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BACKGROUND Paraspinal muscle strength and fatigue are considered important in low back pain (LBP) prevention and rehabilitation. High reliability of paraspinal strength and electromyographic (EMG)-fatigue parameters has not been universally reported. Moreover, the discriminative validity of these parameters requires further exploration, under the threat of potentially poor reliability of the methods examined. AIM To investigate the reliability and discriminative validity of paraspinal strength and EMG-related fatigue in subjects with recurrent LBP and healthy participants. METHODS Test-retest measurements were performed in 26 healthy and 66 LBP volunteers, for reliability. Paraspinal isometric maximal and mean strength were determined with a maximum voluntary isometric contraction (MVIC) protocol, performed in a custom-made device. For the fatigue test, participants performed a 60% MIVC level continuous isometric contraction of the paraspinals, in conjunction with EMG analysis from 4 muscle sites of the lumbar spine. Initial median frequency (IMF), the median frequency slope (MFslope), as well as the root mean square (RMS) slope EMG parameters were used as fatigue measures. Data were analysed with repeated measures ANOVA for test-retest differences. For reliability, the intraclass correlation coefficient (ICC3,1), standard error of the measurement (SEM) and the smallest detectable difference (SDD) were reported. Group-related differences for fatigue measures were analysed with a Multivariate Analysis of Covariance, with age, weight and strength as covariates. RESULTS Isometric strength presented statistically significant between-day differences (P < 0.01), however these did not exceed 10% (healthy: 7.2%/LBP-patients: 9.7%) and ICC reliability values were excellent, yet test-retest error was increased for the patient group (healthy: ICC3,1: 0.92-0.96, SEM: 5.72-5.94 Hz, SDD: 18.51%-18.57%/LBP-patients: ICC3,1: 0.91-0.96, SEM: 6.49-6.96, SDD: 30.75%-31.61%). For the frequency data, IMF reliability was excellent (healthy: ICC3,1: 0.91-0.94, SEM: 3.45-7.27 Hz, SDD: 9.56%-20.14%/patients: ICC3,1: 0.90-0.94, SEM: 6.41-7.59 Hz, SDD: 17.75%-21.02%) and of MF raw and normalised slopes was good (healthy: ICC3,1: 0.78-0.82, SEM: 4.93-6.02 Hz, SDD: 13.66-16.67%/LBP-patients: ICC3,1: 0.83-0.85, SEM: 6.75-7.47 Hz, SDD: 18.69%-20.69%). However, the reliability for RMS data presented unacceptably high SDD values and were not considered further. For discriminative validity, less MVIC and less steep MFslopes were registered for the patient group (P < 0.01). CONCLUSION Reliability and discriminative ability of paraspinal strength and EMG-related frequency parameters were demonstrated in healthy participants and patients with LBP.

Background and aims There is a growing body of evidence suggesting that the psychedelic plant tea, ayahuasca, holds therapeutic potential. Uthaug et al. (2018) demonstrated that a single dose of ayahuasca improved mental health sub-acutely and 4-weeks post-ceremony in healthy participants. The present study aimed to replicate and extend these findings. A first objective was to assess the sub-acute and long-term effects of ayahuasca on mental health and well-being in first-time and experienced users. A second aim was to extend the assessment of altered states of consciousness and how they relate to changes in mental health. Method Ayahuasca ceremony attendants (N = 73) were assessed before, the day after, and four weeks following the ceremony. Results We replicated the reduction in self-reported stress 4-weeks post ceremony, but, in contrast, found no reduction in depression. Also, increased satisfaction with life and awareness the day after the ceremony, and its return to baseline 4 weeks later, were replicated. New findings were: reduced ratings of anxiety and somatization, and increased levels of non-judging 4-weeks post-ceremony. We replicated the relation between altered states of consciousness (e.g., experienced ego dissolution during the ceremony) and mental health outcomes sub-acutely. The effects of ayahuasca did not differ between experienced and first-time users. Conclusion Partly in line with previous findings, ayahuasca produces long-term improvements in affect in non-clinical users. Furthermore, sub-acute mental health ratings are related to the intensity of the psychedelic experience. Although findings replicate and highlight the therapeutic potential of ayahuasca, this needs to be confirmed in placebo-controlled studies.

Oroxylum indicumalso known as ‘pucukbeko’ in Malaysia is often consumed as raw salad (ulam) due to the belief that the plant has numerous therapeutics activities that could improve health. Despite its medicinal potential,however, there has been very limited data on the plant’s safety and toxicity profile particularly for long term consumption. More depth insight and evidence-based studies are needed to verify its safety as a potential herb. Therefore, this study aims to investigate sub acute oral toxicity of ethanol extract of O. indicum in C57BL/6 male mice. Twenty-five mice (n=5) were orally administered at single dose of normal saline (control), vehicle (5% DMSO), extracts (100, 200 and 500 mg/kg bw), respectively in accordance with OECD Guideline 420 for 28 days. Liver, kidneys, heart, lungs, testes, spleen,and blood samples were collected to determine the effects of the extract on the relative organ weight, tissue changes, and blood profile alterations in the end of the study. The sub-acute toxicity results demonstrated no lethal effects and abnormal behavioural changes in mice treated with an expansion dose up to a maximum of 500 mg/kg. No significant (p>0.05) changes in body weights, relative organ weight and haematological evaluation. Nevertheless, there were significant differences (p

