Fabrication and evaluation of anticancer potential of diosgenin incorporated chitosan-silver nanoparticles; in vitro, in silico and in vivo studies.

The discovery of effective therapeutic approaches with minimum side effects and their tendency to completely eradicate the disease is the main challenge in the history of cancer treatment. Fenugreek (FGK) seeds are a rich source of phytochemicals, especially Diosgenin (DGN), which shows outstanding anticancer activities. In the present study, chitosan-silver nanoparticles (ChAgNPs) containing Diosgenin (DGN-ChAgNPs) were synthesized and evaluated for their anticancer activity against breast cancer cell line (MCF-7). For the physical characterization, the hydrodynamic diameter and zeta potential of DGN-ChAgNPs were determined to be 160.4 ± 12 nm and +37.19 ± 5.02 mV, respectively. Transmission electron microscopy (TEM) showed that nanoparticles shape was mostly round with smooth edges. Moreover, DGN was efficiently entrapped in nanoformulation with good entrapment efficacy (EE) of ~88 ± 4 %. The in vitro anti-proliferative activity of DGN-ChAgNPs was performed by sulforhodamine B (SRB) assay with promising inhibitory concentration of 6.902 ± 2.79 µg/mL. DAPI staining, comet assay and flow cytometry were performed to validate the anticancer potential of DGN-ChAgNPs both qualitatively and quantitatively. The percentage of survival rate and tumor reduction weight was evaluated in vivo in different groups of mice. Cisplatin was used as a standard anticancer drug. The DGN-ChAgNPs (12.5 mg/kg) treated group revealed higher percentage of survival rate and tumor reduction weight as compared to pure DGN treated group. These findings suggest that DGN-ChAgNPs could be developed as potential treatment therapy for breast cancer.

Silybum marianum: An Overview of its Phytochemistry and Pharmacological Activities with Emphasis on Potential Anticancer Properties.

Silybum marianum (SM) belongs to the family Asteraceae, which holds therapeutic significance in medicinal chemistry. Phytochemistry analysis revealed an abundance of active constituents, particularly silymarin, composed of polyphenols and flavonolignans. Silymarin is majorly found in leaves, seeds, and fruits and is comprised of seven flavonolignans. Silymarin derivatives, specifically silybin, were reported for their medicinal properties. This review summarizes the studies conducted to evaluate SM's pharmacological properties and proposed mechanisms. SM exhibited anticancer properties due to being capable of modifying the induction of apoptosis, inhibiting the STAT3 pathway, decreasing the transcription of various growth factors, impeding the growth of 4T1 cells and inducing cell cycle arrest in various types of cancers, i.e., skin cancer, liver cancer, breast cancer, ovarian cancer etc. Silymarin and its derivatives protect the liver and ameliorate various immune-mediated and autoimmune hepatic diseases. Moreover, antimicrobial, antidiabetic, cardioprotective, nephroprotective, and neuroprotective activities were also reported. Based on testified in vitro and in vivo studies, SM can serve as an alternative to cure various pathological ailments.

N-Arylacetamide derivatives of methyl 1,2-benzothiazine-3-carboxylate as potential drug candidates for urease inhibition.

Urease enzyme is an infectious factor that provokes the growth and colonization of virulence pathogenic bacteria in humans. To overcome the deleterious effects of bacterial infections, inhibition of urease enzyme is one of the promising approaches. The current study is designed to synthesize new 1,2-benzothiazine-N-arylacetamide derivatives 5(a-n) that can effectively provide a new drug candidate to avoid bacterial infections by urease inhibition. After structural elucidation by FT-IR, proton and carbon-13 NMR and mass spectroscopy, the synthesized compounds 5(a-n) were investigated to evaluate their inhibitory potential against urease enzyme. In vitro analysis against positive control of thiourea indicated that all the synthesized compounds have strong inhibitory strengths as compared to the reference drug. Compound 5k, being the most potent inhibitor, strongly inhibited the urease enzymes and revealed an IC50 value of 9.8 ± 0.023 µM when compared with the IC50 of thiourea (22.3 ± 0.031 µM)-a far more robust inhibitory potential. Docking studies of 5k within the urease active site revealed various significant interactions such as H-bond, π-alkyl with amino acid residues like Val744, Lys716, Ala16, Glu7452, Ala37 and Asp730.

