Transition metal-based electrocatalysts for alkaline overall water splitting: advancements, challenges, and perspectives.

Water electrolysis is a promising method for efficiently producing hydrogen and oxygen, crucial for renewable energy conversion and fuel cell technologies. The hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) are two key electrocatalytic reactions occurring during water splitting, necessitating the development of active, stable, and low-cost electrocatalysts. Transition metal (TM)-based electrocatalysts, spanning noble metals and TM oxides, phosphides, nitrides, carbides, borides, chalcogenides, and dichalcogenides, have garnered significant attention due to their outstanding characteristics, including high electronic conductivity, tunable valence electron configuration, high stability, and cost-effectiveness. This timely review discusses developments in TM-based electrocatalysts for the HER and OER in alkaline media in the last 10 years, revealing that the exposure of more accessible surface-active sites, specific electronic effects, and string effects are essential for the development of efficient electrocatalysts towards electrochemical water splitting application. This comprehensive review serves as a guide for designing and constructing state-of-the-art, high-performance bifunctional electrocatalysts based on TMs, particularly for applications in water splitting.

Recent Progress on Nickel- and Iron-Based Metallic Organic Frameworks for Oxygen Evolution Reaction: A Review.

Developing sustainable energy solutions to safeguard the environment is a critical ongoing demand. Electrochemical water splitting (EWS) is a green approach to create effective and long-lasting electrocatalysts for the water oxidation process. Metal organic frameworks (MOFs) have become commonly utilized materials in recent years because of their distinguishing pore architectures, metal nodes easy accessibility, large specific surface areas, shape, and adaptable function. This review outlines the most significant developments in current work on developing improved MOFs for enhancing EWS. The benefits and drawbacks of MOFs are first discussed in this review. Then, some cutting-edge methods for successfully modifying MOFs are also highlighted. Recent progress on nickel (Ni) and iron (Fe) based MOFs have been critically discussed. Finally, a comprehensive analysis of the existing challenges and prospects for Ni- and Fe-based MOFs are summarized.

Mo-based MXenes: Synthesis, properties, and applications.

Ti-MXene allows a range of possibilities to tune their compositional stoichiometry due to their electronic and electrochemical properties. Other than conventionally explored Ti-MXene, there have been ample opportunities for the non-Ti-based MXenes, especially the emerging Mo-based MXenes. Mo-MXenes are established to be remarkable with optoelectronic and electrochemical properties, tuned energy, catalysis, and sensing applications. In this timely review, we systematically discuss the various organized synthesis procedures, associated experimental tunning parameters, physiochemical properties, structural evaluation, stability challenges, key findings, and a wide range of applications of emerging Mo-MXene over Ti-MXenes. We also critically examined the precise control of Mo-MXenes to cater to advanced applications by comprehensively evaluating the summary of recent studies using artificial intelligence and machine learning tools. The critical future perspectives, significant challenges, and possible outlooks for successfully developing and using Mo-MXenes for various practical applications are highlighted.

Cross-cultural adaptation and validation of the Northwick park neck pain questionnaire to Urdu language.