Background: Chikungunya is a mosquito-borne viral disease and presentation usually follows 3 phases: acute, sub-acute and chronic. Erratic, relapsing and incapacitating arthritis is the hallmark of chikungunya and many patients go on to develop post-chikungunya arthritis. Bangladesh experienced a major outbreak of chikungunya since April-May of 2017 which created a mass panic among people. The present study aimed to evaluate the course and pattern of musculoskeletal manifestations of patients who had been diagnosed as a case of chikungunya fever Methods: It was a prospective observational study, conducted in Department of Internal Medicine, BIRDEM General Hospital from October, 2017 to August, 2018. Total 100 patients suffering from chikungunya were selected and data were collected by interview using a semi-structured questionnaire and medical records analysis. These patients were followed up after 3 weeks and 3-months of symptom onset and musculoskeletal features were recorded. Results: A total 100 patients were studied and among them female patients were 54%. Mean age of the patients was 49.7 years. Eighty-three patients were managed from outpatient department. All of the patients had history of fever and joint pain at the onset. Among 100 patients, musculoskeletal symptoms resolved in 23 patients within the acute phase and 77% went through sub-acute phase. Twenty six percent patients entered into chronic phase. Conclusion: Study revealed that for one-fourth patients, musculoskeletal manifestations resolved in acute phase, three-fourth patients entered in sub-acute phase and one-fourth patients entered in chronic phase. BIRDEM Med J 2021; 11(3): 166-171

BACKGROUND & OBJECTIVE Stroke is a very common neurological condition affects various aspects of health. The primary objective of this study was to find out the frequency of functional disability and cognitive impairments in Sub-acute Stroke patients. MATERIAL AND METHODS A cross-sectional survey was conducted on 112 Sub-acute Stroke patients in Karachi, Pakistan. Using Barthel Index (BI) and Mini-Mental State Examination (MMSE) test was used to find out the frequency of functional disability and cognitive impairments of Sub-acute Stroke patients. RESULTS The correlation of BI scores with MMSE scores for the Male gender was 0.576 whilst the correlation of BI scores with MMSE scores for the Female gender was 0.440. The severity of functional disability concerning age groups assessed P-value was 0.026 using Chi-Square Test. The severity of functional disability (BI severity) concerning gender, P-value was found 0.097 using the same test. CONCLUSION Functional Disability is directly linked with age. However, there was no linkage established between Cognitive Impairment and age as well as gender. On close inspection, there was a trend between Functional disability and gender but not statistically significant.

Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22 years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study’s findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.

Tobacco consumption may pose a very serious threat to the physiological state of the body; yet, fewer records have been documented in that regard. We investigated the impact of aqueous extract of t...

AIMS This review aimed to synthesise evidence on the impact of communal dining and/or dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in hospital (acute or subacute), rehabilitation and residential aged-care facility settings. METHODS Five electronic databases were searched in March 2020. Included studies considered the impact of communal dining and/or dining room enhancements on outcomes related to malnutrition in hospital (acute or subacute), rehabilitation and residential aged care facility settings. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality checklist. Overall quality was assessed using GRADEpro software. Outcome data were combined narratively for communal dining and dining room enhancements respectively. RESULTS Eighteen articles from 17 unique studies were identified. Of these studies, one was a randomised control trial (moderate quality) and 16 were observational studies (all low quality). Communal dining interventions (four studies, n = 490) were associated with greater energy and protein intake and higher measures of quality of life than non-communal mealtime settings. Dining room enhancement interventions (14 studies, n = 912), overall, contributed to increased intake of food, energy, protein and fluid. CONCLUSIONS Results indicate that communal dining and/or dining room enhancement has a positive impact on several outcomes of interest, however, most available evidence is of low quality. Therefore, there is a need for further large-scale, well-designed experimental studies to assess the potential impacts of these interventions.

Byrsocarpus coccineus is an indigenous herb widely dispersed in tropical Africa and commonly known as Crimson thyme. The leaf and root of the plant is noted to possess medicinal benefits in traditional medicine of the Western part of Nigeria. The plant has been reported to possess analgesic, antiplasmodial, inflammatory, antidiarrhic and antipyretic activities. The present study was therefore aimed at determining the sub-acute toxicity of ethanolic leaf extract of Byrsocarpus coccineus. The ethanolic leaf extract of the plant was administered orally at 250, 500, and 1000 mg/kg to three groups A, B and C of Wistar rats respectively for 14 days while the control group D was administered orally with 3ml/kg of distilled water. Blood samples were then obtained from the anaesthetized rats for haematology and serum biochemistry. The result obtained from serum analyses showed a significant increase (p

For centuries honey has been regarded as wonderful gift of nature in which the properties of an excellent food, beneficial alike to adults and children, are combined with medicinal properties. Surprisingly, its sub-acute effect on coagulation is unknown. Hence; this present study aims at evaluating the effects of raw honey on coagulation in albino wistar rats. Thirty (30), 3-4 months old albino wistar rats both males and females were used for the study. The experimental animals were divided into five (A, B, C, D, E) groups with six rats per group. The test groups (B-E) were gavaged with graded doses (625, 1250, 2500, 5000 mg/kg body weight) respectively of the raw honey once daily for nine days. Group A served as control. Two (2) animals were bled from each group after 3, 6 and 9 days through the ocular plexus. Four (4) ml of venous blood was collected. Two (2) ml was delivered into 0.25ml trisodium citrate anticoagulant bottle for determination of Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT). The remaining two (2) ml was delivered into K3EDTA anticoagulant bottle for platelet value determination. There was no statistical significant difference (P > 0.05) recorded in all the parameters investigated among the test groups when compared with the control group on Day 3. However, group B revealed a statistical significant decrease (P < 0.05) in PT when compared with the control group on Day 6. In addition, no statistical significant difference (P>0.05) was recorded on Day 9 when all the parameters investigated among the test groups were compared with the control group. Furthermore, there was no exposure related statistical significant difference (P>0.05) in the test groups in PT and APTT in the ANOVA. However, there was a time related significant difference (P

