Pre-operative Factors Predicting Mortality in Six Months and Functional Recovery in Elderly Patients with Hip Fractures

@#Introduction: This study aimed to determine on-admission and perioperative factors predicting six-month mortality and functional recovery in Vietnamese patients with hip fracture. Materials and methods: Between April 2020 and July 2021, 118 patients participated in this prospective study. Patients’ data were collected from medical records. Harris hip score (HHS) was used to evaluate the functional recovery six months after fractures. The obtained data were analysed using a univariate and multivariate model. Results: The mean age of the participants was 79.5±9.4 years and 68.6% of the patients were female. The six-month mortality rate was 5.9% and independently associated with age (odds ratio (OR): 3.512, 95% confidence interval (CI) 1.538 – 8.019; P<0.001, patients aged >80 years vs those aged ≤80 years) and hypoproteinemia (OR: 2.859, 95% CI: 1.001 – 8.166, P=0.049). Among 111 survivors there were 66 (59.5%) of patients with a good functional recovery. Patients aged >80 years had a higher risk of poor functional outcome (OR: 3.167, 95% CI: 1.386 – 7.235, P: 0.006) compared to those aged ≤ 80 years. No significant correlations between other clinical (gender, body mass index, comorbidities, type of fractures or surgery, time until surgery) or laboratory parameters (anaemia, hyperglycemia, marked elevation of C reactive protein level, electrolyte abnormalities, elevated urea) and mortality or functional outcome were found. Conclusion: Advanced age is the most important factor affecting both mortality and functional outcome while hypoproteinemia is associated with a higher risk of mortality in elderly patients with hip fractures.

Leptin and interleukin-1β levels associated with osteoarthritis in Vietnamese patients: a cross-sectional analysis

Leptin and interleukin-1 beta (IL-1β) are two extensively studied biomarkers associated with metabolic syndrome (MetS) and osteoarthritis (OA). Previous studies have mostly focused on either MetS or OA alone, with no available data on Vietnamese patients. This study aimed to investigate the levels of leptin and IL-1β in this patient population and explore their association with clinical parameters of MetS and OA. The study included 164 patients with primary knee OA, who were classified into two categories based on the presence of MetS, and 78 healthy controls. The plasma leptin and IL-1β levels were quantified by ELISA and correlated with clinical parameters. Leptin levels were higher in patients with OA (11.50±10.04 ng/mL) than in healthy controls (0.54±0.37 ng/mL) and increased in patients with MetS compared to those without MetS. IL-1β levels were also significantly higher in OA patients (14.63±15.87 pg/mL) than in controls (7.79±5.11 pg/mL), but were not significantly different between the MetS and non-MetS groups. Leptin levels were positively correlated with body mass index, waist-to-hip ratio, visual analogue scale scores, HbA1c and insulin levels, and HOMA-IR index, whereas IL-1β levels were only correlated with insulin levels and HOMA-IR index. ROC curve analysis revealed that leptin and IL-1β levels could distinguish individuals with and without OA (AUC=0.96; 0.88, respectively), and individuals with and without MetS (AUC=0.82; 0.71, respectively). Our findings suggested that both leptin and IL-1β levels were associated with both MetS and OA and may play a critical role in the pathogenesis of MetS-related OA.

Decreased growth differentiation factor 9, bone morphogenetic protein 15, and forkhead box O3a expressions in the ovary via ulipristal acetate

SUMMARY OBJECTIVE: Folliculogenesis is a complex process involving various ovarian paracrine factors. During folliculogenesis, vitamin D3 and progesterone are significant for the proper development of follicles. This study aimed to investigate the effects of vitamin D3 and selective progesterone receptor modulator ulipristal acetate on ovarian paracrine factors. METHODS: In the study, 18 female Wistar-albino rats were randomly divided into three groups: control group (saline administration, n=6), vitamin D3 group (300 ng/day vitamin D3 oral administration, n=6), and UPA group (3 mg/kg/day ulipristal acetate oral administration, n=6). Ovarian tissue was analyzed by histochemistry and immunohistochemistry. For quantification of immunohistochemistry, the mean intensities of growth differentiation factor 9, bone morphogenetic protein 15, and forkhead box O3a expressions were measured by Image J and MATLAB. Blood samples were collected for the analysis of serum anti-Müllerian hormone levels by ELISA. RESULTS: Atretic follicles and hemorrhagic cystic structures were observed in the UPA group. After immunohistochemistry via folliculogenesis assessment markers, growth differentiation factor 9, bone morphogenetic protein 15, and cytoplasmic forkhead box O3a expressions decreased in the UPA group (p<0.05). Anti-Müllerian hormone level did not differ significantly between the experimental groups (p>0.05). CONCLUSION: Ulipristal acetate negatively affects folliculogenesis via ovarian paracrine factors. The recommended dietary vitamin D3 supplementation in healthy cases did not cause a significant change.

