Prenatal genomic medicine now generates data at a scale that exceeds what unaided human interpretation can process within the time available to a continuing pregnancy. Cell-free DNA screening, chromosomal microarray, exome sequencing and, increasingly, genome sequencing produce millions of candidate observations per case, and computational methods described as artificial intelligence have been proposed at almost every step of the resulting pipeline. This critical narrative review evaluates the strength, consistency and clinical relevance of the evidence supporting those methods when they are applied specifically to the genome of a fetus in utero. Literature was identified through structured searching of biomedical and multidisciplinary scholarly sources from 1997 to 20 June 2026, prioritised by methodological quality and by direct relevance to prenatal application rather than by citation count. The evidence divides sharply. Analytical performance for tasks that are essentially signal-detection problems, including trisomy classification from low-coverage plasma sequencing, fetal fraction estimation and small-variant calling, is supported by internally consistent and technically credible work. Evidence for tasks that require inference about meaning, including missense and splice-effect prediction, phenotype-driven gene prioritisation and automated candidate diagnosis, is substantially weaker in the prenatal context, because the models were trained and calibrated on postnatal cohorts whose phenotypes were fully observable. Fetal phenotypes evolve during gestation, are captured through imaging rather than examination, and map imperfectly onto the ontologies that phenotype-driven algorithms consume. Several studies show that ontology-driven gene selection in fetuses misses a substantial minority of causative genes that curated prenatal panels retain. Almost no prospective study has tested whether an artificial intelligence component changes a prenatal decision, and reporting quality across the field falls short of contemporary prediction-model standards. Structural inequities in reference genomic resources compound these problems. Priorities include prenatally calibrated variant-effect evidence, gestational-age-aware phenotype representation, prospective evaluation with decision-relevant endpoints, and governance that treats uncertainty as a reportable output rather than a defect to be smoothed away.
Upper-limb dysfunction in Parkinson’s disease compromises dexterity, movement scaling, coordination and the performance of everyday tasks, yet rehabilitation research has historically prioritised gait and balance. Virtual reality (VR) can deliver repetitive, task-specific practice with augmented feedback, adaptable challenge and game-based engagement, but the clinical value of VR specifically for arm and hand rehabilitation remains uncertain. This scoping review mapped and critically synthesised evidence on VR-based interventions and VR-enabled assessment relevant to upper-limb rehabilitation in adults with Parkinson’s disease. Searches covered peer-reviewed literature from 2010 to 18 June 2026, with earlier seminal work retained where necessary for conceptual context. Evidence was organised by VR modality, therapeutic target, outcome domain, feasibility and methodological quality. The direct intervention literature remains small and heterogeneous, spanning non-immersive exergaming, optical hand tracking, fully immersive head-mounted systems and experimentally manipulated sensory feedback. Across small trials and feasibility studies, trained measures of movement speed, coordination, dexterity, strength or proprioception often improved, and adherence and acceptability were generally favourable. Nevertheless, the best current comparative evidence does not establish superiority of immersive VR over dose-matched conventional upper-limb training. Improvements in game performance frequently exceeded transfer to standardised clinical outcomes, and evidence for sustained gains, everyday activity, participation and quality of life is sparse. Methodological weaknesses include small samples, heterogeneous comparators and intervention doses, inconsistent medication-state reporting, short follow-up, fragmented outcome selection and limited safety reporting. VR is therefore best regarded as a promising delivery format and adjunct for intensive upper-limb practice rather than a proven superior treatment. Future trials should use adequately powered multicentre designs, active dose-matched comparators, blinded outcome assessment, standardised reporting of training dose and feedback, meaningful activity-level outcomes and longer follow-up, while explicitly testing whether immersion, sensorimotor feedback or adaptive game mechanics add benefit beyond equivalent conventional practice.