Background Although cesarean delivery is one of the most commonly performed surgical procedures, robust data regarding post-cesarean pain is still lacking. Recent studies showed an association between pain upon local anesthetic (LA) injection for spinal anesthesia, or the use of a "three simple questions", and acute post-cesarean pain. Nevertheless, these assessments have yet to be validated further, despite their relative ease of use. We aimed to assess the association between pain score upon LA injection with acute post-cesarean pain after 24 hours at rest (primary outcome) and sub-acute post-cesarean pain lasting for 4 weeks or more (secondary outcome). Methods Women undergoing cesarean delivery under spinal anesthesia were given pre-operative questionnaires on pain and psychological vulnerability. We also assessed the pain score upon LA injection and mechanical temporal summation. Univariate and multivariable logistic regressions were performed. Results The incidence of moderate-to-severe acute post-cesarean pain at 24 hours was 21.0% (95% CI=16.6-27.6%) (48 of 217 patients). Pain score upon LA injection was not significantly associated with acute post-cesarean pain after 24 hours at rest (unadjusted OR=1.10, 95% CI=0.95-1.27, P=0.21). However, pain score upon LA injection was significantly associated with sub-acute post-cesarean pain (adjusted OR=1.29, 95% CI=1.07-1.55, P=0.0089) with significant covariate of increased pre-operative central sensitization inventory (CSI) scores (adjusted OR=1.05, 95% CI=1.01-1.09, P=0.0111; area under the curve (AUC)=0.691). Conclusion There was no association between increased pain score upon LA injection and acute post-cesarean pain, but it was associated with sub-acute post-cesarean pain. Further work is needed to define pain score upon LA injection as a convenient pragmatic measure of risk stratifying patients predisposed to sub-acute post-cesarean pain.

Background Robot assisted upper limb (UL) therapy has been identified as an intervention with the potential to help improve the amount of practice performed by stroke survivors. Objectives This study aimed to measure the amount of UL practice (i.e., repetitions, duration, intensity) performed by subacute stroke survivors, in particular those with severe UL impairment, pre and post implementation of robot assisted upper limb therapy (RT-UL) into an inpatient rehabilitation setting. Methods Two observational study phases (pre-RT-UL and post-RT-UL) were undertaken of occupational therapy and physiotherapy sessions performed by subacute stroke survivors. Upper limb tasks observed and recorded in therapy were classified as either impairment-related therapy or activity-related. Results In the pre-RT-UL observational phase, 7 subacute stroke survivors were observed across 11 days involving 25 therapy sessions. Post-RT-UL, 12 subacute stroke survivors were observed across 12 days involving 29 therapy sessions. There were no significant differences in characteristics of patients observed in each phase (p > .05). The mean difference (95% CI) between pre and post RT-UL for repetitions (reps) (569 (1 to 1136) and intensity (7 (4–11)) reps/min of practice increased for all patients, including those with severe UL impairment (337 (37–638)) reps and 8 (2–14) reps/minute, with the duration of therapy unchanged. Conclusions This is the first study to have observed an increase in UL practice with the inclusion of RT-UL as part of routine clinical practice. This increase in practice is considered to be due to RT-UL providing highly supportive and expeditious semi-supervised practice. Notably, RT-UL was able to be implemented within the existing organisational structures with only basic training of therapy staff. IMPLICATIONS FOR REHABILITATION Robotics presents as a viable intervention to increase the amount and intensity of upper limb practice performed by stroke survivors in routine clinical practice Robotics were able to be implemented within the existing organisational structures with only basic training of therapy staff

Introduction: The essential oils of Xylopia aethiopica fruits have been reported to possess numerous biochemical effects. However, no toxicological data is available regarding the safety evaluation of the essential oils from the plant spice. The present study was performed to evaluate the safety of essential oils from X. aethiopica (XAEO) fruit by acute and sub-acute oral toxicity studies in experimental rodents. Methods: In assessing the safety of XAEO, acute and sub-acute oral toxicity tests were performed following OECD guidelines 425 and 407, respectively, with slight modifications. At the end of each test, hematological and biochemical analysis of the collected blood was performed. Histopathological examination of vital organs of the animals was conducted for gross findings and for comparison to controls. Results: In acute oral toxicity, signs of toxicity were observed in the initial period of the experiment which culminated in the death of the mice before the end of the experiment. The sub-acute test observations indicated that generally, there were no significant differences (p

Objective: This study aimed to evaluate acute and sub-acute oral toxicity of ethanol extract of Clinacanthus nutans leaves in Swiss mice. Methods: Acute oral toxicity study was performed as per OECD-423 guidelines. Sub-acute oral toxicity study was performed as per OECD-407 guidelines. The extract was dissolved in 10% dimethyl sulfoxide and administered orally, while the control group received only the vehicle. Results: The acute oral toxicity test on mice showed that this extract was well tolerated up to LD50 5000 mg/kg body weight/day oral dosage level and non-toxic to mice under the present experimental conditions. The sub-acute toxicity study was carried out on mice with the oral dosage of the extract from 100 mg/kg–500 mg/kg body weight/day and 5000 mg/kg body weight/day for 28 d. The results showed that this extract did not induce death or adverse effects in activity, feed consumption or body weight gain. There were not significant changes in heamotological and biochemical parameters between control and experiment groups. Conclusion: Thus, Clinacanthus nutans leaf has a very low toxicity value.

Despite the reported favorable patency of stents in the treatment of femoropopliteal lesions, concern regarding stent fracture is increasing. Development of pseudo-aneurysm by stent fracture is rare and has been reported to occur in the chronic phase owing to mechanical fatigue. Here, we present the first report of a pseudo-aneurysm caused by stent fracture in the “sub-acute” phase after endovascular therapy for in-stent restenosis lesion. A 79-year-old man underwent endovascular therapy for an in-stent restenosis lesion of the right superficial femoral artery. Echography 48 days after the treatment showed a saccular pseudo-aneurysm at the proximal stent site, suggestive of stent fracture. Angiography confirmed the pseudo-aneurysm caused by stent fracture. A self-expandable endoluminal stent graft was deployed, which showed complete resolution of the pseudo-aneurysm. A pseudo-aneurysm caused by stent fracture can occur in the “sub-acute” phase after endovascular therapy for in-stent restenosis lesions.

