Impacto do taping no Tendão de Aquiles nos parâmetros da marcha em indivíduos assintomáticos obesos e acima do peso / Impact of Achilles Tendon taping on parameters of gait in asymptomatic-overweight and obese individuals

INTRODUÇÃO: O taping do Tendão de Aquiles afeta os parâmetros da marcha em adultos com sobrepeso e obesos? O comprimento dos passos, o comprimento das passadas e a cadência são todos mais curtos nestes indivíduos, com maiores índices queda. OBJETIVO: Saber o efeito do taping do Tendão de Aquiles nos parâmetros de marcha em indivíduos obesos e com sobrepeso. MÉTODOS: Um ensaio clínico será realizado em um ambulatório de fisioterapia. Um total de quarenta participantes com Índice de Massa Corporal (IMC) maior que 25 serão recrutados pelo método de amostragem por conveniência. Cada grupo terá 20 participantes, com idade entre 18 e 35 anos, sobrepeso com IMC>25 a 29,9 e obesidade com IMC>30. Ambos os grupos caminharão por 10 metros e um minuto usando um analisador de marcha, e ambos os grupos terão taping nos Tendões de Aquiles. A variável preditora será o taping do Tendão de Aquiles e as variáveis de resultado serão o comprimento do passo, o comprimento da passada e a cadência, que serão medidos antes e imediatamente após a bandagem. O software SPSS 20.0 será utilizado para análise estatística, com nível de significância de p<0.05. PERSPECTIVAS: A conclusão do ensaio clínico fornecerá informações sobre o impacto da bandagem do Tendão de Aquiles na marcha em indivíduos com sobrepeso ou obesos. Além disso, poderia potencialmente demonstrar que a bandagem pode reduzir o risco de quedas e, assim, impactar positivamente na qualidade de vida.

INTRODUCTION: Does Achilles Tendon taping affect gait parameters in overweight and obese adults? Step length, stride length, and cadence are all shorter in these individuals, with increased fall ratios. OBJECTIVE: To know the effect of Achilles Tendon taping on gait parameters in overweight and obese individuals. METHODS: A clinical trial will be conducted in a physical therapy outpatient clinic. A total of forty participants with a Body Mass Index (BMI) greater than 25 will be recruited by convenience sampling method. Each group will have 20 participants, aged between 18 and 35 years old, overweight with BMI>25 to 29.9, and obese with BMI>30. Both groups will walk for 10 meters and one minute using a gait analyzer and both groups will have taping on the Achilles Tendons. The predictor variable will be the taping of the Achilles Tendon, and the outcome variables will be step length, stride length, and cadence, which will be measured before and immediately after taping. SPSS 20.0 software will be used for statistical analysis with a significance level of p<0.05. PERSPECTIVES: Completion of the clinical trial will provide information on the impact of Achilles Tendon taping on gait in overweight or obese individuals. In addition, it could potentially demonstrate that taping can reduce the risk of falls and thus positively impact the quality of life.

Efeito do taping no Tendão de Aquiles nos parâmetros da marcha em indivíduos assintomáticos obesos e acima do peso / Effect of Achilles Tendon taping on parameters of gait in asymptomatic-overweight and obese individuals

INTRODUÇÃO: Sobrepeso e obesidade afetam variáveis de marcha tais como cadência, comprimento do degrau e comprimento dos passos junto com a deterioração do tendão de Aquiles. A rígida rosca do tendão de Aquiles reduz a tensão e aumenta a estabilidade da articulação e pode ser empregada como suporte externo durante o treinamento da marcha para modificar os parâmetros da marcha. OBJETIVO: Descobrir se o taping modifica os padrões de marcha com o aumento do peso. MÉTODOS E MATERIAIS: Foram recrutados 40 sujeitos (20 acima do peso e 20 obesos) cujo comprimento dos degraus, comprimento dos passos e cadência foram medidos antes e depois da fita rígida do tendão de Aquiles. Cada pessoa completou o teste de caminhada de 10 metros usando o aplicativo Gait Analyzer. RESULTADOS: O teste Shapiro-Wilk é usado para avaliar a normalidade dos dados. O Wilcoxon Signed Rank Test e o Mann-Whitney U Test são usados para diferenças dentro e entre grupos. As diferenças dentro do grupo foram significativas nos parâmetros de marcha p <0,05 (Passo comprimento p<0,001, Stride comprimento p<0,001 e cadência p=0,009). Os parâmetros de marcha não diferiram estatisticamente entre os grupos. CONCLUSÃO: A aplicação de fita rígida no tendão de Aquiles tem um efeito semelhante nos parâmetros da marcha em indivíduos com excesso de peso e obesos. Após a aplicação da fita adesiva, verificou-se uma diferença significativa em termos de comprimento da passada, comprimento do passo e cadência na população estudada antes e depois da aplicação da fita adesiva para Aquiles. Isto implica que, independentemente do peso corporal, a intervenção com fita adesiva afeta a mecânica da marcha de forma comparável e destina-se a evitar movimentos articulares excessivos, a fornecer informações proprioceptivas durante as atividades e a diminuir o desconforto.