Frozen shoulder is a painful and mobility-limiting condition of the glenohumeral joint whose fibrotic, inflammatory and neuro-immune substrate has been characterised in increasing detail over the past decade. Rehabilitation practice has nevertheless diversified faster than the supporting evidence, and two mechanically dissimilar adjuncts have entered routine use: instrument-assisted soft tissue mobilisation, in which rigid ergonomic tools deliver controlled shear and compressive loads to periarticular soft tissue, and cryokinetics, in which localised cooling to numbness is followed immediately by graded active exercise. Clinicians are increasingly asked to choose between them, yet the comparative basis for that choice has not been examined critically. This review defines the conceptual boundaries of both interventions, appraises the direct and indirect evidence for each in frozen shoulder and adjacent shoulder disorders, and evaluates whether the two literatures can support a defensible comparative conclusion. Searching of open scholarly databases and citation tracking identified one randomised trial of instrument-assisted soft tissue mobilisation conducted specifically in adhesive capsulitis, several shoulder-region trials in other diagnoses, and three recent meta-analyses of mixed musculoskeletal populations. No controlled trial of cryokinetics in frozen shoulder was identified, and the cryokinetics literature rests largely on ankle and tendon models, a small number of shoulder tendinopathy trials of limited methodological quality, and physiological studies of cooling. The two evidence bases therefore differ not merely in magnitude but in maturity, outcome selection and risk of bias, and no head-to-head trial exists. Claims of superiority for either modality in frozen shoulder are consequently unsupported. Reported benefits are modest, short-term and vulnerable to non-specific effects, and cooling before exercise raises unresolved questions about proprioceptive and force-generating impairment. Priorities include a sham-controlled dose-defined trial programme, standardised force reporting, and stage-stratified designs anchored to clinically meaningful thresholds.
Background: Healthcare workers (HCWs) in high-burden tuberculosis (TB) settings face elevated occupational risk of latent TB infection (LTBI). Although Tuberculosis Preventive Therapy (TPT) reduces progression risk by 60–90%, uptake among Kenyan HCWs remains suboptimal. Aim: To assess TPT uptake, adherence, knowledge, and factors influencing uptake among HCWs at Meru Teaching and Referral Hospital (MeTRH), Kenya. Methods: A descriptive cross-sectional survey was conducted among 214 HCWs selected by simple random sampling from a target population of 560 (response rate 94.3%). Data were collected using a structured self-administered questionnaire aligned with World Health Organization TPT guidelines. Descriptive statistics, Pearson’s chi-square tests, Spearman’s correlations, and binary logistic regression (unadjusted and adjusted) were performed. The level of statistical significance was set at p < 0.05. Results: Only 39.3% (84/214) of respondents had ever initiated TPT despite 78.5% reporting occupational TB exposure. Among initiates, 66.7% completed the full course; side effects (35.7%), work-related time constraints (21.4%), and financial limitations (17.9%) were the main reasons for non-completion. Formal training was reported by 44.9% and was significantly associated with uptake (χ² = 16.25, p < .001). Self-rated knowledge was also associated with uptake (χ² = 13.34, p = .010). After adjustment, formal training remained the strongest independent predictor (adjusted OR 2.71, 95% CI 1.47–4.99, p = .001). Gender, age, and stigma were not statistically significant. Conclusions: TPT uptake and completion among HCWs at MeTRH, Kenya, remain inadequate and are constrained primarily by modifiable programme-related factors, especially gaps in structured training, rather than demographic characteristics. Mandatory recurrent training, strengthened pre-initiation counselling, proactive follow-up, workplace-based dispensing, and expanded access to shorter regimens are recommended.
Background: The Air Quality Index (AQI) is a measure of the level of air pollution. Its assessment is important in urban and industrial regions, where rapid development increases emissions from vehicles, factories and other sources, leading to detrimental environmental and health outcomes. This study assessed the AQI in selected areas of Port Harcourt Metropolis, Rivers State. Methods: The research employed a cross-sectional design. An air-quality monitoring device was used to measure the AQI in selected areas of Port Harcourt Metropolis over one year. All ethical procedures were followed. Approval for the study was obtained from the University of Port Harcourt Research Ethics Committee (UPH/CEREMAD/REC/MM91/067). Data were analysed using the Statistical Package for the Social Sciences (SPSS), version 25. Descriptive statistics, including frequencies and percentages, were calculated, and inferential statistics were performed using the chi-square test. A p-value of ≤ 0.05 was considered statistically significant. Results: The study recorded variation in air-quality parameters across the six locations. Statistically significant differences were observed in PM₁.₀, PM₂.₅ and PM₁₀ concentrations across the study areas, with p-values of 0.003, 0.003 and 0.002, respectively. Unhealthy carbon monoxide levels were reported in Elekahia and Rumukurushi, and relative humidity was above the stated acceptable limit in these locations. Ambient temperature and noise levels were reported as moderate and within the acceptable limit. Conclusion: Unhealthy levels of particulate matter, carbon monoxide and relative humidity were observed in different parts of Port Harcourt Metropolis. These findings indicate the need for localised air-quality management strategies and prompt action by policymakers and urban planners to mitigate pollution sources and protect public health in Port Harcourt Metropolis and its environs.
