Effect of blood flow restriction as a stand-alone treatment on muscle strength, dynamic balance, and physical function in female patients with chronic ankle instability.

BACKGROUND: Blood Flow Restriction (BFR) training has gained popularity as a novel training strategy in athletes and rehabilitation settings in recent years. OBJECTIVE: To investigate whether BFR as a stand-alone treatment would affect muscle strength, dynamic balance, and physical function in female patients with chronic ankle instability (CAI). METHODS: Thirty-nine patients with CAI were randomly allocated into 1 of 3 groups: BFR as a stand-alone (BFR) group, BFR with rehabilitation (BFR+R) group, and rehabilitation (R) group. All groups trained 3 times per week for 4 weeks. One week before and after the intervention, strength of muscles around ankle joint, 3 dynamic balance indices: Overall Stability Index, Anterior-Posterior Stability Index, and Medial-Lateral Stability Index, and physical function were assessed via an isokinetic dynamometer, the Biodex Balance System, and the Foot and Ankle Disability Index, respectively. RESULTS: The strength of muscles around ankle and dynamic balance indices improved significantly in BFR + R and R groups (P < .006), but not in BFR group (P > .006). All dynamic balance indices showed improvement in BFR + R and R groups except the Medial-Lateral Stability Index (P > .006). Foot and Ankle Disability Index increased significantly in BFR + R and R groups (P < .006), however; no improvement occurred in BFR group (P > .006). CONCLUSIONS: The BFR as a stand-alone treatment hasn't the ability to improve the strength of muscles around the ankle, dynamic balance, and physical function in females with CAI compared to the BFR + R or the R program. In addition, the strength of muscles around the ankle correlated significantly with both dynamic balance and physical function in BFR + R and R groups.

A Case Report and Literature Review of Icterus Marginatus: Demarcated Subcutaneous Jaundice, A Sign of Retroperitoneal Bile Leak After Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy (LC) is one of the most commonly performed general surgical procedures worldwide. Common bile duct (CBD) injuries are occasionally seen after this procedure and manifest as biliary peritonitis or bile collection; however, retroperitoneal bile leak is an extremely rare phenomenon manifesting as yellow discoloration of the abdominal wall, and a few cases are reported in the English literature. In this article, we describe one case of retroperitoneal bile leak that manifested as flank discoloration and its management.

Visceral Basidiobolomycosis Causing Bowel Ischemia.

Basidiobolomycosis is a rare fungal infection caused by saprophyte Basidiobolus ranarum. It is rarely seen in healthy adult patients; however, it usually affects children. The commonly involved sites are skin and subcutaneous tissue, mostly found in the Middle East and the southwestern United States. The diagnosis is challenging because of the lack of specific clinical presentation and the absence of predisposing factors. In our case report, we discuss a 38-year-old male patient who presented with a 2-months history of right lower quadrant pain. Initially, his pain was intermittent and gradually increased in intensity; it localized to the right lower quadrant and radiated to the right flank region. No relieving or aggravating factors were noted. In addition, the patient mentioned a history of constipation, weight loss, decreased appetite, and vomiting-however, no history of fever, night sweats, trauma, or recent travel. The diagnosis was made based on computerized tomography (CT) guided biopsy of the mass, illustrating the findings of fungal hyphae with a gradual increase in the eosinophilic count since admission. The patient was managed using a combined medical and surgical approach, including surgical debulking of the mass and a well-monitored course of anti-fungal therapy. Gastrointestinal basidiobolomycosis infection (GBI) can present in many forms, with an increasing potential to invade the colon, ultimately forming an inflamed mass. Nonetheless, the presence of a mass invading the colon, adjacent vessels, and a retroperitoneal area, along with an increase in the number of eosinophil count in the Middle East region, should raise the suspicion of basidiobolomycosis fungal infection.

Melanocytes and keratinocytes morphological changes in vitiligo patients. A histological, immunohistochemical and ultrastructural analysis.

