Host inflammatory response is the major marker of severe respiratory syncytial virus infection in older adults

OBJECTIVES

We aim to study the viral kinetics and host inflammatory response of RSV infection in older adults, and their correlation with disease severity.

METHODS

We performed a prospective observational study in adults with RSV infection. We serially collected nasal-throat swabs for quantification of RSV-A and RSV-B viral load, and peripheral blood samples for measurement of cytokine/chemokine concentrations. The study endpoints were (i) requiring supplemental oxygen therapy, and (ii) non-invasive ventilation, intensive care, or died within 30 days of admission. We performed multivariable logistic regression models to identify independent variables for severe disease.

RESULTS

We enrolled 71 hospitalized patients and 10 outpatients treated for RSV infection (median age 75 years, 51% male, and 74% with comorbidities). Among hospitalized patients, 61% required supplemental oxygen therapy, and 18% had severe disease requiring non-invasive ventilation or intensive care, or died within 30 days. Inflammatory cytokine/chemokines IL-6, CXCL8/IL-8, CXCL9/MIG and CXCL10/IP-10 increased significantly during the acute phase of illness. IL-6 concentration was independently associated with severe disease after adjusting for confounding factors. RSV viral load was not associated with disease severity throughout the course of illness.

CONCLUSION

Host inflammatory response is a major marker of severe disease in older adults with RSV infection.

The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis

Objective

To analyze the effectiveness of exercise interventions on falls and fall-related fracture prevention among community-dwelling elderlies.

Methods

Literature search was conducted in Pubmed and Embase. Keywords used for literature search were “fracture” AND “fall” AND “exercise”. Randomized controlled trials involving community-dwelling elderlies older than 60 years old with physical exercises as intervention were included. A systematic review and meta-analysis was performed. The primary outcomes were falls and fractures.

Results

Twelve studies were included and 4784 participants were involved with a mean age of 75.4. The most common exercise interventions were strength and balance exercises. The results of meta-analysis of 11 studies showed that exercise intervention had beneficial effect on fall prevention (RR = 0.71, 95% CI, 0.62–0.82; I² = 24%, p < 0.0001). The effect was better when exercise intervention applied to women participants (RR = 0.64, 95% CI, 0.49–0.83; I² = 28%, p = 0.00009) compared to men and women participants (RR = 0.75, 95% CI, 0.64–0.89; I² = 24%, p = 0.001). The results of meta-analysis of seven studies showed that physical exercise had significant effect on fracture prevention (RR = 0.54, 95% CI, 0.35–0.83; I² = 25%, p = 0.005). However, the effect was significant when exercise intervention applied to women participants only (RR = 0.37, 95% CI, 0.20–0.67; I² = 0%, p = 0.001) but not significant when exercise intervention applied to both genders (RR = 0.80, 95% CI, 0.58–1.09; I² = 0%, p = 0.15).

Conclusion

Exercise interventions, especially the combination of strength and balance training, were effective in preventing falls. Resistance exercises and jumping exercises were effective for fracture prevention among community-dwelling older population. The effectiveness of exercise interventions on fracture prevention have more significant effect on women. Further studies are needed to test the effectiveness of exercise interventions in men.

Translational potential

The use of effective exercises or biophysical interventions including vibration therapy can be incorporated into Fracture Liaison Services to prevent future fall and fracture.

Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: an age-period-cohort analysis

Background

there is little evidence to suggest that older people today are living in better health than their predecessors did at the same age. Only a few studies have evaluated whether there are birth cohort effects on frailty, an indicator of health in older people, encompassing physical, functional and mental health dimensions.

Objectives

this study examined longitudinal trajectories of frailty among Chinese older people in Hong Kong.

Methods

this study utilised data from the 18 Elderly Health Centres of the Department of Health comprising a total of 417,949 observations from 94,550 community-dwelling Chinese people aged ≥65 years in one early birth cohort (1901-23) and four later birth cohorts (1924-29, 1930-35, 1936-41, 1942-47) collected between 2001 and 2012, to examine trajectories of the frailty index and how birth cohorts may have contributed to the trends using an age-period-cohort analysis.

Results

more recent cohorts had higher levels of frailty than did earlier cohorts at the same age, controlling for period, gender, marital status, educational levels, socioeconomic status, lifestyle and social factors. Older age, being female, widowhood, lower education and smoking were associated with higher levels of frailty.

Conclusion

more recent cohorts had higher levels of frailty than did earlier cohorts. Frailty interventions, coupled with early detection, should be developed to combat the increasing rates of frailty in Hong Kong Chinese.

