Acute pancreatitis as first presentation of primary hyperparathyroidism: an observational study attertiary care centreJammu and Kashmir, India

Metabolic causes of acute pancreatitis though uncommon, are important as early recognition helps in the management and prevention of recurrent episodes. Among the uncommon etiologies, Primary hyperparathyroidism (PHPT) is one of the important causes of acute pancreatitis. We studied nine patients with acute or recurrent acute pancreatitis with etiology of PHPT. All patients had elevated serum calcium on admission and high levels of circulating parathyroid hormone. Ultrasonography, 4D CT and Sestamibi scan was used to localize parathyroid adenoma. These patients underwent parathyroidectomy and post-operative histology was consistent with parathyroid adenoma.

Machine learning empowered COVID-19 patient monitoring using non-contact sensing:An extensive review / 药物分析学报

The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which caused the coronavirus disease 2019(COVID-19)pandemic,has affected more than 400 million people worldwide.With the recent rise of new Delta and Omicron variants,the efficacy of the vaccines has become an important question.The goal of various studies has been to limit the spread of the virus by utilizing wireless sensing technologies to prevent human-to-human interactions,particularly for healthcare workers.In this paper,we discuss the current literature on invasive/contact and non-invasive/non-contact technologies(including Wi-Fi,radar,and software-defined radio)that have been effectively used to detect,diagnose,and monitor human activities and COVID-19 related symptoms,such as irregular respiration.In addition,we focused on cutting-edge machine learning algorithms(such as generative adversarial networks,random forest,multilayer perceptron,support vector machine,extremely randomized trees,and k-nearest neighbors)and their essential role in intelligent healthcare systems.Furthermore,this study highlights the limitations related to non-invasive techniques and prospective research directions.

Identification and growth optimization of a Marine Bacillus DK1-SA11 having potential of producing broad spectrum antimicrobial compounds

Control of harmful bacteria in food, aquaculture, pharmaceuticals, agriculture, hospitals and recreation water pools are of great global concern. Marine bacteria are an enormous source of bio-controlling agents. The aim of this study was to identify and optimize the growth conditions including effect of different biotic and abiotic factors on antimicrobial activity of strain DK1-SA11 isolated from Qingdao Bay of China Yellow Sea. Microscopic characterization, API[registered sign] 20E and 50 CHB kit base carbohydrates utilization, 16S rDNA and DNA gyrB gene sequencing studies identified the bacterium as Bacillus subtilis subsp. spizizenii DK1-SA11. Antimicrobial spectrum of cell free supernatant [CFS] has shown antimicrobial activities against all test strains including methicillin-resistant Staphylococcus aureus, E. coli O157:H7, Candida albicans, Klebsiella pneumoniae, Listeria monocytogenes, Vibrio parahaemolyticus, E. coli, Pseudomonas fluorescens, Salmonella typhimurium and Vibrio cholerae. Among all the media tested, Marine Broth 2216 was found to be the best medium for bacterial growth and production of antibacterial compounds. The other optimum conditions for growth were pH:7 and incubation temperature: 25[degree sign] C with >/= 180 rpm for 60-72 h. Out of 49 different carbohydrates tested, D-mannose increases the antibacterial activity by 33.3% while Darabitol decreases it by 44.4%. Crude CFS showed activity even after three months of storage below -20[degree sign] C and boiling for 10 min, whereas it loses 100% of its antimicrobial activity after enzymatic treatments of lipase, trypsin and papain. The production of antimicrobial compounds and broad spectrum of antimicrobial activity against all tested pathogens suggested that the strain DK1-SA11 can be used as a source for probiotics, synbiotics and antibiotics

Comparative results of repair of ischemic mitral regurgitation [IMR]: conventional against trans-septal approach

Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. [American Heart Association] AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation [IMR]

Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography [TEE]

Result Total number of patients included in study was222, out of those 153 [69.9%] patients underwent conventional approach and 69 [31.1] patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach

Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well

Skeletonized versus pedicled internal mammary harvest: relationship of pain towards technique

Objective purpose of this study is to compare skeletonized versus pedicled internal mammary harvest

