Muscle Paralysis Research Articles

Exploring the Association between Diabetes Mellitus, Obesity, and Recurrent Stroke Events: a Cross-sectional Study

Stroke is the most significant cause of death and cause of disability in the world because it causes neurological deficits in sufferers, such as muscle paralysis, swallowing weakness, communication damage, and vision disorders to cause death. Stroke can be recurrent and have a severe impact compared to the initial attack. The purpose of this study was to explore the association between diabetes mellitus, obesity, and the incidence of recurrent strokes in post-stroke patients at a regional general hospital in Aceh province. It is a cross-sectional study carried out from 3–12 August 2022. The sampling technique used in this study was a purposive sampling of 154 patients. The instruments used were questionnaires of patient demographic characteristics, data analysis using chi-square assays, and logistic regression. The results showed that there was no association between diabetes mellitus (p>0.05) and obesity (p>0.05) with the incidence of recurrent strokes. One of the preventive measures for the occurrence of recurrent strokes is to provide education about the prevention of recurrent strokes related to diabetes mellitus and obesity, one of which is a healthy lifestyle. In conclusion, there is no relationship between diabetes mellitus, obesity, and the incidence of recurrent strokes in post-stroke patients at a regional general hospital in Aceh province.

A Systematic Review and Comparative Analysis of Botox Treatment in Aesthetic and Therapeutic Applications: Advantages, Disadvantages, and Patient Outcomes.

The objective of this review article is to comprehensively analyze Botox treatment, emphasizing its aesthetic and therapeutic applications, along with the associated advantages, disadvantages, and patient outcomes. By reviewing current literature, the article evaluates Botox's efficacy and safety in various clinical settings, including cosmetic procedures and medical treatments for conditions such as chronic migraines and excessive sweating, while also exploring patient satisfaction and potential risks. This review article provides a comprehensive analysis of Botox treatment, focusing on its aesthetic and therapeutic applications, as well as the associated advantages, disadvantages, and patient outcomes. Botulinum toxin, derived from Clostridium botulinum, is widely recognized for its ability to induce temporary muscle paralysis, leading to significant improvements in both cosmetic and medical conditions. The article reviews findings from recent clinical trials, case reports, and observational studies, highlighting the efficacy and safety of Botox in treating various conditions such as chronic migraines, excessive sweating, and muscle spasticity, alongside its cosmetic use in wrinkle reduction. While the benefits of Botox are substantial, including its minimally invasive nature and high patient satisfaction rates, potential risks and complications, including rare adverse events, are also discussed.

Oriented artificial nanofibers and laser induced periodic surface structures as substrates for Schwann cells alignment

People with injuries to the peripheral nervous system, due to its poor functional regeneration, suffer from paralysis of the facial muscles, fingers and hands, or toes and feet, often for the rest of their lives. Therefore, to improve patients’ quality of life, there is an urgent need for conduits that effectively support the healing of large defects in nerve pathways through specific guidance of nerve cells. This paper describes two specific methods for achieving directed growth of Schwann cells, a type of glial cells that can support the regeneration of the nerve pathway by guiding the neuronal axons in the direction of their alignment. One method implies the exposure of a poly(ethylene terephthalate) (PET) foil to a KrF* laser beam, that renders a nanorippled surface topography. The other method uses aligned polyamide-6 (PA-6) nanofibers produced via electrospinning on a very fast rotating structured collector, which enables easy nanofiber detachment, without additional effort. Schwann cells growth on these substrates was inspected after one week of cultivation by means of scanning electron microscope (SEM). For both methods we show that Schwann cells grow in a certain direction, predetermined by nanoripples and nanofibers orientation. In contrast, cells cultivated onto unstructured surfaces or randomly oriented nanofibers, show an omnidirectional growth behavior.

