Relationship between Lifestyle and Frailty among Iranian Community-Dwelling Older Adults: Pilot Study

Background

Aging affects physical, mental, and social functions, which can lead to an increase in frailty. Old adults with frailty syndrome are prone to disabilities and hospitalization. Lifestyle is a context-based factor that has the potential to prevent frailty.

Objectives

This study aimed to assess the relationship between lifestyle and frailty among Iranian community-dwelling older adults.

Design Setting

This is a descriptive-analytical cross-sectional study. The participants were 513 older adults over 60 years by the convenience sampling method from the retirement center.

Measurements

Data were collected using Tilberg's frailty index, the Iranian elderly lifestyle questionnaire, and the Mini-Cog test. Data were analyzed with SPSS v.26 software by chi-square and logistic regression tests.

Results

The age of the participants was 66.43 ± 4.69 years. The male-to-female sex ratio was 1.5 (39.2% women). The lifestyle of 96 (19.3%) old adults was unfavorable. 18.7 percent of older adults had Frailty syndrome. The logistic regression test showed that moderate and favorable lifestyle (OR= 0.06; 95% CI: 0.02-0.16), age over 75 years (OR= 5.25; 95% CI: 2.35-11.69), retired employment status (OR= 0.13; 95% CI: 0.29-0.05) are factors that have a significant relationship with frailty (P< 0.05).

Conclusion

The findings showed that lifestyle can predict frailty. Therefore, it seems that an optimal lifestyle can prevent the frailty of older adults.

The Modified Hospital Elder Life Program (HELP) in geriatric hospitalized patients in internal wards: A double-blind randomized control trial

Background

Hospital Elder Life Program (HELP) provides protocols based on factors for reducing delirium. Due to the lack of geriatric wards and aged care teams in Iran, it seems that some of the original HELP interventions need to be modified through a trial study. Hence, this study was conducted to determine whether the Iranian modified HELP could reduce delirium in geriatric hospitalized patients.

Methods

This double-blind randomized controlled trial was designed and conducted in a hospital at Kashan University of Medical Sciences in Iran. A total of 195 hospitalized patients aged ≥70 years, were 84 in the Intervention Group (IG) and 111 in the Control Group (CG). After assessing delirium risk factors, participants in the IG group received interventions based on the cognitive, vision/hearing, sleep, mobility, feeding, and hydration protocols by nursing students and the CG group received routine care.

Delirium incidence was assessed by the Confusion Assessment Method. Delirium incidence, cognitive and functional abilities, frailty, fall, and length of stay were outcomes.

Results

The mean age of the patients was 78.53(Standard Deviation = 5.87) years. Delirium incidence was higher in the CG comparing to IG (14.71% vs 3.66%).Significant reduction observed in risk incidence of delirium because of interventions [Odds Ratio:0.124, Confidence Interval: 0.03–0.48].

Conclusion

The modified HELP effectively reduced delirium rates in geriatric hospitalized patients.

Trial registration

This study was registered at the Iranian Registry of Clinical Trials IRCT20180910040995N1.

Effects of metabolic syndrome on bone health in older adults: the Bushehr Elderly Health (BEH) program

Based on the clinical, BMD, and TBS data of 2380 participants aged ≥ 60 which was gathered during the BEH program, stage II, we showed that MetS was positively associated with BMD, while a negative or no association was observed between MetS and TBS depending on the sex and the adjustment model.

INTRODUCTION

The results of previous reports in regard to the effect of metabolic syndrome (MetS) on bone health are not conclusive. This study aimed to evaluate the association between MetS with bone mineral density (BMD) and trabecular bone score (TBS) as an indicator of bone quantity and quality, respectively.

METHODS

Using a cross-sectional design, this study was carried out based on the data collected during the BEH Program, stage II. MetS was defined according to NCEP-ATP III criteria. BMD (at the lumbar spine and the hip) and lumbar spine TBS were assessed by dual-energy X-ray absorptiometry device.

RESULTS

The data of 2380 participants (women = 1228, men = 1152) aged ≥ 60 were analyzed. In the fully adjusted regression models (including BMI), significant associations between MetS and mean BMD were observed across all locations in men (P values ≤ 0.001) and in the lumbar spine in women (P value = 0.003). In addition, the prevalence of osteoporosis (based on BMD) was significantly lower in those with MetS than those without MetS in both sexes, even after full adjustments (women, OR = 0.707, P value = 0.013; men, OR = 0.563, P value = 0.001). In contrast, in age-adjusted regression analyses, the prevalence of degraded bone microarchitecture (TBS ≤ 1.2) was significantly increased in those with MetS than those without, irrespective of the participants' sex (P values < 0.05). The mean TBS was also negatively associated with MetS in women (β = - 0.075, P value = 0.007) but not in men (β = - 0.052, P value = 0.077), in age-adjusted regression models. However, after including BMI in the adjusted models, all significant associations between TBS values and MetS disappeared.