Objectives Does adapted cardiac rehabilitation (CR) improve the physical behaviours of people with mild-to-moderate stroke in the sub-acute recovery phase using a compositional data analysis (CoDA) approach? Design Before-after. Setting University Hospitals of Leicester, Glenfield Hospital, UK. Participants 24 individuals completed CR and provided valid physical activity (PA) data (mean (SD) 63.1 (14.6) years, 58% male (14/24)). Intervention 6-week adapted CR program within 6-months of stroke. Main outcome measures Physical behaviours were assessed using waist-worn accelerometry. Step count, stationary time (ST), light PA (LPA), and moderate-to-vigorous PA (MVPA) were compared pre post CR using conventional analyses and CoDA. Analysed compositions were: Waking day (ST, LPA, MVPA); ST (1–9-minutes, 10–29-minutes, ≥30-minutes bouts); and MVPA (1–4-minutes, 5–9-minutes, ≥10-minutes bouts). Results Following CR, patients took significantly more steps (mean (SD) 3255 (2864) vs 3908 (3399) steps/day, P = 0.004) and engaged in more bouts of MVPA lasting ≥5 and ≥10-minutes (≥5-minutes: mean (SD) 0.7 (1.4) vs 1.2 (1.8) bouts/day, P = 0.008). Using CoDA, no changes in waking day or ST compositions occurred. For waking day, 42% (10/24) increased their LPA and MVPA at the expense of ST. For ST, 33% (8/24) increased their short bouts at the expense of medium and long bouts. For MVPA, 13% (3/24) increased their medium and long bouts at the expense of short bouts. Conclusion People with stroke in the sub-acute stage of recovery exhibited low levels of PA. CR appears to be an effective intervention to increase step count but did not alter the overall proportion of time individuals spent being sedentary, or engaging in LPA or in MVPA. Registration ISRCTN65957980.

Background Cerebrovascular events (CVEs) are not uncommon complications of transcatheter aortic valve replacement (TAVR). Our study aimed to determine the predictors of peri-procedural and sub-acute CVEs following TAVR. Methods Using the Japanese multicenter registry, we evaluated 1613 patients undergoing TAVR between October-2013 and July-2016. Occurrences of 24-hour and 1- to 30-day CVEs were evaluated to clarify the predictors of CVEs following TAVR. Results The mean age was 84.4 years and mean Society of Thoracic Surgeons score was 8.3%. Overall 24-hour and 30-day CVE rates were 1.2% and 2.7%, respectively. A multivariate analysis demonstrated that independent predictor of 24-hour CVEs was index aortic valve area (iAVA) [adjusted OR (adjusted-OR), 0.001; 95% CI, 0.001–0.13; p = .005]. The receiver operator curve derived cut-off value of iAVA for the prediction of 24-hour CVEs was 0.40 cm2/m2. In contrast, independent predictors of 1- to 30-day CVEs were paroxysmal atrial fibrillation (PAF; adjusted-OR, 3.35; 95% CI, 1.36–8.27; p = .009) and iAVA after TAVR (adjusted-OR, 0.11; 95% CI, 0.02–0.66; p = .02). Consequently, independent predictors of 30-day CVEs were prior stroke (adjusted-OR, 2.18; 95% CI, 1.07–4.45; p = .03), PAF (adjusted-OR, 2.18; 95% CI, 1.05–4.56; p = .04), and prior coronary artery disease (adjusted-OR, 1.88; 95% CI, 1.01–3.48; p = .05). Conclusions Within 24 h, small iAVA impacted the increased risk of CVEs, whereas PAF and iAVA after TAVR impacted the increased risk of 1- to 30-day CVEs following TAVR. The mechanism of CVEs might differ according to onset.

With the changing times, it is essential integrate behavioral health within the primary care of patients. The need is based on the research that links a number of health issues being directly to su...

The present study was carried out to evaluate the acute and sub-acute toxicity of Algerian Peganum harmala L. seeds (Zygophyllaceae). For the acute toxicity assessment, oral administration of P. harmala crud extract to mice in single doses of 0-12 g/kg caused dose-dependent general behavior adverse effects and mortality with LD50 of 2,86 g/kg. In the sub-acute study, daily oral administration of the crude aqueous extract for 28 consecutive days did not result no mortality. However, our results showed a significant difference in organs weights between control and treated animals. In the biochemical analysis, significant changes occurred in Bilirubin, uric acid (UA) and alkaline phosphatase (ALP) in the treated animals when compared to the control ones. Hematological analysis showed differences in WBC count and Hemoglobin estimation. However, urinalysis was negative for all parameters except Glucose in the treated group. Pathologically, a few gross abnormalities and histological changes were observed in hepatic and nephritic tissues. Keywords: Peganum harmala L., Acute and Sub-Acute Toxicity, Hematological parameters, Biochemical parameters

Background: Intensive rehabilitation is one of the most important aspects of care for people with stroke, and there is evidence that it leads to better recovery and higher levels of independence. H...

Background: Group therapy has shown benefit in language recovery in patients with aphasia (PWA). However, many in the field question its role in improving quality of life for PWA, as well as whethe...

