Efficacy of early structured pulmonary rehabilitation program in pulmonary function,exercise capacity,and health-related quality of life for patients with post-tubercular sequelae: A pilot study

BackgroundResidual structural changes in the lung along with pulmonary impairment remain in a large number of patients of tuberculosis after microbiological cure. The aim of this study was to determine whether 12 weeks of a structured pulmonary rehabilitation program (PRP) administered along with antitubercular treatment improved the baseline measurement of pulmonary function, exercise capacity, and health-related quality of life (HRQOL).MethodsA pilot study with single blind randomized control design was carried out in a tertiary care chest center. Spirometry, exercise capacity by 6-minute walk distance (6MWD), and HRQOL using St George respiratory questionnaire (SGRQ) score were evaluated in 62 patients, divided into 2 groups: intervention group (IG) (n = 31) and control group (CG) (n = 31) patients at baseline and at end of 12 weeks. IG completed 12 weeks of PRP.ResultsSignificant difference in forced expiratory volume in 1st second (FEV1) (2.94 L at baseline vs 3.18 L at end of 12 weeks of PRP, diff 0.239 L, p-0.001), forced vital capacity (FVC) (3.43 L vs 3.75L, p −0.00), 6MWD (440.6 m vs 574.6 m, p = 0.00), and SGRQ score of at baseline (24.5 m vs 11.1m, p = 0.00) was seen in the IG. At end of 12 weeks, there was statistically significant difference in FEV1(L) (p = 0.01, 95% CI −0.317 to −0.046), FVC(L) (p = 0.00, 95% CI −0.359 to −0.139),6MWD(m) (p = 0.00; 95% CI −101.6 to −49.57) between CG and IG. There was no statistically significant difference in SGRQ scores between the 2 groups (p = 0.231).ConclusionPRP administered along with treatment is beneficial in reducing residual pulmonary impairment.     

Higenamine as a Potential Pharmacologic Stress Agent in the Detection of Coronary Artery Disease

Myocardial perfusion imaging (MPI) is valuable for the diagnosis, prognosis, and management of coronary artery disease (CAD). The most commonly used pharmacologic stress agents at present are vasodilators and adrenergic agents. However, these agents have contraindications and may cause adverse effects in some patients. Thus, other stress agents feasible for more patients are required. Higenamine (HG) is a β-adrenergic receptor agonist currently approved for clinical trials as a stress agent for myocardial infarction. It also has a promising value in MPI for the detection of CAD in preclinical and clinical studies. This review summarizes the application of HG on MPI, including its mechanism of action, stress protocol, efficacy, and safety.     

Metabolic clues regarding the enhanced performance of elite endurance athletes from orchiectomy-induced hormonal changes

This article examines the metabolic performance of an elite cyclist, Lance Armstrong, before and after his diagnosis with testicular cancer. Although a champion cyclist in 1-day events prior to his diagnosis of testicular cancer at age 25, he was not a contender in multi-day endurance cycle races such as the 3-week Tour de France. His genetic makeup and physiology (high VO2max, long femur, strong heavy build) coupled with his ambition and motivation enabled him at an early age to become one of the best 1-day cyclists in the world. Following his cancer diagnosis, he underwent a unilateral orchiectomy, brain surgery and four cycles of chemotherapy. After recovering, he returned to cycling and surprisingly excelled in the Tour de France, winning this hardest of endurance events 7 years running. This dramatic transformation from a 1-day to a 3-week endurance champion has led many to query how this is possible, and under the current climate, has led to suggestions of doping as to the answer to this metamorphosis. Physiological tests following his recovery indicated that physiological parameters such as VO2max were not affected by the unilateral orchiectomy and chemotherapy. We propose that his dramatic improvement in recovery between stages, the most important factor in winning multi-day stage races, is due to his unilateral orchiectomy, a procedure that results in permanent changes in serum hormones. These hormonal changes, specifically an increase in gonadotropins (and prolactin) required to maintain serum testosterone levels, alter fuel metabolism; increasing hormone sensitive lipase expression and activity, promoting increased free fatty acid (FFA) mobilization to, and utilization by, muscles, thereby decreasing the requirement to expend limiting glycogen stores before, during and after exercise. Such hormonal changes also have been associated with ketone body production, improvements in muscle repair and haematocrit levels and may facilitate the loss of body weight, thereby increasing power to weight ratio. Taken together, these hormonal changes act to limit glycogen utilization, delay fatigue and enhance recovery thereby allowing for optimal performances on a day-to-day basis. These insights provide the foundation for future studies on the endocrinology of exercise metabolism, and suggest that Lance Armstrong's athletic advantage was not due to drug use.     

