bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstructive sleep apnoea is associated with dynamic intra-thoracic central airway collapse: results of a 10-year multi-centre retrospective analysis
Authors: Crowhurst Thomas David , Tcherveniakov Petar , Lorraine Brett , Polasek Jonathan Frederick , Nguyen Phan Tien , Yeo Aeneas
Published: June 2020

Background

Disproportionate bulging of the pars membranosa into the central airway on expiration, now termed ‘excessive dynamic airway collapse’ (EDAC), has poorly characterised significance. Despite physiological arguments supporting an association between obstructive sleep apnoea (OSA) and dynamic intra-thoracic central airway collapse, this is unproven.

Methods

An audit was conducted of patients having had both a dynamic CT chest and a diagnostic polysomnogram between 2009 and 2018 and within 2 years of one another. Dynamic airway collapse was quantified by the presence of EDAC (≥75% collapse) at any of five sites plus a composite index of mean cross-sectional area (CSA) change. Linear regression models were used to assess associations between pre-defined variables.

Results

A total of 59 patients was included. Median apnoea-hypopnoea index (AHI) was 13 events/hour (IQR: 5–31 events/hour | range 0–153 events/hour). EDAC was not identified. Median composite dynamic airway collapse index was 18% (IQR: 9–30% | range: 0–63%). Unadjusted and adjusted linear regression analyses demonstrated statistically significant associations between degree of dynamic intra-thoracic central airway collapse and multiple OSA indices. In the adjusted model, every 10% worsening in dynamic airway collapse was associated with an increase in apnoea-hypopnoea index (AHI) of 5 events/hour (95% confidence interval: 0.9–10 events/hour | p = 0.019). No association was found between dynamic airway collapse and symptoms or healthcare utilisation.

Conclusions

This study supports an association between dynamic intra-thoracic central airway collapse and OSA, despite the failure to identify EDAC, which was likely due to retrospectively audited CT scans not being performed to research standards.
Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country
Authors: Solomon Ahmed , Stanwix Anne E. , Castañeda Santos , Llorca Javier , Gonzalez-Juanatey Carlos , Hodkinson Bridget , Romela Benitha , Ally Mahmood M. T. M. , Maharaj Ajesh B. , Van Duuren Elsa M. , Ziki Joyce J. , Seboka Mpoti , Mohapi Makgotso , Jansen Van Rensburg Barend J. , Tarr Gareth S. , Makan Kavita , Balton Charlene , Gogakis Aphrodite , González-Gay Miguel A. , Dessein Patrick H.
Published: June 2020

Background

It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients.

Methods

Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines.

Results

Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound.

Conclusions

Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.
Comparative phytochemical, antioxidant, and antibacterial study of different parts of Doigota plants (Bixa orellana L.)
Authors: Ahmed Sium , Moni Bilkis Mehrin , Ahmed Shawon , Gomes Donald James , Shohael Abdullah Mohammad
Published: June 2020

Background

Bixa orellanaL. is a plant native to Brazil but grows in other parts of the world including Bangladesh. This plant has been used for many years by indigenous people around the globe for a variety of applications. In Bangladesh, it is known as Doigota and the plant is underutilized and reported endangered. The present study aimed to perform comparative profiling where aqueous, ethanolic, and methanolic extracts of the seed, branch, and leaf ofB. orellanaplants were investigated for in vitro phytochemicals, antioxidant, and antibacterial activities.

Results

Phytochemical screening indicated the presence of nine different phytochemicals in varying degrees, which suggests the chemical diversity of this plant. Quantification of phenolics, flavonoids, and tannins was performed where leaf extracts contained significantly higher quantities of these phytochemicals than extracts from seed and branch. The highest phenolics (186.02 mg/g) were found in the methanolic extract of the leaf, whereas the highest flavonoids (61.01 mg/g) and tannins (36.74 mg/g) were found in aqueous extract of the leaf. Antioxidant activity has been evaluated by DPPH scavenging assay where the aqueous extract of leaf showed 93.62% scavenging activity at 800 μg/mL extract concentration. Although the extracts prevented the growth of both Gram-positive and Gram-negative bacteria, the antibacterial activity (zone of inhibition) of aqueous and methanolic extracts of the leaves were higher than those of the seed and branch extracts against Gram-negative (Escherichia coli) and Gram-positive (Bacillus subtilis) bacteria, respectively.

