The level of ratio between matrix metalloproteinase-1 (MMP-1) and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) after prolotherapy intervention and the functional outcome in patient with frozen shoulder: A randomized controlled trial

OBJECTIVE

To determine the effect of prolotherapy on functional outcome changes, along with ratio of matrix metalloproteinase-1 (MMP-1)/tissue inhibitor matrix metalloproteinase-1 (TIMP-1) as an indicator of tissue repair in the glenohumeral joint in frozen shoulder patients.

DESIGN

Single-blinded randomized controlled trial.

SUBJECTS/PATIENTS

Participants with frozen shoulder.

METHODS

The prolotherapy group is the study group, and the normal saline (NS) group is the control group. Each group was given injections at weeks 0, 2, 4, and 6. Level of biomarker levels was measured at week 6 and week 12 after there. Functional outcomes were measured at weeks 0, 6, and 12.

RESULTS

A significant difference in week 6 and week 12 was demonstrated in the ratio of MMP-1/TIMP-1 level between the prolotherapy group and the normal saline group (P value = .002). Both groups performed well regarding the Numerical Rating Scale score and functional outcome. Compared to the normal saline group, prolotherapy changed the mean range of motion in flexion and internal rotation.

CONCLUSION

Prolotherapy is considered to play a role in repairing cartilage based on biomarker assessment, particularly the ratio of MMP-1/TIMP-1-prolotherapy effectiveness in improving functional outcome and Numerical Rating Scale score.

A Case Series: Effect of Comorbidities on the Outcomes of Prolotherapy Injection for Frozen Shoulder Patients

Frozen shoulder (FS) is a disease caused by an inflammatory condition that causes severe pain and decreased range of motion by loss of glenohumeral mobility. Frozen Shoulder restricts daily life's functional aspect, increasing morbidity. Hypertension and diabetes mellitus are risk factors that make an FS poor prognosis during treatment because of the diabetes glycation process and hypertension-enhanced vascularization. Prolotherapy injects an irritant solution into the tendon, joints, ligaments, and joint spaces to release growth factors and collagen deposition, reducing pain, restoring joint stability, and increasing the quality of life. We report 3 cases of patients with confirmed FS. Patient A with no comorbidity, patient B with diabetes mellitus, and patient C with hypertension, with all patient's chief complaints of shoulder pain and limited ROM, and symptoms affected the general quality of daily life. This patient was provided injection with Prolotherapy treatment combined with physical therapy intervention. Patient A had significantly improved ROM to maximum after 6 weeks with relieved pain and improved shoulder function. Patients B and C showed increased ROM, still tiny, decreased pain, and improved shoulder function. In conclusion, prolotherapy demonstrated a beneficial effect in a patient with FS with comorbidities, although not to the maximum extent in patients without comorbidity.

Histo-morphologic and gravimetric changes of teeth exposed to high temperatures - An in-vitro study

BACKGROUND

Fire intelligence is the multidisciplinary basis of reconnaissance, which includes determining the origin, cause, and identification of fire victims. Fire is a destructive force capable of inflicting significant damage. Destruction of soft tissue in fire disasters makes victim identification nearly impossible. Teeth are hard and resilient and withstand such conditions. Analyzing the precise morphological, stereomicroscopic, histological, and gravimetric findings can extract valuable information from dental evidence in forensic investigations.

MATERIALS AND METHODS

Thirty-six mandibular premolar teeth extracted for therapeutic purposes were exposed to high-temperature gradients. Macroscopic, stereomicroscopic, histological, and dry weight analyses were performed at each temperature gradient.

RESULTS

The colour of teeth changed from yellowish orange to metallic black bronze to chalky white. Stereomicroscopy showed intact teeth at 100°C, gradual micro-cracks at 500°C, and a fully fractured crown at 900°C. Decalcified sections revealed dilatation of dentinal tubular pattern at 300°C. Dentinal tubules showed appearance of vapour bubbles at 400°C, resulting in loss of typical architecture. In the ground sections, alterations in scalloping nature of dentino-enamel junction, coalescing radicular dentinal tubules, and sand cracking appearance of teeth were noted at 100°C, 300°C, and 900°C, respectively. Significant reductions in the weight of the teeth samples were observed with higher temperatures.

CONCLUSION

From the morphological, histological, and gravimetric changes in a tooth caused by fire, it might be possible to determine the temperature and duration of fire exposure, and the cause of the fire.

