Sedentary behavior, abdominal obesity and healthcare costs in Brazilian adults with cardiovascular diseases: a cross-sectional study

ABSTRACT BACKGROUND: Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce. OBJECTIVE: The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases. DESIGN AND SETTING: This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018. METHODS: The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient. RESULTS: The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive. CONCLUSION: Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

The effectiveness of closed-loop oxygen therapy for adult non-mechanical ventilation patients: a Meta-analysis / 中国实用护理杂志

Objective:To evaluate the effect of closed-loop therapy system in adult non-mechanical ventilation patients in order to provide evidence-based basis for promoting the safety of oxygen therapy.Methods:Randomized controlled trials of closed-oxygen therapy system on the percentage within SpO 2 target, the incidence of hypoxaemia or hyperoxia, oxygen consumption, the mean oxygen therapy days, as well as the length of hospital stay in adult non-mechanical ventilation patients were searched in PubMed, Web of Science, Embase, Cochrane, CNKI, Wanfang, VIP from inception to June 30, 2022. Data extraction, and literature quality evaluation were performed by two researchers independently, RevMan 5.3 was used for meta-analysis. Results:A total of 5 articles including 502 patients were included. The results showed that the closed oxygen therapy system could significantly improve the percentage of time within SpO 2 target of patients ( SMD=1.56, 95% CI 1.22-1.90, Z=9.04, P<0.001) and reduce the percentage of time with hypoxaemia ( SMD=-0.35, 95% CI-0.50--0.19, Z=4.37, P<0.001) or hyperoxia ( SMD=-0.91, 95% CI-1.07--0.75, Z=11.04, P<0.001) of patients. Moreover, the mean oxygen flow rate of closed oxygen therapy ( SMD=-0.64, 95% CI-1.25--0.03, Z=2.07, P<0.05), the mean oxygen therapy days ( SMD=-0.55, 95%, CI-1.06--0.03, Z=2.08, P<0.05), as well as the length of hospital stay ( SMD=-1.68, 95% CI-2.22--1.14, Z=6.11, P<0.001) were lower than those of patients with manual adjustment systems. Conclusion:The closed oxygen therapy system can promote the safety of oxygen use, but it needs clinical application to further explore.

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results

ABSTRACT Introduction: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. Objective: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. Conclusion: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

RESUMO Introdução: A má oclusão de Classe III deve ser interceptada e tratada em idade precoce, a fim de evitar uma futura necessidade de procedimentos complexos e invasivos. O tratamento com máscara facial ortopédica tem o objetivo de obter alterações esqueléticas, minimizando os efeitos colaterais na dentição. O uso de ancoragem óssea em mini-implantes, associada ao protocolo Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) pode ser eficaz no tratamento de um grande número de pacientes Classe III em crescimento. Objetivo: Realizar uma síntese da literatura baseada em evidência sobre o tratamento da má oclusão de Classe III em pacientes adultos jovens, e ilustrar sua aplicação e eficácia por meio do relato de um caso emblemático. Conclusão: A resolução e o acompanhamento em longo prazo do caso apresentado, juntamente com estudos conduzidos em uma amostra maior, demonstram a eficácia da combinação estratégica dos tratamentos ortopédico e ortodôntico usando um expansor palatal híbrido e o protocolo Alt-RAMEC para corrigir a má oclusão de Classe III em pacientes adultos.

Factors influencing adherence to asthma control measures among patients in Mama Lucy Kibaki Hospital, Nairobi Kenya

BACKGROUND :Asthma is an obstructive respiratory disease characterized by wheezing, chest tightness, cough and shortness of breath that is evidenced by expiratory airflow limitation. Patient awareness of asthma control measures is key in ensuring compliance with asthmatic drugs. The main aim of the study was to assess determinants of adherence to asthma control measures among adult asthmatic clients attending chest clinics in Mama Lucy Kibaki Hospital. MATERIALS AND METHOD We employed a descriptive cross-sectional study design involving asthmatic patients interviewed at Mama Lucy Kibaki Hospital in Nairobi, Kenya. The study participants had to have been diagnosed with asthma for at least three months preceding the study, attend the chest clinic and consent to participate in the study. We pretested the study tools at Mbagathi county hospital on 11 asthmatic patients. A systematic random sampling method was used to select 110 study participants and data was collected using a modified questionnaire and lung function test between March to June 2018. Quantitative data was analyzed using SPSS 22.0. The Chi-square test was used to establish the association between independent variables and asthma adherence control measures at a 95% confidence interval. RESULTS Our findings report a response rate of 89% (98). The majority (58.2%) of participants were females. On average 57.1% had good adherence to asthma control measures. Control of asthma was poor, with well-controlled being 27.5%, moderately controlled at 53.1% and poorly controlled at 19.4%, respectively P (0.003). Respondents with adequate knowledge were 56.1% and positive attitude with 71.2%. There was a significant association between adherence to asthma control measures and participants' attitude (P-value=0.000), knowledge (P-value=0.000), level of education (P-value=0.000), level of asthma control (P-value=0.003). Environmental factors were cleaning carpets/curtains (P-value=0.001), type of fuel (P-value=0.003), and use of carpet (Pvalue=0.014). CONCLUSION Adherence to asthma control measures was suboptimal resulting in a generally poor asthma control. Adequate knowledge was associated with a positive attitude. Adherence was strongly associated with attitude, knowledge, education and asthma control.

