Relaxant Research Articles

Effects of relaxation techniques in reducing stress and anxiety among infertile women: A systematic review

Infertility affects millions of women worldwide and can lead to increased levels of stress and anxiety, impacting overall well-being and quality of life. Relaxation techniques, such as Mindfulness-Based Stress Reduction (MBSR), Yoga, Progressive Muscle Relaxation Technique (PMR), and Guided Imagery, have emerged as potential interventions to alleviate emotional distress in infertile women. A comprehensive review of the existing literature is needed to assess the effectiveness of these techniques in addressing stress and anxiety in the context of infertility.Following PRISMA guidelines, a systematic review was conducted by searching electronic databases for relevant studies published up to September 2021. The search used keywords related to relaxation techniques, infertility, stress, and anxiety. Two reviewers screened the identified articles based on predefined criteria. Included studies examined the effectiveness of relaxation techniques in reducing stress and anxiety among infertile women and used validated measures as outcomes. Data extraction and quality assessment were independently performed.The review included 18 studies that explored various relaxation techniques' effectiveness in reducing stress and anxiety among infertile women. MBSR, Yoga, PMR, and Guided Imagery interventions consistently showed significant reductions in perceived stress and anxiety levels. MBSR interventions proved particularly promising in promoting emotional well-being and coping with infertility challenges. Yoga offered a holistic approach, incorporating physical postures, breath control, and meditation to address multifaceted stress. PMR provided practical coping tools, and Guided Imagery offered guided visualization for anxiety management.This systematic review highlights the potential of relaxation techniques like MBSR, Yoga, PMR, and Guided Imagery in reducing stress and anxiety among infertile women. These interventions offer accessible and cost-effective strategies to enhance emotional well-being and coping skills in infertility contexts. Healthcare providers and counselors can consider incorporating these techniques into treatment plans to address the emotional needs of infertile women and improve their overall well-being and quality of life.

The efficacy of P0.1-guided sedation protocol in critically ill patients receiving invasive mechanical ventilation: A randomized controlled trial

Background: Mechanical ventilation is a lifesaving treatment in patients with acute respiratory failure. Despite optimal support, some patients still exhibit excessive respiratory drive, leading to patient self-inflicted lung injury (P-SILI) and diaphragmatic dysfunction. Sedation and muscle relaxants are commonly used to reduce respiratory efforts and manage patient-ventilator asynchrony (PVA). Conventionally, sedative drugs are adjusted based on the sedation level assessed by the Richmond Agitation-Sedation Scale (RASS), which may not correlate with the patient’s respiratory drive. Drop in airway pressure at the first 100 milliseconds of the beginning of the inspiration after the end-expiratory occlusion (P0.1) is a simple and reliable method of respiratory drive monitoring by mechanical ventilation at the bedside and may be the more suitable sedation target. Objectives: To assess the efficacy of a sedation protocol targeting optimal P0.1 and RASS score compared to conventional sedation strategy in patients requiring invasive mechanical ventilation in the medical intensive care units in terms of successful extubation. Methods: This is an open-labeled, single-center, randomized controlled trial conducted in medical intensive care units at a tertiary care hospital in Bangkok, Thailand. We randomly allocated mechanically ventilated patients in a 1:1 ratio to receive a sedation protocol targeting both optimal respiratory drive measured by P0.1 (intervention group) and light sedation (RASS 0 to -2) or standard of care (control group targeting RASS alone). The primary outcome is the rate of successful extubation within 14 days after randomization. Hypothesis: We hypothesize that sedation protocol targeting optimal P0.1 and light sedation will increase the rate of successful extubation at 14 days in mechanically ventilated patients compared to conventional sedation strategy. Conclusions: This study aims to evaluate the efficacy of a sedation protocol using P0.1 measurement to monitor and target optimal respiratory drive, in conjunction with sedation scores, in critically ill patients receiving invasive mechanical ventilation. Ethics and dissemination: This study protocol was approved by the Human Research Protection Unit of the Faculty of Medicine, Siriraj Hospital, Mahidol University (Certificate of Approval no. Si 915/2023). Trial registration: NCT06203405