Effectiveness of Prolotherapy Combined with Physical Therapy Versus Physical Therapy Only for Frozen Shoulder: A Case Report

Case series

Patients: Male, 66-year-old • Male, 65-year-old

Final Diagnosis: Frozen shoulder

Symptoms: Limited range of motion of shoulder • pain radiating into the neck and elbows • shoulder pain

Medication: —

Clinical Procedure: Injection of prolotherapy • physical therapy

Specialty: Rehabilitation

Optimizing Early Rehabilitation Intervention: Insights from Different Outcomes in 2 Patients with Severe COVID-19

Case series

Patients: Male, 53-year-old • Male, 68-year-old

Final Diagnosis: COVID-19

Symptoms: Cough • desaturation • paraparesis • shortness of breath

Medication: —

Clinical Procedure: —

Specialty: Rehabilitation

Social and behavioural determinants of consistent condom use among hotel and bar workers in Northern Tanzania

Bar and hotel workers ( n=519) in Moshi, Tanzania were interviewed to obtain information about potential predictors of condom use. Samples were collected for the diagnosis of sexually transmitted diseases (STDs), including HIV. Consistent condom use was defined as always using condoms with sexual partners in the past five years. Overall consistent condom use in this population was 14.1%. In multivariate analyses, consistent condom use was inversely associated with low condom self-efficacy (adjusted odds ratio [AOR], 0.20; 95% confidence interval (CI), 0.06-0.71), low condom knowledge (AOR, 0.11; CI, 0.01-0.80), and having more than three children (AOR, 0.23; 95% CI, 0.09-0.54). Other significant predictors included perceived condom acceptability and using condoms when last exchanged sex for money or gift. These results indicate that increased specific condom knowledge, improved self-efficacy, and reduced social stigma could be effective strategies in the promotion of condom use in this population.

Neonatal morbidity and mortality in a Tanzanian tertiary care referral hospital

In developing countries, neonatal mortality accounts for 50-70% of infant mortality. The purpose of this study was to describe morbidity and mortality patterns, with a focus on neonatal infections, in a Tanzanian special care baby unit (SCBU). During a 3-month period, 246 consecutive admissions to the SCBU at Kilimanjaro Christian Medical Centre were audited. Prematurity, low birthweight and suspected infection accounted for 61% of all admissions. The overall mortality rate was 19%, but varied considerably according to gestational age, birthweight and diagnosis. Thirty-one neonates (two-thirds of all deaths) died during the 1st 24 hours of life. Of 27 infants admitted on grounds of perinatal asphyxia, 11 (41%) died, and, of 19 infants with a gestational age <31 weeks, 13 (68%) died. More than two-thirds of all infants were treated with antibiotics. Septicaemia confirmed by blood culture was found in 16 cases. The susceptibility pattern of bacterial isolates did not indicate high rates of resistance to commonly used antibacterial agents. A reduction in the number of preterm deliveries and improved perinatal care to avoid and treat perinatal asphyxia would be the two most important measures in reducing neonatal mortality in this setting.

Quantitative validation of media for transportation and storage of Streptococcus pneumoniae

The need to design effective Streptococcus pneumoniae vaccines and to monitor resistance means that it is essential to have efficient methods to determine carriage rates. Two liquid media, consisting of skim milk, glycerol, glucose, and tryptone soya broth (STGG) or skim milk, glycerol, and glucose (SGG) alone, were evaluated for their ability to maintain pneumococcal viability. Optimal recovery of S. pneumoniae was achieved when swabs were transferred to STGG medium prior to plating onto blood agar-gentamicin selective plates (22%) compared to 7% when plated out directly (P < 0.0001 by Fisher's exact test). Both STGG and SGG media are appropriate for the long-term storage of pneumococci and primary swab samples at -70 degrees C, with no decrease in viable count observed following repeated freeze-thaw cycles. Samples could be stored refrigerated for up to 3 days in either STGG or SGG medium with no significant loss of viability. Viability decreased progressively in storage at 20 to 30 degrees C, with greater losses of viability occurring at the higher temperatures. There were no significant differences in viability between isolates in the two media. STGG preserved pneumococci significantly better (about twofold) than SGG medium at 21 degrees C (P < 0.0001) and 30 degrees C (P < 0.0001). Samples can be stored for 4 and 2.5 days at 6 to 8 degrees C, 28 and 17 h at 21 degrees C, and 15 and 7 h at 30 degrees C in STGG and SGG media, respectively. For field studies undertaken in resource-limited environments, SGG medium can be prepared by using locally available materials. The quantitative data reported in this study will enable researchers to plan appropriate transport and storage protocols.

Randomized controlled trial of a drug regimen that includes ciprofloxacin for the treatment of pulmonary tuberculosis

The fluoroquinolones are promising new antituberculous agents. A randomized controlled trial of 200 adult patients with sputum smear-positive pulmonary tuberculosis was conducted in Tanzania. Patients received either a trial regimen (HRC) consisting of isoniazid (300 mg), rifampin (600 mg), and ciprofloxacin (750 mg) or a control regimen (HRZE) consisting of isoniazid (300 mg), rifampin (600 mg), pyrazinamide (25 mg/kg), and ethambutol (15 mg/kg). The 168 evaluable patients all had negative smears and cultures by month 6, but the time to conversion to negativity was longer for the HRC group than for the HRZE group because of the poor response of patients infected with human immunodeficiency virus (HIV) to the HRC regimen. Relapse was more frequent in the HRC group. The sterilizing activity of ciprofloxacin does not appear to be equal to that of the combination of pyrazinamide and ethambutol, but the difference in outcome was significant only among HIV-infected patients.