Conclusions

We found thatB. orellanaleaf extracts possess the highest antibacterial activities. The extracts had significant antioxidant and free radical-scavenging activities. The antioxidant and antibacterial activities could be attributed to high flavonoid and phenolic contents. These results suggest that the extracts ofB. orellanapossess bioactive compounds that could be used for different purposes such as source of new antibiotics or alternative natural preservatives in food matrices due to mainly their antioxidant and antibacterial activities.
ISAAC written questionnaire versus incorporating videos before the questionnaire for asthma prevalence among middle schools students in Al-Sharkiya Egyptian Governorate
Authors: Amer Osama T. , Ragab Hussnia M. , Bahgat Shereen M. , Elsayed Sameh A. , Gad Marwa , Fawzy Ahmed , Hegazy Salwa , Mokhtar Eman , Yaseen Hala , Sarhan Dina T.
Published: June 2020

Background

Asthma is the most common chronic respiratory disorder in childhood with worldwide increasing in its prevalence and global burden. The International Study of Asthma and Allergies in Childhood (ISAAC) provides a standardized methodology to describe the prevalence and severity of childhood asthma symptoms all over the world using simple standardized questionnaires that allow comparisons across geographic and linguistic boundaries. This study aimed to find a suitable application of ISAAC asthma questionnaire to improve the perception and response of the middle (preparatory) school students in Al-Sharkiya Governorate as a step to update the Egyptian prevalence of asthma among children through the translation of the ISSAC written questionnaire into Arabic and to compare the student’s response to the translated questionnaire with their response to the same questionnaire after showing ISAAC videos.

Results

The percentage of student’s positive answers for asthma symptoms in the written questionnaire after watching ISAAC videos was significantly lower when compared to their written questionnaire answers without watching videos with no significant agreement between the student’s answers in the two methods.

Conclusion

Using ISAAC videos before filling the written questionnaire improved the students’ understanding of and dealing with the written questionnaire.
Conventional versus selective balloon-occluded retrograde transvenous obliteration of gastric varices
Authors: Ahmed Ramy , Kiyosue Hiro , Mori Hiromu , Abdelaziz Samy , Othman Moustafa , Abdel-Aal Sherif , Maruno Miyuki , Matsumoto Shunro
Published: June 2020

Background

Balloon-occluded retrograde transvenous obliteration (BRTO) is a well-established interventional radiological technique for treatment of isolated gastric varices (GV). The aim of this study is to compare outcome after different BRTO techniques, i.e., conventional, selective and superselective techniques.

Fifty-nine consecutive patients underwent BRTO as a primary prophylactic treatment for GV were retrospectively categorized into group A (38 patients underwent conventional BRTO) and group B (21 patients underwent selective or superselective BRTO). Group B was sub-grouped into group B1 (11 patients underwent selective BRTO) and group B2 (10 patients underwent superselective BRTO).

Results

Median volume of ethanol amine oleate iopamidol (EOI) was significantly higher in group A than in group B2 (14.8 Vs 7.4 ml, p = 0.03). Complete GV thrombosis was significantly lower in group B2 (50%) than in A (89.5%, p = 0.01) and B1 (100%, p = 0.01). GV bleeding rate after BRTO was significantly higher in group B2 than in group A (20% vs 0%, p = 0.04). GV recurrence rate was not significantly different between group A and B (p = 0.5) or between group A, B1 and B2 (p = 0.1). Cumulative ascites exacerbation rate was significantly higher in group A than B (p = 0.005), B1 (p = 0.03), and B2 (p = 0.03). Cumulative esophageal varices (Es.V) aggravation rate was significantly higher in group A than B (p = 0.001), B1 (p = 0.01), and B2 (p = 0.03). Volume of EOI was a significant risk factor for ascites exacerbation (p = 0.008) while shunt occlusion and pre-existing partial portal vein thrombosis were significant risk factors for Es.V aggravation (p = 0.01 and 0.03, respectively).

Conclusion

Selective and super-selective techniques had a lower ascites exacerbation, and Es.V aggravation rates than conventional technique. However, superselective BRTO had a lower GV complete thrombosis and higher GV bleeding rates after BRTO than other techniques.
Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework
Authors: Iwelunmor Juliet , Nwaozuru Ucheoma , Obiezu-Umeh Chisom , Uzoaru Florida , Ehiri John , Curley Jami , Ezechi Oliver , Airhihenbuwa Collins , Ssewamala Fred
Published: June 2020

Background

Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention’s impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework.

Methods

We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions.

Results

A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%).

Conclusions

Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.
Spontaneous intestinal perforation followed by necrotizing enterocolitis in an extremely low birth weight neonate: case report and review of the literature
Authors: Ibrahim Ashraf H. M. , Hader Hamad A. , Alsherbiny Hatem , Hussein Mahmoud R. A. , Khan Safwan A.
Published: June 2020

Background

Spontaneous intestinal perforation (SIP) is usually an isolated perforation occurring most commonly in the terminal ileum of neonates with very low birth weight (VLBW) and extreme low birth weight (ELBW) of unknown etiology. It can be identical to perforated necrotizing enterocolitis (NEC) both clinically and radiologically raising a diagnostic challenge. In such cases, the differentiation is only possible by laparotomy and histopathology. This is important because the differentiation has management and prognostic consideration. The authors are presenting a case of SIP which was followed by NEC after 4 days only of its onset.

