Abstract:

The relationship between infections, vectors, and hosts influences vector-borne diseases (VBDs), which are increasingly linked to climate change. The physiological and ecological dynamics of vectors, particularly mosquitoes and ticks, are changed by rising global temperatures, which promotes the spread of these organisms into new geographical areas. As tropical species move into temperate zones and higher elevations, where they establish populations in formerly non-endemic locations, this expansion is especially visible. For example, the elevation range of malaria vectors has increased significantly, and diseases such as dengue and West Nile virus are spreading throughout Europe and North America as a result of favorable climate circumstances. The association between climate factors and the transmission of VBD is complicated; higher temperatures can increase the rates at which vectors bite, leading to an increase in the incidence of the disease. Furthermore, variations in precipitation patterns add to the amount of standing water that is available, which provides mosquitoes with the perfect environment for breeding. However, because of the interaction of several factors including changes in land use and human migration, it is still difficult to precisely attribute specific outbreaks to climate change. There are grave consequences for public health. If current trends continue, projections suggest that by 2070, an additional 4.7 billion people may be vulnerable to illnesses like dengue and malaria5. To reduce these risks, we urgently need effective intervention techniques such as improved surveillance systems, vector control measures, and public health preparation programs. Inaction will probably cause the burden of VBDs to increase, worsening global health inequities and placing a strain on healthcare systems all over the world. The continual adaptation of vectors to climate change emphasizes the need for adaptive management approaches to protect public health from this impending threat.

References:

Abstract:

Preeclampsia (PE) is a pregnancy complication characterized by the onset of high blood pressure after 20 weeks of gestation with proteinuria and abnormal liver enzymes. The early diagnosis and prophylactic use of aspirin can reduce the long-term complications of PE. In the current study, we utilized machine learning tools for the differential diagnosis of EOPE and LOPE based on demographic, clinical, and biochemical data. We employed SYBR green-based real-time PCR to study the differential expression of hsa-miR-4743-5p, miR-149-5p, miR-331-5p, and miR-483-5p in both forms of PE. A classification and regression tree (CART) model was developed to differentiate between EOPE and LOPE. This was achieved by determining thresholds of systolic blood pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Body Mass Index (BMI), urine protein, and SGOT. The RT-PCR-based DEM profile identified an association of miR-4743-5p with both forms of PE; miR-149-5p with EOPE, and miR-331-5p and miR-483-5p with LOPE. MiRDip analysis revealed that genes targeted by these miRs influence TGF beta signaling in EOPE; cholesterol and lipid homeostasis and NOTCH2 signaling in LOPE. In conclusion, SBP, MAP, BMI, urine protein, DBP, and SGOT are key determinants of EOPE and LOPE. The DEM profile clearly distinguished EOPE and LOPE.

References:

[1].   Yang, Y., Le Ray, I., Zhu, J., Zhang, J., Hua, J., & Reilly, M., 2021, Preeclampsia prevalence, risk factors, and pregnancy outcomes in Sweden and China. JAMA Network Open, 4(5), e218401. https://doi.org/10.1001/jamanetworkopen.2021.8401.

[2].   Tyrmi, J. S., Kaartokallio, T., Lokki, A. I., Jääskeläinen, T., Kortelainen, E., et al., 2023, Genetic Risk Factors Associated with Preeclampsia and Hypertensive Disorders of Pregnancy. JAMA cardiology, 8(7), 674–683. https://doi.org/10.1001/jamacardio.2023.1312

[3].   Muldoon, K. A., McLean, C., El-Chaár, D., Corsi, D. J., Rybak, et al., 2023, Persisting risk factors for preeclampsia among high-risk pregnancies already using prophylactic aspirin: a multi-country retrospective investigation. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 36(1), 2200879. https://doi.org/10.1080/14767058.2023.2200879

[4].   Hercus, A., Dekker, G., & Leemaqz, S., 2020, Primipaternity and birth interval; independent risk factors for preeclampsia. The Journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 33(2), 303–306. https://doi.org/10.1080/14767058.2018.1489794

[5].   Stitterich, N., Shepherd, J., Koroma, M. M., & Theuring, S., 2021. Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study. BMC pregnancy and childbirth, 21(1), 413. https://doi.org/10.1186/s12884-021-03874-7

[6].   Dai, F., Pan, S., Lan, Y., Tan, H., Li, J., & Hua, Y., 2022, Pregnancy outcomes and risk factors for preeclampsia in dichorionic twin pregnancies after in vitro fertilization: a five-year retrospective study. BMC pregnancy and childbirth, 22(1), 830. https://doi.org/10.1186/s12884-022-05184-y

[7].   Fox, N. S., Roman, A. S., Saltzman, D. H., Hourizadeh, T., Hastings, J., & Rebarber, A., 2014. Risk factors for preeclampsia in twin pregnancies. American journal of perinatology, 31(2), 163–166. https://doi.org/10.1055/s-0033-1343775

[8].   Jaatinen, N., Jääskeläinen, T., FINNPEC, Laivuori, H., & Ekholm, E., 2021, The non-traditional and familial risk factors for preeclampsia in the FINNPEC cohort. Pregnancy hypertension, 23, 48–55. https://doi.org/10.1016/j.preghy.2020.11.001

[9].   Weitzner, O., Yagur, Y., Weissbach, T., Man El, G., & Biron-Shental, T., 2020, Preeclampsia: risk factors and neonatal outcomes associated with early- versus late-onset diseases. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 33(5), 780–784. https://doi.org/10.1080/14767058.2018.1500551

[10].  Suksai, M., Geater, A., Phumsiripaiboon, P., & Suntharasaj, T., 2022, A new risk score model to predict preeclampsia using maternal factors and mean arterial pressure in early pregnancy. Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology, 42(3), 437–442. https://doi.org/10.1080/01443615.2021.1916804

[11].  Choorakuttil, R. M., Rajalingam, B., Satarkar, S. R., Sharma, L. K., Gupta, A., et al., 2022, Effectiveness of the First Trimester Samrakshan Protocol for the Identification of Pregnant Women at High Risk for Preterm Pre-eclampsia. The Indian journal of radiology & imaging, 33(1), 98–100. https://doi.org/10.1055/s-0042-1759856

[12].  Chaemsaithong, P., Pooh, R. K., Zheng, M., Ma, R., Chaiyasit, N., Tokunaka, M., et al., 2019, Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population. American journal of obstetrics and gynecology, 221(6), 650.e1–650.e16. https://doi.org/10.1016/j.ajog.2019.09.041

[13].  Marić, I., Tsur, A., Aghaeepour, N., Montanari, A., Stevenson, D. K., Shaw, G. M., & Winn, V. D., 2020, Early prediction of preeclampsia via machine learning. American journal of obstetrics & gynecology MFM, 2(2), 100100. https://doi.org/10.1016/j.ajogmf.2020.100100.

[14].  Melinte-Popescu, A. S., Vasilache, I. A., Socolov, D., & Melinte-Popescu, M., 2023, Predictive Performance of Machine Learning-Based Methods for the Prediction of Preeclampsia-A Prospective Study. Journal of clinical medicine, 12(2), 418. https://doi.org/10.3390/jcm12020418.

[15].  Zhao, X., Wang, Y., Li, L., Mei, J., Zhang, X., & Wu, Z.,2021, Predictive value of 4-Hydroxyglutamate and miR-149-5p on eclampsia. Experimental and molecular pathology, 119, 104618. https://doi.org/10.1016/j.yexmp.2021.104618

[16].  Wang, G., Li, Y., Liu, Z., Ma, X., Li, M., Lu, Q., et al., 2020, Circular RNA circ_0124644 exacerbates the ox-LDL-induced endothelial injury in human vascular endothelial cells through regulating PAPP-A by acting as a sponge of miR-149-5p. Molecular and cellular biochemistry, 471(1-2), 51–61. https://doi.org/10.1007/s11010-020-03764-0

[17].  Mayor-Lynn, K., Toloubeydokhti, T., Cruz, A. C., & Chegini, N., 2011, Expression profile of microRNAs and mRNAs in human placentas from pregnancies complicated by preeclampsia and preterm labor. Reproductive sciences (Thousand Oaks, Calif.), 18(1), 46–56. https://doi.org/10.1177/1933719110374115.

[18].  Calvier, L., Chouvarine, P., Legchenko, E., Hoffmann, N., Geldner, J., et al., 2017, PPARγ Links BMP2 and TGFβ1 Pathways in Vascular Smooth Muscle Cells, Regulating Cell Proliferation and Glucose Metabolism. Cell metabolism, 25(5), 1118–1134.e7. https://doi.org/10.1016/j.cmet.2017.03.011

[19].  Haider, S., Lackner, A. I., Dietrich, B., Kunihs, V., Haslinger, P., Meinhardt, G., et al., 2022, Transforming growth factor-β signaling governs the differentiation program of extravillous trophoblasts in the developing human placenta. Proceedings of the National Academy of Sciences of the United States of America, 119(28), e2120667119. https://doi.org/10.1073/pnas.2120667119

[20].  Antonić, T. D., Ardalić, D. Č., Vladimirov, S. S., Banjac, G. S., Cabunac, P. J., Zeljković, A. R., et al., 2021, Cholesterol homeostasis is dysregulated in women with preeclampsia. Polish archives of internal medicine, 131(12), 16144. https://doi.org/10.20452/pamw.16144

[21].  Zhao, W. X., Wu, Z. M., Liu, W., & Lin, J. H.,2017, Notch2 and Notch3 suppress the proliferation and mediate invasion of trophoblast cell lines. Biology open, 6(8), 1123–1129. https://doi.org/10.1242/bio.025767

Abstract:

Customizing treatments according to each patient's distinct genetic, molecular, and clinical traits, precision medicine holds the potential to completely transform the way cancer is treated. Advances in immunotherapy, liquid biopsy technology, multi-omics, and gene editing methods like CRISPR are all contributing to this strategy. By combining these advancements, it will be possible to develop tailored medicines that focus on the underlying genetic causes of cancer, increasing the precision and efficacy of cancer treatments. Furthermore, machine learning and artificial intelligence provide strong instruments for forecasting therapy outcomes and refining therapeutic approaches. Widespread adoption is still hampered by issues like the intricacy of cancer genetics, the high expense of sophisticated therapies, restricted access in environments with limited resources, and the requirement for uniform clinical data. In order to alter global cancer treatment and improve patient outcomes, it will be imperative to address these issues and guarantee that all patients may benefit from precision medicine.

References:

[1].   Collins, F. S., and Varmus, H., 2015, A new initiative on precision medicine, New England Journal of Medicine, 372(9), 793-795.

[2].   National Research Council, 2011, Toward precision medicine: Building a knowledge network for biomedical research and a new taxonomy of disease, National Academies Press.

[3].   Ashley, E. A., 2015, The precision medicine initiative: a new national effort, JAMA, 313(21), 2119-2120.

[4].   Szalai, R., Hadzsiev, K., and Melegh, B., 2016, Cytochrome P450 drug metabolizing enzymes in Roma population samples: systematic review of the literature, Current Medicinal Chemistry, 23(31), 3632-3652.

[5].   Advani, D., Sharma, S., Kumari, S., Ambasta, R. K., and Kumar, P., 2022, Precision oncology, signaling, and anticancer agents in cancer therapeutics, Anti-Cancer Agents in Medicinal Chemistry, 22(3), 433-468.

[6].   Ross, D. T., Scherf, U., Eisen, M. B., Perou, C. M., Rees, C., Spellman, P., and Brown, P. O., 2000, Systematic variation in gene expression patterns in human cancer cell lines, Nature Genetics, 24(3), 227-235.

[7].   Bashor, C. J., Hilton, I. B., Bandukwala, H., Smith, D. M., and Veiseh, O., 2022, Engineering the next generation of cell-based therapeutics, Nature Reviews Drug Discovery, 21(9), 655-675.

[8].   Stratton, M. R., Campbell, P. J., and Futreal, P. A., 2009, The cancer genome, Nature, 458(7239), 719-724.

[9].   Hurley, J., Doliny, P., Reis, I., Silva, O., Gomez-Fernandez, C., Velez, P., and Slamon, D. J., 2006, Docetaxel, cisplatin, and trastuzumab as primary systemic therapy for human epidermal growth factor receptor 2–positive locally advanced breast cancer, Journal of Clinical Oncology, 24(12), 1831-1838.

[10].  Abdel-Aziz, A. K., Abdel-Naim, A. B., Shouman, S., Minucci, S., and Elgendy, M., 2017, From resistance to sensitivity: insights and implications of biphasic modulation of autophagy by sunitinib, Frontiers in Pharmacology, 8, 718.

[11].  Zhang, L. J., Gan, Y. M., and Yu, L., 2015, Occurrence of BCR/ABL fusion gene in a patient with acute promyelocytic leukemia, Medical Oncology, 32, 1-3.

[12].  Mardis, E. R., 2008, Next-generation DNA sequencing methods, Annual Review of Genomics and Human Genetics, 9(1), 387-402.

[13].  Sabour, L., Sabour, M., and Ghorbian, S., 2017, Clinical applications of next-generation sequencing in cancer diagnosis, Pathology & Oncology Research, 23, 225-234.

[14].  Kyrochristos, I. D., Glantzounis, G. K., Ziogas, D. E., Gizas, I., Schizas, D., Lykoudis, E. G., and Roukos, D. H., 2017, From clinical standards to translating next-generation sequencing research into patient care improvement for hepatobiliary and pancreatic cancers, International Journal of Molecular Sciences, 18(1), 180.

[15].  Lazaro, T., and Brastianos, P. K., 2017, Immunotherapy and targeted therapy in brain metastases: emerging options in precision medicine, CNS Oncology, 6(2), 139-151.

[16].  Ferreira-Gonzalez, A., Ko, G., Fusco, N., Stewart, F., Kistler, K., Appukkuttan, S., and Babajanyan, S., 2024, Barriers and facilitators to next-generation sequencing use in United States oncology settings: a systematic review, Future Oncology, 20(35), 2765-2777.

[17].  Chen, M., and Zhao, H., 2019, Next-generation sequencing in liquid biopsy: cancer screening and early detection, Human Genomics, 13(1), 34.

[18].  Chalmers, Z. R., Connelly, C. F., Fabrizio, D., Gay, L., Ali, S. M., Ennis, R., and Frampton, G. M., 2017, Analysis of 100,000 human cancer genomes reveals the landscape of tumor mutational burden, Genome Medicine, 9, 1-14.

[19].  Druker, B. J., Guilhot, F., O'Brien, S. G., Gathmann, I., Kantarjian, H., Gattermann, N., and Larson, R. A., 2006, Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia, New England Journal of Medicine, 355(23), 2408-2417.

[20].  Nahta, R., 2012, Molecular mechanisms of trastuzumab‐based treatment in HER2‐overexpressing breast cancer, International Scholarly Research Notices, 2012(1), 428062.

[21].  Shaw, A. T., Ou, S. H. I., Bang, Y. J., Camidge, D. R., Solomon, B. J., Salgia, R., and Iafrate, A. J., 2014, Crizotinib in ROS1-rearranged non–small-cell lung cancer, New England Journal of Medicine, 371(21), 1963-1971.

[22].  Krzyszczyk, P., Acevedo, A., Davidoff, E. J., Timmins, L. M., Marrero-Berrios, I., Patel, M., and Yarmush, M. L., 2018, The growing role of precision and personalized medicine for cancer treatment, Technology, 6(03n04), 79-100.

[23].  Hauschild, A., Grob, J. J., Demidov, L. V., Jouary, T., Gutzmer, R., Millward, M., and Chapman, P. B., 2012, Dabrafenib in BRAF-mutated metastatic melanoma: a multicentre, open-label, phase 3 randomised controlled trial, The Lancet, 380(9839), 358-365.

[24].  Saltz, L. B., Lenz, H. J., Kindler, H. L., Hochster, H. S., Wadler, S., Hoff, P. M., and Chen, H. X., 2007, Randomized phase II trial of cetuximab, bevacizumab, and irinotecan compared with cetuximab and bevacizumab alone in irinotecan-refractory colorectal cancer: the BOND-2 study, Journal of Clinical Oncology, 25(29), 4557-4561.

[25].  Malani, P. N., 2012, Harrison’s principles of internal medicine, JAMA, 308(17), 1813-1814.

[26].  Ribas, A., and Wolchok, J. D., 2018, Cancer immunotherapy using checkpoint blockade, Science, 359(6382), 1350-1355.

[27].  Zhang, Q., Huo, G. W., Zhang, H. Z., and Song, Y., 2020, Efficacy of pembrolizumab for advanced/metastatic melanoma: a meta-analysis, Open Medicine, 15(1), 447-456.

[28].  Si, Y., Melkonian, A. L., Curry, K. C., Xu, Y., Tidwell, M., Liu, M., and Liu, X. M., 2021, Monoclonal antibody-based cancer therapies, Chinese Journal of Chemical Engineering, 30, 301-307.

[29].  Ayodele, O., and Razak, A. A., 2020, Immunotherapy in soft-tissue sarcoma, Current Oncology, 27(Suppl 1), 17.

[30].  Kimiz-Gebologlu, I., Gulce-Iz, S., and Biray-Avci, C., 2018, Monoclonal antibodies in cancer immunotherapy, Molecular Biology Reports, 45(6), 2935-2940.

[31].  Malani, P. N., 2012, Harrison’s principles of internal medicine, JAMA, 308(17), 1813-1814.

[32].  Ribas, A., and Wolchok, J. D., 2018, Cancer immunotherapy using checkpoint blockade, Science, 359(6382), 1350-1355.

[33].  Zhang, Q., Huo, G. W., Zhang, H. Z., and Song, Y., 2020, Efficacy of pembrolizumab for advanced/metastatic melanoma: a meta-analysis, Open Medicine, 15(1), 447-456.

[34].  Si, Y., Melkonian, A. L., Curry, K. C., Xu, Y., Tidwell, M., Liu, M., and Liu, X. M., 2021, Monoclonal antibody-based cancer therapies, Chinese Journal of Chemical Engineering, 30, 301-307.

[35].  In, G. K., Hu, J. S., and Tseng, W. W., 2017, Treatment of advanced, metastatic soft tissue sarcoma: latest evidence and clinical considerations, Therapeutic Advances in Medical Oncology, 9(8), 533-550.

[36].  Kimiz-Gebologlu, I., Gulce-Iz, S., and Biray-Avci, C., 2018, Monoclonal antibodies in cancer immunotherapy, Molecular Biology Reports, 45(6), 2935-2940.

[37].  Janne, P. A., Engelman, J. A., and Johnson, B. E., 2005, Epidermal growth factor receptor mutations in non–small-cell lung cancer: implications for treatment and tumor biology, Journal of Clinical Oncology, 23(14), 3227-3234.

[38].  Hudis, C. A., and Gianni, L., 2011, Triple‐negative breast cancer: an unmet medical need, The Oncologist, 16(S1), 1-11.

[39].  Jain, R. K., Duda, D. G., Willett, C. G., Sahani, D. V., Zhu, A. X., Loeffler, J. S., and Sorensen, A. G., 2009, Biomarkers of response and resistance to antiangiogenic therapy, Nature Reviews Clinical Oncology, 6(6), 327-338.

[40].  Le, D. T., Uram, J. N., Wang, H., Bartlett, B. R., Kemberling, H., Eyring, A. D., and Diaz Jr, L. A., 2015, PD-1 blockade in tumors with mismatch-repair deficiency, New England Journal of Medicine, 372(26), 2509-2520.

[41].  McGranahan, N., and Swanton, C., 2015, Biological and therapeutic impact of intratumor heterogeneity in cancer evolution, Cancer Cell, 27(1), 15-26.

[42].  Grigg, C., and Rizvi, N. A., 2016, PD-L1 biomarker testing for non-small cell lung cancer: truth or fiction?, Journal for Immunotherapy of Cancer, 4(1), 48.

[43].  Lim, S. M., Syn, N. L., Cho, B. C., and Soo, R. A., 2018, Acquired resistance to EGFR targeted therapy in non-small cell lung cancer: mechanisms and therapeutic strategies, Cancer Treatment Reviews, 65, 1-10.

[44].  McCarthy, J. J., McLeod, H. L., and Ginsburg, G. S., 2013, Genomic medicine: a decade of successes, challenges, and opportunities, Science Translational Medicine, 5(189), 189sr4-189sr4.

[45].  Choi, H. Y., and Chang, J. E., 2023, Targeted therapy for cancers: from ongoing clinical trials to FDA-approved drugs, International Journal of Molecular Sciences, 24(17), 13618.

[46].  Tesi, B., Boileau, C., Boycott, K. M., Canaud, G., Caulfield, M., Choukair, D., and Lindstrand, A., 2023, Precision medicine in rare diseases: what is next?, Journal of Internal Medicine, 294(4), 397-412.

[47].  Sharma, S. V., Bell, D. W., Settleman, J., and Haber, D. A., 2007, Epidermal growth factor receptor mutations in lung cancer, Nature Reviews Cancer, 7(3), 169-181.

[48].  Islam, A., Shaukat, Z., Hussain, R., and Gregory, S. L., 2022, One-carbon and polyamine metabolism as cancer therapy targets, Biomolecules, 12(12), 1902.

[49].  Zhang, Z., Stiegler, A. L., Boggon, T. J., Kobayashi, S., and Halmos, B., 2010, EGFR-mutated lung cancer: a paradigm of molecular oncology, Oncotarget, 1(7), 497.

[50].  Mosele, F., Remon, J., Mateo, J., Westphalen, C. B., Barlesi, F., Lolkema, M. P., and André, F., 2020, Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: a report from the ESMO Precision Medicine Working Group, Annals of Oncology, 31(11), 1491-1505.

[51].  Wu, J., and Lin, Z., 2022, Non-small cell lung cancer targeted therapy: drugs and mechanisms of drug resistance, International Journal of Molecular Sciences, 23(23), 15056.

[52].  Bahar, M. E., Kim, H. J., and Kim, D. R., 2023, Targeting the RAS/RAF/MAPK pathway for cancer therapy: from mechanism to clinical studies, Signal Transduction and Targeted Therapy, 8(1), 455.

[53].  Ke, X., and Shen, L., 2017, Molecular targeted therapy of cancer: The progress and future prospect, Frontiers in Laboratory Medicine, 1(2), 69-75.

[54].  Bai, R., Chen, N., Li, L., Du, N., Bai, L., Lv, Z., and Cui, J., 2020, Mechanisms of cancer resistance to immunotherapy, Frontiers in Oncology, 10, 1290.

[55].  Le, D. T., Uram, J. N., Wang, H., Bartlett, B. R., Kemberling, H., Eyring, A. D., and Diaz Jr, L. A., 2015, PD-1 blockade in tumors with mismatch-repair deficiency, New England Journal of Medicine, 372(26), 2509-2520.

[56].  McGranahan, N., and Swanton, C., 2015, Biological and therapeutic impact of intratumor heterogeneity in cancer evolution, Cancer Cell, 27(1), 15-26.

[57].  Breimer, L. H., Nousios, P., Olsson, L., and Brunnström, H., 2020, Immune checkpoint inhibitors of the PD-1/PD-L1-axis in non-small cell lung cancer: promise, controversies and ambiguities in the novel treatment paradigm, Scandinavian Journal of Clinical and Laboratory Investigation, 80(5), 360-369.

[58].  Lim, S. M., Syn, N. L., Cho, B. C., and Soo, R. A., 2018, Acquired resistance to EGFR targeted therapy in non-small cell lung cancer: mechanisms and therapeutic strategies, Cancer Treatment Reviews, 65, 1-10.

[59].  McCarthy, J. J., McLeod, H. L., and Ginsburg, G. S., 2013, Genomic medicine: a decade of successes, challenges, and opportunities, Science Translational Medicine, 5(189), 189sr4-189sr4.

[60].  Cervello, M., McCubrey, J. A., Cusimano, A., Lampiasi, N., Azzolina, A., and Montalto, G., 2012, Targeted therapy for hepatocellular carcinoma: novel agents on the horizon, Oncotarget, 3(3), 236.

[61].  Mosele, F., Remon, J., Mateo, J., Westphalen, C. B., Barlesi, F., Lolkema, M. P., and André, F., 2020, Recommendations for the use of next-generation sequencing (NGS) for patients with metastatic cancers: a report from the ESMO Precision Medicine Working Group, Annals of Oncology, 31(11), 1491-1505.

