Patients Complain Research Articles

Herbal Drug Use to Treat Urolithiasis: An Updated Review

World Health Organization (WHO) estimates that 12% of the world's population suffers from urolithiasis, a disorder that causes stones to develop in the kidney, bladder, and/or urethra (the urinary system). The illness increases the likelihood of developing chronic renal illnesses in addition to impairing kidney function. Three phases make up the mechanism for the production of stones: nucleation, growth, and aggregation of crystals. Because of their medicinal and antioxidant properties, as well as their active substances, medicinal plants have positive benefits on human health. The traditional medicinal herbs' diuretic qualities are increasingly being backed by scientific research. Urinary calculi patients complain of hematuria, discomfort, or infection. Individuals with tiny, non-obstructing stones or staghorn calculi have moderate, easily managed symptoms in addition to other symptoms. The illness increases the likelihood of developing chronic renal illnesses in addition to impairing kidney function. Therefore, a plant's or a herbal formulation's antiurolithiatic effect may be the result of a combination of its antioxidant, diuretic, and crystallization-inhibiting properties. Keywords: Urolithiasis, diuresis, herbal drug, calcium oxalate stone

010. Ileus Obstruktif Letak Tinggi E.C Susp Hirschprung pada Pasien Umur 22 Tahun di RSUP Prof. Dr IGNG Ngoerah pada Tahun 2023

Background: Hirschsprung is a disease that occurs in the intestine, and cases most often appear in the colon (colon). Symptoms that usually arise are chronic constipation, failure to grow, and malnutrition. The surgical procedure approach that can be performed in this case is by carrying out an exploration laparatomy and placed a colostomy on the patient. Case: A 22-year-old male patient presents to the emergency department with abdominal pain, His pain began suddenly then dissappear gradually, accompanied by flatulence and nausea since a week ago. Other complaints such as fever and vomiting are denied. Patients with a history of defecation patterns every 2-3 days. Patients complain of difficulty defecating since last week before admitted, the stool form was a small amount of liquid, frequency is 2-3x/day. Stool with blood (-), black or tarry stool (-). Patients with a history of circumcision surgery. The results of the examination showed an increase in WBC 15.11. Based on the BOF results, the results described as a leading to paralytic ileus, Fecal material prominent as high as the pelvic cavum. In addition, based on the results of abdominal ultrasound, it is said that most of the scanning areas are covered by prominent intestinal gas, mild fatty liver. After the exploratory laparatomy, no signs of malignancy were found in the patient, but there was suspicion towards Hirschsprung where the patient did not have the flexura hepatica ligament and the lienalis flexura ligament. Conclusion: Hirschsprung requires surgical procedures that must be explained throughly to patient and families. The surgical procedure approach that can be performed in this case is by carrying out an exploratory laparatomy and the placed a colostomy on the patient. And colon in loop will be used to determine and evaluate the intestine height with aganglionic.

On intimate care in men: A review

Even though intimate hygiene plays an essential role in the prevention of various genital diseases, there are currently few studies on this topic. There is a wide range of diseases that affect the male genital organs. There is a wide range of diseases that affect the male genital organs. Inflammation of the glans penis (balanitis) occurs in 3–11% of males during their lifetime; one of its leading causes is poor hygiene. However, many non-venereal dermatoses occur in this anatomical region. Most often, patients complain of itching, as well as pain, burning, and various rashes. The most common reason for seeking medical attention is irritant contact dermatitis. Various allergens cause more acute reactions in the anogenital region due to the structural features of the skin of the genitals. Components of detergents and hygiene products, accessories for sexual practices, medications, and contraceptives can become provoking factors of genital allergic dermatitis. Among the dermatoses affecting the male genitalia, lichen planus should be noted, which occurs in males twice as often as in females, and the oral mucosa is often involved in the inflammatory process. Lichen sclerosus can also occur on the skin of the penis, leading to phimosis, a decrease in quality of sexual life, and often requiring circumcision. Psoriasis also can affect the anogenital area. Rashes may be isolated, but other anatomical areas are also involved in most cases. Psoriatic lesions of the genitals are visually different from typical elements in other areas of the skin. Minimizing discomfort due to these diseases is possible by using specialized care products. The skin of the genitals in men has specific features that are important to consider when developing the composition of the products.

