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Global prevalence of constipation in older adults: a systematic review and meta-analysis

Salari N, Ghasemianrad M, Ammari-Allahyari M, Rasoulpoor S, Shohaimi S, Mohammadi M

Wien Klin Wochenschr, 2023 Aug;135(15-16):389-398.
PMID: 36826591 DOI: 10.1007/s00508-023-02156-w

BACKGROUND AND OBJECTIVE: Constipation is one of the most common functional disorders of the gastrointestinal tract in older adults. To date, no systematic review or previous meta-analysis has estimated the global prevalence of constipation in older adults. The prevalence of this disorder has been reported differently in different studies; therefore, this study aims to systematically review the publications and to perform a meta-analysis of the prevalence of constipation in older adults.
METHODS: The electronic databases PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect were systematically searched for studies reporting the prevalence of constipation in older adults up to February 2022. To perform the analysis, the random effects model was used, and heterogeneity was assessed by Cochran's Q test and expressed as I2.
RESULTS: Out of 5341 evaluated publications, 36 met the eligibility criteria. These studies included 58,405 older adults aged 60-93 years. The overall prevalence of constipation in older adults was 18.9% (95% confidence interval [95% CI]: 14.7-23.9%). The prevalence of constipation in older adults according to Rome II criteria was 16.2% (95% CI: 6.8-33.7), based on Rome III criteria was 19.2% (95% CI: 12.6-28.1), and based on Rome IV criteria was 10.3% (95% CI: 5.8-17.7). The highest prevalence of constipation was found in older adults in Africa at 32.3% (95% CI: 21.5-45.4), and the lowest in Asia at 13.6% (95% CI: 9.1-19.9). Concerning diagnostic tools, the highest prevalence of constipation was found if a self-reporting tool was applied with a value of 19.7% (95% CI: 15.8-24.3).
CONCLUSION: The results suggest that health policymakers should pay more attention to the prevention of constipation in older adults, including raising public awareness to the importance of nutrition and diet and physical activity in older adults.

Matched MeSH terms: Middle Aged
Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure

Wan KS, Moy FM, Mohd Yusoff MF, Mustapha F, Ismail M, Mat Rifin H, et al.

Sci Rep, 2024 Jun 01;14(1):12625.
PMID: 38824234 DOI: 10.1038/s41598-024-63617-4

Treatment intensification is essential to ensure guideline targets are attained in diabetes patients. The failure to intensify treatment when the targets are not achieved is therapeutic inertia. This study aimed to determine the proportions and factors associated with treatment intensification and therapeutic inertia of antihypertensive therapy in type 2 diabetes patients with uncontrolled hypertension in Malaysia. A retrospective cohort analysis was conducted utilising registry data. Diabetes hypertensive patients with uncontrolled baseline systolic or diastolic blood pressure were included. Treatment intensification was the increase in the number of antihypertensive agents from the index treatment. Therapeutic inertia was the absence of treatment intensification when the second blood pressure reading was still uncontrolled. About 6956 patients were followed up over 2.5 ± 1.1 person-years. Treatment intensification was observed in 29.8% of patients, while 38.6% had therapeutic inertia. Chinese, Indian, and 'others' ethnic groups, retinopathy, more antihypertensive agents, and higher systolic blood pressure were associated with therapeutic inertia. Underweight, overweight patients and those with dyslipidaemia had lower risks for therapeutic inertia. The results indicate suboptimal quality of care in public health clinics in Malaysia. Further studies are needed to determine the underlying causes to formulate precise interventions to tackle the problem in Malaysia.

Matched MeSH terms: Middle Aged
Unveiling the link between drinking patterns of alcohol and risk of major adverse cardiovascular events after acute coronary syndrome

Chia JE, Ang SP

Eur J Prev Cardiol, 2024 May 11;31(7):843-844.
PMID: 38236074 DOI: 10.1093/eurjpc/zwae019
Matched MeSH terms: Middle Aged
Fulltext Accessory respiratory muscles performance among people with spinal cord injury while singing songs with different musical parameters