Case Report: A 5 Yea kan r Old Girl with Diphtheria

Background: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. It is characterized by the formation of pseudomembranes in the tonsils, pharynx, and/or nasal cavity, which can lead to severe complications such as airway obstruction, myocarditis, and paralysis of the palate muscles. Aims: This study aims to detail the clinical course and treatment of a pediatric diphtheria case, emphasizing the importance of early diagnosis and appropriate therapeutic interventions. Methods: The case of a 5-year-old girl presenting with a 3-day history of fever at K.R.M.T Wongsonegoro Hospital is described. Clinical evaluation, including history, physical examination, and supportive tests, led to a diagnosis of diphtheritic tonsillitis. Findings: The patient exhibited classic symptoms of diphtheria, including sore throat, fever, and the presence of a dirty, greyish-white pseudomembrane on the tonsils. The membrane extended to adjacent structures, causing a condition known as bullneck. The treatment protocol included the administration of diphtheria antitoxin (DAT), antibiotics, antipyretics, corticosteroids, and symptomatic management. Conclusion: Diphtheria remains a serious infectious disease requiring prompt diagnosis and treatment to prevent complications. The case highlights the importance of early intervention, continuous monitoring, and the evaluation of therapeutic efficacy to improve patient outcomes. Implications: This study underscores the necessity of vigilant clinical practices in managing diphtheria cases, particularly in pediatric patients, to reduce morbidity and mortality.

Compassionate Ventilator Release in Patients With Neuromuscular Disease: A Two-Case Comparison

Dyspnea, the subjective sensation of breathlessness, is a distressing and potentially traumatic symptom. Dyspnea associated with mechanical ventilation may contribute to intensive care unit (ICU) associated post-traumatic stress disorder and impaired quality of life. Dyspnea is both difficult to alleviate and a cause of significant distress to patients, their loved ones, and care providers People living with neuromuscular disease, such as amyotrophic lateral sclerosis (ALS) or myasthenia gravis (MG), often rely on a ventilator at late stages of illness due to complications of progressive respiratory muscle weakness and paralysis. When unable to wean from the ventilator, conversations turn towards goals of care and release from the ventilator for comfort and end of life (EOL). Patients with and without neuromuscular disease have high risk for dyspnea at EOL upon ventilator liberation. Although limited recommendations have been published specific to patients with ALS, no guidelines currently exist for the terminal liberation from mechanical ventilation in patients experiencing respiratory muscle insufficiency from a neuromuscular disease. Further research on this topic is needed, including creation of a protocol for ventilator release in patients with neuromuscular disease. The following case reports detail the dissimilar EOL experiences of two patients with different forms of neuromuscular disease.

Surgical treatment of unilateral acquired superior oblique muscle palsy in adults by inferior oblique belly transposition: a retrospective analysis.

Evaluate and analyze the efficacy of inferior oblique belly transposition (IOBT) in treating adult patients with diplopia and small-angle hypertropia caused by mild to moderate inferior oblique overaction (IOOA) secondary to acquired superior oblique palsy (SOP). Nine adult patients with diplopia and small-angle hypertropia associated with mild to moderate IOOA secondary to unilateral acquired SOP were included in the current retrospective study. All patients received the IOBT procedure between February 2019 and May 2023 at The Second People's Hospital of Jinan and were followed up for more than 6months after the surgery. During the procedure, the belly of the inferior oblique muscle was fixed to the sclera at 5mm posterior to the temporal insertion of the inferior rectus muscle. The following indicators were reviewed pre- and post-surgery: the vertical deviation (VD) in the primary position and in the Bielschowsky test, the fovea disc angle (FDA) of the affected eye, changes in IOOA, and diplopia. After IOBT, the VD in the primary position decreased from 7.22△ ± 1.72△ (range 4△-10△) to 1.22△ ± 1.30△ (range 0△-3△). The VD in the Bielschowsky test decreased from 13.00△ ± 1.80△ to 3.22△ ± 1.09△. The FDA decreased from 10.02° ± 3.34° to 6.26° ± 1.91°. The grade of IOOA was reduced from 2.00 (1.00, 2.00) to 0.00 (0.00, 1.00). All changes were statistically significant (P < 0.001 or P = 0.006). Diplopia was resolved completely for all patients. IOBT can effectively treat adults with diplopia and small-angle hypertropia caused by mild to moderate IOOA secondary to acquired SOP.