Case presentation

The authors report on a unique case of SIP which was followed by perforated NEC after 4 days of its onset in a 28-week gestational age with an ELBW. On the 3rd day of life, abdominal X-ray showed a significant pneumoperitoneum with neither pneumatosis intestinalis nor portal venous gas. The diagnosis of SIP was made at laparotomy. On the 4th post-operative day the patient developed pneumoperitoneum again due to perforated NEC as confirmed later on by histology. In this odd case (which we believe to be the youngest in the literature), the sequence of SIP followed after few days by perforated NEC is presented. Methods of differentiating these two conditions and their management are discussed.

Conclusion

SIP should be differentiated from perforated NEC by laparotomy and histopathology if this is not possible clinically and radiologically, and the patient is stable. Primary peritoneal drainage (PPD) is reserved as a step to stabilize the patient only in both conditions.
Stochastic perturbation optimization for discrete-continuous inverse problems
Authors: Azevedo Leonardo , Grana Dario , de Figueiredo Leandro
Published: June 2020

Accurate subsurface modeling and characterization require the prediction of facies and rock properties within the reservoir model. This is commonly achieved by inverting geophysical data, such as seismic reflection data, using a two-step approach either in the discrete or the continuous domain. We have adopted an iterative simultaneous method, namely, stochastic perturbation optimization, to invert seismic reflection data jointly for facies and rock properties. Facies first are simulated according to a Markov chain model, and then rock properties are generated with stochastic sequential simulation and cosimulation conditioned to each facies. Elastic and seismic data are computed by applying a rock-physics model to the realizations of petrophysical properties and a seismic convolutional model. The similarity between observed and synthetic seismic data is used to update the solution by perturbing facies and rock properties until convergence. Coupling the discrete and continuous domains ensures a consistent perturbation of the reservoir models throughout the iterations. We have evaluated the method in a 1D synthetic example for the estimation of facies and porosity from zero-offset seismic data assuming a linear rock-physics model to demonstrate the validity of the method. Then, we apply the method to a real 3D data set from the North Sea for the joint estimation of facies and petrophysical properties from prestack seismic data. The results show spatially consistent rock and fluid inverted models in which the predicted facies reproduce the vertical ordering as observed in the well data.
Estimating local slope in the time-frequency domain: Velocity-independent seismic imaging in the near surface
Authors: Griffiths Matthew P. , Pugin André J.-M. , Motazedian Dariush
Published: June 2020

Seismic reflection processing for multicomponent data is very time consuming. To automatically streamline and shorten this process, a new approach for estimating the local event slope (local static shift) in the time-frequency domain is proposed and tested. The seismic event slope is determined by comparing the local phase content of Stockwell transformed signals. This calculation allows for noninterfering arrivals to be aligned by iteratively correcting trace by trace. Alternatively, the calculation can be used in a velocity-independent imaging framework with the possibility of exporting the determined time and velocities for each common midpoint gather, which leads to a more robust moveout correction. Synthetic models are used to test the robustness of the calculation and compare it directly to an existing method of local slope estimation. Compared to dynamic time warping, our method is more robust to noise but less robust to large time shifts, which limits our method to shorter geophone spacing. We apply the calculation to near-surface shear-wave data and compare it directly to semblance/normal-moveout processing. Examples demonstrate that the calculation yields an accurate local slope estimate and can produce sections of better or equal quality to sections processed using the conventional approach with much less user time input. It also serves as a first example of velocity-independent processing applied to near-surface reflection data.
Fracture properties estimation using distributed acoustic sensing recording of guided waves in unconventional reservoirs
Authors: Lellouch Ariel , Meadows Mark A. , Nemeth Tamas , Biondi Biondo
Published: June 2020

Perforation shots excite guided waves that propagate in a low-velocity unconventional shale reservoir. They have a frequency content of up to 700 Hz and are dispersive. We have analyzed horizontal crosswell perforation shots recorded by a distributed acoustic sensing (DAS) array. As guided waves propagate through a previously stimulated area, we observe a dramatic influence on the guided SH waves in the form of delayed arrival times, scattering, phase incoherency, and loss of amplitude and frequency. The leaky compressional waves undergo a gradual slowdown. Using a simple geometric analysis of the spatial locations of the distortions in the direct arrivals of the guided SH waves, we can estimate the half-lengths of the induced fractures, which range from 50% to 75% of the distance between the perforated and monitoring wells. Furthermore, we find that the propagation disturbances originate from the middle of the stimulated area. Other diffracted signals, notably from frac plugs, are clearly visible in the data. We report the first large-scale use of DAS records of guided waves. Their potential for high-resolution imaging and inversion of subsurface properties before and after hydraulic stimulation opens new possibilities for the use of seismology in optimizing production from unconventional reservoirs.
Dissociative identity disorder: a developmental perspective
Authors: Wilkinson Simon , DeJong Margaret
Published: June 2020

