concurrently delivered via the device during SIP. The step height measurements were derived from hip flexion data captured by the sensor and the accuracy of the stepping height was compared to and validated by kinematic video analysis software. [ 20 ] The results show that PD subjects tend to have a significantly lower stepping height relative to controls under all conditions. The dual-task performance of PD freezers was particularly worse than PD non-freezers and the controls during concurrent serial 7 subtractions, even controlled for disease severity. [ 18 , 20
Guoxin Wang, Xiang Liu, Sheng Wang, Nan Ge, Jintao Guo and Siyu Sun
access the excluded stomach with deployment of a LAMS over a wire to create a gastrogastric or jejunogastric fistula, which allowed passage of the duodenoscope through the LAMS and performance of conventional ERCP. [ 75 ] Jah et al . [ 76 ] have reported EUS-guided drainage of an abdominal fluid collection following a Whipple procedure using an Olympus GF-UCT240 EUS endoscope (GF-UCT240, Olympus, UK), which was passed through the gastrojejunostomy. The serosanguinous collection was completely aspirated using a 19-gauge Echotip-Ultra needle (Wilson-Cook, Ireland
With the rise in long-term conditions, health care systems around the world are under pressure to curb health care costs while maintaining quality. In response, many countries have introduced pay for performance (P4P) programs that incentivize institutions and professionals to provide high quality care and to mitigate the potential weaknesses of other payment mechanisms such as fee for service. [ 3 ] P4P programs have been widely adopted internationally in low, middle, and high income countries such as UK, US, Thailand, Germany, and Australia
1. Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 1996;153:976-80.
2. Clark CJ, Cochrane LM, Mackay E, Paton B. Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training. Eur Respir J 2000;15:92-7.
3. Debigaré R, Maltais F. The major limitation to exercise performance in COPD is lower limb muscle dysfunction. J Appl Physiol 2008; 105: 751-3.
4. Donaldson AV, Maddocks M, Martolini D, Polkey MI, Man WD
Objectives: First objective was better understanding of the indications of chemotherapy in elderly with advanced cancer, tolerability and toxicity of chemotherapy in this age group. The second objective was to define current practice in chemotherapy for elderly people with advanced cancer for a selected group of patients treated in Institute of Oncology Bucharest (IOB). Materials and Methods: The study makes a clinical analysis of medical records of 27 patients from the archive of Institute of Oncology Bucharest treated by the same doctor. Patients were selected according to: age ≥ 65 years, ECOG performance status 0-1, normal blood counts and blood biochemistry, histological confirmation of the diagnosis of cancer, patients should received at least 3 cycles of chemotherapy. We extract characteristics of the patients to see if they were a homogeneous group of patients and to compare them with data from the literature. Overall survival was calculated by the Kaplan Meyer curve. Results: 295 patients more then 65 years were treated in our site in 2 years 2011, 2012. 93 patients received chemotherapy and only 27 patients were enrolled in this study following inclusion criteria. Common sites of cancer were lung and breast. The most used cytostatics for lung cancer was gemcitabine and carboplatine and cyclophosphamide, metotrexat and 5 fluorouracil for breast cancer. Toxicity was mild with the prevalence of hematologic toxicity. Overall survival without taking into account the type of cancer was 27.7 month. Conclusions: For selected patients, chemotherapy was well tolerated and appears to prolong survival regardless of the location of cancer. The relatively small number of elderly patients who received chemotherapy is probably due to lack of compliance to treatment, the increased number of co-morbidities and evaluation of performance status only by the ECOG index known not to be good enough to establish the indication of chemotherapy.
Jaspreet Kaur, Shailendra Kumar Singh and Jaspreet Singh Vij
Background and Aims: diabetes mellitus one of the non-communicable disorders which is spreading globally irrespective of nation being developed or developing. The aim of this study was to optimize the exercise protocols and to find the efficacy of these protocols on glucose control, balance, gait and proprioception in patients suffering from type 2 diabetes mellitus.
Material and Methods: 40 individuals with type 2 DM with age 35 to 60 were randomly allotted to four groups with 10 subjects in each. Cycle ergometer based aerobic exercises were given with duration of 20 or 30 minutes twice or thrice weekly for 6 weeks. Pre and post intervention was collected using Fullerton Advanced Balance scale for balance, spatiotemporal gait parameters for gait, Continuous passive motion for Proprioception and High Performance Liquid Chromatography in the laboratory.
Results: data was analysed using Design Expert software. Full factorial design was used to compare role of duration and frequency of exercise on each patient. The results showed significant effect of exercises on balance, gait, proprioception and glycated haemoglobin (HbA1c).
Conclusion: Aerobic exercises if given for 30 minutes and thrice weekly can show a significant improvement in complications in Diabetics.