Effect of early physical therapy interventions on post-operative ileus following abdominal hysterectomy.

This study was conducted to determine the effect of early physical therapy intervention on symptoms of post-operative ileus after abdominal hysterectomy. This randomised control trial was carried out at the Railway General Hospital, Rawalpindi, Pakistan, from February 2021 to July 2021. Participants were randomly allocated to experimental (n=21) and control (n=21) groups using sealed envelope method. The experimental group received an enhanced physiotherapy rehabilitation plan of care consisting of patient education, breathing exercises, early mobilisation, connective tissue manipulation, and transcutaneous electrical nerve stimulation, while the control group only performed ambulation. The intervention was carried out during the first three days after surgery. Subjective measures were used to determine post-operative ileus. The study results conclude that enhanced early post-operative rehabilitation programme following abdominal hysterectomy has the potential to improve symptoms of post-operative ileus.

The Role of Rehabilitation Services in the Optimal Management of Urinary Incontinence in Women.

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Deep Learning Assisted Automated Assessment of Thalassaemia from Haemoglobin Electrophoresis Images.

Haemoglobin (Hb) electrophoresis is a method of blood testing used to detect thalassaemia. However, the interpretation of the result of the electrophoresis test itself is a complex task. Expert haematologists, specifically in developing countries, are relatively few in number and are usually overburdened. To assist them with their workload, in this paper we present a novel method for the automated assessment of thalassaemia using Hb electrophoresis images. Moreover, in this study we compile a large Hb electrophoresis image dataset, consisting of 103 strips containing 524 electrophoresis images with a clear consensus on the quality of electrophoresis obtained from 824 subjects. The proposed methodology is split into two parts: (1) single-patient electrophoresis image segmentation by means of the lane extraction technique, and (2) binary classification (normal or abnormal) of the electrophoresis images using state-of-the-art deep convolutional neural networks (CNNs) and using the concept of transfer learning. Image processing techniques including filtering and morphological operations are applied for object detection and lane extraction to automatically separate the lanes and classify them using CNN models. Seven different CNN models (ResNet18, ResNet50, ResNet101, InceptionV3, DenseNet201, SqueezeNet and MobileNetV2) were investigated in this study. InceptionV3 outperformed the other CNNs in detecting thalassaemia using Hb electrophoresis images. The accuracy, precision, recall, f1-score, and specificity in the detection of thalassaemia obtained with the InceptionV3 model were 95.8%, 95.84%, 95.8%, 95.8% and 95.8%, respectively. MobileNetV2 demonstrated an accuracy, precision, recall, f1-score, and specificity of 95.72%, 95.73%, 95.72%, 95.7% and 95.72% respectively. Its performance was comparable with the best performing model, InceptionV3. Since it is a very shallow network, MobileNetV2 also provides the least latency in processing a single-patient image and it can be suitably used for mobile applications. The proposed approach, which has shown very high classification accuracy, will assist in the rapid and robust detection of thalassaemia using Hb electrophoresis images.

Recent advances in the pelvic floor assessment and rehabilitation of Women with Pelvic Floor Dysfunction.

Pelvic Floor Dysfunctions (PFDs) are a group of disorders characterized by inter-related symptoms of urology, gynaecology, colorectal or general pelvic pain. These mainly cause voiding or defecation disorders, pelvic organ prolapses, sexual dysfunctions and pelvic pain. PFDs adversely impact various domains of women's life including psychological, physical, social and sexual well-being. Pelvic Floor Rehabilitation (PFR) has been recommended as part of a multidisciplinary approach for evaluation and management of the multiple PFDs. The assessment of PFD has improved with utilization of new measurement tools and specific outcome measures for PFDs. PFR is a first-line treatment approach effective for PFDs. However, robust research is needed to test standardised assessment and physical therapy treatment protocols with long term efficacy. In this review, we discuss a range of PFDs, impairment-based classification, recent updates, and advances in the evaluation of PFDs, physical therapy tools and techniques for the treatment of PFDs.