Dissociation is a common and often overlooked symptom in traumatised children. Although there is a lack of a scientific consensus as to the nature of dissociation and very limited research about dissociative identity disorder (DID) in children, the authors have seen children given this diagnosis recently referred to their clinic and are concerned about this practice and the parenting approaches that have ensued. The diagnosis of DID in children may be rare or of doubtful validity, but repeated traumatic experiences of an interpersonal nature can have a profound effect on a child's identity, memory and self-organisation. Furthermore, abuse and neglect can increase the risk of dissociative symptoms. This brief article considers dissociation in post-traumatic stress disorder, then outlines developmental factors hypothesised to be associated with dissociation in childhood and early adulthood. It warns that clinicians should keep an open mind about how dissociation may manifest transdiagnostically, and concludes with recommendations for further research.
Understanding the impact of fibroblast heterogeneity on skin fibrosis
Authors: Griffin Michelle F. , desJardins-Park Heather E. , Mascharak Shamik , Borrelli Mimi R. , Longaker Michael T.
Published: June 2020

Tissue fibrosis is the deposition of excessive extracellular matrix and can occur as part of the body's natural wound healing process upon injury, or as a consequence of diseases such as systemic sclerosis. Skin fibrosis contributes to significant morbidity due to the prevalence of injuries resulting from trauma and burn. Fibroblasts, the principal cells of the dermis, synthesize extracellular matrix to maintain the skin during homeostasis and also play a pivotal role in all stages of wound healing. Although it was previously believed that fibroblasts are homogeneous and mostly quiescent cells, it has become increasingly recognized that numerous fibroblast subtypes with unique functions and morphologies exist. This Review provides an overview of fibroblast heterogeneity in the mammalian dermis. We explain how fibroblast identity relates to their developmental origin, anatomical site and precise location within the skin tissue architecture in both human and mouse dermis. We discuss current evidence for the varied functionality of fibroblasts within the dermis and the relationships between fibroblast subtypes, and explain the current understanding of how fibroblast subpopulations may be controlled through transcriptional regulatory networks and paracrine communications. We consider how fibroblast heterogeneity can influence wound healing and fibrosis, and how insight into fibroblast heterogeneity could lead to novel therapeutic developments and targets for skin fibrosis. Finally, we contemplate how future studies should be shaped to implement knowledge of fibroblast heterogeneity into clinical practice in order to lessen the burden of skin fibrosis.
A Drosophila model of oral peptide therapeutics for adult intestinal stem cell tumors
Authors: Bajpai Anjali , Quazi Taushif Ahmad , Tang Hong-Wen , Manzar Nishat , Singh Virender , Thakur Ashwani , Ateeq Bushra , Perrimon Norbert , Sinha Pradip
Published: June 2020

Peptide therapeutics, unlike small-molecule drugs, display crucial advantages of target specificity and the ability to block large interacting interfaces, such as those of transcription factors. The transcription co-factor of the Hippo pathway, YAP/Yorkie (Yki), has been implicated in many cancers, and is dependent on its interaction with the DNA-binding TEAD/Sd proteins via a large Ω-loop. In addition, the mammalian vestigial-like (VGLL) proteins, specifically their TONDU domain, competitively inhibit YAP-TEAD interaction, resulting in arrest of tumor growth. Here, we show that overexpression of the TONDU peptide or its oral uptake leads to suppression of Yki-driven intestinal stem cell tumors in the adult Drosophila midgut. In addition, comparative proteomic analyses of peptide-treated and untreated tumors, together with chromatin immunoprecipitation analysis, reveal that integrin pathway members are part of the Yki-oncogenic network. Collectively, our findings establish Drosophila as a reliable in vivo platform to screen for cancer oral therapeutic peptides and reveal a tumor suppressive role for integrins in Yki-driven tumors.

This article has an associated First Person interview with the first author of the paper.
Effects of fragility fracture integrated rehabilitation management on mobility, activity of daily living and cognitive functioning in elderly with hip fracture
Authors: Aftab Anam , Awan Waqar Ahmed , Habibullah Shaista , Lim Jae Young
Published: June 2020

Objective: To determine the effectiveness of Fragility Fracture Integrated Rehabilitation Management (FIRM) on mobility, activity of daily living and cognitive functioning in elderly with hip fracture.