A acute pontine infarction with one-and-a-half syndrome as the manifestation: A case report.

Sudden ocular dyskinesia is usually associated with ophthalmic diseases and rarely with cerebrovascular diseases. This is a rare case of a patient with a sudden onset of ocular dyskinesia due to occlusion of the anterior inferior cerebellar artery and the spiral modiolar artery. This article describes eye movement disorders associated with cerebrovascular disease, aiming to improve our understanding of cerebrovascular diseases and improve the ability of early diagnosis and differential diagnosis. A 52-year-old man presented with acute pontine cerebral infarction 2 days before presentation. The main symptoms were the inability to adduct and abduct the left eyeball, the ability to abduct but not adduct the right eyeball, and horizontal nystagmus during abduction. Cranial computed tomography in our emergency department suggested cerebral infarction, and magnetic resonance imaging examination after admission confirmed the diagnosis of acute pontine cerebral infarction. This patient was ultimately diagnosed with acute pontine cerebral infarction. He received aspirin, clopidogrel, and butylphthalide, as well as acupuncture and Chinese herbal medicine. After 10 days of treatment, the patient's paralysis of the eye muscles improved significantly. Eye movement disorders are sometimes an early warning sign of impending vertebrobasilar ischemic stroke. Patients with acute ischemic stroke who have early detection of oculomotor disturbances should be promptly imaged, as missed diagnosis may lead to serious consequences or even death. It provided us with a new diagnostic idea.

A RARE CASE OF JUVENILE MYASTHENIA GRAVIS

Juvenile Myasthenia Gravis is arare auto immune disorder affecting children and adolescents, characterized by ptosis, muscle weakness and fatigability, untreated patients may progress to paralysis of the respiratory muscles and the risk of aspiration, particularly at times when they have an upper respiratory tract infection. Early recognition of this disease helps avoid unnecessary testing, prevent undue parental anxiety and stop the progression of symptoms. An 18 months old girl admitted with progressive dropping of eyelids, swallowing difficulty, loss of head control and generalized fatigability. She had positive acetyl cholinesterase test. Investigation releavedelectro decrementalresponsonse in electromyography. Patient treated with oral pyridostigmine bromide and steroid resulted in improvement in muscle strength and functional ability with regularly followed in OPD.JMG requires prompt recognition and management to prevent complications. This case highlights the importance of considering JMG in children with persistent weakness and fatigue.

PHYSIOTHERAPY MANAGEMENT OF AIDP GUILLAIN-BARRÉ SYNDROME VARIANT IN A TERTIARY HOSPITAL IN SOUTH-WEST NIGERIA: A CASE REPORT

Guillain-Barré Syndrome (GBS) is an acute neurological condition marked by swift muscular weakening, with the most prevalent form being the Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) variety. This case report provides a comprehensive account of the physiotherapy treatment of a 35-year-old patient diagnosed with Acute Inflammatory Demyelinating Polyneuropathy (AIDP) in a tertiary hospital in South-West Nigeria. After contracting a gastrointestinal infection, the patient developed a gradual loss of strength in their limbs and paralysis of the facial muscles on both sides of the face. The diagnostic assessments verified Acute Inflammatory Demyelinating Polyneuropathy (AIDP), and the treatment consisted of intravenous immunoglobulin (IVIg), plasmapheresis, and a planned physiotherapy program. During a period of four weeks, the patient demonstrated notable enhancements in muscle strength, functional autonomy, and pain levels. This case emphasizes the significance of initiating physiotherapy early and maintaining a consistent approach. It also demonstrates the potential of customized rehabilitation programs to improve recovery in settings with limited resources.

Probable paralytic rabies in a dog: ante-mortem clinical diagnosis implications in limited resource settings.

