Transcranial direct current stimulation (tDCS) for neurological disability among subacute stroke survivors to improve multiple domains in health-related quality of life: Randomized controlled trial protocol.

OBJECTIVES: The primary goal of the current proposal is to fill the gaps in the literature by studying the effectiveness of transcranial direct current stimulation (tDCS) on lifestyle parameters, and physical, behavioral, and cognitive functions among stroke survivors, and understanding the factors that mediate the effects of various domains related to Health-related Quality of life (HRQoL) improvements. METHODS: Anticipated 64 volunteer subacute stroke survivors (>7 days to 3 months post stroke) aged 40-75 years with National Institutes of Health stroke scale (NIHSS) score of >10 and Mini-Mental State Examination (MMSE) score between 18 and 23 will be randomly assigned at a ratio of 1:1 to receive either: (1) 20 sessions of anodal tDCS or (2) sham tDCS in addition to conventional rehabilitation. Battery driven tDCS will be applied at 2 mA intensity to the dorsolateral prefrontal cortex and primary motor cortex for 20 minutes. The primary endpoints of study will be 36-Item Short Form Survey (SF-36) post intervention at 4 weeks. The secondary outcomes will include Stroke Specific Quality of Life Scale (SS_QOL), Montreal cognitive assessment (MCA), Beck Anxiety Inventory (BAI), Fugl-Meyer Assessment (FMA), 10 m walk test and Modified Barthel Activities of daily living (ADL) Index. At 0.05 level of significance, data normality, within group and between group actual differences will be analyzed with a moderate scope software. DISCUSSION: Our knowledge of this technique and its use is expanding daily as tDCS motor recovery studies-mostly single-center studies-in either single session or many sessions have been completed and shown positive results. The field is prepared for a multi-center, carefully planned, sham-controlled, double-blinded tDCS study to comprehensively examine its feasibility and effectiveness in enhancing outcomes in stroke population. CONCLUSION: The function of Transcranial Direct Current Stimulation in aiding stroke recuperation will be ascertained.

Association between back-leg-chest muscle strength and kicking speed in soccer players: an observational study.

BACKGROUND: Several studies have been performed on soccer kicks and stressed the significance of strength/power and coordination between the agonist and antagonist muscles of the lower limb. Along with accuracy, speed is also an important factor in a successful kick. It is reported that trunk musculature, hip and knee extensors of the non-kicking extremity, and hip adductors of the kicking side have a role in increasing the foot velocity while kicking. Since muscles do not work in isolation while kicking and several muscle groups of the leg and trunk have been reported to have a role in high-speed kicks, therefore measuring the combined strength of the leg, trunk, and arm muscles will be an appropriate method to examine their association with the kicking speed. The aim of this study was to examine the association of the combined strength of the lower extremities, back, chest, and arm muscles with the kicking speed of soccer players. METHODS: Forty male soccer players (mean age 15.7 years) participated in the study. The back-leg-chest (BLC) dynamometer (Baseline, New York, NY, USA) and the mobile camera measured isometric muscle strength and kicking speed, respectively. The BLC dynamometer measured the isometric strength of the knee, hip, back extensors, and arm muscles. The kicking speed was measured by asking participants to kick a football in three directions - right, middle, and left - from 11 meters. RESULTS: Significant (P<0.001) negative correlations of isometric strength of the back, leg, chest, and arm muscles and kicking speeds were found in all three directions. In all three correlations, Pearson's correlation coefficient was -0.989. Simple linear regression results showed that 97.8% (adjusted R2) of the variance observed in kicking speed (KS; RT), KS (MD), and KS (LT), was explained by the movement in BLC muscle strength values. CONCLUSIONS: Kicking speeds in the right, middle, and left directions were negatively associated with the isometric strengths of the back, leg, chest, and arms muscles, measured using the BLC dynamometer, in participating soccer players.

Unleashing potential and optimizing adolescent roller skating performance through a structured exercise program - a randomized controlled trial.

