Trunk-oriented Exercises Versus Whole-body Vibration on Abdominal Thickness and Balance in Children with Duchene Muscular Dystrophy.

OBJECTIVES: Progressive proximal muscle weakening in children with Duchenne muscular dystrophy (DMD) impairs postural adjustments by impairing motor function and preventing ambulation. During daily activities, for gait and dynamic balance, certain postural modifications are required. The objective was to compare the impact of trunk-oriented exercises versus whole-body vibration on abdominal muscle thickness and balance in children with DMD. METHODS: Participants in this study were 30 boys with DMD, aged 6 to 10 years old. Children were divided into two groups (A and B) randomly. Children in group (A) underwent a prescribed regimen of physical therapy along with trunk-oriented exercises, whereas group (B) received the same regimen as group (A) together with whole-body vibration three times per week for three consecutive months. Balance and the thickness of the abdominal muscles were measured using the Biodex balance system and ultrasonography, respectively, before and after therapy. RESULTS: When compared to the pre-treatment results in both groups, the post-treatment results showed a significant difference in all measured variables (p<0.05). Post-treatment values showed that all of the measured variables significantly differed in favor of group A. CONCLUSIONS: Trunk-oriented exercises can improve abdominal thickness and balance more effectively than whole-body vibration in children with DMD. CLINICALTRIALS: gov ID: NCT05688072.

High-intensity versus low-level laser in musculoskeletal disorders.

PURPOSE: To evaluate the current evidence comparing low level to high level laser therapy to reveal any superiorities in the treatment of musculoskeletal disorders. METHODS: Five databases were searched till September 2022 to obtain relevant RCTs comparing high intensity and low-level laser therapies in the management of musculoskeletal disorders. Two authors assessed the methodological quality of the included studies using the Physiotherapy Evidence Database scale and meta-analysis was conducted for studies that showed homogeneity. RESULTS: Twelve articles were included in this systematic review with a total population of 704 participants across various musculoskeletal pathologies including tennis elbow, carpal tunnel syndrome, chronic non-specific low back pain, knee arthritis, plantar fasciitis, and subacromial impingement. There were no statistical differences between the two interventions in pain, electrophysiological parameters, level of disability, quality of life, postural sway or pressure algometer, however, Low level laser therapy showed superiority in increasing grip strength compared to high intensity laser therapy while results were significant in favour of high intensity laser therapy regarding long head of biceps diameter and cross sectional area, supraspinatus thickness and echogenicity and acromio-humeral distance. CONCLUSION: The current literature suggests no superiority of both types of laser therapy in musculoskeletal disorders, however, more RCTs with larger sample size are required to reach a definitive conclusion regarding the superiority of either form of laser therapy in musculoskeletal disorders.

Utility of diffusion tensor imaging in differentiating benign from malignant hepatic focal lesions.

OBJECTIVES: To assess the diagnostic accuracy of diffusion tensor imaging (DTI) in the characterization of hepatic focal lesions (HFLs) and compare it to diffusion-weighted imaging (DWI). METHODS: Prospective analysis was done for 49 patients (23 male and 26 female) with 74 HFLs who underwent dynamic MRI, DWI, and DTI. Apparent diffusion coefficient (ADC) values from DWI, fractional anisotropy (FA) values, and mean diffusivity (MD) values from DTI were measured by two independent radiologists. HFLs were classified into benign and malignant HFLs; the latter were subdivided into HCC and non-HCC lesions. Binary logistic regression was performed to analyze the associations between the DTI parameters and the distinction of malignant lesions. RESULTS: The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10-3 mm2/s, ≤ 1.71 × 10-3 mm2/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. The mean ADC and MD values of hemangiomas were significantly higher than HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs. The ADC and MD were very good discriminators at cutoff values of > 1.03 × 10-3 mm2/s and > 1.12 × 10-3 mm2/s, respectively. The FA at a cutoff value > 0.38 is an excellent discriminator for HCC versus non-HCC malignant lesions. Only FA value > 0.38 was a statistically significant independent predictor of HCC versus non-HCC lesions among the three parameters. There was an excellent inter-observer agreement with ICC > 0.9. CONCLUSION: MD and FA of DTI are non-invasive, very good, and excellent discriminators superior to ADC measured by DWI for the differentiation of HFLs. KEY POINTS: • The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10-3 mm2/s, ≤ 1.71 × 10-3 mm2/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. • The mean ADC and MD values of hemangiomas were significantly higher than those of HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs, respectively. • Multivariate regression analysis revealed that only FA value > 0.38 was a statistically significant independent predictor of HCC vs. non-HCC lesions. A lesion with FA > 0.38 has 34 times higher odds of being HCC rather than non-HCC lesions.

