Pulmonary hypertension in adults completing tuberculosis treatment.

Background: Pulmonary hypertension (PH) after tuberculosis (TB) is typically not included among the chronic lung diseases causing PH (group 3 PH), with few data available to support the inclusion. Objectives: To determine the prevalence of PH in an adult population completing TB treatment. Methods: This single-centre, cross-sectional study only included patients with their first documented episode of TB, and who were in the second half of treatment or had recently completed treatment. PH was assessed using transthoracic echocardiography. Questionnaires were completed, and spirometry and a 6-minute walk test were performed. Results: One hundred patients were enrolled, with a mean age of 37.1 years, of whom 58% were male and 46% HIV positive. The median time since initiation of TB treatment was 22 weeks. The mean (standard deviation) measured right ventricular systolic pressure (RVSP) was 23.6 (6.24) mmHg. One participant had PH (defined as RVSP ≥40 mmHg; 95% confidence interval (CI) 0.0 - 3.0) and a further 3 had possible PH (RVSP ≥35 and <40 mmHg), with a combined PH prevalence of 4% (95% CI 0.2 - 7.8). Airflow obstruction on spirometry was found in 13.3% of 98 patients, while 25.5% had a reduced forced vital capacity. There was no association between RVSP or PH/possible PH and sex, age, HIV status, systemic hypertension, spirometry measurements or 6-minute walking distance. Smoking status was associated with RVSP, but not with the presence of PH/possible PH. Conclusion: There was a significant prevalence of PH in this preliminary study of predominantly young patients completing treatment for a first episode of TB. Larger and more detailed studies are warranted. Study synopsis: What the study adds. Of 100 adult patients with their first episode of tuberculosis (TB) who underwent echocardiograms near the end of treatment completion to determine the prevalence of pulmonary hypertension (PH), 1 (1%) had PH and a further 3 (3%) had possible PH. There was no association between sex, age, HIV status, lung function or 6-minute walking distance and the presence of PH. The study adds to the growing awareness of the association of TB with pulmonary vascular disease. It shows that even in a young population with a first episode of TB treated in an ambulatory setting, there is a significant prevalence of PH on treatment completion.Implications of the findings. Given that 10.6 million people acquire TB annually, the absolute global burden of cases with PH is likely to be high, but is underappreciated to date. Further work is urgently needed in this field.

Are elderly pedestrians allowed enough time at pedestrian crossings in Cape Town, South Africa?

A descriptive, cross-sectional analytical study was conducted to determine whether the recommended walking speed of 1.2 ms(-1) would allow elderly pedestrians to safely clear pedestrian crossings in Cape Town, South Africa. Male and female volunteers (n = 47), aged 65-93 years and resident in four homes for older persons, were recruited. Pedestrian clearance intervals at 40 traffic lights within 5-km radius of the selected homes were measured. The mean walking speed required at these traffic lights was 0.86 +/- 0.32 ms(1). The maximal walking speed over 12 m was measured without carrying any load and when carrying a predetermined weight of an average shopping bag. Participants' emotions associated with pedestrian road safety were also assessed through an interview. The mean maximal unloaded and loaded walking speeds were 1.36 +/- 0.31 ms(-1) (0.73-2.03 ms(-1)), and 1.36 +/- 0.33 ms(-1) (0.58-2.12 ms(-1)), respectively. Over 30% of the participants walked slower than the recommended walking speed of 1.2 ms(-1). Participants felt that traffic lights did not allow for sufficient time to cross roads (51.1%) and reported emotions of apprehension (44.7%), anxiety (17.0%), and fear (10.6%) when crossing. A review of traffic planning and public policy is recommended to ensure older pedestrians safely clear pedestrian crossings.

Some neuromuscular effects of the crude extracts of the leaves of Abrus precatorius.

