Quality Studies on Cynometra iripa Leaf and Bark as Herbal Medicines.

Cynometra iripa Kostel. is a Fabaceae species of mangrove used in traditional Ayurvedic medicine for treating inflammatory conditions. The present study aims to establish monographic botanical and chemical quality criteria for C. iripa leaf and bark as herbal substances and to evaluate their in vitro antioxidant potential. Macroscopic and microscopic qualitative and quantitative analyses, chemical LC-UV/DAD-ESI/MS profiling, and the quantification of key chemical classes were performed. Antioxidant activity was evaluated by DPPH and FRAP assays. Macroscopically, the leaf is asymmetrical with an emarginated apex and cuneate base. Microscopically, it shows features such as two-layered adaxial palisade parenchyma, vascular bundles surrounded by 3-6 layers of sclerenchyma, prismatic calcium oxalate crystals (5.89 ± 1.32 µm) along the fibers, paracytic stomata only on the abaxial epidermis (stomatal index-20.15), and non-glandular trichomes only on petiolules. The microscopic features of the bark include a broad cortex with large lignified sclereids, prismatic calcium oxalate crystals (8.24 ± 1.57 µm), and secondary phloem with distinct 2-5 seriated medullary rays without crystals. Chemical profile analysis revealed that phenolic derivatives, mainly condensed tannins and flavonoids, are the main classes identified. A total of 22 marker compounds were tentatively identified in both plant parts. The major compounds identified in the leaf were quercetin-3-O-glucoside and taxifolin pentoside and in the bark were B-type dimeric proanthocyanidins and taxifolin 3-O-rhamnoside. The total phenolics content was higher in the leaf (1521 ± 4.71 mg GAE/g dry weight), while the total flavonoids and condensed tannins content were higher in the bark (82 ± 0.58 mg CE/g and 1021 ± 5.51 mg CCE/g dry weight, respectively). A total of 70% of the hydroethanolic extracts of leaf and bark showed higher antioxidant activity than the ascorbic acid and concentration-dependent scavenging activity in the DPPH assay (IC50 23.95 ± 0.93 and 23.63 ± 1.37 µg/mL, respectively). A positive and statistically significant (p < 0.05) correlation between the phenol content and antioxidant activity was found. The results obtained will provide important clues for the quality control criteria of C. iripa leaf and bark, as well as for the knowledge of their pharmacological potential as possible anti-inflammatory agents with antioxidant activity.

Hepatic steatosis induced by nicotine plus Coca-Cola™ is prevented by nicotinamide riboside (NR).

Introduction: Cigarettes containing nicotine (Nic) are a risk factor for the development of cardiovascular and metabolic diseases. We reported that Nic delivered via injections or e-cigarette vapor led to hepatic steatosis in mice fed with a high-fat diet. High-fructose corn syrup (HFCS) is the main sweetener in sugar-sweetened beverages (SSBs) in the US. Increased consumption of SSBs with HFCS is associated with increased risks of non-alcoholic fatty liver disease (NAFLD). Nicotinamide riboside (NR) increases mitochondrial nicotinamide adenine dinucleotide (NAD+) and protects mice against hepatic steatosis. This study evaluated if Nic plus Coca-Cola™ (Coke) with HFCS can cause hepatic steatosis and that can be protected by NR. Methods: C57BL/6J mice received twice daily intraperitoneal (IP) injections of Nic or saline and were given Coke (HFCS), or Coke with sugar, and NR supplementation for 10 weeks. Results: Our results show that Nic+Coke caused increased caloric intake and induced hepatic steatosis, and the addition of NR prevented these changes. Western blot analysis showed lipogenesis markers were activated (increased cleavage of the sterol regulatory element-binding protein 1 [SREBP1c] and reduction of phospho-Acetyl-CoA Carboxylase [p-ACC]) in the Nic+Coke compared to the Sal+Water group. The hepatic detrimental effects of Nic+Coke were mediated by decreased NAD+ signaling, increased oxidative stress, and mitochondrial damage. NR reduced oxidative stress and prevented mitochondrial damage by restoring protein levels of Sirtuin1 (Sirt1) and peroxisome proliferator-activated receptor coactivator 1-alpha (PGC1) signaling. Conclusion: We conclude that Nic+Coke has an additive effect on producing hepatic steatosis, and NR is protective. This study suggests concern for the development of NAFLD in subjects who consume nicotine and drink SSBs with HFCS.