BACKGROUND: Despite its widespread use for assessing pain and disability in patients suffering from neck pain, the Northwick Park Neck Pain Questionnaire (NPQ) has yet to be translated and validated in Urdu. The purpose of the present study was to translate and cross-culturally adapt the NPQ into Urdu language (NPQ-U), and to investigate the NPQ-U's psychometric properties in patients with non-specific neck pain (NSNP). METHODS: The NPQ was translated and cross-culturally adapted into Urdu in accordance with the previously described guidelines. The study included 150 NSNP patients and 50 healthy participants. The NPQ-U, Urdu version of neck disability index (NDI-U), neck pain and disability scale (NPDS), and numerical pain rating scale (NPRS) were completed by all participants on first visit. After three weeks of physical therapy, the patients completed all of the questionnaires listed above, along with the global rating of change scale. Test-retest reliability was determined on 46 randomly selected patients who completed the NPQ-U again two days after the first response. The NPQ-U was evaluated for internal consistency, content validity, construct (convergent and discriminative) validity, factor analysis, and responsiveness. RESULTS: The NPQ-U demonstrated excellent test-retest reliability (intra-class correlation coefficient = 0.96) and high internal consistency (Cronbach's alpha = 0.89). There were no floor or ceiling effects for the NPQ-U total score, indicating good content validity. A single factor was extracted, which explained 54.56% of the total variance. For convergent validity, the NPQ-U showed a strong correlation with NDI-U (r = 0.89, P < 0.001), NPDS (r = 0.71, P < 0.001), and NPRS (r = 0.73, P < 0.001). The results revealed a significant difference between patients and healthy controls in the NPQ-U total scores (P < 0.001) demonstrating significant discriminative validity. A significant difference in the NPQ-U change scores between the stable and the improved groups (P < 0.001) confirmed its responsiveness. Furthermore, the NPQ-U change score showed a moderate correlation with NPDS change score (r = 0.60, P < 0.001) and NPRS change score (r = 0.68, P < 0.001), but a strong correlation with NDI-U change score (r = 0.75, P < 0.001). CONCLUSION: The NPQ-U is a reliable, valid, and responsive tool for assessing neck pain and disability in Urdu-speaking patients with NSNP.

Translation and validation of the Urdu version of the neck pain and disability scale.

PURPOSE: To translate and cross-culturally adapt the neck pain and disability scale (NPDS) into Urdu language (NPDS-U), and to investigate the NPDS-U's psychometric properties in patients with non-specific neck pain (NSNP). METHODS: The NPDS was translated and cross-culturally adapted into Urdu in accordance with the previously described guidelines. The study included 200 NSNP patients and 50 healthy participants. The NPDS-U, Urdu version of neck disability index (NDI-U), neck Bournemouth questionnaire (NBQ), and numerical pain rating scale (NPRS) were completed by all participants. After three weeks of physiotherapy, the patients completed all of the above-mentioned questionnaires, along with the global rating of change scale. Reliability, factor analysis, validity, and responsiveness were all tested. RESULTS: The NPDS-U demonstrated excellent test-retest reliability (ICC2,1=0.92) and high internal consistency (Cronbach's alpha = 0.96). There were no floor or ceiling effects. A three-factor structure was extracted, which explained 70.42% of the total variance. The NPDS-U showed moderate to strong correlations with NPRS, NDI-U, and NBQ (r = 0.67-0.76, p < 0.001). A significant difference in the NPDS-U change scores between the stable and the improved groups (p < 0.001) confirmed its responsiveness. CONCLUSION: The NPDS-U is a reliable, valid, and responsive scale for assessing neck pain and disability in Urdu-speaking patients with NSNP.

The Urdu version of Neck Pain and Disability Scale (NPDS-U) is a reliable and valid tool for assessing neck pain and disability in Urdu-speaking patients with non-specific neck pain (NSNP).The NPDS-U can be used to distinguish between people who have neck pain and disability and those who do not.NPDS-U exhibited a 3-factor structure.The NPDS-U is a responsive instrument that can be used to assess treatment efficacy in NSNP patients.The NPDS-U is a simple and easy to use in clinical and research settings.

Cross-cultural adaptation and validation of the Neck Bournemouth Questionnaire into Urdu language.

