote better eating habits among future healthcare providers.

Exploring Short-term Outcomes of Dry Needling in Knee Osteoarthritis Patients: A Prospective Study

Kavitha Rani Nagendra, Arun Heddur Shanthappa, SJ Karthik, Prabhu Ethiraj

Introduction: Osteoarthritis (OA) of the knee is one of the most encountered musculoskeletal and rheumatologic diseases in the Outpatient Department of Orthopaedics. Around 250 million people worldwide suffer from OA knee. There is evidence that physiotherapy has been shown to be highly effective in treating OA knee. Dry Needling (DN) uses a similar needle to those used in acupuncture, but the application of the technique is different. In regard to DN, within the muscle, the needle is moved up and down exactly at the myofascial trigger points. Aim: To assess the short-term efficacy of DN in patients with knee OA. Materials and Methods: The present prospective study was conducted in the department of Physiotherapy attached to RL Jalappa Hospital and Research Centre in Kolar, Karnataka, India for a duration of six months from December 2022 to May 2023. This study included 40 patients who met the specified inclusion criteria and were closely monitored over a span of three and a half weeks, with an intervention of CZ Hong’s Fast in and Fast out needling technique subsequent to the identification of trigger points in the affected limb. At the end of three and a half weeks, the collected data on quantitative measure for Visual Analog Scale (VAS), Knee Range of Motion (ROM), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) was tested for normality conditions, and mean±SD was used to present the data. The difference in pre and post mean were tested by paired t-test, p-value <0.05 was considered as statistically significant. Results: At the end of 10 sessions of DN, there was a significant reduction in the Pain Pressure Threshold (PPT) (p-value=0.001), VAS score, (p-value=0.001), increase in Knee ROM, (p-value=0.001) and reduction in the disability scores of WOMAC (p-value=0.001) and KOOS scores (p-value=0.001). Conclusion: The findings of the present study suggested that the PPT, WOMAC score and knee flexion range showed clinically relevant improvement for patients who underwent DN for 10 sessions added to therapeutic exercise program for older adults. However, these results should be interpreted with caution because of the small sample size and short follow-up.

Latest Trends and Modern Technology in the Diagnostics of Antimicrobial Resistance: A Scoping Review

Introduction: Antimicrobial Resistance (AMR) is emerging as a global threat, claiming millions of lives due to therapeutic failures. For a long time, the detection of AMR has been confined to conventional culture methods, which are tedious and resource-demanding. This results in delays, inaccuracies, or misdiagnoses, worsening the burden of AMR worldwide. Thus, the need of the hour is for rapid, feasible and accurate diagnostic methods that use novel technologies for the precise detection of resistant strains and degrees of resistance among different microbes. This will aid healthcare providers in combating this hidden pandemic. Aim: To extensively analyse and report on the evidence and gaps in the current trends in diagnosing AMR. Materials and Methods: The present scoping review obtained information on newer diagnostic approaches for AMR by reviewing 491 articles retrieved from scientific databases like Google Scholar and PubMed. Based on the eligibility criteria for this review, 13 scientific research articles were included. The filtration process involved three levels: title screening, abstract screening and full-text screening. The articles selected after full-text screening were independently analysed by the authors and the collected data were scrutinised by other authors of this study. The extracted data were categorised and represented using tables, charts, figures and graphs. The entire manuscript was written in adherence to the reporting guidelines of the PRISMA-2020 extension for scoping reviews. Results: The selection process yielded 13 articles that met the eligibility criteria. The predominant method for diagnosing AMR is the Polymerase Chain Reaction (PCR) technique. Most diagnoses were conducted using samples from urinary tract infections and sexually transmitted infections. Automated amplification tools have proven to diagnose AMR rapidly and cost-effectively compared to conventional culture methods. Conclusion: Given the rapidly spreading AMR, newer, faster and more accurate modes of diagnosis should be developed to combat this hidden pandemic. Compared to traditional culture methods, genome amplification and Point-Of-Care (POC) techniques have proven to be beneficial and superior. Therefore, measures should be taken to advance these molecular techniques to broaden the scope of newer AMR diagnostics.

Comparison of Auditory Brainstem Evoked Responses between Migraine Patients and Healthy Controls: A Cross-sectional Study

Daniya Khalid, Jyotsna Shukla, Abhishek Saini, Rajni Fulwariya

Introduction: Migraine is a complex neurological disorder associated with noise hypersensitivity most evident during attacks (ictal), however persistent during the post-attack (interictal) period as well. Previous studies on cortical auditory potentials have established abnormal sensory processing during the interictal phase but findings related to subcortical (brainstem) involvement remain inconclusive. Aim: To compare Wave I and Wave V amplitude of Auditory Brainstem Evoked Responses (ABER) between migraineurs during the interictal phase and healthy controls at 40-, 50-, and 60-dB above Sensation Level (SL) for both ears. Materials and Methods: The present study was a cross-sectional study conducted at the Department of Physiology, SMS Medical College, Jaipur, Rajasthan, India. Thirty-five diagnosed migraine patients during the interictal phase from the Neurology Outpatient Department (OPD) and 35 age and gender-matched healthy controls were enrolled. The Wave I and V amplitude (μV) were measured, at 40-, 50-, and 60-dB above SL bilaterally, in both groups. Statistical Package for Social Sciences (SPSS) software version 25 was used to analyse the results and an unpaired student’s t-test was employed for comparison in a side-specific manner. The significance level was assigned at a p-value <0.05. Results: The amplitudes of Wave V at 50-db SL (p-value: left ear=0.03, right ear=0.01) and 60-dB SL (p-value: left ear=0.005, right ear=0.013) were significantly higher among migraineurs during interictal phase than their matched controls. The amplitude difference for Wave I was statistically insignificant between the two groups at all recording intensities. At 40 dB SL, both Wave I (p-value: left ear=0.68, right ear=0.63) and Wave V (p-value: left ear=0.30, right ear=0.50) amplitudes did not exhibit any significant difference in results between migraine patients and healthy controls. Conclusion: The subcortical auditory dysfunction is significant for brainstem nuclei beyond the cochlear nucleus (peripheral auditory neurons) at higher intensities, indicating a more noticeable central processing disorder. This could eventually lead to irreversible auditory pathway damage, ABER can be utilised as a tool for early detection and localisation of the insult, providing an opportunity for early intervention and use of prophylactic measures.

Fracture Resistance of Endodontically Treated Premolar Teeth Restored with Glass Ionomer Cement, Glass Ionomer Cement with Fibres and Nanoceramic Composite Restorative Material: An In-vitro Study

Introduction: Restoring endodontically treated maxillary premolars is challenging due to their weakened state from caries, trauma, and the endodontic access itself, making them prone to fracture. Long-term success hinges on their ability to withstand biting forces. The core build-up, replacing lost tooth structure, is crucial. The restorative materials chosen for both the core and final crown significantly influence the tooth’s overall fracture resistance, as their mechanical properties dictate stress response. Aim: To evaluate the fracture resistance of endodontically treated premolar teeth restored with Glass Ionomer Cement (GIC), GIC with fibres and nanoceramic composite restorative material. Materials and Methods: The present in-vitro study included eighty maxillary premolar teeth which were extracted due to orthodontic purpose were collected and divided into four groups with 20 teeth in each group. Group I was noted as negative control with no preparation. Groups II, III and IV were restored with GIC, GIC with fibres and with nanoceramic composite, respectively. After restoration, the samples were subjected to evaluation of fracture resistance by using universal testing machine and values were subjected to statistical analysis. Results: The highest fracture resistance of 913.858 N (newtons) was noted for nanoceramic composite. There was no statistically significant difference observed between Groups III and IV (p=0.9870); however, both groups exhibited higher fracture resistance compared to Group II. Conclusion: The fracture resistance with fibre reinforcement was higher than conventional CIC and similar to that of nanoceramic composite.

Dexamethasone versus Clonidine as Adjuvants to Ropivacaine in Popliteal Sciatic Nerve Blocks for Postoperative Analgesia in Foot and Ankle Surgeries: A Randomised Clinical Study

Sheetal Jayakar, Grace Mammen

Introduction: Effective postoperative pain management is crucial in foot and ankle surgeries to enhance patient comfort and recovery. Popliteal Sciatic Nerve Blocks (PSNBs) are particularly useful in this context, as they provide site-specific, long-lasting analgesia with minimal systemic side effects, offer motor-sparing benefits, and facilitate early postoperative mobilisation. When combined with adjuvants like dexamethasone or clonidine, they may significantly improve the quality and duration of pain relief. Aim: To compare the analgesic efficacy, sensory and motor blockade, haemodynamic variability, and patient satisfaction when dexamethasone and clonidine are used as adjuvants to ropivacaine in PSNBs for patients undergoing foot and ankle surgeries. Materials and Methods: A prospective, randomised, double-blind trial was conducted in the Department of Anaesthesiology, Dr. D. Y. Patil Medical College and Research Centre, Pimpri, Maharashtra, India from March 2024 to March 2025 on 50 American Society of Anaesthesiologists (ASA) I and II patients aged 18-75 years undergoing elective foot and ankle surgery. Using a computer-generated randomisation sequence, patients were randomly assigned to two equal groups (n=25 each). Group RD received 28 mL of 0.5% ropivacaine with 2 mL (8 mg) dexamethasone, while Group RC received 28 mL of 0.5% ropivacaine with 2 mL (100 μg) clonidine. All blocks were administered under ultrasound guidance via the lateral approach. The primary outcome was the duration of analgesia, while secondary outcomes included Visual Analogue Scale (VAS) scores, durations of sensory and motor blocks, haemodynamic variability, and patient satisfaction. Statistical analysis was performed using independent t-tests and Chi-square tests, with p<0.05 considered significant. Results: Group RD demonstrated significantly prolonged analgesia (24.24±2.18 hours) compared to Group RC (18.00±2.45 hours, p<0.001). VAS scores were significantly lower in Group RD after 12 hours postoperatively (2.08±0.49 vs 3.36±0.49, p<0.001). The duration of the sensory block was 21.80±2.94 hours in Group RD versus 14.16±2.94 hours in Group RC (p<0.001), and the motor block duration was 21.36±4.48 hours versus 18.96±4.48 hours, respectively (p=0.03). Haemodynamic variability was comparable across groups, with no adverse effects, and patient satisfaction was higher in the dexamethasone group, though this was not statistically significant. Conclusion: Dexamethasone, when used as an adjuvant to ropivacaine in PSNBs, provides superior and longer-lasting analgesia, extended block duration, and better pain control compared to clonidine, with excellent safety and tolerability.

Association between Body Mass Index, Age at Menarche with Skeletal Maturity Indicators using Hand Wrist Radiograph in Bengali Female Population: A Cross-sectional Study

Introduction: Estimation and use of craniofacial growth is crucial in addressing skeletal discrepancies for orthodontic correction of young and growing children. It is crucial to determine each patient’s skeletal age and compare it to their dental and chronological ages before diagnosing a proper treatment plan. An essential biological indicator for determining a female’s physiologic maturity is her age at puberty. Menarche and hand wrist skeletal maturation can be used to determine the beginning and conclusion of the pubertal growth spurt. Aim: To find association between Body Mass Index (BMI), age at menarche with hand-wrist radiograph in Bengali female population. Materials and Methods: The present cross-sectional study was conducted at Department of Orthodontics and Dentofacial Orthopaedics in collaboration with the Department of Pedodontics, Guru Nanak Institute of Dental Sciences and Research, Kolkata, India from March 2022 to January 2024. Hundred subjects were evaluated in the age range of 9-15 years. Subjects’ menarcheal age, BMI and Skeletal Maturity Indicators (SMI) using hand wrist X-ray were assessed and tabulated. Statistical analysis was done to find association between these three parameters. (GraphPad Prism Software version 9.5, La-Jolla, California) was used for analysis. Parametric tests, One-way Analysis of Variance (ANOVA), Post-hoc Tukey’s and Chi-square (χ2) test were used for inferential statistics. Results: The mean menarche age of subjects were 12.2±1.2 years. It was observed that obese girls had the onset of menarche at an early stage (10.06±0.35 years), followed by overweight girls (11.15±0.72 years), normal weight girls (12.73±0.68 years), and then underweight girls who had their menarche at 14.2±0.14 years; p<0.001*. Higher skeletal maturity (stage VII, VIII), 40%, 42.5%, respectively was achieved only at higher age groups and was dependent on the age at menarche (p<0.001**). BMI showed an inverse association to skeletal maturity. Subjects with healthy BMI (healthy) showed good skeletal maturation rate. Conclusion: Obese girls experienced menstruation earlier as compared to healthy and underweight girls. Data indicated that menarche and BMI percentile were inversely associated. Significant statistical relation was seen in between the BMI percentile and the SMI and between peak pubertal growth assessed by hand-wrist X-ray as SMI and the menarche onset.

Nootropic Activity of Methanolic Extract of Evolvulus alsinoides Linn. Whole Plant in Mice with Sodium Nitrite Induced Amnesia: An Experimental Study

Karnam Nithya, Naiyma Choudhary, Rajesh Kumar Manchi, S Rajaram, BSR Sangeeta

Introduction: Many ancient medical systems, including Ayurveda and Unani, have utilised plants as therapeutic agents for ages. Both structured and unstructured types of medicinal plants have been used extensively to treat a variety of illnesses, including cognitive impairment. One plant identified as having the ability to cure neurological conditions and enhance cognitive function is Evolvulus alsinoides Linn, also referred to as Vishnukranthi. Aim: To evaluate the effect of Evolvulus alsinoides methanolic extract in treating sodium nitrite-induced amnesia in male Swiss albino mice through behavioural, biochemical and histological parameters. Materials and Methods: This experimental study was conducted at ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Velappanchavadi, Chennai, Tamil Nadu, India. Healthy male Swiss albino mice weighing between 25 and 30 g were used as subjects. The experiment was designed to evaluate the potential cognitive-enhancing effects of Evolvulus alsinoides through two behavioral tests: the Elevated Plus Maze (EPM) test and the passive avoidance test. The EPM test is commonly employed to assess anxiety and memory by measuring the time animals spend in the open arms versus the closed arms of the maze. It also evaluates the total transitions made by the animals between the arms, providing insights into their exploratory and memory behaviour. Results: A notable difference was observed between the sodium nitrite-treated group (GSN) and the sodium nitrite-treated with piracetam group (GSNP), where the piracetam-treated mice (GSNP) exhibited a significant reduction (p-value=0.0001) in the number of transitions. The Evolvulus alsinoides-treated groups (GSNLD and GSNHD) showed a significant reduction in the number of transitions when compared to the GSN group. In the passive avoidance test, the comparison between GSN and groups GSNLD and GSNHD (treated with Evolvulus alsinoides) showed a statistically significant improvement in step-down latency in the treated groups. Biochemical parameters of brains indicated reduced GSH and AChE levels, which were considered supportive evidence for the behavioural parameters. Conclusion: These findings suggest that Evolvulus alsinoides may be a promising agent for the development of new treatments for memory impairment and cognitive disorders.

Plasminogen Activator Inhibitor-1 Levels in Heart Failure Patients: A Cross-sectional Study

Amrit Pal Kaur, Jaskiran Kaur, Gurinder Mohan, Sahiba Kukreja

Introduction: Heart Failure (HF) is a worldwide health concern and a major cause of morbidity and mortality globally. Among the numerous biomarkers associated with HF, Plasminogen Activator Inhibitor-1 (PAI-1) has received attention for its role in poor fibrinolysis and thrombosis. Aim: This study aimed to compare serum PAI-1 levels in patients diagnosed with HF to those of healthy participants. Materials and Methods: This cross-sectional study was conducted in the Department of Biochemistry, in collaboration with the Department of Medicine at Sri Guru Ram Das Hospital, Amritsar, Punjab, India. The study comprised 50 individuals with confirmed HF from the inpatient department of the Medicine Department and 50 healthy individuals of comparable age, conducted from October 2019 to December 2023. Serum levels of PAI-1, N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), Brain Natriuretic Peptide (BNP), creatinine, and Urine Albumin-to-Creatinine Ratio (UACR) were investigated and compared. The data were statistically analysed and presented as mean and Standard Deviation (SD). Odds ratio and Student’s t-test were performed. Results: The study included 100 participants, with a mean age of 62.3±10.4 years, comprising 68% males and 32% females, ensuring age and gender representation across both HF patients and healthy controls. The mean±SD of serum PAI-1 was 10.09±1.68 ng/mL in healthy individuals and 35.16±11.14 ng/mL in HF patients, indicating that PAI-1 could be a valuable indicator for diagnosing HF. A comparison with healthy controls showed significantly higher levels of PAI-1 (p<0.001) in HF patients. PAI-1 had a significantly high Odds Ratio (OR) (585.8, 95% CI: 32.5-10554.5), showing a strong association. Furthermore, as the condition became more severe, the levels of these biomarkers increased significantly. Conclusion: Serum levels of PAI-1 are significantly associated with HF, indicating that they could be used for the identification of HF. Further studies are required to validate these findings and evaluate the clinical benefit of targeting PAI-1 in HF management.

Burden of Chronic Kidney Disease: A Cross-sectional Study Assessing Socio-demographic Correlates and Co-morbid Conditions in Chengalpattu District, Tamil Nadu, India

Vaishnavi Nagarajan, Aamina Hussain, VV Anantharaman

Introduction: The global prevalence of Chronic Kidney Disease (CKD) is approximately 10-15%, with India experiencing an increasing burden due to lifestyle changes, diabetes, hypertension and environmental factors. Despite the high prevalence, region-specific epidemiological data remain scarce. Understanding the occurrence and contributing factors of CKD in Chengalpattu district is crucial for developing effective prevention and management strategies. Aim: To estimate the prevalence of CKD in Chengalpattu district. To identify the socio-demographic determinants and co-morbid conditions associated with CKD. Materials and Methods: A community-based cross-sectional study was conducted in Chengalpattu district from June 2024 to December 2024. A multistage sampling technique was used to select 420 adults. Adults who gave consent and were over 18 years old were chosen according to the Screening for Occult Renal Disease (SCORED) criteria. The study tool included socio-demographic details and the SCORED questionnaire. The Modification of Diet in Renal Disease (MDRD) equation was utilised to measure the estimated Glomerular Filtration Rate (eGFR). Data entry and analysis were performed using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 26.0, respectively. The Chi-square test was used to identify associations between selected variables, with a p-value <0.05 considered statistically significant. Results: The study revealed that the overall prevalence of CKD was 55.5% (206 participants). Out of 420 participants, 371 were tested for eGFR, among whom the majority were in CKD stage 2 {177 (47.7%)}. A smaller proportion was diagnosed with stage 3a {22 (5.9%)}, stage 3b {2 (0.5%)}, stage 4 {4 (1.1%)} and stage 5 {1 (0.3%)}. The majority of participants were aged over 50 years {245 (58.3%)}, with a higher proportion of females {286 (68.1%)} and unemployed individuals {140 (33.3%)}. Proteinuria was found to be a strong and significant predictor of CKD, with an adjusted odds ratio of 11.55 (5.61-26.12). Age over 50 years showed a borderline significant effect on CKD {p-value=0.054, OR=3.71 (0.98-14.01)}. Conclusion: The study findings indicate that CKD is a significant public health issue in the region, with a substantial proportion of the population exhibiting risk factors such as advanced age, male gender, a history of co-morbidities and proteinuria. This underscores the urgent need for early screening, lifestyle modifications and improved access to nephrology care.

Audiological Profile of Heavy Vehicle Drivers: A Cross-sectional Study from Southern India

Introduction: Noise-Induced Hearing Loss (NIHL), a permanent sensorineural hearing loss that usually develops undetected until it becomes functionally significant, can result from ongoing exposure over time. Aim: To ascertain the prevalence of hearing loss and the audiological profile among heavy vehicle drivers in South India. Materials and Methods: A cross-sectional study was conducted at the Department of ENT, Chettinad Hospital and Research Institute (a tertiary care centre), Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India, from September 2024 to February 2025 among 90 participants. The study population consisted of heavy vehicle drivers (e.g., truck, bus, or lorry drivers) aged 18 to 60 years with a minimum of five years of occupational exposure, attending the Ear, Nose and Throat (ENT) Outpatient Department (OPD). Demographic details, local examinations and pure tone audiometry were conducted for all eligible participants and the findings were documented. A paired t-test was applied to find the difference in hearing loss between the left and right ears. A p-value of <0.05 was considered statistically significant. Results: The overall percentage of hearing loss among the 90 drivers was 26 (28.9%) in their better ear (right ear) and 30 (33.3%) in their left ear. However, at higher frequencies (3000 Hz to 8000 Hz), the mean hearing loss was consistently greater in the left ear compared to the right ear. The differences were statistically significant at 3000 Hz, left ear (30.5 dB) vs. right ear (28.9 dB) (p=0.041); at 4000 Hz, left ear (37.8 dB) vs. right ear (35.2 dB) (p=0.028); at 6000 Hz, left ear (45.1 dB) vs. right ear (42.7 dB) (p=0.015); and at 8000 Hz, left ear (43.9 dB) vs. right ear (40.6 dB) (p=0.008). Conclusion: There is a significant increase in hearing loss in the left ear compared to the right ear at higher frequencies (≥3000 Hz), indicating that high-frequency hearing may be more affected in the left ear among the study population.

Comparison of Platelet Rich Plasma Therapy, Granulocyte Colony Stimulating Factor, and Estradiol Valerate on Endometrial Thickness in Patients with Infertility: A Prospective Interventional Study

Roopal Khare, Madhulika Shukla, Saurabh Shukla

Introduction: According to World Health Organisation (WHO) infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”. Aim: To compare the effect of Platelet Rich Plasma (PRP) therapy, Granulocyte Colony Stimulating Factor (GCSF) and estradiol valerate on endometrial thickness in infertile patient with thin endometrium. Materials and Methods: The present prospective interventional, single-blind study was conducted on patients attending the outpatient clinics with complaints of infertility in the Department of Obstetrics and Gynaecology, GSVM Medical College, Kanpur, India, from January 2019 to September 2020. A total of 75 patients attending the outpatient clinics with infertility were included. The patients were divided randomly into three groups of 25 each. Patients in the group 1 were given PRP 0.1 mL infusion following ovulation induction with letrozole. Patients in group 2 were given GCSF infusion following ovulation induction with letrozole and patients in group 3 were given estradiol valerate following ovulation induction with letrozole. They were then instructed to come on day 13 when Transvaginal Scan (TVS) was done to assess the thickness and character of endometrium. Kruskal Wallis Test and paired t-test were used. Results: Mean age of the patients was 28.1±4.36 years. The change (increase) in endometrial thickness is significant in the PRP group compared to the GCSF group and highly significant compared to the estradiol valerate group (4.19±2.06 vs 2.78±1.72 vs 1.94±1.69). However, the increase in endometrial thickness is comparable among GCSF and EV groups. The pregnancy rate was higher in PRP compared to GCSF and EV (32% vs 8% vs 20%). Conclusion: It was found that the local administration of PRP is significantly effective in increasing endometrial thickness thus improving the possibility of pregnancy in patient with refractory endometrial thickness (<6 mm).

Evolving Antimicrobial Susceptibility Patterns in Salmonella spp. Isolated from Blood Specimens, Over 10 Years: A Retrospective Observational Analysis

Introduction: Species of Salmonella, particularly Salmonella Typhi and Salmonella Paratyphi, remain a significant cause of Bloodstream Infections (BSIs) in developing countries, complicated further by rising antimicrobial resistance. These infections contribute substantially to morbidity, mortality and the public health burden, especially in regions with poor sanitation and limited access to healthcare. The emergence of Multidrug-Resistant (MDR) Salmonella strains has rendered many first-line antibiotics less effective, complicating treatment strategies. Aim: To assess the prevalence of Salmonella spp. and the antimicrobial patterns of Salmonella isolates over a ten-year period (2014–2024) at a tertiary care hospital in Tamil Nadu, India. Materials and Methods: This was a retrospective observational study conducted at Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu, India. Blood culture records from January 2014 to December 2024 were reviewed. All patients with confirmed Salmonella-positive blood cultures were included. Blood samples were processed using standard microbiological protocols, including conventional and automated (BACTEC) methods and antibiotic susceptibility was tested using the Kirby-Bauer disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Demographic details such as age and gender were documented. Data were compiled using Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 20.0; categorical data were expressed in percentages. Results: Among the 304 isolates, I#IS. I?ITyphi was the most frequently identified species (225, 74%), followed by Salmonella Paratyphi A (66 isolates, 21.7%), Salmonella Paratyphi B (7 isolates, 2.3%) and Salmonella Typhimurium (6 isolates, 2%). A male predominance (213, 70.1%) was observed and the greatest occurrence (162, 53.3%) was recorded in the 21-60 years of age group. Antibiotic sensitivity analysis revealed sustained susceptibility of all serotypes to ceftriaxone, tetracycline, chloramphenicol and cotrimoxazole. However, a predominant level of ciprofloxacin resistance was reported in I#IS. I?ITyphi and I#IS. I?IParatyphi A isolates. Year-wise data showed fluctuating resistance patterns, with a notable dip in ceftriaxone sensitivity in 2020 and variable trends in ampicillin and chloramphenicol resistance. Conclusion: Over the past decade, I#IS. I?ITyphi remained the predominant pathogen isolated from BSIs, particularly affecting adults. Although conventional antibiotics continue to be effective, alarming fluoroquinolone resistance trends underscore the need for routine antimicrobial surveillance and judicious antibiotic use. The findings reinforce the importance of empirical therapy guided by local susceptibility patterns and highlight the ongoing challenge of managing drug-resistant Salmonella infections in endemic regions.

Prevalence and Determinants of Acute Respiratory Infections among Under-five Children in Rural Health and Training Centre, Tamil Nadu, India: A Cross-sectional Study

Introduction: Acute Respiratory Infections (ARIs) are a leading cause of morbidity and mortality among children under-five, especially in low-resource settings. In India, the burden of ARIs is notably high in rural areas due to environmental and socioeconomic risk factors. Aim: To estimate the prevalence of ARIs and identify associated determinants among children under-five in a rural population. Materials and Methods: A cross-sectional study was conducted from November 2017 to October 2018 in the service area of the Rural Health and Training Centre (RHTC) in Thiruvallur district, Tamil Nadu, India, among 323 children under-five from nine randomly selected villages using multistage sampling. Data on ARI episodes and associated factors were collected using a pretested, semi-structured questionnaire administered in Tamil. Descriptive statistics and logistic regression were performed using Statistical Package for the Social Sciences (SPSS) v23, with significance set at p<0.05. Results: The prevalence of ARIs was 24.5% (n=79). Significant determinants included kutcha/semi-pucca housing (OR: 2.45, 95% CI: 1.4-4.2; p<0.001) and pet ownership (OR: 3.27, 95% CI: 1.78-6.0; p<0.001). Female children were at a higher risk of developing ARIs compared to males (OR: 1.90; p=0.049). Other factors, including overcrowding, socioeconomic status, and birth weight, showed no significant association. Conclusion: Poor housing and pet exposure significantly contribute to the prevalence of ARIs in rural children. Public health measures targeting these modifiable environmental factors are essential to reduce the disease burden.

Comparison of Core and Pelvic Floor Strengthening versus Yoga Poses for Primary Dysmenorrhea among Young Adult Females: A Comparative Experimental Study

Adeeba Ahsan, Pramod Kumar Sahu, Jyoti Sharma, Aksh Chahal, Mohammad Sidiq

Introduction: Dysmenorrhea is the most common gynecological condition in women of reproductive age. Primary Dysmenorrhea involves pain in the lower abdomen and pelvis, with potential radiation to the inner thighs and legs, occurring without identifiable pelvic pathology. Additional symptoms may include stress, nausea, vomiting, headaches, and fatigue, primarily due to excess prostaglandin hormone production. Aim: To compare the effects of physiotherapeutic pelvic floor and core strengthening exercises against yoga poses on primary dysmenorrhea in young adult females. Materials and Methods: This comparative experimental study was carried out at the Department of Physiotherapy, Galgotias University, Uttar Pradesh, India from September to December 2023. Total 60 female subjects between the ages 18-25 years with clinically diagnosed primary dysmenorrhea with regular menstrual cycles were included. Participants were randomised to two groups (n=30 in each group). Group A engaged in core and pelvic floor strengthening exercises, and Group B practiced some specific yoga postures. Both interventions were implemented three times per week over eight weeks. Pre and post intervention measurements were made using the WaLIDD scale (Working ability, Location, Intensity, Days of pain, Dysmenorrhea) and EQ-5D-5L questionnaire to gauge the effect of pain and quality of life. Demographic data such as age, Body Mass Index (BMI), and menstrual history were observed. Statistics were conducted with the help of Statistical Package for Social Sciences (SPSS) version 22 IBM USA, using paired and independent t-tests. The p-value <0.05 was deemed to be statistically significant. Results: The study results suggested a significant difference between the pre and post assessment of the WaLIDD and EQ-5D-5L scale in Group A (p<0.05) and similarly in Group B (p<0.05). But no significant difference was reported when group A and group B were compared. Conclusion: The study concluded that both the physiotherapeutic pelvic floor and core strengthening exercises and yoga poses are significantly efficient at easing the signs and symptoms of primary dysmenorrhea in young adult females. Physiotherapeutic pelvic floor and core strengthening and yoga pose both can be used as non-pharmacological treatment for primary dysmenorrhea without any side-effects.

Clinical Presentation and Short-term Outcomes of Endovascular Onyx Embolisation in Dural Arteriovenous Fistula: A Prospective Observational Study

Rahul Arkar, Rashmi Saraf

Introduction: Dural Arteriovenous Fistulas (dAVFs) are abnormal vascular channels formed between venous sinuses or cortical veins and dural arteries, with idiopathic or multi-factorial causations, varied clinical presentations, and complex radiological angio-architecture. However, intra-arterial embolisation is the preferred management. Aim: To study the clinical presentation and short-term outcomes of endovascular onyx embolisation for dAVFs. Materials and Methods: The present prospective observational study was conducted at a tertiary care centre in Maharashtra, India from September 2016 to August 2017. Adults presented to an Emergency department with the symptoms of headache, convulsions, vomiting, or stroke and subsequently underwent Digital Subtraction Angiography (DSA) were screened. Patients diagnosed with dAVFs and treated with endovascular embolisation under general anaesthesia via the transfemoral route using a liquid embolic agent (onyx) were studied. Clinical presentation and angio architecture of dAVF have been reported along with the post embolisation complications. Results: A total of 10 (8 males) patients were studied. Patients had an age range of 21-45 years. Convulsions 5 (50%) neurodeficit, and headache 4 (40%) each) were the most common presenting complaints. Left transverse sinus was the prominent dAVF location observed 4 (33.33%). A total of 12 arteries were embolised, (10 (83.33%) arteries showed no angiographic residue after a single session of embolisation, and 2 (16.67%) patients had minimal residue after two sessions of trans-arterial onyx embolisation). Conclusion: Endovascular onyx embolisation should be the treatment of choice for dAVFs. Onyx in appropriate concentration and a finely-honed technique achieves better cure rates.

Effects of Intravenous Magnesium Sulphate Administration on Postoperative Analgesia in Infraumbilical Surgeries under Spinal Anaesthesia: A Double Blinded Randomised Clinical Study

Shahbaz Hasnain, Subhashree Jena, Reem Khatib

Introduction: Inadequate management of postoperative pain can lead to complications like prolonged recovery time, ileus, nausea, urinary retention, and infection. Although spinal anaesthesia is highly effective in intraoperative pain relief, its effects wear off after surgery, with a tendency to produce opioid dependence. Magnesium sulphate, an NMDA receptor blocker, has the potential to augment spinal anaesthesia effects and postoperative analgesia. Aim: To determine whether intravenous magnesium sulphate infusion could improve postoperative pain management in patients who had undergone spinal anaesthesia for infraumbilical surgery. Materials and Methods: The present double-blind, randomised clinical trial including 60 American Society of Anaesthesiologists (ASA) I-II patients who had infraumbilical spinal anaesthesia was conducted at Dr. D. Y. Patil Medical College in Pune, Maharashtra, India. Patients were given 15 mg of 0.5% hyperbaric bupivacaine intrathecally, along with a random assignment to receive either intravenous magnesium sulphate (Group M) or normal saline (Group C). Statistical Package for Social Sciences (SPSS) v27 was used to assess and analyse postoperative pain {Visual Analogue Scale (VAS)}, haemodynamics, block characteristics, time to first analgesia, and side-effects. The data was collected, compiled and tabulated. Data entry was done in Microsoft Excel and tables and apt charts was formed. Quantitative data was analysed using unpaired student t-test and qualitative data was analysed using Chi-square test analysed by SPSS software 27. Results: Demographic characteristics and haemodynamic data were similar across groups. The mean age of the patients was 41.93±11.64 in Group M and 36±13.5 in Group C. VAS scores in Group M were lower from 45 minutes through to 16 hours postoperative compared with Group C. Analgesic duration was longer, and the time to the first rescue analgesia in Group M was longer than in Group C. The time to onset for sensory and motor block was identical, but blocks lasted significantly longer in Group M. Conclusion: Intravenous magnesium sulphate as an adjuvant to spinal anaesthesia safely extends postoperative analgesia, decreases pain severity, and postpones the need for rescue analgesia without inducing significant haemodynamic instability or side-effects. Therefore, magnesium sulphate is an effective and safe adjuvant for enhancing postoperative pain relief in infraumbilical operations.

Clinical and Radiographic Outcomes in Distal Radius Fractures using K-wires versus Fragment-specific Plates: A Prospective Interventional Study

Satyam Jawa, Vinod Nair

Introduction: Orthopaedic practice frequently deals with Distal Radius Fractures (DRFs); however, the treatment strategies for optimal functional outcomes remain uncertain. K-wiring (Kirschner Wire) is a minimally invasive technique preferred for simple fractures, whereas Fragment-Specific Plating (FSP) offers targeted fixation for complex fracture patterns. Aim: To compare the functional and radiological outcomes of DRFs managed with K-wiring versus FSP. Materials and Methods: The present prospective interventional study was performed in the Department of Orthopaedics of a tertiary care hospital at Pune, Maharashtra, India, over 24 months from January 2023 to December 2024. A total of 40 patients were randomly categorised: K-wire group (n=20) and Plate group (n=20). Functional outcome was assessed with the Mayo modified wrist score, while radiological outcomes included radial inclination, radial height, and volar tilt. The patients were followed-up at 3, 6, and 12 months. Results: At three and six months, significantly greater proportion of patients in the Plate group had higher range of motion (p=0.003 and 0.029, respectively), and total scores (p=0.017 and 0.039, respectively). Similarly, at 6 and 12 months, patients in the Plate group had higher grip strength scores (p=0.025 and 0.010, respectively). Moreover, at three and 12 months, patients in the plate group had higher satisfaction (p=0.003) and higher pain scores (p=0.028), respectively. Both the groups had comparable radial inclination at all the intervals (p>0.05) and volar tilt at three months (p=0.116). At three months, the mean radial height was significantly greater in the plate group (p=0.012). Furthermore, at six and 12 months, the plate group demonstrated significantly higher radial height (p=0.003 and <0.001, respectively) and volar tilt (both p<0.001) compared to the K-wire group. However, the K-wire group was associated with significantly reduced operative time and shorter duration of hospital stay (both p<0.001). Conclusion: Both K-wiring and FSP are effective surgical methods for managing DRFs. However, FSP provides significantly better functional and radiological outcomes, and should be preferred, particularly in patients with complex DRFs.

Effectiveness of Dynamic Taping Combined with Resistance Band Training on Dynamic Balance, Jumping Performance, Agility, Sprint Speed and Lower Limb Strength among Young Male Football Players: A Pilot Study

Mohd Asif, Mohammad Sidiq

Introduction: Football, a high-intensity sport, requires abilities such as dynamic balance, agility, jumping performance, sprint speed, and lower limb strength. These demands place repetitive stress on the hips, knees, and ankles of young individuals, making them susceptible to lower limb injuries such as hamstring strains, ankle sprains, Anterior Cruciate Ligament (ACL) tears, meniscus injuries, Patellofemoral Pain Syndrome (PFPS), and shin splints. Dynamic taping is an advanced intervention in sports physiotherapy that differs from classic kinesiology taping in its biomechanical properties and uses. Dynamic taping provides additional features, including multidirectional joint support, enhanced joint stability, and proprioceptive feedback, without limiting joint movement. Its unique elasticity allows for greater force absorption and enhanced neuromuscular control. The combination of dynamic taping with Resistance Band Training (RBT) may suggest a coactive strategy to improve athletic performance and reduce injury risk. However, the evidence to support this vital combination remains limited. Aim: To investigate the effectiveness of dynamic taping combined with RBT on key performance factors in young football athletes. Materials and Methods: This pilot study was conducted at the Growing Star Sports Club in Delhi, India, from December 2024 to January 2025 with a total sample size of 12 participants who were selected and allocated to either the experimental group, which engaged in dynamic taping combined with resistance band exercises, or the control group, which performed only resistance band exercises, using simple random sampling. Double blinding was used during assessments to minimise bias. Vertical jump, sprint speed, Y-balance test (YBT), t-test agility, and lower limb strength were evaluated before and after the 4-week intervention (3 sessions per week). The analysis was performed using descriptive statistics and paired-samples t-tests. Results: The baseline characteristics of participants in the control (n=6) and experimental (n=6) groups were comparable in terms of age (15.67±1.03 vs. 15.83±0.75 years) and Body Mass Index (BMI) (20.21±1.22 vs. 19.54±0.94). Post-intervention, the experimental group showed greater improvements in vertical jump, lower limb strength, agility, balance, and sprint speed, with significant effect sizes (Cohen’s d: vertical jump d=4.73, agility d=2.48). Strong correlations were found between improvements in lower limb strength (r=0.88) and balance (r=0.86) (p<0.05). Conclusion: The findings of the study suggest that dynamic taping combined with RBT can significantly enhance key athletic performance measures in football players.

Assessment of Salivary pH, Flow Rate, Buffering Capacity and Alpha-amylase Enzyme Activity in Caries-free and Caries-active Children: A Cross-sectional Study

Pallavi Nagappa Kuri, Umapathy Thimmegowda

Introduction: It is generally accepted that the caries process is largely controlled by a natural protective mechanism in saliva. The pH, flow, buffering, and remineralising capacity of saliva are recognised as critical factors that affect and regulate the progression and regression of the caries process. Salivary Alpha-Amylase (SAA) is an enzyme in saliva that has a high affinity for binding to oral streptococci and plays a role in carbohydrate digestion, potentially leading to enamel demineralisation. Aim: To estimate and associate the pH, flow rate, buffering capacity, and SAA levels in the saliva of children with and without caries. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatric and Preventive Dentistry at Rajarajeswari Dental College and Hospital in Bengaluru, Karnataka, India where 50 children were included. They were divided into two groups: Group A (Caries-active) and Group B (Caries-free), each consisting of 25 children. Unstimulated saliva samples were collected and analysed using a pH meter and Ultraviolet (UV) spectrophotometer, with parental consent and after obtaining ethical clearance. The Mann-Whitney Test was used to compare mean salivary amylase scores between the two groups. An Independent Student’s t-test was used to compare the mean initial pH values, buffering capacity values, and Salivary Flow Rate (SFR) between the two groups. Spearman’s correlation test was conducted, and the level of significance was set at p<0.05. Results: The mean age of the children in the caries-active group was 5.52±0.71 years, while in the caries-free group it was 5.40±0.76 years. Assessment and correlation were conducted between caries scores and all parameters in the study group. Salivary pH, flow rate, and buffering capacity showed a statistically significant negative correlation with caries activity (rho=-0.60, -0.53, -0.38), whereas alpha-amylase showed a statistically significant strong positive correlation with caries activity and caries score. Comparison of the mean values of all parameters based on the number of caries (<6 and >6) showed statistically significant results at p<0.05. Conclusion: Based on the results, it can be concluded that SAA levels were increased in children with Early Childhood Caries (ECC), showing a significant positive correlation with caries activity.

Development of Gene-based Conventional PCR Assay for Diagnostic Application of Streptococcus pneumoniae Infections as an Alternative to Conventional Culture: A Cross-sectional Study

Jignishaben Sanjaykumar Patel, Jignaben Pranav Naik

Introduction: Streptococcus pneumoniae (S. pneumoniae), an opportunistic pathogen, is the primary cause of pneumonia and is classified as a high-priority bacterial pathogen. However, it is often underdiagnosed by conventional microbiological tests. The present study was conducted to develop a simple, rapid and reliable molecular method for the early and accurate diagnosis of S. pneumoniae using the Duplex Polymerase Chain Reaction (PCR) Assay. Among various genes responsible for the pathogenesis of pneumococci, the LytA gene and the CpsA gene were targeted for the molecular identification of S. pneumoniae. Aim: To evaluate the developed duplex PCR assay alongside the microbial culture of the S. pneumoniae pathogen. Materials and Methods: This study was carried out at the microbiology department of Surat Municipal Institute of Medical Education and Research (SMIMER), Surat, Gujarat, India, from March 2020 to March 2022. A molecular method for the detection of S. pneumoniae present in various clinical samples by PCR was developed. The optimised Duplex PCR assay employs primers specific for the LytA and CpsA genes of S. pneumoniae. The method involves the extraction of bacterial genomic DNA, PCR amplification and agarose gel electrophoresis to analyse the amplification products. The performance of the newly developed Duplex PCR assay was evaluated and compared its results with previously described assays, such as monoplex PCR assays targeting a single gene and conventional microbiological tests. Different clinical samples (n=75) from patients with pneumonia-like symptoms were used for PCR analysis and culture. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the PCR assay were determined in comparison with the gold standard microbial culture test. The level of significance was assessed using Fisher’s exact test, with tests considered significant at a p-value <0.05. Results: The duplex PCR assay demonstrated the best performance in terms of sensitivity and specificity, with no misidentifications found among non-pneumococcal strains for the CpsA and LytA genes. The assay was capable of detecting 6 CFU/mL of S. pneumoniae American Type Culture Collection (ATCC)® 49619™. The specificity of the developed Duplex PCR assay was 100% for both LytA and CpsA-specific genes. In total, 20% (n=15/75) of different clinical samples yielded positive results using the culture method. S. pneumoniae was isolated from 7 (9.3%) of sputum samples, 4 (5.3%) of blood cultures, 3 (4%) of Cerebrospinal Fluid (CSF), and 1 (1.3%) of pleural fluid samples, respectively, by conventional microbiological culture methods. Using the S. pneumoniae-specific Duplex PCR assay, 23 (30.7%) of samples tested positive for S. pneumoniae, as these samples exhibited amplification for both the LytA and CpsA genes. Of these, S. pneumoniae was detected in 9 (12%) of Nasopharyngeal/Oropharyngeal (NP/OP) swabs, 6 (8%) of sputum samples, 4 (5.3%) of blood cultures, 3 (4%) of CSF samples, and 1 (1.3%) of pleural fluid samples, respectively. The sensitivity, specificity, PPV and NPV of PCR for detecting S. pneumoniae in comparison with the culture method were 100%, 96.7%, 88% and 100%, respectively. Conclusion: The developed and optimised S. pneumoniae-specific Duplex PCR assay targeting the CpsA and LytA genes, as described in this study, is a powerful strategy that resulted in no false identifications. This significantly increases the sensitivity and specificity of pneumococcal identification compared to standard microbial culture and monoplex PCR assays targeting only a single gene.

Efficacy between Ultrasound Therapy and Fluoroscopy-guided Intra-articular Steroid Injection in L3-L4 and L4-L5 Facet Arthropathy: An Interventional Cohort Study

Subhadeep Batabyal, Saumen Kumar De, Tanvir Ahmed, Rathindra Nath Haldar

Introduction: Lumbar facet joint or Zygapophyseal Joint (ZJ) arthropathy is one of the common causes of low back pain, particularly prevalent at the L3-L4 and L4-L5 levels. Evidence shows the efficacy of Ultrasound Therapy (UST) and intra-articular steroid injections in lumbar facet arthropathy, but there is a paucity of data regarding the comparative efficacy between the two. Aim: To compare the efficacy of fluoroscopy-guided corticosteroid and local anaesthetic injection in the facet joint with UST in cases of L3-L4 and L4-L5 facet arthropathy. Materials and Methods: An interventional cohort study was conducted in the Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India, for 18 months, from April 2017 to September 2018. Participants aged between 18 and 70 years with unilateral chronic low back pain due to L3-L4 and L4-L5 facet arthropathy of more than six months duration were included in the study. A total of 17 participants in Group 1 received fluoroscopy-guided corticosteroid and local anaesthetic injections, while Group 2 (also consisting of 17 participants) received UST. Demographic variables such as age and gender, as well as clinical parameters including Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and lumbar range of motion (flexion), were assessed. UST was delivered over the L3-L4 and L4-L5 regions in continuous mode using a frequency of 3.0 MHz at 0.5 W/cm2, covering an area of approximately 100 cm2 and lasting for 5-10 minutes per session over six continuous days. Comparisons between groups were made using Student’s unpaired t-test, while within-group comparisons were analysed using repeated measures Analysis of Variance (ANOVA) for continuous variables. Fisher’s-exact test was used for categorical variables. A two-tailed p-value of <0.05 was considered statistically significant. Results: The groups were comparable in terms of age and gender distribution. The average ages were 47.76±11.06 years for Group 1 (intra-articular injection) and 48.12±11.35 years for Group 2 (UST). In Group 2, there were statistically significant changes in VAS, ODI and lumbar flexion scores from baseline to two weeks, four weeks and 12 weeks, but not from four weeks to 12 weeks. In the intergroup comparison, a significant improvement in VAS was observed at 12 weeks of follow-up. There was a statistically significant difference in ODI at only 12 weeks (p-value <0.001) of follow-up. A statistically significant difference in lumbar flexion measurements was found at only six weeks of follow-up. Conclusion: Both treatments are efficacious for short-term pain relief (up to four weeks). However, intra-articular facet joint injection demonstrates greater efficacy for long-term pain relief (up to 12 weeks).

Mild Cognitive Impairment and Hand Dexterity in Individuals with Type 2 Diabetes Mellitus: A Cross-sectional Study

Spoorthi Uday Shetty, Jayesh Chandran, Yughdtheswari Muniandy

Introduction: Type 2 Diabetes Mellitus (T2DM) presents various complications, but Mild Cognitive Impairment (MCI) has recently gained considerable attention due to its potential progression to dementia. Hand dexterity is highlighted as crucial for cognitive tasks, suggesting that even minor cognitive impairments can impact daily activities. Despite this, there has been no exploration of the relationship between MCI and hand dexterity in individuals with T2DM. Aim: To determine the relationship between MCI and hand dexterity in people with T2DM. Materials and Methods: This cross-sectional study included 45 diabetic patients aged 40-60 years from Justice KS Hegde Charitable Hospital in Mangaluru, Karnataka, India. The study was conducted from May 2023 to March 2024. Participants were recruited based on specific inclusion criteria and screened using tools such as the Semmes Weinstein Monofilament and the Montreal Cognitive Assessment (MoCA). Subsequently, selected participants underwent the hand dexterity test using the Box and Block Test (BBT) and their performance values were recorded. The categorical variables were presented as frequency and percentage. The continuous variables were presented as mean±SD. Correlation was performed using Pearson’s correlation coefficient. Linear regression was conducted for significant correlations. A p-value <0.05 was considered statistically significant. Results: Individuals in the study scored lower than expected values on both right and left hand tasks compared to normative scores. Moderate positive correlations were found between BBT scores and MoCA scores for both right (r-value=0.469, p-value=0.001) and left (r-value=0.516, p-value <0.001) hand tasks with p-value <0.05. Conclusion: The study reveals a significant positive correlation between BBT and MoCA scores. This suggests that hand dexterity is closely linked to cognitive function, emphasising the importance of integrating manual dexterity assessments into cognitive evaluations, particularly in populations where both motor and cognitive abilities are clinically relevant.