Prevalence of Risk Factors of the Female Athlete Triad among Young Elite Athletes of Pakistan.

BACKGROUND: Female athletes who are not vigilant about their food choices and choose extraneous physical activities may head towards negative health effects. PURPOSE: The purpose was to determine the prevalence of risk factors that may lead to the Female Athlete Triad among young elite athletes in Pakistan. STUDY DESIGN & METHODS: A cross sectional questionnaire-based study was conducted in 2018 at Pakistan Sports Board to investigate the risk factors of The Female Athlete Triad among young elite athletes based in national training camps of major metropolitan cities. Trained and professional female elite athletes of age 18 - 25 years, able to comprehend questionnaire in English were included. Athletes completed the questionnaire including demographics, educational qualifications, Body Mass Index, sports participation, and playing hours. The Eating Aptitude Test-26 (EAT-26) and questionnaires on risks of amenorrhea and risks of low bone mineral density were completed. Individual prevalence of the risk factors of three components was assessed. The data were analyzed using SPSS-20 and descriptive statistics applied. RESULTS: A sample of 60 elite athletes, (23.57 + 2.37 years, BMI 21.97 +1.90) who participated in various sports were included. EAT-26 results indicated that 50% of athletes were at risk of an eating disorder. Disordered Eating behaviors in need of referral were identified in 83.3%. Risks for amenorrhea were identified in 15%, and concerning low Bone Mineral Density, no risks were identified, except the intake of caffeinated beverages in 51.7%. CONCLUSION: The prevalence of risk for disordered eating was found to be significant among female elite athletes of Pakistan, but risk of amenorrhea and low bone mineral density were not of major concern. LEVEL OF EVIDENCE: 3b.

Effects of high intensity aerobic training on symptomatology of primary dysmenorrhoea.

This study was conducted to determine the effects of high-intensity aerobic training on the symptomatology of primary dysmenorrhoea. The study was conducted at Shifa Tameer-e-Millat University, Islamabad, Pakistan, from February 2021 to July 2021. The participants were randomly allocated to two groups - experimental and control - with 21 participants in each group, using the sealed envelope method. Experimental group underwent a structured eight-week high-intensity aerobic training regimen on a treadmill (Intensity 80-90% of target heart rate). The participants in the control group were given low-intensity aerobic training (Intensity 40-60% of target heart rate). The severity of dysmenorrhoea symptoms was assessed using Menstrual Symptom Questionnaire. The study concluded that high-intensity aerobic training is effective in reducing the symptoms of primary dysmenorrhoea.

Effects of high-intensity multi-modal exercise training (HIT-MMEX) on bone mineral density and muscle performance in postmenopausal women. A Pilot randomized controlled trial.

Objectives: To determine the effects of high-intensity multimodal exercise training on bone mineral density and muscle performance in postmenopausal women. METHODS: The two-armed, parallel, pilot randomised controlled trial was conducted from November 2020 to July 2021 at Riphah Rehabilitation Centre, Rawalpindi, Pakistan, and comprised women aged 45-70 having been in the post-menopause phase for at least 3 years, with body mass index <30, community ambulant and willing to have exercise therapy. The subjects were randomised into two equal groups. The experimental group A received supervised high-intensity resistance, weight-bearing, balance and mobility training twice weekly for 8 months. The control group B received low-to-moderate intensity exercises. Femoral neck and lumbar spine bone mineral density (g/cm2) were taken through a dual-energy X-ray absorptiometry scan. Muscle performance was measured using 1 repetition maximum for leg and trunk extensors, and 30 sec sit to stand test. Data was analysed using SPSS 21. RESULTS: Of the 101 women screened, 28(27.7%) were enrolled; 14(50%) in group A having mean age 53.36±6.28 years, and 14(50%) in group B having mean age 51.71±4.82 years (p>0.05). Group A showed significantly more improvement than group B both with respect to lumbar spine bone mineral density and muscle performance (p<0.05). CONCLUSIONS: Supervised high-intensity multimodal exercise training protocol had a positive effect on lumbar spine bone mineral density and muscle performance in postmenopausal women. Clinical Trial Number: NCT04653350, Link https://clinicaltrials.gov/ct2/show/NCT04653350.