Clinical and Ultrasonographic Characteristics of the Achilles Tendon in Hemodialysis Patients.

Background and Objectives: The early recognition of tendon alterations in chronic hemodialysis (HD) patients, an awareness of the factors that influence the condition, and active intervention have considerable clinical relevance. The aim of this study was to investigate the musculoskeletal ultrasound (MSUS) features of the Achilles tendon in chronic HD patients and determine the factors associated with tendon abnormalities. Materials and Methods: This study was conducted on 46 HD patients and 24 sex- and age-matched controls. All participants were evaluated clinically for any signs of Achilles tendon abnormalities. Then, the Achilles tendon was scanned bilaterally using MSUS. Results: Among the 92 Achilles tendons in the HD patients, there was tenderness and swelling of only two (2.2%). Regarding MSUS features, there were statistically significant higher thicknesses in the proximal end (p < 0.001), midpoint (p < 0.001), and distal end (p < 0.001) of the Achilles tendons in the HD patients when compared with the healthy controls. Tendinosis was found in 12 (13%) of the HD patients' Achilles tendons, which was statistically significant in comparison to the healthy controls (p = 0.008). There were statistically significant higher scores of structural abnormalities (p = 0.005), bone erosions (p = 0.017), and calcifications (p = 0.015) in the HD patients when compared to the healthy controls. According to the results of a univariate regression analysis, age and male gender were predictive for US abnormalities in HD patients (p = 0.002 and 0.025, respectively). Conclusions: The Achilles tendon in subjects on chronic HD showed frequent US abnormalities. These abnormalities in HD patients appear to be more related to age and gender and may be asymptomatic.

Structure based design and synthesis of 3-(7-nitro-3-oxo-3,4-dihydroquinoxalin-2-yl)propanehydrazide derivatives as novel bacterial DNA-gyrase inhibitors: In-vitro, In-vivo, In-silico and SAR studies.

Antimicrobial resistance (AMR) is one of the critical challenges that have been encountered over the past years. On the other hand, bacterial DNA gyrase is regarded as one of the most outstanding biological targets that quinolones can extensively inhibit, improving AMR. Hence, a novel series of 3-(7-nitro-3-oxo-3,4-dihydroquinoxalin-2-yl)propanehydrazide derivatives (3-6j) were designed and synthesized employing the quinoxaline-2-one scaffold and relying on the pharmacophoric features experienced by the quinolone antibiotic; ciprofloxacin. The antibacterial activity of the synthesized compounds was assessed via in-vitro approaches using eight different Gram-positive and Gram-negative bacterial species. Most of the synthesized compounds revealed eligible antibacterial activities. In particular, compounds 6d and 6e displayed promising antibacterial activity among the investigated compounds. For example, compounds 6d and 6e displayed MIC values of 9.40 and 9.00 µM, respectively, regarding S. aureus, and 4.70 and 4.50 µM, respectively, regarding S. pneumonia in comparison to ciprofloxacin (12.07 µM). The cytotoxicity of compounds 6d and 6e were performed on normal human WI-38 cell lines with IC50 values of 288.69 and 227.64 µM, respectively assuring their safety and selectivity. Besides, DNA gyrase inhibition assay of compounds 6d and 6e was carried out in comparison to ciprofloxacin, and interestingly, compounds 6d and 6e disclosed promising IC50 values of 0.242 and 0.177 µM, respectively, whereas ciprofloxacin displayed an IC50 value of 0.768 µM, assuring the proposed mechanism of action for the afforded compounds. Consequently, compounds 6d and 6e were further assessed via in-vivo approaches by evaluating blood counts, liver and kidney functions, and histopathological examination. Both compounds were found to be safer on the liver and kidney than the reference ciprofloxacin. Moreover, in-silico molecular docking studies were established and revealed reasonable binding affinities for all afforded compounds, particularly compound 6d which exhibited a binding score of -7.51 kcal/mol, surpassing the reference ciprofloxacin (-7.29 kcal/mol) with better anticipated stability at the DNA gyrase binding pocket. Moreover, ADME studies were conducted, disclosing an eligible bioavailability score of >0.55 for all afforded compounds, and reasonable GIT absorption without passing the blood brain barrier was attained for most investigated compounds, ensuring their efficacy and safety. Lastly, a structure activity relationship study for the synthesized compounds was established and unveiled that not only the main pharmacophores required for DNA gyrase inhibition are enough for exerting promising antimicrobial activities, but also derivatization with diverse aryl/hetero aryl aldehydes is essential for their enhanced antimicrobial potential.

