Streptococcus uberis induced expressions of pro-inflammatory IL-6, TNF-α, and IFN-γ in bovine mammary epithelial cells associated with inhibited autophagy and autophagy flux formation.

Autophagy is a highly conserved cellular defensive mechanism that can eliminate bacterial pathogens such as Streptococcus uberis, that causes mastitis in cows. However, S. uberis induced autophagy is still unclear. In this study, we tested if certain inflammatory cytokines such as IL-6, TNF-α, and IFN-γ, critical in mastitis due to S. uberis infection, regulate autophagy activation in bovine mammary epithelial cells (bMECs). Using Western blot and laser scanning confocal microscope in bMECs challenged by S. uberis, showed that the expression of IL-6, TNF-α, IFN-γ oscillated with the expressions of autophagic Atg5, ULK1, PTEN, P62, and LC3ӀӀ/LC3Ӏ. S. uberis infection induced autophagosomes and LC3 puncta in bMECs with upregulation of Atg5, ULK1, PTEN, LC3ӀӀ/LC3Ӏ, and downregulation of P62. The levels of IL-6, TNF-α, and IFN-γ increased during autophagy flux formation to decrease during autophagy induction. Autophagy inhibition increased the expression of IL-6, TNF-α, and IFN-γ and increased S. uberis burden. This study indicates autophagy is induced during S. uberis infection and IL-6, TNF-α, and IFN-γ contribute to autophagy and autophagy flux formation.

MicroRNA miR-223 modulates NLRP3 and Keap1, mitigating lipopolysaccharide-induced inflammation and oxidative stress in bovine mammary epithelial cells and murine mammary glands.

Bovine mastitis, the most prevalent and costly disease in dairy cows worldwide, decreases milk quality and quantity, and increases cow culling. However, involvement of microRNAs (miRNAs) in mastitis is not well characterized. The objective was to determine the role of microRNA-223 (miR-223) in regulation of the nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 (NLRP3) inflammasome and kelch like ECH-associated protein 1 (Keap1)/nuclear factor erythroid 2-related factor 2 (Nrf2) oxidative stress pathway in mastitis models induced by lipopolysaccharide (LPS) treatment of immortalized bovine mammary epithelial cells (bMECs) and murine mammary glands. In bMECs cultured in vitro, LPS-induced inflammation downregulated bta-miR-223; the latter interacted directly with the 3' untranslated region (3' UTR) of NLRP3 and Keap1. Overexpression of bta-miR-223 in bMECs decreased LPS and Adenosine 5'-triphosphate (ATP)-induced NLRP3 and its mediation of caspase 1 and IL-1ß, and inhibited LPS-induced Keap1 and Nrf2 mediated oxidative stress, whereas inhibition of bta-miR-223 had opposite effects. In an in vivo murine model of LPS-induced mastitis, increased miR-223 mitigated pathology in the murine mammary gland, whereas decreased miR-223 increased inflammatory changes and oxidative stress. In conclusion, bta-miR-223 mitigated inflammation and oxidative injury by downregulating the NLRP3 inflammasome and Keap1/Nrf2 signaling pathway. This study implicated bta-miR-223 in regulation of inflammatory responses, with potential as a novel target for treating bovine mastitis and other diseases.

Hijamah (Cupping Therapy) for Pain Management in Patients with Cervical Spondylosis.

