Antioxidant, carbonic anhydrase inhibition and diuretic activity of Leptadenia pyrotechnica Forssk. Decne.

Background: Leptadenia pyrotechnica Forssk. Decne is a member of family Apocynaceae and locally known as 'Khipp'. It is found in dry, sandy habitat of Pakistan and in several other regions around the world including Asia, Tropical Africa, Western Gulf and Mediterranean countries. It has nutritional value, containing 4 % lipids, 23 % proteins, 28 % carbohydrates, 4 % fibers, vitamin E and several minerals. Traditionally, this plant has been used by several communities for pain, different inflammatory and kidney disorders. Ethno-botanical studies have reported the use of L. pyrotechnica in nephrolithiasis, kidney disorders and induction of diuresis, which requires a detailed pharmacological study to validate the folkloric use of L. pyrotechnica as diuretic. Methods: The 70 % methanolic L. pyrotechnica (Lp.Cr) extract was prepared and qualitatively checked for the presence of various phytochemicals. Phenolic, flavonoid, tannin and saponin contents were quantified. GC-MS analysis of Lp.Cr was also performed. Antioxidant potential of Lp.Cr was evaluated by DPPH, ABTS and nitrite radical scavenging assays. CUPRAC and FRAP assay described the reducing potential of Lp.Cr. Diuretic activity was performed in both acute and prolonged models at different doses followed by the estimation of electrolytes, urea and creatinine levels. The mechanism of diuresis was described by pre-treatment with atropine, l-NAME, indomethacin and carbonic anhydrase inhibition. Results: Lp.Cr. indicated high phenolic and flavonoid contents which correlated with good antioxidant activity. GC-MS analysis showed the presence of 104 compounds from different phytochemical classes. Diuretic activity was performed at 10-300 mg/kg concentrations where the dose of 100 and 300 mg/kg showed good diuretic and saluretic activity comparable to furosemide. Lp.Cr exhibited diuresis both in acute and prolonged study protocols which can be attributed to carbonic anhydrase inhibition, effect on prostaglandins and cholinergic pathways. Conclusion: L. pyrotechnica contained several phytochemicals and exhibited good antioxidant activity. It induced diuresis and saluretic activity which was comparable to furosemide at higher doses. Diuretic activity can be attributed to carbonic anhydrase inhibition, prostaglandin synthesis and cholinergic pathways.

Amelioration of Rheumatoid Arthritis by Fragaria nubicola (Wild Strawberry) via Attenuation of Inflammatory Mediators in Sprague Dawley Rats.

Background and Objectives: Fragaria nubicola has never been evaluated scientifically for its anti-arthritic potential despite its use in folkloric systems of medicine. The research was conducted to assess the potential of F. nubicola against rheumatoid arthritis. Materials and Methods: The current study provided scientific evidence by evaluating the effects of plants using an in vivo CFA-induced model of arthritic rats and subsequent microscopic histopathological evaluation of ankle joints along with the determination of paw edema using a digital water displacement plethysmometer. The study also gave insight by determining levels of pro-inflammatory cytokines, matrix metalloproteinase enzymes (MMPs), prostaglandin E2 (PGE2), nuclear factor kappa B (NF-κB), vascular endothelial growth factor (VEGF), and biochemical and hematological parameters. GCMS analysis was also conducted for the identification of possible anti-inflammatory plant constituents. Results: The data showed that F. nubicola-treated groups attenuated the progression of arthritis and paw edema. Microscopic histopathological evaluation validated the anti-arthritic potential by showing amelioration of bone erosion, infiltration of inflammatory cells, and pannus formation. RT-PCR analysis displayed that treatment with F. nubicola down-regulated IL1ß, IL6, TNFα, NF-κB, VEGF, MMP2, MMP3, and MMP9 levels. Moreover, ELISA exhibited a reduction in levels of PGE2 levels in treatment groups. The levels of RBCs, platelets, WBCs, and Hb content were found to be nearly similar to negative control in the treated group. Statistically, a non-significant difference was found when all groups were compared for urea, creatinine, ALT, and AST analysis, indicating the safety of plant extract and fractions at test doses. GCMS analysis of extract and fractions showed the existence of many anti-inflammatory and antioxidant phytochemicals. Conclusion: In conclusion, F. nubicola possessed anti-arthritic properties that might be attributed to the amelioration of MMPs and pro-inflammatory cytokines.

