Frailty assessment in critically ill older adults: a narrative review.

Frailty, a condition that was first defined 20 years ago, is now assessed via multiple different tools. The Frailty Phenotype was initially used to identify a population of "pre-frail" and "frail" older adults, so as to prevent falls, loss of mobility, and hospitalizations. A different definition of frailty, via the Clinical Frailty Scale, is now actively used in critical care situations to evaluate over 65 year-old patients, whether it be for Intensive Care Unit (ICU) admissions, limitation of life-sustaining treatments or prognostication. Confusion remains when mentioning "frailty" in older adults, as to which tools are used, and what the impact or the bias of using these tools might be. In addition, it is essential to clarify which tools are appropriate in medical emergencies. In this review, we clarify various concepts and differences between frailty, functional autonomy and comorbidities; then focus on the current use of frailty scales in critically ill older adults. Finally, we discuss the benefits and risks of using standardized scales to describe patients, and suggest ways to maintain a complex, three-dimensional, patient evaluation, despite time constraints. Frailty in the ICU is common, involving around 40% of patients over 75. The most commonly used scale is the Clinical Frailty Scale (CFS), a rapid substitute for Comprehensive Geriatric Assessment (CGA). Significant associations exist between the CFS-scale and both short and long-term mortality, as well as long-term outcomes, such as loss of functional ability and being discharged home. The CFS became a mainstream tool newly used for triage during the Covid-19 pandemic, in response to the pressure on healthcare systems. It was found to be significantly associated with in-hospital mortality. The improper use of scales may lead to hastened decision-making, especially when there are strains on healthcare resources or time-constraints. Being aware of theses biases is essential to facilitate older adults' access to equitable decision-making regarding critical care. The aim is to help counteract assessments which may be abridged by time and organisational constraints.

[Physical activity and chronic illness, a theoretical framework]. / Comprendre l'activité physique dans la maladie chronique : proposition d'un cadre théorique d'analyse.

The positive effects of adapted physical activity (PA) in patients with chronic illness are scientifically recognized, and PA promotion is part and parcel of public policy. In this context, one task in public health research consists in improving knowledge of PA practice in persons with chronic illnesses. As a complement to studies evaluating the importance of various determinants of PA practice, qualitative research is called for. In this framework, the present article will propose a theoretical analytical framework for study of PA in chronic illness. It will be built around two key concepts, namely the "standards of life" drawn from the notion of health in the philosophy of Georges Canguilhem and the "illness trajectory" drawn from the interactionist sociology of Anselm Strauss. We will attempt to improve understanding of the important yet frangible "labor" of patients at work in transformation of their habits and life standards involving PA professionals.

Jewel scarabs (Chrysina sp.) in Honduras: key species for cloud forest conservation monitoring?

Jewel scarabs, beetles in the genus Chrysina Kirby (Coleoptera: Rutelinae: Scarabaeidae), receive their name from the bright, often gold, green elytra that reflect light like a precious stone. Jewel scarabs are commonly observed at light traps in Mesoamerican cloud forests, and their association with mountain forests makes them potentially interesting candidates for cloud forest conservation monitoring. The absence of survey protocols and identification tools, and the little ecological information available are barriers. In the present study, collection of Chrysina species assembled during biodiversity surveys by Operation Wallacea in Cusuco National Park (CNP), Honduras, were studied. The aim of this overview is to provide an easy to use identification tool for in the field, hopefully stimulating data collection on these beetles. Based on the data associated with the collection localities, elevation distribution of the species in the park was analyzed. The limited data points available were complemented with potential distribution areas generated with distribution models based on climate and elevation data. This study is aimed at initializing the development of a survey protocol for Chrysina species that can be used in cloud forest conservation monitoring throughout Central America. A list of Chrysina species recorded from Honduras so far is provided. The six identified and one unidentified species recorded from CNP are easy to identify in the field based on color and straightforward morphological characteristics. Literature research revealed ten species currently recorded from Honduras. This low species richness in comparison with surrounding Central American countries indicates the poor knowledge of this genus in Honduras. Chrysina species richness in CNP increases with elevation, thereby making the genus one of a few groups of organisms where this correlation is observed, and rendering it a suitable invertebrate representative for cloud forest habitats in Central America.