Luliconazole (LZ) is a broad-spectrum antifungal agent whose topical performance is limited by poor aqueous solubility and restricted skin penetration. This study aimed to develop and characterise LZ-loaded bilosomes incorporated into a topical gel to enhance cutaneous delivery. Eight bilosomal formulations were prepared by thin-film hydration using soy phosphatidylcholine, cholesterol and Span 80, followed by incorporation of the optimised bilosomal suspension into a Carbopol/HPMC gel. The formulations were assessed for particle size, polydispersity, zeta potential, entrapment efficiency, morphology, in vitro drug release, skin permeation, antifungal activity and stability. BLS-6 showed a particle size of 187.45 ± 5.12 nm, a PDI of 0.289 ± 0.042 and an entrapment efficiency of 86.34 ± 3.21%. The vesicles showed spherical, well-defined morphology without noticeable aggregation or visible drug crystals. At 24 h, BLS-6 released 71.23 ± 3.45% of the encapsulated drug, compared with 94.12 ± 2.89% from the free drug. Skin permeation flux was 45.23 ± 2.89 μg/cm²/h versus 18.67 ± 1.45 μg/cm²/h for the control gel. The bilosomal gel showed MIC values of 2.5, 3.1 and 2.8 μg/mL against Candida albicans, Aspergillus niger and Trichophyton mentagrophytes, respectively. After 8 weeks, drug retention was 91.34 ± 2.45% at 25°C/60% RH and 85.67 ± 3.12% at 40°C/75% RH. These findings support further evaluation of the LZ-loaded bilosomal gel as a controlled topical delivery system.
Introduction: Immunisation as a public health intervention has proven to be one of the most effective methods of controlling and eliminating life-threatening infectious diseases that cause morbidity and mortality among infants and children. Despite its availability and effectiveness, many children remain unvaccinated and vulnerable to infectious diseases because of vaccine hesitancy and other barriers in many low-income countries. Thus, this study investigates barriers to immunisation among parents and caregivers and effective strategies for improving uptake and coverage in Yobe State, Nigeria. Method: A qualitative study comprising Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) was conducted with mothers, fathers, caregivers, religious and traditional leaders, health workers, Ward Development Committee members, and community influencers in six selected wards across three Local Government Areas in Yobe State, Nigeria. Participants were purposively selected to capture different perspectives on barriers to immunisation and to identify effective strategies for improving uptake and coverage in the study areas. Results: Barriers to immunisation identified in the study included fear of side effects, family opposition, transport and accessibility challenges, religious and cultural beliefs, long queues and waiting times, and health workers’ attitudes towards parents and caregivers. Community awareness and education, the involvement of traditional and religious leaders, immunisation defaulter tracking, the organisation of immunisation outreach services, and the provision of cash and non-cash incentives were the strategies found to be effective in improving coverage in the communities. Conclusion: Findings from the study show the need for government commitment to providing and upgrading health facilities in the communities. Collaboration among stakeholders, policymakers, and community leaders is also needed to educate parents and caregivers and raise awareness of the importance and benefits of immunisation.
Background: Leukoencephalopathy with vanishing white matter (VWM), also known as childhood ataxia with central nervous system hypomyelination, is a rare autosomal recessive leukodystrophy caused by pathogenic variants in EIF2B1–EIF2B5; EIF2B1-related disease is comparatively uncommon. Case Presentation: An 11-year-old girl with essentially normal early development developed progressive loss of motor milestones and spasticity from approximately four years of age. Brain magnetic resonance imaging demonstrated near-symmetrical T2-weighted and FLAIR hyperintensity of the bilateral cerebral white matter with periventricular cystic change, additional involvement of deep grey matter, brainstem and cerebellar grey matter, and diffuse thinning of the corpus callosum. Whole mitochondrial genome sequencing was unremarkable. Clinical exome sequencing identified likely compound heterozygous EIF2B1 variants, c.439C>T (p.Arg147Ter) and c.824A>G (p.Tyr275Cys), supporting a diagnosis of EIF2B1-related VWM. At neuropaediatric physiotherapy assessment, lower-limb-predominant spasticity was evident, with Modified Ashworth Scale grades up to 3 at the knee flexors and ankle plantar flexors, brisk deep tendon reflexes, bilateral extensor plantar responses, bilateral knee flexion contracture, and marked limitation of standing and walking. Gross Motor Function Measure dimension scores were 100% for lying/rolling, 100% for sitting, 63.85% for crawling/kneeling, 19.14% for standing, and 0% for walking/running/jumping. Speech, cognition, and attention remained age-appropriate. Conclusion: The case demonstrates the complementary diagnostic roles of neuroimaging and molecular testing and the value of structured physiotherapy outcome measures for rehabilitation planning in progressive VWM.
