Comparação do desempenho funcional e parâmetros cinemáticos da marcha em idosos com fragilidade e saudáveis / Comparison of functional performance and kinematic gait parameters in frail and healthy elderly people

Objetivo: Comparar o desempenho funcional e as alterações cinemáticas da marcha em idosos saudáveis e em idosos com manifestações da síndrome da fragilidade, viventes na comunidade. Métodos: Estudo transversal do tipo caso-controle. Participaram do estudo 15 idosos, viventes na comunidade, separados em dois grupos, de acordo com a presença de manifestações de fragilidade: (n = 10) e controle (n = 5). Foram coletados dados sobre desempenho funcional, capacidade aeróbia, presença da síndrome da fragilidade e avaliação cinemática da marcha. Foram utilizados testes como: TC400m, dinamometria e SPPB. Para a análise de dados, foi utilizado o pacote estastístico PASW 18.0 (SPSS inc). Resultados: O tempo no teste de caminhada de 400m foi 11 segundos maior no grupo com sinais de fragilidade (p = 0,03), e a força de preensão palmar foi 25,8% maior no grupo sem fragilidade (p = 0,01). Conclusão: Concluimos que idosos frágeis possuem declínio no desempenho funcional em testes que avaliam a resistência aeróbia e a força muscular.

Objective: To compare functional performance and kinematic gait abnormalities in healthy elderly people and in elderly people with manifestations of the frailty syndrome, living in the community. Methods: A cross-sectional case-control study. Fifteen elderly people, living in the community, participated in the study. They were separated into two groups, according to the presence of manifestations of frailty (n = 10) and control (n = 5). Data on functional performance, aerobic capacity, presence of frailty syndrome, and kinematic gait assessment were collected. Tests, such as: TC400m, dynamometry, and SPPB were used. For data analysis, the statistical package PASW 18.0 (SPSS inc) was used. Results: The time in the 400m walk test was 11 seconds higher in the group with signs of frailty (p = 0.03), and handgrip strength was 25.8% higher in the group without frailty (p = 0.01). Conclusion: We conclude that frail elderly people have a decline in functional performance in tests that assess aerobic resistance and muscle strength.

Oxidative and osmotolerant effects in Salvator merianae (Squamata: Teiidae) red blood cells during hibernation

Abstract Hibernation is a natural condition of animals that lives in the temperate zone, although some tropical lizards also experience hibernation annually, such as the lizard native from South America, Salvator merianae, or tegu lizard. Even though physiological and metabolic characteristic associated with hibernation have been extensively studied, possible alterations in the red blood cells (RBC) integrity during this period remains unclear. Dehydration and fasting are natural consequences of hibernating for several months and it could be related to some cellular modifications. In this study, we investigated if the osmotic tolerance of RBCs of tegu lizard under hibernation is different from the cells obtained from animals while normal activity. Additionally, we indirectly investigated if the RBCs membrane of hibernating tegus could be associated with oxidation by quantifying oxidized biomolecules and the activity of antioxidant enzymes. Our findings suggest that RBCs are more fragile during the hibernation period, although we did not find evidence of an oxidative stress scenario associated with the accentuated fragility. Even though we did not exclude the possibility of oxidative damage during hibernation, we suggested that an increased RBCs volume as a consequence of hypoosmotic blood during hibernation could also affect RBCs integrity as noted.

Resumo A hibernação é uma condição natural dos animais que vivem na zona temperada, embora alguns lagartos tropicais também experenciem hibernação anualmente, como é o caso do lagarto nativo da América do Sul, Salvator merianae ou teiú. Embora as características fisiológicas e metabólicas associadas à hibernação tenham sido amplamente estudadas, possíveis alterações na integridade das hemácias durante esse período ainda permanecem obscuras. A desidratação e o jejum são consequências naturais da hibernação por vários meses e podem estar relacionadas a algumas modificações celulares. Neste estudo, investigamos se a tolerância osmótica de hemácias do lagarto teiú sob hibernação são diferentes das células obtidas de animais em atividade normal. Além disso, investigamos indiretamente por meio da quantificação de biomoléculas oxidadas e da atividade de enzimas antioxidantes se a membrana das hemácias dos teiús em hibernação poderia estar associada à oxidação. Nossos resultados sugerem que as hemácias possuem maior fragilidade durante o período de hibernação, embora não tenhamos encontrado evidências de um cenário de estresse oxidativo associado à essa fragilidade acentuada. Embora não tenhamos excluído a possibilidade de dano oxidativo durante a hibernação, sugerimos que um aumento no volume das hemácias como consequência de sangue hipoosmótico durante a hibernação também poderia afetar a integridade de hemácias, tal como foi observado.