1,3,4-Oxadiazole-naphthalene hybrids as potential VEGFR-2 inhibitors: design, synthesis, antiproliferative activity, apoptotic effect, and in silico studies.

In the current work, some 1,3,4-oxadiazole-naphthalene hybrids were designed and synthesised as VEGFR-2 inhibitors. The synthesised compounds were evaluated in vitro for their antiproliferative activity against two human cancer cell lines namely, HepG-2 and MCF-7. Compounds that exhibited promising cytotoxicity (5, 8, 15, 16, 17, and 18) were further evaluated for their VEGFR-2 inhibitory activities. Compound 5 showed good antiproliferative activity against both cell lines and inhibitory effect on VEGFR-2. Besides, it induced apoptosis by 22.86% compared to 0.51% in the control (HepG2) cells. This apoptotic effect was supported by a 5.61-fold increase in the level of caspase-3 compared to the control cells. Moreover, it arrested the HepG2 cell growth mostly at the Pre-G1 phase. Several in silico studies were performed including docking, ADMET, and toxicity studies to predict binding mode against VEGFR-2 and to anticipate pharmacokinetic, drug-likeness, and toxicity of the synthesised compounds.

Ligand-based design and synthesis of N'-Benzylidene-3,4-dimethoxybenzohydrazide derivatives as potential antimicrobial agents; evaluation by in vitro, in vivo, and in silico approaches with SAR studies.

Herein, a series of N'-benzylidene-3,4-dimethoxybenzohydrazide derivatives were designed and synthesised to target the multidrug efflux pump (MATE). The antibacterial activities were screened against S. aureus, Acinetobacter, S. typhi, E. coli, and P. aeruginosa, whereas their antifungal activities were screened against C. albicans. Compounds 4a, 4h, and 4i showed the most promising antibacterial and antifungal activities. Moreover, compounds 4h and 4i being the broader and superior members regarding their antimicrobial effects were selected to be further evaluated via in vivo testing using biochemical analysis and liver/kidney histological examination. Additionally, molecular docking was carried out to attain further deep insights into the synthesised compounds' binding modes. Also, ADMET studies were performed to investigate the physicochemical/pharmacokinetics features and toxicity parameters of the synthesised derivatives. Finally, a structure-antimicrobial activity relationship study was established to facilitate further structural modifications in the future. HighlightsA series of new N'-benzylidene-3,4-dimethoxybenzohydrazide derivatives were designed and synthesised targeting the multidrug efflux pump (MATE) guided by the pharmacophoric features of the co-crystallized native inhibitor of the target protein.The newly synthesised compounds were assessed through in vitro, in vivo, and in silico approaches.Using the agar well diffusion assay, the antibacterial activities of the synthesised compounds were screened against S. aureus, Acinetobacter, S. typhi, E. coli, and P. aeruginosa, whereas, their antifungal activities were screened against C. albicans.The minimal inhibitory concentration (MIC) and the minimal bactericidal concentration (MBC) of the synthesised compounds were investigated on variable microbial species.Compounds (4h and 4i) -as the broader and superior members regarding their antimicrobial effects- were further evaluated via in vivo testing using bio-chemical analysis and liver/kidney histological examination.A molecular docking study and ADMET in silico studies were performed.A structure-antimicrobial activity relationship study was established to facilitate further structural modifications in the future.