BACKGROUND: The intricate nature of an athlete's abilities evolves dynamically with the enhancement of motor skills. Hence the study sought to investigate the impact of a tailored four-week exercise program`encompassing exercises focused on balance, agility, and speed. The primary objective was to determine how this exercise program influences both the roller skating talent and overall physical fitness proficiency in young male roller skaters. METHODS: Thirty male participants (age 11-14 years) enrolled in the school skating team were recruited. The participants were randomized into either an experimental group [n = 15], performing a short-term exercise program, or a control group [n = 15], involved in the physical education classes for eight sessions over four weeks. The primary outcome measure, the skating performance, was measured by the linear speed test (LST). The secondary outcomes, i.e., balance, agility, and speed, were evaluated using the star excursion balance test (SEBT), agility t-test (ATT), and arrowhead change of direction speed test (ACDT). SEBT was assessed in 8 directions. The study was registered with the Clinical Trials Registry India (TRN: CTRI/2018/09/015713) before the recruitment of the participants on 14/09/2018. RESULTS: The results showed that LST, ATT, and ACDT improved significantly (p < 0.05) in both groups, however, greater (p < 0.05) improvement was observed in the experimental group (Cohen's d 0.8 to 1.3). Regarding SEBT, improvement was observed in a few directions only in both groups. However, no significant difference was observed between both groups in SEBT measurements. CONCLUSIONS: A short-term structured exercise program consisting of balance, agility, and speed exercises significantly improved the talent of skating, agility, and speed compared to physical education classes activities in young male roller skaters. The study highlights the potential of targeted training interventions to enhance athletic performance in this population.

Factors Contributing to the Change in Overweight/Obesity Prevalence Among Indian Adults: A multivariate decomposition analysis of data from the National Family Health Surveys.

INTRODUCTION: Concerns over the escalating burden of non-communicable diseases call for the redressal of behavioral risk factors like increased body mass index. Most studies have failed to quantify the contribution of socio-demographic characteristics in a linear trend. The present study aims to estimate the current prevalence of overweight and obesity in Indian adults and the contribution of different socio-demographic factors to the increasing prevalence. METHODS: We carried out a secondary data analysis of two National Family Health Survey (NFHS) rounds. The final sample includes 558,122 women and 84,477 men from round 4, and 574,099 women and 74,761 men were included from round 5, using a multi-stage stratified random sampling approach. Overweight/obesity was our primary dependent variable. Weighted bivariate analysis was used to ascertain the prevalence, and the adjusted odds ratios were computed to ascertain the potential predictors. The contribution of different factors towards rising burden over two time points was estimated using multivariate decomposition analysis for non-linear response models. RESULTS: Overall weighted prevalence of overweight and obesity in males and females per NFHS-5 was 44.02% and 41.16%, respectively, compared to 37.71% and 36.14% in NFHS-4. Decomposition analyses depict that the proportion of obesity increased by 6.37% and 5.10% points among men and women, respectively, over the two rounds. Compositional differences of participants (endowment) attributed to 16.54 and 49.90% differences, and the difference in coefficient or effect accounted for 83.46 and 50.10%, respectively, of the increase in the prevalence. The most significant factors contributing to increased prevalence were age, improving socio-economic status, smoking, unclean cooking fuel, and diabetes. CONCLUSIONS: The incremental rise in such a short period, mainly attributed to the effect of socio-demographic variables, is concerning. Policy interventions should prioritize health advocacy programs and aggressively target behavioral modifications while preparing the health systems to manage the people living with obesity.

Assessment of Risk Factors and the Relationship between Hypothyroidism with Hypertension in Diabetes Mellitus Patients: A Cross-Sectional Community-Based Study.