Introduction one of the commonly used procedures for multi-vessel and left main coronary artery disease is Coronary Artery Bypass Grafting [CABG with fewer and recurrent complication i.e. Post procedure pain that is an outcome of mechanical, thermal or ischemic injury to the inter-costal nerves during Internal Thoracic Artery [ITA] harvesting

Methodology this study is being done to examine whether skeletonized or pedicle harvesting results in lesser occurrence and intensity of post-CABG pain with aim to identify which one is the better of the two techniques that can be used in future for patients planned with CABG. 63 consecutive patients were recruited at Tabba Heart Institute who underwent median sternotomy for CABG with Internal Thoracic Artery harvest was included. Group A went harvesting through skeletonization whereas patients in group B underwent harvesting by Pedicle ITA. This initial screening was done with the help of pre designed questionnaire. The data statistically analyzed by SPSS

Results the results of study concluded that skeletonization of ITA does not reduce post coronary artery bypass graft surgery pain at the end of one month intervals. It is suggested that that skeletonized ITA is only beneficial when bilateral ITA are used

Conclusion it was concluded that skeletonization of ITA does not reduce post coronary artery bypass graft surgery pain at the end of one month intervals. We suggest that that skeletonized ITA is only beneficial when bilateral ITA has been used

Surgical closure of ASD's and concomitant procedures needed in adults: a 3 year cardiac centre experience

Objective the study aims to evaluate the surgical closure of Atrial Septal Defect [ASD] and concomitant surgical procedures needed at Cardiac Care Centre

Introduction an ASD is a hole of variable size in the atrial septum. A patent foramen ovale that is functionally closed by overlapping of limbic tissue superiorly and the valve of the fossa oval inferiorly [in response to the normal left-to-right atrial pressure gradient] is excluded. ASDs generally permit left-to-right shunting at the atrial level. Partial anomalous pulmonary venous connection [PAPVC] is a condition in which some but not all pulmonary veins connect to the right atrium or its tributaries, rather than to the left atrium

Methodology a prospective cohort study was done at Tabba heart institute. 115 consecutive patients were reviewed and investigated. All the patients with surgical closure of ASD and concomitant surgical procedures who returned for follow-up from June 2011 to May 2016 in the study were included as population sample

Results total ASD repair only patients were 80 and patients who needed concomitant procedures too were 35. The size of the defect ranged from 3mm to 58mm, with a mean of 26.96+/-11.02mm. The relative frequencies of different ASDs were secundum 57 [80.2%], primum 4 [5.6%], and sinus venosus 10 [14.08%]. Major post-operative complications by Age group and by procedure were evaluated and presented

Conclusion it was concluded from our results that surgical repair of atrial septal defects and its variants is associated with very low morbidity in different age groups due to its excellent results

Relationship between PTEN and gestational diabetes in Asian Indians womens

Gestational diabetes mellitus [GDM] is defined as glucose intolerance of variable severity with onset of first recognition during pregnancy. GDM occurs in at least 30% of women with a family history of T2DM/GDM, suggesting that some women are genetically predisposed to develop GDM. Phosphatase and tensin homolog [PTEN] on chromosome 10 is a tumor-suppressor gene. Studies have demonstrated that PTEN dysfunction affects the function of insulin. However, the relationship between GDM and PTEN has not been studied. The aim of the present study was to investigate the relationship between PTEN and GDM in Asian Indian women. The case-control study used PCR-RFLP analysis to assess the PTEN?9C/G polymorphism in 150 GDM cases and 150 controls [non-GDM]. No alleles or genotypes were detected at statistically significant frequencies. All subjects were normal, and no variants were detected in any of the pregnant women. In conclusion, PTEN has no role in GDM, consistent with previous studies