New-onset diabetes mellitus type 2 treated with metformin - is it possible to slow the development of pancreatic cancer?- case report

In this article, we present the case of an 87-year-old patient whose initial symptom of developing pancreatic cancer was newly diagnosed type 2 diabetes mellitus. She was treated with metformin, which, on the one hand, could slow the development of pancreatic cancer and, on the other hand, delayed a key cancer diagnosis. However, before the definitive diagnosis, the patient's symptoms were considered merely as side effects of metformin treatment, delaying the proper diagnosis. We consider that early diagnosis of pancreatic cancer remains a significant challenge. Often, the first symptom is newly diagnosed diabetes mellitus type 2. In this article, we aim to demonstrate the importance of being vigilant when diagnosing and treating diabetes mellitus with metformin. We also present the impact of metformin on the course of pancreatic cancer. Additionally, we emphasize the need to be attentive when patients complain of side effects of this medication, as they may often mask the development of pancreatic cancer.

Management of Knee Osteoarthritis with integrative approach using Regimenal therapy (Massage and Medicated Steam Fomentation) and Pharmacotherapy (Habb-e -Muqil): A Case Study

Osteoarthritis (OA) is the most common progressive musculoskeletal disorder, that is characterized by pathological changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of day to day life activities. It affects an estimated more than 240 million people worldwide. It can involve almost any joint but typically affects the hands, knees, hips, and feet. In India, 28.7% of adults ≥ 40 years of age and 45.5% of adults ≥ 60 years of age have KOA. The annual incidence rate of KOA in India is 2.4%. The management of KOA involves a comprehensive approach, including non pharmacological management, pharmacological management, and surgical management. In Unani medicine, KOA comes within the domain of a broader term, “Waja-ul-Mafasil”, which refers to joint pain. It occurs due to quantitative and qualitative derangement of Akhlat (humors) and derangement of optimal temperament (Mizaj). We present the case of a 48 year old male patient, who was presented to the OPD of Regimenal therapies at National Institute of Unani Medicine, Bengaluru. Patient complains of bilateral knee pain, stiffness, limited mobility and difficulty in daily activities since 3 years. Pain exaggerates on walking for more than 50 minutes and standing continuously for more than 30 minutes. The patient was assessed and examined clinically prior to intervention and was diagnosed with bilateral KOA, which was further accentuated by radiological investigations. The patient received treatment for 6 weeks. The patient was assessed using multiple assessment parameters at baseline, 3rd and 6th week. The patient reported improvement in both subjective and objective parameters. The study found that massage therapy and steam fomentation along with pharmacotherapy can be an effective approach in treatment for KOA, however it merits further research. Keywords: Osteoarthritis, joint pain, bilateral knee pain, stiffness, limited mobility

Alterations in Emotional Expression Through Speech in Patients With Unilateral Vocal Fold Paralysis: A Preliminary Study

Unilateral Vocal Fold Paralysis (UVFP) have a known impact on patients’ quality of life. One of the potentially affected domains that has not been studied yet is the emotional prosody. To produce and transmit an efficient emotional prosody, several vocal parameters are modulated by the speaker, principally the fundamental frequency, the speech rate, and the voice intensity. We retrieved 300 sentences produced by 10 patients suffering from UVFP, equally in neutral, anger, and sadness. A jury of 6 healthcare voice experts were asked to hear these sentences and choose an emotion for each vocalization, between neutral, anger, and sadness. The jury mainly considered the heard sentences as being in a neutral emotion. Vocal parameters analysis of the anger and sadness sentences that were mistook as neutral showed the absence of significant difference in their fundamental frequencies and speech rates. By being unable to modulate their vocal parameters as needed to produce emotional prosody, specifically the fundamental frequency and speech rate, patients with UVFP suffer from limitations in their capacity to produce the emotional prosody wanted, making the emotions they feel hardly transmitted to their entourage, which can explain the social barriers these patients complain of.