Eichhornia crassipes Ameliorated Rheumatoid Arthritis by Modulating Inflammatory Cytokines and Metalloproteinase Enzymes in a Rat Model.

Background and Objectives: This study was planned to investigate the anti-arthritic property of flowers of E. crassipes in a Sprague-Dawley rat model by administering Freund's Complete Adjuvant (FCA). Materials and Methods: Arthritis was induced at day 0 in all rats except negative controls, while arthritic progress and paw edema were analyzed on specific days (8th, 13th, 18th, and 23rd) via the macroscopic arthritic scale and a digital Vernier caliper, respectively. Histopathological parameters were examined using a Hematoxylin and Eosin (H&E) staining method. Blood samples were withdrawn from rats to investigate the effects of the E. crassipes flower on the mRNA expression values of inflammatory markers, via a reverse transcription PCR technique. Serum samples were used to determine prostaglandin E2 (PGE2) levels using enzyme-linked immunosorbent assay (ELISA). Values of alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine, and urea, besides hematological parameters, i.e., the hemoglobin (Hb) content and complete blood count (CBC), were investigated. Results: The data showed that E. crassipes inhibited the arthritic progress and ameliorated the paw edema. The amelioration of parameters assessed via the histopathological analysis of ankle joints, as well as via hematological analysis, confirmed the diminution of rheumatoid arthritis (RA) in the plant-treated groups. Treatment with E. crassipes inhibited the expression levels of tumor necrosis factor-α (TNF-α), interleukins (IL-1ß and IL-6), nuclear factor KappaB (NF-κB), matrix metalloproteinase (MMP-2 and MMP-3), and vascular endothelial growth factor (VEGF). Serum PGE2 levels were also found to be reduced in treatment groups. A biochemical investigation revealed the improvements in hepatic markers in plant-treated groups. The data indicated that the plant has no hepatotoxic or nephrotoxic effects at the studied dose. GC-MS (Gas Chromatography-Mass Spectrometry) analysis displayed the presence of phytochemicals having known anti-inflammatory and antioxidant properties. Conclusions: Therefore, it may be concluded that E. crassipes possesses anti-arthritic characteristics that could be attributed to the modulation of pro-inflammatory cytokines, MMPs, and PGE2 levels.

Intrarater and interrater reliability of the dynamic gait index in post stroke patients with eye movement disorders.

BACKGROUND: The Dynamic Gait Index (DGI) is a useful tool that has been evaluated for its reliability in patients with vestibular disorders, elderly people and, in chronic stroke population. Present study was aimed to evaluate the intrarater and interrater reliability of the DGI to measure dynamic balance and gait performance in stroke patients with eye movement disorders. METHODS: A sample of 30 stroke patients suffering from eye movement disorders were recruited. Two Physical therapists assessed the intrarater and interrater reliability of the DGI in two testing sessions three days apart. In the later session, two raters assessed the patients' performance simultaneously on the DGI. The reliability was calculated using the intra-class correlation coefficient (ICC2, 1). Standard error of measurement (SEM) and minimal detectable change (MDC95) at 95% confidence interval were also calculated. A significance level was set at p-value <0.05. RESULTS: The (ICC2, 1) for intrarater and interrater reliability of total DGI scores was 0.86 and 0.91 respectively. While (ICC2, 1) for intrarater and interrater reliability of individual items ranged from 0.73 to 0.91 to 0.73-0.93, respectively. The (SEM) and (MDC95) for intrarater reliability of total DGI scores were 0.76 and 2.10, respectively. Corresponding values for interrater reliability were 0.62 and 1.71, respectively. CONCLUSIONS: The DGI is a reliable tool for evaluating the dynamic balance and gait performance in stroke patients with eye movement disorders. This tool showed good to excellent intrarater and interrater reliability of total DGI scores and moderate to good intrarater and interrater reliability of individual items of the DGI.

Effectiveness of ultrasound guided dry needling in management of jumper's knee: a randomized controlled trial.