Ramli MI, Hamzaid NA, Engkasan JP, Usman J, Salleh M, Hueh WD

PLoS One, 2024;19(7):e0305940.
PMID: 38968230 DOI: 10.1371/journal.pone.0305940

People with spinal cord injury (SCI) experience respiratory dysfunctions which include hypersecretions, bronchospasm, and respiratory muscles weakness. Singing therapy has been implemented as part of respiratory muscle training (RMT) to improve their muscle strength. Singing different types and genres of songs may elicit specific recruitment of respiratory muscles, attributed to the variation of the songs' characteristics including tempo, pitch, and rhythmic complexity. This study aims to determine the effect of singing songs with different characteristics on the accessory respiratory muscle performance among people with SCI. Thirteen male SCI participants of ASIA A and B (C4 -T11) were recruited. Respiratory muscle signals were retrieved by placing two mechanomyography (MMG) sensors on the sternocleidomastoid (SCM) and rectus abdominis (RA) muscles. Eight music experts categorized several songs into four categories based on their pitch, tempo, and rhythmic complexity. Each participant sang one song from each category. Findings showed statistically significant difference in RA and SCM responses among all categories (P < 0.01). The SCM muscle is most active while singing high pitch songs. While the RA is most active during slow tempo and easy rhythmic complexity. This shows that different accessory respiratory muscle is activated by people with SCI while singing songs with different characteristics. Clinicians could benefit from this knowledge while prescribing singing therapy or exercise among people with SCI in the future.

Matched MeSH terms: Middle Aged
Fulltext Secondary hemophagocytic lymphohistiocytosis: an unusual complication in disseminated Mycobacterium tuberculosis

Ing SK, Lee GWC, Leong TS, Lee YH, Lau GYL, Yusof NN, et al.

Clin Med (Lond), 2023 Jul;23(4):414-416.
PMID: 37524430 DOI: 10.7861/clinmed.2023-0171

Tuberculosis-associated hemophagocytic lymphohistiocytosis (TB-HLH) is a rare and life-threatening complication of tuberculosis infection. Early recognition and treatment of TB-HLH is crucial for improving outcomes. Treatment typically involves a combination of antituberculosis therapy and immunosuppressive therapy to control the immune system's overreaction. In this report, we present the case of a 53-year-old ambulance driver who was diagnosed with TB-HLH. His CT scan revealed splenic abscesses, hepatomegaly and bilateral lung consolidation. He subsequently developed multiorgan failure, including acute respiratory distress syndrome (ARDS), transaminitis and bone marrow dysfunction. The clinical course and simultaneous increase in serum ferritin raised the suspicion of HLH. His Hscore was 254, indicating a high probability of hemophagocytic syndrome. TB diagnosis was confirmed by positive endotracheal TB GeneXpert and bone marrow aspiration (BMA) which detected acid-fast bacilli organisms. The patient was promptly started on anti-TB, dexamethasone and IVIG. The patient responded well to treatment and made a full recovery without any lasting complications. This case highlights the importance of promptly recognising HLH and identifying the underlying cause. In critically ill patients, it is crucial not to delay HLH-specific treatment while working up for differential diagnosis.

Matched MeSH terms: Middle Aged
Case Report: Callosal disconnection syndrome manifesting as mixed frontal-callosal-posterior alien hand syndrome following extensive corpus callosum infarct

Zainudin MF, Soo KC, Nyein Yin K

F1000Res, 2023;12:529.
PMID: 38716229 DOI: 10.12688/f1000research.133838.1

Alien hand syndrome (AHS) is a rare neurological phenomenon first described by Goldstein over a century ago. The most widely recognized variants in literature are frontal, callosal, and posterior AHS. AHS due to the corpus callosum lesion can occur alone or as part of callosal disconnection syndrome (CDS). This report presents a unique CDS case manifesting clinical features from all three AHS variants, resulting from an extensive corpus callosum infarct. Our patient exhibited various clinical features from the three AHS variants, which include grasping, groping, and difficulty releasing objects from the hand (anterior); intermanual conflict (callosal); arm levitation, mild hemiparesis, and hemisensory loss (posterior). Additionally, the extensive disruption of the corpus callosal fibers produced neurological manifestations of CDS, such as cognitive impairment, ideomotor and constructional apraxia, behavioral disorder, and transcortical motor aphasia. We employed a range of rehabilitation interventions, such as mirror box therapy, limb restraint strategy, verbal cue training, cognitive behavioral therapy, bimanual hand training, speech and language therapy, and pharmacological treatment with clonazepam. The patient showed almost complete resolution of CDS and AHS features by nine months post-stroke Our case report highlights distinctive clinical variations of AHS and the challenging correlation between clinical manifestations and neuroanatomical substrates. Future studies are necessary to explore the intricate neural connections and the precise function of the corpus callosum. This can be achieved by combining comprehensive neuropsychological testing with diffusion tensor tractography studies. It is also essential to develop a validated tool to standardize AHS assessment. Finally, the scarcity of evidence in rehabilitation interventions necessitates further studies to address the wide knowledge gap in AHS and CDS management.