BACKGROUND: The Neck Bournemouth Questionnaire (NBQ) has been translated and validated in a number of languages and has good psychometric properties for assessing neck pain. However, an Urdu translation is currently unavailable. PURPOSE: To translate, cross-culturally adapt, and validate the NBQ into Urdu language (NBQ-U) in patients with nonspecific neck pain (NSNP). METHODS: The NBQ was translated and cross-culturally adapted into Urdu using previously described guidelines. The study included 150 Urdu-speaking patients with NSNP and 50 healthy participants. All participants completed the NBQ-U, Urdu version of neck disability index (NDI-U), neck pain and disability scale (NPDS), and numerical pain rating scale (NPRS). After three weeks of physical therapy treatment, the patients completed all of the above-mentioned questionnaires, along with the global rating of change scale. Reliability, validity, and responsiveness were all tested. RESULTS: The NBQ-U demonstrated excellent test-retest reliability (intra-class correlation coefficient = 0.92) and high internal consistency (Cronbach's alpha = 0.89). The NBQ-U showed moderate to strong correlations with NDI-U, NPDS, and NPRS (r = 0.67-0.73, P < .001). The results revealed a significant difference between patients and healthy controls in the NBQ-U total scores (P < .001). The NBQ-U has a single factor structure with no floor or ceiling effects for individual item scores or total scores. A significant difference in the NBQ-U change scores between the stable and the improved groups (P < .001) confirmed its responsiveness. Furthermore, the NBQ-U change score showed moderate correlations with NDI-U, NPDS, and NPRS change scores (r = 0.52-0.62, P < .001). CONCLUSION: In Urdu-speaking patients with NSNP, the NBQ-U demonstrated good reliability, validity, and responsiveness.

Phase 1 trial of intraperitoneal paclitaxel in combination with intravenous cisplatin and oral capecitabine in patients with advanced gastric cancer and peritoneal metastases (IPGP study).

AIMS: Gastric cancer with peritoneal involvement has a poor prognosis. Intraperitoneal (IP) paclitaxel has shown promising results in these patients. However, this approach has only been studied in the Asian population, and in combination with S-1. We investigated the maximum tolerated dose of IP paclitaxel, with a standard chemotherapy combination, in the Australian population. METHODS: The study of the population included metastatic human epidermal growth factor receptor 2 (HER2) negative gastric adenocarcinoma with peritoneal involvement. Treatment included six 21-day cycles of cisplatin (80 mg/m2 IV, day 1) plus capecitabine (1000 mg/m2 PO BD, days 1-14) plus IP paclitaxel (days 1 and 8). IP paclitaxel doses for cohort 1-3 were 10, 20, and 30 mg/m2 , respectively, in a 3 + 3 standard dose-escalation design. RESULTS: Fifteen patients were enrolled of which 6 were female and the median age was 63. Two patients developed dose-limiting toxicities. No grade 4/5 toxicities were recorded. The maximum tolerated dose was not reached. Therefore, as defined by the study protocol, the recommended phase-2 dose for IP paclitaxel was determined to be 30 mg/m2 . The 12-month survival rate was 46.7%, and the median survival was 11.5 months (interquartile range [IQR]: 15.3-6.9). CONCLUSIONS: IP paclitaxel is safe in combination with cisplatin and capecitabine and the recommended phase-2 dose is 30 mg/m2 .

PdO@CoSe2 composites: efficient electrocatalysts for water oxidation in alkaline media.

In this study, we have prepared cobalt selenide (CoSe2) due to its useful aspects from a catalysis point of view such as abundant active sites from Se edges, and significant stability in alkaline conditions. CoSe2, however, has yet to prove its functionality, so we doped palladium oxide (PdO) onto CoSe2 nanostructures using ultraviolet (UV) light, resulting in an efficient and stable water oxidation composite. The crystal arrays, morphology, and chemical composition of the surface were studied using a variety of characterization techniques, including X-ray diffraction (XRD), scanning electron microscopy (SEM), high resolution transmission electron microscopy (HRTEM), X-ray photoelectron spectroscopy (XPS), and Fourier transform infrared (FTIR) spectroscopy. It was also demonstrated that the composite systems were heterogeneous in their morphology, undergoing a shift in their diffraction patterns, suffering from a variety of metal oxidation states and surface defects. The water oxidation was verified by a low overpotential of 260 mV at a current density of 20 mA cm-2 with a Tafel Slope value of 57 mV dec-1. The presence of multi metal oxidation states, rich surface edges of Se and favorable charge transport played a leading role towards water oxidation with a low energy demand. Furthermore, 48 h of durability is associated with the composite system. With the use of PdO and CoSe2, new, low efficiency, simple electrocatalysts for water catalysis have been developed, enabling the development of practical energy conversion and storage systems. This is an excellent alternative approach for fostering growth in the field.