(1) Background: hypertension (HTN) and diabetes mellitus (DM) represent two widely noncommunicable diseases that are prevalent globally, and they often correlate with chronic health issues. There has been an acknowledged connection between diabetes, hypertension, and hypothyroidism for quite some time. However, the extent of thyroid dysfunction among the diabetic population is not uniform and significantly differs across different research studies. This study was conducted with the objective of identifying the risk factors associated with hypothyroidism as well as assessing the relationship between hypothyroidism and hypertension in patients with diabetes. (2) Materials and Methods: Participants aged 18 years and above were included in this study, while pregnant women were excluded. Trained health professionals measured sociodemographic, behavioural, food practices, and anthropometric information about the participants. Each respondent sought medical advice regarding their health, and a face-to-face interview enabled them to express concern about the likelihood of being diagnosed with diabetes mellitus and hypertension. (3) Results: The study encompassed 640 participants, with an average age of 49.20 ± 13.0 years. Among these participants, 65.5% were female, and 34.5% were male. Of the total, 31.25% were diagnosed with diabetes mellitus, and 18.75% had hypertension. Interestingly, co-occurrence of both conditions was observed in 9.68% of the population. A comparison of thyroid function and indicators of blood sugar levels yielded consistent results across the different patient groups. Specifically, for diabetes mellitus (DM) patients, the average levels were 3.4 ± 9.8 pg/mL for fT3, 0.9 ± 0.7 ng/dL for fT4, 3.3 ± 6.2 µiU/mL for TSH, 153.1 ± 68.0 mg/dL for fasting plasma glucose (FPG), 213.2 ± 97.2 mg/dL for postprandial glucose (PPG), and 8.3 ± 3.2% for HbA1c. (4) Conclusion: It is concluded that patients with hypertension had a significant prevalence of diabetes mellitus. Subclinical hypothyroid subjects must be frequently screened for hypertension. Of 120 individuals with hypertension, 45 (37.5%) were also diagnosed with diabetes. This co-occurrence was significantly higher in subjects aged over 50 years (26.7%), in the lower socio-economic class (18.5%), and among those who were married (14.7%). Additionally, patients with hypertension exhibited a high prevalence of diabetes across different educational backgrounds and occupations, with the highest prevalence among postgraduates (37.5%) and professionals (24.0%), respectively. These findings highlight the need for an integrated approach to the management of hypertension and diabetes, particularly in high-risk demographics.

Effects of a program consisting of strain/counterstrain technique, phonophoresis, heat therapy, and stretching in patients with temporomandibular joint dysfunction: A pilot study.

BACKGROUND: The present study was conceptualized as a pilot study to examine the effects of a 3-week program consisting of strain/counterstrain technique (SCST), phonophoresis, heat therapy, and stretching exercises on pain and functions in patients with temporomandibular dysfunction (TMD). METHODS: Seven participants (mean age 25.85 years) diagnosed with TMD having pain in the temporomandibular joint (TMJ) area with decreased jaw opening were recruited for the study. Treatment interventions consisting of SCST, phonophoresis (ultrasound gel mixed with diclofenac gel), heat therapy, and stretching (mouth-opening) exercises were performed 3 days a week for 3 weeks. SCST was performed on the masseter, medial, and lateral pterygoid muscles. No control group was present in the study. RESULTS: Paired samples t test revealed a significant difference in numerical pain rating scale (NPRS) (decreased by 50%, P < .001) and jaw functional limitation scale (JFLS) (reduced by 59.58%, P < .001) scores after 3 weeks of intervention. A large effect size (Cohen d = -3.00 for NPRS and -3.16 for JFLS) was observed for both variables. No correlation (R = 0) was found between the baseline values of NPRS and JFLS. CONCLUSION: A 3-week program consisting of SCST, phonophoresis, heat therapy, and stretching exercises was effective in reducing the pain and improving the functions related to TMJ in patients suffering from TMD. However, a randomized controlled trial is needed to reach a definite conclusion.

A Cross-Sectional Study Using STROBE Platform to Examine Sleep Characteristics, Mental Health and Academic Performance of Female Applied Medical Sciences Students in the Southwest of Saudi Arabia.

