DESIGN: Sarcopenia (age-related muscle loss) causes significant morbidity to the elderly, leading to frequent hospitalizations, disability and death. Few have characterized sarcopenia in the HIV-infected who experience accelerated aging.
METHODS: Sarcopenia was defined as low muscle mass with weak grip strength and/or slow gait speed using lower 20th percentiles of controls. Multivariate logistic and linear regression analyses were used to explore risk factors and health-related outcomes associated with sarcopenia among HIV-infected individuals.
RESULTS: We recruited 315 HIV-infected individuals aged at least 25 years with at least 1-year history of undetectable viral load on treatment (HIV RNA <50 copies/ml). Percentage of sarcopenia in 315 HIV-infected was 8%. Subsequently, 153 of the 315 were paired with age, sex and ethnically matched HIV-uninfected. The percentage of sarcopenia in the HIV-infected (n = 153) compared with uninfected (n = 153) were 10 vs. 6% (P = 0.193) respectively, whereas of those at least 50 years of age among them were 17% vs. 4% (P = 0.049), respectively. Associated risk factors among the HIV-infected include education level, employment status, BMI, baseline CD4 cell count, duration on NRTIs and GGT levels. Identified negative outcomes include mortality risk scores [5.42; 95% CI 1.46-9.37; P = 0.007) and functional disability (3.95; 95% CI 1.57-9.97; P = 0.004).
CONCLUSION: Sarcopenia is more prevalent in HIV-infected at least 50 years old compared with matched controls. Our findings highlight associations between sarcopenia with loss of independence and greater healthcare burden among treated HIV-infected individuals necessitating early recognition and intervention.
METHODS: Prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong, and Malaysia of adult patients presenting to the ED with dyspnea as a main symptom. Data were collected over three 72-hour periods and included demographics, comorbidities, mode of arrival, usual medications, prehospital treatment, initial assessment, ED investigations, treatment in the ED, ED diagnosis, disposition from ED, in-hospital outcome, and final hospital diagnosis. The primary outcomes of interest are the epidemiology, investigation, treatment, and outcome of patients presenting to ED with dyspnea.
RESULTS: A total of 3,044 patients were studied. Patients with dyspnea made up 5.2% (3,105/60,059, 95% confidence interval [CI] = 5.0% to 5.4%) of ED presentations, 11.4% of ward admissions (1,956/17,184, 95% CI = 10.9% to 11.9%), and 19.9% of intensive care unit (ICU) admissions (104/523, 95% CI = 16.7% to 23.5%). The most common diagnoses were lower respiratory tract infection (20.2%), heart failure (14.9%), chronic obstructive pulmonary disease (13.6%), and asthma (12.7%). Hospital ward admission was required for 64% of patients (95% CI = 62% to 66%) with 3.3% (95% CI = 2.8% to 4.1%) requiring ICU admission. In-hospital mortality was 6% (95% CI = 5.0% to 7.2%).
CONCLUSION: Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.
METHODS: A total of 108 pleural, peritoneal, and pericardial effusions/washings diagnosed as unequivocally reactive (n = 41) and metastatic carcinoma (n = 67) by cytomorphology over 18 months were reviewed. Among the metastatic carcinoma cases, 54 were adenocarcinoma and others were squamous cell carcinoma (n = 1), carcinosarcoma (n = 1), and carcinoma of undefined histological subtypes (n = 11). Cell block sections were immunostained by EZH2 (Cell Marque, USA). The percentages of EZH2-immunolabeled cells over the total cells of interest were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off score to define EZH2 immunopositivity.
RESULTS: A threshold of 8% EZH2-immunolabeled cells allows distinction between malignant and reactive mesothelial cells, with 95.5% sensitivity, 100% specificity, 100% positive predictive value, and 93.2% negative predictive value (p < 0.0001). The area under the curve was 0.988.
CONCLUSION: EZH2 is a promising diagnostic biomarker for malignancy in effusion cytology which is inexpensive yet trustworthy and could potentially be used routinely in countries under considerable economic constraints.