Vitiligo is an idiopathic acquired chronic stigmatizing disease. It is a pigmentary disorder that affects the skin and the mucous membranes, and it is characterized by well-circumscribed, depigmented milky white macules and patches. It has an estimated prevalence of 0.5-2% of the population worldwide. In the previous studies, several mechanisms such as autoimmune, oxidative stress, genetic factors, melanocytorrhagy, and neural hypothesis have been suggested for vitiligo pathogenesis.We aimed to assess the morphological changes of epidermal melanocytes and keratinocytes in patients with vitiligo. This aim will be fulfilled by histological, ultrastructural, and immunohistochemical analysis of skin biopsies from lesioned and non-lesioned sites in vitiligo patients.The study was carried out on 15 selected patients with stable vitiligo vulgaris but not receiving treatment in the last year and they fulfilled our inclusion criteria.Biopsies were taken from lesioned and non-lesioned sites in the same vitiligo patients, and they are processed for examinations by LM (using Hx & E, and Masson Fontana stain), immunohistochemical analysis (using Melan-A, E-cadherin, and caspase-3), and TEM (to demonstrate the ultra-structures).By LM, staining with Hx & E, lesioned skin in vitiligo patients showed hyperkeratosis, basal vacuolization, acanthosis with an increase in the epidermal thickness, ballooning of keratinocytes, and spongiosis. Regarding melanocytes, we observed a few numbers of melanocytes, also we detected some basal epidermal cells contain brown melanin granules. Using Fontana-Masson stain, we found that the melanin pigment is present in both lesioned and non-lesioned skin of vitiligo patients. We confirmed the presence of melanocytes in the lesioned skin by the immunohistochemical staining with Melan-A. The epidermal cells in lesioned skin of vitiligo patients showed weak positive expression of E-cadherin between them and an increase in the number of apoptotic Caspase-3 positive cells. BY TEM, the lesioned skin in vitiligo patients showed that the keratinocytes and melanocytes had various degenerative changes, disturbance of desmosomes in between keratinocytes, and absence of melanosomes in the keratinocytes. The detected melanocytes were degenerated and contained some melanosomes, melanin granules, and autophagosomes.We concluded that vitiligo pathogenesis is a combination of several factors and cannot be explained by only one mechanism. The pathology in the lesioned vitiliginous skin is a combination of several degenerative changes in keratinocytes, and melanocytes.

Effectiveness of a Multi-Modal Exercise Program Incorporating Plyometric and Balance Training in Children With Hemiplegic Cerebral Palsy: A Three-Armed Randomized Clinical Trial.

AIM: To evaluate the effectiveness of a multimodal exercise program incorporating plyometric and balance training on muscle strength and postural stability in children with spastic hemiplegic cerebral palsy (SHCP). METHODS: A total of 57 children with SHCP were enrolled in the study and randomly allocated into three treatment-based groups: plyometric exercises (PLYO group; n = 19), balance exercises (BAL group, n = 19), and combined plyometric and balance exercises (PLYO-BAL group; n = 19). The maximum isometric muscle strength (IMSmax) and postural stability [anterior-posterior stability index (AP-SI), mediolateral stability index (ML-SI), and overall stability index (O-SI)] were measured pre- and post-intervention. RESULTS: By applying the intention-to-treat analysis, the PLYO-BAL group showed greater post-treatment IMSmax than the PLYO and BAL groups for the quadriceps (p=.03 and p=.0002 respectively), hamstrings (p=.018 and p<.0001 respectively), and dorsiflexors (p=.006 and p<.0001 respectively). Also, the PLYO-BAL group achieved better post-intervention stability scores as compared to PLYO and BAL groups regarding AP-SI (p<.0001 and p=.0001 respectively), ML-SI (p=.001 and p=.015 respectively), and O-SI (p=.011 and p=.04 respectively). CONCLUSIONS: Incorporation of plyometric and balance exercises in a multimodal rehabilitation program could be an important consideration for enhancing muscle strength and boosting postural stability in children with SHCP.

Beyond the Acute Phase: Understanding Relationships Among Cardiorespiratory Response to Exercises, Physical Activity Levels, and Quality of Life in Children After Burn Injuries.

