Effect of task specific circuit training on Gait parameters and mobility in stroke survivors

Objective of the study was to investigate effects of task specific circuit gait training to improve gait parameters and mobility among sub-acute and chronic stroke patients. A randomized control trial was conducted on stroke survivors of either gender being capable of standing 10 seconds and having 2-4 score on Rankin Modified Scale. Sample comprised of 30 participants randomly assigned into two groups. Training was given for a session of 40-50 minutes for 3-4 days/week for six weeks. Timed get up and go test [TUG], Cadence, Step Length and Step Width assessed measures of concern. The sample included 16 males and 14 females with mean age of 54.10 +/- 10.10 years. After six weeks, significant improvement was recorded in TUG [p=0.014]. Cadence [p=0.001], step length [p<0.001] and step width [p=0.009] were also significantly improved. Circuit gait training improves mobility and gait in stroke patients

Copy Number Profiling of MammaPrint™ Genes Reveals Association with the Prognosis of Breast Cancer Patients / 한국유방암학회지

PURPOSE: The MammaPrint™ gene signature, currently used in clinical practice, provides prognostic information regarding the recurrence and potential metastasis in breast cancer patients. However, the prognostic information of the 70 genes included can only be estimated at the RNA expression level. In this study, we investigated whether copy number information of MammaPrint™ genes at the DNA level can be used as a prognostic tool for breast cancer, as copy number variations (CNVs) are major contributors to cancer progression. METHODS: We performed CNV profiling of MammaPrint™ genes in 59 breast cancer cell lines and 650 breast cancer patients, using publicly available data in The Cancer Genome Atlas (TCGA) database. Statistical analyses including Fisher exact test, chi-square test, and Kaplan-Meier survival analyses were performed. RESULTS: All MammaPrint™ genes showed recurrent CNVs, particularly in TCGA cohort. CNVs of 32 and 36 genes showed significant associations with progesterone receptor and estrogen rector, respectively. No genes showed a significant association with human epidermal growth factor receptor 2 status and lymph node status. In addition, only six genes were associated with tumor stages. RFC4, HRASLS, NMU, GPR126, SCUBE2, C20orf46, and EBF4 were associated with reduced survival and RASSF7 and ESM1 were associated with reduced disease-free survival. CONCLUSION: Based on these findings, a concordance of CNV-based genomic rearrangement with expression profiling of these genes and their putative roles in disease tumorigenesis was established. The results suggested that the CNV profiles of the MammaPrint™ genes can be used to predict the prognosis of breast cancer patients. In addition, this approach may lead to the development of new cancer biomarkers at the DNA level.

Effectiveness of functional electrical stimulation [FES] versus conventional electrical stimulation in gait rehabilitation of patients with stroke

Objective: To compare the effectiveness of functional electrical stimulation [FES] versus conventional electrical stimulation in gait rehabilitation of patients with stroke for finding the most appropriate problem-oriented treatment for foot drop patients in a shorter time period. Study Design: Randomized controlled trial. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, from July to December 2016

Methodology: Subjects with foot drop due to stroke were allotted randomly into 1 of 2 groups receiving standard rehabilitation with Functional Electrical Stimulation [FES] or Electrical Muscle Stimulation [EMS]. FES was applied on tibialis anterior 30 minutes/day, five days/week for six weeks. EMS was also applied on the tibialis anterior five days/week for six weeks. Outcome measures included Fugl-Meyer Assessment Scale, Modified Ashworth Scale, Berg Balance Scale [BBS], Time Up and Go Test [TUG] and Gait Dynamic Index [GDI]. They were recorded at baseline, after 3 and 6 weeks. Pre- and post-treatment scores were analyzed between two groups on SPSS-20

Results: After six weeks of intervention, significant improvement was recorded in Fugl-Meyer Assessment score [p<0.001], modified Ashworth Scale score [p=0.027], Berg Balance Scale score [p<0.001], Time Up and Go Test [p<0.001] and Gait Dynamic Index [p=0.012] of the group subjected to FES

Conclusion: Gait training with FES is more effective than EMS in improving mobility, balance, gait performance and reducing spasticity in stroke patients. The research will help clinicians to select appropriate treatment of foot drop in stroke patients

Comparison between Captopril and Imidapril in relation to their in vitro effects on tracheal tissue

Objective: To observe two drugs [captopril and imidapril] action on smooth muscle tone of trachea and to facilitate safe and rational use of ACE inhibitors, particularly in patients with chronic obstructive airway disease

Study Design: Comparative controlled in-vitro experimental Study

Place and Duration of Study: This study was conducted at the Pharmacology Department, Army Medical College, Rawalpindi from December 2012 to May 2013

Materials and Method: First the effect of bradykinin acetate on the smooth muscle of trachea has been observed. Cumulative concentration-effect relationship was studied with different concentrations of bradykinin on the smooth muscle starting with 22 micro g to 132 micro g/dl. The method was done again with captopril 10[-5] M concentration and imidapril 10[-5] M respectively. In second set of experiments cumulative concentration-response curves were prepared by increasing concentrations of captopril and imidapril separately with fixed concentration of bradykinin 66 micro g/dl