Novel 6-hydroxyquinolinone derivatives: Design, synthesis, antimicrobial evaluation, in silico study and toxicity profiling.

Infectious diseases of bacteria and fungi have become a major risk to public health because of antibiotic and antifungal resistance. However, the availability of effective antibacterial and antifungal agents is becoming increasingly limited with growing resistance to existing drugs. In response to that, novel agents are critically needed to overcome such resistance. A new series of 6-hydroxyquinolinone 3, 4, 5a, 5b, 6a and 6b bearing different side chains were synthesized and evaluated as antimicrobials against numbers of bacteria and fungi, using inhibition zone technique. As one of these derivatives, compound 3 was identified as a potent antibacterial and antifungal agent against all tested microorganisms with good minimum inhibitory concentration values comparable to reference drugs. Molecular docking studies were performed on antibacterial and antifungal targets; microbial DNA gyrase B of Staphylococcus aureus (PDB ID: 4URO); N-myristoyltransferase of Candida albicans (PDB ID: 1IYK), respectively, to predict the most probable type of interaction at the active site of the target protein in addition to binding affinities and orientations of docked ligands. Additionally, in silico prediction in terms of detailed physicochemical ADME and toxicity profile relating drug-likeness as well as medicinal chemistry friendliness was performed to all synthesized compounds. The results indicated that a novel 4,6-dihydroxyquinolin-2(1H)-one (3) is likely to be a newly synthesized drug candidate, indicating low toxicity in addition to good in silico absorption. In order to pave the way for more logical production of such compounds, structure-activity and toxicity relationships are also discussed.

Pharmacophore-linked pyrazolo[3,4-d]pyrimidines as EGFR-TK inhibitors: Synthesis, anticancer evaluation, pharmacokinetics, and in silico mechanistic studies.

Targeting the epidermal growth factor receptors (EGFRs) with small inhibitor molecules has been validated as a potential therapeutic strategy in cancer therapy. Pyrazolo[3,4-d]pyrimidine is a versatile scaffold that has been exploited for developing potential anticancer agents. On the basis of fragment-based drug discovery, considering the essential pharmacophoric features of potent EGFR tyrosine kinase (TK) inhibitors, herein, we report the design and synthesis of new hybrid molecules of the pyrazolo[3,4-d]pyrimidine scaffold linked with diverse pharmacophoric fragments with reported anticancer potential. These fragments include hydrazone, indoline-2-one, phthalimide, thiourea, oxadiazole, pyrazole, and dihydropyrazole. The synthesized molecules were evaluated for their anticancer activity against the human breast cancer cell line, MCF-7. The obtained results revealed comparable antitumor activity with that of the reference drugs doxorubicin and toceranib. Docking studies were performed along with EGFR-TK and ADMET profiling studies. The results of the docking studies showed the ability of the designed compounds to interact with key residues of the EGFR-TK through a number of covalent and noncovalent interactions. The obtained activity of compound 25 (IC50 = 2.89 µM) suggested that it may serve as a lead for further optimization and drug development.

Transition to active learning in rural Nepal: an adaptable and scalable curriculum development model.

BACKGROUND: Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning. METHODS: The intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted. RESULTS: Lecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3-6, maintained at 31% through months 6-12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site. CONCLUSION: We demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.

Gastric Emptying and Small Bowel Water Content after Administration of Grapefruit Juice Compared to Water and Isocaloric Solutions of Glucose and Fructose: A Four-Way Crossover MRI Pilot Study in Healthy Subjects.