Nursing Care for Mr. S, Diagnosed with Pulmonary Tuberculosis (TB) in the Emergency Department (ED) of Gunung Jati Hospital in Cirebon City

Tuberculosis or TB is a disease caused by infection of the Mycobacterium tuberculosis bacteria in the lungs. This condition is sometimes referred to as pulmonary TB. Tuberculosis bacteria that invade the lungs cause respiratory problems, such as chronic cough and shortness of breath. TB patients usually also experience other symptoms, such as night sweats and fever. This study aims to provide an overview of the implementation of Nursing Care in patients with a medical diagnosis of Pulmonary Tuberculosis (TB) in the emergency room of Gunung Jati Hospital, Cirebon City. The method used is a case study approach. The subject in this case study was one patient diagnosed with Pulmonary Tuberculosis (TB) in the emergency room. The results showed nursing care management in patients diagnosed with Pulmonary Tuberculosis (TB). The nursing problem is Ineffective Airway Cleansing, which is carried out by interventions, namely effective cough techniques; interventions are carried out when the patient has difficulty removing sputum, the results obtained at the time of assessment, the patient complains of shortness of breath, coughing and difficulty removing sputum. Before performing effective cough techniques, respiration was 28x/minute, and after performing effective cough techniques, respiration decreased to 25x/minute. This study implies non-pharmacological techniques, such as effective coughing techniques, can be essential in managing patients with pulmonary tuberculosis alongside pharmacological therapy. This study provides a valuable contribution to improving the understanding and practice of nursing care in Tuberculosis cases in the hospital environment, especially in the emergency room of Gunung Jati Hospital, Cirebon City.

The Essential Guide to Managing morphological oddity of Two-rooted Mandibular Premolar: A case report with review of 10 years incidence

Introduction- The root canal morphology of teeth is often extremely complex and highly variable. One such morphological oddity is the presence of two roots, with a reported incidence of 1.8%. Case- A 16-year-old female patient complains of pain in the posterior left mandibular tooth for the past 2 weeks. After clinical, radiographic examination, and vitality testing, we diagnosed the patient with Acute apical periodontitis of tooth #34. It was decided to treat the left mandibular first premolar with two roots endodontically. The patient was reviewed after 1 month, 3 months, 6 months , 1 year and radiographs showed satisfactory healing. Conclusion- This case report details the endodontic management of a sparse case of mandibular first premolar with two roots and two canals, which ended with a favorable outcome due to the satisfactory execution of the preferred constituents.

Effect of TAMSULOSIN on Sexual Dysfunction in Patients Complaining of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia

Abstract Background Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and Erectile Dysfunction are common disorders of advancing age. Aim and Objectives The aim of the study was to assess the effect of Tamsulosin on sexual function in patients complaining of LUTS suggestive of BPH. Subjects and Methods We evaluated the sexual function, erectile & ejaculatory, of patients enrolled in the study using validated questionnaires. This evaluation was done before treatment with Tamsulosin and 3 months later, comparing the Pre & Post-Treatment scores. Results There was a statistically significant deterioration of orgasmic function domain of IIEF between Pre & Post-Treatment. However, no significant changes were noticed with the other IIEF domains. Also according to the MSHQ-EjD-SF, there was a significant deterioration in the ejaculation domain and ejaculation bother domain. Conclusion Tamsulosin was found to be with higher risk for decreasing the orgasmic frequencies and the ejaculation for patients suffering from BPH.