Antinociceptive activity of ethanolic extract and isolated compounds of Urtica circularis.

ETHNOPHARMACOLOGICAL RELEVANCE: Urtica circularis (Hicken) Sorarú is a medicinal plant commonly used in traditional medicine to relieve pain in inflammatory processes. AIM OF THE STUDY: In the present study, the in vivo antinociceptive effect of Urtica circularis ethanolic extract and its isolated compounds has been investigated. MATERIALS AND METHODS: Antinociceptive activity was evaluated through writhing, formalin and hot plate tests in mice. The phytochemical analysis was performed. RESULTS: The extract produced significant inhibition on nociception induced by acetic acid (ED50: 72.2mg/kg, i.p.) and formalin (ED50: 15.8 mg/kg, i.p.) administered intraperitoneally and also orally. Atropine diminished the activity of the extract in the acetic acid test. In this model, at dose of 10mg/kg i.p., vitexin was the most active of the isolated compounds (inhibition of 91%), and chlorogenic acid, caffeic acid and vicenin-2 (6,8-di-C-glucosyl apigenin) produced an inhibition of 72%, 41% and 41%, respectively, whereas apigenin did not show any activity. CONCLUSIONS: These results suggest that Urtica circularis extract produced antinociception possibly related to the presence of vitexin, chlorogenic, caffeic acid and vicenin-2. The activation of cholinergic systems seems to be involved in the mechanism of antinociception of the extract.

Ab initio study of the elastic properties of single and polycrystal TiO(2), ZrO(2) and HfO(2) in the cotunnite structure.

In this work, we study theoretically the elastic properties of the orthorhombic (Pnma) high-pressure phase of IV-B group oxides: titania, zirconia and hafnia. By means of the self-consistent SIESTA code, pseudopotentials, density functional theory in the LDA and GGA approximations, the total energies, hydrostatic pressures and stress tensor components are calculated. From the stress-strain relationships, in the linear regime, the elastic constants C(ij) are determined. Derived elastic constants, such as bulk, Young's and shear modulus, Poisson coefficient and brittle/ductile behavior are estimated with the polycrystalline approach, using Voigt-Reuss-Hill theories. We have found that C(11), C(22) and C(33) elastic constants of hafnia and zirconia show increased strength with respect to the experimental values of the normal phase, P 2(1)/c. A similar situation applies to titania if these constants are compared with its normal phase, rutile. However, shear elastic constants C(44), C(55) and C(66) are similar to the values found in the normal phase. This fact increases the compound anisotropy as well as its ductile behavior. The dependence of unit-cell volumes under hydrostatic pressures is also analyzed. P-V data, fitted to third-order Birch-Murnaghan equations of state, provide the bulk modulus B(0) and its pressure derivatives B'(0). In this case, LDA estimations show good agreement with respect to recent measured bulk moduli of ZrO(2) and HfO(2). Thermo-acoustic properties, e.g. the propagation speed of transverse, longitudinal elastic waves together with associated Debye temperatures, are also estimated.

Prueba pretransfusional en medio enzimático utilizando test en gel: presentación de un caso / Pretransfusional test using gel technique with enzimed treated cells in screening and identification of irregular antibodie: case report

Se presenta paciente de 55 años, sexo femenino politransfundida con falta de respuesta al tratamiento instituído, identificándose un Anti E con técnicas enzimáticas, que no fue detectado en Liss-Coombs. Está bien demostrado desde la literatura internacional que un 35 por ciento de anticuerpos reaccionan sólo con este método y que el 0,5 por ciento del total de los resultados son falsos positivos, se destaca la importancia de trabajar con esta metodología evaluando riesgos-beneficios.