Profile of uropathogens in pregnancy over 5 years from a large tertiary center in South India

Objectives: Urinary tract infections (UTIs) are a common medical problem in both antenatal and postnatal women. Data from India on the demography of these women, microbiology and antimicrobial susceptibility of the causative bacteria, need elucidation. Material and Methods: We performed an observation study that collected data on UTI in antenatal and postnatal women between 2013 and 2017 at our tertiary care center in South India. Antenatally, urine dipstick-positive patients, high-risk, and symptomatic patients submitted urine cultures. Postnatally, all symptomatic patients had urine cultures. This was 20% of all antenatal and postnatal women resulting in 20,203 cultures. Results: Of 20,203 cultures, significant bacteriuria was seen in 9.48% of antenatal and 13.28% of postnatal women. A higher mean age was seen among those with UTI, antenatal 27 (SD 3.5) and postnatal 26.4 (SD 4.7) years versus 23.9 (SD 3.6) with no growth in culture. The mean BMI among antenatal was 28.2 (SD 3.5) and postnatal was 28 (SD 7.4). Most (60%) were primigravida. At delivery, 37% required cesarean sections while 21.2% required instrumental delivery. Recurrent UTI was seen in 25% antenatally and 10% in the postnatal period. Escherichia coli accounted for 66 and 60% of infections among antenatal and postnatal women, respectively. Enterococcus species accounted for 13% in both while Klebsiella species was 4.9 and 7.3%, respectively. Among E. coli, 68.3 and 59.2% of isolates in antenatal and postnatal period were cefpodoxime susceptible. Nearly 75% of ante- and postnatal isolates were susceptible to amoxicillin-clavulanate while 90.2% and 92.5% were susceptible to nitrofurantoin. Enterococci spp. up to 84.4 and 97.1% in ante- and postnatal isolates were susceptible to ampicillin, 64.4 and 77.4% susceptible to high-level gentamicin, and 84 and 95.5% susceptible to nitrofurantoin. Asymptomatic bacteriuria in pregnancy was documented in 2.1% of antenatal outpatients and E. coli was isolated in 74% of these cultures. Conclusion: Importance of microbiological evidence prior to administration of antimicrobials is evidenced by 79% negative cultures in this 5-year cohort. Escherichia coli accounted for 60-66% of significant bacteriuria followed by Enterococcus and Klebsiella species with 30-40% E.coli probable ESBL producers. Nitrofurantoin followed by amoxicillin-clavulanate were found to be the best oral antimicrobial options.

Antibody response of sheep to simultaneous vaccination of foot-and-mouth disease, peste des petits ruminants, sheep pox and goat pox, and bluetongue vaccines

@#There are many infectious animal diseases in Turkey and generally, vaccination is the primarly control strategy to combat them. However, it is difficult to apply all vaccines in a definite period in the field due to limitations of the labor and finance. Rapid vaccination and effective use of labor can be possible with the help of simultaneous vaccine administrations. The study aims to show the effects of simultaneous foot-and-mouth disease (FMD), peste des petits ruminants (PPR), sheep pox and goat pox (SGP), and bluetongue (BT) vaccine administration on the antibody response of sheep. For this aim, 30 sheep were divided into one experiment and 5 control groups. Blood samples were collected in each group at 0, 30 and 60 days post-vaccination (DPV). Immune response was measured with virus neutralization test (VNT) and, liquid phase blocking ELISA (LPBE) for FMDV; VNT for BTV and PPR. A live virus challenge study was performed to determine the immune response of SGP vaccine. As a result, antibody titers for each vaccine agent decreased on 60 DPV with the simultaneous vaccination except FMD. The difference between means of antibody titer decrease with single and simultaneous vaccinations is significant especially for BTV and PPR vaccines at 60DPV (p<0.05). Briefly, this decreasing immune response of three live vaccines can be explained with the development of the interference, administration of these vaccines from the same injection site, the effect of cytokines, especially IL-10 effect of SGP vaccine. It was concluded that four vaccines can not be used simultaneously in sheep.

