Effects of Virtual Reality Training Using Xbox Kinect on Balance, Postural Control, and Functional Independence in Subjects with Stroke

Purpose: To determine the effects of virtual reality training using Xbox Kinect on balance, postural control, and functional independence in subjects with stroke. Methods: The parallel double-blind randomized control trial was conducted on 41 individuals based on selection criteria. Participants were divided into two groups by concealed envelope method. Intervention group received exergaming by Xbox Kinect, and control group was given exercises comprising balance training, upper limb strengthening, and core strengthening. Berg balance scale (BBS), functional independence measure (FIM), trunk impairment scale (TIS), and timed up and go (TUG) were the outcome measures. Data were analyzed using SPSS v21. Results: Mean age of the participants of Xbox and exercise group were 58.6 ± 3.3 and 58.1 ± 4.3 years, respectively. Within group improvement was observed in both groups from baseline to 8 weeks postintervention; BBS: 34 ± 4.7 to 40.9 ± 4.9 in intervention group and 34.1 ± 4.4 to 38.1 ± 7.6 in control group, TUG: 25.6 ± 3.9 to 21.4 ± 3.8 and 28.6 ± 5.0 to 25.9 ± 4.7, TIS: 15.2 ± 1.8 to 19.2 ± 1.3 and 13.2 ± 1.7 to 15.3 ± 1.6 and FIM: 58.7 ± 7.7 to 52.5 ± 7.8 and 66.2 ± 7.6 to 62.6 ± 7.2 in intervention and control group, respectively. Between group improvement was observed in TUG, TIS, and FIM in experimental group with P-values 0.003, <0.001, and <0.001, respectively. Conclusions: Wii Fit improved functional mobility, independence, and trunk coordination extension in the stroke patients, whereas balance could be equally improved from Wii Fit and exercises. Trial Registration Number: ACTRN12619001688178.

Prevalence of musculoskeletal disorders among chefs working in restaurants of twins cities of Pakistan

BACKGROUND

In the recent era, musculoskeletal disorders have affected millions of people worldwide. Chefs and other workers of the catering industry are at high risk of physical stresses, which makes them susceptible to develop various musculoskeletal pains and disorders.

OBJECTIVE

The aim of the study is to examine the frequency of musculoskeletal symptoms among chefs working in restaurants of Islamabad and Rawalpindi.

METHODS

A cross-sectional observational study was conducted on 307 chef participants from the restaurants of the twin cities. The participants were included via convenient sampling and data was collected through Nordic musculoskeletal questionnaire, Fatigue Assessment Scale (FAS) and Numeric Pain Rating Scale (NPRS) from February to July 2021.

RESULTS

Out of 307 participants, 285 were males and 22 were females with a mean age of 32.87±7.03 years. The working duration of 192 chefs were 9-12 hours while 106 and 9 chefs worked only for 4-8 and more than 12 hours, respectively. A total of 101 chefs reported lower back and knee pain. The chefs presented with pain in the shoulders, upper back and ankle as well as feet areas were 98, 93 and 26 respectively.

CONCLUSION

Chefs can develop musculoskeletal symptoms including pain as a result of increased physical stress on their bodies during their work, specifically in the lower back and knee area.

Role of Physical Therapy in Palliative Care of Cancer Patients

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Factors associated with joint contractures in adults: a systematic review with narrative synthesis

PURPOSE

The primary objective of the review was to collate the available evidence on factors associated with joint contractures in adults.

METHODS

A systematic literature search was conducted on MEDLINE, CINAHL, AMED, and EMBASE. Studies that involved participants aged ≥18 and assessed joint contracture as a primary or secondary outcome were included. Two independent reviewers screened studies against the eligibility criteria, performed data extraction, and assessed the quality of evidence. A narrative synthesis by domain and sub-domain was undertaken. The protocol was registered on PROSPERO: CRD42019145079.

RESULTS

Forty-seven studies were included in the review. Identified factors were broadly classified into three major domains: sociodemographic factors, physical factors, and proxies for bed confinement. Sociodemographic factors were not associated with joint contractures. Functional ability, pain, muscle weakness, physical mobility, and bed confinement provided the most consistent evidence of association with joint contractures. The evidence regarding the relationship between spasticity and joint contractures remains unclear. Other factors might be important, but there was insufficient evidence to make inferences.

