RESPIRATORY MUSCLE TRAINING WITH THERABAND VERSUS INCENTIVE SPIROMETER AMONG INDIVIDUALS WITH BRONCHIAL ASTHMA

Objective: To determine and compare the effects of Theraband exercises with Incentive Spirometer exercise in improving respiratory muscle strength among bronchial asthma. Methods: In this study, 30 Individuals with Bronchial asthma were taken and assessed for FEV1/FVC, Maximum voluntary ventilation (MVV) using a computerized spirometer, dyspnea level graded using MMRC scale and diaphragm muscle strength assessed using manual muscle testing (MMT) as pre-test then the individuals were randomly allocated in two groups: Group A and Group B. Group A (n=15) received Theraband exercise and Group B (n=15) were treated with incentive spirometer for a total period of 4 w following which the outcome measures were repeated for post-test. Results: Based on the obtained statistics, both the groups showed significant improvement within groups when comparing pre and post-test measures. On comparing the mean values of the post-test between the groups, theraband exercises showed clinically higher significant results than incentive spirometer exercises. Conclusion: From the result, it shall been concluded that both theraband exercises and incentive spirometer exercises shows improvement in MVV, FEV1/FVC, reduced dyspnea and increased respiratory muscle strength. Hence, theraband exercises are effective compared to the incentive spirometer

Ocular injuries and eye care seeking patterns following injuries among cocoa farmers in Ghana

Background: The work environment of cocoa farmers exposes them to several ocular hazards that predispose them to eye diseases and injuries. However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in Ghana.Objectives: To determine the prevalence of ocular injuries and health seeking behaviour following injury among cocoa farmers in Ghana.Methods: Five hundred and fifty six participants were recruited through simple random sampling using a multistage approach from four cocoa growing districts in Ghana. A structured questionnaire was used to collect relevant information such as demography, ocular hazards and injuries experienced. An ocular examination was also conducted to assess the eye health of the participants. Descriptive and regression statistics were used to analyze the data. The rate of ocular injuries was calculated by using the number of injuries reported that resulted in lost work time/days divided by the number of worker years at risk of injury (sum of years worked in cocoa farms for all the participants).Results: The rate of ocular injuries was 11.3/1000 worker years (95% CI: 9.4 - 31) which led to lost work time of 37.3/1000 worker years (95% CI: 34.1 - 40.8). The major causes of ocular injury were plants/branches (n=73, 51.1%), chemicals (n=27, 18.9%), cocoa pod/husk (n=14, 9.8%) and occurred mostly during weeding, harvesting and chemical spraying. Few (n=34, 6.1%) participants reported the use of ocular protection. Fifty-five (38.5%) participants visited the local chemical shops, while 37 (25.9%) visited hospitals/clinics for ocular treatment of their injuries.Conclusion: There is a high rate of ocular injuries among cocoa farmers who make insufficient use of appropriate eye care services. There is the need for eye health education among cocoa farmers in Ghana.Keywords: Ocular injuries, cocoa farmers, ocular protective device, eye care service

EFFECT OF STRETCHING RESPIRATORY ACCESSORY MUSCLES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

ABSTRACTObjective: To determine the effects of respiratory accessory muscles stretching in chronic obstructive pulmonary disease (COPD).Methods: A total of 30 patients with COPD were selected based on the inclusion and exclusion criteria. Group allocation was randomized anddivided into two groups: Group A was treated with stretching respiratory accessory muscles and Group B was treated with conventional therapy(diaphragmatic breathing exercise and thoracic mobility exercise). All the patients were evaluated with chest expansion measurement using inch tape,dyspnea grade using modified Borg's scale, and 6 minutes walk test at baseline after which, treatment for a period of 4-week was given and same testswere repeated for post-test analysis at the end of 4 weeks.Results: There is a significant difference between pre- and post-tests mean values in both groups. Group A being highly significant with a greaterdifference in pre- and post-tests values with a p<0.0001 for chest expansion measurements, modified Borg's scale and 6 minutes walk test.Conclusion: This study showed that respiratory accessory muscle stretching significantly improved chest expansion, reduced dyspnea, and increaseexercise tolerance level in patients with COPD.Keywords: Chronic obstructive pulmonary disease, Respiratory, Accessory muscle stretching

EFFECT OF SMOKING ON HEART RATE VARIABILITY IN NORMAL HEALTHY VOLUNTEERS

ABSTRACTObjective: The aim of this study is to determine the effect of tobacco smoke on heart rate variability (HRV).Methods: This study included 90 male smokers (30-mild, 30-moderate, 30-severe) (Group II) and 30 age-matched non-smokers as controls (Group I).HRV analysis was performed using 8 channels Physiopac of Medicaid Company. All the subjects were subjected to HRV test. The short-term 8 minutesHR recording was performed for HRV analysis.Results: Mean RR, mean HR, root mean square of the successive differences, of the smokers and non-smokers, did not differ significantly. However,smokers NN50, Pnn50, high frequency (HF) declined significantly, and the smokers show significantly higher low frequency (LF), LF/HF ratio whencompared with those of the non-smoking individuals (p<0.05).Conclusion: HRV analysis of smokers and nonsmokers showed that smoking subjects had an autonomic imbalance suggestive of an increasedsympathetic tone or decreased parasympathetic tone. Sympathetic overactivity may lead to cardiovascular disease development in smokers.Keywords: Smoking, Healthy volunteers, Heart rate variability