CONCLUSION

It seems that a positive association exists between MetS and BMD, while MetS is either not associated or negatively correlated with bone quality as measured by TBS.

Pulicaria gnaphalodes powder in broiler diets: consequences for performance, gut health, antioxidant enzyme activity, and fatty acid profile

The search constantly continues to identify potential alternatives to the use of antimicrobial growth promoters (AGP) in broiler production. This trial was conducted with broiler chicks to investigate the effect of different levels of Pulicaria gnaphalodes powder (PGP) in comparison with AGP, and probiotic (PRO) on growth performance, gut microflora, intestinal morphology, antioxidant enzyme activity, and fatty acid profile of meat. Ross 308 male broiler chicks (n = 576) were randomly assigned into 6 dietary treatments with 8 replicate pens per treatment and 12 birds per pen. The dietary treatments consisted of a basal diet as control (CON, with no additive), CON + 0.1% PGP, CON + 0.2% PGP, CON + 0.3% PGP, CON + 0.1% probiotic mixture (PRO), and CON + 0.05% bacitracin methylene disalicylate (AGP). Higher body weight gain and lower feed conversion ratio were obtained in birds fed AGP and 0.3% PGP compared with those fed CON and 0.1% PGP during grower, finisher, and the entire study (P < 0.05). On day 42, birds on PRO, 0.2 and 0.3% PGP treatments had lower counts of Escherichia coli and higher lactobacillus spp. in ileum and cecal contents compared to the CON and 0.1% PGP (P < 0.05). Villus height and villus height to crypt depth ratio of the duodenum were increased (P < 0.05) in response to dietary AGP, PRO, and 0.3% PGP. The diets containing PRO and different levels of PGP increased superoxide dismutase and glutathione peroxidase activities and decreased malondialdehyde level in serum, liver, and thigh muscle (P < 0.05). Total polyunsaturated fatty acid and n-3 fatty acid of birds fed PRO and PGP diets were higher than birds in CON and AGP groups (P < 0.05). In summary, supplementation of PGP could be a potential alternative to AGP in broiler diets due to its combined positive impacts on performance, serum cholesterol, intestinal health, antioxidant activity, and fatty acid profile in meat. Such effects, however, need to be further verified under compromised health or a disease challenge condition.

Investigation of anti-leishmanial efficacy of miltefosine and ketoconazole loaded on nanoniosomes

Leishmaniasis is a group of parasitic disease caused by protozoa of Leishmania genus. Leishmania major accounts for the cutaneous leishmaniasis (CL). The current treatments of this disease are expensive with high toxicity and are associated to difficulties of healing and parasite resistance. Miltefosine and ketoconazole have been found to be effective against CL. In this study, miltefosine- and ketoconazole-loaded nanoniosomes were prepared by the thin film-hydration method, and their anti-leishmanial effects against Leishmania major promastigotes and amastigotes were evaluated. The particle size and zeta potential of the nanoniosomes were determined. Release from the formulations showed enhanced and controlled dissolution of the drugs. The miltefosine- and ketoconazole-loaded nanoniosomes inhibited the growth of promastigote and amastigote forms of Leishmania major in vitro after 48 h of incubation and had IC₅₀ values of 53.39 ± 0.02 and 86.38 ± 0.07 μg mL^-1, respectively. The formulations provided improved anti-leishmanial activities for the treatment of cutaneous leishmaniasis.

Flow mediated dilation with photoplethysmography as a substitute for ultrasonic imaging

Flow mediated dilation (FMD) is a non-invasive method for endothelial function assessment providing an index extracted from ultrasonic B-mode images. Although utilized in the research community, the difficulty of its application and high cost of ultrasonic devices prevent it from being widely used in clinical settings. In this study we show that substituting the ultrasonic device with more easily handled and low cost photoplethysmography and electrocardiography is possible. We introduce new indices based on the photoplethysmogram (PPG) and electrocardiogram (ECG) and show that they are correlated with the ultrasound-based FMD Index. To this end, a conventional ultrasound FMD test was carried out whereas PPG and ECG were simultaneously recorded from 20 healthy volunteers (13 M, 7 F) in the age range of 23-32 years. Our results show a significant correlation between our proposed index and ultrasound FMD when using the ECG in conjunction with the PPG (R = 0.77, p < 0.000 01). Using the PPG alone produces a lower correlation (R = 0.72, p < 0.0001). Compared to conventional FMD, the proposed method is low cost and does not require any special operator skills. Hence it may be easily utilized as a screening tool in locations deprived of high-end ultrasound imaging devices.

