Efficacy of Motor Imagery Training with Gait Training to improve Dynamic Balance and Gait Speed in Post Stroke patients

This study compares the effectiveness of Motor imagery training combined with Gait training versus Gait training to improve dynamic balance and gait speed of patients with post stroke hemiparesis. In twenty patients with moderate stroke dynamic balance was tested by Functional reach test and Time up and go test and gait speed was tested by 10 Meter Walk test. They were divided into experimental and control group, with 10 subjects in each group. Experimental group subjects were given warm up exercises for 5 minutes, Motor imagery training combined with Gait training 50 minutes and cool down exercises for 5 minutes. Control group subjects were given warm up exercises for 5 minutes, Gait training for 50 minutes and cool down exercises for 5 minutes. The duration of the exercises program was six weeks. At the end of the program on the 42 day, dynamic balance and gait speed was done again. The results were analyzed using students ‘t’ test. The analysis of results showed that Motor imagery training combined with Gait training improved the dynamic balance and gait speed in patients with post stroke. Hence it can be concluded that Motor imagery training combined with Gait training given to the experimental group proved to be superior than Gait training alone given to the control group. The exercise program is brief and simple. Risks are also minimal if patients are taught properly and made to do at home after initial supervision by the therapist. This exercise program can be prescribed for post stroke patients whose dynamic balance and gait speed is affected and related secondary injuries

Clinical and Hematological evaluation of leukemias, using cytochemical stains and immunophenotyping

INTRODUCTION: Leukemias are abnormal proliferation of hematopoietic cells, causing progressive infiltration of the marrow. It is the eleventh most common cancer in the world, and increasingly found now. Two widely used classification are used now, the FAB, and the WHO classification, which has got supplanted now, with increasing knowledge on cytomorphology and cytogenetics. This study attempts to evaluate the role of cytochemistry in the various types of leukemias, as well as the role of immunophenotyping in a select few cases, in patients which were referred to the Department of pathology, at Thanjavur Medical College. AIM OF THE STUDY: The main aim of the study was to assess the type and subtype of leukemia, using cytochemistry and their morphology, as well as to see the distribution of demographic data among them, and to evaluate their clinical and hematological presentation. RESULTS: 56 cases of leukemia, identified by morphology and cytochemistry, were seen in the study between January 2015 and June 2015. Cytochemical stains used were Sudan black B, and PAS. Out of the total, 36 cases were acute, rest were chronic cases. AML accounted for 43% of the cases, followed by CML at 33%, and ALL at 22%. A slight female preponderance was seen in the number of AML cases, but a male predominance in ALL. ALL was common in the child age group, followed by AML, and CML in the 21-40 age group, followed by AML.CLL was seen mostly above 40 yrs of age. Anemia was seen more in acute leukemias especially ALL, followed by AML. Total count values were seen high in CML, followed by AML. Platelet counts were less in acute leukemias, especially ALL, followed by AML. Splenomegaly was the commonest feature seen in 21 cases. Immunophenotyping was done in 6 cases, 4 cases were concordant, showing a 67% rate. CONCLUSION: In a setting where there is a lack of facilities for flow cytometry, as in majority of centres in the developing countries, morphology combined with cytochemistry, still serves as the best means in diagnosing leukemia cases