Background: Cervical spondylosis is the most common cervical spine disorder which is clinically manifested by axial neck pain, stiffness, and limited movement and sometimes it is accompanied by tingling and radicular symptoms in the upper extremities. Pain is the most frequent complaint for which patients, suffering from cervical spondylosis, consult physicians. In conventional medicine, pain and other symptoms of cervical spondylosis are controlled by systemic and local use of non-steroidal anti-inflammatory drugs (NSAIDs), however long-term use of such medicines produces adverse effects like dyspepsia, gastritis, gastroduodenal ulcer and bleeding. Methods: We searched articles for neck pain, cervical spondylosis, cupping therapy, Hijama, etc. from various databases, including PubMed, Google Scholar, and MEDLINE. We also searched for these topics in the books of Unani medicine available in HMS Central Library, Jamia Hamdard, New Delhi, India. Results: This review elucidated that in Unani medicine several non-pharmacological regimens known as Ilaj bi'l Tadbir (Regimenal therapies) are advised in the management of painful musculoskeletal disorders. Hijama (cupping therapy) stands out among all these regimens and in most of the classical Unani literature, Hijama is suggested as one of the best regimens for the management of pain in Waja' al-Mafasil including Waja' al-'Unuq (cervical spondylosis). Conclusion: On going through the classical texts of Unani medicine and published research papers, it may be concluded that Hijama is a safe and effective non-pharmacological treatment for the management of pain due to cervical spondylosis.

Mycoplasma bovis subverts autophagy to promote intracellular replication in bovine mammary epithelial cells cultured in vitro.

Mycoplasma species are the smallest prokaryotes capable of self-replication. To investigate Mycoplasma induced autophagy in mammalian cells, Mycoplasma bovis (M. bovis) and bovine mammary epithelial cells (bMEC) were used in an in vitro infection model. Initially, intracellular M. bovis was enclosed within a membrane-like structure in bMEC, as viewed with transmission electron microscopy. In infected bMEC, increased LC3II was verified by Western blotting, RT-PCR and laser confocal microscopy, confirming autophagy at 1, 3 and 6 h post-infection (hpi), with a peak at 6 hpi. However, the M. bovis-induced autophagy flux was subsequently blocked. P62 degradation in infected bMEC was inhibited at 3, 6, 12 and 24 hpi, based on Western blotting and RT-PCR. Beclin1 expression decreased at 12 and 24 hpi. Furthermore, autophagosome maturation was subverted by M. bovis. Autophagosome acidification was inhibited by M. bovis infection, based on detection of mCherry-GFP-LC3 labeled autophagosomes; the decreases in protein levels of Lamp-2a indicate that the lysosomes were impaired by infection. In contrast, activation of autophagy (with rapamycin or HBSS) overcame the M. bovis-induced blockade in phagosome maturation by increasing delivery of M. bovis to the lysosome, with a concurrent decrease in intracellular M. bovis replication. In conclusion, although M. bovis infection induced autophagy in bMEC, the autophagy flux was subsequently impaired by inhibiting autophagosome maturation. Therefore, we conclude that M. bovis subverted autophagy to promote its intracellular replication in bMEC. These findings are the impetus for future studies to further characterize interactions between M. bovis and mammalian host cells.

Patient's perspective and awareness of materials used in dentistry.

OBJECTIVE: To assess patients' knowledge and attitude towards different dental materials used in private and public dental facilities in an urban setting. METHODS: The cross-sectional study was conducted at the Islamabad Dental and Medical College, Islamabad, Pakistan, from February to July 2019, and comprised individuals at private dental clinics and teaching hospitals. Data was collected using a pre-validated structured questionnaire that recorded socio-demographic information as well as patients' perception on evidence-based dentistry using visual analogue, trust on the dentist, quality of materials and the source of information. Data was analysed using SPSS 21. RESULTS: Of the 269 participants, 151(56.1%) were females with a mean age of 33.87±12.63 years, and 118(43.9%) were males with a mean age of 33.28±13.71 years. Overall, 208(77.3%) respondents were in favour of using materials with long-term scientific data; 201(74.7%) recognised a difference in quality of materials used at private clinics and teaching hospitals; 128(63.7%) believed that poor quality materials were used in teaching hospitals; 229(85%) trusted their dentists for using high-quality materials; and 108(40%) identified dentists as the source of information. There was a significant relationship between patient's education level and realising the importance of using dental materials supported by scientific evidence (p≤0.01). CONCLUSIONS: Majority of subjects believed that poor quality materials were used in teaching hospitals compared to private dental facilities.

