Bio-valorization of Tagetes floral waste extract in fabrication of self-healing Schiff-base nanocomposite hydrogels for colon cancer remedy.

The drastic boom in floriculture and social events in religious and recreational places has inevitably led to generation of tremendous floral waste across the globe. Marigold (Tagetes erecta) is one of the most common loose flowers offered for the same. Generally discarded, these Tagetes floral wastes could be valorized for biogenic syntheses. In this study, we have utilized the floral extract towards green synthesis of nano ZnO, the formation of which was affirmed from different analytical techniques. Bionanocomposite Schiff-base hydrogel composed of chitosan and dialdehyde pectin was fabricated by the facile strategy of in situ polymer cross-linking, and the ZnO nanoparticles were embedded in the hydrogel matrix. The hydrogel exhibited remarkable self-healing ability. The antioxidant and anti-inflammatory activities were enhanced owing to nano ZnO. Furthermore, it was hemocompatible and biodegradable. A controlled release drug profile for 5-fluorouracil from the hydrogel was accomplished in the colorectum. The exposure of the drug-loaded nanocomposite hydrogel demonstrated improved anticancer effects in HT-29 colon cancer cells. The findings of this study altogether put forth the successful biovalorization of Tagetes floral waste extract for colon cancer remedy.

Platelet-rich Plasma in the Treatment of Recurrent Flexor Tenosynovitis of Wrist Complicated with Carpal Tunnel Syndrome in a Patient with Type 2 Diabetes Mellitus: A Case Report.

Introduction: Hand disorders are common manifestations in persons with diabetes mellitus. Flexor tenosynovitis (FTS) of the wrist is a relatively less common occurrence when compared with FTS of the finger. In the presence of uncontrolled diabetes, recurrence is not uncommon, and management may become difficult. There is no mention in the literature about the management of FTS in the wrist, especially in recurrent cases. Case Presentation: A 38-year-old lady presented with pain and swelling over the volar aspect of the wrist associated with weakness of the grasp. In addition, she reported tingling and a current-like sensation in the radial three and a half digits. Routine laboratory investigations and plain radiographs of the wrist and hand revealed no abnormalities. An ultrasound (USG) scan of the carpal tunnel showed thickening of the flexor tendons, surrounding hypo- to anechoic areas with enhanced color Doppler signal. In addition, there was associated thickening of the median nerve compared to the healthy side. She reported recurrence of the symptoms despite several trials of conservative management and one injection of local corticosteroid. We planned a single injection of platelet-rich plasma (PRP) under direct USG visualization in an in-plane and short-axis view. There was a significant improvement in both pain and function scores up to a 3-month follow-up. Conclusion: FTS of the wrist is a less commonly reported entity that can be missed with clinical examination only. A USG scan can help in the detection of this condition whenever the diagnosis is uncertain. In patients with uncontrolled diabetes, PRP injection appears to be a safe and appropriate treatment option that can improve pain and function scores in the moderate term.

Platelet-rich plasma injection in the treatment of patellar tendinopathy: a systematic review and meta-analysis.

PURPOSE: The objective of the study was to assess the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of patellar tendinopathy. METHODS: The PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for clinical trials which compared PRP injection with other 'active treatment' interventions ('Non-PRP' injection and 'No-injection' treatments) or 'No-active treatment' interventions. Randomized and non-randomized clinical trials that had been published up to 15 November 2021, were included in the meta-analysis. The primary outcome, pain relief, was measured on a 'visual analog scale.' Secondary outcomes were knee functional activities and quality of life (QoL). The PRISMA guidelines were followed throughout the study. RESULTS: Eight comparative studies were identified for inclusion in the meta-analysis. Assessment of these studies revealed that there were no significant differences in pain relief, functional outcomes, and QoL in the short, medium, and long term between PRP injection and Non-PRP injection interventions. Similarly, comparison of PRP injection to the No-active treatment intervention showed no differences in short- and medium-term pain relief. However, when PRP injection was compared to the No-injection treatment intervention extracorporeal shock wave therapy (ECWT), the former was found to be more effective in terms of pain relief in the medium term (mean difference [MD] - 1.50; 95% confidence interval [CI] - 2.72 to - 0.28) and long term (MD - 1.70; 95% CI, - 2.90 to - 0.50) and functional outcomes in the medium term (MD 13.0; 95% CI 3.01-22.99) and long term (MD 13.70; 95% CI 4.62-22.78). CONCLUSIONS: In terms of pain relief and functional outcomes, the PRP injection did not provide significantly greater clinical benefit than Non-PRP injections in the treatment of patellar tendinopathy. However, in comparison with ESWT, there was a significant benefit in favor of PRP injection.