Background: Hypotension is a frequent complication of spinal anaesthesia. Crystalloid preloading and coloading are commonly used fluid strategies, but evidence from mixed surgical populations in sub-Saharan Africa is limited. Methods: This prospective quasi-randomised comparative study was conducted at Bowen University Teaching Hospital, Ogbomoso, Nigeria, from June to August 2025. Ninety-two adults aged 18 to 60 years with American Society of Anesthesiologists physical status I or II were assigned by odd or even surgical-list order to receive 500 mL of 0.9% saline either before spinal anaesthesia (preloading, n = 46) or immediately after intrathecal injection (coloading, n = 46). The primary outcome was any episode of post-spinal hypotension within 60 minutes, defined as absolute systolic blood pressure below 90 mmHg. Unadjusted risk ratios and absolute risk differences were calculated from the reported aggregate counts. Results: Post-spinal hypotension occurred in 15 of 46 patients (32.6%) in the coloading group and 25 of 46 patients (54.3%) in the preloading group. The unadjusted risk ratio was 0.60 (95% confidence interval 0.37 to 0.98), and the absolute risk difference was -21.7 percentage points (95% confidence interval -39.6 to -1.5). Rescue ephedrine was administered to 14 patients (30.4%) after coloading and 25 patients (54.3%) after preloading, corresponding to an unadjusted risk ratio of 0.56 (95% confidence interval 0.34 to 0.93). The reported systolic blood pressure series was broadly similar between groups at most time points, but patient-level repeated-measures analysis was not available. Conclusion: In this single-centre quasi-randomised study, crystalloid coloading was associated with fewer observed episodes of post-spinal hypotension and less rescue ephedrine use than preloading. Predictable allocation, baseline heterogeneity, limited sample size and absence of adjusted and repeated-measures analyses restrict causal interpretation.
Adequate sleep is increasingly recognised as a modifiable determinant of somatic growth and endocrine function during childhood and adolescence, yet the strength and consistency of this relationship across different sleep dimensions remain incompletely resolved. This critical narrative review synthesises evidence on how sleep duration, sleep quality, and sleep timing relate to linear growth, pubertal maturation, and metabolic-endocrine regulation in paediatric populations. Literature was drawn from peer-reviewed biomedical and life-science sources, general and specialist scholarly indexes, and citation tracking of recent reviews, covering mechanistic, cohort, cross-sectional, and intervention studies published predominantly since 2000, with foundational older work retained where historically necessary. The relationship between slow-wave sleep and pulsatile growth hormone release is well established physiologically, but its translation into measurable differences in childhood height remains inconsistent across cohort studies, with nighttime sleep duration showing more reproducible associations with linear growth than total sleep time. Evidence linking sleep quality, particularly obstructive sleep-disordered breathing, to growth faltering and post-surgical catch-up growth is comparatively robust. The association between sleep duration and pubertal timing is bidirectional and modest in magnitude, with genetic and observational data suggesting that later menarche modestly lengthens habitual sleep, while shorter sleep in mid-childhood may be associated with earlier pubertal onset in some age windows. Sleep curtailment is consistently associated with unfavourable leptin, ghrelin, and insulin-sensitivity profiles, although effect sizes vary by measurement method, pubertal stage, and adiposity status. Sleep timing and circadian misalignment, including social jetlag, appear to influence cardiometabolic risk independently of sleep duration, particularly in female adolescents. Cortisol regulation is sensitive to both sleep duration and sleep architecture in children, although the direction of causation is difficult to establish from existing designs. Across domains, methodological heterogeneity, reliance on subjective sleep measures, and a scarcity of studies spanning the pubertal transition limit the strength of causal inference that can currently be drawn. Priorities for future research include objectively measured, longitudinal cohorts extending across puberty, mechanistic paediatric studies of appetite-regulating hormones, and trials of sleep extension or circadian realignment with endocrine and growth endpoints.