Cognition enhancing effect of rosemary (Rosmarinus officinalis L.) in lab animal studies: a systematic review and meta-analysis

Patients with mild cognitive impairment eventually progress to Alzheimer's disease (AD) causing a strong impact on public health. Rosmarinus officinalis has long been known as the herb of remembrance and can be a potential cognition enhancer for AD. The aim of this review was to summarize the qualitative and quantitative aspects of R. officinalis and its active constituents in enhancing cognition. A structured search was conducted on Google Scholar and PubMed to find relevant studies that assessed the effect of R. officinalis extract or any of its active constituents on cognitive performance in animals. The following information was extracted from each study: 1) article information; 2) characteristics of study animals; 3) type of intervention: type, dose, duration, and frequency of administration of R. officinalis; and 4) type of outcome measure. Data were analyzed using Review Manager and meta-analysis was performed by computing the standardized mean difference. Twenty-three studies were selected for qualitative analysis and fifteen for meta-analysis. From the fifteen included papers, 22 with 35 comparisons were meta-analyzed. Effect sizes for intact and cognitively impaired animals were 1.19 (0.74, 1.64) and 0.57 (0.19, 0.96), indicating a positive effect on both groups. The subgroup analyses showed substantial unexplained heterogeneity among studies. Overall, R. officinalis improved cognitive outcomes in normal and impaired animals, and results were robust across species, type of extract, treatment duration, and type of memory. However, studies had a considerable amount of heterogeneity, and subgroup analyses failed to find any heterogeneity moderator.

Uso de ayudas diagnósticas en el paciente intoxicado en el servicio de urgencias / Use of diagnostic aids in the poisoned patient in the emergency department / Uso de ajudas diagnósticas em paciente intoxicado no atendimento de emergência

Objetivo: La incidencia de intoxicaciones en el servicio de urgencias viene en aumento en Colombia. En el abordaje inicial se solicitan paraclínicos de rutina, en ocasiones sin una correlación entre el xenobiótico, la fisiopatología y el riesgo clínico. El objetivo de esta investigación es describir el uso de las ayudas diagnósticas en el paciente intoxicado en el servicio de urgencias de un hospital de alta complejidad. Metodología: Estudio descriptivo transversal con disponibilidad de datos para el periodo 2014-2016. Se recopiló información de los registros de las historias clínica de los pacientes que acudieron al servicio de urgencias con diagnósticos relacionados con intoxicaciones. Resultados: El 55.4% de la población fue de sexo femenino, el 54.5% eran menores de 25 años y la mayoría pertenencia al área urbana (77.7%). La intencionalidad en el 68.9% fue suicida. Se reportó el toxídrome en el 17.6% de los casos, donde el sedante fue el más común (9.2%). Las sustancias más usadas fueron los psicofármacos (22.8%), siendo los antidepresivos tricíclicos más comunes con un 10.9%; seguidos de los plaguicidas (19.1%), donde los organofosforados fueron los más comunes (8.8%). Las ayudas diagnósticas más solicitadas fueron el hemograma en un 94.3% de los casos, seguido de la creatinina en un 90.2%. El electrocardiograma se realizó en el 49.7% de los casos y los tóxicos en orina en el 7.8%. Conclusión: Se evidencia un uso rutinario de ayudas diagnósticas en el servicio de urgencias; se requieren estudios adicionales que evalúen la pertinencia de ayudas diagnósticas en este escenario.

