Introduction: Repair by arthroscopic double-row suture bridge technique is widely accepted modality of treatment for repairable large-to-massive rotator cuff tears. Repair by mini-open approach has also shown comparable results in such cases. Double-row repair either by mini-open or by arthroscopic approach imposes substantial financial burden on patients belonging to economically deprived & uninsured group. Surgical Technique: We propose a new suture configuration for cuff repair by mini-open approach in which variant of modified Mason-Allen suture technique is used in transosseous manner to provide suture configuration similar to that of suture bridge double-row repair. The knotless nature of the configuration reduces incidence of re-tear that is seen at medial row of the double-row suture bridge repair and the “X” configuration provides large area of contact between the cuff and the footprint which is the advantage of traditional double-row suture bridge repair. Apart from above advantages, this technique is very economical.

Aim: This study aims to analyze the relationship of rate of perceived exertion on lactate threshold and physiological variables with the incremental running test. Subjects and Methods: The study included 50 males who are physically active and athletes (Group A and B; 25 each). The athletes were taken from running sports and physical active males from gymnasium with a mean age (20.8 ± 2.3), body weight (67.8 ± 6.7), height (176.6 ± 5.1), and body mass index (22.0 ± 2.6). Results: Significant correlation was found. Conclusion: The findings of the study will provide guidance to prepare training schedules on the basis of the physical fitness capacity of the individual.

Background: The shooter's performance was mainly depends on the accuracy of the target. Physical and psychological health (anxiety, irrational belief) helps to achieve target. There is no study to find the irrational belief among elite level shooter. Purpose: The aim of this study is to find the prevalence of irrational beliefs among the elite shooters. Methods: A cross-sectional survey was conducted among 21 professional shooters (14 female and 7 male), and data of irrational beliefs were collected by Short General Attitude Belief Scale was administrated among them. Results: The result shows that elite level shooter has irrational belief about their performance. In irrational belief, demand for the fairness of the performances (3.13 ± 0.89, 65%) and need for achievement (2.97 ± 0.93, 60%) were higher percentage than the other irrational belief. Conclusion: In irrational belief, demand for the fairness of the performances and need for achievement was higher percentage than the other irrational beliefs.

Objective: Low back pain (LBP) has considered the most common problem worldwide. The purpose of this study was to see the comparative efficacy of lumbar stabilization exercises versus Mulligan mobilization in LBP. Materials and Methods: This randomized controlled trial was conducted at Physiotherapy Department of Mayo Hospital, Lahore. Forty-four patients were randomly selected in two groups. Group A patients were treated by stabilization exercises. Group B patients were treated by Mulligan mobilization protocol. Results: The participants in Mulligan mobilization group showed marked improvement as compared to stabilization exercise group. Conclusion: It was concluded from the results of this study that Mulligan mobilization is more effective than stabilization exercises for the treatment of LBP. Mulligan mobilization not only decreases pain but also improves function and flexibility of the spine.

Objective: Osteoarthritis (OA) is a disease of diversified etiology that causes the degeneration of the articular cartilage leading to proliferation of novel bone and reshaping of joint outline. A randomized controlled trial was conducted at the Department of Physiotherapy, Mayo Hospital, Lahore, to examine the effects of manual therapy training and neuromuscular training on knee OA. Materials and Methods: We conveniently selected a sample of 58 patients and placed into two groups. Manual therapy was applied in Group A and neuromuscular training in Group B along with conventional physiotherapy for 4 weeks. Results: The goniometry, visual analog scale, and Western Ontario and McMaster Osteoarthritis Index for knee OA were assessment tools to assess all the patients before and after 2 weeks of physical therapy intervention. Patients in Group A showed marked improvement as compared to Group B (P>0.05). Conclusion: The manual therapy group shows better results in improving pain and reducing physical disability. This study concluded that manual therapy had a more positive impact in improving pain, range of motion, and function as compared to those patients who were treated by neuromuscular training.