Results: Dose related vacillating contraction of smooth muscle of trachea is produced by bradykinin. The average value of effect received with 132 micro g/dl of bradykinin in the presence of captopril was 51.33 +/- 2.79 and in the presence of imidapril was 25 +/- 7.26. All these ACE inhibitors displaced the concentration effect curves of bradykinin to left and upward. On comparison among themselves it was observed that imidapril produced least enhancement of tracheal contraction. Similar results were produced by second set of experiments

Conclusion: Imidapril is found to cause least enhancement of contraction caused by bradykinin on tracheal muscle. Further clinical trials may be conducted to establish the differential effects of various clinically used ACE inhibitors on the respiratory passages in hypertensive patients concomitantly suffering from COAD

Therapeutic implications of Nigella sativa against cancer metastasis

Nigella sativa [N. sativa], remedial usage against different diseases associated with skeleton, cardiovascular, digestive and urinary systems has a long-standing history. At present, efforts are underway to study its effects against various cancers at both the cellular and molecular levels. In this review, the role of active constituents like thymoquinone [TQ] on different types of cancer has been explored. TQ putative involvement in metastasis has been assessed by elucidating its effects on cell proliferation, adhesion, invasion and angiogenesis. Up regulation of caspase 3, Smac and down regulation of p-AKT, p65, XIAP, Bcl-2, COX-2 is also influenced by N. sativa. These findings prove a significant positive correlation between TQ concentrations and induction of apoptosis, decrease in motility and a reduction in invasion and angiogenesis in cancerous cells. However, there are still quite a few unaddressed domains, which need to be understood. One of these may include target specificity of N. sativa against cancerous tissues, mode of administration, dosage and downstream regulators in mediating these effects. In reference to earlier findings and low cost availability, N. sativa may, also, be suggested as either a suitable sole remedy for cancer or as a complementary to ongoing conventional therapy based extensive and rigorous in vivo optimization and validation

Cystic duct anomalies and their surgical implications in patients undergoing laparoscopic cholecystectomy

Background: During cholecystectomy, to avoid common bile duct injury or other per operative complication, the knowledge of cystic cyst anomalies is imperative. This study aimed to highlight cystic duct anomalies identified during laparoscopic cholecystectomy and report their implications

Methods: This prospective study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro over a period of six years [2009-2014] in the department of Surgery. Over this specified period a total of 775 patients underwent cholecystectomy and were included in this study

Results: Among 775 patients who underwent laparoscopic cholecystectomy, abnormal confluence was found in 7.22%, short cystic duct in 26.78%, long cystic duct in 17.86% and double cystic duct in 12.50%. Surgical problems encountered due to these variations were cystic duct avulsion, common bile duct injury, bleeding and bile leak

Conclusion: During laparoscopic cholecystectomy, unidentified anatomical variations of cystic duct may cause drastic complications including ductal injuries which significantly increase morbidity and may raise mortality

Orbital floor reconstruction with titanium mesh; our experience

Objective: To determine the outcome of orbital floor reconstruction with titanium mesh in terms of diplopia, enophthalmos, dystopia and infection etc. Study design: Descriptive case series. Place and duration of study: Department of Oral and Maxillofacial Surgery, Punjab Medical College / Allied Hospital Faisalabad. One and Half year from 01-10-12 to 31-03-14

Material and Method: Twenty two patients clinically and radiographically having defect in the orbital floor due to trauma were included in the study. Titanium mesh was used to reconstruct the orbital floor through infraorbital rim incision and secured in place with 5mm micro screws. The variables to be analyzed were diplopia, enophthalmos, orbital dystopia and infection

Results: In our study male gender predominates over female 20/22. Mean age of patients is 29.36 years +/- 5.21. Diplopia persisted in 2/10 [20%] patients. Enophthalmos persisted in 7/18 [38.8%] patients. dystopia persisted in ¼ [25%] patients. Infection didn't develop in any of our patient [0%]. Visual acuity was not affected in any of the patient [0%]

Conclusions: Titanium mesh is a suitable material for reconstruction of orbital floor fractures with little complication rate and no donor site morbidity

incidence, pattern and outcome of stray bullet injuries: a growing challenge for surgeons

Objective: To study the incidence, pattern of injuries, presentation and management of stray bullet injuries

Methods: All patients presented and admitted with stray bullet injuries during a period of 4 years from January 2006 to December 2010 were included in this prospective study which was conducted at Liaquat University of Medical and Health Sciences Hospital Hyderabad/Jamshoro. All of the study subjects were admitted through casualty and were initially thoroughly examined and resuscitated. The pattern of injuries was noted and requisite investigations performed. Patients who sustained injuries demanding surgery were prepared accordingly and were submitted for laparotomy or other procedures depending upon the severity of injuries. The data collected on individual basis and variables studied including demographics, pattern of injuries, time since injury occurred and management