CONCLUSIONS

The review identified and collated evidence on factors associated with joint contractures, which can be utilised to develop effective prevention and management strategies. Implications for rehabilitationClinical interventions based on the timely identification of risks related to joint contractures in vulnerable adults have the potential to prevent or ameliorate their development or progression.Quality and consistency of care for vulnerable adults would be enhanced by developing effective joint contracture prevention and rehabilitation strategies based on the evidence presented in this review.As many vulnerable adults are located in the community or non-acute care settings, strategies should target these loci of care.Structured risk assessments that can support non-physiotherapy staff working in these loci of care to identify risks related to joint contractures would provide an important resource for risk management.

Association of sleep-wake pattern with cognitive performance and academic achievement in young adults

Objective: To determine the association of sleep wake pattern with cognitive performance and academic achievement in young adults. Methods: It was a cross sectional study conducted in March 2019 after approval from the Institutional Review Board & Ethics Committee of the study setting on February 28, 2019. Total sample of the study was 189 calculated by using Rao software. Inclusion criteria was healthy young adults of age 18 to 24 years from Doctor of Physical Therapy department of Shifa Tameer-e-Millat University, Dar-ul-Shifa campus, Islamabad. Exclusion criteria included all those students who were married, diagnosed psychological disorder and were taking any sedatives. Data was collected through three questionnaires named Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ) and Montreal Cognitive Assessment (MOCA) in addition to inquiry regarding GPA of latest exam. Results: A total sample was 236 students with a mean age of 20.94±1.58 years with range 18-24 years. The sample comprised of males n=24 (10.2%) and females n=212(89.8%). Mean GPA was 3.10±0.53. MOCA showed that 70(29.66%) students had mild cognitive impairment, 166(70.34%) were students with normal cognition. The results obtained by applying independent T-test showed a significant difference of cognition between high and low achievers (P value: 0.029<0.05. Students who scored high were definite morning types. Conclusion: There is a significant association between cognitive performance and academic achievement with high achievers being definite morning types. Keywords: Cognition, Sleep, Academic success, Young adult.

Role Wii Fit exer-games in improving balance confidence and quality of life in elderly population

OBJECTIVE

To determine the effects of Wii Fit exer-gaming on balance confidence, quality of life and fall risk in elderly population.

Methods

The double-blind randomised control trial was conducted at Kulsum International Hospital, Islamabad, Pakistan, from July 31 to October 30, 2018, and comprised vitally stable, physically independent subjects of either gender aged 60 years and above, having no serious systemic disease. The subjects were randomly allocated into experimental group A and control group B using the concealed envelope method. After baseline assessment, group A received Wii fit gaming, while group B received balance training for 30 minutes twice a week for 8 weeks. Activities balance confidence (ABC), European Quality of Life-5 Dimensions (EQ 5D-5L), timed up and go (TUG) and Fukuda were used to assess the impact of the intervention. Data was analysed using SPSS 21.

RESULTS

Of the 90 subjects, 83(92.2%) completed the study. There were 51(62%) males and 32 (38%) females; and 45(50%) in each of the two groups. Group A had 42(50.6%) subjects with 26(62%) males and 16(38%) females, and 41 were in group B, with 25(61%) males and 16(39%) females. Balance confidence improved in both groups, but it was significantly higher in group A (p<0.001). Mobility, self-care, usual activities, pain/discomfort, anxiety/depression as well as timed up and go and Fukuda showed significantly more improvement in group A compared to group B (p<0.05).

CONCLUSIONS

Wii fit was found to have the potential to improve balance confidence and quality of life, reducing the fall risk among the elderly.

Clinical Trial Number

IRCT20180417039344N1 by Iranian Registry of Clinical Trials.

Effects of Wii Fit exer-gaming on balance and gait in elderly population: A randomized control trial

OBJECTIVE

To assess the effect of exer-gaming on balance and gait in the elderly.

Methods

The randomised controlled trial was conducted at Kulsum International Hospital, Islamabad, Pakistan, from July to October 2018, and comprised physically independent subjects aged 60 years and above who were randomised into experimental and control groups using concealed envelope method. The cases received exer-gaming for 30 minutes twice a week for 8 weeks, while the controls received balance training exercises twice a week for 8 weeks. Assessment was done at baseline and after 8 weeks of intervention. Outcome measures were assessed with Berg balance scale and the gait abnormality rating scale modified. Data was analysed using SPSS 21.

