Correlation of fatigue on walking ability in myasthenia gravis patients: a cross-sectional study.

Introduction: Myasthenia gravis (MG) is a neuromuscular junction autoimmune disease characterised of intermittent muscle weakness that increases with activity and recovers with rest. Objective: Analysing the correlation of fatigue on walking ability in MG patients. Methods: This study used a cross-sectional design with consecutive sampling. Participants MG patients took in this trial. Data collection encompasses fatigue and walking ability, with fatigue being assessed using the fatigue severity scale (FSS) and walking ability being assessed using the 10-metre walking test. The 10-metre walking test assessment contains three components: comfortable walking speed (CWS), maximum walking speed (MWS), and natural cadence. The statistical analysis used in this study includes the Pearson correlation and Spearman rank tests with P<0.05. Results: The number of participants was 23 MG patients, and most of the participant was female (69.6%). The participant's fatigue value was 5.46±1.13, including MGFA 1=5.32±1.15, MGFA 2A=5.5±1.11, and MGFA 2B=5.61±1.30. Meanwhile, the participant's walking abilities included CWS of 1.10±0.11 m/s, MWS of 1.31±0.15 m/s, and natural cadence of 110.91±7.74 steps/min. No significant correlation of fatigue on walking ability including FSS vs. CWS (r=-0.141; P=0.520), FSS vs MWS (r=-0.169; P=0.442), and FSS vs. natural cadence (r=-0.050; P=0.822). Conclusion: There was no significant correlation between fatigue and walking ability in MG patients who had MGFA 1, MGFA 2A, and MGFA 2B.

Extracorporeal Shock Wave Therapy as Regenerative Medicine in Knee Osteoarthritis: Pre-Experiment for Matrix Metalloproteinase-3 Evaluation.

BACKGROUND: Knee osteoarthritis (KOA) is currently treated by regenerative therapies that aim to inhibit arthritic degeneration. Extracorporeal shock wave therapy (ESWT) is one of the physical regenerative approaches used for KOA management. However, little is known regarding the impact of shock wave treatment on matrix metalloproteinase-3 (MMP-3), which is one of the enzymes mediating cartilage degradation. OBJECTIVES: To evaluate the effect of ESWT on MMP-3 levels and pain intensity in patients with KOA. METHODS: Fourteen patients diagnosed with Kellgren Lawrence, grades 2 and 3 KOA were recruited for the study. ESWT piezo shockwave was applied once a week for six weeks. MMP-3 levels in the blood were measured pre-test, mid-test (three weeks after therapy) and post-test (one week after the last session) by enzyme-linked immunosorbent assay (ELISA). The perceived pain was recorded at each session by the Wong Becker Face Scale. RESULTS: The median pre-test, mid-test and post-test MMP-3 levels were 19.92 ng/mL, 15.89 ng/mL and 18.82 ng/mL, respectively, and there were significant differences between the pre-test and mid-test, and the pre-test and post-test values (p < 0.05). The pain scores also decreased significantly over the period of intervention. CONCLUSION: MMP-3 levels decreased significantly in KOA patients after ESWT, and the decline was most obvious after 3 weeks of therapy. Therefore, EWST should be considered as a suitable treatment option for KOA.

Effects of Otago Exercise Program on serum Interleukin-6 level in older women.

Background: Otago Exercise Program (OEP) has been demonstrated to minimize the risk of falling in older adults by improving muscular strength and balance. Meanwhile, reduced IL-6 level serves as a biomarker of regular physical activity. Objective: Analyzing OEP effect on decreased IL-6 level in elderly women. Methods: This study used a randomized control trial design from October 2020 to May 2021. 26 participants were divided into a treatment group (13 participants) and a control group (13 participants). The treatment group received OEP for 8 weeks, in which the OEP was carried out 3 times during the first week. On the other hand, the control group did not get intervention. The IL-6 level was measured 2 times, before and after OEP. The measurement results were analyzed using paired t-test and independent t-test, which were declared significant if p < 0.05. Results: The participants' average IL-6 level at pretest and posttest was 4.77 ± 1.71 pg/mL and 4.57 ± 1.74 pg/mL, respectively. The IL-16 level of the treatment group at pretest and posttest was 4.22 ± 1.72 pg/mL and 3.97 ± 1.67 pg/mL, respectively (t = 1.058; 95% CI = -0.770 - 0.267; p = 0.311). Meanwhile, the IL-6 level of the control group at pretest and posttest was 5.30 ± 1.59 pg/mL and 5.16 ± 1.65 pg/mL, respectively (t = 0.382; 95% CI = -0.969 - 0.680; p = 0.709). The ΔIL-6 level in the treatment and control group was -0.25 ± 0.85 pg/mL and -0.14 ± 1.36 pg/mL, respectively (t = 0.240; 95% CI = -1.030 - 0.815; p = 0.813). Conclusion: The OEP didn't lower serum IL-6 levels after eight weeks.

The Effect of Green Tea with EGCG Active Compound in Enhancing the Expression of M2 Microglia Marker (CD206).

