Degeneración combinada subaguda / Subacute combined degeneration

Introducción: La degeneración combinada subaguda (DCS) es un trastorno caracterizado por la degeneración difusa de la sustancia blanca a nivel del SNC, que afecta específicamente los cordones posteriores y laterales de la médula espinal, con pérdida de la mielinización periférica y central. De manera frecuente, las manifestaciones clínicas son parestesias y debilidad generalizada causada por deficiencia de vitamina B12. Presentación del caso: Paciente masculino de 79 años, con cuadro clínico de 3 meses de evolución de limitación funcional para la marcha acompañado de desorientación. Al examen físico evidenció desorientación, cuadriparesia e hiporreflexia, con niveles séricos bajos de vitamina B12, RM cervical con focos hiperintensos en el segmento C3/C6 y endoscopia de vías digestivas altas con atrofia de la mucosa gástrica. Presentamos un caso clínico de DCS. Discusión: Este es un caso de DCS que se manifiesta por medio de una alteración neuropsiquiátrica, con una presentación inicial inespecífica que comprende deterioro de la marcha, movimientos anormales con afectación cognitiva y psiquiátrica dada por alucinaciones visuales y desorientación. Su sospecha es importante en pacientes con factores de riesgo por medio del conocimiento de la patología, para una adecuada sospecha diagnóstica y una instauración oportuna de reposición vitamínica, la cual presenta una excelente respuesta. Conclusión: La DCS es un trastorno en el que se evidencia anemia con deficiencia de vitamina B12, des-mielinización del tejido nervioso y en muchos casos signos sugestivos de atrofia gástrica, y para ello es crucial la detección temprana de esta enfermedad por medio de la determinación de niveles séricos de vitamina B12, asociado a síntomas neurológicos, para así lograr su adecuado diagnóstico y tratamiento.

Introduction: Subacute combined degeneration (DCS) is a disorder characterized by diffuse degeneration of white matter at the CNS level, specifically affecting the posterior and lateral cords of the spinal cord, also with loss of peripheral and central myelination, frequently the clinical manifestations are paresthesias and generalized weakness caused by vitamin B12 deficiency. Case presentation: A 79-year-old male patient with a 3-month history of functional limitation for walking accompanied by disorientation. On physical examination, he revealed disorientation, quadriparesis, and hyporeflexia, with low serum levels of vitamin B12, cervical MRI with hyperintense foci in segment C3/C6, and upper digestive tract endoscopy with atrophy of the gastric mucosa. We present a clinical case of DCS. Discussion: This is a case of DCS that manifests itself through neuropsychiatric alteration with a nonspecific initial presentation with gait impairment, abnormal movements with cognitive and psychiatric affectation given by visual hallucinations and disorientation. Its suspicion is important in patients with risk factors. risk through knowledge of the pathology for an adequate diagnostic suspicion and a timely establishment of vitamin replacement for which it presents an excellent response. Conclusion: DCS is a disorder where anemia with vitamin B12 deficiency, demyelination of the nervous tissue and in many cases signs suggestive of gastric atrophy are evident, for which early detection of this disease is crucial through the determination of serum levels of vitamin B12 associated with neurological symptoms, in order to achieve its proper diagnosis and treatment.

Motives for physical activity participation among lebanese adults aged 18 to 50 years: a cross-sectional study / Motivos para participação de atividade física em libanes adultos de 18 a 50 anos: um estudo transversal

ABSTRACT Background: Sports participation motivations can be intrinsic, extrinsic, or even amotivational. Few studies on adult participation in PA have been found in the Lebanese context. This study aims to: a) investigate significant differences in sports participation motivation across gender, age, occupation, and time of practice, and b) investigate sports participation motives that discriminated the best between those variables. Material and methods: The Arabic version of the Sport Motivation Scale was collected electronically from 531 volunteers practicing regular PA for the last six months. Gender, occupation, marital status, and time of practice were all analyzed using Mann-Whitney U test and the Kruskal Wallis Test with 0.05 as level of significance. Results: Internal motivation subscales (particularly the intention to accomplish) were the most influential motives for both genders. A significant difference across gender was reported in the extrinsic motivation and amotivation subscales. Furthermore, age, occupation, marital status, and time of practice show significant differences in motivation factors either dependent or regardless of gender distribution (p<0.05). Conclusion: no significant differences in the intrinsic motivation for sports participation between genders. Other factors, on the other hand, had a substantial impact. Research contribution: these findings are intended to contribute to a better understanding of differences in motivation for participating in PA and to aid in its promotion among Lebanese adults

