An Overview of Disease and Health Research Vol. 4

Effect of Personalised Physiotherapy Protocol on Managing Fatigue, Anxiety and Depression during Radiotherapy for Oesophagal Squamous Cell Carcinoma: A Case Report

Tushara Naira — 2025-07-07

Squamous cell carcinoma of the oesophagus is the eighth most common cancer found in the world and is also one of the leading causes of death. In this condition, the squamous cells on the inner lining of the oesophagus divide uncontrollably, resulting in the narrowing of the lumen, leading to difficulties in swallowing and painful swallowing. A 35-year-old female patient diagnosed with squamous cell carcinoma of the oesophagus operated in who underwent a feeding jejunostomy, was admitted to the ward for chemoradiation therapy. The patient had complaints of fatigue and was also suffering from depression and anxiety. A personalised physiotherapy protocol was formed, which included general mobility, strengthening exercises, aerobic exercises, yoga, relaxation and recreational activities. The fatigue was assessed using the Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-F) subscale and the Hospital Anxiety and Depression Scale (HADS) was used to assess hospital-based depression and anxiety. This case study concluded that this personalised protocol was found to have positive effects on fatigue, depression and anxiety.

Various Skin Manifestations in Tuberous Sclerosis with Case Report

Hetal Pandya — 2025-07-07

Tuberous sclerosis (TS) is an autosomal dominant neurocutaneous disorder characterised by a triad of epilepsy, mental retardation and adenoma sebaceum with multisystem involvement. The clinical presentation is associated with severe morbidity and potential mortality, making early diagnosis, lifelong surveillance, and appropriate management crucial. This study reports a case of a young male who presented with uncontrolled seizures following a symptom-free interval of nearly 15 years. This case of TS was presented for its uniqueness of having almost all known skin manifestations associated with TS. Clinical examination of the patient revealed the presence of adenoma sebaceum over the face. The patient also had shagreen patches over the umbilicus, ash-leaf hypomelanotic spots over the flank and subungual fibroma. The patient was treated and discharged with recommendations for regular follow-up. This case emphasises the importance of clinical criteria in the diagnosis of TS, as they provide a fast, inexpensive and universal standard in view of the absence of definitive diagnostic investigations. While there is no definitive cure for TS, symptoms can be treated symptomatically. Hence, awareness regarding different skin manifestations and various organ involvement of TS is very important.

Unfreezing the Joint: Understanding the Mechanism and Comprehensive Physiotherapy Management of Frozen Shoulder

Mayur Kalavadiya — 2025-07-07

This chapter explores frozen shoulder, a debilitating condition marked by progressive shoulder stiffness and pain. It outlines the pathophysiology, clinical stages, and risk factors, emphasizing the importance of accurate diagnosis and stage-specific physiotherapy. Evidence-based interventions like joint mobilization, scapular PNF, and adjunct therapies are highlighted to restore function and reduce pain. Outcome measures and long-term strategies are discussed to ensure sustainable recovery. With a patient-centered approach and interdisciplinary coordination, physiotherapists can play a transformative role in managing frozen shoulder and enhancing quality of life.

A Comprehensive Study of Supernumerary Digits along with Its Clinical Implications

Rajani Singh — 2025-07-07

Supernumerary digit, also known as polydactyly, is the most common digital defect of the upper and lower limbs. It is grouped into three types, namely postaxial or ulnar, preaxial or radial, and axial or central. Each type of polydactyly is caused by a fixed gene and exhibits ethnic differences. The primary aim of this chapter is to highlight the occurrence, diagnosis and management of polydactyly. Polydactyly may be associated with certain congenital defects, such as Trisomy 13, Ellis-van Creveld and Smith-Lemli-Opitz syndromes, to name a few or may occur in isolation. Polydactyly can be diagnosed as early as 9 weeks of intrauterine life. If Polydactyly is detected in fetus, the developing child should be screened for associated congenital anomalies so that appropriate advice and counselling may be provided to parents. The management of this medical condition is very important as a child with polydactyly becomes conscious of the digital anomaly, he is put to emotional stress because he starts comparing the appearance of his hand/foot with that peers and may undergo depression and may not mix with other children. So, detailed knowledge of supernumerary digits is very essential to clinicians.