Shoulder pain and functional disability in type 1 diabetic patients: A cross-sectional survey.

OBJECTIVE: To assess the prevalence of shoulder pain and functional disability (SPFD) in Type-1 diabetic patients, and to explore its association with duration of the disease, age and gender. METHODS: A cross-sectional survey was carried out on previously diagnosed patients with Type-1 diabetes mellitus between April 2019 and March 2020. Data was collected from six hospitals including three tertiary care hospitals of Islamabad and Rawalpindi. Three hundred and twenty-eight patients were recruited through convenience sampling. Shoulder Pain and Disability Index was used to determine SPFD among participants. Point-biserial and Pearson correlation coefficients were calculated to find out the correlation between the variables. Independent t-test was used to determine the difference in the mean scores between the variables. RESULTS: The prevalence of SPFD was found 85.7%. A significant correlation was found of the SPFD with age (r = 0.332, p < 0.001), duration of the diabetes mellitus (r = 0.154, p = 0.005) and gender (rpb = 0.171, p = 0.002). A significant difference was found in SPFD mean scores between female and male patients (female patients = 43.42±22.80, male patients = 35.31±22.91, p = 0.002). CONCLUSION: SPFD seems prevalent among Type-1 diabetic patients. Increasing age, long history of diabetes mellitus and female gender appear the associated risk factors for the shoulder pain and disability.

Silver nanoparticles functionalized Paclitaxel nanocrystals enhance overall anti-cancer effect on human cancer cells.

For chemotherapeutic drugs, precise tumor-targeting and high anti-cancer efficiency is equally important in order to enhance chemotherapy and reverse drug resistance. The combination of multifunctional agents to achieve synergy should be a promising strategy. In our study, we have successfully developed novel multifunctionalized drug nanocrystals to realize co-delivery of the organic drug Paclitaxel (PTX), inorganic silver nanoparticles (AgNPs) and a tumor targeting agent. To be specific, PTX nanocrystals were first prepared as a template, then coated with polydopamine (PDA). The PDA layer was utilized as the connection bridge to produce and deposit AgNPs in situ, and provide sites for tumor-targeting peptide NR1 (RGDARF) grafting. As a result, these NR1/AgNP-decorated drug nanocrystals exhibited dramatically improved cellular uptake efficiency, in vitro anti-cancer activity and an anti-migratory effect against a variety of cancer cells, which was attributable to the synergistic, or at least additive, effect of the AgNPs and PTX, enhanced cellular uptake efficiency through NR1-receptor interaction, pH-responsive drug release and the nanoscaled nature. In particular, high anti-cancer activity and low side effects from these NR1/AgNP-decorated PTX nanocrystals were well balanced in terms of good selectivity and biocompatibility. Moreover, these novel drug nanocrystals displayed strong apoptotic-inducing potency, resulting in cell membrane lysis, nuclear damage, mitochondria dysfunction, excessive ROS release and double-stranded DNA breakage. The potential acting mechanism and molecular basis of these novel drug nanocrystals is relevant to the regulation of mitochondria-mediated apoptosis with a greater Bax-to-Bcl-2 ratio and the activation of pro-apoptotic P53 and caspase 3.

Frequency of wrist pain and its associated risk factors in students using mobile phones.