Oxidative and osmotolerant effects in Salvator merianae (Squamata: Teiidae) red blood cells during hibernation / Efeitos de oxidação e osmotolerância dos eritrócitos de Salvator merianae (Squamata: Teiidae) durante a hibernação

Abstract Hibernation is a natural condition of animals that lives in the temperate zone, although some tropical lizards also experience hibernation annually, such as the lizard native from South America, Salvator merianae, or "tegu" lizard. Even though physiological and metabolic characteristic associated with hibernation have been extensively studied, possible alterations in the red blood cells (RBC) integrity during this period remains unclear. Dehydration and fasting are natural consequences of hibernating for several months and it could be related to some cellular modifications. In this study, we investigated if the osmotic tolerance of RBCs of tegu lizard under hibernation is different from the cells obtained from animals while normal activity. Additionally, we indirectly investigated if the RBCs membrane of hibernating tegus could be associated with oxidation by quantifying oxidized biomolecules and the activity of antioxidant enzymes. Our findings suggest that RBCs are more fragile during the hibernation period, although we did not find evidence of an oxidative stress scenario associated with the accentuated fragility. Even though we did not exclude the possibility of oxidative damage during hibernation, we suggested that an increased RBCs volume as a consequence of hypoosmotic blood during hibernation could also affect RBCs integrity as noted.

Resumo A hibernação é uma condição natural dos animais que vivem na zona temperada, embora alguns lagartos tropicais também experenciem hibernação anualmente, como é o caso do lagarto nativo da América do Sul, Salvator merianae ou "teiú". Embora as características fisiológicas e metabólicas associadas à hibernação tenham sido amplamente estudadas, possíveis alterações na integridade das hemácias durante esse período ainda permanecem obscuras. A desidratação e o jejum são consequências naturais da hibernação por vários meses e podem estar relacionadas a algumas modificações celulares. Neste estudo, investigamos se a tolerância osmótica de hemácias do lagarto teiú sob hibernação são diferentes das células obtidas de animais em atividade normal. Além disso, investigamos indiretamente por meio da quantificação de biomoléculas oxidadas e da atividade de enzimas antioxidantes se a membrana das hemácias dos teiús em hibernação poderia estar associada à oxidação. Nossos resultados sugerem que as hemácias possuem maior fragilidade durante o período de hibernação, embora não tenhamos encontrado evidências de um cenário de estresse oxidativo associado à essa fragilidade acentuada. Embora não tenhamos excluído a possibilidade de dano oxidativo durante a hibernação, sugerimos que um aumento no volume das hemácias como consequência de sangue hipoosmótico durante a hibernação também poderia afetar a integridade de hemácias, tal como foi observado.

Robustness assessment of cardiovascular meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To evaluate the robustness of cardiovascular meta-analysis with use of fragility index. Methods     By searching PubMed, EMbase, and Web of Science databases from 2018 to 2022, relevant literature on cardiovascular meta-analysis was systematically collected and the fragility indexes were calculated; Spearman correlation analysis was used to explore the relationship between fragility index and sample size, total number of events, effect size and its confidence interval width. Results     A total of 212 meta-analyses from 29 articles were included, with a median fragility index of 11 (5, 25), a median sample size of 10 301 (3 384, 48 330), and a median total number of events of 360 (129, 1 309). Most meta-analyses chose relative risk as the effect measure (179/212), and chose Mantel-Haenszel method (102/212) and random effects model (153/212). The fragility index was positively correlated with the sample size (rs=0.56, P<0.05) and the total number of events (rs=0.61, P<0.05), and negatively correlated with confidence interval width of the effect size (rs=−0.52, P<0.05). No statistically significant results were obtained in the correlation between the fragility index and effect size. Conclusion     The fragility indexes of cardiovascular meta-analyses published in comprehensive journals of high impact factors and professional cardiovascular journals are generally low, and therefore lack robustness. Fragility index is suggested to be reported in medical researches, assisting in explaining the P-value.

A comparison of complication rates between early and delayed surgery among Filipino patients with fragility fractures of the hip

Objectives@#Existing standards of care recommend operative management for fragility fractures of the hip. Early intervention has been associated with lower incidence of morbidity and mortality. A lack of consensus remains in the Philippines however, regarding timing of surgery. We sought to determine the effects of surgical timing on in-hospital complications among Filipino patients with fragility hip fractures.@*Methods@#All patients admitted for fragility hip fractures in a single tertiary-care facility from 2014-2016 were analyzed retrospectively. Subjects treated within 72 hours were grouped under “early intervention,” while those managed beyond were designated “delayed intervention.” Primary outcomes were complications during admission, while secondary outcome was length of hospital stay. A total of 96 patients met our inclusion criteria, of which 41 (42.71%) underwent early intervention. Baseline characteristics for both groups were comparable.@*Results@#A significantly lower incidence of pressure ulcers (2.4% for ≤72hours vs 45.5%; p=<0.0001), pneumonia (7.32% vs 47.27%; p=<0.0001), and urinary tract infection (4.88% vs 40%; p=<0.0001), as well as shorter hospital stay (mean: 8.85 days±5.4 vs 14.6 days±13.3; p=0.01) were seen in the early intervention group. More cases of documented deep vein thrombosis were recorded in the delayed intervention group (83.3% versus 16.6%), as was the only case of in-hospital mortality. @*Conclusion@#Early intervention showed a significantly lower incidence of in-hospital complications among patients with fragility fractures of the hip, suggesting that surgery within 72 hours may lead to better outcomes by helping to reduce the incidence of pressure sores, pneumonia, and urinary tract infection among Filipinos with hip fractures, while reducing length of admission.

