In vitro antibacterial activity of antibiotics and plant essential oils against Escherichia coli MTCC443 supported through the molecular docking and pharmacokinetics study.

Most of the Escherichia coli turned into serious pathogens or developed antibiotic resistance, mainly due to their ability to show different phenotypic traits. In order to overcome the resistance to these antibiotics, the use of essential oils (EOs) is of great significance against highly pathogenic microorganisms. This study has been made to compare the in vitro antibacterial activity and further validated the same through the molecular docking study of 13 antibiotics such as ciprofloxacin, chloramphenicol, erythromycin, ampicillin, cefotaxime, rifampicin, kanamycin, vancomycin, streptomycin, penicillin, nalidixic acid, trimethoprim, and polymyxin, and 10 EOs such as garlic, tulsi, neem, clove, thyme, peppermint, coriander, tea, lavender, and eucalyptus against the target protein (DNA gyrase) of E. coli MTCC443. E. coli Microbial Type Culture Collection 443 was found to be highly sensitive to ciprofloxacin (zone of inhibition [ZOI], 2.5 cm ±0.1) and chloramphenicol (ZOI, 1.8 cm ±0.1), whereas garlic oil (ZOI, 5.5 cm ±0.1) and coriander oil (ZOI, 4.4 cm ±0.1) were found comparatively most effective. Further, the in silico investigation observed the same; ciprofloxacin (binding affinity: -7.2 kcal/mol) and chloramphenicol (binding affinity: -6.6 kcal/mol). Penicillin (binding affinity: -4.2 kcal/mol) and polymyxin (binding affinity: -0.3 kcal/mol) were found to be least effective against the tested microbe, whereas vancomycin (binding affinity: +0.8 kcal/mol) had no effect on it. Garlic (binding affinity: -7.8 kcal/mol), coriander (binding affinity: -6.8 kcal/mol), peppermint (binding affinity: -6.2 kcal/mol), and neem (binding affinity: -6.2 kcal/mol) oil exhibited the potent antibacterial activity against E. coli MTCC443, whereas thyme (binding affinity: -6.1 kcal/mol), tea tree (binding affinity: -4.9 kcal/mol), and tulsi (binding affinity: -3.8 kcal/mol) oil were observed moderately effective. Eucalyptus (binding affinity: -2.9 kcal/mol) and lavender (binding affinity: -2.8 kcal/mol) oil were found to be the least effective among all the oils tested. The pharmacokinetics and networking were performed to the pharmacology of the potential compounds.

Evaluation of Glenoid Fossa Position in Class II Malocclusion Associated with Mandibular Retrusion and Class III Malocclusion Associated with Mandibular Protrusion.

Objective: This study examined the glenoid fossa in Class II and Class III malocclusions with mandibular retrusion and protrusion. Materials and Methods: A retrospective investigation examined 60 Class II and 60 Class III cephalometric radiographs. Cephalometric landmarks and glenoid fossa measurements were taken. Statistical analysis contrasted the two malocclusion groups' glenoid fossas. Results: Class II malocclusion had a much lower mean Sella-Nasion-Condylion (SNCd) angle (glenoid fossa sagittal position) than Class III (14.6° ± 1.9). Class II malocclusion had a lower mean Sella-Nasion-Gonion (SNGo) angle (32.5° ± 4.3) than Class III (36.2° ± 3.9). The SNCd angle and SNGo angle in both groups demonstrated a negative correlation, demonstrating a relationship between the glenoid fossa and the mandibular sagittal axis. Conclusion: The glenoid fossa location differs significantly between Class II malocclusion with mandibular retrusion and Class III with protrusion. Class II malocclusion has a posterior glenoid fossa, while Class III has a less posterior one. Understanding these links may help patients receive more personalized treatment.

Physiotherapy: A potential and novel treatment approach for phantom limb pain in post-amputee patients - A systematic review.

