Progressive resistance training improving gait performance and mobility in acute and chronic stroke patients

Stroke, a neurological disorder, leads to long-term disability thereby greatly affecting gait and mobility. The purpose of the current study was to investigate the effects of progressive resistance training in both acute and chronic stroke patients. A quasi interventional study was designed and 46 stroke patients were recruited through convenience sampling technique. Sample size was calculated using epi-tool. Patients who had cognitive problems, balance impairments and contractures were excluded from the study. The study was conducted from January to June 2018, at Rafsan Rehab & Research Centre, Peshawar. Progressive resistance exercises starting at 50 % of one repetition maximum (RM) were performed three days/week and for a total duration of nine weeks. Blind assessor measured readings at baseline and after nine weeks. Gait dynamic index (GDI), Six-Meter Walk Test (SMWT) and Five Times Sit-to-Stand (FTSTS) tools were used to collect the required data. The data was analysed at baseline and after nine weeks on SPSS-20. After nine weeks of intervention significant improvement was recorded in patients on GDI (p<0.001), SMWT score (P<0.001) and FTSTS (p<0.001). Progressive resistance training improves mobility limitations and gait in both acute and chronic stroke patients.måsjekke

THE IN VITRO AND EX VIVO EFFECT OF PHYLLANTHUS NIRURI METHANOL EXTRACT ON HEPATIC GLUTATHIONE S-TRANSFERASE ACTIVITY IN STZ-INDUCED DIABETIC SPRAGUE DAWLEY RATS

ABSTRACTObjective: The aim of this study was to investigate the in vitro and ex vivo (acute and sub-chronic doses) effect of Phyllanthus niruri methanol extract (PNME) on the activity of cytosolic glutathione S-transferase (GST) in streptozotocin (STZ)-induced diabetic young female Sprague Dawley (SD) rats.Methods: Young female SD rats were induced type I diabetes mellitus using STZ (60 mg/kg i.v.). The in vitro study was performed on cytosolic fraction of diabetic rat livers using PNME in concentrations of 0.01, 1 and 10 µg/ml. Meanwhile, ex vivo studies were performed on diabetic rats using PNME in doses of 500, 1000, 2000 and 5000 mg/kg p.o. for acute study (1 day) and 100, 500 and 2000 mg/kg/day p.o. for sub-chronic study (14 days). The GST activity in the cytosolic liver fraction was measured using spectrophotometric analysis.Results: The in vitro study showed that, there is no significant effect of the three concentrations of PNME versus control on GST activity in cytosolic fraction of diabetic young female SD rat livers, while for ex vivo study, there is a significant dose independent induction effect on GST enzyme activity at all doses used in acute study. Meanwhile, sub-chronic study showed significant dose-independent induction effect at doses 500 and 2000 mg/kg.Conclusion: This study suggests that Phyllanthus niruri may increase the clearance of drugs that are metabolized by GST enzyme in phase II metabolism when given concomitantly with this plant extract.Key words: Phyllanthus niruri, GST, diabetic rats, cytosolic liver fraction, phase II metabolismÂ

Trans-articular chondrosarcoma grade 2 of proximal phalanx resulting in its fracture along with destruction of middle phalanx of 2nd toe right foot: a case report and review of the literature

Foot is an unusual site for chondrosarcoma and involvement of phalanges is extremely rare. We report a case of grade 2 chondrosarcoma of proximal phalanx resulting in its fracture along with transarticular extension to the middle phalanx of the 2nd toe of right foot in a 62 year old female. The patient presented with 1 and ½ year history of pain and swelling in right 2nd toe. X-ray showed presence of expanding lytic lesion with amorphous calcification along with fracture proximal phalanx. Fine needle aspiration cytology showed some pleomorphs, osteoclasts and some giant cells. We went for amputation of toe without a biopsy. Histopathological examination of specimen showed multiple pleomorphic cells, nuclear atypia, hyperchromasia with some giant cells (grade 2 chondrosarcoma)

Peer review audit of trauma deaths in a developing country

OBJECTIVES: Peer review of trauma deaths can be used to evaluate the efficacy of trauma systems. The objective of this study was to estimate teh proportion of preventable trauma deaths and the factors contributing to poor outcome using peer review in a tertiary care hospital in a developing country. METHODS: All trauma deaths during a 2-year period (1 January 1998 to 30 December 1998) were identified and registered in a computerized trauma registry, and the probability of survival was calculated for all patients. Summary data, including registry information and details of prehospital, emergency room, and definitive care, were provided to all members of the peer review committee 1 week before the committee meeting. The committee then reviewed all cases and classified each death as preventable, potentially preventable, or non-preventable.RESULTS AND CONCLUSION: A total fo 279 patients were registered in the trauma registry during the study period, including 18 trauma deaths. Peer review judged that six were preventable, seven were potentially preventable, and four were non-preventable. One patient was excluded because the record was not available for review. The proportion of preventable and potentially preventable deaths was significantly higher in our study than from developed countries. Of the multiple contributing factors identified, the most important were inadequate prehospital transfer, limited hospital resources, and an absence of integrated and organized trauma care. This study summarizes the challenges faced in trauma care in a developing country