Pharmacokinetic-Based Prognostic Markers for Advanced Intrahepatic Cholangiocarcinoma Treated with Standardised Extract of Atractylodes lancea (Thunb.) DC

Teerachat Sae-heng — 2025-07-07

Background: Intrahepatic cholangiocarcinoma (ICC), a biliary tract cancer, is a major cause of primary liver cancers. It is recognised as a deadly gastrointestinal cancer with a poor disease prognosis due to the lack of effective biomarkers for early diagnosis and effective treatment. Recently, research has indicated that Atractylodes lancea (Thunb.) DC. (AL) may offer greater clinical benefits for patients with advanced-stage ICC when compared with standard supportive care.

Aim: This study investigated the relationships between clinical efficacy and pharmacokinetic parameters of serum bioactivity of AL and its active constituent, “atractylodin,” and determined the therapeutic ranges.

Methods: A retrospective study was conducted as part of a single-centre, open-label, randomised controlled Phase 2A trial, which took place over four months at Sakhon Nakhon Hospital, Sakhon Nakhon Province, Thailand. Patients with advanced-stage ICC were randomised to three groups. Group 1 received daily doses of 1,000 mg of standardised extract of the capsule formulation of AL (CMC-AL) for 90 days. Group 2 received daily doses of 1,000 mg of CMC-AL for 14 days, followed by 1,500 mg for 14 days and 2,000 mg for 62 days. Group 3 (the control group) received palliative care. The Cox proportional hazard model and the Receiver Operating Characteristic (ROC) curve were applied to determine the cut-off values of AUC_0-inf, C_max, and C_avg associated with therapeutic outcomes. Number-needed-to-be-treated (NNT) and relative risk (RR) were also applied to determine potential predictors. Mann-Whitney U test and Wilcoxon signed-rank test were used for non-normally distributed data. Paired t-tests and unpaired t-tests were applied to analyse normally distributed quantitative variables, while chi-square analysis was used for qualitative variables. A significance level of α = 0.05 was used.

Results: The AUC_0-inf of total AL bioactivity of> 96.71 µg*h/ml was identified as a promising predictor of disease prognosis, specifically progression-free survival (PFS) and disease control rate (DCR). C_max of total AL bioactivity of>21.42 was identified as a predictor of the prognosis of death. The therapeutic range of total AL bioactivity for PFS and DCR is 14.48-65.8 µg/ml, and for overall survival is 10.97-65.8 µg/ml.

Conclusions: The predictors of ICC disease prognosis were established based on the pharmacokinetics of total AL bioactivity. The information could be exploited to improve the clinical efficacy of AL in patients with advanced-stage ICC. These predictors will be validated in a phase 2B clinical study. Further study is needed to validate the model externally with a larger sample size to confirm its accuracy and applicability.

Association between Depression, Anxiety and Personality Among Rural Adolescent Boys and Girls- A Community-based Cross-sectional Study

Hana Zaiba Z — 2025-07-07

Background: Personality is defined as a set of stable and enduring psychological qualities that influence an individual's characteristic pattern of behaviour across different situations and over time. The emergence of depression and anxiety disorders also seems to cause a temporary and sometimes permanent alteration in personality features. The objective of the study is to find out the association between anxiety and depression with personality facets and domains among rural adolescent boys and girls.