Matched MeSH terms: Middle Aged
Fulltext A 12-week Taijiquan practice improves balance control and functional fitness in fall-prone postmenopausal women

Bai X, Xiao W, Soh KG, Zhang Y

Front Public Health, 2024;12:1415477.
PMID: 38989125 DOI: 10.3389/fpubh.2024.1415477

PURPOSE: Falls are the leading cause of accidental death among older persons, with postmenopausal women facing a greater hazard of falling due to osteoporosis. This study aimed to examine the effects of Taijiquan practice on balance control and functional fitness in at-risk females.
METHODS: Chinese women who self-reported a tendency to fall and had a baseline one-leg stand test time (4.1 s in the Taijiquan group) below the national average for their age group (60-64 years: 10.9 s, 65-69 years: 9.9 s) were assigned to either a control group (n = 26, mean age = 63.9 years) or a Taijiquan group (n = 24, mean age = 63.9 years). The Taijiquan group participated in a 12-week supervised intervention, while the control group maintained their daily activities. The average duration of each exercise session was 52 min. Static balance and functional fitness were assessed at the beginning and end of the intervention.
RESULTS: After 12 weeks, the Taijiquan group significantly outperformed the control group in terms of balance, flexibility, and muscular fitness (all p

Matched MeSH terms: Middle Aged
Fulltext Ruptured Liver Abscess Post Severe COVID-19 Infection: A Case Report

Isa MFM, Ghazi FN, Merican SRHI, Zulkifli AZ, Singh P

Prague Med Rep, 2024;125(3):273-278.
PMID: 39171554 DOI: 10.14712/23362936.2024.25

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) caused imminent acute infection of respiratory tract known as Coronavirus disease 2019 (COVID-19). Complications of hepatobiliary system especially liver often found in post-acute COVID-19 patients. However, there are only few studies specifically discussing about liver abscess in patients who had history of contracted COVID-19. We present a case of a 54-years-old gentleman with no previous medical illness and no history of vaccination, who was presented with ruptured liver abscess post COVID-19 infection Category 4 (symptomatic with lung infection and the need of oxygen supplementation). Percutaneous drainage was performed to drain the abscess and collections.

Matched MeSH terms: Middle Aged
Fulltext Metallic foreign body penetrating the carotid sheath: a case report

Vamanshankar H, Nair AB, Rajan N

Malays J Med Sci, 2011 Jan;18(1):72-5.
PMID: 22135577

Foreign bodies are a common problem seen in otolaryngological practice. Of the reported foreign bodies, metallic foreign bodies are a rare entity. One of the least common complications of foreign body ingestion is penetration and migration. We describe a case of a migrating metallic foreign body in a 50-year-old woman with a history of accidental ingestion causing odynophagia. In the present case, the foreign body migrated extraluminally into the carotid sheath. Our review of literature revealed that few such cases have been reported.