Aims: To compare the effects of habituation exercises versus gaze stability exercises on dizziness severity using the Dizziness Handicap Inventory in patients with migraine-related dizziness. Study Design: Participants were allocated to groups by simple randomisation in a two-arm parallel-group randomised controlled trial. A comparative study with a pre- and post-test design was conducted. Place and Duration of Study: The study was conducted over a period of 6 months among subjects selected from physiotherapy and rehabilitation centres across Bangalore between June 2025 and June 2026. Methodology: Forty subjects of both sexes, aged 20-40 years, with a history of migraine-related dizziness lasting from more than 2 weeks to 6 months were selected. After demographic data were collected, the subjects underwent clinical evaluation using the dynamic visual acuity test, Motion Sensitivity Quotient, and Dizziness Handicap Inventory scale. Testing was performed for all 40 subjects over a period of 10 months, after which a post-test was conducted and the results were compared. Results: There was no significant difference between the two groups at baseline. Following the 6-week intervention, there was an overall improvement in the Dizziness Handicap Inventory scale, Motion Sensitivity Quotient, and dynamic visual acuity test between the pre- and post-test assessments. The results showed a significant between-group difference for the Motion Sensitivity Quotient value [p < 0.0001], whereas the dynamic visual acuity test value [p > 0.290] and Dizziness Handicap Inventory value [p > 0.443] were not statistically significant. Conclusion: The pre- and post-test scores for the dynamic visual acuity test, Motion Sensitivity Quotient, and Dizziness Handicap Inventory scale showed significant improvement in the rehabilitation of subjects with migraine-related dizziness in both groups. Hence, based on the results, both therapies were equally effective in improving the Dizziness Handicap Inventory and dynamic visual acuity test scores; however, habituation exercises were more effective than gaze stability exercises in improving the Motion Sensitivity Quotient scores in the treatment of migraine-related dizziness.
Background: Poor adherence to antiretroviral therapy (ART) may worsen organ impairment in persons living with HIV (PLHIV). Objective: To assess the effect of ART adherence on hepatic and renal functions in patients with HIV. Methods: A cross-sectional comparative study was conducted among 90 participants (30 ART-adherent HIV-positive participants, 30 ART-non-adherent HIV-positive participants, and 30 HIV-negative controls). Serum biochemical parameters (liver enzymes: AST, ALT, and ALP; bilirubin; kidney function: urea, creatinine, and electrolytes) were determined using standard colorimetric methods. Data were analysed using one-way ANOVA followed by post-hoc LSD and Student’s t-tests in SPSS version 25 (p < 0.05). Results: ART-non-adherent participants had significantly higher liver enzymes (AST, ALT, and ALP), total and conjugated bilirubin, urea, creatinine, sodium and potassium levels compared with adherent participants and controls (p < 0.05). The profiles of adherent participants were akin to those of HIV-negative controls. Among non-adherent patients, sodium levels differed significantly among regimens (p < 0.05), and longer interruption (7–12 months) was associated with worse biochemical derangements than shorter interruption (3–6 months) (p < 0.05). Conclusion: Non-adherence to ART is strongly associated with hepatic and renal dysfunction. Long-term adherence preserves organ function. Routine monitoring, adherence counselling and re-engagement strategies are recommended.
Persistent impairment of trunk control is an important constraint on balance, mobility and independence after stroke. Selective trunk exercise performed on a stable mat or plinth and on an unstable gym ball has therefore been proposed to extend task-specific practice beyond conventional limb-focused rehabilitation. This critical narrative review evaluates the comparative effects, plausible mechanisms, methodological quality and clinical applicability of mat- and gym-ball-based trunk exercise for adults with chronic stroke. Searches of PubMed/MEDLINE, the Cochrane Library and the Physiotherapy Evidence Database were supplemented by citation searching and verification through publisher, PubMed and Digital Object Identifier records; eligible evidence available up to 23 April 2026 was considered. Direct comparative evidence remains limited. In an acute pilot trial, the between-group change favoured physio-ball training by 3.06 points on the total Trunk Impairment Scale. In a 108-participant chronic-stroke trial, plinth- and Swiss-ball-based programmes produced mean improvements of 3.6 and 4.1 points, respectively, relative to standard physiotherapy, with similar benefits between the two active surfaces. A subsequent 84-participant chronic-stroke trial likewise found that stable- and unstable-support core programmes improved trunk control, strength, weight-bearing symmetry and balance confidence relative to standard physiotherapy, without significant differences between active conditions. Meta-analytic evidence supports trunk training for trunk-specific outcomes and standing balance, although certainty is commonly low and transfer to activities of daily living is attenuated in dose-matched comparisons. The most defensible interpretation is that repeated selective movement, multidirectional weight shift, feedback, progression and sufficient active practice account for much of the benefit, whereas surface instability is an optional method of grading task demand rather than a necessary therapeutic ingredient. Surface selection should therefore reflect impairment, goals, tolerance, supervision and setting. Independent, adequately powered, dose-matched comparative trials with objective biomechanics, prospective falls, participation, fidelity, adverse-event and economic outcomes are required before surface-specific superiority can be established.