Resistance pattern of clinical isolates involved in surgical site infections

Wound infections due to the incursion of microbes need to be averted or to heal the wounds by antibiotics. Antibiotics are not only aid in cure of infections but also help to prevent the flourishing and production of one or more species of microorganism, resultant in purulent discharge. This current study was carried out to evaluate the resistance pattern of clinical isolates from surgical site infections by the Kirby Bauer disc diffusion method. A total of 257 clinical isolates were collected from different hospitals in Karachi and evaluated by using fifteen antibiotics belonging to different groups. Staphylococcus aureus [n=87], Escherichia coli [n=76], Pseudomonas aeruginosa [n=56], Proteus [n=21] and Klebsiella [n=17] species are the most common clinical isolates of surgical site infections. Among the semi-synthetic penicillins, ampicillin was found to be resistant to nearly all clinical isolates but amoxicillin was moderately sensitive to S. aureus. Combinations of semi-synthetic penicillins are more sensitive than the penicillin alone. Co-amoxiclave exhibits superior sensitivity to all the surgical infection isolates except Pseudomonas aeruginosa which showed 68.75% resistance. Pseudomonas aeruginosa was highly resistant to cephalosporin except ceftraixone which showed 21.88% resistance. S. aureus was slightly responsive to cefazolin, cephradine, cefaclor, ceftizoxime, cefuroxime and ceftriaxone. E. coli, Gram-negative clinical isolate was showed 25% and 31.25% resistance to ceftriaxone and cefuroxime. In the Klebsiella species, 71.42% and 64.29% resistance to cefazolin and cefuroxime respectively, was observed. Aminoglycosides such as gentamycin and tobramycin were found to be more susceptible to all the clinical isolates. Quinolones like ofloxacin and enoxacin were showed good sensitivity to nearly all the clinical isolates. On the basis of the present study, it is recommended to adopt a rational use of antibiotics in prophylaxis and the utilization of a coordinated scheme of surgical wound inspections.

Distribution frequency of hepatitis C virus genotypes in pateints attending liaquat university hospital Jamshoro/Hyderabad

To assess the frequency of different genotypes of Hepatitis C virus in patients attending Liaquat University Hospital [LUH] Jamshoro Sindh. This descriptive cross sectional study was carried out at Department of Medicine at Liaquat University hospital Jamshoro from June to December 2012. A total of 107 patients with Hepatitis C fulfilling the selection criteria and with informed consent were included in the study. Blood samples were taken from patients for HCV genotyping. A qualified pathologist performed HCV genotyping. Total 107 patients of Hepatitis C were selected by non probability consecutive sampling. Mean age was 36.58 +/- 10.5 years. Fifty six [52.3%] were male and fifty one [47.7%] were female. The commonest genotype was genotype 3 [72.9%] followed by genotype 2 [18.7%], genotype 1 [7.5%] and genotype 4 [0.9%]. The commonest HCV genotype 3 subtype was subtype a [73.8%] followed by subtype b [25.2%] and subtype c [0.9%]. HCV genotype 3 with distribution frequency of 72.9% and subtype a with distribution frequency of 73.8% were the commonest in our study population.

Purification and characterization of extracellular, polyextremophilic alpha-amylase obtained from halophilic engyodontium album

alpha-Amylases [EC 3.2.1.1] are covering approximately 25% of total enzyme market and are frequently used in food, pharmaceutical and detergent industries. The first ever detailed characterization of amylase from any halophilic Engyodontium album is presented. An extracellular a-amylase was studied from halophilic E. album TISTR 3645. The enzyme was extracted and purified by column chromatography. SDS-PAGE was performed to find the molecular weight of the enzyme. The effects of pH, temperature and salinity on the isolated enzyme were determined. The effects of various additives on enzyme were studied. The molecular weight of the amylase was 50 kDa. The enzyme specific activity was 132.17 U.mg[-1] with V[max] and K[m] values of 15.36 U.mg[-1] and 6.28 mg.ml[-1], respectively. The optimum enzyme activities were found at pH 9.0, 60°C and 30% [w/v] NaCl. BaCl[2], CaCl[2], HgCl[2] and MgCl[2] improved amylase activity, beta-mercaptoethanol, EDTA, FeCl[2] and ZnQ[2] decreased enzyme activity. Polyextremophilic characteristics of alpha-amylase from halophilic E. album TISTR 3645 were revealed during the characterization studies, demonstrating promising features, making it a useful candidate for various industries