Background: Medical students are expected to excel in their academics. Hence exposing them to a certain amount of strain may sometimes cause sleep disruptions. The purpose of this study was to determine the sleep quality among Saudi Applied Medical Sciences students and its potential connections with their academic performance and mental health. Methods: This online cross-sectional questionnaire-based study was conducted at Jazan University's College of Applied Medical Sciences in Saudi Arabia. The Pittsburgh Sleep Quality Index (PSQI), a known indicator of sleep quality, a validated mental health measure; Depression Anxiety Stress Scales-21 (DASS-21), and Academic Performance Scale (APS) with 89 internal consistencies were included in the questionnaire. The cumulative grade point average (GPA) was also used as a covariate to evaluate students' academic success. Results: 112 people responded (response rate = 93%), and 105 of them presented comprehensive information about their backgrounds, way of life, academic standing, sleep patterns, and mental health. Participants' average GPA and APS scores were 4.23 ± 0.52 and 33.16 ± 5.63, respectively. The mean global PSQI score was 6.47 with 2.34 of standard deviation (SD). The majority of individuals (60%) had poor sleep quality particularly due to abnormal sleep latency and lesser sleep duration, as determined by their PSQI score. The prevalence rates for depression, anxiety, and stress were higher; 53%, 54% and 40%, respectively. Both depression and anxiety were substantially correlated with poor sleep quality (p-value = 0.008, p-value = 0.01, respectively). Sleep quality had no significant effect on GPA while global PSQI and depression were significantly negatively correlated with an APS score of participants (p-value = 0.007 and 0.015, respectively). Conclusions: Higher rates of poor sleep quality and psychologically negative emotions were prevalent. Unhealthy sleep patterns were linked to increased levels of anxiety and depression. Self-perceived academic performance was negatively impacted by inadequate sleep and negative emotions, despite the fact that the GPA results were unaffected.

Effectiveness of Epley-Canalith Repositioning Procedure versus Vestibular Rehabilitation Therapy in Diabetic Patients with Posterior Benign Paroxysmal Positional Vertigo: A Randomized Trial.

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder, characterized by brief episodes of vertigo caused by changes in head position. The condition can cause significant functional impairment and reduced quality of life. BPPV is especially common among diabetic patients. The Epley-canalith repositioning procedure (CRP) and vestibular rehabilitation therapy (VRT) are two commonly used interventions for the treatment of BPPV. The objective of this study is to compare the effectiveness of Epley-canalith repositioning procedure (ECRP) and Vestibular Rehabilitation (VR) therapy in the management of vertigo among Type 2 Diabetes Mellitus patients. A total of 30 subjects with Type 2 diabetes mellitus, aged between 40 and 65 years, were randomly allocated to either the ECRP or VR therapy groups using a lottery method, and then underwent Epley-canalith repositioning procedure or vestibular rehabilitation therapy, respectively. The outcomes measured by the study were Vertigo Symptom Scale-Short Form (VSS-sf) score and Berg Balance Scale (BBS) score, assessed pre-treatment (pre) and 4 weeks post-treatment (post). The results demonstrated that both ECRP and VR therapy led to improvements in VSS-sf and BBS scores. However, VR therapy was found to be more effective, resulting in a 13.6% higher improvement in VSS-sf scores (p = 0.03) and a 5.1% higher improvement in BBS scores (p = 0.51) compared to ECRP. Both Epley-canalith repositioning procedure and vestibular rehabilitation therapy are effective in managing BPPV in diabetic patients. Although the differences in BBS scores are not statistically significant, VRT demonstrated a trend towards greater improvement. Vestibular rehabilitation therapy can be used by clinicians as another rehabilitation technique for improving vertigo, postural stability, and activity of daily living in diabetic patients with BPPV.

Utility of Opportunistic Infections, Joints' Involvement and Accuracy of Various Screening Tests to Diagnose Rheumatoid Arthritis Patients.

Background and Objectives: Rheumatoid Arthritis (RA) is an auto-immune disease in which the body mistakenly considers some parts of its own system as pathogens and attacks them. Prevalence is approximately 0.75% in India. About 40% of the diseased become work disabled within 5 years from the onset of symptoms. The objective of this paper is to assess the sign/symptoms, joints' involvement, difficulties in daily activities and screening accuracy of serology tests of clinically suspected RA patients. Material and Methods: A cross-sectional cohort study design was conducted on two hundred ninety clinically suspected subjects who were referred by different OPDs of hospitals for screening. The profiles of study subjects were carried through a semi-structured, pre-tested schedule method. About 2 mL of blood samples were collected in a plain vial from each patient and tested for diagnostic tests RF, CRP and AntiCCP by using RF-Latex, CRP Latex and ELISA method, respectively, by the laboratory persons. Results: Joint pain shows to be a leading problem in RA as compared to other signs and symptoms. The majority of the study subjects suffer from knee problems (62%). Approximately equal numbers of RA-positive cases were screened by RF and AntiCCP tests. The CRP test screened about one-third of cases. CRP+ AntiCCP, RF+ AntiCCP and RF + CRP all have good sensitivity, and RF+ AntiCCP + CRP has a very high sensitivity for diagnosing RA. Conclusions: This study found that a substantiation of a major proportion of clinically suspected RA patients were suffering from knee pain. Predication of AntiCCP increased the possibility for the diagnosis of RA. However, RF was also moderately related to the diagnosis of RA, and the combination of both tests was more valuable.