Rabies is a dreadful zoonotic viral disease that affects animals and humans with a fatality rate of 100%. This report aims to create awareness among the veterinarians and general public about the paralytic form of rabies in order to understand the antemortem clinical diagnosis implications in limited resource settings, so as to follow the post-exposure prophylaxis at the golden hour period of rabies transmission. A one-year-old female dog was presented to the Ambulatory Clinic Unit, Veterinary Clinical Complex, Veterinary College and Research Institute, Theni, Tamil Nadu, India with the ailment of a dropped jaw and was unable to swallow food and water for the past three days. Epidemiological investigations revealed that the animal had dog-bitten wounds from a week ago. On clinical examination, facial distortion, changes in the vocal cord, and paralysis of the throat muscle were noticed. Based on the anamnesis, clinical, and epidemiological investigations, the animal was diagnosed to be a probable case of paralytic form of canine rabies. In the limited resource settings, antemortem clinical diagnosis was practiced to suspect rabies-infected dogs. Further, the owner was advised to implement preventive measures to safeguard against rabies infection. The dog was kept under isolation and succumbed on day two with evidence of progressive paralytic signs. This report emphasizes the importance of paralytic rabies, alongside of furious form of rabies, further creating awareness among the general public about the antemortem clinical diagnosis under limited resource settings.

Prevalence and associated factors of myopia among adolescents aged 12–15 in Shandong Province, China: a cross-sectional study

Myopia is a growing concern worldwide, especially among adolescents. This study aimed to investigate the prevalence and associated factors of myopia in adolescents aged 12–15 in Shandong Province, China. This cross-sectional study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and involved stratified random cluster sampling of 128,678 students from 186 middle schools across 17 cities in Shandong Province. Data collection was conducted from March to April 2024. We excluded students with organic eye diseases, abnormal binocular vision functions, or a history of eye injuries or surgeries. Myopia was assessed using the standard logarithmic visual acuity chart and autorefractor without inducing ciliary muscle paralysis. A comprehensive questionnaire survey was conducted to gather demographic characteristics and daily life behaviors. With the chi-squared test for univariable analysis and multivariable logistic regression for identifying significant factors. This study included 126,375 participants, with a gender distribution of 51.02% male and 48.98% female. The overall prevalence of myopia was 71.34%. Higher prevalence was observed in girls (72.26%) compared to boys (70.45%), and the prevalence increased with age, peaking at 73.12% in 15-year-olds. Urban residents had a higher prevalence (71.86%) than rural (70.39%). Factors such as increased frequency of eye usage while lying down or leaning forward, frequent use of eyes while walking or riding in a car, prolonged screen time, and extended homework duration were associated with higher odds of developing myopia. Conversely, higher frequency of outdoor exercise, maintaining proper posture during reading and writing, greater distance from eyes to screen, and longer sleep duration were associated with lower odds. Additionally, female gender, older age, urban residence, and parental history of myopia increased the risk. The high prevalence of myopia among adolescents in Shandong Province was influenced by a combination of demographic, behavioral, and environmental factors. The study highlighted the importance of lifestyle modifications, such as increasing outdoor activities and maintaining proper visual habits, limiting the duration of screen exposure and homework sessions, and extending sleep duration, to mitigate the risk of developing myopia. These findings underscored the need for targeted public health interventions and educational campaigns to address this significant public health issue.

Recurrent Right-side Bell’s Palsy in Association with Neurovascular Cross-compression: A Case Report

Introduction: Bell’s palsy is a lower motor neuron (LMN) palsy that affects the facial nerve (CN VII) and causes weakness or paralysis of the facial muscles. It can be associated with various causes, including neurovascular cross-compression (NVCC). This case report highlights the challenges in treating recurrent Bell’s palsy caused by NVCC and the need for a multidisciplinary approach. Case report: A 17-year-old girl presented with recurrent right-side Bell’s palsy along with NVCC involving the right and left anterior inferior cerebellar artery forming a loop around the VII and VIII cranial nerve complex. Motor Nerve Conduction Studies (NCS) indicated a right-side facial nerve lesion with prolonged distal latency. Discussion: Despite prior physiotherapy sessions, which proved effective, the patient showed no improvement after five sessions, leading to further investigations. This case also underscores the diagnostic and therapeutic complexities associated with NVCC-induced Bell’s palsy, which emphasizes the urgency of quick diagnosis and intervention to prevent functional limitations. Conclusion: Continued research and advancements in diagnostic and therapeutic modalities are required for better outcomes and improving the quality of life in such patients, particularly in such cases.