Identification of proteins responding to pathogen-infection in the red alga Pyropia yezoensis using iTRAQ quantitative proteomics.

BACKGROUND: Pyropia yezoensis is an important marine crop which, due to its high protein content, is widely used as a seafood in China. Unfortunately, red rot disease, caused by Pythium porphyrae, seriously damages P. yezoensis farms every year in China, Japan, and Korea. Proteomic methods are often used to study the interactions between hosts and pathogens. Therefore, an iTRAQ-based proteomic analysis was used to identify pathogen-responsive proteins following the artificial infection of P. yezoensis with P. porphyrae spores. RESULTS: A total of 762 differentially expressed proteins were identified, of which 378 were up-regulated and 384 were down-regulated following infection. A large amount of these proteins were involved in disease stress, carbohydrate metabolism, cell signaling, chaperone activity, photosynthesis, and energy metabolism, as annotated in the KEGG database. Overall, the data showed that P. yezoensis resists infection by inhibiting photosynthesis, and energy and carbohydrate metabolism pathways, as supported by changes in the expression levels of related proteins. The expression data are available via ProteomeXchange with the identifier PXD009363. CONCLUSIONS: The current data provide an overall summary of the red algae responses to pathogen infection. This study improves our understanding of infection resistance in P. yezoensis, and may help in increasing the breeding of P. porphyrae-infection tolerant macroalgae.

HSP70 binding protein 1 (HspBP1) suppresses HIV-1 replication by inhibiting NF-κB mediated activation of viral gene expression.

HIV-1 efficiently hijacks host cellular machinery and exploits a plethora of host-viral interactions for its successful survival. Identifying host factors that affect susceptibility or resistance to HIV-1 may offer a promising therapeutic strategy against HIV-1. Previously, we have reported that heat shock proteins, HSP40 and HSP70 reciprocally regulate HIV-1 gene-expression and replication. In the present study, we have identified HSP70 binding protein 1 (HspBP1) as a host-intrinsic inhibitor of HIV-1. HspBP1 level was found to be significantly down modulated during HIV-1 infection and virus production inversely co-related with HspBP1 expression. Our results further demonstrate that HspBP1 inhibits HIV-1 long terminal repeat (LTR) promoter activity. Gel shift and chromatin immunoprecipitation assays revealed that HspBP1 was recruited on HIV-1 LTR at NF-κB enhancer region (κB sites). The binding of HspBP1 to κB sites obliterates the binding of NF-κB hetero-dimer (p50/p65) to the same region, leading to repression in NF-κB mediated activation of LTR-driven gene-expression. HspBP1 also plays an inhibitory role in the reactivation of latently infected cells, corroborating its repressive effect on NF-κB pathway. Thus, our results clearly show that HspBP1 acts as an endogenous negative regulator of HIV-1 gene-expression and replication by suppressing NF-κB-mediated activation of viral transcription.

Measuring glutathione redox potential of HIV-1-infected macrophages.