OBJECTIVE: To assess the frequency of wrist pain in students due to mobile phone usage, and impact of usage hours and screen size of mobile phones on pain and disability at wrist joint. METHODS: A cross-sectional survey was conducted among students studying in different universities of Islamabad and Rawalpindi belonging to both public and private sectors. The study was conducted between May 2018 and March 2019. Sample size was 360 students which were selected through convenience sampling. Data was collected through self-formulated closed ended questionnaire. Patient Rated Wrist Evaluation questionnaire was used to assess pain and disability at wrist joint. Data entry and analysis were done using SPSS 21. Results were analyzed using descriptive statistics. Spearman's and point-biserial correlation coefficients were applied to determine association between different variables. RESULTS: Point, last month, last 3 months, last 6 months, last year and lifetime frequency were found to be 9%, 18.6%, 29%, 33.3%, 42% and 45.3% respectively. Duration of mobile phone usage was found to be of significant association factor that could lead to wrist pain and disability (p=0.004). Wrist pain was not significantly related to mobile phone screen size (p=0.488). CONCLUSION: It appears that wrist pain is common among mobile phone users and an increase in use of mobile phones increased pain and disability of wrist joint. In addition, it seems that screen size of mobile phone has no significant effect on pain and disability of wrist joint.

Hyaluronic Acid-Coated Camptothecin Nanocrystals for Targeted Drug Delivery to Enhance Anticancer Efficacy.

Tumor-targeted drug delivery via chemotherapy is very effective on cancer treatment. For potential anticancer agent such as Camptothecin (CPT), high chemotherapeutic efficacy and accurate tumor targeting are equally crucial. Inspired by special CD44 binding capability from hyaluronic acid (HA), in this study, novel HA-coated CPT nanocrystals were successfully prepared by an antisolvent precipitation method for tumor-targeted delivery of hydrophobic drug CPT. These HA-coated CPT nanocrystals demonstrated high drug loading efficiency, improved aqueous dispersion, prolonged circulation, and enhanced stability resulting from their nanoscaled sizes and hydrophilic HA layer. Moreover, as compared to crude CPT and naked CPT nanocrystals, HA-coated CPT nanocrystals displayed dramatically enhanced in vitro anticancer activity, apoptosis-inducing potency against CD44 overexpressed cancer cells, and lower toxic effect toward normal cells due to pH-responsive drug release behavior and specific HA-CD44 mediated endocytosis. Additionally, HA-coated CPT nanocrystals performed fairly better antimigration activity and biocompatibility. The possible molecular mechanism regarding this novel drug formulation might be linked to intrinsic mitochondria-mediated apoptosis by an increase of Bax to Bcl-2 ratio and upregulation of P53. Consequently, HA-coated CPT nanocrystals are expected to be an effective nanoplatform in drug delivery for cancer therapy.

Eco-friendly green synthesis of clove buds extract functionalized silver nanoparticles and evaluation of antibacterial and antidiatom activity.

Biological fouling has caused a lot of concern in marine industries due to the attachment of microorganisms on marine surfaces. Silver nanoparticles (AgNPs) have a great potential to inhibit and hold strong toxicity against microorganisms on artificial surfaces immersed in seawater. In this study, AgNPs are synthesized using extract of clove buds (CE) plant as a reducing and stabilizing agent by biological synthesis method. The obtained CE-AgNPs product was characterized by using different techniques. Ultraviolet-visible spectroscopy (UV-Vis) results confirmed the formation of CE-AgNPs with its surface plasmon resonance peak range. Fourier-transform infrared spectroscopy (FTIR) study showed the formation of functional groups responsible for the reduction of Ag+ into Ago. X-Ray Diffraction (XRD) results revealed face-centered cubic (fcc) silver crystals having four different diffraction peaks at 38.08, 44.21, 64.42 and 77.32 with corresponding lattice plane value recorded at (111), (200), (220) and (311), respectively. Structural characterization using scanning electron microscopy equipped with energy dispersive X-Ray Analyzer (SEM-EDX), Transmission electron microscopy (TEM) and atomic force microscopy (AFM) also confirmed the successful formation of CE-AgNPs with fcc structure. The histogram of particle size distribution through TEM image showed an average size of 9.42 nm of the synthesized product. Finally, the antibacterial and antidiatom activity of the synthesized product was analyzed. The CE-AgNPs synthesized using CE possesses good inhibitory activity against the marine bacterium community and Nitzschia closterium diatom. These results indicate that CE-AgNPs can be used as a novel material for antibacterial and antidiatoms means to inhibit the biofouling on marine surfaces.

