Self-reported Hearing Loss Associated with Frailty among Afro-Caribbeans / Pérdida de la audición autoreportada asociada con la fragilidad entre los afrocaribeños

ABSTRACT Objective: Data on ethnic differences in the relationship between hearing loss and frailty are sparse. We investigated the relationship between self-reported hearing loss and frailty in four ethnic groups. Methods: This was a cross-sectional study of a community-dwelling sample of African American, Afro-Caribbean, Hispanic, and European American individuals aged 60 years or older (n = 484). Participants had to be able to ambulate independently or with the help of a device, and had an age- and education-adjusted Mini-Mental State Examination score of > 23 to be enrolled. Self-reported hearing loss was measured by a single question: 'Is your hearing excellent, very good, good, fair or poor?'. Answers of excellent, very good and good were considered as 'no hearing loss', and answers of fair and poor as 'self-reported hearing loss'. Frailty was defined as reporting three or more of the following criteria: weight loss, weakness, exhaustion, slow walking speed, and low physical activity. Results: In unadjusted (odds ratio: 3.075; 95% confidence interval: 1.149, 8.233; p = 0.025) and adjusted (odds ratio: 7.509; 95% confidence interval: 1.797, 31.386; p = 0.006) models, self-reported hearing loss was associated with frailty in Afro-Caribbeans, but not in African Americans, Hispanics and European Americans. Out of the five frailty criteria, only exhaustion was significantly more common in the self-reported hearing loss group among Afro-Caribbeans. Conclusion: Self-reported hearing loss was associated with frailty among Afro-Caribbeans, and this association was largely due to the frailty criterion of exhaustion.

RESUMEN Objetivo: Los datos sobre las diferencias étnicas en la relación entre la pérdida auditiva y la fragilidad son escasos. Investigamos la relación entre la pérdida de la audición autoreportada y la fragilidad en cuatro grupos étnicos. Métodos: Se trató de un estudio transversal de una muestra de una comunidad de residentes afroamericanos, afrocaribeños, hispanos y euroamericanos de 60 años o más (n = 484). Para ser seleccionados, los participantes tenían que ser capaces de deambular independientemente o con la ayuda de un dispositivo, y tener una puntuación de >23 en el Mini Examen del Estado Mental ajustado a la edad y al nivel educacional. La pérdida de audición autoreportada fue medida con una sola pregunta: '¿Es tu audición excelente, muy buena, buena, satisfactoria, o pobre?'. Las respuestas de 'excelente', 'muy buena', y 'buena', se consideraron como 'sin pérdida de la audición', y las respuestas de 'satisfactoria' y 'pobre' como 'pérdida de la audición autoreportada'. La fragilidad se definió a partir de reportar tres o más de los siguientes criterios: pérdida de peso, debilidad, agotamiento, velocidad de marcha lenta, y baja actividad física. Resultados: En los modelos no ajustados (odds ratio: 3.075; 95% intervalo de confianza: 1.149, 8.233; p = 0.025) y ajustados (odds ratio: 7.509; 95% intervalo de confianza: 1.797, 31.386; p = 0.006), la pérdida de audición autoreportada se asoció con la fragilidad en los afrocaribeños, pero no en los afroamericanos, hispanos y euroamericanos. De los cinco criterios de fragilidad, sólo el agotamiento fue significativamente más común en el grupo de pérdida de la audición autoreportada entre afrocaribeños. Conclusión: La pérdida de audición autoreportada estuvo asociada con la fragilidad entre afrocaribeños, y esta asociación se debió en gran parte al criterio de agotamiento como aspecto de la fragilidad.

Addiction treatment: level of care determination.

Substance use disorders occur in 10% to 20% of patients presenting to the primary care physician. It is estimated that every fifth patient in a primary care practice has a substance use disorder. One of the challenges for the primary care physician after the initial assessment is a referral to the appropriate level of care. Substance abuse treatment is now a multibillion dollar industry, and there are a wide variety of options for those with resources. Most patients depend on community resources and state- and county-funded programs.

Incidental prostatic adenocarcinoma in patients with PSA less than 4 ng/mL undergoing radical cystoprostatectomy for bladder cancer in Iranian men.