Efficacy of Low-level Laser Therapy on Motor Recovery and Functional Independence among Individuals with Incomplete Spinal Cord Injury: A Randomised Controlled Trial

Divya Rathore, Jasobanta Sethi, Chitra Kataria

Introduction: Incomplete Spinal Cord Injury (ISCI) results in permanent neurological deficits, leading to challenges in self-care, respiration, sphincter management, motor function and overall functional ability. Despite advancements in the treatment of spinal cord injuries, many individuals still experience motor deficits and struggle with functional independence, significantly lowering their quality of life and limiting their capacity for independent living. Low-Level Laser Therapy (LLLT) has been shown to be effective in neuroprotection, including cell regeneration, Schwann cell activation, cell growth, reduction of spasticity and improvement of various functions. However, its effectiveness in enhancing these functional domains in individuals with incomplete spinal cord injuries remains underexplored. Aim: To assess the effectiveness of LLLT on motor recovery and functional independence among individuals with ISCI. Materials and Methods: This randomised controlled trial was conducted at the Indian Spinal Injury Centre in Vasant Kunj under Amity University Noida from January 2023 to November 2024. A total of 104 participants who had suffered ISCI between six months to one year prior to enrollment and were classified as grade C or D were recruited. The experimental group received LLLT, while the control group received placebo LLLT on nine points around the fractured vertebrae. Both groups underwent conventional therapy. Evaluations were performed at baseline and after four weeks of intervention using amplitude-based surface Electromyography (EMG) on the lower extremities to assess motor recovery and the Spinal Cord Independence Measure (SCIM) to evaluate improvements in self-care, respiratory function, sphincter management and mobility. The normality of the data was checked using the Kolmogorov-Smirnov test. Paired t-tests and Independent t-tests were conducted within and between the groups, respectively, using a p-value of ≤0.05. Results: Both groups showed improvement; however, the experimental group demonstrated better improvement in EMG scores in the majority of the muscles of the lower extremity compared to the control group, suggesting a positive impact on motor recovery. SCIM scores indicated significant improvement within the groups, but non significant differences were found between the groups regarding self-care, respiratory function, sphincter management and mobility. Conclusion: The study indicated that LLLT had a positive effect on motor recovery and functional independence. These findings may serve as an effective measure for both clinicians and the patient community.

Early Active Mobilisation Protocol following Six-strand Core Repair for Flexor Tendon Injury: A Prospective Observational Study

Nemichand, R Chandan Kumar, Prashant Bahirani, Itisha Agrawal, Sunil Sharma

Introduction: Flexor Tendon Injuries (FTIs) in Zones II-V pose significant functional challenges due to adhesion formation and loss of tendon gliding. Early Active Mobilisation (EAM) following six-strand core repair improves outcomes by enhancing tendon healing while minimising complications. Aim: To evaluate the efficacy of EAM after six-strand flexor tendon repair by assessing functional recovery, grip strength and complications. Materials and Methods: A prospective observational study was conducted over 18 months at Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India involving 38 patients (aged 18-60 years) with complete flexor tendon lacerations in Zones II-V. All patients underwent a six-strand modified Kessler repair and received postoperative immobilisation in a dorsal splint. EAM was initiated on postoperative day 2, following the Belfast and Sheffield Mobilisation Protocol. Functional outcomes were assessed at 6, 8 and 12 weeks using the Buck-Gramcko II criteria, grip strength was measured using a Jamar dynamometer and pain was evaluated using a Numeric Pain Rating Scale (NPRS). Descriptive statistics were presented as means/standard deviations and medians/Interquartile Ranges (IQRs) for continuous variables, as well as frequencies and percentages for categorical variables. Group comparisons for categorical variables were conducted using the Chi-square test. Results: The mean age of patients was 26±5.5 years for females and 32±9.9 years for males. The study population comprised 30 males (78.95%) and 8 females (21.05%), with an age range of 18-60 years. The majority of injuries occurred in Zone V, involving 22 patients (57.89%). At 12 weeks, 20 patients (52.63%) achieved excellent outcomes, 13 patients (34.21%) had good outcomes, 3 patients (7.90%) had fair outcomes and 2 patients (5.26%) had poor outcomes. Most patients, i.e., 32 (84.21%), resumed work at six weeks. Grip strength improved to over 56 kg in 84.21% of cases and pain scores progressively decreased. Complications were minimal, with 1 patient (2.63%) experiencing a wound infection and 1 patient (2.63%) with skin necrosis; there were no tendon ruptures. Conclusion: EAM following six-strand flexor tendon repair is a safe and effective approach that promotes optimal functional recovery, reduces adhesions and facilitates an early return to work.

Comparison of Clonidine versus Gabapentin as an Oral Premedication on Haemodynamic Response to Laryngoscopic and Tracheal Intubation in ENT Surgeries: A Double Blind, Randomised Clinical Study

Priya Kishnani, Devendra Joshi, Tejash H Sharma, Dinesh K Chauhan

Introduction: Laryngoscopy and tracheal intubation are recognised as potent stimuli which cause significant haemodynamic responses. Various pharmacological strategies have been employed to attenuate the haemodynamic responses associated with this, including opioids, beta-blockers, calcium channel blockers, and α-2 adrenergic agonists. Aim: The present study aimed to compare the efficacy of oral clonidine versus oral gabapentin in attenuating haemodynamic responses during laryngoscopy and endotracheal intubation. Materials and Methods: The present study was a double blinded, randomised clinical study and it was conducted at Dhiraj Hospital from April 2024 to April 2025. The study was approved by the Institutional Ethics Committee (SVIEC/ON/Medi/SRP/April/24/76) and registered with Clinical Trials Registry - India (CTRI/2024/10/075366). Sixty patients aged 18-60 years of American Society of Anaesthesiologist physical status I-II, posted for elective surgeries under general anaesthesia were randomised into two groups (n=30 each): Group Dg received oral gabapentin 800 mg and Group Dc received oral clonidine 0.2 mg, 30 minutes prior to induction. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) were noted at baseline, after medication, after induction, during intubation, and at 1, 3, 5, and 7 minutes post-intubation. Data were analysed using unpaired Student’s t-test for numerical variables and Chi-square test for categorical variables. Statistical significance was set at p<0.05. Results: Demographic profiles were comparable between groups. The mean age of patients was 39.97±9.92; 44.23±11.72 years (p=0.13), gender distribution showed 46.67%; 36.67% males (p=0.43), ASA I physical status 66.67%; 70% (p=0.78) in Group Dg and Group Dc, respectively. During intubation, HR was 91.83±6.84 bpm; 97.10±11.38 bpm, p=0.0338 in Group Dc and Group Dg, respectively. During intubation, 1, 3, 5 and 7 minutes post-intubation, SBP (143.20±7.30: 127.73±5.06, 137.40±7.22: 118.03±6.36, 131.33±5.93: 108.70±8.16, 127.80±6.65: 105.87±9.73, 123.73±6.33: 104.27±8.74, p<0.0001), DBP (105.23±6.04: 87.33±8.87, 102.23±5.30: 87.50±6.31, 98.77±5.26: 81.97±6.71, 94.83±5.76: 76.63±7.42, 91.33±6.21: 70.27±8.13) in Group Dc and Group Dg, respectively. Conclusion: Oral clonidine is better than oral gabapentin at reducing the HR and especially the blood pressure spikes that occur during laryngoscopy and endotracheal intubation for general anesthesia. This makes clonidine a potentially better choice for premedication, particularly for patients at higher risk of heart problems.

Influence of Ergonomic Breastfeeding on Risk of Developing Musculoskeletal Disorders on Lactating Mothers and Quality of Infant’s Latch: A Quasi-experimental Study

Introduction: Breastmilk is recognised as the best infant nutrition, but Exclusive Breastfeeding (EBF) rates remain as low as 63.7% in India and 48% worldwide. One barrier is the development of Musculoskeletal Disorders (MSDs) in postpartum mothers due to a lack of education on proper breastfeeding posture. These factors can impact the quality of the infant’s latch, resulting in early cessation of breastfeeding. Aim: This study aimed to assess the impact of ergonomic breastfeeding on the risk of developing MSD in lactating mothers and infant latch quality. Materials and Methods: The present quasi-experimental study was conducted in SDM Hospital, Dharwad, Karnataka, India, from August 2022 to January 2024, involving 70 participants. Postpartum mothers were evaluated to determine if they met the inclusion criteria. Baseline information was gathered, including the assessment of infant mouth attachment and effective suckling using the World Health Organisation (WHO) B-R-E-A-S-T feed observation form and Rapid Upper Limb Assessment (RULA). Mothers received ergonomic education on the advisable breastfeeding position during each session. On the discharge day, the mothers were reassessed. Statistical methods such as the Chi-square test, Wilcoxon matched pair test, and Mann-Whitney U test were used, with significance set at a p-value of <0.05. Results: Seventy lactating mothers participated, with a majority above 25 years 40 (57.14%) and multiparous 38 (54.3%). Cradle hold was the most preferred breastfeeding posture 56 (80%). Postintervention, significant improvements (73.23%) were noted in infant attachment and suckling scores (mean increase 5.47, p<0.0001) and maternal posture as per RULA scores for both right (2.41±1.47) and left side (2.54±1.39). No significant association was found with delivery type. Conclusion: Ergonomic breastfeeding education reduces MSD risk and promotes effective infant latch. This highlights the essential role of physiotherapists in promoting effective breastfeeding ergonomics and preventing musculoskeletal issues in postpartum mothers, irrespective of the type of delivery or parity.

Mandibular Flexure and its Impact on the Biomechanics of Implant-supported Prostheses: A Systematic Review

Mahima Agrawal, Anjali Borle, Surekha Godbole, Rushikesh Kalpande

Introduction: Mandibular flexure, a biomechanical phenomenon that occurs during functional mandibular movements, greatly influences the biomechanics of implant-supported prostheses. The rigid connection between implants and prosthetic frameworks affects stress distribution and may increase peri-implant bone stress, as well as impact the stability of the prostheses. Aim: To integrate the literature on the current research regarding the impact of mandibular flexure on the biomechanics of implant-supported prostheses. Materials and Methods: The present review assessed studies investigating mandibular flexure and its impact on implant-supported prostheses using the following keywords: “mandibular flexure,” “implant-supported prostheses,” “Finite Element Analysis (FEA),” “Cone Beam Computed Tomography (CBCT),” and “peri-implant bone loss.” Data were extracted from clinical, radiographic, in-vivo, and FEA studies. Outcomes included stress distribution, peri-implant bone loss, prosthetic failure, and material performance. A structured analysis was performed to identify patterns across variables such as framework design, implant placement, loading conditions, and biomechanical methods. Nine studies were included in the review. Results: Across the nine studies included in the review, mandibular flexure significantly impacted the distribution of stress around the implant, with magnitudes of stress ranging from 0.073 mm deformation in brachyfacial types to 300 N in specific loading scenarios. Segmented frameworks reduced stress by up to 20% compared to non segmented designs. Bone loss was most pronounced in distal implants, with rates exceeding 15% in high-stress regions. Material performance varied, with titanium and cobalt-chromium frameworks showing superior biomechanical stability compared to polymeric alternatives. Dynamic and oblique loading conditions caused higher stress concentrations than static loading. Conclusion: Mandibular flexure affected implant-supported prostheses by altering stress distribution and increasing bone loss around the implants, especially in distal areas. Framework segmentation and material optimisation proved to be effective in mitigating these effects. These results highlight the importance of individualised biomechanical solutions to improve the longevity of prostheses and clinical outcomes.

The Impact of Different tDCS Intensities on Higher Mental Function in the Elderly Population with Cognitive Impairment: A Pilot Study

Dhruv Bawa, Subhasish Chatterjee, Mousumi Saha

Introduction: Cognitive decline in the geriatric population significantly impacts higher mental functions, such as memory, executive skills, and decision-making, which are essential for daily life and mental well-being. Transcranial Direct Current Stimulation (tDCS), a non-invasive and low-risk neuromodulation technique, has demonstrated the potential in improving cognitive performance by modulating cortical excitability in the dorsolateral prefrontal cortex. Despite its growing use, the optimal tDCS intensity for enhancing higher mental functions in elderly individuals with cognitive impairment has not been established. Aim: To evaluate the effects of varying tDCS intensities on higher mental functions in the geriatric population with cognitive impairment. Materials and Methods: This pilot study recruited participants based on specific inclusion criteria. Subjects were randomised into four groups: Group 1 received 0.5 mA, Group 2 received 1 mA, Group 3 received 1.5 mA, and Group 4 received 2 mA of tDCS targeting the dorsolateral prefrontal cortex. Each session lasted 20 minutes and was conducted five days a week for six consecutive weeks. Cognitive performance was assessed using the Montreal Cognitive Assessment Scale (MoCA) before and after the intervention. Statistical analysis included the Shapiro-Wilk test for normality, with parametric or non-parametric tests applied based on data distribution. Results: The study observed a dose-dependent improvement in cognitive performance, with Groups 3 (1.5 mA) and 4 (2 mA) showing significant enhancements in MoCA scores compared to Groups 1 (0.5 mA) and 2 (1 mA). Statistical tests confirmed that higher intensities of tDCS resulted in greater improvements in higher mental functions. Conclusion: This pilot study highlights the effectiveness of higher tDCS intensities (1.5 and 2 mA) in improving higher mental functions in the geriatric population with cognitive impairment. These findings provide a foundation for optimising tDCS protocols in geriatric cognitive rehabilitation and call for further large-scale studies to confirm these results.

Role of Pilates Exercise on Athletic Performance of Badminton Player: A Literature Review

Tanbeer Hassan, Nitin Kumar Indora, Reshma Parihar

Badminton is a popular sport around the world, played both individually and in teams. Physical endurance, core strength, agility, balance, and coordination are required for powerful smashes and fast court movements. Badminton performance is determined by a number of factors, including physical, psychological, and sociological elements. Pilates combines the mind, body, and breath to strengthen the core and improve back agility. It is based on six core principles: centering, concentration, control, precision, flow, and breathing. The aim of this narrative review is to evaluate the role of Pilates exercise on athletic performance of badminton player. Published literature was reviewed using the PICO strategy, the Pub Med, Google Scholar, Cochrane, DOAJ, PEDro and MEDLINE databases for relevant research published from 2000 to 2024. The search terms such as “Pilates and physical fitness in badminton players”, “Impact of Pilates on agility, strength, and flexibility in badminton players”, “Mat-based Pilates for athletic performance in badminton”, “Pilates exercises " using Boolean operators AND, OR were used. The entire free full text original article, English language articles in explicitly explaining the role of Pilates exercise on athletic performance of badminton player were included, irrespective of the type of the study. Letter to editor comment, duplicate study, other language except English language were excluded. A total of articles were retrieved from different databases, out of which only 3 articles fulfilled the inclusion criteria and 347 articles were included in the exclusion criteria. A total of 110 participants were included and divided into two groups: the experimental and control groups included 55 participants each. The results showed that Pilates exercises helps in improving core muscle strength, lower limb strength, dynamic balance, agility, flexibility, and also benefit overall psychophysical development. This review concludes that Pilates exercises were effective in improving core muscle strength, balance, agility, flexibility and lower body strength. Coaches can include Pilates movements into badminton instruction to enhance core muscle strength, balance, and agility.

Correlation between Neck Mobility, Craniovertebral Angle, Body Mass Index and Hip Waist Ratio Across Genders: A Study Protocol

Viren, Gurjant Singh, Nidhi Sharma

Introduction: The Craniovertebral Angle (CVA), which measures neck posture and mobility, is crucial for evaluating musculoskeletal health. Despite the fact that changes in neck mobility and posture have been linked to factors such as Body Mass Index (BMI) and hip-to-waist ratio, particularly across genders, they have not been thoroughly determined. Need for this study: The findings are expected to identify postural and biomechanical variations, potentially aiding in the development of targeted interventions for improved musculoskeletal health across genders. Aim: This research aims to examine the variations in correlations between neck mobility, CVA, BMI and hip waist ratio across both genders. Materials and Methods: A cross-sectional study was conducted with a group of individuals recruited on basis of selection criteria. A goniometer will be used to measure neck mobility. Kinovea software will be used to evaluate CVA. The BMI and Hip waist ratio will be estimated using anthropometric measures.

Vision and Physiotherapy and the Role of Ocular Muscle Training in Myopia Management: A Case Report

Jayshankar Choudhary, Nidhi Sharma

Myopia is the most prevalent refractive error of the eye, where light from distant objects fails to focus directly on the retina but instead converges in front of it, leading to blurred vision. Myopia is frequently managed by wearing glasses, while severe myopia is often treated surgically in conventional medicine. However, some patients seek alternative treatments due to personal preferences or affordability. This case presents a 24-year-old male with high-grade myopia. Despite recommendations for medical intervention from an ophthalmologist based on investigations of signs, symptoms, visual acuity, pinhole test, diopter measurements, and spherical equivalent refraction, the patient opted for an integrative approach combining medicine, wearing spectacles, and physiotherapy. The physiotherapy treatment aimed to promote tissue strengthening, enhance vision, and provide therapeutic interventions, including fast blinking, tight eye squeezing, wide eye opening, upward movement, downward movement, medial movement, lateral movement, diagonal movement, rotational movement, focus exercises, and visual field exercises. Concurrently, physiotherapy focussed on strengthening the surrounding musculature, improving vision, and enhancing function. Over the treatment period, the patient experienced reduced eye pain, improved vision, and significant enhancement in function, enabling a return to daily activities without surgical intervention. This case underscores the efficacy and feasibility of an integrative approach to managing myopia, providing a holistic, non-surgical option for patients who are reluctant or unsuitable for conventional surgical interventions.

Reliability Testing and Validation of Profitmapneck Questionnaire in Hindi for Measuring Symptoms and Function Limitation in Neck Pain: A Study Protocol

Palak Dhadwal, Aditi Popli

Introduction: Neck pain is a prevalent issue globally, having a big influence on people's quality of life all around the world. Assessing neck pain might be difficult. An established tool for evaluating the symptoms and functional constraints of neck discomfort is the ProFitMap-neck questionnaire which is available in English, Turkish, Chinese, French. As most people in India uses Hindi language as a mode of communication, so it is of great need to establish a Hindi version of ProFitMp-neck questionnaire. Aim: The aim of the study is to translate and cross-cultural adaptation the ProFitMap-neck questionnaire into Hindi, and establish its reliability and validity for use among Hindi-speaking individuals with neck-related issues. Materials and Methods: Using Beaton's guidelines in the first stage of forward translation (N1 and N2), the two translators will translate an assessment questionnaire or questionnaire into the target language, which are advised as a fundamental guide for the translation process. To verify its originality, a common translation, N-12, will be synthesised and then will be backward translated. The N-12 draft will be sent to an expert panel for evaluation. Pretesting and final testing will be conducted using this questionnaire. Through cross-cultural adaptation, therapists can adjust cultural behaviours to meet the needs of their clients, improving their performance. Cross-cultural adaptation enhances validity and reliability by ensuring that majors are valid and applicable across cultural groups.

Impact of Vibrotherapy along with Resistance Training Exercises in Improving Balance and Proprioception in Patients with Knee Osteoarthritis: A Study Protocol

Dikshita Kabba, Kanu Goyal, Manu Goyal

Introduction: Knee Osteoarthritis (OA) is a degenerative joint condition characterised by cartilage degradation, synovial inflammation, bone sclerosis and osteophytes formation. These alterations can damage sensory receptors, particularly mechanoreceptors, resulting in decreased proprioception. Vibration therapy has shown promise in improving balance and proprioception in various populations, however, limited evidence exists on the effectiveness of vibrotherapy in addressing balance and proprioception deficits in patients with knee OA. Need for this study: The findings of this research will contribute valuable insights into the efficacy of local joint vibration therapy in managing the functional limitations associated with knee OA, reducing the risk of falls and ultimately improving the quality of life. Aim: To determine the impact of local joint vibration therapy in improving balance and proprioception in patients with knee OA. Materials and Methods: Study design is single blinded randomised controlled trial study. The sample size will be calculated after pilot testing. Participants recruited based on inclusion criteria will be randomly allocated into two groups, group 1 and group 2 through computer-based random allocation techniques. Group 1 will receive vibration therapy along with resistance training exercises and group 2 will receive sham vibration therapy along with resistance training exercises. Pre-test and post-test assessment will be done by Comprehensive Knee Osteoarthritis Index (CKOAI) and Sensamove.

Effect of Respiratory Muscle Proprioceptive Neuromuscular Facilitation on Respiratory Muscle Strength in Spinal Cord Injury Individuals

Mansi Negi, Shambhovi Mitra, Harpreet Singh

Introduction: Spinal Cord Injury (SCI) refers to damage to the spinal cord that results in impairments related to its function, along with some respiratory complications. Inspiratory Muscle Training (IMT) is the most commonly used technique to improve respiratory function in tetraplegia. Respiratory muscle Proprioceptive Neuromuscular Facilitation (PNF) entails the application of manual stimulation to specific regions of the chest wall. Aim: This study aims to examine the combined effect of PNF and IMT in tetraplegics. Materials and Methods: This study (CTRI/2024/10/075261) (INSTITUTIONAL ETHICS COMMITTEE -ISIC/RP/2024/020) involved 14 tetraplegic individuals (experimental group: n=7, control group: n=7). Baseline respiratory muscle strength was assessed, then participants were randomly assigned to receive either combined PNF and IMT (experimental group) or sham training (control group) for 4 sessions/week over 4 weeks. Post-intervention respiratory muscle strength was reassessed. The study was single-blinded, with an independent assessor for outcome measurement. Results: The groups showed significant changes in respiratory muscle strength post intervention. Conclusion: Combination of PNF and IMT may improve respiratory strength in SCI individuals.

Availability of Different Physiotherapy Treatment Strategies of Modified Constrained-induced Movement Therapy (mCIMT) in Patients with Hemiplegic Cerebral Palsy: A Systematic Review

Shamama Athar, Tanima Bhattacharyya, Rajnee Mishra

Introduction: Cerebral palsy is a group of disorders that affect the development of movement, balance, posture, and muscle tone. According to Charlotte Metz et al, it occurs in 2 out of 1000 live childbirths. Due to the unwillingness of children to be restrained in the method of application of Constrained-induced Movement Therapy (CIMT), mCIMT was developed. Studies suggest mCIMT is more effective than CIMT in improving motor function in hemiplegic cerebral palsy. Aim: The study aims to find a standard treatment protocol for mCIMT for treating hemiplegic cerebral palsy. Search engines like Google Scholar, Research Gate, Cochrane, SAGE Journals, and Academia, were electronically searched. An article was included if, the articles consisted of treating cerebral palsy children through mCIMT, or mCIMT combined with other treatments or comparative studies with bimanual therapy. Results: A total of studies accounted for the study, from which 9 studies were purely contingent on mCIMT, and 10 studies included comparative studies of bimanual therapy and mCIMT. Five articles had mCIMT as the treatment along with other conventional treatments. Nine studies were excluded as they did not meet the inclusion criteria. The studies included were mostly Randomised Controlled Trials (RCTs), pilot studies, multisite trials, systematic reviews, and meta-analyses. All 24 articles were read thoroughly to identify the particular time frame, length of the treatment, and specific tasks used by the therapists. They suggested that time varies from 1 to 3 hours a day of intensive treatment with up to 6 hours of constraint, 3 to 7 days a week, and a 2-10 weeks treatment period. The repetition of each activity may vary from 10 rep to 20 rep for 5 to 20 minutes. The tasks included catching and throwing a ball, using paint, clay, and manipulating sand. Puzzles, pegboards, card games, and functional activities are also included. Conclusion: In conclusion, the treatment protocol for mCIMT may vary in time, days, and weeks. More studies are needed for a specific time duration for a single activity.

A Comparative Study between Effectiveness of Motor Relearning Programme and Mirror Therapy on Upper Extremity Functions in Post-stroke Patients

SK Abdul Aziz, Tanima Bhattacharyya, Rajnee Mishra

Background: Stroke is a global health problem that is the second commonest cause of death and fourth leading cause of disability worldwide. Both motor relearning programme and mirror therapy helps to improve upper extremity functions in post stroke patients. The aim of the study is to compare the effectiveness of motor relearning programme against mirror therapy on upper extremity functions in post stroke patients. Materials and Methods: Post stroke 30 patients with upper limb disability were selected by convenient sampling method based on inclusion and exclusion criteria and then assigned into two groups, group A and group B. Group A (motor relearning programme group) received motor relearning programme; whereas group B (mirror therapy group) received mirror therapy for 4 weeks. Outcome Measures: The Fugl Meyer Assessment of Physical Performance of Upper Extremity (FMA-UE) scale and Chedoke Arm And Hand Activity Inventory Scale (CAHAI) were used to evaluate and compare the effectiveness of motor relearning programme and mirror therapy on upper extremity functions in post stroke patients, at 1st day and at the end of 4th week. Intervention values for upper extremity functions were measured before and after treatment. Results: Statistical analysis done by using paired ‘t’-test and independent ‘t’ test showed that there was significantly improvement in subjects who received motor relearning programme. Paired ‘t’ test revealed upper extremity functions in post stroke patients were improved significantly in group A after applying motor relearning programme for 4 weeks i.e. (p=7.73815×10-11 in FMAUE scale) and (p=8.47303×10-11 in CAHAI scale). Paired ‘t’ test also revealed upper extremity functions in post stroke patients was improved significantly in group B after applying mirror therapy for 4 weeks i.e. (p=4.27209×10-7 in FMA-UE scale) and (p=2.77828×10-7 in CAHAI scale). Independent ‘t’ test revealed upper extremity functions in post stroke patients was extremely significant in group-A after applying motor relearning programme i.e. (p=1.08411×1015 in FMA-UE scale) and (p=1.56334×10-15 in CAHAI scale). So when compared within the groups, motor relearning programme and mirror therapy were effective in improving upper extremity functions. But when compared between the groups, motor relearning programme was found to be extremely significant for improving upper extremity functions in post stroke patients. Conclusion: In light of the study’s findings, it is concluded that the motor relearning programme is more effective and extremely significant in improving upper extremity functions in post stroke patients as compared to mirror therapy.

Designing a Physiotherapy Rehabilitation Protocol for Multiple System Atrophy: A Narrative Review

Megha Sharma, Jasmine Anandabai, Ritika Mani, Shikha Singh

Multiple System Atrophy (MSA) is a rare, debilitating, adult-onset neurodegenerative disorder that manifests clinically as predominant parkinsonian type or cerebellar type with autonomic dysfunction affecting Quality of Life (QoL) of MSA patients. Despite the importance of physiotherapy in improving the symptoms, there is a lack of standardised treatment protocol for MSA. This study aimed to develop a rehabilitation protocol for MSA to improve the QoL via reducing the symptoms of MSA. A comprehensive literature review was conducted including 5 randomised controlled trials, 3 retrospective analysis, 8 literature review, 1 cross-sectional study, and 8 case studies. The results showed that the physiotherapy rehabilitation protocol does reduce the symptoms and improves the QoL of MSA patients. The developed protocol consists of a four week intervention program focussing upon the mobility, strengthening, gait, balance and coordination as well as swallowing difficulties. The protocol has the potential to reduce the symptoms, improve the functional outcomes and enhance the QoL of MSA patients. Therefore, this study provides a standardised rehabilitation protocol for MSA, which can be used to attain symptomatic relief and to improve the QoL of the patient.

Gait Analysis in Cerebral Palsy: A Systematic Review

Shivangi Choudhary, Jasmine Anandbai, Uzma Khan, Shikha Singh

Introduction: To comprehensively investigate the methods, results, and clinical relevance of gait analysis in children with Cerebral Palsy (CP), with an emphasis on spatiotemporal, kinematic, and kinetic parameters. Materials and Methods: A comprehensive analysis of research from 2019 to 2024 that was retrieved from PubMed, Scopus, and Google Scholar was carried out. Peer-reviewed research utilising motion capture, force plates, and Electromyography (EMG) for gait analysis in CP was one of the selection criteria. We extracted and synthesised data on population, interventions, methods, and results. Results: Only 10 of the 65 reviewed studies were deemed eligible for inclusion. Measures like stride length, cadence, joint angles, and muscle activation patterns were frequently examined. According to the review, gait analysis can be used to customise treatments such as orthotic management and Selective Dorsal Rhizotomy (SDR). Conclusion: This study highlights developments in wearable sensors and machine learning while synthesising the most recent data on gait analysis in CP. The study emphasises how gait analysis can be used to improve functional outcomes and refine treatment strategies.

Effect of Resistance Exercises on Sleep Quality, Functional Capacity and Insomnia among Postmenopausal Women: A Pilot Study

Ishika Sahu, Hina Vaish

Introduction: Menopause is the permanent cessation or absence of menstruation. Postmenopausal women report to experience a decline in their sleep quality, functional capacity and insomnia, which can further exacerbate their health concerns. However, evidence suggests that resistance exercises can be beneficial in improving their insomnia and sleep. Aim: To study the effects of resistance exercises on sleep quality, functional capacity and insomnia among postmenopausal women. Materials and Methods: Ten postmenopausal women aged 40-60 years were enrolled for this pre-test post-test quasi-experimental study by purposive sampling method and were rendered resistance protocol using Thera band for 60 minutes, three days in a week for 4 weeks. The exercises included in the protocol were diagonal flexion, concentration curl, dynamic hug, seated row, side bend and extension of hips. The primary outcome used in the study were Pittsburgh Sleep Quality Index Scale to measure sleep quality, Insomnia Severity Index to measure insomnia and 6-minute walk test for assessing functional capacity. The outcomes were assessed at baseline and after four weeks. Results: The data were analysed using the IBM SPSS (version 16). Non parametric statistics presented in median and interquartile range. The median age and the menopausal age of the participants were found to be 50.5 years and 45.5 years, respectively. The effect of the intervention on the outcome measures were assessed by using the Wilcoxon Signed Rank test, which showed a significant decrease in the Pittsburgh Sleep Quality Score (Z = -2.829, p= 0.005), 6-minute walk distance (Z= -2.527, p= 0.012) and insomnia severity score (Z=-2.823, p= 0.005). The effect size of the outcomes was also calculated. Conclusion: Resistance exercises are effective in improving the quality of sleep, functional capacity and insomnia.

Association of Functional Capacity with Quality of Life among Postmenopausal Women: Preliminary Findings of A Cross-sectional Study

Km. Priyanka Gautam, Hina Vaish

Introduction: All women experience menopause, a natural physiology in women’s body. Menopausal symptoms may have a significant impact on Quality of Life (QoL) of postmenopausal women. Decline in Functional Capacity (FC) is a common feature in postmenopausal women. There are evidences which show FC is associated with QoL among older adults. Aim: To find out the relationship between functional capacity and QoL among postmenopausal women. Materials and Methods: Sixty postmenopausal women were recruited in this cross-sectional study; aged between 40-60 years, asymptomatic with stable vitals. The FC was assessed by 6-minute Walk Test (6MWT) according to the American Thoracic Society (ATS) guidelines. After taking the consent from the participants, they were asked to cover the distance as much as they can in 6 minute and stop in between the test if they feel any discomfort. There after the covered distance was recorded. Baseline data and post-test data were recorded and QoL was assessed by Hindi version WHOQOL-BREF questionnaire. It contains 26 questions which assesses overall QoL. Participants were asked to fill the form on the basis of their past two weeks experience. Results: The data were analysed by Kolmogorov Smirnov test to assess the normality of the data. The data shows non-normal distribution therefore, the Spearman’s rho test was used to find the correlation between 6MWT and QoL. Results show that there is a significant correlation between 6MWT and QoL with correlation coefficient of 0.323 (p =0.012). P≤0.05 was considered significant. Conclusion: The findings of the study show decline in FC results in poor QoL in postmenopausal women. Ethical Approval: Approved by the Human Ethical Committee, Chhatrapati Shahu Ji Maharaj University, Kanpur, India. HEC Reference No.: 2024-Oct-006

The Groin Pain with a Focus on the Prevalence of Different Pathological Pain Sources in Football Players: A Systematic Review

Abhas Pratyush, M SAnwar, Amartya Mallick

Introduction: Groin injury accounts for 5% to 18% of all sports injuries, frequently affecting athletes in sports like soccer and Australian football, which involve repetitive kicking, side-to-side movement, and twisting. In professional football, the impact is particularly pronounced, with players averaging two time-loss injuries per season. Aim: To determine the prevalence of groin pain suggestive of various defined pathology terminology used in Doha agreement. Materials and Methods: A systematic literature search was undertaken across several major online databases, including PubMed, BJSM, SAGE Journals, Research Gate, and Google Scholar. The search strategy encompassed cohort studies, systematic reviews, and randomised clinical trials published from database inception through December 2024. Studies reporting data on the prevalence of groin injury pathology, using terminologies defined in the Doha agreement, were included in this review. Results: A search using the keywords “groin injury in football player,” “groin pain in football player,” and “occurrence of groin harm in football player” yielded eleven studies for analysis of groin pain prevalence. While all studies compared the prevalence of adductor-related and iliopsoas-related groin pain, the infrequent use of other Doha agreement terminology limited this analysis to these two specific pathologies. Conclusion: The review findings indicate that groin pain in football players stems primarily from hip adductor injuries, with iliopsoas injuries as a secondary cause. Clinically, this suggests a need for further investigation into other potential sources of groin pain, as current understanding is limited regarding pathologies outside of these two muscle groups. Since adductor and iliopsoas injuries are known risk factors, preventive strategies targeting these muscle groups are essential.

Effectiveness of Task Oriented Aerobic Exercise along Sensory Integration on Aerobic Capacity, Sensory Profile and Attention in Attention Deficit Hyperactivity Disorder Children: A Randomised Control Trial

SJeyanthi, SSuhara, V Lakshmipriya

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental illness characterised by symptoms of inattention, hyperactivity, and impulsivity that affects roughly 5-8% of children globally. Motor problems and sensory issues are predominantly observed in ADHD children along with the core deficits. Aim: To find out the effectiveness of task oriented aerobic exercise along with sensory integration on aerobic capacity, sensory profile and attention in ADHD children. Materials and Methods: Institution approval was taken for this study. The study design was a randomised control trial, 42 children with ADHD were selected and randomly allocated into three groups. Group A (n=14) received task oriented aerobic exercise and sensory integration therapy and group B received sensory integration therapy alone for 6 weeks. Group C (n=14) was control group continued with their routine activities. The outcome measure were 12 minute walk test, Stroop Test , Wisconsin Card Sorting Test and Short Sensory Profile, which was assessed pre and post test after 6 weeks. Task oriented aerobic exercises includes stepping, throwing and catching ball, rope jumping performed for 15 minutes and sensory integration exercise includes tactile (brushing), vestibular (swing, rolling, and spinning), proprioception (bouncing on trampoline or large ball, pushing activities, playing with weights), visual (focussing, following and tracking), and auditory (sing-songs, loud and slow noise). was performed for 30 minutes. The exercises were performed 3 days in a week for 6 weeks. Results: Data was analysed by ANOVA using SPSS 21. The statistical analysis showed significance improvement in group A and B (p<0.05) on aerobic capacity (F=37.69), short sensory profile (F = 39.98) and attention (F = 23.42). Tukey’s post hoc analysis revealed group A was significantly better than Group B and C. Conclusion: This study concluded that the task oriented aerobic exercise along with sensory integration (group A) showed more significant improvement in aerobic capacity, sensory profile and attention among children with ADHD when compared with sensory integration alone (group B) and controls (group C).

Correlation of Earpods Usage and Sleep Quality among Young Adults: A Correlation Study

SJeyanthi, V Lakshmipriya, SSuhara

Introduction: The prevalence of using earpods among young adults is high, ranging from 38% to 62%.Vestibular centre in the brain process and regulate the body sleep wake cycle. Noise electromagnetic radiations produced by ear pods has the potential to damage the vestibular nuclei of the brain over time. Any dysfunction in the vestibular part led to loss of balance, sleep quality, insomnia and daytime fatigue. Aim: The aim of the study was to correlate the earpods hourly & yearly usage and quality of sleep among young adults. Materials and Methods: This study was correlation study with convenient sampling, 194 young adults who are using ear pods were selected. Ear pods usage pattern for individual was assessed through structured questionnaire. Sleep quality was measured by using Pittsburgh sleep questionnaire. Institutional Ethics committee approval was taken. Results: Pearson correlation was performed to analyse correlation between sleep quality and hourly & yearly usage of earpods.The results obtained revealed that 47% had poor sleep quality. Among the partcipants, more than 65% had subjective sleep quality affected, 44% had major sleep disturbance due to overthinking, stress and work/social/exam related anxiety. The 31% of participants had longer sleep latency and 33% had daytime dysfunction including sleepiness. Interestingly, the sleep duration of 85% are not affected, they slept for at least 7 hours. The hourly usage of earpods, years of usage of earpods and quality of sleep were negatively correlated with r=0.83; 0.88. Conclusion: The ear pods usage per day and the years of usage had a negative impact on sleep quality.

Evaluating the Impact of Primary Dysmenorrhoea Intensity on Anxiety, Sleep Quality, and Academic Performance among University Students: A Cross-sectional Study

Simran Sethi, Anushree Rai, Aditi, Pinki

Introduction: Primary Dysmenorrhea (PD), characterised by painful menstrual cramps, is a common condition affecting many women, particularly university students. In India, studies report that approximately 50-80% of women experience dysmenorrhea, with significant variations in intensity and duration. The condition can lead to increased anxiety, poor sleep quality, and decreased academic performance, affecting students' overall well-being and productivity. Aim: The present study aimed to investigate the impact of primary dysmenorrhea intensity on anxiety, sleep quality, and academic performance among university students. Materials and Methods: A cross-sectional design was employed, with a sample of 88 female participants aged 18-30 years. The inclusion criteria were female students experiencing primary dysmenorrhea symptoms, while individuals with secondary dysmenorrhea, endometriosis, adenomyosis, pelvic inflammatory disease, cervical polyps and uterine fibroids were excluded. The primary outcome measures included anxiety levels, sleep quality, and academic performance. The study found a high prevalence of the negative effects of primary dysmenorrhea on academic performance among female undergraduates in the Delhi NCR and Haryana regions. Results: Analysis revealed a weak positive correlation between pain intensity and sleep quality, and a moderate positive correlation between pain intensity and anxiety levels. Participants reported several academic difficulties, including challenges with studying, completing homework, concentrating in class, actively participating in discussions, and engaging in sports activities. Conclusion: The findings of this study highlight the significant impact of primary dysmenorrhea on various aspects of university life, particularly academic performance, among female students. The study also underscores the need for further research to explore effective interventions to alleviate the academic and psychological burdens associated with dysmenorrhea in this population.

Exploring the Relationship between Smoking and Musculoskeletal Parameters of the Neck and Shoulder: A Cross-sectional Study

Pinki, Aditi, Anushree Rai, Simran

Introduction: Tobacco use is a major preventable cause of death, with India having 253 million adult users. It increases the risk of diseases like atherosclerosis, respiratory disorders, and skeletal issues, including poor posture. In India, 28.6% of adults use tobacco, with higher rates in men (42.4%) than women (14.2%). Aim: This study aimed to explore the relationship between smoking and musculoskeletal parameters of the neck and shoulder, specifically focussing on posture and muscle impairment in smokers. Materials and Methods: A cross-sectional design was used, with a sample size of 128 participants aged 20-40 years, including current smokers with a minimum smoking history of 3 years and non-smokers. Smokers were selected using snowball sampling, while non-smokers were chosen via simple random sampling. Exclusion criteria included individuals with neurological disorders, musculoskeletal conditions, psychological impairments, recent surgery, spinal or upper limb pathology, or those undergoing treatment for neck pain. Participants who used phones for more than 4 hours or worked on computers for over 6 hours were also excluded. The study's outcome measures included forward head posture, cervical muscle strength, shoulder protrusion, and range of motion. Results: Key findings indicated a statistically significant association between smoking and an increased prevalence of neck and shoulder musculoskeletal symptoms, such as pain, stiffness, and reduced range of motion. Smokers were found to experience more severe musculoskeletal issues compared to non-smokers. In smoker group, cervical flexor strength, cervical extensor strength and lateral rotator left strength showed statistically significant difference with p values 0.04, 0.39 and 0.39, respectively whereas, in non-smoker group, cervical flexor strength and lateral rotator right strength showed significant difference with p values 0.08 and 0.43, respectively. Conclusion: The study emphasises the demand for further exploration to establish a causal relationship between smoking and musculoskeletal issues in the neck and shoulder, suggesting that smoking cessation may be an effective intervention to improve musculoskeletal health.

Effectiveness of Virtual Reality and Augmented Reality in Parkinson’s Patient for Ambulophobia and Basophobia: A Case Report

AjithKumar Arumugam, G Subalakshmi, Subapradha Jayamoorthi

Basophobia and ambulophobia are prevalent among Parkinson’s patients, stemming from the fear of falling and difficulty walking due to motor symptoms like rigidity, tremors, and balance issues. Virtual Reality (VR) and Augmented Reality (AR) are emerging technologies that enhance motor skills, balance, and cognitive function through immersive, therapeutic exercises. A 70-year-old male patient with stage 2 Parkinson’s disease underwent the 4-week intervention consisting of VR and AR exercises, with pre- and post test assessments using the Morse and ABC scale to evaluate progress. The patient underwent 30 minutes of VR and AR therapy, three times a week, for four weeks. The results showed significant improvements in reducing ambulophobia and basophobia, as measured by the Morse and ABC scales. VR and AR enhanced motor skills, balance, cognitive function, and boosted confidence and daily mobility. The patient demonstrated improved gait quality, reduced fear of falling, and enhanced overall quality of life. VR and AR offer promising solutions to alleviate ambulophobia and basophobia in Parkinson’s patients, improving mobility, confidence, and overall quality of life.

The Efficacy of Dual Task Training in Improving Cognitive Motor Functions in Traumatic Brain Injury Patients: A Systematic Review

Saundarya Kumari, Shikha Singh

Introduction: Cognitive and motor impairments are common sequelae of Traumatic Brain Injury (TBI), often disrupting patients' ability to perform daily activities that require simultaneous physical and mental effort. DTT, which involves performing cognitive and motor tasks concurrently, has been proposed as an effective rehabilitation strategy. Aim: To examine the efficacy of Dual-task Training (DTT) in improving cognitive and motor function in patients with TBI. Materials and Methods: A systematic review and meta-analysis were conducted, including randomised controlled trials and observational studies focussing on TBI patients undergoing DTT. Outcome measures included improvements in cognitive function (e.g., attention, executive functioning) and motor performance (e.g., gait stability, balance). Additionally, the transfer of dual-task improvements to real-world tasks was evaluated. Results: DTT significantly improved cognitive-motor interaction, with marked enhancements in reaction time, task accuracy, and gait parameters under dual-task conditions. Patients also demonstrated better attention allocation and increased adaptability in dynamic environments. Importantly, improvements were maintained in follow-up assessments, suggesting lasting neuroplastic effects. However, the efficacy of DTT was influenced by factors such as injury severity, task complexity, and training duration. Conclusion: DTT is an effective and promising intervention for improving cognitive and motor function in TBI patients, facilitating their reintegration into daily life. Future research should explore optimal task combinations, individualized training protocols, and long-term outcomes to maximise its clinical applicability.

Integrated Effect of Cognitive Behavioural Therapy and Structured Exercise for the Treatment of Problem Behaviour in Early Adolescents: A Randomised Controlled Trial

Shayasta, Narkeesh Arumugam, Damanjeet Sandhu, Divya Midha

Introduction: Adolescence is a transformative phase marked by significant emotional, social, and cognitive changes, often giving rise to problem behaviours such as anxiety, aggression, and rule-breaking. These behaviours disrupt functioning and relationships in adolescence. Cognitive Behavioural Therapy (CBT) is a type of psychotherapy that helps teaching positive coping skills. Physical activity can enhance emotional regulation by the release of neurotransmitters. The integration of psychological interventions and physical activity represents a current thrust area of research aimed at effectively addressing Behavioural issues in adolescents. Aim: To determine the effect of CBT along with structured exercises in reducing problem behaviour and improving life satisfaction in adolescents. Materials and Methods: Thirty early adolescents between the ages of 11 to 14 years, documented with problem behaviour constituted the study's participant pool. This study was approved by Ethical committee of Punjabi university, Patiala. Participants were randomised into two groups: A and B. Group A received a combination of a total 9 CBT sessions and a pre-designed exercise programme of 3 days a week for 5 weeks and group B received only the exercise programme. Assessment was done on Day 0, Day 17 and Day 35, using Child Behaviour Checklist, Pediatric Symptom Checklist and Multidimensional Student Life Satisfactory Scale. Data were analysed using SPSS 20. Results: The results showed significant improvements in Group A across the Child Behaviour Checklist, Pediatric Symptom Checklist, and Multidimensional Student’s Life Satisfaction Scale, with p-value <0.05 for all variables. Conclusion: The study concluded that combined effect of CBT and structured exercise programme is an effective treatment option for improvement in Problem Behaviour and life satisfaction as compared to structured exercise programme alone.

Effectiveness of Interactive Neuromotor Training Versus Sensory Integration-based Exercise Training on Balance, Motor Function and Quality of Life in Individuals with Traumatic Brain Injury: A Quasi-experimental Study

Mohamed Shafiulla, Manikumar

Introduction: Traumatic Brain Injury (TBI) often results in impairments in balance, motor function, and quality of life. Interactive Neuromotor Training (INT) and Sensory Integration based Exercise Training (SIET) are promising rehabilitation approaches for improving these outcomes. However, there is limited evidence comparing the effectiveness of these interventions in individuals with TBI. Aim: To compare the effectiveness of INT and SIET on balance, motor function, and quality of life in individuals with TBI. Materials and Methods: A quasi-experimental design was used with 28 participants (aged 18–55 years) diagnosed with mild to moderate TBI. Participants were randomly assigned to either the INT (n=14) or the SIET group (n=14). Pre- and post-intervention assessments were conducted using the Berg Balance Scale (BBS) for balance, the Fugl-Meyer Motor Assessment (FMMA) for motor function, and the Quality of Life after Brain Injury (QOLIBRI) scale for quality of life. Statistical analysis was performed using paired t-tests and independent t-tests. Results: Both groups showed significant improvements in balance, motor function, and quality of life (p<0.05). The INT group demonstrated greater improvements in all outcome measures compared to the SIET group. The INT group showed a larger increase in balance (BBS) and motor function (FMMA), and more pronounced improvements in overall quality of life (QOLIBRI) scores. Conclusion: INT is more effective than SIET in improving balance, motor function, and quality of life in individuals with TBI. Both interventions, however, provide significant therapeutic benefits, suggesting that they can be used as part of a comprehensive rehabilitation program for TBI patients.

A Qualitative Study among Patients with Knee Osteoarthritis during Physiotherapy

Chandra Bathran, Asir John Samuel

Introduction: Perceptions, experiences, and the factors that facilitate, and inhibit the rehabilitation process in Patients with Knee Osteoarthritis (PKOA) may be influenced by their lifestyle and context. Aim: To investigate PKOA in Lower-Middle-Income Country (LMIC) India,about their views and lived experiences and to explore and the factors that support and hinder Physiotherapy (PT) among PKOA. Materials and Methods: Qualitative design using phenomenological approach were employed. PKOA were recruited using a purposive sampling technique. Demographic data of a PKOA were collected using a data entry form, and their economic status was entered according to the Modified Kuppuswamy Scale (MKS). One-to-one, semi-structured interviews were conducted face-to-face or by telephone, recorded using Sony ICD-UX570 audio recorder, and transcribed verbatim. Data were analysed using Braun and Clarke, six stages of thematic analysis based on recent recommendations (2024) with NVivo software version 15. Results: Fifteen PKOA were included with a mean age of 56.3 years, height 157.3 cm, weight 66.5kg, and Body Mass Index (BMI) 26.9 kg/cm2. Educational and socio-economic status were assessed using MKS, distributed across lower (13.33%), upper lower (6.67%), lower middle (60%), upper middle (20%), illiterate (26.67%), primary school certificate (20%), middle school certificate (33.33%), high school certificate (13.33%), and graduate (6.67%). Interviews duration ranged from 10 to 30 minutes. Four themes were developed, including perceptions, experiences, facilitators, and inhibitors. Twenty-nine sub-themes were developed under these themes. Conclusion: Patients lacked knowledge of disease and the efficacy of PT for knee OA. PKOA has experience with PT more positively and less negatively. Personal, physical, social, health-related, and organisational factors were both facilitating and inhibiting PT and its adherence during the rehabilitation process.