RESUMO Contexto: As motivações para a participação desportiva podem ser intrínsecas, extrínsecas ou mesmo amotivacionais. Poucos estudos sobre a participação de adultos em AF foram encontrados no contexto libanês. Este estudo tem como objetivos: a) investigar diferenças significativas na motivação para a prática desportiva em função do género, idade, profissão e tempo de prática, e b) investigar os motivos da prática desportiva que melhor discriminaram entre essas variáveis. Material e métodos: A versão árabe da Sport Motivation Scale foi coletada eletronicamente de 531 voluntários praticantes regulares de AF nos últimos seis meses. Gênero, ocupação, estado civil e tempo de atuação foram analisados por meio do teste U de Mann-Whitney e do teste de Kruskal Wallis com nível de significância de 0,05. Resultados: As subescalas de motivação interna (particularmente a intenção de realizar) foram os motivos mais influentes para ambos os sexos. Uma diferença significativa entre os gêneros foi relatada nas subescalas de motivação extrínseca e amotivação. Além disso, idade, ocupação, estado civil e tempo de prática mostram diferenças significativas nos fatores de motivação dependentes ou independentes da distribuição por gênero (p<0,05). Conclusão: não houve diferenças significativas na motivação intrínseca para a prática desportiva entre os sexos. Outros fatores, por outro lado, tiveram um impacto substancial. Contribuição da pesquisa: esses achados pretendem contribuir para uma melhor compreensão das diferenças na motivação para participar da AF e auxiliar na sua promoção entre adultos libaneses.

Paciente con anemia perniciosa y cambios comportamentales / A patient with behavioral alterations due to pernicious anemia

La anemia perniciosa es una patología hematológica caracterizada por anemia con volumen corpuscular medio alto, secundaria a la incapacidad del organismo para absorber la vitamina B12 por deficiencia de factor intrínseco. Se puede deber a la destrucción de las células parietales o la presencia de anticuerpos contra este factor, disminuyendo los valores séricos de cianocobalamina y alterando la síntesis de ADN y ARN. Dado que compromete las 3 líneas celulares, pueden tener variedad de síntomas clínicos. Las principales manifestaciones se dan en los sistemas nervioso central, periférico y gastrointestinal. El diagnóstico se basa en el hallazgo de cifras bajas cianocobalamina, anormalidades de la mucosa gástrica por atrofia, la cual debe confirmarse con biopsia. Se describe el caso de una paciente de 68 años de edad con cambios de comportamiento en sus funciones cognitivas, hemograma con evidencia de pancitopenia con anemia, volumen corpuscular medio elevado, así como niveles bajos de vitamina B12 y una endoscopia que mostraba gastritis eritematosa crónica atrófica. Se inicia suplencia con vitamina B12 con posterior recuperación completa de sus funciones cognitivas y cambios comportamentales.

Pernicious anemia is a hematologic condition characterized by anemia with an increased mean corpuscular volume, secondary to impaired vitamin B12 absorption due to lack of intrinsic factor. It may be associated with the destruction of parietal gastric cells or the presence of anti-intrinsic factor antibodies which generates decreased serum levels of cyanocobalamin and impair DNA and RNA synthesis. Given it involves the three cell lines it may have a varied symptomatology. Main manifestations are seen in the central and peripheral nervous system and gastrointestinal system. Diagnosis is based on finding low cyanocobalamin serum levels, associated with gastric mucosa anomalies due to atrophic gastritis, which must be confirmed by a biopsy. A case is described in a 68 year old female patient with behavioral alterations and cognitive impairment. Hemogram showed pancytopenia and anemia, increased mean corpuscular volume, as well as decreased serum vitamin B12 level and an endoscopy evidenced chronic erythematous atrophic gastritis. She received vitamin B12 therapy with full cognitive recovery and reversal of behavioral alterations.