Lytic peptide-grafted beta-cyclodextrin polymer based nano-scaled drug delivery system with enhanced camptothecin anti-cancer efficacy.

The aqueous solubility of drug molecules is closely related to its bioactivity like bioavailability and subsequent therapeutic index, especially in the case of hydrophobic drugs like camptothecin (CPT), a potential broad-spectrum anti-cancer agent. Enhanced anti-cancer activity and selectivity of CPT are equally important. Inspired by host-guest effect and drug combination regimen, we developed a novel tumor lytic peptide incorporated drug delivery system by forming beta-cyclodextrin polymer (BCDp) based inclusion complex in nano-scaled size. In this study, BCDp formed inclusion complex with CPT and then a lytic-type peptide (ZH) was grafted. The resulting combinational formulation of BCDp, CPT and ZH, named as ZH-BCDp-CPT inclusion complex, demonstrated greater solubility resulting from its nano-scaled size, amorphous solid state and inclusion structure. Moreover, ZH facilitated quick internalization of conjugated drug via cell membrane lysis, leading to efficient intracellular drug delivery. This novel drug formulation was featured with prolonged circulation, enhanced anti-cancer efficacy, selectivity, anti-cell migration activity and better biocompatibility in comparison with crude CPT and binary BCDp-CPT inclusion complex, all of which were attributed to a cooperative action between ZH and BCDp-CPT inclusion complex. Our results suggested ZH-BCDp-CPT inclusion complex induced cell apoptosis by up-regulation of Bax and P53 and down-regulation of Bcl-2, primarily involved in the mitochondrial pathways.

Phase I open-label trial of intraperitoneal paclitaxel in combination with intravenous cisplatin and oral capecitabine in patients with advanced gastric cancer and peritoneal metastases (IPGP study): study protocol.

INTRODUCTION: Gastric cancer with peritoneal metastasis has a poor outcome. Only a few studies have specifically investigated this group of patients. Japanese researchers have shown that chemotherapy with intraperitoneal paclitaxel (IPP) and oral S-1 (tegafur/gimeracil/oteracil) is active and well tolerated. These results have been achieved in a specific genetic pool (Japanese population), using regimens that may not be available in other parts of the world. We have designed this phase I trial to investigate IPP in combination with a standard chemotherapy combination in these patients. METHODS: We use a 3+3 expanded cohort dose escalation until a predefined number of dose-limiting toxicities are reached. Patients will have an intraperitoneal catheter placed surgically after trial enrolment. Chemotherapy includes a maximum of six cycles (21 days) of capecitabine (X) (1000 mg/m2 two times a day, days 1-14)+cisplatin (C) (intravenous 80 mg/m2 day 1) and IPP (days 1 and 8) with the following doses: cohort-1: 10 mg/m2, cohort-2: 20 mg/m2 and cohort-3: 30 mg/m2. Primary endpoint is to determine the maximum tolerated dose of IPP. Secondary endpoints include determining the safety and tolerability of IPP in combination with C and X, overall response rates, ascites response rate, progression-free survival, overall survival and effects on quality of life.Important inclusion criteria include age ≥18 years, human epidermal growth factor receptor 2 non-amplified gastric adenocarcinoma with histological or cytology-proven peritoneal involvement and adequate organ function. Exclusion criteria include previous malignancy within 5 years, recent abdominal or pelvic radiation treatment, significant abdominal adhesions or sepsis. ETHICS AND DISSEMINATION: The study is approved by Southern Adelaide Clinical Human Research Ethics Committee. A manuscript will be prepared for publication on the completion of the trial. This study will be conducted according to the Note for Guidance on Good Clinical Practice (CPMP/ICH/135/95) annotated with TGA comments (Therapeutic Goods Administration DSEB July 2000) and in compliance with applicable laws and regulations. The study will be performed in accordance with the NHMRC Statement on Ethical Conduct in Research Involving Humans (© Commonwealth of Australia 2007), and the NHMRC Australian Code for the Responsible Conduct of Research (©Australian Government 2007), and the principles laid down by the World Medical Assembly in the Declaration of Helsinki 2008. TRIAL REGISTRATION NUMBER: ACTRN12614001063606.