Redox signaling plays a crucial role in the pathogenesis of human immunodeficiency virus type-1 (HIV-1). The majority of HIV redox research relies on measuring redox stress using invasive technologies, which are unreliable and do not provide information about the contributions of subcellular compartments. A major technological leap emerges from the development of genetically encoded redox-sensitive green fluorescent proteins (roGFPs), which provide sensitive and compartment-specific insights into redox homeostasis. Here, we exploited a roGFP-based specific bioprobe of glutathione redox potential (E(GSH); Grx1-roGFP2) and measured subcellular changes in E(GSH) during various phases of HIV-1 infection using U1 monocytic cells (latently infected U937 cells with HIV-1). We show that although U937 and U1 cells demonstrate significantly reduced cytosolic and mitochondrial E(GSH) (approximately -310 mV), active viral replication induces substantial oxidative stress (E(GSH) more than -240 mV). Furthermore, exposure to a physiologically relevant oxidant, hydrogen peroxide (H2O2), induces significant deviations in subcellular E(GSH) between U937 and U1, which distinctly modulates susceptibility to apoptosis. Using Grx1-roGFP2, we demonstrate that a marginal increase of about ∼25 mV in E(GSH) is sufficient to switch HIV-1 from latency to reactivation, raising the possibility of purging HIV-1 by redox modulators without triggering detrimental changes in cellular physiology. Importantly, we show that bioactive lipids synthesized by clinical drug-resistant isolates of Mycobacterium tuberculosis reactivate HIV-1 through modulation of intracellular E(GSH). Finally, the expression analysis of U1 and patient peripheral blood mononuclear cells demonstrated a major recalibration of cellular redox homeostatic pathways during persistence and active replication of HIV.

Apoptosis-induced activation of HIV-1 in latently infected cell lines.

BACKGROUND: Despite much work, safe and effective approaches to attack and deplete the long-lived reservoir of cells latently infected with HIV-1 remain an elusive goal. Patients infected with HIV-1 treated with cytotoxic agents or bone marrow transplantation can experience decreases in the reservoir of HIV-1 latently infected cells. Other viruses capable of long-term latency, such as herpesviruses, can sense host cell apoptosis and respond by initiating replication. These observations suggest that other viruses capable of long-term latency, like HIV-1, might also sense when its host cell is about to undergo apoptosis and respond by initiating replication. RESULTS: Pro-monocytic (U1) and lymphoid (ACH-2) HIV-1 persistently infected cell lines were treated with cytotoxic drugs - doxorubicin, etoposide, fludarabine phosphate, or vincristine - and activation of latent HIV-1 was evaluated using assays for HIV-1 RNA and p24 production. Both cell lines showed dose-dependent increases in apoptosis and associated HIV-1 activation following exposure to the cytotoxic agents. Pretreatment of the cells with the pan-caspase inhibitor Z-VAD-FMK prior to exposure to the cytotoxic agents inhibited apoptosis and viral activation. Direct exposure of the latently infected cell lines to activated caspases also induced viral replication. HIV-1 virions produced in association with host cell apoptosis were infectious. CONCLUSIONS: The results indicate that latent HIV-1 can sense when its host cell is undergoing apoptosis and responds by completing its replication cycle. The results may help explain why patients treated with cytotoxic regimens for bone marrow transplantation showed reductions in the reservoir of latently infected cells. The results also suggest that the mechanisms that HIV-1 uses to sense and respond to host cell apoptosis signals may represent helpful new targets for approaches to attack and deplete the long-lived reservoir of cells latently infected with HIV-1.

Targeting IκB proteins for HIV latency activation: the role of individual IκB and NF-κB proteins.

Latently infected cell reservoirs represent the main barrier to HIV eradication. Combination antiretroviral therapy (cART) effectively blocks viral replication but cannot purge latent provirus. One approach to HIV eradication could include cART to block new infections plus an agent to activate latent provirus. NF-κB activation induces HIV expression, ending latency. Before activation, IκB proteins sequester NF-κB dimers in the cytoplasm. Three canonical IκBs, IκBα, IκBß, and IκBε, exist, but the IκB proteins' role in HIV activation regulation is not fully understood. We studied the effects on HIV activation of targeting IκBs by single and pairwise small interfering RNA (siRNA) knockdown. After determining the relative abundance of the IκBs, the relative abundance of NF-κB subunits held by the IκBs, and the kinetics of IκB degradation and resynthesis following knockdown, we studied HIV activation by IκB knockdown, in comparison with those of known HIV activators, tumor necrosis factor alpha (TNF-α), tetradecanoyl phorbol acetate (TPA), and trichostatin A (TSA), in U1 monocytic and J-Lat 10.6 lymphocytic latently infected cells. We found that IκBα knockdown activated HIV in both U1 and J-Lat 10.6 cells, IκBß knockdown did not activate HIV, and, surprisingly, IκBε knockdown produced the most HIV activation, comparable to TSA activation. Our data show that HIV reactivation can be triggered by targeting two different IκB proteins and that IκBε may be an effective target for HIV latency reactivation in T-cell and macrophage lineages. IκBε knockdown may offer attractive therapeutic advantages for HIV activation because it is not essential for mammalian growth and development and because new siRNA delivery strategies may target siRNAs to HIV latently infected cells.