Background: Cordyla pinnata (C. pinnata) is commonly used in traditional medicine for the treatment of various ailments. The aim of this study was to assess the toxic and safety potentials of the methanol extract of C. pinnata in rats. Methods: The methanol extract of C. pinnata was administered to the rats orally once daily at a dose of 0, 150, 300 or 600 mg/kg, body weight for 21 days. The toxicity was assessed using mortality rate, clinical signs, body and organ weights, hematological and serum chemistry indices. Results: The extract at 150, 300 or 600 mg/kg significantly decreased (p

Aims: Although Melanthera scandens is a plant widely used in traditional medicine for the management of seizures, stomach ulcers and sores, dysmenorrhea, diabetes and malaria, there was scanty information about its safety. There was, therefore, a need to evaluate the sub-acute and subchronic toxicity studies of this plant which would reflect on its safety. Methodology: This was an experimental laboratory study. The research was conducted at Kampala International University-Western Campus at the Pharmacology laboratory from February to June 2017. The sub-acute toxicity was evaluated after administering daily oral doses of M. scandens crude extract (250, 500 and 1000 mg/kg) for 28 days and 90 days for subchronic study, after which the effect on haematological, biochemical and histopathological parameters were assessed in male and female Wistar rats (five of each sex). Results: Sub-acute toxicity results revealed that there was a significant decrease in the AST between the male Wistar rats that received 250 mg/kg (P= .005) and those that received 500 mg/kg (P= .05) as compared with the control group. Subchronic studies showed a significant increase in ALP (P= .05) at 1000 mg/kg compared with 500 mg/kg. Terminal necropsy did not reveal any treatment-related histopathological findings. There were also no toxicologically significant treatment-related effects on haematological parameters. The sub-acute toxicity results suggest that doses of 250mg/kg and 500mg/kg are safe and could be hepatoprotective due to reduced levels of AST and ALP, while the subchronic toxicity study results suggest that doses greater than 1000 mg/kg could be toxic to the plasma membrane, liver cells or endoplasmic reticulum due to increased ALP levels at this dose. Conclusion: The M. scandens crude extract did not cause significant toxicity on haematological and histopathological indices, after sub-acute and subchronic administration in Wistar rats.

Introduction: The effect of eugenol on white blood cells (WBCs ) and corticosteroneis known. However, pharmacological properties and activities of eugenol such as anti-inflammatory, antioxidant, anesthetic, muscle relaxant, improved motor coordination, and increased red blood cells were reported in stress - induced rats. Objective: To evaluate the effect of eugenol on WBCs in sub -acute restraint stress-induced Wistar albino rats. Materials and Methods: Female Wistar albino rats (n = 30) weighing (150–220 g) were divided into five groups with six animals in each group, Group I: normal control; II : vehicle polyglycerol treated (PG); III: eugenol treated alone - TA (150 mg/kg/i.p for 15 days); IV : stress -induced (SA-stress alone), and V: stress followed by treated (T/S) with. Blood samples were collected at the end ofthestudyand total leucocyte count (TLC), differentiation leucocyte count (DLC), platelet count (PC) and concentration of corticosterone were estimated. Results: The TA group showed significant (p group. The platelet count was significantly less in the SA group as compared to T/ S group (p effect of eugenol on DLC did not show a significant difference with respect to neutrophil and lymphocytes count in T/S groups, when compared with other groups, whereas, no significant differences were observed between basophils, monocytes, and eosinophils of T/S when compared with SA group. No significant differences were observed in corticosterone levels in all groups. Conclusion: Acute restraint stress induced distribution of WBC was not significantly attenuated by eugenol and no changes were observed in corticosterone level. However, eugenol increases platelet aggregation. Keywords: Stress, Eugenol, Total leukocyte count, Differentiation leukocyte count, Platelets, Corticosterone.

Asthma is a chronic respiratory disease. It is an inflammatory condition of the lower airways that affects around 275–300 million people globally and 25 to 30 million people in India. It can attack all age groups and is characterised by recurrent attacks of breathlessness, wheezing and coughing, which may vary from person to person in severity and frequency. It is caused by inflammation of air passages, hypersensitivity to allergens, pulmonary oedema and congestion of lungs. This case report is an evidence of successful treatment of sub-acute exacerbations of bronchial asthma by using homoeopathic medicine based on acute totality of the case. The case of a 32-year-old woman with bronchial asthma is reported here who was treated with Blatta orientalis 30C. All investigations and pulmonary function tests (spirometry) indicated the diagnosis to be bronchial asthma with moderate obstruction of small airways. After case taking, Blatta orientalis 30C was prescribed, following which, after 6 months of treatment, patient felt better in all aspects with reduction in the number of asthma attacks and marked improvement in Elizabeth Juniper's Asthma Control Questionnaire Score and other investigations.

Transient cerebral ischemia followed by reperfusion in an infarcted brain comes with predictable acute and chronic morphological alterations in neuronal and non-neuronal cells. An accurate delineation of the cerebral infarct is not a simple task due to the complex shapes and indistinct borders of the infarction. Thus, an exact macroscopic histological approach for infarct volume estimation can lead to faster and more reliable preclinical research results. This study investigated the effect(s) of confounding factors such as fixation and tissue embedding on the quality of macroscopic visualization of focal cerebral ischemia by anti-microtubule-associated-protein-2 antibody (MAP2) with conventional Hematoxylin and Eosin (HE) staining serving as the control. The aim was to specify the most reliable macroscopic infarct size estimation method after sub-acute focal cerebral ischemia based on the qualitative investigation. Our results showed that the ischemic area on the MAP2-stained sections could be identified macroscopically on both cryo-preserved and paraffin-embedded sections from both immersion- and perfusion-fixed brains. The HE staining did not clearly depict an infarct area for macroscopic visualization. Therefore both immersion-fixed and perfused-fixed-MAP2 stained sections can be used reliably to quantify cerebral infarcts.

To decrease the Vicia faba beans cooking time, some chefs added ethylene diamine tetra-acetic acid (EDTA) during the cooking process. This study addressed the effect of sub-acute and chronic administrations of faba bean's cooking media containing EDTA (C.M./EDTA) on hepato-renal functions in mice. Ninety male mice were divided into three groups (n = 30). The group 1 (Gp1) divided into Gp1a and Gp1b, both were served as control for sub-acute and sub-chronic treatments. Gp2 divided into Gp2a and Gp2b then administered with 200 µl of C.M. for 15 and 90 days, respectively. Gp3 divided into Gp3a and Gp3b then administered 200 µl of C.M./EDTA (10 mg/kg) for 15 and 90 days, respectively. Hematological, biochemical, and histopathological alterations were investigated. The results showed that sub-acute administration of C.M./EDTA did not show any signs of toxicity, however, sub-chronic administration showed substantial toxicity evidenced by alterations in some biochemical and histological investigations.