A preprogram appraisal of factors influencing research productivity among faculty at college of medicine, University of Lagos

A defining feature of any university is its dedication to scholarly activities, leading to the generation of knowledge and ideas Research productivity is a measure of achievement of a scholar. The number of research publications in peer-reviewed journals is an important criterion for assessing productivity and prestige in the academia. Aims and Objectives: This cross-sectional descriptive study assessed the level of research productivity (RP) among junior faculty at the College of Medicine, University of Lagos, and investigated factors affecting their research output prior to the implementation of a 5-year training grant funded by the National Institutes of Health. Methods: Seventy junior faculty members attended a pre-program training, and the self-reported number of peer-reviewed publications (PRPs) was used as an indicator. Intrinsic and extrinsic factors influencing RP among the attendees were assessed and ranked. Results: The majority (42/70, 60%) of the respondents had <10 PRPs. The median (interquartile range) number of PRPs was 7 (3­18). A desire for the development of their personal skills, contribution to society, and personal research interests topped the list of intrinsic factors influencing RP. Work flexibility, research autonomy, and scholarly pursuits were the bottom three. A desire for promotion, respect from peers, and increased social standing were the top three extrinsic factors, while monetary incentives, employment opportunities, and the need to attend conferences were the lowest three. The top barriers to RP were lack of resources and lack of mentoring. Perceived older age, lack of time, and motivation were the lowest three barriers. Older age and professional cadre were associated with increased RP (P < 0.05). Conclusion: Among the participants, research output appears to be motivated primarily by a desire for personal development,promotion, and respect from peers. Lack of access to resources was the main barrier to increased RP. These factors may need to be considered when developing programs designed to promote RP

Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape

Background: The fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix.Aim: The study aimed to determine the factors that influence patient falls.Setting: A private hospital group in the Cape Metropole of the Western Cape.Methods: A quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS).Results: Intrinsic factors contributing to patient falls includedthe patient's age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment.Conclusion: The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals

Endoparasites of Small Mammals in Edo State, Nigeria: Public Health Implications

Some small mammals occur as household pests and harbour a number of parasites that could be of public health importance. This study profiled the helminth and protozoan parasites in trapped small mammals within and around human dwelling places (houses) located across 4 major towns (Auchi, Benin, Ekpoma, and Uromi) and environs in Edo state, Nigeria. Six genera (Apodemus sp., Crocidura sp., Mastomys natalensis, Mus musculus, Rattus sp., and Sorex sp.) were identified from 502 trapped small mammals. Overall, M. musculus (71.9%) and Rattus rattus (20.1%) were the most frequently trapped. In total, on examination of blood, gastrointestinal contents, and brain tissues, 12 helminth taxa (Angiostrongylus sp., Aspicularis sp., Capillaria sp., Gongylonema sp., Heterakis spumosa, Hymenolepis diminuta, Hymenolepis nana, Mastophorus muris, Moniliformis moniliformis, Nippostrongylus brasiliensis, Strongyloides sp., Trichosomoides sp., and Trichuris sp.), and 6 protozoan parasites (Babesia sp., Trypanosoma lewisi, Plasmodium sp., Eimeria sp., Isospora sp., and Toxoplasma gondii) were isolated. Most prevalent helminths with relatively heavy mean intensity were Strongyloides sp. and Heterakis spumosa, while Plasmodium, Eimeria, and Isospora were the most prevalent protozoan parasites. Generally, intrinsic factors like sex and age had marginal influence on the rate and burden of infection in M. musculus and R. rattus. Although the infection rate and prevalence of zoonotic parasites were low, they were largely recovered in rodents from Ekpoma. This study elucidates the public health implication of the presence of zoonotic parasites in these small mammals.