Vertical variations and environmental heterogeneity drove the symphony of periphytic protozoan fauna in marine ecosystems.

Periphytic protozoa are esteemed icons of microbial fauna, renowned for their sensitivity and role as robust bioindicators, pivotal for assessing ecosystem stress and anthropogenic impacts on water quality. Despite their significance, research exploring the community dynamics of protozoan fauna across diverse water columns and depths in shallow waters has been notably lacking. This is the first study that examines the symphony of protozoan fauna in different water columns at varying depths (1, 2, 3.5 and 5 m), in South China Sea. Our findings reveal that vertical changes and environmental heterogeneity plays pivotal role in shaping the protozoan community structure, with distinct preferences observed in spirotrichea and phyllopharyngea classes at specific depths. Briefly, diversity metrics (i.e., both alpha and beta) showed significantly steady patterns at 2 m and 3.5 m depths as well as high homogeneity in most of the indices was observed. Co-associations between environmental parameters and protozoan communities demonstrated temperature, dissolved oxygen, salinity, and pH, are significant drivers discriminating species richness and evenness across all water columns. Noteworthy variations of the other environmental parameters such as SiO3-Si, PO4--P, and NO2--N at 1 m and NO3--N, and NH4+-N, at greater depths, signal the crucial role of nutrient dynamics in shaping the protozoan communities. Moreover, highly sensitive species like Anteholosticha pulchara, Apokeronopsis crassa, and Aspidisca steini in varying environmental conditions among vertical columns may serve as eco- indicators of water quality. Collectively, this study contributes a thorough comprehension of the fine-scale structure and dynamics of protozoan fauna within marine ecosystems, providing insightful perspectives for ecological and water quality assessment in ever-changing marine environments.

Antioxidative Sirt1 and the Keap1-Nrf2 Signaling Pathway Impair Inflammation and Positively Regulate Autophagy in Murine Mammary Epithelial Cells or Mammary Glands Infected with Streptococcus uberis.

Streptococcus uberis mastitis in cattle infects mammary epithelial cells. Although oxidative responses often remove intracellular microbes, S. uberis survives, but the mechanisms are not well understood. Herein, we aimed to elucidate antioxidative mechanisms during pathogenesis of S. uberis after isolation from clinical bovine mastitis milk samples. S. uberis's in vitro pathomorphology, oxidative stress biological activities, transcription of antioxidative factors, inflammatory response cytokines, autophagosome and autophagy functions were evaluated, and in vivo S. uberis was injected into the fourth mammary gland nipple of each mouse to assess the infectiousness of S. uberis potential molecular mechanisms. The results showed that infection with S. uberis induced early oxidative stress and increased reactive oxygen species (ROS). However, over time, ROS concentrations decreased due to increased antioxidative activity, including total superoxide dismutase (T-SOD) and malondialdehyde (MDA) enzymes, plus transcription of antioxidative factors (Sirt1, Keap1, Nrf2, HO-1). Treatment with a ROS scavenger (N-acetyl cysteine, NAC) before infection with S. uberis reduced antioxidative responses and the inflammatory response, including the cytokines IL-6 and TNF-α, and the formation of the Atg5-LC3II/LC3I autophagosome. Synthesis of antioxidants determined autophagy functions, with Sirt1/Nrf2 activating autophagy in the presence of S. uberis. This study demonstrated the evasive mechanisms of S. uberis in mastitis, including suppressing inflammatory and ROS defenses by stimulating antioxidative pathways.