Effectiveness of High Power Laser Therapy on Pain and Isokinetic Peak Torque in Athletes with Proximal Hamstring Tendinopathy: A Randomized Trial.

Athletes such as long-distance runners, sprinters, hockey, and/or football players may have proximal hamstring tendinopathy (PHT). Laser therapy has been shown to be effective in tendinopathies. High power laser therapy (HPLT) is used for the treatment of several musculoskeletal conditions; however, its efficacy on PHT has not been investigated. This study is aimed at examining the effects of HPLT on pain and isokinetic peak torque (IPT) in athletes with PHT. The two-arm comparative pretest-posttest experimental design was used with random allocation of 36 athletes aged 18-35 years into two groups (experimental and conventional group). The experimental group included the application of HPLT for 3 weeks. The conventional group included treatment with a conventional physiotherapy program including ultrasound therapy, moist heat pack, and home exercises for a total of 3 weeks. Pain and IPT of the hamstring muscle were measured before and after the application of the intervention. Pain score decreased, and IPT increased significantly (p < 0.05) after application of HPLT, by 61.26% and 13.18%, respectively. In the conventional group, a significant difference (p < 0.05) was observed in pain scores only, which decreased by 41.14%. No significant difference (p > 0.05) was observed in IPT in the conventional group. When HPLT was compared with conventional physiotherapy, a significant difference was found in pain scores only. HPLT for 3 weeks was found to be effective in improving pain in athletes with PHT. However, no significant difference was found between HPLT and conventional physiotherapy (US, moist heat, and home exercises) in improving the IPT of the hamstring muscle.

Timed Vibration Sense and Joint Position Sense among Male University Students Experiencing Phantom Vibration Syndrome, Affecting Their Lifestyle.

Background: Vibration dysfunction can cause a number of pathologies in the body, starting with the distal joints and swiftly progressing to proximal joints if not addressed. As a result, it's important to be aware of vibration dysfunction and syndromes like phantom vibration syndrome. The purpose of the following study was to determine if phantom vibration syndrome affects university male students' lifestyles in terms of vibration sensitivity and joint position sense. Methods: A cross sectional study design with a total of 96 individuals were chosen on the basis of random sampling. Participants were assessed for potential phantom vibrations using a self-structured and validated questionnaire approved by clinical experts. Following the completion of questionnaire, the individuals timed vibration sense and Joint position sense were tested using a tuning fork (128 hz) and a full circle goniometer respectively. Results: According to the results of the survey, 100% (96) of individuals experienced phantom vibrations, and 97.9% (94) of individuals assume their phone was ringing when it isn't. 56.3 % (54) of people become anxious due to phantom vibrations or ringing of phone. When current study's median value for timed vibration sensation (4 sec) was compared to previous studies, the results were found to be within normal ranges, implying that the phantom vibration syndrome had no physiological influence on timed vibration sense (VBS). In previous studies, the hip joint position sense average absolute error score decreased linearly from the target position. The reproduce angle from the target position reduced overall in the current study, indicating no change in joint position sense in people experiencing phantom vibration syndrome. Conclusion: Phantom vibration syndrome effects individual psychologically but not physiologically.

A study protocol on nerve mobilization induced diffusion tensor imaging values in posterior tibial nerve in healthy controls and in patients with diabetic neuropathy-multigroup pretest posttest design.