Association of Mycoplasma Pneumoniae Infection with Henoch-Schonlein Purpura

 We present a  child with Henoch-Schonlein purpura and Mycoplasma pneumoniae infection, an association that was rarely described in  the literature. The infection was confirmed serologically and by using PCR.

Cutoff point of waist circumference for the diagnosis of metabolic syndrome in an Iranian population

SUMMARY

BACKGROUND

Proposed cutoffs for waist circumference (WC) in western populations may be not appropriate for Asian populations. The published data among Iranians are insufficient to address this issue. This study was designed to identify cutoffs for WC that confer increased risk of metabolic syndrome in Iranian adults living in Zanjan, a province located in the west of Tehran.

MATERIALS AND METHODS

Data of a cross-sectional sample of 3277 Iranian adults aged more than 20 years were analyzed. In the original study individual body weight, height, WC, and blood pressure were assessed and fasting plasma glucose, triglycerides, total cholesterol, low- and high-density lipoprotein cholesterol were measured. After excluding WC, existence of two or more of the remaining four risk factors of the modified NCEP III criteria for metabolic syndrome were defined as multiple risk factors. Receiver operating characteristic (ROC) analysis was used to find out the optimal cutoff values of WC to predict metabolic syndrome.

RESULTS

The cutoff level yielding the maximal sensitivity and specificity for predicting the presence of metabolic syndrome (multiple risk factors) was 87 cm in men and 82 cm in women. Cutoffs corresponding to body mass index (BMI) 25 and 30 kg/m(2) to predict metabolic syndrome were 84 and 97 cm in men and 78 and 91 cm in women, respectively.

CONCLUSIONS

Lower cutoffs for WC should be considered in the identification of Iranian population at high risk of metabolic syndrome.

An apparatus for concurrent measurement of thermoelectric material parameters

We describe an apparatus which concurrently and independently measures the parameters determining thermoelectric material conversion efficiency: the Seebeck coefficient, thermal conductivity, and electrical resistivity. The apparatus is designed to characterize thermoelectric materials which are technologically relevant for waste heat energy conversion, and may operate from room temperature to 400 °C. It is configured so the heat flux is axially confined along two boron nitride rods of known thermal conductance. The Seebeck coefficient and thermal conductivity are obtained in steady-state using a differential technique, while the electrical resistivity is obtained using a four-point lock-in amplification method. Measurements on the newly developed NIST Seebeck standard reference material are presented in the temperature range from 50 °C to 250 °C.

Spatial distribution and molecular identification of leishmania species from endemic foci of South-eastern iran

BACKGROUND

Cutaneous leishmaniasis constitutes a major public health problem in many parts of the world including Iran. The primary objective of this study was to identify Leishmania species in endemic districts of Kerman Province, south-eastern Iran.

METHODS

This study was conducted by random sampling as cross- sectional descriptive between 2008 and 2010. Overall, 203 skin scraping smears were taken from the patients. Nested -PCR was performed to amplify variable minicircle fragments of Leishmania kDNA.

RESULTS

Bam was the most infected district (71.1%), followed by Kerman (14.7%), Jiroft (5.4%), Baft (2.7%), Sirjan (1.6%), Shahr-e Babak (1.5%) and others (3.0%). L. tropica was the most common species identified (194 cases, 95.6%), while L. major was found in only 9 cases (4.4%). Of 203 identified patients, all species in Bam (l07 cases), Kerman (32 cases), Jiroft (l6 cases) and Shahr-e- Babak (l1 cases) were detected as L. tropica, whereas infected subjects in Baft and Sirjan showed L. tropica or L. major. Characterization of Leishmania species resulted in generation of 750 bp and 560 bp fragments, corresponding to those of L. tropica and L. major, respectively.

CONCLUSION

L. tropica is the main species (95.6%) caused ACL in endemic areas of Kerman Province; however L. major is present in low level (4.4%).