Integrated Effect of Repetitive Transcranial Magnetic Stimulation and Task-specific Trunk Control Training on Balance in Individuals with Parkinson’s Disease

Akshita Jain, Narkeesh Arumugam, Divya Midha

Introduction: Parkinson's Disease (PD) is a neurodegenerative disease characterised by rigidity, bradykinesia, tremor, and postural instability which are attributed to the loss of striatal dopaminergic neurons. Disease progression reduces functional limits of stability, impaired postural responses, and gait dysfunction, which increases the risk of falls. There are advanced innovative rehabilitation strategies such as repetitive Transcranial Magnetic Stimulation (rTMS) used to enhance cortical excitability and task–specific training which puts demands on the cortex thus, promote neuronal plasticity. Aim: To investigate the combined effect of rTMS and task-specific trunk control training on balance in individuals with PD. Materials and Methods: Ten participants diagnosed with PD were randomly allocated to Group A (experimental) and Group B (control). Both groups underwent interventions 5 sessions per week for 3 weeks. Group A received high-frequency rTMS (10 Hz at 90% Resting Motor Threshold) for 20 minutes, followed by 30 minutes of task-specific trunk control exercises and conventional physiotherapy in each session. In contrast, Group B received sham-rTMS for 20 minutes, along with the same task-specific trunk control exercises and conventional physiotherapy. Evaluations were done on day 0 and day 15, using the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-III), modified Clinical Test of Sensory Integration in Balance (m-CTSIB), and Parkinson’s Disease Quality of Life (PDQL) as outcome measures. Result and conclusion: There was a significant difference observed in MDS-UPDRS-III, mCTSIB and PDQL in both Group A (experimental) and Group B (control). However, the p-value (p<0.05) was significantly greater in Group A as compared to Group B. The findings indicate that integrating rTMS with task-specific trunk control training significantly improves balance in individuals with PD.

Comprehensive Overview of Parental Experiences and Expectations from Physiotherapy for Children with Down Syndrome

Fathimath Akhila, Asir John Samuel

The purpose of this review was to provide a comprehensive overview of the parental experiences and expectations associated with physiotherapy interventions for children with Down syndrome (DS). Literatures available till 2024 were included in the review sourced from Scopus, PubMed, and ProQuest databases. The initial search yielded 84 articles, of which 30 duplicates were identified and removed. Following a rigorous screening process, 46 articles were excluded based on relevance and quality criteria, resulting in 7 articles being included in the final review.The findings highlight that DS is one of the most common genetic disorders, characterised by intellectual disability, congenital anomalies, and developmental delays. The findings reveal that DS imposes considerable medical, social, and emotional burdens on families. While physiotherapy is instrumental in improving motor and functional abilities in children with DS, there remains a significant lack of research examining the specific needs and expectations of parents engaging in these interventions. This review identifies key themes, including emotional, social, and physical challenges faced by families, financial constraints, barriers to accessing quality therapy services, and the critical role of multidisciplinary support systems. Despite the recognised importance of family-centred approaches, few studies have explored the intersection of parental perspectives and therapeutic outcomes. Furthermore, gaps were observed in research representing underprivileged regions, particularly low- and middle-income settings.By addressing these limitations, future studies can advance family-centred care models and enhance outcomes for children with DS and their families. This review underscores the urgent need for targeted, qualitative research to bridge these gaps and optimise support for parents navigating physiotherapy interventions.

Additive Effect of Contract-Relax-Antagonist- Contract Stretching and Petrissage Massage on Motoneuronal Excitability

Ishaan Gupta, Sandeep Singh, Ishika Garg

Introduction: Muscle tone abnormalities are mainly witnessed in individuals inflicted with nervous system disorders. Cause of hypertonicity is due to increased Motoneuronal Excitability (MNE) whereas decreased MNE leads to hypotonicity. Changes in MNE are also observed in healthy individuals such as in muscle spasm or increased muscle tension. Also decreased MNE (hypotonia) is seen in healthy individuals such as after long-term cast immobilisation or with impaired proprioception or sensation. In healthy individuals, especially in athletic populations it is always desired to decrease muscle tension to achieve muscle relaxation post fatigue or during spasm. Numerous physiotherapy methods are employed for this purpose but massage and stretching remains the most preferred modalities. Petrissage and Contract-Relax-Antagonist-Contract (CRAC) stretching have been reported to be most effective methods for reducing MNE hence muscle tension, but the effectiveness of these methods have not been validated by objective neurophysiological tests. So present study investigated combined effect of Petrissage massage and CRAC stretching on reducing muscle tension via motor pool excitability using H-reflex test which is considered a direct measure of MNE. Aim: To investigate the additive effects of Petrissage and CRAC stretching technique on motoneuronal excitability in healthy individuals through H-reflex methodology. Materials and Methods: Thirty healthy participants were randomly assigned to two groups. Group A (n=15) received Petrissage massage (wringing) for 3-6 minutes, followed by CRAC stretching, while Group B received only CRAC stretching. Electromyography unit was used to measure parameters of H-reflex (M-latency, M-amplitude, H-latency, H-amplitude, and H/M ratio) before and immediately after the intervention. Results: There was significant difference observed in H-amplitude (t=2.14, p=0.04) and H/M ratio (t=2.46, p=0.02) in Group A as compared to the individuals of Group B. Conclusion: The results suggest that combining Petrissage with CRAC stretching notably decreased motoneuronal excitability in healthy individuals, although the inter subject variability should not be ignored.

Effect of Vestibular Rehabilitation and Gaze Stabilisation Exercises in Indivi duals with Motion Sickness: A Study Protocol

Isha Goel, Subhasish Chaterjee, Mousumi Saha

Introduction: Vestibular rehabilitation exercises are commonly employed to improve balance, gaze stability, and functional mobility in individuals with vestibular disorders. These exercises aim to enhance the integration of sensory inputs, including visual, vestibular, and proprioceptive systems, to promote equilibrium. Need for this study: This study provides a comprehensive and progressive approach to vestibular rehabilitation, combining static and dynamic exercises to address a range of vestibular dysfunctions. Aim: This protocol outlines a structured series of vestibular exercises designed to target specific aspects of vestibular function. Materials and Methods: The protocol consists of seven exercises, each targeting unique vestibular and balance components. Exercise 1 emphasises controlled vertical and horizontal ocular movements, promoting visual-vestibular integration. Exercise 2 incorporates dynamic movement with visual fixation, requiring participants to track their hand while performing diagonal body movements. Exercise 3 involves seated ball-tossing to challenge gaze stabilisation and coordination. Exercise 4 introduces ambulation with eyes open and closed, focussing on proprioceptive and vestibular reliance during gait. Exercise 5 includes marching in place with and without visual input and stable support to build independent postural control. Exercise 6 uses an unstable surface to challenge vestibular reflexes during marching, combined with visual fixation on a distant target. Lastly, Exercise 7 incorporates the Brandt-Daroff manoeuvre, a widely used positional therapy to reduce vertigo symptoms and habituate the vestibular system.

The Effectivness of Virtual Reality based Exercise Therapy for Upper Limb Rehabilitation in Sub Acute Stroke: An Experimental Study

Gurbhej Singh, Narkeesh Arumugam, Divya Midha

Introduction: Stroke is the third most common cause of death and second most common cause of disability overall. The most prevalent disability that causes dysfunction following a stroke is weakness or paralysis, which often leads to upper limb impairments, Limiting independence in daily activities. (VR) has emerged as recent treatment approach in stroke rehabilitation. VR therapies give stroke survivors the rare chance to engage in a rich environment while receiving scalable, structured training opportunities reinforced by multimodal feedback to improve neuroplasticity and skill acquisition via repeated practice. Aim: To evaluate synergistic effect of VR based exercise therapy along with conventional physiotherapy in improving upper limb motor functions, cognition and quality of life in individuals with stroke. Materials and Methods: Ethical approval for the study was taken from the Institutional Ethical Committee, Punjabi university, Patiala. This single group, pre-post experimental study involved 8 stroke survivors in sub-acute stage of stroke. All participants received VR- based exercise therapy along with conventional exercise therapy, 5 times per week for 4 weeks. Data were collected at day 0 and at day 20th by using the outcome measure tools like Fugl Meyer Assessment-UA, Montreal Cognitive Assessment scale and Stroke impact scale. The analysis of the data was done by using SPSS Software. Results: Significant improvements was observed in Fugl Mayer- UL (p<0.05), MoCA (p<0.05), and only Emotion (p<0.05) or IADL (p<0.05) domains of Stroke Impact Scale. Conclusion: VR-based exercise therapy along with conventional physiotherapy shows potential to improve motor and cognitive functions in stroke survivors.

Correlation between Six-minute Walk Test and Pulmonary Function Test in Chronic Obtructive Pulmonary Disease Patients with Exacerbations: A Feasibility Pilot Trial

Prachi Rana, Subhasish Chatterjee, Sameer Singhal

Introduction: Exacerbations of Chronic Obstructive Pulmonary Disease (ECOPD) frequently occur in primary care, but diagnosing them accurately and promptly can be challenging. Six-minute Walk Test (6MWT) is a cost-effective and well-documented field test used to assess aerobic capacity, response to medical treatments in cardiopulmonary diseases, and predict cardiorespiratory fitness. Aim: This study aims to explore the relationship between the 6MWT and pulmonary function variables in COPD patients with exacerbations within the local population. Materials and Methods: From January to November 2024, 46 consecutive COPD patients with a history of exacerbations were included from a tertiary care hospital. Patients had a post-bronchodilator FEV1/FVC ratio <0.7, and 6MWT were conducted per the American Thoracic Society (ATS) guidelines. Percent predicted 6MWD was calculated, and the correlation between spirometry and 6MWT was analysed. The study was approved by the Institutional Ethical Committee (MMDU/IEC/2700). Results: Pearson's correlation coefficient (r) determined a positive correlation (r = 0.510) between the 6MWT and FEV1/FVC in COPD patients with exacerbations. Conclusion: The findings of our study indicate a strong positive correlation between the 6MWT and the spirometry variable (FEV1/ FVC) in COPD patients experiencing exacerbations. These results may have clinical significance in assessing disease prognosis and estimating aerobic capacity (VO2 max) in COPD patients during exacerbations.

Effect of Strategic Targeted Exercise Programme on Balance in Elderly People: An Experimental Study

Gagan Deep Singh, Yogeshwar Bindra

Introduction: For older adults, falls and fall-related injuries are frequent and dangerous health issues. For the elderly people of age>65 years, the fifth most common cause of death is unintentional injury. Lack of balance, confidence and fear of falling are reported to have a debilitating effect on mobility and functioning in geriatric people. Aim: To determine the effect of strategic targeted exercise on balance in elderly people. Materials and Methods: This experimental study included a total of 50 participants who matched the inclusion criteria from old age home and relatives of patients obtained from T.D.T.R. D.A.V. Institute of Physiotherapy and Rehabilitation, Yamuna Nagar, Haryana, India. The study was of 8 weeks duration and 3 sessions per week. The participants were randomly allotted to an experimental group- Strategic Targeted Exercise and balance training (n=50) and a control group-balance training alone (n=50). Outcome measures used were the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test. A paired t-test was used to determine significant variations between the pre- and post-test measurements and unpaired t-test was done to determine between group variations. Results: The average mean of age was found to be 69.04 years. The experimental group and the control group both show notable changes in terms of within group differences. BBS (p=0.0497) and TUG (p=0.0380) both showed greater improvement in experimental group as compared to control group. Conclusion: Strategic targeted exercises along with balance exercises showed better outcome in BBS and TUG as compared to balance exercises alone.

Increasing Prevalence and Progression of Parkinson’s Disease in Punjab- Is Pesticides the Main Etiology?: A Systematic Review

Disha Grover, Narkeesh Arumugam

Introduction: Parkinson’s Disease (PD) is the second-most common progressive neuro-degenerative disorder, affecting the elderly population. The increasing prevalence of PD worldwide underscores the importance of identifying factors that influence disease outcomes and potentially leading to its progression. In recent years, Punjab, a prominent agricultural region in India, had witnessed a significant increase in onset of Parkinson's Disease. This trend had raised concerns about the potential contribution of environmental factors in its etiology. Aim: The review study investigated the potential contribution of pesticides to the increasing prevalence and progression of PD in Punjab. Materials and Methods: A comprehensive literature search in accordance with the PRISMA guidelines (2020) was conducted across multiple databases and search engines. From 2020 to 2025, articles published in English were reviewed in PubMed, Medline, EMBASE, Scopus and Web of Science databases. The review included the studies that explored association between pesticides and PD and on the studies that explored environmental risk factors for PD, particularly in agricultural regions like Punjab. Results: Ten articles (7 case control, 2 cross-sectional and 1 longitudinal cohort) were included and thoroughly reviewed. The literature highlighting pesticides as a major risk factor contributing to the rising prevalence of Parkinson's Disease cases were reviewed. The findings indicated a significant association between chronic pesticide exposure and increased PD risk. The studies have also shown that chronic pesticides exposure leads to the progression of both motor and non-motor symptoms in PD. Conclusion: The review study strongly suggested that the prolonged exposure to pesticides is associated with the increased prevalence and progression of PD symptoms in Punjab. The review emphasised the need for awareness about pesticides as a significant contributor to the increasing prevalence of PD.

Understanding Factors and Insights Influencing Manual Dexterity with Age, Expertise and Beyond: A Comprehensive Review

Smitha Damodar, Shivarama Bhat, Manikandan Natarajan

Dexterity can be divided into manual dexterity and fine finger dexterity. It is an important skill required to perform daily living activities. For an individual to have good manual dexterity, there has to be intact musculoskeletal and neurological function and good eye-hand coordination. It is of paramount importance that the tools used for the assessment of hand function should have good validity and reliability so that they can provide accurate results and aid in rehabilitation. In this article, the authors have identified manual dexterity, grip strength, pinch strength, tactile acuity, and hand anthropometry as the significant factors contributing to hand performance. Full-text articles in English were gathered from various search databases. There is a need to see the influence of these factors on manual dexterity. The sensorimotor cortex of the human brain undergoes functional organisation with stimulation of the sensory system or learning of motor skills. Structural and functional changes in the brain usually occur with practice, learning, and expertise. With training, there is an alteration in the brain regions involved in planning and execution. It has been documented that the pinch strength, grip strength, and cutaneous sensation decline as age advances. From an in-depth literature search of the factors that affect hand performance, we can conclude that as age advances, cutaneous sensation and motor performance decrease in healthy individuals. However, whether the role of expertise and dexterity skills in occupations involving dextrous manipulation in adulthood can help preserve dexterity as one advances in age when no other underlying pathology exists is the area left unexplored. The potential of work-related activities as preventative measures for maintaining hand dexterity in adulthood is highlighted by research showing that consistent participation in activities requiring tactile feedback and fine motor skills may help prevent age-related decline in hand function. According to research on neuroplasticity, the brain maintains the capacity for adaptation through repeated skill-based practice, thus presenting opportunities for exploring whether occupational expertise in dexterity promotes anatomical or functional adaptations that alleviate the age-associated decrease in sensory and motor capabilities.

Identifying and Overcoming Rehabilitation Barriers Towards Hemiplegic Patient Care at Institutional and Home-based Setting: A Study Protocol

Sharad Kumar, Subhasish Chatterjee

Introduction: Stroke is a leading cause of disability worldwide, often resulting in hemiplegia, which significantly impacts functional independence. Rehabilitation, whether institutional or home-based, plays a crucial role in minimising disability and improving recovery. However, various barriers may hinder rehabilitation outcomes, making it essential to explore factors influencing patient care. Need for this study: The study aims to propose effective solutions for optimising rehabilitation strategies, improving functional recovery, and enhancing the quality of life for stroke survivors. Aim: This study aims to identify the barriers and facilitators affecting institutional and home-based rehabilitation for hemiplegic patients. The study focusses on exploring physical, social, emotional, and environmental factors influencing rehabilitation, identifying patient-specific motivators and challenges, and developing strategies to overcome barriers and improve rehabilitation outcomes. Materials and Methods: A structured questionnaire will be developed through a literature review and refined based on patient interviews. A Delphi survey with expert physiotherapists will be conducted for validation, and the content validity index will be calculated. Patient-reported responses will be analysed using Interpretative Phenomenological Analysis (IPA) with an inductive approach, utilising QDA Miner Lite for qualitative data interpretation.

Advancements in Chest Physiotherapy for Paediatric Bronchopneumonia: A Comprehensive Review of Current Techniques and Outcomes

Geetanjali Kaul, Neha Sharma

Bronchopneumonia is the most common clinical manifestation of pneumonia in paediatric population, particularly life threatening in young children aged between 0 to 5 years. It is also seen in children aged between 5-15 years with chronic complications and long term illness. It is an important cause of neonatal and childhood morbidity and mortality in developing countries, with death rates greatest in children and adults older than 75 years. Approximately 40% of pneumonia during childhood requires hospitalisation. Children with chronic respiratory or neuromuscular diseases benefit from chest physical therapy, which is a crucial adjuvant in the treatment of the majority of respiratory ailments. Helping children's tracheobronchial secretions to be cleared is the main goal of chest physical therapy. This improves gas exchange, lowers airway resistance, and facilitates breathing. A search strategy was performed for the past five years with original research published in English language between 2020 to 2024. Three databases, that is, Scopus, PubMed and PEDro were searched for full text articles. Four original papers revealed that chest physiotherapy including postural drainage, percussion, deep breathing and vibrations together are helpful in clearance of airway secretions from the lungs. Modern techniques, including forced expiration, active cycle of breathing, autogenic drainage, assisted autogenic drainage, and slow and prolonged expiration, utilise variations in airflow through breath control to facilitate the mobilisation of secretions. Also, the assisted physiotherapy techniques are worthy and beneficial in non cooperative paediatric patients in which coughing is not as effective to eliminate secretions which tends to increase the risk of infection. More assisted techniques can be helpful in improving the quality of life and cardiorespiratory capacity of paediatric patients suffering from bronchopneumonia.

Artificial Intelligence and Computer-aided Diagnosis in Lumbar Prolapsed Intervertebral Disc: A Systematic Review with Meta-analysis

Sandeep Pattnaik, Manu Goyal, Rajneesh Kumar Gujral

Introduction: Lumbar Prolapsed Intervertebral Disc (PIVD) is a common and debilitating lower back condition. Accurate and timely diagnosis is crucial for its effective management. Conventional diagnostic methods like Magnetic Resonance Imaging (MRI) and computed tomography often require expert interpretation, which can be subjective, time-consuming, and prone to false positive interpretation. Artificial Intelligence (AI) and Computer-aided Diagnosis (CAD) techniques have the potential to revolutionise the diagnosis of lumbar PIVD by improving accuracy, efficiency, and objectivity. Thus, there is a critical need for a systematic evaluation of the existing evidence on the efficacy of AI and CAD in lumbar PIVD diagnosis. Aim: This systematic review with meta-analysis aims to thoroughly assess the available knowledge on the usability of different AI and CAD in lumbar PIVD diagnosis. Materials and Methods: A systematic search of electronic databases like PubMed, EMBASE, and IEEE for relevant full-text studies published in peer-reviewed journals between 2014 and 2024, only in the English language. The included studies were evaluated for methodological quality assessment using the Quality Assessment of Diagnostic Accuracy Studies tool. The primary outcomes for review included the diagnostic accuracy (sensitivity, specificity, accuracy) of each AI and CAD system. Subsequently,a meta-analysis was conducted to synthesise the results of the included studies and assess the overall effectiveness of AI and CAD in lumbar PIVD diagnosis. Results: Following the extensive search, a total of eight studies were identified, evaluating 13 CAD or AI systems. Four of these studies utilised the CAD model, three employed deep learning and one used machine learning. All the studies analysed lumbar MRI data. The meta-analysis involved three of the studies, and it demonstrated a high pooled sensitivity (0.901, 95% CI: 0.871- 0.924) and specificity (0.919, 95% CI: 0.898-0.936) for the included studies using CAD system for lumbar PIVD diagnosis. Moreover, the least heterogeneity (I^2 value= 0%) was observed in both sensitivity and specificity across the included studies, suggesting that the observed diagnostic accuracy is likely to be generalisable across different AI/CAD systems and study populations. Conclusion: To conclude, these findings strongly support the potential of AI/CAD systems to improve the accuracy and efficiency of lumbar PIVD diagnosis.

Efficacy of Cranial Electrotherapy Stimulation on Cognition Among Perimenopausal Women: A Quasi-experimental Pilot Study

Naveeta Thakur, Nidhi Sharma, Prachi Ranjan

Introduction: Cognitive alterations are common in clinical practice during menopausal transition time, with subjective reports of “cerebral fog” impairing daily cognitive performance. Cranial Electrotherapy Stimulation (CES) is a neuromodulation approach that delivers pulsed, alternating microcurrent (<1000 μA) to the head via electrodes placed on the earlobes or scalp. It is used to treat anxiety, depression, insomnia, cognition, and headaches. Aim: To explore the efficacy of CES on cognition among perimenopausal women. Materials and Methods: This quasi-experimental pilot study was performed in 16 perimenopausal women, aged between 40-55 years. Ethical approval was obtained from the Institutional Ethical Committee with the registration number MMDU/ IEC-267. The trial was registered with the Clinical Trials Registry-India (CTRI) with the identification number CTRI/2024/04/066346. All participants received active CES for 30 minutes, for 4 days a week for 4 weeks. Pre and post assessments of all participants were performed using Montreal cognitive assessment scale (MoCA) to test cognitive function. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Version 26.0). The Shapiro-Wilk test was used to determine the normality of the demographic and baseline characteristics. A paired t-test was used to compare the pretest and post-test results. Results: The MoCA score at baseline was significantly deviated from a normal distribution. For within-group analysis paired t-test was used, MoCA score at baseline was 21.125±177;2.09 and that after intervention was 22.187±177;1.64. The result exhibited a significant improvement (p=0.001) when comparing the baseline values to after four weeks of intervention with an effect size of 0.56. Conclusion: CES significantly improved cognitive performance (delayed recall and attention) among perimenopausal women. No study-related adverse events were reported. It would be valuable to further explore or confirm the effects of CES on cognition.

The Effectiveness of Shockwave Therapy in Diabetic Neuropathy Patients: A Narrative Review

Yashica Sharma, Sunita Sharma, Krishnagopal Mondal

Diabetic neuropathy is a common and debilitating complication of diabetes, often resulting in chronic pain, sensory disturbances and functional impairments. Traditional pharmacological treatments offer limited effectiveness, leading to the exploration of alternative therapies like shockwave therapy. Shockwave therapy is a noninvasive treatment that utilises acoustic waves to promote tissue healing, reduce pain, and improve nerve function. This review aimed to assess the effectiveness of shockwave therapy in improving pain, nerve function, and quality of life in patients with diabetic neuropathy. A systematic search was performed using PubMed, Scopus, Cochrane and Google Scholar databases for studies published between 2014-2024. Boolean operators such as “AND” and “OR” were used in search strategy as “shockwave therapy” AND “diabetic neuropathy” OR “diabetic nerve damage” AND “pain” OR “quality of life”. The inclusion criteria focussed on randomised controlled trial involving shockwave therapy assessed in relation to pain reduction, nerve function improvement and overall quality of life. Out of 4,500 studies screened, 6 studies met the inclusion criteria. These studies revealed that shockwave therapy significantly reduced pain intensity (measured via the visual analogue scale). Improved nerve conduction velocity, and enhanced functional outcomes. Patients also experienced improved quality of life, as reflected in standardised quality of life assessments such as SF-36.Shockwave therapy demonstrated significant potential as an adjustive treatment for diabetic neuropathy, with notable effects on pain reduction, nerve function, overall quality of life.

Test-retest Reliability of the 360° Turn Test in School going Children with Different BMI

Suraya Niyaz, Riya Kalra, Kanu Goyal

Introduction: Dynamic balance is an important component of motor performance, plays a vital role in the physical activity and functional mobility of children. The 360-degree Turn Test (360DTT) is a reliable measure for assessing dynamic balance. This study investigates the test-retest reliability of the 360DTT in school-going children aged 6–17 years with varying Body Mass Index (BMI). The rising prevalence of childhood obesity underscores the importance of assessing balance to mitigate the associated risks of physical inactivity and motor deficits. Aim: To estimate the test-retest reliability of the 360DTT and examine its influence on BMI on dynamic balance in children. Materials and Methods: This cross-sectional observational study recruited 153 children (51 in each BMI group) from a school. Demographic data, including age, height, weight, and BMI, were measured. Participants performed the 360DTT in a controlled environment, and the test was repeated after 48 hours. The time taken to complete the test in clockwise and counterclockwise directions was measured using a stopwatch. Test-retest reliability was assessed using Cronbach’s alpha, Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimum Detectable Change (MDC 95%). Results: The normal and obese groups demonstrated excellent test-retest reliability (Cronbach’s alpha ≥0.89, ICC ≥0.89), while the overweight group showed moderate reliability (Cronbach’s alpha =0.71, ICC=0.71). Measurement errors (SEM: 0.70–0.92) and MDC95% (1.94–2.55) were minimal across all groups. Performance times were consistent, with mean differences between trials remaining statistically insignificant (p=0.001). Children with higher BMI displayed slower test performance, indicating potential balance impairments. Conclusion: The 360DTT exhibits high reliability for assessing dynamic balance in school-going children, particularly in normal and obese groups. Overweight children showed moderate reliability . The test’s ease of use and reliability make it a valuable tool for evaluating balance and guiding interventions to improve motor performance, particularly in children with obesity-related challenges.

Effectiveness of Cupping Therapy on Crosssectional Area of Gastrocnemius in Patients with Plantarfasciitis: A Quasi-experimental Pilot Study

Prachi Ranjan, Simranjeet Kaur, Faiz Zubair Shaikh, Amit Mittal

Introduction: Plantar fasciitis, a common cause of heel pain, is often associated with muscle imbalances, particularly in the gastrocnemius. Cupping therapy, an alternative treatment, may enhance blood flow, relieve muscle tension, and support healing. This study examines the effectiveness of dynamic cupping therapy in reducing gastrocnemius muscle size and alleviating pain in plantar fasciitis patients. Aim: The aim of this study was to evaluate the effectiveness of cupping therapy on the cross-sectional area (thickness) of the gastrocnemius muscle and pain reduction in patients with plantar fasciitis. Materials and Methods: A quasi-experimental, pilot study with ethical approval obtained from the Institutional Ethics Committee with the registration number MMDU/IEC-2997. The trial was registered with the Clinical Trials Registry-India (CTRI) with the identification number CTRI/2024/09/073314. The study was performed on 16 participants of gastrocnemius tightness associated with plantar fasciitis, aged between 18-45 years. Participants were pre-assessed using B-mode ultrasonography for measuring the cross-sectional area and muscle thickness and pain intensity using the Visual Analogue Scale (VAS). All participants received single session of dynamic cupping therapy with pressure +1 mmHg for 10 mins. Pre-intervention (on the 1st day), and post-intervention (on the 3rd day) assessment were obtained for the outcome measures. Results: A significant decrease in the cross-sectional area of the gastrocnemius post-treatment (mean increase of 10%, p<0.01) was observed along with a notable reduction in pain intensity, with a mean decrease of 3 points on the VAS (p<0.01). These results suggested that cupping therapy exhibited a positive effect on muscle thickness and pain relief in patients with plantar fasciitis. Conclusion: Cupping therapy assisted the treatment of plantar fasciitis by improving blood flow, reducing pain, enhancing muscle flexibility, and supporting tissue healing, addressing issues like muscle tightness and gastrocnemius dysfunction.

A Study Protocol of Effects of Neuromuscular Taping on Facial Impairmens among Patients with Bell’s Palsy

Sarita Pandey, Kanika

Introduction: Bell’s Palsy (BP), a type of peripheral facial palsy affects the superior and inferior hemiface. BP is the most common cause of facial nerve palsy accounting for 49-51% of all cases, with an estimated annual prevalence of 20-32.2 per 100,000 people. Its incidence is higher in the ages of 15-45 years and there is a recurrence rate of 8-12%. Neuromuscular Taping (NMT) is a technique of applying elastic adhesive tape to the skin without any tension over the target area.NMT is supposed to induce pain relief, facilitation of lymphatic flow and increased vascularity by employing decompressive stimulation and dilation of underlying body tissue. Aim: To determine the effectiveness of NMT on Facial Disability in Patients with Bell’s Palsy. Materials and Methods: Twelve participants with BP will be recruited based on the selection criteria. Participants will be randomly allocated into two groups. Experimental Group (EG) will receive treatment with NMT and conventional exercises and Control Group (CG) will receive sham NMT and conventional exercises. Treatment will be given for consecutive 6 days for one week. Outcome measures, such as House- Brackmann grade, Facial clinimetric scale and Facial index scale will be used. NMT will be done on the following muscles: Frontalis muscle, Orbicularis oculi, Risorius, Zygomaticum, Buccinator, Masseter, Levator Labii Superior, Levator anguli oris, and Temporalis muscle from origin to insertion without any stretch in it. Sham NMT will be applied to the same muscles, but it will be performed incorrectly. Results: The data found to normal distributed will be represented as mean and standard deviation and the data which was found to be not normal distributed will be represented as median and interquartile range (IQR). Conclusion: This study aims to explore the potential benefits of NMT combined with conventional exercises in patients with BP. By comparing the outcomes of the experimental and control groups the findings will provide valuable insights into the efficacy of NMT as a therapeutic approach. If proven effective, NMT could emerge as a complementary intervention for enhancing recovery in individuals with BP, paving the way for its broader clinical application.

Relative and Absolute Reliability of Hand Behind Back Test for Dominant and Non Dominant Hand in Healthy Adults: A Study Protocol

Chhaya, Kanu Goyal, Manu Goyal

Introduction: Hand-behind-back (HBB) motion constitutes a fundamental functional movement involved in numerous activities of daily living, including reaching for posterior pockets, dressing, undoing the bra clasp, and back scratching. The shoulder HBB Range of Motion (ROM) is one of the very useful clinical parameters for the measurement of pain and functional disability in patients with pathology of the shoulder. This motion represents a complex pattern of movement by the shoulder with internal rotation, adduction, and extension. HBB ROM measurement provides a standardised and objective method of measuring shoulder internal rotation, which is essential for accurate diagnosis, development of individualised rehabilitation strategies, and objective monitoring of patient progress. Need of this study: This study is intended to find out the relative and absolute reliability of HBB test for dominant and non dominant hand in healthy adults. Materials and Methods: A cross-sectional study will be conducted in MMDU, Mullana. A sample of healthy adults will be recruited for the age group of 18-25 Years. The HBB will be measured for each participant. During this test, patients will be asked to reach behind their backs and slide their hands upward along the spine, with the highest vertebral level reached by the thumb. Then the distance will be measured using tape measure from the highest vertebral level attained with the thumb and posterior superior iliac spine.

Workplace-based Physiotherapy Programmes for Preventing Carpal Tunnel Syndrome: A Scoping Review

Rubina Nazz, Simranjeet Kaur, Nidhi Sharma

Carpal Tunnel Syndrome (CTS) is a common musculoskeletal condition, especially among individuals who perform repetitive hand and wrist jobs. Workplace-based physiotherapy programmes have been suggested as preventive measures, however there is insufficient information on their efficacy, implementation approaches, and associated challenges. This scoping review outlines the existing literature on physiotherapy procedures targeted to prevent CTS in occupational settings. It aims to identify the types of treatments used, evaluate their effectiveness, investigate techniques for successful implementation, and investigate the barriers to program acceptance and sustainability. A thorough search was done across many databases, including PubMed, Scopus, CINAHL, Embase, Ovid MEDLINE, AMED, and Cochrane Library, to locate research on workplace physiotherapy programmes for CTS prevention covering studies published from December 2000 to December 2024. The initial search identified 627 articles, which were refined to 113 articles after removing duplicates. Following a screening process for relevance, 7 studies met the inclusion criteria and were included in the final review. This review adhered to the scoping methodology described by Arksey and O’Malley, Levac et al., and the Joanna Briggs Institute. Qualitative and quantitative studies were considered, including randomised controlled trials, cohort studies, and systematic reviews focussing on physiotherapy, occupational setting, and quantitative outcomes like pain relief, increased function, and worker engagement. This review identified a wide range of physiotherapy interventions, including ergonomic assessments, stretching and strengthening exercises, manual therapy, and postural correction programmes. Effectiveness varied, with some studies indicating reduced CTS symptoms and increased worker productivity, while others found minimal long-term effects. Insufficient organisational support, employee restricted time, and poor participation rates were major barriers to program implementation. Workplace-based physiotherapy programmes have the potential to prevent CTS, but their success depends on a variety of factors, including program design, workplace culture, and resource availability. Future study should concentrate on enhancing program models, assessing cost-effectiveness, and overcoming implementation challenges to ensure widespread acceptance and long-term influence on occupational health.

Translation and Validation of a Stroke Specific Quality of Life Scale in Hindi: A Study Protocol

Sanskriti Srivastava, Kanika

Introduction: Stroke is an important global health risk that contributes high rate of mortality and long-term disability. The health-related quality of life of 60–70% of stroke survivors can be significantly impacted by stroke. A reliable instrument for assessing the psychological, social, and physical effects of stroke is the Stroke- Specific Quality of Life Scale (SS-QOL). Despite being available in several languages, it is unavailable in Hindi, a crucial language for the Indian population. This gap needs to be address to assess the health-related quality of life of stroke survivors for Hindi-speaking populations. Need for this study: The translated version of SSQOL will provide an essential tool to assess and address the health-related quality of life of Hindi-speaking stroke survivors. Aim: The aim of the study is to translate, perform cross-cultural adaptation and validate the SS-QOL scale in Hindi language. Materials and Methods: The scale will be translated into Hindi using a systematic procedure. Permission will be obtained from the esteemed authors who developed the original SSQOL scale. Beaton’s guidelines will be followed for the translation process. All the steps; forward translation, synthesis, backward translation, expert panel review, pretesting, content validation, and cross-cultural adaptation will be executed sequentially. Professionals from both medical and non-medical backgrounds will be involved at different stages of the process. The Delphi technique will be employed, utilising a panel of experts to review each step and question to ensure the translated questionnaire is error-free. The technique will also calculate the Individual Content Validity Index (I-CVI), Scale Content Validity Index/Average (S-CVI/Ave), and SCVI/Universal scores. To ensure cultural appropriateness, a prefinal version will be tested on Hindi-speaking stroke patients to assess its comprehensibility. Test-retest reliability will be evaluated using Bland-Altman plots and Intraclass Correlation Coefficents (ICCs).

Effect of Proprioceptive Neuromuscular Facilitation Stretching on Hamstring Flexibility: A Literature Review

Gourab Deb, Sunita Sharma

The hamstrings muscle which are found at the rear of the thighs, are essential for sprinting, jumping, and walking. Tightness in these muscles can cause compensatory movement patterns, change biomechanics, and limit Range of Motion (ROM), which may lead to lower back discomfort and other musculoskeletal problems. There are several types of stretching that may be applied in order to enhance muscle flexibility either acutely or chronically. Proprioceptive Neuromuscular Facilitation (PNF) is believed to improve flexibility through neural mechanisms such as autogenic inhibition, where the contraction of the target muscle triggers a relaxation response, and reciprocal inhibition, where contracting the opposing muscle group promotes relaxation of the target muscle. This review aimed to collect existing literature on the effects of PNF stretching on hamstring flexibility. The electronic searches were conducted using studies published in various databases, including PubMed, Scopus, Google Scholar, and PEDro covering the period from 2015 to 2025. This literature review provided insights into the effectiveness of PNF techniques for enhancing hamstring flexibility in adults.After identifying 28 papers, reviewing their titles, and removing those that were irrelevant, seven research were selected to meet the review’s inclusion criteria.The findings indicated that a PNF protocol can lead to a 20–30% increase in ROM compared to baseline measurements following a six-week intervention. Additionally, immediate improvements of 10–15% in ROM were noted after just one session of PNF stretching. Overall, PNF stretching was found to be more effective than static stretching and IASTM for enhancing hamstring flexibility, making it a valuable approach for clinicians and rehabilitation practitioners.

Proprioceptive and Balance-focussed Exercise Training in Patients with Chronic Ankle Instability: A Narrative Review

Vanshika Uppal, Sunita Sharma, Yashasvi Parmar

Chronic ankle instability (CAI) is a prevalent disorder characterised by recurrent episodes of ankle instability and related functional restrictions. It frequently lowers physical activity levels and reduces quality of life. Up to 70% of people who have acute ankle injuries develop CAI, a common side effect of lateral ankle sprains. Decreased proprioception, muscle weakness, and changed movement mechanics are common in people with CAI, and these symptoms increase the risk of recurrent injuries and cause ongoing. It has been shown that proprioceptive and balance-focussed exercise training can be a useful strategy for addressing these problems. Consolidating the most recent data on the effectiveness of various therapies for people with CAI is the goal of this narrative review. To find studies on different aspects of proprioceptive and balance-focussed exercise training, a comprehensive literature review covering the years 2015–2024 was carried out using the PubMed and Scopus databases. The review concentrated on how it enhanced ankle joint functional performance, joint position awareness, and dynamic balance. The promising initial results underscore the necessity of extensive research to improve procedures, address discrepancies, and assess long-term results. The findings suggest that proprioceptive and balance-focussed exercise training improves functional performance and enhances ankle stability among patients undergoing rehabilitation training. Despite the heterogeneity in study designs, exercise protocols, and outcome measures, the overall evidence supports the effectiveness of rehabilitation in CAI. This review identifies opportunities for further research, including long-term effectiveness and the creation of standardised protocols, while highlighting the clinical value of proprioceptive and balance-focussed exercise training in the treatment of chronic ankle instability.

Effect of Myokinetic Stretching Technique on Pain and Range of Motion in Individuals with Upper Trapezius Trigger Points: A Study Protocol

Shivani Chauhan, Simranjeet Kaur, Nidhi Sharma, Navneet Kaur

Introduction: The most common causes of non specific neck pain are myofascial or mechanical disorders. Among these, trigger points is the most important broad, long- lasting muscle disorder that impact people of all ages and socioeconomic backgrounds, irrespective of their work, physical characteristics, or degree of physical activity. An innovative technique for managing trigger points is the Myokinetic Stretching Technique (MST), a form of myofascial release, which involves active or passive stretching and movement as well as muscle energy techniques until a desirable release from the taut band is achieved. Need of this study: In patients with upper trapezius trigger points, the MST is expected to improve cervical range of motion, improve the pain pressure threshold, and substantially reduce pain intensity. Aim: To evaluate the efficacy of the MST in reducing pain and improving range of motion in individuals with upper trapezius trigger points. Materials and Methods: A quasi-experimental study will be conducted on 40 individuals; aged 20-30 years with active upper trapezius trigger points. Participants will be undergoing two-week intervention involving MST thrice per week (total 6 sessions) on alternate days. Pain intensity will be measured using the Numerical Pain Rating Scale (NPRS), Pressure Algometry will be used to measure Pain Pressure Threshold (PPT), Universal goniometry will be used to measure Cervical Range of Motion (CROM) and Neck Disability Index (NDI) will be used to assess functional disability of neck. Pre- and Post-intervention data will be analysed. Ethical approval was granted by the institute’s Ethics Committees (IEC- 2996) and the CTRI registration number CTRI/2024/09/073719.

The Effect of the Different Sensitisers of Straight Leg Raise on Conduction Velocity Characteristics of Sciatic Nerve in Individuals with Sciatica using Nerve Conduction Velocity Parameters: A Cross-sectional Study Protocol

Abhishek Mandal, Mandeep Kumar Jangra, Akanksha Saxena

Introduction: The Straight Leg Raise (SLR) is the most commonly applied physical test for individuals with sciatica.During SLR, sensitizers like hip internal rotation, adduction, and ankle dorsiflexion are used to create tension along the sciatic nerve and to confirm the diagnosis. As stretching myelinated nerves increases Nerve Conduction Velocity (NCV), these parameters can help identify the most effective sensitizer. Aim: The aim of the present study is to investigate the most sensitising position of SLR that subjects the sciatic nerve to excessive stress using NCV parameters. Materials and Methods: Fifty males and females, aged 17 to 65 years, will be recruited if their pain is radiating to lower limb, or are diagnosed with sciatica. Subjects were excluded if they had any lower limb and spine pathology, any metabolic disorders, tumour or malignancy or any progressive neurological condition. SLR will be then performed with using three different sensitizers like neck flexion, hip adduction and internal rotation, and ankle dorsiflexion in varying range of motion. The motor NCV and the Numerical Pain Rating Scale (NPRS) scores will be then noted to assess the most sensitizing position. Results: Data will be analysed using the Statistical Package for Social Sciences (SPSS) software. Normality will be assessed using the Shapiro-Wilk test and if data found to be normally distributed it will be presented as mean±SD and if not normally distributed as median (interquartile range). Conclusion: The study results show that the position of the leg during the SLR may significantly impact how the sciatic nerve conducts signals. This finding highlights the sensitivity of nerve conduction to changes in body position, offering valuable information for healthcare professionals in diagnosing and treating conditions like sciatica. This approach may enhance both the mechano-sensitivity and conduction velocity of the nerve, thereby helping the clinician to select the particular sensitizer for neural testing.

Exploring Biomechanical and Muscle Activation Pattern Changes in Different Grades of Osteoarthritis Knee: A Narrative Review

Aiyesha Khatun, Sunita Sharma

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease that severely limits functional movement, especially during sit-to-stand (STS) tasks. The biomechanical changes that accompany KOA development affect joint moments, muscle activation, and movement choices. Understanding these alterations is critical for developing effective rehabilitation methods.This narrative review aims to synthesise studies on the biomechanical and muscular activation aspects of the STS task in individuals with varied degrees of KOA. It focusses on discovering compensating methods, kinematic and kinetic differences, and how these relate to treatment therapies. A literature search was conducted across multiple databases, including PubMed, Scopus, and Web of Science, focussing on studies published between 2016 to 2024. Keywords such as “knee osteoarthritis,”“biomechanics,”“sit-to-stand task,” and “muscle activation” were used to identify relevant articles. Inclusion criteria involved studies that analysed kinematic and kinetic parameters during the STS task in KOA patients. Data from selected studies were reviewed and synthesised to identify key findings Depending on the severity of the disease, KOA patients use a variety of compensatory techniques throughout the STS task.Patients with mild KOA have decreased knee-ankle angular velocity, increased pelvic Range of Motion (ROM), and changed sagittal plane motions. Muscle activation patterns show that the vastus lateralis and gluteus medius are less engaged, while the biceps femoris is more activated in response. Severe KOA patients showed trunk flexion, trunk obliquity, and execution time variation indicating functional constraints and compensatory strategies. The hip joint contributes significantly to the overall support moment during the STS activity in both mild and moderate KOA. Patients with moderate KOA show increased trunk flexion and decreased knee joint contribution, which suggests a knee load reduction strategy.The reviewed studies demonstrate how biomechanical abnormalities in KOA evolve from mild to severe phases, highlighting the significance of individualised rehabilitation techniques. Increased trunk flexion and modified joint contributions are examples of compensatory mechanisms that are essential for reducing knee load and controlling pain.

Effect of Muscle Energy Technique on Hamstring Flexibility: A Literature Review

Akanksha Sharma, Amita Aggarwal

Muscular flexibility is an essential aspect of normal human function. Limited flexibility has been shown to predispose a person to several musculoskeletal overuse injuries and to affect a person’s level of function significantly. Hamstring tightness is a causative factor for reduced range of motion and can lead to reduced flexibility of the pelvis, hip and knee. The hamstring muscle is a two-joint muscle significant for hip extension, knee flexion, and pelvic posterior tilt movement. Muscle Energy Technique (MET) is a manual technique, also termed an active muscular relaxation technique, used for various purposes, including lengthening of a shortened muscle and contraction of a subject’s muscle in a controlled direction against the resistance provided by the physical therapist. MET has shown an improved range of motion, increased muscle strength and pain reduction. A literature review of randomised controlled trials was conducted in PubMed. The following terms have been extensively searched: “Hamstring muscle,” “Tightness,” “Muscle energy technique,” and “Muscle stretching exercises.” Randomised controlled trials, original papers in full text, and studies written in English were included in this review. The outcomes studied were hamstring length test (using active knee extension and straight leg raise). A total of 6 articles were selected based on inclusion criteria. Four articles included active knee extension, and two included straight leg raises. The study concluded that the MET was effective in increasing the hamstring muscles’ flexibility.

Effectiveness of Manual Therapy among Patients with Adhesive Capsulitis: A Literature Review

Vaishali Gupta, Amita Aggarwal

Frozen shoulder, or adhesive capsulitis, is a common shoulder condition that causes pain and a progressive loss of glenohumeral mobility. It is categorised as either primary or secondary. Primary idiopathic frozen shoulder can occur with other illnesses. Secondary adhesive capsulitis may develop following shoulder injuries or immobilisation. There are four stages of adhesive capsulitis development: inflammatory, freezing, frozen, and thawing. The first conservative treatment for adhesive capsulitis is rehabilitation; other recommended treatments include anti-inflammatory medications, intra-articular corticosteroids, injections for capsular distension, and surgery. Manual therapy involves a medical professional (such as a physiotherapist) moving the joints and other structures. A literature review of Randomised Controlled Trials (RCTs) was conducted in PubMed and Embase. The following terms have been extensively searched: manual therapy, joint mobilisation, manipulation, frozen shoulder, peri arthritic capsulitis and adhesive capsulitis. RCTs and studies written in English from 2015 to 2025 were included in this review. The outcomes of interest were pain, shoulder Range of Motion (ROM) and disability. Out of 74, 10 articles were selected in the study based on inclusion criteria. All articles recorded pain (using VAS or NPRS), while five reported ROM and function (shoulder pain and disability index). The results showed that manual therapy is strongly recommended for pain relief, improvement of ROM, and functional status in patients with adhesive capsulitis. The evidence suggests that manual therapy effectively decreases pain and increases ROM in patients with adhesive capsulitis. The best outcomes are often seen with early intervention, combining manual and exercise therapy.

Neural Mobilisation Techniques: A Comprehensive Review of Methods and Applications

Shahrukh Ansari, Shantha Kumar

Neural mobilisation treatments are specific therapeutic procedures that improve nerve mobility, reduce neural tension, and relieve symptoms caused by nerve compression or irritation. They are often used to treat upper-limb diseases like carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome. Mobilisation treatments for the upper limb are mainly directed at the median, radial, and ulnar nerves. Median nerve mobilisation includes procedures like nerve gliding and tensioning, which target wrist, elbow, and shoulder motions to improve neural mobility. Radial nerve mobilisation addresses entrapment locations by including sliding and tensioning motions with wrist flexion, elbow extension, and forearm pronation. To reduce tension and enhance function, ulnar nerve mobilisation applies techniques like gliding and tensioning through actions of elbow flexion, wrist extension, and shoulder abduction. Nerve flossing and oscillatory treatments are two general procedures that induce neural desensitisation and increase total nerve mobility. Functional approaches frequently include cervical motions or manual treatment to address proximal nerve involvement and improve results. Individual examination determines the approach used, which targets specific neurological pathways and efficiently addresses symptoms. Neural mobilisations should be supervised by a certified therapist to best achieve positive effect with adequate safety measures with effectiveness. Some of these techniques greatly enhance mobility with decreased pain as well as facilitating recovery in both the functional capacities of patients that have upper-limb neuropathy. However, caution should prevail with the approach since movements done must not stir up symptoms, so adjustments accordingly should be established.

