Effects of home-based exercise training on functional outcomes and quality of life in patients with pulmonary hypertension: A randomized clinical trial

Objectives The objective of this study was to assess the effects of home-based exercise training (HBET) on function and quality of life (QoL) in patients with pulmonary hypertension (PH). Methods A prospective, nonblinded, randomized clinical trial was carried out on 84 medically stable patients with PH belonging to any functional class or etiology and of either sex. Patients were randomized to either standard care or HBET. Both groups also received education using the Pulmonary Hypertension Manual (PulHMan). Outcomes included functional capacity from 6-min walk distance (6MWD), QoL using the Medical Outcomes Survey Short Form – 36, functional class (FC), and right heart indices (right ventricular systolic pressure [RVSP] and tricuspid annular plane systolic excursion [TAPSE]) and were assessed at entry and after 12 weeks. Results HBET improved 6MWD by 48.5 m and 13 m in the experimental and control groups, respectively (p < 0.001). QoL showed statistical improvements after HBET between the groups for the physical and mental components and for the various subdomains (except body pain). Furthermore, FC improved by one grade with HBET (p < 0.001). Conclusion HBET program improved functional capacity, QoL, and FC in patients with PH.

Prediction of Antigenic and Binding Sites of Neurotoxin 23 of Scorpion (Lychasmucronactus Sp.).

Identification of antigenic and binding site of protein is highly desirable for the design of vaccines and immunodiagnostics. The present exercise deals with a prediction of antigenic as well as binding sites of neurotoxin 23 of Lychasmucronactus. This species of scorpion having diverse molecules of toxic peptide, the peptide neurotoxin 23 is 96 amino acids long of which 23 to 96 specifically code for neurotoxin. The total of 27 such different ligand binding residue were identified by ConSurf and Raptor X server. The web tool Ellipro which implements Modeller and Jmol viewer, predicted and visualized the linear and discontinuous antibody epitopes ofneurotoxin 23 protein sequence.Thus the information discussed here provides a clue for understanding antigenic site and molecular function of neurotoxin 23.

Characterization and biological activities of extracellular melanin produced by Schizophyllum commune (Fries).

Melanins are enigmatic pigments produced by a wide variety of microorganisms including bacteria and fungi. Here, we have isolated and characterized extracellular melanin from mushroom fungus, Schizophyllum commune. The extracellular dark pigment produced by the broth culture of S. commune, after 21 days of incubation was recovered by hot acid-alkali treatment. The melanin nature of the pigment was characterized by biochemical tests and further, confirmed by UV, IR, EPR, NMR and MALDI-TOF Mass Spectra. Extracellular melanin, at 100 µg/ml, showed significant antibacterial activity against Escherichia coli, Bacillus subtilis, Klebsiella pneumoniae and Pseudomonas fluorescens and antifungal activity against Trichophyton simii and T. rubrum. At a concentration of 50 µg/ml, melanin showed high free radical scavenging activity of DPPH (2,2-diphenyl-1-picrylhydrazyl) indicating its antioxidant potential. It showed concentration dependent inhibition of cell proliferation of Human Epidermoid Larynx Carcinoma Cell Line (HEP-2). This study has demonstrated characterization of melanin from basidiomycetes mushroom fungus, Schizophyllum commune and its applications.

Test-retest reliability of a portable gas analysis system under free living conditions.

Introduction: K4b2 (COSMED Srl Italy) is a portable device that is considered valid and reliable for measuring oxygen uptake (VO2) and carbon dioxide production (VCO2) under laboratory conditions. Objectives: Evaluate the test-retest reliability of K4b2 during walking, stair climbing and descending stairs under free living conditions. Methods: Twelve participants completed two self-selected comfortable paced walking tests and 20 participants completed two self-selected comfortable paced stair climbing and descending tests. VO2 and VCO2 were measured during the tests using K4b2. Results: ICCs for VO2 (ICC & 95% CI: 0.91, 0.72-0.97) and VCO2 (0.91, 0.72-0.97) of walking demonstrated high reliability whereas reliability was moderate for stair climbing (VO2: 0.82, 0.6-0.93; VCO2: 0.73, 0.44- 0.88) and low for descending stairs (VO2: 0.67, 0.33-0.85; VCO2: 0.51, 0.1-0.77). Conclusion: K4b2 is a highly reliable device for VO2 and VCO2 measurement during self-paced walking in free living environment.

community-based cross-sectional study of cardiovascular risk in a rural community of Puducherry

Background: The World Health Organization [WHO] / International Society of Hypertension [ISH] risk prediction chart can predict the risk of cardiovascular events in any population

Aim: To assess the prevalence of cardiovascular risk factors and to estimate the cardiovascular risk using the WHO/ISH risk charts

Materials and Methods: A cross-sectional study was done from November 2011 to January 2012 in a rural area of Puducherry. Method of sampling was a single stage cluster random sampling, and subjects were enrolled depending on their suitability with the inclusion and exclusion criteria. The data collection tool was a piloted and semi-structured questionnaire, while WHO/ISH cardiovascular risk prediction charts for the South-East Asian region was used to predict the cardiovascular risk. Institutional Ethics committee permission was obtained before the start of the study. Statistical analysis was done using SPSS version 16 and appropriate statistical tests were applied

Results: The mean age in years was 54.2 [ +/- 11.1] years with 46.7% of the participants being male. On application of the WHO/ISH risk prediction charts, almost 17% of the study subjects had moderate or high risk for a cardiovascular event. Additionally, high salt diet, alcohol use and low HDL levels, were identified as the major CVD risk factors

Conclusion: To conclude, stratification of people on the basis of risk prediction chart is a major step to have a clear idea about the magnitude of the problem. The findings of the current study revealed that there is a high burden of CVD risk in the rural Puducherry

Work related musculoskeletal disorders among medical laboratory professionals: a narrative review.