Differential Analysis of Erythrocyte Flexibility of PbK173 Artemisinin-sensitive Strains / 中国实验方剂学杂志

ObjectiveTo detect the flexibility differences of Plasmodium berghei K173 （PbK173）-infected red blood cells with varying degrees of sensitivity to artemisinin-based drugs and to preliminarily explore the underlying mechanisms of the differences. MethodA total of 102 specific-pathogen-free （SPF） male C57BL/6 mice were randomly divided into three groups， with 30 mice each in the control group and PbK173-resistant （PbK173-R） group， and 42 mice in the PbK173-sensitive （PbK173-S） group. Except for the control group， the rest groups were vaccinated with 1×107 PbK173-S/PbK173-R infected red blood cells to establish a mouse malaria model. During the administration and recovery periods （control group， PbK173-R/PbK173-S）， dihydroartemisinin （DHA， 40 mg·kg-1） and malaridine （MD， 6 mg·kg-1） were administered continuously for four days. Peripheral blood was taken from the PbK173-S/PbK173-R groups with an infection rate equal to or greater than 20%. Peripheral blood and each organ were taken on the first day at the end of administration （dosing period） and on the fifth day at the end of administration （recovery period）， and blood parameters and organ indices of each group were examined. The osmotic fragility of peripheral blood red blood cells in each group was detected using the red blood cell osmotic fragility test. Western blot was applied to determine the levels of Piezo1 and Band3 proteins in the red blood cell membrane. ResultDuring the administration and recovery periods， there were no significant differences between the PbK173-S MD group and the DHA group. During the administration period， there were no significant differences in hematological parameters between PbK173-S and PbK173-R in the MD group. However， during the recovery period， the red blood cell count， hemoglobin concentration and hematocrit of the PbK173-R group were significantly higher than those of the PbK173-S group （P<0.05） in the MD group. Compared with that of the control group， the osmotic fragility of the PbK173-S/PbK173-R groups was significantly enhanced （P<0.01）， and the osmotic fragility of the PbK173-S group was significantly stronger than that of the PbK173-R group （P<0.01）. The osmotic fragility of red blood cells in the PbK173-S group during the administration period was significantly stronger than that in the control group and PbK173-R group during the administration period （P<0.01）. The osmotic fragility of red blood cells in the PbK173-R group during the recovery period was significantly higher than that in the control group during the administration period and the PbK173-S group during the recovery period （P<0.05）. Compared with those in the control group， the Piezo1 protein and Band3 protein in the red blood cell membrane of the PbK173-S group were significantly reduced （P<0.01）. Compared with those in the PbK173-R group， the Piezo1 protein and Band 3 protein in the red blood cell membrane of the PbK173-S group were significantly reduced. ConclusionThe flexibility of PbK173-infected red blood cells with different sensitivities to artemisinins differed. Plasmodium-infected red blood cells significantly reduced the levels of Piezo1 and Band3 proteins in the red blood cell membrane， and the erythrocyte flexibility exhibited a decreasing trend in the following order： normal group， PbK173-R group， and PbK173-S group.

Hemophagocytic syndrome in a patient with Fanconi anemia and VACTERL association / Síndrome hemofagocítica em paciente com anemia de Fanconi e associação VACTERL

INTRODUCTION: Hemophagocytic syndrome results from hyperactivity of histiocytes and lymphocytes, triggered by infections, mainly viral by cytomegalovirus, Epstein-Barr and herpes. Fanconi anemia (FA) is a rare genetic disease with heterogeneous symptoms common to other diseases such as VACTERL, a disease of unknown etiology in which there are several congenital malformations. The concomitance of Fanconi and VACTERL anemia occurs in 5 to 30% of FA patients. REPORT: A 14-month-old male infant was admitted to investigate fever, hepatosplenomegaly, and granulopenia. The patient was diagnosed with hemophagocytic syndrome due to hyperferritinemia, bone marrow hemophagocytosis, transaminase elevation, decreased fibrinogen, and cytomegalovirus (CMV) infection confirmed by serology and PCR. The test with mitomycin C (MMC) showed chromosomal fragility. The patient was diagnosed with a VACTERL/FA association for having a clinic and a test compatible with both FA and VACTERL. CONCLUSION: The VACTERL/FA association is seldom described, but is present in pediatric medical practice. This study presented the main clinical-laboratory aspects and reviewed the main aspects of the concurrence of this pathology.