Jumper's knee is highly prevalent condition in athletes. Very limited evidence is available on clinical effects of tendon dry needling. Therefore, the objective of this study is to compare the effects of ultrasound-guided dry needling (UG-DN) combined with conventional physical therapy and conventional physical therapy alone in patients with jumper's knee. A total of 96 patients with pre-diagnosed jumper's knee were randomly assigned to experimental group (UG-DN + CPT) and conventional group (CPT alone) with 48 participants each. Pain intensity and functional disability were recorded using visual Analogue Scale (VAS), Victorian Institute of Sports Assessment-Patellar Tendinopathy (VISA-P) questionnaire, Lysholm Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS) respectively at baseline, at 1st, 2nd, and 4th week. Whereas ultrasonographic features of patellar tendon were measured through musculoskeletal ultrasound (MSKUS) at baseline and 4th week. Total 8 sessions of treatment were provided. Mann Whitney U test and Friedman test were used to compute between and within group differences respectively. P value was significant at 0.05. Results showed that patients in both groups had improvement in signs of jumper's knee but the improvement in UG-DN + CPT group was more significant (p ≤ 0.05). Significant difference was seen after 4 weeks of intervention in UG-DN + CPT group in VAS (Median ± I.Q.R = 3 ± 1, p = 0.000), VISA-P (Median ± I.Q.R = 83.5 ± 7, p = 0.000), KOOS (Median ± I.Q.R = 83.5 ± 8, p = 0.000), , Lysholm (Median ± I.Q.R = 84 ± 5, p = 0.000) than CPT group VAS (Median ± I.Q.R = 1.5 ± 1, p = 0.000), VISA-P (Median ± I.Q.R = 92 ± 2, p = 0.000), KOOS (Median ± I.Q.R = 92 ± 3, p = 0.000), Lysholm (Median ± I.Q.R = 92 ± 4, p = 0.000) and ultrasonographic features of jumper's knee were more significant in experimental group(p-value ≤ 0.05). The Ultrasound guided dry needling with conventional physical therapy of patellar tendon had been found an effective treatment for jumper's knee and helps in reducing pain intensity, improving function and ultrasonographic features in patients with jumper's knee. UG-DN + CPT group showed more significant results as compared to CPT.Trial registration: (IRCT20210409050913N1). Dated: 17.04.2021.

Efficacy of ultrasound guided dry needling as an adjunct to conventional physical therapy for patients with jumper's knee: A randomized controlled trial.

Background: Jumper's knee is a degenerative condition among athletes, and it has been treated with conventional physical therapy (CPT). Ultrasound guided dry needling (USG-DN) is a relatively new technique to explore clinical outcomes in patients with tendinopathy. Methods: This parallel group, single-blinded randomized controlled trial was carried out involving 94 athletes with clinically diagnosed jumper's knee, divided into an intervention group (USG-DN + CPT, n = 47) and a control group (CPT, n = 47). Participants received a 4-week programme; the intervention group received ultrasound guided patellar tendon dry needling (DN) in conjunction with CPT. The control group received only CPT. The visual analog scale (VAS), Victorian institute of sports assessment-Patellar tendinopathy (VISA-P) questionnaire, Lysholm scale, Knee injury and osteoarthritis outcome score (KOOS) and ultrasonographic features of patellar tendinopathy were evaluated at baseline,1 week, 2 weeks, and 4 weeks. The data were analyzed through SPSS-26. Results: The study found statistically significant differences (P < 0.05) regarding VAS, Lysholm, VISA-P, and KOOS scales at baseline, 1st, 2nd, and 4th week post-intervention. Within-group differences also showed statistically significant results after the intervention. There were significant results observed in ultrasonographic outcomes between both groups at 1 month post-intervention (all P < 0.05). Conclusion: The results of the current study suggest, ultrasound guided DN of patellar tendon in combination with CPT reduced pain, improved function, and showed a tendency to decrease tendon thickness in patients with patellar tendinopathy. Clinical Trial Registration Number: (IRCT20210409050913N1). Dated: 17.04.2021. https://www.irct.ir/user/trial/55607/view.

Translation, cross-cultural adaptation, and psychometric properties of the Urdu version of Rand Short Form 36-item survey (SF-36) among patients with lumbar radiculopathy.