[62].  Banerjee, D., Bhattacharya, A., Puri, A., Munde, S., Mukerjee, N., Mohite, P., and Al Shmrany, H., 2024, Innovative approaches in stem cell therapy: revolutionizing cancer treatment and advancing neurobiology–a comprehensive review, International Journal of Surgery, 110(12), 445-461.

[63].  Shanmugarathinam, A., Elamaran, N., Kirubakaran, D., Irulappan, G.B., Baig, A.A. and Vasantharaj, K., 2025, Sustainable Synthesis of Zinc Oxide Nanoparticles from Vicoa indica Leaf Extract: Characterization and Evaluation of Antibacterial, Antioxidant, and Anticancer Properties. Biomedical Materials & Devices, 1-16.

[64].  Malakondaiah, S., Pavithravedhavalli, V., Kayal, L., Ryntathiang, I., and Jothinathan, M. K. D., 2024, Stem cell therapy: A new path in tackling oral cancer. Journal of Stomatology, Oral and Maxillofacial Surgery, 101967.

[65].  Shekar, N. D., Kayal, L., Babu, N. A., Jothinathan, M. K. D., and Ryntathiang, I., 2024, Pioneering the use of micro-biomarkers in oral cancer detection. Oral Oncology Reports, 100412.

Abstract:

The pharmaceutical industry is one of the biggest investors in research and innovation. Most countries have controlled the trade and patent of pharma products. Under the control of Trade-Related Aspects of Intellectual Property Rights (TRIPS) (1994), many countries have controlled their patent protection for pharma products. This is used to induce investment in clinical trials and innovations. Most of the pharma product’s production process can easily be duplicated with fewer investments than that of original brand-name products.  After patent exclusivity expires, generic producers will face intense competition in the market, which may or may not lead to lower prices, making safe access to essential medicines more difficult. Our government introduced the generic drugs which are approved by Food and Drug Administration (FDA) in (i) dosage, (ii) concentration, (iii), safety and, (iv)route of administration must be comparable to the parent drug (the drug described in the reference). v) quality, vi) results and vii) utility. Generic medicines were formulated in different countries at many times, from 1984 in USA and 1996 in Italy. Generic medicines are gaining increasing interest from many stakeholders because they allow patients to have similar treatment at a lesser price. At the same time, the research shows that the progress of this market is deliberate. Against these conditions, research on customer buying behavior for generic drugs has been used by health policy-makers and business leaders, mainly in countries such as India and Brazil, where regulations boost the manufacture and sale of generic drugs. This research will review those studies which will throw light on the purchase intentions and attitudes towards generic medicines in Tamil Nadu.

References:

[1].   Jain, S., 2022, Knowledge, Attitude, and Practice of Generic Medicines Among Consumers in India. Journal of Health Management, 24(1), 55-66.

[2].   Rao, P., 2021. Consumer Behavior Towards Generic Medicines in Tamil Nadu. Indian Journal of Pharmaceutical Sciences, 83(4), 425-433.

[3].   Sims, S., Kantipudi, S. J., Ashok, Y., et al. 2024. Effectiveness of virtual-compensatory cognitive training (V-CCT) for improving cognition in persons with schizophrenia: A multi-centre randomized controlled trial. Trials, 25, 736.

[4].   Arunkumar, R., Venkatesa Palanichamy, N., Rohini, A., and Nirmala Devi, M., 2021. A study on customer buying pattern of generic medicines from Jan Aushadhi medical stores in Coimbatore city of Tamil Nadu, The Pharma Innovation Journal, SP-10(10), 01-05.

[5].   Mohan, R., 2023. Research on Generic Medicine Acceptance: A Tamil Nadu Case Study. Health Economics and Outcomes Research, 15(2), 211-220.

[6].   Raj, K., 2022. Enhancing the Acceptance of Generic Medicines. Journal of Healthcare Management, 17(4), 362-370.

[7].   Anushree Mishra, Delivering medicines access for all: The Tamil Nadu model for state drug procurement.

[8].   Basak, S. C., and Sathyanarayana, D., 2012. Exploring knowledge and perceptions of generic medicines among drug retailers and community pharmacists, Indian Journal of Pharmaceutical Sciences, Doi: 10.4103/0250-474X.110611.

[9].   Venkatesa Palanichamy, N., Santhosh Kumar, M., Kalpana, M., Balakrishnan, N., Rajavel M., and Divya, M., 2024., A Review on Consumer Patterns and Behaviours’ Towards Generic Medicines, Advances in Research, 25(4), Page 456-464. Doi:10.9734/air/2024/v25i41125

[10].  Sanjiv Kumar, Promotion of Generic Medicines: Laudable Efforts But Must Engage all Stakeholders.

[11].  Tamil Nadu State Health Policy Vision, 2030.

[12].  Mudhalvar Marunthagam to cut back on soaring medical bills https://www.dtnext.in/news/tamilnadu/mudhalvar-marunthagam-to-cut-back-on-soaring-medical-bills-803728?form=MG0AV3

[13].  Biju, A. K., B. N., & Shanmugam, R. 2024. A thorough examination of Peltophorum pterocarpum phytochemicals in network pharmacology-based management of acne vulgaris. Cureus, 16(8), e68159.

[14].  Gowri Parvathy, S. R., Sowparnika Treasa Sabu, and Shaiju Dharan, S., 2020. Insights on Patient Perception towards Generic vs Branded drugs, World Journal of Pharmaceutical Research, 9(11), 840-851.

[15].  Ankit Pandey, Shivangi Singh, Vaishali Yadav, Jhalki Sagar, Alok Verma, 2024, Understanding Doctors and Pharmacist Perspective on Generic Medicine, International Journal of Pharmacy and Pharmaceutical Research, 30(5), 1-14.

[16].  Yaser Mohammed Al-Worafi, 2023, Generic Medicines’ Knowledge, Attitude, Practice, and Acceptance by Patients and Healthcare Professionals.

[17].  Nisha, B., Gopal, S., Venkatasubramanian, P., Durairaj, J., Ashok, Y., Joseph, E., Ramachandran, P. 2025.Predictors of user engagement in online psychosocial interventions for schizophrenia in Chennai, India. Indian Journal of Psychiatry, 67, S208.

[18].  Ricardo Arcaro, Cássia Rita Pereira da Veiga, Wesley Vieira da Silva and Claudimar Pereira da Veiga, 2021, Attitude and Purchase Intention to Generic Drugs, International Journal of Environmental Research and Public Health, 18(9), https://doi.org/10.3390/ijerph18094579

[19].  Patel, A., 2019. Economic Influences on the Acceptance of Generic Medicines. Journal of Public Health Policy, 40(3), 345-354.

[20].  Kumar, V., 2020. The Impact of Government Initiatives on Generic Medicine Usage. Health Policy and Planning, 35(5), 489-497.

Abstract:

Cancer, a multifaceted disease, arises from a complex interplay of genetic mutations, epigenetic modifications, and proteomic alterations that drive tumor progression and therapeutic resistance. Traditional genomic approaches have identified key oncogenes and tumor suppressors; however, the functional consequences of these alterations at the protein level often remain elusive. Proteogenomics, an integrative approach combining next-generation sequencing and mass spectrometry-based proteomics, bridges this gap by linking genomic aberrations to proteomic changes, enabling a deeper understanding of cancer biology. This review highlights the pivotal role of proteogenomics in unraveling cancer mechanisms, focusing on its contribution to understanding signaling pathways, post-translational modifications (PTMs), and tumor heterogeneity. Proteogenomic studies have elucidated key oncogenic pathways, such as PI3K/AKT/mTOR and MAPK, revealing how dysregulated proteins and PTMs drive tumor growth and therapeutic resistance. The approach has also identified novel biomarkers and molecular subtypes across cancers, facilitating precision medicine. Furthermore, proteogenomics has been instrumental in addressing therapeutic resistance by uncovering compensatory mechanisms, clonal evolution, and proteomic adaptations in resistant tumor cells. Breast cancer and melanoma case studies illustrate its potential in developing combination therapies to counter resistance. With clinical applications advancing, proteogenomics holds promise for transforming cancer treatment through personalized medicine, patient stratification, and biomarker-driven therapies. Integrating multi-omic data provides a dynamic and comprehensive view of tumor biology, paving the way for innovative strategies to improve patient outcomes and combat therapeutic resistance. This review underscores proteogenomics as a cornerstone in the evolving landscape of oncology research.

References:

[1].   Balasooriya, E. R., et al., 2024, Integrating clinical cancer and PTM proteomics data identifies a mechanism of ACK1 kinase activation. Molecular cancer research: MCR. 22, 2, 137–151.

[2].   Eroglu, Z., and Ribas, A., 2016. Combination therapy with BRAF and MEK inhibitors for melanoma: latest evidence and place in therapy. Therapeutic advances in medical oncology. 8, 1, 48–56.

[3].   Fujimoto, Y., et al., 2020, Combination treatment with a PI3K/Akt/mTOR pathway inhibitor overcomes resistance to anti-HER2 therapy in PIK3CA-mutant HER2-positive breast cancer cells. Scientific reports. 10, 1, 21762.

[4].   Gerlinger, M., et al., 2012, Intratumor heterogeneity and branched evolution revealed by multiregion sequencing. The New England journal of medicine. 366, 10, 883–892.

[5].   Kannan, B., Pandi, C., Pandi, A., Jayaseelan, V. P., & Arumugam, P. 2024, Triggering receptor expressed in myeloid cells 1 (TREM1) as a potential prognostic biomarker and association with immune infiltration in oral squamous cell carcinoma. Archives of oral biology, 161, 105926.

[6].   Hanahan, D., and Weinberg, R. A., 2011, Hallmarks of cancer: the next generation. Cell. 144, 5, 646–674.

[7].   Lei, J. T., and Zhang, B., 2021, Proteogenomics drives therapeutic hypothesis generation for precision oncology. British journal of cancer. 125, 1, 1–3.

[8].   Li, Q., et al., 2022, Targeting the PI3K/AKT/mTOR and RAF/MEK/ERK pathways for cancer therapy. Molecular biomedicine. 3, 1, 47.

[9].   Li, Y., et al., 2023, Proteogenomic data and resources for pan-cancer analysis. Cancer cell. 41, 8, 1397–1406.

[10].  Ramarajyam, G., Murugan, R., and Rajendiran, S. 2024, Network pharmacology and bioinformatics illuminates punicalagin's pharmacological mechanisms countering drug resistance in hepatocellular carcinoma. Human Gene, 42, 201328.

[11].  Mertins, P., et al., 2016, Proteogenomics connects somatic mutations to signalling in breast cancer. Nature. 534, 7605, 55–62.

[12].  Nesvizhskii, A. I., 2014, Proteogenomics: concepts, applications and computational strategies. Nature methods. 11, 1, 1114–1125.

[13].  Pan, L., et al., 2024, HER2/PI3K/AKT pathway in HER2-positive breast cancer: A review. Medicine. 103, 24, e38508.

[14].  Rascio, F., et al., 2021, The pathogenic role of PI3K/AKT pathway in cancer onset and drug resistance: An updated review. Cancers. 13, 16, 3949.

[15].  Rodriguez, H., et al., 2021, The next horizon in precision oncology: Proteogenomics to inform cancer diagnosis and treatment. Cell. 184, 7, 1661–1670.

[16].  Sekaran, S., and Ganapathy, D., 2024, Tumor-grafted chorioallantoic membrane model: A versatile approach to study head and neck squamous cell carcinoma physiopathology and therapeutics testing. Oral Oncology Reports. 10, 100360, 100360.

[17].  Sever, R., and Brugge, J. S., 2015, Signal transduction in cancer. Cold Spring Harbor perspectives in medicine. 5, 4, a006098–a006098.

[18].  Tariq, M. U., et al., 2021, Methods for proteogenomics data analysis, challenges, and scalability bottlenecks: A survey. IEEE access: practical innovations, open solutions. 9, (2021), 5497–5516.

[19].  Terekhanova, N. V., et al., 2023, Epigenetic regulation during cancer transitions across 11 tumour types. Nature. 623, 7986, 432–441.

[20].  Yadalam, P. K., and Ardila, C. M., 2024, Artificial intelligence-driven multiomics network analysis reveals resistance mechanisms in oral cancer. International dental journal. 74, 5, 1180–1181.

[21].  Yip, H. Y. K., and Papa, A., 2021, Signaling pathways in cancer: Therapeutic targets, combinatorial treatments, and new developments. Cells (Basel, Switzerland). 10, 3, 659.

[22].  Zhang, B., et al., 2014, Proteogenomic characterization of human colon and rectal cancer. Nature. 513, 7518, 382–387.

[23].  Zhang, Y., et al., 2017, A pan-cancer proteogenomic atlas of PI3K/AKT/mTOR pathway alterations. Cancer cell. 31, 6, 820–832.e3.

Abstract:

The internet provides us with a wide range of information and effortless communication but its’ usage in excess can lead to internet addiction and is termed as problematic internet use. Internet addiction is increasing among the youth especially with the dawn of Covid-19 pandemic, due to the lockdowns imposed by the government. This study was conducted to estimate the prevalence of internet usage among students aged 15- 18 years of age. This is a cross sectional study conducted among school students of age group 15 to 18 years in Urban cities. Sample size of 300 was obtained from a study where prevalence was found to be 36.7%. A pre tested semi structured questionnaire (circulated as google forms) which included demographic details of the participants and questions regarding internet addiction was collected, data was entered in Microsoft Excel and analyzed using SPSS software. Among the 300 participants 49% of the participants play online games and about 61.7% of the participants resorted to sports as their extra-curricular activity. Among the participants who play online games 61.2% of them had played with their friends. Male sex was associated to have more incidence in playing online games, staying online longer than intended and making new relationships online which was found to be statistically significant. There was a significant association among those who play online games with those who didn’t have a play area nearby (p-0.035), Covid-19 pandemic (p<0.001) and among those residing in independent homes (p<0.001). This study shows us that male participants were addicted to the internet than female participants. Online gaming has increased with the new pandemic and measures should be taken to curtail their internet usage.

References:

[1]. Li, Y., Sun, Y., Meng, S., Bao, Y., Cheng, J., Chang X et al., 2021, Internet Addiction Increases in the General Population During COVID‐19: Evidence From China. The American Journal on Addictions, 30: 4:389-397.

[2]. Jamir, L., Duggal M., Nehra R., Singh P., Grover S., 2019, Epidemiology of technology addiction among school students in rural India. Asian Journal of Psychiatry, 40:30-38.

[3]. Ziapour, A., Lebni, J., Toghroli, R., Abbas, J., NeJhaddadgar, N., Salahshoor, M., et al., 2020, Jan, A study of internet addiction and its effects on mental health: A study based on Iranian University Students. Journal of Education and Health Promotion, 9:1:205. Available from: https://doi.org/10.4103/jehp.jehp_148_20

[4]. Cha, S. S., Seo, B. K., 2018, Smartphone use and smartphone addiction in middle school students in Korea: Prevalence, social networking service, and game use. Health Psychol Open, 5:1:2055102918755046. Available from: https://doi.org/10.1177/2055102918755046

[5]. Liu, Y., Wu, N., Yan, J., Yu, J., Liao, L., Wang, H., 2023, Mar 24, The relationship between health literacy and internet addiction among middle school students in Chongqing, China: A cross-sectional survey study. PLOS ONE.18:3. Available from : doi: 10.1371/journal.pone.0283634.

[6]. Zhang, M. W., Lim, R. B., Lee, C., Ho, R. C., 2018, Prevalence of internet addiction in medical students: A meta‑analysis. Acad Psychiatry, 42:88‑93.

[7]. Reshadat, S., Zangeneh, A., Saeidi, S., Ghasemi, S. R., Rajabi, Gilan, N., Abbasi, S., 2015, Investigating the economic, social and cultural factors influencing total fertility rate in Kermanshah. J Mazandaran Univ Med Sci, 25:108‑12.

[8]. Bisen, S. S., Deshpande, Y. M., 2020, Prevalence, predictors, psychological correlates of internet addiction among college students in India: A comprehensive study. Anatol J Psychiatry, 21:117‑23.

[9]. Abbas, J., Aman, J., Nurunnabi, M., Bano, S., 2019, The impact of social media on learning behavior for sustainable education: Evidence of students from selected universities in Pakistan. Sustainabil, 11:1683‑91.

[10]. Xu, D. D., Lok, K. I., Liu, H. Z., Cao, X. L., An, F. R., Hall, B. J., et al., 2020, Oct, Internet addiction among adolescents in Macau and mainland China: prevalence, demographics and quality of life. Scientific Reports, 1:10:1.

[11]. Vigna-Taglianti, F., Brambilla, R., Priotto, B., Angelino, R., Cuomo, G., Diecidue, R., 2017, Problematic internet use among high school students: Prevalence, associated factors and gender differences. Psychiatry Res, 257:163–171. Available from: https://doi.org/10.1016/j.psychres.2017.07.039.

[12]. Cao, H., Sun, Y., Wan, Y., Hao, J., Tao, F., 2011, Problematic Internet use in Chinese adolescents and its relation to psychosomatic symptoms and life satisfaction. BMC public health, 11:802. Available from: https://doi.org/10.1186/1471-2458-11-802.

[13]. K. W. Beard, 2002, Internet addiction: current status and implications for employees. Journal of Employment Counseling,1: 2–11.

[14]. Takahashi, M., Adachi, M., Nishimura, T., et al., 2018, Prevalence of pathological and maladaptive Internet use and the association with depression and health-related quality of life in Japanese elementary and junior high school-aged children. Soc Psychiatry Psychiatr Epidemiol, 53:1349–1359.

[15]. Rigi, Kootesh B., Raisi, M., Ziapour, A., 2016, Investigation of relationship between internet addict with mental health and quality sleep in students. Acta Med Mediterran,32:1921‑5.

[16]. Kaboudi, M., Dehghan, F., Ziapour, A., 2017, The effect of acceptance and commitment therapy on the mental health of women patients with type II diabetes. Ann Trop Med Public Health, 10:1709‑13.

[17]. Special report––Digital 2023, Your ultimate guide to the evolving digital world. 2023, Date of access: 27/12/2023, Available from: https://wearesocial.com/uk/blog/2023/01/digital-2023/

[18]. Turkish Statistical Institute, Turkstat. 2021, Date of access: 27/12/2023, Available from: https://data.tuik.gov.tr/Bulten/Index?p=Cocuklarda-Bilisim-Teknolojileri-Kullanim-Arastirmasi-2021

[19]. Guclu, Y., Guclu, O. A., Demirci, H., 2024, Mar 4, Relationships between internet addiction, smartphone addiction, sleep quality, and academic performance among high-school students. Revista da Associação Médica Brasileira, Available from: https://www.scielo.br/j/ramb/a/YhS8DWq3sNqcDRWRsC5nhHD/

[20]. Li, Y., Zhang, X., Lu, F., Zhang, Q., Wang, Y., 2014, Internet addiction among elementary and middle school students in China: a nationally representative sample study. Cyberpsychol Behav Soc Netw, 17:111–116.

[21]. Paulus, F. W., Ohmann, S., Von, Gontard, A., Popow, C., 2018, Internet gaming disorder in children and adolescents: a systematic review. Dev Med Child Neurol, 60:645–659.

[22]. Yamada, M., Sekine, M., Tatsuse, T., Asaka, Y., 2020, Prevalence and associated factors of pathological Internet use and online risky behaviors among Japanese elementary school children. Journal of Epidemiology.

[23]. Abel, T., McQueen, D., 2020, The COVID-19 pandemic calls for spatial distancing and social closeness: not for social distancing. International Journal of Public Health, 65:3:231-231.

[24]. World Health Organization encourages people to game due to coronavirus . Windows Central. 2021, Date of access:27/10/2021, Available from: https://www.windowscentral.com/world-health-organization-encourages-people-game-during-coronavirus-outbreak

[25]. World Internet Users Statistics and 2021 World Population Stats, Date of access: 27/10/ 2021, Available from: https://www.internetworldstats.com/stats.htm.

[26]. Samaha, A., Fawaz, M., El, Yahfoufi, N., Gebbawi, M., Abdallah, H., Baydoun, S., et al., 2018, Assessing the Psychometric Properties of the Internet Addiction Test (IAT) Among Lebanese College Students. Frontiers in Public Health, 6.

[27]. Balhara, Y., Harshwardhan, M., Kumar, R., Singh, S., 2018, Extent and pattern of problematic internet use among school students from Delhi: Findings from the cyber awareness programme. Asian Journal of Psychiatry, 34:38-42.

[28]. Yadav, K., Jain, A., Sharma, R., Gaur, K., Yadav, N., Sharma, P., et al., 2020, Jan, Study of internet addiction and its association with depression and insomnia in university students. Journal of Family Medicine and Primary Care, 1:9:3:1700. Available from: https://doi.org/10.4103/jfmpc.jfmpc_1178_19

[29]. Sayılı, U., Vehid, S., Erginöz, E., 2021, Problematic Internet use in Turkish high school students: Prevalence and related factors. Am J Health Behav, 1:45:1:31–43. Available from: http://dx.doi.org/10.5993/AJHB.45.1.3

[30]. How internet addiction may affect your teen’s brain, according to a new study. CNN HEALTH. 2024, Date of access: 05/06/2024, Available from: https://edition.cnn.com/2024/06/04/health/internet-addiction-teen-brain-activity-wellness/index.html

[31]. Acharya, S., Adhikari, L., Khadka, S., Paudel, S., Kaphle, M., 2023, Apr, Internet Addiction and Its Associated Factors among Undergraduate Students in Kathmandu, Nepal. Journal of Addiction [Internet], 8:2023:1–9. Available from: https://doi.org/10.1155/2023/8782527

Abstract:

Laparoscopic cholecystectomy (LC) is the preferred surgical approach for treating gallstone disease; however, there are cases that pose significant challenges, often leading to a switch to open surgery. This study aims to identify preoperative indicators that suggest a difficult laparoscopic cholecystectomy (LC), focusing on demographic factors, inflammatory markers, and intraoperative challenges. A prospective study was performed on patients diagnosed with acute or chronic cholecystitis, examining factors such as gender, age, diabetes mellitu), CRP, ESR, and TC. The findings revealed a strong association between male gender, older age, and diabetes mellitus with surgical complications (p = 0.001). CRP, ESR, and TLC were significantly linked to intraoperative challenges and the need for conversion to open surgery. The severity grade of the Tokyo Guidelines (TG-13) was substantially associated with surgical difficulty (p = 0.001). These findings points out the significance of preoperative evaluation in recognising high-risk patients, facilitating enhanced surgical planning and improved patient outcomes. Nevertheless, constraints such as a single-center design and retrospective data collecting require more multi-center prospective research to improve predictive accuracy and investigate sophisticated imaging and biochemical indicators for enhanced risk stratification.

References:

[1]. Rakesh, T., 2003, Diseases of gallbladder and biliary tract. API text book of medicine, Dr. Siddarth N Shah. (7th edition), 642–44.

[2]. Sigmon, D. F., Dayal, N., Meseeha, M., 2023, Biliary Colic. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

[3]. Baiu, I., Hawn, M. T., 2018, Gallstones and Biliary Colic. JAMA., 320(15):1612.

[4]. Agrawal, N., Singh, S., Khichy, S., 2015, Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method. Nigerian journal of surgery: official publication of the Nigerian Surgical Research Society, 21(2), 130–133.

[5]. Griffiths, E. A., Hodson, J., Vohra, R. S., Marriott, P., Katbeh, T., Zino, S., et al., 2019, Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc., 33(1):110–121. doi:10.1007/s00464-018-6281-2.

[6]. Ramírez-Giraldo, C., Alvarado-Valenzuela, K., Isaza-Restrepo, A., Navarro-Alean, J., 2022, Predicting the difficult laparoscopic cholecystectomy based on a preoperative scale. Updates Surg., 74(3):969–977.

[7]. Raza, M., Venkata, R. M., 2019, Predicting difficulty in laparoscopic cholecystectomy preoperatively using a scoring system. Int Surg J., 6:957–962.

[8]. Inoue, K., Ueno, T., Douchi, D., Shima, K., Goto, S., Takahashi, M., Morikawa, T., Naitoh, T., Shibata, C., Naito, H., 2017, Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013. BMC Surg., 17(1).