Background: Intestinal malrotation refers to the partial or complete failure of rotation of midgut around the superior mesenteric vessels in embryonic life. Arrested midgut rotation results due to narrow-based mesentery and increases the risk of twisting midgut and subsequent obstruction and necrosis. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist, and CT scan showed dilated large and small intestine segments with air-fluid levels and twisted mesentery around superior mesenteric artery and vein indicating "whirlpool sign". In our patient Case presentation: 42 years old male who presented to the emergency department with acute onset of pain in the RUQ, vomiting, and absolute obstipation for the last 2 days. This patient had a history of similar two episodes of sub-acute intestinal obstruction in the last 6 months which has been managed conservatively. The patient underwent an elective exploratory laparotomy after 2 days of failed conservative management. Operative findings included the presence of adhesive bands in the RUQ (Ladd's Band), volvulus of the mid-portion of the small bowel in a clockwise fashion, and multiple intraabdominal adhesions and empty RIF and caecum pulled up in RUQ. We subsequently performed a Ladd's procedure, multiple adhesiolysis, and caecopexy and the patient had an uneventful recovery with eventual discharge on postoperative day 12. This case report reviews the incidence of malrotation in adults. It also high Conclusion: lights the difficulty in diagnosing midgut volvulus in the adult population given the nonspecific, insidious symptoms, therefore, prompting awareness of its existence and a high degree of clinical suspicion. Malrotation should be considered in the differential diagnosis in patients presented with acute abdomen and intestinal ischemia.

Regulatory limits for shellfish toxins are required to protect human health. Often these limits are set using only acute toxicity data, which is significant, as in some communities, shellfish makes up a large proportion of their daily diet and can be contaminated with paralytic shellfish toxins (PSTs) for several months. In the current study, feeding protocols were developed to mimic human feeding behaviour and diets containing three dose rates of saxitoxin dihydrochloride (STX.2HCl) were fed to mice for 21 days. This yielded STX.2HCl dose rates of up to 730 µg/kg bw/day with no effects on food consumption, growth, blood pressure, heart rate, motor coordination, grip strength, blood chemistry, haematology, organ weights or tissue histology. Using the 100-fold safety factor to extrapolate from animals to humans yields a dose rate of 7.3 µg/kg bw/day, which is well above the current acute reference dose (ARfD) of 0.5 µg STX.2HCl eq/kg bw proposed by the European Food Safety Authority. Furthermore, to reach the dose rate of 7.3 µg/kg bw, a 60 or 70 kg human would have to consume 540 or 630 g of shellfish contaminated with PSTs at the current regulatory limit (800 µg/kg shellfish flesh), respectively. The current regulatory limit for PSTs therefore seems appropriate.

Increased physical activity is required in patients with stroke that are hospitalized in the rehabilitation unit. This study investigated the association between the daily number of steps and walking independence in order to determine the cutoff value of daily number of steps for walking independence in hospitalized patients with sub-acute stroke. This cross-sectional observational study included 85 stroke patients admitted to the rehabilitation unit. The average daily number of steps, 6-minute walk test, and Fugl-Meyer assessment of the lower extremities were measured at 30 days after stroke onset. The category of walking independence was classified using the Functional Ambulation Category (FAC). The subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was conducted to investigate the association of daily number of steps with walking independence and a receiver operating characteristic curve was used to identify the cutoff value of daily number of steps for walking independence. The daily number of steps was independently associated with walking independence (odds ratio (OR); 1.001, 95% confidence interval (CI); 1.001–1.002, p = 0.009). The cutoff value of daily number of steps for independent walking was 4286 steps (area under the curve = 0.914, sensitivity of 0.731, and specificity of 0.949). The daily number of steps was associated with independent walking in hospitalized patients with sub-acute stroke. The daily number of steps may be a useful target in rehabilitation for patients with sub-acute stroke.

Background. Upper-limb impairment in patients with chronic stroke appears to be partly attributable to an upregulated reticulospinal tract (RST). Here, we assessed whether the impact of corticospinal (CST) and RST connectivity on motor impairment and skill-acquisition differs in sub-acute stroke, using transcranial magnetic stimulation (TMS)–based proxy measures. Methods. Thirty-eight stroke survivors were randomized to either reach training 3-6 weeks post-stroke (plus usual care) or usual care only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and contralesional cortical connectivity (surrogates for CST and RST connectivity, respectively) to weak pre-activated triceps and deltoid muscles with single pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity Index) and synergies (Fugl-Meyer upper-limb score). Results. Strength and presence of synergies were associated with ipsilesional (CST) connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar reaching skill beyond that expected from spontaneous recovery and occurred for both weak and strong ipsilesional tract integrity. Reaching ability, presence of synergies, skill-acquisition and strength were not affected by either the presence or absence of contralesional (RST) connectivity. Conclusion. The degree of ipsilesional CST connectivity is the main determinant of proximal dexterity, upper-limb strength and synergy expression in sub-acute stroke. In contrast, there is no evidence for enhanced contralesional RST connectivity contributing to any of these components of impairment. In the sub-acute post-stroke period, the balance of activity between CST and RST may matter more for the paretic phenotype than RST upregulation per se.