INTRODUCTION: Overweight and obesity affect gait variables such as cadence, step length, stride length, and Achilles tendon deterioration. Rigid Achilles tendon Taping reduces stress and enhances joint stability and can be employed as external support during gait training to modify gait parameters. OBJECTIVE: To find out whether taping modifies gait patterns with increasing weight. METHODS AND MATERIALS: 40 subjects were recruited (20 overweight and 20 obese) whose step length, stride length, and cadence were measured before and after rigid Achilles tendon taping. Each person completed the 10-meter walk test using Gait Analyzer application. RESULTS: The Shapiro-Wilk test is used to assess the normality of the data. Wilcoxon Signed Rank Test is used for within-group differences. Within-group differences were significant in gait parameters p <0.05 (Step length p<0.001, Stride length p<0.001 and cadence p=0.009). CONCLUSION: Rigid Achilles tendon taping have a similar effect on gait parameters in overweight and obese individuals. After taping, there was a significant difference in terms of stride length, step length and cadence in the study population before and after Achilles taping. This implies that regardless of body weight, the tape intervention affects gait mechanics in a comparable way and is intended to prevent excessive joint motion, provide proprioceptive input during activities, and lessen discomfort.

Terapia a laser de alta intensidade para rigidez muscular dos isquiotibiais: fundamentação e desenho do estudo para estudo controlado randomizado simples-cego / High-intensity laser therapy for hamstring muscle tightness: rationale and study design for a single-blinded randomized controlled trial

CONTEXTO: Sentar-se por muito tempo e um estilo de vida sedentário podem resultar em encurtamento dos isquiotibiais. Um declínio na atividade física regular pode levar a uma diminuição da flexibilidade do músculo em um adulto mais jovem. Aumentar a flexibilidade dos músculos isquiotibiais pode diminuir as possibilidades de lesões e prevenir a dor lombar. A aplicação da terapia a laser de alta intensidade (TLAI) tem demonstrado inúmeros benefícios para diversas condições. No entanto, até o momento, não hápesquisas publicadassobre a eficácia dessaterapia para melhorar o comprimento dos músculos isquiotibiais em adultos jovens saudáveis. Este artigo descreve o protocolo de estudo para investigar os benefícios do TLAI no tratamento da rigidez muscular dos isquiotibiais em adultos jovens. MÉTODOS: 136 indivíduos jovens saudáveis serão recrutados, pelo método de amostragem intencional, para participar de um estudo randomizado, simplescego e controlado por simulação. Os participantes recrutados serão divididos aleatoriamente em dois grupos, o grupo TLAIativo e o grupo TLAI placebo. A duração do tratamento será de 8 a 10 minutos por sessão em ambos os membros inferiores, em dias alternados, durante duas semanas. O teste de extensão ativa do joelho e o teste de sentar e tocar são as medidas de resultado que serão registradas na linha de base, no final do período pós-intervenção de 2 semanas. O valor de p ≤0,05 será considerado estatisticamente significativo. DISCUSSÃO: Os resultados do estudo fornecerão os dados para determinar se aTLAI seria uma futura intervenção não farmacológica não invasiva para reduzir a tensão muscular dos isquiotibiais em adultos jovens. REGISTRO DE ENSAIO: Registro de Ensaios Clínicos NCT05077761.

