Peutz-Jeghers syndrome: management for recurrent intussusceptions.

BACKGROUND: Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by hamartomatous gastrointestinal polyps along with the characteristic mucocutaneous freckling. Multiple surgeries for recurrent intussusception in these children may lead to short bowel syndrome. Here we present our experience of management in such patients. METHODS: From January 2015 to December 2023, we reviewed children of PJS, presented with recurrent intussusceptions. Data were collected regarding presentation, management, and follow-up with attention on management dilemma. Diagnosis of PJS was based on criteria laid by World Health Organization (WHO). RESULTS: A total of nine patients were presented with age ranging from 4 to 17 years (median 9 years). A total of eighteen laparotomies were performed (7 outside, 11 at our centre). Among 11 laparotomies done at our centre, resection and anastomosis of bowel was done 3 times while 8 times enterotomy and polypectomy was done after reduction of intussusception. Upper and lower gastrointestinal endoscopy (UGIE & LGIE) was done in all cases while intraoperative enteroscopy (IOE) performed when required. Follow-up ranged from 2 months to 7 years. CONCLUSION: Children with PJS have a high risk of multiple laparotomies due to polyps' complications. Considering the diffuse involvement of the gut, early decision of surgery and extensive bowel resection should not be done. Conservative treatment must be tried under close observation whenever there is surgical dilemma. The treatment should be directed in the form of limited resection or polypectomy after reduction of intussusception.

Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study.

Introduction: Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients. Materials and Methods: This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software. Results: The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups. Conclusion: Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.

Retroperitoneal yolk sac tumour encroaching the liver and adrenal gland with tumour thrombus in cavo-atrial region and hepatic veins.

Paediatric germ cell tumours (GCT) are rare tumours and are unique because of varied clinical presentation and locations. Yolk sac tumour is the predominant malignant histology and a serum marker; alpha fetoprotein is used to see treatment response and recurrent disease. It is extremely rare to find a retroperitoneal GCT with tumour thrombus extending up to the cavo-atrial region with involvement of the hepatic veins. We report a case of retroperitoneal yolk sac tumour (RPYST) with extension to the liver and right adrenal gland along with tumour thrombus in the inferior vena cava and in the right and middle hepatic veins. The child was operated after satisfactory response to chemotherapy. Excision of the tumour along with the right adrenal gland and around 5 cm of retro-hepatic caval resection was done. Inferior vena cava resection was tolerated without reconstruction. Currently child is disease-free and symptom-free at 22 months of follow-up with normal serum marker.

Mutation Analysis of SARS-CoV-2 Variants Isolated from Symptomatic Cases from Andhra Pradesh, India.

There has been a continuous evolution in the SARS-CoV-2 genome; therefore, it is necessary to monitor the shifts in the SARS-CoV-2 variants. This study aimed to detect various SARS-CoV-2 variants circulating in the state of Andhra Pradesh, India. The study attempted to sequence the complete S-gene of SARS-CoV-2 of 104 clinical samples using Sanger's method to analyze and compare the mutations with the global prevalence. The method standardized in this study was able to amplify the complete length of the S-gene (3822 bp). The resulting nucleotide and amino acid mutations were analyzed and compared with the local and global SARS-CoV-2 databases using Nextclade and GISAID tools. The Delta variant was the most common variant reported in the present study, followed by the Omicron variant. A variant name was not assigned to thirteen samples using the Nextclade tool. There were sixty-nine types of amino acid substitutions reported (excluding private mutations) throughout the spike gene. The T95I mutation was observed predominantly in Delta variants (15/38), followed by Kappa (3/8) and Omicron (1/31). Nearly all Alpha and Omicron lineages had the N501Y substitution; Q493R was observed only in the Omicron lineage; and other mutations (L445, F486, and S494) were not observed in the present study. Most of these mutations found in the Omicron variant are located near the furin cleavage site, which may play a role in the virulence, pathogenicity, and transmission of the virus. Phylogenetic analysis showed that the 104 complete CDS of SARS-CoV-2 belonged to different phylogenetic clades like 20A, 20B, 20I (Alpha), 21A (Delta), 21B (Kappa), 21I (Delta), 21J (Delta), and 21L (Omicron).