Green synthesis characterization and antimicrobial activity against Staphylococcus aureus of silver nanoparticles using extracts of neem, onion and tomato.

Recently, it has been shown that silver nanoparticles (AgNPs) exhibit great potential for different applications, including food storage, cosmetic products, electronic components, biosensor materials, cryogenics, dental materials and especially for drug-delivery activities. In this study, we synthesized AgNPs with neem extract (NE) alone and mixed plant extracts of neem, onion and tomato (NOT) as a combined reducing and stabilizing agent by a green synthesis method at different pHs. The synthesized products were characterized by ultraviolet-visible spectroscopy (UV-vis), X-ray diffraction (XRD), dynamic light scattering (DLS), atomic force microscopy (AFM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The antibacterial effects of the synthesized products were studied by the Kirby disk diffusion method. It was confirmed that the AgNPs work effectively as a drug material against Gram-positive bacteria Staphylococcus aureus in nutrient agar. In addition, it was seen that the reducing and stabilizing agent NOT could work effectively with six medicines with a different nature at the maximum addition of 15 µg. However, the synthesized product with NE alone only worked for four of the medicines. Therefore, it was evident that the AgNPs synthesized with NOT extract were more susceptible to the Gram-positive bacteria Staphylococcus aureus. We believe that this new route for synthesizing AgNPs with NOT extract could be more beneficial in comparison to NE alone for improved antibacterial properties in drug-delivery applications.

The effects of neck mobilization in patients with chronic neck pain: A randomized controlled trial.

OBJECTIVE: To determine the effect of mobilization and routine physiotherapy on pain, disability, neck range of motion (ROM) and neck muscle endurance (NME) in patients having chronic mechanical neck pain (NP). METHODS: Sixty eight patients with chronic mechanical NP were randomly allocated into two groups by using a computer generated random sequence table with 34 patients in the multi-modal mobilization group and 34 patients in the routine physiotherapy group. Baseline values for pain, disability, NME, and neck ROM were recorded using visual analogue scale (VAS), neck disability index (NDI), neck flexor muscle endurance test and universal goniometer respectively, before the treatment. Each patient received 10 treatment sessions over a period of four weeks and at the end of four weeks all the outcome measures were recorded again. RESULTS: A paired t-test revealed significant pre to post treatment differences for all outcome measures in both groups (p ≤ 0.001 in all instances). An independent t-test revealed statistically significant differences for pain, disability, NME, and neck ROM in favor of the multi-modal mobilization group with a between group difference of 1.57 cm for VAS (p < 0.001), 11.74 points for NDI (p = 0.001), 18.45 s for NME (p < 0.001) and 6.06-8.24° for neck ROM (p < 0.05). CONCLUSION: The results suggest that a combination of cervical mobilization with routine physiotherapy is more effective for reducing pain and disability and improving NME and neck ROM in patients with chronic mechanical NP compared to routine physiotherapy alone.

Lower thoracic syndrome.