Objective: To evaluate the efficacy of conventional and novel non-pharmacologic, non-invasive therapeutic interventions in physiotherapy for the treatment of phantom limb pain (PLP) in post-amputee patients. Methods: A systematic search for the articles was conducted in multiple electronic databases such as PUBMED, Google Scholar, EMBASE, Cochrane library and Physiotherapy Evidence Database (PEDro), following the PRISMA method and only published articles from the last 12 years (2010-2022) evaluating the efficacy of different physiotherapy interventions for the treatment of PLP in post-amputee patients were included. The methodological quality and risk of bias of the articles were assessed and evaluated by two independent reviewers using the PEDro scale, Methodological index for non-randomized studies scale (MINORS), and Cochrane collaboration's assessment tool. Result: A total of 1840 articles were identified, out of which 17 articles (11 RCTs and 6 pilot studies) were ultimately chosen after the full-text screening. After reviewing the articles, evidence identified in RCTs and pilot studies indicates towards significant improvement in reducing the severity of PLP in post-amputee patients by using different physiotherapy interventions. Conclusion and discussion: Physiotherapy interventions with advance modalities and exercises can be used to increase the overall effectiveness of the treatment and to reduce the severity of phantom limb pain in post-amputee patients. However, due to the lack of consistent evidence for a given intervention, it becomes even more difficult to reach a majority consensus as to which intervention better assess all the mechanism of PLP thereby alleviating the problem of PLP in post-amputee patients. Therefore, more rigorous randomized controlled trials will be required in the future to reach a conclusion.

Kennedy Epitope (KE)-dependent Retrograde Transport of Efficiently Cleaved HIV-1 Envelopes (Envs) and its Effect on Env Cell Surface Expression and Viral Particle Formation.

Efficiently cleaved HIV-1 Envs are the closest mimics of functional Envs as they specifically expose only bNAb (broadly neutralizing antibody) epitopes and not non-neutralizing ones, making them suitable for developing vaccine immunogens. We have previously identified several efficiently cleaved Envs from clades A, B, C and B/C. We also described that truncation of the CT (C-terminal tail) of a subset of these Envs, but not others, impairs their ectodomain conformation/antigenicity on the cell surface in a CT conserved hydrophilic domain (CHD) or Kennedy epitope (KE)-dependent manner. Here, we report that those Envs (4 - 2.J41 and JRCSF), whose native-like ectodomain conformation/antigenicity on the cell surface is disrupted upon CT truncation, but not other Envs like JRFL, whose CT truncation does not have an effect on ectodomain integrity on the cell surface, are also defective in retrograde transport from early to late endosomes. Restoration of the CHD/KE in the CT of these Envs restores wild-type levels of distribution between early and late endosomes. In the presence of retrograde transport inhibitor Retro 2, cell surface expression of 4 - 2.J41 and JRCSF Envs increases [as does in the presence of Rab7a DN and Rab7b DN (DN: dominant negative)] but particle formation decreases for 4 - 2.J41 and JRCSF Env pseudotyped viruses. Our results show for the first time a correlation between CT-dependent, CHD/KE regulated retrograde transport and cell surface expression/viral particle formation of these efficiently cleaved Envs. Based on our results we hypothesize that a subset of these efficiently cleaved Envs use a CT-dependent, CHD/KE-mediated mechanism for assembly and release from late endosomes.

Harnessing Nature's Ingenuity: A Comprehensive Exploration of Nanocellulose from Production to Cutting-Edge Applications in Engineering and Sciences.