Atmospheric Microplastics: Perspectives on Origin, Abundances, Ecological and Health Risks.

Microplastic (MP) pollution has aroused a tremendous amount of public and scientific interest worldwide. MPs are found widely ranging from terrestrial to aquatic ecosystems primarily due to the over-exploitation of plastic products and unscientific disposal of plastic waste. There is a large availability of scientific literature on MP pollution in the terrestrial and aquatic ecosystems, especially the marine environments; however, only recently has greater scientific attention been focused on the presence of MPs in the air and its retrospective health implications. Besides, atmospheric transport has been reported to be an important pathway of transport of MPs to the pristine regions of the world. From a health perspective, existing studies suggest that airborne MPs are priority pollutant vectors, that may penetrate deep into the body through inhalation leading to adverse health impacts such as neurotoxicity, cancer, respiratory problems, cytotoxicity, and many more. However, their effects on indoor and outdoor air quality, and on human health are not yet clearly understood due to the lack of enough research studies on that and the non-availability of established scientific protocols for their characterization. This scientific review entails important information concerning the abundance of atmospheric MPs worldwide within the existing literature. A thorough comparison of existing sampling and analytical protocols has been presented. Besides, this review has unveiled the areas of scientific concern especially air quality monitoring which requires immediate attention, with the information gaps to be filled have been addressed.

Mucolipidosis: A mimicker of juvenile idiopathic arthritis.

Juvenile idiopathic arthritis is the most common form of chronic arthritis in children and at times misdiagnosed in those presenting with arthropathy secondary to non-inflammatory causes. The overlap of symptoms often pose a diagnostic challenge for clinicians. This mostly results in a delayed diagnosis subjecting children to unnecessary use of long-term immunosuppressants and disease-modifying drugs. We present the case of a 9-year-old boy who was previously misdiagnosed as a case of juvenile idiopathic arthritis. Detailed evaluation later led to the diagnosis of mucolipidosis (type III) which was confirmed on genetic testing. Emphasis on detailed history and clinical examination including the subtle hints like lack of signs of inflammation, family history, no morning stiffness and normal inflammatory markers should be picked up to make a timely diagnosis. In today's era of genetic testing and diagnosis, it is prudent to offer these tests for such patients to make an accurate diagnosis and prognosticate them for the long-term outcome.

Geochemical fractionation, bioavailability, ecological and human health risk assessment of metals in topsoils of an emerging industrial cluster near New Delhi.

Urban spaces have become sink for metal-rich waste, particularly in unorganized industrial clusters and metro-cities. Geochemical distribution of metals in different forms and their mobility and bioavailability in topsoils of Bhiwadi Industrial Cluster (BIC) near New Delhi are studies following m-BCR-SEP. Contamination factor (Cf), risk assessment code (RAC), ecological risk assessment (Er), and carcinogenic and non-carcinogenic health risk (HRA) were calculated to assess health and environmental risks. Residual fraction (F4) contained considerable amounts of Cd (57.2%), Cr (81.5%), Fe (86.1%), Mn (62.5%), Ni (58.3%), and V (71.4%). Pb was present in reducible fraction (F2; 52.8%), whereas Cu was distributed in F2 (33.3%) and F4 (31.6%). Zn showed equal distribution in acid exchangeable (F1; 33.9%) and oxidizable fraction (F3; 32.5%). High Cf was observed for Zn (0.9-20.9), Cu (0.46-17) and Pb (0.2-9.9). RAC indicated high risk of Cd, Cu, Mn, Ni, and Zn due to their high mobility and toxicity. High potential bioavailability of Cu, Pb, and Zn (> 65%) was found in samples collected near to metal casting, electroplating, and automobile part manufacturing industries. Considerable to extremely high ecological risk was observed for Cd, low to high risk for Cu, low risk to moderate risk for Cr, Mn, Ni, Zn, and Pb. All topsoil samples were in low to very high-risk range for metals. Ingestion was major pathway of metals followed by dermal and inhalation. Children were more prone to non-carcinogenic risks (hazardous index: 3.6). Topsoils had high carcinogenic risk to exposed population for Cd, Cr, Ni, and Pb.