INTRODUÇÃO: A síndrome hemofagocítica decorre da hiperatividade de histiócitos e linfócitos e é desencadeada por infeções, principalmente virais por citomegalovírus, Epstein-barr e herpes. A anemia de Fanconi (AF) é uma doença genética rara com sintomas heterogêneos em comum a outras doenças como a associação VACTERL, uma doença de etiologia desconhecida na qual existe diversas mal formações congênitas. A concomitância da anemia de Fanconi e VACTERL é descrita em 5 a 30% dos pacientes AF. RELATO: Lactente de 14 meses, sexo masculino, admitido para investigar um quadro de febre, hepatoesplenomegalia e granulopenia. Os exames laboratoriais mostraram a hiperferritemia, elevação da transaminases, medula óssea com hemofagocitose e, sorologia e PCR positivos para citomegalovírus (CMV). O paciente foi diagnosticado com síndrome hemofagocítica por citomegalovírus. Como havia também hipoplasia do polegar esquerdo, presença de hemivértebra, agenesia renal e teste positivo de fragilidades cromossômicas com mitomicina C (MMC), o paciente foi diagnosticado com associação VACTERL/AF. CONCLUSÃO: O citomegalovírus quando infecta pacientes com problemas de imunidade como AF, apresenta risco de desencadear a síndrome hemofagocítica. A associação VACTERL/AF é pouco descrita, mas presente na prática médica da pediatria. Esse estudo descreveu os principais aspectos clínicos-laboratoriais e revisou os aspectos fundamenais descritos sobre a concomitância dessas patologias.

Analysis of neural fragility in epileptic zone based on stereoelectroencephalography / 生物医学工程学杂志

There are some limitations in the localization of epileptogenic zone commonly used by human eyes to identify abnormal discharges of intracranial electroencephalography in epilepsy. However, at present, the accuracy of the localization of epileptogenic zone by extracting intracranial electroencephalography features needs to be further improved. As a new method using dynamic network model, neural fragility has potential application value in the localization of epileptogenic zone. In this paper, the neural fragility analysis method was used to analyze the stereoelectroencephalography signals of 35 seizures in 20 patients, and then the epileptogenic zone electrodes were classified using the random forest model, and the classification results were compared with the time-frequency characteristics of six different frequency bands extracted by short-time Fourier transform. The results showed that the area under curve (AUC) of epileptic focus electrodes based on time-frequency analysis was 0.870 (delta) to 0.956 (high gamma), and its classification accuracy increased with the increase of frequency band, while the AUC by using neural fragility could reach 0.957. After fusing the neural fragility and the time-frequency characteristics of the γ and high γ band, the AUC could be further increased to 0.969, which was improved on the original basis. This paper verifies the effectiveness of neural fragility in identifying epileptogenic zone, and provides a theoretical reference for its further clinical application.

Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition

INTRODUCTION@#The growing years are paramount for bone growth and mineral accrual. Children with long-term neurological condition (LTNC) have multiple risk factors for poor bone health and fragility fractures. In Singapore, this has not been studied systematically. Therefore, we aimed to evaluate the risk factors associated with fragility fractures in children with LTNC.@*METHODS@#In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC on follow-up in the paediatric neurology clinic and patients who presented with fracture to the paediatric orthopaedic clinic. Information on patients' demographics, medical history, intervention, biochemical bone markers and fracture history was collected.@*RESULTS@#In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (Gross Motor Function Classification System [GMFCS] V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or were on oral pureed diet. Furthermore, 60% were on anticonvulsants. The fracture rate was 3% in this population and was associated with low-impact activities such as transfer and dressing. Only 7.4% and 33% of the patients had undergone measurements of vitamin D and calcium levels, respectively.@*CONCLUSION@#The local prevalence of fragility fractures in children with LTNC on follow-up at the neurology clinic was found to be 3%. Risk factors identified were limited ambulation and compromised nutritional status associated with feeding difficulty. Recommendations to optimise bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight children, avoiding vitamin D deficiency and ensuring adequate calcium intake.

Fracture Liaison Service and Its Role in Secondary Fracture Prevention in Malaysia: A Scoping Review

@#Introduction: Fragility fractures, which occur after a lowtrauma injury, increases with advancing age. Such fracture doubles the life-time risk of sustaining another fracture. This risk is highest in the immediate 18 months after the index fracture. However, most patients do not receive the appropriate risk assessment and intervention to reduce this risk. A coordinated model of care termed Fracture Liaison Service (FLS) has been reported to address this treatment gap. Materials and methods: This scoping review aims to explore the potential role and delivery of FLS services in Malaysia. Scientific and non-scientific sources relevant to FLS were identified from electronic bibliographic databases, specialist journals and relevant websites. Findings were categorised into themes and presented narratively. Results: FLS services remain concentrated in the Klang Valley. Even within FLS services, many do not have extensive coverage to risk assess all fracture patients. These services are multidisciplinary in nature where there are links between different departments, such as orthopaedics, osteoporosis expertise, bone densitometry, rehabilitation, falls services and primary care. FLS was able to increase the number of people undergoing fracture risk assessment and treatment. The importance of FLS was highlighted by local experts and stakeholders. Its implementation and delivery are supported by a number of national guidelines. Conclusion: FLS is central to our national efforts to reduce the impending fragility fracture crisis in the coming years. Continued effort is needed to increase coverage within FLS services and across the country. Training, awareness of the problem, research, and policy change will support this endeavour.