Background: Dual clinical practice (DCP) is prevalent among healthcare workers in South Sudan, yet no specific, legally binding regulatory framework governs the practice. This study assessed the socio-demographic profiles of participants, examined existing policy frameworks, and proposed context-appropriate regulatory options for managing DCP in Juba, South Sudan. Methods: A mixed-methods, cross-sectional, sequential study was conducted in Juba, South Sudan, from March to April 2026 among 288 healthcare workers selected through multistage stratified random sampling from 20 public and private health facilities. Qualitative data were obtained through 22 purposively selected key informant interviews and three focus group discussions involving policymakers, academics, professional bodies, health service users, and community members. Quantitative data were analysed using descriptive statistics (frequencies, proportions, and 95% confidence intervals), while qualitative data were analysed thematically using ATLAS.ti version 7. Results: Among the participants, 52.8% were male, and approximately 40% were aged 20–29 years. Regulatory awareness was critically low: only 15.6% (95% CI: 11.5–20.1) reported knowledge of existing DCP policies, 33.7% (95% CI: 28.5–38.9) reported no awareness, and 50.7% (95% CI: 44.8–56.3) were uncertain. Only 14.9% believed that the current framework adequately regulated DCP, while 66% considered DCP acceptable under appropriate regulation. Qualitative findings consistently indicated strong opposition to outright prohibition, with participants advocating a regulatory approach incorporating salary reform, improved working conditions, conflict-of-interest management, and accountability mechanisms. A desk review of South Sudanese policy documents further indicated that, although the 2011–2015 human resources for health policy recommended establishing a DCP governance framework, subsequent national health policies remain silent on the practice and provide no explicit regulatory guidance. Conclusion: South Sudan faces a substantial health-policy and regulatory gap in governing DCP. The findings support the development of a permissive, context-specific, and politically feasible regulatory framework that combines financial incentives for healthcare workers, improved working conditions, conflict-of-interest disclosure, and accountability mechanisms rather than prohibition. Policymakers should prioritise multisectoral stakeholder involvement in co-designing and implementing evidence-informed DCP governance policies that strengthen health-worker performance and support progress towards Universal Health Coverage (UHC).
Background: Cervicogenic headache is a disorder arising from dysfunction of the upper cervical spine. It is characterised by restricted cervical range of motion (ROM), neck pain, functional disability, and reduced quality of life. Although manual therapy has been shown to alleviate headache symptoms effectively, the mechanisms underlying its therapeutic effects remain poorly understood. Objective: This study aimed to investigate whether improvements in cervical ROM mediated the effects of manual therapy on pain intensity, neck disability, headache impact, and health-related quality of life in patients with cervicogenic headache. A secondary objective was to compare the mediating effect of cervical mobility between upper cervical manipulation alone and upper cervical manipulation combined with upper thoracic manipulation. Methods: This prospective, assessor-blinded, randomised controlled trial included 76 individuals with cervicogenic headache, who were randomly assigned to either Group A (upper cervical manipulation with conventional physiotherapy; n = 38) or Group B (upper cervical manipulation with upper thoracic manipulation plus conventional physiotherapy; n = 38). The primary outcomes were pain intensity, assessed using the Visual Analogue Scale (VAS), and neck disability, assessed using the Neck Disability Index (NDI). Secondary outcomes included the HIT-6, headache frequency, headache duration, the Short Form Health Survey (SF-36), patient satisfaction, and cervical ROM. Statistical analyses included repeated-measures ANOVA, correlation analysis, and mediation analysis. Results: Following treatment, all clinical outcomes improved significantly in both intervention groups. However, Group B achieved significantly greater reductions in pain, disability, headache impact, frequency, and duration, together with larger improvements in cervical ROM, quality of life, and patient satisfaction, than Group A. Mediation analysis indicated that manual therapy restored cervical ROM, which significantly mediated the association between manual therapy and improvements in pain, disability, and quality of life, supporting the interpretation that restoration of cervical mobility is a principal mechanism of clinical recovery. Conclusion: Manual therapy is effective for cervicogenic headache. In particular, combining upper cervical and upper thoracic manipulation produced superior clinical outcomes compared with upper cervical manipulation alone. Recovery of cervical range of motion appears to be a major biomechanical pathway through which manual therapy may reduce pain and disability while improving recovery and quality of life. The findings suggest that mechanism-based rehabilitation strategies aimed at enhancing cervical mobility should be considered an important component of cervicogenic headache management.