BACKGROUND AND AIMS: Although Rand Short Form 36-item (SF-36) questionnaire is a frequently used tool for evaluating a patient's quality of life in both clinical and research settings, but its translation into Urdu language and its psychometric properties has not been tested before, in accordance to the pre-established guidelines. This study aimed to translate and assess the psychometric properties of Urdu version of SF-36 (SF-36-U) in lumbar radiculopathy patients. METHODS: In this cross-sectional study, one hundred and eight patients of lumbar radiculopathy filled SF-36-U questionnaire, Urdu version of Oswestry Disability Index (ODI-U) and visual analogue scales for pain (VAS pain) at baseline and after 7 days. Two types of reliability i.e. internal consistency and test-retest reliability while three types of validity i.e. face, content, and construct validity were evaluated. Psychometric properties were assessed contrary to the a priori hypothesis and alpha level was kept at < 0.05. RESULTS: SF-36-U presented good to excellent test-retest reliability for all eight domains (ICC2,1 = 0.75-0.92). Internal consistency was also acceptable for all domains (Cronbach's alpha = 0.73-0.90). Face and content validity were found to be good. Pearson correlation revealed moderate to strong correlations of SF-36-U domains with ODI-U (r = 0.43-0.54), VAS pain (r = 0.32-0.49) and each of its own question (r = 0.37-0.88) which shows good construct validity. CONCLUSION: SF-36-U revealed acceptable psychometric properties and is considered as a reliable and valid questionnaire for assessing the health-related quality of life in Urdu-speaking patients having lumbar radiculopathy.

Effects of balance training with and without gaze stabilization exercises on clinical outcomes in elderly patients with chronic dizziness: A randomized controlled trial.

OBJECTIVE: To compare the effects of balance training with and without Gaze Stabilization exercises on clinical outcomes in elderly patient with chronic dizziness. METHOD: Total 64 participants after referral from neurologist at Lahore General Hospital were recruited in this study. These participants were randomly assigned into two groups i.e. Group A (Gaze group) and Group B (control group) with 32 participants in each group by sealed envelope method. Gaze group performed balance exercises with gaze stability exercise whereas, group B performed balance exercises with saccade eye exercises. Berg Balance Scale, Disability Handicapped Inventory, and Activity Specific Balance Confidence Scale were used to measure outcome variables. RESULTS: Demographic variables were represented by mean, standard deviation and frequency distribution. Results showed that there was no baseline difference between gaze and control group (p > 0.05). Both groups showed improved results with the gaze group showing significantly more improvement as compare to the control group on balance (p < 0.05, Mean Group A = 44.1, Mean group B = 40.91), perceived disability (p < 0.05, Mean Group A = 52.84, Group B = 56.09), and risk of fall (p < 0.05, Mean Group A = 53.84, Mean Group B = 50.72) respectively. CONCLUSION: This study concluded that gaze stability exercises with balance training are effective in improving balance, level of perceived disability, and risk of fall prevention among elderly patients with chronic dizziness.

Clinical application of low-level laser therapy (Photo-biomodulation therapy) in the management of breast cancer-related lymphedema: a systematic review.

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a frequent issue that arises after mastectomy surgery in women and compromises physical and mental function. Previously published studies have shown positive effects with the use of Low-level laser therapy in another term Photo-biomodulation therapy (PBM). This research investigated the efficacy of clinical use of LLLT (PBM) in the treatment of metastatic breast cancer-related lymphedema. METHODS: PubMed, PEDro, Medline, and the Cochrane Library were searched for LLLT clinical trials published before October 2021. The methodological quality of randomized trials and the effectiveness of Laser Therapy for BCRL were evaluated. The primary objectives were arm circumference or arm volume, whereas the secondary goals were to assess shoulder mobility and pain severity. RESULTS: Eight clinical trials were analyzed in total. Typically, the included RCTs had good research quality. At four weeks, there was a considerable reduction in arm circumference/volume, and this continued with long-term follow-up. However, no statistically significant change in shoulder mobility or pain severity was seen between the laser and placebo groups at 0-, 1-, 2-, and 3-month short-term follow-up. CONCLUSIONS: The findings of this comprehensive study demonstrated that LLLT (PBM) was successful in diminishing arm circumference and volume than improving shoulder mobility and pain. Data indicates that laser therapy (PBM) may be a beneficial treatment option for females with PML. Because of the scarcity of evidence, there is a strong need for well-conducted and longer-duration trials in this field. TRIAL REGISTRATION: Details of the protocol for this systematic review were registered on PROSPERO and can be accessed at www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42022315076 .

Effects of low-intensity pulsed ultrasound on pain and functional disability in patients with early-stage lumbar spondylolysis: A randomized controlled trial.