Preparation and characterization of handsheet using cellulose based Agri-weed: A sustainable utilization of Urena Lobata fiber.

The increasing depletion of reserves of natural resources has led to a growing worldwide focus on the exploitation of available waste in new domains. The presence of weedy plants is pervasive on a global scale and has detrimental effects on several aspects of the environment, agriculture, and people's health. Therefore, repurposing these Agri-weed plants for beneficial purposes would be a significant achievement. Furthermore, since raw materials constitute a substantial portion of manufacturing costs, using weeds as a feasible substitute for raw materials might potentially provide considerable advantages for manufacturers. In this study, an endeavor has been made to the utilization of agricultural waste "Urena Lobata", for the purpose of paper production. In the interim, the utilization of Urena Lobata as an alternative and sustainable raw material for pulp and paper industry could potentially offer a beneficial approach to mitigation of deforestation. The effective production of handsheets with weights of 70 g/m2 and 80 g/m2 was achieved using Urena Lobata fiber, Bleached Urena Lobata Fiber, and hardwood kraft pulp. Mechanical characteristics of handsheet's were comprehensively examined by the bursting index, tensile strength, tear index, brightness percentage and scanning electron microscope for handsheet's morphology. The results show that the handsheets produced by Urena Lobata fiber exhibit a much lower brightness percentage, high tensile strength and bursting index. Alongside, handsheets by bleached Urena Lobata fiber indicate higher brightness percentage, satisfactory values for tensile strength, bursting index, and tear index. The prepared materials are suitable for a broad spectrum of prospective applications, encompassing newsprint, tissue paper, filtration paper as well as high-quality writing and printing paper.

BdSL47: A complete depth-based Bangla sign alphabet and digit dataset.

Sign Language Recognition (SLR) is crucial for enabling communication between the deaf-mute and hearing communities. Nevertheless, the development of a comprehensive sign language dataset is a challenging task due to the complexity and variations in hand gestures. This challenge is particularly evident in the case of Bangla Sign Language (BdSL), where the limited availability of depth datasets impedes accurate recognition. To address this issue, we propose BdSL47, an open-access depth dataset for 47 one-handed static signs (10 digits, from ০ to ৯; and 37 letters, from অ to ँ) of BdSL. The dataset was created using the MediaPipe framework for extracting depth information. To classify the signs, we developed an Artificial Neural Network (ANN) model with a 63-node input layer, a 47-node output layer, and 4 hidden layers that included dropout in the last two hidden layers, an Adam optimizer, and a ReLU activation function. Based on the selected hyperparameters, the proposed ANN model effectively learns the spatial relationships and patterns from the depth-based gestural input features and gives an F1 score of 97.84 %, indicating the effectiveness of the approach compared to the baselines provided. The availability of BdSL47 as a comprehensive dataset can have an impact on improving the accuracy of SLR for BdSL using more advanced deep-learning models.

Water, sanitation and hygiene challenges of forcibly displaced Myanmar nationals in Rohingya camps in Bangladesh.

Improved water, sanitation and hygiene (WASH) facilities in water-scarce areas is one of the most important barriers to improving the standards of people's life, which is even worse in a locality with forcibly displaced people (e.g., nearly 1 million Rohingya refugees in Bangladesh). In attempting to understand the extent of vulnerability and risks of WASH facilities, their impacts, and adaptive practices in the communities, an exploratory study has been carried out in five selected camps (13, 15, 16, 24 and 27) in Cox's Bazar, Bangladesh. Examination of water facilities shows that households in camps 13, 15 and 16 suffered from an adequate supply of water during summer as there is no direct access to surface water from adjacent water reservoirs, while camps 24 and 27 have such facilities. The frequency of water shortage for drinking purposes in camps 13, 15 and 16 was not so severe as in camps 24 and 27. Drinking water collectors had to spend 3-5 h in queues. All latrines were communal/shared latrines, which made users feel uncomfortable and vulnerable. This study implies that WASH facilities need to be reinforced, and community sensitization on WASH behavior needs to be strengthened to reduce WASH-related health hazards.