[9]. Stanisic, V., Milicevic, M., Kocev, N., Stanisic, B., 2020, A prospective cohort study for prediction of difficult laparoscopic cholecystectomy. Ann Med Surg., 60:728–733.

[10]. Panni, R. Z., Strasberg, S. M., 2018, Preoperative predictors of conversion as indicators of local inflammation in acute cholecystitis: strategies for future studies to develop quantitative predictors. J Hepatobiliary Pancreat Sci., 25(1), 101–108.

[11]. Anees, K., Faizan, M., Siddiqui, S. A., Anees, A., Faheem, K., Shoaib, U., 2024, Role of C-Reactive Protein as a Predictor of Difficult Laparoscopic Cholecystectomy. Surg Innov., 31(1), 26–32.

[12]. Joshi, M. R., Bohara, T. P., Rupakheti, S., Parajuli, A., Shrestha, D. K., Karki, D., Laudari, U., 2015, Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy. JNMA J Nepal Med Assoc., 53(200), 221–226.

[13]. Kaushik, B., Gupta, S., Bansal, S., Yadav, B. L., Bharti, D., Kalra, D., Sodha, V. S., 2018, The role of C-reactive protein as a predictor of difficult laparoscopic cholecystectomy or its conversion. Int Surg J., 5(6), 2287.

[14]. Date, R., Mok, K. J., Goh, Y., Howell, L., 2015, Is C-reactive protein the single most useful predictor of difficult laparoscopic cholecystectomy or its conversion? A pilot study. J Minim Access Surg., 12(1), 26.

[15]. Hussain, A., 2011, Difficult laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech., 21(4), 211–217.

[16]. Dhanke, P. S., Ugane, S. P., 2014, Factors predicting difficult laparoscopic cholecystectomy: a single-institution experience. Int J Students' Res., 4(1).

[17]. Arer, İ. M., Yabanoğlu, H., Çalışkan, K., 2017, Can red cell distribution width be used as a predictor of acute cholecystitis?. Turk J Surg., 33(2):76–79.

[18]. Fujimoto, G., Deguchi, T., Shirai, J., Saito, K., 2024, Risk factors for difficult Three-Port laparoscopic cholecystectomy. Cureus.

[19]. Fisher, A. T., Bessoff, K. E., Khan, R. I., Touponse, G. C., Yu, M. M., Patil, A. A., Choi, J., Stave, C. D., Forrester, J. D., 2022, Evidence-based surgery for laparoscopic cholecystectomy. Surg Open Sci., 10, 116–134.

[20]. Chen, G., Li, M., Cao, B., Xu, Q., Zhang, Z., 2022, Risk prediction models for difficult cholecystectomy. Videosurgery Other Miniinvasive Tech., 303–308.

Abstract:

Osteoporosis and osteopenia are one of the significant public health problems due to related low bone mineral density (BMD) and increased risk of fracture. Dual X-Ray Absorptiometry (DXA) is considered the gold standard for BMD assessment but is limited in availability and cannot assess bone microachitecture. This study assessed the diagnostic performance of Computed Tomography (CT) against DXA based on sensitivity, specificity and interrater reliability. This prospective study was done over 12 months in a tertiary health care hospital in Chennai which included 128 adult patients who underwent routine CT Abdomen and Pelvis for unrelated conditions. CT-derived Hounsfield Unit (HU) measurements were compared with T-scores from DXA. Sensitivity, Specificity and interrater reliability (Intraclass Correlation Coefficient, ICC) were calculated. Statistical methods included Pearson correlation and linear regression analysis. CT had a sensitivity of 0.88 and specificity of 0.92 for identifying osteoporosis, while DXA had a sensitivity of 0.85 and specificity of 0.90 when compared to CT. For osteopenia, CT was also more sensitive (0.78) and specific (0.85) than DXA (0.75 and 0.80, respectively) The interrater reliability of radiologists interpreting CT scans was strong, with intraclass correlation coefficient (ICC) of 0.92 for osteoporosis and 0.85 for osteopenia. A significant positive correlation (r = 0.75, p < 0.05) was found between HU values and BMDCT provides a reliable alternative to DXA for pathologic identification of osteoporosis and osteopenia, with high sensitivity, specificity and reproducibility. Opportunistic supplementation of HU values during routine CT scans is easy to perform in practice, and provides a tool for detecting individuals at high risk for metabolic bone disease.

References:

[1]. Pirayesh Islamian, J., Garoosi, I., Abdollahi Fard, K., Abdollahi, M. R., 2016, Comparison between the MDCT and the DXA scanners in the evaluation of BMD in the lumbar spine densitometry, The Egyptian Journal of Radiology and Nuclear Medicine, vol. 47, no. 3, pp. 961–967. doi: 10.1016/j.ejrnm.2016.04.005

[2]. Chia, K. K., Haron, J., Nik Malek, N. F. S., 2021, Accuracy of computed tomography attenuation value of lumbar vertebra to assess bone mineral density, Malaysian Journal of Medical Sciences, vol. 28, no. 1, pp. 41–50.

[3]. Pu, H., Chen, Q., Huang, K., Wei, P., Jiang, P., Zhang, C., 2022, Correlation between wrist bone mineral density measured by dual-energy X-ray absorptiometry and Hounsfield units value measured by CT in Lumbar spine, Research Square, doi:10.21203/rs.3.rs-1540685/v1

[4]. Genant, H. K., Cooper, C., Poor, G., Reid, I., Ehrlich, G., Kanis, J., et al., 1999, Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis, Osteoporosis International, vol. 10, no. 4, pp. 259–264.

[5]. Sözen, T., Özışık, L., Başaran, N.Ç., 2017, An overview and management of osteoporosis, European Journal of Rheumatology, vol. 4, no. 1, pp. 46–56.

[6]. Black, D. M., Rosen, C. J., 2016, Clinical Practice. Postmenopausal Osteoporosis, New England Journal of Medicine, vol. 374, no. 3, pp. 254–262.

[7]. Butera, A., Maiorani, C., Gallo, S., Pascadopoli, M., Venugopal, A., Marya, A., Scribante, A., 2022, Evaluation of Adjuvant Systems in Non-Surgical Peri-Implant Treatment: A Literature Review, Healthcare (Basel), vol. 10, no. 5, pp. 886. doi:10.3390/healthcare10050886

[8]. Link, T. M., 2012, Osteoporosis Imaging: State of the Art and Advanced Imaging, Radiology, vol. 263, no. 1, pp. 3–17.

[9]. Engelke, K., Adams, J. E., Armbrecht, G., Augat, P., Bogado, C. E., Bouxsein, M. L., et al., 2008, Clinical Use of Quantitative Computed Tomography and Peripheral Quantitative Computed Tomography in the Management of Osteoporosis in Adults: The 2007 ISCD Official Positions, Journal of Clinical Densitometry, vol. 11, no. 1, pp. 123–162.

[10]. Krueger, D., Fidler, J. L., Perkinson, B. C., Binkley, N., 1994, Dual-Energy X-ray Absorptiometry of the Lumbar Spine: Theoretical Principles and In Vivo Performance of the Norland Apollo Densitometer, Journal of Bone and Mineral Research, vol. 9, no. 9, pp. 1411–1422.

[11]. Silva, B. C., Broy, S. B., Boutroy, S., Schousboe, J. T., Shepherd, J. A., Leslie, W. D., 2015, Fracture Risk Prediction by Non-BMD DXA Measures: The 2015 ISCD Official Positions Part 2: Trabecular Bone Score, Journal of Clinical Densitometry, vol. 18, no. 3, pp. 309–330.

[12]. Senkutvan, R. S., Jacob, S., Charles, A., Vadgaonkar, V., Jatol-Tekade, S., Gangurde, P., 2014, Evaluation of nickel ion release from various orthodontic arch wires: An in vitro study, Journal of International Society of Preventive & Community Dentistry, vol. 4, no. 1, pp. 12–16. doi:10.4103/2231-0762.130921

[13]. Cody, D. D., Gross, G. J., Hou, F. J., Spencer, H. J., Goldstein, S. A., Fyhrie, D. P., 1999, Femoral Strength is Better Predicted by Finite Element Models than QCT and DXA, Journal of Biomechanics, vol. 32, no. 10, pp. 1013–1020.

[14]. Baum, T., Müller, D., Dobritz, M., Rummeny, E. J., Link, T. M., Bauer, J. S., 2013, BMD Measurements of the Spine Derived from Sagittal Reformations of Contrast-Enhanced MDCT Without Dedicated Software, European Journal of Radiology, vol. 82, no. 2, pp. e80–e86.

[15]. Boutroy, S., Bouxsein, M. L., Munoz, F., Delmas, P. D., 2005, In Vivo Assessment of Trabecular Bone Microarchitecture by High-Resolution Peripheral Quantitative Computed Tomography, Journal of Clinical Endocrinology and Metabolism, vol. 90, no. 12, pp. 6508–6515.

[16]. Schwaiger, B. J., Gersing, A. S., Kopp, F. K., et al., 2019, Diagnostic Value of Routine Chest CT for Detection of Osteoporosis and Vertebral Fractures in Patients with Lung Cancer, European Journal of Radiology, vol. 110, pp. 50–55.

[17]. Faulkner, K., Moores, B. M., 2000, The Relationship Between Age, Sex, and the Effective Dose from DXA Scans, Physics in Medicine and Biology, vol. 45, no. 9, pp. 2531–2540. doi:10.1088/0031-9155/45/9/318

[18]. Vaid, N. R., Sabouni, W., Wilmes, B., Bichu, Y. M., Thakkar, D. P., Adel, S. M., 2022, Customized adjuncts with clear aligner therapy: “The Golden Circle Model” explained, Journal of the World Federation of Orthodontists, vol. 11, no. 6, pp. 216–225. doi:10.1016/j.ejwf.2022.10.005

[19]. Kanis, J. A., Borgström, F., Compston, J., et al., 2020, SCOPE: A Scorecard for Osteoporosis in Europe, Archives of Osteoporosis, vol. 15, no. 1, p. 172. doi:10.1007/s11657-020-00857-6

[20]. Messina, C., Bignotti, B., Codella, U., et al., 2021, Evaluation of Bone Mineral Density by DXA and HR-pQCT in Males with Isolated Hypogonadotropic Hypogonadism at Baseline and After 18 Months of Androgen Replacement, Clinical Endocrinology (Oxford), vol. 94, no. 6, pp. 935–943. doi:10.1111/cen.14440

[21]. Li, N., Li, X.M., Xu, L., et al., 2013, Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women, International Journal of Endocrinology, vol. 2013, Article ID 895474. doi:10.1155/2013/895474

[22]. Deshpande, N., Hadi, M. S., Lillard, J. C., et al., 2023, Alternatives to DEXA for the Assessment of Bone Density: A Systematic Review of the Literature and Future Recommendations, Journal of Neurosurgery: Spine, vol. 38, no. 4, pp. 436–445. doi:10.3171/2022.11.SPINE22875

[23]. Pu, M., Zhang, B., Zhu, Y., Zhong, W., Shen, Y., Zhang, P., 2023, Hounsfield Unit for Evaluating Bone Mineral Density and Strength: Variations in Measurement Methods, World Neurosurgery, vol. 180, pp. e56–e68. doi:10.1016/j.wneu.2023.07.146.

Abstract:

Oral cancer is one of the most common cancers in the world and 90% of the oral cancers are oral squamous cell carcinoma (OSCC). The treatment modalities of oral squamous cell carcinoma includes surgery, chemotherapy and radiotherapy. Though these treatment modalities are considered to be effective, they have their own adverse effects. Treating OSCC with a plant-based drug through an effective drug delivery system may increase the quality of life of the patients. The aim of this study is to formulate a liposomal drug delivery of Tecomaquinone I for oral squamous cell carcinoma. Tecomaquinone I extract of Tectona grandis Linn was extracted. Pegalated liposome infused with Tecomaquinone I extract was fabricated using conventional method. The MDA-MB-231, A549 and SCC-25 cancer cell lines were treated with the pegalated liposome infused with Tecomaquinone I to analyse the cell cycle arrest, cytotoxic effects and apoptotic effects of Tecomaquinone I. Liposomal Tecomaquinone I showed substantial accumulation of cells in the G2/M phase, indicative of mitotic arrest and enhanced apoptotic cell death in SCC-25 (OSCC) cell line. Tecomaquinone I exerts potent cell cycle arrest, cytotoxic and apoptotic effects on Oral squamous cell carcinoma cell line (SCC-25).

References:

[1]. Tiwari, G., Tiwari, R., Bannerjee, S., Bhati, L., Pandey, S., Pandey, P., Sriwastawa, B., 2012, Drug delivery systems: An updated review. International Journal of Pharmaceutical Investigation, 2:2.

[2]. Nsairat, H., Khater, D., Sayed, U., Odeh, F., Bawab, A. A., Alshaer, W., 2022, Liposomes: structure, composition, types, and clinical applications. Heliyon, 8:e09394.

[3]. Jha, S., Sharma, P. K., Malviya, R., 2016, Liposomal Drug delivery system for cancer therapy: advancement and patents. Recent Patents on Drug Delivery & Formulation, 10, 177–183.

[4]. Cabanes, A., Even-Chen, S., Zimberoff, J., Barenholz, Y., Kedar, E., Gabizon, A., 1999, Enhancement of antitumor activity of polyethylene glycol-coated liposomal doxorubicin with soluble and liposomal interleukin 2. Clin Cancer Res, 5, 687–93.

[5]. Fassas, A., Anagnostopoulos, A., 2005, The use of liposomal daunorubicin (DaunoXome) in acute myeloid leukemia. Leukemia & Lymphoma/Leukemia and Lymphoma, 46, 795–802.

[6]. Rudramurthy, S. M., Jatana, M., Singh, R., Chakrabarti, A., 2012, In vitroantifungal activity of Indian liposomal amphotericin B against clinical isolates of emerging species of yeast and moulds, and its comparison with amphotericin B deoxycholate, voriconazole, itraconazole and fluconazole. Mycoses, 56, 39–46.

[7]. Chang, H. I., Yeh, M. K., 2011, Clinical development of liposome based drugs: formulation, characterization, and therapeutic efficacy. International Journal of Nanomedicine, 49-60.

[8]. Angst, M. S., Drover, D. R., 2006, Pharmacology of Drugs Formulated with DepoFoam??? Clinical Pharmacokinetics, 45, 1153–1176.

[9]. Ghantous, Y., Elnaaj, A. I., 2017, Global Incidence and Risk Factors of Oral Cancer. Harefuah, 156, 645–649.

[10]. Nethan, S. T., Ravi, P., Gupta, P. C., 2022, Epidemiology of Oral Squamous Cell Carcinoma in Indian Scenario. In: Routray, S, (eds) Microbes and Oral Squamous Cell Carcinoma, Springer, Singapore, pp 1–7

[11]. Mehrotra, R., Yadav, S., 2006, Oral squamous cell carcinoma: Etiology, pathogenesis and prognostic value of genomic alterations. Indian Journal of Cancer, 43(2), 60-6.

[12]. Reichal, P., Ramani, P., Kizhakkoottu, S., 2024, Association of site and recurrence in oral squamous cell carcinoma patients visiting private hospital in Chennai: a retrospective study. Cureus, 16(1), e52774. https://doi.org/10.7759/cureus.52774

[13]. Thomas, P., Mathew, D., Anisha, K., Ramasubramanian, A., Ramalingam, K., Ramani, P., Sekar, D., 2024, A retrospective analysis of the clinicopathological profile of oral squamous cell carcinoma in tobacco and non-tobacco users: highlighting the significance of chronic mechanical irritation. Cureus, 16(5), e59953. https://doi.org/10.7759/cureus.59953.

[14]. Pérez-Sayáns, N., 2009, Genetic and molecular alterations associated with oral squamous cell cancer (Review). Oncology Reports, 22(6), 1277-82. https://doi.org/10.3892/or_00000565.

[15]. Field, J. K., 1995, The role of oncogenes and tumour-suppressor genes in the aetiology of oral, head and neck squamous cell carcinoma. J R Soc Med, 88(1), 35P-39P.

[16]. Murugan, A. K., Munirajan, A. K., Tsuchida, N., 2012, Ras oncogenes in oral cancer: The past 20 years. Oral Oncology, 48(5), 383–392.

[17]. Devi, P., Dwivedi, R., Sankar, R., Jain, A., Gupta, S., Gupta S., 2024, Unraveling the Genetic Web: H-Ras Expression and Mutation in Oral Squamous Cell Carcinoma—A Systematic Review. Head and Neck Pathology, 18(1), 21.https://doi.org/10.1007/s12105-024-01623-8.

[18]. Palsuledesai, C. C., Distefano, M. D., 2015, Protein prenylation: enzymes, therapeutics, and biotechnology applications. ACS Chemical Biology, 10(1), 51–62.

[19]. Simanshu, D. K., Nissley, D. V., McCormick, F., 2017, RAS proteins and their regulators in human disease. Cell, 170(1), 17–33.

[20]. Rowinsky, E. K., Windle, J. J., Von Hoff, D. D., 1999, RAS protein farnesyltransferase: a strategic target for anticancer therapeutic development. Journal of Clinical Oncology, 17(11), 3631–3652.

[21]. Umashankar, K., Selvaraj, J., Ramani, P., 2021, Expression of ITG β-1, MMP9 and Vimentin in Oral Squamous Cell Carcinoma – A Real Time PCR Based Approach. Journal of Pharmaceutical Research International, 33(44B), 81–87.

[22]. Oladeji, O., 2016, The characteristics and roles of medicinal plants: Some important medicinal plants in Nigeria. Natural Products : An Indian Journal, 12(3), 102.

[23]. Desai, A., Qazi, G., Ganju, R., El-Tamer, M., Singh, J., Saxena, A., Bedi, Y., Taneja, S., Bhat, H., 2008, Medicinal plants and cancer chemoprevention. Current Drug Metabolism, 9(7), 581–591.

[24]. Greenwell, M., Rahman, P., 2015, Medicinal plants: their use in anticancer treatment. International Journal of Pharmaceutical Sciences and Research, 6(10), 4103-4112. https://doi.org/10.13040/ijpsr.0975-8232.6(10).4103-12.

[25]. Goswami, D., Nirmal, S., Patil, M., Dighe, N., Laware, R., Pattan, S., 2009, An overview of Tectona grandis: chemistry and pharmacological profile. Pharmacognosy Reviews, 3(5), 181–185.

[26]. Cadelis, M. M., Bourguet-Kondracki, M. L., Dubois, J., Valentin, A., Barker, D., Copp, B. R., 2016, Discovery and preliminary structure–activity relationship studies on Tecomaquinone I and tectol as novel farnesyltransferase and plasmodial inhibitors. Bioorganic & Medicinal Chemistry, 22 (14), 3102–3107.

[27]. Rafique, M., Sadaf, I., Rafique, M. S., Tahir, M. B., 2016, A review on green synthesis of silver nanoparticles and their applications. Artificial Cells, Nanomedicine and Biotechnology, 45(7), 1272–1291.

[28]. Kavitha, R. K., Vijayalakshmi, S., Babu M. B., 2019, Synthesis and Characterization of Silver Nano Particles using Tecoma Stans Flower Extract. International Journal of Recent Technology and Engineering (IJRTE), 8(4), 5624–5629.

[29]. Lombardo, D., Kiselev, M. A., 2022, Methods of liposomes preparation: Formation and control factors of versatile nanocarriers for biomedical and nanomedicine application. Pharmaceutics, 14(3), 543.

[30]. Lu, W. L., Qi X. R., 2017, Liposome-Based drug delivery systems. Biomaterial engineering, https://doi.org/10.1007/978-3-662-49231-4.

[31]. Lasch, J., Weissig, V., Brandl, M., 2003, Preparation of liposomes. In: Liposomes - A Practical Approach. 2nd edition. Oxford University Press eBooks, pp 1–29.

[32]. Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., Jemal, A., 2018, Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 68(6), 394–424.

[33]. Mathur, P., Sathishkumar, K., Chaturvedi, M., Das, P., Stephen, S., 2022, Cancer incidence estimates for 2022 & projection for 2025: Result from National Cancer Registry Programme, India. Indian J Med Res, 156(4&5), 598-607.

[34]. Long, S. B., Casey, P. J., Beese, L. S., 2002, Reaction path of protein farnesyltransferase at atomic resolution. Nature, 419(6907), 645–650.

Abstract:

Wernicke encephalopathy (WE) is a less frequently occurring but severe neurological disorder resulting from thiamine deficiency. Chronic alcoholism is the most common and serious risk factor for Wernicke encephalopathy. However, nonalcoholic causes like hyperemesis gravidarum also induce WE. Besides, the clinical presentations and early diagnosis of the disease are often challenging but essential to avoid severe maternal and fetal complications. In our investigation, we report two cases of pregnant women with persistent vomiting and neurological symptoms, including abnormal eye movements and gait disturbances. Both patients were diagnosed with WE based on clinical findings and MRI evidence of characteristic periaqueductal lesions. Prompt administration of high-dose intravenous thiamine resulted in significant clinical improvement, with symptom resolution and successful transition to oral thiamine therapy. These cases highlight the importance of considering Wernicke encephalopathy in pregnant women with prolonged vomiting. Early recognition and treatment with thiamine can prevent severe neurological complications and improve maternal and fetal outcomes.

References:

[1]. Chiossi, G., Neri, I., Cavazzuti, M., Basso, G., Facchinetti, F., 2006, Hyperemesis Gravidarum Complicated by Wernicke Encephalopathy: Background, Case Report, and Review of the Literature. Obstet Gynecol Surv., 61(4), 255.

[2]. Ota, Y., Capizzano, A. A., Moritani, T., Naganawa, S., Kurokawa, R., Srinivasan, A., 2020, Comprehensive review of Wernicke encephalopathy: pathophysiology, clinical symptoms and imaging findings. Jpn J Radiol, 38(9), 809–20.

[3]. Jennings, L. K., Mahdy, H., Hyperemesis Gravidarum. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Jul 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532917/

[4]. Miglani, U., Laul, P., Khandelwal, N., Miglani, S., 2021, Hyperemesis Gravidarum: Looking Beyond Pregnancy. Obstet Gynecol Res., 4(1), 21–5.

[5]. Ogershok, P. R., Rahman, A., Brick, J., Nestor, S., 2002, Wernicke Encephalopathy in Nonalcoholic Patients. Am J Med Sci., 323(2), 107–11.

[6]. De Lorenzo, C., Martocchia, A., Fedele, E., Di Gioia, V., Gagliardo, O., Martelletti, P., 2022, Thiamine Deficiency in the Pathophysiology and Diagnosis of Wernicke-Korsakoff Syndrome: Case Report and Literature Review. SN Compr Clin Med., 4(1), 239.

[7]. Frank, L. L., 2015, Thiamin in Clinical Practice. J Parenter Enter Nutr., 39(5), 503–20.

[8]. Wiley, K. D., Gupta, M., Vitamin B1 (Thiamine) Deficiency. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Jul 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK537204/

[9]. Chataway, J., Hardman, E., 1995, Thiamine in Wernicke’s syndrome--how much and how long? Postgrad Med J., 71(834), 249.

[10]. Kotha, V. K., De Souza, A., 2013, Wernicke’s Encephalopathy following Hyperemesis Gravidarum. Neuroradiol J., 26(1), 35–40.

[11]. Gárdián, G., Vörös, E., Járdánházy, T., Ungureán, A., Vécsei, L., 1999, Wernicke’s encephalopathy induced by hyperemesis gravidarum. Acta Neurol Scand., 99(3), 196–8.

[12]. Netravathi, M., Sinha, S., Taly, A. B., 2009, Bindu, P. S., Bharath, R. D., Hyperemesis-gravidarum-induced Wernicke’s encephalopathy: serial clinical, electrophysiological and MR imaging observations. J Neurol Sci., 284(1–2), 214–6.

[13]. Toth, C., Voll, C., 2001, Wernicke’s encephalopathy following gastroplasty for morbid obesity. Can J Neurol Sci J Can Sci Neurol., 28(1), 89–92.

[14]. Togay-Isikay, C., Yigit, A., Mutluer, N., 2001, Wernicke’s encephalopathy due to hyperemesis gravidarum: an under-recognised condition. Aust N Z J Obstet Gynaecol. 41(4), 453–6.