Exploring The Impact of Prolonged Screen Time on Balance Abilities: A Scoping Review

Tamanna Sharma, Nidhi Sharma, Preeti Kapri

Balance is defined as the ability to maintain the body’s position and stability, involving the coordinated functioning of the vestibular system, sensory input, and motor control. In today’s world, the use of electronic devices such as televisions, computers, tablets, and mobile phones has become integral to daily life. Prolonged screen time, typically defined as four or more hours of screen use per day, has been associated with various physical and cognitive effects, including compromised balance, particularly in middle-aged and elderly individuals. This scoping review investigates the impact of prolonged screen time on balance abilities in individuals. To explore this connection, a comprehensive literature search was performed across multiple databases including PubMed, The Cochrane Library, Scopus, and OVID, covering studies published from December 2000 to December 2024. The initial search identified 4,841 articles, which were refined to 1,563 articles after removing duplicates. Following a screening process for relevance, five studies met the inclusion criteria and were included in the final review. This review adhered to the scoping methodology described by Arksey and O’Malley, Levac et al., and the Joanna Briggs Institute. The results of the reviewed studies suggest a significant correlation between prolonged screen time and impaired balance. Specifically, daily screen time exceeding four hours was found to have a detrimental effect on balance abilities. These negative effects were attributed to poor posture, musculoskeletal pain, and proprioceptive deficits. In addition to these factors, prolonged screen time is also linked to visual fatigue, poor posture, and mental fatigue, all of which can negatively influence balance. Though the findings demonstrate a clear relationship between prolonged screen time and balance impairment, the area remains an evolving field of study. Further research is required to fully understand the long-term effects of screen time on balance and overall physical health.

Impact of Neuromuscular Exercises in Management of Tibiofemoral Osteoarthritis: A Narrative Review

Mahavir Singh, Manu Goyal, Aditi Popli

Knee osteoarthritis (OA) is a widespread degenerative joint condition that affects approximately 53% of individuals with self-reported symptomatic OA, primarily older adults. Characterised by pain, functional limitations, and reduced quality of life, it often targets the medial tibiofemoral compartment, making daily activities increasingly challenging. Neuromuscular exercises have gained attention as a therapeutic intervention to address these issues, improving biomechanics, functional performance, and muscle activation patterns. This review evaluates the impact of neuromuscular exercises on pain relief and physical function in patients with medial knee OA. A systematic search of Scopus, PEDro, and PubMed databases covering studies from 2015 to 2024, identified five studies that met the inclusion criteria.The findings reveal that neuromuscular exercises are highly effective in reducing pain and enhancing mobility in individuals with tibiofemoral OA. These exercises improve joint stability, strengthen surrounding musculature, and optimise movement patterns, contributing to better overall function and quality of life. However, the limited number of studies on this subject underscores the need for further research to validate these benefits and explore the full potential of neuromuscular exercise as a treatment option.This review highlights the promising role of neuromuscular exercises in managing tibiofemoral OA and encourages continued exploration to provide more robust evidence for integrating these interventions into standard care protocols for osteoarthritis management.

Hindi Translation and Validation of American Shoulder and Elbow Surgeons Shoulder Assessment Form: A Study Protocol

Shweta Sharma, Gurjant Singh, Nidhi Sharma

Introduction: The American Shoulder and Elbow Surgeons Shoulder Assessment Form (ASES) includes two sections: the physician assessment and the patient self-evaluation. It is valuable for assessing the functional abilities and pain levels of patients with different shoulder conditions, which often impact their daily activities. It has been already translated into many languages, yet to be translated into Hindi. Need for this study: This study will provide a Hindi-translated version of ASES and content validity of patients having shoulder pathologies will be determined. Aim: The purpose of this study is to translate the ASES into the Hindi version and to evaluate its validity. Materials and Methods: The study method incorporates the Beaton guidelines which include the translation of the ASES in the Hindi language from English by two translators i.e.T1 and T2 from medical and non-medical backgrounds. The recording observer then takes a seat to create a T12 version of the translated scale. The reverse translation from the T12 form to the previous form will be done. The expert panel analyses all the stages and items so that the translated form is free of errors, allowing it to be field-tested. Evaluation of the content validity will be done. The pre-final form is then fully tested on patients, and the validity will be reported. Finally, the translated scale version will be analysed by the ethics committee.

Impact of Swiss Ball Exercises on Enhancing Core Stability and Physical Fitness in Athletes: A Narrative Review

Ritu Raj Singh, Sunita Sharma

Swiss ball exercises have gained popularity in physical education and therapy because they improve core stability, muscular strength, flexibility, endurance, and balance. The Swiss ball is a multipurpose training and therapy item that enhances proprioception and engages a variety of muscle groups due to its dynamic and unstable nature. This review was conducted to investigate the uses of Swiss ball exercises in athletic training and rehabilitation, as well as their impact on physical fitness measures like core strength, agility, balance, flexibility, and endurance. A literature search was conducted across multiple databases, including PubMed, Scopus, and Web of Science, focussing on studies published between 2020 to 2024.This review summarises study including quasi-experimental and randomised controlled trials exploring the impact of Swiss ball exercises. The studies included male participants, primarily aged 18– 25 years, comprising students, untrained individuals, and athletes. Pre- and post-intervention assessments measured physical fitness parameters, including core strength (McGill’s core endurance tests), agility (Illinois Agility Test), flexibility (sit-and-reach test), muscular strength, and endurance (dynamometry, push-ups, and crunches). Results were compared against control groups or traditional exercise regimens.Swiss ball activities, as opposed to conventional exercises or control groups, markedly increased muscular endurance, flexibility, balance, agility, and core strength. There was no improvement in leg strength, but there were noticeable gains in back strength. Circuit training combined with Swiss ball workouts produced further improvements in endurance and flexibility. These exercises improved proprioception and neuromuscular coordination by demonstrating superior stabilising muscle engagement. Exercises using Swiss balls are a great way to improve several aspects of physical fitness, including balance and core strength. Their ability to train proprioception and neuromuscular coordination makes them very promising for enhancing athletic performance and preventing injuries.

Applications and Efficacy of Russian Current Therapy in Musculoskeletal Rehabilitation: A Narrative Review

Suraj Pradhan, Sunita Sharma

Russian current is a medium-frequency sinusoidal alternating current with a frequency of 2500 Hz. Initially developed for athletic training, it has been integrated into physiotherapy for musculoskeletal conditions as its characteristic feature is increasing muscle strength. Its use has been integrated into physiotherapy for other conditions, including osteoarthritis, post-surgical recovery, and injury rehabilitation. A narrative review was conducted by searching databases like PubMed, and Scopus for articles published between 2010 and 2024. The review summarises findings from five randomised controlled trials and one case study. Inclusion criteria were studies focussing on Russian current application of quadriceps muscle strengthening, clinical efficacy, and comparative outcomes like Hand-held Dynamometer (HHD). Findings were then synthesised qualitatively. The review revealed that Russian current therapy enhances quadriceps strength, reduces pain, and improves functional mobility in various musculoskeletal conditions. Comparative studies indicate that combining Russian current with isometric or dynamic exercises yields exceptional results. However, variability in parameters such as duty cycle, amplitude, and session duration impact the comparability of results across studies. Russian current therapy demonstrates significant benefits in musculoskeletal rehabilitation, particularly for improving muscle strength and reducing pain. While the modality shows potential for improving muscle strength and endurance, inconsistent treatment protocols limit its widespread clinical application. Standardised protocols and long-term outcome studies are needed to optimise its clinical application.

Determining the Effect of Dual-task Training and Virtual Reality on Cognitive-motor Interference in Patients with Parkinson’s Disease: A Three-arm Single-blinded Multicentered Study Protocol

Sandhya Saini, Nidhi Sharma

Introduction: In Parkinson’s Disease (PD), rehabilitation is a high-potential strategy for enhancing mental and physical abilities. Numerous studies have examined the impact of dual-task training on enhancing gait, balance, motor symptoms, and cognitive function in individuals with PD. Research have shown that virtual reality significantly enhances gait and balance in patients with PD compared to traditional therapy. However, there is a scarcity of literature that explores the combined effects of Dual-task Training (DTT) and Virtual Reality (VR) on Cognitive-Motor Interference (CMI) in individuals with PD. Need for this study: DTT effectively improves cognitive deficits, while VR enhances motor abilities in individuals with PD. Hence, it would be expected that the combined treatment can greatly benefit the patients with PD. Aim: To determine the effect of DTT and VR on CMI in patients with PD. Materials and Methods: The participants recruited in this study protocol will be between 50 and 70 years old and randomly allocated into three groups. For five times a day for four weeks, experimental group 1 will receive treatment with VR, group 2 will receive DTT and group 3 will receive combined treatment of group 1 and group 2. Outcome measures, such as a modified version of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment (MoCA), and the Timed Up-and- Go test (TUG), will be used to assess the subject pre-intervention and post-intervention.

The Role of Digital and Wearable based Exercise Programme in Weight Management and Cardiorespiratory Fitness in College Students: A Narrative Review

Shivi Bajpai, Neha Kashyap, Shikha Singh

Significant health hazards, such as decreased cardiovascular fitness and increased metabolic disorders, are associated with the rising overweight and obesity among college students. The use of wearable and digital technology to encourage physical activity and enhance health outcomes in young adults presents a promising path as these tools become more and more popular in fitness and health management. In order to help overweight college students maintain their weight and improve their cardiovascular fitness, this study investigates the potential of wearable and digital workout regimens. Physical activity, heart rate, calorie expenditure, and sleep habits may all be tracked in real time with digital platforms and wearable technology like fitness trackers, smart watches, and smartphone apps. According to research, these kinds of treatments may greatly improve adherence to physical activity recommendations, which leads to quantifiable gains in cardiorespiratory endurance and body composition. Using MeSH phrases such as “cardiorespiratory fitness,” “overweight,” “wearable electronic devices,”“fitness trackers,” and “young adults,” a thorough search was conducted throughout databases like as PubMed, PEDro, Google Scholar, Ovid, and others. According to the inclusion and exclusion criteria, articles published within the previous five years were included. In this we found that anthropometric measurements have been significantly impacted by the incorporation of structured exercise regimens, such as resistance training, High-intensity Interval Training (HIIT), and aerobic training, through digital platforms. In addition to improved fat oxidation and the retention of lean muscle, studies show decline in body weight, Body Mass Index (BMI), and waist circumference. Several devices like Xiaomi 8 smart watches, Myworkout GO, Fitbit charge 5, Apple watch series 8 have shown good results. Additionally, gains in cardiovascular fitness, as demonstrated by elevated VO2 max and decreased resting heart rate, demonstrate how well wearable-based therapies support cardiovascular health. The potential of wearable and digital exercise regimens as efficient, scalable, and user-centered approaches to college students’ weight management and cardiovascular health is highlighted by this review. These initiatives can enable young individuals to create long-lasting habits for a healthier future by fusing technology with conventional health promotion initiatives.

Efficacy of Different Clinical Diagnostic Tests and their Psychometric Properties in Diagnosing Piriformis Syndrome

Apoorva Saini, Mandeep Kumar Jangra, Akanksha Saxena

Piriformis Syndrome (PS) is caused by the sciatic nerve compression in the gluteal region causing pain, tingling and numbness in the buttock and the nerve pathway down to lower thigh and into leg. Diagnosing PS is quite difficult and is often misinterpreted. So, there is a need to identify various clinical diagnostic tests and their accuracy. To explore different clinical diagnostic tests, criteria and their psychometric properties for diagnosing PS. Total 516 full-text published articles were identified from PubMed, Scopus and Science Direct from 2012-2024. Only full text prevalence/incidence, review articles and observational studies on individual with PS were included. After duplicate deletion from Mendeley, 225 articles were left to screen at title and abstract level. Finally, 26 full text articles related to research topic were further analysed at full-text level. Out of which only 5 articles were selected and included in the review for analysis. Various clinical diagnostic tools including FAIR, Beatty test, Hand on Hip sign, SLR, active piriformis and seated Piriformis stretch test are available defined to be reliable and valid measures for the study.The SLR had sensitivity of 0.15, specificity of 0.95, Active piriformis test had sensitivity of 0.78, specificity of 0.80, Seated piriformis stretch test had sensitivity of 0.52, specificity of 0.90, the FAIR test had sensitivity and specificity of .88 and .83, HHS was found to have a sensitivity of 86% and a specificity of 75%. We found two clinical criteria also in which one is utilising clinical symptoms and diagnostic imaging to diagnose PS while another one took into account clinical symptoms, clinical diagnostic tests, aggravating and relieving factors to diagnose PS. The scoping review concludes that various clinical diagnostic tests, like Flexion, Adduction, Internal Rotation (FAIR), Beatty maoeuver, Straight Leg Raise (SLR), active piriformis test and seated piriformis stretch test are sensitive and specific tools in diagnosing PS.

Efficacy of Balance Training in Patients with knee Osteoarthritis: A Literature Review

Bibhujit Mishra, Amita Aggarwal

Knee Osteoarthritis (OA), affecting 30-40% of people by the age of 65 years, is a leading cause of mobility issues and disability, particularly in the knee joint. OA commonly results in decreased proprioception and balance, increasing fall risk. Balance exercises are recommended to improve stability and reduce falls in elderly patients with knee OA. The review aims to evaluate the efficacy of balance training in patients with knee OA. The database was searched on PubMed from 2014 to 2024. The search utilised MeSH keywords, including knee OA, balance training, and proprioception exercise, using Boolean Operators (AND/OR/NOT). Out of 2617 articles in the database, 4 fulfilled the eligibility criteria and were included in the present review. Four studies specifically examined the impact of balance training on knee OA. These studies primarily utilised outcome measures such as the WOMAC Questionnaire and the Visual Analogue Scale to assess function and pain. Out of 4 articles, two studies have demonstrated the significant impact of balance training on pain using the Visual Analogue Scale, and all four studies have consistently shown significant improvements in function by using WOMAC as an outcome measure among individuals with knee OA. The review concludes that balance training interventions effectively improve pain and function in individuals with knee OA, as evidenced by significant improvements in pain and functional outcome measures.

Reference Values of Mass Grasp, Toe-toexaminer’s Finger and Alternate Heel-to-knee; Heel-to-toe Test among Young Adults

Priyanka Negi, Nidhi Sharma, Preeti Kapri

Introduction: Coordination refers to the mechanism by which the brain and body work together to produce controlled and purposeful movements. This process involves This process involves the integration of sensory information—such as visual, auditory, and proprioceptive inputs—with motor functions to effectively perform tasks. It includes both gross and fine motor skills, as well as motor planning. Coordination can be evaluated through both non-equilibrium and equilibrium coordination tests. Aim: This study aimed to determine the reference values for the mass grasp test, toe-to-examiner’s finger test, alternate heel-to-knee test, and heel-to-toe test among healthy young adults aged 18 to 25 years. Materials and Methods: The study recruited 466 participants aged 18 to 25 years through convenience sampling, ensuring that individuals met predetermined eligibility criteria. The sample comprised an equal gender distribution. Each participant was instructed to perform three specific motor tests; the mass grasp test, toe-to-examiner’s finger test, and the alternate heel-to-knee; heel-to-toe tests. Participants completed three trials for each test. The readings for both the right and left limbs were recorded in each trial by using a mobile based stopwatch. The tests were administered in a consistent order to minimise variability.Ethical approval was obtained from the MMIMSR (Maharishi Markandeshwar Institute of Medical Sciences and Research) Mullana, Ambala, with the ethical number IEC-2672. Results: Age, height, weight and Body Mass Index (BMI) of recruited young adults were 21.61+2.02 years, 165.43+9.16 cm, 61.00+10.60 kg, and 22.25+2.83 kg/m², respectively. The reference values obtained for the mass grasp test were (0.28±0.073) milliseconds for the right limb and (0.27±0.70) milliseconds for the left limb. For the toe-to-examiner’s finger test, the values were (0.96±0.20) milliseconds for the right limb and (0.94±0.20) seconds for the left limb. For alternate heel-to-knee and heel-to-toe tests were (1.94±0.51) milliseconds for the right limb and (1.92±0.52) milliseconds for the left limb, respectively. Conclusion: Reference values for the mass grasp test, toe-to-examiner’s finger test, and alternate heel-to-knee and heel-to-toe tests in young adults aged 18 to 25 years have been established.

Study Protocol on Effect of High-Intensity Functional Training on Visuospatial Working Memory in Middle-aged Adults

Abhishek Aaryan, Nidhi Sharma

Introduction: Visuospatial Working Memory (VSWM) is necessary for people to live, study, and work effectively. Impairment or degeneration in VSWM can lead to disruption in performing Activities of Daily Living (ADL’s). Physical activity has received a lot of attention as a preventative measure for neurocognitive health and as an alternative to drugs to lower blood viscosity. Need for this study: Physical activities might help in improving VSWM and researches in this field are being conducted to understand the importance of physical activities in enhancing the VSWM Aim: To determine the effect of High-intensity Functional Training (HIFT) on Visuospatial Working Memory (VSWM) among middle-aged adults. Materials and Methods: A total of n=34 middle-aged adults will be recruited according to specified inclusion and exclusion criteria, using a convenience sampling method in a single-group pre-post design. The intervention will consist of a HIFT protocol, and using the N-back test and Corsi block-tapping tasks as an outcome measure. These outcomes will be assessed twice: pre intervention and after completing 3-months intervention. Each HIFT session will begin with a dynamic warm-up, followed by a structured sequence high-intensity, anaerobic and aerobic exercises. After each round, participants will have 2-minutes rest, repeating this cycle five times per session. Each session will end with a 5-minutes cool-down involving stretching exercises.

Impact of Hand Eye Co-ordination Training in Table Tennis Players: A Literature Review

Pinky Chauhan, Mandeep K Jangra, Probhjot Singh Nalwa

Table tennis and other sports requiring accurate interceptive movements depend heavily on Hand-eye Coordination (HEC). Numerous studies demonstrate how HEC improves all aspects of sports performance, such as serve practice, stroke accuracy, and game-specific abilities. With an emphasis on its function in performance enhancement and real-world applications, this study looks at previous studies to evaluate the effects of HEC training on table tennis players. This review aimed to explore the effects of hand-eye coordination training programmes on table tennis players’ motor skills, game-specific performance. Databases such as Google Scholar, Web of Science, Scopus, EBSCO, and PubMed were used to review research material from 2011 to 2024 using keywords like HEC training, table tennis, and injury prevention. Five studies out of a starting pool of 1327 publications satisfied the requirements for inclusion. These experimental investigations includes techniques involving audiovisual aids, reaction drills, and sport-specific exercises to improve HEC. The duration of the interventions was 4–8 weeks. Paired t-tests, MANOVA, and Pearson’s correlation coefficients were used for the data analysis. Review showed there was improvement in players’ motor skills, sensory performance, serve accuracy, and backhand stroke precision. The participants who received HEC training performed significantly better than those in control groups and also shows male participants often performed better than female participants. Focused HEC training strongly improved key performance skills, enhancing players’ overall abilities. Regular training regimens that include these activities enhance response times, serve skills, and stroke accuracy. To optimise player growth, coaches are urged to use cutting-edge HEC training methods including audiovisual aids and quick-reaction drills.

Calming Distress- Impact of Relaxation and Chest Proprioceptive Neuromuscular Facilitation Technique in Neonatal Respiratory Distress Syndrome: A Case Series

Payal Mehta, Shweta Sharma

Respiratory Distress Syndrome (RDS) in neonates is a critical condition, due to insufficient surfactant production in the lungs. Majorly, preterm neonates are at a huge risk of respiratory complications due to immature lung formation and alveolar collapse. The clinical signs of Respiratory Distress are usually cyanosis, grunting, chest wall retractions and irregular respiratory rate and abnormal breathing pattern. Thus, in this case, therapeutic interventions are necessary to promote relaxation and improve the pattern of breathing to avoid severe complications like hypoxia or respiratory failure. With this perspective in mind, this case series highlights a detailed history of prenatal, natal and post natal assessment of mother and baby along with necessary observations and detailed anthropometric measurements and thorough cardio-respiratory examination of the neonates. It demonstrates how Relaxation techniques and Chest Proprioceptive Neuromuscular Facilitation (PNF) techniques provided every two weeks for ten days on infants with RDS shows improvement. Warm light touch, soft-voiced communication, tucking position facilitation, soft rocking, olfactory stimulation with mother’s milk, and parental audio engagement were among the relaxing techniques used in the intervention. Low vertebral pressure, thoracic squeezing, mild chest percussion, intercostal stretching, and perioral stimulation were all used in chest PNF techniques. The neonates were on non-invasive breathing support with Continuous Positive Airway Pressure (CPAP) and exogenous surfactant treatment. Assessments conducted before and after the intervention showed notable clinical improvements in terms of oxygen saturation (spO2) level, Silverman- Anderson Score (SAS) and Neonatal Infant Pain Score. The Arterial Blood Gas (ABG) analysis has also remarkably shown transition from respiratory alkalosis to mild respiratory acidosis. This underscores how a collaborative approach achieves successful outcomes in saving lives.

The Impact of Advanced Therapeutic Modalities in Managing Plantar Fasciitis using the Foot Function Index: A Literature Review

Sanam Maurya, Sunita Sharma, Shavez Mansoori

Plantar Fasciitis (PF), an inflammatory condition affecting the plantar fascia, causes heel pain and limits foot function.Traditional treatments include stretching,orthotics, and physical therapy. Advanced therapies may improve treatment outcomes by stimulating tissue healing.The aim of this literature review is to critically evaluate existing research on the impact of advanced modalities on foot function and pain in plantar fasciitis by using Foot Function Index (FFI). A literature search was conducted from Pubmed, Cochrane Library, and PEDro from year 2018 to December 2024. The search utilised MeSH key terms such as “Plantar fasciitis,” “Advanced modalities,” “Foot function index,” “Quality of life,” and “Range of motion” employing Boolean operators (AND, OR). A total of 7856 articles found from different databases.Duplicate articles were removed. Five articles fulfilled the eligibility criteria and were included for the present review.The 7856 reviewed articles, 5 only those demonstrating the impact of advanced modalities such as laser therapy and shockwave therapy on foot function and pain in PF using the FFI met the inclusion criteria. This review demonstrates that advanced modalities significantly improve pain and function, as assessed by the FFI, in patients with PF. This review shows that shockwave and laser therapy can significantly improve foot function and reduce pain in PF patients, as measured by the FFI.

Study Protocol for a Single-blinded Randomised Controlled Trial Comparing the Effects of the Spray and Stretch Technique and Muscle Energy Technique on Pain and Functionality in Patients with Chronic Non Specific Neck Pain

Duyu Nunya, Gurjant Singh, Nidhi Sharma

Introduction: The second most prevalent musculoskeletal condition and the third leading cause of shortened life expectancy is neck pain. It is a common cause of disability for many individuals, leading to limitations in daily activities, reduced work productivity, and a diminished quality of life. Muscle Energy Technique (MET) uses patient-generated muscular contractions to increase strength and range of motion, whereas the spray and stretch technique uses a vapocoolant spray to help with muscle stretching. Although there is potential for managing Non Specific Neck Pain (NSNP) with both non-invasive methods. Aim: To plan a study protocol of spray and stretch technique in reducing pain and improving functionality in patient with chronic NSNP against MET on upper trapezius tightness. Materials and Methods: Patients will be recruited based on selection criteria. Subjects will be randomly allocated into group A and group B. Group A will receive spray and stretch technique with conventional therapy and Group B will receive Muscle Energy Technique (MET) with conventional therapy. Pre-test and post-test assessment will be done by using numeric pain rating scale, Neck Disability Index and Universal Goniometer. The treatment will be administered alternately three days a week for four consecutive weeks.

Effectiveness of Various Intensities of Laser Therapy in Managing Primary Dysmenorrhoea: A Systematic Review

Etika Rana, Subhasish Chatterjee, Sudhamoy Maity, Mousumi Saha

Primary dysmenorrhea, characterised by painful menstrual cramps without an underlying medical condition, significantly impacts the daily lives and well-being of many women worldwide. Traditional pharmacological treatments, while effective, are often associated with side effects, prompting a need for safer, noninvasive alternatives. Laser therapy, particularly Low-level Laser Therapy (LLLT) and High-intensity Laser Therapy (HILT), has emerged as a promising approach. This review evaluates the effectiveness of various laser therapy intensities in reducing pain and improving quality of life in women with primary dysmenorrhea. A systematic search was conducted using databases such as PubMed, Scopus, Web of Science, and the Cochrane Library, covering studies published between 2000 and 2024. Relevant keywords included “primary dysmenorrhea,”“low-level laser therapy,” and “high-intensity laser therapy.” Out of 42 articles initially identified, 15 studies met the inclusion criteria based on relevance and methodological quality. Articles were excluded if they focussed on secondary dysmenorrhea, lacked clear outcomes, or were not peer-reviewed. The findings revealed that both LLLT and HILT are effective in reducing pain associated with primary dysmenorrhea. LLLT, particularly at 940 nm, showed progressive improvement with repeated use, while LED photobiomodulation at 630 nm also provided significant pain relief and enhanced quality of life. Additionally, hormonal analysis across studies reported reduced cortisol levels, indicating a physiological shift in pain perception. HILT, with its deeper tissue penetration, was especially effective for severe cases. Importantly, no adverse effects were reported in any of the reviewed studies. In conclusion, laser therapy, including both LLLT and HILT, offers a safe and effective alternative for managing primary dysmenorrhea. These modalities provide significant pain relief and improve overall quality of life, making them valuable nonpharmacological options. Future research should focus on standardised treatment protocols and exploring the long-term benefits of these therapies to optimise their clinical application.

Effect of Yogic Eye Exercises on Chronic Neck Pain with Visual Complaints: A Narrative Review

Sneha Thakur, Amita Aggarwal

Chronic neck pain is a common problem that is frequently accompanied by visual problems like eye strain, hazy vision, and headaches. These symptoms are commonly associated with poor posture, cervical spine dysfunction, and muscular stress. This narrative review aims to examine the effects of yogic eye exercises on chronic neck pain and related visual problems, exploring their potential to alleviate pain, reduce visual discomfort, and enhance overall health and well-being. Databases were searched on PubMed and EMBASE. The articles published in English from January 2014 to January 2025 were screened. Out of 155 articles identified in various databases, duplicate articles were removed, and five met the qualifying criteria. Eligible studies will consist of randomised controlled trials, cohort studies, and observational studies that evaluate the impact of yogic eye exercises (such as palming and eye rotations) combined with other yoga practices on chronic neck pain and visual complaints. Yogic eye exercises and other yoga practices show potential in treating chronic neck pain and visual issues. However, more research is needed to standardise protocols and confirm long-term benefits.

An Investigation of Physiotherapy Interventions in the Management of Lower Cross Syndrome: A Literature Review

Vaishali Rai, Sandeep Pattnaik

Lower Cross Syndrome (LCS), characterised by muscular imbalances with weak gluteals/abdominals, tight hip flexors/lumbar extensors, contributes to a range of musculoskeletal complications. Physiotherapy interventions have been its primary treatment modality. Given the increasing prevalence of sedentary lifestyles and the availability of diverse physiotherapy interventions,there is a critical need to understand the most effective physiotherapy interventions for managing LCS. This literature review, therefore aims to investigate the effectiveness of various physiotherapy interventions in managing LCS. To achieve this, an extensive search for full-text articles addressing the role of physiotherapy intervention for the treatment of LCS, published in the English language between 2019 and 2024, was thus carried out through the databases PubMed, EMBASE, Cochrane Library, PEDro and EBSCOhost using a combination of keywords, including 'Lower Cross Syndrome,' 'Postural Disorder,' 'Exercise Therapy,' and 'Physiotherapy,' and Boolean operators to refine the search strategy.No geographical limitations or study design restrictions were applied for study inclusion. Following the comprehensive search, a total of 5 randomised clinical/control trials and 2 experimental studies met the eligibility criteria. The study population comprised males and females aged between 11 and 50 years. The physiotherapeutic interventions included 6 to 24 sessions of conventional physiotherapy involving stretching and strengthening exercises and the use of specific manual therapy techniques like Janda’s approach, Sahrmann’s approach, muscle energy technique, proprioceptive neuromuscular facilitation technique, dynamic neuromuscular stabilisation training, and lacrosse ball massage technique. The effectiveness of these interventions was assessed using outcome measures, including the Oswestry Low Back Pain Disability Questionnaire for functional disability, Modified Thomas test and goniometry for hip flexibility, sit-and-reach test for overall flexibility, visual analogue scale and numeric pain rating scale for pain, manual muscle testing for abdominal and gluteal strength, Y-balance test and functional movement screening for postural control, McGill Pain Index and plank test for muscle function, and clinical measurements such as costovertebral angle, lumbosacral angle, and anterior pelvic tilt for postural assessment. Findings suggest that physiotherapy plays a crucial role in LCS management. A comprehensive approach encompassing strengthening, stretching, manual therapy, and patient education is recommended. Future research should focus on standardised protocols and long-term outcomes to enhance treatment efficacy.

The Role of Transcranial Direct Current Stimulation in Managing Pain and Enhancing Mobility in Knee Osteoarthritis: A Narrative Review

Yashasvi Parmar, Sunita Sharma, Vanshika Uppal

Knee osteoarthritis (OA) is a common condition characterised by chronic pain and reduced mobility, particularly in the elderly population. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, has proven to be a promising intervention in managing OA. This narrative review aims to synthesize existing evidence on the effectiveness of this intervention in patients with OA, with a primary focus on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale as a key outcome.A comprehensive literature search was conducted in PubMed and Scopus databases from 2017 to 2024 to identify studies that investigated various aspects of tDCS, including its effects on clinical and experimental pain, neurophysiological mechanisms, combination therapies, and feasibility in different settings, according to predefined eligibility criteria. The review summarises findings from randomised controlled trials and pilot studies. Evidence indicates that tDCS over the primary motor cortex with the cathode over the contralateral supraorbital area effectively reduces pain severity, enhances pain modulation mechanisms, and improves mobility in knee OA patients. The findings highlight that tDCS improves functional outcomes as measured by WOMAC and benefits in clinical and experimental pain modulation. Preliminary findings are promising, necessitating large-scale trials to optimise protocols, address inconsistencies, and assess long-term effects. This review underscores the clinical relevance of using tDCS in managing OA and identifies gaps for future research, in long-term efficacy and standardised protocols.

Exploring The Role of Virtual Reality Rehabilitation in Enhancing Recovery after Hip Arthroplasty: A Narrative Review

Amrita Kumari, Gurjant Singh, Nidhi Sharma

Total hip arthroplasty minimises symptoms and greatly enhances hip function and functional independence, making it one of the most significant surgical operations of the past century. It is among the most economical medical procedures in terms of both financial capabilities and the health advantages. Based on current epidemiological data and future forecasts regarding osteoarthritis and other degenerative bone and cartilage conditions, Virtual Reality (VR) system recreated authentic and artificial environments where patients can interact with (concentration) and experience as real (existence) using advanced software as well as equipment. The aim of the study is to determine the feasibility and acceptability of virtual reality rehabilitation in the context of hip arthroplasty recovery. A thorough literature search was conducted using key databases such as PubMed, Google Scholar from December 2000 to December 2024 comprising. The search utilised terms such as “virtual reality”, “hip arthroplasty” and “osteoarthritis” employing Boolean operators (AND, OR). After applying the exclusion criteria,a total of six studies were identified as meeting the required standards and were subsequently selected for the study. The non-English articles were excluded in this study.This study suggested the VR rehabilitation in enhancing recovery after hip arthroplasty. The potential advantages of VR rehabilitation in improving hip arthroplasty recovery are highlighted in this narrative review. VR rehabilitation offers significant advantages over traditional methods including improved functional outcomes, reduced pain, muscle strength, and discomfort and enhanced patient motivation to restore their functional capabilities making it an effective and innovative approach to rehabilitation.

Effectiveness of Motion Minder Therapy (MoMT) on Fine Motor Skills among Children with Spastic Hemiplegic Cerebral Palsy: A Pilot Study

Jeevarathinam Thirumalai, Vinodhkumar Ramalingam

Introduction: Motion Minder Therapy (MoMT) employs Motion Minder watches to provide tactile vibration prompts, enhancing hand function in spastic hemiplegic cerebral palsy children. This phase 1 study evaluates safety, acceptability and efficacy, laying the groundwork for larger-scale trials. Global cerebral palsy prevalence ranges from 1.5 to 3.4 cases per 1000 live births, varying by income level, while MoMT employs wearable technology to potentially enhance hand function and quality of life in neurological conditions. Aim: To evaluate the feasibility, safety, and acceptability of MoMT in enhancing fine motor skills among children with spastic hemiplegia. Materials and Methods: This pilot study was conducted at Aadhuraa Special School, Kanchipuram, with 5 children (age 9.6±1.81 years) diagnosed with spastic hemiplegic cerebral palsy. Children were screened using functional classification systems, including the Manual Ability Classification System levels I-III, Bimanual Fine Motor Function levels I-III, Modified Ashworth Scale levels I-III, and Communication Function Classification System levels I-III. Additionally, children had a Mini-Mental State Examination score of 15. The study outcomes were measured using the Shriners Hospital Upper Extremity Evaluation and ABILHAND-Kids assessments. Data were analyzed with Repeated Measures Analysis of Variance and Bonferroni post hoc tests. The study is registered with the Clinical Trials Registry - India (CTRI/2024/01/061490). Abbreviations DFA, GR, AKQ could not be expanded Significant improvements were noted in school function assessment (baseline: 27.80±3.56 to week 4: 36.20±5.01, p=0.010) and DFA (baseline: 37.40±12.44 to week 4: 57.80±8.65, p=0.011). GR improved from week 2 (3.80±0.447) to week 4 (5.00±0.70, p=0.08). AKQ showed a significant increase from baseline (26±3.16) to week 4 (37.60±5.31, p=0.04). Conclusion: MoMT effectively enhances fine motor skills in children with spastic hemiplegia. Despite measurement challenges, the intervention shows promise. Phase II will focus on refining therapeutic strategies and optimising outcomes.

The Use of Rehabilitation Technology in Functional Tests for Osteoarthritis (Oa) of the Knee: A Literature Review

Raj Kumar, Amita Aggarwal

Osteoarthritis (OA), a common disease in the aged, may cause the structural integrity of joints to gradually decline, indicating that OA affects 10-20% of the elderly population. Clinical symptoms of OA in the knee joints, such as joint stiffness, discomfort, and functional deficits, may harm the quality of life (QoL) of people with OA. Among those having knee OA, rehabilitation technology can improve their QoL and functional outcomes. This review aimed to identify different types of rehabilitation technology and assess their effectiveness in enhancing functional outcomes for individuals with OA in the knee. A literature search was conducted from PubMed, Scopus, and Embase Data Base from December 2020 to December 2025. The search utilised terms such as “rehabilitation technology”, “machine learning”, “knee osteoarthritis”, “patellofemoral arthritis”, and “tibiofemoral arthritis”, employing Boolean operators (AND, OR). Related review articles, systematic reviews, conference papers, and articles in languages other than English were excluded. Two hundred thirty-nine articles were found from three databases, out of which only five met the inclusion criteria. These studies suggest that rehabilitation technology (virtual reality, wearable sensors, tele rehabilitation platforms) effectively and significantly improves functional outcomes. The findings suggest that patients with knee OA may find rehabilitation technology helpful in improving functional outcomes. The included research quality varied, and several had methodological problems despite the encouraging data.

Foreign Body Aspiration in Paediatric Dental Practice: A Systematic Review

Kavita Rai, Deepshikha Mehrotra, R Nidhish Krishna, Athul Ramesh, R Manju

Introduction: Foreign Body Aspiration (FBA) is an acute event with a clinical presentation ranging from severe respiratory distress to minimal symptoms, and it may lead to life-threatening conditions. Foreign objects can vary significantly in shape and size and can become lodged in the gastrointestinal or respiratory tract. Aim: To review the available literature regarding the diagnostic methods, complications, and management strategies of FBA in paediatric dentistry. Materials and Methods: In the present systematic review, case reports and series on FBA in paediatric dental practice published until December 2023 were searched in various databases (PubMed, Scopus, and Google Scholar). Based on the inclusion criteria, 25 studies were selected, and symptoms, complications, anatomical locations, spontaneous passage, and management of these cases were assessed. The risk of bias was evaluated for the included articles using the Joanna Briggs Institute (JBI) critical appraisal checklist for case reports. Results: Out of the 25 studies, seven focused on aspiration and 18 on ingestion. Endodontic files were the most commonly aspirated and ingested foreign bodies. Aspiration or ingestion of burs, dental crowns, arch wires, orthodontic brackets, teeth, dental retainers, or clamps was also reported. Objects located in the stomach and intestines were more commonly passed spontaneously than those at any other site in the gastrointestinal system. Complications such as pleural effusion, lung abscess, or gastric ulcers were frequently reported when sharp-edged objects were involved, and these were managed through endoscopy followed by bronchoscopy. Conclusion: Based on the review of cases, endoscopy was the most commonly used technique for removing foreign bodies, with high success rates. Standard patient safety protocols, such as using a rubber dam, gauze, throat screen, and attaching dental floss to dental crowns, rubber dam clamps, and hand files, are recommended to prevent aspiration or ingestion of foreign bodies.

Plyometric Agility Training: Enhancing Basketball Skills and Performance: A Literature Review

Rishita, Shweta Sharma, Probhjot Singh Nalwa

Introduction: Agility is the capacity to maintain body position and quickly change the direction during sequence of motions. It is an essential factor in determining performance in basketball as it requires speed and quick decision-making skills. Agility training plays a crucial role in enhancing athletic performance like power, improved footwork, increased speed and strength, faster response and injury prevention. Agility training includes plyometric training, lateral plyometric jumps, shuttle runs, jump box drills. Plyometric agility drill training is found to have a significant effect among basketball players.It is used widely in training protocols for overall performance enhancement in basketball athletes. Aim: This study is intended to comprehensively explore the effects of plyometric agility training among basketball players. Materials and Methods: Research literature published from 2011 to 2024 was searched in Google scholar, Web of science, Scopus, EBSCO, PubMed databases with agility training, basketball, plyometric training as keywords. A total of 1000 articles were identified initially. On the basis of predefined inclusion and exclusion criteria, non English articles and duplicates were excluded. A total of 12 articles were included that met the specified criteria. Results: Studies showed that plyometric agility training can be effective at change of direction ability. The studies also stated that plyometric agility training improves jumping and sprinting in basketball players. Other study showed effectiveness of plyometric training in coordination and enhancing power among basketball players. Other studies indicated plyometric training improves explosive strength by increasing volume of muscle in lower limb, reducing jumping time and the rate at which force develops. Conclusion: This literature review concludes that plyometric agility training plays an important role in improving change of direction, jumping, sprinting , coordination ,explosive strength and enhancing power among basketball players.

Validation and Test Retest Reliability Testing of The Telematic Fugl Meyer Assessment Scale - Upper Extremity (TFMA-UE)

Muskaan, Subhasish Chatterjee, Mousumi Saha, Etika Rana

Introduction: Stroke remains a significant global health challenge, contributing to high rates of mortality and long-term disability. The Telematic Fugl Meyer Assessment Upper Extremity (Telematic FMA-UE) scale is a remote-friendly adaptation of the traditional FMA-UE, allowing for the assessment of sensorimotor impairments through telemedicine platforms. However, the absence of a validated Hindi version hinders its utility among the over 609 million Hindi speakers worldwide. Addressing this gap is essential to expanding access to remote stroke rehabilitation for Hindi-speaking populations. Aim: This study seeks to translate the Telematic FMA-UE scale into Hindi, validate the translated version, and examine its test-retest reliability in stroke patients who primarily speak Hindi. Materials and Methods: Permission from the original authors of the scale will be obtained prior to initiating a structured translation process. The scale will be translated into Hindi independently by bilingual professionals with expertise in healthcare and linguistics. The translations will then be harmonised into a unified version and back-translated into English to verify accuracy and equivalence. Content validation will involve an expert panel using the Delphi method to calculate Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index Average (S-CVI/Ave). The prefinal version will be tested on a small group of Hindi-speaking stroke patients to ensure its comprehensibility and cultural relevance. Test-retest reliability will be measured by administering the scale twice at a fixed interval, with consistency assessed through Intraclass Correlation Coefficients (ICCs) and Bland-Altman plots. Results: The Hindi adaptation of the Telematic FMA-UE scale is anticipated to exhibit strong content validity, reflected by high I-CVI and S-CVI/Ave scores. Additionally, reliability testing is expected to demonstrate robust ICC values and consistent results across assessments, as visualised through Bland-Altman plots. Conclusion: The validated Hindi version of the Telematic FMA-UE scale will serve as a reliable tool for tele-rehabilitation, improving accessibility and supporting more effective rehabilitation for Hindi-speaking stroke patients.

A Comparison of the Effects of Dynamic Cupping on Thoraco-lumbar Region and Suboccipital Myofascial Release on Cervicogenic Headaches: Study Protocol for a Single-blinded Randomised Controlled Trial

Trishala Rangare, Gurjant Singh, Nidhi Sharma

Introduction: Cervicogenic headache (CGH) is a caused by cervical spine dysfunction, often linked to muscle and fascia tension. Suboccipital Myofascial Release (MFR) and remote MFR are the manual therapy approaches used to alleviate CGH. Based on the principles of anatomical trains theory, MFR and dynamic cupping will be given on cervical and thoraco-lumbar regions. AT hypothesis has been validated by a few earlier researchers; however, none have applied it for thein CGH patients, the cervical area is painful, and applying dynamic cupping to a remote location can be more tolerant than suboccipital MFR for these patients. Need of this study: This study will determine the more effective technique of suboccipital MFR and remote release by dynamic cupping on CGH, potentially guiding improved treatment protocols. Aim: To plan a study protocol suboccipital MFR and remote release by dynamic cupping in improving pain, range of motion, and quality of life in individuals with CGH. Materials and Methods: According to eligibility requirements, 56 individuals between the ages of 20 to 30 years of age will be selected for a single blinded randomised clinical trial. Patients were allocated into group 1 and group 2. Group 1 will receive suboccipital MFR and Group 2 will receive dynamic cupping therapy on thoraco-lumbar region. Outcome measures like the numeric pain rating scale (NPRS) and neck disability index will be used to assess the subject pre-intervention and post-intervention.

Study Protocol for a Single-blinded Randomised Controlled Trial Comparing the Impact of Neuromuscular Joint Facilitation and Conventional Physiotherapy on Pain, Balance, and Function in Patients with Knee Osteoarthritis

Anchal, Gurjant Singh, Nidhi Sharma

Introduction: The increasing prevalence of osteoarthritis (OA), especially in the knee joint, highlights the need for effective rehabilitation strategies to manage symptoms and enhance functionality. Sensorimotor dysfunction plays a role in the progression of knee OA. However, evidence supporting the effectiveness of neuromuscular joint facilitation (NJF) that comprehensively targets sensorimotor components such as, balance, coordination, and proprioception remains limited. Therefore, this study aimed to evaluate the efficacy of NJF incorporating these elements on pain, functional outcomes, and balance in individuals with grade 2 and 3 knee OA. Aim: To plan a study protocol for neuromuscular joint facilitation and conventional physiotherapy techniques in reducing pain, balance and function in Grade 2 and 3 knee osteoarthritis. Methodology: An experimental study will be conducted on Grade II and III patients with knee OA. According to inclusion criteria, 60 individuals (30 in each group) between the ages of 40 to 70 will be selected for a single blinded randomized clinical trial. Participants will be randomly assigned into group 1 and group 2. Group 1 will receive neuromuscular joint facilitation technique and Group 2 will receive conventional treatment. Outcome measures like Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), single leg stance test will be used to compare patient’s pre-post intervention status. Result: Data will be analyzed by using SPSS software version 20.To determine whether the data is normal, Kolmogorov-Smirnov tests will be used. Conclusion: The study will explore which technique is more effective. Neuromuscular joint facilitation may or may not demonstrate superior effectiveness compare to conventional physiotherapy in reducing pain, improving balance and enhancing functional outcomes in patients with grade 2 and 3 knee osteoarthritis.

Hindi Translation, Validation and Test-retest Reliability of the Trunk Impairment Scale 2.0: A Cross-sectional Study Protocol

Ruchika, Shanthakumar Kalimuthu

Introduction: Stroke is one of the leading cause of impaired trunk control, weight shifting and equilibrium reaction. The Trunk Impairment Scale (TIS) was created to assess specific trunk motions associated with activities in daily living in stroke patients by assessing their static and dynamic sitting balance and trunk coordination. The lack of a Hindi version of TIS 2.0 limits its usefulness for the 609 million Hindi speakers.The results of stroke rehabilitation could be significantly enhanced by creating a Hindi version. Aim: To translate the TIS 2.0 into Hindi , validate the translated version and determine its test-retest reliability in Hindi speaking stroke patients. Materials and Methods: Experts with linguistics and medical background will translate the scale into Hindi with the authors’ permission. Accuracy will be ensured by back-translation into English after the translations have been harmonised into a single version. Scale-level Content Validity Index Average and Item-level Content Validity Index will be calculated by an expert panel using the Delphi technique to validate the content. To ensure cultural relevance and intelligibility, a small group of stroke patients who speak Hindi will test the pre-final version. Bland-Altman plots and Intraclass Correlation Coefficients will be used to evaluate test-retest reliability in order to guarantee consistency.

The Impact of Pranayama on Pulmonary Function in Healthy Adults: A Narrative Review

Priyanka Tah, Akansha Saxena, Mandeep Kumar Jangra

Pranayama is a Sanskrit word formed by the conjunction of two words, namely “prana,” meaning breath of life/vital energy, and “ayama,” meaning expansion/regulation/control. It is the yogic art of breathing, has gained attention for its potential benefits on respiratory health. Evaluation of the effects of different Pranayama techniques on pulmonary function metrics, such as Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and Peak Expiratory Flow Rate (PEFR), is the goal of this systematic study. A systematic search was conducted using PubMed and Google Scholar databases covering studies published between 2015 to 2024 focusing on randomised controlled trials and observational studies involving healthy adults practicing Pranayama.Keywords used for the search included “Pranayama,” “Pulmonary function,” “healthy adults” employing Boolean query.Inclusion criteria involved studies measuring pulmonary function parameters before and after the training of pranayams. Reviews, book chapters, and articles in other language were excluded from review. “A total of” 13935 articles were extracted from both databases and after duplicate deletion, 13312 articles were left for screening. On the basis of titles and abstracts, 13299 articles were excluded. Remaining 13 full text articles were assessed for eligibility, out of which 4 studies were included. Duration of pranayama varied from 4 to 12 weeks and all studies evaluated pulmonary function as seen on FVC, FEV1, ratio between FEV1 and FVC (FEV1/FVC), PEFR after techniques/ pranayama like Om chanting, nostril breathing,Pranav, Nadi Shuddhi, Kapalabhati, and Bhastrik. Studies demonstrated a significant effect on FVC, FEV1, FEV1/FVC and PEFR. However, the level of improvement was influenced by differences in practice frequency and duration. In conclusion, Pranayama, appears to significantly enhance pulmonary function in healthy adults, likely due to improvements in respiratory muscle strength and lung capacity.