Objective: The incidence of poisoning in the emergency department is increasing in Colombia. In the initial approach, paraclinical routines are requested, sometimes without a correlation between xenobiotic, pathophysiology and clinical risk. The objective of this research is to describe the use of diagnostic aids in poisoned patients in the emergency department of a high-complexity hospital. Methodology: Descriptive cross-sectional study with retrospective data availability for the 2014-2016 period. Information was collected from the medical records of patients who came to the emergency department with diagnoses related to poisoning. Results: 55.4 % of the population was female, 54.5 % were under the age of 25, the majority belonging to the urban area (77%). The intentionality in 68.9% of them was suicidal. Toxidrome was reported in 17.6% of cases, the sedative being the most common (9.2%). Psychotropic drugs were the most commonly used substances (22.8%), the tricyclic anti-depressant being the most used with 10.9%, followed by pesticides with 19.1%, among which organophosphates were the most common (8.8%). The most requested diagnostic aids were the hemogram in 94.3% of the cases, followed by creatinine in 90.2%. The electrocardiogram was performed in 49.7% of the cases and the toxic in urine in 7.8%. Conclusions: A routine use of diagnostic aids is evidenced in the emergency department. Therefore, additional studies are required to evaluate the relevance of diagnostic aids in this setting.

Objetivo: A incidência de intoxicações no setor de emergência está aumentando na Colômbia. Na abordagem inicial, são solicitadas paraclínicas de rotina, às vezes sem correlação entre o xenobiótico, a fisiopatologia e o risco clínico. O objetivo desta pesquisa é descrever a utilização de meios auxiliares de diagnóstico em pacientes intoxicados no pronto-socorro de um hospital de alta complexidade. Metodologia: Estudo transversal descritivo com disponibilidade de dados para o período 2014-2016. As informações foram coletadas nos prontuários dos pacientes que compareceram ao pronto-socorro com diagnóstico de intoxicação. Resultados: 55,4% da população era do sexo feminino, 54,5% tinham menos de 25 anos e a maioria pertencia à zona urbana (77,7%). A intencionalidade em 68,9% foi suicida. Toxidromia foi relatada em 17,6% dos casos, sendo o sedativo o mais comum (9,2%). As substâncias mais utilizadas foram os psicotrópicos (22,8%), sendo os antidepressivos tricíclicos mais comuns com 10,9%; seguido por agrotóxicos (19,1%), onde os organo-fosforados foram os mais comuns (8,8%). Os meios diagnósticos mais solicitados foram o hemograma em 94,3% dos casos, seguido da creatinina em 90,2%. O eletrocardiograma foi realizado em 49,7% dos casos e a urina tóxica em 7,8%. Conclusão: Evidencia-se o uso rotineiro de meios auxiliares de diagnóstico no pronto-socorro; Estudos adicionais são necessários para avaliar a relevância dos auxiliares de diagnóstico neste cenário.

The Role Of Platelet Rich Plasma And Quercetin In Alleviating Dimethylnitrosamine-Induced Acute Spleen Injury Through Regulating Oxidative Stress, Inflammation And Apoptosis