The Barriers and Facilitators of Family-Witnessed Resuscitation (FWR) in Adult Patients in the Emergency Department (EDS): A Systematic Review

@#Aims: Aims: When attending family members, the procedure for the resuscitation of cardiac arrest patients remains controversial. There have been conflicts on why healthcare professionals, should include the family during resuscitation. This systematic review seeks to identify the barriers and facilitators related to the FWR of adult patients at Emergency Department. Design: A systematic review was conducted on ten studies. This review utilized a clearly formulated research question then the data was gathered and analysed from the included studies. Data Source: Studies on the barriers and facilitators related to allowing family members to attend were included during January 2020 to May 2020. Methods: A systematic review of studies that investigate the barriers and facilitators of the FWR of adult patients at emergency department. All studies evaluated the barriers and facilitators related to allowing family members to attend cardiopulmonary resuscitation. This systematic review was registered in PROSPERO with the registration number CRD42020169383. Results: This review has demonstrated that the facilitators reduce conflict and provide a supportive presence that builds the emotional adequacy and closure related to the resuscitation. These policies can eliminate barriers, such as conflicts in EDs and negative attitudes, and expedite the accommodation of the professional as well as individual staff’s needs during witnessed resuscitation.

Analysis of the etiological characteristics and drug resistance of adult patients with bloodstream infection in a hospital in Hainan, 2018-2020 / 中国热带医学

@#Abstract: Objective　To analyze the etiological characteristics and drug resistance of patients with bloodstream infection (BSI) in the bacterial resistance monitoring network in Hainan Province from 2018 to 2020, so as to provide laboratory data for clinical diagnosis and treatment. Methods　The clinical data of the subjects were collected, and the etiological characteristics of BSI patients and drug resistance of commonly used drugs in clinical treatment were analyzed retrospectively. SPSS 26.0 software was used for statistical analysis. Results　A total of 877 strains were isolated, including Gram-negative bacteria (584 strains, 66.6%), Gram-positive bacteria (239 strains, 27.2%) and fungi (54 strains, 6.2%); male patients (591 cases, 67.4%), female patients (286 cases, 32.6%); inpatients (780 cases, 88.9%), outpatient and emergency patients (97 cases, 11.1%); the main primary diseases of BSI patients were hypertension, cerebral infarction and type 2 diabetes, and the main primary infections were pulmonary infection and urinary system infection. Intensive care unit (25.2%, 221 cases), emergency department (10.9%, 96 cases), oncology department (9.1%, 80 cases), nephrology department (6.8%, 60 cases) and hepatobiliary and pancreatic surgery department (4.3%, 38 cases) had the highest proportion of pathogenic bacteria. Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, coagulase-negative Staphylococcus, Viridans group streptococci and Candida albicans were the most frequently isolated pathogens. The detection rates of carbapenem-resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii were 3.4%, 15.2% and 36.4% respectively. The carbapenem-resistant Escherichia coli was not checked out. The detection rates of methicillin resistant Staphylococcus aureus and methicillin resistant coagulase negative Staphylococcus were 18.5% and 79.1% respectively. Conclusions　Gram-negative bacteria are the most common pathogens of BSI, and inpatients are the main source of BSI. Age, underlying diseases and primary infection are the risk factors of BSI. Clinical laboratories should strengthen the etiological monitoring of high-risk patients with BSI, and the resistance analysis of common antibiotics can provide a basis for the rational use of antibiotics in clinical practice.