The long-term cardiorespiratory function in burn-injured children can be jeopardized due to complications brought on by the injury. This study sought to assess the cardiorespiratory responses to maximal exercise in children who sustained a burn injury and explore the relationships among cardiorespiratory response, physical activity levels (PALs), and health-related quality of life (HRQL). Forty-five burn-injured children (age: 13.89 ± 2.43 years; duration since burn injury: 3.13 ± 0.93 years) and 52 age- and gender-matched healthy children (14.15 ± 2.27 years) participated in this study. Both cohorts were evaluated for the maximal exercise capacity (defined by peak oxygen uptake [VO2peak], maximum heart rate [HRmax], minute ventilation [VE], ventilatory equivalent [VEq], respiratory rate [RR], and respiratory exchange ratio [RER]), PALs, and HRQL. The burn-injured children had significantly lower VO2peak (P = .0001) and VE (P = .003) and higher VEq (P < .0001) and RR (P = .007) than their healthy controls, indicating less-efficient cardiorespiratory capacity. However, the HRmax (P = .092) and RER (P = .251) were similar. The burn-injured children reported significantly lower PALs (P = .014) and HRQL (P < .0001). The PALs (r [95% CI] = .411 [0.132-0.624]; P = .005) and HRQL (r [95% CI] = .536 [0.284-0.712]; P = .0001) were significantly correlated with the cardiorespiratory capacity represented by VO2peak in burn-injured group. The variations in VO2peak explained ~17% and 28.7% of the variations in PALs and HRQL, respectively. In conclusion, the cardiorespiratory efficiency of the burn-injured children may remain limited, even up to a few years following the injury. The limited cardiorespiratory capacity accounts in part for the reduced PALs and HRQL.

Comparison of two periods of Schroth exercises for improving postural stability indices and Cobb angle in adolescent idiopathic scoliosis.

BACKGROUND: Adolescents with idiopathic scoliosis present postural instability when compared with healthy subjects. Although Schroth exercises therapy (SET) is broadly utilized, its effect on postural stability is still not clear. OBJECTIVES: To compare the two treatment periods of the SET for improving the postural stability indices and Cobb angle, and to examine the correlation between the Cobb angle and stability indices in adolescent idiopathic scoliosis (AIS). METHODS: Twenty girls aged 10-16 years with AIS (study group) and 20 age-matched girls without AIS (control group) were examined. The Biodex Balance System was used to evaluate the overall stability index (OSI), anteroposterior index (APSI), and mediolateral stability index (MLSI) in the study group before SET and one and three months after the therapy. A plain X-ray was used to measure the Cobb angle before and three months after SET. Stability indices and Cobb angle were measured only once for the control group. RESULTS: One-way repeated-measures ANOVA revealed that the three-month duration of SET was the most effective for improving OSI, APSI, and MLSI (p< 0.001). The significant proximities of OSI, APSI, and MLSI to the normal values post three months of SET were 29.65%, 24.07, and 20% respectively. The MLSI was robust and correlated with the Cobb angle (r= 0.85) three months post intervention. CONCLUSION: Stability indices and Cobb angles were highly improved after three months of SET compared to one month among AIS patients. The MLSI is the most substantial index correlated with the Cobb angle.

Low-energy laser therapy application on knee joints as an auxiliary treatment in patients with polyarticular juvenile idiopathic arthritis: a dual-arm randomized clinical trial.

Patients with juvenile idiopathic arthritis (JIA) always experience persistent pain and stiffness which induces muscle weakness, fatigue, and functional limitations. This study evaluated whether applying low-energy laser therapy (LLT) on the knee joint could be an effective adjuvant intervention for patients with JIA. Sixty children with polyarticular JIA participated and were randomly allocated to receive either LLT (wavelength λ = 903 nm; power output of 50 mW; and energy of 1.5 J) plus exercises (LLT group) or exercises alone (control group). Pain, peak concentric torque of quadriceps muscles, fatigue, and functional status were measured by the visual analogue scale, isokinetic testing system, Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, and Childhood Health Assessment Questionnaire, respectively pre- and post-intervention, and at 6-month follow-up. Per the mixed-model analysis of variance, the LLT group showed a statistically more favorable improvement in pain (P = .003, ηp2 = .014), fatigue perception (P = .004, ηp2 = .015), and functional status (P = .022, ηp2 = .09) across the three assessment occasions, as compared to the control group. However, no significant difference was demonstrated between both groups concerning peak concentric torque (all P > .05). Incorporation of LLT into the standard physical rehabilitation program for patients with JIA has the potential to induce more conducive improvements in pain, fatigue, and functional performance, but is not effective for improving muscle performance.