Methods: A randomized control trial was conducted at Seoul National University Bundang Hospital, South Korea from August 2017 to January 2018. Patients of both genders with the age 65-95 years, diagnosed cases of hip fracture specifically fractures neck of femur, intertrochanteric, subtrochantric, patients who got bipolar hemiarthroplasty, total hip replacement arthroplasty, reduction and internal fixation were included in this study. A total of n=39 sample was collected through non probability convenience sampling technique and randomly divided into Fragility Integrated Rehabilitation Management (FIRM) group (n=20) and Conventional Physical therapy (CPT) group (n=19). The data was collected through KOVAL for walking ability, modified barthal index (MBI) for behaviors related to activities of daily living (ADLS) and mini mental status examination (MMSE) for cognitive functions at baseline on 2nd postoperative day and after 10th FIRM session on 15th postoperative day.

Results: The mean age of study participants was 82.07±6.00 years. The post intervention comparison did not show any significant difference (p>0.05) in walking ability, overall ADLs and cognitive functioning. But FIRM group showed significant improvement in stair climbing {0(5) ver. 2(7.5), p=0.049} and ambulation or walker use {8(5) ver. 2(4), p=0.037}, as compared to CPT group.

Conclusion: Both groups improved in indoor mobility with walker and crutches as well as activities of daily living. But FIRM showed more improving ambulation with walker and stair climbing. While cognitive functioning was observed only in FIRM group.

ClinicalTrials.gov Identifier: NCT03430193. https://clinicaltrials.gov/ct2/show/NCT03430193.

doi: https://doi.org/10.12669/pjms.36.5.2412

How to cite this:Aftab A, Awan WA, Habibullah S, Lim JY. Effects of fragility fracture integrated rehabilitation management on mobility, activity of daily living and cognitive functioning in elderly with hip fracture. Pak J Med Sci. 2020;36(5):965-970.   doi: https://doi.org/10.12669/pjms.36.5.2412

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Frequency, Co-morbidities and outcome of acute kidney injury in elderly admitted patients
Authors: Mahmud Huma Mamun , Dastoor Hormatz Diar Dara
Published: June 2020

Objectives: To analyse the frequency, co morbidities and outcome ofAcute Kidney Injury (AKI) in elderly patients.

Methods: This is an observational retrospective study performed in a secondary care Hospital located in Abu Dhabi. Study include adult patients admitted during 01st January 2018 till 31st December 2018. We uses KDIGO criteria of more than 26.5 micromol/L increase in serum creatinine within 48 hours or 1.5 times increase from baseline within seven days to define AKI. Patients were followed from admission till discharge from hospital either to Home, to other facility or death. Analysis was done on SPSS version 20.

Results: Total admissions for age 60 and above were 880. AKI was observed in 71 patients (8.0%). Most common co-morbidity found was hypertension being observed in 85.9%. Renal recovery was observed in 70.4% out of whom complete recovery was seen in only 32.4% and rest shows partial recovery. Hemodialysis was required in 16.90% and death results in 22.5% of our study patients.

Conclusion: AKI is frequent among elderly admitted patients, commonest co- morbidity in these patients is hypertension. Outcome of AKI in elderly patients is poor with death in 22% of our patients.

doi: https://doi.org/10.12669/pjms.36.5.2429

How to cite this:Mahmud HM, Dastoor HDD. Frequency, Co-morbidities and outcome of acute kidney injury in elderly admitted patients. Pak J Med Sci. 2020;36(5):920-924. doi: https://doi.org/10.12669/pjms.36.5.2429

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Science and Sustainability in Food
Authors: Vaz A. , Trindade A.P. , Pedro P. , Henriques C. , Sequeira L. , Zaragoza M. , Viegas M.
Published: June 2020

In this project we studied the aquaponics system that allows the simultaneous production of some species of vegetables and fish. In this way, it allows the identification of the circular economy system, present in this production circuit. When feeding fish in an aquarium, the excrement produced by them is rich in nutrients that feed the plants that, in turn, filter the water for the fish. With a water pump, that keeps the water in circulation, a continuous closed circuit is achieved. We concluded that, with water and energy savings, without using phytopharmaceuticals, and with naturally occurring processes, an economy of means and the food quality is guaranteed: plants and fish. In studying this, we looked for ways to obtain the material, we do the installation and maintenance of the system, performed daily tasks and monitor the growth of plants and animals, managing to use aromatic herbs for the school bar and also divulge it.
Trash @ School
Authors: Coelho A. , Moleiro M. C.
Published: June 2020