We describe the case of a 55 years old woman that has the history of politransfusion but she hasn't res­ponded to this treatment and it was identified in her serum sample an anti-E antibody that was active only by the enzyme test with gel method. As Literature des­cribe that 35 per cent of alloantibodies only react with this method and 0,5 per cent has false positive result, it is relevant the fact of working with this method testing risk and benefits.

Antinociceptive activity of Eupatorium buniifolium aqueous extract.

The antinociceptive properties of the aqueous extract of Eupatorium buniifolium aerial parts were investigated in chemical and thermal models of nociception in mice. Oral doses of 250 and 500 mg/kg produced an inhibition of 42.3% and 73.9%, respectively, of the abdominal writhes induced by acetic acid in mice. This antinociceptive effect was not reversed by pretreatment with naloxone. In the formalin test, the administration of 500 and 1000 mg/kg p.o. had no effects in the first phase (0-5 min) but produced a dose-dependent analgesic effect on the second phase (15-30 min) with inhibitions of the licking time of 38.9% and 57.3%, respectively. In the hot plate test, no effect was seen at the dose of 500 mg/kg p.o.

Antinociceptive and antiinflammatory activities of Artemisia copa extracts.

The aqueous extract from aerial parts of Artemisia copa Phil. (Compositae), was evaluated for antinociceptive activity using writhing, formalin, and hot-plate tests in mice. A dose-related antinociceptive response was obtained in the writhing test at doses of 500 and 1000 mg/kg p.o. (percentage of inhibition 23.3 and 52.70, respectively). The extract also inhibited the second phase of formalin test (38.81%) and this effect was not antagonized by pretreatment with naloxone 5mg/kg i.p. Furthermore, no significant effect was obtained in the hot-plate test. Dichloromethane and ethanolic extracts, were analyzed for antiinflammatory activity with the carrageenan-induced paw edema in rats and the ear edema induced by 12-O-tetradecanoylphorbol-13 acetate (TPA) and arachidonic acid (AA) in mice. Both extracts showed antiinflammatory activity in the TPA (88 and 54%), and the ethanolic extract showed a 37% inhibition in AA test. No effects were seen at doses of 300 mg/kg p.o. and 100 mg/kg i.p. in the carrageenan test. The results obtained indicate that A. copa has analgesic and topical antiinflammatory activities that supports the folk medicinal use of the plant.

Impacto de la floruración del agua potable en la prevalencia de caries y fluorosis dental en la población escolar del Municipio de Oberá Misiones Argentina

El trabajo analiza las condiciones socioeconómicas considerando que estas no provocan una situación diferencial (estadisticamente significativa) en materia de caries cuando son evaluados al paso del estrato de niveles socieconómico más alto a los más bajos, aumentan los porcentajes de niños sin experiencia odontológica, con caries que sangran y lo que es más importante se incrementan el porcentaje de escolares que presentan una higiene dental calificada como mala y de los que no tienen acceso al agua potable. Estos resultados plantean la necesidad de mejorar la cobertura de agua potable de atención odontológica en los sectores de menores ingresos e insistir en la realización de campaña de concientización que enfaticen la importancia de una buena higiene dental como medio que contribuye a prevenir las caries

Influencia de factores socioeconómicos y culturales en la asociación entre índices de caries dental y la floruración del agua potable

El presente trabajo mide el impacto del agregado de flúor al agua potable en la reducción de caries dental en la población escolar de la localidad de Oberá. Misiones (Argentina) y evaluar la asociación entre los índices ceod y CPOD y variables cualitativas tales como el nivel socioeconómico, la higiene bucal y el acceso al agua potable florurada

Influencia de factores socioeconómicos y culturales en la asociación entre índices de caries dental y la floruración del agua potable