Effect of deep cervical flexor muscles training using pressure biofeedback on pain and disability of school teachers with neck pain.

[Purpose] The job of secondary school teachers involves a lot of head down posture as frequent reading, assignment correction, computer use and writing on a board put them at risk of developing occupational related neck pain. Available studies of neck pain experienced by teachers are limited. The purpose of this study was to determine whether training of deep cervical flexor muscles with pressure biofeedback has any significant advantage over conventional training for pain and disability experienced by school teachers with neck pain. [Subjects] Thirty teachers aged 25-45 years with neck pain and poor craniocervical flexion test participated in this study. [Methods] A pretest posttest experimental group design was used in which experimental group has received training with pressure biofeedback and conventional exercises while control group received conventional exercises only. Measurements of dependent variables were taken at baseline, and after 2 and 4 weeks of training. Pain intensity was assessed using a numeric pain rating scale and functional disability was assessed using the neck disability index. [Results] The data analysis revealed that there was significant improvement in pain and disability in both the groups and the results were better in the experimental group. [Conclusion] Addition of pressure biofeedback for deep cervical flexor muscles training gave a better result than conventional exercises alone. Feedback helps motor learning which is the set of processes associated with practice or experience leading to permanent changes in ability to respond.

Association Between Internet Use, Sleep, Cognition and Physical Activity Levels During COVID-19 Lockdown.

Purpose: The purpose of this study was to compare internet usage, sleep, cognition and physical activity in college professors and collegiate students during COVID-19 lockdown and to study the association of internet overuse with sleep quality, cognition and physical activity during the COVID-19 lockdown. Methods: A sample of 125 participants {professors (n = 52) and collegiate students (n = 73)} was recruited from Jamia Hamdard, New Delhi, India. Criteria for inclusion were college professors and collegiate students who uses internet. Both the groups were assessed for internet usage (Internet Addiction Test), sleep quality (Pittsburgh Sleep Quality Index), cognition (Cognitive Failure Questionnaire) and physical activity (Global Physical Activity Questionnaire) via google forms. Results: There was a significant difference for internet usage (p < 0.05), sleep quality (p = 0.032), cognition (distractibility, p = 0.019) and physical activity in college professors and collegiate students. It has been also reported that there was a significant association of internet usage with sleep quality and cognition and sleep quality with cognition. Conclusion: Students have more problematic internet usage, bad sleep quality, more cognitive failures and less physical activity than college professors during pandemic lockdown. It has been also observed that problematic internet usage has correlation with sleep quality, cognition and physical activity.

Effect of an Integrated Physiotherapy Protocol on Knee Osteoarthritis Patients: A Preliminary Study.

BACKGROUND: Exercise therapy can potentially relieve symptoms and improve functional status of the knee osteoarthritis population. Despite the proved practical benefits, there is no standard, comprehensive physiotherapeutic protocol available targeting the physical and physiological impairment cluster associated with disease. Osteoarthritis is a whole joint disease, affecting joint cartilage, ligaments, menisci and joint associated muscles, from variable pathophysiological processes. Hence, there is a need to develop a physiotherapy protocol to address the multi-structural physical, physiological and functional impairments associated with the disease. OBJECTIVE: The objective of the present study is to evaluate the efficacy of designed, therapist supervised, patient education, progressive resistance exercises, passive stretching exercises, soft tissue manipulation, muscle energy technique, Maitland mobilization, aerobic exercise, and neuromuscular training physiotherapy protocol on pain, disability, balance, and physical functional performance in knee osteoarthritis patients. METHODOLOGY: The preliminary study was conducted on a (n = 60) sample of convenience. The samples were randomly allocated into two study groups, intervention, and control group. The control group was advised on a basic home program. On the other hand, the treatment of the intervention group was designed with a therapist supervised Physiotherapy Protocol. The outcome variables studied were the Visual Analogue Scale, Modified WOMAC Scale, Timed Up and Go Test, Functional Reach Test, 40 m Fast Paced Walk Test, Stair Climb Test, 30 s Chair Stand Test. RESULTS: The results of the study revealed a significant improvement among most of the studied outcome measures in the intervention group, hence the designed supervised physiotherapy protocol was found effective in relieving multiple physiological impairments associated with this whole joint disease.