Methods: It was a community-based cross-sectional study carried out for 12 months from March 2024 to February 2025 among 20 randomly selected rural schools of Kolar Taluk. Personality was assessed using the Personality Inventory for DSM-5 (PID-5), a 220-item self-report questionnaire that evaluates 25 personality facets grouped into five broad domains: Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism. Anxiety was measured using the 7-item Generalised Anxiety Disorder scale (GAD-7), and depression was assessed using the Beck Depression Inventory-II (BDI-II), which consists of 21 items. The sample size was calculated based on previous research. The interview technique collected all the data. Descriptive statistics will be applied wherever needed to compare groups after checking for the normality of data. To compare between groups, a t-test and ANOVA were used with a level of significance defined as a p-value less than 0.05. IEC clearance was obtained before the start of the study.

Results: 430 rural school children took part in the study. 247 (57.4%) were boys, and 273 (63.5%) belonged to the 10^th standard, 120(27.9%) had Moderate anxiety, and 79 (18.4%) had Borderline depression. Adolescents with severe anxiety had higher scores in facets like Anxiousness, attention seeking, callousness-anxiety, grandiosity, manipulativeness, risk-taking, suspiciousness, unusual beliefs and experiences, impulsivity, perceptual dysregulation, and withdrawal facets. Rural school children with Mild depression had higher scores in personality facets like anxiousness, eccentricity, emotional liability, irresponsibility, impulsivity, perseveration, and suspiciousness.

Conclusion: The present study suggests that mental health screening at school for anxiety and depression, along with personality assessment, should be implemented in school mental health programs.

Meckel’s Diverticulum: A Comprehensive Review of Diagnosis, Management, and Controversies

Kumar H.R. — 2025-07-07

Meckel’s diverticulum is a congenital gastrointestinal anomaly commonly seen in the pediatric age group. It can be divided into symptomatic and asymptomatic presentations, with the most common clinical presentation being gastrointestinal bleeding, intestinal obstruction, and perforation. The diagnosis uses imaging modalities like ultrasound or computerised tomography, with the technetium 99 scan and angiography reserved for complicated presentations. Meckel’s diverticulum is treated by performing a diverticulectomy or resection, which can be performed as an open or laparoscopic procedure. The treatment of incidental Meckel’s diverticulum is controversial due to the absence of any management guidelines.

Mega Prothesis: A Ray of Hope in Tumor Resection

Noel Samuel Macwan, PT — 2025-07-07

Megaprostheses consistently produce positive outcomes for as long as patients are alive. Most methods provide instant weight-bearing and replace damaged bone tissue rather than trying to promote bone healing. There is strong evidence to support the use of these systems, which can undoubtedly improve patients' quality of life, even for those with a poor prognosis. Literature shows that not only these prostheses used in tumour patients, but they are also used to treat non-oncologic patients. They have become the most popular reconstruction technique following segmental resection of the long bones in the extremities during the past three decades. These devices are a promising substitute that may lead to quick recuperation, joint function restoration, and, in the worst situations, amputation avoidance. Megaprostheses are comparatively simple to operate, and their highly modular systems enable a wide range of resections to accommodate as many patients as feasible. There are many different kinds of megaprostheses implants available for limb salvage surgery. They differ in their shape, size, make and functioning. An important issue that significantly affects prosthesis survival is prosthetic joint infection. An elevated risk of infection is linked to the usage of megaprostheses.

The Current Surgical Management of Complicated Left-Sided Colonic Diverticulitis: A Narrative Review

Kumar H.R. — 2025-07-07

Acute left-sided diverticulitis is the most common presentation of acute diverticulitis, and it can be divided into complicated and uncomplicated diverticulitis. The surgical management of complicated diverticulitis can be divided into Hartmann’s procedure or Sigmoid resection and anastomosis with a covering ileostomy. Damage control surgery is performed for complicated left-sided diverticulitis who are hemodynamically unstable. Laparoscopic lavage is a bridging procedure that is performed in complicated diverticulitis with purulent discharge or Hinchy 3 to stabilise them and perform definitive surgery later. In this review, we will look at the role of surgical management of complicated left-sided diverticulitis, the Hartmann’s procedure, and colonic resection with anastomosis. We will also look at the role of laparoscopic lavage for complicated diverticulitis.

