DOI: 10.3897/folmed.68.e166916

Authors: Vasilka Gyurova-Kancheva, Angelina Kirkova-Bogdanova, Daniela Taneva, Hristo Bozov, Yozlem Kyuldzheva

Abstract: Introduction: Ulcers caused by a diabetic foot are among the most common and serious complications of diabetes mellitus and lead to severe medical and social consequences for individuals and society. Their treatment should be complex and individualized, given the complex etiology and pathogenesis of this type of lesion. One of the established complementary methods in therapy is the application of oxygen by inhalation under high pressure (above atmospheric) or the so-called hyperbaric oxygenation. Aim: This study aims to evaluate the effect of hyperbaric oxygen therapy on the treatment of diabetic ulcers. Materials and methods: This pilot study was conducted from October 2024 to January 2025. The study group comprised 15 patients (10 males and 5 females) diagnosed with diabetic foot ulcers. All participants underwent hyperbaric oxygen therapy as a complementary treatment. Blood sugar levels, wound area, Wagner score, and pain level were followed up before and after therapy. Results and discussion: Regarding blood sugar levels, no definitive evidence was found to confirm or rule out the influence of hyperbaric oxygenation. A statistically significant difference was observed in the mean wound area values before therapy (20.46±16.12 cm2) and after 10 HBO sessions (11.38±10.58 cm2) (p=0.019). The mean Wagner score prior to therapy was 2.92, and after the 10th session it was 2.00, p=0.014. The difference in pain perception before and after hyperbaric oxygenation therapy was statistically significant (p<0.0001) with an effect size r=−0.99. Conclusions: Hyperbaric oxygen has a positive effect as an adjuvant therapy in the treatment of patients with diabetic foot ulcers. Due to the small sample size and number of sessions, more in-depth and large-scale clinical studies are needed to confirm the results.

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DOI: 10.3897/folmed.66.e130873

Authors: Sevinç Külekçioğlu

Abstract: Introduction: Myofascial pain syndrome (MPS) is a disorder of the musculoskeletal system that is distinguished by the presence of pain, tenderness, muscle spasms, restricted joint range of motion, fatigue, and, in rare cases, autonomic dysfunction. Aim: The purpose of this study was to compare the effectiveness of laser and dry needling (DN) treatments for enhancing cervical joint range of motion, neck pain, and quality of life in patients with active upper trapezius myofascial trigger points who experience persistent neck pain. Patients and methods: A total of 50 patients who were clinically diagnosed with MPS were included. They were divided into two treatment groups, the DN (n=25) and laser (n=25) groups, by sequential randomization. The parameters used in the study were the visual analogue scale (VAS) score and cervical rotation, flexion, extension, lateral flexion, and extension to determine the cervical range of motion (ROM). Additionally, the Nottingham Health Profile (NHP) questionnaire was used to evaluate quality of life. VAS, NHP, and ROM measurements were performed on patients in both groups before treatment (BF), after treatment (AT), and at 1 month. Results and conclusion: Both low-level laser therapy and DN were found to be effective in reducing pain intensity, increasing cervical range of motion, and improving quality of life in patients suffering from myofascial pain syndrome.

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DOI: 10.3897/folmed.66.e135838

