Medicina
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Randomized Controlled Trial
Effect of Foot Insole on Planter Pressure Distribution in Patients with Neuropathic Diabetic Foot Ulcer: A Prospective, Randomized, Double-Blinded, Controlled Clinical Trial.
Background and Objectives: Patients with diabetes polyneuropathy are at a heightened risk for developing foot ulcers, often due to dynamic plantar foot pressure patterns that lead to increased pressure and shear forces in specific foot areas. This study aimed to evaluate the effects of foot insoles on peak pressure and the pressure-time integral in patients with polyneuropathy diabetic foot ulcers over a twelve-week period followed by an eight-week follow up. Materials and Methods: This was a prospective, randomized, double-blinded, controlled clinical trial involving 60 patients aged between 50 and 65 years of both genders. ⋯ Results: The results indicated significant differences in peak pressure and pressure-time integral measurements for the rearfoot, midfoot, hallux, and both medial and lateral forefoot areas after twelve weeks of using foot insoles compared to the control group. This suggests that the use of foot insoles effectively reduces peak pressure and the pressure-time integral in these critical areas. Conclusions: The findings of this study support the use of foot insoles as a beneficial intervention for decreasing peak pressure and the pressure-time integral on the hallux, medial, and lateral forefoot in patients with polyneuropathic diabetic foot ulcers, and they could play a crucial role in preventing further complications.
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Background and Objectives: This systematic review evaluates the effectiveness of exercise interventions for managing nonspecific low back pain (NSLBP) and explores their impact on related biopsychosocial factors, physical health variables, and inflammatory biomarkers. Materials and Methods: A comprehensive search of five databases (PubMed, CINAHL, PEDro, SCOPUS, Cochrane Library) was conducted, covering studies from 2019 to 2024. Fifteen randomized controlled trials involving 1338 participants aged 18 to 65 years with NSLBP were included. ⋯ Additionally, it enhanced physical parameters like proprioception, muscle thickness, and physical performance. However, the review found insufficient evidence regarding the effects of exercise on inflammatory biomarkers in NSLBP patients. Conclusions: The findings suggest that physical exercise is an effective intervention for pain reduction and the improvement of overall health in NSLBP, though further research is needed to clarify its impact on inflammation.
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Randomized Controlled Trial
Effects of Sacroiliac Joint Manipulation on Autonomic Nervous System and Lower Abdominal Pain in Women with Primary Dysmenorrhoea: A Randomized Controlled Trial.
Background and Objectives: Autonomic nervous system (ANS) disorders are responsible for primary dysmenorrhea and are closely linked to the spine. This study aims to evaluate the effects of sacroiliac joint manipulation on the ANS and lower abdominal pain in women with primary dysmenorrhea and proposes an alternative treatment method. Materials and Methods: A total of 40 participants were randomly assigned; however, 35 participants remained in the final analysis after 5 dropped out; they were assigned to either the sacroiliac joint manipulation group (n = 18) or the superficial heat therapy group (n = 17). ⋯ The MMDQ scores decreased after sacroiliac joint manipulation (p < 0.05), with greater improvements compared to the superficial heat therapy (p < 0.05). Conclusions: Sacroiliac joint manipulation positively affects ANS balance and is effective in alleviating lower abdominal pain and menstruation-related symptoms, with sustained effects observed over time. Therefore, sacroiliac joint manipulation can be an effective alternative treatment for women with primary dysmenorrhea.
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Background and Objectives: Rib fractures are common in patients with trauma, and patients with multiple rib fractures often require surgical stabilization. Because rib fractures may occur at different sites along the ribs, the technical approach to surgical stabilization varies. Here, we present a case of posterior rib fractures with multiple paraspinal fragmented rib segments that were successfully treated with costovertebral plate fixation. ⋯ However, the anatomical orientation of the rib and the transverse process of the thoracic spine are different, which complicates surgical planning and maneuvers. Therefore, a thorough understanding of the costotransverse anatomy is critical for successful surgical stabilization of fractured ribs. Conclusions: This is a good example of a challenging case of rib fractures requiring paraspinal plate stabilization.
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Stroke remains a leading cause of global disability and mortality despite advancements in acute interventions. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has primarily been studied for its effects on cortical excitability, with limited exploration of its neuroprotective and hemodynamic benefits. This review examines the role of tDCS in stroke, with a focus on neuroprotection in acute settings and cerebral blood flow (CBF) modulation in both acute and chronic phases. tDCS offers rapid, localized delivery to salvageable ischemic tissue, exerting pleiotropic effects that address a broader spectrum of pathological processes compared to pharmacological agents. ⋯ Bihemispheric stimulation may offer additional benefits, with evidence suggesting a dose-dependent relationship between stimulation parameters and therapeutic outcomes. Further research is warranted to optimize stimulation protocols, evaluate safety and feasibility, and explore the potential of tDCS to promote neuroplasticity and functional recovery across different stroke populations and stages. By addressing these gaps, tDCS could emerge as a valuable adjunctive therapy in stroke management, complementing current interventions and expanding therapeutic windows.