RESULTS

Of the 90 subjects, there were 45(50%) in each of the two groups. The intervention group had better outcome in terms of gait (p<0.05) except for foot contact and shoulder extension (p>0.05), while the difference related to balance was not significant (p>0.05).

CONCLUSIONS

Exer-gaming was found to be effective in improving various components of gait in the elderly compared to exercises.

Cell membrane enveloped polymeric nanosponge for detoxification of chlorpyrifos poison: In vitro and in vivo studies

Organophosphates are highly toxic compounds as they are involved in irreversible inhibition of acetylcholinesterase, causing various neurotoxic effects via acetylcholine accumulation throughout the nervous system. Traditional treatments for organophosphate poisoning are not effective enough to overcome all the toxic effects. There is a need for alternate treatment of life threatening poisoning of organophosphates. For this purpose a biomimetic nanosponge of poly (lactic-co-glycolic acid) is prepared, characterized and analysed as an antidote for organophosphate poisoning. In this nanosponge red blood cell membranes are used for coating poly lactic co-glycolic acid nanoparticles. In vitro studies are conducted to investigate the retention of acetylcholinesterase activity on the prepared nanosponge as well as to assess the scavenging ability of prepared nanosponge for model organophosphate, chlorpyrifos. In vivo studies are conducted to evaluate the detoxification potential of nanosponge in rabbit model, poisoned with chlorpyrifos. Hepatotoxicity and renal toxicity of nanosponge/chlorpyrifos complex is also studied in survived rabbits and the data is analysed statistically.

Comparative Study of Selenides and Tellurides of Transition Metals (Nb and Ta) with Respect to its Catalytic, Antimicrobial, and Molecular Docking Performance

The present research is a comparative study that reports an economical and accessible method to synthesize niobium (Nb) and Tantalum (Ta) selenides and tellurides with useful application in the removal of pollutants in textile, paper, and dyeing industries as well as in medical field. In this study, solid-state process was used to generate nanocomposites and various characterization techniques were employed to compare two groups of materials under investigation. Structure, morphology, elemental constitution, and functional groups of synthesized materials were analyzed with XRD, FESEM coupled with EDS, FTIR, and Raman spectroscopy, respectively. HR-TEM images displayed nanoscale particles with tetragonal and monoclinic crystal structures. The optical properties were evaluated in terms of cut-off wavelength and optical band gap using UV-visible spectroscopy. A comparative behavior of both groups of compounds was assessed with regards to their catalytic and microcidal properties. Extracted nanocomposites when used as catalysts, though isomorphs of each other, showed markedly different behavior in catalytic degradation of MB dye in the presence of NaBH₄ that was employed as a reducing agent. This peculiar deviation might be attributed to slight structural differences between them. Escherichia coli and Staphylococcus aureus (G -ve and + ve bacteria, respectively) were designated as model strains for in vitro antibacterial tests of both clusters by employing disk diffusion method. Superior antibacterial efficacy was observed for telluride system (significant inhibition zones of 26-35 mm) compared with selenide system (diameter of inhibition zone ranged from 0.8 mm to 1.9 mm). In addition, molecular docking study was undertaken to ascertain the binding interaction pattern between NPs and active sites in targeted cell protein. The findings were in agreement with antimicrobial test results suggesting NbTe₄ to be the best inhibitor against FabH and FabI enzymes.

Twenty-eight loci that influence serum urate levels: analysis of association with gout

OBJECTIVES

Twenty-eight genetic loci are associated with serum urate levels in Europeans. Evidence for association with gout at most loci is absent, equivocal or not replicated. Our aim was to test the loci for association with gout meeting the American College of Rheumatology gout classification criteria in New Zealand European and Polynesian case-control sample sets.

METHODS

648 European cases and 1550 controls, and 888 Polynesian (Ma¯ori and Pacific) cases and 1095 controls were genotyped. Association with gout was tested by logistic regression adjusting for age and sex. Power was adequate (>0.7) to detect effects of OR>1.3.

RESULTS

We focused on 24 loci without previous consistent evidence for association with gout. In Europeans, we detected association at seven loci, one of which was the first report of association with gout (IGF1R). In Polynesian, association was detected at three loci. Meta-analysis revealed association at eight loci-two had not previously been associated with gout (PDZK1 and MAF). In participants with higher Polynesian ancestry, there was association in an opposing direction to Europeans at PRKAG2 and HLF (HLF is the first report of association with gout). There was obvious inconsistency of gout association at four loci (GCKR, INHBC, SLC22A11, SLC16A9) that display very similar effects on urate levels.