Probability of Early Retirement Among Emergency Physicians / 예방의학회지

OBJECTIVES: Early retirement occurs when one's job satisfaction suffers due to employment mismatch resulting from factors such as inadequate compensation. Medical doctors report high levels of job stress and burnout relative to other professionals. These levels are highest among emergency physicians (EPs), and despite general improvements in their working conditions, early retirement continues to become more common in this population. The purpose of this study was to identify the factors influencing EPs intention to retire early and to develop a probability equation for its prediction. METHODS: A secondary analysis of data from the 2015 Korean Society of Emergency Physicians Survey was performed. The variables potentially influencing early retirement were organized into personal characteristics, extrinsic factors, and intrinsic factors. Logistic regression analysis was performed to identify risk factors and to develop a probability equation; these findings were then arranged in a nomogram. RESULTS: Of the 377 survey respondents included in the analysis, 48.0% intended to retire early. Risk factors for early retirement included level of satisfaction with the specialty and its outlook, slanderous reviews, emergency room safety, health status, workload intensity, age, and hospital type. Intrinsic factors (i.e., slanderous reviews and satisfaction with the specialty and its outlook) had a stronger influence on early retirement than did extrinsic factors. CONCLUSIONS: To promote career longevity among EPs, it is vital to improve emergency room safety and workload intensity, to enhance medical professionalism through a stronger vision of emergency medicine, and to strengthen the patient-doctor relationship.

The investigation of the positive rate of intrinsic factor antibody and deficiency rate of vitamin B(12) in normal physical examination population / 中华血液学杂志

Objective: To explore the positive rate of intrinsic factor antibody (IFAb) and level of vitamin B(12) (VitB(12)) in normal physical examination population and the possible relation between IFAb, VitB12 and sex, age, number of RBC, HGB and MCV. Methods: A total of 1 427 people who came to Peking Union Medical Colleague Hospital (PUMCH) for physical examination were enrolled. There were 758 males with average age of (52.5±14.5) years-old and 669 females with average age of (50.3±14.3) year-old. Beckman DxI800 automatic biochemical-immune analyzer and corollary reagents were used to analyze the level of serum IFAb and VitB(12). The results in different sex, age were documented and their correlation with the value of whole blood cell count was tested later on. Results: Among the 1 427 normal subjects, 66 (4.63%) were positive for IFAb. The positive rate for IFAb in the population≥40 years-old was higher than those<40 years-old (5.66% vs 1.48%, χ(2)=7.46, P=0.006). The deficiency rate of VitB(12) in the population<40 years-old, 40-59 years-old and ≥60 years-old was 2.22%, 2.51% and 5.50%, respectively (χ(2)=8.55, P=0.014). There were no difference between people with different sex in the positive rate of IFAb (5.15% for males and 4.04% for females, χ(2)=0.99, P=0.320) or in the deficiency rate of VitB(1)2 (3.83% for males and 2.69% for females, χ(2)=1.44, P=0.230). The results of multiple linear regression showed that HGB level of IFAb positive subjects was 3.05 g/L lower on average than those of IFAb negative, but IFAb had no effect on both RBC and MCV. There was no correlation between VitB(1)2 deficiency and HGB, RBC and MCV. Conclusion: The positive rate of IFAb and deficiency rate of VitB(1)2 increase as age increases. But the presence of VitB(12) deficiency is later than the positive findings of IFAb. IFAb showed some effects on the level of HGB, which may compensate the limitations of VitB(12) detection to some extent. It is necessary to check the IFAb and level of VitB(12) in people with middle or old ages.

Factors Influencing Korean Nurses' Intention to Stay: A Systematic Review and Meta-analysis / 간호행정학회지

PURPOSE: To systematically review research articles that examined factors affecting Korean clinical nurses' intention to stay in their jobs. METHODS: Articles related to Korean clinical nurses and published both in Korean and English languages were retrieved from computerized databases using a manual search. Data extraction, quality assessment, and analysis including meta-analysis were completed. RESULTS: The review included 15 studies. There was strong evidence for the effects of 19 factors on Korean clinical nurses' intention to stay. Factors were categorized into three major categories; demographic, extrinsic, and intrinsic factors. In the meta-analysis of 10 articles, career experience of more than 6 years was the main factor that led to high intention to stay (OR=−0.5, p < .001). Job performance related factors (28.1%) and nursing work environment or organizational climate for caring (21.9%) were studied as the main extrinsic factors. Job related attitude (28.1%) including job satisfaction and organizational commitment and nursing value (15.6%) were studied as the main intrinsic factors. CONCLUSION: Expert nurses are more likely to retain their current positions as well as quality workplace environments or psychological capitals. Healthcare organizations must be responsible for improving professional and psychological capital of beginner nurses and affecting change for a warm organizational environment.

