Prevalence of quadriceps muscle weakness in patients with COPD and its association with disease severity

INTRODUCTION: COPD presents with an array of extra-pulmonary symptoms of which skeletal muscle dysfunction, particularly of the quadriceps, is well recognized. This contributes to impaired quality of life and increased health care utilization. Work on the quadriceps originated from the observation that a good proportion of COPD patients stop exercise due to the feeling of leg fatigue rather than breathlessness. This study was carried out with the aim of finding the prevalence of quadriceps weakness in a population set and correlate it with severity of COPD. METHODOLOGY: This cross-sectional study was conducted in 75 subjects suffering from COPD aged 45 years or above. COPD severity in the subjects was graded based on the GOLD staging system. A digital hand held dynamometer (HHD) was used to measure quadriceps muscle strength. Descriptive statistics were done, and Pearson’s Correlation Coefficient and ANOVA analysis was used for expressing the results. RESULTS: Ninety two percent of subjects were suffering from quadriceps muscle weakness. Quadriceps weakness was present in significantly high proportions even in those suffering from mild disease and belonging to a younger age group. The mean quadriceps muscle force value decreased with disease severity and this relation was found to be significant (P<0.01). CONCLUSION: Majority of the COPD patients were found to be suffering from quadriceps weakness, which was also present in significant proportions in subjects belonging to younger age groups and suffering from mild disease. These findings indicate that onset of muscle weakness in COPD may precede the onset of symptoms. These findings suggest need for early remedial measure to prevent occurrence of associated systemic diseases

Charge Density Wave Order in the Topological Insulator Bi2Se3Bi_2Se_3

Hexagonally deformed Fermi surfaces and strong nesting, found in topological insulators (TIs) such as $Bi_2Se_3$ and $Bi_2Te_3$ over the past decade, have led to several predictions of possible Density Wave order in these systems. Recent evidence for strong Fermi nesting in superconducting $Cu-Bi_2Se_3$ and $Nb-Bi_2Se_3$ has led to further speculation about the importance of charge order in the context of unconventional superconductivity. Here, we report what we believe is the first direct observation of Charge Density Wave (CDW) order in $Bi_2Se_3$. Our results include the observation of a 140K metal-insulator-metal transition in resistivity as a function of temperature. We corroborate this with nuclear magnetic resonance (NMR) studies of the spin-lattice relaxation $\frac{1}{T_1}$ rate of the $^{209}Bi$ nucleus, which also displays a transition at 140K. Additionally, we use electron diffraction to reveal a periodic lattice distortion (PLD) in $Bi_2Se_3$, together with diffuse charge order between $\vec{k}$ and $\vec{k} \pm \Delta\vec{k}$. This diffuse scattering points toward the presence of an incommensurate charge density wave (I-CDW) above room temperature, which locks into a CDW upon cooling below $\sim140K$. We also observe two additional transitions in $\frac{1}{T_1}$ near 200K and 15K. The transition at 200K appears to display some anisotropy with the direction of applied magnetic field. In this report, we focus on the CDW transition at 140K. We include some speculation of the two other transitions observed at 15K and 200K by NMR, also revealed here for the first time.Comment: 16 pages, 5 figure

Dual Primary Malignancy: A Rare Organ Combination

A 63-year-old female smoker was evaluated for lump over the right breast, fine needle aspiration cytology of which showed infiltrating ductal carcinoma. Investigations also revealed the presence of left upper lobe mass lesion, the biopsy of which suggested small cell carcinoma. The existence of two malignancies having different histopathologies at anatomically distinct sites suggests the diagnosis of dual primary malignancy involving the breast and the lung which, being a rare combination, prompted us to report the case

Evaluation of Preclinical Task Based Learning program in Medical Education [version 1; peer review: 1 approved, 2 approved with reservations]