Authors: Trupti B. Mehta, Amit Sharma

Abstract: Introduction: Lower crossed syndrome (LCS) is a biomechanical muscle imbalance causing low back pain. Aim: This study aimed to compare specific treatment protocols versus generalized treatment protocols for managing low back pain associated with LCS. Materials and methods: This randomized, single-blinded trial involved 200 patients (aged 20-40 years) with low back pain and LCS. Patients were divided into four groups: A1 and A2 (specific protocols for posterior and anterior LCS), and B1 and B2 (generalized protocols). Interventions were administered thrice weekly for two weeks. Outcome measures included Numerical Pain Rating Scale (NPRS), Modified Oswestry Disability Questionnaire (MODQ), Lumbar Lordosis Index (LLI), abdominal and gluteal muscle strength, and iliopsoas and back extensor flexibility. Results: All groups showed significant improvements in all parameters (p<0.01). However, specific protocols demonstrated superior outcomes. Group A1 showed the greatest reductions in pain (median NPRS decrease: 5), disability (median MODQ decrease: 45), iliopsoas tightness (median decrease: 12°) and back extensor tightness (median decrease 6.5). Group A2 exhibited the highest improvements in abdominal strength (median increase: 8 kg) and gluteal muscle strength (median increase: 8 kg). Conclusion: Specific treatment protocols were significantly more effective than generalized protocols in managing low back pain associated with LCS. These findings emphasize the importance of accurate LCS classification and tailored interventions for optimal therapeutic outcomes in patients with low back pain.

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DOI: 10.3897/folmed.64.e60562

Authors: Korosh Khanaki, Adel Fekri, Mahmood Abedinzade, Ekram Mohammadi, Fakhroddin Aghajanpour

Abstract: Introduction: Stroke is one of the most common causes of death worldwide. Inflammation and apoptosis play an important role in the cascade of ischemic stroke. Aim: The aim of the present study was to evaluate the pretreatment effects of Lamium album (L. album) extract on caspase-3 and cyclooxygenase-2 (COX-2) expression, infarct volume, and neurological deficit score in a rat model of middle cerebral artery occlusion (MCAO). Materials and methods: Wistar male rats were randomly divided into three groups: 1) MCAO group (1 h after MCAO, reperfusion was allowed for 24 h by retracting the thread); 2) L. album + MCAO group [receiving L. album extract (100 mg/kg via intraperitoneal) for a week before MCAO]; 3) sham group. The expression level of caspase-3 and COX-2 in the core, penumbra, and subcortex regions was measured by real time-PCR technique. Infarct volume and neurological deficit score were also assessed. Results: The mRNA expression of caspase-3 in the core, penumbra, and subcortex regions in L. album group was significantly reduced compared to MCAO group (p<0.05). Expression level of COX-2 in the subcortex of the rats exposed to L. album was statistically decreased relative to MCAO group (p<0.05). Infarct volume in the core, penumbra, and subcortex was significantly reduced in the L. album group compared with MCAO group (p<0.001, p<0.001, p<0.05, respectively). Neurological deficit score was remarkably decreased in the L. album group in comparison with the MCAO group (p<0.05). Conclusions: It appears that pretreatment with L. album extract may attenuate brain tissue damage after ischemic stroke. The potential protective effects of this plant extract against this condition might be in part attributed to its anti-inflammatory and anti-apoptotic activities.

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DOI: 10.3897/folmed.63.e59311

Authors: Dimitrios Kechagias, Christos Chatzipapas, Makrina Karaglani, Konstantinos Tilkeridis, Athanasios Ververidis, Georgios Drosos

Abstract: Introduction: Determining the effect of body composition on chronic low back pain seems to have the potential to improve our understanding of its mechanism and to develop novel preventive and therapeutic approaches. Aim: The purpose of the present study was to assess by electrical impedance the composition of lower extremities of individuals with chronic low back pain.Materials and methods: One hundred and twenty-one adult participants with diagnosed chronic low back pain were recruited in this study. The study activities were divided into three phases: phase 1 – self-administered questionnaires, phase 2 – biomedical examination (including anthropometric measurements and physical function performance tests), and phase 3 – bioimpedance analysis.Results: Our results showed that chronic low back pain differentiates the circumference of thigh and calf of the symptomatic leg. Besides, patients experience pain also in hip, thigh, and calf, which act as a barrier to patient’s personal, professional, social, and recreational activities. Furthermore, patients appear with ‘unstable’ walking, reduced balance, and reduced general physical condition that affect all of the neuromuscular structures of the locomotor system. Interestingly, patients seem to be characterized by a tendency to deposit fat and to decrease muscle mass in the symptomatic limb regardless of the gender.Conclusions: In the present study, we determine the profile of a patient with chronic low back pain through a variety of measurements. Chronic low back pain causes several structural changes to the symptomatic leg of the patients leading to ‘unstable’ walking, reduced balance, and reduced general physical condition. It is clear that further studies using bioimpedance analysis are needed to address the concerns raised by investigating a multifactorial condition such as chronic low back pain.