A study of serum copeptin level in Acute Myocardial Infarction

INTRODUCTION: Acute Myocardial Infarction is the well known cause for morbidity and mortality in the world wide. AMI is a clinical cardiac event due to prolonged myocardial ischemia and necrosis. Myocardial ischemia defines reduced oxygen and nutrient supply to the cardiac myocytes due to decreased perfusion. The diagnosis is done by symptoms, signs and electrocardiogram findings, but in some patients, it is not possible. Rapid diagnosis of these patients helps to direct further management. Early diagnosis leads to proper treatment in time and also it prevents complications, thereby improving patients outcome. Cardiac biomarkers namely, Cardiac Troponin and CK-MB are available for detection of myocardial necrosis. These markers are released only after myocardial necrosis occurs. Delay in release of these markers affects the management. Therefore, cardiac markers with pathophysiology independent of myocardial necrosis might improve rapid diagnosis of AMI. COPEPTIN (CT-pro-vasopressin) is a new recently tested bio marker of acute endogenous (haemodynamic) stress. COPEPTIN is 39 amino acids glycopeptide and secreted with arginine vasopressin (AVP) and it is released from the hypothalamus together in stoichiometric pattern from stimulation of AVP release. The present study aims to evaluate the serum levels of COPEPTIN as an early marker in AMI, since AMI is an acute stress condition. AIM OF THE STUDY: To estimate the serum level of COPEPTIN in patients with Acute Myocardial Infarction within four hours of onset of chest pain. OBJECTIVES: 1. To correlate the S.COPEPTIN level with S.CK-MB. 2. To evaluate the correlation between S.COPEPTIN and other several known risk factors for AMI such as Random Blood Sugar, Blood.Urea, S.Creatinine and Lipid profile (S.Total Cholesterol, S.Triglycerides, S.HDL-C, S.LDL-C, S.VLDL). 3. To prove the use of S.COPEPTIN as an early marker of AMI. MATERIALS AND METHODS: The study was conducted in Thanjavur Medical College, Thanjavur. 50 patients with symptoms of Acute Myocardial Infarction presented within 4 hrs of onset of pain in the casuality with ECG findings correlated and were taken as subjects.50 age and sex matched controls were taken as control group. The following parameters were estimated immediately after the serum separation. 1. Serum COPEPTIN, 2. Serum Creatine Kinase-MB, 3. Random Blood Sugar, 4. Blood Urea, 5. Serum Creatinine, 6. S.Total Cholesterol, 7. S.Triglycerides, 8. S.HDL cholesterol, CALCULATED PARAMETERS: 1. Body Mass Index:(BMI) = Weight in Kg/(Height in meters), 2. S.Very Low Density Lipoprotein = TGL/5, 3. S.Low Density Lipoprotein = T.Chol – (LDL +VLDL). ESTIMATION OF SERUM COPEPTIN: Serum COPEPTIN was measured in all the samples within one month of collecting the samples by Sandwich Enzyme – Linked Immuno Sorbent Assay (ELISA). RESULTS: A total of 100 participants were included in the study. Out of these, 50 were grouped under control and 50 were under cases. The serum value of Copeptin, S.CK-MB, Random blood sugar, B.Urea,S.Creatinine,S. Total Cholesterol, S.HDL and S.TGL were estimated for all the samples in both the groups. BMI, S.VLDL, and S.LDL were calculated. In this study,the mean value of serum COPEPTIN (62.5 + 46.44 ng/L ) was significantly higher than that of healthy controls (34.8 + 13.4 ng/L).The mean S.CK-MB (16.08 + 10.71) level in the study group was significantly higher than in control group (9.68 + 3.86 ). But , CK-MB did not increase significantly as S. COPEPTIN increased in the early hours of AMI. Pearson correlation analysis also showed significant correlation between S.COPEPTIN with S.CK-MB. The mean S.total cholesterol level in the study group (201.5 ± 34.9) was higher than the control group (179.8 ± 14.5 ) which was statistically significant. The mean serum HDL-C which is lower in the study group compared to the control group (34.7± 3.4 versus 38.4 ± 5.7) which was statistically significant (p < 0.0001). The mean values of S.LDL-C, S.VLDL, and S.TGL are also significantly increased in the study group than the control group. This study shows that serum levels of COPEPTIN are high in patients with AMI at very early stage. CONCLUSION: COPEPTIN is a new bio marker of acute endogenous (haemodynamic) stress. In AMI, which is an acute stressful state, S.COPEPTIN level rises. Measurement of S.COPEPTIN helps to diagnose AMI in Emergency Department before the onset of necrosis.. Measuring S.COPEPTIN along with ECG and other markers improves the diagnostic sensitivity of the method. S.COPEPTIN can be used as a novel early marker in patients with AMI. Hence, earlier diagnosis helps in reducing the morbidity and mortality from AMI