Matched MeSH terms: Middle Aged
Older people's experiences of participation in mindfulness-based intervention programmes: A qualitative systematic review

Hmwe NTT, Chan CM, Shayamalie TGN

Int J Ment Health Nurs, 2024 Oct;33(5):1272-1288.
PMID: 38717012 DOI: 10.1111/inm.13350

This systematic review aimed to synthesise the qualitative evidence of mindfulness-based interventions and focused on the perceptions and experience of older people. A literature search was conducted using electronic databases including CINAHL, EMBASE, EMCare, and MEDLINE. The inclusion criteria for the review were an original study that includes qualitative data on experience and perceptions of mindfulness interventions, a study population involving older people aged 60 years and above, and articles published in English. Eleven articles are included in this review. Four major descriptive themes were generated from the data synthesis: benefits on physical health, improved psychosocial well-being, development of new perspectives, and motivators and challenges of mindfulness practice. Mindfulness practice provided health benefits for pain management, promoting sleep quality, psychosocial well-being, and development of positive strategies such as a new way of coping in negative situations, acceptance, and a sense of freedom. Health benefits and positive reinforcement were reported as motivators, whereas time commitment and an easily distracted mind were barriers to continued mindfulness practice. In addition to the descriptive themes, two analytical themes were derived: inner peace and well-being through mindfulness and development of acceptance-based coping. The positive outcomes indicated in this review suggest that mindfulness-based interventions could be an effective therapeutic tool for the well-being of older people.

Matched MeSH terms: Middle Aged
Fulltext Constructing causal pathways for premature cardiovascular disease mortality using directed acyclic graphs with integrating evidence synthesis and expert knowledge

Hasani WSR, Musa KI, Chen XW, Cheng KY

Sci Rep, 2024 Nov 21;14(1):28849.
PMID: 39572630 DOI: 10.1038/s41598-024-80091-0

Cardiovascular disease (CVD) is a major global cause of premature mortality. While multiple studies propose CVD mortality prediction models based on regression frameworks, incorporating causal understanding through causal inference approaches can enhance accuracy. This paper demonstrates a methodology combining evidence synthesis and expert knowledge to construct a causal model for premature CVD mortality using Directed Acyclic Graphs (DAGs). The process involves three phases: (1) initial DAG development based on the Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAGs) framework, (2) validation and consensus-building with 12 experts using the Fuzzy Delphi method (FDM), and (3) application to data analysis using population-based survey data linked with death records. Expert input refined the initial DAG model, achieving consensus on 45 causal paths. The revised model guided selection of confounding variables for adjustment. For example, to estimate the total effect of diabetes on premature CVD mortality, the suggested adjustment set included age, dietary pattern, genetic/family history, sex hormones, and physical activity. Testing different DAG models showed agreement between expert ratings and data accuracy from regression models. This systematic approach contributes to DAG methodology, offering a transparent process for constructing causal pathways for premature CVD mortality.

Matched MeSH terms: Middle Aged
Fulltext Total thyroidectomy: the procedure of choice for toxic goitre

Hussain M, Hisham AN

Asian J Surg, 2008 Apr;31(2):59-62.
PMID: 18490216 DOI: 10.1016/S1015-9584(08)60059-7

Over the years, subtotal thyroidectomy has been the mainstay of treatment for toxic goitre; however, total thyroidectomy is increasingly being considered as the procedure of choice. This study aimed to review our experience with total thyroidectomy in toxic goitre and evaluate the outcome of this procedure.

Matched MeSH terms: Middle Aged
Uncommon radiological findings: a case report

Tandjung YR, Hong CP, Nambiar P, Ibrahim N

Int Dent J, 2007 Jun;57(3):173-6.
PMID: 17695738

A 50-year-old friendly and attractive Chinese lady was examined by the Primary Care Unit, Faculty of Dentistry, University of Malaya. Her requests for treatment included implants and crowns. Two periapical radiographs of teeth 16 and 48 were taken to aid diagnosis. Interestingly, pin-like radio-opaque objects were found over the crown of the impacted tooth 15 and also tooth 17. These objects were initially interpreted as silver points or radiographic artifacts but further investigation employing panoramic radiography revealed the distribution of more radio-opaque objects in the orofacial region. Based on a review of the literature and the opinion of experienced radiology and oral surgery lecturers, these foreign radio-opaque objects were diagnosed as susuks or charm needles.