BACKGROUND: Prolonged sitting and a sedentary lifestyle may result in hamstring shortness. A decline in regular physical activity could lead to a decrease in the flexibility of the muscle in a younger adult. Increasing hamstring muscle flexibility could decrease the possibility of injuries and prevent low back pain. The application of high-intensity laser therapy (HILT) has proved to be innumerable benefits for many conditions. However, to date, no published research is available on the effectiveness of this therapy in improving hamstring muscle length in healthy young adults. This article describes the study protocol for investigating the benefits of HILT in treating hamstring muscle tightness among young adults. METHODS: 136 healthy young individuals will be recruited, by purposive sampling method, to participate in a randomized, single-blinded, sham-controlled study. Recruited participants will be randomly divided into two groups, the active HILT group, and the sham HILT group. The treatment duration will be 8-10 minutes per session, on both lower limbs, for alternate days a week, for two weeks. The active knee extension test and sit-toe and touch test are the outcome measures that will be recorded at baseline, end of the 2-week post-intervention period. The p-value ≤0.05 will be considered statistically significant. DISCUSSION: The study findings will provide the data to determine whether HILT would be a future non-pharmacological non-invasive intervention to reduce hamstring muscle tightness among young adults. TRIAL REGISTRY: Clinical Trials Registry NCT05077761.

Waste management practices among dental surgery staff of major hospitals in Accra: a descriptive cross-sectional study

Introduction: the practice of dentistry in contemporary times produces considerable waste that could be harmful to individuals and the environment at large. In Ghana and many other jurisdictions, there are guidelines that outline how these wastes should be managed. This study was conducted to explore practices concerning dental waste management among dental surgery staff in some public facilities in Accra, Ghana. Methods: a descriptive cross-sectional study involving dental surgery staff of four major facilities in Accra was done. Overall, 124 staff from the selected facilities participated in the study, and 51 different dental surgeries were assessed. Data were collected using a structured questionnaire and an observation checklist. The questionnaire included questions on socio-demographics, as well as knowledge and practices regarding dental waste management. Results: there was unsatisfactory knowledge of waste disposal, while practices did not generally meet international recommendations and the Ministry of Health´s (MOH) guidelines. Though all respondents stored their sharp waste in puncture-proof containers, 98.4% did not label their clinical waste, while 62.9% would dispose of used X-ray fixers by pouring them down the drain. None of the 51 surgeries observed had more than one colour code available. Conclusion: there is a palpable need for education, monitoring, and empowerment concerning waste management in Ghana´s oral healthcare system.

Proposal of novel staging system CNM (Crohn’s primary site, nodes, mesentery) to predict postoperative recurrence of Crohn’s disease

After oncologic resection, histological grading and staging of the tumor give important prognostic information about the future risk of recurrence and hence influence the subsequent management plan. Several studies and their meta-analysis have shown that various histological features (e.g., microscopic positive resection margins, plexitis, granuloma, mesenteric inflammatory activity) can predict postoperative clinical/endoscopic/surgical recurrence after resection in Crohn’s disease (CD). Inclusion of mesentery in surgical resection specimens has been shown to reduce surgical recurrence after ileocolonic resection in CD. However, there is no uniform histopathological staging system for risk stratification in postoperative CD to systematically predict postoperative recurrence. This is because the prediction to date is based on clinical characteristics (smoking status, disease phenotype, surgical history). Histopathological predictors are still not adopted in routine clinical practice due to the lack of a uniform staging system, heterogeneity of published studies and lack of standardized definition of histological features. In this article, we attempted to incorporate all such histological features in a single histological staging system CNM (Crohn’s primary site [resection margin positivity, plexitis, granuloma, depth of infiltration], nodes [presence of granuloma], mesentery [involved or not]) in surgical resection specimen in CD. The proposed CNM classification would help to enable systematic reporting, design future clinical trials, stratify postoperative recurrence risk and choose appropriate postoperative prophylaxis.