Muscle Fibrosis, NF-κB, and TGF-β Are Differentially Altered in Two Models of Paralysis (Botox Versus Neurectomy).

Objective: Volumetric muscle loss results in intramuscular axotomy, denervating muscle distal to the injury and leading to paralysis, denervation, and loss of muscle function. Once the nerve is damaged, paralyzed skeletal muscle will atrophy and accumulate noncontractile connective tissue. The objective of this study was to determine differences in connective tissue, atrophy, and inflammatory signaling between two paralysis models, botulinum toxin (Botox), which blocks acetylcholine transmission while keeping nerves intact, and neurectomy, which eliminates all nerve-to-muscle signaling. Approach: Twenty male Sprague Dawley rats were randomized and received a sciatic-femoral neurectomy (SFN), Botox-induced muscle paralysis of the proximal femur muscles, quadriceps femoris, hamstrings, and calf muscles (BTX), or sham. Muscle force was measured 52 days postsurgery, and samples were collected for histology, protein, and mRNA assays. Results: SFN and BTX decreased twitch and tetanic force, decreased fiber size by twofold, and increased myogenic expression compared with controls. SFN increased the levels of all major extracellular matrix proteins correlating with fibrosis [e.g., laminin, fibronectin, and collagen type(s) I, III, VI]. SFN also increased profibrotic and proinflammatory mRNA compared with BTX and controls. Innovation: SFN and BTX were similar in gross morphology and functional deficiencies. However, SFN exhibited a higher amount of fibrosis in histological sections and immunoblotting. The present study shows evidence that nerve signaling changes NF-κB and TGF-β signaling, warranting future studies to determine the mechanisms involved. Conclusion: These data indicate that nerve signaling may influence fibrogenesis following denervation, but the mechanisms involved may differ as a function of the method of paralysis.

An automatic measure for speech intelligibility in dysarthrias-validation across multiple languages and neurological disorders.

Dysarthria, a motor speech disorder caused by muscle weakness or paralysis, severely impacts speech intelligibility and quality of life. The condition is prevalent in motor speech disorders such as Parkinson's disease (PD), atypical parkinsonism such as progressive supranuclear palsy (PSP), Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS). Improving intelligibility is not only an outcome that matters to patients but can also play a critical role as an endpoint in clinical research and drug development. This study validates a digital measure for speech intelligibility, the ki: SB-M intelligibility score, across various motor speech disorders and languages following the Digital Medicine Society (DiMe) V3 framework. The study used four datasets: healthy controls (HCs) and patients with PD, HD, PSP, and ALS from Czech, Colombian, and German populations. Participants' speech intelligibility was assessed using the ki: SB-M intelligibility score, which is derived from automatic speech recognition (ASR) systems. Verification with inter-ASR reliability and temporal consistency, analytical validation with correlations to gold standard clinical dysarthria scores in each disease, and clinical validation with group comparisons between HCs and patients were performed. Verification showed good to excellent inter-rater reliability between ASR systems and fair to good consistency. Analytical validation revealed significant correlations between the SB-M intelligibility score and established clinical measures for speech impairments across all patient groups and languages. Clinical validation demonstrated significant differences in intelligibility scores between pathological groups and healthy controls, indicating the measure's discriminative capability. The ki: SB-M intelligibility score is a reliable, valid, and clinically relevant tool for assessing speech intelligibility in motor speech disorders. It holds promise for improving clinical trials through automated, objective, and scalable assessments. Future studies should explore its utility in monitoring disease progression and therapeutic efficacy as well as add data from further dysarthrias to the validation.

