Impacts of frailty on the negative health outcomes of elderly Brazilians / Impactos da Fragilidade sobre desfechos negativos em saúde de idosos brasileiros

Abstract Objective: to verify the association between frailty and the occurrence of falls, hospitalization and death among Brazilian elderly persons. Methods: a representative sample of elderly persons from the city of Juiz de Fora, Minas Gerais, Brazil, who had been evaluated with regard to frailty, socio-demographic conditions and health in 2009, were reevaluated in terms of negative health outcomes between 2014 and 2015 (n=304). Results: The results revealed a greater incidence of falls, hospitalization, and death among frail elderly persons. The frail group also had an increased risk (1.5, crude estimate) of death during the follow-up period than the robust individuals. The pre-frail elderly had a 55% (crude) and 58% (adjusted) greater risk of falls, and an 89% (crude) greater risk of death than robust individuals. Conclusion: frailty, as well as pre-frailty, can increase the risk of adverse events in the health of the elderly. AU

Resumo Objetivos: verificar a relação da fragilidade com a ocorrência de quedas, hospitalização e óbito em idosos brasileiros. Métodos: Para tal, uma amostra representativa de idosos moradores do município de Juiz de Fora, Minas Gerais, Brasil, a qual foi avaliada quanto à fragilidade, condições sociais, demográficas e de saúde no ano de 2009, foi reavaliada quanto aos desfechos negativos em saúde entre os anos de 2014 e 2015 (n=304). Resultados: Os resultados demonstram uma maior incidência de quedas, hospitalização e óbito entre os frágeis. O grupo frágil também apresentou risco aumentado (1.5, bruto) de falecer durante o seguimento do que os robustos. Já os pré-frágeis, exibiram risco 55% (bruto) e 58% (ajustado) superior de quedas e 89% (bruto) de falecer em relação aos indivíduos robustos. Conclusão: Conclui-se que a fragilidade, assim como a pré-fragilidade, podem aumentar o risco de eventos negativos na saúde de idosos.AU

Pseudomoniletrhix: defecto estructural del tallo piloso, fragilidad capilar aumentada / Pseudomonilethrix: structural defect of the hair shaft, increased capillary fragility

Presentamos un caso clínico de pseudomoniletrhix, defecto estructural del tallo piloso con aumento de la fragilidad capilar; en una paciente de sexo femenino de 22 años de edad. Realizamos una revisión de la patología considerando, en especial, el diagnóstico diferencial con el moniletrix.

We report a case of pseudomonilethrix, structural defect of the hair shaft with increased capillary fragility, in a female patient 22 years of age. We review the pathology especially considering the differential diagnosis with monilethrix.

Frequency of bleeding disorders diagnosed at armed forces institute of pathology Rawalpindi

To determine the frequency of bleeding disorders diagnosed at Armed Forces Institute of Pathology, Rawalpindi [AFIP Rwp]. Descriptive study. Department of Hematology, AFIP Rwp from January 2006 to June 2009. A total of 1836 patients of bleeding diathesis were included in the study. Hess test was done to investigate the vascular defects. Bleeding Time [BT] was done to screen platelet function defects. The 'clotting screen' and mixing studies were done to detect coagulation protein defects. Clot solubility test was performed to screen factor XIII deficiency. Out of 1836 patietns of bleeding diathesis 435 [23.7%] were diagnosed as having haemostatic defects. Out of these 435 patients 273 [62.8%] had coagulation factor deficiency, 81 [18.6%] had platelet function defects and 81 [18.6%] had vWF deficiency. Among the 273 coagulation factor deficiency patients, factor VIII deficiency was in 121 [44.3%], factor IX deficiency in 32 [11.7%], factor V deficiency in 18 [6.6%], factor XIII deficiency in 15 [5.5%], factor VII deficiency in 12 [4.4%], factor X deficiency in 9 [3.3%], factor I deficiency in 8 [2.9%] and factor II deficiency was in 3 [1.1%]. Multiple factor deficiency was 55 [20.1%]. No defects of vasculature were identified. Coagulation factor deficiencies, with factor VII deficiency being the commonest are the most frequent bleeding disorders. Platelet function defects and vWF deficiency also comprise significant proportion of the bleeding disorders

Acute Dermal Capillary Rupture in a Patient with Diabetic Nephropathy / 대한신장학회지

A 46-year-old diabetic woman visited our hospital with generalized edema and high blood pressure. An appropriately sized noninvasive blood pressure cuff was placed on her right arm above the elbow to measure blood pressure. While we were checking her blood pressure, we noticed small red petechial spots distal to the cuff involving her entire right forearm. Her blood pressure was 170/96 mmHg. The laboratory findings showed no abnormality of anticoagulation. The rest of the patient's extremities were not affected. The petechiae on the right arm resolved spontaneously after ten days. The most likely explanation for these petechiae is acute dermal capillaryrupture, which is called the Rumpel- Leede phenomenon. Acute dermal capillary rupture appears as petechiae in an area following application of vascular constriction such as application of tourniquet to draw blood specimen or use of blood pressure cuff due to capillary fragility or abnormal platelets in numbers or in function. This situation has been reported previously in the literature as the Rumpel-Leede phenomenon in association with prolonged noninvasive BP monitoring. In the patient described herein, increased venous pressure from blood pressure measurement and capillary fragility associated with diabetes mellitus may have increased the risk of acute dermal capillary rupture.

