Asian Journal of Medicine and Health

Heterogeneity of Protocol Parameters in Dynamic Cupping Therapy for Lower Extremity Musculoskeletal Conditions: A Critical Narrative Review

2026-07-30T12:51:11+00:00

Cupping therapy has re-entered mainstream sports medicine and rehabilitation practice, and a subset of clinicians now apply the cup while the underlying tissue is actively or passively moved, a variant commonly described as dynamic or moving cupping. This critical narrative review examined the available evidence on dynamic cupping applied to lower extremity musculoskeletal conditions, with particular attention to the consistency of the treatment parameters used across studies. Literature published in English between 2006 and May 2026 was identified through PubMed, PubMed Central, Semantic Scholar, the Directory of Open Access Journals, and publisher platforms including Elsevier ScienceDirect, Frontiers, Springer Nature, SAGE, Taylor & Francis, Karger, J-STAGE, and Cureus, supplemented by backward citation tracking through recent systematic and umbrella reviews. A genuinely dynamic protocol, defined as either active limb movement performed while a stationary cup remains applied or a cup that is manually slid across the skin, was described in a small number of controlled and uncontrolled studies targeting the hamstrings, hip and knee region, and lower leg. These studies varied markedly in cup material and diameter, negative pressure or displacement depth, treatment duration, number of cups, movement pattern, session frequency, and comparator condition, and the outcome measures ranged from joint range of motion and isokinetic power to pain and disability indices. A larger body of static and pulsatile dry-cupping trials for knee osteoarthritis, plantar fasciitis, and hamstring tightness offered indirect context but frequently reported null or conflicting between-group findings, and mechanistic dosing evidence linking negative pressure and duration to blood flow and muscle stiffness has so far been generated almost exclusively on upper limb tissue. Confidence in any single parameter combination for the lower extremity therefore remains low. Reporting of cupping interventions was inconsistent with the Standards for Reporting Interventions in Clinical Trials of Cupping, further limiting comparability. Future research should prioritise dose-ranging trials conducted directly on lower extremity musculature, transparent parameter reporting, and adequately powered sham-controlled designs before dynamic cupping can be recommended for specific lower extremity conditions with confidence.

Ritucharya, the Ayurvedic Seasonal Regimen, for Health Maintenance and Disease Prevention: A Critical Narrative Review of Classical Rationale and Contemporary Biological Evidence

2026-07-30T13:17:56+00:00

Ritucharya, the seasonal regimen codified in the classical Ayurvedic compendia, prescribes graded adjustments to diet and conduct in accordance with the annual cycle, with the explicit aim of preventing disease and preserving health. As non-communicable and seasonally patterned illnesses continue to dominate the global burden of mortality, season-sensitive preventive frameworks have acquired renewed relevance, and Ritucharya is increasingly invoked as an ancient precedent for such approaches. This review critically evaluates the strength, coherence and limitations of the evidence bearing on Ritucharya, distinguishing its internal classical logic from claims about its physiological validity and clinical effectiveness. The classical scheme is first reconstructed as a coherent theoretical system built on the solar half-years, doshic accumulation and pacification, the seasonal behaviour of digestive capacity, and the transitional vulnerability of inter-seasonal periods. Contemporary evidence is then examined across three domains that the regimen implicitly engages: the chronobiological organisation of human physiology, including documented annual variation in immune and metabolic gene expression; the seasonal restructuring of the gut microbiome and its links to diet, cold and energy balance; and the seasonality of cardiovascular and infectious disease. Across these domains, the biological plausibility of a season-adaptive regimen is reasonably well supported by mechanistic and epidemiological work of moderate to high quality, and several specific classical recommendations show qualitative congruence with modern findings. The direct clinical evidence for Ritucharya as an intervention is, by contrast, sparse, methodologically weak and concentrated in lower-tier outlets, and constitution-based individualisation rests on preliminary and partly inconsistent data. The regimen is therefore best characterised as a biologically plausible and historically sophisticated preventive heuristic whose specific efficacy claims remain largely untested. Priorities for rigorous prospective evaluation, standardised operationalisation and mechanistically anchored outcome measurement are proposed. The synthesis is intended to support disciplined integration rather than either uncritical endorsement or premature dismissal.