ASQ-3 scores are sensitive to small differences in age in a Peruvian infant population

OBJECTIVE

The Ages and Stages Questionnaires Edition 3 (ASQ-3) are a well-validated international screen for developmental delays in young children. However, previous studies demonstrate variable scores between children eligible to take the same ASQ-3 interval. This study aimed to determine a relationship between age and ASQ-3 score for each screening interval.

METHODS

This was a baseline exploratory cross-sectional study of infants under 2 years old evaluated for the Peruvian social programme Cuna Más. Participants were included in Cuna Más if they lived in districts with fewer than 2000 inhabitants or 400 homes, indicating a predominantly rural population. The appropriate ASQ-3 screening interval was administered to each subject. Subjects were divided into four 2-week chronological subgroups based on age within each 2-month screening window and aggregated across all 12 screening intervals. Fisher's exact test, analysis of variance and Bonferonni post hoc test were used to compare differences between age subgroups. Linear regression was performed to assess the relationship between ASQ-3 score and both aggregated and disaggregated age subgroup.

RESULTS

A total of 5850 Peruvian infants were evaluated in 2013. Mean age was 13 ± 6.6 months, 50.7% were male and mean maternal education was 6.6 ± 4.0 years; 34.8% infants were stunted, 7.8% were underweight, 0.9% were wasted and 2% had age adjusted greater than 35 days for prematurity for ASQ-3 interval assignment. Mean total ASQ-3 was 42.2 ± 8.2. The ASQ-3 allocated 49.6% with suspected delay in one or more developmental areas. Before and after adjusting for wealth quintile, maternal education level, infant nutritional status and prematurity adjustment, age subgroup remained significantly associated with total ASQ-3 score (β = 1.8, CI: 1.7-2.0, P < 0.001), sectional ASQ-3 score (all P < 0.001) and inversely associated with one or more scores indicating suspected developmental delay (P < 0.001).

CONCLUSIONS

The ASQ-3 may underestimate the sensitivity of child development to small differences in age in this population.

Deep vein thrombosis following hip fracture and prevalence of hyperhomocysteinaemia in the elderly

INTRODUCTION

The prevalence of deep vein thrombosis (DVT) in the West is reported to be as high as 50% after hip surgery. A study performed 14 years ago showed the incidence in Singapore to be <10%. Lately, some case-control and cross-sectional studies have suggested hyperhomocysteinaemia as an independent risk factor for DVT. This study investigates the local incidence of DVT and plasma hyperhomocysteinaemia in elderly patients presenting with proximal hip fracture.

MATERIALS AND METHODS

We recruited 104 consecutive patients from April 2001 to November 2001 who satisfy certain criteria. Firstly, patients of both genders who were >55 years old with radiological diagnosis of neck of femur fracture, intertrochanteric or subtrochanteric fracture. Secondly, these patients must not have any haemorrhagic or thrombogenic disease. Thirdly, patients were not given folate and B complex pre- or postoperation. Duplex ultrasound was then done for these patients on the 5th to 7th postoperative day.

RESULTS

The incidence of DVT above the trifurcation was 7.7%, no incidence of pulmonary embolism (PE) was detected. The incidence of hyperhomocysteinaemia was 52.3%.

CONCLUSIONS

The incidence of DVT in the local population after proximal hip fracture is much lower than in the West. The use of DVT prophylaxis in Asians should be selective to avoid incurring extra cost and its associated morbidity. Case-control studies and cross-sectional studies clearly indicate that hyperhomocysteinaemia is an independent risk factor for venous thrombosis. Given the high incidence of hyperhomocysteinaemia in our elderly with hip fracture, the prophylactic correction of hyperhomocysteinaemia with folate and vitamin B supplements is justified.

Profunda femoris artery pseudoaneurysm presenting with triad of thigh swelling, bleeding and anaemia

INTRODUCTION

We describe an alternative presentation of 2 cases of femur fractures with pseudoaneurysms of the profunda femoris artery.

CLINICAL PICTURE

In both cases, there is a recurrent triad of: (1) thigh swelling, (2) bleeding from the fasciotomy wound, and (3) anaemia with a falling haemoglobin trend.

TREATMENT

Surgical exploration is often not diagnostic or therapeutic. Angiography can accurately diagnose the presence of a pseudoaneurysm and intervention with coil embolisation is effective in arresting further bleeding.

OUTCOME

Both cases show good outcome following coil embolisation.

CONCLUSION

Recognition of this triad is necessary to ensure early accurate diagnosis so that proper treatment is rendered to prevent further recurrent bleeds.