Clinical and radiological effects of Corticosteroid injection combined with deep transverse friction massage and Mill's manipulation in lateral epicondylalgia-A prospective, randomized, single-blinded, sham controlled trial.

BACKGROUND: The knowledge about the effective implementation of corticosteroid injection (CS) with deep transverse friction massage (DTFM) and Mill's manipulation (MM) on clinical and radiological changes (Magnetic resonance imaging-MRI and Ultra sound) in lateral epicondylalgia (LE) is lacking. Therefore, the objective of this study is proposed to find and compare the effects of corticosteroid injection (CS) DTFM and Mill's manipulation on clinical and radiological changes in lateral epicondylalgia. DESIGN, SETTING, PARTICIPANTS: Randomized, single-blinded, controlled study was conducted on 60 LE participants at university hospital. The active MM group (n = 30) received corticosteroid injection with DTFM and active Mill's manipulation (MM) three sessions a week for 4 weeks and the sham MM group received corticosteroid injection with sham manipulation. The primary outcome was pain intensity, measured with the visual analog scale. The other outcome measures were percentage of injury measured by MRI and ultrasound, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life which were measured at 4 weeks, 8weeks and at 6 months follow up. RESULTS: The between-group difference in pain intensity at 4 weeks was 1.6 (CI 95% 0.97 to 2.22), which shows improvement in the active group than sham group. The similar effects have been noted after 8 weeks and at 6 months 2.0 (CI 95% 1.66 to 2.33) follow up in pain intensity. Similar improvements were also found on percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life (p = 0.001). CONCLUSION: Corticosteroid injection with DTFM and Mill's manipulation was superior to sham group for improving pain, percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life in people with lateral epicondylalgia. TRIAL REGISTRATION: Clinical trial registration: CTRI/2020/05/025135 trial registered prospectively on 12/05/2020. https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2020/05/025135.

Chemical Speciation, Bioavailability and Human Health Risk Assessment of Metals in Surface Dust from an Industrial Cluster in India.

In this study, distribution of metals in different geochemical forms, their mobility and bioavailability in bulk surface dust samples of Bhiwadi industrial cluster (BIC) in Rajasthan, India, was assessed by modified Community Bureau of Reference (m-BCR) sequential extraction procedure. Potential risk of metals in surface dust to environment and human health was evaluated using Contamination factor (Cf), Mobility Factor (MF) and Risk Assessment Code (RAC), and carcinogenic and non-carcinogenic health risk. Residual fraction contained significant amount of metals as Cd(55.86%), Cr(86.05%), Fe(90.06%), Mn(69.94%), Ni(66.08%), and V(71.80%). Pb(52.43%) was present in reducible fraction, while Cu was equally distributed in reducible (27.66%) and oxidizable (28.20%) fractions. Zn was equally distributed in acid exchangeable (33.15%) and reducible (35.01%) fractions. High Cf values were observed for Zn (1.32-16.98), followed by Pb (0.38-11.23) and Cu (0.26-8.22). RAC indicated high risk of Cd, Mn, Ni and Zn to environment due to their high mobility and toxic nature. Zn, Pb, Cu and Cd showed highest mobility (potential bioavailability) in samples collected around metal casting, electroplating, and automobile part industries. Data indicated that metals can bio-available with the changes in redox conditions in environment. Ingestion was major pathway for carcinogenic and non-carcinogenic health risks followed by dermal and inhalation. Hazardous Index value (6.32) indicated higher susceptibility of children for non-carcinogenic risk as compared to adults. Carcinogenic risk of Cr, Cd, Ni and Pb was higher than acceptable levels in surface dust, suggesting a high risk of cancer to exposed population.

Clinical and Endocrinological Responses to Different Exercise Training Methods in Chronic Low Back Pain: A Randomized Controlled Trial.