Primary material supply is the heart of engineering and sciences. The depletion of natural resources and an increase in the human population by a billion in 13 to 15 years pose a critical concern regarding the sustainability of these materials; therefore, functionalizing renewable materials, such as nanocellulose, by possibly exploiting their properties for various practical applications, has been undertaken worldwide. Nanocellulose has emerged as a dominant green natural material with attractive and tailorable physicochemical properties, is renewable and sustainable, and shows biocompatibility and tunable surface properties. Nanocellulose is derived from cellulose, the most abundant polymer in nature with the remarkable properties of nanomaterials. This article provides a comprehensive overview of the methods used for nanocellulose preparation, structure-property and structure-property correlations, and the application of nanocellulose and its nanocomposite materials. This article differentiates the classification of nanocellulose, provides a brief account of the production methods that have been developed for isolating nanocellulose, highlights a range of unique properties of nanocellulose that have been extracted from different kinds of experiments and studies, and elaborates on nanocellulose potential applications in various areas. The present review is anticipated to provide the readers with the progress and knowledge related to nanocellulose. Pushing the boundaries of nanocellulose further into cutting-edge applications will be of particular interest in the future, especially as cost-effective commercial sources of nanocellulose continue to emerge.

Combined effect of Brunnstrom's hand rehabilitation and functional electrical stimulation for improving hand function in patients with chronic stroke: A randomized controlled trial.

BACKGROUND: Motor recovery of the upper extremity is one of the most common challenging outcomes after stroke. OBJECTIVE: To find out the combined effects of Brunnstrom hand rehabilitation (BHR) and functional electrical stimulation for improving hand functions in patients with chronic stroke. STUDY DESIGN: Randomized controlled trial. METHOD: 25 participants, both male (n = 11) and female (n = 14), age group between 40 and 70 years were randomly divided into control group (n = 12) and experimental group (n = 13). The treatment protocol was continued 5 days per week, for 4 weeks. The experimental group received Brunnstrom hand training and functional electrical stimulation (FES) along with conventional physiotherapy. The control group received only conventional physiotherapy. Participants were evaluated at baseline and after 4 weeks of intervention. OUTCOME MEASURES: Fugl Meyer Assessment scale-upper extremity, Modified Ashworth scale, Handheld Dynamometer, and Jabsen Taylor Hand Function Test. Paired t-test was used to compare within-group variables and an independent t-test was used for between-group comparisons. P-value was set as 0.05 to minimize type-1 error. RESULTS: Statistically significant difference was obtained in favor of the experimental group undergoing FMA (p < .001), MAS (p = .004), JTHF (p = .018), and HHD (p < .001) in between-group analysis. However, both groups showed significant improvement [experimental group; FMA-UE (p < .001), MAS (p < .001); JTHF (p < .001), and HHD (p < .001), and control group; FMA-UE (p < .001), MAS (p < .001), JTHF (p < .001) and HHD (p < .001)] in within-group analysis at post-intervention. CONCLUSION: Brunnstrom hand rehabilitation and FES in combination were found to be more effective in improving hand function than conventional physiotherapy treatment. CLINICAL TRIAL REGISTRATION: URL: http://www.ctri.nic.in. No: CTRI/2019/06/019,905.

Gut brain regulation using psychobiotics for improved neuropsychological illness.

"Psychobiotics" are a novel class of probiotics that are beneficial to the health and functional efficiency of our brain and psychology. The main hold on command in ill conditions of the brain and psychology is overtaken by these psychobiotic bacteria (a dietary supplement) via the action/determined role of bacterial neurochemicals or neuroactive substances that are released by them in the intestinal epithelium after their ingestion. Although these psychobiotics flourish in the gut of the host consuming them, the effect is widely spread to the brain due to the communication between the gut and the brain via the bidirectional gut-brain axis. The nervous system involved in this directional process includes both the enteric nervous system and the central nervous system. With time, several corroborations have proved the effectiveness of psychobiotics in terms of mental illnesses and brain disorders. In the prevailing situation of the coronavirus pandemic, psychobiotics may serve as an aid because a majority of the population worldwide is already suffering from psychological issues due to changes in lifestyle and dietary habits, and in need of an immediate solution to cope with it. Moreover, the in silico approach is also vital for the development of biological relevance to neurosubstances.