Clinical and Genetic Analysis of Adrenoleukodystrophy in Adults / 罕见病研究

  Objective  Adrenoleukodystrophy (ALD) is the most common peroxisomal diseases with high clinical and genetic heterogeneity. Our study is to analyze the phenotype and genotype characteristics of adult patients with ALD.  Methods  A total of 18 adult patients with ALD admitted to Beijing Tiantan Hospital from May 2016 to April 2021 were recruited, and their clinical manifestations, imaging features, and genetic results were comprehensively analyzed.  Results  Among 18 patients, 6(33%) patients were diagnosed as adrenomyeloneuropathy (AMN), 2(11%) were cerebral AMN, 5(28%) were adult cerebral ALD (ACALD), 2(11%) were childhood cerebral ALD (CCALD), 1(6%) were adolescent cerebral ALD (AdolALD), and 2(11%) were cerebellar variant of ALD. AMN patients presented with adult-onset stiffness and weakness of lower limbs as the initial and main symptoms, and can developed additional cerebral demyelination; In the case of cerebral ALD, ACALD is more common than CCALD and AdolALD. The prominent manifestations were psychiatric disorders, cognitive, and motor impairment. The imaging features were predominantly occipitoparietal involvement or predominantly frontal involvement with or without contrast enhancement marginal to the demyelinated areas; cerebellar ataxia is the main manifestation in patients with cerebellar variant, and the imaging feature was symmetrical involvement of the cerebellar dentate nucleus. Genetically, the most common mutation type was missense mutation (10/18, 55.6%), followed by frameshift mutation (7/18, 38.9%), and splice site mutation (1/18, 5.6%). Moreover, we found five novo mutations, all of which were frameshift mutations.  Conclusions  AMN is the most common subtype of adult patients with ALD. ACALD is common among the cerebral ALD. The proportion of cerebellar variant might have been underestimated.

Factores de riesgo asociados a la periodontitis crónica en pacientes adultos / Risk factors associated to chronic periodontal disease in adult patients / Fatores de risco associados à periodontite crônica em pacientes adultos

RESUMEN La periodontitis es la enfermedad crónica inflamatoria más común que se observa en humanos. Con el objetivo de identificar los factores de riesgo asociados a la periodontitis crónica en pacientes adultos, se realizó un estudio analítico, de casos y controles en el Policlínico David Moreno Domínguez de Santa Rita, Jiguaní, Granma, de octubre 2017 - agosto 2019. De un universo de 989pacientes atendidos en consulta de Periodoncia, se seleccionó una muestra probabilística de 126 pacientes, entre 35 y 64 años (42 casos y 84 controles). Se realizó examen bucal e interrogatorio. Se aplicó el índice periodontal de Rusell y el IAHB de Love. Para el análisis univariado se empleó la razón de productos cruzados Odds Ratio y el Chi-Cuadrado, con una confiabilidad del 95 % y una probabilidad < 0,05. Mostraron asociación a la periodontitis crónica: el tabaquismo (OR= 9,5372; p= 0,0000), la diabetes mellitus (OR= 6,4339; p= 0,0001), la higiene bucal deficiente (OR=5,693; p=0,0000) y el sexo masculino (OR=2,5294, p= 0,0281). El factor de riesgo que presentó mayor valor de asociación a la periodontitis crónica fue el tabaquismo. La edad no constituyó un riesgo a tener en cuenta para la aparición de la enfermedad.

ABSTRACT Periodontitis is the most common chronic inflammatory disease observed in humans, with the objective of identify the risk factors associated with chronic periodontitis in adult patients. An analytical, case-control study was carried out at the David Moreno Domínguez polyclinic in Santa Rita, Jiguaní, Granma, from October 2017 - August 2019. From a universe of 989 patients seen in the Periodontics clinic, a probabilistic sample was selected of 126 patients between 35 and 64 years old (42 cases and 84 controls). Oral examination and interview were performed. Russell's periodontal index and Love's IAHB were applied. For the univariate analysis, the ratio of crossed products Odds Ratio and Chi-Square were used, with a reliability of 95% and a probability <0.05. Smoking (OR = 9.5372; p = 0.0000), diabetes mellitus (OR = 6.4339; p = 0.0001), poor oral hygiene (OR = 5.693; p = 0.0000) and male sex (OR = 2.5294, p = 0.0281) showed an association with chronic periodontitis. The risk factor that presented the highest value of association with chronic periodontitis was smoking. Age was not a risk to take into account for the onset of the disease.

RESUMO A periodontite é a doença inflamatória crônica mais coman observada em humanos. Como objetivo de identificar os fatores de risco associados à periodontite crônica em pacientes adultos, foi realizado um estudo analítico caso-controle na Policlínica David Moreno Domínguez em Santa Rita, Jiguaní, Granma, de outubro de 2017 a agosto de 2019. De um universo de 989 pacientes atendidos no consultório de Periodontia, foi selecionada uma amostra probabilística de 126 pacientes, com idades entre 35 e 64 anos (42 casos e 84 controles). Exame oral e questionamento foram realizados. O índice periodontal de Russell e o IAHB de Love foram aplicados. Para a anúlese univariada, utilizo u-se a raseo dos produtos cruzados Odds Ratio e o Qui-quadrado, com confiabilidade de 95% e probabilidade <0,05. Eles mostraram associação com periodontite crônica: tabagismo (OR = 9,5372; p = 0,0000), diabetes mellitus (OR = 6,4339; p = 0,0001), higiene bucal precária (OR = 5,693; p = 0,0000) e sexo masculino (OR = 2,5294, p = 0,0281). O fator de risco que apresentou maior valor de associação à periodontite crônica foi o tabagismo. A idade não foi um risco a ser levado em consideração para o início da doença.