The role of thoracic spine related dysfunction in producing lower extremity symptoms is not clear. This case study describes the assessment and treatment of a patient with low back pain and bilateral lower extremity (BLE) symptoms. It was found that patient education about postural awareness and passive mobilization are valuable aids to decrease BLE symptoms due to sympathetic nervous system (SNS) dysfunction and lower thoracic hypomobility. The clinicians need to consider examination and treatment of the lower thoracic area in patients with BLE symptoms. More research is required to explore the role of SNS dysfunction in producing BLE symptoms.

The prevalence of low back pain in Iranian dentists: An epidemiological study.

OBJECTIVE: Low back pain (LBP) is one of the most common and prevalent work-related conditions. The aim of this study was to estimate the prevalence and risk factors associated with LBP in dentists and to analyze the association between individual and occupational characteristics and LBP. METHODS: Following ethical approval, 300 dentists from Tehran Iran have voluntarily participated. Different questionnaires were completed to collect personal, occupational characteristics and the prevalence and risk factors of LBP. Visual analogue scale and Oswestry disability questionnaires were used to determine pain intensity and level of functional disability. RESULTS: The results indicated that point, last month, last six month, last year and lifetime prevalence of LBP were 24.6%, 24.9%, 27.7%, 28.1% and 31.4%, respectively. A significant correlation was found between the prevalence of LBP and preventive strategies, general health condition, having an assistant and job satisfaction. Body mass index, age and gender were not significantly correlated with the prevalence of Low back pain. CONCLUSIONS: The prevalence of Low back pain in dentists appears to be high. Further studies focusing on the effectiveness of different preventive strategies are recommended.

Urdu version of the neck disability index: a reliability and validity study.

BACKGROUND: Despite the wide use of the neck disability index (NDI) for assessing disability in patients with neck pain, the NDI has not yet been translated and validated in Urdu. The first purpose of the present study was to translate and cross-culturally adapt the NDI into the Urdu language (NDI-U). The second purpose was to investigate the reliability, validity and responsiveness of the NDI-U in Urdu-speaking patients experiencing chronic mechanical neck pain (CMNP). METHODS: Translation and cross-cultural adaptation of the original version of the NDI were carried out using previously described procedures. Seventy-six patients with CMNP and thirty healthy participants were recruited for the study. NDI-U and visual analogue scales for pain intensity (VASpain) and disability (VASdisability) were administered to all the participants at baseline and to the patients 3 weeks after receiving physiotherapy intervention. The global rating of change scale (GROC) was also administered at this time. Test-retest reliability and internal consistency were carried out on forty-six randomly selected patients two days after they completed the NDI-U. The NDI-U was evaluated for factor analysis, content validity, construct validity (discriminative and convergent validity) and responsiveness. RESULTS: An intra-class correlation coefficient (ICC2,1) revealed excellent test-retest reliability for all items (ICC2,1 = 0.86-0.98) and total scores (ICC2,1 = 0.99) of the NDI-U. The NDI-U was found internally consistent with a Cronbach's alpha of 0.90 and a fair to good correlation between single items and the NDI-U total scores (r = 0.34 to 0.89). Factor analysis of the NDI-U produced two factors explaining 66.71% of the variance. Content validity was good, as no floor or ceiling effects were detected for the NDI-U total score. To determine discriminative validity, an independent t-test revealed a significant difference in the NDI-U total scores between the patients and healthy controls (P < 0.001). For convergent validity, Pearson's correlation coefficient showed a strong correlation between NDI-U and VASdisability (r = 0.83, P < 0.001) and a moderate correlation between NDI-U and VASpain (r = 0.62, P < 0.001). To measure responsiveness, an independent t-test showed a significant difference in the NDI-U change scores between the stable and the improved groups (P < 0.001). Furthermore, moderate correlations were found between the NDI-U change scores and the GROC (r = 0.50, P < 0.001), VASdisability change scores (r = 0.58, P < 0.001) and VASpain change scores (r = 0.55, P < 0.001). CONCLUSION: The results showed that the NDI-U is a reliable, valid and responsive questionnaire to measure disability in Urdu-speaking patients with CMNP.