Kinematic Assessment Utilizing Xsens Gait Motion Analysis in Upper Cross Syndrome: A Case Report.

Upper crossed syndrome (UCS) characterizes a prevalent postural dysfunction involving dysfunctional tone in the musculature of the shoulder girdle and cervicothoracic region. The discordant balance among the sternocleidomastoid, pectoralis major, levator scapulae, and upper trapezius musculature potentially precipitated cervical discomfort, thereby hindering routine activities and fostering the progression of UCS. Clinical scales are routinely utilized to assess and monitor the progress of rehabilitation; nonetheless, they often present inherent limitations. In contrast, advancements in three-dimensional (3D) motion capture technology furnish detailed kinematic data, thereby augmenting the capacity to objectively quantify and elucidate movement deficits with heightened precision. This case highlights the critical significance of employing kinematic analysis with Xsens as an outcome measure to elucidate the intricacies of UCS, thereby offering invaluable insights for therapeutic interventions in similar clinical scenarios and providing objective insights into movement biomechanics, muscular function, and functional limitations. Leveraging this information, clinicians can skillfully tailor treatment modalities to address underlying musculoskeletal imbalances, ultimately optimizing patient outcomes. In this case study, we examine the kinematic analysis of a 48-year-old office worker experiencing persistent headaches, restricted range of motion, and neck and shoulder pain over a four-month period. Despite prior interventions, symptomatology deteriorated, prompting consultation with a neurophysiotherapist. The evaluation revealed localized pain in the right shoulder, upper back, and neck, characterized by gradual onset and dull ache, exacerbated by activity and alleviated by rest and medication, without diurnal fluctuations. Physical examination delineated UCS features. Following the implementation of a four-week physiotherapy rehabilitation protocol, initial assessments utilizing Xsens gait motion analysis were undertaken. Subsequent to the rehabilitation program, significant improvements were noted across various parameters. These encompassed augmented range of motion, heightened muscular strength, and enhanced flexibility. Additionally, discernible enhancements were observed in posture and gait, characterized by the restoration of normal cervical spine curvature and an expanded range of motion.

The Integral Role of Physiotherapy in Combined Complete Anterior Cruciate Ligament and Posterior Cruciate Ligament Arthroscopic Reconstruction: A Case Report.

Combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries are infrequent in clinical practice, often leading to severe knee instability and functional limitations. A 30-year-old male presented with right knee pain and swelling following a two-wheeler accident. Diagnostic investigations confirmed complete ACL and PCL tears. The surgical intervention comprised arthroscopic-assisted ACL reconstruction using semitendinosus and gracilis tendons, accompanied by arthroscopic PCL reconstruction. Postoperatively, structured physiotherapy rehabilitation was initiated. After 12 weeks of rehabilitation, significant improvements in range of motion and muscular strength were observed. Tailored physiotherapy facilitated prompt recovery, enhancing functional mobility and independent ambulation. This case highlights the efficacy of comprehensive surgical intervention followed by structured rehabilitation in achieving favorable outcomes in patients with combined ACL and PCL injuries. Tailored physiotherapy plays a crucial role in optimizing functional recovery and facilitates the enhancement of the patient's functional mobility and independent ambulation.

Physiotherapeutic Approach in Enhancing Recovery and Quality of Life After Vaginal Hysterectomy: A Case Report.

Uterine prolapse is a manifestation of pelvic organ prolapse distinguished by the descent of the uterus from its normal anatomical position into the vaginal canal. Vaginal hysterectomy is a surgical intervention performed to excise the uterus via the vaginal canal. Hysterectomy is correlated with various complications; thus, prompt mobilization and engagement in physiotherapy are imperative postoperatively. This is a case report of a 78-year-old female who reported a persistent sensation of something protruding from her vagina over the past two years. Investigations revealed a third-degree uterocervical descent, leading to the decision for a vaginal hysterectomy. Commencing on Day 5 post-surgery, early mobilization and a comprehensive physiotherapeutic regimen were implemented, encompassing breathing exercises, upper limb mobility exercises, core strengthening routines, pelvic floor exercises, and postural correction. Evaluation using the Modified Oxford Pelvic Floor Muscle Contraction Scale, Pelvic Floor Impact Questionnaire (PFIQ), and World Health Organization Quality of Life (WHO-QOL) demonstrated notable improvement. The findings suggest that promoting early mobilization and facilitating the rehabilitation of pelvic musculature, along with core strengthening through physiotherapy, plays a pivotal role in expediting recovery and enhancing the overall quality of life for hysterectomy patients, potentially alleviating difficulties in performing daily activities.