AIMS AND BACKGROUND: The knowledge about the effective implementation of different exercise training methods on clinical and endocrinological responses in soccer players with chronic low back pain (LBP) is lacking. Hence the study is proposed to find the effects of different exercise training methods on clinical and endocrinological responses in soccer players with chronic low back pain. METHODS: Through the three-block randomization method, 60 chronic LBP participants were randomly divided into the isokinetic exercise group (IKE; n = 20), (CSE; n = 20), and conventional exercise group (n = 20). They received respective training for four weeks. Clinical (pain intensity & kinesiophobia) and endocrinological (glucose, insulin, HOMA-IR, growth hormone, prolactin, ACTH, and cortisol) values were measured at baseline, after 4 weeks, and at 3 months follow up. RESULTS: The baseline data between the groups showed no statistical difference (p ≥ 0.05). Four weeks following training IKE group showed significant changes in pain intensity and kinesiophobia than CSE and conventional training groups (p < 0.05). After 4 weeks of training, all the serum hormone variables show significant changes between the groups (glucose; p = 0.049, insulin; p = 0.005, HOMA-IR; p = 0.021, growth hormone; p = 0.006, prolactin; p = 0.001, ACTH; p = 0.001 and cortisol; p = 0.001). At 3 months follow up, the values for Glucose and Insulin (p > 0.05) variables did not show any statistical changes, but the rest of the variables (p = 0.001) showed significant differences. However, the maximum improvement was seen in the IKE group as calculated by the post hoc Tukey-Kramer's test. CONCLUSION: Our study suggested that strength training through isokinetic exercises improved pain, kinesiophobia status, and temporary changes in serum stress hormone levels than other training methods in soccer players with chronic low back pain.

MRI and Ultrasound Analysis of Corticosteroid Injection Combined with Extracorporeal Shockwave Therapy in Lateral Epicondylitis-A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial.

OBJECTIVE: The knowledge about the effective implementation of corticosteroid injection and extracorporeal shockwave therapy on radiological changes in chronic lateral epicondylitis is lacking. Therefore, the objective of this study is to find and compare the effects of corticosteroid injection and extracorporeal shockwave therapy on radiological changes in chronic lateral epicondylitis. METHODS: A randomized, double-blinded controlled study was conducted on 60 LE participants at a university hospital. The active extracorporeal shockwave therapy group (n = 30) received a corticosteroid injection with active extracorporeal shockwave therapy one session a week for 4 weeks, and the placebo extracorporeal shockwave therapy group received a corticosteroid injection with placebo extracorporeal shockwave therapy. The primary outcome was pain intensity, measured with the visual analog scale. The other outcome measures were the percentage of injury measured by magnetic resonance imaging and ultrasound, functional disability, handgrip strength, patient perception, kinesiophobia, depression status, and quality of life. RESULTS: The between-group difference in pain intensity at 4 weeks was 1.4 (CI 95% 0.77 to 2.02), which shows more improvement in the active group than in the placebo group. Improvements in the effects were noted after 8 weeks and at 6 months (1.8; CI 95% 1.50 to 2.09) follow-up. Similar improvements were also found in the percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status, and quality of life. CONCLUSION: Extracorporeal shockwave therapy has added effects on corticosteroid injection for improving pain, percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life in people with chronic lateral epicondylitis.

A novel sugar beet cyst nematode effector 2D01 targets the Arabidopsis HAESA receptor-like kinase.

Plant-parasitic cyst nematodes use a stylet to deliver effector proteins produced in oesophageal gland cells into root cells to cause disease in plants. These effectors are deployed to modulate plant defence responses and developmental programmes for the formation of a specialized feeding site called a syncytium. The Hg2D01 effector gene, coding for a novel 185-amino-acid secreted protein, was previously shown to be up-regulated in the dorsal gland of parasitic juveniles of the soybean cyst nematode Heterodera glycines, but its function has remained unknown. Genome analyses revealed that Hg2D01 belongs to a highly diversified effector gene family in the genomes of H. glycines and the sugar beet cyst nematode Heterodera schachtii. For functional studies using the model Arabidopsis thaliana-H. schachtii pathosystem, we cloned the orthologous Hs2D01 sequence from H. schachtii. We demonstrate that Hs2D01 is a cytoplasmic effector that interacts with the intracellular kinase domain of HAESA (HAE), a cell surface-associated leucine-rich repeat (LRR) receptor-like kinase (RLK) involved in signalling the activation of cell wall-remodelling enzymes important for cell separation during abscission and lateral root emergence. Furthermore, we show that AtHAE is expressed in the syncytium and, therefore, could serve as a viable host target for Hs2D01. Infective juveniles effectively penetrated the roots of HAE and HAESA-LIKE2 (HSL2) double mutant plants; however, fewer nematodes developed on the roots, consistent with a role for this receptor family in nematode infection. Taken together, our results suggest that the Hs2D01-AtHAE interaction may play an important role in sugar beet cyst nematode parasitism.