Spontaneous Remission of Pernicious Anemia / 대한내과학회지

Pernicious anemia is a macrocytic anemia that is caused by vitamin B12 deficiency, itself a result of the absence of intrinsic factors due to autoimmune destruction of parietal cells. We report here the case of a 43-year-old female with spontaneous remission of pernicious anemia. The patient presented with fatigue. Her serum vitamin B12 level was low, hemoglobin level was 7.6 g/dL, and serologic tests for anti-intrinsic factor and anti-parietal cell antibodies were positive. We diagnosed her with pernicious anemia, but did not administer vitamin B12 because her hemoglobin level increased spontaneously. Since then, the patient's hemoglobin and serum vitamin B12 levels have been within the normal range.

Treatment of dental erosion caused by intrinsic and extrinsic etiology: a case report

Dental erosion is defined as tooth structure loss by acidic chemical substance. It is caused by extrinsic factors such as acidic foods, drugs, and working environments, and also intrinsic factors such as gastric acid regurgitation in gastro-esophageal disorder or intensive vomiting in bulimia nervosa. These lesions can be treated with direct resin filling, laminate or full contour crown depending on the intensity of clinical problem. This is a case report about treatment of rare clinical case: labial erosion of anterior tooth caused by frequent intake of acidic fruit and palatal erosion of anterior tooth caused by intensive vomiting in bulimia nervosa.

Medications as Risk Factor for Falls / 대한평형의학회지

Falls are the most common cause of accidents among the older population, leading to both fatal and non-fatal injuries. Falls is a syndrome resulting from the cumulative effect of various extrinsic and intrinsic factors. It is considered to be a multifactorial disorder. Medication use is considered a risk factor for falls. We reviewed medications associated with falls in older individuals. In geriatrics populations, polypharmacy is associated with falls. Medical doctors should be aware of the possibility that starting a new medication, such as antihypertensive agents, benzodiazepine, antidepressants, opioid agents and antihistamines, may act as a trigger for the onset of a fall.

Tendinopathy as Sports Injury: Characteristics and Management / 대한스포츠의학회지

With increased participation in sporting activity, overuse tendon injuries are a major problem in sports medicine. Tendinopathy is generic descriptive term for the clinical conditions in and around tendons arising from overuse. Tendinopathy is debilitating condition that results in significant deficits in performance and prolonged time away from activity. Histological studies show either absent or minimal inflammation. There are three main theories to explain the development of tendinosis, including the mechanical theory, vascular theory, and neural theory. Risk factors are divided into intrinsic factors and extrinsic factors. The management of tendinopathy revolves around modulating tendon pain, as pain is the presenting and limiting factor for activity. Despite an abundance of therapeutic options, the scientific evidence base for managing tendinopathies is limited. The aim of this review is to report the options for most widely used conservative management of tendinopathy.

Causas poco frecuentes de obstrucción en la salida gástrica en pediatría: Utilidad de la ecografía / Unusual causes of pediatric gastric oulet obstruction. Utility of ultrasound