BACKGROUND: Low Intensity Pulsed Ultrasound (LIPUS) is beneficial in accelerating fracture recovery, enhancing their capacity to execute tasks of daily life and, as a result, their autonomy. OBJECTIVE: To compare the outcomes of routine physical therapy and routine physical therapy along with LIPUS in patients with early-stage lumbar spondylolysis. METHODS: Thirty-four (29 males and 5 females) patients exhibiting symptomatic low back pain for at least four weeks were recruited and randomly divided into control group (CG) and intervention group (IG) group. Randomization was done by using goldfish bowl method and allocation was done by using sealed envelope method. Parallel assignment was done. Numeric Pain Rating Scale (NPRS) was utilized for the measurement of pain and Oswestry Disability Index (ODI) for functional disability. Patients were assessed at baseline, at the end of 12th and 20th week. Interventions were applied by two physical therapists (one male and one female) having more than eight years of clinical experience for 10 weeks on alternate days. RESULTS: Intervention group reported significant percentage change of 47% at 12th week and 65% at 20th week for pain and 42% at 12th week and 81% at 20th week for functional disability compared with 40% at 12th week and 37% at 20th week for pain and 3% at 12th week and 25% at 20th week follow-up for functional disability from baseline in control group. CONCLUSION: Low-intensity pulsed ultrasound has significantly reduced pain and functional disability in patients with early-stage lumbar spondylolysis by using following parameters; 1.1-MHz oscillation frequency, 1-kHz pulsed frequency, 100-mW/cm2 spatial intensity, 2 ms pulse duration, 100Hz pulse repetition rate, 20% pulse duty cycle, and 20-min duration on alternate days.

An overview of microalgae biomass as a sustainable aquaculture feed ingredient: food security and circular economy.

Sustainable management of natural resources is critical to food security. The shrimp feed and fishery sector is expanding rapidly, necessitating the development of alternative sustainable components. Several factors necessitate the exploration of a new source of environmentally friendly and nutrient-rich fish feed ingredients. Microalgal biomass has the potential to support the growth of fish and shrimp aquaculture for global food security in the bio-economy. Algal biorefineries must valorize the whole crop to develop a viable microalgae-based economy. Microalgae have the potential to replace fish meal and fish oil in aquaculture and ensure sustainability standards. Microalgae biomasses provide essential amino acids, valuable triglycerides such as lipids, vitamins, and pigments, making them suitable as nutritional supplements in livestock feed formulations. Fish and microalgae have similar nutritional profiles, and digestibility is a critical aspect of the aquafeed formulation. A highly digestible feed reduces production costs, feed waste, and the risk of eutrophication. Due to low input costs, low carbon footprint, wastewater treatment benefits, and carbon credits from industrial CO2 conversion, microalgae-based fish and shrimp feeds have the potential to provide significant economic benefits. However, several challenges must be addressed before microalgal biomass and bioproducts may be used as fish feeds, including heavy metal bioaccumulation, poor algal biomass digestion, and antinutrient effects. Knowledge of biochemical composition is limited and diverse, and information on nutritional value is scattered or contradictory. This review article presents alternative approaches that could be used in aquaculture to make microalgal biomass a viable alternative to fish meal.

Effectiveness of Low-Level Laser Therapy in Patients with Discogenic Lumbar Radiculopathy: A Double-Blind Randomized Controlled Trial.

Purpose: To determine the effectiveness of low-level laser therapy (LLLT) in patients with discogenic lumbar radiculopathy and correlation among pain intensity, functional disability, and lumbar range of motion (LROM). Study Design/Setting. A double-blind RCT was conducted at physical therapy departments of different hospitals of Islamabad, Pakistan. The study period was March 2020 to August 2021. Patient Sample. The study comprised 110 patients with acute LBP and unilateral discogenic lumbar radiculopathy. Outcome Measures. The outcomes of the treatment were measured on the first day and then after 18 sessions from each patient's pain intensity, functional disability, L-ROM, and straight leg raise by using visual analogue scale, Oswestry disability index, dual inclinometer, and straight leg raise test. Methods: A total of 110 participants with a mean age of 38 ± 7.4 years were randomly assigned into two groups of 55 each. The experimental group of 55 patients was treated with LLLT and conventional physical therapy. The control group of 55 patients was treated with conventional physical therapy alone. Both groups had received 18 treatment sessions. The data were analyzed through SPSS-21.0. Results: The results of the Wilcoxon signed-rank test score as well as Mann-Whitney U test indicated a statistically significant difference in values (p < 0.05 in all instances) within the groups and between the groups, respectively. Conclusions: The LLLT is proved as an efficient adjunct therapy to conventional physical therapy for discogenic lumbar radiculopathy.