Effect of exercise under blood flow restriction on risk of fragility fractures in postmenopausal patients with chronic obstructive pulmonary disease / 中国康复理论与实践

ObjectiveTo explore the effect of blood flow restriction (BFR)-based aerobic exercise and low-intensity resistance program on bone strength, hormone secretion, lung function and exercise capacity in postmenopausal patients with chronic obstructive pulmonary disease (COPD), to relieve the risk of fragility fractures and mortality. MethodsFrom June, 2020 to January, 2021, 67 postmenopausal patients with COPD were selected from seven community hospitals such as Chongqing Yuxi Hospital, etc. The patients were randomly divided into control group (n = 33) and experimental group (n = 34). Both groups received conventional treatment and implemented a pulmonary rehabilitation program consisting of aerobic exercise and low-intensity resistance, while the experimental group finished the low-intensity resistance under BFR, for 24 weeks. Before and after intervention, the femoral neck bone mineral density (BMD) was measured with dual-energy X-ray; the interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), 25-hydroxyvitamin D3 [25(OH)D3], estradiol (E2), bone-specific alkaline phosphatase (BALP), tartrate-resistant acid phosphatase (TRACP), osteocalcin (BGP), β-I collagen cross-linked C-terminal peptide (β-CTX), growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels were measured with ELISA; the forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) were measured with lung function test; the maximum oxygen uptake (VO2max) and anaerobic threshold (AT) were measured with cardiopulmonary exercise test; the body mass index (BMI) and muscle mass were measured with bioelectrical impedance; the peak torque of knee flexion and extension, and fatigue index were measured with isokinetic muscle strength test; and they were also assessed with distance of 6-minute walk test (6MWT), modified Falls Efficacy Scale (MFES), Timed Up and Go Test (TUGT), and Tinetti Performance Oriented Mobility Assessment (Tinetti). ResultsFour cases dropped down in the control group, and five in the experimental group. All the indexes improved in the experimental group after intervention (|t| > 2.208, P < 0.05), and most of the indexes improved in the control group (|t| > 2.052, P < 0.05); while the E2, GH, IGF-1, IL-6, TNF-α, TRACP, β-CTX, BALP, FEV1, AT, distance of 6MWT, muscle mass, peak torque of knee flexion and extension, fatigue index, time of TUGT, and scores of Tinetti and MFES were better in the experimental group than in the control group (|t| > 2.141, P < 0.05). ConclusionExercise under BFR may improve the bone strength, lung function, estrogen secretion and exercise ability of postmenopausal patients with COPD, which may help to relieve the risk of fragility fractures.

Case-control study on fragility fractures in coal miners: A comparison between surface and underground workers / 环境与职业医学

Background The prevalence of osteoporosis and osteopenia is higher among underground coal miners than surface workers. The special underground work environment and unhealthy habits such as smoking, drinking, and a high-salt diet may lead to changes in bone metabolism, increasing the risk of fragility fractures and placing a heavy economic burden on individuals and society. Objective To identify potential factors influencing fragility fractures among coal miners in different working environments and to provide a basis for targeted preventive measures to reduce the occurrence of fragility fractures. Methods Male participants who attended at least one of the physical examinations in Kailuan Group between June 2006 and December 2020 were included in the study. The participants were divided into two groups based on their working environment: surface or underground. A case-control study was conducted, where patients with new fragility fractures served as the case group and participants without fragility fractures served as the control group. The two groups were matched with a case:control ratio of 1:4 by age (±1 year) and the same year of physical examination. The matching process was repeated twice, once for the surface working population and once for the underground working population. The analysis of risk factors was conducted using conditional logistic regression models. Results Among a total of 113138 employees in Kailuan Group, 82631 surface workers and 30507 underground workers were included, respectively. The number of individuals who suffered fragility fractures was 1375, accounting for 1.22% of the total population. The incidence of fragility fractures in underground workers was significantly higher than that in surface workers (1.63%>1.07%, P<0.001). The results of conditional logistic regression model showed that current smoking (OR=1.26, 95%CI: 1.05, 1.51), manual labor (OR=1.37, 95%CI: 1.06, 1.78), diabetes (OR=1.26, 95%CI: 1.04, 1.54), sinus tachycardia (OR=1.81, 95%CI: 1.23, 2.66), history of stroke (OR=1.51, 95%CI: 1.09, 2.09), education at college and above (OR=0.65, 95%CI: 0.45, 0.95), high income level (OR=0.69, 95%CI: 0.54, 0.90), elevated hemoglobin (OR=0.91, 95%CI: 0.85, 0.98), and elevated total cholesterol (OR=0.90, 95%CI: 0.82, 0.99) were associated with fragility fractures in the surface working population of coal mines; current smoking (OR=1.48, 95%CI: 1.17, 1.87), current drinking (OR=1.26, 95%CI: 1.01, 1.56), manual labor (OR=2.64, 95%CI: 1.41, 4.94), history of dust exposure (OR=1.28, 95%CI: 1.03, 1.58), and obesity (OR=0.72, 95%CI: 0.52, 0.96) were associated with fragility fractures in the underground working population of coal mines. Conclusion In preventing fragility fractures, special attention should be paid to the bone health of underground workers engaged in manual labor or having a history of dust exposure. It is important to correct their unhealthy behaviors in a timely manner, such as smoking and drinking, and to appropriately increase body weight to prevent fragility fractures. For surface workers, particular attention should be given to the high-risk group for fragility fractures, such as low family income per capita, manual labor, and having a history of stroke or diabetes; in addition, close monitoring of their resting heart rate, hemoglobin levels, and total cholesterol levels may help prevent fragility fractures.