Performance evaluation of external compound parabolic concentrator integrated with thermal storage tank for domestic solar refrigeration system.

The aim of this research was to develop a model for a solar refrigeration system (SRS) that utilizes an External Compound Parabolic Collector and a thermal energy storage system (TESS) for solar water heating in Chennai, India. The system parameters were optimized using TRNSYS software by varying factors such as collector area, mass flow rate of heat transfer fluid, and storage system volume and height. The resulting optimized system was found to meet 80% of hot water requirements for the application on an annual basis, with an annual collector energy efficiency of 58% and an annual TESS exergy efficiency of 64% for a discharge period of 6 h per day. In addition, the thermal performance of 3.5 kW SRS was studied by connecting it to an optimized solar water heating system (SWHS). The system was found to generate an average cooling energy of 12.26 MJ/h annually, with a coefficient of performance of 0.59. By demonstrating the ability to efficiently generate both hot water and cooling energy, the results of this study indicate the potential for utilizing a SWHS in combination with STST and SRS. The optimization of system parameters and the use of exergy analysis provide valuable insights into the thermal behavior and performance of the system, which can inform future designs and improve the overall efficiency of similar systems.

Terapia a laser de alta intensidade para rigidez muscular dos isquiotibiais: fundamentação e desenho do estudo para estudo controlado randomizado simples-cego / High-intensity laser therapy for hamstring muscle tightness: rationale and study design for a single-blinded randomized controlled trial

CONTEXTO: Sentar-se por muito tempo e um estilo de vida sedentário podem resultar em encurtamento dos isquiotibiais. Um declínio na atividade física regular pode levar a uma diminuição da flexibilidade do músculo em um adulto mais jovem. Aumentar a flexibilidade dos músculos isquiotibiais pode diminuir as possibilidades de lesões e prevenir a dor lombar. A aplicação da terapia a laser de alta intensidade (TLAI) tem demonstrado inúmeros benefícios para diversas condições. No entanto, até o momento, não hápesquisas publicadassobre a eficácia dessaterapia para melhorar o comprimento dos músculos isquiotibiais em adultos jovens saudáveis. Este artigo descreve o protocolo de estudo para investigar os benefícios do TLAI no tratamento da rigidez muscular dos isquiotibiais em adultos jovens. MÉTODOS: 136 indivíduos jovens saudáveis serão recrutados, pelo método de amostragem intencional, para participar de um estudo randomizado, simplescego e controlado por simulação. Os participantes recrutados serão divididos aleatoriamente em dois grupos, o grupo TLAIativo e o grupo TLAI placebo. A duração do tratamento será de 8 a 10 minutos por sessão em ambos os membros inferiores, em dias alternados, durante duas semanas. O teste de extensão ativa do joelho e o teste de sentar e tocar são as medidas de resultado que serão registradas na linha de base, no final do período pós-intervenção de 2 semanas. O valor de p ≤0,05 será considerado estatisticamente significativo. DISCUSSÃO: Os resultados do estudo fornecerão os dados para determinar se aTLAI seria uma futura intervenção não farmacológica não invasiva para reduzir a tensão muscular dos isquiotibiais em adultos jovens. REGISTRO DE ENSAIO: Registro de Ensaios Clínicos NCT05077761.