Systematic review of the histological and functional effects of botulinum toxin A on masticatory muscles: Consideration in dentofacial orthopedics and orthognathic surgery

IntroductionBotulinum toxin type A causes muscle paralysis and is widely used in the masticatory muscle for stomatognathic diseases, such as temporomandibular disorder, bruxism, or masseteric hypertrophy. Nonetheless, its muscular effect remains unclear. Better understanding could aid improved use and perhaps new indications, particularly in dentofacial orthopaedics and orthognathic surgery. MethodsThis systematic review explored the histologic and functional effects of botulinum toxin in animal and human masticatory muscles and was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The MEDLINE, Web of Science, and Cochrane Library electronic databases were searched for relevant articles. The inclusion criteria were human or animal masticatory muscle analysis after botulinum toxin injection(s) AND histological structural/ultrastructural analysis by optical or electronic microscopy OR functional effect analysis by bite force evaluation (occlusal force analyzer) and muscle activity (electromyography). ResultsOf an initial 1578 articles, 44 studies were eventually included. Botulinum toxin injection in the masticatory muscle altered its histological structure and functional properties. The human and animal studies revealed ultrastructural change, atrophy, and fiber type modifications of the masticatory muscles after one injection. Botulinum toxin decreased bite force and muscle activity, but recovery was uncertain. ConclusionsMuscle forces applied on the skeleton is a key feature of facial growth. Masticatory muscle paralysis changes mechanical stress on bones, which rebalances the force applied on facial bones. This new balance could benefit dental deformity or surgical relapse. Therefore, botulinum toxin could limit the orthognathic effect of the masticatory muscles in such patients. Given the uncertain recovery, multiple injections should be avoided, and usage should not deviate from established consensus.

Ứng dụng tiêm Botulinum Neurotoxin dưới hướng dẫn của siêu âm và điện cơ trong điều trị loạn trương lực cơ cổ: Ca lâm sàng

Dystonia is a movement disorder characterized by persistent or intermittent muscle contractions, involuntary, creating repetitive and/or abnormal postures and movements. Dystonic movements result in characteristic twisting or tremor patterns. Dystonia often begins or worsens with intentional movements, combined with excessive muscle activation. Dystonia is classified according to the affected body regions: focal dystonia, segmental dystonia, multifocal dystonia, hemidystonia, and generalized dystonia. Anterocollis is a type of cervical dystonia, caused by persistent, repetitive contractions of neck muscle groups, leading to excessive neck flexion. Anterocollis is described in the context of movement disorders in Parkinson’s syndrome (Parkinson’s disease, multiple system atrophy, etc.). Treatment of dystonia is primarily symptomatic: medications, Botulinum Neurotoxin (BoNT) injections, surgery, and physical therapy. Among these, BoNT injections are considered the first choice for focal or segmental dystonia.Botulinum Neurotoxin acts at the neuromuscular junction, leading to muscle paralysis. BoNT injections require injection equipment, surface disinfection, and determination of the injection site based on clinical landmarks. Some deep and difficult injections require specialized techniques such as electromyography (EMG) and ultrasound. In the case of anterocollis, BoNT is often applied to both superficial and deep muscles. To achieve effectiveness and limit complications during and after injection, practitioners often use combined EMG and ultrasound techniques. We present a clinical case to illustrate the value of using BoNT injections under the simultaneous guidance of EMG and ultrasound in treating anterocollis at the Neurology Department of Hanoi Medical University Hospital.

Exploring vertebral bone density changes in a trunk with adolescent idiopathic scoliosis: a mechanobiological modeling investigation of intact and unilaterally paralyzed muscles

This study aimed to elucidate the vertebral bone density variations associated with adolescent idiopathic scoliosis (AIS), specifically examining the impact of unilateral muscle paralysis using an integrated approach combining Frost’s Mechanostat theory, a three-dimensional subject-specific finite element model and a musculoskeletal model of the L2 vertebra. The findings revealed a spectrum of bone density values ranging from 0.29 to 0.31 g/cm3, along with vertebral micro-strain levels spanning from 300 to 2200, consistent with existing literature. Furthermore, the ratio of maximum von Mises stress between the concave and convex side in the AIS model with intact muscles was approximately 1.08, which decreased by 4% due following unilateral paralysis of longissimus thoracis pars thoracic muscle. Overall, this investigation contributes to a deeper understanding of AIS biomechanics and lays the groundwork for future research endeavors aimed at optimizing clinical management approaches for individuals with this condition.

