Objectives: This study investigated the inter-rater reliability of three structural end range lumbar segmental instability tests with the highest positive likelihood ratio ( z LR) against flexion-extension radiographs, and three functional mid-range clinical tests that predict the success of lumbar stabilisation exercises in patients with recurrent or chronic low-back pain (R/CLBP). The study also investigated the reliability of lumbar segmental instability, subclassification as: functional, structural and combined instability. Method: Forty adults with R/CLBP (30 men and 10 women), aged 21-71 years, underwent repeated measurements of specific clinical tests for structural or functional lumbar segmental instability. Results: All functional-instability tests: the prone instability test (PIT), the aberrant motion test and the average passive straight-leg raise (PSLRw91u u) test showed a high percentage agreement (90, 97?5 and 95%, respectively) and a high kappa coefficient (0?71, 0?79 and 0?77, respectively). In addition, two structural tests: the lumbar flexion range of motion (ROM) w53u u and the passive lumbar extension test (PLET) showed a high percentage agreement (82 and 73%, respectively), and a moderate kappa coefficient (0?48 and 0?46, respectively). The lack of hypomobility with the posteroanterior (PA) glide test was found to be unreliable (agreement525%; k5{0?02). Locating the pain-provoking segment, as the first portion of PIT, was found to be moderately reliable (k50?41). The subclassification categories of lumbar segmental instability (functional, structural and combined) were found to be significantly reliable (PABAK) 0?90, 0?70 and 0?95, respectively). Discussion: All investigated tests (except the lack of hypomobility with the PA glide test), in addition to subclassifying the categories of lumbar segmental instability, were significantly reliable in the assessment of lumbar instability.

Nanogel is a promising drug delivery approach to improve the pharmacokinetics and pharmacodynamic prospect of phytopharmaceuticals. In the present review, phytopharmaceuticals with astonishing therapeutic utilities are being explored. However, their in vivo delivery is challenging, owing to poor biopharmaceutical attributes that impact their drug release profile, skin penetration, and the reach of optimal therapeutic concentrations to the target site. Nanogel and its advanced version in the form of nanoemulgel (oil-in-water nanoemulsion integrated gel matrix) offer better therapeutic prospects than other conventional counterparts for improving the biopharmaceutical attributes and thus therapeutic efficacy of phytopharmaceuticals. Nanoemulgel-loaded phytopharmaceuticals could substantially improve permeation behavior across skin barriers, subsequently enhancing the delivery and therapeutic effectiveness of the bioactive compound. Furthermore, the thixotropic characteristics of polymeric hydrogel utilized in the fabrication of nanogel/nanoemulgel-based drug delivery systems have also imparted improvements in the biopharmaceutical attributes of loaded phytopharmaceuticals. This formulation approach is about to be rife in the coming decades. Thus, the current review throws light on the recent studies demonstrating the role of nanogels in enhancing the delivery of bioactive compounds for treating various disease conditions and the challenges faced in their clinical translation.

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Background: Neck pain is the second largest cause of disability worldwide. The chronic neck pain prevalence is 14% which is somewhat higher in females as compared to males. In India, the reported prevalence is 6%. Therapeutically, neck pain is managed by physiotherapists using rest, stretching and strengthening exercises, educating patient, and intense proprioception and positional exercises. Aim: We aimed to determine the evidences for the efficacy of sustained natural apophyseal glides (SNAG s) in the management of mechanical neck pain. Methods: One hundred patients (age group: 25–45 years) who were diagnosed with neck pain, with onset >1–3 months (chronic), were randomly assigned to Group A receiving conventional physiotherapy plus SNAGs and Group B receiving conventional physiotherapy plus ultrasound (US). Treatment was given for three times a week for the period of 2 weeks, once a day for 6 sessions. Before treatment and after 2 weeks of treatment, pain, range of motion (ROM), and neck disability were assessed on Visual Analog Scale (VAS), goniometer, and Neck Disability Index (NDI), respectively. This study was conducted in Raj Nursing and Paramedical College, Gorakhpur, ClinicalTrials.gov registration number: NCT04617288. Results: Patients in Group A that received conventional physiotherapy plus SNAGs showed greater improvement in pain and ROM compared with the conventional physiotherapy plus US group on the 2nd week compared with pretreatment (P < 0.050). Conclusion: The result of the study suggests that both the SNAG and US groups improve the symptoms of neck pain. The US group improved the pain symptoms but was too small to reach satisfactory outcome for patients. Based on these results, conventional physiotherapy plus SNAGs should be the treatment of choice for neck pain rather than conventional physiotherapy plus US.