Condylar advancement osteotomy for correcting condylar malunion of the finger

Unicondylar fractures of proximal and middle phalanges of the finger can unite with intra-articular malunion, which may result in joint pain, stiffness and deformity. There is currently no satisfactory technique of corrective osteotomy for these fractures. Extra-articular osteotomies often do not give good results and existing techniques of intra-articular osteotomy through the healed fracture site are technically difficult due to the small bone fragment, difficulty achieving stable fixation and the risk of avascular necrosis. We propose a different method of intra-articular correction with a longitudinal osteotomy and advancement of the malunited condyle. The "condylar advancement osteotomy" can overcome problems encountered with the other techniques. Excellent results were obtained in six patients.

Enantio- and diastereodifferentiating cis,trans-photoisomerization of 2beta,3beta-diphenylcyclopropane-1alpha-carboxylic acid derivatives in organized media

[reaction: see text] Four methods of asymmetric induction in the cis, trans-photoisomerization of 2beta, 3beta-diphenylcyclopropane-1alpha-carboxylic acid derivatives were studied. Best results (ca. 80% de) were obtained by irradiation of chiral esters, amides, and salts in NaY and LiY zeolites and in the pure crystalline state.

Benign duodenal tumors

BACKGROUND/AIMS

Benign duodenal tumors are rare and less common than malignant tumors. They comprise a wide variety of pathologies. Treatment is by endoscopic excision or surgical resection. In this report, we aim to review the management of benign tumors located in the proximal duodenum.

METHODOLOGY

A retrospective review of 11 patients with benign duodenal tumors treated in a single institution was performed over 10 years. Malignant tumors and periampullary tumors were excluded from the study.

RESULTS

The most common presentations were abdominal pain and upper gastrointestinal bleeding. Diagnosis was established by gastroduodenoscopy with biopsy. Seven tumors were located in the first part of the duodenum. The mean size of the tumors was 2.8 cm. Three patients with bleeding tumors were treated with endoscopic hemostasis and underwent surgery because the tumors were larger than 2 cm. Four patients had endoscopic polypectomies and 5 patients had surgical excision. The histological types included 6 adenomas, 3 Brunner's gland adenomas or harmatoma, 1 schwannoma and 1 leiomyoma. The results were good with only 1 case of recurrence.

CONCLUSIONS

The presentation of benign duodenal tumors is non-specific. They are diagnosed by gastroduodenoscopy and the tumors can be removed if small and pedunculated. Endoscopic ultrasound is useful in detecting submucosal involvement of sessile tumors. In such cases and large tumors (> 2 cm), surgical excision by laparotomy or laparoscopy should be undertaken.

Influence of finishing time on marginal sealing ability of new generation composite bonding systems

Although variation in finishing techniques has been shown to affect microleakage, little research has been published on the influence of finishing time on the marginal sealing ability of new generation composite bonding systems. The objective of the present study was to evaluate the influence of finishing time on the enamel and dentine marginal sealing ability of four new generation composite systems. Two class V preparations, which were solely in enamel or dentine, were made on the buccal surfaces of 96 freshly extracted molar teeth. The teeth were randomly divided into four groups of 24 and restored with composite resin (Silux Plus) utilizing the following bonding systems: Scotchbond Multi-purpose, Fuji Bond LC, Prime & Bond 2.0 and Bisco One-step. Half of the restorations in each group were finished immediately after light polymerization and stored for 1 week. For the remaining restorations, finishing was delayed for 1 week. The storage medium was isotonic saline at 37 degrees C throughout the experiment. All restorations were then thermocycled, subjected to dye penetration testing, sectioned and scored. The results suggest that the finishing of composite restorations, bonded with the bonding systems evaluated, should be carried out immediately after light polymerization. Delayed finishing does not improve but instead can be detrimental to the marginal seal of the restorations. The effects of delayed finishing are, however, both bonding system and tissue specific.

Fluorescent cytochemical oestrogen receptor assay: is it valid in breast cancer?

The performance of a fluorescent cytochemical oestrogen receptor (ER) assay has been compared with an established dextran-coated charcoal ER assay in 85 cases of primary breast cancer. Both assays were performed on tissue samples from the same tumour, by independent observers in different laboratories. A good qualitative correlation between the two methods was found, with agreement in 92 per cent of cases (P less than 0.0005). Criticisms of the fluorescein-labelled oestrogen methods are discussed. It is concluded that such methods should be validated in each laboratory by comparison with a conventional, quantitative ER assay before being used for clinical decisions.