Enfrentamiento terapéutico del paciente adulto hipertenso en Atención Primaria de Salud: una propuesta a considerar / Therapeutic coping of hypertensive adult patients in Primary Health Care: a proposal to consider

Arterial Hypertension (HT) is one of the most widely spread chronic diseases in the world, with a suspicion in the Chilean population of 27.6%, according to the results of the 2017 National Health Survey. Reponsible for high morbidity and mortality, being, in Chile, the main risk factor related to years of life lost due to disability and premature death (DALYs). This fact has motivaded a constant publication of clinical practices guidelines and recomendations from many scientific societies in whole wide world. Hypertension represents a significant proportion of medical consultations for the primary care doctors. In fact, may be a huge challenge to get acceptable percentages of compensation in blood pressure, and mainly, to reduce morbidity and mortality in their patients. Because of this, we propose a set of questions and answers to guide the management of hypertension un primary care, based on the recommendation of the main guidelines of clinical practice.

Factores estresantes percibidos por pacientes en unidades de cuidados intensivos en una institución de Bogotá / Stressors perceived by patients in intensive care units in an institution in Bogotá

El presente estudio, es de tipo descriptivo y tiene como objetivo, determinar cuáles son los factores estresantes percibidos por los pacientes adultos en las UCI (UCI Cardiovascular y UCI Medica) y comparar sus resultados en una institución de cuarto nivel de complejidad en la ciudad de Bogotá. La muestra correspondió a 210 pacientes que cumplieron con los criterios de inclusión establecidos. S realizo una entrevista a cada paciente y se aplicó el instrumento IFEPP-UCI y un formato de variables clínicas y sociodemográficas. En los resultados se pudo determinar que cuanto, a los factores de estrés evaluados, en la gran mayoría existe una proporción mayor de pacientes que reporta sentirlos en la UCI Médica en comparación con la UCI Cardiovascular, evidenciando que los pacientes de UCI Cardiovascular tienen en general una menor cantidad de factores de estrés asociados a su condición y diagnóstico. Los principales factores estresantes percibidos por los pacientes adultos en las UCI (UCI Cardiovascular y UCI Medica) fueron: la imposibilidad de movilización, tener sed, permanecer en la misma posición, no poder comunicarse, tener dolor, el ruido, no saber el día ni la hora, la iluminación, y no poder dormir. Para concluir Los resultados obtenidos en los análisis descriptivo y multivariado permiten identificar factores relevantes estresantes que perciben los pacientes en las UCI, los cuales orientan al profesional de enfermería para el desarrollo de intervenciones que permitan mejorar la percepción del paciente durante su estancia en UCI y así facilitar su recuperación

The present study is descriptive, and its objective is to determine which are the stressors perceived by adult patients in the ICU (Cardiovascular ICU and Medical ICU) and to compare their results in an institution of fourth level of complexity in the city of Bogota. The sample corresponded to 210 patients who met the established inclusion criteria. An interview was carried out with each patient and the IFEPP-UCI instrument and a format of clinical and sociodemographic variables were applied. In the results it was possible to determine that regarding the stress factors evaluated, in the vast majority there is a greater proportion of patients who report feeling them in the Medical ICU compared to the Cardiovascular ICU, showing that Cardiovascular ICU patients generally have fewer stressors associated with your condition and diagnosis. The main stressors perceived by adult patients in ICUs (Cardiovascular ICU and Medical ICU) were inability to move, being thirsty, staying in the same position, not being able to communicate, having pain, noise, not knowing the day or the time, the lighting, and not being able to sleep. To conclude, the results obtained in the descriptive and multivariate analyzes allow identifying relevant stressful factors perceived by patients in the ICU, which guide the nursing professional to develop interventions that improve the perception of the patient during their stay in the ICU and thus facilitate your recovery

Application of"family member-like"care strategies among COVID-19 patients in an isolation ward / 中南大学学报(医学版)