The lipolysis inhibitor acipimox reverses the cardiac phenotype induced by electronic cigarettes.

Electronic cigarettes (e-cigarettes) are a prevalent alternative to conventional nicotine cigarettes among smokers and people who have never smoked. Increased concentrations of serum free fatty acids (FFAs) are crucial in generating lipotoxicity. We studied the effects of acipimox, an antilipolytic drug, on e-cigarette-induced cardiac dysfunction. C57BL/6J wild-type mice on high fat diet were treated with saline, e-cigarette with 2.4% nicotine [e-cigarette (2.4%)], and e-cigarette (2.4%) plus acipimox for 12 weeks. Fractional shortening and ejection fraction were diminished in mice exposed to e-cigarettes (2.4%) compared with saline and acipimox-treated mice. Mice exposed to e-cigarette (2.4%) had increased circulating levels of inflammatory cytokines and FFAs, which were diminished by acipimox. Gene Set Enrichment Analysis revealed that e-cigarette (2.4%)-treated mice had gene expression changes in the G2/M DNA damage checkpoint pathway that was normalized by acipimox. Accordingly, we showed that acipimox suppressed the nuclear localization of phospho-p53 induced by e-cigarette (2.4%). Additionally, e-cigarette (2.4%) increased the apurinic/apyrimidinic sites, a marker of oxidative DNA damage which was normalized by acipimox. Mice exposed to e-cigarette (2.4%) had increased cardiac Heme oxygenase 1 protein levels and 4-hydroxynonenal (4-HNE). These markers of oxidative stress were decreased by acipimox. Therefore, inhibiting lipolysis with acipimox normalizes the physiological changes induced by e-cigarettes and the associated increase in inflammatory cytokines, oxidative stress, and DNA damage.

Quality, Safety and Biological Studies on Campylanthus glaber Aerial Parts.

In Cabo Verde, several endemic species are used in traditional medicine. However, no scientific studies have been conducted on the quality, efficacy, and safety of most of these plants. This study focused on establishing the botanical and chemical identification parameters required for a quality monograph of Campylanthus glaber Benth. aerial parts, a medicinal plant of Cabo Verde traditionally used to treat fever and muscular pain. In addition, in vitro antioxidant and antihyperglycemic activity, cytotoxicity, and genotoxicity were assessed for this medicinal plant. Optical microscopy, LC/UV-DAD-ESI/MS, and colorimetric assays were used for botanical, chemical, and biological studies, respectively. Cytotoxicity was assessed by the MTT assay with HepG2 cells, and genotoxicity by the Ames test. Microscopically, the xeromorphic leaf of C. glaber presents a thick cuticle (13.6-25.5 µm), thick-walled epidermal cells, anomocytic-type stomata, glandular trichomes (stalk length = 49.4-120.8 µm), and idioblasts containing calcium oxalate microcrystals. The chemical screening of aqueous and hydroethanolic extracts of this medicinal plant revealed the presence of organic acids, iridoids, phenylethanoids, and flavonoids as the main classes of marker compounds, with malic acid, citric acid, and verbascoside being the main marker compounds identified. Both extracts showed similar LC/UV-DAD/ESI-MS qualitative profiles and DPPH radical scavenger activity (IC50 = 130.9 ± 1.4; 134.3 ± 3.1 µg/mL). The hydroethanolic extract inhibited both α-amylase and α-glucosidase enzymes in a dose-dependent manner. Both extracts showed no cytotoxicity (up to 1000 µg/mL) by the MTT assay and no genotoxic potential with or without metabolic activation up to 5 mg /plate. The results obtained are an important contribution to the monographic quality assessment of C. glaber aerial parts and suggest that this medicinal plant may be safe and potentially used as an herbal drug raw material for pharmaceutical purposes.