Efficacy of Barbed Reposition Pharyngoplasty and Uvulopalatopharyngoplasty for Retro Palatal Obstruction

Abstract Background Obstructive sleep apnoea (OSA) is a common problem affecting almost 4% of the population. Although continuous positive airway pressure (CPAP) is considered the standard of care, the patient compliance for long term use is poor. Clinicians have explored surgical options for cure with varying success. Objective To analyze the efficacy of a new modified pharyngoplasty technique (BRP) in comparison with other UPPP techniques to displace the soft palate anteriorly and lateralize the lateral pharyngeal wall in the treatment of OSA. Patients and Methods Types of studies: Systematic review/Meta-analysis. Types of participants: Patients Complain of OSA caused by mild to moderate retropalatal obstruction. Study outcome: efficacy of barbed suture and UPPP operations for retropalatal obstruction, study of success rate. Study of failure rate. Study of complications. Results Regarding Change in ODI Associated with Barbed Sutures, it was found that only 2 studies assessed ODI, and this analysis showed that Weighted mean difference = -23.32 (95% CI = -35.08 to -11.56). There is substantial heterogeneity across studies (Cochran Q test P-value = 0.099, I-squared = 63.33%). In the UPPP procedure, only two studies assessed the ODI, this analysis showed that the weighted mean difference = -14.27 (95% CI = -20.62 to -7.92). There is substantial heterogeneity across studies. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Conclusion Both Barbed reposition pharyngoplasty and Uvulopalatopharyngoplasty techniques were effective in the treatment of cases with obstructive sleep apnoea (OSA). Barbed reposition pharyngoplasty (BRP) can be considered as the gold standard procedure. BRP seem to be more effective than UPPP in a single-level surgical setting. However, being quick, easy to learn and less invasive, BRP is a safe, effective and promising option for treatment of patients with OSA.

Clinical Manifestations of Runny nose among Patients Attending Baqubah Teaching Hospital

Background: The runny nose refers to a discharge (fluid) coming from the nasal passages.Runny nose is associated with inflammation and swelling (congestion) of the inner lining of the nasal passages and sinuses. May associated with atopic condition the patient complain from nasal obstruction, runny nose, episode of sneezing, and nasal pruritis. Objective: To examine the demographic distribution, clinical features, and age disparities among male and female patients with Runny nose (Rhinorrhea). Patients and Methods: A study was done on 100 AR patients at Baqubah Teaching Hospital. Information on demographics, clinical symptoms, and age variations between males and females were gathered and examined through the use of descriptive statistics and independent sample t-tests. Results: The Findings revealed that most of the subjects were women (56%) and homemakers (38%), with an average age of 29.73 years. Frequent symptoms comprised of sneezing (93%), runny nose (83%), itchy nose (74%), and stuffy nose (92%). There was no notable variation in age between males and females (p = 0.139). Conclusion: Clinical symptoms of runny nose are often recognized consist of rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation and pruritus of the nasal mucosa, conjunctiva and oropharynx with history of allergic rhinitis. Conditions commonly associated with allergic rhinitis include asthma, sinusitis, allergic conjunctivitis and atopic dermatitis. Long standing disease can lead to mucosa remodeling, atrophic skin changes, nasal infection and overall increased morbidity.

Clinical Manifestations of Runny nose among Patients Attending Baqubah Teaching Hospital

Background: The runny nose refers to a discharge (fluid) coming from the nasal passages.Runny nose is associated with inflammation and swelling (congestion) of the inner lining of the nasal passages and sinuses. May associated with atopic condition the patient complain from nasal obstruction, runny nose, episode of sneezing, and nasal pruritis. Objective: To examine the demographic distribution, clinical features, and age disparities among male and female patients with Runny nose (Rhinorrhea). Patients and Methods: A study was done on 100 AR patients at Baqubah Teaching Hospital. Information on demographics, clinical symptoms, and age variations between males and females were gathered and examined through the use of descriptive statistics and independent sample t-tests. Results: The Findings revealed that most of the subjects were women (56%) and homemakers (38%), with an average age of 29.73 years. Frequent symptoms comprised of sneezing (93%), runny nose (83%), itchy nose (74%), and stuffy nose (92%). There was no notable variation in age between males and females (p = 0.139). Conclusion: Clinical symptoms of runny nose are often recognized consist of rhinorrhea, sneezing, obstruction of the nasal passages with lacrimation and pruritus of the nasal mucosa, conjunctiva and oropharynx with history of allergic rhinitis. Conditions commonly associated with allergic rhinitis include asthma, sinusitis, allergic conjunctivitis and atopic dermatitis. Long standing disease can lead to mucosa remodeling, atrophic skin changes, nasal infection and overall increased morbidity. Keywords: Runny nose, nasal obstractions , nasal pruritis, stuffy nose