OBJECTIVE: To assess the incidence of prostate adenocarcinoma in patients undergoing radical cystoprostatectomy due to bladder cancer in Iranian men. MATERIALS AND METHODS: Fifty cystoprostatectomy specimens removed due to bladder malignancy (2004-2005) at two referral centers (Shaheed Modarress and Shaheed Labbafinejad Hospitals, Tehran, Iran) were examined for the coincidental finding of prostate cancer (PCa). At the time of surgery the patient's serum PSA was less than 4 ng/mL and there were no suspicious lesions by digital rectal examination. Pathologic grade, stage, morphometric volume, number of tumor foci and association with areas of high grade prostatic intraepithelial neoplasia (HGPIN) were assessed by light microscopy. All specimens were totally embedded and whole-mounted. Clinically significant cancers were defined as tumors with >or= 0.5 mL volume, Gleason pattern 4 or 5, pT3, positive surgical margin, and multifocality > 3. RESULTS: Incidentally detected cancer was found in 7 (14%) of cystoprostatectomy specimens. HGPIN was present in 1 (14.3%) of the cystoprostatectomies with incidentally detected prostate cancer. None of cystoprostatectomies without prostate cancer had HGPIN. Four (57%) of the detected cancers were significant. CONCLUSION: We conclude that incidentally detected prostate cancer in Iran is lower than the rates reported in other countries. Further studies are warranted for better declaration of variability of prostate cancer between different ethnic groups.

Incidental prostatic adenocarcinoma in patients with PSA less than 4 ng/ml undergoing radical cystoprostatectomy for bladder cancer in iranian men

OBJECTIVE:To assess the incidence of prostate adenocarcinoma in patients undergoing radical cystoprostatectomy due to bladder cancer in Iranian men. MATERIALS AND METHODS: Fifty cystoprostatectomy specimens removed due to bladder malignancy (2004-2005) at two referral centers (Shaheed Modarress and Shaheed Labbafinejad Hospitals, Tehran, Iran) were examined for the coincidental finding of prostate cancer (PCa). At the time of surgery the patient's serum PSA was less than 4 ng/mL and there were no suspicious lesions by digital rectal examination. Pathologic grade, stage, morphometric volume, number of tumor foci and association with areas of high grade prostatic intraepithelial neoplasia (HGPIN) were assessed by light microscopy. All specimens were totally embedded and whole-mounted. Clinically significant cancers were defined as tumors with 0.5 mL volume, Gleason pattern 4 or 5, pT3, positive surgical margin, and multifocality > 3. RESULTS: Incidentally detected cancer was found in 7 (14 percent) of cystoprostatectomy specimens. HGPIN was present in 1 (14.3 percent) of the cystoprostatectomies with incidentally detected prostate cancer. None of cystoprostatectomies without prostate cancer had HGPIN. Four (57 percent) of the detected cancers were significant. CONCLUSION: We conclude that incidentally detected prostate cancer in Iran is lower than the rates reported in other countries. Further studies are warranted for better declaration of variability of prostate cancer between different ethnic groups.

The role of psychopharmacotherapy in improving the long-term outcome of schizophrenia.

Drs. Alam and Janicak briefly review the current indications and problems associated with the use of atypical antipsychotics in schizophrenia treatment. When called for, they may be augmented by mood stabilizers, such as lithium; antidepressants; benzodiazepines (for rapid tranquillization during agitated psychotic episodes); and stimulants, even nicotine, to improve cognition. Even though extrapyramidal side effects are less frequent and less intense that those seen with traditional antipsychotics, they do occur; the authors spell out the attributes of those patients who are most vulnerable. Clinicians should also look for weight gain and the risk of activating or aggravating type 2 diabetes in patients, as well as cardiac risk involving prolongation of the QTc interval. Because, despite of modern approaches to treatment, 80% of patients end up rehospitalized and only 1 in 3 can be said to have a good level of socialization, active measures must be taken to ensure continuity of care, monitoring for prodromal symptoms, early intervention, and psychosocial rehabilitation.

A comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction.

INTRODUCTION: Our aim was to compare clinical and radiological outcomes, complications, and hospital stay in laparoscopic and open pyeloplasty. MATERIALS AND METHODS: From February 2002 to February 2003, 69 patients with ureteropelvic junction obstruction (UPJO) were assigned into two groups. Thirty-seven patients underwent transperitoneal laparoscopic pyeloplasty and 32 underwent open surgical pyeloplasty. Clinical symptoms were assessed before and after surgery, subjectively. Radiological assessment was also done three months postoperatively. RESULTS: Mean operative time was 3.2 hours and 2.2 hours in laparoscopic and open pyeloplasty groups, respectively. Intraoperative bleeding was trivial in both groups and no complication or conversion to open surgery occurred. Postoperative complication rates were 24% and 6% in laparoscopic and open pyeloplasty groups, respectively. Mean hospital stay was similar (6.2 days) in the two groups. Mean follow-up was 16.5 months versus 11.4 months. Clinical and radiological success rates were 89% and 83.8% for laparoscopy group versus 96.5% and 87% for open pyeloplasty group. Due to recurrence of stricture, repeated surgery was performed in 4 patients of laparoscopy and 1 of open pyeloplasty groups. CONCLUSION: Laparoscopic pyeloplasty is a less invasive method with less pain, cosmetic advantages, no long incision, and outcome comparable with open surgery. Hospital stay is also not longer than that in open surgeries. Hence, laparoscopic pyeloplasty can be a substitute for skilled surgeons.