Hepatic sinusoidal ectasia in association with Hodgkin's disease

A patient developed abnormal liver function tests in association with hepatic sinusoidal ectasia concurrently with relapse of Hodgkin's disease. Tests returned to normal following successful chemotherapy for the Hodgkin's disease. Sinusoidal ectasia and the related condition, peliosis hepatis, should be recognized as rare non-infiltrative manifestations of Hodgkin's disease.

Influence of spinal curvature on exercise capacity

It is well recognized that scoliosis in excess of 65 degrees results in cardiorespiratory impairment. Lesser degrees of spinal curvature have been noted to have near normal respiratory function studies at rest. Because of the great cardiorespiratory reserve, decreases in function secondary to scoliosis may be masked in studies conducted at rest. To study this concept, an investigation of the work capacity of 38 adolescent children with varying degrees of adolescent idiopathic scoliosis was undertaken. The maximal oxygen capacity and endurance time was measured and compared with a group of normal controls. A significant negative correlation between percentile endurance time and degree of spinal curvature was found showing a reduction in endurance time with every 20 degrees increase in spinal curvature (p less than 0.006). The application of "the exercise capacity test" as an investigative tool for scoliosis was found to be practical, since endurance time is a reliable index of the cardio-pulmonary status.

The assessment of the internal rotation gait in cerebral palsy: an electromyographic gait analysis

A study of 12 cerebral palsied children with internal rotation revealed three patterns of electromyographic activity: (1) Diagnostic pattern--where a simple muscle group stood out as the responsible agent--notably the medial hamstrings; (2) Nondiagnostic pattern--nonrecurring pattern; (3) Nondiagnostic pattern--recurring "mass limb reflex" pattern. In all cases, electromyography was useful for: (1) confirmation of clinical impressions. Electromyographic confirmation of phasic hamstring overactivity gives a firm basis for tendon surgery with expectancy of good results. (2) Detection of the responsible muscle group where clinical methods fail to do so. It detects the "at risk" patients, where follow up with tendon surgery at the appropriate time could be performed with predictable results. (3) Selection of patients who are likely to respond to tendon surgery, and those unlikely to benefit from it. The adductors and internal rotators may play only a secondary role in children whose predominant problem is internal rotation during gait. The medial hamstrings stand out as the most important single muscle group causing this problem. Consequently, it is important to analyze gait problems with the patient walking, and examine electromyographs during walking in the overall assessment of a patient with dynamic gait problem.

The clinical manifestations and pathomechanics of contracture of the extensor mechanism of the knee

Experience with thirty-eight Asian children and adolescents who presented with either stiffness of the knee, genu recurvatum, habitual dislocation of the patella or congenital lateral dislocation of the patella showed that all those disorders were manifestations of contracture of the extensor mechanism, which fell into two groups according to the components involved. In Group I the main components affected were in the midline of the limb, namely rectus femoris and vastus intermedius; these patients presented with varying degrees of stiffness of the knee, or worse, with genu recurvatum. In Group II the main components involved were lateral to the midline of the limb, namely vastus lateralis and the ilio-tibial band; these patients presented with habitual dislocation of the patella, or worse, congenital lateral dislocation of the patella. In both groups untreated patients developed secondary adaptive changes such as subluxation of the tibia or marked genu valgum which made operative procedures more formidable and less effective. Release of the contracture should therefore be performed as early as possible.

Diverticula of the vermiform appendix: a report of nine cases

The incidence, clinical features and pathology of nine cases of diverticula of the appendix in Malaysians are reported. The findings are discussed and compared with those previously reported. The pathogenesis of the lesion in eight cases is unknown. The rare association of lumenal obstruction by a carcinoid tumour and diverticulum formation in the appendix is seen in one case.

Fractures of the neck of the femur in childhood and adolescence

Twenty cases of fracture of the neck of the femur in children and adolescents below the age of 20 were reviewed. The most important single prognostic factor was the degree of displacement of the fracture at the time of injury. Undisplaced fractures, whether treated conservatively or by internal fixation, did well. Displaced fractures, however, always required internal fixation with thin pins after accurate correction of displacement. The various complications of this fracture in children are discussed. Acute necrosis of articular cartilage following this fracture in children is recorded for the first time in 2 cases.

Morphology of Piedra hortal

Piedra hortai, an ascomycete causing black piedra, was studied with light and electron microscopy. The nodule on the hair contains septate hyphae, asci and free ascospores, all of which were smaller than those previously reported. A mode of spread of infection is suggested.