Management of Severe Odontogenic Infection: Case Report

Introduction: Submandibular abscess caused by odontogenic infection is a frequent case, but in some cases it can be deadly because it spreads and blocks the respiratory tract. The purpose of this study is to described a case of fatal submandibular abscess with early management effective. Case report: A 46 years old male patient with complaints of left submandibular, submental, left buccal and left temporal swelling. History of systemic disease was denied. Patients complain of tightness and changes in voice. Therapeutic intervention consists of Covid- 19 screening, complete blood lab, abscess decompression under local anesthesia, left submandibular and submental through and through drainage incisions, drainage incisions in the buccal area as well as multiple tooth extractions and penrose drain applications both extra oral and intra oral carried out in general narcotics, and swab culture sensitivity and antibacterial resistance tests were carried out. The antibiotics given were ceftriaxone and metronidazole. The patient was followed up and showed good general condition and decreased swelling. Conclusion: Odontogenic infections that spread and block the respiratory tract can be deadly. The abscess can expand even more quickly during preparation for surgery. Decompression of an abscess can be an effective treatment so that the abscess does not spread further and can reduce the risks of the operation being carried out. The management carried out must be complete and comprehensive, in this case a drainage incision and extraction of the focal infection are carried out. Initially, broad spectrum antibiotics can be given, but if the results of the antibacterial resistance test are obtained, it is very important to give more specific antibiotics. Submandibular abscess with poor prognostic consequences obstructed respiratory tract must be treated immediately and closely monitored. Keywords: Abscess, Odontogenic infection, Decompression

Instrumental Evaluation of the Effects of Vertebral Consolidation Surgery on Trunk Muscle Activations and Co-Activations in Patients with Multiple Myeloma: Preliminary Results.

Multiple myeloma (MM) patients complain of pain and stiffness limiting motility. To determine if patients can benefit from vertebroplasty, we assessed muscle activation and co-activation before and after surgery. Five patients with MM and five healthy controls performed sitting-to-standing and lifting tasks. Patients performed the task before and one month after surgery. Surface electromyography (sEMG) was recorded bilaterally over the erector spinae longissimus and rectus abdominis superior muscles to evaluate the trunk muscle activation and co-activation and their mean, maximum, and full width at half maximum were evaluated. Statistical analyses were performed to compare MM patients before and after the surgery, MM and healthy controls and to investigate any correlations between the muscle's parameters and the severity of pain in patients. The results reveal increased activations and co-activations after vertebroplasty as well as in comparison with healthy controls suggesting how MM patients try to control the trunk before and after vertebroplasty surgery. The findings confirm the beneficial effects of vertebral consolidation on the pain experienced by the patient, despite an overall increase in trunk muscle activation and co-activation. Therefore, it is important to provide patients with rehabilitation treatment early after surgery to facilitate the CNS to correctly stabilize the spine without overloading it with excessive co-activations.

A Case Study of Korean Medicine Treatment in a Patient Complaining of Generalized Dystonia

We report a case of generalized dystonia that developed from oromandibular dystonia and improved following Korean medicine treatment. The patient was hospitalized for 18 days and treated with herbal medicine, mainly Hyeongbangsabaek-san and Soyangbowi-tang, acupuncture, electroacupuncture, pharmacopuncture, cupping, and moxibustion. To evaluate the clinical effects of the treatment, we used the Unified Dystonia Rating Scale (UDRS) and Global Dystonia Severity Rating Scale (GDS) and checked dyskinesia occurrence in a diary recorded by the patient’s guardian. After 18 days of hospitalization, the UDRS for the trunk, upper extremities, and lower face improved by more than 50%, and the GDS for the whole region, except the larynx and lower face, also improved. In addition, the maximum duration of dystonia decreased from 6 hours to 3 hours, and the pain and numbness associated with dystonia disappeared. This case suggests that Korean medicine treatment is effective in treating generalized dystonia.