Comparative evaluation of in vitro cytotoxic effects among parent abietyl alcohol and novel fatty acid ester derivatives against MCF7 and hepatocellular carcinoma cell lines

Synthesis of twelve hitherto unreported esters of abietyl alcohol and screening of these esters against four cancer cell lines including one breast cancer line MCF7 and four hepatocellular carcinoma cell lines [HCC] Huh7, Hep3B, Snu449 and Plc has been determined using SRB assay. The Cell cycle progression showed changes in cellular behaviour after 48 and 72 hours in MCF7 and Huh7 cell lines. Abietyl alcohol was obtained from the reduction of abietic acid, a tricyclic diterpene, isolated from oleoresin of Pinus longifolia Roxberghii

Serum vitamin D level in type 2 diabetic patients

To find out serum vitamin D levels in type 2 DM patients in Hyderabad. Cross sectional study. Private clinics, OPDs of government hospitals like Qasimabad, Latifabad and Pretabad. Duration: January to July 2013. Total 550 patients were selected, 450 patients [250 males and 200 females] taken from different OPDs of Hyderabad and towns or Tehsils with diagnosis of type 2 Diabetes mellitus and another 100 patients were taken as control [60 males and 40 females]. The mean age was 45.6 years. The written consent was obtained and demographic features were noted, 3cc of blood was taken for estimation of vitamin D levels. The level of vitamin D was done on an Electrochemiluminescence Immuno Assay [ECLIA] at Diagnostic and Research laboratory Liaquat University of Medical and Health sciences [LUMHS] Jamshoro, Sind. Out of 550, 450 diabetic subjects tested for vitamin D, females were 44.4%and 55.5% were males. The deficiency was seen in 33.7% patients [p <0.04] and Vitamin D insufficiency was observed in20% in both sex. In control group, the deficiency was observed in 23% in females and 20% in males while insufficiency noted in 5% in both sex. The study showed significant decreased levels of vitamin D in type 2 Diabetic subjects than normal individuals. The vitamin D deficiency increased considerably in females with diabetes type 2

ABCA1 C69T gene polymorphism and risk of type 2 diabetes mellitus in a Saudi population.

Type 2 diabetes mellitus (T2DM) is a disease induced by complex interactions between environmental factors and certain genetic factors. Genetic variants in the Adenosine Binding Cassette Transporter Proteins 1 (ABCA1) have been associated with abnormalities of serum lipid levels of high-density lipoprotein (HDL-C). Decreased serum levels of HDL-C have often been observed in T2DM cases, and this condition has been considered to be involved in the mechanism of insulin resistance (IR). Therefore, we investigated possible association between ABCA1 C69T gene polymorphism and T2DMin a Saudi population. This study was carried out with 380 healthy control subjects and 376 T2DM patients. Genotyping of ABCA1 C69T polymorphism was carried out by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism technique. We observed that the frequency of the T allele of the ABCA1 C69T gene was significantly higher in healthy subjects compared to T2DMpatients (0.28 vs 0.45; p<0.0001; OR (95% CI) = 0.4624 (0.3732–0.5729), and therefore the T allele may be a protective factor against T2DM in the Saudi population.

Predictive value of Body Mass Index [BMI] AND Waist Circumference [WC] for Coronary Artery DISEASE [CAD] and clinical outcomes using gated myocardial perfusion imaging