IntroductionThe diagnosis of bilateral varicocele and sub-acute appendicitis co-existing in the same patient is rare and we report the management of a patient who presented to Lily Hospitals Limited, Warri, Delta State, Nigeria with both recurrent right iliac fossa pain and scrotal pain.Case presentation A 27 year old male who presented with recurrent scrotal pain of 3 years duration and recurrent right iliac fossa pain of 2 years duration. Following evaluation, the diagnosis of bilateral varicocele and sub-acute appendicitis was made and he subsequently had open bilateral inguinal varicocelectomy and open appendicectomy at the same sitting under regional anaesthesia. He had uneventful post-operative recovery and was subsequently discharged.ConclusionA thorough evaluation of patients presenting with scrotal and right iliac fossa pains is invaluable to avoid missing the diagnosis of both bilateral varicocele and appendicitis when they co-exist in the same patient.

Background: The cerebrovascular episode is one of the significant causes of adult injury. This research will aim to investigate the effect of MRP along with FES on ankle dorsiflexors of improving gait parameters for functional mobility and enhancing quality of life in stroke survivors. Method: The participants will be enrolled in experimental or control groups with a ratio of 1:1 allocation. The study group members would receive MRP along with FES following baseline tests over a span of 6 weeks. Conventional participant will experience only FES. Both participants were measured with outcome measures and Gait parameters for pre-treatment and post-treatment. Discussion: Most research indicated that MRP is successful because it takes a lengthy period of time; however in the case of FES it is known that it is not efficient without some physiotherapy intervention. The results of the analysis will benefit stroke survivors, and provide a newly developed recovery process.The clinical trial registry-India(CTRI) registration number for this trial is CTRI/2021/05/033578.

BackgroundPatients transported by paramedics for non-emergent conditions are increasing in Ontario and contribute to an emergency department (ED) crisis. Redirecting certain patients to sub-acute healthcare may be beneficial and suitable. We examined if ED interventions conducted on non-emergent paramedic transported patients could be conducted in sub-acute health centres.MethodsA RAND/UCLA modified Delphi study was conducted. Twenty emergency and primary care physicians rated the suitability of the 150 most frequently recorded interventions for completion in sub-acute healthcare centres and provided comments to augment ratings. Interventions were performed on non-emergent adult patients transported by paramedics to an ED, and abstracted from the National Ambulatory Care Reporting System database (January 1, 2014 to March 31, 2018). We used two rounds of a modified Delphi process and set consensus at 70% agreement.ResultsConsensus was reached on 146 (97.3%) interventions; 103 interventions (68.7%) were suitable for sub-acute centres, 43 (28.7%) for ED only; 4 (2.6%) did not receive consensus. For sub-acute centres, all 103 interventions were rated for urgent care centres; walk-in medical centres were applicable for 46 (30.6%) and nurse practitioner-led clinics for 47 (31.3). Diagnostic imaging availability, physician preferences and staffing were determining factors for discrepancies in sub-acute centre ratings.InterpretationThe majority of included ED interventions performed on non-emergent patients transported by paramedics were identified as suitable for urgent care clinics, with one-third being suitable for either walk-in medical centres or nurse practitioner-led clinics. In combination with additional patient details and supports, knowledge of interventions suitable for sub-acute healthcare centres will inform a patient classification model for paramedic-initiated redirection of patients from ED.Study registrationID ISRCTN22901977.

Background: The present study was performed to evaluate Alterations in biochemical markers of liver and kidney function and oxidative stress indices on sub-acute exposure of enrofloxacin in albino rats. Methods: Albino rat weighing 200-300 gm were treated with enrofloxacin orally with the help of gavage needle and devided into three groups each group consist six rats. The rats of group I were served as control. However, rats of group II and III were treated with enrofloxacin @ 5 mg/kg b.wt., enrofloxacin @ 10 mg/kg b.wt. respectively. All the groups received medication orally, once daily for 28 days and blood samples were collected on the 28 day of experiment by the help of capillary tube and processed by laboratory methods. Result: Enrofloxacin altered the functions of liver and kidney as indicated by the alteration in the biochemical markers of liver and kidney function. Enrofloxacin significantly enhanced the concentration of biochemical markers of liver function viz. ALT, AST, GGT, ALP, albumin and bilirubin as compared to control. The concentration of biochemical markers of kidney function viz. BUN and creatinine was significantly enhanced after enrofloxacin administration as compared to control. Enrofloxacin administration induced oxidative stress in rats as indicated by significant decrease in concentration of catalase, superoxide dismutase and reduced glutathione in blood as compared to control. However, lipid peroxidation was significantly enhanced as indicated by increased level of MDA in blood as compared to controlConclusion: Thus, enrofloxacin have ability to altered the biochemical markers of liver and kidney and also have potency to induced oxidative stress in albino rats after the sub-acute exposure for 28 days.

This study aims to determine the relationship between indicators of the motor activity, pH factor, rumen and rectal temperature within 10 days after calving and to analyze the possibility of using the studied parameters as prognostic signs for diagnosing sub-acute rumen acidosis (SARA). The measurements were taken using bolus with sensors designed to monitor cow health. The motor activity, pH factor and ruminal temperature of 10 cows were measured during 10 days at a measurement interval of every 60 seconds. Next, the researchers calculated the average values of the obtained readings, which were divided into 2 groups according to a measurement interval of every 12 hours. Rectal temperature was measured using a veterinary thermometer every 12 hours (at 8 a.m. and at 8 p.m.). As a result, 200 measurements were obtained. Descriptive sampling statistics were calculated using the SPSS Statistics program. An increase in motor activity reduces the pH level of the rumen environment. Lowering the pH factor of the rumen environment leads to an increase in ruminal temperature. There is a positive statistically significant correlation between ruminal and rectal temperature. The nosology of SARA can be predicted by measuring the motor activity and rectal temperature of dairy cows. RESUMO Este estudo visa determinar a relação entre indicadores de atividade motora, fator de pH, temperatura ruminal e retal em até 10 dias após o parto e analisar a possibilidade de utilizar os parâmetros estudados como sinais prognósticos para o diagnóstico de acidose ruminal subaguda (SARA). As medições foram feitas usando bolus com sensores projetados para monitorar a saúde das vacas. A atividade motora, o fator de pH e a temperatura ruminal de 10 vacas foram medidos durante 10 dias em intervalos de medição de 60 segundos. A seguir, os pesquisadores calcularam os valores médios das leituras obtidas, que foram divididos em 2 grupos de acordo com um intervalo de medição a cada 12 horas. A temperatura retal foi medida com um termômetro veterinário a cada 12 horas (às 8h e às 20h). Como resultado, foram obtidas 200 medições. As estatísticas de amostragem descritiva foram calculadas usando o programa SPSS Statistics. Um aumento na atividade motora reduz o nível de pH do ambiente ruminal. A redução do fator de pH do ambiente ruminal leva a um aumento da temperatura ruminal. Existe uma correlação positiva estatisticamente significativa entre a temperatura ruminal e retal. A nosologia com SARA pode ser prevista medindo a atividade motora e a temperatura retal de vacas leiteiras.