Matched MeSH terms: Middle Aged
An additional muscle in the back of the leg

Rao KG, Bhat MS

Clin Anat, 2006 Nov;19(8):724-5.
PMID: 16944500
Matched MeSH terms: Middle Aged
Absence of the isthmus of the thyroid gland: anatomical and clinical considerations

Taty-Anna K, Farihah HS, Norzana AG, Farida H, Das S

Clin Ter, 2012 Nov;163(6):503-4.
PMID: 23306746

The right and left lobes of the thyroid gland are connected by an isthmus. The isthmus lies at the level of the second and third tracheal rings. Occasionaly, the isthmus may be absent. We hereby, report the absence of isthmus in a 52-year-old male cadaver of unknown origin. Both the right and left lobes were normal but they were separated. Both the right and left lobes of the thyroid gland measured 4.3 cm vertically. The separation distance between right and left glands was noted at the upper, middle and lower parts. The upper end of medial border of both lobes were separated by a distance of 1 cm while the separation distance was 0.7 cm and 1.5 cm at the middle and lower parts, respectively. The anatomical and clinical significance of absence of isthmus is important for medical personnel and the surgeons operating on the thyroid gland. The present case report is a an attempt to highlight such.

Matched MeSH terms: Middle Aged
Fulltext Severe hypertriglyceridemia in a nondiabetic treated with low dose insulin infusion

Tong CV, Velaiutham S, Aziz NA, Lim SL, Khaw CH

Med J Malaysia, 2015 Aug;70(4):249-50.
PMID: 26358023

We report a case of a 54-year-old man with severe HTG which did not respond to conventional anti lipid therapies. He was treated with intravenous insulin and concurrent dextrose infusions which led to a dramatic reduction in serum triglyceride levels.

Matched MeSH terms: Middle Aged
Incidental radiographic finding of the concealed art of susuk

Devang Divakar D, Mavinapalla S, Al Kheraif AA, Ramakrishnaiah R, Abd Rahim MF, Khan AA

Med Sci Law, 2016 Jul;56(3):230-2.
PMID: 26271077 DOI: 10.1177/0025802415599567

Susuk, or charm needles, are small, metallic needles inserted under the skin, considered to enhance beauty, health and luck. This hidden secret of inserting susuk is a traditional superstitious ritual, widely practiced among women of Southeast Asia. Here, we present an interesting case of incidental radiographic finding of the concealed art of susuk, which was exposed on a panoramic radiograph taken on a routine basis as a part of diagnostic work up at our centre. An orthopantomogram revealed bilateral metallic foreign bodies in the maxillo-facial region. Anamnestic data affirmed the practice of the body art of susuk. The charm needles were present in the orofacial region without the patient experiencing any pathological signs or symptoms.

Matched MeSH terms: Middle Aged
Fulltext Endoscopic repair of spontaneous cerebro-spinal fluid rhinorrhoea: a report of 3 cases

Gendeh BS, Wormald PJ, Forer M, Goh BS, Misiran K

Med J Malaysia, 2002 Dec;57(4):503-8.
PMID: 12733180

Three cases of spontaneous Cerebrospinal Fluid (CSF) rhinorrhea were managed at the National University Hospital, Kuala Lumpur. Case 1 had bilateral leak secondary to empty sella syndrome and the rest two cases had unilateral leak. Four transnasal endoscopic approaches were performed on these three cases since March 1999. The role of intrathecal Sodium Fluorescein is highlighted in localising the CSF fistula. Case 3 required postoperative lumbar drain as an adjunct. No recurrent leak was noted on post operative follow up in Case 2 and 3 ranging from nine to thirty two months. A recurrent left leak at six months was noted in Case 1 which could likely be due to her sudden bout of cough attacks and patient refused further surgical intervention.

Matched MeSH terms: Middle Aged
Fulltext Menopause and hormone replacement therapy. Facts and misconceptions

Raman S, Damodaran P

Med J Malaysia, 1996 Dec;51(4):407-8.
PMID: 10968025
Matched MeSH terms: Middle Aged
Fulltext Simultaneous electrocardiography and Doppler echocardiography in pulsus alternans

Khalid Y

Med J Malaysia, 1994 Jun;49(2):174-5.
PMID: 8090099

Pulsus alternans, the alternating strong and week pulses which occur in patients with severe heart failure, was first described by Traube in 1872. Since then various methods, both invasive1,2 and non-invasive3,4, have been used to study this phenomenon. This study demonstrates the utility of using simultaneous electrocardiography (ECG) and Doppler echocardiography to document pulsus alternans, and to differentiate it from other causes of alternating pulses.

Matched MeSH terms: Middle Aged

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