PCNL in the management of lower pole caliceal calculi.

INTRODUCTION: Several therapeutic methods are used in the management of lower pole caliceal calculi. This survey has been conducted to evaluate the safety and efficacy of percutaneous nephrolithotomy in the management of lower pole calculi. MATERIALS AND METHODS: Fifty-five patients, 43 males and 12 females with a mean age of 41.5 (range 11 to 75) years, who had suffered from lower pole caliceal calculi and treated by standard percutaneous nephrolithotomy (PCNL) between 1997 and 2001, were enrolled in this study. The stones were classified as follows: small (less than 25 mm), intermediate (25 to 34 mm) and large (more than 35 mm). Mean follow-up was 6.2 months (range 2 weeks to 34 months). RESULTS: The stones were completely extracted by one session PCNL in 43 patients (79%). Repeat PCNL was needed in one patient and another method was used for stone extraction in another patient. Regarding the size of stone, 88%, 79%, and 74% of small, intermediate, and large stones were completely extracted, respectively. No major complication was noted. CONCLUSION: PCNL has high success rate in patients with stones larger than 2 cm and its morbidity would be low, provided that it is performed by skilled surgeons.

An in situ dissolution study of aspirin crystal planes (100) and (001) by atomic force microscopy.

PURPOSE: To observe in situ and on individual aspirin crystal faces the comparative rates and processes of dissolution of the dominant faces. METHODS: The kinetics of the dissolution rate of two aspirin crystal planes (001) and (100) under 0.05M HCl are studied in situ at room temperature using Atomic Force Microscopy. The dissolution process of each crystal plane was followed by observed changes in topographic features. RESULTS: The results revealed that crystal plane (001) dissolves by receding step edges, and has a dissolution rate of 0.45 nm s(-1). Conversely. plane (100) displays crystal terrace sinking at an average rate of 2.93 nm s(-1). Calculated intrinsic dissolution values (g s(-1) cm(-2)) for planes (001) and (100) are 1.37 x 10(-7) gs(-1) cm(-2) and 8.36 x 10(-7) gs(-1) cm(-2), respectively. CONCLUSIONS: These values indicate that the rate of flux of material from plane (100) is approximately six times greater than that from plane (001), under 0.05M HCl. Interpretation of the data, based upon intrinsic dissolution rates and dissolution rate velocities, correlate with reported variations in the dissolution behavior of commercial aspirin products. These observations illustrate the suitability of the technique for characterizing the dissolution behavior of crystalline drugs.

Surface characterization of aspirin crystal planes by dynamic chemical force microscopy.

Tapping mode (TM) atomic force microscopy (AFM) has been applied in a novel fashion to characterize and distinguish the (001) and (100) surfaces of individual aspirin crystals. The surface characterization was achieved by amplitude-phase, distance (a-p,d) measurements employing gold-coated AFM probes functionalized with self-assembled monolayers (SAM). Experiments using model probes coated with -CH3 and -COOH terminated SAMs have been performed on the two aspirin crystal planes (001) and (100). Results indicate that the hydrophobic -CH3 terminated AFM probes had a greater degree of interaction with the crystal plane (001), whereas the -COOH terminated AFM probes had a larger interaction with the crystal plane (100). Interpretation of these data, based upon the chemistries of the probes, correlates with current understanding of the crystal surface chemistry derived from X-ray diffraction data and dissolution rate studies.

Discrimination of polymorphic forms of a drug product by localized thermal analysis.

In chemical processing, it is important to distinguish between and identify polymorphic forms. We demonstrate the novel use of scanning thermal microscopy (SThM) and localized thermal analysis to distinguish and identify polymorphic forms of the drug cimetidine. These forms cannot be resolved by classical bulk thermal analysis. SThM reveals a sample consisting of a 50 : 50 mixture of the polymorphs contains regions of different thermal conductivity, corresponding to the different polymorphs. Localized thermal analysis of small volumes of pure polymorphic samples (approximately 50 microm3) shows that the origin of the thermal conductivity contrast lies, at least in part, with the presence of a surface water layer on the more hydrophilic polymorph.