A Case of Chronic Deep Infrapatellar Bursitis Complicated by Patellar Tendinopathy and its Evaluation With Musculoskeletal Ultrasound.

Knee pain is a very common complaint in routine physiatry and orthopedic practice. While bursitis is a well-known and common cause of knee pain, deep infrapatellar bursa (DIPB) involvement is relatively less common. Inflammation of DIPB occurs commonly due to either direct trauma or overuse, but other rare causes have also been reported in the literature including infection, juvenile idiopathic arthritis, gout, and juvenile ankylosing spondylitis. We report a case of chronic inflammation of DIPB caused by direct trauma and associated with patellar tendinopathy. Additionally, we describe the characteristic findings on musculoskeletal ultrasonography (MSK-USG). For ultrasound evaluation, the patient should lie supine with the knee slightly flexed. Deep infrapatellar bursitis can be seen as an anechoic fluid-filled structure immediately posterior to the distal patellar tendon and anterior to the tibial tuberosity. While MRI can confirm the diagnosis of bursitis, MSK-USG can be quick, highly sensitive, and is able to confirm the diagnosis as well as to detect dynamic changes in the patellar tendon and adjacent structures. USG can also help in the treatment by guiding corticosteroid injection into the bursa. Activity modification and eccentric exercises play an important role in the rehabilitation program in these cases.

Neuropathic Pain in Hospitalized Patients With COVID-19: A Prospective Case Series.

Objective: To report the demographic and clinical characteristics of 8 patients hospitalized with COVID-19 and presenting with neuropathic pain (NeuP). Design: A prospective case series with 1-month follow-up. Settings: COVID-19-dedicated wards of a tertiary care center. Participants: We included 8 consecutive cases of laboratory-confirmed cases of COVID-19 (by reverse transcription polymerase chain reaction) who presented with NeuP during the course of their acute hospitalization (N=8). Interventions: Not applicable. Main Outcome Measures: A verbal rating scale was used to assess NeuP severity at presentation and at 1-month follow-up. The Douleur Neuropathique 4 questionnaire was used to diagnose NeuP at presentation. Results: Most patients were diagnosed as moderate to severe COVID-19 (6/8) and presented with mild to moderate NeuP (6/8). A substantial proportion of patients (4/8) displayed persistence of mild pain symptoms at 1-month follow-up. Furthermore, participants displayed a favorable response to gabapentinoids with or without antidepressants. Conclusion: NeuP is a less commonly encountered symptom of COVID-19, but its early diagnosis and prompt management are of utmost importance. More studies including a larger cohort and longer follow-up are recommended for better understanding of COVID-19-associated NeuP.

Respiratory rehabilitation in patients recovering from severe acute respiratory syndrome: A systematic review and meta-analysis.

BACKGROUND: With an increase in published reports on respiratory rehabilitation (RR) in severe acute respiratory syndrome (SARS), there is a need for a meta-analysis and systematic review to measure the effects of the RR in SARS. OBJECTIVE: Objective of the review was to evaluate the efficacy and safety of RR in patients recovering from SARS. METHODS: PubMed/ MEDLINE, CENTRAL, EMBASE, and Clinical Trial Registries were systematically searched (between January 1, 2003, to July 31, 2021) to identify all patients who received RR, at least for six days, following SARS. The primary outcome was exercise capacity [6-meter walking distance (6-MWD)], and secondary outcomes were change in pulmonary function test (PFT) parameters, activities in daily livings (ADLs), and quality of life (QoL). Meta-analysis was performed by using RevMan 5.4. RESULTS: Twenty-one observational studies, including eight comparative studies, were included. Eight comparative studies participated in quantitative meta-analysis. The intervention group, who received RR, improved significantly in exercise capacity (6-MWD) [mean difference (MD):45.79, (95% CI:31.66-59.92)] and PFT parameters, especially in forced vital capacity (FVC%) [MD:4.38, (95% CI:0.15-8.60)], and diffusion lung capacity for carbon monoxide (DLCO%) [MD:11.78, (95% CI:5.10-18.46)]. The intervention group failed to demonstrate significant improvement in ADLs and QoL outcomes. No significant adverse events were reported during the intervention. CONCLUSION: Respiratory rehabilitation can improve exercise capacity and PFT parameters in patients recovering from SARS infection. The RR does not cause serious adverse events. Clinical trials to determine the best RR program (in terms of initiation, duration, and components) in SARS and its treatment efficacy, both in the short and long- term are needed.