The conventional curriculum in preclinical medical education has a need for early clinical exposure programs that help in correlation of basic science data with clinical skills. This is helpful to develop clinical reasoning skills, problem-solving abilities, team work, communication skills and overall attitudes and behaviour relevant for a healthcare provider. Preclinical task based learning (TskBL) is an active learning strategy in which the focus for the first year medical student is a real task done by a doctor. In this strategy the student-doctors undergo a standardized patient encounter and discuss the learning issues related to the task in the first year of medical school. The current study is focussed on the student perception of the effectiveness of task based learning module.The TskBL was conducted among first year medical students for nine topics that are commonly encountered in the clinics. After TskBL was planned and implemented the evaluation of the modules was done using focus group discussions. The students highlighted the importance of standardized patients in the TskBL strategy in providing early clinical exposure in preclinical medical education. They reported its usefulness gaining essential knowledge, skills and attitudes for medical learning. They reported positive outcomes of module design and processes and activities in TskBL. Based on the negative aspects of the modules, future improvement was suggested in improving the usefulness of standardized patient encounter. This study showed the novice learners’ outlook of the potency of TskBL for several other topics of clinical relevance to provide early clinical exposure in medical schools

X-linked agammaglobulinemia rare disease with a rarer presentation

X-linked agammaglobulinemia (XLA) is a rare disorder, characterized by absence of mature B cells leading to severe antibodies deficiency. This translates to recurrent sinopulmonary infections in affected children. The most common age group of presentation is 6 months to 2 years. Being an X-linked recessive disorder males are affected, females are carriers. Intravenous immunoglobulins and antibiotics remains the corner stone of treatment. Here in, we report a case of 11-year-old male having recurrent episodes of fever with one episode of hospitalization 3 years back. Child was treated at healthcare facility elsewhere for recurrent fever. He presented to our institute with signs and symptoms suggestive of meningitis, investigated, had culture proven Staphylococcus aureus meningitis with a low Absolute Lymphocyte Count (ALC). On further work up found to have low serum immunoglobulins (IgG, IgM, IgA) and Flowcytometry showing absence of B cells (CD19/CD20). Child was diagnosed to have XLA. This case highlights the importance of having strong clinical suspicion of XLA, despite not having recurrent sinopulmonary infections.</jats:p

Residual life estimation of structural beam using experimental and numerical modal analysis methods

A structural beam is a common element in many mechanical structures such as ship propeller shaft, crane boom, and aircraft wings. In the present paper experimental and numerical modal analysis are carried out for estimating the damage, geometric location of the damage, severity of damage and residual life of structural beam to prevent unexpected failures of mechanical structures. Experimental and numerical modal analysis results for healthy and cracked beam are compared for validation of numerical methodology used in the present paper. Experimental modal analysis is performed on both healthy and cracked beam with the help of impact hammer, acceleration sensor and FFT (Fast Fourier Transformer) analyzer associated with EDM (Engineering Data Management) software. Modal tests are conducted using impact method on selected locations of the entire healthy and cracked beam to find the first three natural frequencies, which are used to detect the presence of damage and geometric location of the damage. Three parametric studies are carried out to know the effect of crack depth, crack location and crack orientation on the natural frequencies of the cracked beam. Finally, the residual life of a healthy and cracked beam was estimated using Basiquin’s equation and finite element analysis software called ANSYS 18.1

Residual life estimation of structural beam using experimental and numerical modal analysis methods

A structural beam is a common element in many mechanical structures such as ship propeller shaft, crane boom, and air craft wings. In the present paper experimental and numerical modal analysis are carried out for estimating the damage detection, geometric location of the damage, severity of damage and residual life of structural beam to prevent unexpected failures of the mechanical structures. Experimental and numerical modal analysis results for healthy and cracked beam are compared for validation of numerical methodology used in the present paper. Experimental modal analysis is performed on both healthy and cracked beam with the help of impact hammer, acceleration sensor and FFT analyzer associated with EDM (Engineering Data Management) software. Modal tests are conducted using impact method on selected locations of the entire healthy and cracked beam to find the first three natural frequencies, which are used to detect the presence of damage and geometric location of the damage. Three parametric studies are carried out to know the effect of crack depth, crack location and crack orientation on the natural frequencies of the cracked beam. Finally,  residual life of a healthy and cracked beam was estimated using Basiquin’s equation and finite element analysis software called ANSYS 18.1.</jats:p