Impact of cognitive capacity on physical performance in chronic obstructive pulmonary disease patients: A scoping review.

Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by impaired cognitive and physical function. However, the role of cognitive function on motor control and purposeful movement is not well studied. The aim of the review was to determine the impact of cognition on physical performance in COPD. Methods: Scoping review methods were performed including searches of the databases: MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane (CENTRAL), APA PsycINFO, and CINAHL. Two reviewers independently assessed articles for inclusion, data abstraction, and quality assessment. Results: Of 11,252 identified articles, 44 met the inclusion criteria. The review included 5743 individuals with COPD (68% male) with the forced expiratory volume in one second range of 24-69% predicted. Cognitive scores correlated with strength, balance, and hand dexterity, while 6-min walk distance (n = 9) was usually similar among COPD patients with and without cognitive impairment. In 2 reports, regression analyses showed that delayed recall and the trail making test were associated with balance and handgrip strength, respectively. Dual task studies (n = 5) reported impaired balance or gait in COPD patients compared to healthy adults. Cognitive or physical Interventions (n = 20) showed variable improvements in cognition and exercise capacity. Conclusions: Cognition in COPD appears to be more related to balance, hand, and dual task function, than exercise capacity.

Electro-surgical management of a traumatic fibroma with clinical assessment of re-epithelialization using methylene blue assay: A clinico-histopathological case report.

This article addresses the clinical presentation, diagnosis, histological features, and management of a case of fibroma. Fibroma is proliferative fibrotic lesions of the gingiva and oral mucosa, which may cause aesthetic and functional problems. Fibrous hyperplasia and fibroepithelial hyperplasia are histological alternates of these nonneoplastic lesions. The case demonstrated an overgrowth in the lower back tooth region. The growth was pale in color, sessile, painless, and firm in consistency. The lesion caused discomfort when chewing food, the lesion was excised using dental electrocautery and sent for histopathological assessment. This lesion was caused by trauma or persistent irritation, and histological examination indicates that the cells in the lesion are from the oral mucous membrane. This case demonstrates the need for proper diagnosis, the role of biopsy, and histologic evaluation in the management of fibrotic lesions.

Evidence based physiotherapy practice in cardiopulmonary subdiscipline: A survey in United Arab Emirates.

BACKGROUND: Evidence based practice (EBP) is widely used by cardiopulmonary physical therapists worldwide. Therefore, it is important to identify whether the therapists have the required knowledge, skills and resources in order to deliver the best evidence-based practice. OBJECTIVES: The main objective of this cross-sectional study is to analyse the self-reported characteristics of behaviour, knowledge, skills and resources, opinion and barriers related to evidence-based practice among cardiopulmonary physical therapists of United Arab Emirates (UAE). METHODS: An electronic questionnaire was circulated among 60 licensed cardiopulmonary physical therapists, of either gender, practicing in UAE with a minimum experience of 1 year via e-mail. The response was further subjected to descriptive analysis. RESULTS: The rate of response was 55% (33/60). The physical therapists of cardiopulmonary disciple reported that they understand the term Evidence Based Practice and frequently update themselves through scientific papers obtained via accessing various databases. Respondents also believe that the exposure in undergraduate or postgraduate course was not sufficient. However, they were also satisfied with amount of discussions taking place regarding EBP at their work place. The barriers commonly reported were difficulty in obtaining full-text papers, lack of time and lack of evidence-based training. CONCLUSION: Thus, concluding that physical therapists from UAE who practiced in cardiopulmonary subdiscipline believe that they have knowledge and skills to use evidence-based practice. Although, they have favourable opinions regarding its application and they still encounter difficulties in implementing it successfully.

Reference value for the six-minute peg board and ring test. A cross sectional study.