Work related musculoskeletal disorders are common health problem and increasing cause of disability. Laboratory professionals are unique group of healthcare professionals who play an essential part in diagnosis and therapy planning and often their work is associated with potential health hazards. Objective of current study was to review literature on prevalence of work-related musculoskeletal disorders among medical laboratory professionals. Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. The searching strategy uncovered 13 reports. Total 7 studies were included for the review. A high degree of heterogeneity among studies was observed. The overall prevalence’s ranges from 40-60%. With neck being more prevalent 18-78%. However additional high quality studies are required in this area.

A review of ongoing trials in exercise based rehabilitation for pulmonary arterial hypertension.

Exercise based rehabilitation for patients with pulmonary arterial hypertension (PAH) is a new treatment option for these patients to improve their functional capacity and quality of life. Despite the benefits seen in cardiopulmonary rehabilitation in various other conditions, it has been underutilized for the patients with PAH. A review of currently registered ongoing trials on exercise training for patients with PAH from the World Health Organization International Clinical Trial Registry Platform was done using the key words “rehabilitation”, “exercise training”, “pulmonary artery hypertension” and “pulmonary hypertension” for a period of 10 years (2002-2012). The search revealed 57 registered trials in various trial registries from which seven met the inclusion criteria. The current studies are being carried out in Germany (n=4), Brazil (n=1), Australia (n=1) and India (n=1). This indicates a shift in focus from the only medical management to the rehabilitation and long term care for patients with PAH.

Effects of combined early in-patient cardiac rehabilitation and structured home-based program on function among patients with congestive heart failure: a randomized controlled trial

To determine the effects of combined in-patient rehabilitation with a home-based program on function and quality of life. Tertiary care, university teaching hospital, randomized controlled trial. Thirty admitted patients with congestive heart failure with New York Heart Association class II -IV. A five step individualised phase-1 cardiac rehabilitation program followed by a structured home based rehabilitation for eight weeks was given to the experimental group while the control group only received physician directed advice. Six minute walk distance was assessed at discharge and follow-up, while quality of life [SF36] was assessed at admission, discharge, and follow-up. Independent t-test, paired t-test and repeated measures ANOVA with Bonferroni post-hoc analysis. At admission patients in both the groups were comparable. After the phase-1 cardiac rehabilitation, there was a change in the six minute walk distance between control and experimental group [310 m vs. 357 m, respectively; P = 0.001]. Following the eight week home-based program, there was a greater increase in six minute walk distance in the experimental group when compared to the control group [514 m vs. 429 m; P < 0.001]. Quality of life as measured by the SF-36 at the end of 8-weeks showed a statistically significant difference [P < 0.05] in the experimental group for both the mental and physical components. Early in-patient rehabilitation followed by an eight week home based exercise program improves function and quality of life in patients with congestive heart failure

Effect of exercise-based cardiac rehabilitation on ejection fraction in coronary artery disease patients: a randomized controlled trial

Exercise training as a part of cardiac rehabilitation aims to restore patient with heart disease to health. However, left ventricular ejection fraction [LVEF] is clinically used as a predictor of long-term prognosis in coronary artery disease [CAD] patients, there is a scarcity of data on the effectiveness of exercise-based cardiac rehabilitation on LVEF. To investigate the effectiveness of exercise-based cardiac rehabilitation on LVEF in early post-event CAD patients. In a single blinded, randomized controlled trial, post-coronary event CAD patients from the age group of 3575 years, surgically [Coronary artery bypass graft or percutaneous coronary angioplasty] or conservatively treated, were recruited from Golsar Hospital, Iran. Exclusion criteria were high-risk group [AACVPR-99] patients and contraindications to exercise testing and training. Forty-two patients were randomized either into Study or Control. The study group underwent a 12-week structured individually tailored exercise program either in the form of Center-based [CExs] or Home-based [HExs] according to the ACSM-2005 guidelines. The control group only received the usual cardiac care without any exercise training. LVEF was measured before and after 12 weeks of exercise training for all three groups. Differences between and within groups were analyzed using the general linear model, two-way repeated measures at alpha=0.05. Mean age of the subjects was 60.5 +/- 8.9 years. There was a significant increase in LVEF in the study [46.9 +/- 5.9 to 61.5 +/- 5.3] group compared with the control [47.9 +/- 7.0 to 47.6 +/- 6.9] group [P=0.001]. There was no significant difference in changes in LVEF between the HExs and CExs groups [P=1 .0]. A 12-week early [within 1 month post-discharge] structured individually tailored exercise training could significantly improve LVEF in post-event CAD patients