The purpose of our study was to determine the added effect of a balance training program to conventional pulmonary rehabilitation on exercise capacity, balance, fall risk and health related quality of life in patients with moderate COPD. A Randomized Control Trial with two groups- Experimental and Control groups. 133 participants were randomly allocated to either the conventional pulmonary rehabilitation group or the combined pulmonary rehabilitation group with balance training. In the present study we found statistically significant improvement in Berg Balance Scale by -22.55%, Timed Up and Go test by -46.46%, Single Leg Stance Test by -51.69%, Activities Balance Confidence Score by 13.89%, Elderly Falls Screening Test by -57.42%, Six-minutes walk test by 3.04%, and St. George respiratory questionnaire total score by -18.16%.It is recommended that implementation of 8 weeks balance training with conventional pulmonary rehabilitation program is beneficial on improving balance, six-minute walk distance and health related quality of life in subjects with moderate COPD.
BACKGROUND The infection caused due to novel coronavirus 2 can cause wide spectrum of disease from asymptomatic mild disease to life threatening disease. The widespread inflammation is most likely the cause of the adverse outcomes. There are numerous markers of the inflammation which are used to identify the severity and prognosis of the disease. Neutrophil lymphocyte ratio (NLR) is one such marker which is easily available and feasible in all the hospital settings. This study intended to evaluate the NLR as a marker of disease severity and prognosis, in those with Covid-19. METHODS This was a retrospective study to determine the utility of NLR as a marker of severity and prognosis among patients with Covid disease. Medical records of 60 patients admitted with mild to moderate Covid-19 disease were reviewed and relevant data was retrieved. The NLR at admission and 72 hours later was noted. High resolution computerised tomography was done and computerised tomography severity score (CT-SS) was calculated. The outcomes of these patients were noted. RESULTS Mean NLR at admission in mild disease was 5.6 and in moderate disease was 9.2. This difference was found to be statistically significant. It was also seen that NLR had a positive co-relation with CT severity score, duration of hospital stay, Creactive protein (CRP) and D-dimer. For predicting mortality, NLR with cut off of 6.6 had a sensitivity of 100 % and a specificity of 66.07 %. CRP with cut off of 6.8 had sensitivity of 100 %, specificity of 76.79 %. D-dimer with cut off of 1.6 had specificity of 78.58 %. For predicting severity, NLR with cut off of 6.6 had sensitivity of 75 % and specificity of 80 %. CRP with cut off of 7.9 had sensitivity of 65 % and specificity of 100 %. D-dimer with cut off of 1.3, had sensitivity of 90 % and specificity of 97.5 %. CONCLUSIONS The study shows that neutrophil–lymphocyte ratio is a good indicator of disease severity and has prognostic significance in Covid-19. There is a positive correlation with high-resolution computed tomography (HRCT) chest score and other markers of inflammation among patients with Covid-19. Serial monitoring of NLR can be utilised as a surrogate to HRCT chest to determine disease severity whenever the latter is not available. This can ensure early intervention and help prevent mortality. KEYWORDS Neutrophil-Lymphocyte Ratio, Severity of Covid
BACKGROUND The clinical history taking and physical examination are the hallmarks of medical teachings and in clinical practice. However in present days these traditional methods are losing their importance due to availability of advanced technologies. The clinicians are more dependent on the investigations. History and clinical examination, till recent times were thought to be less objective and individualized. But there are statistical parameters based on evidence based medicine and clinical care that can be used to make the clinical examination more objective and precise. Utilizing these parameters the clinical examination will be more beneficial to the clinicians. In resource limited settings, clinical examination combined with the following statistical parameters will help to narrow down the diagnosis and provide timely diagnosis. The article tries to give a template for predicting the probability, establishing treatment and testing thresholds for common respiratory symptoms based on the evidence based medicine methods.
BACKGROUND Systemic lupus erythematosus is an autoimmune disorder characterised by multisystem involvement. Pulmonary involvement is common in SLE. Pulmonary manifestations include pleuritis, pleural effusion, interstitial lung disease and shrinking lung syndrome. There are few such studies in India. Hereby, we studied pulmonary manifestations of SLE in a tertiary centre in South India. MATERIALS AND METHODS 50 patients diagnosed to have SLE with disease duration more than 5 years were included in the study. Detailed clinical history and examination was conducted. They were subjected to chest x-ray, high-resolution CT scan, pulmonary function test and sputum examination was done. These patients were screened for various respiratory symptoms. The radiological features and pulmonary function test features were analysed for both symptomatic and asymptomatic patients. Pulmonary manifestations in patients of lupus nephritis was also studied.
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