CONCLUSIONS

We provide the first evidence for association with gout at four loci (IGF1R, PDZK1, MAF, HLF). Understanding why there is lack of correlation between urate and gout effect sizes will be important in understanding the aetiology of gout.

Practices and views on fetal heart monitoring: a structured observation and interview study

OBJECTIVE

To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring.

DESIGN

Qualitative study.

SETTING

Large teaching hospital in the UK.

SAMPLE

Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades.

METHODS

Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software.

MAIN OUTCOME MEASURES

Deviations from recommended practice in relation to fetal monitoring and insights into why these occur.

RESULTS

All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context.

CONCLUSION

Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution.

Chronic orchidectomy does not influence the sensitivity of the pituitary somatotropes to varying doses of GHRH administered intravenously to the adult male rhesus monkey

In the present study, the pituitary growth hormone (GH) response to graded doses of GH-releasing hormone (GHRH) was determined in intact (n = 3) and chronically orchidectomized (n = 3) adult rhesus monkeys (Mucaca mulatta). GHRH in doses of 0, 6.25, 12.5 and 25 microg/kg BW was infused through a teflon cannula implanted in the saphenous vein. Blood samples were collected 60 min before and 90 min after the injection of the neurohormone at 15 min intervals. All bleedings were carried out under ketamine hydrochloride anesthesia. The plasma levels of GH were determined by using AutoDELFIA time-resolved flouroimmunoassay, whereas plasma levels of testosterone and estradiol were determined using specific radioimmunoassay systems. The GH responses to GHRH were not significantly different between intact and chronically orchidectomized monkeys at any of the dose levels tested (p > 0.05). The administration of GHRH resulted in a significant (p < 0.05) stimulation of GH secretion at all the doses tested and in both the groups studied. In both intact and orchidectomized animals, the greatest response was observed at 6.25 microg/kg and no further increase was noted with the higher doses of GHRH. In conclusion, the present study suggests that chronic orchidectomy does not influence the sensitivity of the pituitary somatotropes to GHRH stimulation implying that the responsiveness of the pituitary somatotropes to GHRH is independent of testicular steroid modulation.

Changes of serum prostate-specific antigen following high energy thick loop prostatectomy

We evaluated the effect of the high electrocuting energy used with the thick loop, in transurethral vaporization resection of the prostate (TUVRP), on serum prostate-specific antigen (PSA). Forty-eight patients with benign protatic hyperplasia (BPH) were included in this prospective single arm sequential study. All patients had TUVRP using the 'Wing' thick resection electrode (Richard Wolf, Germany). Serum PSA was measured before, 1 day and 6 weeks in the morning post TUVRP. PSA values were correlated to preoperative prostate size and to prostatic resection weight. Serum PSA values (mean +/- SD) were 6.29+/-4.4 ng/ml, 14.9+/-11.1 and 2.3+/-1.9 before, 1 day and 6 weeks post TUVRP respectively. The mean increase in the PSA at 1 day over baseline value was 2.72, this was statistically significant (p < or = 0.0001). The PSA level returned to less than pre TUVRP value in all but 3 patients by 6 weeks. The PSA value 1 day post TUVRP correlated well with the pre PSA level, prostate size and prostatic resection weight (r = 0.58, r = 0.38 and r = 0.44 respectively) however, the PSA level at 6 weeks correlated only to pre TUVRP values (r = 0.53). We conclude that that serum PSA is not reliable within 6 weeks of TUVRP. The reversible increase in serum PSA value is similar to other forms of prostatectomy which, suggests that the increased level of electrosurgical energy that is used in TUVRP does not have an added adverse effect on the PSA levels.