Objective:To control the pandemic of coronavirus disease 2019 (COVID-19) effectively, strict isolation measures have been taken in China. Suspected patients must be isolated, and the confirmed patients specifically are isolated in negative-pressure isolation rooms. During the isolation, patients face difficulty in adapting to their surrounding environment, worry about the prognosis of the disease, lack confidence in treatment, separate from their families, and have a sense of distance from medical staff. Isolated patients may possess the feelings of negativity, including loneliness, anxiety, depression, insomnia, and despair. Hence, to reduce the risk of adverse psychological outcomes,"family member-like"care strategies were developed and implemented to solve problems associated with the COVID-19 pandemic. This study aims to examine whether using"family member-like"care strategies can improve psychological resilience and reduce depression, anxiety, and stress symptoms among patients with COVID-19 in an isolation ward.Methods: A quasi-experimental design was used to evaluate the"family member-like"care strategies for adult patients with COVID-19 in an isolation ward. COVID-19 patients in the Xiangya ward of the West District of the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology in Wuhan, Hubei province, were included in this study from February 9 to March 20, 2020. Healthcare providers who volunteered as family members were assigned to patients. They practiced one-to-one care and provided continuous and whole care for the patients who were from admission to discharge. Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Depression Anxiety Stress Scale-21 (DASS-21) were used to evaluate the resilience and psychological status of COVID-19 inpatients upon hospital admission, 2 weeks after admission, and at their discharge from the hospital. Results: The questionnaire response rate of the"family member-like"strategies was 100％. Of the 60 patients, 39 (65.0％) were male, and 21 (35％) were female. The hospital stay was (27.5±3.5) days. All the 60 patients were cured and discharged without any death and serious complications. The total scores for CD-RISC were 8.83±6.86 at admission, 29.13±5.42 at 2 weeks after admission, and 33.87±6.14 at discharge, which were significantly improved at the 2 follow-ups (F=404.564, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant improvements in tenacity (F=360.839, P<0.001), strength (F=368.217, P<0.001), and optimism (F=328.456, P<0.001) at the 2 follow-ups. The total scores of DASS-21 were 49.27±11.30 at admission, 30.77±16.71 at 2 weeks after admission, and 4.17±11.03 at discharge, and the scores were significantly decreased at the 2 follow-ups (F=270.536, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant decreases in depression (F=211.938, P<0.001), anxiety (F=285.592, P<0.001), and stress (F=287.478, P<0.001) at the 2 follow-ups.Conclusion:"Family member-like"strategies had positive effects on improving psychological resilience and reducing the symptoms of anxiety and depression of COVID-19 patients. It might be an effective care method for COVID-19 patients. It should be incorporated into emergency care management to improve care quality during public health emergencies of infectious diseases.

Jaundice in adult patients above 50 years of age: a comparative study of liver function tests

Background: Diagnosis of jaundice involves a range of tests. The liver function tests are done in all to arrive at a diagnosis and then manage the case appropriately. With advancing age, the incidence of liver disease increases. Understanding these changes is important for the management of liver diseases in the elderly. We conducted this study to find the difference in mean levels of Liver enzymes in younger and older age group of patients suffering with jaundice.Methods: It was a prospective observational study. All patients admitted with jaundice in the medicine ward satisfying inclusion/exclusion criteria were enrolled. The results of liver function tests in younger age and older age participants were then compared.Results: Total 100 participants were enrolled during the study period. 53 were enrolled in group one and the rest in group two. Anorexia (90%) was the most common symptom followed by abdominal distension (54%). The total bilirubin (8.8±4.7) as well as conjugated bilirubin (3.4±2.8) were higher in group one though they were not significant statistically (p=0.10 and 0.25 respectively). Mean AST and ALT levels were much higher in group 1 and statistically significant (p values <0.004 and 0.002 respectively). Conversely the mean PT values were higher in group two (p=0.02).Conclusions: Although the symptom severity may be more in elderly, the LFTs are not deranged proportionately. So there is a need to devise separate cut offs and these have to be lower for the older age group patients with jaundice. More studies with larger sample size are required to confirm the results.

Plantar pressure and gait characteristics in older adult patients with diabetes / 中国组织工程研究

BACKGROUND: Plantar pressure is one of the major risk factors for diabetic foot ulcers. OBJECTIVE: To explore the characteristics of plantar pressure under natural gait in older adult patients with diabetes and compare them with those in healthy older adults, providing data for preventing foot diseases and designing foot decompression products. METHODS: The study protocol was performed in accordance with the Medical Ethics Committee of Tianjin Medical University, China. Forty-one older adult patients with diabetes and 30 healthy older adults, both aged over 60 years, received plantar pressure detection using an insole-type root pressure measurement system. Peak plantar pressure, percentage of peak time, X offset, Y offset, 95% confidence ellipse area, step frequency, step velocity, stride length, standing phase, and swing phase were measured. After fully understanding the study protocol, each participant provided written informed consent. RESULTS AND CONCLUSION: Compared with healthy older adults, peak plantar pressure was significantly increased in the 2nd-4th metatarsal region, the peak time was decreased in most area of the left foot and increased in the right root heel and arch area in older adult patients with diabetes (P < 0.05). Compared with healthy older adults, standing phase was decreased, swing phase was increased, step frequency was decreased, stride length in males was increased, step velocity was increased, stride length in females was decreased, and step velocity was decreased in older adult patients with diabetes. Compared with healthy older adults, 95% confidence ellipse area was decreased, and X offset and Y offset were increased in older adult patients with diabetes. These results suggest that the stability and flexibility of older adult patients with diabetes are lower than those of healthy older adults. In older adult patients with diabetes, plantar pressure is obviously transferred from the heel to the humerus. Therefore, much attention should be paid to plantar pressure in foot care.