A description of the risk factors related to fragility fractures in adults and their associated costs

Objective: to identify bone fragility risk factors associated with increased total fracture care costs at a clinic in Medellín, Colombia. Design: an observational study with retrospective and prospective measurements taken from the medical charts of patients admitted for fractures and followed until discharge. Frame of reference: Hospital Alma Mater de Antioquia, Medellín, Colombia. Participants: four hundred fifty-two patients diagnosed with fragility fractures on admission. Main measurements: the prevalence of bone fragility risk factors, a description of the total care cost by risk factor and an estimate of the association between the risk factors and total costs. Results: Diabetes (24.3%) and active or passive smoking (21%) were the most prevalent fragility risk factors. Hip fractures were the most frequent and costly (36%, Md: COP 7,882,579). Fracture care was more costly for active or passive smokers (Md: COP 7,484,185), and those 75 years old or older (Md: COP7,057,678). According to the significant adjusted estimates (p<0.05), the median cost for active or passive smokers exceeds that of nonsmokers by more than COP 2,300,000, and every year of age increases the median cost by more than COP 90,000. Conclusions: this study emphasized that bone fragility is a public health problem. Factors like active or passive smoking and age were found to increase fragility fracture care costs, implying more complications and need for services. This adds to the evidence for strengthening monitoring programs to reduce the morbidity, mortality and direct costs of this disease in Colombia. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2351).

Objetivo: identificar factores de riesgo de fragilidad ósea asociados al aumento de costos totales de atención de fracturas en una clínica de Medellín, Colombia. Diseño: estudio observacional con medidas retrospectivas y prospectivas tomadas de la historia clínica de pacientes atendidos por fractura y seguidos hasta su egreso. Marco de referencia: Hospital Alma Máter de Antioquia, Medellín, Colombia. Participantes: cuatrocientos cincuenta y dos pacientes diagnosticados con fracturas por fragi lidad al ingreso. Mediciones principales: prevalencia de factores de riesgo de fragilidad ósea, descripción de costos totales de atención según factores de riesgo, y estimación de asociaciones entre factores de riesgo y costos totales. Resultados: diabetes (24.3%) y tabaquismo activo o pasivo (21%) fueron los factores de riesgo de fragilidad más prevalentes. Las fracturas de cadera fueron las más frecuentes y costosas (36%, Md: COP7 882 579). La atención de fracturas fue más costosa para pacientes fumadores activos o pasivos (Md: COP7 484 185), y de 75 años o más (Md: COP7 057 678). Según las estimaciones ajustadas significativas (p<0.05), los fumadores activos o pasivos tienen una mediana de costos de más de COP2 300 000 mayor que la de no fumadores, y cada año de edad incrementa la mediana de costos más de COP90 000. Conclusiones: este estudio enfatizó que la fragilidad ósea es un problema de salud pública. Se identificó que factores como fumar activa o pasivamente, y la edad aumenta los costos de atención de fractura por fragilidad implicando mayores complicaciones y necesidad de servicios. Esto añade a la evidencia para fortalecer los programas de vigilancia que reduzcan la morbimortalidad y costos directos de esta enfermedad en Colombia. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2351).

Is Frailty Syndrome a Predictor of Morbimortality in Postoperative Cardiac Surgery? - A Retrospective Cohort Study

Abstract Background Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age. Objective To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery. Methods A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted. Results The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015). Conclusions Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.

Complicaciones quirúrgicas infecciosas en adultos mayores tras cirugía abdominal de urgencia

Introducción: En la actualidad el aumento de la población envejecida, asociado al desarrollo de la anestesiología, la cirugía y los cuidados intensivos ha generado un incremento del número de adultos mayores con abdomen agudo, que requieren tratamiento quirúrgico con urgencia, no exentos de complicaciones. Se realizó una revisión en bases de datos bibliográficas y se seleccionaron 25 documentos en idioma inglés y español. Objetivo: Analizar las características esenciales que identifican a los pacientes adultos mayores con complicaciones quirúrgicas infecciosas tras cirugía abdominal de urgencia. Desarrollo: En el plano biológico suceden cambios por reducción de la reserva fisiológica del adulto mayor: respiratorios, cardiovasculares, genitourinarios, digestivos, endocrino-metabólicos y del equilibrio ácido-base, que los hacen vulnerables al estrés quirúrgico. Las complicaciones posoperatorias constituyen un importante indicador de calidad: retardan la evolución de la enfermedad, prolongan la estadía hospitalaria e incrementan los índices de morbilidad y mortalidad de modo significativo en enfermos de este grupo etario. Conclusiones: A pesar del aumento del número de adultos mayores con abdomen agudo que requieren tratamiento quirúrgico con urgencia, la edad no debe considerarse como una limitante para efectuar la operación. Además del tratamiento específico y preventivo de las complicaciones tras cirugía abdominal de urgencia, las comorbilidades y la fragilidad presentes en estos pacientes requieren adecuada compensación preoperatoria, operatoria y posoperatoria, a fin de garantizar la evolución satisfactoria de estos enfermos.