The Impact of Pulmonary Rehabilitation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD): A Case Report.

This study focuses on a 56-year-old male laborer who presented to the respiratory department with grade III dyspnea persisting for 20 days, aggravated in the mornings, accompanied by chest pain over the last two days. The patient reported a productive cough producing yellowish sputum for 15 days and an ongoing fever during this period. With a two-year medical history of seasonal bronchial asthma, the patient had been using an inhaler three times daily for the past month. Additionally, a 20-year history of smoking, averaging five cigarettes per day, was disclosed. Investigations revealed hyperinflation of the lungs on X-ray, indicative of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The patient was prescribed a four-week pulmonary rehabilitation protocol, incorporating physiotherapy. Baseline assessments were conducted using outcome measures such as pulmonary function test (PFT), functional independence measure (FIM), and six-minute walk distance (6MWD) before initiating treatment to evaluate the patient's performance. Following the prescribed pulmonary rehabilitation regimen, notable improvements were observed in PFT, FIM, and 6MWD. These findings underscore significant enhancements in exercise tolerance and overall functional capacity. The results suggest that a structured pulmonary rehabilitation program can lead to meaningful clinical benefits in individuals experiencing AECOPD, particularly when tailored to individual patient needs and characteristics.

Physiotherapeutic Interventions in Diabetic Foot Ulcer Management: A Case Report.

Diabetic foot ulcers (DFUs) represent prominent complications arising from diabetes mellitus, characterized by the development of severe and persistent wounds involving the loss of epidermal and/or dermal layers, with the potential to extend into subcutaneous and underlying tissue structures. In the presented case, a 62-year-old male patient presented with complaints of pain and the emergence of blisters on the right foot, marked by an insidious onset and gradual progression in size, ultimately leading to ulcer formation subsequent to blister rupture. The patient had a medical history spanning 25 years of diabetes mellitus, accompanied by diminished range of motion and muscle strength in the affected foot. The primary goals in the management of DFU encompass addressing muscular weakness, skin manifestations, and any associated underlying health comorbidities. Central to this management approach lies the incorporation of physical therapy and rehabilitation modalities. The rehabilitation regimen designed for the patient was tailored to include targeted resistance exercises, infrared radiation therapy, and sensory integration therapy. Outcome measures, including the Numeric Pain Rating Scale (NPRS), World Health Organization Quality of Life questionnaire (WHO-QOL), and Diabetic Foot Self-Care Questionnaire (DFSQ-UMA), demonstrated substantial improvements, reflecting enhanced activities of daily living. This case underscores the pivotal role of incorporating physiotherapy into a comprehensive multidisciplinary approach for optimizing the management of DFUs. Such integration aims to improve patient outcomes and overall quality of life.

Role of Physiotherapy in Osgood-Schlatter's Disease in Adolescent Volleyball Smasher: A Case Report.

A 14-year-old female presented to the sports physiotherapy with a diagnosis of Osgood-Schlatter's disease (OSD), a condition particularly prevalent in adolescents engaged in sports with repetitive knee motions, such as volleyball. This ailment commonly manifests at the tibia, directly beneath the patella, eliciting discomfort and inflammation. The chronic overuse injuries involve repetitive activities inducing fatigue in specific anatomical structures. Adequate recovery mechanisms allow for tissue adaptation, mitigating the risk of injury. In the absence of proper recovery, microtrauma ensues, instigating inflammation mediated by substances like histamines. The release of inflammatory cells and enzymes inflicts damage on local tissue, and prolonged stress contributes to degenerative changes, resulting in weakness, diminished flexibility, and chronic pain. These manifestations are intimately associated with OSD in chronic or recurrent instances. The primary symptom of OSD is knee pain, often of sufficient severity to induce limping. Patients report discomfort during activities such as kneeling, descending stairs, prolonged stationary positions, prolonged episodes of sitting with the knee rendered immobile, and engagement in sporting activities. This case study specifically underscores the efficacy of tailored physiotherapy in the management of OSD among adolescent volleyball players. The study's findings indicate that the patient successfully alleviated symptoms, facilitating recovery with improved outcomes. Furthermore, the physiotherapy regimen appears instrumental in enhancing the patient's functional mobility, as evidenced by the study's outcomes.