Nano-ayurvedic medicine and its potential in cancer treatment / 中西医结合学报

Nano-ayurvedic medicine is an emerging field in which nanoparticles are functionalized with active principles of potent ayurvedic herbs to enhance their efficacy and target-specific delivery. Scientific advances in the past couple of decades have revealed the molecular mechanisms behind the anticancer potential of several ayurvedic herbs, attributed chiefly to their secondary metabolites including polyphenols and other active substances. With the advancement of nanotechnology, it has been established that size-, shape-, and surface-chemistry-optimized nanoparticles can be utilized as synergizing carriers for these phytochemicals. Nano-ayurvedic medicine utilizes herbs that are commonly used in Ayurveda to functionalize different nanoparticles and thereby enhance their potency and target specificity. Studies have shown that the active phytochemicals of such herbs can be coated onto the nanoparticles of different metals, such as gold, and that they work more efficiently than the free herbal extract, for example, in inhibiting cancer cell proliferation. Recently, an Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH)-based clinical trial in humans indicated the anticancer potential of such formulations. Nano-ayurvedic medicine is emerging as a potential treatment option for hyperproliferative diseases.

Development and validation of a mobile application based on a machine learning model to aid in predicting dosage of vitamin K antagonists among Indian patients post mechanical heart valve replacement

Patients who undergo heart valve replacements with mechanical valves need to take Vitamin K Antagonists (VKA) drugs (Warfarin, Nicoumalone) which has got a very narrow therapeutic range and needs very close monitoring using PT-INR. Accessibility to physicians to titrate drugs doses is a major problem in low-middle income countries (LMIC) like India. Our work was aimed at predicting the maintenance dosage of these drugs, using the de-identified medical data collected from patients attending an INR Clinic in South India. We used artificial intelligence (AI) - machine learning to develop the algorithm. A Support Vector Machine (SVM) regression model was built to predict the maintenance dosage of warfarin, who have stable INR values between 2.0 and 4.0. We developed a simple user friendly android mobile application for patients to use the algorithm to predict the doses. The algorithm generated drug doses in 1100 patients were compared to cardiologist prescribed doses and found to have an excellent correlation.

Covid-19 presenting as isolated severe thrombocytopenia in an HIV-lymphoma survivor

Coronavirus disease has myriad manifestations and can present with predominantly extrapulmonary manifestations. We describe a 50-year-old man, a person living with HIV (PLHA), a non-Hodgkin lymphoma survivor, who presented with isolated severe thrombocytopenia. He was found to have immune-mediated thrombocytopenia, and showed excellent response to intravenous immunoglobulins.

A study of the effect of yoga on C-reactive protein, lipid profile and insulin resistance in obese patients

Background: Obesity is defined as a state of excess adipose tissue mass. In the last decade, there has been an alarming prevalence of obesity in the developed and developing countries like India. While modern medicine has so far been unable to control the menace of obesity, yoga offers an alternative holistic approach to tackle the problem of obesity by inculcating an approach towards balanced diet (Satwik aahar), physical activity and behavior modification (through pranayama). In this study, we have included the core anthropometric parameters of obesity, as well as associated abnormalities secondary to obesity like, insulin resistance, glucose intolerance, hypertension, atherogenic dyslipidemia. Methods: The study was conducted in the department of medicine, L.L.R.M. Medical College and associated S.V.B.P. Hospital, Meerut, U.P. during 2020-2021 with the objective to assess the role of yoga therapy in modifying anthropometric and biochemical parameters of obese patients. It was a prospective, controlled trial in which 120 obese patients (BMI?25 kg/m2) were enrolled and followed for a period of six months.Results: Yoga therapy along with dietary restrictions is highly effective in improving the various anthropometric and biochemical parameters in obese patients and also beneficial in controlling complicationslike hypertension, diabetes and dyslipidemias secondary to obesity. It also improved the quality of life of these patients.Conclusions: This study is a modest attempt to ascertain the role of yoga in obesity and it hopes to encourage further research in the field.

Nocardia otitidiscaviarum as Possible Etiologic Agent of Non-resolving Pneumonia

Nocardia otitidiscaviarum is an infrequent cause of nocardial pneumonia and rarely affects non-immunocompromised individuals. Pneumonia may not resolve if the causative organism is not susceptible to the empirically given antimicrobial drug. Amoxicillin朿lavulanic acid is a commonly used initial empiric antibiotic for suspected community-acquired bacterial pneumonia on outpatient basis. We report an unusual case of N. otitidiscaviarum as a possible etiologic agent of non-resolving pneumonia due to amoxicillin-clavulanic acid resistance in a previously healthy adult male.