Cyclin K inhibits HIV-1 gene expression and replication by interfering with cyclin-dependent kinase 9 (CDK9)-cyclin T1 interaction in Nef-dependent manner.

Human immunodeficiency virus-1 (HIV-1) exploits a number of host cellular factors for successful survival and propagation. The viral protein Nef plays an important role in HIV-1 pathogenesis by interacting with various cellular proteins. In the present work, we identified Cyclin K (CycK) as a novel Nef-interacting protein, and for the first time, we showed that CycK inhibits HIV-1 gene expression and replication in a Nef-dependent manner. The positive elongation factor b complex comprising cyclin-dependent kinase 9 (CDK9) and Cyclin T1 is a critical cellular complex required for viral gene expression and replication. Enhanced expression of CycK in the presence of Nef induced CycK-CDK9 binding, which prevented CDK9-Cyclin T1 complex formation and nuclear translocation of CDK9, resulting in inhibition of HIV-1 long terminal repeat-driven gene expression. Furthermore, this effect of CycK was not observed with Nef-deleted virus, indicating the importance of Nef in this phenomenon. Finally, silencing of CycK in HIV-1-infected cells resulted in increased translocation of CDK9 into the nucleus, leading to increased viral gene expression and replication. These data also suggest that endogenous CycK might act as an inhibitory factor for HIV-1 gene expression and replication in T-cells. Thus, our results clearly demonstrate that CycK utilizes HIV-1 Nef protein to displace CycT1 from the positive elongation factor b complex, resulting in inhibition of HIV-1 gene expression and replication.

A New Clinical Sign In Meningitis-Jamil's Sign.

BACKGROUND: This study explored a new clinical sign in meningitis: neck stiffness in lateral position, also known as Jamil's sign. METHODS: A patient was placed in the left lateral position. The examiner held the patient's occiput with his left hand and the chin with his right hand. Then, the examiner performed a manoeuvre by fully extending and then fully flexing the neck. By doing so, the examiner was able to get ample time and range of movement to judge the tone. The tone was assessed during flexion and extension. If the examiner felt resistance, rigidity, or stiffness while performing this manoeuvre, Jamil's sign was present. Otherwise, it was supple, and Jamil's sign was absent. RESULTS: Of the 419 patients, Jamil's sign was present in 362 patients and absent in 57 patients. Upon lumbar puncture, 361 patients had meningitis, and 58 patients did not have meningitis. Among patients with meningitis, Jamil's sign was present in 357 patients and absent in four patients. Jamil's sign had a sensitivity of 98.89% and a specificity of 91.38. CONCLUSIONS: Due to its high sensitivity and specificity for the diagnosis of meningitis, Jamil's sign obviates the need for unnecessary lumbar puncture, which is performed in doubtful situations of neck stiffness in the supine position.

Influence of Tensioner's Mobilization on the Centralization of Symptoms in Cervicobrachial Pain Syndrome: A Randomized Controlled Trial.