[15]. Harper, C. G., Giles, M., Finlay-Jones, R., 1986, Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy. J Neurol Neurosurg Psychiatry, 49(4), 341–5.

[16]. Antunez, E., Estruch, R., Cardenal, C., Nicolas, J. M., Fernandez-Sola, J., Urbano-Marquez, A., 1998, Usefulness of CT and MR imaging in the diagnosis of acute Wernicke’s encephalopathy. AJR Am J Roentgenol, 171(4), 1131–7.

[17]. Zuccoli, G., Gallucci, M., Capellades, J., Regnicolo, L., Tumiati, B., Giadás, T. C., 2007, Wernicke Encephalopathy: MR Findings at Clinical Presentation in Twenty-Six Alcoholic and Nonalcoholic Patients. Am J Neuroradiol., 28(7), 1328–31.

[18]. Indraccolo, U., Gentile, G., Pomili, G., Luzi, G., Villani, C., 2005, Thiamine deficiency and beriberi features in a patient with hyperemesis gravidarum. Nutr Burbank Los Angel Cty Calif, 21(9), 967–8.

[19]. Rane, M. A., Boorugu, H. K., Ravishankar, U., Tarakeswari, S., Vadlamani, H., Anand, H., 2022, Wernicke’s encephalopathy in women with hyperemesis gravidarum – Case series and literature review. Trop Doct., 52(1), 98–100.

Abstract:

The prevalence of diabetes, particularly Type 2 Diabetes Mellitus (T2DM), has surged in Tamil Nadu, reflecting a broader global trend. This review examines the impact of sedentary lifestyles on the increasing incidence of diabetes in the region, highlighting key contributing factors and potential interventions. Sedentary behaviour, characterized by prolonged sitting and minimal physical activity, has become a dominant lifestyle pattern due to urbanization, technological advancements, and occupational demands. This shift has led to a rise in obesity, insulin resistance, and other metabolic disorders, which are precursors to T2DM. Studies conducted in Tamil Nadu reveal a stark urban-rural divide, with urban areas exhibiting higher diabetes prevalence due to sedentary work environments and dietary changes. However, rural populations are not immune, as modernization introduces similar lifestyle changes. Key risk factors include high body mass index (BMI), positive family history of diabetes, and lack of physical activity. Women, married individuals, and those with limited health literacy are disproportionately affected. The review underscores the urgent need for targeted interventions, including public health campaigns promoting active lifestyles, dietary modifications, and regular health screenings. Community-based programs tailored to local cultural and socioeconomic contexts can effectively address these challenges. Additionally, workplace wellness initiatives and urban planning that encourages physical activity can mitigate the impact of sedentary lifestyles. By addressing these factors, Tamil Nadu can curb the diabetes epidemic and improve the overall quality of life for its residents. This review serves as a call to action for policymakers, healthcare providers, and communities to prioritize diabetes prevention and management strategies.

References:

[1]. National Institute of Medical Statistics, Indian Council of Medical Research, 2009, IDSP Non-Communicable Disease Risk Factors Survey, Tamil Nadu: Prelims.

[2]. Anuradha, R., Priyadharshini, S., Patil, A., 2021, Lifestyle Behaviour among Undergraduate, Journal of Clinical and Diagnostic Research, vol. 15, no. 10, pp. LC01–LC04.

[3]. Boornema, A., Priya, R., Charles, A. C., 2024, Risk Assessment of Type II Diabetes Mellitus Using Indian Diabetic Risk Score Among Adults In a Tertiary Care Hospital, Tamil Nadu – A Cross Sectional Study, International Journal of Academic Medicine and Pharmacy, vol. 6, no. 3, pp. 895–901.

[4]. Koshy, J. M., Johnson, W. M. S., Priya, B. S., 2015, Sedentary Work-A Risk Factor for Diabetes with a Positive Family History, International Journal of Science and Research (IJSR), vol. 4, no. 9, pp. 812–815.

[5]. Selvaraj, J., Prasad, M., Natarajan, S. R., Krishnamoorthy, R., Alshuniaber, M. A., Gatasheh, M. K., Veeraraghavan, V. P., Rajagopal, P., Palanisamy, C. P., 2025, Molecular mechanisms underlying the effects of beta-sitosterol on TGF-β1/Nrf2/SIRT1/p53-mediated signaling in the kidney of a high-fat diet and sucrose-induced type-2 diabetic rat, Chemico-Biological Interactions, vol. 411, p. 111443. https://doi.org/10.1016/j.cbi.2025.111443

[6]. Gorely, T., Tomaz, S. A., Ryde, G. C., 2023, Sedentary Behaviour and the Social and Physical Environment, in Leitzmann, M.F., Jochem, C., Schmid, D. (eds), Sedentary Behaviour Epidemiology, Springer, Cham. doi:10.1007/978-3-031-41881-5_2

[7]. Henson, J., De Craemer, M., Yates, T., 2023, Sedentary behaviour and disease risk, BMC Public Health. doi:10.1186/s12889-023-16867-2

[8]. Bellettiere, J., LaMonte, M. J., Healy, G. N., et al., 2021, Sedentary Behaviour and Diabetes Risk Among Women Over the Age of 65 Years: The OPACH Study, Diabetes Care, vol. 44, no. 2, pp. 563–570. doi:10.2337/dc20-0709

[9]. Yuan, S., Li, X., Liu, Q., et al., 2023, Physical Activity, Sedentary Behavior, and Type 2 Diabetes: Mendelian Randomization Analysis, Journal of the Endocrine Society, vol. 7, no. 8, pp. 1–8. doi:10.1210/jendso/bvad090

[10]. Kalra, S., Anjana, R. M., Verma, M., et al., 2024, Urban–Rural Differences in the Prevalence of Diabetes Among Adults in Haryana, India: The ICMR-INDIAB Study (ICMR-INDIAB-18), Diabetes Ther, vol. 15, pp. 1597–1613. doi:10.1007/s13300-024-01602-w

[11]. Mohan, S. K., Veeraraghavan, V. P., Balakrishna, J. P., Rengasamy, G., Rajeshkumar, S., 2020, Antidiabetic activity of methanolic extract of Artabotrys suaveolens leaves in 3T3-L1 cell line, Journal of Pure and Applied Microbiology, vol. 14, no. 1, pp. 573–580. https://doi.org/10.22207/JPAM.14.1.59

[12]. Stappers, N. E., Bekker, M. P., Jansen, M. W., et al., 2023, Effects of major urban redesign on sedentary behavior, physical activity, active transport and health-related quality of life in adults, BMC Public Health, vol. 23, 1157. doi:10.1186/s12889-023-16035-6

[13]. Sengkey, S. B., Sengkey, M. M., Tiwa, T. M., et al., 2024, Sedentary society: the impact of the digital era on physical activity levels, Journal of Public Health, vol. 46, no. 1, pp. e185–e186. doi:10.1093/pubmed/fdad163

[14]. Thivel, D., Tremblay, M. S., Chaput, J. P., 2013, Modern Sedentary Behaviors Favor Energy Consumption in Children and Adolescents, Current Obesity Reports, vol. 2, pp. 50–57. doi:10.1007/s13679-012-0032-9

[15]. OECD, 2022, Healthy Eating and Active Lifestyles: Best Practices in Public Health, OECD Publishing, Paris. doi:10.1787/40f65568-en

[16]. Edwards, P., Tsouros, A., 2006, Promoting physical activity and active living in urban environments, WHO Regional Office for Europe.

[17]. World Health Organization, n.d., Health promotion. Retrieved April 2, 2025, from https://www.who.int/health-topics/health-promotion

[18]. Smith, S., Salmani, B., LeSarge, J., et al., 2024, Interventions to reduce sedentary behaviour in adults with type 2 diabetes: A systematic review and meta-analysis, PLoS ONE, vol. 19, no. 7, e0306439. doi:10.1371/journal.pone.0306439

[19]. Zhang, X., Qiao, X., Peng, K., et al., 2024, Digital Behavior Change Interventions to Reduce Sedentary Behavior and Promote Physical Activity in Adults with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Int. J. Behav. Med., vol. 31, pp. 959–973. doi:10.1007/s12529-023-10188-9

[20]. Queral, J., Llauradó, E., Wargers, A., et al., 2025, Comparison of the four co-created interventions to improve snacking and physical activity behaviour in European adolescents: the SEEDS project, BMC Public Health, vol. 25, 829. doi:10.1186/s12889-025-22091-x

[21]. Lagisetty, P. A., Priyadarshini, S., Terrell, S., et al., 2017, Culturally Targeted Strategies for Diabetes Prevention in Minority Populations: A Systematic Review and Framework, The Diabetes Educator, vol. 43, no. 1, pp. 54–77. doi:10.1177/0145721716683811

[22]. Centers for Disease Control and Prevention (CDC), n.d., Diabetes Prevention Programs: Equity Tailored Resources. Retrieved from https://www.cms.gov/files/document/culturally-and-linguistically-tailored-type-2-diabetes-prevention-resource.pdf

[23]. Harris, J., Malaiappan, S., Rajeshkumar, S., 2023, The development and evaluation of melatonin-loaded, calcium oxide nanoparticle-based neem and clove extract: an in vitro study, Cureus, vol. 15, p. e46293. https://doi.org/10.7759/cureus.46293

[24]. Balagopal, P., Kamalamma, N., Thakor, G., Patel, R., Misra, R., 2008, A Community-Based Diabetes Prevention and Management Education Program in a Rural Village in India, Diabetes Care, vol. 31, no. 6, pp. 1097–1104. doi:10.2337/dc07-1680

[25]. Liu, Y., Cai, C., Tian, J., et al., 2025, Community-Based Peer Support for Diabetes Management: 24-Month Changes Relative to Comparison Communities, Diabetes Care. doi:10.2337/dc24-2748

[26]. Apollo 24|7, 2024, Community resources for diabetes management in India. Retrieved from https://www.apollo247.com/blog/article/community-resources-for-diabetes-management-in-india

[27]. Smith, S., Salmani, B., LeSarge, J., et al., 2024, Interventions to reduce sedentary behaviour in adults with type 2 diabetes: A systematic review and meta-analysis, PLOS ONE, vol. 19, no. 7, e0306439. doi:10.1371/journal.pone.0306439

[28]. Ispas, S., Twakor, A. N., Mindrescu, N. M., et al., 2025, From Sedentary to Success: How Physical Activity Transforms Diabetes Management: A Systematic Review, Journal of Mind and Medical Sciences, vol. 12, no. 1, p. 10. doi:10.3390/jmms12010010

[29]. Diabetes Australia, 2017, Sit less, move more. Retrieved April 1, 2025, from https://www.diabetesaustralia.com.au/blog/sit-less-move-more/

[30]. Alzarbah, R. N., Asiri, A. M. Y., Aljohani, K. S. Q., et al., 2022, The Role of Public Health Campaigns in Promoting Healthy Life, Journal of Population Therapeutics and Clinical Pharmacology, vol. 29, no. 3, pp. 668–675. https://www.jptcp.com/index.php/jptcp/article/view/5598

[31]. National Institute of Public Health Training and Research, 2025, Diabetic Educator. Retrieved April 1, from https://www.niphtr.mohfw.gov.in/course/view/WVhkQ21CTTN4YlFFa256ZlJHMk9RZz09

[32]. Diabetes Foundation India, n.d., Community health interventions and education. Retrieved April 1, 2025, from https://diabetesfoundationindia.org/programs.html

[33]. Landais, L. L., Jelsma, J. G. M., Dotinga, I. R., et al., 2022, Office workers' perspectives on physical activity and sedentary behaviour: a qualitative study, BMC Public Health, vol. 22, 621. doi:10.1186/s12889-022-13024-z

[34]. Bailey, D. P., 2021, Sedentary behaviour in the workplace: prevalence, health implications and interventions, British Medical Bulletin, vol. 137, no. 1, pp. 42–50. doi:10.1093/bmb/ldaa039

[35]. Stappers, N. E., Bekker, M. P., Jansen, M. W., et al., 2023, Effects of major urban redesign on sedentary behavior, physical activity, active transport and health-related quality of life in adults, BMC Public Health, vol. 23, 1157. doi:10.1186/s12889-023-16035-6

[36]. Health Desk, 2024, Environmental and lifestyle factors influence sedentary behaviour among adolescents, reveals global study, The Financial Express. Retrieved April 1, 2025, from https://www.financialexpress.com/life/environmental-and-lifestyle-factors-influence-sedentary-behaviour-among-adolescents-reveals-global-study-3682991/

[37]. Pronk, N. P., 2020, Implementing movement at the workplace: Approaches to increase physical activity and reduce sedentary behavior in the context of work, Progress in Cardiovascular Diseases. doi:10.1016/j.pcad.2020.10.004

[38]. Racciatti, L., 2025, 10 energizing ways to add physical activity to your daily routine, HealthPrep.com. Retrieved April 1, 2025, from https://healthprep.com/articles/fitness-nutrition/10-energizing-ways-to-add-physical-activity-to-your-daily-routine/

[39]. Prendergast, C., 2023, A guide to incorporating exercise into your daily life, Physio Ed. Retrieved April 1, 2025, from https://physioed.com/incorporating-exercise-into-daily-life/

[40]. Doctor Urgent Medical Care, 2025, How to incorporate more physical activity into your daily routine. Retrieved April 1, 2025, from https://doctorumc.com/blog/how-to-incorporate-more-physical-activity-into-your-daily-routine/

[41]. Women Entrepreneurship Policy Intervention, NITI Aayog. (2021). Moving the Needle: The Women Entrepreneurship Platform. Retrieved from NITI Aayog.

[42]. Priya, S., Ra, B. A., & Charles, C. A., 2024, Risk assessment of Type II diabetes mellitus using Indian Diabetic Risk Score among adults in a tertiary care hospital, Tamil Nadu: A cross-sectional study. International Journal of Academic Medicine and Pharmacy, 6(3), 895-901. Retrieved from Journal Article.

Abstract:

Medicinal plant products have been used in health care for the treatment of human illnesses since old times. Various homegrown medicinal plants have been used the cure of blood-related issues due to the disturbance of the coagulation pathway. The goal of the study is to characterise the isolated plant leaf extracts of Tridax procumbens that displayed strong anticoagulant properties. The objective of the study is to demonstrate haemolytic activity, wound healing activity, and assessment of the impurity in the partially purified leaf extract from the plant Tridax procumbens. The same fractions were assessed for pro- or anti-angiogenic properties as their therapeutic potential and cellular toxicity for the safety and efficacy of the purified plant extract. The purified leaf extracts contained 31% carbohydrates, 1.1% protein, and 0.9% lipids. The primary active component responsible for the anticoagulant activity is likely to be Azulene, a naphthalene-based derivative. A significant cellular migration was observed, assisting the wound healing. The anti-angiogenic was observed in the purified leaf extracts with no significant cellular toxicity by haemolysis and MTT assay. Traces of protein and lipid sources are present in the purified leaf extract fractions. About 31% of the leaf-extracted fraction has carbohydrates as an active anticoagulant content. The extract showed 90-60% cell migration, suggesting it to be a potent wound healing ability. The purified fractions did not show cytotoxicity at a concentration of 4-500 μg/mL in T47D cells.

References:

[1]. Bhat, R. B., Etejere, E. O., Oladipo, V. T., 1990, Ethnobotanical studies from central Nigeria. Economic Botany, 44(3), 382-390.

[2]. Diwan, P. V., Tilloo, L. D., & Kulkarni, D. R., 1982, Influence of Tridax procumbens on wound healing. Indian J Med Res, 75, 460-464.

[3]. Jachak, S. M., Gautam, R., Selvam, C., Madhan, H., Srivastava, A., & Khan, T., 2011, Anti-inflammatory, cyclooxygenase inhibitory and antioxidant activities of standardized extracts of Tridax procumbens L. Fitoterapia, 82(2), 173-177. doi:10.1016/j.fitote.2010.08.016

[4]. Singh, C. P., Mishra, P. K., & Gupta, S. P., 2016, Design and Formulation of Tridax procumbens based Polyherbal Cream for Wound Healing Potential. Pharm. Lett., 8, 15-21

[5]. Taddei, A., & Rosas-Romero, A. J., 2000, Bioactivity studies of extracts from Tridax procumbens. Phytomedicine, 7(3), 235-238. doi:10.1016/S0944-7113(00)80009-4

[6]. Tiwari, U., Rastogi, B., Singh, P., Saraf, D. K., & Vyas, S. P., 2004, Immunomodulatory effects of aqueous extract of Tridax procumbens in experimental animals. J Ethnopharmacol, 92(1), 113-119. doi:10.1016/j.jep.2004.02.001

[7]. Cushnie, T., & Lamb, A., 2005, Antimicrobial activity of flavonoids International Journal of Antimicrobial Agents 26 (5): 343-56.

[8]. Ndebia, E., Kamgang, R., & Nkeh-ChungagAnye, B., 2007, Analgesic and anti-inflammatory properties of aqueous extract from leaves of Solanum torvum (Solanaceae). African Journal of Traditional, Complementary and Alternative Medicines, 4(2), 240-244.

[9]. Ramachandran, V., Kumar, G. V., Sugumar, S., Sundaram, V., & Ahamed, H. N., 2020, Cardioprotective effect of Tridax procumbens Linn in Isoproterenol Induced Myocardial Infarction in rats. Research Journal of Pharmacy and Technology, 13(4), 1923-1927.

[10]. Thalkari, A. B., Karwa, P. N., Shinde, P. S., Gawli, C. S., & Chopane, P. S., 2020, Pharmacological actions of Tridax procumbens L.: a scientific review. Research Journal of Pharmacognosy and Phytochemistry, 12(1), 27-30.

[11]. Balkrishna, A., Sharma, N., Srivastava, D., Kukreti, A., Srivastava, S., & Arya, V., 2024, Exploring the Safety, Efficacy, and Bioactivity of Herbal Medicines: Bridging Traditional Wisdom and Modern Science in Healthcare. Future Integrative Medicine, 3(1), 35-49.

[12]. Lowry, O. H., Rosebrough, N. J., Farr, A. L., & Randall, R. J., 1951, Protein measurement with the Folin phenol reagent. J Biol Chem, 193(1), 265-275.

[13]. Morse, E. E., 1947, Anthrone in Estimating Low Concentrations of Sucrose. Analytical Chemistry, 19(12), 1012-1013. doi:10.1021/ac60012a021.

[14]. Pasha, A., Kumbhakar, D. V., et al., 2022, Role of Biosynthesized Ag-NPs Using Aspergillus niger (MK503444.1) in Antimicrobial, Anti-Cancer and Anti-Angiogenic Activities. Front. Pharmacol., 12 :812474.doi: 10.3389/fphar.2021.812474

[15]. Rodriguez, L. G., Wu, X., & Guan, J. L., 2005, Wound-healing assay. Methods Mol Biol, 294, 23-29. doi:10.1385/1-59259-860-9:023

[16]. Rajkumar, K., Mvs, S., Koganti, S., & Burgula, S., 2020, Selenium nanoparticles synthesized using Pseudomonas stutzeri (MH191156) show antiproliferative and anti-angiogenic activity against cervical cancer cells. International journal of nanomedicine, 4523-4540.

[17]. Ribatti, D., Vacca, A., Roncali, L., & Dammacco, F., 1996, The chick embryo chorioallantoic membrane as a model for in vivo research on angiogenesis. The International journal of developmental biology, 40(6), 1189-1197

[18]. Kumar, P., Nagarajan, A., & Uchil, P. D., 2018, Analysis of Cell Viability by the MTT Assay. Cold Spring Harb Protoc, 2018(6). doi:10.1101/pdb.prot095505

[19]. Naqash, S. Y., & Nazeer, R. A., 2011, Anticoagulant, antiherpetic and antibacterial activities of sulphated polysaccharide from Indian medicinal plant Tridax procumbens L. (Asteraceae). Appl Biochem Biotechnol, 165(3-4), 902-912. doi:10.1007/s12010-011-9307-y

[20]. Grada, A., Otero-Vinas, M., Prieto-Castrillo, F., Obagi, Z., & Falanga, V., 2017, Research Techniques Made Simple: Analysis of Collective Cell Migration Using the Wound Healing Assay. J Invest Dermatol, 137(2), e11-e16. doi:10.1016/j.jid.2016.11.020

[21]. Ausprunk, D. H., Knighton, D. R., & Folkman, J., 1974, Differentiation of vascular endothelium in the chick chorioallantois: a structural and autoradiographic study. Developmental biology, 38(2), 237-248.

[22]. Manjamalai, A., Kumar, M., & Grace, V., 2012, Essential oil of Tridax procumbens L induces apoptosis and suppresses angiogenesis and lung metastasis of the B16F-10 cell line in C57BL/6 mice. Asian Pacific Journal of Cancer Prevention, 13(11), 5887-5895.

[23]. Burgos-Pino, J., Gual-Orozco, B., Vera-Ku, M., Loria-Cervera, E. N., Guillermo-Cordero, L., Martinez-Vega, P. P., Gamboa-Leon, R., 2023, Acute oral toxicity in BALB/c mice of Tridax procumbens and Allium sativum extracts and (3S)-16,17-didehydrofalcarinol. J Ethnopharmacol, 301, 115840. doi:10.1016/j.jep.2022.115840

Abstract:

Childhood is a critical period for shaping human behavior, especially for left-behind children who experience periods of separation from their parents. This often leads to significant gaps in care. This study uses qualitative research methods to examine the support available to these children in Zhoukou City, Henan Province, China. The focus is on the services provided, professional assistance, and the overall impact on the children's mental health and well-being. The findings show that professional social work interventions can improve resource integration and the effectiveness of community services, thereby enhancing the mental health and well-being of left-behind children. However, challenges such as suboptimal service outcomes and limited child participation still exist. To provide optimal support, it is crucial to develop community-specific initiatives, utilize local resources, enhance talent development, and increase community involvement. This will ensure the comprehensive development of left-behind children.

References:

[1]. China Youth & Children Research Center., 2020. Care and support for left-behind and migrant children. Retrieved from http://www.cycrc.org.cn/kycg /seyj/202009 /t2020 0901 _105497.html

[2]. The State Council., 2016. Opinions of the state council on strengthening the care and protection of left-behind children in rural areas. Retrieved from http://www.gov.cn/zhengce/content/2016-02/14/content_5041066.htm.

[3]. Yakin, J. A., and McMahon, S. D., 2003. Risk and resiliency: A test of a theoretical model for urban, African-American youth. Journal of Prevention & Intervention in the Community, 26(1), 5–19. https://doi.org/10.1300/J005v26n01_02.

[4]. Gardner, M., and Brooks-Gunn, J., 2009. Adolescents' exposure to community violence: Are neighbourhood youth organisations protective? Journal of Community Psychology, 37, 505–525. https://doi.org/10.1002/jcop.20310.

[5]. Maguire-Jack, K., and Font, S. A., 2017. Intersections of individual and neighborhood disadvantage: Implications for child maltreatment. Children and Youth Services Review, 72, 44–51. https://doi.org/10.1016/j.childyouth.2016.10.015.

[6]. Wu, Q., Lu, D., and Kang, M., 2015. Social capital and the mental health of children in rural China with different experiences of parental migration. Social Science & Medicine, 132, 270–277.

[7]. Guan S., and Deng G., 2019. Whole-community intervention for left-behind children in rural China. Children and Youth Services Review, 101, 1–11.

[8]. Zhang, X., Li, M., Guo, L. and Zhu, Y., 2020. Community-Based Family Workshop Intervention Improved the Social Adaptation of Left-Behind Children in Rural China. Frontiers in Public Health, 8, 506191.

[9]. Zhao, C., Zhou, X., Wang, F., Jiang, M., and Hesketh, T., 2017. Care for left-behind children in rural China: A realist evaluation of a community-based intervention. Children and Youth Services Review. https://doi.org/10.1016/j.childyouth.2017.09.034.

[10]. Man, X., Barth, R.P., Li, Y. E., and Wang, Z., 2017. Exploring the new child protection system in Mainland China: How does it work? Children and Youth Services Review, 76, 196-202.

[11]. Abdul Rahman, M. R., Abd Hamid, A. I., Noh, N. A., Omar, H., Chai, W. J., Idris, Z., and Abdullah, J. M., 2022. Alteration in the functional organization of the default mode network following closed non-severe traumatic brain injury. Frontiers in Neuroscience, 16, 833320.