Looking beyond the obvious: Role of non?invasive electroanalgesia in management of cancer pain

Pain is considered as one of the most debilitating symptoms of cancer and its treatment. Owing to the limited efficacy of traditional pharmacological interventions to address cancer pain in its entirety, an avenue exists for exploration into nonpharmacological therapies. Analgesia using non?invasive electrotherapeutic modalities such as transcutaneous electrical nerve stimulation (TENS) and scrambler therapy emerges as a viable option to address cancer pain. The inability of these modalities to find a place within the recommended clinical guidelines has possibly resulted in the paucity of application of the same within the clinical setup. This perspective article aims at stimulating a discussion surrounding the inclusion of non?invasive neuromodulatory treatment techniques such as TENS and scrambler therapy to combat cancer pain and explore the benefits and pitfalls of using these techniques as an adjunct to the pre?existing treatment strategies. It is envisioned that this opinion piece will open a dialogue about a possible home for non?invasive electroanalgesia within the clinical treatment pathway for cancer pain.

Percutaneous coronary intervention in unprotected left main coronary artery stenosis: Mid-term outcomes of a single-center observational study

Background: Percutaneous coronary intervention (PCI) is an appropriate alternative to coronary artery bypass grafting (CABG) for revascularization of unprotected left main coronary artery (ULMCA) disease in patients with low-toeintermediate anatomic complexity or when the patient refuses CABG even after adequate counselling by heart team. We assessed the safety, in-hospital and mid-term outcomes of ULMCA stenting with drug-eluting stents (DES) in Indian patients. Methods: Our study was a retrospective analysis of patients who had undergone ULMCA PCI at a tertiary center, between March 2011 and February 2020. Clinical characteristics, procedural data, and follow-up data were analyzed. The primary outcome was a composite of major adverse cardiovascular and cerebrovascular events (MACCE) during the hospital stay and at follow-up. The median follow-up was 2.8 years (interquartile range: 1.5e4.1 years). Results: 661 patients (mean age, 63.5 ± 10.9 years) had undergone ULMCA PCI. The mean SYNTAX score was 27.9 ± 10.4 and the mean LVEF was 58.0 ± 11.1%. 3-vessel disease and distal lesions were noted in 54% and 70.6% patients, respectively. The incidence of in-hospital MACCE was 1.8% and the MACCE during follow-up was 11.5% (including 48 [8.4%] cardiac deaths). The overall survival rates after one, three, five, and nine years were 94%, 88%, 84%, and 82%, respectively. The multivariate analysis revealed that age >65 years and high SYNTAX scores were independent predictors of mid to long-term mortality. Conclusion: ULMCA PCI with DES is safe and has acceptable in-hospital and mid-term outcomes among patients with low-toeintermediate SYNTAX score

Role of Dinacharya in Prevention of COVID-19

World is facing an unprecedented pandemic of covid-19 caused by SARS-CoV-2. Globally about 340,543,962 were suffered and 5,570,163 deaths were recorded. This covid-19 is affecting physical as well as psychological levels. Ayurveda is science of life which deals with physical and mental well-being. The awareness about oneself, maintenance of health and boosting up immunity is achieved by Ayurveda. Ayurveda has come forward in this critical situation. Preventive measures are more important in such infectious diseases. Boosting the body’s natural immunity plays a significant role in maintenance of health. Ayurveda has explained about Dinacharya (daily regimen), Ritucharya (seasonal regimen), pursuing these regimen can lead to prevention of such types of infectious diseases. Principle of Dinacharya is connected with body and environment, this will balance the Doshas and keep biological clock regular. It can be extremely effective in restoring health as well as in prevention. Importance of Uthapana, Dantadhavna, Jivhanirlekhniya, Gandusha, Abhyanga, Vyayama for the restoration of health in this pandemic era is reviewed. This is basically an ideal lifestyle in form of daily regimen. In busy life, everyone need to understand the importance of Dinacharya (daily regimen). One should follow Dinacharya (daily regimen) and boost their Bala (strength) to fight against virus, bacteria.