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DOI: 10.3897/folmed.63.e57713

Authors: Devaraja Sannaningaiah, Ashwini Shivaiah, Jayanna Kengaiah, Chandramma Srinivasa, Sharath Kumar M. Nandish, Chethana Ramachandraiah, Sujatha Hanumegowda, Bhagyalakshmi Manjappa, Sebastin Santosh Martin, Ramesh Komalapura Laxmaiah, Manohar Shinde

Abstract: Introduction: Oxidative stress plays a critical role in the progression of diabetes, arthritis, cancer, eryptosis, cardiovascular disease, and thrombosis. Currently, antioxidants from natural sources are in high demand due to their beneficial role in the management of said diseases.Aim: The purpose of the study was to evaluate the protective effect of sorghum protein buffer extract (SBE) on sodium nitrite-induced oxidative stress and thrombosis.Materials and methods: Protein characterization of SBE was done using SDS-PAGE. Oxidative stress in RBC was induced using sodium nitrite (NaNO2) and the key stress markers such as lipid peroxidation (LPO), protein carbonyl content (PCC), and the level of antioxidant enzymes (SOD and CAT) were measured. The anticoagulant effect of SBE was identified by employing in-vitro plasma recalcification time, activated partial thromboplastin time (APTT), prothrombin time (PT), and in-vivo mouse tail bleeding time. SBE antiplatelet activity was examined using agonist adenosine diphosphate (ADP) and epinephrine-induced platelet aggregation. Non-toxic property of SBE was identified using in-vitro direct haemolytic, haemorrhagic, and edema forming activities using experimental mice.Results: SBE revealed similar protein banding pattern under both reduced and non-reduced conditions on SDS-PAGE. Interestingly, SBE normalized the level of LPO, PCC, SOD, and CAT in stress-induced RBCs. Furthermore, SBE showed anticoagulant effect in platelet rich plasma by enhancing the clotting time from the control 250 s to 610 s and bleeding time from the control 200 s to more than 500 s (p<0.01) in a dose dependent manner. In addition, SBE prolonged the clot formation process of only APTT but not PT. SBE inhibited the agonists ADP and epinephrine induced platelet aggregation. SBE did not hydrolyze RBC cells, devoid of edema and haemorrhage properties.Conclusions: This study demonstrates for the first time the anticoagulant, antiplatelet, and antioxidant properties of SBE. Thus, the observed results validate consumption of sorghum as good for health and well-being.

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DOI: 10.3897/folmed.63.e54386

Authors: Ali Javadi, Mohamad Reza Pourmand, Javad Hamedi, Fatemeh Gharebaghi, Zohre Baseri, Abbas Morovvati, Razieh Mohammadzadeh, Seyyed Saeed Eshraghi