The Role of Physiotherapy in Chronic Osteomyelitis of the Second Metatarsal for the Restoration of Function in a 20-Year-Old Patient: A Case Report.

Osteomyelitis, which is a bone inflammation brought on by an infectious agent, is a challenging clinical issue. Chronic osteomyelitis, characterized by persistent inflammation and infection of the bone tissue, poses significant challenges to both physical health and functional well-being. A 20-year-old male came with complaints of pus discharge from an ulcer present on the dorsum of the right foot with pain and swelling around it. He was unable to stand or walk properly so he came to Acharya Vinoba Bhave Rural Hospital, Wardha, India, where investigations were done which confirmed the diagnosis of chronic osteomyelitis of the second metatarsal. The patient then underwent debridement and curettage due to which he had trouble walking, his ankle joint's range of motion was restricted, and his ability to carry out everyday tasks was compromised. Physiotherapy rehabilitation was administered, and outcome measures were assessed, revealing notable enhancements in the patient's range of motion and muscular strength. A physiotherapy routine helped the patient overcome this, which is crucial to a quick and complete recovery. It also aided the patient's functional mobility and independent ambulation.

Targeting Weakness With a Combination of Isotonic Exercises in Dermatomyositis With Polyneuropathy: A Case Report.

Dermatomyositis, an autoimmune inflammatory myositis commonly linked to polymyositis, is marked by inflammatory and degenerative transformations impacting muscles, skin, limb girdles, the neck, and the pharynx. These changes result in symmetrical weakness and diverse levels of muscle atrophy. Uncommonly, the condition may impact the esophagus, lungs, and heart. While dermatomyositis is believed to involve genetic, immunological, and environmental factors, its precise etiology remains elusive. Typically, the classical presentation involves a symmetrical proximal myopathy alongside dermatological manifestations such as a purplish-red rash affecting the face, arms, hands, legs, and other areas. Additional symptoms may include dysphagia, myalgia, fever, and weight loss. The primary objectives of managing dermatomyositis are to address muscular weakness, skin manifestations, and any underlying health concerns. Integral to this management is the utilization of physical therapy and rehabilitation interventions. This study introduces a 23-year-old female patient with a noteworthy medical history covering a duration of two months. The patient reported a chief complaint of persistent thigh pain and a concurrent complaint concerning bilateral weakness in upper and lower extremities. Furthermore, the patient faced the additional challenge of difficulty swallowing. Intriguingly, the patient's clinical presentation was marked not only by the aforementioned symptoms but also by the development of a distinctive facial rash. This facial rash was accompanied by symptoms of stiffness in both small and large joints and a reduction in the range of affected joints. The physiotherapeutic assessment revealed quadriparesis of bilateral upper and lower limbs. The rehabilitation programme for the patient was planned by targeting proprioceptors to increase dynamic trunk balance in patients with DM. The Proprioceptive Neuromuscular Facilitation (PNF) technique employs diagonal movement patterns, thereby proving instrumental in enhancing the patient's daily activities. This methodology serves to optimize the individual's capacity to execute routine daily tasks, promoting independence in their daily life. An investigation like the Nerve Conduction Velocity (NCV) report shows the absence of motor excitation, suggesting motor axonal neuropathy. This approach, comprising isometric, concentric, and eccentric contraction exercises, demonstrated efficacy in mitigating muscular weakness, enhancing motor function, and alleviating the diverse symptoms associated with this condition.

Usefulness of The Bethesda System of Reporting Thyroid Cytopathology in Surgical Planning.

The Bethesda system for reporting thyroid cytopathology (TBSRTC) has attempted to standardize thyroid fine needle aspiration cytology (FNAC) reporting internationally into six diagnostic categories and help in clinical decision making. But there exists a significant variation in the reporting percentage and rates of malignancies in each category across the centres which complicates clinical decision making. To study the usefulness of TBSRTC in surgical planning of thyroid nodules and to correlate TBSRTC with final histopathology. 85 patients with thyroid nodules who underwent surgery were evaluated prospectively. Preoperatively FNAC and TBSRTC reporting was done and following surgery histopathology was correlated with cytology. Distribution of 85 patients amongst the six categories of TBSRTC was as follows: 2.35% in Category I, 68.23% II, 7.05% III, 16.47% IV, 2.35% V and 3.52% VI. In 93% (79) of patients TBSRTC correlated with histopathology whereas in 7% (6) it did not. Risk of malignancy calculated was 0% in II, 33.33% in III, 7.14% in IV and 100% in V and VI categories. Sensitivity, specificity, Positive Predictive Value and Negative Predictive Value of TBSRTC was 100% for V, VI categories, whereas it was 100%, 78%, 15% and 100% respectively for III, IV. The diagnostic accuracy in our study is 100% for Category V and VI whereas it is 79% for Category III and IV. TBSRTC proved to be a very good screening platform for triaging patients with thyroid nodules into benign and malignant groups, as it is directly related to risk of malignancy in each category. It has helped in appropriate surgical planning in 96.4% of our patients.