A Contrast-Enhanced MDCT Study on the Morphology of Renal Vessels, Their Variations and Clinical Implications

Introduction: The kidneys—the main organs of the excretory system, are supplied by a paired renal artery, originating from the Abdominal Aorta at the level of a disc between L1 and L2 and drained by a paired renal vein exiting from the hilum of the kidney to the Inferior vena cava. Aim: To evaluate the morphology of renal vessels, their variations & clinical implications during renal surgeries in the subjects of the North India population by contrast-enhanced MDCT. Materials and Method: The present study was conceptualized & carried out in the Department of Anatomy, in collaboration with the Department of Radiodiagnosis, Santosh Medical College & Hospital, Ghaziabad and from Dr. O.P Gupta Imaging Centre, Meerut. This study was performed on the 108 patients who were referred for abdominal CECT examination with suspected abdominal pathologies. Contrast-enhanced MDCT scan images of the Abdomen were reviewed for normal anatomy of renal vessels and their variants. Result: Out of 108 patients, anatomical variations of the renal vessel were found in 72 (66.66%) patients. Variations of the renal artery were found in 56 patients (51.85%). Out of these 56 patients, 47 had supplementary renal artery, 17 had early branching of the renal artery and 8 patients had both supplementary and early branching of the renal artery. Supplementary renal arteries were seen in 15 patients on the right side, 16 patients on the left side & 16 patients bilaterally. Earlier branching of the renal artery was found in 9 patients on the right side, 10 patients on the left side and in 2 patients bilaterally. Variations of the renal vein were more commonly found on the right side, late renal vein confluence was seen in 28 (25.92%) patients and supplementary renal veins in 9 (8.3%) patients. On the left side, 2 (1.85%) patients had late renal vein confluence and 2 (1.85%) patients had retroaortic vein. Conclusion: Variations of the renal artery are found frequently. Morphological evaluation of renal vessels is useful for planning and performing the endovascular, laparoscopic and urological procedure.

Repurposing of Metformin for the prevention and treatment of Tuberculosis

Abstract The bidirectional relationship between tuberculosis (TB) and diabetes mellitus (DM) is a major concern for medical professionals and epidemiologists as DM affects the severity, progress and outcome of TB and vice versa. Patients affected with TB have a higher rate of morbidity, treatment failure and mortality. Likewise, DM triples the risk of contracting TB and therefore poses a threat to the progress made in the reduction of TB incidence. Hence, it is pivotal to address both the diseases keeping in mind the each other. It is known that adjunct therapy with immunomodulatory drugs can enhance TB immunity among diabetic patients. Metformin, a commonly used anti-diabetic drug with adenosine monophosphate-activated protein kinase (AMPK) activation property, has shown the capacity to reduce the growth of Mycobacterium tuberculosis within the cell. This drug inhibits the mitochondrial complex and possesses anti-inflammatory action. Therefore, Metformin can be considered as an ideal molecule for host-directed or host-targeted therapy for TB.

Pediatric oral vitiligo: Case report and literature review / Vitiligo oral pediátrico: reporte de caso y revisión de la literatura

ABSTRACT: Vitiligo is an acquired hypomelanotic disorder of the skin resulting from loss of functional melanoctyes and it affects approximately 0.5-1% of individuals. 25% of vitiligo in children are diagnosed before 10 years of age. The age of onset of vitiligo in children ranges between 4 to 8 years. Depigmentation in oral cavity can be easily noted and awareness about the condition can be created if they are not aware about vitiligo elsewhere in their body and can be guided for the treatment.

RESUMEN: El vitíligo es un trastorno hipomelanótico en la piel que resulta de la pérdida de melanocitos funcionales y afecta aproximadamente al 0,5-1% de los individuos. El 25% de los casos de vitiligo en niños se diagnostican antes de los 10 años. La edad de aparición del vitiligo en los niños oscila entre los 4 y los 8 años. La despigmentación en la cavidad oral se puede notar fácilmente y se puede crear conciencia sobre la afección, si no son conscientes del vitiligo en otras partes de su cuerpo, y pueden ser guiados para el tratamiento.

Eficácia da terapia a laser de tecidos profundos na cicatrização de úlceras por pressão em paciente com tetraplegia: relato de caso / Efficacy of deep tissue laser therapy in pressure ulcer healing in patient with quadriplegia: Case Report