Some neuromuscular effects of the crude extracts of the leaves of Abrus precatorius were investigated using isolated toad rectus abdominis and rat phrenic nerve-diaphragm muscle preparations as well as young chicks. The ethanol extract of the leaves inhibited acetylcholine-induced contractions of both toad rectus abdominis and rat phrenic nerve-diaphragm muscle preparations. The effects were concentration-dependent and reversible. The extract also caused flaccid paralysis when injected intravenously into young chicks. The ethanol extract had no effect on direct electrical stimulation of rat diaphragm. The inhibitory effect of the ethanol extract on the rat phrenic nerve-diaphragm preparation was potentiated in the presence of reduced calcium ions, elevated magnesium ions, or reduced potassium ions. Thus, the ethanol extract showed a similarity to d-tubocurarine in respect of the pattern of neuromuscular blockade. Both the petroleum ether and the water (cold and hot) extracts had no observable effects on the skeletal muscles used in this project. Apparently, the poisonous neuronal component of the leaves of Abrus precatorius resides mainly in the ethanol extract.

Low back pain--back care through proper lifting technique.

The study was designed to evaluate the level of knowledge of the subjects about back care and proper lifting techniques. Two groups of subjects were taught correct lifting method and back care through practical demonstrations and illustrated diagrams. The subjects' knowledge was measured pre- and post-test, using written and practical tests. Subjects with low back pain and those without back pain both benefited from the training. The need for physiotherapists to teach back injury prevention to the general populace was highlighted.

Determinants of academic and clinical performance in the physiotherapy education programme at the University of Ibadan, Nigeria.

A retrospective study was conducted to determine the best predictors of academic and clinical performance in the physiotherapy education programme in the University of Ibadan, Nigeria. Reviewing the records of 94 students enrolled in the programme between 1983 and 1987, multiple and stepwise regression analyses revealed that pre-admission requirements were not significantly related to academic and clinical performance. When all the predictor variables were included in the multiple and stepwise regression analyses, the variance accounted for by the predictor variables was dismally low: 33.8% and 21.3% for academic achievement and clinical performance, respectively. We concluded that the pre-admission requirements are not viable predictors of academic and clinical performance in the programme.

Rehabilitation of the handicapped child--what about the caregiver?

The mental health of caregivers of handicapped children (n = 68) and of caregivers of children with minor ailments (n = 40) was assessed using the General Health Questionnaire (GHQ). In the comparative study, the caregivers of handicapped children had a significantly higher mean score (6.8), which was above the threshold score of 4. This suggests that the task of caring for disabled children may have a stressful impact on the caregivers which may contribute to psychiatric morbidity. There is a need periodically to assess the mental health of the caregiver, even as the rehabilitation of the handicapped child progresses. Addressing the psychological disturbances in the caregiver should form part of the treatment of the handicapped child.

Perceived and experienced restrictions in participation and autonomy among adult survivors of stroke in Ghana.

BACKGROUND: Many stroke survivors do not participate in everyday life activities. OBJECTIVE: To assess the perceived and experienced restrictions in participation and autonomy among adult stroke survivors in Ghana. METHOD: The "Impact on Participation and Autonomy Questionnaire" (IPAQ) instrument was administered in a survey of 200 adult stroke survivors to assess perceived restrictions in participation and autonomy, followed by in-depth interviews with a sub-sample on the restrictions they experienced in participation. RESULTS: Perceived restrictions in participation were most prevalent in the domains of education and training (3.46±0.79), paid or voluntary work (2.68±0.89), helping and supporting other people (2.20±0.82), and mobility (2.12±0.79). There were significant differences in two domains between survivors who received physiotherapy and those who received traditional rehabilitation. Over half of the survivors also perceived they would encounter severe problems in participation in the domains of paid or voluntary work, mobility, and education and training. The sub-sample of stroke survivors (n=7) mostly experienced restrictions in participation and autonomy in going outside the house, working, and in fulfilling family roles. CONCLUSION: If these perceptions and experiences are not addressed during rehabilitation, they could further inhibit the full participation and social integration of stroke survivors.