Evolution of Long-term Care Neighbourhoods for Older People: The Rhetoric and Reality of Meeting Older People’s Future Care Needs in Japan and England

Ala Szczepura — 2025-07-07

The world population aged 65+ will triple from 6.9% to 20% by 2050. The fact that people are living longer is a positive reflection on improvements in health and long-term care services; at the same time, falling birth rates are leading to a decrease in the working age populations available to provide care. This chapter considers the health and social care challenges that many countries are increasingly facing with an aging population and a reduced workforce. Providing long-term care services to meet the needs of older people is complex. As people age, they will require both health and social care services to maintain their functioning and retain a good quality of life. Integration of these, previously separate services will need to be achieved in order to provide cost-effective long-term care. The World Health Organisation recommended in 2020 that all countries should have integrated long-term care strategies to better support their older populations. Exploration of the rhetoric and reality of policies of integration of neighbourhood services for older people is now needed. Such an analysis can provide evidence on the strengths and weaknesses of different strategies, but it may also highlight the need to temper rhetoric with reality, as well as identify challenges for the future. Countries are at various points in the journey to address the challenge of integration. Some, like Japan, which has the most rapidly ageing society in the world, started to address this challenge systematically in the 1990s. By 2017, it had introduced a national policy for integrated long-term health and social care services for older people at a local geographical level (neighbourhood). Other countries, such as England, have only recently embarked on a plan for integration of health services for older people. It has also chosen to develop services at a neighbourhood level. We describe the evolution of the neighbourhood approach to care for older people in both countries. We also consider historical and cultural factors, and the future role of technology. Through international comparisons, the reader can identify critical lessons that could inform the strategy development in their own country. In conclusion, this chapter provides an overview comparing the development of neighbourhood care models in two countries with different historical, cultural and health and social care backgrounds.

Effect of Mindfulness Meditation on Self-Regulation in individuals with Bordeline Personality Disorder: An Integrative Review

Ribeiro BL — 2025-07-07

Borderline Personality Disorder (BPD) is a complex diagnosis in which the patient presents important symptoms related to impulsivity, mood swings and emotional instability, leading to psychological distress and significant interpersonal conflicts. The objective of the study is to conduct an integrative literature review to analyze the relationship between mindfulness, specifically mindfulness-based interventions, and BPD. The search was conducted by evaluating studies found in the PubMed and BVS (SciELO and Lilacs, Psychinfo) databases, with 26 articles included in this review. Although the diagnostic criteria have existed for some time and are discussed in the literature, its treatment and symptoms still require revisions and literary development to assist in the clinical improvement of these patients. Among the possible therapeutic approaches, the benefits of Mindfulness for self-regulation of patients with BPD have been studied with greater frequently, being one of the skills employed in Dialectical Behavioral Therapy (DBT) and its objective is full attention (concentration in the present moment, intentionally and without judgments). Studies show that the integration of mindfulness as an adjunct therapy in the treatment of borderline personality disorder (BPD) can lead to reductions in stress symptoms and improvements in the quality of life of patients. Breathing as a tool for self-regulation (as used in mindfulness) can systematically enhance the influence of the vagus nerve over the heart. Studies on Dialectical Behaviour Therapy (DBT) demonstrate that improvement in emotional regulation is directly related to the reduction of symptoms of Borderline Personality Disorder (BPD) and the control of impulsive behaviours. Thus, the study helps to clarify the therapeutic benefits of Mindfulness for patients with BPD and offers the possibility of theoretical reflection on the literature presented on the subject. Given the therapeutic potential of the association between mindfulness and BPD, it is crucial that more research includes this patient group, as investing in this intervention could expand access to treatment for a large number of patients who do not respond to other recommended therapies.