After the inauguration of a local park located next to Venda do Pinheiro school, students quickly began to encounter problems of misuse. Specifically, they complained about garbage scattered in a park that was still new: cigarette butts in the skate and sports areas, dog waste, and other situations. The aim of this project was to challenge students to find solutions to make park users aware of how to improve their behavior. After identifying this common problem, each group had to design a multimedia product to raise public awareness, either by creating a video campaign or designing a piece of urban furniture using 3D modeling and printing.
Municipal Young Assembly
Authors: Paixão H. , Romeiro S.
Published: June 2020

This project results from the need to encourage young people to actively participate in the life of the Municipality. In the 2018/2019 academic year, the theme “Climate change: reversing global warming” was worked on in almost all curricular areas, in two 8th grade classes of the school. The classes elected their own "Young Municipal Deputies". Throughout the project, students were prepared for the final session, where each school represented a party and allparties presented and defended their proposals, to all the Assembly.
Healthy Eating Habits
Authors: Martins L. , Bruno G.
Published: June 2020

This project focuses on the theme of healthy eating habits and is being developed by students from class 8.ºD and under the scope of our school’s social inclusion program. Two questionnaires were applied, one on food and the other on hydration in a school environment, to all classes in the 7th grade and class 8.ºD. In order to alert the school community to the needfor good hydration, the class 8.ºD organized a tasting session on flavoured water. In collaboration with the project, the nurse from the school health centre gave two lectures on healthy eating habits. Schools’ shutdown due to Covid-19 pandemic did not allow more sessions to be held, nor to share with the community the questionnaires’ results. Nevertheless, one of the projects main goals is to implement in the school flavoured water dispensers, to encourage students to drink more water.
Message in a Bottle
Authors: Matos M. M.
Published: June 2020

This project aims to develop a culture of affection, with a view to humanization and the development of the feeling of belonging in the relations of the school community, based on the exercise of citizenship. Messages, prepared by students in Portuguese classes, were placed in reused plastic bottles, decorated for this purpose in Visual Education classes. The messages were translated by students to English, French and German classes and by various elements of the school community, totalling nine different languages. The bottles were successfully delivered by the school to health care institutions. This project has been implemented since the 2015-2016, and 416 messages were distributed to 20 stakeholders. We want messages to be sent to as many people as possible, both at regional, national and international level.
wasH
Authors: Azevedo M.
Published: June 2020

In a bathroom, practically everything is contaminated. The simple act of washing your hands after use can prevent contamination and decrease the appearance of some diseases. But there are few people who carry out this simple action. wasH is an awareness campaign designed by students in professional health education aimed not only at the entire school population butalso at the entire population of Entroncamento. Some workshops were held and there are already many restaurants and coffee shops participating in the campaign.
We are all School
Authors: Sousa A. N. , Couto P. A.
Published: June 2020

The project “We are all school” aimed to break down barriers between the school and the community, to convey the idea that we all have something to add to the school, as we are all educational agents. Our intention was to give more visibility to the activities that the school develops with the community in general. As this community is made up of people from different parts of the world, with diverse cultures and knowledge, we set out to look for  their experiences and knowledge so that the school could benefit from the richness of this diversity. We also set out to involve the whole community more actively, valuing all the knowledge that could be carried to benefit the full learning path of students, regardless of their origin or social position.
Neuropathic Pain: How to Assess and Treat a Maladaptive Pain Response
Authors: Roh Young Hak
Published: June 2020

Neuropathic pain is associated with primary lesion or dysfunction of the peripheral and central nerve systems, affecting up to 10% of the general population. Although both nociceptive pain and neuropathic pain utilize the same nervous system pathways, physiologic differences exist in the pathologic mechanism, clinical presentation, and treatments. Ectopic activity in primary afferent fibers, excitatory and inhibitory somatosensory signaling, nociceptive neuron alterations, and central pain modulation have been implicated in neuropathic pain. These neuropathic mechanisms are associated with the complexity of symptoms, difficult treatment decisions, and challenging poor outcomes. Treatment options include pharmacologic (e.g., anticonvulsants, antidepressants, lidocaine, N-methyl-D-aspartate antagonist, opioids), physical, psychological (e.g., cognitive behavioral therapy), or interventional management (e.g., peripheral or neuro-axial nerve blockade, spinal cord stimulators, intrathecal medications). Medication selection should be individualized, considering patients’ symptoms and potential beneficial or deleterious effects (side effects) on comorbidities. The interventional management of chronic neuropathic pain should be considered for patients who have not responded to pharmacologic and non-interventional treatments, as an integral component of a more comprehensive approach. This article presents an overview of physiological mechanisms, clinical presentation, and assessment of neuropathic pain, and discusses treatment options for neuropathic pain.
COVID-19 and dentistry: perspectives of an unfolding pandemic
Authors: Samaranayake Lakshman
Published: June 2020