Musculoskeletal and Neurological Pain Symptoms Among Hospitalized COVID-19 Patients.

OBJECTIVE: As the coronavirus disease 2019 pandemic continues to grow, its clinical manifestations are still emerging and are being widely investigated. However, the pain symptoms, including neurological and musculoskeletal pain symptoms, are still poorly understood. DESIGN: In this cross-sectional study, we investigated the prevalence of musculoskeletal and neurological pain symptoms among hospitalized coronavirus disease 2019 patients. Furthermore, the association of clinical and demographic factors with the prevalence of pain symptoms was also investigated. RESULT: We included 182 hospitalized coronavirus disease 2019 patients with a mean age of 48.86 ± 13.98 yrs. Pain symptoms were reported by 61.54% patients (n = 112). Most common symptoms reported were generalized myalgia (n = 60, 32.96%), headache (n = 50, 27.47%), and low back pain (n = 41, 22.53%). Interestingly, neuropathic pain was present in 14 participants (7.69%). Logistic regression analysis revealed an association of pain symptoms with coronavirus disease 2019 severity, male sex, higher body mass index, and a history of addiction. CONCLUSIONS: Pain symptoms are common manifestation of coronavirus disease 2019. Generalized myalgia, headache, and low back pain are the three most common new-onset pain symptoms in hospitalized coronavirus disease 2019 patients. Further investigation of pain symptoms and their predictive factors are recommended, which may guide healthcare workers and policymakers to plan in this direction. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand common musculoskeletal and neurological pain symptoms among hospitalized COVID-19 patients; (2) Understand the basic etiopathogenesis of COVID-19 associated pain; and (3) Identify factors associated with presence of COVID-19 pain symptoms. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Type 2 diabetes mellitus, physical activity, and neuromusculoskeletal complications.

Objectives: The objectives of the study were to investigate the neuromusculoskeletal complications of Type 2 diabetes mellitus (T2DM) and their associated factors, including the level of physical activity (PA) and clinicodemographic characteristics. Materials and Methods: In this cross-sectional analysis, we included 370 participants diagnosed with T2DM for no <1 year who satisfied the inclusion and exclusion criteria. Demographic and clinical characteristics were noted and a thorough clinical examination was performed on all the participants. International PA Questionnaire-Short Form was used to evaluate the level of PA of the participants. The continuous data is presented as mean ± SD and the categorical data is presented as the number of participants (n) and percentage (%). A logistic regression model was used to investigate the predictors for the prevalence of the complications. Results: The mean duration of T2DM was 7.32 ± 5.53 years and the mean hemoglobin A1C (HbA1c) level (%) was 8.16±1.67. A majority of the participants were having uncontrolled diabetes with an HbA1c level ≥7.5% (n = 190; 51.35%). The level of PA was low in a substantial proportion of the participants (n = 276; 74.59%). A total of 162 (43.78%) participants were diagnosed with neuromusculoskeletal complications. Low back pain was the most common complication and degenerative disk disease was the most common diagnosis overall. Longer duration of diabetes, poor glycemic control, and low PA were associated with the prevalence of neuromusculoskeletal complications (P < 0.05). Conclusion: Neuromusculoskeletal complications of T2DM are common and can result in significant disability in this population. Low PA is very common among T2DM patients and an important contributor to the development of complications. Health-care providers should consider PA an integral component of the management protocol for T2DM patients.

Injection Botulinum Toxin A in Treatment of Resistant Chronic Low Back Pain: A Prospective Open-Label Study.

Objective The aim of this study was to evaluate the effect of botulinum toxin A (BTX-A) injection on patients with chronic low back pain (CLBP). Design In this open-label prospective study, patients with CLBP who satisfied inclusion and exclusion criteria received 100 units of BTX-A injection. Patients were followed up at four weeks, three months, and six months after injection. Pain and function were assessed with visual analog scale (VAS), Roland-Morris Disability Scale (RMS), and Oswestry Disability Index (ODI) at baseline and subsequent visits. Results A total of 19 participants with a mean age of 41.11 years completed the study. Compared to baseline, a significant improvement in all scores was observed that persisted up to six months post-injection (P<0.001). Only two patients reported transient injection site pain that improved over two to three days without any treatment. Conclusion BTX-A injection is safe and improves pain and function in patients with resistant CLBP. The effects are more beneficial when the population is more homogenous in diagnosis and devoid of negative predictors for the outcome.