Las causas de obstrucción en el vaciamiento gástrico (OVG) pueden ser intrínsecas, de la pared o extrínsecas. En Pediatría, la más frecuente es la estenosis hipertrófica del píloro. El objetivo de este trabajo es mostrar la utilidad del ultrasonido (US) en el diagnóstico de OVG de causa poco común. El estómago es fácilmente visualizable con US, cuando la luz se distiende adecuadamente con líquido. El protocolo de estudio incluye la realización de cortes en los planos transversal y longitudinal, evaluando la pared (normalmente de 3mm aprox.) y el vaciamiento gástrico. Presentamos una serie de 7 pacientes, entre los 9 meses y 12 años de edad, con síntomas de OVG, que fueron estudiados en nuestro hospital entre 2009 y 2012. El US mostró engrosamiento de la pared, ocupación de la cavidad gástrica o alguna imagen en íntimo contacto con la pared, sin plano de clivaje. Los diagnósticos fueron: enfermedad granulomatosa crónica, duplicación con heterotopia gástrica y metaplasia intestinal focal, gastritis crónica, linfoma de Burkitt, quiste de duplicación con ectopia pancreática y tricobezoar. En los niños con vómitos alimenticios y sospecha de OVG debemos hacer un estudio ecográfico minucioso de la región antropilórica para valorar la pared, el contenido y las relaciones extrínsecas, de modo de orientar el diagnóstico y sugerir en cada caso qué estudios realizar para confirmarlo. La endoscopia con biopsia generalmente es concluyente, evitando la seriada esófago gastroduodenal (SEGD) y, en muchos casos, se utiliza la tomografía computada (TC), por lo menos antes del diagnóstico histológico de certeza.

The stomach is easily observed in an ultrasound (US) exam when is filled with liquid. The US scan protocol includes longitudinal and transversal views of the stomach, evaluating the muscular wall thickness (normal up to 3mm) and the gastric outlet. Causes of gastric outlet obstruction can be intrinsic, extrinsic or from the stomach wall. In children, the commonest cause is the hypertrophic pyloric stenosis.The aim of this work is to show the usefulness of ultrasonography (US) in the diagnosis of gastric outlet obstruction of uncommon cause. We present 7 patients from 9 months to 12 years old, studied in our hospital between 2009 and 2012, who presented gastric outlet obstruction symptoms. US showed thickening of the stomach muscular wall, filling of the stomach lumen or a mass in close relationship with the stomach wall. Granulomatous disease, gastric duplication with heterotopy, focal intestinal metaplasia, chronic gastritis, Burkitt lymphoma, duplication cyst, pancreatic ectopic tissue and bezoar were found in our serie. Gastric outlet obstruction (nonbilius emesis) in children is an entity that must be studied with detail through US including the pyloric channel and the gastric antrum. Endoscopy guided biopsy is conclusive in most of the cases avoiding the need for an Upper GI study and, in many cases, the need for a CT scan.

Factores determinantes de la motivación en atletas veteranos españoles / Determinants of motivation in veteran Spanish athletes

El objetivo del presente estudio es conocer motivaciones, ansiedad precompetitiva, adicción al entrenamiento y competición, satisfacción intrínseca, percepción y creencias sobre las causas del éxito en su deporte en una muestra de 401 atletas de pista veteranos (mayores de 35 años) españoles. También, obtener unos modelos predictivos suficientemente sólidos, por sexo, de sus motivaciones atendiendo a estas variables psicológicas. Se partió de la hipótesis de que la motivación intrínseca se podría predecir por valorar alto el placer y la relajación, la orientación hacia la tarea, la diversión y el esfuerzo, así como por una baja valoración en el empleo de técnicas de engaño. La motivación extrínseca se podría predecir por una valoración alta en carencia de control, orientación hacia el ego, diversión y empleo de técnicas de engaño, así como por una baja valoración en la orientación hacia la tarea. La amotivación por valorar alto la ansiedad cognitiva, carencia de control, aburrimiento y empleo de técnicas de engaño, así como por valorar bajo la diversión. Los resultados confirmaron que la motivación más alta es la intrínseca, sobre todo en mujeres. En ambos sexos, la percepción de éxito en el deporte por la tarea fue similar a la dada por el ego; les resultó muy satisfactorio obtener medallas y, mejor aún, récords en su categoría de edad mediante el esfuerzo que implica el dominio de su especialidad, y el uso de técnicas de engaño fue poco importante. Por último, se obtuvieron unos modelos predictores de las motivaciones que concuerdan en gran medida con las hipótesis y referencias.