Health implications, distribution and source apportionment of heavy metals in road deposited dust of Jammu City in northern India.

Road deposited dust (RDD) is an important indicators of heavy metal contamination in urban areas. In this study, we measured eight heavy metals (V, Cr, Mn, Fe, Ni, Cu, Zn, and Pb) in RDD collected from 34 different locations in Jammu city represented by different land uses such as industrial, urban-residential, high-density traffic, and sub-urban locations, and evaluated their ecological and health risks. The ratio of metal concentrations in RDD to their respective background levels varied as: Cu (3.94) > Pb (3.75) > Zn (3.01) > Cr (1.75) > Ni (1.51) > Mn (1.40) > V (1.35) > Fe (1.1) suggesting Cr, Ni, Cu, Zn and Pb were enriched anthropogenically. Geospatial maps revealed a heterogeneous distribution of metals in Jammu city with metal(s) specific hotspots primarily localized around high traffic density locations and industrial clusters. The index of geoaccumulation indicated 32%, 26%, 20%, 9%, and 8%, of samples belonged to "moderately polluted" category for Zn, Cu, Pb, Cr, and Ni respectively. Health index (HI) showed low non-carcinogenic hazards of metal contamination to adults but a high hazard to children. Though the values of total carcinogenic risks (TCR) (6.53E-05 to 3.71E-04) considerably exceeded the USEPA acceptable levels (1 × 10-6 ≤ TCR <1 × 10-4) suggesting high carcinogenic risks of metal contamination to both adults and children. Besides potential ecological risk index (PERI) revealed that 56% of samples had PERI >40 suggesting "moderate to high ecological risk" of metal contamination in the Jammu city RDD.

Clinical (BMI and MRI) and Biochemical (Adiponectin, Leptin, TNF-α, and IL-6) Effects of High-Intensity Aerobic Training with High-Protein Diet in Children with Obesity Following COVID-19 Infection.

Objective: To find the clinical and biochemical effects of high-intensity aerobic training with a high-protein diet in children with obesity following COVID-19 infection. Methods: By using the block randomization method, the eligible participants were randomized into two groups. The first group received high-intensity aerobic training with a high-protein diet (Group A; n = 38) and the second group were allowed to do regular physical activities and eat a regular diet (Group B; n = 38) for 8 weeks. Clinical (basal metabolic index (BMI) and muscle-mass-cross-sectional area (CSA)) and biochemical (Adiponectin, leptin, TNF-α, and IL-6) measures were measured at baseline, on the 8th week, and at 6-months follow-up. Results: Baseline demographic and clinical attributes show homogenous presentation among the study groups (p > 0.05). After eight weeks of intervention, and at the end of 6-months follow-up, the basal metabolic index (BMI) (6.3) (CI 95% 4.71 to 7.88), mid-arm CSA (17) (CI 95% 14.70 to 19.29), mid-thigh CSA (13.10) (CI 95% 10.60 to 15.59), mid-calf CSA (11.3) (CI 95% 9.30 to 13.29), adiponectin (−1.9) (CI 95% −2.13 to −1.66), leptin (5.64) (CI 95% 5.50 to 5.77), TNF-α (0.5) (CI 95% 0.42 to 0.57), and IL-6 (0.21) (CI 95% 0.18 to 0.23) showed more improvement (p < 0.001) in Group A than Group B (p > 0.05). Conclusion: Overall, this trial found that high-intensity aerobic training with a high-protein diet decreased the BMI percentile and muscle mass (arm, thigh, and calf), and positively altered the biochemical variables in children with obesity.