Characterization of a Stress-Induced Alternate Sigma Factor, RpoS, of Coxiella burnetii and Its Expression during the Development Cycle

Coxiella burnetii is an obligate intracellular bacterium that resides in an acidified phagolysosome and has a remarkable ability to persist in the extracellular environment. C. burnetii has evolved a developmental cycle that includes at least two morphologic forms, designated large cell variants (LCV) and small cell variants (SCV). Based on differential protein expression, distinct ultrastructures, and different metabolic activities, we speculated that LCV and SCV are similar to typical logarithmic- and stationary-phase growth stages. We hypothesized that the alternate sigma factor, RpoS, a global regulator of genes expressed under stationary-phase, starvation, and stress conditions in many bacteria, regulates differential expression in life cycle variants of C. burnetii. To test this hypothesis, we cloned and characterized the major sigma factor, encoded by an rpoD homologue, and the stress response sigma factor, encoded by an rpoS homologue. The rpoS gene was cloned by complementation of an Escherichia coli rpoS null mutant containing an RpoS-dependent lacZ fusion (osmY::lacZ). Expression of C. burnetii rpoS was regulated by growth phase in E. coli (induced upon entry into stationary phase). A glutathione S-transferase–RpoS fusion protein was used to develop polyclonal antiserum against C. burnetii RpoS. Western blot analysis detected abundant RpoS in LCV but not in SCV. These results suggest that LCV and SCV are not comparable to logarithmic and stationary phases of growth and may represent a novel adaptation for survival in both the phagolysosome and the extracellular environment

Differential Expression of Translational Elements by Life Cycle Variants of Coxiella burnetii

Coxiella burnetii replicates as distinct morphological forms, which may allow potential life cycle variants to survive the harsh environment of the phagolysosome. Monoclonal antibodies (MAbs) were compared by Western blotting for reactivity with large cell variant (LCV) and small cell variant (SCV) antigens to characterize proteins differentially expressed by C. burnetii. MAb NM7.3 reacted with a ∼32-kDa LCV-upregulated antigen, and MAb NM183 reacted with a ∼45-kDa LCV-specific antigen. MAb NM7.3 was used to screen a λZapII C. burnetii DNA expression library, and an immunoreactive clone was identified with sequence similarity to the Escherichia coli tsf gene, which encodes elongation factor Ts (EF-Ts). Since a similar screen with MAb NM183 did not identify immunoreactive clones, an alternate strategy was devised to clone the reactive antigen based on observations of cross-reactivity with the 45-kDa elongation factor Tu (EF-Tu) protein from Chlamydia trachomatis. The highly conserved nature of EF-Tu among eubacteria allowed PCR amplification of a tuf gene fragment (encoding ∼95% of the predicted EF-Tu open reading frame) from C. burnetii using degenerate primers. The product of the cloned tuf gene fragment reacted with MAb NM183 in Western blot analysis, confirming the identity of the 45-kDa LCV-specific antigen. Identification of two proteins differentially expressed by C. burnetii, EF-Tu and EF-Ts, both essential components of the translational machinery of the cell, supports the hypothesis that LCVs are metabolically more active than SCVs

Ocular injuries and eye care seeking patterns following injuries among cocoa farmers in Ghana.

Background: The work environment of cocoa farmers exposes them to several ocular hazards that predispose them to eye diseases and injuries. However, the extent of ocular injuries and health seeking patterns following these injuries are unknown among cocoa farmers in Ghana. Objectives: To determine the prevalence of ocular injuries and health seeking behaviour following injury among cocoa farmers in Ghana. Methods: Five hundred and fifty six participants were recruited through simple random sampling using a multistage approach from four cocoa growing districts in Ghana. A structured questionnaire was used to collect relevant information such as demography, ocular hazards and injuries experienced. An ocular examination was also conducted to assess the eye health of the participants. Descriptive and regression statistics were used to analyze the data. The rate of ocular injuries was calculated by using the number of injuries reported that resulted in lost work time/days divided by the number of worker years at risk of injury (sum of years worked in cocoa farms for all the participants). Results: The rate of ocular injuries was 11.3/1000 worker years (95% CI: 9.4 - 31) which led to lost work time of 37.3/1000 worker years (95% CI: 34.1 - 40.8). The major causes of ocular injury were plants/branches (n=73, 51.1%), chemicals (n=27, 18.9%), cocoa pod/husk (n=14, 9.8%) and occurred mostly during weeding, harvesting and chemical spraying. Few (n=34, 6.1%) participants reported the use of ocular protection. Fifty-five (38.5%) participants visited the local chemical shops, while 37 (25.9%) visited hospitals/clinics for ocular treatment of their injuries. Conclusion: There is a high rate of ocular injuries among cocoa farmers who make insufficient use of appropriate eye care services. There is the need for eye health education among cocoa farmers in Ghana. Keywords