ß-Cyclodextrin-Functionalized Fe3O4-Supported Pd-Nanocatalyst for the Reduction of Nitroarenes in Water at Mild Conditions.

In this study, a novel heterogeneous catalyst (Fe3O4@ß-CD@Pd) has been developed by the deposition of palladium nanoparticles on the ß-cyclodextrin-functionalized surface of magnetic Fe3O4. The catalyst was prepared by a simple chemical co-precipitation method and characterized extensively by using Fourier transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), X-ray diffraction (XRD), field-emission scanning electron microscopy (FE-SEM), energy dispersive X-ray spectroscopy (EDX), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS), and inductively coupled plasma-optical emission spectrometry (ICP-OES) analyses. Herein, the applicability of the prepared material was evaluated for the catalytic reduction of environmentally toxic nitroarenes to the corresponding anilines. The catalyst Fe3O4@ß-CD@Pd showed excellent efficiency for the reduction of nitroarenes in water under mild conditions. A low catalyst loading of 0.3 mol % Pd is found to be efficient for reducing nitroarenes in excellent to good (99-95%) yields along with high TON values (up to 330). Nevertheless, the catalyst was recycled and reused up to the 5th cycle of reduction of nitroarene without any loss of significant catalytic activity.

Non-Invasive Portable Technologies for Monitoring Breast Cancer Related Lymphedema to Facilitate Telehealth: A Scoping Review.

Breast cancer related lymphedema (BCRL) is a common, debilitating condition that can affect up to one in five breast cancer surviving patients (BCSP). BCRL can significantly reduce the quality of life (QOL) of patients and poses a significant challenge to healthcare providers. Early detection and continuous monitoring of lymphedema is crucial for the development of client-centered treatment plans for post-cancer surgery patients. Therefore, this comprehensive scoping review aimed to investigate the current technology methods used for the remote monitoring of BCRL and their potential to facilitate telehealth in the treatment of lymphedema. Initially, five electronic databases were systematically searched and analyzed following the PRISMA flow diagram. Studies were included, specifically if they provided data on the effectiveness of the intervention and were designed for the remote monitoring of BCRL. A total of 25 included studies reported 18 technological solutions to remotely monitor BCRL with significant methodological variation. Additionally, the technologies were categorized by method of detection and wearability. The findings of this comprehensive scoping review indicate that state-of-the-art commercial technologies were found to be more appropriate for clinical use than home monitoring, with portable 3D imaging tools being popular (SD 53.40) and accurate (correlation 0.9, p 0.05) for evaluating lymphedema in both clinic and home settings with expert practitioners and therapists. However, wearable technologies showed the most future potential for accessible and clinical long-term lymphedema management with positive telehealth outcomes. In conclusion, the absence of a viable telehealth device highlights the need for urgent research to develop a wearable device that can effectively track BCRL and facilitate remote monitoring, ultimately improving the quality of life for patients following post-cancer treatment.

Modified Graphite Pencil Electrode Based on Graphene Oxide-Modified Fe3O4 for Ferrocene-Mediated Electrochemical Detection of Hemoglobin.

This study describes the synthesis of graphene oxide-modified magnetite (rGO/Fe3O4) and its use as an electrochemical sensor for the quantitative detection of hemoglobin (Hb). rGO is characterized by a 2θ peak at 10.03° in its X-ray diffraction, 1353 and 1586 cm-1 vibrations in Raman spectroscopy, while scanning electron microscopy coupled with energy-dispersive spectroscopy of rGO and rGO/Fe3O4 revealed the presence of microplate structures in both materials and high presence of iron in rGO/Fe3O4 with 50 wt %. The modified graphite pencil electrode, GPE/rGO/Fe3O4, is characterized using cyclic voltammetry. Higher electrochemical surface area is obtained when the GPE is modified with rGO/Fe3O4. Linear scan voltammetry is used to quantify Hb at the surface of the sensor using ferrocene (FC) as an electrochemical amplifier. Linear response for Hb is obtained in the 0.1-1.8 µM range with a regression coefficient of 0.995, a lower limit of detection of 0.090 µM, and a limit of quantitation of 0.28 µM. The sensor was free from interferents and successfully used to sense Hb in human urine. Due to the above-stated qualities, the GPE/rGO/Fe3O4 electrode could be a potential competitive sensor for trace quantities of Hb in physiological media.