Patterns of thyroid dysfunctions in adolescent patients suffering from severe acne during isotretinoin treatment.

Although oral isotretinoin has been widely used as a basic treatment of acne in adolescents, several studies have noted some alterations in thyroid functions during oral isotretinoin therapy. Therefore, the present study aims at evaluating the possible changes in thyroid-stimulating hormone (TSH), free thyroxin (fT4) and free triiodothyronine (fT3) levels during isotretinoin treatment and analyzing the possible factors which may contribute to such changes. In the present study, 47 patients received (0.5 mg/kg oral isotretinoin) for treatment of severe acne. TSH, fT4 and fT3 were measured at baseline, after 3 and 6 months. ANOVA tests were used for statistical analyses. The levels of fT4 and fT3 decreased significantly during isotretinoin treatment (from 0.85 ± 0.04 and 3.1 ± 0.26 at baseline to 0.81 ± 0.023 and 2.76 ± 0.2 after 6 months, respectively). The decrease was accompanied by significant elevation of TSH (0.66 ± 0.05 at baseline to 0.695 ± 0.05 after 6 months). The duration of therapy (but not the dose) has significantly affected all the hormonal changes. Previous incomplete or intermittent isotretinoin treatment had significantly influenced the changes in fT4 only, while gender affected the changes of TSH. Isotretinoin treatment can decrease fT4, fT3 and increase TSH. The pattern of these changes was affected by gender and previous isotretinoin therapy. Different doses of isotretinoin did not affect the hormonal changes, but the duration has been the major influencing factor.

Effect of adding plyometric training to physical education sessions on specific biomechanical parameters in primary school girls.

OBJECTIVES: The study aimed to determine the effect of adding a school-based plyometric training program (PMT) to physical education (PE) sessions on the strength, balance, and flexibility in primary school girls. METHODS: Students from grades 3-6 were randomized equally to a plyometric or control group. In the control group, students took their regular PE classes twice a week. In the plyometric group, students performed PMT twice a week during the initial 20 minutes of every PE session. The Lido Linea closed kinetic chain isokinetic dynamometer, Star excursion balance test (SEBT), and sit-and-reach test were used to assess muscle strength, balance, and flexibility, respectively, before and after nine weeks of training. RESULTS: The improvement in extension peak force (p=0.04) and extension total work (p<0.001) was more prevalent in the PMT group than in the control group. SEBT scores had improved significantly (p<0.05) for all directions in the PMT group, except in the anterior direction, which was highly significant (p<0.001). Hamstring and lower back flexibility had improved more in the PMT group than in the control group (p<0.001). CONCLUSION: Adding PMT to regular PE classes has a positive and notable effect on muscle strength, balance, and flexibility in primary school students.

Seasonal variations of heavy metals in water, sediment, and organs of Vossia cuspidata (Roxb.) Griff. in River Nile ecosystem: implication for phytoremediation.

The present study aimed at investigating (1) the seasonal concentrations of heavy metals in different organs of Vossia cuspidata (Roxb.) Griff. in its main natural habitats in the River Nile ecosystem in Cairo, Egypt, (2) the bioaccumulation and translocation of heavy metals in the organs of V. cuspidata and its potentials as a phytostabilizer, and (3) the seasonal changes in the dry matter (DM) biomass of the organs. Two river islands were selected for seasonal sampling of water, sediment, and plant organs in eighteen randomly distributed quadrates (0.5 × 0.5 m each) during the period from February 2018 to January 2019. The total annual mean DM biomass was ≈ 18.7 ton ha-1. The aboveground organs had significant seasonal variations in DM biomass (p < 0.05). The belowground DM biomass represents 23% of the aboveground DM biomass. Belowground organs had the highest DM biomass values in winter for the roots (23.85 g DM m-2, 4.75% from the total DM) and spring for the rhizomes (108.96 g DM m-2, 37.3% from the total DM). Regardless of the heavy metals concentrations in water and sediment, V. cuspidata can accumulate Fe, Mn, Ni, and Pb at high levels. There was a statistically significant interaction between the effects of seasons and organs on the concentrations of Mn, Ni, and Pb at p < 0.001. The root was the main accumulating organ for the analyzed elements in the present study. Vossia cuspidata can transfer low concentrations of the analyzed metals from belowground to aboveground organs. We recommend V. cuspidata as a potential phytostabilizer to Fe, Zn, Mn, Cu, Ni, and Pb from the mainstream of River Nile.