Sorina Maria Aurelian, Ana Capisizu, Andreea Zamfirescu and Dan Cheţa
With age, arteries become more rigid and pulse waves propagate faster. The pathogenic mechanisms that causes vascular stiffness in type 2 diabetes are complex but incompletely understood. An important element in the development of this phenomenon appears to be insulin resistance. One of the first line health problems that persist in the present is the failure to detect cardiovascular diseases in the preclinical stage which is important since more frequent cardiac events (myocardial infarction, sudden death) occur in people without obvious cardiovascular pathology in the medical history. One of the degenerative diseases with the greatest impact on the autonomy is dementia of elderly people. Recent studies have shown the association and even the possible involvement of cardiovascular risk factors and arterial stiffness in the pathogenesis of dementia and cognitive impairment. Although pulse wave velocity in the aorta is related to subclinical coronary atherosclerosis (being an important biomarker of cardiovascular risk in asymptomatic individuals), arterial stiffness is also a predictor of cognitive performance, cognitive decline or dementia.
Patrick M. Honore, Rita Jacobs, Olivier Joannes-Boyau, Willem Boer, Elisabeth De Waele, Viola Van Gorp and Herbert D. Spapen
Polymyxins are ‘‘old’’ antimicrobials which were abandoned for almost 30 years because of significant renal and neurological toxicity. However, the alarming rise of multi-resistant Gramnegative bacterial infections worldwide has revived interest in these ‘‘forgotten’’ agents. Colistin (polymyxin E) is one of the main antibiotics of this class. It is most often administered as the pro-drug colistimethate sodium. Doses for treatment of systemic infections in adults range between 3 and 9 million IU per day. Colistin is increasingly used for treatment of pneumonia and bacteremia in critically ill patients. During their ICU stay, many of these subjects will need continuous renal replacement therapy (CRRT) because of acute kidney injury or an unstable hemodynamic condition. Based on recent pharmacological data and own experience, we postulate that patients undergoing CRRT may receive substantially higher doses of colistin (i.e., a high loading dose, followed by a maintenance dose up to 4.5 million IU tid). Treatment can be continued for a prolonged time period without increasing toxicity. CRRT counteracts colistin accumulation because the drug is continuously filtered and also significantly adsorbed in the bulk of the dialysis membrane. Implementing such ‘‘CRRT rescue’’ therapy does require the strict use of highly adsorptive dialysis membranes in association with citrate anticoagulation to increase membrane performance.
Rajesh Kumar Wadhwa, Zaigham Abbas, Syed Mujahid Hasan, Nasir Hasan Luck, Mahira Younus, Sabiha Anis and Muhammed Mubarak
Background: Esophageal varices (EVs) are serious consequences of liver cirrhosis. Several studies have evaluated the possible non-invasive markers for the diagnosis of EVs to reduce the number of endoscopic procedures in patients with cirrhosis but without varices. This study was performed to evaluate the diagnostic performance of two such parameters (platelet count to splenic diameter ratio and splenoportal index) for the detection of EVs. Materials and Methods: A total of 111 patients with liver cirrhosis were analyzed after performing upper gastrointestinal endoscopy and non-invasive tests including platelet count and ultrasound abdomen including Doppler study. Appropriate statistical tests were applied to compare the non-invasive tests with the gold standard of endoscopy. Results: Of 111 liver cirrhotics, 80 (72.1%) were male and 31 (27.9%) were female. EVs were present in 68 (61.3%) patients and absent in 43 (38.7%) patients. In platelet count to splenic diameter ratio, a cut-off value of 1014 was obtained, which gave a sensitivity of 75.0%, specificity of 65.1%, positive predictive value (PPV) of 77.3%, negative predictive value (NPV) of 62.2% and diagnostic accuracy of 71.2%. In the splenoportal index, a cut-off value of 3.5 cm/s was obtained, which gave a sensitivity of 79.4%, specificity of 72.0%, PPV of 81.8%, NPV of 68.8% and diagnostic accuracy of 76.5% for the diagnosis of EVs. Conclusions: The platelet count to spleen diameter ratio and splenoportal index are non-invasive and fairly accurate alternatives in identifying the presence or absence of EVs in patients with compensated cirrhosis.
Mohammad Qasim Khan, Vijay Anand, Norbert Hessefort, Ammar Hassan, Alya Ahsan, Amnon Sonnenberg and Claus J. Fimmel
, dedicated patient visits, and is therefore not easily applicable to large patient populations. In recent years, a number of serum-based fibrosis tests have been developed and validated. Many studies have reported reasonable performance characteristics and good agreement with biopsy or elastography data.[ 4 , 5 ] With the advent of electronic medical record systems, fibrosis scores can be easily calculated after extracting the pertinent test results for each patient. This process does not require additional patient visits, and can be applied to large patient cohorts. As