Results: A total number of 165 patients with a mean age of 17.1 years, SD 13.807 and range of 74[2-76] presented with stray bullet injuries during study period. The study population comprised 117[70.90%] males and 48[29.09%] females. Majority of the patients were brought late because of delay in diagnosis or delay in transportation. The commonest victims were young children in their teens and comprised 78% of the study population. Haemothorax/ pneumothorax or peritonitis was the common presentations occurring in 11% and 61.81% of the study population respectively. Of the total number, 92 [55.75%] patients underwent laparotomy while remaining patients either had chest intubation or some other procedures done accordingly. Nine [5.45%] patients developed permanent disabilities while 13[7.87%] patients died either immediately after arrival or later on in the hospital during or after the operative treatment. Mortality was related to the time of arrival in hospital since the injury and thus was highest among those brought 4 or more hours after the shot [P < 0.001]. Patients who did not sustain major injuries were kept under observation and were subsequently discharged

Conclusion: Stray bullet injuries are an ever increasing challenge in our society. Unlawful and jubilant use of weapons in celebrations, weddings and similar occasions are causing a lot of morbidity and mortality in the society

Validity of surgical bypass in un-resectable pancreatic cancer

To evaluate the efficacy of surgical bypass as a palliative procedure in patients with pancreatic cancer. This prospective descriptive analytical study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro, Sind, Pakistan from January 2005 to December 2010. All patients with obstructed jaundice and gastric outlet obstruction, later on diagnosed as pancreatic cancer are included in the study. LFT'S, Blood CP, Ultrasound abdomen, CT scan abdomen, and x-ray chest were performed in all patients. Surgical treatment was planned after assessing the resectability of the tumor. The variables studied included presentation, procedure performed, post operative complications and follow up after discharge from the hospital. The Chi square test is applied and data were statistically analyzed on SPSS v17. Forty three patients with a mean age of 62.09 +/- 6.782, with advance carcinoma of head of pancreas were operated and bypass surgical palliation was done. The morbidity, mortality and efficacy of various surgical bypass operations are evaluated. Bilio-gastric bypass still offers a reasonably safe and effective method of billiary decompression and duodenal obstruction caused by inoperable pancreatic cancer

Laparoscopic cholecystectomy in complicated gallstone disease

Objective: To assess the role of laparoscopic cholecystectomy [LC] in gallstone disease with its complicated problems. Design: Prospective observational study. Setting: Surgical Department of Liaquat University of Medical and Health Sciences, Jamshoro and Private Hospitals of Hyderabad, Sindh-Pakistan; from May 2001 to April 2005

Methods: The patients were categorized as cases of complicated gallstone disease on the basis of clinical assessment, investigations especially ultrasound abdomen and operative findings noted during laparoscopic cholecystectomy. All patients were explained for advantages and disadvantages of early LC with their difficult disease problem and willing taken for study. Sampling strategy was convenient. The patients with uncomplicated gallstones, obstructive jaundice, acute pancreatitis and carcinoma of gall bladder were excluded from this series

Results: 120 out of 400 patients presented with one of the known complication of cholelithiasis such as chronic cholecystitis 50%, acute cholecystitis 12.5%, empyma 18.33%, mucocele 10% and fibrosed gall bladder in 9.17% of cases as assessed on clinical examination, ultrasound and laparoscopic findings. Majority [75%] of cases were having adhesions around gall bladder and 25% without adhesions. Problems encountered during LC were difficult separation of tight adhesions around gallbladder [50.0%], grasping and holding of thick walled and distended gallbladder [41.67%], dissection and identification of structures in Calot's triangle [29.17%], haemorrhage from main cystic artery and gall bladder bed 20.83% and delivery of large and thick wall gallbladder in 25% of cases. Intra operative complications seen during procedure were haemorrhage in 20.83% cases, perforation of gallbladder by instrumentation in 12.5% and avulsion of cyctic duct in 1.67% of cases. Two patients [1.67%] were converted to open cholecystectomy due to bleeding. Postoperatively 12.5% of patients developed biliary leak, out of which 3 cases [2.5%] were due to actual common bile duct injury, 2.5% of cases developed port-site sepsis as main postoperative complications. Cases with bile duct injury were re-explored and managed accordingly. Hospital stay varied from 2-7 days but majority of patients were discharged [70.83%], within 2-3 days, no mortality was seen in this series

Conclusion: Laparoscopic cholecystectomy like uncomplicated biliary stone disease is equally effective procedure for complicated cholelithiasis. Its applicability is almost 95% in experienced hands

Evaluation of the Ochsenbein-Luebke flap technique in periapical surgery at Punjab Dental Hospital Lahore Pakistan

There have been no direct studies comparing the Trapezoidal flap with the Ochsenbein-Luebke flap in endodontic surgery. The present study is aimed to provide an insight into the relative performances of these two procedures. This comparative study, carried out at Punjab Dental Hospital Lahore Pakistan from May to October 1998, involved 120 patients [60 in each group]. Evaluation of technique[s] involved assessment of intra-operative technical considerations as well as postoperative morbidity, healing and cosmetic results. It was found that O-L flap is easy to reflect, has good visibility, less bleeding duration and is easy to handle during surgery. Stitches are less time consuming, there is less tearing, better cosmetic result and no recession of gingiva. However more studies should be done to evaluate the procedure in larger number of patients