Fatty Acid Excess Dysregulates CARF to Initiate the Development of Hepatic Steatosis.

CARF (CDKN2AIP) regulates cellular fate in response to various stresses. However, its role in metabolic stress is unknown. We found that fatty livers from mice exhibit low CARF expression. Similarly, overloaded palmitate inhibited CARF expression in HepG2 cells, suggesting that excess fat-induced stress downregulates hepatic CARF. In agreement with this, silencing and overexpressing CARF resulted in higher and lower fat accumulation in HepG2 cells, respectively. Furthermore, CARF overexpression lowered the ectopic palmitate accumulation in HepG2 cells. We were interested in understanding the role of hepatic CARF and underlying mechanisms in the development of NAFLD. Mechanistically, transcriptome analysis revealed that endoplasmic reticulum (ER) stress and oxidative stress pathway genes significantly altered in the absence of CARF. IRE1α, GRP78, and CHOP, markers of ER stress, were increased, and the treatment with TUDCA, an ER stress inhibitor, attenuated fat accumulation in CARF-deficient cells. Moreover, silencing CARF caused a reduction of GPX3 and TRXND3, leading to oxidative stress and apoptotic cell death. Intriguingly, CARF overexpression in HFD-fed mice significantly decreased hepatic steatosis. Furthermore, overexpression of CARF ameliorated the aberrant ER function and oxidative stress caused by fat accumulation. Our results further demonstrated that overexpression of CARF alleviates HFD-induced insulin resistance assessed with ITT and GTT assay. Altogether, we conclude that excess fat-induced reduction of CARF dysregulates ER functions and lipid metabolism leading to hepatic steatosis.

Efficacy of Caregivers Training in Rehabilitation of Stroke Survivors in Bangladesh: A Quasi-experimental Study.

BACKGROUND:  A proper rehabilitation program may prevent post-stroke neurological, structural, and functional disabilities. We aimed to evaluate the efficacy of caregiver training in the rehabilitation of stroke survivors and compare rehabilitation interventions done by the therapist. METHODS:  This quasi-experimental study was conducted among 67 stroke survivors divided into group A (home-based exercise by family caregivers; n=33) and group B (hospital-based supervised exercise by a physiotherapist; n=34). Family caregivers were trained according to "The London Stroke Carers Training Course." The functional independence measure (FIM) evaluated all patients after three months of physiotherapy.  Results: The mean age of the participants in group A and group B were 56.85 ± 11.49 and 58.65 ± 16.92 years, respectively, where most of the patients in both groups were male. In group A, 17 (51.5%) participants had left-sided involvement, while in group B, 17 (50.0%) participants had left-sided involvement. There was no significant statistical difference in FIM between groups A and B at baseline (p=0.532). At three months, the mean FIM of the participants in group A (98.54 ± 11.85) was significantly higher than in group B (89.85 ± 8.15) (p=0.001). A quasi-significant difference was observed between the right (18.41 ± 9.37) and the left (23.42 ± 11.68) hemisphere involvement regarding mean improvement of FIM (p=0.057). CONCLUSION:  Therapeutic approach provided by trained caregivers was found to be more effective and efficient than that done by a physiotherapist.

The Genus Cynometra: A Review of Ethnomedicine, Chemical, and Biological Data.