Impact of Exercise Therapy on Functional Mobility Across Ages through TUDS: A Scoping Review

Ahana Sah, Shweta Sharma

Timed Up and Down Stairs (TUDS) test is clinically used to evaluate the functional mobility which demands good balance, muscle strength, coordination and Range of Motion (ROM) of lower extremities. To perform TUDS, the individual is asked to stand on the bottom of stairs (14 steps) wearing a regular shoes without orthosis, on command “go” the child has to quickly and safely go upstairs till 14 steps, then turn around on the top landing and come all the way down until both feet lands on the bottom step. The individual may hold the railings as per the need. This is widely used to assess functional mobility in individuals with varied ages, but still it is unexplored in literatures. To retrieve literature about impact of various therapeutic approaches on TUDS test, the Google Scholar, PubMed and Cochrane Library databases were accessed for this scoping review. Fifty articles were determined to be pertinent to the investigation. In summary, 10 met the review's inclusion specifications, so they had been thoroughly reviewed. The findings highlight that various training approaches improve functional mobility, as measured by the TUDS test, across all ages. In paediatric rehabilitation, the TUDS test is especially helpful since it gives healthcare professionals a quantifiable way to monitor changes in mobility and functional independence over time. Despite these positive outcomes, heterogeneity in the intervention protocols and study designs necessitates further standardisation. This review highlights the clinical relevance of incorporating individualised therapeutic approach to improve functional mobility (TUDS score) and identifies gaps for future research, particularly in long-term efficacy and standardised protocols.

Hindi Translation, Validation and Test-retest Reliability of the Smoking Abstinence Self-efficacy Questionnaire: A Cross-sectional Study

Tai Yayum, Mousami Saha, Subhashish Chatterjee

Introduction:Smoking increases the prevalence of various disease in our body. It is also one of the primary risk factors for infections in the human respiratory, digestive, reproductive, and other systems. In a dose-dependent manner, smoking exacerbates the progression and prognosis of infectious diseases and raises their occurrence. A psychometric tool used in prospective smoking cessation trials is the Smoking Abstinence Self-Efficacy Questionnaire (SASEQ), a six-item self-efficacy scale. The six items depict situations in which smokers can rate their ability to stop smoking on a 5-point Likert scale (0–4). Higher levels of smoking cessation self-efficacy are indicated by higher scores. Aim: This study aims to translate the SASEQ scale into Hindi, validate the translated version, and determine its test-retest reliability in Hindi-speaking stroke patients. Materials and Methods: The SASEQ scale must be carefully translated into Hindi by multilingual specialists with the author's consent. This procedure will entail integrating the viewpoints of a linguist and a medical expert. To ensure accuracy, combined translations will be back-translated into English. Linguistic equivalency will be ensured by an expert panel using the Delphi technique to validate the content. Pretesting will assess appropriateness and comprehensibility. Results: The study expects the SASEQ scale to be successfully translated into Hindi with strong language translation. The item-level Content Validity Index (I-CVI) will be calculated using the Delphi method for item assessment. Uniformity is guaranteed by the Scale-level Content Validity Index Average (S-CVI/Ave). Test-retest reliability is assessed using Bland-Altman plots and Intraclass Coorelation Coefficients (ICCs), which provide mean scores and standard deviations between sessions. Bland-Altman graphs visually indicate score agreement, while ICC values show reliability. Conclusion: The Hindi scale will help with evaluation in communities that speak Hindi. This methodology improves clinical evaluation and rehabilitation techniques by guaranteeing linguistic adequacy.

The Feasibility of the Weight-bearing Lunge Test in the Assessment of Calf Muscle Flexibility in Individuals with Plantar Fasciitis: A Literature Review

Chakshujot Kaur, Sandeep Pattnaik

Plantar fasciitis is a prevalent foot condition characterised by inflammation and degeneration of the plantar fascia resulting from repetitive stress applied to the medial calcaneal tuberosity. This condition can be precipitated by an excessive accumulation of stress at the plantar fascia enthesis. Restricted calf muscle flexibility has been implicated as a contributing factor in the development of plantar fasciitis, as well as its associated musculoskeletal complications. It causes the plantar fascia to experience an increase in tensile force during the stance phase of gait. The Weight-Bearing Lunge Test (WBLT) constitutes a valuable assessment tool for investigating the functional biomechanics of the lower extremities, including calf muscle flexibility, particularly in individuals presenting with plantar fasciitis. The purpose of this review is to propose if WBLT is feasible in cases with plantar fasciitis. A comprehensive literature search was done utilising databases including PubMed/MEDLINE and Google Scholar, and Physiotherapy Evidence Database (PEDro). Thirteen articles were initially discovered, out of which 6 articles met the inclusion requirements. In those studies, the weight-bearing lunge test was used as a standardised assessment tool to evaluate calf muscle flexibility at pre- and post-intervention in patients with plantar fasciitis. Calf muscle flexibility was assessed using two distinct methodologies across the six studies. Four studies measured the distance between the toe and the wall with the help of a measuring tape, while two relied on goniometric measurements. Also, WBLT demonstrates high inter-rater reliability (0.97-0.98), regardless of the therapist's level of clinical experience. Thus, to conclude, the WBLT emerges as a practical and feasible tool for evaluating calf muscle flexibility in cases of plantar fasciitis. Given the crucial role of calf muscle flexibility in the development and management of plantar fasciitis, the WBLT offers a valuable clinical tool for assessing this key parameter and guiding treatment strategies.

Physiotherapeutic Interventions and Outcomes Reported in Cystic Fibrosis: A Literature Review

Nandni Goel, Neha Sharma

The respiratory and digestive systems are severely impacted by Cystic Fibrosis (CF), a chronic, progressive hereditary disease that impairs lung function and causes recurring lung infections. In order to improve lung function, lessen symptoms, and improve overall Quality of Life (QoL), physiotherapeutic treatment options are essential in the management of CF, especially in children. The several physiotherapy approaches utilised in the treatment of paediatric CF are examined in this article, including breathing exercises, exercise therapy, and airway clearing procedures. We evaluate how effectively these treatments work to enhance pulmonary function, lessen exacerbations, and foster mental and physical well. Research indicates that frequent Airway Clearing Treatments, including mechanical devices, postural drainage, and chest percussion, as well as organised exercise regimens, are critical for enhancing lung health and lowering hospitalisation rates. Additionally, it has been shown that breathing exercises can improve respiratory efficiency. Notwithstanding the favorable results, there are still several issues with accessibility, tailored care, and therapeutic adherence. To improve physiotherapy techniques, investigate new technology, and assess long-term results, further research is required. In summary, physiotherapy is essential to the multidisciplinary treatment of children with CF, increasing long-term disease management and promoting physical and mental wellbeing.

Efficacy of Transcutaneous Electrical Diaphragmatic Stimulation and Myofascial Release on Diaphragm Mobility, Pulmonary Function Test Parameters and Activity of Daily Living in Patients with COPD: A Study Protocol

Shanvi Priya, Subhasish Chatterjee, Mousumi Saha

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition characterised by reduced diaphragm mobility, impaired pulmonary function, and decreased ability to perform Activities of Daily Living (ADL). Transcutaneous Electrical Diaphragmatic Stimulation (TEDS) and myofascial release have shown promise as interventions to improve respiratory mechanics and functional outcomes. However, the combined efficacy of these techniques in COPD patients remains unexplored. Need for this study: This study will outline a rigorous approach to assess the efficacy of TEDS and myofascial release in improving respiratory function and quality of life in COPD patients. Findings from this trial are expected to guide future rehabilitation strategies for COPD management. Aim: This study aims to evaluate the efficacy of TEDS and myofascial release on diaphragm mobility, Pulmonary Function Test (PFT) parameters, and ADL in patients with COPD. Materials and Methods: A randomised, controlled, double-blind study will be conducted with participants meeting specific inclusion criteria. Subjects will be randomly assigned to the experimental group and the control group. The experimental group will receive TEDS at a frequency of 30 Hz for 30 minutes per day, five days a week and diaphragm myofascial release for 2 sets of 10 repetitions with a 1-minute interval between sets. The control group will receive sham TEDS and the same myofascial release protocol. Both groups will undergo treatment for 3 weeks. Pre- and post-intervention assessments will include diaphragm mobility will be measured using ultrasonography, PFT parameters will assessed via spirometry, and ADL will be evaluated using the London Chest Activity of Daily Living Scale.

Punjabi Translation, Cross-cultural Adaptation, Validation and Reliability of the Western Ontario Rotator Cuff Index Questionnaire: A Study Protocol

Navneet Kaur, Simranjeet Kaur, Nidhi Sharma, Shivani Chauhan

Introduction: The Western Ontario Rotator Cuff (WORC) Index is a self-assessment instrument that has been developed to measure the quality of life of patients with rotator cuff disease. The WORC index was developed by Kirkley et al., 2003 to evaluate the disease-specific quality of life of patients with rotator cuff disease. Aim: To translate the WORC index into Punjabi language (P-WORC) and to evaluate its adaptation, validation and reliability among patients with Rotator Cuff tendinopathy. Materials and Methods: Beaton’s guidelines have been followed for the translation process after obtaining approval from the original developer, then forward and backward translations by two independent translators will be performed.Cultural adaptation was achieved through feedback from 30 outpatient participants regarding the scale’s clarity. Content validation was conducted using the Delphi method, involving a panel of 10 experts with more than five years of experience.Experts evaluated each item for relevance and consistency, deeming it valid if at least 80% rated it as "valid." Reliability testing was performed on a sample of 51 patients. Ethical approval was granted by the Institutional Ethics Committees (IEC-2995) in June 2024, and the study was registered with the Clinical Trials Registry of India (CTRI/2024/08/072815) on August 21, 2024.

Impact of Subtalar and Talocrural Joint Mobilisation on Static Balance in Older Adults: A Study Protocol

Aditi Nagpal, Kanu Goyal, Manu Goyal

Introduction: Balance begins to diminish gradually from midlife, generally at the age of 50 years. The ankle and foot structures are particularly significant because they serve as the body's foundation of support and transfer weight to the ground. However, regular age-related changes, such as diminished strength and restricted Range of Motion (ROM) resulting from musculature or joint complex degeneration, have an adverse effect on balance, changing gait patterns and increasing the likelihood of falls. In case of ankle arthrokinematics, it is clear that manual treatment based on mobilisation of joints techniques has become a significant tool for restoring the normal ROM and balance. Aim: To determine the impact of subtalar and talocrural joint mobilisation on static balance in older adults. Materials and Methods: Two group pretest- posttest experimental study will be conducted in a tertiary care setting. Participants will be recruited based on selection criteria. Participants will be divided into two groups - experimental and sham group (passive ROM) respectively. Four stage balance test and Balance Error Scoring System (BESS) will be recorded as outcome measure for static balance at baseline and post intervention (immediate after the session). Grade III Maitland accessory mobilisation, 3 sets of 30 repetitions with 60 sec intervals, will be performed bilaterally.

Impact of Pilates on Proprioception: A Review

Aradhana Chhabra, Manu Goyal, Kanu Goyal

Proprioception, or the body's awareness of its location and motion in space, is essential for balance and general motor function. The effectiveness of proprioceptive training methods has drawn more attention in recent years, particularly when examining various physical fitness disciplines. Pilates is unique because it emphasises alignment, controlled movements, and core stability. In addition to increasing physical strength, this type of exercise promotes increased body awareness, which is crucial for the development of proprioception.Participating in Pilates can help people become more balanced and coordinated, which can improve their performance.To study the impact of Pilates on proprioception. To retrieve the literature about proprioception, the Cochrane Library, PubMed, and Google Scholar databases were consulted to get the literature on proprioception for the current review, which covered the period from July 2012 to November 2024. A total of 18 articles were deemed relevant for further inquiry. In conclusion, 10 articles have been selected and thoroughly examined as they satisfy the review inclusion criteria. Accordingly they have been selected and systematically reviewed.According to research, proprioceptive skills, which are critical for preserving balance and body awareness, are greatly improved by Pilates exercises. Proprioception indicates that postural instability, a characteristic frequently seen in people with musculoskeletal diseases, can be effectively addressed by Pilates. Pilates treatments, demonstrating its wider influence on posture correction and proprioception. Together, these studies highlight Pilates' potential as an effective therapy for improving proprioceptive function in a variety of demographics. Pilates movements' role in enhancing proprioceptive awareness and muscle endurance. It has been discovered that the Pilates intervention improves proprioception more than the traditional balancing intervention. In conclusion, Pilates has shown substantial advantages in improving proprioception, especially because of its focus on body awareness and regulated movements. According to research, Pilates not only helps with stability and pain management, but it also strengthens the bond between the body and the mind and promotes a heightened awareness of one's body.

Assessment Tools used in the Rehabilitation Phase of Pott’s Paraplegia

Manoj Joshi, Shikha Singh, Neha Kashyap

Pott’s paraplegia, a condition caused by spinal Tuberculosis (TB), frequently results in serious motor and sensory impairments. For those with Pott’s paraplegia, the rehabilitation phase is essential to enhancing their functional independence, quality of life, and avoiding problems. For the purpose of creating individualised treatment programmes and evaluating advancement, effective assessment is crucial throughout this stage. Physical function, neurological state, psychological well-being, and quality of life are among the several components of the patient’s condition that are assessed using a range of assessment instruments. The American Spinal Injury Association (ASIA) Impairment Scale for neurological function is one frequently used tool. The Functional Independence Measure (FIM) to measure Activities of Daily Living (ADLs) and the Berg Balance Scale to measure balance. In addition, instruments such as the World Health Organisation Quality of Life (WHOQOL) questionnaire for psychological and social evaluation and the Visual Analogue Scale (VAS) for pain assessment offer important insights into the comprehensive rehabilitation process.Another essential phase in the assessment process is psychological evaluation, which addresses problems like social isolation, anxiety, and depression that are prevalent in long-term illnesses like Pott’s paraplegia. Malnutrition may impair immune function and delay recovery, so nutritional evaluations and interventions are also prioritized. Technology-based tools like virtual reality systems, robotic-assisted devices, and neurostimulation are being used more and more in modern rehabilitation. These tools complement traditional therapies by offering creative and entertaining ways to speed up recovery. In addition to directing therapeutic treatments, these evaluation techniques support patient progress monitoring, realistic rehabilitation goal formulation, and efficient multidisciplinary care. This study examines several assessments utilized in the Pott’s paraplegia therapy phase, emphasising their value, advantages, and disadvantages in supporting an all-encompassing rehabilitation strategy.

Hindi Translation and Validation of Anterior Knee Pain Scale: A Study Protocol

Md Rafe Ansari, Gurjant Singh

Introduction: Patellofemoral pain is a prevalent condition often assessed using the Kujala score a reliable scoring system for anterior knee pain. Although this score has been translated in to multiple languages, no Hindi version exists for the population that primarily communicates in Hindi. A validated and culturally appropriate Hindi version is essential for accurate evaluation and meaningful patient feedback. Aim: To plan a protocol to translate and evaluate each translated domains of the Anterior Knee Pain Scale to see its reliability and content validation to be utilised in patients with patellofemoral pain syndrome in Hindi language. Materials and Methods: The study method will incorporate the Beaton guidelines which will include the translation of the Anterior Knee Pain Scale in Hindi language from English by two translators i.e. T1 and T2 from medical and non-medical background, respectively. The recording observer then will take a seat to create a T12 version of the translated questionnaire. The reverse translation from theT12 form to the previous form will be done then. Then, an expert panel analyses all the stages and all of the questionnaire tems that the translated form of the questionnaire is free of errors, allowing it to be field tested. Evaluation of content’s validity is done. The pre-final form is then fully tested on patients, and the scale's validity is reported. Finally, the translated questionnaire version will be analysed by the ethical committee.

Impact of Hamstring Active Release Technique Programme on Pain, Range of Motion and Hamstring to Quadriceps Strength Ratio in Patients with Knee Osteoarthritis: A Study Protocol

Satwinder Kaur, Sandeep Patnaik

Introduction: Knee osteoarthritis, a degenerative joint disease of the tibiofemoral and patellofemoral joint, arises from the progressive breakdown of articular cartilage, leading to pain, stiffness, and functional limitations. This degenerative process can result in significant muscle and capsule tightness, periarticular muscle weakness, altered gait patterns, and increased knee adduction moments. Hamstring tightness is one of such common findings. Current management strategies often involve a multidisciplinary approach, including different exercise therapy and manual therapy. However, there is a growing interest in exploring alternative and complementary therapies. One such alternative therapy is the Active Release Technique (ART), which is a form of alternative manual therapy that aims to address soft tissue restrictions and improve muscle function. Hardly there is any literature exploring its effectiveness in patients with knee osteoarthritis. Need of this study: This study will be conducted to provide potential benefits of the ART programme in the management of grade 1 and 2 knee osteoarthritis. Aim: To outline the methodological design to be used for determining the effectiveness of the hamstring ART programme on pain, range of motion and the hamstring-to-quadriceps strength ratio in patients with grade 1 and 2 knee osteoarthritis. Materials and Methods: This study will employ a randomised controlled trial design. Participants of both genders, aged 35- 55 years, meeting the inclusion criteria for grade 1 and 2 knee osteoarthritis, will be recruited and will be randomly allocated to two groups using computer-generated randomisation. The intervention group will receive the Hamstring ART in conjunction with conventional physiotherapy, while the control group will receive conventional physiotherapy alone. Pre- and post-intervention assessments will include pain intensity measured using the numeric pain rating scale range of motion assessed using a universal goniometer, and hamstring-to-quadriceps strength ratio measured using the modified Sphygmomanometer test.

Prevalence of Knee Injury in Hockey Players: A Systematic Review of Systematic Reviews

Knee injuries are among the most common and debilitating musculoskeletal injuries in hockey players. Understanding their prevalence is crucial for developing preventive strategies and improving player health and performance.This systematic review of systematic reviews aims to summarise and synthesise existing evidence on the prevalence of knee injuries in hockey players across different levels of play. A comprehensive literature search was conducted across major electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, to identify systematic reviews published up to 2025. Studies were included if they reported on the prevalence of knee injuries in hockey players and met predefined inclusion criteria. Data were extracted and synthesised to provide an overview of injury rates, risk factors, and variations across player demographics, playing levels, and playing surfaces. Four systematic reviews, with AMSTAR scores between 6 and 11, highlighted a higher risk of knee injuries in elite field hockey players, especially on artificial turf. Injury rates ranged from 4.5 to 57.9 per 1000 player-hours, with a pooled rate of 48.1 per 1000 player-hours for injuries requiring medical attention. ACL injuries were more common in females (63%) than males (50%), mainly from non-contact incidents. Contact injuries dominate in tournaments, while non-contact injuries are more frequent in regular play. Common injuries include ligament sprains, meniscal tears, and strains, with risk factors such as high-intensity play, poor conditioning, and previous injuries. This systematic review of systematic reviews highlights the significant burden of knee injuries in hockey players. Findings underscore the need for targeted prevention strategies, such as injury prevention programmes focussing on neuromuscular training and improved protective equipment. Further research is recommended to address gaps in understanding the influence of gender, playing surface, and age on knee injury prevalence.

Assessing the Efficacy of Magnetotherapy in Individuals with Adhesive Capsulitis: A Study Protocol

Sahil Kumar, Sandeep Pattnaik

Introduction: Shoulder adhesive capsulitis is a debilitating condition characterised by pain, impaired function and significant restrictions in the shoulder joint range of motion in multiple directions. Physiotherapeutic interventions, such as exercise therapy, manual therapy, electrotherapeutic modalities, are commonly employed in its management. Magnetotherapy, utilising pulsed electromagnetic fields, has demonstrated potential therapeutic benefits in various musculoskeletal conditions by modulating inflammation, promoting tissue repair, reducing pain. However, its specific efficacy in addressing shoulder adhesive capsulitis remains relatively under-explored. Need for this study: This study will provide high-quality evidence on the potential benefits of integrating magnetotherapy into the management of shoulder adhesive capsulitis. Aim: This study protocol aims to outline the methodological design to be employed with the objective of investigating the therapeutic efficacy of magnetotherapy on pain, range of motion, and functions in individuals with shoulder adhesive capsulitis. Materials and Methods: The proposed study will employ a single-blinded, randomised controlled trial study design. Participants of both genders, aged 35-50 years, meeting the inclusion criteria for shoulder adhesive capsulitis in the freezing and frozen stage, will be randomly assigned to one of two groups: an intervention group receiving both magnetotherapy and conventional physiotherapy and a control group receiving conventional physiotherapy alone using computer-generated randomisation method with sequentially numbered opaque sealed envelopes to conceal the randomisation sequence. Both groups will undergo the assigned physiotherapy regimen twice weekly for two weeks. The sample size will be determined based on the outcomes of the pilot study with 12 participants, 6 in each group, to ensure adequate statistical power. Outcome assessments, including pain intensity by the Visual Analogue Scale, shoulder range of motion by universal goniometer, and functional disability by Shoulder Pain And Disability Index, will be conducted prior to the intervention and immediately following the completion of the intervention period.

Influence of Brain Gym Exercise on Children’s Behavioural Problems with Autism Spectrum Disorder: A Review

Sudhamoy Maity, Subhasish Chatterjee, Etika Rana, Mousumi Saha

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by deficits in social communication, repetitive behaviours and restricted interests. Brain Gym, a series of physical exercises designed to improve neurological functioning, has been proposed as a complementary intervention for individuals with ASD. Aim: The objective of this review is to synthesise evidence from studies investigating the impact of Brain Gym exercises on children’s behavioural problems with ASD. Materials and Methods: A comprehensive search of multiple databases, including PubMed, Scopus, and PEDro, was conducted for articles published between 2020 and 2024. Inclusion criteria consisted of Randomised Controlled Trials (RCTs), quasi-experimental studies, longitudinal studies and articles published in English language and focussed on Brain Gym interventions in individuals diagnosed ASD with behavioural problem. Results: After conducting searches across multiple databases, 2 studies were selected from a total of 2,784 studies. An additional 5 studies were identified through citation tracking. In the end, 4 studies were included in the review: 2 were found via citations from the initially selected publications, and 2 were discovered through database searches, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Conclusion: Among the studies, 2 articles indicate that Brain Gym activities can reduce children’s behavioural issues, while the other 2 suggest no significant effects. However, the methodological flaws in the existing body of evidence limit the strength of these conclusions. Further high-quality research, incorporating longer durations, larger sample size and robust study designs, is needed to validate the efficacy of Brain Gym.

Current Trends and Evidence-based Interventions in Physiotherapy Management of Shoulder Instability: A Narrative Review

Ankita Jalota, Sunita Sharma

Shoulder instability is a prevalent pathology among patients worldwide, particularly among the young who play contact sports, leading to pain, dysfunction and recurrent dislocations that have a significant impact on an individual’s quality of life. Due to multifactorial aetiology and variable presentations of the condition, the management of the disease remains a challenge with limited evidence of an effective treatment in the existing literature. The present narrative review investigates the emerging trends and gathers the best evidence-based physiotherapy interventions for treating shoulder instability and what strategies could be implemented to achieve better outcomes. A comprehensive literature search was conducted across databases such as PubMed, PEDro, Cochrane Library and CINAHL for studies published over the years 2015- 2024 using various combinations of search terms like “shoulder instability” AND “physiotherapy” and extraction of data were carried out in the present review. Total 109 studies were found on different databases. A total of five studies were selected, all of them comprising of randomised controlled trials, that addressed physiotherapy interventions for shoulder instability. A total of 328 patients participated in the study. The Western Ontario Shoulder Instability Index (WOSII) was used as the primary outcome measure.The study found that neuromuscular exercises showed significantly greater improvement than standard care exercises in traumatic anterior shoulder dislocation. Neuromuscular Electrical Stimulation (NMES)-enhanced physical therapy is an effective novel treatment approach for Functional Posterior Shoulder Instability (FPSI), a severe type of shoulder instability. The Watson shoulder instability programme, which emphasises on restoring patient-specific scapular motor control, typically scapular upward rotation, before beginning rotator cuff or deltoid strengthening exercises, was the most successful in the management of Multidirectional Instability (MDI). High-load strengthening exercises were proven to be more effective in improving patient lifestyle and emotion about shoulder pain and function, than low-load strengthening exercises. Digital physical therapy was equally effective when compared to conventional in-person physical therapy. Hence, telerehabilitation has become a viable option for managing chronic shoulder pain associated with shoulder instability in terms of accessibility and convenience. Nonetheless, lack of studies and the diversity of protocols necessitates the need for further research to obtain solid evidence.

Validity and Reliability of 2 Minutes Step Test in patients with Different Grades of Knee Osteoarthritis: A Study Protocol

Ritika, Kanu Goyal, Manu Goyal

Introduction: Climbing steps up and down remain difficult in individual with knee Osteoarthritis (OA). To evaluate the functional capacity in patient with knee OA, several tests have been recorded such as 6 min walk test, Time Up and Go (TUG) test Chair Stand Test (CST) and Stair Climb Test (SCT). Being quick to execute and inexpensive, 2 Minute Step Test (2MST) presents more feasible to conduct in clinical settings as compared to 6 min walk test, TUG, CST and SCT which requires larger space and specific infrastructure. Two minutes step test is a valid and reliable test in patients with knee OA. By measuring how many steps a person can take in two minutes, it provides valuable insight into their aerobic capacity and overall fitness level. Even though 2MST is a promising method for examining functional capacity, there is currently a dearth of information in the literature about the concurrent validity and reliability of its use in individual with knee OA. Need for this study: The 2MST will be a valid, reliable and established tool for analysing knee OA patients and their functional capacity with outstanding validity and reliability. Aim: The study objective is to evaluate concurrent validity and test intra-rater reliability of 2MST in patients with knee OA. Materials and Methods: Patients will be recruited based on the principle of inclusion and exclusion standards. Fifty-one patients of each grade will be recruited on the basis of Lynn criteria. The sample will be recruited from orthopaedic physiotherapy lab on the basis of grading of OA according to Kellegren-Lawrence grading (Grade I, II, III) and individuals will be further divide on the basis of grade I, II, III. One examiner will assess the patients at two times with interval between the test and retest from 7 to 14 days.

Assessment Tools for Evaluating Reaction Time: A Comprehensive Review of Methods and Applications

Mritunjay, Shikha Singh, Neha Kashyap

Reaction Time (RT) is one of the important quantitative measures of cognitive and motor performance, and a measure used to determine neurological function, sensorimotor coordination, and psychomotor speed. Application fields include sports science, clinical diagnostics, ergonomics, and cognitive psychology. Tests for RT measure it in varying applications, each with its advantages and disadvantages. RT tests, such as catching a dropped ruler, are still employed in educational and research settings. Advanced and automated instruments have gained popularity because of their accuracy and the ability to judge multiple factors simultaneously. Psychomotor alertness tests are used in clinical and vocational settings to measure sustained attention and alertness by measuring the speed of response to visual stimuli. The decision and response time tests allow Choice Reaction Time Tests to generate more complex data. The Finger-Tapping Tests, on the other hand, Visual and Auditory Reaction Time Tests can give clues in diagnosing neurological disorders on sensory input-motor output integration. Advanced research has employed neurophysiological tools like Electroencephalography (EEG) and functional Magentic Resonance Imaging (fMRI) to assess the brain activity in RT tasks to uncover neural mechanisms and study reaction time in controlled environments, by pointedly focusing on factors such as cognitive load and aging. This paper reviews various assessment tools used to evaluate RT, discussing their applications in different domains, as well as their advantages and limitations in providing accurate and reliable measures of human performance.

Mat Pilates as an Adjunct Therapy for Cardiometabolic Risk Management and Oxidative Stress in Diabetic Population: A Narrative Review

Anushka, Neha Kashyap, Shikha Singh

Feasibility Study on Evaluating the Effects of Earphone Usage on Reflexive Responses and Reaction Times in Young Adults

Preeti Kapri, Nidhi Sharma, Priyanka Negi

Introduction: The increased use of earphones by young adults has created much concern about its influence on auditory processing and reflexive responses. Since most of them use audio content in a multitude of activities, people raise questions about the cognitive function effects of using earphones, especially regarding reaction time and reflexive response to auditory stimuli. The vestibulo-ocular and vestibulo-spinal reflexes in critical reflex studies are impacted by auditory stimulation. Thus, this report aims at the feasibility analysis of assessing the effect of earphone usage on young adults’ response times to reflexive performances. Aim: The aim of this study is to evaluate the feasibility of assessing how earphone usage and exposure to different sound frequencies affect Vestibulo-ocular Reflex (VOR), Vestibulo-spinal Reflex (VSR), and reaction times in young adults. Materials and Methods: Healthy young adults (n=230), aged 18 to 25 years, were recruited to assess how different sound frequencies influence vestibular reflexes and motor response times among college-going students recruited for the study. Ethical approval was obtained from the Institutional Ethics Committee with the registration number MMDU/IEC-2670. Subjects were asked to perform head impulse thrust test to examine Vestibulo-Ocular Reflex (VOR), the Fukuda Step Test to examine Vestibulo-Spinal Reflex (VSR) and reaction time were examined through the Ruler drop test. Results: The findings demonstrated that sound frequencies significantly influenced VOR, VSR, and reaction times. In young adults, sound frequencies of 76-80 dB were found to have the most pronounced effects. A significant negative correlation was observed between these sound frequencies and reflexive responses (VOR, r=-0.29; VSR, r= -0.10), particularly for the VOR and VSR. Similarly, reaction times for both dominant and non-dominant hands showed significant negative correlations at 76-80 dB exposure (r=-0.30, and r=-0.28) respectively. These results suggest that exposure to higher sound frequencies is associated with decreased VOR and VSR responses, as well as increased reaction times. Conclusion: This study concludes that vestibular reflexes and reaction times are differentially affected by varying sound frequencies. While lower sound frequencies (61-65 dB) showed minimal impact, higher sound intensities (76-80 dB) significantly affected VOR, VSR, and reaction times in both dominant and non-dominant hands. These results underscore the critical influence of sound intensity levels on human reflexive and motor responses, suggesting that exposure to higher sound intensities may compromise neuromuscular performance.

Utility of Nerve Conduction Studies in Diagnosing Guillain-Barre Syndrome: A Scoping Review

Bhumika Kashyap, Subhasish Chatterjee, Mousumi Saha

Guillain-Barre Syndrome (GBS) is a rare autoimmune disorder that attacks the nervous system. It often follows infections and can cause muscle weakness or paralysis. Nerve Conduction Studies (NCS) are essential for diagnosis and management, helping doctors assess nerve damage and guide treatment. However, there is a lack of research, particularly in India, on the optimal use of NCS in GBS. The aim was to analyse existing literature, highlight the significance of NCS, and identify research gaps to improve patient care. Out of 453 articles identified between 2020-2024 from PubMed, Cochrane, and PEDro, 172 duplicates were removed. The remaining 281 articles were screened by titles and abstracts, leading to the removal of 211 articles. Following further analysis based on the selection criteria and PRISMA-ScR guidelines, led to the selection of 8 papers for review. Nerve Conduction Studies (NCS) are crucial for diagnosing and monitoring GBS, with repeated testing improving accuracy by detecting changes like conduction block and reduced Compound Muscle Action Potentials (CMAPs). Axonal variants are linked to severe symptoms and poorer outcomes, while demyelinating forms show better recovery. Early markers like neuropathies and nerve enlargement via ultrasonography aid in early detection. Sensory involvement and motor excitability changes further highlight disease severity and progression. NCS are crucial for diagnosing and monitoring GBS, improving accuracy through repeated testing. Axonal variants show more severe symptoms, while demyelinating forms recover faster. Early markers like nodopathies and nerve enlargement aid early detection, with sensory involvement and excitability changes reflecting disease progression.

Hindi Translation, Cross-cultural Adaptation and Validation of Chedoke McMaster Stroke Assessment (CMSA) Scale: A Cross-sectional Study

Introduction: Stroke is one of the leading causes of death and long-term disability worldwide, emphasising the need for effective rehabilitation strategies. The Chedoke McMaster Stroke Assessment (CMSA) is a reliable and valid measure developed in Canada used to assess both impairment and activity levels in persons with stroke. The widespread use of Hindi, there is no Hindi translation of the CMSA. Developing a culturally and linguistically appropriate version of the CMSA for Hindi speakers could enable rehabilitation personnel to evaluate change in the patient’s motor control and functional ability. Aim: This study focussed on translating and adapting the CMSA into Hindi to ensure its relevance and effectiveness for assessing stroke recovery for patients in India by Hindi-speaking rehabilitation specialists. Materials and Methods: We obtained permission from the original author of the CMSA to translate the tool into Hindi. The translation process adhered to recognise guidelines for cross-cultural adaptation. Two bilingual experts, one with a medical background and the other a linguistic specialist, independently translated the CMSA into Hindi. The translations were combined and back-translated into English by independent translators to ensure consistency with the original tool. To ensure content validity, we used the Delphi method to assess the relevance of each item in the scale. The experts evaluated each item on a 4-point scale, and the Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index Average (S-CVI/Ave) were calculated. Results: There is an evidence of its criterion validity which demonstrated it as high degree of linguistic and cultural equivalence. The Hindi CMSA achieved an I-CVI of 0.98985, an S-CVI/Ave of 0.98985, and an S-CVI/UA of 0.881944, indicating strong evidence of its validity. Conclusion: The Hindi CMSA has been culturally adapted and validated for evaluating stroke-related impairments and functional activity in Hindi-speaking healthcare environments. This version will enhance the ability of rehabilitation personnel in conducting clinical assessments and customising rehabilitation strategies for this population.

Impact of Magnetotherapy in Chronic Low Back Pain: A Literature Review

Akanksha Pandey, Bhawna Vats

The most common musculoskeletal pain or discomfort localised in the lumbosacral region, with or without leg pain (sciatica) that persists for more than 3 months. Over 80% of people experience Low Back Pain (LBP) at some point in their lives, making it a very common ailment. According to data, over 33% of people with acute LBP do not recover and develop Chronic LBP (CLBP). There are various causes of LBP. They range from simple spasm or mechanical causes to more serious causes such as herniated disc. The clinical symptoms of CLBP include pain, stiffness, difficulty in walking, impaired sleep, aching or stabbing pain etc. Electromagnetic therapy provides a noninvasive, safe, and easy method to treat pain with respect to musculoskeletal diseases. The aim of this review is to assess the effectiveness of magnetotherapy in reducing pain intensity and enhancing functional ability with CLBP. From December 2015 to December 2025, a literature search was done using the PubMed, Scopus, and Embase databases. Boolean operators (AND, OR) were used in the search, which included terms like “magneto therapy, magnetic therapy, chronic low back pain, pain relief, and pain management.” The magnetotherapy articles were included in this review. Non-English and full articles were excluded. A total of 1025 articles were found from different database, out of which only four met the inclusion criteria. The review suggests that magnetotherapy shows an effective and significant pain reduction and improve functional outcomes. The review showed that patients with CLBP may find that magnetotherapy is a useful treatment for reducing pain and improving functional outcomes in LBP.

Cyberchondria among University Students

Jasnoor Waraich, Supreet Bindra

Cyberchondria is defined as a multifaceted concept that involves an escalation in worry about one’s own general health, as a consequence of the extreme evaluation of information on the worldwide web, and contains mainly two cognitive-emotional aspects: excessiveness and elevated anxiety. In recent years, more and more young individuals have expressed their health concerns via the internet. This study aimed at determining the prevalence of cyberchondria among university students.The data was collected via self-administered questionnaire, designed for the purpose and Cyberchondria Severity Scale produced using google forms. Cyberchondria must be seen as a serious public health concern among university students. Since it is associated with distress and worry, measures need to be adopted to evaluate, prevent, and treat it at the population level. The results will be discussed at the time of presentation.

Injuries in Gym: A Review Study

Gurleen Kaur, Supreet Bindra

Gym or Gymnasium is defined as a place or club where one can go to exercise using machines, weights and other equipments. A fitness injury is defined as any physical complaint experienced by an individual during or as a consequence of fitness training, while fitness and strength training provide numerous health benefits and play a critical role in addressing the public health issue of physical inactivity, They also introduce the risk of exercise-related musculoskeletal injuries. This study aims to determine the frequency, patterns, and factors predisposing the injuries in gym. A computer search of peer reviewed articles from databases such as PubMed (National library of medicine) Google Scholar Medline, Research Gate, was conducted focussing on studies published from 2010 to 2024. Going to gym offer various health benefits, but on the other hand it also has various disadvantages. Studies show a high prevalence of these injuries among gym users, with areas like lower back and shoulders are more prone to injuries.

A Comparative Study between the Effects of Maitland and Mulligan Mobilisation on Range of Motion in Adhesive Capsulitis: A Literature Review

Ranvijay Singh Sidhu, Supreet Bindra

The term “frozen shoulder” was first introduced by Codman in 1934. He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty sleeping on the affected side. Frozen shoulder can be a primary or idiopathic problem or it may be associated with another systemic illness.A variety of interventions are used by physiotherapists to reduce pain and disability which includes exercise and electrotherapy along with different types of mobilisations such as Maitland and Mulligan mobilization.Despite of many studies, there are no studies found in the literature on the superiority between these 2 techniques. This study aims to compare the effects of Maitland and Mulligan Mobilization on Range of Motion in Adhesive Capsulitis.A computer search of peer reviewed articles from databases such as PubMed (National library of medicine) Google Scholar Medline, Research Gate, was conducted focussing on studies published from 2010 to 2024. Studies show that the Mulligan Mobilization to provide much better results in increasing range of motion of patients of adhesive capsulitis.

The Effect of Extracorporeal Shock Wave Therapy in Rotator Cuff Injury: A Narrative Review

Priyanka Sharma, Bhawna Vats

Rotator cuff injuries are most common in athletes and individuals who perform repetitive overhead activities. Rotator cuff tears have two main causes: injury and degeneration. Acute tears are usually due to injury the prevalence increased with age. Thirty-six percent of the subjects with current symptoms had rotator cuff tears. Injury can lead to pain, weakness, reducing functional ability. Extracorporel Shock Wave Therapy (ESWT) is the most common therapy used in the treatment of rotator cuff injury. The aim of the review was to assess the effect on pain and functional ability with rotator cuff injuries. A literature search was performed from PubMed, Pedro, Cochrane Library, Google Scholar database from 2000 to 2024. The search utilised terms such as “shock wave therapy”, “electrotherapy modalities” and “rotator cuff injuries” employing Boolean operators (AND, OR). Articles in which treatment includes ESWT was included in this review, non-English articles were excluded. A total of 75 articles extracted from different database, out of which only four met the inclusion criteria. The studies suggest that ESWT is an effective treatment for reducing pain intensity, and enhancing functional ability in patients with rotator cuff injury. The findings suggest that patients with rotator cuff injuries may find that ESWT is a useful treatment for reducing pain intensity and improving functional outcomes. The quality of the included research varied, and several had methodological problems, despite the encouraging data.

The Effect of Cardiovascular Health on the Fourth Trimester: A Narrative Review

Annu, Jahanvi Dave, Rittu Sharma

The term 4th trimester is the period that starts after childbirth and during the first few months of latest parenthood. Cardiovascular fitness is one of the physiological changes the body experiences throughout this phase and responsible for vascular resistance, blood quantity changes, and elevated heart rate. The cardiovascular device experiences healthy, adaptive modifications throughout pregnancy to ensure enough uteroplacental blood flow and oxygen and nutrient exchange to support and maintain the developing fetus. Although oxygen is important for the foetus’s growth and development, it plays a critical function during pregnancy. Oxygen is still necessary for the mother and the baby for the production of energy for tissue repair.This narrative review aimed to evaluate the impact of yoga on cardiovascular health in terms of postpartum cognitive fitness for women who are at high risk for cardiovascular health issues following childbirth, such as postnatal problems or metabolic syndromes, was found from a comprehensive Google Scholar search to find studies published as of currently. We utilized keywords like “parturition,” “metabolic syndrome,” and “females” to build search queries. After an initial investigation of 400 studies, 15 randomised controlled trials were discovered and included in this evaluation. Numerous beneficial effects on cardiovascular health have been linked to yoga practice throughout the postnatal period. Yoga seems to be beneficial for postpartum cardiovascular health. The combination of yoga’s regulated breathing, physical activity, and mental relaxation offers these benefits.Yoga reduces postpartum stress and anxiety, increase coronary heart rate variability, improve blood stress regulation, lower postpartum weight and cholesterol, and enhance overall cardiovascular and mental health development. A safe and effective method, yoga help postpartum women restore cardiovascular fitness while encouraging normal physical and mental healing. During the postnatal period, it is important to improve lifestyle and healing intervention approaches in order to lower the risk of cardiovascular disease further on.

A Literature Review Assessing Psychometric Properties of Field-based Cardiorespiratory Fitness Tests Across Diverse Populations

Darshil Mishra, Sandeep Pattnaik

Cardiorespiratory Fitness (CRF), is a vital health metric that affects performance and physical health in a variety of groups. A range of assessment methods exist, including laboratory-based test likes step tests, cycle ergometer test, treadmill test, and field-based test. Some of them are performed in maximal while a few are done at submaximal level. Choosing the optimal CRF test can be difficult due to the wide range of available options. It is further complicated by age, health status, and available resources and other demographics. This literature review therefore, aims to critically evaluate the reliability and validity of various field-based CRF tests across different populations. To achieve this an extensive search was conducted across databases PubMed, and EMBASE, for full-text English language articles exploring the psychometric properties of different field-based CRF tests, published between 2014 to 2024. Only observational studies were considered, regardless of geographical location.Keywords including “Cardiorespiratory Fitness,” “Field-Based Tests,” “Validity,” “Reliability,” “VO2max,” and and related terms with Boolean terms were used to conduct search. Data on validity, reliability, demographic characteristics, their utility in a variety of populations and important findings were then retrieved from utilised in a variety of populations. Analysis of the retrieved articles suggested that the 30-15 Intermittent Fitness Test was well suited for military infantry, exhibiting moderate to high validity (r = 0.695 - 0.930) and high reliability (Intraclass Correlation {ICC}=0.960 - 0.975), while the 4x10 Shuttle Run Test showed unusually high reliability (ICC = 0.998) for adults. In comparison, the Yo-Yo Intermittent Recovery Test Level 1 demonstrated moderate to excellent reliability (ICC = 0.78 - 0.98) and validity (r = 0.74) for young athletes.Conversely, the Yo-Yo Intermittent Recovery Test Level 2 demonstrated good reliability (ICC = 0.86 - 0.96) but poorer validity (r=0.47) for elite athletes. These results emphasise how crucial it is to choose tests that are appropriate for particular demographics. Inconsistencies in all tests, however, highlight the necessity of population-specific modifications and standardised procedures and feasibility studies of each tool in different population.

Evaluation of a Diagnostic Approach for Tennis Leg Players: A Literature Review

Sarita Kumari, Probhjot Singh Nalwa

The typical calf muscle injury, especially in tennis players but often in non-athletes, is known as a “tennis leg.” This typically harms the soleus or gastrocnemius muscle. Physiotherapy is proved to be crucial for the medical management and cure of tennis leg, or calf muscle strain, enabling individuals to resume their normal sports or activities. A muscle strain or partial tears are commonly brought on by significant rises in activity or overstretching. The diagnosis of tennis leg needs a thorough and systematic approach that focusses on history, physical examination, differential diagnosis, and imaging that is necessary. Reducing acute pain and inflammation, healing the injured muscle, restoring strength and flexibility, and preventing further harm are the main objectives of physical therapy. The musculotendinous junction or the gastrocnemius muscle is most frequently strained or torn in tennis leg, which can occur during acute motions like running or jumping. Analysing diagnostic methods properly aids in accurate diagnosis, timely intervention, and reducing misdiagnosis. The aim of this review is to discover the most accurate and effective ways to diagnose tennis leg. A literature search was conducted using the PubMed, Scopus, Google Scholar, and Embase databases from December 2015 to December 2024 with the search terms inflammation, acute pain, tennis leg, and diagnostic approach. Boolean operators AND,OR were used. All the free text article, english language articles were included.A total of 50 articles were retrieved from different sites, out of which only 8 articles were found to meet the inclusion criteria. The diagnostic approaches included x-ray, ultrasound, and Magentic Resonance Imaging (MRI). Medical professionals can improve their ability to accurately recognise and treat a tennis leg by evaluating the condition using the mentioned diagnostic methods.This review concludes that concludes that MRI, ultrasound, x-ray and ultrasound are highly accurate diagnostic tools to evaluate tennis leg.

Establishing Reference Value of Seated Medicine Ball Throw Test among Collegiate Squash Players: A Feasibility Study

Reshma Parihar, Nitin Kumar Indora, Tanbeer Hassan

Introduction: The Seated Medicine Ball Throw (SMBT) test assesses upper-body muscular power by determining the furthest distance an individual can throw a medicine ball from a seated, isolated position. Widely used across various groups, the SMBT validates other upper-body power measures such as the bench press power test and plyometric push-ups. Due to its cost-effectiveness and simplicity, it is preferred over other upper-body power assessments. Though the SMBT is recognised as a reliable and valid test for upper-body power, there are no established reference standards for most populations, including college going squash players aged 18-25 years. Aim: This study is to validate the practicality and limitations of the methodology and procedures for large-scale studies aimed at establishing normative reference scoresof seated medicine ball throw for squash player aged 18-25 years. Materials and Methods: A feasibility trial of total 50 male and female squash player aged 18-25 years performed the SMBT test three times in one day. After recording their height, body mass, Body Mass Index (BMI) and athletic identity measurement scale score participants threw a 1, 2, and 3 kg medicine ball seated at a 90° angle. Each will throw three times and average of the three trials will be recorded. Results: The age, weight, height, and BMI of the players were 20.38±1.8 years, 63.39±10.48 kg, 168.79±9.0 cm, and 22.24±2.17 kg/m², respectively. The reference data of the average trials for 1 kg was 4.87±.64, 2 kg was 4±.58 and 3 kg was 3.2±.49. Pearson correlation coefficients for between age and average score of 1, 2 and 3 kg were r=.294, r=.248, and r=.286, respectively and full stop Conclusion: The results suggest that it is practical to carry out a more extensive study with a larger sample size to enable broader generalisation of the findings. The collected data offers an initial set of benchmark standards for coaches and students to assess upper-body muscular power using SMBT.

Influence of Different BMIs on Rr Interval Parameters in Healthy Young Individuals: A Cross-sectional Study Protocol

Shruti Sai, Mousumi Saha, Subhashish Chatterjee

Introduction: Body Mass Index (BMI) is a widely used indicator of overall health, as it measures weight relative to height. Variations in BMI are associated with conditions such as heart disease, diabetes, and certain cancers. Similarly, Heart Rate Variability (HRV), assessed through RR intervals, serves as a reliable marker for evaluating autonomic nervous system function and predicting potential health risks. Aim: The primary aim of this study is to examine the impact of different BMI categories on RR interval parameters, which are crucial indicators of HRV, in healthy young individuals. By investigating the relationship between BMI and autonomic nervous system function, the study seeks to shed light on how body weight variations influence cardiovascular health within this population. Materials and Methods: The study will include healthy individuals with varying BMI levels, who will be recruited based on specific inclusion criteria. Written informed consent will be obtained from all participants. Based on the Asian BMI classification, individuals will be divided into four groups. RR interval measurements, essential for HRV assessment, will be recorded using an electrodiagnostic machine. The recorded parameters will then be analysed using descriptive and correlation statistical methods.