The aim of this study was to determine the motivations, precompetitive anxiety, addiction to training and competition, intrinsic satisfaction, perceptions and beliefs of the causes of success in their sport in a sample of 401 veteran Spanish track athletes (aged over 35). This study also aimed at obtaining sufficiently solid predictive models - by gender - of their motivations regarding these psychological variables. It starts from the assumption that intrinsic motivation could be predicted by having high values in pleasure and relaxation, an orientation to tasks, fun and effort, as well as low values in the use of techniques of deceit. Extrinsic motivation could be predicted by having high values in lack of control, ego orientation, fun, use of deceit techniques, and low values in task orientation. Amotivation could be predicted by a high value of cognitive anxiety, lack of control, boredom and deception techniques, and low values in fun. The results confirmed that the highest levels of motivation were intrinsic, especially in women. The perception of success in sports by task was similar to ego in both genders, in that it was very satisfactory for them to win medals. Better yet, they obtained records in their age group by the effort involved in the domain of their specialty, but the use of deception techniques was unimportant. Finally, predictive models were obtained from motivations and they agreed to a great extent with the hypothesis and references.

Central Nervous System Complication due to Pernicious Anemia in a Patient with Rheumatoid Arthritis

Pernicious anemia (PA) is an autoimmune disease characterized by atrophic gastritis and deficiency in intrinsic factor leading to impairment of vitamin B12 absorption in the ileum. Anemia is commonly found in rheumatoid arthritis (RA); however, PA is rarely found in RA. There are few reports describing patients with both conditions; none in Korea to date. We report on a case of a 46-year-old female who presented with hypesthesia and general weakness. She was previously diagnosed as seropositive RA with myelodysplastic syndrome. She had severely impaired sensation, especially for vibration and proprioception in all limbs. Subacute combined degeneration was observed on her magnetic resonance imaging and serum vitamin B12 level was very low. Further exam results were consistent with PA and her symptoms improved with cobalamin injection. This case demonstrates that PA should be considered in RA patients presenting with both central nervous system manifestations and anemia.

Frequency of intrinsic factor antibody in megaloblastic anaemia

To evaluate the presence of intrinsic factor antibody in vitamin B12 deficient patients. Cross-sectional, observational study. Fauji Foundation Hospital, Foundation University Medical College and Armed Forces Institute of Pathology, Rawalpindi, from January 2011 to June 2012. A total of 120 patients of megaloblastic anaemia were selected on the basis of low serum vitamin B12 level. The intrinsic factor antibody tests were performed by ELISA method. The patients were considered positive or negative on the basis of presence or absence of intrinsic factor antibody respectively. The data was analyzed by using SPSS version 14. Pernicious anaemia with intrinsic factor deficiency was found in 13.3% in 120 vitamin B12 deficient patients. The mean age of patients of pernicious anaemia was 41.5 years, with a male to female ratio of 1:2.5. It was relatively more common in older age [17% in age more than 60 years] as compared to other age groups. Frequency of pernicious anaemia in megaloblastic anaemia was 13.3%. The male to female ratio was 1:2.5 and it was relatively more common in age group of more than 60 years

Hippophae rhamnoides L. leaves extract enhances cell proliferation and neuroblast differentiation through upregulation of intrinsic factors in the dentate gyrus of the aged gerbil / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hippophae rhamnoides L. (HL) exerts antioxidant activities against various oxidative stress conditions. In this study, we investigated effects of extract from HL leaves (HLE) on cell proliferation and neuroblast differentiation in the subgranular zone (SGZ) of the dentate gyrus (DG) of aged gerbils.</p><p><b>METHODS</b>Aged gerbils (24 months) were divided into vehicle (saline)-treated- and HLE-treated-groups. The vehicle and HLE were orally administered with 200 mg/kg once a day for 20 days before sacrifice. Cell proliferation and neuroblast differentiation were examined in the DG using Ki67 and doublecortin (DCX), respectively. We also observed changes in immunoreactivities of superoxide dismutase 1 (SOD1) and superoxide dismutase 2 (SOD2), brain-derived neurotrophic factor (BDNF), and phospho-glycogen synthase kinase-3-beta (p-GSK-3β) to examine their relation with neurogenesis using immunohistochemistry.</p><p><b>RESULTS</b>The administration of HLE significantly increased the number of Ki67-positive cells and DCX-positive neuroblasts with well-developed processes in the SGZ of the DG of the HLE-treated-group. In addition, immunoreactivities of SOD1, SOD2, BDNF, and p-GSK-3β were significantly increased in granule and polymorphic cells of the DG in the HLE-treated-group compared with those in the vehicle-treated-group.</p><p><b>CONCLUSIONS</b>HLE treatment significantly increased cell proliferation and neuroblast differentiation, showing that immunoreactivities of SOD1, SOD2, BDNF, and p-GSK-3β were significantly increased in the DG. These indicate that increased neuroblast differentiation neurogenesis may be closely related to upregulation of SOD1, SOD2, BDNF, and p-GSK-3β in aged gerbils.</p>