Hemiarthroplasty of Pedicle-Frozen Proximal Tibia for Primary Malignant Bone Tumours.

The proximal tibia is one of the most common locations for primary malignant bone tumours and is usually seen in a population that has not attained skeletal maturity. Most of the surgical techniques for resection and reconstruction of the proximal tibia in children involves sacrificing the distal femoral epiphysis, which leads to a significant limb length discrepancy. Hemiarthroplasty is a relatively lesser known technique for knee joint reconstruction that preserves one of the epiphyses around the knee joint. Pedicle freezing is a sterilization technique used to treat malignant bone tumours, without performing an osteotomy of the diaphysis, thereby preventing non-union which is the most common complication of biological reconstruction techniques. We describe the surgical technique of hemiarthroplasty of the pedicle-frozen proximal tibia for malignant bone tumours of the proximal tibia. This is a novel, safe and effective reconstructive method in children, resulting in reduced limb length discrepancy and excellent functional outcomes. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00658-9.

Conditional Alternative Protein Splicing Promoted by Inteins from Haloquadratum walsbyi.

Protein splicing is a post-translational process by which an intervening protein, or an intein, catalyzes its own excision from flanking polypeptides, or exteins, coupled to extein ligation. Four inteins interrupt the MCM helicase of the halophile Haloquadratum walsbyi, two of which are mini-inteins that lack a homing endonuclease. Both inteins can be overexpressed in Escherichia coli and purified as unspliced precursors; splicing can be induced in vitro by incubation with salt. However, one intein can splice in 0.5 M NaCl in vitro, whereas the other splices efficiently only in buffer containing over 2 M NaCl; the organism also requires high salt to grow, with the standard growth media containing over 3 M NaCl and about 0.75 M magnesium salts. Consistent with this difference in salt-dependent activity, an intein-containing precursor protein with both inteins promotes conditional alternative protein splicing (CAPS) to yield different spliced products dependent on the salt concentration. Native Trp fluorescence of the inteins suggests that the difference in activity may be due to partial unfolding of the inteins at lower salt concentrations. This differential salt sensitivity of intein activity may provide a useful mechanism for halophiles to respond to environmental changes.

Comparison of Paravertebral Block with Conventional Spinal Anesthesia in Patients Undergoing Unilateral Inguinal Hernia Repair.

CONTEXT: Although spinal anesthesia (also known as subarachnoid block [SAB]) is used widely for inguinal hernia repair, the paravertebral block (PVB) that produces unilateral, segmental analgesia is used with a high success rate in inguinal hernia repair. AIMS: The aim of the study was to compare SAB and PVB in inguinal hernia repair, in terms of the duration of postoperative analgesia and adverse events. SETTINGS AND DESIGN: This was a prospective, randomized, controlled double-blind study. METHODS: This study was done on 60 male patients of American Society of Anesthesiology (ASA) I and II. Patients were categorized into 30 in each group, either to receive PVB block at two levels T10 and L1 using 15 mL and 5 mL of 0.5% bupivacaine and 1 µg.kg-1 of buprenorphine or SAB with 12.5 mg of 0.5% hyperbaric bupivacaine injected intrathecally. STATISTICAL ANALYSIS USED: SPSS 18.0 and R version 3.2.2 were used for analyzing the data. Categorical measurements were presented in number (%) and analyzed using Chi-square/Fischer's exact test. Continuous measurements were analyzed using Student's t-test. RESULTS: Age, weight, height, and ASA status were comparable in both the groups. In the PVB group, eight patients had failure of block. Hemodynamic responses, time to first analgesia and ambulation, time required to perform the block, Bromage score, satisfaction score, failure rate, and intra- and postoperative drugs used showed a statistically significant difference between the groups (P < 0.001). CONCLUSION: PVB is not a sole anesthetic technique due to a higher failure rate and increased intraoperative fentanyl requirement but has advantages such as prolonged analgesia, stable hemodynamics, and early ambulation.