Comparison of mobilization with movement and Mulligan knee taping on Patellofemoral pain syndrome.

OBJECTIVE: To compare the effect of mobilisation with movement and Mulligan knee taping on anterior knee pain, hamstring flexibility and physical performance of the lower limb. METHODS: The randomised controlled trial was conducted from July to December, 2019, at the physical therapy department of Sahat Clinic, Rawalpindi, Pakistan, and comprise participants of both genders having patellofemoral pain who were randomised into mobilisation with movement group A and Mulligan knee taping group B. Both the groups were treated for 2 days per week for 2 consecutive weeks. Outcome was measured using the numeric pain rating scale, the Kujala pain rating scale, the active knee extension test and the time-up-and-go test. Assessments were taken at baseline, and at 2nd and 6th weeks post intervention. Data was analysed using SPSS 21. RESULTS: Of the 34 participants, there were 17(50%) in each of the two groups. Overall, there were 6(17.6%) males and 28(82.4%) females with a mean age of 31.17±7.22 years. Group A showed significant improvement (p<0.0001) in terms of pain, while group B had better hamstring flexibility (p<0.0001). Both the groups showed a significant difference (p<0.0001) for all outcome variables post-intervention. CONCLUSIONS: Mobilisation with movement was found to be more effective in the treatment of patellofemoral pain and associated knee functional performance.

Effects of thoracic spine manipulation on pressure pain sensitivity of rhomboid muscle active trigger points: A randomized controlled trial.

OBJECTIVE: To determine the effects of thoracic spine manipulation on pain pressure sensitivity of rhomboids muscles and thoracic spine mobility. METHODS: The randomised controlled trial was conducted at the Women Institute of Rehabilitation Sciences, Abbottabad, Pakistan, from July to December 2019, and comprised subjects aged 18-30 years having active trigger points in rhomboid muscle. The subjects were randomised into experimental group A and control group B. The eperimental group received thoracic manipulation along with conventional physical therapy, while the control group only received conventional physical therapy. The intervention lasted 2 sessions per week for 3 weeks. Pre- and post-intervention assessment was done with numeric pain rating scale, algometry, inclinometer and the neck disability index. Data was analysed using SPSS 20. RESULTS: Of the 60 subjects, there were 30(50%) in each of the two groups. There were 21(70%) females and 9(30%) males in group A with an overall mean age of 23.86±4.56 years. In group B, there were 18(60%) females and 12(40%) males, with an overall mean age of 23.93±3.96. There was significant improvement in terms of pain (p<0.01) and pain pressure sensitivity (p<0.05). All outcome measures showed significant intra-group differences (p<0.000). CONCLUSIONS: Upper thoracic spine manipulation was found to be more effective in treating interscapular pain and pain pressure threshold of trigger points in rhomboid muscles. CLINICAL TRIAL NUMBER: This trial was registered at www.ClinicalTrails.gov with registry number NCT04179214.

Effects of biodex balance training on symptomatic knee osteoarthritis in Rawalpindi: A randomized control trial.