Bone defect reconstruction after radicular cyst enucleation with bovine bone graft and protein rich plasma: A case report

Background: Radicular cyst enucleation and reconstruction with bone graft is a surgical procedure used to remove a cyst that has formed around a tooth root. The procedure involves making an incision in the gum tissue to expose the cyst, removing the cyst and any affected bone, and then filling the resulting defect with a bone graft. The bone graft is typically taken from the patient's own body, such as from the chin or the iliac crest, and is used to promote new bone growth and help stabilize the surrounding teeth. After the procedure, the gum tissue is sutured back into place, and the patient may be prescribed pain medication and antibiotics to help manage any discomfort or infection. The success of the procedure depends on the size and location of the cyst, as well as the patient's overall oral health. Purpose: To aim management of cyst enucleation and reconstruction bone defect with bovine bone graft and protein rich plasma (PRP). Case(s): A female 19 years old with the chief complaint of the patient have caries io the lower left jaw tooth. The patient complains of frequent oedemmon left cheek site. On panoramic radiologic examination, a radiolucent lesion with a radiopaque border was found in the apical region of tooth 36. Case Management: The patient underwent enucleation of cyst and bone defect reconstruction with general anaesthesia. After 14 days, the sutures were removed and the wound were healed. Conclusion: This case of radicular cyst can be used for guideline with enucleation of radicular cyst and bone defect reconstrtion

VISION TRAINING TO IMPROVE CLASSROOM ENDURANCE POST-TBI: A CASE STUDY WITH A 26-YEAR-OLD FEMALE

Background: Concussions, also referred to as a mild traumatic brain injury (mTBI), can present a multitude of symptoms due to the complex pathophysiology incurred by the brain. It is known that these mTBI-induced symptoms, when left unresolved, can lead to post-concussive syndrome (PCS). Commonly, these patients complain of vision-related dysfunctions. These dysfunctions interrupt patients’ everyday lives, including students when participating in the classroom due to the heavy visual involvement. Numerous vision therapies and management strategies have been successful for the treatment of mTBI-induced visual-related symptoms such as exotropia, suppression, and oculomotor dysfunction. Vision training has been found to be successful in improving oculomotor endurance, giving patients the ability to maintain focus for long periods of time and to mitigate against suppression. Background: Concussions, also referred to as a mild traumatic brain injury (mTBI), can present a multitude of symptoms due to the complex pathophysiology incurred by the brain. It is known that these mTBI-induced symptoms, when left unresolved, can lead to post-concussive syndrome (PCS). Commonly, these patients complain of vision-related dysfunctions. These dysfunctions interrupt patients’ everyday lives, including those of students, when participating in the classroom due to the heavy visual involvement. Numerous vision therapies and management strategies have been successful for the treatment of mTBI-induced visual-related symptoms such as exotropia, suppression, and oculomotor dysfunction. Vision training successfully improves oculomotor endurance, allowing patients to maintain focus for long periods andmitigate against suppression. Case Report: This report describes a 26-year-old female presenting with activity-induced sensory overload, specifically in the setting of her college classroom lectures. The patient described symptoms appearing as headache, fatigue, and blurred vision. Upon initial examination, she was determined to have a left eye exophoria with fatigue-induced left eye suppression and left eye lateral abduction deficiencies. A personalized action plan was designed to improve left-right oculomotor symmetry and endurance and mitigate against suppression through a weekly structured vision training program. In this 7-week program, individual and dual eye saccadic exercises improved, with both eye horizontal saccades improving from 26 characters read aloud per minute to 36 characters read out loud per minute. With these regular vision training sessions, the patient displayed improved oculomotor endurance, decreased suppression with prolonged activity, and better dual-eye coordination. After the post-vision training program, the patient could attend her college lectures without invoking symptoms.