BACKGROUND: Diabetic neuropathy is the commonest chronic disabling complication of diabetes which may lead to amputation and compromising patient's quality of life. It is characterized by pain, sensation loss associated with neural edema. Diffusion tensor imaging parameter i.e. fraction anisotropy determines the free water proton diffusion in the healthy nerve. Since the diabetes leads to altered mechanosensitivity of the posterior tibial nerve thereby, might interferes with the water molecules movement. Therefore the present clinical trial will provide the evidence of improving the diffusion tensor imaging in the diabetic neuropathy directly by targeting the nerve through nerve mobilization treatment. METHODS: Participants with Type II Diabetes Mellitus induced peripheral neuropathy will be selected randomly on the basis of eligibility criteria and informed consent will be taken. Participants will be recruited into three groups. Group A (experimental group A) will receive neural mobilization technique, Group B (experimental group B) will receive conventional therapy and Group C (control group) will receive sham treatment for 3 weeks. MRI technique, Visual analogue scale and neuropathy specific quality of life questionnaire will be used as assessment tools. Assessment will be taken at baseline and post intervention. CONCLUSION: this clinical trial will provide the evidence of efficacy of nerve mobilization in determining the diffusion tensor imaging (DTI) changes in the posterior tibial nerve in patients with diabetic neuropathy. This trial will also be the first one in itself to look at the treatment induced DTI changes in the peripheral nerve. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI/2019/06/019552).

A preliminary report on physical activity patterns among children aged 8-14 years to predict risk of cardiovascular diseases in Malwa region of Punjab.

OBJECTIVE: To determine the pattern of physical activity specific to age and gender among young Indian school going girls and boys aged 8-14 years. DESIGN: Cross-sectional study. SETTING: Private and government sponsored schools in Patiala and Mansa District of Punjab, India. PARTICIPANTS: Two hundred thirty four school going girls and boys aged 8-14 years. METHODOLOGY: A structured questionnaire recorded the various forms of daily physical activity, sedentary activity as well as physical activity level of all the participants. The energy expenditure was also calculated using the standard metabolic equivalent index. RESULTS: There is a significant difference between mean weights of participants belonging to different physical activity levels (p<.04). In comparison to boys, the girl participants have significant lower values of physical activity duration as well as total metabolic equivalent expenditure (p<.05). The total duration of moderate/vigorous physical activity declined in both girls and boys as the age increased. CONCLUSION: Physical activity among children in Northern regions of India is on decline as their age increases especially among girls. It is important to determine physical activity duration in early age groups and motivate children for daily physical activity.

Cardiovascular risk factors in middle age obese Indians: a cross-sectional study on association of per cent body fat and intra-abdominal fat mass.

OBJECTIVES: To determine the association of per cent total body fat (TBF), intra-abdominal fat (IAF) mass and subcutaneous abdominal fat with cardiovascular risk factors in middle age obese Indians. DESIGN: Cross-sectional study. SETTING: Hydrostatic Laboratory, Department of Sports Medicine and Physiotherapy, Guru Nanak Dev University, India. PARTICIPANTS: 51 subjects aged 30-55 years with a body mass index value 23 and above. METHODOLOGY: In all the participants, TBF was estimated by underwater weighing machine and IAF and subcutaneous fat were measured by ultrasonography. Lipid profile was determined by a semiautomated analyser. Main outcome measures were: IAF, per cent body fat to TBF ratio, lipid profile and risk of developing cardiovascular diseases. RESULTS: IAF was found to be significantly associated with lipid variables (95% CI, p<0.01) and risk of developing cardiovascular diseases (95% CI, p≤0.05) in both male and female subjects. TBF and subcutaneous fat thickness showed no significant results (95% CI, p>0.05) with either lipid variables or risk of developing cardiovascular diseases (tables 1 and 2). IAF mass showed significant association with age (95% CI, p<0.01) and significant negative association with physical activity (95% CI, p<0.05) in male subjects (tables 3 and 4). CONCLUSION: An ultrasonic measurement of IAF is a better predictor of the risk of developing cardiovascular diseases in middle aged Indian population. In male subjects, physical activity of 5 or more days a week showed lesser amount of IAF as compared with those with physical activity <5 days a week.