OBJECTIVE: To determine the effect of Biodex training on lower limb functional performance, balance, pain and proprioception in symptomatic knee osteoarthritis patients. METHODS: The randomised controlled study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from February to June 2018, and comprised patients of both genders aged 35-65 years with bilateral knee osteoarthritis. The patients were randomised using sealed envelope method into two equal control and experimental groups. The former received traditional exercise programme, while the latter received balance training on Biodex and traditional exercise programme. Assessment was done at baseline and post-intervention, and the two values were compared both intra-group and inter-group. Data was analysed using SPSS 21. RESULTS: Of the 48 patients, there were 24(50%) in each of the two groups. Experimental group showed significant improvement in pain severity, overall stability and in terms of anteroposterior stability (p<0.05). There was significant improvement in both groups from the baseline (p<0.05). CONCLUSIONS: Biodex balance training was found to be more effective in improving functional performance, stability, proprioception and in decreasing sway and pain compared to the traditional exercise programme.

Effect of Pressure biofeedback training on deep cervical flexors endurance in patients with mechanical neck pain: A randomized controlled trial.

OBJECTIVE: To compare the effects of Cranio cervical flexion training with and without pressure biofeedback on deep cervical muscular endurance in patients with mechanical chronic neck pain. METHODS: A randomized control trial was conducted at Railway General Hospital Rawalpindi, from May to December 2019. It consisted of thirty participants with the age ranging from 25 to 40 years, and having chronic mechanical neck pain. The participants were randomly allocated into two groups Group-A received Craniocervical flexion training with pressure biofeedback and Group-B received Craniocervical flexion training without pressure biofeedback. The intervention was applied for four weeks (3 sessions per week). Assessments were taken at Pre, Post intervention and after six weeks of follow up. Data analysis was done using SPSS-21 version. RESULTS: The mean age of Group-A and Group-B was 29.40±3.08 and 31.33±4.95 respectively. Between-group analyses has shown statistically and clinically significant improvement in Group-A regarding deep neck muscles endurance (p<0.05). Whereas within group analysis of both groups A & B showed a statistical and clinically significant difference (p=0.00) for deep neck muscles endurance. CONCLUSIONS: Cranio-cervical flexion training with Pressure Biofeedback has proven to be more effective in improving endurance of deep cervical flexors in patients with mechanical neck pain.

The UN Incheon strategy Implementation and the Pakistani quagmire; ground realities.

The Economic and Social Commission for Asia and the Pacific is the regional developmental arm of the United Nations. There are over 650 million persons with disabilities living in the region. In 2012, member countries, including Pakistan, launched the new decade of persons with disabilities from 2013 to 2022, adopting the Incheon Strategy to 'Make the Right Real', based on the Put Convention on the rights of Persons with Disabilities" and aimed at accelerating the disability inclusive development with 10 measurable goals and targets. The year 2017 marked the mid-point of that decade at which point member countries were to submit the Government Members Report on the Implementation of Incheon Strategy. The ambiguity in usage of terms, variable definition of disability, and use of impairment screens in population census of Pakistan has resulted in flawed data and underreporting of persons with disabilities. Pakistan provided data on only 13 of the 30 core indicators as part of its midpoint review. There is lack of awareness among ministries regarding the Incheon Strategy implementation.

Comparison between dynamic oscillatory stretch technique and static stretching in reduced hamstring flexibility in healthy population: A single blind randomized control trial.

OBJECTIVE: To compare the effects of dynamic oscillatory stretch and static stretching techniques in order to improve hamstring extensibility in healthy individuals with asymptomatic hamstring tightness. METHODS: The single-blind randomised controlled trial was conducted from March to June 2018 at Sadiq Hospital, Sargodha Institute of Health Sciences, and District Headquarter Teaching Hospital,Sargodha, Pakistan, and comprised young healthy individuals with hamstring tightness who were randomly divided into groups 1 and 2, with the former getting exposure to oscillatory stretch technique and the latter to static stretching technique. Assessment of hamstring length was done using reliable clinical measurement test along with pain for stretch tolerance during passive straight leg raise using numeric pain rating scale. Measurements were taken at baseline, immediate (10min) and 1 hourpost-intervention. Data was analysed using SPSS 20. RESULTS: Of the 83 subjects, 42(%) were in group 1 with a mean age of 24.22±4.09 years, and 41(%) were in group 2 with a mean age of 25.85±6.09 years.Group1 showed significantly more improvement in all variables of hamstring flexibility and perceived pain at both post-intervention checkups compared to group 2 (p<0.05). CONCLUSION: Dynamic oscillatory stretch technique was found to be more effective in improving hamstring flexibility and perceived pain compared to static stretching technique.