The first of a continuing series of articles to keep the readers abreast of the current data on COVID-19 pandemic impacting dentistry
A case of resected retroperitoneal metachronous solitary metastasis from caecal cancer
Authors: Kazama S , Anzai H , Matsuzawa N , Nishimura Y , Ishii H , Nishizawa Y , Kanda H , Kawashima Y , Sakamoto H
Published: June 2020

Colorectal cancer metastasis to the retroperitoneum, especially solitary metastasis allowing curative resection, is rare. We report a case of complete resection of retroperitoneal metachronous solitary metastasis from caecal cancer without distant metastasis. An 80-year-old woman with caecal cancer underwent laparoscopic ileocaecal resection with regional lymph node dissection. According to the eighth edition of the TNM classification, the pathological diagnosis was stage IIA (T3N0M0). Six months following the surgery, computed tomography revealed a solitary mass of 2cm diameter, dorsal to the right kidney. A second procedure for the removal of the tumour was performed. The lesion was pathologically diagnosed as a metachronous solitary retroperitoneal metastasis from caecal cancer. The patient is surviving and free from recurrence 17 months following the second procedure.
Idiopathic retroperitoneal haematoma causing duodenal obstruction: a case report and review of literature
Authors: Merali N , Singh G , Ghorpade A , Shirol S , Singh S , Veeramootoo R
Published: June 2020

Idiopathic retroperitoneal haematoma is a rare clinical entity; resulting duodenal obstruction is even more occult. It can pose a diagnostic challenge due to variable presentations. Timely management requires a high index of suspicion and a multidisciplinary approach. Surgery is indicated in patients refractory to conservative treatment and failure of endoscopic or interventional radiology options. We report an interesting case illustrating the rarity and severity of this condition, with a review of the literature.
Small bowel knots
Authors: Beg MY , Bains L , Lal P , Maranna H , Kumar N P
Published: June 2020

Introduction

Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful of cases reported in literature. We present a rare case of ileoileal knotting and review of small bowel knots. The aim of this review was to summarise the existing evidence on small bowel knots and to postulate the possible mechanisms for knotting.

Methods

A systematic search was conducted for literature published up to December 2019 using MEDLINE, PubMed and Google Scholar databases, together with the references of the full-text articles retrieved. Papers with case reports of small bowel knots were considered to be eligible for inclusion in the review.

Findings

A total of 14 case reports were evaluated. There was no clear predilection for age or sex. Mostly cases were from Asia and Africa with no cases from the West. The presenting complaints were abdominal pain (93%), vomiting (64%), abdominal distention (57 %) and obstipation (43%). The bowel was gangrenous in 78% of cases. All underwent exploration, with the majority requiring resection and anastomosis of the involved segment.

Conclusion

Ileoileal knotting is a very rare cause of intestinal obstruction. Possible mechanisms include loaded bowel with longer mesentery, vigorous peristalsis, single bulky meal, pregnancy and intussusception. The condition is extremely difficult to diagnose preoperatively and it is usually diagnosed intraoperatively. The standard of treatment is resection of gangrenous part and anastomosis.
Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis
Authors: Khan K , Hunter IA , Manzoor T
Published: June 2020

Introduction

Management of the rectal defect following transanal endoscopic microsurgery (TEMS) or minimally invasive surgery (TAMIS) carried out for excision of neoplasm in the lower rectum is controversial. We aimed to extract evidence by carrying out a meta-analysis to compare the peri- and postoperative outcomes following rectal neoplasm excision carried out by TEMS and/or TAMIS, whereby the defect is either sutured or left open.

Methods

A literature search of Ovid MEDLINE and EMBASE was performed. Full-text comparative studies published until November 2019, in English and of adult patients, whereby TEMS or TAMIS was undertaken for rectal neoplasms were included. The main outcome measures were postoperative bleeding, infection, operative time and hospital stay.

Findings

Three studies (one randomised controlled trial and two comparative case series) yielded 555 cases (283 in the sutured group and 272 in the open group). The incidence of postoperative bleeding was higher and statistically significant (p = 0.006) where the rectal defect was left open following excision of the neoplasm (19/272, 6.99% vs 6/283, 2.12%). There was no statistical difference between the sutured and open groups regarding infection (p = 0.27; (10/283, 3.53% vs 5/272, 1.84%, respectively), operative time (p = 0.15) or length of stay (p = 0.67).

Conclusion

Suturing the rectal defect following excision of rectal neoplasm by TEMS/TAMIS reduces the incidence of postoperative bleeding in comparison to leaving the defect open. However, suturing makes the procedure slightly longer but there was no statistical difference between both groups when postoperative infection and length of hospital stay were compared.
Real-time assessment of learning curve for robot-assisted laparoscopic prostatectomy
Authors: Tamhankar A , Spencer N , Hampson A , Noel J , El-Taji O , Arianayagam R , McNicholas T , Boustead G , Lane T , Adshead J , Vasdev N
Published: June 2020

Introduction

The learning curves analysed to date for robot-assisted laparoscopic prostatectomy are based on arbitrary cut-offs of the total cases.