Eye lens and thyroid gland radiation exposure for patients undergoing brain computed tomography examination.

This study aims to estimate the effective radiation dose and organ dose from head CT procedures. It was conducted in three main private hospitals in Khartoum State-Sudan, using Toshiba machines with 64 slices. The total number of patients included in this study was 142 patients (82 males and 60 females). The effective dose and organ dose were calculated by CT Expo software. The effective dose slightly varied among patients according to gender and age. The effective dose for female patients (5.99 mSv) was higher than that for male patients (5.84 mSv), and the pediatric dose (5.46 mSv) was lower than the adults' dose (5.94 mSv). The dose for eye lens was found lower for male patients (89.117 mSv) than the dose for female patients (94.62) mSv). According to patients' age: the dose received by the lens of the eye was much lower in pediatric (79.93 mSv) than the adults (92.41 mSv). The dose for thyroid in female patients (33.52 mSv) was higher than the male patients (28 mSv). The pediatric dose (28.34 mSv) was lower than the adults' dose (30.64 mSv). Departmental imaging protocol and lack of training among hospital staff are expected to be responsible for these variations. Therefore, this study recommends that the CT technologists be trained on suitable strategies to achieve dose optimization. Moreover, patients' doses must be monitored regularly.

Giant mammary hamartoma in a middle aged female. Case report and review of literature of the last 15 years.

BACKGROUND: Mammary hamartoma is a benign rare tumour occurring in both sexes, with size range mostly between 2-4 cm. Giant breast hamartoma (GMH) is very rare and can reach unexpected sizes in women. PRESENTATION OF THE CASE: A 26 year old Egyptian female presented with left breast lump since 3 years, gradually increasing in size, with no other associated complaints. No family history of breast cancer, she did not smoke or consume alcohol, and had no past medical history. Examination revealed a large soft freely mobile mass (12 × 9 cm) in the lower outer quadrant of the left breast at the 3-6 o'clock position. There were no palpable axillary lymph nodes in both sides. Nipples and right breast were normal. DISCUSSION: The diagnosis of GMH can be made by examination and imaging only. The specific features that appear in mammogram and ultrasound can be used to reduce the need for core biopsy in hamartoma. Wide local excision is curative. We include a review of the literature of cases of GMH > 10 cm published during the last 15 years. CONCLUSION: A non-invasive mammogram and ultrasound provide sufficient evidence of the tumour, hence core biopsy might not be critically required. However, if a breast hamartoma is still clinically suspected but with inconclusive or unequivocal mammographic and ultrasonographic features or if there is suspicion of dysplasia, then invasive core biopsy is justified. Recurrence is low and prognosis is good.