CONTEXTO: Úlceras por pressão (UP) são a complicação mais comum observada em pacientes acamados. O objetivo deste relato de caso é explorar a eficácia da terapia a laser no infravermelho próximo de classe IV no tratamento de úlceras de pressão grandes e graves. DADOS: Um homem de 53 anos com diagnóstico de tetraplegia devido à tuberculose da coluna cervical no nível C5-C6 foi admitido em um hospital com úlcera por pressão instável sobre o sacro e úlceras de pressão do National Pressure Ulcer Advisory Panel estágio 3 sobre a área trocantérica direita para lesão por pressão. Não havia comorbidades associadas, como diabetes mellitus e hipertensão. Utilizou-se o Lite Cure Gallium-Aluminium-Arsenide (GaAlAs) classe IV laser próximo ao infravermelho, sem contato, emissão de feixe contínuo (não pulsante) no comprimento de onda de 980 nm. Os parâmetros de dosagem usados foram: 7,5 - 10 watts de potência; faixa de dosagem 7 J / cm2 - 9 J / cm2; área sacral (13 × 9) cm2 e área trocantérica (10 × 8) cm2; em diferentes densidades de energia; o tempo de tratamento varia entre 8 a 15 minutos para cada úlcera. No total, 19 sessões durante um período de 6 semanas foram administradas para tratar úlceras de pressão. Dimensões (área) e estágio de gravidade da úlcera por pressão foram anotados antes da intervenção e após a conclusão da intervenção. Os dados pós-tratamento revelaram melhora clínica em ambos os desfechos. CONCLUSÃO / SIGNIFICADO CLÍNICO: Este relato de caso demonstra um efeito anti-inflamatório, analgésico e bioestimulante de cicatrização do tratamento com laserterapia Classe IV, apresentando redução nas dimensões e gravidade das úlceras por pressão.

CONTEXT: Pressure ulcers (PU) are the most common complication noted in bed-ridden patients. The purpose of this case report is to explore the efficacy of class IV near-infrared laser therapy in the treatment of large and severe pressure ulcers. FINDINGS: A 53-years-old male diagnosed with quadriplegia due to cervical spine tuberculosis at level C5- C6 was admitted to a hospital with an unstageable pressure ulcer over the sacrum and National Pressure Ulcer Advisory Panel Pressure stage 3 ulcers over the right trochanteric area for pressure injury. No associated comorbidities like diabetes mellitus and hypertension were present. The Lite Cure Gallium-Aluminum-Arsenide (GaAlAs) class IV near-infrared laser, non-contact, continuous beam emission (non-pulsing) at 980nm wavelength, was used. The dosage parameters used were: 7.5 - 10 watts power; dose range 7 J/cm2 - 9 J/cm2; sacral area (13×9) cm2 and trochanteric area (10×8) cm2; at varying energy densities; treatment time ranges between 8 to 15 minutes for each ulcer. Total 19 sessions over 6 weeks were given to treat pressure ulcers. Dimensions (area) and severity stage of pressure ulcer were noted pre-intervention and after the intervention. The post-treatment data revealed the clinical improvement in both outcomes. CONCLUSION/ CLINICAL SIGNIFICANCE: This case report demonstrates the anti-inflammatory, analgesic, and bio-stimulative healing effects of Class IV laser therapy treatment showing a reduction in the dimensions and severity of pressure ulcers.

Terapia manual e exercícios de ampliação de canais versus fisioterapia convencional em estenose lombar - um protocolo de estudo / Manual therapy and canal enlargement exercises versus conventional physiotherapy in lumbar stenosis ­ a study protocol

INTRODUÇÃO: A estenose do canal lombar (ECL) é conhecida como a razão bem estabelecida de dor e capacidade de marcha reduzida em pacientes com manifestações de parestesia e dor na parte inferior das costas, região glútea, coxa posterior e pernas, denominadas 'Claudicação Neurogênica' (NC). A terapia manual combinada com exercícios de alargamento do canal e fisioterapia convencional pode ser considerada na erradicação dos sintomas de dor e NC, melhorando assim a qualidade de vida. MÉTODOS E MATERIAIS: Pacientes com LCS com canal de diâmetro de 8-12 mm no nível de L 4 e abaixo serão recrutados para este estudo por meio do método de randomização em Bloco. Eles serão randomizados em dois grupos de intervenção: grupos Terapia Manual e Alargamento dos Canais (MTCE) (n = 16) e Fisioterapia Convencional (Cp) (n = 16). O grupo MTCE receberá terapia manual e exercícios de alargamento do canal, enquanto o grupo Cp receberá apenas fisioterapia convencional. Ambos os grupos de intervenção receberão 3 dias de tratamento por semana durante 4 semanas. O questionário de deficiência de Oswestry modificado (MODI), diâmetro do canal ântero-posterior (AP), escala numérica de dor (NPRS) e distância de claudicação (CD) serão usados para a avaliação. O índice de deficiência de Oswestry modificado, diâmetro do canal AP, NPRS, distância de claudicação e SLR serão medidos no início e após a intervenção. DISCUSSÃO: Os resultados desta pesquisa ditarão a aplicabilidade da terapia manual com um protocolo de exercícios de alargamento do canal na dor e incapacidade funcional em pacientes com SCL.