Emergence delirium following sevoflurane anesthesia in adults: prospective observational study / Delirium do despertar após anestesia com sevoflurano em adultos: estudo observacional prospectivo

Abstract Background and objectives: Emergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence. Design & methods: A prospective observational study was conducted in adult patients who had non-neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC). Results: The incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) (p = 0.04), emergency surgery (p = 0.04), African ethnicity (p = 0.01), longer duration of surgery (p = 0.007) and number of intubation attempts (p = 0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium. Conclusions: The incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.

Resumo Justificativa e objetivos: O delirium do despertar após a anestesia geral com sevoflurano não tem sido relatado com frequência em adultos como nas crianças. Este estudo teve como objetivo determinar a incidência de delirium do despertar em pacientes adultos submetidos à anestesia com sevoflurano como agente volátil e os prováveis fatores de risco associados à sua ocorrência. Desenho e métodos: Um estudo observacional prospectivo foi conduzido com pacientes adultos sem distúrbios neurológicos ou psiquiátricos submetidos à anestesia geral para procedimentos não neurológicos. Dados demográficos como idade, sexo, etnia e dados clínicos, inclusive estado físico ASA, estado cirúrgico, tentativas de intubação, tempo de cirurgia, hipotensão intraoperatória, drogas usadas, dor pós-operatória, analgesia de resgate e presença de cateteres, foram registrados. A intensidade do delirium do despertar foi medida com a Escala de Triagem de Delirium em Enfermagem (Nursing Delirium Scale - NuDESC). Resultados: A incidência de delirium do despertar foi de 11,8%. Os fatores significativamente associados ao delirium do despertar incluíram idade avançada (> 65) (p = 0,04), cirurgia de emergência (p = 0,04), descendência africana (p = 0,01), tempo maior de cirurgia (p = 0,007) e número de tentativas de intubação (p = 0,001). Fatores como sexo, uso de álcool e drogas ilícitas e especialidade cirúrgica não influenciaram a ocorrência de delirium do despertar. Conclusões: A incidência de delirium do despertar em adultos após a anestesia geral com sevoflurano é significativa e não tem sido relatada adequadamente. Fatores de risco modificáveis precisam ser abordados para reduzir ainda mais sua incidência.

The appropriate use of Proton Pump inhibitors in adult patients admitted in the Intensive Care Unit of a tertiary hospital

Introduction@#Proton pump inhibitors (PPI) have been used as stress ulcer prophylaxis (SUP) in intensive care unit (ICU) patients due to their high risk for stress-related upper gastrointestinal (GI) bleeding. With its dramatic increase in prescription, studies have noted its misuse and associated complications. This study aimed to determine the appropriateness of the use of PPIs in adult patients in the ICU of Medical Center Manila (ManilaMed).@*Methods@#This eight-month study conducted a retrospective chart review, and analyzed through descriptive statistics using Stata 13. Out of 292 patients, 188 satisfied the inclusion and exclusion criteria. The indication of use of PPI was based on the American Society of Health-System Pharmacists (ASHP) Therapeutic Guidelines on SUP. @*Results@#The patients were mostly male, median age of 62 years, stay in the ICU of five days, overall hospital stay of 13 days, and 75% were admitted from the emergency room. About 58% of PPIs were prescribed in the intravenous route for an average of 10 days, 38% of which is prescribed by cardiology consultants. Of the 73% of patients prescribed PPIs, most were septic and intubated for >48 hours, as well as being older and with longer overall hospital stay. Only 53.7% were prescribed appropriately; adverse outcomes included pneumonia, GI bleeding, anemia, renal failure, combined complications and overall mortality. @*Discussion@#The 46% inappropriate use of PPIs may indicate its routine use was common. The adverse outcomes, despite appropriate use, cannot be concluded as having causative effect owing to the nature of the study and given the possibility that these patients may have been sicker on admission hence prescribed the PPI.@*Conclusion@#Results indicated that PPI prescription in the ICU were mostly guidelines compliant. This paper recommends the development of ManilaMed’s own strategies to minimize its inappropriate use, in turn allowing proper allocation of funds and maximizing medical treatment.

Augmentation of Aripiprazole versus Bupropion on Specific Symptoms of Depression in Older Adult Patients : A Post-Hoc, Multi-Center, Open-Label, Randomized Study / 생물치료정신의학

