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.

Correlation Analysis Between Pain Intensity, Functional Disability and Range of Motion Using Low-Level Laser Therapy in Patients With Discogenic Lumbar Radiculopathy: A Cross-sectional Study.

Introduction: Low-level laser is a pain-free and non-invasive treatment modality. It is used in many acute and chronic painful conditions. This study aimed to determine the correlation between pain intensity, functional disability, and range of motion using low-level laser therapy (LLLT) in patients with discogenic lumbar radiculopathy. Methods: This cross-sectional study was conducted as a part of a randomized controlled trial of LLLT to treat patients with discogenic lumbar radiculopathy in physical therapy departments of three different hospitals in Islamabad, Pakistan, from August 2021 to September 2021. The study was conducted according to STROBE guidelines. Fifty-Five patients from the experimental group of the trial were invited to participate in this study. The outcomes of the treatment were recorded on a semi-structured questionnaire on the first day and last day of their treatment from each patient's pain intensity, functional disability, and Lumbar range of motion (L-ROM) (flexion and extension) by using the visual analogue scale (VAS) for pain intensity, Oswestry Disability Index (ODI) for functional disability, and dual inclinometer for L-ROM. The data were analyzed through SPSS version 26.0. Results: The results of the correlation coefficient/Pearson's correlation of VAS, ODI, and dual inclinometer were varied. The strength of correlation between variables was weak to moderate (r=0.033 to 0.425) with statistically insignificant correlation coefficient (P > 0.05, 95% CI) except for lumbar flexion (P<0.05, 95% CI). Conclusion: For acute low back pain (LBP) with discogenic lumbar radiculopathy, LLLT at a wavelength of 830-nm and a dose of 3J/point in conjunction with conventional physical therapy had no significant correlation, but rather weak to moderate values with pain intensity, functional disability, and L-ROM.

Reliability of dual inclinometer for lumbar range of motion using two different Landmarking techniques.

Objective: To measure the intra-rater and inter-rater reliability of active lumbar extension and flexion movements using dual inclinometer with two different landmarking techniques. METHODS: The reliability study was conducted at the Physical Therapy Department of the University Teaching Hospital, The University of Lahore, Pakistan, in January 2020, and comprised patients of either gender aged >18 years with mild or symptomatic lower back pain, and healthy subjects s controls. Repeated measurements with dual inclinometer were taken by two examiners and data was recorded by two separate observers. A set of three active lumbar extension and flexion movements were performed for an initial warm-up. The examiners repeated a palpation of bony landmarks prior to each trial. The two different landmarking techniques were applied on the lumbar spine to identify the start and end points. Both the examiners measured each participant thrice. For each examiner and each landmarking technique, the three data sets were acquired for active lumbar extension and flexion for a total of 120 sets per session per examiner per landmarking. Each set comprised three alternating active lumbar extension and flexion movements. Data was analysed using SPSS version 26. RESULTS: Of the 40 subjects with mean age 27.8+11.0 years, 19(48%) were males and 21(52%) were females. There were 15(38%) cases; 6(40%) males and 9(60%) females. The remaining 25(62%) were controls. The two landmarking techniques with dual inclinometer produced a high to very high intra-rater reliability (intraclass correlation coefficient:0.73-0.91) for both lumbar extension and flexion movements with moderate to low standard error of measurement values (0.36-1.31), while a high inter-rater reliability (intraclass correlation coefficient: 0.72-0.76; standard error of measurement: 0.52-0.63) for extension measurements and only moderate inter-rater reliability (intraclass correlation coefficient: 0.59-0.65; standard error of measurement: 1.36-1.49) for flexion measurements. Conclusion: Dual inclinometer along with skilled examiners and accurate landmarking methodology provided clinically reliable measurements.

Variations in Mineral/heavy Metals Profiling and Preventive Role of Trichomes in Peach Fruits Treated with CaC2.