Inherited platelet function defects are characterized by sub-acute and chronic mucocutaneous bleedings leading to iron deficiency anemia (IDA). Oral supplementation is the mainstay of treatment of IDA; however, it can be insufficient to compensate the losses and is often associated with gastrointestinal (GI) side effects. Intravenous (IV) iron is indicated for severe anemia or to overcome GI intolerance. Previous IV iron formulations were limited by the risk of free iron toxicity and immunogenicity, while currently available compounds (ferumoxytol, iron isomaltoside and ferric carboxymaltose (FCM)) allow the administration of high doses with low immunogenicity. There are neither any randomized studies nor case reports evaluating the efficacy of FCM in patients with inherited platelet disorders. We herein present three cases of patients with IDA related to Glanzmann thrombasthenia and Bernard-Soulier syndrome, who have been successfully treated with FCM with increase in hemoglobin levels, reduced hospital visits and improvement in quality of life.

Context/objective: Information on the safety and feasibility of lower extremity powered exoskeletons for persons with acute/sub-acute spinal cord injury (SCI) is limited. Understanding the safety and feasibility of employing powered exoskeletons in acute/sub-acute (

The aim of the current study is comparison the protective effects of curcumin and nanocurcumin against lung injury induced by sub-acute exposure with paraquat (PQ) through modulation of oxidative s...

α-l-Guluronic acid (ALG; G2013) has been previously introduced as a new anti-inflammatory agent with promising therapeutic effects. Thus, in the present study, we aimed to evaluate the acute and sub-acute toxicity of ALG through intravenous (i.v.) administration in Balb/C mice. ALG was administrated i.v. to the mice with doses of 300, 600, and 1000 mg/kg of body weight to investigate acute toxicity (single dose) and with doses of 25, 50, and 100 mg/kg of body weight to sub-acute toxicity study (daily injections for a period of 28 days). The mortality rate, food and water intake, behavior, body weight, gross necropsy, hematological and biochemical parameters as well as histopathological presentations of the vital organs (kidneys, liver, lungs, spleen, and heart) were examined in treated groups and compared to the healthy controls. The results of both acute and sub-acute studies showed that i.v. administrations of ALG did not affect the investigated parameters in both sexes, indicating that the LD

Summary: Daily exposure to fractionated petroleum products could be connected to respiratory disorders in industrialized countries and insectary egg of high proteins may be applied as the diet for its management. This study checked the effect of dietary supplemented Mantisa religiosa egg case (DSMREC) on pulmonary dysfunctions triggered by sub-acute exposure to petroleum hydrocarbons in the animal model. Animals were divided into eight groups (n = 8): control group; normal rats exposed to 15 ml aerosolized kerosene, petrol, and diesel, respectively for 1hr daily for 14 days; positive control rats treated with 4% DSMREC only; rats exposed to 15 ml aerosolized kerosene, petrol, and diesel, respectively and co-treated with 4% DSMREC. The results elevated lung ADA, 51-nucleatidase activities and MDA content following exposure to aerosols of petroleum hydrocarbons. Also, aerosols thickened the pulmonary interstitial cells, distended alveoli (emphysema), proliferated bronchial associated lymphoid tissues followed by the congestion of pulmonary blood vessels. Amazingly, 4% DSMREC prevented these alterations. Therefore, our results suggest some possible mechanisms of action by which 4% DSMREC prevents petroleum-induced pulmonary toxicity in rats. Keywords: Mantisa religiosa egg case, Aerosols, Petroleum hydrocarbons, Pulmonary toxicity, Diet

Background: A standardized polyherbal preparation (POL-6) containing six plant extracts Hypericum perforatum, Bacopa monnieri, Centella asiatica, Withania somnifera, Ocimum sanctum and Camellia sinesis have good antioxidant, anti-inflammatory, and immunomodulatory activities. The present study was carried out to evaluate the safety profile of POL-6 through acute and subacute oral toxicity models in Wistar rats. Methods: In acute safety evaluation, a single dose of 2000mg/kg of POL-6 was given orally to five rats and was observed for 14 days. In subacute safety evaluation POL-6 at the doses of 250, 500 and 1000 mg/kg was given orally to the rats once a day for 28 days. The animals were observed for the signs of toxicity and mortality during the study period. Results: In acute toxicity evaluation, POL-6 treatment did not show any toxic signs and mortality in animals during the observation period. In subacute toxicity studies, no changes were seen in any of the dose levels of POL-6 treatment during the total body weights, organ weights and hematobiochemical parameters examination of the rats. No lesions were seen during the gross/histopathological examination. Conclusion: The study revealed that administration of POL-6 for 28 days showed no significant treatment generated toxic effects in the animals, hence it can be considered as non-toxic if it is ingested in a time not greater than a month.