Hipersensibilidade neurorganovascular / Neurorganovascular hypersensibility

Considerações patogenéticas sobre edema e principalmente hemorragia transudativa (por deapedese), originária de hipersensibilidade, com atuação nervosa local e vasodilatação paralítica. Destacam-se o papel do órgão hipersensibilizado e a conseqüente subordinação de seus vasos ao mesmo, cuja manifestação baseia-se na lei escalar de Ricker. O método é a pesquisa observadora de muitos casos de biópsia e necropsia, não especificamente assinalados, incluindo hematêmese, AVC, epistaxe, infarto etc. É concebida uma "hiperemia paralítica" ou "hiperemia passiva arterial", capaz de provocar infarto

A Case of Polycythemia Vera with Splinter Hemorrhages

Once splinter hemorrhage can be considered as a pathognomonic sign of subacute bacterial endocarditis. But it can also be associated with a variety of systemic disorders that increase capillary fragility or primary nail bed involvement in dermatologic disorders. The cause of splinter hemorrhage can usually be established by careful history and physical examination. We report a case of 33-year-old man with splinter hemorrhages, who had polycythemia vera.

Itching púrpura / Itching purpura

Se describe un caso de itching purpura o angiodermatitis pruriginosa diseminada. El trastorno consiste en una erupción petequial intensamente pruriginosa que se manifiesta inicialmente en las piernas, para luego diseminarse a tronco y miembros en el transcurso de algunas semanas, asociándose a descamación fina, pápulas y liquenificación. La etiología de la enfermedad es desconocida y se considera como una variedad diferente dentro del grupo de las dermatosispurpúricas pigmentarias. Su curso está sujeto a marcadas fluctuaciones, con períodos de mejoría y exacerbación . Puede esperarse una completa resolución del cuadro después de tres a seis meses, aunque en algunos casos puede llegar a durar hasta dos años

Protección por cinarizina-dobesilato de calcio de las lesiones cerebrales inducidas por la histamina en la rata / Protection by cinnarizine calcium dobesilate against cerebral lesions induced by histamine in the rat

Las condiciones patológicas en las que la relación aporte/demanda de oxígeno está alterada son especialmente deletéres apra el tejido nervioso. Algunos trabajos sugirieron que es posible la restitución de la función cerebral, después de períodos isquémicos prolongados. La combinación dobesilato de calcio (2,5 dihidroxibenzeno-sulfonato de calcio) y cinarizizna fue utilizada para proteger la fragilidad capilar experimental y para el tratamiento de la arteriosclerosis cerebral humana leve y moderada. Esto llevó a investigar si la combinación dobesilato-cinarizina, podría modificar los efectos de la histamina sobre los vasos y parénquimas cerebrales de la rata. Se utilizaron 17 ratas hembras adultas cepa Wistar, que se dividieron al azar en 3 grupos: grupo control (n = 5); grupo dobesilato de calcio + cinarizina (n = 6); grupo cinarizina (n = 6). Las drogas se adminstraron a las dosis de 3 mg/Kg/peso/día durante 7 días, al 8- día se les inyectó ev una suspensión de azulde Evans, a los 10 min se les inyectó por vía ip 50 microg de 1-metil-histamina y después de 10 min se las sacrificó. El sistema nervioso central se estudió mediante cortes coronales seriados que se evaluaron cuantitativamente. La administración de cinarizizna produjo una disminución del número total de vasos lesionados con respecto al grupo control. Dobesilato-cinarizina produjo una disminución mucho más marcada del número de vasos lesionados. En los vasos con lesión de tipo moderada, cinarizina no produjo una disminución de los vasos lesionados, mientras que la administración de su combinación con dobesilato de calcio, produjo una disminución significativa del daño. Lo mismo ocurrió con la lesión del tipo grave, en que la administración de las dos drogas produjo una disminución significativa del daño vascular. Con respecto al daño neuronal, tanto la cinarizina como el dobesilato con cinarizina, disminuyen el daño celular total. Parece existir un sinergismo de acción de ambas drogas frente al efecto histamínico en la presente situación experimental, lo que podría explicarse porque el dobesilato de calcio protege a los cambios provocados por la histamina en el glicocálix, que recubre la capa externa de las células endoteliales capilares y la cinarizina actúa como "desacoplante del calcio"

Efectos de la deficiencioa de ácido ascórbico (vitamina c) en la dieta, sobre la fragilidad capilar / Efectos of the ascórbico acid deficiency (vitamin c) in the diet, on, hair fragility

La hipovitaminosis de ácido ascórbico, repercute sobre poblaciones extensas, especialmente en niños. Su cuadro es facilmente confundido con poliomielitis, artritis; determina un análisis clínico adecuado. La vitamina c es hidrosoluble actúa en la síntesis de colágeno, remoción de hierro de la ferritina. Sus principales fuentes son cítricos y verduras, se observa desarrollo de fragilidad capilar y aparecimiento de síntomas en distintos niveles de vitamina en la orina. Los niveles oxidados de vitamina en la orina se mide por el método de yodometría. De los dos casos problemas los dos murieron por hipovitaminosis; el peso actúa como variable importante en el desarrollo de la patología, la dieta con arroz escorbutógena....