Assessment of knowledge, attitude and practice of basic life support among physical therapy practitioners in Rawalpindi and Islamabad.

OBJECTIVE: To assess the level of knowledge, attitude and practice of basic life support among physical therapy practitioners. METHODS: The descriptive cross-sectional study was conducted at Riphah International University, Islamabad, Pakistan, from February to July 2018, and comprised data collected from physical therapy practitioners working at four public-sector hospitals in Rawalpindi and Islamabad. A 30-item structured questionnaire adapted from the American Heart Association was used. Data was analysed using SPSS 21. RESULTS: Of the 100 subjects, 65(65%) were females and 35(35%) were males. The overall mean age was 25.54±3.76 years. The mean score of BLS knowledge and practice was 7.27±1.79 and 3.77±1.65 respectively. of the total, 61(61%) had received prior basic life support training, and the difference in knowledge and practice scores between trained and untrained professionals was significant (p<0.05). Gender-based difference was significant (p=0.02). All (100%) participants showed positive attitude towards basic life support training. CONCLUSIONS: Physical therapy practitioners possessed average basic life support knowledge, but practising skills were lacking.

Comparison of Spencer muscle energy technique and Passive stretching in adhesive capsulitis: A single blind randomized control trial.

OBJECTIVE: To compare the effects of Spencer muscle energy technique and passive stretching in adhesive capsulitis. METHODS: The single-blind randomised control trial was conducted at the District Headquarter Hospital and Fatima Hospital, Sargodha, Pakistan, from February to May 2018, and comprised patients of either gender aged 30-55 years with idiopathic frozen shoulder stage 1 and 2 or stiff painful shoulder joint for at least 3 months. They were randomised into two equal groups using the sealed envelope method. Group 1 was exposed to muscle energy technique, while group 2 was exposed to passive stretching. Pain, shoulder range of motion and function were assessed by numeric pain rating scale, goniometer, shoulder pain and disability index and the quick version of the disabilities of the arm, shoulder and hand questionnaire. Measurements were taken at baseline, 2nd and 4th week. Data was analysed using SPSS 20. RESULTS: Of the 60 patients, there were 30(50%) in each of the two groups. There were 39(65%) females and 21(35%) males with an overall mean age of 45.84±5.88 years. All parameters significantly improved in group 1 compared to group 2 t post-intervention (p<0.001). CONCLUSIONS: Spencer technique was found to be more effective than passive stretching in treating patients with adhesive capsulitis.

Frequency of work related musculoskeletal disorders and ergonomic risk assessments among tailors.

OBJECTIVE: To determine the frequency of work-related musculoskeletal disorders and to assess postural ergonomic risk among tailors. METHODS: The cross-sectional study was conducted from September 2017 to February 2018 in Rawalpindi and Islamabad, Pakistan and comprised tailors of both genders aged 25-60 years, working for more than 6 months and having small and medium enterprises. To calculate ergonomic risk of work posture, Quick Exposure Check was used and work-related musculoskeletal disorders were determined through body mapping chart. Data was analysed using SPSS 20. RESULTS: Of the 400 tailors, 382(95.5%) were males. The overall mean age of the sample was 36.9±10.96 years. The mean Quick Exposure Check score was 46.11±14.83. Acceptable work posture was found in 373(93.25%) subjects. The most common work-related acute musculoskeletal symptoms were found in the upper back 320(80%). CONCLUSIONS: Most tailors had acceptable work posture but work-related pain in upper back was common.