Methods

We analysed a large dataset of robot-assisted laparoscopic prostatectomies from a single centre between 2008 and 2019 for assessment of the learning curve for perioperative outcomes with respect to time and individual cases.

Results

A total of 1,406 patients were evaluated, with mean operative time 198.08 minutes and mean console time 161.05 minutes. A plot of operative time and console time showed an initial decline followed by a near-constant phase. The inflection points were detected at 1,398 days (308th case) for operative time and 1,470 days (324th case) for console time, with a declining trend of 8.83 minutes and 7.07 minutes, respectively, per quarter-year (p<0.001). Mean estimated blood loss showed a 70.04% reduction between the start (214.76ml) and end (64.35ml) (p<0.001). The complication rate did not vary with respect to time (p=0.188) or the number of procedures (p=0.354). There was insufficient evidence to claim that the number of operations (p=0.326), D’Amico classification (p=0.114 for intermediate versus low; p=0.158 for high versus low) or time (p=0.114) was associated with the odds of positive surgical margins.

Conclusions

It takes about 300 cases and nearly 4 years to standardise operative and console times, with a requirement of around 80 cases per annum for a single surgical team in the initial years to optimise the outcomes of robot-assisted laparoscopic prostatectomy.
Extensive pneumatosis intestinalis and portal venous gas mimicking mesenteric ischaemia in a patient with SARS-CoV-2
Authors: Kielty J , Duggan WP , O’Dwyer M
Published: June 2020

We present the case of a critically ill 47-year-old man diagnosed with SARS-CoV-2 (COVID-19) who developed extensive pneumatosis intestinalis and portal venous gas in conjunction with an acute abdomen during the recovery phase of his acute lung injury. A non-surgical conservative approach was taken as the definitive surgical procedure; a complete small-bowel resection was deemed to be associated with an unacceptably high long-term morbidity. However, repeat computed tomography four days later showed complete resolution of the original computed tomography findings. Pneumatosis intestinalis from non-ischaemic origins has been described in association with norovirus and cytomegalovirus. To our knowledge, this is the first time that this has been described in COVID-19.
Acute right iliofemoral deep vein thrombosis mimicking acute appendicitis in the postpartum period: a case report
Authors: Karaisli S , Selcuk E
Published: June 2020

The risk of venous thromboembolism increases during pregnancy and postpartum. The incidence in the first six weeks following delivery is approximately 0.15%. Deep vein thrombosis may present with acute appendicitis-like symptoms such as right iliac fossa pain, nausea and vomiting.

A 22-year-old woman was admitted with complaints of abdominal pain and vomiting 20 days after spontaneous vaginal delivery. Physical examination and radiological findings were compatible with acute appendicitis. Preoperative re-examination and re-evaluation of computed tomography revealed concomitant deep vein thrombosis on the right side. The patient underwent laparotomy and a normal appendix and ovaries were found. She had an uneventful recovery. Anticoagulant treatment was administered for six months.

Early and correct diagnosis should be established to avoid complications of deep vein thrombosis and prevent unnecessary surgical interventions. Physicians should be aware of deep vein thrombosis in women who present acute appendicitis-like symptoms, especially during pregnancy and in the postpartum period.
High-resolution quantitative phase imaging based on a spatial light modulator and incremental binary random sampling
Authors: Wang Zhao , Wei Gong-Xiang , Ge Xiao-Lu , Liu Hui-Qiang , Wang Ben-Yi
Published: June 2020

We propose a single-beam high-resolution quantitative phase imaging method based on a spatial light modulator (SLM) and an incremental binary random sampling (IBRS) algorithm. In this method, the image of the test object presents on the image sensor through an optical microscopy system composed of an objective lens and a collimating lens. A transmittance SLM displaying a group of well-designed IBRS patterns is inserted in the optical microscopy system to modulate the object wavefront. The phase information of the object image can be quantitatively retrieved from the recorded intensities using the IBRS algorithm and the amplitude obtained directly from the diffraction intensity. The IBRS algorithm employed in our method has higher accuracy for phase retrieval compared with our previously proposed complementary random sampling algorithm, which is confirmed by simulations. Further, we demonstrate experimentally the feasibility of our method through several examples: phase imaging of immersion oil droplets with a diffraction-limited lateral resolution of 1.54 µm and a few microbiological specimens with 0.70 µm. Experimental results reveal that our proposed method provides a feasible single-beam technique for quantitative phase imaging with a high spatial resolution.