STUDY DESIGN: This study was designed as a randomized controlled trial. PURPOSE: The present study aimed to determine the impact of neural mobilization by tensioner's technique (NMTT) on the centralization of symptoms and pain in patients with cervicobrachial pain syndrome (CBPS). OVERVIEW OF LITERATURE: CBPS is a disabling condition of the neck that is characterized by pain and paresthesia in the upper quarter. Several techniques have successfully provided immediate and long-term relief in CBPS; however, few studies have evaluated the effect of these techniques on the centralization of symptoms. METHODS: Thirty patients aged 18-45 years with a complaint of pain in the neck that had persisted for 2-12 weeks radiating to the arm and fulfilling Elvey's criteria were randomly selected and divided into two groups. Group A received NMTT plus conventional treatment (hot pack and postural advice with cervical lateral glide), and group B received only conventional treatment 3 times a week for 2 weeks. The outcome measures were Wernicke's scale score for the centralization of symptoms and Visual Analog Scale score for pain intensity. Within- and between-group comparisons were made before initiating treatment and at the end of the 3rd and 6th sessions. Within group analyses for the centralization values were performed using Friedmann test, and between-group analyses were performed using Mann-Whitney test. A 2×3 mixed model of the analysis of variance was used for analyzing the pain levels. RESULTS: There was a significant difference (p<0.05) within and between the groups for both the measures at the end of the 3rd and 6th sessions. Thus, NMTT may be beneficial in decreasing the peripheralization of symptoms and pain intensity in patients with CBPS. CONCLUSIONS: NMTT can be used as an alternative and effective treatment option for patients with CBPS.

Transoral Odontoidectomy - Our Experience in A Limited-Resource Setup.

BACKGROUND: Although posterior procedures are used for most cases of basilar invagination, transoral decompression is an important tool in complex deformities with severe degeneration and neural compression. METHODS: Consecutive patients who underwent transoral odontoidectomy for basilar invagination and atlantoaxial dislocation at the neurosurgical unit of Lady Reading Hospital Peshawar between June 2016 and January 2022 were retrospectively included. Preoperative and postoperative neurological, clinical, and radiological parameters were recorded and compared. RESULTS: Of the 33 patients included in this study, 22 were men and 11 were women. The mean age was 23.4 years ±8.4 years (mean ± standard deviation). The most common presenting symptoms were gait abnormalities and neck pain. A total of 28 patients were treated for the first time, while 5 patients had prior posterior fusion. The mean distance of the tip of the dens above the chamberlain line was 8.9 ± 4.2 mm, while the mean anterior atlantodental interval was 6.5 ± 2.1 mm. Seven patients had an anomalous course of vertebral artery on at least one side. A total of 28 patients improved significantly, while 5 patients did not improve at the follow-up. The mean follow-up was 8.5 months ±6.3 (mean ± standard deviation). The mean Nurick and Modified Japanese Orthopedic Association scores improved postoperatively (P < 0.05). Three patients underwent reoperation including one with vertebral artery injury. Three patients underwent tracheostomy. CONCLUSIONS: With proper patient selection, transoral odontoidectomy can be safely performed in a limited-resource setting.

Association of eccentric quadriceps torque with pain, physical function, and extension lag in women with grade ≤ II knee osteoarthritis: An observational study.

Knee osteoarthritis (OA) is a prevalent disabling disease among women and quadriceps weakness is attributed to one of the causes of knee pain (KP) and disability. The study aimed to test the correlation of eccentric quadriceps torque (EQT) with 2 subscales of the reduced WOMAC questionnaire (KP and physical function) and extension lag range of motion (ROM) at the knee joint in osteoarthritic women. A cross-sectional design was used. A total of 70 patients (mean age 41.1 years) who had grade I or II knee OA participated in the study. The pearson correlation coefficient was used to test the correlation between the EQT and 2 subscales of the reduced WOMAC questionnaire and extension lag ROM. EQT presented a significant moderate negative correlation with pain (r = -0.489, P < .001) and physical function (r = -0.425, P < .001), and low positive correlation with available ROM (R = 0.349, P < .001). KP, physical function, and extension lag in the early stages of knee OA in women are associated with EQT. Therefore, designing a rehabilitation program that has eccentric quadriceps strengthening exercises may improve KP and physical activities, but more randomized controlled trials are needed to verify this.