Abstract 4140180: The Effect of Benzodiazepine Use in Patients with Atrial Fibrillation and Obstructive Sleep Apnea

Introduction: Sleep apnea is a common sleep disorder that can worsen atrial fibrillation(AF) prognosis. Benzodiazepines(BZD) are commonly prescribed for insomnia, which often accompanies sleep apnea. However, BZDs have been associated with worsening of sleep apnea due to respiratory depression, pharyngeal muscle relaxation, and increase of arousal threshold, which all may lead to prolonged hypoxia. There is little research on the effect of BZD use in AF patients with sleep apnea. Therefore, the objective of this study is to investigate the effects of BZD usage on outcomes in the AF population with sleep apnea. Methods: Data from patients with AF and sleep apnea seen at Tulane Medical Center between 2010 and 2019 was obtained from Research Action for Health Network(REACHnet), a Clinical Research Network in PCORnet®. Patients with AF and sleep apnea were divided between those with a prescription of BZD and those without BZD. These two groups were compared using the Kaplan-Meier method for time-to outcome for all-cause mortality, ischemic stroke, myocardial infarction(MI), and hospitalizations in the five years following their AF diagnosis. Cox regression analysis was used to investigate proportional hazards and control for demographics, comorbidities, and medication use. Results: There were 524 total patients included with AF and sleep apnea. Of these, 413(78.8%) were not prescribed BZDs, while 111(21.1%) were taking BZDs. Use of BZDs was associated with worse outcomes. In the no BZD and the BZD group over the 5 years following AF diagnosis, the rate of mortality was 6.1% and 12.6%(p<.001), the rate of ischemic stroke was 16% and 23.4%(p=.008), the rate of MI was 11.9% and 22.5%(p<.001), and the rate of hospitalization was 51.8% and 59.5%(p<.001), respectively. In multivariate Cox regression, use of BZD was associated with higher mortality(HR: 2.65; CI: 2.26-3.05; p=.013) and hospitalization(HR: 2.15; CI: 1.99-2.31;p<.001). Conclusion: BZD use was associated with an over 2-fold increase in all-cause mortality and hospitalizations in patients with AF and sleep apnea. This suggests that BZDs should be used with caution in this patient population, and other treatment modalities for insomnia should be considered.

Effect of Facial Acupuncture Stimulation: Magnetic Resonance Imaging-Based Masseter Muscle Volume Analysis and Questionnaire Evaluation

Abstract Background Cosmetic acupuncture may improve wrinkles, swelling, sagging, and facial asymmetry and may lift facial contours. Objectives To investigate the impact of cosmetic acupuncture on masseter muscle volume and its implications for facial aesthetics Methods We included 10 apparently healthy adult women (average age, 50.3 ± 6.45 years) and performed acupuncture once a week for 8 weeks. Magnetic resonance imaging was conducted before acupuncture stimulation and 3 days after the treatment. The collected image data were analyzed using ZioCube software (ZioSoft Co., Ltd., Tokyo). Before and after the intervention, two evaluators measured the masseter muscle volume thrice each and calculated the average value. Results The average total volume of the left and right masseter muscles decreased from 40.73 ± 8.2 cm3 to 37.81 ± 8.57 cm3 after cosmetic acupuncture, a significant reduction of 2.92 ± 2.48 cm3 (7.37%, p < 0.05). All 10 subjective evaluation items showed significant decreases, particularly in facial sagging, contour, and asymmetry, confirming aesthetic improvements and psychological satisfaction among participants. Cosmetic acupuncture reduced masseter muscle volume, leading to noticeable aesthetic benefits. Conclusions Acupuncture stimulation at acupoints around the masseter muscle can reduce the muscle volume due to muscle relaxation. The improvement in subjective evaluation and changes and decreases in masseter muscle shape enable the attainment of facial contour aesthetics, contributing to the evidence in support of cosmetic acupuncture.