Continent ileocecal diversion with an unaltered in situ appendix conduit.

PURPOSE: We performed continent urinary diversion using an unaltered, in situ appendix to decrease the risk of appendicocolic manipulation. MATERIALS AND METHODS: Since September 1994, 19 patients a mean of 46.5 years old underwent continent urinary diversion with an ileocecal segment and an unaltered, in situ appendiceal conduit. In 1 case of a permanent colostomy we performed simple transposition of the appendix on the ileal pouch as a conduit, which to our knowledge is the first reported case. RESULTS: During the 4 to 24-month followup (mean 12) 17 patients were continent day and night, defined as being completely dry for 3 to 5 hours. Two patients were occasionally incontinent at night. One patient with a history of multiple operations who was completely incontinent achieved complete continence with endoscopic polytetrafluoroethylene (Teflon) injection at the appendicocecal junction. CONCLUSIONS: This unaltered in situ appendix technique is timesaving, safe, effective and comparable with other methods that provide urinary continence.

Epidemiological aspects of kala-azar in Meshkin-Shahr, Iran: human infection.

During the last decade, kala-azar, which used to be a sporadic disease, became endemic in parts of East-Azerbaijan province in north-west Iran. Many of the 1051 cases observed between 1985 and 1990 were in the district of Meshkin-Shahr (800 cases). The diagnosis was based on symptoms and signs of the disease plus a positive serological test (indirect immunofluorescence assay or direct agglutination test) and, in some cases, the finding of parasites in bone marrow smears. About 90% of the cases were children under 5 years of age. The disease incidence in 1990 was almost ten times that in 1985. New cases are diagnosed throughout the year, but mostly from January till April. Cases were treated with meglumine antimoniate with very satisfactory results; deaths were few among the treated children.

PIP: Sporadic cases of kala-azar have appeared in East-Azerbaijan province, Iran, over the past fifty years. The number of cases began to increase, however, after the mid-1970s and large numbers have been reported from all parts of the country, but mainly in Meshkin-Shahr district. This paper describes the extent of human infection in the district over the period 1984-90, before the implementation of a control program in 1991. 1051 cases were observed in Meshkin-Shahr district hospital over the period 1985-90. 800 of the cases were from Meshkin-Shahr district, with more than 50% of cases being from the city and neighboring larger villages. 90% of cases were children under five years old. 35 cases were diagnosed in 1985 compared to 344 in 1990. New cases were diagnosed throughout the year, but mostly from January to April. Cases were treated with meglumine antimoniate with very satisfactory results; deaths were few among the treated children.

Proper use of gastrointestinal tract to achieve continent urinary diversion in 73 patients.

Different segments of the gastrointestinal tract have been used to reconstruct the bladder and all have been reviewed in regard to achieving urinary continence. In 53 patients with detubularized ileocecal cystoplasty, the continence rate, both during the day and night, was 88%, while 95% of the patients were continent during the daytime. In nine patients in whom an ileocecal continent reservoir was made, 100% had dry stoma on intermittent catheterization, both during the day and night. We conclude that detubularization of the right colon has a significant effect in achieving urinary control and making a good low pressure pouch. This has helped us to avoid conduits with their inherent problems. Also, the right colon by virtue of the ileocecal valve has good versatility for use in both anti-incontinence or anti-reflux procedures as needed.

An endemic focus of visceral leishmaniasis in Meshkin-Shahr, east Azerbaijan province, north-west part of Iran and IFA serological survey of the disease in this area.

The incidence of visceral leishmaniasis has being increased in Iran during the recent decade. Since 1980, more than 200 cases have been diagnosed from East Azerbaijan province, mostly, from Meshkin-Shahr area. It seems, that kala-azar has being endemic in this area for a long time. The majority (86%) of kala-azar cases were found among children up to 4 years. The sex incidence ratio of males/females was 1.27/1. In IFA serological survey, sero-positive rate in females was higher than males. However, geometric mean of leishmanial antibody titers in males was, slightly, more than females. These serological findings indicate that females are exposed to the infection at least as much as males. The cross-sectional IFA serological survey, relatively reflected the kala-azar status among different studied groups with various incidences of the disease in Meshkin-Shahr area. IFAT showed also a good efficiency in the assessment of the treatment in the treated kala-azar patients.