BACKGROUND: Prolonged sitting and a sedentary lifestyle may result in hamstring shortness. A decline in regular physical activity could lead to a decrease in the flexibility of the muscle in a younger adult. Increasing hamstring muscle flexibility could decrease the possibility of injuries and prevent low back pain. The application of high-intensity laser therapy (HILT) has proved to be innumerable benefits for many conditions. However, to date, no published research is available on the effectiveness of this therapy in improving hamstring muscle length in healthy young adults. This article describes the study protocol for investigating the benefits of HILT in treating hamstring muscle tightness among young adults. METHODS: 136 healthy young individuals will be recruited, by purposive sampling method, to participate in a randomized, single-blinded, sham-controlled study. Recruited participants will be randomly divided into two groups, the active HILT group, and the sham HILT group. The treatment duration will be 8-10 minutes per session, on both lower limbs, for alternate days a week, for two weeks. The active knee extension test and sit-toe and touch test are the outcome measures that will be recorded at baseline, end of the 2-week post-intervention period. The p-value ≤0.05 will be considered statistically significant. DISCUSSION: The study findings will provide the data to determine whether HILT would be a future non-pharmacological non-invasive intervention to reduce hamstring muscle tightness among young adults. TRIAL REGISTRY: Clinical Trials Registry NCT05077761.

Effectiveness of immersive virtual reality training to improve sitting balance control among individuals with acute and sub-acute paraplegia: A randomized clinical trial.

OBJECTIVES: Spinal cord injury (SCI) is a disabling condition with physical, psychological, and financial consequences. The study's goal is to compare the effectiveness of immersive virtual reality (VR) training in balance among individuals with incomplete paraplegia to that of functional electrical stimulation (FES). DESIGN: Two groups, randomized clinical trial. SETTING: Neurological Physiotherapy Out Patient Department, Tertiary Care Hospital. PARTICIPANTS: Eighteen people aged 18-60 years with incomplete SCI. INTERVENTIONS: VR training along with conventional physical therapy (CPT) and FES for Rectus Abdominis and Erector Spinae with CPT five times a week for 4 weeks. OUTCOME MEASURES: The outcome measures were Modified Functional Reach Test (mFRT) and Function in Sitting Test (FIST) to assess sitting balance and Spinal Cord Independence Measure III (SCIM III) for the level of independence. Assessments were taken before initiating treatment and at the end of the 2 and 4 weeks after treatment. Within-group analyses for the mFRT values were performed using Repeated Measures ANOVA test, and between-group analyses were performed using the independent t-test test. Friedman and Mann-Whitney U-tests were used for analyzing FIST and SCIM III. RESULTS: All variables (mFRT and FIST) improved significantly in both groups (P < 0.05), with the VR + CPT group showing a more significant result than the FES + CPT group (P value < 0.05), except for SCIM III. CONCLUSION: VR as an adjunct to CPT demonstrated proved to be an effective treatment to improve balance among individuals with incomplete paraplegia.Trial registration: Clinical Trials Registry India identifier: CTRI/2020/03/024080.

Collagen Application in Pediatric Superficial Burns: The Right Time!

Introduction Delayed presentation of burn patients, in a developing country with the patient being referred from one center to another higher one, is a common occurrence. Efficient management of such delayed burn wounds thus becomes critical to decrease the morbidity of the patient within economic constraints. The advantages of collagen dressing are numerous. However, there is scarce literature on the timing of its application. Traditionally, it is thought that collagen sheets should be applied within 24 hours of burns as the wound is still sterile. This thus becomes ironical as patients are presenting late. Hence, we studied retrospectively the result of collagen application in delayed presentation of burns. Methods A retrospective study was conducted in which records of pediatric patients of less than 10 years with less than 30% total body surface area scald burns were considered. Collagen dressing was done in all these patients. Presentation time from burns, timing of collagen application, status of wound at various check dresses, complication of burn wound, and total healing times were recorded. Appropriate statistical formulas were used to calculate significance levels for continuous and categorical variables. Result Fifty-three patients, 33 male and 20 female were studied. The most common cause of scald was hot water spillage from baths and cooking, with the anterior trunk being the most involved site. The mean time of presentation of the patient from burns is 71.74 hours and that of collagen application was 76.4 hours. Fourteen (25.4%) patients had wound complications in the form of soakage, fever, and pus. Eight patients had their collagen removed. The average healing time for patients with intact collagen was 12.15 days and that for those on daily dressing was 21.9 days. Conclusion Collagen should be preferred even when the patient presents after 24 hours of burns. A thoroughly washed wound is a necessary prerequisite before collagen application. Burn patients presenting after 3 days have a higher incidence of wound infection. No such time stamp of application of collagen sheets within 24 hours can thus be given for its use as the advantages of adhered and successful collagen dressings outweigh those on daily dressings.