Obesity is generally considered as a risk factor for coronary artery disease [CAD] and cardiac deaths but some reports suggest better survival in obese with CAD. The objective of this study was to find out predictive value of body mass index [BMI] and waist circumference [WC] for CAD and its outcome using gated myocardial perfusion imaging [GMPI]. This was a prospective study conducted at Nuclear Cardiology Department of Karachi Institute of Heart Diseases [KIHD], Karachi, Pakistan from August 2011 till May 2013. 400 patients who qualified study criteria were included and were divided in [a] to Obese [BMI30 Kg/m[2]] and Non-obese [BMI<30 Kg/ m[2]] and [b] Low-WC group [male<90 cm and female < 80 cm] and High-WC group [male 90 cm and female 80 cm]. Rest and stress GMPI using Tc-99m MIBI was performed in all patients and abnormal GMPI was followed by coronary angiogram. These patients were followed for 12-18 months regarding fatal and non-fatal events. Non-Obese group included 281 patients [Male: Female = 131:150] with a mean age of 58 +/- 12 years and mean WC 100 +/- 15 cm. Obese group included 119 patients [Male: Female = 36:83] with a mean age of 55 +/- 11 years and mean WC 101 +/- 13 cm. Normal GMPI was found in 172 non-obese and 85 obese patients [p<0.05]. GMPI was abnormal in 109 non-obese and 34 obese patients [p<0.05]. WC was not found independent predictor of abnormal GMPI but high WC was found to a significant predictor of CAD in non-obese females [Odd ratio 8.04; 1.041 - 62.127]. At 18 months event-free survival in normal GMPI group for non- fatal MI was 99.4% in non-obese group and 94.1% for obese [significant P value]. For fatal MI, event-free survival was 99.4% in non-obese and 100% for obese [non-significant P value]. In patients with abnormal GMPI event-free survival for non-fatal events was 95.4% in non-obese group and 82.3% in obese group [significant P value]. While event-free survival for fatal MI was 96.3% in non-obese group and 98.1% for obese [significant P value]. We conclude that CAD was found less prevalent in obese group and High-WC predicted CAD in non-obese females only and was not found an independent predictor. A normal GMPI predicted very high event free survival for fatal events in obese and non-obese but significantly lower for non-fatal events in obese group. Obese group with abnormal GMPI had lower risk for cardiac deaths but higher risk for non-fatal events than non-obese patients with abnormal scans

Frequency of retinopathy in adult diabetics in Bahawalpur city

To determine the frequency of diabetic retinopathy in adult diabetic population of Bahawalpur city. A cross-sectional population based study was carried out to determine the frequency of diabetic retinopathy among adult diabetics of Bahawalpur City from January 2009 - June 2010 at Ophthalmology Department Bahawal Victoria Hospital, Bahawalpur and Department of Pathology, Quaid-i-Azam Medical College, Bahawalpur. Two thousand sixty diabetics [males=1090, females = 970] aged 18 - 55 years [mean age = 38 years] were included in the study who were residing in Bahawalpur for last 3 years. Anthropometric measurements including weight, height and waist measurement were obtained using standardized techniques. Blood pressure was recorded in the sitting position in the right arm to the nearest 2 mm Hg with a mercury sphygmomanometer. A fasting blood sample was taken after ensuring 8 hours of overnight fasting for estimation of plasma glucose. According to ADA criteria, patients having fasting plasma glucose > 99 mg/dl were considered to have impaired glucose level and OGTT was performed. Those having fasting plasma glucose level >/= 125 mg/dl were considered diabetic. For retinal studies, pupils were dilated in both eyes. The four fields taken were stereoscopic picture of the macula, disc and superior temporal and inferior temporal quadrants. Color photography [35 mm] was used because of better clarity and the stereo effect. The frequency of diabetic retinopathy in study subjects was found to be 34.5%. Occurrence of diabetic retinopathy shows a positive correlation with duration of diabetes. Frequency of diabetic retinopathy in Bahawalpur City is 34.5% and hyperglycemia, BMI, obesity, hypertension and dyslipidemia are direct association with diabetic retinopathy

Effect of combination of nigella sativa and trigonella foenum-graecum seeds with glibenclamide on blood sugar levels in type-2 diabetes mellitus patients

To evaluate the effect of combination of Nigella sativa and Trigonella foenum-graecum seeds with Glibenclamide on blood sugar levels in type-2 diabetes mellitus patients. Arandomized clinical trial. Diabetic outpatient clinics of Isra University Hyderabad and Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from March to August 2008. For this study, Type-2 diabetic mellitus patients on Glibenclamide, who gave written consent to volunteer in the study, were randomly divided into two groups. Fifty patients in Group [A] [Control Group] remained on routine dose of Glibenclamide, while fifty patients in Group [B] [Intervention Group] were kept on a capsule containing combined powder of N-sativa and T. foenum-graecum seeds powder, in addition to their routine dose of Glibenclamide. Patients in both the groups were evaluated for a period of 3 months for fasting and random sugar levels. It was found that the blood sugar level fasting [p-value=0.003] and the random [p-value<0.001] significantly decreased in intervention group compared to control group. This study indicates that combination therapy of N. sativa and T. foenum-graecum seeds with Glibenclamide has significant effect in controlling hyperglycemia