METHODS: in this study, a fixed retrospective cohort design has been conducted by using data from the Indonesia Family Life Survey (IFLS) in 2007 and 2014. A total of 6,863 respondents who were not diagnosed with NCD by medical personnel in 2007 were successfully traced. After being controlled for covariates, the association between NCD type and poor physical function was measured by using the Adjusted Risk Ratio (ARR) and Population Attributable Risk (PAR).
RESULTS: respondents with poor physical function were at a significantly increased of being diagnosed with stroke (ARR: 6.9, 95%CI: 4.3-10.9), diabetes (ARR: 3.1, 95%CI: 2.4-4.1), or heart disease (ARR: 3.2, 95%CI: 2.4-4.5). The PAR score of respondents with diabetes was 0.006, meaning 0.6% of diabetes cases are attributed to poor physical function and can therefore be prevented if people maintain good physical function.
CONCLUSION: poor physical function can be assessed to identify risk of diabetes, heart disease, and stroke. Healthcare personnel should provide education programs that inform patients on the importance of maintaining a healthy physical ability.
MATERIAL AND METHODS: In this retrospective observational study the records of patients attending a tertiary urogynecological unit between January 2012 and December 2014 were analyzed. POP assessment included a standardized interview, clinical examination using Pelvic Organ Prolapse Quantification and four-dimensional translabial ultrasound. Puborectalis muscle trauma was assessed with tomographic ultrasound imaging using two continuous scoring systems and a previously established discrete system. Receiver operating characteristics and adjusted odds ratios were used for comparison of scoring systems in predicting symptoms and signs of POP.
RESULTS: Of 1258 women analyzed, 52.6% complained of prolapse symptoms. On ultrasound imaging, 65.7% of women had sonographically significant POP. Complete avulsion was diagnosed in 25.3% of women, being unilateral in 13.9% and bilateral in 11.4%. A maximum score in the 6-point and the 12-point tomographic ultrasound imaging scale increased the odds for a diagnosis of any significant POP on ultrasound by 4.4 and 4.8 times, respectively, compared with 4.6 times for the discrete diagnosis of bilateral avulsion. For all avulsion scoring systems the relation was strongest for cystocele and uterine prolapse.
CONCLUSIONS: A continuous avulsion scoring system based on tomographic findings does not provide superior performance for the prediction of subjective symptoms and objective findings of prolapse compared with a discrete diagnostic system of unilateral or bilateral avulsion.
MATERIALS AND METHODS: We searched the Pubmed, Medline, Embase and EBSCO databases for full-text, peer-reviewed journal publications from January 1965 to August 2020. Data extraction was done using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
RESULTS: Our search yielded 45 case reports involving 48 EMTM teeth. The mean age of the patients was 46.3 years with an age range of 22-80 years. Thirty-two cases were seen in women as compared to 13 cases in men. The majority of the cases (42) were unilateral, with only three bilateral cases. Among the 48 EMTM teeth, 21 were seen in the condylar region followed by 13 in the ramus, seven in the sigmoid notch, three in the angle and two each in the coronoid process and the lower border of the mandible. Twenty-five EMTM teeth had histopathologically confirmed dentigerous cysts, eight teeth had chronic infection/inflammation/granulation tissue, two had radicular cysts, two had infected cysts, two teeth had normal follicular spaces, and associated lesions were not mentioned for nine teeth. The most common symptoms were swelling (33 teeth) and pain (29 teeth), and six teeth were asymptomatic. Surgical removal through intraoral approach was carried out for 27 teeth, while an extra-oral approach was adopted in 15 teeth, a spontaneous regression of the pericoronal radiolucency was noticed in one tooth, four teeth were not treated and choice of treatment was not mentioned for one tooth. Mild transient paraesthesia was frequently observed; however, serious post-surgical complications were not reported.
CONCLUSIONS: The present review found that EMTM can present with complex clinicopathological characteristics, with a majority of the cases being asymptomatic in the beginning and turning out to be symptomatic with lesions at later stages, requiring surgical intervention.