Revisiting the high-performance reconfigurable computing for future datacenters

Modern datacenters are reinforcing the computational power and energy efficiency by assimilating field programmable gate arrays (FPGAs). The sustainability of this large-scale integration depends on enabling multi-tenant FPGAs. This requisite amplifies the importance of communication architecture and virtualization method with the required features in order to meet the high-end objective. Consequently, in the last decade, academia and industry proposed several virtualization techniques and hardware architectures for addressing resource management, scheduling, adoptability, segregation, scalability, performance-overhead, availability, programmability, time-to-market, security, and mainly, multitenancy. This paper provides an extensive survey covering three important aspects-discussion on non-standard terms used in existing literature, network-on-chip evaluation choices as a mean to explore the communication architecture, and virtualization methods under latest classification. The purpose is to emphasize the importance of choosing appropriate communication architecture, virtualization technique and standard language to evolve the multi-tenant FPGAs in datacenters. None of the previous surveys encapsulated these aspects in one writing. Open problems are indicated for scientific community as well

A novel training simulator for portable ultrasound identification of incorrect newborn endotracheal tube placement – Observational diagnostic accuracy study protocol

Background: Endotracheal tube (ETT) placement is a critical procedure for newborns that are unable to breathe. Inadvertent esophageal intubation can lead to oxygen deprivation and consequent permanent neurological impairment. Current standard-of-care methods to confirm ETT placement in neonates (auscultation, colorimetric capnography, and chest x-ray) are time consuming or unreliable, especially in the stressful resuscitation environment. Point-of-care ultrasound (POCUS) of the neck has recently emerged as a powerful tool for detecting esophageal ETTs. It is accurate and fast, and is also easy to learn and perform, especially on children.Methods: This will be an observational diagnostic accuracy study consisting of two phases and conducted at the Aga Khan University Hospital in Karachi, Pakistan. In phase 1, neonatal health care providers that currently perform standard-of-care methods for ETT localization, regardless of experience in portable ultrasound, will undergo a two-hour training session. During this session, providers will learn to detect tracheal vs. esophageal ETTs using POCUS. The session will consist of a didactic component, hands-on training with a novel intubation ultrasound simulator, and practice with stable, ventilated newborns. At the end of the session, the providers will undergo an objective structured assessment of technical skills, as well as an evaluation of their ability to differentiate between tracheal and esophageal endotracheal tubes. In phase 2, newborns requiring intubation will be assessed for ETT location via POCUS, at the same time as standard-of-care methods. The initial 2 months of phase 2 will include a quality assurance component to ensure the POCUS accuracy of trained providers. The primary outcome of the study is to determine the accuracy of neck POCUS for ETT location when performed by neonatal providers with focused POCUS training, and the secondary outcome is to determine whether neck POCUS is faster than standard-of-care methods.Discussion: This study represents the first large investigation of the benefits of POCUS for ETT confirmation in the sickest newborns undergoing intubations for respiratory support

Factors associated with low birthweight in term pregnancies: A matched case-control study from rural Pakistan

Low birthweight (LBW) remains a significant public health problem in Pakistan and further understanding of factors associated with LBW is required. We conducted a hospital-based matched case control study to identify risk factors associated with LBW in a rural district of Pakistan. We found that illiteracy (AOR: 2.68; 95% CI: 1.59 - 4.38), nulliparity (AOR: 1.82; 95% CI: 1.26-2.44), having a previous miscarriage/abortion (AOR: 1.22; 95% CI: 1.06-2.35), having \u3c 2 antenatal care (ANC) visits during last pregnancy (AOR: 2.43; 95% CI: 1.34-2.88), seeking ANC in third trimester (AOR: 3.62; 95% CI : 2.14-5.03), non-use of iron folic acid during last pregnancy (AOR: 2.72; 95% CI: 1.75-3.17), having hypertension during last pregnancy (AOR: 1.42; 95% CI: 1.13-2.20), being anemic (AOR: 2.67; 95% CI: 1.65-5.24) and having postpartum weight o

Behind the counter: pharmacies and dispensing patterns of pharmacy attendants in Karachi.

BACKGROUND: There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries. OBJECTIVE: This study obtained background information on pharmacies assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi. METHODOLOGY: This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants. RESULTS: Of the 219 pharmacies surveyed, 62% reported more than 50 customers daily and 20% also sold items of general provision. Mean operating hours were 13. Only 24 (11%) had a visible license. On an average 3 attendants were employed per pharmacy. We interviewed one in each. Amongst the 219 interviewed, 77 (35%) were intermediate qualified and only 26 (12%) pharmacologically trained. Correct frequency of ORS administration was not known by 167 (76%) and 21% incorrectly suggested an anti-diarrhoeal preparation for viral diarrhoea in children. The knowledge of those with pharmacological training was significantly better. For respiratory tract infection in children approximately 60% did not know the correct dose of Paracetamol and Amoxicillin. Only 13 (6%) knew that Propanalol was contraindicated in hypertensive asthamatics. For Cotrimoxazole, metronidazole and lomotil only 40%, 21% and 15% respectively, were aware that these could not be dispensed without prescription. CONCLUSION: In the absence of trained pharmacists existing pharmacy attendants should be trained to improve drug-dispensing patterns