El presente trabajo mide el impacto del agregado de flúor al agua potable en la reducción de caries dental en la población escolar de la localidad de Oberá. Misiones (Argentina) y evaluar la asociación entre los índices ceod y CPOD y variables cualitativas tales como el nivel socioeconómico, la higiene bucal y el acceso al agua potable florurada

Impacto de la floruración del agua potable en la prevalencia de caries y fluorosis dental en la población escolar del Municipio de Oberá Misiones Argentina

El trabajo analiza las condiciones socioeconómicas considerando que estas no provocan una situación diferencial (estadisticamente significativa) en materia de caries cuando son evaluados al paso del estrato de niveles socieconómico más alto a los más bajos, aumentan los porcentajes de niños sin experiencia odontológica, con caries que sangran y lo que es más importante se incrementan el porcentaje de escolares que presentan una higiene dental calificada como mala y de los que no tienen acceso al agua potable. Estos resultados plantean la necesidad de mejorar la cobertura de agua potable de atención odontológica en los sectores de menores ingresos e insistir en la realización de campaña de concientización que enfaticen la importancia de una buena higiene dental como medio que contribuye a prevenir las caries

Evaluación de factores de riesgos asociados con caries dental en dientes transitorios y permanentes : parte 1

Examina la asociación entre la presencia de caries dental y el consumo de agua fluorada y evalua la influencia en dicha asociación de los factores nivel socioeconómico, resultado de la experiencia odontológica e higiene bucal. El consumo de agua fluorada constituye un factor de protección OR= 0,57 (IC : 0.36-0.93) que reduce el riesgo de caries

The hypoglycemic effect of Phyllanthus sellowianus fractions in streptozotocin-induced diabetic mice.

Phyllanthus sellowianus Müller Arg. (Euphorbiaceae) is a plant used in folk medicine as a hypoglycemic and diuretic agent. The present study describes the hypoglycemic effect of fractions obtained from the stem barks of P. sellowianus using a bioassay-guided fractionation protocol and streptozotocin-induced hyperglycemic mice. The aqueous extract was partitioned between dichloromethane and butanol to yield the dichloromethane (D), butanol (B) and the remaining aqueous (A) fractions. Fractions B and A, administered at the dose of 200 mg/kg p.o., caused a significant reduction in blood glucose concentration at 6 and 9 h, while the same dose of fraction D was ineffective. The reduction in blood glucose levels obtained with the B and A fractions was similar to that observed with glibenclamide (10 mg/kg) which was used as a reference for the hypoglycemic activity. Phytochemical analysis of fractions B and A revealed the presence of flavonoid compounds, of which rutin and isoquercitrin were the major constituents, respectively. The possible involvement of these flavonoids in the hypoglycemic effect of the active fractions is discussed.

Hepatoprotective activity of Achyrocline satureioides(Lam) D. C.

Aerial parts of Achyrocline satureioides(Lam) D. C. (Asteraceae) are used in folk medicine as infusions or decoctions for the management of several diseases including gastrointestinal and hepatic disorders. These data and the presence of flavonoids and caffeoyl derivatives have led us to study its hepatoprotective and choleretic activities. The hepatoprotective activity was evaluated in the bromobenzene- (BB-) induced hepatotoxicity model in mice through the measurement of the serum levels of alanine-aminotransferase (ALT) and aspartate transaminase (AST), thiobarbituric acid reacting substances (TBARS) and glutathione levels. The aqueous extract of the aerial parts of A. satureioides administered before BB, at the dose of 300 mg kg(-1)p.o., demonstrated significant inhibition (P< 0.01) in the BB increase of liver ALT and AST and in the BB-induced increase of liver TBARS content. Also it was able to significantly increase (P< 0.05) the depleted levels of liver glutathione. In addition, at the same dose, a significant increase (P< 0.01) in the bile flow of rats was found. The results obtained with the aqueous extract of A. satureioides support its use in popular medicine as a hepatoprotective and digestive agent, and the effects might be mediated through the antioxidant and choleretic activities.