En Pointe But Off Balance: Foot Deformities in Ballet Dancers and Need of Physiotherapy

Deepanshu, Neha Kashyap, Shikha Singh

Ballet is a high-impact art that necessitates a good amount of physical stamina, strength, and stability. The biomechanical impact that ballet places on the body, particularly the perils of the feet associated with en pointe and demi-pointe, predisposed dancers to a variety of foot deformities. The most common foot conditions among ballerinas include hallux valgus, metatarsalgia, stress break fractures, and sesamoiditis. These deformities manifest as a result of strain, poor technique, and the intense physical demands of the dance. However, while these deformities can severely impair performance and life standards, they frequently go unnoticed by the general population until they become a significant source of pain.This review highlights the onset and prevalence of foot deformities in ballet dancers identifying the roles of intrinsic and extrinsic causes like anatomical predisposition, footwear and training intensity. Early intervention is very crucial in terms of injury prevention, pain management and rehabilitation. Physiotherapy plays a vital role. Physiotherapy deals with muscle imbalance, joint mobility and proprioception so the risk of chronic injuries can be decreased. With individualised exercise programmes, there are evidence-based therapeutic techniques like manual therapy and kinesiology taping that are best suited to the unique demands of this art form. Furthermore, this review highlights the need for the inclusion of physiotherapy into professional dancers' training routines to facilitate musculoskeletal health long-term. With focus on the interrelationship of biomechanics, foot health and performance optimisation, we aim to provide insights for dancers, trainers and healthcare practitioners through this study. It calls for a collaborative model involving various fields to prevent and manage dance-related injuries, allowing dancers to perform gracefully well into the future while avoiding the risk of life-altering and/or debilitating aberrations.

Effectiveness of Robotic Hand Therapy in Enhancing Functional Recovery of Hemiplegic Hands after Stroke: A Narrative Review Study

Introduction: Stroke is one of the leading causes of long-term disability, often resulting in hemiplegia that impairs motor function and the ability to perform daily activities. The recovery of hand function in stroke patients is crucial for improving quality of life and independence. Robotic hand therapy has been explored as an innovative rehabilitation technique to promote motor recovery in post-stroke hemiplegia. This technology leverages robotic devices to provide repetitive, task-specific training that enhances motor control and fosters neuroplasticity. Aim: This narrative review aims to assess the effectiveness of robotic hand therapy in enhancing functional recovery of hemiplegic hands following stroke by analysing articles that examine various robotic devices and their impact on motor function, hand dexterity, and activities of daily living (ADLs). Materials and Methods: A comprehensive search of the literature was conducted using electronic databases, including PubMed, Scopus, and Google Scholar. Studies published from 2010 to 2024 were screened for relevance. Key search terms included “robotic hand therapy,” “hemiplegia,” “stroke rehabilitation,” “motor recovery,” “functional recovery,” and “neuroplasticity.” Articles were selected based on the following inclusion criteria: (1) studies using robotic devices for hand rehabilitation, (2) trials measuring motor recovery or improvement in ADLs, and (3) studies that provided outcomes related to the effectiveness of robotic interventions. Exclusion criteria included studies not focussed on stroke rehabilitation, non peer-reviewed articles, and those without relevant outcome data. After screening, a total of 12 articles were included in the review. Results: The review identified consistent positive outcomes in studies investigating robotic hand therapy. Robotic devices such as exoskeletons, glove-based systems, and wearable robotic suits were found to improve hand function, grip strength, and fine motor skills. Several studies reported enhanced performance in ADLs and increased independence. The therapy was shown to facilitate neuroplasticity, with patients exhibiting improvements in motor coordination and functional abilities through repetitive, task specific movements. Conclusion: Robotic hand therapy appears to be an effective intervention for improving the functional recovery of hemiplegic hands following stroke. The reviewed studies consistently demonstrated positive outcomes in terms of motor function and ADLs.

To Examine the Effect of Pneumatic Compression in Sports Rehabilitation: A Literature Review

Iram Kausar, Probhjot Singh Nalwa

A pneumatic compression is a medical device that improves circulation by applying compressed air to the legs or other body parts. It is also termed as Intermittent Pneumatic Compression (IPC). Nowadays, this therapy add has popular in the sports rehabilitation because it is non-invasive evidence-based technology and the main role of this therapy in sports is to enhance the recovery, improve performance, prevent injuries and rehabilitation programmes. The main aim of this literature review is to examine the effect of pneumatic compression in sports rehabilitation, which generally focusses on the rehabilitation programme after injury. There were various researches performed on the PubMed, physiotherapy evidence-based database (PEDro), Cochrane and Google Scholar from year 2017 to 2024. A total of 2000 articles were obtained in different databases, with the key words of “pneumatic compressions,” and “atheletes.” After exclusion of non-English and duplicate articles, 10 articles are included by their preferable criteria comprising randomised controlled trials, systematic review add and cross sectional surveys. The findings of this literature review states that pneumatic compression has shown effects in reducing oedema, swelling, and pain, and it supports the management of acute lateral ankle sprains. Additionally, blood circulation improvement is also seen. This study concludes that pneumatic compression can be effective in athletic recovery and rehabilitation processes. While current evidence prop-up its effectiveness, to check its long-term benefits and to scout its role in combination with other therapeutic modalities further research is needed. Clinicians should continue to assess the most appropriate interventions for pain management and muscle recovery, with pneumatic compression serving as a promising option in rehabilitation protocols.

Developing an Efficient Rehabilitation Protocol for Early Mobilisation in The ICU to Reduce Intacranial Pressure in Subarachnoid Haemorrhage

Shah Faisal, Yukta Rastogi, Jasmine Anandabai, Shikha

Introduction: Subarachnoid Haemorrhage (SAH) is a medical emergency that can result in high mortality rates and significant morbidity. Despite the importance of early mobilisation in improving outcomes, there is a lack of standardised treatment protocols for SAH patients. Aim: This study aimed to develop an efficient rehabilitation protocol for early mobilisation in the Intensive Care Unit (ICU) to reduce Intracranial Pressure (ICP) in patients with SAH. Materials and Methods: A comprehensive literature review was conducted, including two randomised controlled trials, three mixed design studies, 10 non randomised studies, and four experimental studies. Results: The results showed that early mobilisation within 24 hours of stroke onset was feasible and did not increase the risk of mortality. Patients who received early mobilisation returned to walking faster, had improved function, and were less depressed. The developed protocol consists of four levels of mobilisation, with increasing intensity and complexity, and includes body positioning, respiratory exercises, and strength training. Conclusion: This protocol has the potential to reduce ICP, improve functional outcomes, and decrease the risk of complications such as pneumonia and cardiopulmonary complications. Therefore, this study provides a standardised treatment protocol for early mobilisation in the ICU to reduce ICP in patients with SAH, which can be used to improve patient outcomes and reduce healthcare costs.

Validity of CAMRY Hand Dynamometers among Young Adults

Vartika Shukla, Hina Vaish

Introduction: Hand grip strength (HGS) is widely used as an outcome. The Jamar dynamometer is an extensively used tool for measuring HGS. The CAMRY dynamometer is proposed as a valid and reliable tool to evaluate HGS among older adults. However, there is scarcity of evidence about its validity in young adults. Aim: To assess the validity of the CAMRY EH101 dynamometer among young-aged adults. Materials and Methods: Young adults (n=50) aged 18-40 years were enrolled by purposive sampling for this cross-sectional study. Hand dominance was measured using Edinburgh Handedness Inventory. HGS was measured using the Jamar Plus + Hand dynamometer and CAMRY EH101 dynamometer. Results: The demographic characteristics are presented as the mean and standard deviation (SD). The data followed normal distribution and parametric and thus, parametric tests were used. The mean age of the participants was 25.20+4.84 years. The average HGS as measured by CAMRY EH101 dynamometer was 28.72±11.45 kg and Jamar Plus + Hand dynamometer was 30.74±9.5 kg but the difference in the values of HGS measured by the two tools was insignificant (p=0.098) with no systematic bias. Conclusion: The CAMRY EH101 dynamometer is valid as an outcome tool for hand grip assessment. The CAMRY EH101 dynamometer might be used as an economical device to measure grip strength among young adults.

Exploring the Effect of Magnetotherapy as a Non-invasive Treatment for Knee Orteoarthritis: A Systematic Review

Anupriya Arya, Shivangi Palsra

Knee Osteoarthritis (OA) is a prevalent degenerative joint disorder that significantly impacts the quality of life, particularly among older adults. Conventional treatments such as Nonsteroidal Anti Inflammatory Drugs (NSAIDs) and physical therapy often yield limited relief and may pose long-term side effects. This systematic review aims to evaluate the therapeutic potential of magnetotherapy, a non-invasive alternative that apply magnetic fields to alleviate knee OA symptoms. A database search was conducted using the following resources: PubMed, Cochrane, PEDro, SCOPUS, and WoS. The following MESH terms were used: [Pulsed Magnetic field AND/ OR Rehabilitation] and [Pulsed Magnetic field AND/OR Knee OA], [Pulsed Electromagnetic field AND/OR Rehabilitation] and [Pulsed Electromagnetic field AND/OR Pain], per the guidelines of the PRISMA statement. Articles published between January 1, 2009 and December 31, 2018 were included as assessment of Knee OA pain conditions, randomised clinical trial including crossover and prospective design studies, focussing on the efficacy, safety, and underlying mechanisms of magnetotherapy in improving pain, joint function, and overall health in knee OA patients. Inclusion criteria encompassed studies utilising defined magnetic field parameters and validated outcome measures, including pain intensity and joint function assessments. A thorough literature search was conducted across multiple databases, employing a comprehensive set of keywords related to knee OA and magnetotherapy. The review will synthesise findings through qualitative and quantitative analyses, including risk of bias assessments and GRADE evaluations of evidence quality. Preliminary findings suggest that magnetotherapy may offer beneficial effects in pain reduction and functional improvement, although clinical evidence remains heterogeneous. This review seeks to clarify the clinical utility of magnetotherapy in knee OA management, highlight existing research gaps, and propose directions for future investigations, ultimately contributing to the development of more effective treatment strategies for this debilitating condition.

Immediate Eefect of Manual Therapy on Pulmonary Function and Thoracic Expansion among Emergency Medical Technician: A Quasi Experimental Study

Aditi Nanda, Aakrit Sharma, Akanksha Saxena, Mandeep Kumar Jangra

Introduction: Effective lung function relies on proper airflow, which is regulated by the coordinated movement of the ribcage, diaphragm, and thoracic spine. Emergency Medical Technicians (EMTs) are more prone to neuro-musculoskeletal dysfunctions, especially in the thoracic spine due to heavy weight lifting in awkward postures during shifting, transporting of patients and rescue operations affecting the pulmonary functions. Manual therapy is a holistic approach comprising of joint manipulation and/or mobilisation, neural mobilization, soft tissue release etc. which shows promising effects in improving the pulmonary functions in older adults and in diseased patients. Aim: To evaluate the immediate effect of manual therapy on pulmonary function and thoracic expansion in EMTs. Materials and Methods: EMTs having age of more than 18 years were recruited according to the selection criteria. Individuals with any cardio-pulmonary conditions and having contraindication to manual therapy were excluded. Manual therapy was given to participants comprising thoracic manipulation, thoracic and diaphragmatic mobilization. Pulmonary Functions as seen on Forced Vital Capacity (FVC), Forced Expiratory Volume in first second (FEV1), (FEV1/FVC), Peak Inspiratory Rate Flow (PEFR), and Forced Inspiratory Vital Capacity (FIVC) were assessed via Spirometry at baseline and immediately post-intervention. Results: Eighteen EMTs with mean age of 33.61±4.03 years participated in this study. Wilcoxon signed rank test was used to compare the pre and post data. Significant difference was observed in FEV1 (p=0.001), FVC (p=0.048), FEV1/FVC (p=0.00), and FIVC (p=0.009) immediately after the manual therapy. No significant difference was observed in PEFR (p=0.647). Conclusion: The result of the current study conclude that manual therapy is effective in improving pulmonary function among EMTs.

Normal Reference Values of Graphesthesia among Healthy Young Adults

Jagriti Mishra, Roushan Kumar Singh, Mandeep Kumar Jangra, Akanksha Saxena

Introduction: Graphesthesia, the ability to recognise letters or numbers written on the skin through tactile sensation, is a critical somatosensory skill used in neurological assessments. Despite its clinical relevance, limited data exists on normative reference values for graphesthesia among healthy young adults. Establishing these reference values is essential for distinguishing normal sensory processing from pathological conditions and aiding in the early detection of neurological impairments. Aim: The aim of this study was to determine the normative reference values for graphesthesia among healthy young adults aged 15–24 years. Materials and Methods: This cross-sectional observational study recruited 50 participants from local colleges and universities who had no history of neurological or dermatological disorders. After obtaining due informed consent, graphesthesia was checked by utilising standardised shape and numbers on the participants' palms using a blunt stylus, in a direction towards the patient and towards the therapist. Response time, and lateral dominance (hand preference) were recorded. Results: Normal reference values for graphesthesia were determined in healthy young adults with an average age of 20.88±1.35 years and an average body mass index of 20.72±2.79. When stimuli were drawn towards the patient, the average graphesthesia scores ( in seconds) for shapes and numbers were 1.91±0.47 and 1.67±0.38 on the palm, 1.91±0.36 and 1.72±0.45 on the palmar aspect of the forearm, and 1.84±0.43 and 1.76±0.43 on the dorsal aspect of the forearm. In contrast, when stimuli were drawn towards the therapist, the scores for shapes and numbers were 1.66±0.40 and 1.68±0.43 on the palm, 1.70±0.38 and 1.73±0.38 on the palmar aspect of the forearm, and 1.66±0.37 and 1.63±0.37 on the dorsal aspect of the forearm. Conclusion: This study successfully establishes normative reference values for graphesthesia in healthy young adults. Future studies may build upon these findings to explore graphesthesia in diverse populations with large sample size.

Investigating the Effects of Sacroiliac Joint Mobilisation on Pain, Function, and Disability in Patients with Lumbar Disc Prolapse: A Study Protocol

Aarunee Srivastava, Sandeep Pattnaik

Introduction: One cause of potentially incapacitating low back discomfort is the lumbar Prolapse Intervertebral Disc (PIVD). Notably, up to 30.7% of individuals presenting with sciatica and low back pain exhibit concomitant Sacroiliac Joint (SIJ) disorder. Need of the study: While SIJ mobilisation has been proposed as a potential therapeutic approach for these cases, further rigorous investigation is imperative to elucidate its efficacy in managing lumbar PIVD. Aim: The purpose of this study protocol is to outline the methodology for a clinical trial to investigate the efficacy of SIJ mobilisation in improving pain, function, and disability in patients with lumbar PIVD. Materials and Methods: This proposed study intends to employ a single-group pre-test-post-test quasi-experimental design. Participants will be of both genders, aged 30-50 years, with acute, unilateral lumbar PIVD. Individuals with chronic PIVD, disc protrusions, or sequestrations will be excluded. A sample size of 45 participants is estimated, accounting for a 20% dropout rate. Baseline data, including demographics and outcome measures, will be collected prior to the intervention. Participants will receive six sessions of SIJ mobilisation, administered on alternate days. The intervention will consist of posterior-anterior and extension glides, with 30 glides per set and 30 seconds of rest between sets. Core strengthening exercises, including pelvic bridging and adductor ball squeezes, will be incorporated as well. Outcome measures will be assessed at baseline and after the sixth session. These include the Visual Analogue Scale for pain intensity, the Timed Up and Go test for functional mobility, and the Oswestry Disability Index for assessing disability.

Hindi Translation,Cross-cultural Adaptation and Psychometric Properties of the Dynamic Gait Index: A Study Protocol

Anmol, Shubhashish Chatterjee, Mousumi Saha

Introduction: Stroke remains a significant global health challenge, contributing to high rates of mortality and long-term disability. The Dynamic Gait Index (DGI) is an assessment tool is used to evaluate gait stability and predict the risk of all among older adults and the individual shaving balance issue. The DGI comprises eight functional tasks that assess the aspects of gait and balance during dynamic movements. However, the absence of a validated Hindi version hinders its utility among the over 609 million Hindi speakers worldwide. Need of the study: Addressing this gap is essential to expanding access to remote stroke rehabilitation for Hindi-speaking populations. Aim: This study seeks to translate the DGI into Hindi, validate the translated version, and examine its test-retest reliability in stroke patients who primarily speak Hindi. Materials and Methods: Permission from the original authors of the scale will be obtained prior to initiating a structured translation process. The scale will be translated into Hindi independently by bilingual professionals with expertise in healthcare and linguistics. The translations will then be harmonised into a unified version and back-translated into English to verify accuracy and equivalence. Content validation will involve an expert panel using the Delphi method to calculate Item-level Content Validity Index and Scale-level Content Validity Index Average. The pre final version will be tested on a small group of Hindi-speaking stroke patients to ensure its comprehensibility and cultural relevance. Test-retest reliability will be measured by administering the scale twice at a fixed interval, with consistency assessed through Intra class Correlation Coefficients and Bland-Altman plots.

Determining the Effect of Vestibular and Auditory Exercises on Postural Control and Coordination Among Individuals with Benign Paroxysmal Positional Vertigo: A Three-arm Single-blinded Study Protocol

Abhay Sharma, Nidhi Sharma, Preeti Kapri

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a vestibular disorder marked by short episodes of vertigo that occur in response to particular head movements. This phenomenon is caused by the displacement of otoconia within the semicircular canals. BPPV notably affects postural stability and coordination, leading to a diminished quality of life and a heightened risk of falls. Need for this study: While the individual benefits of vestibular rehabilitation has been increasingly acknowledged for patients with BPPV, there remains limited evidence on the combined effect of vestibular and auditory exercises in the patients. Aim: To assess the effects of vestibular and auditory exercises on postural control and coordination in individuals with BPPV. Materials and Methods: A total of 36 participants will be recruited and subsequently assigned at random into three equal groups, each consisting of 12 participants. Group 1 will undergo active auditory exercises, group 2 will participate in vestibular exercises, and group 3 will undertake a combination of both auditory and vestibular exercises. Outcome measures such as Mini BESTest, Timed Up and Go Test (TUG), Dizziness Handicap Inventory (DHI), Tandem Walking, and the 6-Minute Walk Test, will be utilized to evaluate the participants for pre and post assessment. The intervention will be conducted four days a week for the duration of four weeks.

Impact of Myofascial Mobilisation on Menstrual Pain and Functional Disability in Women with Dysmenorrhoea: A Protocol

Pakeeza Altaf, Kanu Goyal, Manu Goyal
Introduction: This study aimed to explore whether patients with primary dysmenorrhea experience changes in mechanosensitivity, pain patterns, and increased myofascial trigger points in the abdomen and pelvic floor muscles. Conditions such as dysmenorrhea can lead to debilitating pain, adversely impacting daily activities and overall quality of life. Traditional management strategies, including pharmacological treatments, may not provide adequate relief or may carry unwanted side effects, prompting the need for alternate therapeutic approaches. Study reveals a research gap in the evaluation of manual release therapy for primary dysmenorrhea, particularly regarding the identification of the most painful days and the effectiveness of treatment adherence. Additionally, there is a need for more comprehensive assessment methods for menstrual symptoms and their relationship to pain and general health outcomes. Need of this study: By employing the suggested design, this study aims to provide potential benefits of myofascial mobilisation into the management of pain and functional disability in dysmenorrhoea. Aim: To find out the impact of myofascial mobilisation on pain and functional disability in women with dysmenorrhea. Materials and Methods: A randomised controlled trial study will be conducted. Two groups pre-test post-test experimental study will be conducted in MMDU Mullana-Ambala. The age range of the recruited patients ranges from 18 to 45 years, depending on the inclusion and exclusion criteria. Using Sequentially Numbered Opaque Sealed Envelope. Myofascial mobilisation is a manual therapy technique that focusses on relieving tension in the fascia, the connective tissue surrounding muscles and organs. Myofascial mobilisation may alleviate pain and improve functional disability in various musculoskeletal conditions. However, its specific effects on menstrual pain and health-related quality of life in women with dysmenorrhea remain under explored. Outcome measures like visual analogue scale and numeric pain rating scale for pain and intensity.

Developing, Validating and Pilot Testing of an Exercise Protocol for Post-menopausal Women: A Study Protocol

Poornima Maurya, Shavez, Akanksha Saxena
Introduction: Menopause refers to a natural biological event, characterised by the cessation of the menstrual cycle permanently. Need of this study: Despite being a physiological phenomenon, menopause is frequently accompanied with symptoms that can significantly lower a woman's quality of life and have a significant impact on her daily activities. Aim: This study aims to design, develop and validate an exercise protocol which will be multi-domain and further to find the effect of the validated protocol in post-menopausal women. Materials and Methods: A brief literature review will be done to find out the the most prevalent symptoms among postmenopausal women. Based on the findings, we will develop an exercise protocol. After which content validation of the developed protocol will be done by Delphi survey method on the basis of relevancy. After the validation, pilot testing of the developed protocol will be evaluated to understand its efficacy among postmenopausal women.

A Comparative Study Protocol for Evaluating Instrument-assisted Soft Tissue Mobilisation and Integrated Neuromuscular Inhibition Technique in Managing Hamstring Tightness: A Single-blinded Randomised Controlled Trial

Anchal Thakur, Gurjant Singh, Nidhi Sharma
Introduction: People of all ages and activity levels are susceptible to hamstring tightness. It frequently causes functional impairments and restricted Range of Motion (ROM), exacerbating pain. Limited muscle extensibility is a prevalent issue affecting healthy, able-bodied people and a variety of patient groups. In addition to low back pain and abnormal gait, hamstring problems are frequently associated with movement dysfunction at the back of the spine, pelvic region, and lower extremities. Aim: To plan a study protocol for instrument-assisted soft tissue mobilisation and the integrated neuromuscular inhibition technique to reduce hamstring tightness while enhancing patient flexibility and quality of life. Materials and Methods: According to the eligibility criteria, 50 individuals between the ages of 18 to 30 years will be recruited. Participants will be randomly assigned into group 1 and group 2. Group 1 will receive Instrument Assisted Soft Tissue Mobilisation (IASTM) and Group 2 will receive Integrated Neuromuscular Inhibition Technique (INIT). Outcome measures like Numeric Pain Rating Scale, Short Form-36 Questionnaire, Pressure Algometer, and Universal Goniometer will be used to compare patient’s pre-post intervention status. Results: Data will be analysed using the Statistical Package for Social Sciences (SPSS) 26.0 software. To determine whether the data is normal, Shapiro-Wilk test will be used. Depending on the normality of the data, parametric tests (paired t-test for within group analysis and independent t-test for between group analysis or non-parametric tests (Wilcoxon signed rank test for within group analysis and Mann Whitney U test for between group analysis) will be applied. Expected Outcome: In recent literature, both IASTM as well as INIT were found to be useful in increasing hamstring flexibility and functional mobility with hamstring tightness. But while comparing the both, one may show better effectiveness than the other.

Evaluation of Comparative Efficacy of Arjunadi Ointment versus Cadexomer Iodine Ointment on Wound Healing of Madhumehjanya Dushta Vrana (Diabetic Foot Ulcer): A Clinical Trial Protocol

Shubham Bhagwan Patil, Sheetal Asutkar
Introduction: Diabetic foot ulcers are one of the most common complications associated with diabetes and are linked to poor glycaemic control, peripheral neuropathy, and vascular disease. Chronic wounds, most often found on the soles of the feet, are the leading cause of lower extremity amputations globally. Traditional treatments primarily focus on infection control and wound closure but often fail to address the complex physiological and pathological processes involved in healing. The present randomised, single-blind, double-arm clinical study compares the effectiveness of Arjunadi ointment, a polyherbal formulation from Ayurveda, with that of Cadexomer iodine ointment in managing diabetic foot ulcers. Aim: To compare the efficacy of Arjunadi and Cadexomer iodine ointments in diabetic foot ulcer healing, integrating Ayurvedic principles with modern clinical methods for comprehensive management. Need of the study: Diabetic foot ulcers affect nearly 15% of individuals with diabetes, often leading to complications such as infections, osteomyelitis, and amputations. While conventional treatments primarily target infection control, other aspects of wound care remain unmet. Arjunadi ointment offers a holistic healing approach with anti-inflammatory, antimicrobial, and analgesic properties. Materials and Methods: The present randomised, single-blind, double-arm trial will take place in the outpatient and inpatient Departments of Shalya Tantra at Mahatma Gandhi Ayurveda Hospital, Wardha, Maharashtra, India. The study will include 30 participants aged 30-70 years with chronic diabetic nonhealing foot ulcers persisting for over four weeks. The study is expected to commence in February 2026. Participants are divided into two groups: Group A, treated with Cadexomer iodine ointment, and Group B, treated with Arjunadi ointment. Ointments will be applied twice daily for 30 days, supplemented with standard antidiabetic drugs and antibiotics. Wound healing is evaluated on days 0, 15, and 30 using the Bates-Jensen Wound Assessment Scale (BJWAS). Statistical analysis, including paired and unpaired t-tests, will determine treatment efficacy. The study trial lasts three months, including a follow-up evaluation on the 60th day after treatment.

Molecular Mechanism of Fluconazole Resistance among Clinical Isolates of Non albicans Candida Species in a Rural Tertiary Healthcare Centre of Central India: A Research Protocol

Deependra Manish, Gargi Mudey, Dipika Shaw
Introduction: The most common fungal infections are caused by Candida spp., and non albicans Candida (NAC) species are increasingly prevalent in India. This study protocol provides a concise summary of fluconazole resistance mechanisms in NAC species. Although fluconazole is fungistatic and resistance can be either intrinsic or acquired, it remains a mainstay of current treatment. Understanding species-specific molecular pathways is crucial because resistance mechanisms differ among species. Clarifying the mechanisms that drive fluconazole resistance is essential to preserve the effectiveness of this important antifungal agent. Need of the study: The results of this study may inform public health initiatives and help shape policies to curb the emergence and spread of antifungal resistance, emphasising the need for targeted interventions and sustained surveillance programs. Aim: To study the molecular mechanisms of fluconazole resistance among clinical isolates of NAC species. Materials and Methods: This will be a cross-sectional study. A total of 78 clinically relevant NAC isolates obtained from specimens received between February 2024 and August 2026 in the Department of Microbiology will be tested for fluconazole resistance using disk diffusion and microbroth dilution methods. Polymerase Chain Reaction (PCR) will be performed to investigate molecular mechanisms of fluconazole resistance by examining mutations in ERG11. Data will be analysed using Student’s t-test, Chi-square test and Fisher’s exact test as appropriate. R and IBM Statistical Package for the Social Sciences (SPSS) Statistics version 29.0 will be used for statistical analysis.

Effect of Pelvic Floor Exercises and Diaphragmatic Activation versus Split Tummy Exercise Program on Inter-recti Distance, Strength and Quality of Life in Diastasis Recti: A Research Protocol

Vaishnavi Sanjay Chawake, Subrat Samal, Ravi Lashkari, Tejaswini Fating
Introduction: Diastasis Recti Abdominis (DRA) is characterised by an increased separation of the rectus abdominis muscles, which is accompanied by the extension of the linea alba tissue and weakness of the abdominal wall. Among women, DRA is prevalent both during pregnancy and in the postpartum period. There is a lack of knowledge regarding the prevalence, risk factors and rehabilitation of this condition. Need of the study: Diastasis Recti can lead to an increased distance between the rectus abdominis muscles and weaken the abdominal muscles, which may contribute to pelvic floor dysfunction and affect its function, ultimately resulting in a reduced quality of life. It has also been noted that Urinary Incontinence (UI), Pelvic Organ Prolapse (POP) and faecal incontinence occur more frequently in women who have DRA. In this study, the combined effect of pelvic floor exercises with abdominal activation and the Split Tummy Exercise Program (STEP) can be a more effective management strategy in reducing diastasis recti and thereby improving abdominal muscle strength and quality of life. Aim: To compare the effects of pelvic floor exercises with diaphragmatic activation and the Split Tummy Workout Program on strength, overall quality of life and inter-recti distance in patients with diastasis recti. Materials and Methods: The present study is a comparative study in which a simple random sampling technique will be employed on participants allocated by a sequentially numbered opaque sealed envelope technique. The total duration of the study will be one year from June 2024 to June 2025, with a total of 60 participants conducted at Datta Meghe Institute of Higher Education and Research, Deemed to be University, Wardha, Maharashtra, India. This research will be conducted in the Department of Community Health Physiotherapy and the Department of Obstetrics and Gynaecology, based on the inclusion criteria of the study. Group A will receive a four-week exercise program that includes pelvic floor exercises combined with abdominal activation, while Group B will follow the STEP program. Outcome measures will include a Digital Calliper, Posterior Pelvic Pain Provocation Test, Visual Analogue Scale (VAS), Sphygmomanometer and Health-Related Quality of Life Scale (HRQOL), which will be performed at baseline and at the last session after four weeks of rehabilitation.

Effect of Benson’s Relaxation versus Mitchell’s Relaxation along with Conventional Physiotherapy Exercise as an Adjunct to Medications to Stabilise Blood Pressure, Anxiety and Quality of Life in Preeclampsia: Research Protocol for a Randomised Controlled Trial

Gauri Kariya, Subrat Samal, Ravi C Lashkari, Tejaswini Fating
Introduction: Preeclampsia, a hypertensive disorder of pregnancy, is a leading cause of maternal and foetal morbidity and mortality worldwide. It involves managing blood pressure, reducing anxiety and enhancing quality of life. This study will recruit participants diagnosed with preeclampsia, randomly allocating them into two groups. The conventional group will receive a routine exercise protocol along with Mitchell’s relaxation technique, whereas the intervention group will receive Benson’s relaxation technique along with routine exercises. Blood pressure will be measured using a digital sphygmomanometer, anxiety will be assessed using the Beck Anxiety Inventory and quality of life will be evaluated using the Health-Related Quality of Life questionnaire. The protocol will be administered over four weeks, with an interim assessment conducted at the second week and a post-assessment completed after the fourth week. Need of the study: The preeclampsia population requires constant monitoring and care, as the vitals of affected women can be unstable. This group is at a higher risk for stroke and heart disease. Preeclampsia can impact foetal growth, leading to mental retardation, placental abruption and preterm birth. There is a lack of information regarding appropriate physiotherapy protocols for this population. Aim: The study aims to compare the effectiveness of Benson’s and Mitchell’s relaxation techniques, combined with conventional physiotherapy exercises, to determine which approach yields better outcomes. Materials and Methods: This randomised control trial will be conducted at Acharya Vinoba Bhave Rural Hospital and the Department of Community Physiotherapy of Ravi Nair Physiotherapy College in Sawangi Meghe, Wardha, Maharashtra, India, from February 2024 to August 2025. A total of 60 patients diagnosed with preeclampsia will be divided into two groups. Group A will receive conventional therapy, while the experimental group (Group B) will receive Benson’s relaxation. After dividing patients into the two groups, each Group A and B will receive Mitchell’s relaxation and Benson’s relaxation, respectively, for 30 minutes, along with breathing exercises. Patients will receive these interventions five days a week. All relaxation techniques will be combined with conventional physiotherapy exercises in both groups.

Impact of High Intensity Laser Therapy on Shearwave Elastography Parameters of Achilles Tendon in Healthy Adults: A Study Protocol

Muskan Bathla, Kanu Goyal, Amit Mittal, Manu Goyal
Introduction: Achilles tendon injuries can happen in a variety of ways. High-intensity Laser Therapy (HILT) has been used more recently in the therapeutic protocols of physiotherapy. The benefits of this noninvasive, painless, and convenient method include increased joint mobility, effective deep tissue stimulation, anti-inflammatory and analgesic effects, and more. Shear wave imaging has the benefit of offering quantitative measurements in a comparatively limited area of the tendon, making it possible to precisely identify and quantify tendon disease, which is known to affect distinct locations. It is yet unclear how HILT will affect the tendon's mechanical characteristics over time (such as its stiffness and elasticity) and whether these modifications will translate into better clinical outcomes. Need of the study: The findings from the study will help to improve clinical outcomes by determining how the effect of high intensity laser therapy will result in the changes in the shear wave properties of Achilles tendon. Aim: This study aims to determine the effect of HILT on shear wave elastography of Achilles tendon in healthy adults. Materials and Methods: One group quasi experimental study will be conducted at a tertiary care superspeciality hospital on healthy individuals. Sample size will be calculated after pilot testing. Patients will be recruited based on inclusion and exclusion criteria using purposive sampling method. Shear wave elastography will be used to determine the pre and post intervention changes in the Achilles tendon. HILT will be given to the patients for 3 consecutive sessions to assess what changes occurred post intervention.

Spencer Technique is Effective for Improvement in Pain and Function, in Patients with Frozen Shoulder: A Systematic Review and Meta-analysis

Shweta Jain
Introduction: Shoulder is the most mobile and complex joint in the body, which makes it vulnerable to various pathological conditions. Frozen shoulder is one of the most common musculoskeletal conditions characterised by persistent pain and stiffness around the shoulder joint, which significantly hampers the activities of daily living. To manage this condition, various joint mobilisations and stretching techniques are frequently used by physiotherapists as an intervention. Aim: The purpose of this article is to assess the effectiveness of Spencer technique as an adjuvant to conventional therapy for the improvement of patients with frozen shoulder. Materials and Methods: Five electronic data bases, (SCOPUS, DOAJ, Science Direct, Medline, PubMed) were searched. Prospective studies that measured the effect of Spencer technique for the shoulder pain specifically the frozen shoulder were included. The articles were reviewed and selected for inclusion by two authors independently. Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias. Results: Twelve studies were retrieved that met the inclusion criteria and nine studies including 311 participants presented data used in meta-analysis that included both males and females. Pain, and functional disability were the primary outcomes. Conclusion: The findings of this systemic review clearly suggest that the Spencer technique is effective for the treatment of Frozen shoulder. This treatment should be accompanied by conventional treatment to maximise the chance of recovery.

Exploring the Efficacy of Dry Needling in Fibromyalgia: A Comprehensive Narrative Review

Rakibul Alam, Sunita Sharma, Yashica Sharma
Fibromyalgia is a chronic pain condition that affects muscles and soft tissues, fibromyalgia causes exhaustion,fatigue, sleep disturbances, and generalised pain. Despite the limited efficacy of pharmaceutical therapies, dry needling has viable substitute. Thin needles are inserted into myofascial trigger points during dry needling in order to reduce discomfort and enhance muscular function. In order to evaluate the effectiveness of dry needling in treating fibromyalgia symptoms, this narrative review emphasizes Randomised Controlled Trials (RCTs). A systematic search was conducted in PubMed, Scopus, Cochrane and Google Scholar databases published between 2014 and 2024 using the terms “dry needling”, “fibromyalgia”, “myofascial pain”. Studies included only RCTs in English and that assessed dry needling’s effect on pain intensity, muscle stiffness and quality of life in fibromyalgia patients were selected. A total of 185 research underwent screening. 8 studies that satisfied the eligibility conditions were selected for consideration after duplicate entries were eliminated and the inclusion criteria was applied. These studies offer more important information about how well dry needling works to lessen the severity of pain, increase functional capacity and improve quality of life.Dry needling hold promise as effective component in management of fibromyalgia, offering pain relief and functional improvement.

Posture Analysis Software for Upper Cross Syndrome: A Review

Ambika Chaudhary, Kanika, Rittu Sharma, Kanika Bhatia
Introduction: The global prevalence of neck pain was estimated at 288.7 million cases in 2017. Neck pain is often described as a condition with recurring episodes throughout life, with varying recovery levels between episodes. Studies on the effects of neck pain on the cervical motor system, posture, and movement have increased significantly, especially in the last 20 years.Decrease in cervical flexor endurance can lead to cervical dysfunction, tissue overload, trauma, and discomfort since it is connected with cervical spine function. Aim: The aim of the study is to examine the relationship between cervical flexor strength and endurance in patients with chronic neck pain. Materials and Methods: A total of 156 patients with chronic neck pain were recruited from Physiotherapy OPD, MM Superspeciality Hospital; the participants were male or female, aged 25-40 years and Visual Analogue Scale (VAS) 3.5-7.4 using convenient sampling method. Participants were excluded if they have acute neck pain, radicular pathology, cervical trauma within last six months and severe neck pain on VAS. Demographic data was recorded after taking consent from the participants. Based on the requirements, cervical flexor strength and endurance were assessed with two test which are pressure biofeedback test and neck Neck flexor endurance test. Results: Statistical analysis was done using SPSS version 22.0. Kolmogorov Smirnov test was used for assessing normality. As the data was not normally distributed, Mann-Whitney U test was used for data analysis by comparing the values of strength and endurance of the cervical flexors muscles. The statistical significant result was set if p-value ≤0.05. Conclusion: There was a statistical significant difference in the strength and endurance of cervical muscles in chronic neck pain patients. The finding of this study suggests that decreasing strength and endurance of neck flexor muscle will contribute to the neck pain and disability.Avoiding fear response commonly seen in the neck pain patients which leads to reduction of muscle strength and endurance.

Exploring the Role of Physiotherapy in the Management of Polycystic Ovary Syndrome: A Research Overview

Savita, Jasmine Anandabai, Shikha Singh
Introduction: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder characterised by irregular menstruation, hyperandrogenism, and polycystic ovaries. Infertility, metabolic abnormalities, and an elevated risk of cardiovascular disorders are linked to it. Physiotherapeutic procedures have become important adjunct therapies for treating the symptoms and enhancing general health in women with PCOS, even if pharmaceutical treatments continue to play a key role. This review aims to examine the role of physiotherapy in the management of PCOS, focusing on exercise interventions, pelvic floor therapy, and lifestyle modifications. The goal is to assess the effectiveness of these approaches in managing the hormonal, metabolic, and psychological aspects of PCOS. A thorough assessment of the literature was carried out, examining research on physiotherapeutic strategies for PCOS, including observational studies, randomised controlled trials, and clinical recommendations. Exercise (including aerobic and resistance training), yoga, manual therapy, and pelvic floor exercises are among the important therapies that were examined. Relevant outcomes were taken into consideration, including quality of life, menstrual regularity, weight control, and insulin sensitivity. Weight loss, testosterone reduction, and insulin sensitivity were all found to be greatly enhanced by physiotherapy therapies, especially regular exercise. Additionally, resistance training and aerobic workouts might help reduce symptoms like exhaustion, despair, and anxiety. Yoga has been demonstrated to lower stress and improve hormonal balance. For some women with PCOS, pelvic floor treatment proved useful in treating dysmenorhoea, irregular menstruation, and pelvic discomfort. Moreover, lifestyle education from physiotherapists enhances self-control and commitment to long-term healthful behaviors. Exercise therapy, pelvic floor exercises, and lifestyle counseling are examples of physiotherapeutic techniques that are successful in treating the complex symptoms of PCOS. These non-pharmacological, holistic approaches can be used in conjunction with conventional medical treatments to improve the physical and mental health of women with PCOS.

Physiotherapy Intervention in Posterior Cruciate Ligament Injury: A Narrative Review

Rubal Saharan, Neha Sharma
Posterior Cruciate Ligament (PCL) is one of the major ligaments in the knee and plays a crucial role in stabilising the joint.It is the biggest and strongest ligament in the knee joint. In addition to providing anteroposterior consistency, the ligament also serves as a buffer against rotational, varus, and valgus forces. The main objective of this review is identify the significant effects of physiotherapy intervention on the patient with PCL injury. For determining full text publications, databases comprising PubMed, Cochrane, Google Scholar, and Scopus were searched for articles published between 2015 to 2024. The evidence-based reviews, follow up studies and a prospective randomized trial studies in English were browsed, including 975 papers that qualified for full text and 567 articles were eliminated because they contained duplicates. A total of 299 abstract and titles were assessed, out of those, 100 were removed due to other treatment. This review entailed 9 published articles. This study found that physiotherapy and conservative management can lead to maximum stability in an individual with PCL. According to the study, post operative management of the PCL injury could lead to minimum damage and enhance stability. Patients following physiotherapy intervention had shown gradual improvement in the condition. During the rehabilitation process, the physical therapy is a key component of PCL injury rehab. In conclusion, physiotherapy helps to strengthen the muscles around the knee, increase adaptability, and regain movement range, focussing on pain management, restoring function and strength, improving proprioception, facilitating a safe return to activity, and empowering patients with the knowledge and skills for long-term joint health.

Effectiveness of Advanced Non-invasive Electroceutic Interventions on Gait Rehabilitation in Parkinson’s Disease: A Literature Review

Anil Kumar, Rittu Sharma, Swarup Ghosh, Jahanvi Dave, Kanika, Kanika Bhatia
Gait impairment is a common motor dysfunction in Parkinson's Disease (PD) marked by dragging feet, shorter steps, and slower walking, often leading to disability and poor quality of life. Noninvasive Brain Stimulation (NIBS) techniques like repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS) have shown promising results in addressing these issues by modulating cortical excitability. These painless methods target reduced activity in premotor and primary motor regions, with tDCS also influencing basal ganglia function through a distributed cortical network. This study synthesises current literature on the effectiveness of advanced non-invasive interventions, such as rTMS and tDCS, in improving gait rehabilitation in PD patients. An initial search across databases including PubMed, Google Scholar, Scopus, and the Cochrane Library yielded 22,004 studies using keywords like “transcranial direct current stimulation,” “transcranial magnetic stimulation,” “gait,” and “Parkinson's disease,” combined with Boolean operators AND and OR. However, only five studies met the inclusion criteria, specifically assessing the effectiveness of these interventions in this population. The reviewed literature primarily focussed on gait and related parameters, employing outcome measures such as the Timed Up and Go (TUG) test, Unified Parkinson Disease Rating Scale (UPDRS), 10-minute walk test, and 6-minute walk test. Two studies found no statistically significant differences (p>0.05) between the tDCS with gait training group and the sham group, while one study highlighted the potential effectiveness of combining anodal tDCS with gait training in improving balance, leaving the evidence inconclusive. Additionally, two studies assessed rTMS, with one demonstrating that frequencies of 1 Hz and 25 Hz were more effective than sham treatment, while the other showed that 10 Hz rTMS improved gait outcomes in PD patients. Future high-quality trials with larger participant samples and long-term assessments are needed to provide more conclusive evidence on the effectiveness of tDCS and rTMS in gait rehabilitation for PD. Comparative studies exploring different frequencies and stimulation protocols are essential to identify optimal treatment strategies. Such research will help establish robust clinical guidelines for non-invasive brain stimulation in this population.

Effectiveness of Scapular Retraction Exercises on Forward Head Posture: A Narrative Review

Shasawat Kumar Gupta, Jatin Sangwan, Urvashi
Forward head posture is the anterior positioning of the cervical vertebrae, which is characterised by the extension of the upper neck bone. This condition can lead to musculoskeletal discomfort, particularly in the neck and shoulders, and is often caused by muscle imbalances, poor ergonomics, and prolonged static postures.This posture leads to structural changes and degeneration of the neck muscles by reducing the dispersion of biomechanical loading. This condition has been exacerbated by the increasing use of devices like smart mobile phones and computers for long periods of time in a bad cervical posture. It is common in university students and working professionals. The aim of this narrative review is to explore the effect of scapular retraction exercises in forward head posture. The present study includes all the databases collected from Google Scholar and PubMed from the year 2019-2024 with the keywords “Forward head posture”, “Scapular retraction exercise”, “students”, and “general population” with the result of 18190 articles. Only three Randomised Controlled Trials (RCTs) remained after the duplicate article removal. A total of 180 participants participated in these three recruited RCTs with the outcome measures being forward head angle (≥ 20°), cervical range of motion, neck disability index, shoulder pain and disability index with an average of 4-week shoulder retraction exercise intervention. All three studies suggest that scapular retraction exercises can positively impact both cervical spine alignment and shoulder posture by strengthening the rhomboids, middle trapezius, and lower trapezius muscles, which are critical in stabilising the scapulae and counteracting forward head displacement.Overall scapular retraction exercises are very effective and improve the forward head posture, reduce the forward head angle, strengthen the neck muscle and are effective in forward head posture pain.

Application of Rancho Los Amigos Level of Cognitive Functioning in Brain Injury: A Narrative Review

Tulsi Thapa, Shanthakumar Kalimuthu
Brain injury is any injury to the structure and function of the brainand is categorised into Traumatic Brain Injury (TBI) and non-traumatic brain injury. TBI and ischaemic stroke are often the main causes of altered consciousness and cognitive impairments. The Glasgow Coma Scale (GCS) is a reliable instrument for detecting changes in consciousness as an initial indicator for recovery or neurological impairment. The Rancho Los Amigos Level of Cognitive Functioning Scale also called the Rancho scale, is a well-known medical scale that analyses the behavioural patterns and cognitive functions observed in patients following brain injury during their recovery.It is often used with GCS in initial assessment, but unlike GCS, it can be employed throughout the recovery.The level of cognition is crucial for the physiotherapist to determine their physical and cognitive status, enabling early recovery. A review is needed to gather further information and to identify the research gap yet to be explored. A literature search was conducted in databases (PubMed, Cochrane Library, and PEDro) using search terms Rancho Los Amigos scale, LOCF, cognitive recovery, TBI, and brain injuries employing Boolean operators (AND, OR). Studies published between January 2014 and December 2024 and articles published in English were included. A total of 2102 articles were available in the databases, of which only 5 studies met the inclusion criteria for this research study. Level of cognitive function along with physical examination helped track recovery, predict outcomes, and guide clinical decision-making.It is limited by its focus on specific areas and potential observation subjectivity.

Foot Deformities in Football Players: A Narrative Review

Navneet Kumar Jha, Jatin Sangwan, Neha Kashyap, Urvashi
Football being a globally celebrated sport, poses tremendous physical demands on footballers leading to multiple stress injuries. Profound stress due to repetitive impacts, rapid manoeuvring on field and long hours of game time leads to a wide range of foot deformities like hallux valgus, pes planus, plantar fasciitis and claw toes. These deformities not only affect the game play and athletic performance but also expose the athlete to chronic challenges related to health. This review was taken up to examine the prevalence, aetiology, causative factors and strategies to manage the foot deformities in football players. Review used assorted studies focussing on primary/ intrinsic (foot anatomy) and secondary/extrinsic (field type, footwear, training, playing conditions) factors in consideration, owing to foot deformities. An exhausting data search was carried out on various databases like Ovid, Scopus, Pubmed, Cochrane etc. to filter out the studies done on footballers suffering from foot deformities as an occupational hazard. Football as a sport uses repetitive patterns like kicking, jumping, sprinting which may be a contributing factor to these deformities. Modifiable factors including footwear, arch support, ill fitted cleat, dehydration, inadequate training are also found to be adding to foot deformities development. This review also highlights the role of strength and flexibility training along with customised shoe wear and orthotics to maximise the athletic performance. Use of specialised cutting edge diagnostic tools like 3D gait analysis, pressure mapping is showing good potential in prognosticating these injuries and should be studied more in this aspect in future researches.

Physical Activity to Modulate Gut Joint Axis in Microgravity to Prevent Skeletal Health: A Literature Review

Shivani, Aditi Popli, Lakshay Panchal
Osteoporosis is characterised by decreased absorption of calcium-containing minerals in bones. Metabolic studies suggests that in astronauts, space night is the cause of decreased calcium levels in the body. The gradual reduction in bone mineral density and gut metabolism is associated with the increasing affluence of gut microbiota, suggesting a potential interplay between the gut microbiome and skeletal health and influencing bone metabolism through the immune system and calcium absorption. During spaceflight, the electromagnetic environment changes due to the absence of gravity which plays a role in space induced osteoporosis.The composition, functioning, diversity, and Short Chain Fatty Acids (SCFAs) production of the gut microbiota are all significantly affected by physical activity. Exercise and gut microbiota have a complex relationship, impacting metabolic and muscular performance. Exercise regulates bile acid pools, supporting the host gut microbiota's health and supporting the gut-joint axis.The study aims to address thespace-induced osteoporosis/osteopenia caused by gut bacterial overgrowth. A comprehensive literature search was performed on PubMed, Scopus and Cochrane Library databases between 2015 and 2024 using the keywords (microbiota OR microbiome) AND (microgravity OR physical activity) in this narrative review . The study concluded that in post spaceflight,the abundance of Firmicutes gradually elevated, while the Bacteroides abundance gradually decreased and the spaceflight-induced osteoporosis may be addressed by targeting the gut microbiota. It is analysed that these changes disrupt bone metabolism and influence host metabolic processes, modulating the regulatory metabolites like SCFAs within the gut-bone axis. Hence, provides the evidence of connection between the intestinal microbiome, diet, and physical activity.