Abstract: Introduction: Bacterial natural products such as biosurfactants and surface-active agents are important compounds which exhibit many applications in the fields of medicine.Aim: The aim of the present study was to isolate and identify Nocardia strains with high biosurfactant production and antibiofilm ability.Materials and methods: In the present study, a biosurfactant producing Nocardia species was isolated and identified by a laboratory method. Nocardia species were initially screened and then tested for their ability to produce biosurfactant. The oil spreading test and the surface tension measurements showed that one strain was a biosurfactant producer. The strain with the best surface activity results was selected for further studies and identified by 16S rRNA gene sequencing method. Fourier transform infrared spectroscopy (FTIR) and compositional analysis proved a biosurfactant structure.Results: Oil spreading test and blue agar plate test confirmed biosurfactants and extracellular anionic glycolipids. E24% assay using olive oil revealed strong emulsifying characteristic of the extracted biosurfactant with 100% emulsifying strength. FTIR spectrum indicated the presence of aliphatic hydrocarbon chain (lipid) along with the polysaccharide portion, confirming the glycolipid nature of the biosurfactant. The stability of the biosurfactant produced in different conditions was significant. Increasing concentration of BS significantly inhibited Pseudomonas aeruginosa biofilm.Conclusions: N. coubleae can be a representative of the genus Nocardia for the production of biosurfactants with beneficial physicochemical properties.

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DOI: 10.3897/folmed.62.e50705

Authors: Tiffany Ostovar-Kermani, Daniel Arnaud, Andrea Almaguer, Ismael Garcia, Stephanie Gonzalez, Yamely Mendez Martinez, Salim Surani

Abstract: Insomnia is a chronic condition that occurs a minimum of three times per week over a period of three or more subsequent months. There are multiple causes of insomnia, and even though it is considered a symptom, it can be associated with chronic illnesses. Chronic pain syndrome, which is defined as pain that persists for a period longer than 3 months, is one of several etiologies of insomnia. The prevalence of insomnia among chronic pain patients is greater in comparison with the general population (percentage or ratio). Chronic pain is common in patients with rheumatoid arthritis, spinal pain (such as chronic back pain) and fibromyalgia. The prevalence of in-somnia is also higher in cancer patients when compared to the general population. When the clinical history indicates a straightforward diagnosis of chronic pain syndrome, patients will complain of insomnia as part of their symptomatology. It is imperative to manage their underlying illness to alleviate their sleep disorder. Various medications may be used to relieve and even improve pain symptoms. Other than pharmacological interventions, non-pharmacological alternatives such as yoga, meditation, acupuncture, and psychotherapy can help improve the quality of life of these patients. The purpose of this article is to review the diagnosis and management of insomnia in chronic pain syndrome and its impact on the quality of life.

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DOI: 10.3897/folmed.62.e47712

Authors: Agung Putra, Ika Rosdiana, Dewi M. Darlan, Iffan Alif, Fitri Hayuningtyas, Indriani Wijaya, Rita Aryanti, Fadhli Rizal Makarim, Arini Dewi Antari

Abstract: Background: Mesenchymal stem cells (MSCs) migrate and transmigrate to acute liver failure (ALF) area due to vascular endothelial growth factor (VEGF) stimulation as an attractant molecule then actively giving the paracrine signaling and or differentiating into primary hepatocytes, however the best route of MSCs transplanted to liver injury area remains unclear. Aim: In this study we compare intravenous (IV) and intraperitoneal (IP) route of MSCs administration by analyzing serum glutamic pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT) and bilirubin level as improvement markers of liver function and VEGF as attractant-proliferation molecule on days 2 and 5. Materials and methods: Eighteen male Sprague-Dawley rats weighting 200 g were used in this study. They were divided in three study groups: vehicle control, IP and IV groups. The IV group was treated by MSCs at dose 1×106 by lateral tail vein injection and IP group received 1×106 MSCs via IP injection. The level of SGPT, SGOT and bilirubin were measured by an automatic analyzer, the VEGF level using enzyme-linked immunosorbent assay (ELISA), while the CD73 expression was evaluated using immunohistochemistry. Results: This study showed that IV injection of MSCs was more efficient for increasing liver function than IP treatment group that confirmed by the observed significant decrease in SGPT, SGOT and bilirubin level on days 2 and 5 (p<0.001). This effect was most likely mediated by the significant increase of VEGF level (p<0.05) on days 2 and 5. Conclusion: Our result conclude that an IV administration of MSCs was more efficacious than the IP administration for liver injury regeneration.

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