Giant renal parapelvic cyst with pelvi-ureteric junction obstruction in an infant: challenges in diagnosis and laparoscopic management.

Renal parapelvic cysts (RPC) have an incidence of approximately 1%-3% in the general population. However, they rarely present in children with only two cases reported in literature. RPC are often misdiagnosed as it is difficult to distinguish them from hydronephrosis on preoperative imaging. We report a case of an infant with a giant RPC with associated pelvi-ureteric junction obstruction, who was managed successfully with laparoscopic complete excision of RPC and dismembered pyeloplasty. In our report, we discuss the challenges faced in the diagnosis and surgical management of this unusual case.

Comparative effectiveness study of low versus high-intensity aerobic training with resistance training in community-dwelling older men with post-COVID 19 sarcopenia: A randomized controlled trial.

OBJECTIVE: To find and compare the clinical and psychological effects of low and high-intensity aerobic training combined with resistance training in community-dwelling older men with post-COVID-19 sarcopenia symptoms. DESIGN: Randomized control trial. SETTING: University physiotherapy clinic. PARTICIPANTS: Men in the age range of 60-80 years with post-COVID-19 Sarcopenia. INTERVENTION: All participants received resistance training for whatever time of the day that they received it, and that in addition they were randomized into two groups like low-intensity aerobic training group (n = 38) and high-intensity aerobic training group (n = 38) for 30 minutes/session, 1 session/day, 4 days/week for 8 weeks. OUTCOMES: Clinical (muscle strength and muscle mass) and psychological (kinesiophobia and quality of life scales) measures were measured at the baseline, fourth week, the eighth week, and at six months follow-up. RESULTS: The 2 × 4 group by time repeated measures MANOVA with corrected post-hoc tests for six dependent variables shows a significant difference between the groups (P < 0.001). At the end of six months follow up, the handgrip strength, -3.9 (95% CI -4.26 to -3.53), kinesiophobia level 4.7 (95% CI 4.24 to 5.15), and quality of life -10.4 (95% CI -10.81 to -9.9) shows more improvement (P < 0.001) in low-intensity aerobic training group than high-intensity aerobic training group, but in muscle mass both groups did not show any significant difference (P > 0.05). CONCLUSION: Low-intensity aerobic training exercises are more effective in improving the clinical (muscle strength) and psychological (kinesiophobia and quality of life) measures than high-intensity aerobic training in post-COVID 19 Sarcopenia.

Optimization of pulmonary function, functional capacity, and quality of life in adolescents with thoracic burns after a 2-month arm cycling exercise programme: A randomized controlled study.

BACKGROUND: Burns to the thorax are at high risk for long-term pulmonary complications due to chest muscle contractures and chronic inflammation in both adolescents and young adults. Few studies have investigated the effects of arm cycling exercise in those individuals. For that reason, this study examined pulmonary function, functional capacity, and quality of life (QOL) in adolescents with thoracic burns subsequent to 2-month arm cycling exercise programme. METHODS: A single-blinded, two-month randomized prospective controlled study was carried out between July 2019 and March 2020 on thirty adolescents with chest burns aged 11-17 years. They were randomized into two equal groups (n = 15), traditional physiotherapy programme (control group), and arm cycling exercise plus traditonal physiotherapy (arm cycling exercise group) for 2 consecutive months. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), six-minute walk test (6MWT), and Pediatric Quality of Life Inventory (PedsQL) were measured in both groups at baseline and after 2-month after intervention. RESULTS: No statistical significance was detected at baseline between control and arm cycling exercise groups (FVC, p = 0.903, FEV1, p = 0.835, 6MWT, p = 0.817, and PedsQL, p = 0.612). 2 months after intervention showed statistical improvements in the arm cycling exercise group in all measures (FVC, p = 0.001, FEV1, p < 0.0001, 6MWT, p = 0.001, and PedsQL, p = 0.001) however, the control group showed statistical improvements in FVC, p = 0.044 and FEV1, p = 0.024 with non-statistically significant changes in 6MWT, p = 0.145 and PedsQL, p = 0.067. The arm cycling exercise group showed greater improvements than control group in the outcome measures (FVC, p = 0.034, FEV1, p < 0.017, 6MWT, p = 0.037, and PedsQL, p = 0.021). CONCLUSIONS: This prospective study clearly demonstrated positive and beneficial influences of two-month arm cycling exercise in the optimization of pulmonary functions, functional performance, and QOL in adolescents suffering from chest burns and thereby eliminating post-burn complications.