INTRODUCTION: In our daily life, arm activities, whether supported or unsupported play a major role. Both simple and complex activities require the muscles, namely trapezius, pectoralis minor, scalene, and intercostals, to participate in arm positioning. These muscles also enact as the accessory respiratory muscles. Therefore, arm elevation increases the load on these muscles and they fail to perform dual activities, resulting in arm fatigue and a feeling of dyspnoea in healthy individuals as well as in chronic obstructive pulmonary disease patients. Various upper limb exercise tests were designed to measure this impairment, one of them being the six-minute peg board and ring test. The aim of the study is to derive a reference value for the six-minute peg board and ring test among healthy Indian population (Mangalore) from the age of 20-70 years of either gender. Also, to find a correlation among the number of rings and body mass index, arm length, arm and forearm circumference, the strength of shoulder and elbow flexors-extensors, grip strength of both sides and level of physical activity. METHODS: Participants performed two tests, thirty minutes apart. They were asked to load as many rings as possible in 6 minutes. Arm length, arm and forearm circumference were measured with a measuring tape. Shoulder and elbow flexors-extensors were assessed using a handheld push-pull dynamometer. Grip strength was measured with the Jamar hand-held dynamometer. Level of physical activity was assessed using International Physical Activity Questionnairelong form. RESULTS: The samples consisted of 450 healthy individuals between the age of 20-70 years. Reference values for each age group for both genders were reported. We found that age was correlated with the six-minute peg board and ring test score (p<0.05). We also found a correlation between the strength variables and the test results (p=0.001). However, no correlation was found between the arm length, arm and forearm circumference and the level of physical activity with the number of rings. CONCLUSION: In this study, we derived a reference value for the six-minute peg board and ring test. There was a correlation among age, strength variables and the number of rings.

Folding of the Ig-Like Domain of the Dengue Virus Envelope Protein Analyzed by High-Hydrostatic-Pressure NMR at a Residue-Level Resolution.

Dengue fever is a mosquito-borne endemic disease in tropical and subtropical regions, causing a significant public health problem in Southeast Asia. Domain III (ED3) of the viral envelope protein contains the two dominant putative epitopes and part of the heparin sulfate receptor binding region that drives the dengue virus (DENV)'s fusion with the host cell. Here, we used high-hydrostatic-pressure nuclear magnetic resonance (HHP-NMR) to obtain residue-specific information on the folding process of domain III from serotype 4 dengue virus (DEN4-ED3), which adopts the classical three-dimensional (3D) ß-sandwich structure known as the Ig-like fold. Interestingly, the folding pathway of DEN4-ED3 shares similarities with that of the Titin I27 module, which also adopts an Ig-like fold, but is functionally unrelated to ED3. For both proteins, the unfolding process starts by the disruption of the N- and C-terminal strands on one edge of the ß-sandwich, yielding a folding intermediate stable over a substantial pressure range (from 600 to 1000 bar). In contrast to this similarity, pressure-jump kinetics indicated that the folding transition state is considerably more hydrated in DEN4-ED3 than in Titin I27.

Effect of Lecture Attendance and Prerequisite Academic Outcomes on Dental Students' Oral Pathology Performance.

Decreased lecture attendance in undergraduate and health science professions education has been noted throughout the world. The limited study of the effect of lecture attendance on dental students' performance has yielded mixed results, with some studies finding a positive effect and others reporting no association. The aim of this study was to evaluate the effect of lecture attendance on dental students' final grades in an oral pathology course at one U.S. dental school. Due to a curriculum change, second- and third-year students (N=233) were concurrently enrolled in the spring 2016 oral pathology (OP) course. Students' course grades were compared to attendance percentage (Att), grades in prerequisite basic science (PBS) courses, and Academic Average and Total Science (TS) scores on the Dental Admission Test. The results showed that both Att (p=0.011) and TS score (p<0.001) were significant predictors of OP grade, while race, gender, and age were not. Students' grades in OP were moderately to strongly correlated with their grades in all PBS courses (p<0.001). These results suggest that lecture attendance in OP should be encouraged but viewed in light of the finding that it was not as strongly correlated as PBS course performance and was a weaker predictor than TS score. Students with lower TS scores and PBS course grades should be encouraged to use additional supports such as tutoring to improve their performance in OP.

Modeling and experimental assessment of a buried Leu-Ile mutation in dengue envelope domain III.