Vascular diseases await translation of blood vessels engineered from stem cells

The discovery of human induced pluripotent stem cells (hiPSCs) opened new avenues for research and potential clinical applications for tissue regeneration and engineering. In particular,hiPSCs may offer a long sought solution for obtaining large numbers of autologous cells sufficient for tissue engineering. For vascular tissue engineering, several methods of generating endothelial cells or perivascular cells from hiPSCs in vitro have been reported. We review the current developments in the generation of vascular progenitor cells from hiPSCs and their functional capacity in vivo, and discuss the opportunities and challenges ahead for clinical translation and modeling vascular diseases using hiPSC-derived vascular cells with a focus on diabetes

Differential Effects of Sorafenib on Liver Versus Tumor Fibrosis Mediated by Stromal-Derived Factor 1 alpha/C-X-C Receptor Type 4 Axis and Myeloid Differentiation Antigen-Positive Myeloid Cell Infiltration in Mice

Sorafenib—a broad kinase inhibitor—is a standard therapy for advanced hepatocellular carcinoma (HCC) and has been shown to exert antifibrotic effects in liver cirrhosis, a precursor of HCC. However, the effects of sorafenib on tumor desmoplasia—and its consequences on treatment resistance—remain unknown. We demonstrate that sorafenib has differential effects on tumor fibrosis versus liver fibrosis in orthotopic models of HCC in mice. Sorafenib intensifies tumor hypoxia, which increases stromal-derived factor 1 alpha (SDF-1α) expression in cancer and stromal cells and, subsequently, myeloid differentiation antigen–positive (Gr-1+) myeloid cell infiltration. The SDF-1α/C-X-C receptor type 4 (CXCR4) pathway directly promotes hepatic stellate cell (HSC) differentiation and activation through the mitogen-activated protein kinase pathway. This is consistent with the association between SDF-1α expression with fibrotic septa in cirrhotic liver tissues as well as with desmoplastic regions of human HCC samples. We demonstrate that after treatment with sorafenib, SDF-1α increased the survival of HSCs and their alpha-smooth muscle actin and collagen I expression, thus increasing tumor fibrosis. Finally, we show that Gr-1+ myeloid cells mediate HSC differentiation and activation in a paracrine manner. CXCR4 inhibition, using AMD3100 in combination with sorafenib treatment, prevents the increase in tumor fibrosis—despite persistently elevated hypoxia—in part by reducing Gr-1+ myeloid cell infiltration and inhibits HCC growth. Similarly, antibody blockade of Gr-1 reduces tumor fibrosis and inhibits HCC growth when combined with sorafenib treatment. Conclusion: Blocking SDF-1α/CXCR4 or Gr-1+ myeloid cell infiltration may reduce hypoxia-mediated HCC desmoplasia and increase the efficacy of sorafenib treatment. (Hepatology 2014;59:1435-1447

First Results on Survival from a Large Phase 3 Clinical Trial of an Autologous Dendritic Cell Vaccine in Newly Diagnosed Glioblastoma

Background: Standard therapy for glioblastoma includes surgery, radiotherapy, and temozolomide. This Phase 3 trial evaluates the addition of an autologous tumor lysate-pulsed dendritic cell vaccine (DCVax®-L) to standard therapy for newly diagnosed glioblastoma. Methods: After surgery and chemoradiotherapy, patients were randomized (2:1) to receive temozolomide plus DCVax-L (n = 232) or temozolomide and placebo (n = 99). Following recurrence, all patients were allowed to receive DCVax-L, without unblinding. The primary endpoint was progression free survival (PFS); the secondary endpoint was overall survival (OS). Results: For the intent-to-treat (ITT) population (n = 331), median OS (mOS) was 23.1 months from surgery. Because of the cross-over trial design, nearly 90% of the ITT population received DCVax-L. For patients with methylated MGMT (n = 131), mOS was 34.7 months from surgery, with a 3-year survival of 46.4%. As of this analysis, 223 patients are ≥ 30 months past their surgery date; 67 of these (30.0%) have lived ≥ 30 months and have a Kaplan-Meier (KM)-derived mOS of 46.5 months. 182 patients are ≥ 36 months past surgery; 44 of these (24.2%) have lived ≥ 36 months and have a KM-derived mOS of 88.2 months. A population of extended survivors (n = 100) with mOS of 40.5 months, not explained by known prognostic factors, will be analyzed further. Only 2.1% of ITT patients (n = 7) had a grade 3 or 4 adverse event that was deemed at least possibly related to the vaccine. Overall adverse events with DCVax were comparable to standard therapy alone. Conclusions: Addition of DCVax-L to standard therapy is feasible and safe in glioblastoma patients, and may extend survival