Effect of Probiotic and Physiotherapy Interventions to Modulate Gut Microbiota in Inflammatory Arthritis: A Narrative Review

Lakshay Panchal, Manu Goyal, Akash Kumar
Inflammatory arthritis is a chronic condition characterised by persistent joint inflammation and systemic immune dysregulation. Emerging evidence highlights that the Gut Microbiota (GM) plays a crucial role in the pathogenesis and progression of inflammatory arthritis. Dysbiosis may contribute to inflammatory arthritis progression through several mechanisms including leaky gut, production of proinflammatory metabolites, dysregulation of the immune system, and molecular mimicry. This review highlights the therapeutic potential of probiotics and physical therapy as complementary interventions targeting GM modulation in inflammatory arthritis. Probiotic supplementation may restore the gut ecosystem, increase the abundance of Short-chain Fatty Acids (SCFAs) producing bacteria, improve intestinal barrier integrity, and promote anti-inflammatory cytokines including interleukin-10. Thus, it mitigates systemic inflammation and reduces disease severity. On the other hand, physical therapy, particularly aerobic exercise, positively modulates GM composition and reduces systematic and intestinal inflammatory markers and endotoxemia. Studies have shown that aerobic exercise increases the abundance of Faecalibacterium and Alistipes, associated with reduced inflammation, improved muscle strength, and enhanced physical function. However, further studies are needed to elucidate the synergistic effects of probiotics and physical therapy in managing inflammatory arthritis.

Importance of Retinoic Acid Derivatives in Breast Cancer: A Literature Review
Due to its specific accumulation in breast tissue and lower hazardous effects, Retinoic Acid (RA) has become increasingly popular in the treatment of Breast Cancer (BC). RA modulates the proliferative activity of BC cells and aids in the redifferentiation of cancer cells into normal breast epithelial cells. The HOXA5 regulates RA (homeobox A5) gene through Retinoic Acid Receptors (RAR) and Retinoid X Receptors (RXR) (-α, -β and -γ) and governs numerous cellular processes, including cellular metabolism and both primary and secondary programmed cell death. RA impairs oestrogen signalling in BC by activating Lysine-Specific histone Demethylase 1 (LSD1) proteins. RA downregulates the survivin protein when combined with other drugs like tamoxifen, taxol and interferon, thereby sensitising BC cells and promoting the progression of cell death. Through cadherin-mediated junction formation, RA regulates mammary gland homeostasis, causing BC cells to undergo lactogenic differentiation, which results in an epithelial phenotype. In the third phase of a mammary carcinoma prevention trial, retinoids reduce the incidence of second BC in older women by modulating the levels of Insulin-like Growth Factor (IGF-I) and Insulin-Like Growth Factor Binding Protein (IGFBP-3), which is its main binding protein, both of which have been connected to an increased risk of BC. Women taking tamoxifen with fenretinide experience a significantly lower rate of hot flashes compared to those taking tamoxifen alone. All-Trans Retinoic Acid (ATRA) reduces the hypercoagulation markers when taken alongside tamoxifen; hence, this combination is recommended for preoperative BC patients. RA derivatives combined with immunotherapy delay the recurrence of BC by increasing lymphocytes and natural killer cells. Targeting Breast Cancer Stem Cells (BCSC) is an effective strategy for BC management, with retinoids acting against BC by targeting BCSC. Thus, RA may help prevent chemotherapy resistance and reduce the recurrence of BC in multiple ways; still, further research is essential for an in-depth understanding of RA and BC.

Artificial Intelligence in Neurosurgery: Enhancing Diagnosis, Treatment and Patient Outcomes: A Narrative Review

Chahat Singh, Pankaj Gharde, Prince Verma, Bhushan Trivedi, Bhagyesh Sapkale
Neurosurgery is experiencing the impact of Artificial Intelligence (AI) in the form of improved diagnostic efficiency, procedural dexterity, and postsurgical management. This narrative review aims to discuss the numerous engagements of AI in the broad subdisciplinary areas of neurosurgery, such as neuro-oncology, functional neurosurgery, vascular neurosurgery, spinal neurosurgery, and Traumatic Brain Injury (TBI) care. The article pays particular attention to the application of machine learning algorithms and topic modeling for more accurate tumour grading, potential prediction of surgical outcomes for each patient and more appropriate patient stratification. Through early diagnosis in diagnostic imaging and individualised treatment regimens, technology—particularly AI—provides decisive information for constructive, real-time intraoperative data analysis. Additionally, the extension of AI applications in the telemedicine system helps to increase the availability of specialised care in relevant areas. While it is important to appreciate the risk of dependency on technology, this does not eliminate the potential for integrating such AI tools with surgical knowledge to continue improving patient care and outcomes. Current and future trends in the practical application of AI in neurosurgery include deep machine learning for neurosurgical planning and individualised patient data/targeted therapy. In general, AI plays an important role in enhancing neurosurgery while optimising the quality and outcomes of patient care.

Efficacy of Blood Flow Restriction Training as a Novel Treatment Approach for Musculoskeletal Conditions: A Narrative Review of Existing Literature

Adarsh Kumar Singh, Mohammad Sidiq, Faizan Kashoo, Jyoti Sharma, Pallavi Singh
Blood Flow Restriction Training (BFRT) helps reduce pain and improve muscle strength and hypertrophy at low intensity by partially occluding arterial inflow and fully restricting venous outflow. This is particularly beneficial for populations contraindicated for High Intensity Resistance Training (HRT). However, there is a lack of research on BFRT that can be used to treat musculoskeletal conditions. The aim of this review is to summarise the current available evidence on the efficacy of BFRT as a novel treatment approach for musculoskeletal conditions, as well as to identify gaps in the literature that may require further research. Databases such as PubMed, MEDLINE, PROSPERO, and PEDro were searched. Articles were included if they described BFRT as a primary intervention. BFRT is an effective treatment approach for musculoskeletal conditions and is indeed a novel strategy. The findings of this review suggest that BFRT can be included in the treatment of conditions like osteoarthritis, low back pain, Anterior Cruciate Ligament (ACL) injury, rheumatoid arthritis, and others. Low load BFRT is an essential treatment option that can be used for musculoskeletal conditions. Individuals contraindicated for high-intensity or high load training can adopt low load BFRT as a primary intervention.

Effect of Virtual Reality Training and Functional Test For Chronic Low Back Pain. A Narrative Review

Shikha Kumari, Aditi Popli
A common ailment that has a substantial influence on both physical function and quality of life is Chronic Low Back Pain (CLBP). Recent data indicates that Virtual Reality (VR) training could offer a current, and effective method of functional rehabilitation and pain treatment. In this study, people with CLBP are examined to see how VR-based training affects their overall quality of life, functional performance, and pain severity. Both VR training and traditional physical therapy groups were assigned at random to the participants. Before and after the intervention, functional tests such as assessments of core strength, balance, and range of motion were carried out. The literature search was performed on PubMed and Cochrane library. Databases focussed on 2015-2024 using key words (CLBP OR physical intervention).According to the findings, the VR group outperformed the control group in terms of pain management, functional performance, and exercise regimen adherence. These results demonstrate VR’s promise as a cutting-edge tool for CLBP therapy, providing an engaging and immersive setting that could improve patient outcomes. To analyse long-term advantages and improve VR-based rehabilitation techniques, more research is necessary.

Conservative Management of Intersection Syndrome: A Narrative Review

Kalyani Kumari, Jatin Sangwan, Urvashi, Aditi Popli
Intersection Syndrome (IS) is a relatively rare overuse tendinopathy characterised by pain, swelling, and crepitus in the forearm. It arises due to friction between the tendons of the first and second dorsal compartments and is a common overuse wrist injury. The review synthesises insights from four recent studies on IS including randomised controlled trials and case reports, focussing on treatment approaches, and outcome measures.Differential diagnosis is essential to distinguish IS from other conditions such as De Quervain’s tenosynovitis. This can be done my using imaging techniques like ultrasound and Magnetic Resonance Imaging (MRI) for evaluation. This review seeks to assess the effectiveness of physiotherapy interventions in the management of IS, with a focus on their ability to reduce symptoms, enhance functional outcomes, and support recovery. A comprehensive search was performed using PubMed, Scopus, and Google Scholar for studies published between 2018 and 2025. IS is effectively treated using a combination of conservative therapies, advanced physiotherapy techniques, and, in severe cases, surgical interventions. Studies indicate that conservative approaches such as rest, splinting non-steroidal antiinflammatory drugs and gradual stretching and strengthening exercises successfully alleviate symptoms in around 60% of patients. Diagnostic tools like ultrasound and MRI were emphasised as crucial for improving treatment accuracy and emerging therapies like pulsed laser therapy, have shown effective results. Studies have indicated that conservative treatments are generally effective, but innovative modalities and surgical options provide alternatives for refractory cases.This analysis highlights the clinical importance of physiotherapy treatment in IS and identifies gaps for future research, particularly in terms of long-term effectiveness and standardised treatment protocols.

Role of Artificial Intelligence in Performance Enhancement among Football Players: A Narrative Review

Jasmeen, Probhjot Nalwa
The implementation of Artificial Intelligence (AI) in football has significantly risen because of its extraordinary effectiveness. Athletes are significantly impacted by muscle re-injuries, especially in football. Poor performance and long-term health problems are the outcomes of these injuries. Initially, football was a game devoid of technological advancements but technology has progressed to the point that it is now necessary for tracking player performance and analysing matches. An athlete’s performance can be understood, interpreted, and eventually improved with the help of AI-powered computer vision algorithms, significantly enhance the extent of performance analysis in sports, boosting accurate strategic planning, and optimising overall team performance, by recognising areas of weakness or projecting prospective injuries, athletes can take proactive actions to cope with these difficulties. The views aim to envision and build AI-driven tools to improve tactical analysis along with performance examination, for providing coaches and players accurate, data-driven insights through the integration of AI technology. These insights can guide strategic choices, streamline training procedures, and eventually enhance overall competitiveness.This review excluded non-English articles that highlights the role of AI in performance enhancement among football players. Searches were carried out in the following databases: PubMed, Google Scholar, ResearchGate from published articles since 2015-2024. The result shows that AI technology creates new opportunities to enhance the objectivity and precision in performance evaluation by identifying hidden trends and patterns in games. Potential limitations such as the high expense and difficulty of putting AI systems into practice, as well as ethical issues like data privacy. In conclusion, AI effectively manages player performance and growth, providing coaches with useful data regarding player performance and potential physical ailments.

The Impact of Cardiovascular Dysfunction on Physiotherapy in End-stage Renal Disease: A Review of Evidence

Jyotsna Tayalm, Neha Kashyap, Shikha Singh
End-stage renal disease (ESRD) is increasingly becoming a public health problem wherein kidneys loses nearly all their abilities to perform essential function. Dialysis offers patients the opportunity to maintain a better quality of life in long term management and while waiting for kidney transplantation. ESRD patients are known for the high risk of cardiovascular comorbidities that effects the quality of life, physical activeness and overall independence. Thus, rehabilitation is imperative to address the profound psychological, physical and majorly functional limitations/impairments associated with ESRD. A comprehensive literature search was conducted where in article from 2010 to 2024 were included using the search terms “End stage Renal Disease” and “Cardiovascular Limitations”, which yielded 2,102 results from various digital databases like PubMed, Google Scholar, Ovid, Web of Science and the Cochrane Library. The search was then further filtered through the inclusion and exclusion criteria which yielded 49 results.These results aided in the analysis of various cardiovascular limitations to physiotherapy rehabilitation in ESRD patients. The reviewed data reflects the prevalence of left ventricular hypertrophy, myocardial/valve disease, arterial stiffness,sarcopenia, chronic fatigue/inflammation and even heart failure in ESRD patients. The factors like fluid overload, uremic toxicity, malnutrition, sedentary lifestyle, and diabetes omit further impair add the cardiac performance and exercise tolerance. These limitations act as the obstacle in providing effective rehabilitation programme. Evidence has confirmed that physical exercise has a major effect on metabolism, muscle contraction and enhancement of various physiological processes of essential tissues. Therefore, implementing specialised rehabilitation programmes that keep cardiovascular risk management in consideration to fabricate effective exercise regimens and comprehensive care to boost functional capacity and improves overall quality of Life.

Different Electrotherapeutic Approaches used for the Treatment of Nocturnal Enuresis: A Narrative Review

Mehak, Shikha Singh, Neha Kashyap
Nocturnal Enuresis (NE) can be defined as infrequent and uncontrolled urination during sleep in children aged 5 years or more without any central nervous system abnormalities. NE is a common condition that causes stress among both children and their families. However, behavioural therapy is the first line of treatment for children experiencing NE but some electrotherapeutic strategies have been most commonly used to treat children with NE like Transcutaneous Electrical Nerve Stimulation (TENS), interferential (IF) electrical stimulation, and laser. The needle acupuncture also has been used as an alternate treatment for NE. This review aimed to evaluate the effectiveness and patient response to various electrotherapeutic methods used for treating NE in children. In this study, we have collected information about NE from published articles from year 2014 to 2024. Searches were carried out from the following databases and search engines: PubMed, Google Scholar, Scopus, and ResearchGate. Several electrotherapeutic approaches have been identified to treat NE. According to studies, TENS, IF electrical stimulations, and needle acupuncture are useful in reducing wet nights. Electrotherapeutic modalities are somewhat helpful in reducing the frequency of wet nights in children with NE. However, no complete cure has been achieved still. IF electrical stimulations seems more effective than other therapeutic methods.

Approaches used for Scale Translation in Medical Research: A Narrative Review

Janvi Behl, Shikha Singh, Neha Kashyap
Nocturnal Enuresis (NE) can be defined as infrequent and uncontrolled urination during sleep in children aged 5 years or more without any central nervous system abnormalities. NE is a common condition that causes stress among both children and their families. However, behavioural therapy is the first line of treatment for children experiencing NE but some electrotherapeutic strategies have been most commonly used to treat children with NE like Transcutaneous Electrical Nerve Stimulation (TENS), interferential (IF) electrical stimulation, and laser. The needle acupuncture also has been used as an alternate treatment for NE. This review aimed to evaluate the effectiveness and patient response to various electrotherapeutic methods used for treating NE in children. In this study, we have collected information about NE from published articles from year 2014 to 2024. Searches were carried out from the following databases and search engines: PubMed, Google Scholar, Scopus, and ResearchGate. Several electrotherapeutic approaches have been identified to treat NE. According to studies, TENS, IF electrical stimulations, and needle acupuncture are useful in reducing wet nights. Electrotherapeutic modalities are somewhat helpful in reducing the frequency of wet nights in children with NE. However, no complete cure has been achieved still. IF electrical stimulations seems more effective than other therapeutic methods.

Efficacy of Exercise Programme in Management of Cancer Cachexia: A Narrative Review

Rishita Sharma, Lakshay Panchal, Aditi Popli
Cachexia, a condition marked by significant weight loss, muscle wasting, and systemic inflammation, poses a major challenge for patients with chronic diseases such as cancer, heart failure, and chronic obstructive pulmonary disease. Exercise has the potential to be a low-cost, accessible intervention that improves the physical and mental well-being of cachexia patient, reduces fatigue, enhances immune function, and may reduce the risk of recurrence. Exercise prescription in cachexia care can lead to improve patient outcomes and enhance quality of life. This review evaluates the effectiveness of exercise interventions in addressing cachexia. The various databases including Pedro, Cochrane and PubMed/ Medline were examined to explore current literature on the impact of exercise on cancer prevention, management, and survivorship. Research indicates that structured exercise programmes, including resistance training, aerobic exercises, and hybrid approaches, play a crucial role in counteracting muscle loss, reducing inflammation, and enhancing physical performance. Resistance exercises promote muscle growth and strength by activating anabolic pathways, while aerobic training improves cardiovascular function and supports mitochondrial health. Additionally, exercise reduces systemic inflammation by lowering pro-inflammatory cytokine levels and enhances metabolic processes such as insulin sensitivity and lipid utilisation. Psychological advantages, including diminished depressive symptoms and improved overall quality of life, are also notable benefits of regular physical activity. Given the diverse severity of cachexia and patients’ varying energy capacities, individualised exercise plans are essential. Combining exercise with nutritional strategies further amplifies its benefits, underscoring the importance of an interdisciplinary approach to treatment.

Effect of Repetitive Transcranial Magnetic Stimulation on Balance and Postural Stability in Individuals with Neurological Disorders: A Systematic Review

Armanpreet Kaur, Narkeesh Arumugam, Priyanka Dangi, Sharanjeet Kaur
Balance impairments are common in many neurological conditions and have a significant effect on quality of life. Repetitive Transcranial Magnetic Stimulation (rTMS) has gained attention as a potential therapeutic intervention for neurological conditions. Recently, there has been growing interest in its use to improve balance in patients with neurological conditions like stroke, ataxia, traumatic brain injury, and Parkinson’s disease. To review the current evidence on the effectiveness of rTMS in enhancing balance in individuals with neurological disorders, a systematic search using multiple databases and search engines i.e. Science Direct, PubMed, and Google Scholar was conducted. The literature search yielded 253 studies. A total of articles were further evaluated to be included from which 7 met all the PRISMA guidelines. Randomised controlled trials, Cross-over trials and case series which were published from 2017-2024 were included. The literature identified was only in English language. The quality risk biasness of the selected studies was assessed by PEDro scale. A total of 4 randomized control trials, 2 cross-over trials and a case series were selected. According to PEDro analysis, studies were of good quality (score 4 to 6). The analysis revealed statistically significant improvement in scores of the Berg Balance Scale, Activities Specific Balance Confidence Scale, Dizziness Handicap Inventory, and Average Trace Error. Hence, rTMS, when combined with conventional rehabilitation methods, has the potential to improve balance and postural stability in many neurological conditions. Current literature indicates that rTMS is a promising intervention for improving balance and postural stability in neurological conditions. The findings provided a valuable reference for the development of optimised rTMS treatment plans in clinical practice.

The Role of Calf Stretching in the Management of Plantar Fasciitis: A Literature Review

Poonam Tomar, Sandeep Pattnaik
About 10% of adults suffer from plantar fasciitis, a common musculoskeletal condition marked by inflammation and pain in the plantar fascia. As first-line therapies, conservative management techniques like stretching exercises are frequently advised. Because tense calf muscles can put more strain on the plantar fascia, calf stretching, in particular, has drawn interest as a possible therapeutic strategy. While anecdotal evidence and clinical practice suggest the benefits of calf stretching, there is a need for robust scientific evidence to confirm its effectiveness.This warrants a review to compile the data currently available regarding the benefits of calf stretching in the management of individuals with plantar fasciitis. Therefore, this literature review aims to evaluate and discuss the effectiveness of calf stretching. A comprehensive literature search was conducted within the databases PubMed, EMBASE, and Cochrane Library for full-text articles published in the English language between 2019 and 2024, exploring the treatment of plantar fasciitis with calf stretching. The search strategy utilised terms such as “plantar fasciitis”, “calf stretching”, “conservative treatment,” “pain relief” and “exercise therapy” employing Boolean operators. No articles were excluded based on their geographical origin or the manner in which their study design was presented. A total of 1286 articles were identified, out of which only six met the inclusion criteria. Analysis of the identified studies suggested that stretching can be a highly effective treatment for plantar fasciitis, leading to significant improvements in pain and foot function. Plantar fascia and calf stretches, especially when implemented consistently over a longer duration (8 weeks or more), provided substantial and lasting relief. While individual responses may vary, stretching was found to be a safe and effective approach for managing plantar fasciitis and improving overall foot health.This review highlights the limited available evidence on the specific efficacy of calf stretching for plantar fasciitis. The small number of studies included limits the strength of the conclusions. Further research with rigorous methodology and larger sample sizes is urgently needed to establish the definitive role of calf stretching in the management of this prevalent condition.

Impact of Pre and Post Physiotherapy on Maternal Quality of Life Following Elective Caesarean Section: A Narrative Review

Pooja, Jahanvi Dave, Neha Sharma
An incision in the abdominal wall, compared to the pelvis and vagina, is used to deliver the living or dead foetus during a caesarean section, only when the situation warrants it, such as in cases of obstructed delivery, cord prolapse, or distressed foetus. Multiple issues are linked to it, which result in low returns to performing everyday tasks and have a major effect on overall health. Pregnant women who are having sedentary lifestyles experience more pain and difficulties. Decreased musculoskeletal harm, fewer spasms of the muscles and lower-extremity fluid retention, improved cardiovascular health, decreased body weight throughout the pregnancy, emotional support, a decline in pregnancy high blood sugar levels, and easier pregnancy are the advantages of antenatal exercises.This study aims to determine the impact of pre and post physiotherapy on maternal quality of life following cesarean section. A thorough online search on the studies at the impact of pre and post cesarean physiotherapy on maternal quality of life was performed on Google Scholar from 2017 to 2024. The search utilised MeSH keywords including cesarean section, Quality of life, physiotherapy, elective cesarean section, exercise and postpartum. Out of 24200 articles found from different databases, duplicate articles were removed. Four articles fulfilled the eligibility criteria and were included for present review. Three studies showed that the requirement of extra pain relievers, the pain associated with recovering to normal daily tasks in postpartum life, and the duration of hospital stays are all decreased by physiotherapy instruction and guidance before elective cesarean section. The study concluded that physiotherapy exercises prior to elective cesarean section have a positive impact on maternal postpartum quality of life.

A Narrative Review on Stroke Mimics and Chameleons: Revisiting and Unveiling the Disguise

Aayushi Singh, Kanishk Veer Khurana, Sourya Acharya, Samarth Shukla
Stroke refers to a neurological deficit that has an acute onset and a vascular origin. The classical signs and symptoms of a stroke include facial drooping, weakness, and disturbances in talking or speech. Sometimes, these symptoms may also arise from conditions that do not involve a cerebrovascular event, leading to a misdiagnosis of stroke, known as “stroke mimics.” Another interesting category is the “stroke chameleon,” which refers to a class of stroke that occurs in the absence of the typical characteristics suggestive of stroke and instead presents with atypical features that can lead to a false negative diagnosis. A thorough history taking, with an emphasis on the onset of symptoms, is crucial because features of stroke are always acute in onset. Prompt neuroimaging is ultimately necessary to prevent misdiagnosis and to provide emergent thrombolysis within the life-saving window period. In this review, we discuss the various possible stroke mimics and chameleons that have been reported and are available across the web.

The Impact of Otago Exercises on Improving Balance in Knee Osteoarthritis: A Literature Review

Shiwangi, Amita Aggarwal
Osteoarthritis (OA), the most common kind of arthritis, is defined by the degeneration of the underlying bone and joint cartilage, which causes stiffness, pain, and physical incapacity. According to WHO as osteoarthritis is more prevalent in older people (about 70% are older than 55), global prevalence is expected to increase with the aging of populations. Common clinical signs include knee pain that begins slowly and increases with movement, knee stiffness and swelling, pain that worsens over time, and pain that worsens after prolonged sitting or rest. The aim of the study is to review the literature stating the role of Otago exercises on balance in knee osteoarthritis. The Otago exercise programme includes strength exercise including balance training. A literature search was conducted from PubMed, Scopus, and Embase Database from December 2015 to 2025 on 7 January 2025. The search utilised terms “Otago exercise,”“balance,”“Otago exercise programme,”“home-based balance exercises,” knee o steoarthritis,”“degenerative,”“arthritis,” cartilage, “tibiofemoral,” and “patellofemoral.” The Inclusion criteria for this study were randomised controlled trials and articles written in english language. Related review articles, systematic reviews, conference papers, and articles in languages other than English were excluded. A total of 423 articles were found out of which only five met the inclusion criteria. The result implied to evaluate the effectiveness of the Otago exercise programme in improving balance in individuals with knee OA. The Timed Up and Go OMIT test is used to assess the outcomes of balance improvement. Further research is needed to strengthen these finding by comparing the efficacy of Otago with other therapeutic technique.

Effect of Nordic Walking on Physical Activity among COPD Individuals: A Narrative Review

Anamika Rajpoot, Akanksha Saxena, Mandeep Kumar Jangra
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disorder that reduces physical capacity and significantly affects quality of life. As COPD progresses, patients often restrict their physical activities, leading to a decrease in endurance and persistent breathlessness. However, exercise and physical activity play an essential role in managing COPD by improving exercise capacity, endurance, decrease dyspena and overall well-being. Nordic walking, a low-impact aerobic exercise performed using two specially designed poles, has gained recognition for its potential benefits in COPD rehabilitation. By engaging both the upper and lower limbs, this exercise helps improve endurance, peak oxygen consumption (VO₂ max), and the ability to perform daily physical activities. This narrative review explored the effects of Nordic walking on exercise capacity and rehabilitation outcomes in individuals with COPD. A systematic search of Scopus, PubMed, and Ovid databases was conducted for studies published between 2010 and 2025, focusing on Randomized Controlled Trials involving COPD patients. Nordic walking interventions were included, while studies involving Myocardial Infarction, Gait Disorders, Cognitive Disorders, or Cardiac Arrhythmias were excluded. Boolean queries were used with keywords such as “COPD,” “Chronic Obstructive Pulmonary Disease,” “Chronic Lung Disease,” “Nordic Walking,” and “Pole Walking.” A total of 134 articles were identified, and after removing duplicates, 91 articles were screened. Based on titles and abstracts, 86 studies were excluded, leaving 7 full-text articles for review. Evidences suggests that Nordic walking is a feasible and effective intervention for COPD patients, enhancing their physical fitness and overall quality of life. It provides a safe and structured way to increase physical activity, making it an excellent option for pulmonary rehabilitation programs. Dyspnoea was recorded by modified Borg scale and exercise capacity by 6-minute walk test, treadmill. In conclusion, Nordic walking proved to be a safe and effective exercise intervention for individuals with COPD. It improved physical activity levels, exercise tolerance, and overall rehabilitation outcomes. By engaging both the upper and lower limbs, Nordic walking provided a comprehensive approach to enhancing functional capacity and quality of life in individuals with COPD, making it a valuable addition to pulmonary rehabilitation programs.

Effect of Intermittent Fasting on Cardiovascular Health: A Narrative Review

Deepa Sharma, Lavanya, Akanksha Saxena, Mandeep Kumar Jangra
Intermittent fasting (IF)/ Time Restricted Feeding (TRF) has emerged as a widely recognised dietary strategy, not only for promoting weight loss but also for its potential benefits to cardiovascular health. IF has been shown to significantly reduce key risk factors for heart disease, including hypertension, high cholesterol, and inflammation. This review examines the potential of intermittent fasting to improve heart health, highlighting its advantages beyond weight management and its promising role in the prevention of heart disease. This narrative review aims to evaluate the impact of intermittent fasting on cardiovascular health focussing on its effects on blood pressure, cholesterol, inflammation, and overall heart function. This review followed IMRAD pattern for non systematic review. The search items like “Time Restricted Feeding”, “Alternate Day Fasting”, “Meal Skipping”, “Intermittent Fasting”, “Caloric Restriction”, “Cardiovascular disease” using Boolean operators AND, OR were used. The databases probed were Google scholar, PubMed, Scopus for relevant research published from 2015 to 2024.The study including both male and female individuals ranging from age group 16-84 years who utilised intermittent fasting as an intervention on cardiovascular health. Initially a total of 1,844 articles were identified through comprehensive database searches. After removing of 1039 duplicates, remaining 805 articles were screened by title and abstract and 788 excluded. Seventeen full text articles were screened for inclusion in this narrative review. Out of 17, 8 full text studies were included in the review. The results of all eight studies revealed that IF/TRF, improves insulin sensitivity, glucose metabolism, liver enzymes, and cardiometabolic health including lipid profiles. Three randomised controlled trials also reported that 4- and 6-hour TRF resulted in mild weight loss over eight weeks. It overall concludes that intermittent fasting is a safe diet therapy and provides a promising effect on cardiovascular and metabolic health.

Impact of Cuevas Medek Exercise in Neuromotor Disorders: A Review

Jasmeet Kaur, Manu Goyal, Kanu Goyal
Cuevas Medek Exercises (CME) are a paediatric physiotherapy approach designed to improve motor skills in children with developmental challenges. These exercises involve dynamic movements manually guided to encourage active participation and minimise passive handling. It focusses on stimulating neuroplasticity, helping the brain reorganise and form new neural connections, by progressively challenging the child. CME shifts the focus of paediatric rehabilitation from passive techniques to active engagement, enhancing motor function development in a more engaging and effective manner. The objective of the study is to determine the application and efficacy of CME in children with diverse conditions. The literature search was done using the Cochrane Library and PubMed including recent studies from 2012 to 2024. A total of 12 articles were reviewed from which four to five articles were found relative according to the inclusion criteria of the study. CME therapy has shown the potential in treating children with developmental disabilities resulting from conditions such as cerebral palsy, hypotonia, or motor delays due to non degenerative diseases. Recent research studies have demonstrated the effectiveness of CME in addressing conditions like corpus callosum abnormalities, congenital heart disease, congenital hydrocephalus, autism spectrum disorder, and cerebral palsy. In conclusion, CME therapy holds potential for treating motor delays in children with non degenerative diseases or neurological genetic conditions like cerebral palsy and autism. However, its application may be limited by factors such as the child’s height and weight, as therapists need sufficient muscular strength to perform the exercises. Given the lack of extensive empirical research, further studies are necessary to validate the therapy's effectiveness and determine its broader applicability.

Exploring the Effectiveness of Aquatic Therapy on Pain Perception in Managing Patellofemoral Pain Syndrome: A Narrative Review

Renu, Aditi Popli
Patellofemoral Pain Syndrome (PFPS) which is one of the most common overuse injury, is characterised by anterior knee pain, decreased functionality, and a lower quality of life. A number of factors, such as obesity, biomechanical misalignments, and excessive use influence it. Since aquatic-based therapies are low-impact and help with joint stress reduction while promoting strength, mobility, and functional benefits, they have become a potential intervention. Evaluating the effectiveness of aquatic therapy in treating PFPS and the extent to which focussed exercise therapies and aquatic therapy help patients with PFPS by reducing pain, improving motor function, and improving balance and examining the differences in results between conventional exercises and aquatic therapy. A literature search was conducted across multiple databases, including PubMed, Scopus, and Web of science, focussing on studies published between 2016 to 2024. Keywords such as “aquatic therapy”, “PFPS”, “pain” and “balance” were used to identify relevant articles. Inclusion criteria involved research on aquatic therapy for PFPS concentrated on quality of life, pain, and balance. The studies included were randomised control trials and experimental studies within the past 10 years that have been published in English and data from selected studies were reviewed and synthesised to identify key findings. Aquatic therapy greatly increased motor function, decreased discomfort, and improved balance. Dynamic balance and knee strength were enhanced by intense aquatic training. On measures including the Visual Analogue Scale (VAS) and Anterior Knee Pain Scale (AKPS), aquatic therapy shown better results in lowering pain and improving functional scores than Vastus Medialis Oblique (VMO) strengthening. The range of motion, pain, functional capacities, and quality of life were all significantly enhanced by aquatic exercises. PFPS can be effectively managed by aquatic therapy, which has been shown to be beneficial for middle-aged people, obese women, and athletes. It continuously improves motor function, functional recovery, pain reduction, and quality of life than conventional exercises.

The Utility of Muscle Energy Technique on Pain and Functional Outcome in Sacroiliac Joint Dysfunction: A Literature Review

Rama, Amita Aggarwal
Around 15% and 30% of people with mechanical low back pain are found to have Sacroiliac (SI) joint pain. Biomechanical studies specified that postural alterations brought on by tightness in the quadratus lumborum, hamstrings, and other muscles may indirectly impact the SI joint's stability. However, to date, there is limited evidence examining the effect of the Muscle Energy Technique (MET) on SI joint pain and dysfunction. Hence, this review aims to provide general guidance regarding the evidence supporting the usefulness of the MET for pain and function outcome improvement in SI joint dysfunction. Studies reporting MET for pain (0-10 scale) and function (Oswestry Disability Index) outcomes improvements for SI joint dysfunction in the English Language were included. At the same time, exclusion criteria were low back pain without SI joint dysfunction, a language other than English and a follow-up of less than one week. From 2020 to 2025, four databases and literature sources (PUBMED, WEB OF SCIENCE, SCOPUS, EMBASE) were searched with the search terms (“sacroiliac joint”) AND ("muscle energy technique",) resulting in a total of 237 studies. Only relevant data from 12 Randomised Controlled trials that matched the inclusion criteria were included. Three of the 12 studies supported manipulation over MET, the other two supported Mulligan Mobilisation with Movement, and one demonstrated that MET is more effective than Mobilisation with Movement for anterior innominate ilio-sacral correction. Four studies have shown that MET is more clinically beneficial and significantly improves pain and functional status in SI joint dysfunction when used with adjunct treatment, functional task training, and/or lumbopelvic stabilisation exercises. Moreover, one more study indicated that Kinesiotaping and MET were practical management strategies with no significant differences. Overall, evidence has shown considerable variation across selected studies compared to other manual therapies. More extensive clinical research is required to better comprehend the actual effects of this intervention, either by itself or in conjunction with other treatments.

Evaluating Questionnaires for Musclestrengthening and Physical Activity Assessment: A Literature Review

Paras Saini, Sandeep Pattnaik
Physical activity and muscle-strengthening exercises are vital components of a healthy lifestyle. Accurate assessment of these activities is essential for monitoring health outcomes, designing exercise interventions and understanding the impact of physical activity on overall health. A few questionnaires are available to assess physical activity levels, with varying emphasis on muscle-strengthening exercises. These include the Muscle-Strengthening Exercise Questionnaire (MSEQ), the International Physical Activity Questionnaire (IPAQ), the Global Physical Activity Questionnaire (GPAQ), and the One Repetition Maximum (1RM) Questionnaire. This review examines the characteristics, effectiveness, and limitations of these tools, focusing on their ability to assess muscle-strengthening activity and overall physical activity. A comprehensive literature review was conducted to identify full-text articles published in English within the databases PubMed, EMBASE, and EBSCOhost. The search strategy focussed on studies exploring the use of the MSEQ, IPAQ, GPAQ, and 1RM Questionnaire for assessing physical activity or muscle strength. No time-related, geographical, or study-design-related exclusions were applied to the search criteria. The review focussed on the methodologies used to validate each questionnaire, their reliability in different populations, and their utility in clinical and research settings. A total of five observational studies were identified, and the selected studies were analysed to assess the strengths, weaknesses and contextual applicability of each tool in assessing physical activity and muscle-strengthening exercise. The review found that the MSEQ and 1RM Questionnaire are more focussed on directly assessing muscle-strengthening activities and muscular strength, while the IPAQ and GPAQ provide broader assessments of overall physical activity, including walking and moderate-to-vigorous intensity exercise. The IPAQ and GPAQ were found to be more generalisable for large-scale epidemiological studies, whereas the MSEQ and 1RM are more effective for individualised or clinical muscle-strengthening interventions. The reliability of MSEQ is 0.76- 0.91 related to IPAQ, GPAQ, and 1RM Questionnaire. To conclude, while the MSEQ and 1RM Questionnaire offered valuable insights into muscle-strengthening exercises and strength, the IPAQ and GPAQ provided broader physical activity profiles. Future studies should focus on cross-validating these tools in diverse populations and settings to improve their generalisability and applicability in clinical practice.

Role of Bunkie’s Test Over Kinetic Chain: A Literature Review

Gargi Bisht, Nitin Kumar Indora
The kinetic chain refers to the activation of the body segment, which transfers mechanical energy to support the movement. If there is any defect, then it affects the transfer of energy, physical performance, and force to the body segment. The kinetic chain is assessed by the Bunkie’s test, which is used to evaluate the core muscular endurance, strength, and fascial lines with 5 different plank positions (bilaterally a total of 10 tests) and hold for 40 sec. For the maintenance of posture and mobility, fascia is an important component. This study aims to find out the role of Bunkie’s test over the kinetic chain, which is used to evaluate the strength, endurance, and stability of the core. It is also used to evaluate the fascial dysfunction and imbalances. The research is conducted by using Google Scholar, PubMed, DOAJ, and Cochrane, including articles from 2000-2024. A total of 8 articles were relevant to my selection criteria, and they were thoroughly reviewed. The sensitivity of Bunkie’s test is 0.89, (95%) and the specificity is 0.52. Every research study supports that the Bunkie’s test is used to test the kinetic chain and fascial dysfunction. Therefore, Coaches and trainers used the Bunkie’s test for fascial dysfunction, and there is no difference between the hold position times per gender. The test can improve the dynamic balance.

The Role of Myofascial Release in Nonspecific Neck Pain: A Literature Review

Azmat Bano, Amita Aggarwal
Nonspecific Neck Pain (NSNP) is a prevalent musculoskeletal condition characterised by pain and stiffness in the cervical region without an identifiable pathological cause. Myofascial restrictions contribute significantly to NSNP by altering muscle mechanics, reducing Range of Motion (ROM), impairing quality of life and causing persistent discomfort. Myofascial Release (MFR), a specialised manual therapy technique, alleviates fascial tightness, improves muscle function, and restores movement patterns. This literature review evaluates the effectiveness of MFR in managing NSNP. A systematic search was conducted using SCOPUS and EMBASE databases for articles published between 2020 and 2025. Reviews, book papers, editorials, and conference papers were excluded. A total of 742 articles were identified, including 26 randomised controlled trials. After screening, 12 studies met the inclusion criteria, explicitly addressing the therapeutic benefits of MFR in NSNP. The reviewed studies utilised outcome measures such as VAS and NPRS for pain, cervical range of motion (CROM), and the Neck Disability Index (NDI) to evaluate disability levels. Two studies demonstrated that combining MFR with standard physical therapy significantly reduced pain and improved ROM. In contrast, two others highlighted the effectiveness of MFR with Instrument-Assisted Soft Tissue Mobilisation in resolving myofascial trigger points, enhancing CROM, and reducing NDI scores. Additional findings revealed the efficacy of vacuum MFR, dry needling, and MFR combined with stretching or strengthening exercises in improving pain, ROM, and functional outcomes in NSNP management. The review highlights the therapeutic benefits of MFR for NSNP, particularly when combined with conventional therapies, demonstrating its effectiveness in improving pain, CROM, and NDI.

EQ-5D-5L in Musculoskeletal Health: A Narrative Review on its Utility and Application

Sunaina Gupta, Sandeep Patnaik
The EQ-5D-5L questionnaire is a widely used tool for assessing health-related Quality of Life (QoL) across diverse clinical and public health contexts.This assessment tool has been adapted for use in various languages, such as Spanish, French, and Hindi, enabling its application across diverse populations. However, the developers have not explicitly outlined the range of musculoskeletal conditions for which this tool is suitable.This narrative review,therefore, aims to comprehensively evaluate the range of health conditions assessed using the EQ-5D-5L, summarising its application across various medical-surgical and rehabilitative domains related to musculoskeletal disorders. A comprehensive literature search was performed across PubMed, Scopus and Cochrane for full-text articles reporting the use of the EQ-5D-5L in evaluating HRQoL for Musculoskeletal medical conditions,published in the English language between 2019 and 2024. All the relevant articles were included, irrespective of study design and geographical presentation. A total of 4 articles were retrieved from different databases that fulfilled the inclusion criteria and were included for the present review. An analysis of these studies revealed that the findings underscore its value as a generic HRQoL tool while advocating for integration with disease-specific instruments for comprehensive assessments. Articles suggested its use in chronic diseases like knee osteoarthritis, low back pain, and osteoarthritis of the metatarsophalangeal joint, as well as in evaluations of healthcare interventions. One of the included articles assessed the QoL of the patients, one articles assessed the functionality of the patient after the intervention, and the other two articles assessed both.This review concludes that although there are multiple QoL assessment tools that can be used indifferent conditions, EQ-5D- 5L has been considered to be an effective generic health-related QoL tool for various musculoskeletal diseases that helps with the assessment and prognosis documentation of patients.The tool also proved valuable in evaluating patient functionality and the impact of healthcare interventions. However, the findings suggest that the EQ-5D-5L may benefit from integration with disease-specific instruments for a more comprehensive assessment of HRQoL in musculoskeletal conditions.

The Role of Buteyko Breathing Technique in Enhancing Aerobic Capacity: A Narrative Review

Sayantan Patra, Akanksha Saxena, Arghya Mondal, Mandeep Kumar Jangra
Buteyko Breathing (BB) is one of popular complementary alternative medicine approach that emphasises nasal breathing, breathing control and relaxation to regulate carbon dioxide (CO²) levels and promote diaphragmatic breathing while minimising the use of accessory muscles, offering potential therapeutic benefits for enhancing aerobic capacity (VO² max) and respiratory health. VO² max is a quantitative measure of an individual ability to transport oxygen and indicate the overall efficiency of cardiopulmonary function. The current narrative review aims on exploring the effects of BB in enhancing aerobic capacity among young adults. The databases probed were Scopus, PubMed, Physiotherapy Evidence Database (PEDro) and Ovid from 2016-2025. The studies with both male and female adults, above age of 18 years using BB as a breathing technique were included. The selected studies were segregated and analysed further. From 2039 initial studies, 18 relevant ones were selected after duplicate removal. Among them, three studies focussed on adults’ population; all collectively indicating a significant positive impact of BB on aerobic capacity. The BB lowers the pulmonary ventilation, which raises the body’s CO² levels.Raising CO² levels can lower blood pH and promote the production of ATP as well as the synthesis of proteins, peptides, nucleic acids, lipids, and carbohydrates. The oxygen-haemoglobin dissociation curve shifts to the right when blood pH drops, decreasing haemoglobin’s affinity for oxygen and allowing more oxygen to enter the tissue. This review concludes that BB can be an effective intervention to improve aerobic capacity.

Pilates based Interventions in Cerebral Palsy Rehabilitation: A Narrative Review

Jatin Sangwan, Urvashi, Lakshay Panchal
Cerebral Palsy (CP) is a neurological condition that affects the movement and posture, leading to activity limitations, due to non-progressive injury to the brain during developing fetus or infant. In addition to motor impairments, children with CP are also experience sensory problems, intellectual disabilities, challenges with perception, communication issues, epilepsy, behavioural concerns and musculoskeletal complications.The prevalence of CP in India is 2.95 per 1000 live births. A literature search was conducted on Google Scholar, Scopus, PubMed, PEDro databases for studies published between 2016 to 2025 by keywords; “Cerebral Palsy” AND “Pilates” which resulted in retrieval of six articles and we included these articles in our review. This narrative review explains the impact of Pilates training as a treatment approach in CP rehabilitation. Pilates is an innovative method which involves exercises that focus on strengthening, stretching and coordination. The six fundamental concepts of Pilates training are flexibility, breathing, control, centering, concentration and accuracy. Children with CP,who can perform functional activities like standing, walking but they require improvements in muscle strength, joint flexibility, mobility andpostural stability may get benefit from Pilates training to enhance muscle contraction, relaxation, flexibility, strength and balance.Furthermore, Pilates may assist to reduce spasticity and improve balance; both components are essential for functional independence and quality of life. The exercises can be customised to meet individual needs, making Pilates training a versatile intervention option for children with varying CP severity. Despite the promising results, the review identifies the gap in existing literature, including lack of standardised protocol, highly reliable outcome measures and high quality studies on Pilates training in CP. However, further research is required to examine the long term effects, optimum dosage and specific exercises that yield best outcomes for CP children.

Poststroke Experiences and Needs in South Asian Communities: A Narrative Review

Suman Pradhan, Subhasish Chaterjee, Mousumi Saha
South Asian countries experience a higher burden of stroke and poorer functional outcomes after stroke compared to the rest of the world. However, the unique poststroke needs of the South Asian community and opportunities for community-based services to address these needs have been little explored in the stroke literature. The aim of this review is to find what is the current knowledge base related to the experiences and needs, including unmet needs, of people living with stroke and their caregivers from South Asian countries. Total 357 full text published articles from PubMed and Scopus from 2020-2025. After duplicate deletion only 140 articles were left for screening and finally 37 full text articles related to research were further analysed at full text level. Out of which only 4 articles were selected and included in the review for analysis. The studies intend to synthesise existing studies on the poststroke experiences and needs of individuals from South Asian communities to uncover opportunities for community-based resources to address these needs.

Evaluating Bone Health in Neonatal Osteopenia: A Scoping Review of Diagnostic Approaches

Pooja Mehra, Neha Sharma
Osteopenia of prematurity is a debilitating condition characterised by reduced bone mineral content. It is often observed in very-low-birth-weight infants because of a lack of foetal mineralisation during the last trimester and neonates with concomitant diseases such as necrotising enterocolitis, pregnancy related conditions (chorioamnionitis, gestational diabetes mellitus and preeclampsia), longer duration of total parenteral nutrition and lack of vitamin-D among mothers. High-risk neonates with prolonged use of diuretics/ corticosteroids are at increased risk of low bone mineral density, resulting in osteopenia. A search strategy was performed for past five year with original researches published in English between 2020 and 2024. PubMed, Scopus, and PEDro databases were searched for full-text articles, resulting in six articles. Six out of 13 papers revealed that dual-energy x-ray absorptiometry was considered as the gold standard for measuring bone mineral density and had low radiation exposure for neonates and quantitative ultrasound, digital x-ray radiogrammetry, radiographic evaluations, peripheral quantitative computed tomography and biochemical markers such as: serum alkaline phosphatase, osteocalcin, C-terminal telopeptide serum calcium, and serum phosphorus were available as other diagnostic measures for assessing osteopenia. While selecting a reliable method for assessment of osteopenia, certain factors such as equipment availability, radiation exposure, cost and specific clinical needs of the neonate should be considered. A combination of techniques may provide a more thorough assessment of bone health in premature infants with osteopenia.

Imapct of Psychological Wellbeing and Health Related Quality of Life among Women with Pcos: A Review

Gunjan Nagpal, Aakanksha Bajpai
Introduction: Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder, affecting 8% to 13% women of reproductive age, characterised by irregular menstrual cycle, cardiometabolic abnormalities and polycystic ovaries. Beyond the physical symptoms, PCOS has significant psychological consequences, such as anxiety, depression, which has detrimental impact on quality of life. Aim: The purpose of this review is to explore the impact of psychological wellbeing and health related quality of life among women with PCOS. By identifying gaps in current research, this review provides direction for future study. Materials and Methods: This review study was conducted by searching peer review articles between the years 2021 to 2024, using electronic data bases such as Scopus, Google Scholar, PubMed and Web of Science. The Boolean terms (AND, OR, NOT) and keywords like “Health related quality of life,” “Lifestyle,” and “PCOS” were used. Results: Ten studies were included, out of which 4 were systematic reviews, 3 narrative reviews and 3 was observational studies. Evidences indicates that women with PCOS are more likely to experience depression and anxiety compared to women PCOS. These mental health disorders are often associated with physical manifestations such as hirsutism, obesity, and infertility, which can negatively impact body image and self-esteem, further deteriorating their quality of life. Conclusion: Women with PCOS experience significant psychological distress, including higher levels of depression, anxiety, which negatively impact their quality of life. Further research should focus on providing psychological counselling and lifestyle recommendations to reduce psychological distress experienced by PCOS women.