INTRODUCTION: Lumbar Canal Stenosis (LCS) is known as the well-established reason for pain and depleted walking capacity in patients with manifestations of paresthesia and pain in the lower back, gluteal region, posterior thigh, and legs which are termed as 'Neurogenic Claudication' (NC). Manual therapy combined with canal enlargement exercises and conventional physiotherapy may be considered in eradicating pain and NC symptoms, hence improving the quality of life. METHODS AND MATERIALS: Patients with LCS with canal diameter 8-12 mm at the level of L4 and below will be recruited for this study. Through the Block randomization method, they will be randomized into two interventional groups: Manual Therapy & Canal Enlargement (MTCE) (n=16) and Conventional Physiotherapy (Cp) (n=16) groups. MTCE group will receive manual therapy and canal enlargement exercises, while the Cp group will receive only conventional physiotherapy. Both interventional groups will receive 3 days of treatment per week for 4 weeks. Modified Oswestry Disability questionnaire (MODI), AnteroPosterior (AP) canal diameter, Numeric Pain Rating Scale (NPRS), and Claudication Distance (CD) will be used for the evaluation. In addition, modified Oswestry Disability Index, AP canal Diameter, NPRS, Claudication distance, an SLR will be measured at baseline and post-intervention. DISCUSSION: The results of this research will dictate the applicability of manual therapy with an exercise protocol of canal enlargement exercises on pain and functional disability in patients with LCS.

Um teste clínico randomizado comparando o fortalecimento de abdutores do quadril e terapia manual em pacientes com fascite plantar: um protocolo de estudo / A randomized clinical trial comparing hip abductors strengthening and manual therapy in patients with plantar fasciitis: a study protocol

| INTRODUÇÃO: A fascite plantar (FP) é uma causa comum de dor no calcanhar e deformidade da articulação do tornozelo. Mais de 11% -15% da população com sintomas nos pés precisa de cuidados de longo prazo. Foi comprovado que várias intervenções de fisioterapia com terapia convencional, que inclui terapia manual, ajudam nessa condição. OBJETIVO: Avaliar o efeito do fortalecimento do abdutor do quadril e da terapia manual (MT) em paciente com fascite plantar (FP). MÉTODOS: O desenho do estudo será um ensaio de controle randomizado de dois grupos, pré-teste e pós-teste. Um total de 30 participantes do sexo masculino e feminino com idade acima de 18-60 anos com dores provocadas pelos primeiros passos da manhã, dor na região plantar do calcanhar, serão alocados aleatoriamente em dois grupos - o Grupo A receberá terapia manual (TM) com fisioterapia convencional enquanto o Grupo B receberá fortalecimento dos abdutores do quadril com fisioterapia convencional. Ambos os grupos receberão 16 sessões de tratamento por 4 dias em cada semana durante 4 semanas. "Foot Function Index", "Podia scan", "Teste de queda do navicular" serão usados como medida de desfecho e serão avaliados na 1ª semana e na 4ª semana de tratamento em ambos os grupos. CONCLUSÃO: Os pacientes que recebem a intervenção de fortalecimento do abdutor do quadril podem ter resultados positivos quando comparados à intervenção de MT entre pacientes com FP. Este será o primeiro estudo a comparar o efeito do fortalecimento dos abdutores do quadril e da terapia manual. REGISTRO DE ENSAIO: Registro de Ensaios Clínicos - Índia. (CTRI / 2020/04/024541)

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%- 15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE: To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group PretestPosttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. "Foot function index," "Podiascan," "Navicular drop test" will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. This will be the first study to compare the effect of hip abductors strengthening and manual therapy. TRIAL REGISTRATION: Clinical Trial Registry- India. (CTRI/2020/04/024541)