OBJECTIVES: The purpose of this study was to compare aripiprazole versus bupropion augmentation therapy in older adult patients with major depressive disorder unresponsive to selective serotonin reuptake inhibitors(SSRIs).METHODS: This is a post-hoc analysis of a 6-week, randomized prospective open-label multi-center study in thirty older adult patients with major depressive disorder. Participants were randomized to receive aripiprazole(N=16, 2.5–10mg/day) or bupropion(N=14, 150–300mg/day) for 6 weeks. Montgomery Asberg Depression Rating Scale (MADRS), 17-item Hamilton Depression Rating scale(HAM-D17), Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores, and Clinical Global Impression-Severity (CGI-S) were obtained at baseline and after one, two, four, and six weeks. Changes on individual items of HAM-D17 were assessed as well as on composite scales(anxiety, insomnia and drive), and on four core subscales that capture core depression symptoms.RESULTS: There was a significantly greater decrease in MADRS scores in aripiprazole group compared to bupropion group at 4(p<0.05) and 6(p<0.05) weeks. There were significantly higher response rate at week 4(p<0.05) and 6(p<0.05) and remission rate at week 6 in aripiprazole group compared to bupropion group. Individual HAM-D17 items showing significantly greater change with adjunctive aripiprazole than bupropion: insomnia, late(ES=0.81 vs. −0.24, p=0.043), psychomotor retardation(ES=1.30 vs. 0.66, p=0.024), general somatic symptoms(ES=1.24 vs. 0.00, p=0.01). On three composite scales, adjunctive aripiprazole was significantly more effective than bupropion with respect to mean change for drive(p=0.005).CONCLUSION: Results of this study suggested that aripiprazole augmentation have superior efficacy in treating general and core symptoms of depression in older adult patients. Aripiprazole augmentation is associated with greater improvement in specific symptoms of depression such as psychomotor retardation, general somatic symptoms and drive.

Primera crisis epiléptica en pacientes adultos / First seizures in adult patients

Resumen: Una primera crisis epiléptica en pacientes adultos es un problema común en la práctica clínica y su manejo representa un desafío para los médicos. El objetivo de esta revisión es proporcionar un abordaje clínico sistemático para la clasificación, diagnóstico y tratamiento de los pacientes que han experimentado una primera crisis porque ello podría auxiliar al clínico a reconocer y tratar apropiadamente esta afección. Debido a que una primera crisis puede tener diversas causas, es esencial identificar si el evento correspondió a una crisis provocada (sintomática aguda) o no provocada. Por tanto, la clasificación adecuada de la crisis es fundamental para establecer la duración del abordaje diagnóstico, la necesidad de una intervención terapéutica y el pronóstico en cada caso. Los pacientes diagnosticados con una crisis única no provocada requieren la realización de un electroencefalograma y una resonancia magnética para estimar el riesgo de recurrencia e identificar a los pacientes que cumplen criterios diagnósticos de epilepsia. Asimismo, se recomienda individualizar el tratamiento con fármacos antiepilépticos para reducir el riesgo de recurrencia temprana (≤ 2 años), debido a que esto puede producir efectos adversos. Por último, señalamos algunas áreas de incertidumbre para incentivar la investigación a futuro en este tema.

Abstract: First seizures in adult patients are a common problem in clinical practice, and their management represents a challenge for physicians. The aim of this review is to develop a systematic clinical approach for the classification, diagnosis and treatment of patients who have experienced a first seizure, which could help clinicians to recognize and treat this condition appropriately. Because these seizures can arise from several etiologies, it is essential to know if the event was a provoked (acute symptomatic) or an unprovoked seizure. Thus, an adequate classification is of utmost importance to establish the length of the diagnosis approach, the necessary treatment and the individual prognosis. Patients diagnosed with a single unprovoked seizure require an electroencephalogram and a brain magnetic resonance imaging to assess the risk of recurrence as well as to identify those patients who meet the diagnosis criteria for epilepsy. We recommend individualized antiepileptic drug therapy to reduce early seizure recurrence (≤ 2 years), even if it can produce some adverse effects. Finally, there are still certain areas of uncertainty to promote future research in this topic.

Hidratación: importancia en algunas condiciones patológicas en adultos / Hydration: Importance in some pathological conditions in adults

Resumen Estar bien hidratado se relaciona con un estado adecuado de salud y bienestar; sin embargo ¿qué pasa en los pacientes adultos que tienen algún padecimiento como obesidad, diabetes mellitus tipo 2, hipertensión arterial, cardiopatía isquémica e insuficiencia cardiaca, alteraciones nefrológicas (insuficiencia, poliquistosis y litiasis renal), enfermedad pulmonar obstructiva crónica, dislipidemia, hiperuricemia o, bien, en adultos mayores y en el periodo perioperatorio, en donde hay pérdida del estado de salud o una necesidad diferente de hidratación y que requieren consumir bebidas no alcohólicas para tener un buen estado de hidratación sin alterar la evolución natural de estas condiciones? Algunos puntos y recomendaciones son: la carbonatación de las bebidas ofrece el beneficio de aumentar la saciedad y disminuir la ingesta energética, lo que puede contribuir a la pérdida de peso; el agua simple es la mejor fuente de hidratación en los pacientes diabéticos, sin embargo, otras fuentes de hidratación pueden ser el agua mineralizada, el agua mineral, la leche (de preferencia descremada), café y té sin azúcar o con edulcorantes no calóricos o bajos en calorías, así como cualquier bebida que los contenga; en pacientes con litiasis renal se recomienda ingerir 2.5 a 4 L de agua al día; las bebidas para deportistas pueden ser consumidas por pacientes hipertensos, siempre y cuando no excedan la cantidad de sodio recomendada por la Organización Mundial de la Salud. En conclusión, la hidratación juega un papel importante en la evolución de las enfermedades mencionadas.