Background: Ipsilateral femoral neck and shaft fractures are an uncommon injury, and many a times, femoral neck fracture is missed initially making treatment of these fractures a challenge to the treating surgeon. Still controversy exists regarding which technique and implant provide optimal treatment of these complex injuries. The purpose of this study was to evaluate the results of ipsilateral femoral neck and shaft fractures treated with reconstruction intramedullary nailing. Materials and Methods: Eighteen patients having ipsilateral femoral neck and shaft fractures were included in this study. One patient was having bilateral involvement. All the patients were treated by close reduction and internal fixation with reconstruction intramedullary nailing. Average follow-up period was 3.5 years (range 2–8 years). Results: According to Friedman–Wayman criteria, the outcome was good in 14 (77.8%), fair in 3 (16.7%), and poor in 1 (5.5%) patient. Femoral shaft fracture in one patient who was having bilateral involvement went into nonunion which required revision nailing with antegrade femoral interlocking nail. Conclusion: The treatment of these injuries with reconstruction intramedullary nailing is advantageous in terms of possible close antegrade nailing with minimal surgical trauma, reduced blood loss, less incidence of infection, and biological fixation of both fractures with a single implant.

Background: Thorough knowledge of anatomy of vertebral artery is essential to avoid inadvertent injury during surgery. The vertebral artery can have a variable course, especially in the upper cervical spine. Materials and Methods: Study area - Burdwan Medical College and Hospital. Study population - Cadaver at Anatomy and FSM Department. Sample size - Thirty-one cadavers. Study design - Institution-based prospective study. In this study, most of the dissection is done through midline incision to avoiding risk in damage to trachea and esophagus. All structures are bluntly dissected to reach the origin of vertebral artery. From there, the level of entry is dissected. Results: Out of 31 cadavers, male cadavers were 22 (71%) and female cadavers were 9 (29%). Anomalous vertebral artery entry found only in 3 (9.7%) cases. All anomalous entry was at C7 level. Vertebral artery entry at C6 foramen in 28 cases (90.3%). In all the 28 cases where vertebral artery entered at C6 transverse foramina, vertebral artery ascended from subclavian artery as it's first branch. Among 28 cases where vertebral artery entered at C6, 20 cases were males and eight cases were females. Out of three cases having C7 entry, two were male cases and one was female case. Altogether 9.7% of cases had C7 anomalous entry. Conclusion: In our study from 31 cadavers, we found 9.7% of cases have anomalous entry at C7 level. Although this is a small study with few cadaver number of anomalous connection is not small, and it is not at all rare.

Aim: Fractures of the distal radius in adults are a common injury, particularly in the elderly people. Closed reduction of displaced extra-articular fractures and percutaneous pinning is a well-established treatment option. The aim of the study was to assess the functional outcomes of percutaneous pinning augmented by Joshi's clamp in patients with displaced extra-articular distal radius fractures. Materials and Methods: Twenty adult patients with displaced fractures requiring manipulation were recruited prospectively over a 1-year period. There were 13 (65%) females and 7 (35%) males, with a mean age of 36.45 years (range; 20–55 years). All the procedures were performed in the operating room by a single surgeon. External plaster support was not needed. Immediate postoperative active wrist mobilization was started. The patients were followed at 2, 6, and 8 weeks, and then monthly for a minimum of 6 months, looking for clinical and radiological union, Cooney's wrist score, and any complication. Results: None of the patients was lost to follow-up. According to the Cooney's score, 9 patients (45%) had good results, 9 patients (45%) had fair results, and poor results in 2 patients (10%). Fracture consolidation was achieved at an average of 43 days (range; 36–50). With regards to complications, 2 patients (10%) had a painful scar and 2 patients (10%) had a pin-tract infection. Conclusion: This technique is a viable alternative option. It allowed minimal soft-tissue injury, adequate stability, and early rehabilitation in our patients. Long-term comparative randomized studies are still warranted.