[12]. Ali, I., Azman, A., Jamir Singh, P. S., Hatta, Z. A., Mungai, N. W., Islam, M. S., and Akhtar, T., 2020. People with disabilities: The role of social workers for rehabilitation in Bangladesh. Building Sustainable Communities: Civil Society Response in South Asia, 403-424.

[13]. Augustine Bala, N., Azman, A., and Singh, P. S. J., 2022. The impact of gender discrimination and HIV stigma on women living in North Central Nigeria. Cogent Social Sciences, 8(1), 2027612.

[14]. Halim, N. N. A. A., Jaafar, M. H., Anuar, Mohamad., Kamaruddin, N. A. K., and Jamir, P. S., 2020. The causes of Malaysian construction fatalities. Journal of Sustainability Science and Management, 15(5), 236-256.

[15]. Jamir Singh, P. S., Azman, A., Drani, S., Mohd Nor, M. I. H., and Che Ahmad, A., 2023. Navigating the terrain of caregiving of children with intellectual and developmental disabilities: importance of benefit finding and optimism. Humanities and Social Sciences Communications, 10(1), 1-7.

[16]. Azman, A., Jali, N. A., Singh, P. S. J., Abdullah, J. M., and Ibrahim, H., 2020. Family roles, challenges and needs in caring for traumatic brain injury (TBI) family members: a systematic review. Journal of Health Research, 34(6), 495-504.

[17]. Oke, A. E., Aliu, J., Fadamiro, P., Akanni, P., Jamir Singh, P. S., and Shaharudin Samsurijan, M., 2023. Unpacking the strategies to promote the implementation of automation techniques in the construction industry. Construction Innovation.

[18]. Singh, P. S. J., Oke, A. E., Kineber, A. F., Olanrewaju, O. I., Omole, O., Samsurijan, M. S., and Ramli, R. A., 2023. A mathematical analysis of 4IR innovation barriers in developmental social work—A structural equation modeling approach. Mathematics, 11(4), 1003.

[19]. Vadevelu, K., Effendi, S., Singh, P. S. J., Badaruddin, R. F. R., Samsurijan, M. S., Latif, A. R. A., and Yahaya, M. H., 2019. Psychosocial Review of Drug Substance Use among Transgender in Penang, Malaysia. Humanities, Arts and Social Sciences Studies (Former Name Silpakorn University Journal of Social Sciences, Humanities, And Arts), 59-69.

[20]. Rashid, M. M., Azman, A., Singh, P. S. J., and Ali, M. I., 2020. Issues and problems of small-scale fishing (SSF) communities in South Asia: a comprehensive overview. Indian Journal of Ecology, 47(3), 775-781.

[21]. Oke, A. E., Aliu, J., Jamir Singh, P. S., Onajite, S. A., Shaharudin Samsurijan, M., and Azura Ramli, R., 2024. Appraisal of awareness and usage of digital technologies for sustainable wellbeing among construction workers in a developing economy. International Journal of Construction Management, 24(5), 521-529.

[22]. Ali, I., Azman, A., Jamir Singh, P. S., Hatta, Z. A., Mungai, N. W., Islam, M. S., and Akhtar, T., 2020. People with disabilities: The role of social workers for rehabilitation in Bangladesh. Building Sustainable Communities: Civil Society Response in South Asia, 403-424.

[23]. Abdullah, A. N., Ahmad, A. H., Zakaria, R., Tamam, S., Abd Hamid, A. I., Chai, W. J., and Abdullah, J. M., 2022. Disruption of white matter integrity and its relationship with cognitive function in non-severe traumatic brain injury. Frontiers in Neurology, 13, 1011304.

[24]. Creswell, J. W., and Guetterman, T. C., 2019. Educational research: Planning, conducting, and evaluating quantitative and qualitative research (6th ed.). Pearson Education, Inc.

[25]. Ali, I., Azman, A., Singh, P. S. J., Drani, S., and Rashid, M. M., 2020. Islamic faith-based organizations and poverty reduction in Bangladesh: A social work perception. Social Work & Society, 18(2).

[26]. Singh, P., Singh, J., Rashid, M. M., Azman, A., and Ali, I., 2019. Fishery policies and acts in present context-experiences from coastal Bangladesh. Indian Journal of Ecology, 46(4), 857-861.

[27]. Oke, A. E., Aliu, J., Fadamiro, P., Singh, P. S. J., Samsurijan, M. S., and Yahaya, M., 2023. Robotics and automation for sustainable construction: microscoping the barriers to implementation. Smart and Sustainable Built Environment, (ahead-of-print).

[28]. Islam, T., Azman, A., Singh, P., Ali, I., Akhtar, T., Rafatullah, M., and Hossain, K., 2019. Socio-economic vulnerability of riverbank erosion of displacees: Case study of coastal villages in Bangladesh. Indian Journal of Ecology, 46(1), 34-38.

[29]. Azman, A., Singh, P. S. J., and Isahaque, A., 2021. Implications for social work teaching and learning in Universiti Sains Malaysia, Penang, due to the COVID-19 pandemic: A reflection. Qualitative Social Work, 20(1-2), 553-560.

[30]. Ali, I., Shaik, R., Maruthi, A. Y., Azman, A., Singh, P., Bala, J. D., and Hossain, K., 2020. Impacts of climate change on coastal communities. In Decision Support Methods for Assessing Flood Risk and Vulnerability, (pp. 42-59). IGI Global.

[31]. Azman, A., Jamir Singh, P. S., and Sulaiman, J., 2019. The mentally ill and their impact on family caregivers: A qualitative case study. International social work, 62(1), 461-471.

[32]. Oke, A. E., Aliu, J., Odia, O. A., Aigbavboa, C. O., Jamir Singh, P. S., Awuzie, B. O., and Samsurijan, M. S., 2023. A quantitative assessment of key drivers for environmental economic practices adoption for sustainable development. Sustainable Development, 31(5), 3579-3594.

[33]. Oke, A. E., Kineber, A. F., Olanrewaju, O. I., Omole, O., Jamir Singh, P. S., Samsurijan, M. S., and Ramli, R. A., 2022. Exploring the 4IR drivers for sustainable residential building delivery from social work residential perspective—A structural equation modelling approach. Sustainability, 15(1), 468.

[34]. Braun, V., and Clarke, V., 2006. Using thematic analysis in psychology. Qualitative Research Psychology, 3(2), 77-101.

[35]. Karen, K. I., and Jody, E. J., 2018. Living-Learning Communities That Work: A Research-Based Model for Design, Delivery, and Assessment. Stylus Publishing, pp. 67-68.

[36]. Fan, X., and Lu, M., 2020. Testing the effect of perceived social support on left-behind children’s mental well-being in mainland China: The mediation role of resilience. Children and Youth Services Review, 109, 104695.

[37]. Zhao, G., He, F., and Zhang, H., 2018. Psychological intervention on the improvement of psychological behavior problems of rural left-behind children in Guangyuan City. Chinese Journal of Child Health Care, 26(7), 775–778.

[38]. Wang, M., Sokol, R., Luan, H., Perron, B. E., Victor, B. G., amd Wu, S., 2020. Mental health service interventions for left-behind children in mainland China: A systematic review of randomized controlled trials. Children and Youth Services Review, 117, 105304.

[39]. Hung, J., 2023. Policy-Oriented Examination of Left-Behind Children’s Health and Well-Being in China. Sustainability, 15(7), 5977. https://doi.org/10.3390/su15075977

[40]. Jiang, M., Li, L., and Zhu, W.X., 2020. Community-based intervention to improve the well-being of left-behind children by migrant parents in rural China. International Journal of Environmental Research and Public Health, 17(7218).

Abstract:

Ischemic stroke is a pervasive and debilitating condition, ranking as a leading cause of disability worldwide. The aftermath of a stroke poses significant challenges for rehabilitation and recovery, emphasizing the need for effective interventions. Rodent models have emerged as indispensable tools in investigating post-stroke rehabilitation strategies, providing valuable insights into the complex mechanisms governing stroke recovery. This systematic review provides a comprehensive synthesis of evidence from 10 experimental studies, carefully selected through a rigorous literature search to investigate the efficacy of physical exercise in promoting functional recovery and neural plasticity in rodent models of ischemic stroke. Study quality was meticulously evaluated using the SYRCLE risk of bias tool, ensuring the precision and trustworthiness of the findings. The findings reveal that treadmill exercise leads to significant, long-lasting improvements in motor and cognitive function, decreases infarct volume, and boosts neurotrophic factors like BDNF, driving synaptic plasticity, neurogenesis, and myelin repair. Notably, the results indicate that exercise-induced neuroplasticity is facilitated by key signaling pathways, including CREB/BDNF and caveolin-1/VEGF mechanisms, offering crucial insights into the underlying mechanisms of exercise-mediated recovery. These findings have significant implications for developing effective rehabilitation strategies for stroke survivors, emphasizing the therapeutic benefits of physical exercise in enhancing functional outcomes and quality of life

References:

Abstract:

Apathy, characterized by reduced motivation, behaviour, and cognitive function, significantly impacts post-stroke recovery, impairing daily functioning and increasing the risk of dementia and depression. This study aimed to evaluate the effectiveness of combining Autogenic relaxation training and cognitive graded activity training in alleviating apathy symptoms in a post-stroke patient. Conducted as a single-case study at the Saveetha Physiotherapy Department, Saveetha Medical College and Hospital, it involved a 46-year-old male patient who had suffered an MCA stroke. The Dimensional Apathy Scale (DAS) was used to assess apathy symptoms before and after a 6-week intervention consisting of 60-minute session of Autogenic relaxation and cognitive graded activity training, five days a week. Results revealed a significant reduction in apathy symptoms, as reflected by a lower DAS score post-intervention. Improvements were observed in emotional responses, cognitive function, and goal-directed behaviour, demonstrating the effectiveness of the combined therapeutic approach. This study underscores the importance of early identification and intervention for apathy in post-stroke patients. The combination of Autogenic relaxation training and cognitive graded activity training shows promise in not only alleviating apathy but also in preventing further cognitive decline and dementia, offering a potential solution for enhancing post-stroke recovery and quality of life.

References:

[1].   Zhang, H., Feng, Y., Lv, H., Tang, S., and Peng, Y., 2023, 'The prevalence of apathy in stroke patients: A systematic review and meta-analysis', Journal of Psychosomatic Research, 174, p. 111478.

[2].   Van Dalen, J. W., Van Charante, E. P., Nederkoorn, P. J., Van Gool, W. A., and Richard, E., 2013, 'Poststroke apathy', Stroke, 44(3), pp. 851-860.

[3].   Tay, J., Morris, R. G., and Markus, H. S., 2021, 'Apathy after stroke: diagnosis, mechanisms, consequences, and treatment', International Journal of Stroke, 16(5), pp. 510-518.

[4].   Eurelings, L. S., et al., 2018, 'Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data', Clinical Epidemiology, 10, pp. 363-379.

[5].   Vasu, D. T., Nordin, N. A., Ghazali, S. E., 2021, 'Effectiveness of autogenic relaxation training in addition to usual physiotherapy on emotional state and functional independence of stroke survivors', Medicine, 100(33), p. e26924.

[6].   Adelirad, F., Javadivala, Z., Dianat, I., Tabieh, A.A. and Chattu, V.K., 2024. Physical and cognitive‐based training in healthy older adults: Evidence from a systematic review and meta‐analysis. BioSocial Health Journal, 1(1), pp.14–25.

[7].   Zannino, L. G., 2017, 'Bionomics, motivational systems and the autogenic state', International Journal of Autogenic Research, 1(1), pp. 1-16.

[8].   Zedlitz, A. M., Fasotti, L. and Geurts, A. C., 2011, 'Post-stroke fatigue: a treatment protocol that is being evaluated', Clinical Rehabilitation, 25(6), pp. 487-500.

[9].   Radakovic, R., et al., 2020, 'The brief Dimensional Apathy Scale: A short clinical assessment of apathy', Clinical Neuropsychology, 34(2), pp. 423-435.

[10].           Chamelee, A., Selvamani, I., Venkatraman, N., Nambi, S., and Chandraleka, G. S., 2019, A cross sectional study of prevalence of depression among patients with cerebrovascular accident. International Journal of Research in Medical Sciences, 7(11), p.4306.

[11].   Vasu, D. T., et al., 2020, 'Feasibility and outcomes of autogenic relaxation training in addition to usual physiotherapy for stroke survivors–a pilot study', Malaysian Journal of Public Health Medicine, 20(3), pp. 134-139.

[12].  Beautily, V. and Jeevitha, U., 2024. Effectiveness of autogenic training on anxiety of the mothers with autistic children in selected hospital. In: 2024 OPJU International Technology Conference (OTCON) on Smart Computing for Innovation and Advancement in Industry 4.0, 5 June 2024, pp.1–6. IEEE.

[13].  Breznoscakova, D., et al., 2023, 'Autogenic training in mental disorders: What can we expect?', International Journal of Environmental Research and Public Health, 20(5), p. 4344.

[14].  Zedlitz, A. M., et al., 2012,'Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial', Stroke, 43(4), pp. 1046-1051.

[15].  Tang, W. K., et al., 2014, 'Apathy and health-related quality of life in stroke', Archives of Physical Medicine and Rehabilitation, 95(5), pp. 857-861.

[16].  Ho, A., et al., 2021, 'Apathy, cognitive impairment, and social support contribute to participation in cognitively demanding activities poststroke', Behavioural Neurology, 2021.

[17].  Geraghty, K., et al., 2019, 'The ‘cognitive behavioural model’ of chronic fatigue syndrome: Critique of a flawed model', Health Psychology Open, 6(1), p. 2055102919838907

[18].  Myhre, P., Radakovic, R., and Ford, C., 2022, Validation of the self-rated Dimensional Apathy Scale in community stroke survivors. Journal of the neurological sciences, 434, p.120103.

[19].  Vasu, D. T., Nordin, N. A., Xu, S. X., Ghazali, S. E., and Zarim, S. N., 2020, 'Feasibility and outcomes of autogenic relaxation training in addition to usual physiotherapy for stroke survivors–a pilot study', Malaysian Journal of Public Health Medicine, 20(3), pp. 134-139.

[20].  Sheela, R., & Francis, K., 2023, "Effectiveness of Autogenic Relaxation Technique on Depression Among Menopausal Women in SMCH", Cardiometry, no. 26, pp. 754-758.

[21].  Zedlitz, A. M., Rietveld, T. C., Geurts, A. C., and Fasotti, L., 2012, 'Cognitive and graded activity training can alleviate persistent fatigue after stroke: A randomized, controlled trial', Stroke, 43(4), pp. 1046-1051.

[22].  Vasu, D. T., Nordin, N. A., and Ghazali, S. E., 2021,'Effectiveness of autogenic relaxation training in addition to usual physiotherapy on emotional state and functional independence of stroke survivors', Medicine (Baltimore), 100(33), p. e26924.

[23].  Breznoscakova, D., Kovanicova, M., Sedlakova, E., and Pallayova, M., 2023, 'Autogenic training in mental disorders: What can we expect?', International Journal of Environmental Research and Public Health, 20(5), p. 4344.

[24].  Sujithra, S., 2013, A study to assess the effectiveness of autogenic relaxation on depression among menopausal women in rural areas at Thiruvallur district. Journal of Nursing and Health Science, 3(1), pp.1-5.

[25].  Akbar, S. A., Ramana, K., Srinivasan, V., and Suganthirababu, P., 2024, 'Efficacy of cognitive behavioural therapy on mental health in hospital housekeeping staff', Psychiatria Danubina, 36(3-4), pp. 400-401.

Abstract:

Stroke is one of the leading causes of death and disability in India. It can lead to complications like pusher’s syndrome and hemineglect. Pusher’s syndrome is characterized by a strong tendency to push towards the paralyzed side, resulting in postural instability and an increased risk of falls. On the other hand, hemineglect is a condition where the patient is unaware of the affected side, often associated with lesions in the right hemisphere. These complications not only hinder the recovery process but also significantly impact the patient’s functional outcomes. This study aims to explores comprehensive rehabilitation strategies for addressing lateropulsion and hemineglect in stroke patients and assessing their effectiveness in improving balance, spatial awareness and functional outcomes. This case report explores the rehabilitation of a 64-year-old man who developed pusher’s syndrome and hemineglect one month following a stroke. The rehabilitation program, conducted over six weeks, included strategies such as visual feedback, visual deprivation therapy, limb activation therapy, auditory cues, and treadmill-supported body weight training to address both pushing behaviour and hemineglect. Progress was monitored using the Burke Lateropulsion Scale (BLS), the Catherine Bergego Scale (CBS), and Functional Independent Measure (FIM) score. By the end of the six weeks, the patient showed significant improvement in both pushing behaviour and hemineglect. A comprehensive rehabilitation approach not only aids in overcoming pushing behaviour and hemineglect but also enhances the overall functional outcomes for stroke patients.

References:

[1]. Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., Das, S. R., De Ferranti, S., Després, J.-P., Fullerton, H. J., Howard, V. J., Huffman, M. D., Isasi, C. R., Jiménez, M. C., Judd, S. E., Kissela, B. M., Lichtman, J. H., Lisabeth, L. D., Liu, S., Mackey, R. H., Magid, D. J., McGuire, D. K., Mohler, E. R., Moy, C. S., Muntner, P., Mussolino, M. E., Nasir, K., Neumar, R. W., Nichol, G., Palaniappan, L., Pandey, D. K., Reeves, M. J., Rodriguez, C. J., Rosamond, W., Sorlie, P. D., Stein, J., Towfighi, A., Turan, T. N., Virani, S. S., Woo, D., Yeh, R. W., Turner, M. B., 2016, Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association. Circulation 133. https://doi.org/10.1161/CIR.0000000000000350

[2]. Xing, C., Arai, K., Lo, E. H., Hommel, M., 2012, Pathophysiologic Cascades in Ischemic Stroke. International Journal of Stroke 7, 378–385. https://doi.org/10.1111/j.1747-4949.2012.00839.x

[3]. Krishnamurthi, R. V., Moran, A. E., Feigin, V. L., Barker-Collo, S., Norrving, B., Mensah, G. A., Taylor, S., Naghavi, M., Forouzanfar, M. H., Nguyen, G., Johnson, C. O., Vos, T., Murray, C. J. L., Roth, G. A., for the GBD 2013, Stroke Panel Experts Group, 2015. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study. Neuroepidemiology 45 (3), 190–202. https://doi.org/10.1159/000441098

[4]. Bhuvana Kalaivanan, Prathap Suganthirababu, Vignesh Srinivasan, Sathya Siva., 2025, The Effectiveness of Circumferential Pressure using Sphygmomanometer on Spasticity and Gait Pattern among Post Stroke patients – A Feasibility Study. Research Journal Pharmacy and Tachnology, 18(3):1161. https://doi.org/10.52711/0974-360X.2025.00167

[5]. Jones, S. P., Baqai, K., Clegg, A., Georgiou, R., Harris, C., Holland, E.-J., Kalkonde, Y., Lightbody, C. E., Maulik, P. K., Srivastava, P. M., Pandian, J. D., Kulsum, P., Sylaja, P., Watkins, C. L., Hackett, M. L., 2022, Stroke in India: A systematic review of the incidence, prevalence, and case fatality. International Journal of Stroke 17, 132–140. https://doi.org/10.1177/17474930211027834

[6]. Umasankar, Y., Srinivasan, V., Suganthirababu, P., and Murugaiyan, P., 2024, Efficacy of Proprioceptive Neuromuscular Facilitation on Jaw Function in Bruxism Among Post Stroke Survivor: A Case Study. International Journal of Experimental Research and Review, 42. https://doi.org/10.52756/ijerr.2024.v42.025

[7]. Iyyapan, G and Maragatham, S., 2024, Blood Glucose as Potential Indicators for Hospital Mortality among Patients with Acute Stroke in a Tertiary Hospital, India. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 3), pp.S2922-S2924. https://doi.org/10.4103/jpbs.jpbs_628_24

[8]. Cardoen, S., Santens, P., 2010, Posterior pusher syndrome: A report of two cases. Clinical Neurology and Neurosurgery 112, 347–349. https://doi.org/10.1016/j.clineuro.2009.12.007

[9]. Clery, A., Bhalla, A., Rudd, A. G., Wolfe, C. D., and Wang, Y., 2020, Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register. PLoS Medicine, 17(10), p.e1003366. https://doi.org/10.1371/journal.pmed.1003366

[10]. Britton, Z., and Arshad, Q., 2019, Vestibular and multi-sensory influences upon self-motion perception and the consequences for human behavior. Frontiers in neurology, 10, p.63. https://doi.org/10.3389/fneur.2019.00063

[11]. Koter, R., Regan, S., Clark, C., Huang, V., Mosley, M., Wyant, E., Cook, C., and Hoder, J., 2017, Clinical outcome measures for lateropulsion poststroke: an updated systematic review. Journal of neurologic physical therapy, 41(3), pp.145-155. https://doi.org/10.1097/NPT.0000000000000194

[12]. Pardo, V., and Galen, S., 2019, Treatment interventions for pusher syndrome: A case series. NeuroRehabilitation, 44(1), pp.131-140. https://doi.org/10.3233/NRE-182549

[13]. Anand, P., Mohanty, U., and Mani, S., 2022, Brain gym exercises and mirror box therapy in hemispatial neglect post-stroke: A randomised clinical trial. International Journal of Health Sciences, 6. https://doi.org/10.53730/ijhs.v6nS4.9339

[14]. Li, K., and Malhotra, P. A., 2015, Spatial neglect. Practical neurology, 15(5), pp.333-339. https://doi.org/10.1136/practneurol-2015-001115

[15]. Zhang, Q., Zhang, L., He, W., Zheng, X., Zhao, Z., Li, Y., Xu, S., Zheng, J., Zhuang, X., Jia, W., and Zhu, C., 2021, Case report: visual deprivation in Pusher syndrome complicated by hemispatial neglect after basal ganglia stroke. Frontiers in Neurology, 12, p.706611. https://doi.org/10.3389/fneur.2021.706611

[16]. Gomez-Risquet, M., Hochsprung, A., Magni, E., and Luque-Moreno, C., 2024, Feedback Interventions in Motor Recovery of Lateropulsion after Stroke: A Literature Review and Case Series. Brain Sciences, 14(7), p.682. https://doi.org/10.3390/brainsci14070682

[17]. Romick-Sheldon, D., Kimalat, A., 2017, Novel Treatment Approach to Contraversive Pushing after Acute Stroke: A Case Report. Physiotherapy Canada 69, 313–317. https://doi.org/10.3138/ptc.2016-28

[18]. Schenke, N., Franke, R., Puschmann, S., Turgut, N., Kastrup, A., Thiel, C. M., Hildebrandt, H., 2021, Can auditory cues improve visuo-spatial neglect? Results of two pilot studies. Neuropsychological Rehabilitation 31, 710–730. https://doi.org/10.1080/09602011.2020.1727931

[19]. Zigiotto, L., Damora, A., Albini, F., Casati, C., Scrocco, G., Mancuso, M., Tesio, L., Vallar, G., Bolognini, N., 2021, Multisensory stimulation for the rehabilitation of unilateral spatial neglect. Neuropsychological Rehabilitation 31, 1410–1443. https://doi.org/10.1080/09602011.2020.1779754

[20]. Nolan, J., Godecke, E., and Singer, B., 2022, The association between contraversive lateropulsion and outcomes post stroke: a systematic review. Topics in stroke rehabilitation, 29(2), pp.92-102. https://doi.org/10.1080/10749357.2021.1886640

[21]. Nolan, J., Jacques, A., Godecke, E., Bynevelt, M., Dharsono, F., Singer, B., 2024, Lateropulsion resolution and outcomes up to one year post-stroke: a prospective, longitudinal cohort study. Topics in Stroke Rehabilitation 31, 795–806. https://doi.org/10.1080/10749357.2024.2333186

[22]. Rossit, S., Benwell, C. S., Szymanek, L., Learmonth, G., McKernan-Ward, L., Corrigan, E., Muir, K., Reeves, I., Duncan, G., Birschel, P., and Roberts, M., 2019, Efficacy of home-based visuomotor feedback training in stroke patients with chronic hemispatial neglect. Neuropsychological rehabilitation, 29(2), pp.251-272. https://doi.org/10.1080/09602011.2016.1273119

[23]. Priftis, K., Passarini, L., Pilosio, C., Meneghello, F., and Pitteri, M., 2013, Visual scanning training, limb activation treatment, and prism adaptation for rehabilitating left neglect: who is the winner?. Frontiers in Human Neuroscience, 7, p.360. https://doi.org/10.3389/fnhum.2013.00360

Abstract:

Peripheral nerve injuries (PNI), particularly median nerve injuries, lead to significant motor and sensory impairments, affecting daily function and quality of life. Rodent models are extensively used for studying nerve regeneration due to their physiological similarity to humans. Accurate assessment of nerve regeneration is critical for evaluating therapeutic approaches, yet existing methods lack standardization and comprehensive analysis. A systematic review was conducted following PRISMA guidelines, searching databases including PubMed, Google scholar and science direct from 2013 to 2024. Inclusion criteria focused on studies using rodent models to investigate median nerve regeneration with surgical interventions and reporting functional, physiological, histomorphometry, or molecular outcomes. Out of 110 studies, 13 studies were selected and reviewed. The review identified various assessment techniques includes, Functional test evaluates motor and sensory recovery. Electrophysiological test measure nerve conduction velocity and muscle action potentials. Histological analyses examine nerve morphology, myelination, and axonal regeneration. Molecular methods assess gene expression and protein markers. A multimodal approach combining these methods provides the most comprehensive evaluation of nerve regeneration. This systematic review highlights the current state of median nerve regeneration in rodent models. The results suggest that rodent models are a valuable tool for studying nerve regeneration and evaluating potential therapeutic interventions. However, there is a need for standardization in the methods used to assess nerve regeneration, as well as the reporting of study results.