Clinical and physical efficiency of virtual reality games in soccer players with low back pain / Eficiencia de los juegos de realidad virtual en jugadores de futbol con dolor de espalda baja / Eficiência clínica e física de jogos de realidade virtual em jogadores de futebol com dor lombar

ABSTRACT Introduction: Virtual reality training (VRT) is an advanced technology that creates virtual games by a computer through specific software. It is a type of rehabilitation training commonly used in balance problems to treat musculoskeletal conditions. Objective: To determine and compare the effects of virtual reality games with those of core stabilization training on physical efficiency in soccer players with chronic low back pain. Methods: A randomized, double-blinded, controlled study was conducted on 60 LBP participants at a university hospital. The first group (n=20) received virtual reality (VR) training; the second group (n=20) received core stabilization (CS) training; and the third group (n=20) received conventional training exercises for four weeks. Scores of clinical and sports performance were measured at baseline, and after 4 weeks, 8 weeks and 6 months. Results: The baseline demographic and clinical characters did not show any significant differences (p>0.05) in the statistical analysis, which shows a homogenous population. Four weeks following the training, the VR training group showed more significant changes in clinical scores than the CS training and control groups (p≤0.001). The scores for sports performance also showed more significant improvement in the VR training group than in the other two groups (p≤0.001). The same improved clinical and sports performance changes were seen at 8 weeks and 6 months of follow-up in the VR training group, when compared to the other two groups (p≤0.001). Conclusion: This study suggests that training through virtual reality games results in long-term improvement in clinical and sports performance compared to other forms of training in soccer players with chronic low back pain.Level of evidence I b; Therapeutic studies - Investigation of treatment results.

RESUMEN Introducción: El entrenamiento de realidad virtual (VRT) es una tecnología avanzada, que crea juegos virtuales por computadora a través de un software específico. Es un tipo de entrenamiento de rehabilitación que se usa comúnmente en problemas de equilibrio para tratar afecciones musculoesqueléticas. Objetivo: Encontrar y comparar los efectos de los juegos de realidad virtual sobre el entrenamiento de estabilización central sobre la eficiencia física en jugadores de fútbol con dolor lumbar crónico. Métodos: Se realizó un estudio controlado, aleatorizado, doble ciego en 60 participantes con dolor lumbar en un hospital universitario. El primer grupo (n = 20) recibió entrenamiento de realidad virtual (VR), el segundo grupo (n = 20) recibió entrenamiento de estabilización central (CS) y el tercer grupo (n = 20) recibió ejercicios de entrenamiento convencionales durante cuatro semanas. Los puntajes de rendimiento clínico y deportivo se midieron al inicio del estudio, después de 4 semanas, 8 semanas y 6 meses. Resultados: Los caracteres demográficos y clínicos basales no mostraron ninguna diferencia significativa (p. 0,05) en el análisis estadístico lo que indica una población homogénea. Cuatro semanas después del entrenamiento, el grupo de entrenamiento de RV mostró cambios más significativos en las puntuaciones clínicas que los de entrenamiento de CS y los grupos de control (p≤0,001). Las puntuaciones de rendimiento deportivo también mostraron una mejora significativa en el grupo de entrenamiento de RV comparadas con los otros dos grupos (p≤0,001). Hubo los mismos cambios clínicos y de rendimiento deportivo a las 8 semanas y 6 meses de seguimiento en el grupo de entrenamiento de RV y en los otros dos grupos (p≤0,001). Conclusión: Nuestro estudio sugirió que el entrenamiento a través de juegos de realidad virtual mejoró el rendimiento clínico y deportivo más que otros entrenamientos en jugadores de fútbol con dolor lumbar crónico a largo plazo. Nivel de evidencia Ib; Estudios terapéuticos, investigación de los resultados del tratamiento.