Effect of Polyethylene Glycol and Activated Carbon Macroparticles on Thermal Conductivity of Paraffin Wax for Thermal Storage Applications.

Low thermal conductivity is the major obstacle for the wide range utilization of phase change materials (PCMs), especially organic PCMs, for most practical applications in thermal engineering. This study investigates the potential of enhancing the charging and discharging rates of organic PCM (RT44HC) by introducing polyethylene glycol (PEG) and activated carbon macroparticles (ACMPs). Different concentrations of PEG and ACMPs ranging from 0.3 wt% to 2 wt% were tested separately. The optimized concentrations found were used as dual reinforcements to attain the highest possible thermal conductivity. The specimens were tested for a complete charging-discharging cycle using an improvised thermal apparatus. Use of ACMP alone resulted in a minimal reduction in complete charging-discharging time due to the settlement of ACMPs at the bottom after 2-3 heating-cooling cycles. However, the addition of PEG with ACMPs exhibited a reduction in charging-discharging time due to the formation of a stable dispersion. PEG served as a stabilizing agent for ACMPs. The lowest charging-discharging time of 180 min was exhibited by specimens containing 1 wt% PEG and 0.5 wt% ACMPs which is 25% lower compared to bare PCM.

Biophysical and Biochemical Characterization of the Receptor Binding Domain of SARS-CoV-2 Variants.

The newly emerging SARS-CoV-2 variants are potential threat and posing new challenges for medical intervention due to high transmissibility and escaping neutralizing antibody (NAb) responses. Many of these variants have mutations in the receptor binding domain (RBD) of SARS-CoV-2 spike protein that interacts with the host cell receptor. Rapid mutation in the RBD through natural selection to improve affinity for host receptor and antibody pressure from vaccinated or infected individual will greatly impact the presently adopted strategies for developing interventions. Understanding the nature of mutations and how they impact the biophysical, biochemical and immunological properties of the RBD will help immensely to improve the intervention strategies. To understand the impact of mutation on the protease sensitivity, thermal stability, affinity for the receptor and immune response, we prepared several mutants of soluble RBD that belong to the variants of concern (VoCs) and interest (VoIs) and characterize them. Our results show that the mutations do not impact the overall structure of the RBD. However, the mutants showed increase in the thermal melting point, few mutants were more sensitive to protease degradation, most of them have enhanced affinity for ACE2 and some of them induced better immune response compared to the parental RBD.

Generation of soluble, cleaved, well-ordered, native-like dimers of dengue virus 4 envelope protein ectodomain (sE) suitable for vaccine immunogen design.

Dengue virus is transmitted by Aedes mosquitoes and dengue is endemic in many regions of the world. Severe dengue results in complications that may lead to death. Although some vaccine candidates are in clinical trials and one vaccine Dengvaxia, with restricted efficacy, is available, there are currently no specific therapies to completely prevent or treat dengue. The dengue virus structural protein E (envelope) exists as a head-to-tail dimer on mature virus, is targeted by broadly neutralizing antibodies and is suitable for developing vaccine immunogens. Here, we have used a redesigned dengue prME expression construct and immunoaffinity chromatography with conformational/quaternary antibody A11 to purify soluble DENV4 sE(A259C) (E ectodomain) dimers from mammalian expression system to ~99 % purity. These dimers retain glycosylation reported for native DENV E, display the three major broadly neutralizing antibody epitopes, and form well-ordered structure. This strategy can be used for developing subunit vaccine candidates against dengue and other flaviviruses.

Mucinous Carcinoma of the Skin: A Case Report.