Objective: Excessive oxidative stress is implicated in spleen injury. Platelet-rich plasma (PRP) and quercetin (QUR) have been shown to protect cells against oxidative stress. This study was designed to investigate their effect on dimethyl nitrosamine (DMN) induced spleen injury in male rats. Methods: Forty male Wistar rats were divided into four groups; Group (1): Negative control group (Con), Group (2): DMN group, DMN was given intraperitonealy at a dose of 4 mg/kg b. wt/day for four weeks for sub-chronic injury of spleen tissue, Group (3): DMN+PRP, rats were injected intraperitonealy with DMN at a dose of 4 mg/kg b. wt/day for four weeks then treated i. v. by single dose 50 μL of PRP, then left for a period of four weeks without any treatments, Group(4): DMN+QUR, rats received intraperitonealy DMN at a dose of 4 mg/kg b. wt/day for four weeks, then treated with quercetin orally at a dose of 50 mg/kg b. wt. in aqueous suspension daily using an intragastric tube for four weeks. Results: DMN inoculation resulted in significant elevations of oxidative stress, as evidenced by the increased malondialdehyde, hydrogen peroxide and xanthine oxidase levels associated with a significant decrease in Superoxide dismutase and catalase activities in the spleen tissue as compared to the normal control group. Moreover, DMN caused an up-regulation in the values of the splenic C-reactive protein (CRP), interleuckin-6 (IL-6), nuclear factor kappa B (NF-κB), leukotriene-C4 (LT-C4), P53 and Fas levels with a significant decline in anti-apoptotic protein B-cell lymphoma 2 level as compared to the normal control group. PRP and QUR significantly attenuated the DMN-evoked spleen oxidative stress and modulated the activities of antioxidant enzymes as compared to DMN group. In addition, treatment of DMN group with PRP or QUR resulted in an improvement in CRP, IL-6, NF-κB, LT-C4, P53 and Fas levels as compared to DMN group. Caspase-3 expression was positive in DMN group while no difference was present in control, PRP and Quercetin groups. However, the VEGF immunopositive reaction was found in DMN, PRP and Quercetin groups compared to control group. Histopathological results showed degeneration, haemorrhage, inflammatory cells and necrotoic areas in splenic tissue from DMN group compared to the treated groups where signs of recovery were observed in the whole splenic tissue. Conclusion: These data suggest that PRP and QUR protect rat spleen from DMN-induced oxidative stress, probably via their antioxidant activity, anti-inflammatory and anti-apoptotic effects. So, PRP and QUR are promising pharmacological agents for preventing the potential spleen injury of DMN following occupational or environmental exposures.

Pesticides `contamination of lactating mothers’ milk in the north-western Himalayan region of India

Aim: The objective of the study was to develop and characterize the properties of sago (sabudana) from cassava based reconstituted dry starch with addition of pre-gelatinized starch and wet starch as binders.Methodology: The dry starch was soaked for 12 hrs at 30 % concentration and then sago was prepared at 40% moisture content with addition of pre-gelatinized starch and wet starch as binders in different treatment combinations. Results: The sago developed from the combination of reconstituted dry starch (75%) and wet starch (25%) had an optimal commercial size (3.36 mm) and shape (sphericity value, 76 %). The swelling power (5.98%) was high in reconstituted dry starch sago and solubility (13.42 %) was high in wet starch sago without the addition of any binders. The increase in cooking time (10.37%) and decrease in cooking loss (1.73%) were observed for sago developed with pre-gelatinized starch as binder. The lowest oil absorption index (0.45 g g-1) was noticed for sago prepared with wet starch as a binder. The storage modulus was comparatively lower for sago paste prepared using wet starch and thus the sago gel behaved like a dilute solution with increase in storage modulus and phase angle. Interpretation: The physico-functional properties of the cassava -based reconstituted dry starch sago can be improved by adding wet starch as a binder due to less retrogradation rate. Further, the addition of pre-gelatinized starch as a binder with reconstituted cassava dry starch can reduce the cooking loss in sago.

Sex does not clinically influence the functional outcome of total knee arthroplasty but females have a lower rate of satisfaction with pain relief

Background@#The aims were to assess whether sex had a clinically significant independent influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Short Form (SF-) 12 scores and patient satisfaction at 1 year. @*Methods@#A retrospective cohort of 3510 primary TKA were identified. Patient demographics, comorbidities, WOMAC and SF-12 scores were collected preoperatively and 1 year postoperatively. Patient satisfaction were assessed at 1 year. @*Results@#There were 1584 males and 1926 females. The preoperative WOMAC and SF-12 scores were significantly (p < 0.001) worse in females but were not greater than the minimal clinically important difference (MCID). When adjustments had been made for confounding differences, females showed a significantly greater improvement in their function (1.5 points, p = 0.03) and total (1.5 points, p = 0.03) WOMAC scores compared to males, but these were not greater than the MCID. When adjustments had been made for confounding differences, females were less likely to be satisfied with their pain relief (p = 0.03) relative to males. @*Conclusion@#Sex does not clinically influence the knee specific outcome (WOMAC) or overall generic (SF-12) health 1 year after TKA. However, satisfaction with pain relief after TKA was significantly less likely in female patients.Level of evidence II: Prognostic retrospective cohort study.