Introduction: Currently, the increase in the aging population associated with the development of anesthesiology, surgery and intensive care has generated an increase in the number of older adults with acute abdomen requiring urgent surgical treatment. A review was carried out in bibliographic databases, and 25 documents were selected in English and Spanish. Objective: To analyze the clinical, epidemiological and therapeutic characteristics that identify older adult patients with infectious surgical complications after emergency abdominal surgery. Development: At the biological level, changes occur due to the reduction of the physiological reserve of the elderly: respiratory, cardiovascular, genitourinary, digestive, endocrine-metabolic and acid-base balance that makes them vulnerable to surgical stress. Postoperative complications are an important indicator of quality: they delay the evolution of the disease, prolong hospital stay and significantly increase morbidity and mortality rates in patients of this age group. Conclusions: Despite the increase in the number of older adults with acute abdomen who require urgent surgical treatment, age should not be considered as a limitation to perform the operation. In addition to the specific and preventive treatment of complications after emergency abdominal surgery, the comorbidities and frailty present in these patients require adequate preoperative, operative and postoperative compensation, in order to guarantee the satisfactory evolution of these patients.

Perfil de morbidade no primeiro ano de vida entre recém-nascidos de alto risco / Morbidity profile in the first year of life among high-risk newborns

Os cuidados destinados aos recém-nascidos prematuros extremos têm propiciado importantes resultados na sobrevida dessas crianças. Objetivo: Caracterizar o perfil de morbidade no primeiro ano de vida entre recémnascidos de alto risco. Materiais e Métodos: Trata-se de uma pesquisa exploratória realizada no ambulatório de seguimento de recém-nascidos de alto risco do norte de Minas Gerais. A coleta de dados foi referente às admissões no período de março de 2014 a abril de 2015. O instrumento contemplava características: demográficas, sociais, condições de gestação e parto, intercorrências no pós-parto e condições de saúde das crianças acompanhadas ao longo do primeiro ano de vida. Realizou-se a análise estatística descritiva e o teste Qui-Quadrado, assumindo-se um nível de significância de 5% para comparação da distribuição das morbidades por faixas de peso. Resultados: Participaram deste estudo 282 recém-nascidos, sendo 53,9% do sexo masculino. Entre as mães, 58,2% era multípara e 35,8% hipertensas. Em relação ao peso de nascimento, 59,6% dos recém-nascidos acompanhados pesaram menos de 1500 gramas. As principais morbidades identificadas no primeiro ano de vida foram atraso do desenvolvimento neuro-psicomotor, infecções de vias aéreas superiores, as alterações neurológicas e as afecções respiratórias crônicas. Foram registradas diferenças estatisticamente significantes para o atraso do desenvolvimento neuro-psico-motor (p<0,001), intercorrências neurológicas (p=0,008) e episódios de diarreia (p=0,047), entre as faixas de peso de nascimento. Conclusão: A assistência ambulatorial para o recém-nascido prematuro de alto risco contribui para a identificação e a prevenção de doenças recorrentes nessa população(AU)

Introduction: Care for extremely premature newborns has provided important results in the survival of these children. Objective: To characterize the morbidity profile in the first year of life among high-risk newborns. Materials and Method: This is an exploratory research carried out at the follow-up clinic for high-risk newborns in the north of Minas Gerais. Data collection referred to admissions in the period from March 2014 to April 2015. The instrument included characteristics: demographic, social, pregnancy and delivery conditions, postpartum complications and health conditions of children monitored during the first year of life. Descriptive statistical analysis and the chisquare test were performed, assuming a significance level of 5% to compare the distribution of morbidities by weight range. Results: A total of 282 newborns participated in this study, 53.9% of whom were male. Among the mothers, 58.2% were multiparous and 35.8% were hypertensive. Regarding birth weight, 59.6% of newborns monitored weighed less than 1500 grams. The main morbidities identified in the first year of life were delayed neuro-psycho-motor development, upper airway infections, neurological disorders and chronic respiratory conditions. Statistically significant differences were recorded for delayed neuro-psycho-motor development (p<0.001), neurological complications (p=0.008) and episodes of diarrhea (p=0.047), between birth weight ranges. Conclusion: Outpatient care for high-risk premature newborns contributes to the identification and prevention of recurrent diseases in this population(AU)

A case report of hereditary spherocytosis (HS): Approach to diagnosis and management of HS

Hereditary spherocytosis (HS) is a type of congenital hemolytic anemia, in which heterogeneous alterations in one of the six genes that encode for proteins involved in vertical associations which tie the red blood cell (RBC) membrane skeleton to the lipid bilayer causes dysfunction or deficiency of cell membrane protein resulting in spherical-shaped, hyper-dense, and poorly deformable RBCs with a shortened life span. We report a case of HS in a 2-month-old female who presented with severe anemia, jaundice, and hepatosplenomegaly. The peripheral blood smear showed spherocytosis and reticulocytosis. The osmotic fragility was positive and direct antiglobin test was negative. The osmotic fragility test and direct antiglobulin test were positive. She was managed with packed RBCs (PRBCs) transfusion and folic acid supplementation