Investigation on some biological aspects of Chrysoperla lucasina (Chrysopidae: Neuroptera) on Bemisia tabaci in laboratory conditions

Bemisia tabaci is one of the most important key pests of many types of cultivated plants. Lacewings (Chrysopidae: Neuroptera) are predatory insects, widely used in biological control programs. Between them green lacewing is a promising biological control agent of pests in green houses and crop fields. In this study, gravid females of the green lacewing Chrysoperla lucasina (Lacroix) were captured from Sarepolzahab ( altitude 540m, latitude 34 degrees ,14' N 46 degrees, 9' E) in western part of Iran. Collected insects were reared in a growth chamber, under experimental conditions (25 +/- 1 degrees C, 70 +/- 5% RH and a photoperiod of 16:8 L: D). Different diets were offered to larvae which consisted of a whitefly species B. tabaci, an aphid Myzus persica and also lyophilized powder of drone honeybee (Apis melifera). As different foods were used to nurish larvae, so for each diet, mean larval period were calculated, and finally means were compared to each other. Anova in MSTAT-C was used for analysis of variance, and Duncan multiple range test (DMRT) to compare between means. The results showed that larvae had maximum duration of 27 +/- 0.33 days when fed on honeybee lyophilized powder and the minimum value was 17.9 +/- 0.3 days for B. tabaci. 25 +/- 0.27 day recorded for M. persicae. Food preference of the 3rd instar larvae of green lacewing was surveyed, they showed a food preference to M. persicae, to compare with B. tabaci, as the former has a bigger body size, so more easily to be captured by the predator larvae. The 3rd instar larvae of lacewing were more voracious on preys, than the 1st or the 2nd instar larvae. Statistically speaking, there were a significantly difference when mean of different preys consumed by predator larvae were compared. We found, that when the predator larvae have fed on B. tabaci, their development time was shorter, and when arrived to adult stage, the adults showed, an improved fertility. The results indicated that the suitable prey not only can increase the rate of through accelerating developmental stages of the predator and by means of an increase in its pupal body weight consequently promoting the fecundity of resulting adults, but also can alter predators population density in relation to own production numbers.

Predicting the value of the Mini Nutritional Assessment (MNA) as an indicator of functional ability in older Iranian adults (Kahrizak elderly study)

OBJECTIVE

We aimed to investigate the appropriateness of the Mini Nutritional Assessment (MNA) in predicting functional ability in older adults.

DESIGN

Cross-sectional study.

SETTING

Participants were recruited from the Kahrizak Charity Foundation (KCF).

MEASUREMENTS

Nutritional and ability status were examined using the MNA and the Barthel Index (BI). Participants were divided according to MNA (≤ 23.5 and > 23.5).

RESULTS

Two hundred and thirty-five ≥ 60-year-old subjects were studied. The MNA and BI were positively correlated (r = 0.199; P = 0.001). The optimal cut-off point for BI with the highest sensitivity and specificity derived from the ROC curve was approximately 91.5 for males and 83.5 for females. The BI was significantly associated with MNA (odds ratio (OR): 1.89; 95% CI: 1.17-3.05, P = 0.009), mobility (OR: 6.39; 95% CI: 3.43-11.89, P < 0.001), consuming ≥ 2 servings of fruit and vegetables (OR: 2.27; 95% CI: 1.09-4.72, P = 0.02) and self-view of nutritional status (OR: 4.15; 95%CI: 1.26-13.63, P = 0.01). The sensitivity (62.9% in males; 68.2% in females) and specificity (51.4% in males and 52.9% in females) of these cut-off points justifies the appropriateness of the MNA for determining functional ability.

CONCLUSION

The MNA is potentially able to verify functional status among the elderly (as BI ≥ 91.5 with those of < 91.5 in males and ≥ 83.5 with those of < 83.5 in females) of KCF. It is suggested that this relationship should be further studied in a larger prospective population-based study.

Transport Measurements of Magnetic Multilayers at Reduced Lateral Dimensions

Abstract We report on the fabrication and transport properties of magnetic multilayers with widths down to 100 nm. We employ e-beam processed nano-deposition masks to pattern magnetic multilayers which define nano-wires by lift-off or by a removal process such as ion-milling. Two different magnetic multilayer systems (antiferromagnetically coupled Co/Cu multilayers and NiFe/Cu/Co spin-valves) are investigated. Structures resulting from the lift-off process show high contact resistance and high resistivities while ion-milled structures show resistivities close to that of bulk. For Fe(50Å)/[Co(15Å)/Cu(20Å)]x20 /Cu(30Å), patterned nano-wire structures display no negative magnetoresistance but a positive magnetoresistance that is linear with applied field and no apparent hysteresis. For Ta(50Å)/NiFe(50Å)/Cu(35Å)/Co(20Å)/Cu(30Å), we found the resistance to decrease as the absolute value of magnetic field is decreased and found hysteresis to be present.