One-year Oxford knee scores should be used in preference to 6-month scores when assessing the outcome of total knee arthroplasty

Purpose@#The primary aim of this study was to assess whether there was a clinically significant difference in the mean Oxford knee score (OKS) between 6 and 12 months after total knee arthroplasty (TKA). The secondary aim was to identify variables associated with a clinically significant change in the OKS between 6 and 12 months. @*Methods@#A retrospective cohort study was undertaken using an established arthroplasty database of 1574 primary TKA procedures. Patient demographics, body mass index (BMI), comorbidities, OKS and EuroQoL 5-domain (EQ-5D) score were collected preoperatively and at 6 and 12 months postoperatively. A clinically significant change in the OKS was defined as 5 points or more. @*Results@#There was a 1.1-point increase in the OKS between 6 and 12 months postoperatively, which was statistically significant (95% confidence (CI) 0.8–1.3, p < 0.0001). There were 381 (24.2%) patients who had a clinically significant improvement in their OKS from 6 to 12 months. After adjusting for confounding, patients with a lower BMI (p = 0.028), without diabetes mellitus (p < 0.001), a better preoperative OKS (p < 0.001) or a worse 6-month OKS (p < 0.001) were more likely to have a clinically significant improvement. A 6-month OKS < 36 points was a reliable predictor of a clinically significant improvement in the 6-month to 12-month OKS (area under the curve 0.73, 95% CI 0.70–0.75, p < 0.001). @*Conclusion@#Overall, there was no clinically significant change in the OKS from 6 to 12 months; however, a clinically significant improvement was observed in approximately a quarter of patients and was more likely in those scoring less than 36 points at 6 months. Level of evidence: retrospective diagnostic study, level III.

One-year Oxford knee scores should be used in preference to 6-month scores when assessing the outcome of total knee arthroplasty

Purpose@#The primary aim of this study was to assess whether there was a clinically significant difference in the mean Oxford knee score (OKS) between 6 and 12 months after total knee arthroplasty (TKA). The secondary aim was to identify variables associated with a clinically significant change in the OKS between 6 and 12 months. @*Methods@#A retrospective cohort study was undertaken using an established arthroplasty database of 1574 primary TKA procedures. Patient demographics, body mass index (BMI), comorbidities, OKS and EuroQoL 5-domain (EQ-5D) score were collected preoperatively and at 6 and 12 months postoperatively. A clinically significant change in the OKS was defined as 5 points or more. @*Results@#There was a 1.1-point increase in the OKS between 6 and 12 months postoperatively, which was statistically significant (95% confidence (CI) 0.8–1.3, p < 0.0001). There were 381 (24.2%) patients who had a clinically significant improvement in their OKS from 6 to 12 months. After adjusting for confounding, patients with a lower BMI (p = 0.028), without diabetes mellitus (p < 0.001), a better preoperative OKS (p < 0.001) or a worse 6-month OKS (p < 0.001) were more likely to have a clinically significant improvement. A 6-month OKS < 36 points was a reliable predictor of a clinically significant improvement in the 6-month to 12-month OKS (area under the curve 0.73, 95% CI 0.70–0.75, p < 0.001). @*Conclusion@#Overall, there was no clinically significant change in the OKS from 6 to 12 months; however, a clinically significant improvement was observed in approximately a quarter of patients and was more likely in those scoring less than 36 points at 6 months. Level of evidence: retrospective diagnostic study, level III.

Atualização das recomendações da Sociedade Brasileira de Hepatologia para o diagnóstico e tratamento do carcinoma hepatocellular / Brazilian society of hepatology updated recommendations for diagnosis and treatment of hepatocellular carcinoma

ABSTRACT Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2015 suas primeiras recomendações sobre a abordagem do CHC. Desde então, novas evidências sobre o diagnóstico e tratamento do CHC foram relatadas na literatura médica, levando a diretoria da SBH a promover uma reunião monotemática sobre câncer primário de fígado em agosto de 2018 com o intuito de atualizar as recomendações sobre o manejo da neoplasia. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização baseada em evidências científicas visando que pudesse nortear a prática clínica multidisciplinar do CHC. O texto resultante foi submetido a avaliação e aprovação de todos membros da SBH através de sua homepage. O documento atual é a versão final que contêm as recomendações atualizadas e revisadas da SBH.