References:

Abstract:

Hemiparesis, commonly resulting from stroke, significantly impacts hand function, strength, and overall quality of life. Traditional rehabilitation often lacks engagement, leading to low adherence and slower recovery. Gamification, which incorporates game elements into therapeutic exercises, has shown promise in enhancing rehabilitation outcomes. This pilot study aimed to explore the effect of gamification on hand grip strength, hand function, and stress reduction among patients with hemiparesis. A total of 10 participants were randomly divided into two groups with blind fold method, labelled as group A and B, each comprising 5 participants. Over a six -week period, Group A underwent gamification as a therapeutic exercise, while Group B underwent conventional therapy. The two groups’ results discovered a statistically significant variance with the “P-value” was <0.001 in hand function (Jebsen taylor hand function test) post-test. The hand grip strength (Dynamometer) the pre and post-test values for group A and B were assessed as same as above, here for between group comparison statistical difference was not significant for the post test (p<0.07), in group A alone post test results showed statistically significant difference, with “P- value” of <0.001. Finally for the stress post values of PSS showed statistically significant difference. This current study showed that gamification was effective in improving the hand function and grip strength of patient with hemiparesis and specifically it helped in the fine dexterity function improvement and also helped in the reduction in stress level.

References:

[1]. Feigin, V. L., Brainin, M., Norrving, B., Martins, S., Sacco, R. L., Hacke, W., Fisher, M., Pandian, J., and Lindsay, P., 2022, World Stroke Organization (WSO): global stroke fact sheet 2022. International Journal of Stroke, 17(1), pp.18-29. doi.org/10.1177/17474930211065917

[2]. Park, J. G., Lee, K. W., Kim, S. B., Lee, J. H., and Kim, Y. H., 2019, Effect of decreased skeletal muscle index and hand grip strength on functional recovery in subacute ambulatory stroke patients. Annals of Rehabilitation Medicine, 43(5), pp.535-543. doi.org/10.5535/arm.2019.43.5.535

[3]. Mitsungnern, T., Inchanta, S., Kongbunkiat, K., Imoun, S., and Kotruchin, P., 2023, The Impact of Gender on Mortality and Symptomatic Intracerebral Hemorrhage in Acute Ischemic Stroke Patients After Intravenous Recombinant Tissue Plasminogen Activator (rt-PA). Journal of Health Science and Medical Research, 41(4), p.2023934.

[4]. Surapaneni, D., 2024. Biomarkers of hemorrhagic transformation of acute ischemic stroke–A cross-sectional study. Romanian Medical Journal, 71(2).

[5]. Liu, G., Xue, Y., Wang, S., Zhang, Y., and Geng, Q., 2021, Association between hand grip strength and stroke in China: a prospective cohort study. Aging (albany NY), 13(6), p.8204. doi: 10.18632/aging.202630

[6]. Vaishya, R., Misra, A., Vaish, A., Ursino, N., and D’Ambrosi, R., 2024, Hand grip strength as a proposed new vital sign of health: a narrative review of evidences. Journal of Health, Population and Nutrition, 43(1), p.7. doi.org/10.1186/s41043-024-00500-y

[7]. Gajardo Sánchez, A. D., Murillo-Zamorano, L. R., López-Sánchez, J., and Bueno-Muñoz, C., 2023, Gamification in health care management: Systematic review of the literature and research agenda. Sage Open, 13(4), p.21582440231218834. 10.1177/21582440231218834

[8]. Patil, S., Licari, F. W., Bhandi, S., Awan, K. H., Di Blasio, M., Isola, G., Cicciù, M. and Minervini, G., 2024. Effect of game-based teaching on the oral health of children: a systematic review of randomised control trials. Journal of Clinical Pediatric Dentistry, 48(4).

[9]. Laffont, I., Froger, J., Jourdan, C., Bakhti, K., van Dokkum, L. E., Gouaich, A., Bonnin, H. Y., Armingaud, P., Jaussent, A., Picot, M., C., and Le Bars, E., 2020, Rehabilitation of the upper arm early after stroke: video games versus conventional rehabilitation. A randomized controlled trial. Annals of physical and rehabilitation medicine, 63(3), pp.173-180. 10.1016/j.rehab.2019.10.009

[10]. Gajjar, N. P., Noronha, T., Anumasa, R., Mariarathinam, P., and Mariappan, A., 2024, Relationship between Hand grip strength and Hand function in patients with Stroke: A Cross-Sectional Study. Clinical Epidemiology and Global Health, 28, p.101657. 10.1016/j.cegh.2024.101657

[11]. Sığırtmaç, İ. C., and Öksüz, Ç., 2021, Investigation of reliability, validity, and cutoff value of the Jebsen-Taylor Hand Function Test. Journal of Hand Therapy, 34(3), pp.396-403. doi.org/10.1016/j.jht.2020.01.004

[12]. Seo, N. Y., Lee, J. H., and Jung, Y. J., 2024, New Possibilities of A Quantitative Assessment Method for the Jebsen-Taylor Hand Function Test: A Preliminary Study. doi.org/10.21203/rs.3.rs-4464229

[13]. Vasava, S., Sorani, D., Rathod, S., and Vasava, S., 2021, Reliability study of manual and digital handheld dynamometers for measuring hand grip strength. J Emerg Technol Innov Res (JETIR), 8, pp.470-5.

[14]. Lee, S. C., Wu, L. C., Chiang, S. L., Lu, L. H., Chen, C. Y., Lin, C. H., Ni, C. H., and Lin, C. H., 2020, Validating the Capability for Measuring Age‐Related Changes in Grip‐Force Strength Using a Digital Hand‐Held Dynamometer in Healthy Young and Elderly Adults. BioMed research international, 2020(1), p.6936879. 10.1155/2020/6936879

[15]. Chan, S. F., and La Greca, A. M., 2020, Perceived stress scale (PSS). In Encyclopedia of behavioral medicine (pp. 1646-1648). Cham: Springer International Publishing. doi.org/10.1007/978-3-030-39903-0_773

[16]. Vanbellingen, T., Filius, S. J., Nyffeler, T., and Van Wegen, E. E., 2017, Usability of videogame-based dexterity training in the early rehabilitation phase of stroke patients: a pilot study. Frontiers in neurology, 8, p.654. doi.org/10.3389/fneur.2017.00654

[17]. Ali, A. S., and Arumugam, A., 2021, Effectiveness of an intensive, functional, gamified Rehabilitation program in improving upper limb motor function in people with stroke: A protocol of the EnteRtain randomized clinical trial. Contemporary Clinical Trials, 105, p.106381. https://doi.org/10.1016/j.cct.2021.106381

[18]. Kottink, A. I., Prange, G. B., Krabben, T., Rietman, J. S., and Buurke, J. H., 2014, Gaming and conventional exercises for improvement of arm function after stroke: a randomized controlled pilot study. GAMES FOR HEALTH: Research, Development, and Clinical Applications, 3(3), pp.184-191. doi.org/10.1089/g4h.2014.0026.

[19]. Almhdawi, K. A., Alazrai, A., Kanaan, S., Shyyab, A. A., Oteir, A. O., Mansour, Z. M., and Jaber, H., 2021, Post-stroke depression, anxiety, and stress symptoms and their associated factors: a cross-sectional study. Neuropsychological Rehabilitation, 31(7), pp.1091-1104. doi.org/10.1080/09602011.2020.1760893

[20]. Ramírez-Moreno, J. M., Vega, P. M., Espada, S., Alberca, S. B., Aguirre, J., and Peral, D., 2020, Association between self-perceived psychological stress and transitory ischaemic attack and minor stroke: A case–control study. Neurología (English Edition), 35(8), pp.556-562. doi.org/10.1016/j.nrleng.2017.09.004

[21]. Tăut, D., Pintea, S., Roovers, J. P. W., Mananas, M. A., and Băban, A., 2017, Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis. NeuroRehabilitation, 41(1), pp.105-118. doi.org/10.3233/NRE-171462

[22]. Zeiler, S. R., and Krakauer, J. W., 2013, The interaction between training and plasticity in the poststroke brain. Current opinion in neurology, 26(6), pp.609-616. DOI: 10.1097/WCO.0000000000000025.

[23]. Bertrand, A. M., Fournier, K., Brasey, M. G. W., Kaiser, M. L., Frischknecht, R., and Diserens, K., 2015, Reliability of maximal grip strength measurements and grip strength recovery following a stroke. Journal of Hand Therapy, 28(4), pp.356-363. doi.org/10.1016/j.jht.2015.04.004

[24]. Shang, X., Meng, X., Xiao, X., Xie, Z., and Yuan, X., 2021, Grip training improves handgrip strength, cognition, and brain white matter in minor acute ischemic stroke patients. Clinical Neurology and Neurosurgery, 209, p.106886. https://doi.org/10.1016/j.clineuro.2021.106886

[25]. Tuah, N. M., Ahmedy, F., Gani, A., and Yong, L. N., 2021, A survey on gamification for health rehabilitation care: Applications, opportunities, and open challenges. Information, 12(2), p.91. doi.org/10.3390/info12020091

[26]. Taekema, D. G., Gussekloo, J., Maier, A. B., Westendorp, R. G., and de Craen, A. J., 2010, Handgrip strength as a predictor of functional, psychological and social health. A prospective population-based study among the oldest old. Age and ageing, 39(3), pp.331-337. doi.org/10.1093/ageing/afq022

[27]. Prather, J. G., and Stanfill, A. G., 2023, An integrative review of the utilization of the perceived stress scale in stroke recovery. Journal of Neuroscience Nursing, 55(2), pp.65-71. 10.1097/JNN.0000000000000695

[28]. Prasomsri, J., Jearudomsup, P., Talang, W. P. N., Madadam, N., Plodauksorn, A., Ratchatapan, K., Sukcharoen, W., Warinkaew, S., Wichitphong, C., and Hama, S., 2024, Effect of Home-Based Task-Based Mirror Therapy on Upper Extremity Function in Stroke Patients: A Four-Week Intervention Study. Journal of Health Science and Medical Research, 42(5), p.20241042.

[29]. Umasankar, Y., Srinivasan, V., Suganthirababu, P., and Murugaiyan, P., 2024, Efficacy of Proprioceptive Neuromuscular Facilitation on Jaw Function in Bruxism Among Post Stroke Survivor: A Case Study. International Journal of Experimental Research and Review, 42. doi.org/10.52756/ijerr.2024.v42.025

[30]. Srinivasan, V., Ruthuvalan, V., Raja, S., Jayaraj, V., Sridhar, S., Kothandaraman, M., Suganthirababu, P., Abathsagayam, K., Vishnuram, S., Alagesan, J., and Vasanthi, R. K., 2024, Efficacy of vagal nerve stimulation on anxiety among elderly retired teachers during the COVID-19 pandemic. Work, 79(2), pp.645-652. doi.org/10.3233/WOR-230356

[31]. Ruthubalan, V., Srinivasan, V., Suganthirababu, P., & Abathsagayam, K., 2025, ‘Technological advancements in the treatment of anxiety and quality of sleep among teaching professionals - A pilot study’, Research Journal of Pharmacy and Technology, 18(1), pp. 333-338. 10.52711/0974-360X.2025.00052.

[32]. Priyadarsini, A., Sangavi, H., Jagadeeswari, J., Cecyli, C. and Dayana, B.A.A., 2024. Impact of Mindfulness through Smartphone Applications on the Anxiety among B. Sc. Nursing Students. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 3), pp.S2904-S2906.

Abstract:

Traumatic brain injury (TBI) can result in significant impairments in executive function, memory, and attention, adversely affecting daily functioning and rehabilitation outcomes. Cognitive rehabilitation after TBI is a challenging process often requiring training in daily living skills. While traditional rehabilitation methods benefit TBI patients, modern innovations like virtual reality (VR) offer promising potential for cognitive recovery. This study aimed to investigate the potential benefits of virtual reality-based therapy for improving cognitive function in individuals with traumatic brain injury. A single-case study was conducted involving a 23-year-old male with TBI, recruited from the neurosurgery rehabilitation ward of Saveetha Medical College and Hospitals. Pre- and post-test measurements were taken using the Digit Span Test and the Montreal Cognitive Assessment (MoCA). The patient underwent a 10-week rehabilitation protocol, including VR-based therapy, delivered six times a week for one hour per session. The MoCA score improved from 18 (pre-test) to 27 (post-test). The Digit Span forward test score increased from 4 to 7, and the Digit Span backward test score improved from 2 to 4. These findings indicate significant improvements in cognitive function following the VR-based intervention. This study highlights the potential of virtual reality as a valuable tool for enhancing cognitive recovery in individuals with traumatic brain injury.

References:

[1]. Gamito, P., Oliveira, J., Pacheco, J., Morais, D., Saraiva, T., Lacerda, R., Baptista, A., Santos, N., Soares, F., Gamito, L., and Rosa, P., 2011, Traumatic brain injury memory training: a virtual reality online solution.

[2]. Baumer, H., Schneider, B., Frank, C. W., Wallesch, M., 2001, Physicians' estimates of rehabilitation requirements after stroke and traumatic brain injury-a questionnaire survey in East Germany. Disability and rehabilitation, 23(7), pp.306-312.

[3]. Cooper, R. A., Dicianno, B. E., Brewer, B., LoPresti, E., Ding, D., Simpson, R., Grindle, G., and Wang, H., 2008, A perspective on intelligent devices and environments in medical rehabilitation. Medical Engineering & Physics, 30(10), pp.1387-1398.

[4]. Wang, P., Kreutzer, I. A., Bjärnemo, R., and Davies, R. C., 2004, A Web-based cost-effective training tool with possible application to brain injury rehabilitation. Computer methods and programs in biomedicine, 74(3), pp.235-243.

[5]. Shekhar, C., Gupta, L. N., Premsagar, I. C., Sinha, M., and Kishore, J., 2015, An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India). Journal of emergencies, trauma, and shock, 8(3), pp.131-139.

[6]. Alqahtani, A. A., Alam, M. K., and Ganji, K. K., 2025, Effect of Distraction by Using Virtual Reality on Pain and Anxiety During the Dental Procedure. Bangladesh Journal of Medical Science, 24(1), pp.285-292.

[7]. Gururaj, G., 2002, Epidemiology of traumatic brain injuries: Indian scenario. Neurological research, 24(1), pp.24-28.

[8]. Pasquina, P., Kirtley, R., and Ling, G., 2014, November. Moderate-to-severe traumatic brain injury. In Seminars in Neurology (Vol. 34, No. 05, pp. 572-583). Thieme Medical Publishers.

[9]. Grealy, M. A., Johnson, D. A., and Rushton, S. K., 1999, Improving cognitive function after brain injury: the use of exercise and virtual reality. Archives of physical medicine and rehabilitation, 80(6), pp.661-667.

[10]. Ross, L. K., 1992, The use of pharmacology in the treatment of head-injured patients. In Handbook of Head Trauma: Acute Care to Recovery (pp. 137-164). Boston, MA: Springer US.

[11]. Soryal, I., Sloan, R. L., Skelton, C., and Pentland, B., 1992, Rehabilitation needs after haemorrhagic brain injury: are they similar to those after traumatic brain injury?. Clinical rehabilitation, 6(2), pp.103-110.

[12]. Vasanthi, R. K., Li, J., Chaw, B., Purushothaman, V. K., Kumaresan, A., Chinnusamy, S., Karuppaiyan, R. K., and Subbarayalu, A. V., 2023, Perceived usefulness and ease of using virtual reality during physiotherapy--A cross-sectional survey from physiotherapists perspective. Electronic Journal of General Medicine, 20(6).

[13]. Alashram, A. R., Annino, G., Padua, E., Romagnoli, C., and Mercuri, N. B., 2019, Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology. Journal of Clinical Neuroscience, 66, pp.209-219.

[14]. Knight, R. G., and Titov, N., 2009, Use of virtual reality tasks to assess prospective memory: applicability and evidence. Brain impairment, 10(1), pp.3-13.

[15]. Sekar, M., Suganthirababu, P., Subramanian, S. S., Vishnuram, S., Ramalingam, V., Arul, A., and Anbarason, A., 2024, The effectiveness of virtual reality (VR) therapy on balance and mobility in elderly patients: a randomized controlled trial. Fizjoterapia Polska, (5).

[16]. Allred, R. P., Maldonado, M. A., and Jones, T. A., 2005, Training the" less-affected" forelimb after unilateral cortical infarcts interferes with functional recovery of the impaired forelimb in rats. Restorative neurology and neuroscience, 23(5-6), pp.297-302.

[17]. Rose, F. D., Brooks, B. M., and Rizzo, A. A., 2005, Virtual reality in brain damage rehabilitation. Cyberpsychology & behavior, 8(3), pp.241-262.

[18]. O'Keeffe, S. T., and Gosney, M. A., 1997, Assessing attentiveness in older hospital patients: global assessment versus tests of attention. Journal of the American Geriatrics Society, 45(4), pp.470-473.

[19]. Geller, R., and Slicer, K., 2024, Montreal Cognitive Assessment (MoCA). In Clinical Integration of Neuropsychological Test Results (pp. 191-204). CRC Press.

[20]. Freitas, S., Simões, M. R., Alves, L., and Santana, I., 2013, Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Disease & Associated Disorders, 27(1), pp.37-43.

[21]. Montana, J. I., Tuena, C., Serino, S., Cipresso, P., and Riva, G., 2019, Neurorehabilitation of spatial memory using virtual environments: a systematic review. Journal of clinical medicine, 8(10), p.1516.

[22]. Pietrzak, E., Pullman, S., and McGuire, A., 2014, Using virtual reality and videogames for traumatic brain injury rehabilitation: a structured literature review. GAMES FOR HEALTH: Research, Development, and Clinical Applications, 3(4), pp.202-214.

[23]. De Luca, R., Bonanno, M., Rifici, C., Pollicino, P., Caminiti, A., Morone, G., and Calabrò, R. S., 2022, Does non-immersive virtual reality improve attention processes in severe traumatic brain injury? Encouraging data from a pilot study. Brain Sciences, 12(9), p.1211.

[24]. Chellapandian H, Jeyachandran S. Retraction Note: Bridging the gap: Enhancing TBI care in Pakistan’s primary and secondary healthcare settings. Neurosurgical Review. 2025 Jan 31;48(1):124.

[25]. Larson, E. B., Ramaiya, M., Zollman, F. S., Pacini, S., Hsu, N., Patton, J. L., and Dvorkin, A. Y., 2011, Tolerance of a virtual reality intervention for attention remediation in persons with severe TBI. Brain Injury, 25(3), pp.274-281.

[26]. De Luca, R., Bonanno, M., Marra, A., Rifici, C., Pollicino, P., Caminiti, A., Castorina, M. V., Santamato, A., Quartarone, A., and Calabrò, R. S., 2023, Can virtual reality cognitive rehabilitation improve executive functioning and coping strategies in traumatic brain injury? A pilot study. Brain sciences, 13(4), p.578.

Abstract:

Stroke rehabilitation has traditionally relied on physical and occupational therapies to improve motor and cognitive functions. Recently, immersive technologies, including Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), have emerged as innovative tools for enhancing recovery. These technologies offer engaging, tailored rehabilitation experiences, potentially improving stroke outcomes. This scoping review synthesizes recent studies on immersive technologies in stroke rehabilitation, focusing on clinical trials, pilot studies, and systematic reviews published in the past decade. Findings indicate that VR, AR, and MR interventions show promise in improving motor function, gait rehabilitation, and cognitive recovery. VR-based interventions, including treadmill training and mirror therapy, have demonstrated benefits such as increased walking speed and enhanced upper limb motor function. However, challenges remain, including participant selection bias, small sample sizes, and a lack of long-term follow-up. Additionally, issues such as physical discomfort, safety concerns, and the need for personalized therapy were noted. The diversity of stroke severity and patient heterogeneity further complicate generalizability. Immersive technologies hold significant potential in stroke rehabilitation by providing engaging and effective therapies. However, challenges such as safety, accessibility, and scalability must be addressed. Future research should focus on larger, multicenter trials with diverse patient populations, long-term follow-ups, and integrating advanced technologies like AI and motion tracking to optimize immersive interventions for stroke recovery.

References:

[1].   Sacco, R. L., Kasner, S. E., Broderick, J. P., et al., 2013, An updated definition of stroke for the 21st century. Stroke., 44(7):2064–2089. doi:10.1161/STR.0b013e318296aeca.

[2].   Maruvada, S. S., Sornavalli, V., Poonambalaganapathi, & Gowri Sankar, A., 2025. Mini mental state examination (MMSE) as a predictor of cognitive recovery in acute stroke. Romanian Journal of Neurology, 24(1):25–30. Doi:10.37897/RJN.2025.1.5.

[3].   O'Donnell, M. J., Xavier, D., Liu, L., et al., 2010, Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet., 376(9735):112–123. doi:10.1016/S0140-6736(10)60834-3.

[4].   Roth, E. J., Harvey, R. L., Rehabilitation of stroke syndromes. In: Physical Medicine and Rehabilitation.

[5].   TP, A., 1990, Rehabilitation of patients with completed stroke. In: Krusen's Handbook of Physical Medicine and Rehabilitation., 656–673.

[6].   Herpich, F., Rincon, F., 2020, Management of acute ischemic stroke. Crit Care Med., 48(11):1654–1663. doi:10.1097/CCM.0000000000004597.

[7].   Chen, X., Liu, F., Yan, Z., et al., 2018, Therapeutic effects of sensory input training on motor function rehabilitation after stroke. Medicine., 97(48):e13387. doi:10.1097/MD.0000000000013387.

[8].   Joypriyanka, M., Surendran R., Sathish Kumar, P. J, Sivasangari A. Game therapy for specially-abled individuals with PPO reinforcement learning in VR-based educational games. In: Proceedings of the 5th International Conference on Data Intelligence and Cognitive Informatics (ICDICI 2024). 2024. Doi:10.1109/ICDICI62993.2024.10810847

[9].   Coleman, E. R., Moudgal, R., Lang, K., et al., 2017, Early rehabilitation after stroke: a literature review. Curr Atheroscler Rep., 19(12):59. doi:10.1007/s11883-017-0686-6.

[10].  Puderbaugh, M., Emmady, P. D., 2023, Neuroplasticity. In: StatPearls. St. Petersburg (FL): StatPearls Publishing.

[11].  Cirstea, M. C., Levin, M. F., 2000, Compensatory strategies for reaching in stroke. Brain., 123(5):940–953. doi:10.1093/brain/123.5.940.

[12].  Li, W., Luo, Z., Jiang, J., Li, K., Wu, C., 2023, The effects of exercise intervention on cognition and motor function in stroke survivors: a systematic review and meta-analysis. Neurol Sci., 44(6):1891–1903. doi:10.1007/s10072-023-06636-9.