Grapefruit juice (GFJ) is known to affect the bioavailability of drugs in different ways. Despite the influence on gastrointestinal enzymes and transporters, the influence on gastrointestinal fluid kinetics is regarded to be relevant for the absorption of several drugs. Thus, it was the aim of this pilot study to investigate the gastric and intestinal volumes after intake of GFJ compared to isocaloric fructose and glucose solutions and water. The gastric and small intestinal volume kinetics after intake of 240 mL of GFJ, 10.6% fructose solution, 10.6% glucose solution, and water were investigated with magnetic resonance imaging in a four-way crossover study in six healthy human volunteers. The carbohydrate content of the administered beverages was quantified by high-performance liquid chromatography. Even with the small sample size of this pilot study, the gastric emptying of GFJ and the glucose solution was significantly slower than that of water. The fructose solution had only a slightly delayed gastric emptying. Small bowel water content was increased by administration of GFJ and fructose solution, whereas it was decreased by glucose compared to the administration of pure water. At 80 min the small bowel water content after GFJ was twice as high as the small bowel water content after administration of water. The observed influence of GFJ on gastrointestinal fluid kinetics may explain certain phenomena in drugs pharmacokinetics. The effect is double edged, as the slower gastric emptying and increased intestinal filling can lead to enhanced or altered absorption. Due to the comparability of fruit juices, a general effect of fruit juices on gastrointestinal volumes is likely.

Oropharyngeal Dysphagia and Diabetes Mellitus: Screening of 200 Type 1 and Type 2 Patients in Cairo, Egypt.

BACKGROUND: Although diabetes mellitus is a well-researched systemic endocrinal disease, literature is scarce addressing the co-occurrence of oropharyngeal dysphagia with diabetes. OBJECTIVE: The aim of this work was to screen Egyptian diabetic patients for symptoms suggestive of oropharyngeal dysphagia using the validated Arabic version of the Eating Assessment Tool (A-EAT-10). PARTICIPANTS AND METHODS: 200 Egyptian adult diabetic patients, aged from 18 to 59 years participated in the study. The inclusion criteria were being diabetic patients of type 1 or type 2. Patients were asked to complete the A-EAT-10 questionnaire. RESULTS: Age progression and being female were found to be risk factors for dysphagia among diabetic patients participating in this study. The most common symptom among diabetic patients who complained of dysphagia was "I cough when I eat." CONCLUSION: The present study suggests the presence of oropharyngeal swallowing problems among patients with diabetes mellitus.

Development and Standardization of a Test for Pragmatic Language Skills in Egyptian Arabic: The Egyptian Arabic Pragmatic Language Test (EAPLT).

OBJECTIVE: The aim of this study was to standardize an Egyptian Arabic Pragmatic Language Test (EAPLT) using linguistically and socially suitable questions and pictures in order to be able to address specific deficits in this language domain. PARTICIPANTS AND METHODS: Questions and pictures were designed for the EAPLT to assess 3 pragmatic language subsets: pragmatic skills, functions, and factors. Ten expert phoniatricians were asked to review the EAPLT and complete a questionnaire to assess the validity of the test items. The EAPLT was applied in 120 typically developing Arabic-speaking Egyptian children (64 females and 56 males) randomly selected by inclusion and exclusion criteria in the age range between 2 years, 1 month, 1 day and 9 years, 12 months, 31 days. Children's scores were used to calculate the means and standard deviations and the 5th and 95th percentiles to determine the age of the pragmatic skills acquisition. RESULTS: All experts have mostly agreed that the EAPLT gives a general idea about children's pragmatic language development. Test-retest reliability analysis proved the high reliability and internal consistency of the EAPLT subsets. A statistically significant correlation was found between the test subsets and age. CONCLUSION: The EAPLT is a valid and reliable Egyptian Arabic test that can be applied in order to detect a pragmatic language delay.

Videokymographic Visualization of Phonasthenia: A Nonorganic Voice Disorder.