Association between vitamin B12 level and anti-parietal cells and anti-intrinsic factor antibodies among adult Jordanian patients with Helicobacter pylori infection

OBJECTIVE: Evaluate the association of Helicobacter pylori infection with anti-parietal cell antibodies (APCA) and anti-intrinsic factor antibodies (AIFA) and their impact on vitamin B12 serum level. PATIENTS AND METHODS: One hundred patients (M/F: 43/57; age 46.5 ± 17.5 years) who underwent upper gastrointestinal endoscopy at King Abdullah University Hospital, Irbid, Jordan were enrolled in the study. The patients were grouped as H. pylori-infected (n = 81) or H. pylori negative (n = 19) by histopathological examination. Fasting serum vitamin B12 levels, antiparietal cell antibodies and anti-intrinsic factor antibodies for patients and controls were determined. RESULTS: Anti-parietal cell antibodies and anti-intrinsic factor antibodies were positive in 9.9% and 18.5% of H. pylori-positive patients respectively. None of the H. pylori negative subjects had anti-parietal cell antibodies or anti-intrinsic factor antibodies. Serum vitamin B12 level was lower in the H. pylori-infected patients (275 ± 70.4 pg/mL) than in controls (322.9 ± 60.7 pg/mL; p 0.05). H. pylori was positive in 94% of the low-vitamin B12 group compared with 64.6% of the normal-vitamin B12 group (p 0.5). CONCLUSION: Patients with H. pylori infection are more likely to have anti-parietal cell antibodies and anti-intrinsic factor antibodies. There was an association between H. pylori infection and lower vitamin B12 levels. H. pylori infection might be a significant factor in the pathogenesis of autoimmune gastritis.

Prevention and treatment of hallux valgus

In hallux valgus, one of the most common conditions affecting the forefoot, the first metatarsophalangeal joint is progressively subluxed due to lateral deviation of the hallux and medial deviation of the first metatarsal. Patients usually complain of medial prominence pain, commonly referred to as "bunion pain," plantar keratotic lesions, and lesser toe deformities such as hammer toe or claw toe deformities. The etiology of hallux valgus is multifactorial. Narrow high-heeled shoes or excessive weight-bearing have been suggested to be extrinsic factors contributing to the condition, and many other intrinsic factors also exist, such as genetics, ligamentous laxity, metatarsus primus varus, pes planus, functional hallux limitus, sexual dimorphism, age, metatarsal morphology, first-ray hypermobility, and tight Achilles tendon. When we evaluate patients with hallux valgus, careful history taking and meticulous examination are necessary. On the radiographic evaluation, we routinely measure the hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle, which are valuable parameters in decision making for bunion surgery. To prevent the development and progression of hallux valgus, a soft leather shoe with a wide toe box is usually recommended. The use of a toe separator or bunion splint may help in relieving symptoms. The purpose of hallux valgus surgery is to correct the deformity and maintain a biomechanically functional foot. When we decide on an adequate surgical option, we should consider the patient's subjective symptoms, the expectations of the patient, the degree of the de-formity, and the radiographic measurements in order to correct the deformity and prevent complications after surgery.