[13].  Teasell, R., Meyer, M. J., McClure, A., et al., 2009, Stroke rehabilitation: an international perspective. Top Stroke Rehabil., 16(1):44–56. doi:10.1310/tsr1601-44.

[14].  Huang, Q., Wu, W., Chen, X., et al., 2019, Evaluating the effect and mechanism of upper limb motor function recovery induced by immersive virtual-reality-based rehabilitation for subacute stroke subjects: study protocol for a randomized controlled trial. Trials., 20(1):104. doi:10.1186/s13063-019-3177-y.

[15].  Bhavani Sowndharya, B., Mathan Muthu, C. M., Vickram, A. S., Saravanan, A., 2025. Bio-ethical considerations in the application of artificial intelligence in spinal surgery. Brain Spine Lett., 10:104161. doi:10.1016/j.bas.2024.104161.

[16].  Bonnyaud, C., Gallien, P., Decavel, P., et al., 2018, Effects of a 6-month self-rehabilitation programme in addition to botulinum toxin injections and conventional physiotherapy on limitations of patients with spastic hemiparesis following stroke (ADJU-TOX): protocol study for a randomised controlled, investigator blinded study. BMJ Open., 8(8):e020915. doi:10.1136/bmjopen-2017-020915.

[17].  Nik Ramli, N. N., Asokan, A., Mayakrishnan, D., et al., 2021, Exploring stroke rehabilitation in Malaysia: are robots better than humans for stroke recuperation? Malays J Med Sci., 28(4):14–23. doi:10.21315/mjms2021.28.4.3.

[18].  Rikhof, C. J. H., Leerskov, K. S., Prange-Lasonder, G. B., et al., 2024, Combining robotics and functional electrical stimulation for assist-as-needed support of leg movements in stroke patients: a feasibility study. Med Eng Phys., 130:104216. doi:10.1016/j.medengphy.2024.104216.

[19].  Suh, A., Prophet, J., 2018, The state of immersive technology research: A literature analysis. Comput Human Behav., 86:77–90. doi:10.1016/j.chb.2018.04.019.

[20].  Slater, M., Sanchez-Vives, M. V., 2016, Enhancing our lives with immersive virtual reality. Front Robot AI., 3:74. doi:10.3389/frobt.2016.00074.

[21].  Diriba Kenea, C., Gemechu Abessa, T., Lamba, D., Bonnechère, B., 2024, Technological features of immersive virtual reality systems for upper limb stroke rehabilitation: a systematic review. Sensors (Basel)., 24(11):3546. doi:10.3390/s24113546.

[22].  Azuma, R., Baillot, Y., Behringer, R., et al., 2001, Recent advances in augmented reality. IEEE Comput Graph Appl., 21(6):34–47. doi:10.1109/38.963459.

[23].  Sigrist, R., Rauter, G., Riener, R., Wolf, P., 2013, Augmented visual, auditory, haptic, and multimodal feedback in motor learning: a review. Psychon Bull Rev., 20(1):21–53. doi:10.3758/s13423-012-0333-8.

[24].  Da Gama, A. E., Chaves, T. M., Figueiredo, L. S., et al., 2016, MirrARbilitation: A clinically-related gesture recognition interactive tool for an AR rehabilitation system. Comput Methods Programs Biomed., 135:105–114. doi:10.1016/j.cmpb.2016.07.014.

[25].  Tang, A., Biocca, F., Lim, L., Comparing differences in presence during social interaction in augmented reality versus virtual reality environments: An exploratory study.

[26].  Phan, H. L., Le, T. H., Lim, J. M., Hwang, C. H., Koo, K.-I., 2022, Effectiveness of augmented reality in stroke rehabilitation: A meta-analysis. Appl Sci., 12(4):1848. doi:10.3390/app12041848.

[27].  Cameirão, M. S., Badia, S. B., Duarte, E., Frisoli, A., Verschure, P. F., 2012, The combined impact of virtual reality neurorehabilitation and its interfaces on upper extremity functional recovery in patients with chronic stroke. Stroke., 43(10):2720–2728. doi:10.1161/STROKEAHA.112.653196.

[28].  Duff, M., Chen, Y., Cheng, L., Liu, S. M., Blake, P., Wolf, S. L., Rikakis, T., 2013, Adaptive mixed reality rehabilitation improves quality of reaching movements more than traditional reaching therapy following stroke. Neurorehabil Neural Repair., 27(4):306–315. doi:10.1177/1545968312465195.

[29].  Page, M. J., McKenzie, J. E., Bossuyt, P. M., et al., 2021, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ., 372:n71. doi:10.1136/bmj.n71.

[30].  Gustavsson, M., Kjörk, E. K., Erhardsson, M., et al., 2022, Virtual reality gaming in rehabilitation after stroke: user experiences and perceptions. Disabil Rehabil., 44(22):6759–6765. doi:10.1080/09638288.2021.1972351.

[31].  Winter, C., Kern, F., Gall, D., Latoschik, M. E., Pauli, P., Käthner, I., 2021, Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke. J Neuroeng Rehabil., 18(1):68. doi:10.1186/s12984-021-00848-w.

[32].  Huang, Q., Jiang, X., Jin, Y., et al., 2024, Immersive virtual reality-based rehabilitation for subacute stroke: a randomized controlled trial. J Neurol., 271(3):1256–1266. doi:10.1007/s00415-023-12060-y.

[33].  Mekbib, D. B., Debeli, D. K., Zhang, L., et al., 2021, A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke. Ann NY Acad Sci., 1493(1):75–89. doi:10.1111/nyas.14554.

[34].  Chatterjee, K., Buchanan, A., Cottrell, K., et al., 2022, Immersive virtual reality for the cognitive rehabilitation of stroke survivors. IEEE Trans Neural Syst Rehabil Eng., 30:719–728. doi:10.1109/TNSRE.2022.3158731.

[35].  Heinrich, C., Morkisch, N., Langlotz, T., Regenbrecht, H., Dohle, C., 2022, Feasibility and psychophysical effects of immersive virtual reality-based mirror therapy. J Neuroeng Rehabil., 19(1):107. doi:10.1186/s12984-022-01086-4.

[36].  Amin, F., Azad, A., Zubair, M., et al., 2024, Effectiveness of immersive virtual reality-based hand rehabilitation games for improving hand motor functions in subacute stroke patients. IEEE Trans Neural Syst Rehabil Eng., 32:2060–2069. doi:10.1109/TNSRE.2024.3405852.

[37].  Li, P., Wang, Z., Zhang, J., et al., 2023, Virtual reality rehabilitation for stroke patients: a meta-analysis of randomized controlled trials. Comput Methods Programs Biomed., 225:107037. doi:10.1016/j.cmpb.2023.107037.

[38].  Kwok, Y., Chen, L., Lee, W., et al., 2024, The impact of virtual reality therapy on cognitive and motor rehabilitation in stroke patients: A review of clinical studies. J Clin Neurosci., 81:13–23. doi:10.1016/j.jocn.2024.04.017.

[39].  Serrano, F., Martínez, C., Sánchez, A., et al., 2023, Effectiveness of virtual reality in post-stroke rehabilitation: a comparative meta-analysis. Arch Phys Med Rehabil., 104(6):1235–1245. doi:10.1016/j.apmr.2023.01.052.

Abstract:

Cerebrovascular accidents otherwise widely known as stroke is a global causative factor for mortality and morbidity. Strokes impact around 13.7 million individuals in India, making them the second leading cause of death and likely the most common reason for disability. The main aim of the study is to compare the effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) and Task-Oriented Training (TOT) to improve balance for stroke survivors. Total of 90 participants based on inclusion criteria and exclusion criteria will be selected. 90 participants should be divided into PNF and TOT as 45 participants in each group. Treatment duration will be for PNF group as 15 times repetitions with 3 sets and for TOT group as 10 times repetitions with 3sets. Outcome will be measured by (BBS) Berg Balance Scale and (PASS) Postural Assessment Stroke Scale. Descriptive and inferential statistics were used to tabulate and evaluate the collected data, apply the mean and standard deviation (SD) to all parameters, and use the t test to analyze significant differences between pre-test and post-test measures of the same group. The results indicate that findings are deemed statistically significant when the p-value is less than 0.0001. In this study the positive impact of 8 weeks of regular task-oriented training and proprioceptive neuromuscular facilitation for improved balance was observed. The berg balance scale and postural assessment stroke were used in this study to compare the effectiveness of task-oriented training and proprioceptive neuromuscular facilitation in patients with stroke survivors.

References:

Abstract:

Convergence insufficiency (CI) is a common binocular vision disorder that affects near vision and can significantly impact the quality of life, particularly in individuals recovering from a stroke. CI is characterized by symptoms such as diplopia, eye strain, headaches, and difficulty with reading, which can hinder rehabilitation. This case study evaluates the effectiveness of a structured orthoptic exercise program in alleviating symptomatic CI in a post-stroke patient. A 51-year-old male with a history of ischemic stroke and complaints of near vision diplopia was recruited. He underwent a structured orthoptic therapy program, including pencil push-ups and stereogram exercises, for 15-minute sessions, three days a week, over a period of three weeks. Pre- and post-intervention assessments were conducted using the Convergence Insufficiency Symptom Survey (CISS). The results revealed a significant improvement in CISS scores, with the Neat point convergence have reduced from ≥15 cm to ≤8 cm and Convergence Insufficiency Symptom Survey (CISS)Score from ≥30 to ≤15, therefore there was a marked reduction in symptoms of diplopia, eye strain, and difficulty in reading. The patient also reported subjective improvements in near vision tasks, indicating enhanced functional vision. These findings suggest that orthoptic exercises can serve as a non-invasive and cost-effective intervention for post-stroke CI rehabilitation. Given the positive outcomes observed in this case study, structured orthoptic therapy may be considered a viable approach for managing post-stroke CI. However, further research with larger sample sizes and long-term follow-ups is warranted to validate these findings and develop standardized rehabilitation protocols.

References:

Abstract:

A 60-year-old male patient, who had suffered a hemiplegic stroke, was admitted to the hospital's rehabilitation unit with the primary goal of regaining walking ability. Upon admission, the patient exhibited significant difficulty walking due to the residual effects of the stroke, which had resulted in pronounced motor weakness and balance issues. To comprehensively assess the patient's baseline function, a range of standardized measures were employed, including the Berg Balance Scale (BBS), which evaluated balance and risk of falls, the Fugl-Meyer Scale (FMS), which assessed motor function in the lower extremities, and a spatial and temporal gait assessment, which evaluated gait performance. Following baseline assessments, the patient underwent a comprehensive 16-week rehabilitation program, which consisted of robotic gait training and exercise therapy, administered three days per week. Robotic gait training was utilized to provide high-repetition, task-oriented practice, facilitating motor learning and recovery. The exercise therapy program was designed to complement robotic gait training, targeting muscle strength, flexibility, and endurance. Upon completion of the 16-week program, post-test assessments were conducted, revealing significant improvements in balance, motor function, and gait performance, as evidenced by enhanced scores on the BBS, FMS, and spatial and temporal gait assessment. These findings suggest that robotic gait training, combined with exercise therapy, may offer substantial benefits in reducing weakness and improving gait and balance in patients with hemiplegic stroke, highlighting the potential of this innovative locomotor training approach in stroke rehabilitation.

References:

[1] Middleton, A., Merlo-Rains, A., Peters, D. M., Greene, J. V., Blanck, E. L., Moran, R., and Fritz, S. L., 2014. Body weight–supported treadmill training is no better than overground training for individuals with chronic stroke: a randomized controlled trial. Topics in stroke rehabilitation, 21(6), pp.462-476.

[2] Umasankar, Y., Srinivasan, V., Suganthirababu, P., and Murugaiyan, P., 2024. Efficacy of Proprioceptive Neuromuscular Facilitation on Jaw Function in Bruxism Among Post Stroke Survivor: A Case Study. International Journal of Experimental Research and Review, 42.

[3] Kuriakose, D., and Xiao, Z., 2020. Pathophysiology and treatment of stroke: present status and future perspectives. International journal of molecular sciences, 21(20), p.7609.

[4] kamalakannan, S., Gudlavalleti, A. S., Gudlavalleti, V. S. M., Goenka, S., and Kuper, H., 2017. Incidence & prevalence of stroke in India: A systematic review. Indian Journal of Medical Research, 146(2), pp.175-185.

[5] Yew, K. S., and Cheng, E. M., 2015. Diagnosis of acute stroke. American family physician, 91(8), pp.528-536.

[6] Sandeep Reddy, K. S., Varadaraj, P., and Senthilnathan, S., 2024. Evaluating the coagulation parameters in acute ischemic versus hemorrhagic stroke patients upon hospital admission. Romanian Journal of Medical Practice, 19(3).

[7] Murphy, S. J., and Werring, D. J., 2020. Stroke: causes and clinical features. Medicine, 48(9), pp.561-566.

[8] Vishnuram, S., Suganthirababu, P., Ramalingam, V., Srinivasan, V., and Alagesan, J., 2024. Effect of Peripheral Nerve Mobilization and VR-Based Gait Training on Gait Parameters Among Patients with Chronic ACA Stroke–A Pilot Study. Physical & Occupational Therapy in Geriatrics, 42(4), pp.470-480.

[9] Arroyo-Fernández, R., Menchero-Sánchez, R., Pozuelo-Carrascosa, D.P., Romay-Barrero, H., Fernández-Maestra, A., and Martínez-Galán, I., 2024. Effectiveness of body weight-supported gait training on gait and balance for motor-incomplete spinal cord injuries: a systematic review with meta-analysis. Journal of Clinical Medicine, 13(4), p.1105.

[10] Tutuncu, O., 2023. The relationship between the meaning in life and the subjective vitality in people with disabilities. Doi:10.57643/lsadj.2023.26.2_08.

[11] Wang, J., Zhao, L., Gao, Y., Liu, C., Dong, X., and He, X., 2022. The difference between the effectiveness of body-weight-supported treadmill training combined with functional electrical stimulation and sole body-weight-supported treadmill training for improving gait parameters in stroke patients: A systematic review and meta-analysis. Frontiers in Neurology, 13, p.1003723.

[12] Mochizuki, L., Bigongiari, A., Franciulli, P. M., Francica, J. V., Alonso, A. C., Ervilha, U. F., Kiyomoto, H. D., and Greve, J. M. D. A., 2015. The effect of gait training and exercise programs on gait and balance in post-stroke patients. MedicalExpress, 2(4), p.M150401. https://doi.org/10.5935/MedicalExpress.2015.04.01

[13] Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Campodonico, F., Zimbaro, C., Alberti, G., Trubia, G., and Zagaria, T., 2018. Helping people with multiple disabilities manage an assembly task and mobility via technology-regulated sequence cues and contingent stimulation. Life Span and Disability, 21(2), pp.143-163.

[14] Ajmal, H., Sharif, F., Shakeel, H., Waqas, M., and Imran, M., 2021. Berg Balance Scale as a clinical screening tool to check fall risk among healthy geriatric community. Rawal Med J, 46, p.209.

[15] Hernández, E. D., Forero, S. M., Galeano, C. P., Barbosa, N. E., Sunnerhagen, K. S., and Murphy, M. A., 2021. Intra-and inter-rater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke. Brazilian journal of physical therapy, 25(6), pp.709-718.

[16] Norasteh, A. A., Balayi, E., and Zarei, H., 2023. Functional gait assessment tests in elderly: A systematic review. Caspian Journal of Neurological Sciences, 9(2), pp.120-128.

[17] Suganitha, B., Vijayakumar, J., TA, K., and Vijayaragavan, R., Safe and Robust Cerebral Ischemia Model: A Possible Way to Improve Therapeutic Approach for Ischemic Stroke. DOI: 10.5281/zenodo.11195220.

[18] Gopal, S.N., Palanasamy, S., David, K. and Rajendran, K., Evaluating Antiplatelet Compliance in Recurrent Stroke Patients.

[19] Surapaneni, D., 2024. Biomarkers of hemorrhagic transformation of acute ischemic stroke–A cross-sectional study. Romanian Medical Journal, 71(2).

[20] Dadi, P. S., Rajasekar, B., and Surendran, R., 2024, July. Exoskeleton Pysiotherapy and Assistive Robotic Arm. In 2024 2nd International Conference on Sustainable Computing and Smart Systems (ICSCSS) (pp. 138-141). IEEE.

[21] Schwartz, I., and Meiner, Z., 2015. Robotic-assisted gait training in neurological patients: who may benefit? Annals of biomedical engineering, 43, pp.1260-1269.

[22] Morone, G., Bragoni, M., Iosa, M., De Angelis, D., Venturiero, V., Coiro, P., Pratesi, L. and Paolucci, S., 2011. Who may benefit from robotic-assisted gait training? A randomized clinical trial in patients with subacute stroke. Neurorehabilitation and neural repair, 25(7), pp.636-644.

[23] Fisher, S., Lucas, L., and Adam Thrasher, T., 2011. Robot-assisted gait training for patients with hemiparesis due to stroke. Topics in stroke rehabilitation, 18(3), pp.269. https://doi.org/10.1310/tsr1803-269

Abstract:

Complex neurological conditions challenge the rehabilitation process. Sellar space-occupying lesions, mainly pituitary adenomas, may affect neurovascular structures, causing visual disturbances, hormonal imbalance, and neurological deficits. Sensory ganglionopathy is a rare peripheral nervous system disorder which causes proprioceptive deficits and impaired coordination. A 25-year-old male was diagnosed with Sellar space occupying lesion and sensory ganglionopathy, experienced impaired balance and coordination due to sensory deficits. These impairments led to limitations in the functional independence of the patient. A targeted physiotherapy program was implemented to address the multifaceted needs of the patient, incorporating strategies such as proprioceptive training, balance training, coordination exercises, strength training, sensory re-education, and patient education. The session was conducted for 45–50 minutes, five times a week for a total duration of 6 weeks. Pre-and post-test assessments was taken using the Berg Balance Scale, the Scale for the Assessment Rating of Ataxia, Romberg's test and the Functional Independence Measure. The patient demonstrated notable improvement in the outcome measures. The study concluded that the targeted physiotherapy approach significantly improved balance, coordination, proprioception and functional independence in a patient with a seller space-occupying lesion and sensory ganglionopathy.

References:

[1]. Emanuelli, E., Zanotti, C., Munari, S., Baldovin, M., Schiavo, G., and Denaro, L., 2021. Sellar and parasellar lesions: multidisciplinary management. Acta Otorhinolaryngologica Italica, 41(2 Suppl 1), p.S30. https://doi.org/10.14639/0392-100X-suppl.1-41-2021-03

[2]. Ugga, L., Franca, R. A., Scaravilli, A., Solari, D., Cocozza, S., Tortora, F., Cavallo, L. M., De Caro, M. D. B., and Elefante, A., 2023. Neoplasms and tumor-like lesions of the sellar region: imaging findings with correlation to pathology and 2021 WHO classification. Neuroradiology, 65(4), pp.675-699.https://doi.org/10.1007/s00234-023-03120-1

[3]. Fong, R., Conger, A. R., 2023. Tumors of the Pituitary Gland, in: Neuro-Oncology Compendium for the Boards and Clinical Practice. Oxford University PressNew York, pp. 110-C7. P166. https://doi.org/10.1093/med/9780197573778.003.0007

[4]. Bhimani, A. D., Schupper, A. J., Arnone, G. D., Chada, D., Chaker, A. N., Mohammadi, N., Hadjipanayis, C. G., and Mehta, A. I., 2022. Size matters: rethinking of the sizing classification of pituitary adenomas based on the rates of surgery: a multi-institutional retrospective study of 29,651 patients. Journal of Neurological Surgery Part B: Skull Base, 83(01), pp.066-075. https://doi.org/10.1055/s-0040-1716673

[5]. Skiba, J., Skiba, Z., Tylczyńska, K., Tylczyńska, N., Kowalik, K., Michalska, M., Zielińska, A., Szypulski, S., Iwaniuk, S., and Maciejewski, I., 2024. Pituitary Neuroendocrine Tumors (PitNETs)–a literature review. Quality in Sport, 33, pp.55879-55879. https://doi.org/10.12775/QS.2024.33.55879

[6]. Appavu, N., 2025.Enhanced MRI-Based Brain Tumor Detection Using Deep Learning Architectures and Optimized Machine Learning Techniques,” in 2025 Eleventh International Conference on Bio Signals, Images, and Instrumentation (ICBSII), Chennai, India: IEEE, pp. 1–6. https://doi.org/10.1109/ICBSII65145.2025.11013258

[7]. Amato, A. A., and Ropper, A. H., 2020. Sensory ganglionopathy. New England Journal of Medicine, 383(17), pp.1657-1662. https://doi.org/10.1056/NEJMra2023935

[8]. Gwathmey, K. G., 2016. Sensory neuronopathies. Muscle & Nerve, 53(1), pp.8-19.https://doi.org/10.1002/mus.24943

[9]. Zis, P., Sarrigiannis, P. G., Rao, D. G., Hoggard, N., Sanders, D. S., and Hadjivassiliou, M., 2017. Cerebellar ataxia with sensory ganglionopathy; does autoimmunity have a role to play? Cerebellum & Ataxias, 4, pp.1-9. https://doi.org/10.1186/s40673-017-0079-1

[10]. Pereira, P. R., Viala, K., Maisonobe, T., Haroche, J., Mathian, A., Hié, M., Amoura, Z., and Aubart, F.C., 2016. Sjögren sensory neuronopathy (Sjögren ganglionopathy): long-term outcome and treatment response in a series of 13 cases. Medicine, 95(19), p.e3632. https://doi.org/10.1097/MD.0000000000003632

[11]. Sheikh, S. I., and Amato, A. A., 2010. The dorsal root ganglion under attack: the acquired sensory ganglionopathies. Practical neurology, 10(6), pp.326-334.https://doi.org/10.1136/jnnp.2010.230532

[12]. Grobe-Einsler, M., Amin, A. T., Faber, J., Völkel, H., Synofzik, M., and Klockgether, T., 2024. Scale for the assessment and rating of ataxia (SARA): development of a training tool and certification program. The Cerebellum, 23(3), pp.877-880. https://doi.org/10.1007/s12311-023-01543-3

[13]. Vadassery, S. J., Kong, K. H., Ho, W. M. L., and Seneviratna, A., 2019. Interview Functional Independence Measure score: self-reporting as a simpler alternative to multidisciplinary functional assessment. Singapore medical journal, 60(4), p.199.https://doi.org/10.11622/smedj.2018048

[14]. Anagnostou, E., Kouvli, M., Karagianni, E., Gamvroula, A., Kalamatianos, T., Stranjalis, G., and Skoularidou, M., 2024. Romberg's test revisited: Changes in classical and advanced sway metrics in patients with pure sensory neuropathy. Neurophysiologie Clinique, 54(5), p.102999. https://doi.org/10.1016/j.neucli.2024.102999

[15]. Sri Lekha, M., Vishnuram, S., K., R., Abathsagayam, K., Suganthirababu, P., 2025. Efficacy of Dynamic Neuromuscular Stabilization Exercises on Balance and Fall Risk in Subjects with Diabetic Peripheral Neuropathy among Geriatrics—A Pilot Study. Physical & Occupational Therapy In Geriatrics 1–15. https://doi.org/10.1080/02703181.2025.2467803

[16]. Milne, S. C., Corben, L. A., Roberts, M., Szmulewicz, D., Burns, J., Grobler, A.C., et al., 2020. Rehabilitation for ataxia study: protocol for a randomised controlled trial of an outpatient and supported home-based physiotherapy programme for people with hereditary cerebellar ataxia. BMJ open, 10(12), p.e040230. https://doi.org/10.1136/bmjopen-2020-040230

[17]. Missaoui, B., and Thoumie, P., 2009. How far do patients with sensory ataxia benefit from so-called “proprioceptive rehabilitation”?. Neurophysiologie Clinique/Clinical Neurophysiology, 39(4-5), pp.229-233. https://doi.org/10.1016/j.neucli.2009.07.002

[18]. Thote, D., Yadav, V., Bhusari, N., Daf, R., Agrawal, I., Bhoyar, S., et al., 2024. Physiotherapy Rehabilitation Approach for Enhancing Stability and Gait in a Patient with Cerebellar Ataxia: A Case Report. Cureus, 16(10). https://doi.org/10.7759/cureus.70967

[19]. Milne, S. C., Corben, L. A., Georgiou-Karistianis, N., Delatycki, M. B., and Yiu, E. M., 2017. Rehabilitation for individuals with genetic degenerative ataxia: a systematic review. Neurorehabilitation and Neural Repair, 31(7), pp.609-622. https://doi.org/10.1177/1545968317712469

[20]. Apriliyasari, R. W., Van Truong, P., and Tsai, P. S., 2022. Effects of proprioceptive training for people with stroke: a meta-analysis of randomized controlled trials. Clinical Rehabilitation, 36(4), pp.431-448. https://doi.org/10.1177/02692155211057656

[21]. Warutkar, V. B., Samal, S., Koul, P., and Warutkar, V., 2023. Impact of vestibular and balance rehabilitation therapy along with conventional physiotherapy in a case of vestibular schwannoma with CP angle tumor: a case report. Cureus, 15(9). https://doi.org/10.7759/cureus.45224

[22]. Vishnuram, S., Abathsagayam, K., and Suganthirababu, P., 2022. Physiotherapy management of a rare variant of Guillain Barre Syndrome, acute motor and sensory axonal neuropathy (AMSAN) along with COVID-19 in a 35-year-old male–a case report. African Health Sciences, 22(3), pp.520-526. https://doi.org/10.4314/ahs.v22i3.56

[23]. Iram, H., Kashif, M., Hassan, H. M. J., Bunyad, S. and Asghar, S., 2021. Effects of proprioception training programme on balance among patients with diabetic neuropathy: A quasi-experimental trial. J Pak Med Assoc, 71(7), pp.1818-1821.https://doi.org/10.47391/JPMA.286

[24]. Winter, L., Huang, Q., Sertic, J. V., and Konczak, J., 2022. The effectiveness of proprioceptive training for improving motor performance and motor dysfunction: a systematic review. Frontiers in rehabilitation sciences, 3, p.830166.https://doi.org/10.3389/fresc.2022.830166

[25]. Sekar, M., Suganthirababu, P., Subramanian, S.S., Vishnuram, S., Ramalingam, V., Arul, A., Anbarason, A., 2024. The effectiveness of virtual reality (VR) therapy on balance and mobility in elderly patients: a randomized controlled trial.  Fizjoterapia Polska 24, 191–194. https://doi.org/10.56984/8ZG020C8UWP

Abstract:

Stroke is a leading cause of long-term disability, often resulting in significant motor impairments, particularly in the upper limbs. This case study explores the use of Virtual Reality-Based Rehabilitation (VRBR) to improve upper limb motor function, muscle tone, and strength in a 35-year-old male with left hemiparesis following a stroke. Over an 8-week period, the patient participated in VR therapy at Saveetha Physiotherapy OPD, engaging in interactive games such as Beat Saber and Fruit Ninja VR to enhance motor coordination and increase patient engagement. The intervention led to significant improvements in the patient’s motor function, muscle strength, and tone. The immersive and engaging nature of VRBR likely helped boost motivation, which contributed to better rehabilitation outcomes. These results suggest that VRBR is a promising tool for improving motor skills and supporting neuroplasticity in stroke patients with upper limb impairments. The study emphasizes the potential benefits of incorporating VR-based therapies in stroke rehabilitation and calls for further research to evaluate its effectiveness in larger patient populations.