The combined effects of virtual reality with motor imagery techniques in patients with Parkinson's disease.

A 60-year-old man and a 63-year-old woman, diagnosed with Parkinson's disease received virtual reality (VR) and motor imagery (MI) with routine physical therapy (PT) treatment to improve balance, motor function and activities of daily living for a total of 60 minutes each session, three visits per week for 12 weeks and follow-up on week 16. This case report revealed 15 and 18 points improvement in motor function on Unified Parkinson's Disease Rating Scale part III (UPDRS) in male and female patients and in Activities of daily living on UPDRS-part II for 9 and 8 points for male and female patients respectively. The Berg Balance Score (BBS) score also improved with a clinically significant change of 9 and 11 points in male and female patients, respectively. The male and female patients reported a significant improvement in their balance, confidence on the Activities-specific balance confidence scale (ABC) scale as 14% and 16% were observed, respectively. VR in combination with MI in addition to routine Physical Therapy showed improvement in outcomes for the 2 patients presented in this case report.

Effects of dry needling in lower extremity myofascial trigger points.

OBJECTIVE: To explore the current evidences on effects of trigger point dry needling as a treatment strategy on pain and range of motion among subjects with lower extremity myofascial trigger areas. METHODS: The systematic review was conducted at the University Institute of Physical Therapy, Lahore, Pakistan, from February to August 2019, and comprised search of studies on Cochrane Library, PubMed, SPORTDiscus and PEDro databases published in the English language from 2000 to July 2019. The search terms used were 'Dry needling', 'Trigger points', 'Myofascial trigger points', 'Trigger area', 'Acupuncture therapy', 'Lower extremity' and 'Acupuncture'. Cochrane Risk of Bias tool was used to assess the randomised and non-randomised controlled trials. Methodological assessment was performed using Physiotherapy Evidence Database 10-point scale. Data synthesis was performed through vote counting method. RESULTS: Of the 564 articles initially found, 30(5.3%) were shortlisted for full-text assessment. Of them, 10(33.3%) were selected for final assessment; with 7(70%) scoring high and 3(30%) fair on the PEDro scale. All the 10(100%) studies documented improvement in the pain over time with dry needling strategy. None of the studies targeted any other outcome, like anxiety and sleep disturbances, related with myofascial trigger points. CONCLUSIONS: On basis of the best evidences available, dry needling seemed to be effective in pain reduction related to lower extremity myofascial trigger points. Evidence also suggested that there was not much positive effect of myofascial trigger point dry needling on depression, anxiety, muscular strength and quality of life.

Effect of whole-body vibration on obstacle clearance and stair negotiation time in chronic stroke patients; A randomized controlled trial.

OBJECTIVE: To assess the effect of Whole-Body Vibration (WBV) and Routine Physiotherapy (RP) on obstacle crossing and stair negotiation time in chronic stroke patients. METHODS: The current study was randomized, parallel-group, assessor-blinded, clinical trial conducted in Physiotherapy Department of Lahore General Hospital, involving 64 patients with chronic stroke. Patients were randomly allocated to 2 groups, i.e., the WBV group (n = 32) and the RP group (n = 32). The WBV group was given additional twelve sessions of vibration therapy (amplitude of 3 mm and frequency of 20 Hz), 6 days/week for 2 weeks. The outcome measures were change in score of height and depth of obstacles cleared, i.e., 6, 8, 10 & 12 inches height and 6, 8, 10 & 12 inches depth and stair negotiation time, i.e., Stair-Climb Test. Chi square test, Independent sample t-test and Paired sample t-test were used to analyze the data. RESULTS: Results show that higher number of patients improved in crossing the maximum height and maximum depth of obstacles in the WBV group but improvement was significant only in height, i.e., (p < 0.05). In the WBV group, Stair Negotiation Time decreased significantly as compared to the RP group, i.e., (p < 0.05). CONCLUSIONS: The present study concluded that both study groups, i.e., RP and WBV, improved despite better results for the latter. Speed of stair climbing and capacity to cross obstacles improved with the WBV therapy in chronic stroke survivors. TRIAL REGISTRATION: IRCT, IRCT20190328043131N1. Registered 03 august 2019 - Retrospectively registered, https://www.irct.ir/user/trial/38832/view.