Holistic approaches to living well with endometriosis

Endometriosis is a common chronic non curable neuro-inflammatory condition, which can cause endometriosis-related pelvic pain (ERPP). Sufferers may struggle with side effects and/or risks from conventional medical and surgical treatments, or not get pain relief. Increasing numbers of endometriosis patients wish to explore holistic management with fewer side effects, however it is important that medical professionals maintain an evidence-based practice for recommended treatments. We present up-to-date evidence of holistic strategies used for managing ERPP including nutrition, body and mind therapies, acupuncture, traditional Chinese medicine (TCM) and the use of adjunct devices such as phallus length reducers and transcutaneous electrical nerve stimulation (TENS). Recent findings: Nutrition: Gluten-free, low-nickel and high intake of omega-3 polyunsaturated fatty acids diets improve ERPP. Low FODMAP (fermentable oligo-, di-, monosaccharides and polyols), plant-based diet and antioxidant vitamin supplementation is helpful including those with concurrent irritable bowel syndrome. Body and Mind: Cognitive behaviour therapy (CBT) is beneficial in postoperative pain reduction, whilst mindfulness has been shown to reduce pain scores and dyschezia. Progressive muscle relaxation therapy and regular yoga sessions improve ERPP and Quality of life. Acupuncture: Acupuncture and moxibustion show improved pain scores compared to conventional therapies alone. Adjunct devices: TENS improves deep dyspareunia and reduces the number of days pain is experienced. Summary: Holistic management strategies for ERPP should be incorporated into routine counselling when discussing conservative, medical and or surgical treatments for endometriosis. The growing evidence presented for the use of holistic management strategies gives hope to those patients who cannot have, or don’t respond to conventional approaches and as an adjunct alongside standard treatments. These findings should be incorporated into the routine counselling when seeing patients in the gynaecology outpatient setting presenting with chronic pelvic pain.

Novel Pharmaceutical Cocrystal Consisting of Chlorzoxazone and Nicotinamide: A New Promising Carrier for Solubility Augmentation.

Chlorzoxazone (CHZ) is a centrally acting muscle relaxant used to treat muscle spasms. It is employed as a first-line medication for treating muscle spasms, offering both musculoskeletal relaxation and mild sedative effects. According to the biopharmaceutics classification system, it belongs to class II drug having poor solubility and high permeability. In order to improve the flow property, water solubility, and dissolution of CHZ, CHZ-nicotinamide (NA) cocrystal was prepared by liquid-assisted grinding cocrystallization (LAG CC) method using methanol as the choice of solvent. CHZ-NA cocrystal was characterized by differential scanning calorimeter (DSC), powder X-ray diffraction (PXRD), Fourier transform infrared spectrometry, and scanning electron microscopy (SEM). DSC scan showed a sharp endothermic peak shift, which is caused by the formation of a new crystal form with altered physical properties, which was further confirmed by PXRD. Also, a change in the surface morphology of LAG CC compared to CHZ was observed in SEM. The resultant CHZ-NA cocrystal displayed improved powder flow properties compared to the native form of CHZ. LAG CC demonstrated a 3.1- and 2.6-fold increase in saturated solubility and intrinsic dissolution rate, respectively, compared to CHZ alone. Furthermore, the in vitro dissolution study showed that the cumulative dissolution of CHZ in 2 h was about 53%. Whereas, dissolution of LAG CC reached 99% in 2 h, showing obvious dissolution improvement. Thus, CHZ-NA cocrystal could significantly improve the flow properties, solubility and dissolution of CHZ.

Effectiveness of Facial Massage and Exercise in Alleviating Visual Fatigue: A Systematic Review

Background: With the widespread use of electronic devices, visual fatigue has become a prevalent issue in modern society. Non-pharmacological interventions, such as facial massage and exercise, have been proposed as effective methods for alleviating visual fatigue. However, the specific effects and mechanisms behind these interventions require further exploration. Objectives: This systematic review aims to evaluate the effectiveness of facial massage and exercise in reducing visual fatigue and to explore the underlying mechanisms of these interventions. Methods: A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Scopus, and the Cochrane Library. Randomized controlled trials and crossover experiments were included for both quantitative and qualitative analyses of relevant studies. Results: The findings suggest that both facial massage and exercise can reduce visual fatigue. Facial massage alleviates eye strain by stimulating the parasympathetic nervous system, reducing stress and anxiety, relaxing muscles, and improving blood circulation. Exercise alleviates visual fatigue through two mechanisms: (1) enhancing overall blood circulation, reducing stress, improving sleep quality, and overall health; (2) directly exercising eye muscles through eye yoga, which helps relieve visual fatigue. Conclusions: Preliminary research indicates that facial massage, full-body exercise, and eye yoga hold potential as non-pharmacological interventions for visual fatigue. Eye yoga has experimental support for its ability to strengthen eye muscles and improve focus. Massage stimulates parasympathetic activity and boosts blood circulation, while full-body exercise enhances systemic circulation to relieve eye fatigue. Future research should focus on investigating the mechanisms of these interventions in more detail and comparing the effects of various types, intensities, and durations to provide more precise clinical recommendations.