Cynometra L. is a Fabaceae genus that is widely distributed throughout the tropics, consisting of tropical forest trees with ecological and economic importance since they are used as food and herbal medicines by the populations of their natural habitats. Our goal is to provide a review of the research data concerning the potential of this botanical genus as a source of herbal medicines and secondary metabolites that are useful for human health. To that end, scientific databases, including PubMed, Science Direct, ISI Web of Science, Scopus, and Google Scholar, were searched using the following terms: Cynometra, medicine, chemical, biological activity, toxicity, and "AND" as the Boolean connector. Eleven Cynometra species (9.7%) were reported to be used in traditional medicine to treat different ailments. A total of 185 secondary metabolites of various chemical classes, mainly flavonoids and terpenoids, were identified in eight Cynometra species (7.1%). Vitexin was the only flavonoid identified as bioactive in the sequence of bioguided studies on this botanical genus. Ten species (8.8%) were submitted to in vitro and in vivo biological activity assays. The main evaluated activities were in vitro antioxidant, antimicrobial, cytotoxic, and in vivo anti-inflammatory activities, but no human clinical trials or safety data about this genus were found. Cynometra cauliflora and Cynometra ramiflora were the most studied species. The present work confirms the use of Cynometra species as a source of medicinal plants. However, more experimental studies must be conducted to better understand this botanical genus's usefulness as a source of raw materials for pharmaceutical use.

Electronic Cigarette Use and the Risk of Cardiovascular Diseases.

Electronic cigarettes or e-cigarettes are the most frequently used tobacco product among adolescents. Despite the widespread use of e-cigarettes and the known detrimental cardiac consequences of nicotine, the effects of e-cigarettes on the cardiovascular system are not well-known. Several in vitro and in vivo studies delineating the mechanisms of the impact of e-cigarettes on the cardiovascular system have been published. These include mechanisms associated with nicotine or other components of the aerosol or thermal degradation products of e-cigarettes. The increased hyperlipidemia, sympathetic dominance, endothelial dysfunction, DNA damage, and macrophage activation are prominent effects of e-cigarettes. Additionally, oxidative stress and inflammation are unifying mechanisms at many levels of the cardiovascular impairment induced by e-cigarette exposure. This review outlines the contribution of e-cigarettes in the development of cardiovascular diseases and their molecular underpinnings.

Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity?

Femoral neck fractures are one of the most common fractures treated by an Orthopaedic surgeon. Arthroplasty is the recommended management for intracapsular neck of femur fractures in the elderly population owing to the high risk of avascular necrosis of the femoral head following an internal fixation. Elderly patients with intracapsular fractures deemed high risk for anaesthesia (American Society of Anaesthesiology Grade more than 2) are recommended a hip hemiarthroplasty. Routine practice throughout the United Kingdom is to obtain a postoperative check radiograph for all hip hemiarthroplasty patients prior to their discharge from the hospital. This may be done for various reasons like checking the presence of any peri-prosthetic fracture, the position of the components along with the presence of any dislocation. However, it is unclear whether a radiograph is the sole identifier of such complications. Through this study, we aim to analyse whether routine recommendation of post-operative radiographs following hip hemiarthroplasty affects the clinical outcome, and whether it is effective in identifying potential complications before the patients report any signs or symptoms.

A Hybrid Active Neutral Point Clamped Inverter Utilizing Si and Ga2O3 Semiconductors: Modelling and Performance Analysis.

In this paper, the performance of an active neutral point clamped (ANPC) inverter is evaluated, which is developed utilizing both silicon (Si) and gallium trioxide (Ga2O3) devices. The hybridization of semiconductor devices is performed since the production volume and fabrication of ultra-wide bandgap (UWBG) semiconductors are still in the early-stage, and they are highly expensive. In the proposed ANPC topology, the Si devices are operated at a low switching frequency, while the Ga2O3 switches are operated at a higher switching frequency. The proposed ANPC mitigates the fault current in the switching devices which are prevalent in conventional ANPCs. The proposed ANPC is developed by applying a specified modulation technique and an intelligent switching arrangement, which has further improved its performance by optimizing the loss distribution among the Si/Ga2O3 devices and thus effectively increases the overall efficiency of the inverter. It profoundly reduces the common mode current stress on the switches and thus generates a lower common-mode voltage on the output. It can also operate at a broad range of power factors. The paper extensively analyzed the switching performance of UWBG semiconductor (Ga2O3) devices using double pulse testing (DPT) and proper simulation results. The proposed inverter reduced the fault current to 52 A and achieved a maximum efficiency of 99.1%.