Effects of mental imagery technique in addition to conventional physical therapy to improve hand functions in chronic stroke patients.

OBJECTIVE: To observe the effect of mental imagery and conventional physical therapy for the treatment of hand function in chronic stroke patients. METHODS: The study was conducted at Rana and Alvi welfare society. A sample of 50 stroke patients was selected and divided in two groups; group A (experimental) and group B (control). Inclusion and exclusion criteria were established and patients meeting inclusion criteria were included in the study. A p-value of <0.05 was considered significant. Group A was treated with conventional physical therapy combined with mental imagery whereas Group B was treated with conventional physical therapy alone. Wolf motor function test and action research arm test was used as outcome measures. RESULTS: Group A consisted of 17 (68%) females and 8 (32%) males and group B comprised of 11 (44%) females and 14 (56%) males. Mean age of group A and B were 59.68±2.37 and 58.52±2.46 years respectively. Mean duration (in months) of stroke for group A was 16.32±3.77 (minimum and maximum duration 13 and 23 months respectively). The stroke mean duration of group B was 16.00±2.34 (minimum and maximum duration 13 and 20 months respectively). Both groups did not show significant difference at 5th week (p=0.721) whereas a significant difference was observed at 10th week (p<0.001). CONCLUSIONS: It was concluded that mental imagery technique in combination with conventional physical therapy is significantly effective to improve hand function among chronic stroke patients in comparison to conventional physical therapy alone.

A Narrative Review on the Phytochemistry, Pharmacology and Therapeutic Potentials of Clinacanthus nutans (Burm. f.) Lindau Leaves as an Alternative Source of Future Medicine.

The application of natural products and supplements has expanded tremendously over the past few decades. Clinacanthus nutans (C. nutans), which is affiliated to the Acanthaceae family, has recently caught the interest of researchers from the countries of subtropical Asia due to its medicinal uses in alternative treatment for skin infection conditions due to insect bites, microorganism infections and cancer, as well as for health well-being. A number of bioactive compounds from this plant's extract, namely phenolic compounds, sulphur containing compounds, sulphur containing glycosides compounds, terpens-tripenoids, terpens-phytosterols and chlorophyll-related compounds possess high antioxidant activities. This literature search yielded about one hundred articles which were then further documented, including the valuable data and findings obtained from all accessible electronic searches and library databases. The promising pharmacological activities from C. nutans leaves extract, including antioxidant, anti-cancer, anti-viral, anti-bacterial, anti-fungal, anti-venom, analgesic and anti-nociceptive properties were meticulously dissected. Moreover, the authors also discuss a few of the pharmacological aspect of C. nutans leaves extracts against anti-hyperlipidemia, vasorelaxation and renoprotective activities, which are seldom available from the previously discussed review papers. From the aspect of toxicological studies, controversial findings have been reported in both in-vitro and in-vivo experiments. Thus, further investigations on their phytochemical compounds and their mode of action showing pharmacological activities are required to fully grasp both traditional usage and their suitability for future drugs development. Data related to therapeutic activity and the constituents of C. nutans leaves were searched by using the search engines Google scholar, PubMed, Scopus and Science Direct, and accepting literature reported between 2010 to present. On the whole, this review paper compiles all the available contemporary data from this subtropical herb on its phytochemistry and pharmacological activities with a view towards garnering further interest in exploring its use in cardiovascular and renal diseases.

Comparative effectiveness of routine physical therapy with and without instrument assisted soft tissue mobilization in patients with neck pain due to upper crossed syndrome.