Primary mucinous carcinoma of the skin is a rare malignant neoplasm showing predilection to the periorbital region. These tumours are indolent and low-grade, with a tendency for local, sometimes multiple, recurrences. Distinguishing between these primary neoplasms and the more frequent metastatic mucinous deposits on the skin from primaries in the breast and gastrointestinal tract constitutes a diagnostic dilemma. In this case report, we have put forth the findings of a 70-year-old male who presented with a slow-growing periorbital swelling and was subsequently diagnosed with mucinous adenocarcinoma. An extensive workup in search of another primary tumour failed to show a primary malignancy elsewhere and the diagnosis of primary mucinous adenocarcinoma of the skin was rendered. Keywords: case reports; mucinous carcinoma; Nepal; sialomucins.

Synthesis and characterization of zinc derivatized 3, 5-dihydroxy 4', 7-dimethoxyflavone and its anti leishmaniasis activity against Leishmania donovani.

This study reports the synthesis and characterization of zinc derivatized 3,5-dihydroxy 4', 7- dimethoxyflavone (DHDM-Zn) compound for the development of new antileishmanial agents. The interaction studies of DHDM with zinc were carried out by UV spectra and fluorescence spectra analysis. Characterization of the complex was further accomplished by multi-spectroscopic techniques such as FTIR, Raman, HRMS, NMR, FESEM-EDX. The morphological and topographical studies of synthesized DHDM-Zn were carried out using FESEM with EDX. Further, it was demonstrated that DHDM-Zn exhibited an excellent in vitro antagonistic effect against the promastigote form of L. donovani. In addition, the possible mechanisms of promastigote L. donovani cell death, by involvement of derivatized compound in arrest of the cell cycle in the G1 phase and residual cell count reduction were investigated. Promastigote growth kinetics performed in the presence of the derivatized compound revealed a slow growth rate. The combination of growth kinetics and cell cycle analysis, made it possible to interpret and classify the cause of leishmanial cell death accurately. These results support that zinc derivatized complex (DHDM-Zn) might work as a lead compound for designing and developing a new antileishmanial drug.

Terapia a laser de alta intensidade (Class IV) e fonoforese em gel de ibuprofeno para o tratamento de osteoartrite de joelho entre pessoas que vivem em terreno montanhoso: um protocolo de ensaio multicêntrico, duplo-cego randomizado / High-intensity laser therapy (Class IV) and ibuprofen gel phonophoresis for treating knee osteoarthritis among people living in hilly terrain: A randomized, double blind, multi-centre trial protocol

INTRODUÇÃO: Pessoas que vivem em terrenos íngremes com carga cíclica anormal podem levar à degeneração da cartilagem óssea. A terapia a laser de alta intensidade (TLAI) e a fonoforese trazem inúmeros benefícios aos pacientes com osteoartrite de joelho (OAJ). No entanto, ainda não está claro qual tratamento é eficaz entre eles na reabilitação de pacientes com OAJ. OBJETIVO: Verificar se a TLAI de 8 semanas não é pior que a fonoforese em gel de ibuprofeno (FGI) no tratamento de pacientes com osteoartrite de joelho que vivem em terreno montanhoso. MATERIAIS E MÉTODOS: Um total de 108 indivíduos com OAJ serão recrutados por amostragem aleatória simples para participar de um estudo randomizado, duplo-cego e controlado. Os indivíduos recrutados com OAJ serão divididos aleatoriamente em dois grupos, grupo TLAI (grupo experimental) e grupo FGI (grupo controle). A duração do tratamento de TLAI e FGI será de 8 minutos em uma sessão/articulação do joelho para cada dia, por 3 dias/semana até 8 semanas, além de seus exercícios convencionais por 30 minutos. O Western Ontario and Mc Master Universities Osteoarthritis Index, o algômetro digitalizado de pressão de dor e o questionário de 36 itens Short-Form Health Survey são as medidas de resultado que serão registradas ao término, no final do período pós-intervenção de 8 semanas. PERSPECTIVAS: Os resultados deste ensaio contribuirão para recomendações baseadas em evidências para a implicação clínica de que o TLAI não é pior que o FGI juntamente com a intervenção de exercício para tratar indivíduos com OAJ que vivem em terreno íngreme.