An almost forgotten neurological entity: man in a barrel syndrome

Man in a barrel syndrome (MIBS) presents with bilateral upper extremity weakness but preserved strength in face, neck, and lower extremities. In this case report, two cases of MIBS were admitted to the emergency department (ED) presented. The first patient injured his neck after falling off a ladder. The second patient was a victim of a traffic accident. Bilateral upper extremity weakness was examined in the first patient at first admission to the ED. On the other hand, progressive weakness was shown in the second patient during ED follow-up. The cervical imaging findings consisted with MIBS. This case report and review of literature highlights that physicians should consider every possible cause, even the rarest ones when a patient complains of neck trauma with non-specific symptoms. Rapid identification and treatment of treatable causes such as cerebral hypoperfusion are vital for patient prognosis.

The Effect Of Quadricepts Strengthening Exercise On Increasing Muscle Strength And Decreasing Pain Intensity In Genu Osteoarthritis Patients At Bhayangkara Kediri Hospital

Osteoarthritis is a joint deformity, often found in progressive degeneration of the articular cartilage, resulting in loss of joint space. Genu osteoarthritis patients complain of pain, limited movement, and a decrease in their functional activities. Patients with severe complaints use mobility aids for walking activities. This research uses a quasiexperimental design with one group pre and post test design approach. The sample for this research was 30 respondents. The sampling technique for this research is purposive sampling, which is a sample selection technique by selecting samples among a number of populations that are in accordance with what the researcher desires. There is an effect of quadriceps strengthening exercise on increasing muscle strength and reducing pain intensity in osteoarthritis genu patients at Bhayangkara Kediri Hospital in 2023. The average muscle strength of genu osteoarthritis patients before quadriceps strengthening exercise was 3.533 and the average pain intensity of genu osteoarthritis patients before quadriceps strengthening exercise was 4.8. The average muscle strength of genu osteoarthritis patients after quadriceps strengthening exercise was 4.6 and the average pain intensity of genu osteoarthritis patients after quadriceps strengthening exercise was 3.05. There is an effect of quadriceps strengthening exercise on increasing muscle strength with P-value 0,000<0,05 and effect of quadriceps strengthening exercise on reducing pain intensity in osteoarthritis genu patients signification p value 0,000<0,05.

A practical ligament-based diagnostic system for cure of pelvic symptoms and prolapse.

The Integral Theory Paradigm (ITP) has a 25-year track record of successfully treating bladder/bowel/pain symptoms caused by laxity in specific ligaments, even when the prolapse is minimal. The ITP-based treatment involves ligament support and can be nonsurgical or daycare surgical. An accurate diagnostic protocol is required. The Integral Theory Diagnostic system is performed in an outpatient setting. It a step-by-step "how to" resource for clinicians who wish to learn a practical anatomical diagnostic method which can quickly and accurately identify a ligament cause for bladder/bowel/pain symptoms, and therefore, potentially cure them. The structured ITP diagnosis flow chart uses symptoms to diagnose anatomical defects. It comprises 4 related steps. The ITP is holistic, and bladder, bowel, pain symptoms co-occur. The first step, therefore, is to establish all possible symptoms for transfer to the Diagnostic Algorithm which is the second step. Because patients complain of one main symptom, other symptoms must be located by direct questioning, using the Diagnostic Algorithm as an aide memoire, or a questionnaire to locate bladder, bowel, pain symptoms. Second step: symptoms are placed into 3 anatomical zones: anterior zone, pubourethral ligament (PUL) [stress urinary incontinence (SUI)]; middle zone, cardinal ligament (CL) (transverse defect cystocele); posterior zone, uterosacral ligament (USL) (uterine prolapse and enterocele). The third step is a vaginal examination to confirm the ligament damage (prolapses) in the three zones predicted by the algorithm. The fourth step is "simulated operations" (mechanical support of specific ligaments per vaginam) to validate the particular ligament indicated by the diagnostic algorithm, is indeed causing that symptom. For SUI, a hemostat test at midurethra supports PUL vaginally to stop urine loss on coughing; the lower blade of a bivalve speculum gently inserted into the vagina can relieve urge and pain.