Effectiveness of Extracorporeal Shockwave Therapy in Managing Patients with Frozen Shoulder: A Literature Review

Krishnagopal Mondal, Sunita Sharma, Yashica Sharma
Frozen shoulder is an inflammatory condition causing pain, stiffness, and limited movement. While most recover within a year, 40% face long-term functional issues. The condition involves the joint capsule and often affects nearby structures like the coracohumeral ligament, rotator cuff tendons, and subacromial bursa. Extracorporeal Shock Wave Therapy (ESWT) is a non-surgical treatment using high-pressure sound waves to stimulate cell metabolism, improve circulation, enhance cell permeability, and break down calcium deposits.This study will conduct a thorough analysis of the current literature concerning the efficacy of ESWT in treating patients with frozen shoulder. An initial search of electronic databases, including PubMed, Google Scholar, Scopus, and the Cochrane Library, identified 1,779 potential articles using the keywords “Frozen Shoulder,” “Adhesive Capsulitis,” “Extracorporeal Shockwave Therapy,” “Pain,” and “Range of Motion,” combined with the operators AND and OR. Only studies involving participants aged 30 years or older, diagnosed with frozen shoulder, and utilising ESWT as an intervention were considered for inclusion. After the removal of duplicate entries, a total of seven studies were deemed eligible for inclusion in this review. The reviewed literature evaluated range of motion, pain, and disability using outcome measures like VAS, NPRS, SPADI, and DASH. Most studies showed statistically significant improvements (p<0.05) with ESWT compared to conventional treatment. However, one study reported no significant improvement in disability, and another found no increase in internal rotation (p>0.05). Additionally, several studies suggested that radial probes in ESWT may provide better therapeutic outcomes than focussed probes, emphasising the importance of probe selection in optimising treatment efficacy. In conclusion, several studies suggest that ESWT is a promising treatment for reducing pain and disability while improving range of motion in patients with frozen shoulder. Future research should explore the effectiveness of combining ESWT with other manual therapy approaches and treatment modalities to determine its potential added benefits in this population.

The Effectiveness of Physiotherapy Treatment for Recurrent Headache Associated with Neck Pain: A Narrative Review

Neha, Jatin Sangwan, Aditi Popli, Urvashi
Recurrent headaches, particularly tension-type and cervicogenic headaches are often associated with neck pain. Several headache subtypes are tension-type headaches, recurrent headaches,migraine and cluster headaches called chronic daily headache syndromes, cause substantial levels of disability.There is a strong association between recurrent headaches and neck pain, and it is found that 50-75% of individuals with recurrent headaches experience neck pain. A potential source for headache has been identified to be the cervical spine and the studies suggest that anomalies in the cervical vertebra can lead to the formation of headaches. This narrative review aims to examine the effectiveness of physiotherapy treatments for recurrent headaches associated with neck pain, focussing on the mechanisms, intervention strategies, and clinical outcomes, which significantly reduces the frequency as well as the severity of headaches. This review utilised PubMed, Google Scholar, and Cochrane to search for relevant literature and identified 20 studies with the keywords “Recurrent Headaches”, “Neck Pain”, and “Physiotherapy interventions” from the last 10 years comprising Randomised Controlled Trial (RCT), and systematic review.Out of 20 studies, 10 articles with an average involving 18 to 55 years old subjects, were found to be pertinent to the review. Studies involved in this review found that physiotherapy, involving various kinds of interventions such as therapeutic exercises, electrical stimulation, therapeutic massage, joint mobilisation, or trigger-point therapy is the common nonpharmacological treatment for headaches, used for recurrent headaches for approximately two-week time period It significantly improve the range of motion, reduce neck muscle tension, and reduce the frequency as and severity of headaches. Evidence suggests that cervical manipulations, combined with strengthening and stretching exercises, are effective in improving neck function and decreasing headache severity.These approaches offer a noninvasive and cost-effective alternative to pharmacological treatments.

Impact of Early Mobilisation on Functionality as an Outcome in Aneurysmal Subarachnoid Haemorrhage Patients: A Narrative Review

Kusum Devi, Rohan Sood, Subhasish Chatterjee
Aneurysmal Subarachnoid Haemorrhage (SAH) is a critical neurological condition with serious consequences. While mortality rates have decreased over the past 30 years, the level of disability caused by SAH remains high. Key factors influencing prognosis include the patient’s age, clinical condition, extent of haemorrhage, and aneurysm size. Additionally, neuropsychological disorders and cognitive deficits play a significant role in determining functional outcomes after SAH. Patients should be assessed using outcome measures typically applied to traumatic brain injury and stroke. Early therapy following SAH improves both physical and cognitive outcomes. Survivors with aneurysmal SAH have a complex recovery that often requires surgery, extended monitoring in the critical care unit, and medication aimed at preventing complications. The goal of this study is to examine and combine existing evidence on the impact of early mobilisation on functional outcomes in patients with aneurysmal subarachnoid haemorrhage. A narrative review was conducted using a systematic search of relevant databases (PubMed, Scopus, and Cochrane Library). Studies investigating early mobilisation interventions in aneurysm patients, published in English between 2012 and 2017, were included. A total of 4 studies met the inclusion criteria, focussing on early mobilisation as an intervention. The primary outcomes assessed were improvements in feasibility and safety. Evidence suggests that early mobilisation started as soon as possible, helps the patient to recover faster. It makes the patient more functionally independent, reducing dependency on other persons, making every task feasible for the patient, and increasing the patient’s safety. The timing, intensity, and frequency of early mobilisation are critical factors influencing recovery. Individualised protocols based on haemorrhage severity and patient-specific factors are recommended to optimise benefits. Barriers such as stafftraining and resource availability must be addressed to implement early mobilisation effectively.

Prevalence of Retained Primitive Reflex among Healthy Preschool going Children

Yukta Sharma, Akanksha Saxena, Mandeep Jangra
Introduction: Primitive reflexes are brainstem-mediated involuntary movements, emerging around the 25th week of pregnancy and fading by six months, supporting motor development. Cortical maturation inhibits these reflexes via motor control pathways. Persistent reflexes may signal neurological conditions like cerebral palsy or milder issues such as learning difficulties. Improper integration can affect motor skills, coordination, behaviour, and learning. Aim: To investigate the prevalence of persisting brainstem-mediated reflexes like Asymmetrical Tonic Neck Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR) and Tonic Labyrinthine Reflex (TLR) among preschool going children. Materials and Methods: This observational study includes 240 school-going children of age 4-6 years from two different schools of Ambala and Punjab and they were screened for persistence of primitive reflex using the Sally Goddard Institute for Neuro- Physiological Psychology battery reflex test. Results: This study showed the maximum persistence/prevalence of right ATNR (83%), whereas extension STNR had the low prevalence rate of (46%). Left ATNR had the prevalence of 78%, extension TLR had 47% prevalence rate, and flexion STNR and flexion TLR had 65% prevalence of persistence. Conclusion: Persistence of ATNR is maximum where as persistence of STNR and TLR has low prevalence. Early screening and interventions to address persistent reflexes like reflex integration therapy can be used to avoid the neurological impairments like attention, reading, coordination, learning difficulties, inability to perform motor tasks and gait impairments which can prevent developmental delay.

Usability of Functional Electrical Stimulation on Upper Limb Rehabilitation of Subacute Stroke: A Literature Review

Sayani Das, Shanthakumar Kalimuthu
Introduction: Stroke is one of the leading cause of long-term disability, often resulting in significant impairments in motor function, especially in the upper limbs. Sub-acute stroke, defined as the phase occurring between 1 and 6 months post-stroke, is a critical period for rehabilitation, as patients have the potential for a significant recovery. It has been discovered from numerous studies that Functional Electrical Stimulation (FES) helps the hemiplegic upper limb patients to improve the motor function by stimulating the muscles using electrodes on or near the innervating nerve fibres. Aim: The aim of the study is to present comprehensive review regarding the usability of FES in upper limb rehabilitation of subacute stroke patients. Materials and Methods: Research literature published from 2008 to 2024 was searched in Google scholar, Web of science, Scopus, EBSCO, PubMed databases with FES, upper limb rehabilitation and subacute stroke patient as keywords. A total of articles 300 were identified initially. On the basis of predefined inclusion and exclusion criteria, non English articles and duplicates were excluded. A total of 10 articles were included that met the specified criteria. Results: Several studies included did not assess the quality of movement as an outcome to assess the role of FES in upper limb rehabilitation of subacute stroke patients. In this context of the applicability of the FES as a tool that contributes to enhancing the quality of movement of the post-stroke subject, it is important to consider the concept of usability as a determining factor. Conclusion: This literature review concludes FES plays an important role to improve muscle strength, motor control, and functional independence makes it a promising intervention for optimising recovery during the critical sub-acute phase. While more research is needed to establish standardised treatment protocols and identify the most effective approaches, the current evidence supports FES as an effective tool in stroke rehabilitation and a promising area for continued investigation.

Effect of Proprioceptive Neuromuscular Facilitation on Pain and Function in Patients with Neck Pain: A Literature Review

Prashant Kumar, Kanika
Neck pain, prevalent in middle-aged individuals and women, often results from degenerative changes or prolonged static positions. The cervical spine, crucial for head stability and mobility, is prone to injuries and chronic pain. While traditional physiotherapy is beneficial, advanced techniques like Proprioceptive Neuromuscular Facilitation (PNF) and Cranio-cervical Flexor Training (CCFT) are more effective in reducing pain and improving function. PNF therapy enhances joint function and proprioception, addressing conditions such as cervical radiculopathy and chronic mechanical neck pain. This review aimed to compile existing literature on the effects of PNF on neck pain. Electronic searches were performed using PubMed, PubMed/Medline, Ovid, Scopus, Google Scholar, and the Physiotherapy Evidence Database (PEDro) for studies published between 2019 and 2025. Searches were restricted to Randomised Controlled Trials (RCTs) and randomised pilot trials available in English peer-reviewed journals. Boolean operators “OR” and “AND” with keywords like “PNF” AND “Neck pain” OR “Cervical pain” AND “Randomised controlled Trial” guided the search process. A total of 13 articles were initially examined, and after reviewing their titles and discarding those that were not relevant, 5 articles were chosen for further analysis. PNF has been proven to be more effective than other manual therapy techniques, electrotherapy and conventional exercises. Research indicated that PNF techniques enhance cervical proprioception, muscle strength, and Range of Motion (ROM), especially in extension and rotation. In the context of cervical spine treatment PNF has been found to alleviate pain, improve daily living activities, and enhance functional outcomes. Specifically, patients with cervical radiculopathy were found to have a notable reduction of visual analogue scale scores from 4.27 to 1.20 with a significant difference of 1.73 points. PNF group showed more improvements in pain intensity, disability scores and quality of life as compared to the control groups. Both PNF and CCFT effectively alleviated chronic neck pain and improved ROM; however, PNF exhibited distinct advantages in certain movement directions. Comparisons with other therapies showed PNF yielded better pain reduction and functional outcomes. These findings supported that PNF is a preferred treatment for neck pain and cervical spine conditions.

The Effect of Diaphragmatic Breathing among Individuals with Motion Sickness: A Narrative Review

Kanu priya, Akanksha Saxena
Motion sickness, caused by sensory conflicts involving movement, balance, and vision, results in symptoms like nausea, fatigue, and light-headedness. Diaphragmatic Breathing (DB), a non-pharmaceutical method, helps manage these symptoms by enhancing Parasympathetic Nervous System (PNS) tone, promoting relaxation, and lowering respiratory rates. DB offers a simple, natural strategy for managing motion sickness and improving well-being. The aim of this narrative review was to find out the effect of DB in individuals with motion sickness. Experimental studies utilising DB as an intervention in individuals with motion sickness was included and prevalence/incidence, review articles were excluded. Total 61927 full-text published articles were identified from PubMed and Scopus from 2012-2024. After duplicate deletion, 54091 articles were left for screening and finally, 7,836 full text articles related to the research topic were further analysed at full-text level. Out of which only 2 articles were selected and included in the review for analysis. Both the studies gave DB and compared with control group. Participants trained in DB achieved slower breathing rates,nearing the ideal range of 3–7 breaths per minute, which was associated with increased heartrate variability, and reduction in motion sickness symptoms. These findings indicate greater PNS activation and thereby alleviating symptoms like nausea and discomfort in motion sickness-inducing situations. These results of this review suggests DB as a practical and side effect-free alternative to medication for managing motion sickness.

Effect of Laser Therapy in De Quervain’s Tenosynovitis: A Review

Muskan Manaktala, Manu Goyal, Kanu Goyal
De Quervain’s tenosynovitis (DQT) is a stenosing overuse disorder that affects the abductor pollicislongus and extensor pollicisbrevis tendons in the synovial sheath of the wrist's first extensor compartment. Treatment options for DQT are expanding and include immobilisation, acupuncture, laser therapy, extracorporeal shockwave therapy, hyaluronic acid injections, anti-inflammatory drugs and ultrasonographic therapy. The main objective of this systematic review is to identify the significant effects of laser therapy on patients with DQT. Databases and search engines such as Cochrane, PubMed, & Google Scholar were searched for articles published between 2000 and 2025, emphasising pilot studies and randomised clinical and controlled studies in English. A total of 1765 papers that were first discovered were qualified for full-text screening, and 465 articles were eliminated because they contained duplicates. A total of 1300 abstracts and titles were assessed, out of those 1290 were removed due to other treatment than laser therapy and seven of those were chosen for in-depth review.The participants from 18 to 65 years of age and both genders were included in this review.The patients with hand deformity and rheumatic disease were excluded from the study. The study found that high-intensity laser therapy and low-level laser therapy have significantly reduced pain,and inflammation and improved range of motion. When compared to other modalities and exercises, laser therapy has proven to be the most effective and gives superior results in enhancing tissue healing.In conclusion, laser therapy can be used alone or in conjunction with other treatments to treat DQT. It enhances functioning and decreases pain. Additional high-quality research with a substantial number of samples is still needed to validate these findings and establish a common treatment regimen.

Use of Single Breath Counting Technique for Pulmonary Assesment: A Literature Review

Mohit Kumar Siradhana, Aditi Popli
Vital Capacity (VC) is typically measured to evaluate pulmonary function using devices like a spirometer or ventilometer, although the general public may not always have access to these tests due to their high cost, portability issues, and need for qualified personnel. To aid in the pathophysiology understanding of lung illnesses, the Single Breath Counting Technique (SBCT) has emerged as a potential substitute for respiratory function tests.In order to take a measurement, patients are asked to inhale deeply and count as far as they can without taking another breath while speaking normally. A metronome set at two counts per second was used to time the counting. The objective of this review is to assess theuse single breath counting technique for assessment of VC when other options are not feasible. We commenced by exploring the databases including PubMed/ Medline, Google Scholar and Scopus to uncover full text publications authored in English. A total of 12 articles were retrieved after extensive data search, which were evaluated and only 5 articles met the inclusion criteria and were reviewed. Male and female adults (aged 18-59 years) were included. SBC is a reasonable alternative to peak expiratory flow rate and can be used effectively. Further investigation in an emergency department setting is warranted. SBC measurement is found to be similar to spirometry and ventilometry and can be used as an adjunct. The findings may be administered in assessing pulmonary function, VC to diagnose diseases, track disease progression difference in range of motion in dominant and non-dominant sides of body.

Impact of Kegel Exercises on Overall Pelvic Health in Postmenopause

Samiksha Makkar, Jahanvi Dave, Rittu Sharma
Kegel exercises provide a secure and effective approach to improve the overall health in postmenopausal women. Pelvic floor is made up by levator All the RCT’s demonstrate that Kegel exercises have an overall positive impact on the pelvic floor functioning in postmenopausal females. It relieves the symptoms of urge urinary incontinence, stress urinary incontinence, reduce its severity, strengthen the pelvic floor muscles, relieve vulvovaginal symptoms, enhances pelvic floor muscle contractility, add and decrease the chances of pelvic floor organ prolapse. It also helps in significantly improving the quality of physical, mental & psychological well-being in menopausal women. Although additional studies are required regarding the duration and intensity of the exercises to be performed. ani and coccygeus muscle which are important to support the abdominal organs.Pelvic floor muscle strength is been decreased due to ageing, pregnancy, normal vaginal delivery, hormonal imbalance and obesity. Due to this, women are experiencing pelvic organ prolapse and incontinence. These problems can be managed by medications and surgeries. Among this, kegel exercise is the best therapeutic way to strengthen the pelvic floor and maintain its alignment. It is noninvasive as well as most convenient method for a woman to practice everyday. Regular practice can maximise the benefits for women associated with menopause. A comprehensive search of electronic databases, including PubMed and Google Scholar was performed to locate studies published up to the current date. Keywords such as “Kegel exercises”, “pelvic floor function”, “postmenopausal women” were used to construct search queries. Following a thorough examination of the titles and abstracts of these studies, along with removal of any duplicates, a total of 7 Randomised Controlled Trials (RCTs) studies were referred. The review provides analysis of current understanding of Kegel exercises, its role and effect upon overall pelvic floor health and function in postmenopausal women. It evaluates the various ways in which these exercises could help the women. It synthesises evidence from different studies to delineate its role in the women’s health.

Effectiveness of Kinesiotaping on Seventh Cranial Nerve Palsy: A Literature Review

Sakshi Gupta, Rittu Sharma, Swarup Ghosh, Jahanvi Dave, Kanika, Kanika Bhatia
Bell’s palsy, is a neurological disorder causing sudden, temporary facial paralysis due to facial nerve dysfunction. It is the most common peripheral facial nerve palsy, affecting nearly two-thirds of cases. Stroke-induced facial nerve paralysis significantly impaired facial muscle function. Physiotherapy is crucial for managing Bell's palsy, focussing on maintaining muscle tone, stimulating nerve function, and preventing contractures. Kinesiology Taping (KT) has emerged as a non-invasive and promising intervention to address facial muscle weakness and asymmetry associated with Bell’s palsy. This review aims to synthesise and summarise the current evidence on the effectiveness of kinesiotaping in managing facial nerve palsy. A comprehensive literature search conducted between 2014 and 2024 using the keywords “kinesiotaping,” “Bell’s palsy,” “facial palsy,” or “seventh cranial nerve palsy” in PubMed, Google Scholar, Scopus and Cochrane Library yielded 9,108 articles. Following the removal of duplicates, only four articles were deemed relevant for further analysis.The reviewed literature primarily employed the House-Brackmann Scale, the Facial Disability Index (FDI), and the Synkinesis Assessment Questionnaire to assess patient outcomes in facial nerve paralysis, with only one study utilising the Arianna Disease Scale. Kinesiotaping, when applied in conjunction with Kabat Rehabilitation, demonstrated statistically significant improvements (p<0.05) compared to Kabat therapy alone. However, the optimal tension applied during kinesiotaping remains a subject of debate due to significant variability across studies. Notably, one study indicated that kinesiotaping alone was less effective than Kabat therapy in managing facial nerve paralysis.While 3 studies suggest that kinesiotaping, when used in conjunction with Kabat rehabilitation, may offer benefits in managing facial nerve paralysis, further high-quality research is needed. Future studies should conduct rigorous trials comparing the independent effects of kinesiotaping and Kabat rehabilitation to establish the unique contribution of kinesiotaping alone. Furthermore, research is needed to determine the optimal tension for kinesiotaping application to maximise its therapeutic efficacy in patients with facial nerve paralysis.

Evaluating the Impact of Pilates on Muscular Strength in Post-menopausal Women: A Systematic Review Protocol

Pushti, Kanika Bhatia, Rittu Sharma
Post-menopausal phase is determined by decline in oestrogen levels in women, leading to reduction in muscle strength, flexibility and overall physical function. These changes increase the risk of musculoskeletal disorders and thus consequently impair mobility and effects the quality of life. However, lack of data on Pilates efficacy in improving muscular strength in postmenopausal women highlights the urgent demand for further research to assess its role in strength enhancement. This study will review the evidence on effectiveness of Pilates for enhancing muscular strength and improving overall physical function in post-menopausal women.The electronic databases PubMed, Scopus, Pedro and Cochrane Library will be searched to find Randomised Controlled Trials (RCTs). Studies included in this review will be conducted among post-menopausal women, which will involve Pilates as the main intervention, and must have outcome(s) related to muscular strength. Isokinetic dynamometer of knee extensors and flexors, Lumbar Extension machine, Sit-and-reach test, trunk lift tests, 30-sec chair stand test will be the primary outcome measures. Non-RCT study designs and non-English studies will be excluded. The review is registered in the PROSPERO database ID: CRD42024620100, following the PRISMA guidelines. Although previous research indicates that Pilates can improve physical strength, but the data is inconsistent due to methodological differences. This systematic review will seek to provide a comprehensive understanding of Pilates as a potential intervention for musculoskeletal health in postmenopausal women by investigating factors such as adherence, supervision, and exercise intensity. Additionally, evaluating impact of Pilates this review will contribute to the findings that will further enable evidence-based clinical and rehabilitation practices.

Effect of Virtual Reality-based Proprioceptive Training for Chronic Ankle Instability: A Scoping Review

Yeshi Tshogyal, Shivangi Palsra
Ankle injuries, including sprains and chronic ankle instability, can severely affect mobility and quality of life, often due to proprioceptive deficits that increase the risk of recurring injuries. Virtual reality (VR) programmes, by simulating real-life sensory experiences, have emerged as innovative tools for enhancing proprioceptive training and improving functional outcomes. This scoping review evaluates the effectiveness of VR-based therapies in preventing ankle injuries. A systematic search of English-language articles published between 2015 and 2024 was conducted using databases like PubMed, The Cochrane Library and Pedro. Search terms included “virtual reality,” “proprioceptive training,” “ankle injury,” “ankle sprain,” and “chronic ankle instability,” combined using Boolean operators. The review focussed on randomised controlled trials examining the impact of VR therapies on balance, proprioception, and neuromuscular control related to ankle health. Six studies met the inclusion criteria. Compared to traditional methods, VR therapies showed significant improvements (P<0.05) in proprioceptive accuracy and balance. By simulating dynamic, sport-specific tasks, VR enhanced functional training outcomes and boosted adherence to protocols through increased participant motivation. These findings suggest that VR-based proprioceptive training can reduce the risk of ankle injuries and improve balance, making it a promising complement to conventional prevention techniques.

Effectiveness of RICE/PRICE Protocol on Acute Ankle Sprain: A Literature Review

Nikee Kumari, Sandeep Pattnaik, Raj Kumar
Ankle sprains (AS) are one of the most common musculoskeletal injuries, associated with a high rate of visits to the emergency department. These injuries are particularly prevalent in sports like basketball and volleyball. These present up to 25% of all musculoskeletal injuries, and almost half of them are sports related. Lateral AS affecting the anterior talofibular ligament, calcaneofibular ligament, and peroneus muscles are most affected among all the ankle sprains. Rest, Ice, Compression, Elevation (RICE) and Protection, Rest, Ice, Compression, Elevation (PRICE) protocols are commonly used to treat acute AS. Despite widespread use, the effectiveness of the RICE/PRICE protocol for acute or subacute AS lacks strong evidence support. Therefore, this literature review aims to evaluate and discuss their effectiveness in reducing pain and improving functional outcomes for individuals with acute or subacute AS. A comprehensive literature search was conducted within the databases PubMed, EMBASE, and Cochrane Library for full-text articles published in English language between 2019 to 2024, exploring the treatment of acute or subacute AS with RICE or PRICE protocol. The search strategy used terms such as “RICE”, “PRICE”, “Acute Ankle Sprain”, “Pain Management” and “Functional Outcomes” employing Boolean operators.No articles were excluded based on their geographical origin or the manner in which their study design was presented. A total of 748 articles were identified, out of which only five met the inclusion criteria. These studies suggest the use of RICE and PRICE protocol as an adjunct to conventional physiotherapy and external orthotic support to have an effective and significant improvement in pain and functional outcomes following acute AS. The quality of the included research varied, and several had methodological problems, despite the encouraging data. While initial findings from a limited number of studies suggest potential benefits when combined with conventional physiotherapy and external support, the evidence base remains weak. Further high-quality research with robust methodologies is crucial to establish the true efficacy of RICE/PRICE in improving pain and functional outcomes for individuals with AS.

Impact of Iyengar Yoga and Coherent Breathing on Major Depressive Disorder: A Narrative Review

Prince Kumar, Bhawna Vats
Major Depressive Disorder (MDD) is widespread, chronic, recurrent in nature and impairing. Depression affects worldwide more than any other disease. Up to 50% of the population acts towards antidepressants medication. For major depressive sickness, up to half of patients who take depression medication do not recover fully. Current depression treatments are inefficient at lowering the rate of disability. Yoga based therapies have potential as supportive treatment as well as monotherapies. Iyengar yoga (a form of hatha yoga) and Coherent Breathing (controlled breathing technique) have emerged as promising techniques for improving the symptoms of depression. This study aims to review the effectiveness of Iyengar yoga and coherent breathing on major depressive disorder. A systematic review of Randomised controlled trials (RCTs) was conducted using PubMed and Google Scholar of the studies published up to the current date. A total of 26 articles were analysed for the study out of which only 4 were selected. Following a comprehensive examination of the titles and abstracts of these studies, along with removal of duplicates, RCTs were considered. Non-RCT’s and non-English studies were excluded. The review showed that Iyengar yoga and coherent breathing over time was associated with reduction in psychological symptoms. Yoga and breathing techniques were linked to improvements in mental health symptoms gradually. Both therapies improved emotions of positivity with reducing anxiety and symptoms of depression. When creating yoga treatments, the advantages of yoga practice have to be calibrated against the time commitment.

Standardisation of A Treatment Protocol to Manage Uterine Prolapse in Females to Enhance their Quality of Life: A Systematic Review

Zaid Ur Rehman, Shah Faisal, Yukta Rastogi, Jasmine Anandabai, Uzma Khan, Shikha
Introduction: Uterine prolapse is characterised by the herniation of the uterus into or beyond the vagina, resulting from the failure of ligamentous support and weakness of the pelvic floor. It is estimated that some degree of prolapse affects approximately 50% of parous women. Aim: This study aims to evaluate the symptoms associated with uterine prolapse and the effectiveness of physiotherapy treatment options in managing these symptoms and improving quality of life and also prevent the progression of uterine prolapse. Materials and Methods: Women with uterine prolapse commonly experience symptoms such as pelvic heaviness, bowel and bladder dysfunction, and sexual dysfunction. Physiotherapy treatment includes pelvic floor muscle training, positioning, respiratory, core training and decrease abdominal pressure and the use of supportive elements (Pessary Ring, Pelvic Pro, K-Taping) and uses modalities like Interferential Therapy, Pelvic Floor Exerciser, Mayo Plus 2 Pro, Moist Hot Pack, Cold Pack and Theraband). Results: Implementation of physiotherapy interventions has been shown to significantly improve the quality of life for individuals with uterine prolapse. Participants reported enhanced management of symptoms and improved ability to perform activities of daily living and prevent recurrence. Conclusion: Physiotherapy offers effective treatment options for women with uterine prolapse, leading to symptomatic relief and improving the overall well-being of the patient, improve quality of life and also prevent the progression of uterine prolapse.

Role of Proprioceptive Training on Anterior Cruciate Ligament Rehabilitation: A Literature Review

Aarti Kumari, Nitin Kumar Indora
Anterior Cruciate Ligament (ACL) ruptures are injuries that affect young adults’ neuromuscular systems. Because the ACL in the knee is essential to the joint's static and dynamic stability, it is particularly susceptible during athletic activities, with an incidence of about 69 per 100,000 person years per year. Following ACL restoration (ACLR), one of the most significant issues is proprioceptive impairments. The aim of the review was to identify effect of proprioceptive exercise training for improving ACL rehabilitation. A literature search was conducted from PubMed, Cochrane Library, and Google Scholar database from 2000 to 2024. The search utilised terms such as “proprioceptive exercise training”, “ACL rehabilitation”, “muscle strength” and “adult” employing Boolean operators (AND, OR). Articles in which proprioception was treated in this review, non-English articles, were excluded. A total of 78 articles add were found from different database, out of which only five met the inclusion criteria. These studies suggest that proprioceptive exercise training add is effective treatment for knee proprioception, muscle strength, pain and functional outcomes.The results obtained indicate that proprioceptive training exercises, when incorporated into the standard rehabilitation expedited protocol, can increase proprioception efficiency in persons who have undergone ACL repair.

Veterinary Physiotherapy in Dogs: A Narrative Review

Jiya Chauhan, Shikha Singh, Neha Kashyap
Veterinary physiotherapy plays an integral position. within the rehabilitation of canines tormented by musculoskeletal, neurological, and postoperative situations. The goal of physiotherapy, which is becoming more and more significant in veterinary medicine, is to help canine patients to improve mobility, lessen pain, enhance restoration, and enhance universal quality of existence for canine patients. This form of therapy uses a variety of strategies, including guided remedy, healing physical activity and hydrotherapy, electrotherapy, and thermal modalities, that can be customised to meet each dog's desires according to their circumstances and age. Manual therapy include joint mobilisations and soft tissue massage, which can enhance range of motion, improve circulation, and lessen discomfort. Therapeutic activities aim to improve proprioceptive functions, expand joint range of motion, and extend healthy gait patterns. They also include stretching, strengthening, and proprioceptive instruction. Hydrotherapy, often carried out in a pool or underwater treadmill, delivers low-impact training for joint or muscle rehabilitation for dogs with arthritis or those recovering from surgery. Moist heat is an excellent method to lessen joint stiffness, enhance circulation, and lessen pain. Low-degree laser is an extraordinary, non-invasive manner to lower pain for animal patients and is generally very well tolerated in dogs, even if their pain severity is excessive. Electrotherapy strategies, which include transcutaneous electric nerve stimulation, can assist in managing pain and inflammation. Physiotherapy has shown great success in treating a wide range of ailments, including hip dysplasia, arthritis, post-operative rehabilitation, neurological issues, and sports injuries. Beyond physical recovery, veterinary physiotherapy may improve dogs’ overall health by reducing stress, promoting relaxation, and boosting mental wellness. In addition to examining its concepts, methods, and scientific pursuits, this study focusses on how well veterinary physical therapy for dogs aids in recovery and preserves long-term health. The importance of veterinary physical therapy in providing dogs with comprehensive care is increasingly acknowledged.

Effectiveness of Aerobic Training in Improving Symptoms of Premenstrual Syndrome in Young Females: A Review

Yuvakshi Bhatnagar, Manu Goyal, Kanu Goyal
Premenstrual Syndrome (PMS) is a set of repetitive symptoms that begin at the end of the secretion phase of the menstrual cycle and ends in the follicular phase which are commonly seen in young females, affecting their daily life, and showing dominant emotional fluctuations. PMS affects women's mental and physical health, with a prevalence of approximately 48% among women of reproductive age. Studies has shown that consistent aerobic exercise lessens the severity of PMS. The present study is aimed to determine the effect of aerobic training in improving pre-menstrual symptoms among young females. A systematic search from various databases like PubMed, PEDro, Cochrane, and Scopus were used which was published from 2012 to 2024 to evaluate the effectiveness of aerobic exercise regimens in relieving premenstrual symptoms in young females, using PRISMA guidelines to assess methodological quality. A total of five studies were determined to be eligible for inclusion. All together, these studies included 307 participants, with intervention periods varying from 6 to 12 weeks and sessions occurring one to three times per week. The outcome measures were; Premenstrual Syndrome Scale (PMSS), Visual Analogue Scale (VAS), and Beck Depression and Anxiety Questionnaire. Young females who participated in aerobic training reported significantly improved premenstrual symptoms (p<0.05). Mechanisms include decreased headache, nausea, low back pain, weakness, bloating, and better psychological and premenstrual symptoms. This review shows that aerobic training could potentially alleviate the psychological and physical symptoms of PMS in females.

Effect of Dry Needling on Spasticity, Gait and Balance in Post-stroke Survivors: A Systematic Review

Harshjot Kaur, Supreet Bindra, Pankajpreet Singh
Stroke is defined as a sudden neurological deficit of the Central Nervous System due to ischaemia or haemorrhage. Spasticity occurs in 30-80% of stroke patients, typically manifested 3-6 months after stroke. (DN) is a relatively new intervention that has been recently suggested for the control of spasticity following stroke. We aimed to evaluate the effectiveness of DN on spasticity, gait and balance in post-stroke survivors. A computer search of Cochrane library, CINAHL, Physiotherapy Evidence Database (PEDro) and PubMed was conducted. We also performed a manual search of references that were included in the selected articles. Studies included were: i) Randomised Clinical Trials (RCTs); ii) case series; iii) involving patients with a diagnosis of stroke; and iv) using DN alone or in a multimodal treatment. Muscular spasticity was the primary outcome and the additional outcome included were: balance and gait. The methodological quality of the studies was assessed with Physiotherapy Evidence Database Scale. The risk of bias of the included studies was assessed with the Cochrane Risk of Bias Tool for Randomised Controlled Trials.A total of seven RCTs with 218 patients were included in the systematic review. All studies generally reported an improvement of spasticity level, gait and balance after the use of DN, alone or combined with other interventions in stroke survivors.DN for lower extremity in post-stroke survivors may impact positively on spasticity, gait and balance. However, there was a significant heterogeneity across trials in terms of sample size, control group, treated muscles and outcome measures. More RCTs are needed to cover aspects of biases found in the literature, in particular the blinding of participants and personnel.

Biomechanical Relation between Calf Muscle and Low Back Pain

Mananjot Kaur, Supreet Bindra
Low back pain is defined as pain and discomfort in the lumbosacral region, below the 12th rib and above the inferior gluteal folds. There are three types of low back pain: nonspecific pain with nerve root symptoms; pain resulting from serious injury. It is the most common musculoskeletal conditions that interferes with functioning and is often associated with muscle tightness. The literature supports the linkage between tightness of hamstrings and iliopsoas muscles but we did not come across studies depicting relationship between tightness of the calf and low back pain. Therefore, the aim is to determine the biomechanical relation between calf muscle tightness and low back pain. The extensive search for this study was conducted through Google Scholar Medline, PubMed (National Library of Medicine), Research Gate, articles including from 2010- 2024 have been used. This study concludes that, calf tightness restricts ankle dorsiflexion, leading tocompensatory movements and disrupts normal alignment of spine contributing to low back pain. It has been found that foot overpronation and flat foot are interrelated and associated with gastrocnemius tightness which is the cause of low back pain. Moreover, restricted ankle dorsiflexion can cause increased anterior pelvic tilt leading to hyper-lordosis and low back pain. Additionally, calf tightness can impair shock absorption capabilities of lower limb transmitting more forces to lumbar spine and increasing the risk of low back pain. So, treating them together comes with better results.

The Impact of Obesity on Padeographic Patterns in Children

Abdullah, Shweta Sharma
Obesity in children is a growing concern as it is found to have a major effect on plantar pressure distribution. The study of plantar pressure distribution is referred as “Paedography”. In addition to supporting an excessive burden of load, children with obesity are vulnerable to develop biomechanical and structural deformity of foot, meaning it leads to in a varied range of biomechanical and physical complications such as flat foot and heel pain etc.The purpose of this study is to investigate the connection between paedographic patterns and obesity, with a particular emphasis on the effects of excess weight on children’s plantar pressure distribution, arch shape, and general gait dynamics. This review utilised PubMed and Google Scholar to search relevant full texts literature, and identified 35 studies from 2004 to 2020 comprising cross-sectional studies, observational studies, systematic reviews, semi-experimental studies and comparative observational studies. Out of 35 studies, 15 articles were found to be pertinent to the review. The study's findings showed a number of significant variations in plantar pressure distribution in obese children. Children who were obese showed noticeably greater peak pressures in all areas of the foot, but especially in the forefoot and hindfoot. According to these results, the extra mechanical strain brought on by excess body weight modifies the typical pressure distribution and foot biomechanics, which may result in chronic musculoskeletal issues. This study highlights the critical need for early measure to tackle the obesity in children to prevent the risk of alteration in foot biomechanics and potential chances of musculoskeletal disorders. It is feasible to lessen the negative effect of obesity on paedographic patterns and encourage better musculoskeletal development.

The Emerging Role of Virtual Reality Rehabilitation and Pelvic Floor Muscle Training in Urinary Incontinence

Ashwani, Shweta Sharma
Urinary Incontinence (UI) is the uncontrollable release of urine, a condition that impacts millions of people around the world and can severely affect their overall well-being and daily activities. It is a prevalent and chronic disorder that affects millions of individuals globally. UI has significant detrimental effect on physical health. Traditional treatments, including behaviour therapy or strengthening the pelvic floor muscles, demonstrates significant improvement in UI. By leveraging Virtual Reality (VR) technology, individuals with UI can engage in interactive and personalised exercises, enhancing motivation and treatment outcomes. A creative approach has shown potential to improved motivation, adherence, with treatment outcome for persons with UI.The purpose of this research is to explore the effectiveness of VR rehabilitation combined with Pelvic Floor Muscle Training (PFMT) in management of UI signs and pelvic floor muscle strength of individuals with UI. This review utilised PubMed, Google Scholar, and Cochrane to search relevant full text literature and identified 25 studies between 2010 and 2024 years comprising cross sectional studies, observational studies, systematic reviews, semi experimental studies and comparative observational studies. After removing duplicates,15 articles were found to be pertinent to the review.According to the review, VR rehabilitation has great potential in treating UI by strengthening the pelvic floor muscles, reducing symptoms, and promoting adherence. It is a compelling substitute for conventional methods because of its gamified and captivating features. This narrative review highlights the revolutionary potential of VR in pelvic health care. VR therapy improved the Pelvic Muscle Testing’s functionally; however, these gains were comparable to those of traditional PFMT.

Effectiveness of tDCS on Dysmenorrhoea: A Systematic Review

Parul Ahlawat, Rohan Sood, Kriti Arya
Dysmenorrhoea, or menstrual cramps, involves chronic pelvic pain, with Primary Dysmenorrhoea (PDM) being common. Symptoms like abdominal pain, back pain, nausea, fatigue, and diarrhoea occur with menstruation, lasting 8–72 hours, and affect physical health, mood, relationships, and work. Prevalence ranges from 34% to 94%, and long-term PDM may alter brain metabolism and pain pathways. Transcranial Direct Current Stimulation (tDCS), effective in chronic pain conditions, shows potential for relieving PDM pain and enhancing quality of life. To evaluate the effectiveness of tDCS in alleviating pain associated with dysmenorrhea. A systematic review of Randomised Controlled Trials (RCTs) was conducted using databases such as PubMed, Scopus, and Cochrane Library. Studies comparing tDCS with sham stimulation or standard care for dysmenorrhea were included. A total of 112 participants were included. The primary outcome measures were pain evaluated by numeric rating scale and McGill Questionnaire score. Secondary outcomes measures were responses to the Positive and Negative Affect Schedule, Hamilton Anxiety Scale. Baseline data were performed during the first menstrual cycle, and during the second menstrual cycle, participants were conducted to tDCS treatment, and postintervention data were collected. All the collected RCTs demonstrate that tDCS applied over motor and prefrontal cortices significantly reduced pain intensity and improved functional outcomes in women with dysmenorrhea. The effects were sustained with multiple sessions, and minimal adverse effects were reported. The tDCS is a promising non-pharmacological intervention for managing dysmenorrhea.Further large-scale RCTs are needed to confirm its efficacy and optimise stimulation parameters.

Effect of Foot Orthosis in Patellofemoral Pain Syndrome: A Literature Review

Harleen Kaur, Supreet Bindra
Patellofemoral Pain (PFPS), also known as runner’s knee and anterior knee pain syndrome, is defined as increased pain in the area behind or around the patella when the knee is bent and loaded with weight. Foot orthosis is an in-shoe medical device used as an intervention for individuals with PFPS to control foot motion, usually excessive pronation. Despite the widespread use of orthosis in managing various musculoskeletal conditions, there remains a notable lack of high quality evidence supporting their effectiveness. This study aims to determine the effect of foot orthosis in PFPS. A computer search of peer reviewed articles from databases such as PubMed (National library of medicine), Google Scholar, Medline, Research Gate published from 2008 to 2024. Foot orthosis proves to be beneficial to reduce pain and in increasing the functional mobility in accordance with knee strengthening exercises.

Neuromuscular Taping Techniques in Neurological Rehabilitation: A Review

Falak Naaz, Rittu Sharma, Kanika
Neuromuscular Taping (NMT) is a modern advancement in taping techniques. NMT involves applying elasticadhesive tape to the skin without any tension over the target area which willcreate wrinkles in skin causing dilation effect on the underlying body tissue. It aids in restoring normal muscle function, improving vascular and lymphatic flow, alleviating pain, strengthening weak muscles, supporting postural alignment, and relaxing overused muscles. Pain relief is believed to result from the stimulation or activation of cutaneous mechanoreceptors. As this approach gains worldwide popularity, researchers are investigating its effects on various conditions. However, there is no comprehensive study that reviews all existing research to assess its impact on different neurological conditions. This review aimed to compile existing literature on NMT for the rehabilitation of neurological conditions. An electronic search was conducted using databases such as PubMed, Medline, Ovid, Scopus, Google Scholar, and the Physiotherapy Evidence Database (PEDro) for studies published between 2018 and 2025. Searches were limited to Randomised Controlled Trials, pilot trials, case series, and case reports published in English in peer-reviewed journals. Boolean operators "OR" and "AND" were used with keywords including “Neuromuscular Taping,” “Neurological conditions,” “Stroke,” “Hemiplegia,” “Cerebral Palsy,” “Multiple Sclerosis,” “Diabetes Mellitus,” “Diabetic Peripheral Neuropathy,” “Balance,” and “Proprioception.”From the initial search, 21 full-text articles were identified. After screening titles, abstracts, and removing duplicates, 15 articles were included in the review. NMT was shown to be effective in improving upper limb and hand function in systemic sclerosis and cerebral palsy, reducing pain in multiple sclerosis, enhancing balance, improving microcirculation in diabetes mellitus, aiding stance phase recovery in stroke patients, managing phantom pain post-amputation, and alleviating musculoskeletal impairments such as hemiplegic shoulder pain and diabetic peripheralneuropathy. The review highlights the potential of NMT as a versatile therapeutic intervention for neurological rehabilitation. While the findings suggest promising benefits across various conditions, the limited number of high-quality studies underscores the need for further research. Future investigations should focus on standardised protocols, larger sample sizes, and robust methodologies to validate and expand the clinical applications of NMT.

The Role of Smart Internet of Things (IoT) Technologies in Transforming Physical Therapy: A Narrative Review

Deeksha, Gurjant Singh
As the world’s population ages, chronic diseases become more prevalent, and technology increasingly being used in healthcare to produce evidence-based results. Small and reliable devices are being used in clinics, hospitals as well as at home. These devices direct patients toward appropriate exercise to promote a speedy recovery. It effectively enhances patient outcomes, efficiency, and satisfaction. Internet of Things (IoT) technologies connect real and virtual things to the Internet, have the potential to improve the quality of life for individuals with impairments. IoT technologies in physiotherapy enable data storage and monitoring to track patient progress, prevent errors, and improve treatment outcomes. As the initial step in the rehabilitative procedure, primary care physicians frequently recommend conservative, routine activities to their patients. Many studies have provided valuable insights into the adoption of IoT-based healthcare technologies among patients, but opinions toward role of IoT transforming physical therapy have rarely been studied. This review aims to explore the impact of smart IoT technologies in transforming physical therapy. A thorough literature search was conducted from PubMed, the Cochrane Library and Google Scholar database from December 2000 to December 2024. The search strategy included terms like ‘‘internet of things”, “smart technology” and “smart IoT”, and employed Boolean operators (AND, OR) to effectively filter and expand results. This review excluded non-English articles that highlight the role of smart IoT technologies in transforming physical therapy. These studies show that smart IoT technology creates new opportunities to enhance patient engagement and improve rehabilitation outcomes. The quality of the included research showed significant variation with notable inconsistencies in methodology.

Role of Lamaze Breathing in Labour Pain: A Narrative Review

Amrita Gautami, Jahanvi Dave
For most women, going through labour is a physically and emotionally taxing event that is frequently marked by severe pain and anguish. Numerous nonpharmacological methods have been developed to assist women in properly managing labour pain and having a happy birthing experience. Lamaze breathing has become one of the most well-known and successful techniques among them. A component of the larger Lamaze approach, which stresses empowerment, knowledge, and natural birthing, is Lamaze breathing. In order to keep women calm, focussed and in control throughout birth, this technique uses rhythmic breathing. Lamaze breathing is essential for lowering pain perception and improving the birthing experience because it increases oxygenation, lowers tension, and creates a focal point. This review aimed to examine how well Lamaze breathing techniques manage labour pain, increase maternal happiness, and lessen the need for pharmaceutical treatments during childbirth. The literature search was performed on PubMed and Cochrane Library. Databases focussed on literature published between 2015- 2024 using key words (CLBP OR physical intervention). A total of 120 pregnant women who were in active labour made up the sample for this study, which used a quasi-experimental design. The participants were split into two groups at random: one that received normal care and the other that practiced Lamaze breathing techniques. The Visual Analogue Scale was used to measure the degree of pain, and a postpartum questionnaire was used to gauge maternal satisfaction. When compared to the control group, the intervention group reported significantly reduced pain levels during the active and transitional phases of labour (p<0.05). Furthermore, the Lamaze group’s ladies expressed greater happiness (p<0.01) with their childbirth experience. In the treatment group, there was a 30% decrease in the need for pharmaceutical pain treatment. One useful nonpharmacological strategy for treating labour pain is the use of Lamaze breathing exercises. They increase overall satisfaction with childbirth, ease maternal discomfort, and lessen the need for medication. Lamaze breathing can enhance natural delivery processes and improve the outcomes in mother, when it is incorporated into prenatal education as a normal practice. It is advised that more research be done to examine its use in a variety of populations.

Immunohistochemistry: Illuminating and Misleading Two Oncology Cases Underscoring the Importance of Case Based Appropriate Immunomarker Selection

Sarbashis Hota, Srabani Chakrabarti, Subhajit Hajra, Dipkana Das
Arrival of immunohistochemistry in the domain of Oncology has revolutionised our approach towards diagnosis as well as in therapeutic decision making. Here, the authors will like to discuss two interesting cases (53-year-old female and 26-year-old male) encountered in the Institution where immunohistochemistry came out to be instrumental in clinching the proper diagnosis. The second case also highlights how misleading it can be, if not applied in appropriate clinical context and without being fully coherent with immunophenotypical spectrum of commonly encountered tumours.

Physiotherapy Intervention on Balance, Motor Skills, and Functional Movement in Children with Developmental Coordination Disorder: A Scoping Review

Anmol Kumar, Sunita Sharma, Neha Sharma
Developmental Coordination Disorder (DCD), prevalent in roughly 6% of primary school children, poses significant challenges to motor development. This common disorder manifests as difficulties with balance, coordination, and postural control, hindering the acquisition of essential gross motor skills. Consequently, children with DCD often exhibit reduced physical fitness, strength, and stamina, and may display passivity and inactivity. This study aims to review and condense existing research on physiotherapy treatments that enhance balance, posture, strength, and gross motor skills in children with DCD. A literature search was conducted across PubMed and Google Scholar databases for the period 2014–2024. The search utilised keywords such as “Children,” “Neuromuscular Training,” “Strength Training,” and “Developmental Coordination Disorder,” combined with Boolean operators AND and OR. Only studies investigating strength training or neuromuscular training as interventions in children with DCD, with measurable treatment outcomes, were included in the analysis. Non-English articles were excluded. Of the 18,521 articles initially identified, only six met the inclusion criteria. The reviewed literature primarily assessed balance, postural control, and strength using various tools, including balance tests for static and dynamic stability, sway energy scores, computerised dynamic postural assessments, and dynamometers. Some studies compared children with DCD to typically developing children using the Movement Assessment Battery for Children. Combined Hems Ball Training showed statistically significant improvements (p<0.05) in balance and postural control, while Functional Movement Power Training (FMPT) proved superior to Functional Movement Training alone for strength and postural control. One study found no significant difference between experimental and control groups with neuromuscular training. Additionally, the timing of gastrocnemius muscle activation and reduced motor unit firing variability in DCD children were identified as key factors affecting performance.Limited studies indicate that Combined Hems Ball Training and FMPT significantly improve balance, postural control, and strength in children with DCD. However, further high-quality trials are needed to provide more conclusive evidence. Furthermore, recognising the crucial role of muscle activation timing and motor unit variability in children with DCD underscores the need for targeted approaches for intervention planning.