Clinician contributions to central nervous system-active polypharmacy among older adults with dementia in the United States.

Exposure to central nervous system (CNS)-active polypharmacy-overlapping exposure to three or more CNS-active medications-is potentially harmful yet common among persons living with dementia (PLWD). The extent to which these medications are prescribed to community-dwelling PLWD by individual clinicians versus distributed across multiple prescribers is unclear. We identified community-dwelling Medicare beneficiaries with a dementia diagnosis and Medicare Parts A, B, and D coverage for at least one month in 2019. Using fill date and days' supply for prescriptions filled between January 1, 2019 and December 31, 2019, we identified beneficiaries exposed to CNS-active polypharmacy (i.e., >30 days of overlapping exposure to three or more antidepressant, antipsychotic, antiseizure, benzodiazepine, opioid, nonbenzodiazepine benzodiazepine receptor agonists, or skeletal muscle relaxant medications). We examined the number and type of clinicians who contributed to polypharmacy person-days among PLWD. The cohort included 955,074 PLWD who were primarily female (64.0%), were White (78.5%), and had a mean age of 83.4 years (standard deviation 8.0). Notably, 14.3% were exposed to CNS-active polypharmacy. At the person level, 24.6% of PLWD experienced polypharmacy prescribed by a single clinician. Considering total days of exposure, 45.3% of polypharmacy person-days were prescribed by a single clinician. Primary care physicians prescribed 63.0% of polypharmacy person-days and accounted for the plurality of days for all seven medication classes, followed by psychiatrists for antipsychotics and benzodiazepines and primary care advanced practice providers (APPs) for antidepressants and antiseizure medications. In this cross-sectional analysis of Medicare claims data, primary care clinicians (both physicians and APPs) prescribed the majority of medications that contributed to CNS-active polypharmacy for PLWD. Future research is needed to identify strategies to support primary care clinicians in appropriate prescribing of CNS-active medications to PLWD.

ASSESSMENT OF ORAL BEHAVIORS AND PSYCHOSOCIAL ASPECTS OF FEDERAL POLICE OFFICERS

Objective: To evaluate the oral behaviors and psychosocial aspects of adults belonging to the Federal Police class. Methods: An observational longitudinal study was conducted with 30 adult individuals from the special group of Federal Police from the city of Curitiba, Paraná. The median age of participants was 39.70 (± 7.35) years. Quality of life, anxiety and perceived stress were assessed using the SF-36, GAD-7 and PSS-14 questionnaires respectively. Awake bruxism was evaluated using the Ecological Momentary Assessment method with the WhatsApp mobile application. Messages were sent 15 times a day, seven days a week, between 9:00 am and 7:00 pm, at random times, to choose one of five oral behaviors: teeth contact, teeth clenching, teeth grinding, mandibular bracing, and relaxed jaw muscles. Cronbach's alpha test, Shapiro-Wilk’s test, Wilcoxon's non-parametric test for paired samples, Friedman's non-parametric test for paired samples, Spearman's non-parametric correlation test, and Kruskal-Wallis non-parametric test, followed by Dunn's 2–2 comparison test were employed. Results: The most frequent oral behaviors during the week were relaxed jaw muscles (49.75 ± 29.28), teeth contact (31.50 ± 24.71), mandibular bracing (10.42± 18.99), teeth clenching (6.82 ± 8.96), and teeth grinding (1.48 ± 3.04). Quality of life was considered excellent, anxiety was low, and there was no stress. There was no correlation between stress, anxiety and quality of life and awake bruxism. Conclusion: The federal police officers evaluated showed a high frequency of awake bruxism, but the psychosocial aspects were considered excellent.