BACKGROUND: Phonasthenia is a voice disorder where the larynx looks essentially normal and dysphonia is not heard but felt by the patient. This study aims to use videokymography (VKG) to detect any abnormalities in the vibratory pattern in phonasthenia and to find out whether or not these abnormalities change after vocal loading. METHODS: Thirty-seven phonasthenic patients and 31 normal subjects participated in a detailed protocol, including analysis of subjective complaints and videokymographic quasi-objective parameters (baseline) followed by loading their voices through prolonged loud reading for 45 min. A second evaluation (experimental) was done after loading. RESULTS: Before vocal loading, patients had significantly more symptoms in all questionnaire questions and higher maximum width difference in VKG than controls. When pre- and postloading values were compared, both groups experienced more symptoms after loading (significant in most of the questions), while the pre- and post-VKG parameters did not show significant differences neither in patients nor controls. On comparing their percent change, the only statistically significant difference between the 2 groups was a greater change in the total score of the questionnaire in the control group. CONCLUSION: Patients had more vocal fatigue symptoms and more amplitude asymmetry between left and right vocal folds than normal subjects.

MRI Surface-Based Brain Morphometry in Egyptian Autistic and Typically Developing Children.

OBJECTIVES: The verbal abilities of autistic children differ from those of typically developing ones and they also differ among autistic children themselves. Neuroanatomical changes and an abnormal organization of functional networks are expected to accompany such a neurodevelopmental disorder. The aim of this study was to delineate the brain neuroanatomical changes in Egyptian children with autism and to compare them with previous studies in order to add more insight into the global brain imaging deviations linked to autism. PATIENTS AND METHODS: Twenty-five autistic children and 25 typically developing children underwent MRI. Further analysis was performed using surface-based morphometry to obtain cortical thickness, brain volume, and cortical complexity. RESULTS: MRI analysis results revealed significantly greater cortical thickness, cortical complexity, and gray matter volume in the autistic as compared to the control group. On the other hand, the white matter volume was significantly smaller. CONCLUSION: These findings generally align with findings in previous studies, except for occasional differences.

Proprioceptive neuromuscular facilitation stretching exercises for treatment of temporomandibular dysfunction in patients with forward head posture: A double-blinded, randomized, controlled trial.

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) stretching exercises have been widely advocated for the management of patients with different musculoskeletal conditions. However, its effect on the treatment of temporomandibular dysfunction (TMD) in patients with forward head posture (FHP) has not been fully investigated. OBJECTIVE: To investigate the effect of PNF stretching exercises on the treatment of TMD in patients with FHP. METHODS: A prospective, randomized, double-blinded clinical trial. Twenty-four patients with TMD and FHP aged from 18-40 years were randomly assigned to PNF or control group. The PNF group composed of 12 patients received PNF stretching exercises of masticatory muscles in addition to routine physical therapy treatment (FHP correction exercises and ultrasound for the temporomandibular joint); the control group composed of 12 patients received routine physical therapy treatment only. Interventions were conducted twice a week for six weeks. Craniovertebral angle, pain threshold, pain intensity, temporomandibular joint ROM, and temporomandibular joint function were assessed for all participants before and after the intervention. The outcomes were analyzed using Two-way mixed MANOVA. For further multiple comparisons, post-hoc tests with the Bonferroni correction were performed. RESULTS: There was no significant difference between both groups pre-treatment (p> 0.05). Comparison between groups post-treatment revealed statistically significant differences in all outcome measures (p< 0.05) in favor of the PNF group. CONCLUSION: Adding PNF stretching exercises of masticatory muscles to routine physical therapy programs is an effective method for management of TMD in patients with FHP more than routine physical therapy programs alone.