In Utero Epigenetic Programming of the Fetal Genome: A Critical Synthesis of Maternal Nutritional, Environmental and Psychosocial Influences

2026-08-01T09:48:44+00:00

The fetal epigenome is established during periods of extensive cellular differentiation and may record, buffer or transmit information about the maternal milieu. This critical narrative review evaluates evidence that maternal nutrition and metabolic state, environmental toxicants and ambient pollution, and psychosocial conditions alter epigenetic regulation in the placenta, cord blood or fetal tissues. Literature published from January 2000 to 26 May 2026 was identified through accessible scholarly indexes, supplemented by citation searching and verification against authoritative bibliographic records. Evidence was appraised across human observational studies, natural experiments, randomised trials and mechanistic animal models. The strongest replicated human evidence concerns sustained maternal smoking, for which newborn DNA methylation signatures are consistent across cohorts and some marks persist beyond childhood. Nutritional programming is mechanistically compelling, particularly for one-carbon metabolism and severe energy or protein imbalance, but human findings are most persuasive in quasi-experimental settings and at metastable epialleles; routine supplementation and dietary interventions have produced smaller, locus-specific or non-replicated effects. Air pollution, metals, phenols, phthalates and per- and polyfluoroalkyl substances are associated with placental or cord-blood epigenetic variation, yet effect sizes, loci and biological interpretation vary with exposure assessment, gestational timing, tissue composition and co-exposure. Psychosocial studies support stress-responsive placental and hypothalamic-pituitary-adrenal pathways, but candidate-gene associations have not translated into a stable epigenome-wide signature. Across domains, DNA methylation dominates measurement, whereas histone regulation, chromatin accessibility and non-coding RNA remain less comprehensively studied in humans. Most findings establish exposure-associated molecular variation rather than durable, causal programming of organ function or disease. Progress requires longitudinal and diverse pregnancy cohorts, repeated exposure measurement, cell-resolved placental and fetal models, multi-omic integration, functional perturbation and causal triangulation. Epigenetic evidence can clarify biological embedding of prenatal conditions, but it should not be interpreted as deterministic or used to individualise responsibility for structurally patterned maternal exposures.

Calisthenics Training and Physical Fitness in Martial Arts: A Critical Narrative Review of Adaptation, Transfer and Programming

2026-08-01T12:49:30+00:00

Calisthenics is widely used in martial-arts preparation because it is inexpensive, portable and adaptable to group training, yet its effects are often inferred from general exercise research rather than demonstrated in martial artists. This critical narrative review evaluates how progressive bodyweight training may influence strength, muscular endurance, power, speed, change-of-direction ability, balance, trunk function, flexibility, cardiorespiratory fitness and body composition in striking, grappling and mixed combat contexts. Peer-reviewed evidence published from 2000 to 26 May 2026 was identified through accessible scholarly indexes, citation searching and DOI verification. Direct calisthenics trials in martial-arts athletes were scarce, so the synthesis integrated three evidence streams: calisthenics and bodyweight interventions in non-martial-arts populations, bodyweight-dominant core, plyometric and interval interventions in combat-sport athletes, and broader evidence on the physical demands and conditioning responses of martial arts. The strongest support concerns improvements in movement-specific upper-body strength and local muscular endurance when exercise difficulty is progressively increased. Explosive bodyweight drills and plyometric-jump training can improve selected power and change-of-direction outcomes, but these effects cannot be generalised to high-repetition calisthenics. Trunk-focused programmes may improve trunk endurance and some balance or sport-related outcomes, although transfer is inconsistent. Bodyweight circuits can enhance cardiorespiratory fitness in inactive or moderately trained participants, whereas short low-volume protocols may only maintain fitness in already trained populations. Evidence for substantial changes in body composition, absolute maximal strength, grip-specific capacity or competitive performance remains weak. Calisthenics is therefore best treated as a programmable resistance and conditioning method rather than a single intervention. Its value depends on matching leverage, range of motion, tempo, external augmentation, velocity intent and session density to the athlete’s discipline, training status and competition phase. Well-controlled martial-arts trials comparing progressive calisthenics with external resistance training are needed before claims of equivalence or superior sport transfer can be sustained.

