Effects of Different Modes of Upper Limb Training in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

OBJECTIVE: To determine effects of different modes of upper limb training on dyspnea and quality of life of individuals with chronic obstructive pulmonary disease (COPD) having different disease severity. METHODS: Randomized clinical trials were retrieved from five electronic databases. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration’s tool and the GRADE approach, respectively. Effects of upper limb training compared to control were identified using standardized mean difference and 95% confidence interval. RESULTS: Fifteen studies with 514 subjects were included. When compared to control, upper limb endurance and strength training with moderate quality of evidence resulted in significant improvement in dyspnea. However, quality of life was not significantly different between upper limb training of all modes of and the control. The upper limb training was more effective in reducing dyspnea in patients with severe COPD than in those with mild to moderate levels of COPD. Although quality of life was slightly improved by upper limb training for those with moderate or severe level of COPD, such improvement did not reach a significant level when compared to the control. CONCLUSION: Upper limb endurance and strength training could significantly improve dyspnea in individuals with chronic obstructive pulmonary disease. Thus, incorporating the upper limb training into pulmonary rehabilitation is recommended to reduce dyspnea, especially for those with severe patients. Further studies with larger sample size and standardized training protocol are needed to confirm these finding (Registration No. CRD42018102805).

Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

OBJECTIVE: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients. METHODS: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration’s tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p0.05). CONCLUSION: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).

Cytokine levels in patients with chikungunya virus infection

OBJECTIVE@#To investigate cytokine profile in patients with chikungunya virus (CHIKV) infection.@*METHODS@#Twenty eight pairs of serum samples collected from CHIKV infected patients during the outbreak of chikungunya fever in South Thailand in 2008 were obtained. A multiple cytokine assay for detection of 17 cytokines was performed.@*RESULTS@#In the acute stage of CHIKV infection, the patients had significantly higher levels of interleukin-6, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein 1 and tumor necrosis factor alpha than the control (P<0.001, P=0.023, P=0.015, P<0.001 and P=0.024, respectively). When the disease developed to the recovery stage, the patients had significantly lower levels of interleukin-6, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein 1 and macrophage inflammatory protein beta than in the acute stage (P<0.001).@*CONCLUSIONS@#This study provides additional information that these cytokines could play roles in pathogenesis of CHIKV infection and could be used as disease biomarkers or drug targets.

Polyethylene glycol 4000 without electrolytes versus milk of magnesia for the treatment of functional constipation in infants and young children: a randomized controlled trial

Background: Functional constipation is a common pediatric problem. Polyethylene glycol and milk of magnesia are osmotic agents used to treat constipation. There were few studies comparing the two laxatives for the treatment of functional constipation in infants and young children. Objective: To compare two laxatives, polyethylene glycol 4000 without electrolytes (PEG) and milk of magnesia (MOM), by evaluating the effectiveness, adverse effects, and patient compliance. Materials and methods: A randomized controlled trial was performed in 94 patients aged one-four years who attended at the pediatric outpatient clinic of Bhumibol Adulyadej Hospital and met the Rome III criteria for functional constipation receiving either PEG or MOM for four weeks. The primary outcome evaluation was the improvement rate. The secondary outcomes included the improvement of stool frequency, adverse effects, and compliance rate. Results: Eighty-nine patients completed the study, including 46 in the PEG group and 43 in the MOM group. Baseline characteristics of age, body weight, sex, initial stool frequency, and duration of constipation were similar between groups. At the four week follow-up visit, 91% of PEG-treated patients and 65% of the MOM-treated patients exhibited improvement (p=0.003). Patients in the PEG group had greater increase of stool frequency after treatment than patients in the MOM group. Overall, adverse effects were mild, transient and not different among groups, but there was more diarrhoea in MOM treated patients. No serious adverse effects were observed. Compliance rates were 89% for PEG and 72% for MOM (p=0.041). Conclusion: PEG was more effective and had greater patient compliance than MOM for the management of functional constipation in infants and children aged one-four years.