Leisure Time Activities And Mental Health Among Iran Older People: A Population-Based Study In Tehran

Background: Leisure activity helps the elderly to improve their physical and mental health. The purpose of this study is to determine the interlink between leisure activity and mental health in older people. Methods: We select 413 people over 60 years old(213 female and 200male).We collected data using GHQ 15-question survey, Nagi questionnaire, and a new reliable and validated the designed questionnaire. We analyzed our data utilizing spearman correlation, and regression analysis in SPSS21. Results: We report a relationship between recreational and religious activities in the absence of confounding factors but only religious activities were associated with mental health in the presence of confounding factors(p-value <0/0001). Among the confounding factors, physical health imposed the most significant effect. Conclusion: Considering the determinative effect of physical health on the types of leisure activity, and the significant relationship between the types of the elderly’s leisure activity and their mental health, having comprehensive planning in the physical health in older people is necessary.

Self-care practices among type 2 diabetic patients in a tertiary care hospital in Bengaluru

Background: Diabetes mellitus (DM) is a leading non-communicable disease in India and contributes to 34% of mortality. Optimal management of DM involves a multipronged approach due to diverse factors including lifestyles, culture, myths, and socioeconomic condition. Self-care practices go a long way in the prevention of complications and improving quality of life. Objectives: The objectives of this study were to assess the self-care practices among type 2 adult diabetic populations in a tertiary health-care setting. Materials and Methods: A cross-sectional descriptive study was conducted on type II adult diabetic subjects in a tertiary care hospital. A pre-tested, structured pro forma was used to collect the baseline data and self-care practices including knowledge of the disease, dietary practices, exercise, habits, health-seeking practices, complications, and prevention of complications. Chi-square test and descriptive statistics were analyzed using SPSS (17.0). Results: A total of 101 patients were studied where 60% of them were males; 57% had diabetes history of >5 years, 44% overweight, and 16% obese. Knowledge about the disease such as risk factors (59%), complications (67%), and dietary practices (92%) was good. Self-care practices were poor with 17% following strict diet, 7% exercised regularly, and 52% of them got their blood glucose monitored periodically. 21% of them never took care of their feet, and up to 96% of them never carried diabetes identification card. The self-care practices were significantly better among literates as compared to illiterates. Conclusion: Although the awareness of the disease and complications is good, self-care practice is poor among the study population.

Lipemia retinalis in a 27 day old neonate: A case report

Familial combined hyperlipidemia, which presents as hypercholesterolemia or hypertriglyceridemia, is the commonest form of genetic hyperlipidemia and is associated with premature coronary artery disease. This is a rare case report of a 27 day-old neonate born out of a third-degree consanguineous marriage, with grade III lipemia retinalis secondary to familial-combined hyperlipidemia.

Difteria en Venezuela: análisis de las manifestaciones clínicas y evolución de una serie de casos

Objetivo: Analizar las manifestaciones clínicas y evolución de los casos sospechosos o confirmados de Difteria en Venezuela. Materiales y Métodos: Se realizó un estudio prospectivo, observacional, descriptivo, longitudinal y multicentrico en los estados Anzoátegui, Bolívar, Carabobo, Distrito Capital, Lara, Mérida, Miranda y Zulia, se siguieron 48 pacientes sospechosos o confirmados para difteria y se describieron sus características clínicas. Resultados: 54,2 % fueron de sexo femenino, 2 de ellas embarazadas, 1 de ellas falleció. La localización más frecuente de lesiones fue la faríngea, sin embargo se observaron otras como la tonsilar, laringotraqueal, nasal y cutánea. Todos los pacientes recibieron antibióticos pero solo 32 toxina antidiftérica. Solo 11 pacientes tenían esquema vacunal completo y 18 presentaron complicaciones. El 18,8 % de la muestra falleció y el resto egresó sin secuelas. Conclusiones: El brote de difteria en Venezuela sigue activo, las cifras de pacientes afectados invitan a implementar estrategias de control a través de la inmunización de susceptibles, erradicación de portadores asintomáticos, diagnóstico temprano, reporte obligatorio, atención y manejo adecuado de los infectados.