High prevalence of low high-density lipoprotein cholesterol concentrations and other dyslipidemic phenotypes in an Iranian population

OBJECTIVE

This study was designed to determine the prevalence of different atherogenic dyslipidemic phenotypes, especially decreased serum high-density lipoprotein cholesterol (HDL-C) in an Iranian population and its relationship to other coronary artery disease (CAD) risk factor.

METHODS

The prevalence of lipid abnormalities was assessed in 2941 people, including 1396 males and 1545 females, aged more than 20 years. The population is representative of Iranian urban adults living in northwestern Iran. In addition to isolated forms of hypertriglyceridemia, hypercholesterolemia, and hypoalphalipoproteinemia, some dyslipidemic phenotypes including hypertriglyceridemia/low high-density lipoprotein (HDL) combination, mixed dyslipidemias, and severe dyslipidemias were assessed.

RESULTS

The most prevalent abnormality was low HDL cholesterol (HDL-C; 73% including 63% for men and 93.3% for women). Hypertriglyceridemia (>150 mg/dL) was the second most prevalent abnormality (40.6%). Increased total cholesterol (>200 mg/dL) was observed in 35.4% of the subjects. The combination of hypertriglyceridemia and low HDL-C was observed in 9.9% of the population. Fifty eight percent of the low HDL-C cases were not accompanied with hypertriglyceridemia, and 24.4% of hypertriglyceridemic subjects had low HDL-C. Among subjects younger than 30 years, 19% had hypercholesterolemia, 13% had isolated low HDL-C less than 35 mg/dL, and 63% had HDL-C less than 40 mg/dL. Unexpectedly, except for the hypertriglyceridemia/low HDL-C pattern, which was more common in males, the other abnormal lipid profiles were more common in females.

CONCLUSION

The prevalence of dyslipidemia, especially low HDL cholesterol, in Iranian adults is very high. Urgent preventive programs and changes in lifestyle are needed in this area.

Multifocal bigerminal mature teratomas of the head and neck

Teratomas and dermoids or hairy polyps of the head and neck are rare congenital tumours, often confused and reported to appear as single masses, that may cause upper aerodigestive tract impairment. Their histological classification, origin and embryological basis of development have been a topic of debate in the past and recent literature.

We report a case of an infant presenting with a multifocal bigerminal teratoma in the nasopharynx and the neck, causing a deep neck infection, and discuss the unique clinicopathological aspects of this case.

Multicentric familial cardiac myxoma

Familial cardiac myxoma is a rare syndrome which constitutes approximately 10% or less of all myxomas. We describe a rare case of LA and LV mass simultaneously in a 35-year-old female presenting to our hospital for evaluation of recurrent cardiac myxoma. Echocardiography revealed both LA and LV mass. Surgery was done and histological findings confirmed the diagnosis of myxoma.

An anatomical study of meniscal allograft sizing

Meniscus-to-femoral condyle congruity is essential for the development of circumferential hoop stresses and thus function of the meniscus. When meniscal allograft transplantation is performed using bony anchorage of the insertional ligaments, accurate graft-to-host size matching is therefore essential. The standard method currently employed for size matching of meniscal allografts is to rely on plain radiographs of the host's knee, from which expected meniscal dimensions are measured. This study aimed to examine the correlation between tibial plateau dimensions and meniscal dimensions. We studied 44 donor tibial plateaus with medial and lateral meniscal allografts attached intact. Meniscal and tibial plateau dimensions were measured. Linear regression analysis was used to calculate expected meniscal dimensions from each specimen's plateau dimensions. Using specific medial and lateral tibial plateau width and length measurements, meniscal dimensions could be predicted with a mean error of only 5.0+/-6.4%. When predicting meniscal dimensions from only total bony plateau width, the mean error observed was 6.2+/-8.0%. The difference between the two methods was not statistically significant. The results suggest that meniscal dimensions can be predicted accurately from tibial plateau measurements, with only small mean errors. However, potential size mismatches should be carefully borne in mind by surgeons using meniscal allografts.