Using Claims Data to Map Unmet Service Needs for Early Childhood Developmental Disabilities in Virginia

BackgroundDevelopmental disabilities (DD) affect over 10% of children 0 to 5 years of age, and early interventions are known to improve outcomes, yet barriers remain in connecting children to these services.ObjectiveTo identify gaps in services for young children with DD and established risk conditions in Virginia.MethodsData from the 2018 Virginia All Payers Claim Database and the American Community Survey were used to estimate the proportion of children with DD, and among those children, the proportion that received at least one intervention service. Logistic and binomial regression models were used to examine the socio-demographic associations with having developmental needs met, at the individual and zip code tabulation (ZCTA) level.ResultsApproximately 12% of children 0 to 5 years were found to have DD or established risk condition diagnosis, and only 54% of these received intervention services during that year. Individual-level analyses suggest that odds of having developmental needs met are higher among older children, boys, and children with public insurance. ZCTA-level analyses suggested higher odds of developmental needs being met in areas with higher levels of unemployment, while areas with high proportions of people with limited English proficiency and a high school education or less had lower odds of having needs met.ConclusionsReceiving early childhood developmental services in Virginia is associated with having public insurance and living in an area with higher levels of unemployment, higher education, and English-proficiency. Efforts are needed to improve delivery of services overall, specifically targeted to those areas with high levels of unmet need.     

Risk of Total Knee and Hip Arthroplasty in Patients With Rheumatoid Arthritis: A 12-Year Retrospective Cohort Study of 65,898 Patients

BackgroundRheumatoid arthritis (RA) is an inflammatory disease that causes the destruction of soft tissues and cartilage around joints. Owing to the widespread use of potent disease-modifying antirheumatic drugs, the need for total knee and hip arthroplasties (TKA and THA) has been reduced in patients with RA. However, the current association between RA and either THA or TKA has not been demonstrated in large-scale epidemiological studies.MethodsWe conducted a large-scale retrospective cohort study of patients diagnosed with RA during a 12-year period (2000-2012) in Taiwan. We recruited 32,949 patients with RA and 32,949 individually propensity score-matched non-RA controls.ResultsAfter adjusting for confounding factors, we found that the risk of THA or TKA was 4.02 times higher in patients with RA than in those without RA (95% confidence interval [CI], 3.77-4.52). The risk of THA or TKA was highest in patients with RA younger than 40 years (adjusted hazard ratio, 43.18; 95% CI, 16.01-116.47). Compared with non-RA patients, patients with RA were 4.82 times more likely to undergo THA (95% CI, 3.84-6.04), 3.85 times more likely to undergo TKA (95% CI, 3.48-4.25), and 19.06 times more likely to undergo both THA and TKA (95% CI, 8.90-40.80).ConclusionThese findings document a 4.02-fold greater long-term risk of undergoing THA or TKA in RA patients relative to non-RA patients in Taiwan.     

Research contributions and implications

Distinguishing and characterizing the terms “chronic conditions” and “disability” is important to the quality of public health research. Research has documented that people with disabilities experience higher prevalences of chronic conditions than the general population; however, these differences are rarely attributable to the pre-existing disability, and instead likely stem from preventable environmental factors. In this paper we describe contributions from the research as well as the need for a paradigm shift to effectively address the unique public health needs of people with disabilities. In addition, we describe evidence of support for such a paradigm shift. We intend for this paper to invite discussion in the field about methods to elicit the changes necessary in public health research for improved policy and practice that better address the public health needs of people with disabilities.     

Effects of cyclooxygenase and lipoxygenase inhibition on eicosanoids and healing of acetic acid colitis in rats

Both cyclooxygenase products, such as prostaglandin (PG) E₂, and lipoxygenase products, such as leukotriene (LT) B₄, are increased in colitis and have potent proinflammatory actions. We studied effects of specific inhibitors of cyclooxygenase and 5-lipoxygenase on the healing of acetic acid colitis in rats. Acetic acid colitis was induced 24 hr before enzyme inhibition began. Four days after induction of colitis, the area of gross colonic mucosal damage was determined by image analysis. Eicosanoid content in the intestinal lumen was quantitated by radioimmunoassay following chromatographic purification. Under these conditions, indomethacin significantly retarded the healing of colonic lesions and inhibited PGE₂ by >90% compared to placebo-treated colitis rats. AA861 had no effect on the healing of lesions, although >75% inhibition of leukotriene synthesis was demonstrated. These results suggest that inhibition of endogenous colonic prostaglandins can impair healing mechanisms in acute colitis even after inflammation has developed. In contrast, inhibition of leukotriene synthesis did not affect healing.