Outcome of Pedicle Screw Fixation in Patients with Clinically Suspected Osteoporosis at the National Orthopaedic Hospital Dala Kano Nigeria

2026-07-30T10:14:49+00:00

Background: Osteoporosis poses a significant challenge to spinal instrumentation because compromised bone quality may predispose patients to screw loosening, implant failure, and reoperation. However, in resource-limited settings where dual-energy X-ray absorptiometry (DEXA) is unavailable, clinicians must rely on clinical and radiographic indicators of poor bone quality.

Aim: This study evaluated the outcomes of pedicle screw fixation in patients with clinically suspected osteoporosis at a Nigerian tertiary hospital and identified factors associated with adverse outcomes.

Methods: A retrospective cohort study was conducted among 61 patients older than 55 years who underwent pedicle screw fixation at the National Orthopaedic Hospital Dala, Kano, from January 2018 to December 2024. Clinically suspected osteoporosis was identified using age, sex, low body mass index (BMI), fragility fractures, and radiographic osteopenia. DEXA was unavailable. Outcomes included screw loosening at one year, reoperation, pain (VAS), neurological status (ASIA grade), disability (ODI), fusion status, quality of life (EQ-5D), and complications. Univariate analysis was used to examine factors associated with adverse outcomes.

Results: Of the 61 patients (47 women and 14 men), screw loosening at one year occurred in 14 (22.9%): 11 women (23.4% of women) and 3 men (21.4% of men). Reoperation was required in 5 patients (8.2%): 4 women (8.5%) and 1 man (7.1%). Univariate analysis showed no statistically significant association between sex and screw loosening (p = 1.00) or reoperation (p = 1.00). Patients older than 75 years had a higher loosening rate (44.4% vs 14.3–25.0%), although the difference was not statistically significant (p = 0.17). Multilevel fusion (≥3 levels) was associated with a higher loosening rate (50.0% vs 9.1–20.0%; p = 0.02). VAS improved from 7.2 ± 1.5 to 3.1 ± 1.8 (p < 0.001), and ODI improved from 58.4 ± 14.2 to 32.5 ± 16.5 (p < 0.001). Complications occurred in 18 patients (29.5%).

Conclusions: Pedicle screw fixation in patients with clinically suspected osteoporosis was accompanied by screw loosening in 22.9% and reoperation in 8.2%. Multilevel fusion was associated with screw loosening. The absence of DEXA screening, cement augmentation, and pharmacological treatment indicates a gap in care. Improved diagnostic capacity and access to appropriate augmentation strategies may support surgical planning in resource-limited Nigerian settings.

Role of Serum C-Reactive Protein in Improving the Diagnostic Accuracy of the Modified Alvarado Score in Patients with Suspected Acute Appendicitis: A Cross-sectional Study

2026-07-30T12:20:10+00:00

Background: Acute appendicitis is a common surgical emergency; delayed diagnosis may increase morbidity, whereas diagnostic uncertainty may lead to unnecessary appendectomy. The Modified Alvarado Score (MAS) is widely used, but its performance may be limited in equivocal cases. Serum C-reactive protein (CRP) may provide complementary inflammatory information.

Objective: To assess whether serum CRP improves the diagnostic performance of MAS in patients with suspected acute appendicitis, using histopathological findings as the reference standard.

Methods: This hospital-based cross-sectional study included 223 consecutive patients aged ≥13 years who underwent appendectomy at Mymensingh Medical College Hospital, Bangladesh, from January 2022 to June 2023. MAS and qualitative serum CRP (>6 mg/L) were assessed preoperatively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated for MAS, CRP, and the combined criterion of MAS ≥7 with raised CRP.

Results: Histopathological examination confirmed acute appendicitis in 209 patients (93.7%). MAS showed 84.69% sensitivity, 78.57% specificity, and 84.30% diagnostic accuracy. CRP showed 93.78% sensitivity, 64.29% specificity, and 91.93% diagnostic accuracy. The combined criterion showed 83.73% sensitivity, 85.71% specificity, 98.87% PPV, 26.09% NPV, and 83.86% diagnostic accuracy. Thus, CRP alone had the highest sensitivity and accuracy, whereas the combined criterion had the highest specificity and PPV.

Conclusion: Serum CRP provides useful adjunctive information to MAS. A positive MAS-CRP combination may strengthen diagnostic confidence because of its high specificity and PPV; however, neither a low MAS nor a normal CRP result reliably excludes acute appendicitis.