BACKGROUND: Phytonutrients in peach fruits have health-promoting antioxidants against various chronic diseases. However, there is no extensive data to show the nutritional values of Local peach cultivars after post-harvest treatments. OBJECTIVE: Mainly this study was objective to determine the effect of calcium carbide on nutritional value and quality of fruits of Pakistani peach cultivars. METHODS: The peach fruits were collected from three different peach orchids of KPK and the fruits were divided into 4 groups while 5th group was collected from a local fruit shop. Each experimental group was treated with different concentrations of calcium carbide whereas control group was not treated. The peel and pulp samples were oven dried and ground to fine powder separately. The elemental compositions were determined using Particle Induced X-ray emission and Pelletron Tandem Accelerator. RESULTS: Sixteen elements were identified in peach fruits and the elements were Al, P, S, Cl, K, Ca, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, and Se. In peel, the concentration of some elements increased or decreased after treatment with CaC2 while in pulp the conc. of nearly all detected elements was increased in treated samples. We found a significantly higher amount of heavy metals traces, including As, Se, Co, Si, and P in peach fruits treated with CaC2 Interestingly, the presence of trichomes in peach skin prevents the transfer of these heavy metals deep into the pulp which was also verified by the elemental profiling of nectarines. CONCLUSION: Conclusively, the artificial ripening with CaC2 changed the nutritional value of peach fruits that has higher health risks if consume with the peel. According to our best knowledge, this is the first report that highlights the effects of CaC2 which deteriorate the nutritional value of peach fruits in Pakistan.

Effectiveness of muscle energy technique as compared to Maitland mobilisation for the treatment of chronic sacroiliac joint dysfunction.

OBJECTIVE: To compare the effectiveness of Muscle Energy Technique (MET) with Maitland mobilisations when using lumbopelvic stability exercises as an adjunct therapy with them in reducing pain and disability in patients with sacroiliac joint dysfunction (SIJD). METHODOLOGY: A randomised controlled trial was conducted at physical therapy departments of Khyber Teaching Hospital, Lady Reading Hospital and Rehab Polyclinic, Peshawar, Pakistan and comprised of data over a to a six-month period from January 2015 to June 2015. Sixty participants (both male and female with an age range of 25-55 years) were randomly assigned to two equal groups of 30 (50%) each by chit-box method. Group-A of 30 patients (experimental group) was treated with Muscle Energy Technique (MET). Group-B of 30 patients (control group) was treated with Maitland Mobilizations at sacroiliac joint. Lumbopelvic stability exercises were given to both groups. The treatment outcomes were measured on the first day and then after 4 weeks (12 sessions) from each subject's pain and disability levels by using Visual Analogue Scale (VAS) for measuring pain and Modified Oswestry Disability Index (MODI) for measuring disability. RESULTS: The paired sample statistics for intra-group analysis of the VAS and MODI showed a significant difference in values i.e. for Group-A, VAS was 16.699 with p-value 0.000 and MODI was 29.125 with p-value 0.000 while for Group-B, VAS was 18.687 with p-value 0.001 and MODI was 28.607 with p-value 0.001. The independent samples test for inter-group analysis of pre-VAS and post-VAS were 0.662 with 0.510 p-value and 1.000 with 0.321 p-value respectively while of pre-MODI and post-MODI were -1.482 with 0.144 p-value and -0.114 with 0.909 p-value respectively This showed an insignificant difference in pain and disability outcomes between the groups. CONCLUSIONS: MET and Maitland mobilisations are both effective in treating the chronic sacroiliac joint dysfunction when using lumbopelvic stabilisation exercises as an adjunct therapy with them.

Reliability of musculoskeletal ultrasound imaging to measure supraspinatus tendon thickness in healthy subjects.