A Comparative Study between Ultrasound Guided Interscalene and Ultrasound Guided Suprascapular Nerve Blocks in Postoperative Pain and Hand Motor Power Affection in Shoulder Scope Surgeries

Abstract Background Interscalene approach of brachial plexus nerve block is recognized as the gold standard technique for postoperative pain control after shoulder scope surgeries. However, it is associated with major adverse effects and patient discomfort due to paralysis of the hand muscles. The suprascapular nerve block is considered to be a safe and effective alternative to interscalene nerve block for shoulder surgery without affecting the motor function of the hand muscles and other serious complications of interscalene nerve block, especially in ambulatory surgery. Aim of the work The aim of this study is to compare interscalene and suprascapular nerve block in terms of postoperative pain, opioid consumption, and hand grip strength in shoulderscopic surgeries. Patients and Methods This prospective, randomized trial was done in Ain Shams University Hospitals. A sample of 50 patients; 25 patients in each group, namely Group ISB (interscalene approach of brachial plexus block) and Group SSNB (suprascapular nerve block). Visual Analogue Scale (VAS) was used to assess Shoulder pain at rest and upon flexion in the first 24 hours. The degree of hand motor power affection, the total amount of opioids used as rescue analgesia, and the incidence of complications were also recorded. Results The findings revealed no statistically significant difference between groups (p-value &amp;gt; 0.05) in pain control all over the 24 hours by VAS score at rest and at arm flexion. SSNB received a larger total narcotic dose (60±26.02) mg of pethidine than ISB (52±22.73). However, there was no statistical difference between them throughout the 24 hours regarding total narcotic consumption and 1st time for pethidine administration. The ISB group showed a statistically significant reduction in the hand power grip strength postoperatively (83.68±4.75 %). Conclusions The results of the present study favour SSNB as the first choice of pain control after shoulderscopic surgeries for a patient scheduled for early home discharge because of the complete recovery of the hand muscles’ motor power.

Contralateral anaesthesia following peribulbar block- Unveiling a rare ocular complication

Peribulbar anesthesia is a common regional block in intraocular surgeries with an excellent safety profile. We report a rare case of contralateral loss of accommodation and extraocular muscle palsy following peribulbar block (PBB). A patient with right-eye pterygium was planned for pterygium excision with conjunctival autograft under PBB. After PBB, the patient developed blurring of vision and loss of extraocular muscle movements in the contralateral eye. Contrast-enhanced computed tomography scan of the brain and orbit was unremarkable. The patient was stabilized, and surgery was deferred. The patient’s vision and extraocular movements returned spontaneously after 4–5 hours.

Elucidating the Epigenetic and Protein Interaction Landscapes in Amyotrophic Lateral Sclerosis: An Integrated Bioinformatics Analysis

Background: Amyotrophic Lateral Sclerosis (ALS) is a debilitating neurodegenerative disorder characterized by the progressive degeneration of motor neurons, leading to muscle weakness and paralysis. Understanding the molecular basis of ALS is crucial for the development of effective therapies. Objective: This study aims to explore the genetic and epigenetic underpinnings of ALS, focusing on the interplay between gene mutations, protein interactions, and epigenetic factors. Methods: We conducted an extensive analysis of key ALS-associated genes including TARDBP, SOD1, ANG, VAPB, and CHMP2B. We used computational tools to assess the functional consequences of identified mutations on neuronal health and explored DNA methylation patterns in gene promoters to investigate epigenetic regulation. Results: Our findings reveal that mutations in ALS-associated genes disrupt critical processes such as amyloid fibril formation and autophagy. We also identified altered DNA methylation patterns, suggesting a mechanism for changes in gene expression linked to ALS. Molecular docking studies highlighted Humulene and Buddledin C as compounds with high binding affinities to the SOD1 enzyme, suggesting their potential to mitigate hallmark features of ALS pathology such as SOD1 aggregation and oxidative stress. Conclusions: Our comprehensive analysis underscores the complexity of ALS pathogenesis, combining genetic, epigenetic, and proteomic approaches. The insights gained not only enhance our understanding of ALS but also pave the way for novel therapeutic strategies, highlighting the importance of integrated approaches in tackling this challenging neurodegenerative disease.