Factors affecting mortality in nonagenarian population following surgery for fragility hip fractures: An experience from a tertiary level trauma center in India

Introduction: Fragility hip fractures in nonagenarian patients pose a great challenge in management. To the best of our knowledge, no study has previously evaluated the outcomes and risk factors for mortality after hip fractures in this subgroup of population from the Indian subcontinent. Materials and Methods: A retrospective observational study was performed on nonagenarian patients (aged ?90) who underwent surgery for hip fractures between March 2016 and March 2019. The patients were divided into two groups: “survivor group” (Group A) and “mortality group” (Group B). The demographic data, type of fracture, side of fractured limb, preinjury ambulatory status, American Society of Anesthesiologists (ASA) status, comorbidities, time interval from injury to surgery, operative time, length of hospital stay, and postoperative ambulatory status were recorded from hospital medical records and were studied between the two groups. The follow-up duration of the study was 1 year. Results: Thirty-four patients were included in the study. Both the groups had 17 patients each. Cardiac dysfunction was the most common cause of mortality. The time interval from injury to surgery (odds ratio [OR] = 11.2), gender (OR = 0.23) and postoperative mobility status (OR = 0.07) were found to be significantly different between the two groups. No significant difference in ASA grade, comorbidities, fracture type, preinjury ambulatory status, operative time, and length of hospital stay was seen between the two groups. Conclusions: Risk factors for mortality after hip fracture surgery in the nonagenarian population are male gender, delay in surgery (>3 days) and poor ambulatory status in the postoperative period. Hence, the aim for such patients with hip fractures should be to perform an early surgery and encourage an early ambulation.

Aplicación de indicadores ambientales para la planificación del uso del suelo en una zona costera de Buenos Aires, Argentina / Application of environmental indicators for land use planning in a coastal area of Buenos Aires, Argentina

RESUMEN El objetivo de este trabajo fue aplicar indicadores e índices ambientales en una zona costera localizada en el noreste de la provincia de Buenos Aires (Argentina). El área de estudio se ubica en el sector de la planicie costera del Río de la Plata, correspondiente al partido de Ensenada. La misma es un área con alto valor para la biodiversidad regional y brinda numerosos servicios ecosistémicos. Además, está expuesta de manera recurrente a inundaciones y anegamientos, los cuales, determinan fuertes condicionantes para el uso del suelo. Se identificaron y seleccionaron indicadores que aportan información sobre características estructurales y funcionales del medio natural, respecto de su fragilidad frente a intervenciones, a partir de los criterios: vulnerabilidad natural, valor patrimonial y condicionamientos naturales frente a intervenciones antrópicas; estos indicadores fueron integrados para obtener un Índice de Fragilidad Natural Territorial (IFNT). Se generaron mapas temáticos de índices parciales y un mapa final correspondiente al IFNT, mediante el uso de Sistemas de Información Geográfica (SIG). Los resultados obtenidos establecen que el 15,1 % de la superficie del partido presenta una fragilidad natural entre muy alta (2,1 %) y alta (13 %) y un 20,2 %, con valores medios, asociados a ambientes de escasa pendiente del centro, W y E-SE del territorio, así como al sector más próximo a la ribera rioplatense, donde se asientan áreas urbanas. Se observó tendencia de crecimiento urbano avanzando sobre sectores identificados con fragilidad entre muy alta y media. Este índice se considera una herramienta útil para la planificación territorial sostenible.

ABSTRACT The objective of this paper was to apply environmental indicators and indexes in a coastal area located in the northeastern province of Buenos Aires (Argentina). The study area is located in the sector of the coastal plain of the Río de la Plata corresponding to the Ensenada district. It is an area of high regional biodiversity value and provides numerous ecosystem services. In addition, it is exposed to frequent flood events and waterlogged soils, which determines strong conditioning factors for land use. In this paper, the application of environmental indicators and indexes developed ad hoc is presented in order to assist in the sustainable land use planning of the territory. Indicators were identified and selected to provide information on structural and functional characteristics of the natural environment regarding its fragility in front of anthropic interventions. These indicators were made following these selection criteria: natural vulnerability, patrimonial value and natural conditioning to anthropic interventions. These indicators were integrated to obtain a Natural Territorial Fragility Index (NTFI). Thematic maps of intermediate indexes were generated, as well as a final map corresponding to the NTFI, integrated in a GIS. The results obtained from the NTFI calculation establish that 15,1 % of the area of the district presents a natural fragility with values very high (2,1 %) and high (13 %) and 20,2 % medium value. In the center, W and E-SE of the territory, as well as in the sector closest to the rioplatense riverbank, the NTFI presents very high to medium values mainly associated with low slope environments. Urban areas are developed in this location. There is an urban growth trend advancing on sectors identified with very high to moderate fragility. This index is considered a useful tool for sustainable territorial planning.