The 'Wing' versus the 'Vapor Cut' electrodes in transurethral electrovaporization-resection of the prostate: comparative changes in safety parameters

We compared the early safety features of two-band resection devices used in transurethral vaporization-resection of the prostate (TUVRP). Ninety patients with prostatic outflow obstruction were prospectively evaluated in two open studies for the treatment using the 'Wing' cutting electrode in group 1 (Richard Wolf, Germany) and the 'Vapor Cut' electrode in group 2 (Karl Storz, Germany). Patients in both groups were comparable in age, presentation, prostate size and blood parameters. Safety features evaluated included changes in serum hemoglobin, hematocrit, sodium concentration and incidence of side effects. The mean drop in hemoglobin, hematocrit and serum sodium 1 h postoperatively for the Wing group were 0.54 g/dl, 2.04 ml/dl and 0.084 mEq/l respectively compared to a mean drop of 1.1 g/dl, 3.07 ml/dl and 3.1 mEq/l in the Vapor Cut group. These differences were statistically significant (p = 0.004, 0.03 and <0.0001 respectively). The mean resection weight was 24.78 +/- 10.4 and 24.46 +/- 14.79 g in groups 1 and 2, respectively; however, the mean operation time was significantly longer in the Wing group (47.7 vs. 37.1 min, p = 0.003). We conclude that both loops were safe and efficacious in the treatment of patients with prostatic outflow obstruction. Safety features that are related to the vaporization effect are influenced by the speed of resection.

The effect of ketamine hydrochloride anesthesia on basal and N-methyl-D,L-aspartate induced plasma prolactin secretion in the adult male rhesus monkey

The excitatory amino acids (EAAs), glutamate and aspartate, acting predominantly on N-methyl-D-aspartate (NMDA) receptor, have been shown to be involved in the central regulation of the secretion of several anterior pituitary hormones including prolactin (PRL), whereas ketamine hydrochloride (KH), a widely used anesthetic, has been reported to antagonize a variety of NMDA receptor mediated actions of these EAAs. In the present study, the effect of KH on basal PRL levels as well as on N-methyl-D,L-aspartate (NMA), an agonist of NMDA receptor, induced plasma PRL secretion was investigated in the adult male rhesus monkey. The values were compared to those obtained from the same animals restrained in primate chairs. The plasma PRL concentrations were higher in animals receiving KH administered either intramuscularly (2.5 mg/kg BW at 30 min intervals) or intravenously (10 mg/kg BW) as compared to those observed in the unanesthetized chair-restrained monkeys. NMA induced an unequivocal increase in plasma PRL concentrations in both conscious chair-restrained and KH anesthetized monkeys, but the response was greater in anesthetized animals than the conscious monkeys. The present findings suggest that KH has stimulatory effects on both basal and NMA induced plasma PRL secretion.

Differential effects of N-methyl-D-aspartate receptor stimulation on growth hormone secretion at specific stages of postnatal development of the male rhesus monkey

The present study attempts to examine the role of N-methyl-D-aspartate (NMDA) receptor in the central regulation of growth hormone (GH) secretion during specific stages of pubertal development of the male rhesus monkey (Macaca mulatta). Infantile (n=4), prepubertal (n=5), peripubertal (n=5) and adult (n=5) intact male rhesus monkeys were given an agonist of NMDA receptor, N-methyl-D,L-aspartate (NMA) (15 mg/kg BW) through a teflon cannula implanted in the saphenous vein. Blood samples were collected 20-60 min before and 40-80 min after the injection of the drug at 10-20 min intervals. NMA was dissolved in normal saline immediately before use and passed through a 0.22 microm filter at the time of injection. All bleedings were carried out under ketamine hydrochloride anesthesia (initial dose 5 mg/kg BW, im followed by 2.5 mg/kg at 30 min intervals). The plasma levels of GH and testosterone (T) were determined by using specific assay systems. The hypothalamic-somatotrope activity under basal conditions was studied by averaging all the GH concentrations obtained before NMA injection, whereas the sensitivity of NMDA receptor to NMA stimulation was determined by comparing basal GH levels immediately before NMA injection at 0 min and GH concentrations obtained 10 min after the injection. The mean basal plasma concentrations of GH in the four groups of animals showed marked age-related differences. The levels of GH were found to be higher in infantile and peripubertal monkeys as compared to those of prepubertal and adult animals. A single iv injection of NMA produced differential effects on GH secretion during specific stages of postnatal development depending upon the level of GH secretion under basal conditions. Whereas NMA had no demonstrable effect on GH secretion in infantile and peripubertal animals in which the basal GH levels were high, it produced pronounced effects on GH secretion in prepubertal and adult monkeys wherein baseline GH concentrations were low. In conclusion, the present study suggests that the glutamatergic component of the control system that governs GH secretion by utilizing NMDA receptor may participate in regulation of age-related changes in the secretion of GH in the male rhesus monkey.