Impact of core stability exercises on bone mineralization and functional capacity in children with polyarticular juvenile idiopathic arthritis: a randomized clinical trial.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most prevalent rheumatic disease in children. The core stability exercises ensure proper muscular strength and balance around the lumbo-pelvic-hip complex. OBJECTIVE: This study evaluated whether the use of core stability exercises would increase the effectiveness of conventional physical therapy (PT) in enhancing bone mineralization and improving functional capacity in children with polyarticular JIA. METHODS: Thirty-three children with polyarticular JIA (age; 10-14 years) assigned randomly into two groups: the control group (n = 16) received the conventional PT, and the study group (n = 17) received the core stability exercises in addition to the same conventional PT program. Both core stability and conventional PT exercises continued for 3 months. The measures of bone mineralization and functional ability were investigated by dual-energy X-ray absorptiometry (DXA) device and 6-min walk test (6MWT), respectively, at baseline and immediately post-treatment. RESULTS: Analysis of covariance (ANCOVA) revealed significant differences between groups in favor of the study group regarding measures of bone mineralization of lumbar spine and femoral neck regions as P < 0.05, except for volumetric bone mineral density of lumbar spine the P > 0.05. There was a significant difference between the two groups concerning functional capacity measured in 6MWT (P < 0.05), where children in the study group walked 531.71 ± 90.59 m compared with the control group 509.31 ± 73.10 m. CONCLUSION: Core stability exercises are an effective adjunctive therapy to enhance bone health status and improve functional capacity in children with polyarticular JIA. Key Points • In addition to conventional physical therapy, core stability exercises had a definite effect on improving bone health status and quality of life in children with polyarticular juvenile idiopathic arthritis. • Improved bone mineralization and functional capacity due to core stability exercises contain two parts: strengthening training and controlling equilibrium.

Effect of Wii-habilitation on spatiotemporal parameters and upper limb function post-burn in children.

BACKGROUND: Limb burns can cause different functional disorders that greatly impact one's quality of life. AIM: The purpose of the current study was to compare the effect of Nintendo Wii sports intervention, and traditional treatment methods on spatiotemporal parameters and upper limb function post-burn in children. METHODS: Thirty children their age ranging from 7-12 years, with dominant side upper limb burn participated in the study.Vicon3-D motion analysis system and Jebsen hand function test were used to evaluate spatiotemporal parameters (movement duration, peak velocity, and time to peak velocity percentage in three functional tasks) and upper limb function respectively. The children were randomly divided into study and control groups. The study group was rehabilitated with Wii training in addition to traditional therapy, while the control group rehabilitated only with the traditional therapy program. For the study group, the games selected were Wii Bowling, Baseball, and Tennis. Both groups were trained for 60 min daily, three times/week for six weeks. The outcomes were measured pre and post the treatment period. RESULTS: The whole-time duration and peak velocity improved significantly in the study group across the hand to head task (p = 0.001, p < 0.001, respectively), hand to mouth (p = 0.001), and hand to shoulder (p < 0.001, p = 0.0018, respectively) compared with the control group. The time to peak velocity percentage was enhanced significantly in the study group (p < 0.001) than the control group in all three-measured tasks. Moreover, the Jebsen hand function test improved significantly (p < 0.001) in the study group than in the control group. CONCLUSION: Wii-habilitation could be advised as an effective tool in the rehabilitation program of children with post-burn injuries.

Pregabalin administration and withdrawal affect testicular structure and functions in rats.

The aim of this prospective experimental study was to investigate the effects of pregabalin (PG) administration and withdrawal on testicular structures and functions in rats. A total of 24 male Wistar rats were divided into two groups (n = 12 each): a control group received normal saline, and PG-treated group received 62 mg kg-1  day-1 PG for 2 months. Half the animals of each group were sacrificed for the collection of blood and testicular samples. The remaining animals were bred for another 2 months without treatment before collection of blood and testicular samples. PG administration decreased testosterone and increased luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels versus controls. PG withdrawal led to a decrease in both FSH and LH and an increase in testosterone levels versus saline withdrawal. Compared to controls, PG administration caused degeneration of seminiferous tubules and decreased the number of spermatogenic but increased the number of Leydig cells. After PG withdrawal, these cells showed a rebound reverse. Reduced glutathione levels increased with PG administration while PG withdrawal increased malondialdehyde levels. Conclusion: PG administration affected testicular morphometry, gonadotrophic and sex hormones; however, there was a rebound reversal in all these parameters and a significant oxidative stress in PG withdrawal.

Two separate tumours-Concomitant papillary carcinoma in thyroglossal duct cyst and right thyroid lobe: Case report and review of the literature.