Separation of biological proteins by liquid chromatography

After the success of human genome project, proteome is a new emerging field of biochemistry as it provides the knowledge of enzymes [proteins] interactions with different body organs and medicines administrated into human body. Therefore, the study of proteomics is very important for the development of new and effective drugs to control many lethal diseases. In proteomics study, analyses of proteome is essential and significant from the pathological point of views, i.e. in several serious diseases such as cancer, Alzheimer's disease and aging, heart diseases and also for plant biology. The separation and identification of proteomics is a challenging job due to their complex structures and closely related physic-chemical behaviors. However, the recent advances in liquid chromatography make this job easy. Various kinds of liquid chromatography, along with different detectors and optimization strategies, has been discussed in this article. Besides, attempts have been made to include chirality concept in proteomics for understanding mechanism and medication of various disease controlled by different body proteins

Cardiac autonomic neuropathy [CAN] in type-1 diabetes, mellitus patients and its association with the duration of disease and glycemic control

To determine the frequency of Cardiac Autonomic Neuropathy [CAN] in type-1 Diabetes mellitus patients and its association with the duration of disease and glycemic control. Descriptive study. Department of Medicine, Liaquat University Hospital, Hyderabad/Jamshoro, from December, 2004 to April, 2005. Fifty patients of type-1 Diabetes Mellitus [DM] of >/= 10 years duration were selected. CAN was evaluated in terms of presence of resting tachycardia, loss of sinus arrhythmia and heart rate response to Valsalva maneuver by electrocardiogram [ECG]. An R-R variation with respiration of >15 beats per minute was taken normal, while 10-15 beats and <10 beats per minute were taken as borderline and definitive CAN respectively. QTc intervals were measured. Patients with HbA1c levels <7% were considered as well-controlled. The associations between CAN, the duration of diabetes and the diabetic control were determined. The mean age was 35.16 +/- 10.58 years with 32 males and 18 females. The mean values for the known duration of diabetes and HbA1c were 13 +/- 7.3 years and 9.36 +/- 2.5 mg/dl respectively. Definitive and borderline CAN were noted in 20% and 24% respectively. Variability of heart rate with respiration was significantly related to the duration but not to the control of the diabetes [p < 0.05]. QTc showed a significant correlation with the known duration of diabetes and heart rate variability with respiration [p < 0.05]. Most of the patients had uncontrolled glycemic status. Cardiac autonomic neuropathy is common in long standing type-1 diabetics. CAN resulted in prolonged QTc interval that may result in cardiac arrhythmias and even death. Intensive glycemic control improves the cardiac autonomic nerve functions

Alternative tool to bone densitometry in ruling out osteoporosis in postmenopausal women between the age of 50 and 65 years

To devise an alternate tool to bone densitometry in ruling out osteoporosis in postmenopausal women between the age of 50 and 65. A descriptive cross-sectional study was conducted on a sample of 200 females aged between 50 and 65, from 1st November 2002 to 15th January 2003. North Medical Ward, Unit-4 and Out Patient Clinics, Mayo Hospital, and Akram Medical Complex, Lahore. Main outcome measures: Application of a tool based on the risk factor assessment in postmenopausal women as an alternative to bone densitometry in ruling out osteoporosis. The study results showed that in postmenopausal women between the ages of 50 and 65 years without any major risk factors as assessed by using the questionnaire, the occurrence of osteoporosis was not evident although bone weakness of varying degrees was observed in 30.5% of the study sample. This tool thus provides us with an inexpensive and efficient way of ruling out osteoporosis in postmenopausal women between the ages of 50 and 65 years without assessing their BMD values