Sensorimotor Training Improves Gait, Ankle Joint Proprioception, and Quality of Life in Patients With Diabetic Peripheral Neuropathy: A Single-Blinded Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of sensorimotor training on gait, ankle joint proprioception, and quality of life in diabetic peripheral neuropathy patients. DESIGN: A prospective, single-blind, randomized controlled experiment was performed. Forty patients with diabetic peripheral neuropathy aged 50-65 yrs were distributed randomly into two groups, the sensorimotor training group ( n = 20), and the control group ( n = 20). Both groups attended awareness sessions about diabetes and foot care for 30 mins, every 2 wks. Moreover, the sensorimotor training group received 6 wks (3 d/wk) of sensorimotor training. Spatiotemporal gait parameters, proprioception accuracy of the ankle joint, and quality of life were measured before and after 6 wks of intervention. RESULTS: Regarding baseline data, no significant differences were identified among groups ( P > 0.05). After 6-wk intervention, the sensorimotor training group exhibited significant improvements in all outcome variables ( P < 0.001), while the control group showed significant changes in quality of life only ( P = 0.03). Comparing groups after intervention reveals statistically significant differences in all measured variables in favor of the sensorimotor training group ( P < 0.001). CONCLUSIONS: Sensorimotor training may improve spatiotemporal gait parameters, ankle joint proprioception, and quality of life of patients with diabetic peripheral neuropathy.

The Efficacy of Whole-Body Vibration in Managing Postburn Victims' Complications: A Systematic Review.

Burn injury is a complicated traumatic event with both systemic and local consequences. These complications include long periods of bed rest, pain, muscle weakness, vitamin D deficiency, and bone mineral density loss. Whole-body vibration demonstrated effectiveness in improving muscle power and bone mineral density in various musculoskeletal populations. This systematic review of randomized controlled trials aims to assess evidence for the effectiveness of using whole-body vibration on postburn survivors with at least 1% total body surface area on sensory and motor outcomes. A systematic search was conducted across six databases, which are, PubMed, Cochrane, PEDro, Scopus, Web of Science, and Google Scholar, from inception till March 2022. Retrieved studies were screened by title and abstract and full-text in two stages using Rayyan web-based. Included studies were assessed for risk of bias using the Cochrane risk of bias tool ROB 2.0. Six randomized controlled trials with 203 participants were included. Five of the included studies demonstrated an overall high risk of bias. Compared to conventional physiotherapy programs, whole-body vibration demonstrated improvement in functional mobility and balance using timed up and go and Biodex balance assessment, respectively. However, there were no differences between whole-body vibration and conventional physiotherapy program alone in bone mineral density and muscle power. Although the current evidence of whole-body vibration is limited, whole-body vibration combined with traditional physical therapy programs may improve functional mobility and balance in postburn survivors compared to physical therapy programs alone.

Effectiveness of a high-intensity laser for improving hemiplegic shoulder dysfunction: a randomized controlled trial.

Hemiplegic shoulder pain (HSP) is a common complication that occurs after stroke and has been reported in up to 84% of hemiplegic patients. One of the recommended treatment options for shoulder pain is high-intensity laser therapy (HILT). This study aimed to determine the effectiveness of high-intensity laser therapy on pain, function and hand grip strength in patients with hemiplegic shoulder dysfunction. Forty-four hemiplegic patients were randomly divided into two groups: Group 1 (study group, n = 22) received 3 HILT sessions a week for three weeks in combination with three sessions of therapeutic exercise per week for three weeks, and Group 2 (control group, n = 22) received a conventional exercise program for HSP three times a week for three weeks. Shoulder pain was evaluated using the McGill pain questionnaire (MPQ), the functional outcome of the shoulder was evaluated with the University of California-Los Angeles functional scale (UCLA), and handgrip strength was evaluated with a hydraulic hand dynamometer. The increase in the UCLA scores and the decrease in the MPQ scores after treatment were significant in the study group (p < 0.001) as well as in the control group (p < 0.05) in comparison with the pretreatment between-group comparison. Additionally, the increase in hand grip strength was significant in both groups after treatment (p < 0.001). The study group showed significant improvement over the control group with respect to the UCLA score, handgrip strength, and MPQ score (p < 0.001). HILT combined with therapeutic exercise provides greater improvement than therapeutic exercise alone in terms of hemiplegic shoulder pain, dysfunction, and handgrip strength.