INTRODUCTION: Malignancy of thyroglossal duct cyst (TGDC) is rare, usually as papillary carcinoma, and less frequently as squamous cell or follicular carcinoma. TGDC carcinoma can present as a mass arising from the neck, with or without compression symptoms. Papillary carcinoma in TGDC concomitant with another papillary carcinoma in the thyroid gland is extremely rare. PRESENTATION OF CASE: 31 years old female with a neck lump since 2 years, slowly increasing in size, with mild pain while drinking fluids, and no change of voice. No past history of neck irradiation or family history of thyroid cancers. Ultrasonography of the neck showed TGDC and right thyroid nodule. Ultrasound guided fine needle aspiration and cytology of the TGDC showed TGDC papillary carcinoma. The patient underwent Sistrunk's procedure and total thyroidectomy. DISCUSSION: Rare case of classic papillary carcinoma arising in TGDC, concomitant with another papillary carcinoma in the right thyroid nodule. Preoperative work up included US and fine needle aspiration and cytology (FNAC). Post-operative histopathology showed papillary carcinoma in the TGDC; and another in the right thyroid lobe that was a papillary carcinoma with follicular patterns. CONCLUSIONS: TGDC carcinoma concurrent with another carcinoma in the right thyroid lobe as two separate tumours are extremely rare. All patients should undergo Sistrunk's procedure, and total thyroidectomy for the thyroid tumour. Follow-up requires thyroxine replacement therapy to treat hypothyroidism and to suppress TSH in order to prevent recurrence; and neck ultrasound and thyroglobulin tumour marker to detect recurrence if present.

Assessment of the Clinical Effects of Aquatic-based Exercises in the Treatment of Children With Juvenile Dermatomyositis: A 2x2 Controlled-Crossover Trial.

OBJECTIVES: This study aims to compare the effect of aquatic-based exercises (AQBEs) and land-based exercises (LBEs) on muscle strength, fatigue and quality of life (QoL), and skin disease activity in children with juvenile dermatomyositis (JDM). PATIENTS AND METHODS: The design of the study was an assessor-blinded, controlled 2x2 crossover trial. Fourteen children (4 boys, 10 girls; mean age 11.7±2.2 years; range, 10 to 16 years) were evaluated. AQBEs and LBEs were applied through two treatment sequences as half of the children received AQBEs first while the second half received LBEs first. Isometric muscle strength, fatigue level and QoL (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale [PedsQL-MFS]), and skin disease activity score (DASskin) were measured at four occasions for each treatment sequence. RESULTS: The AQBEs had significant superiority over LBEs with improved hip flexors' strength (p=0.007) and hip abductors' strength (p=0.001), while both types of treatment had the same effect in increasing strength of shoulder flexors and abductors (p<0.05). AQBEs improved PedsQL-MFS, and DASskin significantly more than LBEs (p<0.001). For all outcome measures, there was no significant difference in the treatment sequence the children received first. CONCLUSION: Supervised AQBEs are more effective in improving muscle strength, fatigue and QoL, and skin disease activity than LBEs in children with JDM. Furthermore, the treatment sequence had no significant effect on measured variables.

The Hemodynamic Response of the Vertebral Artery to 3 Time Durations of the Static Stretching Exercise in the End Position of Contralateral Cervical Rotation.

OBJECTIVES: To evaluate the effect of 3 different time durations of sustained end-range cervical rotation during static stretching exercises on the hemodynamics of the vertebral artery. METHODS: This observational study used Doppler ultrasonography to measure the average vertebral artery hemodynamics at the sustained end-range cervical rotation after 3 time durations of static stretching exercise: 10 seconds, 30 seconds, and 60 seconds. The sustained end-range cervical rotation was applied to 30 asymptomatic male participants. RESULTS: The peak systolic velocity 35.2 ± 6.9 cm/s and the end systolic velocity 12.7 ± 1.6 cm/s reduced significantly, while resistive index 0.74 ± 0.03 increased after 60 seconds of sustained end-range contralateral cervical rotation by 39.1%, 32.4%, and 8.8%, respectively, compared with the neutral position. There were no significant differences found between peak systolic velocity and resistive index after a stretching duration of 60 and 30 seconds. Similarly, there were no notable changes in end systolic velocity when comparing 10 seconds with 30 seconds. CONCLUSION: The static stretching exercise using sustained end-range cervical rotation for 60 seconds induced marked changes in the hemodynamics of the vertebral artery.