References:

[1] Dutta, D., Sen, S., Aruchamy, S., and Mandal, S., 2022. Prevalence of post-stroke upper extremity paresis in developing countries and significance of m-Health for rehabilitation after stroke-A review. Smart Health, 23, p.100264.

[2] Hedau, V. N., and Patil, T., 2024. Mounting Stroke Crisis in India: A Systematic Review. Cureus, 16(3).

[3] Behera, D. K., Rahut, D. B., and Mishra, S., 2024. Analyzing stroke burden and risk factors in India using data from the Global Burden of Disease Study. Scientific Reports, 14(1), p.22640.

[4] Ramos-Lima, M. J. M., Brasileiro, I. D. C., Lima, T. L. D., and Braga-Neto, P., 2018. Quality of life after stroke: impact of clinical and sociodemographic factors. Clinics, 73, p.e418.

[5] Ingwersen, T., Wolf, S., Birke, G., Schlemm, E., Bartling, C., Bender, G., Meyer, A., Nolte, A., Ottes, K., Pade, O., and Peller, M., 2021. Long-term recovery of upper limb motor function and self-reported health: results from a multicenter observational study 1 year after discharge from rehabilitation. Neurological Research and Practice, 3, pp.1-10.

[6] Stanescu, I., Dabala, V., and Vanta, O., Recovery of precise hand movements after stroke.

[7] Plantin, J., Godbolt, A. K., Pennati, G. V., Laurencikas, E., Fransson, P., Baron, J. C., Maier, M. A., Borg, J., and Lindberg, P. G., 2022. Motor inhibition and its contribution to recovery of dexterous hand use after stroke. Brain Communications, 4(5), p.fcac241.

[8] Zhou, Z., Li, X., Wu, X., and Wang, X., 2024. Impact of early rehabilitation therapy on functional outcomes in patients post distal radius fracture surgery: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 25(1), p.198.

[9] Sinclair, M. C., Craven, M. M., and Phillips, D. V., 2024. Virtual-Reality Pain Science Positively Impacts Pain and Function, Return to Work, Customer Experience and Return On Investment: A Case Study. Journal of Clinical Exercise Physiology, 13(s2), pp.441-441.

[10] YILDIZ, A., 2024. Virtual Reality (VR) and Augmented Reality (AR) in Rehabilitation. Complementary Medicine with New Approaches, p.135.

[11] Bateni, H., Carruthers, J., Mohan, R., and Pishva, S., 2024. Use of virtual reality in physical therapy as an intervention and diagnostic tool. Rehabilitation research and practice, 2024(1), p.1122286.

[12] Fluet, G. G., Gorin, H., Rothpletz Puglia, P., Qiu, Q., Patel, J., Merians, A. S., Cronce, A. L., and Adamovich, S.V., 2024. A convergent mixed methods design to assess the use of the home virtual rehabilitation system by persons with chronic stroke. Games for Health Journal, 13(4), pp.278-287.

[13] Roy, B., Sur, M., Nath, P., Roy, S. D., Singha, P., and Bhattacharjee, K., 2024. Neuroplasticity and its implications for vestibular rehabilitation: A narrative review. International Journal of Orthopaedics and Physiotherapy, 6(1), pp.05-10.

[14] Pardini, S., Gabrielli, S., Olivetto, S., Fusina, F., Dianti, M., Forti, S., Lancini, C., and Novara, C., 2024. Personalized virtual reality compared with guided imagery for enhancing the impact of progressive muscle relaxation training: pilot randomized controlled trial. JMIR Mental Health, 11, p.e48649.

[15] Ehioghae, M., Montoya, A., Keshav, R., Vippa, T. K., Manuk-Hakobyan, H., Hasoon, J., Kaye, A. D., and Urits, I., 2024. Effectiveness of virtual reality–based rehabilitation interventions in improving postoperative outcomes for orthopedic surgery patients. Current Pain and Headache Reports, 28(1), pp.37-45.

[16] Paiva, H. W. A., Golçalves, J. G., Rodrígues, D. Z., and Rosa, R. L., 2024. A Comprehensive Analysis of Virtual Reality Applications in Healthcare. INFOCOMP Journal of Computer Science, 23(1).

[17] Fugl-Meyer, A. R., Jääskö, L., Leyman, I., Olsson, S., and Steglind, S., 1975. A method for evaluation of physical performance. Scand J Rehabil Med, 7(1), pp.13-31.

[18] Amin, F., Waris, A., Iqbal, J., Gilani, S.O., Rehman, M. Z. U., et.al., 2024. Maximizing stroke recovery with advanced technologies: A comprehensive assessment of robot-assisted, EMG-Controlled robotics, virtual reality, and mirror therapy interventions. Results in Engineering, 21, p.101725.

[19] Vishnuram, S., Suganthirababu, P., Ramalingam, V., Srinivasan, V., Alagesan, J., 2024, Effect of Peripheral Nerve Mobilization and VR-Based Gait Training on Gait Parameters Among Patients with Chronic ACA Stroke–A Pilot Study. Physical & Occupational Therapy in Geriatrics. 2024 Mar 21:1-1.

[20] Ramakrishnan, V., Subramanian, S. S., Selvarj, K., Jerome, A., Ramanathan, K., Alhalaiqa, F., Alyahyawi, H. Y., Alfawaz, S. S., Gaowgzeh R. A., Effectiveness of shoulder kinesio taping and conventional exercises on FuglMeyer assessment scale and Rivermead mobility scale in subacute hemiplegic subjects with shoulder subluxation: A single group prepost design.

[21] Nath, D., Singh, N., Saini, M., Banduni, O., Kumar, N., Srivastava, M.P., and Mehndiratta, A., 2024. Clinical potential and neuroplastic effect of targeted virtual reality based intervention for distal upper limb in post-stroke rehabilitation: a pilot observational study. Disability and Rehabilitation, 46(12), pp.2640-2649.

[22] Zhang, J., Yang, J., Xu, Q., Xiao, Y., Zuo, L., and Cai, E., 2024. Effectiveness of virtual reality-based rehabilitation on the upper extremity motor function of stroke patients: A protocol for systematic review and meta-analysis. PloS one, 19(11), p.e0313296.

[23] Okamura, R., Nakashima, A., Moriuchi, T., Fujiwara, K., Ohno, K., Higashi, T., and Tomori, K., 2024. Effects of a virtual reality-based mirror therapy system on upper extremity rehabilitation after stroke: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Neurology, 14, p.1298291.

[24] Rambabu GV, Manasa K, Kavya RV, Santhi GB. Virtual Reality Applications in Healthcare Rehabilitation Therapy and Medical Training Innovations. InITM Web of Conferences 2025 (Vol. 76, p. 04001). EDPSciences.

Abstract:

Pusher syndrome, or contraversive pushing, is a common post-stroke condition, particularly in patients with right hemisphere lesions. It is characterized by an altered perception of verticality, leading patients to push toward their hemiplegic side, resulting in postural imbalance and increased fall risk. Unlike typical stroke patients who lean toward their weaker side, those with pusher syndrome actively push away from their non-paretic side, making rehabilitation more challenging. This study aimed to assess the prevalence of pusher syndrome in stroke patients, examine recovery duration, and evaluate its occurrence and rehabilitation outcomes in posterior cerebral artery (PCA) strokes. A 12-month cross-sectional observational study was conducted in a stroke rehabilitation facility using the Scale for Contraversive Pushing (SCP) and a questionnaire to assess pusher behavior in stroke survivors. PCA involvement was observed in 60% of participants, with pusher syndrome present in 36% of PCA cases. A significant association was found between PCA involvement and pusher syndrome (Chi-square = 23.70, P < 0.001), along with an impact on recovery duration (Chi-square = 37.0, P < 0.001). These findings emphasize PCA's role in pusher syndrome and its effect on rehabilitation. Pusher syndrome is more prevalent in PCA strokes, with moderate severity on the SCP scale. The results underscore the need for specialized rehabilitation strategies to manage pushing behavior in this stroke population.

References:

[1]. Valliappan, S., Indiran, M., Mallikarjuna, S. K., Arumugam, G. S., 2024, Atypical presentation of tuberculous vasculitis: dual large vessel occlusions leading to malignant ischaemic stroke. BMJ Case Reports CP, 17(12):e262681. Available at: https://doi.org/10.1136/bcr-2023-262681

[2]. Deepthi, V., Sriharsha, T., Nanda Gopal, Kannan, R., 2024, Role of serum ferritin and prediction of neurological outcome in acute ischemic stroke patients. South Eastern European Journal of Public Health, 25(S1):1223–1227. Available at: https://doi.org/10.70135/seejph.vi.2025

[3]. Sivalingam, A. M., Sureshkumar, D. D., Pandurangan, V., 2025. Cerebellar pathology in forensic and clinical neuroscience. Ageing Res. Rev. 84, 102697. https://doi.org/10.1016/j.arr.2025.102697

[4]. Pare, J. R., Kahn, J. H., 2012, Basic Neuroanatomy and Stroke Syndromes. Emergency Medicine Clinics of North America., 30(3):601-615. Available at: https://doi.org/10.1016/j.emc.2012.05.004.

[5]. Śliwka, A., Piliński, R., 2013, Pusher Syndrome in stroke patients. The current state of knowledge on assessment and physiotherapy. Medical Rehabilitation, 17(4):19-27. Available at: https://doi.org/10.5604/14266972.1118361.

[6]. Pedersen, P. M., Wandel, A., Jørgensen, H. S., Nakayama, H., Raaschou, H. O., Olsen, T. S., 1996, Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms and impact on rehabilitation. Neurorehabilitation and Neural Repair, 10(3):187-194. Available at: https://doi.org/10.1177/154596839601000307

[7]. Babyar, S. R., Peterson, M. G. E., Reding, M., 2016, Case–Control Study of Impairments Associated with Recovery from “Pusher Syndrome” after Stroke: Logistic Regression Analyses. Journal of Stroke and Cerebrovascular Diseases. Available at: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.08.024

[8]. Weiller, C., et al., 1996, The role of the right hemisphere in postural control: Evidence from a study of patients with stroke. Brain, 119(1):141-151. Available at: https://doi.org/10.1007/s00221-016-4603-y

[9]. Duncan, P. W., et al., 1990, Measurement of balance in stroke patients. Physical Therapy., 70(12):824-835. Available at: https://doi.org/10.1093/ptj/70.12.824

[10]. Bishop, A., et al., 2014, Assessment of contraversive pushing in stroke patients: The Scale for Contraversive Pushing. Journal of Neurology, 261(3):598-605. Available at: https://doi.org/10.1177/1545968306291849

[11]. Saver, J. L., et al., 2018, Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. New England Journal of Medicine, 378(1):11-21. Available at: https://doi.org/10.1056/NEJMoa1706442

[12]. Qureshi, A. I., et al., 2016, Intracerebral Hemorrhage: A Guide to Diagnosis and Treatment. Springer International Publishing. Available at: https://doi.org/10.1056/NEJMoa1603460

[13]. Jauch, E. C., et al., 2013, Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2013 Update. Stroke. Available at: https://doi.org/10.1161/STR.0b013e318284056a

[14]. Santos-Pontelli, T. E., Pontes-Neto, O. M., Leite, J. P., 2012, Letter by Santos-Pontelli et al regarding article, “Prevalence and length of recovery of pusher syndrome based on cerebral hemispheric lesion side in patients with acute stroke.” Stroke, 43(9): e89-e90. Available at: https://doi.org/10.1161/STROKEAHA.112.658310

[15]. von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., Vandenbroucke, J. P., STROBE Initiative., 2007, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ., 335(7624):806-808. Available at: https://doi.org/10.1136/bmj.39335.541782.AD

[16]. Baier, B., Karnath, H.O., 2005, Incidence and diagnosis of 'pusher syndrome'. Journal of Neurology., 252(8):927-934. Available at: https://doi.org/10.1007/s00415-005-0788-2

[17]. Babyar, S. R., Peterson, M. G. E., Reding, M., 2016, Case–Control Study of Impairments Associated with Recovery from “Pusher Syndrome” after Stroke. Journal of Stroke and Cerebrovascular Diseases., 25(8):2049-2056. Available at: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.04.015

[18]. Patel, S. N., Huang, Y., 2022, Timing of Rehabilitation after Stroke: Improvement in Functional Independence. Stroke Rehabilitation Review., 14(4):223-224. Available at: https://doi.org/10.1007/s11739-022-02956-5

[19]. Gonzalez, R. A., Martin, P. F., 2021, Age-Related Factors in PCA Stroke Incidence and Recovery. Journal of Aging Health., 33(8):1845-1860. Available at: https://doi.org/10.1177/0898264321990290

[20]. Arboix, A., Arbe, G., García-Eroles, L., et al., 2011, Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients. BMC Research Notes., 4:329. Available at: https://doi.org/10.1186/1756-0500-4-329

Abstract:

Aerobic exercise is structured, repetitive, and purposeful, aiming to improve physical fitness and enhance cognitive performance, which includes processes like language, perception, attention, memory, and decision-making The aim of this study was to provide a detailed understanding and awareness of the effects of aerobic brain exercise among physiotherapy students. Quantitative Cross – sectional study, self – administered questionnaire design. Ethical approval was obtained. All Malaysian physiotherapy students were selected at random. Google Form was used to create the questionnaire, which included closed-ended questions. Using IBM SPSS statistics version 22.0, frequency analysis was carried out. Among physiotherapy students, 83.9% (n=302) knew that aerobic exercise (AE) improves cognitive function, while 16.1% (n=58) did not. 46.4% identified the recommended 150 minutes of moderate-intensity AE per week. 27.5% strongly agreed AE raises academic standards, 41.7% agreed it protects thinking and memory, and 48.7% said it improves focus. 44% believed AE enhances learning and attention, while 30.8% thought it produces new brain cells. 37.7% agreed AE improves verbal and memory skills, and 55.6% strongly agreed AE enhances motor function. The current study revealed that majority of the physiotherapy students reported being aware of the AE on CF. However, half of the physiotherapy students does not have the knowledge that regular AE improves CF.

References:

[1]. Penedo, F. J., Dahn, J. R., 2005, Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry, 18(2):189-93. Doi: 10.1097/00001504-200503000-00013. PMID: 16639173.

[2]. Erickson, K. I., Hillman, C., Stillman, C. M., Ballard, R. M., Bloodgood, B., Conroy, D. E., et al., For 2018 Physical Activity Guidelines Advisory Committee, 2019, Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines. Med Sci Sports Exerc, 51(6):1242-1251. Doi: 10.1249/MSS.0000000000001936. PMID: 31095081; PMCID: PMC6527141.

[3]. Pescatello, L. S., editor, 2014, ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.

[4]. McAuley, E., Kramer, A. F., Colcombe, S. J., 2004, Cardiovascular fitness and neurocognitive function in older adults: a brief review. Brain Behav Immun, 18(3):214-20. Doi: 10.1016/j.bbi.2003.12.007. PMID: 15116743.

[5]. Churchill, J. D., Galvez, R., Colcombe, S., Swain, R. A., Kramer, A. F., Greenough, W. T., 2002, Exercise, experience and the aging brain. Neurobiol Aging, 23(5):941-55. Doi: 10.1016/s0197-4580(02)00028-3. PMID: 12392797.

[6]. Lojovich, J. M., 2010, The relationship between aerobic exercise and cognition: is movement medicinal? J Head Trauma Rehabil, 25(3):184-192. https://doi.org/10.1097/HTR.0b013e3181dc78cd

[7]. Cotman, C. W., Berchtold, N. C., 2002, Exercise: a behavioral intervention to enhance brain health and plasticity. Trends Neurosci, 25(6):295-301. https://doi.org/10.1016/s0166-2236(02)02143-4

[8]. Sallam, N., Laher, I., 2016, Exercise Modulates Oxidative Stress and Inflammation in Aging and Cardiovascular Diseases. Oxid Med Cell Longev, 2016:1-32. https://doi.org/10.1155/2016/7239639

[9]. Cabral, D. F., Rice, J., Morris, T. P., Rundek, T., Pascual-Leone, A., Gomes-Osman, J., 2019, Exercise for Brain Health: An Investigation into the Underlying Mechanisms Guided by Dose. Neurotherapeutics, 16(3):580-599. https://doi.org/10.1007/s13311-019-00749-w

[10]. Singh, M., Sachdev, S., Raj, D., 2022, Intelligence, Stress and Cognitive Functions Assessment after three months Practice of Moderate Intensity Physical Exercise. JK Sci J Med Educ Res, 24(4):221-224.

[11]. Alagesan, J., Brite, Saghaya Rayna A., 2020, Effectiveness of Aerobic Exercise on Short Term Memory and Sustained Attention among Developmental Coordination Disorder Children. Indian Journal of Public Health Research & Development. 2020 Apr 1;11(4).

[12]. Park, D. C., Lautenschlager, G., Hedden, T., Davidson, N. S., Smith, A. D., Smith, P. K., 2002, Models of visuospatial and verbal memory across the adult life span. Psychol Aging., 17(2):299-320. https://doi.org/10.1037/0882-7974.17.2.299

[13]. de Greeff, J. W., Bosker, R. J., Oosterlaan, J., Visscher, C., Hartman, E., 2018, Effects of physical activity on executive functions, attention and academic performance in preadolescent children: a meta-analysis. J Sci Med Sport, 21(5):501-507. Doi: 10.1016/j.jsams.2017.09.595. PMID: 29054748.

[14]. Akbar, A. S., Srinivasan, V., Suganthirababu, P., 2024, Efficacy of Cognitive Behavioral Therapy on Mental Health in Hospital Housekeeping Staff. Psychiatria Danubina. 2024 Dec 28;36(3-4):400-1.

[15]. Nouchi, R., Kawashima, R., 2014, Improving Cognitive Function from Children to Old Age: A Systematic Review of Recent Smart Ageing Intervention Studies. Adv Neurosci, 2014:1-15. https://doi.org/10.1155/2014/235479

[16]. Tomporowski, P., McCullick, B., Pendleton, D., Pesce, C., 2015, Exercise and children's cognition: The role of exercise characteristics and a place for metacognition. J Sport Health Sci, 4(1):47-55. https://doi.org/10.1016/j.jshs.2014.09.003

[17]. Xu, J., Akhter, S., Apuke, O. D., 2025, The effectiveness of combining interactive media based cognitive behaviour therapy with art and music therapies for ameliorating the generalised anxiety disorder of children exposed to abduction. Psychiatry Research. 2025 Jul 1;349:116498.

[18]. Tin, T. T., Ee, L. C., Rong, J. C., 2024, Sleep quality as a mediating role in general health and academic performance in the context of sustainable education. Int J Innov Res Sci Stud, 7(2):690-700.

[19]. Şendil, A. M, Canlı, U., Sheeha, B. B., Alkhamees, N. H., Batrakoulis, A., Al-Mhanna, S. B., 2024, The effects of structured coordinative exercise protocol on physical fitness, motor competence and inhibitory control in preschool children. Scientific Reports, 2024 Nov 18;14(1):28462.

[20]. Li, S. C., Brehmer, Y., Shing, Y. L., Werkle-Bergner, M., Lindenberger, U., 2006, Neuromodulation of associative and organizational plasticity across the life span: Empirical evidence and neurocomputational modeling. Neurosci Biobehav Rev, 30(6):775-790. https://doi.org/10.1016/j.neubiorev.2006.06.004

[21]. Revathi, S., John, S., 2019, Learning preferences transformation in tertiary education. International Journal of Recent Technology and Engineering (IJRTE). 2019;8(2S):215-20.

[22]. Netz, Y., 2019, Is There a Preferred Mode of Exercise for Cognition Enhancement in Older Age?—A Narrative Review. Front Med, 6:1-10. https://doi.org/10.3389/fmed.2019.00057

[23]. Altaim, T. A., Subramanian, S. S., Sam, A., Alenezi, L., Ramanathan, K., Gaowgzeh, R. A., Arjunan, P., Salman, A. F., 2025, The relationship between physical activity and academic performance among health professional students: a correlational study. Retos: nuevas tendencias en educación física, deporte y recreación. 2025(66):872-81.

[24]. Raj, J. A., Patra, R. C., Ramya Krishna, M. L., Vaheedha, S., Himabindu, K., et al., 2025, Impact of exercise on cognitive function and motor impairment in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. J Adv Biomed. 11(2). Doi:10.53555/jab.v11i2.177.

[25]. Mihailova, A., Kaminska, I., Bernane, A., 2014, Physical activity in physiotherapy and physical education high school students. SHS Web Conf, 10:1-8. https://doi.org/10.1051/shsconf/20141000025

[26]. Giles, G. E., Cantelon, J. A., Eddy, M. D., Brunyé, T. T., Urry, H. L., Mahoney, C. R., Kanarek, R. B., 2017, Habitual exercise is associated with cognitive control and cognitive reappraisal success. Exp Brain Res, 235(12):3785-3797. Doi: 10.1007/s00221-017-5098-x. PMID: 28975416.

[27]. Bjørnebekk, A., Mathé, A. A., Brené, S., 2005, The antidepressant effect of running is associated with increased hippocampal cell proliferation. Int J Neuropsychopharmacol, 8(3):357-368. Doi: 10.1017/S1461145705005122. PMID: 15769301.