Background: Lifestyle modification with exercises such as brisk walking and stress management programs are known useful approaches in the treatment of diabetic individuals. Aims: This study aims to compare effects of regular evening versus morning walk on biochemical and stress profile in newly diagnosed diabetic patients in a population of eastern India. Materials and Methods: This pilot study was conducted in a time span of 1 year after taking institutional ethical clearance and informed consent of the individuals. Two hundred newly diagnosed diabetes patients were included. One hundred individuals were advised to walk in the morning. One hundred individuals were advised to walk in the evening. Initial laboratory values (Fasting and PP sugar, glycated hemoglobin (HbA1c), lipid profile) and anthropometric measurements (height, weight, body mass index [BMI], waist/hip ratio) were recorded. Life event stress and perceived stress of the individuals were measured by using presumptive life event stress scale and perceived stress scale, respectively. All the parameters were reassessed 3 months after practising the walking regimen. Results: There were significant changes in both groups before and after the walking regimen, in fasting blood sugar, postprandial blood sugar, HbA1c, serum cholesterol, triglyceride, low-density lipoprotein, very low-density lipoprotein level, and perceived stress scores. No significant change in both groups was observed before and after the walking regimen, in BMI, waist/hip ratio, serum HDL, and presumptive stress score. There was no significant difference in mean values of different parameters, between the two groups before and after the walking regimen. Conclusions: Walking in the morning and evening may be considered to be equally effective in respect of glycemic control, lipid metabolism, and stress management of diabetic individuals.

Background: Most stressing curricula in the world at present is medical science; excess stress among students lead to a decrease in their performance due to physical as well psychological decline. The study under consideration was done for determination of the psychological stress that is perceived by the undergraduate medical students, to identify the stressors causing stress, domains in which it is more prevalent in students of various medical disciplines in Pakistan. Materials and Methods: A comparative cross-sectional study using Medical Students Stressor Questionnaire was carried on a sample of 300 students of various medical disciplines of public and private universities chosen by convenience sampling. Results: Across the various disciplines of medical education, more stress was found in the DPT students and least in the AHS students. The results reported the prevalence of stress 28.5% in DPT students, 24.2% in MBBS students, 23.7% in DHND students, and 23.6% in AHS students. Among the sectors, more stress level was found in public sector university students (77.6%) than private sector students (22.4%). The stressors causing more stress among the undergraduate medical students were identified to be the group activity-related stressor and social activity- related stressor. Conclusion: The study showed that the high prevalence of stress was found to be in the DPT students followed by the MBBS, DHND, and AHS. Stress was more prevalent in public sector medical students as compared to the private sector.

Objectives: The objective of this study is to determine the pattern of physical activity among adults visiting a major primary health-care center in Riyadh, Saudi Arabia and to identify the determinants and barriers of performing physical activity. Materials and Methods: A cross-sectional study in a major primary health-care center in King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia, during July 2016. Participants were interviewed using the short version of the International Physical Activity Questionnaire. The analysis was performed to identify the pattern of physical activity and possible influencing factors. Results: The study included 305 participants with a mean age of 33.18 ± 11.45 years. The pattern of physical activity among participants was as follow: highly active (8.9%), minimally active (15.1), and physically inactive (76.1%). There was no significant association between activity levels and gender, age, presence of chronic disease, and indication of facing barriers. The total time spent in physical activity is far below recent recommendations. Male participants were more likely (69.2%) to sit more than 6 h/day compared to the 58.9% of the females. The mean body mass index of our sample was 27.63 with 64% of the participants being either overweight or obese. Conclusion: This study confirmed previously published low level of physical activity among males and females in the Saudi community. There was also a noted high prevalence of overweight and obesity. The combination of physical inactivity and prolonged total sitting time will certainly contribute to adverse health outcomes and increased morbidity and mortality.

Sudden cardiac death (SCD) is the leading cause of death in athletes. Among which, cardiomyopathy is the most common in young asymptomatic sportsperson. The electrocardiogram (ECG) is used as a primary screening and diagnostic tool for detecting underlying conditions associated with SCD. However, providing medical clearance for an asymptomatic athlete without any positive personal or family history is especially challenging when the athlete demonstrates abnormal ECG, particularly repolarization patterns, highly suggestive of an inherited cardiomyopathy, or ion channelopathy. This paper presents two such cases of contrasting diagnostic conundrum which may help sports physicians and cardiologists working with athletes.

Divergent dislocation of elbow is a rare injury with few reports or short series. These dislocations require prompt diagnosis with careful evaluation of radiographs and emergent reduction and splinting. Axial force overflexed or semi-flexed elbow may be initial mechanism that dislocates the elbow and propagation of force then separates radius and ulna as in our case. Injury in school drills are usually minor, but complex dislocation may occur in events involving somersault and backflips requiring caution for the prevention and urgent management. We, hereby, describe relevant details of transverse divergent elbow dislocation in a 10-year-old child with appropriate management leading to uneventful recovery and satisfactory functional outcome.