Envelope protein domain III (ED3) of the dengue virus is important for both antibody binding and host cell interaction. Here, we focused on how a L387I mutation in the protein core could take place in DEN4 ED3, but cannot be accommodated in DEN3 ED3 without destabilizing its structure. To this end, we modeled a DEN4_L387I structure using the Penultimate Rotamer Library and taking the DEN4 ED3 main-chain as a fixed template. We found that three out of seven Ile(387) conformers fit in DEN4 ED3 without introducing the severe atomic clashes that are observed when DEN3 serotype's ED3 is used as a template. A more extensive search using 273 side-chain rotamers of the residues surrounding Ile(387) confirmed this prediction. In order to assess the prediction, we determined the crystal structure of DEN4_L387I at 2 Å resolution. Ile(387) indeed adopted one of the three predicted rotamers. Altogether, this study demonstrates that the effects of single mutations are to a large extent successfully predicted by systematically modeling the side-chain structures of the mutated as well as those of its surrounding residues using fixed main-chain structures and assessing inter-atomic steric clashes. More accurate and reliable predictions require considering sub-angstrom main-chain deformation, which remains a challenging task.

Structural and biophysical analysis of sero-specific immune responses using epitope grafted Dengue ED3 mutants.

Dengue fever is a re-emerging tropical disease and its severe form is caused by cross-reactivity between its four serotypes (DEN1, DEN2, DEN3 and DEN4). The third domain of the viral envelope protein (ED3) contains the two major putative epitopes and is a highly suitable model protein for examining the molecular determinants of a virus' sero-specificity. Here we examine d the sero-specificity and cross-reactivity of the immune response against DEN3 and DEN4 ED3 using six epitope grafted ED3 variants where the surface-exposed epitope residues from DEN3 ED3 were switched to those of DEN4 ED3 and vice versa. We prepared anti-DEN3 and anti-DEN4 ED3 serum by immunizing Swiss albino mice and measured their reactivities against all six grafted mutants. As expected, both sera exhibited strong reactivity against its own serotype's ED3, and little cross-reactivity against their counterpart serotype's ED3s. E2 played a major role in the sero-specificity of anti-DEN3 serum, whereas E1 was important for DEN4 ED3's sero-specificity. Next, the reactivity patterns corroborated our working hypothesis that sero-specificity could be transferred by grafting the surface exposed epitope residues from one serotype to the other. To analyze the above results from a structural viewpoint, we determined the crystal structure of a DEN4 ED3 variant, where E2 was grafted from DEN3 ED3, at 2.78Å resolution and modeled the structures of the five remaining grafted variants by assuming that the overall backbone remained unchanged. The examination of the electrostatic and molecular surfaces of the variants suggested some further rationale for the sero-specificity of the immune responses.

Pregnancy in women aged 35 years and above: a prospective observational study.

ABSTRACT: Pregnancy is affected by maternal age from conception till delivery. Various studies have been conducted globally to study this effect; few in developing countries. Maternal age is increasing in developing countries as well, so we have conducted this study. METHOD: This was a prospective observational study consisting of 1,263 women booked at Jehangir hospital during a period of 2 years, fulfilling inclusion criteria and consenting for the study. They were divided into two groups; women aged 35 years and above and women less than 35 years of age. Pregnancy outcomes were studied in terms of antepartum, intrapartum and postpartum complications. Neonatal outcomes were studied in terms of birth weight and NICU admissions. Data was analyzed statistically using statistical package for social sciences version 17, by applying Chi square test and Fisher exact test. A p value below 0.05 was considered significant. RESULTS: Women aged 35 years and above constituted 9.63 % of the total study population. Most were multigravidae. Rate of assisted conception was significantly higher among women aged 35 years and above; early pregnancy loss was also high in this group. Pre-eclampsia and abruption were significantly higher among them. Neonatal outcomes were comparable. CONCLUSION: Women with advanced maternal age are at higher risk of complications from conception till delivery and should be provided close supervision for better pregnancy outcome.