INTRODUCTION: People living in hilly terrain with abnormal cyclic loading could lead to bone cartilage degeneration. High-intensity laser therapy (HILT) and Ibuprofen gel phonophoresis (IGP) have innumerable benefits for patients with knee osteoarthritis (KOA). However, it is still unclear which treatment is effective among them in rehabilitating patients with KOA. OBJECTIVE: To verify whether 8-week HILT is no worse than the IGP in treating patients with knee osteoarthritis living in hilly terrain. MATERIALS AND METHODS: A total of 108 individuals with KOA will be recruited by simple random sampling to participate in a randomized, double-blind, controlled study. Recruited individuals with KOA will be randomly divided into two groups, the HILT group (experimental group) and the IGP group (active control group). The treatment duration of HILT and IGP will be 8 minutes in one session/knee joint for each day for 3 days/week up to 8 weeks in addition to their conventional exercises for 30 minutes. The Western Ontario and McMaster Universities Osteoarthritis Index, Digitalized pain pressure algometer, and 36-Item Short-Form Health Survey questionnaire are the outcome measures that will be recorded at baseline, end of the 8-week post-intervention period. PERSPECTIVES: The results from this trial will contribute to evidencebased recommendations for the clinical implication of whether HILT is no worse than IGP, along with exercise intervention for treating individuals with KOA living in hilly terrain.

Compound Heterozygous MYO5B Mutation, a Cause of Infantile Cholestasis: A Case Report.

Infantile cholestasis is a common clinical problem in early infancy characterised by impairment in bile formation and/or flow. It requires prompt evaluation for underlying aetiology to initiate appropriate management. Although biliary atresia remains the most important aetiology, metabolic and monogenic disorders are increasingly identified with advances in diagnostic genetic testing. Progressive familial intrahepatic cholestasis disorders characterised by defects in biliary canalicular transport are among the most common monogenic disorders of cholestasis. Homozygous or compound heterozygous mutation in the Myosin 5B gene leading to a progressive familial intrahepatic cholestasis-like phenotype with or without intestinal features of microvillus inclusion disease is a relatively recently identified disorder. The incidence of these newer variants of progressive familial intrahepatic cholestasis is not yet known due to the paucity of studies. We report an uncommon cause of refractory cholestasis reported in a girl who presented with severe pruritus as the primary manifestation.

Safeguarding from COVID-19: educating healthcare workers about the available protective equipment.

Aim: Coronavirus disease 2019 (COVID-19) is a viral illness which is transmitted through droplet spread and possibily the aerosol method. Older individuals are at higher risk compared with younger adults and children due to the presence of weaker immune functions. Healthcare workers are also at higher risk due to close proximity with the infected cases. Proper precautions and hand hygiene techniques can prevent the transmission of the disease. There is a dearth of evidence on how to manage the disease; therefore, protective measures might help to reduce the spread of infection. This article aimed to evaluate the preventive measure and use of protective equipment among healthcare workers and community settings. Subjects and methods: Various recent literature searched in the following databases-Medline/PubMed, CINAHL, Scopus-recommendations from centre for disease control and prevention (CDC) and World Health Organization (WHO) reports on preventive measures of COVID-19 were included. Results: After reviewing the previous literature, we summarized proper precautions and hygiene techniques, use of PPE and applicability of surgical and N95 (can block 95% small particles but not resistant to oil) masks to prevent the transmission of disease. Conclusion: This viewpoint can be considered as a unique example of information on infection control and protective measures. However, due to the lack of evidence, further research is required to compare the effectiveness of medical masks and N95 masks.