RESUMO Introdução: O treinamento com realidade virtual (TRV) é uma tecnologia avançada que cria jogos virtuais para computador por meio de software específico. É um tipo de treinamento de reabilitação comumente usado em problemas de equilíbrio no tratamento de doenças musculoesqueléticas. Objetivo: Determinar e comparar os efeitos dos jogos de realidade virtual com o treinamento de estabilização central na eficiência física de jogadores de futebol com dor lombar crônica. Métodos: Estudo randomizado, duplo-cego e controlado realizado com 60 participantes com lombalgia em um hospital universitário. O primeiro grupo (n = 20) recebeu treinamento de realidade virtual (RV), o segundo grupo (n = 20) recebeu treinamento de estabilização central (EC) e o terceiro grupo (n = 20) recebeu exercícios de treinamento convencional por quatro semanas. Os escores de desempenho clínico e esportivo foram medidos no início do estudo e depois de 4 semanas, 8 semanas e 6 meses. Resultados: As características demográficas e clínicas basais não mostraram diferença significativa (p > 0,05) na análise estatística, o que indica população homogênea. Quatro semanas depois do treinamento, o grupo RV mostrou mudanças mais significativas nos escores clínicos do que os grupos EC e controle (p ≤ 0,001). Os escores de desempenho esportivo também mostraram melhora significativa no grupo RV do que nos outros dois grupos (p ≤ 0,001). As mesmas mudanças benéficas de desempenho clínico e esportivo foram observadas em 8 semanas e 6 meses de acompanhamento no grupo RV em comparação com os outros dois grupos (p ≤ 0,001). Conclusão: Este estudo sugere que o treinamento com jogos de realidade virtual resulta em melhora do desempenho clínico e esportivo a longo prazo do que outras formas de treinamento em jogadores de futebol com dor lombar crônica. Nível de evidência Ib; Estudos terapêuticos, Investigação dos resultados de tratamentos.

Effects of Postoperative Rehabilitation on Gait Parameters and Electromyography Variables in Acute and Chronic Anterior Cruciate Ligament Reconstruction Surgery in Football Players.

RESULTS: The results of the a-ACLR, c-ACLR, and control groups were compared. At 8 weeks following postoperative rehabilitation, the a-ACLR group shows more significant changes than the c-ACLR group (p < 0.001). At 6 and 12 months, there are normal values of kinematic and kinetic values in a-ACLR compared with the results of the control group (p < 0.001). CONCLUSION: The study showed that postoperative rehabilitation provides significant effects in the kinematic, kinetic, and EMG gait parameters in acute ACLR than chronic ACLR subjects. Early surgical intervention and postrehabilitation are mandatory to get the significant effects in the clinical parameters in acute and chronic ACL injury.

Prevalence and Nonpharmacological Interventions for Sarcopenia among Cirrhotic Patients.

Sarcopenia is the most common feature of hepatic cirrhosis characterized by progressive loss of muscle mass and function and increases permanently the mortality and morbidity rates among those patients. The incidence of sarcopenia in cirrhotic patients ranged 40-70% associating with impaired quality of life and augmented rates of infection. Based on these issues, this review is aimed at determining the prevalence and main causes of sarcopenia among cirrhotic patients and recognizing the recent diagnostic and physical treatment modalities that prevent risk factors for sarcopenia in those patients. No ideal modality is currently demonstrated for diagnosing sarcopenia in hepatic diseases, particularly cirrhosis; however, recent studies reported different diagnostic modalities for muscle function in different individuals including handgrip strength, skeletal muscle index, six-min walk test, liver frailty index, short physical performance battery, and radiological assessments for quadriceps and psoas muscles. Exercise training and therapeutic nutrition are strongly recommended for controlling sarcopenia in cirrhotic patients. The exercise program is designed and carried out on a frequent basis within an extensive scheduled time aimed at improving functional performance, aerobic capacity, and healthy conditions. Finally, a combination of exercise training and therapeutic nutrition is powerfully recommended to control sarcopenia in cirrhosis.