Three-Phase Six-Level Multilevel Voltage Source Inverter: Modeling and Experimental Validation.

This research proposes a three-phase six-level multilevel inverter depending on twelve-switch three-phase Bridge and multilevel DC-link. The proposed architecture increases the number of voltage levels with less power components than conventional inverters such as the flying capacitor, cascaded H-bridge, diode-clamped and other recently established multilevel inverter topologies. The multilevel DC-link circuit is constructed by connecting three distinct DC voltage supplies, such as single DC supply, half-bridge and full-bridge cells. The purpose of both full-bridge and half-bridge cells is to provide a variable DC voltage with a common voltage step to the three-phase bridge's mid-point. A vector modulation technique is also employed to achieve the desired output voltage waveforms. The proposed inverter can operate as a six-level or two-level inverter, depending on the magnitude of the modulation indexes. To guarantee the feasibility of the proposed configuration, the proposed inverter's prototype is developed, and the experimental results are provided. The proposed inverter showed good performance with high efficiency of 97.59% following the IEEE 1547 standard. The current harmonics of the proposed inverter was also minimized to only 5.8%.

Fracture Nonunions and Delayed Unions Treated With Low-Intensity Pulsed Ultrasound Therapy: A Clinical Series.

The incidence of nonunion of fractures has been steadily rising owing to improved life expectancy following severe injuries along with rising cases of polytrauma. Once a nonunion is established, the chances of spontaneous healing are deemed to be quite low. Fracture nonunion continues to be a challenge in clinical practice with nonunions having a considerable impact on patient's quality of life causing both functional and psychosocial disability. Low-Intensity Pulsed Ultrasound (LIPUS) therapy is being projected as a viable and non-interventional alternative to surgical management of nonunions and delayed unions. LIPUS therapy is being widely recommended as a standalone treatment option for the treatment of established nonunions and delayed unions as it is believed to promote healing in all phases of fracture healing viz., inflammatory, intramembranous ossification, chondrogenesis, endochondral ossification and remodelling. In the current scenario of varying results and unclear clinical role of LIPUS therapy, we present a prospective case series of fracture nonunions and delayed unions treated with LIPUS therapy at a large District General Hospital.

Rehabilitation Following Surgically Treated Distal Radius Fractures: Do Immobilization and Physiotherapy Affect the Outcome?

Distal radius fractures (DRF) are one of the most common fractures treated by orthopaedic surgeons around the globe. It has been estimated that the National Health Services (NHS) spends an average of £1375.34 per patient for surgical fixation of DRF with a volar locking plate as a day case. This figure climbs to £1983.39 if the same patient stays at the hospital overnight. Inpatient physiotherapy costs the NHS a staggering £82.03 per day, while each outpatient session with physiotherapy is £40.70 for the NHS. This means that a substantial amount is spent by the NHS on rehabilitation and physiotherapy for each DRF, whether fixed surgically or non-surgically. Post-operative rehabilitation involving initial immobilization followed by physiotherapy/hand therapy is an indispensable part of the total management concept of DRF. Most of the conservative management protocols also advocate a five-week immobilization followed by physiotherapy/hand therapy. Due to the fact that more than 50% of the patients with DRF are still employed, the impairment caused by a restriction of range of motion, duration of the sick leave and the effects of DRF on quality of life play a very important socio-economical role in the broadest sense. Patients are routinely referred to physiotherapists/hand therapists following DRF to improve the range of motion (ROM), manage pain, strengthen the wrist and develop full functionality to pre-injury levels. However, the real impact of supervised exercises and active physiotherapy in restoring mobility and strength to the fractured wrist is still not well understood. This article aims to review the existing literature and evidence base regarding the efficacy of immobilization and physiotherapy in improving the functional outcome of surgically treated DRFs.