Abstract Being well hydrated is related to an adequate state of health and well-being; however, what happens in those adult patients having some pathological conditions such as obesity, type 2 diabetes mellitus, high blood pressure, ischemic heart disease and heart failure, kidney diseases (renal failure, polycystic renal disease and renal lithiasis), chronic obstructive pulmonary disease, dyslipidemia, hyperuricemia, or in the elderly and in the perioperative period, where there is loss of health or a different need for hydration and require the use of non-alcoholic beverages in order to have a good state of hydration without altering the natural evolution of these conditions? Some key points and recommendations are: carbonation of beverages offers the benefit of increasing satiety and decreasing energy intake, which can contribute to weight loss; simple water is the best source of hydration in diabetic patients; however, other sources of hydration may be mineralized water, mineral water, milk (preferably non-fat), coffee and tea without sugar or non-caloric sweeteners or low-calorie, as well as any beverage containing them; in patients with renal lithiasis it is recommended to take 2.5 to 4 L of water per day; sports drinks can be consumed by hypertensive patients as long as they do not exceed the amount of sodium recommended by the World Health Organization. In conclusion, hydration plays an important role in the evolution of the pathologic conditions mentioned above.

Philippine Costs in Oncology (PESO): Describing the economic impact of cancer on Filipino cancer patients using the ASEAN costs in oncology study dataset

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Cancers are among the top causes of mortality in the Philippines. The treatment regimens are also costly and put Filipinos at risk of financial catastrophe. The economic impact, however, has not been documented.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This analysis aimed to describe the economic impact of cancer in the Philippines and analyze predictors of financial catastrophe among Filipino cancer patients.</p><p style="text-align: justify;"><strong>METHOD:</strong> The analysis used the dataset from the ASEAN costs in oncology study, a prospective study of adult cancer patients in Southeast Asia. Cancer patients were recruited at time of diagnosis and were monitored in terms of health outcomes, costs, and quality of life. Multinomial regression models were generated to assess predictors of death and financial catastrophe.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Information from 909 respondents in the Philippines was included in the analysis. Overall, 240 (26.4%) of the cohort were dead at the end of the study while 40.6% were still alive at Month 12 but had experienced financial catastrophe. Mean combined Month 3 and Month 12 out-of-pocket expenditure was PhP181,789.00 (n = 458, sd = 348,717.47). Belonging to higher income groups (vs. belonging to the lowest two) was significantly associated with lower risk of financial catastrophe. Insurance did not confer significant change in risk of death or financial catastrophe.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Cancer can be a significant economic burden for Filipinos leading to financial catastrophe. Insurance mechanisms at the time of study failed to protect against catastrophe.</p>

Risk Factors for Antibiotic-associated Diarrhea in Chinese Adult Patients:A Meta-analysis / 中国药房

OBJECTIVE:To evaluate the risk factors for antibiotic-associated diarrhea (AAD) in Chinese adult patients systematically,and to provide evidence-based reference in clinic. METHODS:Retrieved from CNKI,VIP,CBM,Wanfang database,PubMed and Embase,etc.,disease control studies about AAD risk factors of Chinese adult patients were collected.The retrieval time limit ranged from Jan. 2000 to Jan. 2018. Meta-analysis was performed by using Rev Man 5.2 software after data extraction and quality evaluation of included literatures with NOS scale. RESULTS:A total of 14 literatures were included, involving 20 914 patients. The result of Meta-analysis showed that age ≥65 years [OR＝2.36,95%CI(1.99,2.79),P＜0.001], fasting [OR＝4.65,95%CI(3.79,5.69),P＜0.001],use of acid suppressant [OR＝5.82,95%CI(3.77,8.98),P＜0.001],serum albumin ≤30 g/L [OR＝2.40,95%CI(2.00,2.88),P＜0.001],invasive operation [OR＝3.95,95%CI(3.03,5.15),P＜0.001], stay in ICU [OR＝2.93,95%CI(2.38,3.60),P＜0.001],hospitalization time ≥10 d [OR＝4.08,95%CI(3.31,5.03),P＜0.001], antibiotic species ≥3 kinds [OR＝1.98,95%CI(1.56,2.51),P＜0.001] and duration of antibiotics use ≥10 d [OR＝6.16,95%CI (3.22,11.76),P＜0.001] were significantly correlated with the occurrence of AAD. CONCLUSIONS:Age ≥65 years,fasting, use of acid suppressant,serum albumin ≤30 g/L,invasive operation,stay in ICU,time of hospitalization ≥10 d,antibiotic species≥3 kinds and duration of antibiotics use≥10 d are risk factors for AAD in Chinese adult patients.