This analytical cross-sectional study evaluated the correlation between glycated albumin (GA) and HbA1c in detecting glucose tolerance disorders among transfusion-dependent children with beta-thalassaemia major. The study was conducted at Ulin Regional General Hospital, Banjarmasin, and included 35 eligible paediatric patients with confirmed beta-thalassaemia major who were receiving regular transfusions after applying predefined inclusion and exclusion criteria. Laboratory parameters included GA, HbA1c, fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), serum ferritin and albumin levels. Statistical analysis was performed after normality testing, and Pearson correlation tests were used to examine the relationships between GA and HbA1c, FPG, OGTT and ferritin levels. The results showed a moderate positive correlation between GA and HbA1c (r = 0.557, p = 0.001), indicating that higher GA values were associated with higher HbA1c values. A significant positive correlation was also observed between GA and OGTT results (r = 0.402, p = 0.017). However, GA was not significantly correlated with FPG (r = -0.035, p = 0.840) or serum ferritin levels (r = -0.073, p = 0.677). These findings suggest that GA correlates with HbA1c and may serve as a supportive biomarker for assessing glucose metabolism abnormalities in transfusion-dependent children with beta-thalassaemia, particularly when HbA1c interpretation is limited by altered red blood cell turnover. Nevertheless, GA did not show a significant association with ferritin or fasting glucose parameters in this cohort, and its interpretation should remain complementary to OGTT and clinical evaluation.
Calisthenics is widely used in martial-arts preparation because it is inexpensive, portable and adaptable to group training, yet its effects are often inferred from general exercise research rather than demonstrated in martial artists. This critical narrative review evaluates how progressive bodyweight training may influence strength, muscular endurance, power, speed, change-of-direction ability, balance, trunk function, flexibility, cardiorespiratory fitness and body composition in striking, grappling and mixed combat contexts. Peer-reviewed evidence published from 2000 to 26 May 2026 was identified through accessible scholarly indexes, citation searching and DOI verification. Direct calisthenics trials in martial-arts athletes were scarce, so the synthesis integrated three evidence streams: calisthenics and bodyweight interventions in non-martial-arts populations, bodyweight-dominant core, plyometric and interval interventions in combat-sport athletes, and broader evidence on the physical demands and conditioning responses of martial arts. The strongest support concerns improvements in movement-specific upper-body strength and local muscular endurance when exercise difficulty is progressively increased. Explosive bodyweight drills and plyometric-jump training can improve selected power and change-of-direction outcomes, but these effects cannot be generalised to high-repetition calisthenics. Trunk-focused programmes may improve trunk endurance and some balance or sport-related outcomes, although transfer is inconsistent. Bodyweight circuits can enhance cardiorespiratory fitness in inactive or moderately trained participants, whereas short low-volume protocols may only maintain fitness in already trained populations. Evidence for substantial changes in body composition, absolute maximal strength, grip-specific capacity or competitive performance remains weak. Calisthenics is therefore best treated as a programmable resistance and conditioning method rather than a single intervention. Its value depends on matching leverage, range of motion, tempo, external augmentation, velocity intent and session density to the athlete’s discipline, training status and competition phase. Well-controlled martial-arts trials comparing progressive calisthenics with external resistance training are needed before claims of equivalence or superior sport transfer can be sustained.