[Purpose] The purpose of this study was to assess intra-rater and inter-rater reliability of musculoskeletal ultrasound (MSKUS) as a tool to measure supraspinatus tendon thickness in healthy subjects. [Subjects and Methods] Twenty healthy subjects were assessed in similar sitting position. Two experienced musculoskeletal ultrasound specialists measured supraspinatus tendon thickness. Tendon was measured twice in one day by each of two raters with an interval of one hour for within day reliability and was re-measured following one week for between days reliability. Data analysis was performed using the intraclass correlation coefficient (ICC) and standard error of measurement (SEM). [Results] Results reflected excellent within day intra-rater and inter-rater reliability with Mean ± standard deviation (SD)=5.14 ± 0.83 and 5.17 ± 0.78, ICC (2,1)=0.89-0.93 and ICC (2,2)=0.98 (0.95-0.99) and SEM=0.18-0.18 and 0.17 while between days intra-rater rater and inter-rater reliability with Mean ± SD=5.14 ± 0.83 and 5.17 ± 0.78, ICC(2,1)=0.88-0.90 and ICC(2,2)=0.95 (0.88-0.98), SEM=0.17-0.38 and 0.17 [Conclusion] The results of the current study indicate that MSKUS is a reliable tool for measuring supraspinatus tendon thickness in healthy subjects.

Assessing manganese nanostructures based carbon nanotubes composite for the highly sensitive determination of vitamin C in pharmaceutical formulation.

This work is the first report describing the development of a novel three dimensional manganese nanostructures based carbon nanotubes (CNTs-Mn NPs) composite, for the determination of ascorbic acid (vitamin C) in pharmaceutical formulation. Carbon nanotubes (CNTs) were used as a conductive skeleton to anchor highly electrolytic manganese nanoparticles (Mn NPs), which were prepared by a hydrothermal method. Scanning electron microscopy and atomic force microscopy revealed the presence of Mn Nps of 20-25nm, anchored along the whole length of CNTs, in the form of patches having a diameter of 50-500nm. Fourier transform infrared spectroscopy confirmed the surface modification of CNTs by amine groups, whereas dynamic light scattering established the presence of positive charge on the prepared nanocomposite. The binding events were studied by monitoring cyclic voltammetry signals and the developed nanosensor exhibited highly sensitive response, demonstrating improved electrochemical activity towards ascorbic acid. Linear dependence of the peak current on the square root of scan rates (R2=0.9785), demonstrated that the oxidation of ascorbic acid by the designed nanostructures is a diffusion control mechanism. Furthermore, linear range was found to be 0.06-4.0×10-3M, and nanosensor displayed an excellent detection limit of 0.1µM (S/N=3). This developed nanosensor was successfully applied for the determination of vitamin C in pharmaceutical formulation. Besides, the results of the present study indicate that such a sensing platform may offer a different pathway to utilize manganese nanoparticles based CNTs composite for the determination of other bio-molecules as well.

Discordance between lipid markers used for predicting cardiovascular risk in patients with type 2 diabetes.

AIMS: Non-high density lipoprotein cholesterol (non-HDL-C) is gaining importance over low density lipoprotein cholesterol (LDL-C) as cardiovascular risk marker in patients with type 2 diabetes. It represents the overall lipid burden and is a surrogate marker for the apolipoprotein B. We studied the discordance between the old (LDL-C) and the new (non-HDL-C) lipid markers in a large group of diabetes patients. METHODS: The lipid profile data of all diabetes (T2DM, aged 18-75, using oral or injectable anti diabetic agents) patients was analyzed in this study. We excluded patients with type1 diabetes, secondary forms of diabetes and gestational diabetes. Elevated lipid parameters (LDL>100mg/dL and non HDL-C>130mg/dL) were defined as per the guidelines of Adult Treatment Panel III. RESULTS: The study participants (409 M:360 F) had a mean age of 47.3±12.4 years, BMI of 28.4±5.6kg/m(2) and an A1c of 8.8±2.2%. Elevated LDL-C was observed in 383 patients (49.8%) and elevated non HDL-C in 418 (54.4%) patients. Of the 383 patients with elevated LDL-C, 346 (90.3%) had corresponding elevated levels of non-HDL-C and out of 418 patients with elevated non HDL-C, 346 (83%) had elevated LDL-C. Discordance between the elevated LDL-C and non-HDL-C values were greater among patients with low triglyceride levels when compared with those with high triglycerides (Pearson's χ(2) test=67.7; P<0.001). CONCLUSION: Our data suggest a significant discordance between the LDL-C and non-HDL-C in patients with diabetes. This discordance leads to the residual cardiovascular risk in diabetes patients.