OBJECTIVES: To determine the effectiveness of routine physical therapy with and without instrument-assisted soft tissue mobilisation on pain intensity and range of motion in patients with neck pain due to upper crossed syndrome. METHODS: The randomised controlled trial was conducted from January to March 2020, and comprised diagnosed male patients aged 18-40 years of upper crossed syndrome complaining of neck pain visiting the Agile Physical Therapy and Rehabilitation Complex and the National Orthopaedic Hospital, Bahawalpur, Pakistan. The subjects were randomised into control group A which received routine physical therapy and experimental group B which received instrument-assisted soft tissue mobilization along with routine physical therapy. The inclinometer was used to measure range of motion and the numeric pain rating scale for pain measurement. Data was analysed using SPSS 22. RESULTS: Of the 60 subjects, there were 30(50%) in group A with a mean age of 31.50±6.388 years and 30(50%) in group B with a mean age of 32.60±5.55 years. Pain rating at baseline in group B compared to group A show significant difference (p=0.01). Neck range of motion, including flexion, neck right bending, and neck left bending showed significant differences between the groups (p<0.05). The results for neck extension showed that both techniques were equally effective (p>0.05). CONCLUSIONS: Instrument-assisted soft tissue mobilisation with combination of stretching exercises was found to be more effective in the management of neck pain in upper crossed syndrome compared to routine physical therapy. REGISTRATION NUMBER: IRCT20190912044754N1.

Phytomedicine-Based Potent Antioxidant, Fisetin Protects CNS-Insult LPS-Induced Oxidative Stress-Mediated Neurodegeneration and Memory Impairment.

Phytomedicine based natural flavonoids have potent antioxidant, anti-inflammatory, and neuroprotective activities against neurodegenerative diseases. The aim of the present study is to investigate the potent neuroprotective and antioxidant potential effects of fisetin (natural flavonoid) against central nervous system (CNS)-insult, lipopolysaccharide (LPS)-induced reactive oxygen species (ROS), neuroinflammation, neurodegeneration, and synaptic/memory deficits in adult mice. The mice were injected intraperitoneally (i.p.) with LPS (250 µg/kg/day for 1 week) and a fisetin dosage regimen (20 mg/kg/day i.p. for 2 weeks, 1 week pre-treated to LPS and 1 week co-treated with LPS). Behavioral tests, and biochemical and immunofluorescence assays were applied. Our results revealed that fisetin markedly abrogated the LPS-induced elevated ROS/oxidative stress and activated phosphorylated c-JUN N-terminal Kinase (p-JNK) in the adult mouse hippocampus. Fisetin significantly alleviated LPS-induced activated gliosis. Moreover, fisetin treatment inhibited LPS-induced activation of the inflammatory Toll-like Receptors (TLR4)/cluster of differentiation 14 (CD14)/phospho-nuclear factor kappa (NF-κB) signaling and attenuated other inflammatory mediators (tumor necrosis factor-α (TNF-α), interleukin-1 ß (IL1-ß), and cyclooxygenase (COX-2). Furthermore, immunoblotting and immunohistochemical results revealed that fisetin significantly reversed LPS-induced apoptotic neurodegeneration. Fisetin improved the hippocampal-dependent synaptic and memory functions in LPS-treated adult mice. In summary, our results strongly recommend that fisetin, a natural potent antioxidant, and neuroprotective phytomedicine, represents a promising, valuable, and therapeutic candidate for the prevention and treatment of neurodegenerative diseases.

Greener synthesis of zinc oxide nanoparticles using Trianthema portulacastrum extract and evaluation of its photocatalytic and biological applications.

Synthesis of nanoparticles (NPs) through "green" chemistry is an exciting area of research with wide applications. Trianthema portulacastrum's extract containing greater amount of reducing agents has been explored first time for the synthesis of ZnO-NPs that characterized with UV/Vis, XRD, FT-IR, SEM,EDX, HR-TEM and XPS. The particles of ZnO-NPs are crystalline and having the size in the range of 25-90 nm. The cell viability of ZnO-NPs was studied using Mouse pre-osteoblast cell line MC3T3-E1 sub-clone 14 cells which confirmed its biocompatibility that render for biomedical applications. The antibacterial properties were evaluated against Staphylococcus aureus and Escherichia coli which showed high potency of synthesized ZnO-NPs against these species. The antifungal activities of ZnO-NPs were screened against Aspergillus niger, Aspergillus flavus, Aspergillus fumigatus of fungal species. The antioxidant activity of the as-synthesized NPs was also studied using DPPH (2, 2-diphenyl-1-picrylhydrazyl) substrate. The ZnO-NPs were evaluated for catalytic activity through degradation of Synozol Navy Blue-KBF textile dye using solar irradiation that causes 91% degradation of the dye in 159 min. Mechanistic pathways for the degradation of Synozol Navy Blue-KBF dye using ZnO-NPs were also proposed from the pattern of the degradation of the dye and the resulting by-products. The results concluded that the ZnO-NPs synthesized by green method have high biological and photocatalytic applications.