Background: Stroke is a neurological deficit due to vascular disorders. Microglia are the first line of defense against brain injury. Anti-inflammatory cytokines activate M2 microglia, which upregulate CD206. EGCG is abundant in green tea, which has an anti-inflammatory effect. Objective: To know the effect of green tea with its active compound EGCG on CD206 expression. Settings and Design: True experimental trial design. Material and Methods: Rattus Novergicus were divided into six groups: a negative control group (Sham), a positive control group (P0), MCAO mice given 10 mg/kg BW EGCG (P1), 20 mg/kg BW EGCG (P2), 30 mg/kg BW EGCG (P3), and 30 mg/kg BW standardized green tea extract (P4). CD206 expression was measured using immunohistochemistry and scored according to the Allred scoring guidelines. Statistical Analysis Used: Descriptive test, Levine test, Kolmogorov-Smirnoff test, Independent sample t test, Pearson correlation test. Results: We discovered that there is a significant difference in CD206 expression between the Sham and P0 groups (P < 0.05). In addition, there are significant differences in expression between the sham group and the other two groups (P1 and P2) (P < 0.05). Furthermore, when we compared the P0 group with each treatment group, we found that CD206 expression between P0-P2, P0-P3, P0-P4 are significantly different. There is a significant correlation between green tea with its active compound EGCG and CD206 expression enhancement. The correlation is positive. Conclusions: Green tea with EGCG active compound increases CD206 expression as an M2 marker in the Rattus norvegicus with MCAO model.

The addition of mirror therapy improved upper limb motor recovery and level of independence after stroke: a randomized controlled trial / A terapia do espelho melhora a recuperação motora do membro superior e o nível de independência após AVC: um ensaio clínico randomizado

Abstract Introduction In stroke survivors, the prevalence of upper motor disability remains high. There has not been much report on the success of post-stroke mirror therapy, especially in developing countries. Objective The focus of this research is to see how mirror therapy, in addition to standard rehabilitation for hand paresis, affects upper limb motor recovery and level of independence in self-care after stroke at an Indonesian teaching hospital. Method This was a randomized controlled trial with no assessor blinding. The study included 18 subacute stroke patients who did not have cognitive or visual impairment. The mirror group received a 20-minute mirror therapy session in addition to conventional rehabilitation, while the control group received only the standard program for 5 weeks (2 times per week). The Brunnstrom score and self-care level of independence elements of the Functional Independence Measure (FIM) were used as outcome measures. Results Baseline comparisons of lesion type and Brunnstrom score showed significant between-group differences. The ANACOVA test showed the difference had no effect on the FIM change in scores (P > 0.05). One patient (mirror group) was dropped out from the study. After 5 weeks (n=17), the mirror group showed improvement in both the Brunnstrom and FIM scores (P < 0.05) compared to the control group. Conclusions Mirror treatment improves upper limb motor recovery and level of independence in self-care after stroke when combined with standard hand paresis rehabilitation 2 times a week for 5 weeks.

Resumo Introdução Em sobreviventes de AVC, a prevalência de deficiência motora nos membros superiores permanece alta. Não há muitos relatos sobre o sucesso da terapia do espelho pós-AVC, especialmente em países em desenvolvimento. Objetivo O foco desta pesquisa é ver como a terapia do espelho, além da reabilitação padrão para paresia da mão, afeta a recuperação motora do membro superior e o nível de independência no autocuidado após o AVC em um hospital universitário da Indonésia. Método Ensaio clínico randomizado sem cegamento do avaliador. O estudo incluiu 18 pacientes com AVC subagudo que não tinham deficiência cognitiva ou visual. O grupo de espelho recebeu uma sessão de terapia de espelho de 20 minutos além da reabilitação convencional, enquanto o grupo de controle recebeu apenas o programa padrão por 5 semanas (2 vezes por semana). O escore de Brunnstrom e os elementos do nível de independência do autocuidado da Medida de Independência Funcional (MIF) foram usados ​​como medidas de desfecho. Resultados As comparações da linha de base do tipo de lesão e do escore de Brunnstrom mostraram diferenças significativas entre os grupos. O teste ANACOVA mostrou que a diferença não teve efeito na mudança da MIF nos escores (P> 0,05). Um paciente (grupo espelho) foi retirado do estudo. Após 5 semanas (n = 17), o grupo espelho mostrou melhora em ambos os escores de Brunnstrom e FIM (P <0,05) em comparação com o grupo de controle. Conclusão O tratamento com espelho melhora a recuperação motora dos membros superiores e o nível de independência no autocuidado após o AVC quando combinado com a reabilitação de paresia de mão padrão 2 vezes por semana durante 5 semanas.

Pain Relief with Wet Cupping Therapy in Rats is Mediated by Heat Shock Protein 70 and ß-Endorphin.

BACKGROUND: Wet cupping therapy is a complementary therapy in pain management. The mechanism of this therapy, however, needs further elucidation. Cells injured by wet cupping therapy seem to stimulate the expression of heat shock protein 70 (HSP70). Its benefit in pain reduction could be mediated by the expression of ß-endorphin. This study aimed at determining the correlation between HSP70 and ß-endorphin after wet cupping therapy. METHODS: Sixteen male Wistar rats were divided into control (CG; n=8) and treatment (TG; n=8) groups. The rats in both groups were injected with complete Freund's adjuvant (CFA) at the footpad. In the TG, wet cupping therapy was done at the left and right paralumbar regions 48 hours after the CFA injection. Twenty-four hours after therapy, the hot plate test was done to assess pain threshold. Thereafter, immunohistochemistry from the skin subjected to wet cupping therapy was conducted for HSP70 and ß-endorphin. RESULTS: The expression of HSP70 was significantly higher in the keratinocytes of the TG (20.25±3.53; P<0.001) than in the keratinocytes of the CG (10.50±2.44; P<0.001). The expression of ß-endorphin was significantly higher in the keratinocytes of the TG (22.37±3.52; P<0.001) than in the keratinocytes of the CG (5.12±1.72; P<0.001). The results also revealed a high correlation between HSP70 and ß-endorphin (ß=0.864; P<0.001). Pain threshold after wet cupping therapy was significantly higher in the TG (22.81±6.34 s; P=0.003) than in the CG (11.78±3.56 s). CONCLUSIONS: The benefit of wet cupping therapy in terms of pain reduction in rats could be mediated by the expression of HSP70 and ß-endorphin.