Paradoxical Agitation and Masseter Spasm During Propofol Procedural Sedation: A Case Report

Introduction: Propofol is an anesthetic agent commonly used in emergency department (ED) procedural sedation. It is often preferred in orthopedic procedures because of its muscle-relaxing properties. Rarely, however, it can induce agitation and muscle hypertonicity. Case Report: A 58-year-old man presented to the ED with a left ankle fracture-dislocation. Propofol was used to facilitate procedural sedation, but the patient became mildly agitated. Ketamine was used to achieve full induction, after which propofol was used again to facilitate muscle relaxation. Near the end of the procedure, the patient had opisthotonos and masseter spasm requiring bag-valve-mask ventilation and subsequent intubation. This reaction was ultimately attributed to adverse effects of the propofol. Conclusion: While propofol is generally well tolerated, it can potentially cause agitation, hypertonicity, and other side effects such as muscle spasms and seizure-like activity. Acknowledging and preparing for these risks can potentially improve patient outcomes.

The Importance of Including Psychophysiological Methods in Psychotherapy.

This paper describes characteristics of sophisticated use of psychophysiological therapy procedures and describes a scoping review of evidence that adding psychophysiological procedures to psychotherapy improves outcome. It also reviews literature describing comparisons between psychophysiological procedures and various CBT and other verbal psychotherapy procedures when used as monotherapies. Some details of progressive muscle relaxation, autogenic training, and biofeedback are described that often are omitted in standard clinical training, including the method of diminishing tensions and differential relaxation training in progressive muscle relaxation, use of autogenic discharges and hypnotic instructions in autogenic training, and resonance frequency training in heart rate variability biofeedback and slow breathing. Although these details are often also missing in outcome studies, tentative conclusions can still be drawn from the empirical literature. As a monotherapy, psychophysiological methods are generally as powerful as verbal psychotherapies, although combining them with psychotherapy yields a larger effect than either approach alone. Psychophysiological methods have their strongest effects on anxiety and depression, with weaker effects for panic and PTSD, particularly when compared with exposure therapy, although the latter comparisons were restricted to relaxation training as a psychophysiological approach. Effects of psychophysiological interventions are weaker among elementary school children than among adults and adolescents. The results suggest that psychophysiological methods should be used along with other psychotherapeutic interventions for greatest effect.

Use of Laughter Therapy for In Vitro Fertilization: A Systematic Review

Background/Objectives: In vitro fertilization (IVF) is an assisted reproductive technique for women and couples experiencing difficulties in achieving a spontaneous pregnancy, often due to stressors that negatively affect fertility. Humor can be beneficial in these stressful situations, helping to reduce symptoms of anxiety and depression. The primary aim was to analyze the effectiveness of laughter therapy in increasing pregnancy rates in women undergoing IVF. The secondary aims were to identify different types of laughter therapy interventions and evaluate their benefits. Methods: A systematic review was conducted using Medline, Web of Science, Scopus, Cinahl, ProQuest and Lilacs, with the search terms “laughter”, “laughter therapy”, “fertilization in vitro” and “fertilization”. Intervention studies published in English, Spanish, or Portuguese were included, with no limits on the date of publication. Studies with other designs, those conducted with animals and grey literature were excluded. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Results: In total, n = 3 studies (1 randomized clinical trial and 2 quasi-experimental) were included, evaluating pregnancy rates and symptoms of depression and anxiety. The interventions included clowns performing magic tricks and interpreting comic situations. Additionally, they incorporated hand clapping, breathing exercises, childlike playfulness, drinking milk, muscle relaxation exercises, candles, and music. Conclusions: This review does not provide clear evidence on the effectiveness of laughter therapy in increasing pregnancy success in IVF. Although it may have some positive effects in reducing symptoms of depression and anxiety, it is important to note that while the reduction of these symptoms may enhance the emotional well-being of patients, it has not been demonstrated to directly lead to an increase in pregnancy rates. Laughter therapy is an innovative, non-pharmacological intervention that is simple, non-invasive, easy to implement and cost-effective; however, the number of available studies is insufficient. More research is needed to provide better and higher-quality evidence using rigorous designs to evaluate this intervention in IVF clinical practice.