Objective: To analize the clinical manifestations and evolution of suspected or confirmed cases of Diphtheria in Venezuela. Methods: A prospective, observational, descriptive, longitudinal and multicentric study was conducted in the Venezuelan's states of Anzoategui, Bolivar, Carabobo, Capital District, Lara, Merida, Miranda and Zulia. The time 1 of the investigation was at the hospital admission and the final time was at discharge. During the hospitalization, the follow-up was performed. Results: 48 patients were followed and all of them had suspected or confirmed Diphtheria. 45,5 % were men and 54.2 % were female, 2 of them were pregnant, and 1 of them died. The most frequent location of lesions was the pharyngeal, however other location were observed such as tonsillar, laryngotracheal, nasal and cutaneous. All patients received antibiotics but only 32 diphtheria antitoxin. Only 11 patients had a complete vaccination scheme and 18 (36 %) had complications. 18.8 % of the sample died and the rest withdrew without sequelae. Conclusions: The diphtheria outbreak in Venezuela is still active, the number of affected patients invite to implement strategies of control through the immunization of susceptibles, eradication of asymptomatic carriers, early diagnosis, mandatory reporting, care and adequate management of the infected.

Myocardial Infarction in Diabetics, Pre-Diabetics and Non- Diabetics: A Prospective Study

Vascular diseases are one of the major public health problems in the developed world, resulting in devastating symptoms involving coronary artery occlusion, cerebrovascular accidents, peripheral vascular insufficiency, and acute myocardial infarction (AMI). These diseases affect millions of people annually, resulting in extensive morbidity and mortality. It is a well-established fact that individuals with pre-diabetes and diabetes are at a higher risk of cardiovascular events including myocardial infarction. The other risk factors for development of coronary artery disease include hypertension, obesity, hyperlipidemia, family history and sedentary life style. In this study we analyzed the data of all patients admitted for the first time for acute myocardial infarction (MI) and evaluated the load of non-diabetics, prediabetics and diabetics among them. In this study patients were analyzed for their biochemical and physiological parameters and cardiac markers at the time of admission. Methods: This was a prospective cohort study jointly conducted by department of physiology and medicine of a tertiary care medical college situated in an urban area. The patients admitted in intensive care unit and diagnosed to be having acute myocardial infarction were included in this study on the basis of a predefined inclusion and exclusion criteria. Various physiological (pulse rate, blood pressure, heart rate and respiratory rate) and biochemical (HbA1c, Plasma glucose, lipid profile and cardiac markers) were studied. Number of diabetics, pre-diabetics and non-diabetics landing in myocardial infarction and correlation of abnormal blood glucose level to severity of myocardial infarction was studied. The statistical analysis was done using SSPE 21.0 software. P value less than 0.05 was taken as statistically significant. Results: Total 89 patients were included in this study. Out of these 89 patients 34 (38.20%) patients were non- diabetic whereas 33 (37.08%) and 22 (24.72%) patients were pre-diabetic and diabetic respectively. The mean age of diabetic, pre-diabetic and non-diabetic patients were found to be comparable with no statistically significant difference amongst them (P>0.05). Gender distribution showed that there were 71 (79.78) males and 18 (20.22%) females with a M:F ratio of 1:0.25. Heart rate as well as systolic and diastolic blood pressure and total cholesterol levels were found to be higher in diabetic patients as compared to pre diabetic and non-diabetic population. Analysis of myocardial enzyme (CK-MB and Troponin I) levels showed that they were also higher in diabetic patients as compared to pre-diabetic and non- diabetic population. Mortality was found to be statistically significantly high in patients with diabetes (P<0.05). Conclusion: The diastolic blood pressure, total cholesterol, triglyceride, LDL cholesterol CK-MB, Troponin I showed an increase in diabetic group of AMI patients. Though the mean age of myocardial infarction was found to be comparable in diabetics, pre diabetics and non-diabetic patients there was statistically significant higher mortality rates in diabetic patients with myocardial infarction.