The fetal epigenome is established during periods of extensive cellular differentiation and may record, buffer or transmit information about the maternal milieu. This critical narrative review evaluates evidence that maternal nutrition and metabolic state, environmental toxicants and ambient pollution, and psychosocial conditions alter epigenetic regulation in the placenta, cord blood or fetal tissues. Literature published from January 2000 to 26 May 2026 was identified through accessible scholarly indexes, supplemented by citation searching and verification against authoritative bibliographic records. Evidence was appraised across human observational studies, natural experiments, randomised trials and mechanistic animal models. The strongest replicated human evidence concerns sustained maternal smoking, for which newborn DNA methylation signatures are consistent across cohorts and some marks persist beyond childhood. Nutritional programming is mechanistically compelling, particularly for one-carbon metabolism and severe energy or protein imbalance, but human findings are most persuasive in quasi-experimental settings and at metastable epialleles; routine supplementation and dietary interventions have produced smaller, locus-specific or non-replicated effects. Air pollution, metals, phenols, phthalates and per- and polyfluoroalkyl substances are associated with placental or cord-blood epigenetic variation, yet effect sizes, loci and biological interpretation vary with exposure assessment, gestational timing, tissue composition and co-exposure. Psychosocial studies support stress-responsive placental and hypothalamic-pituitary-adrenal pathways, but candidate-gene associations have not translated into a stable epigenome-wide signature. Across domains, DNA methylation dominates measurement, whereas histone regulation, chromatin accessibility and non-coding RNA remain less comprehensively studied in humans. Most findings establish exposure-associated molecular variation rather than durable, causal programming of organ function or disease. Progress requires longitudinal and diverse pregnancy cohorts, repeated exposure measurement, cell-resolved placental and fetal models, multi-omic integration, functional perturbation and causal triangulation. Epigenetic evidence can clarify biological embedding of prenatal conditions, but it should not be interpreted as deterministic or used to individualise responsibility for structurally patterned maternal exposures.
Postpartum hypophysitis is an uncommon inflammatory disorder of the pituitary gland that may present with headache, visual symptoms, or varying degrees of hypopituitarism. Presentation with refractory shock, cardiomyopathy, central diabetes insipidus, severe adrenal insufficiency, and torsades de pointes is exceptionally unusual and may obscure timely diagnosis in the postpartum period. We report a 26-year-old woman, six months after caesarean delivery, who presented with breathing difficulty, lower abdominal pain, recurrent vomiting, weight loss, and fatigue. She had fluid-refractory hypotension requiring vasopressor support. Initial evaluation showed severe left ventricular dysfunction with an ejection fraction of 25-30%, hypokalaemia, bicytopenia, hypothyroidism, and a markedly low morning serum cortisol level of 1 microgram/dL. During magnetic resonance imaging of the brain, she developed torsades de pointes with cardiac arrest and required two cycles of cardiopulmonary resuscitation and electrical cardioversion. Magnetic resonance imaging demonstrated a partially empty sella with a flattened pituitary gland, an absent posterior pituitary bright spot, and a small optic chiasmal lesion abutting the infundibular stalk. Treatment included stress-dose hydrocortisone, vasopressin, magnesium and lignocaine infusions, electrolyte correction, ventilatory and vasopressor support, and heart-failure therapy. Following hydrocortisone initiation, haemodynamic status improved, vasopressors were withdrawn, and the ejection fraction increased to 45% within 10 days. At follow-up, left ventricular function and the QTc interval normalised, while morning cortisol levels remained low and diabetes insipidus improved with desmopressin. This case highlights a rare postpartum presentation of probable hypophysitis complicated by reversible cardiomyopathy, refractory shock, and torsades de pointes, supporting early endocrine evaluation in postpartum patients with unexplained shock.
Background: Sedentary academic lifestyles common in university settings, yet the specific contribution of hamstring flexibility to broader musculoskeletal health in this population has not been adequately examined. Objectives: This study aimed to measure hamstring flexibility using two clinically validated tools, establish the pint prevalence to hamstring tightness among undergraduate students, and determine whether hamstring flexibility independently predicts musculoskeletal wellbeing outcomes. Methods: A cross-sectional observational design was employed among undergraduate students affiliated to university in South India. Hamstring flexibility was evaluated using the Sit-and-Reach test (SRT) and the Active Knee Extension (AKE) test. Musculoskeletal outcomes were quantified through various validated instruments. Multiple linear regression modelling identified independent predictor of a composite Musculoskeletal Wellbeing Score (MWS). Results: Hamstring tightness was detected in 126 participants (60.0%). Female students recorded substantially higher SRT scores than males, whereas males showed greater bilateral AKE angles reflecting more pronounced tightness. All musculoskeletal outcome measures worsened in a graded manner across flexibility categories (P<0.001 to 0.003). In the regression model SRT score emerged as the strongest independent predictor (β = -0.36; p <0.001); daily sitting time and physical activity level also contributed significantly. Conclusion: Hamstring flexibility is a significant and independent predictor of musculoskeletal wellbeing in university students. The 60% prevalence of tightness in this cohort warrants structured institutional screening. Both the SRT and AKE test provide reliable, complementary assessments suitable for university health appraisals, and modifiable behavioural factors like prolonged sitting and physical inactivity should be addressed alongside flexibility training.