Exploring Antidepressant and Skeletal Muscle Relaxant Effects of the Hydroalcholic Extract of the Sedum lineare Thunb

Exploring Antidepressant and Skeletal Muscle Relaxant Effects of the Hydroalcholic Extract of the Sedum lineare Thunb

A holistic intervention for alleviating anxiety, depression, and fatigue in cervical cancer

ObjectiveEvaluate how well an intervention program reduces anxiety, depression, and fatigue. MethodsThe study was carried out at the Postgraduate Institute of Medical Education in a hospital in Lebanon. A randomized controlled trial (RCT) was conducted with 30 patients undergoing radiotherapy or chemotherapy. Participants were randomized into two groups of 15 each using an approach for comprehensive enumeration sampling. The Zung Anxiety Scale, Beck Depression Inventory, and Fatigue Scale were among the research instruments. The study approach involved counseling, home care, and the Progressive Muscle Relaxation technique. ResultsBoth groups had comparable sociodemographic and clinical profiles. The study comprised 30 participants, averaging 32 years in the experimental group and 28 years in the control group. Most of the participants were married (74 % experimental, 60 % control), with a significant proportion identified as housewives (87 % control, 60 % experimental). In addition, many had limited education, with 74 % of the experimental group and 67 % of the control group below the primary level. The intervention group, which received counseling, home care and Progressive Muscle Relaxation, experienced significantly greater reductions in anxiety, depression, and fatigue, with p-values below 0.001 for all variables. Statistical analyzes, including paired and independent t-tests, confirmed these findings. ConclusionsThe therapeutic program significantly reduced anxiety, depression, and fatigue in patients undergoing cancer treatment, with p-values less than 0.001. These findings highlight the importance of tailored support, suggesting that integrating such interventions into standard care can improve patients’ mental and emotional well-being

Neuromuscular blockade monitoring in pediatric patients.

The administration of neuromuscular blocking agents (NMBAs), the cornerstone of pediatric anesthesia, facilitates intubation and muscle relaxation during surgery. However, NMBAs can also lead to serious complications including respiratory depression, residual paralysis, and prolonged recovery. Neuromuscular monitoring (NMM) in pediatric patients is therefore essential, as it is in adults, to ensure adequate paralysis during surgery and prompt recovery from NMBA-induced paralysis. This article aimed to provide a comprehensive overview of NMM in pediatric anesthesia including the various available methods, their advantages and disadvantages, and the importance of a standardized NMM approach.

Malignant Hyperthermia: A Life-Threatening Condition in Patients Undergoing Surgical Intervention

Malignant hyperthermia (MH) is a rare, potentially fatal genetic disorder characterized by an unexplained elevation of expired carbon dioxide despite increased minute ventilation, muscle rigidity, and rhabdomyolysis, hyperthermia, tachycardia, acidosis, and hyperkalemia. It can be triggered by many pharmacological agents such as potent inhalation agents (halothane/ isoflurane/ sevoflurane/ desflurane), the depolarizing muscle relaxant (succinylcholine), and extreme physiological conditions such as vigorous exercise and working excessively in a hot and dry environment. Prompt and early recognition of the condition and rapid initiation of treatment measures are necessary to salvage the patient. Since MH is commonly encountered in the operating room or early postoperative period, anesthetists and surgeons need to keep themselves updated regarding the same. This review article aims to summarize our understanding of MH's pathophysiology, current diagnostics, management, and treatment strategies, along with a brief review of literature of published cases in Indian Subcontinent.

Clinical audit on management of Post Operative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) are common complications following surgery, affecting up to 30% of patients despite advances in anaesthesia and surgical techniques. It can be distressing for patients and may lead to complications such as dehydration, electrolyte imbalances, wound dehiscence, and delayed recovery. Several factors contribute to PONV, including patient-related factors (such as age, gender, history of motion sickness, and smoking), anaesthesia-related factors (type and duration of anaesthesia, use of volatile anaesthetics, opioids, and muscle relaxants), and surgical factors (type and duration of surgery, intraoperative hypotension, and use of certain drugs like opioids and nitrous oxide). It can be determined by APFEL score which says that female sex, non-smokers, history of motion sickness and post operative use of opioids have high chances of PONV. Although PONV is a very detrimental disorder, it can last for several hours to days. Not only it depends on the anaesthetic factors it is also affected by surgical stress. PONV is said to the most important factor resulting to delayed recovery and prolonged hospital stay.

Erector Spinae Plane Block for Chronic Lumbosacral Pain: A Case Report

Chronic low back pain is a prevalent and debilitating condition that often resists traditional management strategies such as physical therapy, pharmacotherapy, and interventional procedures. The erector spinae plane (ESP) block, a relatively new regional anesthesia technique, has shown promise in managing various types of pain, including chronic conditions. This case report details the use of the ESP block in a male patient in his late 60’s with chronic low back pain unresponsive to conventional treatments, including acetaminophen, muscle relaxants, gabapentin, epidural steroid injections, diagnostic medial branch blocks, and sacroiliac joint injections. Given the refractory nature of his pain, a right-sided lumbar ESP block was performed under fluoroscopic guidance. This case highlights the potential of the ESP block as an effective treatment for chronic lumbar pain, particularly in patients who have not responded to other interventional modalities. The safety profile of the ESP block, coupled with its efficacy in this case, supports its consideration as a viable option in chronic pain management. Further studies and clinical experience will be essential in defining its role and establishing standardized protocols for its use in chronic pain settings.

Troponin I and Its Clinical Significance

Troponin I is one of the regulatory proteins of the troponin complex (troponin I, troponin C and troponin T) found in both cardiac and skeletal muscle. The letter I stands for its inhibitory character as binding is prevented between actin and myosin in relaxed muscle. It plays a significant role in holding actin-tropomyosin complex in place by binding actin in thin myofilaments. Binding of calcium to troponin C causes certain conformational changes, leading to troponin I dislocation and thus exposing binding site of myosin on actin, which leads to muscle contraction. It is frequently used in the diagnosis of acute coronary syndrome and myocardial infarction, and also serves as a prognostic marker in their management (1). There are three distinct forms of troponin I with tissue-specific expression patterns: 1. Slow-twitch skeletal muscle isoform troponin I, 2. Fast-twitch skeletal muscle isoform troponin I and 3. Cardiac troponin I.

Inter-rater and Intra-rater Reliability of Het’s MMT in Pelvic Floor Assessment

Abstract Objective: Pelvic floor dysfunctions (pfds) such as urinary incontinence, pelvic organ prolapse, and vaginismus are very common and are affecting the quality of life of the female suffering through it. The pelvic floor muscles can be in spasm, thus resulting in the inability to relax or the pelvic floor muscles can be extremely weak or loose, resulting in the inability to contract strongly and completely. The spasmodic pelvic floor can result in vaginismus, dyspareunia, chronic pelvic pain, constipation, etc., Moreover, a weak pelvic floor can lead to issues such as urinary incontinence, pelvic organ prolapse, and sexual dysfunction. There is a scarcity of a valid and reliable scale that assesses both the components of pfd. Subjects and Methods: The present study was conducted on 1349 participants which were divided into three groups on the basis of their symptoms. Group A – No symptoms (n = 439), Group B – Hypotonus pfd (n = 658), and Group C – Hypertonus pfd (n = 252). Examination: Vaginal examination to assess the pelvic floor muscles relaxation and contraction was done by Het’s Manual Muscle Testing (MMT). Inter rater reliability was assessed by comparing the data of two independent examiners on the same day. The intra rater reliability was assessed by comparing the data of test and retest at an interval of 1 week. Results: The intra rater reliability at 95% confidence interval (CI) was 0.92 – Normal pelvic floor function, 0.96 – Hypotonus pfd, and 0.97 – Hypertonus pfd. Moreover, inter rater reliability at 95% CI was 0.93 – normal pelvic floor function, 0.95 for hypotonus pfd, and 0.98 – hypertonus pfd. Conclusions: This study concludes Het’s MMT is a highly reliable manual muscle testing tool to assess the pelvic floor muscles.